HomeMy WebLinkAbout3004 DEODAR AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3004 DEODAR AV
Suite:
Vicinity: COMMERCIAL BLDG
Parcel Number: 13920109
Applicant: HARTMAN, HEIDI
Address: 2626 NEWPORT BL
COSTA MESA, CA
Owner: RENIER, RUSSELL
Address 2953 JAVA RD
COSTA MESA, CA
Contractor: PETRONELLA ROOFING
Address: 2626 NEWPORT BL
COSTA MESA, CA
Zip: 92627
Zoning: CL CL
Phone: (949)548-1645
Zip: 92627
Phone:
Zip: 9262G3610
Phone: (949)548-1645
License: 460707
Stalus: ISSUED
Applied: O6/11/2004
Issued: 06/11/2004
ISSUED BY:
Arch : Eng:
Address: " Address:
�� Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF COMMERCIAL BLDG: T/O EXISTING FLAT AND SLOPED ROOF. 3-PLY TORCH MODIFIED BY "CERTAINTEED." SLOPED ROOF
APPLY "30-YEAR COMP SHINGLES BY GAF" WITH 1 LAYER 15# FELT. REPAIR/REPLACE SHTG WITH 1/2" CDX.
26 SQUARES
Plan Check: $0.00
Permit: $209.25
SMIP Res: $0.00
SMIP Com: $2.35
Other: $0.00
Inspection: $0.00
Total: $211.60
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING ExisGnq: 0
Rear 0-0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
s� i,zoo.00
5i t,2oo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremems under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
� EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wilh all applicable codes, and all
requlred Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
zaasas ls�oo)
WORKERS'COMPENSAnONDECLARAnON:
I hereDy aNirm under pBnelty of perjury one of the following declara�ions:
❑ I heve and will malNain e cenificate ot wnsent to sel4lnsure for workers' compensetion, as pmvitletl tor by section 3700 oi the Lebor Code, for the peAortnance of tha
work for w�ich Ihis pertnit Is issued.
�I I have end will malntain workers' compensatlon insurance, as required by section 3700 of Ne Lebor CaAe, Por the petlortnance of Iha work for which Nis pertnl� Is Issued.
My workers' compensetlon Insurewnce� er and policy num6er ere: Q / .�
Cerrier: S77'S�7��NF� `OMP�S�i'%/M� /NS POIIcyNumber: IS/ �CLM �
(This section need not be comp�efed i! the pertnit is velued e! one huntlred dollars ($/00) or less.)
❑ I certify that in the pedormence W the work for which this pertnit is issued, I shell nol employ any person in any menner so es to become subject to the workers'
wmpensation laws of Celifomie, end egree that if I�ecome subjact to the workers' wmpensatlon provisions of Section 3700 oi �he Labor Code, I shell forthwit�
camplywiththes pmv ons / /'�
AppliwntSignetura: Date: (!/ // F��
WARNINO: FAILURE TO ECURE WORKERS' �NSAiION COVERAGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOYER TO CRIMINAL PENALTIES ANDCML FlNES UP TOONE HUNORED
TFKKISAND DOLLARE (51N.�1. IN ADOITION TO iHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIW 3]OB OF THE L4BOR CODE, IFIrEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
1 �ereby ettirm that I em licensetl u e provisic
lorce end eHect. Lic. q
Contraaots Signature:
9(commencing with Section 7000) of Division 3 0l the Business and Professions Code, anA my license Is in full
ciagg « /; 3 9
.t.— oate: _ G —// —� 4—
CONSTRUCTION LENPING AGENCV:
❑ I hereby aHirtn �ha� �here is a construction lending egenty for the peAormanca ol ihe work for which Ihis Dertnit is issued. (Sec. 3097, Civil Code).
Lendefs Neme: � Lenders Address:
SignaNre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eflirtn that unda� Penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following raason (SecJ031.5, Business entl Protessions
Code: Any ciry or county w�ich requires e permit to construct, alter, impmve, demolish, or repair any sWCWre, prior to its issuanta, also requires the applican� lor such permit
to file e signed statemeN that he or she Is licansed pursua�t to ihe provisions of ihe Comracmrs License Lew (Chepter 9(commencing with Sectlon 7000) ot DlNslon 3 o1lha
Business end Protessions Cotle) or that he or she is exempt Iheretrom end tha Cesis for the alleged exemption. Any violation o1 Section 7031.5 by any apPlicent for a permit
subjects tha applicant t0 e civil penalry ot not mora ihen five �undred dollars (3500).):
❑ I, as ownar af the properry, or my employees with wages es their sole compensatlon, WILL DO THE WORK, entl tha structura Is not intantletl or aHered for sale (Sec.
7044, Business antl Pmfessions Code: The Contractors License Lew does not apD�Y �o an owner ot property who builds or improves thereon, and who does s�ch work
himself or herself or ihrough his or her own employeas, provided ihat such improvements are not Intentled or offered tor sele. If, however, tha building ar improvement is
soltl within one year ol completion, the ownervbuiltler will have the burtlen ot proving that he or she ditl not build or improve for purpose of sale.). �
❑ I, es owner o( lha proparty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business ana Pmfew�ons
Cotle: 7he coniraG�ors License Law tloes no� epDN �o an owner ol property who �uiltls or impmves thereon, and who mnirecis for such pmject with a contrector(s)
license pursuant to the Comrecbrs License Lews.).
❑ I am ezempt unde� sec. Business and Professions Code for this reeson:
Signature: Date:
Owner ID veritiad by dri�er's license. � Yes ❑ No Drivers License No.
Verilicetion ot Ownership by (type of daument, i.e. - property taz bill or deed):
DIVISION OF INDUS7qIAL SAFETV PERMR CERTIFICA710N:
Expires:
❑ I hereDy cehity iha� no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connectlon with work authorizetl Dy ihis
permit, entl �hat n0 builtling siructure, scattolding, falsework, or demolition or tlismantling thereof, will be more than �hirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calib�nla Adminisirative Gode).
❑ As owner-builder, I will not employ enyone to tlo work which would require e permit irom the Dlvislon of Intlustnal Safety, es noted ebove, unless such person hes a
permit to do such work fmm ihe division.
Signature: Da�e:
Division of Industnal Salery Permit NumOer:
CERTIFlCATE OF COMP�IANCE AND AUTHORIZATON OF ENTFiY: I cenity under penalry of perjury t�at I have read this application and stete ihat Ihe intortnetion given is
correct. I agree to comply wlih all state laws and ciry ordinences relating to building construction, end authotlze representatives ol the Ciry of Casia Mesa to enter upon the
e6ove-described properry ior inspection puryoses. I egree not lo occupy or allow occupancy of any builtling aulhorized by ihis permil until tinal ins0ection.
COUE I, INSPECTIONTYPE
1616 Fixad System Ginel Fire Prevention
1266
200
201
202
203
204
Pool Spa Finel
Finel Re�Roof
Final BIocWReteininq Wall
Final Fadory Fire Place
Final Sign
Final Demolition
� INTffIALS
�j.� ([.�I/Af�
� �/('�D�
Date
tOpEt INSGECTIONTYPE
206 Final Mechanicel
208 Final Plumbing
210 Final Eledrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupanry
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� PERMIT NU; P 085345 FL:9N CHECIi NG: N GuV'I: N:iUFP: N
i:GNSTRUCTIGN TYPE: PERMIT TYPE: PLU l�URi�i:rSE; ALI'
JG6 UESCRIPTION : INSTALL PRItiA'fE SHuWER, WASHER d URYr.R SQ FT:
�LAIM VALUfi: CALC-VALUB: �RGi7P Gi:C: b i
uwr:
LICENSED COHfNACTONS DECWNATON: I hereby elf m u�der penely d psjury Ntl I em licansad uMm po�'v'wianro M Cheqs B
(mmmentl�q wilA Soctian ]OW) d Div�vion 3 d Ne Buainea eM Pidmsone Cotle. eM mY �M*� 6 m hA lorp ud Mlatl.
cm uc. No.: uc. cuss: uc. No.: t,jZp �
Da1B: GaN�etlIX:
OWNEP BUILDEP DECIARRTION: I Mreby elfirm u�Mer peiWY d pa�juy tAai l em exemq hom IM CoNmtlm L'wme lew Ip Ns
Idbw^B �eason (Smion 1W 1.5 Busiwa eM Prdeuiaa Coda: �M cYy m m�iY MhirA nOwm e Va^�E lo conwc�. Ns.'vnGro.e.
oofuh. «npei eiry �huUure: p'v m Ya eauenoe. e6o'equ'ux �hs aopiuN la wcl� pami io Ns e spnaE mlenrtl tlW M a�he
cerued W�� lo Ihe pwuima d Ns CW�etlaf liroma lew �CMplv 9(cammenvq xVA $tlion 1Q00) d Oiieun ] d �M
eiM» eM Prdmaum Codal a �Mt ha n Me n e�emq Iharohan vd tM Maa la tha eAWeE axemqon. MV viaWion d Seaion
N�t.S W enY aVWirani la � Vermu ud"qa� IM aGWiw� �o e dril W�Y d nol mae ihen IM� lunG�d doW� �SfAU�.
n I, a+owner d �M propeny a my ampbyros wih wepea n �hei wb rompen�elbn. vrill Eo iM1e xoh, eM ihs N�unun b ria imaMeA
X� noltereElaWa(SactionlOu.B�sironeMPmleavmcCoEe:TMConirmanLiuroalewEomnoleppl�toenmmerdpropMy
wlw buida a inpoves iherean. mk nfio doea euM work IvmeNl a Mred a Wwph he a Aer own empbyas�. pwiESE ihet ach
impwemew ue nal uueMeE a cMsad In veb. 0. hoWws. ihe buitliry a inpwanM u eotl rritNn one yaer d oomplelion.lhs
ow�«a�m.. wi n� in, w� a vw��u n. a.ne ad ou nmb «�o� �� wma• a.w1.
� I. av owis d IM PWNY. em udi�'W mMretlnY wCh M.wwd wroMae b wnmw tM p9� (Seaun ]Ou. &sunw� md
Vrdesscna Gode: The CaqraCon L'ceme lew Eom nal wWY m an owiw d pcw�Y Me bWN a imP�+p tlwaan xd who
wnvsu lu wdi prqadn xiN a mtlrador(e) IieaeeW queueN to tM CaMrews L'mna lnnj.
� Dm I tJC � ��� /� /� B.oBWP.�Cr. b Nu �eeson: � C/�
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1« m,.wn:n « mmawion han, �n. �.ai�. v�emmY aa�itl. rwksam mm�,a'v� •w��..�. •T�N �� m«
YOv�.
ome: �va�:
WOflKEP'S COMPENS�TION DECIARATION: I Mrapy affiim uMx parWiy d psjwy ar d tM IoOoxi�p Asdueliaa:
� I heve vM rril meimen e cenifceb d raueM to Wlivu�a br xaken' mnWe�mlion. u poridad lor Ey Saebn 9100 W �M lebar
cae. �« in. wn�a a me � i> w�n �� o� o a.wa.
� I hew eM xi1 meinien wMsa' mmM�+dion imurenro. m nw� W Saeim 9)00 d tM Lebv Coda. br tM D��W� d tM
wak /a xAiN Nb Ga� e asuE. MY waken' cwnM�+vion i�wnerca mnier e�d 0�/ iwnbx an:
c.�.:
aacv N�,n«:
s mnbn neee � ae m,�d•red r rns v�• %+ ro. are nunel<a eouer. lsiool w iu,.l
� 1 eMh � in �M parlmianee d IM wak M whieh t�b peemu u Ivued. I ahe0 m� ampb� ury perwin in ury manrw o m �o
becoma wbjatl lo Ihe xwVa+' mmDa�+mion lew+ N CeNurva. uM epne Nel J I JnuN baronr n�J to IM walmn'
camDans+�ion V�'�oro d Setlion ])OU M iM lebor Cods. I WA taNw'n� mmW xAh Yve pwmms.
oma: �opk,�v:
Wemlip: F�Yun b uc�n rolkeri ro�tlon rov�rr� h unl�wiul, �M NtlIWDNef �n w�ploy�r b MMmI p�ntltlp u�0
dhl Ilno �q ro aw �'ntlrM tlrous�M Je/Nn (JIGq000A M ballbn b IM cwf o/ mmpwu�tbM1 Mnyp1a u prvHEW Iw In
Sxtlm JlG6 0l tlro LeborCOW, IMxwt, eM �ttamsyl Iw
CONSTFUCl10N LENDINO AGENCY: I hereby elfirm uMm peneXy d per'Fvy ihel iMn b a a�nn�uaion Wdhp epricy br IM
perlormaim d tM xoh Iv whirh ��h pamY b uaed (Smun �09). CM. CI.
LENDEP'S NMIE:
LENDEN'3 ADDNESS:
I cenAy thet I Mw raetl Nb eppfraum eM mma ihet Ne ebove iNmiWion b cansq. I ep�w io canply w'vh N r'ny ud coumy adwnoes
eM ele�e laxa relm"eq b Wikiq emmWian a�d Mraby eNAnce �epaeenlelrvm d IIJe tl�y lo aMer upan IM ebo.a�menlipwd papaety
la impatlion Wrpoeec.
BEntu3�.CE fitiiAON
-��/��J� /// Pnnt e ' A-
� .C.0 'l/% ` /LN ' � Dab: D O �
Sprewre WAppiranUGontreea
(5151-a6.WG)
8 Seiery: O�eamFb: CenW-App5mM: Pink-Reimw: l3oldenmd-beeaaor
COMMENTS: "�USMETuLOGY" STuRE TI. RfiF:b-85348
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Z O N I N G k E Q il I R E M E N T 5
5 E T B A C fi S
------------ MAIN bUIiLZNG ---------- --------- ACCESSuRY BiJZLLING ---------
FRNT: FT IN REIUZ: FT IN rHNT: FT IN REAk; ri iN
LEFT; FT IN RGHI': FT ZN LEr'T: FT IN RVHT; F'T IN
PARRING REy-: PRGii; PARCEi: 13920109 ZNE; R�.F Ni):
FLANNING NU'IES> -
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bOIiLING APYltUUEL aY : - '��1 uA'I�.: �I�
APFiICATIuN ISSUEL bY; �' uAI6;
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LEGALIZAI'IGN:N F E E 5 U M M A R Y sYRUi:Ti.it2Ai, 56GME137:N
tiLLG PMT PL'JMbING ELECiRIC MfiCHANZC riRE SMYPiRtS i.;ftlaulNG
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25's SMIPiNUtv�-RES
PLAN
ISSiJE FE�. [2.00
t1UlLLING-LI�J-> PERMII' ZSSii�. PLAN-CA�.Cri 'IuiAi, YAlU uUE
TuTAiS----> d,75 22.00 0."v"v �u.75 3G,75 ,u0
REtiENUE LIVISIUN 'IG'IALS--> CGLLtC'IEL; �v,75 u"vtRiSHGR'I: .u`v
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3t7.75
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I N L I V I L U A L F r. E b h E A R L G W N
TYFE Sj7Y" u r. S C R I P 7 I G N UNIT CuSi TGY.4i, Ci�Si
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�NL Gr FEES
18-21-1997/82:19 Pp/f3B.75
RCPT1:81-0814286
PERMIT:085349
i
-. �QNSTRUCTION AND PLANNING •: P00' ;PA
�.�APpROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. .T. emporary Elecvical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement �
, 3` E1¢ctricai Conduit Utiliiy-Undcgmd. 54. Forms
�' S4r Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
i-
�5'. Stsel Re�nforcement 56. (iough Plumbing & Pressure Test
:'fi:' Etectrical UFEfl Grnd. 57. APPROVAI TO COVER-GUNITE
,i ..
; �7x� F:ootings 58. Electrical ConduirUndrgrnd. �
r'8; Foundation 59. Gas Pipe, O Undrqrnd., Test =
'9. W;ter Pipe-Undrgmd. 60. Backwash Lines, P�Trap, � Undrgr�d.
10. Structural Floor System 67. APPROVAL TO DECK
11. ProPerty Sewer Line & House Connection 62. Backwash & ReceptorFinal
12. Sewer Cap 63. Heater & Vent-Final .
13. Roof Orains . � 64. Plumbing System • Final
14. Rough Plumbing ,n - 65. Electrical�Final
15. Rough Electricai•Conduit � 66. Solar SYstem�Final
16. Rough Electric Wiring � �67. Fencing & Access Approval
17. Rough Wiring Sign -68. APPROVED FOR PLASTEflING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEM5 FINAC
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
r �, -� y p. .� .
20. Fiougfi Factor"y, Fireplace � � r r z r �•� ?,' k' APPyOVF�I;Sy � Y"�
Pe�nit #
L• „
21 . Dutts, in_Stru.Cture; r. •� �• -+,S " :S �7 �� G "' 70.' UndergYoUn F�1�dro �
r -� 1 v
22. QuctS Vertila`ting'�� :�S k ' �h".71. ProduYFi�in C��,.�as ❑Oil
� V x i d r� �t, � .• :• 5E P 9
23. Gas Pipe,�ough & TF.St � �a � -�r O'n � 72. UndergroLmd FIGsh < �
24. 'Roo�Framing•� '-' "�� �. �� .� r,� v 7� Undergmd. Stor,�� Tank`0 Gas ❑iSii
: , :; _ ,
25. Roo4,$haathing .� , i : r� �7 v u� J4-; Overhead Nydro �
26. T-9ar'Ceiling (Struct�ural) & A8'oQ�oat k r'= � 4 75'. Dry Chep�ical � '- � "
^.J �Z.
27. Erame ar� Flashin� t. j�; x + r •r �n k 76. Dry StanapPpe -.�*i : ��
.28. Lathing&Siding'�'�'^ .�aj� _ �,`�- ••� , "�N 77y FIXED�YSTENj�fNA[ . '
. • *� i �. �.
29. Insulaiiori, : - •• : � � r 7$' FIRE PREV. FIN'AL �-' -•
30. Drywal�Nailing �i , � ' � � i ' _' HEALTh7DEPT.REQUIREMENT
37. Plaster BiDwn��Coai�;; c ,r�r .� � � I�. 79• FINAL INSPECTION � J
-� 32. E'tectrica{tPoWBr Nlem�,r�Final ' k'� � � r 80; FOOD CERTIFtCATE I�SSUED
� � r n � : �k .- � -� t
33. �inat,Electric. �;; ,� �. �� Noces: � -���. . -
-. 34. Fina4Heating�& Air ConditionicB,�.S � k i � • r - �,� = =
y ..P T I l ;�
� �: - �
. 35. Kinal'Gas{Pioe,-Tes( A �_ i" .. �. � � ' 'e � j.� .�
i.
• 36. Hood or GanoPY � T"' � � �� '• y� y ' "
lF . r, "' ' •*'
� 37. Finai.FaeTory Fireplace _ ' � �+ ,� � T' � �� � � ,
38. FinalYlumbing R �� v . _ ;j�� � _ ;'� -� ' "
- z �.
39. lNatei SerGice�Fina� ' ' �` � �' ' -, ' ° `
- i . - �;
:, 40. Gas Service-Final .,y a:,r . 5 � 7 � �R �is -
� 47. Solar OomesticFinaf - � ^ , ? { i �+ , �
t 't s . , t .
� 42. Backfiow,;Preventer g r. � � .r z - i-'. -�
. -
� 43. Backflow Irrigation Y ^=`� 4,�. �' Y.
� l
44. Landscape Irrigation System � -I.> . *1 ' '' ` v " ' ` . .
" _�r - �-- r
49. Sound Atten�8tion k � r � � n '• � ;, �� � `'' � ' y S ` �
46. Nandicap.Regulations ` , �" -� � _ . � '
T �\
a7�. FINaI STRUC7URE & BUILDING ` ^ "� � - - _ ' . ,
. . � j .. . r
48� FINAL P�ANNING • � - ' ' �,- . � " �
49� Eleciric Release to Edison � I �, ,- ,. �� " :.
5Q. Gas Release to Souttiem CaliforniaGasCo r ; ��. - •' y • _ •
51: CER7IFICATE OF OCCUPANCY r k: . _' - - - ,
No. Date
�!�„Essaem�nuw: jVV9 LtUL.'�lit I-1V
•• ENSNAYEIF,p10WN: j-j�,XKUN� Lir.F(Nll.t
_ wonEss: :SV"V�1 LEVLAli AV
` '`' CuSIA MESA,CA 7LbLb
MFL. AW IINO ADDNESS
AIKXRELT Ofl FNtlNEER
IiRCX.OH Fl!(i.'S,NOPE55:
ura: b
ua no.:
UNT:
CONfH�cidi'S ��.
COHIP�CTORSM411NU
/�DOXE55: UC.NO.:
uxr:
LICENSEO COHfPACTONS UECL�PATION: I hereby aN'vm under penapy d pajury ihe� I am liceneed uMm provieiene d Cheqer 9
(rommenonp wilh Secion )W0) oi Drvieion 3 W �he Businem end Profeeeions COEe, enE my licenae ie in hll brte eM eMed.
CRY LIC. NO.: 11Q CLA55: LIC. NO.: r,7iY :
De�e: CaNretlor.
OWNEN BUILOEN DECLRHRTION: I hareby elfirm uMm pendy ol perjury �he� 1 em eRemq Irom the Comiaaae Liceema lew ta Ihe
�dbwip �eamn (Sedion )03�.5 Buarosa enE Proleviona Code: AnY c'ry a ooumy xfiidi fpuirm e pertnil to ooretrucY. Mer. impaw.
ndo�, a repei eiry awnure, qbr ro �a asuance. ebo mpuim �M eppimnt la wch pumil to fib a dpmd ettlement �het he a ehe
icenseE punuani to �M proviviona d Me Comreaore licensa law �Chepter 9(mmmeneip v�lh Sedion ]000) d DHeion � d the
�airwm eM Profesaions Coda� or ihm he a eha ia eremq iherelran eM the beaia la Me dlapad exemqion. My videton of Swion
)031.5 by eny epplicenl far e permn eubjade �he eppl'rant ta e civil penelly ot m� maa tAen INe huiMrad Aal4n �5500��.
� I, es ownar d Ihe pmpaity or my ampbyeee wAh weges as iMi eole mmpaneeiion, will do ihe vrork, end the evucture o nd in�anded
a Mered la eele (Section ]OOC. Buvnew end PrWesaians Code: Tha Comredore Lirenae Lew Emv iat eppyto en amerol popeily
wlw buiEa w impraves ihereon, end xho doas euch xwk IimeaH w heneX a ihraph he a her oxn emplvyaee, pwked thet eueh
'mpiwemen�s ve mt intentled «oHered la sele. p, Mwaver, tM buiNiep w mprwanem is aold wnhin ma yev d oompbtion, IM
owner-buiNer will heve tM burEen d pwi�q M or aM dk nol WiN a impiow ta tM W�e d aeb).
� I. m ovmer d the YOVeM. em utlu.ti„M' mn�reanY xnh Grnread convac�«e b consm�e Me wM� (Smion 1011. Bueiewa eM
Prdea'aie Cade: The Comrmoee liense Lew doea rwi epply io en owror d popeny xfio builda ar impovm iherem enE who
convecls br axi� prqees wE� e mnreq«(s) IicanxE WrsuaN lo IM Comretlaa licema law).
I em exem uMm Secwn: B. 8 P. , tor t j/raemn: [�V'v`/W '`-
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c�a:
Palcy Number.
,ia section mad nof Ee complered M �he peimAis M one hundred ddlara (Sf001 w bae.)
� I eerlAy �hel in Ilie paAaemerce W Ihe wwk fw whieh ihis paimX is imueE. I ahell ial employ erry pe�eon in eny menmr eo u to
pecome abl� to iM wwkera' compenaelia� �ex+ W CelEwnie. erd epree Ihet X I Mouk bxome wbjeG b iM xorken'
compensalion pwisuna d SeUion 3)00 M the lebor Code. I ehell lonhv.ilh mmpy wnh Uwae prwiaiona.
Dme: ApqiceM:
Wem/np: Fellun M aecuro warteri nmpsn�etlon covereps la �nlawNl, enJWll wE/ect an wmploysr ro uIMrW pxvltlp an0
elH/ nnu �q ro om hinareJ rlauaud aoll+n lS/OQOOOA In xldltbn ro!M ewt ol rompenaaWn, �armW u proH4M ror in
Sxtlan 9105 0l ths La6or Cotls, Infraf, end etfomsy'a New
CONSTflUCIION LENMNO RGENCY: I hereby �rm uMx peialry d per'ryry ihel Ihem ie e const�bn bnGrp epe�wy M �he
�no,m�� m m<.oM ro, .n�d� ina ro�� � m=�a �saao� aos�, ca. c�.
LENDEN'S NAME:
LENDEH'S ADUHE54:
� cennr inm � nave reea mis ead���on e�e ama met ae ebove i��o�me�io� is co�ea. � eo� �o camWr wnn d� my ene ca,my obinencee
end etete levn rNding to buildvq wnpruqion vd heraby aullwrize repreeenleiivae d �he oryto enlx upon tM ebow�mentioneE pmpeny
lorirupedion purposes.
dEkNIECE Htt(itVIV
i J
Dete: � {
(5151 de.W P� Whilo-BuiWvp 8 5elely; GreerrFlle; Cenery-AOG���: oink-Revenue: Gokenro�Asaea+ar
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HiLG PMI PiliMB2iVG ELECTRIC MECriAiVIC tIhE SMIPiTVI GRAuING PLAN—CHECK
17.5u
........................................................................ ..... . ...
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I1-B6-1997/11:27 A11/f17.58
kLf'iq:b1-5�15101
PEk►�iIT e 0g ;638
.
:�
,,�����.:ONS7RUCTION AND PLANNING � t, POO SPA
APPROVALS Permit # Date Inspector �-•� APPftOVALS Permit 3k Date Inspector
, L�Temporary Etectricat Service oc Pote 52. Poof & Equipment Locatiun �
2. Soii PiPe�Undrgmd. . � 53. Steel Reinforcement
. 3. Electrical Canduit Utility-Undrgrnd. + 54. Forms '
4. Electrical Conduit-Undrgrnd. � 55. Eleccrical Bonding �� j
5. Steel Reinforcemenc 56. Rough Piumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE� -
7, Footings 58. Electrical Conduit�Undrgmd.
: 8. Foundation ' � 59. Gas Pipe, u Undrgmd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•7rap, � Undrgrnd.
10. Structural Floor System � 6}. APPROVAL TO DECK
71. Property Sewer �ine & House Connection � 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains . 64. Plumbing System � Final -
14. Rough Plumbing . ' - � � ' 65. Electricai-Final -
15. Rou9h ElectricabConduit '. 66. Solar System-Flnal �-"
16. Rough Eleciric Wiring . ' g7, Fencing & Access ApProval � �
17. Rough Wiring Sign G8. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ' � 69. P00 VSPA SYSTEMS FINAL
� 19. Rough Heating & Air'Conditioning � FIRE DEPT. REQUIREMENT _
20. Rough Facrory Fire�lace _ ; - ' - = qPPROV�ILS Pe[mit # � �
21. Ducts, in Structure •• "' _ ' � ' 70. Undergiound Hydro �
22. Ducts, Ventilating � ; � ', `; 77, Prodiict Fiping rJGas QOiI
23. Gas Pipe•Rough & Test i �j � � n ��� ��- 7y, Undergrounci Fiu£h �
24. Roof Framin9� ' �' �' �. -' ' . 73. Undergrnd.StorayeTank �Gas ��it
25. Roof 5heaxhing .. - � � ' 7q. Overhead Hydro �
Z6. T�Bat Ceiling (Sv�cturall & Monocoat � �' - �_ 75, Dry Chemical
2). Frameand Plashing, �, r • - 76. Dry Standpipe �� ��
28. Lathing & Siding ' ' " ', ' ' '� " 77, PIXED SYSTEM F7NA�
29. Insulation � 78. fIRE PREV. FINAL ' -
' 30. Drywa�� Nailing � ' �' ' HEALTH DEPT. REQUIREMENT
37. Plaster Bro�an�.Coat . � I� 79. FINAL INSPECTION
32. Electrical Pow2r MeFer•Final -� � �� - 80� FOOQ CERTIFI'CATE ISSIJED �
�
33, Pinal�Electric � • , Notes: - � . _
34. Final Heating & Air Conditioning" � � . ' � " � �
2
35. Finai Gas Pipe�Test . � ' . � � .
36. Hood 0� Canopy + � ' � � -� - �
37. F.inal �actory FireRlace '
7
38. Final'Flum6ing �2/j/� �
39. Water Service-Finai _ ' . � �,: . ' �
40. Gas Seroice-Final � , . �. � 1 _ . �
41. Solar pomestic�Final ; � ' . -
42. Backflow Preventer � ' - � ' '
43. Backflaw irrigation � � - A � : �� � .
44. Landscape Irrigation System i�� �� i� � �
45. Sound Attanuation � ' � . ' - i' ��
46. Handitap Regulations � `
47. FINAL STRUCTURE & BUILDING , ' � . .
48. FINALPLANNING '.�'`� � ' ' "
49. Electric Release to Edison 'r ! �
, -.�. .
50'. Gas Release to Southem Califomia Gas Co �'� ' •
51'. CER7IPICATE OF OCCUPANCY �
No. Date �
•i
�aew�m+o: nEttKVN, ybEn
NAYEIFqqMN: �VV� llt,VUa�.21
�o°xess' �.G51A Me.SA,
�av�. �uuxc �oox�ss:
�11CNRECT Ofl EN�IEEH:
1pCIL OX FHG'S AWPE59:
� urr:
7LbLli
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UNT:
ca+m�crara run:
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urrt:
LICENSED CONtRACTON4 DECL�XATION: I hereEy eRem uiMer per�ety W pae'ryry Net I un liwnasd uMx pawaia M CMyx 9
(mmmeMirq wil� Seclian )000) d Orviaion J d Ne Bumiros5 eM P2/eseimf CaEe. eM mY limnn b in �IF�.j OnE e%Otl.
CRY LIC. NO.: LIQ CLA54 LIC. NO.:
o�a: c�irea«:
OWNEN BUILOEP DECIAPRTION: I hereby elfirm uMer periely d perjury �hel I em vmmq liom iM CoMretlae liceme Lew la the
IdbwnB reemn (Seubn )0.'11.5 Busrom enC Wdeeaona Code: AM cYY a wmiY whirA n0uiree e V�G to wnoW 1. eEa. impo.e.
Mmd'oh. n repei ary eouclun. pe'v b Ia uwarioe. eho requitm IM epplkenl la euc� pemil lo Rb a eyneA ete�emeN Nd M a sM
licrosod W��t lo IM pm,mona d IM CoeureCore Limnse few �Cheplm 9(mmmend�q xilh Sodian )OW) tl Dii'vion 9 al lhe
reima enC Prdeesiwu Cadel a Inm he a ehe b ezemq Iherahan arM iM bcw la Ihs dbpad uamqion. My violetion d Saaion
� t.s W anr wp�� �« . w,�^n ad'pd. me eod�m m a dw o�n d na ma. inen rw. n�m�.a mp.n Rsrop.
�� 1, es owrer OI IM piape�Y a mY empbyeea vAh wegea m Ihei eob mmpeneelion, will Ao �M v.ork, eM tlq ehucluro u rwl iMeMaE
w dlxed Im eaie (�� �aa. Budroc+end PrdeasiomCode: The CaNradore licenne lew doee nd eppy loen owrnrd popeny
wlw Wide ar in0��+�hrea^. ^^d'M'^ d°°' ewh wak Nmsetl or henel or Ovaqh hu a hm own amWoyee�. pwkeE �Im euM
impmmneeua ue not uneMeE a allsed la eda. tl. lawewr. �M bu9tlinp a vnpwenM o rotl xlthm ons Y� d camplatbn. tM
owiw�EUJEer wJl hew �M buedm d pw'up he a ehe d'd m bWi a'unpova lu �M qrtpa�s d rlo).
❑ I. m owner d IM nwaH. em udwiMY mmreun0 wdh fm�med oonVectae a canetrua ths P9a (Swbi ]Oa1. Bw'vra and
Prdeaians Code: The Cdpretlon lim�ue law Jms nol eCWY b en ownar d pW�Y xM builds n 1lw�an md who
convxv lu wN qajetla wuh a mNretlo�(e) li;snwd punuru io �M Commms liuma lewl.
