HomeMy WebLinkAbout2858 ELLESMERE AVE - Building PermitsAOP�icant to fill in al1 spaces ezceo< tnose witnin neavy eoraer lines ana si9� all aoProvriate aeclantions.
CITY OF COSTq MESA CONSTRUCTION PERMIT PERMIT NO. T CT NO. LOT NO. UNIT NO.
2Sl,s� ELLFSAMFRF AV� � ��g . �� 7371 8/29/84 17„G� 'I-
' Project Address . '
s��� TVPEOFCONSTRUCTION NEW AD� ALTERATION REPAIR ,
Applicant'S Maili�g Address ❑ CONVERSION ❑ DEMOLISH � OTHER - q,p, # ��_ �} _ 3 Zone �
Owner's Name _}"• Q�� EC ICF Phone�7 G�� DESCRIPTION OF WORK/USE OF BLDG. � +4�-1 PAYId C�nVfiR
Address � — � S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT GRADlrvG FOUNDATION STRUCTURAL T Front � �p O
Addre55 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear $ � � N
Convactor's Name SE� � Phone � �OTHEa . .
Address (mailing) PROJECT DESCRIPTION 5�. FT. OCCUPnNCv��-W1 �I L�' K Right P.'r-r�� G
CONSTRUCTIONTYPE VALUATION$ SIX�• g �eft "f �
" R
Ciry License No. Zprae GRADIfJG CU. VOS. ACRES Ping. Ref. # � Parking�Req./Provided / E
LICENSED CON7RACTOR OECLARATION Q
I nereby aHirm [hat 1 amlicen5ed untler proviSiOns o1 Charte� 9(comm¢ncinq q�marks: ' ( Planning Notes: L � Z� � S � � M
with section 7000) ot Division 3 oi the Businesz antl Professions Cotle, antl T
my license is in lull lorce ana ef/ect.^' (� ' ' • . �� � S.
License Class l J L7 License No. , -
Date— - Signa���— ' � PLUMBING FEES 6 �
WORKERS' COMVENSATION DECLARATION Bar Sink Showers ELECTRICAL � FEES
1 h¢reby atfirm [tlal I have a certifital¢ of cOnsent t0 self-Insu�e or a cmtiflcate
ot Workerz' Corqpen5ation Insu�ance, or_a certifi¢tl cOpy thereo� (Sectlon gackflowPrevenrer S¢rviCE$Ink
3800, �ao, c.) Automatic Washer 7ranstormer ❑ 15-50 KW
Policy No. Gompany Beckflow Irrigation Sewer Cap '= Construction Pole Sub. � 50 + KW
8 Certifietl coOY i5 hereby tumi5h¢tl. •• ,
Certitietl copy is iiletl with the city Builtling Dlvision. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date AOPlicant � �
EXEMPTION FROM W00.KER5' COMPENSATION DECLARATION Clarifief5 $olar Coll¢c[or5 Dishwa5he� Meter �over 100 amps
(ThiSzection need not be complatotl If the permit is focOne huntlretl (E100) o� .
less). Dishwdsher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certi(y that In the performance of tne work for which this perm�t Is issuetl, I -
�shall not employ any person in any manner so,as to become�bject to the Drinking Fountains Solar Tank ' Fan Motors �67 HP 07'h - 6
Workers' Compuqsation �aws oi Califomi 'n
Date Signawre �,�r. � f "''' Floor Drains Swimming Pool w/Spa � F.A.U. Ina Solar 09-15 HP 016-15+
� NOTICE: If, afte� makinq this tleclaration, you shoultl become subject [o th¢ '
Wolkerz' Compehsalion plovision5 of the Ldbor Cotle, you must toltllwlth FIOOf $i0k5 Ufindl - - FixtUf¢s MiclOWave
comply witM1 SUGh p�ovisions or lhi5 permit sball be tleemetl revoketl.
LONSTRUCTION LENDING AGENCV �� Gd5$2fviC2 Oud¢LS WBt2lCIOS¢t �
1 hereby affl�m t4al there i5 a consl�uction lentling a9ency fo� tne perfo�mance Devic¢ BOx¢5 POI¢ Light
ot the work iOr whfch this permit is issu¢tl (Section 3097 Civ. CJ Interc¢ptOrS Wa[¢r H¢at¢! Outl¢IS Rdng¢
Lentler's Name —
Lentler's Adtlress , Kitchen Sink Water Service Switches Sign
OWNER BUILD6R UECLARATION ,
1 hereby affirm that 1 am exempt from th¢ Con[ractor'S Ucense �Law for tne �avatories
following reason (5ection ]031.5 Buslness.antl Professlonal Cotle: Any tlty or Garba9e Disposal ' Standing Sections
county whicn requires a permit to construtt, alter, Imorove, aemolish or repair p_7�ap Generator �0-5 KW �5-15 KW Trash Compactor
any structu�e, prlo� to its issuance, alm �equire5 [he aOP���ant tor SUCM1 Oermit
t0 file a signetl s(atement [hat he/she Is licensetl pur5uan[ to the provisions ot ROOf OfainS � �
the Contractar'i Licenze Law (Chapter 9(commencing with Sec[ion ]000) of
Dlvision 3 oi l4C Busine55 antl Profes5ion5 Cotle) or that he/She it exemOt
lherefrom antl the ba5iz fo� th¢ allegetl exemption. Any viOlatmn o/ $ection
703L5 by any applicant tor a permit subjeGts the applicant to a civil
�enalty of no[ more tM1an five hunGretl tlollars (E500).
I„ as owner o� the Oroperty or TY employees wi[n wage5 as their sole ReinSpEGtiOn FBB $15 ISsuO F80 $ 3
compensation, wi11 tlo the work, antl tne structure is not intentletl or offeretl Rainspection Fee $15 luue Fee $ 3
for sale (Section 7044, Business antl Protessional Cotle: The Contractor's . MECHANICAL FEES
License Law tlo(5 mt appty to an owner Of a p�op¢rry wM10 builtls or imp�Oves �
tnereon, antl w�o tloes such work himseif/herselt or thrau9h his or her own DEVELOPMENT SERVIC S REQ IR MENTS:
omployees, provitlotl that such �mprovaments aro nol intentletl or ollorotl tor BOile� HoOd o� TypB I ❑ . .. _�
sale. If, however, tne builtling cr Improvement iz soltl within one year of mm- Canopy Type II ❑ Zomng Approved By_ — ✓ Date
pletion, tne owner will have the burtlen of proving he/she tlitl not builtl o� 7m- Duct - Undet Ground Building Approved 8� � � ���•• Date ��� 9—
�rOve for the puhpose ot salej. . . /� p,�
U I, as owner ot the property, am exclusivery contractln9 with licensetl con- Duct-Structural Refrigeration System Appliration IsSued By—� Date g'ZQ��T
t�actorsto con5[�uct the projecl ($ectlon ]044, Buslne55 antl Protessions Cotle:
The Contracror's License Law does not apply to an owner ot property who Duct - Ven[ilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES , „J(—Q
Uuiltls or improyes thereon, antl who contracts to� such projects with a con- ��Q
tractor(s) license pursuant to ihe Gontractor's License Law). I am aware that � Exhaust Syscem ❑ MWtiple ❑ $ystem Repair/Alterotion BUI LDING PERMIT $ � SMIP $
prooi ot their Warker's Compensation insurance shoultl be provitletl m me. PLAN CHECK $ (O�� PERMIT
❑ I am exemo� unaer Section e. & V. C. (or this reason Firepl/Fact. Blt. ICBO �k PLUMBING $ ISSUANCE $
� Date ownm � Heating System & Ducting PLAN CHECK 25% $ ENERGY P.C. $
i hereby certity that I have read tnis application antl state that t�e above ❑G700,OOOBTU �t00,000BT ELECTRICAL $ GRADING $
Inlormation is correct. I agree to comob with all dty antl wunty ortlinances
antl stace laws relatin9 �o builaing consVuction antl hereby authoriza repre- �PLAN CHECK 50% $ MICROFILM $
sen[atives ot [his. city. to enter upon the above-mentionetl property for �
1 inspectian puroase�s� Q � S ki MECHANICAL
$ TOTAL FEE $ n. �
Slqnature � _�
�eanq vink - qccoun[mg; uowenroa - qssessoe
CONSTRUCTION AND PLANNING , POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility�Undrgrnd. 54. Forms "
