The URL can be used to link to this page

Home My WebLink About1565 DOUGLAS DR - Building PermitsCity of Costa Mesa Development Services pent CERTIFICATE OF OCCUPANCY NO. 0(} ((.d..� qq Building Safety pivinion ision U Ud, P.O. Box 2200 Costa Mesa, California The Building located at 7SF�i_ in]aa_Dri,VA 07 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto fora Group R-1 Occupancy. / *y Use of Building /f/� �!/ ¢dr• Legal description 420-012-10 (Sae reverse side for Metes and Bounds) Building Permit No R38,$dI Electrical Permit No.F18807 Plumbing Permit No,P18692, P19163 Mechanical Permit No. M1962S, M20116 Number of apartments and/or guest rooms �) / ISSUED TO: Building Official"' -7/1 Fairvusv7 Detrelowmt C' -o VwW 1691 Kettering by I vim CA Date This Certificate of Occupancy SMALL 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 lel U,8,C. CMF 1015-06 rev, 2/83 White • Owner; Canary • Numerical File; Pink - Bldg. Permit File (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT Job Address: 1565 DOUGLAS DR Suite: Vicinity: HARBOR VILLAGE APT BLDG 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 10/19/2001 Issued: 10/19/2001 Parcel Number: 42005103 Zoning: Permit: Applicant: SANDOVAL, CHUCK $0.55 ISSUED BY: Address: 1101E CHESTNUT DR Other: $0.00 Phone: (714) 285-1180 - $0.00 SANTAANA,.CA,/,, ( _ - Zip: 92701�- Owner: STATE OF -CALIFORNIA Address %FAIRVIEW DEV CNTR 2501 HARBOR BLVD - - Phone: - DEPT OF DEV SERV' - Zip: 92626 Contractor: EVANS ROOFING COMPANY INC Address: 1101 E CHESTNUT DR - - - • Phone: (714) 285-1180 - SANTA ANA, CA - - - Zip: 92701 License: 610549 Arch - �,� Eng: Address: Addressi - �- - • - Phone:, - Phone: ,Zip: - License: License: SCOPE OF REROOF "HARBOR VILLAGE APT'BLDG: T/O, REPAIR SHTG AS t CLASS A COMP SHINGLES, 74 SQUARES - - ' . - " - - . - Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.55 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 FEE SUMMARY i I 1 LAYER 30# FELT, INSTALL 25 -YEAR Calc Valuation: Claim Valuation: Total: $125.80 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear ; 0- 0 Left 0-0 Right 6-o - ACCESSORY Front 0-0 Rear ',0-0 - Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: $5,500.00 $5,500.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aa64e (stoo) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. ❑ 1 have and will maintain workers' compensatlon Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this peril Is Issued. My workers' comperg5allon Insurance carder and policy number are: Carder: 0 Policy Number: (This section need not be completed If the permit /s valued at one hundred dollars ($100) or lass.) " ❑ 1 certify that in the performance of the work for which this permit Is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 01 the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby afflr that I ama untler p Ions of apter (common g with Sect 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Uc. 4 Class k Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby a at here constructio endi agency for the perforant o the work for which this perlt is Issued. (Sec. 3097, Civil Code). Lenders Name Lenders A ss: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per+' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner o1 the property, or my employees with wages as their ace compensation, WILL 00 THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Buslness and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Lew does not appy to an owner of property who builds or Improves thereon, and who contracts for such project with a contractods) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify, that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrable Code). ❑ As owner-bullder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a repotted year a quantity of hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _........_—._.........._— _ _ _...—....._.... nfor.._................_.................................._...._.................... 2 Does or will the epPlicanl or present or future building occupant need to lila a registration for for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safely Code, with some exceptions, requires registration with the Costa Mese Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o1 compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepan RMP (Ris re ePk Mnt anagemeand Prevention Program for acutely hazardous materials)? ❑ Yes ❑ PPo (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully compiled with? ❑ Yes ❑ No ......................................... _............................ _.................................... __._................... _.____............__....................___..................................................................................._....................._.._......._____._.. 