HomeMy WebLinkAbout317 RAMONA PL - Building Permits� �p MF
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(714)754-5273 • Fax(774)754-4856
� CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
.�obnddress: 317 RAMONAPL
Suite:
Vicinity:
Parcel Nunmber: 42532105
Appliwnt: MARTINEZ, GEORGE
Address:
owner: KLATTE, ERNEST WILLIAM
Address 317 RAMONA PL
BUILDING PERMIT
Zoning:
Phone:
Zip:
Phone:
COSTA MESA,CA Zip: 92627
Contractor: AMERICAN HOME IMPROVEMENT
Address: 10415 SLUSHER DR
Arch I Eng :
Address:
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
SANTA FE SP CA
Phone:
Zip: 90670
License: 721379
. PERMIT NUMBER
898-01939
77 FAIR QRIVE, COSTA MESA, CA 92626
Phone:
Zip:
License:
SCOPE OF PERMIT
INSTALL NEW VINYL SIDING OVER EXISTING WOOD SINGLED WALLS, ICBO #3663.
$0.00
$99.75
$0.50
$0.00
$0.00
$0.00
$100.25
S�TBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0. 0
Rear 0. 0
Required: 0
FEE SUMMARY
PLANNING & ZONIfYG
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0• 0
Right 0- 0
Status: iSSUEDV�N'"
_,,
Applied: t0127/1998
Issued: t012711998
$5,000.00
as,000.00
EXPIRqTION: 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 ot 180 tlays. .
. INSPECTIONS: In order for the work aWhorized under this permit to be considered legal, such work must comply with all applicable code5, antl all
� required inapectlona entl final epproval must be obtained. Failure to obtain inspections antl final approval will resWt in the ezpiration ot this permit.
'� FOA INSPECTIONS CALL: (774) 75456Y8
WORKERS' COMPENSATON DECLARATION: '
I hereby aHirtn under penelry ot perjury one ot Ihe Idlowing declarelions:
❑ I have end will melntain a certificate ot consent to sell-Insure tor workers' wmpen5atlon, B9 provitled fOr by seclion 3700 of lhe Lebor Code, lor Ihe pertortnance ot lhe
work tor which Ihis pertnit is issuetl.
❑ I �ave entl will mein m workers' mmpensatim insurance, es requireC by section 3700 of ihe Labor Code, for Ne peAortnance oi �he work lor whid� ihis partnit is iswed.
My wo/rkers' w urence cartier end policy numDer are: �G J�/���9_ �„ I'
Cartier. h/I�I��U�U/j2_ � PolicyNumDer.� �/ �Y�
(lhls section neetl nat be plet�qpermit is valued e! me hundretl CW/ers (5100) oi /oss.J
/
❑ I cetli�y the� In �ha perto nCe � the c for which �t1 js.permit is Issuetl, I s�all not employ any person in eny manner so as m becane suDject to the workers'
compensetion lawa,oi domi. en [a ��ultl became su6Ject to lhe workere' crompensetlon provislons oi Section 3700 ot tha Lebor Cotle, I shall tonhwith
comply wIN these pr �si �l
/ ./ �az�/�.�
Applicanl Slgnature: � � a�e: T_
WARNMO: FAILURET � EC FS' COfd TION ODVEPAGE IS UNLAWFUL AND SHRLL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES M1D dVIL FlNES UP TO IXJE HUNDRED
TFIIXISANO OOLLPAE ). IN ADOrt10N TO E OF GOMPENSATION, OAMAGES AS PROVIDED FOR IN SEC�ION 31W OF THE IABOR CODE, IMEflEST. M1D ATTORNEYS FEES.
LICENSED CONTRACI
I hereby eHirm ihel I em
brce entl aNecL Lic.�,_
Conirector's Siflneture:
CONSTRUCTION
p I hare6y ettir
l.enders Name:
SigneWre: _
9(cammencing with Sectlon 7000) of Division 3 ot Iha Business aycf Professions Cotle, end my Ilcense Is in tull
Gass x 17
Date: /1 /,q
Is e construcGo le ing egency tor the peAortnance of the work lor which �his permit is issue0. (Sec. 3097, CINI Code).
Lendefs Address:
Date:
OWNER•BUILDER DECLARATIONS:
I hereby eMirtn Ihet under penalry ot per�ury that I em EXEMP7 FROM THE COMRACTORS LICENSE LAW for tha following reason (Sec. 7031.5, Buslness antl Professions
Code: Any city or county which requires e pertnit ta construcl, alter, Improve, demolish, or repelr eny siructure, prior to its issuance, elso requires the eppliranl tor suU pertnit
to tile e signeA statemem Ihat he or she is licensed Dursuant ro the provisions ol the Contractors IJcense Lew (Chapter 9(commencing wlih Sectlon 7000) af DHlsion 3 ot the
Busineu end Protessions Cotle) or t�at he or she is exempt therefrom and Ihe basis lor the alleged exemption. Any violation ot Section 7031.5 Dy any epplicant tor e pertnii
subjecLs the epDlicant to e civ�l penalry of not more than Me hundred dollars (3500).):
❑ I, es owner oi the D�opeM. or my empbyees vrith wages es t�eir sde compensetlon, WILL DO THE WORK, and Ihe strudure is not intendad or oNeretl tor sele (Sec.
7044, eusiness entl Protessions Code: The Contractors License Lew tloes not epply to an owner ot properry who builtls or imprwes thereon, and who tloes such work
himsell or herselt or Ihrough his or her own emplayees, provided ihat such Improvements ere not intended or aHered for sele. If, hawever, the builtling or Improvemeni is
sold wilhin one year ol completion, the owner-builder will have �he Gurtlen of proving that he or she tlitl not builtl or improve tor Ourpose ol sale.).
❑ I, as owner of the properry, am EXCLUSIVELY CONTRAC7ING WI7M LICENSED CON7HACTOHS to wnsiruct ihe project (Sec. 70a4, Business and Professions
Code: The contractors License Lew does not appty to an owner ol propehy who bulltls or impmves thereon, and who wntrecls for such project with a cnntracbr(s)
license pursuant to the Contracbrs License Laws.).
❑ I am exempi unCer sec. Business antl Professions Cotle for this reason:
Signature: Date:
Owner ID verifietl by driver's license. ❑ Ves ❑ No Drivers License No.
Vaniication of Owners�ip by (ype ol documem, i.e. - pmperty tan Dill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMfT CERTIFICATION:
Ezpires:
❑ I hereby certlty Ihat no exceveNon five (5) or more feel in Aept� into which e persan Is requlretl ta tlescentl, wlll be metle in connectlon wlth work euthodzed by this
pertnit, end thet no hulitling strucWra, scaHolding, lalsework, or tlamolitlon or tlismantling thereot, will be more then ihirry-six (38) teet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Atlminisiretive Code).
❑ As owner-bulltler, I wlll not employ enyone to do work which would require a permlt Irom Ihe DlNsion of Indusirial Sefery, as noted ebove, unless such persan hes a
permit ta do such work from the Aivision.
Signeture: Date:
Divislon of IndustAal Selery Pertnit Number:
ICERTFlCATE OF COMPLIANCE AND AUiHORQATION OF ENTHV: I certily under penalry of perjury tha� I have read Ihis application end s�ete thet �he information given is I
correct. I egree to wmply wit� ell stete laws end ciry ordlnances relating to buil0ing construction, end euthorize representetives ol the Clty of Costa Mesa to enter upon the
eb�-described prop�ipr inspecGon puryoses. I agree not 10 occupy or allow occupency ot any building authodzed by this parmlt until linal inspedion.
Fized System Finel Flre Prevention
1288 Pool Spa Finel
200 Finel Re-Rool
201 Finel BIocWRetaining Wall
202
203
204
244&a8
Finel Fectory Fire Place
Final Sign
Finel Demolitlon
� LD%7 �
-�� Date
�QpE( INSPECTIONTYVE QA7E II�EL$
208 Finel Mec�enical
20B
210
212
220
Finel Plumbing
Final ElecMcel
Final Fire Preventlon
Flnel Plenning Approvel
222 Finel Site
250 Final Bulltling/Occupancy
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LICEN OMNACTOFS UECLAPATION: I heroby ellim uMer p�nely d pajury tlut I em I'raneeE uMs pwuimn d Cheqar D
( ercin w+lh SMbn ]ODO) d Oivoion � N ihe Buwmn eM Pmleaaona COEe, eM my limnea ia in hll lorce uM eXeA.
LIC. N.: IJG C1A55: C. NO.: l//_ At—�.�j Y.•
Dme: � Comreda: ..���/��{.// �"
OWN BUILDEF OECLAPATION: I Mmby elfiim unEer penely d pa�ry lhet I em uemq �m �M Cmtretlon Liceme Law la Ihe
' g reewn (SeGion )IXi1.5 Bueiwss enA Proimsiona Cada: Any �ey a counry xfiich reQuirea e peimil lo mmVun, ellar, impove.
emoloh, or repei eny ei�ucluro, pim to ils 6wence, eleo raquires �hq applicem iw auch peimit to fib e eipned eWement Ihet ha m eM
is liceneed W nuenl �o Ihe provieiona d tM Conlretlora Li�ensa law �Chepter 9(mmmenorp xilh Sedion ]000) d D'vcion 3 d iM
Bueinma end Prdanun+ Codej or ihel M or ehe n examq �herehan end tha basis lor ihe elleped exemqion. My voletion d SeCion
]031.5 by eny eppliranl for e permit eubpds tM epplcen� b e civil p9�¢�ry d rid mae ihen fve hundred ddlan �f500�).
� I, m oxnar d Iha Oroperly ar my empbyaea wilh wepas m thai eela compenmlbn, will do IM wark, end tha eVUCuro i rrol imandeA
w aRereE lor eele (Secibn ]0<I, Bueiren enE Prdeeeions COEe: The CoMredon Licenae lewtloea nM epply�a en owner d O�VeM
who Euida or'vn0�� �herean, eM who doae such work NmsaH w MnaM a iMrouph hw a Mr own employem, pmvidod thm euch
impovememe ere not inleMed ar Wlered lor eele. tl; however, �he buiNi�q a'vnprwemem ia eotl wilhin aro yeer d complNbn, ihe
ownerbuiMer vrill heve tM burden d pmvinp he a ehe did nd p�ilE w imprwe lor IM purpaee d edal,
� 1. ea owrer d tM propeM. � eRdueively oontredirp xilh lice� �IreMae lo canffiva tM 0�1� (�A^ ]OIA. Buei�wee arM
Proleeeiom Code: Ths ContreGon liume lew doee�M epWy to en owner d proparly who WiMe or'unpovp �Mraan eik who
convecn Iw �uch prqecle xilh e mMredm(+) IcansaE OunueM �e ihe Caniredae licame �ew).
� I em exemq undr Seciian: ;� B. 8 P.C., lu thy �s¢y�:
Dele: Owner
i ao n«eW c.n�y mv i em ..m. a ena �meBiana ine �a���e�a d ceuan,ie �xenn .�a smmr coee seaia�. zsws. nsa3. ene
255�0. erb Mel l a enY �un Wikmp ¢wpenl will / wil rwl (deeb qy) need w eompty wIh eeid tltla mdu xk �M repuimmann br
a Gamiil lw muwctian a modifretionhwntM/v�vu9amanl Distritl. ResidmXwl mnfivaion eVG�iwwen awemN Imm Iheaa
�lGNSM119.
Deb: AVW�
WONKEH'S COMPENSATON DK WIArION: I Mreby dfimi uMp p�ryy d pxjury me d tha Idbwiip Esfum'wn:
� IheveWWmeiNeinecMJi[tledmruentloeelliwrebrv,p�ay'�gqnn.mprovNeElabySetlianJ]OOdlMlebar
coae, r« in. oen�. a ub ..� i« w�n mo �n o o,,,,e.
.❑ I hen W wil meiman worken' comDe�ion imu�w. m reQuirtE M SeUian �]OU d tha labar CoEe. br �Ae PMormence d the
wak fa whid� ihie 0�^n ie iesueE. MY waken eanPanaetion imueenea rarier vW Cd'x.Y wmber ere:
Garuer:
� PdiryNumber.
(This exxion rreW mt be comderee i �hs 0�! ia tur a1e hunGred tlolkrs (S�OJI w hn.)
cerlAy �hm in tM pMomivice d iM wwk la xfich Ihie penr�� is ivuad. I Mell M employ enY P�� in eiry menmr eo ea lo
wbjea m �M wwka�e' ownpenalion �ex+ d CelXp�ie. enA pr ahouW bacama eubjee io iM woMn'
I mp0na91iM pTVi89ne d$BCIIM 3100 W Iha ldbOl COtle. I q� ' � µj� �/'' i
o� �r- ��r - 5 -� ADWicent:
em/np: Fellun ro sxun woAsn' compawtlan row�aps la ur�lawyl, and �hs/l aub� employsr ro crlminNpen�ltl�� erW
Ivll flmi up ro om huntlrstl tMusend Eoller� (510q0001. ��I/tlon ro fhs ewt ol eompensetbn, rinmeps� u provWetl lor In
SxHon 3)O6 0l Ms LeborCOW, /nfxest, and efromsyl ha.
