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HomeMy WebLinkAbout2136 SABOT COVE - Building Permits . D `�(N.,"•-11---€,k, • CITY OF COSTA MESA \ .., • O ' y�►...y30"�„s CALIFORNIA 92628-1200 P.O. BOX 1200 > o _ t DEVELOPMENT SERVICES DEPARTMENT , `64"0. 95a 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 W44 Irvine, CA 92714 77 FAIR DRIVE Building Division (714)754-5625 • Code Enforcement/Business License(714)754-5234 • Planning Division(714)7545245 • �c A CITY OF COSTA MESA 4 - BUILDING DIVISION >y'n�..� DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER t PERMIT E02-00380 Ng (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2136 SABOT COVE Status: ISSUED Suite No Applied: 05/09/2002 Vicinity: Issued: 05/09/2002 Parcel Nunmber: 93603080 Applicant: ANTOINES INTERNATIONAL TILE & MARBLE ISSUED BY: Address: 10661 ELLIS AVE UNIT GPhone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 Owner: ESPENSCHIED, MARY FRANCES Address TR - NEWPORT BEACH,CA Phone: PO BOX 592 Zip: 92661-0592 Contractor: ANTOINES INTERNATIONAL TILE & MARBLE Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 License: 667375 SCOPE OF PERMIT BATHROOM REMODEL.REF B02-00648.2 OUTLETS • • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $25.70 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)7545626 2418-4e(890) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will this et is certificatesof consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. GH I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. \,My worker ' Isatlo rance-cprrier and policy number are: / {� Carrier: C '1'� r'W Policy Number: I(Q7C� // (This section need not be completed If the peis valu:• :t one hundred dollars($foo)or less.) ❑ I certify that In the perfo ,- -of the w•• f.r wt ch . is permit Is issued,I shall not employ any person in any manner so as become subject to the workers' coder,''• ews• - :'• •ia,end an:0 hat i I s ould become subject to the workers'compensation revisions of$ectlo 3700 of the Labor Code,I shall forthwith •• pg :se y••si.,. - L 0Z pplicant Signetet ',SA SS (/jplp[y_a)te: • -RNI •• R. 05• RE• ORKE.+ "ENSATION, E-•GE IS UNLAWFUL AND SHALL SUBJECT AN OVER TO CRI PENALTIES AND CML RNES UP TO ONE HUNDRED . THOUSAND DOLLARS($100,..;. ADD • ••0 THE COST 0 ".•.•• NSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS -DECLARATION:'km I here. :• m that I am Ilc:n•:d-'f of C .pt-A1(commencing with Section 7000)of Division 3 of the Busines and ssionseCode,end my license is in full fort: im lc.a 0..,:-0..,:- / . C Canty: tors •'attire. A. S SVAV i 0 gra,,,. e' ,u ,—, CONSTRUCTION LENDING AGENC ❑ I hereby affirm that there is a•• • lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Wit the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ __ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermif for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 01 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE 0 AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with al :te laws : • city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the Asabove-described•r••arty for insion•rp ..I agree not to occupy or allow occupancy of any building authorized by this permit u it final inspection. � � •rI ner(s) _ ate An. •t Auih. zed ••pli t WI CODE • r•,� E gMELS LODE( INSPECTION TYPE fall Mai 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 7/47/0- aC/t'>`jw� 201 Final Block/Retaining Well 212 Final Fire Prevention /P(� 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 . Final Demolition 250 Final Building/Occupancy Cg F CITY OF COSTA MESA 4 ►9@ BUILDING DIVISION >• „„,,,,,w„, DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER t: pis PERMIT 11111 +Porno 4b' 02-00309 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2136 SABOT COVE Status: ISSUED Suite No Applied: 05/20/2002 Issued: 05/20/2002 Vicinity: ISSUED BY: Parcel Nunmber: 93603080 Applicant: BRIAN TREMBLAY Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 Owner: ESPENSCHIED, MARY FRANCES Address TR NEWPORT BEACH,CA Phone: PO BOX 592 Zip: 92661-0592 Contractor: ANTOINES INTERNATIONAL TILE & MARBLE Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 License: 667375 Arch/ Eng: Address: Phone: Zip: License: SCOPE OF PERMIT B02-00648. 1 SHOWER. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor • $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $33.30 • COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21.92) 'EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • 2448-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. a? 1 have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. , �C My workers'compensation Insurance carrier and policy number are: Cartier. Policy Number. (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law • - _-- and :• •• •: hould become subject to the workers'compensation provisions ofSelion 3700 of the Labor Code,I shall forthwith comply :se•rovisio ` /I7 `— r ,AppcanbSignat ru a liSig _� �Delc ( WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI��NAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby afflrmthatFFamlic•nsed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Profession;Code,and my license is in full force anEeffecf.Llc.