HomeMy WebLinkAbout2229 ELDEN AVE - Building PermitsAODlicant to fill in all spaees eace0� those witnin neavy borCer lines ana sign all approoriate aeclaratians.
CITV OF COSTA ME1SAn CON TRUC N P� fp�MIT . /1 -PCM�f�Lq. ��,.� � TRACT NO, LOT NO. UNIT N0.
a*rojectAddress L�' �1 ���^' Y YjY �yt1q, L" 6
�,�D � \YlU -�- TVPEOPCONSTRUCTION NEW ADD ALTERATION REPAIR
9217 E/C6/':7 ^ r
Appliian;'s Maili Adc�ress
Y\S l HJ I,�WIK� S � CONVERSION ❑ DEMOLISH ❑ OTHER p� p�6 Zona
�Owner's Name ! Phone DESCRIPTION OF WORK/USE OF BLDG. �
'Address 1 �'\V�o QU 5 Main Building: Accesmry euilding:
Arch/Eng. J�� '`�-�� �icense No. TVPE OF PERMIT GRAD�niG FOUNDATION STI7UCTURAI. T Front p
Address � ❑ TENANT ❑ E�ECTRICAL ❑ PLUMBIn�.� ME��J1 ANICA� B Rea� N
❑ OTHER �y.Nn7n�a�y 4'�L.e...-, YO � \.�� �� A I
Convactor's Nam hone � C Right � N
Address (mailing) PROJECT DESCRIPTION Q. FT. OCCUPANCV
GONSTRUCTION TVPE VALUATION 5 S Left G
CityLicenseNo. ZOrvE GRADINGCU.VDS. ACRES R
LICENSED CONTRACTOR OECLARATION Ping. Ref. # Parking Req./Provided E
1 hereby aHi�m inat 1 am licensetl untler provislons of Charter 9(commencing Remarks: � Planning No[es: �
with 5ection 7000) ot Divislon 3 of the Business antl Professions Cotle, antl M
my license i5 in full tOrre antl GffecL T
LicenSe Class License No. S
Date Signature PLUMBING FEES
`RKERS' GOMPENSATION DECLARATION Bdr Sink ShOwers
reby a(firm that I nave a certiticate of consent lo seli-insure or a certificate ELECTRICAL FEES
Workers' Compensation Inmrance, or a certitietl cooY mereof (Section BackflowPreventer ServiceSink -�
3800, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW
Policy No Company Backflowirrigation SewerCa ❑ 50+KW �
eCertifietl copy is �ereby fumishetl. P Const�uction Pole Sub.
Certifietl copy is filetl with the city Builtling Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date APPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clafifiel5 Solar C011ector5 Di5hwa5her Meter �over 100 amp5
(Thiz section neetl not be com0�etetl it the permit is for one huntlred (5300) or
less) Dishwasher � Solar Pipin9 Dryers ❑Gas ❑Electric Sub Panel
I c¢rtify that In the performance of the wo�k (o� wnich this Oe�mit is is5ue0, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains SolarTank Fan Motors �0.7 HP 01X-8
Workers' Compensation Laws of Calitomia.
Date Signature Floor �rains Swimming Pool w/Spa . '
NOTICE: It, afte� making Ihis tleclaratiOn, you ihOultl beGome subject ro me _ F�A�U� Inc.Solar �9�15 HP 016-75+
Workers' ComOensation provi5ion5 of [he 12bot Cotle, you musi forthwltM1 FIOOI SinkS U�iOdl - Fi%tu�¢5 -
comply with suth provisions or [M1is pe�mit shall be tleemeC rewk¢tl. Mic�Ow3v2
CONSTRUCTION LENDING AGENCY Gas Service .. OuUets WatE� CI052[ D¢vic¢ BOxeS
I ltereby affirm that there is a const�uction lentling agency fo� the performdnce POIe Light
of the wo�k for which fhi5 p¢rmi[ is i55uetl (Section 3097 Civ. C.) Inte�C¢pt0l5 Water Heater �utl¢t5 '
Lpntler's Name Range ,
Lentler's Atlaress Kitchen Sink Water Service
OWNEH BUILDEH �ECLARATION SwilGhes Sign �
I ne�eby affirm that I am exampt frOm tne Gontraclor'S License Law for fhe Lavatories AuLO�WeSh
foliowin9 reason (Section 7031.5 Business antl Professional Cotle: Any city or Garbage Disposal S[anding Sections
county which requlres a permit to construct, alteq improve, tlemolish or reoalr p_7rap . Laundr Tra s
any slructure, prlor lo I[s issuance, dlso requires the appliCan[ tOt such permi[ Y Y - Generamr �0�$ KW 05�7$ KW T�25h COmp0Ct0�
lo fiie a siqned Stat¢menl that h¢/She Is Ilcensetl purSuant to the p�oviSiOns 01 Roof D�ains
�"• Contractor's Ucense Law (Chap[er 9(commencin9 witn Section 7000) oi
:ion 3 0l the Busine55 antl Pro�essions Cotle) ot that he/sh¢ iz oxompt .
�kom antl the basis tor [he allegetl exemption. Any violation of Section
.1.5 by any applicant tor a petmii subjet[5 Ihe applicant lo a clvil
genalty of not more tban five Ituntltetl Oollars (E500). 3
LJ I, as owner o/ tne property or my employees wim wages as tnoir sole Reinspection Fee $15 laue Fea g
compensation, will tlo Ihe work, ana tne slructure Is not intenaetl or ofleretl Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business antl vrotessional Cotle: Tne Contractor's MECHANICAL FEES
License Law tloes not apply lo an owner ot a propetry who DuiltlS or improves
lhereon, antl who tloes Such work himself/M1erselt o� through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provltletl that such Improvements are noI intentletl or offeretl for Boilel Hood of Type I ❑
xale. If, nowever, the builtling or Improvement is soltl within one year of com� Cnnopy Type I I ❑ Zoning Approved By Date
ple[ion, the owner will have tho burtlen of 0/oving he/she tlitl not builtl or Im- Duct - Under Ground guilding Approved 6y _ Data
p�ova for the purposa of sale).
❑ I, as owner of the property, am eatlusively contractin9 witn licensetl mn- Duct - Structural Refrigeretion System AppliUtion Issued By - Dat —��
tractors to consbuct the project (Section ]044, Buslness antl Professlons Cotle:
The Contracmr's License Law tloes not apply to an owner oi O�operty who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU . SUMMARV OF FEES -
builtls or improves Ihereon, antl who con[racts to� such projec[s with a con-
tractor(sl I¢ense pursuant to tne Contractor4 License Law). 1 am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PEFMIT $ SMIP §
proot of their Worker's Compensatlon insurance shoultl be provitletl ro me. PLAN CHECK $ PERMIT
❑ I am exempt untler Section e. & P. C, for Ihis reason Firepl/Fact. BIt. ICBO # Fire Dampers ISSUANCE $
�. � � - -� /J I PLUMBING $
n ��21�� n,.,�o. ___.1_r� MTD--( 1TJ��'�M'UC�� Heating System & Ducting Registers ENERG� P.C. 5
I here certity tnat 1 have re tl thii application and state that the above ❑0.100,000 BTU �100,OOOBT P�N CHECK 25% $�
Information is mrrect. I agree o complY�with au dty antl wunty ortlinances ELECTRICAL $ GRADING 5
antl state laws relating to bu' tling�con �uction, antl hereby aumorize repre- p� MICROFILM 5
sentatives of this city to er o the abov -mentlonea prpperty tor , PLAN CHECK 50% T-}—
inspection purposes. L v �
Signature Data ��)ls a MECHANICAL S TOTALFEE $ �
Drivers' License or 55 � Rainspection Fee $15 Issue Pee - $ 3 PLAN CHECK 25% $
MF 0865-46, �e�. 10/84 White - Builtling: Canary - Applicant; Pink - Accountin9: Goltlenrotl - Assesso� �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole ' 2. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. �
70. Structural Floor System 61. APPROVAI TO DECK
17. Property Sewer 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. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring � � 67. �encing & 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 OGas ❑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 J8. 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 pomestic-Final
42. Backflow Preven[er , '
43. Backflow Irrigation
44. Landscape Irrigation 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 , ��
;: .
AOP���ant to /ill in ail svaces ezcept those within neavY oorGer lines antl sign all avPropriate aec�arations.
CITY OF;COSTA MESA CONSTRUCT ON PtFiMI I PEFIMIT NO. TRACT NO. LOT NO. �UNIT NO.
ProieciAddress �_LL �
' AFj,licant's Mailing Address � r� w�i ��(' ��
Owner's Na�m(�e}^y-t�il�-rz.is t�-tro n'- Fi1-llN�� Pn�/A �'h( '� /`
Address "<'`� G�r��'U �-��i/ �
Arch/Eng. License No.
Address
Contractor's Name _ Phone
Address Imailing)
Ciry License No.
LICENSED CONTRACTOR DECLAH/>TION '
I M1ereby affi�m that I am licensetl untler provislons oi Charter 9(commencin9
with section 7000) ot Oivision 3 of the Business antl Protessions Cotle, antl
my license is in fuil torce antl efiect.
License Class License No.
Date Signature
'ORKEHS'COMPENSATION DECIARATION
,ereby atfirm that I have a certiticate of consent to seltdnsure or a certificate
..t Workers' Compensation InSurancC, or a certifietl copy thereot (Section
3800, Lab. C.) �
Policy No. Company
eCertifietl copy is hereby furnished.
Certifietl copy is filetl with the city Builtlin9 Division.
Date Applicant
EXEMPTION FpOM WORKERS' COMPENSATION DECLA0.ATION
(TM1issection need not be completetl if the permit is for one huntlr¢tl ($300) or
I¢55). /
I certify tM1at in the performanc¢ o( [he w YI< ( r w�h this pe�mit Is issuetl, I
shall not employ any person In any ma e so to become subject [o the
Workers' Coi{ryensatip s ot Califor i , L. . / ��
Date '��� Signature _ LL<F�
NOTICE: If, after makm this tlecla� /ou shoultl become subjeci to the
Workers' Compensation provisions f the Labor Cotle, you must forthwith
wmply with such provisions tnis permit Shall be tleemetl revoketl.
CONSTRUCTION LENDiNG AGEN�Y
I hereby affirm that there is a construGtion Ientling agency (or the performance
of [he work for wnicn this perrriit is issuetl (Section 3097 Civ. G.)
Lentler's Name
Lentler's AGtlr¢ss
OWNER BUILOER DECLARATION
I hereby aftirm ihat I am exempt fram the Contractor's License Law for the
following reason (Section �031.5 Business antl Professional Cotle: Any ciry or
county whlch requires a permit to construct, alter, improve, demollsh or repair
any structure, prior [o its issuance, a�5o requires [he aOP�icant for such permit
to file a signetl Statement that he/shi is licensetl pu�suant to the provisions ot
� Contractor's LicenSe Law (ChaptEr 9(commencing with Section 7000) of
ision 3 of the Busine55 antl Professions Cotle) or that he/she is exempt
refrom antl the basis far the allegetl exemption. Any violation of'Section
.o31.5 by any applicani for a p6rmit subjects tne applicant to a civil
pendlty of not more than five huntlretl tlolla�s ($500).
❑ I, as owner of the property or my employees witlt waqes as their sole
compensation, will do ihe work, and the structure is not intentletl or offeretl
for sale (Section ]044, Business aPtl Professional Cotle: The Contractor'S
License Law tloes not appry to an oWner ot a property who builtls or imo/oves
tbereon, anC who tloes 5ucn work bimselt/herself or thraugh his o� her own
employee5, provitletl that such impr0�ements are not intentletl or offeretl for
sale. If, howeveq the builtling or im0�ovement is Soltl within one yea� of com-
pletion, e owner will have the bu�den Of proving he/she tlitl no[ b W Itl or Im-
rove f the purpose of saie):
s own¢r of tM1e prope�ty, am Cxclusively contracting with litensetl con-
CIOIS i0 COOSIYUCi Lh¢ pYOjEC[ (SECPnOL aO44� BI151O255 dOd PlOi2551005 COCE:
The Contractor's License Law tloes PPIy to an owner ot prope�ty who
builtls ot impwves lhereon, antl who contracts for such prolects with a con-
tractor(5 ucense pursuant to tlte Co�«acto�'s Litense Law). 1 am aware that
proof o� their Worker's Compensatio� insurance shoultl be provitletl to me.
❑ I am eKempt untler Section— B. & P. C. for this reason
Date -7L ^�IAHs- -
I nereby certity tha
information is correc
antl state laws relatii
SCII(dIIV¢5 Oi I1115 CI
inspec[ion purposes.
Siqnature .
