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HomeMy WebLinkAbout366 15TH ST - Building Permitsa 1 Applicant to /ill in all spaces except those within heavy bottler lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. / TRACT NO. LOT NO. UNIT NO. Project Address ' TYPE OF CONSTRUCTION L1 NEW Ll ADD ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Applicant's Mailing Address Owner's Name Phone Address A.P.# Zone S Main Building: Accessory Building: Arch/Eng. License No. Address TYPE OF PERMIT GRADING ❑ TENANT ❑ ELECTRICAL ❑ OTHER ❑ FOUNDATION ❑ STRUCTURAL ❑ PLUMBING ❑ MECHANICAL T Front p B A Rear N I C Right N Contractor's Name Phone CityAddess License in. City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. PROJECT DESCRIPTION 5o. FT. occuPANcv CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES S Left R Ping. But. # Parking Req./Provided E Remarks: Planning Notes: Q M T License Class License No. - - S. PLUMBING FEES Signature YORKERS' COMPENSATION DECLARATION (OT i hereby affirm that I have a certificate of consent to self -insure or a certificate Bar Sink Showers ELECTRICAL Oee FEES of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Prevent¢r Service Sink Automatic Washer Transformer ❑ 15-50 KW Backflow Irrigation Sewer Ca P Policy No. Company BCertified copy is hereby furnished. Certifiedd copy i5 filed withththethe city Building Division. Construction Pole Sub. ❑ 50+ KW Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps Date Applicant - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps (This section need not be completed if the permit is for one hundred ($100) or Tess) certify that in the performance of the work for which this permit is issued 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws Of California. Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 110-1 HP ❑1 % - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar E19-15 HP Ell 6-15+ Date Signature NOTICE: If, after making this declaration, you should become subject to the Floor Sinks Urinal Fixtures Microwave Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet Device Boxes Pole Light 9 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the Work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Interceptors Water Heater - Outlets Range 9 Kitchen Sink Water Service Switches Sign Lender's Address _ OWNER BUILDER DECLARATION Lavatories Garbage Disposal 9 P 'Standing Sections I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or P—Trap p Generator ❑0.5 KW ❑5-15 KW Trash Compactor county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit o file a signed statement that he/she Is licensed pursuant to the pro7visions Of fe Contractor's License Law (Chapter 9 (commencing with Section 000) of Division 3 of the Business and Professions Code) or that he/she isexempt therefrom and the basis for the alleged exemption. Any violation of Section Roof Drains 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner Of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- move for the purpose of sale). LJ I, az owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with a con- MECHANICAL FEE$ Boiler Hood or Type I ❑ Canopy Type II [1 Duct- Under Ground DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data Duct -Structural Refrigeration System Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES Exhaust System ❑ Multiple ❑ System Repair/Alteration _who tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. C1I am exempt under Section B. & P. C. for this reason BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL $ $ $ $ $ SMIP $ PERMIT ISSUANCE $ P.C. $ GRADING $ Firepl/Fact. Bit. ICBG # Date Owner I hereby certify that have read this application and state that the above I,formation is correct. agree comply with all city and county ordinances Heating System & DuctingENERGY ❑0.100,000 BTU E1100,000BTL and state laws relating to building construction, and hereby authorize yfor of this city t0 enter upon the above-mentioned property for inspection inspection purposes. Signature Date Drivers' License or SS PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ MICROFILM $ TOTAL FEE $ Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor I. so CONSTRUCTION AND PLANNINGC APPROVALS Permit 4A Date Inspector I & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. " 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow)rrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 3111111111 -Applicant to fill inallspaces crxcepl those within heavy re^�der lines and sign all appropriate declarations. CITY OF COSTA MESA- - - - ` RMIT N P O. - ' TRACT NO. LOT,NO.3819 1161,- - ' 3RGoi/f-' Ti CONSTRUCTION PERMIT 0 1 376p .-7/1 Project Address - a TYPE OF CONSTRUCTION I ^NEW LJ ADD Q ALTERATION LJ REPAIR Applicant's Mailing Address; ��s f.*.��- E] CONVERSION ❑ DEMO/LtISH OTHER Cf A•P•# �O Zane Owner's Name / e Gi 5' hone DESC�,I PTION OF WORK `" ,t❑ ie /t;� �� / S Main Buildingq - - Accessory Building: 2 p yo, IZ �y. - E ., O Address L, / TYPE OF PERMIT GRADING FOUNDATION. STRUCTURAL T 'Front." .. N , ArchlEng.. '`'u�`'Li e e No. ❑TENANT ❑ELECTRICAL ❑PLUMBING ❑MECHANICAL B / // - 2 �2 OTHER -' A Rear -N Address - C Right ,G Contractor's No n � PROJECT DESCRIPTION 5O. FT. OCCUPANCY K R Address (mai l ing) f CONSTRUCTION TYPE VALUATION$ S f Left A- E City. License No. - ZONE GRADING CU.YDS. ACRES Plug. Ref. # _ 3-' 7 Park.Fees $; o�oZ 38 O LICENSED CONTRACT6111E ATION Remarks: C (�.� 3 -00 L Parking Req./Provided - U (hereby affirm that I am licen tl on er provisions of harter 9 (commencing ' g with section 7000) of bivisiol 3' of he Busi and Pro and - Use of Building: L'pk� -. I -E my license is I II fore and feet. 1 rZ— 'M License lass ens No - - PLUMBING _ FEES Planning Notes: I r = - E Date Signatu Bar Sink Showers cN WORK RS' COMPENSATION D CLA RAT ION hereby affirm that I have a certificate of consent to self -insure or a certificate Backflow Preventer Service Sink - I - ' -:S of Workers' Compensation. Insuranc or_a cerci ied co thereof (Section ' 3800, Lab. C) • •, - . u'"- Backflow Irrigation Sewer Gap - ": ,I . �' ' • ELECTRICAL ,-• ', - FEES - Policy Na. ®Certified copy is hereby furnish Co d. Pant" .. " I Bathtubs I Sewer Connection_ ., Automatic Washer ' Transformer. ❑ 15 50 KW- _ I Certifi d copy i with the ty B ilidmg Division. - -' "' ❑ 50- ' (' Date Apphca Clarifiers ` Solar Collectors Construction Pole Sub. EXEM i F M WORKERS- CO ON DECLARA (This section need not be completed if the permit Is for one hundred ($100) or is was er -- Solar Piping - - Cookie Unit - - g- I - Meter. ❑u to 100 amps P- - ; less): , 1 certify R hat in the performance the anner or'whto this permit iect et Drinking Fountains ,•i Solar'T2nk 1;y / „ r, `F , Dishwasher - Meter []over 100 amps: _. �.. t shall not employ any parson in any manner spas to become subject to the n Workers' Compensation. Laws California. I Floor Drains Swimming Pooljw/Spa I Dryers ❑Gas ❑Electric ISub Panel Date —Signature - —. NOTICE: If, after making this declaration, you should become subject to the Floor Sinks 1 Urinal - Fan' Motors ❑0.1 HP 1:11 %- 8 -Workers' Compensation provisions of the Labor Code, -you -must forthwith 'with such or this shall be deemed revoked. I comply provisions permit. Gas Service :Outlets _ Water Closed F.A.U. Inc. Solar ❑9-15 HP 1:116-15+ CONSTRUCTION LENDING'. AGENCY - I hereby affirm that there Is a construction lending agency for the performance 'work _ Interceptors Water Heater Fixtures: Microwave ' of the for .which this permit is issued (Section 3097 Civ. 'C.). Lender's Name - - Kitchen Sink - Water Service - Device Boxes Pole Light Lender's Address OWNER BUILDER DECLARATION ; .' .the Lavatories' Outlets Range I hereby affirm that 1 am exempt from the Contractor's License Law for -Trap - - ' following reason (Section 7031.5 Business and Professional Code: Any city or 1P p - Switches 1 Sign -county which requiresa permit to construct, alter, improve, demolish or. repair any structure, prior to its Issuance, also requires the. applicant for such permit 'Roof Drains - __ Garbage Disposal- - - ' Standing Sections - - •' -` - to file a,signed statement that he/she is licensed pursuant to'the provisions of he Contractor's License Law (Chapter 9 (commencing withSection7000) of 'vision, Generator ❑0.5 KW ❑5-15 KW Trash Compactor p 3 of the Business and Professions Code) or, that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a' permit, subjects the applicant- to a civil " Reins ection Fee P $25 Issue Fee " $ 3 ' renalty of not more than five hundred dollars ($500). - LJ 1, as owner of the property or my employees with wages' as their sole I Reinspection Fee $25 Issue Fee $'3 compensation, will do the work, and the structure is not intended or offered MECHANICAL FEES _ for sale (Section 7044, Business and Professional Code: The Contractor's _ PUBLIC SERVICES FQyIREI�IELIN`S: License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I ❑ - thereon; and who does .such work himself/herself or through his Or her own , Canopy Type II ❑ nxxrr // Zoning Approved By- - Date employees, provided that such improvements are not intended or offered for Duct- Under Ground I sale. If, however, the building or improvement is sold within one year of Com- Application Approved By I Date pie veIf the Owner willfhave the bdrtlen Of proving he/she OIO not build or im- t rove for the purpose of sale). � Duct -Structural Refrigeration System Application Issued By n�l-b Data 7� 1, as owner of the property, am exclusively contracting with licensed con- ❑0.100,000 ❑100,000 tractors to construct the project (Section 7044, Business and Professions Cotle: ' Duct - Ventilating BTU BTU SUMMARY OF FEES The Contractor's License, Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- Exhaust System El Multiple IJ System Repair/Alteration- - BUILDING PERMIT ' $ -;3-7!?-SMIP 1 $ I 7 tractor(s) license pursuant to the Contractor's License Law). , PLAN CHECK $ 1 PERMIT ' ❑ 9 -am exempt under Section B. & P. C. for this reason Firepl/Fact-Bit. ICBO # 'ISSUANCE I PLUMBING $ $ Date Owner, I Heating System & Ducting I PLAN CHECK $ I ENERGY P.C. $ ' I hereby certify that I have read this application and state that ttie above ❑0.100,000 BTU ❑100,000BT � GRADING $ ' information is correct. I agree to comply with all city and county ordinances - - .. � ELECTRICAL $ and state laws relating to building construction, an hereby authorize retire- PLAN CHECK - $ MICROFILM $ sentatives o this t to a ter tion he abov tinned property inspecti an/t �ni� �i/N'1_fP/ _ ' MECHANICAL $ Signature ""'d'!f(/%R/� CMF 086546 rev. 7/83-. White -Building; Canary - AOpiiwnt; Pink - Accounting; Goldenrod - Assessor • CONSTRUCTION AND PLANNING APPROVALS Permit # Date. Inspector PO. � SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. _ - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. _ 57. APPROVALTO COVER-GUNITE 7. Footings, (el 11re-- 58. Electrical Conduit-Undrgrnd. 8. Foundation - sy d d, 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd'. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final ' 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit- - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough-Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Tactory Fireplace :, 21. Ducts,, in Structure 70. Underground Hydro 22. Ducts, Ventilating. 71. Product Piping ❑ Gas ❑ Oil 23. Gas-Pipe-Rough&Test 72. Underground Flush 24. Roof lFraming 73. Undergrnd. Storage Tank El Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar, Ceiling (Structural) &'Monocoat 75. Dry Chemical 27. Frame-and Flashing �� C,--�' 76. Dry Standpipe 28. Latfiing & SidinIg / Ll�,- 77. FIXED SYSTEM FINAL 29. Insulation LA-, 78. FIRE PREV. FINAL 30. Drywall Nailing VL HEALTH DEPT. REQUIREMENT .31. Plaster Brown Coat., 6- 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ef-4 Z Z 7L/�- 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy - 37. Final Factory Fireplace's 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap, Regulations 47. FINAL STRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCYy �.p� No. DateJ _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MA COJVST UC ON RMIT Project Address Applicant's Mailin dr ss Ownersa Phgne Address _ 'j�-/ Ly Arch/Eng. License No. Address Contractor's Name — on r Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION , I hereby'affirm that I am licensee under provislonS of Charter 9 (commencing with section 7000) of Division 3of the Business and Professions Code, ai my [license is in II III/ antl effect. /�/J/'J Llcen�J..7 Date Signature l WORKERS' OM ENS ATION DECLARATIO I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Cympemzition Insurance, or a certified copy thereof (Section 3800, Lab. Ca)1.1-,��./ li No. r/4/Ly6�rr'-F/ 2 Co pony r' Certified opy'i hereby Turn ishotl. Certs d y' with the city B. g n Date Applicant EXEMPT[ N P M WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100)' or less). - I certify that in the performance of the work for which this permit [s issued) shall' notl employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date ! Signature NOTICE: If, after making this declaration, you should' become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's. Address OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair anystructure, prior to Its Issuance, also requires the applicant for such permit .to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/She is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Entity of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole comp¢nsa t[on, will do the work, antl the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rrove for the purpose Of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who - builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to -me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner Ihereby certify that I have real information is correct. I agree to and -state I s r ati ng to b 'Idi sentatives f ci t inspection or Signature Drivers' License or SS - CMF 0865.46, rev. 4/84 Pink -Accounting; Goldenrod-AssessorPink -Accounting; Goldenrod -Assessor Hood or Type ❑ Canopy l Type I I' ❑ Refrigeration System 00-100,000BTU 0100,000 System Repair/Alteration Issue Fee A.P. # S Main Building: E T Front A Rear C Right K S Left Ping. Ref. # Planning,Notes: 3834 7/11/84 3:90n TL Zone Accessory Building: 2 O N I N G R Parking'Req./ProvidedE . Q M S. ELECTRICAL FEES Automatic Washer Construction P01e Sub, j Transformer ❑ 15-50 KIN - ; ❑ 50,+ KW Cooking Unit .1 Meter ❑up to 100 amps ' Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel I Fan Motors0-1 HP 1:11%-8 F.A.D. Inc. Solar ❑9-15 HP 111 6.15t Fixtures ' Microwave - Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal ' Standing Sections Generator ❑0-5 KW 05.15 KW Trash Compactor - FEES Reinspection fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ 2, PLAN CHECK 25% $ 6500 ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ $ 3 PLAN CHECK 25% $ $ 3 FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE . $ 33'w I� CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location -- 2. Soil Pipe-Undrgrnd. ,-:''� �� 53. Steel Reinforcement -' I 3:-Electrical'Conduit.Utility-Undrgrnd 1 54. Forms 4' Electrical]ConduiT-Undrgrrid. 55. Electrical Bonding 5. Steel Reinforcement �`• 56. Rough Plumbing &Pressure Test -• 6. Electrical UFER GrndJ 57. APPROVAL TO COVER-GUNITE :<; •: 7'. Footings' �•_ j' �"f 58. Electrical Conduit-Undrgrnd. 8:,Fo6ndation -( Y? 59. Gas Pipe, O Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, -Trap, ❑Undrgrnd. 10: Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line,& House CoAriection '1 . {9 62. Backwash & Receptor -Final 12. Sewer Cap .i''" .") "r 63. Heater &Vent -Final 13. Roof Drains "' �. '" '�•'� 64. Plumbing System - Final 14. Rough Plumbing-,. 1O/I601i LEO 65. Electrical -Final - 15. `Rough Electrical -Conduit- - 66. Solar. System -Final - 16._Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 2. Ducts, Ventilating 71. Product Piping O Gas' O Oil 23. Gas Pipe -Rough & Test •. _ 72: Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank•13Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing &Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final - 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning y 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer ' 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE- OF. OCCUPANCY o. Date ' •- i Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA, �ONSTR CTION PERMIT PERMIT NO.. TRACT NO. LOT NO. UNI=NO. Project Address Applicant's Mailin Address Owner's Namewhy �pyjlone Address Y&Q AWL, i Arch/Eng. _ License No. Address}--�j- Contractor'sNam ,Alc1%'hone '`fC-a�C Address Imailing) P D _5` - • 11 vv. ` City Licence No // 5 I LICENSED CONTRACTOR DECLARATION , I hereby affirm that 'I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is n full, to, 9 a ffect License ee No. Date Signature WORKERS' COMPENSATION DECLARATION - I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C. ; Pink - Accounting; Goldenrod - Assessor FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping _ Solar Tank Swimming Pool w/Spa, Urinal Water Closet - . Water Heater Water Service - Issue Fee $ 3 JANICAL FEE Hood or Type I ❑ , Canopy Type 11 ❑ Refrigeration System 00.100,000BTU 0100,000 BTU System Repair/Alteration Issue Fee 1 $ 3 A.P. # S Main Building: E T Front ARear C Right K Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit . Dishwasher 8033 2/22/95 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50.KW , ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps ,'•'.P13 TL FEES Z O N I N G R E Q M T S. Dryers ❑Gas ❑Electric Sub Panel - I Fan Motors ❑0-1 HP ❑1'h - B F.A.U. Inc. Solar ❑9-15 HP ❑16.15+ Fixtures Microwave Device Boxes . Pole Light Outlets Range Switches Sign Garbage Disposal StandingSections Generator ❑0-5 KW 05-15 KW Trash Compactor I I Reinspection Fee 1 $15 1' I Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT . $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ SSS ISSUANCE $ PLAN CHECK 25% $ 2, ENERGY.P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ 13 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # - . j Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. f 53. Steel Reinforcement 7 �. 3.'Electrical Conduit Utility-Undrgrnd'. �` 54. Forms 4. Electrical Conduit-Undrgrnd. .l'• 55. Electrical Bonding '.5. Steel'.Reinforcement �� .!J 56. Rough Plumbing & Pressure Test • . 