HomeMy WebLinkAbout2421 ELDEN AVE - Building PermitsCITY OF COST�A, M1E A CO
Project Address L�'�2� �n�
�
Applicant's Maili�ng A�d�dres ���
Owner'sName�' ��`�-�L�J
Address 32q�' I fl 4D S
.°.Dp�leant to fill in all spaees exce0t those wilhin heavy eeraer lines ana sign all aooroo�iate Oeclarations.
PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. A P# �1 3i7 �
r� rn esi� cra ' t� 39 4Za � 5 r3� �2a � `._� `.,
I�, �.� �. TYPE OF CONSTRUCTION NEW ADD ALTERATION
❑ CONVERSION� ❑ D�MOLISH ❑ OTHER
^Phooe^_i_ DESCRIPTION OF WORK/USE OF BLDG�IPA� !ti,� �
ArchlEng?Vwcla-Ur�l�+ ��'��T License No. _
Address ' �
Contractor's Nam � PhonL �
Addresslmailing) �si2 1 `���-�-
City License No. � ] U�
LICENSED CONTRACTOR DECLARA iON
1 hereby affirm that I am licensetl untler provisions of Charte� 9(mmmencinq
with section ]000) of Divislon 3 ot the Business antl Pro�essions Cotle, antl
my license is in f I forceI antl effect. /'
License CIj� �'�p� �� k�/-�/-�J���J' e� e No�.`�`�����
Oate� /V—T/—� c'nna� �o ���ILL�'�J""'"`�
'""jRKERS'COMPENSATION DEGLARATION
reby aflirm that I have a certificate ot consent [o self-insure or a certificate
Workers' Compensation Insurance, or a certi(ietl copy thereof (Section
3800, Ldb. C.)
Policy No. Company
BCertifietl copy is hereby /urnishetl. . ,
Certifietl copy is filetl with the city Builtling Dlvision.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neeG not be completed if the permit is tor one buntlretl ($100) or
less).
I ce�tify [hat in the pe�tovmance of the worWfOr whlcp this pe�m�t is issuetl, I
shall n�=mplo�� person in any mdn �r 50 5 t6 h¢c�ubject to the
Worke Co{9p on LawS o( Calif / �/
oate «r Signature � » +
NOTICE: If, atter making this tleclara[ion, you shoultl become subjecl to the
Wotkers' Compensalion provi5ion5 of Ihe Labor Cotle, you must forthwith
comply with such provisions or this pe�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby alflrm that there is a constructlon lentling a9ency for tne performance
of the wo�k for which this permit is i55uetl (Sectlon 3097 Civ. C.)
l.entler's Name
Lentler's Atltlress
OWNERBUILOER DECLARATION
I hereby aftirm lhat I am exempt trom the Contractor's License Law for the
tollowing reason (Section ]031.5 Business antl Professional Cotle: Any city or
county whicb �equires a pe�mil to wnst�uct, alter, improve, tlemolisb o� repdir
any structure, prior lo its issuance, also requires tlte applican[ (o� such permit
to tile a signetl statement that he/sM1e is licensetl pursuant to the provisions ot
the Con[ractor's License Law (Chapter 9(commencing with 5¢ction ]000) of
'vision 3 of the Business antl Profezsions Cotle) or that he/she is ezempt .
re(rom anG tne basis for the allegetl exemption. Any vlolation of Section
SLS by any applicant for a petmit Subjects the appllcant to a civil
„enalty of not more [han five huntlretl dollars (g500).
❑ I, as owne� of the D�operty or my employees witb wage5 a5 Iheir sole
compensation, will tlo the work, antl the structure Is not intentletl or offeretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
LitenSe Law tloes not apply to an owner ot a p�operty who builtls or Imp�ove5
thereon, and who tloes such wo�k himself/herself o� through his ot her own
employee5, provitletl ihat su<h improvements are not intentletl o� otferetl fo�
sale. I(, however, the builtling or improvement Is soltl within one year ot com-
pletion, the owner will have tne burtlen ot proving he/she ditl not buila or im-
p�ove forthe pu�po5e of sale).
❑ I, as owner oi Ihe property, am exclusively contracting with Iicensetl con-
Vactors to construct the project (Section 7044, Business and Protessions Coae:
The Coniractor's license Law tloes no[ apply to an owner of property who
builtls or improves thereon. antl who mntracts for such oroiects with a mn-
tractor�51 lmense pursuani to me ConVactor•5 Llcense Law). I am aware that
proof o1 tlteir WorkeYs Compensation insu�ance Shoultl be provitletl to me.
❑ I am exempt unEer Section B. & P. C. for this reason
�ate Owner'
1 he�eby certity that I M1ave rea<
information is correct. 1 a9ree to
antl sta[e laws relating to builtlin
sentatives o( thi city to e t
insoectlon ��
Signature
Orivers' License or 55 �
this
upon
:ation and state that the above
i all tlty antl county ortlinances
on, antl hereby authorize repre-
above-mentionetl property for
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJEC7 DESCRIPTION 5Q F oCCUVANCY
CONSTRUCTIONTVPF ��— VALUATION$ �I IT1]
20NE GRADINGCU.VDS. ACRES
Remarkr. f � (,i � � � ^
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwdsher
. Drinking Fountains
Floor Orains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ven[ilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. iC60 #
Heating System & Ducting
❑0.100,000 BTU 0100,0006T
RainsOection Fee � $15
0865-46, rev. 5/88 White - Building; Canary - APPlicant; Pink - Accounting: Goltlenrotl - ASsessor
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
Laundry Trays
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBTU
System Repair/Alteration �
Fire Dampers �
Registers
luue Fee
S Main Building:
E
T Front
A Rear l I
C Right �
SLeft 3
Ping. Ref. #
Planning Notes:
"_�� _-�
,iJ' � - '� Zone . Z \'
Accessory Buildin9:
. 2
O
�t � N
N
� G
R
Parking Req./Provide E
U
M
� �� T
.i �� S.
FEES Automatic Washer
Construction Pole Su6.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$witches
Garbage Dispoul
Generator �0.5 KW 05-15
� Reinspection Fee ! $15
$ 3 DEVELOPMENTSERVICESREQ
Zaning Approved By
FEES Building Approved By
$ 3
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors�0.1 HP�1X-8
Inc.Solar �9-15 HP 016-15+
Microwave � � '
Pole Light ' '
Range
Si9n
Standing Sections
Trash Compactor
luue Fee
FEES
$ 3
SUM RV OF FEES irY�
BUILDINGPERMIT $ �� SMIP $ ���
PLAN CHECK $ PERMIT
PLUMBING $ �SSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ �
PLAN CHECK 25% $
O1 QQQ32645—CD032647 's'��T =' , '-
OA?E: DS/:0/E° TIrE: 11:Y3
�CONSTRUCTION AND PLANNING POC SPA
Date Inspector Date Inspector
. APPROVALS Permit # APPROVALS Permit #
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 Co 1duit-Undrgrnd. 1 55. Electrical Bonding ��'
5: Steel Reinforcement ' 56. Rough Plumbing & Pressure Test �� _
6= Electrical'UFERGmd.• - . 57. APPROVALTOCOVER-GUNITE ,i�
7.� Footings � � �'�-" � �� d9 58. Electrical Conduit�Undrgrnd. �f� i
S. Foundation �� . �� �� � 59. Gas Pipe, O Undrgrnd., Test i
9. Water Pipe-Uridrgmd. - 60. Backwash Lines, P-Trap, O Undrgrnd. ��
10.- Structural Floor Sy'stem � ' 67. APPROVAL TO DECK �
11.. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
�'12. Sewer Cap !� . 63. Heater & Vent-Final '_
13 Roof Dreins � i, , � 64. Plumbing System - Final -
r 14' Rough"Plumbingl 65. Electrical-Final "
15. Rough Electrical-Conduit 66. Solar System-Final -
1�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 �
1.9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace 't APPROVALS Permit #
21. DuG�s: in Structure �� 70. Underground Hydro
22. Dur'ts, Ventilating ;! ! . 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test �� 72. Underground Flush
, -
24. Roof Framing , , 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. YRoof'Sheathing ,�i. 74. Overhead Hydro
26,. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing �� - 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL '
30. Drywall Nailing �� �� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � i . 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. Fiiial.Plumbing ' ,
39. Water Service-Final
40. Gas Service-Final , �
41. Solar pomestic-Final .-�
�,
42. Backflow Preventer . _ {� •
43. Backflow Irrigation : � -
44. Lindscape Irrigation System
45. Sound Attenuation' ' �
46. Handicap Regulations. . .
47. FINAL STRUCTURE & BUILDING p/3 �} �
48. Special Requirements Completed
. �
49. Electric Release to Edison ���, ,
50. Gas Release to Southern California Gas Co . �? ' '' �
.'
�51. CERTIFICATE OF OCCUPANCY '�' �' '_ '
No. Date Y �
Applicant to till in all spaces except lhose within neavY bortler Iines ana sign atl apvropriate tleclarations.
PE T N TRACT NO. LOT NO. UNIT NO.
CITV OF COSTA es CO S7RUCTIO PE M Tq . � R�q,,..12 � G A.P.# �j _'� _ 3 za�e RZ
Project Address � �`�� •_ S Main Building: Accessory Building:
� - TyPE OF CONSTRUCTION NEW ADD ALTERATION EPAI�
AppliCa�t'S Mailing AddfCs � ❑ CONVERSION � DEMOLISH ❑ OTHER /. 1 7 Ffont �
Owner's Nam �� P� �F�'VI , DESCRIPTION OF WORK/USE OF BLDG. %� Q'.•� ��� T. A Rear .2. �J / N
Addres L � .\
Arch/En , M �u License No. TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL I C Right N
Addreis lal � �LLS 1 . ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL S� Left � G
Con�ractor's Name � ��� � P one � � OTNER , Ping. Ret. # Parking Req./Provided E
^� �+ PROJECT DESCRIPTION Sq FT oCCVPANCv �
Address �mailingl 4 ZL� L`—' ' �` /� Planning Notes: r t� � M
�1 CONSTRUCT!nniTVPF^���[� VALUATIgNS SIeI
City Lic@nse No. �� v� ZONE GRADING CU. VDS. ACRES � T
LICENSED CONTRACTOii DECLARqTION eO� _ OR SPEC S
I hereby affirm [hal I am licensetl untlGr prOvislons of Chdrter 9(commencing Remarks: �� _ � � �� ��' 2 2z
with section 7000) ot Olvision 3 ot [he Business antl Professions Cotle, antl
my licenbe iz in tul orce antl effect. (�'Q 9� ELECTRICAL FEES
Licenz Class Lic se o.� `✓�`� AutOmatiC W25hEf TfenSformer
Date �0- ^ Si9nature PLUMBING FEES ❑ 15-50KW
WORKERS' COMPENSqTION DECLARATION Construction PoleSub. � 50+KW
I hereby atfirm that I have a certiticate of consent to selbinsure or a certificate Bar Sink Showers
Workers' Compensation Inzurance, or a certifietl copy thereof (Sectlon Backflow Prevenier Service Sink Cooking Unit Meter ❑up to 100 amps
J, L9b. CJ
iicy No. Company Backflow Irrigation $ewer (:ap Dishwasher Meter ❑over 100 amps �
BCmti�{ea cooY K hereby fumishetl. Dryers ❑Gas ❑Elettrit Sub Panel �
Certifietl copy is tiletl with the ciry Builtlin9 Division. Bathtubs Sewer Connection r. �
Date Applicanl Fan Motors�0.1 HP �i,'h-8
E%EMP710N FROM WORKERS' COMPENSATION DECLARATION Clarifiers SOId� COIIECLO�S
(Thissection neetl not be completetl If the permi[ is for one huntlretl (g100) or F.A,U. Inc. SOIa� �9-15 HP 016-15+
less). Dishwasher SOlar Piping
I C¢rti(y tryal in the per(ormance of th¢ wo�k for whfCh th(s pe�m�t i5 i55uetl I FixtU�ES
shall not employ any person in any manner so as to become sup iect to t{�e Drinking Fountains Solar Tank Mitrowave
Workers' CompM tlon Laws of Califorr�la�,_ �/ .
Date 6-�C)-D� Signature `"� ✓`� ��'�-i�.�- Floor Drains � Swimming Pool w/Spa Device Bozes Pole Light
NOTIC�: H, at[er making this tlecldratlon, you ShOUItl become Subject to tha Out12L5
Workers' Compensation provisions ot [ne Labor Gotle, you must forthwith Floor Sinks Urinal RangE
comply with such p/Ovision5 or thi5 plrmit snall be tleemetl �avok¢�.
CONSTRUCTION LENDING AGENCV GasServicC OUtletS WeterCloSet SWitChes Sign
! nereby afRrm that there ts a construciion lentlin9 agency for the Oer7ormance � Garba e Dis o521
ol tne work for which this permit Is issuetl (Section 309� Civ. 0.) �nterceptors Water Heater 9 P Standing Sections
I_entler's Name
�entler's qadress Kitchen Sink Water Service Generator �0.5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm lha[ I am ezempt from the Contractor's License Law for tbe LavatOries Auto�Wash
lollowing reason (Sectian 7031.5 BuSiness antl Profe551onal Cotle: Any city or
county which �equ�res a Oermit to construct, alter, iTprove, tlemolish or repatr p-Trap Leundfy Tr8y5
any slrUCWre, p/io� t0 Its i55uance, also requi�eSlhe dOPli<anl for such OerTit
to tile d signetl statement [hat he/she is Ilcensetl pursuan[ to the provisions of Roof D�ains
tne Con(ractor's License Law (ChaDter 9(cOmmencing witn $ectlon J000) ot
Divisio� 3 of tne Business antl Professions Cotle) or that he/she is exempt Reinspeetion Fee $15 155ue Fee
'-+ebom an0 the basis for the 511egetl exemption. Any violation of Sectlon $ 3
l.5 by any applicant for a permlt subjects the apP���ant to a civll
dty ot not more than tive nuntlretl aollars (55006 $ 3 DEVEIOPMENT SERVICES REQUIREMENTS:
� u'I, ai owner ol the property or my omployees with wages as their sole Reinspeetion Fea $15 Issue Fee Zoning Approved By ��T� Date�-�
compensation, wlll tlo Ihe wo�k, antl the stru<tu�e i5 nOt Int¢ntletl Or offe�otl C
lor sale (Seciion 704a, eusiness antl Professional Cotle: The Contractor'z MECHANICAL FEES Building Approvad B� �
License Lnw tloes not appty to an owner of a property wno builCs or improves Date
thereOn� antl who tloes such work niTSelt/hersel( or [nrough M1Is or he� own AppliWtlO� ISSUed By '�Dat
emploYees, Provitletl that such imProvements are noi intentled or aiferetl for Boiler Hood o� Type I ❑
sale. I1, however, the builtling or improvament Is soltl witM1ln ono year oi com- CenOpy Type II ❑ SUMMARV OF fEES ` j�/1
plction, the owner wlll have the burtlen of provinq ne/sho tlitl not bulltl or im- Duct - Under Ground ��J
prove �br the ourpose o/ saie). BUILOING PERMIT $ �7 �G SMIP $
❑ I, as owner o/ the property, am extlusivery contracting with licensetl con- Duct -Structural Refrigeratlon System PLAN CHECK
tractorgto construct the project (Section 7044, Business antl Professions Cotle: $ PERMIT
The Contractor's License l.aw does not apply to an owner ot property who Duct - Ventilatin9 �0.100,000 BTU ❑100,000 BTU PLUMBING
buiitls or imoroves tnereon. antl who conVacts tor such oroiects witn a con- g �SSUANCE S
tractor�sl 6cense pursuam co me Contractors License Law). i am aware thai Exhaust System ❑ Multiple ❑ System fiepair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
prool O( tneir Worker's Compensation insurance shoWtl be proWCetl to me. ELEC7RICAL $ GRADING $
❑ 1 am exempt unaer Section e. & P. C. tor this reason Firepl/Fact. Blt. �CBO # Fire Dampers MICROFI LM $
PLAN CHECK 50% $ �
Date owner Heating System & Ducting Registers MECHANICAL
I nereby �¢rtlry that I nave reaa this appllcation antl state that the above ❑6700,000 BTU Q700,OOOBT $ TOTAL FEE $ ��
Inbrmation is mrre<t. I agree to comO�Y �+�th al1 city antl countY ortlinances PLAN CHECK 25% $
antl Sldte laws r¢lating to bull mg <Onz[�uction, anq he�eby autho�iie repre-
senta[Ives of tnis��o�e r upon the above-mentloneC Proper[y for
Inspection pur e Y� ��
Signature �a�
- A<muntin9: GolaenroC - AssesSor DAiE. t75/Iq1E? T���r: :�;.'..
