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HomeMy WebLinkAbout1013 EL CAMINO DR - Building PermitsApplicant to fill in all spaces CITY OF'COSTA ES C TION PERMIT /A,}� c Project Address I�b�.-�-���� k- Applicant's Mailing Address Owner's Name Phone ,tom AddressV/I/� G1i 47�/ 15 2 Arch/Eng. License No. Address /��I r _ Contractor's Nam,A 131.41 «� Phone�'yU -vky6 Address (mailing) City License No. . •_ 7 �/� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under Provisions of Charter 9 (commencing with section ]000) of Division 3 of the Business and . Professions Code, and my license is in full f rce tl ffect. q Llceris Class (cense o.- 1 `�/ f Date _ - Signature WORKERS'COMPENSATION DECLARA- )ereby affirm that I have a certificate of consent to self -insure or a certificate . Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No: - Com Pany 1 Certiie . Certi tied copy iF f letlbw ith rthehcity BUi�j� ivi Date Applicant EXEMPTION FROM WORKERS' COM NSATION DE ARATION (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 lin any manner, so as to became 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 issued (Section 3097 Civ. C.) Lender's Name OWNER BUILDER DECLARATION I hereby affirm that I am exempt fromBusiness Contractor's License Law for the following reason (Section permit t Burmese antl Professional Code: Any r re or county which requires a permit to construct, alter improve ,'demolish or repair any structure, prior to its issuance, also requires pursuant applicant for such permit to file a signed statement that (Chapter i9 licensed pursuant to the provisions fof 4he Contractor's License Law (Chapters (commencing n9 with Section is exempt of yt:y,ivi sion -3 of the Business and Professions Cade) or that he/she of exempt 1.5 -befromy and the basis for the alleged exemption. Any violation of Section '.31.5"by any applicant for a permit subjects the applicant [o'a civil J(_En 1, a of not more than five property r d011ars ($500employees . IJ 1, n owner of the Property ar my employees with wages as their sole compensation, will do the work, and the structure Is not intended etl n offered Licensee (Section not Business and Professional Code: The Contractor's License Law does not apply to an ownerf a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not it hin o or year ofoffered for .dale. If, however, the building or improvement is Sold within one year of r m - prove f, the owner will have the burden of proving M1e/she did not build or im- prove for the purpose of sale). 11c1 o as owner construct the property, Se exclusively contracting with ssio s con- Thetracforsto actor' ULi the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply ;tor s owner je property who tracto-or improves. thereon, and who contracts for such projects aware a'con- tra of o .license orrer'nt to the Contractor's License Lawe I ov aware that Proof o� their Worker's Compensation insurance should be provided to me: ❑ 1 am exempt under Section B. & P. C. for this reason - Date Owner I hereby certify that I have read this Application and state that the above information.is correct. 1 agree to comply with all city and county ordlnances and state laws relating to building construction, and hereby author)ze repre- sentatives of this city to enter u the above- en ti one 0 property for . those within heavy border lines and sign all appropriate TRACT NO. I LOT NO. ,UNIT NO. 0 TYPE OF CONSTRUCTION 'LJ NEW LJ -ADD LJ ALTERATION LJ REPAIR ElCONVERSION ❑ DEMOLISH ❑OTHER DESCRIPTION OF WORK/USE OF BLDG.'— TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. I OCCUPAN CONSTRUCTION TYPE VALUATION I$_ ZONE GRADING CU. YDS. Remarks: - i Roof Drains , Reinspection Fee $15 Boiler - Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ ' Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT inspection our s ���J� Signature Date ll.. -s.