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Home My WebLink About2417 ELDEN AVE - Building PermitsCity of Costa Mesa DB�elopment Services Department Building Safety Division P. O. Box 1200 Costa Mesa. Califomia CERTIFICATE OF OCCUPANCY No. Ul�,_�.L.1 The Building located at 2417 Elden t�venua. 1�(llt8 A�B�C.D.E�F,G has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-3 Occupancy. U5e of Building Aaartm2nts i\ Legal Description 439-281-40i41 (See reverse side for Metes and Bounds) : 827047.B27099.B25872 E28106�E29451�E28105 P27493.P28996 �`� BUilding Permit No 82�096iB27048 Electrical Permit No.E23950iE2%324plumbing Permit No. P274�[i.P27dQ9 E28107,E29Q49 p28�97�p2gggh `� M280o8, t�II728069 p�RGS� Mechanical Permit No. Number of apartments and/or guest rooms Fire Prevontion Permit — F28667 ISSUED TO. Building Offfcial P]illiam T. Hot�a[d ;\ Cambridge C�pital Group � r ° • � 2943 S. Pullman St. by .1-��y . �^, r . :•ii �� .� �a� Santa Ana, CA 92705-5852 � Date Sentembar 14. 1987 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 Cosxa Mesa under Sec. 307 (el U.B.C. CMF 1015-46 rev. l/e3 White -C!'^'�er, Canary. Numerical File; Pink - Bldg. Permit File �\ Applicant to fill in a11 spaces except those witnin �eavy boraer lines ane sign all appropriate Eeclarations. CI7Y oF coST,4 MESA�7 �/G NSTFi UC ON P RMIT "'""' '"" '""`'' '"" '-" ��° : urvrr o. . Project Address ` ]� ��,f � � �� . Applicant'S Mailing Address _�J� /��bY//II TYPE OF CONSTRUC ION NEW ADD ALTERATION REPAI R Owner's Name ' Pnone , � CONVERSION ❑ DEMOLISH ❑ OTH A P # t, DES RIPTION OF WORK/USE OF BLDG. �'��P � ✓�+'� Address ' ��/�/�� — S Main Building: Arch/Eng. License No. TVPE OF PERMIT GRADING ❑ F UNDATION ❑ STRUCTURAL T Front Addre55 'pI ❑ TENANT ❑' ELECTRICAL WMBING ❑ MECHANICAL B Rear Contractor'S Name • Phone ��1✓� � OTHER /� � PROJECT DESCRIPTION 5q. F7. OCCuaarvCv C Right Addresslmailingl�L�f M�rr�1% Q✓.�- K ^yp^,7', CONSTRUCTIONTVPE VAWATION$ g Left � City License No. I- // ZONE GRADING CU. VDS. ACRES # LICENSED GONTRACTOR DECLAftATION I Itereby afli�m Iha[ I am licensetl untle� 0/ovisions ot Charte� 9(commEnGng witM1 section ]000) of Division 3 of the Business antl Professions Cotle, and my license is in fu orc efiecf. License I 55 � I nse Date $i9nature � � WORK RS' OMPENSATION CL �RATION I hereby aftirm that I have a certiticate of consent to selt-insure or a certificate of Workers' Compensati/on Ins/urance, or a certifietl copy thereof (Se ion �400Y Nao. C.)�� i.� ( ��f��omPa � �l/� J Certifietl opy is hereby fu�nistletl. /// ❑ Cevti e d wrth the city Bui ing Divi�n. Oate � � Applicanf E%EMPT ON F OM WOftKERS' COM ENSATION D CLARATION (Tnissec ion ne tl no[ be completetl if the permit is for one huntlretl (b100) or less). I certify thal in lhe periormance of the work for which this permR is issuetl, I shall not employ any person in any manne� so as to become subject to [he Workers' Compensation taws ot Calitornia. Date Siqnature NOTICE: If, after making this tleclaration, you shoultl became subject to the Workers' Compensation provisions of Ihe Labo� CODe, you must fo�thwith mmpry with such provisions ot this permit shall be tleeme0 �evoketl. CONSTRUCTION LENDING AGENCV I hereGy affirm tha[ there is a conSVuction lentling agency for [he pertormance of the work for wM1ich this permit is issuetl ($ection 3097 Civ. C.) �enAer's Name Lentler's Atltl�ess OWNER BUILDEN OECIARATION 1 hereby a�ti�m that I am exempt from [he Contractor'S LitEnse Law for the followinq reason (Section 7031.5 Business antl Professional Cotle: Any ciry or county whiCh requires a permit to construct, alter, imD�ove, tlemolish or repair any s[ructure, prior to its issuance, also requires the applicant for sucb permit to tile a si9netl statement that ne/she is licensetl pursuant to tne pr6visions ot the Contractor's �icense Law (Chapter 9(mmmencin9 with Section ]000) of Division 3 of the Business antl Professions Cotle) or that ne/she is ezempt theref�om antl the basi5 for the alleg¢tl exemption. Any violation of $ection ��31.5 by any applicant fo� a permit subjects the applicant lo a civil 31ty ot not more tnan five huntlretl tlollars (y500). as owner o( the properly o� my employees with wa9es as tM1eir sole �..mpen5a[ion, will tlo the work, antl the structure is not intentletl or offeretl (or sale (Section 7044, Businesz antl Protessionat Cotle: The Contractor's 1 icense �aw tloes not aoply to an own¢r of a proper[y who builtls or improves a�a tor[ne purpose as owner of the bWltls ar improves tn tractor(sl bcense purs proof of their Worke ❑ I am exempt untler Date I hereby certif I informatlon is orrec I antl state law r in � sentatives ot s cit inspectian ou ses. Signature Drivers' L' nse or S� such work himselt/herself or [hrough his or he� own t such improvemen[5 are not intentletl or off¢retl for iltling or improvement is soltl within one year of mm- iave tne burtlen of proving he/sne tlitl not buiitl or im- sale). operty, am excluslvery contracting with IicenSetl cOn- project (Section ]044, Busine55 antl Professions Cotle: �e Law doez m[ apply to an owner of proPerty who eon, antl who mntracts for suth projects with a con- nt to the ConVactor'S License Law). I am aware tha[ Compensation insurance shoultl be provitled to me. �ction B. & P. C. for this reason above Remarks: Sink Preventer Irrigation Drinking fo� Floor Dreins Floor Sinks Gas Service Ineerceptors Kitchen Sink Lavatories P—Trap Roof Drains ReinspeMion Fee Outlets $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System� ❑ Multiple ❑ Firepl/Fact BIL IC80 # � Heating System & ing ❑ 0-100,0�0100,000 BT ReinspeMion Fee - � $15 CMF OB65-46, rev. 30/B4 - Accounting; Goltlenrotl - AsSesso� Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service AUlO-WdSh Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration Syste ❑0-100,0 U ❑100,000 �em Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 $ 3 Ping. Ref. Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switch¢5 Garbage Disposal e__� �i==i.7 _. Zone Accessory Building: ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100amps Meter ❑over100amps Generaror ❑ KW �5-15 KW Sub Panel Motors OO-7 HP 1%- B Inc.Solar �15 HP �16�15+ Range Si9n Standing Sections Trash Compactor I Reinspection Fee I$15 � I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By Building Approved By , � , Appliption Issued BY SUMMARV OF FE BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ S :tJO PLAN CHECK 25% $ ELECTRICAI S PLAN CHECK 50% $ MECHANICAL 3 PLAN CHECK 25% $ FEES $ 3 SMIP $ PERMIT ISSUANCE . $ ENERGY P.C. $ GRADING 5 MICROFILM $ TOTAL FEE $ S�O Z O N I N G R E Q M T $ CONSTRUCTION AND PLANNING POOL & SPA - APPROVALS Permit�# Date Inspector qppROVALS Permit# � Date inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgmd. - 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-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 - 74. 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 Sheathin9 . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and �Flashing . s 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 MeterFinal 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 �,� � +-� � , i 38."Final Plumbing �'3� � � • i � . >�%� 39� Water Service-Final . � �. • ' „ 40. GasServye-Final � i � � ' . � 4,1. Solar pomestic-Final .. , � � �. -42�BackflowPreventer �� -+-' � . ` 43�. �Backflow Irrigation - � . ' �� 44. Landscape Irriqation System , � _ 45�. Sound Attenuation � `- , , 46. Haniiicap Regulations . , 47��FINALSTRUCTURE&BUILDING , • ' �;"_ 4S. S�cial Requlrements Completed � ' •�.." . .� ' 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co .' ;r > 57. CERTIFICATE OF OCCUPANCY No. Date � AOP�icant to fill in all ipaces excepl thos¢ wi�hin heavy Eortler Ilnes antl sign all apPropriate tleclarations. CITY OF,COSTA MESA CONS�T^R TION P RMIT �/��7 Proiect Address 2y�7 R ��/��+ �} �+ ApplicanYs Mailing Address . � ' /sipY�� ( ��' Owner's Name Phone Address Arch/Eng. — - License No. Address � / �.' Contrector's Name ,Q hone(O yf-?�ii�,� Address(mailing) �� µr/�'�'��/ //� City License No. `�ys 7 � IICENSED CONTRACTOR DECLAftAY�ON I hereby atfitm lhat I am licensetl untle� Provisionz of Charter 9(commencing with section ]000 of Division 3 Ot th¢ BuSinesS antl Professions Cotle, antl my license is in f o^cC�'iQ'eifect. Licens � ss �'� �� se No. Date 519nature WORK RS' OMPENSATION D LARATI I hereby aifirm that I have a certificate of consent to self-insure or a certiticate �f Wo�kerz' Compensation/'InSurance, J� a certi(f'i'¢/tl� cPpy thereof (SecY'on ofc�Y No.7��7�_�/LS�s��7 Cor*� nY w.lP lT� `"^�I � eCertifie copy i M1ereby furnishetl. Cer ' ie y tl with the city iltli g isi ' Date � Applicant � EXEMP ION ROMWORKERS'GO PENSATIO DECL RA ON (This se tion n etl not be mmple[etl it the permit is for One huntlr¢tl ($300) or le5s). I certify thai in Ihe performance Of th¢ work tor whith thi5 perm�t is i55uetl, I Shall not employ any person in any manner so as to become subjeG[ to the Workers' Compensation Laws oi Califo�qia. Date Signature NOTICE: If, after making this declaration, you shoultl become subject to the Workers' Compensation p�ovisions of t�e Labor Cotle, you must fo�thwith tompty with such O�ovisions or this Pe�mit snall be tleemed revoked. CONSTRUCTION LENDING AGENCV I hereCy aftirm that there is a construction lentlin9 agency tor the peribrmance of the wa�k fo� which Ihis permi[ is issuetl (Section 3097 Civ. CJ Lentler's Name LenOer'S Atltlre55 OWNER BUILOEI2 �ECIARATION ' 1 hereby affirm that I am exempt from tne Contractor's License Law �o� the followin9 reason (Seclian ]031.5 BuslnCss antl Professional Cotle: Any city or county which requires a pe�mit to con5ttuct, alter, Improve, tlemOlish Or repai� any s[ructure, prior to its issuance, also requires the applicant for such permit to file a siqnetl statement that he/she is licensetl pursuant to the p�ovision5 ot the Contractor's License Law (Chapter 9,(�ommencinq witb Section �000) of Division 3 of the Business antl Profess�ons Cotl¢) or that he/she i5 exempt �he�efwm antl the basis (o� the allegetl?xemption. Any violation of Section 31.5 by any applicant for a permit subjects Ihe applicant [o a civil '�alty�of not more than five huntlretl tlollars ($500). � I, as owner of tbe property or my employees witM1 wages as their sale compensation, will tlo the work, antl Ihe structure is not intentletl o� offe�etl for sale (Settian 7044, BuSiness antl Professional Cotle: The Contractor's License Law tloes not appty to an owneY of a p�operty who builtls or imp�oves thereon, antl who tloes such work him5elf/herSElf or Ihrough his or her own employee5, provitletl [M1at sucM1 improvert�ents are no[ intentletl or offuretl tor sale. It, however, tne builtlin9 or imp�oVement is soltl wlthin one yea� of com- pletion, tne owner will nave the burtlen ot proving he/she tlitl not builtl or im- prove tor the purpose of sale). ❑ I, az owner of the property, am exclusively contracting with licensetl com Vactorsto construct [he project (Section 7044, Business antl Professions Cotle: The Contrattor'S License Law tloes not apply to an owner of praperty who builtls or improves tnereon, antl who contracts for such projects with a con- fractor(5) li<ense pursuant to the Contr3�tor's License Law). I am aware that proof of their Wo�ker'S Compensa[ion insurance shoWtl be provitletl [o me. -� I am exempt untle� Section _ B. & P. C. for [hi5 reason Date I hereby certif hat I information is r ecL I antl state la I ing t sentatives of is ity inspection p poze . $ignature Driverz' License or 55 � IF OB65-46,rev.10/84 � owner an cou above ' J TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTH DESCRIPTION OF WORK/USE OF BLDG. �!, ' � �''' �� TVPE OF PERMIT LJ GRADING �LJ �FOUNDATION Ll STRVCTURAL ❑ TENANT ❑ ELECTRIGAL I `f�/LUMBING ❑ MECHANICAL ❑ OTHER PRO�ECT DESCRIPTION SQ.FT. oCCUCArvcv— CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCV.YDS. ACRES— Remarks: Sink Preventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Dreins Floor Sinks Gas Service Outlets Interceptor5 Kitchen.Sink Lavatories Roof Drains Showers Service Sink Sewer Cap Sewer Connection Solar Collec[ors Solar Pipin9 ' Solar Tank Swimming Pool w/Spa Urinal� Water Closet Water Heater Water Service Auto-Wash FEES Reinspection Fee' � $15 I. I Issue Fee I $ 3 Duct- UnderGround Duct - Structurel Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. IC80 # Heating SYstem & Duct ❑0-100,OOOBTU 100,000BT qeinspection Fee Pink - Accountin9; Goltlenrotl - Assesso� $15 Hoodor Typel ❑ Canopy Type I I ❑ ❑0-100,0� ❑100,OOOBTU �m flepair/Alteretion Fire Dampers Registers Issue Fee $ 3 A.P. # S Main Buildi E T Front 6 Rear A C Ri9ht K Left 5 Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Suh. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures D¢VICC BOXPS Outlets Switches Garbage Dispo �c c��,.=/-- r_. 'i�. Zone Accessory Building: Z O N I - N G R Parking Req./Provided E Q M T 5 ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 700 amps Meter ❑over100a Sub Panel Motors -1 HP �1 % - 8 Inc Iar 09-15 HP �i6-15+ KW LJ5-15 KW Pole Light Sign Standing Sections Trash Compactor Fee 1$15 I I Issue Fee DEVELOPMEN7 SERVICES REQUIREMENTS: 2oning Approved By Date Building Approved By � ,� Date FEES $ 3 SUMMARV OF FEES � � BUILDINGPERMIT $ SMIP $ PLAN CHECK $ pERMIT PLUMBING _ $ ��-aO �SSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GFP.DING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ .��%� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING � ' POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement � 3. Electrical Conduit Utility-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 Undrgmd. � 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap .� 63. Heater & Vent-Final 13. Roof Drains " 64. Plumbing System - Final � 14. Rough Plumbing � 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final . 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 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 r 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 � 35. Final Gas Pipe-Test 36.' Hood or Canopy ' 37:�Final Factory Fireplace . ' , t 38. Final Plumbing ��.� j�, �/ .' ' , , •, r . , 39. Water Service-Final ' � � , �� ' ' � 40. Gas.Ser'vice-Final �� ,�' ` �'. .. : '41. $olar�Domestio-Final - � � - r '42. Backflow Preventer / � ' 1. ; � - 43. Backflow Irrigation � ' � ' �. ; " � � �44. Landscape Irrigation System � �''" . _ � �- � • �'� , 45. Souhd Attenuation ' ' ' _i �- �46."Handicap Regulations - � , a 47. •FINAL STRUCTURE & BUI LDING ' • ' � ,� f'. i � ., 48� Sp�cal RequirementsCompleted � �_1 49.-Electric Release to Edison � � "_ _ 50. Gas Release to Southem California Gas Co ."� l' •- ' `• 51. CERTIFICATE OF OCCUPANCY , No. Date 4 � � ��..,_.,� ro��r.,� , , .._. _ . - , � �� Applicant to fill in all spaces excev< <hose within heavy borOer lines antl sign all apvrooriate aeclarations. CITYOFCOSTAME GUNJIHUGIIVN t1iIVl11 Project Address {� �7 - q � AppliCari�S Mail�in%a Addr�Pc/c r - O�C 1 ) Owner'siVaip,a �/AL F-,//DLW�/�-t Pho / Address / �� L� ; y. Arch/En�j, License No. Address �,�y��,,, �/��/y� Contracmr's NamP N"K'V�%- /i ��.�� Phone S(C�.d,�/� Addresslmailing) � - � ��v��'�`� ��' �A - City License No. � 0 � LICENSED CONTRACTOR OECLARAT ON � 1 he�eby affi�m thal I am licensetl untler provisions o( Gbarter 9(commencin9 wi[h section 7000).of Division 3 of the Business antl Professlons Cotle, antl � my license is in full force�ntl efiect. Mp(�Y License�7ry"'`�` � �� Oate �/� /J ��y S9 t WORKERS' COMGENSATION OECL ATIO 1 - hereby affirm Inat 1 have a certificate t c nt to self-insure or a certiticate : Workers' CompenSatiOn InSuran �, or a ce�tltleG coOY tnereof (Section' POOc�Y NowpBb-3P23�-nComPanY._/�-�—�-! Cer tl copy is hereby fuinishetl. ' rUtietl ilql wRh the city uild • Date� Applicant : EXEMPTIO F OMWORKERS'COM N ECLARATION (Thiszeclion neetl no[ be comD�e[eC it th ' is (or one huntlratl (5300) or' less). I certi/y that In the per(ormance of the work for wnlch this permlt is issuetl I shall nol employ dny person in any manner so as to beCOme SubjeG[ [o ttie Workers' Compensation Laws ot CalifOrnia. . Da[e Signature �'�, NOTICE: If, atter making this tleclaration, you shoultl become subject to the ��. WorkCrs' Compensalion provisions of Ihe Labor Cotle, you mu5t torthwith ', comply with such provisions or this permit shall be tleemetl revoketl. �ICONSTRVCTION LENDING AGENCV i 1 hereby atfirm lhat there is a mnstruction Ientling a9ency lor the per/ormance I ot tne work tor 'wAic�U�S Dffanit iy�.iasiieG.!$eGlion 3097 Civ. CJ Lentler's Name /07nP « IveWD(J.�� Lentler's Atldress —� !��y✓' L�(_�17i�7 / _ � OWNER BUILDEN,�ELLARATION � ' I hereby atfirm tha[ I am exempt from the Contractor's License Law for lhe following reason (Section ]031.5 Buslness antl Professional Cotle: Any city or county w�ich requir¢5 a permil to con5t�utt, al[e�, improvo, tlemoli5h Or �epal� any Slructure, prb� to. its issuance, alm requir¢5 Ihe applicant for such Oermit t0 file a sign¢tl�slalemCnt that he/she is licensetl pursuant to th¢ P�oviSions Ot the Contractor's License Law (Chapter 9(mmmencing wltb SecHon 7000) ot livision 3 ot- the Bu5inG55 antl ProtesSions CotleJ or that he/she i5 exBmp[ �eretrom and the basis for the allegetl exemption. Any vlolation oi Section .031.5, �y any applicant for a permit subje<[s tbe apP��cant lo a civil �enalty ot not more tban irve huntlretl tlollars (y500). I, as owner of the property or my employee5 witM1 wages ds thul� solu wmpensation, will tlo the work, antl tne strvcture is not Intantlea or ofieretl for ule (Section 7044, Business antl Professional Cotle: The Conlractor'S License Law Goes not appry to an owner of a Oroperty who builtls or improves ihereon, antl who tloes such work himselt/herzeli or through his or her own employees, Orovltled Ihat sucM1 improvements are no[ in[entlatl or offeretl tot sdl¢. II, howevet, lhe builtling or improvement is soltl withln on¢ yea� of Com- pletlon, tne owner will nave the burtlen,oi proving he/sh¢ tlitl not builtl or im- ' orove tor the purpose oi zale). ❑ I, as owner ot tne property, am exclusively contracting with Ilcensetl con- tlactofs t0 consV uct the pro�ect (Section 7044, Bu5ine55 antl PrOfe55ion5 CotlO: T�e Contractor's License Lnw does not apply [o an owner. of property wM10 builtls or imorovns4nereon, antl who contracts for such projeGts with a con- tractor(s) bcense pursuant to tne Contractor's Licenze Law). I am aware that proof of ttl¢ir Wo�ker'S COmpensallon insu�ance shoultl be 0/ovltletl to me. ❑ 1 am ezemo� untler Section B. 6 P. C. tor this reazon Date I hereby certify that I h Signature � Drivers' cense or 5' CMF 0865-a6, rev. 30/04 this applicatlon antl state tnat tha above omolv wi[h all citv antl coun[v o�tlinances Z3 0 �7 5 Z (; Q(� TYPE OF CONSTRUCT�O�11 NEW ADD ALTERATION REPAIR ❑ CONVERSION � DEMOLISH ❑ OTHER q,p, # .'�(�_ DESCRSPTION OF Wj],�K/USE OF BLDG. S Main Buildin9: .t'/ t � L�u n ✓ TVPEOF�PERMIT GRA ING FOVNDATION ❑STRUCTVRAL � T Front a � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reaf ' � � ❑ OTHER PROJECT DESCRIPTION FT. OCCUPANCV � C Righi CONSTRUCTION TVPF�� VALUATION $ sa�SfY3•?o g Left � ��5 ZO�vE GRAO�NG CU. VDS. ACRETT— p��9. Ref. #�- t Remarks_ 'P�'� �' �� .� � � Planning Notes: � $ink Preventer Irrigation Drinking Fountains Floor D�ains Floor Sinks Gas Service � Outlets Interceptors - ' Kitchen Sink Lavatories P-Trap Roof Drain , Reinspec[ion Fee $15 Duct - Under Ground Duct - Structural . Duct - Ventilating ', Exhaust System ❑ Multiple ❑ FirepVFact BIt ICBO # " Heating System & Ducti . Oo-,00,000erup oo,oboer FeB � $15 White - Builtlinq; Canary - Applicant; Pink - Accounting; Goltlenrotl - AsseSm� Showers Service Sink Sewer Cap Sewer Connection Solar Collec[ors Solar Piping Solar Tank Swimmin ool w/Spa Water Closet Water, Heater Water�Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy Type II ❑ Refrigeration $ys ❑0-100,0 TU ❑100,000 em Repair/Alteration Fire Dampers - Registers ' � _ $ 3 FEES $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Oryers,�Gas ❑Elea Fan , F.A.U. Fix[ures Device Boxes O ut lets Switches Garbage Dispoul Generator 00.5 K Fee JAN 27 i98% � ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW 5-15 KW Meter LJup ro 100amps Meter �over 100 amps Sub Panel '/ Motors OO-1 HP�]1 % -8 InaSolar C�9�15 HP �16 Microweve � e Light Range � Sign Standing Sections Tresh Compactor Issue Fee DEVELOPMENT SER VICES REDUIREMENTS: Zoning APProved 6Y_ j Building Approved By _L_>r �',/�aL Aouliption laued Bv�C�LL � SUMMARV OF F BUILDINGPEFMIT $ �-39/•�O y�[� PLAN CHECK $ ��3•� p9~ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK � 50% $ MECHANICAL $ PLAN CHECK 25% $ 7 FEES $ 3 0 6 z O N I N G R E � M T S tJ SMIP � � $ -G,D/ PERMIT ISSUANCE $ ENERGV�P.C. $ GRADING $ MICROFILM S �-�C TOTAL FEE $ ��"7J CONSTRUCTION �+ND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcemsnt 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVALTO COVER�GUNITE 7. Footings ' � 58. Electrical Conduit�Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor SVstem ' LA 3 t 61. APPROVA�TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap ' 63. Heater & Vent-Final � 13. Roof Dreins 64. Plumbing System - Final - 14. Rough Plumbing � 65. Electrical-Final 75. Rough Electrical-Gonduit � 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-7 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. Proiiuct Piping O Gas ❑ Oil 23. Gas Plpe-Aough & Test 72. Underground Flush , 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing � ? 74. Overhead Hydro . 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frameand Flashing " � 76. Dry�Standpipe � 28. Lathing & Siding .S� 77. FIXED SYSTEM FINAL ` 29. Insulation � �� . 78. FIRE PREV. FINAL 30. Drywall Nailing .$7 HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 1.� 87 �k T G/P.�PEXT %/ 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � �(; - 36. Hood or Canopy � Q...� L7 37�.. Final Factory Fireplace , � - ,�� 38 �Final Plumbing � � j , � 39. Water Service-Final ' � �' " ' t� /40. Gas Service-Final � �' "s �� , , � 41. Solar pomestic-Final . � ; � ' ,l � � .. � 42. Backflow Prevenier 'j ��. ' ' , .t i 43. Backflow Irrigation �� i • • � � � 44. �Candscape Irrigation System ' � l . � . , 45. Sound Attenuation `' � . 46. Handicap Regulations ' - 47. F.INAL STRUCTURE & BUILDING ,�^/ . � .`,� �' , - ';, ' � 48. Special Requirements Completed u �� - r• , ' 49. Electric Release to Edison ' � • � '� 50. Gas Release to Southern California Gas Co � .' ' 51. CERTIFICATE OF OCCUPANCY � No. Date '/ Applicant to fill in all spaces except lhose within heavY Dortler lines antl si9n all appropriate Eeclarationi. r' ," , �`�''— y'r�?� `� / CITY OF CCSSTA M SA CrO-N1Sr-T�.R�-nUlCTION PERMIT ' PERMIT NO. TRACT NO. LOT NO. UNIT NU. �p ) �� ProjectAddress �� G✓�t�n''l�� /1 � a a � 52 . cy�R�oR�s � � JAN 27 �.�U7 /') AppliCant'S Mailing Addr S� �' '�✓ � L• tiV TYPE OF CONSTRUCTION NEW P.DO ALTERATION REPAIR /� " �� .�' '`,.�/ '❑ CONVERSIpN_ ❑ DEMOLISH ❑ OTHER q,p,# •� �••�=V � � r r C. Zo E^ Owner'sName ' one Y_ U� L DESCRIPTIO OFWORK/US OFBLDG.'� �� - Address � f ' � O.tw / _u �_� _lOC� lr C � , . E Main Building: � Acce-ssory Building: Z Arch/Eng. License No. TVPE OF PERMIT GRADING ��FOUNDATION ❑ STRUCTURAL T Front �y � ' p � ❑ TENANT ❑ ELECTRICAL ❑ PIUMBING ❑ MECHANICAL 8 N Address � Rear • � ��" .n /J��y/s ❑ OTHER � %� � Contractor's Name C Right G i " - - N _a��3//,C�i� Phone pROJECT DESCRIPTION Sa. FT. occucA v Address Imailing) UJ�� %k��" N� � � —� p�U K ,y G � r�9c�� CONSTRUCTIONTYPE VALUATION$ ��.`l�`%� $ Lef o�, CityLicenseNo. ^S � ZONE GRA�INGCU.YDS. ACRESy R �ICENSED CONTRACTOR DECLARAT�ON Ping. Ref. #`DiZ ��p � 3 � Parkinj Req./Provided E I hereby atti�m that 1 am licensetl untler provisions ot Cha�ter 9(mmmencing �� Remarks:. � .�r- � � ' Pldnni0y NOt¢5: � M with section �00�) 01 OIVISIOfI $ Of ine Business antl Protesslons Cotle, antl -i _ _ . T �my ticense is in full far ntl etie . � Qq , , - - License CI s No. �� S ^ Date Slqnature , PLUMBING FEES �� WORKERS' COMFENSHTION OEC A ON Bar Sink , Showers I hereby affirm that'I have a certificate of mnsent to selt-insure or a certiticate , ELECTRICAL FEES � of Workers' Compensalion Insurance, Ot a certifietl copy thereot (Section gackflowPreventer S¢rviceSink - 3eo0, �ab.� C,.%/�/ q�j �^�J�,�,,,�}� - P.utomatic Washer Transformer ❑ 15-50 KW � Policy Now�'OOiY'3�'�/ ��'"i�/�// Baikflowlrrigation SewerCa � � 50+KW � P Construction Pole Sub. � ❑ Certifie copY is bereby furnizhe . Q�rti� c i tl with the city n � s Bathtubs Sewer Connecvon Cooking Unit Meter �up to 100 amps � Date---lir� APPlitant . _) EXEMP ION ROM WORKERS' C PENS N OECLARATION CIB�if(¢�5 $Oldf COII¢Cf0�5 - Di5hwd5h¢f MetE� ❑Ov2� 100 3rtlp (� (Thizzection need not be mmpletetl if mit is for one huntlretl ($300) or - less). ' Dishwasher Solar Piping Oryers ❑Gas ❑Electric Sub Panel I certify that in [he pertormance ot the wo�k tor which this pe�mit is issuetl I - . - shall not employ any oerson in any manner so as to become subject to t{�e Drinking Fountains . , Solar Tan Fan Motors ❑ HP �7'/x - B Worke�s' Compensation Laws ot Califomia. Uate Si9nature Floor Drains � . Swi ing Pool w/Spe � F.A.U. � NOTICE: H, after making this tleclaration, you shoultl become subject ta the — Inc.S r �9-15 HP �16-15+ Workers' Compenzation provisions of the Labo� Cotle, you must forthwith FI00� SinkS . �inal ' ' Fi%tu�¢5 c�OwavE� tomply wilh such p�ovisions or� IM1iS permit shall b¢ tleemetl �evoketl. CONSTRUCTION LENOING AGENCV GBSS¢rvic2 'OuU¢t5 WatE�C1p52t D¢vic¢BOxes I bereby affirm that there is a construction lentling a9ency for the performance 7ole Light of the work .for wWst�.i,thX. Per�it �issu�.Q��eFon 309] Civ. CJ InterCeptor5 � Water Heat¢r Outlets Lentler'S Name, e1Y�i✓/G [i' _ �•vy Range Lentler'sAtltlress /��%�� KitchenSink ' WaterService Switches� ' OWNER BUILDER D CLARATIO Sig� I hereby a}firm tha4'I�am exempt hom'the Contractor's LicenSe�, Law tor tne � Lavatories � ' AUtO-Wdsh �- - following reasbnf(Section ]031.5 Business antl Professional Cotle: Any city or Garbage Disposal Standing Sections .