. . ,,.. ..
-��'Cb�}VSTRUCTION AND PLANNING POOL �A
�� 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 - ; � � c� 58. Electrical Cqnduit-Undrgrnd.
8. Foundation� -� , .� � • 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Uniirgrnd. '� 60. Backwash Lines, P-Trap, � Undrgrnd.
10. �Str�uctural Floor System � � 61. APPROVAL TO DECK
71. �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 Plumb`ing � � 65. Electrical-Final
75. Rbugh 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 �,� f� 71 . Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test �^ 72. Underground Flush
24. Roof Framing �f 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof.Sheathing ti';� 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 f� .' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat'� " 79. FINAL INSPECTION
�•
32. Elearical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Finel Electric i• Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test .
36. Hood or Canopy •
37. Final Factory Fireplace a
38. Final Flumbing _ ' .
39. Water Service-Final �
40. Gas Service-Final ' � --
41. Solar pomesticFinal '�
42. Backflow Preventer � . , �j
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 . �� , " '
Y' �
No. Date '
ApO��eant �o fill In all spaces except those wll�in IteavY �orOer Ilnes antl sign all aDCroo��ata tleclarations.
•�PCOSTAMESA CONS RUC O P RMIT P{���,L{/�_+J� TR�A�T�NO' LOTNO. U��N��NpN � AP # 2p� � I� Za�a 2
Y� /V��J�- � "m J �J
'ect Address S� ti � S Main Building: Accessory Building:
/'� TVPE OF CONSTRUCTION NEW P.DD a ALTE TION REPAI E Z
.liCant'S Maili g Addrei ❑ CONVERSION ❑ DEMOLISH ❑ OTHER /�L� (OZL. ' 7 Ffont p
i '
ner's a e � e r Ph� DESCRIPTION OF WORK/ L G. ��%� A Rear N
Addreu �JE 19DD N�inl s7'roVS ��'� � FiDD �7-�u f�✓e�i (
PQ
—� i C Right 3� N
ArChIEn � ense No. TVPE OF PE� GRADING LJ FOUNDATION STRUCT AL � K G
Address� t ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g Lef[ l.� . R
Contractor's Name �1- G. `�i�.hO.n p o UJi ❑�OTHER . Ping. Ref. # Parking Req./Provided E
J ,Jn � V� PROJECT DESCRIPTION Sci. FT.—�� oCCUPAN v Planning Notes: n
Addre551mailingl CONSTRUCTION TVPE � N VALUATION $ r M
Ciry License No. T
ZONE GRA�INGCU.VDS. ACRES C-��� $,
LICENSED CONTRACTOR DECLARATION �
I hereby af/irm Ihat I am Iicen5e0 untler provislons ot Chdrte� 9(mmmencing Remarks: � ��g L � �D• �
with seclion 7000) ot Oivision 3 Of the Business antl Prof¢SSionS Cotl¢, antl ��
my Iicense is in ful arce ntl eftect. ,'(G.,
�Y� � Z 8 ELECTRICAL FEE
Llcen a —� � u5gn� No.�7_L_LSLL� D Auromatic Washer Transformer ❑ 15-50 KW
Datc.� �U' Signature �YYtA�- 0-h^-"�' PLUMBING FEES
WORKERS' COMVENSATION OECLARATION Construction PoleSub. � 50+ KW
I nereby a(tirm that I have a certificate of consent to salf-insure or a cerUficate Bar Sink Showers �
Wotke�s' Compensation InsuranGe, O� a c¢rtlti¢tl COpy th¢re0f ($ectlon Cooking Unit M¢t¢� ❑up t0 1002mpi
), Lab. C.) Backflow Preventer Service Sink
�icy No. Company Backflow tr�igation Sewer Cap Dishwasher Meter ❑over 100 amps.
BCertitietl copy Is nereby tumishetl. Dryers �Gas ❑Electric Sub Panel � _
Ccrti(ietl copy is (Iletl with the city Builtling Dlvlsion. Bathtubs Sewef Conn¢ction
Date Applicant Fan Motors�0.1HP�1'h-8
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clafifief5 Solaf Collectofs
(Thizsection neetl not be completetl ii the permit is for one huntlretl (5300) or Dishwa5her Solar Piping F�'4�U• Inc.Solar �9-15 HP �16-15+
less).
I certi/y that in [he pe�fo�mance of the wo�k tor whiGh thls pe�m�t ISlssuetl, I FixtUf¢5 �'
Thall not employ any pe�son in any� manner 50 a[O be5p m subjeq� ct to the Drinking Fountains $018� Td�k MicfOw2v¢
WOrker�^pmpeps tlon Laws o( Calito�r �„/� �!L (_� � Devic¢ Box¢5 ' '
Date �'�' 'a� Si9nature � I' +�/`-�� �y `^�'� Floor Drains Swimming Pool w/Spa Pole Light
NOTICE: If, after making this tleclaration, you sM1oultl become subject to the OutlEts Ran e
Workers' Compensatlon orovisions of the Labor Cotle, you must forthwith FlootSinks U�inal 9
comply wiln suc� p�ovi5ion5 or this pe�mlt shall be tleemetl revoketl. SWitCh¢5
CONSTRUCTION �ENDING AGENCV GasSefviCe Outlets WatefCl052[ Sign
I hereby allirm ihat ihere is a cons[rucHon lentling agency for the pertormance -
Ot tha work fo� whiGh this pe�mit is issuetl (58CtiOn 3097 Civ. C.) rid�bdg¢ Di5pO5dl Standing Sections
�entlerz rvame Interceptors Water Hearer
�entler•s Aatlrezz Kitchen Sink Water Service Generator �a5 KW �5-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby aHirm lhat I am exempt irom the Contractor's Llcense Law for the Lavetories Auto-Wash
followinq reason (Section 7031.5 Business antl Profes5ional Cotle: Any citY or
counry wnich requires a permit to construct, alter, improve, tlemolizh or repair P—Trap Leundry Tra'ys -
any sVucture, prlOr to Il5 issuance, a150 r¢quires Ihe applicant for such perTi[
to tile a Si9n¢tl zlatement thai he/sh¢ I5 licens¢tl pUfsuant IO the proviSiOns of R001 DldiOS
tne Contractor's LicenSe law (Chapter 9(commencing with Section ]000) o(
Division 3 0/ the Business antl Professions Cotle) or that he/sne is exempt Reinspection Fee $15 Issue Fee $ 3
-re(rom an0 the ba5is for the allegetl exemption. Any violation of Section
l.5 by any applicant (or a permil subjecls th¢ appllcant [o a civil
.Ry ot not more tnan five huntlretl tlollars (E500). DEVELOPMENT SERVICES REQUIS�(VTS: /�
I, as owner of tne prope�ty or my employees with wa9es as their sole Reinspection Fee $15 laue Fee $ 3 ZoninB APP�oved By ��XT Date � _
compen5ation, will tlo Ihe work, antl tne structure is not intentletl Or offeretl �' �—�
for sale (Section 7044, eusiness and Professional Cotle: The Contractor's MECHANICAL FEES Building Approvad By 9
�� License law tloe5 n01 aOPly to an owne� ot a prOperty who builtls or improve5 � DBtB
IM1ereon, antl who tloes such wo�k himself/he�selt or thrOU9h nis or he� own HoOd Or Type I ❑ ApplitetiOn ISsued By Ddt
omployees, provitlotl that such improvemen[s are not In[endetl or oiferetl for BOiI¢�
sa1e. Ii, however, the builtlin9 or improvement is soltl wlthin one year ot com- Canopy Type II ❑ SUMMARV OF FEES
Oletion, [he Ownm will have the bu�tlen Of proving ho/she tlitl not bulltl or Im- DuCt - Und¢� CirouOd
n�ova for tne purpose oi saie). BUI LDING PERMIT $__1G.3.Op SMIP $ • SO
❑ I, as owner of the property, am exclusively contratting witn licensetl con- Duc[ -Structural Refrigeration System �. p�,qN CHECK $ PERMIT
tractors to construct the oroject (Section 7044, Business antl Protessions Cotle: .
The Contractor's License Law tloes not aoPly to an owner oi property who Duct - Ventilating ❑0-100,000 BTU ❑700,000 BTU PLUMBING § ISSUANCE $
builtl5 or improves lhereon. antl who conVatts to� Suth oroi¢cts wlth a ron- .
tractm�sl Lcense pursuam ro me ConVactors Licanse Law). I am aware that Exhaust System � MWtiple ❑ System Repair/Alteration . PLAN CHECK 25% $ ENERGV P.C. $
prool ol tneir Worker's Comoensation insurance zhoWtl De proviae0 to me. ELECTRICAL 5 GRADING $
❑ I am exempt untler Section e. & P. C. Por lhis reason Firepl/FacL BIL ICBO � Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date owner Heating System & Ducting Registers � MECHANICAL ��
❑0-100,000BTUOt00,0006T $ TOTALFEE $ �
I hereby certify that I have reatl Ihi applicatiOn antl state that the above PLAN CHECK 25Ya
in(ormation is correct. I agree to o ly with all clty antl counry ortlinances $
antl sta[e laws relalin9 to builEi c M[ruction, antl hereby authorize re0re-
� sentatives of tnis Uty t ent u n the above-mentlonetl property tor
� Inspe<lion pu�0 e . ,
Signature. Date� peinspec[ion Fee $15 laue Fee g a 01 00032700-00032701 T�3�1 ��.,�i�
Drivers' License or 55 � . •
DATE: OS/tQ/39 TIflE: 21:4�,
0865-46, �ev. S/98 Wnrte - tluu0mg; Canary - HPPucdn[; Vlnk - Hccounung; uoiaenroa - N.ssessor
T
RUCTION AND PLANNING POOL 'A
' APPROVALS Permit # Date Inspector qppROVALS Permit # Date Intpector
� i. 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 ,• -
i �
5.'S[eel�Relnforcement -� 56. Rough Plumbing & Pressure Test
- i.
6. �Elecfrical 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. �r
10. Structural Floor System 61. APPROVAL TO DECK �'�
11. Property Sewer Line & House Connection 62. Backwash & Recepior-Final
12:�Sewer Cap � 63. Heater & Vent-Final
13. Roof, Drains 64. Plumbing System - Final
14. Rough Plumbing� � ' 65. Elec[rical-Final '
15. Rough Electriral-Conduit 66. Solar System-Final
"16. Rough Elearic Wiring 67. Fencing & Access Approval
•17. Raugh Wiring Sign . 68. APPROVED FOR PLASTERING
�18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough �Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace • APPROVALS Permit #
�'
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating f,�j � 71. Product Piping � Gas ❑ Oil
23. Gas Pipe:Rough & T,est �, 72. Underground Flush
24. Roof Framing �� 73. Undergrnd.StorageTank OGas ❑Oil
25.•Roof SHeathing p71b �" 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &�Mqnocoat 75. Dry Chemical
27.,Frame and Flashing � '. 76. Dry Standpipe
28. Lathing & Siding !j ,, 77. FIXED SYSTEM FINAL
29. Insulation ����'l 78. FIRE PREV. FINAL
30. Drywall Nailing „'� ;.�. HEALTH DEPT. REQUIREMENT
� ,i
�31. Plaster Biown Coat�}'' J� 79. FINAL INSPECTION
32. Electrical Power`Meter-Final'' 80. FOOD CERTIFICATE ISSUED
. , �'
33. Final Electric Notes: �� t� ���� ��,� � �
34. Final Heating & Air Conditioning
bL O
35. Final Gas Pipe-Test 2 ,�/J O.�E 7
. -n
36. Hood or Canopy
.37. Fieal Factory Fireplace �
38. Final Plumbing �L.' . �
39. Water Service-Final , ,
40. Gas Service-Final �
41. Solar pomesticFinal .� _
42. Backflow Preventer � �
�+^�
r-
43. Backflow Irrigation � ' ;,
44. Landscape Irrigation�System
45. Sound Attenuation-
46. Handicap Regulations , � �,� ;
47. FINAL STRUCTURE & BUILDING O�3 �! �
48. Special Requirements Completed
49. Electric Release to Edison� �l
ir _ � .
50. Gas Release to Southern California Gas Co �y ', �. �
51. CERTIFICATE OF OCCUPANCY /', ', , �. � '
No. Date %' � ��i
,r_
Aoolicant to flll tn all soaces exceot lhose witnin heavr �orEer Ilnes ana si9� all appropriata tleclaratians.
CITY OF COSTA MESA CONSTRUCTIQN PERMIT PERM�NO. �n 3 TR�ACT6N0. LO� 0; UNIT NO. E A P�y .�� ^ '� Zone Z
� / �T
Proje[t Address �'Z� �7-�%� 5]_ L'rPCi li� rn,�Sj� S Main Building: Accessory Building:
Applicant's Mailing Address Q��yLz' /LLS iL TVPE OF CONSTRUCTION NEW ADD AL7ERA71oN R A�R E Front Z
d�� �L.a�.r.j— ❑ CONVERS�ON ❑ DEMOLISH ❑ OTH�/�R.'. ' � T O
Owner'sName '� u hone DESCRIPTIONOFWORKNSEOFBLDG.��✓ �n� CU� �� B Rear i N
Address �'�{'i],i, (i) yf� S j% � U��i �/{� �i'• . A � ^ �
/q/j.{/:ELL/�� %�aN ���TI' TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL � C Rlght N
Arch/Eng. ,- �.�r�, ��// icense No. �y ' K G
Address � v�^ � �T N"1 - . ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . g � Left '3`� • R
Contractor's Nam ' Y"�� Phone�— ��OTHER � , Ping. Ref. # Parking Req./Provided E
Address (mailingl � d '� „�.��—� PROJECT DESCRIPTION SQ. T. oCCUPANCV � Planning Notes: M
CONSTRVCTION TVPE VALUATION $ T
City Lice052 NO. ZONE GRADING CV. VDS. ACRES r'P.C{.�L I $.
LICENSED CONTRACTOR DECIA ATION ��my. C
1 hereby allitm inat I am licensetl untler provi5lonz of Cha�te� 9(commenCing Remarks: G — L `� OS ,Q 'jg 1^" ��
with section 7000)�( Divislon 3 of the Business antl Professlons Coae, antl ELECTRICAL FEES
my license is in fullj�rcepntl effect.
Licen CI���� �;7—'� Lic nse ZdZi'
Date���c.�.(� Siqnatur�� PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW
WORKERS' COMPENSATION DECLARATION Construction PoleSub. � 50+ KW
I hereby a/ilrm that I have a cer[ificate ot consent to selt-insure or a certiflcate Ba� Sink Showers
Vorkers' Compensation Insurance, or a certlfietl copY Ihereof (Sectlon gackflow Preventer Servite Sink Cookirg Uni[ Me[er Qup ro 700amps
]. Lab. C.) ' -
roiicy rvo. Gompany Backflow Irri9ation Sewer Cap Dishwasher Meter ❑over 700 amps .
