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Home My WebLink About235 FAIRWAY PL - Building PermitsAVDlieant to till in all spaees exceo< those within neavY �ortler lines anG sign all aDVroDriate Oeclarations. :ITY oF coSrn nnESA^ C STRUCT ERMIT Project Addreis Applicant's Mailing qddr s � Owner's Name -r'��!d� Phone Address Arch/Eng. License No. Address ��,.q Convactor's Name Phone� � •``/� � Address Imailing) ��/q � City License Na ��Z LICENSED CONTRACTOR DECLARATION 1 hereby a/fi�m that 1 arti licensetl untle� provisions o( CM1arter 9(commencing with section ]000) ot Oivision 3 of the Business antl Grotessions Cotle, antl my license is in full force antl effect. ' .� License Qass �'� % � �' license No.�S�ffV� Da[e./4 —'�— P L Si9nature WORKERS' COMPENSATION DECLARAT�ON I hereby attirm tnat I have a certiticate of mnsent to self-inzure or a ttrtificate �Workers' Compensation Insu�ance, o� a certifi¢tl coOY thereof (Section 0, Lab. C.) ' iicy No. Company eCertifietl copy is hereby fumishetl. . . Certifietl coOY Is tiled with the city Builtling Dlvision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl nOt be com0letetl if the pe�mit is for one huntlretl ($100) or less). i certity ihat in the perto�mance ot tne work for hich thi5 perm�t iz i55uetl, I S�all not emDloy any person in any manne as o become subject to the Workers' om e}5ajion Laws of Califor '. Da[e '� ��CS�Signature NOTICE: If, fter makin9 this tlectaratlo , you s ultl become subject to ihe Workers' Compenzation provisions of the LabO Cotle, you mu5t forthwith comply witn su[h p�ovisions or thi5 permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV � I hereby affirm Iha[ [here is a const�vction lentling agency to� the perfo�mance of the work tor which tnis Oermit is issuetl (Section 309� Civ. C.) Lentler's Name Lentler's Atltlress OWNERBUILDEH OECLARATION I hereby affirm that I am ezempt trom Yhe Contractor's License Law tor the followin9 rea5on (Se[tion 7031.5 Busine55 antl Protesslonal Cotle: Any city or c0unty which requives a permi[ to const�uct, alter, improve, tlemolish or repai� any sVucture, prior to its issuance, also requires the applicant for such permit to fiie a signetl statement that he/she is licensetl pursuant to the provisions ot the Contractor's License Law (Chapter 9(commencinq with Section �000) of Divizion 3 of the Business antl Professions Cotle) or [ha[ he/sne is exempt �"�efrom antl tne basis for the allegetl exemption. Any violation oi Section .5 by any applicani fo� a permit subjects the applicant [o a civil .ty of not more than five huntlretl tlollars ($500). . �. I, as owner of the property or my employe¢s with wages as their Sole compensatian, will do the work, antl the st�ucture is not intentletl o� offeretl for 5ale (Section 7044, Business antl Protessional Cotle: The Confractor's License� Law tloes not apply to an owner o( a property who builtls o� improves thereon, antl who tloes sucn work himself/herself or through nis or her own employees, provltletl tnat such improvements are not Intentletl or offereG tor sdle. If, howeveq (he builtling o� improvement is soltl within one yea� of com- ple[lon, ihe owner will M1ave the burtlen of proving h9/5M1e tlitl not builtl or im- prOve tor the purpose of sale). ' ❑ I, as owner ot the property, am e%clusivery conl�acting with Iicense0 mn- trattors fo construct the project (Section 7044, Business antl Protessions Cotle: The Contractor's License Law does not apply to an owner of property who builtls or improves Ihereon, and who contracts far such prajec[s witn a con- tractor(z) i¢ense pursuant to tne Contractor's License L.aw). I am aware that proof of their Worker's Compensation insurance should be provitletl [o me. ❑ I am exempt untlet Section _ B. & P. C. tor this reason Date• Owner ' I hereby cer[ify that I have reatl tM1is application antl state that Ihe above intormation is correct. I agree [o comply with all city antl county ortlinances antl-state laws relating to builtliny construction, antl hereby