6. Electrical UF ER Gr`nd.• F =� 57. APPROVAL TO COVER-GUNITE _" • J 7.•Footings •.•j; 58.. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test r 9.. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑Undrgrnd. 10. Structural Floor System % 61. APPROVAL TO DECK ' 11. Properiy-Sewer Line & House Connection '+ 62. Backwash & Receptor -Final •12. Sewer Cap ? ' ' 63. Heater &Vent -Final , 13. Roof Drains _ 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final , 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning n FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts; Ventilating 71. Product. Piping O Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrhd. Storage Tank D Gas D Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding ' 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 131. Plaster Brown Coat I . 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 3105-1 Gk0 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - • 50. Gas Release'to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date vJ C WORKERS' COMPENSATION DECL RAT,1 N . Applicant to fill in all spaces except those within heavy bolder lines and sign all appropriate declarations. CITY -OF COSTA MESA f - T— - - PERMIT NO. - TRACT NO. LOT NO. - -BLD .-NO. 3800, Lab. CJ 824232 1 FAIRMONT Policy No. ' Company 1 Certified copy is hereby furnished. j CONSTRUCTION PERMIT .. Unit"' -• - -- �/}}t5 Bathtubs y •� �:,' i Sewer Connection I f D Certif d y s filed with the city Bui in v i _ ,,_ ,, ���. ',,,.J,. Date-�' �4 I Applicants ^nn Vh.wt%f.I� Project Address ^'166 F. _ A Srh _ Sr'_' TYPE OF CONSTRUCTION' LA NEW LJ ADD -LJ -ALTERATION LJ REPAIR. EXEMPTION FROM WORKERS' COMPENVkD CLARATION- - (This section need not be completed if the r ne un'($100) or Applicant's Mailing Address .❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Owner's Name THE HEIGHTS PARTNERS Phone 831-941_9 DESCRIPTION OF WORK S Main Building: Address' P.0; BOX• 958 - =NEWPORT BEACH, CA _ - E' T Front TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL_ Arch/Eng. License No. ❑TENANT ❑ELECTRICAL ❑PLUMBINIdAG MEDH ANIC AL B• ' _ i ❑ OTHER A Rear, Address C , RightK Contractor's Name SIERRA FNVIROMF.NTAL `.Phone957-8991 PROJECT DESCRIPTION SO. FT. OCCUPANCY Address(mailing) 2121 S_ (:RAND AVF CONSTRUCTION TYPE 4 VALUATIONS $ Latt - - i i 61Ping. ZONE ' GRADING CU.YDS, ACRES- Ref. City -License No. -- LICENSED CONTRACTOR DECLARAT) ON - Remarks: ' - Parking Req./Provid I hereby affirm that 'I am Ii cc rise,uno er rov s ons of Charter (commencing B14031'6 with section 7000) of Division 3 of th eo Proles ns Code, and , ' Use of Building: ffac� my license is in full force antlin Lu :.yds - ' uicense s5, + PLUMBING - FEES Planning Notes: Date ' 1 Signature ' 1644 2r 14 1119 - I B i S k Sh WORKERS' COMPENSATION DECL RAT,1 N . ar in owers .SUMMARY OF FEES $ ELECTRICAL Backflow Prevemar I Service Sink - - - - - -- - -- ;Transformer El 1550 KW I I hereby affirm that I have a certificat of cons nt to xilfAnsilre or a certificate -of Workers' Compensation Insurance, or -a certified copy thereof (Section El 50'+ KW 3800, Lab. CJ 824232 1 FAIRMONT Policy No. ' Company 1 Certified copy is hereby furnished. j Backflow lrrigailon Sewer Cap - Unit"' -• - -- ' Bathtubs y •� �:,' i Sewer Connection I f I Certif d y s filed with the city Bui in v i _ ,,_ ,, ���. ',,,.J,. Date-�' �4 I Applicants ^nn Vh.wt%f.I� I ClBrif iers ' j+% Solar Collectors ' Sub Panel _ ^ $ EXEMPTION FROM WORKERS' COMPENVkD CLARATION- - (This section need not be completed if the r ne un'($100) or - h Dishwasher - " J -Solar Piping PLAN CHECK ELECTRICAL PLAN CHECK less)' , I I certify that in the performance of the this per i not employ any person in any m b om the Workers' Compensation' Laws of Cali Por i - r - - j Drinking Fouri[alns . Solar Tankshall $ $ $ - t Floor Drainsl 19N' I : ' Swimming Pool w/Spa i ' - y Date '9-13-811 Signature NOTICE: If, after making this declaration, you sh0)Y(CiAecome sub" ct to the Workers' Compensation- provisions of -the Ubor-Code, you must forthwith - comply with such provisions,or, this.-p?rmiti shall be deemed revoked., CONSTRUCTION' LENDING -AGENCY - . x+ - ' FIOor Sinks - Urinal - TOTAL FLEE - Gas Service Outlets Water -Closet; t_ - ' $ 3 Interceptors Water Heater ) - $ 2,00 I hereby affirm that there Is a'construction lending agency -for the performance' ; of the work for which this, permit Js issued � (Section 3097 Civ_. C.). Kitchen Sink - . Water Service 1 - - Lender's Name' r' - Lender's Addre'ss t- OWNER BUILDER DECLARATION , Lavatories -_ 1 hereby affirm'that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or to file a the Coni 'efrom and the basis for the alleged exen 1'.5 by. any applicant for; a. permit su alty of not more than five hundred dollars I, as owner of the, property ,or my emf Ipensation, will do the work, and the stn sale (Section 7044, Business and Profe that he/she is exempt y'violation of Section applicant to a' civil License Law does not apply to an owner of a property wno,puuas or improves thereon, and who does such work himself/herself or through his or'her own 1 employees, provided that such. improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have,the burden of proving he/she ala not build or im- rove for the purpose of sale). ' I 1, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The . Contractor's License Law tloes not apply to an owner of property. who. builds or improves thereon, and who contracts for such projects with a con. tractor($)license pursuant to the Contractor's License Law). ❑' ]'am exempt under Section B. & P. C. for this reason I Date Owner' I hereby certify that I information Is cor r_ec and: state laws relati sentatives of. this ci inspectlon purposes. ; Signature Drivers' License or 5 5P CMF 0865-46 rev. 7/83- - Roof Drains 'Reinspection Fee $25 Boner _ Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑* 1' Firepl/Fact. Bit. ICBG'#1560 1 Heating System & Ducting and state that the above f -100,000 BTU ❑100,000BTL a di -ny an ty or minces ntl' y out horize repre- entiohad property for ' Reinspection Fee - Applicant; Pink - Accounting; Goldenrod - Assessor $25 , Issue Fee Hood or' Type I ❑ ' Canopy Type 11 ❑ ; Refrigeration System ❑o-100,000 arU 0 106,000 61 Issue Fee BICf5 9/13/84' Zon Accessory Building: Fees $, t BUILOINGOERMIT .SUMMARY OF FEES $ ELECTRICAL c Washer ;Transformer El 1550 KW I - El 50'+ KW :ion Pole Sub. t Unit"' -• - -- :Meter ❑upto100amps-- l er' k 'Meter, Cover 100amps� - I PLUMBING )Gas, ❑Electric I Sub Panel _ ^ F.A.U. Fixtures I i Device Boxes , Outlets Switches. ' Garbage Disposal Generator ❑0.5 KW ❑5.15 KW ,. $ 3 , FEES Reinspection Fee I $25 PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Application Approved By Aooliration Issued By X A Motors ❑0.1 HP ❑1'/:- Inc. Solar 09-15 HP ❑l Pole Light Range Sign Standing Sections . Trash Compactor Issue Fee 15+ O N I N G R E Q U I R E M E �© W■ $'3 BUILOINGOERMIT .SUMMARY OF FEES $ SMIP $ 1 - 1 PLAN CHECK $ PERMIT PLUMBING $ 1 'ISSUANCE $ PLAN CHECK ELECTRICAL PLAN CHECK $ $ i $ ENERGY P.C. GRADING MICROFILM $ $ $ ' MECHANICAL $ ��� TOTAL FLEE $ O Q $ 3 PLAN CHECK $ 2,00 'CONSTRUCTION AND PLANNING -.APPROVALS Permit 4# %.,Date Inspector POOL & SPA :APPROVALS ,Permit# Date Inspector 1. Temporary Electrical Service or Pole, 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms_ ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - - 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59.. Gas Pipe, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. _ - . 60. Backwash Lines, P -Trap,❑ Undrgrnd. 10. Structural Floor System j.. - 61. APPROVAL TO DECK - 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap - _ 63; Heater & Vent -Final 13, Roof Drains •; .- 64. Plumbing System- Final . 14: Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit _ - 66. Solar System -Final - . 16. rRough Electric Wiring '�' - 67. Fencing & Access Approval 17. Rough Wiring Sign - - 68. APPROVED FOR PLASTERING 18. Rough Electri6l-T Bar Ceiling i 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning_N./ �� FIRE DEPT. REQUIREMENT APPROVALS Permit # 2W Rough Factory Fireplace �G �0 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24! Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing - 76. Dry'Standpipe 28. Lathing & Siding' 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREV, FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric } Nates: 34. Final Heating & Air Conditioning/yam 35. Final Gas Pipe -Test - - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINALSTRUCTURE &'BUILDING , 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51: CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 'CITY OF COSTA MESA CONSTRUCTION PERMIT Project Addres,3- E %C / Automatic Washer' - Applicant's Mal' g Address I $15 1 1 Issue Fee Owner's Name /G.4/T•S X1.3 PhoneV/-9W Address P.O -�9.5 8 �ne�o.aj 9266 / Arch/Eng. 4, A07--T'EFMeRF Lirense No.A0_Ar.r Address P, 0 • /( z - CSM - '262 Contractor's ZY/ PhonA /- / Address (mailing) P /_33 - ,/ A /�2- 4 49==3 City License_ No. 02777 3 Swimming Pool w/Spa LICENSED CONTRACTOR DR ON / F.A.U. I hereby affirm that I am Ilce fied etl unun r provisions of Charter 9 (commencing . with section 7000) of Divisio 3 of t e Busines my license is in full force and direct. nd Pro essions Cotle, and yORKEAS' COMPENSATION DeG+:ARAT10N 1 hereby affirm that I have a cert it' c f consent to self -insure or a of Workers' Compens3tion.ln Sur F,e, r -a certified copy there0 3800, Lab? —� � �^ Policy No ^ Com any Cert if i@@d copy s hereby:f ur n is eiJ>„ CeLtIfISO cpp-y s JLjLC4&th the city, Bu' Qjng Divisio . EXEMPTION FRO44 WORKERS' COMPENSATION DECLARATMN (Thissection need not be completed if the permit is for One hundred ($100) or less). n I certify that in the perfofmance of the work for which this permit is issued, I shall not employ any person in any+Tanner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for performance of the work for which this permit is issued_(Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby, affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit 10 file a signed statement that he/she Is licensedpursuant to the provisions of :he Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil malty of not more than five hundred dollars ($500). I, as owner of the property or my -.employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for Sale. If, however, the building Or Improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- t ractoreto construct the project' Sect l on 7044, Business antl Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(st license pursuant to the Contractor's License Law). 1 am aware that I proof o their Worker's Compensation insurance Should be provided to me. ❑ I am ejempj under Section - V---- B. & P. C. for this reason Date tate that the above infor anon is co re<t. Imp)d county ordinances antl s ate laws r ating consby authorize repre. Ives of thi cityponioned property for inspe tion our as. Signa ur Driver se or.55 # 4626 7/20/84 TYPE OF CONSTRUCTION XNEW IJ ADD IJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEM(LISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: Accessory Building: TYPE OF PERMIT U GRADING1:1 FOUNDATION El STRUCTURAL T Front ❑ TENANT i�y'�'ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right KLeft CONSTRUCTION TYPE VALUATION $ $ ' ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: /JM iT L' n IJ I h'7 / Planning Notes: Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Roof Drains Reinspection Fee FEES ELECTRICAL Service Sink - - / Automatic Washer' - Sewer Cap I $15 1 1 Issue Fee Construction Pole Sub. Sewer Connection $ 3 Cooking Unit Solar Collectors / Dishwasher Solar Piping Date Date Date Dryers as Electric Solar Tank 3 Fan, 1 Swimming Pool w/Spa / F.A.U. Urinal SUMMARY OF FEES $ $ $ $ f1� $ 3G• L1yz_ $ i 41,40 $ $ /0 Fixtures Water Closet - - Device Boxes Water Heater 31 Outlets Water Service / Switches Garbage Disposal Generator ❑0.5 KW 05.15 KW $151 1 - Issue Fee $ 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 58.20 TL FEES - '-Transformer LJ -15-50 KW - I - ❑ 50,+ KW Meter *up to 100 amps , Meter Oover 100 amps Sub Panel IfO Motors E10-1 HP❑1%-8 ';2 Inc. Solar 09-15 HP 016.15+ Microwave ^2 Pole Light Range Sign a Standing Sections Trash Compactor / Z O N I N G R E Q M T S. Reinspection Fee I $15 1 1 Issue Fee $ 3 AANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By— Date Date Date Hood or Type ❑ Canopy Type II ❑ Refrigeration System ❑0.100,000 BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ f1� $ 3G• L1yz_ $ i 41,40 $ $ SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 96 2-0 System Repair/Alteration Issue Fee $ 3 CONSTRUCTION AND PLANNING - h` APPROVALS Permit# Date Inspector P�-L & SPA - APPROVALS Permit# Date Inspector - -•-_ 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. _ 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd.` 54. Forms 4. Electrical Conduit-Undrgrnd. •� 7� �! 55. Electrical Bonding 'eC 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test . 6. Electrical UFER Grnd.�, 3OC 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd: 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water, Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. •� ' 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 13. Roof Drains .. 64. Plumbing System'- Final 14. Rough -Plumbing - 65. Electrical -Final 15. Rough Electrical -Conduit - ( 66. Solar System -Final ' 16. Rough Electric Wiring C 67. Fencing & Access Approval - 17. Rough Wiring Sign i 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating-& Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pioe-Test 36. Hood or Canopy 37. Final Factory Fireplace .38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation ' 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date , City of Costa Mesa Development Services Department Building Safety Division C E R T I F I C i T E OF OCCUPANCY No.001229 P. O. Box 1200 Costa Mesa, California The Building located at 366 FAST 15TH STET UNIT Stn i has been inspected and found to comply with theirovisions of all City of Costa Mesa Ordinances applicable thereto for a Group P-1 Occupancy. Use of Build Legal Description wee reverse side for Metes and Bounds) Building Permit No. n—ldn'lr .Electrical Pim it No. T7-1 At Fn Plumbing Permit No.vl 5n51 _A17FFQ Mechanical Permit No. _^+_ ci no Number of apartments and/or guest rooms ISSUED TO: I Building Official A'li THE HEIGHTS PARS by P.O. BOX 858, AUBOA. CA. 92661 �/� /„ ✓� Date This Certificate of Occupancy SHALL BE posted in a cobicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 301) U.B.C. CMF 1015-46 rev. 1/83 White • Owner; Canary - Numerical Fi Pink - Bldg. Permit File Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address ' / i /- L ' / Applicant's Mailing Address 7, Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Name Phone i Address (mailing) r City License No. •�� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect, License Class f _ 4 License No. Date—' Signature YORKERS' COMPENSATION DECLARATION nereby affirm that I have a Certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance. or a Certified copy thereof (Section 3800, Lab. C.) Policy No. /-- Company 1. BCertified copy is hereby furnished. Certified copy is.filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to Ike Workers' Compensation Laws of California. Data Signature _ 'NOTICE: If, after making this declaration, you Should become Subject t0 the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signedistatement that he/she Is licensee pursuant to the provisions of '•a Contractor's License Law (Chapter 9 (commencing with Section 7000) of vision 3 of the Business and Professions Cotle) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil anally of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole coin an. ion, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a properly who builds or Improves thereon, and who does such work himself/herself Or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of Com- pletlon, the owner will ,have the burden of proving he/She did not build or im- rove for the Purpose of sale). 1, as owner of the properly, am exclusively contracting with licensed con- tractors to Construct the project ISCCtign 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds orImproves thereon, and who contracts for Such projects with a con. tractor(st license pursuant to the Contractor's LlcOnse Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. d P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. 1 agree to comply with all City and County ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection purposes. , Signature f Date Drivers' License or SS 9F TYPE OF CONSTRUCTION U NEW U ADD LJ ALTERATION LJ REPAIR FEES ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 10 DESCR IPTION OF WOR K/USE OF BLDG. Bar Sink Showers S Main Bu Service Sink E Automatic Washer Construction Pole Sub. TYPE OF PERMIT 13 GRADING 0 FOUNDATION EJ STRUCTURAL T Front TENANT 1-1ELECTRICAL❑ PLUMBING ❑ MECHANICAL Cooking Unit f❑ Meter ❑up to 100 amps A OTHER Rear U C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU. YDS. ACRES ping. Ref. Remarks: i- .. - Planning No Zone Accessory Building: Parking Req./Provided Z O N I N G R E G M T S CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors❑0-1 HP❑i%-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 1:19.15 HP ❑16.15+ Floor Sinks Urinal Fixtures Microwave / Gas Service Outlets Water Closet - Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal ; Standing Sections P—Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Foe $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date, Building Approved By Date Application Issued By Data ' Boiler Hood or Type ❑ Canopy Type II ❑ Duct - Under Ground Duct - Structural Refrigeration System 00.100,000 BTU 0100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $ $ OF FEES SMIP $ PERMIT ISSUANCE $ - ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG+ Fire Dampers Heating System & Ducting ❑6100,000 BTU ❑100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ' APPROVALS Permit 4h Date Inspector Pt & SPA APPROVALS Permit# Date Inspector 11. