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Home My WebLink About2335 ELDEN AVE - Building Permits (9)PERMIT TYPE � � J � 7 CITY OF CO�TA M�SA BlIILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvrH.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER. M07-00571 JOB ADDRESS: Vicinity: SQ. FT: 0 MECH �' �� U � 2335 D ELDEN AV CM �`STATUS: �D`ATE ISSUED: �,ISSUED BY: Suite/Unit: D ISSUED 1 211 3/2 0 07 SOK SCOPE OF WORK: REPLACE.FAU < 100K BTU IN UNIT D LOCATED IN THE ATTIC. � OWNER: HIRAMOTO, DOUGLAS H Address: 2335 ELDEN #D U�it: PHONE: .�� City/State/Zip: COSTA MESA, CA �- APPLICANT: HIRAMOTO,THERESA . � ... Address: 2335 ELDEN AV Unit:UNIT D PHONE: 949-642-7386 � .- City/State/zZip: COSTA MESA, CA � CONTRACTOR: OWNER-BUILDER Address: Unii: � PHONE: � CitylState: ZipCode: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: , $0.00 INVESTIGATION FEE: - $0.00 REINSPECTION FEE: � � � . $0.00 TOTAL FEES: $38.30 License No. 000000 CELL: NOTICE: The work authorized by this permit shall comply vrith all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. COUE/, INSPECTIONTYPE OR INTI7IRL CQOE� INSiECTI0N1YiE DATE IN7111A� 1818 Fized System Final Fire preventbn 206 Final Mechanical �� I O_ O� � 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electntal 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition " 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATION: � ( . I hereby aNirm under penally of perjury one ot the following tleclarations: ❑ I have and will mainlain a certificate o( consenl to self-Insure for workers' compensalion, as provided for by section 3700 of the Labor Code, for the peAormance of the work for which lhis permit is issued. ❑ I have and will maintain wnrkers' compensation insu2nce, as requiretl by section 3700 of the Labor Code, for the peAormance of lhe vrork for which this pertnit is issued. My vrorkers' compensation Insurance carrier and policy num6er are: Carrier: (ilvs seppn nenY nof �e cpndete0lMe pem�i is valuetl al me hunpred Wlars f5f 001 n kssJ Policy Number: ❑ 1 certify that in the peAormance of ihe wnrk for which this pertnit is issuetl, I snall not employ any person in any manner so as to become subject to the workers' wmpensation laws of Calitomia, antl agree that if I should become subject to the workers' compensation provisions of Seclion 3700 of the Labor Code. I shall torthwith comply with these O�ovisions. Appli�'anfs Sgnature Oa�e WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed untler provisions of Chapter 9(commencing vnth Sec[ion 7000) of Division 3 of the Business and Professions Cotle, and my license is in (ull force and eftect. Lic. # Class # Cwlrector's Signawre Date CONSTRUCTION LENDING AGENCY: ❑ I herehy affirtn ihal there is a consiruction lending agency for the peAortnance of the Mork fa wfiich this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Adtlress: Signalure Da�e OWNER-BUILDER DECIARATIONS: 1 hereby aKrm Ihat under penalty of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor Ihe following reason (Sea 7031.5, Business antl Professions Cotle: Any city or county which requires a permit to consWct, alter, improve, tlemolish, or repair any slNcture, pnor to its issuance, also iequires the applicant (or such permit to file a signed stalement [hat he or s�e is licensetl pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 0� lhe Business and Pro(essions Code) or that ha or she is exempt Iherefrom and ihe basis for ihe alleged ezemption. Any violation of Section 7031.5 by any applicant for a permil subjects ihe applicanl to a civil penalty of not more than fve hundretl Oollars ($500).): ❑ I, as owner of lhe property, or my employees with wages as their sole compensation, WILL DO TME WORK, antl the stmcture is not intended or oRered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, provided that such improvements are not intended or oflered for sale. If, however, the building or impmvement is sold within one year of completion, Ihe owner-builder will have the burden o( proving that he or she did not huild or improve for purpose of sale.�. �I, as ovmer of lhe property, am EXCLUSIVELY CONTRACTING WITH CENSED CONTRACTORS to constmct Ihe project (Sec. 7044, Business and Protessions Cotle: The contractors License Law dces not apply to an ovmer of propeAy wfio builds or improves thereon, and who contracts for such project with a contracta(s) license pursuant to Ihe Cont2ctors License Laws.). ❑ I am exempt under set. Business and Professions Cotle for this reason: �Q -- h� .._1- ..3 0 r Sgna�we-. '��...W „ 1 ` ate 305�.4$'(�107� 1'._/ T �' Owner ID venfied Cy drive/ rExoires:. ,� � fication of Ovmership by (rype of documen�= property fax bi I or tleetl): DIVISION OF tNDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certdy that no excavation frve (5) or more feet in depth into which a person is requiretl to descend, will be made in conneclan with work authonzed by this pertnit, and that no building sWcture, scaffdaing, falsework, or demolition or tlismantling thereof, will be more than thiriy-su (36) feet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, Tille 8, Cali(omia Atlminislrative Code). ❑ As owner-builder. I vrill not employ anyone to tlo work which vroultl require a permit from the Division of Industrial Safery, as noted above, unless such person has a permit to do such vrork from lhe division. Appiwm's SignaWre Division of Intlustrial Safely Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fulure builtling occupant need to fle antl certify a Business Plan for emergency response to release or threatened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 of the California Health and Sa(ety Code requires, with some exceptions, that a Business Plan be filed vnth lhe Costa Mesa Fire Depahment by every business which has at any one time during a reported year a quantiry of hazardous materials equal to or greater lhan a weight of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas al standard [emperature and pressure). 