HomeMy WebLinkAbout2801 EUROPA DR - Building PermitsPNOJECT AOUflE55: Z 8 O 1 EUROPA AR
OWNEN'S NAME: CAMPOBASSO �TOE TR
nooeess: ?g01 EUROPA DR
COSTA MESA,CA 92626
�' S49-1978
AflCNIENGINEEH:
AOONE55:
flEC.NO.:
UNIT:
UNIT:
PEXMITTEE: SOE COMPABASSO ( 714 ) 549-1978
nonness: zg01 EUROPA AR
C.M. CA 92626
LICENSEo CONiNACTOB oECIAPAiION: I nereDy aHirm tly� I am Iicense0 un0er Drovitions ol Cnapter 9 kommencing wilh Section
7000� ol Oivision 3 0l t�e Busin¢55 antl Prolessions Coae. and my license �s in full larce anG etiect.
CITY LIC.: STFTE LIC.: ClASS:
Date: Signature:
WORNENS' COMPENSRTION oEtIABRTION: I nereEy allirm �nat I nave a cenilicate oi consent to self-insure or a cenilicate ol warkers'
Campen5alion Insurance, or a cenilie0 copy tner¢Of I��n 3800. �ao. CI.
POLICY NO.: EMP. DATE:
camraNr:
, � CenilieE copy is �erehy furttis�etl. ❑ Cenifie0 copy is IileE wit� t�e dry Buil�ing Divisron.
e1e: ApOtitdni:
EXEMPTION FXOM VlONIIEXS' COMPENSATION DECLAflATION: Rryq �� �� nW b¢ romple;eU il �lie pamii is la an¢ �unErM (510D) Or less�.
I certify Iha� in Ihe petlorman[e of t�e woM1 lor w�ic� �his perryu� is issuetl. I s�all no� emOby any person in any manner so as to become
sublec� Io Ihe WorkeR' Com0en5aiion LaxS ol Cahfomia.
�a�e: Signamre:
NOTICE: I�, alier making Ihis declaration, you 5Aau10 OBcame SuUlect lo lhe Warkers' Compensation pmvisions ol Ihe Labor
Cotle. you musl fonhwi@ comDty witn such provisions or inis oermil snall De Jeemed revokea.
CONSTPUCTION LENOING AGENCY: 1 �ereGy aflirm tna11A¢re is a con9mction IenEing aAency lor t�e peAormance ot t�e waB for
wnich Ihis permil is issuea �Seclion 3097. Civ. C�.
LENDEfl:
FODNESS:
OWNEB BUILOER DEClAHR710N: 1 �ereby altirm I�at I am eKempi tmm Ine Contractor5' Sta1e License Law lor t�e lollowinp reason
�Section 703L5 Business an0 Pmfusronal CaOe: pny ciiy o1 coumy wliic� repuirts a permit lo cmnvuct, altec impmve, UemolisA, or
reDan any struclure, ywr to ia lssuance, aW repuires tAe dppticant br wN permit to lile a vqne0 statemem thal �rJsne is Iicense0
oursuant lo Ine piovivons ol tne fAnttactor5' Slate licen5! Law IClWpte� 91�'ummenunA vnN Section 7000) ol Divi9on 3 0l ine Business
ana Pmlessions Coee1 or �nai ne/sne is ecempunere�mm anOlne Da45 �or ihe alleqea exemp�ion. My Wolation ol Section 7031.5 Ey
any appliCani lof a permil SUUiectS ihe appli[ant Io a civil penally 0� nol mom Itun live AundreO Uallars (5500�.
� I. as owner al me Dmpeay ai my employees vnin wapes as Iheir sole comDensalion, will aa me work, an0 Ih¢
s�mclure is noi inlenGed or o��ereA lor 5ale (Sec�ion 7paa, Business anC Pralessional COAe: TAe Conlraciors' State License Law
aoes no� apply to an ownei ol a pmpetly wlq GuilAa or impmves t�ereon, an0 w�o tloes SucA work Mmselll�erself or ihmugh
hi5 or her own emD�oyees, prOvi�ea ��al SUC� imprbvCmenlS are na�inlen0etl Or o��ered lor sale.li, however Ih0 building or
improvemcn� is so10 wilhin one y¢ar of compietion. ��e ownet will �ave I�e burtlen ol proving Oe/s�e tlid noi �uiltl m improve
mr Ne ouroose a1 salel.
' I. as owner ol I�e pmpeny. am eKctusivety coniractinp wiin IicenseU tanlraciors ta fAn9Nct Ihe proj¢ci �Seclion 7044, Business
❑ antl Prolessions Coae: The Comractors' State Lkense Law aces not appry m an owner of O�ocerty� �uilGs or Impmvus IAereon
an0 wh0 Coniratls �or SUC� pmletis wi�h a fAnVatlor�S�1kBn5C DulSuanita lhe Conlratio(5' Sia�e LI[ense law),I am aware
Inal p�onl ot Iheie Warke(5 ComOe��i011 in5urante ShoWG Oe O�oviOetl �0 me. O
,� i am eremD� uMer Sec�i^n: B, 8 p, C// /� /
la� �hi5✓.ason: �r � / �-. _ ! / A �
.r�i
I Oo reEy cenily IJdt 1 am aware ol an0 unGerslan0 ��e reQuirements al �mia Heatt� anU $aleiy CoUe Seclions 25:
2557< ana Iha� I okny lulure Duildmg ocapanl x+IVwiA nol �CirtlO one) neetl Io comOh �'^�� saiA Siale w�e5 an0 Ih¢ re�
peimil lor conAmction Or mo4Aicalqn tmm Ihe Au alily Managem¢nl USint�. He94ential [onSWttiOn aOD�itali0n5 a
IACSe O�ovi5ipn5 '
oaie: nooi nC
1 hereby ceNfy I�at I have reaa inis a071icalian ntl sla�e Iha� �ne aUove inbrmalion is correcl. I agree to comply wilh all
o�Umancesantl5latelawSrelaUngto�uil0ingc stmc�ionantlnereeyawnorizereorese�iti o��hisciryioenlerupon�he[
pmpetly Ior insny�ion omny�'s. /� / /
oale
Signawre:
onver� �icens�r Sonai Secunry <:
16E1�a6 W�ne—BwMing; Green—Coae EnloecemenC Qznary—AOp��C Pi�k—R¢venue:
and
or a
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: IE 05273
�PERMIT NO: IE 052736 PLAN CHECK NO; N GOVT: N SOPP: Y
�CONSTRUCTION TYPE: PERMIT TYPE: ELE OTH PURPOSE: ADD
JOH DESCRIPTION : REINSPECTION FOR EXPIRED PERMIT#PME30575 SQ FT:
CLAIM VALUE: CALC-VALOE; GROUP OCC; R-3 /
COMMENTS: ��:#B27018 FOR RESDI ADDITION
�t�t�r�t***�r** x�x��t******�*x��t**+r**x****�**********+t*�**�*�t**�***�***�**�**+�**+���r*x*
7, O N I N G Ft E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT: . FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 13940410 ZNE: REF NO:
PLANNING NO'i'ES>
i
*��*��r�t+r�t**�***�t*�t�*�r****��*�r***x*�ir**�t�r*�r+r�*+r*�t**+t�e*+t**x�***�r��t**+r*+r*�r�******�t*
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
20NING APPROVED BY
HUILDING APPROVED BY
APPLICATION ISSUED BY:
�f af iF 1F iF 3F if iF 1E k Ih±f If iF iF iF iE iF iF 3f iF 1FiF�iFiF
if iE 1F IE 1F if if iE if iF if 1f 1E aF if IE ik if if 3E iF iE iE 1F iF if if 1f if iE iE It if if
LEGALIZATION:N F E E
BLDG PMT PLUMBING ELE
' DATE:
DATE;
DATE• �
��i �***�***+�* *�
iE �E IE �E if ik if it �f iE �f M!f 1f if iE iF if iF M�E iF iE i! 1E if if 1E fE IF iF 1E iF IF iF iF iF if if 1E iE iE if 1E
S U M M A R Y STRUCTURAL SEGMENT:N
TRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 30.UU
SOY SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECR TOTAL PAID DUE
TOTALS----> 30.00 0.00 0,00 30.00 30.00 .OU
REVENUE DIVISION TOTALS--> COLLECTED; 30.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
30.00
ifiEifkffikkilMiEiFkifiEkitiEif*iFlfkiEifiFiEififlfkiFllkkiflfiE�EiF3kiFiflf1k1f1FaE1fif1fiF1F1F1FiflkiEKlFiEifiFikifiEiFaEkffaElFiFlFifaf#IfiEiE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T Z O N UNIT COST TOTAL COST
ELE 1 ELECTRICAL RE-INSPECTION FEE 30.00 30,00
END OF FEES /
/ � �
9: QOD?15� i-7C)SIy!,; -�.,T ;'-
D9TE: 07.'tt �?i ;?, �t ',:;
CON4TRUCTION AND PLANNING - P��� �A
APPROVAL$ Permit # - Date Inspecto� qppROVALS Vermi* # Date Inspector,
1. Temporary E�ectrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steel Feinforcement .
. ,
.'� 3f `Flectriwl Condt�ft 14SilitY-Undrgrnd. 54. Forms ..t
4: EleCtrical CondGit-Undrgrnd. 55. Electrical Bonding .
',5. Steel Reinfarceh7ent 56. Roagh Plumbing & Pressure Test�
?&. .ElActrical UFERG�nd. 57. APPROVAL TO COVER�GUNITE `
' 7, FoOtings �'� 58. Electncal Conduit-Undrgmd.
� B;,Foundation � 59. Gas Pipe, O Uhdrgmd., Test
9. Water Pipe•Undrgmd. 60. Backwash Lines, P-Trap, Q Undrgrnd. �r
i
10. Structural Floor System 67. APPROVAL TO DECK '
11. Property Sewer Line,& House Connection 62. Backwash & Receptor-Final �
12. SGwer Cap �, 63. Heater & Vent�Final '
13. Root Droins '� 64. Plumbing System - Final
14. Rough Plumbin� r 65. Electrical�Final '
15. Rough Electrical�Conduit 66. Solar System-Final .
16. Rough ElectricWiring 67. Fencing & Accest Approval % .
17. Reugh Wiring Sign 68. APPROVED FOR PLASTERING ��,
18. Rough Electricat�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL '
19. Rough Heating &%a�r Condi[ioning FIRE DEPT. REQUIREMENT
• x .