Drivers' License or
1F 0865-46,rev. 10/84
a
above
IdfICCS
G 2£'s 66¢
TVPE OF CONSTRUCTION NEW ADD ALTERATIp/py�, REPAI R
� O CONVERSION ❑ DEMOLISH ❑ OTHER �R.��� `-'^'U�1
DESCRIPTION OF WOftK/USE OF BLDG. —�
TVPEOFPERMIT GRADING FOUNDATION ❑STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq. FT. pcCuvarvcv
CONSTRUCTION TYPE VALUATION S _
ZONE � GRADING CU. VDS. ACRES_
Remarki:
Sink
Irrigation
Jrinking Fountains
=1oor Drains
Roor Sinks
Gas Service Ouilets
Interceptors
Kitchen Sink
Lavatories
P—Trap
RoOf Drains . �
Reinspection Fee � $15
Boiler
Duct- Under Ground '
Duc[ - Structural
Duct-Ventilating '
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ductin9
❑0-100,000 BTU 0100,000
oa,zv �tu �£ 6
' Reinspection Fee $15
; Canary - Applicanq Pink - Accountin9: Goltlenrotl - Assesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water $ervice
Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑t00,0008TU
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
A.P. #
S Main Building:
E
T Front
B Rear
A
C Right
S Left
PIn9. Ref. #
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
as LJElectric
Fan
F.A.U.
Fixtures
Device Bozes
Outlets
Switches
Garbage Disposal .
Generaror DO-5 KW
8842 6/C2/?7
Zone
Accessory Building:
Parking Req.IProvided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 700 amps
Sub Panel
Motors 00.1 HP 01'f. - 8
Inc.Solar �9-15 HP �i6-15+
Microwave
Pole Light
Range
� I Standing Sections
5 KWr I Trash Compacmr
$ 3 I
—�— Reinspection Fee $15 Issue Fee
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
Buildin9 Approved By �
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP _
PLAN CHECK $ PERMIT
PLUMBING $ S. OC �SSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ � GRADING
PLANCHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $
$
Pof,, i�
FEES
$ 3
$
$
5
$
$ 8.00
Z
O
N
1
N
G
R
E
Q
M
T
S
CONSTRUCTION AND PLANNING POOL & SPA �
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
i: 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�R 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 & Receptor-Final
12. Sewer Cap C���� G� 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
76. Rough Electric Wiring . 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOUSPA SYSTEMS FINAL
19. Rough Heatiny & 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.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. FIXEDSYSTEMFINAL
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��y� (�L�) ,
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final '
42. Backflow Preventer �
43. Backflow Irrigation �' � �
44. Landscape Irripation System
t
45. Sound Attenuation ' �
46. Handicap Regulations . ' �
47,.-FINALSTRUCTURE&BUILDING � �
48. Special Requirements Completed
.
49. Electric Release to Edison ��
50. Gas Release to $outhern California Gas Co � .
.�
51. CERTIFICATE OF OCCUPANCY � �
No. Date ,
CI
Applicant to fill in all ipates exeept t�ose wit�in heavy bor0e� Ilnes anC sign all appropriate tleclarations.
CITY OF COSTA MESA CONS UCTION PERM�T P MIT NO. TRACT LOT NO. UNIT NO.
Project Address � t � " � ��� 1 �
Applicant's Mailing A r¢55 �{�� C TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
Ownef'SName �rFHone � � CONVERSION ❑ DEMOLISH ❑ OT�{I-6R A p �6
DESCRIPTION OF WORK/USE Of BLDG. I�'s�4 L�NCL •
Address � L - S Main 8uildi
Arch/Eng. � License No.
Address � (� f�
Convactor's Name � r � Phone
Address (mailing) �
Ciry License No.
IICENSED CONTRACT00. DECLARATION
I M1ereby affirm that I am licensetl untler provisions of Charter 9(commencin9
with secUon ]000) ot Oivision 3 oi the Business antl Protessions Cotle, antl
my license is in (ull torce antl et/ect.
License Class License No.
nate Signature
`RKERS' COMPENSATION DECLARATION
:reby af/irm that I have a cerlitiWte o( consent to selLinsure or a<ertificate
of Workers' Compensation Insurance, or a certlfietl copy thereof (Sectlon
3800, Lab. C.)
Policy No. Company
8 CertilieC cooY �s hereby fumishea.
Certifletl copy IS filetl wi[h the tlty 8uiltling DIvISIon.
Date Appllcant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(TM1issection neetl not be completetl If the permit is for one M1untlratl ($100) or
less). q
I cevlity tM1al in e rtormance ot the work for wh�t f`5 perm�t is lssuetl, I
snall not empl a person in any manner so tome subject to the
WOrke 5' Co ' w5 of Calitytnla. �
Dat� Signalure �
NOTICE: aft makinq �his tleclaration, 5 o bero subjecl to tM1e
Wotkers' ompensation provi5ion5 of the or Cotle, you must lorthwith
compty wilb such provisions or this mit shall b¢ tl¢¢metl revoketl.
CONSTRUCTION LENDING AGENCV
I nereby affirm that [here is a consiructi n lentling agency for tne performance
of tht work fo� which th15 p¢r is Issuetl ($ection 309] Civ. CJ
Lentler's Name
Lentler's Adtl�e55
OWNER BUILOEH GECLARAT ON
1 hereby at(Irm that I am exempt irom the Contractor's License Law for the
following reason ($ettlon 7033.5 BuSiness antl Profezsional Cotle: Any clty or
county whlch �equires'a permlt to const�uct, alter, Improve, tlemolish o� �apair
any 5trucWre, priOr to•its i55uance, also requires lhe appliCan[ fo� such permit
�� tile a signetl slalemenl that ne/she is licensetl pur5uant to ttle provisions of
Con[raclor'S Literee Law (Chapter 9(commencing witM1 SeCtlon 7000) of
5ion 3 of the Business antl Professions Cotle) or that he/she Is exempt
:efrom antl th¢ basis for thC allegetl exemption. Any violatlon of SeCtion
iU31.5 by any applicant for a permit subjects tho applicaM to a civll
p¢ y of not more than five huntlretl tlollars (5500).
�as owne� of thc O�operty or my employees with wa9es as lheir salo
Coenpensation, will tlo the wo�k, antl Ihc slructura i5 no[ IntenCetl or ofte�etl
tor sale (Sec[ion J044, Busin¢55 antl Protessional Cotle: The ContraCtor'S
License Law tloes nol apply to an owner of a property who builtls ov impwves
[nereon, antl who tloes such work himself/herseH o� through his or h¢r own
employees, provitletl [hat such improvements are nol in[entletl or offoretl Por
SaIC If, howev¢r, tne builtling or imp�ovement is soltl within one Yea� of com-
pletion, the owner will have the burtlen Of p�oving he/she tlItl ml builtl or im-
prove for lhe purpose of sale).
❑ 1, as owner oi the property, am exUusively contracting with Ilcensea con-
tractors[o constructlhe project (Section 7044, Busine55 antl Prote55ion5 Cotle:
The Conlractor's LicenSe Law does not appty to an owner of proporty who
builtls or improves thereon, ana who contracts for such projects with a con-
tractor(s) iicense pursuant to tne Contractor's License Law�. I am aware that
proof of Iheir Worker'S Compensation Insurance shoultl be prOvitletl to me.
❑ I am exemo✓und�r Se<tion , /� �. & P. C. tor this reason
Oate '�!_L,C
I hereby�6rtir� I
iNormatldn is <or
antl state laws rel
5¢llldt�IVCS Of Ih15
inspectlon purpos�
SignaturE
Owner
ng
Drivers' License f/i 55 $ /�'
AF 0865��/84 White - Bulltling; Canary
TVPE OF PERMIT lJ GRADING YJ FOVNDATION L"J STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PIVMBING ❑ MECHANICAL
❑ OTHER
PROJECT OESCRIPTION Sa. FT. ocCUaANC/y�
CONSTRUCTIONTYPE VALVATIONS �VLO
ZONE GRADINGCU.VDS. ACRES—
Remarkz:
Sink
<flow Preventer
<flow Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outiets
Interceptors
Kitchen Sink.
Lavatories
P—Trap •
Roof Drains
Reinspaction Fee � $15
Boiler
Duct - Under Ground
Duct - Strucmral
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. IC80 #
Heating System & Ducting
❑0-100,000 BTU 0100,OOOBT
Reinspection Fee
; Pink - Accountin9: Goltlenrotl - Aszessor
$15
ir,ir.�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto�Wash
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000eru ❑ioo,000ar
System fiepair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
$ 3 � `
E
T Front
8 Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Suh.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generamr �0-5 KW �5�'
Fee
2753 I/07/8d
Z � ` Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Mecer ❑over 100 amps
Sub Panel
Motors �0-7 HP 07'h - 8
Inc.Solar �9-15 HP �16�15+
Microwave
Pole Light
Ranoe
15,61 TL
FEES
Standing Sections
5 KW Trash Compacror
$15 Issue Fee $
Z
O
N
1
N
G
R
E
�
M
T
S
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By ���� Date �
Building Approved By Dato
Application Issued By Date ��
SUMMARV OF FEES
BUILDING PEFMIT $ j3 •.V'0 SMIP $ • S�
PLAN CHECK $ —a„r�f_ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. 3
ELECTRICAL $ GRADING' $
PLANCHECK 50% $ MICROFILM $ ��' ��
MECHANICAL $ TOTAL FEE $ _L��_
PLAN CHECK 25% $ . �
CONSTRUCTION ANDPLANNING P�C ��SPA
APPROVALS Permit# • Date Inspector qppROVALS Permit# Date Inspector
1. TemporarY Electriral Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd>�. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE �
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation _ 59. Gas Pipe, O Undrgrnd., Tesf-'
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK °
11. Property Sewer 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. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SVstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wi�ing 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 Fraining 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 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final S0. 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 pomestic-Final
42. Backflow,Preventer
43. Backflow Irrigation _
44. Landscapc Irrigation System �
45. Sound Attenuation
46. Handicap Regulations
47. FIIVALS7RUCTURE&BUILDING � �d �✓ � �
Oo
48. Special Requirements Completed �
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date
Aoalicant to flll in all soaees exeeo� those within heavy boraer lines anG sign all aov�opriate eeclarations.
ciTV OF coSTr�n� C NSTRU 10 PERMIT
� I%
P,�,oject Address �
r�ApplicanYs Mailin� �A�7dd�/re�ss� �,,���
Owner's Name ��:f/JI.l�1! !!1L_Phone �
Address
Arch/Eng. License No.
Address
Contractor's Name Phone
Address (mailing)
City License No. �
LICENSED CONTRACTOR DECLARATION
I hereby atiirm that 1 am licensea untler provislons of Charter 9(commencin9
with section 7000) of Dlvislon 3 of tha Buslness antl Professions Cotle, antl
my license is in full force antl effect.
License Class licen5e No.
Date Slgnature
WORKERS' COMPENSATION DECLARATION
I hereby afflrm thal I have a certificate o( conzent to self-insure or a certiflcate
of Workers' Gompen5a[iOn Insurance, o� a certitied copY Ihereof (Sec[iOn
3800, Lab. C.) .
Policy No. Company
BCertifietl copy I5 hereby furNzhetl.
Certifietl copy isliletl with IM1e city Builtling Division.
/Oate AppliCant
EXEMVTION FROM WORKERS' COMPENS9TION DECLFRATION
(Thizsec[ion need not be completetl if the p rt isttt or one huntlretl ($100) or
IC55). //////
I cer[ify that in the perfOrmance of tne o�k oyy6hich thi5 perm�t is i55uetl, I
shall not employ apy Pe�son in any an 94� s fo becom iect to the
WorkerS' CofiRepsall�fJ�awS of Cali r /U�/Aw i
NoI�ICE: l4, �e�ter m�/ng this tlecla ' n, you shoulE become subject to the
Worker5' Cortlpensatio�� provisio of the Labor Cotle, you musf torthwim
comply wlth such provisions r this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby atllrm thal there is onstruction lentling a9ency for ihe performance
of tne work tor wbich this permit iz issuea (Sectlon 309] Civ. CJ
Lentler'z Name
Lentler's Atlaress
OWNER BUILDEN DECLARATION
I hereby aflirm that I'am oxempt irom tne Contrac[or's License Law for ihe
tollowinq reason (Sectlon ]031.5 Business an0 Crofessional Cotle: Any city or
<ounty whi<h requires a permit lo con5truct, alte�, Improve, tlemolish or repair
any stru<ture, orior to its Issuance, also requires the applicant for such permit
to fil¢ a signetl Sta[ement that M1e/She I5 IicenSCtl pu�suant to Ih¢ Provisions of
(he Contraclor's License Law (ChaO�er 9(commencing with Section J000) Ot
DiviSiOn 3 of the Bu51ne55 dntl Pfote55ions Cotle) of ihdl he/she Is ex¢mp[
therefrom antl tlte basis for tM1e allegetl exemption. Any violation of SecHon
7031.5 by any applican[ tor a permit suble�ts the applicani to a tivil
eenalty of not more than five huntlred tlollars ($500).