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof grains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' CITY OF COSTA MESA . CONSTRUCTION PERMIT Project Address � / 7 /t Applicant's Mailing /Address + 49 - Owner's Name ''/mak h 1 Address, • /amp 1�5� �'r No. 4�_G' / Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. I TRACT NO.-, I LOT NO. I BLD Address �' -r 4 OVZ' / L yr yr Contractor's Nam r� � one2.4 � 5Sr Atltlress Imailin9l=.-v-1--�3( � - C City License No. LICENSED CONTRACTOR DECLARON I hereby affirm that I am licensed un er 1 ovisi ons of Ch ter 9 (commencing with section 7000) of Division 3 o the usiness and P fesslons Code, antl my license is MVI fo ce and effect License qlass - c rise N Date Signature WORK RS' C MPENSATION DEC ION - 1 hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance or.a certified c thereof (Section 3800, lab - Policy No. _ m any 8 Certified o y is hereby Itiml he Certit ed c y is f' ed with the ci B ding Division. Date Applicant EXEMP IONROM WORKERS' COM SATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or - less). . ' - 1 certify that in the performance of the Work for which this permit is issued I shall not employ any person in any manner so'as to become subject to the Workers' Compensation Laws of California. Data 1 Signature I NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation -provisions of the Labor Code, -you must forthwith. comply with such provisions' or this _permit shall be deemed revoked. ` CONSTRUCTION LENDING'.AGENCY. 1 hereby affirm that there is a•constfuction lending agency -for the performance of the ,work for which. this permit is Issued (Section 3097 Civ. C.) Lender's Nam. Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5•Business and Professional, Code: Any city or county which requires a permitto construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of ,e Contractor's License Law (Chapter 9 (commencing with Section 7000) of vision 3 of the Business and Professions Code) or that he/she is exempt .lerefrom and the basis for the alleged ex em pilon: Any violet ion of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). LJ I, as owner of the property .or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale(Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year. of com- pletion, the owner will have the burden of proving he/she did not build orim- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s)license pursuant to the Contractor's License Law). 0 1 am exempt under Section B. & P. C. for this reason Date - owner I hereby certify that I have read this a le that the above county ordinances y authorize repre- tied property for TYPE OF CONSTRUCTION ^NEW LJ ADD IJ ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑OTHER - DESCRIPTION OF WORK 4D NkQ TYPE OF PERMIT LJ GRADING .t_7`FOUNDATIONIL STRUCTURAL_ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER+�Lf PROJECT DESCRIPTION SQ. FT. —0L OCCUPANCY_ CONSTRUCTION TYPE - VALUATION$ j ZONE GRADINGCU.YDS. (ACRES_ Remarks: 0 /P S C/J 7 C' CY-/ ,D ? Backflow Preventer Service Sink BUILDING PERMIT $ Backflow Irrigation Sewer Cap .� •� I Bathtubs Sewer Connection- ✓' • PLAN CHECK Llikifiers Solar Collectors,-, •,. '�" - Dishwasher - -Solar Piping - Drinking Fountains SolargTank r ISSUANCE $ Floor Drains Swimming Pool,w/Spa' I' Floor Sinks 1 Urinal $ $ $ ENERGY P.C. GRADING MICROFILM Gas Service Outlets Water Closet t, ' Interceptors Water Heater. Kitchen Sink - Water Service TOTALFEE $ Lavatories= - - - P -Trap. PLAN CHECK - u - Roof Drains I • Reinspection'Fee S25 - Issue Fee, _1 $ 3 Duct- Under Ground Duct -Structural ' Duct - Ventilating Exhaust System ❑ Multiple 0 Firepl/Fact. Blt. IC80 dh Heating System & Ducting 00-100,000 BTU 11100,000137 Signature / / Drivers' Li cenor SS -- — Reinspection Fee CMF 0865-46 rev. 7/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $25 Hood or • Type I . ❑ Canopy Type ❑ Refrigeration System CIO-100,OOoeTU ❑lo0,000 System Repair/Alteration Issue Fee A.P. # S Main Building: E T Front A ', Rear tiO3- C Right 701 S Left 6/ Ping. Ref. # _2LC' e- Parking Req./Provided Use of Building: n'. Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit - Dishwasher ; Dryers ❑Gas ❑Elec Fan' F.A.U. Fixtures Device Boxes Outlets Switches 3820 7/1.1/B4 0 Zone Accessory Building: L Park. Fees $ 02 ELECTRICAL %_ ,ly Transformer ❑ 15 -CO KW ' ❑ 50,+ KW' Meter Oup to 100 amps. Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP E11Y. - 8'- 'Inc.Solar 09-15 His El 1'6-15+ Microwave Pole Light Garbage Disposal Generator ❑05 KW 05-15 KW Sign Standing Sections Trash Compactor ; 3614.71\T1 Z O N I. 'N G ,R E O U I . R E M -E N T S FEES + `1 Reinspection Fee • • I $251 Issue Fee 1 $ 3 1 PUBLIC SERVICES REQUIR IENTS: Zoning Approved By {.+W ff LLL Date 7 1 Application Approved By Date_t - BUILDING PERMIT $ -SUMMARY OF FEES 3? 9. &0 SMIP $ .� •� I • PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK ELECTRICAL PLAN CHECK $ $ $ ENERGY P.C. GRADING MICROFILM $ $ $ MECHANICAL _ $ TOTALFEE $ >-.7 $ 3 PLAN CHECK $ • CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PC & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement �(Jj .56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings apoll 58. Electrical Conduit-Undrgrnd. 8. Foundation vL+ 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough%Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro 22..Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas'Pipe-Rough & Test 72. Underground Flush 24. Roof -Framing 73. Undergrnd. Storage Tank 0Gas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing �� �(-/ 76. Dry Standpipe 28. Lathing & Siding /� 7�x/( �` 77. FIXED SYSTEM FINAL 29. Insulation ,-f / sS/ �G/ 78. FIRE PREV. FINAL 30. Drywall Nailing / 7 CA- HEALTH DEPT. REQUIREMENT .31. Plaster Brown Coat:; g 79. FINAL INSPECTION t32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning l 2�L7 35. Final Gas Pipe -Test 36. Hood or Canopy . 37. Final Factory Fireplace 38. Final Plumbing- 39. Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer - 43. Backflow Irrigation ! 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co •' 51. CERTIFICATE OF OCCUPANCY No. /Z-364 Date !lam �'" CITY OF COSTA �Sfa FONSTP I Project Address Applicant's Maili A dre Owner's Nave Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ERMIT/I P MIT NO. O TRACT NO. LOT NO. UNI O. Arch/Eng. License N6. Address Contractor's Name Pho Address (mailing) City License No. 1 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f 11 fort n ect. / License Dale 711AW Signature WORKERS' cjbMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-Insuro or a certificate of Workers' Compensation Insurance, or a cern led copy thereof (Section 3800, Lab. fC.'^,15. Q ��� NON//r(f� �`'``'` Company Certified copy is hereby furnished. Cer r o i led with the city n Ion Date Applicant EXEM IO FR MWORKERS' COMPENSATION DECLARATION (ThIS Section need not be completed if the permit Is for one hundred ($100) Or less). I certify that in the Performance of the work for which this permit Is ISsued I Shall notemploy any person in any manner so as to become.subject to the Workers' Compensation LawS of California. - Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which, this permit is Issued (Section 3097 Civ. C.) Lender's Name. Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profession$ Cotle) or that he/She is exempt therefrom and the b4sis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole ccmpensati on, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement i$ sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or im- rovefor the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions CO(IO: The Contractor's License law does not apply to an owner of property who builds or Improves thereon, and _who contracts for Such projects with a con- tractor(s) license purtuarit.to. the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have iea, Lignalure Drivers' License or SS # � CMF 0865-46, rev. 4/64 ; Pink - Accounting; Goldenrod - Assessor Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 fANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By a Date Date_j DateZ� Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00.100.000 BTU 0100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 5D% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ Z%.Ca $ %.leo $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 33.0 System Repair/Alteration - Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit :# Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.MY '•� 53. Steel Reinforcement - 3.'Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical•ConduibUndrgrnd. 1 55. Electrical Bonding 5. Steel Reinforcement •` ,; 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. j 57. APPROVAL TO COVER-GUNITE 7,„ -footings. 58. Electrical Conduit-Undrgrnd. B. Foundatipn - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd.' 71.,3 60..Backwash Lines, P -Trap, O Undrgrnd. 10. 'Structur'al Floor System ; : '' 61. APPROVAL TO DECK 11. Property'Sewer Line & House Connection 7 � y2��y_ f! n,t/� 62. Backwash &Receptor -Final 12. Sewer Cap ' • - ,r 63. Heater & Vent -Final 13. Roof Drains 'l,,. r �`' 64. Plumbing System - Final 14. Rough Plumbing . (016/1 q, Leo 65. Electrical -Final - 15. Rough Electrical=Conduit 66. Solar. Sy stem -Final 16. 'Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOil 23.'Gas Pipe -Rough & Test 72: Underground Flush 24:,Roof Framing 73. Undergrnd. Storage Tank OGas OOil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace - 38. Final Plumbing 2�Z1 CXD 39. Water Service -Final 3 , 40. Gas Service -Final ' 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITYOFCOSTAMPQA C JUST TIg PERMIT . Project Address tG , r PER T N � 1 � � �' 8 TRACT NO. - LOT NO.. UNIT O. 8044 2/2L/85 C o 13 R. TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION 1-1DEMOLISH❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR �+�- Applicant's Mailin ddress D A .�/ Owner's Na P e Address � - A.P. L Zone S Main Building: Accessory Building: E Z Arch/Eng. License No. Address11 TYPE OF PERMIT D GRADING El FOUNDATION LJ STRUCTURAL ❑ TENANT E] ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES T Front 0 BTHER A Rear N Contractor's Nam - _ hon Address (mailing) % City License No. `J ./ �`�J1J LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with 7000) of Division 3 of the Business and Professions Code, and my license i in fu I r d effect Lice ns I 'c No. Date Signature C Right N K $ Left G R Ping. Ref. # Parking Req./Provided E Remarks: I U 3 Planning Notes: M section T S PLUMBING FEES WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate Bar Sink Showers ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.)� /qq / / j� - Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Backflow Irrigation Sewer Ca - P Policy No. L(/L L -}Company /f �j(�ry/�fl �] �ertifted copy i5 hereby furnished Cpdstructwn Pole Sub. ❑ 50+ KW Bathtubs Sewer Connection 'Cooking Unit - Meter ❑up to 100 amps 7XCerti d 1 ith the city ; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ' APPROVALS Permit # Date Inspector - POOL &SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • , 53. Steel Reinforcement ' ' 3r ,Electrical Conduit Utility-Undrgrtid' .; 54. Forms - •4.;Elec6cal Conduit-Undrgrnd. `,' - /1 55. Electrical Bonding ! 5. �Steel'Reinforcemene • 56. Rough Plumbing &Pressure Test . 6.' Elecfrical UFER Grnd''. v - 57. APPROVAL TO COVER-GUNITE 7: 'Fpotngs; ,' .' 58. Electrical Conduit-Undrgrnd. 8:;Foundation - 59. Gas Pipe, 0 Undrgrnd., Test j ,- 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System t, 61. APPROVAL TO DECK 11. Property Sewer Line•& House Connection i 62. Backwash &Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains - 64. Plumbing'System - Final 14. Rou h'Plumbin 9 9 i•"% _ 65. Electrical -Final ".( 15. -Rough ElectricalwConduit f6r Solar System -Final - 16. Rough Electric Wiring _ 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS .FINAL - 19. Rough Heating & Air Conditioning r.' FIRE DEPT. REQUIREMENT - APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro . 22. Ducts, Ventilating 71. Product Piping O Gas 0Oil 23. Gas Pipe -Rough & Test �- 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe " 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31.iPlaster Brown Coat 79. FINAL INSPECTION 32. 'Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy - 37. Final Factory Fireplace .. 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final - 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING 48. Special Requirements Completed _ 49. Electric Release to Edison - 50' Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. - Date ' _ - . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OP-CDSTA MESA CONSTRUCTION PERMIT Project Address 166 E. _ 19 Applicant's Mailing Address Owner's Name THE HEIGHTS PARTNERS Phone 831-9419 Address P.O. BOX 958 Arch/Eng. License No. Address' Contractor's Name SIERRA ENVIROMENTAL hone' 957-8991 Address(mailing) 2121 S. GRAND AVE., SANTA ANA. City License No. C-20-450194 LICENSED CONTRACTOR DECLARATasine I hereby affirm that I am licensed under f Charter 9 (commencing with section 7000) of Division 3 ofthentl Professlo s Code, and my license.is in full fZc Zpd effect. 45License Class UDate CI-1'i_R4 SignatureCORKERS' COMPENSATION DEC LA hereby affirm that I have a certificate o consent to self -Insure or a certificate of -Workers' Compensation Insurance, r a certified copy thereof ( ection Polio, Lab. c.) Policy No. R24232 FAI ONT Co ny Certified copy is hereby furnished. ' Certified copy is filed with they B din io Date 4_19_R4 Applicant EXEMPTION FROM WORKERS' COMP NSATION DELL R (This section neetl not be completed if th permit is for one hun red ($100) Or less) I certify that in the performance of the work for which this permit is issued I , shall not employ any person In any manner so as to become subject to Ills Workers'o yn Ion Laws of California. Date-�.+-� Signature NOTICE: If, after making this declaration. you should become subject to the -Workers' Compensation provisions of the Labor Code, you must forthwith - comply with such provisions. or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section. 3097 Civ. C.) ' Lender's Nam. Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License law for the file a sianed statement that he/she is licensed pursuant to ierefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I,pas owner of the property or my employees with wages as their sole Com will do the work, and the structure is not Intended or offered for Sal¢ ($ecfion 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon; and who does. such work himself/herself or through his Or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- Tve for the purpose of sale). LI I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project'Section 7044, Business and Professions Code: The Contractor's Licena9 law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). ❑'I am exempt under Section A- B. & P. C. for this reason Date Signature Drivers' License -CMF 086546 rev. 7/83 H tate that the above d County ordinances soy authorize repre- ioned property for Date TYPE OF CONSTRUCTION - X)jj)(vE ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORK ADD LJ ALTERATION OTHER' NU. C REPAIR A.P. qW S Main Buildi E TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL T Front. E] TENANT ❑ ELECTRICAL C1Rk PLUMBING MECHANICAL B R ❑ BOTHER A ear PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE - GRADING CU.YDS. 'ACRES C K S Right Left Ping. Ref.# Remarks: B14035 I Parking Req./Pri Automatic Washer - Construction Pole Sub. Use of Building: . PLUMBING - FEES IPlanning Notes: 3ackflow Preventer 3ackflow Irrigation + 3athtubs rN Clarifiers Dishwasher Drinking Fountains - Floor Drains L'r Floor Sinks Gas Service .Outlets Interceptors, - KitchenSink ' Lavatories - P -Trap Roof Drains ` Reinspection',Fee S25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ 1 Firepl/Fact Bit. ICBG+ 1560 1ting System & Ducting IJ -100,009 BTU 0100,00087 Reinspection Fee White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $25 Service Sink_ Sewer Cap Sewer Connection 'Solar'Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet' Water Heater Issue Fee Hood or Type 1 ❑ Canopy Type I1 ❑ Refrigeration System ❑0100,000 BTU 11100,000BTU System Repair/Alteration Issue Fee 8104 9/13/84 Zone Accessory Building: i_ Park. Fees $ I50V, TL O N I N G R E O U I R E N E N T $ ELECTRICAL FEES Automatic Washer - Construction Pole Sub. Transformer ❑ 15.50 KW ID 50+ KW Cooking Unit ' - Meter ❑up to 100 amps f - - Dishwasher Meter EJ over 100 amps Dryers ❑Gas, ❑Electric 'Sub Panel _ Fan __ Motors 00-1 HP Ell X-8 F.A;U. Inc. Solar 09.15 HP ❑ 16-15+ Fixtures .-Microwave Device Boxes Pole Light - Outlets Range Switches I Sign Garbage Disposal Standing Sections Generator ❑05 KW ❑5.15 KW Trash Compactor $ 3 Reinspection Fee $25 Issuer Fast $ 3 FEES PUBLIC SERVICES REQUIREMENTS: Zoning Approved By nate Application Approved By Date Application Issued By Cid nate 1 �J • BUILDING PERMIT . PLAN CHECK PLUMBING PLAN CHECK - ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK v `SUMMARY OF FEES $ SMIP $ $ PERMIT , $ ISSUANCE $ , $ i ENERGY P.C. $ $ GRADING $ $ MICROFILM S $ `moo TOTAL FEE $ _`'L 06 $ 2 -Oct - ac $ 3 _ CONSTRUCTION AND PLANNING APPROVALS 'Permit # Date Inspector -P( & SPA APPROVALS Permit # Date Inspector . 1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location i 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54.. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement ." 56. Rough-Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd. ' B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains -64.. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final . 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning, _y .¢y £ FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace �O S 21. Ducts, in Structure 70. Underground Hydro - 22.Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy '. 37. Final Factory Fireplace LIf- 38. Final Plumbing , 39. Water Service-Final - 40. Gas Service-Final ' 41. Solar Domestic-Final,. 