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Home My WebLink About1002 POPPY CIR - Building PermitsRex 7. .6 T�LAv I'( 4- . bOr U7/Y/b r A- da-Od3.9D(l?6U-0�.�6> 3 k5/J✓ifc�arfP<,�J 6/1 /oa yaw akok-Oqp; g y w , /AY/j,9 neq? CITY OF COSTA MESA BUILDING DIVISION i 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us `!4 FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BX08-00299 PERMIT TYPE B_MISC STATUS: ISSUED APN: 41237206 DATE ISSUED: 10/10/2008 Zoning: R1, ISSUED BY: KJB JOB ADDRESS: 1002 POPPY Cl CM Vicinity: GARAGE - -:Primary Occ: SO. FT: 0 " ",Valuation: SCOPE OF WORK: REPLACE A SECTION OF DRYWALL -IN GARAGE. OWNER: HARDESTY, REX:MURRAY TR!' AddrE City/State: COSTA MESA' ;,CAI . Phone: 714-545-1188; APPLICANT: HARDESTY, REX MURRAY-TR ' Addr City/State: COSTA MESA, CA Phone: 714-545-1,188 CONTRACTOR. Address: - - - City/State: Zip Code: ARCHITECT: Phone twill ENGINEER: �� '- .:'.. -•- License No. ---. -`--- - -' Phone Final Re -Roof 201 FEE SUMMARY '. Building Plari_Check: .,,: , - - $0.00-_- - Building Permit: -. „$23.50, ' Electrical Permit:'- 40.00 - SMIP Residential$0.50 SMIP Commercial `^ $0.00 TOTAL FEES $24.00 Unit Unit: Unit: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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 inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. DE I. INSPECTION TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re -Roof 201 Final Slock(Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition DATE INTITIALe CODES INSPECTION TYPE 206 Final Mechanical X i -u -ll MP h 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuiWMWOccupancy DATE INTITIAL WORKERS' COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (Thissectm readout aecompleted11 thepen its valuedat one hundred dollars ($100)wless) Polof Number: certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become s fact to the workers' compensation provisions of Section 3700 of the Labor ode, I shall forth comply with these provisions -Ap icanfs Signature to WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Contractor's Signature Class # CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work far which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to_the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5.by any applicant for a permit subjects the applicant to a civil penalty of not more than R red dollars ($500).): I, as owner of the property, or my employees with wages as their sole pens ation,, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or, herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 3057-16(3/07) Owner ID verified by drive. _ ddense. ❑ Yes ❑ No -Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, voll be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ,of,compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑'No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If "yes", attach certificate of compliance from the appropriate air'pollution control officer). - CERTIFICATE OF COMPLIANCE: I certify that'underpenalty of perjury the information given above is correct. 1' agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. " Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of -perjury that I have read this application and slate that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City ofosta Mesa to enter upon the above-described property for= r inspection p oses. I agree not to occupy or allow occupagcy of any bui Ing authorized b hismarmiWntil final inspection. - . iA . N / . 'SiNiature of Legal Owners) And/or Authorized Applicant Date (714)754-5273 • Fax(714)754-4856 Job Address: 1002 POPPY CI Suite No Vicinity: Parcel Nunmber: 41237206 CITY OF COSTA MESA - BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT, PERMIT ELECTRICAL PERMIT Applicant: HARDESTY, REX MURRAY TR Address: 1002 POPPY CIR COSTA MESA, CA Owner: ,HARDESTY, REX MURRAY TR Address 1002 POPPY CIR Contractor: Address: COSTA MESA, CA Phone: 714-545-1188 Zip: 92626 Phone: Zip: 92626 Phone: Zip: License: SCOPE OF PERMIT REF: B00-00468, 3 LIGHTS, SWITCHES, 4 OUTLETS. PERMIT NUMBER E00-00390 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/28/2000 Issued: 04/28/2000 ISSUED BY: r t�` NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under 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 the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 _ FEE SUMMARY Quantity - _ Quantity ISSUE FEE $23.50 _ Temp Dist System / Lighting $0.00 0 Temp service test $0.00 - - Busway /100 (t - $0.00 0 Res. a/c package $0.00 - Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 _ ................up to 10 kva/kw $0.00 0 Lighting Fixts $3.30 3 ................. up to 50 kva/kw $0.00 0 Recept Outlets $4.40 4 - ................. up to 100 kva/kw $0.00 0 Switches $2.20 2 - ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc..Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to ihp - $0.00 0 - Circus (mech ride or lights) $0.00 0 Motors to IOhp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand .$0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 1 00h $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $o.00 Pole Light Pk9 $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $33.40 Intermed Pole $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under 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 the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 _ DECLARATIONS WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: . Carder: Policy Number: (This section need not be completed i/ the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOIJ.ARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Uc. # Class # Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). I am exempt rider sec. Business and Professions Code for this reason: Date -O His by drivers license. Ja-:e6` ❑ No overs LicenseN xpires: VO Verification of Ownership by (type of document, i.e. - property tax bill or deed). DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will an --._.._-- y part of the facility to be constructed under this permit be within 1000 feat from the outer boundaries of a school? ❑Yes ❑ No (It yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No e (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S' elure Of Legal Owners) ate - LTJ rid Date CODE #, INSPECTION TYPINTRIAls CODE I INSPECTION TYPE DATE txmuLs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 z CITY OF COSTA MESA j BUILDING DIVISION PERMI NUMBER f � DEVELOPMENT SERVICES DEPARTMENT. � PERMIT 'a.m®� 100-00468 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1002 POPPY CI Suite: Vicinity: REAR Parcel Number: 41237206 Zoning: R1 R1 Applicant: HARDESTY, REX MURRAY TR Calc Valuation: $13,000.00 Address: 1002 POPPY CIR Claim Valuation: $13,000.00 SMIP Res: $1.30 Phone: 714-5451188 SMIP Com: COSTA MESA, CA Zip: 92626 Owner: HARDESTY. REX MURRAY TR Address 1002 POPPY CIR Total: $369.66 Phone: COSTA MESA, CA Zip: 92626 Contractor: Address: Zip: Arch Address: Phone: License: Eng: Address: Status: ISSUED Applied: 04/12/2000 Issued: 04/28/2000 ISSUED BY: Or— Phone: Phone: Zip: License: License: , SCOPE OF PERMIT CONSTRUCT TWO WALLS TO CREAT A 391SF LIVING AREA" ROOF IS EXISTING" WITH A SECOND FLOOR DECK ABOVE. V ENCROACHMENT OF DECK INTO REQUIRED 20' REAR YARD PERMITTED THROUGH MM -00-13 BECAUSE THE REAR PROPERTY LINE ABUTS WAKEHAM PARK AND BECAUSE THE HOUSE HAS -A 10' SIDE SETBACK WHICH ABUTS THE SIDE YARD OF THE ADJOINING RESIDENCE. — - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under 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 the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 FEE SUMMARY 1 Plan Check: $145.11 Calc Valuation: $13,000.00 Permit: $223.25 Claim Valuation: $13,000.00 SMIP Res: $1.30 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $369.66 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 10-0 Left 10-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under 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 the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 I ECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit Is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby offirn that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Class # Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The co rectors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) [��license pursu to the Contractors License Laws.). I empt de sec. Business and Professions Code for this reason: e: Dat : UO verified drivers lice e. No D' wen No. pir O Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industnal Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazartlous materials)? ❑ Yes ❑ No - (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Cade been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this 2pplicalion apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No e (it "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. 1 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) CQ Date t Date CODE I. INSPECTION TYPE p INTITIAL¢ CODE INSPECTION TYPE p]Tf, INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 de Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT P.O. BOX 1200 MINOR MODIFICATION Reference No.: Status: APPROVED Applied Date: 04-12-2000 Approved Date: 04/122000 Denied Date: MINOR MODIFICATION NO.: MM -00-13 Project Address: 1002 POPPY CI Suite: Parcel Number: 41237206 Project Applicant: HARDESTY, REX MURRAY TR PROPOSED MINOR MODIFICATION: MM TO ALLOW A 1' ENCROACHMENT OF A DECK INTO THE REQUIRED 20' REAR SETBACK. THE REAR OF THE PROPERTY ABUTS WAKEHAM PARK. THE DECK WILL BE SET BACK 10' FROM THE SIDE PROPERTY LINE. THE SIDE PROPERTY LINE IS THE SIDE PROPERTY LINE FOR THE ADJOINING HOUSE. THEREFORE, ENCROACHMENT WILL NOT IMPACT ADJOINING PROPERTY. REQUIRED FINDINGS:Y The improvement will not be materially detrimental to the health, safety and general welfare of persons residing or working within the immediate vicinity of the project or to property and improvements within the neighborhood. Y The improvement is compatible and enhances the architecture and design of the existing and anticipated development in the vicinity. This includes the site planning, land coverage, landscaping, appearance, scale of structures, open space and any other applicable features relative to a compatible and attractive development. PROJECT PLANNER: BOUWE W NOTES: 77 FAIR DRIVE Building Division (714) 754-5273 Code Enforcement (714) 754-5623 1 Planning Division (714) 754-5245 FAX (714) 754-4856 TDD (714) 754-5244 ADDRESS: 1002 POPPY CI UNIT: A*SNAME: HARDESTY REX ADDRESS: 1002 POP15Y CIR COSTA MESA,CA 92626 ARCH/ENGINEER: FETHER CONSTRUCTION REG.NO.: 00 ADDRESS: 3510 PO BOX 751-6409 9A 00 COSTA MESA CA 92628 PERMITTEE: REX HARDESTY (714)850-9005 ADDRESS: 1002 POPPY CI C.M. CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that ) am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect. CITY LIC.: STATE LIC.: CLASS: EXP: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell insure or a candidate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. Q. POLICY NO.: EXP. DATE: COMPANY: ❑ Certified Copy is hereby furnished., ❑ CenihetllcOpy is filed with the city Building Division. Date. Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this. Issued. I s all not a ny person in any manner so as to become su n 10 the Workers' Co (sensation Laws of Califor�i Date: Signature: - DTICE: If. al er making this declaration, you should become subject to me Workers' Compensation provisions of the Labor Code. you must (mill comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ, C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that ne/she is licensed pursuant to the provisions of the ContractorsSlate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). I, as owner of the properly or my employees with wages as their sole compensation, will do thework, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselftherself or through his or her awn employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' Slate License Law does not apply to an owner of propeny who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ® I am exempt under Section: BP 70 4 4 B. 8 P. C. Y tormisreason :OWNER–BUILDER n ate _� I q Owner.�,y L hereby candy shat I am ware of and understand the requirements Of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any Injure building Occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and county Ordinances and stale laws relating to building constructions uthOrize repr�ycjy�Cnterhe obove-mentioned aI y to nn rection purposes 1 Signature. `!1 mar's LiCelSse or Social Se unity a; Annlloant Pink—Revanim Gnldanrcd—Assessor CITY OF COSTA MESA – BUILDING PERMIT PERM NO: B 068478 PERMIT NO: B 068478 PLAN CHECK NO: 02902-94 L' GOVT: N SUPP: N CONSTRUCTION TYPE: V–N PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION ADD 186SF ROOM SQ FT; 186 CLAIM VALUE: 15,000.00 CALC–VALUE; 13,764,00 GROUP OCC: R-3 / COMMENTS: ADD 186SF TO FAMILY LIVING ROOM MMMMMMMMMMMMM MMMMMM M�r+r+E**�E*x-*�E+t �E x-*��r*�F*�r kr x-*�F*�F �E �E �E�**+E*aF�****�F �E►**�F*�E***�F**�Fx�E �F* Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT; 10 FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ; 2 PROV: 2 PARCEL: 41237206 ZNE: R1 REE NO: PLANNING NOTES> 186,SF.ADDI-T (EXPAND EX, LIVING/DINING ROOMS) TO EX, SFR, (1 > STORY/151' OR LESS), FIN, FLOOR TO BE MIN, 32' ABV SEA LEVEL M M M MMMMMMMMM MM M M MMitit M M MM MMit.M MM MMMM M M M M M M M M MMMM M M MM MM M MM M M M MM M MMM M MMM M M M M MMMM MMM 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 – ZONING APPROVED BY CDP DATE: BUILDING APPROVED BY; 7 �//rye' DATE: l� APPLICATION ISSUED BY: / DATE: L$/ M MMMMMMMMMMMMiEMMMMMMMir1F�TrTrTE�ar �E �r��si�FiE 3F E�#CE3F �PTr x**�E �E �F'�Fx-*i—t��rTE*�E �F it it lt �trfr***�A 1r xtix- MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMitMMMMiFlE iEfE if It iE fE iE ik it iE iE It iE it iE iE iEfE fl iE lE it it ak it iE it iE LEGALIZATION;N F E E S U M M A R Y.:, STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC, MECHANIC it FIRE SMIP/RES GRADING PERMIT 153,00 SAKE D 1'38 SMIP/NON–R ES PLAN 99.45 ETEGTOR - 1 ISSUE FEE ,�jJ,p BUILDING–DIV–> PERMIT�IECK / `TOTAL PAID DUE TOTALS ---- > 154,38 0,00 —219,45.,,,,, •x`253,83 253,83 ,00 REVENUE DIVISION TOTALS--> COLLECTED: ^ ,154,38 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE• SMIP/TOT GRADING PLAN–CHECK 153,00 j Y= 1,38 Y MlE it iEMMMMit it it iE aE if Mit MiEMMMBt it MitMMMit MiE it iEM MMiE lEMMitM MM MMitM MMMiEiitMMMMMMMMM MMMMMMMMMMMMMMMMM I N D'I V I D U A L FSE E 'B;R E 1 K D O W N TYPE QTY D E S C R I P T I O N ,, UNIT COST TOTAL COST SFR 186 DWE–TYPE V–WOOD FRAME-–GOOD.1 74 QD 13,764,00 END OF) FEES ar EXPIRED 1 plate lnspectu" 66) C� AUG 1 1954 1 T • CONSTRUCTION AND PLANNINU POOL & SPA Date " Inspector APPROVALS Permit # Date inspector APPROVALS Permit �k 1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location _ - 2. Soil Pipe-Undrgrnd. " - 53. Steel Reinforcement �i '�• 3. EJectrical;C6ntlyii Utility-Undrgrnd. - 54. Forms > >_ . AAIE ctrical' ondu.it-Undrgrnd. 55. Electrical Bonding - 5.,�Steel Reiofor cefnent �L 9y 6(, * 56. Rough Plumbing & Pressure Tzst�' 6..Electrica, lti+.F.:E';f 6rnd. � 57. APPROVAL TO COVER-GUrATE 7:. Fooiings�•tt - 'p Ga p YI•' (y 58. Electrical Conduit-Undrgrnd. -_ - 8. Foundation, { 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe,Undrgrnd. 60. Backwash Lines, P -Trap. ❑ UncJrgrnd, 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line,& House Connection 62. Backwash & Receptor -Final-' 12. Sewer Cap V I 63. Heater &Vent -Final ---- p _ 13. Roof Drains -• ^; 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical -Final �`• ;.-i r' 15. Rough Electrica'f•Condwt 66. Solar System -Final i 16. Rough Electric' Wiring 67. Fencing & Access Approval 17. Rough Wiring Sjgn 68. APPROVED FOR PLASTERING I 18. Rough Electric -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPRGVAM D ZPerniit # � _ 20., Rough Factory Fireplace J D 21.7+Juc{f, in-Struitu e * ..',: _ - - _ .� -.70. Undeiground.Hydro 22. Ducu, Ventilating t;J1. Product'Piping 016as 0;00 .y ', n_ _ 2. UndergVuJ Flui723.,GasfPipe.'4o+&Test 7ro' - 24rPoof Framing' '-1 • �' - 3: Undergrnd'StorageTank Gas "Oil ,yL7 25. Ro f Sheathing (,.� -�74: Overhead H drop 26. -T-Bar Ceiling (Structural) & Monocoat • + . "z .. 75.;'pry Chemical ..: 27. Frame an Fldshin ' _y t <d 9 4!A t = J1 in 76. Dry Standpipe r. 3 28.'Lathing4Siding: '7 s.. :q� 77.-F' ED SYSTEM%F�1NALz %29. Insulation -2' '1C 4 78..F PREY. FINAL, I - ;30. Drywall Nailing g�6(i✓�i r ,,HEALTH'0EPT.-REQUIREMENT; _ 31. Plaster B can Coaf ; _ j ; " 79.`' F I ' L SPECTION - '_!12.:ElectricalPosder Mefer-Final I < ox v; 4 •-;80.oE00 • 6.j' IFICATE ISSUED - 33. Fina( Electric "_ " ` � Ih "� - NotPs: 34., Final - Heating -P Air Conditioning 35.r4inal•GasPipe=7egi` "� Ix�" • ' _ r� (�- � 36.•Hodd:or Canopy _, r t �' <+ I I I. r _ _ ll✓(("'{✓✓/JJ3Y VVV •�� .l 37, Fina ltFactory Fireplace ; ;_.-' -• � I � 'c ''tJ•M I 1� -Y 38. Final:Plumbing 39. Water Service-Finallo - 40. Gas Service -Final :41. Solar Domestic -Final _ -i '- ., j -• :s: ' _�' .l. W t !_.w Jmt 42. Backflow Preventer •- I- tr- -: vretiy= 43. Backflow Irrigation '-- •- �' =y- �-, . i '44. Landscape Irrigation System- ,7• ;; r� ; -,; - _ �� •- 45.•Sound Attenuation 46. Randicap,Regulations 47. FINAL STRUCTURE &BUILDING 46. ,FINAL PLANNING, ' '. / ..,, _ - _ --°•^ _ 49. :Electric Release to Edison 50. Gas Release to Southern California Gas Co - y - I CCUPANCY 51. CERTIFICATE OF OCCUPANCY- No. Date No. a 17 PROd"gjT ADDRESS: 1002 POPPY CI OWNER'S NAME: HARDESTY, REX ADDRESS: HARDESTY, JENNIFER O 1002 POPPY CIR COSTA MESA,CA ARCHIENGINEER: JERRY TUCKER ADDRESS: N/A UNIT: 92626 REG.NO.: 52��7 N.B.CA 92000 PERMITTEE: ADDRESS: REX HARDESTY (714)545-3749 1002 POPPY CI C.M. CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotleand my license is in full farce and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature'. WORKERS' COMPENSATION DECLARATION: I hereby affirm that t have a certificate of consent to sell -insure or a certificate of Workers' Compensation Insurance, or a candied copy thereof (Section 3800. Lab. C). DLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. DateApplicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less). I certify that In the performance of the work for which this d is issued, I shall not employ any person in any manner so as to become subject to th Work rs' Compensation Laws of Cablo la. Date: I Signatu / NOTICE: If, after making this declaration, you should becamo th ork Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 70315 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that delete is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that helshe 1s exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the 7 structure is not intended or offered for sale (Section 7044, Business and Professional Code. The Contractors State License Law does not apply to an owner of a properly who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose at sale). I, as owner of the property. am exclusive[ y contracting with licensed contractors to construct the project (Section 7044. Business and Professions Cade: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. & P. C for this reason if I Dale. _ 1 A 1. I Ch..1 N L_ _ Owner I do hereby teddy that I aA1 aware of and understand the requirements of California Reallh and Safety Cade SZctions 25505, 25533, and 25534 and than of any lutufe huilding occupant will/will not (circle one)need to comply with said state codes and the requirements fora permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby ready that I have read this application and stare that the above information is correct, l agree to comply with all city and county ordinances and state laws relating to budding construcdi hereby authorize reprZkZ o enter upon the above mentioned Property Int inspection purposes c Dale: 1 1 1 g G Slgnatu e' CiC Driver's License or Social Security x: Applicant: Pink—Revenue; Goldenrod—Assessor COMMENTS: REPLACE 2 EXISTG WINDOWS W/FRENCH DOORS Z O N I N G S E T B A C K SR E Q U I R E M E N T S ------- --- MAIN BUILDING ---------- --------- ACCESSORY 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: 41237206 ZNE: R1 REF NO: PLANNING NOTES> BALCONY ABOVE EXISTING GARAGE > r� 1ElF iF if if if fE lE iE it iE iE***1E*iE 1E iE BF if lE if BE iF BE BF iE*Bt iE BE iE*Be iE 1E BE iE if if iE iF iE iE iE iE lE iE iE iE 3E iF iF if iE*iF iE iE if%*iE if 46 iE *iF iFiE iE if it**ie aF 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 lT S ZONING APPROVED BY ajaa DATE: `L044b ftA BUILDING APPROVED BY : DATE: %? APPLICATION ISSUED BY: DATE: 1 6 1e Bf lF iE aE ff lE lE iEiE iE *iE je if it iF lE if fE ie ie if 1E 9E 1f-ae aE lE aE iF;E r iE iE iE 1E iE iE iE BE BE It ie iE iE 1lielf iE ielF lE ie ie iE iE iE k iE*iE*if lE jE ie lE k Bf 1t, BE 1E*if iE***kae iE if it BE iE**iE*M1f iE it if iF aF jE iE aE.iF aF,iE Be if jE if iE lE BE iF if*iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 54.00 _ 50 PLAN 35,10 ? SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE .PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 54,50 0,00 -35,10 89,60 89,60 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 89,60 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC,;MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 54,00 ,50 35,10 ie 1e iE iE if * 3E ie 1E * iE * iE aE iE iE iE 1F iE iE iE iF it iE iE ie if iE sf iE it 1e ii iE.iE iE * iE iF iE iE if iE % 1E * ik lF * ie ie if * eE ff jk im iE iE iE iE * ie fE iF if #e iE ie iF ik ie iE ie iE ie iE iE aE I N D I V I D U At :' F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 162 RES—BALCONY, EXTERIOR STAIRWAY 14,80 2,39) SFR 500 ALTER BY VALUE RESPDENTIAL NOZONE 1,00 500;00 END7 OF FEES EXPIRED incomplete Inspel ' D x^F 01 0[114?U83-002490E4 Till 84.60 DATE: I0119.193 TIME: 16:1` CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 064503 PERMIT NO: B 064503 PLAN CHECK NO: 04065-93 L GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION CREATE 162SF DECK, REMOVE PART OF ROOF SQ FT: 662 CLAIM VALUE: 2,000,00 CALC—VALUE: 2,897,60 GROUP OCC: R-3 / COMMENTS: REPLACE 2 EXISTG WINDOWS W/FRENCH DOORS Z O N I N G S E T B A C K SR E Q U I R E M E N T S ------- --- MAIN BUILDING ---------- --------- ACCESSORY 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: 41237206 ZNE: R1 REF NO: PLANNING NOTES> BALCONY ABOVE EXISTING GARAGE > r� 1ElF iF if if if fE lE iE it iE iE***1E*iE 1E iE BF if lE if BE iF BE BF iE*Bt iE BE iE*Be iE 1E BE iE if if iE iF iE iE iE iE lE iE iE iE 3E iF iF if iE*iF iE iE if%*iE if 46 iE *iF iFiE iE if it**ie aF 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 lT S ZONING APPROVED BY ajaa DATE: `L044b ftA BUILDING APPROVED BY : DATE: %? APPLICATION ISSUED BY: DATE: 1 6 1e Bf lF iE aE ff lE lE iEiE iE *iE je if it iF lE if fE ie ie if 1E 9E 1f-ae aE lE aE iF;E r iE iE iE 1E iE iE iE BE BE It ie iE iE 1lielf iE ielF lE ie ie iE iE iE k iE*iE*if lE jE ie lE k Bf 1t, BE 1E*if iE***kae iE if it BE iE**iE*M1f iE it if iF aF jE iE aE.iF aF,iE Be if jE if iE lE BE iF if*iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 54.00 _ 50 PLAN 35,10 ? SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE .PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 54,50 0,00 -35,10 89,60 89,60 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 89,60 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC,;MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 54,00 ,50 35,10 ie 1e iE iE if * 3E ie 1E * iE * iE aE iE iE iE 1F iE iE iE iF it iE iE ie if iE sf iE it 1e ii iE.iE iE * iE iF iE iE if iE % 1E * ik lF * ie ie if * eE ff jk im iE iE iE iE * ie fE iF if #e iE ie iF ik ie iE ie iE ie iE iE aE I N D I V I D U At :' F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 162 RES—BALCONY, EXTERIOR STAIRWAY 14,80 2,39) SFR 500 ALTER BY VALUE RESPDENTIAL NOZONE 1,00 500;00 END7 OF FEES EXPIRED incomplete Inspel ' D x^F 01 0[114?U83-002490E4 Till 84.60 DATE: I0119.193 TIME: 16:1` CONSTRUCTION AND PLANNINU APPROVALS Permit # Date - Inspector ,L & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole '- 52.Pool &Equipment location 2. Soil Pipe-Undrgrnd. " _ 53, Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical. Conduit-Undrgrnd. 55. Electrical Bonding S..Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings r- 56. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK "-- 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final -.I 14. Rough Plumbing 65, Electrical -Final 15. Rough Electrical -Conduit 66, Solar System -Fina! I 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure -70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping G'Ghs u Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73.Undergrnd. Storage Tank ❑ Gas 0011 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 -t 32. Electrical Power Meter -Final 33- Final Electric 34. Final Heating & Air Conditioning 80. FOOD CERTIFICATE ISSUED01 'Notes: �jb Ial � Tf.N.IOti �Oi�l0ai o�F� ►��A� ll w X11. e0d54L - /Jb IJ - 35. Final Gas Pipe -Test 36. Hood or Canopy 5 37.'Final Factory Fireplace - l 38. Final Plumbing - •. 39. Water Service -Final 40. Gas Service -Final ' 41. Solar Domestic -Final 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING r 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date J I I� PRSTECT ADDRESS: 1002 POPPY C I 1 UNIT: OWNER'S NAME: HARDESTY REX ADDRESS: 1002 POPPY CIR COSTA MESA,CA 92626 ARCH/ENGINEER: FETHER CONSTRUCTION REG.NO.: OO .00 ADDRESS: 3510 PO BOX 751-6409 �iLR. PERMITTEE: COSTA MESA CA 92628 ADDRESS: REX HARDESTY (714)850-9005 1002 POPPY CI F LICENSED CONTRACTOR DECMLAAATION: I hereby affirm that I am licensed under provisic9os of Chapeer 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: EXP; Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800. Lab. C), POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This Section need not be completed if the permit is lot one hundred (5100) or less). I certify that in the Pertor ante eI the work for which this rml l Oed. I shall not employ any person in any manner so as to become subject to the lorkers m ens tion Laws of California. I ,L Date. Signature: Q ❑� NOTICE: I alter along A declaration. you should become subject to the Dor orsCompensation provisions of the Labor Cade. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 70011) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1. as owner of the property or my empoloyees with wages as their sole compensation, will do the wore, and the ❑ structure is not intended or offered for sale (Section 7044, Business and Professional Code : The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. 11, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I. as owner of the property. am exclusivelyy contracting with licensed contractors to construct the project (Section 7044. Business Eland Professions Code: The Contractors' Beale License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a Contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. I am exempt under Section: B P 7 O 4 4 B. S P. C. for lines eased: OWNER—BUILDER Date: I do here�yOwne r: ^ c ily That I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 5534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit lot construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and state that the above information is correct, I agree to comply with all city and county ordinances and stale laws relating to building construction�yood�LU@�reby authorize representatives of this city to enter upon the above-mentioned property lore lion purposes. �Bate: IF all ✓ Signature' Driver's License or ocial Secunly p: 1641 46 White—Building', Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT I PERM NO: E 06873C PERMIT NO: E 068730 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: ADD JOB DESCRIPTION ADD 186SF ROOM, RE:#B68478 SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: ADD 186SF TO FAMILY LIVING ROOM Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 41237206 ZNE: REF NO: PLANNING NOTES> 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 DATE: BUILDING APPROVED BY ; DATE: APPLICATION ISSUED BY: DATE:.3� LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 12.00 508 SMIP/NON—RES PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 12,00 15.00 0.00 27.00/ 27.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N ELE 8 FIXTURES LIGHTING 1 ST 20 ELE 8 RECEPT/OUTLET 1 ST 20 END OF FEES � EXPJ �wns l+C V UNIT COST TOTAL COST EA. 75 6.00 EA. .75 6.00 ( / V 01 00167067-00167067 TCD T 27.00 DATE: 09/01/94 TIN: 15:52 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit dk Date Inspector 1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -• - 3. Electrical Conduit l'ltility-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, 0 Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P Trap, O Un.drgrnd. 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. Etectrica l- 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 Electrica LT Bar Ceiling 69: POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS i Permit 20. Rough Factory Fireplace 21. Duces, in Structure,70. Uridergiound Hydro 22. Ducts; Ventilating 11. Product .Piping CGas 000 23. Gas Pipe -Rough & Test 72. Underground F!usfi , 24. Roof Framing . _ 73. Undergrnd. Storage Tank 0 Gas O Oil 25. Roof Sheathing - 74. Overhead Hydro - 26. T -Bar Ceiling (Structural) & Monocoat r 75. Dry Chemical 27. Frame and Flashing } 76. Dry Standpipe 28. Lathing & Siding , 77. -FIXED SYSTEM FINAL - 29. Insulation' t 78. FIRE PREV. FINAL ' 30. Drywall Nailing - � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat' i 79. FINAL INSPECTION a 32. Electrical Power Meter -Final 33. Final Electric _ 34. Final Heating & Air Conditioning '' 80. FOOD CERTIFICATE ISSUED Notes: - 35. Final Gas Pipe -Test - 36. Hood or Canopy . - i 37. Final -Factory Fireplace - 38. Final Plumbing --� 39. Water Service -Final 40. Gas Service -Final - 41. Solar Domestic -Final ' 42. Backflow Preventer - 43. Backflow Irrigation ' 44. Landscape Irrigation System - - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48, FINAL PLANNING 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy bu der lines auu'slgnate declarations./ f CITY OF COSTA MESA,-' - Plan' '4 Elev AR i PERMIT NO, - TRACT NO. LOT NO. BLDG. NO.- CONSTRUCTION PERMITlot I. �S I,LO lI Project Address '1OOZ Poppy Cirr'Ie' TYPE OF CO . NSTRUCTION LJ NEW LJ ADD LJ ALTERATION U REPAIR• Ad B E] CONVERSION El DEMOLISH ❑ OTHER' P # ,ppilcant s Malhng Ad rens, X565 W._.MacArth ur vLl d - , Meter El up to 100 amps' A. / 7- ? —5 Owner's Name Stan4ar4 PB&7f�-,o—oar— ' f I Phone 54:+�-' -J_1 l fi I DESCRIPTION OF WORK Fan _ _' _ ` 'Motors 00-1 HP Ell '/.