LJ 1, as owner ot tno property or my employees with wages as their sale
comp¢nsation, will �o the wotk, antl ihe ztructure is not intentletl or oftered
for sale (Section 7044, Business antl Professional Cotle: The Contractor'z
License Law tloes not appty to an ownar ot a properry who builtls or improves
thereon, antl who tloes such work himself/he�selt or tnrough bis or ner own
employees, provltletl that such improvemenis are not intenaed or oiterea for
sale. I/, however, [he builtling or improvement is soltl within one year of com-
pletio , the owner will have the burtlen of proving he/she tlitl not builtl ar im-
pro forthe purpose of sale).
I, as owner of the property, am ezclusively contracting wifh licensed con-
tractorsto consVuct the project (Section 7044, Busine55 antl Professions Cotle:
The Contractor's License Law does nol apply to an owner of property who
builtls or Improves thereon, antl who contracts for such projecis with a con-
tractor(s) ucense pursuant ro[he Contracto Li ; se Law). I am aware [hat
J prooi of Ih¢ir Worker'S COmpensation m u, c M1oultl be provitletl to me.
❑ I am exempt untle� $ecUon B. & P. C. far is reason
�._ n i
Signature
Drivers' Licen or 55
CMF 0865-46, �ev. 10/84
Owner
White �- Bui
tion antl state that the above
all city antl county ortlinances
i. antl herebv authorize reore-
T
0
TVPE OF CONSTRUCTION LI NEW IJ ADD LJ ALTERATION LJ REPAIR
�❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p#
DESCRIPTION OP WORK/USE OF BLDG.
S Main Building:
E
TVPE OF PERMIT GRApING FOUNDATION STRVCTURAL T Front
❑ TENANT ❑ ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL � B Reef
❑ OTHER %�
PROJECT DESCRIPTION Sp. FT. OCCVPA Cv C Right
K Left
CONSTRUCTION TYPE VALUATION 5 g
ZONE GRApING CU. VDS. ACRES P1n9. Ref. #
Remarkz: / " Planning Notes:
I iJ�/iL, � _7 7LZ%% . / %.l
Sink
iflow Preventer
kflow Irrigation
Clarifiers
Drinking Founiains
Floor Drains
Floor Sinks
Gas Service Outlets
Incerceptors
Kitchen Sink
Lavarories
Roof Drains
Reinspection Fee � $15
Duct-UnderGround
Duct - Structural
Duct � Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,000
Reinspection Fee
Appliwni; Pink - Accounting; Goltlenrotl - A55assor
$15
Showers
Service Sink
7—
Sewer Cap
Sewer Connection -
Solar Colleciors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
luue Fea
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑ 100,000 BTU
System Repair/Alteration
Fire Dampers �
Registers
Issue Fee
FEES
5972 4/13/B7
Zone
Accessory Building:
ELECTRICAL .
Automatic Washer Transformer ❑ 15-50 KW
ConstructionPoleSub. ❑ 50+KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
FixWres
Device Boxes .
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW �5-75 KW
23000 TL
Z
O
N
1
N
G
H
E
Q
M
T
S
Meter ❑up to 100 amps
Me[er ❑aver 100 amps
Sub Panel
Motors�0-1 HP�1'/.-8
Inc.Solar �9-15 HP �16-75+
Microwave
Pole Lighc
Range
Sign
Standing Sections
Trash Compactor
$ 3 I
�� Reinspection Fee $15 Issue Fee
FEES
T DEVELOPMENT SERVICES REQUIREMENTS:
I 2anin9 APProved By
� Building Approved By .
� Appliwtion Issued By
$ 3
SUMM/+p/ RVAF FEES
BUILDINGPERMIT $ �J���� SMIP
PLAN CHECK $ PERMIT
PLUMBING $ �— ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLANCHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $
FEES
$ 3
$ , S(7
CONSTRUCTION AND PLANNING POOL & SPA
APPROVAL$ Permit# Date Inspector 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 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, 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
15. Rough Electrical-Conduit 66. Solar SYstem-Final
76. 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 OGas ❑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. Dfy Chemical
27. Frameand Flashing , 76. DryStandpipe
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 pomestic-Final
42. Backflow Preventer '
43. Backflo� Irrigation - �
.44. Landscape Irriqation System �
� 45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING � � /'�.
C�
4 . Special Requirements Completed � �
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - K
No. Date f
(-
Applicant to fill in all spaces exceD� lhose within heavy borEer iines anC si9n all ao0rooriate tleelarations.
C17Y�OF COSTA MESA CONSTRUCTION PERMI/�T R PERMIT NO. TRACT NO. LOT NO. UNIT Nn _
, Project Adtlress z�'Zy EL:.1�-h/ �1VG n� V�
'Applicant'sMailingAddressJ`st= yA'I.�LA��NO AVE iQ-ICYD
Owner'sName%?uQ)5/MO N' [dL� A PhoneSS�✓'3gs�
Address � SAM�- L!G
Arch/Eng. -%�Y��ENCS LicanseNo.Zloiel / '
nddress 13ZO GAV1c7T�+ AV E. LONC+ b'ERGtI 9af
Contractor'sName ��g , PhoneSSG�3RBO
Address (mailing) Sa�%��
City License No.
IICENSEO CONTRACTOfi DECLARATION
1 M1ereby aftirm that I am licensetl untler provisions o/ CM1arter 9(commencing
with section ]000) of Division 3 ot the Busine55 antl Prote55ions Cotle, dntl
my licenze is in tull fo�ce anC effect.
License Class Licgnse No.
Date Signature
WORKE0.5' COMPENSATION DECLARFTION
I nereby atfirm that I have a certificate of consent tb self-insure or a certificate
of Workers' Compensation Insurance, or a certlfietl copY thereof (Section
3800, Lab. C.) '
Policy No. ' Company � ,
Certifietl coOY is hereby tumishetl.
Certifletl coDY is tiletl with the city Builtling Div�sion. �
Date Applicant
EXEMPTION FROM WORKERS' COMPEN ON DECLARATION
(Thi55ection neetl not be completetl if the rmi or one nuntlretl (5300) or .
Icss).
I cerlify [hat in the pertormance of Ihe o�k hich thi5 pe� t is i55uetl, I
shall no[ employ any person in any m n o 0 o subjec['to the
WolkC1Y Qampepsa�¢dw5 of Galit '
NOTIC�: If, aiter maki�g this tleclara n, you shoultl become subject to the
Workers' Compensation provisions the Labor Code, you must forthwith
mmpty with such provisions or his permit shall be tleemetl revoketl.
CONSTRUCTION NDING A NGV
I hereby affirm that ere/fs a construttio lentli g d9ency the perf rmance
of the work f �iE�.t1�i5 per jrt �' s .(Sect 30 7 ' C.)
Lentler'S Nam —� �—N.� �� �
�entler'sAtltlress � ��µK`� � y
OWNER BUILD R �ECLA0.ATION
I hereby affirm that I am exempt trom the Contractor's License Law tor the
rollowing reason (Section 7031.5 Business antl Professianal CoOe: Any ciry or
county wM1ich requires a permit to construct, alteq {mp�ove, tlemoliSM1 or �epair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signetl statement that he/sne is licensetl pursuant to tne provisions of
tne Con[ractor's License Law (Chapter 9(commentin9 �+�<h Section 7000) of
Divlsion 3 ot the Bu5ine55 antl Professions Cotle) or that he/she is exempt
:ner¢from antl the basi5 tOr the all¢getl exemptiory, qny violation of Section
]031.5 by any applican[ for a permit subjec[S the applicant lo a civil
pe�dlty of not mo�e Ihan five huntltetl tlo11ar5 (5500).
❑ I, a5 owne� of the p�operty o� my employeQS with wages as [M1eir Sole
comp¢nsation, will tlo the work, antl the st�uctur@ is not intentled o� otf¢retl
for.sale (SeGtion 7044, Businezs antl Protessional Cotle: The Contractor's
License l2w tloes mt appty to an owner ot a property who builtls or improves
th¢rEOn, antl who tloes SucM1 work himselt/herseif or through hIs or her own
employees, provitletl [hat such improvements are not intentled or offeretl tor
sale. It, bowever, the builtling or improvement is soltl within one year of com-
pletion, the owner will have the burtlen of p�oving he/she tlid not builtl or im-
p�ov0 to� the putpose of sale).
❑ I, as owner of the pro0erty, am ezclusively contractlng with Ilcensetl con-
Vactor5 t0 construct the project (Section ]044, Business antl Profe55ion5 Cotle:
The Conl�actor's License Ldw tloes not apply to an owne� ot Property who
builtls or improves tnereon, antl who con[racts tOi Such projec[5 with a con-
tractor(z) iicense pursuant to the Contractor's License Law). I am aware mat
proof of Iheir Worke�'S Compensation insurance shoultl be provitletl to me.
❑ I am eaempt untler Section _ 8. & P. C. tor this reason
Inspectiong� rpos s.
Signaturc/
Drivers' Licens r 5'_
CMF OB65-46, rev. 10/84
all
g 287Db !l / ft ' t5
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER A p # L':�
DESCRIPTION OF WORK/USE OF BLDG.
S Main Build
TYPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front �
,3 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL B Rear
❑ OTHER A
�%PROJECTDESCRIPTION SQ.FT. � Z oCCUaarvCV.�— '—I C Right
CONSTRUCTIONTVPE VALUATION$ �2 / �L g5 $ Left
ZONE - GRADING CU. VDS. ACRES Ping. Ref. # C
� Remarks: A/1 � I/nn ��S%�i , Planning Notes
B'ar Sink
Backflow Preventer
Backflow tr�igation
Bathtubs
Clarifiers
Dishwasher
Orinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors . _
Kitchen Sink
Lavamries ; �
>
P—Trep .
Roof Drains _ - .
Reinspection Fee � $15
Boiler
Duct- UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Mul[iple ❑
Firepl/Fact. elt. ICBO #
Heating System & Ductin
❑0.100,000 BTU �19 ,OOOBT
— ��� I I Reinspection Fee I $15
White - Building; Ganary - qppllcant; Pink - Accounting; Goltlenrotl - Assessor ,y
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9�
$wimming Pool w/Spa
Urinal
Water Closet
Water Hearer
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
efrigeration System
] j100,0008TU ❑100,000
�ystem Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
'o s2 -
5�'�b C
., ri
/v / y7rl
58�
�-$"T-O
�On��-r �
Automatic Washer �
Construction Pole5u6.
Cookinq Unit '
sa�:i -i�, i
Zone `%Z Z
Flccessory Building:
Parking Req.IProvided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Dryers LJGas LJElectric
Fan
F.A.U.
Fiztures
Device Boxes
Outlets
Switches
Garbage Disposa
Generator ❑ -5 KW �5-15 KW
Met¢r ❑up to 100 amps
Meter ❑over100amps �
Sub Panel /�
Momrs�01 HP�1'/:-8 .
I . olar �9-15 HP �i6-15+
Microwave
Pole�Light
Range
Sign
Standinq Sections
FEES
Z
0
N
I
N
G
R
E
Q
M
T
S
$ 3
Reinspection Fee $15 Issue Fee $ 3
FEES
��DEVELOPMENTSERVIC UIREMENTS:
Zoning Approved By �� Date ��- 3- 8 7
Building Approved 8y Date�
Appliption Issued By Data
$ 3
SUMMARV OF FEES -
BUILDING PERMIT $ '44� •�0 SMIP $ g• SS
PLANCHECK31g•i�'$ _ 7�%.�%� PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ � MICROFILM $
MECHANICAL $ TOTAL FEE $ 5l 8.11.
PLAN CHECK 25% $ �
'CONSTRUCTION,ANDPLANNING � POOL&SPA
APPROVALS Permit # Date Inspector 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 Gmd. � y �✓ 57. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd.
8. Foundation Y /✓ 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
70. 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 �
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.StorageTank OGas ❑Oil
25. Roof Sheathing, � 6 �,/ 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat . 75.. Dry Chemical . \
27. Frame and Flashing �, � 76. Dry Standpipe
28. Lathing & Siding 0 �(V . 77. FIXED SYSTEM FINAL
29. Insulation �S G/✓. 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 NoceS: FOR�SP�CIALREQUIREMENTS
34. Final Heating & Air Conditioning .Q�� � O� G�.✓��
35. Final Gas Pipe-Test
t6 P �T: C+. /'�'
36. Hood or Canopy 7 •� AQ
37. Final Factory Fireplace I„"I 88 �
38. Final Plumbing
39. Water Service-Final • �
40. Gas Service-Final - , „
47. Solar pomestic-Final � �
42. Backflow Preventer
43. Backflow Irrigation _ � • ' �
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations � �
47.�FINALSTRUCTURE&BUILDING { �,��-��U
48. Special Requirements Completed � j'
49. Electric Release to Edison '.
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY � .
No. Date
i .
\� . � A
CiTv oF COSTn mESA CONSTRUCTION PERMIT
Projb'ttAddre:s %-1a-�1 E���Cr �7�
Applican{'SNAailinPg Addres �S3`t Y�(>`�Qb�/l0. S
OW.�er'sName `�r°`�� CG 4."'�� Phon�'���3�
Address
Arch/Eng. License No.
Address
Convacror'sName v""`5 �k�` '�� Phoneby�'���5
Address (mailing) Is3q Ma `'�Qo V ��-.
City License No. �� 1 Z� �
LICENSED CONTRACTOR DECLARATION �
1 hereby atfirm [hat I am licens¢tl untlGr provisions of Char[er 9(commencing
with section 7000) ot DIvi5lon 3 ot t�e Business antl Prof¢Ssions Cotle, antl
my ii<ense is in tu � rce and enect. �LZ� �
License Class L�ense No.
Date 7 —�$-91 Siqnature
WORKERS' COMPENSATION DECLARATION
1 hereby aHirm Ihal I have a cMti(ita[e o( consent to seli-insure or a certificate
of Worke�s' Compensation Insurance, or a certifietl copy lhereot (Section
3800, Lnb. C.)�f ryf.��
Policy No. / ��"D�O � Company �' —' ` �
Certifietl copy is hereby furnishea. /�
ietl opy � filetl with the City B,��'ry'y(� n�g },./�/'vl n. �,
Date_�—��`�� Applltan[ �✓`�Ir�
EXEMPTION FROM WORKERS' COMGENSATION DECLARATION
(Thi55eClion neetl nOt be complatetl if [hC permi[ is faf One huntlretl ($300) ol
less).
I certify that in tbe pe�fo�mance of th0 wOrk fox which tM1is perm�t is i55uetl, I
shall not employ any persOn in any rt �n �s to become subject to the
Workers' Compensatlon �aws ol CaliPo
Date Slgna[ure
NOTICE: If, after making tnis declaration, you shoultl become subject to the
Workers' Compensatlon provisions of the Labor Cotle, you must torthwith
comply with such provislonz or lhis pe�mit shall be tleemetl vevoketl.
CONSTRUCTION LENDING AGENCV
I he�eby affirm lhat the�e Is a consVuctlon lentling agency for the Oertormance
ot th¢ work lor which ihi5 p¢rmit i5 issultl (Sectlon 309] Civ. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILDEN �ECLARATION
I hereby affi�m lhat I am exempt irom [he Cont�actor'S LI<ense l.aw to� tM1e
followin9 �reason (Sectlon 7031.5 Business antl Professional Cotle:'Any city or
counry which requi�es a p¢rmil to cOnst�ucl, dllGr improve, tlemolish or repai�
any sV ucture, oNor to its Issuance, also requires t�e applitant tor such permit
to file a signetl Sta[ement lhat he/She is Ilcensetl pursuant to the provisions of
the Contracior's License Law (ChaO�er 9(commencing wilh Section ]000) of
Division 3 of [he Bu5ine55 antl P�ote55ion5 COO¢) o� tnat M1e/she is ezempt
herefrom ana lne basi5 t0/ lhe allegetl exemptlon. Any viola[ion of Section
'031.5 by any applican[ for a Pe�mlt subjecl5 [he applicant to a civil
��enalty ot not mor¢ tnan tive huntlretl tlollars (§500).
I, as owner of lM1e propor[y or my employees with wages as thei� sole
I�ompen5ation, will tlo'the work, antl tne stru<ture is not intentletl or otteretl
for sale (Section 7044, Businesz anC Professional COCe: The Contractor's
License Law tloes not appry to an owner ot a property wno builtls or improves
tbereon, antl who tloes such work himselt/herselt or tnrou9h his or her own
employee5, prOviDetl that Su<h improv¢ments are not in[entletl o� otferetl for
sale. I/, hOwever, the bulltling or improvement Is soltl wlthin one year of com-
pletion, the owner wlll havo Iho burtlon of proving he/she tlitl not builtl or im-
prove for che purpose of sale).
❑ 1, as owner Oi the 0/operty, am exclusively con[raciing with lic¢nse0�con-
tractors to comtruct the project (Section �044, Business ana Professions Cotle:
The Contractor's Licensa Law tloes not apoly to an owner ot property wno
builtls or improves lh¢reon, antl who con[racts for such projects with a con-
tractor(S) I¢ense pu�suant [o the Contractor's License Law). I am aware that
proof of thelr Work¢r'S Compensatlon insurance shoultl be provltle0 to me.
❑ I am exempt untler Sectlon B. & P. C. !or this reason
Date
I hereby certify tba
information is cOrtec
antl state laws relatii
sentatives of is ci
inspectian purp ses.
Signature
Drivers' License or 5:
CMF 0865-46; rev. 30/84
_ Owner .
have reatl
a9ree lo c
o builtlin9
to ,epler
pplicant ta fill in all s0ates exce0� t�ose within heavy borAe� Iines antl si9n all appropriate Oeclarations.
PERMIM T'NO." /1����� TRACT NO. LOT NO. q��,
��+o—a {
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
.D ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p �6
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TVPE OF PERMIT GRnoiNG FOUNDATION ❑ STPUCTURAL . T Front
' O�TENANT ❑ ELECTRICAL PWMBING ❑ MECHANICAL B Rear
❑ OTHER %�
PROJECT DESCRIPTION Sa. FT. ocCuanNCv C Right
K Left
CONSTRUCTIONTYPE VALUATIONS $
ZONE GRADING CV. VDS. ACRES Ping. Ref. �k
Remark � '�Q (J �ij Planning Notes:
Sink
Prevenrer
Irrigation
7rinking Fountains
Floor Drains
Floor Sinksv �
GasService /O Outlets
InterCeptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fea � $15
Boiler
Duc[ - Under Ground
Duct - SVuccural
Duct - Ventilating
Exhaust System � Multiple
Firepl/Fact. BII. IC80 #
Heating System & Duj� '
❑0.100,000 BTy�100,000
Fee � $15
White - BUIltling: Canary - Appllcant; Pi�k - Accounting; GoltlenrOtl - Asse55or
PLUMBING
Showers '
Service Sink �
Sewer Cap '
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
'�,. Water Heater
Water Service
Auto-Wash
Isue Fee S 3
Automatic Washer
Construction Pole Sub.
Cooking Unit �
Dishwasher
Oryers ❑Gas ❑Elec1
Fan
F.A.U.
Fixtures
2��% %���/.�
2one
Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
ELECTRICAL
Trensformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 700amps
Meter ❑over100a
Sub Panel
KW �5-15 KW
HPO1h-8
15 HP 016-
Pole Li9ht
Range
Sign
S[anding Sections
Trash Compactor
Reinspection Fee $15 Issue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESRE�UIREMENTS:
ypel ❑
Canopy Type I I � Zoning Approved By
e�ud�oa Ava�oved er
tefriaeration Svst Application Issued Bv
❑0.700,yw o i U ❑100,000
�tem Repair/Alteration
Fire Dampers
Registers
luue Fee $ 3.
BUILDING PERMIT $
PLAN CHECK $
PLUMBING $ �
PLAN CHECK 2596 $
EIECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLANCHECK 25% $_
FEES
$ 3
SMIP $
PERMIT
ISSUANCE $
ENERGY P.C. $ �
GRADING $
MICROFILM $ �Q'
TOTAL FEE $ �V"
CONSTRUCTION ANDPLANNING � POOL&SPA "
APPROVALS Permit # Date Inspector 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 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 � � a, 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. ROOUSPA 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.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme and Flashing �, 76. Dry Stan�pipe '
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: /� F� �.�
34.' Final Heating & Air Conditioning '
�
35. Final Gas Pipe-Test � �; �
36. ,Hood or Canopy
37. Final Factory Fireplace �
38.�FinalPlumbing � � �
�
39. Water Service-Final � '
40. Gas Service-Final �
41. Solar pomestic-Final •
42. Backflow Preventer �
43. Backflow Irrigation ' , �- � '
44. Landscape Irriqation 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 z �
No. Date '
\
AVG���ant to fill in all spaces ezceot those within heavy borCer Ilnes ana si9� a11 avG�opriate aeclarations.
CiTY oF COSTa MESa ' COSTR UCTION PER
Project Address 'z �'��. �= L fl�'`� �
Owner'sName -.{?�+��� LU'UJ4N"!a phone ��
Address — �
Arch/E-,. License No.
Address
Contractor's Nam � p5 E�� ST/� Phone csa-�bvy
Addresslmailingl—�S�b�/�{[Jrlreu/q (L!y .�l�uLL.� &at <<.4ffi
Ciry License No. � �'23� �
LICENSED CONTRHCTOR DECLARATION
I nereby aftirm that I am Iicensetl untler provisions of CM1arter 9(commencing
with section ]000) of Division 3 ot [he Business antl Professions Cotle, antl
my license is in tull force antl eftect. O ./
License Clas — LI ens o
Date � Si9nature
WORKERS' COMGENSATION DECLARATION
I hereby affirm thal I have a certificate ot consent to selt-insure or a certificate
of Workers' Compensation InSurance, or a certlfletl copy the�eof ($ectlon
3800, Lab. C. �� Q _
Pnolicy Nai�7�'���� Company G���
P1`CertS,!tieg coPY )15� ��IeObwithrtbehc tlY B� tl� �9 �}yL o9':/�./�/ /
oate �1�L�' "LZ�" APPlitant .� �fr� .rr�. �6�
EXEMPTION FROM WORKERS' COMPENSATION ECLARATION
(Thissec[ion neetl not be completetl if the permit is for one huntlretl (5100) or
Iess).
I certify that in the Performance o1 Ihe wo�k fo� which tnis De�m�t is issuetl, I
shall not employ any person in any manner so as to become subjett to the
Worke�s' Compensation laws ot Calitornia.
Date Si9nature
NOTICE: If, atter making this tleclaration, you shoultl bemme subject to tha
Workers' ComOensation provisions of the Labor Cotle, you must torthwith
compry with such O�ovivon5 or thi5 permit Shall b¢ tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 bereby atfirm that there is a construction lentlin9 agency for [ite performance
ot tne work tor which this Oermit is issuetl (Section 30B] Civ. C.)
ttntler's Name
Lentler's Hatlresz
OWNER BUILDER DECLARATION
I hereby aHirm Nat I am exempt from the Contractor's License Law for the
followin9 reason (Section 7031.5 Business antl Protessional Cotle: Any citY or
munty which requirez a permit to Construct, alter, improve, tlemolish or repair
any struc[u�e, prior to its issuance, also requires the applicant (or Such po�mit
to file a signetl s[atement [hat he/she is licensetl pursudnt t0 Ihe provi5ion5 ot
the Conlractor's LicenSe Law (Chapter 9(commenCing wi[tt Section ]000) of
��vision 3 Ot tbe BuSinesS antl Prote551ons Cotle) Or that Ile/she i5 exGmp[
:refrom antl ihe basis for the alle9etl ezemp[ion. Any violation of Section
31.5 by any applicant for a pe�mi[ Subjects the applicant to a civil
enalty of not more than five huntlretl t1011ars (E500).
� I, as owner ot the property Or my employee5 with waqes as their sole
compensation, will tlo tne work, antl the ztrucWre is not intentletl or oHeretl
for sale (Section 7044. Buziness and Professional Cotle: Tbe Con[raclor's
License law tloe5 nOt apply to an owner Of a pro0erty who builtlz o� Improves
thereon, antl who tloes such work himselt/nersel! or through his or her own
employees, provitletl that such improvem¢nts ar¢ not Intentletl or offe�etl for
sdle. It, howeve�, the builtling or imp�ovement is Toltl witltln one year of com-
pletlon, the owner will ttave Ihe burtlen of proving he/She tlltl m[ bWltl or im-
��ove tot the pu�pose ot sale).
I, ds owner ot [he property, am exclusively cont�atling with licenietl COn-
tractors to consVuct the Droject (Se<tion 7044, Business antl Protessions Coae:
The ConVacior's License law tloes not apply to an owner of property who
builtls or improves thereon, antl who contracts (or such projects wilh a com
tractor(s imense pursuant to tne ConVattar'z License �aw). I am aware that
proof o� Iheir Worker's Compensation insurance shoultl be proviEetl to me.
❑ I am exempt untler Section B. & P. C. �or this rea5on
Date Owner _
I herebvi certity that I have reatl lhis
inspection purpo Y.'
Signature �
Drivers' License or 55 ��
TVPEOFCONSTRUCTION {L9.NEW LI ADD LJ ALTERATION LJ REPA�R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p#
DESCRIPTION OF WOFK/USE OF BLDG.
