HomeMy WebLinkAbout2119 COLLEGE AVE - Building Permitsomuxswaeiva+wm:uVLLvrr, l.nCx
�ooxcss 2119 COLLEGE
COSTA MESA,CA
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MCHRECT OX F18iNEEN:
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92627
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ue No.:
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car+mecTarsru�:NOCcK PLUMHING ( 714 ) 895-1296
CWfNACTORSYNIING S S V S 2 KNOTT ST
�ooxEss:GARDEN GROVE CA uc.ra.: 707775
92841 uur: 17
LICENSED CONTRACTONS DECL�PPTION: I hereby ellim uMx paraly d pe�ury that I em IironeeE unJx yovieions ot Chepter 9
(mmmerc3q xnh Saeion ]OW) d Oivnion i d Ihe Busiron vd PNoebna Code. vk mY lieeem u in IuA taa vM Wetl.
o��No.:050386 �o.�uss:C-36 uo.r,o.:70777� EXP: 02/99
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OWy BUILDEN DECLARATION: I Mreby elfiim uMx peroly d pmjury Ihtl I am eumq hom tM Comiatlaa liceme lew la Ihe
'•�w�p raemn (Sauion )0�1.5 &nirosa rd Rdeavurn COEe: MyW a rnwY whid� npu'vas e P�G 10 amah�wl. eds.'vnVan.
mden, «repei enr a�Nnu�e, wKK ro ea eeueMe. dw mau�e. ine evp�m �«.,cn o� �o rue a ew�ea.wemaa mm n. «.ne
licenaed punuenl lo tM pwia'vu d Ns CONreGon Licenee LaW �Cheqs B(mnunendtp wGh Setlian ]000) d D'v'vion 3 d tFe
8usmeo and Praleo"an Cadel a Ihel M a eM u uamq �hselmn ud IM bmw la Na aAepaA xamqun. My violelion d Setlion
lW t.5 by ary epplimm lar e Po�mn eubpae tM epplicenl lo e dvil porally d nd maa ihen Me hunEreC Edlas j5500j).
� I. n awrer d tM piopeity a my «nplo�aee v.Yh wepes n Ihei c4 canpmmlion. �nT do Ihe xak, end Ne Wuqu�s u m�'vnpded
«dieradtor eeb (Section ]ou. euvrov eM PMmabn.COEe: TMConveean liorue law Ama na aOdYm en owm a pwe�Y
wro buids a in0�! �haaon. md w/o Eow �uch wk FBnrtl a hanN a NruW he a hr own emPMe%+. Aa'� �hel aN
owrer�'bu�.e;olae�mne�dud«en��ww+roM>'.M�dtlnU1dultl�«'�vnwm+ ��Wmw.dd+.Mela»rmracampetia,.m.
� I. ev ox�r d iM pW�Y. em each�'eN mniman0 xn� 4caneM mnranae ro cauvurJ IM W9� (Setlion )Ou. Bua'vre vd
vw�w�+ coae: rne comunon �c«ve �.w me. na wpv ro.n owner a ww�r �•no wum « imww.. me�.m d,a wn
oomreela Ior vdi peopaa v.ith a mNreaa(e) firroed pveuxa m tM Can�eme liorue lew).
� I em e�emq uMx Sec�un: B. b P.G.. br Nu �aevon:
Dma: ��:
I Eo hereby ceniiy iMt I em ewere d eM uMseiend the repuirema�m d Cel/omu HaeXh eM Selety Code Sed'am Y5505, 2553J, uk
25531. erd thm I a emi Mura buJGeq ottupent xill / wil rid (� �) � to eanply wih eeid mta mdee uM ihe raQu'vemeNa br
eP��/wcauvunionarmodifiralionhwniM�i u�iy enWemenlDiArci.RmiEenlielconpiudianeGG�'+�ianenmmmphantlwe
proNaiona.
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WOpKER'S COMPENSATION DKL�flATON: I hsrepy elfi�m uMx penMy d prjwy ar d tlre tdbwirq detleretuna:
� IhmeaMxdmainlenecarlMiuledmroen�loteXinwnlaxakerioompenWon.mpo+idadtaby5oman3'lOOdtMlebn
CoGa, la �M pa�iwmence d IM wak la wlich I�ie permil u iwued.
-r] � neve ena xi� meim.�.ork.n• mmro�un ma,reno.. m na�n.e W swm 9lao a uie lebor coEe.'« �n. v�«menro a �n.
�r ��p��'m�"�������vW��nGO�DEN EAGLE �wm���� EXPIRES
c�«: n
Pdiry Numbar: � 9� 0 1� 9 p
lThis aeeion neeJ mf 6s canda�ed /�Is Os'mt u br aa hwMeC dw9en (JI00/ a bn.)
