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Home My WebLink About2510 SHELLEY CIR - Building Permits'a . C1T'�OF COS7A M�Sa ON!S RUCTION P RMIT Project Address �� `� �� Applicant's Mail/in�p�A ddreu � �cA� Owner's Narr�e N � s N Phone L Address � `S ApO��cant to fill in all spaces exeept those within �eavy bortler lines an0 si9n all apOropriate Oeclarations. � Coniracror's Nam� � �'��Phong�G�D�lO � Addresslmailingl� �J� �� _ � City License No. � 3 90� �� LICENSED CONTRACTOR DECLARATION �� I her¢by aifirrn that 1 am IicenSetl untle� provi5iOq5 oi Cbarter 9(commencinq with sectlon ]000) of Oivision 3 oi the Business antl Professions Cotle, antl my Ilcense is in tull te tl eftecL � Licen 5 � � � ��%^^^_^ �� Oate � Si9nature ,_ - WOR�' COMPENSATION DECLARATION . I hereby aHirm that 1 have�a certiticate ol mnsent to sel7-Insure or a<ertHica[e ' ' Workars' Compensation Insurance,' or a certitietl copy (i�reof (Sectlon 300, Lab:� ��% �� V/�,/ L p.yo�licy No. /h/// _�� Company =�T ��iH µ� Certitiatl'copy is hereDy /umishetl. 'LJ Cer ' etl with the city$� n9 islon �ate Applicant/�� . EXEM TION-^�RKERS' COMPENSATION DEGLARATION (Thiisection n¢etl not be completetl i( the p¢�mit i5 for One huntlretl (5100) Or less). I certity that in t�e Perto�manCe of thC wo�k tor �yhlGh this perm�t is i55uetl, I shall not employ any perzon in any manner so as to become subject to the Work¢r5' Compen5d[iort l.aws of California. . Date Si9nature NOTICE: If, after makinq this tleclaration, you shoultl become subject to the • Workers' ComDensation pwvision5 of the laCor Cotle, you must forthwith compry with sucn provisions or this permit shpll be aeemetl ravoketl. CONSTRUCTION LENDING AGENCV I hereby atfirm tnal there is a consVuction lentling agency tor the performance of the wark tor which thls permit is ISSu¢tl ($eCtion 3097 Civ. C.) I�ntler's Name Lentler'z AUtlrasS � � � OWNER BUILOER DECLARATION - I hereby affirm that I am exempt from the Con(ractor's Llcense Law tor fhe following reason (Seclion 7031.5 Business antl Professional Cotle: Any ci[y or COunty whlGh �eQUIreS a pe�mit to construCt, al[e�, imprOve, tlemollsn O/ �¢pai� any sbucture, O��er to Its issuance, also requires �pe applicant for such permit to fiie a signetl slatement that ne/she is licensetl pursuant to (he Provisions ot Ih¢ Contra<tOr'S �ICenS¢ Law (Chapter 9(comme��ing with Section ]000) ot - , DiviSion 3' ol the BUSiness antl Professions Cod¢) or lhat h¢/Sh0 i5 !x¢TPt `.f�etetrom dnd ,tna-basis to� thG allege0 ex¢mption. Any viOlation.of Section - :•� �31.5"�by�,apY' aDP��anl for a permit SubjeCts th¢ appllcant to a<Ivil ;i �+��-�nalty o( not_more than five nuntlretl tlollars (EB00). � LJ I, as owncr:oi th¢ Property o� my emplOyees with wa9e5 a5 th¢I� sole compensation, will tlo the work, antl the structure is not intentletl or ot(eretl for sale ($ection 7044, Businesz anE Protessional Cotle: The Conlractor's Liconse Law tloes not apply co en owner of a property who bulltls or improves theraon, ana who tloes such work himself/herself or througn his or her own Cmpl0yee5, prOvitletl that such implovement5 ar@ n0[ Intelltletl or offeletl tol sale. If, hOwCve�, the builtlin9 0� imprOvement I5 soltl within One yea� ot com- � plelion, tne owner will nave the �urtlen oi proving he/she aiE mt builtl or im- �rove �or Ihe purpose of sale). I, a5 ownCr ot Ihe property, am exclusively Contractln9 wlth IlcenS¢tl Con- tractorsto construct the proiect (Section 7044, 9usiness antl Protessions Cotle: The Conlrattor's License Law tloes not apply to an owner ot property who builtls or improves thereon, antl who contracts {or such projects with a con- tractor(51 littnse pursuant to the Contractor's License Law). I am aware that proo/ 01 their WOrker'S Compensatian insuranCe shoultl be provitletl to me. ❑ 1 am exempt untler $eclion B. & P. C. for this reason Date Owner I hereby certlfy that I have rea intormation is correcL I aqree to antl state laws relating to builair Sentative5 Ot this city to ent Inspection� Signature Orivers' License or SS $ _� TYPE OF CONSTRUCTION IJ NEW LJ ADD LJ ALTERATION LJ RECAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p# DESCR IPTION OF WOfi K/USE OF B LDG, . �n�U c� �-A�'� S Main Builc --��7-a-�� E TVPE Of PERMIT lJ GRADING LJ'FOVNDATION 1—I STRUCTVRAL T Fron[ -O TENANT ELECTRICAL1 •❑'�,PLUMBING ❑ M�/E�.C�F{1qNIGAL A Rear ❑-0THER � '�RA'/IYi n1wi�� W \� PROJECT DESCRIPTION s�. Fr. oCCuaANCv C Right K Left CON54RUCTIONTVPE VAWATION$ $ _ 20NE GRADING CU. VDS. ACRES Ping. Ref. #• Remarks: , - P.lanning Note� Bar Sink Preventer Irrigation Clarifiers Dishwasher � Drinking Fountains Floor Drains PloorSinks � Gas Service Outlets Kitchen Sink Lavatories P-Trap Roof Orains Reinspection Fee $15 Boiler Duct - Under Ground � Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact Blt. ICBO # Heating SVstem & Ducting ❑0-100.000 BTU 0100.000BT Reinspection Fee � S75 CMF 0865-46, rev. 4/84 WM1ite - Builtling; Canary - qppliwnp Pink - Atcoun[ing; GOICenrotl - Assesm� Service Sink ' - ' Sewer Cap Sewer Connection Solar Collectors � $olar Piping Solar Tank � Swimming Pool w/Spa' � Urinal � - - - Water Closet . Wacer-Heacer • Water Service I�sue Fee Hoodor Typel ❑ Canopy Type I I � Refrigeration System ❑0-700,000 BTU ❑100,000 BT System Repair/Alteration � laue Fee G' 0 Construction Pole Cooking Unit Dryers LJGas� LJElectric Fan F.A.U. Fixtures �� - � Device Boxes OutIeLS Switches Garbage Dispoul Generator �0�5 KW �5d5 KV 0589 4/03/85 Zone Building: Parking Req./Provided ELECTHICAL Transformer ❑ 15-50 KW - ❑ 50+KW Meter �up to 100 amps . Meter ❑over 700amps � Sub Panel � �Motors�0-1 HPOi'h-8 Inc.Solar 09�,15 HP 016-15+ Microwave � Pole Light Range • Sign • Standing Sections � 7 Trash Compacror 8.0�7 iL FEES Z O N I N G R E Q M T S. $� � Reinspection Fee $15 Issue Fee $ 3 � FEES DEVELOPMENT SERVICES RE�UIREMENTS: 2oning Approved By Date Building Approved By Data Applintion Issued By Dat �-� � SUMMARV OF FEES BUILDING PERMIT $ � SMIP $ PLAN CHECK $ PERMIT ,� PLUMBING $ ISSUANCE S PLAN CHECK 25% S ��j�— ENERGY P.C. $ ELECTRICAL $ � �✓•'�— GRADING $ PLAN'CHECK 50% $ MICROFILM $ MECHANICAL 5 TOTALFEE $ �OO $ 3 PLAN CHECK 25% $ � .� �'�• CONSTRUCTION AND PLANNING POOL PA �� APPROVALS Permit # - Date Inspector AppROVALS Permit # Date Inspector 1. Tempo�ary,Eiectrical Service or Pole' �� ! �� 52. Pool & Equipment Location "'2. Soil Pipe,Uridrgrnd. '� � . 53. Steel Reinforcement �� • 3. Electrical"Conduit'Utility-Undrgrnd. �'. 54. Forms 4. Electrical Conduit-Undrgrnd. '� , . 55. Electrical Bonding ' ,i 5. Steel�Reinforcement; 56. Rough Plumbing & Pressure Test .� , �� 57. APPROVAL TO COVER-GUNITE ' � 6..Electrical:UFERGrnd. . � , 7: Footings� " �� . i;f ' �� 58. Electrical ConduirUndrgrnd. �. 8. Foundafion_ � ' .� ' � 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 71. Property^Sewer Line & House Connection i�� 62. Backwash & Receptor-Final 12. Sewer Cep �.�� '�� ; i , 63. Heater & Vent-Final -A / 13. Roof,Drains .• ,, . 