CONSTNUCTION LENDINO 16ENCY: I hereby elfirm urMer penqryy d perjury ihel IMre c e mnsirudion biMinp epency br IM
performance M Ihe vrork br xfiitli tho pefml is eeued (SeUon 3091, Ciu. C).
LENDEP'S NAME:
LENDEN'S �UDNE4S:
I ce�ity ihet I heve reatl I�is eppl'retbn eM �eb tlul �he ebova inlom�dion ia wned. I egree to compty wilh ell dry end counry ordinencm
end atete lewa nletYp �o WildmB ���tlion eM hereby eWwri�a reye���¢�rvay W Ihb dlyto emer upon tM ebova-memioneE qopeM
1« imP�ion vuro�s,
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11-IB-1997/�4:12 RM/598.68
RCL�Tk:fl1-Ea15619
PEFtMIT:085795
CONSTMUCTION AND PLANNING - POOL & �SPA
APPROVALS Permit #' � Oate tnspector APPROVALS Permit #T Date lnspector
�, 7emporary Electrical Service�or Pole - 52. Pool & Equipment Location
I
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement !
r
3. �lectrical Conduit Utility-Undrgrnd. 54. Forms . '� .
4. Electricat Conduit-Undrqrnd. ' 55. Electrical Bonding -
5. Steel Reinforcement ��.. ��- � � 56, Rough Plum6ing & Pressure Test
6. �lectriwl UFER Grnd. 57. APPROVA� TO COVER-GUNITE 1
7. �ootings ��.. [�� � �[✓fj� 58. EleMrica� Conduit�Undrgrnd.
8. �oundation 59. Gas Pipe, d Undrgrn�., Test
9. bNater Pipe�Undr9rnd. � 60. Backwash Lines, P�Trap, � Undrgmd. �
10. Sxructural Floor Svstem 61. APPROVAL 70 DECK
: 1 t, property Sewer Line & House Connection . 62. Backwash & Receptor-Final
�Z• SeWe� Cap 63. Heater & Vent-Finai �� ,
13. Roof Drains ,� � � 64. Plumbing SYstem - Final ('�
14. Fough Plumbing �, 65. Electrical-Final
75. Rough Electrica6Conduit 66. Solar System-Finai - ��
76. Rough Electric Wiring � 67. Fencing & Access Approval
17. Rough Wiring Si9n 68. APPROVED FOfl PLASTERING "
18. F4ough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS fINAL �
19. Rough Heating & Air Conditioning , , fIRE DEPT. REQUIREME(VT .
20. Rough Factory Fireplace � APPROVAIS Permit #
21. Oucts, in Structure �� � 70. Underground Hydro
22. Oucts, Ventilating . 77, product Piping O Gas O pil
23. Gas Pipe-Rou9h & Test - . . - 72. Underground Flush
24, Foof Praming 73. Undergmd. Storage Tank O Gas O Oi�
25. Foof Sheathing ' 74. Overhead Hydro
26. 7-Bar Ceilin9 IStructuraq & Monocoat . 75. Dry Chemical � '
27, prame and Flashing' u 2,S �'? 76. Dry Staridpipe,;
28. Lathing & Siding � Z6_ �Gr� 77. FIXED SYSTEM FINAL
29. Insulation � 76. FIRE PREV. FINA�
30. �rywall Naifing ' HEALTH DEPT. REQUYREMENT
37. Plaster Brown Coat � ��� q? �4.�t 79. FINAL INSPECTION ; �
32. Electriral Power Meter-Final �� 80: FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final HeSting & Air Conditioning . - . �
35. F�nal Gas Pipe•Test � • � .
36. Hood or Canopy . _ - �
37. Final Faaory Fireplace - - : �
i _
38. Finai Plumbing , � �
39. Water Service�Final ' '
40. Gas Service-Final ' .
41. Solar Qomestic•Final
42, Backflow Preventer �
43. Backflow Irrigation �
44. Landscape Irrigation System - �
q§. $ound Attenuation .
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING _
' AB. FINAL PLANNING , .ti _ .
49. Electric Release to Edison `
"' �l
50. Gas Release to Southern Caiifornia Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
•oonessaBatm+o: jl / 2tANIV7VlN YL
OWNERSNNIEIFpIN'M: KLA11E, Y,t(NtSl W1LLlAM
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(oommemnp wilh Sec�ion ]000) d Oivuion � d Ne Buairom eM Pmimauna Code. enE mY ��� u in lull brca eM Wsp.
CRY IJC. NO.: IJQ CVSS: LIC. NO.: (y 1/ �GXY ;
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N BUILOEN UECIANATION: I Iwnby elfi�m uMx perely ot perjiry Ihel I em ue Imm Ihe Coninqan Liceme Lew lor Ihe
y iaeaon (Sepion ]W1S Bwiima eM Prolessiom COJe: /ury ciY a ooun�Y wlid� mCwm e V�a io mmWcl. a4er. imVow.
md'eh, a rpei eny �tiuclu�e. prior b m eaw�ca, ebo reyu'vee ihe eppliwu la ad� prmtl to Rb e eqmd aWeme�a Net he a�M
r.�.,e w�w io ine aw�o�. a m. co�ureao�. ��,a i.. Ien.a., a l��o wnn seao� �000l a oe,e�, a a me
Butliwaa aeW Rde»'nu Codal a ihel he a ehe b exemq Ihaehom enE �M Ees6lor Ne dbY^d uamqion. AM'vialelion W Ssaion
I)W t.5 by em/ epdium la � permil abpa� the eppliceM to e cvd pe�Wry d ml mas tM Iws �unEretl Edbn �f500U.
� I. u owner d IM qopenY a my emWqaee xilh wapm av Ihei ede compansaiion. will do the woM. uM the eVuclun u nd imaMed
or dlered lor veb (`�Inn l0as. Bmeme e�M Pmfeseiona Cda�. TM COMreaas Lioenx Lew Eoea ro� epplyto en oxner d propeily
who bWde or inqovee �herean, eM nho doee euM Mwk Nmaell or Mnel a ihraph ho «her oxn empb�eae, p�w�ideE �he� wch
imponmems va nal imeMed a allereO fa seb. tl. howa.er. iM EUJdinp a inprmxneM ro edd wnhin one yeer d canplelion. Ihe
owrrr-0uitler xitl heva tM buMen M qvnnp M ar she did nq ddd or impa<tar tM WT�e d vab).
❑ �. e� mni. d in. wwen..m ud�eN cworu�.a:�a .,m, rnw.e canvxyus ro aauow m. a�aee Iswun roN. einins. w
Pmfavian Coh: The Comrenm Liaw Lew dou rcn WNY b en oxner af P�W�Y x1a buffi or inWao ihaaon end xfio
emveev la ad� pqwa xdh e weurmar�e) IieereeE pwsuW to the Camreme lioeiue law�.
� 1 am eaemq unEer SecYm: B. 8 P.C.. M Me �eavm:
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coas. i« m. v�no�. a m. wk ia � mq o� A 4+we.
� I Mvs eM W mei�uen waFse' camprumion wu�erce, m mW'ved by SeCian 3)OD tl Ne teEar CaEe. br iM pMnmanoe tl tM
wwk ta whirA Nb G�a o u�ued. MY worken' mmP�ion mwrarce faner eM W�Y ^�^ber ma:
ceiner
va� r+�mc«:
�rni aeaio� �e.d �a ns cmmderee r m. w�� �* ro� ma hu�d�sd edi.�.lsiaol a ws.�
I cMh' �� in Ne peAomienca d tM wark la xfich �hie pama la inueE. I aheN ral emplo/ vry pei�n in enY menrwr w n to
e«ome wnib �o �ne wone�a� wnpwe�ian mw. a celE«N.. .�a w� � �.nwk euniw b �ne wunen•
cwnG�wbn OA^a'vn d Swion 2/00 d iM lebor Coda. I ehell IathvA pfy N e a�
ms: Md�:
W rny: F.uun ro��c�n rerkwa• rompwwtlen cerarp� l� unl�wlul, �rM alW/ �tl/sr �n wmpreyw ro erlMrul vwNr.M
ll Ilnu �q ro on� h,nArM tMua,nd dolkn (SIOq000A ��Ifbn ro M� cwt ol rompauetbn, denupu �a povMW ror In
SxHon J106 0/ tlr� LWor COJe, Inhnsf. aib ettomsy's lon.
CONSiflUCT10N LENOINO �GENCY: I Mreby elfirm uMer peneMy d perjury ihet ihas u e wnstiudan brdi�p eperwy br Me
peAormeMe W Ihe xork 1« MfiiN t�b parmi ia caued (Sed'on 309]. C'v. C).
LENDER'S NAME:
LENDER'S �DONESS:
I wniy Ihet I have roeE I�u eppl' �ion vM pMe Ihei tM ebova iMormelion ia wnea. I eprte lo ewnply ��nh NI r'ey uM caunry adineim
eM aiqa lewe mleln0 to Wildip conslrueion eM hereby eNhwrse repaeentatiren d ihe cnY to enler upon �he ebova.meniioned popnry
lor impedion Wrpoeee. -- — —
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ftCDT�:�l-flti156ed
F'EkI'iIT:085797
CONS7RUCTION AND PLANMING + �O� & SPA
APPROVALS Permit # � Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soii Pipe-Undrgrnd. .� 53. S[eel Reinforcement � '
3. Electrical Conduit Utility•Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. �� 55. Electricai Bonding �
5. Steel Reinforcement 56, Rough Piumbing & Pressure Test _
6. �Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE �
7. Footings 58. Eloctricai Conduit•Undrgrnd.
S. Foundation 59. Gas Pipe, Q Undrgr�d., Test
9. Water Pipe-Uncirgmd. - 60. Backwash Lines, P�Trap, Q Undrgmd.
10. Structural Ploo� System 61. APPROVAL TO DECK !'� �
; 11. �Property Sewe� Line & House,Connection 62. Backwash & Receptor�Final -.
72. Sewer Cap ' 63. Heater & Vent-Final �
13. Roof Drains � 64. Plumbing System � Final ��
14. Rough Plumbing , ' � 65. Electricai-Finat ' "
15. Rough Electrical-Conduit 66. Solar SYstem-Final '
16. Rough Electric Wiring 67. Fencing & Access APP�oval :+�:
1�. Rough Wiring $ign 68. APPROVED FOR PLASTERING �
78. (iough Electrical•T Bar Ceiling ' 69. POOUSPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REnUIREMENT
20. Rough Factory Fireplace Z g� APPqOVALS Permit #
21. Oucis, in Structure � 70. Underground Hydro �'"
22. Ducts,Ventilating� � 77, productPiping�Gas ❑Oil
23. Gas Pipe-Rough & Test � z � 7Q, Undergrbund Flusli
24. Roof Framing � ' 73. Undergmd.StorageTank OGas ❑Oil
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � '
27. Frame and FlaShing' -� 76. Dry Standpipe
28. lathing & Siding - 77. FIXED SYSTEM FINAL
29. InsWation � . 78. FIRE PREV. FI(YAL �
30. Drywall Nailing ��HEALTH DEPT. RE�UIREMENT
31. Plaster Brown Coat � � � 79. FINAL INSPECTION
32. Electrical Powsr Meter�Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: -
34. Final Neating & A�r Conditioning
35. Final Gas Pipe-Test ' '
,.
36. Hood or CanopV �
37. FinaPFactory Ficeplace ,l�' . ? - .
38. Fina! Plumbing �
i
39. Water Service-Final ' ,
40. Gas Service•Final . , � -
47. Solar pomestiG•Final
42. Backfiow Preventer' ,
43. Backflow Irrigdtion
44. Landscape Irriqation System
45. Sound Attenuation �
46. Handicap Regu�ations _
4�. FINALSTRUCTURE & BUIL�ING
46. FINAIPLANNING •
49. Electric Release to Edison �
50. Gas Release to Southern Calitornia Gas Co `"'� .
51. CERTIFICATE OF OCCUPANCY •
No._ Date -
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LICENSED COMXRCTOflS DECLAXATION: I hereby dfvm under peneXy A pepury thd I em liceneed under povieiorre W CMpter 9
�mmme ' xilh Section ]000) oi Dirieion � d the Buei�ron eM Pmieasions Cada, a�M my liceme ie in lull lorce arM eHec1.
rcm .No. uc.cuss: uc.No.: � EjCY;
D : � ' ConheUor: ��
O NER B DER OECLAHATION: I hneby eifiim uMm penely d perjury �het I am e�cemq mm IM CoMretlaa Liceme Lew la IM
I bw'vq (�� lW 1.5 Buaie+s eM Adeevme Coda: MY cry a wuMy whidi iapui�ea e Po�4 �o wneun. eCx. impare.
dem '. n repei vry a��ucwre. qia b 4s aeuerioe. ebu raVuirae the eppliam t« wrch pamM to fik e agneE afelemanl Nel M a ehe
� �,w w�mwv �o ine a��s a ihe com�.aa. um�.a ie.. Icneq> a l�me�am .nn seau� �000) a or�eon a a me
Bwiiwx eM Prdmior v COEeI a thet ha a ehe ie exemp Ihareham aM the batis la Ihe elbpeE axemqion. Nry violation d Seaun
)OJ1.5 by ury eppliunl �w a permn eubjetl5lM epplicen� �o e i vJ panelry d ml more �hen I'vs h�Mrod ddlera �55W�.