� I centy Nel in Ne pMmrercs d the wark br xfich thu paimn ie muad, I eM1NI roi empby any pason in e'ry men�r eo m to
yY� b�aa �o IM wMns' wmpreetion kws d Ceftlama. eM yns Net G I elwuk bxmn arbpd to �M xaAmn'
/cpjpenxtim pewiaom M Seaiop�lW d iM lebor COEa. I MNI IathrmA cwnpy�Noee p�o�pebqs.
d—� v �n �oa�v: � "� 7`—z
F�Nun ro ucvn woM�n'roiryw�utlon rov�rp� Is unNwNl, �ntlWll uDhrt �n �mplonr ro�MirW pruftlu �nJ
�q ro aro h�rtlro0 MouurM JVINn (J10q000A M atlLltlon b tlr� cwf ol ronperuatbR d+�P+ u provldM br In
C�ONSTRUCTION LENDINO ROENCY: I hereby e1Nm uMs penely d perjsy IhN Ihen o e conYr�ctian bM'vq apeM.y br ths
peAameMs d �Ir xvrk br whidi the pmmi u'ssuM (Seaion �09]. C'v. CI. .
LENDEP'S NNIE:
LQlDEF'S ADORE53:
i�«�y mm i new rme w� wa�, w.w. inm me.na,. w�,mo� m c�ea. i wa �o �Nr.an m mr.�d m�ar «d:�.�oe
eM eime lexa rele�sq io Wildvp cmatrupion erd MreEy eWwr¢e iaqevantetrvee oi Ihe tlry ro eMm upon iha ebo.e�meMianed qopaty
�« ��'D'� °��D� RON NOCK
�
o�<: � —ra�— 9�
(5151.C6.WP) WhAe-Buikiq 8 SeINY:OreorFle: Cenery-App4fenl: Pink-Ravenue:OOlden�o�Rseasror
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: P 087167 PLAN CHECK NO: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU
JOH DESCRIPTION : INSTALL WATER HEATER
CLAIM VALUE: CALC-VALUE:
9 -o
PERM NO: P 087167
GOVT: N SUPP: N
PUAPOSE: OTH
SQ FT:
GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT
�e**�r***+r***�r**r**�**���****�r+r*+r*rr***+r+�**+r*�r*******�r****�r�r�r**+��******�*�r**rr�e*r
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN AEAR: FT IN
"LE�`T: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ: PROV: PARCEL: 41917114 ZNE: REF NO:
PLANNING NOTES>
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IE1t1Eif1tlEMiFMMit1Ek±FiFiFiFiEikkikiEifiFkikiElklFkiflEifiElfiEiEKMMMMiFMitlFMifKiFiEMiEKiEikMlfNitikKiEiEMiEit1('ikiEifMikiENif*ikiE
D E V E L O P M E N T S E R V I C E S �R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
HUILDING APPROVED BY :
APPLICATION ISSUED BY
MMMMMNiFifikikMMMikifKiElfMikif
LEGALZZATION:N
HLDG PMT
PEAMIT
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
1 1 , Q Q
25Y
La!l:l�J
DATE:
DATE:
STRUCTURAL SEGMENT:N
SMIP/RES GRADING
SMIP/NON-RES
PLAN
ISSUE FEE 22,00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 11.00 22.00 0.00 33.00 . 33,00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 33.00 OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
33.00
MikMlkitffififkikMMMkikkikiEiEitiflfiEaFMlfikkifMitkltMKMMikkkMMilM1FlkMMkMlFikikkiFifiEMiFifiFiEitlkiEitMikkifkMifkiflFMiFM
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT I1.00 I1.00
END OF FEES
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� 'T
�(�f ��
83-1�-199b/09:17 HY/f33.06
RCPT�:A1-6d'c�632
PEkMIT:087167
CONSTRUCTION AND PLANNING P�G(._ h SPA
APPROVALS Permit # Date Inspector qPPROVALS Permit # Date inspector
7. Temporary Etectrical Servic�or Pole 52. Pool & Equipment Location
�, 2.,�Soil Pipe•Undrgjnd,..� � 53. Steel Reinforcement
�3,�lectrical ConduiUitilityU drgrnd. 54. Porms
O 4.rElectrical Conduif=l�drgrnd. 55. Electricai Bonding ->
-n (', • ri
: Ci' � ^
.�'C,Steel Re��forceTertq 56. Rough Plumbing & Pressure Test x
`��•B.��ectrical UFEA¢'3/dd. 57. APPROVA(. TO COVER�GUNITE
;� �-r ��, -
�`��7�.;�,Footingt ���� 58. ElectricalCon'di,l�,-Undrgrnd.
,'$. Foundat�on 59. Gas Pipe, O Umir.gr�d., Test
rr
r' 9. Water Pipe-Undrgrnd.,'c'� 60. Backwash Line�y�7,-Trap, 0 Undrgrnd.