4. Electrical Conduit-Undrgrnd. 55. Electrical Bontling
5. Steel Reinforcement 56. RougFi Plumbing.& Pressure Test . .
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings . . 58. Electrical Conduit-Undrgrnd.
S. Foundation . 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK
i t. Property Sewer Line & House Connection � 62. Backwash & Receptor�Final
12. Sewer Cap . 63. Heater & Vent-Final ,
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing � 65. Electrical-Final
15. Rough Elecvical-Conduit " 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough�Wiring Sign' , 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure ' 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
2�3. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing � 76. Dry Standpipe '
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing , HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electriral Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. �Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test . ,
36. Hood or Canopy I �
37. Final Factory Fireplace .
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final
41. Solar pomestic-Final
42. 8ackflow Preventer � �
43. Backflow Irrigation . .
44. .Landscape Irrigation System �
45. Sound Attenuation
46. Handicap Regulations , ' .
47. FINAL STRUCTURE & BUILDING D
48. Special Requirements Completed '
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY
No. ' Date , , .
City f Costa esa Building D pt. LAWN
i
6Y -� lOAT g� 14g -
THESE i U+NS MUST BE C:1 i JOB ,i ALL TIMES
MAKE NO CHAN6'S WITHOUr PRI00. APPAOVAC
Of qEYT. �
iHE IESL' �':C: Cd C�G `iflP.� �d H FEdN;� C:2 I,PPROYAL
C� PLA6S R' �£f LCIfLFTI.. >::,�. PJi F- CO`13TRUED
TO fE A fCfi (IT f=R, C2 fV !-::!'? G, f,t:Y V1C�TIOM �
CF f,qY C*I �' f,'.CV'_.0 ; C' i iC�I' �DL ttJ f=RNIT PRE-
SU:NI�G T� IY: PUTh.C.<liv 1) \:�1L1TE C3 CA�CEL THE
PROVI_f�NS (� 1'.I'i CCCc L.,.!! B- 1R"_ID. IX:CPf Itl SU
fARlS 1hE h hR (,�i ll�E h..7�N If �ufipR7Z� fS fawFtlL
1HE Il iU�iVCE CF A I:"r ti aSE) UPGA F�NS AN� �
SPECIFICATIU(`' SHALL �UI' I�di'/E.'7 IH: �UILCIA7 OFfI �+L
fRON THEfiEA lER FEQUI�tIN6 1HE C iRCCTION 0' G7' U�19
Iq Sq�D PiA(V' w\D SPEC�FICATIO.^F 0� FRUN PRE'J 7� �
BUILOIkG OPE TIONS BEItiG CARftI 71 THERpJNO ''WHFtI '�
IN VIO
.. y�u ''"c ��
C�a� R �ny p� COSTA MESA
, , p�,A NING DEPT.
�,bL SU6JER O 81DG. DEM. 9Efk
1A110N E]HIS COD . ._. 1CIBLiCb u
OE THE �� E _i.-_
.�..�....�. � �
. 36 --::
w pt�Tio '
• v
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w
ti
�
p16EC�OG OF
�ect TO '
DIR`-R�*J
'RESIDFNGE
�' Q���JE.GKE
`:'S3� E L�ES �'� c {� r1�V
CO$T%R /�^�ESP �A p=6=�
Na,— T� SG4�E
Gocre-r � D,
S�
RM1,
FSNCE
V
Z
�
N
O
� SCPARP,TE PERMITS ARE RE�UIRED �
LAW ►� fOR F� ECT�ICAL, PLU'16'�' ;, �
! �;E'1TI � ;, ' .'7'I.�,�l��G A�10
! RF"n"' �,`.�"1iJ t'du!�K
- — --------- -----' , :+ - -�4_�_ --
!� v�� �i i �
-- - —`-- F.C��'.''.?�1� .�
�� , .�', h�C��C$TS
�,L� ,..
%% � , cC3 6:':_ i:: "' '.i�R� PER$OJS A.RE s(
i ar �r.: .:.�: ...� s� e�:s: :�;.�;,r
^ s-a� o; c,a_i-�a.s:, ��ti��sles� a� �
�L�s/�'���E �TU�I IiJOJS�;;inLS,';'�t�l'SECOt:SU�?E�➢FOF.•;
nmm�nv,�� BF(It�1RFP5:i� �'.C_
Y
i
PATIO COVER DETAIL — 12/9/B1 — NOT TO BE USED FOR SUNDECK, ETC.
��'
ru
�
57ATE-��,� �
SIZE $PACING SPAN
OVERHAN6 * � _.3�' % /Q - � 12
�1 RAFTERS:� ry�in. tl4
'3 /-V ^ f� SLOPED FOR DRAIN
MA7(IMUM %7 SPAN �
��
Z
�
i
z
f
4' %
�-BEAM
� R �
STATE SIZ
� � � s
3/16 X 2��-T-
POST-BEAM
CONNECTION
3� a S��aqe 32% �
?redrill Ledqer �
Predrill Eal�linp '/�-3 Deep
JOIST NANGER
Or olAer opproved methods
of eupport � fie.
ALL LUMB£R DOUGLAS F/R
CONSTRUCTION GRADE FOR
TABLE N0.1
� 2 OR BETTER FOR TABLE NO. 2
` POST
�" N � �
SNOW SIZE SHOW SPACING
SHOW LOCATION ON REVERSE SIDE.
5L/�¢� O,IG, i�'� ��- �VT=�U�T
DROP PATIO FLOC
�— SLOPE 70 DRAIN — 2" maz. @ door
- ��'�3 ' TMICK SLAB `� � -
'� ' �� � PUDDLED SAND FILL
' :..'
� Remove G.acs And Weeds DoMn To Neturol G.ade �
• _Y 1z• •� CONCRETE MIX 1:3�4 MAXIMUM WATER CONTENT
POST ANCMOR � �•�. ��. 7} GAILONS PER SACK CEMENT.
For Pipe Posl, Embad �1z� Providt 26 Go G.I. Floshiny At Wood Floo� Const.
Pipe in Footing to within 3" of 8ottom, and
Proride detail of Flange or Weld Plate Screwed or Bolted to Frame.