-6 _ S _ Main Building: - 'AddressSdrBP Device Boxes , TYPE OF PERMIT E7GRAotNG 0 FOUNDATION LFSTRUCTURAL Range ` T Front 4 b/ - Garbage Disposal Arch/Eng Adam$ Str'.PPrer License No. T.rin�i ❑, TENANT. ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - r B Rear. Addressl - 179$1 Sky_ PArk=Cirolp `Trying 1 F ❑LOTHER� PLAN CHECK ' $ A - ' Contractor's Name .See OWniar Phone - PROJECT DESCRIPTION SG. FT. 2190 ' ,OCCUPANCY —: C Right !, - ( CONSTRUCTION TYPE ` VALUATION $ 1 12O 264 Address Imal ling) City License No �j IJO 90 I ZONE GRADING CU.YDS. ACRES ping. Ref. #'Z- �3� LICENSED CONTRACTOR DECLARATION `. + Remarks: G _ '3/ o 3 A, - ` Parking Req./Provided I, hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and - Use of Building: r .my license is in full fo a ntl effect.�/1� 1 - ' License Class' -� ' , / /D entl�--- 248011 PLUMBING FEES Planning Notes: - 'hereby affirm that t hive a certificate of consenPulmt to self -insure o� a certificate �f Workers' Compensation Insurance; or a certified copy"theieof (Sectlon P.10 No: AWP -84-225-856 cpmpany Fremont. Indemnti,y ACertified copy Is hereby furnished. I Certifyep cpl{Y 1 fj,led with the ;city f uJlcl ng Divigtoq. , Date 17 I9 4 Applicant— Landdr0 cif1C 1 EXEMPTION FROM WORKERS• COMPE NSATIONDECLARATION ` (This section need not be completed if the permit Is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner sojas to become subject to the Workers' Compensation. Laws of California. Date r Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation^provisions of the Labor Code, you must -forthwith` comply with such . provisionsor this permit shall be -deemed revoked. CONSTRUCTION I LENDING "AGENCY. - - ., =''. i _ 1 hereby affirm that there is a. construction lending agency for the performance' of the work for which- this permit is issued ,(Section. 3097" Civ. C:) Lender's Name - Lender's Address f - OWNER BUILDER DECLARATION - I hereby. affirm'.that I am exempt from the' Contractor's License Law for the a ,,herefrom and the basis for,the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit r subjects -the applicant -to a civil .penalty of not more than five hundred dollars ($500). _ I, as owner of the property or,rmy employees with wages as that' sole 'compensation, will' do the work, and the structure is not intended or offered for sale, (Section 7044, Business and Professional Code: The Contractor's ' License Law does not apply to an owner of a property who builds or improves thereon, and whoidoes such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered ,for sale. If, however, the building or improvement Is sold within one year of corn- , pletion, the owner will have the burden of proving he/she did riot build or im- rove for the purpose of sale). I ! I, as owner of the property, am exclusively contracting' with'. licensed con- tractors to construct the project (Section 7044, Business and Professions Code: ' .The Contractor's License .Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con. ' tractor(s) license pursuant to the Contractor's License Law). ❑ .I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application antl state that the above information Is correct. I agree to comply with all city and county' ordinances and state laws relating -to building construction, and hereby authorize repre- sentatives O is t i/lnte upon the above-mentioneit 'pr ert for Inspection est !/ , Si nature r Date Bar Sink Backflow Preventer Backflow Irrigation 1 Bathtubs 1 Clarifiers 1 Dishwasher Drinking Fountains Floor Drains;., Floor Sinks N Lunen omn Lavatories '- P -Trap, Roof Drains' ' Reinspection Fee ;S25 Boiler ` Duct - Under Giound Duct -Structural Duct -Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICED =h: t Heating System & Ducting ❑o-100,000 BTU 0100,000 9 Drivers' License c , I I Reinspection fee CMF 0865-46 rev. 7/83 White- Building; Canary - Applicant;Pink - Accounting; Goldenrod - Assessor _\ $25 Showers _ Service Sink_ Sewer, Cap Solar Collectors.,, Solar Piping Solar'Tank T Swimming Pool w/Spa 1 Urinal Water Closet r Water Heater c i Issue Fee IANICAL Hood or Type I. ❑ Canopy Type II' ❑ MI® MIMI® MINE ®® 51614.' 3/01/84 ',`57$•85 TL Zone / "Accessory Building: Z O N I N G R E Park:Fees I"- r ELECTRICAL ` Automatic Washer -Construction Pole Sub. , Transformer ❑ 15-50'KW ' ❑ 50 +.KW Cooking Unit - - Meter El up to 100 amps' Dishwasher ,Meter Clover 100 amps ' Dryers ❑Gas ❑Electric 'Sub Panel ' Fan _ _' _ ` 'Motors 00-1 HP Ell '/.-6 _ 'F.A.U.:I nc. So to r -15 HP 016-15+ Fixtures. ', Microwave Device Boxes Pole Light Outlets - 1 Range ` Switches' Sign - Garbage Disposal . Standing Sections Generator 00-5 KW 115-15 KW Trash Compactor , : $ TOTAL FEE Reinspection Fee $25 'Issue Fee PUBLIC, SERVICES REQUIREMNTS: Zoning Approved By "'0 �n Application Approved By / Application Issued By ' (; + I .•. KG Date Date__ '/ 1 Dates-'-/ J $ 3 ❑0,100,000 BTU 0100,000BTU BUI_DING PERMIT PLAN CHECK $' $ SUMMARY OF FEES ftR- _Cid SMTP - 78-89 PERMIT $ `8.46 " System Repair/Alteration PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK $ $ $ $ .ISSUANCE ENERGY P.C. GRADING MICROFILM $ $ $ $ " MECHANICAL : $ TOTAL FEE $ 1F70 S2C Issue Fee $ 3 PLAN CHECK ' $ • CONSTRUCTION AND PLANNING_ '- APPROVALS . Permit # Date Inspector PG. A SPA - • -.APPROVALS Permit # - Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, - 54. Forms. 4. Electrical Conduit-Und[grnd. - ' ..55. Electrical Bonding 5. Steel Reinforcement - - - 56. Rough Plumbing & Pressure Test " '6. Electrical LIFER Grnd." • - r - 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgind. ' 8. Foundation - • 59.- Gas Pipej] Undrgrnd:; Testa . - 9: Water Pipe-Undrgrnd., - '50.. Backwash Lines, P-Trap, 0 Undrgrnd. ' 10. Structural Floor System' ` ' - 61. APPROVAL TO DECK ' 11: Property Sewer Line & House Connection 62. Backwash & Receptor-Final" 12:• Sewer Cap 63. Heater & Vent-Final 13. Roof ,Drains -- - •64?Plumbing System'- Final 14: Rough Plumbing _ 65? Electrical-Final - 15. -Rough Electrical-Conduit ` ` 66. Solar System-Final- i6. •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' APPROVALS Permit # _2O: Rough Factory Fireplace t 21. Ducts, in Structure 70. Underground Hydro 22r Ducts, Ventilating v 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test' 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas 00il 25: Roof Sheathing 7 �g 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75..DryChemical 27. .Frame and Flashing Z�76. f de- Dry Standpipe 28. 72,37 �C� 77. FIXED SYSTEMFINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. ;Plaster Brown Coat 79. FINALINSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED - 33: Final Electric Notes: 34. Final Heating &•Air Conditioning 35. Final Gas Pipe-Test - 36. Hood or Canopy - 37. Final Factory Fireplace•+ 38. Final Plumbing '•�� - - 39. Water Service-Final , 40. Gas•Service-Ficial , ti 41. Solar Domestic-Final' 42. Backflow Preventer i - 43. Backflow Irrigation 44. ,Landscape Irrigation System , 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE&BUILDING 48. Special Requirements Completed /��9'�P¢ ,��-• 49. Electric. Release to Edison - - - 50. Gas Release to Southern California Gas Cc y- 51. CERTIFICATE.OF OCCUPANCY No. . ' Date N Applicant to fit ces etos! winaVY bor nes an0 Y1gn all appropriate declarations. . 'CITY OF COSTA /M•�ESA�1 C(J�J"ISTRUCTI(7��N PE MIT PER4T NO. TRACT NO. LOT NO. UNIT NO. ' Project Address �✓� of // �iQ. (z.!/7,� - _ - Applicant's Maili g ddr 5 _ TYPE OF CONSTRUCTION EW ADD ALTERATION REPAIR - Owner's Name ��'` Phn�'1 �� ❑CONVERSION'❑DE LISH ❑OTHER A.P.# Zone ZS�OS' �Yl� �L DESCRIPTION OF WORK/USE OF BLDG. Addressn �� S Main Building: 'Accessory Building Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL - T Front ((l✓��/-`-Jtt Address ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL A Rear N I W Contractor's Nam Phon iI -❑'OTHER - I _ O Right - - - N PROJECT DESCRIPTION' SQ. FT. - OCCUPANCY' - - - G- ( Address IT - •CON STRUCTION TYPE VALUATION$ $ left- City.LicenseNo. IZONE GRADING CU. YDS. ACRES' - - E LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided - 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing . Remarks: Planning Notes: r - 0 with section 7000) of Division 3 of the Business and Professions Code, and T my license is in full for ar.�(.e fect. - LICCnsf� S5 Jv ' LIC2n 5e tyO. b/7��} .— Date /��Z Signature l PLUMBING FEES NOR KERS' COMPENADECRATION Bar Sink ' Showers ELECTRICAL - FEES - hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance,' or a certified copy thereof. (SectBackflow ion _ - Preventer Service Sink _ _ _ _t_ - - Automatic Washer; - - - Transformer LI -15-50 KW - Pol0iC0y Nb ) /%�/ Company /T `rN Backflow Irrigation - Sewer Cap Construction Po le_,Sub. 1 ❑ 50+ KW Cert" ied copy is hereby furnished. C cap l ileo with the /Bil in isMion c Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps it, PTION F OM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter ❑Over .100 amps' (This section need not be completed if the permit is for One hundred ($100) or - - less). . I Dishwasher Solar Piping Dryers ❑Gas. ❑Electric Sub,Panel 1 certify that in the performance of the work for which this permit is,issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan ' Motors 00-1 HP 121% - 8 Workers' Compensation Laws of California., , - Date - Signature Floor Drains Swimming Pool w/Spa. F.A•. U.i NOTICE: If, after making this declaration, you should become subject to the Inc. Solar ❑8-15 HP ❑16-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal - - - — Fixtures - _ comply with Such provisions or this .permit; shall be deemed revoked. Microwave - - - CONSTRUCTION LENDING -AGENCY:•- Gas Service Outlets - Water Closet Device Boxes I hereby affirm that there is a construction 'I ending agency for the performance Pole Light i of the •work for which; this permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater Outlets Range I Lender's Name' - l Lender's Address _ Kitchen Sink / Water Service Switches Sign OWNER BUILDER DECLARATION-- - = 1 hereby affirm that 1 am exempt from tM1e Contractor's License Law for the y LavatOrieS - - o i ' • following reason (Section 7031.5 Business and Professional Code: Any City or ` O Garbage Disposal Standing Sections r county which requires a permit to