HomeMy WebLinkAbout1026 POPPY CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address:
1026 POPPY Cl
Status: ISSUED
Suite No
Applied: 02/06/2002
Issued: 02/06/2002
Vicinity:
Parcel Number:
41237307
ISSUED BY:
Applicant:
BROWN, BARBARA/,,,,'
Address:
3801 LENAWEE AVE =
-
X"
Phone:
\
(310) 253-5229
CULVER'CITY, CA -
_ Zip:
90232
X
Owner: ',DIAMOND,
MARKS
Address:
1026 POPPY CIR
-
Phone:
- -
COSTA MESA, CA -
Zip:
92626-1673
Contractor: '
GEORGE BRAZIL PLUMBING, HTG.
- Address:
,3801 LENAWEEAVE���
Phone:
(310)253-5229
CULVER CITY, CA
Zip:
90232
'
License:
679898
SCOPE OF PERMIT
_
-
CHANGE OUT OF FAU < 100.K BTU.
FEE SUMMARY
Quantity
=
Quantity
ISSUE FEE
$23.50
ti
Repair / Alt Absorbtion Unit
i, $0.00
10
Inst FAU <100 k BTU
$14.80 -1_
Repair / Alt Refrigeration'Unit
,� $0.00
0 '
Inst FAU.>100 k BTU
$0.00 _0'
_
- -
Ventillation System
ri $0.00
- 0
Repair/ All Cooling/Heat $0.00 0
Evaporative Cooler
; / $0.00.
-0
Inst/ -Rep. Recess Wall
Htr $0.00 0
Commercial Incinerator
-�,� $0.00
0 ,
Refrig Sys <100 k BTU
$0.00 0
Domestic Incinerator - .;/,
$0.00
0
Refrig Sys >100 k BTU
$0.00 0
Compressors / Absorption Systems
r "
Gas Piping
$0.00 0
Up to 3 hp 1100 k BTU$0.00)
01
Factory Fireplace
$0.00 0_
3 To 15 hp/500k BTU , ;%j
`\ $0.00
, 0 ;
Hood w/Mech Exhaust
$0.00 0
15 To 30 hp 11,000 k BTU i .• :
$0.00
01`
'0
VAV Boz
$0.00 0 -
-
30 To 50 hio /_1,750 k BTU �: %�
_ - $0.00,
Vent Fan / Single Duct,
`��> $0 00.-_-0 :: ,
Over 50 hp770ver;1 750�BTU ;i �
.- $0.00 "
/0
Appliance. �.
$0.00 0.
- Boilers
Fire Dampers-�$0.00,�
- 0 :.-Up
to 3 hp - '� -��
$0.00
0
Smoke Dampers ` "
$0.00_; 0
3 To 15 hp "�
$0.00
0
Inst or Relocate Appl Vent - $0.00 0 -
15 to 30 hp - _ -
$0.00
0
Air Handlers < 10000cfm. $0.00 0 -
30 to 50 hp
, " x$0.00
0
Air Handlers > 10000cfm " $0.00 0
Over 50 hp
$0.00
0
Floor Furnace
$0.00 0
Other Mechanical Fee "
Floor or Suspend Heater $0.00 0
Investigation Fee
$0.00
Plan Check Fee
$0.00
Reinspection Fee
$0.00
i
.� TOTAL CALCULATED FEES
$38.30
COMMENTS I SPECIAL CONDITIONS
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
2446-46161001
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 Code, for the performance of the work for which this permit is Issued.
My workers' camp nsation Insurance carrier and policy number are:
Carrier: C• L. / 1 Poli Number:
(This sectio�be m late if the permit is valued at one hundred dollars ($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'
Z
n laws of C forms, and agree that it I sh tl become sub re', ct to the workers' comp §§§LLLsation\provisions of Socin 3700 1 the Labor Code, I shall forthwith
o�mpl wjth.t se pr isi ns. J _ /9
Date: �— o / l� 7
WA LURE TO CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMi PENH ES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($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 here rm th I am licensed under provisions of Cha ler 9 (commencing with Section 7000) of Division 3 oft iness antl Professions Code, and my license is in full
for an . LIc. # G ' C as #
Cont actors S gnature: D
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).
Lenders Name: Lenders 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 contractors 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 pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's 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, 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? ❑ 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.
..................................................... ................ ... ........................................ ........... ......-............................................................................................................... ............. .................... -.......................... ........................................... ..................................
d If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
........................................_..................................................................................................................................................................................................................................................................................................................................................
5 Does or w111 the applicant or present or future building occupant require for the work which is the subject of this a plication apemlit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 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 It 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 (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. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
% /tgnature Olyer(s) 71,
Date
(l� 'AnWOr Aefforized Ap an ejIs
CODE f. INSPECTION TYPE 2AN INTRIALS CODE If INSPECTION TYPE^ g9g�I� INTrrIAL
1616 Fixed System Final Fire Prevention 206 Final Mechanical 21 - CSA_
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final BlocWRetaining 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
- a Applicant
to fill in all spaces except.those withinheavy h d r lines and sign all appropriate declarations.
Solar Piping - -' i-- - -
p
-CITY OF COSTA MESA - PLAN -3 'El eV: BR' -
�kgl%STRUCTION PERMITLOT .23._
'
PERMIT NO. `
i i.��.:. ' -
TRACT NO:'
/y0ll ;
-LOT NO.
Project Address- 1925 Poppy-Urc]es'BO sta Mesa - j',
Applicant's Mailing Address t
TYPE OF CONSTRUCTION. U NEW LJ ADD ' ALTERATION- LJ REPAIR
❑
• CONVERSION ❑ DEMOLISH 1:1 OTHER _ (
A,P. # 412
.lewd DerifiG_' tr4 - Phone
Owner's NameStd1l.��.� �_�.}.
Address SGri••' '_ -
Arch/Eng.,-A;a„rsfStreeter License No. 2598.3
Address' A 7981 . 61ty—Rarl� 6i rel a IrYi ne
s�
Contractor' am = ' Phone'
.� .Bee 01mer _ ..
Address (mailing) i
DESC RIPTION OF WORK
- I
•
S'
Main Building: '
'.'TYPE OF PERMIT- 'GRADING' FOUNDATION; STRUCTURAL
❑'TENANT ❑ELECTRICAL ❑PLUMBING'❑MECHANICAL -
❑ OTHER , " •. , - -
_
• PROJECT DESCRIPTION SQ. FT. ?S0& - OCCUPANCY -
'
CONSTRUCTION TYPE 'VAL UATION$TA4 .G 1_r_s9 0
T'
Front-2ZY'
B
A
Rear, -2./l
C
Right .. �
K
S
Left /
Ping. Ref. # Q
ZG !3_
L3 p
City -License No.
LICENSED CONTRACTOR DECLARATION - l ' '
ZONE GRADING CU.YDS. :ACRES '
Remarks:- ' ,�'
-
Parking•Req./Provided
'
I•hereby affirm that I am licensed under provisions of-Charter.gr(commencing
with section 7000) of Division 3 Of the Business and Professions Code, and
MY license is in full orae and effect:
�- I - 248042
License Class ns
Date i1`2' 1F-S2Q Signature
1RKERS' COMPENSATION DECLARATION, _ 1
i l
/
Use of Building: 17 (t
o- ' PLUMBING - FEES
l
Planning Notes:
g l
Bar.Sink ' Showers
i nd��
Backflow Preventer Service Sink _
--i - - - -
,
areby affirm that I have a certificate of consent to self -insure or a certificate
Workers' Compensation- Insurance, or a certifledicopy thereof (Section
3800, Lab. c. I
Policy No. W�-84-225-856' company Fremont Indemnity
BCertified copy is hereby furnished. I
Certified cop is filed with the'city Build! Divisi n.
Date 17_1 �,-A7-R"i Applicant StanTarN �a Cific -'
, Backflow Irrigation Sewer Cap
-.-
Bathtubs -' Sewer Connection' -_• -, 1,
'Automatic Washer
, , Y. ,'� ,
Clarifiers I Solar Collectors. •" ,*'
Construction Pole Sl
5.70 3/01/SLi S44ea6 ti
_ y Zone - Accessory Building:. - -
EXEMPTION FROM WORKERS COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) Or
Dishwasher -
Solar Piping - -' i-- - -
p
' 'Cookin Unit ,
g
less). .• ' t
I certify that in the performance the work for which this permit is issued, I
- Drinking Fountains
9
Y
Solar Tank - ��
'Dishwasher '
n
shall not employ any person in any manner so as t0 become subject to the
Workers' Compensation' laws of California, j
FI00r Drains,
-
Swimming Pgol'w/Spa ° I
'
'
Dryers ❑Gas, ❑Electric
Date Signature
$
I -
Lender's Name -
NOTICE: If,'after making this declaration, you should become subject to the
Floor Sinks j ;
Urinal-
Fan I
Workers' Compensation provisions oftheLabor Code, you must 'forthwith
$.'
