HomeMy WebLinkAbout321 FLOWER ST - Building Permits�-
�PI�INFC'�RDOBESS: � 3ZS FLOWER ST UNIT:
own�hh�sxnrnE: STRASSEL RICHARD A �
�oosess: 321 FLOW�R ST '
COSTA MESA,CA 92627 ' , '
598-7408
RflCN/ENGINEEfl: � � pE0.N0.: �
ROOHES3: . � � ' - UNR:
PEPMITTEE: CAANK HROTHERS ROOFING . ( 714 ) 548-5569
• AODflE33:' , SZ6 COMMERCIAL' WAY ' ' . .
� . C:M. : CA 92627 '.
UCENSEO CONTMCTOB UECIAMTION: I here0y aifirm that I am IicenseU un0er pmvisions ol Chaptar 9(commencing witA Section
7000) oi Oivisiou 3 olihe Businass anC Prafessions CoOe, antl my license is in fullforce an0 etlect. �
cmuc.:005993 5T�7ELIC.:QOHGi%/� cu(S$� C39/, �f -�
Oaie: � `� � " ,'� 6 SipnaNre: �/ S /<-sr./-e�iL�-L� `LL.�'''efd
WONNEBS' COMPFNSRTION OECLAMTION: I hereEy aHirm t�at �ave a certifcate ai conuni ta selbinsure ar a cetlificate at Workers'
Compenution s r c ietl coDY ��ereof (Section 3800„ LaE.�( � '
aoucr xo.: �����`� �� E%P. DRTE: V �� O 1 I 9 1 ,
.ebrnrnxr: STATE •
� Certifie0 copy is hereby fumishe0.' � CetlifieE copy is filetl wiN t�e ciry iltlmA Oivision. �l � /�
Oate: � ' � Z A " 3 G ADPlicant �" _ • `„'� ."- -L/ l c'_�.^..
E%EMPTIOX fBOM WONKENS' COMPENSIITION OECWWTION: Qhis sectlon need not be completW ii Ue Oermii is Yor one hundreE ($100� less�.
I certity t�at in tAe Dehormance oi lAe work for whicA tAis permit is issued, I shall not employ any parson in any manner sa as to become
suDle�� ro the Workers' Cumpensation Laws af Calitomia. f '
Oate: � Signature:
XO!ICE: Ii, aher making tAis Oeclaration, you s�ou10 become sublect ta [he Workers' Campensation O�ovisions ai Ihe Labor
Cade, yau must fortAvnt� camDly with such proNsions or Nis pe�mit shall 6e tleemeU revake0.
CONSTflUCT10N IFN�ING �GFNCY: I Aereby affirm Iha� th¢re is a construction IenAinq apenry Por tAe pedarmance of the waM far
w�ich.ihis permit i5 i55ueE (Section 3097, Civ. C�.
lFNOER:
nooxess: •
� ,
OWNEq BUILOEfl DECLAMTION: 1 herehy aflirm t�at I am axempt trOm �he COntractors' State License Law for Ne followinA 2ason
(Section 7031.5 Business anA Pmfeuional COAe: Hny ciry of counry which requires a permit to consimct, alter, imD�ove, tlemolish, or
repair any simcture, Orior to its issuanu, also requires Ihe aODlican[ for such�parmit ro file a sipned statement ihat he/she is licensad
pursuant to the D�ovisions of ihe Caniradors' State License Law (Chapter 9(cammencing witA Section 7000) ot Division 3 of [he Business
antl Pmfessions Cotle) or that he/she is ezempt [herefmm and Iha basis'tor tha alleged exemD�ion: Any violation of Section 7031.5 hy
any applicant fo� a permit suEjecis Ihe applican� Io a civil penalry oi not more than five hundretl dollar5 (5500�. �
I, az owner of the Droperry �or my employees wi�� waAes az t�eir sole,campensation,�will Ao the work, antl the
simcture is not imenOeA ar oflered for sale (Section 7044„Business an0 Protesional CoOe: The Contrectars' State Licenu Law
� does not aDPly Io an owner af a Droperty wlq builUs or improves tAereon, and who dces such work �imself/hersetl or throuph
his or her own employeu, provitled t�at such imDrovements are no[ intentleU ar aHereO for sale. 11, however Ne buildinq or
� improvement ¢ saltl wit�in ane year of campletion, the awner vnll �ave ihe burtlen of pmNnq �e/she tli0 no[ builE or imprwe
�lor the purpou of sale�. � .
