HomeMy WebLinkAbout1128 CARSON ST - Building PermitsV Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
'
CITY OF COSTAiMESA M/+NSTRUCT�pN PERMIT
Project Address x Z•+Ci C Q Lv
PE$jv1I110.�3 s
YFY.JGJG
TjtA�T Ivo.
�-7idv
LOOTT� UNIT NU.
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
� CONVERSION ❑DEMOLISH ❑OTHER- � r
DESCRIPTION OF WORK/USE OF BLDG. s/ic(�"
Applicant's Mailin Address 2. Z 'ZF'01"A 1
0* er's Name - -4 4i-- ZC95 '' �i Irl �''i ' I
_Phone
Addr s c.r.,i%L$V P]
p• P # 14 k� � Zone
S
Main Build Ing: Accessory Building:
Arcti%E- g. SES License No. N ✓+
Address �ZY LN fZSL'3
TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL RAL
❑TENANT El ELECTRICAL El PLUMBING 11 MECHANICAL
❑ OTHER Olv-�'{ �rinny l�OM
PROJECT DESCRIPTION SQ. FT. 4 Occ UPANCv
, C O N ST RUCTI ON TYPE V VALUATION$
ZONE GRADINGCU.YOS. ACRES
T
Front �, Q
p
A
Rear I
N
Contractor's Name 5 41-- Phone N f
Address (mailing) 112 C'_il Kc;0^
City License No. ti/�
LICENSED CONTRACTOR DECLARATION
hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, andT
my license is in fun force and effect.
License Class License No.
Date Signature
C
Right
N
K
S
Left 1
G
R
Ping. Ref. # Parking Req./Provided
E
Remarks: P
Planning Notes: OV y s V .4.
2
M
V O 8 S
tti @ ` t f
S
PLUMBING FEES
Com'
2 r s �'.t
f
Bar Sink
Showers
L•^—W.- ✓ sA
J
FEES
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self-insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.)
Policy No. Company
BCertified copy is hereby furnished.
Certified copy is filed with the city Building Division.
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer L]15-50 KW
❑ 50+KW
Backflow Irrigation Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit
Meter ❑up t0 100 amps
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
Clarifiers
Solar Collectors
Dishwasher
Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) Or
less).
certify that in the performance of the ork for which this p It is issued, I
Shall not employ any person in any ner s as to th s bject to the
Works '' Cjyenjp Qn Laws of Calif - a. ,�
Data S f /'/ I S Signature
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains - Solar Tank
Fan Motors ❑0-1 HP 1'/a - 8
SQ
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc. Solar E19-15 HP 016-15+
NOTICE: If, after making this declaration, yo should become subject to the
Floor Sinks
Urinal
7 Fixtures
Microwave
S 2
Workers' Compensation provisions Of the La or Code, you must forthwith
comply with such provisions or this permit Shall be deemed revoked.
Gas Sertiice Outlets
Water Closet
Device Boxes
Pole Light,
CONSTRUCTION LENDING AGENCY
thereby affirm that there is a construction lending Agency for the performance
Interceptors
Water Heater
1 Outlets
Range•
Z
of the work for- which this permit is issued (Section 3097 Civ. C.)
_
Lender's Name
Kitchen Sink
Water Service
Switches
Sign
-3 0
Lender's Atldress /
OWNER BUILDER DECLARATION
1 hereby affirm that I.am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/She is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commenting with Section 7000) of
Division 3 of the Business and Professions. Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subject; the applicant to a civil
eendlty'of not more than five hundred dollars ($500),
L� a as owner of the property or my employees With wages as their sole
compensation, will do the work, and the structure is not intended or offered
I for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself Or through his or her own
employees, provided that such improvements aro not Intended or offered for
Sale. If, however, the building or improvement is Sold within one year of com-
pletion, the owner will have the burden Of proving he/She did not build or im-
l Eove for the purpose of sale).
L� I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance Should be provided to me.