# � . 7 S Class# CS L Contracto_rsS�g�ur: ��t_ Date Zaire_ CONSTRUCTION LENDING AGENCY: . ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Ul Yes L-I No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized Ee by this peer/mit until final inspection. And/Or Autho�zed'Applicant �.J L Date CODE I Ifl$PEGTIONTYPE ' gdIE INTITIAL$ FOOE! INSPECTION TYPE `- PATE I8II0A1.S 1616 Fixed System FinalFire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing 7-0.2-0Q ,r/ttiptl- 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy o • 'F 9 CITY OF COSTA MESA 4 BUILDING DIVISION F • ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �4 PERMIT `�� V02-00648 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2136 SABOT COVE Status: ISSUED Suite: Applied: 05/09/2002 Vicinity: Issued: 05/09/2002 Parcel Number: 93603080 Zoning: Applicant: ANTOINES INTERNATIONAL TILE& MARBLE ISSUED BY: Address: 10661 ELLIS AVE UNIT G - Phone: (714)968-3555 FOUNTAIN VALLEY,CA • Zip: 92708 Owner ESPENSCHIED, MARY FRANCES Address TR NEWPORT BEACH,CA Phone: PO BOX 592 Zip: 92661-0592 • Contractor ANTOINES INTERNATIONAL TILE & MARBLE Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 License: 667375 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT BATHROOM REMODEL. - FEE SUMMARY Plan Check: $54.11 Calc Valuation: 53,000.00 Permit: $83.25 - Claim Valuation: $3,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $137.86 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR,INSPECTIONS CALL: (714)754-5626 244&46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the.3urtormarye of the work for which this permit is issued. ".• I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers' pensati--onlnsura ce carrier and policy number are: /(9 7S' /J,(`_3_ Carrier: . --17PAC. Policy Number: 11 (This section need not be completed if the perrni is valued of one hundred dollars($100)or less.) ❑ I certify that in the ped! ? :'of the wo, f+r w h t permit is issued,I shall not employ any person in any manner so as to come subject to the workers' co•,_ 5: o la mia,end agr:: hat'V sh••become subject to the workers'compensation provisions of Se tion 300 of the Labor Code,I shall forthwith •mplywit th•.in" , . . /� // Appli :• e: I..$J� ♦ _ L • q Date: 6 �/ WARNING:FAIL ARE TO 11119.11 WO' ERS'•• PENS TION COVE-•GE IS•NLAWFUL AND SHALL SUBJECT EMPLO TO CRIMIN PE LT1ES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN••DITION P THE • T OFCOM' NSATI• ,DAMAGES AS PROVIDED FOR IN ON 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED TRAOTORS D CLA: •TION: I hereby tfirrn" at I am licens:d •d: •rov • s ofhap ..11 9(commencing with Section 7000)of Division 3 of the_Busi ss of ssions Code,and my license is in full force and . .. e • _ - / Class-if 1 Contractor's Sign. . e: i_PA, t 1 Q -nor es CONSTRUCTION LENDING AGEN•� ❑ I hereby affirm that there is a col ction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or 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-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE ' 'D AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I ogre: - ply with all .tate I: s an. city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-de ' .ed property for ins/p: ion• rpos' I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ell ature ! Leg. ••wner(s) Q I Date / ii.' ^I ILDC) t A •Or Autho zed ••pll : t U -Date CODE 1 INSPECTION TYPE PATE INTITIALS CODE( INSPECTION TYPE GATE INIIUALS 1616 Fixed System ' :I Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing , 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy 9-69 '0 GW fl- �1. M4 CITY OF COSTA MESA p L. 1.x,1'1';$ CALIFORNIA 92628-1200 P.O. BOX 1200 DEVELOPMENT SERVICES DEPARTMENT +`O C" 4Fnv- fe 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(7141 754-5234 • Planning Division(714)754-5245 iL fl{51�J'\.L�-+� _aiJ EotCove Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF'P�gg ST MESA CONSTRU IO ERMIT iM PERMIT NO. TRACT NO LOT NO. UNIT NO. �T.� FojectQ.4 '?�I�i2 Mer•ri�� A 4 6 ) 3 BAASO Mgt /40 Par Zm2am LYYi���� '' 11S Main Building: Accessory Building: Applicant's Mailing Address S. I 4i ma. / / s4/ TYPE OF CONSTRUCTION XL NEW LI ADD U ALTERATION H REPAIR E ► !Z //��s --// 6 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T_ D r T Front Z3 �. 10 Owner's Name {./lid.a& s• Phone . ' A I z N DESCq IPTI�N OF WOR r/USE OF BLDG. f4J K� OW Rear5 i Address A-4,LLIA/Q f CA . • r' ti/ i. r i - i = - C Right 5 el N Arch/Eng. License No. , TYPE OF PERMIT • GRADI ❑ F•-NDATION r STRUCTURAL K / e" IG • Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ Left ICJ '3 ..� �r� R,, Contractor's Name C / Phone ❑ OTHER 1 Ping. Ref.4 Da_ SI_Oe/ Parking Req./Provided S/-S E PROJECT DESCRIPTION SQ. FT.327 'Yr OCCUPANCY_R2 PlanningNotes: O Address (marling) �s �/ .�s OL M CON ST RUCTION TYPE SF VALUATION S�So .IL -'p5 ""� - � � �"•'� - —_._------ --— zoi.L__ GRADING CU. YDS. ACRES y t i':/co C4 - it It( iii`[-C.: T ; LIC .' 'rJ CONTRACTOR DECLARATION I_I Ir �'�f It .