� I em ezemq ;Mr Seftian: � B. 8 P.C., b N�'. i �/ n/ . 0
I do M�eh' con�Y Nm �em ewue d aW urdenieM iha repuirem«ua d Cdianu FkeEh W Se1W CaEe Seaiam 25505. 255Si. ard
255N, ud Na I a eny Muro buildi^0 ompeni. rrill / wil m� (deeb an) �weE b oomWY wih vaid eima mdee end iM nCu'vemWs tar
aGa�lawuYuctionamodifimtionhanlMAr�ia6 .�Y ����Oipntl.RuidetlielcmYiudioneppFdiaueraexemphomtlme
pmisionc.
Date� AOd��
WOPKEH'S COMPEN3ITION DECL�flAT10N: I Mreby etFrtn undx penelly d pe�jury aw d tha lollawirp detluetiora:
� IhevseMwilmeinieneceniliceledconeenitoseMariwrefaxvM1en'wmpenation.e�po+idad/abybeuion3)OOdthalebar
COEs. iw �M peAoemviee M Ne xwk la wlveh thia peimit ie 6eueE.
� I hm eM wil mdnlen wM1en' mmpemelon irourvra. m reyuiiad by Secim 3]00 d IM leEa Code. br �b pMnmv�oe d IM
work la xfiitl� tlw V�� ie 6aued. MY waken' mmP��ion imurerca wris end VdKY number ere:
c�:
Pd'ry Number:
e eecTion rraed rat bs mmqMe� / tM pemril u b ore hundmJ dollas �S10J/ a Nv.)
❑ 1 cenh thm in Ihe peAmnvica d Ihe wak for Mfiich �ho permn b ivainG. I Mell nd amplv/ ury prson m erry memwr n m to
e«o�» a4� m me ..ona.• �w�� Vw• a c�nome. �e m� uw a i e,wu n.��. m,qse �o m. ���
e�,roromo� wwmu�. d sea�a, a�oo d me �mo. eoaa. i.n.o ew,.mn �vN.w inm. ponriom.
Dm•: Md�
W�mlip: F�Nun ro ucun woilra�'ronpawtlon roverap� la unYrNl. mtlWll a�!/�ct m urplqv ro alMrol puultlp nW
UHI llnu'p ro aa �,ndnJ fhouund JWhn (SfOqP00A O+��n b tlH cwt o/ ronp�rrutlon Wrnpp u pnvMW br In
S�ctlon 3](16 0l IM LMor Cod, InMu4 �d �ttomsy'a /wa
CONSTtiUCiION LENdNO AOENCY: I haeb/ elfirm uMu perohy d perjury Ihn iMm b e aonqrvtlion bd'vq yanry Por IM
pmfwmarwe d iM wM /a whidi �hn pe�mi u uweA (Seaun 309). Giv. GI.
LENDEF'S NRYE
LOIDEH'S �DONE55:
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LEGALIZA7IUN:N r E E 5 U M M A it Y SIiiU�IUeiAL �t�MENi:N
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15.25 .
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i1-84-1997/11:26 API/E15.25
PERMITcT085591
:.
.�I J CONSTNUCTION AND PLANNING POOI 'PA
'� APPROVALS Pefmit# � Date Inspector qppROVAIS Permic# 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 Piumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE �
7. Fpotings - - 58. Electricai Conduit-Undrgrnd.
8. faundation 59. Gas Pipe, O Undrgrnd., Test
9: Water Pipe�Undrgmd. � 60. Backwash Lines, P�Trap, �7 Undrgmd.
10. Structural Floor System 61. APPROVAL TO DECK
i t. Property Sewer Line & 4ouse Connection 62. Backwash & Receptm'-Final
12. Sewer Cap 63. Heater & Vent�Final
13. Roof Drains �- f�4, plumhing System • Final
14. Rough Plumbing , . 65. Elect�ical-Final
15. Rough Electrical•Conduit ' . 66. Solar SYstem-Final .
16. Rough Elect�ic Wiring � 67. Fencing & Access ApProval
17. Rough Wiring Si9n 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling - � � 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rougb Factory Pireplace , . , � APFROVAL$- Permit #� "
21. Duets, in Structure - 70. Underg+ound Nydro
22. Duas, Ventilating, ' - 71. Product Piping C�J Gas � OOiI
23. Gas Pipe�Rough & Test � �� _ 72. Underground Ftush �
24. Roof Framing ' �' � ,, 73. Undergrnd. Stcirege Tank � Gas ❑ Oil
25. ROof Sheathing �� _ � 74. Overhead Hydro
26. T�Sar Ceiling IStrucwrall & Monocoat 75. Dry Chemicai t
27.� Frame and Flashing , 76. Dry Standpipe •�
26. Lething & Siding� ' ' � ' - ' ' 77. FIXED'SYSTEM FINAL
29. Insulation � _ � � 78. FIRE PREV. FtNAL �
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat . 79. FINALINSPECTION
32. Electrical Po.wer Meter�Final � 80. FOOD CERTIFICATE`'IS$UED .
i-
33. Final Electric � � • ^ Notes: . � - �
34. Final Heating & Air Conditioning ' _ � ��/�/S� �.� ���A -
� � - -
35. Final Gas Pipe�Test � /!/��4 7.��ac��rr_OK �e�• _
36. Hood or CanopY
37..Final Factory Fireplace � � .
38. Final Plumbing � � �
�
39. Water Service�final �
r'
40. GBs Service�Final . � � .
qi. $olar pomestirFirjal " � '. �
42. Backflow Preventer � " '
43. Backflow Irrigation � . .
44. Landscape Irriqation System� �� ' , • �
45, $ound Attenuation , . �
46. Handicap Regulacians -
47. FINAL STRUCTl1RE & BUILDING -
48. �FINAL P�ANNING � �
4g. Elearic Reieate to Edison � � ��-�
50�. Gas Release to Southem Califomia`GasCo �
51. CERTIFICATE OF OCCUPANCY
No, Date
ADDPESS Oi BUILpNG: 3 V V�I L Y. VLAlC Fi V
OYMERSNWEIFRlqYN: HERAUNL bEkNICE
�gs �uu4 uni�LAR Av
- CGSTA MESA,CA 92b2o
1PPl. YNIIW I�WNE54
AqCNRECT OR FNtlNEEfl:
aliCll OIIENG'4 ADURE54:
cannAttdPs xu�
carm�croas �uwx�
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UNT: �
CIiY GF CGSTA NiESA - BuILLING PERMIT
Ytt(M1T NO: E 08�0�5 riAN CHECK NG: N
CGNSTRi.iCi IuN 1 YYE.; YGtfMl l 1 YYt; GLC
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UNi:
ue ra_
urr:
UCENSED CONfN�CTONS OECLIF�TION: I Mraby dlim uMr parely d pujury Nm I em Icemed uMer qo�ieims d Cheqa B
(wmm«wrq wCh Seclion ]000) d Oivnon 3 d Me Bummv eM PNesaona Code. erd mY 4uiw u in hA faa enE elletl.
cm uc. No.: uc. cuss: uc. No.: � j( y:
Dme: Comrean:
OWNEH BUILUEfl DECIANATION: I Mmb/ dfiim under pmuly W perjury Ihet I em exemq han �M Capredas liunas law Ip iAa
IOAo'^TO reawn (Saqian ]0�1.5 Buaiae� erd Pm/aniana Gode: R�y c�Y n cauM�/ wliich �eVurea e M�i lo mrovun. Ms. imYaro.
demd'ah, or rapei eny aVucNre, pior b Ns eaiienoe, dao requim tha epplimm la such parmn to file e aqr�eE elelement Met M a eM
ie liceneed punuent lo t�e qoviaione d Iha ConVaqan lioanae lew �Chepix 9(mmme�eq Milh Setlpn'l000) al Diveion � d �M
Buairwse eM RMete'va Cadal a Ihel M a ehe ie uemq Ihxelmm eM IM bme la Ne elbped memqion. My vide�cn G Setlion
]W �.5 b/ ary epplium la e permn eubpaa IM epqicanl io a avA parely d ml mas Ihen fne huMred doAan �550011.
�] I. m awnar M iha propehy or my ampbyeea wIh wepea ea ihei eob mmpensation, will da ihe v.oM, vM iha euucturo e iwt inleMeE
or oileroE Iw eele (Seciion ]Oa4. Buei�roa end Froleasiona Cale: Tha Contreaors licenea Lew Eoae �wt epplyto en ownar W propeiry
who buide w inprovee ihereon, erd wl�o tloee eucM1 v.vrk limwtl u hana� «Nrauph ha or her own employam, povidM Ilid such
impmameMs ve M imeMed a d1ereC la veb. tl, howewr, �he buidiip a inpwrnem e edd wnhin ans yaer al camWMian, ihs
ownerbuitlm wJl heve IM WNen d qan�p M a eM1e did iM DuiM « imqwa fa ihe purpwa d eeb).
� 1. ea oxner ol ihe MOGeM. em uduerveh oontreaM xit� licanaed conlrec�on ro conevW iM WW� (Sedion )014. Bueiris� vM
ProteaHon� Code: TM Comreum liwrue lnw daea M epply b en ovmar d piapMy w}w buJG a impwm iher�on vd Mn
wnvacb Ia aM qqetls weh e ouuretlor�e) licomed punuam to the CoM�epoes Limiea lawl.
fl ilam e�emduMx Seciion: _ B. 8 P.C., br1Ae ieeson: . ,�
�'255�e, vW tl� I am ewere d vd uMe'aunA Ne �W���mb d Cauarie IbeM and $daY Cods Saa'vu 25505. a5]�. eM
Net I a eny heura buikinp ompe�u will / wil ria (tlrtb one) need ro cm�pl� wh eek qete wEea W IM epui�am«m far
e pemin lammvunion amod'Rmionhan IheAiSwLiyl�aripement Oiarie. Pemdentil mimvaion eppirmiomeie ewemq Imm Ihs�a
powiam.
ome: �VP4eb:
WOflKEfl' COYFENSATIONDKL1fl�T10N:IMebyelfirmuMerper�MyMpajuryonedlhelo0ow'vpExWaliom:
� I heve W wJ maimen e cenliuis M anmm� io utluuu�a lor wakem m�psuuion. a prwiCaE la by Swion 3%00 d iM leba
coee. t« in. wnamerc. a Ne .ax ror wlien w. v� s m,i,ee.
❑ ine.�.enewumeuna:�.a+m.•�o�on:,wre�.mr.a�eMs.am�ooaubi.no,coe..wrm.ro��am.
wpk la xfi'rh thn permil ie iwueE. MY waMen' ownpenaetbn ireurerica mmer erd pdiry number me:
c�«:
ra:.v N�ee.:
m6 «aion n..e rar ns mndmw � u. w�� o mr w,e n�ndnd ad�as �f�aol a rou.l
� I cenN �� in Ihe palamuica d �M wark la whch ihis pem�u b iauad, I cMll na empiry a�ry pemon m arty manmr �o ro to
beconn abjxt to iM xarkme' mmpeneatian kre d Catifamia, uH aprea thm J I ehaJE bamro aiEjw lo �M xaken'
canPe^wian pwvoro d Sstbn ])00 d �M lebor CoCs. I Me9laNrrilh canW xVh Ihw prwmoiu.
Daia: Applicent:
WeminO� F�Nun b wc✓n wo�kw�'ro�amvtlon eoverap� l� unl�wN( �nJ �IWI iuD/�cf ur wAvloysr roWMivl pm�ltlu �rr0
c/vll flnu �p ro me hurArM tlauuM AWkn (tIP0,000A M eddlfbn ro M� ewt o� rompsru�Wr� esmpu u pvvWM br In
Sxtlon 31P6 0/ Me LeEor Cob, /nf�na�, �nJ ettomsy i lsu.
CONSTRUCTION LENDINO AOENLY: 1 Mmby eHirm unEer panelry d perlNr/ �� �� � e conniud'wn bMi�q epency M Ne
perlpmeMe d tM wak la w1iiM iM1e permY ia'ovueE �Sepun JOB), Civ. C�.
LENOEF'4 NPYE:
�v�oen�s nooxess:
I ronify ihei I heve reed Nu eppl'r,Yion ud uele thN Na above iNamdion o corteu. I ep�ee io campy wn� ell �Yy enE couMy adinenn�
erd einle lexe Me1M to WiWvq cw4Wun eM hmebY eiMwrse iePeeen�etFea d �hc ctY lo eNs uD� IM ebws�meNiMwd pWenY
In inspedion W�W�as.
B EAN i EC r. l'1 t.!(it V N
D�i/Li �As/ �1c1/O A oma: !/
s�cw � �u.��nov��m,comrea«
(515t�8.WP) Whee-BuddnOdSdaY��eemFb:CvwY-�GV�:Rnk-Herwn»:Gddenm�Avawaar
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COMMEN75: "CuSMEiuLGGY" STGRfi iZ, RcF;b-d5346
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YLAivNING Nu7c5�
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FIRE SMIF/707 GkALING PLAN-CHE�K
i4 ie ie ii iF ii� ie if i' iF ii i'r ie iE iE ie iE ie ie iE iE iE iE ie ie if ie iE ie ii i'e ie ie ie i'r ie i'e ie iE i' iF if ic iE'sE �li "si ii if if ii� ii ii ii i'r iF ii� i4 w i'v if iE i'r ie ii� ie ii if i"r si ii� ic ii� ic ii� ic ii ic ic
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i1-06-1997/11:27 Aq/;44,5�
RCRiH:ul-CG15122
DEkI'iIT: 085639
CONSTRUCTION AND PLANNING ' POOL ,PA
A�PROVALS� Permit # Date Inspecto�.. � APPROVALS Permit # Date Inspettor
i. Temporary Electrical Service or Pole �' S2. Pooi & Equipment Location
2. Soi1 Pipe�Undrgrnd. , 53. Steel Reinforcement �
? 3, E�ectrical Conduit Utility-Undrgrnd. 54. Forms �
4. �IecNical Conduit�Undrgrnd. ' 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure 7est �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE �
7. Foot�ngs 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Wate� PiPe-Undrgmd. 60. 8ackwash Lines, P•Trap, CJ U�drgrnd. �
10. Structural Floor SYstem 61. APPROVAL TO DECK
t t. Property Sewer 1.ine & House Connection � 62. Backwash & Receptor-Final .
12. Sawer Cap • 63. Heater & Vent•Finai
13. Roof Drains � . � 64. Plumbing System - Final
74. Rough Plumbing , � 65. ElectticabFinal �
15. Rough Electrical�Conduit � � 66. Solar SYttem�Finat -
16. Rough Elettric Wirin9 67. Fenciny & Access Approval
77. Rouqh Wiring Sign - G6. APPROVED FOR PLASTEftING
18. Rough Electrical-T Bar Ceiling 69. POOLJSPA SYSTEMS FINAL '
19. Rough Heating & Air Condiiioning FIRE DEPT. REQU�REMENT �
. �
20. Rough Factory Firepiace . ' � ; � ; � ,' APPROVALS- Permit # � .
21. Ductz, in Structure •� �• 70. Undergro�nd Hydro
22. Ducts, Ventilating. �� 77. Product Piping OGas �Oil
23. Gas PiPe•Rough & Tes[ � . � 72, Undeiground Flush '
24. Roof Framing - '� ' 73. Undergrqd.StorageTank OGas ❑D�I
25. Roof Sheathing . � ' '� 74. Overhead Hydrd �
26. T�Bat�Cei�ing (StrucCural) & MonoCoat � � � 75. Dry Chemical , � '
27. Frame and Flashing ' � , -• 76. Dry Standpipe � �
26. LatMng & Siding � � � , " - - ", ' � 77: FIXED SY57ERkfiNAL �
� 29. Insulation . � -� . � . 78, FIRE PREV. FINAL � - -
30. Orywall Nailing , ' � ,HEALTW DEPT. REQUIREMENT
t i
, �
37. Plastar Browrt Coat �- �� � 79: FINAL INSPECTfON -
32. Electrica4Power MeterFinal ' `:✓ FOOD CERTIFICA7E ISS�IED
33. Pina4 Eleciric � . ; h3��� � ces . . -
l
34. Final Heating & Air Condrtioning � � � ' • � ' �
�
35. Final Gas.Pipe•Test � -
36. Hood or Canopy . '
37. Final FactorY Fireplace � I„�# �
38. Final Plumbing � � -
� 39. Water Service�Final ' ' ' ' ' .
40. Gas 5ervice-Final � .. � � ' •
;
� 41. Solar pomesticFinal . ' � � .
42, Backflow Prevenier � �� ' � '
43. Backflow irrigation � � , . .
44. Landscape Irrigation System ^ � �' � � � �
45. Sound Attenuation �, ,; , . , , � -
46. Handicap.Regulations �
47. PINALSTRUCTURE & BUILDWG .
r'�
48. FINAL PLANNING �
49. Elea�ic Release to Edison �� -
50. Gas flelease to Souchern Californta Gas Co
51. CERTIFICATE OF OCCUPANCY .
No. Date
noopasoFauaaric: jVO4 'LlhuLAtt Av �
qYHERSNAYEIFplOWN: ��K�UN� YiGHNl�.t
""�� su09 'v�.uUAk AV
CUS'IA Mc.SA,CA 5t62o
APPL.WIWlG AUDFESS
AXCNRECT OH FfNNiINEFH:
JICN. ON ENG: S AOOflE53:
uc. xo.:
CONIqACTIXfSu��.
CRRXACTORS M411N0
.NORE55: 11C. NO.:
UNT:
UNT:
b CITY GF CGS`1'A MESA — bGILuING rfikMl7
FniiMZT Nu; B "v85348 YiAN Cii�CIi NG: u91d3-57 S
iGNSTRUCTIGN 'I'YPE: FERMI'I 'IYFE: Sfk
JUH LESCRIPTIGN : INSZAiL PR3VAYE SHUWER, WASHER 6 UkYEk
um:
IICENSEO COHfPRCTOFS OECLpPOTION: 1 Mreby eflim under penely d pajury ihet I am IcerceA �Mer provisione d CMqm 9
�comme�ip xiih Sectan ]OOU) W Diviaion 3 N the Bueinw eM PMessions Code, erd my licenee o in full lace erd eHetl.
cm uc. No.: uc. cuss: uc. No.: EXF ;
o�a: co�rc�c«:
WNEN 9UILOEA OECL1fl1TION: I hereby eifirtn uMer penetly d perFN�Y �� I em ewnq Irom iM ConiMas Limrue lew la the
awvp reamn (Sxiion ]031.5 Busiiess end Pmleeaiana Cade: Rny cAy Q munry wh'.h rpuirea e permN lo ooruhucl, eller, impwa.
.amoleh, or repeir eiry evunure, qior b na asuence, eho requiree Ihe eppliranl /or euch permil to file e sgmd etebmant Mat he a she
ia licanseE punuani to tha provisions d Iha Contrmore liceroe lew [Chepa e(cwnma�np wil� Setlion lOW) W Diveion � d �ho
Busmza ard Prdesaom Codal w ilw he or ehe ia examq Iherahan eM tM bmie la iha dkY^� ezemqun. �M vidmion W Seaon
J031.5 by eny epplicenl Iw a permA wbp6+tM eppli�aM lo e tivJ parWty d rwl mpe �hen INe huMreE ddlen �SSW�.
�] I, es owner d iha pmpeM a my ampbyeea x'vh wepea es �hee eale wmpenaeiion, will do tM vro'Ic, eM IM Mrudure o iwt inlendad
a oHared la sele (Section 101d, Buaiiw» entl Prolessionn Cade: Tha Conveqon Lioanee lewdoae � eppyto an ownarol prope�ly
wM W iEs a inprovae iheraon. eM wlw doee euch work NmeeM a henell a thraph he a her own emplv�eee. pwided �hm euch
imprtrvemanU ue rot inteMeE a allsed Iw eeb. X. Iawever.IM WYCiiq a vnpovameM is �dd wilhin pwYw d mmpM�un. the
a.�,a.awm« w�n ne� in� e��da, a o�w�m n. o, .ne db �a w�a « �mwa* r« ma wmo.e a me).
❑ I. ee ovmer W �ha P�PeM. ��duarey canlreclip wilh IicenaeE canlrectae b mnsVud Iha pojed (Sepion'lOI4. Buairre eM
Prolessione Code: The Conlreclon License law Eoas ml epqy b en ovmer d popMy wlw WiNa a imqwn the�aon eM wfio
n M euch prqecb wnh e oonlratlor(e) liceneed W�� �o the Conlredaa Lioanae law�.
1 em undm Seclion: B. 8 P C., b o �enaon: ,
� , o I `�7 9 `) o�,,:`�Di�.,.r.r��c. .s�-.—
reby ceMity Ihe� I em ewara M enJ unda�siend iM requiremeMe af Cel'tomie Heetlh eM Seley COEe SeUims 25505, 25539, eM
, arM �hel I a eny lulure Wileiip omipent will / wil rwl (aicb aro) nead la comply w�h veid Wle wdn md IM requirtmann bt
eV��lammVur.tionamodifm�ionhomiheA'r ue�iy araqmemDme"vf.fie�iEentielm�mivaionewk'mbmersezanqhomtlwa
a�m�a.
Dete: ApplcenL
WOPKER'S COMPENSATIDN �ECIARATION: I M�eby dfirm imder per�diy d perjury ma d the Idlowi�p detla�wiom:
� IheuaeMxilmeimeneceNl'ratedmreenitoeellimurelorxwken'wmpeneetian.npwidsdlabySetlion3l00MtMlabor
cod.. �or �n. wname�we d �ne xwk �« w�:cn mc ro�n ie mauea.
�] 1 heve end xiX mamein vroMen' compensmion insurerca, sv reQuireE by Seaim 3]00 d tM Lebor CoEe, br IM perbrmence d the
work la w1iiM Ihie pe�mn ia ivueC. My wakera' mmpensation inwrence urrier uM pdiq numbar me:
c�.:
ra:.v rmmn�:
(Th/9 eMlm need nIX be mmOb(eE / I�B Gartnrt is lw onB �UMreC Eollem (SI00/ a bes.)
� I cenM � in the perlormence d �ha woA 1« v.hch thia parme ia ivuad, I ehdl � empoy arry panm in eiry menmr eo m �o
becoma subl� �o �M woMero' mnpen5atim lewe M Celilanie, eM eprte Ihel d I elwuN becwne wbjatl to IM woAun'
compeination qwiabre d Saaion 3100 d tM Lebor Code. I ehell lonhwnh compy xiM Noae prwivone.
Dde: �ad�
Wam/n0� Felluro ro�xun wolken'rompxuatlon rovsnPo �� unlawlul, erb �MII aub/ecl en xnployer ro cr/MrW px�eMu mC
clvll flrci �y ro ons Mn�rW tMus�rd Jollen (S1pJ,00pA M etld/tlan ro Me rost ol rompslwlbR damsW u provldsC br In
Sxtlon J]OS ol fhe LeborCotle. Intaa4 � ettomsY'a lsu.
CONSTNUC110N LENOING AOENCY: I heraby dfiem uMar pendry d parjury IM1et �here u e wnaeuaion bMi�q epezy br Ne
penwmence of �ne woM ror wnim �na re�� �s Aa�ea (seeun aos]. c'v. cl.
�, LENDEP'S NANE:
ii LENDER'S ROUflE55:
�, ioan�yin�ina�reeemu.ndK���eamemmmamo��oro��,��o�a.iw��o�dv•mnviard,a�w�nw�.
and sime lexs rele�mg to Euildeg conevueun end hereby eNhor¢e represenletivea d Ihc rity b enler upon iM ebv+e-menlianeE propeM
for impaclion purpoaes. _
n
dERNIECE A�:RAuN
(5t51de.WP) Whne-Buikmp85ffiery:Oreer�Fle:Cenery-Appiram:Rnk-Rermue:OdEm�a�Meevw
rY.RM NV: t! VS�J�}
GVV1; IV :iUl'2'; IV
k'UtZl'l.1St.; aSL7
Si,� F'I': Z,uuv
i:LAIM VALUE: 2,�"v0."v0 CALC-VALUE: 2,Ou0.0"v GROUP GCi:: 6 i
CUMMENTS: "CUSME?OLOGY" STURE TI.
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� U N I N G R E� U I R E M E N T S
5 E I b A C H 5
------------ MAIN BUZLLING ---------- --------- ACCESSt�RY" ttUILLINi; ---------
FRNT: FT IN REAFt; FT IN FRN1: FT IN REAR: Fi ici
LEFT: rT IN Ri;HT; FT IN LEFT: F'I IN RGriT; t'f IiJ
PARkING REQ: Pkc:�V; PARCti: 139201u9 ilvn; CL nbF NG;
PLANNINt� NG7ES> INTERIUk ALTERATIUlvS iu Auu A Si-iGWcR, TGiLET ANL WAHER"'Alvu
> DRYBR Tt7 DNIT "b" . --.
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ZuNING APPki�VEL bY uAIE:
bt7ZiLZNG :9PPRGVEL aY : �'N�- LHYE: `J � �
y
APFLICATIGN ISSUEU BY: � uATE: '� �
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LEGALIZP,TIGN:N F E E S U MI M A R Y 5'IRUCTURAL StGMENT; ii
BLLG YMT PLUM&ING ELEC'PRIC MECHANZC FTRE SMIP/TtES vRE1LING
PERMIr 62.25
SMIPiNGN-Rt5
PLAN 4u.46 ,Su
ISSUE FEE
bUZlLING-uIU-> PnRMIT ISSUE PLAN-CHECIi ?G'iAi YF.Iu LuE
TUZALS----> 02,75 "v,00 4"v,4o 1G3,21 1G3,21 ,uv
kEVENUE uZVISZUN TGTALS--> CGLLECTc.u: 0�,7� UVERiSHGRI: ,G0
BLLG PMI PiUMBING ELEi'TkIC MECriANIC EIRE SMIPiiGI i;RADIN� FLAiV-CiiE�ri
o2.i5 .5"v
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cp �S �e4��td �g\��ea 2�.92i 18-21-1997/82:19 PM/f62.75
' a� tutes an28 §1,12- PERMITPTB85348
S�° p1o.92-
�pcd•
CONSTRUCTION AND PLANNING � � P ��` SPA
APPROVALS Permit # Date Inspector AppROVAIS Permit # Date in:pector
� t. Temporary Electrical Service or Poie 52. Pool & Equipmenx Location
2. Soii Pipe-Undr9rnd. 53. S[eel Rei�farcement
� >>3:,.�Iectrical Conduit Utility-Undrgrnd. 54. Forms
;4{�'Electrical Conduit�Undrgmd. 55. Electrical Bonding �
��.5:; Steei Reinforcement 56. Rough Plumbing & Pressure 7est - I
'-^fi� Electrical UPER Gmd. 57. APPROVAL TO COVEfi�GUNITE
. ; �7' Footings 58. Electrical Conduit-Undrgmd. -
:" 8i Foundation ' S9. Gas Pipe, � Undrgrnd., Test �
c
9..fNater Pipe�Undrgmd. � 60. Backwash Lines, P�Trap, G Undrgrnd.
10. Structural Floor SYstem 61. APPROVAL TO DECK
i t. 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 r, ' � 65. Electrica6Final
15. Rough Electricai-Conduit. �� � . 66. Solar SYstem-Finai
76. Rough EleCtric Wiring , ' 67. Fencing-& ACcess Approval
� 17. Rough Wiring Sign � 68. APPROVED FOR P�ASTERING
18. Rough Electricai-T Bar Ceiling - � ' ' 69. POOL/SPA SYSTEMS FINAL '
� 79. Rough Heating & Air Conditioning PIRE DEPT. REQUIREIVIENT
�w • l l '� Y .T�.^1 ..:1� � n .'� i � I
r---�
20. $oug(i P �tor Fi {ilace � �ziT' ;'7 ° _ '� � i' ' APP �OVp LS� =, Pe�mit # � '., �
� �; .� r 1 .S � : .1', b �T K ` �. �7' .. -,--:--
21. Dus�, in�Structure; P I•' " ��- � � J ��� 70. iJndergrou ' Hydro �
Y � Y � 1 •
22. Ducts', Vent�lasting,. A ! k - 5 ' q: 77, product PiAiing Ll�as (�Oil
i
23. �Gas,P.ipe-8ough & Test *�5 : k h ��' 2 � � - 72. Unde�gr6Lnd Flush'. � - `
- -, �
24. Roo��Framing• ; 4: ''' "�;� r�=' .� T r!� ` 73; Undergn5d. Sto eye Yanl�-� Gas ❑ Oil
25. Roof,Sheathing � ` i�. ' i:j � _+, 7y �Ovefhead Hydra f �� I
2fi. �-Ba7Cailin9 (Struct'"vral) & Mo 6�oat '• Y � y �z' �� ' " I
� r p - .S ., � �� .a j G 75. bry_Chemical , .., +� ��
27. frame and Fld�hir } r j�x�Y �� ri ��� �'r s 76. Dry Starxipipe�� � y T �
- _ r _ ,-
28. Lathing&�5ding r � '� '� d-� " �� `� "F- 7Z FIXED $YSTEM-fINA�'. � � �p
� � _,.z._ �. J k ..i 'x �
� 29. Insulatio . • �'a r � 1� J x � ^ 78: fIRE PREV. PIMAL �= �X
i;
- 30. Drywali Nai��� � ` � I '' ' K -' 'HEALT€1 DEP �:'REQUIF,�'EMENT
z' I •ti -1 v-a I I � i: $ L.� � i � �
Y 1' 1 �:Y -i I: I IC J '.
' 31. Plaster B'rowmCoat �; .-�n �� � �R ..- 79. FINAL IiJSPECTtON r�' .
_ L_-�.- . ..
� 32.'Electrical�Pa�nier N}efer-,'r'i�al � '?' � ^� �K ' SO% FOpD CERTIF.I��ATE I�S�UED ..�
� ' . i .. t r��� � a ' � �x: =i »_ �. ._
-� 33. FinaLEiecir�c� n y � �. I �- � No,tes: - k; _ �_ �1
.' 34. F,inai'Heatir�g'� Air Conditionir83.� � .. +' : , � °� �c '� � x S �'�7
r � -i r:i 4' '> t I �x i+ -� �• 4, r -
_ ~ -�,1 �
35. 'Final"Gas�PiPe Test : , „ - �� ,� � ,_ ' ' -i'"��, ; ' ��-
�,.
. 36. Hood•or CanoPY �-� V r, �7r. �% i l : � i ,n T: z r^ t' �i r :i c?=tl: � �
- . - a . � ,<;..�
: 37. Final'FactorY Fireplace , , ' ° .'' x'� � I �F, z, � � y °i � �=
: W = _ " .,v �--
- 38. Einal.Piumbing } � A � �. •� � , .� - ` � � �
' 39. Water•SerJice:Finai ' '.S ti , i � {" ' - ' k - � .;, �� m -`• d�
^ ` 4.r
. 40, �Gas Service�F nai t r _, ,� r � r � ��• �� - � � _ =' c � �
4 I IK ..1;�" �4
' 41. Solar po yesxl'c-fina( `- r •. y �-�' � i �� „ 7� * 3- �,;y �� c� �� �s
� 42. Beckfiow Freventer ; .~ , . � � i �'. r. > _ . � J � ,� . • = = �
- *:' R r� n ti�l I
�43. Backflow Irrigation ` �' `-� r r � , J ' '' `� " ` �
\ �J +
F J V (` �
44. Landscape trnpation.5ystem : =i �� C C • •• 7 " ' • t -� � ' r =' � ,� r``
�' - _ "� : " � V' fJ
45. Sound Aitenuation } - . •• �� J � ;, r � � ' ,� . S `. _ ,
46. Nandiwp.Re9ulations : ' r � _ • - � _ � '
47; P�tNAL STRUCTURE & BUILDING -!� / '' - -' . ' �
n : :. +� ^.i�� �� � � -
48�. FINALPLANNING, � -. �. ! •. ! `��' x � r -ti ; �� : ,
� �: � � i
ri9,'. Electric Release to Edison ' ' ;F : r ' ` .. _ "
.,. I' � �m • • ,
50�. Gas Reiease to SoutFiern California-Gas Co -� � �i. `� - � � � „ • .
- - -� �� -
51?. CERTIFICATE OF OCCUPANCY r r:� : n� - . � �
No. Date
- Applieant to fill In all spaces exceRt'those v�?thin �eavy borGer lines anG zlgn all aDProoriate tleelarations.
CITY OF COSTA MESA ''�'� PERMIT NO. �� � TRACT NO. LOT NO. BLD . .