` -/Y— -- Drivers' License 6r 55 qq� $EgAeReinspection Fee CMF 0865-46, rev. 10/84 White - Building{ Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15' Fee Hood or -Type) ❑ Canopy Type 11 ❑ Refrigeration System 06-100,000BTU 1:1100,00013T System Repair/Alteration Fire Dampers - Registers. Issue Fee i 'TL - A.P. # Zone - , S Main Building: Accessory Building: Issue Fee -. $ 3 — E T Front' DEVELOPMENT SERVICES ,Zoning Approved By Building Approved By 'Application Issued By REQUIREMENTS: Z O -. Date Date Data - B A1 Rear N — C Right .- - - - . .. _ N S Left G R — Ping. Ref. # Parking Req./Provided E Planning Notes: M S 1 ELECTRICAL - FEES Automatic Washer * Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KW _ Cooking Unit Meter ❑up to 100 amps ' Dishwasher Meter Dover 100 amps Dryers ❑Gas .❑Electric Sub Panel Fan Motors DO -1 HP❑i%-R I F.A.U. -_ _ Inc.Solar ❑9-15 HP 1:116-15+ _ Fixtures Microwave I Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections _ Generator ❑0-5 KW El 5-15 KW Trash Compactor .$, 3 I , Reinspection Fee $15 Issue Fee -. $ 3 FEES , - ' DEVELOPMENT SERVICES ,Zoning Approved By Building Approved By 'Application Issued By REQUIREMENTS: _ - -. Date Date Data - ' - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% - ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY0'O'F $. $ - $ $ $ $, $ $ - FEES {�1_ SMTP -PERMIT ISSUANCE - ENERGY P.C. - GRADING' - MICROFILM TOTAL FEE $ '$ '$ '•- , $ ,�✓�-Ly�, ' - $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# - Date Inspector POOL & SPA APPROVALS Perrnit# 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, D 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 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 D Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D 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 V-2,14 29. Insulation 78. FIRE PREV. FINAL > ,y•.� 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 - E•. 40. Gas Service -Final 41. Solar Domestic -Final '42. Backflow Preventer 43. Backflow Irrigation 44.e Landscape Irrigation System - 45. Sound Attenuation - 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 K - API CITYOF'COSTA�MIEtSA CO_NSTRUCTION'PERMIT Project Address J_ I1 3 GtL. G /Le L. AJ e) Applicant's Mailing Address Owner's Name I 1 /l/ S (3 A RR66A&Phone.z�—n3 Address Arch/Eng. License No. Address Contractor's Name PELTA ELEG— e phim, ke.N Address (mailing) a 1-7 S IY RDAyccie y SA Aj r^ �'l i1�j City License No. -Zq �-/ / % ' 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 Cotle, and my license is in full force and effect. L License Class ' C — License No. I Date q� f�-� Signature WORKERS' COMPENSATION DECLARATION hereby affirm-that'I have a certificate of consent to self -insure or a certificate I Workers' Compensation Insurance, or a certified copy thereof (Section a800, Lab. C.) i , Policy No. 1 Company H Certified copy is hereby furnished. Certified copy is filed with.the city Building Division. Date Applicant 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 be me subject to the Workers' Com �ne io Laws of Califor ia. I rte ; Date Signature ,Q - NOT IC >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 constructlon lending agency for the performance Of the work I for which this permit is issued (Section 3097 Civ. C.) ican_t to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. -I LOT NO. I -I INIT Mn' TYPE OF CONSTRUCTION L] NEW LI ADD WALTERATION LI REPAIR - ❑ CONVERSION' 1:1 OEM OLISH ❑ OTHER SUMMARY OF FEES: BUILDING PERMIT , _ AP DESCRIPTION OF. WORK/USE OF BLDG. PLAN CHECK - $I PERMIT --. PLUMBING S Main Bt TYPE OF PERMIT�,/ GRADING FOUNDATION STRUCTURAL T Front. 1-1TENANTLL7 ELECTRICAL ❑PLUMBING ❑ MECHANICAL B $� I 'E1 OTHER .. ` -. A Rear PROJECT DESCRIPTION SQ. FT. _ OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE - 'GRADING CU.YDS. ACRES Ping. Ref. # Remarks: 01�At�U ," Planning No Bar Sink - ' Backflow Preventer Backflow Irrigation Bathtubs.