GRADING
- - - - --
comply with such provisions or .this, permit shall be deemed revoked.,.
Gas Service 1 Outlets I
Water Closet
F.A.U. '
,CONST R UCTION, LENDING. AGENCY
SUMMARY OF FEES
�•� BUILDING PERMIT
I hereby affirm that there is a, construction lending agency for the performance
Interceptors -
Water Heater
PLAN CHECK
Fixtures '
of the ;work for which' this permit! is issued•._(Section 3097 Civ. C.)
_
_
_
$
I -
Lender's Name -
Kitchen Sink
Water Service
ENERGY P.C.
,De"vice Boxes '
Lender's Adtlress
$.'
GRADING
$
" PLAN CHECK
OWNERBUILDER DECLARATION-
,Lavatories
$
' MECHANICAL
Outlets
I hereby affirm that I am exempt from the' Contractor's, Lice rise Law for the
p -Train' '
PLAN CHECK
$
following reason (Section 7031.5 Business and -Professional Code: Any city or
county which requires a permit -to construct,alter, improve, demolish.or repair'
in'
Switches'
'any structure; prior to Its,issuance, also requires the applicant.for such permit
lRoofDrains•
Garbage Disposal '
:Preirom and the basis toy the alleged exemption. Any, violation of Section ,
31.5 by any applicant for -a{ subjects the applicant -to a civil
;penalty of not more than five hundred dollars ($500). ! _ I
LJ I, as'owner of the. property or, *my employees with wagesl 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 0who'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-.
potion, the owner will have the burden of proving he/she did not build or im-
Erove,for the purpose of sale). r (
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 toan owner of.property who
builds or improves thereon, and who contracts for such projects with a con- '
tractor(s) license pursuant to'the Contractors License Law).
❑ I am exempt under Section B. & P. C. for this reason
Date Owner
I herebv'rertifv that I have read this aoolication and ctnte that the above
Drivers' License or SS
'CMF 0865-46 rev. 7/83
l ` ,
(.Reinspection -Fee I S25'
Boiler
Duct- Under Ground
Duct -Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bh. ICBG #
Heating System & Ducting
00-100,000 BTU 1:1100,000 BTL
, I I Reinspection Fee
Building; CanaryApplicantl Pink - Accounting; Goldenrod -Assessor
$25
r Issue Fee
IANICAL - FEES
Hood or Type I ❑ , _
Canopy Type I I ❑
tefrigeration System
110-1100,000 BTU 12 100,000 BTU
System Repair/Alteration
Issue Fee I $ 3
Generator 710.5
7.6 11 1 Park.Fees
ELECTRICAL•'y
Transformer ❑ 15-50'KW '•
❑ 50:, Kw
Meter, ❑up to 100'amps --
Meter ❑over 100 amps
iSub Panel I I t
_
Motors 00-1 HP❑1%-8 '
I Inc. Solar•❑9-15 HP El 16-15+
Pole Light
I Sign
Standing Sections
❑5.15 KW -Trash Compactor
l r 1
$25 1 ,Issue Fee
PUBLIC SERVICES REOUI
Zan. .9'Approved By—
Application Approved By _
Application Issued B
Y
Z
O
N
1
N
G
R
E
D
U
I'
R
E
M
E
®M
_■
®E
®■
EM
ME
M■
ME
ME
_■
M■
MEN ME
'
SUMMARY OF FEES
�•� BUILDING PERMIT
$
rar, Sri_SMIP
_
$ ' 1 12
PLAN CHECK
$
ri PERMIT
' PLUMBING
$
ISSUANCE
$
' PLAN CHECK
$
ENERGY P.C.
$
ELECTRICAL
$.'
GRADING
$
" PLAN CHECK
$'
MICROFILM
n
$
' MECHANICAL
$
- TOTAL FEE
$ 64.4_26_
PLAN CHECK
$
CONSTRUCTION AND PLANNING -
oAPPROVALS ' Permit # "- Date
Inspector
.. - PO/ SPA.
APPROVALS Permit #
Date -
-
Inspector
..1. Temporary Electrical .Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - -
53. Steel Reinforcement `t -'-
3. Electrical Conduit Utility-Undrgrnd.
54. Forms -
4. Electrical Conduit=Undrgrnd.-
r
55. Electrical Bonding '
5. Steel Reinforcement d
_
. 56. - Rough Plumbing & Pressur,e Test-
' 6: Electrical LIFER Grnd. -
57. APPROVAL TO COVER-GUNITE
7. Footings
-,
58. Electrical Conduit-Undrgrnd.
8: Foundation _
L 7
59. Gas Pipe, O Undrgrnd.; Test•,
9. Water Pipe-Undrgrnd., ..
60. -Backwash Lines, P -Trap, 0 Undrgrnd.
10, Structural Floor System
, 61, APPROVAL -.TO DECK
s
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 �1
71. Product Piping EJ Gas 0Oil
23. Gas Pipe -Rough & Test ,IZ-
V,/,
72. Underground Flush
24. Roof Framing
c
73. Undergrnd.Storage Tank 0Gas 00il
25. Roof Sheathing
74. Overhead Hydro ,
26. T -Bar Ceiling (Structural) & Monocoat
- _
75. Dry Chemical
,. X27'. Frame and'Flashing V
1 I
76. Dry Standpipe
28. Lathing &Siding - -,
''�r
(���
77. FIXED SYSTEM FINAL _
29. Insulation
I.�'{ b�
G
78. FIRE PREY. FINAL
30. Drywall Nailing,
D -f /
�/�.-
HEALTH DEPT. REQUIREMENT
' 31. Plaster Brown Coat
f'�T
vi
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 -F i replace'
38. Fin,alPlumbing
39. Water Service -Final -, 'f
- -
40. Gas Service -Final
- -
41. Solaf Domestic-Final'T -
_'� •, ,
42. Backflow Preventer
43. Backflow Irrigation
44. ,Landscape Irrigation System
45. Sound. Attenuation
46. Handicap Regulations
47. FIN'AL'STRUCTURE&BUILDING1.
48. Special Requirements Completed
l912
-
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 ex. tFos it in� y bortler es antl sign all appropriate declarations.
/.-
Cl YOF-COSTA MES S9 C/fQJNSTRIT,
Project Address
Applicant's Mai nnyjA,ddr _
weer's ,Ni�amD�Ph�o/n. (/v!
Arcli/Eng. License No.
Address
Contractor's Nam o(f
(,1rJ Address( mai l i ng)
City LicenseNo.
-CONTRACTOR CONTRACTOR DECLARATION f
I hereby affirm that I am licensed under provisions of Charter.9 (commencing
(� with section 7000) of Division 3 of the Business and Profes Ions Cotle, antl
�i my license s infull Larave an a fect. ��/r /yJ 1
Clcen �v A' / r L'c!2FF� o o /
Date I 5"gnature /Z
a Lr
YORKERS' COMPENSATION DECLARATION: I '
hereby affirm that I have a certificate of consent to self -insure or a certificate
A Workers' -Qom Sensation � Insurance,tor_a certified' in of (Section
380Q Lab. fA Z;Z21/,// Company I
Polity No (G Y '
ertif ietl c py is herby furnished.
ertif" h with the C ildi�9 ��j/�r n.
ate APPlicant�/�/v/�(/��ilr•/AIT/�
EXEMP I
N,
WC RS•�CD MP EN SATION DECLARATION
(Thissection need not be completed if the permit is for one hundred ($100) or
less).r
I certifyrthat in the performance of the work for which this permit is issued, I
'hall' not employ any person in any manner so as to become subject to the
Workers' Compensation' Laws of California.