BCerti(ietl copy is hereby fumishetl. - � Dryers �Gas �ElecVic Sub Panel �
Certilietl copy is tiletl witn tne city Building Division. Bathtubs Sewer Connection
Date AOP�icant Clarifiers Solar Collectors Fan Motors �0.1 HP O1 Ya � 8
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
iessjs section neetl not be completetl if the permit ls tor one hunaretl (E300) or Dishwasher Solar Piping F.A.U. Inc. Solar �9�15 HP.�16-15+
I certify tltat in the perfo�mance ot th¢ wo�k (o� which th15 perm�t Is Issuetl, I FI%t��2S
shall not employ any person in any manner so as be e bject to the Orinkin9 Fountains Solar Tank Microwave .
Worke � pe n Laws of Califg�ip/�
Date � Si9nature ')�L Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: 1/, df[er ma <ing lhis tleUaratiOn, you shoUltl b¢COme subject to [hE OutIC[5 Rd0 ¢
Workers' Compensatlon provisions of the Labor Cotle, you must Porthwith Floor Sinks Urinal 9
comply with such p�ovi5ion5 0� tM1is permit s�all be tleemetl revoketl. SwltCh¢5
CONSTRUCTION LEN�ING AGENCV GaiSerVice OUtletS WatelCloset Sign
I hereby afflrm lhat tnere is a constructlon lentlin9 agency for the per/ormance �
oi tha work for whlch this permit is issueC (5¢��ion 3097 Clv. CJ Garbage Disposal Standing $ection5
Lentler's Name Interceptors Water Heater
�enaer�s ntltlress ` Kitchen Sink Water Service Generator 00.5 KW �5-15 KW Trash Compactor
OWNER BUILDER DECLARATION
1 hereby aftirm lhat I am exemp[ from tbe Contra�tor'z Llcense l.aw for the �avato�ies AutO-Wash
tollowin9 reason (Section ]031.5 Business antl Proiesslonal Cotle: Any cltY or -
county wnicn requires a permit to construct, alter, imOrove, tlemolish or repair P—Trap Laundry 7rays
any structure, prlor to its issuan<e, also requires the apP���ant (or such permit
to lile a Si9n¢tl slatement tM1at he/she Is licensetl pUrsuant to lhe O�ovisions of Roof Orains
the Contracto�'s Li<ense Law (Cnapter 9_(comm00cing with SecUon 7000) oT
Division 3 of t�e Business antl Profezsions Cotle) or that he/she is exampt Reinspection Fee $15 Issue Fee $ 3
�e(rom antl ln¢ basis tor the allege0 exempti0�, Any v101ation Of $eclion
LS by any applicant 1or a pe�mit Subjects (he applicant to a civil
alty oi not moro than five hundrea tlouars (E500). DEVELOPMENT SERVICES RE� NTS:
u I, as owner of ihe property or my employees with wages az their sole Reinipection Fea $15 laue Fee $ 3 Zaning Approved By Date ��
compenSatiOn, will tl0 the work, antl Ihe structu/e Iz not Int¢naetl ov o(te�etl
for sale (Section 7044, Business antl Professional Cotle: Tha Contrattor's MECHANICAL FEES Building Approvad 8y " Date
Licenm Law tloes not apply to an owner o( a prope�ry �yryo bulltls or improves T
thereon, antl who tloes such wofk tlimself/her5¢11 0! ttllough t1i5 oI he! own BOiI¢f HOOd OI Ty�e I ❑ APPlicdtiOn ISSUBd By • L�Detd
employCes, provitletl Ihat such imOrovement5 are qot intentlotl or oHeretl fo�
sale. I/, however, lhe builtling or improvement is spltl wlthin one year oi com- Canopy Type II ❑ SUM V OF FEES
pletion, the owner will hav¢ the burtlen of proving h2/She tlltl not bulltl or im- DUCt - UOd¢� Groulld
prove tor the purpose oi zale). BUILDING PERMIT $ ���� SMIP $ ��
❑ I, as owne� o� tne property, am exUusively <ontracting with licensed con- Duct -S[ructural Refrigeration System PLAN CHECK $ PERMIT
tractorsto conslrucl tne projec[ (Section 7044, Businezs antl Profession5 Cotle:
The Contractor's License Law tloes not apply to an owner of o�operty who Duct- Ventilating ❑0.700,OOOBTU ❑100,000 BTU PLUMBING $ ISSUANCE $
builtls or Imoroves thereon. antl wno contract5 �or such oroieCtS with a r.on-
tractor(s1 license pursuan� m cne ConVactors Licanse Law). i am aware that Exhaust System ❑ Mulliple ❑ System RepaidAlteration PLAN CHECK 25% $ ENEfiGY P.C. $
proof o( tneir Worker's Compensation insurance shoWtl be provitletl to me. ELECTRICAL § GRADING $
❑ I am exemo� untler Section B. & P. C. �or this reason Firepl/Fact. BIt. ICBO # Fire Dampers MICROFI LM $
PLAN CHECK 50% $
Date Owner Heating System & Ducting Registers MECHANICAL $ � �
I hereby tertify that I have reatl tnis application antl state that the above �6100,000 BTU �100,OOOBT TOTAL FEE $
information is correct. I agree to comply with all Uty antl county ortlinances PLAN CHECK 25% $
antl state laws relating to buil�ing co ruction, a�tl hereby authorize repre-
sentatives of Ihis city f0 n[er n the abOve-m¢ntlOnetl prOpefty fof
InsOect�on pur�
Signature �_ �6 peinzpeaion Fee 515 Isue Fee $ 3 01 OOD3269E-00032699 T�7� 17 �C;
Drivers' Licenze or ss � _ OATE: QS/�0/39 TSF1P: ll�o.i
0865-46, rev. 5/88 Whlte - Builtling; Canary - qpplican[; Pink - Accounting; Goltlenrotl - Asseszor
:�CONSTRUCTION AND PLANNING POOL 'PA
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-Electric'al Gonduit Utility-Undrgrnd. 54. Forms "
4., Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5.'Steel1Reinforcement 56. Rough Plumbing & Pressure Test �-,
6� Elcctrical:UFER Grnd. 57. APPROVAL TO COVER-GUNITE � �'
7.-Footings �� - -� � • �� 58. Electriral Conduit-Undrgrnd. ,
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Wa[er 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 & VenbFinal '
Y •
1,3. Roof Drains � 64. Plumbing System - Final
� 14. Rough Plumliing ' � ' 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar System-Final
16. 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 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 Sheathi�g 74. Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ; 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31'. Plaster Brown Coat ' 79. FINAL INSPECTION
32. Electriral Power MeterFinal' 80. FOOD CERTIFICATE ISSUED
�. u�_
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 - i�
r
� 42. Backflow Preventer � r � �
43. Backflow Irrigation -
44. I_andscape Irrigation System .
45. Sound Attenuation
46. Handirap Regulations . •
47. FINALSTRUCTURE&BUILDING O IJ �
48. Special Requireme�ts Completed
49. Electric Release to Edison ^
50. Gas Release to Southern California Gas Co ' � �
r)' - .'
51.CERTIFICATEOFOCCUPANCY 1- ,�, ,
No. Date r •
Ciry of Costa Mesa
�uilding Safety Depdrfinenf
P. O. Box 377
Costa Meso, California
CERTIFICATE OF OCCUPANCY N� IH3O C
The Building located at 2�F21 E].deA AYC. � D� E Ss I+
has 6een inspected a�d found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereTo
for a Group g� J Occupancy.
Use of euilding TP3U1Cx Recidence and Detached GFsrage _
Legal Description_ A�P. s!b119–(122-08
, ($ee rev¢rse side for Mefes ond Bo�nds)
Building Permi4 No._��L–� Electrical Permit No. `21318 Plumbing Permit No._ �lFS�. _
Floor Load Signs havs been installed as Room Capacity Signs have been insfaled as
required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. —
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obTained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apariments or guest rooms
3) Ownership
If Group H Occupancy, number of apariments and/or guest rooms as required under Sec. 17050.1 (d), California
Adminis}rative Code, Title 8, Chapter 9, Article 8. -
Number of aparTments__�.— and/or guest
ISSUED TO: Building Official
A]1en. �F. -Weston � by /1 `i a--
- - —6rc�-= /�
Date � / � � /b �%
i
Yhis Cer7ificaTe of Occupancy SHALL BE posted in a conspicuous place on fhe premises and SHALL NOT BE removed
excepf by the Building Official of ihe City of Costa Mesa under See. 306 (e) U.B.C. aor,n suas-inx-ii-�a--s-s r
_.. � ���F�s —�� . v E� RECEI� ��
COSTA MESA BUILDING-SAFETY DEPARTMENT Gl�l 9����5� �
P.O. BOX 3I] COSTA MESA. CALIFORNIA FINANCE DEPT:
� ry (�F COSTA ME�
FOR APPL/CANT TO f/LL /N COMPLfTELY aPa�icano�L FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING lJ �! '7 l r_ ; i'1 C i/i�
COSTA MESA. CALIFORNIA
� CITY
LEGRL I LOT �
DESCRIPTION NO.
A.P. NO. / 7'�
S�ZE E6 � k
OF LOT
% � / �/ - ..�.
TNO / G� � qDDR
LIC.
NO.
FIRE
ZONE
L G NO./�✓/ d a gyPRi
� �
ZONE
� ITRACT�O � I
APPRI
BY
' NO.OF BLOGS. n yppn�,
SETBACK LINE FHOM /
CENTER OF 6TNEET REAR YARO !
SIOE YARD ILEFT IRIGHT �
DESCRIPTION OF WORK
' REPAIR I II MOVING
S ZIE DING ri / y /✓�{ R
✓ E7 /l �JL
BE
I�u[�I�IFI:I
ED
< < . / J/�o"
1 HEREBY ALK! WLEDGE THAT 1 HqVE RE�� THIS APPLICATION
�IND STATE TH�\T THE ABOVE IS CORRECT RNO NGREE TO COM�
PLY WITH ALL CITY OFOINANCES AN� STATE LpW9 REGULAT N1G
BUILDING CONSTFU�I N. � � �
SIGNATURE OF /iAA
IZED AGENT
e
�o,e officE usF oNcr
I PECEIPT NO. I �v IT�'
COSTA MESA. CALIFORNIA
ZONING
NO.OF I �SE OF NEW
PLRNS Z� BOIL�ING
fCE^;E'R LINE 8T.1 C ��
w�ns.J G'Lj�6N t- �� F.v',p�
/'b � - �
D�—
THE AMOUNT BHOWN UN VALUATION 18 FOH THE
PUNPOBE OF ESTABLIS �G A PEFMIT FEE ONLY.
VALUATION � � —
PERMIT FEE $
$/n C`(/�J PLAN CHECK S / 3--
,_. ��.
TOTAL FEE 5 s 9-
,
" 10�'7�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPL/CANT TO f/LL /N COMPLETELY
TYPE OR PRINT
BUILDING O ' �
ADDRE55 ✓�
COSTA MESA. CALIFORNIA
�ae�i�
LEGAI ILOT �
OESCRIPTION NO. � E
A.P.NO. �J7" {/�0��
STATE
LIC. NO,
��/
�% I
a �� REC��EIV ���
APPLICATION 'FO �E MIT
F�i�i"���i��
C►TY OF COSTA ESA
fOR Off/C£ USE OM[Y
I RECEIPT NO. I PERMIT NO.
lL 3i.
IIVED BY_ I OATE RECEIVED I DFTE ISSUEO
BUIIDING
Ealb� s.,.,o«<
$IZE � / � � O� i NO. OF BLDG9. �
OF LOT [aJ (i' X I How oH �oi
EX STING BLDG. .L/ ��/4– hh � /"/ ��
SETBACK LINE FROM <
CENTER OF 9TREET �� REAR YARD l
J' / �
SIDE YARD LEFT r7 RIGHT ��
DESCRIPTION OF WORK
Nf I' IIALTERATION I IIADDITIC
REPAIR I II MOVING I II DEMOLI:
BUILDING / NO.OF � /
SIZE • b— �Z ROOMS �'Y STOR
y �. � ����... C(.�-
COSTA MESA, CALIFORNIA
� APPROVED
BY DATE
ZONING
ZONE �I/^ NO. OF USE OF N
Q� !l f/ IP�A�6 �� I BUILDING
�!��1/1_%�-� � �/.
dc � �,- .. i 'Xa o �
I HEREBY ACI OWLEUGE THAT I HwVE READ THIS APPLICATION
pN� STATE TIAT THE ABOVE IS CORRECT PND AGREE TO COM-
PLY WITH ALL qTY OFlUINpNCES AND STATE LAWS REGULATING
BUILDING CONSTRUCI ON. �
SIGNATURE OF / �(�(�L`,�
PERMITTEE
AUTHORIZED AGENT
(CENTfiN LINE
REAR
io�yF " ��
--- a s�a °�" �- �
THE AMOUNT SHOWN fIN R VALUATION IS FOR THE,
PURPOSE OF E9TA9L13MING R PERMIT FEE ONLY.
VALUATION �f / ,
PERMIT FEE S oc 'F/
$ /O �//��J PLAN CHECK S ��
�" 0 �
TOTAL FEE S 9 —
�
-' ' 1���7 e
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 3f] COSTA MESA.GALIFORNIA
fOR APPL/CANT 70 f/ll /N COMPIfTE[Y
TYPE OR PRINT
BUILDING � � /
ADDRE55
COSTA MESA, CALIFORNIA
OWNER77"/�/../ �� � J�l/(�S/ O/1/
� E�� �EC����
APPLICATIONFFOi7C�F� �►�t��SA
BUIL�DYING�O��R
fOR Off/Cf USE ONLY
I NECEIPT NO. I PEftMIT NO.
TNO%�.rb33d'3 qDD E�SSaf�� ' �
N��' COSTA MESA.
�/�.iJ %� �.�}- STATE
li(/ (.O / LIC. NO.
LEGAL LOT `/
oEscniviioH NO. BLOCK � 7 TRAC'
A.P.NO. �� G
$IZE � y NO.OF BLDGS.
OF LOT L� /� �DS I NOW ON LOT
USE OF /� {��� r�� / �� A
EXISTING BLDG. �✓ � � ���
SETBNCK LINE FROM
CENTEa oF STHEET � E% REAR YARD �
SIDEYARO ILEFT D / IRIGHT �/ /
DESCRIPTION OF WORK
NE I— 11 ALTERATION I II ADDITION
� SIZIE DING y/ y�/�L ROOMS
JC'17
EXTERIOR WALLr� ROOF
COVERING .l TVLU COVER��.
U�
�
C�,,r 'I
ZONING
ZONE NO. OF USE OF NEW
PLAN9 �1 BUILUING
J.
APPROVED
BY DATE
YARDS EVES
REQUIRED ALLOWED
ICENTEN LINE 6TJ
FRONT �D FT.
R. SIDE % FT.
REAR 1�� Ff. IN.
�%��l �ac�
1 HE EBY ACKNOWLED THAT 1 HAVE fiEAD THI6 APPLICATION
ANO 9TATE THAT THE BOVE I6 COFRECT AND AGREE TO COM- THE AMOUNT 6HOWN UN�EH VALUATION IB FOR THE
PLV WITH ALL LITY OPDINANCES AND STATE LAWS REG LNTING PUflP08E OF ESTABLISHING p pEPMIT FEE ONLY.
auLLo�NG CONSinu ioH. VALUATION
SIGNATURE OF � � ��� PERMIT FEE S ��
PERMITTEE
( PLAN CHECK $ � ,� �
$ l d, S�S��-
AUTHORIZED AGENT TOTAL FEE S � —
�,,Q � 2Q4 I 3
�� COSTA MESA BUILDING-SAFETY DEPAR`fMENT
P. O. BOX 91] COSTA MEBA. CALIPORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRWT
COSTA MESA, CqLIFORNIA
� ARCHITEGT
NO.OF
■ BETBACK LINe FROM
DESCRIPTION OF WORK
BUILDIN6 < NO.OF
SIZE � - � � ROOM$ BTORIE:
EXTERIOR WALL r^ ROOp
COVERING fY. COVkwlrue CAH
I HENEBY ACKNOWLEOOH iHAT 1 HAVp RGD iHIB APPLICATION
ANO BTATH THAT TH6 ABOVH 19 CORf�ECT AND AOREB TO COM-
PLY WITH ALL CITY OR IN He AND 9TAT8 LAWB PHGULATIlIG
BOILOING<ONBTROCT N
SIGNATURE OF �
PERMITTE�',
AUTHORIZED A6ENT
F��1 ��EIVED
� �f ��I'll���jLBlfJti PERMR
�- �,' c�irq�o��t�ra�n�A�
116C61R NO. PERMIT NO.