❑ �,eau..,�erainernremo,myemdweee.Mnwep„esine:edammwnemion,xi��eeun.rork,endin..wcwre'vnamiendae
a oflereE la Wa (Section 10aa, Buairea eM PMesebneCOEe: The ConVetlan Licenae Lew Cme nM eppyto en ownmd prape�ly
who Wilda or improvea �hareon. eM xfio daee auch vrork himmX or Misetl a ihrough he ar her own empbyeea. O�deE tliel euch
improvamenls are mt imerded a ol�ered br ede. M, hawever, tha WiMinB or'vnpovemenl ie eoN wilhin are ymr ol mmqa�ion, tM1e
wnerbuiNer vnll have tha buNen d O�ovirp M or she did mt build or improve Iw tha Ouryoea d eeb).
❑ I. m axmr at iM proparry. em exduaiveH �nVedi�q wilh licenaed con�rec�on lo wnqruq iM popd (Sequn ]MG. Busirima eM
PMaseiom Code: The comreeon licenx lew Eoee ml epply �o en owrwr d properry x1a buiMe a impviec �hereon eM x1w
convecta 1« wrh prqMs wilh a m�uredor�e) IiceneaE Wnuenl lo Ihe Conlred«e Licen�s Law).
� I em memq uMr Section: B. 8 P.C.. b Nia reeaon:
Dme: �:
i eo nmenv �.nM �nm i em a.me a md �aasiene me rea���aw a ca�rom�e Heenn .�e sate�v code seao�+uws. usas. e�e
255�1. eM iM1et I a ury Mure WiNinp ocwpam xill / wll �(ti2b �) � to canply wIh eeid mte mEm enE ihe reyuvemarce M
a Permn IaoomhuctionamodificmionhaniM �i�y .+reYemem Osfrid. Ra+idmiW w�iueun WG�iwnue eaemN Immiheve
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W ONKEN'S COMPENSRTION DKL�NATION: I hereby eifi�m uMer penelly d perjury aro d IM lollovn�q Jadeie�iwre:
� I hew eM xil meintein e eerlilicela d mnaeni io eeM.ieuure iw xakera' mmpenemian, ee provided ta by Sadim 3)00 d iM lebar
Code, tar �ne pertormenu W ine xoh In whicn inie paimn ie iaeued.
❑ i neve ena �;� mdm� „onmre oomo�� ��.�,�e. m�ea���d M saa� aroo d in. ien« cod.. ror me ro�rormenm a m.
wwk la whiM Ihis pemin ia ivuad. My wakeA mmperuelion inwrence'artier end pdiry number ero:
Cariix:
Pofwy Numbar:
eaim �eea mr m mmo�ea r ue v�t;� ro. � n�ered ed� R+aol d r.u.)
oenN u�m m u� v�o�� a in� w� m, wnrn mo w�a o�a. i.ndi �a �Wm� d+r o� m�r m.��..o o��
�Q eubjetl to tM waMne' eompenWion 4we d Celitwnie, eed eprae Mm A I houk become wEjetl to IM xwken'
' m//� poyrs d Seaion 9)(10 d IM lebor Code. I ehdl IMh � p!� i� ^
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m/np: F/llun ro ieturo woMtwi rompNuetlon cav�rp� l� uM+wlul, �ntl �Mll subf�ct an rployer ro crlMrcl pmaltlu iM
c/WI Am� up ro on� hwdrsd thouaard doll�n /5100,0001, In M1/tlon ro M� ro�t ol romp�utbry 0am�p� u povMed br In
4xXon 3106 0/ Ms Le6orCOW, InNnst, entl aRomsy'a /su.
CONSTHUCiION LENDINO R�ENCV: I he�eby eifiim undar panely d pmjury Ihet �hen ie e mnatrud'pn bMing epency lor tM
paAoimenca W the wo�c br whi A the peimi ia aeuad (SeGon �U9]. CN. Cl.
LENDEfi'S NMIE:
LENOEfl'S10DNE55:
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eM eta�e lewa ielmM to WiNip mnfbuCion erd Aereby aulha¢e tepeaenleliva d Iltif tily �o m�w upon IM ebwe-menlioned pmpMy
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� r, 11-Ib-1997f�4:12 PH/f24.00
- ' � RCF'T�:01-G615618
�' � PERMIT=085796
�=
�
CONSTRUCTION AND PLANNING POOL & SPA
APPROVAI.S Permit # � Date Inspector AppROVAIS Permit # Date Inspector
1. Temporary Etearical Service or Pole 52. Pool & Equipment Location '
� ,
2. Soil PipB-Undrgrnd. � 53. Steel Reinforcement -.
3. Electrical Conduit Utiliry-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electriral Bond�ng �� �
5. Steel Reinforcement ,, 56. flough Plum6ing & Pressure Test � �` �,'
6� Electrical UFER Grnd_ 57. APPROVAL Tp COVER�GUNITE
7. Footings 58. Elec[rical Conduit-Undrgrnd. �
8. Foundation . 59. Gas Pipe, � Undrgmd., Test
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgmd.
10. Structural Floor Syscem 61. APPROVAL TO DECK ,
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer CaP ����. 63. Heater & Veni�Final
�• , .
13. Roof Drtins � 64, Plumbing SYstem � Final . �
14. iiough Plumbing . 65. Electrical-Finai f •
15. Rough Electriwl-Conduic ' 66. Solar.SVstem-Final
76. Rough E�ectric Wiring , 67. Fencing & Access AnProval
17. Flough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elettrical-T Bar Ceiling 69. POOL;SPA SYSTEA4S FINAL
79. Rough Heating & Air Conditioning � FIREDEPT. REQUIREMENT I
20. Rough Factor.y Fireplace � APPROVFILS Permit #
21. Ducts, in $tructuae, 70. Underground HYdro
22. Ducts, Ventilating 71. Product Pipi�g O Gas ❑ Oil
23. Gas Pipe-Rough & Test � ' 72, Underground Ftush
24. Roof Frdming � � � • 73. Undergrnd.Stora9eTank OGas ❑Oil
25. Roof Sheathing � 74, Overhead Hydro
26. T-Bar Ceiling (Structurall & Monoeoat 75. Dry Chemical ,
27. Frame and Flashing ' . 76. Dry Standpipe.
28. Lathing & Siding . � 77. FIXED SYSTEM FINAL
29. Insulatian 78. FIRE PREV. FINAL
30. Drywali Nailing � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat �, 79. FINAL INSPECTION
32. Electrical Power Meter-Final 8�. FOOD GERTIFICATE ISSUED
33. FinalElectric . '� Notes: O� �ipuf� ZJ 7�+
34. Final HeSting & Air Conditioninq I„L�1_�� Cl��s� ,� ��� `��
ft'�f l KJ .�
35. Final Gas Pipe•Test _ � �.�-,-/�. ���� �,�\� /J i
36. Hood or Canopy . "� J ,6f�
37. Final Factory Fireplace ' ,
38. Final Plumbing �
39. Water Service-Finai
40. Gas Service-Final � � . � .
41. Solar �omesticFinal
42. Backflow Preventer
43. Backflow Irrigation '
44. Landscape Irrigation System � .
45. Sound Attenuation - �
46. Handicap Regulations
47. FINAL5TRUCTURE&BUILDING "�•
46. FINAL FLANNING '
49. .Electric Pelease to Edison "'
50. Gas Release to Southem Califomia Gas Co -
51. CEiiTIFICATE OP OCCUPANCY '
No. Date
AGP���ant to fill in a11 SDaces except l�ose within neavy bortler lines anE sign all apDroDriate tleclarations.
Y.'VF COSTA MESA CypONSTRUCTI PERMIT � {,A PERMIT NO TRACT NO. LOT NO. UNIT NO.
'ProjectAddress �17 �la�I1�h0 ��QGG l-1"1
Applican�'s Mail/in'g� Ad�dr�e�ss `
Owner's Name C/�1n.� Phone
Address � �7 Y`{�( �0i1U � GfP ' e M
Arch/Eng. License No.
Address
�
Convactor's Name 1� �� Phone
Address Imailing� a S QA �{n \% P
Ciiy License No.
LICENSED CONTRACTOR OECLARATION
I hereby a/fi�m that I am licensetl untler pro��sion5 of Charter 9(commenCing
witn section �000) of Divizion 3 0l tne B�siness antl Professions Cotle, antl
my license is in t WI force antl eftect.
Llcense Class Llc¢nse No. �
Da[e 57gnature
VORKERS'COMPENSATION DECLARATION
�ereby ai/irm that I nave a certificate ot mnsent lo selLinsure or a certiticate
.f Workers' Compensation Insurance, or a certltietl COpY thereof (Section
3800, lab. C.)
PoliCy No. Compahy
Certili¢tl copy is hemby tumlSM1ed.
Certifletl coPy is filetl with the city Builtlin9 Dlvlsion.
Date APPlicant
EXEMPTION FROM WORKERS' COMPEN$qT�ON DECLARATION
(Thi55ectlon neetl not be completetl it Ihe Oa�mit IS fOr One huntl�etl ($300) or
less). ' '
I CCrtify that in the perto�manCe of [he wo�k for whiGh this pe�mit is i55uetl, I
shall not employ any person In any man So as yo become s [o the
Workerz' p ns t' n aws o( California ��
Dat¢ Signature ��< </�Y �,�f
�'NOTICE: If, after makin9 this tleclara[lon, yQu shoultl become subject to the
Workers' Compen5alion provision5 of [he I�bor Cotle, you must torthwith
comply with such provizions or Ni5 permit shall be tleemetl revokeG.
CONSTRUCTION LENDING AGENCV
I he�eby afFl�m tha[ the�e I5 a con5truttlon lentling agency for (he perfo�mance
ot the work for �wbich this permit is issuetl (Sec[ion 309] Civ. C.)
Lentler's Name
Lentler'S Atltlress -
OWNER BUILDEH'�ECLARATION
1 h¢rebv affirm that.l am eaempt frOm the Contracror'S Litense Law for the
on 7031.5 Business dntl Profeisional Cotle: AnY city or
a perm7[ to con5truc�, alter, improve, tlemolish or repai�
�its issuance. also requires tne aoolicant for such permit
t0 file a signetl siatem2nt thai he/she is licensetl pursuant to the Proviswns ot
'he Contractor's License Law (Cbap(er 9(cqmmencing wilh Sectlon 7000) of
)ivision 3 0l the Business antl Profeszion5 Cotle) or that he/5he is exempt
.nerefrom antl the basis for the alleqetl ex¢mptlon. Any violation o( Section
7031.5 by any applicant tor a pe�mil Subjects th¢ applicant to a civil
�enalty of not more lhan five huntl�etl t1011a�s (E500).
I, as owne� of [he property ' � Ie
will Oo the wo�k, antl Ihe SlrucWre i5'not intentletl o� offeretl
10! Sd10 ($CGII00 %044� BUSI0055 dtld i�lO(eSTIOOdI Cotle: The COOiIdCiOf'S
Llcense Law tlo¢s not apply to an owner ot a property who builds or improves
[hereon, antl who tloes such work M1im5clf/ryers4lf or tM1rougFl hi5 or her own
employees, provltletl Mat such improvements ara not Intenaetl or otteretl for
sale. If, however, the builtling or improvement is soltl wi[hin one year of com-
pl¢tion, the ownev will have the burtlen of provin9 he/slte dltl not builtl or im-
!L/ove tor tM1e pur0ose of sale).
Ll I, as owner ot,the property, am exclusiyely contracting with licensetl con-
VaCtOY5f0 COOSt�UCt fll¢ P�O�¢CL (52CLIOn J�G4� B11510055 dOtl PIOfE5510O5 COtlB:
The ConVactor's License Law tloes not aqply lo an owner o( property who
builas or improves thermn, and wno contracts for such projects with a mn-
trac[or(s) license pursuant ro Ihe Contrattpr's Llcense Law). 1 am aware that
proof ot Ihelr Worker's ComOensalion Insu�ance shoultl be provitletl to me.