= Clarifiers' Dishwasher = Floor Sinks I Lenders Name - - Lenders Address - - L - - - _ --- - - - Kitchen Si OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories fnunw na reason-ISectlon 7n31-5 Rusiness antl Professional [otlei Anv cl[wor I to file a signed statement that he/She is licensed pursuant to the provisions Or the ContractoCs License Law (Chapter 9 (commencing with Section 7000) of *-ywision '3 of the''Susiness and -Professions -Code) `or that'he/she is exempt- ^'refrom antl the basis for the alleged exemption. Any violation of Section i A .)31.5 by any applicant for a permit subjects the applicant toga civil jtPnalty of not more than,five hundred dollars ($500). n I; as owner of .the' property or my employeeS with wages as their sole corn e[ion,]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 aproperty 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 mle:'If,.however,the building or improvement is sold within one year of com- t pletion, the owner will have the burden of proving he/she did not build or Im. rove for the purpose of sale). - I -1, 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 does not applytoan owner of property who builds or improves thereon, and who contracts for such projects with a con- tract or(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: ❑"1 am exempt under.Section B. & P. C. for this reason. Date' - Owner ' I hereby certifyethaCl 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_ th city to_enter upo 'the above-mentioned Property for l inspection' purpo es. Signal ure Date 9-� i -k t I PLUMBING Showers t " Service Sink - - Sewer Cap - Sewer Connection - Solar Collectors - Solar Piping ' Solar Tank. I •- j Swimming Pool w/Spa 'Urinal Outlets Water Closet ' I Water Heater i - -- Water Service I Auto -Wash I LaondrylTrays I i t Feed $15 ,Issue Fee' Boiler Duct - Under Ground Duct - Structural Duct - Ventilating ' Exhaust System ❑ Maltiple Firepl/Fact. BIL ICBO # Heating System & Ducting C3 0-100,000 BTU ❑1DD,000 $15 Oriveri' License or SS # - - Reinspection Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type I ❑ , Canopy Type 11 ❑ Refrigeration System ' 00.100,000BTU 0100,000BTU System-Repair/Alteration Fire Dampers - Registers. - FEES Automatic Washer Construction,Pole Sub. ' Cooking Unit I Dishwasher r Dryers'❑Gas ❑Elec Faq F.A.U. Fixtures Device Boxes Outlets t Switches- 1- +-- Garbage Disposal Generator ❑0-5 KW:: t 2916 9/11/86 10.651 TL Zone _ Accessory Building: Z O N 1 - - .-- , -- - G" R _ ,Parking Req./Provided ' I E Q - M T - S ELECTRICAL' I -a FEES Transformer ❑' 15-50 KW -0 56 '7 i I Meter 0 u to 100 amps . Meter ❑over`100 amps - I ) , Motors et _ Ina Solar I Microwave Pole Light Range Sign Standing S 15 KW Trash�Com $13 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS:i 1 Zoning Approved By Building Approved By Issue Fee '$ 3' 1 I ation Issued By. i ,1. Data a -L' ( SUMMARY OF FEES: BUILDING PERMIT , $ - SMTP $ _ •: PLAN CHECK - $I PERMIT --. PLUMBING $ t ISSUANCE ' C„ '$ '1 PLAN CHECK 25%- $' _ ENERGY P.C., $ . ELECTRICAL - $� I -GRADING ; $ PLAN CHECK 50% $ MICROFILM. $ c MECHANICAL $ .,TOTAL FEE $ PLANCHECK 25% $- CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector IPOOL & SPA -JAPPROVALS 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 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 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 'be-Test 67-Hood or Canopy n 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final , 41. Solar Domestic-Final i� ,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 border lines and sign all appropriate declarations. CITY 6FC0$- AI MESA CONSTRUCTION PERMIT PERMIT a V& TRACT NO. LOT NO. UNIT NO. OB2I B/05/86 •- 25.60 7L Project Ad(Siess Li1i F l Gr4Nw ! ! V • • - -' Mailing Address 3 y'/ G9+1 / "U TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR 1jpolicarlt's ❑ CONVERSION El ❑ OTHER Owners Name L"ut-S - JRwe a f Phone A. P. 6 Zone DESCRIPTION OF WORK/USE OF BLDG. L + — OJ f Address S �"" f' r ZZ(9 S Main Building: Accessory Building: E Z Arch/Eng. License No. TYPE OF PERMIT GRADING 0 FOUNDATION LJ STRUCTURAL T Front O ❑ TENANT ❑ ELECTRICAL &PLUMBING 0 -MECHANICAL N Address //ss ❑ A Rear Contractor's NameACA"'I IE 0i1, 13r V'a) G Phoned?