HomeMy WebLinkAbout2135 SABOT COVE - Building Permits (-.
,.<,OgfH�MFs9,. CITY OF COSTA MESA
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p At.::\ CALIFORNIA 92628-1200 P.O. BOX 1200
Fi.w A
DEVELOPMENT SERVICES DEPARTMENT
��.eananaRO'.
August 16, 1989 (REVISED)
To:
Building Safety Division Pacific Bell (2)
Code Enforcement Police Dept. - Ping. & Research
Communications Santa Ana Heights Water Company
Copley-Colony of Costa Mesa Sanitary District Engineer
County Administration Office Southern California Edison Co.
County Clerk/Bd. of Supervisors Southern California Gas Co.
County Registrar of Voters State Board of Equalization
County Tax Assessor Street Division
Engineering Division (2) U.S. Post Office - AIS
Fire Prevention U.S. Post Office, Adams Avenue
Manager, MIS U.S. Post Office, Santa Ana
Mesa Consolidated Water Dist. Zip 4 - Santa Ana
Newport-Mesa Un. School Dist. (2) File (2)
The City of Costa Mesa wishes to advise you that the following
addresses have been changed or added:
OLD ADDRESS NEW ADDRESS A. P. NO.
152 Merrill Place •
Unit "D" 2135 Sabot Cove 426-132-01
Unit "C" 2137 Sabot Cove
Unit "A" 2134 Sabot Cove 426-132-22
Unit "B" 2136 Sabot Cove
For your convenience we are listing the agencies above that we have
notified of the change. In addition to those listed, you are
• advised to notify your correspondents of the change in order to
avoid any possible interruption of mail service.
Your cooperation in this matter is appreciated.
Sincerely,
EANNE RUSSELL
Planning Intern
JR: j1 (ADDCHNGE. 43)
cc: Michael S. Talbott
5051 Alton Parkway #44
Irvine, CA 92714
77 FAIR DRIVE
Building Division(714)754-5626 • Code Enforcement/Business License(714)754-5234 • Planning Division(714)754-5245
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STp ki CITY OF COSTA MESA
!p" 4;11., CALIFORNIA 92628-1200 P.O. BOX 1200
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DEVELOPMENT SERVICES DEPARTMENT
•: a
tit�'De0 ofE ..
August 16, 1989 (REVISED)
To:
Building Safety Division Pacific Bell (2)
Code Enforcement Police Dept. - Ping. & Research
Communications Santa Ana Heights Water Company
Copley-Colony of Costa Mesa Sanitary District Engineer
County Administration Office Southern California Edison Co.
County Clerk/Bd. of Supervisors Southern California Gas Co.
County Registrar of Voters State Board of Equalization
County Tax Assessor Street Division
Engineering Division (2) U.S. Post Office - AIS
Fire Prevention U.S. Post Office, Adams Avenue
Manager, MIS U.S. Post Office, Santa Ana
Mesa Consolidated Water Dist. Zip 4 - Santa Ana
Newport-Mesa Un. School Dist. (2) File (2)
The City of Costa Mesa wishes to advise you that the following
addresses have been changed or added:
OLD ADDRESS NEW ADDRESS A. P. NO.
152 Merrill Place •
Unit "D" 2135 Sabot Cove 426-132-01
Unit "C" 2137 Sabot Cove
Unit "A" 2134 Sabot Cove 426-132-22
Unit "B" 2136 Sabot Cove
For your convenience we are listing the agencies above that we have
notified of the change. In addition to those listed, you are
advised to notify your correspondents of the change in order to
avoid any possible interruption of mail service.
Your cooperation in this matter is appreciated.
Sincerely,
df
EANNE RUSSELL
Planning Intern
JR: j1 (ADDCHNGE. 43)
cc: Michael S. Talbott
5051 Alton Parkway #44
Irvine, CA 92714
77 FAIR DRIVE
Building Division(714)754-5626 • Code Enforcement/Business License(714)754-5234 • Planning Division(714)754-5245
left/
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' 2, n,9 AI 35 S re (� I Lr___l—_on'cant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
MO ERMIT NO. TRACT NO. LOT N
• C ' E : . C1NSTRU TIO PERMI pQ , `I I' [[[///���(. (0. UNIT NO. A.P.# (.4/262 - ' 7j � - Or Zone RZ
coject Addres . ' ':J-'-*MAINS � .) D (�/ (l/ 1('�/J �(O� emieUJ
u may_ 4 S Main Building: Accessory Building:
Applicant's Mailing Addr ss roc/ !4'I?D�t) �� TYPE OF CONSTRUCTION NEW ADO
OTHE L-I V 0 T� UI.C. R T Front 20 0
�M F ❑ CONVERSION ❑ DEMOLISH
Owner's Name _(tCl_lS d� 7/A-rbD �f Phone - J- we B N
'�lf I. C� DE RIPTI N O WORK/USE OF BLDG. 4 - Rear ' r�-
o,ddress �- l 2• x_94 VLYf FS I C Right pi's "�, N
Arch/Eng. License No. TYPE OF PERMIT GRADI ❑ FOUNDATION STRUCTURAL K ' �� G
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL S Left Orr 12 Co
• ��/�s� ❑ OTHER ` I Ping. Ref. # a'z- _00 Parking Req./Provided �/tj Q
Contractor's Name_f915` Phone Y
PROJECT DESCRIPTION SO. FT. b _l=l—OCCUPANCY/_�'S/ � Planning Notes: 'TWA, ,I- 61
�a;j.r•l7iw '(j.( j,� condo M
A'dress(mailing) Cl 4,-L '�•"""r
City
CONSTRUCTION TV PE VALUATION $ ,� 6•
City License NO. ZONE GRADING CU.Y1115. ACRES T
LICENSED CONTRACTOR DECLARATION �� •'l S.
i'here; affirm that I am licensed under provi '•• ar er 9 (commencing Remarks: l
with sect'. •Ir of Division 3 • :usiness and Professions Code, and 255 •- e 70 13% ELECTRICAL FEES
my license is in full o -- :•- Pc
License Cla • •. - ✓ 1
Date Signature PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW
'"ORKER5'COMPENSATION DECLARATION Construction Pole Sub. 0 50+ KW
!reby affirm that I have a certificate of consent to self-Insure or a certificate Bar$ink Showers -
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter Our)to 100 amps
3800, Lab. C.) •
•
Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter (Dover 100 amus ,
8 Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan
Motors
Solar olar Collectors 0-1 HP 1$-B
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers •
(This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.U. Inc.Solar ❑9-15 HP ❑16-15+
less).
