HomeMy WebLinkAbout2257 ELDEN AVE - Building Permits• � . Applicant to fill in all spaces eKceO< <�ose within heavY bortler lines ana si9� all aoo�aVriate aeclarations. .
� CIT�IFCOSTAM SA CONSTRUCTIONP RMIT PERMIT<NO.' ,, TRACTNO. L'OTNO. UNITNO. „�
.'ProjectAddre��2z57 $LDEN STREET � ' M g'V �� � � -
AppliCant'SMailingAddress Zlzl S. GRAND AVE. ' TYPEOFCONSTRUCTION, rvEW ADD ALTERATION REPAIR
.O'vJnef;s Name RICH FIOCK Phone 645-0968 � CONVERSION ❑ DEMOLISH ❑ OTHER A p #;;.
Address,; 2479 ORANGE AVE. � � ' , DESCRIPTION OF WORK/USE OF BLDG.
S Nlain�Building: •.
� �AYsh/Eng. ' LiCense No. TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL . T Front
. . r,..:: ,. - , ,
. "'AddfCsS. - - -' � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B, Reef
957-8991 � OTHER A'
'��Coniractor's Namr SIERRA ENVIRONMENTAL phone � . C Right � �
Address (mailingl _ 2121 RAND AVE FAa1ECT DESCRIPTION 5c?. FT. oCCUPANCv K Left �
CONSTRUCTION TVPE � � VALUATION $ $ •+ ,
•CiryLicenseNo. OZ4912 � ZprvE GRADINGCU.VOS. ACRES
'LICENSEp CONTRACT00. DECLARATION - . PIOg. R¢f. #
�� - I hereby attirm that 1 am licensetl unaer provisions of Charter 9(commencing' Remarks:� • Planning Notes: �
�witn section 7000) ot oivision 3 of tne ausiness ana arotess�ons coae, ana BUILDING PERMIT B24422
` my license is in ruu torcC� e�tect. • ' 405144 ' ' ' � �
� � .:Ucense Class l.icense No.�
' PLUMBING
'Date��Il�R�+ ' ' Signature � , .
n� WORKERS'COMPENSATION bECLARHTION �
`.i � I h¢reby af�irm that I have a ce�li(icdte ot tonsent to self-insu�e or a certificate Ba/ SiOk �/ � , $hOwB�s � ' .
V" of Workers' Compensation Insurance, or a certifietl copy thereof_,(Sectlon, . BackflowPreventer � -ServiceSink —
� 3aoo, �b. ��1071230WC � . FARMERS T � � � ,
Poiicy No. Company Backflow Ifri9ation � Sewer�Cap' � •
� �Certifi¢tl coOY is hereby fam�5he0. � . � . �
� Certifietl copyJ (J'letl with the city Builtlin9 Oivislon. r � � � B2thtUbs l� . � • Sewer Connection •
Date ' a�b�/�b. APPlicant' • . � .
EXEMGTION FROM W00.KER5' COM7ENSATION DECIARATION � Clarifiers �'� ' � Solar C011eCtors
(Thissec[ion neetl nobbe compl¢tetl'if the permi['I5'fbr one huntlretl ($100) or, '
less). . • i � Dishwasher; �r� � Solar Piping
I certify thet in [he perfo�manCe of the work to� wM1lch this perm�t ISISsued, I, - - .
Sh511 not employ any pe�son iq any� manne� so as to become subjec[ t0 Ihe Drinking Fountains � Solar Tank
Workers' Compensation Laws oY California. ' '
. Date ' Siqnature Floor Dreins • i' ' Swimming Pool w/Spa � i
T'NOTICE: If, after making this tleclaration, yau shoultl become subject to the ,
� Workers' Compenwtion provisions of [he tabor Cotle, you_must Yorthwith _ Floor SinkS. ' . -Urinal -- - -
comply with such provisions or this oermit zhall be tleemetl revoketl:
CONSTRUGTION IENDING AGENCV � � ' � ' ' Gas�Service �' Outl¢LS _ � WytC��C105¢t '
I hcreby attirm that tnere is a construction lentlinq agency for the �per�ormance � ' -
of ,the work, for„ whicn this, p¢rmit iz issuetl (Section 3097 Civ. C.) � � Interceptors � Water Heater �
LPntler's`' Name
�entler's Atltlress � ' � � . Kitchen Sink ' ` . Water Service '
OWNER BUILDER DECLARATION '� � � � - � �
I hereby dfflrm thal I am exeTpt trom Ihe Conlydttor's LlcenSe Law fOr the �� Ldvd101i¢5 , ��' �- AULO�W25h �
following reason (Section 7031.5 Businass antl Professional Co�e: Any clty.or _ .
counly wnicn.requires a permit to2onstruct, alter, iinprove, tlemolisn or repalr . f" p-Trep < - ' - �" Leundry.Trays ' '
- anys[ructure, prior to its issuance, also requires the aDO�IcanLfor such.permlt - �
to file�a slgnetl statefil¢n[ Ihat h¢/She I51iCen5¢tl pul5udn[ to Ihe prOvisions of ROOf Df2in5 ' �: --- ---
' [he Con[ractor's License-Law (Cnapter 9 (commentin9.wi[n Sectlon 7000) of - - - - _ _- -' - -
Dlvision 3 bf [he Business antl Prote55iOn5 Cotle) br [hat he/She'is,ezempt . - —_-- �- -.
therefrom antl the basis fOr.the allEgetl exemptiOn: Any'violatiOn �of 5¢ct(On , � '
„�7031.5 by any aOP��CanE (or d Pe�mit Subjec[s the applltant to� a clvll - '
`�:wendlty of not more [han tive huntlretl tlullars (E500)., • .. 1 . -
"'��1, as-owner of tlie oroper(y or my eenployees"with wages as tneir sole ReinspeCtion Fe9� , $15 - Istue Fee .
�� compensation, will tlo the work, antl fhe s[ru<ture Is not intenCetl or ot(eretl _ ,
(or saie (Section 7044, Business,ana Professional'Cotle: The Contractor's , , . MECHANICAL
License Caw tloes not apply to an owner oi a property who bulltls or improves
lhereou, antl who tloes such Work hlm5el//herselt or thrOuqlt M1IS Or he� own ' HOOd O� T
employees, p�ovitletl Ihat such improvemenls are nOt Intentletl o� offeratl foc BOiI¢� � YpC I ❑
sale: It, however, tne builtling or improvemen[ is soltl within one year oi com- , Canopy Type II ❑
pletion, the owner will have tha �urtlen ot pwving he/sha GItl n0[ builtl Or im- DuCt ; Und2� i�i�0und
prove for[he purpose of 5ale). ' � ,.
❑ I, a5 owne� oi ihe property, am oxclusivery mnlracting wlth Ilcens¢tl con- Duct - St�uctu�el , ' Refrigeration System .
'[ractor5to constructthe Oroject�(Section ]044, Busine55 antl Profe55ions Cotle:
The Convactor's License Law tloes not apply to an owner of oroperty who Duct - Ventilating • ❑0.100,000 BTU ❑100,000 BTU
'builtls a�'Improves thereon, aqtl who wntractk forsuth projec[5 wittt d con- ' � ' "' ' '
tractor(sl Ilcense pursuant'to tne Contractor's License Law). I am aware that '] Exhaust System'�, Multiple ❑ System Repair/Alteration
p�oof o� their Wotker's Compensation insurance shoultl be p�ovitletl to me. T - `
� ❑ I am exempt untler Section B. & P. C. for this reason � FirepUFact BIt. IC80 # I JG9 Fire Dampers .
Date ' � owner Heating System & Ducting Registers �
1 hereby certify thai I�have reatl mis apolicatiom antl state that the above a�0-100,000 BTU �100,0008T -� -
In(ormation is correct I gree to comply i h ail tlty antl counry ortlinances '
antl sta[e laws rel ing t Guiltl�ons ion antl he�eby autho�ize repre- • '
sentatives ot tK city e po �e ve-mentionetl property tor. , . �
inspectionpurpo , g/6/86 ' �
Siqnature ` Date ,Reinspection Fee :$15 � Issue Fee
Drivers' Licen e or 55 � - -
CMF 0865-46, rev. 30/84 White . guiltlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
. . . '
FEES
I I
" . ' Automatic Washer
�
' Construction Pole
� � � Cookin9 Unit
2463 9/03/86
� ' .Accessory8uilding'.
Dryers LJGas ❑Electric �
Fan � �
:`r F.A.U. � � i
�Fizture5 -- -- - �-
i
-. . . Device Boxes ' ,
g_ 3 I
FEES
$ 3
i
�
' _ ' � � ,
35.50 TL
Zone
2
O
N
I
' . N
G
q
�E
O
' M
, T
- S
CTRICAL , , '
-' Transformer.�'15-50KW L
� ❑ 50+KW �
Meter �up to 100 amps !
Meter �over100amps �
� Sub Panel � �
, Motors�0.7 HP�ih-8
� IncSolar 09-15 HP �i6-15+
' Mi'crowave ' '- ---'
Pole Light �
Range � �
Garbage Disposal , � I ,I! Standing Sections
G¢nerator �0�5 KW 05�15 KW ' Trash Cmmr�.icmr:. -_ _
'FEES '
= Reinspaction Fee � $15 ' Issue Fee $ 3
� DEVELOPMENTSERVICESREQUIREMENTS: � �
� I .
� •2oning Approved By , Date '
Building Approved By Date�C���_/����J]��� [
� Application luued By_ - S�-� Date aT�/__P.�ti2_
�� � � i SUMMARY OF FEES -
)O BUILDING PERMIT $ . SMIP ; $
PLAN CHECK $ PERMIT ,
i PLUMBING $ � �SSUANCE $
�� PLAN CHECK 25% $ ENERGV P.C. $'
���c ELECTRICAI $ i • GRADING S�
� � PLANCHECK 50% $• ' MICROFILM� 5 ��- �j�
�� MECHANICAL � S � q �� � TOTAL FEE $, �"
� PLAN CHECK 25% $ �n _5� i � ' . .
CONST�RUCTION AND PLANNING POOL 'A
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
� i. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. .Soil Pipe-Undrgrnd. " � - 53. Steel Reinforcement
3. Electrical Conduit U[ility-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. .- .
6. Foundation 59. Gas Pipe, O Undrgrnd., Test ' s�
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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
75. 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 Electricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �� FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. FrameandFlashing 76. DryStandpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: y� C" Q. v
34. Final Heating & Air Conditioning `�/Y7 •�
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 At[enuation
46. � Handicap Regulations
47. FINAL STRUCTURE & BUILDING �
48. Special Requirements Completed
49. Electric Retease to Edison � .
50. Gas Release to Southern California Gas Co
51-. CERTIFICATE OF OCCUPANCY �
No � Date
i
��
CONSTRUCTION PERMIT
AOGlicant to fill in all spaces excev< those within heavy eoraer Iines antl sign all aoDroOriate eeclarations.