- S Main Buildi
E
TVPEOFPERMIT GRADING FOUNOATIO��N/ STRVCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ,L/.MECHANICAL B Rear
❑ OTHER %�
PROJECT DESCRIPTION Sq.F7. oCCuaAivCv C Right
K Left
CONSTRUCTION TVPE VALUATION 5 S
ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
qemarks: �Meii... r 8Lf%�i. lwNat rJ%Qinr7 PlanningNotes:
Sink
Preventer
Irrigation
dlhlUhS
king Fountains
r Drains
�r Sinks
Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fea
§15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/Fact. Blt. ICBO �
Heating System & Ducting
�0-100,000 BTU O 100,000 BTi
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 White - Bulltling: Canary - Applicant; Pink - AccountMg; GolOonrotl - A55essor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Warer Heacer
Water Service
Auto-Wesh
Issue Fae
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration Sys[em
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher -
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generamr �0-5 KW C
6129 9/28/07
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL -
Transformer ❑ 15-50 KW
❑ 50+KW
5-15 KW
Meter Uup to 100 amps
Meter ❑over100amps
Sub Panel
Momrs �0.1 HP 01'/: - 8
InaSolar �9-15 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compacmr
� Reinspection Fee �$15 ' I Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zonin9 APProved By
6uilding Approved 9y
Application Issued By )
30050 TL
FEES
$ 3
Z
O
N
I
N
G
R
E
�
M
T
S
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK 3 PERMIT
PLUMBING § ISSUANCE $
PLAN CHECK 25% S ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $ ��
MECHANICAL $ � TOTALFEE $ �'�"
PLAN CHECK 25% $ �
CONSTRUCTION AND'.PLANNING POOL & SPA � �
/APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1;��-,emporary Electrical:Se��vice 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�.�F�Oundation �:' � 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
74. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wi[ing Sign 68. APPROVED FOR PLASTERING
18. Rough ETIQctriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Fieating & Air Conditioning FIRE DEPT. REQUIREMENT '
20. Rough Factory Fireplace APPROVALS Permit # _
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. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED '�-�
i�
33. Final Electric Notes: '
34. Final Heating & Air Conditioning � �.fi � � _
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Faaory 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
48. Special Requirements Completed
49. Electric Release to Edison � � "
50. Gas Release to Southern California Gas Co ' °
51. CERTIPICATE OF OCCUPANCY �
No. Date `
. i-
ADo���ant to fill in all soaces except those within heavy eortler lines antl sign a11 aoo�opriate tleclarations.
CITV OF COSTA MESA CONSTRJUCTION^ PERMIT �
ProjectAddr�s �� 2.�-Q � t/(�`!�'c� ry-Jl=
/app}icant'siNailin Address ��� �//�'�"^��^A4S� .� S"rE �'
Own'er's Name �•i 12 � S1Mn �;,_Lm Po phone
Address S�i A�'`��2�N0 '�:J(� Q-10(O CM
Arch/Eng: License Na.
Address
I Contracror's Nam TN �� Phone �2.,7 U�3 ,
Address (mailing) 4' 2� � �
City License No. �� �
LICENSED CONTRACTOR DECLARA ION
1 hereby atfirm that I am licensetl untler provislons of Charter 9(commencing
with section 700�) of Olvision 3 of Iha Business antl Profe551ons Cotle, antl
my Iicense is in full�p rce antl efiect. �1^
license Class (_—�D .- License No. ��IP� /O �
Date Signature
WORKERS' COMPENSATION DECLARATION �
1 hereby affirm that I have a certi(icate ot consent to self-insure or a<ertlticate
ot Workers' CompensaliOn Insurance, or a cerllfletl ropy theveof (SeCdon
3800, Lab. C.)
Po11cy No. Company
eCertifietl copy is hereby fumishetl.
Certifietl copy is filetl with the city Builtling Dlvision.
Oate Applitant
EXEMPTION FROM WORKERS' COMVENSATION DECLARATION
(TM1issettion neetl nOt be completetl it the permit Is tor one huntl�etl ($100) or
iess).
I certity ihat in the performance of the wo for whlcM1 IhiS pe�m�t is iszuetl, I
shall not ¢mploy any person in an man o as t bec e su0'ect to the
Workers' pen tio� Laws of Calitorni .�_ y
1
Date � Si9naWre � -- A� L.«�a<<�
NOTICE: If, after a1 ing Nis tleclaration, you shoultl become subject to the
Workers' Compensatlon pwvisions ot th¢ Labor Cotle, y0u mu5t forthwlth
comply with such provisions or this perTit Shall be tl¢¢mBtl revok¢E.
CONSTf3UCTION LENDING AGENCV
1 he�eby affi�m that there is a construclion lentlinq d9ency for the per(ormance
ot the work for which this permit is issue❑ (Section 3097 Civ. C.)
Lentler's Name
i
Lentler's Htltlress
OWNER BUILDEH bECLARATION •
I hereby atfirm thal 1 am exempi Trom the Contractor'S Llcense L.aw for tM1e
followinq reason (Section 7031.5 Business antl Professional Code: Any city or
county which requires a permit to construct, alter, improve, tlemolisn or repair
any struc[u/e, p�Io� to its issuance, also requires the applicant for such permit
to file a siqnetl 5[atement tnat he/she is licens¢tl pur5uant to the provisions a(
the Contractor's License Law (Chapter 9(commencin9 with Section 7000) of
�ivi5ion 3 of the Business antl Professions CoOe) o� tM1at be/sne Is exempt
�,e�efrom antl [he basis fo� ttte allegetl ex2mptiOn. Any violation ot $ection
J3L5 by any applicanf for a permit subjects lhe applicant to a civil
�ndlty of not more than five huntlretl tlollars ($500). '
LJ I, as owner oi the properry or my employees with wa9es as their soie
compensation, will tlo the work, antl the structure is not intentletl or offeretl
for sale (Settion 7044, Business antl Professional Cotle: The Contrac[or'S
License Law tloes not apply to an owner ot a property who builds or improves
[hereon, antl who Coes such work hlmselt/he�self o� tM1rough his or her own
employees, Provltled that zuch improvemeMs are not in[enCetl or ofteretl (or
sale. It, h0�+'eveq the builtlin9 or improvemen[ is soltl wlt�in one year of mm-
pletion, [he owne� will have the burtlen of provinq M1e/s�e tlid no[ builtl or im-
prov! �or [M1e purpose ot sale).
❑ I, as own¢r of [he properly, am exclusively contracting wlth Iic¢nsetl Con-
tractorsto constrvct the project (Section 7044, 6usiness and Professions Cotle:
Tne Contractor's License Law tloes not apply to an owner of property who
builtls or Improves thereon, antl wno contracts for such proiects with a con-
trattor(sl ucense pursuant to Lhe COM�actOr'S LicenSe �aw). I am aware that
oroof of ltleir Wo�ker'S Compensatlon insu�ance shoultl b¢ provitletl [o me.
❑ I am exempt untler $ection B. & P. C. for this reason
�ate Owner
I hereby certity that I nave reatl tnis application antl state tnat the above
intormation is mrrecL I agree to compty wi[h all clty antl county ortllnances
antl s[ate laws r lating to bulltling tons[ru<tlon, and hereby au[horize re0re-
sentatiwz of t i ity to ente upon tho above-mentione� property !or
inspection purp Z
Signa[ure Date % ^� �
Drivers' LlcenSe Or 55 # �%
TYPE OF CONSTRUCTION L^/NEW U ADD LJ ALTERATION LJ REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT �LJ GRADING LI FOUNDATION LJ STRUCTURAL
❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 50. FT. ocCUCANCv—
CON.STRUCTION TVP _. VAWATION $
ZONE GRADINGCU.YDS. ACRES_
Remarkz: �] G �Q O
_ _ _ _ � v � O
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Drinkin9 Fountains
Floor Drains
Floor S�nks
Gas Service
Interceptois
Kitchen Sink �
P-Tr6p
Roof Drains
PLUMBING
Showers .
Service Sink
Sewef Cap
Sewer Connection
Solar Collect
Solar P' ' g
Pool w/Spa
Urinal _
Water Closet
Water Heater
Water Service
Auto-Wash
Reinspection Fee � $15 � � Issue Fee � $ 3
Boiler
Duct - Under Ground
Duct - Struc[ural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ o-i oo,000 aru O � oo,o�
Reinspection Fee � $15
CMF 0865-46, rev. 30/B4 White - Builtling; Canary - Applicant; Pink - Accountinq; Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑ , 00 BT
SVstem Rep ' It¢ration
Issue Fae
A.P. #•
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas �Eler
Fan
F.A.U.
Fixtures
Device Boxes
CI9G 7IC� �_%
Zone
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Switches
Garbage Disposal
Generator �0.5 KW �5-75 KW
Meter �up to 100 amps
Meter �over100amps
Sub Panel
Motors �0-1 HP 01 X- 6
Inc. Solar 09�15 HP 016-15+
Microwave
Pole Light '
Range
Sign
Standing Sections �.
Trash Compactor
Reinspection Fee � $15 luue Fee
FEES
�DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Building Approved By /�
Aooliration luuad Bv L� • - � �'+�=-
$ 3
SUMMARV OF
BUILDING PERMIT j
PLAN CHECK $
PLUMBING S
PLAN CHECK 25% $
ELECTRICAL § �
PLAN CHECK 50% $
MECHANICAL q
PLAN CHECK 25% $
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SMIP $
PERMIT
ISSUANCE $
ENERGV P.C. 3
GfiADING S
MICROFILM S
TOTAL FEE $ s�.s ao
,CONSTRUCTION AND PLANNING � :.� �` � - 4 � � POOL & SPA
� ^ , , Date Inspector� Date Inspector
APPROVALS Perm^t # �. � APPROVALS Permit #
1.�Temporary Electrical'Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Steel fleinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms . '
4. f_lectrical Conduit-Undrgrnd. -a3"Fs7 J C• 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. N/aier Pipe-Undrgmd., 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer 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. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final �
16. Rough Electric Wiring ` q 67. Fencing & Access Approval
77. 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 77. Product Piping �Gas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Ronf Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurap & 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 MeterFinal r n�� ��� 80. FOOD CERTIFICATE ISSUED .
33. Final Electric �,�, � Notes: � �. e�
34. Final Heating & Air Conditioning Ok�
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. Handir.ap Regulations . ' '
47. FINAI_ STRUCTURE & BUILDING
48: Special Requirements Completed
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co I
51. CERTIFICATE OF OCCUPANCY � ' '
No. Date - •
. AOP�icant to /ill in all ipaces exee0t those within heavy Eo�Oer lines anE Slgn all apprapriate tleclaralions.
CITY.fJ1F COSTA�MESA CONSTRUCTION PERMIT l PERMIT pNO�.O TRA/CT NO. LOT NO. U IT NO. Ati�(n (__�/ Q7 ��� .., „
Project Address 'i22G% G!'Ac-� %+v�+ C� p� � (�. ( Z O � ! � � � � L+ y(I`jC• u� �I � � / �/
AppliCant'SMailingAddresSSSd PRu.�HRiNo Au6 •trA-ic�, TVPEOFCONSTRUCTION - NEW ADD ALTERATION REPAIR -
� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # %I Zone
Owner'sNa�ne �U�$1M� N Ctll-(JJ✓L/�M�ioneSSfo'J�S80 'DESCRIPTIONOFWORK/USEOFBLDG. ����OS].— RZ
Addreu 5'?MF � S Main Building: �+ccessory Building:
Arch/Fn9•�p'y �l6NES LicenseNo. 2��yq O TVPEOFPERMIT GrtaolNG FOVrvDATiOiv STRVCTUan� T Front �,i.rj�-��'q,�,0 � •�7• �� C.Ku O
ZO iiV �OTA VG LONC> � 9OOI'3 � � TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Rea� �5� C(, N
Add/CSS V ❑ pTHER
Contractor's Name � Phone Sf�O - 78� C Right � ���� G
Address (mailingl `�AYLLf "PROJECT DESCRIPTION 5Q. F. 4 Z oCCUaArvcv d K
CONSTRVCTIONTYPE � VALUATION$ �� i3SI g Left 3y�2//
City License No. ZONE GRADING CU.YDS. ACRES R
LICENSEO CONTRACTOR OECLARATION Ping. Ref. #�� —g'1 .. Q1,.� Parking Req./Provided E
I nereby alfi�m tnat I am licensetl untle� provisions of Charter 9(commencing Remarki: �..# Pld�nin NOL¢5: � n
with section 7000) of Divislon 3 af the Business antl Protessions Cotle, antl ��0� � g 7 A 9 ONr � L J PL M
my Ilcense is in full torce antl efiect. � T
LJcense Class Litense No. S
Date Signature " PLUMBING FEES � - ' - �
WORKERS' COMPENSATION DECLARATION 83� $ink $hOw2�5
I hereby atiirm that I have a certificate oi consent to self-insure or a certificate ELECTRICAL . FEES
of Workers' Compensation Insurance, or a certliied mpy thereof (Sectlon � gackflowPreventer ServiceSink
3800, Lab, c.) • P.utomatic Washer Transformer ❑ 75-50 KW
aoiicy rvo. company Backflow Irri9ation Sewer Ca . � ❑ 50+ KW
. P Construction PoleSub.
eCerti/i¢tl coOY �5 h¢reby fumishetl.