CONSTRUCTION PERMIT $.E. — � � : '"?�(�� 5� � (
AppliCent'S Melling Addfess _ . TV�E OF CONSTRUCTION NEW AD� p.LTERATION REPAIR
PrOj¢ctAddress, � �' � ^� ❑ CONVERSION ❑ DEM�O��LIS,H' �❑ ^O,'T'HE ,�
OWnef 5 Ne e 4 i on2 , �`S DESCRIPTION OF WORK �y ,�U�� ' 'h'�� � �
Addf255 " �'' y ' TVPEOFPERMI GRA�ING FOVNDATION STRUCTURAL'
A�Ch/Eng._• � LICenS¢ No. � TENANT �,ELECTRICAL qPLUMBING MECHANICAL
Addr25s� , ' ' �.��OTHER � ' O TD�
.�,rJ�IL/Ji rz l�e2i i i�
Contractor's Nam Phone PROJECT DESCRIVTION 5�. F �� oCCUVANCY,t�,� �
Add�e55lmeiling) ' ' ' CONSTRUCTIONTVPE VALUATION$�l�/Nr
' . ' - � i . - ' � 20N� ' GRADING CU. VDS. ACRES
Cicense Na. � � - : � ,
UCENSED CONTRACTOR DECLARATION � ' Remarks: ' ' ` ' �
I hereby atilrm that I am 6cen5eE untlar p�ovi5ion5 of Charter�9 (commentlng �
with se<tion 7000) of Divislon 3 of the Business antl Profe55ionz Cotle, antl t �'
my Ilcense is in tull force antl.effect. ' '� � ' ' �
Llcense Class ' License No.' - ; PLUMBING ' � � '
^�te Si9nature � ' -
RKERS' COMPENSATION DECLARATION' � I 80r� SiAk Sew2f CepJ •
ereby affirm-that I.hava a certiticate of conunt to self-insure or a certificzte • Backflow Prev¢nt2t - "'- - Sewe� ConnectiOn' •
, of Workers' Compensatlon Insurance, or a cerSitletl coDY thereoi (Sectlon _
3800, Lab. C.) -., : Backflow Irrigation Solar Collectors
Poli<y No. ' ' Company � - -
8 Certitietl�<opy is hereEy furnlshetl. ' � : � � Bathtubs ' , Solar Piping ' ' ' -
Cartifietl Copy i5 fil¢tl with the city Builtlin9 DlviSion.
Date � � ApPltcant Clarifiers � � So1arT3nk � ,
EXEMPTION'FROM WORKERS' COMPENSATION DECLARATION i DiShWeShel ; ' SWimming Pool W/Spa •
(Thizsectlon neetl not be complatetl it the permit i5 for'one huntlretl (E300) or . . _—. _
� less). � ' � � ' ' Drinkin Fountains ' � Urinal � �
' I certlfy,that in the perTormSnce of tb - � for whic thi ermR is Issuetl, 1 _, 9 _ _ ; '
shall�not e ploy any persoo In any ma r :as me subject.to the . - � - � . �
worker , p Hon;Laws ot Ca11 r a Floor Diains . � yVater Closet: ' i '
Date i9nature � ' , .
NOTICE: af mdking thi5'tleclala o, o'ShoUltl me sllbject to the' , FIOOf SIf1k5 •� ! WdtEl H¢dt¢f� � -
Workers' omp nsation provisions of the Labor Cotle, ou must torthwith
comply -with such "provisions<o� this=permit �shall be'tleemetl, revoke0. GasService�' �Outlets � Wate�Service . ,
CONSTRUCTION LENDIN6 AGENCV '-� �' ' , .
I neretiy atfirm that ere is a mnstruction lentling a9en<y tor the�performance� ' , Interceptors , �' ' � -' ' - �
of the work tor�hic - S � Pern t�is'' � �( I � 3097 Civ: C.J- ; r
LenOer's Name� G Kitchen'Sink . " ' '
Lentler'S 'Atltlres� /,y 1� 1+��• ' , . �. ,
OWNER'BUILOE0. �ECLARATI N � � ' Y . � LeVatories � . , . - �'
. I hereby atfirm �that I am exempCfrom the Contractor'S License Law for the 1-� p_Tra < " '' , -; t�'/ -
. followin9 reason.(Section 7W1'.5 Business antl Professional Cotle: Any city or ' P _
tJ I, as own@r oi thi
tompensation will tlo
tor sale.(Se<fion 704
�License Law tloe5 not�
fhereon, antl :who tloe
employees, proviaetl tl
sale. If, however, the t
pletion, the owner wll
� ve for the purpose �
I, as owne� oA thE
ra torsto construct th
The Contractor•5 lice
builtls or Improves [h�
tr3Ctar(5) Ilcense pulsu
❑ 1 am ex mpt, untler
Date
a•
tlemolish or�repair . .., ,
iPfor such permlt Roof Drains ` -
the provisions of ' '
�eCtion ]000) of : .
he/she is ezempt � ' Showers � i' -
lation�of Sectlon ' ,
licant to a <ivil ' '�
� Service5ink; �� ' I
�ges�as their sole -
:entletl or offeretl . ' ' ' � �
The� Contractor'S
:o an owner oi a properry wno ouilGs or improves Boile[ � ^ �.
work himself/herself or [hrough his or her own
:h �improvements are not intentletl or otteretl tor , � Duct'- Under Ground �
q or improvement is soltl wlthin one year of com- . ,
the burtlen ot proving he/she tlitl not builtl or im- , Duct - Structu�al �
ty, am exclusively contracting with 4icensetl con- � Duct - Ventilatin
:ct ISectlon 7044,.Business antl Professions Cotle:. 9 _ ..
w does not appry to an owner of property who � �- �
antl wno contracts for such projects with a con- i Exhaust System ❑ Multiple ❑
the Contractor's License Law). ' �
n� � . ._ B•!� P• C. for this reason � Firepl/Fact. Blt. ICBO #
��
upon
Drivers' LicenSe or 55 # �� �
CMFO865-46rev.12/82 White-Builtlinq;
� i Heating System & Ducting .
hat�theabove�-- ❑0.100,OOOBTU�100,OOOBTI
nty ortlinances '
ithorize repre- ' Hood or 7 �
o Pe ty�tor �Pe � �
$ Cano T e II ❑�
Registers
Pink - Accounting; Goltlen�otl - As5e55or
; .. »
. � Reinspection,Fee
$15
$ 3
❑aioopooeru ❑ioo,000e�ru
System Repair/Alteration .�� '
�;,�
... . .. . . -... . - .
� Reinspaction Fee� $15
Issue Fee � ' . $ 3
PLNG. REF. �k
LEFTSIDE VARD
PKG.SPACE REQ.
STflEET WIDTH
SPECIAL CONDITIONS:
�onscruccion roie , �
Cooking Unit ' �
Dishwasher � �
Dryers ❑Gas���Electric
Fan�
F.A.U. ,
Fixtures ' ' I
Device Boxes ; ,
Garhage Disposal � •
Generator00-5KW 05-15KW
Transformer �15-50KW
� ' �5U+KW� ,
Meter ❑up to 100 amps i
Zonin9 APProvad BY �
)
APPliption ApProved By
� I
AppliptiOn IsUBd BY
��s� B/29/03
� ZONE �f - ..
. ' BUILDING �
crTaerir ri cT �
REAR VARD (TO P/U '
RIGHTSIDE VARD
. PROVIDED �
PARK FEE $
� -
� Sub Panel; � (�'
Sub Pole . � !� �.
Motors �0-1 HP �7�'/:�-1
� I nc. Solar, 09-15 HP � � 1
Microwave ,
.. Pole Light �
Range __ _
Signf '
� Standing Sections , '
' ITrash Comoactor
. t
Fee
' ' � . SUMMARV OF FEES � � �
�BUILDING PERMIT $ � , SMIP - $ ' �"��
�'PLAN CHECK� � $ �� PERMIT ` • '
;PLUMBING $ � ISSUANCE $�
•PLANCHECK $ � GRADING . . $
�ELECTRICAL $ .�DO � . $
'PLAN CHECK E $ , / �OO � MICROFILM $ ;
�MECHANICAL $ � - � TOTAL,FEE i $ '
PLAN CHECK $ • � LESS �• � � . � ;
, � ADVANCED PC � $ �
. ' � , FINAL FEE, � $ �
� ' °CONSTRUCTION:AND;PL'ANNING' "`� �' � �.� - . ' , - �--� � POF�--�"'..SPA �..-. � , ; .- ; '
;, �? -� � = ��Date� .Inspector � � " ' ;, Date' In'spector, ,�
APBROVALS , Permif#-', £-` -5� �� . APPROVAL:S Permit,# _ �
.in.i :3 �n��- � . , r .- . . .
- ,1�. Temporary,Electrica�l Service or�Pole ' �' - _ .�-P �� -• "52: Pool &�Equipment Location � '
r.� r�t i: .� _.r . -
�� 2: Soil Piqe-Undrgrnd ` 7 , � c � _ � � `; ' , ; ; s' � 53° Steel Reinforcement � _ � . �.� � � ' '�
.
� _ 3: Elect�ical.Conduit.Uiilitv-Undrgrnd! 's; . -_ '� C�- 54�Forfis�': _ �� -- -` - � . �j� � �
- ,�. _
'� 4". Elecf'rical�Conduif=Undr,grnd: = =: . ` h � . � >', `" ' . 55.'� E�ectiiceG.Bontling : � ' � � , .�
�, , i, _ _
' �r-�= ''" � i -
5. Steel �Reinforcemeni � "' , � ;,, � � _ _ _ . '56. Rougfi Rlu'mbing & Pressure Test . '�- �'
6: �Electrical-UFER Gmd.� ' �% � `� � .�=: - 57, APPROVAL'TO COVER-GUNITE� •. �-
7. Foofings ,� � ! . � . � , -` � � ' � • �58: Electrical Conduit-Undror�d. ,. ' � � � �' `-
'-. . ' ' • . ' � I � ; _ � - ". � -. - . . �_ . - -
, 8. -Foundation � : � �. - � � : .,- � 59. Gas�Pipe; O Undrgrnd.; Test ' . ' -
�
' 9. INater Pipe-Undrgrnd. � � w - ` � .•'� � ,"gp, gackwash�.'Lines,-P-Trap, O Undrgrnd.
%10. Structural=Floor System � �" � � ^� _ �•? � 61. APPROVAL-TO�DECK � � ' � `-
�
11.�Property Sewer Line &�House_Connection� c '- zV ;� � 62. Backwash�& ReceptorFinal � ,-, ' �
12..Sewer Cap.' , ; F �� i "_ � � 63. Heat'er & Vent-Final � _ _ ' f.� '
13. Roof'Drains I i � I r� �,� � � , '�64. Plumbing;Sysfem - Final� � • ," _
14: Rough•.Plumbing' ! � ' �� � � � ' ' - • 65. Electrical-Final' " - � ' �
f'-'�.'15.�Rougfi Electrical=Co�lduit"i - �"'�'� �-' � '( � ��� i-�, "� -i � 66. SolariSystem-Final'- - - --� • " -"` ' � " 1 '
�,.�1�6�riflough�ElecfriaWiring� � �_ � ,+ , T i -9� . -j: ,67. Fencing &�Access Approval�'- � ' ', "'-- � ' �
:5 n'17��Rough Wiririg'Sign;�. � -�r � ' GI ; _ ' 68.� APPROVED FOR PLASTERWG � -
- '' � � �
? �� 18. Rough,Electrical,T Bar Ceiling �� ' � � � i � - � � ,69.; POOLJSPA SYSTEMS FINAL ' . ' '
i 19:'�ough Heating &'Air�Conditioning , � - � I � � � ,FIRE DEPT.'REQUIREMENT� . , ' ,
i
20: �Rough.Factory"Fireplace � � � � ` � � � � � APPROVALS Permit# �
.r
',;�21. ,Ducts, in S4r'ucture;1 � � � j'1 �� � � ' ( �� � � � 70.� Unde�ground H�ydro � � . �
�_� �22.�Ducts,yVentilatin9 ,�.`�; ^ � ;i ,� � i � � • ;7L� Product Piping �Gas ❑Oil ' '
� ,. -
,' 23. ��Gas:Pi e-Rou h & Test � . , ; -T-� -- . . . ..
P 9 .� i_,'� � � �72� Underground Fiush�
�
-24� Roof.F}amings - � , � � '' � . � � • � �� ' : i � � _- �73. Undergrrid. Stoiage Tank�'��Gas ❑ Oil ' '
'� �` 25.'Roof Sheathing _i . ' ' I' " - � - t � � i �� � 7q; Overhead Hydro � � _ '
- - I f�'- -.i'. �I-
� 26. iT-Bar Ceiling (S�ructurall. & Monocoat` � � ! �: � ,u� I � `� � - �75 � Dry Chemical � � � , � ' �
- ��_27. Frame and'Flashing. � i i � �; �� i � i � � • ' � 76.� Dry Standpipe , . - . � , �
' 28. Lathing&Sidingi � -, ' � � � ;, � 1 � :C� � � J7,' FIXEDSYSTEM.FINAL �
«��29.j.lnsulation�-, � �� i � ' i � � �f � �78.FIREPREV.FINAL � � � �
' -'30. Drywall Nailing � � � ; � # � � �.Notes� i9 7 ; � � � �� � �
� 31.:Plaster Brown Coa£;I ' , I . � -- �- : ` , � ,- . _ __ _-- - - ---- . -
; i I I
V32. Electriral�Power MeterFinal � ;; � � 1 � ' I � � . . � ' � ' � �
_ _. . . � - � � � �
- �� 33. Final Electric ' � � !� � �� ;� � � } � � '
�
34. Final Heating &�Air Cond tioning , � � �, �F �:•.i , , . ' '
�
35. Final Gas Pipe�Test � � ^' ^' �� � � , � ' _ � . -
�
` i
36. Hood "or �CalioPY. � � ' � { : ' ' � ' ' - '
4.t t � _ ,� � .
� �i
37. Final Factory Fi�eplace` � _ , ; t � , . � - • �
� � � ; i ; i � i� ,
38. Final Plumbing ' ' . � , ' ' -.. '
� .
39. Water;Service-Final', .' ' � � j ' � = i , � ' i � ' - , . '
n� . � , � � . . _
40. Gas Servi'ce�Final � " • � ! � � � � � � � f � � � ' • �
, � �� � � i � �'� .
41. Solar pome's'tic-�Final � � � �� I � ._,� _ _ __ ' � ' � _ ' � � � . ' .
-i - -
42. Backflow P.ceventer, . j ' � , � � i ��--� � - - -_-- ---_ - _! � . � - :• r,. �� .
�r.,� . � : . � � . ��,i � - . , r i � , , ,
43. Backflow I�r�igation t ' i : � =- " � I � � , . ,
, . . ' �> �� :� � . � _ , � � .
: ; � � � .
44. Landscape lrrigation$Ystem' � �,.; �: � ;, i � i ; � . j - � - � , - .
_ ,_ � .. . : . - i . _ . �; . . - .
45. Sound� �Attenuation ;. � _' + 4 � ' �� �.. - ' , � :' f � ' - " � .., _, �
46. Handicap Regulations � i � � ; ! =' � � �" � "; ; � I ' � ' _, � ' � ' � � • , ' '
47. FINALSTRUCTURE�&BUILDINGu �u .� �� �$' - C' � � ' � � � �
48. Special Requireine�nts Completed ' ; ,� � ' , ' , � � ' . . ; . .
49. Elec[ric Re�ease to ��Edy$on` �. �' 1-. L�.�-� - - • _- '-_*- - _ - , -- -` - • '
50. Gas R�elease to Southern California Gas Co ' ; 1 , • � , , •" i� +, . , f
i ' �'.
51. CERT�F,ICATE'OF OCCUPANCY 'j ! � � � " • •`' r-' ti �.!'
I , � . � j __._!__�--- - - � �- �---.-.Y �l.- - --
; ti
No i� � Dat�e �_ �_i , -�i:.. �^ �
�w
ry
P"
CITY OF COSTA MESA
BUILD�NG DIVISION
01NNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require
the return of, an owner-builder verification.
Attenti0n Property Owner:
An 'owher-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be
issued until this verification is received.
1. I personally plan to provide the ma or labor and materials for construction of the proposed
property improvement. ❑ Yes � No
2. I(have/have not) Jr signed an application for a building permit for the
proposed work.
3. I have con1t'r,acted wi _the fol�wing person �tirm) to provide the proposed construciion:
Name 1fG !-!'.n
5
Address
Phone (
Contractor's Lic. No
City
I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address —
Phone ( 1
Contractor's Lic.
City
I will provide some of the work but I have contracted (hired) the following persons to provide
the work indicated:
Name
Address
Phone � Type ot Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the
State of Califor ' ealth and Safety Coc�e and have completed the above information to the best of my
personal knowl dge, i c mplian�vit �iis State law. �
Signed: � Date: UG• ^ ��
Name: '
(Printed or Ty ed)
C.D.L. �or S.S. # �'
CMF 3042-46
754-5273
Aoolleant to �ill In all zoaees ezcept those within heavy bortler Ilnas anG zl9n all aDorooriata Eaclaretions.
CITV OF COSTA MESA PE IT NO. TRACT NO. LOT NO. BL
CONSTRUCTdON PERMIT �E—��7� �j(, I `i � ( �
AppliCenYS Meiling Addf855 ' T/PE OF CONSTRUCTION NEW ADD LTERATION REPAIR
Project Addreu �� G � � - ❑ CONVERSION ❑ DEM�LISH ❑ OTHER` '`
'� '^ , z, DESCR�PTION OF WORK � ��� /� L� T I
Owner'sNa e ry�e �--����� _
AddrEss '�1 T PE FPERMIT GRAOING FOUNDATION IJSTRUCTURAL
ArCh/Eng.� LiCense No. ENANT O ELECTRICAL 4 P;�LU�M�BING ❑ MECHANICAL
AddfMs , ❑�OTHER = On. AL/{�(pllD� .� n
Contractor's Nam hone PR0.IECT DESCRIPTION 5�. F OCCUPANCV^,� y
Addfe55 (melling) CONSTRUCTION TVPE VALUATION $� �7LC�'��
� - , • . ZONE GRADINGCU.VDS. ACRE$ '
Licenx No.
UCENSED CONTRACTOR DECLARATION � '
1 hareby afiirm that I am Iicenietl untler provi5ion5 of Charter 9(commencing
with'sectlon 7000) ot Dlvislon 3 of the Business antl Professions CoCa, anA
my Ilcensa Is In full force antl afiect. ' ' '
LJcensa Class � License No.
Date� 519�ature � '
`RKERS•COMPENSATION DECLARATION�
ueby afflrm that-1 hava a certificate of consent to self-Insure or a certlficxte
. Workars' Compensatlon Insu�ance, or a certifietl�copy thereof (Sectlon
3800, lab. 0.) ' ' ' ; ,
Policy No. � Company '
eCertitletl coOY I5 hereEy furnishetl. �, i . �
Certlfietl copy IS filetl wlSn tne city Builtling Division.
Date ADGlitant .,
EXEMPTION FROM WORKERS'COMPENSATION DECLA(3ATION'
(Tnis section neatl not be comDletetl if the Dermit is for one hunGred ($300J or 1
lezs).
I certify that In the performance oi th��k for which t i perm�i Is Issuetl I
shall not m0� Y any person In any a n s as me subjett.to t�le
Worker e satlon Laws ot Calitorn'
Date � Si9naiure �
� NOTIC : 1 a te� mdking this tlacla�ati y0u'ShOUItl b �Te suDfect to tha
Workers' Compenution provi5ions.ot the labor CoCe,. u must (orthwiih
comO�Y w�th such Drovlslons or this permit �shall be tleemeU revoketl.�
CONSTRUCTION LENDING AGENCV' � '
' I hereby afflrm that t�ere Ira construc[1on IenOin9 agency for the performance�
' ot Ihe work for'lv Ici h��permlO-1s'IsSMeU.ISacUon 3087' Civ. CJ
'� LenAer's Nama L AL6 L1h AL IL
LenAer's AOGres � LS `�' �' uJi �`
' OWNER BUILDE0. OECLARATIO ' '
I heraby aifirm that I am exempt from tha Contractor'S �license Law for the
followin9 �eason (Section 7031.5 BuSiness antl Professional Cotle: Any clty or
'toun[v whlch reautre5 d DBrmIC[o.cOnstruct. alter. ilnprove: tlemoll5h�or; repair
lars ($500). . . ' �
I, as �own6r ofi the,property or�my employaes.with wages as thair sole
ipenSaUon wllhtlo the work, antl the SVucture is not intentletl or oftereC
sale (Secfion 7044, Buslness, antl. Professional Cotle: � The' Contractor'z :
:nse Law tloes not apply to an owner of a property who bullOs or Improves ,
reon, antl who tloes such work bimself/herselt pr Ihrough his or har own ,
�loy ees, provitletl that such improvemencs are'not intentled or offereC for
�.. If, howevar, the bulltlin9 or improvement Is soltl within oneyear of com- �
:lon, the owner�wlll have tne burtlen ot proving he/she tlitl not bulltl or Im-
ve tor the purposa of sale). � � '
1. as ownar of the orooertY. am exclusively contracting with Iicensetl con- I
The Contractor'S Llcense Law aoes not app�y to an owner ot Oroperty wno
bulltls or improves [hereon, antl who contra<tz tor such projects with a con-
tractor(5) Iicense pursuant to tne Contractor'S Licenu Law).
❑ I�am eaem t untler Sectlon B. P. C. for this reazon
Date O � � e�
I' hereDv er ify that t' have reatl this application an state tha[ the aDova
Drivers' LlcenSe or;55 �
CMF 0865-06 rev. 12/82 White - BUIItlin9: Canary - Applicant; Pink
Remarks: -
Sink
<flow Preventer � � -
<flow Irrigation ,
Drinking Fountains � '
Floor Drains �
Floor Sinks - - -
GasService Outleis
Interceotors ' -
lavatories � . .
P—Trap -
RoofAiains. � �
Shawers � � � �
Service Sink ` , , '
Duct- Under Ground �
Duct-Structural ,
Duct-Ventilating _ �
Exhaust System ❑ Multiple ❑
FirepUFact. BIt IC60 #
Heating System & Ducting .
❑ P7 00,000 BTU O 100,000 BTi
Hood or Typel ❑
Cano T e II ❑
Registers '
Goltlenrotl - Assessor
Solar Collectors". !
Salar Pipin9 ' .
Soiar Tank '
Swimming Pool w/Spa
Urinal '
Water Closet
Water Heater � � -
Water Service � '
. � Reinspection Fee �
laue Fee
�ANICAL
Refrigeration System .
❑0-100,OOOBTU ❑100,OOOBTU
System Repair/Alteration
1
ReinsOection Fea
Issue Fee '
PLNG. REF.9k
TO BUILDING
PROPERTV LINE
LEFT SIDE VARD
PKG.SPACE REQ.
STREET WIDTH
. Automatic Washer �
ConStruction POIe
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric'
$ 3
$15
$ 3
Fan
F.A.U. '
Fixtures
Device Boxes ,
Outlets '
7428 4/19/83
flEAR VAR� (TO P/U/
ffIGHT SIDE�VqRD,/
PARK F�E $ '
t
�tl� J`J' TL
Meter LJover 1 W amps � ' -
Su6 Panel
Sub Pole � � �
Motors OO-1 HP ❑1%r8 .
IncSolar�945HP �16-15+ i
PolelLight �- �
_ -Range_ � � �
Sign �
'StandingSections .
Trash Compactor
Generator OO-5 KW 05-15 KW
Trerisformer 075-50KW
❑5U+ KW
Meter ❑up to 100 amps
Zoning Approvad By
APPlifation APProved By .
Appliption laued By '
�
Reinspection Fe6 .
- � �% S�U'MMARV OF FEES -
BUILDINGPERMIT $ �—�•�� SMIP ' , $ O,SO
PLAN CHECK $ � PERMIT . ' , •
PLUMBING $ • �SSUANCE , $
:PLAN CHECK � $ . GRADING : $
ELECTRICAL $ � � $
PLANCHECK $ /.3o MICROFILM $
�MECHANICA� $ TOTALFEE �, $
PLAN CHECK $ LESS � �
, ADVANCEDPC $ � �/
, , , � FINAL FEE ' $ ./a `�n S
�' j,CONSTRUCTION;AND`PLANNING� � r � �; � = . ; : i •'.'.,POC SPA : --- --� - :
j- z L�''�� : Date'� Inspector ' ' Date'' Inspector. ��
:APPROVALS _. Permit:# �� -. �APBROVALS ' PeimiY# �
•..7 i . ' - i� r - - � - < - - . . . . . _ . �
� t1;: �Temporery iElectrica�l Service orPole � v � � `� c r �� o -- - ' 52S Pool & �Equipment, Location � � � . ' � � � m � ,;
� 2?.Soil Pipe-Undrgrnd: ��� s :. _ � I ' � ° y . yy � � � � _ � -
, ,. ' �' �' �'53� Steel Reinforcement � � , � � �; � � � rc
� 3l Electrical Conduit Utilitv-Undrgrnd: , � - 54' Forms'� " - � - " ��'
� _ .
': 4; Electrical Conduit-Undrgrnd�. �_> , c C � 5.' � ' � , �55G�E�ectrical�Bonding� • _ - ' . ' ' �
5' Steel Reinforcement � � �' ; � ;; _ - _ _ � '� . � ;�" . 56. Rough Plumbipg`& Pressure Test � . ' �
�a
6: Elect�ical UFER Grnd. � �''P � i +� ' � � 57�.;ARPROVAL-TO.COVER-GUNITE , : - • ' �
� ' -
7. Fqoti�ng� ., I i � � i �: ^,� , �� � .. .' - - � 58: ,Electrical Conduit-Undrar.,d. . ' - �' _
. , . . . . - �' r
8. F.oundation � � ' ' _ , � � ' - ". ''59. Gas�Pipe,?�� Undrgrnd�., Test' � ' '
. I
9. Water, Pipe ;Undrgind. ' i • _ � � ; � 60. Backwash Lines,-P-Trap, � Undrgrnd.' - . . �. S
10.6tr;uctu�aPFloorSystem '��� -' ; .� � ��, - 61. AFPROVA�L'TO-DECK �� -� � - �
11. Property Sewer Line &-House Connection. - ' - - ` �62. Backwash�&.Recepfor-Final� � - ' � � � �
I i � I - - '�i .
12.�Sewer. Cap � , , ; � , �, "� 63. Heater.&'Vent-Final - �� - �
r.- - '
13. Roof'Drains � � ' � "_ ' � .. 64. Plumbing:System�- Final� - � • .
,. 14. Rough Plumbing' ' ' � � ' ' `' 65. Electrical=Final ' � - � � � � � "
i
- �`15�.`.Rough Elect�iral=Conduit "-- -'*-" � " ' ' ' � - � -- ' �- , -� --
1 � ; I �66' Solar Sys'tem-Final
;, � �76. `Rough �Electric�Wiring� ; � - � �, -' - " � - �67. -Fencing & Access Approyal � - •
� ', 17�.• Rough:N/iringSiynY �:': � � ' ,. � i : , ,_ ' ; � ' - . ;68. APPROVED F.OR PLASTERING . . - �
� -
1,8.:'RoughjElectrical-T,Ba'rCeilingl �� '�� � � . 69. POOL/SPASYSTEMS-FINAL '.� f ,
v� _ � � �_ -. . ; . .
� � 19. jiough'Heating &jAir Conditioning ', , FIRE DEPT.�REQUIREMENT - � '�
�0. �Rough �Pactor`y'Fireplace, � � �E '�, � ' � , � � � '
APPROVALS; Permit#
c� r i I ,
- z 21.�Ducts,�in Str'uutu�e ' � � � , � � � � ! I � , �
� � 70.� Unde�ground Hydro
�
,_22. Duc['s, Ventilating _ �^ � '.' ' � � I i � � 71.' Product Piping 0 Gas ❑ Oil � ' �
i
� i � ' r- � �- - Y- -..._ _; ,.._ . . . __
ry� 23. Gas�Pip'e-Rough & l'est � � i!^ �� f_ .I. . i � � � i72•� Undergrouncl Flush. � ' � � �
i
� M1�' . - � � I'i� i � . � . .
I. 24. �Roof,Framing � � � ; �- , 2 � ' ., n � „ : � j . 73 � Undergmd. Storage Tank O Gas ❑ Qil � .
- �. i .� � t �-;p _i..' ;
; � 25:.Roof Sheathing '; � . � 4�,'.� ' � i ' j ; = I `� �� = � �7q.� Overhead Hydro ' ; � � , '
�( . ... ; r_ i - i ` . - f � c • ' i 1 . .
� -,�26. ,T-6ar Ceiling (Structuraq, & Monocoat � � i �f: I � '� ,,. ! 75. Dry Chemical � � � . . , �. � _
.�:27: �Frame and Flashing� ' � ' � j, ' � �L� � � (76.i Dry Standpipe . � � . , � "
i -l9=$3
128.'�Lathin9 & Siding ' ' , � �' �� � . � � I � 77.' FIXED SYSTEM FINAL � '
� i
r�"29.�;Insulation - - - � ^ I � ;i '� � � � � Jg� FIRE PREV. FINAL
-�30. Drywall Nailing � ~ ' ' � ! ' i � � Notes: ' . ' , - '
°� � - � -- - � - --- - - -
i � �� � � - - - - - . '- -,
� 31�. �Plaster Brown Coat ' � ! ;� ! i � , ' � ; i '
^� ��� 32. Electrical�Power MGter-Final ' ij ' � � � � y I � � I � ' ' - � `'
- �� � i � , � i- -- � , . , � .
.. u ,. .
; �+ 33.,Final Electric � j__,; _::_ _ x', y !__ � ,l ' ' .�_._ � � ' k
: _ _..�.--�_�....' _. .... .
„ 34. Fina4Heating&iAirConditioning . � � ! � ' � ��,(;��Lj � '
. . �� • - � � � � � i � � <. � �c � � - , � .
35. Final Gai Pfpe�Test� �- , � " i ^'.� . � ' � _ -
�' 1 � T. -
36. Hood "or�CanoPY �`� ,' ` �i � � � _ � � ' .. " - ' . � ._ -�
u � - � i �
37. Final Fac[ory Fireplace . ` i i� , ' � � :. i ; -- , I ; � � � ,-_, - � � �
38. Final P.lumbing! � � � • ; i �. i . _ . � , � ! ; ' , : .
39. WaterService-Final � � � �� i , I i �; . . , � , � � .
40. Gas Seivice-Final � � i � � � ; � ,` � � '
41. Solar pomestic 1Final � � � '- �- -� ,- - � _ � �� i _ � _.� --- - -- -_ '
; �. � , � ,� i � i � ; �i � - � . �
42.Backflow,Preventer��� ( I --.� � � , , • , .
.<<• i _� �,-� - - - r- - -�� �--'- - '
' '. � -. . r' _ I _
i `
, i . c:
43. Backflow� Ir'r_igation� - � � ' �� � � , v � " i �� , _ , � ; . ' , . �
h' � � � 1` ��:
44. Landscape I�ri9ation�System I I ' � � ;, ; � o � ' - � ' � � "„ ; ' ' � � � +
-� ,� ��. ' �� , . _ ti-
45. Sound :Attenuation ; �: i z � , r �' ;: 1 '�: =;t � . � � _! .. i , ` .. .
_, , � ;
46. HandicaP Reguiations-�� ! � 1 , � � i � � � _ I � . , � � .. � :, . • ..
� �
47.�FINALSTR�UCTURE�&BUILDING� �o �� �. ' � � �" � ' � �
48. Special Requireinents Completed � �� � ;' I � . ' � i , � . ,
� �
49. Electric Release4o �Edison� � � � ' _ _ . _ .' . __ _ - ' ,- " �
50. Gas Release to Southem Galifomia Gas Co � � ' ' � ' �' , , . � � ' "
51. CERTIFICATE;OF 06CUPANCY _ ' ' � ' ' __ _i_j_�.' ' i
�I r � �j '� . i� . • ' r
No. .rY!]/S`� Date '• i� ! � !�. =� � � . .� -
L`- - '--�- '
�OIJTMlAN CALIFORNIA dO1L AND TS9TIN0. INC.
gZBO RlvEfiOd1 .TNEET. F O. BOX 20887. SAN D1E00. �-.��FORNl4 �1� (7LJ1 ZBO-43Q1
1� VYEHT ai/VJC�7TIOqPE. PLALEMTIA. COLIFOfiJ1O. 82670 f7W) 324-B73D .