Date k Signature -
NOTICE: If, after making this declaration, you should become subject to the
Workers', Compensation provisions oftheLabor 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
ofthe ,work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name. -
Lender's Ad&ess
OWNER BUILDER DECLARATION
I hereby affirm -that I am exempt from the Contractor's License Law for the
following reason (Section7031.5 Business and Professional Code: Any city o,
county which requires a permit to Construct, alter, improve, demolish or repai
any structure, prior to its issuance, also requires the applicant for such permil
herefrom and the
7031.5 by any ap
penalty of not more
LJ 1, as owner of
compensation, will
for sale (Section 7
License Law does n
thereon, and who (
owner
purpose
he
builtls Or Improves tr
tractors) license ours
proof of their Worke
❑.I amiexempt under
Date
Signature
IDrivers'I License or SS $License or SS $
—CMF 0865-46, rev. 4/84
for a permit subjects the applicant to a civil
e hundred dollars ($500). '
perty Or my employees with wages as their sole
vork, and the structure is not intended or offered
Isiness rand Professional Code: The Contractor's I
.to an owner of a property who builds or improves
h work himself/herself-or through hisor her own
Ch improvements are not intended or offered for
ng -or improvement is sold within one year of com-
e the burden of proving he/she did not build or im-
frty, am exclusively contracting with licensed con -
jest (Section 7044, Business and Professions Code: .
zw does -not apply to an owner of property who
antl)who,contracts for such projects with a son-
o the Contractor's License Law). I am aware'that
�mpensation insurance should be provided to me.
in B. & P. C. for this reason
I state that -the above `
and county ordinances
rE Il NO ZTRACT
NO.
LOT NU.
UNIT N0.
TYPE OF CONSTRUCTION -NEW LJ ADD LJ ALTERATION REPAIR
q' -p, #
El CON ❑DEM LISC1H OTHER -
DESCRIPTION OF WORK/USE OF BLDG.
' - I
S
-
Main Building:' -- - Accessory Buildirig:,. -
Z
FOUNDATION 1 STRUCTURAL
TYPE OF PERMIT GRADINGt���
T
Front' - - ,L
'O
---D���//A11
1 UTENANT ❑ ELECTRICAL! L LWPLUMBING EJMECHANICAL_
B
-
N
-❑ OTHER - 7 1
A
Rear J ' c
I
K
Right
G
PROJECT DESCRIPTIONi 54. FT. ' - OCCUPANCY
CONSTRUCTION TYPE EVALUATION$
S
Left
R
Ping. Ref. # Parking Req/Provided
E
ZONE I GRADING CU. YDS. ACRES
O
Remarks:'
Planning Notes:
M
I
S.
' PLUMBING
FEES
Bai Sink 1 Showers -
I -
ELECTRICAL FEES l
' Backflow Preventer -• - - - - Service'Sink - - • --
- -
Automatic Washer '- 'Transformer ❑ 15-50 KW - -
Construction PoleSub., ❑50+KW
BackflowIrrigation Sewer Cap I
Bathtubs Sewer Connection ) ,
--
Cooking Unit Meter ❑up to 100 amps ,
Clarifiers Solar Collectors
Dishwasher Meter Dover 100 amps,
Dishwasher Solar Piping
Dryers ❑Gas•' OElectric •Sub Panel I
Drinking Fountains ' Solar Tank 1
Fan, Motors ❑0-1 HP 01 % - 8
Floor Drains Swimming Pool w/Spa,
F.A.U. Inc. Solar, 09.15 HP 016.15+
- Floor Sinks �- --- - - Urinal - -
Fixtures - - - Microwave - -- -
Gas Service Outlets -- • Water Closet - -
Device Boxes Pale Light
Outlets Range
Interceptors; - - Water Heater ;-
Kitchen Sink -Water Service
Switches Sign
Lavatories -
, -
Garhage Disposal 'Standing Sections
P -Trap 1 '
Generator 1-10-5 KW 05-15 KW 'Trash Compactor '
Roof Drains
)
Reinspection -Fee
$15 - Issue Fee I
$-3
Fee
$15 Issue Fee $ 3
- 'Reinspection
MECHANICAL
FEES
DEVELOPMENTSERVICES REDUIREMENTSk e
Boiler'
Hood or, Type 1, El
Canopy Type If El -
Zoning Approved By ' Date
I
Duct'- Under Ground
Building Approved By Date'�--77))--��--iice�
Application Issued By Dat
Duct - Structural
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
_ _
Duct - Ventilating
SUMMARY OF FEES
BUILDING PERMIT' $ SMIP $ ,
PLAN CHECK $ - PERMIT
MBING j� /'7( IS ANCE $Heating
E 5" R P. .❑0=
nE
Exhaust System ❑ Multiple ❑
-
System Repair/Alteration
ICED
,
Heating System &Ducting
100,000 BTU❑100,000BT
L $ ' GR N
-
- '-
I
PLANICHECK 50% $ MICROFILM ; $
r
•
MECHANICAL $ kTOTAL FEE $
Reinspection Fee
•$15'
Issue Fee
;$ 3l
PLAN CHECK 125% $ I
White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor
i" CONSTRUCTION AND PLANNINGPot.
�'APPROVALS Permit#
Date
Inspector
a SPA
APPROVALS Permit
-
Date
Inspector
1. Temporary Electrical Service or Pole;
-
52. Pool & Equipment Location
2. Soil Pipe ,Undrgrnd.
. '
53. Steel Reinforcement
"Q -•
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
• �•
4. Electrical Conduit-Undrgrnd.: i
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. ElectricaljUFER Grnd,:, _
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
-
,' 8. Foundation ! i'
59. Gas Pipe, O Undrgrnd., Test
,
♦i
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 I
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 0Gas 0Oil
.
23. 'Gas Pipe -Rough & Test -
72. Underground Flush
-
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
25. Roof Sheathing -
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical ,
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
• 29. Insulation
78. FIRE PREV. FINAL
30.Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION '
32. Electrical Power Meter -Final
,•
80.E FOOD CERTIFICATE ISSUED
' 33. Final Electric
Notes: --
34. Final Heating & Air Conditioning
'
35. Final Gas Pipe -Test
UW
36. Hood or Canopy
-
37. Final Factory Fireplace
_
38. Final Plumbing
fQJOM�
L
-
39. Water Service -Final
-
40. Gas Service -Final
41. Solar Domestic -Final
'
42. Backflow Preventer
43. Back flow.lrrigation
44. ,Landscape Irrigation System
7.
45. Sound Attenuation,;
'
46. Handicap Regulations .
c-'
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
P'`' : Applicant to fill In all spaces except those within heavy border lines and sign all appropriate d
3 CIT STA MESA
CONSTRUCTION PERMIT PERMI I Nu., ' TRACT NO. LOT NO. JI_DG M1TCT
Projekt Address_ - ? TYPE OF CONSTRUCTION : NEw ADD ALTERATION REPA
Applicant's Mailing Add fess:; _ '❑ CONVERSION . ❑ DEM LISH ❑ OTHER '
�4� 11� + ,DESCRIPTION OF WORK
Owner's Nem R '' _ Pnn
Address `�/'l
- TYPE OF. PERMIT GRADIN FOUNDATION-STRVCTU RAL
Arch/Eng.' License No.l❑'TENANT 11ELECTRICAL PLUMBING ❑ MECHANICAL +
Addrissl.' ❑ BOTHER "
Contractor's Nam _ on&)!2 PROJECT DESCRIPTION SQ' FT. OCCUPANCY
Address'(mailing)
i CONSTRUCTION TYPE VALUATION $
rn� C.
City License No. Z_l$ `� ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Remarks:
Showers a
' -"Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
' Water Heater, -
Water Service
I , _
1 _
S251 Issue Fee
Hood or Type l ❑
Canopy Type 11: ❑ . I
Refrigeration System
1:10-100,00OBTU ❑100,000 BTU
❑ System Repair/Alteration
$25 I Issue Fee i
ciarations.._.,,
5763 3/09/84 i - C 40:`'50 TL
S MaimRwidma _ - - Accessory Buildina:' _ - Z
E
T . Front
ARear - - -
C Right -•
— IK
S: Left '
,Ping. Ref. # ' Park.Fees $
Parking Req./Provided -
Use of Building:
Planning Notes: '
Automatic Washer',
Construction Pole:
Cooking Unit
Dishwasher
Fan
F.A.U.
Fixtures
Device Boxes f
- t
a
ELECTRICAL
Transformer ❑ 15-50 KW
b ❑ 50+KIN
Meter 06pto•100amps
Meter Cover 100 amps
lectric Sub Panel i
-- , Motors ❑0-1 HP❑1%-8
Inc. Solan ❑9-15 HP. ❑ 16-15+'
I�
s
N
G
R
E
Q
u
R
E
M
E
N
T
S
FEES
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
Outlets
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is In full orce and effe t.
License Class O Lican No.�9_
Switches
Sign
rate signature4'
7RKERV COMPENSATION DECLARATION '
Bar Sink
Backflow Preventer -
Garbage Disposal ,
.ereby affirm that I have a certificate of consent to self-insure.or a certificate
ef Workers' Compensation Insurance, or a certified cop thereof (Seetion,-
Backflow Irrigation
3800, Lab, y� 5-I �q ��
Policy No. Ci V Companik�OXp��J •t
Bathtubs
Generator 00-5 KW 05-15 KW .Trash Compactor
Certified copy Isherebyfurnlsfied.