�„ 'munty whlcn requires a petmit to construct, alteq �mprove, tlemolish or repair P—T,rap Laundr Tra s ' �" . _ ,�ny ztructure, piioi to its issuance, also �equire5 the applicant for such pe�mit Y � Generator DO- W �545 KW T�dSh COrtlpaCtO/ f0 file a signetl statement that he/she is licensetl pu�suan[ to the provisions of qoOf in5 ' � ' the Contractor'sCicens¢ Law (Chapter 9(commencing wi[h Section ]000) o( • Division� 3 of the Business antl Pro�ezsions Cotle) or that he/she is exempt -- - , - � � � therefrom antl lhe basls fo� the aliegetl exemption. Any violation of Section � � � ]031.5 by any applicant tor a permit subjects the applicant to a civil _ �nalty of not more than five huntlretl tlollars ($500). � � - I, as owner ot the� property or my employees with wages as tneir sole ReinspeMion Fee $15 �55ue Fee $•3 mmpensation, will tlo the work, antl the structure is no[ in[entletl or offeretl Rein5p0[tion F¢¢ $15' ISSU¢ Fee ' _$$ for sale (Section �044, eusiness ano Professional Cotle: The Contractor's MECHANICAL FEES ' License Law tloes no[ apply to an owner of a property who bUiltls or improves , tharmny antl wno aoes such work himself/herselt or mrou9h his or her own . � � DEVELOPMENT SERVICES REQUIREMENTS: nn /� /.� 7,�p employees, provitletl tM1at such improvements are no[ intentletl or offeretl Por BOiI¢� HOOd O� Type 1 ❑ s- sdle. If, howeve�, ihe builtling or improvemenf is soltl within one year ot com- CdnOpy TypC II ❑ ZOning App�oved By S fd� � ate l, - pletion, the owner wlll nave ihe bUrtlen ot proving he/she tlitl not builtl o� Im- DuCt - UndC� G�OUnd - ' Building Approv¢d By Ddte �' � 7' �S7 .provG for the purpose Of sale). r��` 7 ❑_I, as owner'oi the property, am excWsively contracting witn licensetl con- Duct -SVuctural Refrigeration Syst ' AppliUtion ISSued By Z' �� nate �' � � tractorsto construct the projeci (Sec[ion 7044, Bu5ine55 antl ProfesSions Cotle: ' � _ The Contractor's License law does not apply to an owner of property�who Duct - Ventilating � . ❑�-100,00 U❑100,000 BTU � SUMMARV OF FEES � � builtls o� improves the�eon, antl who conttacts fo� such projects with a con- • ' tractor(s) ucense pursuant to the Coritractor's Licenre Law). I�am aware that Exhaust System ❑. Multiple � S m Repair/Alteretion . �+�j BUILDING PERMIT $ R� aJ�C%+ SMIP ;r $. • 7 7 proof of their Worker's Compensation insurance shoultl be provitlea ro me. 2 �j,dP�AN CHECK $. -��•� PERMIT- � � _ ' L� I am exempt untler Section , e. & P.;C. for this reason - FirepVFact.6lt: ICBO # Fire Damp¢ts . ff" pLUM81NG $ ISSUANCE - $ , Date owne7 Heating System & Ductin � Registers � ' PLqN CHECK �25% $ ENERGY P.C. $ 1 nereby certify that I have reatl tnis application ana state that tne above ❑0-100,000 BTU ,OOOBT " � ' GRADING • $ Information is mrrect. I agree to wmply with all city antl county ordinances` - ' ELECTRICAL :$� . antl state la ting to builtling construction, and hereby authorize repre- . � ` MICR�FILM $ sentatives o this er upon the above-mentionetl propert or - � . ' PLAN CHECK 50% $ . i inspectionp es. - ' - MECHANICAL � $ I�l��'33 Si9nature Date , , TOTAL FEE $ Drivers' Li einspection Fee $75 • laue Pee - $ 3 ' PLAN CHECK 25% $ CMF 0865-46, rev. 30/89 White - Builtlinq; ing; Goltlenrotl - Assesso� �� CONSTRUCTION AND PLANNING POOL & SPA . APPROVALS Permit # Date Inspector qPPROVALS Permit # � Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gmd.. 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 70. Structural Floor Syste �� S�y G� 61. APPROVAL TO DECK � 11. Property Sewer Line & House ConneGtion 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 i6. Rough Electric Wiring 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,FactoryFireplace APPROVALS Permit# _ 21. Ducts, in Struaure 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 ��7 Q� 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 r 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT_ 31. Plaster Brown Coat 79. FIN'AL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: .� � G/✓ 34. Final Heating & Air Conditioning _ - - �T , 35. Final Gas Pipe-Test .�(�,. 36. Hood or Canopy � � 37. Final Factory Fireplace � ! ' 4. r,i, (i i �38. Final Plumbing, � � � r �� I '39. WaterService-Final . �� '�: ��'_ e 40. Gas Service-Final l� " . r . i ,. 1 / . �(47. Solar pomestic-Final " ��' �9 , ��, • "� � ,;42. Backflow Preventer - `� � { � . � � • ` � � ., ' r: l, 1' �^ ;� 43. Backflow Irrigation , - • '� � '' �, , � r' ;1 % ✓ .. ,i:� 44. Landscape Irrigation System 'vyr , ' . 45..-Sound Attenuation � � . . 46. Handicap Regulations `� - i 47. FINALSTRUCTURE&BUILDING ��,�✓ �, r t: �� ,. 48. SPecial Requirements Completed i, � 49. Electric Release to Edison ' r 50. Gas Release to Southern California G8s Co ` " 51. CERTIFICATE OF OCCUPANCY ' No. Date � � n A$$fiEB orfF'f� T�ilTin4d1� CiTY OF cos'r r CONSTRUCTION PERMIT Project Addres; '�' �� p�� p�TS � � { C^Z Applicant'sMailingAddress �� R"��G��r�.�CP NB Owner'sName �%A� i�D�W�� p�o�3 y"� jb7 Address ��`�X �9�I5g LA i G1 � r'l��/�( ' � Arch/Eng. N�.4 � � License No. NtA Address N�� - Contractor's Name � �7� �i�� Phone ��S � Address (mailing) �� ,,��^��STW� � ' N� `j2�j3 Ciry License No. —��/�b �' � LICEIVSEO CONTRACTOR DECLARATION � � I hereby attirm that I am�licensetl untler provisions of Charter 9(commencing with section ]Oo0) of Division 3 oi the Business antl Protessions Cotle, antl my license is in full Porte antl etfecL ' �/ .L License Class � L' No T�Z�!�/ Date tA ^li i%! _ C WORKERS'COMPENSATION D� AT� I hereby atfirm that I have a certiticate of consent to selt-insure or a certificate of Workers' Compensation Insurance, or a certifietl copy thereof (Section 3800, Lab. C . Poiicy No wP's` - 38233o-a� Company �� _ np� �tifietl copy is hereby fumishetl. fdCertifietl co y iz} �(iletl with the city ' Date �V'��—C"' Applicant - . EXEMPTION FROM WORKERS' COM ION DECLARATION (Thissection need not be completetl if the permit is tor one huntlretl ($300) or lesz). I certity that in the performance ot the work fo� which thi5 perm�t is issuetl, I shall not employ any person in any manne� so as to become subject to the Workers' Compensation Laws of California. � � Date Si9nature ' � NOTICE: If, afte� making this tleciaration, you shOultl become subject to the Wo�kerY Compensation provisions of the Labor Cotle, you mu5t forthwith comply with such provisions or this permit shall be tleemetl revoketl. CONSTRUCTION LENOING AGENCV I hereby atfirm that there is a consiruction lentling agency for the pertormance of the work Por which this pe�mit is iSsuetl, (Section 30W Civ. C.) Lentler's Name � Lentler's Atldress - - OWNER BUILOER DECLARATION I he�eby aftirm that I am exempt from the Contractor's License Law tor fhe following reason (Section ]031.5 Business antl Professional Cotle: Any ciry or county which requiies.a permit to construct, alter, imprbve, tlemolish or repair any structu�e, prior to its issuance, also requires the applicant tor such permit to file a signetl statement that. he/she is licensetl pursuant to the provi5ion5 of the Cont�actor'S LicenSe Law (Chapter 9.(commenan9 with Section �000) of Division 3 af tM1e 8usine55 antl Professions Cotle) o� that he/she is'ezempt theref�om antl the ba5i5 fo� the alleged exemption. Any violation ot $ection ']031.5 by any applicant tor a permit subject5 tbe� applicant to 'a civil penalty of not more than five nuntlretl tlollars ($500). . � I, as owner of the. property or my employees with wages as their sole compensation, will tlo the work, antl the structure is not intentletl or offered for sale (Section 7044, Business antl Professional Cotle: The Contractor's - License Law tloes not apply [o an owner of a property who builtls or improves thereon, antl who tloes such work himselt/herself or throu9h nis or her own emploYees, provitletl that such improvements are not intentletl or offeretl for sdle. If, however, the builtling �o� improvement is soltl withln one year of mm- ,pletion, tne owner wi�l nave the burden of proving he/she tlitl not builtl or irtrv � �ove tor the purpose of sale). ' - � I, as ownei of the property, am ezclusivety contracting with licensetl con- tractorsto construcYthe pro]ect (Section �044, eusiness antl Professions Cotle: `The Contractor's License Law does not apply to an owner of property who builtls o� improves thereon, antl who contracts for such projects with a con- tractor(sl Imense pursuant to the Contractor's �icense Law). I am aware that , proof of their �Worker'S Compensation insurance Shoultl be pravitletl'to me. ❑ I am exempt untler Section B. & P. C. far this reason Date - Owner I hereby certify that I have rea� information is correct. I agree to. dOtl SSdI2 �dWS relatinq to builtli� Signature C �—T— orivers' License or 55 � tate that the above tl county ortlinances ;by authorize repre- ionetl property tor Date �"tl'�7-1�6 M1eavY bortler lines antl si9n all TRACT NO aeclaratians. 0 TYPE OF CONSTRUCT�ION� I.J NEW • U ADD� LJ �ALTERATION lJ REPAI R ❑ CONVERSION [SGDEMOLISH � OTHER A p # . DESCRIPSION OF WORK/USE OF BLDG - , f � , � ; S Main Building: E TVPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL � T F�Ont ❑ TENANT ❑ ELECTftICAL ❑ PLUMBING ❑ MECHANICAL A Reaf . ❑ OTHER ' PROJECT DESCRIPTION SQ. FT. OCCUPAN6v C Ri9ht CONSTRUCTIONTVPE VALUATION$� g Left • ZONE � GRADING CU. VDS. ACRES p�ng. Ref. # ' Remarks: ' � , Planning Notes:� Sink Preventer Irrigation Drinking Fountains FIOOf �f3105 Floor Sinks GasService Outlets Interceptors - Kitchen Sink lavamries P-Trep ' Roof Drains ReinspeMion Fee �, $15 Duct- UnderGround Duct-Strucwrel ' Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIt. ICBO # Heating SYstem & Ducting ❑0-100,000 BTU 0100,000 � Reinspec[ion Fee $15 F 0865-46, rev. 10/84 WM1ite - Builtling; Cana�y - Applicant; �Ink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap '� ' Sewer Connection � •Solar Collectors Solar Piping .Solar Tank Swimming Pool w/S� Urinal Water Closet Water Heater Water Service A uto-W ash Issue Fae Hoodor TYPeI ❑ Canopy Type I I ❑ Refrigeration System - � ❑0-100,000 BTU ,0100,000 BTU � System Repair/Alteration � Fire Dampers Registers � � Issue Fee FEES 6624 10/21/86 1�8.00 ,TL , _ _ .I . . . , .. � i " _ ' ' _ _ Zone ' � AccessoryBuilding:� Z O N � I ' " ' _' ' ' , ' _ N G R Parking'Req./Provided � ' E Q ' ' M - T S Automatic Washer . Construction PoleSub. Cooking Unit_ Dishwasher Dryere �Gas ❑Elec Fan � F.A.U. ' Fixtures D¢vice BOxes , Outlets Switches - Garbage Disposal Generator �0-5 KW C ELECTRICAL � � � Transformer ❑ 15-50 KW � . ' ❑ 50+KW Metef ❑up Lo 100 amp5 Merer ❑overv100amps � Momrs DO-1 HP; 01'/: - 8 Inc.Solar �9-15 HP 016-1 � Microwave � ' Pole Light Range _ Si9� . . . _. Standing Sections 5 KW Trash Compactor �� $ 3 ' Reinspection Fee -$15 Issue Fee ' FEES , �DEVELOPMENTSERVICESREQUIREMENTS: i Zanin9 ApProved 6Y _ Building Approved By $ 3 $ 3 SUM Vrrr�� ' EES . � BUILDINGPERMIT $ _�� SMIP - $ 4�� -- PLAN CHECK $ �- PERMIT,� � . ' PLUMBING $ ' � ISSUANCE $ ' s - . PLAN CHECK 25% $ � '" � �ENERGV_P.C� $ ELECTRICAL $ GRADING. $ - PLAN CHECK 50% $ ' � MICROFILM $ MECHANICAL , $ , , �.TOTAL FEE $ 1 .�DD � PLAN-CHECK 25% $ ' CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit UtilitY-Undrgmd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Elect�ical Bonding � 5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings �•,; 58. Electrical Conduit-Undrgrnd. � S. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 6D. Backwash Lines, P-Trap, � 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 $ign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil , 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framing 73. Undergrnd.StorageTank DGas OOiI 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (5tructural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT I 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood or CanopY 37. Final Factory Fireplace � t- " �'• ,. 38. Final Plumbing � �' . �' n- '- w� <, d ` v 39! Water Service-Final - • " .' � � " r '� H 40. Gas Service-Final - a,'. ' " � • � -' !: �f� 41. Solar pomestiaFinal � � ��. �•, - '? �'42. Backflow Preventer ' j � �t' " f <. �� 43. Backflow Irrigation ' r� �� : !- �44. Landscape Irrigation System A�, �' � , , ; `' �45. �Sound Attenuation �� . , , �, � 46.'Handicap Regulations , � � �, , -. _ 47.FINALSTRUCTURE&BUILDING � /'�/ ' : . ��'-��- � C7' n ' J � ¢. 48. Special RequirementsCompleted . !.� ' � ' "' � 49. �Elearic Release to Edison • � . ' , 50. Gas Release to 5outhern California Gas Co � �: 51. CERTIFICATE OF OCCUPANCY . �. No. Date r ' AOV��ant to fill in all s0aces except those wit�in �eavy Oartler �ines anC si9� all apOroOriate tleclarations. CITY oF COS7A M.E$Ay�ONS7T�f�2�,l/}�CTIO PERC l�D Project Addresz � /�� ApplicanYs Mailin� /p�fdress �/_ �� M„-.Y%�� ' Owner's Name ✓`^ l �I^ ��e ic�c Pho�rip �- G Addreu Arch/Eng. License No. Address I Convactor's Nam � Phone Address (me'I'nnl lI�Y ��..-r J �� . City License No. Z-y� 7 z LICENSED CONTRACTOR DECLARATION I hereby aftirm that I am licensetl untler provislons of Charter 9(commencing with section ]000) ot �ivision 3 of the Business antl Professions Cotle, antl my Ilcense is in /ul/y orc tl eftect. / �/ License ass `� Licens��O(ODV b Datc `�, 5�9 t �� /� � WORK R$'� O�SATIONDECWRATION 1 hereby aflirm lhat I have a cer[ificate of consen[ [o sel/-insure or a certiflcate � of Workers' Compensation Insurance, or a certifietl cop thereof ( ctlon 3800, Lab. C. � ^ i PoIiCY No. �• .�� ComPanY ^` A � � y�...�.� f•i�etl Copy is hereby furnishetl. L�TCe� ie c y ' a with tM1e city 8 iltl g i �� Oalc Applitant-/�C�a��R'�•i/�- f-- E%EMP ION ROM WORKERS' COMPENSATION DECLARATION (Thisse [ion n etl no[ be completetl if the permil is tor one huntlretl (5300) or less). I tertify that in the performance of the work tor whiGh this permR is issuetl, I shall not employ any person in any manner So as f0 become subject to the Workers' Compensa[ion Laws ol Californla. Data Signature NOTICE: H, after making this tleclaration, you shoultl become subject to the Workers' Compensation provisions of tne Labor Cotle, you must forthwi[h comply with such provisions ot ShiS permit Shall Oe tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby atfl�m lhat IhCre is a construclion lentling agency for the perto�mance of lM1e work for wM1ich this permit is issuetl (Section 3097 Civ. CJ LPntler's Name , Len48!'S Add(e55 OWNER 6UILOEH bECLARATION I hereby atflrm Ihat I am exempf from the Cont�actoYS License Law for the lollowing reason (Section �031.5 Business antl Protessional Ctitle: Any city or county which requires a permit Jo construct, alter, improve, Eemolish or repair any SVucturq D/io� to i[5 issuance, alm �equire5 [he applicant f0� such petmit to file a signetl slatement tha[�he/she is Iicen5e0 Pursuant'to tba provisions of the Contraclor's License Law (Gnapter 9(mmmencinq wi[h Settion 7000) ot Division 3 0( the Business antl Pro(essions Cotle) or that he/she is exempt [he�efrom antl lhe baSiS fOr the allegetl exemptiOn. Any violation ot Section 7031.5 by any applicant tor a permit subjects tbe applicant to a civil �enally of not more than five huntlretl tlollars (E500). I, as owner of tne property or my emo�oYees with wages as their sole mmpensation, will tlo the work, antl the structure is not intentletl or offered for sale (Se<lion 7044, Business antl Professional Cotle: The Contractor's LicenSe Ldw tloe5 nol apply to an owner of a property who builtl5 or impwves thcreon, antl who tloes such work himself/nersel( or Inrough his or ner own employees, providetl that such improvements are not Intentletl or offeretl for I sale. If, hOweveq the bulltling or improvement Is soltl within one year of com- pletlon, ine owne� will have tne burtlen of proving h¢/she tlitl m[ builtl or Im- prove for [hu pu�po5c oi Sale). ❑ I, as owner oi the property, am exclusively contracpng with Ilcensetl ton- tractors t6 construct the prolect (Section 7044, Busines5 antl Professions Cotle: The ContractoYs license Law tloes not apply to an owner o1 property who builtls or Improves thereon, antl who contracts for such projectz with a con- traclor(s) iicense punuani m the Convactor's License Law). I am aware that proof O( Ihelr WorkeYS CompensatiOn insurance snoultl be providetl to me. ❑ I am exempi untler Section B. & P. C. for this reason oate Owner I herebvi cerlilY that I have rea antl state �aw r la[ nq 1 sentatives oi rs ity inspection p ses, Signature Drivers' Li ens r 55 # CMF 0065-46, rev. ]0/84 TYPE OF CONSTRUCTION L%YNEW IJ ADD LJ ALTERAT�ON LJ REPAIR ❑ CONVERSION ❑ OEMOLISH ❑ OTH`p, a q.p.# DESCRIPTION OF WORK/USE OF BLDG. N'� ��Cti —T S Main Building: E TVPE OF PERMIT GRADING UNDATION STRUCTURAL T FrOnt ❑ TENANT ❑ ELECTRICAL PIUMBING ❑ MECHANICAL 8 Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCV C Right K Lett CONSTRUCTION TYPE VAIUATION $ $ ZONE GRADING CU. VDS. ACRES Ping. Ref. # aemarkz:� � 7'7 /� C/ ) Planning Notes: Sink Preventer Irrigation Dishwasher Drinking Founteins Floor Orains Floor Sinks Gas Service �` I n tercepmrs Kitchen Sink Roof Droins Reinspection Fee � $75 Boiler Duc� - Under GrOund Duct - Structural Duct � Venlilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU 0700,000 Reinspection Fee � $15 - Appllcanh Pink - Accounting; Goltlenrotl - AssesSor ; PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service P.l1LO�Wd511 laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑aioo,000aru ❑ioo,000 System Repair/Altera[ion Fire Dampers Registers luue Fae FEES $ 3 $ 3 Auromatic Washer Construction Pole Sub. Caoking Unit Dishwasher ' Dryers ❑Gas ❑Eleci Fan F.A.U. Fixtures Outlets Swicches � Garbage Disposal Generetor �P5 KW �! Fee 3015 ei2�ia� 2one Accessory Building: � Parking Req./Provided ELECTRICAL Transtormer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100amps Meter ❑over 100 amps Motors �0-1 HP �7'h-8 Inc.Solar �9-15 HP 016� Microwave . Pole Light Range Standing Sections 5 KW. � Trash Compactor $15 Issue Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By Bui�ding Approved By _ �— 5+ so,5u T� FEES $ 3 Z O N I N G R E Q M T S SUMMARV OF FEES BUILDING PEFMI7 S SMIP $ PLAN CHECK $ � PEfiMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% S ENERG�' P.C. 5 ELECTRICAL $ GRADING _ $ PLANCHECK 50% g MICROFILM $ MECHANICAL $ TOTAL FEE $ SO PLAN CHECK . 25% $ � 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. 3�?�$%7 �j� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgmd. 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 y� /�7 � 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 74. Rough Plumbing /,I� S' 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 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure � 70. Underground Hydro $'2'7rY( G+�� 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing . � � 76. Dry Staa dpipe � 28. �athing & Siding 77. FIXED SYSTEM FINAL� � 29. Insulation 78. FIRE PREV. FINAL . 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION �' i 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 � p f� � � � � � � : � 39� Water Service-Final s l�7 L�9 � ' 40. Gas Service-Final ' LZ tf% �O � 41. Solar pomestic-Final � !� � . , : • ' 42. Backflow Preventer � � - � 43. Backflow Irrigation ' � • 44. Landscape Irrigation System ; � - 45. Sound Attenuation - . % � � ' � 46. Handicap Regulations ' . �9 � 47. FINALSTRUCTURE&BUILDING . . � i , . 48. Spedial Requirements Completed - � � � 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co '�-� - 51. CERTIFICATE OF OCCUPANCY l No. Date ADClicant to fill in all spaces except enose within heavy oorOer lines antl sl9n all aporopriata tleclarations. CITY OF COSTA MESA CO T J�J(�;TIO PERMIT/ �^/� / P �T NO. TRACT NO. LOT NO. UNI NU Project Address • ��/1 «. � � •�.� Applicant'sMailingAddress �� Me/!i I �. Owner's Name Phone Address ArchlEng. License No. Address � Contracror's Name � � one ' � Addreu (mailing) . Ciry License No. LICENSED CONTRACTpp DECLARATION 1 hereby affirm that I am licensetl untler O�ovi5ion5 01 Cbarler 9(commencing with section �000) ot Di��sion 3 of the Business antl Professions Cotle, antl my license is in ( torp otl eltect. License��...pasjjj �� —' �en No. �ate� 5'g ( ,r� WOR CO D SATION D� ATIO � I hereby ffirm that I have a certificate of consent to selt-insure or a certificat �of Workers' CompenSatiOn Inm�ance, or a ceriifietl cop ittere (Se<tlo 3800, Lab. C ` Policy No. Como \ e Cert' 'e co a hereby furnishetl. . \ Cm i p iletl Wj[h [pe city iltlin n Date APplicant �EXEM 10 R WORKERS'C NDECLA A ION (This ctio eetl not be Completetl if the permlt 5 far one �untlretl ($300) o� Iessl. I certi/y [hat in the perfOrmance oi the work fo� wttich th15 pe�m�t i5 issuetl, I shall not employ any pe�son in any manne� so a5 lo become subject to the Workers' Compensation LawS of Califomia. Date Signature NOTICE: II, aiter making �hiz tleclaration, you shoultl become subject to tne Workers' Compensation provlsions of Ne Ldbor Cotle, you must torthwilh compty witn such prov{sions or thiz permit Shall be tleeme0 revoketl. CONSTRUCTION LENDING AGENCV I herfby atfitm thal th¢re is a Const�uctlon lentling agency fo� the pertormance o/ the work for which this permit is issuetl (Section 309] Civ. C.) Lentler'S Name Lentler's AOtlress OWNER BUILOER bEC�ARATION I heveby aHi�m that I arp exempt from the Cont�acto�4 License Law tor [he lollowin9 reason (Sec[lon ]031.5 Business antl Professional Cotle: �Any city or county wbith requires d be�mit lo ConsVuct, dlt¢r, Improve, tlemolish o� repair any sVuc[ure, prlor to i[E Issuance, also requires the appllcant for such perml[ to tile a zignetl Slatemenf that he/she i5 Iicensetl pu�suanl to the provisions of ro¢ Contractor'S License I�w (ChaO�er 9(commencing wilh 5ection 7000) of Division 3 of [he Bu5ine55 antl Professions Cotl¢) o� that M1e/she is exempt therefrom antl the basis tor the alle9ea exemption. Any violation of Section ]031.5 by any applicaq[ tor a permit subjects lhe applicant to a clvll �enalty of not more than {jye huntlretl tlollars (E500�. U I, as owner of the propmty or my employees with wages as their sole compensation, will tlo Ihe work, antl the structure is not intentletl or oifered for sale (Section ]044, Bu5ine55 and Professional Cotle: The Con[�aclor'S LicenSe Law tloes not apply to an owner of a property who builCs or improve5 Ihereon, antl who tloes such work himselt/herself or tnrough his or her own employeez, provitletl that such improvements are nol intenEetl or oiferetl tor sal¢. If, M1oweveq [M1e buil0ing or improvement is zoltl within one year of com- pletion, Ine owne/ will have Ihe burtlen of proving he/she tlitl not builtl or im- prov! �or lhe pu�pose OI Sale). ❑ I, as owner ot the 0/Operty, am eKUusivery mnt�attlng with lic¢nSe� con- Vactorsto consVuct tM1e project (Section 7044, Business antl Professions Cotle: The ConVactor's Licens� L,aw tloes not apply to an owner of property who bWltls or Improves tnerepn, antl who mnVac(s for such projects with a con- tracto�(s) license pursuaqt [o the Contractor's Licanse Law). I am awaie that proof of their Worker's Compensation insurance shoultl be provitletl to me. I ❑ 1 am exempt untler Se�tlon B. & P. C. tor this reason �ate I he infoi Owner [hat I hay� reR�1 [his secL 1 oF6elo como ISi9naWre�i��` _—� L Bulltling: Canary - Applitant: Pink - ACcounting; Goltlenrotl - ASSEssor Show¢rs Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urindl Water Closet Water Heater Water Service Auto Wash Issue Fee Hood or Type I ❑ Canopy Typell ❑ 7a�,e6,000sru ❑iao,000 >ystem Repair/Alteration Fire Oampers � Regiscers laue Fae G $ 3 $ 3 A.P. # S Main Buildin9: E T Front B Rear A C Right K Left S Ping. Ref. # Plannin9 Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0.5 KW OS-� Fee �._�� _.� � . . Zone Accessory Building: Z O N I N G R Parking Req./Provided E Q M T S ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Merer ❑up ro 100 amps Meter ❑over100amps Sub Panel Motors - HP�1h-8 Inc olar 09-15 HP �76-15+ icrowave Pole Light Range Standing Sections 5 KW Trash Compatror $15 Issue Fee DEVELOPMENTSERVICESREQUIREMEN75: Zoning Approved By Building Approved By �., ,.,.e� / SUMMARY OF F BUILDING PEfiM1T $ PLAN CHECK $ ,�.�/� PLUMBING $ L� PLAN CHECK 2546 $ ELECTRICAL $ PtAN CHECK 50% $ MECHANICAL $ PLAN CHECK Z5% $ FEES $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM S TOTAL FEE $ '� � CONSTRUCTION ANP 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 56. Electrical Conduit-Undrgrnd. 8. Foundation � ' 59. Gas Pipe, � 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 75. 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. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framin ' 9 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 ' L 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 Metef-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 Faaory Fireplace , � 38.!Final Plumbing /�1��/�7 f" �' , (• '. . 