autho�iie re0re- sentatives ot this cit e� `Upon he above-mentionetl property for 'inspectlon purpozes. /_ / ��' /2 _ � " — �.. '-C�� Signature �+' y Da[e —T—�� Drivers' License or 5) CMF 0865-46, rev. 10/84 TVPE OF CONSTHUCTION U NEW LJ ADD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ OEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. � - TVPEOFPERMIT GRADING FOUN�ATION ❑ STRUCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PIVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.FT. � occuPnNcv O� CON STRUCTION TVPE VALUATIOM$ � ZONE GRADINGGU.VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs � Clarifiers � Dishwasher Drinking Fountains Floor Drains - Floor Sinks Gas Service Outlets Interceptors Kitchen Sink � Lavatories P-Trap Roof Drains Reinspection Fee UnderGround Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Tank Swimming Pool w/Spa Urinal Watef CIOSei Water Heater Water Service A uto-W ash ES A.P. # S Main Building: E T Front' B Rear A C Right g Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher � Dryers �Gas ❑Electric Fan F.A.U.� Fixtures , ' Device Boxes ^ Outlets Switch¢5 Gar6age Disposal � � Generator �0-5 KW �5-15 ��e O $75 �� lau ee $ 3 MECHANICAL FEE Hood or Type I ❑ Canopy Type I I ❑ . Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact Blt. ICBO # Heatin9 System & Ducting ❑ o-i oo,000 eTu O i oo,00a sr Reinspection Fee I .$15 White - BUlltling; Canary - Applicanq Pink - ACCounting; Goltlen�otl - Asse55or Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers � Registers . Ittue Pee � �$'3 8200 12/04/86 Zone Accessory Building: Parking Req./Provided ELECTRICAL - Transformer-❑ 75-50KW ❑ 50+KW Meter LJup to 100 amps � Meter ❑over100amps Sub Panel , - Motors OO-1 .HP O1 Yh - 8 Inc.Solar 09-15 HP �16� Microwave Pole Light Standing Sections Tresh Compactor � Reinspection Fee �$15 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2aning Approved By Building Approvad By �Application luued By 13.00 TL FEES $ 3 Z O N I N G R E Q M T S . � SUMMARV OF FEES . ' BUILDING PERMIT $ SMIP ' $ - ' PLAN CHECK $ .PERMIT ' � PLUMBING $ '�� ' �SSUANCE $ PLAN CHECK 25% y ENERGY P'.C. $. � ELECTRICAI - $ � - GRADING. �' $ ' - PLAN CHECK 50%. $ - MICROFILM $, - MECHANICAL� $ TOTALFEE , $ �3 � PLAN CHECK 25% $ - � CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector 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 UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � 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 ��/S�� 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 Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �� 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Fac[ory Fireplace APPROVALS Permit # 21. Dutts, 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.StorageTank �Gas OOiI 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. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED � � i� 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy �� 37. Final Factory Fireplace ,. ,�t 38. Final Plumbing � -• .. 39 �Water Service-Final ' f 40. Gas Service-Final . ' 41. Solar pomestic-Final � i .42. Backflow Preventer , ,. . � .43. Backflow Irrigation ,' � - - � 4�4.. Landscape Irrigation System ' • 45t Sound Attenuation - � . � � ; ! 46. Handicap Regulations � � •� ' 47: FINALSTRUCTURE&BUILDING , � i ; � 48. Special Requirements Completed � `, � ' � ' 49. Electric Release to Edison 50. Gas Release to Southem California Gas Co '" 57. CERTIFICATE OF OCCUPANCY No. Date Ao��cant to�fill in ali,dpaees excevt tnosa witnin heavy GorCer lines anE sign aii apOropriate Ceclarations. CITY OF COS7A MESA CONSTRUCTI N PEFIMIT Project�Address .Applicant's Mailing ddress �� Owner's Name � Phone Address C �/ Arch/Eng. License NO. Address — � Contractor's Nam� P one Address (mailing) City Licenu No. - J LICENSED CONTRACTOR DECLARATION I hcreby affirm thal 1 am IlcenSetl untler provi5ion5 of Cbarter 9(commendnq wi[n section 7000) of Division 3 of the Business antl Pro(essions Cotle, antl my