Certitietl copy is fileC with the city Builain9 Division. Bathtubs Sewer Connection Cooking Uni[ Meter ❑up to 100 amps
Date APplicant
EXEMGTION FROM WORKERS' COMPENSA N D ARATION Cl2fi(i¢fi SOIa� COII¢ct0/5 Di5hwd5hE� M2L¢� �over 100 amps
(Tnis se<lion neeE not be com0leletl if the per t is t on huntlretl (§300) o�
less). Dishwasher Solar Pipin9 Dryers OGas ❑Electric Sub Panel
1 certity that in the perfo�mance ot the w fo� ich iIs perm�t is issuetl; 1 .
snall no ploy any person in any ma r to e e bject t the� Drinking Fountains Solar Tank Fan Motors �0-7 HP 07'h � 8
Worke pensafl ws of Calitor
�at Siqnature �-- Floor Droins Swimming Pool wlSpa F.A.U. Inc. Solar �9�15 HP 016-15+
NOTI : I r m i g this aeclarat" , u shoultl become subject to the
Wo�kers' Compensati0 Provl5ion5 the Labor Cotle, YOu must �orthwltb FI00� $iOkS U�indl Fixtur¢5 Mic�Owav¢
comply wilh such O�ovi5ion5 or bis pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING A NCV Ci25 $¢NiC¢ Outl¢LS' W3L¢I CIOSCt D¢viC2 BOxES
1 hereby aflirm that re i a co tructio ntli g ag for the pertorman<e Pole Light
oi the work � hic h' . perm iz tl ion 3 Civ. G.) �nterceptors �F Wa[er Heater Outlets Ran e.
Lentler's Name ��� � , 9
�enaer's AEaress - Kitthen Sink Water $ervice Switches -
OWNER BUILDEN O CLARATIOW , Sign
1 hereby affirm lhal I am exempt from tne Conlractor's License �aw for the Lavatories Auto-Wash Garba e Dis osal
following reason (Section ]031.5 Buslness antl Grotessional Coae: Any Uty or 9 P Standing Sections
county which reqWres a permit to construct, alter, improve, tlemolish or repalr P—Trap • Laundry Trays Generamr �0�5 KW �5-15 KW
any structur¢, ptio�'t0 ils Issuance, also requires Ihe applicant (or such pe�mit � T�BSh COTp2Ct0�
to file a signCtl stalement lhat he/she i5 licensetl Oursuant to Ihe provisions of Roof Drains ' ' '-
the Contractor's License Law (Cnapter 9(commencing with Section �000) of - '�
Divlsion 3 ot thC Busines5 an0 Professions' Cotle) or that he/she i5 exernpt �
tnere/rom antl the basis for the alleqetl exemp[ion. Any vlolation of Sec[ion
7031.5 by any applican[ lor a permit sublects tM1e aOPlicant to a civil
eenalty of nat more tM1an tive huntlretl tlollars ($500).
LI I, as owner o( the propurty or my employees with wa9es as their sole ReinspeMion Fee $15 Issu9 Fee $ 3
compensation, wiu tlo the work, antl the structure is not intentletl or otteretl Rainspection Fee $15 Issue Fee $ 3
for sale (Section �044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES
licen5¢ Ldw tloes not apply to an owner ot a properry wM10 builtls or improves
thereon, antl wno does such work himself/herself or through his or her own DEVELOPMENT SEFVICES RE IREMENTS: Q
em0�oy ees, Owvitletl [hat such improvements are not intentletl or otfereC for Boiler Hood or Type I ❑ � �� 7)— �� 7
sale. If, however, che builtling or improvement Is soltl within one year of <om- Canopy Type 11 ❑ Zoning Approved By m Data
pletioq the owner will have the burtlen of proving he/sne tlitl not bulltl or im- Ducl - Under Ground guilding Approved By Date
p�ov! for Ihe purpOse of sale).
❑ I, as owner o/ tne property, am exclusively contractin9 with licensetl ton- Duct -Struttural Refrigeration System Appli�'ation ISsued By Data
tracto6lo const�uct the projec[ ($ection ]044, Business antl Profe55ions Cotle:
The Convactor's License Law tloes not appty to an owner ot property who Duct - Ventilating ❑0�100,000 BTU ❑100,000 BTU " SUMMA QF FEES
builtls o� Improves Utereon, antl who cont�acls fo� such prolects wi[h a con- q
tracmr(sl i�cense pursuant to the Contractor's License LawJ. I am aware Ihat Exhaus[ System ❑ MWtiple ❑ System Repair/Alteration BUILDING PERMIT $ 3a` SMIP $ �Z • I�
proof Of tneir worker's Compensatlon insurance shoum be provitletl to me. PLAN CHECK ^ ) PERMIT
❑ 1 am exempt untler Sectlon e. & P. C. for this reason Firepl/FatL BIL ICBO # Fire Dampers �� �$ � �� ,$ry ISSUANCE $
Daie ner Heating System & Ducting Registers pLqN CHECK 25% $ ENERG�' P.C. $
i hereby certity h t i v read this applicatlon antl state ihat the above �0.100,OOOBTU�t00,000BT GRADING $
information n rr ag e to mmply with all city antl county ortlinances ELECTRICAL $
antl state law re ' t Wltling onstruction, antl hereby aumorize repre- PLAN CHECK 50°,6 ^y MICROFILM $
sentatives of t on the above-mentionetl o�ty^or
inspection r '�kNe � MECHANICAL s 3•3D
Siqnat Dat TOTAL FEE $
Orivers' ' ense or 55 � Reinspection Fee $�5 Issue Fee $ 3 PLAN CHECK 25% $
;MF 0865-46, �ev. 10/84 Wnite - Builtling: Canary - Applican ; Pink - Accounting; Goltlenrotl - A55essor
�� �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit� Date Inspector 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 " 7 Z.�r GJ 56. Rough PVumbing & Pressure Tesc
6. Electrical UFER Grnd. 7 y ^/ 57. APPROVAL TO COVER�GUNITE
7. Footings v - br✓ 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 & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbfng System - Final •
74. Rough Plumbing 65. Electrical-Final -
15. Rough Electrical-Conduit 66. Solar Sys[em-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. Duc[s, in Structure 70. Und rground 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 c1 �(� �/ 74. Overhead Hydro
26. T-Bar Ceiling (Structura�) & Monocoat 75. Dry Chemical
27. Frame and Flashing �� G... 76. Dry Standpipe
28. Lathing & Siding 2 (yryJ 77. FYXED SYSTEM FVNAL
29. Insulation o y -t ��✓ 78. PIRE 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: HOLD FOR SPECIAL REQjJIItBMI�N�PB
34. Final Heating & Air Conditioning � �Q L�2'tML �
35. Final Gas Pipe-Test �S O
o �P E�cr.
36. Hood or Canopy •
v4 ��GL
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. FINALSTRUCTURE&BUILDING ! l�ig� �6 � � , ,
48. 9pecial Requirements Completed I� � .
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co , � �
51. CERTIFICATE OF OCCUPANCY
No. Date j
AGO���ant to flll in all spaces except t�ose wit�in neavy bortler lines antl sign all a00/opriate tleclarations.
CI.FY OF GOSTA MESA CONST UCTIpN PERMIT PERMIT NO. TRACT NO. ' LOT NO. UCNITQNp,�
Project Address Z Z Z�l C,��'� �� h-r' '�
Applicant'S Mailinj -Addre ��� V��O v� �oJ\.� �° �}� TVPE OF CONSTRUCTION NEW P.DD ALTERATION REPAIR
Owner's Name "�� C` ^^ `^� Phone 5570 -38�J0
Address
Arch/Eng. � License No.
Address n
Convactor'sNama EVG��S T� W�'" ��phone bKb'I�frS
Addresslmailingl �SSGl inOne✓U�C 3
City License Na. 3� Z� Si
LICENSED CONTRACTOR DECLARATION
I hereby atfirm tha[ I am licensetl untle� 0/ovisioqz ot Charte� 9(commencing
with section 7000) of Division 3 of tne Business antl Protessions Cotle, antl
my license Is in fy� Jorc¢ antl effect. �7 � b� q,�
Licen e Clas •��i - i?�=-,e rvo.
Date �—��— 7 � '�
WORKERS' COMPENSATION OECLARATION
1 nereby affirm that I nave a certificate ot consenl to zelt-insure o� a certifica[e
�f Workers' Compensa[ion Insurance, or a certl{(y�pY therCO (SeG[ion
800, lab. C
Policy No. _ Z��� � CompanyJ �
❑ Cee�rtitf�ietic �copPy is �h�e�e�e�by fumishetl. � '
Date `�` /S-� Y��WqPPhtanl�Y Byllping o}v1zipq�, y
/ i( G�/ G
EXEMPTION FROM WORKERS' COMPENSATIpN DECLARATION
(Thizsection ne¢tl not be completee i( lhe permit i5 Por one huntlretl ($100) or
less).
I certity that in the pertormance of the work tor �yhich tnis oerm�t is issuetl, I
shall not employ any person in any manne� so as to become subject lo the
Workers' Compensalion Laws of California.
Date Si9nature
NOTICE: H, af[er makinq this tleclara[lon, you shoultl become suDject to the
Worke�s' ComOensalion p�ovisions of lM1e Labo� Cotle, y0u must fo�thwith
comply with zucn provisions or tnis permit snall be tleemetl rovoketl.
CONSTRUCTION LENDING AGENCV '
I nereby affirm that there is a constructlon tentlinq a9ency /or the Oe�formance
of the work � tor whi[h thi5 permit is Issuetl (Section:'309] Clv. C.)
Lentler'S Name /
Lentler's Atltlress � �
OWNER BUILDEN DECLARATION
I hereby a/9rm that I am exempt from the Contractor's,Licens¢ Ww for the
following reasOn (Section 7031.5 Business anA P�ofessional Cotle: Any [ity or
county whlch requires a permit to cons(ruct, aller, improve, aemolish or repair
any structure, orior to its izsuance, also requires tne appllcant tor such permit
to tile a Signetl Stat¢ment that he/she Is licensetl pursuanl to the OroviSions of
[he Contractor's �Icense l.aw (Chapter 9(commepcing with Se<tlon 7000) of
OivisiOn 3 0/ Ihe Bu5ine55 antl Professions Cotl¢) or that h¢/She' i5 eXempl
'herefrom and the basis for the allegetl exemptibn. Any violalion of Section
J31.5 by any applicant for a pe�mit subjec(s the apP���anl [o d Civil
dnalty of not more than five huntlre� tlollars (y500).
❑ I, as oW�er of the property or my employees with wag05 as tM1ei� sole
compensation, wlll ao tne work, ana the structure is not intentletl or ofteretl
for sale (Soction ]044, Business antl Professiohal Cotle: The Contractor'S
License 1. w tloes not apply to an owne� ot a property who bulltl5 or Improves
[hereon, antl who tloes such work himself/hersell or throug� his or ner own
employees, prOvitletl tha[ zuch improv¢ments are not intentletl o� oHOretl 10�
sale. If, howover, tne bWltling or imD�ovement is soltl within one year of com-
pletion, the own¢r will have the burtlen of Provl�g he/sM1c tlitl not Culltl or im-
p�ove for tne PurpoSe 01 Sale).
❑ I, as owner of the property, am ¢xclusivety cpn[ractin9 with licensetl con-
t�aclors to consirucl the project (Section ]044, BUsiness antl Professioni COtlo:
The ConVactor's License Law tloes not apply �b an owner of oroperty who
builtls or InfProves thereon, antl who contracts fo� such Oroje<tz wilh a con-
iractor(s) ncense pursuant to tne Convactor's �icense �aw). I am aware that
proo( of their Worker'S Compensation insurancn shoultl be p�ovitletl t0 me.
❑ I am exempt untler Section B. & P. C. tor this reason
Date Owner '
I hereby certity that I have reatl thiz appliwtiVn antl state that tne above
information Is mrrect. I a9ree to comply with all U[y antl county ortllnances
antl State laws relating [o builtling conSVuctlon, antl hereby authorize re0/e-
sentatives o/ lhis ci y� ter upon Ne abqve-mentionetl pmperty for
ins0ectlon p oses �i
Signature � Oaie7—��O
Drivers' License or 55 � �—? �'[ % `]._
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, #
DESCRIPTION OF WORKlUSE OF BLDG.