_; �L/ OTHER - C flight N �/ �!� i�r� PROJECT DESCRIPTION SO. FT. OCCUPANCY K G (mailing) ����� 2 n r/H / H✓r-lT- F 'CON ST RUCTION TYPE VALUATION $ Left CityAddress City License No. % 7 .TL Licens9 2orvE GRADIrvG Cu.YDs. ACRES Ping. Ref. # Parking Req./Provided R E LICENS EO CONTRACTOR DECLARATION Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - O Planning Notes: - M with section 7000) of Division 3 Of the Business and Professions Code, and T my license is in full force and effect.OO 'f'C7 / S License Class J License No.y - Oaletr q, — k4- Signature ! PLUMBING - FEES e"1RKERS' COMPENSATION DE TION Bar Sink Showers - ELECTRICAL FEES coy affirm that I have a certificate of consent to self -Insure or a certificate Yorkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink a 1 Automatic Was her Transformer ❑ so00, Lab. C.) 15-50 KW Policy No. Company Backflow Irrigation - Sewer Ca - P - Construction Pole Sub. . ❑ 50+'KW 8 Certified'copy Is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs' i Sewer Connection Cooking Unit Meter ❑up to 100 amps ate Applicant EMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers - I Solar Collectors - Dish Washer Meter ❑over 100 amps This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is issued, I shall not employ in any man er s as become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP Ellh- 8 Woo Worker Compe tI n ws Of Calif Or Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP E116.1 5+ -NOTIC If, after making this tleclara on, u s uld become subject to the - Workers' Compensation provisions 'of tha Labor Cotle, you must forthwith Floor Sinks Urinal Fixtures Microwave - comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service / Outlets Water Closet Device Boxes - - Pole Light g 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.) Interceptors Water Heater •-Range Outlets,, Lender's Name Lender's Address - Kitchen Sink Water Service .�. Switches Sign OWNER BUILDER DECLARATION F I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto -Wash ' 9a P Garbo Disposal Standing Sections following reason (Section 7031.5 Business antl Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair to its issuance, also requires the applicant for such permit P—Trap P 0, Laundry Trays ^^ o� - Generator ❑0-5 KW ❑5-15 KW Trash Compactor any structure, prior to filo a signed statement that he/she Is licensed pursuant to the provisions of �� Roof Drains e•- Contractor's License Law (Chapter 9 (commencing with Section 7000) of - tion 3 Of the Business and Professions Code) or that he/she is exempt ifrom and the basis for the alleged exemption. Any violation of Section A.5 by any applicant for a permit subjects the, applicant to a civil malty of not more than five hundred dollars ($500).' $ 3 LJ I, as Owner of the properly or my employees with wages as their 5010 Reinspection'Fee $15 Issue Fee compensation, will do the work, and the structure is not Intended or offered for sale (Sectlon 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Reinspection Fee $15 Issue Fee .$ 3 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 Boiler Hood or I ❑ DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Improvement is sola within of com- ,Type Canopy Type ❑ Zoning Approved By Date sale. If, however, the building or one year pletion, the owner will have the burden of proving he/she did not bulla or im- Duct - Undar Ground 11 Building Approved By Prove for the purpose of sale). _Date . ❑ 1, as owner of the property, am exclusively contracting with licensed con- Duct - Structural Refrigeration System, _ Application Issued By p Date S tractors to construct the project(Section 7044, Business and Professions Code! does apply to an owner of who 130.100,000 BTU 11100,000 BTU ' The Contractor's License Law not property builds or Improves thereon, and who contracts for such projects with a con- Duct - Ventilating SUMMARY OF FEES tractor(sl license pursuant to the Contractor's License Law). I am aware that V Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ . proof o their Worker's Compensation Insurance should be provided to me.