�E ITNO. `� T���-NO. �dGO2S r7Nl�"NB
� %� � - . - . oS ol
ProjBct Addres5 �1
App�icant'S Mai�lina7 Address 2T� � � . G.�. TYPE OF CONSTRUCTION EW ADD ALTERATION REPAIR
Owner'sName ^K��/�.�� �`�'C�—phone�Q.�s_Qq(q
Address �,�(y� �A��Q �`[�
Arth/Eng.l .,—p1.• LicenseNo.��/��%S
, Address
Contractor's Nain � �h �� Phone
Addreu (mailingl .
Ciry License No. -
LIGENSED CONTRACTOR DECLARATION
I hereby afli�m that I am II<ens¢tl untler provisions of Charter 9(comm¢ncing �
with section ]000) of Divislon 3 oi the Business antl Professions Cotle, antl
my license is in tWl torce antl effect.
License Class License No.
Date ,Signature
WORKERS' COMPENSATION DECLARATION '
I nereby affirm tnal I have a certificate of mnsent to self-insure or a<¢rtificate
of Wo�kers' Campensation Insurance: Or a ce�tifletl copy tnereo( �Section .
, 3800, Lab./ p y 1'.i�( , ' 1 '� �v��
PoIiCY No. (]��J ��� F � any ��
y�'.�1 Certifietl coOY is heretiy4ur etl.
LJ Certlljetl qpPy R f�2tl with he <ity i Di�sio �
(Thissection neetl not bC COmple[etl if th\ perinl[ iTto� O1R�huntlretl (5100) or .
less). �J
1 certity tha4 in the performanca of the work for whlch this perm�i iz issuetl, 1
zlmll not employ any person In any manner'so as to become subject to�the
Workers' Compensatlon LawS of Cp IitO/nia.
Daty Sl9naluPe
'NOtICE: If, af[e� making thi5 tl¢cla�ation, you shoultl become subje<t t0 fhe
Workers' ComOensdtion provisions of the Labor Cotle, you muSY forthwitn
comply with such p�ovl5ion5 or this pe�mit shall be tle¢metl �evoketl.
CONSTRUCTION IENDING AGENCV. '
� 1 hereby affirm that tne�e IS a construction lentling aqency for the pe�formant¢
Ot lhe wOrk for whith this permll i5 i55uetl (Section: 3097 Clv. C.)
Lentler's Namd
'� Lentler's Atlereu — --- - — - �
- -OWNER BUILDEH DECLARATION
I hereby a�fi�m that I am ¢xBmpt from Ih¢ ConVactor'S License Law 10/ the
followin9 reason (Section 7031.5 BuSiness antl Professional Cotle: Any city or
county which requires a permil lo consVuct, alter, improve, demollsh or repair
any structure, prlor to Its Issuance, also requires Ne applicant ior su<h permit
to fiie a Si9netl Sldtement Ihat he/she i5 Iicensetl pursuant to the Provisions ot �
tM1e Contractor's License Law (Chapter 9(commencin9 with Sectlon ]000) of
Dlvision 3 oi Ihe BusinEss antl Professions Cotle) or that he/she i5 exempt
lher¢from antl the ba5is tor the Sllegetl exemption. Any vlolation of Sectlon
]031.5 by any applicant lor a permit subjects Ihe, applicant to a civil
' �endlty of ndt more tM1an five huntlretl tlollars ($500�.
1, as owner of the p.operty or/my employees witn wages as their sole ,
r comoensation, will Go th¢ work, antl lhe structure Is not intentletl or offeratl
for sale (Sec[ion ]044, Business antl Professional Cotle: The Contra<tar's'
License Law tlo¢5 nol dpplY lo an owner ot a prop¢rty wha builtls o� improv¢s
thereon, antl wno tlo¢s such wo�k himzelf/nerzelf or, (hrough his on nar own
employees, p�ovitletl Inat Such imprOvements a�e not Intentle0 or olfe�etl for '
sale. H, M1owaver, tne bulltling or ImD�o�ement is Soltl wi[bin one yea� ot com-
pletion, the owner will nave the burtlen of provin9 he/she tlitl not builtl or im-
�p,�va /or the purpose olsale). �
,�I, as ownCr ot the property, am extlusively cont�acting with license� con-
'VaTor5t0 construcl [he Oroject (Seclion 7044, Bu5ine55 antl Prot¢ssions Cotla:
The ConVaclor's License Law tloes not apply to an owj�er.of p� erty who
buil�s or improws thereon, antl who contracts for SuchIP rqect5 Ith a con-
�.artn.id licenze oursuant�t e Cw[t�[ti.a'te['S License L,WI. I d aware that
u I am
Oate _
I hereb
� /$ignaWre
LDrivers' LI se ol55 ' �
�CMF OB65-46, rev. 30/84 White
� pro idetl [o me.
C, fo thi5 r¢ason
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCR1PTLON OF WOAK/USE OF BIDG. —
TVPE OF PERMIT LJ GRADING LJ FOUNDATION y`J�STRUCTURAL
❑ TENANT ❑ ELECTftIGAL ❑ PLUMBING ❑ MECHANICAL �/
❑ �OTHER . � 1✓I =
PRQIECT DESCRIPTION Sa. FT. � OCCUaA�aCv �
ZONE �VGT�N TVPE�NADING CU. VDSVALUATION C(�/
�L.
Remarks: � �% "/ if - 5/ �ii � _ G� ( y• % . y. -�j
��� �� �.O
3ar Sink
3eckflow Preventer� � '
3eckftow Irrigation '
Bathtu6s ' � '
Clarifiers . � .
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks �
GasService Outlets
Interceptors - -.r-
Kitchen Sink '
Lavarories� �
P-Trap � � ' -
Roof Drains -
t
Reinspection Fee $15
Duct - Under Ground
Duci-Structutal '
Duct - Ventileting - � -
Eahaust System ❑ MWtiple ❑
FirepVFacL Blt. IC80 #
Heating $Vstem & Ducting '
❑P7�00,000 BTU 0100,000BT
��- I. I Reinspection Fee I $15
: Canary - qpplicant: Pink - ActounHng; Goltlenrotl - Assessor
Showers
Service SinP
Sewer Cap �
Solar Collectors
Solar'Piping
Solar,Tank '
Swimming Puol w/Spa
Urinal
Weter ClOset -
WarerService
AU20-WeSh
Laundry Troys
Isiue Fee
Hood or Type I ❑ '
Canopy � Type I I ❑
Refrigeration System
❑aioo,000sTu ❑ioo,aoo
System Repair/Altera[ion
Fire Dampers
Registers
luue Fee
FEES
�
A
�— / 8704 7/02/86. 666
A.P. # %( - � O
S Main Building:
TFront 0 � F�C,
ARear �(��jl��,�
C Righ[
SLeft
Ping. Ref. # �e' �`
Planning Notes: p V
.. � i.
Aummatic Washer �
Construction Pole Sub. .
Cooking Unit
Dishwasher
Dryers OGas ❑Electr
Fan
F.A.U.
Fixtures =r.�
� 2ona
Accessary Building:
. 2S� G�enM P
riPE.
/ _ .
��
Parking Req./Provided �/
wrTN 2 ATrHcNE
ELECTRICAL � fiEES
� Transformer ❑ 15-50 KW �
❑ SO+KW
Meter ❑up to 100 amps
- - Meter ❑over 100 amps •
Device:BOxes- _ -_ ' _ - '
DUL12t5 �, .
Switcties '
Garbage Disposal
Generatoi �0.5 KW �5-75 KW
$ 3 .. . * ,
Reinspection Fae � ' $15
FEES
DEVELOPMENT SERVICES REQUIR
Zonin9'APProved By _
'.,,. Buildin9 APProved By
. +' APPlicatian Issued BY.�. �
$ 3
Sub Panel � �
Motoro �0-1 HP O1 X'- 6
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Sign
; Standing Sections
Tresh Compactor
Issue Fee
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
$
. ' SUMMARV OF FEES
BUILDING PERMIT $ �Sa3• 00 SMIP $ �3� � 2
�.PLAN CHECK �� $ '� PERMIT �
�PLUMBING $ ISSUANCE $
� . PLAN CHECK ..25% $ ENERG�' P.C. $
ELECTRICAL' . $ ' GRADING $
PLAN CHECK 50%: $' MICROFI M $ �
MECHANICAL � $ � 7q7p� $ Y/�v!!/'l�
PLAN CHFCK 25% $ �� �
'
I
� �'�CONSTRUCTION AND PLANNING ' ` POOL & SPA -
•�',FPPROVALS Permit# Date Inspector p�ppROVALS 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. r �� �j 55. Electrical Bonding
5. Steel �Reinforcement ., �- 56. Rough Plumbing & Pressure Test '
. i
6.• .Electricaf UFEF� Gmd. %/C �f(, (�C/ 57. APPROVAL TO COVER-GUNITE ' -
7. Footings ' 7 /6 � � v 58. Electrical Conduit-Undrgrnd. . . - ' +�
8.' Foundatian � �' G �C 59. Gas Pipe, O Undrgrnd., Test �
9. Wafer Pipe-Undrgrnd, °' z 60. Backwash Lines, P-Trap, O Undrgrnd.
70.'Structural Floor System + 61. APPROVAL TO DECK t
17. �Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewe;.�Cap " ' 63. Heater & VenrFinal - � � . �
�
13. Roof DrainS� - 64. Plumbing System - Final o
14. Rough�Plumbing �� 65. Electrical-Final '
15. Roug�i,Electrical-Conduit � 66. Solar System-Final
76. Rough Electric Wiring � 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditionin9 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.',6as'Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI
25. Roof Sheathing / 74. Overhead Hydro�
26.'T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27:;'Frame and Flashing � �'6 76. Dry Standpipe '
28., Lathirig & Siding �r L2�� �� 77. FIXED SYSTEM FINAL
29.�Insulatibn (,y ff4 � 78. FIREPREV.FINAL
30TDrywall �Nailing .. - y . HEALTH DEPT. REQUIREMENT .
31! Plaster Brown Coat •• � 79. FINAL INSPECTION
32. Electrical Power Meter-Final, 80. FOOD CERTIFICATE ISSUED
33. Fina� E�ectric Notes: HOLD FOR SPECIAL REQUQ�EIV�NT$
34. Final Heating & Air Conditioning , 7�� �
' i✓C:
35. Final Gas Pipe-Test � ='L
36. Hood or Canopy s�i l� gs
37. Final Factory Fireplace � 4 l S1 a�i
� �
i 38. Final Plumbing � �, , �G� �,�P � � �
39. Water Service-Final � (�, � L g.-� QQi
40. Gas Service-Final � �
41. Solar pomestic-F�inal
42. Backflow PreJenter• . '
- 43. Backflow Irrigation �
� 4�1. Landscape Irrigation System
45. Sound Attenuation
, 46. Handicap Regulations � � e
7. FINAL STRUCTURE & BUILDING / � �
. �
� 48. Special Requiiements Completed �
I 49. Electrlc Felease to Edison
50. Gas Release to Southern California Gas Co
�-51. CERTIFICATEOFOCCUPANCY ,
� No. Date I
1, � ,
A
�
�^"J Apolicant to flll in all spaces except those witnin heavy Doraer Ilnes antl sign all aporoDriate eeclantions.