2. Does or will the applicant or present or fuWre building occupant need to file a regislration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health antl Safety Code, with some exceptions, requires reqistration with the Costa Mesa Fire DepartmeN by each business which at any one time has on hand a quan[ity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standartl temperaNre and pressure). 3. Does or will lhe applican[ or present or fuWre building occupanl need to pre0are an RMPP (Risk Management and Prevention Program for acu[ely hazardous malenals)? ❑ Yes ❑ No (Seclion 25534 of the Califomia Health and Safety Cotle pmvides that the Costa Mesa Fire Department may require t�e preparetion, certification and filing wiN the Fire Depariment of an RMPP by businesses which are required b register acutely hazardous materials with Ihe Fire Department. 4. If an RMPP is presentty required, has Section 25534 of the Califomia Healt� and Safery Code been fully complietl with? ❑ Yes ❑ No 5. DoeS or will the applicant or present or future building occupant require tor the work which is the subject of this application a permit for such construclion or modifcation from the South Coast Air Quality Management Distnct or from any other air pollution coNrol disMct or agency? ❑ Yes ❑ No (Section 65850.2 of Ihe Califomia Govemment Code requires that me requested infortnation be fumishetl on applications fv non-resitlential building permits). 6. Will any parl of lhe faciliry ro be consWcted under this permi[ 6e within 1000 feet fmm �he ouler boundaries of a school? 0 Ves ❑ No Qf'yes", the (acility must meet the requirement of Sections 25534 antl 42303 of the Califomia Health and Safery Code). 7. If a permit (rom the South Coast Air �ualiry Management District or other air polWtion contml district or aqency is required for Ihe work which is Ihe subject of this application, have all of the disclosures prescnbed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes", attach certificate of compliance from the appropnate air pollution control oRicer). CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the intormation given above is covecL I agree to comply with all state laws'and city ordinances regarding Hazardous Matenals and Emissions. SignaWre Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cerlify under penalty o( perjury that I have read this application and state that ihe information qiven is correct I agree to comply with all state laws and city ortlinances relaling lo building construction, and authorize representa[ives of the Ciry of Cosla Mesa to enter upon the above-describetl property for inspection purposes. I agree not to occupy or allow occupancy of any building aul n ed �y this permit yn{il final inspecho -2�-'f sV�Q/`J"� .�.2. _3 0 'i �Signatu��ol.Lagal�Owoer(e1°'^"t'�` � Da�e � 1 MOIorAulM1onzeEAOp�i�an1 Ddle . , ; CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICE$ DEPARTMENT Transaction Receipt Date: 12-13-2007 ACTIVITY NUMBER: M07-00571 SITE ADDRESS: 2335 EIDEN AV Unit / Suite D APPLICANT: HIRAMOTO,THERESA 2335 EIDEN AV UNIT D COSTA MESA, CA 92627-1592 949-642-7388 OWNER: HIRAMOTO, DOUGLAS H 2335 ELDEN #D COSTA MESA, CA 92627-1592 TYPE: CONTR: `�/ �� t% � � ._� . � OWNER-BUILDER STATELICENSE 000000 CITY LICENSE TOTAL FEES: $38.30 TRANSACT. AMOUNT: $38.30 BALANCE: (PERMIT FEES) $0.00 PAYMENT METHOD: Other NOTATI ON: � TRANSACTION RECEIPT DETAIL INFORMATION FOR TREASURY: 2015 Mechanical Fee 0270 $38.30 6000021302 SOK B000021302 Building Division (714) 754-5273 • Code Enforcement (714) 756-5623 • Planning Division (774) 7545245 FAX (714) 754d856 • TOD (714) 754-5244 • w�w+.ci.wsta-mesa.ca.us � .. � _�.o • ApPlicant to flil in all ipaees except ihose within heavy �ortler lines anE sign all appropriate tleclaratlons. Ci.rv OF Cosra MESn • CO/N—ST/RUCTION PERIVIIT Project AAdress �� (' � a YY � �_ � Applican�'S Mailin ddress�}. %.3�� %.o �u_LYJGY_�jC�� ' Owner'sName n��C�1r0✓i-' Phone Address � �% / � r �j �//v5 � -( �V �� Arch/Eng. �icense No. Address Contracmr's Name � Phone �6 2zf�' Addresslmailing) ��11 �Q Y((.