HomeMy WebLinkAbout2640 FAIRVIEW RD - Building PermitsADVllcant ta /III In all s0aces except thosa wlt�ln �eavy DorEer Iines dntl Sign all aoo�oDriata Eeclarations.
CITV OF COSTA MESA � . � PERMIT NO � T�.NQ. LOT NO.- BLD . .
CONSTRU�TION�PERMIT , ' — �/TL�.� J`'
PfojeCl AddrMS •_ TVPE OF CONSTRUCTION NEW ADD ALTERATIO REPAIR
Applitent'S Mailin9 Add� ss � �/ S • �• � � CONVERSION ❑ DEMOLISM ❑ OTHE.�Ra ���• �wC� q,p, �L '
n ' �''/%iA_f //KC . �O%
DESCRIPTION OF WORK
Owner's Name � hone ' 8j � , � � : . - S Main Building: _
•��9 4�. Ba s�' l` i'yl•' . e
Address: _ � � ; TVPE OF PERMIT GRADING FOVNDATION STRUGTURAL T Front . '
Arch/Eng. . License No.C'�O'3E�I7O ❑ TENANT � ELECTRICAL ❑ PIVMBING ❑ MECHANICAL . B
Addrew � � ' - A Rear
• " ��!ep O�'OTHER . ..
Contractor's Nam � CA . �Q /el � ��+ hone�j PROJECT DESCRIPTION SQ. FT. �Q%��O OCCUPANCV� K Right
Add�e55�mailingli��9 w•'^'-�3�ST'- `•�' �� • CONSTRUCTIONTVPE VAWATIONS �0�.�� g Left '
� ' 20NE ' GRADING CV. VOS. ACRES ping. Rei. �WW .�
City�Licanse No. ,
LICENSED CONTRACTOR UECLARATION . � Remarks: • . ' � . Parking R2q./Provided
I hereby aftirm tnat t am Iicensetl under provislons ot Charter 9(commencing ,
' witti section ]000) ot Divislon 3 of the BuSineu antl Professions Cotle, antl ' , � ' ' Use of Building:
my Iicense.is in (W torce antl eHect. � �p -
IJtense Ci �' �� ,�cens �� °�`� 7 d PLUMBING . PEES Planning Notes:
Dat¢ ��' %� 3 ciana�u.e . .
�ORKERS' COMPENSATION DECLARATION � Bar Sink Showers
hereby afflrm that I have a cer[Hicate of consent to selfinsure or a certificate gackflow Preventer � Service Sink ' �
ot WOrkars' CompenSatiOn InSurance, ot a ce�U(ietl copy Ihereof (Section_
3800, Lab. C.) ' � BaCkfIOW I�fige[ion $ewer Cap ' � ' ;
Polity No. � ' Company � - �
8 Certilietl Copy is M1ereby fuTizhetl. ' i . Bath[ubs • Sewef Conn2ction �� AUtOmatiC Washei
Certitietl capy is filed with the tlty Builtlin9 �ivision. ' � - -
Date ' ' applicant Clarifiers • Solar Collecrors - 9. Construction Pole
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION_ � � Dishwa5htt - � ' Sola�'Piping � � - CoOking Unit
(Thissection naetl no[ be completetl if the permit is for one huntlretl (y100) or
iess). � ' Drinkin Fountains � '
I cerfi(y�that:in [he perJolmdnC< Of th0 wofk fof�w�5hlch thi5 Oerm�t is'i55uetl, 1 9 ' $OId1 TdOk ' Di5hWZ5hQf
snall. not employ any person In any manner sO to}� come�} �ect to the .
Work¢rs' Cop1pens�i7o Laws ot California.�� J�/,� //� � Floor Drains I $wimming Pool w/Spa _ Dryers ❑Gas C
Date ��— /" y � Si9nature F •6q�S(.C{ ,
NOTICE: II, al[er making this tleclaratlon, you shoultl become subject to the FIOor Sinks Urinal Fan .
� Workers' Compenutlon provisions�oi tne Labar Cotle, you must forthwith
comply wlth, suc�.provislons o� thl5 pOrmit Shdll b¢'Oeemetl revoketl. GasService �UlICtS WaterCloset� F.A.U. '
CONSTRUCTION LENDING AGENCV � � _
I hereby aHlrm that there 15 a con5trutUon lentling agency for Ihe performance . IniCrc2ptOrs ' � Water HeOter FixturCs
Of [he work 4or whith� tNi� DGrmit is IssueU (SecHon-�309] Civ. CJ . _ - -
Lentlor's Name � . , Kitchen Sink ' Water Service - � DCvice Boxes
I Lenear's Atltlress � • � - '
IOWNERBUIL�ER�UECLARATION . '- ' - Lav6rorie5 . ' ' _ _ � � ' �, . Outleti '
� hw.anv aI11.m eFat 1 dm OxCTPt tfOlil Ih8 COnVactol'S licenSe Ldw foI tlle ' �
�o
antl
on 0031.5 Business antl Profes5lonal Cotle: Any city or P—Trep Switches
a pa�mil to ConStrutl, altGr, Irtlprove, tlemolish o�'re0dl� ' - � �
ils issuan<e, also mqWros the applicanl for such permlt ROof Dreins " . - ' ' Gurbnge Oizpos
int lhal �e/shc Is Ilcansotl purSuant t0 ttlG OrOVIsiOns Of _ .
e L�w ( Nn0.01er 9(commentiog w„th Sec�lon �000) of . .�. � ,
�...... . e..� .,. ., e , e . . i. e ..,.., . � . � • . . Generator �0.
