HomeMy WebLinkAbout210 16TH PL - Building PermitsJob Address: 210 16TH PL Status: ISSUED
Suite: _ Applied: 01/082007
Vicinity: UNITS A THRU E ONE BLDG. Issued: Ot/082007
Primary Occ: R-� Type of Cons�ruttion: V-N
Parcel Number: TPN007001 Zoning:
Applicant: LA RUE, CHERYL
Address: 113 SOUTH MINNIE ST
Phone: 714-731-3425
SANTA ANA, CA �,. ,r—.,- >� ,�2ip: ., 92701 _
_ �,:, : . . . _ -
Owner HOA i �- '� - � ��
Address 21016TH-PL,%�%�%�- ' . ' , _
, �
CARE�OF�MARK CHRISTENSEN � Phone: ' ,- -
COSTA�MESA, CA�� ! �� .- Zip:� � 92627
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Contraaor." i�WEATHERLINE ROOFING INC � '
Address�i113 S MINNIE.ST �' - - .
: � i �",,,,-/
/ .j � � � /�/// Phone: 714-731-3425 '--` .
��, �/ � �SANTA ANA�CA � �
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' '1 Zip: 92701����� License: 729560
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TEAR OFF SHAKE ROOF,.SOLID:SFIEATING IS EXISTING,
. � ' ��., � �` � .
\� Plan Check:� _ $0.00
Permit: $209.25
' � �SMIP Res: � $0.00
SMIP Com: $0.00
Other' , $0.00
Inspectiori: ; � , $0.00
;�r — �� �,
� `` -Total: �` �`'�,�' $209.25
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ISSUED BY:
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Phone:
License:
PE OF PERMIT ' �-• - "
WITH FELT AND 40 YEAR COMP SHINGLES.�ICBO ER 5414.
' . FEE SUMMARY `
� ' sJi P�- . � l:✓ � � Ir 1� 1' ' -� �--'�i � • ��'Calc Valuation:
- - Claim Valuation:
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MAINSTRUCTURE Front�0 0 � Rea�.��4�Oc„��- ,,Lefl, --0=0;;�,r Right O,Oi,'
�A �
ACCESSORY -' �Front 0'0 �`, � ^= •'Rear 0-0_ = . � Left 0.0 ��� ��'`�Right ,- 0-0 �
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PARKING ��- Ezishnq �� o�� ��Re vired 0: - Pr000sed: 0 �
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ai z,000.00
Si2,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 72-27-92)
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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2946661fl�00)
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirm under Denalry of perjury one ol ihe following declarations:
❑ I have en0 will maintain a conilicate of consent to selFlnsure for workars' compensetion, es provided lor �y section 3700 0l tha Labor Cotle, for the peAormance of the
� /,/"ork fOr whiCh ihi5 permil Is Issuetl.
� I have antl will maintain w rkers' i.ompensatio insurance, s reqmred by section 3700 0l Ihe La6or Cotle, Por the peAormance of the work for which ihis permit is issuetl.
My workers' comp satl i I 5u n e cerrier 0 olicy n er are: �%�"�� �%C
Carner. l� � PolicyNumOer. ""—LJ'�� � ���
(TAis section need not be comp ed I! fhe permit is veluetl af one hundrad dallers ($100) or Iess.J �
❑ I cenity that in the performence of Ihe work for w�ich this permit is Issued, I s�all nol employ any person in any menner so as to become subject to tha workers'
compensetion lews of Califomia, entl egrea the� if I should become subjact to the workers' crompensation provisions of Sectl n 3700 o the Labor Code, I shall foAhwith
crompty with ihese p o1visions. � p /x� O %
'Applican— ISign e:��An3AdY�� U O Date: � f V 1
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WARNINO: FAILUPE TO SECURE WORK S' COMPENSAiION COVERAGE IS UNIAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMIWIL PENALTIES AND CIVII FlNES UP TOONE HUNORED
THOUSAND DOLLARE (5100,000), IN AODITION TO THE COST OF COMPENSAT1pN, DAM4GE5 AS PROVIDEO FOR IN SECTION 3IO60F THE IABOR CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DBCLARATION:
I hereby aflirtn ihat I am licensetl untler pmvislons of Chepter 9 o menc�i Qwrth Section 7000) ot DlNsion 3 of the Bi
force enA eHect. Lic. N � �� �lD � qass a
ContractaYs g eturef' —�- E l 1 ./1 Date:
Cotle, entl my license is in fuil
CONSTRUCTON LENDING AGENCY:
❑ I hereby eHirtn ihat there is e construction lending egency lor the peAormance ol the work for which this permit is issued. (Sec. 3097, Civil Code�.
Lendefs Name: Lender's Atltlress:
SignaNre:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby effirm that untler penalry oi perjury that I am EXEMPT FROM THE CON7fiAC70RS LICENSE LAW for iha tollowing reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or counry which roquires e permit to construd, elter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicani for such permit
to file a signed statement Ihet he ar she is licensetl pursuant to the provisions oi Ihe Comractors License Law (Chapter 9(commendng with Section 7000) of Division 3 oi the
Busineu enA ProFessions Cotle) or that �e or she is e:empt t�eretrom and the basis for the elleged exemption. Any violation oi Section 7031.5 Dy eny applicant for a pertnit
subjects the applicent ta e civil penalry at not more ihen five hundred dallars (5500J.�:
❑ 1, as owner ot the property, or my employees with wages es their sole compensation, WILL DO 7HE WORK, antl the siructure is not intendetl or offeretl tor sale (Sec.
706d, Business antl ProfesS�ons Code: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who tloes such work
himsell or herself or ihrougn his or her own employeas, provitletl Ihet such improvements are not intended or oHered for sale. If, however, ihe builtlinq or improvement is
sold within one year of completion, tha owner�builder will heve Ihe bwden of proving that he or she tlitl not build or improve for purpose of sale.).
❑ I, as owner oi the properly. am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the p�olect (Sec. 7046, Business antl Prolessions
Cotle: The conlraciors Ucense Law tloes no� epply to an owner of propetly w�o builds or Impmves Iheraon, antl w�o coniracts lor such pmject with a coniracbr(s)
license pursuant to the Con�ractors License Laws.).
❑ 1 em exempt untler sec. Business antl Protessions Cotle tw ihis reason:
Signature: Date:
Owner ID veritied by driver's license. ❑ Ves ❑ No Driver's License No.
Vadficatlon of Owners�ip by (ype ol daumant, i.e. - property lex bill or tleetl):
E:pires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certity the� no exce�etion five (5) or more feet in depih into which a person is required to descend, will be made in connectian with work au�horized by thi5
parmit, and that no building strucWre, sceMoltling, talsework, or demolition or dismantling tharaoi, will he more than ihiny-six (36) fee[ high. (Chap. 32, Grp 2, An 2, Sec.
341, Title 8, Califomia Atlministretive Code).
❑ As owneo-builder, I will not employ enyone to do work which woultl require a permit irom Ihe Division ol IndusMal Satety, as noted above, unless such person has a
permit to do such work from Ihe division.
Signature: - Date:
Division of Indusinal Safery Perm�� Number.
CEHTIFlCATE OF COMPLIANCE AND AUTMOR¢ATON OF ENTRY: I Certity untler penalty ol perjury iha� I have reatl IhiS application and slate that Ihe information given i5
cnrrecL I egcee to comply with all stete lews and ciry ardinences relating to building consiruction, and authonze representatives of the Ciry of Cosla Mesa Io enter upon Iha
ebove-descnbetl property lor inspection purposes. I agree not to acupy or allow acuDancy ol any building authonzed by this permit until tinal inspection.
COOE �. INSGECTONTYPE
1616 Flxetl System Final Fire Prevenlion
1286 Poal Spa Final
200 Finel Re-Roof
201 Final Black/Retaining WWII
202 Final Factory Fire Place
203 Final Sign
204 Final Demoli�ion
P6g
I � l �ate
U
ate
CODE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Elecincal
212 Final Fire Pravention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupenty
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PP0.IECT FOUNESS: � 1 0 1 6 TH PL .
owaen�sxnme SHELIA GERHART
FODNE55: ZSO 16TH PL UNIT A
COSTA MESA
CA 92627
714 631-6268
AflCMIENGINEEfl:
AOONE55:
flEG.NO.:
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uxiT:
PEPMITTEE: GEORGE BRAZ IL ( 714 ) 541-0917
nooecss: 3022 N. HESPERIAN WY 101
SANTA ANA CA 92706
LILENSEO CONTRACTON DECNPRTI�N: I hereDy afiirm Inatl am licensed untler o�ovisions of ChaD�er 9(commencing wilh Seclion
7000� ol Division 3 0l ihe Business antl Pmfessions Code. antl my license is in lull �orce and e�lect. //��
c�Tvuc.: �29919 sTareuc.:443064 cuss: �-36�y�����/L�
Date: �����_ Signamre: _
� WONIIEBS' COMPENSRTION OECIANpTION: I �ere0y alfi t l have a n� te ol cansent to seli-insure or a cenificate oI Warkers'
� Comoensalion �u�e1 � e�=� wpy mereof (Sec� 3eo0. �ao. 1/ O 1/ 91
POLICY NO.: EXP. DPTE: '
comaner. UNITED PAC,
'�������
1641 46 W�ile—Builtling;
Pink—Revenue: GoltlenraE—Assessor
antl
rITY OF
PERMIT NO; P 049926
CONSTRUCTION TYPE: V—N
MESA — BUILDING PERMIT
N CHECK NO: N
ERMIT TYPE: PLU
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• �. a
JOH DESCRIPTION ; CHANGE OUT 40 GAY2 WATER HEATER GAS SQ FT;
CLAIM VALUE: CALC—VAL`F�£ GROUP OCC: R-3 /
COMMENTS: CHANGE OUT 90 GAL WATER HEATER GAS
�r**+�**�r****�x�r+�*+�*�e*���r�r******�r*�r�r�**�r****�r�r***�r�r�r**�r*�+�+r*+t*�r*��r**�r*****+�*�r*�r*�r
2 O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAA: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING RE�• PROV: PARCEL: 00000000 ZNE: REF NO;
PLANNTNG N TES>
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if M k if iE iE 3f iE k iF if if iF 1f M iF ik if if If If if ik iE jE 1k IF if iF if iE iE �F if if 1f iE k if if 1E 3F iF if fF ik if k if IE if iF IF ik 4 if M� k 1F 1E !F iE iE k 1f iF if IE IE iFiF k 1F iF �k iF k ik if
D E V E L O P M E N T S E R V I C E S R,E Q U I R E M E N T S
20NING APPROVED HY DATE:
HUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY• �G�w �� DATE: /� �C7
*If1FiF1fiflEiEif3FiFdFiFiFifififlFiElEifif3fif�f7fiF�f�FiFififiFiFiFiFiF �iFiFiF7Fif�7FiFTfiFiFiF'ifiF3Faf1ElEiFiFlfiflE�i(� '�'i�'�"4-7FIFiF
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LEGAliIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRLC� MECHANIC FIRE SMIP/RES GRADING
PERMIT 2 00
�SY ' , • SMIP/NON—RES'
PLAN ' y� '
ISSUE FEE 3.00 ' ' " . �
BUILDING—DIV—> PERMIT xSSUE PLAN'—CHECK TOTALc PAID DUE
TOTALS----> 2.00 3.00 - 0.00 ! 5.00 5.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 5,00 OVER/SHORT; 00
BLDG PMT PLUMBING ELECTRIC MECHANIC - FIRE SMIP/TOT GRADING PLAN—CHECK
S.UU - ' -
k k M iF if iF k if 3E k�f k if iE iE k k k iF iE k IE iF k iF if if if if If iF iF it if if if iFif �F iE 3f if if iE k If 1f if !! iE it iE k it it it iF �f IF it *!F k k!t if• �k 1E 9E 3k 3E ik iF if if iF if iF 3f
I N D I V I D U A L F.. E'r'E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT � 2,00 2,00
END OF FEES
:
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Oi Q007418�—�L�074;.°.3 ?f_�7' i,:'
DA7E� 11/i4/90 TIttE: 09057
i �
CONSTRUCTION AND PLANNING - P��` & SPA
APPROVALS Qermit # J ate Inspector APPROVALS Permit �h Date Inspector
�
1. Temporary Electrical Service or Pole _, � 52. Pool & Equipment location �
2. Soil Pipe-Undrgmd.. ,a� G� - 53. Steel Reinforcement '
;3.�,Electrical Conduit Utility UndrgrnC. T� 54. Forms �
4rElectrical Cond"uiDUndrgrnd.�� 'y� 55. Electrical Bonding ��
' 5. Steel Reinforcement - 56. Rough Piumbing & Pressure Test ,
� i6. Electrical UFER Grnd. . 57. APPROVAL TO COVEF�GUNITE -
-7. FOotings . - i� 58. Electrical ConduiDUndrgmd. �
� 8:'FOundation � �,'i � !� 59. Gas Pipe, O Undrgrnd., Test �
� ..
9. Wate� Pipe-Undrgrnd. ' , � 6p. Backwash Lines, P�Trap, � Undrgrnd. `�ti
10. Structural Floor System -• /� 67. APPROVAL TO DECK �-
11. Property Sewer Line & Hous"e Connection 62. Backwash & Receptor-Final '"�
72. Sewer Cap ;� �� Ll - � 63. Heater & Venc-Final �
,-�
13. Roof Drains . � '� 64. Plumbing SYstem - Final '� �
' `i.
'14. ROugh Plumbing �� l ' � - 65. Etectrical-Final '� � �'
/:
15. Rough Electrical-Conduit , �� 66. Sotar System-Final '�
16. Rough ElectricWirin ' � ' '
9��' . 67. Fencing & Access Approval _ •,%
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING l
18. ROugh Electrical-T Bar.Ceiling 69. POOL(SPASYSTEMS FINAL �
�
19. Rough�Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20t ROugh,Eactory Fireplace : 'j. ' - - � - � - APPROVA'LS:' = Permit # ' �: _
�' � : -.. - _.v� .�
21.' Ducts, in St�utture, ` .. � - = �. 70. Underground Hydro
22. Duccs, Ventilating ° i ', r _ ��; 71, Produci Piping �O�Gas d Oil
23.,Gas Pipe�Rough &:Test � �;:.:� : , � � 7Z, Underground FIusF,i . :
24. Roof Framing .� � - - � ^ y.�. 73P UndergrnB. Storage Tank O Gas O Oil •
25. Roof Sheathing ; , - ''' � ` ,� "7q- Overhead HYdro� �
26. T-Bar Ceiling (Structural) & Monocoat y � 75�' Dry Chemical ' = -
27'-�Frameand Flasliing 'jl. '� �:; ; 76. DryStandpipe �;�i � `�
28. Lathing,& Siding. • . _� ..• . ^� ^� • � T 77r FIXED SYSTEM:F�NAL _ �
� 29. Insulation �_ - '- '� �� ; � I , !. � 7g. FIRE PREV. FINAL . - .
��30. DrYwall Nailing .,�� �� � I I � �. � HEALTH:DEPT. REQUIREMENT
. 31. Plaster Brown Coat .,�. ;.� I '' 79: �FINAL INSPECTION ' 1
32: Electrical Power Meter-Final ` . � I• • 80. FOOD CERTIF.ICATE ISSUED _
33�Fin,alElectric = � ' Notes:'L-Z(-q0! O OH. O �'
I"(:" .. 1 ti(, r. _�+ o�,� • c.�
.�34: FinalHeating&.AiiConditioning; � j �`g: � �:.. ��� �. , -.
(- C�A�QA ' [.�e..D,^;,' ,,':
35�iFinalGa`sPipe-Test � � _ , •`-�� 3�_�_q�-_(�o°onE�y�.t,E��-Cq,�_�p
36. HoodoiCanopy.., �,:- -� - 1 ;'.3��2-ai ��i2MlT'�i✓�1�0 �(✓%82T�8t
37-� Final Factory Fireplace: . ` ' �.' ' -
� " (� O,G. L� �, ,
` 38. Final Plumbing .� �; � - ' � � � . � ' -n
�
39. Water SBrvice-Final ' •- � ;'' -, � ,+�
�..40. Gas Service-Final ' , . ; '. ,,, ' ' - .� �;:•: .
� 41. Solar pomesticFinal ' - - �
i � c=• -
42r Backflow Prevente� ;� -� � � r , _ � , �
43. Backflow Irrigation r' '`" � ' `^ - _
.
44. Landscape Irripation System ; �- �, , - - _ +� �_ ; ,� �
45�.. Sound Attenuation ' � i� ' ' ' � ` ':
� '� - '. .
�_46.,_Handicap Regulations - �_ ' � � � �. :r 1 _ _
47..FINALSTRUCTURE&BUILDING � � -�' �' .' � �
s r �
48. FINAL PLANNING � � ' � . . " ��. �� � �.: r� .
49. Electric Release to Edison � � i� ` - � - ,
�. .
',�50..Gas Release to Sou'them Califomia Gas Cv , I � ' f , : - - � ` _ .
, 51. CERTIFICATE OP, OCCUPANCY � �_,-, �}; , � �� ,�
No Oate
�PHOJECTRO�flE55: Z1O E '��.iTH ST
OWNEN'S NFME: HNOCIiG � �iHRY �'i
noos¢ss: KNOCHE, HAREN A
2244 *ri COAST HWY #200
NEWPORT BEACFI,CA 92663
RNCM/EHGINEEB:
RODflE$S:
flEG.NO.:
uxrt:
UNR:
VEXMRTEE: BRIGGS DEVELQPMENT ( 7 i 4) 380-0686
aooxess: z3046 CARLOT�'A AV 315
LAGUNA HILLS CA 92653
LICENSEO CONTflACTOfl DECUMTION: 1 Aereby affirm ��at I am licenseE untler provi9on5 0� Chapter 9(tommenunp with Section
7IXq� ol �ivision 3 0l t�e Business anE Pmfessians COOE. anU my licenu is in lull iwca antl ellect.
CITY LIC.: STqTE LIC.: � CU1SS:
Oale: SiqnaWre?
WONNENS' COMPENSRTIOM OECUBRTION: I AereGy aflirm ihat I nave a ceniliwte af conunt Io sel4insute or a cenilicate ol workers'
Comcensation Insurance. or a ttniliea covY ��e�eo� (5ection 3800. LaU. C). ^
PoIICY NO.: E%P. O�TE:
comvnxr:
�] C¢niliM copy ¢ MreUy Iumis�e0. ❑ CeNIieO coOY �s IileO vnih t�e dry BWGinq Divisbn.
.nte: ApWiwni: "
E7fEMP110N FBOM WONI(Efl5' COMPENSITION UFCNMTION � Rhis secuon neeA naI be mmDletN il Ne permil is fa one hunOre7 (5100) or Iess�.
I ceNty t�al ln ihe petlormance o� t�e work lor wAic� tnis D��mii is i55ue0, I s�all no� emplay any person in any manner so as to become
suCle�� �0 ��e Workers' Compensalion Laws ai Calilomia.
Oam: Siqnature:
NOTICE: II, afrer makinp ��is Oeclaration, you shoul0 became subiect ta tAe Workers Compensation prwisions of tAe Labor
CoOe, you mu5i IarlMnl� compty vri�h suc� provisions or ihis permit s�all Ge GBlmEG rCvok¢G.
CONSTBUCTION tENDING �GENLY: I nereEy affirm inat t�ere is a canstmctbn lentlinq a0e�' �or the performanu o1 tne work tor
w�it� I�is Dermii is issueA (�tion 3097. Gv. CI.
lFNOEP:
aoosess:
OWNEN BUIIDEH OECWflATION: I h¢Rhy aflirm Illal I am eaem0� �rom IIiE COniratlars' SWte Licerrse Law lor tne iWbxinp reason
�Seciion 7071.5 Business an0 Pmlessional CoCe: 0.ny city af county whic� requirts a Dermit io mmiruct, atter, imD�we, OemalisA, or
reDair any stNcture. D��or toi45 iuuante. also reQuires Ihe aDDlicant for sucn permit to lile a sipne0 statement ttWt he/sne is litensetl
pursuant lo ihe provitians al Ihe Contractars' State License Law �Chapler 9 �wmmenGnp wilA StttiOn 7p10) ot Oivision 7 0l tne BusineSS
antl Pmlessions Cotle) or Ilut �PJ511e is exemD� �Aerefmm and the ba9s foi I�e allep¢O exemption. My doldtion of SeClion 7031.5 by
any apDliWn� lor a permit suDjEtis Ihe ap0���� �o a civil penalty al no� more thdn live �unOreA dallars (5500�.
I, as axner ot I�e pmpeny or my employees wiih waAes as t�eir sole compenution, will Oa Ihe wark, antl Ihe
❑ s�mcmre is not inten0e0 or olfer¢C for sale (SecUon 7044, Busineu arM Pmlessional COAe: T�e Coniractors' State License Law
aoes not apDN �o an ovmer of a o�ooerlY who builtls or improves inereon, anE who dces such work himseli/Aersell ar thmu0h
�is or her own emDbYeeS, prDviOetl I�al 5uth improv¢menls are n0i inlenEBG Or ofl¢r¢O for sale. II, howEv¢r Ih! Evildin0 or
imprwemenl is sde vnlhm one year ol compleiion, �he owner will hav0 t�2 OUNen ol provinq �e/s�e Gi0 not GuiIE Or imprOve
lor the Durpase al salel.
I, az awner 01 I�¢ pmpEny, am exthrsivery cont2ding vnih IicenseG conirattars to cdi5trun tApipmject (Settian 7044, Business
� and Professions CaAe: t�e Canlactors' State License Law Coes not aoPN Io an owner ol pro 6� wln emld onmproves thereon
anG wtw comroctsfor wcn Drqecis witA a comractoqs�license Ourswnl b t�e Canta r State ' e Law),I am aware
tlut proal ol t�eu Worker's ComDensation insurance shoulG Oe D«tletl Io
� I am exempt uMer Senion: B. d P. C. ��
for INs reazOn: � ,..� %f �� /// / ,
�aie: � - i.� ` L�/�
I Ao �ereUy cenify Ihai I am aware ol anE un0erstand ihe requiaments ai alilom
255Ja antl I�at I or any lulure buit0inp occuDant will/witl nal (circle one� nee0lo c
Oermil Ior con51mtli0n ar modilicaiion �mm �he`Air ualiry ManaAemen� Dislricl.
I�ese pmviAons.
Oate: Apvlicam: _
I tlertGy cenily rtial I luve rea0 �Ns ippli[d�ion antl sWte Ih
oitlinances antl state IawS �Nai'uq lo WdGirp CO�IfUC�qll d
proOMy lar inSD��� Dur �
(
Oate: � � — • Signaiu . _
Drive�'s License a Sadai Securiiy x:
I6a1-06 WM1ile-9uil0ing; G�ean—COtle Enlorcemen�:
IE Safery CotlE Setfions 25505, 25533, anA
Shcd SIdIC COOES d00 RIC fEQ01fCIpE015 10f d
canstmciion apDlicatians are eeem0� �mm
Pink—R¢vewe: GdEenroE—Assessor
CITY OF COSTA MESA — BUILDING FERMIT PERM NO: B 05723E
PERMIT NO: H 057236 PLAN CHECK 1�0: 01656-92 S GOVT: N SUPF: N
CONSTRUCTION TYPE: PERMIT TYPE: STR Pl3RPOSE: OTH
JOB DESCRIPTZON : 35LF-6FT HIGH CITY STANDARD BLOCR WALL SQ FT: 35
CI.AZM VALUE: 700.00 CALC—VALUE: 700.00 GROUP OCC: R-3 /
COMMENTS: CI7'Y STANDARD BLOCK WALL
iE iE 1F�1E iE )f iF 3E �X-if %��%� iE �N if iE jF if iF�lt if �f 3C iE it iFiF iE if 1F 7F iE if a(� iF k�1F ih �e if �1!� 36if iEiF iE �IE �7F �(•�k iR �lE �1f iF�lf �IE �1FiE iF�K�%-IFif iF �7E i( �Y.� 3f iE �� 9E 3F d6�E �)E �l� �IF 4F Y�
Z O N I N G R E Q U I R£ M E N T S
s e•r B a r. x s
----------- MA7N BUII,DING ---------- --------- ACCESSORY BUII.UING --------
FRNT: FT IN REAR: FT IN FRNT: 10 FT IN REAR; FT IN
LEF'T: FT IN RGAT: FT IN LEFT: FT TN RGHT: FT IN
PARKING RE • PROV; PARCEL: 42520119 7.NE; R2 REF NO:
PLANNING N'I'ES> 35 L,FT., 6' HLOCK WALL HUILT TO CITY STDS,
�
IE iF if )F IF �1F iE �FiElF iE �E 4 iF v if 3f iE iF iF if iF jE if * iE if iE # iE �E lE iE i! iE iE iF if if iF iF 3F �E if if IE k jE if i( iE iF iF 9f 3E-7f� aE iE �f if �F �E iF if If iE iR i(� if �(—IF'3E iF iE 1E if iF if iE
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N=,T S
'LQNING APPROVED BY �� DAiE; �G�L�'�
BUZLDING APPROVED BY ; DATE; .�
AAPLICATION ISSUED BY; S�� DATE; �����
�EiEiEK�3EihlEiEiEkikifk�ffEiEiEiFK�if1EiFR'iF'iFiFiFiFiFiFiFiFiF�iriF'iF%3F%'iF'iFTv3Fir 7FiFTfit{FiFYT7FTi�lt'aFiEfFifiFiflE�ElPif +c �)kiE
3t iE if iE iF if iF IE IE if iF iF iF if iF if 1t aE ie ie iE iE?E iF IE 1E if if if !f !t �F if �E iElt iE iE iE iF iP 3t iF ie if iE iE iE 1f if if tf !F 16 r. {f IF if i� 1F iE iF iE if 1F if iE!'r �f fE iE iF 3F M� #h if iE if *
LEGALIZATION;N F E E S U M M A R Y STRUCTJRAL SEGNENT:Y
BLDG PMT PLUM.BING ELECTRIC MECHANIC FIRE SMZP/RES GRADING
PERMIT 19.00 ,50
SMIP/NON—RES
PLAN 12.35 �
ISSUE FEE ''
BUILDING—DIV—> PERMIT ISSUE PL'AN—CHECK TOTAL PAID , DUE
TOTALS----> 19.50 0.00 �' 12,35 31,85 31.85 .00
REVENUE DIVISION TOTALS--> COLLECTED: 31,85 OVER/S:IORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIF/TOT GRADING PLAN—CHECK
19.00 .SO 12.35
,,
if 1F iF iF 3F jF iF iF IF ik iF iE iE �E IE iE IP �F If iF 3E �E if 3F k�lE �F k if ik ik # iE if iHE aF 3E iFif if iF iFlE IE iE # if iF 1E aE iF ie iE if iF �(• if If iF ii� fE 3F R�1F iE 3F if� ie �f )f iE i6 3F iF 3F ��1E #
Z N D I V I D U A L F E E H R E A R D O W N
TYPE QTY D E S C R I P T I O 2� iJNIT COST TOTAL COST
,
SFR 35 RES—CONCRETE BLOCK WALL / FT. 20,00 700.00
END OF FEES
n� n����, - .i -. _' _
i. �' J
��M' �. L . _ , � . _ . .
.;�TRUCTION AND PLANNING .
APPROVALS Permit #
1, Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utilitv-Undrgrnd.
�1. Electriwl Conduit-Undrqrnd.
b. Steel Reinforcement
t6. Electrical UFER Grnd.
7. Footings � S�y(!�L
8. Foundation
9. Water Pipe-Undrgrnd.
10. Structural Floor System
i t. Property Sewer Line & House Connection
12. Sewer Cap
13. floof Drains
14. Rough Piumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical�T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts,in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Tesc
24. Roof Framing
25. Roof Sheathing
26. T�Bar Ceiling (Structurall & Monocoat
27. Frame and Flashing �
28. Lathing & Siding
29. Insulation
30. Drywall Nailin9
31. Plaster Brown Coat
32. Electrical Power Meter�Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Finai Factory Firepiace
38. Final Plum6ing
39. Water Service�Final
40. Gas Service-Final
47. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Eiectric Release to Edison
50. Gas Release to Southern California Gas Q
Date
Date
POOL m sPA
Inspector AppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement ^ �
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test _�
57. APPftOVALTOCOVER�GUNITE'�,
OiQ� 58. Electrical Conduit-Undrqmd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & fleceptor•Final '� -�
63. Heater & Vent-Final i"�
64. Plumbing System � Finai ✓ �
65. Electrical�Final ' •
�'�,
.
66. Solar System•Finai � , �
67. Pencing & Access ApProval ��
68. APPROVED FOfi PLASTERI G
69. POOL/SPASYSTEMSFINAI
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
77. ProductPiping�Gas ❑Oil
72. Underground Flush
73. Undergrnd.StorageTank OGas OOiI
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. RE�UIREMENT
' � 79. F�NAL INSPECT�ON
80. FOOD CERTIFICATE ISSUED
' Notes: 4� _ /G . /).., _ . _ . ��
Date Inspector
• �.
' 1
i ;�
i
,.�
•' �
moness aF emim�o 210 16 TH P L
o�a+ru�EiFp+oxN: GEBHARDT, SHEILA
��+ SAME
�rv�. �w�aa �oo�sx
wcxrtecr ow �¢n:
MCIL OH FNQ'S �ODI�.A:
camucrarsru�:NOCK PLUMHING
CQLINICTORSY/i6➢l011612 KNOTT ST
ue xo:
urir: #A
uMr:
(714)895-1246
�ss GARDEN GROVE CA ucro_ 511971
92641 wn: 17
LJCENSED COMP�CfOR4 OECLAH�TION; I Mnby � uMs pruly d peQury tlW I em IkmuaE �vdr pwidau d CMqw B
(mrvnanuq wdA Saciion 1ao0) d Cimion � d Ns Biwinms rd Pmlwdms CoEe. uM mY lianw 6 in hA laa rtl �Ilad.
cm .no.:05 .38 ue.cuss:C-36 ue.wo.: 5 1971 EXP: 02/96
/ : � ��>: �1� PLum�3��
OWN BUILOEF OECLAP4TION: I MrW� tlfm� uMr prW y d parjry iM I am �umq Imn IM CaYMm Licw� lew In IM
1 ' mm� (Sadion 10]1.5 &anaa mM PNariam CoM: MV UY n odm�Y wlikA nV� e V�i ro ewswp. ela. �mM�.
md'e�, v repai eny ��tuc�ure, prior b ih ewu�oe, e6o npwu Ns appfimM In auc� qmN to fib e dpneE qetemsM Net M a�M
�, 4orwa www io ins a�� a N. caar.aas uoue. le.i jCn.q« c(camm«wrro Mvn s.ao, �aoo) a oiiebn a d iro
uwws md Prahvioro Code) a ihet M a de u ecwnW �Mehan uM tM bm h Yr NeYb azsmqbn. MY vbWbn d 9edian
�ait.s Ey eiry appfcani t« e permil wbjeq� ihe nppfra+to e mi psuAy W nd man iMnlw� hunN�E tloEr� �SSOOp.
� I. m owar d tM popeny ar my empb/w WA wapee u tlr W oompeme�bn, wOEo ih� wik, erM IM WucM�'s nal'udeMeE
a Mared N We ISoetim ]ou. B�nima mM FmtmsuuCaM: Tha Camsaae Uorw lardou nd �wNwm anw tl popaery
wln buide a inrcv.at Ihmean, eM Ma doaa tuM xak IinfeY Or henN a WwOh h's a Iw own rnObl�n. pwidsd Ihtl tuch
mmrauuaer..w n... ins d,reen a na+�u ns «.na m na aaa « unwa+�« w wwd• d wel.
❑ I. u o.�w a �M P�w«iY.•m utlui+W oav'seM wn YOYved convactm �o mmua iM n9b (Saaion lou. Bwiros. md
v.a«.on. coe.: n» wnreaa. ucen,. �er+ eo.. iw wMr m.� mme. a wwem .ro w'd. a.:�m.w. nwem .m .�w
canVacY b vA Pqana Mil� a mNrapMsl4amM Pu�wN Io iM Canlrtla� Licana leM'i.
� I em enemq wda Sectian: B.8 P C.. br Nu ramm:
Dets: �+
I do harsby erlJy N�t I em ewva d end iMr�wd tlro rpiiean�nb d Cellarm IMetlh aM 9tlMy CoM S�Gbm 25.505. SSS1l. enE
RSSN, ud Nm I a eny M14un bWld4q amryW rri4l wil nal (vcle ona) neaE lo oomDN M� riE eet� aoAu rd �Ir np�tlr�m�em b
Ume: Mq'urC
WOFlKEP'S CAYPENS�TON DEC WiATON: I lw�by tllum iatlr pwW y af prryry pr tl Ne kYow'vq dMueom:
❑ IMevdxilme'vYbiecaNl'cqsdmnmCtoWumuatrworkss'wmpx�otion,epwidadtabyS�mon3)OOWiMIeEar
//���/ cnd.. ror �n. o��^.Me d nn .wk �« r1iN mu o� e:�a.
