HomeMy WebLinkAbout177 COSTA MESA ST - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA?CON 4TRU.IQNeE�I PERMIT NO.&a I TRACT LOT NO. UNIT NO.
• Project Address jM� lpJ '//T P(J]C.
Applicant's Mailin• •ddress �a C• �J� "�j�7�•L TYPE OF CONSTRUCTIpN , 0 NEW ADD Li ALTERATION U REPAIR /
Owner's Name £= :Ohm – a�.rl� Phonhl'L1dZ O ❑ CONVERSION J1tDEMOLISH ❑ OTHER qp•�µ, �D/.. 7/— /ff Zone 2;i
Address '�� DESCRIPTION OF WORK/USE OF BLDG. S Main Building:! U Accessary Building:
]�SHO EYt 3'T �0•�'/CI�(5 E . Z
Arch/Eng. License No. TYPE OF PERMIT 0 GRADING U FOUNDATION STRUCTURAL T Front 0
Address / ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL B Rear N
Contractor's Name Cl`/�1J�1�72L� Phone ❑ OTHER P• I
Address(mailing/
((( PROJECT DESCRIPTION SQ. FT. OCCUPANCY5419(9' Right G
CONSTRUCTION TYPE VALUATION$ /ODDS $ Left R
City License No. ZONE GRADING CU.YDS. _ ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CmNhRACTOR DECLARATION l ibm0 _ O
I heby affirm that I am licensedion underprovisions f Charterro9 ns eng Remarks: Planning Notes: r7(f n r M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in full force and effect. PC ,L�_ x•�s
License Class License No. T r •
Date Signature PLUMBING FEES r d
WORKERS' COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) Backflow Presenter Service Sink Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub.
0 50+KW
Certified copy is hereby futhehed. ❑U to 100 amps
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter pp
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(Thissection need not be completed if the permit is for one hundred ($100) or •
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit Is Issued I
shall not employ any person in any manner so as to beco • subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1%-8
Work Corrlp�ns Laws of Calif• -
Date�- r 1'J Signature �� - '�-% " Floor Drains SwimmingPool w/Spa
NOTICE:If,after making this declare i0•, 'au sig Id become subject to the wp F.A.U. Inc.Solar❑9-15 HP 016-15+
Workers' Compensation provisions of he .be ode, you must forthwith Floor Sinks
comply with such provisions or this�pe-mit shall be deemed revoked. Urinal Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit Is issued (Section 3097 Civ. C.) -
Lender's Name Interceptors Water Heater Outlets Range
Lender's Address Kitchen Sink Water Service • Switches - •
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business end Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays 1 Generator 00-5 KW 05-15 KW Trash Compactor
any structure, prior t0 Its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9.(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt ,
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit Subjects the applicant to a civil
LJenalty of not more than five hundred dollars($500). I 3
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $
compensation, will do the work, and the structure Is not intended or offered 11 - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUI/B�E�/�I/E1N1T$,' //JyJ�
employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I 0 ZoningApproved B ••t M c-cr Date• a r—`�
sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type II ❑ pp y
pietion, the owner will have the burden of proving he/She did not build or in- Duct- Under Ground Building Approved By Date
prove for the purpose of sale). — /�+S 1ek
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By —' Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑o-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Re air System Exhaust System 0Multiple 0 BUILDING PERMIT $ .2 co SMIP $
proof of their Worker's Compensation Insurance should be provided to me. yRepair/Alteration
PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date ' �g/Lger Own 77000 Il.81ffilei•, Heating System& Ducting Registers ENERGY P.C. $
..(, PLAN CHECK 25% $
I hereby certify that I have read is .PPli,hn and state that the above ❑O-100,000 BTU 0100.000 BTL ELECTRICAL $ GRADING $
information is correct. I agree to co •.1 with .II city and county ordinances
and state laws relating to building co truttlon,and hereby authorize repre- MICROFILM $
p
sentatives of this city to e• • u•• the a•ove-mentioned proArty f r PLAN CHECK 50% $
Inspection • 5. lir
Signature Sj,
Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
0100010274-00010275 TOT 25.50
CONSTRUCTION AND PLANNING POOL &
to Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
. 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings58. Electrical Conduit-Undrgrnd.