5 Doles or will me applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes UNo (Section 65850.2 of the California Government Code requires that me requested information be furnished on applications for non-residential building permits). ..........__....................._......................._...._._...._.___.—..._____.._................__._..................._................................................................... ........__........ ........_._...........___..__. 8 Will any pert of the facility, to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air prescy Management District or other air pollution control district n agency is required for the work which is the subject of this application, have all 01 the dlsdosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No ...8.......�it ............... ___..__._._..____..............._�..._.___ yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cer ity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: ff CERTIFICATE OMPU E AND AUTH RQATI J OF ENTRY: I certify under nal of perjury that I have read this application and state that the information given is cored. r to ompty w h II state law antl city o Inances r 1 ting to building cons ctlon, and authorize representatives of the City of Costa Mesa to enter upon the above esc�i ed pr rty fa in PmxW pu oses. I egr AT t to oc y low o an of any building authorized by this per ntll final in ction. I I-�i-9 SignaturfirOf Lilgal Owner(s) Date And/Or Authorized Applicant Data CODE /. INSPECTION TYPE 26a 1NITTIeta CODE If INSPECTION TYPE BATE IfiTrrIAle� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Finales 208 Final Plumbing 200 Final Re-Root2 210 Final Electrical 201 Final Block/Retalnl^g Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy II a WV�9C1I)_aG�2U J'r'UL/�Nif=ff6c1 COSTA MESA UCTION PERMIT Project Address . lle / f/ats T4 4— Applicant's Mailing Address Owners Name Address Arch/Eng. 7t �A� _ �•� License No. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. phone Address (mailing) .7yy�%�� '�_�(�is s�isrS4 ri City License No. 13Lr•' '�`J''�Jcr/r>1 �-� ' - ) LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, 4ag my license is In Lull force and effect. Y0 ,/ 8�C6 Licen ,,,,tt Cl Ice No. 7 Date pa'�0� Signatur&eF `rORKERS' COMPENSATION DECLARATION lereby affirm that 1 have a certificate of consent to self -Insure or a certificate r Workers' Compensation Insurance, or a certified copy thereof (Section 3800, tab. C.) PollCY No.N g S� I COmPanY �I %('YLDn eCertified copy is hereby furnished. Certif' py is filed with the city B I I gillq C:S Date Applicant EXEMPTPT ONFROM RKERS' COMPENSATIONDECLARATION (This section need not be completed if the.permit is for one hundred ($100) or less).- • I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions Of the Labor Cotle, you must forthwith comply with such provisions or .this permit shat% be boomed revoked: CONSTRUCTIONLENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit' IS issued (Section, 3097 Civ. C.) Lender's Name Lender's Address- - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's Licens¢ Law for the following reason (Section 7031.5 Business and Professional Code: Any city or .county which requires a permit to construct, alter, improve, demolish or repair •refrom and the basis for the alleged exemption. Any violation of Section .031.5 by any applicant for a. permit subjects the applicant to a cvil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon; and who does such work nimself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rovefor the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law Oes'not apply -to an Owner of property who builds or Improves thereon, and who contracts for such projects with a con. tractor(s) license pursuant to the Cootractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason Date Owner I -hereby certify that I hav read this application and state thatthe above information Is correa I a e to comply with all city and county ordinances and state laws relat t ullding constru ctl on, and hereby authorize repre. sentatives of this _ enter upon the above-mentioned .properly for Inspection purpose e Signature 7 rA # TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMO ISH ❑ OTHER DESCRIPTION OF WORK TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT /,0 OCCVPA Y CONSTRUCTION. TYPE ✓ X11 VALUATION$ 8 ZONE GRADING CU.YDS. ACR Remarks: /� Q'1 / el it FEES • Bar Sink Showers Backflow Preventer. Service Sink _ Backflow Irrigation Sewer Cap Bathtubs Sewer Connection: Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa ' 1 ' Floor Sinks Urinal Gas Service ,Outlets Water Closet Interceptors Water Heater. _ Kitchen Sink - Water Service Lavatories - - - P—Trap GRADING Roof Drains PLAN CHECK $ Reinspection Fee $25 Issue Fee $ 3 _ MECHANICAL FEES TOTAL FEE Boiler f - ,PLAN CHECK Hood or Type I ❑ Canopy Typell ❑ I Duct- Under Ground Duct - Structural Refrigeration System 00-100,000 BTU ❑100,000 BTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICSO # Heating System & Ducting' ❑0.700,000 