�i Ll.l:•I. 3.. ""'- ' i I., ,: :,turn ' 'i bees sod unocr ,.uns of Charter 9 (commencing Remarks: with sectionis 7000) of Divi • 1C Business and Professions Code, and my license is in full force ' - elect. tes- ELECTRICAL FEES License Class License No. �� PG R Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORKERS' COMPENSATION DECLARATION Construction Pole Sub. ❑ 50+ KW I hereby affirm that I hay., a certificate of consent to self-insure or a certificate Bar Sink ShowersI of vrorxeis' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter Dup to 100 amps 3800, Lab. C.) Dishwasher Meter Cover 100 amps Policy Nq. Company Backflow Irrigation Sewer Cap r _Certified copy is hereby furnished. Dryers ❑Gas DElectric Sub Panel Certified copy is filen with trig city Building Division. Bathtubs Sewer Connection Date Applicant Fan Motors 00-1 HP 01%-B EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred (5100) or F.A.U. Inc.Solar ❑915 HP 016-15+ less). Dishwasher Solar Piping I certify that in the per ormance of the work for which this permit is issued, I Fixtures shall not employ any person in any mann¢r so as to become subject to te Drinking Fountains Solar Tank Microwave Workers' omp a'i99 Laws of California / .I /// DateO �fe mO� Signaturee4_ Device Boxes / Pole Light Floor Drains Swimming Pool w/Spa `/// 9 NOTICE:Compensation orois ions ofi h, you r becomesubject to iter - Outlets comply provisions of the Labor Code, you et forthwith h FlOpr Sinks Urinal Range T with suchprovisionsIGor this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Service Switches Sign I Gas Outlets Water Closet 9 herebyrthat there is a construction lending agency for the performance work the for which this p r3 Til is Mss ue (Section S 97 Civ. C.) Garbage Disposal Standing Sections Lender's Name At Ci ftp-➢hl Interceptors Water Heater -- L c ,eer's Address .St_JJ_I=C—$r• c 1,l l i.J,'>C T-[4 • Kitchac Sink Water Service Generator ❑O.5 KW D5-15 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-Trao Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit , o file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - , e Contractor's License Law (Chapter 9 (commencing with Section 7000)of Avision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee I $15 Issue Fee _ the'elrom and the basis for the alleged exemption. Any violation of Section I -I __ $ 3 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: ❑ I, as owner of the property or myemployees with wages as their sole Reinspection Fee $15 - Issue Fee OP. ' y y e $ 3 Zoning Approved By 1 Date !b compensation, will do the work, and the structure is not intended or offered _ ST for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Imo' Date License Law does not apply to an owner of a property who builds or improves w". / ' iter eon, and who Goes such work t/herselt or through his or her rjwn Application Issued By - /_. _Dat`-"/_`1 employees, provided that such improvements are not intended or efiere coot Boiler Hood or Type I ❑ • sale. If, however, the building or improvement is sold within one year of coal- Canopy Type II 0 SUMMARY OF FEE pletion, the owner will have the burden of proving he/she did not build or ir'. Duct- Under Ground (� • e for the purpose of sale). . BUILDING PERMIT $ /1.0/y 00 SHIP $ P� 7 ' as owner of the property, am exclusively contracting with licensed coir- Duct-Structural Refrigeration System PLAN CHECK $ 67.1 PERMIT ractors to construct the project (Section 7044, Business and Professions Code:'•t The Contractor's License Law does not apply to an owner of property who, ,-'S Duct- Ventilating100,000 BTU ❑100,000 BTU ISSUANCE $ builds or improves thereon. and who contracts for such oroiects with a cont, PLUMBING $' tractor(s) license pursuant to me Contractor's License Law). I am aware that\•.. Exhaust System 0 Multiple 0 System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $ proof of then Worker's Compensation insurance should be provided to me.,( ELECTRICAL $ GRADING $ • 0 I am exempt under Section B. & P.C.for this reason . , Firepl/Fact.Bit. ICBG d Fire Dampers MICROFILM $ PLAN CHECK 50% $ L] � Date Owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ 3 /73. 2 I hereby certify that I have read thi application and state that the above100 -100,000 BTU 0100,000 BT1.� information is correct. I agree to comply with all city and county ordinances I PLAN CHECK 25% $ and slate laws relating to building construction,and hereby authorize repre • - sentatives of this city to en er upon the above-mentioned pro rty for inspection purposes. / , Signat ure e,- Date h Drivers' License or SS* air - • Reinspection Fee $15 Issue Fee $ 3 I . . • 0865-46.rev. 5/88 White - Building: Canary • Applicant: Pink -Accounting:Goldenrod - Assessor - -CONSTRUCTION AND PLANNII `OL & 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 3. Electrical Conduit Utihiy-Undrgrnd. 54. Foims 4.i Electrical Conduit-Unciw td. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 070739 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10' Structural Floor System 61. APPROVAL TO DECK • 11. 'Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof'Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Concluit 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. RoughiHeating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough-Factory Fireplace APPROVALS Permit# 21. Ducts, iu_Structure 70. Underground Hydro 221 Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil • 23: Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25; Roof Sheathing 74. Overhead Hydro 26. T-Bar-Gelling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe Lathing &-Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric • - • Notes: '/ Ma // 34. Final Heating & Air'Conditioning 35. Final Gas Pipe-Test , ate1/4 44/ c. LthJ( p[�* 36. Hood or Canopy OFIZ3� N oT V- P•Q'-\ 37. Final Factory Fireplace O% r/Cr) 4/' 38. Final Plumbing 39. Water Service-Final %t- CONSuCT 40. Gas Service-Final 2- . X1 (b� N(f� � n 41. Solar Domestic-Final I 1 `^CJ / 42. Backf Vow Preventer, 2-hib '. .\n. . S� ' 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation' "� - 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 11-??-5 7 c 48. Special Requirements Completed Or/q1, / s 49. Electric Release to Edison 50.,Gas Relee to Southern California Gas Co • - - v'- 51. CERTIFICATE OFOCCUPANCY No. Date • i • • • CERTIFICATE OF COMPLIANCE ,2 VOQ • PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCHOOL DISTRICT Developer/Applicant : 114)e- d �L�'�,.n✓ - 1 �5 `_ . Address : _ US/ 4-,Tont' PA/CC.L' 6/ c/ Telephone Number : `7/ 1-4 72'i & CI ( -t O Tract/Parcel and Lot Number(s) : n Location of Project : / 5 Z /`Yr' 12/2i It 7/izcc (-P1 Number of Square Feet ofG7L/.3 ,&/4, J5 Residential Space . ' x $1 . 50 Total' . 544 . 0 - p yl O O &ten,o Number of Square Feet of /,3 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 . Bus` ess Manager Newport-Mesa Unified School District • • • • BREMNER • G RA•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 Civil Engineering trading plan. This plan has been labeled "AS-BUILT" and with the Surveying • exception of the revisions made thereon, this project has been Zc..i_tructed Land Planning within substantial confortnance of the approved precise grading. plin. Sincerely, • Bremner (haves Cornorition re - �` '3erL""' David W. Graves, P.E. • • Enclosures cc: Mike Talbott, V.N.E. Devc:iopineut • RECEWEE f!OV 0 9 1989 CITY OF COSTA ME PUBLIC SERVICE • 4350 Von Karman Ave •. Suite 100 Newport Beach,CA 92660 • 714 •756 • 1811 FAX •719 .851 .5910 I PROJECT ADDRESS: a )34 UNIT:AMB \ CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 045011 OWNEWSNAME: MICHAEL TALBERT ADDRESS: 5051 ALTON PKWY #44 �� — PERMIT NO: P 045011 PLAN CHECK NO: N GOVT : N SUPP : N IRVINE 92714 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE : NEN ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION • : GAS LINES SQ FT : ADDRESS: UNIT: CLAIM VALUE: CALC--VALUE: GROUP UCC: / PERMITTEE: MICHAEL TALBERT ( 714 ) 721-3745 ADDRESS: SAME COMMENTS: REFER TO #38950 IRV. CA 92714 ******************************************************************************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: _)(S :TATE LIC.: CLASS: Date: l ! )I 7 '1signature: /11 - J MAIN BUILDING - - - -------- - - - - ACCESSORY BUILDING WORKERS'COMP RATION ECLARATIO I hereby affirm that I have a certificate I consent to sell-insure or a certificate of Workers' FRid'I; FT IN REAR : FT IN FRNT: FT IN REAR : FT IN Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT - IN RGHT: FT IN ' - POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 42613201 ZNE: REF NO: ❑ Certified copy is hereby famished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: ****************************************.*******it******************************w EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1001 or less). DEVELOPMENT S E R V I.' C E S. . - R E Q U I R E M E N T S I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . " DATE: Date: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : .- DATE: __ Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION ENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for AP P L I CATION ISSUED B Y: DATE: I - ( - 601 which this permit is issued(Section 3097,Civ.C). ***************************itiF'3FiF3F3F�*3F7FTf t3��iFFFFiiiiT £ F ****************** ** UNDER: ******************************************************************************* ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: N OWNER BUILDER DECLARATION: I hereby affirm that l am 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: My 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 for such permit to file a signed statement that he/she is licensed S pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 254 r N I P/NON-R E., PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil 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, win do Inc work, and the BUILDING-DIV-- > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE EJ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTAL S--- - > 4 . 00 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 REVENUE DIVISION TOTALS--> COLLECTED• 7. 00 OVER/SHORT' • . 