- ❑ 1 am em t u or SecjiDn 8. C. for this reason � Firepl/Fact Bit. ICBO # Fire Dampers PLAN CHECK $ PERMIT -. PLUMBING $ ISSUANCE - $ Date -' - owner Heating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. - _§, -�-' -- I hereby certify that I have read t icxtion —and state that the above ❑0.100,000 BTU 13100,0008 ELECTRICAL $ . GRADING $ information is correct. 1 agTtmplYlwith all city antl county ordinancesantl state laws relating 0 construction, and hereby authorize repre- l for I PLAN CHECK 50% $ MICROFILM $ sentatives of this t pon the above-mentioned property inspection purpos �� _y� Date, MECHANICAL $ .TOTAL FEE = $ Signature - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK - 25%-_ $ Drivers' LI<en or 5 # ,MF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date .: Inspeytor r 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. -V'744 LAD 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. c 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 9-744 1-90 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 �.� G 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 00il 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 r 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 143. Backflow Irrigation ' _ - 44. Landscape Irrigation System 45. Sound Attenuation -, 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING .. / 48. Special Requirements Completed • r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date a Am I Applicant to fill In all spaces CITY'dCLcosTAMES-A CONSTRUCTION PERMIT Project Address /0-4?, LL C^ At /Al Applicant's Mailing Address t5 H M t' Owner's Name. W(oSlAl _57 p e Address -Ir-4 - it F!M C Arch/Eng. License No. Address ' Contractor's Name ��— Phone v sr Address Imailing) I r, 3G City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I ani 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 force and effect. License Class License No. Date—Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATIONOEC LARATION (This section need not be completQfpermit is f r one hundred ($100) or less). I certify that in the performancerk for ch thI a 'tisissuetlsnail not employ a rson in ner to be on bject to LilaWorkerC�omq� iso Laws df Date /Y/ \ NOT CE: It, after making this aeclarat on, you should .become subject to tt T Workers' Compen sa lion provisions of the Labor Code, you must forthwit comply with such provisions or th permit Shall be deemed revoked. CONSTRUCTION LENDING• AGENC 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 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 - she Contractor's License Law (Chapter 9(commencing with Section 7000) of 4vision 3 of the Business and Professions Code) or that he/she is exempt - ierefrom and the basis for the alleged exemption. Any violation of Section /031.5 .by any applicant for a permit subjects the applicant to a civil Hnalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is Sold within one year of com- pletion; the owner will have the burden of proving he/she old not build orIm- Dve efor the purpose of sale).' L I, a1owner of the property, am exclusively contracting with licensed,con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(S) license pursuant to th ntrattdr'S 'cense Law),I am aware that proof off their Workers Com neat n insgra shpuld be provided to me. ❑ lam exempt untle SectionliC 1/8. `4 PP, C. for this reason Drivers' License or SS yp CMF 0865-46, rev. 1'1484 Owner tion and all city a a, antl in those within