scertify thatm in the performance of the work for so aswhich othis permit is t to I • Fixtures M' rowave
shall not employ any person in any mann sq as to become subject the Drinking Fountains Solar Tank
•
workers' omns i�0 Laws of California
Date - - —1—Signature is Floor Drains Swimming Pool w/Spate Device Boxes Pole Light '
'
I-1
NOTICE:If,after making this declaration, y u should become subject to the Outlets ' ' Range
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. •
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches 7
Sign
I hereby affirm that there is a construction lending agency for the performance
of the work for WAhis permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
i ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Treys •
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 Roof Drains
'Contractor's License Law(Chapter 9 (commencing with Section 7000)of
'Contractor's
3 of the Business'and Professions Code) or that he/she is exempt Reinspection.Fee $15 Issue Fee $ 3
:efrom and the basis for the alleged exemption. Any violation of Section .
.v31.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500). I $ 3 DEVELOPMENT SERVICES REQULB EMENTS:
I, as owner of the property or my employees with wages as their sole ReinspeMion Fee ` $15 Issue Fee (j)I,� Date
compensation, will do the work, and the structure is not intended or offered Zoning Approved By
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date 6 `
License Law does not apply to an owner of a property who builds or improves _ __ _.___ --. ._._-®.......
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type 0 Application Issued By • Date���--
Itr
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- Canopy Type II 0 SUMMARY OF FEES
pi 'on, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
ve for the purpose of sale). BUILDING PERMIT $ 6 as2 't 0SMIP $ •2�
s owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ 17/. p-3 PERMIT
ractors to construct the project (Section 7044,Business and Professions Code: ❑0-100,000 BTU ❑100,000 BTU
he Contractor's License Law does not apply to an owner of property who Duct-Ventilating / PLUMBING $ ISSUANCE $
builds or imoroves thereon.and who contracts for such oroiects with a con- ENERGY P.C. $
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ ystem Repair/Alteration • PLAN CHECK 25% $
proof oftheir Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG dk Fire Dampers • MICROFILM $
L
A PLAN CHECK 50% $ Q
Date owner �S_ Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ j 231:7
:7
I hereby certify that I have read this application and state that the above 00100,000 BTU 0100,000 BT PLAN CHECK 25% $
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 cit o enter upon the above-mentioned property for
inspection purposes. oq --Signature Date 414 / f'•, 'TIT- . r•y 1 _-Drivers' License License or Reinspection Fee $15 Issue Fee $ 3 J 1_=) ((.,.:,... �
7:.„..., ,..:y
0865-46,rev. 5/88 white - Building; Canary - Applicant; Plnk - Accounting; Goldenrod - Assessor
PC SPA �, ,�•
+ ,
CONSTRUCTION AND PLANNING . .
APPROVALS Permit# `
Date IInspector " APPROVALS Permit# Date Inspector
•' .1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location
'2.1 Soil Pipe-Undrgrnd. t 53. Steel Reinforcement
3.'Electrical Conduit Utility-Undrgrnd. -t _ 54. _Forms
4. Electrical Conduit-Undrgrnd. '' 55. Electrical Bonding - '
5. Steel•Reinforcement ll 56. Rough Plumbing & Pressure Test
' 6.••Electrical UFER Grnd. ' i 57. APPROVAL TO COVER-GUNITE
7. Footings58. Electrical Conduit-Undrgrnd.
.8:• Foundation 2707S0259. Gas Pipe, 0 Undrgrnd., Test f
9.,Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
104 Structural Floor System pi
61. APPROVAL TO DECK
l 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
ll 12"Sewer, Cap 63. Heater & Vent-Final
II 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
48. Rough Electrical'T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
•J9• Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough-Factory Fireplace APPROVALS Permit#
21. Ducts, in-Structure 70. Underground Hydro
( :,
22. Ducts, Ventilating t ' 71. Product Piping 0 Gas 0 Oil
23.-Gas Pipe'-Rough & Test _ 72/Underground Flush i
24. Roof Ft- ming -'' 73. Undergrnd.Storage Tank 0 Gas 0 Oil /�
r
25: Roof Sheathing.(r 74. Overhead Hydro
26. T-Bar Ceiling (Stcucturall & Monocoat 75. Dry Chemical
27. Frame and Flashing SC/9 442- 76. Dry Standpipe
28. &-
LathidgSiding 77. FIXED SYSTEM FINAL
29. Insulation • S�s/� a 78. FIRE PREV. FINAL
30. DryeMl Nailing `- HEALTH DEPT. REQUIREMENT
31. PlasterBrownCoa ..t 79. FINAL INSPECTION
.,
32: EIectr'IcaI Power Meter-Final ' , 80. FOOD CERTIFICATE ISSUED
33. Final Electric 1 Notes: ��
* F%G s t u..z., ern.a/ Ft"a ilam
34. Final Heating & Air Conditioning
/i 6/J_7/$;Ii
35. Final Gas Pipe-Test
36. Hood or Canopy . .. 0lit cavy„i-A en it e-2/Ce -�
37. Rol Factory.Fireplace o7oc - Ct`K�
38. Final Plumbing r701( h re c� fcithirttpvcatif 4, 1--
--
39. Water Service-Final
40. Gas Service-Final.' k-7/9O • c5
( 41. Solar Domestic-Final - . .1
•
42. Backflow Preventer _// '
. f-.
a
43. Backflow Irrigation •
. .;
44. Landscape Irrigation System '; 41 '
45. Sound Attenuations ' • .1./.1-
46.