, �� �/3
q6CSIV[D!Y OA q^6C,4��{[D �pATHI55U
� L µ � i� � �
BUILDING � i}•)�
ADDRfiS � LCY
FIRE � �
ZONE T1'PE GROUP
q�PROVED� ��^ nare ��7 [: )
ZON[ NO. O/ 7 UY60F N6W f�Y+:r%�e(
�7_ Z �ur�e t_, eui�o�na�/�¢�r l
LEOAL . P.�l�— rs� �7���v�
U86CPI'TION
A.P.NO. II / —OLZ — �� '
N07E: NOEAVEOVERHAN66HALLBELESSTHAN
80" TO SIOE @ REAR P. L.
EAVE9
ALLOWED (U.B.Q REQUIRBMENT.
YARD8APPROVED YARD9APPROVED
MAIN BUILOING ACCESSORY 9UIL�IN6
/FROM GLBTREET)
FRONT 3� FT. �/�` F('.
R.81D6 S—FT. !— /� t�. �
L. 61OH �� FT. V �( FT. � �--
REAR � z� FT�~ I 3 �'. " –
DI3TANCE BET. BET _MAIN 8 _ � �
VAR. �j I DATE
TXH AMOUNT
PURPO58 OF
r� � � o
VRLIlAT10N 18 FOF THE F
A PEHMIT FEE ONLT. Q
0
IT FEE $ , � S� n
l _ m .
1�
1 \
Applicant to 1i11 in all spaees en<ev� those within heavy boraer Itnes anE sign all apo/opriate aeclarations.
CITYOF.COSTA MESA CONSTRUCTION PERMIT
Pr6je�� Address za21 Elden St. Building 3
ApplicanYs Mailing Address 324 So. Eariham, Oranae
Owner's Mame J�llnes E. DobYott pho�e 756-2505
Addreu 18022 C_,^!:�?n._Sii p 0 B� TnrinP,�4
Arch/Eng. License No.
Address
Contractor'sNama Ell].Ott ROOf Md111tP17azl���e99i-4938
Addreulmailing) 324�j So. E�rlham, Orange� CA 92669
City License No. 3 p/ ��
LICENSED CONTRACT00. DECLARATION
I hereby affirm l�at I am IicenSetl untle� provisions oi Chartet 9(commencing
with section 7000) of Division 3 0l the Business anC Professions Cotle, antl
my license is in (ull force antl eftect.
ucense ciass — Licensp� rvo, d�iS�i44
Date �r r Si a e N
WORKERS' COMPENSATION D CLARATION
' hereoy aifirm that I have a certificale oi consent to setl-Insure or a certificate
workers' Compensation Insurance, or a certifletl covY thereof (Section
:oo, �o. ca 571785 State F1and
Policy No. Company
[]_Certifiea copy is hereby tumished. 1'15UTdI1C2 Fi.ID .
L2iCer�t�'f�ietl� So�p� '/ileQ�v�,th the City Builtling �ivi5ion
oace_F"�GII_l�� Ly+AHPlicant �TaTfl�'S H Fllintt
EXEMPTION FROM WORKERS' COMPENSATION OECLARATION
(This section neetl mt be completetl it the permit i5 for One huntlretl ($100) o�
less).
I certify thal in lhe pCrfo�mance ol lhe work for whlCh this permit is Issuetl, I
Shall no[ employ any pe�son In any manner so as [o become subject to the
Workers' CompensaUon Laws ot California.
Date $ignature
NOTICE; ii, afler making.this tloclaraUon, you shoultl become su�ject to ihe
Workers' Compen5ation�provislon5 0( Ihe Labor Cotle, y0u musf fo�thwith
comply with sucM1 provl5ion5 or this pe�mil shall be Eeemetl r¢voketl.
CONSTRUCTION LENDING AGENCV
I h¢reby affirm that tnere is a consVuctlon lentling agency (or the periormance
Ot the work tor whiGh this Oe�mit i5 i55uetl (Sectlon 3097 Civ. CJ
Lentler•s Name
LenAer's Atltlress
OWNER BUILDEH OECLARATION
I hereby affirm thal I am ¢xBmp[ �fiom the Cont�actor's Litense Law for the
following reason (Sectlon 7031.5 Businesz antl Professional Cotle: Any city or
county which �equire5�a pe�mit lo cOnst�uct, alter imp�ove, tlemolizh o� �e0air
any structure, pdorto Its issuance, also reqWres t�e apo���ant for sucn permit
to file a signetl ztalement Ihat he/She Is Iicensetl pur5udn[ to the provi5ion5 of
the Contractor's License Law (Chapter 9(commen<in9 wi[n Section 7000) ot
Division '3 ot [he BuSinesS antl Profe551on5 CotlE) Or that ne/she is ezempt
�erefrom antl thG basis (or th¢ allegetl exempUOn. AnY viola[ion oi Section
131.5 by any aOP���an[ tor a permit su0jects lne applicant lo a civil
enalty of no[ more than five huntlretl tlollars (y500).
❑ I, as owner ot lha prooerty or my employeM wllh wages as tneir sole
wmpensation, will tlo4be work, antl the 5[ructure is not intentletl or offere0
tor wle (Section 7044, Business antl Profe55ional Cotle: The Contractor's
Lirense Ldw tloei not apoly to an owner of a prooerty who builCs or improves
thereon, antl who aoes such work himself/herselt or throu9h nis or her own
employees, provitletl tha[ sucM1 improvemen[s are mt In[enUetl or offeretl for
sale. If, however, the builtling or improvement Is soltl wltnin one year ot com-
pletion, the owner wlll have lha burtlen of pwving he/she tlitl not builtl or im-
- �1rove for the purpose oi sale�.
�..J 1, as own¢r Ot the Oroperty, am exclusively cont�actin9 with IlcenSetl con-
tractors to cons[ruct lhe project (Seclion ]064, Business antl Profe55ion5 Code:
The ConVatlor's License Law does not apO�Y to an owne� of property who
builtls or Improves thereon, antl who contracts for such orojects with'a con-
tractor(s) iicense pursuanf to the Contractor's Licanse Law). I am aware that
p/Oof of their Worke�'S CompenSaHon in5urance shoultl be provitletl to me.
❑ I am exemo� untler Sectlon B. & P. C. for this r¢ason
Date Owner
I hereby certi�y that I have reatl tnls applicatlon antl state that Ihe above
Information is correct. I agree to comply with all clty antl county ortllnances
antl state laws relating to builtling construction, antl hereby authorize repre-
Sentatives ot lhi5 Cily to enter upon the abOve-mentionetl 0� perty tor
ins ection oses. 6+
signature�� ��%'� oate 7 � 3
Orivers• L¢ense or 55 �
- Appllcant; Pink - Accounting; Goldenrotl - A55e55or oi ono�s2a�-oaeas��9 Tr�� 73,��y
• n�tG� nzi�7iao 7TMi• iL•ti
�CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS �Permit# Date Inspector qpPR�VALS 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-Ur�drgrnd. 55. Electrical Bonding
5. Steel Reinforcemerit-� . 56. Rough Plumbing & Pressure Test
6. Electrical UFER G�nd.-" 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation .� ' ' 59.' Gas Pipe, � Undrgmd., 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
i6. Rough Electric Wiring �r°? � 67. Fencing & Access Approval
17. Rough Wiring Sign � ��"68: APPROVED FOR PLASTERING
18. Rough Elecfrical-T Bar Ceiling � ��_�6�. POOUSPA 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 � ' jT;, 71. Product Piping OGas ❑Oil
23. Gas Pi e-Rou h& Test �;`
P 9 �-. .72. Underground Flush
24. Roof Framing � .. 3 ��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 � J7. 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. FINAL STRUCTURE & BUILDING � j� � t� • ��
48. Special Requirements Completed
49^ Electrie Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -,
No. Date
.
Aoo���ant to /lll in all s0aces except those wlthin neavv bortler Iines ane ti9n al1 aovroD/�ate tleclarations. � �
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CI7v oF COSTn MESA CONSTRUCTION PERMIT z A.P. # zo�a
Project Address 2421 Elden St. Building 2 �Tg � S Main Building: Accessory Building: -
�?.pplicznt's Mailing Address 324 So. Earlham, Oran�e TVPE OF CONSTRUCTION rvEW ADD aLTERaTION aEPAIR E Front ' � Z
> ❑ CONVERSION ❑ DEMOLISH ❑ OTHER �T 0
Owner's Name James E. Dobrott Phone %SFi—i5n5 � DESCRIPTION OF WORK/USE OF BLDG. Ted� O an re-roo 8 Rear N
Address 18022 Caaan, Suite �O�H, Tn�ina,sA q��i4 � usin a 3-Tab A h p-� A �
Arch/Eng. LiCenSe NO. TWPE OF PERMIT GRADING FOUNDATION 4�J STRUCTURAL I C Right � N
K Left G
Addr2s5 ❑ TENANT ❑ E�ECTRICAL ❑ PWMBING ❑ MECHANICAL , S'
❑ OTHER R
Contractor's Name El l i n}t Rnnf M-�i ntanannmane-qQ���,dQ7R Ping. Ref. # Parking Req./Provided E
Q
PROJECT DESCRIPTION SQ. FT. �' OCCUPANCV Plannin Notes:
Address Imailingl ��4 Sn F�rl]'kiRl �� d"D 9 M
39¢�s CONSTRUCTIONTVPE �t'/'•� �__ VALUATION$^IO T
City LiC¢OS¢ NO. ZONE GRADING CU. VDS. ACRES S.
LICENSED CONTRACTOR DECLARATION
I he�e�y altirm that I am licensetl un0er provision5 0( Charte� 9(tommencin9 Remarks:
with section 7000) of Division 3 of tho Business antl Profeszions COCe, antl ELECTRICAL FEES
mv iicense is in twi �orce ana ette<t.C-39 465344
License Class L cense No. PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW
Date �iZ' k1 ���reaQ?Kb?/%U�r'� �50+KW
WORKERS' COMPENSATION 6ECLARATION Baf Sink ShOw2t5 Conitruction PoleSUb.
"�¢reby aitirm t�at I have a ce�tificate of COnS¢nl to sel�-Insu�e o� a ce�tificat¢
� Norkers' Compensation Inmrance, or a certlfietl copy thereof (Sectlon CoOking Uni[ MEter ❑up to 100 amps
o, Lao. C.1 Backflow Preventer Service Sink
y 5�1�85 y n Backflow Irrigation .Sewer Cap Dishwasher Meter over 100 amps
aoiic rvo. Compan Sf �t-ca (`rm..o.���+;..
��ertitietl copy i5 her¢by �umisltetl. �j'jSUYanCe �lnd Dry¢�S OG85 ❑EI¢Ct/IC P2n¢I
ecp� I op filep�yy{�+ [he city 8yIltling DIy�sion Bathtubs S'ew¢� Connection
Date �°��� ��• 1J4�plicant �1clIi1E-'S H. F' 110 Y Fan Motors�0.1 HP �1'h-8
f� Clarifiers �Solar Collectors
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neea not be completetl if the permit is for one huntlretl ($300) or Dishwasher Solar Piping F.A,U. Inc.Solar �9-15 HP 016-15+
less).
� I cerlity thal in lhe performante ot the wo�k for which this permR is Issuetl, I Fixtu�¢5
shall not employ any person in any mannel 50 as [O become subject to th8 DflnkinJ FOUOtdinS 013f TdOk MiClOwdv¢
Workers' Compensatlon Laws of California. . Device Bozes '
Date Signature Floor Drains Swimming Pool w/Spa Pole Light
NOTICE: II, atter makinq this tleclaration, you shoultl become subject to the Outlets Range
Wo�ke�s' COmpenSatiOn p�ovisions ot th¢ L2bo� Cotle, you muzt fO�t�with FI00� $inki Urinal
comply wilh such p�ovisions or this pe�mlt Shall b¢ Oeemetl �evoketl.
CONSTPUCTION LENDING AGENCV G85ServicC Outlet5 WaterClOiet $WitChes gj9�
I hereby a111rm that Ihe�e Is a conztruttion lentling d9¢ncy to� tne pe�fo�manC¢ -
of tne work for which this permit is issuetl (Section 309� Civ. C.) Interceptors Wa[er Heater Garbage Disposal Standing $ections
i.entler's Name Generator �45 KW �5-15 KW Trash Compactor
Lender's Aatlress Kitchen Sink Wacer Service
OWNER BUILDER DECLARATION
I hereby attirm lhat I am exempt irom the Contractor's License Law for the Lavalories Auto-Wash
followin9 reason (Sectlon 7031.5 Businass antl Professional Cotle: Any city or
county wnich requires a oermit to construct, alter, improve, tlemolish or repair p—Trap Leundry Trays
any slfucture, priOf to il5 i55uance, al5o fequlreSlfle aOP��cant for SUCh pefmlt
t0 lile a sign¢tl s�atemeN Ihat he/she is Iicen5o0 pu�5udnt to th¢ provi5ion5 ot ROOf D�dinS
the Contra<tor's License Law (Chapter 9,(commen<ing with Section 7000) of
nivision 3 ot me Business antl Professions Cotle) or that he/she is exempt Reinspeetion Fee $15 Issue Fee $ 3
.,`;!'�.retrom antl tne basis for the allegetl exemption. Any violatlon of Sectlon
:".�;�1.5 by any applican[ for a permit subjects the applicant to a civil
'�ialty ot not more than five huntlretl tlollars (E500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS:
��yb I, as owner ot the property or my employees witn wa9es as their sole Reinspeetion Fee $15 laue Fee Zoning Approved By
wmpen5atio0, will tlo lhe wo�k, antl [he St�uctu/¢ i5 not intentletl or offeretl DatB
tor sale (Section 7044, Businezs antl Protessional Cotle: Tne Contractor's MECHANICAL FEES Building Approved By Date
LiCense 12w tloes nOt apply to an own¢� of a property who builtls o� improves �
thereon, antl who tloes Such wo�k himselt/her5¢If o� Ih�ough his o� h¢r own BOiI¢� HOOd Of Typ¢ I ❑ %�PPlitltion ISSUBd By � Dat
employeez, provitletl that such improvements are not Intentletl or offeretl for �
salc. If, howeveq Ihe bulltling or improvemenl Is soltl wllnin one year of com- Opy TypC I I ❑ $UMMARV �F F $
pletlon, thC owner will �ave the bu�tlen Of PrOving he/Sh¢ tlitl not builtl or im- DUCI - Und¢� i�i�OUnd 7 L, O�
prova tor the purpose oi saie). BUILDING PERMIT $ ,-- SMIP $ i��
❑ I, as owner o� lhe property, am ezclusivery contractin9 with licensetl con- Duct -Strucmral Refrigeration System P�AN CHECK $ PERMIT
traclors to conStruGl Ihe Orojec[ (SectiOn 7044, BuSiness antl PrOtesSiOns Cotle:
The Coniractor's License Law tloes not apply to an owner oi oroperty who Duct - Ventilating ❑0.100,000 BTU ❑100.000 BTU PLUMBING $ ISSUANCE $
builtls or ImOloveS thereon. antl who conVdctS fOr Such oroieCts wi[h a mn-
tractor(s1 license uursuan� eo cne Coniracior•s License Law). I am aware lhat Exhaust System ❑ Multiple ❑ System Repair/Alteration P�N CHECK 25% $
proof o( their Worker'z Compensation insuranca shoultl be provitletl to me. ELECTRICAL $ GRADING $
❑ 1 am ezempt untler Section B. & P. C. tor this reason Firepl/FacL BIL iCBO # Fire Dampers MICROFI LM $
PLAN CHECK 50% $
Date owner HeatingSystem&Ducting Registers MECHANICAL $ TOTALFEE $ �3 •--5�
I he�eby c¢rlify that 1 have reatl this applicatVon dntl State that the abova ❑o-100,D00BTU �100,���BT
information is mnect. I a9ree to comply with au clty anA county ortlinances P�AN CHECK 25% $
dntl state laws relating to builtling ronsVuctiOn, antl he�eby duthoriie repre-
sentatives of this city to enter upon the above-menlionetl property for
inspectlon purpo 5. � Date�
Signafure Rainspection Fee $15 Issue Fee $ 3 Qi �a�7$2/p5—QQQ')v2�% ��T Tj.:r�j
Drive�s' Lice se o� ss � Oi�TC: 03/13/89 TI11%: 26:4a
0865-46, rev. 5/88 White - Builtlin9; Canary - AOP��Canp Pink - ACcounLnq; GOltlen�o0 - A55055oi
� � . i N�� .� �
'�CONSTRUCTION AND PLANNING - POO' 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-Unt3�grnd. 55. Electrical Bonding .
