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Home My WebLink About290 CAREFREE LN - Building Permits(714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT JobAddress: 2JO CAREFREE LN Suite No Vicinity: Parcel Nunmber: 43920304 ,4pp�icant ERIC COOLEY Address: 34001NVESTMENT BLVD HAYWARD, CA owr,er: EMPG TRUST Address 290 CAREFREE LN . COSTA MESA, CA Con�ractor: JUST WATER HEATERS INC Address: 34001NVESTMENT BLVD HAYWARD,CA WATER HEATER CHANGE OUT ISSUE FEE Backflow irrigation Backflow Preven�er Balhtub' Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor �rain, Rainwaler Drain, Roof Drinking Fountain Expansion Tank Gas EaAhquake Valve Gas (1-4 oullels) Gas (Over 4 outl��s) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 50.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 S0.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 QTY Phone�. 714-614-2547 Zip: 94545 Phone: Zip: 92627-6612 Phone: 800-909-9483 Zip: 94545 license: 591329 SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub / Washer 50.00 Landscape Irriga�ion 50.00 P-Trap 50.00 Pressure Regulator $0.00 Frocess Piping (per 10 ft) $0.00 F2eceptors 50.00 Septic Tank $0.00 Sewer Cap for Demo 50.00 Sewer Connect 50.00 Sewer Private Line 50.00 Shower 50.00 Sink, bar � 50.00 Sink, commercial 50;00 Sink, Floor 50.00 Sink, kitchen 50.00 Sink, service/mop 50.00 Spa (private) i0.00 Spa (public) � 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: OS/02/2007 Issued: 05/02/2007 ISSUED BY: � Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bktlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT 50.00 50.00 50.00 50.00 50.00 50.00 $0.00 $0.00 50.00 $0.00 512.30 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 TOTAL CALCULATED FEES: $35.80 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlone and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244G48 (6/00) WORKERS' COMPENSATION DECLARATION: I hereby ettirm under penalry of perjury one of the following declarations: ❑ I �eve end will mainlain e certiticete of wnsent to self-Insure for workers' compensetion, as provided for by sedion 3700 oi Ihe Lebor Code, for ihe peAortnence of ihe �wr-o�rk for which ihis pertnit is issued. u��qgave and will maintain workers' compensation insurance, es required by section 3700 of tha Lebor Cotle, for the pertortnence of the work for which Nis pertnit Is issued. �►i'FA orkers' compensation Insurence cartler antl policy num�er ere: �� ce jy�f i�lL Bdicy�Number. �.��rN.lio0�0"18 his section need nat be completed i! the pe�mit is valued ef one hundred dollars ($100) or less.) ❑ I certify �hat in the pertormance of the work for which this pertnit is issued, I shall no� employ eny person in any manner so as to become su�ject to ihe workars' compensetion laws of Celifornla, end eg�ae ihat if I should become subject to the workers' compansation provisions oi Sectlon 3700 ot ihe Labor Code, I she0 fonhwith comply,with.thesepmvisi APPI��p�Icent�S-�ig'natwe: � /� ,,:Date:. � �S� ��2,�0% ARW NINO: FAILURE TO SECURE WORKER$' WM ENSATIIXJ COVERAGE IS UNLAWFUL ANO SHALL SU&IECT AN E- PLOYER TO CRIMINAL PENALTIES AND qVIL FINES UP TOONE HUNDRED THOUSAND DOUAFE (510U,000�, IN