8. Foundation i _ 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
•
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
-
•
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
•
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
.43. Backflow Irrigation
• 44. Landscape Irrigation System
X45. Sound Attenuation
•
46. Handicap Regulations - rp/
47. FINAL STRUCTURE & BUILDING z/DI't j
48. Special Requirements Completed +
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY
No. Date •
Il
C• ITY OF COSTA MESA
• BUILDING DIVISION
,; DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER
1.141 • PERMIT B06-02056
'Ra„ v
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 177 COSTA MESA ST Status: ISSUED
Suite: Applied: 12/08/2006
Vicinity: DETACHED HOUSE AND GARAGE Issued: 12/08/2006
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 42603118 Zoning:
Applicant: BOTT, KATHLEEN M
Address: 177 COSTA MESA ST
Phone: 949-646-5834 ISSUED BY:
COSTA MESA,CA Zip: 92627-2228
Owner BOTT, KATHLEEN M
Address 177 COSTA MESA ST
Phone: 949-646-58342111
COSTA MESA,CA Zip: 92627-27-222 28
Contractor: OWNER-BUILDER •
Address:
Phone: N 140:F-
Zip: - License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF(E)ROOF MATERIALS,INSTALL 1 LAYER OF 30#FELT ON THE 8:12 AND 4:12 PITCHED AREA OF ROOF,2 LAYERS OF 15#FELT ON-
PITCHED AREA OF ROOF,A FLAT AREA LOCATED AT REAR OF HOSUE AND REROOF W/30 YEAR COMP SHINGLES(OWENS CORNING)AND C
DETACHED HOUSE AND GARAGE.REPAIR AND REPLACE SHEATING AS NEEDED.
REROOF OF DETACHED HOUSE AND GARAGE TO BE DONE CONCURRENTLY.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $9,169.00
. Permit: $181.25 Claim Valuation: $9,169.00
SMIP Res: $0.92
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $182.17
PLANNING R ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear• 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. •
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(6/00)
1
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: '
I hereby affirm under penally of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed i/the permit is valued at one hundred dollars($100)or less.)
pjr-1 certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
?comply with thea proms
r_
Applicant Sig ,� �.� (bate: -Veil eiVz
WARNING:FAILURE TO SEC RE WO RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES/AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Llc.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5.Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty cf not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
--I,—as
The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License L' s.).
❑ I am exem. , ec--- _ Business and Professions Code for this reason: 1� �./
,Sign �. /af— Cleans-
Expires
Verification of Ownership by(type of document,i.e.-property tax bill or deed):��
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1, Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or pre enl or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(It yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for�'nspe purposes.poI agree not to occupy or allow occupancy of any building authorized by thiss p�errmiit untilfinalinspection.
kin
4th, , 1 . /�� -.?
' \ S rat d. [agar'Orf e s--- 1tlete--- -
An r Authorized Applicant Date
CODE r INPSPFCTION TYPE BAIL LNQIDAL1 CODE! INSPECTIONTYPE BAIL IKIMALI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final Jr Final Plumbing
200 Final Re-Roof CL% 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
a� 1g Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. ,
CITY V F COSTA MESA�'•�ANSTIR-UACTION PERMIT PERMIT NO. TRACTC`� NO. LOT NO. UNIT NO.