5. Steel Reinforcement' • 56. Rough Plumbing & Pressure Test �. �'-
6. Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE •`'
7. Footings � , 58. Electriral Conduit-Undrgrnd. �y
8. Foundation 59. Gas Pipe, 0 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
A6� Rough Eleatric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. 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 3.� 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme and Flashing 76. Dry 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 r
40. Gas Service-Final �
41. Solar pomestic-Final � f.r r �
42. BackflowPreventer �� �'
43. 8ackflow Irrigation . � -
i
44. Landscape Irrigation System �
45. Sound Attenuation � ;r�
46. Handirap Regulations �
47. FINALSTRUCTURE&BUILDING � 3� d
48. Special Requirements Completed
49. Electric Release to Edison "•
50. Gas Release to Southem California GasCo . � ,���
51. CERTIFICATE OF OCCUPANCY �
j
No. Date r � ',
/
�
\
�
ApO�icant to fill in all ipacas except t�ose within heavy Do�tle� Iin¢5 antl sign all app�opriale Eeclarations.
CI7YeF,�OS7AMESn CONSTRUCTIONPERMIT
ProjectAddress �d71 F1APn St..A B C
P�plicant'sMailingAddress i 4 S arlh m Oranae 9266
Owner's Name •T�moq F. Tbhrntt vhone 756-2505
Addrew 1Rf199 ['r..,�, 5nita 709R� Tn�ina� ('n 97714
Arch/Eng. Licenu No.
Address
com�ac�o�'s rvam Elliott Roof Maintenanq��e 997-4938
Addresslmailing) �24 Sn_ Far_1_ham �anC)� C,A 92669
Ciry License No. 3q y��
UCENSE� CONTRFCT�R DECLARATION .
I hereby aHirm tltat 1 am Ilcensed untler p�ovislons of Charter 9(commencin9
with zection 7000) ot Divlsion 3 e� tne Business antl Professionz Cotle, antl
my licenze Is in tull forte antl effet�.
License Class no C-39 �ense� 65344
Date�"]dLc'h 1 3. �14��re �' �
WORKERS' COMPENSATION OECLARATION
1 hereby afflrm that I nave a certiflcato ot consent to Rli-insure or a certiticate
' Workers' Compensation Insuranca, or a certltietl cooY thereof (Seciion
;00, Lab. C.
✓or v No. 5�1785 _ comoany.$1'a a F1ind Tnaur�C
CertifleU copy is hereby furnlshetl.
oacei�`i°�14°Pi3 �r��3`J'8'�'Po IcantY BuTrtl3�mP41vHon.F.� � i O
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(ThisseGtiOn n¢etl nBt be comple[Cd It the permi[ is tor one huntlretl ($100) or
less).
I certify [hat in the per/Ormance of th0 wOrk fOr whlCh thii pe�m�t is i55ueQ I
shall not employ any pe�son in any manne� so as to becom0 Subject to the
Workers' Compensation Laws ot Calitornia. ,
Da[e SignaWre
NOTICE: If, after making this tleG�aration, you shoultl becoma subject to Iha
Workers' Compensation proNzlons of the Labor Cotle, you must tortnwi[h
comply with such p�ovisions 0� IM1IS pe�mit shall be tleemetl revoked.
CONSTRUCTION LEN�ING AGENCV
I hereby affirm that there is a construction Ientling a9ency tor tne performance
of the work � for which Ihis permit is issuetl (Section 3097 Civ. CJ
Lentler's Namc
Lentler's Atltlress �
OWNER BUILDER OECLARATION
I hereby attirm that �I am axamp� fiom tne Contractor's License Law for the
tollowing reason (SetBon' �031.5 Buslness antl Professional Cotle: Any city or
county wnicn �equires a petmit to const�uct, al[¢r, improve, tlemolisM1 o� �e0ai�
any struclure, prior to its Issuante, also requires the applicant for such permit
to file a Sign¢tl statertlent thdt he/She I51lcensetl pu�suant to Ihe provi5ion5 ot
ihe Contractor's License Law (ChaO�e� B(commencing with Section 7000) of
OlviSion 3 of tbe'Bu5lness antl P�ote55ion5 Cotl¢) or tha[,he/ihe is exemo�
-lerefrom antl the basis tot [he allegetl ex¢mptlon. Any vlolation oLSetUOn
�31.5 by any applicant for J Permit sublects Me aoonca�e to a civil
.nalty of not�more than five huntlretl tlollar5 (E500).
L� I^as ownei of the prop¢�ty o� my employees wltM1 wa9es as their Sole
, rnm encalinn. will ao tM1e work. antl thc sVuc[ure Is not inlentletl or offeretl
I License Law tloes not apply to an owner ot a propercy wno owiaz or improves
thereon, antl who tloes such'work himselt/hersetl or Ihrough hiz or her own
employeas, provitletl [hat such IrPP/ovemints are not intentletl o� offeretl 10r
sdl¢. 1f, howeve�, the �ulltlinq o� fmOrovement IS Soltl wlthin one yGar of cOm-
pietion, the owner will nave the burtlen of proving he/she tlitl not builtl or im-
p�ove for thC putpo5e oi zale).
❑ I, a5 owner ot the property, ?m exCluSively Contrac[inq wi[h liG¢nsetl can-
tractorsto consVuct the project (Settion 7044, Business antl Protessions Cotle:
Tne Contra<tor's Llcense Law does not apPIY to an owner of Oroperty wh0
buil�s or Improves lhemon, antl `�'ho coM�ac[s /Or Such projects with d con-
Iractor(51 I�cense pursuant to tne ConVac(or's LlcenSe Law). 1 am aware /hat
proof of their Worker'z Compensa��on insurance shoultl be provitletl to me.
❑ I am exempt untler Section 8. & P. C. for Ihis rea5on
Da[e� Owner
1 hereEy certity ihat I have reatl thls application antl state tnat the above
intormation Is mrrecL I agr¢e to comply with all clty antl county ortlinances
and state laws relating to builtlin9 �onstructlon, antl hereby autnorize repre-
sentatives of this city to enter Noon tne above-mentionetl property tor
insoection p oses. "
Signature Date
Orivers' License or 55 �
� 37�13 $ C
TYPE OFCONSTRUCTION NEW .qDD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p#
DESCRIPTION OFyVOfiK/USE OF BLDG. T ar O n�j r-T00
TYPE OF PERMIT LJ GRADING
❑ TENANT ❑ EL�CTRICAL
❑ OTHER
PROJECT DESCRIPTION 5c�. FT.
CON STRUCTION TVPE�
ZONE GRF
Remarki: � � __ _„ _ _ _�
Sink
Preventer
Irrigacion
Floor'Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains �
Reinspaction Fae
S Main Buildi
E
FOVNDATION STRUCTURAL T Front �
PLVMBING � MECHANICAL 8 REa� �
—�— A
��V OCCUPANGV C A�9ht
VALUATIONS 1�'SOD�O S Left
IG CU. V�S. ACRES p�ng..Ref. #
� �9QS(1d PlanningNotes:
l/ G/ii//./ M✓.
Service Sink
Sewer Cap
Sewer Connection
Solar Collecwrs
Solar Piping
Solar Tank
Swir�ming Pool w/Spa
Outlets � ' Water Closet
� Water Heater
� Water Service
Auto-Wash
� - Laundry Trays
$15 Issue Fee
8oiler
Duct�UnderGround
Duc[ - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL ICBO # �
Heating System & Ducting
❑6700,000 BTU 0100,000
Reinspectian Fee � $15
CMF 0865-46, rev. 30/84 White - 9uiltling; Canary - Applicant; Pink - Accou�ting; Goltlenrotl - Assessor
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0.�00,OOOBTU ❑100,000
'�ystem Repair/Alteration
Fire Dampers
Registers
luue Fea
$ 3
FEES
$ 3
Auromatic Washer
Cansvuction�Pole Sub.
Cooking Uni[
Dishwasher
lecbic
Zone
Parking ReqJProvided
0
ELECTRICAL ;
Transformer ❑ 15-50 KW
❑ 50+KW
i
Meter �up to 700 amps
Meter �over100amps
' Sub Panel � . ' .
Fan
F,A.U.
Fixtures
Device Boxes
Outlets
Switches
Garba9e Dispoul
Generaror'�0.5 KW 05-15 KW
M�ors OO-1 HP O 1%- 8
Inc.Sofar �9-15 HP �16-15+
Microwave
Pole Light,
Range
Standing Sections
Trash Compactor
Fee � ffi75 � � luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved 6y %� �
BUILDING PERMIT $
PLAN CHECK . $
PLUMBING S
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL � $
PLAN CHECK 25% $
2
O
N
I
N
G
R
E
Q
M
T
S,
FEES
$ 3
SMIP $ • SZ%
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $ �� —
TOTAL FEE $ 3 � •��
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-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 Syst�m 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 PLASTEFiING
18. Rough Electrical-T Bar Ceiling �'69. POOL/SPA SYSTEMS FI�N�,41 . i
19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT ._
20. Rough Factory Fireplace ,: 'APPROVALS Permit# -
21. Ducts, in Structure � ';.•70. Underground Hydro ',� i'
22. Ducts, Ventilating , � ' . 71. Product Piping O Gas O.OiI "�
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. FrameandFlashing 76. DryStandpipe � _
28. Lathing & Siding 77. FIXED SYSTEM FINAL ,„ ' �
29. Insulation 78. FIRE PREV. FINAL r r; �
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 Irripation System ,
� 45. Sound Attenuation
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING / � 9� �
48. Special Requirements Completed
49: Electric Release to Edison
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
. �
No. Date
ADO���ant to /III in all spaces except those within heavy �o�tler Iines anG si9n ali approDriata eeclantions.
IGTY OF COSTA MESA CONSTRUCTION PERMIT ���^^'T nin roerT nin i nr nin i�ni�r.,�.. —
' Project Address ?421 .1 d n St. B ti 1 di n� 1
Applicant's Mailing Address 324 So. Earlham
ow��is ruame James E. Dobrott pno�e �56-2505
Address � g�22 Caaan Suite 202B Irvine 92714
Arch/Eng. LiCenu No.
Address
Contracmr's Name � Fl � i ntt RObF ai ilt nam�,e 997-4938
A.ddress Imai�ingl qa, 92669
Ciry LicenseNo. 3 99s
LICENSED CONTRACTOR DECLARATION
I hereby affirm l�a[ I am licensetl unde� p�ovlsions o1 Chdrter 9(commencln9
witn section 7000) 01 Division 3 of l�e Businesi antl Professions Cotle, anA
mv ��cense is in �w� torce and artect. C-39 465344
License Class L. icense No.
Date �r h 1 ,LQ��ture—C��.L� .�d��—
n WORKEFS' COMPENSATION DECIARATION
�\ � nereby affirm that I have a cerHlicata ot consen[ to self-in5ur¢ Or d CGrti/iwte
' Workers' Compensalion InSurant¢, Or d Certifietl cOPy tnereo/ (SeCtion
oo, �b. c.�571785- State C sation
Policy No. Gompany �n
certitied copy is nereby tumished. InSUTanC2 �]na.
\Certifietl Co y Is filyc� y�i,(h tbe tlty Builtlinq DIvJ51on
oaieT'larr-h i"i� 141fk(PPIi[dnt T i11PS H .1 iOtt
l� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
1� (This section need not be compleletl it the permit Is for one huntlratl (5300) or
less).
1 certify that in the pertormanca oi the work for whlch this perm�t is Issuetl I
shall not employ any perzon in any manner so as to become subject to t�e
WOrkers' Compensa�ion LawS ol CallPomia.
Date Signature
,NOTICE: If, af[er making this tleclaratlon, you shoultl becoma subject to the
Workers' Compensation provisions of Ihe Labor Cotl¢, y0u mus[ fortnwith
[omply wilh such provizions o� thi5 D¢rmit Shall be deemetl ravok¢tl.
CONSTRUCTION LENDING AGENCV
1 hereby af(irm that [here iz a construcclon Ientlin9 a9ency for tne performan<e
Of the work for whic� tnis permit is i55uep (Section 309] Civ. C.)
LPntler's Ndme
LentleYs Atltlress
OWNEH BUILDER DECLARATION
I hereby affirm ihat I am exempt lrom the Contractor's License Law for the
. followinq reason (Section 7031.5 Business antl Professional Cotle: Any city or
county wnich requires a permit to <onstruct, alter, improva, tlemolish or repair
any sVuc[ure, prlor to its issuan<e, also requires ttte appli<ant for such permit
tn file a sionee statement tnat he/slte i5 licensetl pu�5udnt [o Ihe prOvlsions Of
�erefrom antl the basis for the allegetl exempUon. Any vbiation o� eeccion
131.5 by any applicant for a permi[ Subj¢c[5 Ihe appli<ant lo d civil
.<nalty of not more Ihan tive huntlretl tlollars (5500).
❑ I, as owner of the property or my employees with wages as [heir sole
mmpensation, will tlo the wo�k, antl the st�uclure 75 nOt Intentletl o��o(f¢r¢tl
tor sale (Section 7044, Business antl Professlonal Cotle: The Contractor's
. �icense Law tloes not apply to an owner of a property wno builtls or improves
thereon, antl who tloes sucn work hlmselt/nerself or through his or her own
employees, provitletl Ihat such Improvamen[s aro not in[entlatl or otforetl Por
sale. It, however, the builtling or improvement is soltl within one Year ot com-
pietion, tM1e owner will have Ihu burtlen of oroving he/she tlitl not bulltl or Im-
p�ove for the purpose ot Sale).
❑ I, as owner of the proOertY� am exclusivelY tontracHng with Ilcensetl con-
tractorsto conslruct tM1e project (Sectlon 7044, Business antl Profosslons Cotle:
The Contractor's License Law doos not apply to an owner ot proporty who
builtls or improves thereon. antl who contracts to� suCh oroiect5 with a con-
trac[o�(51 license pursuani to tne ConVacto/'S LICBnS¢ Law). I arn aware tha[
proof ol their Worke�'s Compensation in5uranCO zhoultl be provltletl to me.