license iz In full ana effect. r(j Licen e s " ' e e ��d Datc � Si9nature WORKERS'COMVENSATION �ECLARATION I hereby affirm that I have a certifi<ate of consent to self-insure or a certlflcate ' Workers' Compensation Insurance, or a certlf'iertl_ copy thereot (Section J0. Lab. �^ I�y�11 _Qn ComPanY V""�' '�-� `� nIiOCY No. �« U_, � -O_il_. • Jj `�'Certifi�e¢ptl <oPYy ��s fletlbwi[hrthehc lY B' in 5 }�� A�. Dale—� V=/ /— �`�–[�{— APPlicant ��`� V" / EXEM TIONP FROM WONKERS' COMPENSATION DECLARATION (This section neetl not be compleletl if the permit is fo� one huntl�etl (5300) or less). I certity tha� in the p¢rfo�mance of the work�f0/ which tttis pe�m�t iSISSu¢tl, I shall noc employ any person in any manner so as to become sub)ect to the Worker5' Compensation LawS ot CalitOmia. \� � Date Si9nature NOTICE: 11, alter making this tleclaration, you shoultl become subject to the Workers' Compensation Orovisions of the Labor Cotla, you must forthwith comply wilh such O�ovi5ion5 or this pe�mlt Shall bB Ueemetl �evOk¢tl. CONSTRUCTION LENDING AGENCV " 1 hereby aHlrm that there is a Wnstruction lentling agency for tne performance Of Ihe wo�k for whi<h this pe�mit is i55uetl ($ection 3097 Civ. CJ LenCer's Name LenOer's Atltlress OWNER BUIIDER DECL'ARATION I hereby altirm ihat I am exempt-from the Contractor's License Law for the following reason (Section �031.5 Business antl Protessional Cotle: Any clty or county which requi�es a permit fo�conSVuct, alt2/, Improve, tlemoli5h O/ �epdir any structure, pNor to its issuance, also requires the applicant for such permit i t0 �ile a signetl s�atemenl that he/sne i5 licensetl purSuanl to lh¢ ProviSiOns ot I the Coniractor's License Law (Chapter 9_(comm¢ncing wllh Seclion ]000) ot Division 3 ot the Business antl Professions Cotle) or that he/she is ezempt ^?�elrom and the basis (or the allegetl ezemption. Any viDlation o1 Section 7.5 by any applicanf tor a permit subjects tha applican[ to a civtl alty oi not more tnan five nuntlretl aollars (5500). .� I, as owner of [he property or my employee5 with wag¢5 as lheir Sole CompensatiOn, will do [he work, antl the st�uclure i5 no[ inten0etl or o�fe�etl for sale (Seclion 7044, Business antl Proteszional Cotle: The Con[ractor's License Law tloes not apply [o an owner of a Oroperty who builtls or improve5 tM1ereon, dntl who tloes such wO�k himselt/herzelf o� th�ou9h hls or h¢t own employees, 0/ovitletl lnat Such ImOrovementz a�e nol i�tCntlotl or olfe�etl f0/ sale. If, however, the builtling or improvement is soltl within one vear of com- pletioq tho owner will have the burtlen oi proving he/she CIC not builtl or Im- prove for the purpose of sale). ❑ I, as own¢r oi lhe prOperty, am exclusively conlractinq with IlcenS¢tl con- tractorsto construct the project (Section ]046, Business antl Professions Cotle: The Contractor's License Law does no[ apply fo an owne� of pro0erty who builtls or improves tnereon. antl who contracts tor such oroiects with a con- tractor(s1 Lcenze pursuam m[ne Contractor�s License Law). I am aware tha[ proof of [helv Worker'S Compensation insuran[e shoultl be provitletl to me. ❑ 1 am exempt untler Section B. & P. C. tor this reason Date Owner I nereby certity that I have reatl tnis application antl state Ihat the aDove information it <orrect. I a9ree to comO�Y �+��h all tlty antl coun[Y ortlinan<es antl State laws �elatin9 to builGing const�uttion, antl he�eby auth0/lie �ep�e- Sentatives of thi5 city t0 enter pon the abOve-men[ionetl property iOr InsDectlon p es �yp Signature '�' Date !-1 6 �1 Drivar5' License or 55 � � 7. . 