7q-B31 VELIE NhY. PALM �SEAT. U1lIFORIVIA B22B0 f7M17 3�IB-�O7B
B7B ENTERPFBE STREET. ESCIXJD�00. Go.L�FORNw 92� (77A1 7WB-a30a
pEPOAT OF COMPAEBSION T�STS
Ki�e n�urNeeA: , 10, 1981 ❑ CONCRETE
.,oe: Robert Herron Office Bl�� �MORTAF
AODR s: j004 Deodar St� Coeta Mesa CA � ❑�aour .
dWNE : ❑GtJNITE
AFlCMI CT: ' O
ENOINEER
CONTR4CTOR: :
�oc;,,T,aw ,� �ucn�wE: middle of wa.11 at 3' high
cEnn�NT: Riverside Type I& IZ ..
a,onnixruae: ilone � � .'
Sl+ND:
ROCK:
Mlx NO, OR PFlOPORT�ONS:
TIME IN..NyXER, MNUTES�
6LUMP, INCMES= .
FABQICATEO BY' T• �Litp�ng TRUCK I�: TICKET Np: -�
LABD:�ATORY Wp: 257� z571 2572 . ..
MARK
DATE MADE� �2� �B1 �
pA7E RECENEO= 12 ��8�
OATE TESTEO: 1Z-�O�A'I 12��%-8� �2�j�-8� .
DIAMETER, INCr1E5= 2 �X L� �
AFEA.SO.INCh�S: 3•�4 .��
MAXIMUM LOA4lB"+� � 6�6�� 8���� 9f500 :
COMPRESSIVE sm c�s�: 2��oa 2�545 3+0�5 ' �
AOE T�STED. D��15= 7�''Ys 14 �3YS 28 �$y9
REO'O PSIAT 2B U�YS: �
UNIT WTfCU FT IRAb'TIO: �
I
oisTaieunow: 2 RobeTt Herron
1 City of C.M.
1 SC9F, Saa Mego �
. JP� � D RF�.n.
80�JTM�AN CALIFOANIA
, • •OIL AND TtBTINO, INC.
l ' a¢v�weo ev:
� /��.'�J
�d �7ove i'aterials '�hgineer
;
SOIJTMERI CALIFOANIA SO�L AND ESTINO, INC.
5280 FIVEROOLE STAEET, P O. BOK OB27. SAN DIEGO. CAUFOANIA 92120 [71Q) 280-4321
� yNEgT pq4NGETHpRPE, PIYCENTIA, COLIFOQNIA 92870 (75G] 524-9'130
X-B31 VELIE WAV. PCLM DESERT, CALIFOiiN1A 92260 f7W1 306-1078 (�
EJB ENTERPR�SE STREET, ESCONO�DO. CCIIFORNiG 9202'3 !7'141 7G6-a500 /-(' �/ y� O
/✓
AEPOqT'OF COMPAESSION TESTS
FILE NUMBER: 7?%� OOTE: DeC� ��� �gB� OCpNCRETE
�oe: Robe-: :e^ran OffiCe 31dE;• ❑ MORTAR
AooRess: j00t: ]eodar St� Costa ::esa CA �GGROIJT I
OWNER� ❑ GUNITE
ARCHITECT: ❑ �
ENGI1YEEp: .
CONTciACTOR:
I
LOCATION IN STPUCTJ:�E �S?'�P� 2S fron middle of :rall.
CEMENT: �
ApMIXTUqE: � (
SOND� Styn�d�
AocK: ::o in£ormation fuxnished
MIX N4„Q� PROPORT�ONS: ��Z9
TIME IN MI%ER. MINUTES�
SLUMP, INCHES:
FABF71C47ED er: mom Fleming TRUCK NO� TICKET NO:
�neoacraav r.�o- 2602 2603 2604 •
MARK
�
DATE MAOE: �-z�(}�8�
DOTE RECEiVEO. �2�'��8�
OATE TE$TEO: iZ��i-B� �'2-�i-8� 1-1-82 I
DIAMETER, INCHES- 3 X 6 .��
ARE4,S�,INCMES:
MAXIMUM LOAR ��� 15oOOO 18�000 25�000 •� I
COMPFiESSIVE ST0. P51: �,665 2 ��� 2�775
4GE TESTEO. De`�5' '7 �,Yg �Q�days z8 �S '
RE�'D P$I AT 2B OA�S: '��OOO
IJNIT WT�/CU FT [FLCS'��CI�
/ �
DISTRIBUTION: 7� �ObETt verron
;1 � City of C.i'.
(1; SCST, San Diego
JA� 11 RE�'Q
SOUTMERN CALIFOFiNIA
SOIL AND TEBTING, INC.
AEviEWEO Bv:
�
�,,�_��,��
. hav =d Bove ?laterial ��ineer
SOUTNEA► CALIFORNIA SOIL AND ^'�STINO, INC.
62BG �:IVEF04LE oTREET, P O. B. 20627 SAN DIEGO. CA��FORNIA 92t2p (7t41 280-632t
1� v�iEST pRANGET1�pqPE. PII�CENTIA. OL-�GpRNl4 92670 (7t4] 52a-9130 -
X-93'� VELIE Wnv. PCLM pESERT, CAL�FORN14 92260 l7'141 346-1078
65 E�TERPFISE STREET, ESCONDIDO, CGLiFORN1.G 92025 17�47 7G6-QSaq
AEPORT OF COMPpE8810N T@STS
FILE NUMBER: ��' � DATE� +�«+C1 14� Z9B1 �CONCRETE
�oe: ?�obe-- :_�^�on Of:ice :51d�. �MORTGR
ADDRESS� 3G=' podar St, Cost2 ::esa CA ❑�aour _
OWNER� ❑ GIINITE
ARCNITECT: . � ❑
ENG�NEER=
CONTpACTOfi: '
LOCATION IN STRUCT..aE �
CEMENT: � ' '
AOMIXTURE� .
SANO:
RpCK: t
MIX Np.O�R1 PROPOpT'�NS� 1:3:1� �. �l�i
TfME IFi'PMIXER, Mlh:�S�
SLUMP, INCHES:
FABRIC4TED e�: T. Flaning TRUCK NO� TICKET NO:
LABO%�ATOqY No: 2691 2692 2693 . �
MARK: ' HE'XYOil Off CE BUll � 12-%-81
OATE MADE� 12-%-$1
D4TE REGEIVED' 12�11-HZ
OATE TESTE�: ��Z�I-81 12_21_g1 1�l�-$2 �
DIAMETER, INC'+ES 2 X Q
4REA,5C].INCHES- 3.,i1�
MAxIMUM LOAO, L65' 5�900 9'9Qo 101,�jQo • �
COMPRESSIVE Sh1.. 05�'� 1�8%5 3,150 .3�344 I
AGE TESTED. On"S % Ia3y5 14 dyy9 2s �iyS �
RE�'O P51 4T 2B Co`�S
UNIT WT�CU FT (P_pSTG� �
/ / �
OISTRIBUT�ON� 1�ObQTt vBiTOR
�i� .'_� Oi C.. •
7: SCS?', San ?ie;,�
� AN 11 REC'D
SOUTMEAN CALIFOANIA
SOIL AND TESTINO, INC.
AEviEWEO BY:
� I �'�� /L�/iL�/ i
�271E; P11 r I.dbOTatAIy N13ndcJeS
SOUTMEAN CALIFOANIA �OIL ANO TBSTINO, INC.
6280 QIVE:�OALE STREET. P O. BO% 2�627. SO.N OIEGO. COLIFORNIA g'2�Pp (7tq1 Zgp-4321
t� N�EST ORANC#TMORPE. PL4CENTIA. COLIFpFlN1A 92870 f 7tal 32a-9130
?1-831 VELIE WAV. PCLM pESERT, G4L�FORN10 92260 1')1G) 348-1078
6�9 ENTERPRiSE STREET, ESCONOIDO. C4LIFORNW 92023 (7141 7W6-a5aa
AEPOAT OF COMPRESSION TESTS
F�LENUMBER: �2J��b DA.TE� �C� �5f �98�� ❑CONCRETE
�oe: .Ttobe^t =:erron Office 31dg� ❑ MORTGF
AooAess: . j00!} Deodar St, Costa ;:esa CA 7QGROUT
OWNER: O GUNI TE
4qCN�TECT: �
ENGINEER: �
CpryTR4CTOR:
I
I
LOCATION IN STqUCTURE �
CEMENT:
ApMIXTURE: � `
sario: Standard P?o inPo�-raation £urnished
ROCK:
MIX NO�� PROPORTIONS�
T�ME tN MIXER, MINtJTES�
SLUMP, INCHES�
F4BRiCOTED BY: TiiUCK NO� TICKET NO:
' �homas Flemin�
LABOR4TORY No= 2697 26�8 2699 • .
MARK
❑ATE MADE: �Z�B�H� I
�ATE RECEIVE�' �2����8�
OATE TESTED: '�Z��5�81 12-22-81 ��5�82 ,
qInMETER, INCMES� 3 X 6 �
AREA.S�.INCH�S: . 9�O '
MAXIMUM LOAD, �05.= 17�BOO 2��00� ZZ�SOO �
COMPRESSIVE S7R., P51: 1�97� •2�33p 2�5�
4GE TESTED. OCvS� 7 dg5r5 �4 �375 28 (�3
FlEO'O PS� OT 2B 04v5:
UNIT WT�CIJ FT IPLASTiC)� /
/
DISTRIBUTION: =� �Ot72Tt ?�EST021
1� City o`' C.:'. ��,c�
(1) SCST, San Diego ' �CU
l�P�
��� �
SOUTMEAN CALIFOQNIA
SOIL AND TE8TING, INC,
aEViEWED B�'�
/ _ / ✓�'c J
r,d Fiove i•laterial z'�n.�ineer
QOl1TMER/� CALIFORNIA �iblL AND _ dSTINO, INC.
6Zgp RIVEROGL@ S�FEE7, P O. BOX 2(�27, $AN DiEGO. COUFORNIo g2f20 (7/al 2B0-a3�1
1� WEST OqMl9EThqRPE. PLACENTIA. COLIFORNIA 92870 [7M7 52G-8130
.'b�B3� VELIE WA`�. POLM OESERT. G4L�FORNI4
B7B ENTERPR�SE STREET, ESCONOIOp, C/aUFORNI�
92260 f71G1 3C6-�078
9202`3 (7�4] 7�G6-aSqA
AEPORT OF COMF�AESSION TE8T8
FILE NUMBER: 5�f� ' DOTE� �C• 1�%, �981 ❑CONCRETE
�oe: Robert ��e`-ron Office Bldg� XF� MOAT0:1
a.ODRE55: �Q TJeO(I3i St� Costa ;:esa CA ❑GROUT �
OWNEF: ❑GUNITE '
AF7CM�7ECT: . O
ENO�NEE F � �
CONTqACTO�i: .
LOCATION IN STRUCTURE � �
CEMENT: TilV2TS1C1@
qpMIxTURE � �
s.allo: i?o infonnation Furnished
ROCK:
MIX NO, OR` PROPORTION$:
TIME IAwM1XEFl. MINUTES:
SLUMP, INCNES:
FABRICATED Bv= T� P�.em1T1�' TRUCK NO: TICKET NO:
lA�4R4TpqY No: 2694 2695 2696 �
MARK
OATE M4DE= �Z—B�B�I
OATE RECEIVED: 1'Z����By -
OATE TESTEO: �'2-15��1� �'Z�'2'Z�B� ��5�8'1
p1AMETER, INCHES� 'J X 4
'
AF7EA.SCi.INCMES= 3�i�
MAXIMUM lOAO. L65.� 3�QQ0 5�750 7��50 •
COMPfiESSIVE sTR. ��: 955 �,830 2,245 '
n�e TE3TE0. OAYS: 7 days 14 dapa 28 days
REO'O P5� 4T 2B 04Y5:
UNIT WT�CU FT (PLASTICI: � 1
/
ois*ra�euriow: 2 �iob2Tt HeTron
,3 ���. of �.�.
(1) SCST, San Diego ,
JA� .� -1 ��.��
SOIJTMBRN CALIFORNIA
801L AIVD T�9TIN0, tIVC,
AEv�E WEO B�':
� �
�'d 3ove i�?aterial �ga�eer.
�OUTNEA�
CALIFOANIA SOIL AND E9TIN0, INC.
gZ9p fiIVEQOAIE BTTiEET, R O. BO% 20027. 90.N DIEliO. CALIFORNIA 9@IZO (Ta) 2B0-o3�1
�� yyEgT pq4MCiETFaOFB�. PLACENTI4. CGLIFORNIY 92B7D [7W7 32a-9730
?1-831 VEl1E' WAY. P4lM OESERT. CALIFORNio B22B0 (7147 3CB-t�7B '
67B ENTERPRISE BTFEET. E9CONOi00. CALIFORNW 92023 (7141 7n6-C34O
REPOAT OF COMPAE88lON TESTS
FILE NIJMIBER: J2�W DATE� 'DEC• �O� �/8�
.,oe: Robert �erxen Office B2dg.
ADDFE83: • 3004 DBOa9,T St� Coeta I`:esa CA �'
OwNEq:
" 4RCNITECT: � .:
�EN6�NEER� . � � � "
CONTRYGTOR:
LOCATION !N 3TRISTURE �
cenneNT: Riverside Plastic
71pPAX7URE �
SAND�
ROCK:
MIX I�,At� PqpPORTipNS�
� �
TIME IN MIXER. MVJUTES�
9WMP, INCMES:
Fnew�cnr�o ev: T. Flemin�
LABOf7A7DRY kp'
M4RK=
OATE MADE�.
p4TE NECEiVEO:
ppTE YESTED:
O�AMETEP, iNCMES=
AREA.SO.INCMES: ,
�NqXIMUM LOAq LB3.:
COMRiES3NE STFL P61:
AGE TESTEO. OaYS�
REO'O PSIYT 2B D4v5:
UNIT WT�CU FT [Pl45TIG/=
DISTRIBU TION �
TRUCK NO�
2688 2689 2690
12-9-81
12-11-81
12-16-81 12-23=81 1-6-82
2 x 4
3.�A
10,350 10,950 12,eoo
3.295 3,4e5 4,0�5
% �df9 i4 adp6 28 d3y9
�
2 Robert Herron
,3 ��� of �.�.
1) SC3P, Saa Diego
❑ CONCRETE
$�MOi7TAR
O GROUT
pGUNITE �
❑
TICKET NO:
�������
f ��
SOIJTMeAN CALIFORNIA
801L AND TlBTINO, INC.
AEViEWEO BV:
� / �v
Fd Bove P'faterial �gineer
v
a
dOUTMHA� :ALIFOp�SO1L AND ' B71N0, INC.
B�HO RiVE�LE STREET, R O. BOJt 20827, SnN OIE[i0, CAIIFOFNI4 g212p (7741 880-435'1
16'S WEST ORMGETFURPE. PLACENTIA, C4LIFORNIA B2B70 (7141 324-813p
T�-B3t VEI�E W4v, PALM OESERT, CALIFORNI4 B22B0 (7VI1 3C6-t07B
B7B ENTERPRISE STREET, ESCONDIOO. C4UFORNIC H2O2B (7107 7Y16-4544
AEPORT OF COMPAESSION TESTS
FILE NUMBER: J2J�� OYTE� Ii2C� 17� �98� ❑CONCRETE
�oe: Robert.T_ierron Office Bldg� X$M��ORTCR
AOORE88: • 3�Q DQOf�T St� Costa Tiesa CA ❑GROUT '
OWNER: ❑ GUN17E
�7CMITECT: ❑
ENC3WEER: - -
CONTRACTOq:
lOCA710N IN STRUCTURE � -,,
cenneNr: Riverside Plastic
AOMIxTURE� �
SANb
aocK: ho information rurnished
MIX fJp_ pq,pqOPORTIONS�
"Y
TIM� IN MIxER, MINUTES�
SLUMP, INCHES= �
FABqICATED BY: TRUCK NO� � TICKET NO:
' T. P'lemin�
LABbfiATOFY NO: 2712 27�j 27�4 , .
M4qK=
DAT� MADE: . �'2-1O-a�F
oArp aeceiveo: 12-14-81
DATE TE6TE�: 12-�%-A�I �2�2[�-81 ��%-82
O14METEF, 1NCHES: 2 X 4 �
AREA,SO.INCMES: 3��4' �/
MAXIMUM LOAq IBS.: 6�000 7� 100 9��� ' .
COMPRESSIVE 9TR., PSI: 1f9�� ' 2f45o 2,895
AGE TESTEO. OAYS= 7�'Y9 �4 �Ys 28 �3yg
REO'D P51 AT 2B OAVS : ' �
UN17 WT�CU FT lPlASTIC)� / I
o�stA�eurior�: 2 Robert Herron
1 City of C.I�.
1 SCSP, San Die�o '
SOYTMBpN CALIFOANIA
801L AND Te8TIN0, INC.
��*f�� �. �. '��j� fiEviEWED BC � ��
����� �
:d Fiove i•iaterial �gineer
SOUTMERN CALIFOANIA SOIL ANO TH8TIN0, INC.
��
6280 A�VEAOOL! _.TREET, P O. BO% 20B27. SFN DIEGO. G. .iFOiiN�G 92120 ITA) 280-4321
�65 WEST ORGNGETMORPE, PL4CENTIA, CYLIFOFiNIG 92670 (7'14) 524-9130
�-B3� VELiE Wo`/, PALM OESERT, CAUFORNiG 92260 (71G7 346-'1070
67B ENTERPR�SE STREET, ESCOND100. CAUFOFNiG 92025 f7�O7 7G6-45G4
REPOFIT OF COMPAE8810N TESTS
FIIE NUMBE:a� S�i�'f� .� pqTE�
�EC� 1'�� 198� ❑GONCRETE
�oe: .Ttobe-t ::erron Gf: ice :.] dr, o nnoaroa
o00RE$S: 3s�l, �eodar St, Costa :'esa CA [`�RpUT .
OWNER: - OGUNITE
oPCMITECT: ❑
ENGiNEEq: - .
CONTRqCTOR: . -
LOCATIQN IN STRUCTURE � ' '
CEMEN7: 1�0 informatim Furnished � -'
GpMIXT{�RE � '
snn,o: Standard �
ROCK: .
MIX NO. OR PfiOPOATIONS� 1129 6�0 sack
TIME Ify,r�%Eq. MINUTES�
SLUfVIP. INCNES:
F4B:a�CYTED BY� T� r1emlI1� TR'aUCKNO� TICKET NO�
LA.BOR4TORY NO� 27�9 271� 27�1 -'
M�AK '
OATE nnooe: 12-10-81
O4TE RECE�VED- �'Z�.1[��$�
DATE TESTED: �Z-17�A� �2-2Q�8� ��7�i2
O��METER, INC'+ES= 3 Y 6
AREA.$p.INCMES� (��O '
MOXIMUM LOA.O, LBS.: 9�5�� ���� '21��� ,'
COMPRESSIVE STR., PSI: '��OSS ��220 2�330
4CaE TESTE�. OD"S' (]yyS 14 �3Srg 28 �g
ciEO'O p51 nT 2B OovS:
UNIT WT�CU FT (PLGSTICI� �
�
�
Oisrc��6ulior�: ��' �Ol�rt `?TTOR
'�1`� Clty O` C.;�.
�.1;� SCS_", 52n Jie ;o
80UTMEAN CALIFOANIA
SOIL AND TESTINO, INC,
AEviEwED Bv:
nN 11 REC�D �d 3ove Plateria�ineer
� H
Sp�JTMEA�" CALIFOANIA SOIL AND lESTINO, INC,
5�-gC �1iVEROOL[ 3TREET, A O BO% 20627. SAN DIEGQ Cr.UFOFINIG g�2p (71q1 2B0-G32'1
� hEST ORGNGETHpqPE. R4CENTIA. COLiFOqNIA 92670 [7�a) 52c-9130 .
X-93' VEL�E Wo`/. PALM OESEqT. CAL�FDAN�q 92260 (7t4) 346-t07B
ES E\TEAPRiSE STqEET, ESCONOiDO, CGL�FORNIn 92025 [7t4) 7G6-4544
AEPDFiT OF COMPAESSIOlV TESTS
FI�E NUMBER' �`� ' DATE� +�-�3`� 14� IJHL ❑GONCFIETE
J6B: RO'J�_`. ._�:'SOII Ci:1C9 .��4°�. BMOFTAR
000caess: j:•=' podar St� Co3tz :'e3a CA ❑GROUT
OWNER: ❑ GUNITE
AhCtiITECT' � ❑
ENGINEER:
CONTFACTOF_ .
L4C4TION IN STRU=�_�E � '
C�MENT:
ObMIXTUFE� '
SANO= �
ROCK: ,L.�
M�X NO. O�Rf PROPC�- �VS� 1:3:1� ".^. �ZOT
TIME IN rv�IxEF1. N:\_�ES�
SL�JMP, INCHES�
FABA�CATED e�: T. Fla[ting TRUCK NO� TICKET NO'
lAB0:7C.TORY Ne 2691 2692 2693 -
MARK' HPSYOII Of Ce B1111 � 12-%-81
�
D4TE MnOE� lz-%-$1 I
DCTE RECEIVEO �-u-Hl i
DnTE TESTEO� �-14-HI �'2�'21�81 j
OIAMETER, INCh-ES z X Q �
A.REA.SO.INCHES 3.14 .
MAXIMUM Lppp, _� �j�90Q p'p� ,
/ J i
CbMVFE55ivE 5'�_ �S�' 1�8%rj 3,i5o
/aGE TESTED. De`s % (,�3y$ �4 days
AEO'O PS� GT 20 =>`S
UNIT WT�CU FT :n_pcTip. -
OISTRIBUTION: �ODC'Tt '�+I'OR
1� ';'_ty O_` C.. .
,1. 3CS", S2n Die;o
SOUTNEAN CALIFOFiNIA
DEC 2$1981 So�� AiVD TESTINO, �Nc.
�+EviEwEO Bv�
�I se'/� fr' /�� i
/-
EU4ene ell, Laboratozy Manager
SOUTFIEP-' CALIFOANIA SOIL ANC �BSTINO, INC.
5ggp RIVEFiOolc STaEET, P O. BOx z062Z SAN DIEGO. �nLIFORNIG gQ�2p (7ta) Zgp-a321
15�j WEST OF/+K'+ETHORPE, PL4CENTIA, CGIIFOfiN14 9267D (7'141 524-9130 �
?1-83'1 VEIIE WAV. P4LM DESERT, CALIFOfiNl6 92260 (TIUI 346-1078
67p ENTERPRISE STREET. ESCONDIDO. CFLIFORNIo 92025 [7101 746-d5G4
qEAOFIT OF COMPRESSION TESTS
F1�E NUMBEF: ��"'8 ' OATE D2CHCIJPY 1�}� 1981 pCONCRETE
.,oa: Rober: _erron Office 31d;,. ❑ MORT4R
000caess: j�� ; 7eodar St, Costa ::esa CA ��GROUT
OWNEq: ❑ GUNiTE
ARGHITECT: Q
ENGINEER:
CONTpqCTpR: .
IOCAT�ON IN STRUCTURE � -
CEMENT: K1VP�51(j2 I�I
qOM�XTU%�E� , '
54ND:
:�OCK ,L_ 1
MIX NO.OR PROPORTiONS� 1;3;1� �a�. (�`QyOT
TIME IN MI%ER. MiNUTES�
SLUMP, INCHES:
FAB:a�CATED B�'� T. FZ�IJ TRUCKNO� TICKET NO�
�LABOfiATOFY NO� 270� 2701 '27�z .
MARK: [-IeSZDn Qf C� Blll.�. � �.Z—%HI
DATE MAOE: �—%"'BZ
DATE qECEiVED: 12-1].—HZ
OATE TESTEO: 12—I�I—HZ �2�`21�8�
DI4M�TEFI, INCNES� 3 j( 6
ARE.o. 50. �NC'+ES 9�1�O _ '
MAXIMIJM LOAR LBS�� J.1�5�0 16�0�0 ,'
COMPRESSivE STR. PSI: ��2%S ��','�'�
AGE TESTED. DGvS� % D3]5 �4 dyy9 -
RE�'O PS� O.T 28 rJAvS:
LJNIT WT�CU FT [PlASTICJ�
015TFiBUT10N' �=� �ObETt uerron
1 � City of C.:'..
( t j SCSP � San �iego
DEC �0 1981. 80UTNERN CAI.IFOFiN1A
SOIL AND TESTINO, INC.
REVIEwED BY:
� �
EUg FDthell, Laboratoxy Managex
SOUTNER' CALIFOANIA SOIL AND E8TIN0, INC.
6280 RiVERD/�LE STAEET, P O. BOX 2062Z SFN OIEGO. CAUFOANIA g2120 (7141 280-432t
�65 V�IEST p[iqNC'aETHORPE, PL4GENTIA, CPLIFORNIA 92670 (7t4) 524-913p
aa-63'I VE�IE W��'. PALM DESERT, CAUFORN�G 92260 f7t41 346-t07B
67B ENTERPRISE STREET, ESGONO��O, CD�IFORNIG 92025 (7t41 746-a5aa
qEPORT OF COMPAESSiON TESTS
FILE NUMBEFI: 7z�'�� OA.TE� �e� �l �0�,� ❑CONGRETE
�ae: Robe-t �_eri'on Gf:iCe ild;�. ❑MORTqGi
/a�OFIESS: 3�J' �eodzr St� Cost2 :"esa CA ;,[tG170UT '
pWNER' ❑ GUNITE
ARCHITECT: ❑
ENGINEER: . '
CONTRqCTOR:
'
LOCATION IN STRUCTIJRE � i
CEMENT:
A�MIXTURE: - I
snnio: St2.;?d::^:? -o i�fo_ :2.t-on fu�i:;hed
ROCK:
MIX NO. OR PROPORT�ONS�
\
TIME IIV MIXEP. MINLJTES�
SLUMP, INCHES:
F4BRICATEO BV: TfiUCKNO� � TICKET NO'
1hom23 �'le^;n;;
LABORATOFIY NO. 2i:'�i7 7p�8 2�°9 .
MARK:
I
D.�TE nnaoe: ��_8_81
DA.TE RECEivED: �2_�1_�',�
pqTE 1esTeo: 12_1j_g1 �2�22-8�
O�AMETER, INCHES' � :; � -
GREA, SO. INCJ-�ES: p O
MCXIMUM LODO. LBS.� �',�BOO 2��000
COMPRESSNE STR., PSI : � p'75 2�330
AGE TESTEO, DGvS: '� d2�� � �4 �3Y5
RE�'D PSI AT 2B OAYS'
UNIT WT�CU FT [PLOST�CI�
piSTRiOUTION� �� �0�2rt ��A�-bn
}1� Cit3• o` .^, --
f 1; SCS'!', Gui•�•e--o I
I
I
DEC 28 w ' SOILTAND T 8TINO,�INC.
1981
� REV�EwEO Bv:
� / -n"Q / �
c�Cl �Ove ��:3tn,•l8� rYl'._T?^:?«
SOIJTFIEA' CALIFOANIA BG�L AN� E8TIN0, INC.
6280 %�iVEROALE STREET, P O. BO% 20822 SI+N DiEGO. COUFORN14 g21Bp (71q) 280-4321
1fi6 N/EST OLiAK:ETFIORPE. PLOGENTIA. COLIFORNiG 92670 ( 7141 526-g13p
�-B3'I VEL�E WAY. PALM DESERT, G�.LIFONN�A 92260 (7tq1 346-t07B
67B ENTERPRISE STREET, ESCONO�DO. CI�LIFORNiG 92�� I71G) .�G6-a54G
qEPOAT OF COMPRESSION TESTS
FILE NUM6EF: �2�Vb O/1TE� �C• ��e �iP� OCONCF+ETE
�oe: Robe^t ::e_ron Office 331dt;� v�iS MORT4R
nooAess: j00Q Deodar St� Costa ::esa CA ❑ GROUT
OWNER: ❑ GL�N� rE
ARCHITECT: O
ENGINEER: '
CONTqACTOR:
�OCATION IN STRUCTURE �
CEMENT: �1V2=^31d2
AOMIXTURE� �
SANb: _ .
`o -n.oma��o-: :'urn_;hed
RDCK:
M1X Np. OR PROPOAT�ONS�
TIM� IN �1%ER, MINUTES�
SLUMP, INCMES:
FABpICATEO Bv: TRUCK NO� TICKET NO:
^_ . :'ler.:in:�
LABQROTORY �: 269L� ZO�j �OCj'� .
MAqK
04T� nnnoe: 12_g_g1
DAT� RECEIVEO: �'�_y��lj�
OAT� TESTEO: 1'�-'15-f31 �'2�'Z'2�8�
D�4METER, INCHES: 7 :, 4
AREA,SO.INCNES: 3.1nr
MAXIMUM L04q LBS.� j�OOO 5175�
COMPRESSIVE STa. �� : 9�5 � �83�
AGE TESTED. DA`/5� 7(1�^�„y5 �4 days
RE�'D PSI nT 2B D!�'S:
UN17 WT�CU FT fPlASTiC)�
DISTq�BUT10N: 2 �tobert ??erron
,3 ��t,. of �.r.�.
f 1� SCSP, San Diego
DEC �$ ����' 801LTAND TE8TINO,�INC,
<+Ev�EwED B�:
� �L_ _ I
�-�.�V
i
��ry -.C':9 ..8t�_'_�� ,:1"-^c'P:.
SOUTNEAf :ALIFORNIA S�IL AND 'STINO, ING.
6280 R1VEA04LE STREET, P O BOX 20627 SC.N DIEGO. CALIFOfiNin g21pp (7147 2B0-a321
�65 WEST ORANGETMORPE. Pl4GENTIA. CGLIFpRNIA 92670 (7�4) 524-9�30
76-B3t VELIE WOv. PGIM DESERT, C?LIFORNiG 92060 f7'14) 346-t�7B
67B ENTEPPRISE STREET. ESCONO�DO, C�IIFORNIA 92025 (7141 7G6-a5da
AEPORT OF COMPAESSION TESTS
' f14E NUM9ER: _' f� T�C• �7� 198� QGONCAETE
J=: � �' pGTE �
JOB: ROO�"� .'ProL1 GLi1CB _6�.(�i�• �MOFTAF
AbDRESS� 3!�"•�� a90(i2.T St� CO3t2 . e52 CA �aOUT -
OWNEF� - OGUNITE '
'4pCH�TECT' O
ENG�NEER: �
c4NrancroFr: - '
LqC�T10N IN STRUCTUAE � .
C�MENT: 1\'O inforlatim I`urnished
A[]MIXTU�7E � '
snn,o: Standa*ei
%�OCK:
MiX NO. OR PROF'OAT�ONS� 1�2J 6'� S3Ck
TlME IN -MIXEFI. h4NUTES�
cc �
SLUMP, INCHES:
FABRiCOTE� BY: r� i TRUCK NO� TICKET NO:
�, leming
LABORATORV NO. Z7O9 Z7�O Z7�� . ..
MAqK �
D4TE MAOE'� �2�1O�H�I
DATE RECEivEO i2-14-87
DCTE TESTED' �I'��1'7�a� �'2�24�8� �
OI4METEq, INCHES- 3 Y 6 � �
�FEG. SO_ INGHES- tj � ��
•
MAXIMUM �oo.o, �es.: 9�500 1�000 i •
CbMPRE55NE STR._ PSI' ��O�JS ��22�
AGE TESTED. On"5: �,yg 14 �ys
Aeo�o Psi nT ae oo�s:
UNIT WT�CU FT (PLGSTIC)'
OISTRIBUTION: �=' '?O�U2rt -�BiI'Oj1 �
<
� � , (�1ty O.` C.:'.
�1;� SCS'!', San �ie;,�-o
..„ .
DEC 2 S 1g81 80UTFiEAN CALIFOFINIA
- . --.- SOIL AND TESTINO, INC.
REV�EWEO BY:
� �
Pd �ove i:ateri�l ���ineer
SOIJTMBAA CALIFOANIA SOIL AND _ L6TIN0, INC.
gZgD qIVE�70GlE STAEET. P O. BOX 20827. SAN OIEGO. COLIFOANIA gp18p (7Li] 2B0-a321
$ yyE$T Qiqf�GETF10i1PE. PIACENTl4. CGLIFORNIA 92870 (717] 326-913p
7MJ-63t VELIE VWV. PAIM OESERT. C?LIFORNIA B22B0 �7141 3eB-107B
B7B ENTERPqISE 6TFEET, ESCONDi00. CAUFORNi4 92026 (7741 7�46-A544
RBPOpT OF COMPpE8810N TESTS
P�LE NUMBER: 525� ppTE� D2C. �7� �98� ❑CONCRETE
.108: ROtICi't 'ierron. Office B�.C�� XEANORTCR
AooAess: j004 Deodar St� Costa I�:esa CA ❑ GRpUT
OWNEFi� ❑ GUNITE
4qCNITECT: O
EN[iINEER�
CONTRACTOR:
L�qTION IN STq{XTIJRE: I
cEMENT: Riverside Plastic
ApMIXTURE� �
SAND
RocK: 'r;o information �rnished
MIX NO.��PROPOATI�N$�
T�ME IN MIXER, MNU'fFS�
SLUMP, INCMES: .