BTU❑100,u0OBT - `- ' =� I I Reinspection Fee I $25. Drivers' License or 55 CMF 0865-46 rev.' 7/83 White -- Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 A.P. # _ S Main Building: E f T Front B Rear 1 A C Right �1 SLeft 5 / IWl Ping. Ref. #&_ i(1— Parking Req./Provided / Use of Building:M! Planning Notes Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U.' Device'Boxes Outlets - Switches Garbage Disposal Generator 00.5 KW I Reinspection Fee PUBLIC SERVICES REQ Zoning Approved By Application Approved By Application Issued By_ 1659 4/23/65 Zone Accessory ELECTRICAL Transformer ❑ 15-50 KW , ❑ 50+KW Meter El up to 100 amps Meter ❑over 100 amps Sub Panel .. Motors ❑0.1 HP ❑1'/:-8 Inc. Solar 09-15 HP 016-15 Microwave Pole Light Range Standing Sections KW . Trash Compactor $25 1 Issue Fee I;yVP1V1 T� Z O N I N G R E Q U I R E N E N T rtale� $ 3 ' SUMMARY OF FEES ' c; BUILDING PERMIT $triO SMTP, $ --F3-2 4o_ - PLAN CHECK $ PERMIT PLUMBING $ .ISSUANCE $ PLAN CHECK $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK $ MICROFILM $ •-. MECHANICAL $ TOTAL FEE $ ,PLAN CHECK $ I APPROVALS Permit # Date ffCONSTRUCTION AND PLANNING Inspector POC SPA APPROVALSPermit # Date Inspector -1. Temporary Electrical Service or Pole. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53.- Steel Reinforcement _ 3. Electrical Conduit'Utility-Undrgrnd. 54. Forms .� -4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding. 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE ,7. Footings 5 13+ 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, D Undrgrnd., Test , 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Tiap, D 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 t 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank DGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.' Frame amd 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 'e r 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe-Test f 36. Hood or Canopy �K b 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final M+ 40. Gas Service-Final 41. Solar Domestic-Final .v 42. Backflow Preventer 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations ;? 47. FINAL STRUCTURE & BUILDINGO / 48. Special Requirements Completed �G " 49. Electric Release to.Edison , 50. Gas Release to Southern California Gas Co '- 51. CERTIFICATE§F OCCUPANCY No. ��/J Date -' /t (� , - CA BobApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 2I 65 5/02/85 _ 283p00 TL aTy orco A MESA CONSTRUCTION PERMIT Prc�-t Address X105 90UGLAS A- n` .•� 1 Applicant's Mailing Address 124 A AV is OIZA E W Zlp� �(LZVIEIJ J(LaNA6EUENr P qne n^ Owner's Name //ss ,,,, h Address 151b SNELLE� USIA /Acct, PER IT NO. TRACT NO. LOT NO. UNIT�O. !* TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF-WORK/USE OF BLDG.' - A.P.# , Zone S Main Building: Accessory Building: Arch/Eng. License No. Address TYPE OF PERMIT El GRADING LJ 'FOUNDATION EISTRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - PROJECT DESCRIPTION SQ. FT. - OCCUPANCY TYPE VALUATIONS ZONE - GRADING CU.YDS. ACRES — T Front - IG BTHER A Rear - � p Contractor's Nam O P%�.t �� dL-Phone �91 % /N; A VIA ►•JGF aNp Address Address (mailing) ' �L(l �RUCTION City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full f Ce n effect. License Class- � License C Right - S Left Ping. Ref. # Parking,, Req./Provided E Ren iks- Ll Planning Notes: Q M ' _ T S' Date ` Signature PLUMBING FEES �\ WORKERS' COMPENSATION OE RATION I hereby affirm that I nave a certificate of consent to self -insure or a certificate Bar Sink Showers ELECTRICAL FEES of Workers' Compensation , Insurance, or a certified copy thereof (Section 3600, Lab. ) e� P licy Na. Q b b3• Company fJ{. �� INS Q-0 ,p9 Certified copy is hereby fu of had. Backflow Preventer -Service Sink - - -- Automatic Washer - Construction Pole.Sub. - Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Ca P y'p Bathtubs Sewer Connection b i 'Cooking Unit Meter ❑up to 100 amps 1 ' IJ Certifietl y Is filed with the city el rl 'sion Date Applicant E%EMPTIO N.FROM WORKERS' COMPE SATION DECLARATION V Clarifiers__ Solar Collectors Dishwasher _ _ _ _ Meter ❑Over 100 amps (This section need not be completed if the permit Is for one hundred ($100) or r less). !-r + certify -that In the performance of the work for which this permit is issued, (- shall not employ any person In any manner so'as to become subject to the Workers' Compensation' Laws of California.. .. Dishwasher �' Solar Piping Dryers ❑Gas ❑Electric Sub Panel 10rinking Fountains Solar Tank Fan Motors ❑0-1 HP OVA - B t Floor Drains Swimming Pool w/Spa F.A.U. .Inc. Solar❑9.15 HP IJ 16-15 Date Signature NOTICE: It, after making this declaration, you should become subject to the Floor Sinks 'Urinal Fixtures Microwave Workers' Compensation provisions Of the Labor Code, you must forthwith comply 'with such provisions or this permit shall be deemed revoked, CONSTRUCTION LENDING AGENCY - 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued •(Section 3097 Civ. C.). Lender's Name Lender's Address - - _ - _ OWNER BUILDER OECLARATION I hereby affirm that I am exempt from the. Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a perm) LtO Construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she IS licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for thealleged exemption. Any violation of Section 703 1. 5 by any applicant for a permit subjects the applicant to a civil npenalty of not more than five hundred dollars ($500). I, as%owner of the property or'my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however, the building or Improvement Is sold within one year Of conn- ' pletlon, the owner wlll'have the burden of proving he/She did not build or inn- prove for the purpose Of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project Section 7044, Business and Professions Code: The ConLicense Law does not apply to an owner of property who Cori builds or improves thereon, and -who contracts for such projects with a con- traclor(s) license pursuant to the.Contractor'i License Law). I am aware that proof 0 their Worker's Compensation insurance Should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason n Gas Service Outlets V Water Closet, - 5 Device Boxes Pole Light Interceptors 6 Water Heater 312 Outlets Ran e 9 KitctSen Sink - 1 Water Service _ 3� Switches Sign ! ' 1/ - , IG Lavatories Auto -Wash - 31 Garbage Disposal ; Standing Sections ' P—Trap' -- p Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor 1 ' ROOF Drains ' Reinspection Fee - ,$15 Issue Fee $'3 ' Reinspection Fee $15 ISSue Fee $ 3 ,- :MECHANICAL FEES , DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date Building Approved By - Date: Application Issued By. Dat zJ Boiler - Hood Or, Type I ❑ Canopy Type I I ElZoning Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct -. Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% , SUMMARY OF FEES $ SMIP $ $ PERMIT $ L -c" f'�-C ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ ' $ TOTAL FEE $ $ ' L �3'�0 Exhaust System ❑ Multiple El System Repair/Alteration Firepl/Fact. BI t. ICBG # Fire Dampers - Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city'and county ordinances and state laws relating to building construction, and hereby authorize repre- Sentatives of this'dty to ent r ypon the above-mentioned roperty for inspettlon puQQ��ois'� � t//��1� ppqp� Signature `,Cate �30'Od Drivers' Li Heating System & Ducting 00.100,000 BTU ❑100,00067 Registers " Reinspection Fee $15 Issue Fee $ 3 IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor i CONSTRUCTION AND PLANNING • ' AIPROVALS Permit 4# Date Inspector POOL, SPA APPROVALS Permit 4# Date Inspector '- 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 5 �S GEp 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. .8. Foundation 59. Gas Pipe, O Undrgrnd., Test .9. Water Pipe-Undrgrnd. J~� (� 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 - CZ49 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 APPROVALS Permit# 20. Rough Factory Fireplace 71. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas EI Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation �' 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test (p/yl�r �.V, 36. Hood or Canopy - 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -,Final 40. Gas Service -Final ,( 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 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 On .. ' 51. CERTIFICATE OF OCCUPANCY No. - Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • (((111 ,`I,, -9 CITY of cosra MESA CONSTRUCTION PERMIT Project Address 1565 Douglas Dr. '(Bldg. 7), Applicant's Mailing'Address - a eY ]Lc e c P 714/863-15 Owner's Na�irVleW Menacement Phone 117.. ,my license is in full force and effect. I , -Transformer -❑ 15-50 KW - ❑ 50+KW TYPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR Q ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIONOF WORK/USEOF BLDG. A artmentS - O A.P. # 1176 Main • St., Irvine; Ca. 92714 S E B. A C K $ Main Buildi _Address Arch/Eng. Gi].};,(,rr A a & Assoc- 8038 t, Y3.12a—Pa7.n 2—DZ-LicerSctNo..1$�_ 'Address T.aguDa'Ra 11cr Ca. 9965ri a �- TYPEOFPERMIT' GRADING FOUNDATION STRUCTURAL ❑TENANT: ❑ ELECTRICAL. ❑ PLUMBING ❑ MECHANICAL - 7 ❑ OTHER - PROJECT DESCRIPTION SQ.FT. 11,040 OCCUPANCY R-1 -CONSTRUCTION TYPE Frame/Stucco VALUATION$ 46S,AAA ZONE GRADING CU. VOS. ACRES Front Rear Contractor's Name DMH Builders, Inc. Phone 714/979-50 Address(mailin) 2512,N.Shelley Circle,Costa Mesa,C6. g - gzbeb City License No. 34704 _ LICENSED CONTRACTOR DECLARATION' I heieby affirm that Dam licensed under provisions of Charter 9 (commencing Bight Left Ping. Ref. # - Remarks: Planning Notes: N a signed statement mat ne/sne Is ucensep pursuant ro um uFov infractor's ,License Law (Chapter 9 (commencing.with Section 7( an 3 of. the Business and Professions Code) or that 'he/she lis rom and the