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Home My WebLink About245 PALMER ST - Building PermitsAOO��ant to flll in all s0aces etcept thase wit�in �eavY �orGar Ilnes anE si9n all a0orav��ale Geclarations. CITV OF COSTA MESA CONSTR UCTION PERMIT PE� �/_� I� Tl ACCNO.� LOT� . UNIT NO. A P� Project Address �� ' � ��'M� J�T �� JO� -- � a s - 3 � r - Applicant's Mailing Address � �� w�,C ' Owner's Name ��T-5�.�..) Phone-ta�.�oTn�S Address �1� A v Arch/Eng. U rLicenu No. C�(+ � S�'] Address ,�'+%i.) ��- Qe^�- � 1 �(� 7��2 / Contractor's Name J�2 R� ru= IA Phone Addresslmailing) ��n2- S% City License No. LICENSED CONTRACTOR DECL TION I her¢by af�i�m tha[ I am IicenSatl ntllr provi510n5 ot Char[er 9(COmmencing witn sectian 7000) of Division 3 of tha Business antl Professions Cotle, ane my Iicense is in full (orce ana effect. License Class Li<ense No. Date Signature 'vORKERS' COMPENSATION DECLApATION iereby alfirm that 1 nave a certificate of consent to self-insure or a cerHitcdte . Workers' Compensation Insurance, or a certifietl mpy thereof (Sectlon 3800, Lab. C.) Policy No. Company Certifietl copy Is hereby furnlsnotl. Ccrtifietl copy is filetl with the Nty gulltling Dlvislon. Dale Applicant E%EMPTION FROM WORKERS' COMpEN5AT10N DECLARATION (Thizsection neetl not be completetl i/ the it {s tor one huntlretl (SI00j or Icss). I cerlity tnat in tlte pertormance o1 the ork or w th this perm4 is issuetl I shall not employ any person in any nne o a to become subject to t�e Workers' Co en ion Lawz ot Calif nia Date �—Si9nature NOTIC : If, af[er making this tleclaratl oultl bemme subject to the Workers' Compensation provizions of � or Cotle, you must forthwith Comply with sucb proviziOns o� t p¢rmit Shall be tleemetl revokeG. CONSTRUCTION LENDING AGE V . I hereby afflrm that there is a wnztructlon lentlin9 a9ency for tba performance 01 lhe work tot ch ttl per il ' S5 (Section 30B7 Civ. CJ Lentler•s Name Lentler'S Atltlte55 �� OWNER'BUILDER GECLAHATIO I hereby a(firm lhat I am ezempt /rom the Contractor's License Law for the tollowing reason (Section 7031.5 Busl�ess antl Professional Cotle: Any citY or county which requires a permit to con5truct, alter, improve, Cemolish or revair anY slructure, prior to its issuance, als0 requires the applicant for such Dermit to file a signetl Statement t�at he/zhe IS Iicensetl pursuant to Ihe p�ovi5iOn5 of • Contrattor's Lic¢nse Law (C�apter g(�omm¢ncing with Section ]000) o( �ision 3 of tne BuSiness antl ProfeSsions Cotle) or that he/sne is exempt sefrom an0 the basis for the alle9etl exemplion. Any violatlon o/ Seclion i031.5 by any applicant for a permit subjects the applicanl lo a tivil enally of not more tnan tive huntlretl pollars (E500). I, as owner of the property or my employees with wages as thelr sole o pensatiOn, will tlo Ihe wo�k, antl the Structu�e is not intentletl o�•offe�etl for sale (Section 7044, Business antl P�o(essional Cotle: The Contractor'S License Law Coes not apply to an ownBr ot a property who builtls or improves lhereon, and wh0 Coez such wOrk hlm5elf/herselt O� tn�ough his o� her own ¢mployees, p�Ovitletl [hat su<h iTp�ovOments ar2 not intentletl o� ofiereG for sale. H, howevaq IM1e building or imprOvem¢nt is soltl within one year of com- pletion, the owner wlll have the burtleh of proving he/she EiG not builtl or Im- �n ve forthe purpose of sale). 