The URL can be used to link to this page

Home My WebLink About1138 EL CAMINO DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 113$ EL CAMINO DR Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Parcel Number: 14161212 Applicant: HERMAN, DAMIEN RICHARD Address: 4050 1/2 BROTHERTON Zoning: ;Phone: (714) 736-5677 Zip: 91719 Phone: Zip: 92626 Phone: (714) 736-5677 CORONA, CA - Zip: 91719 License: 348265,., Arch - Eng; Address: - Address: Status: ISSUED Applied: 01/17/2003 Issued: 01/17/2003 ISSUED BY: Phone: - Phone: Zip: - License: License: -r - SCOPE OF PERMIT- REROOF RESIDENCE AND ATTACHED.GARAGE: T/O,EXISTING WOOD SHAKE ROOF, 1/16" OSB SHTG, 1 LAYER 30# FELT, APPLY "40 -YEAR COMP SHINGLES." 26 SQUARES CORONA, CA-' Owner: BARTLETT, NICHOLAS STARR Address 1138 EL CAMINO DR _- COSTA MESA, CA Contractor: HERMAN ROOFING Address: 4050 1/2 BROTHERTON Zoning: ;Phone: (714) 736-5677 Zip: 91719 Phone: Zip: 92626 Phone: (714) 736-5677 CORONA, CA - Zip: 91719 License: 348265,., Arch - Eng; Address: - Address: Status: ISSUED Applied: 01/17/2003 Issued: 01/17/2003 ISSUED BY: Phone: - Phone: Zip: - License: License: -r - SCOPE OF PERMIT- REROOF RESIDENCE AND ATTACHED.GARAGE: T/O,EXISTING WOOD SHAKE ROOF, 1/16" OSB SHTG, 1 LAYER 30# FELT, APPLY "40 -YEAR COMP SHINGLES." 26 SQUARES NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714) 7545626 2"6A6 (6/00) - FEE SUMMARY , Plan Check: $0.00 _- Calc Valuation: $4,400.00 Permit: $111.25 Claim Valuation: , $4,400.00 SMTP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left - 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714) 7545626 2"6A6 (6/00) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty Of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ' ❑ 1 have and will maintain workers' compensation insurance, as; required by sectlon 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance Cartier and policy number are: Carrier: Policy Number: �(Ttu{his section need not be completed i1 the permit is valued of one hundred dollars ($100) or less.) i 1 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia, andBettis that if I Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provlslon re: Applicant SignatuDate: WARNING: FALURETOSECURE ORKERS'COMPENSATIONSATION COMPENSATION, IS UNLAWFUL AND SHALL SUBJECT I N EMPLOYER TO CRIMINAL PENALTIES AND EST, FINES TO TOONE HUNDRED THOUSAND DOLLARE (5100,000), 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 under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. Lic. k Class Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Commencing with Section 7000) of Division 3 01 the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered 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 through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of Completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (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 contracts for such project with a contractor(s) license pursuant to the Contractors License laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, B. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of 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 standard temperature and pressure). _ _ .............. .......................................... 2 Does or will the applicant or present or future building occupant need to file a registration torn far acutely hazardous materials. ❑ Ves ❑ No (Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity 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 standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ yes ❑ No ............._..............................................................................................................................................................._.........._...........................................................................................................................................,.................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! Yes LJ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). B Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If -yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......................... .................................................................................................................................................................................................................................................. __.............................. ...................................................... .......... -.......... 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? [3 Yes [:1 No ................................................. ............................ ......................... -.............. ................. ............-....... .... ..... ........... ............ -._.