F4B:a�CATEO BV: TRUCKNp� TICKET N0=
T. Pleming
LABORATORY r.�p: 2�1z 27�j 2��4 �
MARK=
�4TE M4DE � � Z—�IO�B�
anre RECEIVEO �2�7C�.�81
OqTE TESTEO: �2��7�8'� �2�24�8�
OIpMETER, INCMES: 2 X 4
APEA.SO.INCWES: 3•�4
MA%IMUM L04Q IBS: ���� �f�00 • I
COMPRESSIVE STTL P51 : 1 f9�� 2s45o
AGE TESTED. OAYS�
'] 3yyg 14 daps
REa'D PS�,n7 2B Oavg: �
UNIT WT�CU FT IPLa5TIC1:
I
OISTRIBUTION: 2 RobePt HePron
1 City of C,M..
1 SCST, Saa Diego
90UTMBAN CALIFOANIA
�81gg1 BOIL AND TE8TIN0, INC.
O�C REViEWEO Bv:
���
e
?�d Bove iiaterial �gineer
e
Address
Contrector
ACP��eant to fill in all swces withln neavy bortler lines ana sign au avProv��ate aeclarations.
COSTFS MESA' PERMIT NO. TRACT NO. LOT NO. ; � BLDG. NO.
�li.i1�N PERMIT F /'� T�'1
(/ TVPE OF CONSTRUCTION -
Phone 37 ❑ NEW ❑ ADD ❑ ALTERATION
� ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
LlCense No. ❑ OTHER
DESCRIPTION OF WORK
LICENSED CONTR/�TOR OECLAKATION L�y(q.ttL/$�1
I hereby a(tirm that 1 am Ilttnsetl untler provision�bf Charter 9
mancing with section ]000) of Divlsion 3 of tha Businef
PIOi25510f15 COd�O+� dfltl T�/ Iicense �5 �fl ill�� �i �E dlltl
Lltense Clas) ' �r,��r% - UcqASEJtl��
WORKEAS' COMVENSi1S10N6ECLARATION � �
I hereby aftirm tbat 1 have a terti/icate of wnsent to self-insure or a
cerHtiwte ol Workers' Compensatlon Insurance, or a certltietl topY
�nereof (Section 3800, Lab. C.).
:y No. Ctimpany
:erHtietl copy Is hereby turnishetl.
LJ Certifietl topy is filed witn t�e clty Bulltling DIvlSion.
EXEMPTION FROM WORKERS' COMVENSATION DECLARATION
(This section neetl not be tompletetl H Ihe permlt is tor one hun tl
(E100) or less)
I<¢rtlfy tha in he performance of lhe work fOr wh�.0 ff� it is
Issuetl, I 5 II n t employ any p¢rson in y ma�J{MF so c e
subject)p e o k �s' Compeni S o( 1(f O f
Date �� Sign
NOTIC : If after making cldratlon, y ShOultl b¢cOm ubj¢ct
to the WOrkGrS' Comp¢nsa on prOWSions of [h¢ Labor Cotle, ou must
forthwitM1 comply with Such provislont or th15 permil Shall be tle¢mCtl
revoketl.
CONSTRUCTION LENDING AGENCV
1 bereby affirm that there is a constructlon lentling agency for th¢ per-
formance of the work for which thls permit is issuetl (Setiion 309]
Civ. CJ. - " -
Lentler'S Name
Lentler•s Atltlrezs �
OWNER BUILDER DECLARATION �
I hereby aHirm that 1 am eYempt from,the Con[racmr's License Law for
the followin9 reason (Seclion 7031.5 Business antl Professlons Cotle:
Any city or county whiGh r¢quires a permit to construcq aller,
Improve, tlemolish o� repal� any St�uCture, prior to Its lszuanc¢, also re-
quires the applicant fo� suCh permit fo file a signetl statement that he
Is Ilcensetl pursudnt to [hC provi5i0ns o( the Cont�actov's LICe05e Law
(Chapter 9(tommencing wi[h Section 7000) of Division 3 of the
P�•<iness antl Prdessions Cotle) or that he is'exempl Iherefrom antl the
for tM1e alleged exemption. Any violdllOn Ot SeCtion 7031.5 by
appliGant for a petmi[ SUbject5 lhe applicanl to a clvll pe0dlty
.�ot more than five huntlretl tlollars (5500).
❑ I, as owner of the pwperty, o� my empioyees with wages as thelr
Sol¢ compensatlon, will tlo fhe work, antl the st�uCture i5 not Intentletl
or offeretl for sale. (Sectlon 7044, Business antl Professions Cotle: The
Cont�actor'S LiGense Law tloes not apply to an owne� ot a p�operty
wh0 builtls o� Improves lhereon, dntl wh0 tlOes such wa�k himselt o�
throu9h nis own employees, provitletl tnat such improvemen[s are not
Intended or o(leretl for sale. If, nowevor, tne builtling or improvamon[
is Soltl within OnC year o� completion, the Owne� wlll have [�a bu�tlen
of proving he tlitl not builtl or improve (o� the purpos¢ of sale).
❑ I, as owne� of thC P�operty, drti ezclusively cont�acting with
�IlcenSetl COniractors ro con5lrutt the prolect (Sectlon 'l044, BuSin¢55
dnd Profe55ion5 Cotle: The COnVac[or's Licenze Law tl025 not appty [o
�an owner o1 property who builtls or improves thereon, antl who con-
t�acls f�om such projeGts witn a-COnt�actor�5) Iicesnetl pur5uant lo
the Cmtractor's license Law�.
,` ❑ I am exempl untler Sectlon B. & P. C. for this
reason
� Date� Owner
VI
I nereby Certity ihat.l have reatl Ihis appliGatipn tl State that lhe a00ve
inPormation is correct. I agree to f�ii ,g' th all clty antl county
ortlinances antl state laws relatina.FC 6 ctlon, antl hereby authorize
�epresentativ¢s of this city 6 pon ¢ abOve nt e
proper ectlon pu
Sipwelv / �'� Oate
ers' License or 55 �
CMF 0865�46 White-Bulltling; Gnary-Appliwnt: Pink-Accountin9: Goltlenrotl-Asseszor
TVPE Of PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURA�
❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHAI
❑ OTHER
PROJEC7 DESCRIPTION .
SQ.FT.
OCCUPANCV_CONSTRVCTION TVPE
VALVATION ZONE
GRADING CU. VDS. ACRES
R K5:
PLUMBING PLAN CHECK '
TOILETS URINALS
LAVATORIES DOUBLE LAVS
KIT. SINKS DISHWASHERS
SERVICESINKS SUMPS
FLOOR SINKS F1.00R DRAINS
DRINKING FOUNTHINS
INTERCEPTORS CLARIFIERS
WATERSERVICE ALTERATION
GASSERVICE OUTLETS
WATER HEATERS BTU OUTPUT
SEWERCONNECTIONS
SOLAR TANK COLLECTORS
SOIAR PIPING SVS.
ISSUE FEE
MECHANICAL a�AN cHECK
HEATING SVSTEM 0-100,000 BTU_
AND DUCTING 100,000 + BTU _
REFRIGERATION 0-100,000 BTU_
SYSTEM 100,000 + BTV __
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
ISSUE FEE
8361 II/17/81
1 i ..
20NING REGULATION:
A.P. �
ZONE PLNG. REF. �
FEFH YARU (l'O P/L)
PKG. SPACE REQ.
STREET WIDTH
?ONING APPqOVED BV
iPEC�AL CONDITIONS:
PROVIDED
PARK FEE
ELECTRICAL � PLAN CHECK
GENERATOR 0-1 KW_1-SO KW
TRANSFORMER
.APPLIANCE 30-SOKW_SO+KW
MOTORS 0-1 HP�1-30 HP
(INC. SOLAR) 10-50 HP 50 t HP
FI%TURES �} OUTLETS SWITCH
GHS TUBE 51 NS �
POLE LIGHTS
J
SERv
APPLICATION APPROVED BV
SUB
AMP
30.32 TL�
DATE
SUMMARY OF FEES
BUILDING
PERMIT E SMIP y
PLAN CHECK $ PERMIT
� ISSUANCE b
PLUMBING S
PLANCHECK § GRADINC�. b
ELECTRICAL $ ��� �� s .
PLANCHECK g MICROFILM $
MECHANICAL b TOTAI FEE S
PLAN CHECK 'E LE55 AD-
VANCEPC $
FINAL FEE E
CONSTRUCTION AND PLANNINcG t POOL & SPA . .` , "� • - --�-V � `
APPROVALS permit # �^ � J Date Inspector qppROVALS Permit # DaLQ - � Inspector
1. Temporary Electrical Service or Pole �' 43. Pool & Equipment Location �
2. Soil ipe-Undrgrn 44. Steel Reinforcement • �
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn .�) [� 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test � - '
6. Electrical UFER Grn �y�N_g v 48. APPROVALTO COVER-GUNITE' -•
7. Footings 49. Electrical Conduit-Undr rn
6. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra �� ndr rn '
10. Structural Floor System 52. APPROVALTO DECK '
11. Property Sewer Line & House Connection 53. Backwash.& Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing
14. Rough Electric-Conduit (i �56. `Electrical-Final
15. Rough Electric-Wiring � 57. Solar System-Final
16. Rough Heating & Air Conditioning � encing & Access Approval
17. Ducts, in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating � _ •
. C�
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frame and Flashin NOTES:
� '23. 'Insulation' � � ' G 11-�FJ-�
24. Lathing & Siding � L
25. Drywall Nailing p
26. Plaster Brown Coat_
27. ; Electrical Power MeterFinal _��2 C
28. ' Final Electric _is- 2
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final �
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATEOFOCCUPANCY
� No� Date . •
`i
'' .4Po�leant to fill In all soaces witnin
CITY OF COSSA MESA PERMIT N9
CONSTRUCTION PERMIT A / (o % cS�
aad.� /6/ 96 t� �9,fiP/�L'C2 ; ti• i3 •
Arch/Eng. License No.
Address
Contractor %1, (,�. '}7�//,l,( //µ: Phor
Address lA// /1i�UQi;C AuLJ ! Xl. . i
I hereby affirm that I am IlcenSeG unGer provislont o( Charter 9(com-
mancing with sectlon ]000) of Dlvislon 3 oi the Buslnest antl
Professlons Cotle antl my Ilcense is In fu❑ forpe ntl �t �.
License C 55 �' LI e 58 N �� �
Date � ' Si9nature yL_
WORKERS' COMPENSATION DECLARATION
I hEleby aftilm that I Ilave d CeltltiCdtB Of COnsent IO SGI/-Insufe of a
�certitiwte Of WOrkers' Compin5ation Iniurance, Or a cerlilletl copy
thereof (Section 3800, Lab. C.).
by No. Company
]ertifietl copy is hereby furnlshetl. _
v Certifletl copy is filetl with the city Bulltling Divitlon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tnis sectlon neetl not oe completetl If tne permit Is for one huntlretl
SE100) or less).
certify that in the performance of tha work for which Ihls permit is
issuetl, I shall not employ any p¢rson in any manner so as to become
subject to the Workeri' Compensatlon Laws of Calitornia.'
Da[e Si9nature
NOTICE: If after making this tleclarallon, you shoultl bacome subject
to the Workers' Compensa[ion provizions ot the labor Cotle, you must
fOrthwith COmply with SUcn prOvi5ion5 or thls permit shall be tleemetl
revoketl.
CONSTRUCTION LENDING AGENCV
I �ereby af(irm that there is a tonztructlon lentling agency tor the per-
torman<e o( Ihe work for wnlch this permit is 15suetl (Section 3097
Civ: C.1.
Lentler'S.Name � �
L.enaer'i.Atlaress ' `'
OWNER BUILDER DECL[1RHTION �` ? "�° " �"��
I hereby atfirm Ihat 1 am exempt trom [he COntractor'S Ucense�Law tor
Ihe following reason (Section 7031.5 Business antl Professions Cotle:
Any ci[y or county whiCh rGquiles a p¢fmit l0 constlUCt,, dlter,
Improve, tlemolish or repair any structure, prlor to it5155uance, also re-
qWreS [h¢ applirznt foi such p¢rmit t0 tile'd Signitl 5[atement t�at he
appuGani ro� a permrt suo�ec[s ma appuran� m a crvu penany
�ot more than five huntlretl tlollars (E500).
�J I, ds owne� of the prop¢rty, or my omploye¢5 with wage5 a5 th¢Ir
sole compen5ation, will tlo the work, and the structure is not intendetl
Conirdctor'S UCCns¢ l.aw Ooei noi appiy .to an owner or a propeRy
who bulltl5 0� imp�oves th¢rEon, and who tloe5 Suth wOrk hlmself Or
th�ough his�own employee5, provitled thaf Such improvement5 a�e no[
intentletl Or otferetl for sale. It, however, the builtling or improv¢men[
is Soltl within onE yBar of.completlon, tha ownar wlll hava thC burtlen
of p�oving he tlitl not builtl Or Improv0 Por th¢ purpose ot sale).
❑' I, as owner of tne property, am exclusivety contracting with
Iicensetl contractors to conSVUGt the OrOj¢Ct (58CUOn 7044, Business
antl Professions Cotle: The Con[ractor'S Llcense Law tloes not apply [o
an owner ot proper[y who builtls or Improves thereon, antl who con-
Yracts from such projects with a contrattor(s) Ilcesnetl pwsuant to
the ContraGtor'S LlcenSe Law).
� 1 am exemp[ untler Section B. & P. C. for ihis
reason
Date Owner
I hereby certify that I have reatl this appllcatlon antl s[ate that tha abOVC
informa[ion is co��ect. I ag�ee to comply wlth all ci[y antl county
ortlinances antl state laws relatln9 to construttion, antl hereby authorize
representatives o this city to gntef7 on the above mentlonetl
property.fo n ectl purppSq�I.. /J� // Q Jr�
4Y .GYJS.�� C
GorOer IIneS anG sign all approp�iate tlecla�ations.
TRACT NO. LOT NO. �BLDG. NO.
TVfE OF CONSTRUCTION
IYINEW ❑ ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER � �"'� �
DESCRIPTION OF WORK
TYPE OF PEHMIT
❑ GRADING ❑ FOVNDAT,I,OJry ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL CJPLUMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION
5�. FT. �
OCCUPANCY_CONSTRUCTIONTVPE
VALUATION ZONE
GRADINGCV.VDS. ACRES
- -.O / 7- / G7
PLUMeING PLnN CHECit
BATHTU85 SHOWERS
TOILETS � VRINALS �
LAV TORIES DOVBLE lAVS
. INKS �/ DISHWASHERS
SERVICESINKS SUMPS
.FLOOR SINK$'-' FLOOR D(3AIN5
DRINKING�FOVNTHIN$ �
INTERCEPTORS CLARIFIERS
SWIMMING POOL PT0.AP
WATERSERVICE ALTERATION
GASSERVICE OUTLETS
WATERHEATERS� BTUOVTPUT
SEWER CONNECTIONS �
SOLAR TANK � COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECIC
HEATING SVSTEM 0-100,000 BTU_
AND DUCTING 300,000 + BTU _
REFRIGERATION 0-300,000 BTU_
SVSTEM 100,000+�TV_
BOILERS BTV
SVSTEM REPAIR, HLTERATION
EXHAUSTSVSTEM MULTIPLE
Signature � � Date I ISSUE FEE
Drivers' License or 9v5/
CMF 0865-46 Wnite-Builtling; Gnary-Applicant: Pink-Accounting; Goltlnnrotl-Assessor
� x�rc
A.G. $
ZONE
8024 11/09%81
REAR YARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH �
ZONING APPROVED BV
SPECIAL CONDITIONS:
ELEC7RICAL
PLNG.
PROVIDED
PARK FEE 5
PLAN CHECK
AR� --
GENERATOR 0-1 KW_ 1-10 KW _
TRANSFORMER
A�PLIANCE 30-50 KW 50 i KW _
MOTORS ' p.l HP_1-10 HP _
(INQ SOLAR) 10-50 HP �50 + HP _
FIXTURES' OVTLETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
51,00 1U
PANELS MAIN SUB
SERVICE AMP -
" ISSVEFEE
APPLICATION APPROVE� BV DHTE -
SUMMARV OF FEES
BUIIDING
PERMIT § SMIP $
PLAN CHECK S �) PERMIT
P�UMBING $_L/ •DO �SSVANCE $
GRADING $
PLAN CHECK $
ELECTRICAL $ E
P�AN CHECK g ' MICROFIIM S
MECHANICAL $ TOTAL FEE $
PIAN CHECK $ LESS AD-
VANCE PC 8
FINAL FEE $_p/_�
CONSTRUCTION AND PLANNING POOL & SPA � '
APPROVALS Permit #�_��7 Date Inspector qppROVALS � permit # Date Inspector
1. Temporary Electrical Service or Pole - 43. Pool & Equipment Location ��
. Soil ipe-Undrgrn � 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn � 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding �
. tee ein orce - 47. Rough Plumbin & Pressure Test '
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE �
7. ootings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test �
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra "❑ ndr rn
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer.Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connpction p(< �,o� � � � 54. Heater & VenbFinal
13. Rough Plumbing S� � � � gc_
� 14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final �
16. Rough Heating & Air Conditioning, �- encing & Access Approval
17. Ducts in Structure � APPROVED FOR PLASTERING �
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing - -
21. Roof Sheathin � ' �
22. Frame and Flashin NOTES:
23. Insulation
i
24. Lathing & Siding ' '
25. Drywall Nailing '
26. Plaster Brown Coat c:- � ,�/
27. Electrical Power Meter-Final � � t'
26. Final Electric � �. MT- ,,,
29. Final Heating & Air Conditioning orc d�.d r la ' p
a r - o s�z
30. Final Gas Pipe-Test
31. Final Plumbing G� �Y•�jt
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations -
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATEOFOCCUPANCY
No Date .
' � ApP���ant to fill In all spaces witnln heavy Dortler lines ane sign all appropriate tleclarations.
CITV OF�' STA MESP � PERMIT NO. TRACT NO. LOT NO. .�k96. NO. 7QO3 I OI I EIBI ' ��OO T�.�
,
CONSTr'ZUCTION PERMIY F_� /�/ � A �6-G- . _ . ._ .. . .._ _.. _ . . _.
Phone
Addrea
Arch/Eng. � �y license No.
Address D — G
Contractor Q'�� Phone
Address '
1 hereby aftirm Ihat I am Iicensetl untlar provi5lons o/ Charter 9(com-
mentin9 wlth sectlon 7000) of Divislon 3 of tha Buslness antl
ProfeSsionS Cotle, antl my IltenSe is In full force antl et(ect.
License Class Ucense No. �
Date Slgnature
WORKERS• COMPENSATION DEGLNRATION
1 hereby aftirm [hat I have a certlficate of tonsenl to self-insure or a
certifiwte of Workers' ComDensaUon Insurante, or a cartlBetl coOY
thereof (Section 3800, La�. C.).
, -y No. Company
irtifieC <opy Is hereby furnlshatl. .
L. ,;ertlfietl copy is filetl with tha city Builtling Dlvlslon. .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This saction need not be complo[etl if tne permlt Is tor one huntlretl
(53001 or less�.
I.certlty Iha[ In [he performanCe of th¢ wOrk fOr whlGh tnis perTlt is
Issuetl, 1 shall not employ any person In any manner so as to become
subjec[ to the Workers' Compentation Ldws of Calltornia. �
Date Slgnatura �
NOTICE: If after making this GeUaration, you shoul0 become sub�ect
to the Workers' Compensation provlsions of the Labor Cotle, you must
fOr:hwith Comply with Such p�ovlSlonS Or thi5 perrtlit Shdll be Oeemetl
revoketl. . . . -
CONSTRUCTION LENDING AGENCV
I hereby affirm tnat there Is a constru<tlon Ientling agency for [ha per-
to�mance ot [he work br which this permlt Is issuetl (SecUon 309]
Civ. C.�.
Lentler's Name
Lentler's Atlaress
OWNER BUILDER DECLARATION '
I hereby affirm that I am ezempt from tne Contractor's Litense Law tor
the following rea5on (Sectlon 7031.5'Buslness antl Professlons Cotle:
Any tlty or county wM1ich requlres a pe�mit to COnStruGt, al[2q
quir25 [h¢ appllcvnt tor SUCh p¢rrrll[ t0 flle a 5ignetl s[atement tnat ne
is licensetl pursuant to the provislons of the Contractor'S License l.aw
(CM1apter 9(<ommencing with Section �000) of Dlvision 3 of the
Bu5ine55 antl Prdessions Cotle) or thaChe I5 exempt therefrom antl the
b- " tor the allegetl exemption. Any violatlon of Section Z031.5 by
pplicant for a p¢rmlt suC)ect5 the dpplitdnl t0 a Clvll penal[y
� t more than five huntlretl tlollars (5500).
�J I, a5 owner of tM1E Prope�ty, or my employees wlth wages a5 thelr
sole compensatlon, will tlo the work, and the sVucture Is not Intentletl
or ofteretl for sale. (Section 7044, Business antl Aofesslons Cotle: The
Contractor's License law tloes nol appry to an owner of a proPerty
who bulltl5 or Improves tnereon, antl who tloe5 Suth wOrk nimseli or
through his Own employee5, prOvltletl that SUCh IR1prOvement5 al¢ not
intentled or ofimetl for sale. If, huwever, tne bUlltling O� Imp�OVOmOnt
I5 sOltl within one yedr Of completlon, Ihe owner wlll hdve the buttlen
f provMg he tlitl not bulltl or improva for the purpose of sale).
I, ds owner of th0 ProPerty, am ezclusively cOnlraGting wlth
i nsetl conVactors to construct tM1e prolect (Sectlon 7044, Bu5lness
antl Professions Cotle: The Contractor'S Liconse Law tloes not apply to
an owner ot property wM10 builtl5 or Improves tnereon, dntl�wh0 ton-
tracts from such projects with a<ontractor(s) Iltesnetl pursuant to
the Coniractor's License Law).
❑ I am exempt untler Se<tlon B. & P. C�or this
reason '
Date Owner
I her2by certify [hdt I have �eaG thi5 apP����ion antl state that th¢ abOve
informallon is correct. I agre to Comply wilh all city dntl COunty
ortlinances Qate laws rela i g to construttlon, antl hereby auihorize
re0�esent Ive ��Jf knisiery�% o ente� upOn th0 dbove /mGptionatl
TYPE OF CONSTRUCTION
�.fJEW _O ADD ❑ ALTERATION ,
❑ REPAIR ❑ CONVERSION ❑.DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTVRAL
❑ TENANT ❑ ELECTRICAL OPWMCBIMNG ❑/�� CHAI
❑ OTHER /���t"�/1J/GlOAI ��ITA` O`^"
PROJECT DESCRIPTION - .
SQ. FT.
OCCUPANCY_CONSTRUGTION TVPE
VALUATION ZONE
GRADING CV. YDS. ACRES
PLUMBING
TOILETS
LAVATORIES
KIT. SINKS
SERVICE SINKS
FLOOR SINKS
DRINKING FOUNTAINS
INTERCEPTORS
PLAN CFIECK
SHOWERS
URINALS
DOUBLE LAV S
DISHWASHERS
SVMPS
FLOOR DRAINS
CLARIFIERS
PTRAP
WATERSERVICE HI.TERATION
GASSERVICE OUTLETS �
WATER HEATERS� BTU OVTPVT
SEWER CONNECTIONS ' -
SOLAR TANK COl_LECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN cHECK
HEATING SVSTEM 0-300,000 BTU_
AND DUCTING 300,000 + BTU _
REFRIGERATION 0-100,0008TV_
SVSTEM 100,000+g7U_
BOILERS BTU
SVSTEM REPAIR, ALTERATION
EXHAVSTSVSTEM MVI.TIPLE
Slgnature Date •�LL_L I
Drivers' L'cense or 55 YF / / ISSV E FEE
CMF 0865-4fi White-Bulltling; Canary-Applicant; Pink-Accounting; GoltlenroA-A55essor
' � `'�
20N1
A.P. �
ZONE
SETBACK T.
51 VARD
L5 D
A R�IGHT
REAR YARD (TO P/L)
PKG. SPACE RE�.
STREET WIDTH
ZONING APPROVED B1
SPECIAL CONDITIONS:
ELECTRICAL
PLNG. REF. �
PROVIDED
PARK FEE 5
PLANCHECK
' GENERATOR 0-1 KW_1-30 KW _
TRANSFORMER
' APPLIANCE ]0-SOKW_SO+KW_
�MOTORS ' 0-1 HP_1V0 HP _
(INC.SOLAR) ]p-50HP 50+HP_
FIXTURES OUTI_ETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
PANELS MAIN SUB
SERVICE AMP
ISSUE FEE
qoPLICATION APPROVED BV pATE
SUMMARY OF FEES
BUILDING
PERMIT S SMIP E
PLANCHECK 5 PERMIT
- ISSUANCE $
PLVMBING b GRADING $
PLAN CHECK $
ELECTRICAL $ $
PLANCHECK § MICROFILM $
MECHANICAL S TOTAL FEE S
PLANCHECK E VANCEPC $_
.�
FINAL FEE §
�•' CONSTRUCTION�AND��PL�,4NNING �. � � ., � POOL&5PA�:,�.�.� --.�':.`. � � � �� •
APPROVALS Permit #�� 1� �� Date Inspector qppROVALS Permit # ` Date Inspector
1. Temporary Electrical Service or Pole �'j � 43. Pool & Equipment Location �
2. Soil ipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding �
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ Undr rn
10. Structural Floor System 52. APPROVALTO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final �
12. Street Sewer Connection 54. Heater & Vent-Final
73. Rough Plumbing �
14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts, in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test � 60., POOL/SPA SYSTEMS FINAL �
20. Roof Praming �
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation
24. Lathing & Siding -
25. . Drywall Nailing
26. ' Plaster Brown Coat � �
27. Electrical Power Meter-Final [�
28. Final Electric G '
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test - '
. 31. Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date
, f
� �"� •� Applicant to fill in all spatts wilhin neavy bortler Iines ana s19��� aoGropriate aeclarotions.
�ITX3�OST�Q MESA PERMIT NO. TRACT NO. OT NO. '�� 6. NO.
�� CO�IS�RUCrt10�V PERMIT M Ic� - `�J
Project Address - �, (� � yTVPE OF CONSTRUCTION
Owner ! p - Phone G � ZF p� NEW ❑ ADD ❑ ALTERATION
Address � �j ;d � �,J/' 'O REPAIR ❑ CONVERSION ❑DEMOLISH
�f0.scli/Eng. ' (A[ - hJAS LicEnSC No. ❑ OTHER
DESCRIPTION OF WORK b-S R '� Z
Address �$(� ' j((, /LJk t�U ' - — - �
Contracror �� - Phone I' TVPE OF PERMIT .
Address ❑ GRADING � ❑ FOUNDATION �STRVCTURAL
LICENSED CONTRACTOR DECLARATION ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHP.I
I hereby affirm that I am licensetl untler provisions ot Charter 9(com- C\ �±` �'i-
mencing with seccion ]000) of Oivision 3 of tne Business antl ❑ OTHER ��'
Protessions Cotle, antl my Iicense is In Tuu forte antl effett. pROJECT DESCRIPTION�
License Clasi License No. 3/O� '
Date Signatur¢ ' Sp. FT.,��_q�_ . �//
WORKERS'COMPENSATIONDECLARATION OCCVPANCV"�rCONSTRUCTIONnTYPE� �"
l hereby atfirm that I have a certificate of consent to SelLinsure or a VALUATION �A����� ZONE u��
certiticate of Worker5' Compen5ation Insurance, or a Certlfied copy . . -
thereot (Section 3800, Lab. C.). GRA�ING CU. VDS. ACRES
Pn��cy No. Company
� � rtifietl copy is hereby tumishetl. � REMARKS: x 30 3f' � 2' � j/j�,9 �
� .rtifietl copy is fileG with the city Builtling Divislon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � � d •�C
(This-section neetl nat be completed if the permit Is for one huntlretl '� `'7
($1��) OI IB55).
I Certify that in the performance ot the work for which this permit is
issuetl, I shall not emPloy any person In any manner so as to' become PLUMBING " PLAN CHECK
subject to the Workers Compensation Laws of California.
Date Signature BATHTUBS SHOWERS
NOTICE: If after making this tleclara[ion, you shoultl become subject TOILETS � URINALS
to the Workers' Compensation provisions of the Labor Cotle, you mus[ LAVATORIES DOUBLE LAVS �-
fo�thwith comply with such p�ovi5ion5 or this permit shall be tleemetl
revoked. - - - -
CONSTRUCTIONLENDINGAGENCV KIT.SINKS DISHWASHERS
Ihereby,affirmthatfhere-isa'con5tructionlentlinqegencyPorthe..pen SERVICESINKS �SVMPS - -
tormance�of ttie work�fior �,ovFich this �peY,mit isrissued�(Section 309] �
Civ. C.).�—� �� � --�c, '�FLOOR�SINKS \FLOOR DRAINS
Lentler's Name - �- - _ _
Lentler's Atldress, - ` DRINKING FOUN�AINS -
_DER DECL/
n that I am'Eo
reason (Sect
6ounty� whi
olish o� �epai
�lirvnt fousw
nuan[ to the
commencin9.
PrWessions G
allegetlfexem
Por a perm
[han (ive hur
�r of tM1e pro
s me appucanc [o a
ars (g500). �' �
my emplayee5 wi[h �
� INTERCEP"
SWIMMING
GAS
tneir SOLAR TANK
�ntletl'
: The SOLAR PIPING SVS.
Law tloes no[ appry [o an owner�Ot a pro0erty' ,
ies [hereon,.antl who tloes such work him5elf or ISSUE FEE i �
I, as owner of the F
icensetl contraclors to co�
antl Professions Cotle: The
an owner of property whc
tracts f�om such proje[ts
the Contracto�'s Li[ense La
❑ I arri exempt untler Secti
reason -�
Date� �0 ` � �Ow
1 hereby cer ify, �' f that I have r
intormation is correct. I �
�itletl thdt suc� improvement5 are�not
�oweveq the builtling or improvemenl
;t�on, the owner will have'the burtlen
�•�mprov¢ fOr [he pu�pose o( sdle�.
ty, am'extluiively coriVacting with
'. the project`(Section ]044, Business
ac[or's License Law GoeS not apply [o
Is o� improves thereon,.dntl wno con-
a contractor(s) IIceSn¢tl pursuant to
B. P. C. for this
. . . � . .� • . -
. ' . : ,�JL�.. •••
�is appli<ation antl 5 that the above
CLARIFIERS
PTRAP -
ALTERATION
OUTPUT
COLLECTORS
MECHANICAL PLarv CHECK
HEATING SVSTEM 0-300,000 BTU_
ANDDUCTING ]OO,OOO+BTU_
REFRIGERATION �0-300,000 BTU_
SYSTEM � 100,000 + gTU _
BOILERS 1 • BTV •
SVSTEM.REPAIR,ALT.ERATION
EXHAUST SVSTEM . _ �'MULTIPLE
. .J 7 . :C � ._ _
�epresentativ s T thi�ty o enter upon. the above ¢[ionetl- - , y
property to� P i u s s. •��' �•� ��.� "' �" 1�
Signature "Date� ' S � �� � . ,
Drivero' Llcense or 55 � ' ' _ ��SSUE FEE ' '
CMF 0865-46 White-Builtling; Canary-Applicant; Pink-Accountinq; Goltlenrod-Assessor
�
�
3
7002 10/16/BI
ZONE
REAR VARD (TO P/L)
PKG. SPACE REq.