$ 3'
or fl d c s lied with the city f� ulldl Q&ftiSion,
ate Applicant T-� sv us /f —>—✓�
_ Clarif lets
EXEMPT IO�RKERS' COMPENSATION DECLARATION
(This section need not be completed If the permit Is for one hundred ($100) Or
less). - ''
a performance n the work for which this permit is Issued 1
I certify that I employ
shall not employ any person In any manner so as -to become subject to the
Dishwasher
Drinking Fountains
9
Floor Drains
Reinspection Fee
Workers' Compensation. Laws of California.
$25 Issue Fee :
Date Signature
Floor Sinks
NOTICE: Itom er this you should became subject to the'
Compensation provisions o/ the Labor Code, you must forthwith
Workers' Com sensori ions f the
Gas Service -Outlet:
comply with such provisions .or•this permlt'shall be'deemed -revoketl.,
pr
'
' BUILDING PERMIT
PLAN CHECK
- PLUMBING
PLAN CHECK 25%$
ELECTRICAL i
PLAN CHECK 50%
r MECHANICAL
PLAN CHECK 25%
CONSTRUCTION LENDING AGENCY
_
Interceptors I
'
$ '
t
$
$ '
1$ '
$ '
$
I hereby affirm that there Is a construction Sending agency for the performance
of the work for which- this permit is issued (Section 3097 Civ. CJ
.
� KitchenSink-
Lender's Name. - _
Lender's Address
OWNER BUILDER DECLARATION -
- '
Lavatories
-
I hereby affirm that I am exempt from the;Contractor's License Law for the
following reason (Section 7031.51Business antl 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
'•� file a.signed statement that he/she Is licensed pursuant to the provisions of
P.—Trap.
p,
Roof Drains
-
Contractor's License Law (Chapter 9 (commencing with Section 7000) of
a',elsion 3 o the Business and Professions Cotle) or, that 'he/she -is exempt
"Pmption"An
efrom' and the basis for the alleged violation of Section
"1131.5 by any applicant fora•permit-subjects the•applicant to a civil
r] enalty of not more than five hundred dollars ($500): 1 -
Reinspection Fee
Pe
I, as, owner of the property or my employees with wages as their sole l
compensation willdo 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 toanowner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
Boiler
-
Duct-'Under,Ground
,
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.wlll have the burden of proving he/she did not build or im-
rove for the purpose of sale).
Duct -Structural
'� 1; as owner of the property, am exclusively contracting withdlcensed con-
tractors to.construct the project (Sectlon.7044„Business and Professions Cotle:_...
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-
Duct,- Ventilating
Exhaust System El Multi
tractor(s) license pursuant to the Contractor's License Law).
❑ 'I am exempt under Section B. & P. O. for this reason ,
1
Firepl/Fact. Bit. ICBO 416
Dateowner; -
Heating System & Ducting
I hereby certify that I -have read thii application and state that the above
Information is correct. I agree to comply with all city and county ordinances
and -state laws relating to building cc nstructl o n, and hereby authorize repre-
sentatives of, this city. to enter upon the above-mentioned pr, pantry
- inspection po5 ,
❑0.100,000.BTU ❑100,C
' -
Reinspection Fee
Sspectio i Date <–
��i--`—
- . Drivers' License or'SS #
' CMF 0865-46 rev. 12/83 - Applicant;Pink - Accounting;
Goldenrod - Assessor
Showers a
' -"Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
' Water Heater, -
Water Service
I , _
1 _
S251 Issue Fee
Hood or Type l ❑
Canopy Type 11: ❑ . I
Refrigeration System
1:10-100,00OBTU ❑100,000 BTU
❑ System Repair/Alteration
$25 I Issue Fee i
ciarations.._.,,
5763 3/09/84 i - C 40:`'50 TL
S MaimRwidma _ - - Accessory Buildina:' _ - Z
E
T . Front
ARear - - -
C Right -•
— IK
S: Left '
,Ping. Ref. # ' Park.Fees $
Parking Req./Provided -
Use of Building:
Planning Notes: '
Automatic Washer',
Construction Pole:
Cooking Unit
Dishwasher
Fan
F.A.U.
Fixtures
Device Boxes f
- t
a
ELECTRICAL
Transformer ❑ 15-50 KW
b ❑ 50+KIN
Meter 06pto•100amps
Meter Cover 100 amps
lectric Sub Panel i
-- , Motors ❑0-1 HP❑1%-8
Inc. Solan ❑9-15 HP. ❑ 16-15+'
I�
s
N
G
R
E
Q
u
R
E
M
E
N
T
S
FEES
Outlets
,Range
Switches
Sign
'
Garbage Disposal ,
'Standing Sections
-
Generator 00-5 KW 05-15 KW .Trash Compactor
$ 3'
Reinspection Fee
$25 Issue Fee :
$ 3 '
FEES.
PUBLICSERVICES REQUIREMENTS: •' , '
Zoning Approved By I Date
I
• Building Approved ByDate
Application Issued By ✓ l Dat
'
' BUILDING PERMIT
PLAN CHECK
- PLUMBING
PLAN CHECK 25%$
ELECTRICAL i
PLAN CHECK 50%
r MECHANICAL
PLAN CHECK 25%
;$
'$
$
L
'$
$
'$
$
SUMMARY OF FEES
SMIP
PERMIT
ISSUANCE
-2570 ENERGY P.C.
f GRADING
MICROFILM
' I -
TOTALFEE
'
$ '
t
$
$ '
1$ '
$ '
$
' -
$ 3
CONSTRUCTION AND PLANNING 1'
Date +
Inspector-
_ - - _POC SPA - " :
- t
"'
5"APR,ROVALS _ Permit #
- -
"APPROVALS Permit #
Date
> ;
.Inspector
Y. Temporary -Electrical Service or Pole
52., Pool & Equipment'Location
r
+. 2_ it Pipe-Undrgrnd. _/y',
53.. Steel Reinforcement
32 Electrical Conduif Utility-Undrgrnd.l
54.• Forms
4,:Electrical,Conduit-Undrgrnd: �,; -
•'
55.=ElectricalBonding`
. , ,
-
- r-`
5" Steel Reinforcement-
56. Rough Plumbing & Pressure Test
e.'1
6.'Electrical'6FERGrntl'J`V -
57:- APPROVAL TOCOVER-GUNITE,-
_ U
•7. Footings: 1
-
58' Electrical Conduit-Undrgrnd == *;
-
1
8. Foundation
59. Gas Pipe, `O;Undrgrnd., Test
+ !
!' •` -
;9. Water 'Pipe, Undrgrnd.
_3/u jt(�
C40
60. Backwash Lines, P -Trap, 0 Undrgrnd.
_
10. Structural `Floor System
-
61. APPROVALTODECK-
11. Property Sewer Line -& House Connection
62. Backwash & Receptor -Final'
12. Sewer Cap
63. Heaier & Vent -Finals.
;} '
13. Roof Drains • '
" -
64. Plumbing.Systerr- Final
_•
:14. Rough_Plumbing n;
(Uttr4f
L,90
` 65. Electrical -Final
•115.- Rough Electrical -Conduit
-: • -
-
66. Solar System' -Final
I
_
' 16. "Rough Electric Wiring-
_
67. Fencing &=Access Approval
- 17',Rough Wiring Sign
68. APPROVED FOR PLASTERING_'
Rough Electrical -T Bar Ceiling
-
69. POOL/SPA SYSTEMS FINAL •; ' .`
M f`:
1 J
. 118.
719. Rough Heating & Air Conditioning
-
FIRE DEPT. REQUIREMENT;, '_ . -
I �' j
•;,
APPROVALS ;Permit
20. Rough Factory Fireplace �
:
21. Ducts, in Structure
'
70.1 Underground Hydro
' + -
- 22. Ducts, Ventilating -
71. Product Piping ❑ Gas ',O Oil
D23. Gas Pipe -Rough & Test - -
--
72,; Underground Flush I --
1--�- i-
- _ •-
24. Roof Framing
73.: Undergrnd. Storage Tank O Gas 'El Oil
25. Roof -Sheathing, .�
74.! Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
-
'27. Frame and Flashing ,
76., Dry Standpipe , -
i •'. 7
I '
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
No_te_s:
34. FinahHeating &'Air�Conditioning
- - -•'- - - _ --'
35. Final Gas Pipe -Test'
(p �'•(
/J ,
�- - 'K
1 _
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,t'.!t
,•
43. Backflow Irrigation
_ _ , - ' - ; Uj
44. ,Landscape Irrigation System
45. Sound Attenuation.
-
46. Handicap Regulations I
r.