CMF 0012�46 (BU 40) ilv. 12/Bl
CONTINUOU$
LEDGER
TYPICAL J015T ANCNOsi
NOTE � USE REVERSE SIDE FOR PLOT PLAN.
�
No. 1 No'. 2
UBC STD. TABLE UBC STO. TABLE
25-27 -J-6 25-21 • R •1
For open egg crate aiumi- For solid sheathing.
num or plastic roof Shingles or built up
covering. roofing.
MAXIMUM SPAN SIZE SPACING MAXIMUM SPAN
17' 2" 2,• x 6" @ 12 o.c. 12. 0.•
75' 7" 2" x 6" @ 16 o.c. 70' 5"
13, 8„ 2„ x 6" @ 24 o.c. 8, 6.,
70' 11,• . 2•• x 4" @ 12 o.c. -
9' .11•• 2„ x 4" @ 16 o.c. _.
e• a^ I x•• . a^ @ za o.�. —
NOTE: FOR PHOPOSED OR FUTURE ROOM,OR WHERE PATIO WALLS
ARE TO BE BUILT. USE N0.2 CHART ONLY.
FOR PROPOSED OR FUTURE ROOM OR WHERE PATIO NIALLS
AHE TO BE BUILT SUBMIT COMPLETE HOUSE AND ADDITION
PLANS FOR APPROVAL.
�
NaT i o
SCA�E
F ;�; ,� �� ��
(itp of Costa N��s B�i{d;r� C: -�.
,�%/�% /
!J -'"1L� __C4TEg �91).�
' THESE VUNS A��UST F_ C.I J�B Ff AL� TIMES
MAKE NO CHANC-E$ WITHOU7 PR'�OR APPRJVAL
Of DEPf.
iNE I£YL'F`..E C i C�"`.II`; C= 0. I'�?v:� C i/S�ZOVAL
OF PIA(S F.:;D SfCCIC:F.i._ ,i S':'LL P�i C C�.`7:TR!1ED
TU BE A f-E51lI? C2. L2 fV !'�"':.1'L C-. iV'! \';�!.pTION
CFliNY QF iHf fRrV:=,,:•; f' I,iG C..i_. P.7 f�RNli VR6
SUN,IRG TO CIVE FUIF.�RIT'f 1J \:�1QE Ci CF.YCEL THE
PROVIS!QM1S C� 7:1'3 C_f= S;i; �L BE \;.LI3. CX:EPi IN SO
FFRlS�ThENOhK Cd L_cYi, L�H ITAUTdOdZ�31S tANFU4
1tIE 1: U^:ALE C' A 1:"..� B+..J L.'C'I F!ANS qN0
SPECIFICFTiI.ni � J:L P.,f I.�CVC:T 1H� f:'LDIVi OFflCIAL
fR�JM 1HEfiLt.fl:.2 R�Q 1141��u 1H= C� ;RCCiI�."7 C� C:iROd$
IN SAID f:A�S !�J S�CIFlCA7:�': Ct fT�.N PftE76V(ING
FUILDIIi^. CFE"rc'.(:. •S E"tING CF43'EJ C'I THEREUAD62 WHEiI
IN1'ICL:,T:'V(F 1.._ C��'E O4 C= ^'' 0�4Ei 0�'I.va,�CF
Of TNE C
��}T Id
GOV�t�'
STRUCTURAL APPROVAL ONLY
-----.-_ � . _______�--
SEPARAi'� PERMfTS ,4RE REO��RED
FOR �L�GTA'C'I_, P'.U'^g1�1�
HEATIt�G, Y� .� , :,-;,�G A?!D
� REI'RiG[^1il��J ;;ORK
ITN�I���US�—�- •�— -�q(JY
AL'l. 1 i 1�;':4 �. �:. .����' �`sTS
FOR BUfI,�:: _: -,�:��„����
BE EhiP10. _; �- _W.i r?�:r THf
srare er- c � �. : ., , � ,;;;�;� �
INDUSTR�nL S..,-u'�' "'� (;�il3l:Li�Q.FQR'
ADDIiIpNAL REi1UIREMEry'fw.
�---__. "' _'_ _,
GRR�G—�
i �
Apv�icant to till in all soaces exceD� tnosa wilhin neavY boroer Iines antl sign a1l appropriate Oeclarations.
CI7Y OF coSTA McESnC CONSTRUCTIOrN� PcERMyI/T
ProjectAddress �dSl����A`i
� Applicant's Mairling Address S/i'M E
Owner's Name I .��^E'�N� G�E Phone�1'�.��
Address ��/„�
Arch/Eng. License No.
Address
Contractor's Name -� L Phone
ABdress (mailing) � •
Ciry License No.
LICENSED CONTf2ACTOR DECIARATlO '
I hereDy affirm that I am lic¢psetl untler provision5 of Charter 9(commenoing
with uction �000) of Division 3 oj�Q e us ess antl Protessions Cotle, and
my license is in full torce antl etiect�` \ ;
License Class �� icense No.
Date � � Signature
�NORKERS'COMGENSATION DEGLARATION' �
�=reby affirm that I have a certificate of consent to self-insure or a certificate
Worker5' Gompensation Insurance, or a certitietl Copy thereof (Section
�r800, �ab. C'.)
�Yolicy No. Company
8 Certifietl copy is hereby furnishetl. '
Certifietl copy is filetl witn the city Builtling pivision.
Dale AOPlicant
EXEMPTION FROM WORKEqS' COMPENSATION DECLARATION
(7his section need not be completetl it the permit is tor one hundrea ($100) or
less) . ' '
I c¢rti(y tha[ in the pe�tormd�ce of the work for which thi5 perm�t is issued, I
shall not employ any person In any manne� o as to becOme subjett to the
Workers' Compensation Laws ot Califo '
Date' Sigqature � 'u^^��'�
NOTICE: H�, after making tnis tleClaration, you shoultl become subjeM to the
Wo�ker5' Compensatian provi6ion5 of the Labar Cotle, you must tOrthwitM1
compty with such O�ovisions o� thi5 permit shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV � ' .
I hereby affirm that tnere is a construction lentling agency (or the pertormance
ot the .work for which this permit is issuetl (Section 309� Civ. CJ
L.enCer's Name
Lentler's Atltlress � �
OWNERBUILDER DEClARq710N�� -
I hereby aftirm that I am ezempt from the Contractor'S LicenSe LaW tor the
following reason (Section 7031.5 Business antl Protessional COGe: Any city or
county wnlch requires a permit to construct, alter, improve, tlemolish or repair
any s[ructure, prior to its issuance, also requires the applicant tor such permit
to file a si9netl statement that he/she Is licensetl pursuant to [he provisions of
the Contractor'sLicense �aw (Chapter 9(commencing with Section �000) of
�ivision 3 of the Business arytl Professions Cotle) o� that he/she is exempt
�,erefrom antl the basis for the allegetl exemption. Any violation of Section
031.5 by any applicant fqr a pe�mit subjects the applicant to a civil
�¢�dlty of not mo�e than flve huntl�etl tlolla�s ($500). ..