❑ I am exempt untler Section B. & P. C. for [his reason
Date Owner
I hereby �certify that I have reatl this applicatlon anC state that the above
Intormation is wrrect. I.agree to comply with all city antl tounty ortlinances
antl State laws �elatin9 to bulltling con5truction, antl hereby autho/lie rep�e-
sentatives ot this city to enter upon the above-man[ionatl pro erty for
�f15pCCI�00 pUI zes. 3 �) �
$ignature /.� Date
Drlvers' L cense or 55 9f
TVPE OF CONSTRUCTION LJ NEW LJ AOD l'SJ ALTERATION
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
4ESCRIPTIOPIOF WORK/.USE_OF BLDG. �—Toar nf�
TYPE OF PERMIT LJ GRADING LJ FOUNDATION 12SI STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Mr
❑ OTHER
PROJECT DESCRIPTION Sq.FT. �ti U oCCUaaNCV
CONSTRUCTION TYPE � � VALUATION $ � �� � �
20NE GRADINGCU.YDS. ACRES
Remarks:
Bar Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains �
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink .
Lavatories
P—Trap
Roof Drains
Rainspection Fea
PLUMBING FEES
Showers
Service Sink
Sewer.Cap
Sewer �Connection
Solar Collecrors
Solar Pipin9
�olar Tank '
� �Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tra'ys
$15 Issue Fee $ 3
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust Sys[em ❑ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑ o-� oo,000 sTu O i oo,000
Reinspection Fee � $15
0865-46, rev. 5/88 White - Builtling; Canary - Appllcant: Pink - Accounting; Goltlenrotl - Assessor
Hood or Ty pe I ❑'
Canoov /ivoe 11 ❑
jEFrigeration System
�0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
N.Y. �
S Main Building:
E
T FrOnt
J� Rear
C Right
SLeft
Ping. Ref. �
Planning Notes:
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer Transformer � 15�50 KW
Construc[ion Pole Sub. � 50 + KW
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switch¢5
Garbage Disposal
Generator �0.5 KW �5-15 KW
Zane
Meter LJup to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors DOl HP � 1'h - 8
In�oiar �9-15 HP �16-15+
Pole Light
Range
Sign
$tanding Sections
Trash Compactor
Reinspection Fee I$15 I � Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
2oning APProved By
Building Approved By
� Applitation IssuBd By �
SUMMARV OF
BUILDING PERMIT $ Zi • �U
PLAN CHECK $ �
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
P�AN CHECK 25% $
O
N
1
N
G
R
E
Q
M
T
$.
FEES
$ 3
SMIP $ �
PERMIT
ISSUANCE $ �
ENERG� P.C. $
GRADING $
MICROFILM $
TOTALFEE $ �'3 '3�
�l Oi1028242-ODQ28243 YQT Z's.SD
DATE: 03/13/89 T?fi�: 16:c9
COIV,STRUCTION AND PLANNING POO. . SPA �
APPFS�VALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . 53. Steel Reinfarcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding
.-
5. Steel Reinfprcement �� 56. Rough Plumbing & Pressure 7est
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings : 58. Electrical Conduit-Undrgmd. ;
8. Foundation � � 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe�Undrgmd. � - 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Strucwral 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 Drain< 64. Plumbing System - Final _
14. Rough Plumbing 65. Electrical-Final ��
15. Rough Electrical-Conduit 66. Solar SYstem-Final
�16. Rough Elec[ric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
iS. 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 St�ucture � 70. Underground Hydro
22. Ducts, Ventilating �•� ��71. Product Piping � Gas ❑ Oil �
-.
23. Gas Pipe�Rough & Test ' 72. Underground Flush
24. Roof Framing • j-/¢-d�f 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 3_�s.� 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. F.INAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown CoaI 79. FINAL INSPECTION
32�Electrical Pawer 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 FaaorY Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final � '
41. Solar pomestic-Final , _ � � �
42. Backflow Preventer � �
43. Backflow Irrigation � � . „
44. Landscape Irriga[ion System • %
45. Sound Attenuation , l' �
.i
46. Handicap Regulations I '
47. FINAL STRUCTURE & BUILDING �?� O .
4R. Special Requirements Completed �
49. Electric Releaseto Edison ���^' '
50. Gas Release to Southern California Gas Co �„ •
51. CERTIFICATE OF OCCUPANCY , -
No. Date ��� '
Applicant to till in all spaces except those wil�in �eavY �orticr lines anE sign all appropriate Oeclaralionz.
Ci7Y OF COS7A MESA CONSTRUCTION PERMIT
Project Address 2421 Elden St. Garage Roofs A B C
Applicant's Mailing Address 324 So. Earlham •
�:vngr's Name James E. Dobrott Phone 756-2505
Addressa�BIl%% ��7+ir7n� S,;_L.�tP z�2B Ixvine 92714 )
Arch/Eng. Licenu No.
Address
Contractor's nlamaEll].Ott. ROOf Md1I1t21ldI1C}Q�one 997-4935
Addreu (mailing) 324 So. Edrlh�n, Oranqe, CA 92669
City License No. '7 q 9��
LICENSED CONTRACTOR DECLARATION
1 hereby atfirm that I am licensetl untler provisions of Charter 9(commencing
with section �000) oi Divisian 3 of the Business antl Pro(essions Cotle, antl
my li<enze is in (ull torce antl etfect.
ucense Gass ' �—�A �icense.No. 465344
Date M�rrh l Z r�$ure �
WORKERS' COMPENSATION DE LARATION
� I hereby afflrm that I nave a certiticate ot consent to self-insure or a certificate
f Worker5' Compansation Insurance, or a certi(ietl copY tbereot (Section
300, Lab. C.
Policy No. 717a5 Company S�1te COffI�J2nS tlOIl
� 8�ertifietl copy ii hereby (urnishetl. ZI15UTd1'1C2 F l�Il�
e[trtietl opy �❑Ioq �y{� lhe city B iltling Diy�sla
n Oate r�rC� 1�• 1�4�3plicant ��5 L7. �'LZlOtt
I` EXEMPTION FROM WORNERS' COMPENSATION DECLARATION
(Thissection n¢etl no[ bo com0�etetl if [he permit is for OnC huntlretl ($300) or
lessj.
I rerti/y that in Ihe Oerfo�mance oi the work for which thiz perm�t i5 issuetl, 1
shall not employ any per5on In any manner so as [o become subject to the
Workers' Compen5dtion Laws of California.
Date Si9nature
NOTICE: If, atter. making this tleclaratlon, you shoultl become subject to the
Worker5' COmpensatiOn Provisions ot the LabOr Cotle, you must forthwith
compry wi[h suclt�0�ovi5ion5 or this perml[ shall be tleemetl revoketl.
CON5T0.VCTION I.ENDING AGENCV
I nereby atflrm�that there is a<onstruction lentling agency for the performance
of the work fm whicb thls permiY is Issuetl (Settion 309] Giv. C.)
LPntlar's Name
L.entler's AEtlress .
OWNER BUILDER DECLARATION
I he�eby dffirm [hat I am exomp[ from lhe Con[�acto�'s License Law fo� the
followinq reason (Section 7031.5 Business antl Profeszional Cotle: Any city or
county wnlU requires a permlt to construct, alter, Improve, tlemolish or repair
any Structure, p�lo� to it5 issuance, also reqWres the applitant fOr such permit
to file a 5igneC Statement [hal he/She Is Ilcensetl pursuant to tM1e provisions of
tne ConVactor's �icense Law (Chapter 9(commencing w1U Sectlon 7000) oi
� Oivision 3 of the Business antl Professions Cotle) or that he/she is exemOt
}: herefrom antl tne basi5 tor [he allegetl ¢x¢mption. Any violdtlon of Seclion
' `�]31.5 by any applicant fo� a p¢rmlt sub�ec[5 Ihe applicant to a Civil
'��fi"�nalty of not more than fiva buntlretl Uollars (5500).
"� I, as owner of tM1e property O/ my employees witM1 wagez as �nei� sole
com0ensation, will �tlo lhe wo�k, antl thG structure i5 not intentleG or otferetl
tor sale (Section 7044, Business antl Grotessional Cotle: The Contractor's
License Law tloes not apply to an owner of a property who builtls or improves
thereon, antl who tloe5 Such work himselt/M1erselt or throuqh nis or her own
employees, Orovitletl that such improvements are not intentletl or offeretl for
sale. If, however, Ihe bWltling or improvoment is zoltl within onc year of <om-
pletlon, tne owner wlll have the burtlen of proving he/she tlitl not builtl or im-
�rova tOr lhe purpose Ot sale).
I, as ownet ot the property, am exUuSivery mntracting wi[h licenzetl con-
tractors to construct [be project (Section 7044, Business antl Professions Cotle:
The Contractor's Li<anse Law does not appry to an owner ot property who
bullds or improves [he�eon, antl who contracts fOr suth project5 witn a con-
[ractOr�s) license pursuanLto [he Cont�ac[or'S License Ldw). I am aware that
proof of thei� Wo�ker's Compen5a[ion insu�ance shoultl be provltletl to me.
❑ I am exempt untler Section B. & P. C. for this reazon
TVPE OF CONSTRUCTION LJ NEW lJ ADD PU ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. T ar pff d —rpOf
, 3-T '
T.YPE OF PERMIT GRADING FOUNDATION � STRUGTURAL
� O TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FL ��� nn OCCVPANCY
- CONSTRUCTIONTVPE �/�� VAWATION$ I�OD,
ZONE GRADING CU. VOS. ACRES
� G�4�• �Z
�
Bar $ink
Backflow Preventer
Backflow Irrigation
Bathtubs �
Clarifiers
n���,,....��,o�- .
Drinking Fountains
Floor Drains '
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen $ink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
Boiler
Duct - Under Ground
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w
Water'Hearer
Water Service
Auto-Wash
Laundry Trays
$15 Issue Fee
MECHANICAL '
Hood or Tvpel ❑
CanoPV TVPe I� ❑
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Date owner Heating System & Ducting
I hereby certify Ihat I have reatl [his application ana state that the above ❑a100,000 BTU �100,��
iniormation is correcL I agree to comply with all clty antl county ortlinances
antl siate laws ralatin9 to builtling constructlon, an0 hereby authorize repre- .
Sentatives of this city to enter upOn tne abovB-men[Ionetl pro e�ty fo�
Inspection purpos /I
Signa[ure - � Date l l
Drivers' License or 55 � Reinipection Fee
CMF 0865-46, rev. 10/84 White - BWltling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
$15
i
Refrigeration System
❑o-iao,aooaTu ❑ioo,000
stem Repair/Alteration
Fire Dampers
Registers .
laue Fee
S 3
FEES
$ 3
A.P. �p
S Main Buildi
E
T Front
B Rear
A
C Right '
K Lef2
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construc[ion Pole Sub.
Cooking Uni[ -
Dishwasher
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
Fixcures
Device Boxes
Outlets
Switches
Garhage Disposal
Generator �0.5 KW C
Fae
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 700amps
Meter ❑over100amps -
Sub Panel � .-
Motors OO-1 HP � 7'/: - 8
Inc„861ar �9�15 HP �16-75+
FEES
a
' Pole Light •
Range
Sign . � '
Standing Sections
15 KW Tresh Compactor _
$15 luue Fee 5 3
DEVELOPMENT SERVICES REUUIREMENTS:
Zoning Approved By
Building Approved By
Aooliotion laued Bv—
z
O
N
I
N
G
R
E
Q
M
T
S
SUMMARV OF FEES (/ "
BUILDINGPERMIT $ ��O SMIP $ `'�,
PLAN CHECK $ . PEFMI7
PLUMBING $ ISSUANCE $_
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ ' GRADING $
PLANCHECK 50% $ MICFOFILM $
MECHANICAL $ TOTALFEE $ 2.�•�S'�
PLAN CHECK 25% $ '
� V L3•
OATE: �3/7��29 Tttt�: 16:3R
CONSTRUCTION AN,D PLANNING POOL & SPA
APPROVALS Permi[ # 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�Uydrgrnd. 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 ��
75. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring , 67. Fencing & Access Approval ,
17. Rough Wiring Sign - r �� 68. APPROVED FOR PLASTERING �
78. Rough Electrical-T Bar Ceiling •.6,9. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT l ,
20. Rough Factory Fireplace � � �APPROVALS Permit # �' �' _ ' � �
21. Ducts, in Struaure � 70. Underground Hydro � •�
22. Ducts, Ventilating • � 71. Product Pipin9 O Gas ❑ Oi!
�
23. Gas Pipe-Rough & Test � • 72. Underground Flush
24. Roof Framing . 73. Undergrnd. Storage Tank �O Gas ❑ Oil
25. Roof Sheathing �.ir 74. Overhead Hydro �
26. T-Bar Ceiling (Structurel) & 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 Sys;em �'
-45. Sound Attenuation .
�46. Handirap Regulations
47. FINAL STRUCTURE & BUILDING � 3i �j '
48. Special Requirements Completed
49. Electric Release to Edison � �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -� , )
No. Date �
- ,� , .
i
Apvlicant to fill in all soaces except tnose within heavY OorEer lines ana sign all aoGropriate Oeclarations.
Ci�l( OF COSTA MESA CONSTR UCTION PERMIT PE IT NO. TFACT NO. LOT NO. UNIT NO. A P#
!PFolect Address 2421 Elden S'fSE'E?t
A� �L•anYs Mailing Address _ 3Z�I SO. EdT1I7dIl1, Orange 92665
Owner's Name James & Bette DobTott phone 756-2505
nddress 8022 Cow n ii 0� B � Tn�ina�C'n 9771C
Arch/Eng. �^ � License No.
Address
Convactor's nlama ElllOtt ROOf M3171tP11dt1C�one 997-4938
Address (mailing) 324 So. Earlha[n, Orarige, CA 92669
City Cicense No. 3 99L S
LICENSED CONTRACTOR DECLARATION
I hereby atfirm tM1at I am licensetl untler provi5iOn5 of Chartet 9(wmmencin9
with section 7000) of Division 3 0! the Business antl Professions Cotle, antl
my license is in f II o ce antl eHect.
License class �' � �ic.,en�se ,rv,$,I 465344
Dale �YCYl . nature /��
WORKEkS' COMPENSATION D CLA�
I hereby afti�m thal I have a certiticate of consent to self-insure o� a certificate
�f Workers' Compensation Insurance, or a certitied copy thereot (Section
800, Lab.
vorcv rvo. 1785-89 comoznv - State C�7D2i]SdtiOi
BCertifietl topy is hereby fumishetl. n� anCe ���
Ce tietl opj�%{ /il �y{� the tity B{�iltling D' �� (��i�����(/�
Date �rC� +V�• �7Q�plitanf Uai[12$ 1�-lOt.l -
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl if tbe permit is for one huntlretl ($300) or
less).
1 certiry that in the performanCe oi the work for wnicn Inis perm�t is issuetl, I
snall �not empioy any person in any manner so as to become subject to the
Workers' �Cg�p en�sati�on Laws of Calitomi.y. �, yq„� J(i
Date �/� Signa[ure /fnC�
rvonce:'u, ar[er maumg [ms aenararron, you snowa oecome SUD�CCL w ma
Workers' Compensation provisions ot tne Labor CoEe, you must torthwith
comply with such provlsions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that�there is a construction lentlin9 agency for the performance
oi the work for'whicn Ihis permit is issuetl (Section 3097 Civ. C.)
ttnaer's �Name
Lentler's Atltlress �
OWNERBUILDER DECLARATION
1 hereby at(irm that I am exempt from the Gontractor'z License Law for the
following reason (Section 7031.5 Business antl ProfeSsional Cotle: Any city or
county which �equire5 d Pe�mit to const�uct, alt¢r, imp�ove, tlemolish o� repai�
any structure, o��or to its issuance, also requires the applicant tor such permlt
lo /ile a siqnetl S(dtement that M1e/sne Is IitenSe� pu�sudnt to [he p�ovisions of '
Ihe Gontractor'S License Law (Chapter 9.(mmmencing with Section �000) ot
DiviSion 3 ot the Business antl P�ote55ion5 CoOe) or that he/she i5 exempt
'herefrom antl Ihe basis for the allegetl exemption. Any violation of Sectlon
�31.5 by any applicant for a permit subjecfs tne applicanc to a civil
enaliy of not more than five nuntlretl tlollars (E500).