1�1 hew aN N ms'vtleF wvM1en' mnD�mun've�vena. m m�m�d b/ Sadian J100 W ihs LeEa Cob. br iM D��� d Ih�
� qak la Mfiirh tlie G�u u iaueA. MY waken' mmpmuNbn inuvenvv wr4r W W�Y rumMr aa:
\ c�.,: EXPIRES
P��m� t���44�- 03/O1/96
mu sncn roM m M cmipWee r Ur v�l b kr ans had�a amva Rrool a 4uJ
❑ i anh u,r n me o«iamerca a ur .an ror .ne, w v«ma u w�re. i wu mi r�r w� „ar mu.�..o .. m
becanr wblb to Jhs workep• canDM�ian Mxs d CWanie.pQ'�rw ttut i�d EcmM nMb lo tM xalan'
om.: w� � i�Tn� �oo�.: L�����
w.�„+�ro: c.au� ro.sun ro�tr�' �omorWua� �w..�. �, w..'n�4 w M�� neN�r.n «roiow ro wnw a�tlu.ne
civc Nrs w ro aM �WrM tlwunL Jalbn (sf W PPOA a tlfltbn ro tM cwt ol mnpMwdon ���W n P+orMM ror In
Ssctlon J106 0l tla L�bor Code. INsrs�t +�+�my� Iw�.
CONSTflIICiION Lp1pN0 �GENLY: I hsaDy af/iem ivds paietly d perjay ihtl �Mn e a eaet'utlion kM q pscy b tlr
paArcm.�u a m. wnc ror .nkn ine v�+ u s.ued (s«aun sn. ci.. cl.
LENDEP'S NA4E:
lFNOER'S MOPESS:
I caWy tlw I hws iuE Nu appfcatan ud ueu ihel M�Ews'vdanwion e conW.l epae to mmpfy rritA e0 ery end cavey atlmancm
entl pan Irwi nle�Y m buitln0 eamuCbn ad Mreh' �Wlar'¢� �qw�etleG.a tl RS MY b wr w� IM �Ew��mwian�d Pwab
ta uapWion WD���
RON NOC
Pmp N
�� DW:_�=i ,�
sq� a 'm«
(5t5tes.WP) WINe-BN'k�qd5day:�reemFb:Cw�qppirsN:Pink-ReVwnie:OoHenmA-M�or
CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO; P 072764 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU
JOH DESCRIPTION : C/O DISHWASHER
PERM NO: P 072764
GOVT: N SUPP: N
SQ FT:
PURPOSE: OTH
CLAIM VALUE: CALC-VALUE; GROUP OCC; R-3 /
COMMENTS; NO OTHER WORK AUTHORIZED HY THIS PERMIT
**�r*��r�r*�rx��r�r�r��r�r�r**�r**x��rxx **���**+�x�x�*�****�r**x x�x�x�***x�***�r+��r�*+�******�+�*�*�r**+r*�r
Z O N I N G R E Q U T A E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT. IN REAR: FT IN
LEFT: FT IN RGHT: , FT IN LEFT: FT � IN RGHT: FT IN
PARKING REQ• PROV: PARCEL: 93673016 ZNE: REF NO:
PLANNING NCS'I'ES>
i
1E iE if ik iF if if 1E if if if iE 1f if' if 1! ik M iE M if If iE if 1E 1f if iF iF if iE� iF iE if 1f 1F iF 1E 1E if 1E IE 1f iE iE it IF 1f iE IF if iE 1E iE 1EM iE iE if iE iE 1E iE 1I' 1E if if iE iF iF iF if 1E IE If if 1f IE iE
D E V E L O P M E N T S E R V I C E S, R E Q U I R E M E N T S
ZONING APPROVED BY .
DATE:
BUILDING APPROVED BY : � . DATE: /
APPLICATION ISSUED BY: :-� DATE: C� �
1FiFMIkiF1FlFiflfiElEifltif1E1E1f1E1E1E1E1k 1f1E1E1FMiE1E1FiE1E 1iii�
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL GM T:N
BLDG PMT PLUMBING ELECTR�IC MECHANIC FIRE SMIP/RES GRADING
PERMIT 7.00
25Y
PLAN
ISSUE FEE 20.00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK
TOTALS----> 7.00 20,00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
HLDG PMT PLUMBING ELECTRIC MECHANIC
27.00
SMIP/NON-RES
TOTAL PAID DUE
27,00 27.00 .00
27.00 OVER/SHORT: 00
FIRE SMIP/TOT GRADING PLAN-CHECK
kltililkkilltlllFlFMlEikik1E1E1l1Ekkk1F1kk1E1l1Fk1Fiklf ikiklEll1E1k1k1EiE1l1l1k1t1kM1k1fM1liE1ElEfFif 1E1F1E1F1i1k1tiEifll1E1E1E1fifiFiFitiklFlEiF1k
I N D I V I D U A L' 'F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N�, UNIT COST TOTAL COST
PLU 1 DISHWASHER � 7,00 7,00
END OF FEES
Ot D013a'73-0�133E7s T 4 Y 27,00 �
CnIE: O6.'Gi/a5 TII"�: !`4:/i;
CONSTRUC710N AND PLANNING POOL ?A
APPROVALS Permit # Date Inspector p�ppROVALS � Permit # Date Inspector
t. Temporary E�ectrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement
^ 31� Electrical Conduit'UtQity�Undrgmd. 54. Forms �
� _,. .
' 4. Elecirical Conduit;Undr9rnd. � 55. Electrical Bonding - �
�5. Steel ReinforcemerR� 56. Rough Plumbing & Pressure Test
6. Eleccricat UFE(iGrnd. 57. APPROVAL TO CQVER�GUNITE i
7. Footings .' � 58. Electrical Cond'uit-Undrgrnd. �
' 8. Foundation �� ' S9. Gas Pipe, � Undigrnd., Test �
� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, O ll�drgrnd.
10. Structural Floor Svstem � 61. APPROVAL TO j3ECK`.
it. Property Sewer Line & Ho�se-Connection 62. Backwash & Receptor-Final
72. Sewer Cap � • 63. Heater & Vent-Final
73. floof Drains 64. Plumbing System - Final
14. Rough Plumbing .� 65. Electrica�-Final
, 75. Rough Elecirical•Conduit - 66. Solar SYstem-Finai
16. Rough Electric Wiririg- . -� 67. Fencing & Access-Approval '
77. Rough Wiri�g Sign - ' 66. APPROVED PO�i PLASTERING �
78. Rough Electrica+-T Bar Ceiling 69. POOL/SPA SYSTEMS F�NAL
19. Rough Heating & Air Conditioning FI.RE,IIEPT. REQUIFjEMENT
- a: • • '
20. �Rough FactorY FireRlace _ _� ' S _� ,. � - qPPROVALS':2' Permit # ' ,
21. Dutts, in $tnictume_' � •• • � 70. Underground F�ydro '
22. Ducis, Veptilating;; - i r .,�, 77, produc{Pipinq�O�Gas �Oil �
23. Gas PiprRough & Test -- � ' � � � - � 7p, Underc�round F�c+sh ' ;
24. Roof� Frafnirtg'. ' ' _ ..= t •. _ _�
� � � 73: Undergmd. Storage Tank� � Gas ❑ Oil
25. Roof Sheathing � � , - _ 74; Overhead Hydro •
26. T•Bar Ceiling (StrucEural) & Monacoat ' :; �. 75: Dry Chemical _-- � ,.
27. �Frame and Fiashing, . +-� .�* 76. Dry Staridpipe`-'% '
�, 28. Lathing & Siding �j� �-- '="' =_ . „ �- " ' i 7j, FIXED;SYSTENI�INAL _ '
i. ' .
29. Insulation �. r _ •� � �� 7$, FIRE-PREV. FINAL �' - '
� 30. Drywall:Nailing :- ` F �'� y�. _' ' HEALTH DEPT. REQUIREMENT
37. Plaster Br`own'Coai:+ <: _ � 4; 79. FINAL INSPECTION r
32.'-Electricai Power Mgter-Fjnal + � . ,� 807 FOOD CERTIPIEATE ISSUED � '
, 33.'Final�Electric � s �� � Notes: -27 � "N � L
�
34.•Final:Heating & Air�Conditi0ning • ` �
�. , � �7�'s-''-cS- `•-� ���
35.'Final�Gas Pipe:Test_'� � ' :. . . � - ` - .
; 36. Hood or Canopy - ' - " ' ,,, ; ' `-
r, r
,' 37. Final'.Factory Fireplace-_ • r._I _ • �- •
38. Final Plumbing �;' "� • � � '_^ " � � .
� �S_
39. Water Service�Final '. . ,. � .
� 40. GasService-Final . - - r. �--� - ' _
� � 41 . Solar pomesticFinal � _ " : ' ; , . �; _ . _
� 42. Backflow Preventer. . � r ��' r
-n r +
43. Backflow Irrigation' • ; : � �, , -,
=44. Landscape Irripation System^-� ~. ' �� " ' � ' � �'� - .
Y -
�45.'Sound A[tenuation " : � * '_ � : _.- i _; , ;� Y _ :
« n
�46. Nandicap.Regulatioris ' • -� - � '
, : �,
47. FINAL STRUCTURE & BUILDING � � � ' � � . ,
+ i.
48. �FINAL PLANNING - � •� '°
. �
49. Eledt�ic Release to Edison �, � ;t ' -
50. Gas Release to Southem California Gas Co + � � � �� -
_ .�
-51. CERTIFICATE OF OCCUPANCY � - • - � • �
No Date
, I
7NPIECT ROONESS: z 1 O 1 6 TH PL
OWNEfl'SNFME: SHELIA GERHART
aooness: ,�,10 16TH PL (INIT A
COSTA MESA
CA 92627
♦ 714 631-6268
pXCM1IENGINEEP:
ADOBESS:
xec.No.:
UNIT; A
uxir:
� PEflMITTEE: GEORGE BRA'LIL ( 714 ) 535-7905
AODXESS: jOZZ N, HESPERIAN WY 101
SANTA ANA CA 92706
LICpNSED CONTRACTOfl OECIAPATION: I hereEy alfirm tlu� I am IicenSeA under prOvisions o� C�aO�er 9 ommencing wiN Section
��D� ol Division 9 0l Ihe Business and Pmfession o0e my li� e is in IWI force an0 flect.
c�,vuc.:02991 STRTELIC.: 3Q�4�(� �uss: -3� /
Dai@: � � SignaWr�>��l_�[� �f �
WOqNENS' CO PENSATION OECIANATION: I �ereGy allirm ttwt I �ave a cenificate ol cansent �o sel4insure or a cenificate oi Worker5
Compensa�ionTI� raAc�ry c npI'Ie coDY ��e�eol �Sec�ion 3800. LaO. 1.
POIILVNO.:^�V`���1� E%P.URTE: SIOS�J2
cornvnxr: UNITED PACIFIC
❑ CeNlietl ro0Y is hereDy, furnisMO. � Ce+ll�le0 co u fil C wi�� iM ny �BOinB Divivon. /� /
Oa�O: i . ..r � � / pOVlicanL � %L- � li/ �i e ��' /`/O �' i . _
E%EMPTION FHOM VlOflIIE S' COMPENSRTION OEQAflNT10N: �This sectqn neeU mi be amplete0 i� Ne permi 5 fa mre hunOreG (5100) or less�.
I Ce�ify Iha� in ��e pedOrmant¢ oi I�e work lor wAkh �iti5 permil i5 hsued. I5ha0 noi employ afry persOn in a�ry manner 5p as to OeCome
waec� to ine WwNers Compensauon lam ol Gtifwnia.
Date: SignaWre: -
NOTICE: II, al�er making I�is declaraiion, you shoul� Uecome suhle�� �o IAe Worker5' Compensaiion D�%'isions of �he Lahor
Caae. you mu9 tonnvnln tamplY wiin sucn prWision5 w iks permit shall �e aeeme0 Bvokea.
CONSTflUC710N LENUING PGENCY: I �ert�y allirm I�at there K a Wnstructi0n IeMinp a0ene/ for t�e petlormance oi l�e work lor
wMt� rtris Perrtnt is inuel(Section 3097. Civ. CI.
LENOEq:
ADONESS:
OWNEP BWLOEfl OECIAMTION: 1 �eRUy allirm Itut I am exempl irom t�e CAnlractar5' State License Law for t�e followinp reason
(Spaion 703t.5 9usiness antl Prolessional CoGe: Any ciry af county w�ic� redares a permit to comimc6 atler, imprave. Eemolish, or
iepair any slmcture, prior to iis issuance. alsU repuires Ihe applicanl lor sucA pErrtn� tolile a sipneC statemeni Ihat he/she is licensetl
pursuani �o tAe Omvisions ai t�e Coniranors' State Li�ense Law (Chapter 9(cammenung wilh Stttion 7000) ol Division 3 of tne Business
antl ProlesSions COUe� or ��a� he/she is exemD� ��erelmm anC ihe havs lot tlle alleAeO exemption. qny vlolalion ol Section 7031.5 by
any aD�liCani far a pBrmi� Subletl5 i�¢ applicant IO a citil penally o� nol mOrt tlun Iiv211unOreO Ooilars (5500�.
q I, as owner ol ine o�ooeny or my employees witn wapes as tneir sole compensation, vnn oo �he work, ane the
suuclure is not intenae0 ar offereG lar sale (Section 70<4, 9usiness and Pmtessimal COAe: T�e Contractors' S�ate Lironse Law
eoes nol apoly lo an owner ol a property wlp builas or imprOveS thueon, an0 who Eoes such work tlimselllA¢rself or ihmuqh
his or her own em0loyees. D�oviOetl ihat suc� impmvemenis are not mten0etl or olfereJ lor sale. Ii, however t�e builUing or
imDrove��en� is SOIG withm one year 01 tampl¢li0n. Ih¢ own¢r vrill have ��e OurOen o� pmvinp �e/50e tlitl noi GuilA or impmu9
lar ihe Ourpose ol sale�.
I, az awner ol lne proDeny. am e�du5ivery COniracting witll li[¢nsetl COntractors to fAnstruct tha O�oject (S¢ction 7004. Bu5ine55
� an0 Pmfessions CoOe: il�e Contractors' Stale Liceme Law Uo¢s no� appry �o an owner ol properry vAro bml0s or imD�m'es I�erean
anG w�o comracts lor sucA prole��s vnt� a conUactoqs�lic¢nse Dursuam ta t�e Comractors' Siate License Law�.l am aware
Iha� prool ol Iheir WOB¢r'S Camp¢nsation ipsmanCe stwultl be pmvMetl Io me.
(a I am exemD� un0er Section: B. d P. C.
bt tnis reason:
Date�, Owner.
I clo Oere�y cenily i�at I am aware ol ana understantl �ne reQuiremen�s oi Caiilomia Heall� antl Sateiy Code Sections 25505, 25533, antl
15594 antlihal lor anyluWre Uuilaing occupanlvnlVwiilnol(circle one� nee0to campry vAtll saitl state coAes antl lhe requiremenisfor a
0@rmi� lor consimc�ion ar mo4i0aiion fmm I�e Air uahry ManaAement Oistrke Hesrtentlal canstruction applicatiom are e.empt Iram
��ese pmdsions.
Ddle: ppp ni:
� here�y cenity thai I nave reatl ihis aoolica�io n0 sta�e I�a e a ve informat' is wrrect. I agree to compl with ' and counry
MOmance5 anOstatelaw5relatirqtoGuitdirq nsbut(iona /eby at7br¢er re52ntilive5 o�tttisdrytoente poni , o�e-meniioned
O�oDeny �orinspeClmn putpases.
Oate�t S9naWre. O /
�river's �icense or Socia� Security x: %
t69Fa6 Wbite—B�ilOng: Grean—COEe Enbecement: Canary—AppliwnC Pink—Revenue: obenroE—Assessor
CITY OF COS'PA MESA - BUILDING PERMIT PERM NO: P 05204
PERMIT Nd; P 052048 PLAN CHECK NO; N GOVT: N SUPP; N
CONSTRUCTION TYPE: V-N � PERMIT TYPE; PLU PURPOSE: OTH
JOH DESCRIPTZON ; CHANGE OUT 40 GAL WATER HEATER GAS SQ FT:
CLAIM VALUE: CALC-VALUE; GROUP OCC: R-3 /
COMMENTS; REINSTATE EXPIRED PEAMIT #P49926
**�*****�t�r*�r�t�*��x********x*******�r�*�**���***�*�***�***x***x�*�*�r�r�r*�tx�**�r*�t�t+�+�*
Z O N Z N G R E Q U I R E M E N'f S
i S E T H A C K S
------------ MAZN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REp• PROV: PARCEL; O�Q000000 ZNE; REF NO:
PLANNING Nt�TES>
� �._�
**+r*+t�*x�r*�***+r*********x�**�r*****�r***x**�*****�r*+�*�**�r*x���+r**u�***+r�rx�*�***�****
D E V E L O P M E N T S E R V I C E S� R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY: DATE• J ��
iEiEiEiEM�Eif�EiElE�FifififiF##ifiElfifiF fflfiE#iEiflEifif# 1E�E
if iE iF if iE aF i! iE iF iE if ik * iF if iF iE iE iF IF iE jE iF if if 1f �f iE ik if if iF �E iE if ±E IF iE if iE 1f iF itlf IF �E if iE 7f iE af if 3F if if IE if ik ik If iE 1E if iE IF iE iE iF IF 1E 3f 1E if iE iF if if 1E if
LEGALI2ATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
PERMIT BLDG PMT PLUM�IN�G� ,ELECTRIC^ MECHANIC FZRE SMIP/RES GRADING
'153 ' SMZP/NON-RES
PLAN - " � .
ISSUE FEE 3.00 ' - •
BUILDING-DIV-> PERMZT ISSUE PLAN-CHECR TOTAL PAID DUE
TOTALS----> 2.00 3.00 • 0,00 5.00 5.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED:' S,00 OVER/SHORT: 00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
5.0a .
iF iE 1f 3f iE iP iE * if iF iF M iF iF IF aF if iE �F if iE iE iF iE 7F iE if iP if iF if iE if iE iE �f Ifr If iE iE iE 1F �E iF if IElf if 1E if 3F IE i4 if iE 1t k 1f� if iF if iEiP IF iF iF iF af� if �E �lE iF iF IF IE aF iE �f iF
I N D I V I D U A L F E•.'E H R E A K D O W N
TYPE QTY D E S C R I P T I O N . UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 2,00 2,00
END OF FEE5
�
Q� Q��.�..1�._!i .l. ' , .
Jl�. 2i: _.li��, T�1!. _. ._
_�
�
CONSTRUCTION AND PLANNING POOL & SPA
� Date Inspector Date Inspector
APPROt'H' LS • Permit # APPROVAIS Permit # .
1. Temporary Electrical Service or Pote, 52. Poo� & Equipment Location
2. Soil Pipe-Undrgrnd. ' � 53. Steel Reinfo�cement
3.,Electrical Conduit-UtilityUndrgrnd, ' 54. Forms
� 4. flectrical Conduit-Undrgrnd. ' - . � 55. Electrical Bonding
, 5. Steel Reinforcement' 56. Rough Plumbing & Pressure Test
r 6.. Electrical UFER Gmd. - • 57. APPROVAL TO COVER�GUNITE
�7. Footings . 58. Electrica� Conduit-Undrgmd. -
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection • 62. Backwash & Receptor�Final
72. Sewer Cap . 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System • Final .
14. Rough Plumbing �� 65. Electrical�Final
15. Rough Electrical-Conduit � 66. Sofar SYstem�Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign, 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Condi[ioning FIRE DEPT. REQUIREMENT �
20. �Rough Factory Fiieplace � � : • APPROVAL& ��Permit #
�
21'Ducts, in•Structure� ... '� .� � � -�� .70. Underground Hydro
22. Ducts, Ventilating �_ '_ r , ���71. ProducYPiping O�Gas O�OiI
u
23:;Gaf Pipe=iiough Bi�Test , - -. � 72, Undergroynd Flush ,
2R.'Roof Framing �• � � " _ - �73. Undergrnd: Storege Tank O Gas O Oil
25. Roof Sheathing � . ` ' � . � �7q,',Overhead Hydro- � .
26. T-Bar Ceiling (Structural) & Monocoat • � 75.• Dry Chemical - '
y
27.-Frameand Flashing 1 - y, �; 76'Dry Standpipe '� • .
28.'Lathing & Siding: . L�; r �� • ��• 77, FIXED SYSTEM,FINAL"
�29. Insulation � � � .' � I � � � 78• FIRE PREV. FINAL .
�30. Drywall Nailing � I i f. . .� �HEALTH�DEPT- REQUIREMENT
.
.31. Plaster Brown Coat, t ; r. � I � f, :; ,79.'FINAL INSPECTION � '
32. Electrical�Power Metec:Final� ' � �. �.BO.�FOOD CERTIFICATE ISSUED '
33 ;Final Electric . . � � ' Nofes:6/4
� � �• ' 9! �`{ood�lENom� -G�F7"CJa24.[!tv
34. Final Heating'& Air4Conditioning•, , � j � i' ' S2?'�Q/ lYoonQ f�acn�-C_F�.�r - G�Eo
35. FinalGasPipe-Test _ � 1 /0-2-�1�,,,?�n'Y��RP1fLE� �S cP�-
36. Hoodor;CanoPY � y . • -. � . I� � �p,3 ...�:l.�.G. G.aFiO
.�
37.-Final.Factory Fireplace,� � �' � � � . ' '
38. Fi�al Plumhiog � • - � � ' � . �;
39. Water Service-Final- -- � • ' -
i
40. Gas Service-Final � . , , � `. �
41. SolarpomesticFinal � • • • I F' ��
I .o
42.�Backflow Preventer• � ' � " � � �� ' '
� f• � .
43. Backflow Irrigation' � � � . .
,.44. Landscape trrigacion System.� . i � � � . - .
-45.�Sound Attenuatiom '" � • - �• � -
� .
46. ,Handicap Reguiations ' '� � � � � �,, � _ ; �
47. FINAL STRUCTUfiE & BUILDING � �• � �
i
4B. FINAL PLANNING, I i• i. ' '
49. Electric Release to Edison • � i ' �. -
-.50�.Gas Release ro Southem California Gas Co , � � ' . ''�� � .
i i � -
51. CER7IFICATE OF OCCUPANCY � ; i_- , `,�. ,, ,
No. Date
^I
1
Applieant to fill in all ipaces �•It�in heavy
GTYAF �OSTA MESA PERMIT�v �
� CQiVSTRUCTION PERMIT C. -�S
Aildrea ,�L�a �'ir�f) ^/s�i?6fiT �`i,
ArchlEng. License No.
Address
Contractor �r �icGl:aAi.✓ Phor
nuwess ' > � /. ' MN. �'i. � fY/ .
LICENSED CONTRACTOR �ECLARATION ~�
I hereDy affirm thal I am Ilcansetl untler provislons of Charter 9(com-
manUng wlth sectlon 7000) ot Division 3 of'-tbe Business and
Pro1e55ions CotlB, dntl Ty IICenSa is'In full iorce antl effeet.
ucen C sz �- � G ense �? 3/ G,�'
Dat fK �`� 15i9nature • � �. f �
WORKERS'COMVENSATION DECLARATION ' ' "'
I hereby a/firm that I have a certlflcate o� tonsent to self-insure or a
certi/lcate of Workers' Compensation InSurance, or a certlfieA copy
thareoT (Settlon 3800, Lab. C.�. _
Policy No. Company
❑ Certlfietl copy I5 nereby furnishetl: "
❑ CertitleC copy is tilatl.wit� the Uty Bulltling Dlvision.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This se<tion neatl not ba tompletotl�if the� permit is for one hunCroA
(E300) or less). -
1 certlfy that In the performance of the�work for whiGh this perTlt is
IssuBG, I Shdll nOt <mPlOy any p¢riOn in dfly rtldnnel So as to become
sub�ect to the Workers Compensatlon Laws ot Calitornia. �
Data Si9nature �
NOTICE: It afle� making tnis tlecla�ation, yoU shOultl D¢COmO sUDjlCt
to the Workers' Compen5ation provisions of the LaEor Cotle, you must
torthwith COmply with sUGh prOvisiOns or this p¢rmit Shall be tl¢¢m!tl
revoketl: ' - -
CONSTRUCTION LENDING AGENCV
I hereby affirm that there is a ConstrutUon lentling a9ency tor Ihe per-
formance of [he work for w�ich tnis permit is issuetl (Section 3097
Civ. CJ.
Lentler's Name
Lentler'S Atltlress
OWNER BUILDER DECLARATION
I hereby affirm tha[ I am exempt from.the Contractor's License Law for
t�a following r¢aSon (SectiOn 7031.5 Business dntl Pro(e55iOn5 Cotlo:
Any ciry or county wnich requfres a permit to, construct, alter,
irtip�ove, tlemollsM1 o� iepdir any struttu/E, prior t0 it5 is5uance, also re-
quires the appliwnt tor such permit to.file a signetl statement that he
is Ilcensetl pursuant [o the provisions of the Contractor'S License Law
(Chapter 9(commencing with Sectlon ]000) ot Division 3 of the
Buslness antl Professions Cotle) or that he is ezempt tneretrom antl the
basis for the alle9etl ezemp[lon. Any violatlon of Settion �031.5 by
any appllcant_for a permit subjecls Ihe applican[ to a civll penalty
f no[ more than five huntlretl tlollars (E500).
� 1, as owner of the proper[y, or my employee5 with wage5 a5 their
Sole CompensatlOn, wlll tlo tn¢ wOrk, antl th¢ sVUCtur! is not intentletl
or afferetl for sale. �Section 7044, Business antl Rofessions Cotle: The
COntrdGtOr's Llcense Law tloes not ap01y to an owner of a property
wM10 builtls or Improves Ihereon, antl who tloes zuch work himselt or
Nrougn hiz own emplOyG¢5, provitl¢tl thdt such improv¢ments are not
intentletl or o(feretl tor sale. If, however, the builtlinq or imOrovemen[
is soitl'wlthin one year of compleHon, tne owne. will nave the buraen
of proving he tlitl not builtl or improve for the purpose of sale).
❑ I, as Owne� ot the prope�ty, am exclusively contracting wilh
li[tllSltl cOntfdtto6 to con5truct lhe proj¢ct (5¢ction ]044, Business
anG Professions Cotle: The Con[ractor's Llcense Law tloes not apply to
an.owner of property who builtls or improves thereon, anC who con-
t�act5 t�oT such p�o�Ccts with a COn[�acto�(5) licesnetl pu�suant l0
the Contra<tor's Licensa Law).
❑ I am exempt unCer Settlon B. & P. Q(or [nis
reason �
Date � Owner
I hereby certi(y lhat I hdve reaC this applita[iomantl Stat! that th¢ abov¢
informalion is corre<l. 1 agree to comply with all city anU county
ortlinances antl state laws relaling to construction, antl hereby authorize
reprezen[atives of I5 ci to ente upon the above mentio etl
property for ip� e ion L Pases. / A
Si9natur¢ 7- �/,7T ,if�i'Sl Dat¢�(�i/'2'O ��
Drivers' License or 55 � .� � '� ��� �_
Ilnes anE sign all dppropriata tleclaration
�T NO. LOT NO. • BLOG, NO.
TVPE OF CONSTRUCTION
�NEW ❑ AOD ❑ ALTERATION
' O REPAIR ❑ CONVERSIOIV ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT
❑ GRADING • ❑ FOVNDATION ❑ STRUCTURAL
❑ TENANT�ELECTRICAL OPLUINBING ❑MECHAN
❑ OTHER �
PROJECT DESCRIPTION - ' �� �
Sq. FT. ' -
OCCVPANCV_CONSTRUCTION TVPE
VALUATION ZONE
GRADING CU. VOS. �' ACRES
REMARKS:
PLUMBING' � PLAN CHECK
BATHTVBS SHOWERS
TOILETS URINAlS
LAVATORIES DOl1BLE LAVS
KIT.SINKS DISHWHSHERS
SERVICE SINKS ' - � ' SUMPS �
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTftAP
WATER SERVICE AI.TERATION
GASSERVICE OU'fl.ETS "
WATER HEATERS BTU OUTPUT
SEWERCONNECTIONS �
SOLAR TANK COCLECTORS
SOLAR PIPING SYS. '
ISSUE FEE
MECHANICAL a�arv CHECK
HEATING SVSTEM 0-300,000 BTU_
AND DUCTING 300,000 + BTU _
REFRIGERATION 0-SOO,OOO BTU_
SVSTEM 100,000 t BTU_
BOILERS BTU
SVSTEM REPAIR,ALTERATION .
EXHAUSTSVSTEM MULTIP.LE
ISSUE FEE
CMF 0865�46 Whlte-Builtling; Unary-Appliwnt; Pink-AccoUnting; GOltlenrotl-A55tssor
0
i
\ � ZONE
• -- -� 7566 i.oiaeiei � ao�i6 r�
ZONING REGULATIONS
�
PLNG. REF. � � ,
REAR VARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
ZONING APPROVED B1
SPEGIAL CONOITIONS:
ELECTRICAL
PROVIDED
PARK FEE 5
DATE
PI.AN CHECK
GENERATOR 0-1 KW_ I-30 KW _
TRANSFORMER
APPLIHNCE 10-50KW_50+KW_
MOTORS - 0-1 HP_1-30 HP _
pNC.50LAR) 70-SO�HP 50 � HP _
FIXTURES OVTLETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
PANELS MAIN j ,SUB
SERVICE .o � (J Q AMP
APpLICATION AVPROVED BV
f;
DATE
� _ . SUMMARV OF FEES �
BUILDING �
PERMIT�i . . g . � SMIP ' g '
PLAN CHECK S PERM�T
PLUMBIjVG § ISSUANCE §
PLANCHECK �E GRADING' E
ELECTRICAL $� E -
� - � MICROFILM §
P�AN CHECK $
� - TOTAL FEE $ -
MECHAl11CAL' $ -
� � � LE55 AD-
PLAN CHECK E VANCE PC E
FINAL FEE §
CONSTRUCTION AND PLqNNING POOC'&�SPA � . '. ""_
�AP.PROVALS �� ��•- Permit# -� 1.5I� Date Inspector pppROVALS � Permit#• Date lospector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
Soil ipe-Undrgm - � 44. Steel Reinforcement '
3. Electrical Conduit Utility-Un rgrn -- - 45. Forms
4. Electrical Conduit-Undrgrn s. 46. Electrical Bondin
. tee ein orce 47. Rough Plumbin & Piessure Test
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNIT�E
7. ootings � ' ' 49. Elec4rical Conduit-Undr rn "
6. Foundation � � � ' - 50.' Gas Pipe, ❑ Undr m, Test ' - � �
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra '❑ ndr rn
10. Structural Floor System 52.' APPROVAL TO DECK
it. Property Sewer Line & House Connection '- � 53. Beckwash & Rece tor-Final -�� � ' �' � �
12. Street Sewer Connection �� 54. Heater & Vent-Final �
13. Rough Plumbing � . _ . - . - _ �
14. Rough ElectricConduit - - � �56. Electrical-Final �
15. Rough Elearic-Wiring - - � - - _ �_ • Z 57. . Solar System-Final . . � � - . .-
16. Rough Heating & Air Conditi0ning • encing & Access Approval - �
17'. Ducts in Structure • � � • � ' APPROVED FOR PLASTERING - � - � • �
�16. Ductf, Ventilating - ,
19. Gas Pipe-Rough &Test . 60. POOL/SPASYSTEMS FINAL � , -
20. � Roof Framing ' - � � '
21. Roof Sheathin � - ,i,-
22. Frame and Flashin � ' � NOTES:
23. Insulation � '
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final ' -
26. Final Electric � _ Z C C.- � � '
29. Final Heating & Air Conditioning ' �
30. Final Gas Pipe-Test � � •
31. Final Plumbing -
. 32-. Water Service-Final - � -
33. Gas Service-Final ' � ��
34. Solar pomestic-Final �
35. Landsca e S rinklin S stem � � � � �
36. Sound Attenuation �
37. Handicap Regulations { �
' 38. FINALSTRUCTURE&BUILDING �
39. Special Requirements Completed ! � ' '
40. Electric Release to Edison � � - -
41. Gas Release to Southern California Gas Co. ' � "'
42. CERTIFICATE OF OCCUPANCY '
� No Date �' - - .