� I, as owner of the Dmperty, am exclusively con[ractinp with licensed con[ractors to consimct tha prolect (Section 7044, Business
❑ and Professions CoOe: The Contractors' SWte License Law Oces no[ apON ro an owner oi Droperry w1w EuilEs or impmves thereon
an0 who contracts for suc� Drajecis'with a coniractoqs) license Oursuan[ ta [he Coniractors' State License Law�. I am awara
Nat proot ol their Warker's Compensatian insuronce should he Drovitle0 to me.� " ' ;
� I am exempt unCer $ec[ion: � B. 8 P. G �
for Ihis reason: � ' . �
� �
Date: � ' bwner. ' �
I do hereby ce�ity t�at l am aware of antl untlerstantl t�e repuirements oI California Heahh anA Safery COAe Sections 25505, 25533, ana
25534 anG t�at I or any fuWre UuilOinA �cupant wiNwitl not (circle ane) nretl ro wmply wi[h saitl state cotles anC tha repuirements for a
permit for constmction or modification irom t�e Nr Oualiry ManaOement Uisinct. Residential consimction aDVlications are exempt imm
��eu pmvisions. '
�
Date: � pppliwnt:
I hereby ce�ity that I have reaE this ap01ica6on anE state tAat the above iniormation is correct. I apree lo comDN with all ciry anA wunry
ortlinances anC SGIe laws relatinA �o buildinq constmction an0 here6y authonze reD�senWnves oi this ciry to anter upon the above-mentione0
pmparry for inspection Duiposes. /�
. Date � � " y � ' .� i} Si9nature: l ^ �L���
�odvecs �icense or, Socia� Secunry x: �
1841-48 Wpite--Builtling; Green—COEe Eniorcemen�; Canary—Applicant; Gink—Revenue; Goltlanro0—Assessor
�
� CITY OF COSTA MESA - HUILDING PERMIT PERM.NO: B� T04922T6
PEAMIT NO: H 049226 PLAN CHECK NO: N„ GOVT: N SUPP; N'
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR . PURPOSE: ALT
JOB DESCRIPTION : REROOF COMP O/ 1LAYER COMP ' SQ FT; 2,045
CLAIM•VALUE: 2,045,00 CALC—VALUE; 2,045.00 GROUP OCC: R-3, /';
COMMENTS; T/OFF RfiROOF W/ BUILT UP GRAVEL ' . , n�
!E ik 1f ik iF �F iFif if iF ik if iF 1f if iF.M iF iF ik �f 3f iF it 1F ik iE iE iF if ik i! 1f ft ff iF ik'!f it i! �IE iE jf j! 1F iF ik fE M ik ff ikit il1E if iF iF iF iF iE iF ik it 3k±! iF �E 1E i! if iF 3E iE iE iE M 3F ik
' 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 HUILDING ---------- --------- ACCESSORY BUILDING.=--------
FRNT: FT IN REAR; FT IN FRNT: FT' IN REAA: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: .FT IN
PAAKING RE�• PROV: PARCEL: 42216212 ZNE: REF NO:
PLANNING N TES> '
7 •
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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: �:
, . i
HUILDING APPROVED BY ; ' DATE: - �
APPLICATION ISSUED H •
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3FiFMffikifiFiflf�kiFiFikifiFiFikMikiEifiFiFififik3fikikMiF M1t
LEGALIZATION:N ' F E E
� HLDG PMT PLUMBING ELE
PERMIT 54.00
PLAN
ISSUE FEE
IC
DATE: �9:z�1 a
if iF iE iE �E 1F fF k iF±f��FiFiF iE
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U M M A R Y STRUCTURAL SEGMENTcY
MECIiANIC FIRE SMIP/RES GRADING
5� '
� � SMIP/NON—RES '
�:� .
BUILDING—DIV—> PfiRMIT ISSUE PLAN—CHECK TOTAL PAID DUE
-TOTALS----> 54.50 0.00 ' 0.00 54,50 54.50 .00
REVENUE DIVISION TOTALS--> COLliECTED; 54.50 OVER/SHOAT:t 00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
54,00 ' .50
iF iF 1F it k ik if k if 1k if iF �F �F 1F 1f ff jf iF �F 1F i!!k ik if if iF ik i! if if ik 1f if 1F 1! fF k iF 1f ik iF iF i! iF ff ik fF M iFlf 1k iflf k!F iklf iF iF iF!! �Flk 1F iFlt 1FlF ik iE iF iElt 1F iE if k 1F
, . I N D I V I`D U A li�: F E E H A E A K D O W N
TYPE QTY. D E S C R I P T.I O'QN UNIT COST� ,TOTAL COST
SFA ' 2045 , AEROOF BY VALUE AESIDENIAL NOZONE 1.00 2,045.00
• £ND OF FEES
i
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u
i ! ,
or 000�os'bi-0!1U70652 �e_a-y- ss,S:.V
C�A?E; d?J?8I90 TitIE: iC:`�7 -- �
;
' � t
� CONSTRUCTION AND PLANNI�G j` " - . . � � SPA �
� APPROVALS Permit #� Date Inspector qppROVALS ,Permit # Date Inspector
1. Temporary Electrical Service or Pole N- � 52. Pool & Equlpment Location. ' '
n: c.�.
' r.� � .
�3;,�Soil Qipe-Undrgmd-� y' �;� .� ' � 53. Steel Reinforcement - �
-�%3:'"Electfieal Con�h^`l$tility-Undrgrnd': 54. Forms '
�r t. ¢u
�;'4�Elect%xal Cond3ii Undrgrnd. � 55. Electrical Bonding
�`S�SieelAeinforc�ment � x 56. Rcugh Plumbing & Pressure Test �»
'i -m r.; r " c.
��61^ETectrical UFF^S;�G�nd. _ . 57. APPROVAL TO COVER-GUNITE ��
�i7=Footings �.^Cl 58. Electrical Conduif�Undrgrnd. :�
��'r8. Foundation �� � � 59..Gas Pipe, O Undrgmd., Test �
�9. Water Pipe�Un�}Jgcnd. � � 60. Backwash Lines, P�Trap, O Undrgmd.
M
10. Sfuctural Flooc $ystem � , 67. APPROVAL TO OECK �
11. �operty Sewei'Line & Ho�i se Con ection . 62. Backwash & Receptor�Final �
12. Sewer Cap N � � �� 63.� Heater & Vent-Final .
13. Roof Drains �. ;r, � � 64.-��Plumbing System � Final, � � ��
14. Rough PlumbiGq ` . - 65.=-Electrical-Final
15. Rough Electri �-Conduit ' � 66. Solar SYstem-Final � ,
16. Rough Elec[riG=Ydiring� �- 67. Fencing & Access ApProval •
� 17. Rough Wiring �19� ' 68. APPROVED FOR PLASTERING
78. Rough Electriaal-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL ' •
19.�Rou h Fleatin &.Air Conditio i -
. 9 r-� ( i9 � i.� � [�'� T _r, X v+ .� 'c'.% �: ; -,FIREpEP,T. �EQUIREMEN'cT� [ti
� � oi � �..:•: � -�. v .J �,.. t+� y�SHFPernit# * � �
20�� Ro h ct y�*eP�ace � Sr• �'�; x 5 �i'�� *' PPRC9V
<v L' �-+��C' T C^� T
27^Duc3s, i St%Cc�e� -. .. '�5 * S o:-�* x 7 rr,e'-' T a .