N P MIT PERMIT NO. ,„_` 7RACT NO. LOT NO. UNIT NO. �
CITV OF COSTA MESA CONSTRUCTIO ER
Project Address� 7 S'%---�.� �LJ�i—%✓ AY.Is.
Applicant'sMailingAddress �1%%y L�.'C•r�'✓Gi� �i✓�. G�i��/
Owner'sName /i�C/fi�A.�'-11 /``/JGK phonedSS/� US'(c6
Addresz S./l'HL
Arch/Eng. � License No.
Address
Convactor's Nama n �/�✓�2 Phone
Addreu Imailing) �
Ciry License No.
LICENSED CONTRACTOR DECLARATION
1 hereby affirm lhat I am licensetl untler provi510n5 of Chdri¢r 9(commencing
with s¢C[ion 7000) oi Division 3 of the Buslne55 antl Professlons Cotle, and
my Ilcense is in full /orce antl effect.
License Class License No.
Datc Signatur¢
WORKERS' COMPENSATION DECLARATION
1 hereby aftirm that I have a certificate of consent to self-insure or a certiticate
of Workers' Compensation Insuranca, or a certifletl copy tnereot (Sectlon
3800, Lati. CJ
Policy No. Company
Certifietl copy is hereby fumishetl. /
� Certiyetl c4qy�111 ith Me ci[y BuiltliryJDlvisio �
Date � �� � ��APPlicant lJ�� � �
EXEMPTION FROM WORKERS' CO ATION DECIARATION
(ThI55ec[ion neetl not Oe com0le[etl if the Oermlt IS for one huntl�etl ($300) o�
Iess).
I certify Ihat in the perfo�mance of the wo�k fo� which thls pe�m�t is issuetl I
Shall not employ any p¢�son in any manner SO a5 to beCome Subject to t�tG
Workers' Compensation Laws of California.
Da[e ' Si9ndtur¢
. NOTICE: If, aiter makin9 this aeclaration, youshoul0 become subject to the .-
Worker5' Compensation provisions o( [ne Labor Cotle, you must torthwitn
comply with suc� provi5ion5 0�l IhiS permit Shall be tle¢metl revoketl.
CONSTRUCTION LENDING AGENCV
�� 1 hereby atfi�m thaClherC IS a<onstrucBon IenGing agency f0� the pe�formance
of the work' lor� which fpis Oerml[ Is issuetl (Section 3097 Civ. CJ
�I LPntler'z Name ��,al�. '
li Lentler's ACtlress �
�i OWNERBUILDER DECLARATION . �
to tne a si9nea statamem mai ne/sne is ncensea pursuani w me p.ov�swrn m
the Contractor'S Ucense law (Chap[er 9(commencing with Se<tlon 7000) of
Olvislon 3'0( th¢ Business antl Prote55ion5 Cotla) or .Inat h¢/She is exempt
Iherofrom antl [he basis /or the allegetl exemption. Any viOlatlon of Section
7031.5 by any appliGant tor a permit subjects the applicant to d civil
�enalty of not more (han five huntlretl tlollars (5500).
I, as owner of the property Or my employees with wages as Meir sole
compensation, will Oo the work, antl [he stru<ture is not intentletl or ofteretl
for Sal¢ ($ection ]044, Businesi antl Protessional Cotle: TM1a Cmiractor's
License l.aw tloes n0[ apply to an Owne� 07 a property who builtls o� im0�ove5
tperdon, antl wno tloes such work himself/nerself or throu9h his or her own
employees, provitl¢tl that SUCh Improvlments are not intentletl O/ offerea for
sale. 11, however, tne bulltling or improvement Is soltl within one year oi com-
D�etion, the owner will have the burtlen ot proving he/she tlitl not bulitl or im-
�rove for the purpose of sale). '
I; as owner o/ the pro0erty, am exclusively contracting with licensetl con-
tractors to construct the project (Section ]044, Businesz antl Professions Cotle:
Th¢ Cont�actor's LiCOnse Law does not applY to an owne� of property who
builtls.or improves thereon, antl who cantracts tor zuch projects wlth a con-
ttacto�(5) lirense'pursuant to lhe Cont�actoYS License Law). I am dware [hat
proof ol thelr Worker's Compensatlon inzurance 5houltl be provl�etl to me.
❑ I am exempt untler Section B. & P. C: for tnis reason
Date _
I hereby certi�
intormation is
and state laws
senlatives ot '
InSpection pur{
Signature
•Drlvers"LlcenS
_ Owner
that I have.reatl
�
[lon antl state tha[ the above
all tlty antl county ortlinantet
i, antl hereby authoNze repre-
�bov menlionetl property for �
oate�,b-2V—YE+
�•
TYPE OF CONSTRUCTION U NEW LJ ADD IJ ALTERATION LJ REPAIR
❑ CONVERSION � DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
�
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MEGHANICAL
� O OTHER
PROJECT DESCRIPTION SQ.FT. OCCUPANCv
CONSTRUCTION TVPE VAIUATION $
�ZONE GRAOINGCV.YDS. ACRES �
Remarks: - � ' �
3ackflow Preventer '
3ackflow I�rigation .
3athtu6s
Claritiers . '
�ishwasher '
�rinking Fountains
FIOOI �f2105 �
Floor Sinks �
3asService Oudets
Interceptors
KitchenSink - .-
Lavatories` � '
P—Trep
Roof Drains � ,
Reinspection Fae $75
Boiler
Duct - Under Ground .
Duct - Structurel
Duct � Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating SVstem & Ducting
❑ ai oo,000 sru O i oo,000 ar�
Reinspection Fee � $75
CMF 0865-46, rev. ]0/84 White - BUIIGin9; Canary - Appllcant: Pink - AcmUntln9: GoltlenrOtl - Assessor
Showers
Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
WBt2f CIOSEi
Water Heater
; Auto-Wash
'Laundry:Treys '
� �
�
Issue Fee
IANICAL
Hoodor Typel ❑
Canopy Type 11 ❑
Refrigeration System
❑dioo,000sru ❑ioo,000
Sys[em Repair/Alteration •
Fire Dampers
Registers
laue Fee
�
A.P. qW
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Eleci
Fan
F.A.U. _
Fixtures
Device Boxes "
Outlets '
Garhage Disposal �_�
Generator 065 KW �5-15
3145 6/24/86 �
Zane
Accessory Building: . !
Parking Req./Provided �
ELECTRICAL � • .
Transformer ❑ 15-50 KW
❑ 50+KW
Merer �up to 100 amps .
Meter ❑over 100�amps
' Sub Panel .
Motors�0.1HP�7h-8 �
� Inc. Solar �9-15 HP �16-1
Microwave '
Pole Light '
Standing
Trash Co
$ 3
Reinspeaion Fee $15 luue Fee
FEES
�DEVELOPMENTSERVICESREQU�REMENTS:
Zoning Approved By
Building Approved By ��5�_
$ 3
26�.00
Z
O
N
I
N
G
R
E
Q
M
T
$
6
$ 3
SU RV OF FEES �
BUILDING PERMIT. $�SQ ' SMIP $ i SO
PLAN CHECK $ PERMIT
PLUMBING . $ � ISSUANCE �' $ �
PLAN CHECK 25% $ ENEPGV P.C. $
ELECTRICAL $ � GRADING $
PLANCHECK 50°,6 $ MICROFILM $
MECHANICAL � $ �.TOTALFEE $ �
PLAN CHECK 25% $ . .
�
�CONSTRUCTION AND PIANNING POOL &�SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
c�
1': Temporary Electrical Service or Pole . 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms r�
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
n
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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap '' 3�f (,�fJ 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/SP •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-Fiough & Test 72. Underground Flush
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 Coai 79. FINAL INSPECTION . �
32. Elr.ctrical 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 t -
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 ; i
46. Handicap Regulations � ' •
47. FINALSTRUCTURE&BUILDING � !' � � �
48. Special Requirements Completed � .
49. Electric Release to Edison � '
50. Gas Release to Southern California Gas Co �.�
51. CERTIFICATE OF OCCUPANCY .
No. ' Date � %`
�1
AOD�ieanl to fili In all spaces except ihose within heavy GorEer Ilnes an0 sign all a00ro0riatv Eeelarations.
CITV OF COSTA_= F�A �Q�r�UCTION PERMIT P_ERMIT NO. TRACT NO. LOT NO. IINITNO.
Project Address � 0. ��-
Applicant's Maili Ad ress _ 0.a � �,��
Owner's'Nam�eA � ���� � hone Y -v �6�
Address� l i� Di4.W y'e� 0.'�'e- G�
ArchlEng. License No.
Address
Contracror's Nam� �-�- u ��' • Phone 7� �"
Addreulma'�'nN 1 G � ? 4iCAC- C.c .91�(��p
City Licens� No_ � � /�� . . _ _. . __ _ . _
IICENSED CONTRACTOR DECLARATION
1 hereby atfirm tnat I am Ilcensetl untlar provizlons ai C�arter 9(commencing
with sectlon ]000) of Oivision 3 of the Busineis antl Professions Cotla, antl
my Iicense is in full fort ntl e(ec
Licen�C=�_ � Lice No
Dale 519 t -Q/��1
WORKEfiS' COMPENSATION D� RA N
1 hereby affirm Ihat I �ave a certif c e o( tonsent to xH-insure or a certlflcate
of Wo�kers' CompansatiOn Insu�ance, o� a certifietl CopY �here0f ($ectlon
3800, �a0. C.)
Policy No. � Company
eCertifletl cooY is hereby tumisneA.
Certi(letl copy Is tiletl with the city Builtling Division.
Dat¢ Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This seciion naetl nOt b¢ compleletl It Ihe permit iz tOr On¢ huntlree (5100) or
less).
' I cettlly lnat In thG performance of Ihe w�c fOr which tl p rm�t Is Issuetl 1
s�all not emplqy, an�y gerson in any ma r so as to g o subject to t�a
Workers' mqy�sAy�q� Lnws O7 CaIH �
Date ��O-5i9naturG
NOTICE: It, atter making thls tlecl on, 5hould bec me subject to the
Workers' CompensatlOn prOvislon Ne bor Cotle, you muzt forlhwith
comply wilh sucn provisions or this permit snall be aeemetl revokoa.