�Fae � 525!
'�031•.5 by any apP���ant for a pe
�¢flilty Of nOt mOra than fivB 11Untlla<
I,•as OwnU� Of Ihe'p�ope�ly o�
Componsatlon, will tlo th¢ work, antl
fOr sale�(SeCtion 7044, BUSiness an
License Law tloes not aoolv to an ow.
ot 5e
to a
os or
�is oi
employees, provltletl Ihal sucn.imp�OvemGnts a�e not intentletl or ofteretl fot
salo. If, however, tha bulltling or Improvement I5 soltl within one year ot com-
pletion, tho ownur will naw tne burtlan ot proving he/she tlltl nat builC or im-
�rove for the pur0ose of salo�. '
I, as ownat o1 the p�operty, ain exclu5lvaly COnt�acting•with IlcenSetl con-
tractorsto con5(rutt the pro�act (Saction 7044, Busin¢sz antl Profeisions Cotla:
The Contractor's.Licanse Law tloas.not apD�Y la an owner of pro0erty who
�bulltls or improves thereon, antl who contracts for such pro7ects with a con-
tractor(s) Iicensa pur5uant lo t�e Contractor;s Licansa law).
❑ I am axempt untler Snction B. & P. C. for [hls reason
i
Date ' • Owner � - �
I hereby ttrtliy that I nave r¢atl thls application antl state that the abova
iniormatiom is correct: I agrae to <omply with albtlty�antl'coun[y ortlinances
antl state laws relatln9�ta bulltling <onsiruct on; antl'.nereby authorize repre-
sentatives o� tnis. city e ter, �pon above-mantionetl properry for
inspectian puiposes. a
Signature �ate_��Q�[
Boiler
Duct - Under Ground
Duct-Svuctural � �
Duct � Ventilating
Exhaust SVstem ❑ Multi
Firepl/Fact,�81t. ICBO ik
Heating System & Duccing
❑0.700.000 BTU 0100,(
Drivers' Licerise or 55 � — � I I Reinspection Fee
CMF 0865-46 rev. 7/83 White • Builtling; Canary - Appliwnt; Pink - Acmuntin9: Goltlenrotl - Assessor
n
$25
laue Fee
Hood or' Type I' � �
Canapy � Type II ❑ �
Refrigeration System �
Oaioo,000sru ❑�oo,000ei
System Repair)Alteration '
5 3
�
laue Fee - , $ 3
0
96'_I I,�-�'� .
I2one .
Accessory Building: .
Park.Fees
. �r•�' .'7
Z
O
� N
I
N
' G
R .
E
., p '
' I
R
E •
M .
E
� . T �
ELECTRICAL � '
.Transformer ❑ 15�50 KW
❑ 50+KW
�'Meter ❑up�to100amps .
Merer over 100 amps '
:lectric � Sub Panel �
� �Motors061HP�1X�8 -
Inc.Solar �415 HP �1G75+
Mittowave
� Pole�Light � �
Range .
. � $10l1 � - .
Standing Sections
KW �5-15 KW Trash Campactor
FEES
I Reinspeetion Fee I S25 I Issue Fee I $ 3 I�
PUBLICSERVICESREQUIFEMENTS: ' .
2oning ApProvad By � Date '
Application Approved By ` Date��
ApPliration Issued By ' � � � � Datfl�f ��' �.�5
f-.t�-"
. , SUMMARV OP FEES ,
BUILDING PERMIT $ SMIP $
PLAN CHECK � $ • � PEPMIT � � -
. PLUMBING ' $ ' ISSUANCE $
PLAN CHECK � $ ENERGV P.C. � $
� ELECTRICAL � $ ��� GRADING $
'. PLAN CHECK .$ � MICROFILM $ � a
, MECHANICAL � � $ TOTALFEE $ �����V
PLAN CHECK $
0
:,' , .
. Y
� CONSTRUCTION AND PLAN If�G � P� .�` SPA
' Date :Inspector Date Inspector
- APPROVALS Permit �p `� qPPROVALS Pe�mit #
R�
�-,�1: Temporary Electrical Service or�Po�e , i 52. Pool & Equipment Location -
�� �2. Soil Pipe-� ndrgrnd. �.�� � �� 53. Steel Reinforcement
�3..EIecViical Conduit�Ut�lity�Undrgrnd.� - � ' 54. Forms � - ".+
4. �Electrical.Conduit-Undrgrnd. '�� 55. Electrical Bonding ' -�
i. ,t-_
' 5.� Steel Reinforcement � - 56. Rough Plumbing & Pressure Test �v
6: �Ele'ctrical�UFER�Grnd. , 57. APPROVAL TO COVER-GUNITE ��
7.�Footing.s'(„ � , "��� , -,e .58. ElectricalConduit-Undrgmd. /�..�
8. Foundation ��` ` " 59. Gas Pipe, O Undrgrnd., Test `� ��
�, , ��'.
9. Water Pipe-Undrgrnd. � • '+ 60. Backwash Lines, P•Trap, O Undrgrnd. IW
'�.
10. Structural Floor System �� 61. APPROVAL TO DECK
i �s,
1 L'Property Sewer Line�& House Connection �' 62. Backwash & ReceptorFinal
F
12, Sewei Capi� ��� ! 63. Heater & Vent-Final ��
13:"Ro'of•DrainsS '� �� " _ 64. Plumbing System - Final �
�- •;
14. RougFi Plumbing'' � 65. Electrical-Final �>
.� _�
15. Rough Electrical-Conduit - 66. Solar�System-Final
16. Rough Electcic 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
.v . .