�rC� 4u �� i• City License No. �-%�Q�ib LICENSED CONTRACTOR DECLFRATION I hereby afti�m [hat 1 am licensetl untl¢r p�ovisions of Cha�ter 9(commencinq with section �000) of Oivision 3 of the Business antl Protessionz Cotle, antl my Ilcense is in f W I force antl etiect. License Clazs License No. Datc - � Siqnature WORKERS' COMGENSATION DECLARATION ' hereby a<firm that t have a certifica(e of consea( to sel:-insure or a certiticate � Workers' Compensation ,Insurance, or a certifietl copy thereot (Section J00, Lab. C.) - � Palicy No. � Com y ❑ Certifietl opy i hereby furnishea. '' ❑ C y ' 0 with the city ' i5m . Date APO��n[ � � EXEMPT ON F OM WORKERS' CO NSATION DECLARFTIO (Thi55¢ction n tl not Ee comDletetl it the permit IS fo� ane �untlretl 300) Or Iess). . ' I certity tha[ in the petfo�mance of the o� Ich i pe �t i5 i55uetl"1' sball not e ploy ny p¢�son in any n e� so . o' m subject to t�fe Workers' en o Laws of Calif . ' Date � SignaturC 'NOTiG t, aR akmg this tleclara o, you shPWa become sub' ct to the ' Workers' Com ensalion provlsions ot lne LabOr Cotle, you must forlbwith comply wilh sucn proviSlOnS or IhiS p¢rml[ Shall be tleemeG revoketl. CONSTRVCTION LENDING AGENCV ' 1 hereby,affirm t0at there iz a Wnitructlon lendin9 a9ency tor the periormante of tho work tor which [hls permit. is issued (Section 309] Civ. C.) �entler's Name Lentler'z Atlare55 � - OWNER BUILDEH DECLARATION I hereCy affirm that I am exempt trom the ContYactor's License Law tor the followin4 reason (Section 7031.5 Buslness antl PrOfe55ional Cotle:.Any dty or rnun�v wnirn .wnuvex a eermlt to construtt. alter. im0�ove, tlemolish or repair � lo tile a signed statement tnat ne/sne is ncensea pu�amu� � u� v��•�•�� the Contractor's Ucense Law (Cnapter 9(commen��n9 �+itb Section ]000) of Oivision 3 of fhe Bu51ne55 antl Profe55ion5 Coae) or lha[ he/ihe i5 exampt �erefrom antl tne ba515 tOt tbe allegetl Cxemption. Any violation of SectlOn J31.5 by any applicant for a p¢rmit 5ubjecl5 ihe applicant to a civll ,,enalty of not more than five hunOretl tlollars (y50o1. ❑ I, as owner of tha oroperty or my emo�oyees with wages as their sole componsation, will ao th¢ wo�k, antl the slructure i5 not Intentletl Or oll¢rCtl /or sal¢ (Section 7044, Business an0 PrOfO55iOPdl Cotle: The Contractor's license Law tloes mt apply [O an owner o1 a properry w�o builtls or improvos Ihcreon, antl who Ooes su<h work himself/hersel� or through his or her own employees, provitled that such improvements are not Intentletl or offeretl for 581e. If, how¢ver, Ine builtling or Improvameni is Soltl wi[hin one year of com- pletioq [he owner wlll nave tbe bur�en Ot prOvin9 hC/She tlltl nof builtl o� Im- prOve fo� the purpose Of Sale). . ' ❑ I, as owner of tM1e property, am excWsivery cOntrac[ing witb licensetl con- t�actorsto construcl tha p�oject (SeGtlOn 7044, 6UvnesS antl Profe55ians Cotle: The Con[raCtor's License Law tloes noi aPPly ttl an owner Ot 0/operty who builds or Improves thereon, antl wha contracts for such projects with a con- tractor(sl license pursuant�[o the ConttaclOr'S LiCense Law). I am aware that orooi of their Worker'S Compmsation insurance shoultl be provitlGtl [O me. ❑ I am exempt untler Section B. & P. 0.!or [his reason Date Owner I heieby cer[ity tM1at 1 have rea �nformation rs mnect. I agree to antl state laws ing to builtlir sentatives o/ is a to r Inspection Ou 5. Signature Drivers' License o 55 � iF 0865-46, rev. 10/84 �n antl state that the above city antl wunty ortlinances dn0 hereby authorixe �epre- �ve�mentionetl orooertv for TVPE OF CONSTRUCTION ILI�RIEW IJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. / TVPE OF PERMIT GRaDiNG ❑ TENANT '� ELECTRICAL ❑ OTHER I�fOVNOATION LJ STRUCTVRAL PLUMBING ❑ MECHANICAL l PROJECT DESCRIPTION Sa. FT. oCCUaANCv CON STRUCTION TYPE VALUATION S_ ZONE GRADINGCU.YDS. ACRES_ Remarks: I"/� � Bar Sink Backflow Preventer Backflow Irrigation Baihtubs . Clarifiers Dishwasher � � Drinking Fountains Floor Dreins ' - Floor Sinks I GasService �Outlets Interceptors � Kitchen Sink � Lavatories P—Trap Roof D�ains � Reinspection Fea � $15 Duct - Under Ground Duct - Struc[ural Duct - Ventilating ' - - Exhaust System ❑ MWtiple � Firepl/Fact. Blt. IC80 # Heating System & Ducting ❑ai oo,000 aru O i oa,00a e� Feinspection Fee � $15 . __ _— — .__ ._. _ White - Bulltling; Canary �%�POlicant; Pink - Acwunting; Goltlenrotl - A55¢sso� Showers Service Sink � Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Waret CIOSei Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hood or. Type I ❑ Canopy Typell ❑ Refrigeration System Oaioo,000eTu ❑ioo,000 System Repair/Alteration Fire Dampers Regisiers Issue Fee FEES $ 3 FEES S 3 A.P. �p S Main Building: E T Fron[ B Rear A C Right K g Left Ping. Ref. �h Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit - ;'^ •Z�_�4. . � �• — " _ Accessory Building: ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Oryers UGas VElectric Fan ti. F.A,U. Fixtures Device 8oxes Outlets Switches Garbage Disposal Generetor �0-5 KW �5�15 KW Meter ❑up ro 100amps Meter �over700amps Sub Panel Motors �0.1 HP 01 h� 8 Inc. Solar 09-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compatmr Fee �$15 � � Issue Fee FEES $ 3 Z O N I N G R E � M T S DEVELOPMENT SERVICES FEDUIREMENTS: Zaning Approved By Data Building Approved By Date Appliption Issued By Dat 2.3 . SUMMARV OF FEES BUILDING PERMIT $ SMIP $ ' � PLAN CHECK $ PERMIT PLUMBING 5 ==�.�SL ISSUANCE � $ PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL $ ' GRADING S ' PLAN CHECK 50% $ MICROFILM S ' MECHANICAL S TOTALFEE $ �a• .3� PLAN CHECK 25% $ � � � ,/ . CONSTRUCTION AND PLANNING P�� PA -,�,/AP�ROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector � � . 1. Temporary Electrical Service or Pole �,i" .� 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. �s27-77G (,� -� 53. Steel Reinforcement ' . 3.. Electrical Conduit Utility-Undrgrnd. '- � 54. Forms . 4. Electrical Conduit-Undrgmd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ' - 58. Electrical Conduit-Undrgrnd. , 8. Foundation • 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 6-y..$6 L�� 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System �� 61. APPROVAL TO DECK 11: Property Sewer Line & House Connection b-(Z-�V L/i0 � 62. Backwash & Receptor-Final 12. Sewer Cap . � 63. Heater & Vent-Final 13. Roof Drains . 64. Plumbing System - Final 14. Rough Plumbing G,�fj_� _�� 65. Electrical-Final 15. Rough Electrical�Conduit 66. Solar System-Final 16. Rough Electric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydra 22. Oucts, Ventilating 77. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. 'Frame and Flashing 76. Dry Standpipe 28. � Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31.-Plaster 8rown Coat 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 t �ry 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed. � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. Date AVVlieant to /lll In all sD��es exteot tnose within heavy boraer Iines antl sign all aporoDrlate aaclarations. �'�C�TY OF EOST/QJ, n rCONSTRUCT`I,ON PERMIT PERMI O. TRACT NO. LOT NO. UNIT NO. . PrAlect AddreSs `�� G L� �v� Applicant's Maiqli9p �Address ' Owner's Name �fG �� Pho � • �� Address �� ' �� Arch/Eng. C Licen e No. Address Convactor's Nam �%'� Phone AdAress (mailingl Ciry Licenu No. �ICENSEO CONTRFCTOR OECLARATION I hereby alllrT Iha� I am Iiconsetl untlar provi5ion5 of Charter 9(mmm¢ncinq with mction 7000) ot Divislon 3 of t�e Business antl Profezsions Cotle, antl my license is In lull lorco antl eHect. Licnnse Clast Litense No. Date Signatura WOPKERS'COMPENSATION DECLARATION hereby a/firm that I have a certllicale oi consent to salf-insure or a certHicate �f Workers' Compensation Insurance, ot a certi'etl CoOY � ereof (S�on 3800, Lab. G.).� � � / Policy No. � � �� Company �Certifietl coOY is heroby fumishetl. Cert�i ef��<o� y/� il wi[h [he ci[ yYi�ion. Date_�/L�� APPlica�'�—��i�mJ� / EXEMPfION F�ROM WORKE0.5' CQMPENS/CTION ECLARATION (This section neetl nol bu com0leletl if th¢ permit is fOr On¢ huntlretl (E300) or lezs). I certity lhat In lM1e p¢rlormanca of [M1e wo�k fOr whlth this Oerm�t i5 i55uetl I shall nOt employ any pa�son In any mannor so as to Gecome zubject [o [�e Workers' Compensatlon Laws ol Calibmia. Date Si9nalure `NOTICE: I(, altcr making (his tloUaratlon, you shoultl become subjett co the Workers' Compensatlon provisions ol the LabOr Cotle, you mu5t forthwith comply wilb such provlslons or thi5 pmmi[ zM1all D¢ tleemed revoked. CONSTRVCTION IENDING AGENCV 1 hereby atllrm that there Is a mnstructlon Ientlin9 agency for tne oerformance 0/ the work fOr Ch t mit 'S Issue Ction 309] Civ. C.) lCntler's Name \ ' LenOer's HOtlress Cr /V ��n OWNER BUILOB'�i OECLARA 10 I nereby allirm that I am axempi Irom the Contractor's License Law tor t�e lollowin9 reason (SacUon ]031.5 Businass antl Protessional Cotle: Any d[y or county whlth require5 a plrmlt to con5truct, al[e�, improve, tlemolish or repalr anY sVUGture, ptlOr t0 Its issuance, alm reqWreS the applicant for SUGh pe�mlt to tile d Signetl Statement lhat he/she Is IicenSetl pu�suanl to lhe provi5ion5 0l [be Contractor'S LI<ensa Law (Chapter 9(commencin9 with Seccion ]OOD) ol DiviSion 3 ot lhe BusinaST antl Prote551on5 Cotle) or [nat ne/ihe is ¢xemp[ iherefrom antl lne basiz lor the alle9etl exemptlon. Any vlolation of Sectlon ]031.5 by any applicant for a permi[ subjec[s the appli<ant to a tivil pe0d1[y ot not mor¢ [han tiv¢ huntl�etl tlolla�s (5500). ❑ 1, az owner ot [ne property or my employees with wages as th¢ir zole compensation, will tlo the work, antl the structure is not intentletl or olferetl tor sale (Section ]044, Bu5ine55 antl Pwfe55ional Cotle: The ConVattor's Licenso law tloes not apO�Y to an owner of a prop¢�ty who builtls Or imp�ovei cnereon, antl who tloes such work himsel(/nerseit or through his or ner own employees, proviaea that such Improvements aro not inconeetl or olferetl for sale. If, however, the builaing or Improvement is soltl wltnin one year oi com- pletion, t�e owner wlll have tlte burtlnn of pwving hE/She tlitl not bullU o� im- prOve for the purpo5e ol sale). ' I, ai ownCr ol tM1e ProOerty, am excluSivery conttac[inq with lic¢nsetl con- tractorsto wns[rucl lho orOject (Section 7044, Business antl ProleSsionS Cotle: The ConVactor'S LicCnse Law does nol apPly to an owner of properly wM10 builtls or impwves tnereon, antl wno contracts Por such projec(s wlth a con- tracto�(51 Ilcenso'pur5uant lo Ihe Cont�ac[or's LICenSe Law). I am awar¢ that proot o! thalr Worker's COmponsatlon Insurance shoultl be provitlCtl to me. ❑ I am ezempt untlar Section 8. & P. C. tor thi5 reason Data Owner I he�eb certify Iba[ I nave rea lhiz applica[ion antl stat¢ Nat th¢ abOve intormation is correct. I aqrae to comply wi[h all cily antl county ortlinances antl state laws relatin9 to buileing consVuctlon, antl hereby authotlze revre- zentatives ot this city to enter upo e above-mention¢a pr erty �or in5pection pu Signature � l �atel � Orivers' Lice se or 55 $ �' a3 �� TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHE'�J,`�4 DESCRIPTIONOFWORK/USEOFBLDG��'�1 '�' �� —�y�� , ��S YTF`I l�!