Applicant to Till in all spaces withlR �eavv GorEer lines anG sign all apv�oo��ate tleclarations.
CITY'OF COSTA�MESA PERNIIT NO. TRACT NO: LOT NO. BLDG. O:
� CONSTRUCTION PERMIT /�/J o�3/02 � r
Proiect Address .�in _ /_ TVPE OF CONSTRUCTION
Address
Address
Contractor
Phone (a'3�� ❑ NEW O ADD ❑ ALTERATION C'...
❑� REPAIR ❑ CONVERSION ❑�DEMOLISH -� ��
LiCense No. ❑ OTHER
DESCRIPTION OF WORK
- Phone .- ' TVPE OF-PERMIT � �
AddfC55 �- � " �GRADING-,.O'FOUNDATION ❑STRUCTURAL
LICENSED CONTRACTOR DECLARATION O TENANT� � ELECTRICAL OPLUMBING -�YIECHAI
I hereby affirm [hat I am Ilcansetl untler provisions of Charter 9(com- , _
man<Ing wifh zattion ]000) -ot DlWsion 3� of the Buslness antl � OTHGR
Professlons Cotle antl my Iltense Is In fu❑ torte a ffe t. �pROJECT'DESCRIPTION-
Llcenso Class � - � ��a No. - . , �;
Date„�i���u��ati�.e'- S�.FT. . ___ _ '
WORKERS'COMPENSATION DEC R ION � �"' 'OCCUPANCV_CONSTRUCTION TVGE
I hereby affirm chal I have a<ertiA ate of consent to selhinsure or.a VALUATION ZONE
<¢rtlfiwte o! WorkGn' COTpenSaHOn InsurancG, or d Ce/Hfietl copy - �- � . -
Ihereof (Section 3800, Lab. C.). . GRADING CU. VDS. ACRES
Policy No. �� � Company � - - ' " '
❑ Certi(letl copy is hereby fumishetl. � - REMARKS: ' ! �. . .
❑ Ce�tlfletl cOpy IS (Iletl with th¢ ci[y Builtlin9 �ivlsiOn.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -' �'
(This.snctlon neetl nat be complatetl if tha permit is.for.one huntlretl
(§1001 or less). � • � '
I CerUry that in [he performance of the work for which this permit is
Issuetl, I shall not employ any parson in any manner so,as to bemme .PWM8ING� �
subje t to-tnG Wppp((( rs' Compensati 5 ot ifornia. ' "
Dale�5lgndturG� �_ BATHTUBS
NOTICE: If afler making this tlecla a o ou oultl become suDjett TOILETS
t0 the WOrkGrS' Compinsation prov ns of the bor Cotle, you must
forthwith comply with Such proviiion5 or this permit Shall be tleemetl LAVATORIES
rovOketl.. � - _ _. _ .__ _ ._
CONSTRUCTION LENDING AGENCV � KIT.SINKS —
I hereby a(tirm that there Is a constructlon lentling agency for the per- SERV ICE SINKS _, �: �
forman<e ot the work lor which this permit Is issuee (Sectlon 3097
CIv:C.I. ' . .. " ' - '-- -- " - "-" FLOORSINKS-�"'
�entle�'S Name
Lentler'S Atltlr¢55 DRINKING FOUNTAI
OWNER BUILDER DECLARATION �- INTERCEPTORS
I neroby affirm that I am ezempt from the Coniractor's License Law for
t�e (ollowing rea5on (SeCtion ]031.5 Bu5ine55 antl' ProfeS510n5 COtle:-' SWIMMING POOL
Any cily or county whiGh rGqui�¢5 a p¢rmit to COnst�uct, alteq
improve, tlemolish or repair any ilructure, prior to i15155uan<e, also re- yyqTER SERV ICE
qulre5lh¢ ap4�iCan[ for suth p¢rmit to file a SignEtl 5[attment Inat he
is Iicensetl pursuant to the provisions of the Contractor'S License•Law -GAS SERV ICE
(Chapter 9(commencing with SecOon 7000) of Division 3 ot the
B
���
URINAl.S - �
DOUBLE LAVS �
DISHWASHERS
IV$ .� . . . .
CLARIFIERS
P'TRAP '
uSine55 antl Prolessions Cotle) or that he is exempt therefrom antl the yyqTER HEATERS BTU OUTPUT -�
basis for tne allegeC exemptlon. Any vlola[ion of Sectlon 7W3.5 by
any appliwnt tor a permit' sublec(s the applicant to a tivll'penalty- SEWER CONNECTIONS � -�� �
of not more than five M1untlretl tlollars ($500).
❑ I, as owner of [he properfy, or my emplbyees with wages as thelr SOLAR TANK. -��' COLLECTORS"'�
sole.compenwtion, will tlo.the work,.antl Ihe stru<ture is.not Intentletl _ _ _
or ofteretl for sale. (Settion -7044, Business antl Professions Cotle: The SOLAR PIPING SVS. '
Contractor'z. License Law tloes not apply to an owner oi a property _. . _ .
who builtls or Impraves tnereon, antl who does suth work himself or ISSVE FEE
dhrougb-hls own.employee5, provitl¢tl that SUCh iTp�Ov¢menls are not
intentled or oHer¢tl br sale. Ii,.noweveq tne builtling or improv¢menf MECHANICAL PLAN CHECK
Is SOIC within one year of completlon, the owner will have the burtlen .
ot proving ne tlia not bulitl or Improve tor the purpose of sale). HEATING SVSTEM 0-300,000 BTV
❑"I; as owner -of the property, am exclusively con[ractin9 with qND DUCTING -� - -
Iicensetl contractor5 to consVutt the projec[ (Sectlon 7044, Business 100,000+gTU
antl Professionr Cotle: The Contractor's License� Law tloes not apply-to '
an owner ot property who builtls or Improves thereon, anA who con- REFRIGERATION 0-100,000 BTU
�tractr'from suth projects with� a �contrattor(s) Iicesnetl pursuanC to SVSTEM - - - ' ' ' ' '
the Conbactor's License Law). 300,000 + gTU
��� I am exempt untler Se<tlon - 8. & P. C. for�thii BOI LERS BTV
reason' - ' -- - � � "
Date -- - Owner - - SVSTEM REPAIR,ALTERATION
I hereby carli(ythat I,have reaC this appliwtion antl state [hal [he above E%HAUST SVSTEM MVITIPLE
IniormaHon is corr¢Ct. I agreC to <ompry with all tlty antl county
ortll�aOG¢s ana state laws rClalin9lo cons[�uctlon, dntl h¢r¢by duthOriz¢ �
roprasen[atives of Ihis dty to ente upon the above mentlonetl�
.p�operty / I 5 C n � a es. 1 ��
Slgnature [e � '
Drivers' Lice s or � � ' 'IS E FE ' ' - �--
CMF 0865-46 White-Builtling; Canary-Applicant; PInk�Accounling; GolAenrotl-Assessor
-: _. ._i�' .0596 I/13/82
— H.P. $
ZONE
e
SEDTBACK C 5T.
IICA �5IIpEYARD
RIGHT
REAR VARD (TO P/L)
PKG. SPP,CE REQ. �
$TREET WIOTH
ZONING,APPROVED B�
SPECIAL CONDITIONS:
I ELECTRICAL -
,� PLNTGp. RUEF. p�
.. PROPE�RTVNLINE
PROVIDED
PARK FEE S
PLAN CHE(
50. FLnv.a _ " . S2 FT_ � .
GENERATOR 0-1 KW_1-lO.KW _
TRANSFORMER
APP�IANCE 30-SOKW_SO+KW'_
MOTORS 0-1 HP_1-10 HP__
•�(INC. SOLAR) -10-SO HP_50 + HG _
-FIXTURES � -OUTLETS-' SWITCHES
GASTVBESIGNS � ' ' "'
POLE UGHTS - -" - - .
POLES METERED SUB
PANElS � MAIN _ �, SUB -,
.II.00 TL
.. . .. �..y. . '" '..I '. �I '
EE "
ON APPROVEO BY� - ' OATE -
SUMMARY OF FEES ,
BUILDING ' ' -'
PERMIT $ � SMIP' S
PLAN'CHECK S PERMIT .
PIUMBING E - �SSUHNCE 5 '
- -- -GRADING $ t
PLAN CHECK y " . _ . � t
�
ELECTRICAL $ $� �
PLANCHECK $_/_�__ MICROFILM�E'
i•� /9p ' ' TOTAL FEE 5
MECHANICAL�$_/_� tC_ �
PLAN CHECK� y 'LE55 AD- _
- VANCEPC E-
. �., _._. FINALFEE E •�/� ,
CONSTRUC710N AND PLANN�IN�G ���^� - ; � " � POOL & SPA - • � �
AP.PROVALS ' .�., ' Permit#JCZ..�X,114L Date Inspector qppROVALS = Permit# Date_ Inspector
1. Temporary Electricai Service or Pole 43. Pool & Equipmenf Location � - -�• �
Soi ipe-Undrgm 44. Steel Reinforcemerrt, -• ' � • - ' • '-
. 3. Electrical Conduit Utility-Undrgrn 45. Forms -� -
4. Electrical Conduit-Undrgrn 46. Electrical Bonding �
. tee ein orce 47. Rough Plumbin & Pressure Test� '
6. Electrical UFER Grn - 48. APPROVALTO COVER-GUNITE �
7. Footings � 49. 'ElectricalConduit-Undr rn
8. Foundation � ' 50. Gas Pipe, ❑ Undr rn, Test - �
. 9. Water Pipe-Unqrgm � 51. Backwash lines P-Tra '�' ndr'rn � - -
10. Structural Floor System 52. APPROVALTO DECK � ' '" ' �� �••
11. Property Sewer Line & House Connection ' 53.. Backwash & Rece torFinal - � � '•
12. Street Sewer Cpnnection � "'�" 54. Heater & Vent-Final � '
13. _ Rough Plumbing � � - - -
14. RoughElectric-�onduit - - ��56,�-Electrical-Final
15. flou h Electric-Wiring ' � � � � � - - 57. Solar System-Final - � • •
16. Rough Heating & Air Conditioning _�� � 7_ encing & Access Approval � .
1�7. Ducts in Structure ' ` ' ' � - � � • 9• �+PPROVED FOR PLASTERING � � -
- 18. Ducts, Ventilating � � - �' � � - ' _„ - r � ' !
19. Gas Pipe-Rough & Test � " � 6D. POO.L/SPA SYSTEMS FINAL � • ! � � � , �
20. Roof: Eraming ' - ' ' ' � � �
21. Roof Sheathin . ' � � _ .
22. Frame and Flashin - ' NOTES: ' . ' ' ' � ' .
23.� Insulation - � ' '
24. Lathing & Siding ' ' � -
. 25. _Drywall Nailing _ ' � - � -
26.. Plaster Brown �oat ' � • • '
27. ._Electrical Power Meter-Final ' -- ' ' � � • '
28. �Final�Electric ' � � - � � � �
29. Final Heating & Air Conditioning S' g ' � �
. 30. Final Gas Pipe•Test ' � ' � �
31. Final.Plumbing � � ' �
32. Water Service-Final. . � - �
- 33. Gas Service-Final . � ' �
34. Solar pomestiq-Final�� -� � ' '
35. Landsca e S rinklin S stem .. ' � '
36. Sound Attenuation - ' � ' '' � ��
37. Handicap Regulations � � � �
38. FINALSTRUCTURE&BUILDING - �
39. Special Requirements Completed i �� � - �'
40. Electric Release to Edison - `� � � - ' ' ' `
41. Gas Release to.Southern Calif r'nia Gas Co: � � -
42. C�\�ERTIFICATE OF OCCUPANCY .._ "'. � _ � ~ �
�Yo. Date '� � - - ' - '!
� . .
� ' ' . _ .`�.t _ ` .. ... i � .
��� Applicant lo fill in all s
ITYOF�"COSTA��MESA �' PERM�ITNO.
CONSTRUCTIONPERMIT � /�-,�./(
Add�ess
Arch/Eng.
cu�vactor
' I am IlcanseE untler pra
on - 7000) of� Dlviilon
antl mv Iltense is in
Phone
License No.
wltM1in heavy bortler Iines anG.sign all appro0�i
'- TRACT NO. ' LOl NO.
dions.
NO. . ._ _ . _ ..
TYPE OF CONSTRUCTION � ' � 9%%2 I2IZI IB)
.�,NEW ❑ ADD ❑ ALTERATION ' BLDG. 1� LOT A, PLAN A�" � �� "
' ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
OESCRIPTION OF WORK
-144 TYPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLUMBING B�AECHAI
9 (cam-
:55 antl ❑ OTHER
eftect. pROJECTDESCRIPTION -
LI<ense Class — Licerys
Date ��—���_—Q�- Si9nature Q.FT. ' . . _
WORKERS' COMPENSATION DECLARATION O UPANCV_CONSTRUCTION TVPE
I hereby affirm tnat I have a certificate of consent to sel niure or a VALU ION ZONE
certitifate Ot Work¢rs' Compan5ation InSUrance, or a certifiBtl CopY — � �--
thareof (SectlWnP�;0701�.a¢�CJ. '" FREMONT' GRADINGCV. VDS. ACRES
Policy No. 4Y Company
� Certlfie0 topy Is hereby turnishetl. - REMARKS:
�(Certl/ietl topy is filatl with the clty Builtlin9 Divlslon.
cXEMPTION FROM WORKERS' COMGENSATION�DECLARATION
(This section neatl not be completetl if the permit Is for one huntlretl
S$3001 or less). �
Cert(fy that in the performance of the.work for whith this permit is'. , .
I55ueC, I shall not emPloy any person in any manner so as to'become ' PLUMBING � -
SUDject to the Workers Compenzatlon Ldws of California. ' . .
Da[e Sl9nature BATHTUBS
NOTICE: If atter making this tleclaration, you shoultl become'subject TOILETS .
to tha Workers' Compensation provisions ot tne LaGor Cotle, you must LAVATORIES
forthwlth COmply with such provi5ion5 Or thi5 p¢rmit Shdll b¢ De¢metl
revoketl. - . - - . . . . . _
CONSTRUCTION LENDING AGENCV KIT. SINICS
I hereby afflrm that there is a construttlon lentling agency for the per- SERVICE SINKS
tormance of the work for wnich this permit is issuetl (Sectlon 3097
CIv. C.). - � � ' " '- � � - FLOOR SINKS
Lender'S Name
Lentler•s Atldress ORINKING FOUNTAINS
OWNER BUIL�ER DECLARATION � � INTERCEPTORS
I hereby afFlrm that I am exempt from,the Contractor's License Law for
the following reason (SettiOn 7031,5 BuSiness antl Prote55ions Cotle: SWIMMING POOL
�� Any city or county wnich requires a permit to wnstruct, alter,
��, improve, tlemolish or repair any sGucture, prior to its issuance, also re- yyqTER�SERVICE
I, as
ale ton
ofessions Cotle) or that he"is exempt [herefrom antl the
legetl exemptlon. Any violation of Section ]03L5 by
b� a pe�mit Tub)ects-Ih¢ appiicant [o a tivil penalty
an five huntlretl tlollars (y500).
ot th¢ property, or my employee5 with wa9e5 a5 th¢ir
on, wlll tlo the work, antl thestruciure is not Intentletl
ale. (Sectlon ]044, Business antl Protessions Cotle: The
:ense Law tloes not apply to an owner.of a property
��mprovEs thereon, antl who tloes SUCh work himself o�
i employees, provitled thdt such Improvemenl5 are not
eretl for sa1e. If, however, the builtlin9 or improvement
ne y¢ar.of completion, the own2r will hdve fhE burtlen
tlitl not builtl or Improve for the purpose of sale).
r ot the property, am-exclusivey mntractinq with
:tors to construct the project (Sectlon �044, Business
Cotl¢: The Contractor'S'Clcense Ldw tloe5 not apply to
an owne� ot prOperty who builtls or Imp�Ov¢5 th¢r¢on, antl who con-
t�act5'/�Om such p�o7ects with-a contraCto�(s) Ilcesnetl pu�suant to'
the Contractor•s License Law).
❑ I am exempt untler Sectlon � B. & P. C. fot tlfi5
reason ' '
Date � � Owner � �- � - �
I. heleby celtify thd[ I hdve rCdtl this appllGa[iOn dntl StdtC thdt [h¢ above
Informatlon is mrrect. I agree to comply with all tity antl county
ortlinances antl state laws relating to mrytruction, antl hereby au orize
representatives of �fhi5 city�[o,�nteq upon tl� above,me ionytl
Si9nature � ��+w+�
Drivers' license or 55 �
CMF 0865-46 Wni[¢-Builtlinq; Candry-Applican[; Pink-AGcounting;
� � 8��
PLAN CHECK' � �
SHOWERS
URINALS' � -
DOUBLELAVS �
�DISHWASHERS '
SUMPS
FLOOR DRAINS
CLARIFIERS
PTRAP- . • _ • ..
ALTERi1T10N - �
WATER HEATERS BTV OUTPVT.
SEWER CONNECTIONS � � �
SOLAR TANK �. COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU_�
AND DUCTING 300,000 + gTU _
REFRIGERATION 0-300,000 BTU_
SVSTEM - � 100,000+gTU_
BOILE(35 � BTV
SYSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MVLTIPLE
^ ISSUE FEE'
ZONING REGULATIONS
A.P. �
ZONE � PLNTGp. RgUEF. �
SETBACK C T.
PROPE�RTVNLINE
LIDE VARD
5EpF
A RIIGHTA . . . _ .
REAR YARD (TO P/L)
PKG. SPACE REQ. PROVIDED -
STREETWIDTH PARKFEE�$ -
ZONING APPROVED BV DATE
SPECIAL CONDITIONS:
ELECTRICAL " ' P�Arv cHECK -
GENERATOR p-1 KW_1-10 KW _
TRANSFORMER
APPLIANCE' 30-50 KW=50 + KW _
MOTORS 0�1 HP_I-30 HP _
-(IN0. SOLAR) � 30-50 HP 50 + HP _
FIXTURES OUTLETS 'SWITCHES
GAS TUBE SIGNS ' "
'POLELIGHTS-' ' — ' '
PANELS �MAIN
SER V ICE
SUB
AMP —
7.00 T4'
�
�
' �
-T
' " r '
'- ' ' APPLICATION P.PPROVED 8Y ' ' DATE -
SUMMARY OF„FEES , ,
BUILDING - '- ' —
PERMIT � $ SMIP "$
� �-F OO pLAN CHECK S � PERMIT
-- - � - � ISSUANCE $�
PLUMBING $ '
PLANCHECK $ - GRADING $
ELECTRICAL $ $—
PLANCHECK g � MICROFILM $_�
�' TOTAL FEE $ � V V
' MECHANICA� $/�
PLAN CHECK g - LE55 AD-
VANCEPC 8_�
3��
FINHL FEE $ 7 • OO
' CONSTRUCTIONANDPLqNNING ' ;� - . POOL&SPA � • � ��
APPROVALS ��� �� �� Peim`it # rn.-aiD9 Date Inspector ' ' Date Inspector
APPROVALS Permit #
1. Temporary Electrical Service or Po�e 43. Pool & Equipment Location �
2. Soil ipe-Undrgrn 44. Steel Reinforcement -' � �-
3. Electrical Conduit Utility-Un rgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce � 47. Rou h Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn �
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn � 51. Backwash Lines P-Tre ❑ ndr rn'
10. Structural Floor System 52. APPROVAL TO�DECK � " � ��
11. Property Sewer Line & House'�onnection 53. Backwash & Rece tor-Final '
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing �
14. Rough Electric-Conduit . -56� Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final �
i6. Rough Heating & Air ConditiOning �/ =a'L encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating .
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing �
21. Roof Sheathin '
22. Frameand Flashin NOTES: �
23. Insulation
24. Lathing & Siding.
25. Drywall Nailing
' 26. Plaster Brown Coat � ' ' -
27. Electrical Power Meter-Final ' � ' ' � - - '
28. Final Electric � �" � • �
29. Final Heating & Air Conditioning ,r' �L
30. Final Gas Pipe-Test ' '
31. Final Plumbing � � -
32. Water Service-Final ' �
33. Gas Service-Final � '
34. Solar pomestic-Final � � � �
35. Landsca e S rinklin S stem �� ,` � �
' 36.. Sound Attenuation ' �
37. Handicap Regu�ations
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed 1 � ' -
40. Electric Release to Edison .
41 . Gas Release to Southern California' Gas Co. -
42. CERTIFICATE OF OCCUPANCY �
No Date , . ,- .. .
nvnr
�CITY�OF COSTA MESA .
CONSTRUCTION PERMIT
� Projec['Address �� D n '
Addrea
Address
fiil In al� spaces witnin
3MIT NQ.
P15�
�c e
Phone
License No.
borCer Iines antl sign �II approprlate aeelarations.
TRACT NO.� OT NO. �BLDG�NO.
TYPE OF CONSTyi1CTION
❑ NEW ❑ ADD �O ALTERATION'
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
� OTHER
OESCRIPTION OF WORK
_ � .
; '
- " ZONING REGUL
A.P. �
ZONE � ""PWGr
Contractor ��/pNs rt�{w�v,, Phone(oYb-1/8"S TVPE OF PERMIT SET ACK
AddfeSS S3 /�Q.J V �v' \ 'Z N ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL SID YARD
LICENSED CONTRACTOR DECLARAT.ION � �O TENANT ❑ ELECTRICAL�PIVMBING ❑M�CHANICA SEpHTA
1 hereby afflrm that I am Ilcensetl untler provisions of Chartor 9(com- R G
mencin9 wlth sec[lon 7000) ot . Divlslon .3 ot tne Buslness antl ❑ OTHER .
Professlons Cotla, �n my Iicenze is In full for�anQ e fe t REHR VARD (TO P/L) �
Litenze Class ense / PFIOJECT DESCRIPTION ` pKG. SaqCE REQ. '
Date Slgnature - SQ. FT. ' � .. , � :,\
WORICERS'COMPENSATIONDECLARATION- OCCUPANCY_CONSTRUCTIONTVPE STREETWIDTH�
I hereby aHlrm that 1 have a certlfiwte o( tonsent to self-Insure or a VALVATIOIV ZONE �'� ��-�' �
CBrtifltdt0 O/� Wofkels' CAmpanSatioO InSufdOGB, Of d CeflHletl copy _ .. _. . „ _. .
lhereof (Section 3800, Lab. C.). � GRADING CU. VDS. ACRES
°oli<y No. - Company - � ' -
� CertitleC <opy Iz hereby fumis�etl. REMA0.K5: - • .. ` � , _ _
❑ Clrtlfletl COpy Is flletl wi[h the City Builtlin9 DiWslOn. O`'
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - �' - �
;This section neeC not ba completetl it tha permlt 15 for one buntlretl -
',E300) or leu). - ' '
I tertify that ln the p¢rfOrTantt Of [h¢ work tOr whiGh this p¢rmit I5
ssuetl, 1 shall not emPloy any person in any manner so as to become PLUMBING PLAN CHECK - -
wDjett to the Workeri Compensation Laws of Calltornla. ' '
7ate Signature ' BATHTUBS SHOWERS �
NOTICE: I( atter makin9 thiz tletlaratlon, you shoultl betome subjet[ TOILETS • URINALS ' ' y" �-
'.o the Workers' Compensatlon provisions of the Labor Cotle, you must ' h
'orthwlth comply with suth provisions or this permit shall be tleemetl LAVATORIES DOUBLE LAVS eL
'evoketl. KIT.SINKS " - DISHWASHERS
CONSTRVCTION LENDING AGENCV �/
I hereby afilrm that there is a construttlon lentling agency for the per SE0.VICE SINKS ''�.. SVMPS
'ormance of Ihe work fOv whlCh this permii Is ISSuetl (SaCflon 309] '
`��' �•�' �� � .� __ - � - . FLOOR SINKS � � - FLOOR DRAINS � '
LendBr;S,Name�-
Lentler•s Atltlress ORINKING FOUNTAINS -
�WNER BUILDER OECLARATION i' �' � �'' ' ' � � � � INTERCEPTORS CLARIFIERS � � �
heraby aftlrm that I am exempt from the ConVactor's �icense Law for '�-
the tollowing reason (Settlon 7031.5 Business antl Professions Cotle:
Any Nty or county which requires a permit to construcq al[er,
improve, tlemolish or repair�any structure, prior�to Its 15suante, also re-
quires the applicant 1or zuch permit to file a signetl statement that he
is Iicensetl purzuant to [he�provislons of the Contra<tor's License Law
(Chapter 9(commencing wlth Section 7000) ot Dlvision 3 ot the
Business antl PrdMslons Cotle) or that-he Is exempt t�erefrom antl lha
Gasis for the allegetl exemptlon. Any violation of Sectlan ]031.5 by
any dpplitd�t f0/ a pl�mit sUbjects Ihe appllt'ant�t0 a Clvil penalty
of no[ more than live huntlretl tlollars (5500).
❑ I, d5 OwnGr of l�e property, or my amployee5 wl[h wages a5 thGir
sole compensation, will tlo the work, antl the structure is no[ In[enUetl
or offeretl for ule. (Settion 7044, Business antl Professioni Cotle: The
CAntfactol'S LICGn59 Ldw tlOes not apply to an Ownel of a property
wh0 bulltl5 Or Imp�oves thereon, antl wh0 tlOes TUth work himself Or
through hls own employees, p�ovitletl thdt zuch ITp/OVGmentS a�e not
intentletl or offereA for sale. If, however, the bullCin9 or Improvement
Is soltl wltM1ln ona year of completion, the owner wlll have the burtlen
of proving he 410 not bulld or improve for the purpose o( sale).
❑ I, as owner Of the property, am axclusively contrdttin9 with
Iicensetl contractor5 to construct the projett (Section ]044, Business
antl Professions Cotle: The Contractor'z License Law does not apply to
an ownor of property wno builtls or improves thereon, antl who con-
[racts from suth pro7ects with a contractor(s) Ilcesnetl pursuant [o
the Contractor's License Law).
❑ I am exempt un0er Sectlon B. & P. C. for this
reason
Date Owner
I hereby certify tnat I have reatl this appliwtion antl state tnat the above
information is corrett. I�a9ree to comply with all city antl counry
ortlinances antl state laws relatlng to mns[ruction, antl hereby authorize
representaUves of lhis Cit y¢yjps Qe����er uDon the dbOv¢ mentlon¢tl
proOertY t i OeC (on �/L' eL/'� �' � �O L(( �%�
519nature Date
$WIMMING'POOL� PTRAP' -'" -
WATERSERVICE ALTERATION "
GASSERVICE OVT�ETS
WATER HEATERS BTU-OVTPUT
SEWEft CONNECTIONS � � "
SOLAR TANK COLLECTORS �;�
SOLAR PIPING SYS. � �
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-100,000 BTU�
ANDDVCTING' 100,000+BTU_
REFRIGERATION 0-300,000 BTU_
SVSTEM 100,000 + BTV _
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
Driv¢r5' Licenze or 55 ak � � ' ISSUE FEE
CMFO865-46 White-BuilOing;Canary-Applicant;Pink-Accounting;Goltlenrotl-Assessor
CONDITIONS:
REF.Yf� • TL
BUIL�ING
)PER V LINE
PROVIDED - `
PARK FEE $ . �
' DATE
ELECTRICAL P�AN CHECK
SO. FT. SfJ- FT.
GENERATOR 0�1 KW_ 1-30 KW _
TRHNSFORMER
APPLIANCE ' 30-SOKW_SO+KW_
MOTORS - Od HP_1-30 HP _
(IN0.50LAR) 30-SOHP_SO+HP�_
FIXTURES ' OUTLETS' 'SWITCHES
GAS TUBE SIGNS ' ' � '
POLE LIGHTS '
� POLES Vv V METERED SUB
" PANElS MAIN ' SUB
- � � 'SERVIGE' ' - --- AMP
_:� " '
n '^ "
' _
' � AVPLICATION APPROVED BV - - - - DATE
SUMMARV OF FEES ,
� BUILDING -
PERMIT $ SMIP $
PLAN CHECK S PERMIT
PIUMBING g� �SSUANCE S
� PLAN CHECK $ ' GRADING S
ELECTRICAL S - s
- PLANCHECK E' MICROFItNI $
MECHHNICAL $ TOTAL FEE $
PLAN CHECK S LE55 AD-
VANCEPC 5_'
� FINAL FEE S � � v
,
CONSTRUCTION AND PLANNI G -- FOOL & SPA . �� i � �
APPROVALS Permit# -�'� Date Inspector qppROVALS Permit#` � Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location � �
Soil ipe-Un rgm ' b fi 44• Steel Reinforcement -
- 3.• �Electrical Conduit:UtilityUndrgm 45. Forms �-
4. Electrical Conduit-Undrgrn 46. Electrical Bonding � �
. tee ein orce . 47. Rough Plumbin & Pressure Test �
6. Electrical UFER Grn - 48. APPROVALTO COVER-GUNITE �
7. Footings - 49. Electrical Conduit-Undr rn
-.8. Foundation ' � - 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgm 51. Backwash Lines P-Tra �❑ ndr �n � � �
10.. Structurol Floor System 52. APPROVALTO DECK
11.. Property Sewer Line & House Connection �0 .7 9/ i .53. Backwash & Rece tor-Final �
- 72. Street Sewer Connection � � - - - 54. Heater & Vent-Final
13. Rough Plumbing ¢ _ - �
14. Rough ElectricConduit �56. . Electrical-Final
15. Rou h Electric-Wiring � 57. � Solar System-Final
16. Rough �Heating & Air Conditioning • encing & Access Approval -
-� 17. Ducts in Structure " 9• APPROVED FOR PLASTERING
18. Ducts, Ventilating . '�� �
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS F INAL ' '
20. � Roof Framing � - - �
21. Roof Sheathin • � { ' "
22. Frame and Flashin NOTES:
23. Insulation � ' ¢ r O . ! '` r � .!
24. Lathing & Siding L . '
25. Drywall Nailing - 4� �,( �
26. Plaster Brown Coat - �
27. Electrical Power Meter-Final ��
28. Final Electric "' � - �
29. Final Heating & Air Conditioning � f Yy �
30. Final Gas Pipe-Test - 3/ 1
31. Final Plumbing. f- S'�
32. Water Service-Final
33. Gas Service-Final � " '
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations ' �
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATEOFOCCUPANCY
_ � .
IVo Date �
Applicant to fill in all
CITY OF C ��TA� MESA � a IT NC
CONSrRUCYIONPERMIT � lS
License
Address
witnin naavy GorGer lines anC sign all appro0riate tleclantions.
TRACT NO. L07 NO. � BLOG. NO. '
�� �� TYPE OF CONSTRUCTION
ZI � NEW ❑ ADD ❑ ALTERATION
,'�, ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
7 ❑ OTHER
OESCRIPTION OF WORK
M• r,�.,.�.,�,.n..viutn
LICENSED CONTRACTOR DECLARATION
I hereby aitirm that 1 am Iicenietl untlar provlslons of Chartar 9(com-
mencing wlth sectlon ]000) ot Divislon 3 of tne BuSiness antl
Professlons Cooe, antl my Ilcense Is In (ull for<e antl effect.
LlCense CIa55 License No.
Data Si9nature
WORKERS'COMPENSATION DECLARATION
1 hereby aifirm that I have a certlficate of consent to 5elf-Insure or a
certlilw[e oT Workers' Compensatlon Insurance, or a cartifletl <opy
thareof (Sectlon 3800, 12b. C.).
Policy No. ComDany
❑ Certifletl copy is hereby furnlshad.
� Certlfietl copy Is f11eC with the clty Builtling DlviSion.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completaa if tne permlt is for one huntlrea
SE300) or Iess). �
certlfy that In the performdnce of Ihe wOrk tOr whlCh thi5.p¢rmit I5
�ssued, � snaii noe emPioy any person In any manner so as to become
sub�ect to the Workers Gompen5ation laws of Callfornia. .
Date Signature
NOTICE: It after makinq Ihiz tlBtlaraUon, you s�ou10 DetOme suDje<t
to the Workers' Compensatlon provisions of t�e Labor CaAe, you mus[
fOrthwlth Com01y wlth suth provl5iOn5 Or thi5 permlt Shall be tleemCO
�evoketl. - ._ . . .
CONSTRUCTION LENDING AGENCV
I hereby a(firm that there I5 a construc[ion Ientling agency for the perv
formance of [he work for which tnis permit is issuetl (Section 3097
Civ. CJ.