77.y / T . .. - . . . �D / lJ i' F CONSTRUCTION NEW ADD ALTERATION CONVERSION ❑ DEMOLISH ❑ OTHER ESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT U GRADING �U�/ FOUNDATION L..I STRVCTVRAL ❑ TENANT ❑ ELECTRICAL J�J PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION S�.FT. OCCUPnrvCV CON STRUCTION TVPE VALUATION $ _ ZONE GRA�INGCV.VOS. ACRES_ Remarks: Sink <flow Preventer Rflow Irrigation Drinking Fountains FlOor Dreins Floor Sinks GasService Outlets Interceptors Kitchen Sink Roof Drains Reinspection Fee � $15 Boiler Duct-UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Blt, iC60 dk Heating System & Ducting ❑P700,000 BTU 0100,000 Reinspection Fee � $15 OB65-46, rev. 5/88 White - Buil�ing; Canary - Applicant; Pink - Atcounting; Goltlenrotl - Assessor 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 Hood or Typel ❑ Canopy Type I I ❑ Fefrigeranon System ❑0.700,OOOBTU ❑100,0008TU System Repair/Alteration Fire Dampers Registers Iwue Fee A.P. � S Main Building: E T Front ARear C Fiight SLeft Ping. Ref. # Planning Notes: FEES Automatic Washer Construction Pole Sub. Cooking Unit � Dishwasher ' Dryers ❑Gas ❑Electric $ 3 FEES : $ 3 2one Accessory Parking ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Fan F.A.U. Fixtures Device Boxes OuUets Switches Garbage Disposal Generator 00.5 KW �5-15 KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors �0.1 HP O1'f, - 8 Inc.Soiar �9-15 HP �16-15+ Microwave Pole Light Range Standing Sections Trash Compactor � Reinspection Fee �$15 � � Issue Fee DEVELOPMENT SERVICES REDUIREMENTS: 'Zoning Approved By �Building ApProved By Aoolintion Issued Bv _ FEES $ 3 N I N G R E Q M T S. �. SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT _ PLUMBING $ �Q� ISSUANCE $ � PLAN CHECK 25% $ ENERGY P.C. $ , ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ � /�-y� - MECHANICAL $ TOTAL FEE $ 'S1—`�'� - PLAN CHECK 25% $ 0100025?52-00025952 '�'t�T `.it0 0.^,TE: 0:/D8/R4 TIti�: 10�1� � '.AA � _ � '.. .. . _ . ., CONSTRUCTION ANDPLANNING POOL �A ' APPROVALS Permit# Date Inspector p�ppROVALS 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-Untlrgrnd. �� 55. Electrical Bonding � 5�Steel'Reinforcement ; 56. Rough Plumbing & Pressure Test 6.= Electrical UFER�Gcnq. - 57. APPROVAL TO COVER�GUNITE ... , 7.�Footings �,i � � 58. ElectricalConduit-Undrgrnd. 8.- Foundation - _ � 59. Gas Pipe, � Undrgrnd., Test �; 9.-Water Pipe-Undrgrnd. '� ' 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ' 11. Property Sewer Line &�House Connection .'� 62. Backwash & ReceptorFinal � - 12. Sewer Cap •: � - 63. Heater & Vent-Final � 13. Roof Drains " ;� � 64. Plumbing System - Final � � 14. Rough Plumbing; ' 65. Electrical-Final 15. Rough Electrical-Contluit 66. Solar System-Final �6. Rough' Electric Wiring 67. Fencing & Access Approval �17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � ;18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1$. Rough Heating & Air Condiiioning FIRE DEPT. REQUIREMENT n 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 & Teqt 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Shea[hing 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 8 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: R-S•u9 P�,e�� wv�� A-s �r� 34. Final Heating & Air Conditioning Z�, 1�, U p�„ ^ (_,. � fl 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. BackflowPreventer-! '.�t' 43. Backflow Irrigation' � � � i • � 44. Landscape Irrigation SYstem 45. Sound Attenuation� .., � ; 46. Handicap Regulatio"ns ' 47. FINAL STRUCTUR� & BUILDING 48. Special Requirements Co.mpleted 49. Electric Release to Edison �� I50. Gas Release to Southern California Gas Co . i� ��/ � 51. CERTIFICATE OF OCCUPANCY ,,.�� No. Date 6 � � � � i I' CITYUF COSTA P�ESA��BAISTRUCTIOJNJ� PERMIT Project AC'ddiess �� 2 «� /_""-��fL-�C�- Applicant's�lailing ddress Owner's Name �� Phone "�� Address /� /� ,e�-�J� �l//YGr'!L �/ %Y�+ r . � Arch/Eng.<=''� �� ' 7 LicenseNo,`��C�✓�-3 ' Address ��t�.� ��7 C�QC� /d. � �%��f' h �-/�O ✓t' Convacmr'sNamr�?�v�' ��;5'h �!�'�S Phone�CU�-y/7��- Address Imailingl'�3 -� L �[!�C/ In �/ h F� --�/i7yL-�� City License No. � �j.� /.5f� !� ' � LICENSE� CONTRACTOR pECLARATION ' � I hereby affi�m that I am IlcenseC u�tler provisions oi Cba�tar 9(commencing� witb section "J0007 of Division 3 01 tha Husinass antl Protessions CoOe, antl my li<ense Is in (ull (orc ntl � -/ _ Licen/se Class � �� , r—License . � �` Da[q�'3' Si9nature -'�� ` . WORKERS'COMPENSATION �ECLA�2ATION I hereby a(firm Iha[ 1 have a certificdte ot consent [o self-insure or a certifiCate ot Workers' Compensation Insuran�e, or a cerHfietl copy'dnareoi (Seciion 3800, Lab. C. 1 / �j C� � Policy No. � � � / �` Company ^�/� � �1 /1!