ASE:Project Address IC)/ CO�5 1 �t 1 M15,4 ST• - � 7 ��
[vveC TYPE OF CONSTRUCTION U NEW ADD LL I ALTERATION U REPAIR
Applicant's Mailing Address -k". ❑ CONVERSION 0 DEMOLISH 0 OTHER � /�
Owner's Name C-C -A)• 3.517- Phone DESCRIPTION OF WORK/USE OF BLDG. L E�gJ4 L�L� fQE�-[(�_ A.P.AP # q .(0- 03) i *' Zone •tea'\,
Address - Suo goopiS Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT U GRADING FOUNDATION ZTRUCTURAL T Front A7tiZt/-f-rCO O
• 0 TENANT 0 ELECTRICAL PLUMBING 0 MECHANICAL BA To /mow ..1nir� /ag_ N
Address J //}/ Rear 5#
r.Gi�411 -'.-/g()Ili/� Phonel'�'� 0 ❑ OTHER piCV Ar---3 C Right I N
Contractor's Nam / PROJECT DESCRIPTION SQ. FT.,/� S J '7 G
Address(mailing) CONSTRUCTION TYPE st ` /s/ VALUATION SA 3i4/o� S Left 1(oe 51 R
City License No. ZONE GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req,/Provided
0
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: pp Pc- p ec aj 414.� 1r2 c) r? .Planning Notes: "5(,� 2OO,t.j is ADI)("f'1 trim M
with section 7000) of Division 3 of the Business and Professions Code,and
ps� T
my license is in full force and effect. ^ / c- 47- (? ((REAR LN
AR S ✓Roam - �'�e cc 9 tJ& �� S
License Class License No. _ I A
Date SignaturePLUMBING FEES `
WORKERS'COMPENSATION DECLARATION ' Bar Sink - Showers ELECTRICAL FEES
i hereby affirm that I have a certificate of consent to self-insure or a certificate
f Workers' Compensation Insurance, or a certified copy thereof (Section _ Backflow Preventer Service Sink 1
Automatic Washer Transformer ❑ 15-50 KW
3800, Lab. C.) 0-
50+KW
Policy No, Company Backflow Irrigation 'Sewer Cap Constructio n�Po le Sub.
8 Certified copy Is hereby furnished. -
Certified copy Is flied with the city Building Division. Bathtubs Sewer Connection Cooking Unit 1 Meter pup to 100 amps /8 Co
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping 1 Dryers Xas ❑Electric Sub Panel , 00
I certify that In the performance of the wo -for which this permit is Issued, I
shall notr�ploy any person in any er so as ..4o-lae‘cpwa,subjec to the - Drinking Fountains Solar Tank Fan
Work en a n- ws of Cal Motors❑0.1 HP ❑1%-8
Oat • Signatur - - Floor Drains Swimming Pool w/Spa F.A.U.—
Inc.Solar ❑9-15 HP ❑16.15+
NOTICE:If,a ter making this decla y.0 �o-Id become subject to the 3 7S
Workers' Compensation provisions of the -la Code, you must forthwith Floor Sinks Urinal 5 Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY '•
Gas Service . Outlets Water Closet Device Boxes Light
I hereby affirm that there is a construction lending agency for the performance Pole 9
of the work for which this permit is Issued (Section 30971 Civ. C.) interceptors Water Heater
Lender's Name p 7 Outlets Range $1S
Lender's Address Kitchen Sink Water Service 1 Switches Sign
OWNER BUILDER DECLARATION 1
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories , 1Auto-Wash ,-°b Garbage Disposal Standing Sections / 4
following reason (Section 7031.5 Business and Professional Code: Any city or -
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap/ _ Trays Generator 00.5 KW 05.15 KW Trash Compactor
any structure, prior to Its Issuance, also requires the applicant for such permit - '
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she Is exempt •
-
therefrom and the basis for the alleged exemption. Any violation of Section
"1.5 by any applicant for a permit subjects the applicant to a civil /
-
Ity of not more than five hundred dollars($500).