STREET WI�TH, . - �s
s
LONING APPqOVEO BV
:PECIAL CONDITIONS:
ELECTRICAL
PLNG.REF.�
PROVIDED
PARK FEE $
PLANCHECK
GENERATOR " 0-1 KW__1-30 KW _
TRANSFORMER
APPLIANCE 30-50'KW_SO+KW_
MOTORS 0-1:HP,_1-lO�HP _
(INC.SOL'AR)' �30-SOHP�_SO�+FiP_
FIXTURES � OUTLETS SWITCHES
GASTUBE'SIGNS '
POLE LIGHTS
PANELS MAIN SUB
SERVICE � ' AMP
477.80 TL�
' APPLICATIONAPPROVEDBVG(f/jTj(Q� 1�r�qTE
SUMMARV OF FEES q� a
BUILDING
PERMIT $���-� SMIP $
PLAN CHECK E PERMIT
ISSUANCE E
PLUMBING E
GRADING S
_ PLAN CHECK $
. ELECTRICAL $ S
PLAN CHECK E MICROFII.M $
TOTAL FEE�
MECHANICAL $
� . LE55 AD-
._ _ 'PLANCHECK $ VANCEPC $_
__ .'\ .. � .. � . , .
/ ,. ` �
. ' � 1 . .`. ,• c'.,� �� FINA�C FEE
7�.
ti
qpplicant to fill in all soaces within
��.� CIT�.�OF COSTA MESA .
COIVSTRUCTION PERMIT
Address ��7��%�� �Q��%�� i�� �u1u�
Arch/Eng. � License No.
Address
Contractor L Phone
Address
I he�eby a(firm thtt I am licensetl untlEr provision5 ot Chart¢r 9(cortl-
O120CIf19 Wl�fl SZC�IOII %000) Of ,DIVI5100 3 O1 [hC B1I511IC55 dllC
Professions Cotle, antl my Ifcense is in tull force antl e(fect.
Llcense Class License No.
Date � Si9natute
WORKERS'COMPENSATION DECLARATION
1 hereby affirm ihat 1 M1ave a certificate of consent to self-insure or a
certifiwte-of Workers' Compensation Insurance, or a certifiee copy
�eof (Section 3800, lab. C.).
cy No. Company
u Gertlfietl copy is hereby furnishetl. �
❑ Certifietl copy is filetl with the city Builtling Division.
EXEMGTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl it the permit i5 for one huntlretl
Sg100) or less).
certify Ihat in [he performance ot the work tor which this permi[ is
Issuetl, I shall not em0�oy any p¢rson in any manner so as to become
SUDject to the Workers' Compensation Laws of Calllornia. .
Date Signatur¢
NOTICE: If afte� making ihi5 tleclaration, you shoultl become subject
to the Workers' Compensation provisions of the Labor Cotle, you musl
fOrthwith mmply wlth such provision5 Or this perrtfit Shall be tleeme0
revoketl.
CONSTRUCTION IENDING AGENCV
I hereby affirm ttiat ihere is a constiuction lentlin9 agency for tM1e per-
formance of the work for: which.this�permit is issuetl,(Section.309'!
Civ. 0.�. �'
Lentler'S:Name �
Lentler's Atltlress' � � �� E' _ '
OWNER BUILDER DECLARATION - � ' � < ' ` �
I hereby affirm ihat I am ezempt from.the Contractor'S.License:L•aw.for
the following reason (Section 703L5 Business and ProfeSsions Cotle:
Any city or county which �equire5 a permit to mnsVuct, alter,
irifprove, tlemolish o� repair any structure, prior to it5 i55uanC¢, alm �e-
qUires tne ap� licant for such permit to file a siqnetl statement that he
is licensetl purzuant to the provisions of the Contractor's LicenSe Law
(Chapter 9(commencing with Section 7000) of Dlvision 3 of the
�ness antl Profeszions Cotle) or that he is exempt iheretrom antl the
for the allegetl exemption. Any violation ot Section ]031.5 by
appiicant for a permit sublects [be applicant to a civil penalty
or not more than five buntlretl tlollarz (y500).
❑ 1, as owner of thc property, or my employees with wa9es as their
Sol¢ Compensation, will tlo the work, antl the structure is not In[entletl
or offeretl for sale. (Section 70a4, Business antl Professions Cotle: Tne
Contractor'S License law tloes not apply to an owner of a property
wha builtl5 or improves fhereon, antl who does Such work himself or
throu9h hi5 own employees, provitletl that such improvementz a�e not
intentl¢d or offe�etl for sale. If, however, the builtlinq or improvemeni
is sold within one year of completion, Ihe owner will have the burtlen
f, proving he tlitl nol builtl or improve for [he purpose of sale).
y"as owne� of tM1e property, am ¢xclusively cont�actin9 �+'�th
IC205¢d COlILfdCLOfS l0 COf15IIUCl IhE pfOj2C[ ($fCI1011 iO44. BUSIfIC55
dnC Professions Cotle: The Contracto�'S Litense'Law tloe5 not apply to
an owner of property who builtls or imp�oves the�eon, antl who con-
t�act!'from sucM1 -projeCts' with a"contractor(s) licesnetl pwsuant to
the Contractor's License Law).
❑ 1 am ¢xempt untl¢r Section� -T��B. & P. C.-tor�thi5
Date � Owner�' � -
I hereby ertif thal I have reatl tM1is appl Cation an state that the
informa[ion is correct. I aqre to comply witn all city antl <
ottlinances tale laws relat�9 [o,const�uction, antl hereby aut
r¢presen ive of this cit lo enter upon the above me
p�opert for i sp ct' r 5 s. � 2 r
L
boraer lines ana sign all appropriate tleclarations.
TRACT NO. LOT NO. BLOG. NO.
TVPE OF CONSTRUCTION
�NEW ❑ ADD ❑ ALTERATION
❑ REPAIR� O GONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT � i(�R/�/fl�+ • -
❑ GRADING ❑ F NDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION
SQ. FT.
OCCUPANCV_CONSTRUCTION TVPE
VALUATION ZONE
GRADING CU. YDS. ACRES
REMARKS: �
PLUMBING
BATHTUBS
TOI LETS ,
LAVATORIES
KIT. SINKS
�SERVICE SINKS
FLOOR•SINKSl �
,DRINKING FOUNTAINS
INTERCEPTORS�� r,
PLANCHECK
SHOWERS
URINALS -
DOUBLE LAVS
DISIiWA5HER5
SUMPS
FLOOR DRAINS
CLA(31FIER5
WATER SERVICE ALTERATION
GASSERVICE OVTLETS
WATER HEATERS BTU OUTPUT
SEWERCONNECTIONS -
SOLARTANK -COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
NEATING SYSTEM 0-100,000 BTU
AND DUCTING' 100,000 + BTU
REFRIGERATION 0-300,000 BTU
SVSTEM ' 100,000 + BTU ` •
BOILERS BTV
SVSTEM REPAIR, ALTERATION
EXHAUSTSVSTEM MULTIPLE
Signature Da[e '�
Drivers' Lic�nse or �5 �
� — 65UE FEE ' - -
GMF 0865-:6 Wnite-Builtling; Canary-Applican[: Pink-Accounting; Goltlenrotl-Assessor
3647 3/24/92
ZONING REGULATION:
A.P. �
ZONE PLNG.REF.�
REARYARD
PKG.SPACE
ZONING APPROVED BV
SPECIAL CONDITIONS:
PROVIDED
PARK FEE
ELECTRICAL PLAN CHECK
GENERATOR 0-1 KW_ 1-30 KW _
TRANSFORMER
APPLIANCE 10-50 KW_50 + KW _
MOTORS 0-1 HP_I-30 HP _
(INC.SOLAR) 30-50HP 50�+HP_
FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS _
POLE LIGHTS ' ' - ' ' ' '
PANE�S MAIN SUB
SERVICE' AMP
ISSUE FEE' ' - '
'LICATION APPROVED BV
t � ���0 T4
r
/♦♦♦SdUM�MARV OF FEES ,. • �
�PERMIT G $��_ SMIP E �
�PLAN CHECK § ,-PERMIS ' .
� -- - ISSUANCE $
PLUMBING $ GftADING $ -�
- - �'PLANCHECK $ ' ' . , -
ELECTRICAL $ �� $
PLAN CHECK - $ MICROFILM $
-�� TOTAL FEE $ _
MECHANICAL $ - - �
'�PLANCHECK g � "CESSAD-
, -VANGEPC $_
/d.da I�
FINAL FEE $
- t . . �. .,� � ' � • '
CONSTRUCT�ON AND PLANNING ], POOL & SPA - �- ' � �t�
APPROVALS Permit# �'+.�Jo� Date Inspector qppROVALS Permit# ��''� Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location � - � - �
2. Soil ipe-Undrgrn � 44. Steel Reinforcement �� �• -
3. Electrical Cond�it Utility-Undrgrn 45. Forms
4. ,Electrical Conduit-Undrgrn 46. Electrical Bonding
tee ein orce 47. Rough Plumbin & Pressure Test - �
6. Electrical UFER Grn 48, qPPROVALTO COVER-GUNITE
7. Footings � 49. Electrical ConduirUndr m � � ��
..S.Y Foundation � � �50. ,Gas Pipe, ❑ Undr rn, Test � � ' �
9. Water Pipe-Undrgrn._ . 51. Backwash Lines P-Tra ❑ ndr rn
10. _ Structural Floor System 52. APPROVAL TO DECK - -- -
' 1.1. _. Property Sewer Line & House Connection _53. Backwash & Rece tor-Final '� ' - �� -
12. Stceet Sewer Connection ' � � � � 54. Heater & Vent-Final � � � ;;R,��
73._ . Rough.Plumbing -
'14. Rough Electric-�onduit - - - • - - �56. Elect�rica6Final � �
.15. Rough Electric-yyiring � -- 57." So�ar System-Final - � � ' ' ' -
76. Rough Heating & Air Conditioning � � encing & Access Approval
17. Du in Structure 59. APPROVED FOR PLASTER�NG
18. Ducts, Ventilating _ .
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL �
. 20. Roof Framing �_ . . . _ ' ' � �
21: Roof Sheathin � - ' -
22. Frame and Flashin NOTES: � �
23.- Insulation � ' -
24. Lathing &-Siding _ -�y"'- - - � ' � " v
25: Drywall Nailing - O-K . '
26. Plaster Brown Coat � � � ' -
27. Electrical PoweF Meter-Final ' � �
- 28. Final Electric - - - �
29. Final Heating & Air Conditioning _ � � � • .'
30. Final Gas Pipe-7est . . � ' ' � � � -
31. Final Plumbing - "
32. Water Service-Final � ' �
�-33. GasService-Final ���� ' � '
� 34. Solar pomestic-Final " �
35. Landsca e S rinklin S stem
- 36. Sound Attenuation - �
37. Handicap Regulations � � - �
38. FINALSTRUCTURE&BUILDING � �
39. Special Requirements Completed " " ' - -
40. Electric Release to Edison ' - '-- ' � " ' � " ' - ' '
41. Gas Release to Southern California Gas Co. � � ' � � '� " - - �
' 42. CERTIFICAT� OF OCCUPANCY
No._._ Date ,
' Applicant to fill in all s
.. �� CI:7°Y• OF COS7A MESA �P�,ERMIT N�.
CONSTRUCTION PEFiMIT I 1.. ^ J�
within �eavy bortler lines anE si9n all aOG�opriatC Oecla�ations.
= TRACT NO. LOT NO. BLDG. NO.
rro�ecc raaress QQ I�VlPE OF CONSTRUCTION
: Owner Phone ��NEW ❑ ADD ❑ ALTERATION
Addrets ���,9'� - ��/�_- `�� ' � REPAIR ❑ VERSION ❑DEMOLISH _
� ArchlEng: - License No. - THER ' �
Address - . DESCRIPTIONOFWORK
Contractor � � / - - Phon TVPE OF PERMIT -- '
Addre55 ' � -' ❑ GRADING ❑ FOUNDATION � STRUCTURAL
LICENSED-CONTRACTOR � CLARATION.. �' ❑ TENANT O�EIECTRICAL ❑PLUMBING ❑MECHANI(
1 hGr�by afti�T thut I am Ilcensetl untle� provisions Of CharlGr 9(COm- . , �
mencing wilh secllon 9000) of Division 3-of tbe Businesz 'antl ❑ OTHER
�Professlons Gotla, ntl y licenze is in full force an effe .
License Ciass �' � "- � �:y e o PROJECT DESCRIPTION , . . �
Date Si9nature _ AYta� SQ. FT.
WORK RS'-COMPENSATION DECLARATION . ' �OCCUPANCV_CONSTRUCTION TYPE
�1 hereby atfirm [hat I bave a certlflcate of mnsenC to 5olLinsure or a VALVATION ZONE
certHiwte oi WorNers' Compensatlon Insurance, or a<ertlfietl copy _
`^reof (Section 3800, Lab. C.�. GRADING CU. YDS. ACRES
Icy'No. - Company - -- - -
Certlfietl copy Is hereby furnisnetl. ' REMARKS: .. �
�� CerHfietl copy 6 tilatl with the city Builtling Division.
EXEMPTION FROM WORKERS"COMPENSATION DECLARATION �" �
(This settion neep not be completetl if the permit is tor one huntlretl �
(5100) or less). ' - �--
I cerHfy that in tne performance of lhe work for which tnlz permit is
issuetl, I shall not emPloy any person in any manner So as to Oecome PLUMBING' PLAN CHECK
5ubjectlotheWorkers CompensatlonLswsofCalifornia. � '
Date Signature BATHTUBS "'-SNOWERS - ' -
NOTICE: If after makinq this tleclaration, you shoultl betome�subjecl TOILETS URINALS �
to the Workers' Compensation provislons of the Labor Cotle, you must � � -
.�forthwith tompty wi[h suGh provislons or ihis permit Shall be tleemetl LAVATORIES DOVBCE CHVS - --
revoketl.. __ � �- KIT.SINKS- ' ' � ' DISHWASHERS
iCONSTRUCTION LENDING AGENCV
I nereby affirm tha[ there is a constructlon lentlinq a9ency for the per- SERVICE SINKS SUMPS ' -- -
tormance of the work lor which thls permit is issuetl (Section 3097
C1°' C'�' ' -� -'- ' ' FLOOR SINKS '- -- 'FLOOR DRAINS ' '
Lentler'S Name
,Lentle�'s Atltlress �' DRINKING FOUNTAINS ' - ' "'
OWNERBUILDER DECLARATION � - INTERCEPTORS-' -" CLARIFIERS ' ' ' '
I hereby aHirm that I am exempt from the Contractor's License Law tor
Ihe following-reason-(Seclion �031.5 Business and Professlons Cotlo: SWIMMING POOL - ' PTRAP
Any city or county which �equires a permit to Construct, alter, �� � � ���
improve, demolizh orrepairvany strutture,�prior to its issuante, also ra- yyqTER SERV ICE' '- ALTERATION^
quires Ihe ap��liGanl for such permit to file a signetl s[a[emen[ tnat he
Is �Iicensetl pursuant to lhe provisions of the Contractor's �icense L.aw GAS SERV ICE - ' OUTLETS' "'� ' '
(Chapter 9(commendng with Sectlon �000) of Division 3 of the
)r�jness�antl Prolessions Cotle)-or that he�is exemp[ the�e(rom antl the yyqTER HEATERS -' 'BTU OUTPVT� �
for the allegea exemp[ion. Any violation of Section 7031.5 by
���;:"applicant for a permit zubjec[s t�e applican[ to a civil penalty SEWER CONNECTIONS -- �
v.'not more lM1an IivC huntlretl tlollars (g500). �
�0' I,�as owner b( the'property; or my employees witn wages as thelr'' 'SOCAR TANK •' '' COLLECTORS • ---
sol¢ Compensation, will tlo lhe work, antl the strutture is nOt intentletl
�or offeretl for sale. (Settion 7044,-Business zntl Professions Cotle: The SOLA'R PIVING SVS: ' ' -
�Cont�actor'S LiCenze Ldw tloes not apply to an owne� of a property
who builtls or improves thereon, antl who does such work himself or ISSOE FEE � ' -'-
N�ough nis own emp IoyeeS, provitlGtl that such improvCments a�e not
intentletl or offeretl for sale. If, however, the builtling oi improvement' MECHANICAL PLFN CHECK
Is 501E wilhin one year O/ cOmplelion, Ihe owner will �ave th¢ burtlen -
of providg he tlitl not builtl or improve-for the purpose of sale). - ' '
'0 I, as. owner of tho properly, -am exclusivery con[rac[ing with HEATING SVSTEM 0-100,000 BTU _ �
licensetl con[ractors to construct Ihe project (Sec[ion ]044, Business AND�DUCTING 100,000+gTU
antl �Profession5 Cotl¢: Tl�e Con[ractor'S LicenSe.Law tloes not apply lo. .
an owner of property who builtls or improves thereon, antl who con- REFRIGERATION 0-300,00� BTU
�ratts-irom such�p�ojocts.wiln.a..contracior(s) lic¢snetl pursuant [o $VSTEM
the Contracto�'S Licenie Law). 100,000+gTV �
❑'t am exempCuntler Sectlon B. & P. C. tor (his ' - - - - � � � ^�
BOILERS BTV
reason - . - � . _
� SVSTEM REPAIR,ALTERATION
Date Owner
I, hereby certifythat I have read Ihis applicatlon antl state [M1a[ the above EXHAUST SVSTEM MULTIPLE
In(ormation Is COrrecl:"I agre¢ to Comply wlth all' Ury @nd county
ortlinances antl stalo laws r¢lating to cOnstruction, antl he�e�y authoriae
�ep�¢5¢ntative5 Of th15 tlty t ¢nter upOn th¢ abOve mentionetl' '
property tor ' p llo pu '
Sl9nature Date � .
Drivers' license or 55 �- ISSUE FEE .
CMF 0865-46 White�Builtling; Canary-Applicant; Pink-Accounting; GoltlenroG-AsseSsor
S.
ZONE
REAR VARD (TO
" iPKGfSPACE REq.
4488 4/18�82
VING REGULATIONS
PLNTGp. RUEF. �
PROPE�RTYn
ZONING APPROVED BY
SPECIAL CONDITIONS:�
ELECTRICAL �
10.00 Tl�
��
PROVIDED - '
' PARK FEE $ "
' DATE -
PLANCHECK ' - -- �
.50. FL�--- - '" - Gfl. FT--
�GENERATOR 0-1 KW_ 1-30 KW _
TRANSFORMER
�APPCIANCE ' - 10-50 Kw_SO�C KW =
MOTORS � � 0-1 HP_1-30 HP =
(INC. SOLAR) �_ 10-50 HP 50 + HP��'_
�FI%TURES -OUTLETS SWITCHES
GAS TUBESIGNS - • -
lani F-i ir_urc - . ., . ._. _
PANELS
SERVICE-
'METE
MAIN
1 SUB '
- SU8 -
AMP
ISSUE FEE' � �- - - ' - �-
APPUCATIONAPPROVED�BY - - - DATE -
SUMMARV OF FEES �. _ � � .
BUILOING -�__
PERMIT $ �•OD . SMIP . $
PLAN CHECK $ PERMIT , _ i
PLVMBING S -" - ISSUANCE'.S �
GRADING S �
PLAN CHECK E � - - , . . _F - -
ELECTFICAL $ - ' ' a
PLANCHECK $ - " '- MICROFILM $ � - 1
' ' ' TOTA'L FEE $ " �'
MECHANICHL E - - � -
PIAN CHECK -$ � -�� � LE55 AD- �
VHNCE'PC $_
FINALFEE § ��•QC]
CONSTRUCTION AND PLANNING POOL & SPA , __� '
�-�/ a.a- Date Inspector ' Date _ Inspector
APPROVALS � permit # -�_ APPROVALS •,,. � Permit #
1. Temporary �Iectrical Service or Pole . 43. Pool & Equipment �Location' ' � ' -
2. Soil ipe-Undrgm - � " 44. Steel Reinforcement � � ' - � - � � � �
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding .
. tee ein orce 47. Rough Plumbin & Pressure Test �- --
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE - •• � �
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra �'� ' ndr rn '
10. Structural Floor SYstem 52. APPROVALTO DECK � � � � � �- � - ' ' '
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer �nnection 54. Heater & Vent-Final
13. Rough Plumbing
14. Rough Electric-Conduit �56. -�Electrical-Final
15. RoughElectric-Wring ` 57. SolarSystem-Final -
i 6. Rough Heating & Air Conditioning ' � encing & Access Approval
17. Ducts, in Structure � - APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test � 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin � �
22. Frame and Flashin NOTES:
23. Insulation
24. lathing & Siding
25. Drywall Nailing -
26. Plaster Brown Coat - �
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test -
31. Final Plumbing
32. Water Service-Final -
33. Gas Service-pinal -
34. Solar pomestic-Final
35. Landsca e rinklin S stem '
� 36. Sound Attenuation
37. Handicap Regulations ' ' �
38. FINA� STRUCTURE & BUILDING _ /_$
39. Specia� Requirements Completed
� 40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
� No Date
�I IAX�'1�� w •c Applicant lo fill in all spaces w��hin neavy boraer lines ane si9� all appropriate tleclarations. l p _ n o
',l.I WY OF I.OS.Tr1 MEyA' PERMIT NO. " � '/ TRACT NO. LOT NO. BLDG NO. I I J3 7IOG�BC a p'I �OO TL'
COIYSTRIJCTIONpEFfMIT � �/ �}-y-- f],/� � �
Address ,z �
� Arch/Eng. �
� Address
Contractor �'
Address �•
LICENSED CO
I nereby affirm
mancin9 wiih
PI'OfC551005 CO
ntl my ���
-• � C�l .
-.License No.
Phone �
�ia Wr�+
iRATION �
nder provisions of Chart�
Jlvlsion 3 of the 6us
E_ IS 1I1 fUl� }OICC d!1
TVPE OF CONSTRUCTION � /
❑ NEW ❑ AD� ❑ ALTERATION � �
❑REPAIR ❑CONVERSION.❑OEMOLISH _
� OTHER
DESCRIPTION OF WORK,
7 TYPE OF PERMIT. �' ` - -� -
� GRADING�/ ��j FOUNDATION ❑ STRUCTURAL -
9 (com- � TENANT. L'7 ELECTRICAL'_OPLUMBING ❑MECHANICA
ass antl - Q OTHER
etiect.. pROJECTDESCRIPTION
/T_ ' S4. FT. _" ' " . ' '
IWORK$RS' EOMPENSATION D¢CLARATION OCCUPANCV_CONSTRUCTION TYPE
I hereby affirm that I have a ce4tifica[e of consent to self-in r or a;,VALUATIOrv ZONE
certifiWte oE.Workers' Con�PenSation InSurance, or_a.cerHfie copy
'`ereof (Section 3800, Lab. CJ. GRADING,CU. YDS. ACRES
IiCYNO. ' ' ' -'. ComPanY ...__ .__" " _ �_' ..-..' '
J Certifietl copy is �ereby furnishetl. __ __ ' � REMARKS: � _
❑ Certlfletl copy is filetl witd the city Builtling Division. '
EXEMPTION' FROM WORKERS'-COMPENSATION DECLARATION - � - � � ���-
(This section neetl not be cPmpletetl if the permit is for one huntlretl - -. . -
($300) or less). ' ' "'_ _ ' ... .. . ',. _ .' . _�. ' __
I tertity lhat in the perto�Tance ot the v,ork for whlch this permlt is
Issuetl, I shall ot employany pers ny ner so s-to' come PLUMBING- _ -, �PLAN CHECK�� -
Subject to he o�kers' CompenSa vs of for � �
Oate - Signature : BATHTU85 ' ' -SHOWERS
NOTIC : If atter making th�s tl laration, you shoultl become s t TOILETS VRIIVAL4 - - �
to the WOrkers' Compen5ati0n ovisions of the l2bor Cotle, y0u st - �
forthwith comply w�th such provisions or Ihis permit shall be tleemetl LAVATORIES DOUBLE LAVS � -
�evoketl.
:GONSTRUCTION LENDING AGENCV � � � " -KIT. SINKS - DISHWASHERS^- - -
I hereby aftirm that tbere is a construttlOn lentling agency for [ne perv SERVICE SINKS SVMPS --
formanGe of the work for Which this pe�mit is issuetl (Sec[ion 309]
Civ. C.).�- - �-, — � - � - -- � - - -� --•- - FLOOR SINKS- ' ' FLOOR DRAINS � ' -
Lentle�'s Name
Centler's Atltlress - � " ' DRINKING FOUNTAINS � � --- - -
OWNERBUILDER-DECLARATION - 'INTERCEPTORS" CLARIFIERS �" -" -
I hereby affivm that I am exempt from the ContraG[or's License Law for
tbe�followinq reason (Section-7031.5-Business_antl.P�otessio�s Cotle: SWIMMINGPOOL --- PTRAP � � ---
Any city or county whicli requires a permit to consbud, alter,
imp�ove, tlemolish or repair dny structure, prionto iIs asuance,�also.�e- yyqTER'SERVICE �--- 'ALTERATION" '-
qW�eS the ap�licant fo� such Permit to file a si9netl Statem¢nt that he
IS �IiCensetl pursuan[ to the provisions ot the GonVaCtor's License.l.aw -�GAS SERV ICE '' -'OUTLETS ' - ��- '
IChapter 9(commencing With Section ]000) of Division 3 of the � �-.�
�siness��antl Professions Code) or thaLhe is exempt therefrom antl ihe -yyqTER HEATERS ---BTV �OUTPUT- ---� - ---
is for the allegetl exempVon. Any vlolation of Section 703L5 by
/� appli�nt fon a p¢rmit subjetts the-appliWnt to,a civil Penalty �- SEWER CONNECTIONS - � � �- -
or not more lhan five M1untlretl dollars (5500).
� 1, as owner ot the prop0rty; o� my employees with waqes'as thelr SOLAft-TANK' �- -COILECTORS �- - -
Sole Compen5ation, will tlo the work, antl the structu�e is not intentletl �
or offeretl'for sale. (Section 7044, Business antl'R'ofessions Cotle:-The SOLAR-PIaING'SVS: ' �' ' ' - ' '
Cont�actor's License Law tl0es not apply to an owne� of a p/operty �'
wM10 builtl5 or improves thefeon,'antl who'tloes Sucn work hlmselYor -'ISSUE"FEE' - -" ' - -
th�ough his Own employees, provitletl tha[ such improvemen[s are not
intentled or offeretl for sale. If,-Fowever"tbe bulltling'or improvement' '-MECHANICAL PLAN CHECK � �
is soltl within one year of completion, the owner will nave tne burtlen
of' proving 'he tlitl noY builtl or improve'for' tbe purpose"'of sale). HEATING SVSTEM 0-100,000 BTU �
❑ I,. as . owner .of the. proPerty,. am ezclu5iv¢ly con[raG[ing. with qND DUCTING �
IicenSetl contratto�s to construcl the projeC[ (Sec[ion ]044, BusinC55 100,000�t BTU �
2ntl-Pmtezsions Cotle: Tfie_ContractoCs Licenze l.aw doe5 not apply.to. . _ _ _.
an owner of property who builtls or improves thereon, antl who con- �REFRIGERATION 0-300,000 BTU !
t�acts t�om such.projects_With a_mntractor(s), IICESnetl_pur5uant to SVSTEM • _ _
the Contractor's License Lzw). � Y00,000 + BTU � ' '
❑ 1 am exempt untler Sectio� -'- B. &-P: C, for this BOI LERS BTU
reason. __
�ate Own6r SVSTEM REPAIR,ALTERATION
1 hereby tertifythal I have reetl [his application antl state that tbe above EXHAUST SVSTEM MULTIPLE
informatlon is cor ect. I ag�ee to' wmply with all City antl county
o�tlinance5 a st laws ela to construction, antl hereby autharize
represent ve U c' o e� er upon the above ¢n onetl --
property fo � sp poses �
Signa[ure Date
Drivers' icense or 55 � ISSUE.FEE
CMF 0865-46 White-Building; Canary-Applicanp Pink-Accountinq; GOIGenrod-Assessor
A.P.
" PLNG. REF. 9f - " " •
L5�E�FTrHnu " ' " " .: . -
RIIGHT _ " . _. . . �..
� REAR l'ARD (TO P/L) ' - - - �
'fPKG.SPACE RE�. - - - ' , PROV.IDED ,
STREETWIDTH-' ' .PARKFEE$:, ,
,ZONINGAPPqOVEDBY' - -- DATE ---
SPECIHL CONDITIONS: - � - -- ' -
. . '_ _ _ ' , �� . '_"' '
• 1 �. �
y
ELECTRICAL -' -� - -' PLAN CHECK -
50. FT. � - . " . -- - �
� GENEf3ATOR -- 01 KW_1 lO,KW ' ' ' -
TRANSFORMER �
APPLIANCE - --10-SOKW_SO�+KW - �� � 1
MOTOR$ - - --0-1 HP_1d0 HP _ --' - �
(INC.SOLARI. _ . .. s• � �, � �
��10-50 HP 50 + HP
�FIXTURES --- -OUTCETS— SWITCHES� - -- '
GAS TUBE SIGNS- - - --- .
POLEI_IGHTS- � . - - - -- --- - -
'POLES � ' - METERED- SOB -- ' �
PANELS - - MAW SUB� �-- - - -
SERVICE/, - - --qMP-- -
_ :G _ �
_� . ' _._. "___ " __' _ _" _ _•1
ISSUE FEE � ---- - � - - - - - -
APPLICATION APPROVED BY- - - OATE- �-
SUMMARV OF FEES.
BUILDING "' '-' - "- - - ' '
_PERMIT $ ,,.SMIP $' �
iPLAN CHECK 5 PERMI.T.�� �
. .._ ISSUANCE_$'
�PLVMBING $ r, '
"G RADI NG� _$
PLAN�CHECK 5 -' / —' � " - ' . '7
�E�ECTRICAC'$s�(� " ' ' $ -
PLANCHECK -$ � � '_ � MICROFILM'§ �
MECHANICAL $ - ' � .'TOTAL FEE $' :
�PLANCHECK $ � � - VANCEPC �5= -
FINAL FEE $ . / /
.
CONS?RUCTION AND PLANNING � POOL & SPA; --� . ' ' •�
APPROVALS Permit # � � Date Inspector APPROVALS Permit # �� Date � Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location' - �
Soil ipe-Un rgm � � 44. Steel Reinforcement - � -� �
3. Electricai Conduit Utility-Undrgrn 45. Forms -
4. Electrical Conduit-Undrgrn .. 46. Electrical Bonding .
tee ein orce 47. Rough Plumbin & Pressuie Test • �� � � ' �
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE•
7. Footings 49. Electrical Conduit-Undr rn �
8. Foundation -- ' 50. GasPipe, ❑Undr rn�Test -
- 9. Water Pipe-Undrgm 51. Backwash Lines P-Tra - � ndr rn � ' �
10. . Structurat Floor System. ' 52. APPROVAL TO DECK � � " '
11. Property Sewer Line & House Connection. 53. Backwash & Rece tor-Final �
12. Street Sewer.Connection - 54. Heater & Vent-Final
, 73. .Rough Plumbing � - �
14. Rough ElectrioConduit ' � - �'56.' •Electrical-Final ' ' • -
15. Rough Electric-Wiring - 57. Solar SYstem-Final �
16. Rough Neating & Air Conditioning� � - • encing & Access-Approval '
17. Ducts in Structure �- ' � 9. APPROVED FOR PLASTERING _. � � - ' '
18. Ducts, Ventilating - -. , �
19. Gas Pipe-Rough & Test � � 60. POOL/SPA SYSTEMS FINAL , . �
� 20. Roof FraFning '
21. Roof Sheathin - - , ' '
22. Frame and Flashin - NOTES: ', � . . - �
23. Insulation -� �-
24. Lathing�& Siding - - - - � - - '
25. Drywall Nailing - � �
26. Plaster 8rown Coat �
27. Electrical Power Meter-Final _�j �' ' '
• 28. Final Electric • � �$ -
29. Final Heating & Air Conditioning � � � -
30. Final Gas Pipe-Test - � �
31. �Final Plumbing - -
' 32: Water Service-Final - - �
33. Gas Service•Final - � '
34. Solar pomesticFinal � - � �
� 35. Landsca e S rinklin S stem �� �
' 36. Sound Attenuation - � - ' ' � ' � ' �
37. Handicap Regulations ' �
38. FINAL STRUCTURE & BUILDING -� �
� 39. Special Requirements Completed � � -
40. Electric Release to Edison �
41 . Gas Release to Southem California Gas Co. � • -
42. CERTIFICATE OF OCCUPANCY - � �
�No. Date . .� .