� n�y �rtitietl copy is heteby fumi5ho0. L Cer " ie co Is filetl with the cItY.�fQ� n O" I on. '�- . �• te '.iy�_ APPlitanf %��u"��'"v�-J � EMPTION FROM IVORKE0.5' COMPENSATION DECLARATION . nissection neetl�uot be comD�etetl if tne permit is for one hundretl (5300) or iess). � � - ' I certly tM1at in the;�erformance o( �he work for which this permit is issuetl,.l. snall not employ any person in any manner so as to become.subject to the' Workers' Compensation Laws of Cal��omia. • . �ate • Signature ' - NOTICE: It, aite� making this tleclaYa[iOn, YOU ShOUItl be[Ome Subject to.the Wo�ke�s' COmp¢nsatlon provisions of tne Labo� Cotle, you must fo�thwith comply wilh such 0/ovi5iOn5 or thiz pCrmit Shall be tleemetl revoketl. CONSTRUCTION lEN�1NG AGENGY I hereby affirm tnat tnerpppiii s a conStN�t�on lenaing agency for me periormance of [ne work for wpTe}r Ihis petmit is issyetl (Sec[ion 3097 Civ. CJ Lentler's Name � �� .Lentler's Atltlress '�' OWNER BUIIDER �ECLARATION � I hereby aifirm that I am exempt irom tho Contractor's l.icense Law for the following reason (Section 'l031.5 Business and Professional Cotle: Any city ar county whlch requires a pe�mit lo const�uct, alter, improve, tlemolish or repai� any sfructure, prior to its issuance, also reqWres the applicant for such permit to (ile a si9netl statement that he/sPe Is Ilcensetl pursuant to the provisions of the ConVactor's License Law (Cnap�er 9(commencing wlth Section ]000) of Oivision 3 ot Ihe Buziness antl P�O�ession5 Cotle) o� that h¢/She is exemp[ therefwm antl the basis�for the all¢9etl exfmption. Any vlolation of Section ]031.5 by any appliCant for a Oermit sublects tM1e applicant to a civil �endlty ot not more Ihan five huntlretl tlollars (E500). 1, as owner of the prope�ty o! my employe¢5 with wag¢s as thei� sole compen5ation, will tlo the work, antl [he structure is not intentletl o� offeretl for sale (Section 7o44, Business .ntl Professional Cotle: The Contractor's ''=nse 12w tloes not apply to an owner oi a properry who builtls or improves �on, antl wha tloes such work himielf/h¢rsalf or through his or he� own loYees, provitletl tnat such imp(ovements are not IntentleG o� offeretl for e: If, nowev¢r, the bulltling o� irNProvament i55oltl within one year of com- Oletioq the owne� will have the bu�tlnn of proving he/she tlitl no[ builtl or im- , prove lor tM1e purpose of sale). I❑ I, as owner ot lhe property, am exclusively con[ractinq with licensetl con- , trac[or5 to con5truc[ Ihe project,($eCtion 7044, Bu5ine55 antl Profe55ion5 Cotle: The Contractor's Licenz¢ Law dOes not apply to an ownet of pmpe�ry wbo builtls or improves thereon, antl wpo contracts for such p�ojects with a com tractor(s) bcense pursuant to tne Convacror's �icense'Law). I am aware that proOf o( their' Worke�'S Compensa��on insutance shOultl be prOvitleE to me. ❑ I am exempt unaer Sectlon B. & P. C. for this reason Date Drivers' Owner ' that I have reatl lhls applicatlo xrect. I agree to campty with all elatinq to builtli onstruction, s city to e r � on the abo +�¢5. / �)1iN.[ .i yL /� or55� � � ant lo (ill in a.._ �ortler lines antl sign all a � PERMIT NO � 1. -- LOT NO. UNI i i O. ��g`�� i,��__ � �- TVPE OF CONSTRUCTION NEW ADD ALTERATION REPA�R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPJIONOF.VyORK/USF,�FBIpG..