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49.. Electric Release to Edison
-
)
"I - +
50. Gas Release to Southern California Gas Co
•r
.; , ,i
51. CERTIFICATE OF OCCUPANCY
No. Date
i
- - - !- -_�. •c
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
'CITY OF COSTA MESA CONSTRUCTION PERMIT
Project Address ��2' /e' e0a&_z
Applicant's Mailing Address
Owner's Name Phone
Address -
Arch/Eng. License No.
Address
Contractor's Name �� �C' Phone
Address (mailing)
City License_ No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing 1
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. { I
License Class _ License No, r
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. k Company I
e
Certified copy is hereby furnished. I
Certified copy is filed with the city Building Division.
it. 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 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-ofthe 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'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 pits 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).1
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';y
License Law does not apply to an owner of a property who builds or improv s
thereon, and who does such work himself/herself or through his or her o
employees, provided that such. improvements are not intended or offered to
sale. If, however, the building or improvement is soldlwithin one year of com-
pletion,'the owner will have the burden of proving he/she did not build or im.
drove for the purpose of sale).
LJ 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(si license pursuant to the Contractor's License Law). 1 am aware that
proof ofi their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner -
I hereby certify that I have read this application and state that 'the above
information is correct..( agree to comply with all city and county ordinances
and state laws relatin
f building construction, and hereby authorize repre-
sentatives othiso enter upon f e above-mentioned property for
inspection purpo C% c
Signature Date �� �� iT•
Drivers' nse or SS # I I Reinspection Fee
rev. 4/84 White-Building;Canary-Applicant;Pink- Accounting; Goldenrod - Assessor
1 I�02-
TYPE OF CONSTRUCTION U NEW LJ ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. —
ALTERATION LJ REPAIR
TYPE OF PERMIT GRADING ❑ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT.- - OCCUPANCY—
CONSTRUCTION TYPE VALUATION $
ZONE P 1 GRADING CU. YDS. ACRES
Bar Sink
Backflow Preventer
Backflow irrigation
Bathtubs
Clarifiers {
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks -- —
Gas Service Outlets -
Interceptors
Kitchen Sink
$15
Duct'- Under Ground .
Duct - Structural
Duct -.Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,00013T
CMF 0865-46,
$15
Showers
Service Sink -
Sewer Cap I
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa'
Urinal -
Water Closet
Water Heater
Water Service
Fee
Hood or Type I • ❑
Canopy Type 11 ❑
Refrigeration System
❑0-100,000 BTU 0100,000 B
System Repair/Alteration
Issue Fee
FEES
A.P. # - -
Zone -
S
Main Building: - -
Accessory Building: _
E
T
Front -'
-
Z
O
ARear
FEES
-
N
C
Right
Date
DataV
N
S
Left'..
1 _
G
R
Ping. Ref. #
Parking Req./Provided - -
E'
Planning Notes:
-
N7
T
S.
- ELECTRICAL FEES
$ 3
Automatic Washer
Constructior Pole Sub. 1
- Transformer ❑ 15-50 KW —,
❑50+KW
Cooking Unit
Meter ❑up to 100amps '
Dishwasher
Meter ❑over 100amps
Diyers ❑Gas ElElectric
Sub Panel
Fan
Motors ❑O-1HP❑1'/:-;R
F.A.U. 1
Inc.Solar 1:19-15 HP 016-15+
Fixtures.
Microwave - - -
Device Boxes
Pole Light
Outlets
Range
Switches -
Sign
Garbage Disposal ,
Standing Sections j
Generator 110-5 KW 05-15 KW
Trash Compactor ,
$ 3
Reinspection Fee
$15 Issue Fee
$ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By 1
•Date�--
Date
DataV
BUILDING PERMIT'
PLAN CHECK
PLUMBING
PLAN CHECK , 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$
$
$ IS -DO
$
$
$
$
$
SMTP $
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING $
MICROFILM $
TOTAL FEE $
S -O
$ 3
t. 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 `
4. Electrical Conduit-Undrgrnd. _
55. Electrical Bonding -
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
a.6. Electrical UFER Grnd. -
_
57.:APPROVALTO,COVER-GUNITE
..
,7, Footings
581 Electrical, Conduit-Undrgrnd.
't 8. "Foundation
59. Gas Pipe;_E] Undrgrnd., Test
-
9. Water Pipe-Undrgrnd.,
60. Backwash Lines, P -Trap, ❑ Undrgrnd.r.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
-'
62. Backwash Sc 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 r
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 O Gas ❑ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush"
24. Roof Framing
73. Undergrnd. Storage Tank ❑ Gas ❑ Oil
25. Roof Sheathing
-
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
-
76. Dry Standpipe
'
28. Lathing & Siding
-''
77.' FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
-
32. Electrical Power Meter -Final
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
'i�Jf7�, '[
C.F6
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
-
42. Backflow Preventer
43. Backflow,lrrigation _
44. Landscape Irrigation System
'
45. Sound Attenuation
I '
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. CERTIFICATEOF,OCCUPANCY
No. - 'Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
F COSTA MESA . CONSTRUCTION PERMIT
ept Address" 1026: Poppy 'Circle
Il_
Applicant's Mailing ABdress
Owner's Name Standard- Pacific Corp. Phone 546-1161
Address 1565 W. 'MacArthur B1Vd. 'Costa Mesa 92626
Arch/Eng. �' � License Na. I
Address - -
Contractor's Name .NpW Pl umhi ng Phone '526-1140
_ Addresslmailingl '7102'N- Fop Ana Anaheim
' City License No. 12871
T LICENSED CONTRACTOR DECLARATION
1 hereby affirm that 1 am licensed under proviso ns of harter 9 (commencing
with section 7000) of Division 3 o the Bust ss an Professions Code, and
my license is in full fo ce d effect. 4261 O9
License Class 4 - ice a No.•
Date]O/10184 - - Signature
` WORKERS' COMPENSATION DECLARATION
-` I hereby affirm that I have a certificate of consent to sell -insure or a certificate
of Workers' Compensation Insurance, -or a certified.copy ther
Policy No. Company
eof (Section
3800, Lab.PfWt-1777141 Home
-
Certified copy is hereby furnished.
Cer Ja'eqpq, r�ppq yx, iiy5 filetl with the ctty Bqi lding visi n. r
Date fU/IU/b4 Applicant :blew Oufnil]ng
EXEMPTIONFROMWORKERS' COMPENSATION DECLARATION
(This section need not be completed -if the permit is for one hundred ($300) or
less).
I certify that in the performance of the work for which this permit is issuetl, 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 Shall be deemed revoked.
CONSTRUCTION LENDING AGENCY J . - I
I hereby affirm that there is a constructionlending 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 1
I hereby affirm that I am exempt from the Contractor's License Law for the
fol lowing'ieasod (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 Iicensed,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 permitsubjects the -applicant' to a civil
coenalty of not more than five hundred dollars ($500).,
-I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure isnot intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work. In t mself/herself or through his or her Own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not butld or im.
trove for the purpose of sale). - )
LJ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to anlowner of property who
builds or improves thereon, and who 'Contracts for such projects with a -con. .
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me.
I ❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner'
1 hereby certify that I.have {eat
information is correct. I acre, to
pro
Drivers' License or SS #
TYPE OF CONSTRUCTION W,a, NEW LJ ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. —
ALTERATION LJ REPAIR
TYPE, OF PERMIT LA
ElttW.
GRADING��,,I1�� FOUNDATION U STRUCTURAL
El TENANT.' TENANELECTRICAL PLUMBING ❑ MECHANICAL
❑ OTHER - I
PROJECT DESCRIPTION SQ. FT. OCCUPANCY_
CONSTRUCTION TYPE VALUATION$
Remarks: (�
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers {
Dishwasher
Drinkinq Fountains
Floor Sinks -
Gas Service 6 ,Outlets
Interceptors
Kitchen Sink
Lavatories
P ,Trap .