20. �Rough Facrory Fireplace , � - . R :WPPROVAL'S' � =Permit # �
y 3. _
21`DuC[s,iMStructUCE� ... � y � " . JiO. Undergra�d_Hycfro
22. Ducts, VBntiiating • ' " �' x . �' • • ,71. Produc('P]ping QZ}as O`Oil
23:,�,Gas Pip��Rough & �est ' . . � - � � �7y, Undergro�nd Flush �� _
24. Roof Fvaming � • . � -' _ J73.iUndergrnfYStorayajank � Gas ❑ Oil
25.rRooj Sheathing ' � y �, � - �'; � �7q?Overhead Hydro� �
26� T�Bar Ceiling IStruoturel) & Monocoat 3. ' �' � 75,"Dry Chemical •� � � �
27: Frame a�d Flashing' _ . ` 76: Dry Stanb`"' e �' �` � �
> i'. P�f? i_
� 28~Lathing&Siding�- _ - r� -' � •� .i 77.' FIXEDSYSfEM�WNAL �-
'29. Insulation .. �� � '. � � � 78.�FIRE PREV. FINAL �, : c �
� 30. Drywall�Nailing ;,� ' I HEALTH DEPT. REQUIREMENT
,31. Plaster Brown CAai,; _ ' � t ' �79 `PINAL If11SP_ECTIC?R} ., ' ' '
32. Electrical Power h'�Me[�Final � � .J � � � ��-� � �
/�� BO.:FOOD CERTIF4ClC�E ISSUED �
�
., 33.,Fin41 EleCtr J - y _ f � �y'�/L `Nof�s: _ _ , ,
� • � .
;�34, Fin�l Heatinq& Air Conditionjng ' i ■ y� . . , -
1' ,
`35.`.,Final Ga's Pipe-Test' .' E` ! ' �- • �� ' �
�t
a �t c
r �
�36 Hood or,Canopy - � • +. - � r �, c � � .�
37:-Fir{51 Factory Fireplace _ - � `� '� � ' ' ' ' �
- L
�J38. Final PI`umbing : T� . • •. -� � '+ { + 1
•�39. WatBr Service-final• ' _ " � r `
. 2 j. 1, ' -
,;40. Ga3"Service-Final `..� - � . - �
t.. _ . .
x41. Solar pomesticFinal� -' •• " �� • So
� - -
42,Backflow Preventer: ' '_ � �. , ;� ' � , '
43. BackfloW Irrigation � '- - �
t r i
, 44. Landscape fr,rigatirn Sysrem� r ; � �� : - ., ;� �i ' �� � .. .
>45�Sound Anecivation � - � � - -^ 'j�= '
, . , : ..
�46 ;'Handicap Fegulations ' � � "� ; x � �`� �• .f
a
47::FINALSTRllC7URE&BUfLDING • • �
�`48. FINAL PI_ANNING � � , . . . �. . .� „ �� '
�' 49., Eleatric Release to Edison �= �i; _
, f: ,
.' 50. Gas Release to Southem Califumia Gas Co - j E, � , : '.
:51. CERT�FICATE OF OCCUPANCY . . ;� _= -
No. Date
PPOJECTADOHESS: 'zBOI EIIROPA DR
OWNEN'S NAME: CAMPOHASSO JOE TR
aoosess: 2801 EUROP.S. DR
COSTA MESA,CA 92626
549-1978
PPCHIENGINEEN:
• aooxess:
flEG.NO.:
UNIT:
uxir:
PEflMITTEE: SOE COMPABASSO f 714 ) 549-1978
noosEss: z g O 1 EUROPA DR
C.M. CA 92626
LICENSED CONiPACTOP DECLARaiION: I here�y alli�m Inal I am licensetl untler Dmvisions ol Chap�¢r 91�ommencing witn Settion
7000� of Division 9 of Ihe Business anA Prolessions CoOe, antl my license is in lull lorce and e��ecl.
CITY LIC.: S1ATE LIC.: LIASS:
Date: Siqnamre:
wOflREflS' COMPENSR710N �ECIABATION: I nereUy allirm Inat I nave a certificale of consent to sel4insure or a cenilicale of workers'
Comoensalian Insurance. or a rertilietl copy Ihereof ISection 3800. Lae. CI.
POLICY NO.: E%P. ORTE:
COMPANY:
� � CeniM1etl copY �s �ereUy lumis�etl. ❑ Cetlifie0 coOY is �ilea wilh IAe cily BuilOing Division.
1dle: PPPlicani:
EXEMPTION FflOM WOPKEflS' COMPENSATION OECIANRTION: Q�6 sec1ion neM nol Ue compl¢teG il Ihe permi is lot one hunCr[d (5100) a less�.
1 ceriily Ihal fn Ihe petlormance ol ��e work lor which this Oermil is i55ue0, I shall nol employ any Oerson in any manner sa as Io 6ecome
suDle�� �o ��e workerY Compensation Laws ol Calilornia.
Oa�e: Signaiure:
NOTICE: II. alier making iAis aeclaration. you shoul0 Uecome su0ject m tAe Workers' Compensation provisions ol t�e Labor
Cotle. you musl fa�hwiih tOmply wif0 SUC� pmvisi0ns Or lhi5 p¢rmii Shall Ue Oeemed revokeE.
CONSTPUC710N LENOING AGENCY: I �ereCy aifirm iha� t�ere is a consimciion IenJing agency lor the performance ol the work lor
wnicn Ihis permilis issued �Seclion 3097. Civ. q.
LENOEP:
AOOflE$$:
CITY OF COSTA MESA - BUILDING PERMZT PERM NO: IB 05273
PERMIT NO; IB 052737 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE: PERMIT TYPE: OTH STR PURPOSE: ADD
JOB DESCRIPTION : REINSPECTION FOR EXPIRED PERMIT SB27018 SQ FT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
COMMENTS: RESID ADDITION MECH 6 PLUM FINALIZED
�*�**�**�**�****�**�r*�r��r(�**�t+t*���r******�e***.*�r�r�rx*��r��r�*�r*�r****+�***�r***�*******�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REp • PROV; PARCEL: 13940410 ZNE; REF NO:
PLANNING NfSTES>
�
iF iF af iE iF if IF if iF if iE iE IF if if �F if if iF iF iF if �F iE if if aF ik iF if if if iE aF aF �t iP M 1E 1E iF if if iE if iE if if iE iE iF 1f if if if if if if iE If iE IF iE if 1F if �E �1E )f IE iF * if if if iE �E iF IE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: �� DATE: ��
iE�tMfE1F�EiEifihiEiEfEifaFiEif3EiEiE3F3FkiF3FiFiFif'iE'��f�if iFif�iF£iE'i�£iFR"iFIF�EiFM�k�F1Flf�Fitif iE1P
iE if k if iE �F 3f iF if iE iE iE iF iF if �E if if 3! if iE 3F k if 1E iE 3f iE 3t ff if if iE iE iF *!f iE �E �)k fF 3F iF �E iE fE �E if IE if if �f 3f iE iE k if if �f if )k iF iE iE IE iE iF 3E IF IF iF iE if )f if iP If �F �1F
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
OwNENBUILOEBOECLANRTIOx: IhereOyaffirmihatlamexempllmmtneContracmrs'StateLicenselawlarthelollawinpreamn HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/}i$S GRPiDING
(Setlian 7031.5 Business antl Pmlessional CoAe: Any cily o� coumy which reQuires a permn Io constmci, alter. imD�o�e, tlemolish, or F1ERM I T fi �, � 0 •
repair any simctwe, prior to iis issuance, also requires ihe aODlicant for such permit to file a signetl statement t�at �e/she is licensetl SMI P/NON—R'ES
pursuam m Ne Omvisions ol �he ComracmrY Siale License Law (C�apier 9(commencinp wilh Seclion 7000) ol Division 3 0� ihe BusineSS PL�
an0 Prolessions Coae) or Ihai �eR�e is eKEmO� �herelmm anA �he ba5i5 ior Ihe allepe0 exemp�i0n. My violali0n a� Setiion 7031.5 Uy `
any aouiicant mr a oermn suoiecu tne aoeiicant to a ci�ii penauy ai not more inan iroe nundred donars R50o6 ISSUE FEE
�. as owner o� roe pmoeny or my employees wi�h wages as meir sole campensation, wi�� eo �he work, antl �he BUILDING-DIV-> P$RMIZ' IS$UE PLAN—CHECK TOTAL PAID "; . DUE
� simcmre is not inten0e0 or oflere0lor sale (Semion 7044, Business ana Pmlessional Catle: The Contractors' State License Law TOTALS----> %� . � 0 0. 0 0 �. 0 � 6 0, 0 0 6 0. 0 �-•-- , 00
Ooes no� ap0ly�o an owner oi a proOetlY who OuilaS arim0�ove5 thereon, ana who does suc� wark himsell/Aerself orlhrouBh . —
his a� �er own employees, pmvi0e0 ��al such impmvemenis are not iniena¢C or oi�ered lor sale. II, �owev¢r t�e Euilding or REVENUE DIVISION TOTALS--> COLLECTED • 60 , 00 OVER /SHORT •. -�� .� -�' 00
impmvemem is soie wiimn one year of completion, i�e owner will have me eumen ol pmvinA he/she tlitl not buila or impmve BLDG PMT PLUMB ING ELECTRIC MEC:HANIC FIRE SMIP /T��1' GRADING �P. LAN-CHECK
lor Ihe purpose o� sale�. .