❑ 1 am exempt unaer Section �' � B. & P. C. fythis reason
Daie - Owner _
I hereby c rti(y na[ I have reatl t
inlormation i5 mrrect. I a9ree to co
antl state lawz r Ytin9 to builtling i
5entatives ot th city [o enteriu
Inspection puipo . �i
Signature �1V1�-
Drivers' License or 55 #
❑on antl state [hat tbe above
all cily antl county ortlinances
i, anC hereby authorize repre-
bove-mention¢tl 3p� erty fpr
ai
Date Gb
�—
E��/�8' a3i b 1
TYPE OFCONSTRUCTION NEW ADD ALT�.E'/RATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH R '�'`u��_�CK� ,p,�6 CJ- '�
DESCRIPTION OF WORK/USE OF BLDG. , 4Dn�P \NQA.�
S Main Building:
E
TVPE OF PERMIT GR.aolniG FOu�vDATIOnI $TRUCTVRAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reaf
❑ �OTHER C Right �
PROJECT DESCRIPTION Sp. FT. OCCVPA v — K
CONSTRUCTIONTVPE �p VALUATION$ g Left � �
ZONE GRADING CV. VDS. ACRE$ Ping. RBf. #
Remarks: Planning Notes: � f
3ar Sink '
3ackflow Prevenrer
3ackflow Irrigation
3athtu6s
Clarifiers
Dishwasher '
Drinking Fountains
Floor Drains
Floor Sinks '
Gas Service Outlets
Interceptors
Kitchen Sink •
Lavetories
P—Trap
Roof�Dreins �
Reinspactian Fee . $15
Juct- Under Ground �
Duct - Structural
Duct - Ventilating
Exhaust System � Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU O100,000BT
Reinspa�tion Fee � 315
CMF 0865-a6, �ev. 30/04 White - Builtling: Canary - Applicant; Pink - A<countin9: Goltlenrotl - AsSessor
Showers
Service Sink
'Sewer Cap
Sewer Connection
Solar Collectors
$oler Pipin9
Solar Tank �
Swimming Pool w/Spa.
Urinal
Water Closet �
Water Heater
Water Service
Auto-Wash
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-� oo,000 eru ❑ i oo,000
System Repair/Alteration
Fire Dampers
Registers
Issue
$ 3
S 3 � _
Automa[ic Washer
Consvuction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Garbage Dispoul
Generator �0.5 KW
Fee
128d '3/19/J6
— 5 Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL '
Transformer ❑ 15-50 KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panel
Motors �0.1 HP �1'h � 8
Inc.Solar 09-15 HP �16�15+
Microwave
Pole Light
Range '
; Standing Sections
5 KW Trash Compactor
$15 luue Fee
DEVELOPMENT SERVICES R
Zoning Approved By
Buildin0 APProved By �
I:: o�.
FEES
§ 3
Z
O
N
I
N
G
R
E
Q
M
T
$
� _ S M HV OF FEES
9UILDING PERMIT $ .Oz% SMIP $ •�
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ � GRADWG S
PLAN CHECK 50% $ �MICROFILM $ %{
MECHANICAL § TOTAL FEE $ I ����J
PLAN CHECK 25% $ � '
�
,
� : � P00 L & SPA �
'CONSTRUCTION AND PLANNING ' �
APPROVALS 'Permit# Date Inspector qppROVALS Permit# Date Inspector,
1:�Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
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. Fouhdation' . 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 & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final .
13. Roof Drains 64. Plumbing System - Final I
14. Rough Plumbing - 65. Electrical-Final
75. Rough Electrical: Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit #
i.
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.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural��& Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final E�ectric ,j'a� � Notes:
34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test
36. Hood or Canopy
37�. Final Factory Fireplace
38. Final Plumbing �
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation ��
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations . .
47. FINAL STRUCTURE & BUILDING � lb:' G. '
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co �
57. CERTIFICATE OF OCCUPANCY
No. Date
of
RailE�s
Mesa Building pe I
�TH SE PLAN; MUST BE CN JOB AT
WIAKE O CHANGES WITIIOUT PRIOR
OH De .
u
'��
N�
iTH ISSLFYC( OR GRA^liING Of A PEfiMIT OR F'PHUVR�
OF PLlU 5 f,fQD S'C�IfiCATIONS SHALL NCT BE CC. 1°
TO LF. FCRNIT f�R, OR F� l,PPROVAL CF, ANY YIOtAiION
OF �ANY OF TIIC Ffi0'JIcf01S CF THIS COD& NO Pi.R.NIT PRE.
SUMIAG TD CIYE I+JTHGRITY TO YlOLA1E OR C�.VCEL T11E
BQ�VISI'ttS CF THIS C�D'e SH�.L BE V�UID, 0(LEPT IN 5U
�it AS HE V:ORfS OF USE 1Yf41fH 1f A�+�D�RIZCS �S U1WF,UL
� HE ISSUANCE GF A fcR.Yl� BFSED CFL:� 11fi�3�A��d
C:�.CI(I RTIOt(S SHALL h0T FFLYC^� iHE CL9!'v:!13 OFilG.tl'
.. , �, 'Ef,U.F7LR flC�UlR1:iG THE CC.��L:T;^.:: (IF L�OR3
�IN(£RI (LANS 1.�� b: CLifICh;;O':: C(2 /R^.;A OR@le.'f:!YG
EU'LOIF � OPCfL'.T;�::S BL..ti Cls3i1LJ E:J iN:F'°:O:J�:R W;tEs1
�IN ��'IOL .S'w^F: Gf THIS CG�E OR Gf �:7'( dTH:.T On��
CF�TfiE 11T�'.
I
I
i
� � 2/�
� 3�� Rc+�vhONA
Pl�a.ce ''
�-- ------ - -- -- -
�RLCiURAI RPPRiI���AL ONLY
SE°�RATF FEP,�l4ff$.AR= R;(IUIRED
FOfl FLEGiRlGAL, r"LUMBiiJf, �
- _�;cATI�!G, �IcRTl.i;i�^J� AND ,
Ri.;'n'!Ci��lli� �il i"r03K �
f��.�,...�;;,, � .����/
LL:ue
rri:;: :�°::,re,€r: �=s/,�::,� ��;.^_.:a�,�t�r
HRL �::�1f`��S;L�i� ff�n4:.�i�=J
Fu.� z!�'i�'IPSti� ".�?iPi {Fr�a�^G;i {2? Lf_: 3��E+
.i'�, i< C] ' Y+��R �4L.�wA4iN 4G
�.,�:v^�`:�.`•:i.. �.�.`'li!�'1�.'��_�r`.���...:.�'"f.fK
`sT .t�93��°?I(-I� i�3�(� N.�cI�TIIG'�Ti'&.It.
_ �NcLOSF_ �K�EZE �n/Aj� ..---
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;
'�ITY OF COSTA
.-
Project F�ess —
Apylicant's Mailini
A�dress
`— Applicant [o fill in.all spaces except those wit�in heavY boraer Iinez antl sign all apPropriate tleclarations.
UCTION PERMIT � �;M'LT."��_„� �j TRACT; ^ LOT_NO. UNITNO.
�.,
Address Imailing) � `� � � � s
City License No. ��
IICENSED CONTRACTOR DECLA0.ATION
I hereby affi�m that I am licensetl untle� provisions of Charte� 9(commentinq
with section ]000) ot DiviSion 3 of the B�ntl Professions Cotl , antl
my Iicense is in full fo�ce ahtl ftect. �
License Clazs y �cense No.
oaie � s'9 < kr :,,�.q�-z
WORKERS'COMPENSAT�ON D' CLARATION
I hereby atiirm that I have a certificate oi consent to selt-insure or a certiticate
of Workers' Campensation Insurance, or a certifietl copY thereof (Section
3800, lab. (� �`f
Poli No. J,�r�QCompany _.—
ertifietl o0Y �5 hereby fu�nishetl.
Certifietl coR y� i5 tiletl wi(h the <ity B' d 9 Divisio
�ate ��%'�o�� qpplicant
EXEMPTION FROM WORKERS' ENSATION DEGLARATION
(This section neetl not be compl etl it Ihe permit is fot one h�ntlretl ($100) or
less).
I cer[ify that in the Perfo�mance ot the wo�k (or which Ihis pe�m�t i5 issuetl, I
shall not employ any pe�gon in any manner so as to become subject to the
Workers' Compensation Laws of California. �
Date Signature
NOTICE: If, afte� making this tlecla�ation, you shoultl becorne subject to the
Workers' Compensation p�ovisions of the Labor Cotle, yoU mu5t forthwitn
comply wit❑ such provi5ions or ihis permit SM1all be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
I hereCy aifirm that Shere �s a mnsVuction lentling agenry tor the pertormance
of SM1e work for which this permit is issuetl (Sectian 309� Civ. C.)
Lentler'S Name
Lentler's Atltlress
OWNER BUIL�ER bEC4ARATION
I hereby affirm thai I am exempt trom the Cant�actor's License Law tor [he
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
county which �equirez a pe�mit to con5truct, alter, imOrove, tlemolish or �e0air
any structure, prior to it5 issuance, alm �equires the appliwnt tor such pe�mit
to fiie a signetl statement that he/She is licrnsetl pursuant t0 the provisions of
the Contracior'S License L��y (Chapter 9(commencin9 with Section ]0�0) of
Division 3 of the Business antl P�ofessions Cotle) or that he/she i5 ezempi
the�efrom antl the basis tor Ihe alle9etl exemption. Any viOlation of $ection
7031.5 by any applicant for a Pe�mit subjectz tlte applicant to a civil
penalty of not more than Five huntlred tlollars (5500).
❑ 1, as owner of the P�operty or my employees with waqes as thel� sole
compensation, will tlo tnC wo�k, antl Me st�ucture is not Intentletl o� otfer¢tl
for sale (Section 7044, gusiness antl Professlonal Cotle: The Contractor's
Licenu Law tloes not apply to an own¢r of a property who builtls or improves
thereon, antl who tloes such work him5elf/he�sClf o� Inrough hiz o� M1er own
employees, provitletl that such imOrovements are not infentletl o� offeretl fo�
sale. If, however, the building or improvement is soltl within one year of com-
pletion, the owner will ha�¢ ihe bu�tlen ot proving he/she tlitl not builtl or im-
prove fo� the pu�pose ot sale).
❑ I, as owner of the property, am exclusively contractinq with licensetl con-
tratto�sto consttuctthe pro7ect (Section 7044, Business and Profes5ion5 Cotle:
The ConVactor's License �p�y tloes not apoly to an owner ot prooerry who
builtls or imOroves lherebn, antl who contracts fot such 0/ojects with a Con-
tractor(s) iicense pursuant to rne Contractor's �icense Law). I am aware tnat
p�oof of [heir Wo�keYs Compensation insurance shoultl be Provitletl to me.
❑ I am exempt untler SeCtion B. & P. �, for this reason
Date Owner
I hereby certify that I 4ave reai
information is correct. I aqree to
antl state laws �elating t4 builtlin
sentafives ot this city
inspection purpose5
Signature
Drivers' nse or 55 � �
this apPlication antl state that the above
�mply with all city antl county ortlinances
con5truction, antl hereby autho�ize repre-
7RSST1"'tfie above-mentionetl p�ogerty for
10/84 White - Builtling; Canary - Applicanh
TYPE OFCONSTRUCTION LJ NEW Id ADD LJ ALTERATION IJ REVAIR
❑ GONVERSION ❑ DEMOLISH ❑ OTH� jR�
DESCRIPTIONOFWORK/USEOFBLDG. �+-���''� �elT��"J
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRVCTURAL
� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL
�❑ OTHE(3
PROJECi DESCRIPTION Sq. oCcuFANC
� �CONSTRUCTIONTYPE � VALUATION$�+
ZONE- GRADINGCU.VDS. ACRES
Remarks: t/C� 7 G /„F �
Bar Sink
. Backflow Preventer
8ackfloW Irrigation
Drinking Fountains
Floor Orains
Floor Sinks .
Gas Service Outlets
Interceptors
Kitchen Sink (
Lavatories '
P—Trep
Roof Drains- . . i
Reinspection Fea � $15
Boiler
Duct - Under Ground
Duct - Svucturel
Duct � Ventilating
Exhaust System ❑ Multiple
FirepVFact BIL ICBO #
Heating System & Ducting
❑ 0-100,000 BTU � 100,000
Reinspectian Fee � $15
ShOwers
Service Sink
Sewer Cap
Sewer Connection'
Solar Collecmrs�
Solar Pipi9g�
.�wimming Pool w/Spa
Urinal
Water Cbset
Water,Heater
Water Service
Auro-Wash
Laundry Trays
laue Fee $ 3
IANICAL FEE
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑o�ioo,000eru ❑ioo,000
System Repair/Alteretion
fire Dampers
Registers
Issue Fee � $ 3
A.P. �k �
S Main Building:
E
T Front 4
B Rear
A
� Fight .3 \
�� Left �
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cookin9 Unit
Dishwasher �
Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
- Garba9e Disposal
Generator DO-5 KW
Fee
7566 10/16/87
� fl Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Trensformer ❑ 15-50 KW
❑ 50 + KW
5 KW
$15
Meter ❑up to 700 amps
if�r ❑over100amps
S�ub Panel
Motors �0.1 HP �1 �- 8
Inc.Solar �g-15 HP �16-15+
Microwave
.Pole �ight
Ran9e
$ign
Standin9 Sections
Trash Compacmr
luue Fee
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning Approved By
Buildin9 Approved By
l S'5�3�
BUILDING���T, �
PLAN CHE �
PLUMBING $
PLAN CHECK 25% $
ELECTRICAI $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
277,58 TL
Z
O
N
I
N
G
R
E
�
M
T
S
FEES
$ 3
ES� i� ,r'S�,r...�
SMIP $ �
ISSUANCE $ ,
ENERGV P.C. $
GRADING $
MICROFILM $
TOTALFEE $ ��7-C�S
CONSTRUCTION,AND PLANNING ' ,' POOL & SPA
� � ��� Date Inspector� � Date -Inspector
APPROVALS 'Permit # '• , APPROVALS Permit # ,
� • : i
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 UF�ER G�rid.� r. ' 57. APPROVAL TO COVER-GUNITE
,7:�Footings � ' /j , � 58. ElectricalConduit-Undrgrnd.