1, ds owner ot the property, am ex�lusively contractinq with Ilcen58tl con- tractors to con5truct the project ($ectia� 7044, Busine55 dnG Pr01es5ion5 Cotle: , The qoMractor's l_icense Law does ne� appry to an owner of proper[y who builtlalor ImOroves Ihereon. antl wbo cont�acti io� such oroi¢CIS wlth a con- Vactor,sl Lcense pursuant to [ne Contracror�s License Law). i am aware tha[ proof o( tM1eir Wo�ker's Compensatlo� {nzurance Shoultl be provitlGd to me. ❑ I am exempt untler Section B. & P. C. for this reason Date Signature Driv¢r5' L 0865-46, Owner have rea Oate��/ S Main Buildin9: TYPEOFCONSTRUCTION, NEW ADD ALTERATION REPAIR E L ❑ CONVERSION'❑ DEMOLISH ❑ OTHER � 7 Front � �y �, �j DESCRIPTIONOF�WORK/USEOFBLDG. A Rear � TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL I C Rlght Q/ K ❑ TENANT ❑ EIECTRICAL ❑ PCUMBING ❑ MECHANICAL " S' Left g' �� 'Q� ❑ �oTHER Ping. Ref. # pQ• ' / PROJECT DESCRIPTION Scl. FT. oCCUaArvOV��`—�_ p�anning Notes: -T-_ � CONSTRUCTION TYPE VALUATION $ y�.y�J ZONE � GRADING CU. VOS. ACRES A Remark5: P . iTA �C �3' � . �.r _� _ � . Bar Sink Backflow Preventer Backflow Irrigation Jrinking Fountains Floor Drains Floor Sinks . Gas Service Outlets Interceptors Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee $75 Boiler • Duct- Under Ground Duct - StruCtufel Duct- Ventilating Exhaust System � Multiple Firepl/Fact. Blt. ICBO � Heating System & Ducting ❑6100,000 BTU �100,000 Reinspection Fee � $15 White - Bulltling; Canary - Applicant; pink - Accountin9; Goltlenrotl - Assessor Showefs Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Type I' ❑ CanoPY TVUe II ❑ � Refrigeration System ❑a� oo,000 sru O i oo,000 System Repair/Alteration Fire Dampers Registers Issue Fee EES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets �, Switches �-- Garbage Disposal � Generamr DO-5KW C $ 3 $ 3 Reinspectio� Fee Zone Buildin9: � �� 5 Req./Provided / '� � / ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100 amps Meter ❑over 100 amps � '� Sub Panel •' •�"�� Motars �0.1 HP O1'h - 8� InaSolar �9-75 HP �1G75+ Microwave ' Pole Light ' Range / � Sign Standing Sections' 5 K W Trash Compactor $15 laue Fee FEES $ 3 N I N G H E Q M T S. oEVELOPMENTSERVICESREQUIREME I�S:, ,� �� 1R 88 Zoning APGroved BY (�-� ��.�. oaee Buildin A � g pproved By _ Date.`.�� ; SUMM RY FEES � BUILDINGPERMIT $ SMIP $ O� �j ' PLAN CHECK $ � �PERMIT �� PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ '� �ELECTRICAL $ GRADING S '�' PLANCHECK 50% $ MICROFILM $ 1 MECHANICAL $ TOTALFEE $ � �� , PLAN CHECK 25% $ � , Oi OOu'2�'iQCS-00020�08 "G'OT »i.�; DATE� Il/18/9� TIME� 15:58 �ONSTRUCTION AND PLANNING PC g 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 ' •� 9: Electrical Conduit Utility-Undrgrnd. 54. Forms 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding � y; 5 Steel:Reinforcement 56. Rough Plumbinq & Pressure Test 6•� Electrical UFER Grncl. " 57. �APPROVAL TO COVER-GUNITE , , 7,` Footings � . +� � ' 58. Electrical Conduit-Undrgmd. • � r• 8. Foundation.. . • 59. Gas�Pipe, � Undrgrnd., Test � � 9.; Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor SYstem 61. APPROVAL TO DECK 11. Property Sewer Line & HouseConnection 62. Backwash & ReceptorFinal 12. Sewer Cap" � ' 63. Heater & Vent-Final ' 13. Roof �Drairis 64. Plumbing System - Final �' 14. Rough Plumbing, 65. Electrical-Final � �,' 15. Rough Electrical-Conduit 66. Solar System-Final J�6. Rough Electric Wiring 67. Fe�cing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' .18: Rough Electrical-7 Bar Ceiling 69. POOUSPA 