L!"46. Handicap Regulations _ ' /j
47. FINAL STRUCTURE &'BUILDING if•a7-Sra/el--
48. Special Requirements Completed 11-161778? cf, ,
49. Electric Releasito Edison (" ` �, 'y"
50. Gas Release to Southern California Gas Co , -;; •;-• , . I:t
51. CERTIFICATE OF OCCUPANCY ,J-,,i y J.
No. 'Date .ori' . ''. 11,1
CERTIFICATE OF COMPLIANCn
PAYMENT OF SCHOOL FACILITY FEES
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
Developer/Applicant : V /Dr /CityD,„ C yNc
Address : 5C: S/ 4-!To/i1 AL.-,/y
Telephone Number : `7/ I--1 17I l q
Tract/Parcel and Lot Number(s) :
Location of Project : / 52 irk1ZR I ( 716ct. CPI"
Number of Square Feet of
Residential Space �o(0-74../3(0-74../3 x $1 . 50 Total f,,/ v /
ace
— a i7/ 6 O c/Eonr o
Number of Square Feet of -57-2-,77,T-
Commercial and
Industrial Space x $0. 25 Total
Commercial/Industrial Project is : (Check One)
Mini-storage Motel Preschool
Movie Theater Bank Auto Repair
Racquet/Health Neighborhood Shops Hospital
Warehouses R & D Large Office
Heavy Industrial Hotel Office Bldg.
Regional Shops Medical Office Restaurant
Light Industrial Office Park Fast Food
The provisions of Government Code Section 53080 are not applicable.
This certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995 .
Checks are to be made payable to Newport-Mesa Unified School District .
y ,
Bus ess Manager
Newport-Mesa Unified School District
The above representation as to square footage is true . Developer/
Applicant agrees that if it is later determined that such representa-
tions are not true then this certificate shall automatically terminate
and the appropriate City/County shall be notified .
Date : q//0/2
Developer/Applicant
m a c�t•e I 4.1-t�1
JUN 191989
:BPE;MNER
G'R A.V E .S
CORPORATION -
•
November 9, 1989
City of Costa Mesa
Engineering Department '
77 Fair Drive, 2nd Floor • • _
Costa Mesa; CA 92628-1200
'Attention: .Robert•Brock . ,
Reference: Precise Grading Plan No. DR-89.08
152 - 156 Merrill Place
Dear Mr. Brock: .. -
•
• Enclosed please.find a duplicate m-,'lar of the above referenced precise
Gvil Engineering grading plan. This plan has been labeled "AS-BUILT"g e r t � 1 and with the
Surveying • exception of the revisions made thereon, this project has been ;;cnstructed
LandPlanning within substantial confoi mance of the approved precise grading plan.
.Sincerely, . •
BremnerGraves CorporationNUJ CJ`'
•
•
D• avid W. Graves, P.E.
• Enclosures
cc: Mike Talbott, V.N.L. DeVeiopmeia
RECEIVES
1'0V 0 9 1989 •
.
• CITY OF COSTA MESA
PUBLIC SERVICE
•
4350 Von Karrnan Ave.
Suite 100
Newport Beach,CA 92660 . , -
719 .756 • 1811
FAX •719 •851 • 5910 • , • ,
",TY OF COSTA MES " ; •
CALIFORNIA 92628-1200 P.O.BOX 1200
Insulation Certificate /6 3 7 :051
oz/�5 5Ilk or L 0V -
-(3' •.* 2 t - rc:77—6}' &—e;fJ
Number and Street City
0n a-,,x g /�'e�poor 0;7yk s Gog
County Subdivision Lot Number
Description of Installation
ROOF
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
EXTERIOR WALL
Material Brand Name
Thickness(inches) - Thermal Resistance(R-Value)
CEILING
Batt or Blanket Type Brand Name
Thickness(inches) Thermal Resistance(R-Value)
Loose Fill Type Brand Name
Contractor's minimum installed weight/ft2 lb Minimum thickness inches
Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value)
RAISED FLOOR
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
SLAB FLOOR
Material (}!/LC'or re- Brand Name
Thickness(inches) Thermal Resistance(R-Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Administrative Code.
Ormued2 r3otld�,z k1/21--
general Contractor(Builder) License Number
ril L- ( ewae,Z ti/«/ s
Signature and Title Date
7 ��/ (1),�zo/ Si1/s . .�Nc � qfl Z
/Sut}Con <toy(lnsyl Lion Installer) e Number
Signature and Tide Date
05-14°
�c4 A �5g9
PROJECT-ADDRESS' --- - ---=,-- UNIT: '
OWCT-ADD ESS'isiE 'a135 � Lam— CITY UP COSTA MESA - BUILDING PERMIT PERM, NO: P. 045010
.MICHAEL TALBERT. Sa2J0f C0%e
• AODRESS: ✓j051 ALTON PKWY #44 PERMIT NO: P 045010PLAN CHECK NO: N GOVT.: N SUPP : N
•
IRVINE 92714 .
CONSTRUCTION TYPE: - PERMIT TYPE: PLU PURPOSE: NEW • ,
•
ARCH/ENGINEER: ( REG.NO.: ' ' JOB .DESCRIPTION : GAS LINES SQ FT:
•
ADDRESS: UNIT: , '
CLAIM VALUE: CALC-VALUE: GROUP OCC: . /
- PERMTTEE: MICHAEL TALDERT ( 7140721 3745
ADDRESS: . SAME COMMENTS: REFER TO #38951 '
IRV. CA 92714 ####################################.kk* EYEYEYEYEYEBEYEYEYEYE EYE##YEYEYEYE##YEYEYEYE9EYEYEYEYEYE#YE9(** *YE3 •
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R E Q U I R E' M E N T S ••
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. • $ E T B ACK S '
CITY UC.: STATE LIC.: CLASS:
Date: signature: -- MAIN BUILDING ------- -- ACCESSORY BUILDING -,-- - --
WORKERS'COMPENSATIONOECLARATION: thereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' PRNT: FT IN REAR: FT IN 'FRNT: FT IN REAR: FTIN
Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: . FT IN LEFT: FT • IN RGHT: - FT IN
POUCY NO.: EXP.DATE:
COMPANY: PARKING REO: PROV: PARCEL: 42613201 ZNE: REF NO: •
i_7 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
> - - . . .. .
Date: Applicant: - - YEYEYEYEBE#YEYEYEYEif3EYEYE#YEiE#ih1e#eleEieiEiEiEiEiElE3fikifiEiliE#iE1EiE1EiEiEi(-ifiEiE,iEiFiEiEyE)f7EififitiEiEiEiFiEifiEikifiE#3Eil•ifiEifik#iE1fiElE
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). ' DEVELOPMENT SERV I" C E S ' R E Q U I R EMEN T S .