U I, as owner ot the propQrty or my employees with wa9es as fheir sole
comoensation, wili tlo the work, antl the sVucture is.not intendetl or oiteretl
for Shce (Section �7044, Busin¢55 antl P�ote55ional Cotle: The Contractot's
LicenSe Law Ooes mt apply t0 an owner of a property wno builtl5 or imp�oves
thereon, anC who aoes such �york himself/nerseli or through his or ner own
em0�oyee5, provitletl tbat such Improvements are nol intentletl or offeretl tor
'� sal¢. If, however, the builGing pr improvement is sold within one year ot com-
plEtion, the owner will M1ave the burtlen Of proving he/she tlitl not bui1G or im-
�tOva forthe'purpose ot5ale).
I, as owner ot the property� am exclusively tont�acting with Ilcensetl con-
tractorsto constructihe proje�t (Section 7044, Business antl Professions Cotle:
The ConVactor's License Law tloes not apply to an owner ot property who
builtls or improves thereon, And who contracts for such projects with a con-
tractor(sl license pursuant to the �Contractor's License Law). 1 am aware that
proof 0( thei� Worker'S CoTpensation insu�ance shoultl b¢ p�ovitletl to me.
❑ I am ezempt unGer Section B. & P. C. �or this reason
n i — ow �
I hereby certify that I have reatl this application antl state that the above
informa[ion is [orreci. I agr¢@ {O comply with all city antl Coun[y orGinances
antl state laws relating to bu�Itling construction, antl hereby authorize repre-
senta[ives of this city to e,t�te��upOn t above-mentiOnetl Oroperty for
Inipec[lon purposes. //�� �� � c
Signature � � � /"""'��- Date 0 �Z%�
Drivers' License or 55 � /�
-,Applicant; Pink -Acmuntin9; GOltlenroG - Assessor
_ _ _ _ _ --
� �
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ O� ER' �— qp.#
DESCR�PTION,OF WORK/USE OF BLDG. - ^- '� ,
� � ' �Ib�i- E Main Building:
TYPE OF PERMIT � GRADINGp� FOUND ION TRUCTURAL T Flont '
❑ TENANT � ELECTRICAL 'W PLUMBING ❑ MECHANICAL B Rear
❑ -OTHER . p'
PROJEC7 DESCRIPTION SQ. FT..� ��/�� C Right
��_ OCCUPANCV K.
CONSTRUCTIONTVPE � VAWATION$ ' Q S Left
ZONE Gf3ADING CU.YDS. ACRES Ping. R¢F, #
Remarks: �1 j% %,�� ' ' Pianning Notes:
Sink
Preventer
Irrigation
Dishwasher
Floor Drains '
Floor Sinks . .
Gas Service Outlets
Interceptors
Kitchen Sink '
Lavatories , � ,
P—Trap
Roof Drai�ns'
Reinspection Fee
$15
Boiler
Duct - Under Ground
Duct - Structurel
Duct-Ventilating �
Exhaust System ❑ Multiple
Firepl/Facc Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 aTu O i oo,000
Reinspection Fee � $15
Service Sink
Sewer Cap
Sewer Cannection
Solar Collec[ors
Solar Pipin9
Solar Tank
Swimming Pool wlSpa
Urinal
Wdi2f CIOS¢L
Water Heater r}�VL
Water Service
Issue Fee
Hood or Type I ❑ �
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑100,000 BT
System Repair/Alteration
laue Fee
FEES
Automatic Washer
Z Constructior Pole Sub.
Cooking Unit -
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A,U.
Fixtures
Device Boxes
� Outlets
Swixches
2 Garbage Disposal
Generator 00�5 KW C
$ 3
$ 3
7178 8/28/84-
Zone
Accessory Building:
Parking Req./Provided �
ELECTRICAL
Transformer ❑ 75-50 KW.
❑ 50+KW
Meter LJup to 100 amps
Meter �over100amps
Sub Panel
Motors OO-1 HP O7 %- 8
Inc.Solar �9-15 HP 016-15f
Microwave .
Pole Light
Range
' Standing Sections
5-15 KW Trash Compactor
"g � vP I�'
/
.�
$15 Issue Fee
DEVELOPMENT SER VICES REQUIREMENTS:
Zonin9 Approved By
Building Approved By �
Application Issued By
9.00 iL
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S.
SUMMARV OF FEES _
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ���Q �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTftICAL $ GRADING $
�' PLAN CHECK 50% $ MICROFI LM $
MECHANICAL $ TOTAL FEE $ �_
PLAN CHECK 25% $
C
CONSTRUCTION AND PLANNING _ � POC .SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. �Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . �
3. �Electrical�Conduit Utility-Undrgrnd. 54. Forms .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .
5. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57.,APPROVAL TO COVER-GUNITE ,
7. Footings . _ �• ' 58. Electrical Conduit-Undrgmd. ' ..
� 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
i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof,Drains 64. Plumbing System - Final
� 14. Rough Plumbing � 65. Electrical-Final �
15. Rough Electrical-Conduit ' 66. Solar System-Final •
.16: Rough Electric Wiring ' 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling . ' 69. 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 � Gas ❑Oil
.'
23. Gas Pipe-Rough & Test � � 72.�Underground Flush
'j24. .Roof Framing , � . 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. �Roof Sheathin9 ' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat , 75. Dry Chemical
27. Frameand Flashing ' . 76. DryStandpipe
28. Lathing &�Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing �� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTIOIV
32. Electrical Power MeterFinal , � �80. EOOD CERTIFICATE ISSUED
33. Final Electric ' � Notes: �
34. Final Heating & Air Conditioning � �
35. Final Ga's Pipe-Test
36. Hood or Canopy � � . ' � �
37. Final Factory Fireplace � . "
38. Final Plumbing �'r� (�G�
39. Water Service-Final
40. Gas Service-Final . � . ��
41. Solar pomestic;Final '
42. Backflow Preventer � � ,' ' ,
43. Backflow Irrigation � � �' � � �I
44. �Landscape Irrigation System � ' - I
45. Sound Attenuation . �
46. Handicap Regulations , � � � � ,
47. FINALSTRUCTURE & BUILDING � �
48. Special Requirements Completed . ,
49. Electrie Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY �
No. Date
..r • � _ _ ' .
�� ` AVOlicant lo fill in all spaces except those wit�in neavY �orOer lines antl sign all a00�opriate Cecla�alions.
" -y
. CI7Y oF coSTA MESA � CONSTRUCTION PERM/�IT
Project Address i Q�� �L. L�5 �L� F 1'� U�
Applicant's Maili Address �
Owner's Name ���' V�- l��i l L L¢ (Z Phon 9�� 4�
Addreu S �'M �
Arch/Eng. License No..
' Address D
Contracror's Nam p�1 Q�Q�� �� I A[C Phone �'a � o�1
AddresslmailinglllSMOfdr4p[.�4y SoLrs�lint Y�-
City License No. � 3 z- �
LICENSED CONTRACTOR DECLARATION '
1 hereby atti�m that ! am'licensetl urytle� O/ovisions ot Charte� 9(commencin9
wi[h'section ]000) ot �ivision 3 0� the Business antl Professions Cotle, antl
my Ilcense is in full force an ftect. � �
I IJCCOSC CId55 �License NO.�� � '
i, Date � f'+ ��� S"g t
v 'N00.KER5 C011PENSATION DEGLARAT N'
� . hereby affirm that I have a certiticate of consent to self-insure or a certiticate
oi Workers' Compensition Insuran<e, or a certitietl wpy.thereof (Secti n
1 3800, Lab. C.) .ij/q 7// Company
\ Policy No. �/�•��3�
� n�.{�=�tifietl copy is hereby (u�nisheU. ,,
OLIT Certifietl c,pY is ' tl rth the ci�y B i� g D'vii on. �.