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 rr 24. Roof Framing �� 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 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 Mete�-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 F,�ctoryaFirePlac� N� 38. Final Plumbi g'� i n'" �,� r. 39. Water Service-Fin21y� , n . ,40. Gas`Service-Final" �y� � . L � L� 41�. Solar pomestic-Final� � , � 42. Backflow Pre"venter �% t , ,�' ' � u 43. Backflow Irrigltio� . � l •• r� 44. Landscape Irrigation Sys�tem - 45. Sound Attenuation 46. Hanclicap Regulations 47. FINAL STRUCTURE & BUILDING � � v 48. Special Requirements Compleied " � , 49. Electric'Release to Edison . � � 50. Ga's �Release to Southem California Gas Co �r � � 51. CERTIFICATE OF OCCUPANCY + No, Date � � Ciry of Costa Mesa Development Servipes Department . Building Safety Division P. O. Box 7200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No.��L'�� The Building located at 295 PALMER has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-1/M-1 Occupancy. Use of Building CONDOMINIUM Legal Description 425-331-12, 11 � (See reverse side for Metes and Boundsl Building Pe�mit No B-36312 Electrical Permit No. PD4E-36738 Plumbing Permit No. P�-36738 Mechanical Permit No. P�-36738 Number of apartments and/or guest rooms , •,�.� . . __.�,�, _ �:' . ,�_: . ISSUED TO: JERRY GALL lllbl SHBRMAN AVENUE GARDEN GitOVE, CALIFORNIA 92643 � .,.. . .,, � ., � - ,• Building Official e�()ges t�FiM3a5�Ata ey ��.,� �� 'I� `I Date AUGUST 29 � 1989 }'�• This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. ; � CMF 1015-46 rev. i/B3 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File ApP��ant to fill In all spaces ezce0� tnaze wilhin neavy bortler Iines an0 si9n all appraD/�ate tlecla�ationy, �� CITY OF COSTA MESA CONSTRUCTION PERMIT P�g MIT NO. TRACT NO. LOT NO. � �� i�� p �J.'2!_21n 12C�Q 2 ProjCctAddres ��.r✓--� �� !� � [.M ApplicanYsMailin Address/II�Z SiVS2JYJiOf� Ad� (oG91(„ Owner'sName t QR� G'u�l Phon 3L-0�05 Address ��iia- ,C�'2i'.✓lu.� O..-t �i�i- Arch/Eng.l�y� ��%�£Lf) License No. � ��SG Address��j 7� S/JN�A��An��Rw /i41. .i�s % G�IV(. 9ZG17 Contracror'sNa� e�.�4�� -s2cYLG Phone�3�"�80-5 Addresslmailingl�ll�2 .S.GS�/GOA�Ad£ (o`G• i9/S<3 City License No. LICENSED CONTRACTOR DECLARATION I hereby attirm [hal I am licensetl untltr provislons o( Ch ¢r 9(commencin9 with section ]000) oi Oivision 3 of t usiness antl Protessions Cotle, antl my license is in tull torce ana ffect. Lic¢nse CIa55 � �Se No� Da[e�5ignature 'YORKERS' COMGENSATION DE RATI �ereby atfirm tnat 1 have a certi e ol consent to Self-insure or a cerUflcate ,1 Workers' Compensation Insu an<e, or a certlfietl coDY �hereot (SecUon 3800, Lab. C.) Policy No. Company 8 Gertilietl copy is nereby tumishetl. Certitietl copy is tiletl with the city Buildin9 Divislon. Date APplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl nol be completetl if t rmll i5 (or one huntlretl ($300) or less). I<ertify that in the performance of t e wo for whith this permk iz issuetl, I shall no[ employ any Oe�son in any man So a t0 become subject to [he Workers' o e n Laws of Cali r Date � - Signa[ure NOTICE: If, after making this Oeclar i , snoultl become subject to the workers' Compensation provisions f he I.abor Cotla, you must torthwith complY '�'��h such p�ovision5 or s pe�mit Shall De tleemetl revoked. CONSTRUCTION LENDING A CV I hereby affirm tha[ tM1ere i5 a construction lentling agency (or the performance ot [he work for