CONSTRUCTION LENDING HGENCV
I nereby aflirm that tnere is a constructlon lentling agency for the partormance
o( th0 work for whiU l�iz permit IS ISSueO (Set[iOn 3097 Qv. CJ
Lender's Name
Lentler•s AOaraii
OWNER BUIIDER UECLARATION - - -
I h0�e�y atfl�m that I am examD� tmm th¢ Contrxcto�'s LiG¢nse�Law for th0
tollowing reaton (Saction ]031.5 Bu5lness antl Pro(essional Cotle: Any ci[y or
county which require5 a pe�mit [O cons�ruct, alllr, improve, tlemolizh or �epalr
any structure, prior to itz hsuanco, also reqWres tne applicant for sucn permlt
lo Iilo a Signatl slatCmant thdt he/she IS II<en58tl Oulsuanl IO [h0 PfoviSiOns ol
t�o Contractor's Lltenso Law (Chapter 9(commenUng with Sectlon �000) of
•�Divlsion 3 of Iha Business antl Prole55ions Cotla) or that he/she i5 Gxempl
[herefrom antl the basis lor the allegetl exemption. Any violation of Sactlon
7031.5 by any applicant tOr a permit SUbjects tne appliCant to a Clvil
�enalty of not more [han livo huntlrotl tlollars (E500).
I, as owncr of tha property or my omployaes with wages as [heir sola
compansaUon, will tlo lho work, antl the structure is not intentletl or oiforae
for sal¢ (Sattlon 7044, pusiness antl Professlonal Cotle: The Contraclor'S
License Law tlous not ap0ly to an ownor of a property who buil�s or Improves
t�ereon, antl who tlous such �work himselt/herselt or throuqh his or har own
employoes, provltletl tnat such ImOrovaments are not intentletl or o1(oretl (or
salo. II, hOwover, lha builtling or improvament I5 SOItl within Ono year of com-
pletlon, tho owncr wlll nave the burtlen oi provin9 he/she altl not builtl or Im-
p�ov! t0/ the pu�po5o ot Talo).
.❑ I, as owner Ot tbe prOper[y, am excluSlvelY cont�actin9 with IlcenSetl con-
t�actoR l0 CanSt�ucl tho Drojett ISeclion 7044, Bu5ine55 antl Profe55ions Cotle:
, The ConVactor's Licenso Law does not aOPly [o an own¢r of property w�o
GuiltlS Or Impwve5 Iho�eon, antl wh0 conVactS tor SUCh projec[s with a con-
tractor(s1 ❑cense Oursuanf to IhC ConVatto�'S License LawL � am aware tnat
proo/ of thei� Worker'S Gompensallon in5uranca Shoultl be provitlatl lo me.
❑ I am exempt untler Section B. & P. C. for this reason
Oate
Siqnatuie
Oriver5' Li
CMF 0865-46,
ownei
Ih¢
abova
ndfIC05
repre-
ty tqr
A G
TYPE OF CONSTRUCTION U NEW LJ ADD LI ALTERATION LJ REPHIR
❑ CONVERSION ❑ DEMOLISH ❑ OTNER Ap y�
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TVPE OF PERMI7 GRADIrvG FOUrvDATION SrRUGTVRAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PWMBiNG ❑ MECHANICAL A Rear
❑ OTHER C Right
PROJECT DESCRIPTION ,5a.F7. oCCUaArvCV K �
CONSTRUGTIONTYPE VALUATION$ S Left
ZONE GRADING CU. VDS. ACRES Ping. Ret. �
Remarks: �"7 -ry 7 2 Planning Notes:
Backflow Preventer
Backflow Irrigation
Bathtu6s ' '
Claritiers �
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks,
Gas Service Outlets
Inrerceptors
Kitchen Sink _
Lavatories.�
P-Trap,'
Roof Drains � '
Reinspection Fee $15
Duct - Under Ground
Duct - Structural
Duct - Ventile�ing
Exhaust System� ❑ MWtiple
Firepl/Fact Blc ICBO;k
Heating System & Ducting
❑0�100,000 BTU 0100,000
Ov 5� %��— I I Reinspection Fee . I $75
]0/84 White - Builtlin9; Canary - qppliwnt: Pink - Accountin9; Goltlenrotl - ASSeSsor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer ConnectiOn
Solar Collxtars
Solar Pipin9
Solar Tank �
Swimming Pool wlSpa
Urinal
Water Closet
Water Heater
— -- Water Service ` -
Auto-Wash
Issue Fea
Hood or Type I ❑
CanOpy Type I I ❑
Refrigeration System
oaioo,000eTu ❑ioo,00a
System Repair/Alteracion
Fire Dampers
Registus
Issue Fee
FEES
Automatic Washer
Construction Pole Suh.
Cooking UniY
Di;hwdsher �
Dryers ❑Gas ❑Elec
Fan
P.A.U.'.. �%j .OG
Fixtures ,Z�
Device Boxes
' 2777 9/OB/86
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer � 15-50 KW
❑ 50+KW
Switches'(� �� ' '
Garbage DisposalCp 40�
Genereror �65 KW �545 KW
Meter �fvp to 100 amps
Meter ❑over 100amps
Sub Panel .
MotorsOal HPO1X-8
Inc.Solar �9�15 HP �16-15+
Miaawave
Pole Light
Range
Si9n
Standing Sections
Trash Compactor
$ 3 I
� Reinspection Fee $15 Issue Fee
FEES
�T �DEVELOPMENTSERVICESREQUIREMENTS:
I Zoning Approvad By
j 8uilding Approved By
T Appliption laued Bv �
$ 3
44:10 TL
Z
O
N
I
N
G
R
E
Q
M
T
S.
FEES
$ 3
SUMMARV OF FEES �
BUILDING PERMIT . $ SMIP $
PLAN CHECK . $ PERMIT . �
PLUMBING $ IS$UANCE 5
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ � GRADING 5 �
PLANCHECK 50% $ MICROFILM $
MECHANICAL - $ TOTALFEE $ �
PLAN CHECK 25% $
CONSTRUCTION AND PLQNNING • POOL & SPA � L�
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel fieinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
. 4. ElectricalConduit-Undrgrnd. 55. Electrical�Bonding :
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test m
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-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. .
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Final �
14. Rough Plumbing � 65. Electricai-Final
75. Rough Electrical�Conduit 66. Solar System�Final
16. Rough Electric Wiring ¢/f� 67. Fencing & Access Approval �
17. Rough Wiring Sign . � 68. APPROVED FOR PLASTERING -
78. Rough Electrical-T Bar Ceiling � � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conc{itioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts,in Structure 70. Underground Hydro �
22. Ducts, Ventilating 77. P�oduct Piping O Gas OOiI
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-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe -
28. tathing & 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 .�,� a 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 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 Co '�
51. CERTIFICATE OF OCCUpANCY �- ,
No. Date ' '
Applicant to flll In all spaces exeeo< <�ose witnin neavy eoraer Ilnes ana sign a11 aoVrovriata aeelantions.
CITV OF COSTA ES ONST j(,CTION PERMIT
ProlectAddress � �`� e—
ApPlicant'sMaili9�[g 0d eu u. q'�e' C.M
Owne�'s e , `�q � ��' ho e
Address ` � � � �
ArchlEng. Licenu No.
Address •
Contractor's Nam � r � �' • hone
Addreu Im� �'��1 Z� P. a,�e- -M. � 2ozG
City Licenu+No I % __ _ _ _ _
LICENSED CONTRACTOR DECLARATION '
1 horeby affl�m thdl I am II<Onsotl untle� p�ovi5ion50f Chartor 9(commencing
with section 7000) ot Division 3 0( the Business antl Professlons Cotln, antl
my Ilcense is in}yl forpe gqa effeci. - n y/�/ n 7 /
Oate�Y�� Si9nature
WORKERS' COMPENSATION C ION
1 hereby affirm that I have a cer te of consent to selhinsure or a<artHicale
of Workers' Compensation InsuranGe, or a cerU(letl copy thereof (Settlon
3800, Lab. C.)
Policy No. Company
BCertifietl <opy iz here�y furnishetl.
CerlHletl copY �5/11ltl with tne city Builtling Division.
Odte ApP��Cant
E%EMVTION FqOM WORKERS' COMPENSATION OECIARATION
(Tnis section neetl not be complete0 if the permi[ 15 for one �u retl (y300) or
lezs).
I certity [hat in lhe pa�formdnGn Of [he wo�k fo� whiGh thi p¢r �R ii (sSueQ I
shall no empl any person in any m r so as bec ro su�ject to the
Workar o sa (f�Laws ot Calijp ��
Da[e � r"�Sl9natuR� -
NOTIC : tl, a tcr making Inis tle r on, sbou tl bec a subjaCt to the
Workori' COmpensalion provl5i S f[he Labor Cotle, y0u mu5t tOrNwith
Comply wltn Suth prOvi510ns lhi5 permit shall ba daemetl r¢vok¢tl.
CONSTRUCTION LENDING AGENCV
1 hereby ailirm ihal thoro is a constructlon lenain9 agoncy for tha pertormanto
Of the wOrk 10� wmm� Inls permit is Issuetl (S¢Ction 3097 Civ. CJ
LenCer's Name
�Lentler's Atltlress
OWNER BUILOEH �ECLARATION - - -
I horaby.a/11rm that I am oxempt irom the Contractor's License Law lor the
tollowin9 reasan (Sottlon 7031.5 Business antl Professional Cotle: Any city or
counry wNch r¢quires a permit to con5truct, alter, improve, Eemolish Or rnpair
any structura, prlor to ili issuance, also requlres Ihe applican[ for such parmil
to fiie a slgnea statement that he/she Is licensea pursuant to the provislons of
the Contracror'S Liconsa Law (Chapter 9(commencMg with Sectlon 7000) of
Oivision 3 of the Business anC Professions Cotle) or that he/she it exempt
tM1er¢/rom antl Ihe ba5i5 br lhe aIICg¢tl ¢xemption. Any violation 01 Sectlon
]031.5 by any appli<ant fo� d permit subjec[5 the applicant to a dvil
�enalty of not more than tive huntlretl Oollars ($500).
LJ I, az owner oi the property or my employees with wages as their sole
compensalion, will tlo lh¢ wo�k, antl [he sVucture is not intentletl Or oHe�etl
tOr wle (Se[tion ]044, Buslne55 antl P�otessional Cotle: The Cont�aclor's
LwenSe Law tloes not aoo�Y �a an owner of a property wtio builtls or improves
thereon, antl wlto tloe5 SUGh work himself/herself or [brough his o� �e� own
employees, 0/ovltletl that such Improvements a�e nOt IntantleU o� ott¢retl fOr
sele. H, nowaver, tne builtlln9 o/ improvemen[ I5 Soltl wlthin one y¢ar O/ com-
pletion, tne owner will have tna buraen ot provin9 he/sne tlIa not buIIE or im-
prov0 lor the purpOza ot sale). .
❑ I, ai own¢r Of the p�optrty, am lxclusively cont�a<ting witn IlcanSatl Co�-
tldCtOfStU COnsirucl[ho plofect lSCction ]044, Bu5Ine55 antl P�ofeiilons COdU:
Tne ConVattor's Licensa Law doas not ap01y to an owner of Oroporty wno
bullas or Improves thereon, antl wno conVacts tor such projacts witn a con-
Vactor(sl ucenie pursuant ro the Contractor's License Lnw). I am awaw Ihat
proot o! lheir Worker's Compensacion insurance ShoWd be Provltlatl lo ma.