I❑ I,'as owner of the property or my employees with wa9es as their sole
'�� comoensation, will do the work, antl tne structure is not intentletl or.otferetl
for sale (Section ]044, Business and Professional Cotle: Tne Contractor's
License Law tloes nol appry to an owne� ot a property who bulltls o� improve5
thereon, antl who tloes such work himself/nerself or through his or ner own
employees, p�ovitletl that such imp�ovements are not Intentletl o� offeretl fo/
sale. If, M1oweveq the bWltling or improvement is soltl within one year ot com-
' pletion, tne owner will nave the burtlen of proving he/she tlitl not builtl or Im-
prove for Ihe purpose of sale). -
❑ I, as owner of tM1e property, am exclusively tontracting with licensed con-
tracton to construct the project ISection �044, Business antl Professions Cotle:
The ConVactor's Litense Law does nOt appty to an owner ot property who
builtls or improves thereon. antl who contracts for such oroiects wlth a con-
tractor(s1 hcense pursuan[ ro�tne Contractor's License Law). I am aware tna[
proof o( Iheir Worke�'s Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Section , B. & P. C. for this reason
Date ' Owner
I hereby �certify that I have.reatl this application antl state tltat the above
Information is correct. I a9ree to comply with all city antl wunty ortllnances
dntl state�laws relating to builtling const�uction, antl hereby authorize repre-
sentatives of this city [o enter uqon the above-mentionetl pr perty. tor
-Inspettion purposes. �9
Signature Date 3 �O �
Drivers' Icense or SS �
.� � 7 7 la�
TYPE OFCONSTRUCTION NEW %�DD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. T2� off and re—roof w��
TVPE OF PERMI7 LI GRADING U FOUNDATION �[J STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5q. F7. SOOO sq. ft oCCUaANCv_
CONSTRUCTION TVPE YP—Y'pr1P VALUATION $ 5�nnr
ZONE GRADING CU. V�S. ACRES—
Remarks: ,
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
qarifiers
Dishwasher
Drinking Fountains
Floor Dreins
Floor Sinks
Gas ServicE Outlets
Kitchen Sink
Lavatories
P—Trap
Foof Drains �
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct-Strucmral ,
Duct � Ventilating �
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. iCBO #
Heating System & Ducting
❑ o-i ao,000 eTu � i oo,000 er
(ieinspectian Fee � $15
0865-46, rev. 5/BB WhRe - Builtling; Canary � Applicant; Pink - Accountinq; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Wdi2f CIOSEI
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
5 Main Buildi
E
T Front
B Rear
A
C Right
K . left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
CAokin9 Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A,U.
Fixtures
Device Bozes
Outlets
Switches
Garbage Dispoul
Generator �65 KW �5-15
zo�a
Accessory
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over100amps
Sub Panel ',,.
Motors 061 HP �1'f.-8
Inc.Solar �9-75 HP 016-75+
Microwave '
Pole Light J,
Range
Standing Sections
Trash Compacmr
- Reinspection Fee ! $15 Issue fee
$ 3 DEVELOPMENTSEHVICESREQUIREMENTS:
2oning Approved By
FEES Building Approved By
Ap'plication Issued Bv
$ 3
N
I
N
G
R
E
Q
M
T
S.
FEES
$ 3
+ SUMM y#1F FEES ��)
BUILDING PERMIT $ `VV SMIP $ _ •>.`!
PLAN CHECK $ PERMIT
: PLUMBING $ �SSUANCE $
�. PIAN CHECK 25% $ ENERGV P.C. $'
� ELECTFICAL $ GRAOING $
• PLANCHECK 50°k $ � MICROFILM $
. MECHANICAL $ TOTALFEE $ �
. PLAN CHECK 25% $
Di 00028t149—�,u023Q�0 '�"s�o'�' '2.`(i
DATE: a3/10i89 TInE: r9:12
. 1_• .
�� ' COp1STRUCTION AND PLANNING POOL � 3PA
APPROVy4LS 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 UtilitV-Undrgrnd. � 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVA�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-Trep, 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 Electrical-Conduft 66. Solar System-Final
�rt'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 APPROYALS Permit #
' 21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. ProductPiping OGas ❑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: 3' I 3- �.
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 � �
--r
43. Backflow Irrigation ,
44. Landscape Irripation System �
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE & BUILDING 7� � -
48. Special Requirements Completed
49. Electric Release to Edison ���•
50. Gas Release to Southern California Gas Co � ( V 1 �•
51. CERTIFICATE OF OCCUPANCY '* " ` �
;y. V
No. Date
CITY OF CO
Project Addre
Applicani's N
Aov�leant to fill In all spacez except t�ose within heavY bortler Ilnas ana sign all aDVraO��ate tleclarations.
P�MIT NO. TRACT NO. LOTUJNO. UNIT NO. � i� A P#, 3 -
�..
Address - C'.� V i`�' ✓�`' ". y"`•i -
Contracmr'sName ��"'�- Phone V�Z
Address (mailingl �� ZV -�i M t%`4'�
City License No. �� �� �
LICENSED CONTRHCTOR DECLAftATION
I hereby affirm that I am licensetl untler provisions ot Char[Gr 9(commencing
witn 5ection 7000) of Divislon 3 of the Business antl Protessions Cotle, ane
my license is in tull o�ce ana enect. LErjFi L�L
�icense Class � Lice N
Date ���-b 5ignature
WORKERS' COMPENSATION DECLARATION
`�ereby attirm tnat 1 hava a cerlificate of consent to seli-insure or a certlficate
Workers' Compensation Insurance, or a certitietl copY thereof (Sactlon
�00, LaG. C.)
Policy No. Company
Certi(ietl copy is hereby furnisnetl.
Ce�tifietl copy IS (iletl with [he city Builtling �Ivision.
Date Applicant '
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be compleletl if Ihe permit is for One hund�ed ($300) o�
less).
I certity [hat in [he pe�/Ormance o� tbe wo�k for which thi5 pppp��� m�t is issuetl I
shall noi employ any OersOn In any manner So� az (p be� bject lo the
WorkeryCqmo Uon l.aws o! Cali(orna.� _ j�
Date �] � Si9nature ��� � �k-
NOTICE: It, after makin9 this tleclaration, you shoultl become subject to tho
Wo�kets' ComOe����On p�ovl5ion5 of th¢ Labo� Cotle, you must forthwitM1
comO�Y �+'��h suc� provisions or thiz permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby attirm that there Is a construction lentling agency for tha performance
ot the work for whi<h this permit is issu¢tl (SectiOn 3097 Civ. C.)
lentler's Name
Lenaer's Aatlress
OWNER BUILDEN DECLARATION
1 hereby affirm ihat 1 am exempt from the Contractor's Licensa Law for tne
followinq reason (Section 7031.5 Business antl Protessional Cotle: Any tlty or
county which requires a permit to cons[ruct, alter, improve, Eemolisn or repair
any Structure, priOr �o il5 i55�ance, a15o �equire5 [he applicant f0/ such pe�mil
LO 111E d Sl9flEd SSdICTCl1I Ihdl I�C/SM1C IS IIC¢l1520 pOISOdll:IOIhC pIOVIS�0O5 Of
t�he Contractor's License law (Chapter 9(commencinq with Section 7000) of
;��,ivision 3 ot the Business antl Protess�ons Cotle) or that he/she is ezempt
4:';ieretrom and tne ba5is for the allegetl exemption. Any violation of Sectlon
';-;x<_)31.5 by any applicant tor a permit subjects the apo�lcant to a civil
� iLenalty of not more [ban (ive huntlretl tlollars ($500). �
LI I, as owner ot the oroperty or my employees with wages as their sole
compensation, will tlo the work, antl ine structure is not Intentletl or offeretl
for sale (Seclion 7044, Busin¢ss antl Professional Cotle: The Contractor's
LicenSe Law Coes not aooly m an owner ot a property who builtls or Improve5
thereon, antl who tloes SUGh work bim5elf/Ite�sel( o� thrOugh n15 Or he� own
employees, provitletl that such improvements are not intentletl or offeretl for
sale. If, however, the builtling or improvement is soltl within one year of com-
pletion, lhe owner will have tha Durtlen of Proving he/she tlitl not builtl or Im-
�rOva far the purpOSe ot sale).
I, az owner of the pro0erty, am exclusively contracling with II<ensetl con-
tractors to construct the project ISection 7044, Business antl Professlons Cotle:
The Con[ractor'S LicenSe Law does not aOPly [o an owne� of property who
builtls or imDrov¢5 lhe�eon. antl who contracts �or such oroi¢Ct5 with a r.on-
tractor�s1 Lcense pursuant [o me Con[ractor's License Law�. I am aware tha[
proof o1 [heir Worker'S Compensation insurance shoultl be provltletl to me.
❑ I am exempl unaer Section B. & P. C. tor this reason
Date Owner
I hereDy� certily that I have reai
informatlon is correct. I a9ree to
antl statj, laws relating to builtlir
Senlatives 0/ this c y t
InSpettion put �
Signature
Drivars' License or 55 �
�7 i 300 �
TVPE OF CONSTRUCTION NEW AD� ALTERATION EPAI R
❑ CONVERS} ON ❑ DEMOLISH ❑ OTH€ R!''
DESCRIPTIQNpFWORK/U6EOFBLDG.!�N`� S7IJ � � L�Y
TVPE OF PERNIIT LJ GRA�ING LJ FOUNDATION LI STRUCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION S�.FT. 1 ocCUPAN V
CONSTRUCTIONTVPE �_AJ VALUATION$ O
20NE GRADING CU.YOS. ACRES—
Remarks: }�C �'7-7— S2��L � 7fii20 /�L
Sink
Preventer
Irrigation
Dishwdsher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Serviee Outlets
Interceptars
Kitchen Sink
Lavatories
Roof Drains
Reinspaction Fee
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water CI p
p����
$15 Issue Fae
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. �CBO dk
Heating System & Ducting
❑ o-i oo,000 aru O i oo,000
Reinspac[ion Fee � $15
0865-46, rev. 5/BB White - Builtling; Canary - Applicant; Pink - Accoun[ing; Goltlenrotl - Assessor
Hood ar Type I ❑
Canopy Type II ❑
Refrigeration System
�aioo,000aru ❑ioo,000
System Repair/Alteretion
F ire Dampers
Registers
S Main Building:
TFront ± �
ARear /
C Right �
K
g left
Ping. Ref. #
Planning Notes: (+
0 FOR SPECIAL REi
FEES Automatic Washer
Construction Pole Sub.
Cooking Unit - -
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
� Fixtures
Device Boxes
�iluHets
DispOul
ir �0.5 KW �5-15 KW
�a v
� , Reinspection Fee $15
�
$ 3 DEVELOPMENTSERVICESHEQI
2oning Approved By �
FEES BuildinB APP�oved By
$ 3
zo�a j� Z
Accessory Building:
Z
O
N
I
N
G
� R
Parking Req./Provided E
Q
Qf1D./l LLU, M
_ , n �n•.. _ T
IICAL
Transformer ❑ 15-50 KW
❑ 50 + KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Suh Panel
Motors O41 HP O 1 Y. - 8
Inc.Soiar 09�15 HP �16-15+
Microwave
Pole Li9ht
Range
Sign
Standing Sections
Trash Compactor
Issue Fee
REMENTS:
FEES
$ 3
SUM Y OF FEES
BUILDINGPERMIT $ •�O SMIP $ Q•`r]
PLAN CHECK $ PERMIT
PLUMBING $ �SSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ r�-
MECHANICAL $ TOTA� FEE $ _��
PLAN CNECK 25% $
01 60032692-OQ032693 �G�T i:S.S%
6AiE: OSl10/S4 TIGE= 11:4:
_'CONSTRUCTION AND PLANNING POG SPA
AP�ROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1.•l'�mporaty Electriral Service or Pole 52. Pool & Equipment Location �
2. Soil Fipe-Undrgrnd. 53. Steel Reinforcement -
3. �Electriral Conduit Utility-Undrgrnd. 54. Forms �
4. Electrica� Conduit-Undrjrnd. 55. Electrical Bonding •., ;
� 5. Steel Reinforcement � . 56. Rough Plumbing & Pressure Test '�
6: Electrical UFER�Gcnd. � 57. APPROVAL TO COVER-GUNITE
7. FootingS �� � ' 58. Electrical Conduit-Undrgrnd. .'
8.. Foundation �� i, - 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
�-72. Seiver Cap ' -� . , � 63. Heater & Vent-Final '
73.',Roof'Drains �� •� , 64. Plumbing System - Final �
r
' 14. �Rough Plumbing, 65. Electrical-Final '�
15. Rough Electrical-Conduit 66. Solar System-Final
1.6. Rough E�ectric 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 Heiting & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough F.actory Fireplace ,�; APPROVALS Permit #
21. Ducts, in.Structure 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Te`st �� , 72. Underground Flush
24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil
25. fioof Sheathing 74. Overhead.Hydro -�'
26. T-Bar�Ceiling (Structural) & Monocoat 75. Dry Chemical _�
27. Frameand Flashing y,' 76. Dry�Standpipe „
28. Lathing & Siding �, 77. FIXED SYSTENI FINAL
29. Insulation -• ; 'J8, FIRE PREV.�FINAL
30. Drywall Nailing �-A ,. ja+' � HEALTH DEPT. REQUIREMENT
31. Plastei Brown Coat��, �! � ' 79,,.FINAL INSPECTION
32. Elect�ical Power Mete�-Final�, ; t �'80. FOOD CE�iTIFICATE ISSUED
33. Final'Electric -�� ' Notes: ' `
34. Final Heating & Air Conditioni'ng '�.
1�
35. Final Gas Pipe-Test . � . �f
� ,.
36. Hood or Canopy '-. �"
37. Final FaMory Fireplace � �
38. Final Plumbing i � �
39. Water Service-Final ` _
40. Gas Service-Final - , '
, 41. Solar pomestic-Final • yf
42. 8ackflow 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-' . � -
r
50. Gas Release to Southern California Gas Co �<' � ''�
51. CERTIFICATE OF OCCUPANCY -+. - _ •
No. Date � -• ' 1
PPCIECT'A00.SESS: z 4? 1 .FLD EN AV � •
OWNER'SNRME: �SSEX. REALTY MANAGtiMENT . �
nooeess: iII022 COWAN #202A
;• `.` IiZVINE, CA 92714 '
' �" ' 756-2505
, RNCNWNGINEEfl: � ' � ' flE0.N0.:
nooxess:
- PEflMITTEE: ESSEX REALTY MANAGEMENT' �( 71.4 ) 756-2505
RDOHE55: 18t)ZZ COWAN ��iH
� IRVINE CA 92T14
110ENSEU CONiP1CTOB OECLAMTION: I �ere6y atlirm that I am licensea under pmNsions ot ChaD�ar 9(com� encing witA Section
7000) ot Oivision 3 ot the BusineSS.and Pmfeuions Cade, an0 my license is in full force an0 eflect.
CITY LIC.: STRTE LIC.: ' CUSS:
Oate: SiAnature:
WOPHENS' COMPENSFTION �ECIAMTION: I �ereby affirm that I have a cenificate of consent to self-insure or a certificate of Workers'
Compensalion�lnsurance, ar a certifie0 copy the2of (Section 3800, Lab. C). �
POLICY NO.: EXP. ORTE: •
COMPRNY:
❑ Certifie0 copy is herehy fumisAeA. ❑ CerlttieE copy is f1eA with the ciry Buildinp Didsion. � ,
Daie: y Applicant: . . . . � •J�"'
E%EMPTION FBOM WOflNEflS' fAMPENSRTION OECUMPON: (ihis i eed noi be wmpleteG if Me permii ¢ lor ane hunOreO ($100) or leu�.