I certify that in the erfo mance of the work for which this permit is issued,I sh n t employ any person in any manner so as to become - i,
subject to the ta ggrrsss'Com ation Lawssp'Califomia. /ZONING APPROVED BY •
DATE:
Date: x/ l �i1 7 Signature: �C - / -
NOTICE:If,aft r makin this declaration,you should become subject tote Workers'Compensation provisions of the Labor ! BUILDING APPROVED BY : i DATE:
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 , AP PL I CATION ISSUED BY: '• DATE: I— (r- 'Bi
which this permit is issued(Section 3097,Civ.C). #####iE##{E{E####iE{e{l.{4e0.{e
#iki(BE 1F iE iE 1E 1E aE#lf)f-if dE iE,>E##aE### iE########3E############ �F## ##
LENDER: I YEiE#YE###YE##YEYEYEYEYEYEiE#YEYEYEYEYEYEYEYEYEYEYe YEYEJE#YE#YEYE9EYEYEYEYE#YEYE#YE##YEYEYE#YEYE#YEYEiE#YEYEYEYE#YEYEYEYEYE#iE#YEYEYEdEYE#
ADDRESS: -•• LEGALIZATION':N F E E S U M M A R Y STRUCTURAL SEGMENT:N '
r '
OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC . FIRE .SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 4 0 0
repair any structure,prior to its issuance,also requires the applicant tar such permit to file a signed statement that he/she is licensed •
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% - SMIP/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN • ,
any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ' . ISSUE FEE ' ' 3 . 00 - •
•
I, as owner of the property or my employees with wages as their sole'compensation, will'do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
CO structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law ' TOTALS--—> 4 . 0 0 , 3 . 00 0 . 00 • 7 ,00 7 . 00 . 00
does not apply to an owner of a property who builds or improves thereon•and who does such work himself/herself or through •
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden'of proving he/she did not build or improve ;REVENUE DIVISION' TOTALS--> COLLECTED:' 7 . 00' OVER/SHORT: . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business - 7 .00 : ,
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
•and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******3E***3***********39******.**i(.#1e*******#..lE#.#.{E%.IE.X.*****##ieio#.If#..IE.%,IF##.##.%#ih****3(###,
that proof of their Worker's Compensation insurance should be provided to me. • IND I V I D U A L • FEE 'D R E A KD 0 W N
❑ I am exempt under Section: B.8 P.C.
for this reason: L G TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Date: 1 ll!0 / • (Owner: C 1 //TYPE
r •
0
I do hereby certify that I am are of nd understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 2 GA$ SERVICE - 2 . 00 4 D
25534 and that I or any tutu buildin occupant will/will not(circle one)need to comply with said state codes and the requirements for a- END OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
r
Date: Applicant:
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 r '
ordinances and state I ws relatin o building con ruction and heruthorize representatives of this city to enter upon the above-mentioned
property for inspect' n pu>�s {v 'A C
T.
Date: •
ns lS lgnature:
DATE: /15/-u". - - r
T_ LJ ..`lc: 11:'. J7
164146 White-Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor - • .
/ PL - & SPA
CONSTRUCTION AND PLANNING ' •
.4 _ Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
.-1. Temporary Electrical Service or Pole f 52. Pool & Equipment Location
7/..Soil Pipe-Undrgrnd.- - 53. Steel Reinforcement -
11,3. Electrical Conduit Utility-Undrgrnd. 54. Forms - . -
l..,'
4.-Electrical Conduit-Undrgrnd. • 55. Electrical Bonding
ii c.-Steel Reinforcement 56.;Rough Plumbing & Pressure Test -
I t' @.-Electrical UFEA Grnd. 57. APPROVAL TO COVER-GUNITE
1417."Footings 58.' Electrical Conduit-Undrgrnd.
i 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
•
,r
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
20.-"Rough Factory Fireplace _ _, r_ : A -APPROVALS--,-Permit # - -
21._Ducts,in Str`uctuFe* " " _ , R 2,70. UndergroundHydro0
22.„Dais, Ventilating S, ~.
g _ _ :,71. Product,Piping 0 Gas ❑iOil
23. Gas-Pi perRough & Test .,�- d - .72. Underground Flush'
' 24,-Roof Framing r y i rt- _ _•73-'Undergrnd.Storage_Tank 0 Gas 0 Oil
25. Roof Sheathing - _y •-1 x - 74POverhead Hydro,: -.
26.:1T-Bar Ceiling (Structural) &`Monocoat h • •, " "r ii. 75s,Dry Chemical -
27. Frame and Flashing_ _ 4 ^ 76. Dry Standpipe '" _ --
28. Lathing & Sidings.. ". ;, :4 •g 77.--.FIXED SYSTEM FINAL - • - '
29. Insulatioh -,a _ • r' 78F,IRE PREV. FINAL '
30. Drywall-Nailing ` fr., _ I - HEALTH DEPT. REQUIREMENT
C31. Plaster Brown Coate "t" _- $, ' '79. FINAL INSPECTION : - _
`32._Electrical Power Meter'-Final; y. • ,. t 80.1400D CERTIFICATE ISSUED .
•335Final Electric; - _ -_ �; a .--• I "' Notes: _ �_ -
.,;34,_Final Heating,& Air'Conditioning- _ - r
35-Final Gas Pipe-Test ,_ 7 i f ig l "' _ '- _
X36. Hood or Canopy c T
-37. Final Factory Fireplace - - -,
38. Final Plumbing -� ±/�� (,(O •,{,
39. Water Service-Final. •- '. i r}
_ . 4., r.
'40. Gas Service-Final ' - '• • - ""' '
'2,41. Solar Domestic-Final- c i s -
42. Backflow Preventers ` "
43. Backflow Irrigation -- - a.
'"44. Landscape IFrigation System'• - -' " - r'
-45.-..Sound Attenuation - •r , - -. w✓ -_.
246. Handicap Regulations a' - -
, is C. 4.:
.47 tFIN'AL STRUCTURE & BUILDING fi - -
48: FINAL PLANNING - 't: _
49. Electric Release to Edison I .
-r r s.
50: Gas:Release to Southern California Gas Co ,- I _
-44 .. t . c
-51. CERTIFICATE OF OCCUPANCY it - - - •.