39l Water Service-Final . �� 40. Gas Service-Final � . ' � `� r • 47. Solar pomestic-Final ' � • ' � 42. Backflow Preventer � .` . . �-, • 43. Backflow Irrigation . � ' '. � . 44: .Landscape Irrigation 5Ystem � � � ' � , 45. Sound Attenuation , ' ' � 46. Handicap Regulations � ' 47. FINALSTFUCTURE&BUILDING .. • � � ,� i 48. Special Requirements Completed . . , , 49.�Electric Releaseto Edison ' r' • �" 50. Gas Release to Southem Califomia Gae Co . f> �% '' ti • 51. CERTIFICATE OF OCCUPANCY No. pate � • - ',._` _\ . _. ' AOPlicant to fill in all spaces ezcept those within heavy EorOer Iines antl si9� all aDOropriate Eeclarations. CITY OP COSTA ME� �q � C,O�I$�U �ON PERMIT� PE�MIT NO. TRACT NO. LOT NO. UNIT�. � Pro'eCt Addre55• _t� _!_ C4. . f �r ' � 7 �—� / �p AppliCAnt"5 Mailing Addre55 �� -rr: � /�• TYPE OF CONSTRUC710N NEW ADD ALTERATION REPAIR Owner�s Name Phone AddreSs Arch/�ng. License No. AddreSs Concractor's Na �< i ho e �— Addre;s (m�'�� Y�.-ri � �. City �icenseNo. �Y97� LICErySED CONTRACTOR OECLARATION I hereby affirm that I am Iicensetl untler provisions ot Charter 9(commencinq witn s¢�tion 7000) ot �ivision 3 ot tna Business antl Professlons Cotle, antl my Ilcense iz in f tort a E e(tect. aarI�(,f�. ��j/� License la � .Ce ¢�fj�o.'C/�%'`lC � Dale ��G. �ry`' 5'g t �� WOR1� 5' C6 PENSATION D�LA ATION � I nereA atfirm nat I have a certilicate oi consent to seH-insure or a certificate ol Workers' Compe�5ation Insurance, or a certifietl copy Ibereof (Sec' � � 3800, lab. C�d � /ZC / ^ ,p�] /�� . � PBoliCerHf e coPY is fieYtlbwit�h [he ciay Om Itl ng `vis' � Oa[e APPlicant EXEM 10 RO WORKERS'COM NSATI DECL (This ction eetl not be completetl if the permit is for one huo retl �$100) or Iess�. I cerlity lM1al in [he pertOrmance of Ih¢ wo�k for which this pe�m�t i5 issuetl, I sna11 not employ any person in any manner so as to become zubject to the workers' Compensalion l.aws of California. Date Signature NOTICE: Ii, after making this tleclaration, You snoultl become subject to the Wo�kers' ComOensation provisions o( Ne l.abor Cotle, you must forthwi[It comply with such O�o��sions or this pe�mit shall be tleemEtl �evoketl. CONSTRUCTION LENDING AGENCV 1 neie�y atfirm [hat t�ere is a construc[lon lentling agency for lhe performance oi thp �yprk fo� Which [h15 Permlt is i55uea ($ection 3097' Civ. C.) Lentler•s Name Lentler's Aadress OWNER BUILDEH DECLARATION I he�Cby affi�m Ihat I am exempt from the ConVac[or'S License Law for the followin9 reason (Section 7031.5 Business antl Professlonal Cotle: Any city or county which requir¢s a 0¢nnil to const�uct, al[e�, improve, tlemOlish or repai� any sVucture, prior to its issuance, also requires the applicant tor such permil [O til¢ a signetl staternenl tnai he/she is licensetl pUtsuanl to the prOvisions of tne Conlrac[or'S Li<¢n5e Law (Chap[er 9(commencin9 with SectiOn 7000) of DlviSiOn 3 of [he B�Sine55 antl Prp(¢55ion5 Cotle) or that ne/sne� is exempt tlteretrom an0 the ba5is for the alleqetl exemption. Any violatlon of Section 7031.5 by any applicant for a permit subjects [he applicant to a civil �endl�y of not more than five huntl�etl tlollats (§500). . 4 as owner o( the property or my emploYees with wages as their Sole compensation, will tlo the work, antl the structure is not in[entletl or offeretl for sale (Section ]044, Business antl Professwndl Cotle: The Contrac[or'S LicenSe Law tloes not apDly [o an owner Of a prop¢rty who bulltlS or im0/oves thereon, ana who tloes such work himzelf/herself or tM1rou9h his or her own employees, Orovitletl that such improvementz are not intentletl or offeretl tor sale. �I, howeveq Ihe builtlin9 or improvement is soia within one year ot wm- ple[IOn, tne owner will nave th¢ burtlen of prOvin9 ne/sne tlid not builtl or im- provC for the purpose of sale). ❑ I, a5 owne� of the proDerty, aT excluSively co�tracting with lic¢nsetl con- IractOrs to consVuct the prOject (Seclion 7044, Business antl Prof¢ssions Cotle: The Cmtractor's License Law tloes not appry to an owner of Oroperty wno builtls or improves thereon, ana wno contracts (or such projects witn a con- tractor(s Imense pursuanl to [he ConVactor'S Litense Law). I am aware that proo� o� tM1eir Worker's Compensation insurance shoultl be provitletl to me. ❑ I am eaempt untler Section B. & P. C. for thi5 reason Date Owner 1 hereby certify tyyt I have reai inf0�lnation is cqR�C�. I agrQOtcy ana state iaws e ui sen[a�ives of ' ci Inspe�tion pur es. $Igndture Drivgrs' L cense or S! CMF OBfiS-46, rev. 30/84 � ❑ CONVERSION ❑ DEMOLISH ❑ OT R _ DESCRIPTION OF WORK/USE OF BLDG. �'� � TYPEOFPEFMIT GRADING OUNDATION ❑ STRUCTURAI ❑ TENANT ❑ ELECTRIGAL �VMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIP710N 50. FT. OCCUaAnCV— CONSTRUCTION TVPE VALUATION S ZONE GRADINGCU.VDS. ACRES_ Remarks: _ _» Sink Preventer Irrigation athtubs iking Fountains x Drains �r Sinks Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fse $15 Boiler Duct - Under Ground Duct - Structurel Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIL ICBO # Heating System & Ducting ❑ai oo,000 eru O i oo,000 ey Reinspection Fee � $15 � - _'. .. __ White - Builtling: Canary - Ap011cant; Pink - Accounting; Goltlenrotl � qssessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU C Sys[em Repair ter Fire pers Issue Fee FEES' $ 3 $ 3 A.P. SW S Mai� Building: E T Front B Rear A C Right SLeft Ping, Ref, ak Plannina Notes: �;-_. • ' --�' OE'! _/_ / " . Zone AccesSory Building: Z O N I N G R Parking Rey./ProvidNJ E Q M T S ELECTRICAL Automatic Washer Transformer ❑ 15�50 KW Construction Pole Sub. � 50 + KW Cooking Unit Dishwasher Dry¢rs ❑Gas ❑ElecVic Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0.5 KW �5-15 KW Meter LJup to 100 amps Meter ❑over 100a Sub Panel Morors -1 HP O 1 X� B In olar �9�75 HP �16-15+ Pole Light Range Sign Standing Sections Trash Compactor I Reinspectian Fee �$15 I I Issue Fee DEVEIOPMEN7 SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Appliwtion Issued By Q • -�-� . � FEES $ 3 SUMMARV OF FEES � BUILDING PEFMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ '%'_O� ISSUANCE $ PLAN CHECK 25% 5 ENERG�' P.C. 5 ELECTRICAL § - GRADING 5 PLAN CHECK 50% $ MICROFILM $ MECHANICAL S TOTAL FEE $ `� �p� PLAN CHECK 25% $ CONSTRUCTION ANDP4ANNING POOL&SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electricsl Conduit Utility-Undrgrnd. 54. Forms 4. Electric8l Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, C7 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 Electrlcal-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 7i. Product Plping O Gas, ❑ 011 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framin9 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead HYdro � 26. T-8ar Ce.iling (Structural) & Mo�ocoat 75. Dry Chemical 27. Frame and Flashing . 76. Dry Standpipe Q 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 Fa�tory Fireplace � � '�� 38. Final Plumbing � f�� / , � " - �, 6'� �. . 39-.�Water Service-Final � +� / •� �� . 40. Gas Service-Final . ;� 41..Solar-DomesticFinal , "i r � ' t � 42`Backflow Preventer ' ' ,., 4� Backflow Irrigation ' � - 44. Landscape Irrigation System ' . � '45/Sound Attenuation _ . � ' � , 'a6. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING . ; �� ,y �� ,� 48. S�ecial Requirements Completed • • � '� 49. Electric Release to Edison , , 50. Gas ReleBse to Southern California Gas Co �✓ � . • 51. CERTIFICATE OF OCCUPANCY No. Date ,��,�„ _ '.,....<� �I _ - ' � Applicant to fill in all spatts except those within neavy bortler lines antl si9n all aDvroorlate tleelarations. ` CiTY oF cOSTA MeSA CONST UC ION PER�VIIT Project Address � � � / Applicant's Mailing Address � _'l Owner's Name —Pho��1L�_7� Address Arch/Eng. License No. Address M� Contractor's Namp /�%A Phone � Address (mailingl �� City Licenze No. �� LICENSEO CONTRACTOH DECLARATION I hereby a(firm IM1a[ I am licensetl untler provislons of Charter 9(commencing wilh section 7000) of Divislon 3 of the Business antl�Professions Coee, antl my license Is in full torce antl eHecL �� % License Class p icense Date y ry'Pa5i9nature ` WORKERS' COMPENSATION DECLARATION I hereby atfirm that I have a certificate of consent to selt-Insure or a certificate of Workers' Compensation Insurance, or a certitie py thsreot (Section 3800, �ab. C.) � � Policy No. � Company certifietl cooY �s hereby lumisnetl. ertllietl copy.l5 fi1etl yuyth the ciry B i� g D lisi /i� pate�'�l��ipp�icant - �f EXEMPTION FqOM WORKERS' GOMPENSATIO �DECLARATION (Thissection nled not be completetl if the permit I5 for one huntl�etl ($300) or less). I certity lhat in [he pertorman[e of the work fo� wltich this pe�m�t i5I55uetl, I shall noi employ any perion in any manner so as lo become subjett to ihe workerz• Compensation Laws of Calitornia. Da(e Si9na[ure NOTICE: H, after making tltis tleclaratiOn, you shOultl bocome subject to the WOBets' Compensation provisions of [he Labot Cotla, you musl forthwrth comply with suclt provislons or this permit shall be tleemetl revoked. CONSTRUCTION LEN�ING AGENCV 1 nereby aHirm that there is a consVuction lentling agency for the perlormance of [he wark for which this permit i5 issuetl (Sec[iOn 3097 Civ. C.) Lentler's Name Lentler'S A4Gress OWNER BUIL�ER �ECLARATION 1 bereby affirm [hat I am exempt from fhe ConVactor'S License Law for the fol�owin9 reason (Section 7031.5 Business antl Professional Cotle: Any city or county wnitn requires a p¢rmit [o con5truc[, alte�, imp�ova, tlGmolish or repai� any sVUGture, p�io� to i[s issuance, also requires [he applican[ fo� SUGh pe�mit to fiie a si9netl statemen[ tnat he/she is licensetl pursuant to the provlsions ot the Gontractor's License Law (ChaD�er 9(commencing with Section 7000) of Division 3 of the Business antl'Profes5ion5 Cotle) or tha[ he/she Is exempt therefrom antl [he Ga5i5 for the allegetl exemption. Any violatlon oi Sec[ion �031.5 by any applicant for a permi[ zubjects the applicanl to a civil �enalty of not more thaA five huntlretl tlollars ($500). I, as ownet of the p�oper[y or my employees wlltt wag¢5 as their Sole comp¢nsation, will tlo the wo�k, antl the structure i5 not in[entletl Or ofteretl fot sale (SeClion 7044, Business antl Prot¢izional Cotle: The Contractor'S �icense Law tloez not apply ro an owner of a property who bWltls or improves ihereon, antl wno tloes such work nimself/herselt or through his or her own employees, provitletl that sucM1 improvements are nof intentleG or offorotl for sale. If, bowev¢r, [he Ouiltling or improvement i55oltl within one y¢ar of com- pletion, Ih0 owner will M1ave the burtlen ot provin9 he/she tlitl ml builtl or im- , p�ova for lho purpose of Sale). �❑ I, as owner of [he property, am exclusively con[racting wlth licensed con- �' t�acto�5 t0 const�uct the pwject ($ection ]044, Buzine55 an� PrOfe55lons Cotle: The ConVactOr'S License Law tloes nol apply lo an owner of proper[y who builtls or Impwves lhereon, antl who conVacts for Suth projGcts wlth a con- tractor�51 Imense pursuant to [he Contractor's License Law). I am aware that proof o( lhelr Wo�kev's COTPensation insu�ance shoultl be provitl¢tl to me. ❑ I am exempt untler Section B. & P. C. �or this reason Oate Owner signature 6 fj(�� Drivers' LicenSe or 55 � this tion antl state tbat [he above all city antl county ortlinances i, antl her¢by authorize rep�e- TVPE OF CONSTRUCTION LJ NEW I.J ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT GRA�ING FOUNDATION STRUGTURAL ❑ TENANT ❑ ELECTRICAI ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 54. FT. OCCUPANCv CONSTRUCTION TVPE VALUATION $ ZONE GRApINGCU.VDS. 11CRE5 Remarks: // ,(�L/ �7 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Orinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspectian Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating Sys�em & Ducling �0.100,000 BTU O 100,000 Reinspection Fee � S75 __ _ � — CMF 0865-46, rev. 30/84 White - Builtling; Canary - Appli<ant; Pink - ACWunting; GOltlenrotl - Assesm� PLUMBING Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Warer Heater Water Service A uto-W ash laue Fee .Hood or Type I ❑ Canopy Type 11 ❑ Fiefrigeration $ystem ❑aioo,000eTu ❑ioo,000 System Repair/Alteretion Fire Dampers Isue Fee Y FEES $ 3 FEES $ 3 A.P. # S Main Building: E T Front A Rear � Ri9ht g Left Fing. ReL # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outleis Switches Garbage Disposal Generator DO-5 KW � 5682 4/08/87 � 2one Accessory Building: Parking Req,/Provided ELECTRICAL Transformer ❑ 15-50 KW ' ❑50+KW 15KW Meter ❑up to 100amps Meter ❑over100amps Sub Panel Motors�0.7 HP�1Yh-8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range Sign Standing $ections Trash Compactor � Reinspection Fee I S75 � � luue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Appraved By Appliwtion Issued Bv n BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ 38s00 TL 2 O N I N G R E Q M T S FEES $ 3 SUMMARV OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING 5 MICROFILM $ � TOTALFEE $ �B� CONSTRUCTION ANp PLANNING 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 Conduii-Untlrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grntl. 57. APPROVAL TO COVER�GUNITE 7. Footings .. 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 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 Wiriny 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 77. 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 �Svuctura7) & Monocoat 75. Dry 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 8rown Coat 79. FINAL INSPECTION , 32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final,Heating & Air Conditioning �,'%l /� j �� r� 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 Irriqation SYstem _ • ' 45. Sound Attenuation ' - 46. Handicap Regulations , ' � 47. FINALSTRUCTURF&BUILDING � � � 48. Special Requirements Completed 49. Electric Release to Eqison 50. Gas Release to Southprn California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date j V \ AOP�ieant to fill in ail spaces except those witnin neavy eoreer linez antl sign all avP�opriate aeelarationz. CITY OF COSTA MESA CONSTRUCTION PERMIT PERf�j=NO,,., ,,,_� TRACT NO. LOT NO. UNIT Nb. ProjectAddress• 2�� QELDF�t� /%✓E. Applicant'sMailingAddress Sl�1 /�.2�L1'l�rion/ � �(1.B• Owner's Name �AL ��W�AA Phone �`f�YL3 Address Areh/Eng. License No. Address ��[/'�� Contrector's Nam •��one �T �/3 Address Imailingl B9� /�iQoo.ic�f'ro.J PG•, .t/B 92ld 3 CitY License No. 2�S�O LICENSED CONTRHCT�R OECLARATION I hereby attirm inat I am licensetl untler pravisions a( Charter 9(commencing WliFl SEC1100 �Q��) 01 DIVISIOII 3 Of Ih¢ BUSIfI¢55 dlld Pl0f2551005 C�Od2� dOtl my li<ense is in tull torce antl effeGt. /2 �JC¢I152 CId55 CCf15 . � Date '�'Z3=T'g% Signature WORKERS'COMPENSATION DECLARA I hereby aifirm that I have a certificate of consent to self-insure or a certificate ot Worke�s' Compensation Insu�dnce, or a ce�tlfietl cOpy tM1e�eof (Section 3800, �ab. Q('�/) �Q �j Policy No.CN�XJ�J�'��COmpany ��✓� �r[ifietl mpY is hereby furnishetl. �titie m is fi with the �ity Bui g O i n. Date `� ApplicHnt EXEMPTIONFROM ORKERS'GOMPE SATI ECLARA ON (Thissection neetl no[ be tom0letEtl if the pe�mit I5 tar One huntlretl (E300) or less). I certify that in the performance of the work tor which thi5 perm�t is i55uetl, I shall not employ any pe�son in dny manne� so as to become subject to the Worke�s' Compensation Laws of California. Date $i9natU�e - NOTICE: If, after making thi5 tledaratiOn, you shOultl become subjecl to the Workers' Compen5ation provisions of the Labor Cotle, y0u must forthwith comply with such, p�ovisions o� this pe�mit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby afiirm that the�e is a construction lentling agency fot [he perfo�mance of the work for which fhis permi[ is issuetl (Section 309] Civ. C.) , Lentler's Name Lentler's Atltlress � OWNER BUILDEH DECLARATION � I hereby affirm that I am eaemp� from tM1e ConVactor's License Law for the following reason (Sec[ion ]03L5 Business and Pro(e55ional Cotle: Any city or county which r¢quires a pe�mit t0 �o�5truct,.alt¢r, improve, tlemolish or repair any structure, prior to its issuance, also requires tne applicant for such permit to tile a signetl statement that heKhe is licensetl pursuant to the provisions of the Contractor's License Law (ChaP�er 9(commencinq with Section ]000) Of Divisi0n 3 0( the Business antl P�ofessions Cotl¢) or tM1at he/she is exertiPt [herefrom anG the basis for the 5��e9etl exemption. Any violation of Section ]031.5 by any applicant for a Pe�mit 5u0jects the applicant to a civil eendl[y of not more than five huntlretl tlollars ($500). LJ I, as� owner of tne property or my employees witb wages as their sole compen5ation, will tlo the work, antl the structure is not intentletl or otte�etl for sale ($ection 7044, Busines4 antl Professional Cotle: The -Con[racto�'s License l.aw does not apply to an ow�er ot a property who builtls or improves thereon, and who tloes such wolk him5elf/hers2lt or throuqh his or her own employee5� prOvitletl tM1at Sucb inlPrOvemBnts aIe not intentletl OY OffE!¢d fOI sale. It, howeveq tne building or improvement is soltl within ane year of com- pletion, the owner will have the uurtlen of provin9 he/she tlltl not builtl or im- prOve for tne purpose of sale): ❑ I, as owner ot tM1e property, am exclusively coM�acting with IicenSetl con- Vactor5 to mnst�uct the project (Se«�on ]044, Business antl Professions Cotle: The ConVacYor's' License Law tloes not apply to an owner ot property who builtls or improves thereon, and �+ho mn[racts for such projects with a wn- tractor(s)�bcense pursuant [o the Cantractor'S LicenSe Law). I am aware that proo( of tM1eir Worker's Compensatlon insurance stloultl be provitletl to me. ❑ I am exempt under Section— B. & P. C. for this reason Date Owner certify tnat I have rea� �hls pplication antl state that the above m is corr¢ct. I aaree to co� with all city antl county ortlinanCes iawc reiatim—flfbu"3CidQ struction. antl herebv au[ho�iie �eore- Siqnature _ _/�� Drivers' LiceRie or SS TYPE OF CONSTRUCTION � LJ NEW LJ ADD U ALTERATION U REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TYPEOFPERMIT GRA�ING ❑FOUNDATION ❑STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL 6 R¢a� ❑ OTHER A C Right PROJEC7 DESCHIPTION Sq. F7. oCCUVANC�' K CONSTRUCTIONTVPE VALUATION$ S Left ZONE GRADING CU. VDS. ACRES p��g, Ref. # Remarks: � �. % %� `% �j�. �J �'/A w ' Planninq Notes: Sink Irrigation Drinking Fountains Floor Drains FlaorSinks • Gas Service Outlets Intercepmrs Kitchen Sink P—Trap; Roof Drains Reinspection Fee � $75 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blc ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 Reinspectian Fee � $75 CMF 0865-46, rev. 10/84 White - BuilGing; Canary - Applicanh Plnk - Ac<ounting; Goltlenrotl - ASzeisor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w(SQa Urinal Water Closet Water Heater Water Service A Uro-W e5h Laundry Treys Issue Fee � $ 3 Automatic Washer Construction Pole$ub. Cookin9 Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Gar6age Disposal Generator �0-5 KW �5-� \ 2305 7/e?/�7 �-;. . Zone Accessory Buildin9: Z O N 1 N , G R Parking Req./Provided E M T S ELECTRICAL Transformer ❑ 15-50 KW 0 50+KW Merer�ap to 700 amps Meter ❑over100amps Sub Panel Motors 00.1 HP 01'/: - 8 Inc.Solar �9-15 HP �i6-15+ Microwave Pole Light Range I I Standing Sections 5 KW I I Trash Compactor Reinspection Fee �$15 ' luue Fea IANICAL FEES Hoodor T DEVELOPMENTSERVICESREQUIREMENTS: YPe I ❑ Zonin A Canopy Typell ❑ � 9 Pproved By �.a`=?i�' Building Approved By Q2�r� Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee � $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL � $ � GRA�ING PLAN CHECK 50% g MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ � $ FEES $ 3 ., � ��1 CONSTRUC710N AND P,L'ANNING �ir FOOL & SPA APPROVAIS Permit'#` Date Inspettor AppROVALS Permit# Date Inspecmr \ 1. Temporary Electrical Serdice 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 i ' 56. Rough Plumbing & Pressure Test �� '� 57. APPROVALTOCOVER-GUNITE 6. Electrical UFER Grnd. � f 7. Footings � 58. Electrical Conduit-Undrgrnd. S. Foundation ' �t� ,+ 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. ; i./ 60. Backwash Lines, P-Trap, O Undrgmd. 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 Dreins 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 � Gas ❑ Oil � 23. Gas Pipe-Rbugh & Test 72. Underground Flush . 24. Roof Framing 73. Undergrnd. Storage Tank ��as ❑ 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 8rown Coat . 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 � � 'i / i �.43. Backflow Irrigation ' . � � -. 44. Landscape Irrigation System � : � . 45. Sound Attenuation ' ' .. �46. HandicapRegulations ' � •� ,� � " i 47. FINALSTRUCTURE&BUILDWG i ' . . • � 48. Special Reyuirements Completed � � ' � • � 49. Electric Release to Edison , � 50. Gas Release to Southern California Gas Co . ' 51. CERTIFICqTE OF OCCUPANCY No. Date � "J �� Aop�icant to fill in all spatts except those within heavy bortler lines antl sl9n all apvropriate tleclaretions. CITY OF COSTA MES�A.s.q�CONSTRUCTION PERMIT PERMIT NO._ � TRACT NO. LOT NO, UNIT NO. Prolect Addrecs ��', ` _ �pp�� Applicant's Mailing Address O'� �L�� n� � / Owner's Name �� U�L � wf'�� Phone y� Address �%Y�9,� � G ' \ TYPE OF CONSTRUCTION I"YNEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p �E DESC PTIO . WOFK/ E OF BLDG. ,�G S Main Buildi E OFPERMIT GRADING FOU OATION STRUCTURAL T Front TENANT LEGTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear OTHER A ECT DESCRIPTION 54. FT. oCCUaANCv— C Right K Left ONSTRUCTION TVPE VALUATION S S �NE GRADINGCV.YDS. ACRE$ PIn9.Ref.# Arch/Eng. — License No. TVPE Address � Convactor's Nam �e �� Phone �Sy�%�3 0 Adtlresslmailing) �� `��'G?7�sJ %t .VB PROJ �OZ�/ ` Ciry License No. � LICEfVSED CONTRACTOR DECLARATION I hereby affirm tnat 1 am licensetl untler provisionz of Chartet 9(commentlng with settion 7000) ot DlviSion 3 of the Bu5ine55 antl Professions COtle, antl my Iicense is in t I orc e t. �� p�/ Licanse Class� icense Mn. VT Date 7 /4 ___ _ . � � i WONKERS'COMPENSATION DEC ATIO I hereby aifirm [hat I nave a certifiW sent to zelf-insure or a certiticate of Workers' CompensatiOn Insu�ance, or a certitietl cOpy thereof (Sectlon 3aoo. �bI.� .��96-3�7sso-o/ ,� ��/o�'— Policy NON Cer ifietl copy I5 hereby tumish erii❑ p S�7 with Ihe city tli oa�o Appllcant EXEMPTION---_�RKERS'CO PENSAT FRATION (Thissection neetl not ba completetl ii is for one huntlrea ($300) or less). I certi(y that in Ihe perlo�mance of the work tOr which this pe�mk is issuetl, I shall not employ any pe�5on in any manner so as to become subject to th¢ Workers' Compen5ation Laws of Calitornia. Date Signature NOTICE: It, after making Ihis tlecla�ation, you Shoultl become subject to the Wotkers' COmp¢n5ation p�ovision5 Of [h¢ Labor Cotle, you must fo�thwith comply wi[h such O�o�I5ion5 or this permit shall be tleemetl revoked. CONSTRUCTION LENDING AGENCV 1 her¢ty a/fl�m that lM1ere IS a Wnstruction lentling agency for the perfotmance Ot the work tor whiCh Ihis permit is issu¢tl (Section 3097 Civ. C.) Lentler's Name Lentler's AtlOress OWNER BUILOEH �ECLARATION I hereby altirm that 1 am exempl trom the ConVactor's License Law tor the /ollowing rea50n (Sectlon 7031.5 Business antl Profe55ional Cotle: Any city or county which requlres a pErmit to construct, alleq improve, tlemolish or repait any 5[ructure, prlor to itz issuance, alio requires the applicant tor suth permit t0 tile a signetl Stat¢ment lhat h¢/She I5 licenzetl purzuant to the prOvisions ot the Contractor'z Ucense Law (CM1apter 9(commencing with Section 7000) oi Olvision 3 OP the Business antl Profe55ion5 Cotle) o� [hat he/She is exempl tnerefrom antl tne basis for tne allegetl exemp[ion. Any violation of Section ]031.5 by any applitant to� a perTil subjects [h¢ applicant to a clvll �enalty oi not more Ihan tive huntlretl tlollars (5500). I, as owner of [ho O�operty or my employees with wa9e5 as their Solo comoensation, will tlo lne work, antl the structure is not intentletl or offeretl for sale (Secilon ]044, Business anC Professional Cotle: Tne Contracfor's Llcense law tloCs not apply to an owne� of a property who builtlz or imp�oves thereon, antl wno tloes zuch work nimself/herseif or through his or ner own employaes, provitletl tha[ such Improvements are not intentlatl or offeretl for sale. It, howeveq [he Dulltlln9 ot Improvement I5 Soltl within one year of com- Oletion, lhe owne� wlll have the butCen Of provinq h2/she tlitl mt builtl or iT- p�ove for the purpo5e 01 sale). ❑ I, as owner ot the property, am exclusively contractin9 with IiWnsetl con- t�acto�sto con5iructthe pro�ect ($ection ]044, Busine55 anC Professlons Cotle: The Contracror's License Law does m[ apply to an owner of property who builtls or improves tnBreon, antl wM10 contractz for Such p�ojetts with a con- Vactor(51 I¢enze pursuanl to Ihe Contractor's License Ldw). 