�'
_8: ;Foundation � �. � �, ' , � � 59. Gas Pipe, O Undrgrnd., Test
_ z
9. Water Pipe-Undrgmd.` '� 60. Backwash Lines, P-Trap, O Undrgrnd.
1
10. Structurel Floor System- 61. APPROVAL TO DECK
11. Property Sewer Lihe�& 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 ��S � 67. Fencing & Access Approval
17. Rough Wiring Sig� 68. APPROVED FOR PLASTERING ;
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL '��
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT� `.; l� ,
20. Rough Factory Fireplace ' APPROVALS Permit# �� ��
21. Ducts, in Structure 70. Underground Hydro �• � �
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
'v
23. Gas Pipe-Rough & Test 72. Underground Flush .. '� •�
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil S�
25. Roof Sheathing �� /� �'./1/• 74. Overhead Hydro ��
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical i' '�
27. Frame and Flashing � 8 g 76. Dry Standpipe '�
. � �_��
28. lathing & Siding � �/r�� 77. FIXED SYSTEM FINAL � f �; �
29. Insulation //S g� 78. FIRE PREV. FINAL ��
30. Drywall Nailing f j,� gg HEALTH DEPT. REQUIREMENT t
.
31. Plaster Brown Coat � � . 79. FINAL INSPECTION
u
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric � � Notes: � O w'LQ� � � �[' •
34. Final Heating & Air Conditioning 6Z (�J l�y a w� Z-'1.�--$ -�
35. Final Gas Pipe-Test . - �- �
'-iG. NoT �� �L-u
36: Hood or Canopy � �J ��
i �� � �
37. Final Factory Fireplace �' �-- - ' �
J;
� 38. Final Plumbing � " � � � . I .
!1'
� 39. Water Service-Final � ' • - �
• :, ,
� 40. Gas Service-Final � � � � , �,� � �� ,',;
• 41. Solar pomestic-Final • � ` '
� i ".I � ;'.,.
' 42. Backflow Preventer , .. ' ��
I. ( t+ .
' 43. Backflow Irrigation � l t; . �
r , �
' 44. Landscape Irrigation System , � t� ' � � ' � '
I � ''� i � . }
l " l�.
' 45. Sound Attenuation � �� : . •�
46. Handicap Regulations �. ' - �� �,'. � - - ^�
47. FINALSTRUCTURE&BUILDING � fY " ; .;'- ����; �'� �',.' �.•
48. Special Requirements Completed � �, �.� ;i, _" "
. 49. Electric Release to Edison � ' l�- � � " " '
.� i � ��
r_
50. Gas Release to Southern California Gas Co ' - .' ..
,�
51. CERTIFICATE OF OCCUPANCY :_ y
No. Date - � ��
' r.
\ �
CERTIFICATE OF COMPLIANCE
PAYMENT OF SCHOOL FACILITY FEES
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
I)eveloper/Applicant:
Address: � l v � �(
t7a
7'elephone Number: ���_ �r) ��
Tract/Parcel and Lot Number(s): _
Location of Project: 3�� �C'"�
Number of Square Feet of ���
Residential Space
Number of Square Feet of
Commercial and
Industrial Space _
x $1.50
x $0.25
Total
Total
-� �� �B
,.
_ The provisions of Government Code Section 53080 are not
applicable.
This certifies that the above-named Developer/Applicant has paid
school facility fees in compli'ance with Government Code Sections
53080 and 65995.
Checks are to be made payable to Newport-Mesa Unified School
District. ' �� � f�
. Business Manager
Newport-Mesa Unified School District
The above representation as to square footage is true,
Developer/Applicant agrees thaC if. it is later determined that
such representations are not true then this certificate shall
auComatically terminate and Che appropriate City/Counhy shall be
notified.
Date: / d Gj
�
RECEIVED �CT i � 1987
��
,
,
,.
:�
TOBIAS �`� MINER
CONSiRUCTION
February 25, 1988
This letter is to confirm that the abo�e referenced property
conforms with existing city drainage requirements and that
water drains from all existing structures to the street.
SIQ,��ST STREET� SUfTf B
NEwPOftT BEACH� CA 92663
(7t4) 673-8897
Applicant to (ill in all svaces exceot those within heavy eortler Ilnes an0 sign a11 approDriate aeclarations.
STAMESA CONSTRUCTIONPERMIT ^RMITNO_'E3��%20 TRAwTNO. LOTNO. UNITNO.
ess O �
��cant's Maili � o��
I����-�.�� pQ��
Owner's Name d N( 0�� 1_� � Phone � t��
Address 3� 7(.�b����� 4� G
Arch/Eng. ��/1'�C}�.���c �i'�.y,lt,���� G��p�,,,,��t('�fcJAse No. . .�
Address _GJ�_��np6 ' ' �`T �� "Z-OS � 02�s�F�a��-��.pFp
Contracmr's Name�Ny�E� M �� Phone.la.{2=n-�_./
Address Imaliingl S� b �'i ?/�� ��t�--�� ����--
�III��� City Licenee No. 7� g�,�
LICENSED CONTRACTOR DECLARATION
1 Itereby affirm lhat I am licensetl untler provisions ot Chdrte� 9(comTencinq
' with section ]000) ot Divisioq 3 ot the Business antl Profeszions Cotle, antl
my license is in iu orc antl ef/ect. 2 `
n`'- �icense Class '� ic se o/���`� Z
\ Date�� Si9na[u�e r
, WORKERS'COMPENSATION ECLARA 10
� I hereby affirm that I have a certificate ot consent to self-Insure or a certificate
� of Workers' Compensation In4urance, or a certifletl Copy lhereof (Section
3800, Lab. C jj �ompanyJJ f_LrJ�I� �1
PoIicY No. TO-�'s359
BCertifietl capy is hereby (urnishetl.
Certitie co is tiletl with th¢ City B ing i 'o _ � y
Date�—��' Applicant "`��
EXEMPTION FROM WORKERS' CO PENSATION DECLARATION
(TM1is section neetl not be tompleletl if the pe�mit is to� One huntlretl ($300) or
less).
I certify that in the performanCe of the wo�k fo� which this perm�t is i55uetl, I
snall not employ any person in any manner so as to become subject to the
Workers' Compensation laws of Califomia.
Date Si9nature
NOTICE: I�, af[er making t�is declaralion, you shoultl become subj¢cl to the
Workers' Compen5a[ion provi5ions O/ the Labor Cotle, you musl for[hwith
comply with such O�o��sions or lttis permit shall be tleemed revoketl.
CONSTRUCTION LENDING AGENCV -
I hereby affirm that tM1ere is a c0�5V uclion lentling agency for th¢ per(ormanCe
o( the work tOr which thi4 Permit i5 issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILOER dECLARPTION
I nereDy af/irm tnat I am exert�P� IrOm Ihe Cont�aclo�'S Llcense Law for the
following reason (Section ]031.5 Business antl Professional Cotle: Any ci[y or
county which requires a De�mi� lo mnslrucl, alter, improv¢, tl¢molish or �e0ai�
any structure, prior.co itz issua��e, also requires the applicant for such permit
lo fil¢ a Signetl Stat2men[ lha[ he/she Is Ilcensetl puRuanl to the provisions of
the Contractor's License Law (Chapter 9(commencin9 with Section 7000) of
Division 3 o/ [he Business antl Proles5ions Cotle) or [hat he/she is exempt
. tM1e�etrom antl lhe basis for tPe alleqetl exemption. Any vlolation of Section
7031.5 by any applicant for a permit subjects the appliwnt to a civil
eenalty of not more than five huntlretl tlollars ($500).
LJ I, as owner of tne property or my employees with wages as tneir sola
rompensa[ion, will tlo the wotk, antl lhe sVuttu�e is nol In[entletl o� ofte�etl
for sale (Seclion 7094, Business antl Pmfessional Cotle: The CwVac[or's
License Law tloes not apply to an Owner ot a property wlto bulltls or iinProveS
lhmcon, antl who tloes zuch wmk M1imself/herself or through hi5 or her own
¢mploy¢es, proviDed that suCh improvements are not Inlentletl or offeretl for
sale. It, howeveq the builtling or improv¢ment is soltl wi[nin one yea� of com-
pletion, Ihe owner will nave LP¢ burtlen of proving h¢/Sh¢ tlitl no[ builtl or im-
prove for Ipe purpose of sale).
❑ I, as owner o/ the property, am ezclusivery contracling with IicenSed Con-
tractors to construct ihe projec� (Sectlon 7044, Business antl Protessions Cotle:
Th¢ ConVactor's License Law �oes mt apply to an owner of property who
builtls or improves thereon, aPtl who contracts for such projecls wltn a con-
tractor(s1 ucense pursuant to tne Contractor's License Law). I am aware that
proot of Iheir Worker'S Compensation insurance shoultl bo provitled to me.
❑ 1 am exempt untler Section _ B. & P. C. �or [hii reason
Date
antl ztate laws relatii
sentatives of t u
inspection pu� 5.
Signature � Q-U
Orivers' Li nse or 5!
CMF OB65-46, rev. 30/B4
Owner
.ve read tnis application antl state enat tne above
�,ree lo comply wi[h all tity antl munry o�tlinances
builtling Construction, antl he�eby authorize repre-
en�er upon lhe above-mentionetl property for
� Dai����
TYPEOFCONSTRUCTION LiNEW LJ ADD LJ ALTERATION LJ REPAIR
/ ❑ CONVERSION ❑ DEMOLISN ❑ OTHER A P,N,
DESCRIPTIONOFWORK/USEOFBLDG.-R�Oh A-OS�1"FICN
S Main Buildi
TVPE OF PERMIT GRADING FOUNDATION STRUCTV RAL T Front
, ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B qear
❑ OTHER %�
PROJECT DESCRIPTION 5a. FT. 5/ 2O oCCVPANCv — K Right
CONSTRUCTIONTYPE�„�"N VALUATION$ Left
ZOME GRADING CL.YDS. ACRES Ping. Ref. #
Remarks: QC� RNr 'jio "7 2 CI Planning Notes:
Bar Sink
Backflow Preventer
6ackflow Irriqation
Dishwasher
Drink�ing Fountains
Floor Orains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap '
Roof Orains
Reinspection Fea � $15
Jucl - Under Ground
Juct - Structural
'Juct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heatin9 System & Ducting
❑ ai oo,000 eru � i oo,000
Reinspection Fee
� -� I I
White � Bulltling; Canary - Applicant; Pink - Accoun[ing; Goldenrotl - Assessor
$15
u
Showers
Service Sink
$ewer Cap
Sewer Connection
$olar COIIeCmrS
Solar Piping
Solar Tank
Swimmin9 Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fea
Hoad or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0-700,OOOBTU ❑700,000
System Repair/Alteretion
Fire Dampers
Registers
Issue Fee
FEES
$ 3
$ 3
Auromatic Washer
Consvuction Pole Sub.
Cook�n9 Unit
Dishwasher
Dryers ❑Gas ❑Eleci
Fan
F.A,U.
Fixtures
Device eoxes
Outlets
Switches
Gar6a9e Disposal
Generator OO-5 KW [
�596 I/05/Bd
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
❑ SO+KW
� Meter ❑up to 100 amps
Meter pover 100 amps
Sub Panel
Morors DO-1 HP �1'/:-8
Inc.Solar �9-15 HP 016�15+
Microwave
Pole Light
Sign
Standing Sections
15 KW Trash Compactor
ioo5
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
I ReinsPectian Fee I$15 � I ISsue Fea I $ 3'
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved 6y ' Date
8uilding Approved By Date
APPliration luued BY Data�
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP ' $
PLAN CHECK $ PERMIT
PLUMBING $, ISSUANCE $
PLAN CHECK 25% 3 ENERGV P.C. S.
ELECTRICA� $ X.oJ GRADING $
PLANCHECK 50% $ 1� � MICROFILM S
MECHANICA� $ TOTAL FEE $ �a• S�
PLAN CHECK 25% $ '
CONS7RUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # � Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd. 54. Forms ,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-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
75. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED fOR PLASTERING "
18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit # -
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof 5heathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe •�
28. Lathing & Siding �7. FIXED SYSTEM FINAL ' �
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT '
37. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electric:al Power Meter-Final 6 8 � 80. FOOD CERTIFICATE ISSUED ..
33. Final Electric ) 6 Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test .-
36. Hood or Canopy � �
37.. Final Factory Fireplace � .
i
38. •Final Plumbing '_ . , - � �
39.,Water 5ervice-Final � , r�." '
40. Gas Service-Final . �
41. Solar pomestic-Final - , ,
''42. Backflow Preventer ' , ' � � �
� - �
�43. Backflow Irrigation _ ; . , � � �
� 44. Landscape Irrigation System . ' : . ,
�'45. Sound Attenuation • ,, � ' ' � ` ,
46. �Handicap Regulations � ' ��' � •
47: �FINAL STRUCTURE & BUILDING • �. .