No. Date
OT✓ipasir_ie wgun)Cove ) et ge)Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
•N` - PERMIT NO. TRACT NO. LOT NO. UNIT
CITY OFC.O MESA CO STR UC PER T P 39 05-g A.P.# •
Zone
Project A �� s� _z1-T - r' S Main Building: Accessory Building:
Applicant's Mailing Address s 7V.� (c: i ,//1r'Ai J/ ,H TYPE OF CONSTRUCTION U NEW LJ ADD U ALTERATION REPAIR E Front Z
^r- 1-4JI YVC- 4-' Phonn 66119 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T N
Owner's Name L — DESCRIPTION OF WORK/USE OF BLDG. • I B Rear
Address TPrL6DTT m LC e
g
TYPE OF PERMIT U GRADING ❑ FOUNDATION U STRUCTURAL C Right GN
•
Arch/Eng. License No. NIR
K G
Address ❑ TENANT ❑ ELECTRICAL ILf.PLUMBING ❑ MECHANICAL g Left
R
Contractor's Name /� Phone CI OTHER Ping. Ref.# Parking Req./Provided E
v PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Planning Notes:
Address(mailing) CON ST RUCTION TYPE VALUATION$
!TM.
City License No. ZONE GRADING CU.YDS. ACRES S.
LICENSED CONTRACTOR DECLARATION al
I
I hereby affisection
m that I am licensedion uner provisionsBusnss Charter 9i (cns end Remarks:
with sense is 7000) of avid 3 of the Business and Professions Code, and
my license is in full force and effect. ELECTRICAL FEES
License Class License No.
Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
'YORKERS' COMPENSATION DECLARATION Construction Pole Sub. 0 50+ KW
treby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Z $hOWersla. �,
Workers' Compensation Insurance, or a certified•cooy thereof (Section• ICooking Unit Meter ❑up to 100 amps
s800, Lab. C.) • ;J• / Backflow Preventer // Service Sink . ^^
Policy •
No. Company '_ / Backflow Irrigation / Sewer Cap Dishwasher ,,.
y Meter Dover 100 amps -
8 Certified copy is hereby furnished. i- / Dryers ❑Gas LMEI¢Clr lc Sub Panel
•
Certified copy Is filed with the city.Building Division. Bathtubs Sewer Connection i P)11`)
nate Applicant - •
Fan - Motors 00-1 HP 011/2-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION / Clarifiers / Solar Collectors -'
(This section need not be completed if the permit is for one hundred ($1 `L 00) or' !
less). Dishwasher /- Solar Piping 4 b'd F.A.U. Inc.Solar 09-15 HP 016.15+
I certify that in the performance of the work for which this permit is issued,1 / Y
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fixtures r-
Microwave
Workers' C9 m ensation Laws of Calif or a
Device Boxes 7 Pole Light
Date (0 7-3 hideclaration,
_� / Floor Drains / Swimming Pool w/Spa 9
NOTICE:Compensation
making thisi ions of
h,you become subject to tto / Outlets Range
Workers' Com such fpr provisions the Labor Code, you et forthwith h FIOOr Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. pelf;
CONSTRUCTION LENDING AGENCY / Gas Service Outlets Water Closet 1 .� N _ Switches Sign
I hereby affirm that there is a construction lending agency for the performance l
of the work for which this permit Is issued (Section 3097 Civ. C.) / Interceptors 2 Water Heater N Garbage Disposal Standing Sections
Lender's Name
Lender's Address • Z Kitchen Sink / Water Service LY )y Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION • sy� /// /
N
1 hereby affirm that I am exempt from the Contractor's License Law for the U Lavatories Auto-Wash ` l0
following reason (Section 7031.5 Business and Professional Code: Any city or / _
county which requires a permit to construct,alter,improve,demolish or repair / P-Trap Laundry Trays .
any structure, prior to Its issuance, also requires the applicant for such permit f
to file a signed statement that he/she is licensed pursuant to the provisions of 7 Roof Drains
Contractor's License Law(Chapter 9(commencing with Section 7000) of
ision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
:Orem and the basis for the alleged exemption. Any violation of Section
...31.5 by any applicant for a permit subjects the applicant to a civil
•e -Ity of not more than five hundred dollars ($500). $ 3 •
DEVELOPMENT SERVICES REQUIREMENTS:
I, as owner of the property or my employees with wages as their sole Reinspection Fee • $15 Issue Fee Zoning Approved By Date
ompensation, will do the work,and the structure is not intended or offered — -
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES 'Building Approved By Date
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own Boiler HOOd or Type 0 Application Issued By Date '- 2
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- Canopy Type II 0 SUMMARY OF FEES
Motion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
l prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System
tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT
The Contractor's License Law does not apply to an owner of property who Duct- Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING ISSUANCE $
builds or imoroves thereon.and who contracts for such oroiects with a con-
tractor(s) license pursuant to the contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ —�ti ENERGY P.C. $
pr of of their Worker's Compensation insurance should be provided to me. • ELECTRICAL $ GRADING $
am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG dk Fire Dampers
?` A_/N.' PLAN CHECK 50% $ MICROFILM $
Date _ /�— owner 7 Heating System&Ducting Registers MECHANICAL $
I hereby certify that I have read this application and state that the above El 0-100,000 BTU Di 00,000 BTL TOTAL FEE $
information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws relating to building construction, and hereby authorize repre- I
sentatives of this city to enter upon the above-mentioned property for
inspection purposes 'lt h - a2-5n07.4132 r
Signature . r Date 6/23 _ _J3: T•3
Drivers' License or SS
Reinspection Fee $15 Issue Fee $ 3 DrE:E: Q5/23/39 TIPiE: i'::._
0865-46,rev.5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING • PO 4 SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit# '
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
'il ..
t 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
Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7`. Footings • 58. Electrical Conduit-Undrgrnd. ••
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test
19. Water Pipe-Undrgrnd. /il9_ 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection q_28,15.GC Irk 62. Backwash & Receptor-Final
12.-Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 9{109 &CO 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
•
11'6. 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
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating • 71. Product Piping 0 Gas ❑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:
• 06 z6,co1 A/or/El1rPh Rt.- v c.-tweoll
34. Final Heating & Air Conditioning Sat- Poo -- 11-421-21, Nor-et; -oy-1_.6o
35. Final Gas Pipe-Test ///3M !l
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing Uf/6/,Q 410
39. Water Service-Final a-Mlle `4.0
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 -
u�✓ ��'` Caw Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
•^'.b (�e�'�'e'� �,�_ PERMIT NO. TRACT NO. LOT NO. UNIT N
CITY O ICp3�T MESA CON . • P =. •—.+ q 9 n9t9 .P.# j zone
lL(( dr��e�s�.`1 ----I-- _ �� /V f tJ 7
Pro)kct ' __ _— —=1� F`_�-2 S Main Building: Accessory Building:
Apple 's Mailing ddressy� � �_/�1] '� y TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION REPAIR E Front
Z
❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T O
Owner's Nam' -� Phone • DESCRIPTION OF WORK/USE OF BLDG. B111 . Rear N
Address _ . .