1 am aware that proof oi Uteir Worker's Compen5ation insurance sttoultl be provltl¢tl to me. ❑ I am exempi untle� Section B. & P. C. fo� thls �eason �ate Owner I hereby certify tnat I have reaa tnis apolicalion antl state that the above information is mrrect. I a9ree to compry with all city antl county ortlinances antl state law relating �o ' on5truction, antl hereby authorize repre- 5¢ntativ i ter up the above-mentionetl pr pert fo� Inspecti pur � /3 �� Siqna[ure _. .._ ___ _ �ate Drivers' Li nse o CMF 0865-46, rev. 30/84 Remarks: p,. �_p � j% �,a ('}yu cTw /' i H I�Ar.lov- Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathwb5 Jrinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories` Roof Reinspection Fee � $15 Boiler Dutt-UnderGround Duct - Structural Duct � Ventilating ExhaustSystem ❑ MWtiple Firepl/FacL BIL IC80 # Heatin9 System & Ductin ❑0.100,000 BTU 0,000 � � I Reinzpection Fee White - Builtling: Candry - Appllcant: Pink � Accounting; Go10¢nrotl - Assesso� $15 PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimmin ol w/Spa Water Closet Water Heater Water Service Auto-Wash Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0�100,000 8 100,000 Sy�epair/Alteration F ire Dampers Regisiers Issue Fea FEES $ 3 $ 3 Automatic Washer �struction PoleSu Cooking Unit Dishwasher Dryers ❑Gas ❑Eb Fan F.A,U. Fixtures Device Boxes OU[I2L5 Switches Garbage Dispoul Generator �45 KW ,,...'".'• r.a. ��. 1 �l ri�� FER 13 19&7 A� ' . _. �,.r.,C':�: C,iC.��i�', zone ' ' ' � Accessory Building: Z O N I N G R Parking Req./Provided E Q M T S ELECTRICAL Transformer ❑ 75�50 KW ❑ 50+KW Meter �up to 700 amps Meter ❑over100amps Sub Panel Motors 041 HP � 7'f. � 8 Inc. Solar �9-15 HP 016-15+ Microwave Pole Light Range Standing Sections KW Trash Compactor IReinspection Fee I$15 ' I Issue Fee bEVELOPMENTSERVICESRE�UIREMENTS: Zoning Approved By Building Appraved B Application Issued By SUMMARV OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ �.DD �PLAN CHECK 50% g MECHANICAL $ PLAN CHECK 25% $ FEES $ 3 SMIP $ PERMIT ISSUANCE $ ENERG� P.C. $ GRADING S MICROFILM $ TOTALFEE S ��v CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS, Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � � 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgmd. 54. Forms - 4. Electrical ConduiDUndrgrnd. 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 71. 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 FOfi PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL, 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplacz � APPROVALS Permit # � _ 21. DuCts, in Structure 70. Underground Hydro, ' 22. Oucts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe-Rough & Tesi 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 f � � 27. FrameandFlashing 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 ��7 � 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: d '' 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test • � 36. Hood or Canopy 37. Final Factory Fireplace . 38. Final Plumbing - ' I 39. Water Service�Final �' 40. Gas Service-Final � - 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation � i 44: Landscape Irrigation System , . 45. Sound Attenuation � 1 46. Handicap Regulations � � 47. FINAL STRUCTURE & BUILOING � ' 4S. Special Requirements Completed � �i 49. Electric Release to Edison � � , 50. Gas Release to Southern California Gas Co • � 51. CERTIFICATE OF OCCUPANCY No. Date • �' . . � � � Applicant to fill in all spaces except those within heavy Oortler Ilnes anO si9n all appropriate Eetla�alions. CITV OF COSTA MESA�( CONSTRU TIOy�N PERGT� Proleci Address �+ T'�?' � C� t Applicant;sMai"ngAddress �SU� MGN�'Wj� � Owner's Name Phone Address Areh/Eng. License No. Address Convacmr's Name � ' P�yne�� Address (mailingl �� 9 MoNrtl�, �C � City License No. � T T�—� IICENSED CONTRpCTOR DECLARA710N I h¢reby a�firm that I am licensetl untler p�ovisions of Charte� 9(commencing witn sectlon ]000) o/ Division 3 Of the Busine55 antl Profe551ons Cotle, antl my license is in full orte�yptl effecL �� OO Licens Cla s V Lic n e No.� Date� — 519nature R RS' COMPENSATION DECLA ION h fii(�9 [yt 1 have a certificate o{ �onsent to setl-Insure or a certifi<ate s'lQa�9mvtion Insurance, or a certllletl topy ther,e1ot (Section 0, L . C iicv No. i�"g� ��i�l cotnoa ��=CO �SU('4AC! Certifletl copy is hereby fumi5h¢tl. Cerfi '¢tl copy � tl with the city Builtli v lon. Date�q� Applicant EXEMPTION FROM WORKERS' COMPENSAT ON DECLAR ION (Thissectlon neetl nol be completetl if the permit is for one huntlretl ($300) or less). I cerli�y tnat in [he Oe�formance of the work fo� wnich this perm�t is iSsuetl, I shall not emo�oY any person in any manner so as to become subject to the Workers' Compensation Laws of Cdli/Ornia. Oate Si9nature NOTICE: If, after making this declaratlon, you shoultl become subject to the Wo�kers' COmpenSation provisions of the Labo� Cotle, you must lorthwith comply wilM1 zuch provisions or [hiS pe�mit Shall be tleemetl revoketl. CONSTRVCTION LENDING AGENCV I hereby atflrm lhat ihere is a con5(ructlOn lentlin9 agency fo� the p¢r/o�mance Of Ihe work tOr which Lhis perml[ is i55uetl (Section 3097 Civ. CJ Lentler's Name Lenaer'S Atltlress OWNERBUILDER DECLARATION I hereby affirm that I am exempt from �he Cont�actor'S LicenSe Law tor [he fallowing reason (Section 7031.5 Businesz antl Protessional Cotle: Any city or munty which �equir¢s a permit [o wnR�uct, alter, Improve, Oemolish o� �epair any SlrucWre, prior to it5 issuance, als4 requires the applicant for such permit to tile a signetl statement that he/she is licensetl pursuant to tne orovisionz ot the Contractor's License Law (Cnapter 9(commencing wi[h Seclion 7000) of Division 3 of lbe Bu5ine55 antl ProtMsions Cotl¢) o� that he/she is exemp[ tnerefrom antl Ihe basis for the allegetl exemp[ion. Any violation of Section ]031.5 by any applicant tor a Pem�it Subject5 IM1e applitani to a civil eenalty oi not more than five huntlretl pollars (g500�. LJ I, as owner of IhC Pvoperty o� my em0loyees with waqes a5 [M1eir Sole com0en5ation, will tlo the work, antl Ihe SVucture Is no[ intentletl or oftetetl for sale (Section 7044, Busine55 antl Protessional Cotle: The Contractor's License law tloe5 not apply [o an owne� of a p�operly who builtls or improves thereon, antl who aoes su<h work hlmselt/herseli or tnrough his or her own employees, provitle0 tha[ such imProvement5 are not intentletl or oHered for • sdle. If, hOweveq lhe bulltling or improvemant is soltl witM1in ona Year of com- pletlon, the owner wlll Itave the burtleq ot proving hC/she tlitl not builtl ot im- �rova fOr lhe purpose oi sale). I, as owner ot the property, am exelusively mntractin9 with licensetl con- [ractorsto constructtne project (Section �044, Businezs antl Professions Cotle: The Conlractor's License Law dOes nOt apply to an owner oi prOPerty who builtls or improves tnereon, antl who Contracts for such projects with a'con- ', tractor(s) utense pursuant to the Contyactor's License Law). 1 am aware that ' proof o( thei� Wo�ker's Compensatioq insurante shoultl� be provitled to me. '� ❑ I am exempt untler $ection B. & P. C. lor Ihis reason Date Owner I hereby ceriity tnat I have reaE mis appli information is correct. I agree to comply wil antl state laws latin9 to buildin9 conSVuct Sentatives of t i city lo n[er upoq [he inspectlan purpo . Signature � Drivers' Llcense r 55 � E z�i o c I I I c., l� __ TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OFPERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sa.Fr. oCCUPArvcv CONSTRUCTIONTVPE - VALUATION3_ ZONE GRApINGCU.YDS. ACRES_ Remarks: �'� �� Bar Sink Backtlow Preventer Bac w Irrigation Dishwasher " Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Intercepmrs • Kitchen Sink Lavatories P—Trap Roof D ins Reinspaction Fee $15 Duc[- erGround Duct-SVuctur � Duct - Ventilating Exhaust System ❑ Multiple_ FirepVFact. Blt. ICBO # ^ Heating System & Ducting ❑0.100,OOOBTU �10 , OBl Rei ection Fee S75 CMF 0865-46, rev. 30/04 Wnite - Builtling; Canary - qpplitant; Plnk - Accounting; Goltlenrotl - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar T Pool w/Spa Water He'dy Water Servi A uto-W ash FEES Issue Fee $ iANICAL F Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑4100,000 BT 100,000 BTU laue Fee � $ 3 A.P. # S Main Buildinq: E T Front A Rear C Right SLeft Ping. Ref. # Planning Notes: Automatic Washer' Construction PoleSi Cooking Unit Dishwasher Drvers ❑Gas ❑EI Fan F.A,U. Fixtures Device Baxes Outlets $witches Garbage Dispoul Generator 00�5 KW 5816 4/09/87 Zone Accessory Building: Parkin9 Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors00.1 HP�If.-8 .. Int.Solar �9-15 HP �16�15+ Microwave Pole Light ' Ran9e ' � I Standing Sections 5 KW � I Trash Compactor � Reinspection Fee �$15 � � Issue Fee DEVELOPMENTSERVICESRE�UIREMENTS: Zoning Approvad By Building qpproved By Applicetion Issuad By SUMMARV OF'FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PIUMBING $ �SSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL § 3 S• 4-O GRADING S PLAN CHECK 50% $ � C• Z� MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK ?5% $ 51060 TL FEES $ 3 S / •do Z O N 1 N G R E Q M T S 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 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNI7E 7. Footings .• I 58. Electrical Conduit-Undrgrnd. 8. Foundation . 59. Gas Pipe, � Undrgrnd., Test . . . �� 9. Watgr 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 72. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 75. Rough Electrical�Conduit � 66. Solar SYstem-Final 16. Rough Electric Wiring � .;� 67. Fencing & Access Approval ' 17. Rough Wiring Sign ` � 68. APPROVED FOR PLASTERING 18. Rough Elect;ical-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 � Gas ❑ Oil 23. Gas Pipe-Rough & Test . 72, Underground Flush 24. Roof Framing � � 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro � 26. T-Bar Ceilin9 (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. FINAC�INSPECTION � �`. 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ,�a,.g J� 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 . � � r . 40. Gas Service-Final � - � �� - 41. Solar pomesticFinal � � �' ' . 42. Backffow Prevenier l ' �� :43. Backflow Irrigation -� - . .� 44. Landscape Irrigation System � .�� 45. Sound Attenuation �-, ' , ' : 46. HandicapRegulatipns • -� �"' 47: FINAL STRUCTURE & BUILDING � - � ' • _, ' 48. Special Requirements Completed ' �. i ' � . 49. Electric Release to Edison . � � _ _ ' , , 50. Gas Release to Southern California Gas Co ��'' " �. i. ' 51. CERTIFICATE OF OCCUPANCY �,, No. Date ' ' � � ApD��ant to fill in all zpaces exceDt those wilhin heavy Dortler I{nes antl sign all a0G/opriate tleclaralions. ci7v oF CosTA qmESA , /CnOfN S�T��RUCTION PERMIT Project Atidress L— � �LLr.GI/� . �j��q ��/� Ar%pl ci enYs Mai�ir/yq� ddre s ��-r- rL /� Ownt"s Name ��' /��,,,y��..y.,�P� ee � � Address � �%�'N �i 'r1 �„ Arch/En9. � License No. Address Contracror's Name � � ��Phone % Addresslmailin9) � �- N'p . City Licence No �� F% V� LICENSED CONTRACTOR OECLHRATION , I h¢reby affirm that I am licensetl untle� provi51on5 ot Charter 9(commencing wiM section ]000) of Division 3 ot the Business antl Professions Cotle, anili my license is in full lorce a effect. - License C s o. �� ^ Date � Signature � ��, WORK RS' C MPENSATION DE LA q I hereby affirm that I have a certificdte of consent to sel(-insure or a certiticate � of Workers' Com ensation Insurance, or a certifle�d� cIoOY tnereof (Section \ Polic�Y No��^UCo anY � 'r`��f� . �fi� tifietl coDY is M1 eby fumishe . _ � ` CCertifie pp il tl with the <it ' va� Date A�plican ' ' '/ " ,�f EXEMPT ON ROM WORKERS' MPENSAT N DECLARATION � .� � p (Thissection neetl not be mm0lete ' the t is tor one huntlretl ($300) ar� less). I certify that in the per/ormance of the wo�k fo� which this pe�m�t i5 i55ued; I shall not employ any pe�son'in any manne� so as to berome subject fo the Workers' ComOensation Laws of California. , Date Si9nature NOTICE: 1(, after making this'tleclaration, you shoultl become subiect'to the Wo�kers' Compensation provision5 of the labor Cotle, you muzt forthwith comply wilh such pr.ovisions or this permit Shall be tleeme❑ revoketl. CONSTRVCTION LENDING AGENCV I hereby aftirm that Ihere is a conscruction Ientlin9 a9ency for the performance I of the work for �s oeld�i;�ff u�, Ctlon 309� Civ. CJ Lentler's Name "� � Lentler�s Atltlress ��%�� OWNER BUILDER �ECLARATIO �, 1 hereby affirm tha[ I am exempt irom [M1e Contracto�'S LicenSe Law for the � Icounry w�ich reqwres a permrt to connruce, auer, iniyrove, ucuw��.�� ..� �=va� any SVuclure, prior to it5 issuance, also requires the applicant for sucb permi[ to tile a 5igr.etl statement that he/She is licensetl putsuant to the provi5ions of the Contractor•s License Law (Chapter 9(commencing witb Section �000) of �ivi5ion 3 of the Business antl Cro(es5ion5 Cotle) or that he/she is exempl therefrom and the basis for the alie9etl ezemption. Any violation of Section ]031.5 by any applicant tor a Permit subjects the applicant to a civil � Oenalty ot not more than five huntlretl tlollars ($500). � 1, as owner of the proper[y or my employees with wages as their sol¢ comDensation, will tlo the work, antl ihe structure is not intentletl or ofteretl ; far sale (Section 7044, Business antl Professional Cotle: The -Contracto�'S (License Law tloes mt apply to an owner of a-property who builtls or improves thereon, antl who tloes such wark himself/herself or Ihrough his or her own employees, provitletl that such improvements a�e not inten0etl or otteretl to� sale. If, howeveq the builtling or improvement is soltl witM1in one year of com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl or iin- prove tar the purpo5e o� sale). '0� I, as owne� ot the property, am exclusivery con[�ac[ing with licensetl'con- tractors to wnStruct the Oroject (Section 7044, 8usiness antl Professions Cotle: The Contractor's License Law does not appry to an owner ot property�wno ; builtls or improves thereon, antl who cont�acts for such projects with a con- tra<tor(5) license pursuant to tne ContrSctor'S Cicense l.aw). I� am aware that proof of their Worker's Compenzation insurahce shoultl be proviCetl to me. ❑ 1 am exempt untler'Section �B. & P. C. for this reason Date Owner - ' I hereby certify that I nave reatl this application antl state that Ihe above information is correct. I agree to comply witlt all city antl county ortlinances and'state IawsJal ' consVuction, antl hereby autM1onze repre� sentatives ot �tbis o en r u the above-mentionetl pr perty or inspection pur Si9nature — J � am / Drivers' Li � e � � 'TYPE OF CONSTRUCTION L�NEW U ADD Ll ALTERATION IJ REPAIR - ❑ CONVERSION ❑ OEMOLISH ❑ OTHER DESCRIPTIpN OF WORK U� O�LfJG. ,4Lp fE X TYPE OF PERMI�ADIN ❑ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIP710N � 54. FT. a-U� � ocGUPt�NCv ' CONSTRUCTIONTVPE�� VALUATION$ Ia�%-�G� � ZONE � GRADINGCU.VDS. ACRES Remarks: Bar Sink Back(low Preventer Backfiow Irrigation Bathtubs �rinking Fountains Floor Drains Floor SinkS GasService � Outlets Interceptors - :� Kitchen Sink ' ' �.dVdtOfIES P-TraP . - Roof Drains inspec[ion,Fee §15 8oiler Duct - Under Gwund Duct - Structural Duct - Ventilating � Exhaust System ❑ � FirepVFacL BIL ICBO Heating System & c ❑aioo,000 u �i R�spection Fee $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Pipmg Solar Tank Swimming ool w/Spa Water Cbset Water, Heater Water"Serviw Auto-Wash Laundry 7rey � Issue Fee' � 1ANICAL Hood or Typel ❑ Canopy Typell ❑ Refrigeratio stem� - - O� ,000 BTU ❑100,000 BTU ,System Repair/Alceration � Fire Dampers ' . � Registers Issue Fee FE $ 3 A $ 3 A.P. # — S Main Building: T Fronq [� � ARear �'J,r � C Right S �eft A Ping. Ref. # '�.� Planning Notes: r{ Automacic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �OGas ❑Elec Fan F.A.U. Fixtures Device eoxes Outlets Switches - Garbage Disposal �11�� n � �F. Ji N •_ Req./Provided ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+KW Meter ❑up to 100 amps . Meter ❑over100amps Sub Panel � - Motors �0- P �1'h- 8 InaSo ❑9=15 HP �16-15+ rowave Pole Li9hi ' Range Generator DO- W �5-15 KW Standing Sections Trash Compacmr Fee �$15 � � Issue Fee . DEVELOPMENT SERVICES REQUIR 2oning Approved By Building Approved By � S FEES $ 3 � 2 SUMMARV OF FEES `� - BUILDINGPERMIT $ '�OSSIJ/7 SMIP �$ - �d , PLAN CHECK $ $�'SS PERMIT PLUMBING $ �SSUANCE � $ PLAN CHECK 25% $- i ENERGV P•.C. $ ELECTRICAL $ � GRADING � $ PLAN CHECK 50% $ " . MICROFILM. $ MECHANICAL S TOTALFEE $ � PLAN CHECK 25% $ CMF 0865-46, rev. 10/84 -)lccounting; Goltlenrotl - Assessor � CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit�k Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcemeni 56. Rough Plum6ing & Pressure Test ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduii-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 67. APPROVAL TO DECK 11. Property Sewer Line & Nouse 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 8ar 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 J2. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing ( gi Q 74. Overhead Hydro 26. T-Bar Ceilin9 (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ` y 76. Dry Standpipe 28. Lathing & Siding .��7 77. FIXED SYSTEM FINAL 29. Insulation S 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 Cond�tioning �iA� � �- 35. Final Gas Pipe-Test 3�� y ENC�S ��T- � utt O�C S23 36y Hood or Canopy p.� - �i (w/ C.7�� 37.-Final Factory Fireplace „ � , 38, �Final Plumbing � � � � ' , 39. Water Service-Final � ; ' � , � -40. Gas Service-Final ' � � � 41. Solar pomestio-Final � r� y �� . . ,� t 42. Backflow Preventer . ; � . , " , � 43. Backflow Irrigation ' ' '- , � � ' ' , � , 44. ,Landscape Irrigation System ' � � - ' f � _ - 45..�Sound Attenuation ' � 46. Handicap Regulations - � � :�,. � ' 47. FINALSTRUCTURE&BUILDING � !Y ��N' . � . 48. Special Requirements Completed �/� g7 - j� .. 49. Electric Release to Edison .� " /� .� l � 50. Gas Release to Southem Califomia Gas Co � /- � 51. CERTIFICATE Of OCCUPANCY ' � � No. Date =+� � Project Address � A.P. Number Building permit Number Owner's Name `� Mailing Address� FEE: CITY OF COSTA MESA PARK FEES Fee Payment Receipt Single Family ' 2-Bedrooms or Less 3-Bedrooms 4•Bedrooms `�.., 5-Betlrooms + t Multiple Family ' � � � Bachelor or Studio 1-Bedroom 2-Bedroom 3-Bedrooms + 001064 Number of Units � @ $ 661.76 = @ 1,205.67 = @ 1,545.62 = @ 1,610.50 = 5 @ @ @ @ 474.37 573.18 887.51 1,229•38 ��_�. , JAN 2'7 "i4b� � i ; __�-- � �� /�,�,��p Total F,e,�e ,"',', •. �• SS Planning Department te (�_ By �,� AIJL�i� + l'fW�CV� Applicanx's Signature ' City ortlinanca 72-44 Clty Or nance 72-45 •** City Rasolution 78-1i6 CMF 017q-30, rev. 7/85 White—Planning; Canary— :n9; Pink—Finance; Goltlenrotl—Appllcant co�sG c a Propert Owner Contrac ROOF COVERING CERTIFICATION Permit No. �� State Contractor License Number //4'�Q� Classification i hereby certify that I have instafled, or caused to be installed, a minimum Class C roof covering ai the above address in conformance with Chapter 32, and Section 1704 of the 1979 Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the manufacturer. ❑ I further certify that I am the owner of the property. (Owner-Builder permittee only�. � I further certify that I am: Q Owner of sole proprietorship company ❑ Full partner of the company Limited partner of the company Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shali deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Received by Building Division by: _ �� -13—&�7 ��a� o,�e SPace for Notarial Slatemen<for autborizetl officer or agent CMF 0990-46 White - Builtling Oiv.; Canary - Contractor, Pink - Owner CityofCostaMesa INSULATION CERTIFICATION� a��d��9s�ret„o��5�0� 2�r'/7F1.�6tiSr � �� a��l�.� ��v� Number end Street Ciiy C�Fty Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF � • Material � r ,��`� Brand Name �� ti�� 7hickness (inches) � Thermal Resistance (R Value) �3O EXT�RIOR WALL Material �� l Thickness (inches) 3� CEI LING � Batt or Blanket Type /�/�:�/��-�� Thick�ess (inches) / Loose Fill Type Minimum Thickness (inches) Area Covered (ft2) FLOQR,ELEV D Material . Thickness (inchesl FLOOR, SLAB/� Material i Thickness (inches) Width (inches) FOUNOATION VyP�lyi . Material �� Thickness (inches) Brand Name ��'�s('-E�'2�/f.Y-"� Thermal Resistance (R Value) �� Brand Name � � Thermal Resistance (R Value) � Brand Name _ Number of bags Weight per bag Thermal Resistance (R Value) Brand Name Thermal Resistance (R Brand Name Thermal Resistance (R Vaiue) Brand Name Thermal Resistance (R Value) DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation'Standards for new residential buildings (located in Title 24 of the �lifornia Administrative Codel. ��'r.e�t��'ll �i/,/'.rs1-S /�oZ��f �— s General Contrecror Builder) License Number ' ,� ��%��,�% ' natu and Title Date Sub Contrector (lnsulation Applicatorl Signature and Title CMF 1�06-46 License Number Date � � r . Applicant to fill in all sDaces exceo< those witnin heavy Doraer lines antl sign all apvroo��ate tleclarations. CiTY oF COSTA��A'CONSTRUCTI N PERMIT Project AddrP�ss % ��--�,� ' �j ApplicanYs Mailing Add`,re�ss/ ��%�'�A'� v • N� Owner's Name v//}"�" �,�p� Phone Address f U �� % ��'� � Arch/Eng. Licenu No. Address �— �/ Contractor's Name. .� iQ/�Phone � Address (mailing) � ��V �� City License No. � LICENSED CONTRACTOR DECLARATION 1 hereby afti�m t�al I am licensetl untler proviSlons of Cna�ler 9(cOmmencin9 with Settion 7000) of Division 3 ot [he Buziness antl ProteSSionS Cotle, antl my license is in lull rce antl effect. /� (� Licenre CI�6q w o No. Q� Date /�1� 5'9 [ ¢ � WORKE 5' COMPENSATION DEC ARATIO ' hereby affirm that 1 have a certificat sent to solf-Insure or a cmtl77cate it Workers' Componsation Insurance, or a certifietl toOY thereof (Setlion 3800, '�°r,�_P6 3Q233a-o/ �j�Qy��.�� Policy No ComOany � �"�" ^'� � Ccrtifietl copy is hereby fumishe ertifi � p'Qletl with Ihe cl Bull ' . Dete � � AOPlicant EXEMP IO�ORKERS' CO EN ELLFRATION (Thissection need not be comple(etl it t mit is tor one huntlretl (E300) or less�. I certity that in tM1e perto�mance of lhe wOrk tOr whith this p¢rm�t i5 fs5uetl, I Shdll not employ any person in any r�anner so as to become subject to the WOrkers' Compen5dtion Laws of CalHomia. Date ' ' Signahrc NOTICE: If, after making this tleclaralion, you shoultl become subject to the Workers' Compensation provi5ions of the Labor Cotla, you mus[ fortbwith Comply with suc� Owvi5ion5 or [his pe�mlt ihall be tleemaA revok¢tl. CONSTRUCTION_LENDING.AGENCV I h¢rety atfl�m that t�ere is a ConS[ruction lentling agency for the periormanG¢ of the work for whiGR tbis �it�,dl�ueth,(�tion 3097 Civ. CJ Lentler4 Name - �- �jTHG /� ctir-u Lentler'S HEtlress i�✓��A � �' OWNER BUILDER OECIARATlO 1 hereby afflrm thal I am ezemo� from the Gontractor's Litense. Law for the followin9 rea5on (Section 7031.5 Bu5ine55 antl Profe55ional Cotle: Any Cily or county which requires a permit lo const�uct, alt¢r, ITp�ove, tlemolish Or re0ai� any sVucture, prlor to its issuance, also requires the aoP��ant for such oermil to tile a signetl statement that he/she Is licensetl vursuant to the provisions of [he Contractor's Licenie Law (Cbapter 9(commencin9 wlth Section 7000) ot Division 3 ot the Business antl Professions Cotle) or that he/she ii axempt '.herefrom antl ihe basis tor the allegetl ¢xerOptlon. Any violation ol $ectlon 7031.5 by any applicant for a permit subjects the applicant ro a civil �enalty ot not more than five huntlretl tlollars (5500). 1, as ownar of ,the property or my employees witn wages as Ihol� sole Wmpensation, will Eo the wo�k, antl tne 5trucfur0 IS not in[entletl or offeretl tor sale (Section ]044, Business antl Professlonal Cotle: The Coniractor's License Law tloes not apply to an owner of a properry wito builtls or improves thereon, ana wno tloes such work nimself/herself or throu9h his or hor own emploYees, provitletl tM1at such improvomenfs are not Intendetl or oflnretl tor sale. It, however, [he builtlin9 or improvement I5 soltl within one year of com- pletion, the owner will have the burtlen of proving ne/she tlitl not builtl o� im- prove tor the purpose of zale). ❑ I, a5 ownCr of the prOperty, am exclusively contraCting with IlcenSetl con- tractorsto construct the project (Sactlon ]044, Business antl Professions eotle: The Contracto�'S License Law does mt apply [o an owner of property who builtls or improves tbe�eon, antl wM10 contracts tor such projeCts with a com Irattor(s) btense pursuant fo [he Contracto�'S License Law). I dm awa�e that proof of tneir Worker's Compensation insurance sboultl be provltletl to me. ❑ I am exempt untler Section , _ B. G P. C. for this reason Date Owner _ I hereby cer[ify that I have reatl this information is correcL I agree to comp a /�'s�7oL(9 I 3�' I. "JZ �Laun�/ry TVPEOFCONSTRUCTION NEW. ADD ALTERATION REPAIR ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCFIPTION OF WOFK/USE OF BLDG. �r�� ^ � rt� odµl A.P. #L}- S Main B E ( _.. � _. � es,� � d� 4 TYPE OF PEf2M1T LI GRADING LJ FouNDa7loN LJ 5-rRUCTURnL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUM�ING ❑ MECHANICAL B Rear , � O7HEa C Right PROJECT DESCRIPTION 5Q. FT, occuPANC , K CONSTRUCTIONTVPE��%'c ' VALUATION$ � g ft ZONE G0.ADINGCU.VpS. ACRES PIng.REf.� Remarks: .�� fifj�'� �j� Plannin9 NOtes: 3ar Sink 3ackflow Preventer 3ackflow Irtigation - 3athtutis C�arifiers Diihvidsher - ' ' Drinking Fountains Floor Orains Floor Sinks GasService OuNets / Intercepmrs Kitchen Sink Lavatories . � P—Trap � RoOf rains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating , Exhaust System � Multiple ❑ Firepl/Fact Blt. ICBO # Heating SyStem & Ducting ❑0-100,000 BTU OJA ,0006T ISignature - a� LI e 55 � �� Reinspeetion Fee '$75 CMF 0865-46, rev. 10/04 White - Builtling; Canary - AppllCant; Pink - Accounting; Goldenrotl - Assesmr ne1NG � FEES Shawers Service Sink � � Sewer.Cap / Sewer Connection / Solar Collecmrs� Solar PipyMf , - Solayfank �imming Pool w/Spa Urinal Water Closet � � Water,�Heater Water'Service AlltO-W85f1 ' Laundry Trays ' Issue Fee Hood or Typel �,❑ Canopy Type I I ❑ Refrigeration Syst � ❑o-ioo,o� u Dioo,000 � m RepaidAlteration . Fire Dampers " . Registers laue Fee Autome[ic Wesher Cons[ruction Pole Cooking Unit Dishwasher Dryers �Gas ❑ Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generaror ��0-5� �� . � ��. _�" .., JP.