ith/}� a mi i issuetl {Section 3097 Civ. C.) LenEer's Name �d•�•'�� OWNER BUIrLDER UEc6LA�ON �C�� I hereby affl�m that'I am ezempt irom the Gontracto�'s Llc¢nse L.aw br the rnuowina reason (SecUon 7031.5 Business antl Professlonal CoOe: Any clty oi any sVuclure, orior to to tiie a si9netl statemi the Contractor4 licen: �ivision 3 ot the Bus .herefrom antl tne ba! 7031.5 by any app10 �enalty oi not more tn I, as owner of thi compensalion, will tlo 1or sale (Sectlon 704 License Law tloes not, thereon, antl who tlot employees, p�ovitletl tl sdle. If, nowever, tne 1 pletion, the owner wil rova for the purpose i � az owner ot tM1e IdCL (SSOCOlISLfUCLLi The Contractor's Lice builtls or imOwves tn tract�r(s) iicense purn proor of theb Wotkei ❑ I am exempt untler t for a permit subjec[s Ne appnwnt to a nvu r��e nu�a.ea aonars (5500). �operty o� my employee5 with wage5 as their sole ! work, antl the structure is no[ in[eneetl or ofleretl BOSI0055 dOd PlOt25510Od1 Cotle: The Contractor's �ly t0 an owner of a prOpe�ry who bUilAs or improves uch work himself/herself or through hls or her own Such imOrovemen[5 a�e nol inientletl or oftcrvtl for tling or Imp�ovBment IS Soltl within one year Of Com- rve the burtlen ot provinq he/sh¢ tlitl not builtl or im- ale). perty, am exclusively mntracting with Ilcenzea con- !Oj¢C[ (5¢CtiOl1 7044, Bu5i0¢55 dOtl PfOfC5TI0O5 COtlB: Law tloes not apply to an owner of property who on, antl who conVacts for such prolects wi[n a con- t to the Contractor's License Law). 1 am awara that Compensation insurance zhoWtl be provitletl to me. :tion B. & P. C. fo/ Ihis reason Date +��-�� V Owner � 1 hereoy certify tna( I have reatl this Information is mrt�ct. I a9ree [o com0 antl Signature Drivers' L CMF 0865-49 upon '�ta[e tM1�et the above ❑ countY ortlinances eby authorize repre- ionatl ptoperty ptor Date_�y� TYPE OF CONSTRUCTION LI NEW LJ ADD lJ ALrERATION LJ REPHIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE'OF PERMIT LJ GRAOING LJ FOUNOATION Ll STRUCTURAI. � O T,ENANT ❑ ELECTRICAL ❑ PWMBING O MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5�. FT. UPANCv— CONSTRVCTIONTVPE �� VALVATION�$ 1�Q• ZONE GRADINGCU.YDS. ACRES— Remarks: o � i. Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink Roof Drains Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Wa[er Closet Wa[er Heater Watei Service - Auto-Wash ' • Laundry Trays $15 Issue Fee $ 3 Boiler Duct- Under Ground Duct - Svucmral Duct � Ventilating ExhaustSystem ❑ MWtiple Firepl/Fact Blt. ICBO # Heating System & Ducting ❑ ai oo,000 aTu O� oo,000 Reinspection Fee � $15 __..._- _ __ _ _—.. 10/84 White - Building; Ganary - APPi��anh Pink - Accountin9; Goltlenrotl - Asse55or Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration Sys[em ❑0�100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers .Issue Fea � $ 3 � A.P. � y-"L,5 — 3S - — �2 S Main Building: E � T Front PAL, A Rear %(,� 'tD G� �J C Right Q� � C(� s �eft � a s' • Ping. Ref. # � - -12 PlanningNotes: 'T'.� /'35a� � _ �, ti ��. r.�-�.o,...�. •. Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Eiectric Fan F.A.U. Fixtures Device Boxes � Outlets Switches Garbage Dispoul Genereror 00.5 KW �5-15 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter pover 100amps Sub Panel Motors �0.1 HP � 1'f. - 8 Inc.Solar �9�15 HP �iG15+ Microwave Pole Light Sign , Standing Sections Trash FEES I Reinspection Fea '$15 � � Issue Fee I $ 3 DEVELOPMENTSERVICESRE�UIREMEN7S�, � � // /� Zoning APProved By (�(-�'�- Date Building Approved By Date Aooliption Issued Bv Oatn� 2 O N 1 N G R E Q M T $ SUM �F FEES � 12 BUILDING PERMIT 3 SMIP $ PLAN CHECK $ � 2� �- PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFIIM $ � MECHANICAi $ TOTAL FEE $ ��_ P�AN CHECK 25% $ 01 UCQ;9497-OOG�±9494 T4T F,?