construct, alter, improve, demolish or repair P—Trap - - '' zany structure, prior to its issuance, also requires the applicant for such permit Generator ❑0-5 KW ❑5-15 KW Trash Compactor to file a signed Statement that -he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000) of I - Division 3' of the Business and Professions Code) or that he/she i5 exempt - therefrom and the basis for the alleged exemption. Any violation of Section - - - 7031.5 ,by, any applicant for a permit subjects the applicant to a civil nnalty of not more than five hundred dollars ($500).. - l I; as owner of the property or my employees with wages as their sole ReinspeMion Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of.a property who builds or improves thereon, and who does such work'himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that Such improvements are not intended or offered for Boller Hood Or Type I ❑ ! sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By , Date pletion,•the owner will have the burden of proving he/she did not build or im- Duct - Under Ground Building Approved By - Date rove for the purpose of sale). I, as owner of'lhe property, am exclusively contracting with licensed con- Duct - Structural - Refrigeration System Application Issued By Dat Z tractors to construct the project (Section 7044, Business and Professions Code: .The Contractor's -License Law does not apply to an owner of'property who Duct - Ventilating _ 00,100,00013 -Fu ❑100,000 BTU SUMMARY OF FEES builds or improves thereon, and who'contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT' $ SMIP $ proof of their Worker's Compensation insurance should be provided to me., Exhaust System ❑ Multiple ❑ System Repair/Alteration PLAN CHECK PERMIT 11 ❑ 1 am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # PLUMB N Date Owner - Heating System &Ducting ' ,f r�j'/�1 GV P. $ PLAN CHEC 25 �t_�. I hereby certify that have read this application and state 't that the above ❑0-100,000 BTU ❑100,000 BT - - ELECT G ADIN $ information is correct. I agree to comply with all city and county ordinances and state laws; S in t0 building consUK9 tipre- PLAN CHECK 50% $ MICROFILM $ and site of [his o enter uponfor - inspection purpos MECHANICAL $ •TOTAL FEE $ Signature Reinspection Fee ) $15, 1 Issue Fee $ 3- PLAN CHECK 25% $ Drivers' License or SS # CMF 0865-46, rev. 4/84 White - Building;Canary - Applicant;Pink - Accounting; Goldenrod - Assessor - t CONSTRUCTION AND PLANNING APPROVALS Permit # _ Date [Inspector P0. - &SPA. - APPROVALS Permit # ' Date Inspector 1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. -• •• 53:'' Steel Reinforcement ,3.E c 'ical Conduii"Utility-Undrgrnd. 54. Forms 4: Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5.-Steel'Reinforcementy, 56, Rough Plumbing & Pressure Test 6. Electrical.UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7."Footings'' 58. Electrical Conduit-Undrgrnd. _ 8. Foundation i 59.- Gas Pipe, 0 Undrgrnd., Test 9 !Water; Pipe-Undrgrnd. ` 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10.'Structural7Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &House Connection 62. Backwash & Receptor -Final 12. Sewer�Cap ;' ` 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final - - 14. Rough'Plumbing� 65. Electrical -Final 15. Rough Electrical -Conduit - 66. SolarSystem-Final 16. Rough Electric Wiring 67.Fencing & Access Approval _ 1 7,., 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 APPROVALS Permit# 201 Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas E) Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil 25. Roof Sheathing ,i 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,CERTI FICATE ISSUED 33. Final Electric Notes: !, j 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test lr7 i5 d'�! GEO 36. Hood or Canopy - 37. Final Factory Fireplace - - 38. Final Plumbing LNC/ C.xv 39. Water Service -Final 40. Gas Service -Final - 41. Solar Domestic -Final ' 42. Backflow Preventer -' 43. Backflow Irrigation. 44. Landscape Irrigation System ' 45. Sound Attenuation 1 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • - 48. Special Requirements Completed .. - 49. Electric Release to Edison r- - - - _ 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ Applicant to fill.in allspaces.except those within heavy border lines and s+gn,all appropriate declarations. � *CITY COSTA -MESA � , - 1 `EONSTRUCTION PERMjJ NO. 1 TRACT NO. LOT NO. ,. BLD .`N � � r � 5]5I '3IOiI�4 � 36•00 -•. TL • PERMIT y 1 , _. Project Address � -�TYPE OF CONSTRUCTION NEW ADDZ ALTERATION REPAIR - _ _ Applicant's MeilingAddre55, L1 CONVERSION ❑DEM LISH ❑OTHER - q,p,# - Zone .Owner's Name Ph -e — �, DESCRIPTION OF WORK ., -� S'_1 Maio -Building: Accessory Buildings l Z - Address :: r ION R L OF PERM 'GRADING-❑ FOUNDAT STRUCTU A TYPE IT E T, Front ": , J O N r _ Arch/Eng' License No.' -- 111��-yyy ❑TENANT ❑.ELECTRICAL LH PLUMBING ❑MECHANICAL B Rear. -t - - - -•- N - Address - ❑pOTH ER - / ' A ,., h - Cdntractor's'Nam hone - PROJECT DESCRIPTION I SQ. FT. OCCUPANCY ' . C Right (- G Address (mailing) CONSTRUCTION TYPE VALUATION $ $ Left ' - - '- E City License No. ZONE GRADING CU.YDS. ACRES ' Ping. Ref. Park r Q U LICENSED CONTRACTOR DECLARATION + � � Remarks: � Parking Req./Provided I I'hereby affirm that -I am licensed under provisions of C sarter,B 'commencing _ - R with section 7000) of Division 3 of the B slness and rotessions Code, and Use of Building: E my licensees in full forcM ndeffe License Class' �' t. I License ) PLUMBING FEES Planning Notes: ; .. M o. I .. E —ate signature Bar Sink - Showers • +- - - T R KERS' COMPENSATION DECLARATION areby'affirrn that I have a certificate of consent 'to self -insure or a certificate Backflow Preventer -- Service Sink - - - - '�"" S r Workers' compensation Insurance, or a certifletl. copy th reof (Section,. 3800, Lab . C.) U� ,` l/�I�p6/�-- '.•i - Backflow Irrigation Sewer Cap { - ' ' ELECTRICAL 'FEES n Policy No. � 5 001 `70 Company Certified copy 'Is hereby furnished. ' °' -,",i Bathtubs I Sewer Connection Automatic Washer,.. Transformer 0 15-50 KW q� C,ertifi- co i elect with the city �qu iltl�`•f'v�is n. , _ ;: 50 +_KW .Date -' .Applicant 1"a�-.1_1'_Y]�gef /t .,. Clarifiers _ _y Solar Collectors . , Construct;on Pole Sub. - ,� EXEMPTMPT O�RKERS C0rMPENSATION DECLARATION I Dishwasher r Solar Piping Cooking Unit Meter Oup to 100 amps ' (This section need not be completed if the permit is for one hundred ($100) ou less). .. : "` m 1 certify that in the performance of the work for which this permit is Issued shall not employ any person in any manner sofas to become subject to tde Drinking Fountains - g Solar Tank + ' _ r` : - i - Dishwasher - + Meter ❑over 100 amps r Workers' Compensation' Laws of California.;, j Floor Drains' + - Swimming Pool w/Spa Dryers ❑Gas (]Electric Sub Panel' , Oat e Signature r NOTICE: If,efter making this declaration', -you should-become"subject to the% Floor Sinks "- `' "'" '-" Urinal Fan -' Motors 061 HP O 1'/: - 8 -` Workers' Compensation provisions of the Labor Code, you .f tn, deemed revolk comply with such .END(provisions, or -this ,permit .shall- be;deemetl revoketl: Gas Service" .Outlets Water Closet' _ F.A: U. - Inc.Solar 09-15 HP,016-15+ CONSTRUCT( LENDING AGENCY - - - I hereby affirm that there is a construction lending agency for the performance - Interceptors - Water Heater, - Fixtures Microwave of the ,work for which this permit -is • issued (Section 3097' Civ. C.) ' - ! _ .. _ .; Lender's Name � - --� -'� _ � . Kitchen Sink, ;, � ',' � -' � '; Water Service Device Boxes' Pole Light Lender's Address .._' - N I .. i OWNER BUILDER DECLARATION W r Lavatories - 4 - Outlets s - „ Range I hereby, affirm that I am exempt from the' Contractor's:Llcense Law for the . IP -Tr_ t i ' reason (Section-] 031.5,Busi ness and Professional(Code:'Any city or. Switches Signfollowing r ' county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its -issuance, also requires the applicant for such permit Roof.Drains+ S - f.• Garbage Disposal Standing Sections f f,le a signed statement•that he/she is licensed pursuant to the provisions of 1'L,Contractor's-License Law (Chapter 9 (commencing,with Section 7000) of -or Generator DO -5 KW 05-15 KW Trash,Compactor 3" of the,Business and Professions Code) that he/she is exempt - .. - gsion, ,riiefrom and the basis for the alleged exemption:'Any. violation of, Section + ' - ^ �+ _ (031.5 by any applicant for,�al permit. subjects the applicant to a> Civil nalty of not more than five hundred dollars ($500). -'Reinspection Fee $25 - Fee $ 3 _Issue Issue Fee LJ I, ,as owner of, the. property or my employees.with kages'as their sole Reinspection Fee $25 $ 3, , compensation will do the work, and the structure is not Intended or offered I - I MECHANICAL FEES for sale, (Section 7044, Business and! Professional. Code: The. Contractor's j -License Law does to builds Improves 4 ❑ PUBLIC SERVICES REQUIREMENTS:' not apply an owner of a property who, or Boller - Hood or Type I - - •I - thereon, and who±tloes such work himself/herself ,Br through his or her own ._ -' Canopy _, Type 11; ❑ ', ! Zoning Approved By - Date amp loyee5, pl OVitletl thdt SUCK Improvements are nqt Intentletl or offered for ,sale. If, however, the bulltling or Improvement is fold within one year of con- 1 Duct - Under Ground, ,» , - - y_ Building Approved ey 1 Date pletlon, the -owner wil l .he ve .the burdan of proving he/she tlitl not bui Id or im-- • the ' Duct - Structural i' i - Refrigeration System ' Zw *,.Application Issued By r i ` Dat drove lfor purpose of salej. ; , , LJ I, as owner of the property, am exclusively contracting with licensed con- _ Duct_Ventllating ❑0.100,000 BTU 100,000 BTU 1 SUMMARY OF FEES . tractors to con strucLthe project-(Section.7044, Busln ass and Professions Cotler :;- ... ;..._ t - -. S •$ The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with acan- - Exhaust System 0 Multiple ❑ System Repair/Alteration -' _, . BUILDING PERMIT -$ I SMIP,! . tractor(s) license pursuant to the Contractor's License Law). - , i 'PLAN CHECK . $ - '' PERMIT El Pam exempt under Section + l B. & P. C. for this reason i Fiiepl/Fact. Blt. ICBO # I 'PLUMBING+ :' -d" I ISSUANCE ; $ t , $ Date '- Owner; ` ` % Heating System &Ducting PLAN CHECK 25% $ 7 ENERGY P.C. 1$ ' hereby certify -'that I have react this application arid -stat e'tnat ttie'above 00-100,000 BTU 0100,000 BT, - I GRACING ;$ ' Information is correct. I agree,to comply with all city and county ordinances ' 1' - - ELECTRICAL $ + ) 1 'MICROFILM and state' laws relating to building construction,, and hereby authorize repre- , t PLAN CHECK 50% $ j$ sentatives of this city to enter, upon the above-mentioned property for '. ! i s y- Inspectionpu poses MECHANICAL $ TOTAL FEE f$''r Signature- Date Reinspection Fee $25 -I Fee - $ 3 PLAN CHECK 25% $ Drivers' Llderisa oq SS # - _Issue ' CMF 0865-46 rev. 12/83 Pink - Accounting; Goldenrod 7 Assessor - - +CCINSTRUCTION AND PLANNINGSRAM.