64. Plumbing System - Final 14. Rougli,Plumbing� . � 65. Electrical-Final • 15. Rough Electrical-Conduii - 66. Solar System-Final i6. Rough Electric Wiri�g 67. Fencing & Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &-Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace . APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22: Ducts, Ventilating - 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24.� Roof Framing 73. Undergrnd. Storage Tank � 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 pomestic-Final .� 42. Backflow Preventer F� � 43. Backflow.lrrigation .. . . - 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 • AOV�icant to fill in all soaces exeept thosa witnin �eavy norticr Ilnes ana.sign an acorooriate aeeiarat�o�s. I ES4 � 0/�8/B�j �%o�� TL CITN OF COSTA MESA CONSTRUCTIO'—N PERMIT ,�R �� Project Address O��iCi �. ��-`�y C.': lJ Applicant�s Ma��l'ng yA�d^dress �� / �c e-_ Cf/�/ner i Name �+ " • `- � ••`- � ��.r5 Phnnx�ll�l �J � � Addreu Arch/En se No. Address Convactor's Nem 1 �., Phon�� Addresslmailingl_A.L '�`� ��\� �� A � City License No. ��i�� LICENSED CONTRACTOR DECLARATION I hercDy allirm that I am Iicen58U untltr provisions of Chart¢r 9(Commencing �with section 7000) of Division 3 of the Business antl Professions CoOe, antl my Ilcense is in tull torce ana e pe . 1 L�C¢!IT¢ CId55 � L�CY 10. � Dalc�C?-7� Si9na ura � WORKERS' COMPENSATION D6CLARATION I hereby al/irm that I have a certitiCata ot consent to selt-insure or a cartlflcdte -f Workers' Compensation Insurance, or a certifiea,cooY thareo( (Section 100, Lab� }y�,�p �� olicy No. �>s6>�bl=+._ Company Q Certifietl m0Y �s he�eby (umisrye . 1 ,�Ce;tl ie�opy�lea with the c ty Builtl� Di ' Date < « APplicant EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (TM1is setlion neetl not be complelptl if lhe perm(t is for one huntlretl (E300) or iess). 1 certify that in the performanca of the work for which this perm�l is iszuetl I shall nOl emplOy any pe�son in any manner so as to beCome subject to t�e Workers' Compensailon Laws o/ Calitomla. Dale Si9nalUro 'NOTICE: 11, atter making this tletlaratlon, you shoula become subject lo the Worker5' Compensation provlsiohs o/ the Ldbo� Coae, you mu5t �Orthwith comply with such O�oviiions Or tnis pe�mil snalt bG tl¢¢metl revok¢tl. CONSTRUCTION LENDING AGENCV ' I hereby df/lrm lha[ there i5 a conS[�uctlon lentlin9 agency for Ihe'per(OrmanGe ot tne work for which this permit is Iisuetl (Sectlon 3097 Civ. C.) Lentler's Name Lantler's Atlarcis OWNER BUILDER OECLARHTIpN I hareby a/fl�m that I am ¢xemp( }�om the Conl�actor'S LlcenSe Law fo� the lollowin9 roason (Seclion 7031.$ Buslneis antl Professional Cotle: Any <Ity or county whlth require5 a pe�mit lo Const�ucl, altGr, Improve, tlCmolish Or �epair any St�uClure, Otlor t0 I[5 issudnCe, atso roqW/es thG applicant for sucn permit to f0e a 5ignotl slatement that ne/sha is Iicensatl pursuant to lhe ProvlSions o! the Contractor'S License Luw (C4apter 9(commentlng wit� Section 7000) ot Dlvision 3 01 [he Busin¢Ss antl PrOtCSsionS COde) or that ho/sho is exempt therofrom antl tne basis tor the allegatl exemption. Any violation ol Sattion 731.5 by any applicant tor a permit su��ects tne applicant to a clvil �,ndlty of nol more than fiv¢ huntlretl D011ars (E500j.. � I, as owner of tha proPartY or my amployaes with wdges ds Ihei� sole compensatlon, wlll tlo Ihe work, antl the structura iz not Intentlntl or olferetl lor salo (Seclion ]044, Bu5ino55 antl Profe55ional Cotle: Tho Conlraclo�'S Utense Law tloes not apply to an owner ol a Droper[y wno GUIIEs o� imprpves lherean, dntl wna tloes such wO�k himself/hCrSClf or through his or ho� Own employ ees, provltle� ihal Sucn Ihiprovements are not Intentlea or olte�atl IOr 5818. If, howave�, tne bulltling or ImprOVOment IS SOItl within one year ot com- pletlon, the owner will �ave t�e burtlon of proving he/s�e tlitl not builtl or Im- �/Ove tor Iha purpose o/ Sale). U I, as owner ot the property, am extlusively contracting witn II<ensoa ton- traclor5 to con5truct [he pfojeGt (5¢CtIOn 7044, Bu5ine55 an0 PIot855iOns COtle: Tha Contractot's license Law a30e5 not dpply to an owner ol proporty wh0 builtl5 0� Improves Ihe�eon, anq wh0 cont�acti tor Such projecl5 wi[h a Con- tractor(sl Ilcense pursuant to the Contractor's Licanse Law). I am aware that oroof of lbelr Worker'S Compa�gallon Insurance shoultl be provitletl l0 me. ❑ I am exempt untler Section B. 6 P. 0.�or this reason Dale Owner _ 1 hereby certi(y that 1 nave re8tl this Information Is correct. I aqree tq compl and stale laws relatin9 to builtling cons Sentdfives/erSTb�city ta e�e��upon 519na[ur8 („y�xfq Drivers' License or 55 q/ CMF 0865-46, rev. ]0/84 oate�d��Q7 -_ a o yg� �r, �.� �,, � R -_. TYPE OFCONSTRUCTION EW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USEAF BLDG �S ��-�p�v(1�—S A P# !` �'a..� GJ S Mein-BeiMi E TYPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear G ❑ OTHER p' PROJECT DESCRIPTION S�.FT. � oCCVaarv C Right � K Left CONSTRVCTIONTVPE VALUATION$ g O ZONE GRADING CU. VDS. ACRES p�ng. Ref. # Remarks: , � Planning Notes: Sink Prevenrer Irrigation rinking Fountains loor Drains loor Sinks 35 $CfVICC �ULIEtS Kitchen Sink � Lavatories � P—Trap ' Roof Drains Reinspection Fea Boiler Duct - Under Ground Duct � Structurel $15 Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 sTu O i oa,000 Reinspection Fee I $15 Whit¢ - BuilEing; [anary - AppliWnt; Pink - Accounting; Goltlen�otl - AssaS50r P ShoWeri Service Sink Sewer Cap Sewer Connection Salar Collectors Solar Piping Solar Tank Swimming Pool wlSpa Urinal Water Closet Water Heater Water Service Auto�Wesh laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System Oaioo,000eTu ❑ioo,000 Syztem Repair/Alteration Fire Dampen Registers Issue Fee FEES $ 3 $ 3 II Purking Req.IProvided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction PoleSub. ❑ 50+KW Cooking Unit Merer ❑up [0 100 amps Dishwasher Meter pover 100amps Dryers ❑Gas ❑Electric Sub Panel Fa� Motors�0.1 HP�1M-B F.A.U. Inc.Solar �9-15 HP �16-15+ Fixtures Microwave . Device Boxes Pole Light Outlets Switches Garhage Disposal Generator �a5 KW �5-15 KW Zone 2 O N 1 N G R E Q M T S Reinspection Fee � $15 DEVELOPMENTSER Zoning APProved BY_ BuildinB APProved Bv Sign ; Standing Section5 Trash Compactar luue Fee S MA�V OF FEES BUI�DING PERMIT $ � SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ FEES $ 3 $ ,50 _ CONSTRUCTION ANDPLANNING POOL `A - � APPROVALS Permit #�- Date Inspector qppROVALS Permit # Date Inspector •1. T�mporary.Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ��., . 53. Steel Reinforcement ' 3,'�ElecfrScal Coriduit Ufilitti-Undrgrnd: !�% 54. Forms �- j ��. 4'.�-Elect��cal Cqnduit. Undrt�rnd. 1 ' (i: 55. Electrical Bonding ; 5� S[eel-Aeinforcem�nt �'�,a � { ��i ..�` 56. Rough Plumbing & Preswre Test � � • �" 6..,.Etectr�cal UFERCGrnd.�� /� ' 57. APPROVAL TO COVER-GUNITE • ]�., Footings . ...�_: ) �• � / � P 3 58. Electrical Conduit-Undrgrnd. . ;��_,�, , S:.Fourielatiorn ''` ; �� . 59. Gas Pipe, O Undrgrnd., Test �� 9: .Waier.�Pipe'Lndrg�n'd, i, 4` 60. Backwash Lines, P�Trap, � Undrgmd. J� 10.