L.entl!/'s Name
L.entler's AtlGress
OWNER BUILDER DECIARATION - "- '
I hereby a(firm [hat I am exempt from.[he Contrattor's LlcenSe Law for
the following reason (Sectlon 7031.5 Busines5-antl Protessions Cotle:
Any tlty or county whith require5 a permit to con5truct, alter,
improve, tlemolish or repalr any structure, prior to its issuance, also re-
quires the applicvnt for 5uch permit to flle a signetl itatement that he
is Iicensetl pursuanl to lhe proJlSions of the Contractor•s License law
9usines5 antl �Rolessions COCe) or that he is exempt tberi
Easis for tne allegeC ezemption. Any violatlon of Sectli
any applicaM tor a permit'subjetts the appliwnt to a
/ not more [han flve M1untlretl tlollars (§500).
� I. as owner of tne orooertv. or mv emolovees witn �
TVPE�OF PERMIT '
❑ GRADING ❑ FOUNDATION ❑ STRVCTVRA
❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECH
❑ OTHER -
PROJECT D/ESC IP ION /J�� �/��/'"� ': ��
5�. FT. __�F'�A��7JrJ/.J G�
OCCUPANCY 3 CONSTRV TION VP
V ALUATI ON � ZONE
GRAOING CU. VOS. ACRES
PLUMBING
BATHTUBS
LA V ATO R I ES
KIT.SINKS
SERVICESINKS � .
FLOOR SiNKS
DRINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOL
WATER SERVICE
GAS SERV ICE
PLAN CHECK
SHOWERS
V RINAlS
DOUBLE LAVS
SUMPS�+•. '•� Sr -
FLOOR DRAINS �
CLARIFIERS
PTRAP '
ALTERATION
OUTLETS
SEWERCONNECTIONS -�
SOLARTANK � COLLECTORS
SOLAR PIPING SVS.
itractor'S Licensa Law tloes not apply to an owner of a property .
� builtls or Improves thereon, antl who tloes suth work himself or ISSUE FEE
>u9h his own employee5, provitletl that Suc� ITprOVGments.are no[
rntletl or offeretl tor sale. It, however, the bullCing o� Imp�ovement MECHANICAL PWN CHECK
>Itl wlthin ono year o( completion, the owner will have the burtlen
provin9 he tlitl not builtl or Improve for the purpoze ot sale). HEATING SVSTEM 0-300,000 BTV _
I, as owner of'the property, am ezclu5lvely �contracting with qND �VCTING
nsetl contractors to canstruct tne project (Sectlon 7044, Buslness 100,000+BTU
Ll 1 am
reason _
Cotle: The Contractor'S Llcanse Law tloes not apply to
operty who builtls or improves lhereon, antl who con- REFRIGERATION 0-100,000 BTU_
b pr0�¢CIT wlth a contlattOr(5) IICBSnBtl pul5uant IO 'SVSTEM ' '
Llcense law). 100,000 + BTU _
untler Section � B. 6 P. C.•for yhis_
. , � .. _ _ __'_ _ . . - . _ `_ . . BOIL•ERS. ``.y. - BTU
I hava reatl this
:et. 1 aaree to
] stat¢ thdt th¢ above
all Uty antl county
antl hereby.authorize
ie abOvO Tentionetl
A.P. � —
ZONE � "�
SETBACK �
L lO VARD s/
Ep
ANICA `��IGHTA S
REAR VARD (TO P/L) �
� PKG.SPACEREQ. �
STREET WIDTH S"
ZONING APPROVED BVD
SPECIAL CONDITIONS:
ELECTfiICAL
PROVIDED
PARK FEE
PLAN CHECK
' GENERATOR 0-1 KW_ 1-30 KW _
TRHNSFORMER
� APPLIANCE 30-SOKW_SO+KW_
' MOTORS " 0�1 HP_1-30 HP _
- � (INC. SOLAR) 30-SO HP SO + HP _
- FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS '
� POLE LIGHTS - � ' '
w..� .. ' '.1'.
SVSTEM REPAIR,ALTERATION �
EXHAUSTSYSTEM MULTIPLE .�
Slgnatura � '���'�� / I
Drlvar5' s¢ Or SS � � - ISSUE FEE
CMF 0 -46 White-Builtling; Canary-Applicant: Pink-Accounting: GolAenrotl-Assessor
PANELS MAIN SUB'
SERVICE AMP
'ACPLICATION AVPROVED'BV
SUMMARV OF FEES
BVILDING ?�/ /-
PERMIT E L+7.7�•00 SMIP S `�
PLAN CHECK E PERMIT
ISSUANCE E_
PLUMBING S GRA�ING E_
PLAN CHECK E - ,
ELECTRICAL S � S-
PLANCHECK S MICROFILM E_
MECHANICAL E TOTAL FEE S_
PLAN CHECK § LE55 AD-
VANCEPC §_
�/� ��}� /�f / _ FINAL FEE § ���
L_ J ( Y
TL'
CONSTRUCTION AND PLANNI�-I2Q/� � • POOL & SPA .
APPROVALS Permit #� Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil ipe- ndrgrn •� 44. Steel Reinforcement �
- 3.-��Electrical ndui4 Utility:UnBrgrn 45. Forms
4. -�Electrical Conduit-Undrgrn . 46. Electrical 6onding
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE �
7. Footings 5� aa �' j� � 49. Electrical Conduit-Undr rn
8. Foundation - .Q S �0 3� � 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn " 51. Backwash Lines P-Tra ❑ ndr rn
' 10. . Structural Floor SYstem - � APPROVAL TO DECK
.11: -'Property Sewer Line & House Connection 5. Backwash & Rece tor-Final
12. .Street Sewer Connection � 54. Heater & Vent-Final
13. Rough Plumbing -
14. Rough Electric-Conduit - •56. Electrical-Final
75. RoughElectric-Wiring - � 57. SolarSystem-Final
� 16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure 5. APPROVED FOR PLASTERING -
� 16. Ducts, Ventilating _
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL , �
20. Roof Framing �
21. Roof Sheathin '
22. Frame and Flashin ' NOTES: � ' '
23. Insulation ' S •,Z�L �
24. Lathing & Siding _y&"Z
� 25. Drywall Nailing
26. Plaster Brown Coat -
27. Electrical Power Meter-Final ' -
28. Final.Electric
29. Final �Heating & Air Conditioning ' '
30. Final Gas pipe-Test • '
31. .Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. � landsca e S rink7in S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING �by �----�
39. Special Requirements Completed ^�J v
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY ,
No Date
AOPlicant to fi11 in all spaeas wltnin heavy Dortlar Iinez anG sign all approo��ata aeclarations.
CITY OF COSTA MESA � PERMIT NO. Ti3ACT NO. LOT NO. �BLDG. NO.
CONSTRUCTION PERMIT E—l'`f'2.D �I ��D < <
C., rl .
Addre55 �'jQ�' � _{� PC(Z'j� � p
Arch/Eng.�¢.(Z (!p�C�P�j LicenseNo:
AddressZ�jcj 1�'l�4- ST CeT{.. 2
Contracror N��-� � � '/� /(� Phor
I hereby at/irm that 1 am IICBnseG untler ptovisions o/ Cnartet 9(tom-
mencing wlth 5ection 7000) of DIVISIon 3 of the Business antl
Profeszions Coae, antl my Iicense Is In (ull forte antl effect.
Litense Class Litense NO.
Date Signature � �
WORKERS'COMPENSATION DECLARATION
I hereby afflrm that I nave a certificate of consent to self-Insure or a
certificate of Workers' Compensatlon Insuranca, or a cer[ifletl <opY
thereof (Sectlon 3800, Lab. C.).
�Ilcy No. � Company
�z�'�¢erti(ietl topy is hereby fumishetl. -
��Certlfietl copy is filetl with the Nty Bulltling Dlvislon.
�%,�
ESCEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This zection neetl not Ee completetl It tha permlt I5 far one huntlred
Sy300) or less).
certity that in the performance of the work tor which.fhis permlt is
IssueO, I shall no[ emPloy any per5on in any manner so as to become
subject to the Workers Compensation Laws ot Glifornia. -
Date Signature
�NOTICE: If afler making IhiS tleclaratlon, you shoultl become.sub�act
to the Workert' Compensation provislons of the Labor Cotle, you must
torthwith comply with such provisions or this permit shall be Geemed
revOketl. - . . -
CONSTRUCTION LENDING AGENCV
I nereby a(tirm that there I5 a constructlon Ien0in9 agency tor the per-
formdnt¢ Ot the wOrk fOr w�ich thls permii is I55Ue0 ($ection 3097
Civ. CJ•
Lentler'S Name
Lentler•s Atltlress
OWNER BVILDER DECLARATION '
I bereby afiirm that I am exempt fromihe Contrac[or's LlcenSe Law far
Ihe following reaion (SectlOn 7031.5 BUSIn¢sz anG Pro(¢55ions Cotle:
Any city or munty which requires a permit to construct, alteq
improve, tlemolizh or repalr any stru<ture, prior to Its Bsuance, alio re-
quire5 the appllwnt for such permit to file a signetl Statem¢nt that h¢
I5 Iltensetl pursuant Co Ihe provisions ot the Con[ra<tor'S License Law
(CM1apter 9(tommencing with Section ]000) of DlWsion 3 of the
Buslness antl Professions Cotle) or tha[ he is ezempt t�erefrom antl'the
, ba5is for tne allegetl exempilon. Any violation of Section 7031.5 by
�� applicznt- for a permtt subjects the apP����� to a"civil penalty
not more than five �untlretl tlollars (5500).
I, as owner of the property, or my employees with wages as [helr
sole compensation, will tlo tha work, anC (he structure is nof Intentletl
or offeretl for sale. (Section 7044, Bu5lness antl Ao/essions Code: The
Contractor•5 License Law tloes not apply to an owner-ot a properly
wh0 buIICS or improvGs thGreOn, antl who doe5 Such wolk hIrtlSGlt Or
through his own employees, provitletl that such improvements are not
Inlentletl Or Offeretl for Sale. It, however, the bulltling Or ImO�ovament
is soltl withln on¢ year of completion, tha owner will have the burtlen
ot proving he tlitl not builtl or improve �or the purpose of sale).
❑ I, as owner o( the property, am ezclusivety contrattin9 with
Iitensetl contrattors to construct the project (Sectlon 7044, Business
antl Protessions CoGe: The Contractor's License Law Coes not apply to
an owner of property wh0 builtls o� imp�oves tne�eon, antl wh0 COn-
tracts from suth projects with a contrattor(s) 'Il<esnetl pursuant to
the Contratlor•s License Law).
❑ I am ezempt untler Sectlon B. & P. C. tor this
reason
Date Owner
I he�eby certify that 1 have �ea� [his dppliUtlon antl Stdta lhat thG dbove
information is corrEct. I agree t0 <omply wifh dll City ana <Ounty
oftllnancCs an4 5[ate laws r¢IaUng to COOStructiOn, dnC h¢reby aUttloli2G
r¢ore5entative5 0( tnls citv to ente� uoon [he above m¢ntlonetl
Slgnature
Drivers' L
TVPE OF CONSTRUCTION
B?JEW ❑ ADD ❑ ALTERATION
�OREPAIR ❑CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT -
❑ GRADING ❑ FOUNDATION ❑ STRVCTVRAL
❑ TENANT �ELECTRICAL OPLVMBING ❑MECMAI
❑ OTHER
PFOJECT DESCRIPTION
sq.FT.14c.� f�s 4 zo C>aIZ'
OCCUPANCV T CONSTRACTION TVPE
VALVATION�V T�� ZONE s
GRADING CU. VDS. ACRES
PLUMBING PLAN CHECK
TOIlETS URINALS
LAVATORIES . DOUBIE LAVS
KIT. SINKS DISHWASHERS
SERVICESINKS SUMPS
FLOOR SINKS FLOOf3 DRAINS
DRINKING FOVNTAINS �
INTERCEPTORS
WATER SERVICE
GASSERVICE
WATER HEATERS
SEWER CONNECTIONS
SOLARTANK
SOLAR PIPING SVS.
ISSUE FEE
CLARIFIERS
PTRAP
ALTERATION
OVTLETS
BTU OUTPUT
COLLECTORS
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-100,000 BTU_
AND DVCTING 300,000 * BTU_
REFRIGERATION 0-100,000 BTU_
SYSTEM 300,000 + BTU _
BOILERS . BTU
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MVLTIPLE
ISSV E FEE
CMF 0865-46 White-Builtlin9; Canary-Appliwnt; Pink-Accountin9; Goltlenrotl-Assessor
7033 10/19/81
ZONING REGULATIONS
A.P. $ ctZ S Zo2_ I S
LONE KTi PLNG. REF. � ;
REAR VARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
SPEGIAL CONDITIONS:
ELECTRICAL
. PRO V,I DED
PARK FEE E
DATE
PLAN CHECK
RII1�
8.00 TL�
GENERATOR 0-1KW_1-lOKW
TRHNSFORMER ��
APPIIANCE 30-SOKW_50+KW '
MOTORS ' 0-1 HP_1-30 HP
QIVC.SOLAR) 10-SOHP SO+HP
FIXTURES OUTLETS SWITCHES
GAS TUBE 51 5
POL S
OLES ME RED SUB
NELS AIN SVB
, SERVICE' ' AMP
ISSVE FEE
APPLICATION P.PPROVED BV
SUMMARV OF FEES
BUILDING-
PERMIT $
PLAN CHECK $
PLUMBING E '
PLAN CHECK E
ELECTRICAL E�
PLHNCHECK $
MECHANICAL E
PLANCHECK E
DATE
SMIP , E
PERMIT
ISSUANCE 5
GRADING E
E
MICROFILM E
TOTAL FEE S
LE55 AD-
VANCEPC E_
FINAL FEE S �
•. l• ' \1/ 1 .(.1�\
CONSTRUCTION AND pLANNING �. - 'POOL & SPA • , , ,
APPROVALS Permit # Date Inspector pppROVALS Permit # Date, , Inspector
1. Temporary Electrical Service or Poie 43. Pool & Equipment Location
2. Soil ipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility- ndrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding -' ' �
. tee ein orce 47. Rou h Plumbin & Pressure Test � ��
6. Electrical UFER Grn ' 48. APRROVALTO COVER-GUNITE �
7. Footings 49. Elect�ical Conduit-Undr rn
8. Foundation �' 50. Gas Pipe, ❑ Undr rn, Test •
9. . Water Pipe-Undrgrn 5i. � Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor SYstem 52. APPROVAl,TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection ' � 54. Heater & Vent-Final
13. Rough Plumbing '
14. Rough Electric-Conduit - �56. Electrical-Fi�al
15: Rough Electric-Wiring - ' � 57. Solar System-Final
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test � 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frame and Flashin NOTES: � � �
23. Insulation ' -
24. Lathing & Siding � '
25. Drywall Nailing ` � �
26. Plaster Brown Coat � � �
27. Electrical Power Meter-Final ' �
28. Final Electric � �
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test �
37. Final Plumbing '
32. Water Service•Final �
33. Gas Service-Final
34. Solar pomestic-Final �
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&QUILDING
39. Special Requirements Completed �
40. Electric Release to Edison
41 . Gas Release to Southern (;alifornia Gas Co.
42. CERTIFICATEOFOCCUPANCY
No Date .
� `�` - nvnn
`SITY L�F COSTA MESA
• 'CONSTRUCTIONPERMIT
Address
Address
in atl soaces witnln heavy GorCar Iinas anO slgn all aoD�ooriate de<IaraUons.
T NO. TRACT NO. LOT,NO. BLDf�NQQ
�� ' !� T�yYPE OF CONSTRUCTION �y
hon — S yfl NEW ❑ ADD ❑ ALTERATION V�
tj� ❑ REPAIR ❑ CONVERSION.�DEMOLISH
No. � ❑ OTHER
y � DESCRIPTION OF WORK
1 hereby afflrm that I am Ilcensetl untler provlsions of Charter 9(com-
mBnUng witn section-7000) o/ Dlvislan 3 of ma-Builnass antl
Professlons Cotle, antl my Ilcanse is In /ull force antl e/fe<t.
LI<enze Clazs License No.
Date Signature
WORKERS• COMPENSATION•DECIARATION
I tlefeby afflrm that I haV2 d C¢rtHlCdtB Of COnSGnt t0 TEINnsurO Of a
ceftlflf2te ot WorkGR' CATpGnSdtiOn InSurdntt, Of a Ceftlfletl coDY
thereot (Se<tlon 3800, Lab. C.).
^'';Y No. ComOany -
�{*'"�artitietl copy is hareby fumishetl. . _-. -
G•�'ertitietl copy is filetl with the city BuilEing Divislon.
EXEMPTION F0.0M W00.KER5' COMPENSATION DECLARATION
(This 5¢CtlOn nlGtl n0t De COTpletGtl it thG 0lrmll IS (of one huntll¢tl
SS300) or less).
certity that in the performan� of the work for whic� t�is permit Is
IssueO, I shall not employ any person in any manner so as to become
subject to tne Workerz' Compensation laws ol Caiifornia. .
Date Si9ndlure
NOTIGE: If af[er making this Geclaration, you zhoWG Detome subjact
[o the Workers' Compensatlon provislons o( tne Labar CoUe, you must
tOrthwith Comply with suth prOviSlOns Or this p¢rTit Shall b¢ tle¢metl
revoketl.
CONSTRUCTION LENDING AGENCV
I hereby atOrm that there is a construttlon lentling agency for tha per
forman<G Of [he wOrk iOr whiGh Ihls permit Is iizu¢tl (5¢Clion 309]
Civ. C.�.
Lentler'S Name
Lentler's Atltlress
OWNER BUILDER DECLHRATION
I hereby aHirm thal I am eaempt from the Contrac[or'S LI<enie Law for
l�0 10110WIng fea50n (SeCliOn J031.5 BUSInOu dntl PlOt¢SSIOnS COtl¢:
Any city or County whiGh r¢qWr85 a p¢rmll f0 COni[rucl, allCr,
Improv¢, tl¢mOlish of repai! any structufe, priof l0 It5 ISivanGe, aISO r8-
qulr2s the appliGnt 1or SUGh parmil lo fi10 a TignGtl StdtGTtM that b0
is Iicensetl pursuant to lhG pwNSiOni of Ih< ConlraGtor'S LI<enso law
`Chapter 9(commencin9 with Settion 7000) oi Division 3 ot thc
Bu5ine55 dntl AdMsiOns COtlO) Or thal h¢ Is ez@mpt t11018trom antl t118
bpfls for tne allegetl exemptlon. Any violatlon of 5ettion ]031.5 by
�.;e=;,applicdnY br a p¢rmlt subjeGts [h0 appllWn[ t0 d Clvil p0nalty
ot more tnan tive huntlretl tlollarc (E500).
-*.`5, ds own¢r Of the prope�ty, or my employee5 wittl wa9os a5 IhOir
solc compensation, will tlo tha work, antl th0 it�ucturo Is nol InlenOCC
or ofl¢rCa for Sale. (SeCtiOn 7044, BuSin¢ss dntl R'olt55ioni COtle: Tne
Conlractor's license� Lsw tloes not apply to an ownar ol a property
wh0 builtl5 or ImprOves th¢rmn, antl who tl0¢5 su<h wOrk himscll or
through his own emD�oyees, prOvitletl thdt sucn ImprOvements a�o nOt
IOtentletl Or OlferGtl �Or sale. It, howuveq the bulltling or Improvamont
Is soltl witnin ona year oi completlon, the owncr will hava tno burtlan
ol proving ha tlitl not Duiltl or improve lor the purpose oi salo�.
� I, as owner of the O�operty, am exclu5lvely tontracting with
licensetl conlractor5 to construGt [he prolect (SeCliOn 7044, Business
antl Pro�e55ion5 Coae: Tne Conl�acio�'s Llcen50 Law Gols not apply to
an ownGr ot p�opmty who bulltl5 or imprOv¢s tncreon, antl who con-
tracts from such pro�ett5 witn a con[racror(s) Ilcasnetl pursuan[ to
lne Contractor's License l.aw).
❑ I am exempt untler Sectlon B. 6 P. C. (or,ihis
reason
Date Owne «'/C
I nereby ter[iry that I have reatl this application antl state that the above
in/ormation is correct. I agree ro compl�l with all cily antl county
ortlinances antl state la�y{ relatlng to coryK➢�k��➢�. antl hereby authorize
Signature
Drivers' L
CMFO fi
TYPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHAI
❑ OTHER � ' � `
PROJECT DES� /�ZD �Q
5�. FT.
OCCUPANCV CONSTRVCTIONTVPE�
VALVATION 6 Q ZONE P'�
GRADING CU. VDS. ACRES
PLUMBING
TOILETS
LAVATORIES
KIT. SINKS
SERVICESINKS
FLpOR SINKS
DRINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOL
WATERSERVICE
GASSERVICE
PLANCHECK
SHOWERS
URINALS
OOVB�E �AVS
DISHWASHERS'
SUMPS � I
FLOOR DRAINS
CLARIFIERS <
P TRAP '
ALTERATION
OVTLETS
SEWER CONNECTIONS
SOLAR TANK � COLLECTOR$
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLArv cHECK
HEATING SVSTEM 0-]00,000 BTU_
AND DUCTING �p0,000 + BTV _
(3EFRIGERATION 0-300,000 BTU_
SVSTEM 100,000 + BTU_
BOILERS � � � • . BTV•
SVSTEM REPAIR, ALTERATION
EXHAUSTSVSTEM MUI.TIPLE
ISSUE FEE
White-Builtling; Canary-Appliwn[: Pink-Accounting; Goltlenrotl-Assessor
u
,..
ZONE
REAR VARD (TO
PKG.SPACE REQ.
ZONING APPROVED BY
SPECIAL CONDITIONS:
ELECTRICAL
LNTGp. REFL. $� N��
PROPE�RTV LINE
�
� /.
PROVIOED
1 � PARK FEE S
�� DATE
PLAN CHECK
GENERHTOR 0-1 KW_ 1-30 KW _
TRANSFORMER
APPLIANCE 10-50 KW_50 + KW _
MOTORS �p-1 HP_1-10 HP _
�" � (ING SOLAR) - �0-50 HP 50 + HP _
� FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS
� POLE IIGHTS '
��
POLES METERED SUB
PANElS' MAIN SUB
SERVICE ' AMP
ISSUE FEE
APPLICATION APPROV ED BY DATE / �
SUMMARVOF�FEES� . '
BUILDING /Jy�� �
�PERMIT y���� SMIP s .63-
PLAN CHECK $ PERMIT
' � ISSUFNCE E
PLUMBING 5
PLANCHECK S GRADING $
ELECTRICAL b b ,
PI.AN CNECK g MICROFILM y
MECHANICAL S . TOTAL FEE E
PIAN CHECK S LESS AD- �
VANCEPC E_
�/�. �SC�� I'7 � FINAL FEE E���•���
l..i ![ J ( �—
CONSTRUCTION AND PLANNI G POOL & SPA ��
APPROVALS Permit #��L Date � Inspector .APPROVALS �� Permit # Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
. s�, .,R Soi ipe-Un rgml �.; ��'-` 44. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrn - 45. Forms - -
4:� Electrical Conduit-Undrgrn 46. Electrical Bonding � ��
. tee ein orce - . 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn , 48. APPROVALTO COVER-GUNITE
7. ootings 5¢.e. T� � `Q � 49. Electrical Conduit-Undr rn �
6. Foundation � � q� ..Q S 1 D 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn ' 51. Backwash Lines P-Tra ❑� ndr rn �
' 10. Structural Floor Systerii � 52. APPROVALTO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor•Final
12. Street Sewer Connection � � 54. Heater & Vent-Final �
13. Rough Plumbing � � •
14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wiring � 57. Solar System-Final
i 6. Rough Heating & Air Conditioning � encing & Access Approval
17. Ducts• in Structure � APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL ��
20.� Roof Framing •
21. Roof Sheathin
22. Frame and Flashin ' NOTES: ,
23. Insulation f� �Z• $�L.
24. Lathing & Siding .��
25. Drywall Nailing . �S -D-B� '
26. Plaster Brown Coat
27. Electrical Power Meter-Final �
. 28. Final Electric
29. Final Heating & Air Conditioning �
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. $o�ar pomestic-Final �
35: Landsca e S rinklin S stem •
36. Sound Attenuation -
37. Handicap Regulations �
38. FINALSTRUCTURE&BUILDING �P"z�
39. Special Requirements Completed �Z O,�
40. Electric Release to Edison '
41. Gas Release to Southern California Gas Co. �
42. CERTIFICATE OF OCCUPANCY
No Date
ACD���nt to flll in all spaces wit�in
CITY..OF COSTA MESA PERM�T NO.
. � C6NSTRUCTION PERMIT ,��.� �S�o
Address
GorEar Iinas anE sign all approprlata Ceclaralions.
TRACT NO. LOT NO. � B44G. NO.
E-!7 f.iC - TVPE OF CONSTRUCTION '
"� PhOne ❑ NEW ❑ ADD ❑ ALTERATION
�C L ❑ REPAIR ❑ CONVERSION ❑DEMOUSH
License No. ❑ OTHER
DESCRIPTION OF WORK
Contractor � [� ` OG ����}1� Phon� - � 20
Address r JG�'�. .'1.'� '%'. C�.'%Q /1 Q.6fi
LICENSED CONTRACTOR DECLARA ION t
I hereby affirm tnat 1 am Iiconsatl untler provl4�ons o/ Charter 9(com-
mBnUng With SBCtiOn 7000) ot Dlvizlon 3 of the Bu5in05t �aCntl
Professions Cotle�=tl/�y Ilcanse Is In full (orcq�nA 3/OX�.
Litense Class Lic9nse Nd�' _
Date Si9nature
WORKERS' COMPENSATION OECLARATION
I hG/BEy affl�m that 1 �ave a carti(Icate of consent to ulf-insura or a
certiilwte of Workers' Compenution Insuran�e, or a<ertiflatl copy
thereof (Section 3800, LaD. C.). .
' y No. Company
irHfletl copy Is nereby furnls�eC.' - -'
L Lertifietl copy is tlleE with the city Builtling Divislon._
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This 5ection oeetl not be�tomplatetl if the peYmit Is for one huneretl
f$�oa, o, �eu;.
certify that n t�e periormance oi the work tor which this permit is
Izsuatl, 1 shall not emPloy any person in any rtwnner so as [o become
sub�ect to [ne Workers Compensatlon Laws of Calitomla.
Date Si9nature
NOTICE: If atter making this Aeclaration, you shoultl betoma subject
to the Workers' Compensation provislons of tne LaGor Code, you must
forthwith COTpIy with SUth provi510ns or this p¢rmit Shall be tleemetl
revaketl. - ' ' ' ' '
CONSTRUCTION LENDING AGENCV
I h¢rGby dtfirm thdt th¢r0 IS d COnSttuCtiOn lenb��9 agency for the per-
formante of Ihe work tOr Whith IM5 permit 15 issuetl (Section 3097.
Civ. C.).
Lentler's Name
Lentler•s Atltlress
reby ainrm tnat i am exempt irom.tne Convaaors ucensa i.nw �or
followin9 reason (Section 7031.5 Bu5ine55 antl Professlons Cotle:
r Uty or county which requires a pGrmlt. [o COnS[ruCl,_alt¢q
love, tlemolish Or r¢pdif dny StruCtulE, priof (O It5I55uance, a15o fe-
�ei the appliwnt for SUCh permit to flle a si9ned StatemenLthat he
censetl pursuanl to the provislons of the Contractor's Lkense Law
aptar 9(commencing wlth Section 7000) o� Divlsion 3 of the
Iness antl Prdes5fon5 Cotle) or that ha is ex9mpt tnerefrom and the
S for the allegetl ¢xemption. Any vlolatlOn a� Settlon 7031.5 by
appllwnt for a parmit sub�ects tha appliwnt to a clvil penalW
�t more than tive huntlretl Eollars (E500).
I, ds owne� of lhe prOplrty, o� my Bmployae5 wlth wage5 a5 thel�
i CompenSdtlDn, wlll tlo th8 wOrk, antl th0 St�uCturG I5 n0[ In[lntlBtl
�ffared for ule. (Socllon 7044, Businesz and Ro(esslons Cotle: The
ItfdCtOr'S Litens¢ l.dw tloes nOt apply to an owner of a prop¢fty
o builtls o� Imp�ove5 thereon, dntl who tlOeS Suth wOrk hlmzGli or
�ugh hls own employees, provltletl tnat sucn Imp.ovomants are not
:ntl¢E or offeretl for Sal¢. If, hOwever, the builtling Or improvement
�Itl withln one year of-completion, the ownar will hava the burtlan
OroWng he tlltl not bulitl or improve tor the purpose ot sale).
I, as owner of the property, am exclus��ly ton[ratting with
nzetl <ontractors to construcl the projett (�ctlon 7044, Business
Rof¢s5lon5 COtl¢: Tha COn[rdCtOr'S LiCBnSB ldW tloes not apply to
owner of O�operty wno builtls or Improves theraon, antl who ton-
:ts irom such pro7ects witn a contractor(s) ���esnetl pursuant to
❑ I am exemp[ untler Sectlon B. & P. C. for tnis
reamn
Date Owner
that 1 have �eatl thi5 appliwtion tntl State that the abOve
correct. I agree t0 COmply with all City antl county
state laws �¢lating to cOnSlruCtioA, arltl h¢r¢by authOriza
of this clty �fo enteq upon the above mentlooeU
Slgnature
TVPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHAI
❑ OTHER -
PROJECT DESCRIPTION •
SQ. FT. �
OCCUPANCV �=CONSTRVCTIONTVPE
VAIUFTIQN ZONE
GRADING CU. YDS. ACRES
� i A V I . . _ . . .
PIUMBING � "'PLANCHECK
TOILETS URINALS
LAVATORIES DOUBLE LAVS
KIT.SINKS DISHWASHERS
SERVICESINKS - SUMPS
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTRAP
WATERSERVICE ALTERATION
GASSERVICE OUTLETS 1
WATER HEATERS BTU OUTPUT
SEWERCONNECTIONS
SOLAR TANK COLLECTORS
SOLAR PIPING SVS.
ISSVE FEE
MECHANICAL cLArvCHECK
HEATING.SVSTEM 0-100,0008TU_
AND DUCTING 300.000�} BTV _
REFRIGERATION 0-300,000 BTU_
SVSTEM
100,000 + BTU _
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAVSTSVSTEM MULTIPLE ,
ISSUE FEE
CMF 0865-46 White-Builtling; Canary-AppliUnt; Fnk-Ac<ounting; Goltlenrotl-Assessor
7565 iaiaeiei
20NE
REAR VARp (TO
PKG. SPACE REQ.
ZONING APPROVEO BY •
SPECIAL CONDITIONS:
REGULATIONS
PLN7Gp. RUEFL. �
PROPE�RTV LINE
PROVIDED
PARK FEE $
DATE
ELECTRICAL PLAN CHECK
GENERATOR 0-1 KW_ 1-30 KW _
TRANSFORMER .
APPLIANCE 10-50 KW_50 + KW _
MOTORS 0-1 HP_1-SO HP _
(INC.SOLAR) 30-50 HP_50 � HP _
FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
40,76 T4
' PANELS MAIN SU0
_a
� ' - .{�SERVICE AMP
— f..�T% � � . ..
ISSUE FEE
APPLICATION APPROVED BV DATE
SUMMARV OF FEES �
BUILDING
PERMIT E SMIP §
PLAN CHECK S PERMIT
�LUMBING E . �SSUANCE 5 �
GRADING E
PLAN CHECK E
ELECTRICAL S� ' ' a
PIANCHECK S MICROFILM E
MECHANICAL S TOTAL FEE S
PLAN CHECK § LE55 AD- � -
VANCEPC $
FINAL FEE § ' "'•
0
�C,i J ' \•.�.\l•1 i �".�'.0
CONSTRUCTION AND PLANNING POOL & SPA ' �
APPROVALS Permit #.����. Date Inspector qppROVALS Permit # Date Inspector
t. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
Soi ipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce - 47. Rough Plumbin & Pressure Test
6. Electrical UFER Gr� 48. APPROVALTO COVER-GUNITE
7. Footings �49. Electrical Conduit-Undr m
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra '❑ ndr rn
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing
14. Rough Electric-Conduit � �56. Electrical-Final
15. Rou h Electric-Wiring 57. Solar System-Final
76. Rough Heating & Air Conditioning • encing & Access Approval -
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19.. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS F INAL
�20. Roof Framing
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing �
26. Plaster Brown Coat
27., 'Electrical Power Meter-Final �
28. �FinalElectric ' - -5Z .-°L
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test ' �
31. Final Plumbing
32. � �Water Service-Final
� 33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem %
36. Sound Attenuation �
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison -�
47. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date - - - - � . -
_ AVPlicant to fill in atl spaees witM1in haavy OorEer lines anC sl9n all apP�opriate Caeiarotions.