❑ I am exempt under Section B. ,l. C. for this reason
Lavattlries
Auto-Wash
Garbage Disposal
Standing Sections
P=Trap_ Laundry Trays
Generator 00-5 KW 05-15 KW Trash Compactor
Roof Drains
-
Reinspection Fee
$15 Issue Fee $ 3
Reinspection Fee $15 Issue Fee
$
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENT
Approved By —Dat
Building Approved By Date
Application Issued By V Dat
Boiler
Hood or Type I ❑
Canopy Type I I LJZonln9
Duct - Under Ground
Duct-Structural
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
_
Duct - Ventilating
BUILDING PERMIT $
�� PLAN CHECK -�
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
SUMMARY OF FEES
( d
Y�9�� CO SMIP $
PERMIT
y�' ISSUANCE $
ENERGY P.C. $
3 00 GRADING $
12.00 MICROFILM $
TOTAL FEE $
'
C
Or J�'
Exhaust System ❑ Multiple ❑
System Repair/Alteration
_
Firepl/Fact Bit. ICBG #
Fire Dampers
Data O
I hereby certify that I have read this app cation and state that the above
information is correct. I agree to comp) with all city and county ordinances
and state laws relating to building con ruction, And hereby authorize repre-
sentatives of this c tly - enter upo the above-mentioned propert or
Inspection purposes.)(, / 7 3i
�%2
Heating System & Ducting
00-700,000 BTU 0100,00067
Registers
FReinspection
Fee
$15
Issue Fee $ 3
Signature / ate1
PLAN CHECK 25% $
p
I.Sj , 2Q
Drivers' License or SS -P
t vVVV-raVr' VU t!•JJ f � •
1JVfYU
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting: Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit # I-�
Date
Inspector,
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location ,
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement+,
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. ' -
`'
57. APPROVAL TO COVER;G,UNITE
7. Footings
% Q•
58. Electrical Conduit- Undrgrnd. 'I
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap,;❑ Pndrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
1
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final--
12.
Sewer Cap
63. Heater & Vent -Final `r
13. Roof Drains
64. Plumbing System - Final.
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final..
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING -
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit# '
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro '
22. Ducts, Ventilating
71. Product Piping 0Gas 0OiI.
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 1--
27. Frame and Flashing
76. Dry Standpipe -'
28. Lathing & Siding
77. FIXED SYSTEM FINAL -
+
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION -
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Q n
Notes: lrles w4l Irc S�
34. Final Heating & Air Conditioning
y, OL poF er/5,
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
: 41. Solar Domestic -Final
'
42. Backflow Preventer
43. Backflow Irrigation
I'
44. Landscape Irrigation System
-"
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
�A
'
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
+
51. CERTIFICATE OF OCCUPANCY
No. Date
-4
-
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations
CITY OF COSTA MESA nCn�yNSTT ^R/�U�CTTIO�I�) PERMIT
'Project Address ���"�/ s..I7/G.76!/V .? C _
Applicant's Mailing rens �2- C
�'-�,s_.'�/�%
Owner 's Name �G - Phone_J_Ci7 �L7
Address %(Lfj P{Q5(�!`1
B MrTA,NO.. O
8
TRACT NO.
Lo O.
UNIT NO.
A.P. its q,Z Zone
1
S
Main Building: Accessory Building: '
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER -
DESCRIPTION OF WORK/USE OF BLDG.
E
T
Front
Z
D
13
A
Rear
N
C
Right
N
Arch/Eng. -545�(_"F License No.
Address
TYPE OF PERMIT GRADING FOUNDATION STRUCTV RAL
1-1TENANT 1:1 ELECTRICAL 1:1 PLUMBING El MECHANICAL
❑'OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCY/����
CONSTRUCTION TYPE VALUATION $!/
ZONE GRADINGCU.YDS. ACRES
KLeft
S
G
R
Contractor's Name Phone
Address (mailing)
City
Ping. Ref. # Parking Req./Provid
E
Planning Notes: t
s
Q
M
T
S.
LICENSED CONTRACTOR
LICENSED CONTRACTOR DEC LARgTION
Remarks:
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
ELECTRICAL FEES
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
License Class License No.
Date Signature
WORKERS' COMPENSATION DECLARATIONConstruction
1 hereby affirm that I have a certificate of consent to self -Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.)
Policy No. Company
8 Certified copy Is hereby furnished.
Certified copy is filed with the city Building Division.