as owner of the property or my employees with wages as their sole Reinspection Fee 1 I $15 Issue Fee $ 3 /r+ op
compensation, will do the work,and the structure is not Intended or offered - - Reinspection Fee $15 Issue Fee $ so
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own Hood or Type I DEVELOPMENT SERVICES R OUIREMEN
Boiler
employees, provided that such Improvements are not Intended or offered for yP ❑
sale. If, however, the building or improvement Is sold within one year of com- - Canopy Type II o Zoning Approved By M /lA C c P Date
citation, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale). c-Fe'
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date 7-1 -F
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- /
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple CI System Repair/Alteration 2.7c BUI LDING PERMIT $ ¢ i b•OSMIP $ "/1
'
Proof of their Worker's Compensation Insurance should be provided to me. _ PLAN CHECK $ PERMIT
❑ I am exempt under Section B.dam.C.for his reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ aj , O O ISSUANCE $
Date Owner ` _' - • -_.: Ilir Heating System& Ducting Registers PLAN CHECK 25% $ . 2.2 ENERGY P.C. $
I hereby certify that I have read th app I at'.n and state that the above ❑0-100,000 BTU 0100,000 BT ELECTRICAL $ 0.0 0 GRADING $
information is correct. I agree to comply- - t .11 city and county ordinances -1
and state laws relating to buildin• construction, and hereby authorize repre-
sentatives of this city to enter s.•n�,�. eboye-mentioned property for
inspection purpo • . - \�s. �1 -��!(1.j�.(,� MECHANICAL $ TOTAL FEE 5 `S 6o'�y
Driverure� A- - -
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
� -'^465-46,rev. 10/84 White - Builtling; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor 01 00009767-00009771 TOT
560.64
r -CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date- Inspector APPROVALS ' Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Lobation .
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms - •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test r
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final - •
13. Roof Drains 64. Plumbing System - Final
14. Rough 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 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •'
27. Frame and Flashing _ 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 7/2j' azi 80. FOOD CERTIFICATE ISSUED
33. Final Electric 02/ g �zdv, Notes: 7� e$ ik
34. Final Heating & Air Conditioning �l/A35. Final Gas Pipe-Test
��Cl
36. Hood or Canopy I I 12-1 f A t ft try,okI _ /„_f
37. Final Factory Fireplace no D I lam 99 i•PiVI�LIJ��-(
38. Final Plumbing /2,/111 42'W ,
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation /s
46. Handicap Regulations
. 47. FINAL STRUCTURE & BUILDING Tb'40g V Ai- ~-
48.i Special Requirements Completed L[
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co y.
51. CERTIFICATE OF OCCUPANCY
No. Date 4 ,-
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate decr..i........- -
- PERMIT NO. RAC N . LOT NO. UNIT NO.
CITY OF COSTA MES�4 _105TRRUCCTIO PERMITp 3534 /� �w�r l•��,iy, A.P.# c.(Zb_O3 iS .. Zone 2L
Project Address r( �,,,��7 a.' ) P ! Y' v S Main Building: Accessory Building:
Applicant's Maili g AAddd/reesss ...-41; M — TYPE OF CONSTRUCTION U NEW •DD U ALTERATION El REPAIR E 1 Z
`��Y Jl �K" Q Phone ❑ CONVERSION ❑ DEMOLISH OTHER T Front 21 0
Owner's Name DESCRIPTION OF WORK/USE OF BLDG. B Rear Cif- N
Address �q/ I C Right 2���`A1111' N
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING 0 FOUNDATION STRUCTURAL K G
Left r
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ (
Contractor's Nart k���/ PnJ it---"r94--- Phone ❑ OTHER ```��G pmt Ping. Ref.# Parking Req./ProvidedjiR
• PROJECT DESCRIPTION SQ. FT. /V 7 OCCUPANCY Planning Notes: -�� . f,,,�-�
Address(mailing) CONSTRUCTION TYPE / VALUATION$ C. g95.2 d Ar rte-,City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION w ( c l -
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: L E�H LI'14q-7L aA r ANT PUR E/
with section 7000) of Division 3 of the Business and Professions Code, and /
my license is in full force and effect. ' pC 47— BPS - ELECTRICAL FEES
License Class License No. - ,
Date Signature . __- ''REF &EP 3ig4i ct PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
•
WORKERS' COMPENSATION DECLARATIONConstruction Pole Sub. 0 50+KW
i hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers
C of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑Up to 100 amps
3800, Lab. C.) Dishwasher Meter ❑over 100 amps
Policy No. Company Backflow Irrigation Sewer Cap
8 Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection
•
Date ApplicantFan Motors 00-1 HP ❑1%-8 •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.U.