�,Str'uci�ural Floor SY,stem . • � 61. APPROVAL TO DECK 1�1, Pr4perty Sewer Line.`& House Connection '; ' 62. Backwash & Receptor-Final i• 12..,SewevCap "•��; 'w. � 63. Heater&Vent-Final � � � � 13. Roof'Drains � M` � � . 64. Plumbing System � Final 14.'Rough Plumbing ; - 65. Elecvical-Final � - � 15. Rougfi Electrical-Conduit 66. Solar SYstem-Final . 16.,Rough Electric Wiring 67. Fencing & Access Approval i �� 17. ,Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Fough Electriral-TBar Ceiling 69. POOL/SPA�SYSTEMS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Struc[ure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Ges Pipe-Rough & Test 72. Underground Flush 24. Roof Frafning �' 73. Undergrnd.StoregeTank OGas ❑Oil 25. Roof ShPathing � 74. Overhead Hydro 26. T-Baf Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame'and Flashing 76. Dry Standpipe 28. Lathirig & Siding 77. FIXED SYSTEM FINAL 29.� Insulation 78. FIRE PREV. FINAL 30. Drywa�ll Nailing �. HEALTH DEPT. REQUIREMENT 31. Plaster�8rown Coat 79. FINAL INSPECTION � Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED �3 �� 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 pomestio-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. Electrie Release to Edison _ . � 50. Gas Release�to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. - Date ApD��ant to fill in all s0aces exeeD� lnose wil�in hedvY Dortler Ilnes anA sign all approo��ate aeelarotlons. � GTY.OF COSTA MESA CONSTRUCTION PERMIT PER T NO. TRACT NO. OT O. UNIT NO. !� /�� .� � /� � n �a i i-��,u�� m-�-oT R �-- IJ . Project Address �S � � 1. � �\e�-�1 `.lr . Applicant's Mailing Ard�d�r1ess �"��p "(�� Owner's Name � " ! -� }]�A ��er5 Phon�i�.L� Addreu �� Arch/Eng. �-�� fT.3A_1,�I�dNo. Address T Contractor's Name�.Y�t�� S _ PhonOS�i��73 Addresslmailingl 1S� � ' ✓NG � City License No. ��3 1 LICENSED CONTRACTQR DEC�ARNTION �� I her¢by a11I�m that I am Iicense0 untle� p�ovision5 of Cha�tC� 9(commencing !\ wiiM1 Sectlon 7000) ot Di��sion 3 01 the Bu5ine55 antl PIOiC5510f15 CO�C� dfld �xJ my Ilcense is in full or qtl e� . ///�� (��%� � LlcanS¢ Class � Li�o.�_y��s_ � Date�L'�i-7� Siy t � — ,r�� WORKERS' COMPENSHTION DECLARATION � I hereby aifirm that I have a certificale oi consent lo self-ns�re or a certifica[e � of Worker5' Gompensation Inmrance, or a c¢rtlfi¢tl cOpy thereof (SeCtion 1 900, 1_ab. ��j�� Iicy No. —•3+— �'_� pan � ia Cer[iiletl copy is hereby furnish ertifletl p�y:�s,�.We tl W{{h the ity�Builtlin9 Ivlsi � ateTn ^��i-i+ APPlicant EXEMPTION FROM WORKERS' COMPENSATION DECL RATION (Thissection need not be completetl if the permit is tor one untlretl ($100) or less). . I certify that in the performance o( tM1e wo�k for which ihls pe�mk is i55uetl, I , shall not employ any person`In any manner so as to become subject to the Work¢rz' Compensatlon L.a�ys�of Calitornla. Date Signature 'NOTICE: Ii, a(ter making this tleclaration, you shoula become subject to the Worken' COmpensalion provi5ions ot the LabOr COtle, you must torthwith comply witM1 such prov{sions o� thi5 permit snall be Ceemetl revoked. CONSTRUCTION LENOING AGENCV ' 1 bereby atfl�m Nat [here {s a construttion lentling a9ency for the perto�mance ot [he work for whicry this permit is issuetl (Sec[ion 3097 Civ. C.) lRntler's Name � LenOer's Ftltlress � OWNER BUILOEN DECLARATION ' ' I hareby aifirm that 1 am exempt from the ContrattoYs License Law for tne following reason.(Section ]031.5 Businoss and Professional Cotle: Any city or muntv which requi�es a bermlt to Const�uct, alt¢r, Improve, tlemoli5h or tepai� d5 se ue, prior to itE issuance, also requlres [he applicant tor such permit 3natl Statement that he/she is licensetl pursuant to the provisions of ctor'S License 1 aw (Chapter 9(commencing with Section �000) of ol the BusinQss antl Professlons COtl¢) o� that he/5M1e is exempt antl [he basis for the alleqetl exemption. Any violation of Section any applicaqt tOr a permit subjects the applicant to a civil not more than five nuntlretl tlollars (E500). wner of the property or my employeos with wa9es as their sole ion, will tlo thp �york, antl the structure is not intentletl or oiteretl iection 7044, Business antl Proteiiional Cotle: The Cont�acto�'S w tloes not apply [o an owner ot a properry wtto builtls or improves ntl who tloes Yuch wo�k himself/h¢r5¢If o� throUg h his or her own , provbetl tbal such Improvemenl5 are not in[entla0 or oftere0 fo�, �wevGq the builtling or improvement I55oltl wi[hin one yea� of com- ¢ Owner will have the burtlen ot proving he/s�e tlitl not builtl or im- he purpOse of :ale). ' vne� ot [he prOperty, am exUusively contractin9 with IicenS¢tl con- con5truct lhe ptojec[ (Section 7044, BuSin¢55 anC P�ofezsions Cotl¢: actor's License Law tloes not apply to an owner ot property who bullas or improves thereon, antl who contracts tor zuch projectz with a con- iractor(sllicense pursuant to Ihe Contractor'S Litanse Law). I am aware that proot of Ihel� Worker'S COTPensation insu�ance shoultl be O�ovitletl t0 me. ❑ I am exempt untler Se�tlon . B. & P. C. for this reason Date Owner _ 1 hereby certlly that I have reatl tliis a informatlon Is correct. I agree to <omplY t TVPE OF CONSTRUCTION }L�NEW IJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTH� q p# Z(' DESCRIPTIONOFWORK/USE,F�BLDG�' c.� �'rF�—�rtQ�fQZ �- •t�_� S Main Building: TYPEOFPEFiMiT GRA�ING OVNDATION STRVCTURAI. T Front ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reaf ❑ �OTHER C Right PROJECT DESCRIPTION $Q. FT.._,�� • L. . L�G _ pCCUPANCGYn K. CONS7RUCTIONTVPE VALUATION$ •'[/� S L¢ft ZONE GRADING CU.Y�S. ACRES Ping. Ref. # Remarks: Planning Notes: 3ar Sink 3ackflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink ' Lavatories P–Trap Roof Orains Reinspection fee $15 Boiler Duct- Under Ground Duct-Strucmral ' Duct � Ventilating Exhaus[ System ❑ Multiple � Firepl/Fact. Blt. ICBO # Heating System & Ducting � 0.100,000 BTU O 7 00,000 BT �inspec on purpos . . \ Signat re Date�b^(—� Drivers' License or 55 � Reinspection Fee CMF 0865-46, rev. 30/84 White - Builtling: Canary - Appliwnt: 7ink - Accounling: Golaenrotl . qssessor $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank � Swimming Pool w/Spa Urinal water Closet Water Heater Water $ervice Auto�Wash Laundry Trays laue Fee Hoad or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑aioo.000sru ❑�oo,aoo System Repair/Alteration Fire Dampers Registers laue Fee 1699 10/OB/85 Accesso�y Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction PoleSub. � 50+KW Cooking Unit Dishwasher Dryers �Gas ❑Electric Fan F.A.U. Fixtures . Device Bazes Outlets Switches Garbage Disposal Generator DO-5 KW �5�15 KW $ 3 Reinspection Fee FEES DEVELOPMENTSERVI Zoning Approved By_ Building Approved By APPliptiOn IssUed BV_ $ 3 $15 Meter LJup to 700 amps Meter ❑over100amps Sub Panel Motors �0.1 HP 01 h- 8 Inc.Solar �9-15 HP �16-75+ Microwave Pole Light Range Si9n ; $tanding $¢ctions Trash Compactor laue Fee 17QOC TL FEES $ 3 O N 1 N G R E � M T $ SUMMARV OF FEES ST BUILDING PEFMIT $_-� ,Y . 