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System " 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ CITY OF COSTA MESA Project Address 13-" Applicant's MailinyE/ZSS Owners Name /.. Address %,0�.10 1 $5$ Arch/Eng. _f=_A tv z: Address _rAt O _//� /41; Contractor's NamLAN Address (mailing) 1? t7 City License No. _e) rxr LICENSED CONTRACTOR I.hereby affirm that I am lir with section 7000) of Divis my license is in full forcean( co E PE Applicant to fill in all spaces except those within heavy border lines and Sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNI 0. L� 3 Of 1 hereby affirm that I have a certificate of consent to sell -insure or a certificate TYPE OF CONSTRUCTION NEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION 11 DE ❑ OTHER DESCH I PTION O F WO R K/USE OF BLDG. Showers AfPTn/b7PS phone�3/—%y/g n A.P. 46 S.4L8oAr S E T B A K S Main Buildi 'uR'�' eLicense NoI3y GI S� TYPE OF PERMI SRADING FOUNDATION STRVCTURAL LJTENANT/�`ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 1:1 SQ. DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES Front Dat¢-rKpERS' Rear �,W—9c O !-+ O Phone STC/ 3 t Right 8 6 3'PROJECT Left Solar Piping RA Ide ION prOvislo t f Charter 11 (commencing Ping. Ref. # Remarks: w i 'T ! Planning Notes: 3 Of 1 hereby affirm that I have a certificate of consent to sell -insure or a certificate Bar Sink Showers Of Workers' CompensS k:O ..9nsurance o a certified py ther of (Section 3800, Lab. C.) v Poiigy No. ^0 ; amp y Backflow Preventer - • Service Sink - Backflow Irrigation Sewer Cap _ A-Certifi coD is herebydurn15 10 . ]5 tifi d d with the cit 'Bull 'ng Dl vi sio Bathtubs Sewer Connection Dat¢-rKpERS' MICROFILM Solar Collectors EXEMPT Nee M WORKERS' COMPENSATION DECLARAT CO (Thio section need not be completed if the permit is for one hundred ($300) or less), Dishwasher Solar Piping I certify that in the performance o/( work for which this permit is , I shall not employ any person in any manner so as to become subjectt to to the Workers' Compensation Laws of California. Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Date Signature NOTICE: If, after making this declaration, you Should become subject to the Floor Sinks Urinal Workers' Compensation provisions of the Labor Code, you must forthwith Comply with Such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater Of the work for which this permit Is issued (Section 3097 Clv. C.) Lender's Name Kitchen Sink Water Service Lender's Address _ OWNER BUILDER DECLARATION Lavatories I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or P—Trap - county which requires a permit to construct, alter, Improve, demolish or repair Soy Structure, prior to Its issuance, alio requires the applicant for Such pe o file a signed statement that he/she Is licensed pursuant to the provisions of . .. __.., ._... ___._ .... ... .........e., i.,� ..,un c..., m.. inn , ..f Roof Drains _ therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the, applicant t0 a civil s(_enally of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's Ll Cense law does not apply to an owner of a properly who builds Or improvas - Reinspection Fee $15 Issue Fee MECHANICAL Boiler $ Hood or Type I ❑ Canopy Type II ❑ thereon, and who does such work himself/herself or through his or nor own employees, Provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion. the Owner will have the burden of proving he/she did not build or Im. prove for the purpose of sale). LI 1, as owner of the property, am exclusively contracting with licensed con. t ractors to co n5t r uct the project (Sect i On 7044, Business antl Pr ofessi o nS Code: The Contractor's License law does not apply t0 an owner of property who builds or Improves thereon, and who contracts for Such projects with a con. GRADING Duct - Under Ground MICROFILM Duct - Structural Refrigeration System ❑Q100,000 BTU ❑ 100,000 OTU Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration traetor(s) license pursuant'to the'Contractor's License Law). I am aware that proof of( their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # Date I hereby ertify [not I h Informati n Is co reef. I a O ner ve reatl t Is applicatlo the above- rlh to co olv/with all CRY and county ordinances Heating System & Ducting ❑0.100,000 BTU ❑100,000 BT Drivers' 6nse or SS $� / - -1~-- I I Reinspection Fee I $15 I I Issue Fee CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers 'NGas INElec Fan F.A.U. Device Boxes Outlets Switches Garbage Disposal Generator 00.5 K W 05.15 4627 7/20/84 Zone ng: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW - ❑ 50+KIN Meter IN up to 100 amps Meter Clover 100amps Sub Panel Motors ❑0.I HP ❑ 1 h - 8 Inc. Solar 09-15 HP 016.15+ Microwave Pole Light Range Stand ing'Sections Trash Compactor 50aku FEES Z O N 1 N G R E O M T S. I I Reinspection Fee 1 $15 1 1' Issue Fee 1 $ 3 1 1. DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By FEES SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL §�, C) PLAN CHECK 50% $ L ). MECHANICAL $ PLAN CHECK 25% $ $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ 3 FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ -2-v CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector .__JL & SPA APPROVALS Permit# Date Inspector 1. Temporary^Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 31 Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit;Undrgrnd. ', Ct 55. Electrical Bonding _ - - 5 "Steel :Reinforcement 56. Rough Plumbing & Pressure Test 6: Electrical LIFER Grnd.�'+j tt` 57. APPROVAL TO COVER-GUNITE .7r Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10..Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection I 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains) 64. Plumbing System - Final 14. Rough Plumbing ) 65. Electrical-Final ' 15. Rough Electrical-Conduit 66. Solar System-Final ' 16. Rough Electric Wiring - C 67. Fencing & Access Approval 17. Rough Wiring Sign I 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL " 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace vi, 21. Ducts, in Structure - .70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil ' 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0Oil ' 25. ,Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 3T. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ) 80. FOOD CERTIFICATE ISSUED 33. Final Electric Vj Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System x 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51.,CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 001230 P. O. Box 1200 Costa Mesa, California The Building located at 366 PAST 15r@i STRFTT IgM W has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 2-1 Occupancy. Use of Building Va-jrY1MTNTTIM Legal Description 49t;-31 1-1)4 (See reverse side for Metes and Bounds) Building Permit No. n-1dn'AS Electrical Permit No. >:'_1d1So Plumbing Permit No.uldndn n17FrA Mechanical Permit No. - I c' n" Number of apartments and/or guest rooms . ISSUED TO: THE HEIGHTS PARINF R.S Building Official /j by P.O. P= 658, BALBOA. CA, 92661 Date / 1 � �%,:C'— / X? J This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address Applicant's Mailing Address Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. '•le Signature ;RKERS'COMPENSATION DECLARATION ,ereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Inskrance, or a certified copy thereof (Section 3800, Lab. C.) Policy No. Company Certified copy is hereby furnished. 'Certified copy is filed with the city Building Division. _ ,to - Applicant EXEMPTION FROM WORKER$' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or Ie55). I car Iffy that in the performance o1 the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLAR VrION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit file a signed statement that he/she is licensed pursuant to the provisions of Contractor's License Law (Chapter 9 (commencing with Section 7000) of .vision 3 of the Business anq professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. I/, however, the building Or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Irn- rdve for the purpose o1 sale). I, as owner of the property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractcr(s Ilcense pursuant to the Contractor's License Law). I am aware that proof o� their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply With all city and county ordinances and state laws relating to building construction, and hereby authorize repre. sentatives of this city to enter upon the above-mentioned properly for Inspection purposes. - Signature / - Date TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. $ 3 A.P. Zone S Main Building: Accessory Building: $15 Issue Fee ❑ STRUCTURAL TYPE OF PERMIT GRADING FOUNDATION ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑OTHER E T Front DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By - Z 0 A Rear N C Right BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% N PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES S Left R Ping. Ref. # Parking Req./Provided E Remarks: { Planning Notes: O M Issue Fee $ 3 T S. PLUMBING FEES �Lj Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1'h - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories I Garbage Disposal Standing Sections P—Trap Generator 045 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 Drivers' License or SS 9P 1, I 1 Reinspection Fee I $15 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 1ANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By - Date Date Date Hood or T Type ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000BTU 0100,0008TU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ System Repair/Alteration Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit =# Date Inspector F - & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []Gas OOil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date my license is in forge and eff t. /7 License CAss-;;+Vaa- 1 f d Icanse o �Z Oatei� ' MMPE SIg t hereby RS' MP I haveI certificate DECLARATION f Workers' eMian that I have a certificate of consent to self -Insure er a certificate .3: .Workers' Compensation :Insurance,) or a certified thereat (Section-. 3800, Lab.C.) _ Policy No.-{� �..��� Co• a Certifieq copy V hereby furnished. a c Certifi m filed with the city ulldi Division Date Applicant - EXEMPT ON.FR M WORKERS' COMATION DECLARATION.. - (- (This section need not be completed if the permit i5 for one hundred ($100) of less) certify'that in the performance of the vi�ork for which this permit is issued, 1 shall not employ any person im any manner sofas to become subject to the Workers' Compensation; Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers'. Compensation provisions -of the -Labor Cotle, you must forthwith 'comply with such provisions or this permit , shall be , deemed revoked. CONSTRUCTION LENDING AGENCY- - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Section 3097 Clv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason fSeation 7031'.S.Buslness and Professional: Code: Anv city or P Ill 7031.5 by any applicant for a- permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I,. asi owner of the property 'or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and, Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon,; and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offeretl for sale. If, however, the bulldmg or Improvement Is soltl within one year of com- pletion, the owner will have the burden of proving he/she ditl not build or im- rove far the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason 1 , Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city -and county ordinances and state laws relating to building construction; and hereby authorize repre- sentatives of his city i to-&, upon he abo,e- entlonetlpproperty f inspection his `/'r2� Bar Sink Applicant to /ill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITY OF COSTA MESA - - -- - PERM IT1�{O. TRACT NO.: LOT NO. BLDG. Cooking Unit - - - - '� CONSTRUCTION PERMIT Dishwasher ' G Trash Compactor Dryers ❑Gas ❑Electric E D U - Issue Fee - Project Address TYPE OF CONSTRUCTION KNEw LJ ADD LJ ALTERATION. :REPAIR , 1 F.A:U. .s'! '�• �/�'r� '❑ CONVERSION ❑ DEMOLISH ❑ OTHER Xp, q� i Applicant's Mailin ddr! -/-/-/�- $25 Issue Fee Owner's Name e �% '✓ e+/^S hone 6 O'2�� OE RI TIO Of �RK Tr n AV'AO / I/J T S Main Building: r/GrG IREM 1 ENTS: 1�� , --Date. Date Dat Address, r - / TYPE OF PERMIT Ll GRADING - OU NDATION TRUCTU RAL ' T Front Refrigeration System 00-100,000BTU ❑t00,000BTUSU Arch/Eng. Q. L' `� t.I ic, -No. _ ❑ TENANT '❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear 1 - I Z V��z ry 't -],OTHER : SY' "/ter A System Repair/Alteration - Address K /a Right 'yg Contractor's Nam one+L�.l_L.[�L PROJECT DESCRIPTION SO. FT. _ nccLipANcv Address (mailing) CONSTRUCTION TYPE VALUATION $ S Left / 1 - ZONE GRADING CU.YDS. ACRES N City License No. LICENSED CONTRACTOR DECLARATION - Remarks: C - —Ig Parking Req./Provide hereby affirm that I am licensed under provisions of Charter 9 commencing 1 with section 7000) of Division 3 the Business and ProfeCde, and - : I Use of Building: - my license is in forge and eff t. /7 License CAss-;;+Vaa- 1 f d Icanse o �Z Oatei� ' MMPE SIg t hereby RS' MP I haveI certificate DECLARATION f Workers' eMian that I have a certificate of consent to self -Insure er a certificate .3: .Workers' Compensation :Insurance,) or a certified thereat (Section-. 3800, Lab.C.) _ Policy No.-{� �..��� Co• a Certifieq copy V hereby furnished. a c Certifi m filed with the city ulldi Division Date Applicant - EXEMPT ON.FR M WORKERS' COMATION DECLARATION.. - (- (This section need not be completed if the permit i5 for one hundred ($100) of less) certify'that in the performance of the vi�ork for which this permit is issued, 1 shall not employ any person im any manner sofas to become subject to the Workers' Compensation; Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers'. Compensation provisions -of the -Labor Cotle, you must forthwith 'comply with such provisions or this permit , shall be , deemed revoked. CONSTRUCTION LENDING AGENCY- - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Section 3097 Clv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason fSeation 7031'.S.Buslness and Professional: Code: Anv city or P Ill 7031.5 by any applicant for a- permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I,. asi owner of the property 'or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and, Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon,; and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offeretl for sale. If, however, the bulldmg or Improvement Is soltl within one year of com- pletion, the owner will have the burden of proving he/she ditl not build or im- rove far the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). ❑ I am exempt under Section B. & P. C. for this reason 1 , Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city -and county ordinances and state laws relating to building construction; and hereby authorize repre- sentatives of his city i to-&, upon he abo,e- entlonetlpproperty f inspection his `/'r2� Bar Sink Showers Backflow Preventer Backflow Irrigation Service Sink Sewer' -Ca' p Construction Pole Sub. - rinking Fountains loor Drains I I loor Sinks as Service Outiets lavarones P -Trap, ' Roof Drains 'Reinspection Fee ,. $25' Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ -Multiple ❑ F irepl/Fact. Bit. ICBG # Heating System & Ducting ❑0-100,000 BTU ❑100,000 BTI S,gnat ure / / I I Reinspection Fee I .$251 CMF 0865-46 rev. 7/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Solar Tank Swimming Pool: w/Sp Urinal Water Closet Water Heater Water Service FEES 362'1 7/11/371 364,71 TL - Zone Automatic Washer " Z Construction Pole Sub. O - Cooking Unit - - - - '� Dishwasher ' G Trash Compactor Dryers ❑Gas ❑Electric E D U - Issue Fee - Fan' ' 1 F.A:U. E Fixtures ' .Reinspection Fee Device Boxes $25 Issue Fee $ 3 �ANICAL FEES 362'1 7/11/371 364,71 TL - Zone Accessory Building: - Z O 'N N G Trash Compactor E D U - Issue Fee - Park:Fees $ as .38 1 E .Reinspection Fee - 0 ELECTRICAL ^FEES Transformer ❑ 15-50'KW^% , El 50-41 R w Meter- ❑up to 100 amps Meter Dover 100amp5-' Sub Panel 'Motors❑0-1 HP 0111/2-8 'Inc.Solar'09-15 HP 016-15+ .Microwave 'Pole Light ' Range Sign EC Eff KA Garbage Disposal I , Standing Sections Generator ❑O-5 KW 05-15 KW Trash Compactor - Issue Fee - $ 3 .Reinspection Fee - $25 Issue Fee $ 3 �ANICAL FEES PUBLIC SERVICES R O Zoning Approved By - Application Approved By Application Issued,By- IREM 1 ENTS: 1�� , --Date. Date Dat Hood or T YpeI ❑ Canopy Type I I ❑ ' - _ Refrigeration System 00-100,000BTU ❑t00,000BTUSU BUILDING PERMIT ' PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL P LAN CHECK MECHANICAL PLAN CHECK $ $ $ $ $ $ $ $ 1 - I p/�y OF FEES • �%� SMIP, PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ �' 7/ ' 354.E 1I System Repair/Alteration - - I ' Issue Fee , $ 3 I KA CONSTRUCTION AND PLANNING APPROVALS Permit # DateInspector P, . & SPA APPROVALS Permit# Date Inspector 1. demporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53: Steel Reinforcement- 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement (J 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings {%` 58. Electrical Conduit-Undrgrnd. 8. Foundation - u ✓Ci 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer, Line .& House, Connection - 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough.Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough.Factory Fireplace` �• 21. Ducts, in Structure -_ 70. Underground Hydro 22., Ducts, Ventilating 71. Product Piping E)Gas C1 Oil 23. Gas'Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof:Sheathing-' i 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.• Frame and Flashing 10/111-6(4 76. Dry Standpipe 28. Lathing& Siding j V L"e- 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat' D /L 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace` 38. Final Plumbing 39. Water Service-Final '- 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation \ 44. Landscape Irrigation System _ 45. Sound Attenuation _ 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING i 48. Special Requirements Completed - - 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPAN p No, / 1 2(0Date l !_1 --1/✓� _ - ' CITY OF COSTA ME %1 COTR Project Address '1 / Applicant's Maili AMss Owner's Name Prion Applicant to fill in all spaces except those within heavy or�ftnes and sign all appropriate declarations. PER T NO, TRACT NO. T NO. UNI O Arch/Eng. — -- License Nd. Address Contractor's Nam _ one C Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in ful rc O effect. Licens I i s 1 Dace Signature NORK RS' OM ENSATION DECLARAT ON 1 hereby affirm that I have a certificate of consent to self -insure or a certifh, le of Workers' compensation Insurance, or a certified copy thereof (Section 3800, Lab.,(j�)�i l.. �� / LLQ /�.