less). Inc.Solar,09-15 HP 0i6-15+
I crtify that in the performance of the work for whl this permit is issued I Fixtures
shall not emplo an person in any ��usuu��- so as o •. o. sub ct to the Drinking Fountains Solar Tank Microwave
Dor�B ddm n Laws Cali , Device Boxes
Date I ,�1 ofSignatureCs' Floor Drains Swimming Pool w/Spa Pole Light _.•
NOTICE: If,after making this declare io sh• • become subject to the
Workers' Compensation provisions of th.•or C••e, you must forthwith Floor Sinks Urinal Outlets Range -
comply with such provisions or this p- it shall be deemed revoked. Switches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign
I hereby affirm that there is a construction lending agency for the performance Disposal
Garbage Dis
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater 9 P Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 005 KW 05.15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
e ally of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: _castLI
�1P�.�`M as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By DateCi"--
Dom pensation, will tlo the work, antl the Structure Is not Intended or.offered —.
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL L FEES Building Approved By 4 Date
License Law does not apply to an owner of a property who builds or improves .. 91-141,'S
���� 1�
thereon, and who does such work himself/herself or through his or her own Hood or Type I ❑ Application Issued By Date b
employees, provided that such improvements are not Intended or offered for Boiler
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im- • Duct-Under Ground •
prove for the purpose of sale). 12-7C BUILDING PERMIT $ fire' • 00 SMIP $ •311
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK s era
tractors to construct the project (Section 7044,Business and Professions Code: - $ PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or improves thereon,and who contracts for such oroiects with a con- __ •
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof oa
their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING ' $
0 I am exempt under Section B.8 P.C.for this reason Firepl/Fact.Blt. ICBG* Fire Dampers
�r� ry PLAN CHECK 50% $ MICROFILM $
Date U own a Heating System& Ducting Registers MECHANICAL $ _
I hereby certify that I have read pli at on and state that the above 00-100,000 BTU 0100,000 BTL TOTAL FEEZ: so
Information is correct. I agree to comp y wi II city and county ordinances PLAN CHECK 25% $ z-;g .7
and state laws relating to building construct on,and hereby authorize repre-
sentatives of icy to - - up•�the .b•ve-mentione propert r
Inspection p \ ^\ ' •
Signature al0. -
--
0865-46,rev. 5/8: White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor
DATE: 09/21158 TIME: 12:58
'
CONSTRUCTION AND PLANNING : POOL &SPA
'APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ) I 53. Steel Reinforcement •!
•
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
i t .
14. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
'5: Steel Reinforcement 56. Rough Plumbing & Pressure Test • \ _ j
f
' 6.I Electrical UFER Grnd. , -)
7. 57. APPROVAL TO COVER-GUNITE ' I (
'1 Footings `� ) • 58. Electrical Conduit-Undrgrnd. - i- .
•
8..Foundation -- 1 59. Gas Pipe, 0 Undrgrnd.,Test
9 Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10Structural Floor System 1� 61. APPROVAL TO DECK
111.1 Property Sewer Line & House Connection ',••••• 62. Backwash & Receptor-Final
12i Sewer Cap 63. Heater & Vent-Final
,
13. Roof Drains _I : "" • 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
v
;L7. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling i' r 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 0 Gas 0 Oil
23? Gas Pipe-Rough &-Test 72. Underground Flush
•24. Robf Framing .,- • 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing , -, 74. Overhead Hydro
26t T-Bar Ceiling (Structural) btrMonocoat 75. Dry Chemical
27•. Frame and Flashing i 76. Dry Standpipe
28. Lathing & Siding ,- 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing ''" HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory'Fireplace
38. Final Plumbing
\ 39. Water Service-Final 1 - -
0. Gas Service-Final
-41'. Solar Domestic-Final
42. Backflow Preventer .
43. Backflow Irrigation.,,
44. Landscape Irrigation System
1 45. Sound Attenuation ' '