2 V SMIP $ (� PLAN CHECK $ PERMIT . PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK � 50% $ MICROFI LM $. l` MECHANICAL $ TOTAL FEE $ _L�Q4L_ PLAN CHECK 25% $ CONSTRUCTION ANDPLANNING POOLt 4 � ., APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector '1. Temporary Electrical Service or Pole 52. Pool & Equipment Location %' . 2. Soil Pipe-Undrgrnd. ? %i 53. Steel Reinforcement � F 3. �Electrical Conduit.Utility-Undrgii�dr ''"� ' 54. Forms ' � 4l`Electrical Conduit,Und��rnd. ,�� 55. Electrical Bonding � 5'. $teel-Reinforcement '.: . �.; ,7� - �S 56. Rough Plumbing & Pressure Test . 6"Electrical UFER�G n'd:' : ' ' 57. APPROVAL TO COVER�GUNITE ;�-�� r. �. -7.,_�Footirigs ,� _ •:� `\ , �� D � 58. Electrical Conduit-Undrgrnd. ��,- 8.'Foundation� �, ��'� 59. Gas Pipe, O Undrgrnd., Test ��':h� ' 'r. -9;;�Nate� Pipe-Undrgrnck � I' � 60. Backwash Lines, P-Trap, O Undrgrnd. '+ � �: i -10 �'Structural F9oor System , ,- , . 61. APPROVAL TO DECK 11:'Property Sewer Line & House Cohnection ' _ 62. Backwash & ReceptorFinal � 12("Se�veF;Cap . ' ;;i r ; 63. Heater & Vent-Final ' �� b3. Roofbrains "'i 1��'� �' 64. PlumbingSystem-Final � � 14.-Rou �h Plumbin � " . , � 9� 9.•: 65. Electrical-Final �.,, 15. Rough ElectricaLEonduit , 66. Solar System-Final i6. Rough Electric Wiring � 67. Fencing & Access Approval 17. Fough Wiring Sign 68. APPROVED FOR PLASTERING � 18.7Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19.,'Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � � 20.. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure ' 70. Underground Hydro � . 22. Ducts, Ventilating ; 71. Product Piping O Gas ❑ Oil ,.'23. Gas Pipe'=Rough & Test 72. Underground Flush ._24. Roof Framing .. - 73. Undergrnd.StorageTank OGas ❑Oil " 25. Roof Sheething ` ' 74. Overhead Hydro 26. T-Bai-Ceiling (Struetural) & Monocoat , 75. Dry Chemical � 27. Frame;�and Flashing i 76. Dry Standpipe �� 26. Lathing & Siding . . 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. DiywaYl Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION �32. EIecU°jcal Power Meter-Final 80. FOOD CERTIFICATE ISSUED , . Final Electric � Notes: 34. Final�Heating & Air Conditioning ' - ' ' 35. Final Gas Pipe-Test • � 36. Hood or Canopy ' 37. Final Factory fireplace ' 38. Final Plumbing - 39. Water Service-Final 40. Gas Service-Final ' � 41. Solar pomestic-Final � 42. Backflow Preventer � � ' 43. Backflow irrigation , �. - , 44. tandscape Irrigation System 45. Sound Attenuation 46. Hsndicap Regulations. � , � 47. FINAL STRUCTU�RE & BUI�LDING ��`� � S 48. Special Requirements Completed ' , 49. Electric Release to Edison - � 50. Gas Release to Southern California Gas Co • � � 51. CERTIFICATE OF OCCUPANCY � No. ✓ Date - Aoo�ieant to /ill in all soaees axcepl tnose witnln haavy Eortlar Ilnes ane.sign a1l aoV�ovriate eeclarotions. CITV'OF coSTA MESA CONSTRUCTION PERMIT �� . Proiect7Wifress �� ^ h \�Pu /�if Applican['s Ma'rlirg Atldress � i Owner's Name _Phone � Address � � ,Arch/�ng� � L---�'C"E'd ��!'�nse No. Address Contra�tor'sNam �� P/�hon�eS�F�i3C Addre� Ima'I'nnl � 1y. '� QY��4 F-\lJ� ^ Ciry License No. 3CaS3� 'J LICENSED CONTRACTOR DECLARATION Q I he�eby atfl�m Ihat I am IicenS¢tl u0tle� Orovi5ion5 ot Cha/te� 9(commentlng wit� section ]000� of Oivision 3 0( the Businesi antl PrOfessions CotlC, antl � my li<Bnse is in full force�ntl _ / ` JLicense Class �— o. �� Date1�=2� S� 59 t ,� - � WORKERS' GOMPENSNTION DECLARATION � I h¢reqy aifirm [hal I have a ce�HfiCatO ot con5ent to selt-inwre o� a CertHicate ot Workers' Compensation Insuranco, or a certifietl copy thereof (Saction � �,00� Lab. �C ' . r�v no. 5("iSRS_3 om v I.� Cer[{{{etl copY �s hereby fumi etl, � i�Ce��ifietl�9 py �.�+� with th tlty Builtlin Divisi6 Oate (�-�+' ��` Applicant E%EMPTION FROM WpRKERS' COMPENSATION DEC ARATION (This sec[ion neetl nat be comple[etl if the permit is for one untlretl (E100) or less). I certify that in the pertormance of the work fo� which this pe�m�[ Is i55uetl I s0all qot emPloy any person in any manner so as to become subjec[ to t{�e workers' Compensation Laws ot Californla. Date Signature 'NOTICE: If, after making this tleclaration; you should become subject lo the Wo�kers' CompensatiOn provisions Of Ih¢ Labo� Code, y0u must forthwitn comply with such provisions or this permlt shall be tleem¢tl revoketl. CONSTRUCTION LEfJDING AGENCV � I here4y aflirm that there is a construction lentling'agency for the Performance ot the work for which [his permit is Issuetl (Section 309] Civ. CJ Lentler's Name Lender's Aatlress � OWNpq BUILDER OECLARATION I her@by atfirm that I am exemp[ from Ihe Contracto�'s Lic¢nse Law to� th¢ following reason (Settion 7031.5 Business antl Protessional Cotle: Any dty or county �yhich �equires a p¢rmit to Const�utl, alte�, improve, tlemOliib or repai� any structu�e, p�io� to its issuanGe, a150 reqWtes the ap0�icant to� such pe�mit to fii@ a signetl stalement that he/she is Ilcenzetl pursuant to the provisions�of tne Contrac[or's License Law (Chapter 9(commentlng witn Section ]000) ot Division 3 of the Business antl Professions Cotle) or that he/she is exempt [neref�om ana [he basi5 for the allagetl exemp[ion, qny violaHon of Section "131,5 by any�applicanl for a,permit Subjects the applicant to a clvil nalty of not more Nan five huntlretl tlollars ($500). � I, as owne� ot fhe property o� my employee5 witb wag05 a5 thob SoIE compensation, will tlo Ihe work, antl tbe structure is noi Int¢ntletl o� otteretl lor sale (Section 7044, Business antl Professional Cotle: The Contractor's Lirense Law tloes not appry to an owner ot a property who builGs or improves Ihereon, antl who tloes such work hlmselt/herself or through his or her own emplryy¢¢5, provitletl that such ImprovemCnts are not Intentletl or offereC for sdle. �(, however, tne bulltling or improvement is soltl within one year of com- pletlOn, th¢ owner will have the burUen Ot proving he/she tli� not builtl o� Im- �rovq to� the Ourpose ot sale). I, ds owne� of thE property, am exclu5iveiy toptracting with OcenS¢d <00- trattors to construct the project ISection 7044, Business antl Professions Coae: Tbe ConVactor's license Law does not apply to dn owner Ot p�operty who builtls or improves thereon, antl who contra<ts tor such projects with a con- traccOr(s Ilcenze pursuant [o tM1e Contractor's License Law). I am aware tha[ prOOf o� Iheit Worker's Com0an5atlon Insurance shoultl be proVitl¢tl to me. ❑ I am exemo� unCer Sectlon � B. & P. C. fo� this reason Date Owner 1 hereby ttrtify tnat I have reatl ihis appiication antl state thai the above information is correcL I a9ree lo wmply witn all city antl county orainances antl sta[e la ting la builtling tonstructlon, antl hereby authoNze repre- sentative5 [nis ty to e r Epon [ above-mentioneG Property for InsOectio OurOozes. � �� Signapure Date Drivers' License or 55 A I "�.- TVPE OF CONSTRUCTION XSLNEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIONOF WORKNSE�`QLDG.