PLUMBING
FEES
Automatic Washer Transformer ❑ 15.50 KW
Pole Sub. El50+ KW
Rar Sink
Showers
Backflow Preventer
Service Sink
Cooking Unit Meter El up to 100 amps
Backflow Irrigation
Sewer Cap
Dishwasher Meter ❑over 100 amps
Bathtubs
Sewer Connection
Dryers ❑Gas ❑Electric Sub Panel
Clarifiers
Soler Collectors
Fan Motors E10-1 HP❑1%-8
no Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Th is section need not be completed if the permit is for one hundred ($100) or
less)
I certify that in the performance of the work for will ch this per It is Issued I
shall not employy Y person in any man rJ�r sq as to become su bje<t to tale
WorkevL�Cd�n pesY{j on Laws Of Californ i3/l..,S
Dale .Jl .�7i 000 Signature F— --.•YY��^'""'ss-xx r
Dishwasher
Soler Piping
F.A.U. Inc. Solar 1:19-15 HP 1:116-15+
Drinking Fountains
Solar Tank
Fixtures '
Microwave
Floor Drains
Swimming Pool w/Spa
Device Boxes Pole light
NOTICE: If, after making this declaration, you sUould become subject t0 the
Workers' Compensation provisions of the Labor Code, you must forthwith
Floor Sinks
Urinal
Outlets Range
Comply with such provisions or this permit Shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Gas Service Outlets
Water Close[
Switches Sign
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit Is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
Interceptors
Water Heater
Garbage Disposal Standing Sections
Kitchen Sink
Water Service
Generator 00-5 KW E35-15 KW Trash Compactor
Lavatories
Auto -Wash
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
County which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing With Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant t0 a civil
an ty of not more than five hundred dollars ($500).
1, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not Intended Or offered for
sale. If, however, the building or improvement Is sold within one year of com-
pletion, the owner will have the burden of proving he/She did not build or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting With licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License law does not apply to an owner of property who
builds or improves thereon. and Who contracts for such croiects with a con.
tractor(s license pursuant to the Contractor's License Law). I am aware that
proof V their Worker's Compensation Insurance should be provided to me.
❑ 1 am xempt under Section B. & P. C or this reason
P -Trap
Laundry Trays
Roof Drains
Reinspection Fee
$15 Issue Fee $ 3
DEVELOPMENT SERVICES REQUIREMENTS: 2 /
Zoning Approved By Date
Building Approved By Date
n
Application Issued By
Reinspection Fee
$15
Issue Fee
$ 3T
MECHANICAL
FEES
Boiler
Hood or Type I El
Canopy Type II ❑
SUMMAR OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ �_ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
- ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
Duct - Under Ground
Duct -Structural
Refrigeration System
❑0.100,000 BTU ❑100,000 BTU
Duct- Ventilating
Exhaust System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICSO dk
Fire Dampers
Date 6 Owner xC A r
1 hereby certify that I have read this applicati and state that the above
Information Is correct. I agree to comply with all city and county ordinances
and state laws r Iating to buil mg construction, and hereby authors ae repre-
sentatives s CityA to a e'r upon the above-mentioned property for
Inspection PIs city f �`-'
Hearin System & Ducting
9 g
❑0100,000 BTU ❑100,000BT
Registers
g
III Co, ]}.`x+14 -!,USS t034 I9 V it
DA.E: 04/26/Z9 TIME: 5:4�
Reinspection Fee
$15
Issue Fee
$ 3
Signature l.G CL at
Drivers'Li<ense r557�
Y,
01 On(s31"'S-CGO$LJ3fi a"r
-v.'1V'; TML: 15.41
0865-46, rev. 5/88 White - Building: Canary - Applicant: Pink - Accounting:
Goldenrod - Assessor
'CONSTRUCTION AND PLANNING
APP40VALS Permit #
Date
Inspector
I
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
,
52. Pool &Equipment Location
t
2. Soil Pipe-Undrgrnd.
-
53. Steel Reinforcement
-
3. Electrical Conduit Utility-Undrgrnd.
-
54. Forms
4:Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5:• Steel Reinforcement
r+
56. Rough Plumbing & Pressure Test
-
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
r.