� u •�` Date - > AIR VALS Permit # Inspector I' - > - -'APPROVALS Permnt-# Date " �I nspector; - *,f- Temporary.Electrical Service or Pole •c.2:� :52. Pool & tquipment-Location-: _ Soil Pipe-Undrgrnd., •' ��y, (r� .53 'Steel Reinforcement' _ r^ -•` �' ' -3`Electrical Conduit Utility -U riHrgrnd.! - 54. Forms'r, 4f Electrica-ECond uit-Undrgrnd. _ Lj " 55: Electrical 6onding� 5. Steel Reinforcement -- - 56. Rough Plumbing & Pressure.Test:?A -'-' - `= �•'� „ - - - 6. Electrical LIFER Grnd." ' ` v. { 57-'APPROVALTO COVER:GUNITE 7. Footings)- -rf-58. Electrical Conduit-Undrgrna.,- n , 8. Foundation; 1 - - • 59. Gas Pipe, O-Undr6rna., Test' _ _ 9. Water Pipe-Undrgrnd�Und C.�(3 60. Backwash Lines, P -Trap, O_ :. = .4 {' -rgrnd. _ 10. Structural Floor System 61,. APPROVAL:TO DECK - x 11. Oro perty:Sewer Line &'House Connection417 ' (,{Q - 62. Backwash & Receptor -Final- - 12. Sewer Cap_ =. '' 63. Heater&Vent-Final '-•? j' _ '`;_ 'i 13. Roof Drains. - 64. Plumbing System -Final -- 14. Rough Plumbing "� C, T14"f C,90 '65. Electrical -Finial 15. Rough Electrical -Conduit - - - 66. Solar Sstem-Final--- '16.'Rou h Electric Wiring 9 9 - 67.' Fencing,&:Access Approval _ -- - -r r- .. -- - `=- 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING_'' - 18.. Rough Electrical -.T Bar Ceiling 69. POOL/SP,A SYSTEMS'FINAL C r { 19.'Rough Heating& Air Conditioning• FIRE DEPT. REQUIREMENT[; _ 5 APPROVALS Peimit# .,20. Rough Factory Fireplace j t - 21. Ducts, in Structure 70., Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas -EJ Oil ' 23. Gas Pipe -Rough & Test _ - - �-• 72.i Underground Flush 24. Roof Framing, 73.,Undergr4Storage Tank!'ElGW1gOil 25. Roof Sheathing ' 74. Overhead Hydro t '26. T -Bar Ceiling (Structural) & Monocoat 75.1 Dry Chemical - '27:' Frame and Flashing 76. Dry Standpipe ! h28. Lathing &Siding 77. FIXED SYSTEM FINAL I 29. Insulation i 78. FIRE PREV. FINAL Drywall Nailing i HEALTH DEPT. REQUIREMENT .30. r i ,31. Plaster Brown Coat j 79. FINAL INSPECTION _ { 32. Electrical Power Meter -Final 80?'_F.00D.CERTI FICATE ISSUED ' '33._ Final Electric Notesl,:'+_i ••' 34. Final Heating & Air Conditioning r J__j- _ -- 35. Final Gas Pipe -Test q /b�[L 9k. GiriO' y i - • _ i; 36. Hood or Canopy 37. Fina! Factory Fireplace - 38. Final Plumbing• 39. Water Service -Final 40. Gas Service -Final - is 41. Solar Domestic -Final -- -- --, 42. Backflow Preventer _ , - _,__j- 43. Backflow Irrigation , 44..La'ridscape Irrigation System ! _ 45.. Sound Attenuation 46. Handicap Regulations ! t 47. FINAL STRUCTURE & BUILDING 48. Special, Requirements Completed 49. Electric Release to Edison ' - , - 'i - I - 50. Gas Release to Southern California Gas Cu I 51. CERTIFICATE OF OCCUPANCY •- - - •--� --'- ! - -- , - ' + No. - - Date-- _ _- _ �- - I. I_ -i.- - . _ - -. _ OgY Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA NS V .TION ERMIT r`"'""' ' Q ss� 19 Project Address .` TYPE OF CONSTRUCTION �' NEW ADD Applicant's Mailin�I�� Address k-' ❑ CONVERSION - ❑ DEMOLISH ❑ OTHER .Yt IS- 1 f• Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Address, -V02 VQPPV- ALTERATION. LJ REPAIR Workers' Compensation Insurance,. or a cc Ifi ' copy ther (Section _ Backflow Preventer _ -Service Sink, Policy No. i Company Backflow Irrigation Sewer Cap I Cert ifi p�y�f(�� ereby furnished. �I I-( Certif �✓YI'��d with the city �W'dipg.xlivlSl�ry. �� Bathtubs Sewer Connection EXEMPTI6N:PR6M WORKERS' COMVt NSATION/OECLARATION (Thissection need not be completed if the permit is for -one hundred ($100) or less): i I I I certify'that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'. Compensation; Laws of California. I Date, Signature 1 I NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of ,the Labor Code, you must forthwith comply-;with'such provisions or this permit shall be deemed revoked. CONSTRUCTION LEND114G AGENCY) ' - j rp : - I - I hereby affirm that Cher I y o tructlon lending agency'forthe performance of the work for w_hl per it is )issued (Section 3097 Civ. C.) LP ntler's Name= Lender's'Aac ress , OWNER BUILDER DECLARATION _ 1 hereby affirm that I am exempt from the Contractor's License Law for the toIIowl ng' reason (Section 7031.5 Business and Professional Cod e: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires.the applicant for such permit ! to file a signed statement that he/she is licensed. pursuant to the provisions of .the Contractor's License Law (Chapter 9 (commencing with Section 7000) of `ivision, 3of the Business and Professions Code) or that he/she is exempt erefrom, and the basis for the alleged exemption. Any violation of Section 131.5 iby any applicant for a permit subjects the -applicant to a civil enalty of not more than five hundred dollars ($500)., > I I, as owner of the property or my.employees with wages as their sole . compensation, will do the work, and tleCstructure is not intended or offered for sale (Section 17044, Business and Professional Code: The Contractor's License .Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or'her own employees, provided that such improvements are not intended or offered for sale- If, however, the building or improvement is sold,within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rpve for the.purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 'property who . builds or improves thereon, and who contracts for such -projects with a con- Vactor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I,am exempt under Section B. & P. C. for this reason Date Owner ' I hereby certify that I have read this application and state that theabove information rrect. agree toco with all city and county or ina as antl-State la elating to building ons r ruction, antl hereby au th I e r re- t th b ti t Clarifiers Arch/Eng.. License No. Address TYPE OF PERMIT EIGRADING- ❑ FOUNDATION L-ISTRUCTURAL I ❑ TENANT ❑ ELECTRICAL' ❑ PLUMBING ❑ MECHANICAL 1:1 - PROJECT DESCRIPTION SQ. FT.' OCCUPANCY RUCTION TYPE VALUATION $ I Contractor's Nam tie Address (mailing) -�) - _ _ Drinking Fountains City License No. ' ZONE GRADING CU. YDS- ACRES I Swimming Pool w/Spa' LICENSED CONTRACTOR DECLARATION - ' y affirm thabl amaision 3 under provisions hatter 9 (commencing 1'ith - Remarks: 1 1 - - 1 n'C with section 7000) of Division 3, of tt Business and Professions C ntl s - t 1 my );tens 's in 1 and effect !.q Cicens I s - i en e 6 Date Signature I I ' PLUMBING - FEES - ' Roof Drains WORK S' C MPENSATION DECLARATION ' ereby affirm that I have a certificate of consent to s If -insure or a certificate Bar Sink ' Showers Pole Light Workers' Compensation Insurance,. or a cc Ifi ' copy ther (Section _ Backflow Preventer _ -Service Sink, Policy No. i Company Backflow Irrigation Sewer Cap I Cert ifi p�y�f(�� ereby furnished. �I I-( Certif �✓YI'��d with the city �W'dipg.xlivlSl�ry. �� Bathtubs Sewer Connection EXEMPTI6N:PR6M WORKERS' COMVt NSATION/OECLARATION (Thissection need not be completed if the permit is for -one hundred ($100) or less): i I I I certify'that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'. Compensation; Laws of California. I Date, Signature 1 I NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of ,the Labor Code, you must forthwith comply-;with'such provisions or this permit shall be deemed revoked. CONSTRUCTION LEND114G AGENCY) ' - j rp : - I - I hereby affirm that Cher I y o tructlon lending agency'forthe performance of the work for w_hl per it is )issued (Section 3097 Civ. C.) LP ntler's Name= Lender's'Aac ress , OWNER BUILDER DECLARATION _ 1 hereby affirm that I am exempt from the Contractor's License Law for the toIIowl ng' reason (Section 7031.5 Business and Professional Cod e: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires.the applicant for such permit ! to file a signed statement that he/she is licensed. pursuant to the provisions of .the Contractor's License Law (Chapter 9 (commencing with Section 7000) of `ivision, 3of the Business and Professions Code) or that he/she is exempt erefrom, and the basis for the alleged exemption. Any violation of Section 131.5 iby any applicant for a permit subjects the -applicant to a civil enalty of not more than five hundred dollars ($500)., > I I, as owner of the property or my.employees with wages as their sole . compensation, will do the work, and tleCstructure is not intended or offered for sale (Section 17044, Business and Professional Code: The Contractor's License .Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or'her own employees, provided that such improvements are not intended or offered for sale- If, however, the building or improvement is sold,within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rpve for the.purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 'property who . builds or improves thereon, and who contracts for such -projects with a con- Vactor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I,am exempt under Section B. & P. C. for this reason Date Owner ' I hereby certify that I have read this application and state that theabove information rrect. agree toco with all city and county or ina as antl-State la elating to building ons r ruction, antl hereby au th I e r re- t th b ti t Clarifiers Solar Collectors I Dishwasher 1 Solar Piping ' Drinking Fountains Solar Tank I Floor Drains Swimming Pool w/Spa' Floor Sinks Urinal Gas Service 'Outlets,— Water Closet Interceptors, - Water, Heater Kitchen Sink _ Water Service Lavatories -_ - P—Trap - - ' Roof Drains ' Pole Light Reinspection Fee $15 Issue Fee Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System El Multiple EJFirepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑100,000BTI sena Ives o is a y to en )La=oned r or y inspection pu Signor. ure Date Reinspection Fee $15 Drivers' License or SS # CMF 0865-46, rev. 4%84 White - Builtling; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor Hood or, Type l� ❑ - Canopy Type It ❑ , Refrigeration System ❑0:100,000 BTU '0100,000 Bl System Repair/Alteration , Issue Fee A.P. # , ' S Main Building: E T Front ARear C Right — K S Left Ping. Ref. # Planning,Notes: , 1425. 