�! 27 i987 Zone —� Perking Req./Provided A..l.� �%Ai3•L+ FOR SPE REQUIRE&IENTS ELECTRICAL FEES Transformer ❑ 15-50 KW ub. � 50+KW i Meter ❑up to 100 amps � Merer ❑over 100 amps / / lec[ric Sub Panel / Motors 00.1 1 Y. - 8 Inc.Solar 9-15 HP �16-15+ Mi wave / Pole Light Range Si9n 15 KW $ 3 ! Reinspection Fee $15 FEES DEVELOPMENTSERVICESREQI i Zoning Approved 9y Building Approved By Application Issued 8y r $ 3 ing Sections Compactor Issue Fee SUMMARY OP I �'��BUILDING PERMIT $ - SpG�`i`C0 PLAN CHECK $ I—LIL � PLUMBING $ � PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50°.6 $ MECHANICAL $ P�AN CHECK 25% $ $ 3 .2 Z O N 1 N G R E Q M T S SMIP �$ r � PERMIT . ISSUANCE $ ,_ ENERGV P.C. $ GRADING' � $ MICROFILM $ � TOTALFEE S ' , CONSTRUCTION AND PLANNING POOL & SPA � APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electric8l Service or Pole 52. Pool�& Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgmd. 55. Electrical Bonding . 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 3 �pi 58. ElectricalConduit-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 i 6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace � APPROVALS Permit # - '' 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. RoofFraming 73. Undergrnd.StorageTankOGas ❑Oil 25. Roof Sheathing ��'1 fu�- 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing Y � 76. Dry Standpipe 28. Lathin & Sidin � 9 9 ��i 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�.,Cfr T jj� � 34. Final Heating & Air Conditioning �� 35. Final Gas Pipe-Test 36�Hood or Canopy � �> 37.-Pinal Factory Fireplace . •!� 38. �Final Plumbing � ( � . ' 39. Water Service-Final �� . � � 40. Gas Service-Final � � . ,,, 41. Solar pomesticFinal ' � � , - 42.- Backflow Preventer , . ;, �.i; :' ,�� • 43. Backflow Irrigation ' .. � � - �. � - ' 44. Landscape Irrigation System � , , - - -, � � . 45. Sound Attenuation � � � • v � 46.'Handicap Regulations � , . � . 47. FINALSTRUCTURE&BUILDING ��y ,G�✓ , � 48. Special Requirements Completed g - , ' - ' � 49. Electric Release to Edison � ' - r 50. Gas Release to Southern California Gas Co � � . u 51. CERTIFICATE OF OCCUPANCY ' No. Date r � ADPlicant to fill in all spaces except tnOse within heavy bortler Ilnes antl sign all apv�opriate tleciarations. CITY OF COSTA MEScA' CO UCTION PERMIT PERMIT .� � TRACT NO. LOT NO. UNIT NU. ProjectAddress �7�� /�-�- F F.G. ' � AppliCant'S Mailing Add es5 � q �� . TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Ownef'SName �`+� � �%��S /}q� e � � CONVERSION ❑�DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BIDG. —�t�� Address Arch/Eng. LiCense NO. TYPE OF PERMIT GRADING� /FpVNDHTION STRVCTURAL Address I�> ❑ TENANT ❑ ELECTRICAL LYPLVMBING ❑ MECHANICAL Contractor's Name ��{ � Phone f� v� � Address (mailingl— �� /i��1'�^/ �� _ PROJ �f 'L�i 9 %z � City License No. � LICENSED CONTRACTOR DECLARATION 1 hereby at�irm that I am licensetl untle� p�ovi51on5 0/ Charte� 9(commencing with section 7000), ot Division 3 of tM1e Business antl Professlons Cotle, antl my Iicense is In h� tor a etfecL , ,/�y License ass � icense V �O Date_ Si9nature wORK RS OP PENSATION D GLARATION 1 hereby alfirm inat I have a certificate of consent to selhlnsure or a certificate of Workers' Compensalion InSurance, o� a C¢rtifi¢tl <Opy th¢reot ($ectlon 3800, Lab. Ch �� 64 Company ✓ ��'�� `^+ PaIiCY No. _� titietl coDY is hereby tumishetl. Cert� ietl y i tl wi[M1 the city il in ', s' . Date APPlicant EXEMPT N F OM ORKERS' GO PENSATION DE RATION (This sect on ne tl not be completee if the permi[ is tor ono huntlretl ($100) or less). 1 certily that in Ihe perto�mance of Ihe work for which lhls perm�t Is I55ueU, I shall not employ any perxon in any manner so as to become subject lo the workers' Compensation laws of Califomia. �ate Signature NOTICE: 11, altor making this tleclaration, you shoultl becoma subject to the Worke�s' Compen5ation O�ovlsions of the Labor Cotle, you must to�tltwith comply wilh such prOvi5ion5 or this permit sM1all be tleemetl revoketl. CONSTRVCTION LENDING A6ENCV I hereby affirm thal there is a consiruction lentling agency for the performance of the work tor whicM1 tnis permit i5 i55uetl (SecHon 3097 Civ. CJ Lentler's Name �entler's Aatlress OWNER BUIIDEH OECLARATION I hereby affi�m t�at I dm exempt from Ihe ConVacto�'S Lic¢nse Law for the following reason (Sectlon 7031.5 Business antl Professional Cotle: Any ciry or county whlch req W�es a permit lo cons[�uct, alter, Improve, tlemOlis� o� repair any structure, prlor to its issuance, also requires the applicant for such permit to ti�e a slgnetl Slatement Ihat he/she i5 licensetl pur5udn[ to the provisions of ihe Contraclor's License Law (Chapter 9(commen<ing with Settion 7000) ot DiviSion 3 O( Ihe Bu5ine55 antl Professlons Cotle) Or that he/sh¢ is exempt lher¢from dntl the basis for the allegetl exemp[ion. Any violation o/ Sec[iOn ]031.5 by any ap0liCant fo� a permi[ subjects lhe applitant to a tivil �enalty of not more (han five huntlretl tlollars (E500). I, as owner of IM10 ProOerty O/ my employees witlt wagos as �heir sole compensation, will tlo the work, antl the structure is not intentletl or ofterea (or sale (Section 7044, Business antl Professional Cotle: The Con[ractor's license Law tlo¢5 nol apply t0 an owner Of a property who builtls or improves the�eon, antl who tloe5 Such wo�k him5elf/M1e�Selt or thrOu9h hls or he� own employees, provitletl tha[ sucb improv¢ments are nOt Intentletl or ofteretl for wle. It, howev¢r, the builtling or improvcment is soltl within one year of com- pletion, the owner wlll M1ave Ihe burtlen of proving he/she tlitl no[ builtl or Im- . prova fOr [ho pu�pose oi Sale). �❑ 1, as owner ot the property, am exclusivety mntractln9 wllh licensetl con- �'� traclors t6 consVuct the project (Section ]044, Business antl Professions Cotle: The Contractor's License Law does nat apply to an owner o1 property wha builtls o� improvas Ihereon, antl who contracts for such projects with a con- tractor(sI Imense pursuant to the ConVactor's License Law). I am aware that oroot of [heir WOrker's Compensation insuranw shoultl be prOvltletl to me. ❑ I am exempt untler Sectlon B. & P. C. lor this reason Date I nereby carti information Is antl state laws sentaHves of inspeclian pu� $i9na[ure � Diivers' Licens _ Owner _ have reatl this o qpl�n9 mn a OTHER ECT DESCRIPTION 5c?. Fr. oCCUP.crvCv ON STRUCTION TVPE VALUATION $ _ nNE GRAOINGCU.YDS. ACRES_ Remarks: . // �' !� Bar Sink Back(low Preventer Backflow Irrigation � Bathtubs Jrinking Pountains Floor Drains Floor Sinks Gas Service /J Interceptors ' Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - $tructural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-100,000 BTU O 100,000 BT Reinspection Fee � S15 CMF OB65-46, �ev. ]0/84 hi[e - Bu Itling: Canary - Applicani: Plnk - Accounting; Goltlenrotl - Azsessor Shawers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Typel O CanoPY TVPeII ❑ Refrigeretion System ❑0.100,OOOBTU ❑100,000 System Repair/Alteretion Fire Dampers Registers laue Fee FEES A.P. # S Main Buildi E T Front B Rear A C Fight K Left S Ping. Ref. # Planning Notes: Automatic Washer Construction Pale Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Device Boxes �` � • L � Outlets i j Switches � � Garbage•Disposal � Generator �0�5 KW �5 $ 3 $ 3 3016 2/27/87 - Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Meter ❑up [0 100 amps Me[er ❑over100amps Sub Panel Morore�0.1 HP �iX-8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light � Range � Standing Sections ' Trash Compactor . I Reinspaction Fee I S75 ' I Issue Fee DEVELOPMENT SERVICES REQUIpEMENTS: Zoning Approved 8y Building Approved By 69.25 TL FEES $ 3 Z O N I N G R E � M T S SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ � PERMIT PLUMBING $ ___ -��'UU _ ISSUANCE $ PLAN CHECK 25% $ I 3. S ENERG�' P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ � MECHANICAL S TOTAL FEE $ _SIC7_, �`� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �+� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 5�. 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 � f/�rJ 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 i 6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. P.00L/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # - 21. Ducts, in Structure 70. Underground Hydro �-ZZ�j! Lh� 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 �.a 76. Dry Standpipe � i 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: . ^ � - - % i i /✓ � 34. Final Heating & Air Conditioning �` � � r T -.� � 35. Final Gas Pipe-Test ' � • � '�� 36. Hood or Canopy • 37. Final Faaory Fireplace - ' , , 38. Final Plumbing �� 39. Water Service-Final S:2y�Y7 Uc0 ' 40. Gas�Service�Final j.t�,-y7 Lk� � � 41. Solar pomestic-Final � • ' 42. Backflow Preventer Y' . . . 43. Backflow Irrigation � ' 44. Landscape Irripation System • , �. , �, g5. Sound Attenuation •T % r ' 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 � � ApPlicant to fill in all spaces exce0t those within heavy bo�0er lines anA si9n a11 aDcroo�iate tleclarations. CITY OF COSTA MESA COI�ST� CT(� N P MIT PER NO. TRACT NO. LOT NO. UNIT N0. . . Project Add�ess ,Z.y�� q�f4!a�i// /�.� � a 7 9� . � 3o i � 2/27/87 21 0 75 �. ApplicanS�SMdilingAddf¢55 _1B�—(yLC�,KI,�II PI TVPEOFCONSTRUCTION EW ADD ALTERATION REPAIR � ❑ CONVERSION ❑ �EMOLISH ❑ OTHER — q,p.# Zone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. � C�-H ' ��++ Address 5 Main Building: Accessory Building: � E Z Arch/Eng. Lic2nse Na. TVPE OF PERMIT GRA�ING ❑ F NDATION STRUCTV RAL T Front � � Add�255 _ `� ❑ TENANT ❑ ELECTqICAL LVMBING ❑ MECHANICAL B qear � N � ❑ OTHER A I Contractor's Name Phone C Right ' N PROJEC7 DESCRIPTION SQ.FT. � OCCUPANCV K , G Addresslmailingl. �7�`(� � CONSTRVCTIONTVPE ' VA�UATION$ S L¢ft R Ciry License No. �! �� ZONE - GRl1pING GU. VDS. ACRES p�ng. Ref. # Parking Req./Provided E LICENSEO CONTRACTOR DECLARATION 1 hereby affi�m tnat I am licensetl untler provisions ot Cha�ter 9(commencing Remarks: .� 2 Planning NOtEs: M with section ]000) of DivisiOn 3 of tM1e BuSiness antl.Professions Cotle, and �Ty IIC2OSC IS 10 iyll iOlWjdj�1 C1f2CI. , T l.icens I ss L—�� V icense ! S ` p� Date Si9nature ' PLUMBING FEES ' '� v\ WORK 0.5' MPENSATION D C RAT10 � . - I hereby affirm that 1 have a certificate of consent to selt-insure or a certificate Bar Sink Showers E�ECTRICAL �FEES of Workeis' Compensation Insurance, or a cerFrtietl co y thereoi �5 tlion gackflow Preventer ServiceSink Automatic Washer Transformer ❑ 15-50 KW �3800, Lab. C. G � PolicyNo.�G ��1 Company Backflowlrrigation SewerCap ConstructionPoleSub. �50+KW rtietl copy is h reby tumishetl. erti 'etl st ith [he city B ftli g{ is' Bathtubi SCW¢� COnn¢cti00 oate Applicant � S� � Cooking Unit Meter ❑up to 100amps EXEMPTI N F M WORKERS' CO SATIO V OECiHRA ION Cld�ifiE�S SOId� C0112CtOf5 ' DiShW35h2� Merer ❑over 100 amps �This secti n need not be completetl if the permit is for one huntl�etl ($300) or , less). Dishwasher Solar Pipin9 Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance ot the wo�k for Which this perm�t is issuetl, I shall not employ any person in any manner so as to become subject to tne Orinking Fountains Solar Tank Fan Workers' Compensa[ion Laws of Calitomia. MOLOfs �0-7 HP �1 %- 8', Date Signature Floor Drains Swimming Pool w/Spa F,A.U. NOTICE: If, afte� makinq ihis tlecla�ation, you sM1oultl become subject to ihe Inc. $012� �9-15 HP 016�15+ Worke�s' Compensation O�ovisions of the Labo� Cotle, you must torthwith FI00/ $ink5 U�inal romply wiM zuch provisions Or this permit Shall be tleemetl revoketl. Pixtu�¢5 Microwave CONSTRUCTION LENDING AGENCV - GasServiCe OUtlels Wate�CloSet DevicCBoxeS I hereGy atfirm that there is a canst�uction lentlin9 a9ency for the pertormanGe �"� „ POIC Light � ot [he work for wnich this permit is issued (Section 3097 Civ. CJ Interceptors Water Heater Outlets � L.entler's Name � . /� i � Range Lentler'sAtltlress Ki[chen5ink � WaterService Q Swiiches � OWNEH BUILDEH �ECLARATION Sign 1 hefeby aftirm that I am ezemOt from the ContrActor'S licenze Law fol the LdvdtOfies AUtO-W35h Galba E Di5 OSdI � ' following reason (Section 7031.5 Business antl Professional Cotle: Any city or 9 P $tanding Sections county which requires a pe�mit to con5truct, al[er, imp�ove, tlemoli5h or repalr P—Tf2p Laundry T�dyS Generetor �0-5 KW �5-1$ KW � any structu�e,.p�io� to it5 i55uance, also requires tne applicant for sucit pe�ml[ _ T�25h COmpdct0� to file a signed sla[ement that he/sM1e is licensetl pur5uant to [he provisions of ROOi D�dipS ' the Contractor's License Law (Chapter 9(commenG�n9 �+ith Section ]000) of _ , Oivision 3 of Ihe BuSiness antl Prote55ions Cotle) or that M1e/she is exempt t0erefrom antl tlte basis for the allegetl exemptioP� Any violation of Sectlon ' ]031.5 by any applican[ for a petmit subjecYS 1h¢ applicant to a civll ee0dlty ot not mure than five huntlretl tlollars (gsoo). 3 �J I, as owner o! the property or my employeCs with wages as their sble Reinspection F2e $15 I550¢ Fee $ mmpensation, will tlo the work, antl the Structur6 i5 not intentletl or otferetl for sale (Section �044, eusiness antl Professional Cotle: The Contracror's MECHANICAL FEES Reinspection Fee $15 luue Fee $ 3 License Law tloes not apply to an owne� of a propBrty who builtls or improves thereon, antl wno Goersuch,work himself/herseH or through nis or her own DEVELOPMENT SERVICES REQUIREMENTS: em0loyee5, provitletl Ihat such Improvements ar¢ pot intentletl or offeretl tor BOiIE� HOOd o� TYP¢ I ❑ sale. If, howeveq the builCing or improvement is s4�tl within one year ot com- CdnOpy Typ211 ❑ Zoning ApproVed By DatO pletion, the owner will nave the burtlen of provinq he/she ditl not builtl or im- Duci - Under Ground Building Approved By Dat� prov¢ for the purpose of sale). � 2 ❑ I, as owner of the property, am exclusively contracting with licensetl con� Duct-Structural Refrigeration Sys[em Applitation luued By Dat tracto�s to consiruct tM1e project ($ection 7044, Bu>iness antl Professions Cotle: The Contractor's Licenze Law tloes not apply to an owner of property wno Duct � Ventilating ❑0-100 OOO BTU ❑700,000 BTU SUMMARV OF FEES builtls or improves the�eon, antl who mntracts for such projCcts with a con- - tractor(s) litense pursuant to the Contractor's License Law). I am aware that Exhaust System � Mukiple ❑ Sys[em Repair/Alteration � BUILDING PERMIT $ SMIP $ proof of tneir Worker's Compensation insurance shoulA be pravitled to me. _ pLAN CHECK $ PERMIT ❑ I am exempt untler Section e. & P. C. for this reason FirepUFact.8lt. ICBO # Fire Dampers PLUMBING $ ISSUANCE $ Oate Owner Heating System & Ducting Registers PLAN CHECK 25% $ ENERGV P.C. $ 1 nereby certity that I have reatl this application antl te mat the above ❑0-100,0006TU �100,0006T GRADING $ inlormation rs c t. I a9r e to comply with I tl county ortlinances ELECTflICAL $ antl state laws e t g to i ing cons[ructi ereby authoriie �epre- MICFOFILM $ sentatives of c ty t pon th entioneh pr erty �or PLAN CHECK 50% $ �% inspection pur es. MECHANICAL $ ' /� Si9nature Date , TOTAL FEE $ ReinspeMion Fee $75 Issue Fae $ 3 - - PLAN CHECK 25% $ Drivers' Li nse or 55 � '� CMF 0865-46, rev. 10/84 - APplicant; Pink - Accounting; GOICenrotl - Assessor CONSTRUCTION AND PLANNING ! POOL & SPA APPROVALS Permit�k Date �Inspector qppROVALS Permit# � Date Inspector i. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgmd. �/8'+J ,� 53. Steei Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - ' 5. Steel Reinforcemeni 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grrid. 57. APPROVALTO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. $. Foundation, 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. sl�y��? £ 60. Backwash Lines, P-Trap, � Undrgmd. � 10. Structural Floor System 61. APPROVAL TO DECK 11. PropertY Sewer Line & House Connection /�? 62. Backwash & Receptor-Final � i 72. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing /��Q.J 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar Systern-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign . ,.� 68. APPROVEU 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 d'�yZ(yz,� C,k/� 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 FiYdro 26. T-Bar Ceiling (Structural) & Monowat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe - i � 28. Lathing & Siding 77. � FIXED SYSTEM FINAL '� ' 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 'T' 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 j/�7 1j'� � � � 39. Water Service-Final � � L2,�jZ LT,� . . . 40. GasService-Final sZZ_�7 L6l� � � . � � � - 41. Solsr pomestic-Final " � � � 42. Backflow Preventer - . � � ' ' . '�43: Backflow Irrigation . ' � "'� ' - : ,44. Landscape Irripation System ' 45. Sound Attenuation ' . � '46. Handicap Regulations n t, � ' 47: FINALSTRUCTURE&BUILDING - ' � � � ,� , 48. S�Secial Requirements Completed ". ' , � ' . .49. Electric Release to Edison � � � �. 50. Gas Release to Southern California Gas Co " r � • 51. CERTIFICATE OF OCCUPANCY � No. Date � ApPlicant to flll in all spaces except those within neavy GorOer lines antl sign all ap0/opriate Oecla�ations. CITY OF COSTA MESA CONSTRUCTION PE MIT PER T NO. TRACT NO. LOT NO. UNIT NO. �/ ,. 'ot��0 �5681 4/OB/87 55a5� 1 Prolect,Address 1 7 �/ �� Applicant's Mailing Addre55 ��ij[/�� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR �wry e �� P�^^��' � J/�`/[} '❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # 2on8 - Owner's Name LH C-.. �� DESCRIPTION OF WORK/USE Of BLDG. Address ' S Main Building: />ccessory Building: Arch/Eng. License No. • TVPE OF PERMIT ❑ GRqDirvG FOUNDA7ioiv ❑ STauCTURaL T Front p Address �f -��r' ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL Bn Redf N Contractor'sNam '-" �� Phonela2�YY � oTHER � C Right . N � C- PROJECT DESCRIPTION 5c1. F7. oCCuca.NCv K G Address (m�"i�� .� 3% a'n!"I/'/�C_��'�/ /Ur� Q2L� ' Left i • CONSTRUCTIONTYPE VALUATION$ $ . City,LicenseNo. ��73GZ � " ZONE GRADINGCV.YDS. FCRES q LICENSED CONTRACTOR DECLARATION � �� Plny. R2f. # Pd�king Req./P�OvidCd E � 1 hereby affirm that I am licensetl untler provislons ot Chdrte/ 9(comm¢ncing qemarki: Planning Nores: ry� with 5e<[ion 7000) of Division 3 ot the Business antl Professions Cotle, antl — T my license is In f WI torc antl ettect. -�/ � ,` _ Licenm C �— — kense t '�L , , S �'�� Date Signature PLUMBING FEES '� WORI(ERS' COMPENSATION DECLARATION . Ba� Sink ShOwC�s - ELECTRICAL FEES I her¢by alfirm Inal I have a certificate ot con5¢nt to selbinwre o� 2 certlficate of Workers' Compensation Insurance, or a cartitietl co thereof (Section - � 3800, �ab. C.) Q %�, �• ��,.� ;/ Back(low Preventer Serv¢e Sink Automatic Washer Trensformer ❑ 15-50 KW Policy No. ��V �� Company� �'�+'�K-'%�� BackflOwl�ri ation ❑ 50+KW 9 Sewer Cap Construction Pole Sub. ❑ Certifietl copY is M1ereby furnishetl. A i� Certiti �o ^Il,V''w th che city By I /1�'i' Div}'��on./J� /J Bathtubs Sewer Connection Cooking Unit Meter �up to 100 amps Date� � V �+ �APPlicant `�(�'�jR /.✓��/-�' ` E%EMPTION FROM WORKERS' COMVENSATION � CLA0.ATI01 Cld�ifiClS $012f COIICCt0�5 Di5hw25h¢� Met¢� ❑ovC� 1�� dmp5 (Thisseclion neetl not be com0letetl if the permit is fo one huntlreG ($100) or � iess). - � Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certi(y that in the performance ot the work (or which this perm�t is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00�1 HP �1'h- 8 Worke�s' Compensation Laws of California. ' . Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar �9-15 HP �16-15+ NOTICE: If, after making this tlecla�ation, you Shoultl become subject to tha Wo�kers' COmpensation provisions ot the l.abor Cotle, you must (orthwith FIOO�Sinks U�indl Fixtu�¢5 Mic/Ow3v¢ Compty with such O�ovisions or this pe�mit snall be tleemetl revoketl. CONSTRUCTION LENDING AGENGV GasService �Utl¢Ls W2L¢fCIOS2t D¢viC¢BOx25 I M1ereby atfirm lhat there i5 a mnstructlon Ientling agency tor the pertormance POIe Li9ht of tM1e work far whicn this permil is ISSuetl (Sectlon 309] Civ. C.) InterCeptOrS Wat¢r Heat¢r Outl¢L5 Rdng¢ LRntler'S Name Lentler's Atltlress Kitchen Sink Water Service Switches Sign - OWNER BUILOEN DECLARATION I hereby afflrm [hat I am ¢xemp[ flom [he Con[factor'S License L.dw fOr the LavatOri25 AUtO-WdSh tollowin9 reason (Section 7031.5 Business antl Protessional Cotle: Any city or Garbage Disposal S[anding Sections tounty wnich requires a permit to construct, alter, improve, aemolisn or repair P—Trap ' Laundry Trays Generator OP5 KW �5-15 KW any sVUGture, prlo! to ils i55uance, also reqWres [be appliCant fo! such permit TfdSh COfilpaCtOf to file a siqnetl statement that he/she is licensetl pursuant to the provisions ot Roo( Dlains Ihe Contractor'S LiCCnse Law (Chapter 9(commencin9 wilh Se[tion 7000) of Division 3 ot [he Business antl Professions Cotle) or tM1at he/she is exempt' lherefrom antl the basis for the allegetl exemptlon. Any viOlation ot Section ]031.5 by any appliGanl for a permlt subjects lhe ap0�icant to a civll penalty of nol more [han tive huntlretl tlollar5 (5500). LJ I, as owner of [lie property or my employees with wages as their sole ReinSpeMion Fee $15 Iwue Fee $ 3 compensafion, will tlo ihe work, antl Ihe s[ruc[ure is no[ intentletl or offeretl Reinspection Fee $15 luue Fee S 3 - for sale (Section �044, Business antl Professional Cotle: The ConVactor's MECHANICAL ' FEES LicenSe Law tlOes not apply to an owner Ot a p�op¢rty who builtls or im0/ove5 thereon, antl who does such work himself/herseli or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employ¢e5, Orovitletl [hat such improvementz a�e no[ intentletl or offeretl to� BOiICf HOOd O� Typ¢ I ❑ sale. 11, howoveq t�e builtliny or Improvement is sola wltnin one year ot com- Canopy Type I I ❑ Zoning Approved By Date pletion, the owner will have the buraen oi proving M1c/she aitl not builtl or im- Duct - Under Ground Buildin9 Approved By DatO� �_ prove lot the pu�0ose of zale). . �� ❑ I, az owner ot the properry, am exclusivery conlracting with licensetl con- Duct -Structural Refrigeretion $ystem Appliption Issuad By— Data =_F_p�rJL Vactorsto conSVuct the project (Seciion ]044, Businesz antl Profezsions Cotle: The Contractor's License Law tloes not apply to an owner ot property who Ducl - Ventilating ❑0-100,000 BTU ❑100,000 BTU �� SUMMARY OF FEES builtls or improves lhe�eon, antl who conlract5 fOr SUCM1 projec[5 with a con- tractor�sl ucense pursuant to the coniractor's License Law). I am aware mat Exhaust System 0 Multiple ❑ System Repair/Alteretion BUILDING PERMIT S SMIP $ o�ooi of their Worker's Compensation insurance shoultl be provitletl to me. PLAN CHECK $ PERMIT ❑ I am exempt untler Section B. & P. C. tor this reason Firepl/Fact. BIt. IC80 # Fire Dampers ISSUANCE $ PLUMBING $ oate owner Heating System & Ducting Registers — $ ENERGV P.C. $ PLAN CHECK 25% I hereby certity that 1 have reatl this appliwtion antl state that the above 7'f' 0-100,000 BTU �100,0006T � GRADING $ information is correct. I aqree to comO�Y with a I cily antl county ordinances � ELECTRICAL $ and state laws relal'qg lo buildin9 �ons o antl hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentalives oi tM1is t to ter ova mentionetl propert �� ,� � �'' Inspecllon purpos (�. MECHANICAL $ � Si9nature � Data ! ��/T TOTAL FEE $ _f.L�� Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Drivers' License or 55 � — CMF 0865-46, �ev. ]0/84 White - Builtling; Cana�y - Applicant; Plnk - Accounting; GOltlenrotl - Assesso� 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. Elecvical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. � Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 67. 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 Electriral-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. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL . 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEP,T. 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 17/�/� � � r � / r pl 35. Final Gas Pipe-T�sY t, a / 36. Hood or Canopy � . 37. Final Factory Fireplace �� y � .��`-- � 38. Final Plumbing -' �i b �i 39. Water Service-Final ' � 40. Gas Service-Final • , 41. Solar pomestic-Final � � ,42. BackflowPreventer • �' 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 ' Applicant to fill in all spaces except those witnin heavy eorder Iines antl sign all avoro0��ate aeclarations. CITY OF �OSTA MESA CONSTRUCTION PERMIT PERMI�O. TRACT NO. LOT NO. UNIT NO. � Pr�ject,Address ��% EL,Gi�ic.% AdE . . �� 23�i{ ]/Q�/"] � ' c .._- � Applicant's Mailing Address ,(/. Fj, TYPE OF CONSTRUCTION rveW AOD ALTERATION R aAIR '/ 3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p# Zo�e Owner'sName X LLU Phone.1/ �'`�/ .DESCRIPTIONOFWORK/USEOFBLDG. Address S Main Building: Accessory Building: E Z Arch/Enq. License No. TVPE OF PERMIT GRAOING ❑ FOUNDATION ❑ 57RUCTURAL T Front p AddresS /'/` '/o� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear . N Contracror's Name—Eu%p�RT �� •�-P7ibne �'�' c3' � OTHER _ ' %� I PROJECT DESCRIPTION �5q. FT. oCcuParvCV C Right N Address (mailingl 84� ��ia.