basis for the alleged exemption.,Any violation of 5 by, any, applicant for a permit- subjects the applicant to y of not more than five hundred dollars ($500). -, as owner of the property or my employees with wages as tt ,nzatihn- will do the work. and the structure Is not Intended;or 1 1 Roof Drains. r sole I . I Reinspection Feel I $15 License Law does not apply to an owner of a property who bullas or Improves thereon, and who does such work himself/herself or through his Or her own employees, provided that such improvements are not intended or offered for sale. If, however; the building or Improvement Is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or im- tELIve for the purpose of sale). I as owner of the property, am exclusively contracting with licensed con- tractors to Construct the project'( Section 7044, Business and Professions Code: The Contractor's License l- does not apply to an owner of property who builds or Improves thereori who contracts for such -projects with a con- tractor(s)license pursuant to the Contractor'S License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me, ❑ I am exempt under Section ' 1 B. & P. C. for this reason Owner I hereby certify that I have read this application and state that the above information is correct. I agreejo comply with all city and county Ordinances and state laws retail to bu' tling construction, and hereby authorize repre. sentatives of this nter upon the above-mentioned properly for inspection purp •s q �r Signature Data Boiler ' Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ 'Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100,000 BTU 0100,000 Drivers' Lim_ CMF 0865-46, rev. 10/84 White - Building; Canary Pink - Accounting; Goldenrod - Assessor $15 0 Showers Service Sink Sewer Cap Sewer; Connection Solar Collectors ' Solar Piping Solar Tank Swimming Pool w/Spa Water Closet - Water Heater. r Water Service" Laundry Trays -- Issue Fee Hood or Type 1 ❑ m Canopy Typell ❑ Refrigeration System 00.100,000BTU 0100,0_00.13TU System Repair/Alteration Fire Dampers Registers Issue Fee 3793 5/30/85 5.50-,TL r Zone Accessory Building: Z O N I N G R Parking Req./Provided - E • _ .. M T s ' ELECTRICAL FEES Automatic Washer -- - Construct ion'Pole Sub. -Transformer -❑ 15-50 KW - ❑ 50+KW - 2 00 Cooking Unit Meter '❑up to 100 amps Dishwasher Meter ❑over 100 amps i Dryers ❑Gas ❑Electric Sub Panel I Fan Motors E10-1 HP 01% - 8 I 1 F.A.U. ' Inc. Solar 09.15 HP 016-15+ - Fixtures - - - - Microwave - - - Device Boxes : Pole Light - Outlets` Range I • Switches Sign ' ' Garbage- Disposal- -- Standing Sections • Generator ❑05 KW 05-15 KW Trash Compactor' ' $• 3 Reinspection Fee S15 Issue Fee ' $ "3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By ' Date Building Approved By Date' Application Issued By Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK • 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ 5.00 $ .50 $ S $ $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $i TOTAL FEE , $ 5.50' I i $ 3 CONSTRUCTION AND PLANNING ,APPROVALS Permit 4# Date Inspector - POO, 3PA APPROVALS Per mit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 5 Ojn 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 1 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings I -58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 6/Z z dS c" 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &House ConnectionGrr;O 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 1 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 C1 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System 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 01130 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. I UNIT NO. Project AddresJ565 DOUGLAS DRIVE Applicant's Mail iny Address PO BOX 2 2 , SANTA ANA Owner's Name DMH BUILDERS Phone Address 2510 N SHELLY CIR., COSTA MESA Arch/Eng. License No. Address Contractor's Name SANTIAGO A/C Phone 957_65( Address (mailing) PO BOX 2426, SANTA ANA City License No. 015264 LICENSED CONTRACTOR DECLARATION I hereby affirm th it I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In fly `ge , f . C/ - License Gals `J• s _ Date O/ Signature _ WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or certificate R Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. Policy No. $P4Company �C1089859 HOME INSURANCE Policy Certified copy is hereby furnished. (a�p /y�'Npp LeerN f/W ffp 5flletd withphe city �Hry l 1 F11idU A/C EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed it the permit Is for one hundred ($100) or less). certify that in the performance of the work for which this p r . Is issuetl I shall n t mplo ,BPy person in any rp at so s ec a lett tlfa Worker ' R YSeY Laws of Call/yr `�/ Date OG✓ P`--� Signature 1 NOTICE: II, after making this declaration, YOU should become sublet[e Workers' Compensation provisions Of the Labor Code, you must fort th comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the