�I//iH'� - Poll No. <I/ ompany—o Certif ietl copy is hereby fumistjed. Certj�'fyytgg�� etl with the cit B i io oat Applicant Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -(Thissection need not be Completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall. not employ any person in any manner so as to become subject to the,: Workers' Compensation Laws of California. , Date Signature -' NOTICE: If, after making this declaration, You should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION' LENDING AGENCY ' 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is . issuetl (Section 3097 Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason (Section 7031.5 Business and.ProfeSsional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of he Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the'Business and. Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the. applicant t0 a civil penalty of not more than five hundred dollars ($500).1 - ,- LJ I, as Owner of the property or my employees with wages as their sole com pensation, will d0 the work and the structure is not intended or offered for sale (Section 7044, Business and Professional Code; The Contractor's License Law does not apply to an owner of a property who builds or improves thereon; and who tloes such work himself/herself-or through his or her own employees, provided that such improvements are not Intended Or offered for sale. If, however, the building Or Improvement is sold within one year of com- Oletion, the owner wllLhave the burden of proving he/she did not build or im- rove for the purpose of sale). I, •as owner of the properly, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for Such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me.• ❑ ham exempt under Section B. & P. C. for this reason Date Owner ng construct r upon the Signature YA(G1/ / Drivers' License or SS W- — a CMF 0865-46, rev: 4/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 03 FEES � Bar Sink Showers PE OF CONSTRUCTION U NEW LJ ADD LJ ALTERATION LJ REPAIR B3P % I I /Al. T:_N,'. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P,# Zone ... _ Transformer 0 1S-50 KIN - - 050+KW DESCRIPTION OF WORK/USE OF BLDG. S Main Building: - Accessory Building: Cooking Unit t, TYPE OF PERMIT GRADING LJFOUNDATION STRUCTURAL T Front Dishwasher O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 Z Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains ❑ OTHER A Rear - —. Floor Drains N F.A.U. - Inc. Solar 139.15 HP 016-15+ Floor Sinks Gas Service Outlets C Right Fixtures Device Boxes' Microwave Pole Light N PROJECT DESCRIPTION SO. FT. OCCUPANCY K Outlets Range Kitchen Sink G CONSTRUCTION TYPE VALUATION$ S Left — - R ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided E Remarks: 140 5q - Planning Notes:- 1 O M T Reinspection Fee $15 S. CMF 0865-46, rev: 4/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING . FEES I Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink - Automatic Washer Construction Pole Sub ., ... _ Transformer 0 1S-50 KIN - - 050+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit t, Meter ❑up to 100 amps ' Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Z Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank I Fan - Motors 00-1 HP 01 h - 8 Floor Drains Swimming Pool w/Spa F.A.U. - Inc. Solar 139.15 HP 016-15+ Floor Sinks Gas Service Outlets Urinal Water Closet C)D Fixtures Device Boxes' Microwave Pole Light Interceptors - Water Heater Outlets Range Kitchen Sink Water Service OQ Switches Sign Lavatories Garbage Disposal Standing Sections P—Trap - Generator ❑0.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 " - MECHANICAL FEES SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By DatO I I Boiler Hood or' Type 11DEVELOPMENT Canopy Type II 0 • Duct -Under Ground Duct - Structural Refrigeration System DO -100,000 BTU ❑ 100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ /o'60'1ERGY P.C. $ ����pp GRADING $ $ i4�SiL $ MICROFILM $ $ TOTALFEE $ $ Exhaust System 0 Multiple 0 System Repair/Alteration Firepl/Fact. Bit. ICBO-# Heating System & Ducting 00.100,000 BTU❑100,000e Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev: 4/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PL-" &SPA - APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location' - 2. Soil Pipe=Undrgrnd. - i y "' 53. Steel Reinforcement 3. ,Electrical Conduit Utility-Undrgrnd. , 54. Forms - 14. -Electrical Conduit!66rgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6) ElectricahUFER Grnd. �� 57. APPROVAL TO COVER-GUNITE '^ . 7. Footings' s 58. Electrical Conduit-Undrgrnd. 8. 'Foundation ". - :'� ,• 59. Gas Pipe, 0 Undrgrnd., Test ; • �� _9. Water Pipe-Undrgrnd': / - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11'::Property Sewer Line'& House Connection •. ,� 62. Backwash & Receptor -Final 12. Sewer Cap r %`� - 63. Heater & Vent -Final 13. Roof Drains - 64. Plumbing System - Final - 14. Rough Plumbing - - lfl(k, 8 �i 65. Electrical -Final 15.iRougK;Electrical-Conduit - - 66. Solar System -Final - - 16. Rough•Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank QGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. • Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing' Zf( 4 19 39. Water Service -Final 2 d, A/ L 40. Gas Service -Final 41. Solar Domestic -Final _ -- - - 42. Backflow Preventer ' • ` 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESS CID STRUCTION PERMIT Project Address �qq q Applicant's Mailing ddress /l1lOd 0-19 . Owners NamePhone �,7/l Address u0-.[( / 10 zubL 0 ; .7� rs�d Arch/Eng. License No. Address q Contractor's Nam LT Phon Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full o nd effect. Lfcense 1 No. Date Signature WORKERS'COMPENSATION DECLARATION' I hereby affirm that I have a certificate Of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified '�(*N�/J copy s thereof (Section 3800, Lab. C')/, o. ��ifCompany Policy N�4�s/ ❑ Cer tifie0 copy is hereby furnislicid rtif p : with the city 1 n�n Date APplicant EXEMPTION Ff OM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance Of the work for which this Permit is Issued, I shall not emplOy any person in any manner So as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions Of the Labor Code. you must forthwith comply with Such provisions or this permit shall - be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Performance of the work for which this permit is Issued (Section 3097 Clv. C.) Lender's Name - Lender's Address - OWNER BUILDER DECLARATION ' I hereby affirm that I arn-exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any Structure, prior to Its Issuance, also requires the applicant for such permit . to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor'% License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged Oxemplion. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty o1 not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (SectlOn 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employe.S. Provided that such Improvements are not Intended Or offered for sale. 1 however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- irove for the Purpose of Sale). I, as owner of the property, am exclusively contracting with licensed con. tra ctorS to construct the project(Sect i o n 7044, Business and Prof essi on Code: The Contractor's License Law ddoes not apply to an owner of Property who builds or ImprOves thereon, and who contracts for Such Projects with a con- tractor(s) Il cen%a purSuan[ to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner that 1 have read this 'rect. I agree to comp) ating to building cons e9city tgwer upon Signature.Ci/A!I Drivers' License or SS # CMF 0865-46, rev. 4/84 I stale that the above and county ordinances 6035 2/22/B5 TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A. P.0 Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION U STRUCTRAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 A Rear ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right KLeft CONSTRUCTION TYPE VALUATIONS $ ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: 14 �� Planning Notes: Bar Sink Backflow Preventer . Backflow Irrigation rinking Fountains loor Drains loor Sinks as Service Outlets Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100.000 BTU 0100,000 I I Reinspection Fee White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Issue Fee Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0.100,000BTU 0100.0008TU System Repair/Alteration Issue Fee FE ELECTRICAL Automatic Washer- Transformer .❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 110-1 HP❑1X-8 F.A.U. Inc. Solar ❑9-15 HP 1:116 - Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 130-5 KW 05.15 KW Trash Compactor $ 3 Reinspection Fee FEES $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By arin"ration Issued By 5+ 6913 TL FEES $ 3 Z O N I N G R E Q M T S. FEES SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $�- ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ 3 5+ 6913 TL FEES $ 3 Z O N I N G R E Q M T S. FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ CONSTRUCTION AND PLANNING APPROVALS Permit # J Date Inspector - POOL & SPA APPROVALS Permit # - Date Inspector ,. 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. raj 54. Forms 4.'Electricel Conduit-Undrgrnd. -.r - 55. Electrical Bonding - 5.. Steel. Reinforcement' 56. Rough Plumbing & Pressure Test - 6.' Electrical LIFER Grnd.^, 57. APPROVAL TO COVER-GUNITE r ' ].,Footing -s -• r y, '� 58. Electrical Conduit-Undrgrnd. 8. ­Foundation �._ 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Bipe.Undrgrnd. -'� 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection i '. 62. Backwash &Receptor -Final 12. Sewer Cap ! ''. 63. Heater &Vent-Final7. _ 13. Roof Drains !; 64. Plumbing System - Final . 14. Rough Plumbing,. 'l, 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 1 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA,SYSTEMS FINAL 19. Rough Heating & Air Conditioning ,,? FIRE DEPT. REQUIREMENT APPROVALS Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 23., Gas Pipe -Rough & Test 'x 72. Underground Flush 24. Roof Framing 73. Undergrnd.'Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical _ 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing I HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing ' 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed. 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA - - 81 03 9/ 13/84 ' . 13.0; TL I PERMIT NO. TRACT NO. -LOT'NO. BLD - -- � , CONSTRUCTION PERMIT I 1�� (S(Gi (p ; Project Address JUD G. ljzn. JEreeC TYPE OF CONSTRUCTION XXINEW LJ ADD LJALTERATION-LJ.REPAIR SUMMARY OF FEES Applicant's Mailing Address ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # - Owner s Name THE HEIGHTS PARTNFRS phone 831-9419 DESCRIPTION OF WORK _ $ Main Building: Address P.O. BOX• 958 NEWPORT BEACH, CA- TYPE OF PERMIT 1:1GRADING LI —FOUNDATION STRUCTURAL' T Front Gas Service -Outlets Wafer Closet - - Arch/Eng. License No. PLUMBING Xi1ECHANICAL ❑ TENANT ❑ ELECTRICAL ElLA B ' Fixtures ❑.BOTHER A Rear - Address Lend'er's, Name - C Right Contractor's Nome SIERRA ENVTROMFNTAI. Phone 957-A991 PROJECT DESCRIPTION 50. FT. 'OCCUPANCY K , Address') mailing) _ 2121 S. -GRAND AVF BANTA ANACA. CONSTRUCTION TYPE -VALUATION $ $ Left CityLicense No. - C-20--450194 t ZONE GRADINGCU.YDS. ACRES Ping. Ref.# LICENSED CONTRACTOR DECLARATION Remarks: B14034 Parking Req./Provided thereby affirm that I am licensed under pro cions of Char at 9 (commencing , _ $ with section 7000) of Division 3 of the B Ines antl Profess n5 Code, and _ I Use Of Building: my license is in full force and�e(tet j0 194 License Class - ens PLUMBING FEES Planning Notes: Date 9-13-84 signature - Bar Sink Showers WORKERS 'COM PENSATION DECLA TI N I hereby affirm that I have a certificate o consen to self -i ore or a certificate Backflow Preventer Service Sink F of Workers'- Compensation Insurance;or a certified- copy thereof (Section -- --- -- - t 3800, Lab. C.) . R24232 FA'IRMON 1 Backflow Irrigation Sewer Cap Policy No. Compan ❑ Certified copy i5 hereby furnished.Bathtubs .-� Sewer Connection it 'Automatic Washer y— ® Certifiesg cgpr —��I i fled with the'city Buil g Di n Clarifiers t'•• Solar Collectors t' Construction Pole Sub. Date Applicant -EXEMPTION FROM WORKERS'CC)MPEt4SATIOrJDE'EeAKAflOK Dih h -- - P' - '-- - '- •Y '- -" (This Section need not be completed if the permit Is for one hundred ($100) or less) I I certify that in the performance n the work for which this permit i2 issued 1 shall not employ any person In any manner so as to become subject to tj!e Workers' Compensation Laws California., Date -O lft $4 Signature s was er 1 Solar Iping SUMMARY OF FEES Cooking Umt i r - Drinking Fou n[aln5 ��-' Solar Tank l BUILDING PERMIT l t Dishwasher - Floor Drains' -, i' Swimming,POol w/Spa' ! $ Dryers ❑Gas• ❑Eb _. Floor Sinks ! Urinal I $ Fan' - - -- NOTICE: I/ after making this declaration, you r Cod become subject to the Workers' Compensation prionsio r t the labor Code, you most forthwith ) comply with. such ENDING or this. permit shall be deemed revoked'. CONSTRUCTION LENDING AGENCY. s • Gas Service -Outlets Wafer Closet - - PLUMBING F.A.U. Interceptors Water Heater 1 - $ Fixtures I hereby affirm that there Ica construction lending agency for the performance of the work .for which this permit is issued. (Section 3097 Civ. C.) _ _ _ Kitchen Sink - Water Service ENERGY P.C. Device Boxes Lend'er's, Name - Lender's Address OWNER BUILDER DECLARATION : I hereby affirm that I am exempt from the) Contractor's License Law for the following reason (Section 7031'.5'Busines5 and Professional Code: Any city or �LavatOries - GRADING Outlets P—Trap - - - , Switches • 7031.5 byanyapplicant Jn ealty of not more than fi I, as' owner of the or compensation, will do the for sale (Section ,7044, E License Law does not appl thereon, and who does so employees, provided that ! Sale. If, however, the colic pletion, the owner will ha, rove fol the purpose of so I, asoowner of the prop tractors to construct the pr The. Contractor', License builds or Improves lhereo tractor(s) license pursuant 111 am exempt under Secl or a permit subjects the applicant to a civil hundred dollars ($500).. arty 'or my employees' with wages as their sole irk, and the structure is not intended or offered ,iness and Professional Code: The Contractor's '.o an owner of a property who builds or Improves work himself/herself or through his or her own A Improvements are not intended or offered for g or Improvement is sold within one year of com- the burden of proving he/she did not build or Im- ty, am exclusively contracting with licensed con - Mt (Sectlon 7044, Business and Professions Code: w does not apply to an owner of property who and who contracts for such projects with a con. the Contractor's License Law). n S. & P. C. for this reason Roof Drains' - - Reinspection•Fee .$25 Boiler ; Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # , c Date O ner Heating System & Ducting I hereby Certify that I hav rea this app Ic tion antl state that the above 1 ®0700,000 BTU ❑100,000 BTi Information IS torr t. agr t ly tl ry and county ordinances - '- antl'state laws relat ng to d C pn, and hereby authorize repre- sentatives of this it t t e e -mentioned property -for inspection purposes, i Signature C, 13� Reinspection Fee S25 Drivers' License or. � - - r CMF 0865-46 rev. 7/83 White - Building;•Canary - Applicant; Pink -Accounting; Goldenrod - Assessor -- -- , Issue Fee Hood or Type I ❑ Canopy . Type 11 ❑ Refrigeration System 00100,000 BTU 0100,000B System Repair/Alteration $ 3 FEES Issue Fee $ 3 Garbage Disposal Generator ❑05 KW p Zone , Accessory Building: Park.Fees $ r t . Transformer ❑ 15-50 KW ❑ 50+ KW Meter 0 u to 100iamps - - Meter ❑over 100 amps , Sub Panel I Motors E30-11 HP ❑1'/,-8 Inc. Sofar'09-15 HP ❑ 16-1 Microwave Pole Light Range Standing Sections t Trash Compactor Reinspection Fee I $251 Issue Fee, PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Application Approved By Application Issued By- oed O N 1 N G R E I R E ' M E , N S FEES �= ®E _■ ME $'3 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK $ ENERGY P.C. , $ ELECTRICAL $ GRADING $ PLAN CHECK $ MICROFILM $ t 1 I O� MECHANICAL $ TOTAL FEE $ PLAN CHECK $ ' CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector - POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location i' 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms '4.` Electrical Conduit-Undrgrnd. 55. Electrical Bonding - -5. Steel Reinforcement - 56. Rough Plumbing& Pressure Test 6. Electrical LIFER Grnd. - 57. APPROVAL TO COVER-GUNITE - 7. Footings _- 58. Electrical Conduit-Undrgrnd. '1 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. - N- - 60. Backwash Lines, P -Trap, 0 Undrgrnd. , 10. Structural Floor System -- 61. APPROVAL TO DECK 11: Property Sewer Line & House Connection - 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough -Plumbing 65. Electrical -Final - 15. Rough Electrical=Conduit - 66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval - 17. Rough Wiring Sign 68.• APPROVED FOR PLASTERING - 18. Rough Electrical -T. Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air, Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace �/ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat - 75.`Dry Chemical. 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31: Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final ' 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation - 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY1 No. Date 1 J Applicant to fill In all spaces except those within heavy. border lines and sign all appropriate declarations. CITY OF COSTAA//MESA CONSTRUCTION PERMIT Project Addressactc, E. 05 rAl of,7oA /Ue'SA Applicant's Mailing Address P.0. 7334- A/R,Z6,-6_3 E N Owner's Name 14 /TS rMRTI00-3PPhone83/-9 Y! Address&/ FS 9' 6,44,aOA / 266/ ' 4 Arch/Eng. 1�✓'L7-eT.2Moge' Lice se NoBA��� Address /- a r Z G 40 2 b Z.5 - Contractor's S p Contractor's Nam D� E0.% M e-Phone2q/-9/-5 Address(mailing) �a /33�0 N ap 42 66 3 City License No. 0 LICENSED CONTRACON I Hereby affirm that 1 ar rovielOns Ch er 9 (commencing with section 7000) of he ustness d Pr fessns Cotle, antl my license is In full forcLIC¢nse lassLi pse N WORK RS' MPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of Workers' CompenSatio - Insu'an or a certified copy thereof (Section 3800, Lab C I Policy No. z—% "O �Co any %QY8s 1��— .