heavy border lines and sign all appropriate declarations. TYPE OF CONSTRUCTION LI NEW LJ ADD V:TALTERATION L-1 REPAIR ❑ CONVERSION, ❑ DEMOLISH ❑ OTHER 3 DESCRIPTION OF WORK/USE OF BLDG. _ TYPE OF PERMIT LJGRADING L -I FOUNOATIOJJ I -'STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING EMECHANICAL b3ffOTHER, ZP?DJECT DESCRIPTION SQ. FT. OCCUPANCY -_-A // CONSTRUCTION TYPE VALUATION '$ ZONE GRADING CU.YDS. ACRES_ Remarks: - PLUMBING 1 -FEE Sar Sink Showers ' Cooking Unit 3ackflow Preventer Service Sink Dishwasher - 3ackflow Irrigation Sewer Cap - Dryers ❑Gas ❑Electric 3athtubs - Sewer Connection Fan - l �. Clarifiers Solar Collectors F.A.U._ _ _ Dishwasher - - Solar Piping l Qrinking Fountains Solar Tank Device Boxes Floor Drain's l Swimming Pool w/Spa ' Outlets Floor Sinks Urinal ' - Switches-- — >- — Gas Service Outlets Water Closet Garbage Disposal Interceptors Water Heater GeneratorE10-5KWE15.15KWJ Kitchen.Sink - --- -- _ Water Service - - - - Lavatories Auto -Wash ' ?-Trap Laundry Trays Roof Drains ReinspectioniFee $15 1 Issue Fee / $'3 Boiler Duct - Under Ground ' Duct - Structural Duct - Ventilating Exhaust System' ❑ Multiple Firepl/Fact: Bit. ICBO # Heating System & Ducting ❑0-100,600 BTU 0100,000 Reinspection Fee 1 $15 Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type M1 Canopy Type 11 ❑ Refrigeration System 00-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee I $ 3 A.P. # S Main Building: E T Front, ARear C Right K Left Ping. Ref. # Planning Notes: 0 4233 10/01/86 Zone Accessory Building: Parking Req./Provided I 6e75 TL Z O N I N G R E Q M T S ' - ELECTRICAL - FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ' 1:150+KW . Cooking Unit Meter ❑up to 100 amps l Dishwasher - Meter EJ over 100 amps Dryers ❑Gas ❑Electric Sub Panel ' Fan - l �. Motors E-10-11 HP ❑1X-8 F.A.U._ _ _ Inc. Solar ❑9-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range - Switches-- — >- — Siyn -• - - Garbage Disposal Standing Sections GeneratorE10-5KWE15.15KWJ I Trash Compactor I Reinspection Fee 1 $15 1 I= Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% S ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK - 25% $ SUMMARY OF FEES , SMTP $ PERMIT ISSUANCE $ ENERGY P.C. S . - GRADING $ - MICROFILM $ - ,TOTALFEE �� $'. CONSTRUCTION AND PLANNING APPROVALS Permit=* Date Inspector POOL & 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, O Undrgrnd., Test ' t 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 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 ❑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 ' 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 t 48. Special Requirements Completed 1" 49. Electric Releaseto Edison-__. - - ---- - 50. Gas Release to Southern California Gas Go No51. CERTIFICATE OF OCCUPANCY . Date ^"� R I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations �� ZL PE ITjVO. 5/ T CT 9 �/❑ La NOO. UNIT NO. BUILDING PERMIT TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH OT ER DESCRIPTION OF WORK/USE OF BLDG. W7 -AZ_ L TAk/� AP # L S Main I Sewer Connection TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT, OCCUPANCY /// ///������,��sr ��- CONSTRUCTIONTYPE VALUATION$ T B A C K S Fiont Rear Right L t -- CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address .42)43 Z --I— «Af,141 D Applicant's Mailing Address .A /�% — Owner's Name %7T 8 5'F L�`7 F Oji f�s'1A f ,{vA hone �L�.�a A Address /��ELe��i 41"0 A MC0 Arch/Eng. License No. Address Contractor's Nam Phone Address Imailing) ` City License No. LICENSED CONTRACTOR ECLARATION I hereby affirm that Imam 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 force and effect. License Class - License No. Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I.have a certificate of consent to self -Insure or a certificate .f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company H Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM.WORKERS' COMPENSATION DECLARATION (Thissection need not be completed permit oro ed ($100) or less). 