70. Structurai Floor System � 61. APPROVAL T:Od, ECK
i i.;Property Sewer Lin�!& Hou4e Connection 62. Backwash & Riieptor-Final
�Z•�Se`^ie� CaP . �: � 63. Heater & Vent�Final
73. Roof Drains L 64. Plumbing System • Final
14. Rough Plumhis;g a; 65. EledricabFinal ,
15. Rough �Iectricai�Conduit •• � 66. Solar SVstem-�j3al '
16. Rough �Iectric�Wiri�" � 67. Fencing & Acc`esy�Approval
17. Rough Wiring Sign ,� 68. APPROVED FpA PLASTERING
� -,
18. Rough Electric2l-T Bar Ceiling 69. POOL/SPA SYS'�EMS FINAL
79.;Rough F�eati�g &: Air Cond�tionin9 ��+ r. n m r�:« �-; � ^ FaREJ3EPTiT'REQUIREMENT o'
%, n �- Tl ^ N.'� O !T7 k '7
20."�ioe�h F"actQr',y F=p�lace � F� x,��.; * �"' ��* n AP��(j[]j O���(Sf��� '"" p1y�j�mit #".� �
� L rl✓�<4 4'�
21.�OuccS, imStructu[Y�' �..�'� x (� r-+ ['i� -� 70F�Under roQ:id P»Ydro x:
�
22:�ueti, �n2� tinQ} � ^ � �� G `< <� "� "�
�� Q• H:r F 77• Produ�{�fiipin�as �1 Oil �
�
23. �Ga�ip�,�to�h Sr st . �M �x o+ S� O 72, Undergreund Liush x r
24. Roof F�pi�ing * ��� '� > a'�! *~' 7�, Under c� d. St�J�e Tan�t O Gas ❑ OiI
:.. �T� v: r N Y;n C�7 G:.:rS 9? K4
25.�iotij� Sh'�'athing �� � � k•� r,�.� j k 74. Overhead Hydm�': a:
26: T-Bar Cefiing (St�aurall & Mb'i�ecoat �^ m C� 7�. Dry Ch�a� pF._, � � t^ �
27.��rame a�1 Flasfii?tg� = y� a x" �w 76. Dry Stat�Dipipeq�� i" ^: x '
28. LathingF&Siding%c�'� -�=.F � ^ I � � 7�'. FIXED�ST��INFfiL�' �� " � �
n
� �t c s •• x '� .x �, i i �
29. Insulati0� �d�: ,� ,;, x,:' ' I F� 7�;�FIRE•PREV. F4R714L X� F'
30. Drywall:iVailing �' `+ +' F" � � ��^� o��HEALYFi DEPT,,,fiF,(,�UI�EMENT '
.: I i . o� ow �.
�, 31.PlasterBtpwB;Co�rs ��_, p � � "r 79. FINAL;�$PEC^ON x;, p. S
321'Electrical Power tlt2ter✓�al * Ex SOl FOOD C�RTI�1^ TE �S, 59JEf7 -
... r-+ r t� �- -n �/
1 i !T1 �..'' �K i I �r' [1 y y•;l ?: 1 J [T1
' 33.-fina`��t Ei�tri� �x S ' ,._,,, N %,- (pptes: ¢ �r;� ., S
I � ,..
34�in Heatin�& ,A'+rdbriditioning - .r � � �t H i �-.� � Y n _
ti t" ( � %X '1 (i i�j'l' j; T� .� C�
35!�Final Gas Pipe-Te,s�� C` " '� " �' ' o •J"� ' � -,
r. �c ,Q W ` fi M. ..�� ,� h;
�
36.�lood or CanoPY��' C� � c�ri -+ s � ��� :, -o < R! T
-� - f Y T. T
37.'Fina(Factory FirrJp�ac�o^ ""�; � r N ( � ';�: ,� ,^ y �
38. FinahPlumbing _+' �*7•� � - � � 9� - ���� � - � �y
n ..� �„ �: r�
r, 39. Water Service-Fir�1K +- ,�, * � � "; ' •� . .'' a: �
'" c+..J r,. .^•i
�, 40. Gas Service-Final �,�. �" !^:.r '- r ^ � I � �=. • oF .t � �
-� ..
41.,S�Solar pomestirFin�t � ; � � � I ' 'M ^" - _ � ': � �
4:- -, ^ O� . r. 5
42. Backflow Prgyenter* �� ;,,..,� � ,� � `� � ;-1p k ` F- �
...- ... r �
43. Backflow Irrj�(ation* �" �' `� '� -- � '" C' •
G�; # 'A: ti K 3 � O
�4.��andscape Irrigatinn SystertC2- !r.. r,. � ¢¢ q i: ^ E� �� Ox e,; �
� ^�r x
45.�5ound Aite�ation� '��'�•• ^ .r. .7 � mt e� c� ¢• F-C�
� F H �. � i C S t M . . ..W ' i / Hv ••r.� r„
::46. fian�icap Regulatio�s � .. y� ,� � dc r=; p �- f� �
c47,��FIMAL STRUCTUf�E & BUIIDING * �-' ;M ' -" * `•'"
�: C ..� r[r y I + '7 .k �7
- 48.,, IPtF}L PLANNINCx � ' �.: �� � � rt . �.-, N S .� �t
� "49. •Elec{ric Release to Edison �� �" �' eC '�' � "
Y. 9c � 7 c� r ('� '-�
_50. Gas�Fielease to Sout4�ern Cali(oqiii Gas Co : � � = jo vn ^: �
_ m.. r c.. o
51. CEfiTIFICATE Of OCCUPANCY
No. Da[e _
ICI'iYn°'.�JSTAMESA CONSTRUCTIONPERMIT
Pro�ddress �i�`l �o�%f:P %iLB (�oS��� %/�C'.r
�aplicant's Mailing Address ��� f SV,fwh .rY. ,�A.