ADO��Gnt to flll in all spacef excepi t�ose within �eavy EorCar Iines anG zign all apOrooriate tleclantions.
�� CIjV OF COSTA MESA
CONSTRUCTION PERMIT
�. ApplicanYs Mailing Addreu �� � ��I
Project Addrea � ` �
Owner i Narrie' W one
- Address b '
Arch/Eng. . Licenre No.
Address
Contrecror's Nam ' hone
Address (mailing)
License No.
IICENSED [ONTRACTOR DECLARATION
1 hereCy affirm ihat I:am Ilcensetl untler provislons of Charter 9(commencin9
with saction 7000) ot Dlvislon 3 ot t�e Business antl Professlons Cotle, antl
my Iicense�is in full force antl effect. .
Ucense Class l.icanse No.
Data Si9natura
"'ORKERS'COMPENSATION DECLARATION �
ereCy affirm that I.have a certifiwta of <onsent [o seltansure or a certificate
Workers• Compenutlon Insuranca, or a certlfletl�coDY thereof (Section
3800, LdD. C.)
Policy No. - ' ' Company
8 CBrtlfietl topy Is heraby furnisnetl.
Certltletl copy Is flletl with lhe city BUIltling Divislon.
� I
TVPE OF CONSTRUC
❑ CONVERSION
DESCRIPTION OF
DEMOLISH
ON LJ REPAIR
TVP�PERMIT LJ GRA�ING LJ FOUNDATION�7.8UCTURAL A.P.1W '� ��'
TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI PLNG.REF.9W
�,�OTHER TO BUILDING
PRQIECT DESCRIPTION Sq. F oCCUPANCv � R P � iNE
CONSTRUCTIONTYPE VALUATIONS�D •U LEFTS�DEVARD
20N� GRADINGCU.VDS. ACRFc PKG.SPACERE�.
Remarkt: ' STREET WIOTH
Sink
cflow Preventer
cflow Irrigation
EXEMPTION FROM WORKERS' COMiENSATION DECLARATION Di5hwa5h2�
(Thls secllon neetl not be complata0 i/ tna permit Is tor one huntlretl (E700) or ,
less). ,
I certify that In the perlormance of t t tor �which thl perm�t is Iisuetl I Drinking Founteins
shall not mpl y any Oenon In any ma ai me sub�ectto t�e .
Workers' tlon Laws of Cali r FIUor Drains
Date Ignature
NOTIC If,-a [er making this tleclarat on, ou shoul � ome subjact to the ' Floo� Sinks
Workers' Co pensation D�ovislons,of tha Labor Cotle, ou.must forthwith .
comply wlth sucb provislons or lhlS�Dermlt shall be Geemetl revoketl. �. GaSService
CONSTRUCTION LENDINC AGENCV � �
I hereby af}irm t�at there ii a constructlon lentling agency for,the per/ormance InterceptOrs
of the work for /O�IEh • ttlis er li �125 tl tip{y 3097 Civ. C.�, �
LendOr's' Name �Q�O ��' � � � .�r�,K� _� ' KitthenSink� '
Lenaer•z Atltlrea• �F14 5. R1EOQ� 1 L�C-IfLJ:bR.791.�� '
R
OWNER BUILDER DECLARATI N . ' Lavetafie5 �
I hereby alfirm that 1 am exempt trom tne Gontractor'S Litense Law tor the ,_ „ r__
hat
'���1:5 by any aOP���ant for a' permi[ sub7ects the aoGlicant to a civil
�enalty ot not more than fiva hunCretl tlollars (E500). �
1, as owner o! the.Oroparty or my employeas with wages as their soie
compensatlon wlll Co the work, antl [he s[ructure is not Intentletl or otfereG
for sale�(Sec�lon 7044, Builness antl Professional Cotle:,The Contractor'S �
LJcensa Law Ooes not a0�b lo an owner o( a property who builCs or Improves '
tM1eraon, antl who tloez sucn work himself/herself or through hls or her own �
employ ees, provlGetl tha[ such improvoments are not intentletl or offaretl for
sale. If, however, t�e bulltling or improvament I5 solC witnin one year of com-
o�etion, tne ownar will nava th0 burCen O7 P�oving h¢/Sh¢ tlItl not bulltl or im-
�r vefortha purpoze of ule). '
1, as awner ot the O�operty, am exclusively contracting wllh licensatl con-
ra torsto.construct [he project (Section 7044, Business antl Protezslons Cotle:
The Contractor's Licanse Law does not apply to an owner of property who
builtlz or improves tharaon, anE who contracts for such projects with a con-
tractor(s) Iicansa pursuant to lhe Contractar•s Ucense law . '
❑ I am a mpt untler Sattion 8. P. C. for thli reason
Date Owner
P hereby �ti y-that I hare reaC ni appllca[�on an ate that the above
_ _'_' '_' . .._� � .....ve .. .,......i., un , i .u„ � e ...�....., ...ni..,..�e. i
Signature �
Drivarz' LJcan or 5 �
Sewer (;ap .
Sewer Cannection
� Solar Collectors
Solar Piping '
So�ar Tank
Swimming Pool w/Spa
� Urinal � ' �
Weter�Closeh, �
� � Water Heater � •
Outlets . Water Service • .
Roof Drains
Shower5 , �
Servite Sink '
i
�
Dutt- Under Ground
Duct - Structurel
Duct - Ventilating _
Exheusi System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO 5'k
Heating'System & Ducting
06100,000 BTU 0100,000 BTi
Hood or Typel ❑- ;
CMF 0865-46 rev. 12/82 Whita - Builtling; Canary - Ap�liwnt; Plnk - Accounting: Goltlenrotl - AsSessor
� Reinspection Fee
laue Fea
iANICAL i
Refrigeration System �
❑0.100,OOOBTU ❑100,OOOBTU
System Repair/Alteration
Reinspec[ion Fee
ISSIIB FBB �
Autamatic Wesher
Construction Pole
i
Cooking Unit �
• Dishwasher
Dryers ❑Gas ❑Electric
i Fan '
F.A.U.
Fix[ures �
� - Device Boxes �
Outlecs
�
- Switches'� • �
Garbage Disposal
Genereror OO-5 KW �545KW
- Trensformer 015�50 KW
�5U+ KW
.$15 , ' •
Meter . Dup to 100 amps
S 3� 2oning APProved BY .
Appliption APProved BY (
$15
$ 3
%��JJ 1i��2�Ci.3
��R VARD (TO P/U
IGHTSIDE VARD '
PROVIDED � -
PARK FEE $
47a1� T�-
�Meter LJover 700emps � .
',Sub Panel�
�Sub Pole , ' ; � ,
Motors �0-1 HP ❑1X-8
InaSolar.��9-15 HP���d6-15+
Microwave . �
Pole Light
Range' � .
Sign ' '
StandingSections �
�Trash�Compactor _ �
Reinspaction Fee
� � ' SUMMARV OF FEES � �--
BUILDINGPERMIT $ S�0 SMIP $ O'J�
PLAN CHECK $ � PERMIT �
''PLUMBING ' $ �SSUANCE, $��
PLAN CHECK� $ GRADING , $ �
.ELECTRICAL $ � $
PLAN CHECK � $ - 0.�� MICROFILM $ �
'� MECHANICAL $ TOTAL FEE $ �
�PLAN CHECK ' $ � � LESS
, . . ADVANCED PC � $ � �
- • � • � , � FINAL FEE � $ ! � �• �
- - -- - -
� ' ���CONSTRUCTION,AND PL'ANNING' ,-' � � � •�r � � �= " -� POOI PA - . - � - ,
� `APPROVALS " Permit #- " � Q ! �'Date � � Inspector � qppROVALS . `Permit # � - Date - � Inspector �. ;
� � ,r „� � _ - - . . . . _
" 1; Temporary. Electrical Service or:Pole � • ' . �'� . ,�52-. Pool & Eguipment Location ... . , ,�' ,
�
�� �: ;Soil Pipe-Undrgrnd.` ^ �- �'� ' - - � - ���53:. Steel Reinforcement - , �
.- 3! Electrical Conduit,Utilitv-Undrgrndl �'' • - ,54:� Forms'' -' � _ �- � - � -
�
�
'' '4: Elect�ical Conduit-Undrgrnd`. = � r � t �� _ � 55�� Electrical Bohding ' - �
IS1 ' �
5. St" I'Rein orcement . , ' - � ' � - � z'• • : ' ` ' " �
?C. f � i - - - •; _. ' 56. Rough Plumbing & Pressure Test . � � "
6. EI@ctrical'UFER Grnd.' , u -,�` � � � • ^ . - - �' �57:, APPROVAL SO COVER-GUNITE �
7. Footings ,- , = v � i . " - �. � � ,� � -�58� Electrical �nduibUndrarnd. . •
i
6. Fou ztion � ' •' ! � _ � ' � � � - �59. Gas;Pipe, O Undrgmd., Test ' � ' i��
-- � ,
9. Water Pipe-Undrgrnd. , � _ _ ' ;60. BackwashLines, P-Trap, ��Undrgrnd. - � �
� ��:
10. Structural Floor System , -'� � � , � � � ' . t � 61. AP.PROV.AL TO-DECK '• � � . - � - . - � �� r � � -
11. Property Sewer Line & House Connection� 62. Backwash'& Receptor-Finaf, �-. "
12. Sewei:CaP � ' � : . f - � ' ' - � ' � _ - . . . �. _
. . .I i . . o'� . �� 63. Heater� & �Vent-Final , -
13. Roof Drains � � � � - � � � � �
. - 64. PlumbingSystem - Final - .
r 14:-fjough'Plumbing� � ' �� ' � � 65. Electrical=Final - � - �- �
V
- 1'S. Rbugh�Elect�ical=Conduit � '-' � -' - ' ' ' -- " �� ' � 66.� Solar System-Final- � , -- . - � �
"1fi: �Rough_Electric Wioing, �; � r , � �i': � ; � �" ��� , i67i Fencing�& Access:Approval .- . - - - -- -,
;>i
' 4T_�Rough Wiring Sign;_' ry -d � ' j , � ' � ' � � � _ 68. APPROVED FOR P,LASTERING' . - ,
; 16. {Fough Elec'trical;T'Ba� Cei�ing� �� ' � � . � � � ;' 69. POOL/SPA SYSTEMS FINAL '
- 19.'Rough�Heating &�Air Conditioning � � -, . . j , i : FIRE DEPT. REQUIREMENT • _ - '
. 20. �Rouyh �Factory Fireplace � , ; �; i ! � ' ' ; � � AppROVALS � Permit # _ � I
�_ . �
« • _ '. . i I ; ' .
_ , `�1. �Ducts,�in S;ructute. �� , , � i i - `70. Underground Hydro , ' '
_22��Ducts, Ventilaiing � 1^ j � � � � ', i71.: Product Piping O Gas � Oil . '
,�.23i .Gas�Pipe;Rough & Test ° ' � �'� � ' , i 72: Underground Flush � �
�-24. 'Roof Framingi i � ' �''� , ; � ' :� i � � .� , ' ., � . �73. Undergrnd. Stoiage Tank O Gas ❑ Oil ' � � i
i _ ,
25. �Rqof Sheathing � - ' �;. _� �74 � OverFiead Hydro _ - ,
_ � ,
-26.'.:$a� i�in ( tructural6& ocoat ; ; �. ,�� `': I ,! .�75. DryChemical ; . � �
�-�27. �Frame a� Flashingcne � '' ; . � ' � 76. Dry Standpipe . , ' . ' • � .
- ; 28. Lathing 8{�3id"ing� ? � � � •� �� � � � ' - j I ' 77. F.IXED SYSTEM-F,INAL - � ' �
� 29. lusulatioo . � � I , � 1 . �78. F�RE PREV. FINAL ' � .
., �30. .Drywall�Nailing . � i ' � � , � � Notes: .f-/y 4 �
- - . . ; ; - _ _ . . ._
' �31 �� Plaster :Brown Coat' � � �� , ' ' �- ' �
� 32.�Electrical Power Me'ter-Fiqal � �.� � � � � � � � uy,�,��` � .
33. �Final Eiearic � , ' ' '"� .7 ,RJ �4y�,,,,,,� F�Q T � •
�
34. Final Heating & Air Conditioning � ' . . ' ' T-��� -�( To �.{
•i -.�. �
35. Final Gas Pipe�7es2� - ^� • ' � � � �� . -' - '' � '
� N�p� �:
36. Hood or,CanopY �. � n �- � ': f _',� , ' � - _ -
'r ".f u' �i � ' i • 1
� v
37. Final Factory Fireplace ' = � _�� �, � � � i � ' , , '
38. Final Plumbing � , ' ' ��� � • • ' � �
i
39. Water Service-Finat .. . .. ' ,. ' ' ! ' � � ' ' � � , � '
40. GasService�Final � � � � � ' i ' ^ �
�
41. Solar D_omestic�F.inal .. : � . ' _' ' ' � . . ' � � .
42. Backfiow Preventer• = � I � � ' � � . �
n• � - - � - -- -`- --� .
��4� ���. . - � _. . . .
43. Backflow Irrigation F - , � ' ' i : _ � "' � . .
�� -�
,.i : � '
44. Landscape lrrigatLLon�System � � - , � � : ,,,� J4� �D� I -
45. Sound��Attenuation;!i;';; i i �, � � .. �� � � `� 'i � '�r � ., . - � .
,: � . _ . , . . , -
46. Handicap Regulatioris' � � ;� � �l , � ; �' � ' � � � - .
�
47. FINA'LSTR�UCTURE�&BU�ILDING; � � �% ' � � . , . � ,
i. i �
48. Special Requirements Completed � i+ F' � , ' . � . - ..
i. � i i .
49. E�ectrtc Reiease�to�Edison' i ' �, � _� � _' _ _ � __i _ __ . t _ � . , , ! � '
1 4'
50. Gas Release to Southem Califorriia Gas Co i' � � , , � -� '
51. CERTIFICATEIOF OCCUPANCY � , +__i . .. ! i_ .__ _. _. __:.'. _ ._ _ . _. •,, ,, .' , , �
No It �I ' i i Date - � � � � �, • � � � � ' � � � �
�e. _ -,e .
.�
.
Y
STRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE RE�liIRED
' fOR ELECTRICA�, PLUM61t�G, ,
HEAT{NG, VE(�T(LATING APJD
REFRIGERATION WORK '
��C9�6� #� '� � � / `f S
THIS l�Ui;'t3�R �.iL'ST RCCO�NPANY
ALL IfQ3PF{;TftJi� t2EQUESTS
FOR 9�!LG:NGS ..ti6tE !'ErS01VS ARE TO
8E EMP�OYE[); iJ't Si�;d_ST T'ri;�T THE
S7ATE OF C.:!l�D�NiFi DI�/ISlON OF
INDUSTRI:eL S.•"E7Y 3F GUNSULTED FOR
ADQITIUNAL REQUIFEMENTS.
. . . __J. . . .. . ... V
r� � ��i_�� � �'
0
9
��
�;
�
�
� � � � � tl � �rt L _
City f Coste Mesa Buiiding �ie t.
�
r
BY ����DATE., a"o- -a._79_.'
THESE PLP.NS MUST BE ON JOB AT�A �TIMES
MAKE NO CHANGES WITHOUT PRIOR`' "��
OF DEPf. � �� –
s�
THE ISSUANCE OR 6RF:YTING OF A PERMJF (v2 APFR V
OF PLANS HND SFEGFICr17I0NS SH� lL NGT BEFC:'NST �
l0 BF A PERMIT FOR, OR AN APFROVAL OF, ANY�VICLATI�?
GF kNY OF THE PROVI3101vS OF THIS GODE. NO FGRYIT PR6�
SU�vIINC TO GNE AUiHORITY TO VIOLATE OP r ^ 4T��c
FRGVISIGNS OF TH1S CODE SNALL 8E \'ALI�; EXC"Pi fN SO
(AR AS iHE tkORK OR OSE WH(CH iT AUTHORIZES f5 tAWFUL.
1HE ISSUANCE OF A PERMIT BpSED UPON FLANS AND
SPECIFICATI0�5 SHALL �OT PREVENT TNE BU:I�ING Of-FICIF�L
�50"d 1HEfiEAFTE2 REQUIRING THE CORRECTI�fI 0.'- CRR0.25
I� SFlID FLANS F.ND SPECIRCATIOS: C3 fROM PREVENiING
F!�ILDING OPER,4TIONS BEING CARRIED ON THEREUNDER WHEN
IA t'MLFitCV OF 7HIS CODE OR 0� ANY O7HER OflDfNANCF
.^' THE CITY, �
� '' I I I
� � F; , �
I 5 `u., � ° I �fT�.' /�v
`�~G''3o I I I �§e C
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iS�:�Vd� S 9tVTL4c�[ �
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GTY OF COSTA MESA
PUWNING DEpT,
NifJECT i0 KDG, pp�. !L�
Or �MINIIIlO
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R � STRUCTURAL°APPROVAL I
i_ S�ARATE PERM�tTS ARE REQ ..
��R EI.ECTR(CAL, PCUMBIi+• ,
' NtATING, �l�f;T;I�TING A �
r I�/ P,EFRIGERATION_WORit. R
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90�JT'MEAN CALIRORNIA � Al1� TR8TIN0, INC.
g2BO f11VERMLE B. :ET, P O. BOx 20BP7 SO�N DIEGO. Ce.l PNIA gg17.p (7lA) 8gp-q3Z�
�p WE3T O7AnCaETHOFWE. PL/ILENTI4. CGl.IF6iJIA 92B70 [71Y1 32A-9130 �.
Jq-B3t VELIE VWV. RCLM DESERT. CALIFOiWW B22B0 f7tG1 3YB-�07B
67B ENTERPFiSE STREET. ESCONO100. CA�IFORNw 926'� (7�4) .�a6-a544
AEPOCIT OF COMPRE8810N TEST8
FILE NUMBER: 5�5� �� oA�:� �o, 19II� ' ❑CONCRETE
.,o : Robert Herron Office 8�.�� �i•MOLiTAR
Ao RES9: �Q �pd3r St� Coeta Mesa CA O GROUT
OW R: OGUNITE
ARCHI T: O
ENGiNEER:
CON7RACTOR: .
LOC4TION W STRUCTURE� �1CIdI2 of �:iall at 3' high � -
cEF^ENT: Riverside "_'ype I Z•: IZ
.aonnixruae: none �
SANd:
F�OCK
MIX IVp, OR PROP0�7T10NS�
TIM� IN MIXER. MOVUTES=
SLUMP, INCMES�
FA�pICATEO BY: m� nle��j TRUCK ND: TICKET NO:
_
IABpRATORY NO: �57� 2571 2J72 .
MARK
DAT� MADE: � �Z� -B�
04T� RECEIVED: �2 ��81
OAT� TESTEO: �2�1��81 �2��7�8� '
OIAMETEF±, INCHES: 2 -` �}
AREG,SQ.INCMES: 3�14
MAXIMUM �o..o. �es.: 6,600 8��00
COMGRESSIVE STR. V51: 2f��� 2f545 '
AGE TESTED. DAYS: 7�'yS 14 days
FiEO.O P5� AT 2B OAYS:
UNIT WT�CU FT (PIASTIp:
o�sra�eunon�: 2 Robert Herron
1� City of C.Y.
1 SCST, San Iliego
�
��
�� SOUTMQAN CALIFOANIA
- G�'1 801L AND TE8TIN0, INC.
\!� REV�EWED BY: (
. . • \_ / �i_'�^�J
�ri 3ove ; `ateri :1s :'n�,ineer
80�,JTMEAN \LIFORNIA BOIL AND Tr 'TINO, INC.
6280 FiIVEROO�E 6TFEET, R O. BO% 20827. SON OIEGO. G4LIFORNI4 g2tPp (7t47'+00-A3Z1
1BS WEST ORAf�GETF/OiX�. PLAC£NTI4. COLIGpGiNl4 9Z670 [7'WI 324-9930
TO-B39 VELIE NA4Y. PCLM DESERT. CALiFOQNIY 92280 [7'WI 36B-�07B
B7B ENTERPRiSE STREE7. ESCONDIDO. C/+LIFOANIC 92026 f714] 7w6-aSaG
AEPORT OF GOMPACSSION TEST8
Fl�E NUMHER�`'lV OATE+�I . �%� �9H� OCONCRETE
.,oa� . Robert ?ierron Office Bldg. � %II`MORTAR
no RESS: ��OQ D20d3i St� Costa liesa CA ❑GROUT
pyy q: ❑ GUN� TE
4FiCM1 CT: O
ENGINEE
CONTRACTOR:
LOC4TION IN STRUCTU:�E �
cE^^ENT: Riverside Plastic
ApMIxTU:�E: � �
SANO:
ROCK: :�O information �u..rnished .
MI% NO. OF� PROPO:�TIONS�
TIME IN MI%EF. MINUTES�
SLUMP, INCNES:
FABRICATED BY: TFIUCK NO� TICKET NO:
T, ilemin�
IABORATOpY NO: 27�2 2�y3 27�� � �.
MARK
D�+TE MADE� 1'2�'�Q�B�j
D.�TE RECEiVED: �2�7��8�
DATE TESTEO� �2��7�81
D14METEFl, INCMES: 2 Y 4 '
AFEA.SO.INCHES: 3•�4
MAXIMUM LOAq LBS.� ����� • ,
COMPpESSIVE STR., PSI: �f9�4
AGE TESTFD. DA`/S: 7 �'✓S
RED'O P5� GT 2B OAVS:
UNIT WT�CU FT (PIASTICI�
DISTRIBUTION: Z Robez't Hei-rOn
1 City o£ C,N.
1 SCST, San Diego
���
�1�
SOtJTMEAN CALIFOANIA
Q�� 801L AND TEBTINO, INC.
�
AEV�EWEO B�':
�/,��
=d �ove ;iaterial �ginee_
SO�JTM�AI �ALIFOANIA 801L AND i8TIN0, INC.
g2gp RIVEROALE STREET, R O. BO% 20627. SAN OIEGO, CAIIGORNIA g212p �(714] 280-4321
1� WEST OF1qNGETHORPE. PIACENTIA. CGLIFORNIY 92870 (714) 524-$13p
�q-B3'1 VELIE' WAV. P4LM OESERT, GALIFORNIA 92280 (7�41 346-'1078
67B ENTEfiPF15E STREET, ESCONOIOO, CAUFOFNIA 92025 (7�47'A46-4544
�
AEPOAT OF COMPAESSION TESTS
. FIIE NUMeea 5�5� oA � c. 1�� �9�� �CONCRETE
.,oe/ Robez�t '_ierron Office Bldg� - �Qv10RTAR
400RES5: 3�4 Deodar St, Costa i"esa CA ❑ GROUT '
OWNE:i� ❑ GUNI TE
.OHCF+ 1��- - --"-� �
ENGINEE�7� ' .
CONTRACTOR'
LOCATION IN STRUCTURE �
CEMENT'� RIVBTSlClB Plastic
nDnAixTURE �
54ND
RpCK:
MIX NO, OR PROPORTIpNS�
4
TIME IN MIXER, MINUTES�
SLUMP, INCHES'
FABRICATEO BY: T� �lemlri�' TRUCK NO� TICKET NO:
LABORAYORY NO� 2688 2689 2690 �
MARK:
DATE MA�E� 12-9-H�
OATE fiECEIVEO: �Z-��I-B�
OCTE TE5TED: ���-�6�8� �
DIAMETER. INCHES: 2 X 4
qqEA.SCJ.INCHES: 3���dy ,
MAXIMUM lOOq 185.: 1��15� •
COMPRESSIVE sT� Ps�: 3,295
OGE TESTEO. O4Y5: 7 �=%,js
REQ'D P51 AT 2B OAYS � '
UNIT WY�CIJ FT [PILSTICl'. !
i
OISTRIBUTION: P ?�obeTt ?Ierron
,3 ���, of �.��.
(1) SCST, San Diego
��
���
G 80UTMBRN CALIFOANIA
f` 801L AND TH8TIN0, 111tC.
�
REVIEWE� BY�
4 / �"�/
cd 3ove 'riaterial ��,�nee�
SOUTFIEAN \LIFOANIA SOIL AND Tr TINO, INC.
6280 AIVEAOP.IE STREET. P O BO% 20927 SAN O�EGO. C�LIFORNin 921Pp (714) 2B0-q321
�65 WEST ORGNGETHORPE. PL4CENTIA. CALIFOAN�Y 92670 f 7t41 52a-9�30
JG-B3� VE�iE WAV. PGLM DESERT, C4LiFOFiN�G 9226G f7161 346-1078
678 ENTERPRISE STqEET, ESCONpipO. CALiF01�Nip 92C25 (7t41 746-d5G4
pEPOFIT OF
FILE NUMB - �-'�F� D/>TE
JOB: RO�_� ..�='SO❑ C:i1C� :���`.
400aes : 3•r2< �odar st, Costa :resz :A
4wNER:
�NGWEER_
CONTRACTOR:
LOCATION IN STRUCTUF:E �
CEMENT:
ADMIXTURE:
SC.NO: J'C2IICIS-�"Q
ROCK
MIX NO.OR` PROFOPTiONS� 1�29 6`� SZ'Cy
TIME IfV MIXER. T,t�N�fTES�
SLUMP, INCMES'-
FABRICCTED Bv: 1. �lemin�
L�BORATOFY N0-
M�FK
DGTE MnDE:
O/aTE RECEivED
pATE TESTEO:
p14METER, INC�+ES
aPEG.SO.WCMES.
MAXIMUM �oAa �es.�.
COMPRESSNE STA. PS� �
AGE TESTEO, Dn"5:
REO'� P5� 4T 2B O/+"5:
UNIT WT,CU FT (ALGSTIC]'
2709
12-10-81
12-14-81
12-17-81
3s6
���
9,500
1e�57
% d3y5
, 1981
❑ CONCRETE
❑ MOATAP
(�f�ROUT
❑ GUNI TE
❑
�'o info*^iatim I�'urnished
TRUCK NO
27�0 2���
D�STaIBUrION. � .'�OD2Tt -@='POII
i - < ,.
� 1 , City o_ C.:'.
r,1j SCS"P, �2n �ie��v
TICKET NO:
SOUTMEAN CALIFOqN1A
SOIL AND TESTING, INC,
AE�^E�YEO BV'
� ��
^d 'ove ::atcrial "n�inee.r.
SOUTNEAt �ALIFOANIA SOIL AND lSTINO, INC.
gZgp RIVEROALE STREET. P O. BOX 20627. ^-...oN D1EG0. CALIFOANIA g2120 (T4] 2B0-a32�
1� WEST pqANGETMORPE. Pl4CENTIA. COLIFORNIA 926�0 [7t41 52a-9'130
7d-B3� YEL�E NlYY. PALM DESEFT. CALIFORNIA 92260 f7M1 346-1078
67B ENTERPRISE STREET. ESCOND�OO. CI�UFORNIA 92023 (7147 7G6-a54G
FIEPORT OF COMPqE8810N TESTS
FIIE �ER: 5z5G�+ DATE: C• �5� �98�
.,a� Robert '_ierron Office ➢ldg. J
AOO:i s: 3ppQ Deodar St, Costa ,�.esa CA
OwNEF
ARCMITECT:
ENGINEE F � '
CONTRACTQR:
LOCF.TION IN STRl1CTU:�E �
CEMENT: �1VBPSld@
AOMI%TUFE:
SANO
ROCK:
MI% NO. Of2 pqpppqTIONS�
�
TIME IN MI?(ER. MqV UTES:
SLUMP, INCNES:
FAB:��CATE4 BV �
T. i�]erin�
LABORG70RY Np:
M4RK
OATE MAOB:
DATE REGEIVEO:
DATE TESTED=
O�4METER, INCHES:
AREA.SO.INCHES=
MAXIMUM �pqq IBS.:
COMPRESSNE STR„ P51 :
AGE TESTEb. DA`/S:
REO'D PSIAT 2B OAYS:
UNIT WT�CU FT (PLASTIC)�
r,•,
12-8-81
12-1'I -81
12-15-81
2 x 4
3.�4
3f���
955
7 days
❑ CONCRETE
Y� MORTAR
❑ GROUT
❑ GLJMTE
❑
�Io info-mation ^urnished
TRUCK NO
2695 2696
DISTRIBUTION � 2 T.iobert Rerron
,3 ��t,, of �.�.
(1) SCSP, San Diego
G
TICKET NO
SOUTMEAN CALIFOANIA
SOIL AND TEBTINO, INC.
AEviEWEO Bv:
� / '_"'�
Iid >ove i�iaterial ��i�eer
SOUTNEAP' CALIFOANIA SOIL AND �8TIN0, INC.
6280 Fl�VEROOIE ,.fREET, P O. BOX 20fi27. SPN �iEGO. Co��PORNIA gpV2p (T4) Zg0-4321
1� WEST OFIANC3ETHORPE. PI.oCENTIA. COI�FORNtA 92670 I7147 52C-9t30 �
�a-63'1 VEL�E WCV. V4LM OESERT, CAL�FORNIA 92260 17�41 346-1078
679 ENTERPRISE STREET, ESCOND�DO. CALIFORNI4 9202� f7'141 746-454Q
I R�POFaT OF COMPAESSION TESTS
FIL� NIJMBER��2���b D � �5� �9f]� ❑CONGRETE
�o�/ $obe-t .=9Z`Pon Off1Ce 31dg� ` ❑ MORTqR
000aess: j00G �eodar St, Costa ::esa CA ,Q�Rour
OWNER: ❑ GUNITE
AFC TEGT: O
ENy`INEE
CONTR4CTpq: '
LOCATION IN STRUCTUFE �
CEMENT:
�OMlxruaE� �
sallo: Standard "o inforsation £u�^nished
ROCK
MIk NO. OR PqOPO:�TIONS�
TIME IN �IXEP. MINUTES�
SLUMP, INCHES�
FAEJRICOTEO BV � TRUCK NO� TICKET NO_
m,homas Fleming
LA�OFATORV No: 2697 2698 2699 �
MOqK
DA7E MADE: 17�8_8�
D.47E RECEIVED= �2����81
DA7E TESTEO: 12�15�81
OIAME7EF, INCMES: 3 X 6
AFlEA.SO.INCHES- p•O
J
MAXIMUM LOAq LBS.� 1�/'800 '
1
COMPRESSIVE STR., PSI � � �975
AGE tesreo, onvs: � days
FiE[3'D PSI AT 2B DO`�5:
UN�T WT�CU FT IPLCSTICI:
DISTRIBUTION� �Z� -?Ob2I't verron
�lj City o` C..'
(1j SCS^, San Diego
��
C���� SOUTFIEAN CALIFOqN1A
� SOIL AND TESTINO, INC.
�� AEviEwED Bv:
/_ /-^'T i
3d sove �:aterial �.�ineer
SOUTNEAN CALIFOANIA SCIL AND ?ESTINO, INC.
�gp RIVEROeLE _.REET, P O. 60X 20627. SAN DIEGO. C�._•:ORNI4 g212p (71a1 2B0-q32t
1� wlEST ORAnC.ETMORPE, PLnCENTIA, CCIIFpqNIG 92670 [7tG) 52A-9'13p
.Y!-g31 VEl1E 4VOY. PGLM L7ESERT. CGLIFOfiN1A 92260 17tO) 306-�078
6�9 ENTEAPRISE STREET, ESCOND�00. COLiFOANIn 92025 171a1 7i46-aSaQ
pEPdFIT "OF COMPqE$S.LO.IV TESTS
FILE NU/fJ�B R: 5�-'� ' O� L�S� 19E1 ❑CONCAETE
JOO�/ Robe} ::erron �fi10E "a�lds�. l.7 MOFiTGR
ADDIFESS: �jCrJ.; 7eodar St, Costa '"esa CA }{$GAOUT �
QWNER: ❑ GUNiTE
�
4RCMIT.ECT: ❑
QNGINEE R � '
CONTR4CT0:�� �
lOC4TION IN STRUCT4QE � �
CEMENT: RjVEZ$1�2 z�i
4DMIXTUFiE � '
SANO
pOCK:
MIX NO. OR PROPOPTiONS� 1:3:1� 1�$. CO,lOI
71ME IN N�%ER, MiNUTES�
SLUMP, INCHES�
�OBFiICATEO Bv: T. FZHR1I1C3 TRUCK NO� TICKET NO:
�4BORATORv NO� 2]�0 z']0]. 2']QZ
MARK: H2YZDR Of 1C2 BU11 ��'%—H1
OGTE MADE: 1�—%—HZ
pATE RECENED: 12�11—HL
DOTE TESTEO: IZ�1�}-81
qIAMETER, iNC'+ES� 3 X G
4REA.Sp.INCMES: 9�O
MAXIMUM L04p, 185.� u�SOO
COMPRESSIVE STR., P$1: I�Z%S
4GE TESTEO. 00"S_ % I]3�1$
qE0'D PSt GT 2B DA`i5:
UNf7 WT�CU FT (FiG5Tf0:
OISTRIBLJTION� 7� �O�it ?erron
� 1 Cl� Of C,r .