�i f� -- n.G6 92�oG3 K Left G 2oS�,/ CONSTRUCTIONTYPE VALVATION$ $ R CityLicenseNo._�— ZpNE GRA�INGCU.YDS. ACRLS LICENSEO CONTRACTOR DECLARATION Ping. Ref. # Pdrking R2q./P�Ovitl2tl E 1 bereby affirm [ha[ I am licensetl untler p�ovi5ions of Cha�te� 9(commencing Remarks: � Z 7e ,� Planning Noces: M � with section ]000) oi Division 3 of the Business antl Professions Code, anG my license is in full f e antl eftecL �29 S License Class _ Lic n � Date� Signature. PLUMBING FEES WORKERS' COM ENSATION DECLAR ON B2� Sink ShOw¢�5 I hereby atfirm Ihat I have a certificate of consent to selt-insure or a certificate ELECTRICAL FEES ot Workers' Compensation Insurance, or a ceriif tl copy thereof (Section gackflowPreventer ServiceSink �.�„ Automatic Washer Transformer ❑ 15-50 KW � 3800, Lab. C�� 38Z3��I /�,/a ��( PolicyNo.�`/(! Company Backflowlrri9ation SewerCa ❑50+KW \ O �rtifietl copy is hereby fumishetl. P COnSL�uCtiOn Pol¢ Sub. Certifi y is �i tl with the city Bui j g Ivis' n. Bathtubs Sewer Connection Cooking Unit Meter p to 100 am s Date �� 'g APPlicant . . - P � E%EMPTION FROM WORKERS'COMP TION OEGLARATION Clarifiers SOId�Coll¢Ct0�5 ` ' DlShwdSh¢� Mete� ❑Ov2/ 100dmp5 (This section neetl not be completetl it the permit is for ane huntlretl ($100) or - , Iess). Dishwasher Solar Piping Dryers �Gas ❑Electric Sub Panel ' 1 certi(y that in [he perto�mance of the wo�k fo� whlcM1 this pe�mR is issuetl, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors �0-1 HP �1 %- 8 Workers' Compensation Laws o( Calitomia. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. � NOTICE: It, aiter making this tleclavation, you shoultl become subject to the Inc. SOId� �9-15 HP �76-15+ Workers' Compensation provisions of the Labor Cotle, you must forthwith Floor Sinks Urinal � comply with such O�ovisions or this pe�mit Shall be tleemetl revoked. FixtU�2S Mic�oWavE CONSTRUCTION LENDING AGENCV ' �'� Gas Service Outlets � Water Closet Device Boxes Pole Li I hereGy atfirm that t�ere is a construc[ion lentling agency for the performance 9ht Of the work tor whlch this Oetmit is issuetl ($ection 309] Gv. CJ Intercepmrs - Water Heater O�[I¢t5 Lenaer'z Name Range � �enaer's Atltlress - Kitchen Sink Water Service Switches Sign - OWNER BUILDEH DECLARATION � I he�eby affirm that I am exempt from the Contractor's License Law for the LavatO/125 , AutO-W35h following reason (Section ]031.5 Business and Professianal eotle: Any city or Garbage Disposal . Standing Sections county which requires a permit to construct, alter, improve, tlemolish or repair P—Trap--- � Laundry TraYs Generetor �0-5 KW OS-15 KW any st�uc[ure, prior to its is5uanc¢, alm requi�es the applicant tor such permif T�aSh COmpact0� to tile a si9netl slaiement that he/slte is licensetl pursuant to the provisions of RoOf,D�ainS � tM1e Contractor's LicenSe Law (Chapter 9(wmmencing with Section 7000) ot • � Division "3 of lhe Business antl Profe55ions Cotle) or that he/she is exempt therefrom antl the basis for lhe allegetl exemption. Any violation of Section ' � , �031.5 by any applicant for a pe�mit subjects the applicant [o a civil penalty of not more than five huntlretl tlollars ($500). ' 3 ❑ I, as owner of the property or my employee5 with wages as their sole ReinspeMlOn FBa $15 � � Issue Fee $ compensation, will tlo the work, antl the structu�e is not intendetl or offeretl tor sale (Section 7044, Business antl Protessional Cotle: The Contractor's MECHANICAL ''FEES Reinspection Fee $15 Issue Fee $ 3 License Law tloes not appry to an owner of a prope�ry wbo builtls or improves thereon, antl who tlaes such work nimself/herseli or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provitl¢tl [hat sucM1 improvements are not intendetl or offeretl for BOiIEf HOOd OI Typ¢ I ❑ zale. It, however, tne builtling or improvement is zoltl wimin one year of com- Canopy Type I I ❑ 2oning Approved By Date pletion, the owner will have the bur0en of proving he/she tlitl not builtl or im- DUCt - Und¢� Ground prove for tbe purpose of sale). Building Approved By �'� ❑ I, as owner of tne property, am exclusively contracting with licensetl con- Duct-Strucmral Refrigeration System , 'Applitation Issued By Dat -- tractorsto mnstruct the project (Section ]044, Business antl Professions Cotle: The Contractor's �icense Law aoes not apply to an owner of property who Duct - Ventilating ❑0-700,000 BTU ❑100,000 BTU SUMMARV FEES builtls or improves Ihereon, antl who wnVacts for suth projects wltn a com _ tractor(s) imense pursuant to the Contractor's License Law). I am aware thai Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's eompensation insurance shoultl be provitletl to me. PLAN CHECK $ PERMIT ❑ I am ezempt untler Section B. & P. C. for Nis reason Firepl/Fact. BIL IC80 # Fire Dampers ISSUANCE $ PLUMBING $ Date Owner Heating System�& Ducting Registers PLAN CHECK 25% $ � ENERGV P.C. $ I hereby certify that I have reatl this application antl state tnat the above ❑0-100,OOOBTU �100,OOOBT �' �� GRADING $ inmrmation is wrrecL I a9ree to compry wi h a city antl county ortlinances ELECTRICAL $___/�._�/C I antl state laws relat� builtling constr i , antl hereby au[honie repre-. 11 MICFOFI LM $� sentatives ci ent n abov entionetl prope y r . . PLAN CHECK 50% $ �(1 Inspection . MECHANICAL $ TOTAL FEE $� Si9nature Daie Reins ection Fee $15 Issue Fee $ orivers' �i ense or 55 #� P $ 3 PIAN CHECK 25% CMr utlbb-4b, rev. 1u/tl4 wn�ie - bulla�ng; Canary - Hppllcant; r�nK - saccoun[�ng; lioloenroa - Hssessor CONSTRUCTION AND PLANNING � :. ��. POOL & SPA APPROVALS Permii #� Date Inspector AppROVALS Permit # ' Date Inspector 1. Temporary Electrical Sef6ice or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgmd. �� 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 t: 6. Electrical UFER Grnd. n; 57. APPROVAL TO COVER-GUNITE 7. Footings �. 58. Electrical Conduit-Undrgrnd. 8. Foundation '�; : 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgmd. ��.;;#+, . 60. Backwash Lines, P�Trap, � Undrgmd. 10. Sirucwral Floor System' � 61. APPROVAL TO DECK 17. Property Sewer Lihe &�House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains . 64. Plumbing System - Final 14. Rough Plumbing ' 65. Electrical-Final 15. Rough Electrical-Conduit � 66. Solar System-Final - , 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �- 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYST.EMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT "�' 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure t � 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil,�'� 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing 73. Undergrnd. Storage Tank 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. F�EQUIREMENT 31. Plaster Brown Coai 7. FINAL INSPECTION %� �: • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' 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 ; � � � •� i 42. 8ackflow Preventer ' - � � � 43. Backflow Irrigation , � � � . �44. Landscape Irrigation System . � _ � 45. Sound Attenuation . , �' • �. . ; 46. Handicap Regulations � ,. � . . ' 47. fINALSTRUCTURE&BUILDING . ' . ' � • .� ti 48. Special Requirements Completed � � . � 49. Electric Release to Edison -� '� . , 50. Gas Release to Southern California Gas Co • 51. CERTIPICATE OF OCCUPANCY ' �� No. Date � AOP��cant to lill in all spaces except those within �eavY �ortler lines antl sign all apDroO��ate tleclarations. . PERMIT NO. TRACT NO. LOT NO. UNIT O. GTY OF COSTA ME�A�GQNS�U�C�ON P�R`MITv �� . � Z$ 1 d7 ry_V A ProjecSAddress z• �� d ��i c�l Lq �� . Applicant'S Mailing AddreSs 1.5 3 y—L�1vnro�i a• 7 TVPE OF CONSTRUCTION NEW P.DD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTNER -A p. • Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG Address ArchlEng. License No. ' Address Contracror's Nam � Phone �D-333 Address (mailing) ^,p �1 ro V 1.� � City License No. `7 2- � A LICENSED CONTRACTOR DECLARATION `` I hereDy aHi�m that I am litensetl untler provision5 of Cha�te� 9(commencing � with sec[ion 7000) of Divl5lon 3 of the Business antl Professions Cotle, antl \my license is in tuil f�cf �(�tl eftect. ^ �C ^ Licen Fi __ �� License -� b� NDate q-'�•a� c{gnari�rn \ ORK 5' COMPENSATION DECLARATION I r ftl�rp [lyt I have a certifi<ate ot consent o salf-Insure or a certificate rs'�0614/panw[ion Insurance, or a certified copy mereof,,,(section b. L b. C 1 -� {7 � F_(l_I_ ��w -F�15�ii�� licy No. �� Company .Cmtitietl copy is nereby fumishetl. Cerfi etl p etl with the city Bui 'g Dlvislon. Date�_ APPllcant . E%EMPTION FROM WORKERS' COMPE TION EC A TION (Thissection neetl noi be com0lo[¢tl If Ihe permit I5 f � One Ituntlretl ($100) o� less). I certify ihat in fhe perfo�mance of the work fOr which Ihis pe�m�t is issuetl, 1 snall not employ any Oe�son in any manner so as to become subject to the Workers' Compensation Laws ot Calitomia. �ate $ignaturC NOTICE: I(, atter making this tleclaratlon, you shoultl become subject to the Workers' ComOensation provl51on5 ot the LabOr Cotle, you must forthwith comply with such provlsions or [nis permi[ shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV 1 M1ereby affirm [hat there� is a constructlon lentling a9ency for tne performance of the work for which this permlt is issuetl ($ectlon 309] Civ. CJ lentler's Name Lentler4 Adtlress OWNER BUILUER dECLARATION 1 hereby aH7�m that I am axempl trom the Contrac[o�'s Licenze Law fo� tM1e followinq reason (Section 7031.5 Businezz antl Professional Coee: Any cily or munry which require5 a petmll lo <Onst�uct, alter, imp/ove, Uemolish or repai� any strucWre, prior to its Issuance, also requires the ap0licant for zuch permit t0 file a signetl statement Ihdt he/sne is Iiten5e0 pu�suant tOlhe p�ovisions ot the Con[rac[or's License Law (Chapter 9(commencin9 with Section ]000) of Oivision 3 of the Business antl �Prot¢Ssmns Cotle) or Ihat he/she is exempt tnere/rom antl (M1e basis tor the alleqed ezemption. Any violation oi Section ]031.5 by any applican[ fOr a pe�mit subjects tne applicant to a civil �endlty of not mor¢ than fiv¢ huntlretl tloliars ($500). LJ I, as owner of tne property or my employees with wa9es as meir sole mmpen5ation, will tlo the wo�k, antl Ine sVucture is no[ intendetl o� offeretl for sale (Section ]044, Business antl Professional Cotle: The Contractor's License Law tloes not apply to an owner ot a property who builtls or improves tnereon, ana wno tloes zuch work M1imseli/herselt or through his or her own employees, providetl tnat such improvements are not intentletl or offeretl for sale. If, however, the buil01n9 or improvement is soltl witM1in one year of wm- pletlon, the owner wlll have tne burtlen of provinq ne/she tlltl no[ builtl or im- prove for the purpose o7 sale). ❑ I, as owner of the property, am ezclusivety contraclin9 wltM1 licensetl com [racto�sto con5trut[ the projecl ISection ]044, Business antl Professions Cotle: The Contractor's License Law does mt appty to an owner of property who builtls or improves thereon, antl wno contracts for such projects with a con- tractar(s1 hcense pursuant to the Conbacto�'S License Law�. I am aware [hat proot of thei� Worker's Compensation insurance Shoultl be provitletl to me. ❑ I am exempt untler Section 6. & P. C. for this reason Date Owner I hereby certify that I have reatl tnls application antl state that the above information is correcL I agree to Comply with all cily antl <ounty o�tlinances antl state laws �p latinq to builtling construction, antl hereby authorize repre- sentatives of t11tc tltv to entar �uqon [he above-mentlonetl property j�a W � S Main Building: TVPE OF PERMIT . GRADING FOUNDATION ❑ STRUCTURAL T Front ❑ TENANT �I ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER %� PROJECT DESCRIPTION Sq. F7. oCCUVAraCv C Right K Left CONSTRUCTION TVPE VALUATION 5 S ZONE GRA�ING CU. VDS. ACRES Ping. Fef. # Remarks: ,� �7p PIdn010y NOf¢5: Sink Prevenrer Backflow Bathtubs rinking Fountains loor Drains loor Sinks as Service Ou[lets Kitchen Sink Lavatories Reinspection Fae Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin Solar T k '�fiming Pool w/Spa Urina Water Closet Water Heater Water Service Auto-Wash Laundry Trays $15 Issue Fee $ 3 Duct - Under Gr�u Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact BIL ICBO # Heating System & Ducting ❑aioo.000 aTu �ioo.000af irivers' License r 55 � I Rei ion Fee $15 0865-46, �ev. 10/B4 White - Builtlinq; Canary - Appllcant; Pink - Accounting; Goltlenrotl - Assessor Hood or Type I ❑ CanOpy Typell ❑ iefrigeration System �0-100,000 BTU � ,000 BTU Syst R Alteration F ampe Registers Issue Fee $ 3 Automatic Washer Construction Pole Sub. Caoking Unit Dishwasher es LlElectric Fan F.A.U. Fixtures Device Boxes OUtletS Switches Gar6age Dispoul Generator 065 KW 5815 4/09/87 ZOf12 Accessory Building: Parking Req./Provitletl ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW . Meter ❑up to 100amps. Meter ❑over 100 amps Sub Panel Motors 00.1 HP � i Yh - 8 Inc:Solar 09-15 HP �16�15+ Microwave Pole Light Range Standing Sections 5 KW Trash Compactor • �$15 � � Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approvad By Building Approved By -L`G f�'S . SUMMAfiV OF FEES BUILDING PERMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERG� P.C. E�ECTRICAL 5 �D • ¢C GRADING PLAN CHECK 50% S �- 7O MICROFILM MECHANICAL 5 TOTAL FEE PLAN CHECK 25% $ $ 14.10 TL FEES 3 $ 3 Z O N I N G R E 0 M T S U CONSTRUCTION AND PLANNING . POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-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 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. 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. 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 �3. Final Electric � .�p�'7 � � � 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 - - q .-• � , 44. Landscape Irriqation System , • ' • 45. Sound Attenuation ' ( , 46. Handicap Regulations ` ' � � ' 47: FINALSTRUCTURE&.BUILDING . � " � •• i 48�_Special Requirements Completed � ,,� � • �t• . 49. Electric Release to Edison . '._ ' 50. Gas Release to Southern California Gas Co ' ' •�' . 51. CERTIFICATE OF OCCUPANCY . No. Date � ' " � � Applicant to �ill in all sDares exceo� those within heavy bortler lines ana si9n all appropriate aeclarations. CIT,Y OF COSTA'ME.S/A CONSTRUCTION PERMIT PERMIT NO._ ^ TRACT NO. � LOT NO. NIT N6. � -, ProjectAddress 2`Y�7 ELOEtJ �E. �� 2306 7/"c�/27 I�'.`'- ApplicanYs Mailinq/Address � 200�/ . N. i3. TYPE OF CONSTRUCTIO NEW ADD ALTERATION REPAI R ( � � Phon��fS- 19�3 �� CONVERSION ❑ DEMOLISH ❑ OTHER q.p. # Zone Ownet'sDi�ame DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Accessory Building: Arch/Eng. License NO. TYPE OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURA� T Front � � Add�¢55 � ��/��, ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 R¢Bf N ContraCcor'SName'�/�� one� � �THER � ' . A . � PROJECT DESCRIPTION Sq. FT. CCUCANCv C fli9ht N Addresslmailing189l��tt�c�te.J PL. ,(J.L%R2G�/e.3 CONSTRUCTIONTVPE VALU�ION$ S L2ft G City License No. 20 S(o� � R ZONE GRAOING cU.vDs. ACRES Ping. Ref. # ' Parking Req./Provided E LICENSED CONTRACTOR DECLARATION � � .` _ I hereby atfirm that 1 am licensetl untle� provisions of Charte� 9(commencing Remarks: _ � � Z& � , _ Planning Notes; M ��% with section ]000) of D��ision 3 ot tM1e BuSiness antl Professions Cotle, antl my license is in full force antl eftect. ZpQ ./ T License Class �� LKolise N /V �y � . S Date �'L''�"%�7 qanature �i� / PLUMBING � FEES � WORKERS' COMPENSATION DECLARATION Bar Sink Showers I hereby atfirm that I hav¢ a certificate of consent to self-insure or a certificate ELECTRICAL FEES ot Workers' Compensati0n Insurance, o� a certi(ietl cOpY thereot (Section p y 3600, Lab. C�' �,�, � Backflow Preventer Service Sink Automatic Washer - Transformer ❑ 15-50 KW `1 Oaoiicy rvo. ��-�J��ompany �2��ON'� gackflow Irrigation, Sewer Ca ❑�rtifietl copy is herebY furnishetl. P ConStruction Pole Sub. � 50 + KW �'�Certif' co,qy fi etl with the city Bui iv' ion� Bathtubs Sewer Connection Cooking Unit Meter p to 100 am s .� P Date G Applicant ' ' EXEMPTION�-�RKERS' COM TION DEGLARATION CIBYifi¢YS _ SOId! COII¢ct0l5 - " � DiShwash2� Meter ❑Ove� 1003mps (Thissection neetl not be completetl if the permit is fo� one huntlretl ($300) or less). Dishwasher ' , Solar Pipin9 Dryers ❑Gas ❑Electric Sub Panel I certity that in the perfo�mance o( the wo�k fo� which this permk is issuetl, I shall not employ any pefson in any manner so as to become subject to the Drinking_Fountains Solaf Tank Fan Motors�0-1 HP �1'/:-8 Workers' Compensation La�+s of Califomia. . ,.. ' Date _Si9nature Floor D�ains . � Swimming Pool w/Spa F.A.U. NOTICE: It, afte� making this tleclaration, you shoultl bemme subject to the _ InC 5010� 09-15 HP.�16-15+ Workers' Compensation provisions ot the Labor Cotle, you must �orthwith FIOOr Sinks Urinal comply with such provisions or this permit shall be tleemetl revoked. FiXtu/¢5 Mic�owav2 CONSTRUCTION LENO�NG AGENCV G255Ervice OuLIetS Wdt2�ClOi¢t DeviceBoxes � I hereGy aHirm that there-is a construction lentlinq agency for the performance - Pole Light of the work tor whicP this permit is i55uetl (Section 309] Civ. G.) �nterceptors ., Water Heater OuU¢ti Lentler's Name Range Lenaer•s natlress Kitchen Slnk Water Service � - Switches Sign � OWNER BUILOEN �EGLARATION I hereby affirm that I art� exempt irom the Contractor's License Law for tne LdvdtO�i05 Auto-WdSh tollowing reason (Section 7031.5 Business antl Professional Cotle: Any �ity or ' Garbage DiSposal Standin9 Sections counTy which �equires a Permit [o construct, alte�, improve, tlemolish or repair p—Tfap„- - LduOd� T�d 5 ' - any structure, prior to itb issuance, also requires the applicant for such permit Y Y Generator �0-5 KW 05-15 KW Trash Compactor to tile a signetl statement tM1at he/she is licensetl pursuan[ to the p�ovisions ot ROOi D�di�S� the Contractor's License I-a�e (Chapter 9(commencing with Section ]000) of Oivision 3 di the BuSinCss antl Professons Code) or that he/she is exempt . therefrom antl the ba5i5 for the alleged exemption. Any violahon ot Section ]03L5 by any applicar�t for a permit subjects the dPPlicant to a civil � �enalty, ot not more than five huntlretl tlollars ($500). � � LJ I, as owner ot the p�operty or my employees with wa9es as their sole ReinSpectiOn Fee $15 ISSue FEe $ 3 � compensation, will do the work, antl the sGutture is not intendetl or offeretl tor.sale (5ection �044, Business antl Profezsional Cotle: The Contractor's MECHANICAL FEES Reinspection Fee $15 Issue Fee $ 3 License law tloes not apaly to an owner of a property wM10 builtls or improves thereon, antl who tloes >urn work himselt/herseli or through his or her own DEVE�OPMENT $ERVICE$ REQUIREMENTS: employees, provitletl tnaY such improvements are not intendetl or offeretl tor BOiler Hood or Type 1 ❑ Zonin A roved B ' sale. If, however, the building or improvement is soltl within one year of com- Canopy Type II ❑ g PP Y Date _ . pletion, the owner will have the burtlen ot p�oving he/she tlid not builtl or im- Duct - Und2� G�OUnd � guilding App�oved By T/ provE tor the purpose of Sale). ❑ I' as owner af the prOPerYy, am exclusivery <ontractin9 with licensetl wn- D�ct-St�uctu�Bl R¢ffiy¢IdtiOn SySteT - Applic3tiOn IssuOd By— D t trac{orsto mnstruct the project (Section 7044, Business antl Professions Cotle: $, The Contractor's License �w tloes not apply to an owner of property who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU . SUMMARY OF PEES ' builtls or improves�thereon, antl who cont�acts for suth projects with a con- _ tractor(s) bcense pursuant to me Contractor's License Law). I am aware that BUILDING PERMIT $ SMIP proof of their Worker's Compensation insurance shoultl be provitletl to me. Exhaust System ❑ Multiple ❑ System Repair/Alteretion , $ PLAN CHECK $ PERMIT -� ❑ 1 am exempt untler Se�tion e. & P. C. for this reason FirepUFact. Blt. ICBO # Pire Dampers ISSUANCE � $ PLUMBING $ Date Owner ' � � Heating SYstem & Ducting Registers - $ ENERGV P.C. $ ❑0-100,000 BTU 0700,OOOBT PLAN CHECK 25% � I hereby certify that 1 Pave reatl this applicati n antl state that the above GRADIN(�i � intormation is correct. I a9ree to compty wth I city antl county ordinances � ELECTRICAL $ antl state 1 b iltl' g c s c" n, antl hereby authorize repre- MICROFILM $ sentatives his t e r p above-m ntionetl prop ty or � PLAN CHECK 50% $ inspection purpo . .'� MECHANICAL S TOTAL FEE $ lQ � Signature Daie Drivers' License or 55 � � ReinspeMion Fee $75 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46. rev. 10/84 White - tling; Canary - Applicanh Pink - Atcounting; Goltlenrotl - Assessor CONSTRUCTION AND PLANNING -,�'° POOL & SPA � � APPROVALS Permit�#'�� Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Ser'vi'ce or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. '� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical �onduit-Undrgrrid�. 55. Electrical Bonding . v 5. Steel Reinforcement 56. Rough� Plumbing & Pressure Test �:;; 6. Electrical UFER Grnd.;� 57. APPROVALTO COVER-GUNITE 7. Footings +� 58. Electrical Conduit-Undrgrnd. 8. Foundation ,. 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgmd. �'�!�� 60. Backwash Lines, P-Trap, � Undrgmd. 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 74. Rough Plumbing 65. Electrical-Final 75. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ � 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 Framfng 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing . 74. Overhead Hydro �"� , 26. T-Bar Ceiling (Structura0 & Monocoat 75. Dry Chemical ,-`: 27. Frame antl 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 9. FINAL INSPECTION ��.� ' 32. Electrical power Meter-Final � 80.. OOD CERTIFICATE ISSUED � 33. Final Eleqtric g7 Notes: ' ' 34. Final Heating & Air_Conditioning . - 35. Final Gas pipe-Test 36. Hood or Canopy . 37. Final Factory Fireptace ' � , . ", 38. Final Plumbing . , � 39. Water Service-Final � � • 40. Gas Servire-Final ' ' - . , , . 41. Solar pomestic-Final � . � � ' �42. BackflowPreventer � ' " �. . 43: Backflow Irrigation ` � � �: � '44:' Landscape Irrigation System _ . ' , � . �, 45. Sound Attenuation „ � � � � � � � 46. Handicap Regulations � �' .' � � � i, .. i 47. FINALS7RUCTURE&BUILDING . .� � � - , „ 48: �Special Roquirements Completed . • �, � ' .�: � 49. Electric Release to Edison „ �. . 50. Gas Release to Southern California Gas Co � � � 51. CERTIFICATE OF OCCUPANCY No. Date � � � � �� a 1 Applicant to /ill in all spaces ezceot those witnin heavy porOer Ilnes anC sion all aoorooriate tleclarations. 1 PERMIT NO. TRACT NO. LOT NO. UNIT NU 581 4 4/09/87 9Bo4� CITY OF COS7A MESA NST U TION PE T � Z$- � O S �,F� G ProjectAddress �� n �� . , Appiicant's Mailing Addre55 � S�� y� �'1'jV �4 TYPE OF CONSTRUCTION NEW /�DD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# Zone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Address � � E Main Building: Accessory Building: Z Arch/Eng. LicenSC No. TVPE OF PERMIT ❑ GRAOING FOUNDATION STRUCTURAL T Front 0 Add�255 � ❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B� Rear N COntractor'S Nam P�ne � � � OTHER %� � PROJECT DESCRIPTION 5�. Fr. ocCVPANCV C Right N Addr¢SSlmeilingl � � CONSTRUGTIONTVPE VALUATION$ g LEft R City License No. � ZONE GRADiNG CU. vDS. ACRES Ping. Ref. # Parking Req./Provided E LICENSED CONTRACTOR DECLARATION Q I hereby atti�m [hat 1 am licensetl untle� O�ovisions of Char[er 9(commencing Remarks: ,� �� Q Planning Notes: M with sectian �000) o/ �ivision 3 0l the Business antl Professions Cotle, antl T my license is in (ull �or e tl eitect. A O � ' S l.icense las Litens No. Date E� Signature _ � PLUMBING FEES - W RK�S' COMPENSNTION DECL RATIO Bar Sink $hoWerS I b ifi m th t I have a certititate oi consent to self-insure or a certificate ELECTRICAL FEES o s' nution Insurance, or a ce�1 iti copy reof (Section kflow Preventer $ervice Sink 380 , Lab. �� 19 � 4 C2. Automatic Washer Transformer ❑ 15-50 KW Jq'�°e�o �Nsw� M Policyrvo. Company Back Irri9ation SewerCap ConstructionPoleSub. �50+KW �Certifietl mpy is h¢reby fumishetl. . Cer[j'tie�J'W�J+� filed wi[h [he city 'Itling DIvlSion Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Da[e 4� `��_ qpplicant EXEMPTION FROM WORKERS' COM ENSAT N DECLARA ION Cla�ifi¢�5 $OIe� C0112ct0�5 � Di5hwd5hC� � MEte� DOv¢� 100 dmp5 s C� (This section neetl not be completetl if the 0¢rm i5 for On¢ huntl�etl ($100) or � iess). Dishvrasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel lS e q 1 certity lital in the performance o� tne wor C't r which this pe�mk is iss tl, . shall no emplo a erso ann as to beco � subject �� Drinking Fountains Solar Tank Fan � Motors �0-1 HP 01'/: � 8 Wor � Date ' i9na u e Floor Drains Swimmi ool w/Spa F.A.U. NOTICE: If, after making this tleclaration, you 5houltl ecome u ject to the Inc.Solar �9-15 HP �16�75+ 3 DO Workers' Compensation pravi5ion5 Of Ih¢ Labor Co e, you must forthwith FIOO�SinkS U�i FiXtu�¢5 Mic�owav¢ 2�O comply witn such provlsions or this Oermit sn I be tleemetl revoketl. � CONSTRUCTION �ENDING AGENCV ('idSS¢rviCE OutleLS L2�C105¢t DeviceBoxes I hereby aifl�m that there is a const�uction lentling agency to� the performanCe POIe Light of the work for which thi5 p¢rmit is i55uetl (Section 3097 Civ. CJ Int¢ft2ptOf5 Wdt¢I dt¢( �utl¢t5 Lender's rvame Range O GO Lentler's Atltlress Kitchen Sink Water Servi . OWNER BUILDER DECLARATION 3 SWitChES Sig� I hereby af/irm that 1 am exempt irom Ih¢ Conllactof's LicenSe Law for the �.dVdiOfieS AUto-WdSh GBfba C Di5 OSdI followin9 reason (Section 1031.5 Bu5lness antl Professional Cotle: Any ci[y or 9 P Standing Sections � county wnich requires a permit to construct, alter, improve, tlemolish or repair . P—Trap Laundry Trays Generator �0-5 KW �5-15 KW any structur¢, prior to I[s Issuance, also requires [he ap0licant for Such permit TraSh CompactOr to file a signetl statement that he/she Is Ilcensetl pursuant to lhe provis�ons o( Roof Dr � s ' [he Contraclor'S License Law (Chapler 9(commenCinq with Sectlon ]000) Ot — Division 3 ot the Bu5ine55 antl P�o�essions Cotle) or that ho/sbe is exempt - � the�etrom antl tM1e baSis for the allegetl ex¢mptlon. Any violation of Sectlon ]031.5 by any applicanl to� a permil subjects Ihe appliCanl lo a civll eenalty of not more tM1an five huntlretl tlollars (y500). LJ I, as owner of tbe properTy o� my employees with wages as [heir sole fieinspection F¢e $15 ISsue FeB mmpensa[ion, will Go me work, antl me structuro Is not Intentletl or offeretl Reinspection Fee $15 Issue Fee $ 3 for sale (Settion ]044, Business antl Pro�essional Cotle: Tne Contractor's � MECHANICAL FEE l.icense Law tloes not apply to an owne� of a property who builtls Or improve5 - thereon, antl who tloes such work nimself/hersell or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: - employees, providetl tnat such improvements are not Intentletl or otteretl for Boil Hood or Type I ❑ sdle. If, hOwever, [he GUlltling or improvemen[ Is soltl within One year of Com- - CdOOpy Type II ❑ ZOninB App/Oved By Date pletion, the owne� will have the burtlen of proving he/she tlitl nOt bulltl o� im- DUCL - U�d2 roUnd ' BUilding App/Oved By DdtO p�ove fo� the purpose of sale). ❑ I, as owner of the proDerty, am exUusivery contracting witn licensetl con- Duct � Structural Refrigeration Sys ' Application luued By Dat tracfors [d wnstruct the projeci (S¢ttion 7044, Business antl Pro/ezsions Coae: T�e-Contractor's License Law tloes not apply to an owner ot o�operty who Duct - Ventilating ❑6100,00 U❑100,000 BTU SUMMARY OF FEES builtls ar Improves tnereon, antl who con[�acts to� such projec[5 wI[h a mn- tractor(sl iicense pursuant to tne Contrattor's License �aw�. I am aware that Exhaust System ❑ Multiple ❑ Sy Repair/Alteration BUILDING PERMIT S $MIP $ proof of iheir Worker's Compenwtion insurance shoultl be provitletl to me. PLAN CHECK $ PERMIT ❑ I am exempt untler Sectlon B. & P. C. tor this reason Firepl/Fact BIC ICBO # i Dampers PLUMBING $ ISSUANCE $ oate Owner Heating System & Ductin Regisiers PLAN CHECK 25% S - ENERGY P.C. S I hereby certity tnat I have reatl this applicatlon antl ztate tnat the above ❑0.100,000 BTU 0,000BT ELECTRICAL • 6� GRADING S in(ormation is mrreci. I agree to comply with all tlty antl county ortlinances S antl state laws r latin9 to builtling construction, antl hereby authorize repre- PLAN CHECK 50% § 4% • fib MICROFILM $ sentatives of t i city to enter u on the above�mentionetl prq perty �tpr ' inspectionpurpo ,(,�Q,{2, � � MECHANICAL $ TOTALFEE $ 4rl�,�e Signature D r�__ Goltlenrotl - Assessor CONSTRUCTION AND PLANNING � POOL & SPa . APPROVALS Permit# Date Inspector qppROVALS Permit#' � Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-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, 0 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 System-Final 16. Rough Electric Wiring �f.d 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 � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing , 73. Under.grnd. 