❑ 1 am nxempt untlor SecHon B. & P. C. for thli reason
Date � Owner
I her¢by CCrti�y t�at 1 havo rea
Information is wrucL I aaree to
Drivers'
CMF 0865
above
��.5� .._._..__. __. .._. '�'
TYPE OFCONSTRUCTION NEW ADD ALTERATIOf� REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A p. �
DESCRIPTION OF WORKIUSE OF BLDG.
S Main Buildi
E
TVPE OF PERMIT GRADING FOUNDATION STRUGTURAL T FrOnt
❑ TENANT ❑ E�ECTRICA� ❑ VLUMBING ❑ MECHANICAL 6 Reer
❑ OTHER p`
PROJECT DESCRIPTION Sa. F7. OCCUaANCv C Right
CONSTRUCTION TVPE VALUATION $ 5 Le}t
ZONE GRADING CU. VDS. ACRES p�ng. Raf, q�
Remarks: � �J L� � � . � Planning Notes:
Bar Sink . -
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers �
Dishwasher -
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen-Sink -
Lavatories, .
P-Trap �
Roof�Drains
Rninspactiori Fee 515
Boiler
Duct - Under Ground
Duct - Structural
Duct � Ventilating
Exhaust System ❑ Muitiple
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,000
��— I I Feinspection Fee I $15
Whil¢ - Builtlin9; Canary - qpplicant; Pink - Acmunting: Goltlenrotl - Assessor ,
FEES
Showers
Service Sink
Sewer Cap
Sewer Connection
$olar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinel
Water Closet
Water Heater � -
Water Service
Aum-Wash
Iss�e Fee g 3
2776 9/OB/B6
_ Zone
Accessory Building:
Parking Req./Pro�ided
„ � ELECTRICAL
Automatic Washer
Construction Pole Sub.
Cooking Unit .
Dishwasher
Dryers �Gas ❑Eleci
Fan
F.A,U.
Fixtures '��
Device Boxes - - -
Outlets �2
Switches '
Garbage Disposal
Generator �0-5 KW C
5-15 K W
Transformer LJ 15�50 KW
❑ SO+KW
Meter p to 100 amps
Meter ❑over 100amps
Sub Panel
Mo[ors�67 HP�1Y,-8
Inc. Solar 09�15 HP �16�15+
Microwave
Pole Light
$tanding Section
Trash Compacror
Reinspection Fee $15 Issue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMEN7S:
YPe I ❑ 2oning APProvad BY Date
Canopy Typell ❑
_ Buildine APP/o�'ed By . Date
Refrigeration System
06100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee � $.3
7.05 TL
Z
O
N
I
N
G
R
E
�
M
T
S
FEES
S 3
SUMMARV OF FEES �
BUILDING PERMIT S SMIP $
PLAN CHECK q PERMIT �
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ � � ENERG� P.C. $ �
ELECTRICAL $ S.7D GRADING $ �
PLANCHECK 50% $ �•��- MICROFILM $
MECHANICAL $ TOTALFEE $ �. d�
PLAN CHECK 25% $ �
CONSTRUCTION ANDPLANNING POOL&SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Condui[ Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undr9rrld. 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, O 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 & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains ' 64. Plumbing System - Final
14. Rougfi Plumbing 65. Electriraf-Finaf
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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Contlitioning FIRE DEPT. REQUIREMENT ,
20. Rough Factory Fireplace APPROVALS Permit # _ .
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Pip'ing O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing , 73. Undergrnd. Storage Tank 0 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
37. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final .b 80. FOOD CERTIFICATE �SSUED
33. Final Electric 1. 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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation �
44. Landscape Irrigation System , ,
45. Sound Attenuation �
46. Handicap Regulations -
47. fINAL STRUCTURE & 6UILDING .
�48. Special Requirements Completed � '
49. Electric Release to Edison
50. Gas Release ro Southem California Gas Co � �
.,
51. CERTIFICATE OF OCCUPANCY .
No. Date
Aoplicant to 1111 in all spaces axceo< <hose witnin heavy Doraer Iinas ana si9n all avProvriate aeclarations.
PE N. YRACT NO. LOT NO. UNIT NO. 94� 25 �
� CI'7v oF CosTA nnE�� ONSTgUCTIO�PERMIT `� _ 3 � 9279 7/ � �/86
Projec[ Address ��Q�� ✓�� ' .
Applicant'S Mailing ddre 5 /���y+ �! /�� l / `, r� ^ TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
Owner'SName �� �����5 T'! ��� �honC�Q � CONVERSION ❑ DEMOLISH ❑ OTHER _ A.p,�, Zone
DESCRIPTIONOFWORKNSEOFBLOG. �� o
Addreu 'Z��q �✓4ut �-�'� S MainBuilding: �AccessoryBuilding:
Arch/Eng. `�%Q L � License No. • TYPE OF PERMIT GaaDING yQ�1rvDaTlOrv STaVCTV RAL T Front p
AddfE55 / • .�� TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL B R¢d/ N
Con[feCtor'SNem� �' hone `W�l�� '� OTHER A . _
e„� , �PROJECT,�DESCRIPTION 5�. FT. pCCUPANCV K Right, G
Address (mailing) �/_ � -
� CON STRVCTION TVPE VALUATION S Leit
Ciry License No. aY %%Z ' S , R
`� •ZONE GRADINGCU.VDS. ACRES
LICENSED CONTRACTOR OECLARATION P��9. RQ}.'b' 7arking Req./Provided E
I Itereby alflrm [hat I am Ilcensn0 untlet provi5ion5 of Charta� 9(commencing� Rema�ks: � 2 .y . PldOniny NO[25: ' M
with se<[ion 7000) of Division 3 0l tho Business and Professions Cotle, antl T
my license iz in lu�(Or� tl ltiect. O��//yy ° .
�s S
D te ��i// ^ 9g t �ens '��� . PLUMBING PEES ' • • �• .
WORKE 5' OMPENSATION DECIARATION � , �
I hereny attlrm tnat I nave a certi(icate of consent to selt-Insure or a<ertifiwta�� Bar Sink $howers ' . ELECTRICAL FEES
of Workeri' Compensatlon Insurance, o� a certi�ietl copy the�eot (Section Backflow.Prevencer ServiceSink - �
3800, �ab. �'+ • � . Automatic Washer Trensformer ❑ 75-50 KW
Poiicy No. �• 96'/a 6 g Company v � L l th/ +� Backflow Irrigation � Sewer Cap Construction PoleSub., , � 50+ KW
� �itietl copy is hereby fumishea. •� - -
C�YCert� � p lea witn fne city e utl g' i � Bathtubs � Sewer Connection Q Cooking Unit Meter �up ro 100 amps
Oate ADPlicant =
(((��� �EXEMPT ON 0.0M WORKERS' CO P SATIO DECLA TI -� Clarifi2r5 . Soler COII¢CtOrS Di5hwa5hef Meter ❑over 100 amp5
,I ` (Thisseclion ne¢tl not bo completeA H tbo parmlt is tor one huntlred ($100) or�, � DiShwasher . �
�, iess). Solar Piping Dryers ❑Gas '�Electric Sub Panel '
\1 certily [hat in l�e portormance ot tne work tor which thii perm�t is iisuetl, 1 _ �
shall not employ any person In any manner so as to become subject to the •�• Drinking Fountains Solar Tank Fan Motors �0.1 HP �i'h - 8
Workers' Compensatlon L.ws of Calltomia. '-
� Oate Slgnature Floor Dreins Swimming Pool w/Spa F.A.U. Inc.Solar �9-75 HP 016-75+
nl NOTICE: It, after making this tleclaration, you shoultl become suD�ect to the
\Workers' ComDensatlon provislons o( Ne Lebor Cotle, you musl forthwith FIoOr Sinks Uiinal Fixtures Mitrowave
comply with suctl provi5ion5 or thi5 pGrmit Thall be deemetl revoked.
CONSTRUCTION LENDING AGENCV . Ga55¢rviCe OUtletS WaterClOsf[ �� --_-- -'--
.�Q � � �0 Oevice Boxes Pole Li ht�-- --
�' I hereby a7firm tnat tnaro Is a mnsiructlon lenaing a9ency for the oer(ormance _ — __ _ - - 9 �
of the work for whit� this permit ii issuetl (SaCUon 309] Civ. CJ � Interc¢ptOrS Wdt¢r H¢dt¢r - OUtI¢l5--
Lentler's Name - - Range
'�entleYs Atltlress _ Kitchen Sink-- --- ' Water Service Q Switches � Sign ' -
OWNER BUILDEN �ECLARFTION - _' _" - --
I hefeby_afflrT Iha[ 1 am BZBmDt�ffom tba COntfdGtof's License 1.2w fOr [he LdVLtOfi¢5 AUtO�WdSh . (�i8Ib8 2 Di5 0501 �
-'-- following rcason (SocUon 7031.5 Busine5t antl Protessional Cotla: Any tltY or _ 9 P '/� Standing $ettiOns , ,
tounty wnicn roquiros a permit to construct, alter, imvrove, tlemolisn or repair ' P—Trap ' Laundry Treys Generator 00.5 KW 05-75 KW ' '
any SVucture, p�iot to Il5 ISSUance, also reQWrti the applicant tor SUCb pe�mit T�25h COrtlpdtt0�
to file a 5l9netl slatement tbat he/sne is Iicensetl pursuant to the provisions of ' i RoOf D�ains ' �'/
the Contractor's LJ<ensa Law (Chapter 9(commencing with Sectlon 7000) of ' ��
DIVISiOn 3 ot the BuSinesS antl PrO1cSSiOns Gotle) oI that hC/she is e%empt ' � -
lherel�om dntl the ba5i5 for th0 allogetl exemption. Any viOlalion of Soctlon
7031.5 by any appli<ant /0� a permit subjeCtS lne aoD��cant to a civil
�enalty o1 not more than Bva buntlratl tlollars (5500�.
I, as owner 01 tha O�operty or my empl0yee5 wltll wage5 d5 thGir sole Rei�ISPBLtion Fao a15 lau8 F!B g 3 �
compen5dlion, witl tlo tha work, antl Ihe structuro is not Inlentic0 or olferetl ReinSpBction Fee $15 Iuue F80
for wle (Sectlon ]oao, Buslnms ana Professional Code: The Contractor's MECHANICAI FEES S 3
License l.aw tloes not apply to an owner ot a property who builtls or improves -
thereon, antl who tloes such work nimsel//hersolf or throu9h his or her own DEVELOPMENT SERVICES RE�UIREMENTS:
employces, prOVltleE lhat such Improv¢menti are not inten�etl o� olfe�etl tor BOiIE� HOOd O� Type l ❑
salo. If, however, t�e builtling or Improvament is solC wlthin on¢ year of com- GnOpy Type I I ❑ Zoning Approved By �ate
pletlon, tne owner will nava the burtlon o1 provinq ne/she aitl not oulltl or Im- Duct - Under Ground Building Approved By Date
�rove lor the purpose af sale�.
i, ds owner 01 [he pfoperry, dm exclu5ivaly COntracting wi[h Iic¢nsed con- DuLt -$tNCtU�81 R¢}liQEfBtiOn $y5i¢T ApplitltiOn ISSUBd By ' � �dtfl 7 �
tractoR t0 COnsHuct thB prOj¢Ct ($BctiOn 7044, BUSineii antl Pfofesslons Cotle:
The Contractor's Liconse Law does not avP�Y �o an owner ol Droperty wno Duct - Ventilating D0�100,000 BTU ❑100,000 BTU SUMMARV OF FEES
builtl5 or im0�ova5 tn¢reOn, antl who conlraClS to! such ploj¢ct5 wifh a<On- ��
tractor(s1 ucense pursuant to tne Contractor's License Law). I am aware that Exhaust SyStem ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof o( lhelr Workar'S Compensatlon inzurdnce Shoultl bn provl0etl [o me. • .