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Struaure � , � 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping L7 Gas ❑ Oil
i 23. Gas Pipe-Rough & Test 72, Underground Flush �
" 24. Roof.Framing � � . 73. Undergrnd. Storage Tank O Gas ❑ Oil
,
25. Roof Sheathing,• � 74. Overhead Hydro
� 26. T-Bai Ceiling (Structuraq & Monocoat 75. Dry Chemical
27. Frsme and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation . � 78, FIRE PREV. FINAL
�
30. Diywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final // Y) 80. FOOD CERTIFICATE ISSUED
33. Final Electric .�� �7 $� Notes:
34. Final Heating�& Air Conditioning .
35. Final Gas Pipe;Test � �
36. Hood oi Canopy
37. Final Factory Fireplace . • ,
38. Final Plumbing ' . . �
39. Water Service-Final , � . � � . ,
40. GasService-Final,
41. Solar pomestic-Final. . '
42. Backflow Preventer ' �:
43. Backflow Irriqation . �
44. .Landscape Irrigation System � �� •
�
45. Sound Attenuation '
46. Handicap Fiegulations
47. FINAL STRUCTURE & BUILDING '
48. Special Requirements Completed ,
49. Electric Felease to Edison .-- '
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY ..
No. � - �Date �
AVD���ant to iill in all soaces within
CITY OF WSTA MESA - PeanniT No. ,!/
CONSTRUtiTION PERMIT �- ,j��2`y'
Addrea
ArchlEng. � License
r�aoress • �
Contractor G= /�./ tJ.;.�%" � Phone
I hereby atflrm thct I am IlcePsetl untler provitions ot Char[er 9(com-
mencing,wkh sectlon 7000) ot Olvision 3-of fha Business an0
'Protusslons Coae antl my Ilcense is in full torte antl eftect.
Licenso Class ��U Lic e No.
'�ate �l �� � �� � � $Igna W�e
WORKERS'COMVENSATION DECLARATION
I hereby affirm t�at I have a certificate of consent to self-Insure�or a
certifiwte oi Workers' Compensation .Insuranta, or. a certifleC copy
-,".�ereof (Sec(lon 3800, Lab. G.).
tw--+Icy Na. Company
�"r-a,' CerUfietl copy is�hereby turnishetl. . . _
-LJ CertiBetl aopy is tilatl with [he city Builtlin9 Divislon.
EXEMPTION.FROM WORKERS' COMPENSATION DECLARATION
'(This setlion neetl "not be cor�P�e[ea it the permit is (or one hunOretl
.SE300) or'leul. • - . .
. cerllfy lhat In [he performaPce of the work tor which this permlt is
'issu¢tl, PShall nOt employ any Pe�son in any mann¢r so a to beCOme
subject'[Jo th'e' Wo�rke'rs` Compe�saiion Lpws of orni
'DatelL�q1�..�5lgnattlre '%r� �•���
�NOTICE: Ii after makin9 �his tleclaration, you shoultl become sublect
�t0 the WOrkGR' Compensation P/ovisions of the Labor Cotle, you rtius[
'forlhwith comply wilh such provi51on5 or thi5 permit snall be tleCmCtl
�evoketl. • ' _ , _
;CONSTqUCTION IENDING AGENCV � � �
I hlr�by afiirm that lM1ere Is a constru<tiOn I¢ntling agancy �o� the pCr-
formance of the work for wbich tM1is permit is issuetl (Sectlon 3097
Civ. CJ. . . . . .. . . . . .
'Lentler's Name
�Lentler's'Atltlress �
OWNER�BVILDER �ECLHRPTION -
I hereby affirm that I am exemP� from the Contracmr's License Law Por
the following reason (Sec[ion �031.5 Business antl Protessions Cotic
Any Cily or county which repulres a permit to const�uct, alter,
Improve, tlemolish or repair anY structure, prior to its issuancq also re-
qulre5 the ap� Ilcant fo��such permit to file a signetl sta[emen[ [hat hC
is.licensetl pursuantto lhe pro��sions of the Conbactor's�License�law
(Chap[er 9(commencing with Section 7000) of Divlsion 3 ot the
'-1ne55 antl Prdessions Cotle) or�that M1e�is exemp[ [herefrom antl the
' for the alle9etl ezempHon. Any violation o� Sectlon 7031.5 by
appll�nt tor a.permit•sub�ects the applicant to a civil penalty�
not mora than fiva M1untlretl tlollars (E500).
❑�I, as owner ol �the propertY, or my employees with wagei as Iheir
Sole compensation, will tlo the �+ork, antl Ihe strutture is not Intentle0
or-ofteretl-(or sale: (Section ]044. Busine5s andProfessions Cotlei The�
Contractor's Li<ense Law tloes not apply to an owner of a prop¢rty,
who bullds or improves lhereOn, antl who tloes suth work himiell or
[hrough his own employe¢5, provitletl that such ImprOvements ar¢ nol
inlentletl or of(eretl tor sale. �Il: however, the builtling or improvemen[
Is soltl wlthin On0 year Ot comP�etion, the owner wfll hdv¢ the burtlen
of pwving he Oitl not builtl or imOrove for fhe purpose of salej.