�,E7 n,�.rr. ��ian•.nn ....�. .�.�r CONSTRUCTION ANDJPLANNING POOL & SPA APPROVALS � Permit # Date Inspector qppROVALS Permit # Date �nspector 1' 1: �Temporary Electrical Service or Pole 52. Pool & Equipment Location / �� , . .. ,. 2. Soil Pipe-Undrgrnd. "' 53. Steel Reinforcement � / 3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms . �� i 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding r' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gmd. (/ 7� �9 �- 57. APPROVAL TO COVER-GUNITE 58. Electrical ConduibUndr �nd. r� ��' 7. Footings �� '��EL ' yG Q 9 ( ' 8. Foundation �� ' 59. Gas Pipe, O Undrgrnd;, Test - 4i ,� ! 9. Water Pipe-Undrgrnd:. 60. Backwash Lines, P-Trap„O Und�grnd. ., . �' 10. Structural Floor System' 1/p $`t Q'� 61. APPROVAL TO DECK" �; T� 11. Property Sewer Line & House Connection 62. Backwash & Receptor,Final n� �`� i w '"�' ' .. 71 DC 'i '1 12. Sewer Cap 63. Heater & Vent-Final .- v` �;' (�, �� n i�: � . 13. Roof Drains - - _ _ - 64. Plumbing System - Final �� ;� � � k% 14. Rough Plumbing 65. Electrical-Final _, � -� 75. Rough Electrical-Conduit 66. Solar SYstem-Final �'`l.� 16. Rough Electric Wiring 67. Fencing & Access App�oval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FIN,4L 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • x; L ( � 20. Rough Factory Fireplace APPROVALS Permit# �'� '� 21. Ducts, in Structure , 70. Underground Hydro '�� 22. Ducts, Ventilating , 71. Product Piping O Gas O'Oil 23. Gas Pipe-Rough & Test 72. Underground Flush i. 24. Roof Framiog � 73. Undergrnd.StorageTank OGas �Oil_ 25. Roof Sheathing 7 4r 74. Overhead HYdro � � 26. T-Bar Ceiling 1Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing ty Q9 76. Dry Standpipe _ ' r 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation y// � 78. FIRE PREV. FINAL 30. Orywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIF�CATE ISSUED � 33. Final Electric Notes: $0 F R SP$CIAL RE UIREMENTS 34. Final Heating & Air Conditioning y L� Q�/,j _ 4 �tl� 35. Final Gas Pipe-Test � 36. Hood or Canopy ' � 1•1 � , 37. Final Factory Fireplace ' �n 38. Final Plumbing ' . i/ ° �� 39�. Water Service-Final � � . . [ . 40. GasService-Final . • �� :,, 41. Solar pomestic-Final - ' - ;f • � 42. Backflow Preventer ` . � ' � % ', , :43. Backflow Irrigation • � � � /- � � � � . .� , , � - i � � :, ; ' 44. Landscape Irrigation System • - � � � �, . � , � � 45. Sound Attenuation � � , ;.• s.' : , � . 46. Handicap Regulations �� " / ' - ' 47. FINAL STRUCTURE & BUILDING �ZZ �� - • � r � P�. r ; 48. Special Requirements Completed / , • � • � . - : '1 . -. � f0 49.- Electric Release to Edison �( , • 50. Gas R�,iease to Southern California Gas Co •. y a 51. CERTIFICATE OF OCCUPANCY � No. Date � �I ciTY oF COS7A MESA CONSTRUCTION PERMIT Pr�p,qt Address ,S ♦ . �ApplicanYsMailing ddress�i ��{p"Z .C%M1�Q.�'rrtnn..., /t�U Owner's Name � " � Phone C-"�L•-- e& Address �' �� Z f 1�El,nw w.