, CITY OF COSTA MESA .ae IT NO. -�� TRACT NO. LOT NO. �BLD NO� ' ' ' '
CONSTRUCTION PERMIT ,$a �j � 7447 10/26/81' � 47.00
� PrOlect AHdress - . ' . . ' "_' " . � .� _ _.. � • . .
IO �+C�, TVPE OF CONSTRUCTION - .
OWneI ��m � � Phone � ❑ NEW ❑ ADD ❑ ALTERATION ..
AHc1fCss � � ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER ZONING REGULATIONS
Arch/Eng. - � License No. A P�
"Addr¢55 � DESCRIPTION OF WORK
20NE PLNG. REFL. p��ry
Contrector V0.� u. ' • Phone(�`Ko'/( TVPE OF PERMIT � �� Bp��RTy LINE �
Addr¢55 ,� " SETBACK C T. O
S3a I�PAIII� 1.Z_ iy ❑GRADING ❑ FOUNDATION ❑STRVCTVRAL SID YARD
LICENSEO CONTRACTOR DECLARATION ' O TENANT ❑ ELECTRICAL '�PIUMBING ❑MECHANICA L5Ep E v �
I hereby affirm tnat I am Ilcensetl untler provisions of Charter 9(com•� .� � {iIGHT �
menUng wlth sectlon -7000) of Dlvislon 3 ot the 8usiness anA ❑ OTHER - - _
Profe551on5 C�antl my ❑c¢n58 IS In full (OrGe d� �HP�.t. ' REAR YARD (TO P/L) ,
PROJECT DESCRIPTION.
LlGens/e Q2�� �t' 8/y�y� � . ��� ' PKG. SPACE RE�. PROVI�ED
DdtO[ �_ ._�'r a�..�r�� e Vl .� $Q.�FT. � . � . .� . . _
WORKERS' COMPENSATION,DECLARATION � � OCCUPANCV_CONSTRUCTION TVGE STREET WIDTH PARK FEE E
I hereby aftirm that I have a ttrtificate of consent to ulf-insure or a � - •-\ � ZONING APPROVED BV DATE '
certififate of Workers' Compensatlon Insurance, or a certifiea copy VALUATION ZONE - ^
thereof (SBction 3800, Lab. C.). GRADING CU. VDS. ACRES SPECIAL CONDITIONS:
Pollcy No. — Company ' ' ' - - - - - - �
� 'erHfietl copy is nereby turNSnetl. _ - . . REMARKS: - ' � � ' • .. .' � . . .
ertifletl copy Is tllea wiih the city Builtling Division. , . „
c..EMPTION FROM WORKERS' COMPENSATION DECLARATION' - ' ' ' �' ' �
(This 5ectian neetl not be completetl if the permit Is for_one huntlretl , ' .
�53001 or less). . . ' ' .. ' - " ' ' ' . . �.
certlfy that ln the performance of [he work for which.this Dermi[ I5
Iszuetl, I shall not emPloy any person in any manner 5o as to�become � PLUMBING � PLAN CHECK ELECTRICAL �- PLAN CHECK, -
subjeci to Ihe Workers Compensation Laws of Cdlifornia. .
Date Signature BATHTUBS SHOWERS �
NOTICE: If after making thls tleclaratlon, you zhoultl become 5ubjecY TOILETS • 3 URINACS �-" ' � GENERATOR- p-1 KW_ 1-30 KW
to thB WOrk¢r5' Compan5ation provi5ions ot tne Labor COtle, you mu5t � TRANSFORMER
for[bwlth mmply wi[h sucb provislons or this permit 5ha11 be tleemetl �VATORIES DOUBLE'LAVS -" ' '� qppLIANCE -' 10-50 KW_50 + KW
revoked. . . . . . _ �
CONSTRUCTION LENOING AGENCY KIT. SINKS � '' DISHWASHERS �- - .�. MOTORS pq HP_1-30 HP ' -
I M1ereby atflrm tha[ [here is a construttlon lentling agency for the per� SERVICE SINKS '� SUMPS -' - (INC. SOLAR) � 30-50 HP 50 + HP -
formance oi the work for which this permit I5 issuetl (Section 3097
Civ. CJ. " - FLOOR SINKS � � FLOOR �RP.INS � FI%TURES ' OUTLETS SWITCHES -"
Lentler'S Name
Lentler'sAtltlress DRINKINGFOUNTAINS � � GASTUBESIGNS �-
OWNER BUILDER DECLARATION - ' - ' � INTERCEPTO(35 CIARIFIERS POCE LIGHTS - " - -
I hereby afBrm that I am exempt from the Contractor'S License Law for
ihe followln9 reason (Sectlon 7031.5 Busine55 antl Protesslons Cotle: 'SWIMMING POOI � PTRAP' - -� -
Any clty or county whlch requires a permit to construct, alter, POLES METERED SUB
Imp rove, demoltsh or re0air any 5tructure, prior to Iis issuance, al5o re- yyqTER SERV ICE ALTERATION � � � PANELS MAIN SUB -
qulres the applicant for sucn permit to file a si9netl statement that he
is Ilcensetl pursuan[ to tne provlsions of the Contrattor'S License Lzw GASSERVICE OUTLETS a — SERVICE ' AMP
(Chapter 9(commencing wlth Sectlon 7000) of Division 3 of the
BusMess antl PrdeSsions Cotla) or tha[ ne is ezempt tnerefrom anC Ihe yyqTER HEATERS� BTU OVTPVT .-- ' - �
basis tor the alle9etl exemption. Any vlolatlon of Section 7031.5 by ••� �
anv appllwnt for a permit sub�ectz the appliwnt to a Nvll penally SEWER CONNECTIONS � �� � � - ''
�t more than (ive nunOretl aollars (E500).
as owner of tne property, or my employees with wages as [heir SOLAR TANK ' COLLECTORSi ,� -` '� `� � -
, compen5ation, will tlo lhe work, antl the sVucture is not Intentletl
or offeretl for Sale. (Sectlon 704G, Business anC Protes5ion5 Cotle: The SOLAR PIPING SVS. � � ��SSUE FEE -
Contractor's Liwnse Law tloes not apply to an owner of a property ' _
who bulltls or improves thereon, antl who tloes such work him5elf or ISSUE FEE � � APPL�CATION APPROV ED BV ' DATE
thvOu9h his own employees, p�ovltletl that sucM1 improvem¢ntz are not
Intendetl or offered for sale. It, however, the builtling or improvement MECHANICAL PLAN CHECK $UMMARV OF FEES
Is soltl wtthin ono year of wmpl¢[ion, the owner will have.t�e burGen . ,
Of prOving he tlitl not bulltl or ImprOv¢ to� th¢ purpoSe of Sale). HEATING SVSTEM 0-]00,000 BTV ' BVILDING � � � .
0 I, as owner of tne property, am exclusively contrac[ing with qND DUCTING PERMIT y SMIP E
Ilcensetl contractor5 to construct the project (Section ]044, Buslness 100,000 + BTU PLAN CHECK y PERMIT .
antl Professlons Cotle: The Contractor'S Licensa Law Coes not apply to - %�� ISSUANCE � S
an owner of property who builtls or improves tnereon, antl who <on- REFRIGERATION 0-100,000 BTU PI.UMBING S� L— -
tracts from such pro�ects wit� a contractor(s) Iicesnetl Oursuant-to SVSTEM GRADING 5.
the Contractor'S Licenre law). 300,000 + gTU PLAN CHECK $
❑ I am exempt untler Seclion B. S P. C. for this BO�LERS BTU ELECTRICAL E S
reason MICROFILM §
Date Owner SVSTEM REPAIR, ALTERATION PLAN CHECK E TOTAL FEE y
I hereby certitytnat I.M1ave reatl this appllcatlon antl 5tate that the above EXHAUST SVSTEM MULTIPLE MECHANICAL S -
Information is correct. I agree to comply with all city ana county 'PLAN CHECK E LESS AD- _
o�tlinances antl Stdte Idws r¢Iating lo cOnstructlon, antl n2�eby authOriz@ VANCE PC $_
representatives of thls ty nter�pon [he above mentionetl
property for � tio pur � Z� �p 26 �
Signature, Date FINALPEE E� �
Drivers' License or 55 � ISSUE FEE - - - . .
Gmr oam-ve rvnne-ouuumy; wnary-sappucanc; nnn-Hccounung; �maenroa-s�.vmwr
.:.CJCONSTRUCTIOMqND�PLANNING POOL&SPA � . \ �
APPROVALS Permit #�P-� Date Inspector qppROVALS Permit #� � Date Inspector
1. Temporary Electricai �rvice or Pole 43. Pool & Equipment Location -
. i ipe-Undrgrn - 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electriral Conduit-Undrgrn 46. Electrical Bondin � � -
. tee ein orce 47. Rough Plumbin & Pressure Test ' �
6. Electrical UFER Grn � 48. APPROVAL TO COVER-GUNITE
7. ootings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test �
9. Water Pipe-Undrgrn 51 . Backwash Lines P-Tre ❑ ndr rn �
10. Structural Floor Systpm 52. APPROVAL TO DECK
1 t. Property Sewer Line & House Connection JO yl 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing ��
14. Rough Electric-Cond�it �56. � Electrical-Final
15. Rough Electric-Wirin 57. Solar SYstem-Final
16. Rough Heating & Air �onditioning • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18: Ducts, Ventilating •- � '� .
19. Gas Pipe-Rovgh & Test � 60. POOUSPA SYSTEMS FINAL
20. Roof Framing �+- '" •
21. Roof Sheathin � � � -
22. Frame and Flashin NOTES:
23. Insulation �
24. l.athing & Siding �
25. Drywafl Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final � �
28. Final Electric ^ -'
29. Final �Heating & Air Conditioning 8`� � -
30. Final Gas Pipe-Test - 'y � 'lj � �
31. Final Plumbing - yz
32. Water Service-Final �
33. Gas Service-Final �
34. Solar pomestic-Final
35. Landsra e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations ' ""
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to �dison
41 . Gas Release to Southern California Gas Co.
42. CERTIPICATE OF OCCUPANCY
� No Date
Applicanl to fl11 in all spacas withi� heavy Dortler lines ana sign all apD�oprlate tleclaroHons.
CITY OF COSTA MESA P�j�p IT O - TRACT NO.- LOT NO. -BLDG. O. �-" ' - ' --�- -- �- -
CONSTRUCTION PERMIT 1 "� � �J�� ' � ' ._ " • '
' 1'; �0597 I%13/8�2� � '`1'11.00'ETL�
Project Address � �a, � TVPE OP CONSTRUCTION � 1� � ` _�� , . - ,' " �' "- ' , �'.,- �' ' '
' Ownef ' ' � PFone ' ❑ NEW ❑ ADD O ACTERATION - ' � ' � - _ ' : , ' -y
' AddrCss ' `� N. � ❑ REPAIR .❑�CONVERSION.ODEMOLISN- ._ � � � _ . _.
'Arch/Eng: � - � � �License N . - 0 oTHER. - ' , ' ZONING REGULATIONS� �� �' �
DESCRIPTIONOFWORK P"P"� ' �^'��
� Addre55' . . . .' "'. . .. . . .. � . . ZOIVE �. . . � PLNG. REF. �, ' , " -'
"'Contrector ; - CA- �-- - -Phone�(p3/ ,3 TVPE OF PERMIT • - - ' -- � B � � - - ��OBv��F�Y LINE �
. SETBAC C L 5T. -
��Add�05s�'--- -"- �" - " _ , "' ❑�GRADING. � ❑ F,OUNDATION ❑STR CTVRAL -LDE,�,VARO - ' - � -
-LICENSED�CONTRACTOR DECLARATION --' ' ' ' ' EF
❑ TENANT ❑ ELECTRICAL ��PLUMBING �GOECHANICA 51DE VA � - � - - � -
� h¢reby affi�T Itidt I am Ilcensetl untler prov�sions of Charter 9(com-; � RIGHT
mencin9 with section' ]000)' ot Division 3 of the �Business antl ❑�OTHER - . .. __ , .
Professlons Cotle antl my license is in full force antl effe . � REAR VARD (TO P/L) . .
�. PROJECT DESCRIPTION .
liten1se Class � ' i<en No , . � - � PKG. SPACE REQ. ., PROV IDED- -
�atei �'�f FfZ5i9nature . . . • . -•. SQ. FT.. _. _ _ .. ,. . ... . _ . - ' " _
"WORKERS' COMPENSATION�DE R ON - - OCCUPANCV '_CONSTRUCTION TVPE STAEET WIOTH PARK FEE�$ ,
I hereby affirm that I have x certificate of consent lo self-Insure or a VALUATION ZONE � ZONING APPROVE� BV � �� - DATE -
-C¢rtifitdt¢ of WO�kefs' CompenSatlon InSufdnCe, or� a certifietl copy -- � - . . . , , _ ... _ - "' _ _
thereof (Section 3800, Lab. �,). �'GRA�ING CV.�YDS. ' ACRES � SPECIALCOfJDITIONS: � .
�Poliry No. ' ' " _ComPanY ' '_ _ _ - ' ' " " ' " ' ._
❑ Certlfietl COpy is hereby fumishetl. __- . - !' REMARKS: ' _ . .
- i
3a1 Certified copy is filetl with the city Builtlinq Divislon. , ,
%?(EMPTION FROM WORKERS' COMPENSIITION DECLARATION' ' ' - ' - - � - ` � -���� �
� 3CThis.section neetl not bE COmplet¢tl if th¢ permit i5.f0�_one,huntlreQ __ - � � . i ��.
f51001 or iess). rr . "... . ' _ . . , ' . ' _�.. .. _. . . _ . . _ . .
I certify_that.in.the�performance�of.the.work for_which this permit fs , .
issuetl, I shall not employ any person in any manner so�as to.0ecome�. -PLUMBING•'� PL�AN CHECK - -- ELECTRICAL- � � PLAN CHECK -
subje t to [h Work sLCompensat/i ( ws of., ifomia: LL _:.I ._ _ ' '
Date � (� �Signature �Yaq�f �9�6� B/�THTUBS -SHOWERS � � � � - - ` , ` - '
NOTICE: If after making this tlecl ia lo� ou houltl b¢coma subject �TOILETS^ ��_ . a VRINACS -"--' '"` -` GENERATOR' ' p_1 KW_4-10 KW �
to the Work¢r5' Compen5ation provk' ns of th Labor Cotle, you must ' - ' �' ' .. ` � TRANSFORMER - � -.. . _ _ .
forthwith complylwith such proWsions or this permit shall be tleemetl LAVATORIES, DOUBLE LAVS" -'' """ '� '- 'qPPCIANCE- �� 10-50'KW_50'+�KW' ' " '��
.r¢vOkCtl.- .� �.
CONSTRUCTION LENDING AGENCV � KIT.SINKS � � �' 'DISHWASHERS' -" " ' MOTORS - ' p-1-HP_1-30 FiP'"' " ' "
I hereby affirm that there is a construction lentling agency for the per- SERVICE SINKS'��"'j)�' SUMPS ` "- "- - ^UNC.�SO�AR)� -30-SO�HPy-��50-+.HP- �=- - -
formant¢ of [h¢ work for which fhi5 p¢rmit IS issuetl (Se[tlon 3097 -
' Civ.-CJ. ' ' -- • - ' - " - - - ' ' -- - -- FLOOR SINKS � ��FLOOR�DRAINS � -� FI%TURES ' "-OVTGETS" �" SWITCHES " ' " , 1
Lender's Name
.__ . _ ... . .. __ _ . . . '_ "' `"_"_'"'_ M1 ' .
Lentler's Atltlress DRINKING FOUNTAINS ' � � - `- - - - - - - GASTUBE SIGNS ' ' " '- ' -
"OWNERBVILDER'DECLARATION"' ' -- " � ' ��� �INTERCEPTORS CLARIFIERS � � -P�LEL'IGHTS "'- -"' ' - -
I hereby aftirm that I am exempt fromSne Contractor's License Law for
the followingreason (Sectlon�7031.5-Business antl Profes5lonsCotle: SWIMMING POOL` ' P'TRAP� ' - ' ' ""' ' - - - -
Any city or <ounty which requires a permit to construcq alteq � POLES METERED SUB�
'improve; tlemollsh-or'repair anystructure, prior'to its issuance,-also re-' yyqTER�SERV ICE - ALTE(3ATION- -'-� � -" � � PANELS ` �-" - MAIN'� . . SUB ` " ' "
qul�es tM1e apHlicant (o� such permlt to tlle a signetl statement tnat ne . u,
'is'licensed pursuanYto'[he'provislons'ot the•Contrattor's-Cicense'Law' "GASSERVICE OVTLETS�� � �� ` 'SERVICE-"' " "' ' " AMP � - ' -� �
(Chapter 9 (commencin9 '�+ith Sec[ion 7000) of Division 3 of ihe - 4 _ _`_ _ - _ �— -
Business'antl' Prdessions Cotle) or that ne'Is exempi tnerefrom antl the- ' yyqTER HEATERS BTU'OUTPUT- � �� -
basis tor the allegetl exemption. Any violation of Section �031.5 by -
'any'appllcant for a permit subjects'tne'applicant-to�a'civil penalty- 'SEWER CONNECTIONS -' 1( - - --"'' - �" � "' " "' - "' "' ' ' ' - `- ' - � '- - '
of nol more [han five huntlretl tlollars ($500). '
1, a5 owner of Ihe property, or my ¢mployee5 witli wa9es a5 their' - SOLAR TANK � - '"' �COLLECTOiiS'—' � � '" -"-' ' ' '^" - "' "' ' ' ' ' - -
rortlpen5ation, will,tlo the work, antl [he st�ucturE is not intentl¢tl, '
otferetl Por sale. (Section 7044, Business antl R'ofesslons Code: The SOLAR PIPING SVS. fy '� �'-�SSUE FEE -- ' '- '" '
_Contractor'S License Law tloez not apply. to.an owner of a property '
`� wh0 builtls or improves thereon, antl wM10 tloes such wo�k himself or �ISSUE FEE �� � ' APPLICATION APPROVEO BV - ', _ '. DATE� f �-�
`� .throu9h_his.own employees, provitletl_that such improvements are not_ ' _
\ intentletl or oitereC for sale. If, however, the builtling or improvement MECHANICAL PLAN CHECK
V JSSoItl within oneyear of completion, tne owner will have the burtlen SUMMARY OF FEES
of provinq he tlitl not build or improve for [he purpose of sale). BUICDING - —' '- �•- -- ---- -
:� HEATING SVSTEM 0-100,000 BTU PERMIT g '.SMIP . $ - �
��❑�I;-as owner-of the property, am exclusively conVacting with qNDDLICTING"' -' � "" '— - "� -�- -- -
licensetl conbaclors to mnstruct the projeCt (Sec[ion ]049, Business 100,000+gTU PLAN CHECK E PERMIT �
�antl Prafezsions-Cotle: The ContractoYs License Law�tloes no[ apply to - _ _ - -- .. - , _ _ ISSUANCE 8 .- �
an owner of property who builtls or improves thereon, antl who con- REFRIGERATION 0�100,000 BTU PLUMBING $
tracts-f�om-SUCh proje[Is-with-a cont�actor(5)•�licesnetl pur5uant to- �SySTEM`- ' - GRADING $
�the Cantractor's License Law). _ _ 100,000 + BTU PLAN CHECK ; E � _ _ - . ' �, .�'^ : < I
❑' 1 am exempt untle'r�5ection � "B. & P.-C.�foPthis- . -8
� _ _ _ __ BOILERS - BTV ELECTRICAL 5� . .
reason - � - - 'MICROFILM,y
SVSTEMREPAIR,ALTERATION PLANCHECK $
-Date� - Owner � TOTAL' FEE § ' � � �
I hereby cer[ify_that 1 M1ave reatl this application antl state that the above EXHAUST SVSTEM NIU�TIPLE MECHANICA� $'�, .
iri(ormation is cmrecL I agree to tomply with zll city-antl county � PLAN'CHECK "E - - LESS AD- ' _. _ ,
VANCEPC �$ � ' ,
pIdl�IdpC25 dOd Sld[¢ IdWS ICIdIl0910 COOSIIUCf10f1� dOd ilElEbY d11ShOIlZE ,�• ��, . , , j
representatives of tfiis ci fo enter upon the abbve mentioned ' Q ' � `OO
,property_for ' spe tlon_p p ses. S
Slgnature , ^_ Date ��`'L- i. � � - - �. .__ . FINAL FEE
�rivers' Licens 5 'I SUE B - --- - � - ---- - - - � - _ .. . .
CMF 0865-46 White-Builtling; Canary-Applicanf; Pink-Accounting; Goltlenrotl-Assessor
. CONSTRUCTION AND PLANNING � :\ � ' POOL & SPA � ' � � �
°'� '� Date Inspector � - Date Inspector
APPROVALS Permit # ��� . APPROVqLS �� , ���� Permit # -,. '� �
1. Temporary Electrical Service or Pole � ' '� 43. Pool & Equipment.location . - - •�
. Soil_ ipe-Undrgm � ' - � 44. Steel Reinforcement � � ' � � � t - - �
J.3. Electrical Conduit Utility-Undrgrn . _ . 45. . Forms � �"-' - � �
4. Electrical Conduit-Undrgm � � 46. Electrical Bonding . - �
tee ein orce . �. L�. 47. Rough Plumbin &-Pressure Test
6. Electriral UFER Grn - ' 48. APPROVAL TO COVER-GUNITE -
7. Footings_ _ �' � 49. Electrical Conduit-Undr m -
8. Foundation ' ' ' ' ' 50. Gas Pipe -� Undr rn, Test � � ' -
9. Water.pipe-Undrgm _ � � 51. Backwash Lines� P-Tra "� ndr rn''"� � - - � - �
10. Structural Floor System •'� � � 52: APPROVALTO DECK -- - - "'-"' "" ' ' ' '- ' �
. 11. Property�Sewer Line & House Connection' ' . 53. Backwash & Rece tor-Final ' � � �� � � � ' �
_ 12.. Street.Sewer Connection � ' ""' ' � _- 54. • Heater & VenbFinal � � �
13. Rough Plumbing � - �� - - • - `� ' -'"" - -` ' '
14. Rough ElectricConduit - � - -- - - -56. �•Electrical-Final ��
15. Rough-Elec4ric-Wiring ��- � - ` - - - - - - - • -57. SolarSystem-Final �.: '�' ' � � '�� ' ' ' � ��' � ` �'
-"16. �Rough Heating & Air-Condicioning•= � - - -- � �� (. � :L- . �cing & Access Approval - • ��
17._. Ducts, in Structure "'' ' a � 9• APPROVED'FOR PLASTERING� ' � �
- 18. - Ducts, Ventilating . '� ' _ ,. ' ' .? , ._ . . ____ . '
19. Gas'Pipe-Rough-&Test '^'' ' . • - .J_ _60. POOUSPASYSTEMSFINAL� _ "�i � . .� r--� , :..
- -- - - . ., • �.-
� 20.� - �Roof Framing. . � ' - ' � � ' � ' � ' � � �
- -- - ---- -- - • - - - � --
21. Roof Sheathin � ` ' ��� ' ' '
_ .. . . - � . _. rr,� .. ,t�.
._. _ , .__ . . _ . -_ .. .
- 22. . Frame.and Flashin � • NOTES:' ' ' � � . , , ". ' ` ". - � . � '. '
�23.- Insulation- . - - - ,., - - - . . , _ . �
� 24. Lathing-& Siding ' ' " - "� ' ' ' - - -- � • �
. _25. Drywall Nailing . - - - - - - - - - ' � �'�. . � . . . . . .
- 26. Plastgc 8rown Coat � " � • � � � � � � � �
_27.. . Electrical Power Meter.-Final.' � � � � ' � '� � - ' � - � - � - - -
28. Final Electric ' � � � � ' � � � �
- 29. Final Heating & Air-Conditioning. �2- � - � - � � � `
30. Final Gas Pipe-Test � ' ' `` ' ' � - " '
31. Final Plumbing ' - � '� ' ' ' ' � �
32. Water Service-Final- � � � �
. 33. Gas $ervice-Final ' ' �
34. Solar pomesticFinal - ' � ' � � � '
35. Landsca e S rinklin S stem ' - ' � � '� �'
36. Sound Attenuation � ' ` �` � � ' '
37. Hanqicap Regulations ' � ' � � ' � �
38. FINqLSTRUCTURE&BUILDING � � � - -- - • � - �� �
39. Special Requirements Completed �� � ' - ' - �
40. Electric Release, to Edison - �. �; ' ' � - - - � � � �-
41. Gas Release to Southern'Calif rnla Gas Co. ' � -
42. �CERTIFICATE OF OCCUPANCY _ � �_ �
• No Date �'' �. � '--' . . -
- - . . . . ...... .
. . , . . . . � _ � �
Y
` Applicant lo fill in aIl spaces within heavy borAer Ilnes ane sign all apo�opriata Ceelarations.
, CITY OF COSTA MESA � PERMIT NO. � TRACT NO. ' LOT NO�. , � BLDG. NO.
CONSTRUCTION PERMIT -�//'S 6 d
ProjectAddress 21� 16TH PIACE� �'� TVPEOFCONSTRUCTION
Owner Phon2 �,NEW ❑ ADD ❑ ALTERATION
Address' ❑ REPAIR ❑ CONVERSION ❑DEMOLISH-
Arch/Eng. - � ' License No. - - ❑ oTHER -
DESCRIPTION OF WORK �
Address - -- - �
1
� Contractor kTN�iFV �TA !'hNnTT7(1NTNf_Phone 779_14 'rvoo nc ovo..�r
BLDG. 2, LOT�B, PLAN B 9773 12/21/BI
� �. -
Addrest ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
LICENSED CONTRACTOR DECLARAT�ON ❑ TENANT ❑ ELECTRiCAL -OPLUMBING }�v1ECHA1
I hercDy atflrm that I am Iicensetl untler provisions ot Charter 9(com- . �
menting with section 7000)' of • Divislon 3 of the Business antl ❑ OTHER
Professions Cotle, �antl my Iitense is in fun torte ntl ettect. ' pROJECT DESCRIPTION"
License Class C-20 License �I 8688 ' - � - �
Date � 7—� �—Q� � Signature ' < . FT. _ _
WORKERS' COMPENSATION DECLARATION _ ' O UPANCY_CONST.RUCTION TYPE _
I hereby at�irm that I have a certlficate Ot consent to self-in ure or a VALUATION- - ZONE
t^"ITltdt¢ Of Work¢r5' ComOensation-In4u�ance, o� a certitietl copy �� �
'of (Section 3800, lab. C.). GRADING CV. VDS. ACRES _
yNo.--WPR1]149R -ComPanr� FRFM(1Nl` .. . . .
�J Certi(ied COpy i5 hereby furnishetl. - -� - -- - REMARKS: ./ . . .
�.Certifietl topy is (iletl with the city Builtling Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLABATION -"- ' ' '"
(ThiS 5¢ctlon neetl noi be COmpl¢t¢tl if the pe�mit i5 fo�.one huntlrEtl .
(E100) or less). .' .�
I certify Ihdf In the pe�fo�mance oi the wo�k fo� whiCh this periiiit i5
Issuetl, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK �
subjecLto the Workers' Compansation LawS of_�alifomia. .. _
Date Signature BATHTU85 SHOWERS '
NOTICE: If after making this tleclaration, You should become'subject TOILETS - URINALS ' �
to the Workers' Compensatlon provisions Uf the Labor Cotle, you must
forthwitn comply with suth provisions or tnis permit shall be tleeme0 LAVATORIES DOVBLE LAVS �
revoketl. � - . - ' - "' ' ' KIT. SINKS - DISHWASHERS � �
GONSTRUCTION LENDING AGENCV
I hereby affirm that there is a con5tructioP lentlinq agency for the per- SERV ICE SINKS ,.SVMPS � �
formance of the work tor which this permit is issuetl (Section 309]
Civ. CJC - - ' - � � �— - FLOOR SINKS FLOOR DRAINS �
Lentler's Name
Lentler'S Atltlress DRINKING FOUNTAINS � - �
OWNER BUILDER DECLARHTION � �� INTERCEPTORS CLARIFIERS
I hereby affirm ihat I am ezempt fromihe Cwtractor's License Law for
[he tollowing r¢a5on (Section 7031.5 BuSinesS antl Professions Cotle: SWIMMING POOL P�TRAP '
Any clty or munty which requires a Permit to con5truct, alter,
� orior to' its'issuance, also re-
a signetl statement that he
^��.;;�e55 and �Profe55ions Cotle) or that he is exempt therefrom antl the
for the alle9etl exemption. Any violAtion of Section 7031.5 by
�'v".'�applicant fot a permit Subjects the applicant to d Civil penalty
�'=4iot more than tive huntlretl tlollars (g500).
❑ 1, as owner of the property, or my emPloyees with wa9es zs their
sole <ompen5ation, will do tne work, antl thestruc[ure is not intentletl
or offeretl for sale. (Section ]044, Business antl Professions Cotle: The
Cont�acto�'s License law tloe5 no[ apply to an owne� ot a p�operty
wh0 builtl5 or improves thereon, antl whtl tloes such work him5elf or
[hrough M1is own employees, provitletl. tha[ such.improvements are not
int¢ntl¢tl Or offer¢tl for Sale. If, however, the builtlin9 or improvement
is soltl within one year of completion, Ihe owner wtll.have the burtlen
of O�oving h¢ tlitl not bui10 0� improv8 fo� tne purpose of sale).
� 1, as owner of the property, am eXclusively- mntracting with
IicenSed contraCtorS to wnstruct the project (Section 7044, Business
antl PrOt¢s5lon5 Cotl¢: Th¢ Cont�acto�'s Li�ense Law tloes not apply to
an owne� of prope�ty who builtls or improve5 thereon, antl who con-
t�act5 f�om such proiects' with a contrac�or(s) licesnetl pursuant to
the Contractor's License Law).
❑ I am exempt untler Section � �B. & P. C, for this
reason
itythat I have read this applical�on antl state that Ihe
Is correcf. I aqree to comply with all city antl [
�tl stale laws relating ro cop stru�t�on, antl hereby aut
25 of this city to entel uPo� the above me/i
WATERSERVICE � ALTERATION
GASSERVICE OUTLETS �
WATER HEATERS BTU OUTPUT-� �^
SEWER CONNECTIONS � �
SOLAR TANK COLLECTORS �
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL aLAN CHECK
HEATING SVSTEM 0-300,000 BTU
liNO�VCTING 100,000+BTU
REFRIGERATION 0-300,000 BTU
SVSTEM 300,000 + BTV
BOILERS BTV
SYSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
Iproperiy or i p u n pur o6 .; .� "" /�
Signature
��Drivers' License or 55 � " ISSUE FEE
`�\ F 0865-46 White-Builtlinq; Canary-ApP�icant; Pink-Accounting; Goltlenrotl-Assessor
7
REAR YARO (TO P/L)
PKG.SPACE REQ.
STREET WIDTH
SPECIAL CONDITIONS:
ELECTRICAL "
� 7.00 TL
PLNTGp. RUEF. p� •
PROPE�RT VNLI NE
PROVIDED
PARK FEE $
DATE.