48. Special Requirements Completed . ' � '
J
49.�Electric Release to Edison •
..
50. Gas Release to Southern California Gas Co �
�
51. CERTIFICATE OF OCCUPANCY �
No. Date
c
��
�� Applicant to fill in all spaces except tnose witnin heavy GorEer lines an0 sign all aDDroo��ate tleclarations.
CirY oF COS7A MESA COdNSTR,(�j(�_;yT,IO PERMIT
Project Address 3� 7 �,�} ��l�M�' �L��' N�-
Appli<ant's Mailing Ad�d/r,e�s '/ �.�
Owner's Name �Q� �/ G IC� �TE Phon
Address -�1i ;PAM0I.14QLy ncfd rCe �%�G=7
Arch/Eng. License No.
Address
Contracmr's Name �•�-��� �C�O�'L�. C Phon�
Addresslmailing) 2Z�D IYs�s �-r���'�S�%`7 2�=`�
City Licensc No. �7 L�
LICENSEp CONTRACTOR DECLARATION
I hereby affirm that I am licensetl untler provision5 of Charter 9(mmmencing
witM1 section ]000� of Dlvision 3 0( tM1e Business antl Professions Cotle, antl
my license is in tull forc�ntl ef e t. �
LIC2f15 CId55 �� Licen i�
�a���-- —R s9 c �Y1
WORKERS' COMPENSATION DECLARATION
I be�eby affirm that I have a certificale of ConS¢nt to selt-insure o� a certifiwt¢
of Workers' Compenmtion Insurance, or a certified copy thereoi (Section
3800, �ab. C.) p C �/
Polic No. ��"Ll� Company STQT� /—V/'�'�
erti/ietl copy is he�eby /umishetl.
Cer itiej� copy is f letl with the cily Div' '
�Date �' C{1 '— �� Applicant y� .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be mmpletetl it lhe permit Is �ar one huntl�etl ($300) or
less).
I certify tha[ in the per(ormance of [he work for which thls permi{ is issued, I
sM1all nol employ any person in any manner so as to become subject [o the
Workers' Compensation LawS of Califomia.
Date Si9nature
NOTICE: Ii, aiter making this declaration, you shoultl become subject to tne
Wo�kers' CompenSatiOn provisions of the Labor Cotle, you must forthwith
comply with such p�ovisions or this pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aifirm lhat there is a mnst�uction lentlin9 agency for the pe�fo�mance
of [M1e work fo� which this permit is issuetl ($ectlon 309] Civ. C.)
Lentler'S Name
Lentler's Atltlress
OWNER BUILDEH bECLARATION
I hereby atfirm that I am exempt Irom [Ite ConVactor'S License Law tor the
following reazon (Section ]031.5 Business antl Professional Cotle: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
' any structure, prior to its issuance, also requires the appliwnt for such permit
to file a signetl 5[atement lhat he/zhe is licensetl pu�suant to [h¢ Provisions of
the Contractor'S License Law (Chapler 9(commencing with Secllon ]000) Of
Division 3 of [he Business antl Profeszions Cotla) or tha[ he/she is exempl
lherefrom antl the basis for tM1e allegetl ezemption. Any violation of Section
1031.5 by any applicanl for a permil subjec[5 the applicant [o a civil
pendlty of nol more lhan tive huntlretl tlollars ($500).
❑ I, as owner of tM1e property o� my employees with wages as IhCir sole
compensation, will tlo the work, antl tne structme is not intentletl or otferetl
for sale (Settion 7044, Business antl Protessional Cotle: The Contraclor's
LicenSe Law does not apply to an owner ot a pwperty who bui105 0� improves
thereon, antl who tloes such work nimself/herself or through nis or her own
employees, provitletl [nat sucli improvements aro no[ intentletl nr offe�eC for
sale. If, hOweve�, the builtlin9 or improvement is soltl wilhin one year of com-
ple[ion, lM1e owner will bave ihe burtlen ot proving he/5M1e tli0 not builtl or Im-
prOVE for [he purpose of Sale).
❑ I, as owner of tM1e property, am excluslvely contractinq with licensetl con-
[radorsto wnsVuct lhe project (Seclion 7044, Business antl Professions Cotle:
The Contractor's License Law tloes not apply to an owner oi property who
builtls or improves thereon, antl wno coniracts for such projects with a con-
tractor(sl I¢ense pursuant to tM1e Contractor's License Law). I am aware that
proof of tneir WorkeYs Compensatlon insurancC shoultl be provitletl [o me.
❑ 1 am exempt untler Section B. 6 P. 0. �or thi5 reason
Date Owner
1 hereby certify tnat I have reatl tnis applicatlon antl state that the above
informa[ion is correcL I a9ree to cOmply with all ci[y antl county ortllnance5
antl state laws relatin< o builQ�ng construction, antl hereby authorize repre-
sentatives of tni to REer u on MC above-menlioneA property for
inspection pu
Signature Date �"�`��
Drivers' License 55 9f � �
TVPE OF CONSTRUCTION Ll NEW L7 ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p.#
DESCRIPTION OF WOfiKIUSE OF BLDG. �
S Main Buildii
E
TVPE OF PERMIT GRAOING FOUNDATION STRUCTVRAI T Front
❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL 6 Reaf �
❑ OTHER A
PROJECT DESCRIPTION Sq. FT. oCCUCArvcv C Right
K Left
CONSTRUCTIONTVPE �Tj '� VALVATION$ $ .
ZONE GRADING CV. VDS. ACRES Ping. Ref. #
Remarku . rl `� PlanningNoces:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathwhs
Clarifiers
Dishwasher
Orinking Fountains
Floor Drains
Floor Sinks
GasService 3 OuUets
Inrerceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspaction Fea � $75
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating Sys�em & Ducting
❑0-100,000 BTU 0100,0 BT
Fainspection Fee � $75
�"-•4v.,10/04 White - Builtling; Canary - Applicant; Pink � Accountln9t Goltlenrotl - Assessor
1
Showers
Service Sink
Sewer Cap .
Sewer Connection �
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
efrigeration System
7/100,000 BTU 0100,000 BTU
�
'ystem Repair/Alteration
Fire Dampers
Registers
luue Fae
FEES
$ 3
$ 3
Automatic Washer
ConsVuction Pole Sub.
Cooking Unit
Dishwashet
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Gar6age Disposal
Generator DO-5 KW [
Fee
' �
2'667 I/06/88 5050 ,,.
Zone
Parkin9 Req./Provided
ELECTRICAL �
Transformer'.� 15�50 KW
❑ 50+'KW
Meter ❑up to 700amps
Meter ❑over 100 amps
Sub Pa I
Mo rs �0-1 HP 01 %� 8
c.Solar �9-15 HP �76-15+
Microwave �
Pole Light
Range
Standing Sections
15 KW Trash Compactor
$15 Issue Fae
DEVELOPMENTSERVICESREQUIREMEN7S:
Zoning Approved By
Building Approved By �
Aoolication Issued Bv
SUMMARV OF I
BUILDING PERMIT $
PLAN CHECK $ ��,
PLUMBING $ � % S�(L
PLAN CHECK 25% $ • '�%
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
Z
O
N
I
N
G
R
E
�
M
T
�
FEES
$ 3
SMIP $
PERMIT
ISSUANCE $ �
ENERGV P.C. S
GRADING $
MICROFILM 5 ��
TOTALFEE $ ✓ ` `"�
'
CONSTRUCTION AND PLANNING POOL & SPA `\
APPROVALS Permit# Date Inspector qpPROVALS Permit# Date Inspe�\
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. Elecvical Conduit-Uridrgrnd. 55. Electrical Bonding �
5. Steel ReinforcemenY" 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd, 57. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electriral 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 & FeceptorFinal
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final �
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Cc�nduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval .
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. DuCts, in Structure 70. Underground Hydro
22. Ducts, Ventila[ing 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Ga; ❑ 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 . I�
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'
35. Final Gas Pipe-Test ��
�� �� G.
36. Hood or Canopy
37. Final Factory Fireplace -
38. FinaV Plumbing
39. Water Service-Final .
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
.43. Backflow Irrigation � � - .
44. Landscape Irripation System '
45. Sound Attenuation . �
46. Handicap Regulations -
47. FINALSTRUCTURE&BUILDING �
�
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date
�l
��
Applicant to fill in all spaces exce0t l�ose within heavy borOer lines antl si9n all appropriale Ceclaralionz.
CITY OF COSTA MESA �NSTRUCTION PERMIT PEj2MIT NO. � „ � TRACT NO. LOT. NO. UN1T NU.
Project Address `�� � 4Mn�%� �G Q�=
ApplicanYs Mailing Ad�c/jres ZZ�6 /�i'a� �Z.T' �.Y7',/i714s�.�
Owner'sName ��• -� e � dTT_SZa—Phon "�+�Z�B�
Address ��7 X.AMd/./A Pl �= . P"1 9 tla�z`7
Arch/Eng. License No.
Address
Contractor'sName � � Cn�-r Phon '��%
Addresslmailing) �L€� NnE'ItctPn,��-� �r M. ��.�7
City License No. � � �
LICENSED CONTRACTOR DECLARATION
I hereby aftirm that I am licensetl untler provisions of Charter 9(Commencing
with sec[ion �000) of Division 3 of the Business and Professions Cotle, antl
my license is in full for e antl efiect. / �t
License Class ' ' Lic �e o Z +
Date,!�'� � ��7 Signature
'ORKERS'COMPENSATION DECLARATI N
ereby affirm tM1at I have a certificate of consent to self-insure or a certificate
. Workers' Compensation Insu�ance, o� a cer[ifietl copy thereof (Section
3800, Lab. C.) �I �
Policy No. =�%`�� ` 8•7 Company � �
rtifietl copy i5 hereby furni e
Certifietl copy is filetl with the ci uiltl' i
Date �7.�L./�1:�7 qpplica
EXEMPTION FROM WDRKERS' OMPEN ON DECLARATION
(This section neetl mt be complet tl if the p rmit is for ane huntlretl ($100) or
less).
I certify Ihat in the performance ot the w rk fOr which this perm�t is issuetl, I
shall not employ any person in any manner so as to become subject to tbe
Workers' ompewiisa' LawSofCalifornia.
Dale Signature
NOTICE: If, aiter making this aeclaration, you should become subject to the
Wo�ke�s' Compensalion provisions of the Labor Cotle, you must forthwitM1
comply with Such provisions or tbis pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereGy affirm that there is a mnstruction lentling agency for the performance
of the work for which this permit is i55uetl (Section 3097 Civ. C.)
Lentler's Name
Lender'S Atltlress
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt trom tbe Contrdctor's License Law for the
followinq reason (Section ]03L5 Business antl Professional Cotle: Any aty or
county which requires a permit to construct, alter, improve, tlemolish o� repair
any structure, prlor to its issuance, also requires the applicant for such permit
to file a siqnetl statement Ihat he/5M1e is licensetl pu�suant to the provisions of
he Contractor's License Law (Chapter 9(commenCing with Section 7000) of
Ivision 3 of the Busines5 antl Professions COGe) or that he/She is exempt
.�eretrom antl the basis for the alle9etl exemption. Any violation ot Section
7031.5 by any applicant for a permit subjects tM1e applicant [o a civil
�enalty of not more than five huntlretl tlollars (g500).
� I, as owner ot the property or my employees with wages as their sale
mmpensation, will tlo the work, antl the structure is not intendetl or ofieretl
for sale (Section �044, Business antl Profe55ional Cotle: The Contractor's
License Law tloes not apply to an owner of a properiy who builtls or improves
thereon, antl who tloes Such work himself/herself or Ihrough his o� ber own
employees, provitletl tM1at such improvements are not intentletl or offeretl fo�
sale. I!, however. the builtling or improvement is sold witnin one year of com-
ple[ion, the owner will have tM1e burtlen of provin9 he/she tlitl not builtl or im-
prove for the purpose of sale).
❑ I, as owne� of the property, am exUusively mntracting with licensed con-
vactors to construct the pro7ect ISection 7044, Business antl Professions Cotle:
' The Contractor's license Law does nol apply to an owner of property who
builtls or improves [hereon, antl who contrac[s for sucM1 prolec[s with a mm
Iractor�s) htense pursuant to the Con[racto�'s License Law). 1 am aware that
proof of thelr Worker's Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner
I hereby certify tha[ I M1ave reai
information is mrrect. I agree to
antl state laws rela[ing to builtlin
sentatives of this cit �-,nter
inspection purposes �
Signature �
Drivers' License or 55 � �
TYPE OF CONSTRUCTION I_I NEW LI ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P #
DESCRIPTION OF WORK/USE OF BLDG. �
S Main Buildin9:
TVPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRVCTURAI. T Flont
❑ TENANT ❑ ELECTRICAL '❑ PLVMBING �MECHANICAL 6 qear
❑ OTHER A
PROJECT DESCRIPTION 5c?. oCCUVArvGv R=?i C Right
COfJSTRUCTIONTVPE VALUATIONS S L¢ft .