� � � x � S � * � H n � * 70. U{idergro,u�d H �1ro *
22<-Duc�ts, �ent�atirtgi;,� i `� j w p a, C�J i-* M.;77. produci .'Y1�i ing O�Qs D�OiI
�-, n �
23.'Gai'Pi e=Ro h & Test � �s * ��� •` � o* � '� ^ r� r =. c
Pr � r,,. ��, �C, � ,_. S r* 72. Undergro'd� FIG)F�i t * �; c
� r� .. i x � �.. � .: � .: � � .� _ • . , �
24. Roof F�aming ,r-_, � r� ; x H� >••73:'7Undergrnd. Storag�ank�] Gas ❑ Oil
- r,
25�floof Sheathing n'i H �'�, � 7 " l �� x�74rpi�erhead Hydro��, �
^.� X -1Ft X. v ��F x ^ } �, y
26�,'T-Bar Ceiling (St;:u�tural) &"Moracoat �: q p-.e r 75�Dry Chemical F_^. ?� � [•;
27;iFrame a�rd Flashing� '^v a� ^' =' �* M 76. Dry Stan`�pfpe E"� �� ~�
� - i .r. n�: - m n x N�: �K et r+. a: G V O
r. r,•:K il i�W 3'. f: �, ..t T �-I�J x
r28. Lat�ting-�� S�{Jing x �y�:.� ,� * � (J,.. :� 77� FIXED SN'�TENF�INALx �-+ ;� �
,�29. Insulatron o �x^ r z.�. ' ��. !i�* 78�PIREPREV.FI�VlL'L ��.," � "
T30. Drywalf �Jai'�i�ng � a =� i � (-. � � ,!, � � S +jEALTFI-DEPT� �EQUIREiV1ENT
'�31. Plaster 87owi�Co�"atx S � ��T' � ( �t� * 79.�FINAL II�ECTI�iN "^ =�
�� � { I � r. ry x. � ;,;.
r.� r-- *[-,, i r c•- �;�,Fc x m -T x �
;�32:;Electrical Pory"er Meter-F�jnali * �, � ;��� �'80,-�FOOD CERTIF[fy E ISSk},�D� t&
. <33SFinaY Efectr�c• � * "' � "� * •. � I � {,� � Noies: ' g� F.�� � ` C n:• ! , ��
T. �"1 !l ]' .�"" ! 1-1 H � G � . P'� 4 � 1 }�
i li �i � �Y • � � � '�% ,Y. ' � � i: C. • ,Y. lJ l
34. Fina�1 Heatin�& Air Con`ditioning .� �j
� - .K: i�7 � � �� �� .-; 1 FC �: [n
t35!'�Final Gas Pipe-Test�x rJ�.� •� �� i I�. !�k * K.o `y x~ �cP
••n x. r ¢
:36.J-lo'� o jCanoPv�� � � ��' � r n .�*'� ` '�o '� "r
�� a: Cl I Cr �1 � ! f' , r. � ;r. �O k [r (*i
J
"�7.•Final FaCtory Fireplacex i FF --� * � � �v * �+: iu
n x c � m x � � �� t,: * #: S
� � N I _n x �K x 5 .-1 � �� _
538. Firia� Plumbin9 � cT! �+ x ' I' �� �-+ � a: �
„� .. � _. � � �. . -. . _ ..
��39. Water Service.Finals g � ��, � f �* � ��� a: � S
� ,: �-, � x cT! m
G40. Gas Service-F�nal x�± �!-�n ,� �: ;e� �K x ��e v� x
Y,� ^;-. -. [Ti M I � M T' �--� . i L Y� '``
t. � . -. :. "'� -.' .
�47. Solar pomesncFinal - � J � I R x ;�+ �o C € x :
_ x. ^ S: i :-+ ^, i x. �
42 Backflow Pre.vente[�' V ��" * I ; q� x X >i� • �� !-,
�.J �K iU UHH # H *# Y ..�`JN X F+
hJ
43. Backflow Irrigationr >+ ti � >.: * �� -- �: ~ t1 •
�-- Y ��� ca �: 3 n
:7 M C� C'.'. �: i�! `v G v� Y -� [li Cli '(.i r, i.i
�p4,ilLandsca`pe I�rrigatiop Systeml,�� r, � � �,Q,;; *-. � s- ;,� G� a. S r, `
:'YH^ t• ? � C� .. n .
245�Sound AtteRuation: --+ •• •• x � �-; ;, TW x �r - <; • �G �
--� c :� .r. ..X :w i i Fy�1J ..1=. K
n , ^ u ' � 'K K�.� �'S G.'] S A:
46.'Handicap'ReqUlations � � .,
x s x� I 1:•f�* r•.v� n �
r1,47."FIfd�4LSTRGCTURE&BUILDING � 6(;tj. ���V� i m W P•
i f��� � i' � ti y O
� F n �(ti 1 Y: �i r: T �� t+ :r
48.:FINAL P_LANNING.. c � ; i:� > n ca s x �; •
,
449.`.Electric-Jelease to Edison � � � ; .�.� x �; E; .n x �
- Fr r v - x n n�
_ . : ; ' �' p: :! �, u G• �� x L.
`-'50=Gai�ielease to SouLhem Califo7°:ia Gas Co � �� s �� ,., '
'�51. CERTIFICATEOF'OCCUPANCY "' "'" " " -
No.___ . Date
PPOJECT AUGHESS: 3 Z S FZ.r�wEFi $T
owxeesxame: cTRASSEL, itICHARU A
aooxess: 321 FLOWER ST
COSTA MESA,CA 92627
AflCH/ENGINEEN:
AOOPESS:
flEG.NO.:
UNIT:
UNIT:
PEflMITTEE: CRANK BkOTHE:RS ROOFING ( 714 ) 548-5569
FDOflESS: SZ� COMMERCIAi WAY
COSTA MESA CA 92627
UCENSEO CONTHRCTOB OECLANATION: I here�y aflirm Ihai I am licensetl untlei provisio Cha (commencing with $ection
7000) of Orv:sion 3 ai @e Business and Pmiessions Cotl , nC my license is in lull lor n tfe .
cirxuc.:005993 sTnreuc.:4086' cuss:
Daie: ��_—���Z� Signamre-
WOHREHS' COMPENSRTION UECIABATI�N: I h y �irm tha� I have a ce�ifica�e oi consenl o se -insure or a cehificale of Workers'
CompenSalion Insurance. or a cerlilietl copY �h eo� ec�ian 3800. La�. C�.
aoucr No.: z 8 5 Z 2 4 9 2 E%P. OATE: O 1 I O 1 I 9?
camvnNr: STATE FUND
❑ Cetl♦ifietl copY is hereby fumished. � Cetli�ietl c y �iletl wi�h the ciry Build' ision.