�,! � � TVPE OF PERMIT� �LJ GRtiDwG LJ FfJUrvDAnbrv LJ STRUCTURAL ❑ TENANT LJYELECTRICAL LF�6LVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5�. FT, oCcuaarvcv— � CONSTRUCTION TYPE VALUATION $ /L� ZONE G0.ADINGCU.VDS. ACHES— Remarks: aI/l /J 3ackflow Preventer 3ackflow Irrigation 3athtubs Clarifiers Dishwasher " 7rinking Fountains Floor Drains Floor Sinks U25$CNICC �UilElS Inrercepmrs Kitchen Sink Lavarories P-Trap Roof Drains Reinspac[ion Fee $15 Boiler Duct � Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple � FirepVFacLBIt.IC80# - Heating System & Oucting ❑0.100,000 BTU 0100,OOOBT Reinspec[ian Fea � $75 I CMF 0865-46, rev. 30/84 White - Builtling: Canary - qpplicant: Pink - Attounting; Goltlenrotl - A55essor l� Showers Service Sink Sewer Cap Sewer Connection Solar Collectors � Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Wacer Service . Auto-Wash Issue Fea Hood or Typel Canopy Typell Re/rigeretion System ❑aioo,aooeru Oioo,000 System Repair/Alteration Fire Dampers Registers laue Fee r: A.P. � — S Main Buildin9: TFront c� ARear C Right Q- K Left s Ping. Ref. # Planning Notes: Automa[ic Washer Cons[ruction Pole Sub. Cooking-Unit , Dishwasher Dryers ❑Gas ❑Elec� Fan F.A.U. � Fixtures Device Boxes Outlets Switches Garbage Disposal 7090 .I�I / I 2/86 �.. Q � 'Accessory Building: _.L1�^ � Parking Req./Provided � � 177 t� TL Zone � � ETLECTRICAL . �.Transformer ❑ 15�50 KW ❑ 50+KW Generetor 065 KW �5-15 KW $ 3 Reinspection Fee FEES DEVEIOPMENTSERVI 2onin8 APProved 6Y_ • Buildin A roved 9 PP BY Appliwtion Issued ev_ $ 3 Meter LJup to 100 amps � Meter ❑over100amps Sub Panel Motors OO-1 HP O1 h- 8 Inc.Solar 09-15 HP 01E15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor 1 $15 � �uue Fea CE$ q,EQUWEMENTS: FEES $ 3 ry9�ry7ARV OF'FEES BUILDINGPERMIT $ ��` •S� SMIP $ • � _ PLAN CHECK $ ��_ PERMIT PLUMBING S � ISSUANCE $ PLAN CHECK 25% $ �� ENERGV P.C. 5 EIECTRICAL g ,1,Q • � GRADING $ PLANCHECK 50% $ '`Y'. �C) MICROFILM $ MECHANICAL $ TOTA�FEE $ PLAN�CHECK 25% $ � Z O N I N G R E Q M T $ �/ CONSTRUCTION AND PLANNING POOL & SPA -; APPROVALS �Permit � Date Inspector p�ppROVALS Permit # Date Inspector 1. Temporary Electrical Seivice or Pole 52. Pool & Equipment Location / 2. Soil Pipe-Undrgrnd. �� I � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Sieel Reinforcemeni 56. Rough Plumbing & Pressure Test � � 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE �� 7..iFootings � 58. Electrical Conduit•Undrgrnd. . j e �8. Foundation � / ,�.�. ' ' , � :59. GasPipe, � , ndrgrnd.,Test �q4�� ('9 � O- �� '� 9; Water Pipe-Undyg�nd� �I; j/ ; -. , . • 60. Backwash' Lines, P-Trap, C]-f:�fflrgrnd_� `. ( 4' �'�,E9 " , � . 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. Root 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 6S. APPROVED FOR PLASTERING . 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • � � $ p � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit# - 21. Ducts, in Structure 70. Underground Hydra C 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergmd. 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. 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: � �� a � 34. Final Heating & Air Conditioning ,� z 35. Final Gas Pipe-Test r ��` _ {1 36. Hood or Canopy ., ��/� L I oc r t � w-n 37. Final Factory Fireplace .,{ � � r�sA - �. 1' .• a � � �t 38. Final Plumbing - ' .0 cr 39. Water Service-Final � Q 8G i1 , � V 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 � � � ' 1i . ` � ��, 50. Gas Release to Southern California'Gas Co ' • , ,. � ' �� * 51. CE�2SIFICATE OF OCCU' 'CY � � ,' ; ' ' • � ' � i . � _ No�. ' ' ; Date� � . , i �. i, � � ' �. . . L � � . � , � ._ t� - . � � � "i �i. � . � ... . ..... .. .. . ... _ ._ ... ^- .. . ' . '�.�' . CITY OF COSTA MESA BUILDING SAFETY DEPARTMENT Registered Deputy Buiiding Inspector — Certificate of Compliance � Date af this Certificate 1�- 1 q- g 6 ' ' Building Address `F33 �. LO�uMB�NE.. SAN�I��Np ... �Q•� 2 4 1986 ., Permit No.�R � Zd2��i Date Issued 1 I- 12 - Q l� _., _-_-- --.. . To the Director of Building Safety: I hereby certify that the following portions of work on the buildings at the above address which required continuous inspection and which I was employed to inspect, were •inspected by me and comply with the provi- sions of the Building Code applicable thereto. - [ ] Concrete [ ] Masonry [ ] Welding [ ] Reinforced Gypsum [ ] Special Cases Swimming Pool Size 3�� [�Gunite [] Hand Pack Sacks of Cement � 3� Tons of Sand 3 b _ Approximate percent of water in aggregate E'�a __,._.