Reinspection Fee
Duct - Under Ground
Duct -Structural
Duct - Ventilating
Exhaust System ❑ Mul
Firepl/Fact. Bit. ICBO #
Heating System & Ducbn
00-100,000 BTU ❑ 100
Reinspection Fee
CMF 0865-46, rev. 4/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
GRADING CU.YDS. ACRES-
-7Z I I OZ
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Tank
Swimming Pool w/Spa r
Urinal
Water Closet -
Water Heater
Water Service
$151 I 1 Issue Fee
Hood or Type ❑
Canopy Type I[ ❑
tefrigeration System
D0400,000BTU ❑100,000BTU
System Repair/Alteration
$15 I I Issue Fee
FEES
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K
S' Left
Ping`. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Su
Cooking Unit I
Dishwasher
Dryers El Gas ❑Eli
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 00 KW
0190 10/12/84 5.50
Zone
Accessory Building: t
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15'-50 KW
❑ 50+KW
Meter ❑ up to 100 amps
Meter Cover 100 amps
Motors 00.1 HP ❑l Y/ - 8
Inc. Solar ❑9-15 HP.016-15+
Microwave
Pole Light
Range
Sign
Standing Sections I
5-15 KW Trash Compactor
$ 3
Reinspection Fee $15 Issue Fee
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Analicxtion Issued 8Y
$ 3
i
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%'
ELECTRICAL . ,
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
$
$
$
$
$
$
$
$
SUMMARY -OF FEES
SMIP
PERMIT
�rSD ISSUANCE'
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE
$
$
$
$
$
$ .SO
$ 3
t_i_LlaNSTRUCTION AND.PCANNING
Permit
Inspector
POOH &SPA'Date
APPROVALS Permit#.
Date
InspectorOVALS
4alry Electrical Service or Pole
52. Pool & Equipment Location
_
jUndrgrnd.-,
53. Steel Reinforcement
• 3. Electrical Conduit Utility-Undrgrnd. "
54._ Forms
4. Electrical Conduit-Undrgrnd. - '
55. Electrical Bonding
5. -Steel Reinforcement.
56.' Rough Plumbing & Pressure Test-
'.
6. Electrical UFER Grnd.
57. APPROVAL.TO COVER-GUNITE
r7.. Footings -�'y
_
58. E lectr i cal Cond u it-Undrgrnd. -
,IV
8. Foundation -y�,r '
-
59. Gas Pipe, O Undrgrnd:, Test
-
' 9. Water Pipe-Undrgrnd.
60. Bac&a9 !. des, P -Trap, 0 Undrgrnd.
(j
10. Structural Floor System
61. APPROVAL --TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
V
12. Sewer Cap
-
63. Heater&.Vent-Final
13. Roof Drains
64. Plumbing System'- Final
14. Rough Plumbing
.65. -Electrical-Final.''
i
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#
t
20. Rough, FactoryFireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts,. Ventilating q
71. Product Piping.0 Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0Oil
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
4170-Y
(-V/
36. Hood or Canopy
'
37. Final Factory Fireplace
38. Final Plumbing
&e(j
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
V,
51. CERTIFICATE OF OCCUPANCY
No. Date
• - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
s�
CITY of COSTA MESA ONSTRAXT110N PERMIT
Project Address r
eAL
Applicant's Mailing dress
Oner's Na e { Ph ne
Adwdress r
Arch/Eng. -License No.
Address
1n Contractor's Name n' Le&r hone
lI Address Imailingl ` /`
rl-T(Y` City License No.
LICENSED CONTRACTOR DECLARATION 1
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions COge, and
My license/is iq fsW teed antl effect. /_A/VJ/ -
Date Signature
WORKERS' LOMPkNSATION DEC ARATI N
I hereby affirm that 1 have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certi i d' copy ther of (Section
3800, Lab. hO Vnlynd
Policy No. �f1ll/AT, Company Um r`
BCertifie c y is ereby furnlshetl, a_ q
Cert ie d with the city B g ivi m (/A/(f7 (/•(p
Date Applicants /�
EXEMOT(OP FRO11, WORKERS' COM PE NSATIO 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 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
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.
CONSTRUCTIONLENDINGAGENCY
I hereby affirm that thel11e �,((s a cmnstructio n.lending agency for the performance
of the work for ww�ldY1 Lhie permit is issued (Section 3097 Civ. C.)
Lender's Name „V, UU�LCi
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
enatty 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 no 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 for the purpose of sale).
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(s1 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 th . I have rea tl this application and state that t
information is Corr ct. I agree to comply with all city and county o
and state laws ral ting to building con Ion, and hereby author
sentatives of t i city to enter up th ab Ov mentioned prof
inspection purp e .
Signature ate
Drivers' Licenser or SS #
PERMIT NO OTRACT
Nt�.
LOT N ,S
UNIT NO.
Reinspection Fee1 $15 Issue Fee
3606 7/06/84
.9.25 . Tl,
TYPE OF CONSTRUCTION NEW ADO ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
A.P. #
Zone
DEVELOPMENT SERVICES REQUIREMENTS:
S
Main Building: Accessory Building:
Hood or Type ❑
TYPE OF PERMIT GRADING- FOUNDATION El �STRUCTURAL'
❑ TENANT 1:1 ELECTRICAL 1:1 PLUMBING L��--heECHANICAL
❑ BOTHER
PROJECT DESCRIPTION SQ. FT.—'OCCUPANCY
CONSTRUCTION TYPE VALUATION$
ZONE GRADING CU.YDS. ACRES
T
Front_
Zoning Approved By C
'0
A
Rear - -
Refrigeration System
N
C
Right
N
System Repair/Alteration
K
S
Left ,
G
R
Ping. Ref. # Parking Req./Provided -
E
PLUMBING $ ISSUANCE
PLAN CHECK 25%, $ ENERGY P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50"/ $ MICROFILM
Remarks:
Planning Notes:
Q
M
_
S.
PLUMBING -
FEES
MECHANICAL $ TOTAL FEE
Bar Sink Showers
ELECTRICAL
FEES
_ Backflow Preventer, .' Service Sink _
Automatic Washer .
Construction Pole Sub.
Transformer ❑ 15-50 KW_-
❑50+KW
� '
- _?
Backflow lrriafion Sewer Cap
9 _
'
Bathtubs Sewer Connection
Cooking Unit
I Meter ❑up to 100 amps
-
f
Clarifiers �.. Solar Collectors I
Dishwasher
Meter ❑over 100 amps
DishwasherSolar Piping
,�
Dryers ❑Gas. ❑Electric
Sub Pariel
Drinking Fountains Solar Tank
"
Fan
Motors 110-1 HP ❑l%- 8
Floor Drains Swimming Pool w/Spa
F.A.U.
Inc. Solar 179-15 HP 016-15+
'
Floor Sinks Urinal _
Fixtures _
Microwave _
Gas Service Outlets' Water Closet _
Device Boxes i
Pole Light
Interceptors .Water Heater
Outlets
Range
Kitchen Sink Water Service '
Switches
Sign i
Lavatories
Garbage Disposal
'Standing Sections
P—Trap
Generator 0&5 KW 115-15 KW
Trash Compactor
Roof Drains
Reinspection . Fee 1 $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducti'g
❑0-100,000 BTU L14f00,000 BT
Reinspection Fee 1 1 $15
CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Issue Fee' (
I - $'3
Reinspection Fee1 $15 Issue Fee
IANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Hood or Type ❑
Canopy Type II ❑
Zoning Approved By C
Building Approved By C
Application Issued By - C
Refrigeration System
FEES
' S�MARY OF FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ 'PERMIT
❑0-100,000 BTU E1100,000BTU
System Repair/Alteration
PLUMBING $ ISSUANCE
PLAN CHECK 25%, $ ENERGY P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50"/ $ MICROFILM
_
MECHANICAL $ TOTAL FEE
Issue Fee
$ 3
PLAN CHECK 25% $ '
$ 3
$
CONSTRUCTION AND PLANNING
APPROVALS Permit #
i'
Date
Inspector
Pou, & 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
5. Steel Reinforcement
-
56. -Rough Plumbing & Pressure Test
6. -Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
- .
58. Electrical Conduit-Undrgrnd.
8. Foundation -
59. Gas Pipe.O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection
62. Backwash & Rec&ptor-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 -
7/��`�[r
Cxp
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
-
22. Ducts, Ventilating
71. Product Piping El Gas OOii
23, Gas Pipe -Rough & Test
72. Underground Flush
24'. Roof Framing
73. Undergrnd. Storage Tank O Gas O 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
// W
LIQ
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
•,/t Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
,
-CIT'?OF COSTA MESA - — I - Q r-
�IJ::
PERMIT N - ' " -
0:
O:
TRACT NO. i
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BLD
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30:1' 6/27
- i937L
, B 5 "=;
ON PERMIT��I
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Pro)ect Address
TYPE ,OF CONSTRUCTION LJNEw
LJ ADD LJ.ALTERATION1--LJ,RILPAIR
A IlCants Mailing,Address' - l
❑, CONVERSION''❑ DEMOLISH ElOTHER
'/' '.
'
- Zone"
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Owner s Name �- I G hone
DESCRIPTION -OF WORK
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Main Building:-
� „ Accessory-Bwldmg
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Address) �G2�{� ✓%%/�. - �f�(//1 ,
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' TYPE OF PERMIT. GRADING• ' FOUNDATION STRUCTURAL
T
Front_
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e
Arch/Eng t [Z-s/� Z2 "k,4 1 _ w No -l- I
❑TENANT ❑ ELECTRICAL
❑PLUM BING'� ❑'
B
+
!