ADDITKKJ TO THE COST OF WMPENSATIIXJ, DAAINGES AS PROVIDED FOR IN SECTIIXJ 31O60F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: ot Chaptar 9(commencing with Section 7000) of Professions Code, and my license is in full CONSTRUCTION LENDING AGENCV: ❑ I hereby aNirtn that there is e construction lending agency tor the pertormance of ihe work for which ihis pefmil is issued. (Sec. 3097, Civil Code). Lentlers Name: Lenders Address: SigneWre: OWNER-BUILDER DECLARATIONS: oate: 1 hereby ettirm that untler penalty ot perJury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Professions Cotle: Any city or counry which reQuires a permit to cons�ruct, elter, improve, demolish, or repelr eny simcture, prior lo its issuance, elso raquires ihe epplicant for such permit to Ole e signed stetement thet he or she Is licensed pursuent to the provislons of ihe Contrectors Ucense Law (Chapter 9(commencing with Sedion 7000) of Dlvision 3 ot ihe Business end Professions Code) or that he or she is exempt tharefrom end the basis for the elleged exemption. Any vlolation ot Section 7031.5 6y any epplicent far a permit sublects the applicant to a civil panelty of not more than five hundred dollers ($500).): ❑ I, es owner of ihe properry, or my employees wi�h wages es ��elr sole compensation, WILL DO TME WORK, and the structure Is not intended or oHeretl tor sale (Sec. 7044, Busineu antl Professlons Cotle: The Contractors License Law tices not apply to an owner of properry who builds or improves thereon, and who does such work himself or harself or ihrough his or her own employees, provitled ihat such improvemenis are not intended or oXered tor sale. N, however, the building or improvement is soltl within one year ol completion, the owner-6uilder will have the hurtlen oi proving that he or she did not build or improve for purpose oi sale.). ' ❑ I, as owner of iha property, em E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct the projact (Sec. 7044, Business antl Profes5ions Code: The conVactors License Lew does not apply to en owner of propetly who builds or Improves thereon, antl who conirects for such project with a contrector(s) license pursuam to the Contrectors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verifietl 6y drivers license. ❑ Yes ❑ No Driver's License No. Expires: Veriticetion of Ownership 6y (type ot document, i.e. - properry tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavetion tive (5) or more fee� In depih into which a person Is required to descend, will be made in connection with work euthonzetl by ihis permi�, and ihat no building structure, scaffoltling, talsework, or demolition or tlisman�ling thereof, will be more then ihirty-six (3fi) teet hiqh. (Chap. 32, Gry 2, An 2, Sec. 341, Ttle e, Calitornie Adminisirative Cotle). ❑ As ownar-builder, I will not employ anyone to do work which would require e permi� trom Ihe Division of Indusirial Safery, es noted above, unless such person has a permi� �o do such work from Ihe tlivlsion. SigneNre: Date: Division of Indusinal Satety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF EMRV: I certify under penalty oi perjury ihat I have read ihis epplication antl