�`�� sName M��� �V' C.MelL�6o4+e
R):.� ��v �. z�v� �,. <os��
Appllcant to fill In all spaces except those wit�in heavY Dortler Ilnes antl tlgn all aDpropriate tleclaratlons.
PERMIT NO. TRACT NO. LOT NO. UNIT NO. A P
�Arch/Eng.' LicenseNo. J��W'r
Address "
Contracror's Nam Phone � '3
Address (mailing) Z'1 � q ��-�- C�'�� n
Ciry License No. �
LICENSED CONTRACTOR DECLARATION
I hereby aftirm inat I am IicenSetl untler provisions o( Charter 9(corrim¢ncin9
with 5ection 7000) of Divislon 3 of the Business antl Protessions Cotle, antl
my license is in full force antl tfect.
License las C — � Lice No. 2 �'
�Date Si9nature �
WORKER ' C MPENSATION DECLARATION �
� -`ereby affirm that 1 nave a certificate of COnS¢nt t0 self-insur¢ o� a certificate
1 Workers' Compen5ation Insurance, or a certitietl covY thereot (Section
�0, Lab.
Policy No. �7 <<%�u'Y= Q� Company �� ��Nl�ih�I//✓ F✓�'D
' �Certitietl coOY i5 hereDy tumisbed.
Ce�tifi op 5 iletl with the city Builtling DivlsOFl /
� Date ApP�icant �
EXEMPTIO--�RKERS' COMPENSATION DECLARA ION
(Shis section neetl not be completetl it the p¢rmit i5 for One huntlretl ($300) o�
Iess).
I certify that in the performance of [tte work for which this perm�t is issuetl I
snaii not emolov anv oerson in anv manner so as to besome suDiectA3 t�e
WOrke 5' 0 n fiOn Laws ot Califo 1 �,�/� �!�i _
Date Signa[ure � - ��/�J—
NOTICE: f, fter making this aeclaratlon, you shoultl bp ome suDject to the
Warkers' Compensatlon provisions of the Labor Cotlepyou must forthwith
comply with suc� provi5lon5 Or Ihis pe�ml[ shall be tleemetl r¢voketl.
CONSTRUCTION LENDING AGENCV
1 hereby affirm that ihere is a mnstruction lentling agency for the performance
of tne work for whiGh thi5 permlt is issuetl (SeCtion 3097 Civ. C.)
Lender's Name
Le�der's Aatlress
OWNER BUILDEft DECLARATION
I hereby aifirm that I am exempt from tne Contractor's LI<ense Law for the
tollowing reason (Settion 7031.5 Buslness antl Professlonal CoOo: Any city or
county which requires a pe�mit t0 const�uGt, al[e�, improve, Oemolish or repai�
any sVucture, prior to Ils issuance, also requires the applicanl for such permil
to fil¢ a slgnetl Statement Ihat he/sh¢ is Iicensetl pursuant to lh¢ prOvisioni Of
tne Contractor'S License Law (Chap[er 9(commencing wlth Sectlon 7000)� of
. tivision 3 of the Business antl Professions Cotle) or tnat he/she is exempt
_-; �refrom antl tne ba5is for lhe allege0 ezemp[ion. Any violation of Settlon
'�"g`,%31.5 by any applicant (or a permlt subjecls Ihe applicant t0 a clvil
-�i�nalty o/ not more than five �untlretl tlollars (y500).
❑ I, a5� owner ol the p�Operty or my employee5 wlth wag¢5 as their Sole
com0ensa[lon, will tlo the work, antl tne structuro is not intentletl or offerea �
tor Sale (SeCtion 7044, Business antl PrOt¢sslonal Cotl¢: The Con[ractor's
License Law tloes not apO�Y to an owner of a property who builtls or improves
tbereon, anC who tloes SucM1 work hlmselt/hGrs¢If o� tbrou9h hIs o� her own
em0loyecs, pwvitletl Ihat suG� improvements ar¢ not intentletl or off¢reA for
ule. u, nowever, tne builtling or improvement is soltl wlthin ona year oi com-
pletion, the ownet will have lhu bu�tlen Of proving h¢/she tlitl nOt Duiltl or IT-
p�ove to� tho putDoSo 01 SaleJ.
❑ I, as owner ot [he properry, am eaclusively contractlng with Iicensetl mn-
trac[orsto construct [he Oroject (Section ]044, Business antl Professions Cotle:
The Contracror's License Law tloes not apply to an owner of property who
builtls or improves thereon. an�,wna conVacts �or such oroiects with a r.om
tractor(s) license pursuanc ro ene ConVa<cor•z Li<ense l.aw). I am aware that
proot of theit Worker'S COmpensa[ion Insurance shoultl be prOvltlatl t0 me.