❑ I, as owner ol t�e property, am exclusively .Contracting wilh
Iicensea contractors'to cons(ruct tne project (Sectlon 7044, Business
antl Profasions Cotle: The Contractor's License Law tloes not apply to
an owner ot property wha bV��tls or ImprovCS [hereon, antl who com
t�acts from such projects wilh..a coM�acto�(5) licesn¢tl pur5uant to
the Contractor's Llcense Lzw).
❑ 1 am exomp[ unGer SecUon ' 6. & P. C', tor tnls
reason
Date pwner
I have �eatl t�is application antl s[ate that [he above
ecL I agree to mmply with all city antl county
laws relatlP9 to const�uction, antl tle�eby autho�ize
thi5 city'"to e te/ upon the abOv¢ menHonetl
eortler lines antl sign all aoPropriate aeclarations.
TRACT NO. LOT NO.' BLDG. NO.
TVPE OF CONSTRUCTION
❑ NEW �O AO� ❑ ALTERATION -
❑.REPAIR ❑C NVER510 ❑DEMOI
,P OTHER ' � " -�
DESCRIPTIONOF ORK �H<%2�/
❑ GRAOING ❑ FOUNDATION ❑ STRVCTURAL
❑ SENANT �ELECTRICAL OPLUMBING ❑MECHAI
❑ OTHER !
PROJECT DESCRIPTION -. ,.
SQ. FT. .
OCCVPANCY �_CONSTRUCTIONTYPE
VALUATION ZONE,
GRADING CV. VDS. ACRES _
REMARKS: �� '
PLUMBING � - �.:PLAN CHECK
BATHTUBS� SHOWE0.5
TOILETS URINALS ' "
LAVATORIES DOUBI_E LAVS -
KIT.SINKS ' ' DISHWASHERS
SERVICESINKS ' SUMPS ' ' �
�FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS � �
INTERCEPTORS CLARIFIERS"
$WIMMINGPOOL 'PTRAP� ' '
WATERSERVICE - ALTERATION '
GASSERVICE ����� 'OUTLETS �
WATER HEATERS� �BTU OVTPUT '-'
SEWER CONNECTIONS . � �
SOCAR'TANK- - COLLECTOfiS
SOLAR PIPING SVS. -
ISSVEFEE ' �
MECHANICAL PLAN CHECK
HEATING SYSTEM 0-100,000 BTU
AND DUCTING � ' - • '
300,000 + gTU
REFRIGERATION 0-100,000 BTU
SVSTEM - ' 100,000+BTV
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
properry �or ins eGt on rpo ��
Signalure ���/A�, oate,�� � 3-ri�
Drivers' License or 55 �' �, y ' ' ISSUE-FEE
CMF 0865-46 White-Builtlin9: Canary-Applicant; Pink-Accountin9: Goltlenrotl-Assessor
. . �
{I931- 1 1 /�7s/�,_
ZONING REGULA710NS
A.P. �
ZONE � PLNG. RHP, p
REAR VARD (TO P/L)
PKG.SPACE REQ.
STREET WIOTH
ZONING APPROVEO BV
SPECIAL CONDITIONS:
ELECTRICAL
13,OC
PROVIDtD
.��PARK FEE E'' . . .
DATE
PLAN�CHECK • � I'
GENERATOR 0-1 KW_1-lO;KW �
•TRANSFORMER
'APPLIANCE 30-50 KW_50 t KW � :
MOTORS ' 0-1 HP=1-10 HP
/ �.
��1NC:SOLAR). � -10-SOHP $O+HP T
FIXTURES -'OVTLETS 'SW�TCHES " "
�GAS TUBE SIGNS - �
;POLE LIGHTS ' - ' ' .. i . -
POLES METERED �SVB �'�'`
•PANELS MAIN ,'.SVB . �'.
'SERVICE' � � / AMP� � .� . . �
. � ., . J. I • ;
ISSUE FEE" ' ' ��. ' : I .
APPLICATION APPROVED BV - .. " DATE
��
SUMMARV OF FEES' . . �
� BUILDING � , ' ' � �
PERMIT E� SMIP - S
- �PLAN.CHECK 5 - PERMIT
� ISSUANCE E
.PLUMBING S ' '-
�� ��p �����) GRADING � E-
PLANCHECK E-:5.�`� .L_ .. •
t
EI_ECTRICAL y s
' PLANCHECK g ; MICROFILM S �
MECHANICHL $ ' - TOTAL FEE E _
PIAN CHECK b � LE55 AD- _
VANCEPC S___
��.X� �� "V�6. FINAL FEE S
��
CONSTRUCTION AND PLANNING � POOL & SPA, � ", . _ , �.,
APPROVALS Permit #�� a' Date laspector APPROVALS - Permit # ' - Date - Inspector„�
w,
t. Tehiporary Electrical Service or Pole � 43. Pool & Equipment Location ' �•
i �pe-Undrgrn � ' ' , Steel Reinforcement ' - - �
3. lectriwl Conduit Utility-Undrgrn � ' 45. Forms ' '--- - ' " ' � -
4. Elsc[rical Conduit-Undrgrn -�46. Electrical Bondin _ �
. tee em orce -� 47. Rou h Plumbin & Pressure'Te"st - �
6. Efectriral UFER Gm 48. APFROVALTO COVER{'iUNITE �• ' '' ' �" �
7. ootings 49. Elecdical Conduit-Undr rn -
8. Foundation . 50. Gas Pi , � Undr rn, Test..
9. Water Pipe:llndrgrn - 51. Backwash ines P-Tra �'Q ' n� ' '' � -
10. Structural Floor System 52. APPROVALTO DECK � �` ' �
li. Propecty Sewer Line & House Connection 53. Backwash & Rece tor-Final . � '
12. Street Sewer Connec[ion ' '' 54. Heater & Vent-Final '�
13. Rough Plumbing
14. Rough Electric-Conduit - � �56. Electrical-Final
' 15. Rough Electric•Wiring - - � � - 57. So�ar System-Final ' � - "
16. Rqugb Heating & Air Conditioning = � _ - • encing & Access Approval '
17. DUcts in $tructure APPROVED FOR PLASTERING
18. Ducts, Ventilating .. ' . . ! . '. _ +� � . ' • • �
19. Gas Pipe-Rough &Test 60• POOL/SP,4 SYSTEMS FINAL
� 20. Roof Framing ' ' - - �
21, Roof Sheathin ' � - � � - - " � � �
22. Frame and Flashin NOTES: '
, 23. Insulation � " - � � �
� 24. Lathin & Siding ' � -- �
25: Dry�vall Nailing ' - - � �
26. Plgster Brown Coat ' ' - - � ' �
27. Electrical Power Meter-Final.� . � � • �
28. inal Electric�� � ' � �
29: `�Rinal Heating & Air Conditioning - � � �
30. Final Gas Pipe-Test.
31. .. Final Plumbing ' �
32. Weter Service,Final '
33: ,�� Gas Service-Final � �- � �
' 34. Solar pomesticFinal '' • � ' � � � � � ��
35. Landsca e 5 rinklin S stem ' - - � ' " - � ' ' � '
36. Sound Attenuation � � �� " � " � - ' � � ' - '
' 37. Handicap Regulations � � ' • � � ' ' �
' 38. FINAL STRUCTURE &�BUI�DING -
' 39. Special Requirements Completed - � � -
40. Electric Release. to Edison ' � � �
' 41. Gas Reiease to Southern California Gas Co. ' �� �� '
42. CERTIFICATE OF OCCUPANCY _ ' '
~ No -' Date- - - � - - � -- ., _ . a_ � � . .
CITV OF COSTA MESAA�- C,ONSTRUCIT'I
Project Address 2� `� �����/��
AoO���ant to flll in all spaces except those witnin neavr Ooraer Iines ana sign a1l a0oroorlate eeclaratlons.
PERMIT NO. � TRACT NO. LOT NO. UN1T NO.
- 3
OFCONSTRUCTION rvEW AOD
CONVERSION ❑ DEMOlISH ❑ OTHER
S�itIPT10N OF WORS/USE9F BLDG.=
Address G LO �lv r%//�" • � w/�✓ / l�J/ qyL/NC,�i
Arch/Eng. Licenu No.
Address
Contracror's Nam %2� � � one (�/�[/��
Addresslmailing) LC3 T�-;C•� C��
Ciry License No. �L � 7�
LICENSED CONTRACTOR DECLARATION
I nereby alfirm lhat I am li<ensetl untler prOvi5iOn5 0l Chdrtar 9(commencing
� with section ]000) of Divislon 3 ot tha Business antl Professians Cotle, antl
my Iicense is in fu)j farce�a eHect. � r-y
License Q s L � Lice se �� �
Date _ Si9na f' _
WORK RS' OMPENSATIO� CLARATION
I hereDy aifirm that I have a cerHiicate ot consen[ to Sel/tinsure or a certiflWte
of Workers' Com0en5alion InSurance, o� a certlfleU copY [nereof (Section
3800, Lab. CJ
Policy No. Company
Certifietl copy is hereby tumishetl.
Certifietl copy is filetl wit� the cl[y Builtlin9 D)vision.
Date APplicant
EXEMPTION FROM WORKERS' COMPENSATION OECLAHATION
(Thi55e<tion need not Ge complatetl H tha Oermi� Is 10� ona huntlretl (E100) or
less)
1 certity thal in Ihe petfo�manCO ot Ihe work to� whlch tbis pe�m�j ,�SlSsuatl, I
Shall not employ aqy p¢rson in any man�ry� So a5 to b¢Copi¢ $�p}q<t tqihe
Workers' CoMpensbtlon Wws o! Califppy/,/� __ _ i/ L(� //
'NOTICE: �I. S/[ldRiakifig tbis Cecl2ietTOM1, you ihOultl beco�sub�ect to lhe
Workers' Compensalion provisioni 01 the Labot Cotle, you must forthwith
comply with such provisions or this permit snall be tleametl revokea.
CONSTRUCTION LER�ING AGENCV
I nereby ai(irm that there is a constructlon lentlin9 agen<y tor tho performanco
of che work for wnlch tnis permit is isiuotl (Sectlon 309] Civ. CJ
12naer's Name
�entler's Atltlress
OWNER BUILDER OECLARATION
I har¢by a�li�m lhat i dm exempt IrOm Ino ConUactOr'S U<onsa Law fOr lna
following rea5on (Sectlon 7031.5 Business anC Protossional Cotlo: Any tlry or
coun[y whiGh requires a permit lo construGt, alter, Improva, tlemolish or rCpair
any 5[ruc[ure, prlor to Its Issuance, alm reqW�es [h0 applicant lor SUGh pe�mil
to tiie a signetl statement that he/sne is Iicansetl pursuant to the provisions of
tM1e Con[raCtor'S Licanso Law (ChaD�er 9,(commoncln9 with 5ectlon 7000) 01
Division 3 of the Busine55 antl Proles3wn5 Cotle) or that hC/She is exempt
� tberofrom anU tne ba5i5 tor tho allegetl ezamption. Any violation ol Snctlon
7031.5 by any applican[ Por a permlt Subjact5 Ihn applicant t0 a civll
�enally of not more ihan livo huntlretl tlollars (5500).