-...... _....................................................... ............................. ............................................................... I............................ 6 (II "yes", attach certificate of compliance from the appropriate air pollution Control Officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to Comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct, I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by (his permit until final inspection. To O eget Owner(s) /17_O3te And/Or Authorized Applicant Date CODE.. INSPECTION TYPE 2AU INITTALS CODEC INSPECTION TYPE QS,N INTITALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof iF119— 210 Final Electrical 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 Y OF COSTA ON P Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Applicant's Mailingdd�dreess Owner's Namely ' 1E-` QIR Ph.n.� l -_ Address Arch/Eng. License No. Address', Contractor's Name Phone Address (mailing) ' e City License No. LICENSED CONTRACTOR DECLARATION hereby affirm that 1 am licenseduntler�,provisions of Charter 9 (commencing with Section 7009) of Division ;.0f the,Business and Professions Code, and my license is in full force and effect. License Class e^ , License No. Date Signature?s WORKERS' COMPENSATION DECLARATION "ereby affirm that I have a certificate fA consent to self -Insure or a certificate Yorkers' Compensation Insurance,'�;&'2' certified copy thereof (Section 0, Lab. C.) -4 ,- .57N ulicy No. " ' C5npany 8 Certified copy is hereby fur is`hed. p Certified copy is filed with the city Ef Ilding Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be compl2led if the permit is for one hundred ($100) or less). q I certify that in the performance,of t work for which this p mli is issued, shall not ejnp toy//an_'y person in•any anner So as t'� bje�.t t h= WOrkers'.411upw0rA 0n.6aws of Calif qiq. _ NOTICE'. If, after making this declarationj yoVsjhould becorimesubject to the Workers' Compensation provisions of the- L-#bcjr Code, you must forthwith comply with such provisions or this perhag shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby.affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code; Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions of -the Contractor's License Law (Chapter 9 (commencing with Section 7000) of r ivision 3 of the, Business and Professions Code) or that he/she is exempt <. "�'efrom and the basis for the alleged exemption. Any violation of Section b 1.5 by any applicant for a permit subjects the applicant to a civil *ilty of not more than five hundred dollars ($500). as owner of the properly or my employees with wages as their sole cdmpensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code; The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, prnvided that such improvements are not intended or offered for Sale. If, however, the building or Improvement is sold within one year of com- pletion, the -owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑.I am exempt'under Section .for this reason Date 11,901,YY Owner ffinitCsi, .v, d✓J i/. antl state I s sentatives o inspection p r2 Signature � Drivers' Limen CMF 0865-46, rev. I h la to 1 state that -the above and countv ordinances TYPE OF CONSTRUCTION . L NEW LJ ADD LI ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH O "11,R) T R /� _ DESCRIPTION OF y'/ORVUSE OF BLDG., . \--I' L Y ti s TYPE OF'PERMIT LJ GRADING LJ FOUNDATION L•TSTRUCTURAL ❑'TENANT' ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑OTHER - - - PROJECT DESCRIPTION SO. FT. OCCUPANCY_ CONSTRUCTION TYPE�VALUATION $_c_ ZONE GRADINGCU.YDS. 'ACRES_ Reinspection Fee 1 -$15 1 1 Issue Boiler Duct- Under Ground Duct - Structural Duct. Ventilating, Exhaust System ❑ -Multiple ❑ Firepi/Fact. Bit. ICBG # / Heating System & Ducting Reinspection Fee I $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES $ 3 A.P. # - _ .._ _ _- I Zone , S Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Pi Drinking Fountains Soffank Floor Drains wimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee 1 -$15 1 1 Issue Boiler Duct- Under Ground Duct - Structural Duct. Ventilating, Exhaust System ❑ -Multiple ❑ Firepi/Fact. Bit. ICBG # / Heating System & Ducting Reinspection Fee I $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES $ 3 A.P. # - _ .._ _ _- I Zone , S Main Building:. Accessory Building: Cooking Unit E Dishwasher Z T Front ' i O A Rear N 'C Right - N. K Outlets G S Left R Ping. Ref. # Parking Req./Provided - E Planning Notes: Q M $ T $ S ELECTRICAL - FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW - ❑ 50+KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric - Sub Panel Fan Motors 0-1 HP Ell G - B F.A.U. I . Solar 09-15 HP 016-15+ ' Fixtures Microwave Device Boxes Pole Light Outlets Range Switches .Sign - - - - Garbage Disposal Standing Sections Generator 00-5 KW 05-15 KW Trash Compactor I I I I.Reinspection Fee I $15 Issue Fee IANICAL FEES —I I Hood or. Type ❑ DEVELOPMENT SERVICES REQUIREMENTS: Canopy Ty I' ❑ Zoning Approved By - I Building Approved By 00) _ 0 tefrige Ion System 00,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee I '$ 3 1 " $ 3 PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT $ ��• O�.J SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL. $ GRADING $ ' PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit r Date Inspector `.` POO L & SPA APPROVALS Permit Date Inspector 1 !,Temporary ElectricalService or Pole 52. Pool & Equipment Location 1 1 2. Soil Pipe-Undrgrnd.'