4%18/65 13.12 TU" Zone Accessory Building: ' Z N N G R Parking Req./Provided E. M T S. ELECTRICAL I . FEES Automatic.Washer _ _ . __ _ Transformer .❑ 15-50 KW_ Construction Pole Sub. - 1150+KW I 1 i Cooking Unit 1 , Meter 0 u to 100 amps Dishwasher I Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan' ;Motors ❑0-1HP❑1X-i8 ' F.A.U. I Inc. Solar 09-15 HP 016-15+ Fixtures _ _ - _ Microwave 7 Device Boxes' Pole Light Outlets Range - Switches Sign ' 1 - Garbage Disposal Standing' Sections Generator 065 KW 05-15 KW Trash Compactor j ' , I $ 3 Reinspection Fee $15 Issue Fee - $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date ' Building Approved By Date�_.�__/�_��/� Application Issued By D te_ - 7 _ - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK .25% t SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ -ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ ,TOTAL FEE $ $1' % - 7 5� e0L22. 1 $ 3i CONSTRUCTION AND PLANNING '., APPROVALS Permit-# - Date Inspector FOLSPA- APPROVALS -- Permit# Date Inspector 1.Temporary Electrical Service or Pole 52. Pool & Equipment• Location ' 2. Soil Pipe-Undrgrnd. - - .53. Steel Reinforcement 23. 'Electrical Conduit.Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uncirgrnd.` 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. ' c 8. Foundation 59. ;Gas Pipe, 0 Undrgrnd., Test _ :9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System ; 61. -APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final - 12. Sewer Cap 63.-- Heater & Vent -Final _ 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. 'Electrical -Final 15. Rough Electrical -Conduit - - - 66: Solar System -Final -16.• Rough Electric Wiring - 67. Fencing & Access Approval - - 17.. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping'D Gas D Oil , 23. Gas Pipe -Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. "Dry Chemical 27. Frame and Flashing - 76. Dry Standpipe 28. Lathing &Siding - 77. FIXED SYSTEM FINAL 29" Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT, ' 31. Plaster Brown Coat ' 79. FINAL INSPECTION - 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Note • I.Z_Aj_9 f 17R..V r %T' rr,*pljZ" A6 -F: / 34. Final,Heating & Air Conditioning 6 303. 0 V mc.. L.." 35. Final Gas Pipe -Test 36. Hoodor;Canopy , 37. Final Factory Fireplace _ - `- 38. Final Plumbing' " 39. Water Service -Final 40. Gas Service -Final - 41' Solar Domestic -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 i ' �- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF.COSTA M CO d T C O, ERMIT Project Address Applicant's Mailing Ad ps Owner's Name Phon Address Arch/Eng. Lic nse o. Address i Contractor's Name t Phone ✓ Address (mailing) City License No. �. LICENSED CONTRACTOR DECLARATION { I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of th Business antl Professions CodA�apd my license ism u111tl effect. License f'y Lice 'tate Signature ORKE O LA that ENSATION DE RATION hereby affirm I have a certificate of consent to4oY r a certificate of workers' Compensation Insurance, or a certifiedeof(Section 3800,Lab. C.)/,(„�J09,,51Company ACertifie co is reby furnished, Certi}i co s fled witM1 the city B in io Date Applicant ) E%EM 10 FR MWORKERS'COMP NSAT16N ECLARATION (This section need not be completed if the permit is for one h d ($100) or les[[) LT / testify tVt In tperf&mancehI`Ve wprk t r w>11h thijA/perroit,4s issued, I uTRlY///��LL1n��iGLF��r�- f7L�a.7I NOTICE: rf/-after myking this declaration, you should beconngslAbject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that thereAs A construction lending agency for the performance of the work for whiNtlitcrit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5. Business and Professional Code: Any city or county which requires a permit,to construct, alter, improve, demolish or,repair pny structure, prior to its issuance, also requires the applicant for such permit ,tfa file a signed statement that he/she is licensed pursuant to the provisions of •.-,�e Contractor's License Law (Chapter 9 (commencing with Section 7000) of �,V.vision 3 of the Business and Professions Code) or that he/she is exempt �erefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant' to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or. my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon; and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove efor the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code; The Contractor's License law does not apply to an owner of .property who builds or improves thereon, and who contracts for such projects with a con- I tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date certify that I have read this applicaY ,n is correct. I agree to copipi% with a Drivers'.License or SS TYPE OF CONSTRUCTION Ltd!NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE.OF BLDG. Automatic Washer Construction Pole Sub. TCooking S Main Bt TYPE OF PERMIT ❑ GRADING FOUNDATION STRUCTURAL E T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear -❑ BOTHER A C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY—K' Solar Piping CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES ping. Ref. # Remarks: Planning No Bar Sink Backflow Preventer Backflow Irrigation Bathtubs = Clarifiers .. Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO,# Heati System & Ducting Ln'S100,000 BTU ❑ 100,000 BTi Reinspection Fee 1 $15 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 3597- 7/06/8,: Zone Accessory Building: Parking Req./Provided B.00 TLr Z O N I N G R E Q M T S. Showers ELECTRICAL FEES Service Sink Automatic Washer Construction Pole Sub. TCooking - Transformer ❑ 15-50 KW - ❑ 50+ KW Sewer Ca P Sewer Connection Unit Meter Cup to 100 amps Solar Collectors _ Dishwasher Meter ❑over 100 amps Solar Piping ,) Dryers ❑Gas ❑Electric Sub Panel ' Solar Tank - Fan Motors ❑0-1 HP OVA - 8 Swimming Pool w/Spa F.A.U. r Inc. Solar, ❑9-15 HP 1116.15+ Urinal Fixtures Microwave _ Water. Closet Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Garbage Disposal Standing Sections • Generator 11015 KW 115-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee, $ 3 1ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By '� Date_ Hood or Type ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU E1100,000BTU SUMMARY BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL 71 Q PLAN CHECK 25% $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 7 System Repair/Alteration • - Issue Fee $ 3 ems. -�_ t CONSTRUCTION AND PLANNING APPROVALS Permit Date Inspector f .- &.SPA APPROVALS 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. y 54. Forms • 4: Electrical Conduit-Undrgrnd. 1 55:1Electrical Bonding 5.' Steel Reinforcement. - 56. Rough Plumbing & Pressure Test 16. ,Electrical LIFER Grnd. - 57. APPROVAL TO COVER-GUNITE ' 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation - - 59. Gas Pipe, ❑ Undrgrnd., Test .9. -Water Pipe-Undrgrnd•. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System , - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &.Receptor -Final - 12. Sewer Cap 63. Heater & Vent -Final - 13. Roof Drains - 64. Plumbing System - Final - - 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical=Conduit - - 66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling . - •69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning N� FIRE DEPT. REQUIREMENT APPROVALS Permit 4#_ - - 20. Rough Factory Fireplace 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 ❑Gas ❑Oil , 25. Roof Sheathing 74. Overhead Hydro ' 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing , 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT' 31. Plaster Brown Coat .79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: .- 34. Final Heating & Air Conditioning /O`/c/l� (QLD 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 Domestic -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 ' Apr CITY OF COSTA MESA CONSTRUCTION PERMIT ' Project Address ' 1002 Poppy Oi rcl e ' Applicant's Mailing Address Owner's Name Standard Parifir rnrp- Phone546-1161 Address' 1FfiF W Mar Arthur Oo.,gta MPGR 92626 Arch'/Eng% - License No. Address; - Contractor.'s Name New Plumbing Phones iR_1140 Address (mailing) 7102 NEPP Ana Anaphim City License No. 32$]] LICENSED CONTRACTOR DECLARATION I hereby'affirm that I am licensed under provision Charter 9 (commencing with section 7000) of Division 3 0( the Busing- an Professions Code, and my license is in full fo�ce�pU effect. 