�� ~ '^'� "�`V �rP � •K.l TVPEOFPEqM1T GaAoiNG OUrvDAnoN STauC7URA� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sa.FT. ocCUPANGv CONSTRUCTIONTVPE VALUATION$ � ZONE GRADINGCU.VOS. ACRES Remarks: � Sink Preventer Irrigation Clarifiers Drinking Fountains Floor Drains Floor Sinks GasService Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains - 'ReinspeMion Fea $15 Boiler Dut[- Under Ground DuCt - S[fuCNfBI Duct - Ventilating Ezhaust System ❑ Multiple FirepVFact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 eru O i oo,00a ReinspeMion Fee � $15 CMF 0865-46, rev. 10/84 White - BUIl01ng; Cana�y - AOGlicant; P��k - Accountin9; Goltlen�otl - Assesso� Showers .ServiceSink . Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinat Water Closet Water Heater Water Service Auto�Wesh Issue Fee Hoodor Typel ❑ Canopy Type II ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers fiegisters Issue Fee FEES A.P. # S �: TFrontLj-S� B Rear � a C Right K Left s Ping. Ref. # Planning Notes: � 1698 I�/08/85 ��e2� �(� Zone 'ip1,c�.�- C Oo^�p L Accessary Building: � � �� h Parking Rea./Provided . Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Oryers �Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �PS KW C ELECTRICAL Transformer ❑ 75�50 KW ❑ 50+:KW Meter �up to 100 amps Meter �over 100 amp5 Sub Panel Motors O0.1 HP O1 �- 8 Inc.Solar �g-15 HP �16-15+ Microwave Pole Light Range ; Standing Sections Trash Compactor $ 3 Reinapection Fee $75 luue Fee FEES DEVELOPMENTSERVICE REQ�IR lyl NTS: Zoning Approved By �� Buildin9 APProved BY I`^ APP�iCd[ian IAUBd BV $ 3 IioO� TL Z O N I N G R E Q M T S FEES $ 3 �X� SUMMA OF FEES BUILDING PERMIT $ � � SMIP $ • S� PIAN CHECK $ PERMIT PIUMBING $ ISSUANCE $ PIAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PIqNCHECK 50% $ MICROFILM $ �/7 MECHANICAL $ . TOTAL FEE $ � PIAN CHECK 25% $ -. CONSTRUCTION AND PLANNING POOL F 4 :. APPROVALS Permit# Jate Inspector AppROVALS Permit# Date Inspector f' 1.� emporary,Electrical Service or Pole 52: Pool & Equipment Location . ,�2. Soil Pipe-Undrgrnd. :�,- 53. Steel Reinforcement � 3: ,ElectP�cal Cbnduicl�t�ili;y-Undrgrnd� .i 54. Forms �: �4: Electrical Gonduit;UndFyrnd. •� �t� 55. Electrical Bonding '� �_5. St@el',Reinforcemeni� .�1 � )�z; �� S 56. Rough Plumbing & Pressure Test ,'� � '; ,, . 6.'Electrical U�,FER�'Grnd:�% '� ' 57. APPROVAL TO COVER-GUNITE �'!� i - r , �- 7'rFootijigs . �_� `�1 . � �L/ � cs 58. Electrical Conduit-Undrgrnd. !'r�f . 8..•Foundatiop;, 59. Gas Pipe, O Undrgrnd., Test t.1' �'' '9.'W�LeG�Pipe-Undrgrnd. �,t . � . 60. Backwash Lines, P-Trap, O Undrgmd. � 10.��Stiuctural Floor System !�''� ' � � 61. APPROVALTO DECK � � 11 i:�Property Sewer Linet& House COnnection ;� ' 62. Backwash & Receptor-Final 12!'Sewec��'Cap ' `�� `�Y`i �'� 63. Heater & VenDFinal '�' � 73. Roof�Drains �-� . 64. Plumbing System - Final ' 14. Rough Plumbing�.� '" � 65. Electrical-Final ,�) 15. �Rough Electrical-Conduit 66. Solar System-Final _ _ 16: Rough Ele�tric Wiring 67. Fencing & Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING . 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # ' 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil 23.'Gas Pipe-Rough &;Test , 72. Underground Flush _ 24. Roof Frarr�ing •' ' 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. �Roof Slieathing - 74. Overhead Hydro � 26. T-Bar"Ceiling (Strucwrap & Monocoat 75. Dry Chemical 27. Frame arid Flashing 76. Dry Standpipe '� 28. Lathi�pg & Siding 77. FIXED SYSTEM FINAL 29. Insulajion . 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT , 31. Plaster.Brown Coat 79. FINAL INSPECTION . Elect�cal Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Finaf Electric Notes: - - " 34. Final Heating & Air Conditioning � � 35. Final Gas Pipe-Test - � 36. Hood o�'Canopy 37. Final�Factory�Fireplace . 38. Final Plumbing � � 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer . � � � - � 43. Backflow Irrigation � � ' 44. Landscape Irrigation System � 45. Sountl 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 ' CiTv OF CosTa M1cES�A^ CONSTRUCTION PERMIT Project Address �..7.�.� � •ShP�� r �Applicant's Mail' g Add e � '^^C�-cA��e��c Owner'sName ��Y �—�= - ��, r� Phon-=��-� Address �' '�(�/� Arch/Eng, � '_-.c�--Q� 5,��`'�dM�c�pse No. .J �� Address Contractor's Name�1�R1��^ �]fLC Phon� '��! � Atltlress Imailing) �� -�� J� Cily License No. 3��3� LICENSEO CONTRACTOP DECIARATION 1 h¢r¢Dy alti�m that I�am IlcenSetl un0er provisiOns o/ Cha�l¢r 9(Commencing with settion 7000) of Division 3 ot lne eusiness antl Professlons Coae, anC "my Ilcense is in tull force a t LicenSa Class LI e [Vo. Date�� Sl9n ture W00.KER5' COMPENSATION DECLAFATION �ereby a(firm that I have a certiticate oi consent to salbinsura or a certificate Workers' CompensatiOn Insu�ance, or a certlfied copy tnereOf (Section oB00, Lab� Policy No. __ Comp � »��=�_ ❑ Certifietl copy is hereby t imishea. � � �Certltietl�$ p d wi[ tne Uty Builtlin Divis Date �� 'U � — Appliwnt EXEMPTION FROM WORKERS' COMPENSATION DEC{ ARATION (Thissection neeU not be tomplatetl it the permit is for onElM1untlr¢tl (5100) or less). I CCrli�y t�at In the pertormance ol [he wOrk fOr whlcb t�ls Oe�m�t i5 is5ue0 I shall not employ any pms04, in any manne� so as to becOme subject to t�e Worker5' Compensa[ion Laws ot Calitornia. Date Signature `NOTICE: Ii, atter making this tl¢Uaratlon, you shoultl Uecome subject to the Workers' Compensation proyi5iOn5 01 the LabOr COtl¢, You mu5t fOrthwith comply with sucn pravizi4ns or thiz permlt shall be tlaemetl revoketl. CONSTRUCTION LENDING AGENCV 1 M1a�eby at/1�m that lh¢ro is d conSVUCtiOn lentling ag¢nty tor [ha pertormanca of Iho work tor whicn tbii permit is isiuetl (SecUon 309] Civ. C.) Lenaer's Name Lentler'S HtlOress OWNERBUILDEN OECLARATION � I nereby a/firm that I am oxampt lrom tM1e Contractor's �Icensa L.aw for the lollowing reason (Sectlon 7031.5 Buslness antl Protesslonal Cotle: Any city or counry which requiras a permlt to construct, alter, improve, tlomolish or repalr any sVucture, prior to Its Issuanca, also reqWres the aoCllcant tor such permil - to Ii10 a slgnetl statemen[ t�at hC/slle IS IltenS¢tl puriudn� lo lhG provi5ion5 of tna ConVactor's License Law (Chapter 9(commen<in9 wllh 5ectlon �000) of llNsion 3 of tbe Business an� Profe55ions Cotle) or tna[ no/she is exem0t �cretrom anC the basis for tlte allegetl exemptlon. AnY ��olatlon of $ection /031.5 Dy any appliGant /or d permit SuOjects th0 applicanl lo d civil �¢nalty ol not more Ihan five huntlretl tlollars (5500). I, O5 owne� ot the proparly or Ty emplOyGes wlth wagas ds tnei� SolO compensation, w(II tlo tne work, and tha structure is not Intnntle0 or oHeraC br salo (Section ]04a, B�slness antl Pro/essional Cotle: The Contractor's LlcenSC ldw tloes not dpPly (O an Ownet of a prOpetty who bulltl5 Or Improve5 thar¢on, antl who tloes SUCh work �ImS¢It/hersolf or IhrOugh hiz o� her own empioYees, proWUetl that sUch fmprovements ara not intentletl or otieretl for salo. H, howoveq th¢ building or improvement is soltl within Ona year of Com- plotlon, the owncr wlll havp tno burtlen of proving he/she a1E not bulltl or Im- prOva lo� tha pu�po5a oi Salp), ❑ 1, as owner of the property, am ezclusively contractin9 wilh Iicensetl con- [rattors to consVuct tha project (Sectlon ]044, Buziness antl 7rotessionz Cotle: The COnlra<tor's License law doas not apply to an owner ol property who builas or Improves thereon, antl who contracts for such projocts with a con- t�actor�5) Ilcense�pursuant to lM1e Con[�actor'S Licania l�w�. l dm dware that proof of their Worker's COmOensaHon tnsurance snoum be proW�etl to ma. L7 I am exempt untler Sectlan B. 6 P. Q to� Ihis rea50n ACD��ant to flll in all spaces except tnose wit�in �eavy OorCer Iinai anE sign all apvro0rlate Geelarations. `\ T PERN]�T NO� �� T� CT NO. .,1�.