/ /_ TYPEOFPERMIT GRA�ING ❑FOUNDATION��STRUCTURAL � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ �OTHER D /�/�� PROJECT DESCRIPTION 5a. F. � OCCUVANCV CONST CT TVPE� VALVATION$ ZONE �� GRAOINGCV.YDS. A6R65�Z-��!G Remarks: C Sink <flow Preventer <flow Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspec[ion Fee � $15 Dutt - Under Ground Duct - Sttuctural Duct - Vemila[ing Exheust System ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑aioo,000 aru �ioo,000an Reinspection Fee � $15 CMF 0865-46, r¢v. ]0/84 White - Builtling; Ganaty - Applicant; Pink - Accounting; GOItlOnrOtl � ASSe55or Showers Service Sink Sewer Cap : Sewer Connection ., Solar Collecrors Solar Pipin9 ' Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash Issue Fee Hood or Type I ❑ Canopy Type I I ❑ A.P.# ,��- Z7� -2/ S Main Buildin9: E T Front T � 8 Fear A C Right � I SLeft Z C� � Ping. Ref. # pA - 8� Planning Notes: ��( -09 T-�z5 -fi/ _�i ' Automatic Washer _ ' � Canstruction Pole Su6. Cooking Unit . Dishwasher . Dryers ❑Gas ❑Elec - Fan F.A.U. Fixiures Device Boxes Outlets Refrigerotion System ❑0.100,000 BTU ❑100,000 BTU Sysrem Repair/Alteration Fire Dampers Registers 5 3 Issue Fea � 5 3 Garbage Dispoul Generaror DO-5 KW 5�19 5/i�!a^ - zone � Z Accessory Building: Z O N I N G R Parking Req./Pro�ided js E � M �I:�LU��V.� T $ ELECTRICAL � I Trans(ormer Meter U Meter ❑ Sub Panel Motors C Inc. Sda( . FEES ❑ 15,50 KW � ❑ 50+_KW � to 100�amps / �r 100 amps i� � I.HP �1:5 - 8 9�15 HP �16-15+ Pole Light Range Sign ; Standing Sections KW Trash Compactor �.Reinspection Fee � $15 DEVELOPMENT SERVICES REQUI Zoning Approved By Building APProved By Ittue Fee $ 3 y � SUM ARV OF FEES t- BUILDING PERMIT 5 2• 0O SMIP $ `� •�G, PLAN CHECK 5 PERMIT � �•PLUMBING S ISSUANCE $ � PIAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL S �GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL S TOTALFEE $ 387, iG PLAN CHE 25% $ �`" /l" • `r '^ Cl"w� . CONSTRUCTION AND PLANNING P�� '` SPp' APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Tempora�y Ele�trical Service or Pole 52. Pool & Equipment Location 2. Soil Pi�e�;Undr,grnd. 53. Steel Reinforcement 3. ;Electr,ical C�onduit Utility-Undrgrnd. 54. Forms 4'.�ElectriC��Con�uit-Undrgmd. 55. ElecVical Bonding . ,,,� 5�; Sfeel'Re1nforcCinent 56. Rough Plumbing & Pressure Test 6.:Electcicgl UF.ER Grnd. 57. APPROVAL TO COVER-GUNITE � ...� 7•�;FqQtings;` `l �� v'� 58. Electrical Conduit-Undrgrnd. 8..FoGndat�on �� 59. Gas Pipe, O Undrgrnd., Test g�1Na[er Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. St4uctut2l Floor System 67. APPROVAL TO DECK 11. Pr,operty�Sewer,Line & House Connection 62. Backwash & Receptor-Final 12. Sewer� _�p 63. Heater & Vent-Final : •�•.'� 13. RQbf,btains^' 64. Plumbing System - Final 14. Rougfi Plumbing 65. Electrical-Final 15. Rougti Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 6). 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 (,bnditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace �' APPROVALS Permit # 21. Duc[s, in Structure 70. Underground Hydro 22. Ducts, Ventilating i-'� � 71. Product Piping O Gas ❑ Oil 23'•Gas Pipe-Rough &-Te�t . 72. Underground Flush 24'. RoofFraming ' �� 73. Undergrnd.StorageTankOGas ❑Oil 25. Roof Sheathing��' ' � ' L 74. Overhead Hydro 26. T-Ba{�rCeiling (Structural) &�Moriocoat 75. Dry.Chemical 27. Frame'and Flasfiing 86 ,Q� 76. Dry Standpipe 28. Lathirig & Siding � Q(� 77. FIXED SYSTEM FINAL 29' Insul�tipn ' � �� 78. FIRE PREV. FINAL 30. Drywa(I_,Nailing ��' • � d �� HEAITH DEPT. REQUIREMENT 31. Plaster Biown Coat; .-�'� , �� 79. FINAL INSPECTION 37 Electrical,Power Nleiei-Final_' 80. FOOD CERTIFICATE ISSUED 33. Final Electric �- � . Notes: S G�� 34. Final Heating & Air Conditioning �'0 �a �E -,0,� � K� 35. Final Gas Pipe�Test 2-10-8� 0 I 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 At[enuation 46. Handicap Regulations ' 47. FINALSTRUCTURE & BUILDING !e 48. Special Requirements Completed 2� MM 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . `. � 51. CERTIFICATE OF OCCUPANCY � - No. Date � - ' �_ \° U � AVD�icant t0 fill in all spaces ezca0t t�ose witMin heavy Dortler lines ana sign al1 apo�eDriate tleclarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PEtiMIT N� �� TRACT NO. LOT NO. UNIT N�U, E`�-'d � , ^ T Project Address +��3 -'Y� P_A �»'. �� L� Applicant's Mailiyg Addre( R��`( -�� l/ Sf; - TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R f� � J � ❑ CONVEi3510N ❑ DEMOLISH ❑ OTHER /� p. �jb Owner's Namc II�`�a' r0 W A1 .. Phone DESCRIPTION OF WORK/USE OF BLDG. YP-S l Y1 Address �.��7 F' � l �e_iS-l�'� S Main euilding: E Arch/Eng. License No. TVPE OF PERMIT GRApING FOVNDATION STRVCTURaL T Front Address � '_-�' Cqp ❑.pTHERT � El_ECTRICAL ❑ PLUMBING ❑ MECHANICAI_, A Rear Contrector's Nam �Q� / Phone 1�.77 �.�LL� pROJECT DESCRIPTION SQ. FT. OCCUPANCv K Right Addre55�mailing�_ .r CONSTRUCTIONTVPE VA�UATION3 � � �$�T�— g Left CityLicenSeNo. ZONE GRADINGCV.VDS. ACRES LICENSED CONTRACTOR �ECLFRATION '+ PIOy. R¢f. # I hereby a(firm that I am Iicensetl untler provisions o( Charter 9(commencing Remarks: Q' � Qy V.