performance of the work for which th's permit is issued (Section 3097 Civ. C.) Lender's Name ^ /7S A /✓ - - Lender's Address _ _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repel any structure, prior to its issuance, also requires the applicant for such permit to file a sinned statement that he/she Is licensed pursuant to the provisions of as owner of hullos or improvgs to tractors) license purl proof off their Worke ❑ 1 am exempt under for the alleged exemption. Any violation of xcuon t for a permit subjects the applicant -to a civil five hundred dollars ($500). roperty or my employees with wages as their sole work, and the structure is not intended or offeretl Business and Professional Code: The Contractor's ply to an owner of a property who builds or improves uch work himself/herself or through his or her own such improvements are not intended or offered for ding or improvement Is sold within One year of core - ,,a the burden of proving he/she did not build or (m- ale). party, am exclusively contracting with licensed con- project(Section 7044, Business and Professions Code: Law does not apply to an owner of property who an, and who contracts for such projects with a con- t to the Contractor's License Law). I am aware that Compensation insurance should be provided to me. :tion B. & P. C. for this reason Date Owner I hereby certify that I have reap information is Correct. I agree to and state laws relating to buildir sentatNes o t S cit t mer Inspection e Signature Drivers' License or SS CMF 0865-46, rev. 4/84 Date 6/20/85 "n '?6.3 — 112055 LLDG 208 TYPE OF CONSTRUCTION LN NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TYPE OF PERMIT ❑ GRADING LJ FOUNDATIIQN LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL El PLUMBING E MECHANICAL B Rear ❑ BOTHER A - PROJECT DESCRIPTION. SO. FT. OCCUPANCY C Right K CONST RUCTION TYPE.VALUATION$ $ Left ZONE GRADING CU.YDS. ACRE$ Ping. Ref. # Remarks: / / Planning Notes: 5577 6/26/85 Zone Accessory Building: Parking Req./Provided - 158.00 TL Z O N I N G R E Q M T S. White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers - ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer '` Construction Pole Sub. - Transformer 0-15-50KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit '. Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping ,� Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP El 1!6 -8 Floor Drains Swimming Pool w/Spa F.A,U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors - Water Heater Outlets Range Kitchen Sink - Water Service "- ' Switches Sign Lavatories Garbage Disposal Standing Sections P—Trap Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains - Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue FeeE]F $ 3 MECHANICAL FEES SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By /Dataz 6 y Boiler Hood or Type IIIDEVELOPMENT Canopy Type II ❑ Duct - Under Ground Duct - Structural Duct -Ventilating Refrigeration System 00-'100,000BTU ❑10Q000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $rf'V. $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ a O�OTAL FEE $ �.. Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO.# 'b Heating System & Ducting ' ❑0.100,000 BTU Elloo,000im /'}7) Reinspection Fee $15 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING - APPROVALS Permit# Date Inspector POG_ a SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms. 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. -Rough Plumbing & Pressure Test' 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE . 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60., Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit _ 66. Solar System -Final - 16. Rough Electric Wiring 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat _ 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: , 34. Final Heating & Air Conditioning ( Lip 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing - - 39. Water Service -Final , 40. Gas Service -Final 41. Solar Domestic -Final f 42. Backflow Preventer i r ' 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 - r 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address ,l) i -I lj Applicant's Mailing Address All n-IPr AVC. Ste. A Owner's Name F Y hone Address Arch/Eng, LA A in= ��L"!cense NOM. Address - 1541 On ~ _vs f�'�"',; 1EZ Contractor's Nam, rQCi, Phone 7 Address (mailingdC I < PII U 'r. Ca -la MfVii%/ City License No. LICENSED CONTRACTOR DECLARATION ' I hereby affirm that" 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license r�is �i(-f$9�force and �`. /o Lice. Q —License Dale�• WORKERS' COMPENSATION DECLARATION _ hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof Sect l on ( 300, Lab. C 1 ,, p� ` 3 Policy No. Q QCX _7 Company Cert! lied copy is hereby furnished. Cert ie co y s filed with the city Buil Division. �1 ate_%-� APplicant.B�'afi� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed If the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work