__, ___ This report covers work completed during week ending � �-�-2-' g6 REMARKS: _ -ai�� S��St.�.��OND�N�� %.1�Qila— Registered Deputy Building lnspettOr Sl££� �.��PRAyC.#�, d' Namel�'�CUARnt. �v6iSA�n � W OQ.1CMANSN�Q Sp��S�PC.�OU�, P�I.IOIi�(��.U,.�NP�f..Q.�.S��.i.i� Address17422VIE�.Lou�(�oWE�� 1 �O�A I...�IJOn. CA ILaboratory 1 W� N f N C. Telephone �� 2�' � �� CMF p0.06-46 (6U 61 �� 2 ��W``� 4``-02 Twiniaq Laboratosies �f ss�u�E�,= cuc�fo2n�. �.�. � 33i0.�trportwav />naaing.�daressP0.3o�� I �ong9eacaGA3080i / i2t�1a26-3355 / �2t316382386 / piaid28-'oa32 TESTIN6 9AaNCH OFFICE'. 15P+�D Norm Susan Slroe� ! San�a Ana. CP 92103 / 1��41551�25�5 r ` December 1, 7986 Examination: SC86-126%3 . COMPRESSION TESTS ON GUNZTE CYLINDERS • Richard L. Hubbard 17422 Yellowstone Avenue Yorba Linda, California 9268b PROJECT SWIMMING POOL (HYLKEMA) aooaeSS 235 Fairway Place, Costa Mesa ARCHITECT CONTRACTOR Blue Haven Pools ENGINEER SUBCONTRACTGR B.C. .9dams SML & Son SAMP�E FROM Transition & Spa SPECIFIED MIX 4.2-1 STRENGTH 2,000 psi DATE CAST 11-19-86 SLUMP SIZE See Below OATETESTED 11-26-86 11-26-86 SPECIMEN NO. 1 2 COMPRESSION 7-Day 7-D8y TOTALLOAD,LBS. 12S>OOO SH�OOO POUNDS PER SQ. IN. 4,870 2�650 28-DAYAVERAGE, PSI 3�760 COMPLIANCE 7-Day tests comply with specified strength. SIZE 5.72" x 12" 5.28" x 12" MADE BY OELIVERED BV RECEIVED ON SPECIMeNS Lopez R. Hubbard 11-21-86 DISTRIBUTION: Richard L. Hubbard - 2 Cpeta Mesa Bldg. Dept�/Scott Priegel i I Rick Hyde ;LL REPORiS aFE SUBMIiTED -5 iHE GON=1DE:lii.:� �FOPEFlV pF C:JEN�S �U�^OFIZ-�IO�u =0F PUSL�C-iIO�V OF pU- FEp_nFic ,�,'ICLl�5�0'�5 O� EtiFaGfS FAO�d OP REG.ACirvG i nEm i5 AESERVED PEaOwG OUA �: iAliT�;i _POGO`b�L =5 ��.W N,�L =40TcC"�G:: ; O C'J'c : f� T-E =U2uC .:;ID �] �='r_�:_5 JJ0 ' 2 ' 9 September 18, 1970 Mr. G. W. I(ylkema 235 ��+4v Place Costa Mesa� Cal.ifornls � RE: residenti&1 additiott at the above address� under Bu ing Pezwit �31156 Dear Sir: This letter ie intended only as a retaia that certain speciel requirements aaist be met before the �inal building apprwal cE�iven. Theae speciel requiremente, vhich varioua city departments require, are noted on your approved•�lans and also on t �heet attached to this letter and must be complied xith snd approved by the various de ments before the Building SaYety Department wil2 be authoriaed $o Pinal 1;his construct It is the reeponsibility of the applicant or owaer to provide plans and speciPica- tlona for the constructio�any improve�nts indicated in the conditions. All im- provenent plane must be ap ved by the proper city department. In order that these requi ements may be inspected, it 1s generally neceasary to give the appropriate department forty-eight (48) hours notice so that an inspection may be echeduled. _ • IY there are aqy questions conceming aqy oY the requirements, plense phone the department invnlved. RFI: dh Eac. 1 Very truly yours, RICHARD HANHART Buildittg Safety Director CITY OF COSTA MESA PLANNIN� ilEP�MENT `C -3�6i�NSAOO 360 0****4�.�0 A. P. No. I� �— ��Y'— � Bldg. Permit No. � %� 5_� Project Ad$r Owner's Name PARK AND RECREATZONAL FEES - Apartment Developments �•� D�� O ^� �� Bachelor or 1- Bedroom Units @$25•00 = 2 - Bedroom Units �/ @ $40.00 = 3 - Bedroom Units @ $55•00 = � 4 - Bedroom Units @ $70.00 =, � 5- or more Units C$75 .00= �7 0, �L-�% Total Fee Total nwnbQr of Dwelling Units � Planning Department Approval Date. Park Area No.�_ � . By (�C.�Applicant's Signature �,e ��y��l. vato CITY OF C0.STA qMESA Pi.ANNIN� �EPARTMENT '.0 -3-69cpsAOO 360Rc�'i**�*4�.