� ��,.1, y} (�i{ 7^], 7"] Q Planning Notes: with 5ection 7000) of DiviSion 3 of the Bu5ine55 antl Profe55ion5 Cotle, antl my license is In full force nd eitect. License Class " L' en e N Oate (� Signature IORKE 5'COMPENSATION DECLA ATION i hereby attirm tnat I have a ceriificate of consent to self-insure or a certiilcate �of Worker5' Compenwtion Inw�ance, o�-a certifietl mpy th,Lereof (Section 3800, �b.��5 - �'iyD4�ompany ��'e/•�/�A(L�yGi�_�% , Policy No. �Certifietl copy is hereby fumishetl. 1 Ce�ti ' co y is t'letl with the city il in i0isi�.� Q�` J Date Applicant (� L� EXEMPTI N F OM WORKE0.5' COMPE ATION OECLARATION (Tnis section neetl not be completetl if lhe permll is 10� one huntlretl ($100) or less). I certify that in [he per/o/mance of the wo�k for which Ihis permk I5155ue0, I shall not employ any person in any manner so as to becoma subject to the Workers' Comoeosation Laws of Califomia. Date Si9nature 'NOTICE: If, after making this tleUaration, you shoultl become subject to the Wo�kers' CompCnsa[ion provlslons o1 ine Labo� Cotle, you must torthwith comply with such provisions or this permit Shall be tleemetl revoketl. ' CONSTRUCTION LENDING AGENCV I hereby affirm that there is a construclion lentlin9 a9ency tor the performance of the work tor which thi5 P rmit iz issuetl (Section 3097 Civ. C.) Lentler's Name �A Lentler's Atltlress J7 OWNER BUILDEH �ECLARAT ON 1 hereby afFlrm tnat I am exemo� from Ihe Contractor's License Law for the tollowing reason (Sectlon 7031.5 Business and Professional Cotle: Any city or county wnich requims a permit to construct, alter, improve, tlemoiish or repair any sVucture, prior to itz issuance, also requirez tno applicant for zuch permit 'o tile a signatl statemen[ that ne/sne i5 Iitensetl pu�suant to lh¢ Provision5 of he Contractor's License Law (Chapter 9(commencing witM1 Sectlon ]000) of Oivision 3 of the Business antl Pro/essions Code) or that he/she i5 exemp[ thmefwm antl tht ba5is fOr Ihe alleged exemplion. Any vlolation of SecUon 7031.5 by any applicant for a permit subjects ihe apP��anl lo a civil �enalty o/ not more tnan five huntlretl tlollars (5500�. LJ I, as owner nt tne property or my employees wlth wa9es as their sole compensation, will Oo the work, antl [ha strutluro iz not intentletl o� oHeretl tor sale (Se<lion ]046, Buslne55 antl Prof¢Ssional Cotle: The Cont�actor'S License Law tlo¢s not apply t0 an owne� ot a proper[y who builtl5 or improves thmeon, antl wito tloes such work himself/h¢rsClf ot lhrou9h his o� her own employees, provltletl that such improvem¢nts are noi Intenaea or otteretl for SaIC If, however, the builtlin9 or improvement i5 Soltl within one year oi com- Oletion, the owner will have tlte burtlen of provinq he/she Oitl not bulltl or im- p�ov0 totlM1e purposC of salc). ❑ I, as owner of the property, am excluzivety contracting with licensetl com tractors to construtt [he projecl ($etiiOn 7044, Business antl Protession5 Cotle: The Contractor's License Law aoes not apply to an owner of prooerty who builtls or improves thereon, antl who cont�acts tor such projecls with a con- tra<[or(51 lic¢nse pursuant�to tM1e Cont�acior's LlcCnse Law). I am awarc thai p�oof o4 thelr WOrker'S CompenSation insuranG¢ shOultl be provitletl [o me. ❑ I,am exempt untler Section B. & P. C. for thi5 r¢a5on Date � Owner 1 hereby tertify that I have reatl this applicaclon antl state Ihat the above information i5 CorrecL I a9ree lo comply with all City antl county ortlinances m9 t city in5pection pu ses. � Si9nature Drivers' Licenz r 55 GMF 0865-46, rev. 10/84 repre- y for Sink Preventer Irrigation Drinking Fountains Ploor D�ains Floor Sinks GasService OuUets IOtCIC2Pt0l5 Kitchen Sink " Lavatories � P—Trap Roof Drains Reinspection'Fee � $15 Duct � Under Ground Duct - Structural Duct-Ventilating ' Exhaust System ❑ Multiple � Firepl/Fact Blt. IC80 # Heating System & Ducting ❑ o-i oo,000 sTu � i oo,00a sT Reinspection Fee , � $15 Wnite - Builtling; Canary - Applitani; Pink - Accounting; Goltlenrod - Assessor Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auro-Wash Laundry Trays Issue Fee Hoodar Typel � Canopy Type I I � Refrigeration Sys[em ❑aioo,000sru ❑ioo,000eru System Repair/Alteration Fire Dampers Fegisters Issue fee FEES � $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec� Fan F.A.U. Fixtures Device Boxes Switches Garbage Disposal Generator �0�5 KW Reinspection Fee 6275 5%28%86 Zane Accessory Building: Parkin9 Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW � Meter up to 700 amps Meter ❑over 100amps Sub Panel Motors 00.1 HP O1 X- 8 Inc.Solar 09-15 HP �76-15+ Microwave Pale Light Range ; Stending Sections 5�15 KW Trash Compactor $15 Issue Fee 43.20 TL FEES $ 3 2 O N I N G R E � M T S DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approvad By Date Building Approved By Date �-- Appliwtion Issued By Dat��/� SUMMARV OF FEES BUILDING PERMIT $ SMIP g PLAN CHECK $ PERMIT PLUMBING 5 ISSUANCE $ PLAN CHECK 2596 $ ENERGY P.C. $ ELECTRICAL $ � GRADING $ PLAN CHECK 50% $ �.3 �U MICROFILM $ MECHANICAL $ TOTALFEE 5 �3.�(� PLAN CHECK Z5% $ � CONSTRUCTION AND PLANNING r, P� -& SPA APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole'' _ 52. Pool & Equipment Location 2. Soil Pipe=Undrgmd. ' . 