❑ I am exempt untler Se<tlon B. & P. C. �or [hls reason
Date Owner
I hereby certify that 1 have reatl this apo!��atiom antl state that the above
information is carrec[. I a9ree to compty with all city antl county ortlinances
antl State IawS rela[in o builtling construt[ion, antl he�eby autho�iie repre-
Sentatives of th's to e �� u the above-men[iOnetl O�o ty fo�
Inspection pu s �
Si9nature �` Oate �f1 I I P
Drivers' �icense or � Reins ection Fee
rev. 5/8B White - Buiidin9; Canary - AppliCanQ Pink - Acwunting; Goltlenrotl - Assessor
� 34-O�I '
TVPE OF CONSTHUCTION NEW .4DD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISFI ❑ OTHER
DESCRIPTIONOFWORK/LZS�Of8�4Dj�,SIO@�C� -
K � 00��
TVPEOFPERMIT GRADING FOUNDATION STRVCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECMANICAL
❑ OTHER'
PROJECT DESCRIPTION 5a. FT. OCCUa�rvcv
CONSTRUCTIONTVPE VALUATION$ �LI�
ZONE GF3ADINGCU.VDS. ACRES
Remarks: LEGAL�-Z� � 1 p
Bar Sink
Backflow Preventer .
Backflow Irrigation �
Bathtubs
Clarifiers �
Drinking Fountains
Floor Drains
Floor Sinks �
Gas.Service OuUets
Inlerceptors
Kitchen Sink �
Roof Drains
Reinspection Fee� I $15
Boiler •
Duct-Unde�Ground .
Duct-Structurel '
Duct-Ventilating ' '
Exhaust System ❑ Multiple ❑
Firepl/Fact.8lt. iCBO #
Heating System & Ducting ,
❑P700,000 BTU �100,OOOBT'
$15
Service Sink
Sewer Cap ''�
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash -
Laundry Tra'ys
laue Fee
Hood or Type I ❑
Canopy Type I I ❑
..#
S Ma� in Builtli
E
T Front
B Rear
A
C Right
SLeft
Ping. Ref. #
Planning Notes:
FEES P.utomatic Washer
�; ConstructianPoleSub.
CoOking Unit
Dishwasher
Dryers ❑Gas ❑Elec1
Fan
F.A,U. '
Fixtures
Device Boxes
Outlets
$WitChES . �
Garbage Dispoul
Generator O0.5 KW C
Refrigeration System
❑aioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
$ 3
FEES
S 3
2one
Accessory Building:
Perking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter IJup to 100 amps
Meter ❑over 100 ampz �
Sub Panel _ � -
Motors 00.1. HP O�i X�- 8
Inc.Soiar 09-15 HP �16�
Mitrowave �
Pole Light ' .
Range
Standing Sections
5-15 KW Trash Compattor
� Reinspection Fee �$15 � � luue Fee
DEVELOPMENTSERVICESRE�UIREMENTS: -' ,
Zoning Approved By - Date
BuildinB APProved By' � Data
Appliwtion Issued By Data
p-EE SUMMARV OF FEES �
I
N
G
R
E
�
M
T
S.
FEES
�
$ ?
D��' 6UILDING PERMIT $ SMIP � $� S�
. PLANCHECK $/�.PERMIT
, /PLUMBING $ �� ID S.O� ISSUANCE $
P�AN CHECK 25% $ ENERGV P.C: $
• ELECTRICAL $ GRADING $
� � PLAN CHECK 50% $ MICFOFILM $
'� MECHANICAL $ TOTALPEE $
PLAN�CHECK 25% $ . �
ii1 +3GL�D54R6-�tD00bS87 TC�T - _30'�,Sfi
� CNNS RUCTION AND PLANNING .� POC SPA
Date Inspector Date Inspector
�,�pp , 'ALS Permit # APPROVALS Permit #
.� i. Temporar! Electrical Service or Pole� ! 52. Pool & Equipment Location �
2. Soil Pip�-Undrgrnd. .� ' '� 53. Steel Reinforcemen[ .
3. Electtic9l Con�uit Utility-Undrgrnd. �• 54. Forms .
�
4. Electrical Conduit-Undrgrnd. �� 55. Electrical Bonding
5.•StCel�Reinforcemen[ � � 56. Rough Plumbing & Pressure Test .
6.' Electrical UFER Grnd. ,� ' 57. APPROVAL TO COVER�GUNITE
�
7. Footings ;. � � ' S8. Electrical Conduit-Undrgrnd.
S. Foundation .'� '� � I � , � 59. Gas Pipe, � Undrgrnd., Test
r '
9. Water Pipe-Undrgrnd. � . , 60. Backwash Lines, P-Trap, O Undrgmd. �
,
10. Striicmral Floor System � 61. APPROVA� TO DECK
11. Property Sewe� Line & House Connection { ' 62. Backwash & Receptor-Final
72. Sewei,�Cap � � � • � . 63. Heater & Vent-Final
�I •
13. Roof;Dra�ns . 64. Plumbing Sys[em - Final
14. Rciugi�.Plumhing �, • 65. Electrica!-Final
15. Rough Electriral-Conduit , 66. Solar System-Final
�1 B. Rough E�ectric Wiring 67. Fencing & Access Approval _
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Condit�oning FIRE DEPT. REQUIfjEMENT
20. Rough FBctory Fireplace ' APPROVALS Permit # ,
21. Ducts, in Structure ' 70. Underground Hydro
22. Ducts, V'2ntilating ' 71. Product Piping O Gas ❑ Oil
23. Gas Pipe.Aough & Test 72. Underground Flush
24. Roof Freming � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Shdathing � 74. Overhead Hydro
26. T�Bar Celling (Structural) & Monocoat 75. Dry Chemical
27. FrameandFlashing 76. DryStandpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31.•Plaster Brown Coat, 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: � pf�� S
34. Final Heating & Air Conditioning •r
35. Final Gas Pipe-Test �
36. Hood or Canopy "�
1
37. Final Factory Fireplace ��
38. Final Plumbing
39. Water Service-Final
40. Gas ServiCe-Final
41. Solar pomestic-Final '" �
42. Backflow Preventer �� "�' -
43. Backflow Irrigation .i,� � �r,
44. Landscape Irriqation System '! '
}
45. Sound Attenuation
46. Handicap Regulations ��T�
47. FINALSTRUCTURE&BUILDING C Z �, C,.. � l �
4fl. Soecial Re�viremenis Completed
49. Elec[ric Release to Edison •.�' ";
'� �
50. Gas Release to Southem CaliforniaGasCo U ,i� 'f. �;
51. CERTIFICATE OF OCCUPANCY " �; �"
No. Date
' / • _�—
I qp0��cant to fill in all spaces except tM1ose within heavy bortler lines an0 si9n all appropriate Oeclaralions.