ZONE GRAOING CU. VOS. ACRES� Ping. Ref. #
Remarks:r - Planning Notes:�
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Draini � '
Floor Sinks
GasService Outlets
Sink
oof Orains
Reinspection Fee
$15
Boiler
Duct-UnderGround •
Duct-Structural �
Duct - Veniilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
/ Ldo-ioo,000eruoioo,000eT
a councy orainances
eby authoriie repre-
ionetl property tor
oaiJL -3�8'7
iieinspection Fee
CMF 0865-46, rev. 30/84 White - Builtlinq; Canary - Applicanh Pink - Accountin9; Goltlenrotl - Assessor
$15
FEES
$howers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service � �
Auto-Wash
luue Fee I $ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
0874 12/�4/87
Accessory Building:
e000 'r�
Zon¢ _
ELECTRICAL
Transformer ❑ 75-50 KW
• ❑ 50+KW
Fan
F.A.U.
Fixtures
Device Bozes
Outlets
Swicches
Garhage Disposal
Generator �0�5 KW �5�15 KW
Meter ❑up to 100amps .
Meter ❑over100amUs
Sub Panel
Momrs �0-1 HP �1 %- 8�
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light �
Sign
Standing Sections
Trash Compactor
Reinspection Fee ' $15 Issue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESRE�UIREMENTS:
YPeI ❑
Canopy Type I I ❑ Zaning Approved By
___. ... _.. . _ . Building APProved BY � � �; ���
Refrigeration System,
❑0-100,OOOBTU ❑700,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
BUILDINGPERMIT 3
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% S
EIECTRICAL S
PLAN CHECK 50°� $
MECHANICAL S
PLAN CHECK 25% S
SUMMARVOF
SMIP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTALFEE
$
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
$
$
S
s g • ��
,CONSTRUCTION ANDPLANNING � POOL&SPA
APPROVALS Permit# Date Inspector ' AppROVALS Permit# � Date Inspector
1.. Temporary Electrical $ervice 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 Reinfarcement r� 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd<''�� 57. APPROVAL TO COVER-GUNITE
i,:
7. Footings �' 1 58. Electrical Conduit-Undrgrnd. .
��,5..�.Foundation --. 59. Gas Pipe, O Undrgmd., Test
��
9:'Water Pipe-Undrgmd.�q 60. Backwash Lines, P-Trap, O Undrgrnd. �
� 10. Structural Floor System 61. APPROVALTO DECK �
11. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final
r��.
72. 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 PL'ASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
` b"
20. Rough Factory Fireplace APPROVALS Permit # _
27. 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 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 '
f'
.i
28. Lathing & Siding . 77. FIXED SYSTEM FINA'L '.�
29. Insulation � 7S. FIRE PREV. FINAL '
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT ,..
31. Plaster Brown Coat 79. FINAL INSPECTION �� ��
32. Electriral Power Meter-Final � 80. FOOD CERTIFICATE ISSUED ,
33. Final Electric Notes:� _„ j_�./. i � ' -
2
34. FinalrHeatin9 & Air Conditioning � � �
35. Final�Gas Pipe-Test � ��s'
36. Hood or Canopy . '
�'
37. Final Factory Fireplace , � � t' `' �
38. Final Plumbing � � �. �' � !
39. Water Service-Final � � ' '�� ! .
40. Gas Service-Final . " !- - .
•�.
"41. Solar pomestic-Pinal � ' ' i� . '. �
�,
,42. BackflowPreventer � �� . .
.
• 43. Backflow Irrigation � � ,��� � � L - �
44.� Landscape Irrigation System ' � i �'y ,�, .,.
�45. Sound Attenuation � ' � ,, .� " ,; ' '
h'
46. Handicap Regulations � ' i ' �� • ✓ -
I, -
47 �FINAL STRUCTURE & BUILDING ,. : , i �,, _
�
48. Special Requirements Completed . , ,�, �- � `�
49. Electric Release to Edison � '' �,
1
50. Gas Release to Southem California Gas Co •� � . ,
51. CERTIFICATE OF OCCUPANCY �
e
No. Date
� 1 Aoolicant to RII in all soaces except tnose within heavY �ortler Ilnas ana sl9n a11 aoVroorlato Oeclarations. '" ��
CITY OF COSTA MESA C NSTR UCTION PERMIT PE MIT NO. TRACT NO. LOT NO. � UNIT NU. � 1— —
. ProjeCtAddress ►tAr^Or[� �� a��� � � 1354 3/19/86 IuoC 7L
Appii�ant's Mailin�g AId�d`�t' ICdZY•�' �•q TYPE OF CONSTRUC710N rlEw /aD� ALTE�tATION REVAiR
Owner's Name 3��rr E Phon i� o T � CONVERSION ❑ DEMOLISH ❑ OTHER , A p # Za�e
(��� %� DESCRIPTION OF WORK/USE OF BLDG.
Addreu � �, 'vT""��' �� v0�rt �'� A � S Main Building: Accessory Building: �
E Z
Arch/Eng. LicenSe No. TYPE OF PERMIT GRADING FOUNDATION STRUCTVRAL T Front �
Addresi � TENANT. O ELECTRICAL� � PLVMBING C�I MECHANICAL . 6 Rear . � � � N
� ����� � �� ,, ❑ OTHER ' %� �
Convgctor's Nam� ={• � �%� � � d° Pho .�19�F ' - _
Address (mailing) �' 6 � �—��' ��� sT' �%� ' PROJECT DESCRIPTION 5�. FT, OCCUaarvCV K Righi G
��D CONSTRUCTION TVPE VALUATION $ g �eft . R
City �iC¢nSC NO. _� ZONE GRADING CV. VDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided E
I hereby allirm thal I am Ilcensetl untler provision5 of Charter 9(commCncing Remarks: PldMipg NOL¢5: - M
Wllh SMI�00 %Q00) Of ��VISIOIt i O( IhC BUSIIIE55 dI1C PlO�ESSIOf15 COEC� dOtl
my IlGense Is in f1ril�l f c anrn etiect. / 99 y � r
Licen e Clasp `� `� � L�i<f{ n�se No. � (' S
Dat��„_/ 5'9 t S�—{�L� y�n�_ _� PLUMBING FEES
WORKERS' COMPENSATION D= ��IOK Bar Sink Showers ELECTRICAL FEES
' I bereby affirm lhat I have a certiiicate ot consent to selt-insuie o� a Cert771catE
o� `�`/orkers' Compensation Insurance, or a certlfletl copy thareoi (Section gackflowPreventer ServiceSink
aeoo, �ao. C G �y �( 1 /l� Automatic Washer Transformer O 15-50 KW
1 Policy No. �� v�7�� Companv"����+���k'�/-1 . Backflowlrrigation SewerCa ❑ SO+KW
P Construction Pole Sub.
8 Certi(ietl copy ii hereby tu�ni5h¢tl.
� /Cer i(ie cooY i' tl wrth th��e/�ity�EEMM u$ju•.;�'rn rv-i�s�ion. Bathtuhs Sewer Connection Cooking Unit Meter ❑up to 100 amps
�Hale�� APD�an�.�✓'�'� d� ��
E%EMGTION FROM WORKERS' COMPENSHTION DECLARATION Cld�ifi2f5 $pfa� COII¢Ct0�5 Disfiwasher Me[er ❑Ov¢� 1008mp5
(This Section neetl not bo complel¢tl if the permit is for One huntlretl (E100) o�
less). Dishwasher Solar Pipin9 Dryers OGas ❑Electric Sub Panel '
1 tertify that In lhe per/o�mance of Ihe work toY whiCh this pCrm�t is i55uetl, I
shall n0[ employ any per5on in any mannel so a5 ta become subjec[ to the Dlipking FOuOtdins SOIa� Tdnk Fd0 MOLOfS �a1 HP �7 h- 8
Workers' Compensation Laws of Calitomia.
oaie 5ignature Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE: 11, aiter making this tleclaration, you shoultl become subjeci to the Inc. Solar 09�15 HP 016�15+
Wo�kQ�s' Compen5dtion provisions o( the I.abo� Cotle, you must torthwith FI00� Sinks U�in21 Fixtu�¢5 �
comp�y �yith such prOvisions Or Ihis pe�mit Shall be tleemetl revoketl. MiCrowave
CON$TRUCTION LENDING AGENCV GdSS¢rviC¢ / Outlets WdterC105¢t . � D¢viGeBOxes POI¢Li ht
I hereby af(Irm tltat there is a con5truction lentling a9ency fo� the performance 9
oi tAe work ior whicn this permit is issuetl (Section 309] Civ: C.) Intfrceprots Water Healer Outlets
Lentlo�•s Namc Range
�entler's Adtlress Kitchen Sink � " Water Service Switches
OWNER BUILOEN bECLARATION Sign
I hereby aftirm that I am exempt from the Con[ractor'S Lit¢nse l2w lor the LdvaLOfiES AUtO-W25h (�idfbd ¢ Di 0531
folloWing reason ($ectlon ]031.5 Business antl Professional Cotle: Any tlty or 9 W ; Standing SEctions
coun�y whicn requires a permit to construct, alter, improve, tlemolish or reoair P—Trap Laundry Trays � Generator �0.5 KW �5-15 KW
any ;Iructure, p/lo� to its isSuanCe, also requires Ihe applicant fo� SUGh Oermif TfeSh Comp0ct0�
to lile a signetl Statement lhat h¢/she is IicenSetl pulsuan[ to Ihe provisions of ROpi Dfdi05
the Contractor'S License l.aw (Chapter 9(commencing wi[n Se<tlon ]00�) ot .
Division 3 oi lhe Busin¢Ss antl Profe55ion5 Coae) or that he/She is exemDt � .
th¢te(rom antl the ba5i5 to� ihe allegetl exem0tion. AnY viOlatlon ot $ec�ion ,
]031.5 Dy any applican[ tor d permit sublects lhe applicant to a clvil
�ena��y of nol more Ihan five huptlretl tlollars ($500�. ' $ 3��
I, as owner oi tne property or my employees witn wa9es as thelr sole Reinspec[ion Fae $15 ISSue Fee . �
compensation, wi11 Eo lhe work, antl the struciure is not intentlea or ofteretl Reinspeetion Fee $15 Iiiue F¢e $ 3
tor gyle (Saction �044, Buziness antl Professional Coae: Tne Contractor's MECHANICAL FEES
Lireqse Law tloes not apPly to an owner oi a property who builtls or improves
thereon, antl who does such work himsel(/herself or through his or her own DEVELOPMENT SERVICES RE�UIREMENTS:
emplpyees, provitl¢U that sucb improvemen[s are mt intmtlotl or offcretl for Boile/ HOOd o� Type I ❑
sa�e. It, however, the bulltling or Improvement is soltl within ona year of com- Canopy Type I I ❑ Zoning Approved By Dete
pletion, the owne� will have the burtlen ot proving he/She tlitl nol builtl or Irn- DuCt - Und¢� CiroUnd BUilding Approved By DdtB
Qrova for the purpose o/ sale). - ,
�J I, as ownm oi the prooerty, am exclusively contracting with Ilcensetl con- Duct-Structural Refrigeration System Applieation luued By Det
tractprsto construct the project ($ec[ion 7064, Bu5ine55 antl Professions Cotle: ,
The Contractor's License Law tloes not apply to an owner of prooerty who Duct � Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES
builtls or imOroveS thereon, antl who contract5 fot sucn p�ojects with a con-
trattor(s) O<ense pu�suant to tne Conbactor's License Law). J am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMR� $ SMIP $
proof ot their Worker's Compensation inzurance shoultl be providetl to me. PLAN CHECK $ ��''�%� PERMIT
❑ I am exempt untler Section B. &' P. C. �or this reason Firepl/Fact. Blt. ICBO �k Fire Dampers PLUMBING $�� ��/ ��UANCE $
Date Owner Heating System & Ducting Registers , Cl� PLAN CHECK 25% $ ENERGV P.C. $
I hereby certity tnat I have reatl this appliwtion anC state that the above "'��: �0.100,OOOBTU 0100,OOOBT � ELECTRICAL GRADING $
information is correct. I a9ree lo comply with all city antl county ordinances $
antl sta[e laws relating to uiitling consVuction, antl hereby authorize repre- , . PLAN CHECK 50% $ MICROFILM $
sentdtives ol oys �city t ente� upon the abOve-mentio�,(p Oro erty `fOr , �
�Signaw�e p oMe'�� �* , MECHANICAL , $ TOTALFEE $ O
;V�, Qi» bba./
� Reinspectian Fee $15 Iszue Fea $ 3 b PLAN CHECK 25% $
Driverz' License or 55 � '
CMF OB$5-46, rev. 30/84 White - Builtling; Canary - qpplicanh Pink �- Accountin9; Goltlenrotl - ASsesior �
. CONSTRUCTION AND PLANNING PUOL & SPA �
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Locauon
2. Soil Pipe-Undrgrnd. . 53. Str.el Reinforcement �
�3. Electrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ,�
5. Steel Reinforcement � ' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
�8. Foundation � 59. Gas Pipe, � Undrgrnd., 7est
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 & 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� _ .
i 6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign , 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough FactorY Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
� 24. Roof Framing 73. Undergmd. 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 & Sidinq 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 ���p y� � �
35. Final Gas Pipe-Test 3� �� �
36. Hood or Canopy
i
37. Final Factory Fireplace � _
38. Final Plumbing �
39. Water Service-Final
40. Gas Service-Final .
41. Solar pomestic-Final
42. Backflow Preventer ' , , .
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation :
46. Handicap Regulations
47. FINALSTRUCTUflE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to SOuthern California Gas Cv
57. CERTIFICATE,OF OCCUPANCY
No. Date �
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN
CONFORMANCE WITH THE CURRENf ENLRGY REGUIIITIONS, CALIFORNIA
ADMINISTRATIVE CODE, TI1T.E 25, STATE OF CAI.IFORNIA, IN Ti�
BUILDING LOCATED AT:
SITE ADDRESS; 3
reet.