Date � APPlican�
� EXEMPTIO FR M WORKERS' CbMPENSAT O DECLARATION
(Thi55ection neetl nat be campletetl �{ the pe�mit is for one huntl�etl ($300) or
less�. : �
I certify tha[ in the perfo�mance ot (h¢ w f which this perm�t is issuetl, I
shall not emplo any pe�son in any m0 n o as to become subject to the
Workers' C e i Laws of CaU r' n� � � �Q_
Date Signa[ure
NOTICE: 1, aft r m�
Workers' Compensat
comply with such
CONSTRUCTION L
I hereby affirm that t
of the work for .
Lender's Name —
Lentler's Ailtlress -
OWNER BUILDER
Cecome Subject to tne
;, you must forthwi[h
be tleemetl revoketl.
:y for!the perPormance
:ction 3097 Civ. C.)
I hereby aftirm that I am exempt from the Contractor's License �aw (or the
tollowing reason (Section ]031.5 Businezs antl Protessional Cotle: Any city or
county which requi�es a permit to Const�uct, alte�, improve, tlemolish Or repair
any structure, prior to its issuance, also requires the applicant for suc� permit '
to file a signetl statement that he/she i5 IicenSetl pu�suant to thC Provi5ion5 of
�the Con[ractor's License Law (Cnapt¢r 9(commencing with Section ]000) oY
Division 3 of the Business antl Prbfessions Cotle) or that M1e/sM1e is exempt
therefrom antl thE basis tor, the all¢getl ex¢mption. Any violation of $ection
7031.5 by any applicant for a permit subjects the applicant to a civil
�enalty of not more than five huntlretl tlollars.($500).'
I, as owner ot the property,o� my employees with wages as their sole
compensation, will do the work, antl the structure is not intentletl ar offeretl
for sale (Section 7044, Bu5ine55 antl Protessional Gotle: The Gontractor's
License Law tloes not apply to an o�yner ot a property who builtls or improves
thereon, antl who tloes such work him5elf/herself �or throu9h his or her own
employ¢es, provitletl tM1at such imOrovements a�e not intentletl or offeretl for
sale. If, nowever, tne builtling cr improvement is sold'within one year of com-
Ole[ion, the owner will have tne bu�tlen Of provin9 he/she ditl not builtl or im-
�rOve tor the purpose of sale).
I, a5 owne� of the property, am exclusively tont�acting with licensetl con-
. t�actOrs [o construct the project (Section 7044, Business antl Profe55ions Cotle:
The Contractor's License law tloes mt apply to_an owner of property who
builtls o� improves thereon, antl who contracts fo� such.projects with a con--
ttactor(sl license pursuant�to the Contractoi's Liwnse Law). I am aware [hat
proot o1 thei� Wo�ker'S Gompen5dtion Insurance shoultl be P�Ovitl¢tl [o me.
❑ I am exem0� untler Section B. & P. C. tor this reason
Date Owner
I hereby certify that I have reatl this application antl state that the above
information is cortect. I agree to cpmO�Y wlth all city antl county ortlinanCes
antl state laws latin9 to builtlinq cons[ruction, antl he�eby autho�iie rep�e-
sentatives of i city to enter Upon the above-mentionetl•property tor
inspeGtiOn 0 r e . .
Signatuie Date �D J�
TVPE OFCONSTRUCTION IJ NEW �ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLD1'i. ��� �'q'�GQ �o'�'�A"�+�
TYPE OF PERMIT lJ GRADING OUNDATION L✓J STRUCTURAL
❑ TENANT �LECTRICAL PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5(]. FT.' � oCcuv.
'CONSTRUCTION TVPE � VALUATION $
ZONE GRADING CU. VDS. � AC
Remarks:
P• - �/ 2 -
—� p
Bar Sink
Backflow Preventer � - �(
Backflow Irrigation �
Drinking Fountains
Floor Drains '
Floor Sinks �
Gas Service Outlets
IntefceptOrs '
Lavatories �. -
P-Trap
Roof �rains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU � 100,000 BT
Drivers' �icense or 5 �'
- Accounting; Goltlenrotl - AS5e55o�
Showers
Service Sink - � ---
Sewer.Cap
Sewer Connection
Solar Collecmrs
Solar Piping
SolarTank
Swimming Pool w/Spa
Urinal -
Water Closet
Water Heater ,
Warer Service
Issue Fee '
iANICAL
HooJor Typel ❑
Canopy. Type II ❑
Refrigeration System
❑O�t00,0006TU ❑100,000
System Repair/Alteration
Issue Fee
,'_ FEES
$ 3
G
A.P. # �-�i -'Z
S Main Building:
E
T Front �
B Rear I
A
C Right (�
S Left !•> 1 N
Ping. Ref. #
Planninq Notes: lL.�.r
Automatic Washer_
Construction Pole 5
Cooking Unit .
Dishwasher
Dryers ,I�}8as
Fan
F.A.U.
Fixtures
Device Boxes
Outlets '
Switches
Garbage Disposal
Generator 00.5 KV
Fee
0999 10/26/B4
� � Zone
Accessory Building:
Parking�Req./Provided
—ELECTRICAL � ,
' ' - Transformer ❑ 15-50 KW
❑ 50+KW
lectric
I �5-15 KW
$15
DEVELOPMENT SER VICES R
Zoning Approved By
Building Approved By —
Meter LJup to 700 amps
Meter ❑over 100 amps
$ub Panel
MotorsOO-1 HPO1'/:-8
Inc.Solar �9-15 HP �1fi
Microwave - �-
Pole Light - � '
Range
Si9n
Standing Sections
Trash Compactor
�
/ �E�n��1. T�
ES
Z
O
N
I
N
G
R
E
�
M
T
5.
Issue Fea � ; I'$ 3 I
JT�_ _ . '^/'p/p�j
Date �f�1Q
�.11 A��---n..... � i ��
I /�
SUMMARV OF FEES
BUILDING PERMIT $ -��+O�"-�../d SMIP $
PLAN CHECK $ �.y,-=�+ PERMIT
P,LUMBING $ _��00 . ISSUANCE $
PLAN CHECK 25°/y $ ENERGY P.C. $
ELECTRICALIaj•{/p� �$ GRADING $
PLANCHECK��O% $ v MICFOFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK Z5% $ _ _.
� ��
CONSTRUCTION AND PLANNING � P��- & SPA .
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
� 1. Temporary Electrical Service or Pole . • 52: Pool & Equipment Location
2. Soil Pipe-Undrgrnd. �. �� ���+-r �� LL./� • 53. Steel Reinforcement •
3. Electrical Conduit Utility-Undrgrnd�. .. 54. Forms '
4. Electrical Conduit'Undrgrnd. 55. Electrical Bonding
.. 5. Steel Reinforcement � _ � �� ��BY ,� 56. Rough Plumbing& Pressure Test
V 6. Electrical UFER Gmd. - �� a �. L��� 57. APPROVAL TO COVER-GUNITE
� 7. Footings ' g� `G�,�_ 58. Electrical,Conduit-Undrgrnd. .