f IN p s •I d (Section 3097' Civ-, CJ Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed Statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of r)wision 3 of the Business and Professions Code) or that he/she Is exempt ,erefrom and the basis for the alleged exemption. Any violation of Section' )31.5 by any applicant for a permit Subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1] I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building -or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not bu ltd or Im- rrgve for the purpose of sale). I, as owner of the property, am exclusivelycontracting with licensed con- tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who 'builds or Improves thereon, and who contracts for such projects with a Con- tractor(s) license pursuant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. &'P. C. for this reason CP Date Owner I hereby certify that I have read this applicati information is correct. I agree to comply with al and state laws relating to building construction, sentatives of this city to, enter upon the ab, Inspection p rip e . Signature � � Drivers' License or SS # - � IF 0855-46, rev. 10/04 White - Building; Canary the -above ordinances PERMIT NU. I HAL I NU. LU I IVU. UNIT NO. - >"120 l 1 b ELECTRICAL .FEES Backflow Preventer Service Sink ' TVPE OF CONSTRUCTION NEW -ADD 0 ALTERATION LJ REPAIR .❑.CONVERSION El DEMOLISH ❑OTHER - FEES A.P. DESCRIPTION OF WORK/USE OF BLDG. ' $ Main Building ,TYPE OF PERMIT 0GRADING L1 FOU NDATipry' STRUCTURAL - ❑ TENANT ❑ ELECTRICAL El PLUM fV5-IO"M ECH ANICAL ❑ BOTHER T A Front ' Rear PROJECT DESCRIPTION Sri. FT. OCCUPANCY- CONSTRUCTIONTYPE VALUATION$ C ,S Right Left ZONE GRADINGCU.YOS. ACRES ping. Ref.# Remarks: - Planning Notes: 7518_ 7/26/85 88.130 TL . 1 I Zone "Accessory Building: - 0 N I N G R Parking Req./Provided - 1 E D M S PLUMBING FEES Bar Sink Showers ELECTRICAL .FEES Backflow Preventer Service Sink Automatic Washer - Transformer ❑ 15-50'KIN - - Construction Pole Sub. 050+KW Backflbwlrrigation - Sewer Cap FEES Bathtubs ' Sewer Connection DEVELOPMENT SER VICES REOUIREMENTS: Zoning Approved By Building Approved By Application Issued By Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors (Hood or Type ❑ Canopy Type 11 ❑ Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Refrigeration'System ❑0-100,000 BTU E1100,000BTU Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL' $ PLAN CHECK 50% $I MECHANICAL- t,lam '7N C1 T PLAN CHECK 25% $' Fan Motors ❑0.1- HP El IA -8 Floor Drains Swimming Pool w/Spa 210 F.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks - Urinal - - - Fixtures -' ' Microwave - - - - Gas Service' Outlets Water Closet - Device Boxes Pole Light Interceptors Water Heater Outlets Range ' Kitchen Sink - Water Service_ - Switches Sign Lavatories Auto -Wash $ 3 Garbage Disposal Standing Sections P -Trap Laundry Trays i - Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains -. ' Reinspection Fee $15 Duct - Under Ground Duct -Structural t Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICEO # Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 nt; Pink - Accounting; Goldenrod - Assessor Issue Fee _ S 3 - Reinspection Fee $15 Issue Fee $ 3 1ANICAL FEES DEVELOPMENT SER VICES REOUIREMENTS: Zoning Approved By Building Approved By Application Issued By I Date - Date' Dat (Hood or Type ❑ Canopy Type 11 ❑ Refrigeration'System ❑0-100,000 BTU E1100,000BTU ' SUMMARY OF FEES BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL' $ PLAN CHECK 50% $I MECHANICAL- t,lam '7N C1 T PLAN CHECK 25% $' . SMIP $ PERMIT. ISSUANCE $ ENERGY P.C. $ (GRADING $1 MICROFILM $ TOTAL FEE $ System Repair/Alteration 210 cc Fire Dampers Registers - Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POO WA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit: Utility-Undrgrnd. 54. Forms 4. Electrical Conduit. Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. 'Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ' 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK, 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Eledtrical-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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating fZ4� (.k7 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas 00il ' 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical -27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test- 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation 44. ,Landscape Irrigation System -- 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 fill in all spaces except those within heavy Cli Y OF COSTA MESA CONST UCTION2PERMIT Project Address Applicant's Mailing Address 1641 Commerce St., Corona owner's Name Butler Housing Phone979-7450 Address 1691 Kettering St., Irvine Arch/Eng. License No Address Contractor'srvamPross State Electric,IncPhone737-8870 Address (mailing) 1641 Commerce St., Corona City License No. 34901 