state ihat ihe infortnalion given is correct I agree to comply wlth ell steie laws and ciry ordinances relating to building construction, and euthonze representatives of the Ciry ot Costa Mese to enter upon Ihe ebove-descnbed properry for insDection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until final insDedion. Signature Of Legal Owner(s) r.,. sOr.!Autli nzed plicent 400E t. INSPECTIONttPE WjF �NiITIRLS 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Ra-Roof 201 Final Block/Retaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition COOE 1 INSPECTION TYPE 206 Final Mechanical 20B Final Plumhing 210 Final Elecincal 212 Final Fire Preventlon 220 Final Planning Approvel 222 Final Site 250 Final euilding/Occupency PAIE INTRIALS �i : Y G► CITYOF'"'__' "__' '.._....'..�...� .�.� nrnse�r i 290 Carefree Ln. Proj^YAw�na '- ' " ' -- —" - �ApplicanYs Ma: � Address � � �� `�� • n �Owner'sNa e � Phone:�L Address � Arch/Eng�_ < < � Licensp No. 7 AVP��ant to fill In all spaces except those within neavr bortler lines antl sl9n all approDriale Aeclarations. �I P RM�N,`0.�� TRgCT NO. LOT�I.Q. UNIT f�D, �l � � v A.P. # V l .. S Main Buildi TVPE OF CONSTRUCTION NEW °.DD ALTERATION REPAIR E �(� ❑ CONVERSION ❑ DEMOLISH ❑ OTFIER T Front (� Q DESCRIPTIONOPWORK/USEOFBLDG.�^�yc7 �yr=y4„t IB Rear Address• � � ^' ^'� w �r- .v[� • � . :. / ConVacwr'sName � ///�� • Phonne��'��'`,'�,/�'/��[ (/ Address (mailing) ��r��/��C• , `� �'� � �"�.� • Ciry License No. � v �r��-_��,Z. ! LICENSEp CONTRACTOR DECLARATION 0 I hereby a/tirm that I ary� licensetl untler p�ovislons of Cha�t¢r 9(commencing with sectlon ]000) of pivision 3 of tne Business antl Protesslons Cotle, antl my license is in lull fo�ca antl efiect. LicenSe Class Llcens¢ No. Dale Signature ' ^RKERS' COMPENSATION DECLARATION •by aHirm tnal 1 haye a certi(icafe oi mnsent to self-insure or a certBicate orke�s' Compensation Insurance, o� a certifietl copy ther¢of (Section ., Lab. C.) � - . . Policy No. Company . 8 Certifietl coOY �s hereby furnishetl: ' ' Certi(ietl mpy is fileq �yi(p tM1e city Builtli Division. Oate� Applitant� �r EXEMPYION FRO WORKERS' COMP N ATI DECL ATION (TM1isseclion neetl nol b@ �ompletetl if the pe�mit iz for pne huntlretl (E100) or less). . 1 certify that in the verformance of the work for which this parm�t is IssueO, I. shall not employ any person in any manne/r so as to becorr)0 sub)ec[ to tltb Worker Compen tion �pws of Califomip/ �� A. Date �2—�f7 Si9nature �'� �^� i NOTICE: 11, atter makiqq this tleclaratio , you s oultl become subject to Ihe 'I workers' Compensation provisions of the Labor Gotle, you must forthwith mmply wilh such p�Ovision5 Or thi5 permit sttall be tlG¢metl ravoketl. CONSTRUCTION LENDING AGENCV . 