� I, as owner ol the pwpetly, am exclusiveiy conlracling wi�h licensed coniractors to consimct �he pmlect (Section 7044, Business 6�,� O � �� '"
❑ antl Pmiessions Cotle: The Conlraciors' State License Law aoes noi aDP�Y �o an owner ot properry wha UudUs ar impmves �hereon �-
and w�o [ontraClS lOr Suth prOjec�s wi�� a Conlratlor�51 license pur5uani to Ihe Con�rati0r5' Slaie l�cense Law�. I am aware if iE iE i1�IfiE iE i4 iFiEiE Ik iFiF�lEif IE Ik if 1E ifiE if if 1(-1F If if iEiE ik 1F iF1kiE�E ak IF1fiE iM1�1Eif�ifiF1F1E if 1E iE 1F 3f If iF iE1F iflkiEif iF IE if�1E iE i(��f IE 3(�iFif,iE iE iE Ih K�4iEi(-
tha� pmo� of ineir worker's Compensation insurance snoWe �e pmvidea �o me. I N D I V I D IJ A L F E E B R$ A K D O W N : ... t
� I am exempt under Section: B. 8 P. ��.
lorthisryason: i TYPE QTY D E S C R I P T I O N UNIT COST �-�f'OTAL COST
I do eby cetlliy ial I am aware o� anA untler!
255 � antllhall i anyfulure builaing occupant
permit br conslmclion ar motlificalion Imm t�e
tlle5¢ prOvisions.
Date:
I hereby cerlity IAai I have rea4lAis
ortlmances antl staie laws relaling to
pmper�y lar inspection. ,purp�ases
oaie: �/_CJ�_y
owne. w INS 2 BUILDING RE-INSPECTTON FEE 30.00 60.00
me ienuiremenis o Aomia Healm ano Saieiy Cotle Sections z55o , 533, and END O� FEES �
�iil nm �circle one . eetl �o comply with said sta�e codes anA the r irements for a
lualiry Managemeni Oislricl. Fesidential cons�mclion applications are exempi �wm ([ �
i � j.
�
�. inal ihe a0ove inlormalion is Wrrecl. I aAree Io comply wiln all city an0
antl hereby authorieerepresenla�iv3 olt�is cilyto enlerupon��e a�ove�me
unverd �mense oi �56ciai Securiiy n:
t6aL<6 WM1ite—Bmltlmg: Green—Cotle Enlorcement; Canary—Applicanl: Pink—Revenuo;
EXPIRED �
Incomplete Inspections
L�'dYC _ _—._ SIg .
O1 9Dfl91�S4C-000915:G 'fi �:'�
DATE: 07/lli."i TSf1L•: 15��e � �
:�
CONSTRUtiTION AND PLANNING , POOI A
APPRpVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
t. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' �
'- 3.'�E'lEctriCal ConduiY_UtilityUndrgrnd. 54. Forms
T .� �
`..��. �Electrical Condait=Undr9rnd. - 55. Electrical Bonding % F'
�; 5. Sieel R,einforcelnA�t 56. Rough Piumbing & Pressure Test
�L'n. �. ��.
'S�=E�ectricatUFERGmd. 57. APPROVALTOCOVER�GUNITE •
-. 7. Footings -" 58. Electrical Conduit�Undrgrnd. C
^'8'.'Poundation ��'� 59. Gas Pipe, O Undrgmd., Test _ n
, n
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
i t. Pfoperty Sewer Line�& House Connection 62. Backwash & Receptor-Final �• �'
�Z. SeWe' CaP . 63. Heater & Vent�Final �
,-�
13. Roof Drains `. �
64. Plumbing System � Final `-�•
14. Rough Plumbi�g '- 65. Electrical-Final ' ,a
15. Rough ElectriE`a�-Conduit 66. Solar SYstem-Final
16. Rough ElectriaWiring 67. Fencing & Access ApP�oval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
18. Rough Electriral�T 8ar Ceiling 69. POOUSPA SYSTEMS FINAL -
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20.�.kough FpctoryF`replace ;'.� " .q�", ,_- . �: q �APPRQVALS .-Permit# -
Y
21 SDucts, in Structuie ; , „ "� ` �' ,- � ° 70. �Jnderground Hydro �• �
22. Ducts, yentifatirtq - � -.. J71. ProduccPiping Q6as 40i1
23> Gas Pip�lRough &'Tes[ ' .F�y �" ' . "' 72. Underground Flush ,. `-
24, Roof FrSming , _� i ;� _ ' � , _ � �� . �73 ^Undergrnd. Storaye�Tank � Gas ❑ Oil
25. Roof Sheathing �-. � " �y , F � _ ,�?,- �74, Qverhead �Hydro, ' � �
26, T�Bar Ceiling (Strueturaq &.[vlonocoat r �, r"� � ' 75: Dry Chemical - � _ ., ^
27; Frame and Flashing �,.r � y - - 76. D}y StandAiDe : �• ,a, � " ' �
> -. �
28• Lathing'& Siding � � . � ��7 >; � � 77. FIXED SYSTEM EINAL - � n =
'29. Insulation - � ' " - �'' � 78� FIRE PREV. FINAL ` ' � �
h30. Drywall�Nailing y . � � : � ` } � HEALYH�DEPT. REQUIR�MENT = �
r
� 31. Plaster BrowP �at" _ � j � 79.• FINAL INSPECTI�N �" � '` � �
•`32: Electricel Power Meter-Final� ^ ,,. I ';. �50., FOOD CERiIFICRTE I$SUED' '
33SFinal Electric "% � - �'� i � • NoSes: ' ' �
1 r � . x i
;'y34.- Final Heating & .�i Conditioning, " �� ' i 1, : k � i ' . _ .
�35._Final Gas Pipe-Tesh - � _ � � i t • . . . : - - -
,36t'Hootlor',Canopy; � , _ - . � ' , " ' �
�•
37.=FinLl Factory Pirepiace ' S.� n.• •n � ' - � .
�e, . .
'�38. Final Piumbing '' ` � � .. •. ; • . �� � = -- -
;`39. Water Service-Finab � o + � • . � . - '-
, -
��-40. Gas�Ser�ce�Final . ,y,,. " ,� I ' ' '
7 41. Solar pomesticFinal , � �•� _ ' �• j �c f
� 42:`Backflow Prevente� � �� � �' ,� - S
,� ; .
43. Backflow Irugation� � :'.> �, � r� � - -
- 44. Landscape Iuigation Syster� �{ : ,� � - - - ,� � ; � �
-455.Sound AtteOuatioa - � � � > �- ' i' ' � e.! �
r <
�46.. Handicap Re�gulatibns - � ' ' " 1 �E�-P
� 47.. FINAL STRIJCTUFiE & B1311DING " � mP t@-IfiSp26t�UA
• ' Y `` ���II l_�r _' Z r �
''48� FINP,L PLANNING � ° ' ; : � - �,. � ;. ,.�e ' �
--49��Eleetric Release to �Edison � � � i. � :� ;i; � � � � �. ?
''50. Gas.Release to Sou�hern Caljfornia Gas Co ; � � � � `., � ; - �� �$
`51. CERTIFICATE OF OCCUPANCY _ . � ' _
No. Date
'
1�^ D Applicant to Iill in all spaces exceDt1tltose within heavy bortler tines antl sign all appro0�iate Eeclarations.
��ITV'� :OSTAMESA CONSTRUCTION PERMIT PERMITNO. TFACTNO. LOTNO UNITNO.
a��s �_$oi u^t,2a�� f.7R `
70/8 434 2
. �s�nailing Address � 2�5 ��L�L�C �, 2�7 TYPE OF CONSTRUCTION NEW .4DD ALTERATION REPAIR
� ❑ CONVERSION ❑ DEMOLISH ❑ OTH R p.p..�6 — b
Owner's Name, �L—�J' GdM diAl'C� phoneS4g �q7$ pES�� IpTION OF WORK/USE OF BLDG. �� O � G eti�
Address �.�OI CV�IOQp 1]ti GOs47s N�FLp 1�v 'j'� 5 Main euilding:
1 j� tf;J O �nn E
Arch/6eg. R�CrIbA4Lfl l:. CDOLJ�iwlc se No. -G �L24 V TVPE OF PERMIT GRA�ING- FOUNDATION ' TRUCTV RAL T Front �
Q�� �1'TQ �i ��'_��gy �y'� ❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL B � • �
Address �. . A Rear
Contracror's Name �, � Phorie ❑ �OTtiER � ° . � � Right � '
Address (mailing) � PROJECT DESCRIPTION 5o. F' OCCV rvCv K
CONSTRUCTIONTVPE - VAL ATION, �rJOO_ g Left �
'City License Na_ � � � 20NE GRAOING CV. VDS. �' AC0.ES p�ng. Ref. #
LICENSEp CONTRACTOR DECLNRATION
I he�eby affi�m that I am.�icensetl untllr prOvislons ot C�arte� 9(commencing Remarks: O.� g�' ` � ' Plannin9 Nores:
wit� sectlon 7000) of Oiy�sion 3 ot the Business antl Professions Cotle, antl
my Ilcense is in (ull lorce a '
, ndeftect. � ` / �r0$ LOl.�i7Lcf7 /N LCtqp (L�/.4 /ep)'Q, I',..,,
lJcense Class License No. PLUMBING -• � FEES� �y,.
Dale Signature '
WORKERS' COMPENSAT�ON DECLARATION � -� Ba�$iOk ShOW2�5
-'. h¢reby a/tirm Ihat I have a certiti[a[G ot mnsent to self-IOSUre or a CertlfiCdt¢
'"�'��i Workers' Compensation Insurance, or a certifletl copy thereof (Section AutOmatic Washer
`BOo, uo. C.) ' -� . . Backflow Prevencer Serviw Sink -
Pollcy No. . Company � Backflow Irrigation . SewerCap - Constructi0n Pole Sub.
8 Certifietl copy is hereby turnishetl.
Certllietl copy is filetl uyitb the'city Builtling.Divislon. , Bathtubs Sewer•Connection � Cooking Unit �
Date Applicant
EXEMPTION FROM WORKERS' COMGENSATION OECLHRATION Clarifiers SOId��C0112Ct0�5� Di5hwd5h¢� .