CITY OF COSTA M S CON T CTION PERMIT PER T O. TRACT NO. LOT NO. UNIT N0.
� �iiq ���% a
Prq �t'A�dress � ['�J
r
F�;�plicanYs Mailin9 dre s � a
Owner'sName. �n (ry� ' Phone�."�1�
Address ��C¢�i / �
Arch/En9. License No.
Address
-qqpp� i
Convacmr's Name 2 Phone�;$'� ✓
` Addresslma'ling) _;:1 - �'E �
� City License No. c���� C� '
LICENSEp CONTRACTOR DECLARATION ��+�
1 hereby affirm that 1 am licensetl untler provisions of Charter 9(mmmencinq'!�
with section ]000) ot Division 3 ot the Business antl Profe55ion5 Cotle. antl.
my license is in full fo ce antl eifecL O
` LICCOSC rrId5 p �,ICCI152�`l0 ���
� Date i' ��p �j' S'9 t i�����1 /
� WORKERS' COMPENSATION DECLARATION � �
iereby aifirm Ihat I have a certificate of consent to self-insure or a certificate :
Workers' Compensation Insurance, or a certifietl co y thereof (Section, �
3800, Lab. C.) /� ,/ r� r ,f^
1 Pn�{oyli,c.Y No. ��� `� �4 �X � ComPany � ' r�--t�� �
�• YJ certifietl cr�oPyy(�is he�rtl�withrn��h�etlY BuJ� ng D'vi io �. ,
Date__e^�r�'n�n_IL— APPlicant �/6 ��� � � .� � �1 - li
EXEMP ION I�ROM WORKERS' COMPENSATION OECLARATION
(Thissection neetl not be mmpletetl if the pe�mit is for one nundretl ($100) oi� �
less).
I certify that in the performance of the work for which tnis permi{ is issuetl; I
' sM1all no[ employ any pe�son in any manner so as [o become subject to the
Workers' Compensation Laws of Califomia.
Date Si9nature =
NOTICE: If, after making this tleclaration, you shoultl become subject ta the '
Workers' Compensation provisions of the Labor Cotle, you must forthwith
mmply with such provisions or thi5 pe�mit shall be tleemetl revoked.
CONSTRUCTION LENDING AGENCV
I nereby aifirm that there is a construction lending agency for the performance
of tlte work tor which this permi[ iz issuetl (Section 309] Civ. CJ
Lentler's Name
Lentler's AtltlreSs
OWNER BUILpEN DECLARATION
1 he�eby affirm Ihat I am exempt trom the ConVactor'S License Law for fhe
following reason (Section ]03L5 Business antl Professional Cotle: Any city or
counry wnicn requires a permit to construct, alter, improve, tlemolish or repair
any sVucture, prlor to its issuance, also requites the applicant fot such permit
to file a si9netl 5[atement [hat he/she is licensetl pursuant to the provisions of
tM1e Contractor's License Lzw (Chapter 9(mmmencing with Settion 7000) of
Division 3 of the Business antl Professions Cotle) o� that he/she is ezempt
'herefrom antl [M1e basis for the allegetl exemption. Any violation of Section
'031.5 by any applican[ for a permit subjec[s the applicant to a civil
�nalty of not�more than five M1untlretl tlollars ($500).
LJ I, as owner of the property or my employees with waqes as their sole
compensation, will'tlo the work, antl the structure is not intentletl or offeretl
for sale (Section 7044, Business antl Professional Code: The ConVactor's
License Law tloe5 not apply to an owner of a property who builtls or improves
thereon, antl who tloes such work himself/herself or through his or her own
employees, provitletl Ih5['sucb improvements are not intentletl o� offeretl for
sdle. If, however, the builtling or improvement is soltl within one year of com-
pletioq the owner will have the burtlen of proving he/she tlltl nat builtl or im-
ptove tor tne purpose of sale).
❑ I, as owne� of the proOertY� am exUusively cont�acting with licensetl con-
tractors lo wnstruct the project (Section 7044, Business antl Professions Cotle:
The ContracloYs License Law tloes not apply to an owner of property who
builtls or improves [hereon, antl who contracts for such pro�ects with a con-
trac[or(5) iicense pursuant to the Cantractor's Litense Law�. I am awa�e that
p�oof of their WorkeYs Compensation insurance shoultl be provitletl to me.