1 hereby aHirm tbat lhere Is a consbuction lentlin9 agency Por ihe pertormance I ot [he work to� whi�p (his permit is issuetl (Section 3097 Civ. C.) Lentler's Name Lentler's Atltlress OWNER BVILDER DECLARATION I nereby aHirm lhat I am eaempt from the ConVactor's Liconse Law for tne following reason (SectiOn �031.5 Business antl Protesslonal Cotle: Any ci[y or munty wnlCh �equi�es 8 Permit to con5truct, alteq iTprOve, tlemolish or repalr any structure, prlor to its Issuance, also requires ttte applicant for such permit to file a Si9netl slaleme�( [hdt he/she I5 licenzetl purSUant to the p�Ovi51on5 01 '� Con[ractor's LicensC Law (Chapter 9(commencing with Section 7000) ot sion 3 of the Bu5ine55 antl Profe55ion5 Cotle) Or [M1ai he/she i5 exempt :(rom antl tM1e ba5i5 tOr the allegetl exemptlon. Any viOlatlon 01 $ectlOn ,1.5 by any applicant for a permit subjects the aDP��cant to a civil enalty ot not more [�an live huntlretl tlollars (5500), � I, as owner ot tne prooerty or my employees with wages as tholr sole compensatiOn, will tlo lhe work, antl Ine structure i5 not intentletl O/ ofter¢tl tor sale (Section 7044, Business antl Protessional Cotle: The ConVactor's License law Ooes not appty [o an owner of a property who builtls or improves thereon, antl who tloeS such wo�k him5elf/ner5elf or th�ough his or he� own employee5, P�ovitl¢tl [Itat such ImOrovemen[s are not Intentlatl or oHered for sale. Ii, howevlr, t�e bulltlin9 or improveTent i5 soltl wl(hin One yea� ot Com- pletlon, the owner will have the burtlen of provin9 he/she altl not builtl or im- prove for the purpose o1 sale). � ❑ I, as owner ol the property, am exclusively contracting with IicenseC con- Vaclors lo ConsV uGl tM1¢ P/oje[t ($ection 7044, Busine55 dntl PrOteSziOns COtle: The Contractor'z License Law does nol dPPIY to an owner ot property who builtls or imoroves thereon. antl who mntracts for such oroiects with a mn- tractor(51 Imense purzuam to me Contractor•s Llcense law). I am aware tbat proo/ ol [heir Worker�s Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler $ectlon B. & P. C. tor this reason _� Date � Owner � nereey�cernry tnat bave reatl [M1is ap0��ca ian antl state hat� `Sbove inform i�n is <orrect. I agree to complY with all city antl county ortlinances antl st�� laws relating to builtlin9 construction, anq hereby authorize repre- 5¢ntaliv.:+ ot thi5 tlly LO enter upon the abOve-m¢ntiOn¢G Oroperty for .IOSpCCIl00 pOIpOSCS. '/ .C� Signature K� J a�- Date/a�k" Drivers' License or 55 — TYPE OF PERMIT Ll GRADING U FOUNDATION LJ STRUCTURAL ❑ TENANT Q�IE�C,T`RnAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER G�qy 1� PROJECTOESCRIPTION SQFT. �6��OCCUaANCV CONSTRUCTIONTVPE VALUATIONS �,,r ZONE GRADINGCU.VDS. ACRES •�� Remarks: � Bar Sink Backflow Preventer Backflow Irrigation Bathtubs rinking Fountains loor Drains loor Sinks as Servic.e Outlets Kitchen Sink Lavatories Roof Drains Reinspection Fae � $15 Duct- Under Ground Duct - Structural Duct - Ventilacing Exhaust System ❑ Multiple ❑ FirepUFact Blt, iC80 �k � � q Heating System & Ducting �' L�JP100,O00 BTU � 700,0006T'. Reinspection Fee � $15 0865-46, rev. 5/88 �cant; Pink - Atcountin9; GOltlenrotl - A558550/ Showers Service Sink Sewer Cap _ Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Iwue Fee Hood or Typel � Canopy Type I I ❑ Refrigeration System �o-�oo,000aTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers laue Fee 6 $ 3 FEES A C Ri9ht K Left S Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Oishwasher - Fan F.A.U. Fiztures ,� Device Boxes Zone � � Accessory Building: Parking Aeq.lProvided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW , Meter ❑up to 700 amps Meter ❑over 100 amps � Sub Panel Motors � 61 HP � 1 X- 8 InaSoiar 09-75tt� �16�15+ .