�� A. P. No. ��` / '��0� � " d� ' Bldg. Permit No. � �� J�� PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address « 3 Owner's Name l' . W' G��"�� w1 � � Bachelor or 1- Bedroom Units @$25•QO = 2 - Bedroom Units �V @ $40.00 = 3 - Bedroom Units 4 - Bedroom Units 5 - or more Units Total number of Dwelling Uni.ts Planning Department Approval Date. By �{ �if,(/UUZG� Applicant`s Signature @ $55•00 = @ $70.00 = � @ �7s . oo= 1i D. ct,a Total Fee Park Area No._�_ ,� � vrvneK NYLKEMA. G. W, uni� i� s oy JOB ADDRESS ��5 Fairvav Plarn BUILDING PERMIT NC so�� GAS W ATER ROUGH PLUMBING PftOP. SWR. LINE Q HOUSE CON. SPRINKLING SVSTEM MISCELLANEOUS ROUGH HEATING TEMPORARV SEI UNDERGROUNO � ROUGH WIRING TRENCHES � FLOOR SYSTEM BOND BEAM � SHEATHING Alft CON�ITIONING FRAME ANO FLASHING LATHING — IN P�ASTER, BROWN COA POWER ST� ��TUHAL� YINpL H IG, VENT., REFRIG. AN� A.C., FINAL aiiu niur, cium FIRE ZONE VALUE GROUP I TYPE SUBCONTRACTOR 31156 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fi!l in Completely BUILDING ry�/— n ADDRESS�,JJ �j�+WCLy f I OWNER �� / I(�P.i�M.C� ADDRESS z3S /�ii �wa y /�� CITV �Q �j � /( Q S a N�LGyb 80 BRANCH ADD{iE55 ) ARCHITECT r.! /,/ %Lq�� TEL. ORFN(;INFFR l VV Y✓l1\VYWdNO. CONTRACTOR �., w� - �pjV✓tG ADDRESS TEL. CITV NO. STATE CITY LI0. NO. LIC. NO. SI2E � �/ � NO.OF BIDC'>S. OF LOT ^� B-Q NOW ON LOT VSE OF /� EXISTING BLOG. (J W �2I � n � NIEWBLOG.I�`X��` FOOMS �v STORIE EXTEftIOR WALL ROOF ` i%t COVERING S��GU COVERIN J�9� USE OF BUILpING AND WOPK TO BE PERFORMED PA[D * �,�** �C -3-69�nsbOO 358 84.00 APPLICATION FOR BUILDING PERMIT RECEIVED V OATERECEIV D DATEISSUE 2- -� /3.i.-3-E /J PERMIT NO. A.P. NO. � % '— � —'O BUILDING A�DRESS ' 3 �j TRACT J�In � LOT .� BLOCK FIRE ZONE TVI APPROVEO � � BV ZON NO.OF PLANS VAPDS APPROV ED MAIN SUtLD{NG (FROM Gl5 R ET) fRONT 2� // SI E FT. (i S � L. SIDE FT. N CS REAR FT.� DISTANCE BET. �FICCh MAIN BLDGS. VAR. # .tr/, c.u.P.#Z'c_in4_In � VALUE $ � GROUP.l f. 9 � DATE ��—J'. `� s USE OF NE � BUILDING 'Q VARb RO� ACCESSQRY BUILDII � FT� � FT./� ( �I.L�Tt/ i B� AIN ACCESS. BLDf'�5. Dn000n „�., ; i._, R _ d�' ;. la � e d-o �-»„ F�d... f A� E �, — E �.; ,.�, � co e. o.� c[�a i: n•, z�c /oN,G � - 1 hereby acknowledge ffiat I I�eve read ffiis application entl state � Shat Me above information is correct antl agree to comply with �' � � all laws regulating building consttuction, and I shall not employ any person in violation of th0 workmads compensation laws of the State ot California. m � I hereby certify ffiat I am properly licensetl as a contrector untler SQ. FT, o the Staie of California B�sinass antl Professions Cotle, Divisicn 3, THE AMOVNT SHOWN UNDER VALUATION IS FOR ChaPter 9, and that such IicenSes are in tull force antl effect, or I THE PURPOSE OF ESTABUSHING A PEFMIT FEE ONLY: ¢ am ezempt trom ffie provisions o( the Staie of Calitornia Business VALVATION antl Protessions tle, Division 3, Chapter 9. PERMIT FEE $ � ,aa „ QO � SiBnacure of ( ,Q m Permittee y� � $��j�(y ��— PLAN CHECK $ Z u� O� E 0 LL Authorizetl Agent TOTAL FEE $ � v D ,Ce�sta Mesa Bnilding Department ' �i �, COSTA MESA CAL FORNIA 1lYC➢ FOR APPLICANT TO FILL IN e ��dog Add� �S Costa Mesa, California Nearest /� /� Cross St / �i] /� n.t�1l /P"iYt.� nronrceec or Engineer Address .tractor Aj �cJ NP. t - Address Setback Centero tion I. No. Metes and PPLICATION FOR PERMIT BUILDiNG � FOR Od+'I+'ICE USE ONLY I Receipt No. I PermiS No. � 7�� by Date Rec'd. Date lesued �v ,P-3i s � 3i-S Costa Mesa, California r Nearest Cross St -�-5/3 Zone /J , � No.of � Type _ � I Block � Tract de�t�P� i/9—/�� - No. of Bldgs 00 Nowon Lot � I No.af �I No.of � Famflies Room� � I Alteration S =iedin9 a�x � Y/ucco I Coveri �-��aae �- „ Addition I Demolish I stn�ies / Date CORRECTIONS APPROVAi,R �.ion � Inspector � Date � Frame: Fire Stops, Bracfng, Bolts I hereby aclmowledge that I have read this Application and state that the above is correM end agree to comply Lath. Int with all City Ordinances-and State Laws regulating building construction. , Lath. Ext Signatureof ...�/ J.�'� � �%� `�(,�.,_ Permittee f¢R�= ��/�i lL plaster, Int AuthoNzed Agt � plaster, Ext Valuatio�. � Permit Fee $ �• �� Masonry Reiniorce /� � ,`1� � Plan Check $ ,� � � Bond Beam $ 7^j�'�' '" Total � v / Fee FINAL `t204 5-BP 2M 8-55 0 :. ' -�. pLOT PLAN Show Iocation and disFances from property line and between buildinga ^ ; . . , � � h n v �.c�• � .� ,o �N D V J O �p. �Y .} � ;t �F D � ' � �