�T NO � UNIT NO. J �S �� u. Y �,Jt — Da[e Owner 1 hereby certiry that 1 have reao this avP��ation Iniormatlon Is wrrect. 1 agree lo compiy with al1 � antl slate elatin9 to Ouiltling consVucUon, ai sentativ ot th city to�enter upon jl�e aDovi � I SlgnatuTe ✓�y_ � Drivers' License or 55 � eoy avmorae �ep�e- lonetl property tor Oate � —S TYPE OF CONSTRUCTION I�fJEW LJ ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHE DESCRIPTION OF WORK/USE OF BLOG. U �' 1'T��r—_ TYPEOFPERMIT GRADING FOVNDATION ' STRUCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER '' ' C PROJECT DESCRIPTION SQ. FT.� ESI., OCCVaAraCv CONSTFUGTIONTVPE VALUATION$ �Y7G�_ ZONE GRADINGCV.VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtu6s Clarifiers Dishwasher Drinking Fountains Floor Orains Floor Sinks Gas Service Kitchen Sink Lavatories P-Trap Roof Drains PLUMBING $IIOWEfS - - Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Outlets Water Closet Water Heater Water Service Auto-Wash Laundry Trays FEES Reinspection Fee I S15 I I lauo Foo I $ 3 Boiler Duct� UnderGround Duct - Structural Duct � Ventilating Exhaust Sysiem ❑ Multiple ❑ Firepl/Fact Blc ICBO;k Heating System & Ducting O ai oo,000 aru O i oo,000 sr� Rainspection Fee � $15 CMF OB65-96, rev. 30/84 Whjt¢ - BUIltling; Cana�y - AOV��: Pink - Accounting; Goltlenrotl - Assesio� Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers laue Fee � 5 3 A.P. �I`- �'I'.Z S E 5 T F�o�c B Rear C A C Right , g tett � � Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit D ishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Garbage Disposal Generator �0-5 KW 1 Reinspection Fee — DEVELOPMENTSER Zoning APProvad BY _ Buildine APProwd By Appliration Issued By_ 1697 10/OB/B5 2one Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 700 amps Meter ❑over100amps Sub Panel . MotorsO0.1 HP O1Y,-8 Inc.Solar �9-15 HP �i6-15+ Microwave Pole Light Si9n ; Standing Sections 15 KW Trash Compactor $15 laue Fee IioOf! TL FEES $ 3 2 O N I N G R E Q M T S S MAR3( OF FEES /` BUILDINGPERMIT $ 'D�� SMIP $ `�V PLAN CHECK $ PERMIT PLUM8ING $ ISSUANCE § PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL § GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ �� PLAN CHECK 25% $ . CONSTRUCTION AND PIANNING POI .SPA " � � . APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location � � i •2. Soil Pipe-U�drgrnd. ;� ,ry 53. Steel Reinforcement ', � 3.:'ElectricalConduiCUFility-Undrgrntl� �� 54. Forms • 4.,Electrical Conc�ui(�Und grnd. • `�; 55. Electrical Bonding �. � 5: Steel'Reinforc�menj�,�`; � �� p S 56. Rough Plumbing & Pressure Test �,\ / . � :� _6 �El�ctricalU,FE,RGrndij . 57. APPROVALTOCOVER-GUNITE • _�'f 7! F,obti�gs ,: '' _1• ' � 58. Electrical Conduit-Undrgrnd. _� :)'• .B,TFdundation� i' ��a ,� 59. Gas Pipe, O Undrgmd., Test .�,�� 9^WateuPipe;UndrgP�ndi - ;) 60. Backwash Lines, P-Trap, O Undrgrnd. . ,10 `St�uctural Floor System •�` : 61. APPROVAL TO DECK r: . 11. PrQperty Sewer Lin2,& House Connection .%" 62. Backwash & Receptor•Final 12! Sewer'CaP ' � ; 'J�j -- t %E', t , i 63. Heater & Vent-Final �"s 13. Roof'brains � 64. Plumbing System - Final ,� t�i 14. Rough� Plumbing';. 65. Electrical-Final '�.�. 15. RoJgh Electrical-Conduit 66. Solar System-Final . 76. Rough Electric Wiring 67. Fencing & Access Approval . 17. �•Rough Wiring Sign , . 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling �69. POOUSPA SYSTEMS FINAL � �� 19^Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT- 20.•Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23.'Ges Pipe-Rough &��est 72. Underground Flush . 24. Roof Framing ' 73. Undergrnd. Storage Tank O Gas ❑ Oil 25..Roof Sheithing i 74. Overhead Hydro 26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frameti�arid Flashing, 76. Dry Standpipe . 28. Lathing��$� Siding � 77. FIXED SYSTEM FINAL 29. Insuletion 78. FIRE PREV. FINAL 30. Drywa(I Nailing . HEALTH DEPT. REQUIREMENT . 3J. Plaster Brown Coat 79. FINAL INSPECTION 32 Electucal Power Meter-Final 80. FOOD CERTIFICATE ISSUED . Final�Electric Notes: i 34.- Final Heating & Air Conditioning 35. Final Gas Pipe�Test � . 36. Hood or�Canopy _ � 37. Final Factory Fireplace . � 38. Final Plumbing " � - ' . 39. Water Service-Final ' 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation -� 44. �Landscape Irrigation System � • 45. Sound' Attenuation � ' . 46. Handicap Regulations � � , ' 47. FINALSTRUCTURE&BUILDtNG Zo � 46. Speciai Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOFOCCUPANCY , � No. • Date , Avo��ant to /III in all spaces vacept tnose witnin �eavy OorCer Iines antl sign a1l aooroprlate aeelantions. CITV OF COSTA MESA CONSTRUCTION PERMIT � i � PEFjq�11T NO. �g ACT NO. OT NO. UNI'i NU O l G. t— � �< � n q,P 7 `+Sr.,..Y..t�^sl P`�w l.c1t Fk r- C Prolecc Address —0 Applicant'sMaili�Addresz ' � Owner'sName� Phon S�"t�..�g Address � �� /� � Arch/Eng. �.�LZL•i� \��'�4tn NLCi1 :-5¢ No. � Address ��`��.�� Contractor's Nam�� y^»�,,.�,,� P/h�a,n�n�,,,={{dLZ��I Addresslmailing) ��V �_�Ssy� Ciry License No. ��3� LICENSED CONTRACTOR DECLARATIpN 1 he�eby afflrm Ihat 1 am Iic¢nsetl untllr provislon5 ot Charter 9(commenGinq with section 7000) ot Division 3 0l the Business antl Professlons Cotle, antl' my li<ense is in full force ntl affes(�` �License Class � � I.ices� � o. oatelA�%� c'��r . -' WOqKERS'COMPENSATION DECLAqATION hereby at(irm that I have a rerNficate of consent to selM1lnsure or a certitiWte Workers' Compensation Insurance, or a certlf{etl copy tbereof (Section 500, Lab�� _- y—� �--� Poli�y No. .,�_ ❑ Certi(ietl copy is hereby tumi5 tl. �Ce�tifi¢tli op letl with th ci[y Builtling ivisi0 Datp �(7 "i�3� APPlicanl E%EMPTION FROM WORKERS'COMPENSATION DECL RATION �Tn{s sectlon neetl not be complatetl it tne permit 1s for one undretl (5100� or less�, � I cer[i/y tltat i0 lhe perforRtanCO o1 lbe wOrk to� whiGh this pe�m�t ISlssuetl, I sndl� not em0�0Y any per50n in any mannet So a510 become Subject to the workers' Compensation Laws of California. DatC - $i9na[ure 'NO710E: If, alter making thls tleUaration, you shoultl becomo subject to the Workers' Compensation provlslDnS ol the Labor Cotle, y0u mu5t forthwith corriply with su<h p�ovisions o� Ihii pe�mit Shall be tleemetl revoke0, CONSTRUCTION LENDING AGENCV I neraby al(Irm Mat there is a constructton lentlin9 agency for tlte performance of the work tot whi<h tN5 pGrmlt i5 ISSuetl (SeGtlOn 3097 Civ. C.) Lentler's Name Lontler's Atltlress OWNER BUILDER DECLARATION I M1e�eby