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 � �t 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 -/0-57 �,1 L, Notes: �- � � 34. Final Heating & Air Conditioning , � 35. Final Gas Pipe-Test � , 36. Hood or Canopy ' - � ti. 37. Final Factory Fireplace . �'.,�., - 38; Final Plumbing � . f � ' . _ i . 39. Water Service-Final ' � � , • ` � � �� , 40. Gas Service-Final ' I , ' ' �41. Solar pomestic-Final � � � � � � , 42. Backflow Preventer �.l s ' . - ' � i � 43. Backflow Irrigation , � � . •- ' ,�. 44' Landscape Irrigation System ? - ' � . � �� . .' � 45 Sound Attenuation � � '� ' . �;. . ' 46. Handicap Regulations 1� �- ,, " ,� 47. FINAL STRUCTURE & BUILDING ! ' � � ^ • ., 48: Special Requirements Completed . z; ,t� 1 , �= J 49. Electric Release to Edison €, �., ,:� ` , 50. Gas Release to Southern California Gas Co �?' �' ' 51. CERTIFICATE OF OCCUPANCY . No. Date ' ' + ,- . � Applicant to fill in all spaces except those witnin neavy Ooraer lines ane sign all appropriate tleclarations. .. � � CiTv oF coSTa MESA .CONSTRUCTION PER^MIT PE T NO. TRACT NO. LOT NO. UNIT�O. BB�J% 6/C�I-% '�" °J Project Address Z�{ �, � L�� ' , E �—� L a 1"� V� � ApplicanYsM2ilingAddre55 I�DIS C•ST. (7�iT�SDt ��. S,Q, TVPEOFCONSTRUCTION� NEw ADD ALTERATION REPAIR Vp` ,1�`��`�p ❑CONVERSION ❑�EMOLISH ❑OTHER q,p,# ZOne Owner's Name �T Phone DESCRIPTION OF WORK/USE OF BLDG. Address p� gOR �qys� :..•ia LQ %�y9 S MainBuilding: AccessoryBuilding: E Z Arch/Eng. License No. TVPE OF PERMIT GRA�ING FOUNDATION STRVCTURAL T FrOnt p Address ❑ TENANT ❑ ELECTRICA� ❑ GLUMBING ❑ MECH'ANICAL A Rear N Contractor's Name �-�A� C�• C'�r� Phone 75�1-91`�b � OTHER PROJECTDESCRIPTION SQ.FT. OCCVPANCV C Fight N Addresslmailing) �bIS �. ST• �<rT'f�1Dt P�• S.A 9Z7 K G CONSTRUCTIONTVPE VALUATIONSE�SOO. OO S Le(t Ciry License No. y � y 1 y ZONE GRADING CU. VDS. ACRES E LICENSED CONTRACTOR DECLARATION Ping. Ref. # P3/king Req./P�ovid¢d Q I h¢reby aHl�m tM1at I am licensetl untler prov iOns of Charter 9(commencing Remarkr. � Q ' Planning Notes: M witn sec[ion 7000) oi �Ivislon 3 o the Bu i ess antl Grofesslons Cotle, antl my Iicense iz in tuu torce antl e+rect. y yQ, . � T License lass �—� lic . y,� v S Date O 7 Signature PLUM8ING FEES WORKERS' COMPENSATION DE l RA 10 Bd� Sink - ShOW¢�5 ELECTRICAL FEES I M1ereby atfirm tnat I nave a certificate ol consent to selt-insure or a certlticate of Workers' Compensation Insurance, or a certifietl coOY thereof (Saction BackflOwP�eventer ServiceSink Automatic Washer Transformer ❑ 15-50 KW 3800, lab. C�,� Q� Polic No. � � Co an � ` � S• L� Backflowlrri ation SewerCa ❑ 50+KW Y Y 9 P . ConstructionPoleSub. �Ccrtifietl copy is hereby furnlshetl. ' � Certif'e cop s iletl with the city Bu tli vis i Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Z� � ADPllcant ' EXEMPTI N FROM WORKERS' COM SA 10 ECLARATION Clefi(iCfS S013f COIICCLOlS DISI1Wd5h2f M¢Le� �Ov¢� 100dmp2 (ThiS S¢ctiOn neetl not be com0�et¢tl if the pe�mit i5 for one huntlrotl (§100) o� less). Dishwasher Solar Piping Dryers �Gas ❑ElecVic Su6 Panel 1 certily [hat In the performanGa of the wo�k fo� which thi5 perm�t IS izsuetl, I - shall not employ any person in any manner so as fo become subject to the Drinking Fountains Solar Tank Fan Workers' Compensation Laws of California. - Motors �0.1 HP 01'h � 8 Dato Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar �9�15 HP �16-15+ NOTICE: H, a/te� making Ihis tleclaralion, you snoultl become subjeGt to the — Worke�s' Comp¢nsa[ion provision5 0/ Ihe Ltbo� Cotle, you must forthwith FI00�$ink5 U�inal FiXtu�25 Microwdv¢ tomply with such 0/ovisions or tnis pe�mit shall be tleemetl �evoked. CONSTRUCTION LENDING AGENCV GaSService OUtletS WatefCloSet DeviceBoxeS I bereby atfirm that the�e is a Construcllon lentling a9ency for tho pe�fo�mance POI¢ Light of the work for which this permit is issuetl (Section 309� Civ. C.) Interceptors Water Heater Outlets Ran e Lentler's Name 9 Lentler�s Atltlress Kitchen Sink Water Service Switches ' Sign OWNER BUILOEH �ECLARATION I hereby affirm [hat 1 am exempt4rom Ihe ConVactoYs License Law foI the Ldv2tOfi¢5 AutO-WdSh (�idlbd ¢ Di5 OSdI following reason (Section 7031.5 Business antl Professional Cotle: Any city or 9 P Standing Sections county whicn requires a oermit to conslruct, alter, improve, tlemolish or repair P—Trap Laundry Trays Generaror �0.5 KW OS-15 KW Trash Compacror any ztruc[ure, prio� to its i55uance, a150 �equires the applicant to� SUCh pe�mil t0 /ile a signetl statement that Ile/sh¢ is licensetl pursuant to the prOvi5ion5 Of ROOf DfdiOS • the Contractor's Licenze law (Chap[er 9(commennng with SecHon 7000) ot Divlsion 3 of the Business antl Professions Cotle) or that'he/5ne Is exempt iherehom antl the basis for Ihe alleged ex¢mption. Any violdtion ot SecHon 7031.5 by any applicant tOr a permit subjects th¢ applicanl t0 a civil �nalty ot noi more [han five huntlretl tlollars (5500). I, as owner of tM1e property or my employees with wages as their sole Reinspection Fae $15 IAue Fee $ 3 com0ensafion, will tlo the work, antl the structure is not intentletl or ofteretl Rainspection Fee $15 luue Fae $ 3 for sale (Section �044, Business antl Protessional Cotle: The Contractor's MECHANICAL FEES License Law tloes not apply [o an Owner Of a properTy who builtls or improves thereon, ana who does such work nimselt/h¢rselt or tnrou9h his ar her own goiler Hood or Type I ❑ DEVELOPMENT SERVICES RE�UIREMENTS: employees, provitletl tM1at suGh improvements ate not intentled o/ offeretl fo� ZOOing Approved By DdtO sale. If, however, !he builtling or improvoment is soltl within ono Ycar of com- CenOpy Typ211 �❑ pletlon, the owner wi11 have th¢ burtlen oi provin9 he/sM1e tlitl not builtl or im- Dutt - Under Ground Building Approved B� � Data ptova fOr Ihe purpose ot sale). ❑ I, as own¢r of the p�operty, am exUusively cont�acting wllh Ilcen5e0 con- DUCt � SVUCW�21 Refrigeration System ApplitetiOn ISSUBd By- -� D2t lracto�s to const�ucl tne projec[ ($eclion 7044, Busine55 antl ProteSsions Cotle: The Contractor's license Law tloes not appry to an owner ot properry who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUML�Q�ES � builUs or improves ihereon, antl who mnt�acl5 for such p�ojtcl5 wit� a Con- tractor(s1 ��cense pursuani m the GonVactor's License Law). I am aware that Eahaust System � Multiple ❑ System Repair/Alteration BUI LDING PERMIT $ SMIP $ � proo/ o( tnel� Worker's Compensation insurance showtl be provitletl to me. PLAN CHECK $ PERMIT . ❑ I am exempt untler Section e. & P. C. for this reason Firepl/Fact. BIt. IC80 # Fire Dampers PLUMBING $ ISSUANCE $ oate owner Heating System & Ducting Registers PLAN CHECK 25% $ ENERGV P.C. $ I hereby ce tify tnat have reatl this application antl state that the above ❑0-100,000 BTU �100,OOOBT GRADING $ iniormation s mrrect agree to como�v wich au city antl county ortlinances ELECTRICAL S antl state la s relatin to b iltling tonstruction, antl hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives o thi cit ter upon the above-mentfonetl pr pert tor inspectlon p pos 5I� MECHANICAL $ Signature Date 0� TOTAL FEE $ Drivers' Lic e or Reinspection Fee $�5 Issue Fee $ 3 PLAN CHECK 25% $ CMF OB65-46, rev. 30/B4 White - Builtling: Canary - Ap011cant; Pink - Actounting: Goltl¢nrotl - Assesior CONSTRUCTION AND PLANNING 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 i t. 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 G r i 20. Rough Factory Fireplace APPROVALS Permit # �� r_ - 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 (Structuraq & Monocoat 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL .(�y.�7 29. Insulation 78. FIRE PREV. FINAL ��y.b 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 , j 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 � 48"'Special Requirements Completed - i 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co - • 51. CERTIFICATE OF OCCUPANCY No. Date OctobeY 3a 19� N�. Larsy iiright 212 Via Ral�l�o �wport S�aCh,, Ct.�li.Porn4s IIO�i' $.'LP: �• On October 2, 1962s en.investigiation was � oY C9e premioes mmed or ca�rolled by yrni, and loce,ted Fat $�19 Sldeu Aveia� (rear)' Mesa, Callfornia. Th4a structure wets Pouafl to be ope� �o Chs public. It-taas stecl se "Unaafe.to Occuq�i' imdez Section 203 0! ths UniPorn SuflBir►g Code, 1961 tion, ead sYia7.l r�ia posted uatil CorrecCione st�e m¢fle to bring thi0 etxuct to the ffini- namm �qutrn�ata oP otate sn8 loeai codeQ. Section 203 of the Unifoxffi Building Code re'sde as : . ��(a) Genereil:. Al]. buil$iage or st �s�wl�ich tare atructurally uasaPe or not •p�ovi8ed e�2th r3dec�to e�+ess, or �fii constitute a Pire hazarfl, or are other- saise daugeraue to Ye, or whieh relaLioa to exfatirig use constiLute � a hs2ard•to ssfety ar th' or pu.blic �aeli�re� by reae� aP inadequate main- teannce, 831qgic]a41oa, 0 losceaco, or abaadammeat, se speciPiefl in thie Code or any other ePPecEive o ce, c�, Yor tlie purpo�: of th9.a Sectiou, imsaPe buildingo. /1L1 euch imssYe ldir�s sre heroby. declsre8 to be publ4c mitaoaces . ond aita]1 be abt�ted by z+ap�ir� rehabilitation' d�eaolition oT tea�oval in asccoa�d-. snce ,�ta �� Broceaure sBecirsea in s�bsecti�ns (b), (ej, (a), ana (e) oY Lhie� SeCt1o$." ' "(b) tdot3ee to O�ner. The Bui].flia,g OPPitial ehall �xmn2nc� or c�use to be ex- affimed csv�xy bu9.ldiag oQ° struetuYe or pox�i� thereoP x�eporte8 a�s ci�nBeroLw or da�ge8 �tEde .3P auch is found to be ust tm6t�Pe bui2diag as 8efiued in thie 3ec- tieaa, Eme DuiLdiaB Of'Fic9.al ahall 81vEs to Lhea o4mer oY suc3s bu9.l8ing or atruc• . ture warittea aat4Co eEatYag th,o BeYects thezeof. Thia naLice na,y reguire the amer ar percaQi in e2iar�e oY the buitA+ � or gremteefl, mith4a L8 heurc� to eem- meace either tLo requta+ed repsira or i�ravmente ar demolition and remove3,7. of the build9,n� or etrustux�a or porLi�s the�of, epd cs7]. such wc+� ahatl. be cm- pletea vsthisa � days rrcm etate of notiae, ,mlesa etherviso sEfpuLstea by tSe Bu42dir� OPPicia2. If �ceasary� euch naLYce sha21 aLso r�gulre Lhe buf2fliag� ��-,�.�=��-� dl �a( T0: R9r. I,sx'ry Wright IINTB: . OCtOber, 3a 19� _g. RC: p�roperty locm�ed c3t 2A1� F1den Avenue, Coata Pdssm, Celiforn3a. . etructure, or portion thereoY to T� vacated forthwith and nat reocc�ied uatil the require3 re�airs and ia�rovemettte are co�leted, iaspc3cted, aud �pproved by the Bui.lBing O£f'I.cial. Proper ses•vice aP. eush.aotice shall bo 'by pereama9. servfce upon the a�rner of record, tf he ahai2 be found Frittsin tite tity limf.ts. Zf ite 1s not Pound i�ithfa tYie city limits such.service mqy be m3de upon es3d dsrneT by regiotered mail or cert3Pied matl; provlded� that if such aoi3ce is by regiatesefl mail or certiYied �Sl;�the design:2ted perlod within which said rnaner or peraon in charge 3e re- gufred to, cc�mpl,y Frith the or@er oP the Building OPficia7. sY�LI. 'begin' as oY the flate he receives euch notice." ��(c} Poating oY 63gns.�� The Building OPf3ciaT ��hall �cause to �� posted mt each ' eirtrance' �o ouch buildin� a aotice to read� :'DO IdOT. ENTER. SAI�E �i'O.00CUPY: � Bullding Depertmeaty City of Costa Mesa". 9uch uot4ce eha]J. n.posted iu►E11 the requi.i�d repairs, denolttStm, or remova]. sre cormpleted. notice shaLl not t� removed Frithout trritten permiasian oP t Building OfYio anfl no pera�s F3ha.Z1 @21L@�Y"Fh9 bUild3rig E'XCRpt�POP tilk: pL1TpOSG' Y makin� t}ae rn ui.red.repairs� or oP. demol3�'hing tk� Duilding." IP Fte esn be oY sajr aesf.st e to you Yn thia.�tter9 do aot tiesitate to co�Eaet this oPfiee. ' YouTe 'very tx�xly, , . . , , h1iCHAt4Y,. BA�BAM Huilciing Official J'FJ:dh 0 0 C by � ' Joseph F. Jones . �P�Y �.1d7..ng �Off3ciel Septenber 2, 1987 To: CITY OF COSTA MESA CALIFORNIA 92628�1200 P.O. BOX 7200 DEVELOPMENT SERVICES DEPARTMENT Building Safety Division Husiness License Division Camminications County Administration Office County Clerk/Board of Supervisors County Registrar of Voters County Tax Assessor Engineerirx3 Division (2) Finance, Revelaie Division Fire Pre�.ention Manager, [�IID Mesa Consolidated h*ater District Newport-Mesa Unified School District (2) Pacific Bell (2) Pr�lice Department - Ping. � Research Santa Ana Heights Water Cottpany Sanitary District Engineer Swthern California Edison Co. Southern California Gas Co. State Boa�] o� Equalization Street Division United States Pcst Office, Adams Avernie United States Pcst Office, Santa Ana Zip 4 - Santa Ana File (2) The City of Ccsta Mesa wishes to advise you that in revising street addresses, the follvairz�.addresses have been char�ged: OLD ADDR$SS 2417 A Elden B „ C " D " 2419 A " B �� NEW ADDRESS 2417 L Elden K " J, " H " � A - ��- B n `. n D " E " F " G " A.P. N0. 439-281-41 For yois con�nience c,e are listing the agencies above that �.e ha�e notified of the diange, in addition to those listed, you are advised to notify your correspondents of the d�ange in order to avoid any pcssible interruption of mail service. � � Building Division (714) 754-5626 Code Enforcement/Business License (714) 754-5234 77 FAIR DRIVE Planning �ivision (714) 754�5245 I� � W A J Pre�ti ys ' � ,,8 . Q�QJ ��hC .I�eeJ ' I�e�J `C D ' 0 /Je�J ' �Nfl.J E � Gcabo Page 2 Septenber 2, 1987 Ywr coq�eration in this matter is appreciated. Sincerely, � �_2e. JAMES E. LEB Planning Intern JEL:hg (F-1^27) cc: Craig S.H�ton 234 East 17th Street, Suite 205 Ccsta Mesa, CA 92627 . �. March 12, 1987 To: CITY DF COSTA MESA CALIFORNIA 92628-1200 P. O. BOX 1200 DEVELOPMENT SERVICES DEPARTMENT Building Safety Division Business License Division Camnun icat ions County Achninistration Office County Clerk/Board of Supervisors Coimty Registrar of Voters County Tax Assessor Engineering Division l�} Finance, Revenue Division Fire Pre�.ention Manager, MZD Mesa Consolidated Water District Newport-Mesa Unified School District (2) Pacific Bell (2) Police Department - Ping. & Research Santa Ana Heights Water Canpany Sanitary District Engineer Southern California Edison Co. Southern California Gas Co. State Board of Equalization Street Division United States Post Office, Adams Avenue United States Post Office, Santa Ana Zip 4 - Santa Ana File (2) The City of Costa Mesa wishes to advise you that in revising street addresses, the follaaing addresses have been changed: OLD P,DDRESS 2q17 Elden and 2419 Elden � NEW ADDRESS 2417 Elden (A-L) excluding I (A,B,C,D�E,F,G,H,J,K�L) A.P. N0. 439-281-41 For your corrvenience we are listirg the agencies abwe that we have notified of the change. In addition to those listed, you are advised to notify your correspondents of the change in order to avoid any possible interruption of mail service. Your c000erstion in this matter is appreciated. Sincerely, • ��, LL.IAM B. MILLER Planning Intern 4�1: dlp ( F-1) cr. Craig S. Hampton 234 East 17th St., Suite 205 C�ta Mesa, CA 92627 Building Division (714) 754-5626 Code Enforcement/Business License (714) 754-5234 77 FAIR DRIVE Planning Division (714) 754-5245 ,. 0 N� �'��' O P � � � GE lRr. Iexteatx tarighL 212 Pla P�sLerso 3Yeiryt>rt Baaoh, Calitb=n1a HEALTH DEPARTMENT aliiy 7/ 3.�%/ t#ec t�easdence, 2A19 sleaa Avem�e, C4etet Mdea, Callias'tfls Dear Mr. �r4ght: EDW. LEE RUSSELL, M.D. HEALTH OFFICER 645 NORTM RO55 STREET P. O. 80X 333 SANTR ANA. CALIFORNIA 92]02 TELEPHONE: S6]-054J AREP CO�E ]I< Ioveatigatioa vne �tde Ju7ar 2� i96A af the pr�i�ee iocatea et aLi9 Sl.den dv�mxe, Coats 1lssa, Calitortsis� Q� Mt. Cearge 8keith, R. S., 6at�ltet'!an vith this Dapartae�. Fh �st4nd qsou are oWaer o� hate eoaLrol. o! thia Di'oDa'�Y• 7�e imrea�iga�tion setenled violatione af 8t6tb BpuYtag Ietts, Health nls� 8atset,q Co�e, Divisloa 73, Part 1.5 ead xules aaQ AQguistioas, Calitarnis AQulnletzaEive t�o&e, stU3 local Bulldin8 D�ar�n6 Regulaf+t�tls. Yio2ationo �ted were 4e follove: 1. Bbsmestion venti2ation opeainge no4 soseaaad. Beetiaa 16742 CAC. 2. Eitch,m gea rangr Tc� abt provl.de8. 8action L6BL8.5 CAC. $. Plza�ing venL pi�pe terainates vasdsr bathroos rimov. Seetione 2b8f>2.2 and 1G861.5 CAC. b. Hot vn� heeter ncsL pzapeQJ�r vaateQ. Saotio�► 3G818 CAC. 5. $itchen range mii v8ter hester w�t pTovlA�ed viLh ehut ot! valve os eock. CasCe t4�l�a Ple�mbiag COde. 6. Nemsrdoue e�cterior electriC Mring, Gbate lfesa Blectrical CbBe. �hia ittter ia a aotice to yon to caa�reet ttie aton�meationefl vioistioas emd to noti2y tLle DapsrCoenb vhea aarsectrian� have beea ae�de ia oawS+er thet e selnapecLion e� bo mde tA deteimi� eoe�7.iance. Ms. tevrenca t,irlgh4 �uY i, �96a . �aae xvc+ - ' Prior to �tia8 �t0' elteraLion� or reDsira� nec�s'sarr Dtnrita sAa].1 be obtalaeQ lko�a the Costa INaa BulldinB Dsp�rtatat. Ii � have �epr Questions rsgerding tLia lette=, pl�e�e co�ot thie ,Depar't�nt. . 9�' �Y �s+ Rob�sL 8. Stoae, R. d., Dittctor � L1lrisian of E1mrlronae�ttal Bsnl.tatioa , , � 7�2 Jl�`,..�-:-- . x. a. ssaaoa, H. s. � 8ttpervl.dng Banitarlaa MJH:rt . cnt Lbats New Buildiag Dapartsent Attut !�. �. !lehotiey e. /j /� �� 4 — /�e :� � �r-�.. �-- a�.K:� �✓�C. fi� � �� .�`�``�..�j:� ��.-. �-�`-'/�``� , � .. . . ��,,�� . 0 APplicant to fill in all spaces exce0t those within heavY �ortle� Iines anE si9n all appro0riate Ceclarations. ciTY oF COSTAM� SA CONSTRUCTION PERM T ProjectAddress �d4'f� ��-DE1�L C'�-� ApplicanYs Mailing Address , � 5�7�"1 i'1� n%�Y�V l'Q� % Owner's Name Phone AAAlC55 - Arch/Eng. License No. Address Contractor's Nam � hon o3337 Address (mailing) ��,�1�L �L01'� � r0(i I f�- �� City License No. 3�t' T 2-' UCENSED CONTRqCTOR DECLARATION I he�eby affi�m [nai I am licensetl untle� provi5ion5 01 Chdrte� 9(commencing with seciion 7000) of Division 3 0l tne Business antl Protessions Cotle, ana my licenze is in full lorce/� a eftec ��` License Class ✓� 1� Licenze � Date ' � Signature — WORKERS' COMPENSATION DECIARATION I hereby affirm that 1 have a certificate oi <onsent to selhinzure or a certiflcate of Workers' Compensation Insurance, or a certlfietl copy tnereot (Section 3800, Lab. �.�q r)/�/�b/ Company POIicY No. ��r 11 a Cer[ifietl mpy Is nereby fumishetl. Certifiet�{qPY-Lz��Ctl�APOncan�Y Buil ' 9 ivi51 e � ` ..� EXEMPTION FROM WORKERS' COMPENSATION OEC RATION (T�is section neetl nOt be tomplet¢tl If the pGrinil IS for On¢ huntlr¢tl (E100) o� iess). I certity that in the pertormance of tne w < tor wh ' perm�t islssuetl, I snall not mploy a erson In any r s a o be e su ft to the Worker i LawS ot Cali O i Oate _Signature NOTICE: If, afler making this tleUarat on, you shoul become sub�ect to [ne Workers' Compensation provisions ot the Labo� Cotle, you must forthwillt comO�Y h'��h such provisions o� thi5 permit Shall b¢ tleemeE ravOk2tl. CONSTRUCTION LENDING AGENCV 1 hereby aftirm that tM1ere is a construction Ien0in9 agency for tbe Derlormance ot the work ior which this permit is issuetl (SeCtion 3097 Civ. CJ Lenaer's Name ' Lentler's AOOress OWNER BUIIDEN DECLARATION I hereby affirm that I am exempt hom the Contractor's License Law (or the followin9 reason (Section ]031.5 Business antl Professional Cotle: Any city or county which requirez a permlt to construct, alter, improve, tlemolish or repalr any slructure, p�lor [o its issuan<¢, also �eqW�es the applicant tor Such permit lo /ile a signetl sia[ement thdt he/sM1e is IicenS¢tl pursuantto th¢ Provisions of the Contractor's UcenSe Law (Cnapter 9(commencing wiih Sectlon 7000) of Division 3 of Ihe Bu5ine55 antl Pro/e55iOns Cotle) or [ha[ he/she i5 ¢xem0t 'herefrom antl the basis for the alle9etl exempHon. Any vlolation ot Sectlon 131.5'- by any applicant tor a permlt subjec[s tna applicant to a civil :nalty of not more tnan five hunaretl tlollars (5500�. L� I, as owner oi 4ne oroperty or my emoloyees witn wages as tholr sole compensation, will Go Ihe work, antl the sVuctWe is nol intentletl or o(teretl iOR Sd�C ($2CIIOO �044. BII51lICSS dfld �fOi25510lId� COdC: ThC COlII(dC101�5 License Law tloes nol apply to an owner oi a property who bulltls or Improves thereon, antl who tloes such work himself/herselt or througn his or ner own Bmployee5, plovitlOtl LM1at SUGh imprOv¢ments a1e f10t Ifltentl¢d Or OHOIetl 1of sale. If, however, the builtling or imP�ovement iz sola wllhin one yea� ol com- pletion, tM1e owner will have the bu�tlen ot proving he/zhe tlid nol builtl Or Im- �/Ove for Ihe purpose of sale). 1, as owner of [he property, am extlusively cont�acting with Ilcens¢d COn- Vactorsto construct the project (Sec[ion 7044, Business antl Professions Cotle: The ConVactor's License Law tloes not apply to an owner ot property who builtls or improves thereon, antl wh0 cont�acts for SUCh projects with a con- trac[or(s) Ilcense pursuant to the Contrattor'S LI<anse Law). 1 am dwaw Ihat prooi of thei� Worker'S Compensatlon Insurance shoultl be provltleC to me. ❑.I am exempt un0er Section B. 6 P. C. for this reason. Date Owner I M1eveby certify that I have reatl this appliCatlOn antl state that tha above in(ormation is corre . agree lo compl with all Uty antl county ortlinances antl state laws r m to builtlin �dn rucHon'l and hereby authorize repre- SEOLdSIVCS Oi 5,c y�O 2lll �p0 th¢ pove-m¢ntionetl loperty f inspection p rpos S � �� Signa[ure Data-��,�--�/- �rivers' License or - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap SewerConm Solar Collec Solar Pipin A.P. # S Main Building: E , T Front ARear C Right g Lett Ping. Ref. # � Planning Notes: Automatic Washer ConstructionPoleSub. � Cooking Unit ' Dishwasher 2�r:.L %�..�� . . Zone Actessory Building: 2 O N I N G R Parking Req./Provided E � M T S ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps io ar Ta Fan . i ool w/Spa F.A.U. ina Fixtures Na r loset Device Boxes N ter Heater Outlets ater Service . Switches Auto-Wash . � Garbage Disposal Laundry Tr � Genereror DO-5 KW 05�15 KW Issue Fee �ANICAL Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑6100,000 ❑100,000 BT Sy Repair/Alteration FireDampers � � Registers ' laue Fee Sub Panel Motors �0.1 HP � 1'h - 8 Ina 5olar �9-15 HP � i 6-75+ Microwave Pole Light Range Sign Standing Sections Trash Compactor $ 3 Reinspectian Fee $15 Issue Fea FEES DEVELOPMEN7SERVICESREQUIREMENTS: Zoning Approved By � Building Approved By Application Issued Bv �' $ 3 SUMMARV OF FEES V . BUILDING PEFMIT $ SMIP PLAN CHECK $ � PERMIT PLUMBING y �SSUANCE - � PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL $ (�..00 GRADING �'�aPLAN CHECK 50% $ � MICROFII.M MECHANICAL 5 TOTAL FEE PLAN CHECK 25% $ 0 $ FEES $ 3 CONSTRUCTION AND PLANNING �. � POOL & SPA . APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgmd. 55. Electrical Bonding . 