�a�e'.( Q — ?' � � Z qpplicant: d—�
EXEMPTION FpOM WOBREPS' COMPENSATION OEC 10 .(This sec�ion nee0 no� be complele0 if tAe permit is �or one hundre0 (510D) ar less�.
I cetlity Ihat in Ihe peAormante o� Ihe waB br ch p¢rmil i5 i55ueQ I s�all nOt employ any per5on in any manner 5o a5 to betOme
5u01ec1 �o �he Workers' Compensation Laws ot omia.
�a�e: Signature:
NOTICE: If, afier making ��is tleclaration, you shoula become su6leci Io IAe Workers' Campensa�ion pwvisions oi ��e Labor
CoOe. you mu5i Io�hvnih comply with 5uch pmvisions ar thi5 permii 5hall De AeemeO revoke0.
LONSTflUC110N LENOING RGENCY: I hereby afiirm tha� �here is a cans�mction lentling agency lor the pedarmance o� Ihe work tor
which Ihis permil is issuea �Secimn 3097. Crv. C�.
LENOEfl:
AO�HE55:
OWNEB BUIWEP OECLANRTION: I hereby aflirm t�at I am exempt �rom the CanVacmrs' S�aie License Law �or the following reason
(Sec�ion 7031.5 Business ana Pmlessional Code'. Fny ciry of counry which requires a Oermit �o constmc6 al�er, impmve, tlemolish, or
repair any s�mc�ure. O��or to i�s issuance, also reqmres the applicant br such permil to lile a�signed statemen� that he/she is licensed
pursuanl m the provisions af Ihe Conlrac�ors' S�ale License Law (Chapter 9(commencing wiih Section 7000) ol Division 3 of �he Business
and Pmfessions Code) or Ihal helshe is e�empt Ihere�mm antl the basis lor ��e alleged exempiian. Hny violatian o� Sec�ian 7031.5 6y
any appl¢ant br a permil sublec�s �he applicant �o a civil penalry of no� more than five hunUred Oollars ($500�.
I, as owner ol I�e pmpetly ar my employees with wages as their sole comDensalion. will do �he work, and ��e
❑ slmcWreis nolinten0etl orolteretlforsale (Section 7044, Business antl PmiessionalCade: The Coniractors' State License Law
Uoes not aDDly to an owner of a propetly who builtls or improves ihereon, antl who tloes such work himself/herself or ihmugh
his or her own employees, pmvitleA Iha� such improvements are nol inlendetl or offeretl �or sale. If, hawever the huilding or
impmvement is sol0 within one year of completion, ihe owner will nave the burtlen ol proving he/she tlitl not builtl or imo�ove
for the Durpose oi sale).
I, as owner ol Ihe propetly. am exclusively conVacting wiih Iicense0 canlraclors lo consimct l�e pmle�� (Sec�ion 7044, Business
❑ antl PmlessiMs Cod¢: The Contrat�or5' S�a�e License Law dces no� aOPly to an owner ol pwOerlY wha builtls or impmves Iherean
an0 who comracts lor suc� pmlecis with a coniractoqs�license pursuam m tAe Coniractors; Stale License Law�. I am aware
Ihai pmo� o� Iheir Workei s Campen5aiion in5urante should be pmviAeA Io me.
� I am exemp� un0ei Section: B. 8 P. C.
for Nis reason:
Date: Owner.
I tlo hereby cenily Iha� I am aware ol anU unders�antl the requiremenis at Cali�amia Heallh an0 Safely Cotle Sec�ions 25505, 25533, and
25534 and Iha� I or any lulure builtling accupant will/will no� (circle one) neea to comDly wilh saitl slaie codes antl ��e requiremen�s �or a
permi� for conslmciion or moai�ication �mm the Air Ouahry Management �iSVicl. FesiOential construction applications are exempt from
I�ese provisions.
Oaie Nppl¢anl:
I hereby cer�tly Ihat I have reaa Ihis applicalion antl sta�e Ih ih above information is correc ree omply wilh all ciry and counry
ortlinance5and5�alelaw5relalinglobuilAingcon5imc�ionan h byaNhorizerepresenla�i ol '� �oemeru heabove-menlionea
pmperry for inspeciion purpases.
Dale' O —�.J— Signa�
oriver's �icense or Sacia� 5ecurny x:
164na6 Wnite—Builtling; Green—Cotle orcemen�; Canary—Ap0licanl; Plnk—Revenue; Goltlenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMI'f PERM NO; B 059746
PERMIT NO: B 059746 PLAN CHECR NO; N GOVT: N SUPP; N
CONSTRUCTICIN TYPE; V—N PERMIT iYPE:: STR PUkPOSB: ALT
JOH DESCRIPTION ; T/OFF REROOF W/PUILT UP ��� Q�,,,F �,�,1�,ySQ FT; 1, 200
y�.�o..