atfirR� that I am Ozompt �roT lhe Contractor'S LIce05¢ Ldw for [he lollowing reason (Seclion 7031.5 BuSiness antl Profes5ional Cotlo: AnY clty�or coUnty which r¢quires a parmlt to construtt, alteq Improvo, tlemolish or repair any sVuctwe, p�lor to It5 ISSuanCO, als0 rtqui�es Ihe appliGant for Suclt perml[ t0 tile a sign¢tl Stdlement that he/sne ii Iicens¢tl pursudn[ to th0 ProvlSions o( tha Contractor's UcenSe I:Ww (Chapter 9(commencing wi[n Se�tion 7000) ot piy�sion 3 of the Business antl Professions Code) or that hp/stta is oxemp[ iRwlrom antl the basis for the allogetl exemptlon. A�Y violallon ol SecHon �31.5 by aOy appllcanl 1or d Pertnit- subjec[s lhe appllCanl to a civil �enalty o( not morC [han Bw huntlretl t1011ars (5500). LJ �, as ownar ot [he praOertY or my employees w7th wa9e5 as thair sole coeppenzation, will tlo the work, antl the 5lrutlurB Is not intentletl or oHeretl f0/ sal¢ (Section ]094, Businasz antl Pro(esslonal COtl¢: Th0 Cont�aclo�'S LICanSe Law tloes nol apply to an owner oi a property who bulltlz or improves tn@rcon, antl who tloez such work nlmself/nersefl or lhrough hls or her own ¢rtlploy Ces, provltl¢tl lhat SUCh ImP�ovOmentS are not Intentlatl or otteretl 1or salp, II, howev¢r, tne bullQing o� ImprOvament ii So10 wllhin on0 Year of Com- 0�@Hon, No owner will have tne Dmtlan of proving he/sh¢ Citl no! bulltl w im� P�Ove tot lh¢ purpose oi Sale�. ❑ 1, as owner oi the oroperty, am excluzively contracting with Iicensea con- t�dclors t0 Co05truct Iha project (Section 7044, Bu5ino55 and ProiBSslons Cotle: Tho Contractor's License law tloes not apPry to an owner of property who bulltls or improves thereon, antl wno conVacts for such proiectz witn a con- [rdctor(5 Ilcensa pursuani�to tne Contractor's Llcense Law). I am aware [hat ��ool o� tbeir Worker's Compensat(on Insuran<e shoultl be provftletl to me. ❑ I am oxempt unUei Settion B. & P. C. lor this reason Da�e Owner ] state antl co bf this ly t0 ent upOn lh Dove-menlionetl P/oper[y tOr pu�0o5e5. � �Y Da[e /O^J-BtS� Drivers' License or 55— —$ ��+� �� TYPE OF CONSTRUCTION RS?IEW I.J ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHE� �C J � A P�, � DESCRIPTION OF WORK/U$E OFC�� ••,{ S Main Building: TYPEOFPERMIT GRAD FOVNDATION STRVCTVRAL T Fron[. O TENAN7 ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Roar � ❑ �OTHER ' p` PROJECT DESCRIPTION 5q. F7. OCCUPANCV C Righc � K COfYSTRUCTIONTVPE VALUATIONS �� g Lefi � ZONE GRAOINGCU.VDS. ACRES PIng.Rei.# Remarks: , �� Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Orinking Fountains Floor Drains Floor Sinks Ci35$CfVIC2 �UIICLS Citchen Sink Levatories P—Trap Roof Drains Rainspection Fee $15 Boiler Duct - Under Ground Duct - Strucwrel Duct - Ventilating ExbaustSystem ❑ MWtiple Firepl/Fact.8lt. ICBO � Hea[ing System & Oucting ❑ ai oo,000 sTu O i oo,000 Rainspection Fee � S15 CMF 0865-46, rev. 30/84 White - Builtling; Canary • AOGllwnt; Pink - Accounting: Goltlenrotl - ASsessor Service Sink Sewer Cap Sewer Connection Soiar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal VV8L2f CIOSEL Water Heater Water Service Auto-Wash Laundry Trays Isua Fea Hood or Typel ❑ Canopy Typell ❑ Re(rigeration System � ❑aioo,aoosTu ❑�oo,000 System RepaidAlteration Fire Dampers Regizters Issue Fae FEES 1695 10/OB/85 �^��,—'��7��}� 1 Zone ��y�, pF. �•+"`[, Accessory Building: Automatic Washer Construction Pole Sub. Caoking Uni[ Dishwasher Dryers �Gas ❑Eleciric Fan F.A,U, Fixtures Device Boxes Outlets Switches Garhage Disposal Generator 00�5 KW �5-15 S 3 I �. Reinspection Feo $15 FEES - DEVELOPMENTSERVICE$�IEQ� Zoning APProved BY 1� Building APProvad By Appliotion laued Bv $ 3 ELECTRICAL 7ransformer ❑ 15-50 KW ❑ 50+KW Meter Uup to 100 amps Meter �over 100amps Sub Panel • Motors �0�1 HP � 1 h- 8 Inc. Solar 09�15 HP �76�75+ Microwave Pole Light Range S[anding Settions Trash Compactor Issue Fea 17o0C TL FEES E3 Z O N I N G R E Q M T S SUMM A,g�/�n- F FEES %� BUIIDING PERMIT $ � SMIP $ • Sv PLAN CHECK $ ' PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL g GRADING $ PLAN CHECK 50% $ MICROFILM $ —�—//��/�— MECHANICAL $ TOTAL FEE $ � PLAN CHECK 25% $ - CONSTRUCTION qND PLANNING P�O SPA � : APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector "1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �� 2.�Soil.Pipe�Undrgrnd. ._�. ' 53. Steel Reinforcement � 3...Elect'lical Cvndtii�;Utilit�-Undrgmil� �'� 54. Forms �� 4;:Electrical Conduit�Wndrgrnd. , „•; 55. Electrical Bonding � 5.��Steel-Reinforcement � . .I'� 56. Rough Plumbing & Pressure Test - ,/�. f?- � : `� • -.,: � 6�.Electrical IJFER.Grnd.'� ' � 57. APPROVALTOCOVER-GUNITE ' �� 7° �Footings „ r � t A� 58. Electrical Conduit-Undrgrnd. "` 8.�;Foundation � j 59. Gas Pipe, O Undrgmd., Test ''�� -� 9^.Water Pipe-Undrgr�ii. i� t 60. Backwash Lines, P-Trap, O Undrgrnd. n � ` 10.';Svuctural Floor System .. •- -� ' 61. APPROVAL TO DECK , �11•.}PrOperty Sewer Line;& House Connection �- ' . , ,� 62. Backwash & Receptor-Final �2; Se�'°Q�jCaP �t `� �i �. �('� 63. Heater & Vent-Final s,-. � 13. Roof� Drains � �- �� , 64. Plumbing System - Final � A4. RoughPlumbing; � • 65. Electrical-Final� � '; l ' 75. Rough' Electriral-Conduit 66. Solar System-Final 76:� Rough Electric Wiring 67. Fencing & Access Approval 77.� Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. �Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19.�Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in;Structure 70. Under9round Hydro . � : - 22. Ducts,.Ventilating 71. Product Piping O Gas ❑ Oil .. .23. (3as Pipe=Rough &,1iest 72. Underground Flush 24. Roof Framing ' 73. Undergrnd.StorageTank O�Gas ❑Oi� � � 25. Roof Sheathing ', . 74. Overhead Hydro 26. T-BafCeiling�(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. Plaste� Brown Coat 79. FINAL INSPECTION : Electncal 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 39. Final Plumbing � . " 39. Water Service-Final 40. Gas Service-Final ' 41, Solar�Domestic-Final ' 42. Backflow Preventer � i' 43. Backflow Irrigation � 44. Landscape Irrigation System - . � 45. Sound Attenuation , . , 46. Handicap Regulations �. 47. FINAL STRUCTUqE & BUILDING z r,� � 48. Special Requirements,Completed � 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co . . 