PLAN CHECK �
.IIGIIAF _._. . . _
" GENERATOR ' 0-1KW_I-lOKW—
TRANSFORMER
APPLIANCE 30'-SOKW_50+KW,__
' ' �MOTORS '0-1 HP_1-10'HP =_
, (INC. SOLAR) - 10-50 HP_50'+ NP' �_
� FIXTVRES� '� OUTLETS SWITCHES
"' -' ?GAS TUBE SIGNS' " ' -
-' - POLE LIGHTS ' - " " ' "'
4
3
PANELS ' - 'MAIN
SERVIGE "
SUB
AMP
ISSUE FEE ' ' - '- '
APPLICATION APPROVED BV' ' OATE -'
SUMMARV OF FEES , �
BUILDING - "- '
PERMIT a SMIP .-E'
PLANCHECK $ � PERMIT � �
PLUMBING g " �SSUANCE $ � -�� �
PLANCHECK $ G0.ADING .$
ELECTRICAL $ � E
PLANCHECK -$ MICROFILM 5
MECHANIGAL $� , T�TAL FEE $ ' _7 • OO
PLAN CHECK g LE55 A�- � ,
VANCEPC $_
FINAL FEE E 7• OO
. , , ,I
� o� CONSTRUCTION AND'PL'ANNING �� c' ' POOL & SPA �
APPROVALS Permit# -�IL� Date Inspecto�� ;APpROVALS. . . Permit# Date� Inspector
1. Temporary Electrical Service or Pole � 43.. Pool & Equipment Location - -- - -
Soil Pipe-Undrgrn 44. Steel Reinforcement � �- � -�
3. Electriral Conduit Utility-Undrgrn , 45. Forms � - �'
4. Electrical Conduit-Undrgrn �' 46. Electrical' Bonding �� �
. tee ein orce � 47. Rough Plumbin & Pressure Test ' �
6. Electrical UFER Grn ' ' 46. APPROVALTO COVER-GUNITE • �
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation � - � 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn � 51. Backwash Lines P-Tra ❑ ndr-Fn'
10. Structural Floor System . 52. - APPROVAL TO DECK ' - � ' ' - - �
11. Property Sewer Line & House_Connection 53. Backwash & Rece tor-Final
12. Street,$ewer,Connection "� ' � � 54. Heater & Vent-Final
13. Rough Plumbing - "" � � � - -
14. Rough Electric-Conduit � � ` - '56. � Electriral-Final -
15. Rough Electric-Wiring -- � � � - 57. Solar SYstem-Final �� � �
16. Rough Heating & Air Conditioning • encing & Access Approval ��
17. .Ducts, in Structure � APPROVED FOR PLASTERING � �
18:. Ducts, Ventilating � -� _ _
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL '
20. Roof Framing . ' �
21. Roof Sheathin � � � . - . �
22. Frameand Flashin •NOTES:
23. Insulation � � �
24. Lathing & Siding
25. Drywall Nailing -
26. Plaster Brown Coat
27. Electr.ical Power Meter-Final ' � �
28. Final Electric � ' ��
29. Final Heating & Air Conditioning S" � s- ,.: �;
30. 'Final Gas Pipe-Test - ' �
� 31. Final Plumbing ' �
32. Water Service-Final - - � � �
33. Gas:Service-Final - -
34. Solar pomestic-Final � � '
35. Landsca e S rinklin S stem � '�
-36. Sound Attenuation � ' '
37. Handicap Regulations - ��
38. FINALSTRUCTURE&BUILDING �
39. Special Requirements Completed ' '
40. Eleciric Release to Edison � "
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
, .
� No Date , . . . , . �
'
. Applieant to fill In all spaces wilhin heavy borEer lines antl sign all apDroDriate tleclarations.
CITY, OF COSTA MESA PERMIT NO. TRACT NO. l_OT NO. BLq� . NO.
: CONSTRUCTION PERMIT ,� s I.� � 7564 10/28/81 ' 39� I I 1
�� ' .. __ .. .- - -.. __ .,,. .
Prolect Address 0 `G TVPE OF CONSTRUCTION � ,� �
OwnCI � F' . %� � �(a • Phone ❑ NEW ❑ AOD ❑ ALTERATION �
Address � �(J /� k� ❑ REPAIR O CONVERSION ❑OEMOLISH ZONING REGULATIONS
Arch/Eng. License No. ❑ o7t�ER
- . DESCRIPTION OF WORK P"P' �
AddrMS '� � ' ZONE PLNTGp. REFL. p� �
Contractor � GyIOG OW Phone.-rj' �2?� TVPEOFPERMIT SETBaCic ST. PROP��RTVNLINE
AddreSS � � � � � ❑ GRADING. ❑ FOVNDATION ❑ STRUCTURAL ID YARD . . ,
LICENSED CONTRACTOR DEGLARATION ' ❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHANICA 5Ep E VA
I hereby affiim that I am Ilcensetl untler provislons ot Charter 9(com- � - RIGHT
mencing with sectlon 7000) o( Divislon 3 of the Bu5ine55 antl ❑ OTHER
Profeislons Cotle antl my Ilcense is in tull forc an ef e t.� - ' � REAR VARD (TO P/L) ' �
License Class ` � ense o PROJECT DESCRIPTION �
SQ.FT. 7KG.SPACE REQ. PROVIDED
Date - Slgnature -� STREET WIDTH ' PARK FEE $ �
WORKERS' C MPENSATION DECLARATION �CCUPANCV_CONSTRUCTION TVPE
I hereby at(irm that I have a certiflcate of consent to self-in5ure-or a VAWATION ZONE ZONING APPROVED BY -. DATE
tertlllcale of Worken' Compensatlon Insurance, or a certifietl copy
thereot (Soction 3800, Lab. C.). . GRADING CU. YDS. ACRES SPECIAL CONDITIONS: ' � � �
Pollcy No. ComDany
'erUfletl CoOY I5 hereby furnBhetl. - " REMARKS: "
ertl(ietl copY is flletl with the city Bulltling Dlvislon. � '
G..EMPTION FROM WORKERS' COMPENSATION DECLARATION � - �> .�
(This sectlon need not be completeC if cbe permlt I5 for one�huntlretl - � - - — - -
SEter��fy thats�n tha periormanu�of the work tor which this permit Is
ISsueC, I s�all not emQloy any person in any manner zo as to become PLUMBING - PLAN CHECK ELECTRICAL PLAN CHECK '
sub�ett to Ihe Workers Compensatlon Laws of Ullfornla. - -
Date Signaturo BATHTU85 SHOWE0.5 ��
NOTICE: If atter making this declaratlon, you shoula become subject TOILETS VRINALS GENERATOR 0-1 KW_1-30 KW
to the Workeri' Compensation provlsions of the Labor Cotle, you must TRANSFORMER - - � �
torthwith comply with such provisions or ihis permit shall be tleemetl LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW_SO+KW
�¢vOk¢0. - ' -
CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS MOTORS 0-1 HP_1-30 HP
I hareby atflrm lhat there Is a constructlon lentling agency for Ihe perv SERV�CE SINKS � SUMPS UNG SOIAR) 30-50 HP 50 + HP
formante of the work for which this permit.is Issuetl (Sectlon 3097
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTVRES OVTLETS SWITCHES
Lentler'S Nama
Lenaer's Atltlras DRINKING FOUNTAINS � �GNS TUBE SIGNS
OWNER BVILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby aHirm that 1 am axempt (rom.the Con[ractor's License taw for ''
th¢ f011owlnq reason (Sectlon 7031.5 BUSin¢Ss antl PrOfe55iOn5 Cotle: SWIMMING POOL P TRAP
Any city or county which reduires a permit to. construct, alter, POLES METERED SUB
Improve, dBmollSh or repair any sfrutture, prior to i[s issuance, al5o re- yyqTER SERVICE ALTERATION PANELS MAIN SVB �
quiret [h0 appllWnt fo� such pormit to tlle a signetl statement t�at he
IS IiG¢nsea pursUant to the provisions ot th¢ Conlydctor't License Law GAS SERVICE OUTLETS �� SERVICE �. O O AMP �
(Ghapter 9(cammencing with Sectlon 7000) ot Division 3 of the
Business antl Ade55ions Cotle) or that he is exempt there/rom antl the yyqTER HEATERS BTU OUTPUT
ba5i5 for the alleqetl oxemption. Any violatlon of.$ection.7031.5 by
a��' appliwnt for a permit sub�etts the appliwnt to a civil penalty SEWERCONNECTIONS q
� t more than (ive hunarea aouars (5500). . '" �%�� r / � �
� ds Own¢r of [he p�operty, or my GmplOy¢¢5 witM1 wages as lltel� SOIAR TANK COLLECTORS . .
soro Compo05atlo0, will tl0 the wo�k, ana the st�ucture Is not in[entlGtl - -
Or 0lfttetl tor SaIC. (Section 7044, Bu5ine55 antl Ao(esslons Cotle: The SOLAR PIPING SYS. ISSUE FEE �
Contrattor'S License Law tloes not apply to an owner of a property
who builtls or improves thereon, antl who Does suth work himselt or ISSUE FEE APPLICATION APPROVED BY � DATE
through his own employees, proviaetl that such Improvements are'not
Intenaetl or o(feretl tor sale. If, however, the builtling or improvement MECHANICAI PLAN CHECK SUMMARV OF FEES
is SOIE withln ono year of <ompletion, the owner' will have the burtlen -
ot proving he tlitl not builtl or improve for the purpose of sale). _HEATINGSVSTEM 0-300,000 BTU BUILDING . �
❑ I, as owner of Ihe property, am exclusively con[racting with PERMIT $ SMIP .$
Iicensetl canVaclors to construct Ihe project (Sec[lon 7044, Business %�ND DVCTING 300,000 t BTU
- P�AN CHECK S PERMIT
antl Protezslons Cotle: The Can[rac[or'S Litense Law tloes not apply to ISSUANCE' S
an owner of praperty who builtls or improves thereon, antl who con- ,.REFRIGERATION 0-300,000 BTV PLUMBING E '
tracts (rom such pro�ects witb a contractor(s) Iicesnetl pursuant to SVSTEM � •.GRADING E� �
th< Con[ractor's License Law). 100,000 + BTU PLAN CHECK E�,� •
❑ I am exempt untler SecHon 6. 6 P. C. for this gOILERS BTU ELECTRICAL S�LL - ' s
red50n MICROFILM §
Date Owner SYSTEM REPAIR, ALTERATION • PLAN CHECK E TOTAL FEE §
I hereby certifythat I have reatl this appliwtion antl�stateihat the above EXHAVST SVSTEM MULTIPLE MECHANICAL S �
Iniormation is correct. I aqree to comply with all cily antl county PLAN CHECK S LE55 AD� �
VANCE PC S
ortlinantes antl sta[e laws relating to construction, antl hereby authorize
representatives of this ity to nter upon the above mantio etl � !�
propnrty for In lo � purpos . �• � D — � - -
$ignalura � Da e �v '°' � - _ FINAL FEE E _�_
Orivars' License or 55 � ' �• ISSUE FEE - ' '- '
GMY Vtlb]-90 wplt8-tlullding; Cdnary-AppliGdnt; VInK-Hccountln9; GDltlenfoO-Hssesso�
� � � �F�. CONSTRUCT110N AND,�PLANNING '' POOL & SPA - - . ' �•
APPROVALS Permit #� 15�7 Date Inspectbr qppROVALS Permit # Date Inspector
i. Temporary Electrical Service or Pole 43. Pool & Equipment Location � �
Soil ipe-Un rgrn 44. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn �/ ,� 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn 46. APPROVALTO COVER-GUNITE � �
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra •❑ ndr rn �
10. Structurai Floor SYstem 52. APPROVAL TO OECK � � �
71. Property Sewer Line & House Connection ' 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing
14. Rough Electric-Conduit �56. E�ectrical-Final
15. Rough Electric-Wiring _(o- 57. Solar,System-Final
i 6. Rough Heating & Air Conditioning � encing & Access Approval -
17. Ducts in Structure APPROVED FOR PLASTERING
18. D'uas, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
- 20. '• Roof Framing � �
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation - '
24. Lathing & Siding
25. Drywall Nailing
. 26. Plaster Brown Coat
27. - •Electrical Power Meter-Final
28�. � Final Electric -i52
29. Final Heating & Air Conditioning
30.' Final Gas Pipe-Test "
31. Final Plumbing - �-
'32. : Water Service-Final � '
33. Gas Service-Final
34. Solar pomestic-Final
35. landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison �
41. Gas Release to $outhern California Gas Co.
42. CERTIFICATE OP OCCUPANCY �
'` No Date . .
�
Applicant to flll in all s0aces within neavy bortler lines anE sign all approp�iate Geclaraliont.
' CITV-OF COSTA MESA - PERMIT NO. �� / - ' TRACT NO. LOT NO. BIQG. O. ''
� CONSTRUCTION PERMIT /� ol' 3/ y- '' �
Project Address TYPE OF.CONSTRUCTION�
OWne1 �'�-� PhOne �j � ❑ NEW _ ❑ ADD ❑ ALTERATION - /� '
Addrea Q — � � � O REPAIR ❑ CONVER510N ❑oEMOLISH ��
Arch/Eng: � -License No. •� - ❑ O7riER:
AddfeSi -' '- - - - - • _ . _ __ DESCRIPTION OF WORK
Contraclor ' �p - Phone ' TVPE OF PERMIT �
Addfeu - ' � " ' ❑ GRADING '❑ FOVNDATION ❑ STRU�,C.,/TURAL -
LICENSED CONTRACTOR DECLARATION � � ❑ TENANT ❑ ELECTRICAL OPLUMBING ➢OMECHANICAL
I nereby affi�m that I am Iicensetl untler provisions of Charter 9.�com- � ' _ /�
men<Ing with section ]000) of Division 3 0/ [he Business� antl �❑ OTHER
Professlons Cotle', antl m Iicense Is In (ull force a tl effecl. pROJECT DESCRIP.TION ��
License Class ' Licen No.� � . �
Date �'-� i-�2' "Si9nahre � SQ: FT. ' . ' . _ .^ _ - _ .
�WORKERS COMPENSATION DE R ON OCCVPANCV=CONSTRUCTION TVPE _
I here�y attirm thal I have a cei[It cata of tonsent to sel(-Insure or,a VALUATION � � ZONE �
Cer[Iflcate' of Workers' Compen5ation InSurantl, Or a cerlilletl �copy - . . .
thereof (Se<tlon 3800, Lab. CJ. ,GRADING CU. VDS. ACRES T
� Policy No. � � - 'Company ' —
Cartlliatl topy Is bereby fumishatl. -. REMARKS: ' . . , ._ _ . . _
]erHtietl copy Is tllatl wlth [he clry Builtling Divislon.
...tEMPT10N FROM WORKERS' COMPENSATION DECLARATION
(T�IS seclion neetl.not be <ompletetl if tne, permlt is lor one nuntlretl
(5100) or less). �
I cartify [hat in the performante of lhe work for w�lch ihis_ permlt is
IssulQ I Shall not emPloy any polson Ifl arly mdnnGf So a5 t0 becoma
subja t lo [h Worfk�ers. Compensation Laws of.Cal rnla. _
Date �S�d�Signat ure � �~
NOTICE: It after making tbiz tleclar o ou s� Wa become'subjoct
to the Workers' Compensation provision5 of the Labor Cotle, you mOst
forthwlth comply with su<h provi510n5 or this permlt shall be tleemetl
revoketl. � _L _. _ _. . ._ ,.... __- _
CONSTRUCTION LENDING AGENCV
I hereby aftirm [hat [nere Is a construction Iantling agency for the per-
formance ot the work for which this permit Is i55uetl (Sec[ion 3097
Civ. C.I.. ' " . " " . "_ , ' " '
Lentler's Name
Lentler's Atltlress �
OWNERBVILDER.DECLARATION ' ' ' - '
Any Clty O! COUOLy W
im rove, tlemollsh or re�
quPreS [he ap4���nt fOr f
Is Ilcensetl pursuaM'to'tl
(Chap[er 9 (commancin
Businesz antl Prdessions
basis for tne allegetl exe
�^v'appllWnt for a p¢r
ml mOr¢ lhan fiva h
., u. owner of the pi
. _ ��
PLUMBING � � � .
TOILETS
LAVATORIES
KIT. SINKS -
SERVICE SINK
FLOOR SINKS-
DRINKING FO�
PLAN CHECK
URINALS-"" - - "
�OUBIE CAVS -' - -
� � DISHWASHERS ' -'
� SUMPS � �-` '
FLOOR DRAINS- � �
NTAINS ' - ' "'-' � "� '
� CLARIFIERS '
�uu.o�euvnessanarro�essionscooe: -SWIMMINGPOOL`' -' PiTRAG" ' "
eQWres a permit to consVucq alter,
"strutture, prbr to its Issuance, also re- y�qTER SERVICE ALTERATION
rmlt to flle a signetl statemenl that ha
ision5 of the'Contractor'S Llcense Caw 'GASSERVICE • OUTLETS
Settion 7000) of Division 3 of the
or tnat he Is exempt tnerefrom and the yyqTER HEATERS BTU OUTPVT
Any violation ot Sectlon 7031.5 by -
bjects the applicant�to a'civil penalty- SEWER CONNECTIONS - � ��
tlollars (5500). ��
, or my employees with waqes as fheir' SOCAR TANK "' COLLECTORS -
work, antl Ihe sVucture is.not In[entlea
14, Business antl Professlon5 Cotle: Tha � SOLAR PIPING SYS. ' �
wno buutls or improves tnereon, ana wno aoes sucn work nimsen or
th�ough. M1I5 own.employees, provitlCtl thdt such Improvement5 a�e not
intentletl or offeretl for sale. If, however, ihe builtling or improvement
i5 Soltl wlthin Ona y¢ar of cOmpl¢lion, th¢ owner will have the burtlen
0/ prOving he tlitl nOt builtl o� Improve for'th¢ purpos¢ of sal¢).
❑ I;-a5 owner oi th¢ property, am �Bxc1u51vBty� cOntraCting with
Iicensetl ton[rac[ors to construct the project (Saction 7044, Business
antl Protessions-Cotle: The Contractor's License Law tloes not apply to
an owner of property who builtls or imp�ov¢s ther2on, dntl wh0 COn-
[�acts from-such prolect5 with-a con[raCto�(s) Ilcesned pursuant to
the Contractor's License Law).
'� I'am exempt untler Sectian - - 'B. 8 P. Q(or [his
Date
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-100,000 BTU_
ANDDVCTING-- 100,000+8TU_
REFRIGERATION 0-100,000BTU_
SVSTEM- - 100,000 i BTU_
BOILERS BTU
SVSTEM REPAIR, ALTERATION
1 hareby tertiy that I_have reatl this application antl state that the above EXHAUST SV:
Informalion ii correCt. 1 d9ree to comply witM1 all clty antl cbunty
ortlinances anE state laws relating to construction, antl hereby authorize
mpresentative5�of-IhiS Cit to enler upon the above mentionetl-
property� for s I n rp ses. � �`� (j� •
Slgna W re Dat¢ ..�.�.._�S.]d
Drivers' Liten r� - --ISSUE FEE
CMF 0865-46 White-Builtling; Canary-ApP���ant; Pink-Accounting; GOltlenrotl�Assessor
�
�
SPIii�9��_
��_
�.����
��
�jt�- . i
� • ' � '.
4
A.R � '
ZONE
0595 I/13/82
1�2�I�uHT�an� - - �
REAR VARD (TO P/L)
�PKG. SPACE REp.
STREET WIDTH
ZONING APPROVED BY
SPECIAL CONDITIONS:
ELECTRICAL �
'!II.00 �TL
UEFL.p$ � �'
�E�RTVNLINE . ' "
PROVIDE� � �
PqRK FEE E � .
DATE
r
i _
PLAN'CHECK - -
50� FT.����. � � SO. FT_ � �:
GENERFTOR ' 'Q.� KW_ 1-10 KW _
TRANSFORMER -
APPLIANCE 30-SOKW_SO+KW '_
MOTORS - 0-1 HP_I-10 FIP =
(FNC.SOLAR)� �30-SOHPy50�+'jiP �_
FIXTURES � -OUTLETS -SWITCNES'- '
GASTUBE'SIGNS ' " `- ' -" ' '
POLE'LIGHTS" - ' ' - ' '
PANELS- - MAIN ' ".SUB-
SERVICE�" " " ' ' AMP
' ISSUE FEE ' - ' '
APPCICATION P.PPROVED BY'
�
�
' OATE-' �'--'
SUMMARY OF FEES � � � _ �
BVILDING ` '� -- - - � � - -
PERMIT § , SMIP' $� I
PLANCHECK S PERMIT: �� �
- �ISSUANCE� 8 ' �
PLUMBING 5 GRADING �S �
PLAN CHECK . E' � - ' ^
ELECTRICAL S ' , a
'PLAN CHECK ' $� ,j /^� ' MICROFILM�$, � �� � I
MECHANICAL S�Fs_61�{� TOTAL FEE S.' -' , �
' ' LESSAD= �� - � ' '
PLANCHECK'- E' ' �- VANCEPC E- �� - "�
. � '. �.
� _ _ FINAL FEE $�00 ,
�
CONSTRUCTION AND PLANNING t-� POOL & SPA. �
' ' Date - Inspector ' 4 - _ �,•, Date. � Inspector
APPROVALS ' � ' � Pe�mit # �� , ' APPROVALS \ ` Permit # �
1. Temporary Electrical $ervice or Pole " 43. Pool & Equipmen� Location � - � -
. Soil ipe-Undrgm - 44. Steel Reinforcement --� � � - - -- � - �
. 3. Electrical Conduit UtilityrUndrgrn 45. Forms -- --
4. Electrical Conduit-U�drgrn 46. .Electrical Bonding
. tee ein orce . . 47. Rough Plumbin & Pressure Test '�
6. Electrical UFER Grn � `48. APPROVALTO COVER-GUNITE
7, ootings ' - 49. Electrical Conduit-Undr rn � �
B. Foundation " 50. Gas Pipe, ❑ Undr m, Test ,_
_ 9. Water Pipe-Undrgrn � 51.� Backwash Lines P-Tra "'� ndr rn" �-' -
10. Struaural Floor System ' 52. APPROVALTO DECK " "' --' -"� '�
11. Property Sewer Line & House Connection -� - 53. Backwash & Rece tor-Final �
_ 12. Street Sewer Connection ' � 54. Heater & Vent-Pinal '
13. Rough Plumbing - '
14. Rough Electric-Conduit - - - - - 'S6. -Electrical-Final�
15. Rough Electric-Wiring � `-- 57. '-Solar System-Final
16. Rough Heating & Air Conditioning . - encing & Access Approval
17. Ducts, in Structure APPROVED FOR PLASTERING ' �
18. Ducts, Ventilating . • _ - � . ' . - -t , !
t9. Gas Pipe-Rough & Test ' ' 60. POOL/SPA SYSTEMS FINAL � � ' � �� ' '
20. Roof Framing � ' ' -
21. Roof Sheathin ' � - ' " � ' � '
22. Frame and Flashin � NOTES: ' � �
23. Insulation - � '- �
24. Lathing & Siding - - - �
25. Drywall Nailing ' � �
26. Plaster Brown Coat '
27. Electrical Power Meter-Final � � � �
28. Final Electric � �
29. Final Heating & Air �nditioning fj�2
30. Final Gas Pipe-Test �
.31. Final Plumbing ' �
32.� Water Service-Final � ' � - - �
� 33. Gas Service-Final
34. Solar pomestic-Final ' �' � �
35. Landsca e S rinklin S stem - ' '
36. Sound Attenuation ' � � � -
37. Handicap Regulations � �
38. FINALSTFUCTURE&BUILDING
39. Special Requirements Completed � -' �
40. Electric Release to Edison \ � ' ' - -
41. Gas Release to Southern California Gas Co. �
42. ,\C� TIFICATE OF OCCUPANCY __��` C� _ -
iJ Date ' � � `"' �
r �.
4
` AVPlicant to fill In all spaCeswllhin �eavy Do�tle� Iinei an0 si9n all app�opriate Gecla�a�ions
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. �BLDC. NO.
CONSTRUCTION PERMIT � / 63 � � �
Projett Address 21 � 1GT�-I rLAG - TVPE OF CONSTRUCTION
Own2� �� Y Phone �j 1—�} Q �NEW ❑ ADD ❑ ALTERATION
AildrCss 4 OLD NEWPORT BLVD. �STE. 6 NEWPO '0 REPAIR ❑ CONVERSION ❑DEMOl15H
ArCh�Eng. - - ' ' LiCenie No. ❑ OTHER
DESCRIPTION OF WORK
Address
CAniractar
I hereby dffitm that I am liCensetl untler provislOnS Of Chdrt¢r 9(com-
menUn9 wkh section 7000) of �DlNslon 3 ot the' Business antl
Rotessions Cotle, ana my Iicense is in tull (orce15r�p6�(e<t
LI<ense Class C-20 .�y� licenie LS
Date���—��—Q� Signaturel!
WORKERS'COMPENSATION DECLARATION
I h!r¢Ey affirm that I have a certlfiGa[¢ of con5¢nt to selbinsure or a
certi77wte ot Work¢r5' ComO¢nSdtiOn insuranca, Or d CerHfletl copy
thereof (Section 800 C.). '
borcv rvo. WP 17'1 � ComPanY FREMONT --
�"`�rNfietl mvY �s hereby fumishetl. '
'_^- �✓titietl cOpy iz fileU with [ite dty Builtling DlvisiOn.
��c``.:eMPT10N FROM WORKERS' COMPENSATION DECLARATION
(This sectlon neetl not be complete0 if tha permit Is for one huntlrltl
(E100) or less). .
I certity Ihat in the perlormanu of th¢ work tor which th15 permit IS
I55ueA, I shall not employ any person In any mdnn¢r SO aS f0 become
subj¢ct t0 the Wo/ke�s' Compen5dtlon 12ws ot Callfo�nla.
DafG Signature
NOTICE: It after making this tleclaraUon, you shoultl bemme subject
to the Workers' Compensa[ion provisions o1 the Labor Cotle, you must
to�thwith comply wi[h Sucn p�ovl51on5 Or [his perTit shall be tleemetl
�lvOk¢tl. � -
CONSTRUCTION LENDING AGENCV
I hereby af/irm tnat there is a construction lentllnq agency for the per-
fOrmance ot the work �O/ which [his pe�mit i5 ISsuetl ($ection 309]
Civ. C.). " ' - .
LenGer's_Name
LentleYs AtlOress
OWNER BUILDER DECLARATION ' �
1 hereby aHirm tnat I am exemp[ from the ConVactor'S License Law tor
the following reason (Section 7031.5 Business antl Professions'Cotle:
Any city o� county which requires a pe�rtlit to conSlruG[, alteq
improve, tlemolizh o� repai� any St�uc[ure, prio� to its lssuanc¢, al5o r¢-
quires the dppliGant for SUCh perTi[ to file a signed statem¢nl [hat ne
is licensetl pursuanl to the provisions ot the Contractor's License Law
(Chapter 9(commencing with Section ]000) of Divislon 3 0( Ihe
6usines5 antl Prolession5 Cotle) or that he Is exempt therefrOT dntl Ihe
basis for the allegetl exemp[ion. Any violalion of Settion 7031.5 by
ar�� applicant tor a permii subjects the applicant to a civll penal[y
� t more than five huntlretl tlollars (g500�.
d5 OWO¢I Of Vle pfoperty� Or 111y employe¢5 wilh wdg25 d5 Lh¢I!
So.< <oTpensalion, will tlo Ihe work, antl lhe strutture is not IntenOetl
or offeretl for wle. (SecHon 7044, Business antl Rotessions Cotle: The
Contractor's License law tloes not appty to an owner.ot a property
who builtls or Imp�oves ther¢on, antl who tloes SUGh work himself or
[hrough Itis own employees, provltletl lhat such ImprOvement5 are not
Intentletl or ofteretl tor sale. If, howev¢r, the builtling or ImprOv¢m¢n[
Is soltl within one year of completlon, lhe owner will have tne burtlen
of proving he tlitl not builtl or improve tor the purpo5e of Sal¢).
❑ I, as owner of the property, am ¢xclusively wnVacting with
Iicensetl conVactoR to construci tM1e projecc (Section ]044, Business
and Professions Cotle: The Contracror's License law tloes not appry ro
an owner of property who builtls or improves the�eon, antl who wn-
lracl5 from sucll-projeCtS wilh a contfactol(s) IlceSnetl pur5uant t0
tne Contraclor'S License L.aw).
❑ 1 am exempt untler Section B. & P. C. for ihi5
reason -
Date ' Owner
Lhereby c¢rtity tM1at I have reatl this appllcation antl state that the above
Information is correct. 1 agree to comply wiih all city antl county
ortlinances.antl s[at¢ laws relatlna to construction. antl herebv authorize
BLDG. 2, LOT C, PLAN B9774'd2/21/8�.
TVPE OF PERMIT •
❑ GRADING ❑ FOUNDATION O STRUCTURAL
❑ TENANT ❑ ELECTRICAL �PLUMBING BD6r1ECHAl
❑ OTHER
PROJECT DESCRIPTION , �
SQ. FT. _
OCCUPANCV_CONSTRUCTION TV PE
VALUATION ZONE
GRADING�CU. YOS. ACRES
PLUMBING PLANCHEGK
BATHTUB$ SHOWERS
TOILETS URINALS
LAVATORIES DOUBLELAVS
KIT. SINKS DISHWASHERS
SERVICESINKS SUMPS �
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS
INTERCEPTORS CLARIFIERS
$WIMMING POOL � - PTRAP `
WATERSERVICE ALTERATION
GASSERVICE OVTlETS
WATER HEATERS BTU OUTPUT�
SEWER CONNECTIONS �
SOLAR TANK COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAI P�Arv CHECK
HEATING SVSTEM 0-300,000 BTU_
ANDDUCTING 100,000+BTV_
REFRIGERATION 0-100,0008TU_
SVSTEM 100,000+BTU_
BOILERS BTU
SYSTEM REPAIR,ALTERATION
E%HAVSTSVSTEM MULTIPLE
'propert zp ipon purpase�/ �//_ /�, (�/
519natu p .0 • x�ip.�r.�r��. /
��Drivers' License ar 55 �'�%� �� � ISSUE FEE
`�1F 0865-46 White-Builtling; Canary-Applicant; Pink-Accounting; Goltlenrotl-Assessor
A.P. �
ZONE
REAR VARD (TO P/L)
PKG. SPACE RE�.
STREET WI�TH
ZONING APPROVED BV
SPECIAL CONDITIONS:
ELECTRICAL '
7.00
REGULATIONS
PLNTGp. RUEFL. p� �
PROPE�RTYNLINE
PROVIDE�
PARK FEE S
DATE
PLAN CHECK � �I�
GENERATOR 0-1 KW_ 1-lO KW _
TRANSFORMER
APPLIANCE -10-50 KW 50 + KW _
' MOTORS " 0-1 HP_1-30 HP _
-- .pNC. SOIAR) 30-50 HP SO + HP �_
�� FIXTURES - OUTLETS �SWITCHES
GAS TUBE SIGNS ' "
POLE LIGHTS '- " ' .
PANELS MAIN ' SUB
SERVICE " ' AMP
!
ISSUE FEE ' " �
APPLICATION P.PPROV ED BY' DATE
- SUMMARY OF FEES ..
BUILDING' '
PERMIT $ SMIP �� b
4.00 �pLANCHECK $ PERMIT ��p�
ISSUANCE S—L=
PLVMBING $ ' �
PIAN CHECK $� - GRADING � $
ELECTRICAL S $
PIANCHECK $�..= MICROFILM E
MECHANICAC �� " TOTAL FEE $ _Z� ��'•
,PLANCHECK $ � VANCEPG S_ � '
3
FINAL FEE $ 7 • OO
r
� CONSTRUCTION�AND P.LANNI�c � 11� e,�' POOL & SPA �
� � � Date , Inspector� - Date �Inspector �- !
APPROVALS Permit #� l � APPROVALS Permit #
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
Soil ipe-Undrgrn 44. Steel Reinforcement � - �
_ 3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical�Bonding -
. tee ein orce � 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE -
7. Footings - 49. Electrical Conduit-Undr rn
8. Foundation • 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra .❑ n r rn
10. Structural Floor System 52. APPROVALTO DECK �
11. Property Sewer Line & House Con�nection 53. Backwash & Rece tor-Final �
12. .Street Sewer Connect}om�_ _, 5. Heater & Vent-Final
13. Rough Plumbing " � ' �
14. Rough ElectricConduit - ' ` -�56. 'Electrical-Final -
15. Rough Electric-Wiring - - - � 57. Solar System-Final � - • � �
16. Rough Heating & Air Conditioning - � � Fencing & Access Approval
17. Ducts in Structure � • APPROVED FOR PLASTERING
18. Ducts,.Ventilating
19. Gas Pipe-Rough & Test - 60. POOL/SPA SYSTEMS FINAL -
20. Roof Framing �
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation �
24. Lathing & Siding
25. Drywall Nailing �
26. Plaster Brown Coat �
27. Electrical Power Meter-Final � �
28. Final Electric - �
29. Final Heating & Air Conditioning f �-
30. Final Gas Pipe-Test
31. Final Plumbing ' �
32. Water Service-Final - ' `
33. Gas Service-Final � - �
34. Solar pomesticFinal ' � ''F � �
35. Landsca e S rinklin S stem � `
36: �Sound Attenuation �� �' �
37. Handicap Regulations • �
38. FINALSTRUCTURE&BUILDING .
39. Special Requirements Completed ' �
40. Electric Release to Edison -
41. Gas Release to Southem California Gas Co. � � �
42. CERTIFICATE OF OCCUPANCY � �
�
' No � � Date �.,,,. - . .
_\
'
/�oolicant lo illl In all spaces wilhln neavy Eoraer Iines antl slgn all aoo/oprlale tleclarations.
��CIT� OFZrOSTA MESA PE IT NO TR T ryO. LOT NO. BLDG. NO.