LICENSED. CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter,9 (commencing with section 70 00) of Division 3 of the Business and Professions Code, and my license.is in full. �orGe�ntl effect. /1 112061 License �la�s $5 11 _ Lice ns0. Date Signature _ WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to Self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section Polio, Policy NoNo. .7c6)INA7293 Company St. Paul 8 Certified copy Is hereby furnished. Certified c, is filed with the cityg 'a on. Date �2—O�y Applicant- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers', Compensation Laws of California. , Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with, such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issuetl_,(Section, 3097 Civ. C.) Lender's Name - _ - Lencler's Address OWNER'BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair ,any structure, prior to its issuance, also requires the applicant for such permit to file a signed statemen Lthat he/she is licensed pursuant to the provisions of .the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom' and the basis for the alleged exemption. Any violation,of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Section 7044, Business and Professional Cotle: The Contractor's License Law does not apply,to an owner of a property who builds or improves thereon; and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion; the owner will have the burden of proving he/she did not build or im- tTLye for the purpose of sale). I, aslowner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and State that the above Information is correct. I agree to comply with all city and county ordinances andstate laws relating to building c nstruction, and hereby authorize repre- sentatives of this city to enter on he above-mentioned property for inspection purp 5-6-85 Signature Date lines ani sign all appropriate declarations. DT NO.I I UNIT NO. 2467 5/06/85 TYPE OF CONSTRUCTION X LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER I A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADING FOUNDATION E ❑STRUCTURAL' T Front ❑ TENANTX❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL R Rear ❑ OTHER _ I A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C RightK - CONSTRUCTIONTYPE VALUATION$ $ Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided .- Remarks. I Planning Notes: , Bar Sink Backflow Preventer - Backflow Irrigation ' Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors - Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Duct Under Ground Duct - Structural Duct - Ventilating . Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO.# Heating System & Ducting E10-1 00,000 BTU'❑ 100,000 BT Drivers' License or SS — — I I Reinspection Fee CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor $15 Showers Transformer 0 15-50 KW ❑ 50+KW Service Sink'-' - Metek ❑up to 100 ampr6 "Automatic Washer Sewer Cap Construction Pole Sub. Sewer Connection Motors 00-1 HP 01'/, - B Cooking Unit Solar Collectors - 17.60 Dishwasher 16 _@ 1.00 Solar Piping Pole Light Dryers ❑Gas ❑Electric Solar Tank 29.60 Fan 36 @ 1 .00 Swimming Pool w/Spa Standing Sections F.A.U. 8 @ 1 .00 Urinal Fixtures 88 @ .20 Water Closet - Device Box H8 @ .20 Water Heater • - - ' - outlets '296 @ .20 Water Service - - '' Switches 148 @ .20 Garbage Disposl6 @ I , Generator ❑0-5 KW Of Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 0100,00OBT System Repair/Alteration Issue Fee ELECTRICAL Transformer 0 15-50 KW ❑ 50+KW Metek ❑up to 100 ampr6 16.00 Meter ❑over 100 amps Sub Panel16 @ 5.00 1 36.00 Motors 00-1 HP 01'/, - B .00 Inc. Solar ❑9-15 HP 1316-15+ - 17.60 Microwave I .60 Pole Light 5 •20 Range 29.60 Sign 30 1 , o6l Standing Sections 5 KW Trash Compactor $ 3 Reinspection Fee $15 Issue FEES DEVE LOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By 543.00 FEES $ 3 Z O N I N G R E Q M T S. SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $363.00 'GRADING $ PLAN CHECK 50% $7 � r� MICROFILM $ MECHANICAL $ TOTAL FEE $ $ 3 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POO. a SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement. 3. Electrical Conduit Utility-Undrgrnd.. 54. Forms 4.'Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFERGrnd.�1 INS C10 57. APPROVAL TO COVER-GUNITE 7.,Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9:,Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10: Structural Floor System ,' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap i 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 00iI 23. Gas Pipe -Rough & Test 72. Underground Flush ' 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe -20-L,thino.& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric b Notes: 34. Final Heating & Air Conditioning 35- Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final , 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System 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