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve • 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).lam aware ********************************************************************if*******N•** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE BREAKDOWN O I am exempt under Section: B.8 P.C. for this reason: Lrstand �—^' TYPE QTY DESCRIPTI O N UNIT COST TOTAL COST Date: I / ( Owner: `6` Y PLU 2 GAS SERVICE 2 . 00 4 . 00 I do hereby I o that am aw a of and the iremems of California Health and Safety Code Sections 25505,255 and END OF FEES L 25534 and that I or any future building occupant ArDwilt/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from i. Nese provis✓`\ 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 • ordinances and state laws relating to building construction and hereby autlgnzgtepresentatives of this city to enter upon the above-mentione property for inspec' n purpos 5 i j 'v/ /f�1� / Date: I /.> Signature: • Driver's Licen or Soci Security Ir: '. 164146 white—Buifdino:Green—Code Enforcement:Canarv—Aoplicam:Pink—Revenue:Goldenrod—Assessor - CONSTRUCTION AND PLANNING Date Inspector 1-,..,,JL & SPA Date Inspector APPROVALS _Permit * APPROVALS Permit # 1. Tgmporary Electrical Service or Pole 52. Pool & Equipment Location . - -2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3."Electrical Conduit Utility-Undrgrnd. 54. Forms . i 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • '1. 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE , 1 7.:Footings 58. Electrical Conduit-Undrgrnd. 1. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval . 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ., -_ .. . FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace _ - .. , , APPROVALS . Permit # 21:Ducts, in;Structuie ..: 70. Underground Hydro ' 22. Ducts, Ventilating., ' - .- •• ' '.71. Product Piping ❑Gas OOil 23. Gas-Pipe-Rough & Test ,. :72. Underground Flush 24. Roof Framing . 7 _. . - 73: Undergrnd.Storage.Tank 0 Gas 0 Oil 25. Roof Sheathing - - 74. Overhead Hydro 26_-T-Bar Ceiling (Structural) &'Monocoat I 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 - 11/e(t LICQ - • 36.. HoOd or Canopy .. . . . . 37. Final Factory Fireplace • - -- . - .. 38. Final Plumbing , -, akin t4' , • _ 39. Water Service-Final . - , -• . 4 "'40. Gas Service-Final ' . 41. Solar Domestic-Final -- - • .. • 42. Backf low Preventer - 43. Backflow Irrigation • • 44. Landscape I'rrigatidn System- _ ' 45. Sound Attenuation - • - . 46..Handicap Regulations - - •. 47. FINAL STRUCTURE & BUILDING . 48. FINAL PLANNING . . _. .49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co .. , -51. CERTIFICATE OF OCCUPANCY ' . - No. Date I llf/ AJ'✓NI LO51e (LR0.Lv/3Gl .. .. ... __ _. ... .. ... ......... .. • __ _ _ CITY O�tCO$T MESA CONSTR UCTI /O1N PERMIT __URMIT NO. Si TRACT NO. LOT NO. UNIT NO. A.P.afy Project Addre�/SZ. Me aat k\ P/6-cL� 4 39 y Zone [Tr / S Main Building: Accessory Building: Applicant's Mailing Address -5-6.57 Al rd Pk""Y 1 y'( TYPE OF CONSTRUCTION ❑ NEW ❑ ADD U ALTERATION U REPAIR E - IZ 10 CONVERSION ❑ DEMOLISH C OTHER ; T Front IO Owner's NaMe —115-1 oT MRita e L Phone7 . 4�9e B IN DESCRIPTION OF WORK/USE OF BLDG. Rear Adds A-t✓/rvc / CH `Td7/� A I Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION U STRUCTURAL C Right N /� G U ❑ TENANT ❑ ELECTRICAL 'PLUMBING ❑ MECHANICAL S Left Address r - R Contractor's Name Phone ❑ OTHER I Ping. Ref. 41. Parking Req./Provided E Address(mailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCY _ Planning Notes: M CONSTRUCTION TYPE VALUATION S _ City License No. T ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION -- S. I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: B JAG c with section 7000) of Division 3 of the Business and Professions Code,and C ` my license is in full force and effect. ELECTRICAL FEES License Class License No. Automatic Washer Transformer 0 15-50 KW Date Signature PLUMBING FEES WORKERS'COMPENSATION DECLARATION .y a�-�' Construction Pole Sub. 0 50+ KW ••) I hereby affirm that I have a certificate of consent to self-insure or a certificate 0 X Bar Sink z N Showers 4 VY I f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit —� Meter ❑up to 100 amps aa00, Lab. C.) Dishwasher Meter Dover 100 amps Policy No. Company Backflow Irrigation Sewer Cap fCertified copy is hereby furnished. ,,/ Iyy Dryers ❑Gas ❑E ectric Sub Panel ❑ Certified copy is filed with the city Building Division. 4 y Bathtubs 2 9( Sewer Connection t 9 Date Applicant (!! Fan Motors❑0-i HP ❑1,-B EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers / Solar Collectors (This section need not be completed it the permit is for one hundred (5100) or. - F.A.U. Inc.Solar 09-15 HP 016-15+ less). 4 Dishwasher j Solar Piping Lrl. I certify that in the performance of the work for which this permit is issued, I 0,/1 Fixtures spall not employ any person in any manne o as to become subject to the Drinking FountainsSolar Tank Microwave Workers' Com ea�sation Laws of California ..--- mite _r,.