❑ 1 am exempt untler Section B. & P. C. fot lhis reason
Date Owner
I hereby certify that I have reatl tnis application and state that the above
intormation is Cor�ecL I agree to comply with dll city antl munty ortlinances
antl state laws relating to buiitling construction, antl hereby authorize repre-
sentatives of this city to en[er upon the above-mentionetl property _for
inspec[ion pur o es. � /r�� � X(�
$19fldtlllB � OdIG v � ✓
Drivers' Lic n5e or 55 � �
�a9�s
PEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ GONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT LJ GRADING�FOUNDATION LI STRUCTURAL
❑^ TENANT ❑ ELECTRICAL PLVMBING ❑ MECHANICAL
O OTHER
PROJECT,DESCRIPTION 54. Fr. oCCUcaNCv_
CONSTRUCTION TVPE VALUATION $
_'ZONE' GRADINGCU.VDS. ACRES_
� Remarks:
Bar Sirik
Backflow Preventer
Backflow Irrigavon
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trep
Roof Drains
Reinspection Fee � $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,OOOBT
Reinspection Fee �. $15
CMF 0865-46, rev. 10/84 White - Pink - Accounting: Goltlenwtl - Assessor
Showers
Service Sink �
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service �
Auto-Wash
Laundrv Travs
Issue Fee
Hood or Typel ❑
Canopy �Type 11 ❑
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
$ 3
A.P. #
S Main Building:
E
T Front
B Rear
A
C Right
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A".U.
F i xwres
Device eoxes
Outlets
Switches
Garbage Disposal
Generamr �0-5 KW C
. �
o�„�i �:i � .
� 2one '
Accessory Building: �
Z
O
N
I
N
G
R
Parking Req./Provided E
�
M
T
�
ELECTRICAL
Transformer ❑ 75-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter �over 100 amps
Sub Panel
Mo[ors DO-i HP Oi %- 8
Inc.Sotar �9-15 HP �16-15+
Microwave
Pole Light
Range
I I Standin9 Sections
15 KW Trash Compactor
I Reinspection Fee �$15 I I Issue Fee
DEVELOPMENTSERVICESREQU�REMENTS: -
Zoning Approved By
Building Approved By
Application Issuad By �
F
$ 3
SUMMARV OF FEES
BUILDWG PERMIT $ SMIP $
PLAN CHECK $ —y�� PERMIT
PLUMBING $ �� .7•� ISSUANCE $ �
PLAN CHECK 25% $ _ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM 5�
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $ ; �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qPPROVALS Permit # Date Inspector
1/Temporary,,�ElectricaF Service or Pole 52. Pool & Equipment Location
•n
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. Elecirical Conduit Utility-Undrgrnd. 54. Forms - '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �-�= �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
�. .
7. Footings ��� 58. Electrical Conduit-Undrgrnd-3
8. Foundation ��- 59. Gas Pipe, O Undrgmd., Test��
9. Water Pipe=Undrgrnd. 60. Backwash Lines, P-Trap, O lir�drgrnd.
10. Svuctural Floor System 61. APPROVAL TO DECK ��
���
11. Proper[y Sewer Line & House Connsction 62. Backwash & Receptor-Fina�"=
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67: Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe '
28. Lathing & Siding 7J. FIXED SYSTEM FINAL '
29. Insulation 78, FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ,�
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �, �
33. Final Electric Notes:
�1.��9 Im6 DoG6 Iry P60cY�0 �(Q2O. G� '�-
34. Final Heating & Air Conditioning --i
�',�i �O J�'l IMNK.a�K•�-� -
35. Final Gas Pipe-Test _ _�. �
36. Hood or Canopy
37. Final Factory Fireplace
38: Final Plumbing -
39. Water Service-Final �
40. Gas Service-Final '
41. Solar pomestic-Final .
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscape Irrigation System -
45. Sound Attenuation � � .
46. Handicap Regulations '
47. FINALSTRUCTURE&BUILDING . ,
48. Special Requirements Completed
49. Electric Release to Edison , '
50. Gas Release to Southern California Gas Co � `
51. CERTIFICATE OF OCCUPANCY J
N0. Date �
� •,
nttunin
70B ADDRESS 21
GENERAL CONTRA�
'AP No. 115-236—
INSPECTIONS
soi�
GRS
WRTER
ROUGH PLUMBING
PROP. $WR. LINE n MI
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGM NERTING ANO RI
TEMPORRRV SERVICE 0
UNOERGROUND � P
ROUGH WIRING
TPENCHES FORMS
FLOOR SVSTEM
BONO BEnM �J STE
SMEATHING
FqqME AND FLASNING
LATNING — IN � f
PLRSTER, BROwN COnT
STRl1CTORAL FINRL
CONDITIONING
HEATING, VENT., REFRIG.
PLUMBING, FIN4L RN� GA
ELECTRIC, FINAL
BUILOING. FIN4l
SPECIAL REOl11REMENTS
REINFORCE
F IN
y_.;_�[�
BUILDING PERMIT N0.