8. Foundation , ' 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor Sy'stem yQ.U,� ���jY l �i 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 . ' �y }Q �� �D A_ 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 Heatin9 & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # �
21'. Ducts, in Structure ' � 70. Underground Hydro �
22: Ducts, Ventilating ; 71. Product Piping OGas ❑Oil �
23. Gas Pipe-Rough & Test , . 72. Underground Flush
24. Roof Framing . " .�' 73. Undergrnd. Storage Tank O Gas OOiI
25. Roof Sheathing � �� a7 $� � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .
27:"Frame and Flashing a' ��"' ' 76. Dry Standpipe �
28. Lathing &�Siding �77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing �'w^��`� f,�.'� -�'� . � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat -� � �(g�qc � �y,. 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ,
33. Final Electric 1 a� g5 �.0 Notes: � �
34. Final Heating & Air Conditioning ' � �? i�
35. Final Gas Pipe-Test . �
36. Hood or Canopy ' �
37. FinalFactory 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
48. Special Requirements Completed -
49. Electric Release to Edison' - � • ; � '
50. Gas'Release to $outhern California Gas Co � " ��
51. CERTIFICATE OF OCCUPANCY "
No. � Date - • � . �
0
AOP�icant to fill in all spaces except lhose within heavY �ortler lines anC sl9n all ap0�o0/iate Oeclaralions.
CI7Y oF COSTA MQESA�' CO•'ILf�S�T,R�UC�TION PERMIT
Project Address pZ.p.��� r�L1—.2.^L1��, 1
ApplicanYSMaili gAddress T ��'�� �� ���� S�
�
Owner's Name _i�� � Phone � Z"� �
Address �r%;'M� � '
Arch/Eng. License No.
Address
Contractor's Nam � [�- f�ane� �_
Addresslm�'I'nnl ?N�' �A l�"�%L'i�1V;� � �v���l
City License No. 3�-%
LICENSED CONTRAGTOR DECLHRATION
I hereby atfi�m tha[ I am licensetl untler provi5ion5 of Charte� 9(commencin9
with seclion 7000) of DiviSion 3 0/ the Business antl Professions Cotle, antl
my Iicenze is in tu for antl eifect.
C
License Class _ ' ' IC! ense ���
Date;��_ _ Si9nature _
WORKERS' COM ENSATION DECLA TIO
I hereby affirm lhal I have a Cer[ifltate o consent lo sel!-insure or a rertlficate
of Workers' Compensation Insurance, or a cer[ifietl copY thereof (Section
3800, Lab. C.) ,
Policy No. Company
eCertifietl copy IS herCby tumishetl.
Certlfietl capy Is filetl wlth the city Builtlfng Dlvision.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl it the permii is for one huntlreC ($100) or
less). '
I c¢rtlfy that in the perPormance of the work fOr which tltis perm is ISsuetl I
shall not employ any person in any ma ner as beco ect to f�e
Work¢�r� �pe�, t,i� qn.LawS oi Calif ni . ��'�
Date � /e�_ll�—Si9nalure
�NOTICE: It, afle� making Ihis tlecla�ation, y shOt)f becom � c to th0
Workers' Compensation provlsion5 Of the La�o� Cotle, you must (Orthwith
comply wilh Such provision5 oi tbis pe�mit shall be tleemetl revoketl.
CONSTRUCTION LEN�ING AGENCV
1 hereby affirm that there i5 a mnst�uction lentlin9 agency fo� the Oer(ormanG¢
of tha work tor whith Ihis Oermit is iszuetl (Section 3097 Civ. C.)
Lenaer's Name
Lentler's Atldress
OWNER BUIIDEN DECIARATION �
I hereby aftirm [hat I am CzemOt irom the Contractor'S License Law (or the
tollowing reason (Section 7031.5 Business an0 Professional Coae: Any city or
county which requires a permit to construct, alter, improve, tlemolish or repair
any sVucture, prior to its Issuance, also requires ttie applicant tor such p¢rmit
to file a signetl sla[ement lhat he/she i5 IicenseG pur5uanl to the provisions of
the Contractor'S License Law (Chapter 9(commencinq with Sec[ion 7000) ot
Division 3 ot the Business antl Profezsions Cotle) or that he/she is exempt
th¢�et�om antl the basi5 fOr Ihe alle9etl exemption. Any violdtion �of SectiOn
]031.5 by any applitant for a permit subjects the applicanc to a civil
�endlly ot no[ more Ihan five huntlretl tlollars ($500�.
LJ I, as owner of the property or my employees.with wages as their sole
compensation, will tlo che work, antl the sVucture is not intentletl or offeretl
for sale (Section ]046, Business antl Profes5ional Cotle: The Contractor's
Liceni¢ Ldw tloes not apply to an owner of a property who builtls or improves
' lhereon, antl wno tloes such wOrk hims¢If/he�self or through his or he� own
em0loyees, P�ovitletl that SucM1 imOrovements are not intentletl o� otieretl fOt
sale. If, howeveq [be bulltling or improvement is soltl within one year of com-
pietion, the owneqwill have the burtlen o( proving he/she tliG not bulltl or im-
prOve for the purpOse of sale). ,
❑ I, as owner oi Ihe D/operty, am exclusively contracting with licensetl con-
traclors lo cons[ruct the project (Seclion 7044, Business antl Protessions Cotle:
Tbe ConVactoYs License Law does not apply to an owner of proPerty wno
builtls or improves thereon, antl who conVacts for such projects with-a con-
Yractor(sl license pu�suan[�to the Contiac[or'S License Law). I am aware that
o�oof of tneir Worker's Compenutlon insurance should be provitletl to me.
❑ I am ezempt untler Sectlon B. & P. C. for tnis reason
Date Owner _
I nerebvi certiH that I nave read this
antl state la ta
SEO[d[IV25 t1�5 C� lD
inspecti n p p .
Signatur _
Drivers' License
Pink - Accountlng; Goltlenrotl - AsseSmr
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solai Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater �
Water Service
Trays
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigerati0n Sys[em
❑0-100,OOOBTU ❑100,000
System Repair/Alteretion
Fire Damperz
Registers
Issue Fee
ES
A.P. #
S Main Building:
E
T Front
B Rear
A
C Right
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer. h^
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ec
Fan
F.A.U.
Device Boxes .
O utlets ^
Switches
Garbage Disposal
Generator �65KW 05-15
3375 12/04/84
Zone
Actessory Building:
Parking Req./Provided
ELECTRICAL - .
� Transformer O 15-50 KW
❑ 50+KW
Merer ❑up to 100 amps
�
Meter ❑over100amps
Sub Panel
Morors�0-1 HP�1X-6
Inc.Solar 09�15 HP �16-15+
Microwave - �
Pole Li9ht
Range
Sign
; Standing SeCtions
I Trash Compactor
5."a0 TL
FEES
3
$ 3 . .
�Reinspection Fee $15 Issue Fee $ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By Date
Buildin9 Approved By Date
Application Issuad By Date
� - SUMMARY OF FEES '
BUILDING PEFMIT $ SMIP $ '
PLAN CHECK $ PERMIT
PLUMBING S �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL S �-�— GFADING S
PLANCHECK 50% 5 MICROFILM 5
MECHANICAL $ TOTALFEE $ q �_c�.O
$ 3 PLAN CHECK ZS% $
Z
O
N
I
N
G
R
E
Q
M
T
S
CONSTFiUCTION AND PLANNING POO� & SPA
� Date Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit #
l. Temporary Electrical Service or Pole 52. Pool & Eq�ipment Location .'i
� 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 Li�es, P-Trap, Q Undrgr�d.