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation -� - • 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 70. Structural Floor System 67. 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 � F,IRE DEPS. 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 . 7q. 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 MeterFinal 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 pomesticFinal • � 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 , •'� f 50. Gas Release to Southem California Gas Co - � �� 51. CERTIFIGATE OF OCCUPANCY � , ' No. Date _ i ♦ AOOlicant to /ill in all spaces ¢xcept ihose within heavY bortler lines an0 si9n all ap0�opriate tleclarations. cITYOF coSrn nnEsa CONSTRUCTION�PERM17 Project Addreu —�� 1 E L-D�✓i 1_.p��yvv�Dr�! Applicant's_MailingAddress ' �S�'I �'Yi�YTNtiCJI K7 Ow.er's Name ohbne Address Arch/Eng. License No. Address ConVacmr'sName � P�h,Qne f�m3337 Address (mailingl �� OU 1 Q� 3F-% City License No. 3 ��Z-� � LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensetl untler provi5ions of Charte� 9(rommencinq with section ]000) of pivision 3 of tM1e Business antl Professlons Cotle, antl my license is in full force an etiect. OO License Q z �� '''(�'�`�%�� Lic e Date �-27 S'g t /1GC[� WORKERS'COMPENSATION DECLARATION I hereby affirm thabl bave a certificate of consent to selt-insure or a certificate of Worke�s' Compensation Inw�ante, or a ce�Hfietl copy thereof (Section 3800, Lab. C.��j��y �y', � � E Policy No. Z7 /� U Company �er[ifietl copy is �ereby furnishetl. ertifie�%9 py js�iye h the city B' tl� g'fi ' ate - /��/��p0licant EXEMPTION FROM WORKERS' COMPENSATION DE NR TION (Thissection neetl not be comple[etl if the pe�mit is fot one huntlretl ($100) or less), 1 certify that in the Oerformance of the wo�k fo� whicM1 tt' perm�t i5 issuetl, I shall not� ey�plo any Oe�son in any m so 5 ec me subje to the Workers'TAm ion Laws o( Cdlif . Oate �" ' Signature - NOTICE: If, after making this Ce[laration, you shoul ecome subject to the Wo�kers' Compensation pravisions ot the Labor Co e, you muzt for[hwi[h comply wiln such p�ovisions or this pe�mit shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV I herety affirm that there i5 a conitruction lentling agenCy to� the pertormance of [he work fOr which this permit is iszuetl (Sectian 309] Civ. C.) Lender's Name - Lentler's Atltlress - OWNERBUILDER OECLARATION I hereby atfirm that I am exempt from the Contractor's Lioense Law for the followin9 reason (Section �031.5 Buslness antl Professional Cotle: Any city or county which r¢quires a Oermit to construct, alter, im0�ove, tlemolish or repair any structure, priot to Its issuance, also requires the applicant for such Oe�mit t0 file a si9netl slatement that he/she Is licensetl pur5uant to [he provisions of the ConiractoYs License liw (Cnapter 9.(mmmencin9 with Section ]000) of Division 3 of the Business antl Professions Cotle) ov that he/she is exempt herefrom antl tM1e basis for the alleqetl exemption. Any violation of Section U31.5 by any applicanl for a permit subjects [ite applicant to a civll lendlty of not more than five huntlretl tlollar5 ($500). ❑ I, as owner of the pvoperty or my employees with wages as their sole compensation, will tlo tM1e work, antl tne structuve i5 not intentled or offeretl for sale (Section 7044, Business antl Professional Cotle: The Contractor'S License Law tloes not apply to an owner of a property who builtls or improves thereon, antl who tloes such work himself/herself or through his or her own employees, providetl that sucM1 improvements are not Intentletl or offeretl for �sala. If, however, [M1e builtling or improvement is soltl i[M1in one year of com- pletion, the owner will M1ave the burtlen Of provinq he/she tlitl not builtl or im- " prove for the pu�pose of zale). � ❑ I, as ownei of the property, ani exclusively mntractinq with IicenS¢tl ton- ' tractorsto construct the project (Section ]044, Business antl Professions Cotle: The ConVaclor'S License Law tloes not apply to an ownet of property who builtls or improves thereon, antl who contracts for sucn projectz wi[h a con- Vactor(sl Ilcense pursuant to the Cont�actor'S License Law). I am aware that proaf of their Worker's Compensation insurance shoultl be provitled to me. ❑ I am exempt untler Section ' . B. & P. C. for this reason Daie � Owner _ I hereby rerti(y [hat 1 have reatl this information is wrrect. I agree to co antl. state laws rela ' g to buildi � con sentatives of t' ty t ent upo inspection p 5 Siqnature � Drivers' License or 55 � above nances TYPE OF CONSTRUCTION ❑ CONVERSION ❑ I DESCRIPTION OF WOR NEW LJ AOD LI ALTERATION LI REPI�IR SH ❑ OTHER TVPE OF PERMIT LJ GRAOING� LJ FOUNDATION LJ STRUCTURAL ❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PfiOJECT DESCRIPTION 54. F7. oCCUVANCV— CONSTRUCTION TVPE � VALUATION $ ZONE G{iADING CU. VDS. ACRES— Hemarks: 0 Bar Sink BackRow Preventer ' Backflow Irrigation Bathtubs ' paritiers Dishwasher ' ' �rinking Fountains Floor Drains ' Floor Sinks GasService Out Inierceptors Kitchen Sink � � '-Trap Roof Drains Showers Service Sink � SewerCap Sewer Connection � Solar Collec s' • Solar P' in9 Swimmirig'Pool w/$pa � ' Urinal � Water Closet I I Water Heater Water Service -- � - •- • Auto-Wash FEES ReinspeMion Fee � $15 I �- Issue Fee I' $ 3 Duct - Under Ground Duct-Strucmral � ' Duct - Ventilating Exhaust System ❑ Multiple FirepVFacL Blt. ICBO # � Heating System & Dy�c ng ❑0-100,0006TU 0100,000 Reinspection Fee � $15 CMF 0865-46, rev. 10/84 Wbite - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Hood or TYPe I � Canopy Type I I ❑ 9efri fation Sys[em -100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers . Registers . Issue Fee � , " � $ 3 A.P. # 5 Main Building: E T Front A Rear C Right g Left Ping. Ref. # Planninq Notes: Construction Pole S� Caoking Unit Dishwasher � Dryers ❑Gas ❑EI Fan F.A.U. Fixtures Device Boxes • Outlets Switches Garbage Dispoul Generator �0-5 KW Fee 245�. 7/=7/=- � Accessory Building: Zone Z / ' O \ N � N , G R Parking Req.lProvided E Q M T S ELECTRICAL Transformer '❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors � 0� i H P � 1%- 8 . Inc.Solar �9-15 HP �i6-15+ Microwave Pole Light Range Standing Sections 5 KW Trash Compactor $15 Issue Fee ' DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Buildin9 Approved By r_c�� BUILDINGPERMIT $ ' PLAN CHECK 5 PLUMBING ` $ � PLAN CHECK 25% 3 ELECTRICAL � $ r OO ��LAN CHECK 50% $ �� MECHANICAL $ PLAN CHECK 25% $ � SMIP PERMIT ISSUANCE ENERGV P.C. GRADING MICROFILM TOTALFEE FEES �� te te ^ a tx' � +S,�T% $" $ $ � . _ $ J . � �00 CONSTRUCTION AND PLANNING . � POOL & SPA - APPROVALS Permit# Date Inspector qppROVALS Permit# ' Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement, 3. Electrical Conduit Utility-Undrgmd. � 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � 5. Steel Reinforcement � . 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE 7. Footings . 58. Electrical Conduit-Undrgrnd. 8. Foundation � � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd.�' � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. PropertY Sewer Line.& House Connection 62. Backwash & ReceptorFinal 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. 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 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 Applicant to fill in all s0aces exeept those within heavy bo�tler Iines antl si9n all aDOroD��ate Eecla�alions. � J CiTY oF COS7A MESA CONSTRUCTION'PERMIT Project Address � F � Applicant'�Mailing Address �S3�T �0�� r!7/% IIi- � Owqer's Name Phone Address A�ch/Eng. License No. Address Convactor's Name ' Phone �,rS 7 Address Im 'i' � � C�JGj VV:��jG� Y� �V�U(R- � N. �� City License No. � �'T �' � LICENSED CONTRACTOR DECLARATION • I bereby aftirm [hat I am licensetl untle� provi51on5 ot Charte� 9(commenGin9 with seclion ]000) Ot Dlvislon 3 oi Ihe Bu5ine55 antl Prote55ions Cotle, antl my license is in full /orce�vd ntl effect. License Clyass `� 9 ll ns N. 0 Da[e (�Z7�1 Si9nature WORKERS'COMPENSATION DECLARATION 1 hereby aitirm that I nave a certificate o( tonsent to selNnsure or a certiilcate ot Workers' Comp¢nsation Insurance, or a CertlBGtl cOpy th¢reof ($ectlon 3800, LaD. C. 1 C Policy No. � � �� %� /� � Company ��e� �Certifi¢tl copy is nereby /umishetl. CerC ietl m f d/w.� rth'the city Bu n Dlvision. Date �L APO�icant EXEM�N Ff10M WORKERS' COMPENSATION DEC ATION (Thissection n¢etl not be completetl il (he permit iz /or On huntlretl (E100) or less�. I certify thdt in [h¢ perlo�mance o( the w0�1ytOr whlch ' p mR is i etl, 1 shall not employ any e� on in any rtW(Y ! so 5 l eco subj to th¢ Workers' �rt�e li ws of Califofn' Date $igna[urf NOTICE: It, atter making this tleclaration, you shoultl b como subject to the Workers' Compensation Provisions ot the Ldbor Cotle, you must torthwith comply wi[h such provision5 Or [nIs pe�mit inall be tleem¢tl revoke0. CONSTRUCTION LENDING AGENCV 1 hereby alfl�m that th¢re is a const�uctlon lentling a9enGy for thC performance of tM1e work for which this permit i5 issuetl (Section 3097 Clv. C.) Lentler's Name lentler's AAtlress OWNER BUILDER OECLARATION 1 hereby aitirm that 1 am ezempt irom the ConVactor'z License Law for the foilowin9 reason (Section 7031.5 Business antl Protessional Cotle: Any city or county wnicn requires a permit to construct, alter, Improve, tlemolish or repalr any St�uCture, p�iot to it5 issuance, dlso requires Ihe applicant for Such pe�mit to file a siqnetl statem¢nt Lbal he/She I5 IlcenSetl pursuant to the prOvisions of the GonVactor's License Law (Gnao�er 9(commencing with Sectlon 7000) ot Division 3 ot the Business antl Protessions Cotla) or that he/sne is exempt 'herefrom antl the ba5i5 for the allegetl ex¢TPtion. Any viOlation of SecNOn '031.5 by any applicant tor a permit 5ubject5 the applican[ to a civil ��enalty of no[ more than five huntlretl tlollars (E500�. I, as owner of the pvoperty or my employees with wagos as their solo compensation, will tlo the work, antl the sVucturo is not Intendetl or ofteretl for sale (Sec[ion 7044, Business antl Professional Cotle: The Contrac[or's License 12w tlbe5 n0[ apply to an own¢r Of a Oroper[y wno builtls Or improve5 i thereon, antl who tloes such work himself/herseli or throu9h nis or her own employees, proviCetl lhat such improvements are not intenaetl or offeretl tor • sale. If, M1oweve�, Ihe bulltling or improvemen[ I5 soltl wi[hln one year ot com- pletion, the owner wlll M1ave the burtlen o( proving hC/she tlitl not builtl or irn- p�Ove tor th¢ purpose of sale). ❑ I, a5 owne� of the property, am exUusively contractlng with Ilcensetl con- tracrors td con5truct lhe projecl I$¢ction 7044, Business antl Professlons Cotle: The Contractor's License law does not appry to an owner oi property who builtls o� improves tM1ermn, antl wbo cont�acti fOr such' projects wI[h a cOn- tractor(sI I¢ense pursuant to tne Cantrattor's Licanse Law). I am aware tM1a[ proof of tneir Worker's ComPensatlon insu�ance shoultl bo provltletl to me. ❑ 1 am exempt untler Section B. & P. C. for this reason oate sentatives of Il�E� ❑ ins0e«�on purpo3e . / Signature L Drivers' License or 55 Owner _ have reaa this pra TVPE OF CONSTRUCTION -� NEW LJ.ADo Ll ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOl.ISH ❑ OTHER p� p# DESCRIPTION OF WO /USE BIDG. � �� N � �..1-- S Main Buildi (((�� ! '/ TVPE OF PERMI� GRADING FOUNDATION ❑ STRVCTURAL T Front ❑ TENANT ELEGTRICAL ❑ PLUMBING ❑ MECHANICAL 8 Rear ❑ OTHER %� PROJECT DESCRIPTION SQ. FT. OCCUPANCV C Right K Left CONSTRUCTIONTVPE VALUATIONS S ZONE GRA�ING CU.YDS. ACRES Ping. Ref. # Remarks: ��C��n Planning Noces: Sink Preventer Irrigation tubs Drinking Fountains � Floor Drains Floor Sinks Gas Service Outlen Interceptors Kitchen Sink - Lavatories ' P—Trap Roof Drains Reinspection Fea $15 3oiler �uct-UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple 0 Firepl/Fact Blt. ICBO # Heating System & Ducting ❑0700,000 BTU 0100,OOOBT Reinspection Fee � � $15 CMF 0865-46, �ev. 30/04 White - Pink - Accountin9: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collec�ors Solar Piping ' Solar Tank Swimming Pool w/Spa Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeretion System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers ' Registers Issue Fee FEES $ 3 FEES $ 3 Automatic Washer ConsVuction Po1e Sub. Cooking Unit Dishwasher Fan F.A.U. Fixtures Device Boxes Switches - Garbage Disposal Generaror DO-5 KW Fea "e�,i.= 7/=-/ Zone Parking Req./Provided ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to t00amps � Meter ❑over100amps Sub Panel Motors � 0-1 HP � i X- 8 Inc.Solar �9-15 HP 016-15+ Microwave Pole Light Ran9e Standing Sections 5-15 KW Trash Compactor $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: ZoninB APProved BV . Building Approvad B Aouliwtion luuad Bv�/i BUILDINGPERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% S ELECTRICAL S CSAO pLAN CHECK 50% .$ MECHANICAL $ PIAN CHECK 25% $ Z O N I N G a E Q M T S FEES $ 3 SMIP $ PERMIT ISSUANCE $ � ENERGY P.C. S - GRADING 5 -' MICROFILM $� 'Q-� TOTALFEE S � CONSTRUCTION AND PLANNING 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-GUN�TE 7. Footings 58. Electrical Conduit-Undrgrnd. S. 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 16. Rough Electric Wiring 67. Fencing & Access Approval - � 17. Rough Wiring Sign 68. APPROVED FOR PLASTEFING , 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 � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof SheatMng 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 . 37. Plaster Brown Coat 79. FINAL INSPECTION ' • -� 32. Electrical Power MeterFinal 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. Backflow Irrigation . 44. ,Landscape Irrigation System • � 45. Sound Attenuation ' .� i 46. Handicap Regulations ', . . 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison � ';� 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY . +� . No. Date � .- `� 12�792 COSTA MESA BUILDING-SAFET P. O. BOX 9f7 COBTA MEBA�� For Appliean+ fo Fill In� . TYPE OR PRINT , COSTA MESA. CALIFPRNIA ST. � FEE RE�EIU�� g� APP� �l �p�PERMIT CITY iNll�diA�4lESA For Office Use Only HECEIPT NO. PCRMIT NO. , ADDREb6 �� / (�('_ (pX[�(/L COSTA MESA. CALIFORNIA J_�- K � �� APPROVED t.�6� /✓ BY '3L /V6�v�citT �tvv /i� .• / / O .S/� ZO �l� G� NO. /�" —O �(� 6 L80AL D88CPIPTIO! /� NO. OP lLDGB. !O X �O!/ NOW �N t(fT � � .. �.� � SET9�CK YN8 PI/OM DESCRIPTION OF WORK /� 37 ROOM6 ZONING NO. OP \ .I-U6E OF ! PLANB �� BUII�ING lCBNTHR LIN[ 6T.1 APPROVED � BY HOLD FOP. s a�i 1 HER3lY AGKNOWL6D08 THAT 1 XAVH R6AD T1118 APPLIGTION }Hg AMOUNT BHOWN UNDEp VALUATION I6 FOR THe ANO BTATE THAT.THB ABOVB IB CORRBGT AND AOREE TO COM- pURP09! OF QBTpBL18HING A PERMIT FEH ONLY. ��PLY WITH ALL CITY OI�INANClB AHD BTATE LAWe PSOULATINO au1LDINo CONBTPu oN. VALUATION �� 61GNATURE OP PERMIT FEE $ PERMITTE \ L(J // Q-aJ S� / //J � PLAN CNECK $ !� L/ CIITLIf1G19R •f�CNT � J �f � , " � 12i93 COSTA� MESA BUILDING-SAFETY DEPARTMENT ' P.O. BOX 31] COSTA MESA. CALIFORNIA fOR APPL/CANT TO F/LL /N COMPLETELY TYPE OR PRINT BUILDING ADDRESS COSTA MESA. CALIFORNIA c•Ll.ra� TEL. NO. FEE RECEIVED �' ' �' b° '� � ��E" DEPT. PPI�, $+c.Nlinf��E�,RMIT . �� BUILDING foR oFFicF vsE oHcy o��/�'1 r�- ��iu/ COSTA MESA. CALIFORNIA FIRE ZONE APPROVED CONTRACTOR LIC.NO. OUOI BY ADDRE55 B V D �ec�� I Lor F T I I Z oescnirnoN NO. BLOCK TRACT O � A.P. NO. I �- � I,J APPROV BV OF LOT �j �Q rvow oN �oi8 2 YAROS REpU1RED USE OF (CENTEfl LINE EXISTING BLDG p W F 1 1 1 N(: Pe C Y � R A G E FRONT SETBACK LINE FFOM cENTER OF s'rREe'r REAR VARO R. SIDE SIDE vARD ILEFT IRIGHT L.SIDE DESCRIPTION OF WORK BUILDING NO.OF SIZE 2�X37 ROOMS E%TERIOR WALL IROOF � I HEREBY ACNNOWLEDGE THAT 1 HAVE qEAD TMIS APPLICAT�ON ANO 6TATE THAT THE r�BOVE IS CORRECT ANO AGHEE TO LOM- PLY WITH ALL CITY OROINANCES AND STATE L1W5 HEGULATING BUILOING CONSTRU ION. SIGNATUFE OF � PERMIiTEE AUTHORI D AGENT � ZONING NO. OF ` USE OF NEW a PLANS � BUILOING �, � l0 1 DATE � � " . REAR FT. / � HOLD FO SPECIAL RcQU 2FMEN „ .Q.� w� GU— S` � ��yc � K' � �� .w � G� 9 -�3_ � THE AMOUNT SHOWN UNDER VALUwT10N IB FOP THE PUHPO6E OF ESTq6L�5HING A PERMIT FEE ONLY. VALUATI ON ap PERMIT FEE $ p�d '� $ I%/ , /� � PLAN CHECK $ /� � /T L./l // !U7 QU TOTAL FEE S p� � -,. . � ` t 8573 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 817 C08iA IdEBA. CALIFORNIA For Applieant fo Fill In Complefely TYPE OR PRINT �t�ci GOSTA MESA GALIFORNIA .�° 7 _ � ` �l. FEE RECEIUED JAN 17 �� FINANCE DEPT. CITY OF COSTA ME5A APPLICATION FOR PERMIT BUILDING For Office Use Only - xece�wr no. Ir�e�ur...{�}q JS'1 / i � RHCEIVSD BY I DA �HC81V�D� I ;AT / 1 � TEL. BUILDING NO ADDRESS TN�' — COSTA MESA. CALIFORNIA �� STATE TEL. LIC. NO. �— NO. 61ZE r 7�y0 Ho, oF Btoce. OF LOT . 0 J I NOW ON LOT U8E OF O EXISTWG HLD ' BHTBACK LINe FROM ,_� �, ceNTCR oP BiReET REAR YARD SIDE YARD I LEFT ' I RIGXT �� DESCRIPTION OF WORK NE' I II ALTERATION I II ADDITION I REPAIR I IIMOVING I IIDEMOLISH� I BUILDING � � NO. OF BIZE e b ROOM6 STORIES EXTERIOR WALL IROOR COVERING COVERING USE OF BUILD7NG AND WORK TO 8E PERFORMED 1 HER88Y ALKNPWLEDGE TMAT I HAVB RBAD TX18 MPLIGTION AND BTATE THAT rxe �nove IB CO(tRECT AND AOHCB TO COM- PI.V WITX ALL G�11' OfiDINANC¢9 AND BTATH I.�W9 pH6ULATNO BUIIDING CONBTRUG//TION. SIGNATURE oF y � % / _ � ��, � I w � AUTNORIZED l ZONING ZONE NO.OF UeH OP NEW-/�� R-Z- I PLANS Z 6UILDINO ycryOl/ /n L6AL p La2�- sa T�Qae-c DEBCRIPTION OY ,e.,,, //9—ozz_.az (GEMCR LIN6 BTd 6 L / ��.1,�/��1/`✓ THE AMOUNT BHOWN UNOER VALUATION 19 POR TH2 PURPOSE OF EbTABlIBHING A PBRMIT FE8 ONiY. _UATION �� PERM17 FEE $ �' 0 /��, 6-0 PLAN CHECK $ E TOTAL FEE �' �� LL . ' 34558 COSTA MESA BUILDINGSAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING 1� C�.� AODRESS � �� - �. �4._ OWNER (j J ^ � (. MAIL � �1_ � Z ADDRESS lKV a U CITV �C ��l�l NO. �p�'�� ZZ Q CONSTRUCTION O N LENDEH am .J 7 BRANCN � J ADDRESS J m ARCHITECT TEL. a OR ENGINE R N U Q w � ADDRESS J � CONTRACTpR ' Q�.�(]R U .O �'t Arl r� m Z l�� -�� , , w � ADDRESS � � O w Z� CITV �DS . 'Q—�� J NOL S� W 0 STATE CITV (q � LIC. NO. �� , LIC. NO. 7 � SIZE NO.OF BLDGS. OF LOT NOW ON LOT PAI[) �" 1 1-77�;;z. �J 479:` *** s*�.U6 APPLICATION FOR BUILDING PERMIT A.P. NO.//� � BUILDING � �j� AODRESS TRACT Q OWNER FIRE _.% +� �rvu. vr PU1PL5 VARDSAPPROVED F" SIZE OF NO. OF ZQ NEWBLDG. ROOMS STORIES L SIDE FT. U EXTEft10R WALL ROOF COVERING COVERING REAR FT. USE OF BUILDING AND WORK TO 8E PERFORMED DISTANCE BET. � �. �y c� Q SS F'iZL��. MAINBLOGS. p Od' l��c FV�F �— 3 � V�� p�,ti _ C URP.� ~ � IXCt+,�� APPROVE tA �.� �aan '` ,I�.1\ � d, ti_ :i�.��V�� lV U39.a..0 c�+�4 ' V1 hereby acknowledpe that I have rea0 this applieation antl stere f � thet the ebove intormation Is corteci entl apree to comply wit� � all laws repulaiing builtlinp consttuctlon, entl I shall not employ F eny parson In vlolatlon of Me workman's eompensatlon lews of y Me State of Celifornia. T� ? I hareby cerNfy thai 1 am properly Iicensatl as a conttactor untlar S tha State of Calltornie Business entl PtOfesstons Cotle, Division 3, THE AMOUNT SH( Chapter 9, and t�at sueh licenses are in full foree antl effect, or I TME PURPOSE OF E am exempt from the provisions ot tha State of Callfornia Bus(ness VALUATION entl vrofess'ipns C a, Dlvlsnion 3, Chepter 9. Sipnetura o `` 1'`� � �fl� [� 7 �. Parmfttae �. �XJ�-.�P�L�aC..�A� '\'l� g / �C Aut�orizetl Apent '� � VALUE USE OF NEW � BUILDING �/JA VAROS APPR ACCESSORV 8 DATE a � /��. m w O VALUATION IS FOR A PERMIT FEE ONLY: � E S 7 � J 0 KS E 0 s GJ � LL �„ - , . . � COSTA MESA BUILDING—SAFETY DEPARTMENT P.O: BOX 1200 Costa Mesa, Calitornia ELERRICIAN (J'Whj-Q(rL — ADDRESS 7 �I lQ -�I/ 'f� fqTE LICENSE NO. ITY LICENSE NO. NO. ITIM Dwelling, Sq. Ft. Gamge, Sq. Ft. firsl ]0 O�Ilett, each Ootlets, Additional Finl 20 Fietures, eath Fixture�, Addilional Dryer Fan � Heater � z Ku/ Oven, Domeslic Vole, Comrmt�ion Range, Oomeyfi[`��' � Mi�ci � �� i� Mobn (Sea Scfiad�la� HP HP HP Meten, eo. Permi! Fee Sub�Totol Fs�� Total Faa� raaM IACM �Ff3 S � � '�"� —z-7� `�=�:' � �,. 00 1z7 ��:«��:i0.75 TRACT NO. REC'D BY ; 3�(�� LOT NO DATE ISSUED �RDING USE /� //.� ///i.� /i' _ ri /" COSTA MESA, GIIFORNIA j� J-51 Y�/rt'. \ � cm �o5��c. _ Ia�PS�i� rci. Ho. 6y�'S 3 S I HEREBV� �CKNOWIEDGE THAT I HAVE READ THIS AYYII- dT10N AND STATE TNAT THE ABOVE IS CORAECT ANO AGREE TO,COMPLV� WITH AlL CITY ORDINANCES AND STATE LAWS REG• ,�UUTING FlECT0.1UL WIRING. �'� ;1' CERTIF1' TNAi 1 POSSESS iHE ABOVE YALID 37AiE OF , GlIFO0.NIA CL1351FIGTION OR I AM iNE IEGAL OWNER OF � TXE SINGIE FAMIIY RESIDENTIAL PROPERTY DESC0.IEED AEOVE. 9V�wwno} ��,,,� G"�"W.� PERMITTFE NO. ITiM IACN Fllf Siyn 6 1 Trons. 4.00 Transformen KW G—S-7 RI.G Generobn KW 5�6-Total iem APPROVALS eu " gLpG. PERMIT NO. ___, For items not listed refer to Fee Schedule y��-� ' '_ ____._--- t � . � '7893 COSTA MESA BUILDING DEPARTMENT P. O. e0% 31� COSTA MESA. CALIFORNIA FOR TO FILL IN BUILOING �/ J � V ADDRE55 COSTA MESA. CALIFORNIA OWNEft 0 LEG�L ILOT � OESCRIPTION NO. A.P. NO. �� SIZE y +� OF LOT � � �/� �7C USE OF •�wL EXISTING BLDG. SETB/.CK LINE FNOM �! CCVTEa OG STREET a / NO. LIC. NO. BLOCK ITRAC � ^ONO.OF BLOGS. NOW ON LOT / ✓ " _ 1� �� .Ci�� fl�1��, a�-S& NCE OEP1. �liY Bi ��TA IIE81► APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY �•, lciir j_/o-L/3.� I/o-se-Ja 7"O�1C ADD EI55 G J I� � L�q'UA/ ///L COSTA MESA. CALIFORNIA FIRE ZONE �� 20 MO.OF j OVP PL�NS � — � 9� O� BVPROVE ��»i. DATE /O ZY � . i� CORRECTIONS i'�.':1:'1. .' r- .1 �. � �UBJECI iv , �C. DtNT. REG. i� (J � / /\ SIDE YARO ftIGHT �/ � L'<FT /�� DESCRIPTION OF WORK NEW ALTERATION ADDITION REF.... MOVING DEMOLISH � 5 ZIE DING �� NO.OF J ROOMS STORIES I EXTERIOR WALI FOOF COVERING COVERING USEOFNEW ...��7 _i 1 ,/•_. T STwTE THAT TNE ABOVE IS CONRECT ��{��/�pff��O{]q LY WITN ALL CITY ORDIN�NCE9 wND �Q�'ARSBVi1l��t �)l1ICD ,'. CONSTRUC- T'o"'. g430 NEWPORT BLVO.. vn�UnrioN SIGNATURE OF COSTA MESA. CAL�F. PERAIIT FEE 5 ,� PERMITTEE I. 8�9'88 �}-� � � PLAN GHECK S Z��/ � g q�gs AUTHORIZED A � � TOTAL FEE 8�6 , �°Y� � . _, �, . %is�i COSTA MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN FDDRE�55 a.��7 � �-i��,�� ,� COSTA MESA. CALIFORNIA OWNER � MAIL ADDRE55 �ITY / ARCHITECT OP �NGINE A� .E55 LEGAL LOT � o[scRiPrior+ NO. � A.P. NO. �� — C SIZE I� OF lOT S/ � � USE OF EXISTING BLOG. / SEiBwCN LiNE FPOM/U� �ErvTER OF STPEET 0 d O �// TEL. NO. LIC. NO. � � d0 NO.OF BLOGS. �/ MOW ON LOT � [�/i�Y� /� � r RIGHT �y LEFT � DESCR1PTlON OF WORK NEW ALTERATION IAODITION REP.., n BUILOING� o�� SIZE r, E%TERIOR WA�L COVERING____ __ USE OF NEV�� 6UILDING /'.�%� NO. OF � ROOMS STORIES I ROOF COVERING ��d.�4io�-rt .)�.,��//. U i�.l� WI��L�u v �v p eosr:. Q �**�, ��I�JAPoCE ��T. 73a 36.OQ:< C11r 03 1eL'�tA � APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY _� RECEIPT NO. � PENMIiNO.' '� a yY ��f'Erve e �) onTE 9ECE�vEo on/iy isysu '///�� / �/1 � �J 7+i ��/ Lil C ADORESS COSTA MESA. CALIFORNIA Z- CORRECTIONS CITY OF STi�MET SA ��• . SUBJECf TO G. DEI'T. REG. STPTE TX�i THE ABOVE IS CORFECt nN0 nGREE TO COMPLT WITH �LL CITY OROIN�NCE$ �NO $TATE L�WS flEGVLRTING BUILDING CONSTRUC� T1ON� BBE6-8'113NOHd VALUATION SIGNATURE OF '�IiM�J �dS3W �IgO7 PERMiT FEE $ PERMITTEE 3N Ofi4Z �. aaa�ine avW 9 2ys PLAN CHECK $ � :.�iTHORIZEO AGEN � / TOTAL FEE $ ,� i eHl '�_ �� '7s3:i � . COSTA MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA. GALIFORNIA FOR APPLICANT TO FILL IN MAIL ADDRE55 CITY ARCHITECT OP -`�GINE A L.... E55 LEGFL oescr+irrwv A.P. NO. � SIZE . COSTA MESA. CALIFORNIA TEL. J/ NO. �C+ LIC. TEL. or e�ocs. � ON LOT I SETBnCN LINE FqOM �f y'r Y rcu.c.. o� SinEei �! •� REAF YARD L NEW / Y ( w-T �j � >RD RIGHT , J � LEFT .� � DESCRIPTION OF WORK ALTERATION II ADOITION P MOVING II OEMOLISH ryG�fA -J ^� NO. OF J d w c3 ROOMS � STORiES OR WALL ROOF Nr. COVERING USE OF NEW--f�' � BWLOING V U i�;� G°3L��%u�i1�U /o- � )- �' Fia�l��E o��r. arn � ��*A �► APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY RECEIPT NO. PERMIT N0 ��., 7� �S ErvE e DwTE RECEIVED OAT ISSII , id --L%Ji� �a zF� ADOREI55 2- /� 7 ✓ N/ �O� COSTA MESA. CALIFORNIA BY ��(�- DATE /v/ZJ/ CORRECTIONS CITY OP DA A MESA �Ef'`F- DEPT. REG. ST.�TE TM4T TNE �DOVE I$ COflRECT �(� O�S WITX ALL CITV ORDINANCES �ND ST��Q�A� F�1 O�ryO�NSTNUC� rion. 2430 NEWPORT BLVD, vALUATioN SIGNATURE OF COSTA MESA. CALIF, . PERMIT FEE $ PERMITTEE ' / g 9 z ys PIAN CHECK 5 AUTHORIZED AGEWT 'G J � / TOTAL FEE � / s%� " . " • � '789�i COST,4 MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BUILDING� �/j^ C �/ %`�y � ADDRE55 �j// / �[ OWNER 0 ARCHITECT O�' 'NGINEER '.,�rA' �'�"" TEL�N O � ., LIC. NO. �/� CI_T,y LIC. LEG/Q ILOT 1� I I � oESCPIPTION NO. � 9LOCK TRACT A.P. NO. � —b � SIZE �/� ✓��j_�� NO.OF BLDGS �p OF LOT / K�«/ iow orv �or y1G/�Ly USE OF E%IST�NG BLDG. a � //� SETBhCK LINE FROM '/�� w CENTER OF STREET �G� � R�qR VARO �0� SI�EVARD RIGHT /9� LKFT �.!J�� DESCRIPTION OF WORK NEN' ALTERATION I ADDITION REPn�rt MOVING I I pEMOLISH BLIILOING �l y� NO.OF SIZE p I!\ ROOMS .� STORIES � EXTERIOR WALL ROOF COVERING COVERING USEOFNF`Vy_y�. ��i .._ _ � ) . .i �_. STFTE TMAT THE FBOVE IS,f�O(tfi�� CITV ORDINRNCES <ND Siyi/9l�N�MS TION. ��. SIGNATURE OF � PERMITTEE AUTHORIZED AG 6 BY �� G�3�.��6�� j�-�7-5� fiNANCE OEPT• GfTr 0� E�'""� 1� APPLICATION FOR PERMIT BUILDING 'FOR OFFICE USE ONLY RECEIPT NO, pERMIT�NC 2 s��7 e N7✓ COSTA MESA. CALIFORNIA CORRECTIONS �CITY OyP_ � STA MESA 1�L.r.y1�'I V SUBJECI" TU �-G. UCYT. REG. WITM ALL CONSTPU<- vnwanoN �y„� PERMiT FEE � V (J % � Cj� PLAN CHECK $ � • l/ �-/ � $ � ^� � TOTAL FEE 5 �:� ��(! �eMi