RIPTION of WORK Adrl Fami 1�. Rn
ZONE VAWE S g 000.00
PE GROUP Z
SUBCONTRACTOR _
•• � � 42b 1.5
� ���P OT BOXE 200 CIOSDT'A M SAFCALI ORNAIA 92G26 T
� For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRE55 '
OWNER /
MAIL _ _ .�,. A /i _ /�. .,
F
�
W
a
¢
�
F
�
W
F
Q
�
J
Q
7
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4
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a
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2
3
CITV
TEL.
NO.
BFANCH �
ADOFESS
ARCHITECT ,_ ��_ TEL.
ADDRESS
CONTRACTOR � ���� C�
ADDRESS 4Y`)��j C1 ,�/yl �,vyyp�/�J,
b� TEI.
CITV '�.� N0.�6�'
STATE CITV
LIC. NO. LIC. NO���(
SIZE NO.OF BLOGS.
OF LOT x' Q�� NOW ON LOT
USE OF /J/
EXISTING BLDG. {�
�
Separate permits are required for
electric, plumbing and heating work.
VSE OF BUILDING AND WORK TO BE PERFORMED
_ � ! � � � _ �. �
I hareby acknowletlga that I hava reatl this application antl state
that tha ebovo Informotlon is corrett end eB�ee to comply with
all laws rapuleting bulltlinB �o�svuction, entl I shall not employ
any person in violatlon of tha workmen'a compensation laws ot
the Staia of Celifornla.
1 hereby cenlfy tnat I em proparly Ilcensatl es a contractor untler
tha State of Celifornla Business entl Professions Cotle, Division 3,
Chapter 9, antl Me[ such Iicenses are In full forca antl effect, or I
am exempt from the provisions ot tha Stete of Celifornla euslness
and Professions Code, Divialon 3 Chapter 9.
Signature ot �/�
Permittee �
Authorizetl ABent
.��-�-�r,`='.- (1 �os, .�t�;.6E.55
r.,:. Q
APPLICATION FOR STRUC7URAL PERMIT
FEC DATE RECEIVED p I��
A.P. NO. // �.
BUILDING �
ADDRESS
TRACT
OWNER
FIRE
VARDS
DISTANCE BET
VALUE
�T=
GROUP
I DATE "
1
USE OF NEW
BVILDING
YAqDS A7PROVED
BET. MAIN &
G f�40 SQ. FT.
THE AMOUNT SHOWN UNDER VALU
THE PVRP06E OF ESTABLISHING A PERI
VALUATION PERMIT FEE $
�� PLAN CHECK S
5 �O T E
TOTALPAID E
�
N
�
m
>
:
m
�
m
e
e
�
m
n
0
LL
�
U
OWNER DIKE & COLE�ROVE, INC. DATE 5�_K7
)OB ADDRESS 2119 College Avenue BllILDING PERMIT NO. #5001
GENERAL CONTRACTOR Ow-ner Bldr, VALUE $ 11�260.00
AP. No. LOT 9 TRACT 3QQ7 FIRE ZONE DESCRIPTION OF WORK Res, w�2tt. 23T.
GROUP T&.i TYPE p ZONE R)i PLAN NO. )i9�0
INSPECTIONS ' I DATE I gUBCONTRACTOR I DATE PERMITSNUMBER
Beam
Final Gas Test /,S /VI F}C kl_u—
'+�^i
4950
cSA BUILDING DEPARTMENT
P.O. BOX 31�
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
MAI l
ADDF
cirv
ICONTRACTOR
LEGAL
OESCPIPTION
A.P. NO.
COSTA MESA. CALIFORNIA
$� j: nl Pgrnva �Tnr.
� E. 17th Street
T�o: LI 8-115
_Mesa
LIC.
arlson & Middlebrtl@k
rden Grove
CITY LIC.
ke andeColegrove �o. 4615
17f.11 J�.�) TEI.
No. yI $.•115
C� BLOCK TRACT32Q7
lOS NO.OF BLDGS.
NOW ON LOT none
USE OF
EXISTING B�DG.
SETB4CH 4NE FFOM
i
ISIOEYARD RIGHT f;i �EFT 51
� DESCRIPTION OF WORK
NEW �[ qLTERATION ADDITION
REPAIR I �MOVING I DEMOLISH
5 ZIE DIN OO S P't. ROOMS � STORIES 1
E%TERIOR WA�L ROOF
COVERING �`�uCCO COVERING COIIIFi
USE OF NEW
BUILDING Sinele Familv Reaidence
FEE RECEIVED
��� 2-S� i��r����.
fINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIGT NO. PERMIT NO. _
•'���y" � y'-oc� '.1 n IYIHI
BUILDING
nooaess
COSTA MESA, CALIFORNIA
STATE THAT TME 4BOVE IS CORRECT RNO /.GflEE TO COMPIY WITH nLL
CITV ONOININCE$ �NO ST�TE L�W$ FEG NG CONSTRUC�
nON. 1�(_ /A / VALUATION
� SIGNATURE OF / � /i .aa •i.O i // //
AUTHORIZED AGENT nl�fE and Col ePOV
CORRECTIONS
s 11,260.00
PERMIT FEE S
PLAN CHECK 5
TOTAL FEE
� I verr