I, as owner of �he propCrly or my Cm0loyees with wug05 as l�eir zola
CompenSdtiOn, will tl0 thC work, antl [ho sVUClur¢ IS nOt Inlantletl Of oHelotl
tor sale (Saction 7044, Business antl ProiMsional Cotle: Tha ConVactor'S
License Law tloes nol apply to an owner of a properly wno bulltls or Improvos
thereon, antl who tloez sucn work himsel(/harsel� o� lhrou9h hls or her own
employces, orovlaed that such Impwvamenis aro not Intentlotl or otferetl lor
sale. If, howawr, tbe builtling or Improvement Is soltl wl(hin ono Yaar nf com-
pletlon, tha owner will bavu tbe burtlen ot proving no/ihe tlitl not bulltl or Im-
prova tor the purpo5e oi salo�.
❑ I, as owne� of lhe property, am extluslvely can[ratting wilh IiCOnsetl con-
IfdCiOlS [O COOSIlUCI Ih! pfOjMl (SCCUOl1 iO44. B115I0055 dI1C PfOiC55IOf15 COEO:
The Contrac[or's License Law tloes not dpply lo an owne� of propCrtY who
builtls o� impraves lhercon, antl who conVactS tor such proj¢c�s wilh a can-
tractor�sl Ilcense pursuant�to the�Contractor'z LicenSe Law). I am awaro that
proof of thelr Worker'S Compansalion insurance Shoultl ba prOvitletl to ma.
❑ I am exempt untler Sec[ion B. d P. C. ior this reason
Date Owner
I hava reatl this aoPlicatlon antl ztate that the above
I agree ta comply with all city antl county ortlinancez
to builtlin9 construction, antl hereby authorl:e repre-
' to entet upop� [h0 abD�e-rnentionetl pro{�rty/fOr
inspection pur
Signature
Drivers' License or 55 qF
ALTERATION LJ REPAIR
TYPE OF PERMIT�q LJ GRADING LJ FOUNDATION LJ STRUCTVRAL
❑ TENANT r�ELECTRIGAL ❑ PLVMBING ❑ MECHANICAL
�O OTHER
� RQIECT DESCRIPTION 5(l.
CON STRUCTION TYPE_
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kiichen $ink
Lavatories
P—Trap
Roof Drains
'T. OCC V 7ANC V
VALUATION 3 _
GfiA�INGCU.VDS. ACRES_
Reinspection Foe � $15
Boiler
Duc�� Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heatin9 System & Ducting
❑ 0.100,000 BTU � 100,000 BTI
Reinspection Fee � $1b
— •
CMF OB65-46, �ev. 30/84 Whit< - Builtling; Canary - Appllcant; Pink - AccOuntin9; Goltlen�otl - Assesso�
r161NG I FEES
Showers
Service Sink
$ewer Cap
Sewer Connection -
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Leundry Trays
Issue Fee � S 3
Hood or Type I �
Canopy Typell ❑
Refrig¢ration System
�0.100,000 BTU ❑ 100,000
System Repair/Alteration
Fire Dampen
Registers
I�sue Fee
A.P. qW
S Main Buildi
E
T Front
B Rear
A �
C Right
K Left
S
Ping. Ref. #
Planning Notes:
2692 ii/20/B4
2one
Atcessory Building:
ELECTRICAI
AutomaticWasher Transformer-� 15-50KW
Construction Pole Sub. � 50 + KW
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
Fan
F.A,U.
FixWres
Device Bozes
Outlets
$witches
Garbage Disposal
Generator 00�5 K W � 5�15 K W
Meter LJuq.m 100 amps
Sub Panel �
Mowrs �0.1 HP � 1 X- 8
Inc. Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Sign
; Slanding Seciions
Trash Compector
Reinspaction Foe $15 Issue Fee
FEES �
DEVELOPMENT SERVICES RE�UIREMENTS:
2oning Approved By
Building Approved By
Appliption Issuad Bv �>�A
$ 3
Eo00 TL
FEES
$ 3
SUMMA'RV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING 5 ISSUANCE $
PLAN CHECK 25% $ d ENERGY P.C. $
ELECTRICAL b Ci�C%D GRADING 5
PLAN CHECK 50% 5 MICROFILM $
MECHANICAL $ TOTALFEE $ g•OO
PLAN CHECK 25% $
Z
O
N
I
N
G
R
E
�
M
T
$
� CONSTRUCTION AND PLANNWG � ,, POOL & SPA -
APPROVALS - Permit# Date Inspector AppROVALS- Permit# Date Insp?cf�r
, 1. Temporary Elec[rical Service or Pole 52. Pool-& Equipment Location .
� 2: -So'nPipe-Undrgrnd. . � ' 53. Steel Reinforcement ,
3: E ec[rical Conduit Wtiiiry-Undrgrnd. = 54. Forms . ,.'
^4. ect�ical Conduii-Undrgrnd. ' � 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ��
6� Electrical UFER Grnd. ' S7. APPROVAL TO COVER�GUNITE .
7. Footings �' - 58. Electrical Conduif-Undrgrnd. . �
8- Foundation '� 59. Gas Pipe, O Undrgrnd., Test .