S Main Buildi
E
TVPEOFPERMIT GRADINCa /FOUNDATION STRUCTURAL T F�Ont
❑ TENANT ❑ ELECTftICFL LL PLUMBING ❑ MECHANICAI B
A Rear
❑ OTHER C Right
PROJECT DESCRIPTION 5�.F7, oCCUCArvCv K
GONSTRUCTIONTYPE VALUATION$ g Left
ZONE GRADING CU. VDS. ACRES p��g, Ret. #
Remarks: � .� '1�7 Q' , Planning Noces:
Bar Sink
Backflow Preventer
Backflow Irrigation �
Bathmbs
Clarifiers
Dishwasher
Drinking Fountains
Floor Orains
Floor Sinks hy
Gas Service / Outlets
�pterceprors
Kitchen Sink
lavatories
P-Trap �
Roof Drains
Reinspection fee $15
Boiler
Duct - Under Ground
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/FacL BIL IC80 �
Heating System ucting
❑aioo.00 u Oioo,000
Reinspection Fee I $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary . qppptant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap-. '
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Pool w/Spa
Urin21
Water Closet ��9
Water Heater
Water Service
Auto-Wash
Laundry Trays
Isue Fee
FEES
Automatic Washer
Construction Pole Sub.
Cooking Uni[
- Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
' Fixtures •
D¢vicC BOx¢5
pZi Outlets ;�
T Switches
� � V Garbag'e;Dispos
Generjtor 0.5 KW C
� �a
A
$ 3
2C4B 7/'./:: '
Zon
Accessory Building:
Z
O
N
I
N
G
R
Parking HeqJProvided E
Q
_ M
T
S
ELECTRICAL
Transformer � 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Su6 Panel
Motors �0- P �1'r5 � 8
Inc. r �9-15 HP �16-15+
mrowave
Pole Light
I I Standing Sections
15 KW I � Trash Compactor
IANICAL FEES Reinspection Fee $15 Issue Fee '
� DEVELOPMENTSERVICESREQUIREMENTS:
Hood or Type I � Zoning Approved By
Canopy Typell �
Building Approved By
iefrioeretion m Aavlication Isued By `
]o-i , oeru Oioo,000sr
�ystem Repair/Alteration '
Fire Dampers
Registers
Issue Fee � $ 3
FEES
$ 3
i
. SUNIpQARV O�EESv
BUILDING PERMIT $ SMIP $
PLAN CHECK $ p PERMIT
PLUMBING $ p g •S� ISSUANCE $
PLAN CHECK 25% $ SLI• i7S � ENEFiGY P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% �$ \ MICROFILM $
MECHANICAL $ �TOTALFEE $ !D g
PLAN CHECK 25% $ "�7���rt-,Zb-�
CONSTRUCTION AND PLANNING POOL & SPA �
APPROVALS Permit # Date Inspector AppROVALS Pe�mit # 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. Electriral Bonding
5. Steel Reinforcement •' _ 56, Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � . 57. APPROVAL TO COVER-GUNITE
7. Footings ' ' 58. Electrical Conduit-Undrgmd.
8.�Foundation , . . 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-lJndrgrnd:. 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
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 Electrica6T 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 OGas ❑Oil
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roo1 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 �� d �
39.�Water Service-Final � Sn
(
40. Gas Service-Final ���q�/�7 _
41. Solar pomesticFinal � -
�42. Backflow Preventer � ' ,
43. Backflow Irrigation �
44. Landscape Irrigation System -
'45. Sound Attenuation �
46. Handicap Regulations � �� '
47. FINALSTRUCTURE&BUILDING �
48. Spr.cial Requirements Completed
49. Electrie Release to Edison � ' �
r
50. Gas Release to Southern California Gas Co �- . . � �
51. CERTIFICATE OF OCCUPANCY ;
No. Date �
e
Aop�icant to fill in all spaces except thosc within neavy GorCer Itnes ana sign all aovrovriate aeclarations.
ciTv oF COST,4 MESyA�/, CO'rI�TRUCTION P/�ER�IT PERMIT NO. ,�. TRACT NO. • LOT NO. UNIT NG.
Project Address �Z zL-`%� !�-�� �/ //i i
Applicant's Mailing A/d�dress �S �nl /�fCr r'a✓/4 �/5 A'^�i �LU•3
Owner'sNam�� '��"�� ������n r,��Phone
i Address : �%�/� ��D�La"'-J��I� �l%G' �''/LI •
�, Arch/Eng. License No. '�
i Address �
�� Convacfor'sName �- r 411•* Phone.�ly
'� Addresslmailing) '�„YOJ/A % )f%37i�[�� Cc. QZ((.'�
' CityLicenseNo. �5'.�+-��4��
� LICENSED CONTRACTOR DECLARATION
I hereby atfirm that I am licensed untler provisionz of Cha�ter 9(commenclnq
� with section ]000) o( �ivision 3 of the Bu5ine55 dntl Profes5ions Cotle, antl
my Iicense is in tull forc antl eHect. �
ucense c�ass ' Z�% Licens o. �
oate Si9nature -
VORKERS'COMPENSATION DECLARATION
hereby aftirm that I have a ceriifiwte of consent to selt-insure or a certificate
. of Workers' Compensation Insurance, or a certifietl copy thereof (SeGtion
3800, Lab. C.) O %�� �
Policy No(�1�3�. G•%�.r�y�� Company�� /Ko•
�� �Certifietl copy is hereby fu�nizhetl.
Certifietl cop is filEtl with ttte city w ng v� . '
�� Date �-% �'S �r Applicant
� EXEMPTION FROM WORKERS' COMPENSATIO DECLARATION
,(Tnis section neetl nat be completetl if the permit is tor one hunaretl (5100) or
less).
I certity that in the performance oi the work for which this permR is issueQ 1
sna11 mt employ any person in any manner so as to become suDject to tne
Workers' Compensation �aws of California.
Date Siqnature
NOTICE: I(, atter makin9 this tleclaratlon, you shoultl become subject to the
Worke�s' Compensation Orovi5ion5 of Ne Labor Coae, you must torthwith
comply wi�h such provisionz or tbis permit shall be aeemea revoketl.
CONSTRUCTION LENDING AGENCV
I hereby atfirm Nat there is a mns[ruciion lentlin9 agency for the performance
of the work fOr whicb tnis permit is issuetl (Section 309] Civ. C.)
�enCer's Name
Lantler's Adtlress
OWNE0. BUILOER DECLARATION
I hereby ai(Irm that I am exempt irom the Contractor's llcense Law tor the
following reason (Seclion ]031.5 Buslness and ProfeSsional Cotle: Any city or
county whlch requirez a permlt to consVuct, alter, improve, tlemolish or repalr
any struclure, prior to Its issuance, also requires the applicant for su<h permit
to fiie a signetl statement Ihat he/she I5 licensetl Oursuant to Ihe provisions o(
9e Contrattor'S License Law (Cnapter 9(commencing wi[h SeGtion 7000) of ,
Ivision 3 of Ihe Busln¢55 antl P�of¢SSIOns Cotle) or thdt h¢/She Is exem0l
.�erefrom antl the baSis lo� lhe allegetl exemption. Any viola[ion of Section
]031.5 by any applicant for a pe�mit subjects lhe ap0�icanl to a civil
penalty of not more [M1an tive huntlretl tlollars (5500).
LJ I, as owner of tha property or my employeez with wages as their sole
compensatlon, will tlo tne work, antl the sVucture is not intentled or oiferetl
tot salC ($ec(ion 7044, Business antl Protessional Cotle: The Con[�aclor's
License Law aoes not appty to an owner of a properry who bulitls or impmves
thereon, antl who doe5 Such work himsclt/M1erselt or throuqh hi5 or he� own
employces, provitletl [hat such improvem¢nls are not intentletl or offere0 for
sale. Ii, however, [�e builtlinq or improvomen[ I5 Soltl wflhin One year ot mm-
pletion, tM1a owner will have ttte burtlen O( O�oving he/she tlI0 nol bulltl or Im-
prOve to� the purpos¢ of sale).
❑ I, as owner of the property, am exclusively contractlng with Iicensetl con-
t�actor5lo Const�Uct itte pro�eci (Section ]044, Business antl Prote55ions Cotle:
The ConVactoYs License Law does not appty [o an owner of property who
builtls or improves lhereon, antl wM10 con[racts for such projects witn a con-
tractor(s) bcense pursuant to th¢ Contractor's Li<enze Law). I am aware that
proot o( their Worker's Compensation insurance shoultl be provitletl to me.
❑ 1 am exempt un0er Section B. b P. C. for Niz reason
Date Owner
I hereby certity that I nave reatl this application antl state that the above
information is correct. I a9ree to comply with all city and countY ortlinances
antl state laws relating [o builtling con r on antl hereby authorize repre-
sentatives of thi5 t,,,999��� to nteriay{1q e a�ve-mentionetl 3Coperty for
inspection purpo �// � /w/[�/� (����G'�-
SignaWre ��- �/�-L i Daiz Y �
Drivers' License r 55 � �
Pink - Accounting; Goltlenrotl - Assessor
SUMMARV OF FEES
BUILDING PERMIT $ SMIP S
PLAN CHECK 3 PERMIT
PLUMBING S ISSUANCE $
PLAN CHECK 25% S ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ � TOTALFEE S
PLAN CHECK 25% $ SC.oZ ' �
44025 TL
FEES
$ 3
Z
O
N
�
N
G
R
E
Q
M
T
S
CONSTRUCTION AI�ID.PLANNING POOL & SPA
n" �-i' Date Inspector AppROVALS Permit# Date Inspector
APPROVALS Permit�.# o
i..�T,emporary ElectricBl �Ser'vice 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,N,Vater Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor SY.s�em; 61. APPROVAL TO DECK
11. Property Sewer Line'&�House Connection 62. Backwash & Recepior-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
76. Rough Electric Wiring 67. Fencing & Access Approval
77. Rougb,Wiring Sign 68. APPROVED FOR PLASTERING
18. Rougti.�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. 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 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 �/�/�� G' ''�
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. 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 �
�
�
CO
AODliwnt to (ill in all soaces ezceDt those wit�in neavy Dortler lines ana si9n all avPropriate tleclantlons.
CITY OF COSTA MESA CONSTRJUCTION PERMIT
Projecc.Asdress _�Z.ZCi ��Cl.�'J �JL=
Applicant'sMailingAddress a� a' wS �- 5-L I$Z
Owner's Name � Mn �' Ph I.
Addre55 �_ ,'.n� -� in�7 )l9 ���p C'.v\ �
�
Arch/Ery.` License No.
I Address
Contractor's Nama M 2'�µ'y C�—d7f1-<<— phone 2—� ,
Addresslmailing) ��-( C�""M� � SE� �Z.
City LicenseNo. 35�� ��
LICENSED CONTRACTOR DECLARATION
I hereby atfi�m [hat I am licensetl untle� provislons of Charter 9(mmmencing
witn section ]000), of Divislon 3 ot the Bu5ine55 antl Protessions Cotle, antl
my license is in (ul/l �orce antl efiect. II n
License Class �"'��� � License No.y-�d�(".72
Date Slgnature
WORKERS' COMPENSATION DECLARATION
`�ereby atfirm that I have a certi(icate of consent to self-Insure or a certiticate
Workers' Compensation Insurance, or a certifietl cooY thereot (Section
.d00, Lab. CJ
Policy No. Company
8 CertifieA copy Is hereby fumiShetl.
Certifietl copy is tiletl with [he city Builtlln9 Division.
Date ApPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �
(This section neetl not bn cOmpleletl if the permit I5 tor One huntlreG ($300) or
less).
I certity that in the performanGe of the o�k fo� wblch Ihis perm�t is issuetl, I
shall no[ employ any pe�son In any nEr so as t ecome subjec to [he
Worker orz� ion Laws o! Califo I
Date S�9nature
NOTICE: t, after makln9 [his tleclaration, you shoultl bemme z bject to the
Workers' Compensation proWslons of [he Labor Cotle, you must forthwith
comply with su[h provisions o� this pe�mit Shall be tleemed revokeU.
CONSTRUCTION LENDING AGENCV
1 hereby af(irm that Ihere is a const�uction lentling agenGy for ihe performance
Of ihe work for wM1ich th15 permil is Issuetl (Section 309] Civ. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILDER DECLARATION
I hereby ditirm that I am exompt hom the Cont�ac[o�'s License Law for the
following reason (Section 7031.5 Business antl Pro(esslonal Cotle: Any ciry or
county which �equires a permit to conStruCt, aller, improve, tlemolish o� repair
any structure, prior to its issuance, also requires the applicant tor such permit
to file a signetl statement that he/5M1e is licensetl pu�suant to the provisiOns of
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
`ivision 3 ot the Business antl Protession5 Cotle) or Ihat hE/She is exempt
>.refrom and lhe ba5i5 for the alleqetl exemptlon. Any violation of Section
i31.5 by any applicanl fo� a permil subjects the applican[ [o a civil
�enalty of no[ more ihan five huntlretl tlollars (E500�.