��
EXTERIOR WALLS
t/ �l
Manufacturer ri� ar✓ v�i1e Thicknese/Type 3 2 R/Value n- _l�
CEILINGS
�/ 1f
Batte: Manufacturer jvt A N Vi �le Thiclrneee�_R/Value�L _�
GENERAL CON'''RACfOR:_ %bf,if�f �- }f1�A/C�/ LIC.��
BY TITLE DATE
INSUI.ATION CQNTRACtOR: WESTER,9 INSULATION LIC.� 290497
BY� P �TITLE__��L1ATE � ^ a Y- �P
`�owNEa PFEIFER, James & Susan unit
„�JOB ADDRESS 317 Ramona Place BUILI
�AP No. 117-2�1-3'( LOT 1'
INSPECTIONS
SOIL
a�a5
" W ATER
TTT����ROUGH PLUMBING
\"PROP. $WR. LINE Q MOUSE CON. �
\jSPRINNLING SVSTEM
:1� M ISCEL LANEOUS
��ROUGH HEATING ANO AIR CONDITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUN� � POWER �
ROI/GH WIRING
TRENCHES � FORMS � STEEL REINF
FLOOR SYSTEM
BONO BEAM ❑ STEEL ftEINFORCE ❑
SHEATMING
FRAME ANO FLASHING
LATHING - IN n OUT �
PlASTER, BROWN COAT
STRUCTURAL,FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST �
ELECTRIC, FINAL
BUILOING, FINAL
SUBCONTRACTOR
cover
� ' .�Jb2�G ! Nn�t;
� n
. �. _ �ai� � �-73�„�.00 s � i �� :::,;: r,x5.5v
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ��
. P I TION FOR BUILDING PERMIT
� For Applicant t Fill in Completely R.� i E Y DATE R PEIV�p
DATE IS ED
BUILOING a ^ S ,�_
ADORESS l -7
1 ��, d ' 7 � PER•�J�c_ .
OWNER A.P. NO. —�
MAIL BUILDING
Z
ADDPESS �jC/J��/ ADDRESS �i
W W TEL TRACT��� O LOT � J BLOCK
a U CITV NO.
ZZ
Q CONST UC�ION � EW AD A TE P
O � LENDEP
d m
J 7 BRANCH�`
J N OWNE
m J ADDRESS VALUE �
J m ARCHITECT TEL. S C � $ �
a OR ENGINEEF . N .
U N FIRE
Z a 20NE ' PE� GROUP �
w � ADDRESS �\,
d w APPROVED
W Z CONTRACTOR BV DATE �
J
°' z 1. �i rZ� �H-�
J � - A�DRESS
W w� � TEL. ZONE NO.OF USE Of NEW � �._D �
�= CITV NO. P�� BUILDING i
-Z �
w�• STATE CITV VAR SAPPROVED VAflDSAPPROVED
N K LIC. NO. LIC. NO. M IN BUILDING ACCESSORV BUILDING
� O � (FROM C/ REET)
SIZE NO.Of BLDGS.
OF LOT � �j ' NOW ON LOT RONT �� FT.
USE OF �'�//�/� �
EXISTING ELDG. SI E �l/'^" FT� T.
I— SIZE OF NO. OF �
Z NEW BLDG, ROOMS STOFIES 1.51DE . FT. T.
a EXTERIOR WALL ROOF
V COVERIN� COVEFING %1EAR �oL FT. FT.
J USE OF BIJILDING AND WORK TO BE PERFORMED - DISTANCE BET. ' BET. MAIN &
a MAIN BLDGS. ACCESS.BIDGS.
a
Q VAR. # DATE
O L �/ C.U.P.$ APPROVED
y� APPROVED �� � �� -7�
O S.� PSE
- U 1 hereby acknowletlge that I have reatl this application and state
� YM1at the above information is correct antl agree to comply with
� all laws regulating builtling consbuction, antl I shall not employ �
F„ any pe�sorl in violation of the workman's compensatiOn laws of
W
y ffie State ot California. �
' z I hereby ce,�tity that I am properly licensed as a contrector untler SQ. FT. o
the State cf Calitornia Business antl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Chapter 9, and that such licenses are in full force aPd effect, or I THE PURPOSE OF ESTABIISHING A PERMIT FEE ONLV:
am exem ± from the ¢
P provisi thPStat o�California Business VA�UATION �ff0
and Profesgjans Cotle, Divi to'n 3, C a rer 9:; �.�� N
!� �� PERMIT FEE $ ]
Sign �— - ���{{{ Q� ' m
Permitt —Ge � `/ $ /�/// .� p�qN CHECK $ ��UJ� E
v C� LL
Authorizeq qg¢nt L TOTAL FEE $�J
OWNER HEINZa J, /� DATE 10-11-Sri
JOBAUDRESS "i17 Ramona �. BUILDINGPERMITNO. lqFir,
GENERALCONTRACTOR J. N. �lark VALUE $ 2,].(7�.00
BLOCK TRACT
1 TVPE V
PERMITS ISSUED
INSPECTIONS J DATE ^J SUBCONTRACTOR DATE I NUMBER
rooting Trench
Foundation Forms and Grade to G
Rough Framing )
Plumbing, Rough to Slab
Plumbl�9� Rough Complete
Temporary Pole
Wiring, Rough
Heating, Rough /� �
Heating, Final
Sewer, House Sewer, St.
Septic Tank or Cesspool
Lathing, In Oui�
Plas[ering rxG�
Plumbing, Final, Fixtures Complel
i�lumbing, Fin,al Gas Test�S �
Wiring,Final � LL/
Occupancy GGy
1� nrm 210 Q-H 15f10 1-55 "
;Costa Mesa Building Department , �/p� APPLICATION FOR PERMIT
� r�< 117 EAST 20th STREET ��p� g U 1 L D i N G '
COSTA MESA, CALIFORNIA
FOR OFF`ICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permlt No.
e�uar�9 •7 G�/ /
Address .3 / � • , p / I �/ /O �`�
Costa Mesa, riB,�OTT11& Rece d by Date Rec'd. Date Issued
Nearest C / �J n !D�//� � �O—//—�
Cross SL ,),/i�l4 i�(� /`y'///'i � 4' t . Bulldin
/ Address
Owner (/ ��e%t/Y
Mail j Costa Mesa, California
Address .3/ /�Q /i/O �� R I 1 C% L'F Nearest
/ Tel. Cross St.
City (���G! N/P�L(, No. Zone ,/ I No.of I Typx � Group �
Arohitector Lic. 9 Plans
Engineer No. ApprovW
b Date
Address COdZRECTIONS
Contracto
tS//!� (- /C�//�/�� NOYLia 3%D�
Address �o ?Q /�UJ%7"'f/ Fi'"' /*!�� '
Legal Lot I
DescNption I No. �� I Block � Traact`�/�
(Attach Metesand Bounds)
No. of Bldgs. /
Size of Lot Now on Lot 0
Use of n No. of No. of A
Existing Bldg. �C'e S I F,amilies I Roomn �
Setback Line from /'/ Rear Vard � —
Center of Street G�f . Side Yard e'rL rC -�,� w
New �%� � Alteration � � Addition �`
Repair I I�Moving I I Demolish I
Building No.of
Size �-3� X '20 Rooms / Storfes �
Exterio9Wa11�/ I Roof 9� — AppROVALS
Coverin 74CY'O Coverin dC/%
Use of New
Building (/�1�� G/S /�-!}Q Lj/� Foundation Location Inspector Date
Forms, Materials, ,
Under-Pinning �
Frame: Flre Stops, .
Bracing, Bolts
I hereby aclmowledge that I have read this Application �
and state that the above is correct and agree to comply Lath. Int. �
with all City Ordinances and State Laws regulating ^
building rnnstruction. ' // /, /" Lath. Ext. iH
Signatureof � �/ ,U�y, /n l"
Permittee �- 7'77////G�� Plaster, Int.
Authorized Agt. Plaster, Ext 'R
7
Valuatfon Permit Fee $ /�. �� Masonry Refniorced
� 6 Q,�'� Plan Check $ , G G Bond Beam '`
$ v %/ ToUI � G —�
Fee � . FINAL �
PLOT PLAN
Show locatlon and dis�inces from
property Iine and between buildings
- - i _ ` . .- . .
' ". .. . �� . . . . , �� `. . .. ..
\ . . � . '� �. .
OWNE�2 _ T��_i.� �.-__G�"Lr'aGROVE DATE ZO—ILL—Sµ
JOB ADDRES3 317 Ramona Place BUILDING PERMIT NO. 6�1
GENERALCONTRACTOR Owner VALUE$ .B�JOO.00
�or 17 BLOCK TRACT 2310 Single Fam. Residence
GROUP 1 TYPE V ZONE RC1 FIRE DISTRICT (�rjrj
PERMITSISSUED
INSPECTIONS DATE SUBCONTRACTOR
_ �___, ., i r� _ DATE I NUMBER
Footing TrenCh
Foundation Forms and Gr
Rough Framing
Plumbing, Roug i o Slab
Plumbing. Rough Comple�
Temporary Pole
Wiring, Rough
Heating, Rough
Heating, Finai
Sewer
Septic Tank or Cesspool
LaYhing
Plastering
. Plumbing, Fin�al, Fixtures
Plumbing, Final GasTest
� Wiring, Final
Occupancy
Form 210 G-H 1M 12•69
- �Costa Mesa Building Department/ ,�APPLICATION FOR PERMIT"-'
^ 111 EAST 20th STREET /_ S 5 --___� � I. L.D ,I,.N G-.-_ --'�
. �� `QOSTA MESq, CALIFORNIA �f
C` . - -
! �'OR OFFICE USE ONLY
FOR APPLICANT TO I+�LL �T � � eece�pt rvo. Perm,it�t�o. j
Building � ' 3 � �s� � '
Address 31% RBtilOIIB j�1flC0
Costa 1lqesa, California Received b� Date Rec'd. Date Issued .
Nearest i � = %0-/�f� 5'�
CrossSt. .4flIIt.fl �1llfl Avenue Building I � �
Atldress i
Owner Dike & Colegrove � Costa Mesa, California ;��
Mail �
Address 419 E. 71�t1 1'. Nearest ' �
Tel. IbeTb9 Cro'ss St. �
Cicy CoatA MAaa No. p..l 15G zone � /` No. or rype �/ I croup �
ArchiteCt or Lia ��Y' I Plans !� � �'
Engineer No. Approved � ' i
by ' ' Date
Address 441 E. lat. St.,Long Beach -, � CORRECTIONS �
atY ���.
Contrector Dike&Coxegrove No. , �
nddress 419 E. 17th St..COstaMesfl
Legal Lot � _ _ '
nescription � No. 17 � e,o�kNone Treet2310 , ' ,
' � ,
(Attach Metes �nd Baund$) �+ - ��
No. of Bidgs. — � � -
Size of �ot i35. �3%60 I Now on Lot NOIIE -- -- -- - " p
Use of No. of No. of I�!�T � A ' i% A
Existing Bldg. �� I F�amilies I Rooms tJb-t-t �--I�� �
Setback Linefrom ' RearVard .SY�-� � � ' -' "--'-'-""� ' " -- - �� Z
Center ot Street 55 � Side vard �J * f _; �; D
DESCRIPTION OF WORH ��'�—�F�L+�ST�-NIESA r
New I Z I Aiteration I i Atltlition I -
Repair I I Moving ( I Demolish ! y
� Buildi�p No. of 1
Size t101199 Area Rooms 8 Stories
F_xterior Wall I Roof
Covering $t,IjC00 Covering (�'O(Qpp�__ A�PR,��Ia���'
Use of New Foundation Location Inspector Date
Building �j�8jg g�i�jT RC9_.— Forms, Materials,
Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
Lath.lnt.
I hereby acknowledge that I have read this Application
and state that the above is correct nnd agree to comply Lath. Ext.
with all City Ordinances and S[ate Laws regulating
building construction.
Signature ot
Plaster, Int.
Permittee
Piaster, Ext.
Authorized Agt
sonry Reiniorced
Valuation / O � Permit Fee $
U Plan Check $ ond Beam
$ ��� Fee,I $��5 � FINAL
�........ �lll.f I:_H 1M 19_i't
a,�+iaaa�raa� 1j; 7`. i
Show loeatlon and distances from
property Ifne and between buildings.
�
e
{ ..�
• . _,} . . •. r t' ._Y
=s �:
f �
y..1. .�•�.
s