� Microwave Pole Light / Range Switches t�� Sign Garbage Oisposai Standing Sections Generator �0-5 KW �5-15 KW Trash Compactor � FEES N I N G R E Q M T $. � Reinspection Fee �$�5 ' I Issue Fee I�$-3' I DEVELOPMENTSERVICESREQUIREMENTS: /7(�� 2oning APProved By �� Data l� • 3• iT � Building Approved By y, r , Date_�_�_ BUILDING PERfv�q� �UMMARV FES�IP $ _ „_� „�- �_ PLAN CHECK $ �PERMIT PLUMBING $ �� UANCE $ PLAN CHECK 25% $�_�,___,—.� ENERGV P.C. $ EIECTRICAL � J�''_� GRADING $ PLANCHECK 50% $ MICROFILM $ ,p,�� MECHANICAL $ � TOTA� FEE $ SdCL(= PLAN CHECK 25% $ � CONSTRUCTION AND PLANNING PO' SPA � ° Date Inspector - . Date Inspector APPROVALS Permit# APPROVALS Permit# . 1. Temporary�Electncal Service or Pole � ' 52. Pool & Equipment Location �-� J' j ' n 2. Soil�Pipe=Uncl�grnd. r �(��' 53. Steel Reinforcement - ' � � .' .3. Electrical Conduit Utility-Uadrgrnd. " " 54. Forms � iT 4: Elec[rical Cooduit-Undrgmd. 55. Electrical Bonding - � 5'. SteeliReinfQrcement 56. Rough Plumbing & Pressure Test �� v �6. Electrical�OF�ER Grnd. d(6 �� 57. APPROVAL TO COVER-GUNITE �f � 7�.. Foo[ings � � _� s�LC. GO �,� t a(B / 58. Electrical Conduit-Undrgrnd. �✓ �� 8[ Foundation ,� 59. Gas Pipe, O Undrgrnd., Test .l �� . 9; 1AFater Pipe-Undrgrnd., -� �D i � LFi� , 60. Backwash Lines, P-Trap, O Undrgmd. 10.'Structural Flo'ar System' �0 2o O� • 61. APPROVAL TO DECK 111; Property Sewer Line & House Connection 62. Backwash & Rece tor-Final , _ , ., , y,3 0 «�, P 12! Sew� Cap�� ', � 63. Heater & Vent-Final � �, 13. Roof Drains y, 64. Plumbing System - Final ,i • � 14. Rough Plumbing ' ' ( Zq � LEQ 65. Electrical-Final �' 15. Rough Electricfll-Condui[ 66. Solar System-Final 16.- Rough Electric Wiring �_� . O 67. Fencing & Access Approval � -1�7: Rough Wiring 5ign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling ;`� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ' Y C� �({/� FIRE DEPT. REQUIREMENT � i^. . 20. Rough Factory,Fireplace _ ,^� � �v �� APPROVALS Permit #�� 2l. Ducts, in Structure �! �� 70. Underground Hydro -• 22.1 Ducts, Ventilating ��' �y- 71. Product Piping O Gas ❑ Oil ' �. 1 '29. Gas Pipe-Rough & Test '� _ 72. Underground Flush . • �� 24'.'Roof Framing � ,.�, 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing � �-; , a � � 74. Overhead Hydro 26. T-Bar Ceiling (5tructurall &.Monocoat 75. Dry Chemical � � �27. Frame'and Flashing ��. � �� 76. Dry Standpipe _28. Lathing & Sidir�g �ti( • rj0 � 77. FIXED SYSTEM FINAL � � 29. Insulation (�o �d 78. FIRE PREV. FINAL � . g_'Z,-�jp W,y,�' 30. Drywall Nailing �. �• �y HEALTH DEPT. REQUIREMENT 31. Plaster'Brown Coat ��. ' p 79. FINAL INSPECTION � -- r 32. Electrical Power�Meter.:Final �,,� - 80. FOOD CERTIFICATE ISSUED -_ � 33. Final Electric _ _. r� � '. 1 : �lotes:�Z�'-?J9' (�jy�g� � �/¢pjrd�,.L'� . , � 34. Final Heating & Air Conditioning ,� �,.L�p •L - Z.� 8/' �K �Ql�' vq�. 35. Final Gas Pipe�Test 7 Q(,�p ��Q = ��- �36. Hood or CanopY - � 37. Final�Facto��ePlace �.' ' �; . ,� ,� r �3�. F.inal•Pl�mbing� n % /OQ(� : Rd � , � �9. Water-Service-F�nal^ 7 ` � 740. Gas�eiGice'Finel � � � . �-i �41 Sol�r pome�tic•Fina� - ' . �' ' � .