)
7: Footings
58. Electrical Conduit-Undrgrnd.
BL Foundation
-
59. Gas Pipe, 0 Undrgrnd., Test
9 Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor-Final
_
12. Sewer Cap
63. Heater & Vent-Final
13. Roof, Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
20. Rough Factory Fireplace
21. Duds, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas ❑oil
23. Gas Pipe-Rough & Test
72. Underground Flush
24, Roof Framing
73. Undergrnd. Storage Tank O Gas 0Oil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27 Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter-Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
�' R
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing '
•39. Water'Service-Final. H
f
40. Gas Service-Final '
41. Solar Domestic-Final_
-
42. Backflow Preventer
43. Backflow Irrigation.
-
44. Landscape i Irrigation System
'
45. Sound Attenuation
i
46. Handicap Regulations
47. FINAL STRUCTURE &BUILDING
'2'S/9'D
i0e.
48. Special Requiremeritstompleted
ir
497 Electric Release to Edison
'
50'. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
cltyol. Cl(,
_DATE lq_ff\
THESEFLANS FAUST 5F 0111 j, CR AT At I. TIMES MAKE
3U_ P_W-R-APPROVAL OF DEFT_
NO CHANGLS WiTI
:12
14G Or {. RE MIT CR -PF;'lDVAL OF
I.. - . 8 - " " V,
E�-QNSTREDIO EA -
cr, 14 Y' .1 q OF ANY OF c,
"'01,; AND
IAL
UeRORS IN
7,P,r 94ErnNa
!HE cify.
"
OF
PiANNINd -D-E-pi.
NW11
CITY OF COS rA MESA
" S OLT TO Uva DEPT. Itm
Ua:
3IXT To SL
LJAIN
L7-
0 u tk) c�
_7
io
17A ---- -- 1"
/1"
2q,l
T-cc;r)
OK -T UD_ PRROCIID
BJE r .YAS E G EXEMPTION
=_j I '
7 1
C.(_('�(C. CI T S_
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations
CITY OF COSTA (y/j A CSQQT``R UCTION PERMIT
Projekt Ali,:rL'ss ` CQ ls�'A' ie,. Carl Q L!o z
Applicant'sili ddr¢ss Z C 3J f�i ClN 9z b
n7
Owner's Name C l;f1 ���� PhtTlfer �S
Address Nzb CF},Q G:M q26 zb
PERMITNO.
3 S
TRACT NO.
LOT NO.
UNIT N0.
A P ,Ay
Zone
S
Main Building: Accessory Building:
TYPE OF CONSTRUCTION NEW ADD LT RATION REPAIR
❑ CONVERSION ❑DEMOLISH ❑ OTHE l
DESCRIPTION ORI$/LISSE OF BLDG. r `
F C�/
E
T
Front
Z
0
B
Rear
N
dreh/EBg. Lieense-No.
ee
TYPE OF PERMIT GRADING FOUNDATION STRUC, RAL
•❑ TENANT ❑ ELECT ICAL ❑ PLUMBING ❑ MECHANICAL
❑OTHER 'n Oo
PROJECT DESCRIPTION SO. FT. OCCUPANCY ffS—
C(J
CONSTRUCTION TYPE VALUATION 5 !_�
ZONE GRADING CU.YOS. ACRES_
22A
K
Right
G
Address
S
Left
R
Contractgc�Nam0 45 Phone
Address (mailing)
City License No. _
LICENSED CONTRACTOR DECLARATION-
Ping. Ref. 9W Parking Req./Provided
E
Planning Notes:
Q
M
T
S.
Remarks:
r)
I her ffirto Ihat I am licensed under pr ovi5i o n5 of Charter 9 encs ng
with section 3 of the Busin essions Cotle, and
my license is In full force o effect —
ELECTRICAL
FEES
1 4�.5-�B e 2 S l2�ph
l
LicenseCI 55
Date _!___tuf_
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.I� 9_i_ Zee �+n/ �� /7 j'��^/ T-1
Policy No. vC Companll-/rTM C�/Y R/.• i
PLUMBING
FEES
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. C3 50+ KW
Bar Sink Showers
Backflow Preventer Service Sink
Cooking Unit Meter ❑up to 100 amps
Backflow Irrigation Sewer Cap
Dishwasher Meter ❑over 100 amps
Certified copy is hereby furnished.