53. Steel Reinforcement ' 3� Electrical Conduft•Utility-Undrgrnd.'� ' 54. Forms 4.'Electrical Conduit,-Undr�rnd. a�' � 55. Electrical Bonding " 5. Steel Reinforcement -<� 56. Rough Plumbing & Pressure Test ..� 6� Electrical UFER G�nd. � �. 57. A,PPROVAL TO COVER-GUNITE 7. Footings �-� �� '� 58. Electrical Conduit-Undrgrnd. ' 8. �Foundation . . �' 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd., -� 60. Backwash Lines, P-Trap, O Undr9rnd. 10. Structural Floor System � � � 61. APPROVAL TO DECK 11. Properry Sewer Line & House Copnection .. 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. Fencin & Access A _ �_/-(� g pproval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling 69. 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 ' 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StoregeTank OGas ❑Oil 25. Roof Sheathing . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &•Monocoat 75. Dry Chemical 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing & Siding �. 77. FIXED SYSTEM FINAL 29. Insulaiion � 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 '` t� 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 ' ' � r43. Backflow Irrigation � r�t:44. Landscape Irrigation System . r45. Sound Attenuation �46. Handicap Regulations �47. FINAL STRUCTURE & BUILDING 48. Special Requiremenis Completed 49. Electric Release to Edison - . 450. Gas Release to Southern California Gas Co ' S 1. CERTIFICATE OF OCCUPANCY n. No. Date /�OP��ant to fill in all spaces except those within neavy bortler Iines anE sign all aporoprlate tlaelarations. CITY oF COSTA MESA23��I�SL��1C��lON PERMIT Project Address Applicant'sMR�ipgljRLef�]. – Z U i3 UW Owner's Nam � 77 RIVERSI.DE � NEWPORT �§�ACH Address Arch/Eng. - License No. Address Contractor'snlam SIERRA ENVIRONMENTAL phone — 1 Addreulmailingl z121 S. GRAND AVE. � SANTA ANA City License No. 024912 LICENSED CONTRACTOR DECLAR TIOP! I heteby at(irm that I am Ilcensetl un r provislons of Chd/ft r 9(Commencing wi[h section 7000) of DiviSiOn 3 t he usln ntl Prhf�SsionS Cotl¢, antl mylicenseisiniullforcea�tletiect� � ��j� � , �,�, ' IDatc �� c/ o� Si9�ature `�ORKERS'COMPENSATION OE LARATION �ereby a/tirm that I nave a certiti ate oi consent to s It-inn e or a certHlcate .( Worker5' Compensatlon InSuranGe, or a certlfletl copy ther¢Of (Snttion 3800, Lab. C.) �Porcr rvo. N910712�11WG � ua�r �ertifietl mpy is hereby turnishetl. `\ ertifietl copy 6 tile0 with the city i i i n uU e Applicant EXEM TI N FROM WORKERS' CO ENSATION DE LARA ON (This section neetl not be <omple[etl If t e Oe�mlt i5 for on huntl tl($300) or less). I certify [hat In tne pe�formdnce o1 the wo�k for whlth thi5 per �t i5 Iszued, I ^ shall not employ any person In any manner so as to become, ubject to the � A Workers' Compen5ation Laws of CalifOrnia. � Date $Ignature �'NOTICE: If, after making Ihis tleclarallon, you shoultl become subject to tne Workers' Compensalion plOV�510lIS Oi II1C LdbO! C0C12� }�OII T1151 iOf[IIW�III comply with Such ptovisions or thi5 permi[ sM1all be tleemetl revoketl. \ CONSTRUCTION LENDING AGENCV �' I hereby atfirm that there is a conz(ruGtion Ientling agency fo� tbe performdnGe af the work for whiCh thiz permit is Issuetl (SeCtion 3097 Civ. CJ Lentler's Name Lentler's Adtlress OWNER BUILDER OECLARATION I hereby affirm [ha[ I am exemp[ from Ihe Cont�actor'S Lic¢nse Law for the following reason (Section ]031.5 Business antl Profezsional Cotle: Any dty or county whlcM1 requires a petmlt f0 conrt�uct, dlt¢r, improve, Gemollsh o� �¢pdir any structure, prior to its issuance, also reqWres [he applicant for such permit to file a signetl statement Ihat ne/she i5 licensetl pur5uant to the provi5ions of -'�e Contractor's License Law (Chapler 9.(commencing with Section 7000) ot 'ivision 3 01 the BuSiness antl Professwns Cotle) or that ne/she is enempt ierefrom and the ba5is for the allegetl exemption. Any violation of Sectlon l03L5 by any applicant fOr a permit subjects tho applicant to a civll �nalty of not more than five M1untlretl tlollars (5500). LJ I, as owner of the property or my employees witn wages as thelr sole compensation, will tlo the work, antl the slructure Is not int¢ntletl or otfere0 for sale (Seclion 7044, Buziness antl orofessional Cotle: The Contractor'S License l2w tloes not apply to an owner ot a property who bulltls or improves thereon, antl who tloes sucn work himseH/hcrsalt or tM1rou9n his nr her own employees, Provitletl tha[ sucM1 improvemenl5 are nOt Intendetl or ofte�etl tor sale. H, however, the bulltlin9 or improvement is soltl within one year of <om- pletlon, ihe owner will have the burtlen ot proving he/she tlitl not builtl or Im+ �rova for the purpose of sale). I, as owner of the pro0erty, am excluslvely contractin9 with licensetl con- tractors to construct the prolect (Section �044, Busine55 antl Pwfessions Cotle: The Conlractor's License Law doe5 mt apply to an own¢r a( Oroperty wh0 builtls or improves thereon, and who contra<ts for such proieats witn a con- tracto�(sl IicenSe pUrsuant to lhe Con[tacto�'s Ucanse Law). I am aware lhat proof o( Iheir W ke�'S COmpensation in5urance shoultl be provltl¢tl [o me. ❑ I am axertlP� �er Section B. & V. C. for thi5 rea5on i Oate inspection Signature Orrvers' Li