�Backflow Prevente� _ . � . _ . , � � • - F J 43. Backflow Irrigatio�+. ' � U ,_ ' �,� 44. Landscape Irrigation SYstem " � 45. Sound Attenuation � 46. Handirap Regulations ' 47. FINALSTRUCTURE & BUILDING (�J • , 48. Special Requirements Completed ' 49. Electric Release to Edlson � �' � 50. Gas Release to 5outhern California Gas Co . �� ` 51. CERTIFICATE OF OCCUPANCY ' ., • No. Date � _• ' ' ' � e�Weci �ooaess: ^ � ^ ^ —to-r-r—S-�v-iii itivi•. OWNEN'SN�ME: KVST ASSOC. � nouxEss: 125 BAKF_R#261—E CM CA92626 714)668-9016 �BCH/ENCINEEP: ' RDONESS: NEG.NO.: uxir. C uxrt: PEPMITfEE: CHARLES SANDERS INH. � ( 714 ) 630-1913 nooeess: 1441 RED GUM ST ' J' ANAHEIM CA 92806 LICENSEO LONTIIACfOB OECIAMTION: I herehy affirm ihat I am IicenSeE unAer pmvisions ol C�apter 9(commencinp vnth Section 7000) of Division 3 0l the Business antl Pmtessions Coae, ana my license is in full lorce anE etlea. cirr uc.: 01 8 4 sure uc.:3 3 2 7 9 8/1/ cuss: C— 2 Q Oate: � � SiqnaNre: �� WOXKEHS' CO PE S�TION OECUIIATION: I �ere�y attirm that I have a certilicate consent �o seli-Insure or a certilicate o1 Worker5' ComDensationXywy2cp, pr� y�rufie1tl Sopy Ihq(eal (Section 3800, Lab.�� / z 8/� 0 POLICY NO.: W W y V V.i L tl.� tl FXP. �1TE: aornvnxv:OHIO CASULTY CeNfieO coDY � �emUy fumisne0. �] Certifietl wDY is li/leyy`nt na dry ullAinq ' sion. ///J Da[0: l �' ApDlicant f � �L— �, E%EMPfION FflOM flIIEflS' COMPENS/�TION OFCIAMTION: (Ihis secGon nee0 nol De com0�� i� Ne permil is br ona hunOreA (5100) ar less). I certity Nat in t�a DeAormance al the work br whic0 t0is permit is issuaG, I shall not employ any person in any manner w as lo bewme SUEjttt to Ihe Wafkets' CAmcenSation Laws al Califomia. Date: Siqnature: NOTICE: If, aher makin0 �his OedaaGon, you shaulU Cecome su6ject lo ihe Workers' Compensatbn praNsians ol t�e LaEor CoOe, you mutt IOM1hwith compty witA sucA pmvisions or tNs permii shall Oe OeemeE revoke0. CONBTBUC710N LENOINO �GENCY: I hereGy aflirm that tAere is a constmction IenOing aAency lor the pedormance ol I�e woM lor which t�is permil is iSsueE (Sectian 3097, Civ. C�. , LENOER: • pODPESS: ' OWNEB BOIIDEB OECIAMTION: 1 �ereDy affirm that I am exempt trom t�e Contractors' State License Law lar tAe followinp reasan (Section 7031.5 Business antl Professlonal Catle: Any ciry o� counry w�ich repuires a permit m consiruct, atler, improve, Eemolis�, ar re0air any sirucNra, pnor ro As iuuance, also repuires the apD��nt lor sucA permit to lile a sipnetl statement ihat Ae/she ¢ IicenseE pursuant b t�e proNsians al t�e Contracrors' State License Law (CAaO�er 9(commencing with Section 7000) af Oivision � ai tAe Busineu an0 Pmlessians Cotle) or t�at he/she is exemD� �Aerelrom ana tAe Easis Por Ihe allegeA exemD�ion. Fny violation ot Saction 7031.5 Ey any applicant lor a permit SuElects Ne aDVlicam ro a civil penalry al not more than Lva AundreE Aollars (f500). 