9. Water Fipe-Undrgrnd. . ' 60. Backwash Lines, P�Trap, O Undr9md. _
10. Structural Floor SYstem L` 61. APPROVAL TO DECK _
71.: Property Sewer Line & House Gonnectiqn 62. Backwash & ReceptorFinal
12. Sewer Cap , � , � ' 63. Heater & Vent-Final .
13. Roof�Drains � • ' � � 64. Plumbing System - Final ' ,
� 14. Rough•P,lumbing � , � ' 65. Electrical-Final i
15. Rough.Electrical-Gonduit - ' 66. Solar'System-Fin21 . - � '-
�. 16. Rough Electric Wiring � 67. Fencing & Access Approval � _
T7.rRough,Wiring Sign ' 68. APPROVED FOR PLASTERING
- 18.; Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL . ��
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
2�. Rough Factory Fireplace APPROVALS. Permit#
21.�Ducts, in,Structure 70. Underground Hydro .
22. Duc[s, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Tes[ 72. Underground Flush
� 24. RoofFraming 73. Undergmd.StorageTankOGas ❑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 � HEAITH DEPT. REQUIREMENT
. 31.�Plaster Brown Coat 79. FINAL INSPECT�ON
32. Electrical Power Meter-Final �� �� � Gj 80. FOOD CERTIFICATE ISSUED
33. Final Electric J (e L1.0 Notes:
34. Final Heating & /�ir Conditioning _
35. Final Gas Pipe-7est - -
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 lrrigadon . ' ,�
44. Landscape Irriqation System � ' �
.� .
45. Sound Attenuation . � i . , �
46. Handicap Regulations � �
47. FINAL STRUC7URE & BUILDING ' ;
48. Special Requirements Completed � , ��
49. Electric Release to Edison - - - :
, - i . ..
.50. Gas Release to 5outhern Califomia Gas Co . . �
51. CERTIFICATE OF•OCCUPANCY , . _ . . _' . .
No. Date
AOD��eant to Iill in all spatei withln
CITY OF COSTA MESA ' PeRrnir No. '
CONSTRUCTION PERMIT E / %� 7
Addrea �d..r�r -
Address
CAntractor
Cortler lines antl sign all apv�oorlate aeelaration
TRqCT NO. LOT NO. BLDG.NO.
C� /77Yf� OF CONSTRUCTION
(,(� ❑ NEW �❑ ADD ❑ ALTERATION
K/� ❑REPAIR ❑CONVERSION ❑DEMOLISH
LiC2n5E NO. ❑ OTHER
DESCRIPTION OF'WORK
LICENSED CONTRACTOR DECLARATION
` I hBreby dtfltm that I am IICanSaC untler provl5ion5 Ot C�drtlr 9
Nmanting with section 7000) o/ Dlvlsion 3 0/ tna Businos
R'ofosslons Cotla, antl my Iitense is in full forcG antl i
Q License C11ss' "�% -'r Utens� N�i�
�WORKERS'LOMPENSATIOIVDECLARATION
� I hereby aHirm that 1 hava a ttrtiBcate of conunt to solt-Insure or a
certificate of Workeri' Compensation Insurance, or a certitietl copY
� Ihereof (Section 3800, LaO. CJ.
'Cy No. Company
:ertifled copy Is hereby fumished. -
�L� Certifle� copy Is tiled with tne city Builtling Division.
EXEMPTION FROM WORKERS' COMPENSATION �ECLARATION
\ (This satlion neetl not Ee completed it tha permi[ is tor one huntlred
V �E100) or less).
c¢rtlfy that in t�e perto�mante Of thG wo�k tor which thl5 pe�mlt IS
issuatl, I shd II not employ any persofJ� in any manner sJ/ as [o'/1;�ecome
� SllbilCt t01/{¢ WOlk¢IS' iATO¢flSdilOO��dwS O( QdllfOftlid._ /t
C Date ��Sl9nat�.�N��T/���
^ NOTICE: It a ter making this tleclaration, you shoultl become subject
Uto the Workers' Compensation provisions ot tne Labor Cotle, you must
forthwitn comply with such provi51on5 or [nis permit shall be tleemetl
revoketl.
CONSTRUCTION LEN�ING AGENCY
I nereby afflrm tnat there ii a tonstruction IenOing agency lor t�e per-
formdnce of th¢ work fOr which this petmit I5 IssueU (Secllon 3097
Clv. CJ•
Lentler'S Nama
LenCer•1 Atltlras
. OWNER BUILDER DECLARATION
qny ci[y of Wun[y w01c0 fequlfe5 a perml[ [O COnSIIUGq al[ef,
Imp rove, tlemolish Or rGpair any struCtUfl, PIIOf to Il5 ISSuante, a150 r8-
qulres the appliwnt for such permlt to tlle a 5i9netl itatement t�at he
Is Iicensetl pursuant lo lhe provi5lon5 0( the Contractor'S License Law
(Chapter 9(commencing with Sec[lon 7000) of Dlviilon 3 0l the
BU5Ine55 antl PrdessiOns Cotle)"or thdl hc is ¢%Ompt therelrom antl th0
' �s for the allegetl exemption. Any Wolatlon ol 5ec[(on ]031.5 by
appll�ani for a Oermit subletts the aDP����� lo a clvil penalty
.�ot more than five hunarea tlollars (E500).