CO�STRUCTION PERMIT -J� i,��Z l� Fj / C
Prolect Address � G TYPE OF CONSTRUCTION �
OWner Q� Phon ��j l � NEN/ ❑ ADD ❑ A�TERATION �
Addfea D ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
' Arch/Eng. d (Jr � License No. %� ❑ OTHER
"AddlCss � 17 O DESCRIPTIONOFWORK
� �
Contrector / P�on I TYPE OF PERMIT �
AddfeSs %% � ❑ GRADING ❑ FOUNDATION' O STRUCTURAL
LICENSED� CONTRACTOR UECLARATION • ❑ 7ENANT ❑ ELECTRICAL �PLUMBING ❑MECHAI
I hereby alfirm that I am II<ensetl untler D�ovisions of C�arter 9(com• �� •
mencing with section 7000) of �Divislon 3 0( the Business antl ❑ OTHER
Professlons Cotle, ana my Iicense Is in tun torce antl attect. pROJECT DE CRI�IFT�QN �/ '� � �' -
Llcense Clast Ucense No. SQ. FT. ��•/`%�Q ��+
Date Signature
WORKERS' COMPENSATION DECLARATION . . OCCVPANCV '�� CONSTRUCTION TYPE �
I hereby af(Irm that I have a certificate ot consent to self-Insure or a VALVATI�ON ZONE ���
tHl [ f W k ' CAm ensation Insurante or a ttrUfletl copy � - -
cer ca e o or ers p ,
Inereof (Section 3800, Lab. C.).
PoliGy NO. CAmpany
r'ertifietl copy is nereby turnishetl. -
er[Ifietl copy is filea with t�e city Builtling DlviSion.
�..cMPT10N FROM WORKERS' COMPENSATION'DECLARATION
(This zaction neeC not be comple[eU it the permit Is br one huntlretl
(E300) or IesSR.
I certify tha[ m tbe pertormance of.the work (or wNth this Dermit ii
issuetl, I shall not emptoy any person in any mannar so as to become
SubjBGt lOIhB Workers' Compeniatlon L,awS O( UIIfOrnia.
Date Si9nature '
NOTICE: If after making this tleclaration, you shoultl bacome subject
to thG Wolkels' CompCnSdtion pfovI51005 Of tha LdbO! COtlO, y0u Tuit
forthwith COmply with suCh prOvl5lons or Inls perTit ihall be tleemed
/¢vOk¢0. _ _ _ .
CONSTRUCTION LENDING AGENCV
I h¢r¢by affirm that there Is a constructlon IenUing agmcy lor Ine per-
tormance of the work 1ar whicn thli permit I5 Issuetl (Section 3097
Civ. CJ.
Lender's Name
LentlerY Atltlress
OWNER BUILDER OECLARATION � "
I M1ereby aifirm that I am ezempt trom the Contractor's Licenie Law ior
the I011owing reason (Sec[ion 7031.5 BuSineis antl Pro/eszlons Cotle:
Any dty or COUnty whlch requirCs a permit ro Conslruct, alter,
Improv8, tllmolish or r0pdir any StruCturC, prlOr to It5 755udnC8, aiSo !e-
quires the appliwnt br such permit to tila a signetl statement that he
is Iicensetl our5uant to 1he orovlslons ot the Contractor'i Litense Law
l�e p�ope�ty, or my emplOyces wlth wa9us as thair
will tlo the work, and tho structurn is not Intontletl
(SCCfIOO 7044� BUSIO8S5 dOtl ROf¢SSIOIIi COtlB: Th0
'�B Law tloes not apply to dn Own¢r oi a prop¢rty
wno nWbs or Improves tnerean, ana wno aoM zucn work mmsert or
thrOu9h his own emplOye¢5, provitlatl tbat Such ImprovemenlS a�a not
in[entletl or otferetl lor sale. It, howaveq the bulltling or Improvemont
is soltl within ono year ot completion, tno ownur wlll nave tho burtlen
�proving ne tlitl nOt bulltl or improve lor lhe purpose af Sd18).
I, as owner of the property, am excluslvely con[racting wilh
licensetl conlractors lo mnsVuct the pro7ect (SecHon 7044, Businest
and Prolessions Cotla Tne Contratior'S Llcense Law tloes not apply to
an Own¢r of p�ope�ly wh0 builtls o� ImprOv¢S lh¢reon, antl wh0 con-
t�aC[s from such 'prOjeC[s with a cont�acto�(5) IICOTnBtl pursuant [o
the Contractor's LI<ense Law).
❑ I am exemD� untler Se<tlon B. & P. C. lor this
•h . �
reason -
Date Owner �
tM1at I have reatl lhls appli<a ion antl dtdle that Ih¢
correcL I agree to comp with all Nty antl <
state I�yNs relating t0 COpStI CJlon, dntl h¢!¢bY aut
GRADING CU. VOS. ACRES _
REMARKS:
PLUM6ING PLAN CHECK
BATHTUBS SHOWERS
TOILETS URINALS "
LAVATORIES DOUBLE LAVS
KIT.SINK$ DISHWASHER$
SERVICESINKS SUMPS'- � � 1
FLOOR SINKS FLOOR DRAIN:
DRINKING FOUNTAINS
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTRAP
WATER SERVICE ALTERATION
GASSERVICE OVTLETS
WATER HEATERS -BTU OUTPUT'
SEwER CONNECTIONS
SOLAR TANK COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN cHECK
HEATING SVSTEM 0-100,000 BTU_
AND DUCTING 700,000 + BTU _
REFRIGERATION 0-100,000 BTU_
SVSTEM 100,000+BTU �_
BOILERS +°�,'�' `� •BTU .
SVSTEM REPAIR, AITERATION
EXHAUSTSVSTEM MVITIPLE
Signature '� 1
Drivers' nse or 55 � � � �SSUE FEE
CMF 8 -46 Wnite-Builtling; Canary-Applicant: Pink-Accounting; Goltlenrotl-Azsessor
ZONE
co e s 338: 3 TL
PLNG. REF. �2F_ � 9/—C 7.
REAR VARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH �
ZONI NG APPRO V ED BY
SPECIAL CONOITIONS:
ELECTRICAL �PLarv CHECK
GENERATOR O-1 KW_1�10 KW _
TRANSFORMER
APPLIANCE 30-50'KW_SO+KW_
MOTORS 0-1 NP_1-10 HP _
(INC. SOIAF) �0-50 HP 50 � MP �_
FIXTURES ' OVTLETS SWITCHES
GHSTUBESIGNS ' -
POL'E LIGHTS '
PANELS MAIN ' SUB
SERVICE AMP
ISSUE FEE
APPLICATION APPROVED BV
SUMMARV OF FEES � �
BUILDING 3 �, 6'�' •
PERMIT E � �a SMIP E
PLAN CHECK E PERMIT , .
ISSUANCE b
PLUMBING E
GRADING S
PLAN CHECK S
ELEGTRICAL S -S
PLAN CHECK S .MICROFILM S
MECHANICAL S TOTAL FEE §
PLANCHECK E VANCEPC $_
�/'� �j �r/�[ / � FINAL FEE E���•� ,
(_ � J T
��
CONSTRUCTION AND PLANNI
APPROVALS Permit # �
1. Temporary Electrical Service or Pol
9. Water Pi
12. Street Sewer Connection
15. Rough Electric-Wiring
16. Rough Heating & Air Conditioni
17. Ducts,in Structure
18. Ducts. Ventilatinq
22: Frameand
23. Insulation
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditi<
30. Final Gas Pipe-Test
37
40. tl¢ctflc Hele25e to ttl150n
41. Gas Release to Southern California Gas Co.
42. CERTIFICATEOFOCCUPANCY
No Date
Date
Inspector qpPROVALS
43. Pool &
44. Steel R�
45. Forms
POOL & SPA
, Peimit #_
ent Location
47. Rough Plumbing & Pressure Test
48. APPROVALTO COVER-GUNITE
49. Electrical Conduit-Undrgrn
50. Gas Pioe. ❑ Undrarn. Test
ao. rencing ty qccess Hpprovai
. APPROVED FOR PLASTERII
60. POOL/SPA SYSTEMS FINAL
NOTES:
Date
Inspector I '
"�
�
t
�'�O
1
�
Applifrant to fill in all spaces wlt�ln heavy DorOer Ilnes anC slgn all apProp�iate tleclarations.
�GTY'OF COSTA MESA ' cE���O�� ' TRACT NO. LOT NO. �BLD^. NO.' %:1�18 I OIZGIQI 4%�OO T4�
' CONSTRUCTION PERMIT N �� ---- •- - -•� - • • • �•
Address
Afth/tng. ' '
Address '
� . i /-' . TYPE OF CONSTRUCTION
Phone ❑ NEw ❑ AD� ❑.ALTERATIOrv - �
- ❑ REPAIR O CONVERSION ❑DEMOLISH
' LiCense No. ❑ OTHER �
�ESCRIPTION OF WORK
COn[rec[or S � rnvne �// TVPE OF PERMIT - � -
Addf25s Q ' • � . ❑ GRADING ❑ FOUNDA 10 ❑ STRUCTVRAL '
LICENSED CONTRACTOR DECIARATION � ❑ TENANT ❑ ELECTRICAL�PCVMBING ❑MECHANIG
1 hereby ai(Irm that I am Iicensetl untler provisions o( Charter 9(com• �
mencing wltM1 secclon 7000) ot Dlvision 3 of the Builne55 antl ❑ OTHER
Professlons COE� jntl my Ilcense is in �^`�fo�rce antl ��ct. pROJECT DESCRIP.TION `^
License Class �A _ '- � .: .
54. FT. _. '. � : � � �i �
Date-1n•2C— �il �i�.. �I— _ . ..
WORKERS' COMGENSATIONYDECLARHTION OCCUPANCV_GONSTRUC710+.T,V`E
;1 heroby affirm that I have a tertiflcate of consent to 5el6insure or a VALUATION ZONE ��� -�` ��'�
tertiflwte'of Workers' Compen5ation�lnsurance, or a certlfbE copy - --
thereof (Sectlon 3800, lab. C.). , . GRADING CU. VDS. ACRES
Polity No. � Company � - - -
r^ertifletl copy Is hereby furnlsnetl. REMARKS: 3 ��b
:rtlfletl copy is Bletl with the tlty Builtling Divislon. . ,
_MPTION FROM WORI(ERS' COMPENSATION OECLARATION ' ' "
(This sectian neaC not be <ompletetl If the.permit is for ona nuntlretl
S$1001 or lessl. ^ � �
ttrdfy that ln tne performance of the work for which [his permit Is .
15suetl, I shall not amPloy any person in any manner so as [o Gecome PLUMBING� PLAN CFIECK
5ubjetLto the Workers Compensation Laws.ot.Californfa. . .
Ddt¢ $I9ndture BATHTVB$ SHOWERS �
NOTICE: If after making tnis tleclaratlon, you shoultl become.subject TOILETS � .�-URINALS � -�
to the Workers' Compensatlan provisions of the Labor Cotle, you must LAVATORIES DOUBLE LAVS' �
forthwith comply wlth sUth prOvi5lon5 or this permit snall be tleemetl -
�evOketl. � - - . -_ . . . _
GONSTRUCTION LENDING AGENCV KIT. SINKS � DISHWASHERS -
I hereby afflrm tha[ tbere Is a constructlon lentling agency for the perv SERVICE SINKS '� SUMPS '' '-�
formance of [ne work Por whlch lhis Dermit is issuetl (Sectlon 309]
Civ. C.). � � � FLOOR SINKS FLOOR DRAINS
LGnOlI'S NaTG
Lantler'S Atltlress DRINKING FOUNTAINS ' '
OWNERBVILDER OECLARATION - �- � ' � INTERCEPTORS � CLARIFIERS ' �
I hereby afflrm that I am exemp[ from the Contracror's License Law for
Ihe tollowing rea5on (Sectlon'7031.5 BuSiness'antl'Professlons�Cotle:
Any city or cOunty whiCh reqWreS a permit ro construct, dlt¢r,
improva, tlemolish or repalr any sfructuro, prior to Its issuance, also re-
qulre5 [he appllcant for Suth perTit to tlle a signetl statement that h¢
Is litensetl pursuant to the provlslons of the Contractor'S Cicense Law
(Chapter 9(commencinq wlth Sectlon 'l000) of Dlvision 3 of the
Business antl Pro(esslons Cotle) or that he is exempt therefrom antl the
basis for tne allegetl exemptlon. Any vlolatlon of 5ection �031.5 by
anv applifant for a permit subjects [he appliwnt'to a Uvll penalty
� �t mOrO than flve huntl�Btl tlolla�s (E500).
as owner 01 lh¢ properly, o� my amployees wltM1 wages ns their
5, tompansatlon, wlll tlo the wOrk, antl the structure is not intentletl
or ofteretl for sale. (Settlon 7044, Business antl Professions Cotle: The
Contractor's LI<ense Law tloes not apply to an owner ot a property
who bulltls or improves [neraon, antl who tloes such work �imself or
lhrough hiz Own amploye85,� ptOviaetl that such� imp�oveme�t5 a�¢ not
In[tnae0 0� o(fe�etl fOr sale. It, however, the builtling or imprOvemen[
Is soltl wilhln ono year ot complation, the owner will.have the burtlen
Of proving ne ditl not bulltl or improve for the purpa5e of zdl¢).
❑ I, a5 Own¢r Ot the prOOerty,- am exclusively contracting with
IiGenietl COnttacto�s lo ConiVUct the project (Section 7044, BuSin¢Ss
antl Professions Cotle: The Contracior's License Law tloes not apply to
an owne� ot prOp¢rty w�o bWItlS or ITprov¢s th¢r¢on, dntl who con-
t�acts f�om SUGh pro�eCtS wlth d cOnt�acto�(s) Ilc¢snetl pu�suant to
the Contrattor•s Llcense I�w�.
❑ I am ezempt un0er Section B. & P. C. fot th15
reason
Date ' Ownar
I her<by certlfy [hat I hav¢ redtl thii appliwtlon antl State that th¢ abov¢
Information is correcl. I agree [o comply with all city antl county
ortlinances antl 5[ate laws re ❑n9 o mnstruction, antl hereby authorize
representatives of lhi5 y �er ypon the above mei � npf}
property for ctlo i pur s `� [-i
Slgnature � �y�Y� 6�
Drivers' Urense or $5 � � �
SWIMMINGPOOL GTRAP'
WATERSERVICE / ALTERATION
GASSERVICE � OUTLETS
WATER HEATERS BTU OUTPUT•
SEWER CONNECTIONS / � ,.
SOLARTANK � COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL a�AN CHECK
HEATING SYSTEM 0-300,000 BTU_
AND DUCTING 300,000 + BTU _
REFRIGERATION 0-100,000 BTU_
SVSTEM 100,000 + BTU _
BOILERS BTV
SYSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
ISSUE FEE
A_P. i
20NE
REF.
0
REAR VARD (TO P/L)
PKG. SPACE REq.
$TREET WIDTH
?ONING APPROVED BV
iPECIALCONDITIONS:
ELECTRICAL
PROVIDED
... PARK FEE $
PLAN CHECK
wtrvnniaiuk - p-1 KW_1-lO.KW_
TRANSFORMER
APPLIANCE 30-SOKW_SO+KW_
MOTORS 0-1HP_1-lOHP'_
(INC. SOLAR) 10-50 HP SO + HP _
FIXTURES OUTLETS SWITCHES
GAS'TUBE SIGNS
POLEL'IGHTS" '- -' ,
PANELS " MAIN SUB
SERVICE '-' ' - ' AMP
APPLICATION APPROVED BV
0
DATE
SUMMARV OFFEES
BUILDING -- " "
PERMIT § SMIP E_
PLAN CHECK $ PERMIT
ISSVANCE 5_
PLUMBING S '� GRADING S_
PLAN CHECK $
ELECTRICAL S 5-
PLANCHECK $ MICROFILM E_
MECHANICAL $ TOTALFEE$_
PLANCHECK E VANCEPC E_
FINAL FEE E �% �
CMF 0865-46 White-Builtling; Canary-Applicant; Pink-Accounting; Goltlenrotl-Assessor
'
�
�� �: �;�r., - -
�°�J CONSTRUCTION AND`�pLANNI �"�/ �' POOL & SPA - ., �,_ "
. `-�.�
APPROVALS Permit# �-l�'``� Date Inspector qppROVALS Permit#^ Date Inspector
� ..
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
Soi ipe-Undrgrn 44. Steel Reinforcement " �
3. �Electrical Conduit Utility-Undrgrn 45. Forms
4.. Electrical Conduit-Undrgrn 46. Electrical Bonding _
tee ein orce. 47. Rough Plumbin & Rressure Test '' � �. •
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE� -' ' -
7. Footings 49. Electrical Conduit-Undr rn
8. .Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe•Undrgm f/ 51. Backwash Lines P-Tra ❑ ndr rn �
10. Structural Floor_System 52. APPROVALTO DECK ' '"
11. Property Sewer Line & House Connection - /' yt 53. Backwash & Rece tor-Final
12. Street Sewer Connection ' 54. Heater & Vent-Final �
13. Rough Plumbing q�
14. Rough Electrio-Conduit ''� I -�56. ��Electrical-Final
15. Rough Electric-Wiring 57. - Solar System-Final
i 6. Rough Heating & Air Contlitioning • encing & Access Approval
17. Ducts in Structure . - ' • APPROVED FOR PLASTERING �
18. Ducts, Ventilating "� - �
19. Gas Pipe-Rough & Test - • 60. 'POOL/SPA SYSTEMS FINAL
20. Roof Framing ' = \ •
21. Roof Sheathin " `� ' ' �
22. Frame and Flashin NOTES: �
23. Insulation
24. Lathing & Siding
25. Drywali Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final "' �
28. Final Electric • '� �
29. Final Heating & Air Conditioning s' F� � � � '
30. Final'Gas Pipe-Test - �,�y3 v - -
31. Final Plumbing ' 1' 9L '
32. Water Service-Final
33. Gas Service-Final '
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation �
37. Handicap Regulations • ' '
38. FINAL STRUCTURE & 6UILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
�- . . _
� ' No Date .
Applicant to fill In all
'CiT�UF COSTA MESA�� � ' aeg�r.N.c
� CONSTRUCTION PERMIT p ��',
, Project Address 'Z � � �(� , (,�,Ct .
Addrea -
Arch/Eng. �
Address
License No.
witnin neavy bortler Iines ane sign ail appropriata tleelarations.
� "- TRACT NO. LOT NO. �BLD��j`10.
r �
� TVPE OF CONSTRUCTION
❑ NEW ❑ ADO ❑ ALTERATION
-� - - ❑REPAI0. ❑CONVERSION�ODEMOLISH
� - - ❑.OTHER ��' `�
DESCftIPTION OF WORK
..� � vrn.v r- gy...-J ���5ptn 1/ a� TYPE OF PERMIT �
� Addf255 S,j �I�QDJ'K -C �nJ ❑GRADING ❑ FOUNDATION 'OSTftUCTURAL
1� LICENSED-CONTRACTOR�DECI.ARATION " --Q'TENANT�O-ELECTRICAL QPCUMBING ❑MECHANIC
"�/ 1 hereby aftirm that I am Iicensetl untler provlslons of Charter 9(com- .
� mencin9' with sectlon 7000) of Divislon 3 oi [he Business antl ❑OTHER- •- -
Professlons C tle, a G my Iicense Is in full torc tl et ect. � '
� „ � �- . - �_�. PROJECT DESCRIPTION ..
� uce �eGcia�' .. . . _ ce sB+rio.� . , �< , .. , ..._
\ �Date a��ar��.o Lli SQ.FT.� ' � ..,�t .'.'•ti."._
WORKERS' COMiEN5AT10N DECLARATION� - OCCUPANCV_CONSTRUCTION TVPE,
I hereby at/irm [hat I �ave a<erHfitate ot consent to ulf-insure or a VAlVAT10N - 20NE �"� '
certiflfate'of Workers' Compensation-Insurance, or�a tertifiea-copy - -- , � —� --
theraoi (Section 3800, Lab. C.). � GRADING CU. VDS. ACRES �
Policy No. � Company � � � � - � � �
�"g��erti(letl topy is here�y fumishetl. � � � � -. � REMARKS:�- 3 .4"�, : �
.� �artlfietl copy is tilea with the dty Builtling Division. . _ _
':.�:�s MPTION FROM WORKERS' COMPENSATION DEGLARATION — - ' ' ' " -
(This section neatl not be completetl if the�permit is for.one huntlretl . , __ _.
(5300 or less). � � � � ^'
I.cert�fy that.ln.the performance otthe work for which_this permit is ._
issuetl, 1 shall not employ any person In any manner so as.to�become PGUMBING •�� PL`AN CHECK �
subject to the Workers' Compensation Laws of Glltornia. :_.__ - ' -
Date Si9nature � BATHTUBS SHOWERS -
NOTICE: It aiter making this tletlaratlon, you shoultl become subject ."TOILETS ,� '"URINALS � -
to the Workers' Compensatlon provisions ot the Labor Code, you must �VATORIES DOUBLE LAVS �
tO�thwith comply with zuch p�ovi5io�5 Or this pe�mit shall be tleemetl f�
revoketl. . . •. . _ —' " "' _ _' _ _" ' ' ' "" ' . " ' " " '
CONSTRUCTION LENDING AGENCV KIT.SINKS DISHWASHERS _
I heroby affirm that there is a construction lentling a9ency for the per- SERV ICE SINKS - SUMPS �
formance of the work tor whith this permit is issuetl (Section 3097
Civ. C.). �� �' FLOOR SINKS FLOOR DRAINS
�Lentler's Name
Lentler's Atldress DRINKING FOUIVTAINS -
OWNERBUILDER DECLARATION � � � :INTERCEPTORS CLARIFIERS
I hereby attirm that I am ezempt from.the Contractor's License Law for
the tollowing reason�(Section �031.5 Business antl "Professions Cotle:' SWIMMING�POOL PTRAP � '
Any .city or county which requires a permlt to construct, alter,
Improve, demolish or repair any structure; prlor to its issuance, also re- yyqTER SERV ICE �-" ALTERATION ��
qulres the appllcant for such permit to file a signetl statement that he
is litensetl pursuant to [he provisioris of fhe Contractor's License Law GASSERVICE 'OUTLETS
(Chapter 9(commencin9 with Settion 7000) of Division 3 of the
Business and Professions CoEe) or that he Is exempt therefrom antl fhe yyqTER HEATERS BTU OUTPUT?--., :'�; ;
basis tor the allegeG exemption. Any vlolation of Section 7031.5 by �
a^�• applifant (or a peimit subjeccs the appllcanYto a-civil penalty SEWERCON7VECTIONS .�'� >
�t more than (ive huntlretl tlollars (E500).
, as owner of [he properiy, or my employees with wages as their
s...: compenutlon, will do the�work, antl the s[ructure is,not intentletl.
Ol 01flICtl (OI Shc¢. ($CCII00 7044� BIISilIEST dfltl PI'Of¢SSIOnS COtl¢: Th¢
Contractor'S License Law tloes not apply to an owner of a property
who bulltls or Improves thereon, antl who tloes such work M1imselt or
through his own employees,�provitletl tha[ such improvements are.not
intentletl or offeretl for sale. If, noweveq the bulltling or Improvement
is Soltl within one yea� of completion, the own¢r will have the burtlen
of proving he ditl not builtl or improve for the purpose of sale).
❑ I, a5 Owner ot the property, aitl exclu5lv¢ly contracting wlth
licensetl contractors to construct the project (Sectlon ]044, Business
antl Professions Cotle: The Contractor's License Law tloes not apply to
an owne� of prOperty wM10 builtls o� imprOves thereon, antl who Con-
tracts from such pro�ects with a contractor(s) Iitesnetl pwsuant to
the Contractor's License Law).
❑ I am exempt under Section B. & P. C. for Ihis
reazon
Oate Owner �
bat I have reatl this
Signalure �
Drivers' �icense or 55 �
CMFO865-46 Wni[e-Builtling;
antl.state that the above
ith all city antl county
in, antl h¢reby authOrize
th¢ dbove �entione
� 26
_ �e
ISSUE FEE
Pink-Accounting; GoltlenrOtl-ASSessor
SOLARTANK COLIECTOR$
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLANCHECK
HEATING SVSTEM 0-100,000 BTU_
AND DUCTING 100,000 + BTU _
REFRIGERATION 0-300,000 BTV_
SVSTEM 100,000 + gTU _
601LER5 BTU
SVSTEM REPAIR, ALTERATION
EXHAUSTSVSTEM _MULTIPLE
7450 ID/26/81
. � i -_ ,
�r ' f F
' 47.0� TL�,
� ZONING REGULATIONS � -
A.P. if -- � . . .
ZONE � PLNG. REF. � . ,
REAR YARD (TO P/L)
PKG.SPACEREQ. PROVIDED' �
STREET WIDTH PARK FEE $
ZONING APPROVED BY DATE -
SPECIAL CONDITIONS: � -
. 'G ' I.
.ELECTRICAL � � PLAN CHECK
GENERATOR' 0-1 KW_1-10 KW �
TRANSFORMER �
APPLIANCE 10-50 KW_50 + KW - ' -
MOTORS ' 0-1 HP_3-30 HP -' � � - -
(INC.SOLAR) 30-SOHP 50+HP _
FI%TURES OUTLETS SWITCHES � "" -
GAS TUBE SIGNS - ' "- ' "
POLE LIGHTS ' ' " - ' - -
__.._...__.._.. .. _ . . ..
POLES METEREO SUB �
PANELS MAIN '" -'SUB� --"- —'� - �
SERVICE '� - AMP ' � '
" d-
- ISSUE FEE � ' ' ' "
' APGLICATIONAPPROVED-BY ' OATE '
SUMMARV OF FEES �
BUILDING '- " " ' ' •
_ PERMIT $ SMIP , . $
PLAN CHECK $ PERMIT't
iSSUANCE $
PLUMBING $ ' '
- . • GRADING E
PLAN CHECK S ?
ELECTRICAL $ � $ ,
PIAN CHECK $ - - MICROFILM E
MECHANICAL $ � TOTAL FEE S
PLAN CHECK $ - - �-E55 AD- _ �
-VANCEPC $'_
FINALFEE $ �L �
1 i r �
. .._ ; oa.u� w:u� . �
CONSTRUCTION AND�PLANN G -''. POOL & SPA.::� '' % '� �\ � .
R Date Inspector J �1 � ' Date Inspector
APPROVALS Permit # � ��`-'. APPROVALS � Permit #
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location � � "" � -
Soil ipe-Undrgrn � 44. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgrn 45. Forms �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding �
tee ein orce � 47. Rough Plumbin & Pressure Te4t � "
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE '
7. Footings - 49. Electrical Conduit-Undr rn ' �
6. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn � � � 51.� Backwash Lines P-Tra � ❑ ndr rn . � � • � � -
10. Structural Floor System ' -52. APPROVALTO DECK -- � � �
. 11. Property Sewer Line & House-Connection ' 17 y/_ � 53. Backwash & Rece tor-Final
12. Street Sewer Connection - 54. Heater & Vent-Final
13. Rough Plumbing 2- - ` �
14. Rough ElectricConduit � C�� "56: Electrical-Final
15. �RoughElectric-Wring 57. SolarSystem-Final � �
16. Rough Heating & Air Conditioning - - - � • encing & Access Approval
17. Ducts in Structure - � APPROVED FOR PLASTERING '
18. Ducts, Ventilating - ' � . - .
19. Gas Pipe-Rough &Test ` 60. POOUSPA.SYSTEMS FINAL •
20. Roof Framing i - ' � � �
21. Roof Sheathin ' � " �
22. - Frame and Flashin NOTES:
• 23. Insulation - � ' � ' �
24. Lathing & Siding
25. Drywall Nailing � � � �
26. Plaster Brown Coat �
27. Electrical Power MeterFinal - � � �
28. Final Electric ' ` 1 �
29. -Final Heating & Air Conditioning � t � �
30. Final Gas Pipe-Test � � ' �
31. Final Plumbing S ' � �
32. Water Service-Final
33. Gas Service-Final � `-- �
34. Solar pomestic-Final
35. Landsca e S rinklin S stem �
36. Sound Attenuation �
37. Handicap Regulations ' � �
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
_,\ 1� �
, r No Date . - � �
AGO��cant lo flll in all s
WTY. :..COSTA MESA �PERMIT NO.
• CONSTiTUCTIONPERMIT I E-
Addres ��o a�o ivFcvvonr
Arch/Eng. � License No.
Address
Contractor E: � P Q o r,,}�0 Phone
Address � /S'— .Z `.,i. ' C�h jncf'e
wilhln
I hemby aHirm that I am Ilcensetl untler Oroviilons of Charter 9(com-
mencing with settlon 7000) of Divlslon 3 0! the Buslness antl
PrOfB5510n5 COtlO�ntl y IICBn58 IS In full 70fCG entl ¢}} C[.
Licens./e CIaSs �� nse No ~ d
DateL(%��S' i� c����/���1�
WORK 5' C PENSATION DECLARATION
I here0y atfirT Ihat I hava a cartl(ICdte Of COn50nt So SelLinsurebr a
cerllficate of Workers' Compensation InSurante, or a cerlifietl copy
thereof (Sectlon 3800, Lab. C.).
��Icy No. Company
�j�,I,,,,,,erUBeO'COOY I5 herl�y /UrNshetl. '
-?���+Lertlfletl topY �s filetl with Me tlry Builtlin9 Dlvision.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
T�is section neatl not be complatatl If�the permit isfor one hunEretl
§1001 or lessl.
certlfy that ln the perfOrTanCe af Ihe work fOr which this perTit Is
IsSuaC, I shall not amPloy any person In any manner so as to become
SUD�ett to tM1e Workers Compensation Laws of Califomia.
Date Signature
NOTICE: If after making this tleclaraclon, you shoultl Decome zubject
to tne Workers' Compeniation provisions of the Labor Cotla, you must
forthwlth Comply with suth proviSions or this permlt Shall be tleemetl
revOketl. - ' '
CONSTRVCTION LENDING AGENCV
I heraby a(tirm that there is a construciion Ientlin9 agenty tor the per-
fOrmdnC! Ot th0 wOfk fOf w11ICh Ihis pelellit Is ISSUCtl (5¢CtiOn 309]
Civ. C.).
Lender's Name
Lentler's Atltlres5
or counry wnirn reqwres a
ITpfOvB� tl¢TOIISl1 OI f8polf dOy II�UCtU10, pflOf t0 1[S ISSYdOC<� d1T0 IO-
qWres lhe appliUnt tor zuGh p¢rTlt [O file a signeC statement t�at he
IS IlcenSetl Wrsuant t0 the provi5ions of Ihe Contractor's LlcenSe Law
(Chaptor 9(commencing with Section 7000) of Divislon 3 of the
Buslness antl Professions Cotle) or that he I5 exempt there�rom antl lhe
basls for the alle9etl exemption. Any vlolatlon of Secilon 7031.5 by
appllWnt lo� a pe�mit subject5 tne applicdnt to a civll pendlty
ol more t�an tive huntlretl tlollars (5500).
�, as owner of Ihe property, or my employees wi[h wages as tholr
sole compen5ation, will tlo the work, and the strutture is nobintentletl
or offeretl for sale. (Sec[lon 7044, Business antl Profezsions Cotle: The
COntraCtOr'S Gcense Law tloe5 not apply lo an owner Of a property
who DullUs o� Improve5 lh¢rBon, antl wM10 tloes suc� work himsel( or
tb�oUgh his Own employee5, provltl¢tl'thd[ sUch Improvements a�e�not
Intentletl or offeretl tor sale. If, however, the builtling or Improvement
Is soltl wilhin ono year of completion, the owner wlil have the�burtlen
OI prOving he tliC nol bulltl or imprOve tor the purpoia of sdle).
❑ I, as owner of tM1e properly, am exclusively mntracting with
Iicensetl contraclors to construct Ihe projact (Sectlon 7044, Business
antl Professions Cotle: The Contractor's License Law tloes not apply to
an owne� of.property wh0 builtls oi ImprOVGs th0�oon, dnd who con-
(ract5 I�om SUCh p�ojects with a contrdt[O/(5) Ilcesnetl pu�suant to
the Contrattor'S UcenSe Law). , .
❑ I am exempt untler Sectlon B. & P. C. for this
f¢dT00
Date � Owrier � '�' � � �
1 h¢vGby certity that I have rCatl this application antl State that the above
Informatlon Is torrect. 1 a9ree to comply with all city antl county
ortlinantes an0 stale laws relating to constructlon, antl hereby authorize
reprozentativez ot_thjvjclty to,�enter upon the above men[ionetl
DorCer lines an0 si9n all aporop�(ate tlaclaratlons.
TRACT NO. LOT NO. �BLDG.NO.
TVPE OF CONSTRUCTION
❑ NEW ❑ ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL �PLUMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION
SQ. FT.