- 4 7 - 7i�1 (Signature JDevice Boxes Pole Light Floor Drains Swimming Pool w/Spa9 [ 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 comply with such provisions or this permit shall be deemed revoked. '7 • CONSTRUCTION LENDING AGENCY / 12 Switches sign Gas Service Outlets 4i Water Closet ru 9 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors 4WrHeater Garbage Disposal Standing Sections Lender's Name �/',/ Li Lender's Address 2 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'/. dr_ Lavatories Auto-Wash ' O� following reason (Section 7031.5 Business and Professional Code: Any city or L7r, pt, -- _j- - . county which requires a permit to construct,alter,improve,demolish or repair P-Trap / Laundry Trays arty structure, prior to its issuance, also requires the applicant for such permit to rile a signed statement that he/she is licensed pursuant to the provisions of I Roof Drains the 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 refrom and.the basis for the alleged exemption. Any violation of Section Reinspection Fee $15 Issue Fee $ 3 31.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). DEVELOPMENT SERVICES REQUIREMENTS: 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • compensation, 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 FEES Building Approved By License Law does not apply to an owner of a property who builds or improves ` �l Date o thereon, and who does such work himself/herself or through his or her own Application Issued By Cit - 7,‘ lel employees, provided that such improvements are not intended or offered for Boiler . rHood or Type I ❑ Date (0 � sale. If, however, the building or improvement is sold within one year of com- - Canopy Type II 0 pletion, um owner will nave the burden of proving he/she did not build or im- Duct- Under Ground SUMMARY OF FEES nr 8 for tee purpose of sale). — BUILDING PERMIT $ SMIP $ 1 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System rectors to construct the project (Section 7044, Business and Professions Code: PLAN CHECK $ , PER MIT 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 improves thereon. and who contracts for such projects with a con- _ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ 1 System Repair/Alteration I It PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ 0 lam exempt under Section B. 8. P. C.for this reason Firepl/Fact.Bit. ICBG 44 Fire Dampers MICROFILM $ / ��,, PLAN CHECK 50% $ nate �c-/�-7_._,/b)_ Owner __AA.,_ hIs F Heating System&Ducting Registers MECHANICAL $ {�J��� I hereby ertify (hat I have read this application and state that the above 00-100,000 BTU 0100,000 BTL.— TOTAL FEE $ information is correct. I agree to comely with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction,and hereby authorize repre- sentatives of this to enter upon the above-mentioned pro rty or inspection purpose Signature ______ itj.- T Date Z Rte( Drivers' License Or Sss 4. Aft{3 $15 Issue Fee $ 3 t ' e.46,rev. 5/e8 White - Building; Canary - Applicant: Pink -Accounting: Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1, Temporary Electrical Ser vice or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. TC, 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grncl. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water"Pipe-Undrgrnd. ;47e , " 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10..Structural Floor System 11 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection q-2614 (AV 62. Backwash & Receptor-Final 12. Sewer,Cap 1 63. Heater & Vent-Final 13: Roof:Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final ^� 15. Rou h Electrical-Conduit r g 66. Solar System-Fined 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 APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ?1.. ploduct Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test . / ,// • -72. Uncle grognd 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. F.OOD.CERTIFICATE ISSUED 33. Final Electric Notes �,• � '�, ,vat- f* '°:/r . !/ c_i-:,.r.-(I 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ii/A4-1 tEQ - 36. Hood or Canopy / 37. Final Factory Fireplace 38. Final Plumbing (ii2DM LED - 39. Water Service-Final • C•1-//K- 40. ,. s..0-40. Gas Service-Final 41. Solar Domestic-Final 42. Backf low Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 4„ 46. Handicap Regulations H 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Ge:.Ce C 51. CERTIFICATE OF OCCUPANCY t' No. Date ( �f / 59/a/ '� ✓ 5,470 n_ Q ' eo vE- • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 1 - -_ - IT E A ONST [ PERMIT NO TRACT NO. LOT NO. UNN IT N CITYj OF dress MESA CONSTRUCTION PERMIT F 372g� LJ A.P. Zone Project Address 2- nt�lC19-0 S Main Building: Accessory Building: SGS[ Iii Tnw YI{sals (r{-c((/ TYPE OF CONSTRUCTION b4 EW U ADD U ALTERATION REPAIR E — Z Applicant's Mailing Address Front ,�sa-LIJo IT •7209 1Q(' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - 18 N Owner's Name 1 l s Phone DESCRIPTION OF WO'K/USE OF BLDG. - 1 Rear Address ., , • "9� Nr/ - . S:/ A , I Arch/Eng. License No. TYPE OF PER - IT��ss//�I III K - G GRADING . FOUNDATION 11 STRUCTURAL C Right N Address LiTENANT ic,ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left l \ R Contractor's Name—©7/3 Phone ❑OTHER I Ping. Ref.