❑ Cert lliep copy i1 hrrrebv furni ted:. V 11 II �� EXEMPTIIDN FR@M WORKERS' Co6MENSATION DEOLA9'ATIO%J (This section need not be completed if the permit Is for one hundred ($100) or less), n Icertify that In the performance of.lhe work for which this permit is issued, I shall not employ any perlon in anyxmanner so as to become subject to the Workers' Compensatlpm Laws of California. Date Signature NOTICE: It, after making this declaration, you should become subject to the Workers' Compensatipn provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LHNDING AGENCY I hereby afflrm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for'the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit ' to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the BYsmess and Professions Code) or that he/She is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as' owner of the' property or';my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Secli on 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who dues such work himself/herself or through his or her own employees, provided that Such improvements are not intended or offered for Sale. If, however, the building or improvement Is Sold within one year of com- pletion, the owner will.have the burden of proving he/she did not build or.im- rove for the purpose of sale). I, as Owner of the property, am exclusively contracting with licensed con- tract Orito construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursua ntto the Con tractor's License Law). I am aware that proof ofi their Worker's Compensation insurance should be provided to me. ❑ ram exempt under Section B. & P. C. for this reason _t1 Date I her infor Owner repre- y for PERMIT NO. s 8 TRACT NO. - LOT NO. UNIT D: 4626 7/20/84 TYPE OF CONSTRUCTION KNEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. # $15 1 1 Issue S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL El TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL El OTHER T Front Date Date not 13 A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YOS. ACRES . K. S Left ff uS� Ping. Ref. # Parking Req./Provide Remarks: /L I r I > '4l Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Drinking Fountains Floor Drains Floor Sinks -- Gas Service Outlets Interceptors - Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU ❑ 100,000 Drivers' nse or S$ —�—T— I I Reinspection Fee' I $15 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU ❑ 100,000 System Repair/Alteration Issue Fee ELECTRICAL Automatic Washer Transformer El- 15 -50 -KIN - Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter Rbp to 100 amps Dishwasher Meter Dover 100 amps' Dryers ,®Gas ViElectric I Sub Panel Fan Motors 110-1 HP ❑ 1 X - 8 F.A.U. Inc. Solar 09-15 HP 1116-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range - Switches Garbage Disposal Generator 00-5 KW 05-15 KW Zone Stand ing�Sections Trash Compactor 58.20 TL FEES Z O N I N G R E Q M T S. $ 3 flainspectipn Fee $15 1 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By - Application Issued By CIrD Date Date not „ SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25%, $ ELECTRICAL $39.910 PLAN CHECK i50% $ ��� Li MECHANICAL $ PLAN CHECK 25% $ FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ ,TOTAL FEE $ ff uS� $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # 1 Date. T1. Inspector I'VOL & SPA APPROVALS Permit # Date Inspector Temporary Electrical Service or Pole- 52. Pool & Equipment Location 2. 'Soil Pipe-Undrgrnd. _ ,, �' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. wElectrical 54. Forms 4.a Conduit-Undrgrnd. CI 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6.^Electrical UFER Grnd_' 0 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8 `Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. -. 60. Backwash Lines, P -Trap, -O Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11.. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final' 15. Rough Electrical -Conduit t ,' 66. Solar System -Final 16. Rough Electric Wiring 'p S 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas El Oil 23. Gas Pipe -Rough & Test '72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank'❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and'Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30..Drywall Nailing HEALTH DEPT. REQUIREMENT 33: Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning i•�" [v -• i 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final ' 42. Backflow Preventer •� 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. "Date City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. 001226 Building Safety Division P. O. Box 1200 Costa Mesa, California The Building located at 366 EAST ISTH STREET UNIT 4B has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group n_1 Occupancy. - Use of Building (yNNTrVWTNTnM Legal Description 4?5-311—O4 (See reverse side for Metes and Bounds) Building Permit No 14_ldn'24 Electrical Permit No. P. -1415R Plumbing Permit NoP14039.P17667 Mechanical Permit No. !_ 2 ct nc Number of apartments and/or guest rooms ISSUED TO: ncm TICTlRJtnC O'Aryr .Tr.` c: Building Official r � Y n n nnv a:;a unT tarn rn a�r;�l Date •�� // t This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File OWNER TURNER; rie.$:-BER.iarC� DATE 10-31-6Q. JOB ADDRESS- .366 E. 15th $t. BUILDING PERMIT NO. 1322 GENERAL CONTRACTOR Clark & Slater - VALUE $ 595.00 AP.Nol-17-261-04 LOT TRACT _ FIRE ZONE DESCRIPTION OF WORK Add Att.Washrm.tO INSPECTIONS I DATE I GROUP I TYPEV ZONE R4 Res. 1 '?rgioll d Soil U.G. Water SUBCONTRACTOR I PERMITS ISSUED - �„ ---I OCCUPANCY Form 210-5M-11.59 S -B P 13226 0 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address Applicant's Mailing Address Owner's Name Phone Address Arch/Eng. License No. Address Contractor's Name Phone Address (mailing) City License_ No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commenting with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature IORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section 3800, Lab. C.) - Policy No. Company H Certified copy is hereby furnished. Certified copy i5 filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become Subject to the Workers' Compensation laws of California. Date Signature NOTICE: It, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for such permit 'o file a signed statement that he/She is licensed pursuant to the provisions Of he Contractor's License Law (Chapter 9 (commencing with Section 7000) of .Division 3 o1 the Business and Professions Cotle) or that he/she IS exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil mally of not more Uran five hundred dollars ($500). as owner of the property or my employees with wages as their sole compensation, will d0 the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Coca: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/horself or through his or her own employees, provided that such improvements are not Intended or offered for sale, 11, however, the building or Improvement is sold within ono year of com- pletlon, the owner will have the burden of proving he/she did not build or im. rove for the purpose of sale). 1, as owner Of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s license pursuant to the Contractor's License Law). I am aware that proof their Worker's Compensatlon Insurance should be provided to me. ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize rcore. senlatives of this city to enter upon the above-mentioned property for Inspection purposes. Signature Date Drivers' License or SS jie TYPE OF CONSTRUCTION U NEW U ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 46 Zone DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: Accessory Building: E TYPE OF PERMIT 0 GRADING ElFOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear El OTHER PROJECT DESCRIPTION 50. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATIONS $ Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: t 1. Planning Notes: Sink Preventer Irrigation Dish Washer Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Roof Drains Reinspection Fee 1 $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG+ Heating System & Ducting 00100,000 BTU 0 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000 BTU 0100,000 System Repair/Alteration Issue Fee FEES l I ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50+ KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP ❑1h-8 F.A.U. Inc. Solar 09.15 HP ❑16-15+ Fixtures Microwave Device Boxes I Pole Light Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW Standing Sections Trash Compactor FEES Z O N 1 N G R E O M T S. $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Date BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ $ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE S $ S $ $ $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector P, _ & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison p 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines ane .%fn all appropriate de. at ions. ' v r OF COSTA MESA - - - - - - - PERMIT NO. TRACT NO. , LOT NO. BLD _CITY CONSTRUCTION PERMIT0?J-737(4 382_ 7/11/84 .3P%1.7/ !. Project AdLless TYPE OF CONSTRUCTION ^NEW LJ Abo -ALTERATION LJ REPAIR A.P. # s5', �O Zone a Applicant's Mailin d ass 2 Owner's Name ` 1ev hone ❑ CONVERSION ❑ DEMOL DES (PTI N FWORK®��� SH ❑ THER '_ S Main Building: Accessory Building: Z 'fryAddress / r TYPE OF PERMIT GRADING FOUNDATION -STRUCTURAL ❑ TENANT '❑ ELECTRICAL PLUMBING �MrE/CHA,NIICAL - ❑ OTHER !�j y _/rte' �/ PROJECT DESCRIPTION SQ. FT. � OCCUPANCY CON STRUCTION TYPE VALUATI ON i l% ZONE GRADINGCU.YDS. ACRES a T Front / - - N Arch/Eng: L C// L' G MO�e Lic rise /NA/. � - ����' /' d�"'ct_. T B A Rear '- I �N Address' Contractor's Nam ones.!— �. Address(nrailing 1 -� City Licnnse No. �� LICENSED CONTRACTOR DEC ATION C Right - - �G K S Left 1 ; R E Ping. Ref. _ Perk.Fees $a O U Remarks: p 3r j4 i�3 Parking Req./Provided .�, S a, I. 1 V 1 hereby affirm that I am license un r provisions of harter 9 (commencing with Section 7 00) of Division o1 a Busin s an rofessi ns.Cede s,d� fit �---V my license is in orc antl off License C ss' — cense No. - Use of Building: - R ,E PLUMBING FEES Planning Notes: .M .E Date Signature NORK RS' MPENSATION DECLARATION Bar Sink Showers N T Backflow Preventer Service Sink -S 1 Hereby affirm that I have a certificate of consent to self nsure Inspectio urpos Signature i / to Drivers' Licen SS Heating 'System & Ducting 1 ❑0-100,000 BTU ❑l00,000BT _ Reinspection Fee $25 Issue Fee $ 3 CMF 0865-46 rev. 7/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - - -- - _ I� CONSTRUCTION AND PLANNING _ APPROVALS Permit # Date Inspector PG.,.. & SPA APPROVALS, Permit # - Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3.'Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement _ �(/ 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE - 7. Footings 7 L 58: Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe,O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60.. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains '. 64. Plumbing System - Final ' 14. Rough Plumbing I 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67: Fencing & Access Approval 17. Rough:Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS -FINAL 19. Rough.Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure „ - 70. Underground Hydro 22., Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough,&'Test r 72. Underground Flush 24. Roof Framing •..� 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25,1 Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) &�Monocoat 75. Dry Chemical 27. Frameand Flashing toll 7& Yv 76. Dry Standpipe 28. Lathing -& Siding 0i xq vL 77. FIXED SYSTEM FINAL, 29. Insulation -. r �/ �t(5 � 78. FIRE PREV, FINAL 30. Drywall NailingVCi HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat' ( �p 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric -, Notes: 17 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hoon or Canopy 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation - 44. ,Landscape Irrigation System, ' 45. Sound Attenuation 46. Handicap Regulations' 47. FINAL STRUCTURE & BUILDING Ac( - 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. '/;03/ -Date � /' -'-' - y, 1 CITY OF COSTA M A CONSTRU I PERMIT Project Address C %- Applicant's Mails ddress Owner's Name Phan Applicant to fill in all spaces except those within heavy border lines ind sign all appropriate declarations. Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No. l LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of ; Pink - Accounting; Goldenrod - Assessor Z O N I N G R E O M T S. MBING FEES " Showers ELECTRICAL FEES Service Sink - Automatic Washer i -, , Construction Pole Sub."' Transformer ❑ 15-50 KW ❑ 50+KW Sewer Cap Sewer Connection 0 Cooking Unit "� Meter ❑up to 100 amps ' Solar Collectors Dishwasher. -Meter ❑over 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan. - ,Motors ❑0-1 Hip ❑1%-B Swimming Pool w/Spa F.A.U. Inc. Solar. ❑9-15 HP ❑16.15+ Urinal Fixtures Microwave Water Closet Device Boxes Pole Light Water Heater Outlets - Range Water Service Switches ' Sign Garbage Disposal Standing Sections Generator 00.5 KW 05-15 KW Trash Compactor Issue Fee - S 3 Reinspection Fee $15 taus Fee $ 3 IANICAL I FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By , Date Application Issued By Data Hood or Type ❑ Canopy Type II ❑ Refrigeration System ❑0.100,000 BTU 0100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL . PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ 27,C0 ISSUANCE $ $ 10.00 ENERGY P.C. S $ GRADING $ $ MICROFILM S $ TOTAL FEE $ $ - .00 System Repair/Alteration Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector F, `& SPA APPROVALS Permit 9P Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location t 2. Soil Pipe:Undrgrnd. ?. 3 e/ S' 53. Steel Reinforcement 3. Electrical; Conduit.Utility-Undrgrnd. ) 54. Forms - - 4. Electrical'Conduit-URdrgrnd. •r 55. Electrical Bonding 5:''Steel.ReinforcemenY - - 56. Rough Plumbing & Pressure Test .•] 6. ElectricalUFERGrnd:% 57. APPROVAL TO COVER-GUNITE 7. Footings' .,' 58. Electrical Conduit-Undrgrnd. S.'Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pi Undr rnd. i be- 9 , % • 3 V � Z' 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10, Structural Floor System i 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final , 13. Roof Drains 't ? 64. Plumbing System - Final ' 14. Rough Plumbing ,,'� IbAb(y -' cil 65. Electrical -Final s 15. Rough ElectricaPConduit 66. Solar.System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval - 17_ Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping ❑ Gas El Oil 23. Gas Pipe -Rough & Test 72- Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O Oil . Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 2 'f/ jj LLQ 39. Water Service -Final/ �r - 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. :ITY OF COSTA MES CONSTRV TI N PERMIT Project Address AJ 7— Applicant's Applicant's Mailin Address Owner's Na Phon n/•�p� Address m Arch/Eng. License No. Address Contractor's Namle Pchone Address (mailing) 1 City License No. CONTRACTOR ONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in I .11f.,nd effect, Licens n o Date Signature WORKERS' MPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure or a certificate Of Workers' Compensation Insurance or a certified copy thereof (Section 3800, Lab. % Policy Np. S�/c rebs Company 0WCertifietl c py is hereby furnished. Datefi s nh the city ala ��L.!✓/A Date_ � ` Applicant„ /,— EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in ahy manner so as to become subject to the Workers' Compensation Laws of C411fornia. Date - Signature NOTICE: If, after making this dechiration, you should become subject to the Workers' Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY' 1 hereby affirm that there is a construction -lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair any structure, prior to its issuance also requires the applicant for such permit to file a sinned statement that he/she is licensed Dursuant to the provisions of therefrom and the basis for the alleged exemption. Any violation of section 7031.5 by any applicant for a permit subjects the .applicant -to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property of my employees with wages as their sole Compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or.through his or her own employees, provided that such improvements are notintended or offered for sale. If, however, the building or improvement is sold within one year Of com- pletion, the owner will have the burden of proving he/she did not build or im- Brove for the purpose Of sale). I, as owner of the property, am exclusively contracting with licensed Con- tractor5to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and Who contracts for such projects with a con- tractors license pursuant to the Contractor's License Law). I am aware that proof o! their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this a nformatlon is correct. I agree to Comaiv and Signature Drivers' L tate that.the above d county ordinances !by authorize repre- ioned pro rtrr Date 91 6 6036 2/22/85 6.13 IL TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: ' Bathtubs - Sewer Connection Reinspection Fee TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Dishwasher Solar Piping - ❑OTHER A Rear - C Right OJECT DESCRIPTION SQ. FT. OCCUPANCY KLeft CONSTRUCTION TYPE VALUATION $ $ 12 za 20NE GRADING CU.YDS. ACRES plug. Ref. # Parking Req./Provided Remarks: 4 -2) Planning Notes: g FEES Z O N I N G R E Q M T S. Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer - Transformer_❑ 15-50 KIN _ Construction Pole Sub. ' ❑ 50,+KW Backflow Irrigation Sewer Cap ' Bathtubs - Sewer Connection Reinspection Fee Cooking Unit - Meter ❑up to 100 amps ' Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank - Fan Motors ❑0-1HP❑1X-B Floor Drains Swimming Pool w/Spa E.