CLAIM VALUE: 1,200.00 CALC—VALUE: 1,200.00 GROUP OCC; R-3 /
COMMENTS• SMOKE DETECTOR RE�UIRED It� THE HOME
*******�r***���w�*,�x��**+t�-**�r **x�*�x�t�*_*�-**x-**t��r*#�t*��-���r�r�*��*****x-�*+t��*xx�xx*�
Z O N I N GS ERTEB�AUCIKRSE M E N TS`�MOKE DETECTO�
----------- MAIN BUILDING --------- -------- ACCESSOkY �E ,; UIRED
FRNT; FT IN REAk; Fi IN FRNT; FT IN Rc n; ,. ZI�
LEFT; FT IN RGHT; FT IN LEFT; FT IN kGHT; FT IN
FARKING RE • PROV; PARCEL; 11725319 ZNE; kEF NO;
PLANNING N TES>
7 �
if 3F iE 1E iE if iE ik ie 3F 3f iF iF iE i(� iE 3F ih if if iE it if iE 1E iE iE �E iE �F iE 3f if iF it iE if iE ik iF iE iF �E iE �E �k 1F iE if if ff ?E IF ii iE �lF if if if jf� dF iF iE 1E if iE iE,1FiF i�f� iF iE 3E iE if iFi(� �%� E
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 N E N� S
��i
20NING APPROVED HY DATE;
BUILDING APPROCTED BY ; DATE; .*
4'
APPLICATION ISSUED HY: DATE; 1•.S
1Eii'iE3fif�(�'1EiflEiEifif+f'1fif1!'if�('i%iEiE1i� ft h -1Fft ]C f[ ft -1lltft ' 'K'3F3%�1Eif�f'ihii�lElf'it ' ' -��TriE'1f
1E �f aF iE iE iE 3E if�%iE ik 3E �E 1f iE iE 3! 4E iE iE fE iF 1E jE iE 1F �k if if iE iF if iFiE iE %�if 3f 3E iE if iE-)f if iF if iE iE 1E 1E iF iE iF 1E �k±E iEiE iF iF )F 3F if� !f it ik iE ?i� N iF iE if 1(� R iE if 3f� if iE
LEGALIZATION:N F E E S U M M A R Y STkUCTiIRAL SEGMENT;Y
BLDG PMT F�LUMBING ELECTRIC MECHANIC F'IkE SMIP/RES GRADING
PERMIT 29,UU ,50
SMIP/NON—kE5
FLAN
ISSUE F'EE
BUIiDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 29.50 0.00 0.00 29,50 29.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 29.50 OVER/SHORT; ,00
HLUG P�7T P�,UMBING ELECTRIC MECHANIC FIRE SMiP/TOT GRAllING PLAN—CHECK
29.00 .SO
fE if iE af iE M� iE if if ie?4 ik iE iE iF if it if iElE iE iF iE if iE iE iE 3F iE %-1E iE iE-)f iE 3f iE jE 3E iE iF if iEiE it iE 3f iE iE iE if iE iE iF iF iF iFiE iE 3E if ik iE iF iE iE ik iE �6 ik �E iP iE%%i!� 7F ih �k
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 5 C R I P T I O N UNZT COST TOTAL COST
SFR 1200 REROOF' BY VALUE kESIDENTIAL NOZONE 1.00 1,200,00
END OF F`EES
~1 C�1<71�1-0^'��1=,� �"'"'.'" i° 5�
USiE' 1�7; :9: i2 1=;ic; ;,?;�•'
I " _ _ .
CONSTRUCTION AND PLANNING- _ . POOL & SPA
� ate Inspector � Date Inspector
APPROVALS Permit-# � APPROVALS Permit # -
,i
1. Temporary Electrical Service or Pole -�_' 52. Pool & Equipmeht Location .
2, Soil Pipe•Undrgrnd. y � . 53. Steel Reinforcement
3. Electrical Conduit Utiliry-Undtgrnd. - 54. Forms - ��
4. Electrical Conduit-Und�grnd. � n� - 55. Electrical 6onding .�
5. Steel Reinforcement 56. Rough Plumbing � Pressure Test �
6. Electrical UfER Grnd. � 57. APPROVAL TO COVER-GUNITE
7. Pootings . � -• � 58. -Electrical Condvit-Undrgrnd.
•8. Foondation � ^ � � . � , 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pip¢-Undrgrnd. � '^ 60. �Backwash Lines, P-Trap, O Undrgmd. "
10. Structural Floor System - 61. APPROVAL TO DECK �
1 5. Property Sewer line & Hoi(se Connection . � _ 62. Backwash & Receptor�Flnal '
�
72. Sewer Cap �� � -/`.� '? � 63. Heater & Vent-Final
13. Roof Drains �' � ��1' -� 64. Plumbing System � Final ' i'
�
14. Rou h Plumbin � , �� '
g 9 � 65. E�ectrical-Final �
75. Rough Electrica6Condui[ 66. Solar System-Final / �
16. Rough Electric Wiring � 67. Fencing & Access ApP�oval
77. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS�FINA�
19. Rough Heating & Air Conditioning � FIRE �EPT. REQUIREMENT
20. Rough Factory Fireplace APPROVA'LS Permit #
21. Ducts, in Structure 70. Underground Hydro
. 22. Ducts, Ventilating 77. Product Piping �Gas ❑Oil
23. Gas Pipe�Fough & Test 72. Underground Flush
24. Roof Fram�ng • , 73. Undergmd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �
27. Freme and Flashing 76. Dry Siandpipe
28. Lathing & Siding � •� 77. FIXED SYSTEM FINAL
�
29. Insulation � i 78. FIRE PFiEV. FIfVAL .
30. Drywall Nailing ' � HEALTH DEPT. REQUIREMENT
`
31. Plaster Brown Coat � � � 79. FINAL INSPECTION
� -
32. Electrical Power Meter�Final � � 80. FOOD CERTIPICATE ISSUED
�
33. Final Electric � � Notes:
34. Final Heatiag & Air Condition+�g � f I .
,35. Final Gas P�Pe-Test I � I
� �
36. Hood or CanopY . j I `
37. Final FacCory Fireplace � I I
38. Final Plurttbing � i �
i
39. Water Service-Finai � �
40. Gas Service; Final � � -
�
41. Solar pomestic-Final � � �
� I �
42. Backflow Preventer - � � �
� ��
43. Backflow?Irrigation ��' .
44. �andscape Irripation �m�-- .
i
45. Sound Attenuation 1'j? i�'
/i
46. Handicap Regulations `j s � .
47. FINALS7RUCTURE;&BUjL',DING ��� qi �
48. FINAL PLANNING (j ; ';"; � � I
�
49. Electric Release to Ediwn' �`-= I I �
, 50. Gas Release to Southem"Galifomia Gas Co I � . .
� 51. CERTIFICATE OF OCC,4IPANCY
No. _ _ Date �
\i
1 Jil YL
'.n PBOJECTAODBESS: �]TRA.JS$L
OWNEfl'S NAME: i � ], FLOW
� ^.� aooness: CqSTA M'r:
''� 548-7408
RICHARD A
JT .
, CA � 9262'7
UNIT:
RPCH/ENGINEEfl: � XEG.NO.:
FDONESS: UNIT:
A-AME5 PLUMHING.& AEATING t7i4)53U-2440
PEFMITTEE: 1 U 4 Z� TRASF AVENUL -
nooxess: GARDEAI G�UVE CA 9269?