I46. Handicap Regulations _
47. FINAL STRUCTURE• & BUILDING T'- 1 81( /� - ,J- .
48. Special Requirements Completed �'( lT
49. Electric Release to Edison '--' • ,,,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY , '
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _
min- PERMIT'NO. J T C{ LOT NO. UNIT NO. �\
CiTYOPCOSTA MESA ONFT,RUCTIONPERMIT ttt? wRACWp._ ,o G
' �., 1 rr+ �2f�PC at. -• ' '�3�22 I tt`�-t C�NrS cilia — \
Project Afidress In�X L \•
I, s. TYPE OF CONSTRUCTION NEW ❑ ADD ALTERATION U REPAIR
Applicant's Mailing press _ - - (,r '...11 a/ - r 7 ( Zone Ra`
Ov<iner's/Mama ���'��� Phone DESCRIPTION OF WQ RK U$E OFF j.QG.' V
Address _ 1,v,n�� .� r 1 /Sri-AC/10 ' ei A-2 44. S Mair Bulldmy r 'y-„ t� Accessory Building: q yip_
Eng. �WNv _ License No. '! TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL - T Front 'f 'e /Q1 ✓(1+[ , 61Jdcr• O
f•i ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B q Z cJ N
Address / ;Rear:>,;.' •'•r:. CJ I
~ Contractor's Name 1 0�0�f 2 ❑ OTHER _ //
L%tA1 U�`�/``.Y Phone -v �60 - OCCUPANCY J4 1 C• Right a 6p' N
�. PROJECT DESCRIPTION SQ. FT. .1 : K-
Address(ma`ling) 'r .7Y. .' S Left p/
CONSTRUCTION TYPE .. VALUATION$ �iR , cast--
City Licer154 NO. ',ZONE GRADING CU.YDS. ACRES E
Ping. Ref.# Parking Req./Provided
LICENSED CONTRACTOR DECLARATION ' ? - �p Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: e - Planning Notes: -SW �„ eit ��ch� 7.,..,-;..M
•with section 7000) of Division 3 of the Business and Professions Code, and ' n� �I (S'
C V' T
my license is in full force and effect. Pc • 41 —• S'es ° - -75S
License Class •
License No. V
'te Signature . PLUMBING FEES 4
IRKERS'COMPENSATION DECLARATION 4.
Bar Sink Showers
dereby affirm that I have a certificate of consent to self-insure or a certificate' • ELECTRICAL FEES
..f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - - Service Sink '
3800, Lab. C.) - Automatic Washer Transformer 0 15.50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
8 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. t Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors• Dishwasher I Meter (Dover 100 amps /8 St
(This section need not be completed if the permit is for one hundred ($100)-or • s
less). Dishwasher Solar Piping Dryers '❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, 1,-
shall not employ any person'in any manner so as t co subje t to.the . Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1'h-B
Workery� o p saY n Jaws of Calif Q -- _
Date/�'� - .: Signature,;��� Floor Drains Swimming Pool w/Spa F,A.U. Ina Solar ❑9-15 HP ❑16-15+
NOTICE:If,after making this declaration yo sh$u d become subject to the
Workers' Compensation provisions of the Labor de, you must forthwith Floor Sinks • Urinal 4- Fixtures Microwave 00
comply with such provisions or this permi shall be deemed revoked. _
CONSTRUCTION LENDING AGENCYGas Service Outlets -- Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance ,„ POIe Light
of the work for which this permit is issued (Section 3097. Civ. C.) Interceptors r Water,Heater /// Outlets Range Co
Lender's Name `/Kip_ S v
Lender's Address • - ^Kitchen Sink • Water Service Switches Sign $ op
- " Q OWNER BUILDER DECLARATION . - �-
f NI hereby affirm thaCYam exempt from the Contractor's License Law for the Lavatories M �� Auto-Wash Garbage Disposal Standing Sections
, :ollowing reason (Section_7031.5 Business and Professional Code: Any city or
..o unly which requires a permit to construct,alter,improve,demolish or repairp—Trap " Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor
iny structure, prior,to its issuance, also requires the applicant for such permit
5 file a signed statement that he/she is licensed pursuant to the provisions of j" .e-.
.Contractor's License Law(Chapter 9 (commencing with Section 7000) of Roof Drains ,^ /,
vision 3 of the Business and Professions Code) or that he/she is exempt
refrom and the basis for the alleged exemption. Any violation of Section
1.5 by any applicant for a permit subjects the applicant to a civil
.Ity of not more than five hundred dollars($500). $ 3 /�'
a1 I, as owner of the property or my employees with wages as their sole Reinspection. Fee' $15 Issue Fee /
c•mpensation, will do the work, and the structure is not intended or offered - Reinspection Fee ! $15 Issue Fee $a-
far
far sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES -
License Law does not apply to an owner of a property who builds or improves -----
thereon,
_
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
Hood or Type I ❑
employees, provided that such improvements are not intended or offered for Boiler ,1,t /'-Y cc``p ''•��j
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By MM OTDate
t Er
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground .
Building Approved By Date_7 f(-8
prove for the purpose of sale). fekiIt,
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating - 06100,000 BTU 0100,000 BTU SUMMAR OF FEES S�
builds or improves thereon,and who contracts for such projects with a con- • —
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple El System Repair/Alteration BUILDING PERMIT $ 09 SMIP $
proof off their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ •ba PERMIT
0 I am exempt under section B. & P.C.for this reason ^ Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ PERMIT
ISSUANCE $
Date 1 `' Owner / ...ark./.4 .-_- - r.-.....t , Heating System& Ducting ' - Registers PLAN'CHECK 25% $ ENERGY P.C. $
•
• I her by certify that I have read thi ap•ii . on and state that the above ❑o-100,000 BTU 0100,000 BTELECTRICAL $' 4?. 00 GRADING $
information is correct. I agree to comply with all city and county ordinances ff
and state laws relating to building construction, and hereby authorize repre-
sentatives of city t. . ter upon the above-mentioned progarty r
inspection p •pos-t; 1 I y f( ' MECHANICAL ' $ TOTAL FEE $ 30 '•
Signature ���%� a� it Datef! ' IZ�
Drivers' Licenskor _ Reinspection Fee $15- Issue Fee $ 3 • PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
�' 01 00010276-00010280 TILT 301.48
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit Date Inspector APPROVALS Permit# • Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -
5. Steel Reinforcement• 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Und'rgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final •1
•
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 }
r4
20. Rough Factory Fireplace APPROVALS Permit# '
21. Ducts, in Structure 70. Underground Hydro '
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing f ' 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing e�i�,Qt^ 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &Monocoat -� ,75. Dry Chemical j
27. Frame and Flashing -• 76. Dry Standpipe l
•
-'.Lathing . Siding 7-171:30606,--77 .7FIXED SYSTEM FINALI - .
29. nsulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT: REQUIREMENT
31. Plaster Brown Coat
rifrO �� 79. FINAL INSPECTION/132. Electrical Power Meter-Final 0 per / 80. FOOD CERTIFICATE ISSUED
33. Final Electric I_4-� elect
- Notes: 1_��G/81 'A� Assa •-Y Ik
34. Final Heating & Air Conditioning �+�'-( (1 (/ Uu'•r
35. Final Gas Pipe-Test //� p�
36.,Hood or Canopy [ L F O� n J,&/F-" lc_ .
37. Final Factory Fireplace
38. Final Plumbing •
39. Water Service-Final tz
40. Gas Service-Final
41. Solar Domestic-Final '
42. Backflow Preventer
43. Backflow Irrigation •
44. Landscape Irrigation System Y
45. Sound Attenuation
46. Handicap Regulations - Off• /O O
1�1r- � �6/�VS771T�_
47. FINAL STRUCTURE & BUILDING
µ _ -_----
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co r i
51. CERTIFICATE OF OCCUPANCY
No. Date
•
(I ea S v U��� `$ mo,{/vahvi /6[ 4- T r1
706 72_ /0 3 S%.,iri .o/ 41J V 4- 41.ei,e,sa.e4,9
-re 76- vkc%To - rig aro /0/2
ea/p%/ `' /elld`Ii c
C //�rc/ /1/e 7"� z ,�d1 OK) ,2 3 2 44/J/
/�A7"te tie, A Z ti r ,7- 4�i'�.��u/ F,r,� 7X. 5c'p e7o.t'S
D-PNC4 M l¢K/! -7%k 7— 7,{v S 74.U e-7-04y ,f r / 2? l°oJ//3 "41-00J.91 SC
CoUn4/0/i�.s .w X. VY / a?°#;:., S" ' SI P /4(4/ itoe As/MovT