(Thissection neetl not be completetl'if the permit I5 for, On¢ huntlretl (5300 or .
less�. - � � Dishwasher ' SolarPipin � �, - Dryers ❑Gas ❑Electric
I certily'Iha[ in the performance of.the wo�k�for'which Ihis perm�i is issuetl, I � .
shall not employ yny person in any�manner so as t ecoma sub" ct to the Drinking Fountains Solar ank ' Fan
Workers' e 5 Laws af Californi .' ' ' '
Dato 5ignature Floor Drains imming Pool w/Spa 'F. A.U.
'NOTIC : If, af er ma �ing Chis tleclaratl , y0u shOultl b om subject the ;
Workers4 Co�ilpensation P�ovisions of e Ldbol Cotle, you Rlust ( flwith FIOOf $i0k5 � � Ulilldl Fi%t11f¢5
comply wlth' SUCh provisions or thls permit" Shall be tleeme revoketl.' ' �
CONSTRVCTION IENDIryG AGENCV ' Gas$¢�vICE Ou[I¢t5 Wat¢lCIOSEt D¢viCEBOx¢5, -
I hereby af(irm fhat there is a construction I¢ntlin9 agency for th performanca �
Ot the work for which this permit I5 issuetl (Section 309] Civ. C.)
Lenaer's Name � Inrerceptor5 � Water H¢ater Outlets ' � -
Lentler's Atltlress � Kitchen Sink Water S¢rvite ' r Switches '
OWNER BUILDER DEC�qRATION � - '
I hereby aftirm that I am exempt trom ma Contractor's License Law (or the Lavatories� Auto-Wash ' � Garbage Disppsal
followina reason ($ection 1p31 S Rusiness anA Professlonal Cotle: Anv ci[v or
es a
to li
�:heretrom antl the basis to� the allegetl ezemption. Any violafion of $ection ,
;�i031.5 ,by any applicanT for a permit subjects the appl7Cant �to a civil
-�'�ndlty of not more than ry�e huntlreU tlolla�s (E500). .
U I, as owner of Ihe oroperty or my employees with wa9es as thelr sole �
compensaUon, will tlo the work, antl the structure Is not intentletl or oiteretl
for Sale- (Section 7044, Busine55 antl Professional COtle: The Contractor's
License Law tloes not appry to an.owner oi a property who bulltls or improves
lhereon, antl� who tloes sUch work himselt/herselt or tnrough his or her own
employ ees, p�ovltletl that such improvements are not Intentletl or otferetl for
sale. It, h0�✓ever, the Cuiltlin9 or improvement i5501tl within onG year of mm-
pletlon, lhe owner will ha�e the burtlen ol proving he/sha tlitl not builtl or im-
p�_OyCfo� tne purpose of sele). . '
Y� I, as�owner ot the property, am exUusively contracNng wit� licensetl con-
trac[ors to �onstruct the project (Section 7044, Business antl Professions Cotle:
Tno ConVactor's License Ly.,y tloes not apply to an owner oi oroperry who
bWltls or imoroves tnerep�� antl who conVacts tor sucn projects with a com .
tractor(s) license pu�suant�to tne Cont�acto�'S Llcense Law). I am aware that �
prooi o( lheir Worker'z Compensation in5urance Shoultl be provitletl t0' me.
❑ I am exemp[ untler Sectfon B. & P. C. tar thls reason
Date Owner
I nerCb � ce tif that I have reatl �s aoolication ntl s[a[e at the above
Inspettion
CMF
Rainspection Fee I ' $15
Boiler
Duct - Under Ground
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/FacL BIL ICBO #
Heating System & Ducting
❑ ai oo,000 eTu O i oo,gpe
i l Date � I I' I
or 5 � Reinspac[ion Fee $�5
rev. 30/84 white - Building; Canary - Appllcanh, vink - Acmunting; Goltlenrotl - Assessor -
IssuB Fae
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,0008TU ❑1
System Rep ' Itereti
Registers
Ittue Fee
0908 I/26/BJ Gn� m T�
�— Zone
Accessory Building: .
Z
O
N
1
N
, . G
R
Parking Req./Provided E
Q
- M
T
S f
� C�.�J'l.Q,
ELECTRICAI,�II��Jt,(,O1 ��(,U1,� �S
TI Trancfnrmer ❑ 15�50KW � - /
Meter
Meter
Sub Pai
� Mators
I O0. SO
ro�n
'-: Pole Li
Generator �j0�5'(CW �5-75 KW
$ 3 -
� Reinspection�Fee '"$15
FEES
. DEVELOPMENTSERVICESREQUIR
2onin8 APProved.6V�
Building Approved By �_
$ 3
❑ 50� KW
t0 1 �� 2Tps
Sign .,
; Standing Sections
Trash Compacror
Issue Fee
8
6-15+
$ 3
�I�
' � SU V OF FEES' t�r
BUILDING'PERMIT $ �� SMIP $ �
.�L. PLAN CHECK $� � � 2� �Z pERMIT
PLUMBING 5 �SSUANCE $
-PLAN CHECK - 25% $ ' ENERGV P.C. $
ELECTRICAL , $ GRADING $ �
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ ��
PLAN CHECK� ZS% $
,
�i
• . . ;\
� ,
STRUCTION ANDPLANNING P00. ,SPA
OVALS Permit #� Date Inspector pppROVALS Permit # Date Inspector
� emporary Electrical Service or Pole � 52. Pool & Equipment Location '�
.�',Li. . - .
2. Soil Pipe�Undrgrnd. 53. Steel'Reinforcement �
3.,EIectPical Conduit Utility-Undrgrnd�. _- � 54. Forms �
4:,Electrical Cbntiuit-Undrgrnd. 55. Electrical Bonding �
� -
5..S�el.RainfSrcement 56. Rough Plumbing & Pressure Test - - �
6.� El�ctricel UF,ER Grnd. 3 b g� � 57. APPROVAL TO COVER-GUNITE �
�_'Footjnqi !;; ;j G.. 58. Electrical ConduiDUndrgmd. �
8,�`Founcjatidn .` 6 �/t�' 59. Gas Pipe, O Undrgrnd., Test
t
9:, Wate?•P(pe�Undrgrnd. . 60. Backwash Lines, P-Trap, � Undrgrnd,
70. �Stiuctural Floor System � 61. APPROVAL TO DECK
17. �.R;operty Sewer Line & House Connection 62. Backwash & Receptor-Final
' 12. Se � C,�p�_ ;; -� 63. Heater & Vent-Final
13. Fjdof,Drains, ', . 64. Plumbing SYstem - Final
14. Rouyh Plumbijig � 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar SYstem-Final
i6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign . 68. APPROVED FOR P�ASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace .. � APPROVALS Permit #
21. Ducts, in Structure , 70. Underground Hydro
22. Ducts, Ventilating ' � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough &',Test 72. Underground Flush �
24. Roof Framing ' • 73. Undergrnd. Storage Tank � Gas ❑ Oil
25 R�oof Sheathing �+ .. b`ra 87 (�'j) 74. Overhead Hydro
26. T-Bar Ceiling (Structural� & Monocoat � 75. Dry Chemical
P7•. Frame and Flashin� �, � �j � 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing , P�� ` HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coai , � 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' � Notes: �Q �� E' G '�'�
34. Final Heating & Air Conditioning � �.r � N-
35. Final Gas Pipe-Test ,y� y� � R� ��2 �
36. Hood or Canopy ' � �- �
37. Final Factory Fireplace � 2 �5 l� `� �'"�YG•
, o5t 3 u5t
38. Final Plumbing 1 �r � �,4
39. Water Service-Final
40. Gas Service-Final O .O
41. Solar pomestic-Final ,
42. Backflow Preventer �
43. Backflow Ir�igation �
4
44. Landscape Irrigation System �''
45.'Sound Attenuation
Inc m t i ections
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING -
48. Special Requirements Completed
49. Electric Release to Edison � - � ''1 .
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY �
No. Date �
�
�I
�oowessasa�mc: zg01 EUROPA DR uxt:
OWNEP'SNMIEIFp10WN: CAMPOBASSO, JOE TR FLOOD: AE-46
"°o"Eu 2g01 EUROPA DR
COSTA MESA,CA 92626
549-1978
AVPL.M/JIIIIG ADOPE55:
AIILXRECiOAENtlNEFA:
ACN.OP FNG.'4 /iW11E55:
uc. ra.:
CONfp1CTq1YN�uc,
ca+m�crartsxuuxa
�ooxtss: uc. ra_
UHf:
uxr:
110EN5ED COMNACTOHS DECL�P�TION: I Mreby nA'rm uMn perwly d perjury iM1n I am IcenaeE uMa pw6iona d CMeqx H
(comme��q rmh Seciim )OW) M Dimion 3 d ihe Burirm� enE Pmleaeiau Cade. ud mY � u in lull lau vd e%ea.
cm uc. No.: uc. cuss: uc. No.: E X P:
oae: convaa«:
OWNEfl BIIILDEF DECIAPATION: I Mreby elfirm uMm pariely d parNrv �� I em eumpt fmm IM ConVecas Liceme Lew Iw �he
Idbvnp reasm (�+� )�tS &niqaa eM Protafeiona Cada: Airy cty n oo�nry xfiith rpu"vea e pe�mn lo mretrucl. Mr. improva.
4.:]emd'oh. n repei vry svuciun. pur b in uwarim, ebo reQwes ihe eppfireM la wch pemJ lo fib e egroE �b�mimt Nm M a�M
✓�` IwenseE W��^� la tha prwiaiom d ihe CaMredwe Liceme Lew jCMqar H I�menriip wnh Seaian ]W0) d Divcian 3 d tir
( y.`::uineae erd Prdeuiom COAeI a IMt he a ehe is eaemp iharelmn eM iM bsva fa Ne elbpaC eammpion. My vialelion W Sed'an
`�imis M enr eoW�� �« e oe�mm e�a�.+ ine rod'cam m e aw ro�v d �a m� in.� r. n��d�.d eond+ tssoop.
f.l I. ea ow�r W IM MW�Yw nrv mmWWwe wYh we9� m Ihei eda mmVamation. xiA do the xwk. vM IM stv.Tin e M inieMed
�r aq��ircaebl��)�.BusimneMPrdeaniansLade:TheCantrmaslioemelewEoeanotepp�yloenowr�erdprope�y
who buida or mY� Oweeon. rd Ma doea �uM wak NmxX a Mner « WauW he a hx own emdN�. pa'� �he� aeA
�mwd+eme�u ar<na we�aee s m..e �« saie. n. nowe.«. ine w�b�re «ma�pn u.dd wan� o�. r.., d mmWa:M. m.
ownerbuiNx xill hew iM hNen d po+i�q M w ehe d'd mi duld w impwe lor �M W�Wee G veb�.