PLAN CHECK $ ^ PEFMIT
❑ I am ezempt untler Sectian B. & P. C. tor this reason Firepl/Fact. Blt. IC80 � Fire Dampers PLUMBING $ /� ISSUANCE $
Date Owner Heating System & Ducting , Registers . - PLAN CHECK 25% $ ��. 2S ENERG�' P.C. §
i ne�eey cerury nat 1 have aa cnis applicatlo scate tnat me atove " ❑6100,000 BTU 0100,0008T GRADING $
in(ormation is ct. I o como�Y � h y antl county ortlinances ELECTRICAL �$
antl state la rela Ing g cons i ❑ hereby authoriz¢ r¢pre- PLAN CHECK SD90 $ MICROFILM $
sentatives his ci e upo ve-mentionetl property for . .
inspettion po5 . ' g yT�
Signature Date �� . MECHANICAL $ TOTALFEE $
Drivers' license or 55 �
Rainspection Fee $15 Issue Fea $ 3 PLAN CHECK 25% $
CMF 0865-4fi, rev. 10/84 White - Builtling: Canary - qOP���^�: P�^k - Accounting; Goltlenrotl - Assessor
CONSTRUCTION AND PLANNING POOL & SPA i_
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
t
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement �
3. Electrical Conduit Utility�Undrgrnd. 7 � 54. Forms
4. Electrical Conduit-Undrgrnd. 55. ElecVical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test :�
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. FootiAgs 58. Elec[rical Conduit-Undrgmd. i
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-U�drgrnd. 6p. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection J �` 62. Backwash & Receptor-Final
12. Sewer Cep 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough plumbing �.�-yL Lf�A 65. Electrical-Final
15. Rough Electrical-Conduit , 66. Soiar 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 OGas ❑Oil
� 23. Gas Pipe-Rough & Test - 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,•
27. Frame and Flashing . 76. Dry Standpipe • • �
28. lathiny & 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 E)ectric Notes: ���. t� _
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test � 7 �
36. Hood or Canopy �_��.� Z� T�.r ��� � .
37.� Final Factory Fireplace
� 38. Final Plumbing �. y� . � , � •
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. Handicyp Regulations • ,
47. FINALSTRUCTURE&BUILDING . '
48. Special Requirements Completed �
49.- Electric Release to Edison � �
50. Gas Release to Southern California Gas Co • � •
51. CERTIFICATE OF OCCUPANCY
No. Date �
,
AOp��canl to fill In all spaees except t�ose wlt�in �eavy DorEer Ilnet antl si9n all a00roDr(ate tlEclaratiOns.
P MI N TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION PERMIT �i �i il n�/1/ � .
Pr0lect Address Z7 �± rY EL/7.r� �t/E -
Applicant's Mailing Addres5 � Z�Z� ARdN�1E R✓.E �:'A
Owner'sName R«��R'�'—� f'��CK Phonel Ys'—�4Gi
AdOress _—$����
Arch/Eng. Licenu Na.
Add�ess
Con[raclor's Neme— � Phone
Add�eu Imailing)
Ciry Licenie No.
UGENSED CONTRACTOR DECLARATION
I tlB�e�y affirm [hdi I am licensetl untle/ Provi51on5 a! Charte� 9(Commend�9
wit� section 7000) ot �ivision 3 of tne Business antl Rofesilo�s Cotla, antl
my license is In full /orce antl etfect.
LicCnse Class License No.
Dale Signatute
WORKERS'COMPENSATION DECLA0.ATION
I hereby atfirm lhat I nave a certificate of consent to selHnsure or a cerliiicate
• Workers' Gompenvtion Iniurance, or a cerqfietl COpY the�eof �Settion
oo, �o. c.) •
.q�icy No. Company
�Certifietl copy IS hereby furniS�eU. ,
LertJ'fietl cop.yC is flle with the <Ity 8 g Div' n.
�ate G —Z( ��� AP�Iicant �=—t� _ �
EXEMVTION FROM WORKERS' COMPENSHTION DECLARATION
(This section neetl not be completetl if tne permit Is /or one hundretl (5300) or
less).'
i �ertity that in tne performance of the work lor wnicn this perm�t is IszueG I
shal� �O[ ¢mpIOY any pe�son in any manner s0 a5 to become TubjlCt to t�e
Workers' Compensatlon Laws of Calitornia.
Dat2 ' S�9�atu�e
NOTICE: I�, al[¢r making tltis declarati0�, You ihoultl Decome su��ect to tha
Workers' CompensatiOn prONsions of the LabOr �otle, y0u must for[nwilh
comP�Y w��h suc� provislons or this �ermit snall be deemetl rovoketl.
CONSTRULTION LENDING AGENCV
1 be/eby afflrm lhat t�ere is a construttlon lentling agency for the performance
oi Ihe work for which lhis per�n�t is (SSuotl (Sec[ion 3097 Civ. CJ
Lentler's Name �� ��
Lentler's AGEresz
OWNER BUILDER.�ECLARATION
I hareoy a/firm that I am oxempt from the Contraclor's Llcense,�aw for_the
lollo�+�ng.reason (SectlonJ031.5 Business antl Profossional Cotla: Any Uty-or
' cou�ty whkn requires a permlt to consVuct, altor, Imo/ove, tlemollsh or repalr
any structuro, p��or to Its Issuance, alto reqWres the appllcant for such permil
[o f�le a slgnod statement that �o/sno is IlcenseG pur5uant to [ne Orovisions of
the Contractor's Ucense Law (ChaD�er B(cammencing with Section 7000) of
Div�Sion 3 of the Businass an0 Profei5�ons Cotle) or tnat he/ihe Ii exomPt
�•�efrom antl the basis for the allegrttl ezempllon. AnY violation ol $ection
'd.5 by any applicant tor a permit subjects ��e aoo���ant to a civil
alty ot not more lhan five huntlred tlollars (5500).
�J I, a5 ownar o/ the proPerty or my ¢mploy¢es with wages as [nelr 5018
Con10en5dtion, will tlo th¢ wOrk, anU the itrUCturB IS not Intentletl or offelotl
tor sale (Sectlon 7044, B�sinass anU Protessional Cotle: The Con[raclor'S
LICC�se Law tlOe1 nol applY to an ownar of a pro0orty who bulltls or Improv0s
tnereon, antl who Goes such work hlmself/harsplf or througn nis or ner own
employees, pro��tleG that such Improvements are not Intentlatl or olfuretl for
��e. �<, nowovar, lha bulftlio9 or improvement is so�tl witMn one year of com-
plat�on, Ihe Owner will hdve the bwUen of proving ht/s�e tlltl nol bulltl or Im-
�io�e tor Ma ourpose ot sale).
U I, as Owno� Of the OrOpE/ty, am BzUuiiv¢ty Con[raCt{ng with IlcensaG mn-
trac�o�s to consV uct [ne Orolect (Sec[ion 7044, Business antl Pro�esiions Cotle:
Th8 Contractor's Licenze ldw doe5 nol appty t0 9n owner o1 proporty Who
builds or Improvas lhereon, antl who contracts lor such projects with a con-
tlaGtol(51 bCOn58 PUlsuant t0 the ContrattOf4 l.fca�58 L2wj. 1 aT awale tllat
proot of thelr WOrker'S COmpensatlon insurance Shoultl be prOvitlatl t0 m¢.
❑ � am exempt untlar Sectian B. S P. �, lor th6 reason
Data Owner
1 herebY certltY that 1 have reai
Sighature L�
DriverY License or 55 °
oate � —25� '�6
TVPE OF CONSTRUCTION LI NEW LI ADD LI ALTERATION LI REPAI0.
❑ CONVERSION m DEMOLISH ❑ OTHER
DESCfiIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRiPTION' �sa. Fr. OCCuaarvCY_
' C O N ST RUCTION TYPE V A LUATION'$
ZONE ' GRADING CU. VOS. ACRES—
Remarks:
Bar Sink
�rinking Pountains
Floor Drains
Floor Sinks �
u85 $EfVICQ �Ul�CtS •
Interceptors
Kitchen Sink '
Lavatories • � -
°—Trap
Roof Drains '
Reinspection� Fee §75
Boiler
Ouct - Under Ground
�UCt - S[fuCNf81
Duct - Ventilating
Ezhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0100,000 BTU � 100,000 BTi
Reinspeetion Fee . � $75
CMF 0865-G6, rev. 30/84 W�i[e - Builtling: Canary - APplicant; Pink - Accounting; Goltlenrotl - Assessor
Service Sink
Sewer Cap
Sewer ConnectiOn
$olar CollectOrs
Solar Piping
Solar Tank
Swiinming Pool w/Spa
Urinal
Wetef ClOiel
Water Heater
Wa[er Service �
Auto-Wash
laue Fae
Hood or Typel ❑
�n�PV TVPe 11 ❑
Refrigeration System
❑0.700,OOOBTU ❑100,000
System HepairlAlteration
Fire Dampers ,
Regizters
Iswe Fee
$ 3
A.P. yf`-
S Main Buildi
E
T Front
B Fear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
� 8146 6%24/86 jB.00
' Zone
Actessory Building:
Z
O
N
� �
" • N
G
R
Parking Req./Prov�ded ' ' E
. �
M
� � T
S
Automatic Washer �
Construction Pole Sub.
Cooking Unit �
Dishwasher .