4261 0( License Class 0D se No. Date )n/1, 0/24 Signature f WORKERS'COMPENSATION DECLARATION I hereby'affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation .Insurance, or a certified copy thereof (Section 3800, Lab.pG t 1777141 Home Policy No. y1I. Company ❑ Certified copy is hereby furnished. L� C�r,(i fJ cy8y, is filed with the city B siding visi n, Dat T(Jf ��/<>4 Applicant �ew �umill ng —EXEMPTION FROM WORKERS -COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or ' less). I certify thatlin the performance of the work for which this permit is issued, I shall not employ any person in any manner so;as to become subject to the Workers' Compensation Laws of Califorpia: Date ' Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions -of the Labor Code, you must forthwith comply with! such, provisions or ,this permit shall be. deems tl revokeI CONSTRUCTION, LENDING -AGENCY, I I - d. I hereby affirm that there is a construction lending agency for the performance of the work for which, this permit ,is issued, (Section 3097 Civ. C.) Lender's Name - - - Lender's Address ' OWNER BUILDER DECLARATION - - - I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct; alter, improve, demolish or repair 'any structure, prior to -its issuance, also requires the applicant for Such permit (' to file a signed statement that.he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of -Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by. any applicant for a permit subjects the applicant -to .a civil � ' enalty •of. not more than five hundred dollars ($500).' ' I; a5 owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered . for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does Such work-himself/herself-or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- grove for the purpose of sale). .L I,'as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and.who contracts ,for such projects with a con tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section 1 B. & P. C. for this reason Date Owner - F hereby certifythatI ave read this'application' and 'state that -the above t information is correct ;I gree to comply with all city and county ordinances and state laws relatin t building construction, and hereby authorize repre. sentatives of this cit o," ntP er upon the above-mentioned property for inspection {1 nt to fill in all spaces except those within heavy border lines and sign all appropriate declarations- ERMIT-NO. TRACT NO. LOT, NO.;UNIT NO. ' ' _491 <-7L 1 TYPE OF CONSTRUCTION XE NEW U ADD -❑ ALTERATION U REPAIR SUMMARY OF FEES I BUILDING PERMIT $ SMIP $ ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - ELECTRICAL FEES A.P,+ DESCRIPTION OF WORK/USE OF. BLDG. ' -. S Maio Bui Cooking Unit _j 1 Meter ❑up to 100 amps PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ 'ENERGY, P.C.' $ l ELECTRICAL $ GRADING $q PLAN CHECK 50% $ 'MICROFILM $ .r Dishwasher Meter ❑over 100amps TYPE OF PERMIT GRADING' FOUNDATION U STRUCTURAL T Front - -❑ TENANT ❑ ELECTRICALX® PLUMBING ❑ MECHANICAL ; B F.A,U. ❑ OTHER - A Rear PROJECT DESCRIPTION SQ. FT.- I 'OCCUPANCY, C K Right CONST RUCTION'TV PE VALUATION$ '$ Left 1 ZONE ' GRADING CU.YDS. ACRES Ping. Ref. #� Remarks: 'Standing Sections I Planning Not 1 I Sink (flow Preventer - <flow Irrigation (tubs ifiers Floor Sinks+-- --- - Gas Service 6 Outlets. ' Interceptors' Kitchen Sink Levamries - .. P=Trap - i - Roof Drains " 1 i Reinspection .Fee-( $15 Duct -Under Ground Duct - Structural Duct -Ventilating_ Exhaust System ❑ Multiple ❑ Firepl/Fact 4 Bit. ICBO,+ Heating System & Ducting ' ❑0-100,000'BTU 1:1100,000 BT Signature lA, Date LU Id Drivers" License or SS I I Reinspection Fee I $15 CMF 0865-46, rev. 4/84 White - Building;Canary -Applicant;Pink - Accounting; Goldenrod - Assessor Showers Service Sink - - Sewer Cap Solar Collectors I Solar Piping' Solar Tank I - Swimming Pool w/Spa' Urinal - - I- -- .Water Closet- 1 -Water Heater 1 - ;Water Service - 1 Issue Fee- IANICAL Hood or, Type I ❑ Canopy' Type I I ❑ nen�yerauun ayssem r ❑6-100,000 BTU El 100,000 B" System Repair/Alteration Issue Fee I 0184 10/12/84 a , 5,50 Tl. I Zone' " Accessory Building: Z 0 N - J N R Parking Req./Provided E 0 1 M T S.. FEES SUMMARY OF FEES I BUILDING PERMIT $ SMIP $ ' - ELECTRICAL FEES ' Automatic Washer,, — Co'nstruction Pole Sub. - Transformer ❑ 15-50 KW - ❑ 50+KIN Cooking Unit _j 1 Meter ❑up to 100 amps PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ 'ENERGY, P.C.' $ l ELECTRICAL $ GRADING $q PLAN CHECK 50% $ 'MICROFILM $ .r Dishwasher Meter ❑over 100amps • Dryers ❑Gas, ❑Electric Sub,Panel ' Fan Motors 1:10-1 HP ❑l1/ = 8 I ' MECHANICAL, $ NOTAL FEE $ "J iSCJ F.A,U. Inc.Solar 1:19-15 HP ❑16-15+ - - Fixtures= - -- - Microwave - - - - 2 50 Device Boxes , Pole Light •- Outlets Range ' ' Switches Sign ' Garbage Disposal 'Standing Sections I ' Generator ❑0-5 KW 05-15 KW Trash Compactor _ S_3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS; I Zoning Approved By Date Building Approved By Date Application Issued By Date_l J I v ' SUMMARY OF FEES I BUILDING PERMIT $ SMIP $ ' PLAN CHECK $� PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ 'ENERGY, P.C.' $ l ELECTRICAL $ GRADING $q PLAN CHECK 50% $ 'MICROFILM $ .r ' MECHANICAL, $ NOTAL FEE $ "J iSCJ $ 3 PLAN CHECK '25% $ ,.- CONSTRUCTION AND PLANNING APPROVALS- Permit#- ,. _ Date Inspector POOL & SPA - ,APPROVALS. 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 1 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding -tea n 5. Steel Reinforcement . - 56. Rough Plumbing & Pressure Test' -' + . .0 6. Electrical UFER-Grnd. � 57: APPROVAL TO COVER.GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. V 8. Foundation 59. Gas Pipe, aUndrgrrid., Test 9. Water Pipe-Undrgrnd.4 160: Backwash Lines, P-Trap, 13Undrgrnd. - SS 10. Structural Floor System + - 61. APPROVAL TO DECK - 77. 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 - r. 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. POOVSPA SYSTEMS FINAL 19.-Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT' APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure J0: 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 ON 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76: Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29.. Insulation - '78. FIRE PREV. FINAL 30.,Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - -' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning, „ 35. Final Gas Pipe-Test 36. Hood or Canopy - - 37. Final Factory Fireplace 38. Final Plumbing (� jl`( LfO. - - 39. Water Service-Final- 40. Gas Service-Final 41. Solar Domestic-Final ' 42. Backflow Preventer ' lL 43. Backflow Irrigatiori _�•-:r.+:-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 0D •,r, 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. f.1TYOF COSTA MESA C01UTRUCTION PERMIT Project Address AO Applicant's Mailing Address Owner's Name.,.,[Phone Address 6,s—L+✓ Arch/Eng. - �G-�_/�4-License No. Address Contractor's Nam/p/1 7 Pho Address (mailing) V 1 City License No. ' LICENSED CONTRACTOR DECLARATION I hereby.affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in ful Lfprce effect. _ License r/�1-- ass CC�` � 'c rise o. Date s+" 'ignature WORKERS' COMPENSATION DECLARATION r 1 hereby affirm that 1 have a certificate of consent to self -insure or a certificate of Workers' Compensation- Insurance, or a certified copy thereof (Section 3800, Lab. C. �- Policy No. (�-� Company sF..II �CT 9Q ertifled copy is hereb furnished. IFfCertif tl co is f" d ith the city R Ing iv' Date Applicant EXEMPTION FROM WORKERS' COMPEN TIOND CLARATION (Th is section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. , Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit 1 shall be deemed revoked. CONSTRUCTION LENDING 'AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for. which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure iS.not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of "a property who builds or improves thereon, and who does Such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. JTe for the purpose of sale). LI I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's. License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rear information is correct. I agree to Drivers' License or SS # TYPE OF CONSTRUCTION , LJ NEW U ADD LJ ALTERATION IJ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SG. FT. OCCUPANCY— CON STRUCTIONTYPE VALUATION$ ZONE GRADING CU.YDS. ACRES Re REPAIR A.P. # S Main Building: E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: 3022 6/27/84 Zone Accessory Building: Parking Req./Provided. 86.85 TL Z O N 1 N G R E Q M T • PLUMBING' FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer - Service Sink Automatic Washer Construction Pole Suh. Transformer ❑ 15-50 KIN ❑ 50+ KW • Backflow irri ation Sewer Ca 1 9 P Bathtubs Sewer Connection '_ ^• Cooking Unit Meter ❑up to 100 amps / Clarifiers _ _ Solar Collectors I -/ Dishwasher _ - Meter CL}over 100 amps Dishwasher Solar Piping :Dryers ❑Gas ❑Electric Sub Panel D rinking Fountains Solar Tank f F' - ! Fan Motors 00-1 HP �'/z-8 t Floor Drains Swimming Pool w/Spa - F.A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal - - Fixtures Microwave - ' Gj Gas Service Outlets Water Closet Device Boxes ! Pole Light 5 Interceptors; Water Heater. Outlets Range Kitchen Sink Water Service 3 Switches Sign Lavatories / Garbage Disposal Standing Sections P -Trap - - _ Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains L I Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 - - MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date ' Building Approved By Date Application Issued By Dat Z{o Boiler Hood or Type ❑ Canopy Type II ❑ Duct -Under Ground - Duct - Structural Duct - Ventilating Refrigeration System ❑0-100,000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK - PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ 'ISSUANCE $ $ ENERGY P.C. $ $ r GRADING $ $ r MICROFILM $ $ TOTALFEE $ rJSO "' $ Exhaust System ❑ Multiple ❑ System Repair/Alteration I _ Firepl/Fact. Bit, ICBG# Heating System & Ducting El 0-100,000 BTU ❑100,000 BT Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor '.� CONSTRUCTION AND PLANNING " APPROVALS Permit # Date Inspector POG _. -a SPA , APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - - -- 2. Soil Pipe-Undrgrnd.._- 53. Steel Reinforcement - 3.�Eleitcical Conduit Utility-Undrgrnd. • - 54. Forms - 4. Electrical Conduit-Undrgmd. 55. Electrical Bonding - 5. Steel. Reinforcement' . 56. Rough Plumbing & Pressure Test 6. Electrical UF,ER Grnd. 57. APPROVAL TO COVER,-GUNITE 7. Footings , - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59.. Gas Pipe, 0 Undrgrnd., Test ,- 9. Water Pipe-Undrgrnd.: 60. Backwash Lines, P -Trap, 0 Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ;� 62. Backwash & Receptor -Final 12. Sewer Cap 63.. Heater & Vent -Final - 13. Roof Drains 64. Plumbing System - Final 14. -Rough Plumbing - 65.- Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 7 �o 'L_ 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 APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test - 72. Underground Flush -24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding. 77. FIXED SYSTEM FINAL 29. Insulation - 78: FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric .Notes: 34. Final Heating & Air Conditioning i Li - 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 Domestic -Final 42. Backflow Preventer - I 43. Back Ilow,lrrigation. 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 r �' kA 11 V Jim Jordan General CanWdor ([1111 9 3 9 0 9 Serving Orange County for 30 years 714/556-3036 I dreambuildersOC.enm BA�m��can Dream - �t