Address; -
❑DTH ER ,.
.MECHANICAL
, I .. -
A
Rear -
N
> a
Contractors No y Z Phone'-
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-
. PROJECT DESCRIPTION SQ. FT..
- 'OCCUPANCY.
-yALUATION$
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Right
_
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Address Ima ngl Q ✓!d ff ��
CONST RUCTION TYPE
+
S
Left, ,
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City,Liccnse No. -
.ZONE GRADINGCU.VDS. ACRES
-
Ping. Ref. #
Park Fees $�
-
O
t
U
LICENSED CONTRACTOR DECLARATION � 'I.
'l
Remarks:- I
_
c-
Parking Req./Provided
1 hereby,affirm thatam IicenseC under provisions Of.Charter 9 (commencing
7000)
1-
'
Use Building:
+
R
with section of Division 3 of the Business and Professions Code, and
- //
.p.
'
of
i
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E
my license is in full ford,antl gf}fct. D
3
'
Licensqq Ciasj �- %G--'/�/ ' No/
f 1
PLUMBING _ i '
FEES
Planning.Notes:
,
I { �:
E
"
Date (O % ' Signature
Bar Sink
Shouters; t
t
)-
��
N
YORKERS' COMPENSATION DECLARATION:
s
T '
hereby affirm that I have a certificate of consent to self -insure or a certificate
Backflow Preventer
Service Sink' !
-
I I
S
of Workers'. Compensation Insurance, or -a -certified .copy thereof -(Section.
3800, Lab. C. -,- 7� a ST ' � I
No. `� i/(te=a - 1
,. Backflow Irrigation
Sewer Cap
.-e
'
f
ELECTRICAL - I
' FEES
'
Policy Company
Certified copy is here y furnished. : I
Bathtubs
Sewer Connection j
�•!`,
Automatic Washer
l �Tran'sformer 0 15-50 KW
j
Certi 'etl c isle�(gw ith the city Bu' in D'
KW
Date / �/ Applicant
Clarifiers
Solar Collectors
'}�'+f
Aonstruction Pole Sub.
,
Q
"
-501+
EX' MPTION;FR, WOR KERS',COMP N TION DECLARATION - .-
- Dishwasher -'
Piping - �'-
"•'
tt" '-
Cooking •--- ""--
- 'Meter Dupto 100 amps---,
'
- -
(This section need not be completed if the permit is for one hundred ($100 or
)
:�
Solar P g'
/
less '. I
certify@hat in the performance of the work for which this permit is issued I
Drinking Fopnt2lns
Solar Tank
-
Dishwasher I
:
, I-!
C
/ ;Meter 615ver 100amps'%
'
'
shall not employ any person in any manner so las to become subject to the 1
-
Workers' Compensation. Laws of California. -
Floor Drains) •
Swimming Pool w/Spa .^s'1
Dryers ❑Gas- (]Electric
Sub Panel
Date Signature
-
NOTICE: If, after making'this declaration, you should become subject to the
Floor Sinks
Urinal I
+
i
Fan
r,!
•Motors ❑0-1 HP CJI+b -8
Workers' Compensationprovisionsof the -Labor Code, you must forthwith -
-
- --'
t
-
complylwithlsuch Provisions_ or this, permit l shall be deemed revoked.
, Gas Service -Outlets
Water Closet i 1
F.A,U. ,
Inc. Solar 09-15 HP 1:116-15+
CONSTRUCTION LENDING"AGENCY ,,.
_
-
1 hereby affirm that there is a'construction lending agency for the performance ,
_
I Interceptors'
Water Heater
Fixtures
'Microwave -
••
-
of the work for which -this permit is issued, (Section -309] Civ. IC.),
Lender's1 rvame
'
Kitchen'Sink - '' .
'.Water Service - -
Device Boxes 1
Pole Light I I
Lenders Address I
`
Lavatories ' -
-
°
D
OWNER BUILDER DECLARATION. - ( -
y
Outlets
Range
!
1 hereby -affirm that I am exempt from the Contractor's License Law for the ,
i
P •Tr_aP) "s
_
'
,
following reason (Section 7031.5,Business and Professional Code: Any city or
•Drains
Switches; i
j Sign
county which requires a permit to construct, alter, improve, demolish or..repair t
-
any structure, prior to Its+issuance, also requires the applicant for such permit
Roof
V
GarbageDisposal
Standing Sections {
to file alsigned statement that he/she is licensed pursuant to the provisions of-
'"vhe Cont ract or's'LicAn se Law (Chapter 9 (commencing with- Section -7000) of-
",•ii
•' !
-
Generator (]0.5 KW ❑5-15 KW ;Trash Compactor
'
vision 3 of the'Business and' Professions Code) or that he/she is exempt
r'
i '
'- 1
-
-
erefrom And the basis for the alleged exemption. Any violation..of Section
7031 - by'
cant' for permi, Subjects the applicant to a civil f
enalty .5 of nott more
ore I an five hundretl dollatrs _($500). � ' - ,
ReinSpectiodFee
I
I •1 +
1, -as, owner of the' property or, my •employees with wages as their sole
Reinspection Fee '
$25 , Issue Fee'
$ 3 l
compensation, will it the work, antl the'struct ure-Is not intended or offered
t �. ' - + MECHANICAL- i -� I
FEES
for, sale (Section 7044, Business and) Professional Code:: The Contractor's
-
PUBLIC SERVICES REQUIREMENTS:.
- j i
License Law does not apply to an. owner.of a property, who bul Ids or'improves
-
Boiler
1
Hood or Type 1 0 1
thereon.; and 'who idoes such work himself/herself or through his or her own j
improvements intended
- ; 1
Canopy Type Ili 0 '
'n
Zoning Approved By
-
Date
employees, provided that such, are not or offeredlfor
sale. If, however, the buildingor improvement is sold within one year of com-
p
Duct- Under Ground
i z
Application Approved By
r
Date - '
,
pletion, the owner will the burden of proving he/she tlitl not build or im-
,
• -
/� ��� - i i
`
�/
t�rove•for the purpose of sale). , , I !
Duct -Structural v ,
Refrigeration System +*.
Application Issued By
N&�? Date
_
LJ 1, as owner of the property, am exclusively contracting! with licensed con-
-
Ventilating +
❑0-100,000 BTU ❑100,000 BTU
I
- l
tractors to construct the project (Section 7044, Business and Professions Code:
I
Duct- 1
{
I$DMMARY OF FEES ,
The Contractor's License Law does not apply to an owner of Droperty_who_
builds or improves thereon, and who contracts for such projects with a con- l
- .. -
Exhaust System 0 Multiple 0
--
System Repair/Alteration I
BUILDING PERMIT
i
$
SMIP - i $
'
tractors) license pursuant to'the Contractor's License Law). - ,
-
PLAN CHECK
$
` PERMIT -
0 I'am exempt under Section B. & P. C. for this reason
Firepl/Fact. Bit. ICBO # i
i
.
'ISSUANCE $
i
PLUMBING
$
;
Date r - Owner I r
Heating System & DuctingI
'
PLAN CHECK
$
+ j ENERGY P.C. $
- i
I hereby certify that I have read this application and state that the above
❑0..100,000 BTU 0100,000BT
t
l
) ELECTRICAL
$G
RADING $
information is correct. -I-agree to comply -cal all city and countyordinanter'
Ing iwing hereby repro-
- - - -
-
'
--`!
' / �.,3 MICROFILM $
! !
and state laws rel a construcMon, and authorize
t
+
: '
PLAN CHECK
$
seniatives of; thi cit I n above-mentioned :prapq,(ty ,tor
inspection purpo //r/•�!
'
MECHANICAL
' $,
TOTAL FEE I $
'
OY'.j/T(/_-
Signature l DatC�
r
Drivers' License or 55 9F
j
Reinspection Fee
• $25
I Issue Fee '.
$ 3
' PLAN CHECK
$
1CMF.0865-46 rev. 7/83 White '- Building; Canary .- Applicant; Pink - Accounting; Goldenrod -Assessor
1 'CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
'Inspector
PC, de SPA
APPROVALS Permit #
Date
Inspector
- 1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - r
.' -
53.' Steel Reinforcement
-
3: -Electrical Conduit Utility-Undrgrnd:
54.' Forms -
4. Electrical Conduit-Undrgrnd.
-
55. Electrical.Bonding
_
5. Steel Reinforcement
_
-
56. Rough Plumbing & Pressure Test
6! 'Electrical UF ER 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
f -.