10. Structural Floor System � 61. APPROVAL TO DECK
� 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
r•
12. Sewer C8P �' 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 2 f4 CI 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18: Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19..Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil
23. Gas Pipe•Rough & Test 72. Underground Flush
' 24. �Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric �J 2���j CC Notes: �8 $� ua Sw�_
34. Final He2ting & Air Conditioning `-. ,;�� -
�cx
35. Final Ga5 Pipe-Test �/L5 �y (,.c.� ' � %'�
�
36. Hood or CanoPY �.{ �/�� � �� �� �.�. �0
37. Final Factory Fireplace
3S. Final Plumbing � Lj fy r r� �
39. Water Service-Final
40. Gas Service-Final •
41. Solar pomesticFinal
42. Backflow Prevenier
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regutations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Rete2se to Southern California Gas Ca
51. CERTIFICATE OF OCCUPANCY
� No. Dace ^
/'
* «
ADD�icant to fill in al1 spaces exceDt tnose within heavy boraer iines antl sign all aourovriata aeclarations. .
/
CiTY Or COSTn'MESA CONSTRUCTION PERMIT. PER^^i O. TRACT NO. LOT NO. UNII NO. _
. fro]ect-Address �RSR F.�'�jPS1i1PYP AVPTIl1P � `�• � ' " � � 9396 7/1.5%B6 5.OQ j�
Applicani'sMailingAddress 3nZ� N_ -HP4T1PYian �j�j TVPEOFCONSTRUCTION' NEW ADD ALTERATION REPAIR �
❑ CONVERSION ❑ OEMOLISH ❑ OTNER
Owner's Name .F?dl,l� Mi 1 � PT' Phone ' � A'P' # � � � Z��e
DESCRIPTION OF WORK/USE OF BLDG. Ra¢i r7ant i al �
Addrew i35$ $11PCmPYa AlPp11P � � S MainBuildin9: Accessory8uildin9:
Arch/En � ' ' Z
9� LicenSeNo. TVPEOFPERMIT � �GRADING FOUNDATION STRUGTURAL E Front O
AddfC55 � � � ❑�TENANT ❑ ELECT.RICAL PLVMBING ❑ MECHANIGAL T � N
Contracmr'sName A11 Am �i ❑�OTHEa , �1 � A Rear - - �
er CEtri Phone Shc—R75 ' ' �
PROJEC7 DESCRIPTION SQ..FT. oCCUVANcv � C Right - ' . N
Addresslmailingl��.�.22 N Hesnerian T'la� ,"I��-(�� ' ' K Left G
' -- ' CONSTRUCTIONTVPE VALUATION$ S ' R
City License No: ��� ],Q ZpNE � GRADING CU.v05. 'ACRES � Ping. Ref. # Parking Req./Provided E
� IICENSED CONTRACTOR DECLARATION " Q
� I hereby af�irm that I am licensetl untle� provisions of Chatter 9(commencing Remarks: � PlBnning NOt¢5: � '� M
wilh sectlon '/000)! of Division 3 of the Business antl PrpfeS5ion5 Cotle, antl � T
Z my license iz in full force antl effect. i - ' �
� S
� LicenseClazs_(�.e�.� �icen o '
oate ti� � 7/ R ti s'o�at .� :� i�— PLUMBING
FEES
WORKERS' COMGENSATION D LARATION
�' I hereb atiirm that I have a cer�cate of consent to self= r Sink � Showers ' ELECTRICAL . FEE:
' Y iniure o� a cer[ifiwte . �
�\ .oi Workers' Compensation Insurance, or a certiilea cooY thereof (Section kflow Preventer � Service Sink Auromatic Washer � Transformer ❑ 15�50 KW
'3800, Lab. C.) ,- . - . .,. - _
'PoiicYrvo. PE601252� Company BackflOwlrrigation . SewerCap ConstructionPoleSub. � �50+KW
erbiietl copy is
Ce 't cy p letl with the cit Bui ' n. Bathwbs � Sewer Connection Cooking Unit � Mecer ❑up to 700amps'
Date � Applicant � � - � , �
- Clerifiers � . , SolarCollecrors Dishwasher Meter ❑over100amps
;(Thiz ection neetl not be completetl' �fhe permit is for one hundretl (g100) or .
, less). Dishwasher ' Solar Pipin9 • Dryere �Gas ❑Electric Sub Panel
I ter[ify thal in lhe perfo�mance of the wo�k fOr which this pe�m�t is issuetl, 1
shau mt employ any person in any manner so as to Oecome subject to the Drinking Fountains . Solar Tank ' Fan Motors �0-1 HP �1 %=8
Workers' Compen5ation law5 of Califomia. • ,
r Date` Signature - Floor Drains Swimming Pool w/Spa F.A.U. InaSolar 09-15 HP �16-15+
�NOTICE:'If, a(ter making this tleclaration, you Should bGcome subject to the
.Workers' Compensalion provisions of the l2bor•Cotle, you must �orthwith FIOOf$i�ks U�inal
'compty with such� 0/ovisions orv-thiz pe�mit shall pe tleemetl r¢voketl. - FizLU�85 . _ Mic�OwOv¢ .
�CONSTRUCTION LENOING AGENCV GasService ' Outleis ♦WaterC105¢t � DEviC260x¢S POI¢Light
I hereby aifirm ihat tnere is a consVuction lentling a9ency for the performance'_ '
of the wOrk for whith this permit is issuetl (Seclion 309] Civ. 0.) InterCeptor5 - Watef Heater Outlets Range
' � Lentler'S � Name -
Lenaer.'s Aatlress • '� � Kitchen Sink � Water Service Switches .
OWNER BUILDER DECLARATION � " - - � SigO
� I hereby afflrm that I am exempt trom [be Conlractor'silten5e LaW fof the LavdtOfiQS , -. AutO-Wdsh GdfbBg¢ Di5pO5dl ; Stdnding SCC[iOnS
following reason (Section �031.5 Business antl Professlonal Cotle: Any cify or
county wnich requires a permit to construct, alteq improve, demolish or repair P-Trap � Laundry Trays - • � Generator DO-5 KW �5-15 KW Trash Com actor
' any st�uctu�e,�pNo� to ItS�issuance, also reQuireS thea00��cant fo� such permlt - P '
[o file a Signetl slatemenl that he/she ii licensetl pur5udnt to the provisions of Roof Oroins � ' ' -
the COMractor'S Litense Law'(Chapter 9(commencing with SectionJ000) ot t �
� Division 3'�of�the Buslness antl Professions Cotl¢) or�[hat h¢/sh¢ is exemp[
� therefrom antl the�basis for the�allegetl exemplion. Any violation of'Section �_ - ' �� - - I
]031.5 by any appliCant tor a permit subject5 lhe applicant to� a civll ' ' ' �
��enalty of not more than five huntlretl tlollars (5500).