�\� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uniirgrnd. �... 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER &A. 57. APPROVAL TO COVER-GUNITE r 7. Footings �� r•.� �' /�58. Electrical Conduit-Undrgrnd. 8. Foundation r 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Uncirgrnd �� 60: Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System , 61. APPROVAL TO DECK 11. Property Sewer Line.&'House Connection 62.'Backwash & Receptor-Final ' 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL,1• ILrr 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT p % J APPROVALS Permit # -r �� :• 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro r^` 'r ' 22. Ducts, Ventilating 71. Product Piping 0Gas OOi1-' , 23. Gas Pipe-Rough & Test t - 72. Underground Flush i ` i7 J 24. Roof Framing . 73. Undergrnd. Storage Tank10 Gas 0 Oil t 25. Roof Sheathing r 74:/Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing / 76. Dry Standpipe -F: •-,'' 1 :,rt 28. Lathing &,Siding i 77. FIXED SYSTEM FINAL- 29. Insulation r� 78. FIRE PREV. FINAL t 30. Drywall Nailing HEALTH DEPFT.REQUIREMENT >- 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning �- r 35. Final Gas Pipe-Test �- 36. Hood or Canopy _ 37. Final Factory Fireplace , 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final - • 42. Backflow Preventer - 43. Backflow Irrigation coom 44. Landscape Irrigation System 45. Sound Attenuation L7riC - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date - _ ' _ �- �• � '�� Applicant to fill in all spaces except those ITY LIF COSTA MESA. CO R CTION P MIT ' Project Address �(�CtM L. ar C Applicant's Maili. ' jldre s - - Owner's Name Prod = � Address BArch/Eng. License No. • Address Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION " 1 hereby, affirm that I am licensed under provisions of'Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATIO N DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) 'n Policy No. 'Company L'-- eCertified copy is hereby furnished. � _ I Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION !r .(Thissection need not be completed if the.permit is for.one hundred ($100) or less). -' certify that in th performance bt t e work for which th"�7permit i iss ed, shall' not ploy ny person in any'gf�n ap he so as to b t5me su 6c o the Wor kqr e I n, Laws of Calitb 1 . Date/ Signature / 'NOT E: If, a er akinq this declaratk , y6 shoultl a su ject to the Workers" Co pensalion provisions of -i or Code,` ou must forthwith complywithsuch provisions or -this p r It shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' 1 hereby affirm that there Is a consttuction lending agency for the performan Ce of the work / for which' thi, yermi� is issued (Section 3097 Civ. C.) Lender's Name Lender's Adoress - ) — OWNER BUILDER DECLARATION -- I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section7031.5 Businessand Professional Code:•Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit .to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter.9 (commencing with Section.7000) of Division 3 of the,Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031'.5 by any applicant tar; a permit subjects the applicant to a civil pepalty of not more than five hundred dollars ($500). as owner of the property or my employees with wages as their sole Y compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's -, License Law does not apply to an owner of a property who,builds or improves thereon; and who does such work himself/herself or through his or her own employees, provided that such -improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of com- pletion, the owner will have.the burden of proving he/she did not build or im- prove efor the purpose of sale). I ' I, as owner of the property, am exclusively contracting with licensed con- ' tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts f or -such. projects with a con- tractor(s) license pursuant to the Contractor's License Law). 1 amaware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date 4Owner 1 hereby certify that I. have read this application and state that the above information is pWrect. I agree to comply with all city and county ordinances and state laws IlNatinq to building construction, and hereby authori re re- sentatives of tresis city) to enter p the be e -mentioned pro rty, for inspection ourpo Signature Date lines and sign all appropriate declarations. TYPE OF CONSTRUCTION ' LJ NEW PSS DD LJ'ALTERATION LJ REPAIR BUILDING,PERMIT' Fan OT R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER F.A:U. A A P # DES�IPTIONOFWORK/USEOF BLDG. ��/Lr m ftayl- Device Boxes. ^ - 4� + -� t p IL�RRZir Switches - .F Building: 11 TYPE OF OF PE��.