� I. a� ownu M Iha D�W�Y. em udutivNY oontrect^0 with Icensed conVeclm ro mM�W Ne P�N� (Satlian 10u. &aFina eM
Pw�� com. rn, cw o�, u�e� �. ao� m rodr w.� o..,�« a ww�v �,o wum «�ww« in�, .oa �.no
canirec�s lar euM h e r(s) licenaed punuam io ihe Conirmon/ licxue lew�.
❑ lemuem ' �� 8.8P.G..MNu Y /�/
o�,: !�-��C1�9 0,,,,,,: ���%Z�_ yr�— --
0
a��..
i � ewa,eh dw �d.�u�d
,.m.ms e.uom4 Nmen em smerv wa seao�o usos. us�..�w
(aeb ) need m oompy rAh eeid mts oode� eM tM �puinmaem br
Oiurif. Rakmiiel wmouaion ew�.'aiiaaen e�emp /mm iMsa
Dme: ApdkeM:
WOflKEF'S COYPENS�TION OEttAfiATION: I Iweby �firm undr pmeAy d perjwy an d iM Idbw'vq ddum'vn:
❑ I hew vM xil mev4en e cendrma d mmmt io �etlimun tar xak«s mnpnmion, o povided la by Samm 3100 d tM lebor
Gotle. /« �M pertmnence al iAe wuk Iw wticn ina permn ie esued.
❑ inew�a.u�a.:�.�a.•�c���*,rerce.m�ea��.eMs.a�mooam.iee«coe..ro,m.w�a�dm.
wdF fa wfiidi Nu Oa^N u uaued. MY wvMn' eomGeeuetion iruweece eerr'w eM D�Y �wmbr are:
c�a.:
Pdiry Number:
,/IJs sedion neeC nof be ttmP'a�ed / Ne V�! is b an hunCreC da0eis IS100/ a hn.)
❑ I uelM � in Ne perlmrerca d the wM f« xfic� Iho pemiM1 b i�aueE. I ehell mi ampby erry pe�em n e�ry men�ror so m to
bacana wbjetl to 1!w xartms' mmpe�umion le� d Cefdoma. eM eprw Ne J I ehwN Exvro wEjq to tM xoAaa'
canGamtlun Wawom d SeUon 3'!00 d iM labar Cotle. I ehell IMhwG� aomDN xM �Mea pw+a'vu.
oe�<: �od�a:
Wamlip: FaYun ro ucun rartari ronpw�utlon rovsip� Is unbMul, mA alWl rO/�cl �n w�qloysr ro cMMiul pen�ltlu �M
elvll fln�� �p ro om h,ndrW lMuaW dd/en (S1 W 000), In xMltlon ro M� ewt o/ rorrrperu�fbn, demepu u proHtleE br In
Sxtlm J106 0l Ms Lebor Cotle, /nronaL ��tl ettomsy'� Iws.
CONSTHUCTON IENqNO pGENCY: I Mreby effirtn under penMy d perjury Rat ihma u e awwiudian bM'up epency br Ne
�1811IX111BfIfB O�I�1! NIXkIIX'M�11(�IIhO iAl�ll� q 6411BE�$R1U11'J09J.riN.Cif.
LEN�ER'S NAME
LENDEH'S AOOFE55:
I ceni�Y �hm I ha+e rtad No mP�istion ud ama �het Ne ebwe iNanbtian b correu. I e0ne to canPh' xilh ell u�y uM cauM' ad'vwrm
eM stele lews rNeiiq b WBdiq canmuuon eM Mreby eWwr'¢s repeeeniativea d �N+my to mtr upan iM ebave�merqioneE popany
la ireperlion p�vpmas.
(5�Std6.WP) Whee-BuiNMd5e1e�Y:GreerFb:CererY-ADV���:Fnk-Rewnue:
CITY OF COSTA MESA — BUILDING PERMIT
PERM NO: IB 07612
PERMIT NO: IH 076129 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE; PERMIT TYPE: OTH STR PURPOSE: ADD
JOB DESCRIPTION : REINSPECTION FOR EXPIRED PERMIT ItB27018 SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 /
*�**rt***i�***i��-*�x���***�*�+t**�*+e�*******�r**iEt**f�f�t��****+Zt*D**�**i�c-**�*�*��+It**�*****
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL: 13940410 ZNE: REF NO:_,
PLANNING NOTES>
� .1
iE 1E iE iE it iE iE 1E i! iE IE 1! 1E iE iE 1E 1E 1E iE iE fE iE iE iE iE iE IE k IE 3E 1E If ff 1F If 1f iE if if IE iF iF fE iE 1E 1E iE iE IE 1E IElk i(� ik if fE fE 7E iE �E iE if IE if iE ik iF �E �E'IE'1E IE iE if if iE iE if iF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N,T S
ZONING APPROVED BY DATE: '�
BUILDING APPROVED BY : DATE: �'
APPLICATION ISSUED BY: DATE; i.:�- 1b
����,��*�����,��,�*�*«����������������������-r�������,�����***����*� *�
LEGALIZATION:N F E E S U M M A R Y STRUCTORAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 60,00
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 60.00 0.00 0.00 60.00 60.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 60.00 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
60.00
iE iE 1E iE iE 1Elf 1E 1E 1E 1E if 7E 1E if 1E if� 1F if 3E iF 1f 1E 1flF 1F 1F 141El8 i81f 1E 1F 1ElE iE iE 1F 1E iE 1E iE iE iE �Ik iE iE i! iE iE iE IE iE iE If 1E 1E 1f iE 1E 1E IE 1E 1E 1E iE iE �IE iE ik 1E 1E if 1ElE ff 1E 1E
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C A I P T I O N UNIT COST TOTAL COST
INS 2 BUILDING RE-INSPECTION FEE 30.00 60.00
END OF FEES
1 . - , " -1.')'... �1,:�� �J �
GONSTRUGTION AND PLANNING . � ��� 'Pa
� APPROVAIS Permit # Data {nspecto� , qppROVALS Permit # Date lnspeetor
1, Temporary Eiectrical Service or Pole � 52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd. � 53. Steel Reinforcemeat
� 3: EHectrical Conduit Utility-Undrgrnd. � 54. Forms
- �-A}Eteetrical ConduibUndrqrnd. ' 55. Electricai Bontling
r.5. Steel Reinforcement 56. Rough Pium6ing & Pressure Test
.6:�E�ectrical UFER Gmd. 57. APPROVAL TO COVER-GUNITE
, 7.� Footings 58. Elecirical Conduit-Undrgrnd.
_�_g. � Foundation 59. Gas Pipe, O U�dr9rnd., Test
. 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
1p. Svuctural Floor Svstem 61. APPROVA� TO DECK
11, Property Sewer Line & House Connection . 62.�Backwash & Receptor-Final � - � �
12. >ewer Cap - 63. Heater & Vent-Final
13. Roof Drains 64. Piumbing Sys[em � Final
)4. Rough Plumbing ,- 65. Electrical�Fina�
15. Rough Eiectricai-Conduit 66. Solar 5Ystem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. flough Wiring Sign 68. APPROVED FOR PLASTERING ,'
18. Rough Electrica!-T Bar Ceilin9 69. POOL/SPA SYS7EMS FINAL f�'
19. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMEMT
- - � �� - - ,-; c . � - -�
20. RDugjt F�tory Ficeptace ' _ „ S =' ` t, "APPRDV(tL�� - Per.'mit # � -
21, Ducts, in STrutture � - � �•• �� • � -� - • 70. t7�dergroand Hydro �
22, pvcts. Ventilatin - _ `� "�
9- 1 �� � ... .71. Product Piping OC�as C70i1
23. Gas Pipe•ffou�h & Test � �� r•, �� ��� 72. Underground Flush � -
24. Roofframing � ^ �: " '� - � n , � �; 73:, Undergrrrd. Stor�ag2 T�nk.O Gas ❑ Oil
25. Roof•Sheathing _. ' ' 74, pverhead Hydro` •
26. T•Bar�Ceiling (Struet�rap & Monpcoat - 75: Drv Chemical _ � ` '� `- � � �
27. �reme and Fiashing � _ � - � • 76. Dry Standpipe � ��
28. Lathing�Siding �r " ,;rt," t;, "' 72• FIXED$if$TEM'PINAL � - �
�29, Insulatiorr �'r � ��� � � • 78.: FlRE PREV. FINAL ' " �
3p, prywall Naifing ;.{ � yEALTH DEP7. iiEQUiR�EMENT
-�37. Plaster BrownrEoat" - . t.� 79. FINAL IkSRECTION �
32. Efectrical Powe: Meter•Final '` �' '�'8U;�FQOD CERTIFICATE 1$SU.ED
� •Y -.r �- :i � - ,� .
-33. F�nal Electric =. �: � . , Nv{es: - . . _ i '
„ : , - _
34. Final.}ieating & AiF`Conditionin�" � , '"' `• � " -
_ �� .