N
Arch/Eng. License No. TYPE OF PERMIT Li GRADING ID FOUNDATION y El STRUCTURAL C Right G
Address /� El TENANT ❑ ELECTRICAL ElPLUMBING%O'M ,CHANICAL $ Left R
Contractor's Name 072+ Phone_ ❑ OTHER I Ping. Ref.# Parking Req./Provided E
PROJECT DESCRIPTION SQ. FT. OCCUPANCY Q
Address(mailing) Planning Notes: M
CONSTRUCTION TYPE VALUATION$ T
City License No. ZONE GRADING CU.YDS. - ACRES S.
LICENSED CONTRACTOR DECLARATION y//s], n / /�
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /S Z /'K,i,/,i// a/ ��
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full force and effect. 6) _ se
in-/
n^/ ELECTRICAL FEES
License Class License No. v 7 J
Date Signature- PLUMBING I FEES Automatic Washer Transformer 0 15.50 KW
WORKERS'COMPENSATION DECLARATION .Construction Pole Sub. 0 50+ KW
ereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers
Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.)
Policy No. Company Backflow Irrigation . Sewer Cap Dishwasher - Meter Dover 100 amps
8 Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - Motors ❑0-1 HP ❑1%-B
(This section need not be completed it the permit is for one hundred($100) or Dishwasher Solar Piping F.A.U. Ina Solar❑9-15 HP❑16-15+
less).
I certify that in the performance of the work for which this permit is Issued I - Fixtures
shall not empl y any person in an man become subject to the Drinking Fountains .. Solar Tank 7 Microwave
workers' Pgry ion Laws of rnia. daadaa
Date �/ Signet eyt Floor Drains + Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: If, iter making this declaration, you should become subject to the
Workers' Compensationprovisions of the Labor Code, you must forthwith Outlets Range
p Floor Sinks Urinal 9
comply with such provisions or this permit shall be deemed revok¢tl.
CONSTRUCTION LENDING AGENCY Gas Service OutletsWater Closet Switches Sign
1 hereby affirm that there is a construction lending agency for the performance
of the work for which t s permit
i issued (Section 3097 Civ. C.) Garbage Disposal Standing Sections
Interceptors Water Heater
Lender's Name /, -
Lender's Address "'�� Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION —
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031,5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays
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 Roof Drains
""I<"eiison r3ctor's of the Busn cense ss and(Chapter
rofesssions Code)i or that Section s0exxempt
"t "•refrom and the basis for the alleged exemption. Any violation of Section Reinspection Fee I $15 Issue Fee $ 3
''-'1b31.5 by any applicant for a permit subjects the applicant to a civil
e ty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
om tion, will do the work, and the structure is not Intended or offered . Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES Building Approved By Date
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 Application Issued By
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ Date
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I, as owner of the property, am exclusively contracting with licensed con- uct-Structural Refri eration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property whoISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con- PLUMBING $f-- ENERGY P.C. $
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration I PLAN CHECK 25% $
proof of their Worker's Compensation insurance should be provided to me. / 1 ELECTRICAL $ GRADING $
❑ I am exempt under Section B.& P.C.for this reason 2 Firepl/Fact.Blt. ICBG / Fire Dampers jg
rr% PLAN CHECK 50% $ MICROFILM $
Oaten Ownerl He ing System& Ducting Registers MECHANICAL $
I hereby certify that I have read this application and state that the above 100,000 BTU 0100,000 BTU TOTAL FEE $
Information is correct. I agree to comply with all city and county ordinances a — PLAN CHECK 25% $ c'i_OD
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city o nter upon the above-mentioned property for
Inspection purposes. ,rICI
Signature L Date P. :J3:1;�5'G'114aC.S 70 --
� Reinspection Fee $15 Issue Fee $� n �-r,nv--- t^.L_,
Drivers' License or 5# _[ DQ E1 ur3 JJ. v9 1111'... ,.
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
•
CONSTRUCTION AND PLANNING . • • • 1 PC k SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
a
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
t
2.s/Soil Pipe;Undrgrnd. 53. Steel Reinforcement
• 3.1 Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
•
5.''Steel Reinforcenient 56. 'Rough Plumbing & Pressure Test - e
6.` Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7,..; Footings 58. Electrical Conduit-Undrgrnd.
8.1 Foundation I 59. Gas Pipe, 0 Undrgrnd.,Test •
,9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection• 62. Backwash & Receptor-Final
12. Sewer. Cap 63. Heater & Vent-Final
13: Roof:Drains 64. Plumbing System - Final
14'. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final ,
1t Rough Electric Wiring 67. Fencing &Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19' Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20'Rough Factory Fireplace q APPROVALS Permit#
21,. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating - 71. Product Piping 0 Gas 0 Oil 1,
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
. t
28. Lathing & Si ling 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
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 /1.17-riLg-a
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
rr .
No. Date •
/35AZF;:z. A
/ ir-, e- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA ESA CONS U T l IM/I�T� E MIT NO. TRACT NO. LOT NO. UNIT NO.