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 ❑ Gas ❑ Oil
23. Gas Pipe -Rough &•Test -
72. Underground Flush -
24. Roof Framing - - -
•
73. Undergrnd.Storage Tank OGas OOil
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
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
;
OJECT ADDRESS: 1026 POPPY C!
OWNERS NAME: LEBEL'JOHN PAUL
ADDRESS: LEBEL, KATHLEEN M
1026 POPPY CIR
COSTA MESA,CA
556-7165
ARCH/ENGINEER:
ADDRESS:
UNIT:
92626
REG.NO.:
UNIT:
PERMITTEE: I)OYLE C FORTH S COMPANY ('714) 556-7165
ADDRESS: 1075 REDDING AV
COSTA MESA 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 Code. and my license is in full force and effect.
CITY uc.: 0X11-15—
5 11 srATE ic.: 4 5 4 3 0 6 Ss: B
Date: '11� Signature:
WORKERS' COMPENSATION DECLARATION: hereby affirm th have a certificate of consent to self -insure or a certificate of Workers'
ompensalmin a or a cert a copy thereof (Sectio 800, Lab. C)
ucYNO.: i� �1�1—�i XP. DATE: .L0/O1 /92
OMPANY: STATE FUND
,�,T
Certified copy is hereby furnished LN Certified copy is he with th 'ng cion.
Data: `f —/s — ; 7i Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (Thiss Ion need not be completed it the permit is for one hundred(5100)or less(.
I cenify that in the performance of the work for which this permit' ssued, I shall not employ any person in any manner so as to become
subject to the WorkersCompensation Laws of California.
Date: Signature:
NOTICE: If. after making this declaration, you should become Scalper 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 there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civ. C).
LENDER:
ADDRESS:
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 0— O,
PERMIT NO: B 057007 PLAN CHECK NO: N GOVT: N SUPE N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION SKYLIGHT, RETILE SHOWER 6 ROOF REPAIR SQ FT: 3,000
CLAIM VALUE; 3,000.00 CALC—VALUE: 3,000.00 GROUP OCC: R-3 /
COMMENTS: OCBO#2469 LEAK, SKYLIGHT 6 TILE
###9E###########3F#8f-##iF ik iE##BE ie fP lf lE iE 1F#1F##±F if lEi('#i('3E#if iF#7f+t iE 1EjE#3E#iE aE 1F j( -3f iE if#iE###)E#Bf iE#Y #1F 1E if i�+E
Z O N I N G S E T B A R E Q U C K S 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 RIGHT, FT IN
PARKING REQQ• PROV: PARCEL: 41217816 ZNE: REF NO:
PLANNING N6TES>
D E V E L O P M E NMT S E R V I C E S R E Q U I R E M E Ni%T S
ZONING APPROVED BY rn DATE:
BUILDING APPROVED BY DATE:
APPLICATION ISSUED BY: � 415,— DATE:
LEGALIZATION:N F E E S M M A R Y STRUCTURAL SEGMENT;X1
0.,~+ 1
BLDG PMT PLUMBING ELECT "C MECHANIC FIRE 5MIP/ ADIN
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
Any improve, demolish,
1 R Eng GR G
PERMIT 54.00 S Q/
(Section 7031.5 Business and Professional Code: pity of county which requires a permit to Construct, alter, 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
SM I P /NUN—RES
pursuant to the provisions of the Contractors' State License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business
for Any Section 7031.5 by
PLAN
and Professions Code) or that he/she is exempt therefrom and the basis the alleged exemption. violation of
five dollars
ISSUE FEE
`•v/f �y�
any applicant for a permit subjects the applicant to a civil penalty of not more than hundred ($500).
BUILDING—DIV-> PERMIT ISSUE PLAN—CHECK
TOTAL PAID x DUE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the
TOTALS ----> 54.50. 0.00 0.00
54.50 5 4.50
structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law
.00
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
1
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 Droving he/she tlitl not build or improve
REVENUE DIVISION TOTALS--> COLLECTED •
PMT PLUMBING
54 .50 OVER/SHORT- •- 00
forme purpose of sale).
BLDG ELECTRIC MECHANIC
..
FIRE SMTP /TOT GRADING LAN—CHECK
54.00
50
I, as owner io the property, Co exclusivelyy contracting with licensed to construct the project (Section Business
❑ Professions Code: The Contractors' late License Law does to builds or improves Thereon
.",
'
aplytoacontractors
and ale Prov
anownerContractors
ctors State
and who contracts for such protects withacontracmr(s)license pursuant to the Contractors'State License Law),I am aware
pursuant
########IE##*#9F#########it###-IE if###)E#1E if IF i(#1F##3h iF#1F##if
iE if#i(•3f iE if iE af-iF iE#7E#iF iE lE iFi(-ii'#'iE#IF iE #)f###
that proof of mein worker's Compensation insurance should he provided to me.
I N D I V I D U A 1. F E E
B R E A K D O W N
❑ I am exempt under Section: B. 8 P. C.
for this reason:
TYPE QTY � D E S C R I P T I O N
UNIT COST DOTAL COS}
Date: owner
SFR 3000 ALTER BY VALUE RESIDENTIAI
NOZONE 1.00 �� 3,000.06
I do hereby cenify that I am aware of and understand the requirements of Calitori Health and Safety Code Sections 25505, 25533, and
END OF FEES
ai 1
25534 and that I of any future 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 Quality Management District. Residential construction applications are exempt from
♦•
these provisions.
�'
! f
Date: Applicant: _
I hereby cerlify that I have read this application and state
ordinances and stale laws relating to building construction a
property forms,clion purposes.
-Date: �� Signature..
Driver's License of Social Security a:
is con . I agree to comply with all city and county
wat sof this -ah, to enter upon the above-mentioned
1641-46 While—Buildino: Green—Code Enforcemen Canary—Anniicanl: Pink—Revenue: Goldenrotl—Assessor
Slvj umIr-CI r
D1 00112?2°-13011297A
DATE: 04li5.n, -,>'n 31' C j
1
1
CONSTRUCTION AND PLAN M1i)_NL
-, .
APPROVALS. permit# -`
Date
Inspector
& SPA
p�PPROVALS 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
5. Steel Reinforcement
..-
56. Rough Plumbing & Pressure Test
-
6. Electrical UFER Grnd. -
57. APPROVAL TO COVER-GUNITE
7. Footings
-
58. Electrical Conduit-Undrgrnd.
B. 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
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
' 70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas OOil
23. Gas Pipe -Rough & Test -
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing
74. Overhead Hydro
_
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
3
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
4
35. Final Gas Pipe -Test
r.
36. Hood or Canopy
37. Final Factory Fireplace
i
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 PLANNINGjo--
49. Electric Release to Edison
n
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
4wtG
F
COMMERCIAL .,ONSTRUCTION'
GENERAL CONTRACTOR -
el-l-cl oL z0U74 ,lam
COS7,q- tii'e�JA� �!�
Permit # I5S 7ov-7
THIS NUMBER MUST A :C
ALL INSPECTION REQUESTS -
Es f8.
l�•'�rr',��Qiu�sT�
Vd 6"
Zees
FOR
CT1pNIS
APPROVED
CA Lt -
754,5626
City of Costa Mesa Building Dept.
y or
_
DATE,2 ¢/S 3.2� 754-5627
PLAN"' IUST EE OAI JOB AT ALL '(IMES MAKE
..r„'rtGF WI LHOI'7 r';=T)— APPRO L OF UEK,
' ANCE Of! GRAN r. F F f MY vP APPROVA,
-
P)S OR AN
J ll w1 - CEJ TF -i” 10 ANY - -
R OR AN ARPI , 17-. -. !;Oill L ANY ^� -
iONSOoT}q Ci M1' P rF,kr Lt r- 7 Ili CIJ�
O VIOLA -IL Qi iN.--L ')F .HIS ..
:- BE VALID cXT !::DZ FARAS TRi_ 6f.::v. :)RUSE
C: MC N I �:VTHOHIZSS IS
TL'- '-0NS S , PERMIT BAST SgUiU r>L:�-AF AND SMOKE DETECTOR
3PECli"[::'�IpNS SHALL fW7 F'ti%VENT THE Bc,9U�ii:G ilrFICIAL
FROIL 'I'ir_ilEAFTER REOUIR:NG TKE CORRECTION' Of GHRORS IN
SAID Pl.+:eS AND SPECIFICATKCN'S Oil FROM PREVENTING REQHiAED
BU U)Fi� "PERATIONS SEiIVG GAP. IIEC ON "i _Rc'UNDER WHEN
!N V'IOfAT-ON OF MIS COD; OR OF ANY OTHER UP.DIDIANCE OF -
THECIFY. -
STATE LIC #454306