B Certified copy is filed with the city Building Division.
Bathtubs $ewei Connection
Dryers ❑Gas ❑Electric Sub Panel
Clarifiers
Solar Collectors
an
Motors E10-1 HP ❑1'r5 - B
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed If the permit is for one hundred ($100) or
less).
1 certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as t0 becom subject to the
Dish Washer
Pi in
Solar• p g
F.A.U.Inc.
Sol ❑9.15 HP ❑ 16-15+
_
Drinking Fountains
Solar Tank
Fixtures
' Owave "
Worker Compe s i0[t ws of California.
3
Date / Signature Io �.IP
Floor Drains
Swimming Pool w/Spe
Device Boxes
Pole Light
NOTICE: Compensation after making his ions f the you sh Itl become Subject to ith
Workers' suchprprovisions of the Labor Code, you must forthwith
comply with such provisions or this permit Shall b¢ tl¢emetl revoked.
CONSTRUCTION LENDING AGENCY
FIOOf Sinks
rival
Outlets
Range
9
Gas Service Outlets
Water Closet
Switches
Sign
I hereby affirm that there Is a construction lending agency for the performance
of the work for which this permit Is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address N(r
OWNER BUILDER D CLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit t0 construct, alter, improve, demolish or repair
any structure, prior to Its issuance, also requires the applicant for such permit
to file a signed statement that he/she i5 licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of SecOon
7031.5 by any applicant for a permit subjects the applicant to a civil
genalty of not more than five hundred dollars ($500).
l41 I, as owner of the property or my employees with wages as their sola
compensation, will tlo the work, and the structure is not :intended n offered
Business and Professional Code: The Contractor's
for sale (Section of apply
License Law does not apply to an owner if a property who gh his or improves
or through his or her Own
thereon, and who dries Such work ovem nes are
that Sieh improvements are not within o or offered for
employees. t,ho ever, the ng a improvement is g h within one year of r im-
sale. If, however, the will
plebe n, the owner will have the burden of proving hr/She did not build Or Im-
have
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such oroiects with a con.
tractors) license pursuant to the Contractor's License Law). I am aware that
VI( o their Worker's Compensatio Wsurance should be provided to me.
LIQ I am exempt under Section 7657 B. p. C. for this reason
,-I nr7 •n r /
Interceptors
Water Heater
Garbage Disposal
9 Standing Sections
Kitchen Sink Water Service
Generator 00-5 KW ❑5.15 KW Trash Compactor
Lavatories Auto -Wash
P -Trap Laundry Trays
Roof Drains
-
Reinspection Fee
$15 Issue Fast
$ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
�
Building�Approved By Date
��
AppllCatlpll Issued By (� Dat
.Z.
Reinspection Fee $15 Issue Fee
$ 3
MECHANICAL
FEES
BOilef Hood or Type 1 ❑
Canopy Type I I ❑
Duct -Under Ground
SUMMARY OF FEES
BUILDING PERMIT $ 00 SMTP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
• 5-29
Duct - Structural effigeration System
Duct - Ventilating ❑0.100,000 BTU 13100,000 BTU
Exhaust System ❑ Multj e ❑ System Repair/Alteration
Firepl/Fact. Bit. ICBO dh Fire Dampers
Dt§ / Owrie,V - '.
y pp' ation and state that the above
1 herebycertify that I have reatl7this
Information is correct. I agree o comply with all city and county ordinances
and state laws relating to b ding construction, antl hereby authorize repre.
sentatives o[[//th' city to rifer upon the above-mentionrj pro ere or
Inspection q}frp /.' h _<i 1Y
Signature -/ Dat i.Z�j�
Drivers' Li 55 ? ,
Heating System & Ducting
❑6100,000 BTU Elmo,
Registers
MECHANICAL
PLAN CHECK 25%
$ TOTAL FEE $
$
�.�1�
-
31 3002? 1^' 1002919t T 0
c u_ •a!
_.