ULENSEO C�I NIB C 0 DEC�ARATION: Ih� rt��pIU,r�,tpyt I am licensetl un0e�,prov1$iq�s of Cha eer 9 commencin with Section
7000) ol OiJ�ip� �Oy ��usiness and Pia�r,9$�}qYyJGp1pJ dha my license is in 147� fer�g qptl ec�P ( 9
�ISY LIC.: l�STRTE LIC.: � CLAS .
�a�e'. _�_�.� �_l Signature: — � .YL� _ _ �� _ —
WOPNEflS' CO�W ION/�Ea.Q_BATION: I hereby a� a� I �ave aFyrt��irf, oic9n�nyo sel insur or a CertifiCa�e ot W kers'
Compensation �p ��.P,�drLcErijQeO toDY ��er¢ol (Settion 3800. Lab. E�.
POLICY NO.: �� 23 �• X E%P. DFTE: .
COMPRNY:
� � Cetlilietl copy is here6y tumishetl. ❑ Cenilietl copy is �i/letlyY't� Ihe ciry BuilOing Division
�ale: Applicant [��� ��n`$"=��.'�"�"`�'/
E%EMPTION iHOM W HNEBS' COMPENSATION OEQABATION: �This sec�ion neee not be complete if the p it) �orone huna� (Stlp) or less�.
I cekity tha� in ��e pedormance oi the work for which �his permil is issueQ i shall not employ any p�rlin any manne/so as lo become
Suhlec�io ihe Nlorkers' ComOansatian Laws al Calibmia. '
Dale: SignaWre:
NOTICE: II, a�ter making Ihis tleclaralion, you shoultl become sublect to ��e Workers' Compensation pmvisions o� the Labor
Cotle. you muSl Iarthwiih comDly wiih such provisions or lhis permit shail �e tleemetl revaked.
CONSTNUCTION LENDING AGENCY: I �ereby aflirm Ihal �here i5 a ton5�mtbOn lentling ag¢nty �or the petlormante of th¢ wOrk for
� whith I�iS permii is issued �SeCiion 3W7. Civ. C�.
�exoex:
AODflESS: ' '
OWNEfl BUILOEfl OELLABATION: I hereby a��irm ihal I am exemp� trom lhe ContrattoK State License Law for �he follovnng reason
ISeclion 7031.5 Business and Pmiessionat Coee: Nny city of counry which requires a permit m constmci, alter, impmve, aemolish, or
repair any slm[lure. prior Io it5 issuance. 515o requires I�e aDPlican� lor such permrt �o file a Slgnetl s�a�emen� �hat he/she is licensetl
pursuanl lo Ihe pmvisions ol Ihe Coniracbrs Sta�e License Law (Chap�er 9(commencing wi[h Seclion 7000� o� DiviSion 3 of �he Busine5s
an0 Prolessions Code� or ihal he/she is exemp� �here�mm and the basis �or �he aliegea exemp�ion. Fny violation o� Sectmn 703L5 by
any applican� for a Oermil 5u01eci5 the applican� to a civil penal�y o� not more than tive hundred dollars ($500). .
I, as ownerol Ihe propeny or my employees wilh wages as iheir sole compensation, will Oo che work, an0 the
❑ s�mcwre is not imeneetl or ofierea lor sale (Section 704a. Business an0 Professional Cotle: The CONractors State License Law
does not apply to an owner of a pmpeny w�o �uiltls or impmves Ihereon, and who Joes such work himsel�/herself or �hmugh
�is or her own employees, pmviaetl �hat such impmvemen�s are no� m[endetl or oflered for sale. I�, however �he huilding or
impmvement is sold wi�hin one year o� comple�ion, �he owner will have �he �urtlen o� pmving he/she tlitl no� build or impmve
br me ouroose of salel.
I. as owner ol the D�openy, am exclusively contracting with licensed contracmrs m consimct the pmlec� (Section 704a, Business
�❑ .. and Pm�essions Code: The Contracmrs' State License Law tloes no� appry �o an owner o� pmperiy who builds or impmves �hereon
antl who con�rac�s �or such Omlec�s with a con�mc�or(5)license pursuan� to �he Contractors' Sta�e License Law�. I am aware
Ihat O�oof ol �heu WOBer's Compensation insurance should be pmviaetl to m&
� I am exempt under Sec�ion'. B. 8 P. C.
br I�is reason: _
Daie: Ownec
I do hereby cenily Iha� I am aware o� an0 untlerstan4lhe requiremems o� Califomia Health anA Safery Code Sections 25505, 25533, and
2553G antl I�at I ar anV �uture builtling occupanl will/will not (circle one) nee0 io campty wii� saitl s�a�e cotles ane Ihe requiremen�s �or a
permit lor conslmction or motldicalian fmm �he Nir Oualily Managemen� �islricL Residential cans�mction applications are exempt fmm
Ihese provisions. . - �
Dale: ' NpplicanP.
I here�Y cerlity Ihal I have read Ihis applicalion and state Iha� Ihe a�ove mtarma�ion is
ortlinances and slatelawsrelaling�o builtling conslmc�ian antl hereby duthorizerepresen�
properry forinspecuon puryoses. �
Da1e,��' ��' .
Orivefs Licrose or Social Securiry x:
1641�C6 While—Bulltling; Green—Catle Enforcemenl', Canary—Applican�',
�o compty wilh all ciiy and caun�y
to enterppon �he above�men�ianea
/! �
CTTY OF COSTA MESA - BUILDING PER,+�I"P
PERMIT NO; P 052397 PLAN CAECK,NO: ,' ' N
CONSTRUCTIUN TYPE: V-N PERMIT TYFE: PLU ,
JOB DESCRIPTIUN : REPLACE WATEk HEATER .
PERN 1V0; P 0�234'7
GOVT: N SiJPP: 'N .
- PiiRFUSE: GTH
S Q F'P :
Ci,AIM VALiJE: , CALC-VALUE: GROUP OCC; R-3 /
CO�MFNTS: 3MOP:E DETECTOR RE�USRED IN THE HOME �
9F�7(-iEiFiE�l[�M�7:if�N��fiF%�jf?F�7%3%!E1EjFifi(lElFiFiPiE if?43h3E�1F�1(•aF3F7E�ii#�EiEiF3E�16if-1F1Eifle3{'iEi4l'riFifN�#i6K�irfiJfi'r3!-?F-X�1f?Eif3EiEifi?EY#:�ii�k�jf
Z O N I N G R E: Q U I R E N, E N T S .