� U l� C�� E! Arch/Eng. License No. Address — Contracmr's Nam Phone Address (mailing) Ciry License No. UCENSED CONTFACTOR DECLARATION I hereby affi�m that 1 am licensetl untler provislon5 ot Chatte� 9(comm2ncing witM1 section �000) ot Divislon 3 of the BuSiness antl Professions CoCe, antl my Iicense is in full (orce antl effect. License Class License No. � Dale Signature WORKERS' GOMPENSATION DECLARATION 'ereby aitirm Ihat I have a certlficate of consent ro self-insure or a cortlficate Workers' Compensation Insurance, or a certitletl copy thereof (Sectlon �00, Lab. C.) � � Policy No. Company � � 8 Certifietl copy is hereby lurnishetl. • �f Certifietl copy Is flled with the city Builtling Division. "' Date AOP��a�� l�� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section n¢<tl not Ge compleletl i M ermit is for One huntlretl (§300) or less). � ' 1 certify thal in thC perlormance the w0 k fo� which fhis pelT�t i5 I55uetl I shall not employ any person in a y man er so a to become.subject to lhe Worker ' o nsat' p Laws of C forni � • .� Date �O�Signature � NOTIC : If, after making this tletlara ' , u sh Itl become subject to lhe WorkerT' Compensalion provi5ion5 e l2bor Cotle, you muSt torthwlth compiy witn such provizlons or �s permit shail be tleemea revoketl. CONSTRUCTION LEN�ING A NCV I her¢by affirm thal [hGrG is a cons[ruc[ion lentling a9en<y for the DGrfOrmdnce of [he work for which Inis Oermit ii i55uetl (Settion 3097 Civ. C.) Lenaer's Name . Lende�'S Atltlreis OWNER BUILDER DECLARATION �� I M1erebv afti�m lhat I am exempt trom the COnt�acto�'S LIC¢nse �aw for lhe also a 'vision 3 ot the Business antl Protezsions Cotle) or tha[ he/sne is exempt refrom antl tne basis for tha allegetl exemption. Any violation of Section 31.5 by any appli<ant tor a permit subje<Is the applicant to a civll enalty of not more than five huntlree tlollars ($500). �I, as owner of tho property or my employees with wages as thelr sole compensdtiOn, will tlo the wOrk, antl the sVuctufe i5 not intentletl Or otfefetl for sale (Section 7044, Business antl Protessional Cotle: The Contractor's License Law tloes not apply to an owner of a property wM10 builtls or Improves thereon, antl who tloes such work himself/herselt or throu9h his or her own employees, provitlotl that such Improvements are not Intentletl or oHeretl for sale. 11, however, the builtling or ImOrovement is soltl within one year of com- O�ellon, the Owner will have the bu�tlen Of P�ovin9 hE/Sne tlitl no[ bulltl o� Im- �fOV! f(lf LhC pl11pO5C O( Shcp). I, az owner oi the property, am exUusively mntracting with licensetl con- t�ac[ors to Co�'.hut[ the Oroject (Sectlon 7044, BuSlness antl Prof¢SSionS COtle: The Coniractor's License Law dOes not appry to an owner of property who builtls or imD��es thereon. antl who contracts ior such oroiects with a con- tractor(s1 licertse pursuan[ ro tne Contractor�s License Law). I am aware lhat oroor o( theiriWorker's Compensalion Insurance shoultl be provitlea to me. ❑ 1 am exemp�untler Sectlon B. 6 P. C. for thii reason Date antl Signature Drlvlrs' L 0865-46,i cn�s aoo�iEauon antl 5tate that tne abova omply with all city antl county ortllnances ConStructiOn,anC hereby aUthOrile repre- upon tne above-mentionetl property for Dale /7-/L-�� — icant to fill In all spaces except those within heavy Eortler Ilnes anG 519� all appropriate Eeelarations. TYPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LI GRADING LJ FOUNDATION IJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sq. FT. oCCUPANGV_ CONSTRUCTION TYPE VALVATION $ 20NE GRAOING CU. V�S. ACRES_ Remarks: � 2/ '7 1�7 Bar Sink Backflow Preventer�,� Backflow Irrigation',�t Bathtubs .