1, as owner ol ihe D�PeM or my employees with wapes as t�eir sole compensation, wiA do tM work, and the ❑ siructure is not intende0 ar oflem0 Por sale (Sectlon 70ad, Busi�reu an0 Professional CoOe: T�e Camractors' S[ate licenu Law Oces not aDDh �a an awner ol a pmperry wlw bNlds ar improves t�ereon, an0 w�o Eces suc� work �imself/Aerself or thmup� his ar Aer own emDloyees, proviAed ihat suc� improvements am not intentletl ar ottereG br sale. If, however t�a Duildinp ar , imD�ovement u m10 wiUin one year at campletion, I�e owner wlll have the 6urtlen ot pmvinp Ae/she tli0 nat builE or improve for ihe Duryose ot sale�. � I, as owner al tAe DmpeM, am exclusively caniraclinp with Ilcense0 contraclors to constmct t�e project (Section 704A, Busineu ❑ an0 Professions Code: The Contracror5' state License Law Oces not aDDN �o an owner of DrapeM �o Umltls or impmves Ihereon � an0 who contracis for such O�ol�is wit� a controctoqs)liunsa pursuant ro I�e Contracrors' State License Law),I am aware ' t�at Droof oi tAeir Worker's Compensation insurance s�oWU be D�oNEeE ta ma. I� I am exempt unCer Sectian: B. 8 P. C. for I�is reuon: . Daie: Ownar: I do herehy certiry ihat I am aware ai ana untlerstan0 ihe reQuiremems of Calitomia Healt� anA Satery COUe Sections 25505, 25533, an0 25534 anG tAat I or any futua builEinA occuDant vnlVwill not (circle ane) neaE ta comDly vnih sai0 state cotles anU t�e reQuirements for a Oermit far consimcibn or moAifiatlon from t�e Nr Ovaliry Manapement Distnct. NeSiUentul conswction apDlicatlons are exemD� �mm Ihese D�ovisions. ' Oate: ApDliWnt: I hereGy certity ihat I have reaE this application an0 Slate that the above information is coracl. I aprea to co ly with all ciry anA counry or0inancw anG state Wvrs relaGnp to huilOinA �onstruction anE Irerep��ut�onze reDresentatrvu af 's ciry to en upon t�e a e-mentianetl O�oDerty �or inspection purposes. //////�� //// Da�e: L � Sipnatua: �� ✓� �L � �t— oriver's �icenu or ia� secunry 1891-ae Wntle—BuIlElig; Graen—COEe Enlorcemem; Canery—Applicam; Pink—Ravenue; GOICenrotl—Assessor CITY GF COSTA MESA — BUILL"ING PERMIT PERM NU: Ft 045225 PERMIT NO: M 045225 PLAN CHECR NO: N COVT: N SUPP: Y CONSTRUCTION TYPE:'V—N PERMST TYPE: MEC . PURPOSE: NEW JOH DESCRIPTION : AIR COND. ADD TO G40374 SQ FT: CLAIM.I�ALUE: 800.00 CALC—VALUE: GRUUF OCC: R-3 /M-1 COMMENTS: AUD AiR COND TO #G40374 it it iE iE iE iE �7E iE 1E iE x� iF iE iE iE 1f �tE iE iE iE iE+i �lE 3E 1E iE �tE iE iE aE iE iE 1E fE iE iE 9F �l(� iE it iE i6 it iE jf iE iE 9E iE�E iF i! �E iE iE iF 3E �If� iE 1F+t �E i4 �IE �)E iE �1(� aF iE rt# 3E if % 1F x-1E x x� Z O N I N G R E Q U I R E M�C N T S S E T H A C K S ------ ----- MAIN AUILllING --------- --------- ACCE5SORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEF'T: FT IN RGHT: FT IN LEFT: FT IN RGIiT: FT IN PARKING REq: PROV: PARCEL: 93920128 ZNE: REF NO:. PLANNING NdTES> . i4 iF iE iF iF iF iF i4 iF if IF iE if # iF �F iF iF if iE iF �F # 3FlE ik iF �k iE 3E �F iF iF k iE iE iE iE 3E �k iE 1E iE jt iE iE 1k 3E 3E iE 3E 3E k fE iE iE iE iE i! iF fk i6 iE iF �)E iE iE iE iE �E 9E 3E 3E 3E iE 3F iF iE 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 20NING APPROVED HY . �."