35. FiPa1 Gas'Pipe-Test'0' - � - �;� _, . ` ` � _' i �
36. Hood or Canopy ^ r '-'7 - � C y (' � +..
at! . ♦ T, - � ,
- 37. �i�al F,actorY PirePlace � . .- „ • �t `' ,. W
38. Final Plumbing -'p � ' - "y . -
� - cc
39. Watei Ser4ice-Finaf� � . - - r : , ' _ ' ' �� �
- 40. Gas Service�Finai - � . � ;.,c� . '
�
-41. 5olar OornCstiaPiqalr `- '' • " �" . -
r +' � =�
42, Backflow Preventer . � �' - - � -
k . Y' r: 1
43. Backflow lirigation 'x=' = � -, . .
s >
44. landscape IrripatiooSystem - n� � � • � ' � �•- ' '
45. 5qund Auenuation,'. ' •„ *' `�+ � -+ ... y -
46. Handicap Regulations -� � i ' � .� - " '
v -i P
47. �iNAl STRUCTURE & BUILDING /�LJS:q d p4i(� � � ' '
48. FfNALPLANNING �_ - � * :� '
� -
qg. �lectric Release to Edison ` . _� �
50. Gas Rflease to Southern CaliFornia-Gas Co � � � - • " - _ •
51. GERFIFICATE OF OCCUPANCY - ' � . � - - - '
No Date
:ITY C' �OSTA MESA CONSTRUCTION PERMIT �
Pr4i¢ct:,Ud(2n
�
Appli ilingAdd ess � 2�`� ��S�i-� ��Z-�, �S
OwnaiName MQ. G_LMPTeTiefCAohone'14`1L1-�E
A
Addrm 2.g�1 �Vi�QA f]Q �Tls fY�EtA
ArchlGg itlf�� O i�9dJt�iwc seNo. �i �2f�t'i
Addrea 2 � 4
Con[racmr's Nam� hone
A�r� (mailingl
Ciry Llcense No.
LICENSED CONTRACTOR DE��RATIOFI
1 �ereEy a/firm t�at I am licen5etl unGer pravisians ol C�arter 9(commsncin9
wit� section 1000) of Divlsion 3 0/ tne Busineu anC �rofeuions CoOa, anC
my Iicenu is tn tull /orce aoG af�ect. ' '
Li�nse Class Llcenu No.
Da[e $i9nature
WORKERS' COM7ENSATION DECLARATION � �
t �ereCy affirm that I �ave a certifitate of conttnt to salf�nsun or a certi��wte
ol Worvers' Compensation Insuran<e„ or a certilie0 coDY thereof (Se<tion
.�"y�,j0 Ue G) . . . . . .
':: `�fcY �. . ComPany� � '
l.� Certifie0 copy Is �ereby /urn�shetr ,. '� .
L� Certifie0 copy Is IIleO wlth [pe Nty BuiltlfnqAWislon.
Date Aoo��cane
E%EMVTION FROM WONKERS' COMPENSATION OECLARATION
(Thissaction neeG not be mmplete0 41 the permit is fw, one nuntlreC (S100j or �
4ss).
1<ertiry tlut in [ha periormanEa oLthe work foi'w�ic� t�ii perm�t is izsue0 I.
sbaR not employ y person I� any madner so ai t ecome zub' ct to t�e
WOrklri' LdwS O� Cdlilofni . �
Date Si9na�uR �
-N071C : If, a er ma in9 Ihis tle��ara❑ , you s�oulG G om suCject Me
Worken' Campenvtion provisioni ol e �abor COEe, you muSt ! �w�th
<omply wit� fuc� provl5lOn5 or thl5 permlf Snall Oe dttme ravokeE;'
CONSfRUCT10N LENDING AGENCV �
I �ereby a/tirm that t�ere is a co�struction lentling agency tor 1� cerlormance
of lna work br whit� Ihis Oermit is i55ueG (Settion 3097 Civ. CJ
LenGer's Name . � -
LenUe�'s AEE�eiT -
OWNEH BUILDER DECI:ARAT��H - '
I �ereCv afflim t�at 1 am axeiAP< <rom t�e Contractor's lJcense Law /0� M�
a signe0 statement t�at
nlractoPs Licenu Ldw (
m ine
"!relram an0 t�e Oasii tor the allegeG examptlon. My vio�aUon ot 5ecuon
�':1)1.5 Oy any applicant tor a permit subjects tha aOG���nt _to a civll
-�-"%Slty o/ not more tnan flve hunareE tlonars (f500).
il:l 1, as owner of lhe OropertY or my employees wi10 wagas as t�e�� sole
compenvlton, will Oo the worN. antl t�e structure ii not intenQeC or offereC
lar nle (Section 7064, Buslness anG Pmfessional COEe: T�e Contraclor's
License Law doas nat aOPly to an awner of a property wno EUItAs or ImO�a�es
tnareon, ana wno aoa such work himself/hersalt or tnrouqn nls or na� own
em0�0ytOi, prOv10lC Ihd[ SUU �Tp�avlmanti ar! nOt IntenCeC o� 0/(tra0 10/
sale. I/, �owaveq Iha builaing 0� �mprovement Is solE wit�in on� yaar ol com-
pi�Uon, t�s ownar wlll �ave Iba burEan ol O�ovinq he/s�1 EIE nol DUIIE or Im•
w�9y� for t�a vurposs o/ sale).
tl l af ownar ol t�e OroOerty, am aaclualvery contractln9'•It� IlcensaE con-
tractonto canstruct the prolect (Sectlon 704a, Businais ana Roissslons Coas:
Tna Coniractor's llcenu Law d0ai not aGply to an ownv of Oroperly w�o
EuilEa or. ImO�ovu t�araon, and p'ho contraUs lor suc� pmjxts wlth a com
tnctorpl tl<ansa punuant to tde Contractar's Llcens� Law) I am awan ihat '
proot o/ t�alr Worker's Compensatlon infuranca inoulG Da G�ovICaO to ms.
❑ 1 am eYempt unGer SecUon B. 6 �. 0.!or t�ls reason
Dat� Ownsr
1 noaC cartll tnat I har� roaA � aou�icatlon n0 sute at the abow
lna
nes anE sign all aOGropriate Eeclantions.
70/8 434 � 2 - -_.
TYCE OFCONSTRUCTION NEW DD ALTERATION REPAIR
❑ CONVE0.51ON ❑ DEMOLISH ❑ OTH ' A p �, �
pESC�gIf'f10NOFWORK/USEOFBLDG. ��^� �[ fV�C� c C�..�
�O(A n/1 ,t- �2 G d' U Nn ^ E Main Building:
TYVE OF PERMIT GRADING FOUNDATION ' T0.UCTURAL T Front �
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B qpaf / •�
❑ �OTHER � � %�
C Right �
PR0.IECT DESCRIPTION SQ. F oCN �' — K
CONSTRVCTIONTVPE VAL ATION O g Le(t �
ZONE GRADING CU. VDS. � ACRFc'
Ping. Ref. �
Remarks: O.. � 3 ' ,' Planning Not23:
/-etdf,��� ��O.OH LOlAT�O /N F�QoOPGtUN//oeYP — --. i�
Sink Showers
<flowPreventer ServiceSink. ..
ctlow Irrigation Sewer Cap� _ .
itubs Sewu�ConnxtioN
ifiers $olar Collecmrs'
iwasher � Splaz Pipin
Drinking Foun[ains
Floor Drains
Floor Sinks _ -
Gas Service Outlets
Intercep[orz
Kitchen Sink �
lavatories�
P-Trap
Roof rains
Reinspection Fee S15
Duct • Under Ground
�uct - Structural
Duct - Ventilating
Exhaurt System ❑ Multiple ❑
Firepl/Fect.8lt. ICBO *
Heating System & Ducting
❑p100.000 BTU �100,qpB94
� Driwrs' L�Ifsd oi �S �%�`/ -���- �� � �,••••_
�� Oees-s , rev. 10/84 wnite � Buiiainq: Ca�ary - Aooiicant: A�v . n���������n� r...�.,,......�
Fn
E15
Poo� w/SDa
Urinal
Water Closet
Water Heater
Water Service
Auro-�Nast�
Lau ndry Trays
laus Fee
Hood or Type 1 ❑
CanopY Type II ❑
iefrigeration System
�aiao.000eru ❑n
System Rap ' terati
Regis[c+� �
Iswe F�e
� � ' Autom9tic Washer
Conztruction Pole Sub.
Cooking Unit
Dishwasher
� Oryen �Gas ❑Elec
Fan
F A.U.
Fixtures
Deuice 8oxes
Oupeb ' •
53
FEES
S 3
Generator
09�.18 i /25/97
_ / Act¢ssory Building:
Parking Req./Provided
/) w. , a i i /'1/ I ll.f -
Meter
Me[er i
Sub Pai
Motors
Inc. So}
�
� i:. ^)
zo�,. p 1 r.
l�/L.I�J� �
r Q� 75-50 KW
O so f Kw
i to 100 amps
er-100 amp
owaes
Pale Ligh� �,
Range .
FL11Y,�8
SHP�IE15+
:)
- ; Standing Sections
15KW TrashCompactor '
,_�. �.
� I ReinspeclioR'Fe� I 315
DEVEIOPMENTSEHVICESHEQi
2oning APOroved By
Buildirq Approwd By �7--
Avolimtion Inuad Bv° �S.c,....i
Issw Fea
53
u
Z ' .
O
N
I
N �
G
R �
E
Q
M
T
S
� SU� Mnq� Y OF FEES"
BUILDiN6PERMIT f_a,1�� SMIP E S9S
PLAN CHECK , s� / / �. /Z PERMIT _
PLUMBING s ISSUANCE f
PLAN CHECK 75% f ENERGV P.C. $
ELEGTRICAI = GRADING § �
PLAN CHECK 50% S MICROFILM f��
MECNANICAL f TOTAL FEE f
VLAN CHECK' 25% S
x • '"
JCTION AND PLAIVNING �
✓ALS Permit �W Date
.iporary'ElQctrical Service or Pole
.ioil Pipe-Undrgrnd.
..,EleCtticdl Co�duit Utility-Undrgrnd.
4:.Electrical CbriTluit-Undrgrnd.
I ' ,, .
5..S�el ReinfOrFement
6.� El�ctricel IiIF,�R Grnd.
7_ Footjng� �� �
8; FounQati6ri -
9:, Wstei•Pfpe•Uhdrgrnd.
70. �Structur�l FIoOr System
11 .'.PSoPerty Sewgr Line & House Connection
12. 8 gi �R_ ..