-` .i, Clarifiers � Dishwasher 'i Drinking Fountains�: Floor Drains ' �� Floor Sinks Gas Service Outlets � Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiier Duct - Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple Firepl/Fact Blt. ICBO dk Heating System & Ducting C�6100,000 BTU 0100,000 Reinzpection Fee � $15 White - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Callectors Solar Piping Solar Tank Swimmin9 Pool w/Spe Urinal 3 Water Closet ( Wa[er Hea[er Water Service Sg Auto-Wesh Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑aiao,000sru ❑ioo,000 System Repair/Alteration Fire Dampers Registxs laue Fee FEES S Main Buildi E T Front B Rear A C Right g . Left Ping. Ret. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Ur�rt, ,�� Dishwasher%r �K.�� Dryers ❑Gas �Elec Fan ' , F.A.U. i' . Outlats $witChES Garbage Dispoul Generator 065 KW Fee zone Accessory Buildin9: Parking Req.IProvided ELECTRICAL , Transformer � 15-50 KW ❑ 50+ KW ' Meter/�(,tup ro 100 amps Meter ❑over 100 amps Sub Panel Motors �0.1 HP 01'h - 8 InaSolar 09-75 HP 01645+ � Mivowave Pole Light � Range Standing Sections 5 KW Trash Compactor � $15 laue Fee $ 3 •;. DEVELOPMENTSERVICESREQUIREMENTS: 2oning APProved By FEES Building Approvad By � APolication laued By -5'S N I N G N E U M T S. FEES i SUMMARV OF FEES , BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PWM8ING $ � ��UANCE $ PLAN CHECK 25% $ ENERGV P.C. $ 7 _. ELECTRICAL § �� GRADING $ PLAN CHECK 50% $ MICflOFILM $ � , MECHANICAL $ � TOTALFEE $ � PLAN CHECK 25% $ b,' �3 oi aoaszoo9-000zzoti r�r i`2.s� oarE: iznaise rrnE: o�:2a Il � COrNSTRUCTION AND PLANNING A9PROVALS Permit # 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. ✓, a 3`�Electrical Conduit Utility-Undrgrnd. !'� . 4?Electrical Conduit�Undrgrnd. , � . � 5.�SteAlYReinforcemet�t 7. 8. 9i � to. ,' 11. •j �1 '- al Floor System Sewer Line & House Connection r ,1•, j 13. Roof Drains ✓ � j� � 14. Rough'�Plumbing 15. Rougp�Electrical-Conduit 16.-Rough Electric Wiring �t � 17:1Rough Wiring Sign 18'JRough Electrical-T Bar Ceiling 19: Rough Heating & Air Conditioning 20:�Rough Factory Fireplace 2Y�'Ducts, in Structure � 2 . Ducts, Ventilating `�� 23. Gas Pipe-Rough & Test '_i : 24. Roof Framing � I�I 25. Roof Sheathing 'i� 26. T-Bar Ceiling (Structural) & Monocoat .' 27; Frame and Flashing ' 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31!A Plaster Brown Coat 32�jElectrical Power Meter-Final � 331 Final Electric 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 pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation 44. .LandSCape Irrigation SyStem 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas � Date �• P00 iP� � Inspector AppROVALS Permit# �� 52. Pool & Equipment Location �9 '4`4 53. Steel Reinforcement �� 54. Forms • 55. Electrical Bonding . 56. Rough Plumbing & Pressure Test '� �' •'57. APPROVALTOCOVER-GUNITE i . r � ' 58. Electrical Conduit-Undrgrnd. �_.::; � 59. Gas Pipe, O Undrgrnd., Test i'1 60. Backwash Lines, P-Trap, � Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final �63. Heater & Vent-Final 64. Plumbing SYstem - Final 65. Electrical-Final 66. Solar System-Final � 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL � FIRE DEPT. REQUIREMENT � � APPROVALS Permit # 70. Underground Hydro 7J./Product Piping OGas ❑Oil 72� U�derground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � _/ 80._FOOD CERTIFICATE ISSUED t � � No. Date � � � ': Date �Inspector 1� .i - nc� (�,i�Gtl•�'�' xlewatK l.p! i �