OCCVPANCV_CONSTRUCTION TVPE
VALUATION ZONE
GRADING CU. YDS. ACRES
PLUMBING � � PLANCHECK
TOILETS
LAVATORIES
KIT. SINKS
SEfiVICE $INK$
FLOOR SINKS
DRINKING FOUNTAINS
INTERCEPTORS
WATERSERVICE
GAS SERV ICE
WATER HEATERS
SEW ER CONNECTIONS
SOLARTANK
3 0/28/BI 51.61 TU
20NINC� REGULliTIONS A1
A.P. �
20NE �PLNTGp. RUEF. p� "' • ' "'
SETBACK L . PROPE�RTV LINE
51 VARD
R�IGHTA �
REAR VHRD (TO P/L) '
PKG.SPACE REQ. PROVIDED '
STREET WIDTH ' PARK FEE $
ZONINGAPPROVED_BY � DATE ,
SPECIAL CONDITIONS:
ELECTRICAL, P�Arv CHECK I
VRINALS TRANSFORMER , 0-1 KW_1-30 KW _
DOUBLE LAVS ,APPLIANCE 30-50 KW_50 + KW _
DISHWASHERS MOTORS 0-1 HP_1-30 HP _
SUMPS (�NC.SOLAR) 30-50FIP SO+HP_
FLOOR DRAINS FIXTURES OVTLETS SWITCHES
� ,GAS TUBE SIGNS
CLARIFIERS , _POLE LIGHTS
ALTERATION
OUTLETS � �
BTU OUTPUT
GOLLECTORS
SOLA(3 PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-100,000 BTU_
AND DUCTING 100,000 + BTU _
REFRIGERATION 0-300,000 BTU_
SYSTEM 100,000 t BTU _
BOILERS BTU
SVSTEM REPAIR;ALTERATION
E%HAUSTSVSTEM MULTIPLE
$Ignature ' " ` ���
% ISSUE FEE
CMF 0865-46 Wnite�Builtling; Canary-Appliwnt; Gink-Accounting; GOIGenrotl-Assessor
_ °
�
PANELS MAIN G�SUB
SERVICE � ,7 d AMP
APPLICATION APVROVED
DATE
_ SUMMARV OF FEES � �
BUILDING
.PERMIT .. $ � � SMIP E
PLANCHECK $ , PERMIT :
PLUMBING g �SSUANCE $
GRA�ING $
PLAN CHECK S
ELECTRICAL $ '�� . $ .
PLANCHECK g MICROFILM $
MECHANICAL $ ' TOTAL FEE $ -
PLAN CHECK g � CE55 AD- -
VANCE PC $
FINAL FEE $_�(QL I ,
, '.
CONSTRUCTION AND PLANNING � � POOL & SPA , , - ' ;." ' %
APPROVALS Permit #�"15�� Date Inspectoi qppROVALS Permit #' Date Inspector
� � �i�.e�TemporaryElec`ri�al�Service.o� Pole - 43. Poof&Equipment Location ' �� - � . �
..Soil Pipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn � 45. Forms
'- 4. Electrical Conduit-Undrgm . � _y , .46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test • -
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE - ' �
7. footings 49. Electrical Conduit-Undr rn
8. Foundation - 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn '
10. Structural Floor System -52. �APPROVALTO DECK - � �
11. Property Sewer Line & House Connec[ion '� 53. Backwash & Rece tor-Final - �
12. Street Sewer Connection � 54. Heater & Vent-Final �
13. Rough Plumbing �
14. Rough Electric-Conduit . �56. .Electrical-Final �
15. Rough ElectrioWiring /-(o _g ` 57. Solar System-Final -
16. Rough Heating & Air Conditioning • encing & Access Approval �
17. Ducts, in Structure 9• APPROVED FOR PLASTERING �
\ 18. \Ducts, Ventilating - . "�
19: .Gas Pipe-Rough & 7est ' � 60. POOL/SPA SYSTEMS FINAL �
20. Roof Framing � . �
� 21. Roof Sheathin • , '
22. Frameand Flashin NOTES: • -
23. Insulation `'•
�.�24..• Lathing & Siding � � ' ' �
�,-25. Drywall Nailing •
26. Plaster Brown Coat �
�27. �Electrical Power Meter=Final �
'�28. . Final Electric ' - , Z _� -
29. Final�Heating & Air Conditioning
30. Final Gas Pipe-Test - � � � �
31. � Final Plumbing �
� '32. "Water Service-Final •
33. Gas Service-Final �
34. Solar pomestic-Final �� �
35. Landsca e S rinklin S stem �
36. Sound Attenuation �
37. Handicap Regulatiqns
36. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed� �
�, ,
40. Electric Release to Edison - D� Z
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY �
��; ��No Date . .
AOP��cant to fi11 in a11 spacas withirt heavy boraer Ilnes ana sign all appmoriate Oeclaratloni.—f-
CITY�OF COSTA�MESA � PERMIT NO. -� ' TRACT NO. LOT NO. BLD „�. '
CONSTRUCTION PERMIT ,M / "'� ; �
Prolecc Address � — TVPE OF CONSTRUCTION
�OWn¢r (� R��(Z �",� ' 'PhonE ' ❑ NEW _ ❑ ADD ❑ ALTERATION � -��
Addre55 ' - -3� - ❑�REPAIR�❑CONVERSION ❑DEMOLISH ��
Arch/Eng: - � - License No. - - ❑ aTHER
AddreiS ' ' - � . . �ESCRIPTION OF WORK
Contrector (� T�a(�C� " � Phone � � TVPE OF PERMIT � � '
AddlCss ' - - -' " ' ' ' ❑ GRADING' ' ❑ FOUNOATION' ❑ STRUCTURAL
LICENSED CONTRACTOR DECLARATION - - ❑ TENANT � ELECTRICAL OPLUMBING OMECNANI(
1 hereby affirm that I am licensetl unCer provlsions of CM1arte� 9(com-
mencing with sectlon ]000) ot Division• 3 of the Business antl ❑ OTHER -
Professlons Cotle, an my Iicenze is in full force an eifect. ' r ';;
License Class Lice se No. � PROJECT DESCRIPTION.
DdtG �-� �'�Z- $i9natur¢ � SQ. FT. . ,
WORKERS' COMPENSATION DE A TIO � ' OCCVPANCV_CONSTRVCTION TVPE
I heroby affirm that I have a terti �ca[e of consent to self-insura or a VALUATION ' ZONE
certlfiwte of Worker5'-CompensatiOn Insurance, or a certitietl COpy - -� � .
thereot (Settlon 3800, Lab. CJ. GRADING CU. YDS. ACRES
�licy No. � � Company - - - ' ' '
Certifietl copy is hereby furnishetl. - REMARKS' � �
Certltietl copy is filetl with the city Builtling Division.
E%EMPTION�FROM WORKERS' COMPENSATION DECIARATION - '- '-
(This section neetl not be completetl if the permlt is tor one huntlretl . _ .
(E1001 or leul. �-
I.cert(ty tha[ In th2 petformance,of the work for which,lhi5 Oe/mlt Is
issuetl, I zhall not employ any person in any manner so s[o-De<ome PLUMBING PLAN CHECK
zubje to t Wo @rs' Gompensati .Law of Ilfornia. ' ' " _
Date LSi9nature BATHTVBS � -SHOWERS
NOTIGE: If after;making this tlecl r H yo noultl become-zubject TOILETS � ' . VRINALS - '
to thC Work¢r5' Comp¢nsation prOvisions ot N l2bar COtle, you must ' ,
farthwlth complywith 5uch provisions or this permit shall be tleemetl LAVATORIES DOUBIE LAVS ' "
r¢vOk¢tl. . . _ . ." _'.' '_ _ -" _ _ _ ' .. . _
CONSTRUCTION LENDING AGENCV KIT.SINKS DISHWASHERS -' ' -
I hereby affirm thaf Ihere is a consiruction lentling agency for t�e per- SERVICE SINKS SUMPS �- ' �
torTanGe Of [he work tor whith this pe�Tit is izsuetl �Settion 309]
Civ. C.). "' -' '- ' "' ' ' ' � -- ' " - - -- FLOOR SINKS FLOOR DRP.INS�
Lentler's Name
LentleYs AtlEress DRINKIfJG FOUNTAINS � � �
OWNER"BUILDER�DECLARATION -" ' ' � - WTERCEGTORS CLARIFIERS
I he�eby atfi�m that I am exempt t�om the Cont�actor's LlcenSe Law for
Ihe following reason (Section ]031:5'Business'antl'Professions Cotle: SWIMMING POOL �� P T0.AP - - "
Any clty or county which requires a permit to COnStruc[, alter,
improve; demolish or repair any structure, prbr to its Issuante'also re- yyATER SERVICE �� HITERAT�ON
quires lhe ap4li�nt to� Such permit to file a sign¢tl Stdt¢m¢nt�tha[ he
is Itcensed pursuant'to the provislons'of'the Contractor's License Law GAS SERV ICE OUTLETS
�Chap�ter 9(commencin9 �+'�tn Section 7000p of Division 3 of the ^ f^ ^^ ^^' ^ ^ T^ __
�.� �. a�n o.�o.���n< r.,nai��rrn,rnP �c a. m„� �na.ar.�,� a�n rna�
�yappliczni for a permit sub�ects t�e applicant to a clvil'penalty SEWERCONNECTIONS � '"
not more lhan tive huntlretl tlollars (5500).
J I, as owner'of tLe property, or my employeei with wnges ai their SOLAR TANK � - COLLECTORS-
Sole.compensation,.will tlo.tite wo�k,.antl the st�uctu�e Is nol inlentled ___ _
or otferetl tor sale. (Section �044, Businezs antl Protessions Cotle: Tne SOLAR PIPING SVS.
ContractorY License law tloes not apply to. an. owner of a property . �_
who bulltls or improves thereon, ana who tloes such work himself or ISSUE FEE
[hrough.his own employees, provitletl.that such imOravements a�e not,
intentled oi of(e�etl tor sale. It, howeveq the builtlinq or Imp�ovement MECHANICAL PLAN CHECK
is soltl within one year o( completion, the owner will have the burtlen
of provin9 M1e Ditl not builtl or improve tor the purpose ot sale). HEATING SVSTEM 0-100,000 BTU_
❑ 1, as �owner -of-the property,-am ezclusively con(ratting with qND DUCTING - � -
licensetl contractors to construct the project (Sec[lon 7044, Business 100,000+BTV _
antl Professions Cotle:-The Contractor'z'License Law tloes noCapply to
an owner of property who builtls or Improves thereon, antl who con- REFRIGERATION 0-100,000 BTU_
tracts from such projects with a contrattor(5) �Ilcesnetl Oursuant tP SVSTEM
Ihe Contractor'S Licenie Law). 300,000 + BTU _
❑ -I am exempt untle� $ection � � - B. & P. C. (o� this '
BOILERS BTU
reason - - - ' - -- - -
Date -- Owner - SYSTEM REPAIR, ALTERATION
I.,hereby certifylhat 1_have read tnis.application antl state that the above EXHAUST SVSTEM MULTIPLE
Information is [orrect. I agree to comply with all city antl county �
o�dinances antl sjate laws rela[ing,to construction, antl h¢rebypu[horiEe Q}
repreSEn[atives of [his ci to ente� upon th¢ above mention<tl
Droperry fa nsp ctio o �
Signat ure Date_ �.�
Drivers'Licens r � '-ISSUE'FEE• - � • -- - � -
CMF 0865-46 Wnite-Builtlin9; Canary-Applicanh Pink-Accounting; Goltlenrotl-Assessor
. ,-
,;t.' �:.. ;� � 0600 I/1,3/82
0
A.P. 3}` ,
ZONE �� PLNG.REF.
\
11.00 TL
REAR VARD (TO P/L)
PKG.SPACERE�. • PROVIDED '-
ST0.EET WIDTH PARK FEE S .
SPECIAL CONDITIONS:
ELECTRICAL� PLAN CFIECK �
50. FT.
GENERATOR p.l KW_1-30 KW � �
TRANSFORMER
APPLIANCE ' 10-50-KW_50'+KW '
'MOTORS' " 0-1 HP_Id0 HP - _'
(IfVQ50lAR) -10-50 HP�_50 t�HP�- •
FIXTURES � OUTLETS SWITCHES -"
GAS TUBE SIGNS ' - - " '
POCE'LIGHTS " ' :
VOLES`V� V METERED SUB �
PANELS "- MAW � SVB--' "
SERVICE ' "' - AMP '
ISSUEFEE - -� ,�,'
APPLICATIONAPPROVEDBV ' -pATE
SUMMARV OF FEES . ' �
BUILDING ' ' -
PERMIT S ' SMIP .•b
P�AN CHECK E PERMIT �
- ' ISSUANCE $
PLUMBING E � -
- GRADING S
PLANCHECK .§ ' ' � -
ELECTRICAL $ � � -� s .
PCAN CHECK E ' __ MICROFII.M S
MECHANICAL E TOTAL FEE S
-oa '.
PLAN'CHECK' $ — ��LESSAD-�_ � _ _
VANCEPC S_
' . . . ' ' � �1 , ,'� . , % .
„ , FINALFEE S�//,OZS
�.. � C
CONSTRUCTION AND pLqNNyIN�.G� ����� ' _' � POOL & SPA., . ' � '
APPROVALS � � , � Permit # 111=.aS�.L!((L Date Inspector qppROVALS � Permit # � � � ' Date � ' Inspector
1. Temporary Electrical Service or Pole • 43. Pool & Equipment�L•ocation - � ' ���
Soi _ ipe-Undrgrn • 44. Steel Reinforcement � - - � - � -
3.. Electrical Conduit Utility-Undrgrn 45. Forms �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
tee ein orce 47. Rough Plumbin & Pressure Test - - '
6. Electrical UFER Grn ' 48. APPROVAI� TO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. . Eoundation. " -� 50.... Gas Pipe, ❑ Undr rn, Tesr �� � � �
_ 9. Water Pipe-Undrgm. _ 51. Backwash Lines P-Tra � Undr m�• ��- -- -� - � -` '
10. Structurel Floor System - � 52. APPROVALTO DECK � -' -" "' ' " ` �
11. Propeity Sewer Line & Hpuse Connection � � 53. Backwash & Rece torFinal ' �
12._ _Street Sewe[ Connection � 54. Heater & Vent-Final �
13. Rough Plumbing � - - - -
14. Rough Electric-Conduit - - - �56.- Electrical-Final ' �
15. Rou9h Electric-Wiring " - � � -- -- - - 57- Solar System-Final - ' � - ' ' �
16: Rough Heating & Air Conditioning� � (2..0 -� �(�Q"i- �- encing & Access Approval � � '
17. Ducts, in Structure . ' � 9• APPROVED FOR PLASTERING -
� � 18.- Ducts, Ventilating �_ - � _ . . _ ' .
19. Gas•Pipe-Rough & Test � � ' ' 60. POOL/SPA SYSTEMS F INAL � �' � � - ' .
20.- Roof Framing. - ' � �
21. Roof Sheathin - � .- � � � � � .
• 22.. �Frame and Flashin � � � � NOTES: � ' ' ' '
23. Insulation - '- ' '� ' � ` ' ' �
24.- Lathing & Siding " � � ' - � � �
25. Drywall Nailing " � � '
26. Plaster Brown Coat ' • ' ' - �
27. _ Electrical Power Meter-Final' - � � � � �
28. Fina6 Electric � � � '
29. Final Heating & Air Conditioning . �' .�1- � ' - - • • �
30. Final Gas Pipe-Test � - -
31. . Final Plumbing
32. Water Service-Final � �
33. Gas Service-Final � ' �
34. Solar pomesticFinal � �
35. landsca e S rinklin S stem '
36. Sound Attenuation
37. Handicap Regulations � � � ' �
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed ' ' ' -
40. Electric Release to Edison - ' " - - - -
41. Gas Release to Southern �ylif6mia Gas"Co. �'
42. CERTIFICATE OF OCCUPANCY � . " ._" � �
i- ..
- •-No. Date ' - --
AVD���ant to fill in all spaees wit�ln
CITY OF COSTA MESA PERMIT NO.
�CONSTRUCTION PERMIT {� ,�-►J�
owner THE HARBOR COMPANY Pno�e
Address 340" OLD NEWPORT BLVD. . STE. E
Arch/Eng. License No.
Address ' - � -
Go�Ee� lines an0 sign all a0D�o0riale Eeelarationz.
TRACT NO. LOT NO. � BLD�. NO.
TVPE OF CONSTRUCTION
,�BXNEW ❑ AOO ❑ ALTERATION
'� REPAIR ❑ CONVERSION ❑DEMOIISH
❑ OTHER
DESCt3IPTION OF WORK
BLDG. 3, LOT-E, PLAN A
ZC
A.P. �
ZONE �
Coniractql�INNEY AIR CONDITIONING Phone772-144 TYPEOEPEFMIT
AddreSS 1441 S. ANAHEIM BLVD. ANA. 280 ❑ GRADING ❑ FOUNDATION' ❑ STRUCTURAL
LICENSED CONTRACTOR DECLARATION- ❑ TENANT ❑ ELECTRICAL ❑PLUMBING �EAECFIAI
1 he�eDy affirm that I am Iicensotl untic� provislons of Charler 9(com-
mencing wilh section 7000) of Dlvislon 3 of 'the Businesz antl ❑ OTHER -
Grofessions Code, antl my Iicense is in fuli force antl e�tect. pROJECT DESCRIPTION
IJcense Class LJcenS¢
Date � %—� �+—Q � Si9nature SQ. FT. _
WORKERS• COMPENSATION DECLARATION OCCUPANCY_CONSTRVCTION TVPE
I hereby affirm that I M1ave a certlficate of consent to sel -inzuro or a .VA�VATION ZONE
certltifzte of Workers'" CompensatlOn InsuranGe, or a Certlfied copy
thereof (Se<tion 800 b C.) GRADING CU. YDS. ACRES
PoIicYNo. WP 1'7��F2'S comoa�v �EMONT
'erttfietl copy is hereby furnlshetl. � -
ertifietl copy is filetl with the dty Builtling Division.
G..EMPTION FROM WORKERS' COMPENSATION DECLARATION
This section neetl not be completetl it [ha permit is for one huntlretl
5300) or less).
Cert(fy thdt in Ih¢ pCrtorrtlanCe Of lh¢ wo�k f0/ whlCh this pe�mli I5
155uetl, I snall not emQloy any person in any manner so as to bocome
SubjBGt t0 the Workers CompensatlOn Ldws of Calffornla.
Date Si9�ature
NOTICE: It atter makinq [his tloGlatatlon, you shoultl betome subjecl
to the Workers' Compensation proviilons o( the Labor Cotla, you must
torthwith COmply witn suth provl5ion5 or tt95 petTit shall be tleGmeO
revoketl. � -
CONSTRUGTION LENDING AGENCY
I he�¢Dy affitm [hat there is a mnst�uttlon lentling aq¢nGy fOr fh¢ per-
Pormance of tne work for whicb this permit Is issuetl (Section 3097
Civ. C.).
Lentler's Name
Lentler's Atltlress
OWNER BUILDER DECLARATION "
I hereby affirm that I am exempt from the Conirac[or's License Law lor
the tollowing reason�(SecHon 7031.5 Business and-Professions Cotle:
Any city or county wM1ich requires a permi[ to con5truct, alter,
ImprOve, tlemolish o� re0ai� any st�ucture, prio� to its i55uance, also re-
qUi�es the ap0lican[ tor Such permlt to til¢ a sign¢tl Slatem¢n[ that h0
IS IlcenSetl pur5uant to th¢ prOvislOnS Of [h¢ Contraclor'S License law
�Chapter,9 (tommencinq with SectlOn 7000) of Division 3 of [he
usiness antl Pro(essions Cotle) or that he is exempt theretrom antl the
basis for the allegetl ezemption. Any violation o( 5¢ttion ]031.5 by
-'^ appliWn[ 7or a permit subjects the applicant to a civll penalty
ol more than tive huntlretl tlollars (5500).
., as owne� of llte prope�ty, o� my employees with wagei a5 [h¢ir
>vie compen5ation, will do Ihe work, antl (he struttur2 is no[ intentletl
or offeretl ror sale. (Section 7049, Business antl R'ofessions Cotle: The
ConirattOr'S License Law tloes not apply to an own¢r ot d prOperty
who bulltls or improve5 lhereon, dntl who tloes such work himself o�
lhrouqh his�own employees, provltlotl�tbat sucM1 improvemen[s are not
Inlentletl or offer¢tl for sal¢. 1f, howev¢r, Ihe buil0ing o� Imp�ovemenl
Is soltl within one year ot complotion, the owner will have the burtlon
of proving he tlitl not bWltl or improve for the pur0ose of sale).
❑ 1; as owner of t�e property, am extlusively con[racting wlth
Ilcensetl conlractor5 [o con5truct the project (Sectlon ]044, Business
antl Pro(essions Cotle: The Con[rac[or's License Law tloes nof apply to
dn owner ol p�operty who Duiltls o� ImprOvez [M1ereon, antl wh0 Con-
tracts from-such pro)ecls witn a-tontrac[or(s) licesnetl pursuan[ to
tne Contrattor's License Law).
❑ I am exempi untl¢r Sectlon 8. & P. C. tor this
reason —
Date ' Owner
I hereby certity Na[ I have reatl Ibis application antl state tha[ thC abOve
Information is correct. I agree ro comply wifh all ciry antl county
ortlinances antl sta[e laws relaling tp construction, antl hereby authorize
reoresentativez of_ this citv io 9nler uoon the above mentionetl
SlgnaWre
Drivers' License or 55 � �
CMF 0865-6fi White-Builtling; Canary-Applicanq
PLUMBING ' PLAN CHECK
BATFITUBS SHOWERS
TOI�.ETS VRINALS
LAVATORIES DOUBLELAVS
KIT. SINKS DISHWASHERS
SERVICESINKS SUMPS
FLOOR SINK$ FLOOR DRAINS
DRINKING�FOUNTAINS � �
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTRAP'
WATERSERVICE ALTERATION�
GASSERVICE OUTLETS
WATER HEF\TERS BTU OUTPUT �
SEWERCONNECTIONS �
SOLAR TANK COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU_�
AND DUCTING 700,000 + BTU _
REFRIGERATION 0-300,000 BTU_
SVSTEM �OO,OOO+gTU_
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAVSTSVSTEM MULTIPLE
ISSUE FEE �
Goltlenrotl-Assessor
REAR YARD (TO
PKG.SPACE RE�.
STREET WIDTH
9776 12/21/81
JING REGULATIONS
PLNTGp. gREF. � �
PROPE�RT�YNLIN
1
PROVIDED
SPECIAL CONDITIONS:
ELECTRICAL
PLAN CHECK
GENERATOR 0-1 KW_ 1-30 KW _
TRANSFORMER
APPLIANCE 10�50KW_SO+KW_
MOTORS 0�1 HP_1-30 HC _
(INC.SOIAR) � 30-SOHP 50+HP _
FIXTURES - OUTLETS SWITCHES
GAS TUBE SIGNS - -
POLE LIGHTS
,�-�
,�-�
�m��
e—�—
MAIN " SUB
AMP
ISSUE FEE " ' �'
�LICATION APPROV ED BY ' DATt
7.00 Tt,
SUMMARY OF FEES .
BUILOING
4.00 PERMIT $ SMIP S
PLANCHECK $ , 6 UANCE $�dSLV�
PLUMBING S
. GRADING .$
PLAN CHECK S
- ` E .
ELECTRICAL S
PLAN CHECK �$ i���� y�' MICROFILM §
MECHAfVICAL $`=�uu TOTAL FEE S %• OO
PLAN CHECK S - ' LE55 AD- ��
' VANCEPC E_
3
FINAL FEE E—L� lLV_
9�
�
\�
CONSTRUCTION AND PLANN�I(Ny�G� ��j%� � POOL & SPA � �
APPROVALS . permit #�`� Date Inspector qppROVALS Permit # ' Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
Soil ipe-Undrgrn •.. 44. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Cqnduit-Undrgrn 46. Electrical Bonding
. tee ein orce � 47. Rough Plumbin & Pressure Test
6. Electrical UFER Gm 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation � � 50. Gas Pipe, ❑ Undr rn, Test
. 9. Water Pipe-Undrgrn 51 . Backwash Lines P-Tra ❑ Undr rn � �-
10. Structural loor System 52. APPROVALTO DECK '
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection, � 54,. Heater & Vent-Final
13. Rough Plumbing '
14. RougF Electrio-Conduit - � ��56.' �Electrical-Final
15. Rou h Electric-Wiring 57. Solar System-Final
16. Rough Heating & Air Conditioning ..1 � encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
�16. Ducts, Ventilating -
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing "
21. Roof Sheathin ' �
22. Frame and Flashin NOTES:
23. Insulation
24. Lathing & Siding -
25. Drywall Nailing
26. Plaster BroWn Coat
27. Electrical Power MeterPinal -
28. Final Electric �
29. Final Heating & Air Conditioning t y ' '
30. Final Gas Pipe-Test � � �
.31. Final.Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final '
35. Landsca e S rinklin S stem
36... Sound Attenuation � �
37. kandicap Regulations -
36. FINAL STRUCTURE & BUILDING �
39. Special Requirements Completed
40. Electric Release to Edison '
41. Gas Re�ease to Southern California Gas Co. '
42. CERTIFICATEOFOCCUPANCY
No Date � . . . �
AVP��cant
C�f'O�:OSTA MESA � i
' CONSTRUCTION PERMIT �
Addrea
Address
Contractor
In all spaces within heavy boraer lines antl.sfgn all appropriate tleclaralion!
7 ryp�� ' /j RAC%NO. L � NO. � �BLD .'N�
[3 4�
C� � �� TVPE OF CONSTRUCTION
Phon � 3 �,NEW ' O ADD. ❑ ALTERATION
Nj� ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
LiCense No. ❑ OTHER
,,. _ . _ DESCRIPTIONOFWORK
Phone
Add�255'rjG� ��� ,v�,� , � � ❑'GRADING ❑ FOUNDATION-' ❑ STRVCTURAL
LICENSED CONTRACTOR DECLARATION � ❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHANIG
I h¢r¢by afflrm that I am Iicensetl untler provislons ot Charler 9(mm- �. . � �
menting with 5ettion 7000) ot DiviSion 3 of tha Busine55 antl ❑ OTHER
Protessions Cotla, antl my Ilcense Is In tull forte antl etfect. pROJECTD $GFiIP^ION t�;� }+ �' ,
Llcense Class License No. � 2� p
Date - � � Signature _ p��
SQ. FT. �09 7 q,JV V.c.
WORKERS' COMPENSATION DECLARATION � OCCUPANCV6�C NSTRUCTION TVPE
1 hereby attirm that 1 have a ttrtificate oi mnsent to self-Insure or a VALUATION��ZONE ���
ttrtifiwte of Worker5' Compensatlon Insurance, or a certi/iea copy -
.Ihereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES
Policy No. � � Company �
:ertifietl copy is hereby turnlshetl. . REMARKS: _
�erti�ietl copy is filetl with tha city Builtling Divlslon. r
ci(EMPTION fROM WORKERS' COMPENSATION DECLAR'ATION � " D. i4
(This section neetl..not be completetl if Ihe permit Is for one huntlretl _ _ . ._ _
S$1001 or less). � ,.
certffy that in the performante of the work for which this permit is
issuetl, I shall not emPloy any per5on in any manner 5o as to�become PLUMBING PLAN CHECK �
subject t0 the Work¢n Comp¢nsa[ion Laws of Califotnid. '
Ddt¢ $i9nature BATHTUBS � � $HOWERS �
NOTICE: If atter makinq this tleclaraclon, you shoultl become subject TOILETS � • URINALS -
to the Workers• Compensatlon provisions of tne Labor Cotle, you must
forthwith comply with suth provisions or this permit shall be tleemetl LAVATORIES DOUBL.E LAVS
�¢vOk¢tl. . . - _ .._. -
CONSTRVCTION LENDING AGENCV KIT. SINKS- ' DISHWASHERS �
I hereby aftirm that there is a consVuc[lon lentling a9enty for the perv SERVICE SINKS SUMPS . ' -
formance of.the work,for, whlch�tM1ls permit is,issuetl (Sectlon 3097, ' �
Civ. C.). ' ' - ' FLOOR SINKS ��, FLOOR DRAINS �
LenGer's Name �
Lender's Atltlress ' DRINKING FOVNTAINS
OWNER BUILDER DECLARATION " � ' � INTENCEPTORS CLARIFIERS,+�
I hereby a(ilrm that I am exempt from.the Contractor's License Law for
Ihe lollowing reason (Section 7031.5•Business antl Professlons Cotle: . SWIMMING POOL " PTRAP '
Any city�or'munty whith requires a permit to construct, alter,.
� ............ .........�... ... .e....i. ...... �...�...... ....,. It "1 1 ' '
�sions COa¢) or that h¢ I5 exei
�.d exemption. Any, violation
a permit subjects the applic
five nuntlretl aollars (E500��. ,
the property, or my amploye
will tlo.the work?antl the�str
(Section ]044,•Business antl
:¢ tdw tlo¢5 not apply to an
WYIO bU11tl5 Of �mproves tnereon, ana
through hls own employees;.provitletl
intentletl or otferetl for sale. If, howe�
Is soltl within"one year of_completlon,
( provin9' he tlitl not builtl� or�iml
I, as' ownei"of 4he=property, a
ic nsetl coneractors to construct the
antl Professlons Cotle: T�e Contractor
an owne� of property who bulltls or
tracts from such projects witn a coi
the Contractor's License Law).
❑ 1 am ekempi unEer Section �
reason -
owner
o s ssuance, a so re- yypTER SERVICE . ALTERATION
^tl statement thabhe" -
rattor'S Litense Law" GASSERVICE � OUTLETS ��
rf Division 3 of the
pt therefrom antl che yyqTER HEATERS � BTU OUTPUT "
f, Section 7031.5 by
nt to a Clvil.penalty $EWER CONNECTIONS ' --'
s with wa9es as thelr � SOLAR TANK� ti1 �„�'COLLECTORS
ictuve�is not Intentletl _ .
4ofessions Cotle: The SOLAR PIPING SVS.
owne� of a p�ope�ty _
�uch,workhimself.ar ISSUEFEE
nplovemen[5 a!¢ ilot -
ding or improvement MECHANICAL PLAN CHECK
will have the burtlen �
he purpo5e ot:5ale). ��HEATING.SVSTEM '0-1�00,000 BTU
:ly contra<tin9�'With qND DUCTING - -
ction ]044, Business. ' -300�,000 + BTU
aw tloes noYapply to '
.ereon, antl who con- REFRIGERATION 0-300,000 BTU
Iicesnetl pursuant to SYSTEM � -
300,000 + BTV�
_B.&P.C;ortnis BOICERS ' BTV �
,. �ELIG�% SVSTEM REPAIR,ALTERATION ,, �'
i state ihat,[he above EXHAUST SVSTEM MULTIPLE �
a❑ city and counry
antl herebv authorize �
Signatur¢ v � Da e v
D/ivers' L e or SS � � ISSUE FEE
CMF OB �46 White-Builtling; Canary-Applicant; Pink-Accounting; Goleenrotl-Aszessor
A�P. 9
ZONE
. 7016 10/16/81
ZONING REGULATIONS
- 2A - / �
PLNG. REF. � '
,' REAR VARD (TO P/L)�
� PKG.SPACE REq.
STREET WIDTH �
ZONING APPROVED BV
SPECIAL CONDITIONS:
i
ELECTRICAL -
FEE $ �
PLAN CHECK `
GENERATOR 0-1 KW_1-10 KW _
TRANSFORMER �
APPLIANCE 30-50KW_SO+KW_
,MOTORS , p.l HP_1-30 HP _
(INC. SOLAR)'� 30-50'HP� � �50 + Hp•_
FIXTURES OUTLETS SWITCHES
GAS TVBE SIGNS •
POLE LIGHTS � ' ,
:PANELS -- MAIN
SERVICE
6
ISSUE FEE " -
APPLICATION APPROVED
350.95 TI,�
� 6
/
� a
SUB , �
SUB'
•AMP
� I�
SU MARV OF FEES
BUILDING '- —
PERMIT $ �� SMIP.r _ $ � 9�"
PLAN CHECK $ PEFMIT
� ISSUANCE $
PLUMBING $ .
- .GRADING $
PLAN CHECK $ " .� ' , , �
ELECTRICAL $ ' $
PLANCHECK $ MICROFILM E
MECHANICAL. $ TOTAL FEE $
PLAN CHECK g ' LE55 AD-
VANCEPC-$_
�C,�S��Z� - FINALFEE $���