51. CERTIFICATE OF OCCUPANCY . • Mo. Dare �J' Applicant to fill In all s0acef except t�ose witnin hlavY OOrGe� Ilnes an0 sign all avvroorlata Caclarations. CI7Y OF COSTA MESA CONSTRUCTION PERMIT "�� • . Project Address � Applicant'eMailingAddress - Ve- •Owner's Name � W� 1"� 1 �� `� phoneS�� Address � (� Arch/Eng. � �� prr�� ense No. Address -�T��^I�� Contractor's Namn,�djt� k C�C PhonE�i�=--S7�1 � Addreu (mailing) «� '�-� �a��-S p1V � �J Ciry License No. -„�533 OLICENSED CONTRACTOR DECLARATION I her¢by affirm lhal � am IlcCnsetl untlGr p�ovi5ions ol Cbarte� 9(commencin9 with sec[lon 7000) ot Dlvision 3 of t�e Bu5ine55 antl Prof¢SSIOnS Cotle, antl � my Iicense is in tull fo e a ftect. �(f � LJcense CIa55�� - �� y nae No( ��-s �� Date�Q Zj;S� c'onar .n� /�2a�a�- WORKERS'COMPENSATION DECLARATION� lereby affirm lhat I have a cerU(icata ot consent to ul1-insure or a certlficate ' . Workers' Compensation Insurance, o� a ce�tltietl copy t�e�eof ($ection �800, Lab. C � Policy No. � �Certifietl copy is nereby tum' hetl. " ' � Certifietl py' witn tl e city Builtling Ivlsid �ate � �` �� AOPlicant Q E%EMPTION FROM WORKER$' COMPENSATION DEC RATION (This section neetl not be tompletetl it [he pe�mit is (or one untlretl ($300) or Iess). , I Certity that in the Oerformanca o( lhe wO�k for which lnis Oe�m�t is isSueE, I shall nol employ any perzOn in any mdnn¢r 50 a5 to bGtOme Subj¢C[ t0 the Workers' Compensalion Laws of Califomla. Date Siqnature 'NOTICE: II, atter makln9 this aeclaratlon, yau shoultl become subject to the Workers' Compensalion O�ovisions of tne Labo� Cotle, you must torthwlth comply wlth zuth provl5iOn5 or Ih{s p�rmlt Shall bG tlaemetl revOkCtl. CONSTRUCTION LENDING AGENCV I hereby atfirm that there Is a mnstructlan lentling a9ency tor ihe performance of the work tor which tbi5 permit is Iszuetl (Sectlon 3097 Civ. C.) �. Lentler's Name Lentler's Atltlresz OWNE0. BUILOEH �ECLA0.ATION I ha�Cby alflrm that I am exempt from tha COntracto�'s License Law tOr Iho following reason (Soction 7031.5 Buslness antl Pro(essional Cotle: Any ci[Y or county whl<h requl�es a p¢rmlt t0 cOnst�uct, aller, Improv0, tlCm011sh o� �epair any sVuchro, prlor to its iszuance, also requbes the appllcant lor such parmit to tiie a slgnetl itatement tbat �e/she is Iiconsotl Oursuant to the provi5ions of the ConVactoYS License Law (Chdp[¢r 9(commencin9 wlth SeCtion 7000) of 'livlsion 3 0l the Business antl PrOt¢zslons Cotle) o� lhal he/Sho I5 oxempt �erefrom antl the basis lor thc allegotl exemption. Any violatlon ot Soctlon 031.5 by any appliGant lor a pe�mit SubjeGts Ihe ap0��ant to a clvil '� enalty oi not more lhan Iive huntlr¢C tlollari (E500). I, as owner ot [he p�operty O/ my employee5 with wa905 as lhoir Solo compensation, wlll tlo ihe work, antl tha structuro is not intentlotl or oltaretl for salo ($ection 7044, Business antl Prolesslonal Cotle: The ConVattor's LiCC050 L.dW tlOCS no[ apply [O dn Ownc1 ot d prop¢!ty wh0 DUlltli O! ImplOVCT lhermn, antl who tloes such wOrk blmseli/h¢r5¢tl or tnrouqh hi5 Or hur own em0�oyees, provltletl that suth Improvemenlz are not intentletl or ofteretl for sa10. 11, M1owev¢r, tne bullCing or improvomenl is SOItl wlthin ona yCdr 01 cOm- pletion, thc owner will have tho burtlen of proving ne/she ditl not builtl or im- �/Ove torthe Ourp05< Olsale�. L.1 I�y as owner of the property, am excluslvery contractin9 with Iicensatl con- Vactors [o conStrucl the project (Sectlan 7044, BUSineSi anC PrOtosslons Co08: TM1e Contrac[o�'s LiCenSe Law tloez not apply t0 an owner of O�operty who builtls or Improves thereon, ana wno contracts tor suth pro7octs wlth a con- Vactor(Sl lican50 pursuant�t0 the Contrac[or'S LiGense Law). I am aware that proof of thel� Wo�ker'S Compensatlon insurance Shoultl b¢ provitletl l0 m¢. ❑ I am exemp[ untler Section B. & P. C. �or this reason Date Owner I hereby cerlity that I nave reai information is correcL I a9ree to antl stat elating lo b'IOin � sentati s o/ [h ci t [er inspec on purpos . iSigna[ure Drivers' License or 55 � Date�'7�l _ 13 ab 9��' I�w„^ax I�� ►-�+ � �-.._..�. � TVPE OF CONSTRUCTION EW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIONOF WORK/USEOF BLDG. � [3.1 T�/ � c TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBIqNG.�❑ MECHANICAL ❑ �OTHER lOL L' F EA� PRQIECT DESCRIPTION 5�. FT. • r OCCUPANCv^� CONSTRUCTIONTVPE VALUATIONS -�w ZONE GRADINGCU.VDS. ACRES Remarks: Sink Preventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service OuUets Interceptors Kitchen Sink Lavatories - . P-Trap Roof Drains Reinspection Feo � $15 Boiler Duct- UnderGround Duct � Structural Duct � Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact, Blt. ICBO iW Heating System & Ducting ❑ ai oo,000 eru O � oo,000 er� Reinspection Fee � $15 _..__ . _-._- ... -. __._. CMF 0865-46, rev. 30/B4 White - Bulltling; Canary - Applicant; Pink - Accountln9: Goltlenrotl - AssesSor Shawers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wesh Leundry Trays Issue Fae Hoad or Typel ❑ Canopy Type II ❑ Refrigeretion System ❑o-ioa,000eru ❑ioo,000 System Repair/Alteration Fire Dampers Registers laue Fee FEES S 3 $ 3 A.P. 51`- L o7{'i " Io� ` S A�G�ding: �i,$�� E � �T Front ARear � C Right � � I S Left � � � Ping. Ret. qIE Planning Noter. . Automatic Washer Construction PoleSub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets $wiLCh¢5 Garbage DisUosal Generamr O0.5 KW OS-'� Foe 2oning Approved By_ Building Approved By 1696 10/08/G5 2one Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up ro 100 amps Meter ❑over 100amps Su6 Panel MOlors �0.1 HP � t Y, � 8 Inc.Solar �9-15 HP �1Et5+ Microwave Pole Light ; Standing Sections 5 KW Tresh Compactor $15 Isue Fee 17o0u TL Z O N I N G R E � M T S FEES SU AR OFFEES BUILDING PERMIT $ SMIP $ � S� PLAN CHECK $ ' S PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENEfiGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICfiOFILM $ MECHANICAL $ TOTAL FEE $ � PLAN CHECK 25% $ ; CONSTRUCTION ANDPLANNING � APPROVALS Permit # �� '� 1. Temporary Electrical Service or Pole � �2. Soil Pipe-Undrgrnd. �•� 4.-�Electrcal Cqnduit,UFldr,t,�md. � � �• .. �: �... 5...,Steel_Reinforcement,�� -`- -6.``Electnical �„�1- ER��irnd:i � �Y . �: .t 7.'�dotings `n �' ` _ . � %i .BrFoLndation� �`� - �` lOrStructural Floor Sys[em ' 11.,Prpperty Sewer Line.& House Co'nn�ct �� 12. Sewer:Cap • ' � ' • H: 13. Rqaf:�rains ' "' 14. �Ro�gh Plumbing �� 15. RoJgl� Electrical'•Gonduit i6. Rough Electric Wiring 17. Rough Wiring Sign 18. �Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning � 20.�Rough Factory Fireplace 21.,DuCts, in Structure � 22r Ducts, Ventilating 23. Gas Pipe-Rough &,Test 24. �Roof Framing '�� i 25. �Roof Sheathing � � 26. �T-Bar��eiling (Stiu�tural) & Monocoat 27.'Frameand Flashing � 26. Lathing & Sidiny 29. Insula[ion � 30. Drywall Nailing'� 31. Plaster�Brown Coat „ 32. Electrical Power Meter-Final inal Electric 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test � � 36. Hood orjCanopy - � 37. Final Factory Fireplace 38. Final Plumbing � � 39. Water�Service-Final' - 40. Gas Service-Final ' 41. Solar pomestic-Final . 42. Backflow Preventer � 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE & BUILDING 46. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. - Date � POC SPA Date Inspector AppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement � 54. Forms 55. Electrical Bonding � b� p5� 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE � � } 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test � 60. Backwash Lines, P-Trap, � Undrgrnd. - 61. APPROVAL TO DECK � 62. Backwash & Receptor-Final � 63. Heater & Vent-Final - 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FORPLASTER�NG 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd.Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. F�RE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: ��Date Inspector i � ':: 1 C`.