I ceRity Ihat in the pedofmance of �he work for which Nis pe ' ue0, I shall no� employ any person in any manner so as to Cecome
suDle�� m tAe Workers' Campensation La af Califor' .�ti
Oate: � 'S— � Signature:
NOTICE: If, atter makinp Ihis Declaration, you s�au 0 �e ome sublect to the Worke'rs' ComDensation
CoOe, you must fortfiwith comply wit�'suc� Omvisions or tNs permit shall 6e deeme0 revoked. .= �
CONSiRUCTION LENOIN6 �GENCY: I herehy aflirm Ihat Nere is a consimc[ion lentling a0ency fonthe'(
which this permit is issuetl (Section 3W7, Civ. C). �"�
LENUEfl: ' - �
' pODXESS: , - ' " • -" � '
ie LaDor
[he wark fot
OWNEWBOIL�EB OECIAMTtON: I �ere6y attirm that I am exemD� �rom Ihe Contractars' State License Law foi Ne fallowinA reasan
(Section 7031.5 Business an� Profeuional Caae: My ciry ot counry which 2quires a Dermit to constmct. alter, impmve, demolish, or
repair any swcWre, D�o� �a ils issuance, also requires Ne aDPlicant for such permit to fila a siA�ed statement fhat he/she is Iicense0
pursuan� �o [he pmvisions o� the Con�raciors' State License Law (Chapter 9(commencing wi�h Section 7000) o� Division 3 ot �he Business
anE Pmhssions Cotle) or thai he/she is ezemp� therefrom and I�e basis �or the allepe0 evemDtion. Any violaiion of,Sec�ion 70315 Uy
any applicant 1or a De�mit suGiects Ne aDPlicant ta a civil penalry oi not moa ihan five hundre0 tlollars (5500).
I, az� owner of ihe pmDeM or my employees with waAes as tAelr saie, campensation, will do the work, and the
❑ structure is no[ intendeA or oflere0 for sale (SecUon 7044, Business an0 Prolessianal Cotle: ihe Coniractors' Slate License Law
Coes not apDh ro an owner of a pmpeM w�a builtls ar impmves t�ereon, and wha Eaes such woM himself/herulf or tArouAh
his or �er own�employees, provideA that such imD�ovemenis are not intentlea or offere0 for sale. If, however ihe builtlinA or
impmvement is so10 within one year of completion, ihe owner will have ��e Durden of pmvinp he/she Ai0 not UuilU or improve
for t�e puryose ol uie�.� ' � . . � _ ,
I, as owner o1 ihe property, am exclusively caniractinp with licensetl contractors to construct ihe Droiect (Section 7044, Business
�' and Pmfessions Code: Tha Contrzctors' State License Law tloes wt appry Io an ovmer of pmDeM who �uiltls or improves tAereon
ana w�o toni2C�5 �of Such proiecl5 wii� a coniractof(5) liCense OursUam to [he ContraC�ors' Sta�e LlCense Law�. I am awaf¢
t�at prool of Neir Worker's Compensation insurance sAou10 be Drovidatl m me. .
� I am exempt under Section: B. 8 P. C. ,
. �or �his reason: � �
Date: /���_ �� I �Owner
I Oo hereby ceniTy that I am aware of anE unAerstan0 the requirements Califo nia Healih an0 Satery CoOe Sections 25505, 25533, ana
2553d antl ��at I orany fuWre builtlinp accupant wilUwill nm (circle one) nee0 to comply with ui0 state cotles antl the reQuirements for a
permtt for cansimction or mo0ification /mm ihe pir Oualiry ManaOemenl Distnct. Fesitlential consimction ap0�ications are exempt fmm
these pmvisions. ' .
Oate: ApDlicant:
I AereUy certity ihat I Aave rea0 ihis application ana state tAat th e iniormation is wrrect I agree ro comply wft� all c%y and counry '
ordinancesanAstatelawsrelatinA�ahuilOinAcanstmctlonan authonzereDreSentativesoithisciryroenteruDonihea�ove�mentionetl .
propeM �orins^Dection Durpases. �
�, Dare: � d S'� �D � siqnat , � ,
i oriver's License or Socia� secunry •
186146 Whita—Builtlirw: Green—Cotle Enbrcement: Cenerv—ApD��canl; Pink—Revenue; GOltlenraE—Asseswr
.• CITY OF COSTA�MESA — BUII,DiNG PERMIT PERM NO: BEP 045�3J
PERMIT NO: BEP 045$33 . PLAN CHECK..NO�; 024]7-90�5 ' GOVT: N SUPP: N
CONS'fRT7C'tION TYPE': V—N PERMIT TYPE: ELE PI,U ST'R . PURPOSE: ALU
JOB DESCRZPTION ; ADD 94SF L'AUNDitY ROOM • SQ FT: • 99�
.CI,AIM C�ALUE: 2.;500.00 CALc:--VAI,UE; '• 1,626.20 GROUP OCC:� R-1 / �,,
. . . . . e�,,.
COMMF.NTS : .
x�����*�•x�x�r*��rx***�r**�**x-*+��**�*+�**��+��x����r*+r**x��+��r*�***#*��+r*��***�*r�x�*���*�*�rx
, Z O N I N G' R E{� U T R E M E N T S
s E T� A c x s
-----------• MAIN DUILDING --------`— --------- ACCESSORY BU:CLDING ---------
FRNT: FT IN REAR: FT .; IN FRNT: 65 FT IN RL•:AI2: 291 FT 6 T.N
LEFT: FT IN RGHT: FT. ZN LEFT: F'T IN RGHT: 5 FT IN
�
PARKING REQ: PROV: PARCEL: 43928139 ZNE; R2 �REF NO:
PLANNING NOTES> 33.6 SQ.FT. LAUNDRY ROOM TO BE ADDED TO 'fHIi OUTSZDE OF AN �
- > EXTSTING GARAGE, � - �
+�+��***+�*+r*+��c.�*�r���r+�� *�x�**����+����r+���r****�� x�*�x�**���r�**ir�*�*x*�*�*****�**��r+�*�*�
' D E V E L O P• M'F �N T S E;R V I C E S� R F.•. Q U I R I' M E,N'=T' a
�ZONING APPitOVGD-..HY ___ _ �J`7I` __ DATE: ���— IC7
I AOILDING AP.PROV,EU HY :_: - :'. ��__,_• • _ DATE: "
APPL:CC'ATION ISSUED BY: ' ` '' ,n? ZS /, < DA'TF•.: ��-� � `0
iFiE 1E if iE it * 3E%�E iF it iE j�if 1E fE iE iE iF !k iF�iF�����i�"3F��iF7F3F'3FiF 3�FSFiFiE�FTFiFif�'�-iF�F?FiF ik �F iE iE if-jE 1E iF iE� ��if i�3F iE-
if if• iE 1F ik iE iE iF 3k iF )f iF i(}iE fk iE ik it 1F # 3f jE iE if 1E iE IE ik iF iP �N� iF it it iE fF if dE IF iF �%3F if if ib iE IF iF if if ik 3F iE !E �% # iE if K i6 k� iE 9E iE 1E IE 3E iE �%� 3F iE iE IE 3E jE iE dE iE 3E
LEGALI7ATION:N F'E E S U M M A R'Y, 5TRUCTURAL,SEGMENT:Y
BI,DG PMT PL[7MHING ELECTRIC .MECFIANICr^ FSRE ' SMZP/RES GRADING
PERMIT � ' 39.00 2. 00 ' �6.'75 ' ,^ � �' ' . Sp
258 508 • � .; �« `"�, ' SMIP/NON—RF•.S
'i PI�AN . .. . 25.35 " ,(' : ,,� F
ISSUE FEE 3.00 '1'S.UO "' %'
HUILDING—DIV-> PERMIT ISSUF.. I�L'AN—CHLCK ; tr' TOTAL r PAIll DUE
'POTALS----? 48.75 18.00 25. 35, . �` ;�.1.'60",:r . 91 .60 .OU
. . ; ` ,,, ; ;. ; ,
KEVENUE DIV7.STON TOTAI�S--> COLP.ECTED:� ' 9�1'.60�,:OVER'/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE..SMIP/TUT GRADING PLAN—CkIT'CIC
39.00 5.00 21:75 (� i,.5 '� -SO 25.35
if iE ik 3f iE iE i( 3f iE iE iF k iE �If iE �E iE iE �lE iF 3E 1E i� jE �E iE if if 3! iE if 3E i6 �iE iE �E iE fElE iE 3f rt iF jE if if ii'IE # iE�%�k iE if iF k ik jE iE iE # iF If%iE jE it iE iE �1P iE iE jE iE df % iE
S N 17 I V I P U A'�`li� F E E B A�: A' K D O'Td N
v`� � !
TYPP QTY D E S C R„ I P T I�" N . �! UNIT COST TOTAL COS'f
/•�'y.�.
SFR 94 ' RES—LAUNDRY RM. APT COMPLX. TYPE V-N.� 1%.70 1,,626.20
EI.F �2 '' PIX'PUR6S, LTGHTING •,1 ST" 20 SA. '" '..75 1. 50
�ELE 3' •RECEPT/OUTLET ' 1 ST 20 'EA.: , :75 2,'l_5
ELE 1 RES APPLIANCE NOT'OVER 1.0 HP','% :f:00 3,Op
PLU 1 LAONllRY"tOFI OR WASA�R —!� 2,00 . 2.00
'E�ND OF F$ES • � ;
' , .w �a i - �'t1 �I .i.• . .
I i.' r�
;%'` • .
�
/`4� �}• ' � � �� I
� 01 Caa�2582-0�?052587 TnT g1.3Q
DA7E: Q1/25/90 iIt1E: OS:34
. _ . .tt`k�.�ei
- CONSiRUCTION AND'PLANNING - . , P��L & SPA . -
� Date Ins ector . Date Ins ector
� �.^�F'?RC�J�ILS Permit # - P APPROVALS Permit # _ P
i
%^ 1.'Temporary Electrical Service or Pole �� 52.' Pool & Equipment �Location � ;"?
n
�
�21._.Soil_P�ipe�Undrgmd._ � � � 53. Steel Reinforcement jv • ��
,
�'ElectricalCond�uit,Utility-Undrgrnd. . �� 54. Forms � � �� J
�- 4° Etectri�al Conduit-`Undrgrnd. � 55. Electrical Bonding a
H15'CSteel Reinforcemey t � ' .. 56. Rough Plumbing & Pressure Test �� q�i
p�.�..- �
.,...6.�Electrical UFER Grnd. � � � 57.� APPROVAL TO COVER�GUNITE a
- e,; 7. footings "` � �� � 58. Electrical ConduirUndrgrnd. ' f�'� o
^;8.v:oundation �?• � ;��� � 59. Gas Pipe, O Undrgmd., Test � �� ✓
�' L�1
9�:�Water Pipe-Und�grnd. ,� �� 60. Backwash Lines, P-Trap, O Undrgrnd/ � �
��
�70. Structural FloorSystem 67. APPROVAL.TO DECK �i�A � .
1't'. Property Sewer`Line:& House Connection 62. Backwash & Receptor.Final %1 � '
. . .
12. Sewer Cap a� ` 63. Heater & Vent-Final � � '
_�
13. Roof Drains �. V . 64. Plumbing System - Final � ,
14. Rough Plumbing � �� 65. Electrical-Final ��� '
15. Rough Electrical-Conduit ' 66. Solar System-Final
�_
78. Rough Electric�Wiring " (�� 67. Fencing & Access Approval � �
� 17. Rough.Wiring Sig� ' 68. APPROVED FOR PLASTERING ' .
��..,
18. Rough E�lectrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL � -
�
19�Rough Heating &rA%ir Conditioning ,� �� ^ T � w* y �FIRE D,EPT. REQUIREMEN�T _i
' � �=.
[s' ' � ' T. '"i >X :J a ..... � Hr.�;^ 'tt �� ^ ti-� �
20:�Rou9h F.actoti,y Fiieplace , S ; �,e s �, C,A * =APPROVQIS f.,;.,Permit #. � _, �. M-,
21!-Dubts, in.Str�ctu�e�� �•' •' '-�S �u S d �70. Underginund Hydro �
c. . c m `e:+ n r .� S<
r�: r i � J� r. � •y'- :: : .-.. ." .
22.-Ducts, Ventilating�� � �� ., r� � r Y,rt -� - 7�, product-Pi'ping O�Gas ❑;Oil
23.�GarPipe�Rough & Test � ?!� X R. G' Q- n� >.< -+7z. Undergroynd Flush�`� _ �: �
24:R.00f Framin '� � �"�' ' " � . --' .
9 , �,:� j �� �..,.� � � 73�Undergrnd. Storage;Tank�O Gas ❑ Oii��� �
� 25.�floof Sheathing . . �v�'Z _t� - .! � r7qy0verhead Hydro:'r � �
Y • . 7
26: �T�Bar Ceiling.lStructural) &-Monocoat; _` .;; � � � .� ; x 75=Dry Chemical _ -i ' " K, �� �:.,:� � .
27��FrameandFlashing pc'.r ��� � 'i+ m�r 76 DryStandpipe v= -'� .
.n
�28: �Lathing'�& Siding ^` n. .j,�� i;G�^ i; { •� •'i '•w y; 77C FIXED SYSTEM;F;INAL; �_ j � .'�-.: '
�29. Insulation v � J 5` •�!��� �- �'RO �;(�/�-y 7g,tiFIRE PREV. FINAI. ^� n. ;�,"�„F"
''30. Drywall'Nailing �,� `���Z,3-� �`� _o.t ,��NEALTH;DEPT:R'EQUIREMENT;�'
,{ • . •���.. tJ� • ' ` r '"'tvV
� 31. Plaster Brown Coat{c 5 �"� � <Lt �Z7 -'79. FINAL INSPECTION� � `.=� .
-Ro. �u� �, .
�32�,Electrica`I Power Mete`r-Finai, S'�' N i � k��80�'FOOD CERTIFICATE ISSUED_ "� "'1
�,33.�Final Electric� r n aj+ '�� � �Notes: � '' �-` ��]:':9Q
C;34"Final Heating & Air�Conditioning� r�'� `� � � X �^"� �`� ^ _� '` ` � - ^'=
ID r, .; - t*MO x7 �� �;�o o, -J' ., p-1�4,
'�35rFinal Gas Pipe-Testi; � � �: L`"'^, �; .i I � _ � � y �ii �:�� �n:�,' r+
�
��',-36SHood or CanoPY * Cn � � ,� a:... ` �1 �'.. . •�� y �„" ^ ..� r � v � �.. �
.�;, e 1.. <r
�. L, �, � �� � J�' W .c iJ v' m . a-�...
�+-37..Final Factory Fireplace�, -,c, . � i. `^7� iY � D i� � >� .'
n
T,38=Final Plumb`ng .. f+�y ''� ' �� �/P�'; � =- `"� �' : � ` -
�n - � •X " ..� 1' i� {- r r+. G
�+ L M r` ' rC 4 �_ �c .T. :i � ' ' �+ �
39�Water Service�FinalK � _ 1 � r „ �� - ' ,� /
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F41�Sola� DomesficFinal" ;.„ Y':� � � � �' �� . _ -,_
42. Backflow Preventerr . � - � -
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43. Backflow Irrigation, � '- � , � • ��,���
- 44. Landscape Irripation System"'" - - � '' - - � � _ - ' '
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45.-Sound Attenuation - ; t � ' "' - �� _ - �' : `
�46.�HandicapRegulations � ' '� � ' . - � � - � �
�47.-FINAL STRUCTURE & BUILDWG - (fO `'
48..FINALPLANNING - � •� � ' ' '
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49.-Electri`Releaseto�Edison ' �, ;� - ,- ' �
�r 50: Gas:Release to Southem California Gas Co '_ - - '' '
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� 51. CERTIFICATE OF OCCUPANCY � ' _ ' �- � -�
No. Date