1 certify that in the performance of tie w k fo is inis per st is issuetl; I Date comply with such provision CONSTRUCTION LENDING I hereby affirm that there Is a r of the work for which in Lender's Name Lender's Address OWNER BUILDER DECLAR I hereby affirm that I am exempt from the Contractor's License Law for the 7031.5 Business and Professional Code: Any city or armit to construct, alter, Improve, demolish or repair Issuance, also requires the applicant for,such'permit that he/she Is licensed pursuant to the provisions of aw (Chapter 9 (commencing with Section 7000) of 'S and Professions Code) or that he/she is exempt or the alleged exemption. Any violation of Section for a permit subjects the applicant to a civil ive hundred dollars ($500). 'operty or my employees with wages as their sole M V become the performance 3097 Civ. C.) 'efrom and the 11.5 by any a alty of not mor 1,. as owner of r oensalion. will 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 of red 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- rov or the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- ' ractors 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 rise Law). I am aware that proof of their Worker's Compensation Insuran a h�..,dd Abe provided to me. ❑ 1 am exempj�under Section q. ty ✓a C. for this reason Date Owner - I hereby ce tifv that I have read this aov,licattori and state that the above in ZONE GRADING CU. YDS. ACRE Ping. Ref. # ' Remarks: _ �/� � n S Planning Notes: 3ar Sink , 3ackflow Preventer 3ackflow Irrigation - 3athtubs Zlarifiers - 3isliwasher- 7iinking Fountains %or Drains %or Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories ?—Trap Roof Drains 1 4z Reinspection Fee Boiler Duct - Under Ground $15 I I Issue Fee • I S 3 Duct - Ventilating Exhaust System ❑, Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting 00.100,000 BTU Ell TIP"" Signature �Date�L Reinspection Fee $15 Drivers' LI SS � � // '' CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00-10010 BTU 11100,000 Sys Repair/Alteration Fire Dampers - Registers Issue Fee 1 $ 3.1 0673 ,8/64/86 73.93 TL Zone (� r 1 Z O N I N G R Req./Provided E D ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter Dover 100am2_ Sub Panel Motors❑ HP❑1'f.-8 IncS r 09-15 HP E116 - Pole Light Range Standing Sections 5 KW Trash Compactor FEES Reinspection Fee 1 $15 1 1 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS, /U (��� Zoning Approved By - 9 1/ t.t-yt !"'—}}ate J{(p Building Approved By 9 Date SUM V EES BUILDING PERMIT $ SMIP - - $ PLAN CHECK $ PERMIT - - PLUMBING $ ISSUANCE, $ PLAN CHECK -25% $ ENERGY P.C. $ ELECTRICAL __ $ -GRADING - $ PLAN CHECK 50% $ 'MICROFILM $ - MECHANICAL ,� $ TOTALFEE $ 3 3� PLAN CHECK 25% $ -- CONSTRUCTION AND PLANNING ,APPROVALS Permit ;Date Inspector POOL & SPA APPROVALS Permit*-Date q 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 W 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding c 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test Q 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE m 7. Footings '.�' 58. Electrical Conduit-Undrgrnd. 8. Foundation �,! : - 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & 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 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 PREY. FINAL ' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - • , 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED _! ,I- 33. Final Electric Notes: t ,. 34. Final Heating & Air Conditioning LO FFR ,SuIrjA[, MQUWAM - •, 35. Final Gas Pipe-Test y 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing , 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final i 42. Backflow Preventer 43. Backflow Irrigation ; ••r, 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING �7 afl.3- U 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date It � 1 -