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures _ Microwave Gas Service .Outlets Water Closet 12 za Device Boxes Pole Light Interceptors Water Heater $ $ $ $ $ $ Outlets Range ' Kitchen Sink - Water Service Switches Sign Lavatories -I I Garbage Disposal Standing Sections P—Trap - - _ Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains l Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIL ICBO # Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT r SS I I Reinspection Fee CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee Hood or Type ❑ Canopy Type I I ❑ 00.100,000BTU 0100,000 System Repair/Alteration Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By ��(1� Date Date DatZ L BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ S $ $ $ $ $ SUMMA OF FEES - S� SMIP PERMIT ISSUANCE. ENERGY P.C. GRADING MICROFILM TOTALFEE $ $ $ $ $ $ $ 3 CONSTRUCTION AND PLANNING APPROVALS . Permit # '. Date Inspector POOL & SPA APPROVALS - Permit # Date - Inspector 1. Temporary Electrical Service or pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � � . �"� a •� t _ 53. SteeLReinforcement 3. 'Electrical Conduit Utility-Undrgrnd. .F; 54. Forms - 4. Electrical Conduit=Updrgrnd. 55. Electrical Bdnding - 5.,Steel,Reinforcement -, 56. Rough Plumbing & Pressure Test 6. ElectricalUFER.Grnd..i,✓ _ 57. APPROVAL TO COVER-GUNITE 7.+Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O, Undrgrnd. ' 10. Structural Floor System 'r �' `� 61. APPROVAL TO DECK 11. Property Sewer Line'& House Connection" �! 62. Backwash &Receptor-Final 12. Sewer Cap 63. Heater &Vent-Final 13. Roof Drains / �� ,!� 64. Plumbing System - Final 14. Rough',Plumbing., 65. Electrical-Final l 15. Rough Electrical' Conduit -' 66. Solar System-Final 16. Rough Electric Wiring '- 67. Fencing & Access Approval 17., Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ' 1 FIRE DEPT. REQUIREMENT APPROVALS - Permit z#- 20. Rough Factory Fireplace - 21. Ducts, in Structure 21. 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []Gas 0011 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural)'& Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT '31.' Plaster Brown Coat I 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy - - 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer , 43. Backflow Irrigation ' 44. Landscape Irrigation System• 45. Sound. Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date . 'therefrom -and the basis for the, alleged exemption. Any violation of Section 7031.5 by any applicant for a' permit subjects the applicant' to a civil ,penalty of not more than five hundred dollars ($500). I, as owner of the' property or"my employees with wages as their sole compensation, will do the work, and the structure is not intended or Offered for sale (Section 7044, Business and Professional Code: The Contractor's Generator 0075 KW Reinspection Fee 1' $25'Issue Fee -- $ 3 FEES License Law does not apply to an owner of a property who builds Or improves thereon,•and who does such work himself/herself or through his Or her own Applicant to fill in all spaces except those within heavy border lines and signau'appropriale declarations. SUMMARY OF FEES • SMIP Duct -Under Ground • CITY OF CbSTA MESA` PERMIT NO. - TRACT NO. LOT NO. BLDG. NO._ CONSTRUCTION PERMIT s-101 S Firepl/Fact. Bit. ICBG+ 1560 Date wrier I hereby certify that I h e sea this applic Ion an at the above 'Information.is correct. see to ly wltn all and county ordinances and state laws relating o build tru ntl'hereby authorize repre- sentatives of this city t ent the ve-mentionetl property for Y�r A rHyeating System & Ducting . L10-100,000 BTU 0100,00OBTI. Project Address _366 E. 15 th. Street Applicant's Mailing Address TYPE OF CONSTRUCTION XX NEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER inspection purposes. 9-13-84 Signature MECHANICAL $11� TOTAL FEE Reinspection Fee $25 QLF 0865-46 rev. -7/83 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor - - Hood or Type ❑ Canopy Type I I ❑ Refrigeration System 00-100,000eTU 0100,006 B7 System Repair/Alteration Issue Fee 8102 i 9/13/84 13.101: TL Zone' Accessory Building: Z 0 N I N G • R E Park.Fees $ - O U I R E M E N T ELECTRICAL Transformer ❑ 15-50 KW , ❑ 50+KW - ,Meter ❑'up to'100 amps- - Meter ❑over 100 amps Sub Panel Motors E30-1 HP❑ 1 Xi - 8 Ina Solar 09-15 HP ❑16-15� Microwave I Pole Light Range Sign Standing Sections 15 KW Trash Compactor Reinspection Fee $25 1 Issue Fee PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Application Approved By Application hued By Qt1il.(5 BUILDING PERMIT $ SUMMARY OF FEES • SMIP I • $ PLAN CHECK $ PERMIT O PLUMBING PLAN CHECK ELECTRICAL r PLAN CHECK $ $ $ $ ISSUANCE ENERGY P.C. GRADING MICROFILM $ $ i $ $ MECHANICAL $11� TOTAL FEE - $ 3. DU $ 3 PLAN CHECK $ 'Z-c'n CONSTRUCTION AND PLANNING ' APPROVALS Permit # _ 7Datinspector -PC & SPA •APPROVALS Permit # Date -1nspecto. 1.' Temporary Electrical Service or Pole 52. -Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms- . 4. Electrical Conduit-Undrgrnd. - - 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings - - 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. -Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. - - • 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System - .61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor -Final 12., Sewer Cap /r r 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit - 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - 7 -dal £ FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace. _7,fy Ae7f- 21. Ducts, in Structure ' 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas 0 Oil 23. Gas Pipe -Rough & Test, 72. Underground Flush 24.E Roof Framing - 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - - _ 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test' - 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service;Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System , 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ) - 49. Electric Release to Edison -- - -- 50. Gas Release to Southern California. Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date- - ' ,V Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 346 E 17 /1 Applicant's Me'lI )g Address P. O, /33 w ra. Owner's Name IW /CT KTS' PA.PrAdpeS Phonei3 Address P BAL AOil ela 5 Arch/En. L gUTTES� 0/2£ 9 f1 License NoL.u/=1 Address phi ����15y, 9 �L Contractor's NamelJ"��w AVi/nI��2 Phone2A Address (mailing) el -3 3 /1/, B- CA, City License_ No. _Q 7 LICENSED CONTRACTOR D CLA ATI` I hereby affirm that I am lice sed un er rovl o sof Cha ter 9 a with section 7000) of Div If n 3 of [he Bus a antl Pr fessions my Iicerpe is in full forcq anq ffect. 7 IORKBRS' COMPENSATION DECLARATION . hereby affirm that I have a certifica o onsent to self -Insure or if certificate of'Workers' Compensation Insuran e,.or a certifal copy they ((SCctlon 3800, Lab_C.) _ 'II is the (This section need not be completed if the permit is for one hundred (5100) or less). I certify that in the performance of,the work for which this permit is Issued, I shall not employ any person in any^manner so as to become subject to the Workers' Compensation Laws of California. Date Signature - NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with' such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit 'o file a signed statement that he/she is licensed pursuant to the provisions of he Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, owner of the property or my employees with wages as their sole compensaastion, will do the work, and the structure IS not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a properly who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and _who contracts for such projects with a con- tractor(s1 license pursuaht Ito the Contractor's License Law). I am aware that proof o [heir Worker's Compensation insurance shouldbe provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owi r - - hereby ertify t t haveatl [his app Ihab the above infor mati n is torr ct. I agreecomply y�untyordinances ng const ru ion, and hereby authorize repre- r upon th above -men Boned property for Drivers' License 01 SS TYPE OF CONSTRUCTION KNEW LJ ADD LJ ALTERATION LJ REPAIR SUMMARY OF FEES ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 91E DESCRIPTION OF WORK/USE OF BLDG. SMIP $ • S Main Building: TYPE OF PERMIT LJ GRADING El FOUNDATION ❑STRUCTURAL T Front ❑ TENANT X ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B PLAN CHECK '25% - ❑ OTHER A Rear - C Right PROJECT DESCRIPTION SQ.FT. OCCUPANCY K $ CONSTRUCTION TYPEFR/N'%1_S"/'cPCCO VALUATION$ $ Left ZONE GRADING CU.YDS. ACRES Ping. Ref. + Remarks: / /at., — 'A n ,. r _ .-, 1 Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Drinking Fountains Floor Drains Floor Sinks _ Sas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal - 'Water Closet Water Heater Water Service Issue Fee Boiler Hood or Type I ❑ Duct - Under Ground Canopy Type I I ❑ Duct - Structural Refrigeration System Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Heating System & Ducting 00100,000 BTU ❑100,000BT Reinspection Fee 1 $15 CMF 0865-46, rev. 4/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor Issue Fee Automatic Washer .- Construction Pole Sub. _ Cooking Unit / Dishwasher $ 3 FEE $ 3 Fan F.A.U. Fixtures Device Boxes I Outlets Switches Garbage Disposal Generator ❑0.5 KW 4625 7/20/84 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KIN / Meter Aw1up to 100 amps Meter ❑over 100 amps l Sub Panel Motors CIO -1 HP ❑ 1 % - 8 Inc.Solar ❑9.15 HP ❑16-15+ r Microwave Range Sign Standing Sections 5 KW / Trash Compactor 581,20 TL FEES ral Z O N I N G R E O M T S. I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES R Zoning Approved By Building Approved By PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ 'PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK '25% $ ENERGY P.C. $ ' ELECTRICAL $ 20.9)0 GRADING $ PLAN CHECK 50% $ I Qi. MICROFILM $ ZO MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # i, '� Dates Inspector F, &SPA APPROVALS Permit # Date Inspector 1. Temporary,Electrical Service or Pole - 52. Pool & Equipment Location ". r 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement !f 3. Electrical Conduit Utility-Undrgrnd� ,� 54. Forms 4 Electrical Conduit-Undrgrnd.- �3 C 55. Electrical Bonding 5. Steel ,R6inforcement - 56. Rough Plumbing & Pressure Test 6. Electrical.UFER Grnd' �. .3 Lt(°- 57. APPROVAL TO COVER-GUNITE r 7%. Footings 58. Electrical Conduit-Undrgrnd..�• 8: Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water -Pi pe- Und rgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. r 10. Structural Floor System 61. APPROVAL TO DECK I 11. Property Sewer Line .& House Connection 62. Backwash & Receptor -Final i 12..Sewer.Cap . r 63. Heater & Vent -Final 13. Roof Drains - 64. Plumbing System - Final . I 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring ,f0 S 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.'Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT `31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - !�` .• ,� i i 35. Final Gas Pipe=Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing - 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer '� / •'rr•U � r 43. Backflow Irrigation 44..Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 001231 P. O. Box 1200 "- Costa Mesa, California The Building located at 3636 FAST IM S'TREk7T UNIT 44A has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group P-1 Occupancy. Use of Building (7f1NLY1c�1INTTP4 Legal Description 425--311-04 (See reverse side for Metes and Bounds) Building Permit No Pt -140'311 Electrical Permit No. t.-14157 Plumbing Permit No.1314n3R.D17FFF Mechanical Permit No. M-1 =1°^ Number of apartments and/or guest rooms ISSUED TO: THE HEIGHTS PARI P 0 BOX QC0 HAT-Wnh CA 92661 Building Official 1z A f �,�461 by,� r ' Date This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 101546 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File \._ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITU OF COSTA MESA Project Address A.P. Zona Applicant's Mailing^Address S Owner's Name OF -1 it AddressBpx gs FOUNDATION ❑ STRUCTURAL RAL ❑ PLUMBING ❑ MECHANICAL Arch/Eng. L. Address RO. �//�X.- (' Front Contractor's N.un.-Amni Z O Address (mailing) Po p (� City License- No, QZ.� C LICENSED CONTRACTOR _I (V Chereby affirm that I am fir PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YOS. ACRES with section 7000) of Divif my licen is in full orce am Left License 1, �v� CONSTRUCTION PERMIT und�r provisidrl$ of 1 of t e Busint antl C� Date Sign ure WORK MPENSATIO LARATION I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certifi py thereof (Section 3800, Lab. C.) Policy No. �j0-��-08 �A;C(mpang �C"! ea cop IP s hereby furnis hetl: f� C d SqPILk Ueo.with the city -BQlltyng,Ql ision. In EXEMPTION le OM WORKERS' COMPENSATIOff- ECLARATION (This section n¢SStl not be complat¢tl i1 the permit is for one hundred (E300) or less). I allcertifyno that in the performance any work for which this permit is issued, I shall not employ any person in any manner so -as to become subject to the Workers' Compensation Laws of California.' Date Signature - NOTICE: Compensation after making this declaration, you shoultl become subject to the c orkers'.thSuchprprio isio r t the Labor Code, you must Irevoke . comply with such provisions or this permit shall be tle¢metl revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction ilendingagency for the Performance issue of the work for which this permit is issued (Section 3097 Civ. CJ Lentler's" Name -- Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its -issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any., applicant for a permit subjects the applicant to a civil "LJpenalty of not ore than five hundred dollars ($500). m 1, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure Isnot Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one Year of com- i pletion, the Owner will have the bUrden of proving he/she did not build Or inn- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Property who builds or improves thereon, and who contracts for such projects with a Con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that proof of{ their Worker's Compensation insurance shoultl be provided to me. ❑ 1 am exempt under Section S. & P. C. for this reason Date of t Owner I Drivers' Clper //\\ fa'or \x CMF 0865-46, rev. 4/84 White -Building; the above Zit ze repre- aperty-for 4624 7/20/84 24o FG TL TYPE OF CONSTRUCTION KNEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. Zona S Main Building: Accessory Building: TYPE OF PERMIS GRADING I1"��1 ❑ TENANT ELECTRICAL ❑OTHER FOUNDATION ❑ STRUCTURAL RAL ❑ PLUMBING ❑ MECHANICAL E T Front Z O 13 A Rear N C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YOS. ACRES K S Left G R Ping. Ref. # Parking Req./Provided E Remarks: Planning Notes: Q M T S. PLUMBING FEES " Bar Sink Showers ELECTRICAL FEES Backflow Preventer - - Service Sink Automatic Washer - Construction Pole Sub. Transformer ❑ 15-50 KW 11 50+KW Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit I Meter KKUP to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher - Solar Piping Dryers ❑Gas OElectric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1Ya - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks - Urinal ID Fixtures Microwave .- Z -CC Gas Service Outlets Water Closet I I Device Boxes Pole Light a Interceptors Water Heater - Outlets Range Kitchen Sink Water Service Switches Sign 2-C Lavatories - - Garbage Disposal Standing Sections ' P—Trap Generator ❑0.5 KW El 5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 8 LJ3 Reinspection Fee $15 Issue Fee ' MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved Date Building Approved By Date Application Issued By— s Date Boiler Hood or Type ❑ Canopy Type II El- Duct -Under Ground Duct - Structural Refrigeration System ❑0-100,000BTU 0100,000BTU Duct -Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ I GRADING $ $ %. Z-0 MICROFILM $ $ TOTALFEE $ 2*•(00 $ ' Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICED # Heating System & Ducting 00-100,000 BTU ❑100,00067 Reinspection Fee $15 Issue Fee $ 3 unting; Goldenrod -Assessor I '. 7CONSTRUCTION AND PLANNING APPROVALS Permit # Date,' Inspector POOL & SPA APPROVALS Permit +_ Date . Inspector 1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3..Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit'Undrgrnd. C�t 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. a.�j C ` 57. APPROVAL TO COVER-GUNITE - 7. Footings -. 58. Electrical Conduit-Undrgrnd. 8.�Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. •'' 10. Structural Floor System - r - 61. APPROVAL TO DECK 11. Property Sewer. Line & House Connection 62. Backwash & Receptor -Final - 12. Sevvel Cap ., 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing. 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring - /0 y' l,lp 67. Fencing & Access Approval 17. Rough Wiring Sign, 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS• Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure ,70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush, 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL - 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31 Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test . 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound -Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed - 49. Electric Release to Edison - *50. Gas Release to Southern California Gas Co - - 51.'CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. TYPE OF CONSTRUCTION LJ NEW LJ ADD CITY OF♦COSTA MESA CONS R TION PER IT ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Project Address s ' ' G.¢ DESCRIPTIONOFW RK/USEOFBLDG. Applicant's Maili Address _ . L(4- - Owner's ame 'N Phonr+ e-;=Jc)'4 S Address Arch/Eng License No. TYPE OF PERMIT GRADING FOUNDATION Address T Contractor's Nart1m ho ❑ MECHANICAL ((`T{��' CFO Address (mailing) -1 l'", � �--, 1 L.hc NLICENSED City License No. CONTRACTOR DELLA ATION ` I hereby affirm that I am licensed under provisions of Charter'9 (commencing A with Section 7000) of Division 3 of,441e Business and Professions Code, and my license is in WSJ force and effect 1 Right - ..ice / ..-e....e TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR PLUMBINU ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. �p DESCRIPTIONOFW RK/USEOFBLDG. ELECTRICAL FEES ' WORKERS' C MPEN$ATION DE ARATION I hereby affirm that I have a certificate of consent to self -insure or a Certificate Backflow PreveOter- Service Sink - S Main Building: of Workers' Compensation Insurance,. or a certified copy thereof (Section 3800, Lab.