�j GRA— OING'® FOUNDATION ® STRUCTURAL t❑ TENANT ).., ELECTRICAL ® PLUMBING ❑ MECHANICAL MECHANICAL $' ❑ OTHER-'+ Rainspectiori Fee r $15, - JA PROJECT DESCRIPTION SQ. FTS OCCUPANCY DEVELOPMENT SERVICES REQUIR Zoning Approved By Building Approved By.,' ."f tCONSTRUCTION TYPE V VALUATION$ ZONE GRADING CU. YDS. CRES ACRES— Remarks: Remarks: .' Planning Notes: _ C. P Bar Sink I i/ Backflow Preventer _ Backflow.lrrigation Bathtubs Clarifiers Dishivvasher Ir Sinks Service reactors :hen Sink P—Trap Roof Drains' -Reinspection Fee Boiler Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating`System & Ducting El 0-100,000 BTU ❑100,000 BT' Drivers' License or PS - _ r Reinspection Fee CMF 0865-46, rev. 10/84 Whit., Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Service Sink. _ Sewer Cap - Sewer Connection'„.. Solar Collectors - Solar Piping Solar Tank - -, Swimming Pool w/Spa Urinal �. Water. Closet Water Heater Water Service Auto-Wasli I a,inrl—Tra vc FEES 11 Issue Fee 1ANICAL Hood o% _Type I ❑ Canopy Type 11 ❑- Refrigeration System ❑0-100,0006TU ❑700,00087 System Repair/Alteration Fire Dampers Registers Issue Fee 2626 ///0-/p' Accessory Building: ;Q 0 E-Lt—f - 11 - �r Ez Automatic Washer , Construction Pole Sub. Cooking Unit Dishwasher ICAL Transformer, ❑' 15-50 KW' ❑ 50+KW' Meter ❑up to 100. amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑t%'- 8 ., Inc.Solar'❑9-15 HP ❑i6 -15 - Microwave - --'I 7 Z O N I N G R E a, e J Sign Standing Sections Trash,Compactor r Issue Fee $ 3 NTS': Dryers ❑Gas ❑Electric l BUILDING,PERMIT' Fan - ' F.A:U. A V? Fixtures-- ro Device Boxes. Outlets r ' PLUMBING d $' PLAN CHECK, 25% $- ' Z.OQ ELECTRICAL; $ PLAN CHECK 50%.$' 2-7C7 Switches - .F IT DO Garbage'Disposai, " Generator 00-5,KW 1:15'15 KW MECHANICAL $' $ .3 Rainspectiori Fee r $15, —FE ES PLAN CHECK 25% $' - DEVELOPMENT SERVICES REQUIR Zoning Approved By Building Approved By.,' ."f ICAL Transformer, ❑' 15-50 KW' ❑ 50+KW' Meter ❑up to 100. amps Meter ❑over 100 amps Sub Panel Motors ❑0.1 HP ❑t%'- 8 ., Inc.Solar'❑9-15 HP ❑i6 -15 - Microwave - --'I 7 Z O N I N G R E a, e J Sign Standing Sections Trash,Compactor r Issue Fee $ 3 NTS': FEES SMIP $ 2.20 PERMIT ISSUANCE $ ENERGY P.C. $ j GRADING $ MICROFILM $ TOTAL FEE $ BUILDING,PERMIT' PLAN CHECK PLUMBING d $' PLAN CHECK, 25% $- ' Z.OQ ELECTRICAL; $ PLAN CHECK 50%.$' 2-7C7 MECHANICAL $' $ 3 PLAN CHECK 25% $' - FEES SMIP $ 2.20 PERMIT ISSUANCE $ ENERGY P.C. $ j GRADING $ MICROFILM $ TOTAL FEE $ r CONSTRUCTION AND PLANNING .r.. 1 APPROVALS - Permit # '.. Date � . '. 'Inspector POOL „PA. - - - APPROVALS Permif # - Date -- t - - - Inspector' ,t r 1. Temporary Electrical Service or Pole -52. Pool &Equipment Location _ - •' - '2. -Soil Pipe-Undrgrnd. - .53. Steel Reinforcement ai'Electiical Conduit Utility-Undrgrnd.• _ .54. Forms - - r .4. Electrical Conduit-Undrgrnd.' G - - 55. Electrical Bonding - 5. Steel Reinforcement = �; �. !%:� 56.- Rough Plumbing & Pressure Test { .,6.1'Elect*rical UFER Grnd. , 57. APPROVAL TO COVER-GUNITE �7..F6oting"s � .. 77 �+j 58., ElectricaLConduif-Undrgrnd. 1 , - • �. ; - 8t, Foundation '. C 59. Gas Pipe, O:Undrgrnd., Test . �•',, - 9.,Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61.: APPROVAL TO DECK _ 11. (Property Sewer Line & House Connection 62. Backwash & Receptor-Final •• -12. Sewed Cap 63. Heater &Vent-Final 13. Roof Drains c. - - 64. Plumbing System - Final - - - 14. Rough Plumbing 3 2S d(S L 65. Electrical-Final ,75. Rough-Electrical-Conduit 66." Solar System-Final" 16l Rough Electric Wiring yfmRn 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 APPROVALS- Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating I 71. Product Piping E3 Gas []Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24: Roof Framing - ,_ 73. Undergrnd. Storage Tank O Gas O Oil 25. Roof.Skeathing 74. Overhead Hydro 26. T-Bar,Ceiling'(Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ✓v .76. Dry Standpipe _ 28.. Lathing& Siding (/(�l 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PR EV. FINAL i. 30. Drywall Nailing 8 V�C__ HEALTH DEPT. REQUIREMENT 31. Plaster,,Arown Coat ;. b J X79: FINAL INSPECTION • 32. Electrical Power Meter-Final - ?' �, 80" FOOD•CERTIFICATE ISSUED 33. Final Electric, $ Notes: / 30✓%/�� %/�'��/DLJ 34. Final Heating & Air Conditioning NO STFEe. 35. Final Gas Pipe-Test 36. Hood or Canopy - G y/AW14t 4UX Al, 37. Final Factory Fireplace - 38. Final-Plumbing,- '"It I S f)^G5/_7 " �N 39. Water Se.. .Final n 0� 7-0 AJAgy; .D K 7Z) 40. Gas Service-Final f^/ON✓ %L£I!-tat/ILL OF �.rl`l�GiarG 19'�•L.-' 41. Solar Domestic-Final I - 42. Backflow Preveriter A ' 43. Backf{ow Irrigation 44. Landscape Irrigation System . 45. Sound 'Attenuation '• 46. Handicap Regulations 47. FINALSTRUCTURE&-BUILDING I i 48.Special Requirements Completed , - •' 49. Electric Release to Edison --i-- -. - - r--�•--'I - - r<'.y ,� 0. Gas Release to Southern California Gas Co I _ CERTIFICATE OF OCCUPANCY - , r i •., , ,Date' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY C<<COSTA-ME �(A t�CO -= PE IT Projecrt Address �'y-+a� / ,/•r10 - Applicant's Mai I Addr{yss(J - Owner'sNa e ^�+�✓t % - •Phone �•'7O `j Address ` xz - Arch/Eng. License No. Address Contractor's Name -Phone Address )mailing) �•,•'.