# Parking Req./Provided • E Address(mailing) PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: - M CONSTRUCTION TYPE VALUATION$ City License No. ZONE GRADING CU.YDS. ACRES T LICENSED CONTRACTOR DECLARATION S. 1 I h. by affirm that I am licensed under provisions of .v - ' (commencing Remarks: /` 3 8'4 L' Q with sec • ••s •f Division 3 of the = • and Professions Code, and my license is in full force an. - +.._ ELECTRICAL FEES License Class License No. r — - D.te Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATION — Bar Sink Showers / Construction Pole Sub. ❑ 50+ KW izrOC., I hereby affirm that I have a certificate of consent to self-insure or a certificate _ ♦,f Workers' Compensation Insurance, or a certified copy thereof (SectionCooking Unit Meter ❑up to 100 amps 3800, Lab.,C.) Backflow Preventer Service Sink - Policy No. Company Backflow Irrigation Sewer Cap - Dishwasher Meter Clover 100 amps Ti 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 ❑1X-B (This section need not be completed if the permit is for one hundred($100)or - F.A.U. Inc.Solar❑9-15 HP 016-15+ less). Dishwasher Solar Piping I certify that in the performance of the work for which this permit is Issued 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. --. Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE: If,after making this declaration,you 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 AGENCYGas 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 to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000)ofdr Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 06 therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: LJ I, as owner of the property or my employees with wages as their sola Zoning Approved By Date compensation, will do the work,and the structure is not intended or offered $ 3 Reinspection Fee ` $15 Issue Fee I 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 ® 'i thereon, and who does Such work himself/herself or through his or her own Boiler Hood or Type I 0 Application Issued By Date 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 ❑ - SUMMARY OF FEE plelion, 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- Duct-Structural Refrigeration 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 who Duct-Ventilating 00-100,000 BTU 0100,0008TU PLUMBING $ ISSUANCE $' builds or Improves [Hereon. and who contracts for such oroiects with a con- - ENERGY P.C. $ tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ELECTRICAL proof oftheir Worker's Compensation insurance should be provided to me. $ 3 O • 00 GRADING $ I 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLAN CHECK 50% $ MICROFILM $ Date Owner Heating System& Ducting RegistersOO I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT MECHANICAL $ TOTAL FEE $ 30 ' Information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to b ilding Construction,and hereby authorize repre- sentatives of this city t nter upon the above-mentioned pr erty for inspection purposes. 7 Signature 4- // / Date /3 0.% Glha, 1' Y R Drivers' License or 55 9f Reinspection Fee $15 Issue Fee $ 3 7%t i JT/.i. /QS [f . Er' Tr_1 Ci• 1./r:9 TRW: In;a• 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING . POt..- &SPA ,AjPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector r • 1 I '", 1. Temporary Electrical Service or Pole iJ/7J (p L� 52. Pool & Equipment Location 1'2.Soil Pipe-Undrgrnd. ( 53. Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd. 54. Forms .%} 4. Electrical Conduit-Undrgrnd. i i 55. Electrical Bonding ,�_ • ,I• 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test .r 6. Electrical UFER Grnd. i; 57. APPROVAL TO COVER-GUNITE , • f' 7. Footings 58. Electrical Conduit-Undrgrnd. 8. .Foundation 1 • 59. Gas Pipe, 0 Undrgrnd.,Test !; d.e:Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System • , 61. APPROVAL TO DECK j,`, 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final ' - i 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final if pi Rough Electric Wiring 67. Fencing & Access Approval 1117. 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 t.20. Rough Factory Fireplace - APPROVALS Permit# r21.-Ducts;in Structure , 70. Underground Hydro 22.'Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil 23.;Gas Pipe-Rough &Test 1•" 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT •31. Plaster Brown coat 79. FINAL INSPECTION ?2, Electrical Power Meter-Final 4* /// 80. FOOD CERTIFICATE ISSUED 11 i 33. Final Electric 'en i9 Totes: 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 • I' 40. Gas Service-Final ( 41. Solar Domestic-Final '� �. 42. Backflow Preventer ./2.-4., n %'. 43. Backflow Irrigation ' i 44. Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations , � 7 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison `' 50. Gas'Release to Southern California Gas Co '.) e' 51. CERTIFICATE OF OCCUPANCY '' • r No. Date '- _. .n • ' L_-_-y 1 r Ay -r a r �-Cl IAA.-, A•plicant to fill in all spaces except those within heavy horde: lines and sign all appropriate declarations. re._,— --_ -. _ _ - _ --_._ _. __ . _ _a 4 • .., CITY OF COSTA M .A CON : • I �_y_:•.-.— .�� PER • .._.,.'