5 E i H A C FC S
------------ MAIN BUIL�DING ----------. -=------- ACCESSORY HJILPING ---------
FRNT: F'P ZN REAR: FT IN FRNT: FT IN REAR: rT IN
LEFT: FT IN RGHT; FT iN LEFT: rT IN RGHT: rT iN
PARKING REQ: PROV: PARCEL; 11725319 ZNE: REF' NO:;.
FLANNING NOTES> , �
�
�7(� 3f iE iF if D4 {F 1f If # 3E ie iE i(� 3f k 3i ii� iE �k 4 k� 3f if� 3E �� 3E 3E �N� iE if 3f� },. iF iF 3(� iF i6 3f N� 3F * iE 3F 1F 3f �K-af *�*#� if lE Y.� �E iE 3F iE iF %#�IE iF 35 3E-IF #E %� af iF �F � if ?4� ti#' 3F 3f
D F. V E i O P M E N't S E R V Z C E S:� R E Q U I R E N E N T S
I l
7.ONINC- AFPROVED HY DATE;
BUZLDING APPROVED BY : DATE: q
APPLICAiZON ZSSUED BY: � _ DATE• 6—l�� /�
3FiEif3fiFiFaE7FiFaFiElf%j(-IEif�if)E�F3Ei(.ii.�7F ..r. .o� . . ii�£SFKY�elE�Fi(-1EaFN-�i(��7'r3�F%�F7F�f
3i3Fi't3f'k�#iF?fi6iE7f�3f1EiFiEiFx�3f�?FY.-If�lf�iEiEl(�1flfii�iFK�ih36iffFiFiF#1c3p}iP?'r 'k if#iEitiE3'rifif�ikiF*ififiea4jr.�Eif�t#'�#�iFi(��7(3i�if34iEifi'r}iFi!�
LEGALI7,ATION:N F E E S U M M R Y STRUCT'URAL SnGMENT:N
BLDG PMT PLUNBING ELECTRIC MECHANIC FIRE SNIP/RES Gr�ADING
PERNIT 2 00
253 � • SMIP/NON-RcS
PI�AN
ISSUE rEB 3,OU -
HUILDING-DSV-> PERMIT' ISSUE PI;AN-CHECK TOTAI, PAID LIUE
TQTALS----> • 2,00 3.00 ��: 0.00 . 5.00 5.00 .OU
REVENUE DIVISIQN TOTALS--> COLLECTED: 5.00 OVER/SHORT: .OU
BLDG PMT PLUMBING ELECTRIC MECHANIC FIR: SMIP/TOT GRAUING PLAN-Ci-IECK
' - rJ . � � '�' � ' .
iE k)F �it lE 7F ti� i6 i!� if 1E If %��7[� ii 3E iE aF �l't i'r N� i� if #� iE i'r }; k� iE k 3E If� iE if� ie�1E if :Y� iE aF iF if 3E iE 3F 1k iF 3'e iE fE �k 3i� lE If #f iF M' �{�% aE if #E �N� k�7F iF iE aF }�. if 1e jf iF 3( X� x if 3F 3f
I N D I V I D i7 A L F � E B R E A K D O W iJ
TYPE QTY
PZ�TJ 1
D E S C R T.P T I U N
WATFR HEATER AND/OR VENT
END UF :'EES
L$
UNIT COST
7..00
TO'1 AL CUS i
2.00
A
r
• Gi 47V1L�E4G1�-G7C1$9f 1Ci �'q:d�&'
�. ' u{Y7�: �1h��1'�/y� iZ�'{�: �.�i+4't�
.i .
u
• �
_ � � ,
CONSTRUCTION AND PLANNING _ POOL .PA �.
'= - Date Inspector � Date Inspector
� APPROVALS Perm�t # . APPROVALS Permit # .
1. Temporary Electrica� Service or Pole . 52. Pool & Equipment Location .� �
2. Soil Pipe-Undrgrnd. '. - '' . 53. Steel Reinforcement •
3. Electrical Conduit Ut�lity-Undrgrnd. 54. Forms
4. Electrical Cond�it-Undrgrnd..' 55. Electrical Bond'+ng �/�
5. Steel Reintarcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. , , 60. Backwash Lines, P-Trap, � 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 . 'r
�
13. Roof Drains � ' 64. Plumbing Sys[em � Final .-
14. Rough Plumbing �; , .� 65. Electrical�Final �.
i�^
15. Rough Electrical-Conduit "'� 66. Solar System-Final ' �
16. Rough Elearic Wirin9 ., 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 Struc[ure • 70. Underground Hydro
22. Ducts, Ventilating _ � 77. Produc[ Piping OGas 'OOiI
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 j ' 78. FIRE PREV. FINAL
30. Drywall Nailing � , � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power MeterFinal � � 80. FOOD CERTIFICATE ISSUED
33.FinalElectric i �� Notes: /rCt(/YoON�(dM7�-�ef°7'C42p,GlitA
34. Final Heating & Air Conditioning � � '� ,
i -
35. Final Gas Pipe _Test � ' � . � �
36. Hood or Canopy • � .
37. Final Faaory Fireplace f'- --
38. Final Plumbing . � �7,g� �,�" -�
39. Water Service-Final � �
40. Gas Service-Fiaal � . .
41. Solar pomestic-Final • �
42. Backflow Preventer , � � . - �
.43. Backflow Irrigation � �
44. Landscape Irrigation System � � . ' "
45. Sound Attenuation •
46. Handicap Regulations � � , -
47�. FINALSTRUCTURE&BUILDING -i3 .