� DATE: BUILDING APPROVED DY : —�� APPI�ICATION ISSUED BY:��F� r �*��***,��**»,��*� 1E it !E iE iE iE �E ik 1E iE �E �f !E 3E iE iE ik ik iE 3F iE if iE IE jE iF IE iE f! iF iE LEGALIZATION:N F E E' . S DATE: ��nATs: �� , ��*�**��*� �� if aE iE 1E aE 941E iE 1E jf �E iE it iE iE iE if i! iE iF iF iE 3E iE it i! iE it 3E iP dE 9E iE iE 9E If 3f M A R Y STRUCT[JRAL SEGMENT:N BLDG PMT PLOMDING ELECTRICI MECHANIC FIRE SMIP/RES GRADING PERMIT � 9.00 . ' 258 PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 9.00 4.50 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC � 13.50 4.50 SMIP/NON—RES TOTAL PAID DUE 13.50 13.50 .00 13.50 OVER/SHORT: .00 FIRE SMIP/TOT GRADING PLAN—CHECK 1f iE iE iE iE it iF iE IE 1t iE iE iF jE 1E iE jE iE iE IE �E 3E �F iE iF if ff iE iE 3E iE if iF iE iE if ik iE iE iF if 1E iF iE iE iE iE 3f 3E it iF 3f iE 3E iE iF �E jE iE iE if �E k iE lE iE if iE 1E !E if iE if jE 3E �E 1E iE IE I N D I V I D U A L F E E B R E A K D O W N TY.PE QTY D E S C R I P T I O N UNTT COST TOTAL COST MEC 1 REFRIGERATION 5YSTEM <= 100 K BTD/H 9.00 9.00 END OF FEES 01 0�04E789—OOU43789 TCbT 13.:'= 6ATE: 12/01/89 TIME: i6:16 CONSTRUCTION AND PLANNING PO� . SPA APPROVA4S Permit # Date Inspector qppROVALS Permit # Date I�spector 1. Temporary Electrical Service or-Pole � 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd:� � -. 53. $teet Reinforcement 3. Electrical Conduit U.tility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE � 7. Footings . �� 58. Electrical Conduit-Undrgrnd. - 8, Foundation � 59. Gas Pipe, O Undrgrnd., Test � . 9. Water Pipe�Undrgrnd. � 60. Backwash 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 • 15. Rough Electrical-Conduit � � 66. Solar System-Final . 16. Rough Electric Wiring ' 67. Fenci�g & Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough He�ting & Air Conditioning _ . FIRE DEPT. REQUIREMENT 20. Rough FaCcory Fireplace , . - � . APPROVALS -� = Permit # 21: DuCts, in 5tructure, _ - `.: 70. Underground Hydro � 22. Duots, Ve�tilating � + � •,71. Product�Piping OGas ❑Oil 23. Gas Pipe-Rough & Test '- - � _ � � '7Z, Underground Flush 24: Roof Framing �• ' � ��73. Undergmd.StoregeTank OGas ❑Oil 25. Roof Sheathing �_ � � �. � 74. Overhead Hydro ' 26. �T-Bar Ceiling (Structural) & Monocoat -- . 75. Dry Chemical - 27. Frame and Flashing -"� - 76. Dry Standpipe , 28. Lathing & Siding . � -• ' 77. FIXED SYSTEM FINAL - 29. Insulation __ � ""y `:' 78. FIRE PREV. FINAL 30. Drywall Nailing �; �' , _- HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � ' � �!� 79. FINAL INSPECTION - 32.-Electrical Power Meter-Final ' ;j , 80. FOOD CERTIFICATE ISSUED . -33. Final Eleccric ` _ � - � � Notes: ' ",�� ' _ - 34. Firtal Heating & Air Coniiitioning . 4d `� � � - , � - 35. Final Gas PiPe�Tesr •• ' � � • " � ' �. �y - i � . . . .. 36. Hooii or CanoPY - - ` � ' �'°' � . . � , ^ ;�j � - 37.� Final Factory Fireplace v�*� 38. Final Plumbing , , . � , j- , � � 39. Water Service-Final �' � ` , • 4�. Gas Service-Fi�al � � . ._ �- 41. Solar pomesticFinal , � �• + 42. Backflow Preventer � � ' � . ' �� 43. Backflow Irrigation • � • '44. Landscape Irrigation System :. � - . , � ; � �45.�Sound Attenuation - • � . � ' , � 46.'Handicap Regulations . -- � � 47. FINAL S7RUCTURE & BUILDING . - �i � � ' . . 48. FINAL PLANNING � r . : 49. Electric Release to Edison ._ . � 50. Gas Release to Southem California Gas Co ,� ` " 51. CERTIFICATE OF OCCUPANCY No. Date L