-P� City License No. LICENSED CONTRACTOR;DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 1 , License Class I ILicense No' Date' I Signature WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have acertificate of consent to self -insure or a Certificate of Workers' Compensation :Insurance, or a certified copy thereof (Section ' 00, Lab. C.) , .. ... - olicy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or . ess). Certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. . Date Signature 'NOTICE: If, after making this declaration, you should become subject to.the ' Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit. shall be deemed revoked. CONSTRUCTION LENDING, AGENCY I hereby affirm that there is a construction lending agency for the performance of the - work for which this permit is issued (Section 3097 :Civ. C.) Lender's ,Name Lender's Address OWNER BUILDER DECLARATION Uereby affirm that'I am exempt from the Contractor's License Law for the lowing.reason (Section 7031.5 Business and Professional Code; Any city or county which requires a permit to construct, alter, Improve, demolish or repair' any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions of . the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3� of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil }I enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structuress not intended or offered 1 ' for sale (Section 7044, Business and Professional Code: The Contractor's License.Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of .proving he/she did not build or im- �ove for the purpose of sale). ' LJ 1, as owner of the property, am exclusively contracting with licensed con- - tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves_ thereon, and'who contracts for such projects with a con- tractor(s) license purs uant .to the Contractor's for Law). Iam aware that proof of their Worker's Compensation insurance should be Provided to me. ❑ 1 amexemptunder Section I B. & P. C. for this reason Date Owner Ihereby certify that I have read this application and state that the above information is correct..) agree to comply with all city and county ordinances and•State laws relating to building oon�sirr ction^antl hereby authorize repre- ) .,...._ ...... .u:. ..... _ ,....... a ..,. ..e ...e ..... .. .......✓.r.� .. Signature ' /L Drivers' License or S! -CMF 0865-46, rev. 10/84 PER IT NO. TRACT NO. LOT NO. UNIT NO. ' TYPE OF CONSTRUCTION Ed NEW ADD ALTERATION LJ REPAIR ❑ CONVERSION- ❑' DEMOLISH ❑ OTHER A.P. # _ DESCRIPTION OF WORK/USE.OF BLDG. ' S Main Building: E TVIPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front 1}❑—I TENANT- ❑ ELECTRICAL ❑ PLUMBING EJ MECHANICAL. _ B Rear LJ OTHER . A PROJECT C Right DESCRIPTION SQ. Fr. OCCUPANCY K. CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: ! Planning Notes: Sink Irrigation Drinking Fountains Floor Drains i Floor Sinks' Gas Service Outlets Interceptors Kitchen Sink .. - P -Trap Roof Drains $15 Boiler ' Duct,- Under Ground Duct -Structural r - Duct -Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO.# Heating System & Ducting ❑0-100,000 BTU 13100,000 BTi e - L— — I I Reinspection Fee Building; Canary - Applicant; Pink - Accounting; Goldenrod --Assessor $15 2333 5/03%B5 _ 15pGi - L , Zone _ Accessory Building:, Z O. N I' N G' R Parking Req./Provided' M T; S' MBING, FEES SUM ILDING PERMIT $ PLAN CHECK i $ PLUMBING $ I PLAN CHECK 25%' $ ' ELECTRICAL $ ' PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ A V 0FEES LL SMIP PERMIT ISSUANCE ;ENERGY, P.C. 'GRADING MICROFILM .TOTALFEE 1 Showers System Repair/Alteration ELECTRICAL t I FEES Service Sink Automatic Washer -- - - Transformer ❑-15-50 KW.. - - - El50+" Construction Pole Sub.. ,KW. Sewer Cap P - Sewer Connection Cooking Unit Meter ❑up to 100-am5s Solar Collectors ' $ 3 Dishwasher Meter ❑over 100a npii Solar Piping - Dryers ❑Gas ❑Electric Sub'Panel ,'✓`, ) Solar Tank I Fan Motors 110-1 HP ❑1:/ - 8 Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP 016-15+ , Urinal _ Fixtures - ._ Microwaves .._ _ ... ._ Water Closet Device Boxes Pale Light Water Heater Outlets Range i - Water Service - - Switches Sign Auto -Wash Garbage Disposal 1, Standing Sections , Laundry Trays- Generator 00.5 KW ❑5-15 KW Trash Compactor Issue Fee ' ' S 3 Reinspection Fee $15 Issue Fee $.3 IANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date i Hood or Type 1❑ Canopy, Type 11 C1- ❑0-100,000 BTU ❑100,000 BTU 'I SUM ILDING PERMIT $ PLAN CHECK i $ PLUMBING $ I PLAN CHECK 25%' $ ' ELECTRICAL $ ' PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ A V 0FEES LL SMIP PERMIT ISSUANCE ;ENERGY, P.C. 'GRADING MICROFILM .TOTALFEE 1 { $ $ I , $ $ ' $ $ !_ System Repair/Alteration Fire Dampers Registers - ,Issue Fee $ 3 . CONSTRUCTION AND PLANNING - -APPROVALS Permit # Date Inspector POOL SPA APPROVALS' Permit # - Date Inspector r* 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. _ - 53. Steel Reinforcement 3. 'Electrical Conduit Utility-Undrgrnd: - 54. Forms - 4: Electrical Conduit-Undrgrnd. -55. Electrical Bonding . 5. Steel Reinforcement 56.. Rough Plumbing & Pressure Test , - 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings - '58. Electrical Conduit-Undrgrnd. ' . 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. - 60. Backwash Lines;P'-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK + 11. Property Sewer Line & House Connection 62.- Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14.. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final - - - 16. Rough Electric Wiring 67. Fencing & Access Approval • 17.. Rough Wiring Sign 68. APPROVED`FOR PLASTERING - 18' Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT;. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 76. Underground Hydro . 22: Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe-Rough & Test . 72. Underground Flush. 24. Roof Framing 73. Undergrnd: Storage Tank❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED,SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat -� 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System 45. Sound Attenuation , 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING l ?1 48. Special Requirements Completed 49. Electric Release to Edison + I 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE-OF OCCUPANCY No. Date - _ _ ' I +• I 'i Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF -COSTA ME ON U TION PER NK PERMI_i NO, - TRACT NO. LOT NO. UNIT NO. Project Address !>'1� /t Applicant's Mailih ddres �'^�-""cam TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Owner's Name e []'CONVERSION ❑ DEMOLISH [:1 OTHER A P # + �/ r DESCRIPTION OF WORK/USE OF BLDG. - $ Main Builth 'Address - - Arch/Eng. - License No. Address - Contractor's Nam Phone Address (mailing) - City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of ,the 6: 'me a Professions Code, and, my license is in full force and effect. License CIasS 1 ns No. Date ' ' Signature _ WORKERS' COMPENSATION DECLARATI N I hereby affirm that I have a certificate of co sent to self -insure or a certificate .`.,Workers' Compensation Insurance, or a certified copy thereof (Section 0. Lab. C.) +®iicy copNo. Company - Certified y is hereby turn isheq., .Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COM,ENSATION DECLARATION (Thissection need not be completed if a permit is for -one hu/Fetl ($100) or less). I certify thaVn in performance of he work for whlch,this rm,t is,jssued I shall not a ploy ny parson in any anner so as b e ubi CS w9p ng comply with such provisions or thi P rm/t Shall be deemed' revoked. CONSTRUCTION LENDING AGENC I hereby affirm that thereis a Corstrhpti an inq gency for the performance of the Work for which this permiss a Section 3097. Civ. C.) Lender's Name Lender's Address OWNER -BUILDER DECLA.Tl 1 hereby affirm that I am exempt from the 'Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code:'Any, city or county which requires a permit to construct; alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for Such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prbfessions Code) or that he/she is exempt '^erefrom and the basis for the alleged exemption.,Any violation of Section 11.5 by any applicant for a permit subjects the applicant to a civil ally of not more than five hundred dollars ($500). - "has owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional' Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees. Provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of.com- pletion, the owner will have the burden of proving he/She did not build or im. 1n�1rove for the purpose of sale). LI I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner _ 1hereby cer 'fythat I have read this application and state that the above, information is orrs ect. I agree to egmpl with all city and county grdinanc and state laws elating to bOiltlIng on uction, and reby authori (' re e- sentatives of t city to ent p e e- toned pro arty inspection purp Signature TYPE OF PERMIT_/IfJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT liiELECTRICAL- ❑ PLUMBING ❑ MECHANICAL ❑.OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE - GRADING'CU.YDS., ACRES' Remarks: p.�Q� I�-3l-9 ' M� �7 S'7, . 3ar Sink 3ackflow Preventers 3ackflow Irrigation 3athtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks - Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct -Structural ' Duct - Ventilating _ Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting' 1:10-100;000 BTU 1:1100,000 BT Drivers' License or S' — Reinspection Fee CMF 0865-46, rev. 10/84 ✓White - Building: Canary - APPIICdnt; Pink -Accounting: Goltlen rod - Assessor $15 , PLUMBING + Showers Service Sink Sewer'Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type ❑ Canopy Type I1 ❑ Refrigeration System , 110.1000008TU 0100,000 System Repair/Alteration Fire Dampers - Issue Fee F T Front B Rear A C Right Ping. Ref. # ^ Planning Notes: Automatic Washer, Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas []Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 K ❑5 Accessory BI Parking Req. I IR.ae• x� Zone - I ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up o 100 amps 1 Meter QrSver 100 amps Sub Pane. Motors 00-1 HP 1 % - 8 Inc Solar 09-15 HP 016-15+ Microwave Pole Light Standing Sections FEES Z O N N G R E O M T $ $ 3 Rei pection Fee $15 Issue e $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By � ^ Application Issued By nate Date Date-V� BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% l MECHANICAL 1 PLAN CHECK 25% $ $, $I $ $ $ $, $ SUMMARY OF I IZ, 00 yi lJV FEES SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE $ $ $ $ $1 $, ' vo $ 3 CONSTRUCTION AND PLANNING .)ate APPROVALS Permit #APPROVALS Inspector 'POOL' 'A Pern��c # Date Inspector ' 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. "Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4., Electrical Conduit-Undrgrnd. 