13. F�6of,Drailts ',
14. fiouyh Plumbyig
-, •�
15. Rough Electrical-Conduit
16. Rou9h Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical�T Bar Ceiling
79. Rough Heating & Air Contlitioning
20, flough Factory Fireplace
21, pucts, in Structure , '
22, pucts, Ventilating ' �
2�3. Gas Pipe-flough 8{,Test �
24. Roof Framing � .
25. R'oof Sheathing �
26. 7-Bar Ceiling (Struetural) & Monocoat �
P7,, Frame and Flashin `�
§ SOe. A,oTt,�
28^l.athing & Siding �
29. Insulation ..;i�-1 . '
b�
30. Drywall Nailing ,,�,� p��
. +
31, plaster Brown Coat � � �
32. Electrical Power Meter-Fina1 �
33. Final Electric '
34. Final'Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy .
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final .
41. Solar pomestic-Final ' ' ,.
42. Backflow Preventer + � �, '
43. Backflow Irrigation �
44, ,I..andscape Irripation SYstem �`'
45.'5ound Attenuation
46. Handicap Regulations �
47. FINAL STFUCTURE & BUILDING
48. SPedal fiequirements Completed �,
4g, Electriq Release to Edison
50. Gas Release to Southern California Gas Cc
51. CERTIFICATEpF OCCUPANCY
No Date
�
POOI & SPA
Inspector AppROVALS Permit �W
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
G 57. APPROVAL TO COVER-GUNITE
� 58. Electrical Conduit-Undrgrnd.
/�' 59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, O Untlrgmd.
� � 61. APPROVALTO DECK
62. Backwash & Feceptor-Final
� � 63. Heater & Vent-Flnal
. 64. Plum6ing System - Final
65. Electrical�Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Under9round Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
L�G/i 74. Overhead Hytlro
• 75. Dry Chemical
76. Dry Standpipe
77. F�XED SYSTEM FINAL
76. FIRE PREV. FINAL
HEALTH DEPT. RE�UIREMENT
79. FINAL INSPECTION
B0. FOOD CERTIFICATE ISSUED
Notes: , „ /� � � J� / i �n .. _ _ �_ _
j�l
�
Date Inspecto
�G.�'
7 1('J
Aov���ant to fill in all soaees exceo� tnase witnin neavy Dortler iines antliign all appropriate Oeclarationz.
Ci7Y0F cOST MESA CONSTpjj UCTION PERMIT
Project Address ��b I F(� �O Y g- .�
Applicant's Mailin9 Address �
Owner's Name �oE � M � q 6/•1 $.S� Pho �!L�,
Address ��;—+r
Arch/Eng. License No.
Address
Contracmr's Name Phone
Address (mailingl
Ciry License No. �
LICENSED CONTRACTOR DECIARATION � �
1 hereby aifirm [hat I am litensetl untler provi5ion5 of ChdrtGr 9(commenCin9
with section ]000) ot Oivision 3 oi tne Busines5 antl Protessions Cotle, antl
my Ilcense is in lull force antl effect.
License Clazs License No.
Date Signature
WORKERS' COMPENSATION OECLARATION
' 9ereby a(firm that I nave a certificate oi consent to self-insure or a tertiticate
WorkeR' Compensation Inmrance, or a certifi¢a toDY ihereot (Sectbn
.00, Lab. CJ ,..�_,
Policy No. �-'' Company
eCertilietl coOY is�hereby fumishetl. ,
Cmtlfletl capY is�fileG with the city Builtling DiV�sion.
Date Applicant
EXEMPTION FROM WORKERS' GOMPENSATION DECLARATdON
(This section naetl not be completetl if the permit IS for one huntlretl ($100) or
ICSSJ. - �� :
I certify that in thG performance of the work fo� Wh� {� thiz p¢rm�� i5 i55uetl, I
shall not employ any Oerson in any �ma�e�so yYj6 beco�e �bject to [he
Workers_ CVm0.Gqsytlon Laws of CalifOrni /� ///
Date ��/_(/,r �—Si9nature '_,C�
NOTICE/It./fter'making tpls tlaclarati6 , you shPultl ecort
Workers' Comp¢nsation provi5ion5'of fhe'Labor Cotle, you
wmply wilh Such provislons o�, this pe�mit shall � be tl
I hereby aifltm that there'is a constiuction lentling a9enty to� the performance
Of lhe wark far whith�ithi5�permlP� is i55ued (Section 3097 Civ. CJ
LentleYs Name �� '
Lender's Atltlre55
OWNER BUILDER �ECLARATION -
I hereby af9rm that I am exempt fmm [ne Contractor'S License Law for tne
followin9 reasan (Settion �031.5 Business antl Prolessional Cotle: Any city or
county wbicb requires a permit to construtt, al[¢r', improve,.Uemolish or r¢pah
any sVUCture, priOr to its issuance, al5o requires Ihe applicanl for SUGh pe�mit
[o tile a sianetl statement that he/she is licensetl pur5udnt [O the pfOvision5 ot
J31.5 by any applicant for a permit subjects mo appucam w�a crvu
alty ot not more than five huntlretl tlollars (E500).
d5 Owne� of lhe property or my em01oy6e5 with wage5 a5 th¢ir sole
OrtID¢nsation, will tlo the work, antl ihe Structu�e is no[ int¢ntletl o� o�feretl
tor sale (Section 7044, Business antl �Professional Cotle: The Contractor's
Lite.nse Law doe5 nOLapply to an owner of a property who bui1C5 0� imp�ov¢5
[hcreon, antl wbo tloes such work himself/hersalf or [Noug� his or her own
emD�oyea5, provitletl ihat Suth improvements are �ot Intentletl or otf¢r¢tl 10�
Shce. If,-howeveq the bulltling or imorovement Is SolO within ona year oi com-
pletlon, tne Owne� will have the burtlen ot provin9 he/she tlId not builtl or iT-
r ve for the purpose of sale).
I, ai owne� oi the p/oDerty, am exclusively cOnt�acting with IlcenSatl con-
ractors to construct the project (Sec[ion 7044, BUsmess antl Profe551ons Cotle:
The Contractor's License Law tloes not apply t0 an owner oi property who
builtls or improves thereon, antl who mntracts'for such pro�ects with a con-
tractor�s imense purouant ro the Coniractor:s LiCense Law�. I am aware that
proof o� tM1eir Worker's Compensatlon inw�ance shoultl be provitletl to mu.
❑ I am exempt untler Section� B. & P. C. Por this reason
I nave
I aore
all
abOve
� 3 �.�7 / . . _ _ _
TVPE OF CONSTRUCTION NEW ADD LTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH O OTHER A p �y
DESCRIPTION OF WORK/USE�OF BLDG. � -
S Main Buildi
TYPEOFPERMIT�� GRADING FOVNDATION STRUCTURAL T Ffont �
❑ TENANT LYELECTRICAL PLUMBING �v1ECHANICAL B Rear '
❑ OTHER A
PROJECTDESCRIPTION $p.�FT. OCCUPANCV C Right
K Leh
CONSTRUCTIONTYPE VALUATIONS S
ZONE GRADING CU. VDS. - qCRES ping. ReL �
Remarks: � 7 n ��7 • Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation '
Bathtu6s
Clarifiers
Dishwasher � '
Drinking Fountains
Floor Drains �
FloorSinks -
GasService Outlets
Intercepmrs
Kitchen Sink _.
Lavatories '
P=Trap
Roof Drains
Reinspec[ion Fee $15
Boiler
Duct-UnderGround �
Duct-Structural - ' �
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt ICBO #
Heating System & Ducting
�j6100,000 BTU O 100,000
ISlqnature ]� C�yy�" Da[e� / I I
Drivers' Licg e 55 � Reinspec[ian Fee
f
CMF 0865-46, rev. 30/84' 'White - Builtling; Canary � APPliwnt; Pink - Accountlnq; Goltlenrotl - Assessor
S75
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
Isue Fee � $ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
lectric
Fan
F.A.U.
Fixtures
Device 8oxes
OUIIeiS
Switches .
Garbage_�ispoul
Generaror 00.5 KW
6705 I0/02/87
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
' Transformer ❑ 15�50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter over 100 amps
Sub Panel
Morors �0-1 HP �1'h-8
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light
Range
Standing Sections
5-15 KW Trash Compacror
Rainspection Fea $15 luue Fee
IANICAL FEES
Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS:
Canopy Type I I ❑ � . Zoning Appraved By
' Building Approved By ��
Refrigeration Sys[em
❑o-ioo,000aru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers. - � i
Isue Fee
$ 3
BUILDING PERMIT $
PLAN CHECK $
PIUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
SUMMARV OF
121.75 .TL I
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
7
$ 3
SMIP , $
PERMIT ' ' . �
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $
TOTAL FEE $ ���
CONSTRUCTION AND PLANNING , • POOL & SPA
APPROVALS Permit# Date � Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � �
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water'Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ���� �„�/j 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains � . 64. Plumbing System - Final
14. Rough Plumbing �-'y�a% C�� 65. Electrical-Final
75. Rough Electrical-Conduit 66. Solar System-Final .
16. Rough Electric Wiring 67. Fencing & Access Approvaf
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �S�`� (,� FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace �p.s�'� 'LK',� APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil �
25. Roof Sheathing 74.-Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical
27. Frame and Flashing . 76. D�y 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 ,� tG (�� � '
o ��
35. Final Gas Pipe-Test ' , '
36. Hood or Canopy -'
37. Final Factory Fireplace
38. Final Plumbing f�� �� (��
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 Fiegulations a �
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
.. - '�. gO / -
CiT.Y OF COSrA Es,�vt .,4 ,�ONyS/T�RUCTION PERMIT
' Projectiy ress .� �K! �+
A�iplica¢'s Mailing Address '�
Owner's Na � Phon
Address /
Grr6lFnn _ I V Q �% /�%Q I icense No.
Applicant to fill in all spaces except those witnin heavY �orCer Iines antl sign a11 appropriate tleclarations.