�
CLN rT5 3 9 7 l ! w A.P. Zone
Project Addres - SMain Building: Accessory Building:
vs A- py11i4ant's Mailing Address i-'3/ e p TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION U REPAIR E Front Z
(.,1.P7TreI aferfris„N'rGNaamme L IA •.�' t/ - or120��7m ❑ CONVERSION, �rI DEMOLISH 10 OTHER • T O
�31 A�-fit • DESCRIJ 10�0/f l9pRK/U56yOF B G A Rear N
Address Arnow (f'
Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION LI STRUCTURAL K Right G
.dress__ .• a s A a'. ❑ TENANT ❑ ELECTRICAL PLUMBING I2ECHANICAL $ Left R
Z i�' 's N7-, r 1�—. ❑ OTHER / Ping. Ref.# Parking Req./Provided E
Phone - /jLf Q
i PROJECT DESCRIPTION SQ. FT. OCCUPANCY tej Planning Notes:
Address(mailing) M
.( SZc 4 CONSTRUCTION TYPE �N VALUATION$ T
City License No. ZONE GRADING CU.YDS. ACRES S.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: O�•• 5 `g�s�/
with section full o(I�lyision 3 of the Business and Professions ode, and os
my license is in full fc e�d/�pya�dd�.�e0(fect. (,7�n ELECTRICAL FEES
Licen its '` LI nse No. Automatic Washer Transformer 0 15-50 KW
Date..6 Signature PLUMBING FEES
7RKERS3COMPENSATION DECLARATIONConstruction Pole Sub. 0 50+KW
O Our)affirm that I have a certificate of consent elf-insure or a certificate Bar Sink Showers
n Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑uto 100 amps
W 3800, Lab. C.)„ n^�` �� C, �,, '
Policy No.t• Y• 'S_y_/ �C '- / Company �ik-.C...ist.Ce2, Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
V I��-II Certifi copy is hereby furnished. - Dryers ❑Gas ❑Electric Sub Panel
—
rti Cert ie op f' d with the city Buil in si n.N Bathtubs Sewer Connection ate Applicant t Fan Motors DI 0-1 HP 01%-B
EXEMPT! N F OM WORKERS'COMPENSATION CL RATIbN Clarifiers Solar Collectors
(This section need not be completed If the pen-nit is for one ndred ($100) or Dishwasher Solar Piping F.A.U. Inc Solar 09-15 HP 016-15+
less).
•
I certify that in the performance of the work for which this permit is Issued I i* Fixtures Microwave
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank
Workers' Compensation Laws of California. Device Boxes
Date Signature Floor Drains Swimming Pool w/Spa Pole Light
NOTICE: If,after making this declaration, you should become subject to the - i Outlets
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service ' Outlets Water Closet Switches Sign
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.) Garbage Disposal Standing Sections
Lender's Name Interceptors Water Heater
Lender's Address • Kitchen Sink Water Service - Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash ,
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
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 Roof Drains
'Contractor's License Law(Chapter 9 (commencing with Section 7000)of
ision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
.eretrom 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). $ 3 DEVELOPMENT SERVICES REQUIREMENTS:
I, as owner of the property or my employees with wages as their sole Reinspection Fee ` $15 Issue Fee Zoning Approved By Date
compensation, will do the work,and the structure Is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES-, Building Approved By / Ar/g/?i Date
License law does not apply to an owner of a property who builds or improves a - Application Issued By � ���OL/r
thereon, and who does such work himself/herself or through his or her own Hood or Typepp - Date
employees, provided that such improvements are not intended or offered for Boiler I ❑
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II D • SUMMA' 0'/EES
pletion, the owner will have the burden of proving he/she aid not build or Im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
D I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Ref ' eration System PLAN CHECK
tractors to construct the project (Section 7044,Business and Professions Code: $ PERMIT
.The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 2 0-100,000 BTU 0100,000 BTU ' Y co PLUMBING $ _ ISSUANCE $
builds or imoroves thereon. and who contracts for such oroiects with a con- ENERGY P.C. $
tractor(s) license pursuant to tne Contractors License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK 25% $ _ ��}x
proof of their Worker's Compensation insurance should be provided to me. - ELECTRICAL $ ,i-`GRADIN tai
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Alt. ICBG# Fire Dampers MICROFILM! -$_ I
PLAN CHECK 50% $ ��-y
Date Owner He g System& Ducting Registers MECHANICAL $ 7 f • 00 TO /I FEfs $ S/' oQ
I hereby certify that ave read this application and state that the above 0.100,000 BTU 0100,000 BTL /g p(„ PLAN CHECK 25% $ I �f 1`r`�y �{{y�
information is correc ree to comply with all city and county ordinances (S - 'v'rt(11'll I
and state laws relati t' b ilding construction,and hereby authorize repre- h.�y
sentatives of this •• -nt:r upon the above-mentioned p��lppp rt �f r 6NI` /v/
inspection purposes�mas G/ Q "yr(/ -
Signature /YA Date L7 0 ()� pC /�'y�•� to idem
Drivers' License or SS
0865-46,rev. 5/B8 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION�AND PLANNING r P( `y SPA
Date Inspector Date Inspector
APPROVALS 'Permit# APPROVALS Permit #
.1. Temporary Electrical Service or Pole - - 52. Pool & Equipment Location
2,Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
31 Electrical Conduit Utility-Undrgrnd. • 54. Forms
• 4r''Elecfrical Coriduit-Undrgrnd. 1,' 55. Electrical Bonding
•
d..
5b Steel-Reinforcement 56. 'Rough Plumbing & Pressure Test
rr: -
6 Electrical UFER'Grnd., 57. APPROVAL TO COVER-GUNITE
74.1 Footings 58. Electrical Conduit-Undrgrnd.
8a Foundation- )-1 59. Gas Pipe, 0 Undrgrnd., Test
91:Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, 0 Undrgrnd.
-
10'..:Structural FloorSystem : 61. APPROVAL TO DECK
Prqpefty Sewer Line & House Connection
62. Backwash & Receptor-Final
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
t i
.1'6. Rough Electric Wiring 67. Fencing & Access Approval
17) Rough Wiring Sign 68. APPROVED FOR PLASTERING •
•
1:8;Rough:Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
•
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Roudh-Factory Fireplace , APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts„Ventilating Ii 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) WMonocoat 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
3i. Plaster Brown Coati. 79. FINAL INSPECTION
32. Electrical PowerMeter-Final 80. FOOD CERTIFICATE ISSUED -
33. Final Electric - Notes:(Net_a'9 t Ori t 'vc' " (tet ' _.
34. Final Heating & Air Conditioning ii��(n lege35. 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 ✓.7"
44. Landscape Irrigation System • 2
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
i ••• _ in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CON TR UCT O P RMIT PERMINO,T r65-- TRACT NO. I LOT NO. UNIT A P # Zone
Projecj�4ddrysr� U ADD U ALTERATION ❑ REPAIR S Main Building: Accessory Building:
f L' ci 'Ar7� Play �-4V TYPE OF CONSTRUCTION KNEW E Z
Applicant's Mailing Address 5 CI CONVERSION CI DEMOLISH CI OTHER T Front 0
Owner's Name �Z✓N'1/C Phone ��y11�j DESCRIPTION OF WORK/USE OF BLDG. I A Rear N
Address
TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ ST RAL I C Right N
Arch/Eng. License No. K G
Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ Left•
R
Co .c • Nam >^ r • one �s��i� ❑ OTHER Ping. Ref.# Parking Req./Provided E
PROJECT DESCRIPTION SQ. FT. O OCCUPANCY___ Q
A sjjfrh ing) - - pes 2 -^pfr Planning Notes: M
_ _I �1
CON STRUCTION TYPE `S- VALUATION$
Ci • License No. �-�t1�z -� //7 1l / ZONE -- GRADING CU.YDS. ACRES 1-1.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing 'Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. `3 145 3O ss- ' ELECTRICAL FEES
License Class License No.