55. Electrical Bonding' - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings' 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test _ 9. Water-Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK . 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains 64. Plumbing System - Final - 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. 'Rough Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign' 68. APPROVED FOR PLASTERING - 18.,' Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT APPROVALS Permit # 20., Rough Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro " 22. Ducts; Ventilating 71. Product Piping 0Gas 0Oil i ' 23. Gas,Pipe-Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank UGas 0Oil - 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 LO Notes: 34. Final Heating & Air,Conditib6ing 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 Domestic-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 f 49. Electric Release to Edison •i ' 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATEDF OCCUPANCY No. Date CITYOF COSTA MESA CONSTRUCTION PERMIT Project Address m39 14-1- G.An ,410 f Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. / 1 .- -�PEHMI I NO_ y TRACT NO. LOT NO. I UNIT No. r Applicant's Mailing Address Owner's'Name g T/E'Z- Phone/�9i� Address /Z-39 d'/ G..lJin NO - Arch/Eng. License No. Address Contractor's Name A/0 Phone?79'-iU Address (mailing) '¢? Al -Gzm < City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full fo ce and effect. License Class' �'510'cense N g DateSignature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insuie or is certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. -C.) _ - Policy No. Company eCertified copy is hereby furnished. ' Certified copy is filed with the city Building Division. Date I Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manne so as to become subject to the Worked _COm P. e. n Laws of Californ�� /� O Date p -/ f�GG Signature G (,L!aeA 44� NOTICE: If, after making this declaration, you should become surjject to the Workers" Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the performance of the work for, which this permit is issued (Section 3097 Civ. C.) Lender's' Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following rea son _(Secti on 7031.5 Business a n d' Professi on a l Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair a TYPE OF CONSTRUCTION LI NEWADD•2S ALTERATION IJ'REPAIR El CONVERSION CONVERSION DEMOLISH H`OOTHER - DESCRIPTION OF WORK/USE OF BLDG. f.S,1�O�.CJGFi Alli c� ^ ��r rlh G� /DSiIT' A )a2 - TYPE'OFPE'OFPE- RMITTt GRADI FOUNDATION J STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS— ZONE ALUATION$ZONE- GRADING CU.YOS. ACRES Remarks: • PLUMBING FEES Bai Sink Showers Boiler ' r Backflow Preventer - - Service Sink r - I sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will .have the burden of proving he/she did not build or on. rove for the purpose of sale). i I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: Backflow Irrigation Sewer Cap - Bathtubs Sewer Connection Duct -Structural Clarifiers Solar Collectors Duct - Ventilating _ Dishwasher Solar Piping' The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and Who contracts for such projects with a con- Drinking Fountains i Solar Tank IV Exhaust System ❑ Multiple Eli Floor Drains, Swimming Pool w/Spa tractor(s) license pursuant to -the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to .me. Floor Sinks Urinal Firepl/Fact. Bit. ICED # Gas Service Outlets Water Closet ❑ 1 am exempt under Section B. & P. C. for this reason I Interceptors. Water Heater _ Date Owner Kitchen Sink Water Service �. Lavatories Auto -Wash - I hereby certify that_I have read this application and state that theabove/ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of 'this city to enter Pon the above-mentioned property for inspection purp ?? G/ Signature DateJ, % 6> Drivers' License or SS P -Trap' Laundry Trays. - l'y 0-100,000'BTU ❑100,000 BT' RoofDrains Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil 3i nnalty of not more than five hundred dollars ($500). ; ' LJ I, as owner of the property or my employees with wages as their sole-R.mspettien Fee compensation, Willydo the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's' License Law does not apply to an owner of a property who builds or improves thereon and who does such work himself/herself or through his or her own $15 employees, provided that such improvements are not intended or Offered for Boiler ' r 'Reinspection Fee $15 Issue Fee $ 3 I sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will .have the burden of proving he/she did not build or on. rove for the purpose of sale). i I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: Duct - Under Ground �ANICAL Duct -Structural Duct - Ventilating _ Hood or Type (IDEVELOPMENT The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and Who contracts for such projects with a con- Exhaust System ❑ Multiple Eli tractor(s) license