Dryers �Gas. ❑Electric
Fan
F.A.U. '
Fixtures � �
Device Boxes � �/
Outle[s `/
Switches . _ - _
Garbage Disposal �
Generator �0.5 KW
Fee
❑5-15 KV
$15
ELECTRICAL
Transfo�mer � 15-50 KW
❑ so + Kw
. Meter Qup ro 100 amps
' Meter �over 100amps
Sub Pane�
Motors�0.1 HP �1�Yh-8
� Inc. Solar 09-15 HP 076-75+
� Microwave �
Pole Light
Range
- - -c..� ---- • ' �
Standing Sections
� Trash Compactor
FEES � �ssue Fee
�DEVELOPMENTSERVICESREOUIREMENTS:
2oning APGroved By
Buildin8 APProved @v
$,3
FEES
3
- SUMMAR``(p� FEES
BU1LOVfdG PERMIT $ ��.Z� SMIP $ � �O
PLAN CHECK $ PERMIT
PLUMBING - $ �SSUANCE S
PLANCHECK 25% $ ENERGY�P.C. $
ELECTRICAL - $ � GRADING $ -
PLANCHECK 50% $ - MICROFILM $ �
MECHANICAL • S � ' TOTALFEE $ .00
PLANCHECK -25%�$ __ �
�
ti
CONSTRUCTION AND PLANNING POOL & SPA _
APPflOVALS Permit#- Date Inspector qPPROVALS Permit# Date Inspector
0
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms ��
W
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding , �
r
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
�
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � �
7. Foo[ings 58. Electrical Conduit-Undrgrnd. o
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Tes[
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
70. Structurel Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap ��s? 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
74. Rough Plum6ing � 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 Facrory Fireplace � APPROVALS P.ermit# _
21. Duc[s, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing ' 73. Undergrnd.StorageTank OGas ❑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 P(iEV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electric�al Power Meter-Final . 80. FOOD CERT�FICATE 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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System �
' 45. Sound Attenuation � �
46. Handicap Regulations
47. FINALSTRUCTURE&BU�LDING
48. Special Requirements Completed �
49. Electric Release to Edison
50. Gas flelease to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date _ /
Ir
. •
Aop��cant to fill in all svaces ezcepl thosa wlthin neavy GarEer Ilnes an0 sign all aoorov��ate tleclarations.
� CITYOFCOSTA ESA O�T�UCTIONPE�RMIT F�MJ+TN�'�Lf TRACTNO. LOTNO. UNI,�110.
Project Address
l e L °'`�� '� ✓
Applitant'S Mail g/�.d reis I {� TYPE OF CONSTRUCTION NEW ADD ALTERATIOfJ REPAIR
Owner's N < < dL hon '� o
Addreu "" � ��-
ArchlEng., Litenu No.
Address �
Controctor's Nam � eG�y� �r5 �� � P o^nne Q' 7
Addreulmailing) «J ,x '� �� �"'rr• ZuZ�
Ciry Licansc No. 3' � 3
LICENSED CONTRACTOR DECLARATION
I hereby aflirm thdt I am IicenSetl untler prOVI5iOn5 of C�arter 9(<ommencing
with sectlon 7000) of Divisian 3 0l cha Business antl Professlons CoOe, anA
my Iicense Is in t W I �{ce a tl 9L�ect.
Licen I a �J —Li nse o
Date � � Signature
W00.KER5' COMPENSATION D C R ON
I heroby aHirm tnat I nave a cert ' te consent to sel/tinsure or a tertiitGdte
` Workerz' Compensation Insurance, o� a C¢/tlfieG copy thereot ($ection
00, Lab. C.)
rolicy No. Company
eCertlfietl copy is hereOy furnishetl.
Certlfletl copy i5 (iletl with the city Builtling DivlSiOn.
Da[e APPlicant
EXEMPTION F0.0M WORKERS' COMPENSATION DECLARATION
(Tnis section neea not be como�eteC if the Oermit is for one huntlrea ($300) or
IC55).
I cerlify (hat in the performance o/ Ib¢ w k f0/ wnlch this f m�l is is5uetl 1
Shall nOl em y �/�Y 0¢rson in any rlf e� so as t eto e Subj¢ct to [�e
Work Co Silf�r Laws o1 Cal�' .
Date � Si9nature
NOTI : If, ailer makinq t�is tlecla � n, ShOultl Decome SUDject to tne
Workers' CompensaHon provision o tl� bor Cotle, you must for[hwith
comply wit� sucn O�ovi51on5 i5 permit snall be Ceemetl revoketl.
CONSTRUCTION LENDING A NCV
1 hCr¢by attl�m that thGra i5 a Wnit/uctlon lentlin9 dgtnty tOr thG perlo�mance
of tbo work lor whic� tnis permit is IiSueU (Sectlon 309� Civ. C.)
Lentler'S Name
Lenticr's P.Ctlress
OWNERBUILDEH �ECLARATION
1 heraby altirm tltat I am exem0l �rom the Con[ractor'S LI<ense l.aw /or the
lollowing reason (Section 7031.5 Businosz antl Proteizlonal Coae: Any,city or
county wnl[n mqWres a permit [O cOnitruGt, altm, improve, tlemOlish or repolr
any structuw, prior to its issuance, also roqWras the applicaM tor such parmlt
to tile a SlgnaO stat¢ment Ihat he/Sh0 IS Ilcen58tl pur5udnt to the O�oviSiOns ot
tha Con[ractor'S Llcense Law (Chapter 9(commancing wilh 5ettion 7000) ol
� Division 3 0! the Business antl Pro/essiont Cotlo) or thal he/she Is oxompl
"+rolrom ana tne basis br tho allegetl exerrmptlon. Any violation ot 5actlon
1.5 by any aOG��tant for a permit 5ub�acl5 th0 applicant t0 a clvil
ally of nol more than five huntlretl tlollaro (5500�.
u I, a5 owner ot [h0 P�oOer�y Or my emplOyaes wlth wa9e5 as [heir So10
compensaHon, will do Ihe work, anE the structure is not IntenOetl or otferetl
for wle (Section 7044, BuSiness antl Prota55ional Code: The Contractor'S
License ldw tloes not aoo�Y to an ownar of a prooerty who builtls or improvns
the�eon, antl who tloe5 such work M1imsulf/hersell or tnrough his ar her Own
empioyaes, provltletl tha[ such Improvemants are nol Intentled or offered for
ule. It, hOwevar, the building or Improvement is Soltl wll�in one year Of COm-
olotlon, tha owner wlll have the burtlen ot oroving he/she tlitl not bulltl or im- ,
�rove �or tho purpose of zale).
I, as awnor of tne property, am axclusively contractin9 with Iicansea can-
tlactoR to coMlruct [he ptojecl I$¢c[ion ]Od4. Buiiness antl ROte55ions CotlB:
The Contractor's License Law dOes not apply to an owner of proper[y who
builtls or Improves tnereon, antl who contracls for such projeGts with a con-
lrattor(s1 license pursuan[ to t�e Contraclor'z UcenSa Law). I am aware that
proot of thelr Wo�ke�'s Comp¢nsatlon in5uranCO zhoultl b¢ provltletl to m0.
• L7 I am exempt unticr Section B. & P. C. for this reason
Date Owner
I nerebvi cerUty that I have reai
I Drivlr5'�5
CMF OB65-46, rev.
C
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p *.
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T Front
❑ TENANT ❑ ELECTRICFL ❑ PLVMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION Sa. FT. oCcuaANGv C Fight
CONSTRUCTION TVPE VA�UATION $ g Left
ZONE ,GRADING CU. VOS. ACRES p��y, Ref. �/'
Remarks: � 2��1 'ZZ Planning Notes:
$ink
Preventer
Irripation
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatorie�` .
P—Trap�
Roo �Drains
Reinspaetion Fee §15
Duct - Under Ground
�uct - StructurAl
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact, elt. ICBO #
Heating System & Ducting
❑ ai oo,000 aTu O i oo,000 sn
Peinspeetion Fee � 515
White - Building; Canary - AOP��wnt; Pink - Accountin9: Gottlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
$Oldf (�.OIIECLOfS
Solar Piping
Solar Tank
$wimming Pool wl5pa
Urinal
Water Closet
Warer Heater
Water Service
Auto�Wesh
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-t00,0008TU ❑100,000
System Repair/Alteretion
Fire Dampers
Registers
Issue Fea
S 3
FEES
§ 3
Automacic Washer
Construction Pole Suh.
Cooking Unit
Di,hvuasher
Fan
F,A,U. '�
Fixtures a�
Device Boxes
Ou2lecs ,
._...... _ , �
Gar6age DiSposal
Generator �0-5 KW
Fee
2778 9/08/B6
2one
Accessory Building:
ELECTRICAL �
Transtormer ❑ 15-50 KW
❑ 50+KW
Meter �"lup to 100 amps
Meter ❑over 100amps
Sub Panel
Motors �41 HP O1'/h - 8
InaSolar �9-75 HP �1�15+
Microwave
Pole Li9ht .
Range
Standing Sections
5�15 KW Trash Compactor
$15 Inue Fea
44.10 TL
FEES
$ 3
2
O
N
I
N
G
R
E
U
M
T
$
OEVELOPMENT SERVICES RE�UIREMENTS: .
Zoning Approved By �ate
BuildinB APP�oved By Dat�
Appliwtion Issued By �� �at �
� SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. 5
ELECTRICAL $ �O.�P(7 GRADING S
PLANCHECK 50°6 $�3• 7� . MICROFILM' S
MECHANICAL g TOTAL FEE 5 yyl D
PLAN CHECK 25% $
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 Tes[ �
6. Electricai UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electriwl Conduit-Undrgrnd. ^
n
8. Foundation 59. Gas Pipe, O 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 & 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 Elecvical-Conduit 66. Solar System•Final
16. Rough Electric Wiring � �� � 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elettrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heatin9 & Air Contlitioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # '
21. Duas, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping DGas �Oil
23. Gas Pipe-Rough & Test �72. Underground Flush
24. floof 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 Meter-Final � b , f 80. FOOD CERTIFICATE ISSUED .
33. Final Electric y i � U 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 pomestic-Final � �
42. Backflow Preventer � j"
43. Backflow Irrigation .
44. Landscape Irrigation System •
45. Sound Attenuation ' ,
46. Handicap flegulations . • ,
47. FINAL SiRUCTURE & BUILDING .
48. Special Requirements Completed � ,•`
49. Electric Release to Edison . �
50. Gas Release to Southern Cylifornia Gas Co � �
51. CERTIFICATE OF OCCUPANCY � �;
No. Date
AOP���ant to lill in all soaces exceot tnose within heavy CorCer lines and si9n all apprapriate tleclarations.
CITY QF COSTA MESA CONSTRUCTION PERMIT . PERMIT NO. � TRACT NO. ,LOT NO. � UNIT Nb.� ' �
Proiect nddress �'L 3"Y% � �L li/—%✓ .��/�E. a �
'+ � c � TYPE OFCONST UCTION New� noo
Applicant'sMailinrqddress '�/ Q�L/,''✓� /4�UL� �
r_ �
Owner'SN�.meT��G�"4'R� ��/=� ' � CONVERSION ❑ DEMOLISH ❑ OTHER
K � Phone �i yS�OLE� DESCRIPTION OF WO(iKNSE OF BLDG. —
Address �i! %9 l7Ff��..F w4f/�_ �/�'r. . . �
Arch/Eng.. License No. TVPE OF PERMIT GRADING� ❑;FOUNDA-
Add�255 � . � ❑ TENANT � ELECTRICAL ❑ PLVMBING
Contracror's Name Ola_l/!/L�%j � ph��e ' ❑.OTHER _TF/09Q. .%d�e/�sQ �
' ' PROJECT DESCRIPTION• sp FT ' �
Address Imailing) �
ALTER.
REPAIR'
LJ STRUCTURAL
MECHANICAL
� � • CONSTRUCTION TVPE .VALUATION
City License No.