Date Signature PLUMBING FEES Z Automatic Washer Transformer 0 15-50 KW
`YORKERS'COMPENSATION DECLARATION Construction Pole Sub. 0 50+KW
lereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ,
. Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink - uuking eni. t----- a Meter l sip to 100 amps ..---
3800, Lab. C.)
Policy No. Company - Backflow Irrigation Sewer Cap visowasner 2 ' Meter Dover 100 amps
U Certified copy is hereby furnished. Jh Dryers as DElectric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection t!•
Date Applicant Fan Motors 00.1 HP ❑1%-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
less).section need not be completed if the permit is for one hundred ($100) or —Dishwasher Solar Piping WF.A,(1 •7 Inc.Solar 09-15 HP ❑16-15+
I certify that in the performance of the work for which this permit is issued, I Fixtures
shall notyploy person in any man er so o become subject to the Drinking Fountains Solar Tank Microwave
Workers'06b/Yq/Wp' alien Laws of Californlnli
Dater Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:If after making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Outlets Range 6,QS 3 v0
comply with such provisions or this permit shall be deemed revoked. Switches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign / Sti'
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.) • a Garbage Disposal i Standing Sections .5-CLender's Name Interceptors Water Heater
Lender's Address Kitchen Sink Water Service Generator ❑0-5 KW 05-15 KWa Trash Compactor
OWNER BUILDER DECLARATION -tea
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash 3 YLp
o ✓ illiccJ l.22 a -
following reason (Section 7031.5 Business and Professional Code: Any city or //��
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays 4.71/ •03s_
any structure, prior to its issuance, also requires the applicant for such permit r
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
-e Contractor's License Law (Chapter 9(commencing with Section 7000)of ,
vision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee ! $15 Issue Fee $452- Q/
arefrom 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). DEVELOPMENT SERVICES REQUIREMENTS:
LII, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date
License Law does not apply to an owner of a property who builds or improves /3/(� VISA?thereon, and who does such work himself/herself or through his or her own Application Issued By /C�-��� VC-a%LAS Date O��-✓ /
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
7owever,
the building or improvement is sold within one year of com- Canopy Type II ❑ SUMMARthe owner will have the burden of proving he/she did not build or im- Duct- Under Ground
r the purpose of sale). - BUILDING PERMIT $ SMIP $
owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System _ PLAN CHECK $ PERMIT
to construct the project (Section 7044,Business and Professions Code:tractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or imoroves thereon. and who contracts for such oroiecls with a con- ENERGY P.C. $
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ID Multiple 0 System Repair/Alteration PLAN CHECK 25% $
proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ ly3. /5GRADING $
IDI am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date - Owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ /713 4/
5-
I hereby c reify that I have read his application and state that the above 0o-100,000 BTU 0100,000 BTI. PLAN CHECK 25%
informatio is correct. I agree to comply with all city and county ordinances - $
andd stat state laws relating to building construction, and hereby duthorize repre-
sentatives of this city to enter upon the above-mentioned properly for
inspection our•• e Date J/
Signature - ►
DATE: 0E/25/29 7Ii'c: 13157
0865-46,rev. 5/88 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING P( & SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
O r.
t224 Soil Pipe-Undrgrnd. 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
• 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE --
r'
T. Footings - 58. Electrical Conduit-Undrgrnd.
. 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
i 12. Sewer Cap 63. Heater & Vent-Final .-
I 13. Roof Drains - 64. Plumbing System- Final
r• 14. Rough Plumbing - 65. Electrical-Final
% 15. Rough Electrical-Conduit - 66. Solar System-Final
.16. Rough Electric Wiring iTac` J-"-�-7-q ,� 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
i20. Rough Factory Fireplace APPROVALS Permit#
I21. 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 la>r- 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing t.• 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
?0. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
52. Electrical Power Meter-Final II 16181 (Sid? 80. FOOD CERTIFICATE ISSUED
33. Final Electric 001 Notes:
34. Final Heating & Air Conditioning/: i ' • y^' I + r
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 1
39. Water Service-Final
40. Gas Service-Final •
41. Solar Domestic-Final I
42. Backflow Preventer ..v
43. Backflow Irrigation
44. Landscape Irrigation System .. ,•,,.
45. Sound Attenuation
46. Handicap Regulations - -
47. FINAL STRUCTURE & BUILDING '2 '
48. Special Requirements Completed
'49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY I I
No. Date 1
•
CITY OF COSTA MESA
• PARK FEES
Fee Payment Receipt 001197
Project Address 152 Merrill PlaceC, A— 0 (at 34" -a (37 loot CO Ve J fiA&/81
A.P. Number 4262 — 13 2 — 01,7 O7. 00035633-00035633 TOT 4917.:
¢
Building Permit Number y Z ,SCS 5.91_51t�� DATE: 06/19/89 TInEC 1I107
Owner's Name (V11 KE, Ta 1 bon 4. Ste V& LIt�beraer
Mailing Address 5L* 1 411100 Pkwu 144.4 .trYi ne q 2,714
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76 =
3-Bedrooms @ 1,205.67 =
4-Bedrooms @ 1,545.62 =
5-Bedrooms + @ 1,810.50 =
Multiple Family **
Bachelor or Studio @ 474.37 =
1-Bedroom @ 573.18 =
2-Bedrooms 'I 881.51 =
k
4
3-Bedrooms+ @ 1,229.38 A D+} q 1Ig2
,r Total Fee ***44/117.91
Planning Department Appr'1 I Date f0� I
• / By I
Applicant's Signature 1' c
* City Ordinance 72-44 ** City Ordinance 72 *** City Resolution 78-116 I „� 1
CMF 0174-30,rev.7/85 white—Planning;Canar, .-fanning;Pink—Finance;Goldenrod—Applicant \, MIR