48. FINAL PLANNING �
49. Electric Release to Edison ,
n .-
50. Gas Release to Southern California Gas Cv , �� �: ' � _
51. CERTIFICATE OP OCCUPANCY
No. Date
ER STRASSEL� R. �
ADDRE55 321 Flower Street
LOT TRACT FIRE ZONE
c�s
W �TER
ijOUGM PLUMBING
PROP. SWR. LINE � HOUS@ WN. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGM NEATING AND �IR CONOITIONING
TEMPORARV SERVICE OR POLE
UNOERGROUNO POWER
ROUGN WIRING
TRENCNES FONMS STEEI RE
FLOOR SVSTEM
BOND BE�M [� STEEL qEINFORCE [
SHEATMING
FRqME r1ND FLASMIN�
LATMING - IN OUT
G' '�TER. BROWN COAT
TURAL,FINRL
iNG, VENT., REFFIG. AND A.C., FI
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILOING, FINAL
DATE
SUBCONTRACTOR
- �"" �29b2
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
F
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7
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For Applicant to Fill in Completely — Use Ink Only
BVILDING ��/ %'��rre !�I ��
ADDRE55 / yJ� v�
OWNER / //2 f/ �/Zl. / � ' ���I+T i�S��
MAIL 3a� �/��<=o �� C�i_
ADDRESS �
TEL.
CITY ..r�il �f�3 NO.
BflANCH
ADDRESS
ARCHITECT
CONTRACTOR ��//ti.�'2 —/;/tG�-/i
ADDRESS �� / �`/((/P'� �/ C �%�
� TEL.
CITY ��f�f �/--+�f/ NO.
STATE CITV
LI0. NO. LIC. NO.
OF LOT �� X/32r�`f t NO.OF BLDGS. '
I NOW ON LOT
USE OF
EXISTING BLDG.
Separate permi[s are required for
electric, plumbing and heating work.
Y6E OF BU7�DINJs' />ND WORK TO BE�PERF,QRME�
I hareby acknowled9e thet 1 have reatl this application antl rtate
ihat iha above iniofmatian is corract antl agrea to comply with
all laws regulatin8 building constructian, antl I shall not employ
any parson in violation of the workman's compenuiion laws ot
the State of California.
I hereby certify that I am prope�ly Iicensetl as a contrector under
the State of Califorr��e Businass end Professions Cotle, Division 3,
Chapter 9, and that such licensas ere in full force antl aifect, or I
am ezempt from thB Provisions of the State of Callfornia Business
and Professions CodB. Division 3, hapter 9. �J
Signaiure of (I�� � �j//�
Permittee ��"���
Authorizetl Agani
0
, Yf.l�. (
�ii _�'f'�fyc:�i� I(i(1.:: .... `��.I,.�.
FORSTRUCTURALPERMIT
DATE RECEIVED � p �csuFn
O. II /� Z�� � 19 I YEFM
'Ess 3Z I F[ow�4 �-
TRACT ��0� LOT �O
ER
E
r �!
N NO.OF VSE OF NEW �QON7
��I PLANS Z BUILDING �q/� �
VAROSAPPROVED VAFDSAPPROVED
MAIN BUILDING ACCESSORV BUILDING
20MC[L,$TF�$O�� IrT/NL __
arF �
#
�
Sp FT.
Z L � �
FT.
&
DATE
APPROVED
"__ ��-%..7
THE AMOUNT SHOWN UNDER�VALUATION IS FOfl
THE PURPpSE OF ESTABLISHING A PERMIT FE ONLV:
VAIUATION PERMIT FEE $ ' �
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�:•�yy ,!y COSTA MESA BUILDING—SAFETY DEPARTMENT ^
P.O. BQX 1200
Coata Mesa, California
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us": GONTRACTOR�5,8 j'�l s� ��,�}7 j�-r � LOT N�
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Address �.rj�3 i:,�e�T^COZiT
��' Gky Zi COde Building
" bT'tfiiiF23F�1 p Q`1i�4.€3� Aaaress
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Sfate License No. �I?�js"j°Class. ��fy Owner_
r--��,- � w City License No. ���� Tel. No� F�g�7� Address
�;- � Q NUMBER TYPE OF FIXTURE OR ITEM FEE
� Bathtub C�tY—
J
RECD. BV y �-! y � (y1j �� ,y
DATE I66U6D
BUILOING USE t
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36.'J J: 1O)Jrb.� , J bL'titi�
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S��@ i7.9 a.�1.ti?i�`-, e�
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��.•' � Tel. No. ��-%°'-�i�i��d
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�'� J laundry Tub or Tray • 1 hereby acknowledge!that:l�have read this application a
r�: �• Q � state that ihe above, is mrce'ct and aBee to compty wiN
�r– Au[omatic Washing Machine
�" � Shower City Otdi�ances�and1Stite'Laws regulating plumbing.
s�= } 1 cer�ify�that�I%posses's Ihe above valid State of Califomia classi-
_ _ J Smk, ear ' ficati�
°= � Sink, Kitchen scribc
Y
� �- � W Wash Basin (Lavatory) � Ycet�
z:"'�� ' a Water Close� Toilet �Indus
;�.- p ( ) i;-t �S 'Ceetd
- � Urinking Fountains <+' y' �1�"� 1-"
4` � - d , ` signa
, Floor Drains .> `i�,n .'st'•'' Perm�
t-"� Z InterceD�ors �,'y ?1-.s� —
W
>r%1 am �the legal owner of [he residential property dr
iove.
fha[ 1 have obtained a permit from [he S[a[e Division of
Safe[y foc excava[ions, o�hcr [han swimming pools, five
or deeper and into Which a person is requ'ved [o descend.
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�„,. . = Rece tors .7 !� .,% .✓
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s��ks comme«�a� o. rd�st��a��� I N 5 P E C T 1 O N R E C O R D
f�,i,, . F Sinks Floor „.'�Y', � \f �. ' ' '
3inks, Service �� 11.,,!"' ! .
;�.� ' �
9wimming Pool�
i�'��' � � . Urinals\�
5.- W
C`. .
d ' Disfiw'asher
� : -� Caiage Disposal .
�;y � Water Sof[ener
,.�».-� � � Water Hearer and Vent L} � 1,JU
= � Gas Sys�em ... Outlets ... �
�� y RoofDrains APPROVALS
4" INSPECT00. DATC
H,2 y Water Piping Alteration
�± ' Rackflow Reventer U/G Soil � � �.
^.�.` • F Lawn Sprinklers (Res or Non-Res U/Ci WeLei � �
�c .'
. ss n
€-
Tank
1'O'I'AL FEE
CMF'0450-46 "
3 L.
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BLDO. PERMIT
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