pursuant to -the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to .me. Zoning Approved By Date Firepl/Fact. Bit. ICED # ❑ 1 am exempt under Section B. & P. C. for this reason I Building Appioved By Data i Application Issued By i Date— Date Owner I Heating System & Ducting RI0-100,000 BTU ❑100,000 BTU I hereby certify that_I have read this application and state that theabove/ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of 'this city to enter Pon the above-mentioned property for inspection purp ?? G/ Signature DateJ, % 6> Drivers' License or SS CO l'y 0-100,000'BTU ❑100,000 BT' System Repair/Alteration Reinspection Fee $15 ,.CMF 0865-46, rev. 10/84 White Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor A.P. # S Main Building: TFront B Rear A C Right K' $ Left Ping. Ref. # Planning Notes: Automatic Waslier Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas- ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 11O-5 KW 05-15 Zone Byilding: Parking Req./Provided I ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW 'Meter ❑up to 100 amps _ Meter Dover 100 amps 'Sub Panel Motors 00-1 HP El Y. -,8 Inc.Solar 09-15 HP E316 - Microwave ` Pole'Light Range Sign ;Standing Sections . 1 Trash Compactor Z. O N I N G R i E Q M ' T S ' Issue Fee $ 3 'Reinspection Fee $15 Issue Fee $ 3 �ANICAL FEES SERVICES REQUIREMENTS: Hood or Type (IDEVELOPMENT Canopy Type II ED- Zoning Approved By Date Building Appioved By Data i Application Issued By i Date— Refrigeration System - RI0-100,000 BTU ❑100,000 BTU CO SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT System Repair/Alteration Fire Dampers - PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. ' $ 1 ELECTRICAL I $ - I GRADING $ PLAN CHECK 50% $ MICROFILM '$ Registers - MECHANICAL $ 11 '00 TOTALFEE $ .Oa PLAN CHECK 25% $ 2 •4 i Issue Fee $ 3 It - CONSTRUCTION AND PLANNING " APPROVALS Permit Date Inspector - POOL & SPA - 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. a 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, 0 Undrgrnd,, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd: ' 10. Structural Floor System 61. APPROVAL TO DECK X11. Property Sewer Line & House Connection 62. Backwashi & 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 Wring 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 /a'�,5`�, FIRE DEPT. REQUIREMENT APPROVALS Permit # ' 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping E) Gas EJ Oil 23. -Gas Pipe -Rough & Test 72. Underground Flush . 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas COil." 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:, 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - - - 36. Hood or Canopy 37: Final Factory Fireplace 38. Final Plumbing.__ - 39. Water SelGica--Final - 40. Gas Service -Final 41. Shcar,Domestic-Final .. 42. Backflow,Pieyenter .. 43. Backflow Irrigation,; 44. Landscape Irrigation System 45. Sound(Aftenuation 46. Handicap Regulations - - - 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed - - - i 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. - Date - -- .. t 20200 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 217 COSTA MESA. CALIFORNIA A For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA, CALIFORNIA Ime TEL. O i0b NO. �. .. .TEL. TT n�F T� H X t: s FEE RECEIVED JR 1:5 1961 APPFLIICvAO� F�$TERMIT UB jr Cror Off/ wwke ui* STATE TEL. Oriole � LIG, NO. 207343 -A -SB -1 TEL SIZE" 791 Tr Q71 r.2...D1 BLDGENnnP SETBACK LINE FROM CENTER OF STREKT591 REAR YARD -411611 BIDEYARDI LEFT T I RIGHT- 1- - DESCRIPTION OF WORK ZONING. ZONE NO. OP UBE OF NEW R-1 PLANS 2 I BUI LOIN,w/ raf-A, £ar. none OVERHANG SHALL BE LESS THAN ARDS APPROVED YARDSAPPROVED ' YMAIIN BUILDING I ACCESSORY BUILDING VAR. DATE SIZE- 1x hlf&1R66-4s 78T RIES 2 Liellixig APPROVED EXTERIOR WALL Mood ROOF oL�t t� ED W. L. D. DATE 7-22-63 COVERING I COVERING Shake SILL USE OF SUI&I ORK TO BE PERFORMED Single farm res. w att, arage 2266 S. 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE, IS CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDIN O CONSTRUCTION. - SIGNATUREOF S 0 an PERMITTET AUTHORIZED AGENT SO. Fr. RECEIPT NO.gM N .1. {AAJI{I F O M p8 IVSD DATE ISSUED r -D 2 I FAFFROVED PLAN CHECK 1 4 TOTAL FEE $//� TYPE GROU DATE STATE TEL. Oriole � LIG, NO. 207343 -A -SB -1 TEL SIZE" 791 Tr Q71 r.2...D1 BLDGENnnP SETBACK LINE FROM CENTER OF STREKT591 REAR YARD -411611 BIDEYARDI LEFT T I RIGHT- 1- - DESCRIPTION OF WORK ZONING. ZONE NO. OP UBE OF NEW R-1 PLANS 2 I BUI LOIN,w/ raf-A, £ar. none OVERHANG SHALL BE LESS THAN ARDS APPROVED YARDSAPPROVED ' YMAIIN BUILDING I ACCESSORY BUILDING VAR. DATE SIZE- 1x hlf&1R66-4s 78T RIES 2 Liellixig APPROVED EXTERIOR WALL Mood ROOF oL�t t� ED W. L. D. DATE 7-22-63 COVERING I COVERING Shake SILL USE OF SUI&I ORK TO BE PERFORMED Single farm res. w att, arage 2266 S. 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE, IS CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDIN O CONSTRUCTION. - SIGNATUREOF S 0 an PERMITTET AUTHORIZED AGENT SO. Fr. N THE AMOUNT SHOWN UNDER VALUATION PURPOSE OF ESTABLISHING A PER NJ I8 FOR THE FEE ONLY. F O VALUATION PERMITTEE r m S 23,925.00 PLAN CHECK 1 4 TOTAL FEE $//