Contractor's Nam Phone
Address (mailing) �
City License No. �
LICENSED CONTRHCTOR DEC {CATION
1 hereby aHirm Ihat 1 am Iicensetl untler prOvizlOnS of Charte� 9(commencing
with section ]000) ot Divislon 3 Ot the Bu51ne55 antl Prot¢5sions COtle, antl
my license is In tull forte and ettect.
License Class License No.
Date Si9na[ure
WORKERS' COMGENSATION DECLARATION
'�ereby atfirm thal 1 have a certiticate ol consent to selPinsure or a certificate
Workers' Compensation Insurance, or a certifiea copy tnereof (Section
6800, Lab. CJ
Policy No. Company
BCerti(ieE copy i5 hereby fumished. .
Certifietl copy is filetl with the city Builtling Div�sion.
Date AOPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thizsection neetl nbt be completetl if the permlt i4 far one huntlretl (5300) or
less)
1 certity that in tite pe�lo�man<¢ Of the wo�k f0/ Whlch 5 e�m�t issuetl, 1
sry� II n9�t employ any p¢r5on in �y mannet so ds to me s �e t to the
.V�otkei��GvpnPenSa[iOn Laws pf E:aliPorni�/s �,. _� �
fTPTICE:1f; atter making this tl laratio o s Q WE bject to the
Workers' Gompensation amvlsio 5 of o COtl , yo ust forthwith
comply with such provisions tnis per it 5ha11 b tleemeC revoketl.
GONSTRVCTION LENDING AGENCV
I hereby atfl�m that [here is a const�uctlon IentlMg ag cy fo� tM1e pe�fo�mance
of the work for which this pe�mil is issued (�Ctlon 309] Civ. C.)
Lentler's Name
Lentler's Atltlress
OWNER BUILDEN �ECLARATION
I hereby aftirm that I am exOmO� from [he Contractor's License Law for th¢
following reason (Section 7031.5 BuSinass antl PrOfessional Cotle: Any city or
county whicb r¢qui�es a permit to const�uct, alt¢r, Imp�ove, demolish or �epai�
any slruCture, p�lo� to its Issuance, also r¢qW/es the applicant fOr sucM1 pe�mit
to file a signetl slatement that he/she is Ilcensetl pur5udnt to the provi5ions ot
the ConVactor's License Law (Chapter 9(commencing wlth Section 7000) of
7iJision 3 of the Business antl Professions Cotls) or lhat he/she is exempt
herefrom antl tM1e ba5i5 for [he allegetl exemption. Any violation of Sectlon
7031.5 by any appliGant to� a permlt subjec6 the applitant [o a civil
alty of not more than five nuntlretl tlollars (5500).
I, a5 owner of the p�operty or my employeBs wltlt wages as their sole
c p¢nsation, will tlo tM1e work, antl the structu�e Is not Intentletl o� otferetl
fo sale (Section 7044, Business antl Professional Cotle: The Contractor's
LicenSe l,dw tloes nol apply t0 an owner Of a p�operty who builtls or improves
Ihereon. antl wh0 tloe5 Such wo�k himself/herSeN or [hrouqh his or hEr own
employ eas, p.ovitled that such improvements are not intentletl or offeretl for
sale. If, howeveq the bulltling or Imp�ovement I5 SoIU wlthin one year of com-
pletion, the owner will have Ihe bu�tlen of pwvin9 he/Shc tlitl nol builtl or Im-
��ove for Ih¢ pu�pose Of sale).
I, as owner ot ihe property, am exclusively cOnt�acting wilh IicenSetl Con-
t�actorsto construct the projeC[ ($ection 7094, BUsine55 antl Profe551on5 Cotle:
The Contractor's License Law tloes not appty to an owner o( property who
builtls or improves thereon, ana who mntracts for zu<h projects wifh a con-
[racior(s) license pursuant to [he ConVactor'S LiGense Law). I am aware tltat
�of of tbeir Worker's Compe tlop� urance shoultl be provitletl to me
I am exempl under Section— V� B. & P. C. lot tni�reason
Date
I hereby cer
Intormation i
antl 5tate law
520Idi1VE5 Oi
inspectlan p
Si9nature�
Drivers' i
_ Owner _
that I have reatl th
�rect. I aqree to cort
�
� .�%2.03
TYPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH OTHER A P #
`DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildin9:
E
TYPE OF PERMIT�/� GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT-�ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g Reat
❑ OTHER A
PROJECT DESCRIPTION SQ. FT. OCCUPANCV C Right
K Left
CONSTRVCTIONTVPE VALUATION$ $
ZONE GRAOING CU.YDS. ACRES p�ng. Ref. #
Remarks: . ' Planninq Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathmbs
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service OuHets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee / ' $15
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIL ICBO #
Heating $ystem & Ducting
❑ ai oo,000 eTu � i oo,000 sr
Reinspeaion Fee � S15
CMF 0865-46, rev. 30/84 Wbite - BWltling: Canary � Applitant: Pink - Accounting; Goltlenrotl - Asseszor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping "
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
AUIO�V`�d5h
Laundry T
laue Fea
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Issue Fee
fEES
$ 3
$ 3
!b=5 7/:-/ ' , .
Zone
Accessory Building:
Z
O
N
1
N
G
R
Parking Req./Provided E
Q
M
T
$
ELECTRICAL '
Automatic Washer Transformer ❑ 15-50 KW
Canstruction PoleSuh. � 50 � KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixture5
Device Boxes
Outlets
Switches
Garbage Disposal
Genereror DO-5 KW 05-15 KW
to 100 amps
r 100 amps
Sub Panel
Motors �Pl HP 01'f. - B
Inc.Solar �9-15 HP �16�15+
Microwave
Pole Light
Range
Si9n
Standing Sections
Trash Compactor
� Reinspection Fee I§75 � I luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning APProved By
8uilding Approvetl By
Appliption Issued By
FEES
$ 3
SUMMARY OF FEES
BUILDING PEFMIT $ SMIP $
PLAN CHECK 5 PERMIT
PLUMBING $ ISSUANCE $ _
PLAN CHECK 25% $ ENERGV P.C. 5 �
ELECTRICAL $ �S.�U GRADING $
PLAN CHECK 50% $ MICROFILM 3
MECHANICAL $ TOTAL FEE $ � �'�
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility�Undrgrnd. 54. Forms •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. _�s�7 J L 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. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
75. Rough Elec[rical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing � '' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINA�
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION , '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33.FinalElectric `�C -l;j'Q� JG, Notes:
TE
34. Final Heating & Air Conditioning 7_���7�_ 6`t A ,�
iL.�l_QE.Q.R.�
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer ��
43. Backflow Irrigation � � • .
44. Landscape Irrigation System � _ . ".
45. Sound Attenuation �
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison ��
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY , � „
No. Date
LIMITED STATEMENT OF RESPONSIBILITY
TO WHOM IT MAY CONCERN:
���� 1 ����� 1� �e
Street A dress
Bldg. Permit #
This Permit #
AP Number
I, �l ��T%����� , as Owner in Title of the above referenced
property, do hereby authorize:
�; �� �,�� �c� �y�-- � � `��
Name Telephone No.
to obtain permits in my behalf, as ownerlbuilder, for � ��L /��)� 7
at the above referenced property.
Should a^v oerson become an emolovee engaged in the improvement of the property, I shall
immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporatio�.
I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties.
- ) � G� G ; J /7r��,�"���
0]lfld6, rev, y8)
7 �
Date
owNER PACESETPER WEST JOIN'P VEN7ARE DATE �CT 2 3 i962
JOB ADDRESS p$pl 7�\�rt�na. Ava. BUILDING PERMIT NO.��
G�NPRAL CONTRACTOR %�ndrOS L&nd CO. VALUE $Q0.112.00
AP No.139-1i0�F-10 LOTQ�F TRACT 4349 FIR� ZON73 DP5CRIPTION OP WORKR2S
IN5PECT10NS I5ignature DA'lti GROUP IBcJ TYPE 1J 7,ONE
Sa� � PPRMITS
� �–' , . � � � SUBCONIRACTOR nA�—
e
� 1�918
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
Fo� Applieanf fo Fill In Complefiely
TYPE OR PRINT
BUILDING 2�/O E(,/ D �
ADDRH66 1�
COSTA MESA. CALIFORNIA
1 STATE / n�1 // I TEL.
LEOAL
FE REGEIl1ED
OCT 1 �ggp
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
ftCCE1R NO. �PLgy�TINp.
��7 il
er n x veo o�re �eeueo
� :���d � " ��T 2 3 t9
2�0
COSTA MESA. CA "ORNIA
ZONING
NO. OF U86 OR N8W Si�p �o1p� �
PLANB � � BUILDINO�../_.y�. _�
81ZE D I NOW ON LOTB �/� �� �7 �� Q
OP LOT A. P. NO. �
U6E OF ypRDS EVE6
E%16TING BLDG APPROVED ALLOWED
6[TBACK LIN6 PROM �/ (GEMCR LINB 9T.1 ^
CeNiBR OR 6TNeLT REAR YARD FRONT � FT. '-
SIDE YARO I LEFT I RIGHi R. SIDE 4 FT. ��
DESCRIPTION OF WORK L.SIDE s FT. �—
NEW I X IIALTERATIONI IIADDITION I oceo �� �r —�
IS ZE DING j9�'T ROOMS
�� �
1 HBPHBY ACKNOWL8D08 THAT 1 HAVB RGO THIB MPLIGTION
ANU 9TATH THAT TH6 ABOVB IB COPRBCT ANO A6REH TO COM-
PLY WITH ALL CIiY ORDINANC¢e AND HT�TB I.�W9 q80ULATINO
BUIlDINO CON9TRURION. ��0 � ,
BIGNATUR6 OP ���5
PERMITfEF
AUTHORIZED AGENT� � � � ' "� �"'L
MPROVED
P�a";��- s o6iO,
TH6 AMOUM BHOWN UNDHR VALUA
PUIiP09¢ OF 88T�OL19HIN6 A P�
S oC O //o?.
IB POR TM6
P8E ONLY.
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