LI I, a5 owner Of [hC prOptrly, Or my employces with wa9ei a5 Ih¢ir
Sol¢ COmpensatlon, wlll tlo lha work, antl tha SVUCture Is nol intentled
Or Ofltr¢tl ta! Shce. ($¢Ctla� 7044, BuSin¢55 dntl ROt¢zslOnS Cotle: Thp
Contractor's License Law tloat nol appty to an owner of a property
who bulltl5 or ImprOvlS thtr¢On, and who tloei Such wOrk hlmsell or
through hi5 Own employees, p�ovitled that Such improv¢ment5 a�e not
inl¢ntletl O/ oHe�etl to� sale. 11, howev¢r, [h! bUilding or Improvamanl
Is sold within ono year ot compleUon, the owner will nave the burtlen
ot proving he tlitl not Duiltl or Improve for the purpasa of sale�.
❑ I, as owner ot the property, am exclusively contrac[ing with
IlcenSetl contrdctors to Cons[ruct Ihe project (SeCtIOn 7044, BUSin¢55
antl PrOte55iOn5 Cotle: The Conllacio!'S LIC8n58 Law tloa5 nOt dpply to
an owner oi property who builtls or improves thereon, antl who con-
tracts trom such pro�etts with a contractor(s) Iittsnetl Oursuanl to
the Contractor•s License Law�.
❑ I am exempl untl¢r 58Clion B. !. P. C. lo� tni5
reason
Da[e Owner
I hereby certity lhat I have read thii appliwtlon dntl 5[a[e lha[ the abov¢
InPo�malion i5 corr¢CL I agrea to comply wl[h all cily antl county
ortlinances antl state laws relating to <onstruclion, antl hereby au[borize
rooresentatives.of this ciN to entar uoon.Ihe above meOtiOn¢tl
Driverz' License or 55 � "
CMF 0865�46 White-Building; Canary-Applicanp Pink-Accounting;
'P'fPE OF PERMIT
❑ GRADING ❑ FOVNDATION ❑ STRVCTURAL
❑ TENANT �ELECTRICAL OPLUMBING ❑MECHAI
❑ OTHER
PROJEC7 DESCRIPTION .
SQ. FT.
OCCUPANCV_CONSTRUCTION TVPE
VALUATION ZONE
GRADING CU. YDS. ACRES
PLUMBING
TOILETS .
LAVATORIES
KIT. SINKS
SERVICESINKS
FLOOR SINKS
DRINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOL
WATER SERVICE
GAS SERV ICE
WATER HEATERS
SEWER CONNECTIONS
SOLARTANK �
PLANCHECK
SHOWERS
VRINALS
DOUBIE LAVS
DISHWASHERS
r SUMPS
F�OOR DRAIN$
CLARIFIERS
P TRAP
ALTERATION
OUTLETS
BTU OVTPVT
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING $VSTEM 0-]00,000 BTU_
AND DUCTING �p0,000 + BTV _
FEFRIGERATION 0-300,000 BTU_
SVSTEM 100,000 + BTU _
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
ISSV E FEE
-AsSessor
8302 II/17/81
ZONING REGULATIONS
A.P. $
ZONE PLNTGp. gRUEF�. p;¢
$ETBACKC/LST. PROPE�RTYNLIN
SIDE VARD
L5EpFT
R�IGHT
REAR VARD (TO P/L)
PKG.SPACEREO. PROVIDED
STREET WIDTM PARK FEE
ZONINGAPPi20VEDBY DATI
SPECIAL CONDITIONS:
ELECTRICAL � PLAN CHECK
TRFNSFORMER 0�1 KW_ 1-10 KW _
APPLIANCE 10-50 KW_50 t KW _
MOTORS 03 HP_1-10 HP _
(INC. SOLAR) 30-SO HP 50 t HP _
FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS
POLE IIGHTS - '
PANElS �\ MAIN ' SUB "
SERVICE Ldd� AMP'
ISSUE FEE
SUMMARV OF FEES
BUILDING
PERMIT E $MIP _ E —
PIANCHECK S PERMIT
ISSVANGE E_
PLUMBING §
GRADING E—
VLAN CHECK S
ELECTRICAL S� s—
PLANCHECK g � MICROFILM E—
MECHANICAL S TOTAL FEE 5_
PLHN CHECK E LE55 AO-
VANCEPC y__
8.00
0
FINALFEE $� I,
CONSTRUCTION AND PLANNING POOL & SPA' , .
APPROVALS ' '� Permit # Date Inspeetor qpPROVALS -'' Permit # _ Date Inspector
1. Temporary Electrical Service or Pole �_ �� 43. Pool & Equipment Location - ��
2. Soi ipe-Undrgrn 44. Steel Reinforcement ' -
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin� & Pressure Test - �� -- �
6. Electrical UFER Grn 48. APPROVALTO COVER•GUNITE • �
7. ootings 49. Electrical Conduit-Undr rn
8. Foundation �� 50. Gas Pipe, ❑ Undr rn Test
9. Water Pipe•Undrgm 51. Backwash Lines P-Tra ��' ndr m
10. Structural Floor SYstem 52. APPROVAL TO DECK � ' '
it. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent•Final
13. Rough Plumbing
14. Rough Electrio-Conduit �56. Electrical-Final
15. Rough Electric-Wiring 57. � Solar System-Final
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure • APPROVED FOR PLASTERING
18. Ducts, Ventilating ' .. , . , ' ' r• ' '
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL �
20. Roof Framing
21. Roof Shea[hin
22. Frame and Flashin NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat �
27. Electrical Power Meter-Final
28. Final Electric � � "`"""`
29. Final Heating & Air Conditioning ,..
30. tFinal Gas Pipe-Tes4 � ' � � ' � � �
31. Final Plumbing •
32. � Water Service-Final .
33. Gas Service-Final
34. Solar pomestic-Final
35. landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
36. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No. Date �`