CMF OBfi5-46, Owner @ TYPE OF CONSTRUCTION �IXkZNEW LJ ADD lJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, q�t DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPEflM1T GRADING FOUNDATION STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING � MECHANICAL A Reef ❑ OTHER PROJECT DESCRIPTION Sa. FT. OCCUaANCv C Right K Left GONSTRUCTIONTVPE VALUATION$ $ ZONE GRADING CU.YDS. ACRES ping. Raf. # nemarks: $UILDING PERMIT # B23778 Planning Noces: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers � Dishwasher - Drinkina Fountains 0 °loor Droins Floor Sinks - �as Service Outlets Interceptors Kitchen Sink LdVdIOII¢5 P–Trap Roof Drains � Reinspactian Fee $15 Boiler Duct - Under Ground muct � Structural Duct - Ventilating Firepl/Fact. Blt. ICBO # ,Heating System & Ducting �0�100,000 BTU 0100,000 Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet � Water Heater . Water Service � Auto-Wash Laundry T ra ys Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑4100,OOOBTU ❑100,000 ❑ Sysrem Repair/Alteration Fire Dampers Registers �• – – �•��" I I peinspection Fea . I $15 I I Iswe Fee >or55� 10/84 White - Bulltlin9: Canary - Appllcant; Pink - Accounting; Goltlenrotl - Assassor FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher' Oryers ❑Gas ❑Electric 9126 7%09%86 Zone Accessory ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Fan . F.A.U. Fixtures ' Device Boxes Outlets Switches Garhage Disposal Generator �0�5 KW �5-15 KW Meter ❑up m 100amps Meter ❑over100amps Sub Panel Motors�61 HP�i%-8 Inc.Solar 09-15 HP �16-15+ Microwave - Pole Light Range Si9n ; Standing Sections Trash Compactor ,c-: 15.50 TL FEES Z O N 1 N G R E Q M T S $� Reinspection Fee $75 Issue Fee $ 3 FEES DEVELOPMEN7SERVICESRE�UIREMENTS: 2oning APProvad BY �ate Building Approved By Date�'7�–}�! Application luued By �� Data..�,/�� SUMMARV OF FEES BUILDING PERMIT $ SMIP , $ PLAN CHECK $ PERMIT . PLUMBING $ ISSUANCE , $ PLAN CHECK 25% $ ENERGY P.C. $ Q ELECTRICAL $ GRADING $ PLAN CHECK 50% $ �� MICROFILM $ MECHANICAL $ LL.a— TOTAL FEE $ � $ 3 PLAN CHECK Y5% $ �• S�� K.,� ._� CONSTRUCTION AND�PLANNING PC L SPA " � APPROVALS Permit # � Date Inspector AppROVALS Permit # Date Inspector 7. Temporery Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � � 3.�Electrical Conduit Utility-Undrgrnd. 54. Forms � '� _ s _ 4. Electric8l Conduit-Undrgrnd. , 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -'" �6. Electrical UFER Grnd. ._ - 57. APPROVAL TO COVER-GUNITE -, � 7. Footings � � '�� 58. Electrical Conduit-Undrgrnd. � � 8. Foundation � '! Y; 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 �rry 62. Backwash & Receptor�Final 12. Sewer Cap " "-�� ' � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final . 15. Rough Electriral-Conduit . 66. Solar System-Final 7�6. Rough Electric Wiring - 67. Fencing & Access Approval �~ � •r 17. Rough Wiring Sign • ' 68. APPROVED FOR PLASTERING ' . 18' Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL . 19:=�Rough Heating & Air Conditioning q i � d FIRE DEPT. REQUIREMENT , 20. Rough Gactory Fireplace ,Zc��L �j� APPROVALS Permit # 21. DuCts, in Structure 70. Underground Hydro 22. Ducts, Ventilating �[-2�(�(e G��) 71. Product Piping O Gas ❑ Oil . - 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing , . 73. Undergrnd.Storage•Tank �Gas ❑Oil 25. Roof Sheathing , 74. Overhead Hydro 26. T-Bar Ceiling (Structuraq & 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 l 33. Final Elacvic Notes: , .; ` 34. Final Heating &,Air Conditioning J e�Q�(� �£ ` 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:�Landscaae Irrigation System .� 45. Sound Attenuation � 46.iHandicap Regulations ' �, 4Z�FINAL 5TRUCTURE & BUIIDING �.; 48. Special Requirements Completed 49. Electric Release to Edison � � _ � 50...Gas Release to Southern California Gas Co � 51,t�ERTIFICATE OF OCCUPANCY . N0. � - Date � . � CityofCqstaMesa INSULATION CERTIFICATION� s��d��9s�fetYo��S�o� � 3,35 �7� ° E�o�� AVE �r,-r� /1/jEr� �'JGz Number and Street City Counry /2f 7� �-� Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF Material ThiCkness �inches) EXTERIOR WALL Material � � /2 Thickness �inches) ✓'�Z �� CEILING Batt or B�anket Type Thickness (inches) Loose Fill Type _ Minimum Thickness (inches) Area Covered (ft2) FIOOR,ELEVATED Material Thickness (inches) FLOOR,SLAB Materi�l Thickness (inches) Width (inchesl— FOUNDqTION WALL Material Thickness (inches) Brand Name Thermal Resistance (R Value) Brand Name '///4A�/�/�-�-L- Thermal Resistance (R Brand Name /"//f%/l�l%/C.LC Thermal Resistance (R Value) Brand Name _ Number of bags Weight per bag Thermal Resistance (R Value) Brand Name Thermal Resistance (R Value) Brand Name Thermal Resistance (R Value) Brand Name Thermal Resistance (R Valuel DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the curre�t regulations setting Energy Conservation Standards for new residential buildings (lopted in Title 24 of the California Administrative Code). ��cQ�1P�s � �2oG✓� QJ,�Zf'r'�� Gener Contrac[or (Builder) License Number ��Z�� ..r..�-,�lQ..�/� [.�/!�/� i WESTERNINSU AII�ii%'atureandTitle "t-7 ' Dace � 3621 W. MOOP.E AVE ,`�/ Z7 � SANTq ANA, CA 92704 [r Sub Contractor (lnsulation Applicator) License Number �, ��2: z /D-�7 Signature and Ti�e - Date CMF 1106-46 P.a