(1; SCST, San Diego
�
�Q�
� SOUTMEAN CALIFOFiN1A
, G� SOIL AND TESTlNO, INC.
�� uEviEwED B�'
� �
E�JER ��1P.�.a. � L�JOidtAYY %1c371dt?J2i
SOUTFIER► CALIFORNIA SOIL AND �-ESTINO, INC.
626C FIIVEROALE �TREET, P O BOX 2062Z SaN OIEGO. C/��IFOf9Nla g^�12p (714) 2BO-q32'I
�:•EST OfiGNGETrIDRPE, PLOGENTiA, COUFORNIO 92670 (7'141 524-9'130 '
X-3.�' VELIE WAY. P4LM pESERT, CAUFpRNIF 92260 (7'141 346-1078
E5 E`.TERPRISE STREEL ESCON��DO. Cn��caFNiG 92025 AtGI 746-4544
pEPOFIT OF COMPqESS10N TESTS
FILE NUMBEA. �` -- _p +�-�`a�. 14/ I9H1 ❑CONCRETE
JOB: /� �O�` 9":'OR OPilCB `��4�.,• �MORTnR
�ODRE'ss: joa¢ podzr St, Costa :"esa CA ❑�RouT _
OWNER\ O GL1N1 TE
ARCHITE['T �_�-'�"'"��� J' - ❑
�NGINEER:
CONTFiACTOH_ � "
LOCATION IN STRUC'_�E �
CEMENT:
�OMIXTURE' -
SANO: �
pOCK 1�.�
MIX NO. OR PAOPCG %"IS� 1:3:1� 1LJ. �l�i�
71ME IN faIXER, Mi\ _�ES�
SLLJMP, INCMES
�4BR�C4TED e� � T. Flgtting TRUCK NO� TICKET NO'
IABOFIATORY No 2691 2692 2693
MARK� HeiJ.�OIl Off C2 BUll � 12-%-81
[�l I
d4TE M40E: 1Z�7-py (
bl�TE RECENED ]_Z-1.1-HI .
b4TE TESTED' IZ-Z�I-HI i
pIGMETER, INCf-+ES Z X Q �
APEA.SO.INGMES 3.1Q �
MAXIMUM L0�10. _BS S�gOQ I .
1
COMPRESSIVE 5z, o$�: 1�$'JS I
AGE TESTEO, pn�5 �] j�3y$ �
�
REO'D PSi GT 2B C„S
UNIT WT�CU FT t�_�ST�Ci� I
b15TfiIBUT10N- lODfit -2iiOR
� ;� "ity of C.:".
1 3CS"� S2n Die��
SOiJTFtER111 CALIFOqNtQ
��� SOIL AND TESTIN[3, INC.
��
^ REviEWED BY:
Ot`G � ..i! � , �
Et�gene ell, I,aboratnry Manager I
SOUTNEA�" CALIFOANIA SOIL AND TESTINO, INC.
6't9p FIVEFtO6Ls .aTi7EET. P O. BOX 20B27 SGN OIEGO. G..JFORNtG gg12p (71C> 2gp-tl321
�E WES7 OFiANGETHONPE. PIACENTIA. CILL.IFOQNi4 926')O [ 7141 52C-9130 .
?i-63� VELIE V4GV. P4LM OESERT, Cl+LIFORNiY 92260 f7t41 346-�O7B
fi/B ENTERPRISE STREET, ESCONO100. CFLIFORN�o 92025 f7�G) 746-aSaG
AEPOAT OF COMPRESSION TESTS
FILE NUMBEii. �= �'� � -Qp � D@C. 1 �� ��R.1 ❑ CONCPETE
�oe: Robe;-: _:a^ron Office 31d;;. ❑ MORTGR I
aooAess j�7JL Jeodar St� Costa ':esa CA �'saour �
OWNEF7� ❑ GUNITE
AFCHITECT: ❑
'ENGINEER�
CONTpACTOR: � .
LOCATION IN STPUCTURE � j2.I7P� QS iSOi(! middle of �.rall. �
CEMENT:
ADMIXTURE; '
snnro: Stand2^d
:�OCK: :O in=o-:�tion fu...*nished
MIX Np.OR PFIOPOAT�ON5=�1Z�
t
TIME IN MIXER. MIHu1"E5:
SLUMP, INCMES�
FABRICATED BV � TOTI rlening TRUCK NO� TICKET NO:
LABORIITORY NO� 26�2 260j 2604 .�
MAFiK
OATE MGDE: �`Z-4-81
D/+.TE RECEiVED' 12�'7_81
OATE TESTED: 1'2����5� �2��ia_8� '
O��.METER, INCHES' 3 X 6 : I
AREA.SO.INCHES'
O�Q I
MAXIMUM LOA4 LBS.: '(S�OOO �S�OOO ,� i
COMPRESSIVE ST�i p5� � 1'665 'L�Q�Q +
AGE TESTED. DG`�S' '7 �,y� 14 days �
Aeo'o Psi nr ze oa.s Q�000 I
UNIT yyT�CU FT [F'LASTp: I
I
DISTq�OUTION � ( =� �0�2Tt uerron
�i i Cl� Oi C�1�•
.(1j SCSP, San Diego
��
,�C�j SOUTMEAN CALIFORNIA
� SOIL AND TESTIN[3, INC.
�
(�_ REV�EWEO BY�
�v �O � �
�mr � :ove :�`ate�ia� �h�ir.eer
SO�JTMER/ CALIPORNIA SOIL AND "aSTINQ, INC.
52Bp RIVEROYLE STREET, P O. BO% 20627 SAN DIEGO. C�..-�FOFN14 9p12p 17141 280-632'1
� NIEST OFiANC�TI-0RPH, PLA.CENTIA. COLiFOfiNIA 92670 ( 7�41 524-913p
.ro-B3T VEIiE N/GY. PCLM DESERT, CAUFORNIG 92260 [7'101 346-tO7B
EJB ENTERPRiSE STREET, ESCOND�00. COLIFpRN1A 92025 (7t47 746-45GG
AEPOFiT'OF COMPqESS10N TESTS
FILENLIMBER. '_�' DATE� DgC� �1� ��j81 OGONGRETE
�� _
�oe�. �iop_. A"^on Cf:iCe 31d��. ❑MO�iTqR
AOOF7E55: �_�].! 7eodaz St� Costa `:esa CA Ej'�:AOUT . �
OWNER: '._. _ ,_ .. -. ❑GUNITE
.4RCMITECT: ❑
ENGiNEEF
CONTRACTOR' �
LOCATION ini sTaucTuae�S2,taples _ron mlddle of :tall'.
GEMENT:
pOMIxTURE� ' �
S4N0� St3T14y�•Q -
ROCK: :O inio*r:�z.tion furniahed
M�X NO.OR PROPOAT�ONS� ��Zg
TIME IN MIXEfi, MrNUTES�
SLUMP, WCHES:
FAB::�COTED B`� � TOrl I'lem=rye TRUCK NO: TICKET N0=
LABOF4TORY Np� 2^02 2603 ZOQi}
MCRK
DA1TE MqOE� 1'z�d�8�
OA7E FECEIVEO 12�7�8�
DATE TESTEO: 12����8�
pI4METER, WG'+ES� 3 y 6 _
AREl+.SO.INCMES-. p�o
MAXIMUM LOAQ LBS.� -��'�QO ,
COMPRESSIVE STR, P5�'. �,665 1���'�
oGE TESTEO, �n�5' 7 �y�
FaEO'D P5� oT 2B DaYS: 2�000 � G
UNIT W T�CU FT ;PLGSTIG7: O
DISTqIBUT10N: �\' �OU2Tt 'ePI'OR
'�i�r Cl� Oi �.'..�.
(1 j SCSI', San Die�
I
1
SDUTMEAN CALIFOFiN1A �
SOIL AND TESTING, INC,
aEviEwED Bv-
�� C�� I
hav �d :;ove ' aterial �h�ineer I
(
' QptJ'TMlii►' CALIFORNIA SOIL Al1O�. 111iC.
gQgp RNEfiD/1L! ,.iTiE6T. P O. BOX 80627. SI.N DIEOQ KOANIA ��� fTq1 2gp-C3Q1
�6 WEST diM[�h10FpE. PLI1�N71A. COLR'ONM 92870 (71A] 3E+l-9S� '
. 7M-631 VELIE NAV. MLM �SERT. G4lIFp7V1A B2'� (1V11 3�iB-1O7B
67B ENTERPR19E STREET. ESCpJD100. CALIFOiN1A 92�3 17'IA7 7W6-ASA4
AEPOAT OF COMPF1E8810N TEST8
FILE NUMBE ' � - �' " �- '--� - DEC� 1O� �9E3� ❑CONCRETE
.,oe: Robert Herron Office Bldg. � �oQTAa
000R�ss: j00q Deodar St, Coata Mesa CA o cAo�r
OWNEq: _ _ _ _.�_. i-_. _ _. r- ❑GUN�TE
ARCN17EC7= O
ENG�NpEfi �
CONTpOC70R: � .
LOCAT�ON IN STRUCTURE � �dC�e of wall at 3' high �
cEnn�NT: Riverside Type I& II
nonn�xruAe: none
S4ND:
ROCK:
MIX fHf]. OR PROPORTION3:
. TIME IN MIXER. MNUTES=
SLUMG, INCMES:
FA�RICATED BV: T. Fleming TRUCKI`�� ' TICICET MO:
IABORATOFY N/Q 2�J7� 257� 2�72
MARK:
OATE MADE � 12� 8�
OATE qECE1VED: �2��8�
OATE 7ESTED: �2��0-8�
O�AM�TER, INCMES= 2 X 4
AREA.Sp.INCMES= 3C��4
MAXIMUM LOA4 LBB: 0�6� � 1 19�
COMPRESSIVE S�R, P31: 2��� (� �
AGE TE3TED. OAvS=
T d3yS 0 \J
REQ'D PV: ^^,7 2B QA�:
UNIT yyT�CU FT [PIASTIO:
oisTA�aunor�: 2 Robert Herroa
1� City of C.M.
1 SC3P� Sen Diego
dO1JTMEAN CALIFOqN1A
•OIL AND TESTINO, INC.
REVIEWED Bv:
�/`Y.�
:d sove ::aterials in.--neer
SOIJTMEAN CALIFORNIA BOIL AND TESTINO, INC.
52Bp qIVEqDAIE STREET. P O. BOX 20827. SAN OIE00. CALIFpQN14 gQ1.ap (7fa1 '�9p-0�1
153 µEgT OR4nGETFOiPE. P�ACENTIA. CILL.IFpiNIA B2B70 f 7M1 32A-B13p .
a6-B3� VEl1E NNv. P4LM OESEFT, CALIFORNIC 92280 (7'W] 3AB-107B
B7B ENTEf7Pfi15E STREET, ESCONOIpp. COLtF�iNlA 92023 (7141 7W6-0340
IiEpORT'OF COMPqESS10N TEST8 `
kILE NUMBER: J2:58 -.� onTe: DeCs[be.r 14� 1981 ❑CONCRETE
�oe: ?tobe^� ;==r:on Office, �31dg� ❑ MORT4R
400RE55:- 3�0�, 7eodar St, Costa nesa��CA . ��aouT '__
bWNER: � , � ❑GUNITE
4FCMITECT: O
ENGINEER
CONTRACTOR:
LOC4l'ION IN STRUCTURE � '
CEMENT: R1VE',Z51� I�I ' '
ApMIXTURE: - - . ` '-
SAND: �
F70CK: L
MIX Np.OR PROPORTIDNS: 1�,3�1�7 1]�. �Ol� V
TIME IN MIKER. MINU7E5� ' '
SLUMP, INCMES: �
FGBRIGATED BY: T. Flsning TRUCK NO� TICKET NO:
_ �aeoaaroav r�o: 2700 2701 2702 -
MARK" HE''YZC?il Of �CE BU7.1� � � 12��-81
OATE MADE� �-%-SZ
OATE RECE�VEO: ' LZ-11-81
OATE TESTED: 12-L�I-SI 12-21_81 1-4-82
Oi4METE1a, iNCHES: 3 X (
qREA,50.INCMES: 9�Q
MAXIMUM LOAO, LBS.� u�SOO �6�QQQ ZF3�OOO ' �
COMPRESSIVE STR., P51: 1�2]�j ��'�'l', 3��1�
4GE 7ESTED. OnvS: % Iidj�S 14 �ys 28 days
REO'O PSI AT 2B OA.vS:
UNIT WT�CU FT �PLp5TiG1� � �
OISTRfBUTIpN: 2� 3obert ?'erron
1 � City of C.i`..
c,;, 5��, ���e� . JAN � g REC'D
- SOUTMEFiN CALIFOANIA
801� ANO TESTINO, INC,
REVIEWED Bv:
�
E1.U�R� JY�'1211� Id�Xirdi:{1Tj� MdI13CJPS
BN FORM 176
BIA FORM 1486 - � "
� � INSULATION CERTIFICATION
This is to certify that, in conformance with the current energy regulations (California Adminis-
trative Code, Title 25, State of falifornia") and approved plans, insulation has been installed in
the building located nt:
WSTA MESA �RANGE
Ciry Counry
-_ .;
300d,DSODAR ST , . . . _ .- .,. r��>, ..... .. ... ... —,. .. .
Sheet No. (If Availa6le) � Sheet Lot Number Tnet No.
DESCRIPTION OF INSTALLATION
ROOFS (Tpp gr,& (�d',) o
Type of Materia Manufacturer ��S ����ihickness 6 R Value** 19
EXTERIOR WAL�
SULATIOH FIBERGLAS
Type of MaterialFISfiRGLAS BA'PT Manufacturer ��P7S CORNIN�ickness�"R Value** 11
IY3St3LATION ro� Tnae Nama) p=BggGLAS
CEILINGS
BATfS: ' . . "
Type of Material Manufacturer Thickness R Value**�
' - (Or Tnde Name)
Sq. Ft. Covered '
BLOWN:
Type of Material Manufacturer Thickness No. Bags_
(Or Tnde Name)
Wt./Bag Sq. Ft. Covered R Value**—
FLOORS �
. Type of Material Manufacturer Thickness �R'Value**_
(Or Trada Name) -�;
5LA6 ON GRADE �;
Type of Material Manufacturer Thickness v`i�l Value**—
(Or Treda N�me) .
Width of Insulation Inches _ �.
FOUNDATION WALLS (iflrequired): ��? :�4 r' � , �i % .,_�.. `} '' ". ' 1" �.�.
Type of Material Manufacturer ' Thickness � R Value**_ 5
(Or TriEe fV�me) �. e �
REMARKS (if desired) ���G 3"� R-11 FZ$BRGLFIS SATT INSULATION
. iSERR023 License Number �
Title ��'V�%� Date � n"3
a
CEL—SPRAY�INC. License Number Z8B950
(Stnta "SRME" if ame es Censrel Contnctar)
�:,, OFFICL MGR ,, , 3/18/82
�'faliPornia'Adminislmtive Coda, @�ergy,lnsulafion Standards, de<lares:
"Como�ion�e.,Uoon <ompletion of Ihe�install6lion o( inaulolion, a<ard
certih��e 1M1oFthe imulafion hm been imfulled in canfarmanca with'fhe
rpeiremenh`o/ fhme�repelations hall'be��<omplafed and exemted by .
the insulaflon aoP�imtor and by th� bvildm..This inrolation mmplianm
, mrd nholl ba poated af a mnspi<�ouv lawllan-withfn fhe dwellinp."�
�•'R Value i� fhe meamre ol Ihe �ezistonw af a moferial or beildiny
omoe�ent to the Oas�aBe af heat. The rasialon�e ralre (R) of ma�s-rype
msulotionx sholl not induda any valm for rofleaim facinp.)
EXCERPT from Se�. 19875 af the Health and Safaty Coda of the Sfa1e
ot� Califomia: ' � �
"No certificate ef e�c�pancy or aimilar cerliFimtion fhat o newly con-
stmcrod holel, metel, aparlmant houxe, home or other� re�identiol
dwelline is habilable shall be ismed�by su<h a beildin8,deparfinenf
unlms the �kuclure of leasl satisfias Me minim�m enereY-1m�lalion
sbndoMs asfoblished persvanl la fAif chal0�er."
\
Fwm 116 —o BUILDING NEWS, INC., 3055 Overland Ave., Los Angeles, Calif. 9 0034---12 1 3) 870-9871 '�
Form 1486-0 BUILDING INDUSTRY ASSOCIATION Of CALIFORNIA, INC., 1571 Beverly Blvd., Los Angeles, Calif. 90026--(2131625•5771
REGISTERED INSPECTOR'S WEEKLY REPORT
CAVERING WORK PERFORMED ❑ REINFORCED CANCFETE
WHICM REOUIRED APPROVAL BV L' PRESTHESSED CANCRETE
TMESPECIA�INSPECTOR OF 70 REINFORCED MASONRY
�4��
86�_6 Ten stu�p b�.eck � 4 baa.a a.t 24 "
!!rm Callfomia Soii 8 Testing, Inc.
�65 WEST ONANGETkOHPE AVENUE
PIACENTIA. CALI�ORNIA 92670
714/5_+-91 30
NO. �, �pINGON
� STRUCT. STEEt lSSEMBIV
�� REINFORCED a(�-'�AIM
u %LE DRIVING
Owner/Des
� .� :• ��J
r.r
�—�—al 1g
G GLUE-UM. FABRICATION
c on+w
mn E, Grout 2(!00 VST marta.r URC �t��
. LA8 RECEIVING 8 T6TiNG CONSTR. MAT�L 54MPLE5
.SCL'L� ZT1C.
INSP'N ��pT�ONSOFWOpKINSPECTED,TESTSAMPLESTAKEN,WORKREJECTED,JO8PR�6LH115.PROGRE55,REMAAKS.ETC.
INCLUDES INFORMq7�N ABOUi—AMOUNTS OF MATERIAL PLACED OR WORK REF�RNm. NUMBER, TYPE 81DENT. NO'S
DATE OF TEST SAMPLES 7AKEN: STRUCT. CONNECTIONS (WELDS MADE N.T. BOLTS TOFOU� CHECKED; EfC.
layiny. Colared block with 1'� ]bs oi oolor, Riv�ssi.de piastic o�ent.
1 c�it tA 3 sand and 1�, lbs. of color. There are m specs for thic
„-,},_ tJEC staedcrd
Inspection today af steel placsrent and of gro�xting.
'���Li�: 7bod[3 sanPles fran middle of wall. 1�c
Ticket #57179.
�i abait 4 yards
, Tnx9c #225,
CERTIFICATIONOFCOMp��ANCE /s/ Tt�s M. Flaning
I HEFiEB V CEATIFY iHAi I HAVE INSPECTEO ALL OF THE ABOVE REPOR7ED SIGMTIF� OP REGISTERED I14PECTOR
WORKUNLESSO7HERWISENOTED.IHAVEFOUNDTHISWORKTOCOMPLV 12-4-81 322
WITM THE APPROVED PUNS, SPECIFICATIpNS, AND APPLICABLE SEG
TIONS OF THE GOVEANING BU�LDING lAWS. p�� pF � REGISTER NUMBER
165 W.
!, AEXN CALIFORNIA TESTINO LAlORATORY
RlGIfTEREp INt►ECTOR'S wEEKLY RE�ORT � wo. Z I'O" """ 12/il/81 �y
(MDINO OM __.,___
CO�ERINC 1�ONK ►ERFORYED ❑ MEINFqICEDCONLRETE � STRUCT. STEEL �SSEMBLY ��UE•LMd. FIiBRIC�TION
1n11CM REOUIREO APPROV�L BY ❑ PRE•STNESSED CCNCMETE ❑ REINFOqCED GVGSUM � OTNER
TME SPECI�L I VECTOR OF � REINiORCED I�MSONRv � VILE DRIVING ..............................................
_�o�-�6bw[�• •UILOIMG P[AYIT NUY��1� PL�N Ill[ NUY�t1�
�',,,, . „ _ , ,,. B-1410 52567
wwswvw �woJ[CrM�Y[ ♦wCw�T(cT
R�bert C. ffice ]3uild. Owner/Designer
ON�TA.Y�T'L� �TY►� �bI.ITC.1I0t{IGM {TAdGTM � fOU11C! 011 wiG11. ING�wEE�1
>��CAI�[ Y�T•l.lYll Q110M.1�(.�Y1 61��D[ � 4IGN..w[L0.AOD. ITC.I OlM[�1�1 CONTM�CT011
86].6 `l'a,o Slusp liloctc, with # 4 ba.rs Owner�Builder
cowtw, oov.a �cnowr[owoea
40 gd. @ 24"¢ ea.ch way,Gr�ut 2000 PSI Latuslcn Mas�nry
.e...e�ovnae � resrv+e cen��w. u�r�. s�ua�u
M�rtar U33C S�. Cniif.S�il &� Testin Inc.
INSP'N. LO�ATIONS OF wOttK INSPECTED, TEST SAMPLES TAKEN, wORK REJECTED, JOB �ROBlEMS, PROGNESS, REMARKS, ETC,
DAT! �HCLUD(� INiOA4�TION �OOUT -�MOUNT� OiMATEI�I�I PL�CEOOM W011N PENiOAM[D� NU�IS[A, TYpF. \ IDENT. NO'�.
Oi �(yT {�YVL(\ T�NEN� �TRVCT. CONNECTIONf IMlLD] M�DE. M.T. pOLT3 TOAOIIEDI CN[CNEO� CTC.
2/7� i Inspec�ioa o! bl.ocic laying, als• •P si:eel placement,$" led er bolt
j�ist atraps, Pwaped 3yds. rf gro ut,aix '� 1129 6.0 contrml rout
Standard Cmncrete,to�k greut prisms fron Tk, #235 Ticicet ,`-� 31273.
Also tomk 3 �orter sa.aoles.
Puaped 3 yds. •f wiz ;� 1129 6.0 contr�l gr�ut, T�ok 3 prisms,
ir�m Tk.#202 Ticket # 31302. Als• t4ok 3■orta.r sn,aple=.
Inspection toda.y •�f block l.a.yinq en 4th. Lift.Started the ra,k
ent}�e eaLl. \'o Rr�utinQ toda.y. Tsok 3 a�rtar sanples,
0/81 Inspecti�a teday efbl�ck 1
T�a� 3 u�rtar simoles. Als
1Pa.11 is �.ppr�xina.tely 22' ft
il B1 rIo ias ectio❑ t�d¢ because
to be mared. Will reauoe e.f
CERTIFICATION OF GOMPLIANGE
I MEQfBY CERTIFY TMAT I NAVE INSPECTED ALL OF THE ABOVE REFORTED
WORK. UNlE55 bTMERWISE NOTED, I NAVE FOUNO THIS WOYK TO
COMV�Y WITN TME AVVROVEO VUNS. SPEGIFICATIONS, AND APiLICABIE
SKTIONS OF THf GOVERNING lUILDING lAWS.
h
st. •f the qear.
Si,Lv�iuAEO� AEI
�/
•rE O AE o i
�
LEAEDINSPECT04 �
�� �
REGISTC/� NUMpER
GTY OF COSTA MESA
BUILDING SAFETY DEPARTMENT
SNF,C/AL /NSPECTOK
lNSYECTOR'S NAML �����Q-v ��a
/
LABORATORY NAML _� - �d' ��e • ����
�
ADDRL:SS ��-F��r � C-a-'
TELEPIIONE �L� — 9/ �U
JOB ADDRESS �c�05� � �OaA2�
OWNER'S NAME �OP �F/ �220.✓
WORKPERFOKMED-DATL' /�iH�rU,eJ� /�-..�
BUILDWG PEftMIT NO.
NOTE: All special inspeciors are tu be registered wiih inspeciur's registrar at Ilia
office uf ihe BuiWing Safery Department.
Inspeciors shall lurnish prouf uf affiliation wiih an appruved iesling agency;
or, a s�ate-liccnxd archi�ee� or engincer, or he shall be in ihe direci hire, unJer state
and federal payroll regulatiuns, uf �he owner/develuper uf �he pruposed prujeci. "Phis
prouf shall be in the form uf a signeJ leUer Gunt any one uf the above thrze.
REMARKS:
CMF Ot61-46
City of Costa Mesa
Development Services Department
Buildin9 Safety Division
r' P.O.eox 1200
. Costa Mesa, Calitornia
CERTIFICATE OF OCCUPANCY No. 0001.53
The Building located at 3004 Deodar Avenue �'C°
has been inspected and found to comply with'the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group B-2 Occupancy.
U se o f B u i I d i n g IntetiOY' A1tPSdtiori4 — Offi�e
Legal Description 139-201-09
`- ISee reverse side for Metes and Bounds)
Building Permit No RF—F,87�i Electrical Permit No. AF-6R7fi Plumbing Permit No.
Mechanical Permit No. Number of apartments —�— and/or guest rooms —�—
ISSUED T0:
���- r. ��
Building Official L/i /( � ���tA�
+L by 4' i l=. '{ LY.l.CL('G�✓—
16.196 Wavfarer Larie, Hunt.incrt�on B2ac1i, CA ��j
�. Date �7 L:7.v1 � �T 7
�ihis Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
� Building Official ot the City of Costa Mesa under Sec. 307 (e) U.B.C. V
CMF 1015-46 rev. 1/83 White -Owner, Canary - Numerical File; Pink - Bidg. Permit File
�
� ♦
�'+� ! : ' !•"e�. ' �
City of Costa Mesa
Development�Services Department
Building Safety Division
� � P.O.eox 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY
' r,
� ��
The Building located at �nna I'kvr'1ar RYrt�at. "A" �
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
No. i�Ei�lQ�.�
for a Group B-2 Occupancy.
�� .
Use of Building Off1C2 � � �
Legal Description 139"=201-09 ' '
(See reeerse side for Metes and Baund5)
•. •I-3035, •I-3?�27 •E-1759, •E-4144
�uilding Permit No 'B-1419 Electrical Permit No. '�-1411 Plumbing Permit No. 'P-1678
Mechanical Permit No. ^ N�—�ti%� Number of apartments "�- and/or guest rooms —�—
ISSUED TO: BuiidingOfficial //. ,�(. /'!/i1n�� .
Robert C. Herron ���� /}- �_�
by / .//i1.d�J � / � _ . ��/�iiTo-� `_
16196 Wavfarer I�ane, HB ��� � �
o�ce_� �i?13 / 9 ,��
� Y T
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premi:es nd SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 3015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File
.5.
°i
.. .� - p � .
Ciry of Costa Meu
Development Services Department
Building Safety Division
P. O. Box 1200
Costa Mesa, Califomia
CERTIFICATE OF OCCUPANCY rvo. Guu(;13
The Building located at 7n�a lp�j�7�,- ct�t� "u"
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group B-2 Occupancy.
Use of Building Office
Legal Desc
139-201-09
(See reverse side for Me[es and Bounds�
" I-3035, I-3227 E-1759, E-4144
3uilding Permit No $-1410 Electrical Permit No. E-1411 Plumbing Permit No. P-167E3
Mechanical Permit No. M-26�6 Number of apartments —�— and/or guest rooms —�—
iSSU,EDTO: BuildingOfficial � /S� ��
Robert C. Hermn �if �•
by i1� 6Lr� // r�
16196 Wavfarer �. � ,� �-� � y �
Date
This Certificate of Occupancy SHALL BE posted i� a conspicuous place on the premises and SHALL NOT BE removed except by che
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File
. .,�
-;p__ , ..
- City of Costa Mesa
Development Services Department
Building Safety Division
P.O.Box 1200
Costa Mesa, Caiifomia
CERTIFICATE OF OCCUPANCY No. 00001�4
The Building located at 3004 DEOddL' Str�t, "C"
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group B-2 Occupancy.
Use of Build
Legal Description 139-201-09
ISee reverse side for Metes and Bountls)
` I-3035, I-3227 E-1759, E-4144
,Building Permit No A-1410 Electrical Permit No. E-1411 Plumbing Permit No. P-16i8
Mechanical Permit No. M-2676 Number of apartments "'�' and/or guest rooms —�—
�SSUEDTO: BuildingOffic' I J G
Robert C. Hermn
by �.¢-v _ ��,�,
16196 Wayfarer IKuie, HB � /
Date
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premise and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
cMF lols-a6 rev. 1/83 White -Owner; Canary - Numerical File: Pink - Bldg. Permi[ File
� � .--} �
—•J!� . .
City of Costa Mesa
Developmem Services Departmen[
Building Safe�y OiviSion
P. O. Box 1200
Costa Meza, Califomia
CERTIFICATE OF OCCUPANCY No. �J����"'J
The Building located at 3��4 D�Y $tr�Ctr "D"
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group B-2 Occupancy.
Use of Buildin
Legal Description 139-201-09 '
(See reveru side tor Metes and eounds)
I-3035, I-3227 � E-1759, E-4144
_iBuilding Permit No,_$�Q�_Electrical Permit No. E-1411 Plumbing Permit No. P-1678
Mechanical Permit No. M-26�6 Number of apartments —�— and/or guest rooms —�—
ISSUED T0: BuildingOfficial !// �i / l .�ctitl�
b� �/s,/.�� �_ �Oiil.y,tv—�
1 �rf Date ' / �Gy�. ��i1"CJ
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed exeept by the
Building Official of the City of Cos[a Mesa under Sec. 307 (e) U.B.C. �
CMF 1015-46 rev. 1/83 White -Owner, Canary - Numerical File; Pink - Bldg. Permit File -
�COSTA MESA BUILDING—SAFETY DEPARTMENT
" P.O. BOX 1Y00 �
Coata Mesa, CaliMrnia
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1.954 2/ I i/B2 35.00 TL I
I 1 � 1� � I TR�CT N0. REC'D BY� m PERMIT N0.
n -- �o. �o. a�O7�
cunnao�o� �S t
AddreSs ' d G _ � BUILOING USE OaTE ISSUEO
CitY r, ZipCode [_ � /� ��
State I.icense No. n Class. �� BW�DING D. �+ "
City License No. � TeL No. . - � ADOAE55 �,�
N0. �TEM EACH I FEES COSTA MESA, CALIFORNIA
�,�.,\
� 1
NEAREST ,�,'� ����
FAU, Wall, or Grav. Ca055 Sr. ��� ;�
� Furn, Incl. Ducls and ,.q ��.
VCntS [f n� /� OwNER p� � Q
t0 lOO OOO BTU -I�UIJ (I1 MAIL / i �
nooaess � y� .t��., .v /L
o�er 100,000 BTU `� �� y
CITY � '�C. ` TEL.NO. �.�C91�/ Jn
V ent 1if not inc1. abovel y, ' O 7 d (4a(
f'v � v
Sus ended Heater 1 heretiy acknowledge that I have read this application
Alter or Replace and ste[e�that the above is corroc[ end agree to comply
qppliance -�+��h all'City Ordinances and S[ate Laws rogulating HeaF
� �in��'Vcntilatin Refri eraUon and Air-Conditionin
ver eet o /� B. 8• B 8•
gas PiPing ,{����+j �"
BOILERS OR `'� � t cereify Nat 1 possess the above velid State of CaIiG
CpMPFESSORS � ✓ ornia classification or I am the legal owner o[ [he single
� 1.1T �� '% tarnily rcsidential proDerty described aqpve.
3 H.P. or less "� W � -
Over H.P. to Q �`� l�.J Signa'tihc of
15 H.P. �` V �i• .
Permitlee
4 �� ,•
Vent Fan-Sin Ie.Duct
(ti �� L` REMARKS: , �
Ventilating�,Hood
MiSC�:� Y �� �
y' o\u. � a•� Ws�
APPROVALS INSPECTOR DATE
Ducts Undergraund
Ducts in Str�cmre
Ducts Ventileting
Heating - Rough
Hoods
Refrigera[ion Lines
Prcssure Test
Sub-Total �1ir-Cond. Final
Ven[ilating F�nal
Reinspection Pee Heating Final - � -�Z
Processing Fee Refrigeration Final
3� Final Cas Test
TOTALFEES
Utility Co. Notified
CMF0449-46 BLDG. PERMIT NO. �/ l0