I, as oWner of the propCrty Or my employeez with wages as Iheir Sole
com0ensa[ion, will tlo the work, antl the structure Is not intentletl or offeretl
for sale (Section ]044, Bu5Ine55 dntl Profezsional COtle: ThE Contrac[or'S
LicenSe Law tloes not apply to an owner of a property who builtls or im0/oves
thereon, ana who tloes such work himself/hersell or through his or ner own
employ ees, provitletl that such imprOvements are not In[entletl o� ofteretl fo�
sale. If, howeve�. the bulltllnq or improvement Is Soltl wl[hin one year of com-
Olelion, tM1e awner will have Ne burtlen of provin9 hC/She tlitl not builtl or im-
prove tor the purpose of sale).
❑ I, as owner ot the property, am ezclusively contractinq with licensetl con-
[ractors to construct the project (Section 7044, Buzinesz antl Professions Cotle:
Tbe Contractor's License Law does not apply to an owne� of p�operty who
builas or imoroves thereon, antl who contracts for such projects with a con-
Vactor(s) license pursuant to lhe ConVactor4 Llcense Law). I am aware that
proof of tM1eir Worker'S Compensation inzuranG¢ ShOultl be provitle0 to m¢.
❑ 1 am exempt untler $ection B. & P. C. fo� this reason
Date
I hereby certi that
Intormation i rrect.
antl state Ia ting
sentatives of t ciry
in5pettion p P e .
Signature
Drivers' License or 55 q
IF 0865-46, rev. 10/84
Owner
I thi5
comp
that the above
mty ortlinances
iuthorize �epre-
1 oroDertY for
E.. ....._. _....._. C,.,�ct�.
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ q.p_#
DESCRIPTION OF WORK/USE OF B�DG. S Main Building:
TVPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear �
❑ OTHER %� _
PROJECT DESCRIPTION SQ. FT. OCCUPANCV_ � C Right
K Le(t
CONSTRUCTIONTVPF VnluqTlONS $
ZONE ADING CU. VDS. ACRES Ping„Ref. #
Remarks: � R /� � . Planning Notes:
8ar Sink
Backflow Preventer
Backflow Irri9ation
Bathtubs
Clarifiers
Dishwasher
Drinkin9 Fountains
Floor Drains
Floor Sinks .
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ 1
Firepl/Fact. Blt. ICB
Heating Syste Du�
❑0.10 BTU �1
Reinspeaion Fee
Whi[e - Builtlin9; Canary - Appllcant; Pink - Accountin9: Goltlenrotl - Assessor
$15
$15
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipi
Pool w/Spa
Urinal
Water Cloret
Water Heater
Wacer Service
A uro-W ash
Laundry TraYs
Isue Fee $ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas lec
Fan
F.A.U.
Fix�ures
Device eoxes .
Outlets
Switches
Garbage Disposal
Generator DO-5 KW C
2�9� %�t� ��7 , '
2one
Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
ELECTRICAL
� Transformer ❑ 15�50 KW
❑ 50+KW
Meter ❑up to 100amps
Meter ❑over100amps
Sub Panel
Motors OO-i HP O1 %� 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
J Range ,
Standing Sections
5 KW Trash Compacton
FEES
IANICAL FEES Reinspectian Fee I$15 luue Fee $ 3
DEVELOPMEN7 SERVICES REQUIREMENTS:
Hood or Type I ❑ Zo�j�B qPProvad By Date
Canopy Typell ❑
Building Approved By Date �-n^
iefrioer � n Svstem Aoalication Issued By — a~'72.�f DatB�
�00,000 BTU ❑ 100,000
System Repair/Alteration
Fire Dampers
Regiseers
Isue Fee � $ 3
SUMMARVOFI
BUILDING PERMIT $ �
PLAN CHECK 5
PLUMBING S
PLAN CHECK 25% $
ELECTRICAL S
PLANCHECK 50% $ ?iR•4F�S
MECHANICAL $
PLAN CHECK ZS% $
ES `�
SMIP $
PERMIT
ISSUANCE $
ENEFGV P.C. S
GRADING 5
MICROFILM $
TOTALFEE $
,CONSTRUCTIONANDPLANNING �� ' �:.� ` � " POOL&SPA
APPROVALS Permit# � Date Inspector � AppROVALS Permit# Date Inspector
,� r. , �
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�Uridrgrnd. .. 3.-�� ,J C, 55. Electrical Bonding
5. Steel Reinforcemen{� 56. Rough Plumbing & Pressure Test
6. ElectricalUFERGrnd.� 57. APPROVALTOCOVER-GUNITE
7. Footings ,• 58. Electrical Conduit-Undrgmd.
8. Foundation 59. Ga ;Pipe, � 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 •
14. Rough Plumbing 65. Electrical-Final � �
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring . a 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 # �
27. Ducts, in Structure 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flush -
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Foof 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 �2�� '� �. 80. FOOD CERTIFICATE ISSUED .
33. Final Electric �2-�-5' ���i Notes: �y �
/ l L' eYfLC4 !O • O/��
34. Final Heating & Air Conditioning
i�
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. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
i
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co � •,
51. CERTIFICATE OF OCCUPANCY . !
No. Date
�\
City of Costa Meu
Development Services Department
Building Safety Division
P.O.Box 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No.' 80�298
The Building located at 2229 Elden Avenue� Units A& B
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group ul Occupancy.
Use of Building 4innla—Familv
Legal Descriptio
(See reverse side for Metes and Bounds)
Building Permit No B 28%Ol Electrical Permit No. E 29413 Plumbing Permit No. P 29396
Mechaniral Permii No. M��R Number of apartments and/or guest rooms
ISSUED TO:
�urisirta N. Columna
2229 Elden Avenuee, #A106
C�sta Mesa, CA 92626
Building Official William T. Howard
by 4� �/"'7 �, �� �.��''/.vti�-...--
� Date Februarv 3, 1988
This_ Certificate of Occupancy SHALL BE posted in a conspicuous place o� the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. t
C�vtF 1015-46 rev. 1/83 White -Owner, Canary - Numerical File; Pink - Bldg. Permit File � i
Ciry of Costa Mesa
DevHlopment Services Department
Building Satety Division
P.O.Box 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No. 80��9�
The Building locaied at 2229 E2d+�n Av�nue. Units A� B
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R1 OCcupancy.
Use of Building .4innlc._Familv
Lega� Description Q�G.-A5J-71
ISee reverse side for Metes and Boundsl
Building Permit No B 28%�l Electrical Permit No. E 29413 Plumbing Permit No. � 29396
Mechanical Permit No. `•� 3�8 Number of apartments and/or guest rooms
ISSUED TO:
Luriai� N. Columna
?229 Elden Avenu�, ikA105
Costa F7asa, CA 92626
Building Official Williarn T. Hoxard
,.% /.> > /
by� _i'", ..�� /�.-�=.>.%:_ ....�
Date Februarv 3, 1988
This.Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec, 307 (e) U.B.C.
CMF 1015-a6 rev. 1/83 White � Owner; Canary - Numerical File; Pink - Bldg. Permit file
CitY of Costa Mesa
Development Services Depanmen[
8uilding Safety Division
P. O. Box 1200
Costa Meu, California
CERTIFICATE OF OCCUPANCY No. ��:-�ti�
The Bui�ding located at �229 Eldan Avertue. Uillts C.D.E
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group w� Occupancy.
Use of Building CinnlcaaFamilv
Legal Description d�6�—(15�-71
ISee reverse side for Meres and Boundsl
Building Permit No A JA701 Electrical Permit No. �'29�d13 Plumbing Permit No. P 29396
Mechanical Permit No. �� 1��Q Number of apartments and/or guest rooms
ISSUED T0:
Piiriaimn N. !`nlvrmla
�909Paularino Ave.� OA105
!`ncYa Nhaa. C'A AiF+iC�'+
Building Official William T. Howard
by , �� .� � f ,-.. _
• ' Date .Tanuacv i9. 19A8
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF'lols-46 rev. 1/83 White -Owner, G' -v - Numerical File; Pink - Bldg. Permit File
OWNER YIXJNG, SidriBy A. DATE 11-1-E>P
JOB ADDRESS 1li2 Virginii�. Pl. BUILDING PERMIT NO. 1 10�—
GEN�RAL CONTRACTOR pwner-Bld2'. VALUli $100.00
AP No.11$-042-21 LOT 7'RACT RIRE ZONE DI's5CRIPTION OR WORKRET'OOf StgE.Bl(
INS{ I:CTIONS Signnturc DA7'P GROUP J TYl Is V 7.ONIs R-2
> >
c PI:RMI'I'S ISSUI'sD
r_ SUBCON'IRAC'COR ...,..., .......,.,.�
coat
OCCUPANCY
.,� '� . I 8 I 06
• r,
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 GOSTA MESA. GLIFORNIA
For Applicanf to Fill In Complefely
TYPE OR PRINT ^/�
BUIL�ING _ , i ,_ . i .• /1///
COSTA MESA.
5d ME
TEL.
NO. OR BLDGB.
� 98TBACK LINB PHOM
DESCRIPTION OF WORK
�
' COVERING WALL/N PJ�I I COVEI
U6E OF BUILDING.AND WORK TO I
�EE RECEIUED
NOV 1 1962
FINANCE DEPT. o
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
PBCHIIT NO. % �Ctry1QT N�
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R C H BY I DATB qHC81VHO OATB 198U[C
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BUILDING /,/ 1 �
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COSTA MESA. IFORNIA
ZONING
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DEBCPIPTION [w [ J �
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YARDS EVE6
APPROVED ALLOwED
fCeNTeH LINe BT.1 �
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�2'�� �:�'u._ c¢u-o( /ltZt✓- �
1 H8p6BY ACKNOWLl008 THAT I HAVB RHAD THIB APPLJGTION {H8 �MOUM BHOWN UNDBp VALUATION 19 FOP THH
AND BTAT! TXAT TH8 ABOVH IB COflfIER ANU AGREH TO COM- pUitP09H OP HOTABLI9HIN0 A veRMIT F[E ONLY.
PLV WITM �LL CIT' OHOINANL¢8 ANO 8iAT6 lAWB NCGULATING
ButtLlNo coNBirtuciloN. � �? VALUATION %
BIGNATURH OF� �,/� ��`� U�.�`'�'� PERMIT FEE $ OC �
PERMITTE !�
' � �, �/ $/��) � PLAN CHECK $
AUTNORIZED AGENT �/ V LGQ
TOTAL FEE
GEN�RAL
P`�
DATE (-lU-b"(
BUILDING PERMI'I
'PTION OF WORK B1oCkwR1 �
:ONE Vni.UE § 500.00
)UP J TYPE III i
SUBCONTRACTOR I n PEF
� Ai' �
' ..
C05fA MESA BUILDINGSAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA� CALIFORNIA 92E2E
Fo� AppI7mM fo Ffll In Compltldy
TYPE OR PRINT
COSTA ME3A. CALIFORNIA
CS
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� BRGI�CK LIH6IROY
DESCRIPTION OF WORK
1 BUILDINO NO.OR
SIZE ROOMH
EXTERIOR WALL I ROOP
! , E-
1 X6RQpY ACNNOWL[OOi TXAT.1 N�VI pi11D TMI� AP�4GTON
•ND 6T�T6 }HAT iNi ABOYi.18 CORR[C} ANO AOR66 M COY.
PLY WIiH wLL CITY ORDINANCY AryD KATt LAW� R[OYI.ATINO
GU�LDINO CONBTRUCT�ON.
816NATUR60� �/ ��
pewa�rree i - �'' -
AUTXORIZ[D AO[MT
PAiD J
JU! 10-67crsr,�0 SIIS u-<='� � '•��S.G�C
ArPLICATION FOR PERMR
BUILDINl3
For Offic� Ua� Only
116C[IRNO. ^�liRIM1''FNO�
r�„ a�r�.,, �
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D[YC111RION
A. P. NO. �I �� O'Y% '� Z I
N0T6: NO 8AV! OVERNANO SHALL B6 L688 THAN
90• TO 81D6 d REAR P. L
EAY88
ALLOWHD (U.B.C.REQUIREMBNT7
YARDlAPPROVED YAIiDB MPROVBD
MAIN BIIILDINO ACCH880RY BUILDINO
( FROM C/L YTRBR)
PR NT RT.
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T1l AMOYt? lNOWN UNOlIi VALUATION �B �OR T1[
■UPPOli O► ifTAGL1oXINO A PlHMI) 168 ONLY. �
VALUATION p
PBRMIT F86 �
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