I, a5 �owner of the property or_ my employees wil� wages as Iheir Sol¢ BeinspattiOn Fae $15 laue Pee � S 3 .
compensation, will do ine work, antl the structure is nol intenaetl or otferetl Reinspection Fee $15 Issue Fee •$ 3
, for sale �Seation 7044; gusiness and Pro/essional Cotle: The Contractor's " � MECHANICAL -- FEES
License l.dw tloes no[ apply to an owne� o( a O�operty who builtls or improves '
thereon, antl who tloes•such work himsell/herself or tnrough his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, prOvitletl thdt such im0/ovements are not intentle� o! ottered for BOiICf . HOOd OI Type I ❑
, sdle. If, hOweve�, [he bulltling o� imprOvement is SoIU within oneyear of com- . C2nOpy Typ¢ I I ❑ 2aning ApprOv¢d By Ddte
pletioq lne owner wlll have (he burtlen oi proving he/sh¢ tlltl no� builtl o� im- DUCt ��UndE� G�Ound • �
orove for the purpose of sale). Building Apprbvetl By Date n
❑ I, as owner ot the property, am exclusively contracting witn Ilcensetl con- Dutt - Structural Refrigeration System , Applintion Issued By � Datp /�
[ractor5 to mns[ruc[ the project (Section 7044, Business antl' Profe55ion5 Cotle: ' ' '
The Contractor's License Law tloes nobapoly to an owner of property who � D - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES '
builtls or im0/oves thereon, antl who�contracts fo� sucM1 projecl5 with a con-
Va<tor(sl license pursuant�to tne Contra`ctoi's Litense Law�. 1 am aware t�at Exhaust System ❑ Multiple ❑ System Repair/AI[eration BUILDING PERMIT $ SMIP '$
proof ol ltlei� WorkEr'S Compensation insu�ance ihoultl be provltle0 to me, i .
- �� PLAN CHECK $ —� � PERMIT '
❑ 1 am exempt untler Section e. & P. C. tor this reaso Firepl/Pact Blt. ICBO # Fire Dampers ' PLUMBING $ 5'� �SSUANCE $
oate � ' ' Owner ' Heating System & Ducting Registers i PLAN CHECK 25% $ ENERGY P.C. $
I hereby certiiy Ihat I have reatl thiz application antl state t the above ❑0.100,000 BTU 0100,0008T GRADING $
Informatlon is mrrect: I�agree to- mply with all clty antl c ty ortlinances '- '-'- ' - '- ELECTRICAL $
antl state'laws relating to buila' mnstruction, antl here autnorize repre- ' PLAN CHECK 50% MICROFILM •$ �q_
'Sentativei his city to en upon the abOvo-me netl property (or $ ��i
inspec MECHANICAL� $ TOTAL FEE $ /
nature�
Pink - Acwuntlng: Goltlenrotl = nssesaor - ' - ' -- ""' " ' ' ' ' - - - . -
r
CONSTRUCTION AND PLANNING � � - POOL & SPA � �
APPROVALS Permit# Date. ��Inspector qppROVALS � Permit# � Date .'Inspector
�
� 1• Temporary Electrical Service or Pole . 52. Pool�& Equipmenf Location
' 2. Soil Pipe-Undrgrnd. , . 53. Steel Reinforcement .
� 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. ' � , 55. Electrical 8onding � - �
5. Steel Reinforcement - 56. Rough Plumbing & Preswre Test �
6. Electrical UFER Grnd. . 57. APPROVALTO COVER�GUNITE
� 7. Footings . 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O�Undrgrnd., Test ' .
9. Water Pipe-Undrgrnd. , 60. Backwash Lines, P-Trap, � Undrgrnd. -.
'�10. Structural Floor System 61. APPROVALTO DECK -
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap � 63. Heater & Vent-Final � � .
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing . 65. Electrical-Final ,
15. Rough Electrical-Conduit 66. Solar System-Final � '
16. Rough Electric Wiring , 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING '
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 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush �
24. RoofFraming � 73. Undergrnd.StorageTankOGas ❑Oil
25. Roof Sheathiny . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT ,
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final , y � . 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 7_Zz-d'` (,.,�D
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 Requiremenis Completed . �
49. Electric Release to Edison " ' - , - ' � �
50� Gas Release to Southern California Gas Co ! ,
51i CERTIFICATE OF OCCUPANCY ' -
No. Date
• � C
�5��� �
COSTA MESA BUILDING-SAFETY DEPARTMENT
r. o. eox sn ��A MHBA. CALIFORNIA
For Applicant fo Fill In Complefely
TYPE OR PRINT
BUILDING �>p�� � N
ADDRH88 9Vw� ��� �E/��✓ �Y
��_C�g COSTA MESA CALIFORNIA
OWNER Paoesetter Jt. Venture
MAIL 1,653 Minorca
AOORESS
CiQBtiB M2$a TEL. 1P_O3�
CITY NO. �
ARCHITEGT TEL.
��-�-�r'����'�
���� �- JUL 31 1961 � e
FINANCE DEPT. / �"
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Offlce Use Only '
N6CHIPT NO. ���� ��
[D BY O i8 R8C81V6O DATe 1 8U8D
� I �-.�7_���I �_�3-��
' �-��--5'�
rnarn urcn rwi rrnowne
ADDRESS 1653J. Mi.norca 7.Qn�n '(�
C�$ Ya �e8a ON6 O�' I plANB 2 � BUILOINO HW%/b ]��
GITY /1 J
{ W
LIG.NO. LeOAL // .s� // p
STATE 1.81269 No: Ki 9-0395 DHBCRIM�ON ��� � d� �
SIZE 7500 S` �, I NO. OP B1D68.o
OF LOT q' now oN wT A. P. NO.
USE OF YARDS EVES
EXIBTING BLDG APPROVED ALLOWED
B6TBAGK LINB PROM «MQw L1Ne BT�� e�—�
cernea or srneer S REAR YARD O FRONT J �7. � IN.
SIDE YARD I LEFT 5 I RIGHT � a. SIDE S FT. IN.
DESCRIPTION OF WORK L. SIDE � FT. -- IN.
NEW I %IIA4TERATION I IIADDITION I REAR l� �, IN.
REPAIR I II MOVING I II DEMOLI6H I B?PROVED ��/� DA� �/Z I// �
(y- h
BUILDING O OF A
aize 1800 S.Ft�'ooMs 7 STORIESl
EXTBRIOR WALLMC tillQ CO ROOF ��yy.�i��y e -/�30 ��
COVERING IYOOa COVERING J111II le
U6E OF BUILDING ANO WORK TO BE PERPORMED �
L�f/�
� Attached garage ¢50 Sq.Ft.
I HePEBY ACKNOW G TXAT I NAVB P6Ap TMI APP GTION }NE �MOUNT lXOWN UNOBR V�LUATION 1! POR THE
AND BTATH THAT T OV6 COR CT ND p CON- pUPP098 OP EBT�GLIBXINO A PERM�T IEe ONLY.
PLY WITH ALL CI ON � 6 M1D A LA Ul.A NO
au1LolNa CONern 1 VALUATION �
BIGNATURH OF � � PERMIT FEE $ � /
PERMITfE � V� �—�y o
$ /� ['•��/ PLAN CHEGK $ �� __) �' £
AUTHORIZED AGEN ' � S� O
TOTAL FE8 y