LICENSED CONTRACTOR OECLARATION�
I hereby affirm thal I am licensetl untler�p�ovlsions oT Charter 9(commencing
witn section ]000) of DiviSion 3 of tha Business antl Protesslons Cotle, antl
my license is in full force antl ettect.
License Class License No.
Date Si9nature
WORKERS' COMPENSATION DECLARATION �
I ne�eby affirm that I have a cer[ifica[e of mnsent to sel(-insure o� a certiticate
ol Workers' Compensation Insurance, or a certlfietl copy tM1ereof (Section
� Pal��ic�Y No. C!'>/v i% C� Co O��
• �jil. !�' .�i�
Q Certifiea coDY is hereby fumishetl. � �
�Q Certifietl mpy I5 (ileG with the city Builtling Divisian.
Date APpliCant
EXENIPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl nat b¢ completetl if the permit IS for one huntlretl (5300) or
less). s
I certi(y that id the perfoimance ot the work for which this perm�t is issuetl, I
shall not employ any pe�son in any manner So a5 to beCome subject to tne
Workers' Compensation Laws of California. ' • .
Date $i9nature
NOTICE: If, after making this.tleclaration, you.shoultl become.subject to the.
Wo�ke�s' Compen5ation p�ovisions o( tM1e Labor Cotle, you mu5t forthwith
comply wi[h such provisions or [his permlt shall be tleemetl revoketl.
' CONSTRUCTION LENDING AGENCV ' '
1 I nereby atiirm that there is a mnstruction lentling agency tor�tne oerformance
of the work �(or which this pe�mit�is i55uetl (Section 309] Civ, CJ
Lentler's Name � •��
Lentler's.AtlOress ' '
OWNER BUILDER �ECLARATION`1—= _— — — —== --� —
'I-hereby atfiim thaC,l am exempt f�om the Cont�acto�'s LicenSe�Law to� tne
foilowing reason (Section ]031.5 BuSiness antl Professional Cotle: Any city or
Sink
<flow Preventer
<flow Irrigation
uisnwdsner
D�inking Fountains
Floor Orains '
Floor Sinks
Gas Service �
Interceptors
�
Outlets '
i
county which �equires a pe�mlt to const�uct, alter, improve, tlemoli5h or repai� P—Tf3p
any structure, priOv to its issuance, also requi�es the applicant for such permit -
t0 file a signetl statement that Ile/she is Ilcensed pursuant to [tle pfovi5ion5 of ROOi DlainS
the Contractor's License Law (Chapter 9:(commencing with Section ]000) ot
-'Division 3 of the BuSiness antl Profes5ion5 Cotle� ov thaPhe/she is-exempt - -
'therefrom and the basis for th¢ allegetl exemptlon. Any violation ot $ection t '
]031.5 by any ap0�icant for a permit subjects [he applicant to a Civil
e¢nalty of not more than tive huntlretl tlollars (5500).
LJ 1, as owner of the property or my employees with wages as thair sole ReinspeMion Fee
com0ensa[Ion will tlo the work, antl the structure is not intentletl or offeretl
for sale (Secfion J044, •Business antl Professional Cotle: The Contractor's .
�icense Law tloes not apply to an owner of a property who builds or improves
the�eon, antl who: tloes such wo�k himselt/h¢r5elf o� [hrough his or he� own gOilCf �
empioyees, proviaed that such improvements are not intentleC or otteretl for
sale. If, howeveq the builtlln9 or imp�ovement i5 Soltl within'one year of mm-
pletion, the oWner will have the burtlen of proving he/she tlitl not builtl o� lm- DUct - Und¢f GrouOd �
prov9 to� the�purpose of sale). ; ' - . �
❑ I, as ownet ot the p�operty, am exclusively contracfing with Iicense0 com Duct-St�uCtufdl
tractorstd construcPthe project (Section 7044, Business'antl Professions Cotle:
The Contractor's License Law does not appty t0 an owne� ot ProOerty�wno Duct - Ventilating
, Duiltls or Improves thereon, antl wno contracts.for such projects with a con-
tractor(s) I�cense pursuant to the Contractor's License Law). I am aware tnat Exhaust System ❑ Multi
proof oi thel� Worke�'S Compensation inswance ShoWtl be provitletl to me.
.� I am exempt untler Section B. & P. C. for this reason Firepl/Fact.6lt. ICBO #
. Date Owner � �� Heating System & Ducting
I hereby certify that I have reatl this application antl state [hat the above� ❑0.100,OOOBTl1 �700,(
Information i5 mrrect.'.I agree ro comply witn all city antl'county ortlinanc¢5, � �' �
�antl Stafe laws rela[ing t builtlin9 const�u Ionp, aVCntl hereby autho�iie repre-.
�se�tatives of th��t� ente upon t , ab -mentione�p�operty f� , .
inspection purpo 0 z ��.,.
� Si nature � �'r4 Date .
brivers' License or 55 � ' ' peinspec[ion Fee �
]MF OB65-66, �ev. 10/84 White - Builtling; Canary - Applicdnt; Pink - Acrounting; GOltlenrotl - As5e55o�
GRADINGCU.VDS. ,
$15
$15
� '
Showers ' �
ServiceSink ' � -
.Sewer Cap . '
Sewer Connection :
.SOIar.Collecmfs
Solar Piping
Solar Tank �
Swimming Pool w/Spa
�Urinal •
Water Closet
.Water Heater � �
Auto-Wash
Laundry Trays
Issue Fae
Hood or Typel ❑ ;
Canopy Type I I ❑ �
Refrigeration System �
❑0.100,000 BTU ❑100,000 BTU
System Repair/Alteration �
Fire Dampers •
Registers � - , . r
— A.P. �k
S Main Buildir
— E
� T Fiont
B Rear ,
A
— C' Right ' '
— K Left
S '
. Ping. Ref. #
� Planning Notes:
�
fEES
-� Issue Fee . $ �3
Automatic Washer
Cooking Unit-
Dishwasher '.-
Dryers ❑Gas �
Fan
F.A.U.
Fixtures
�Device Boxes �
Outlets
• � 8726 `7%02(86
owiwnea '. _- '. . .
Garbage Disposal +
Generator �0-5 KW ❑
1
Zone
Building:'
q./Provided �
- �
�
ELECTRICAL . � � � �
'Transformer ❑ 15-50KW
, . ❑.50+KW ,
Meter � Dup to 100 amps -
..Meter ❑over'100amps �
�Sub,Panel ' '
„Motors �0-7 HP 01 h,- 8• �
Inc.Solar �19=15 FIP �16-75
Pole Light + �
Range_ � � � --
' -J' Sign 1 .- , •
Standing Sections , �
5 KW Trash Compacmr •
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' � Reinspection Fee _ � $15- � � luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
2oning APProved BY .
Building Approved By
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AppiicatiOn laUed By ��`�� � '' � Date ���z� iSF
, � � - SUMMARV OF PEES �� � ' � •
� � BUILDING PERMIT $ � �SMIP. ; �� $ . �
- PLAN�CHECK ' $ - ��PERMIT ' i � , _ "
PLUMBING ' $ ' �-ISSUANCE . $ ' , , .
� � ' PLAN�CHECK :25% $ g�� � .ENERGV P.C. - $ �;
ELECTRICAL $ ����� �C--�/�/� GRADING � $ - �
„ PLANCHECK 50% $ e���'—; ; MICROPILM` $ .'
- � MECHANICAL $ TOTALFEE $ f�
' - PLANCHECK �25� $ � __" ' '
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CONSTRUCTION AND PLANNING ?OOL & SPA , -�
APPROVAIS Permit# Date Inspector qppROVALS Permit# Date Inspector
-s
. �
1. Temporary Electric86Service or Pole '�-� 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd.- � 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrqrnd. 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . _i
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test � �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE� r
7. Footings 58. Electrical Conduit-Undrgrnd. �
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P�Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71. 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
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace . APPROVALS Permit # _
21. DuCts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank 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 ��'-J
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning �
L 1� ,
35. Final Gas Pipe-Test _ _ � � , ��
36. Hood or Canopy , ... .
37'.- Final Factory Fireplace
38.-' Final Plumbing . . , , ,
39 � Water Service-Pinal � ' � •
�40. Gas Service-Final , „
�41. Solar pomestic-Final
�42. Backflow Preventer ��- ; ` ,
�43. Backflow Irrigation ` ' �
"44.:Landscape Irrigation SYstem ' • � � '
45. Sound Attenuation . . .. '
46. Handicap Regulations ' �- ' '
,_
47. FINALSTRUCTURE&BUILDING � � "
� ,
48:.Special Requirements Completed � '� �
i �:.
49. Electric Release to Edison - '
50. Gas�Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY '
No. Date • ;,r
,
Ciry of Cos[a Meu
Development Services Department C E R T I F I C A T E 0 F O C C U P A N C Y IVO. �j J.'. �j 2�
Building $yfety DiviSion
P. O. Box 1200 �
Costa Mesa, California '
The Building located at 9�S^r.lAan a.+la......
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group n_� Occupancy.
UseofBuilding ne.�,.�.�..�;,.i
Legal Description a n �� A��_nc�_no
(See reverse side for Metes and eounds)
BP2�S275. E25253, BP2A275,
Building Permit No o�An�� Electrical Permit No. F����� Plumbing Permit No.p�aS7'i
Mechanical permit No. ���� � G� � ' Number of apartments and/or guest rooms
ISSUED 70: Building Official �tai 1 � ia,,, T. Hn.harA
Ric'.iard Flock �_1`lj_ / �%`�
2979 Orange Avenue bY �� -�;�� � �� ,
Cost3 .:��a. CA 92C27 �
Date ,7an„arv 99 �QR7
This Certifi�ate of Oecupancy 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. 1/83 White � Owner; CanarY - Numerical File; Pink - Bldg. Permit File
Ciry of Costa Meu
Development Services Department
Building Sa(ety Division
P.O.Box 1200
Costa Mesa, Calilomia
CERTIFIC'laTE OF OCCUPANCY No. uQ���3
The Building located at �SSu v7A�., x
has been inspected and found to comply with the
for a Group n—'i Occupancy.
Use of Buildin
isions of all City of Costa Mesa Ordinances applicable thereto
Legal Descriptionfl � !1A�t_n�v_no '�i
� (See reueru side tor Metes end Bounds)
E24426,
Building Permit No p7���G Electrical Permit No. F����n Plumbing Permit No. ��dG�Z
Mechanical Permit No. ��� �� �� �Number of apartments and/or guest rooms
ISSUED TO: .
Ric:�arc� Flnek
2n79 Oranqe Avenue
rosra eiP��. ru a�F��
Building Official ra� i i a�.., m n.,..-�...a
by �`_��f,' ,�( �:��, .
,
� D2t0� .Tam»rv 99 1QA7
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 Corta Mesa under Sec. 307 (e) U.B.C.
CMF 1o15-a6 rev. 1/e3 White -Owner; Canary - Numerical file; Pink - Bldg. Permit File