• CO - Policy No. o pany Certifietl copy is hereby furnish¢ . 07 e Car t'fi c py s 'le with the ci Bui ding Dilsian. 'C E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Dishwasher Meter ❑over 100 amps TENANT (This section need not be completed if the permit is for one hundred ($100) or less). I certify that -in the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to t6 Dishwasher I Solar Piping Rear ❑ OTHER'- l Drinking Fountains Solar Tank A Fan Motors 1:10-1 HP ❑1'h- 8 Workers' Compensation Laws of California. 1 C Right - PROJECT DESCRIPTION SQ. FT.' OCCUPANCY KLeft CON STRUCTION TYPE VALUATION$ S ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: 2973 6/26/B4 Accessory Bui Parking Req./Provided e.uc Zone Z O N 1 N G R E O M T S. Dale Signature PLUMBINU FEES Bar Sink 1 Showers ELECTRICAL FEES ' WORKERS' C MPEN$ATION DE ARATION I hereby affirm that I have a certificate of consent to self -insure or a Certificate Backflow PreveOter- Service Sink - Automatic Washer Transformer ❑ 15-50 KW ❑ 50+KW Construction Pole Sub. S of Workers' Compensation Insurance,. or a certified copy thereof (Section 3800, Lab.• CO - Policy No. o pany Certifietl copy is hereby furnish¢ . 07 e Car t'fi c py s 'le with the ci Bui ding Dilsian. 'C Backflow Irrigation Sewer Ca 4 P Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant EXEMPT N ORKERS• COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). I certify that -in the performance of the work for which this permit is issued I shall not employ any person In any manner so as to become subject to t6 Dishwasher I Solar Piping - Dryers ❑Gas ❑Electric Sub Panel l Drinking Fountains Solar Tank Fan Motors 1:10-1 HP ❑1'h- 8 Workers' Compensation Laws of California. 1 Floor Drains Swimming Pool w/Spa F.A:U. Inc. Solar ❑9-15 HP ❑ 16-15+ DaleSignature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be' deemed revoked. CONSTRUCTION LENDING AGENCY- I hereby affirm that there is a con StruCtion lending agency for the performance Floor Sinks Urinal Fixtures Microwave Gas Servicer ,'.Outlets Water, Closet - Device Boxes' Pole Light Interceptors Water, Heater p Outlets Range of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name _ Kitchen Sink Water Service - Switches' Sign Lender's Address - OWNER BUILDER DECLARATION .. Lavatories - -- Garbage Disposal ' SLandid9 Sections I hereby atfirm'lhat I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or count which requires a permit to construct, alter, improve, demolish or repair any structure, prior to it'izsuance, also requires the applicant for such permit to file a signed statement that he/She Is licensed pursuant to the or of he Contractor's License Law (ChapterB (Commencing with Section7000) of Division' 3 of the Business and Professions Code) or that he/she is exempt _ P -Trap ./ _ - Generator ❑0.5 KW ❑5-15 KW 'Trash Compactor , �R OOf Drains. - therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any -applicant for a permit subjects the applicant to a civil nenalty of not more than five hundred dollars ($500). I, as owner of the property or my -emploYeei with wages as their sale compensation, will do the work, and the structure is not intendetl or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of'a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletlon, the owner Will have the burden of proving he/she did not build or im- Eve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tra Ct ors 10 construct the project1Se ct i on 7044, Bu Si n ass ano Pro t essi o ns Code: The Contractor's License Law does not apply to an•owner of property who ; builds -or Improves thereon, and who contracts for such projects with a con- , tractor(s) license pursuant to the Contractor's License Law). Iam aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason _ Reinspection Fee-., $15 Issue Fee '- $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL - FEES - DEVELOPMENT SERVICES REGUIREMENTS: . Approved By Date Building Approved ByDate Application Issued By Data_ Boiler '- Hood or Type 1 ❑ Canopy Type II IDZoning ' Duct - Under Ground Duct -Structural Refrigeration System ❑0-100,000 BTU ❑100,000 BTU _ Duct - Ventilating i SUMMARY OF FEES BUILDING PERMIT $ l SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact: Blt. ICBO # Date _ Owner Heating System &Ducting PLAN CHECK 25% $ ,ENERGY P.C. $ 1 hereby c 1f that I have read this application and state that the above In is c rect, I agree to cpmply with all city antl county ordinances and stat laws re ting to builtlin con�R�and hereby authorize rept¢- sentative of chi city b enter upon ve-mentionetl pr pert for t InspecU purp ez. Signator Date Drivers' License or SS 5r ; Pink -Accounting; Goldenrod -Assessor - - - - - CONSTRUCTION AND PLANNING - APPROVALS Permit # Date Inspector P� -- &SPA APPROVALS Permit # Date -- Inspector . Temporary Electrical Service or Pole 52. Pool & Equipment Location - - -, 2. Soil Pipe-Undrgrnd. '' 53. Steel Reinforcement ' -3. 'Electrical Conduit Utility-Undrgrnd: 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test - 6..Electrical U_ F E R Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. -' 8. Foundation -' 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property;Sewer Line & House Connection ' 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13.1 Roof'Drains .. - - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final - .. 15. Rough Electrical-Conduit ' - .66. Solar System-Final -� 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign_ 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas E) Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:. to/'9'. moo' gyp` 34. Final'Heating & Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood or Canopy - 37. Final Factory Fireplace - - 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic Final 42. Backflow Preventer ' 43. Backflow Irrigation - 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE & BUILDING - 48. Special Requirements Completed 49. Electric Release to Edison - - - - 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF. OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA ME4A CO SSTR CTION PERMIT Project Address 3 &`C _ . J / `Sr. Qii meq Applicant's Mailing Address 1 711 �.._-71.2)1F. y -t- Owner's ry(jre f"1 E,1 rp 1"1 T S %�F�yT"D � Address t• 0 X p �4—ea R 2 coSp 1 Arch/Eng. _ License No. Address Contractor's No �r1�2'tL(O Y1 Pho i'Cii Address (ma l ng11713 2 C-11,71 City License_ No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed untieprovisions of hatter 9 (commencing with section 7000) of Division 3 -oft Bust nets an rofessions Code, and my license is in full rc antl'e tett_ 0 License CI ss Z _ Sr _Lic � % Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certlf�uqd copy in t Section 3800, Lab. C.) ,10-/���, Policy No. WL '7 Co pang Certif led cop Is hereby furnished. (-, Certif) o led with the city B I Ing DIvIS ate Applicant EXEMPTIO ROM WORKERS' CO SATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. _ Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this Permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Cly. C.) Lander's Name Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that 1 am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, altar, improve, demolish or re Pair any structure, prior to Its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the Provisions of he Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions COge) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil ee nalty of not more than five hundred dollars ($$00). LJI, as owner of the property or myemployeeswith wages as their sole compensation, will do the work, and the Structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements art not intended or offered for Sale. I1, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- ro ve efor thw purpose of sale). I, a'own or of the property, am exclusively Contracting with licensed con. tractors to cnstruct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a Con- tractor( 5)) Il cense pursuant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. 6 P. C. for this reason Date Owner I hereby ceir fy t at I have read this application and state that the above Information is Corr t. I agree to comply with all city and county ordinances and state laws relat g to buildi g co strucllon, and hereby authorize reps sentatives of this y to en r up the above-mentioned pro rt f inspection purp s. y�- / Signature 4a�� Drivers' License or SS $ TYPE OF CONSTRUCTION . 2Q NEW LJ ADD 'L ALTERATION LI REPAIR ❑ CONVERSION El DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Sf:.JEdfe TYPE OF PERMIT U GRADING L FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES_ Remarks: Bar Sink Backflow Preventer Backflow Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets. Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w, Urinal Water Closet Water Heater Water Service ®�I —_I psi Reinspection Fee ' I • $151 1 ' Issue Fee 1 $ 3 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple C Firepl/Fact Bit. ICBG # Heating System & Ducting 00-100,000 BTU ❑ 100,000 Bl Reinspection Fee 1 $15 /1 CMF 0865-46, rev. 4/84 White - Building; Canary - APPliwnt; Pink - Accounting, -Goldenrod - Assessor I`' Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System DO-100,000BTU ❑100,000 System Repair/Alteration Issue Fee A.P. S Main Building: E T Front A Rear C Right BLeft Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec' Fan'. F.A.U. Fixtures Device Boxes Outlets 1493 6/01/84 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW --- EJ 50+KIN Meter ❑up to 100 amps Meter ❑over.100amps Sub Panel Motors 1:10-1 HP 111%, - 8 Inc. Solar 09-) 5 HP ❑ 16-15+ Microwave Pole Light Garbage Disposal Generator 1:10-5 KW 05-15 KW Range Sign Standing Sections Trash Compactor Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning'APproved By Building Approved By Application Issued By- LI- rJaQfJ X�1. FEES $ 3 Z O N I N G R E Q M T S. BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ PERMIT $ .OU ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ $ $ $ $ $ $ ��-6 0 $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # DatalinspectorP,.. - - & SPA APPROVALS Permit# Date Inspector + 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil'P.ipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical ConduitUtility-Undrgrnd. 54. Forms. - -'k- 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing &Pressure Test 6. Electrical UFER Grnd. - t . 57. APPROVAL TO COVER-GUNITE 7:" Footings ..f i %� 58. Electrical Conduit-Undrgrnd. J •8. Foundation - - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pi a-Undr md. P g 60. Backwash. Lines; P -Trap, ❑Undrgrnd. 1.10. Structural Floor System J �• - 61. APPROVAL TO DECK ) 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap G �/y 63. Heater & Vent -Final '. '• 13. Roof Drains •," 64. Plumbing System - Final - 141'Rough. .Plumbing - 65. Electrical -Final... " 15."Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace .. 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test ..• 72. Underground Flush 24( Roof Framing 73. Undergrnd. Storage Tank ❑Gas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26' T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing &Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ' 34. Final Heating & Air Conditioning a 35. Final Gas Pipe -Test S 36. Hood. or Canopy , r 37. Final Factory Fireplace 38. Final -Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 13226 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 317 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINCTBUILDING� ADDRESS 366 L` /.5 �� CS7J-ee.y COSTA MESA. CALIFORNIA FLEE RECEIVED Z a gO�C/T+�3111�9660T' APPLIC�CS.rI'P��OpplR�iA NIT BUIUULFFDINGA MESA For Office Use Only ' OWNER t3 CG' /`�' PN RECEIPT NO.q�pMIT NO. i a6 MAILRe�I;D ADDRESS 3 66.. I q�_13U D6 CITY TEL. (_O J`7K ���RY NO. BUILdHQG ADDRESS e3GG ARCHITECT TEL. OR ENGINEER NO. COESA. CALIFORNIA ADDRESS FIRE ZONE APP TYPE GROUP �O '3 �I / ACTOR �/ �`'� '7- S ���I�-' LADDRESS/ 20 C(l ! %C!-' /YI��- Z — 6 LEGAL DESCRIPT d /.ATE a NI G I 0. or I USE OP NEW PLANE BUILDING _ [,nom _14t ��� cva/,r Ci T E TEL.cc LIC.TNO. NO. �! OZ/�� SIZE OF LOT 7S X NO. OF Bas. LD I NOW ON LOT A. P. NO. D USE OF EXIST( G BLDG. (IG.�- YARDS APPROVED EVES ALLOWED SETBACK LINK FROM �. CENTER OF STREET /2 REAR YARD 1Y (CENTER LINE FROM ET.) t FT - .�1.. IN. SIDE YARD LEFT / Q I RIGHT 3 R. SIDE / FT. IN: DESCRIPTION OF WORK L. SIDE FT. IN. NEW I I ALTERATION I ADDITION I REAR FT. IN. REPAIR L II MOVING I II DEMOLISH I AAPPROVED ` DATE U BUILDING NO. OF SIZE ROOMS STORIES EXTERIOR WALL ROOF (COVERING COVERING -USE OF BUILDING AND WORK TO BE PERFORMED i F- U 1 HEREBY ACKNOWLEDGE THAT [,HAVE READ THIS AFPUCATION AND STATE THAT THE ABOVE IB CORRSCY AND AGREE' TO COM- PLY WITH ALL GTY ORDINANCES AND STATE LAWS REGULATING THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF EBTABLIBHINO A PERMIT FEE ONLY. TION U BUILDING CONSTRUC ION.VAL SIGNATURE OF .Q y( PERMIT FEE $ / r� PLAN CHECK $ PERMITTE i (/ ` TOTAL FEE AUTHORIZED AGENT a WN .moi j , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. I I 1�1 QITY OF CV -i MESA CONSTRUCT ON YEHMIT Project ;,td—S 3 r6 • s ��sl Applicant's Mail in Address &01, Al Af4 ir pde• S Lr Owner's Name V jof,0 w d%W Of -JP Phone Address ��)/ (Z� •l�iO:�� C M' Arch/Eng. License No. Address9!9 14 (�r.�>r� Contractor's Nam N. honge zas_rir_ 7 Address (mailing) a City License No. , `�- 34 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensedjunder provisions of Charter 9 (Commencing • with section 7000) of Division 3 Of the Business and Professions (Code, and my license is in full force and effect." R7 I I I Licen Class C 2 q- (cense No. (37 Datei A^ Signature �w+�-rte WORKERS' COMPENSATION DE ARATION I hereby affirm that I have a certificate of consent to self4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section • 3800. Lab. Cy% tl?�` ,J 1 i�'T�i L. -r rU/VI Policy ab Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Divisi n. Date f1 — /. s , Applicant AtrJ� EXEMPTION FROM WORKERS' COKVENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less) I certify that in the performance of the work for which this permit is issuetl1 Shall not employ any person in any manner so as to become subject to INCh Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Clv. C.) Lender's Name Lender's Address . OWNER BUILDER DECLARATION 1 hereby afflrm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she i5 exempt therefrom and the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a civil ,enalty of not more than five hundred dollars ($500). ❑ 1, as ..net of the property or my employees with wages a5 their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of COM- , pletion, the owner will have the burden of proving he/she did not build or im. hove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. 6 P. C. for this reason Date I hereby certify that I Information is correct. I and state lawsrelating I sentatives of this city inspection our ses. Signature Drivers' Li rise orjyi� CMF 0865-46, rev. 4/84 Owner I this application and State that the above comply with all city and county ordinances g construction, and hereby authorize repre- upon the above-mentioned Property for S Date Z =[[_:_fir TYPE OF CONSTRUCTION 11i NEW LJ ADD Li ERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHEPF. ",, A.P. Zs DESCRIPTION OF WORK/USE OF BLDG. ,J •-C t.IIA L S I S Main Building: TYPE OF PERMIT , GRADING FOUNDATION STRUCTURAL '(IA,,T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 A Rear ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ �'JOQ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: A•O FEES 0112 10/12/84 Accessory Building: L it Ir IO 73052 TL Zone Z O N 1 N G R E Q M T S. Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub. ❑ 50 f=KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection SMIP Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors PLAN CHECK Dishwasher Meter Dover 100 amps Dishwasher Solar Piping 2 �� PERMIT Dryers ❑Gas ❑Electric Sub Panel - Drinking Fountains Solar Tank PLUMBING Fan Motors 00-1 HP ❑11a 8 Floor Drains Swimming Pool w/Spa ISSUANCE F.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal PLAN CHECK Fixtures Microwave Gas Service Outlets Water Closet ENERGY P.C. Device Boxes Pole Light Interceptors Water Heater ELECTRICAL Outlets Range Kitchen Sink Water Service GRADING Switches Sign Lavatories PLAN CHECK Garbage Disposal ' Standing Sections P -Trap - Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains MECHANICAL , $ TOTAL FEE $ Reinspection Fee $15 Issue Fee $ 3 25% Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00100,000 BTU E31 00,000 BT ; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type I I ❑ Refrigeration System 00.100,000BTU 0100,000 System Repair/Alteration Issue Fee .1 $ 3 Reinspection Fee $15 Issue Fee DEVELOPMENTSERVICES REQUIREMENTS Zoning Approved By Building Approved By 1111W - Application Issued By $ SU'MM,AqR` FEES BUILDING PERMIT $ SMIP $ ' PLAN CHECK $ 2 �� PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL , $ TOTAL FEE $ PLAN CHECK 25% $ - CONSTRUCTION AND PLANNING APPROVALS Permit# 11Temporary Electrical Service or Pole Date Inspector POOL .PA APPROVALS Permit# 52. Pool & Equipment Location - Date Inspector - 2. Soil Pipe: Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd: 54. Forms _ 4?)Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. _ 57. APPROVAL TO COVER-GUNITE 7. Footings .. - ) i 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK - 11. Property Sewer Line & House Connection .• 62. Backwash& Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final + 14. Rough Plumbing• 65. Electrical-Final - 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22, Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank []Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar, Ceiling (Structural) & Monocoat 75. Dry Chemical ' 27, Frame and Flashing 76. Dry Standpipe 28. lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning�� 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace .. 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Rackflow Irrigation 44. -Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations -' 47. FINAL STRUCTURE & BUILDING rory2 48. Special Requirements Completed ' 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date _