> ,-.,,
Reinspection Fee
$15 Issue Fee
$ 3
0865-46, rev. 5/88 White - Building; Canary - Applicant: Pink - Accounting;
Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit #
r
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
�. Temporary Electrical Service or Pole
r• r i
2. Pipe-Undrgrnd.
52. Pool & Equipment Location
53. Steel Reinforcement
:. 3: Electrical Conduit Utility-Undrgrnd.
54. Forms
Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
'6�Electrical LIFER Grnd.
r
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8 Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final '
13. Roof Drains
64. Plumbing System - Final
14. Rough PI.. gibing t
15. Rough Ele ll ical-Conduit
65. Electrical -Final
66. Solar System -Final
167 Rough Electuic Wiring-
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling '-
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure • r
i
70. Underground Hydro
22. Ducts, Ventilating ; . .�."
71. Product Piping 0 Gas 0 Oil
23. Gas Pipe=Rough & Test -
72. Underground Flush
24. Roof Framing t
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar,:Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing -
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall,Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster. Brown Coat %-
79. FINAL INSPECTION
32. Electfieal Power Meter -Final--_
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: / f7 90 -.o Jti �L Q
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test''
36. Hood or Canopy
37. Final Factory Fireplace
-
38. Final Plumbing
"
39. Water Service -Final
,
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
/.
43. Backflow Irrigation
'
44. Landscape Irrigation System
'
45. Sound Attenuation
46. Handicap Regulations
+
47. FINAL STRUCTURE & BUILDING
2 9
�/
48. Special Requirements Completed
49. Electric Release to Edison
'
50. Gas Release to Southern California Gas Co
-
51. CERTIFICATE OF OCCUPANCY
No. Date
2!353
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX SIT COSTA MESA, CALIFORNIA
For Applicant to Fill in Completely
TYPE OR PRINT
BUILDING O O
ADDRESS I'
COSTA MESA, CALIFORNIA
�.S
FEE RECEIVED
JAN 17 1964
FINANCE DEPT. m.J
CITY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO. �p/Ep1M�T((AAN^O
[D EY
DA7K R C ED DDATK ISS
BD
IsFIRE
ZONE TYPE Y/ GROUP
ARCHITECTt 1 - I - TEL. 5ZIUO BY DATE
OR ENGINEER �. NO.
ZONING
ADDRESS Z NO. OP ^/ USE OF
k` PLLANS BUI
CONTRACTOR .;C(% J
1` LBGAL
ADDRESS 1 ` Q� e.S DESCRIPTION
A. P. NO.
CITY 1 Q
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE ,ice TEL "� SO" TO SIDE @ REAR P. L.
LIC. NO. V NO. _
EAVES
SIZE //., /� NO, OF SLDGB. --ALLOWED (U. B.C. REQUIREMENT)
OF LOT & O ,'L/ O NOW ON LOT
YARDS APPROVED YARDS APPROVED
USEOF - MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE FROM FRONT FT. FT.
CENTER OF STREET S REAR YARD
SIDEYARDI LEFT J RIGHT ' R•81D6 C PT. Fr•
DESCRIPTION OF WORK L. SIDE '> I Fr.
REAR -� FT. FT.
NEW AMOVING LTERATION DEMOLISH DISTANCE BET. BET. MAIN @
REPAIR
MAIN SLOGS. ACCESS. BLOG8.
BUILDING NO. OF VAR.# DATE
SIZE ROOMS STORIES C.U.P. APPROVED
EXTERIOR WAL ROOF ` BAPYPRCIff
GATE
COVERING COVERING
�' SEOF UILD BAND ORK T`O-BE PERFORMED
'Q- I
3 - 7"
BQ. FT. i5 B
I HEREBY ACK EDWTIRAD THIS APPLIGTIONTN8 AMOUNT SHOW DER VALUATION 18 ROR THBAND STATE wT TH8 wAND AREE TO COM- PURP09E OF 88TAB IBNINO A PERMIT FEE ONLY. PLY WITH L CITY O T8 LAWS REGULATING VALUATION
BUILDING �PERMIT FEE $ SIGNATU
PRM rMrr
PLAN CHECK 5
AUTHORIZED AGENT �%` (�O-/1 O Cfl ^ A L
TOTAL FEE $