. .. Zone MIT NO. • •• • • • Project Addr._� ��a$— ..v �s—Jens r S Main Building:APP - Accessory Building: Applicant's Mailing Address Y a / a A) (.Lt tY TYPE OF CONSTRUCTION I NEW U ADD . ALTERATION REPAIR E • IZ 10 CONVERSION El DEMOLISH ❑ OTHER T Front 10 Owner's Name `� �n-v(/UC Phone G '� " 7y� DESCRIPTION OF WORK/USE OF BLDG. I B Rear �N Address C ❑ STRUCTURAL C Right N Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING IDFoury DATION/ K G Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL S Left {I R Contractor's Name Phone ❑ OTHER Ping. Ref.# Parking Req./Provided ` E c�� PROJECT DESCRIPTION SQ. FT. OCCUPANCY PlanningNotes: 0 Address(mailing) C�� ( � M /lI ()J/i•L1� CONSTRUCTION TYPE VALUATION $ City License No. ZONE GRADING CU.YDS. ACRES - T LICENSED CONTRACTOR ARATION S. I hereby affirm that I am licensed untie, provisions of Charter 9 (commencing =111=n4 ' with section 7000) of Division 3 of the Business and Professions Code, and a my license is in full force and effect. 4 _ J c2 s' ELECTRICAL FEES License Class Date Signature License No. PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION DECLARATIONConstruction Pole Sub. 0 50+ KW • I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers 1 \ 1 of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter Dup to 100 amps 3800, Lab. C.) 1 Policy No. Company Backflow Irrigation Sewer Cap Dishwasher. Meter Dover 100 amps Certified copy is hereby furnishe . Date Applicant Sub Panel Da Certified copy is filed with the citydBuilding Division. Bathtubs Sewer Connection Fan Motors O0-1 HP ❑1%-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100)or F.A.U. Inc.Solar 09-15 HP 016-15+ less). Dishwasher Solar Piping Dryers ❑Gas DElectric I certify that in the performance of the work for which this permit is issued, I Fixtures Microwave I shalt not empl any person in any manse so as become subject to the Drinking Fountains Solar Tank Workers' ion Laws of California. Device Boxes Date Signature C Floor Drains Pole Light NOTICE: 1 ,a/tei making this declaration,you should become subject to the I Workers' mpensation provisions of the Labor Code, you must forthwith Floor Sinks Gas Service Outlets Water Closet Outlets Sign comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Switches Si n I 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 p PC.77v` Interceptors Water Heater Lender's Address Kitchen Sink Water Service Generator 00-5 KW 0515 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto Wash I. 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 _ the Contractor's License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3 therefrom and the basis for the alleged exemption. Any violation of Section r 7031.5 by any applicant for a permit subjects the applicant to a civil j any of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: E I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee - $ 3 co ensation, will do the work,and the structure is not intended or offered Zoning Approved By ����JJJJ nate for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date y 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 \ (�s�07 Fir employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Date sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground SUMMARY OF FEES prove for the purpose of sale). BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- •uct-Structural Refrigeration System tractors to construct the protect (Section 7044, Business and Professions Code: _Cl/ PLAN CHECK $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct- Ventilating r 0.100,000 BTU ❑100,000 BTU So PLUMBING $ ISSUANCE $ I. builds or improves thereon, and who contracts for such orniects with a con- - tractor(s) license pursuant to me Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ 0 I am exempt under Section B. & P.C.for this reason /y Firepl/Fact.Blt. ICBG# • . Fire Dampers le PLAN CHECK 50% $ MICROFILM $ • • • Date / Owner k.)1 u Hng System& Ducting Registers MECHANICAL $ 'd0 "' 0 TOTAL FEE 6Q, alb I hereby citify that I have read this application and state that the above % 0.100,000 BTU 0100,000 BT $ Wiginformation 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- sentatives - sentatives of this city to or upon the abve-mentioned property for Inspection purpos Signature DDate '• - Drivers's' mLicense SS Reinspection Fee $15 Issue Fee 865-46,rev. 5/88 White - Building; Canary . Applicant; Pink • Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Insp. 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil,Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4r Electrical Conduit/Undrgrnd. 55. Electrical Bonding .f . 5. Steel{Reinforcement, • 56. Rough Plumbing & Pressure Test 6. Eiecirical LIFER drnd:- 57. APPROVAL TO COVER-GUNITE 7. Footings, ` 58. Electrical Conduit-Undrgrnd. 8. Fotiddation• 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: SevLe7 Cap 63. Heater & Vent-Final 13. Root 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 1'7. 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. REOUIREMENT 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 [(Jaen 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 1t(nM Lfp 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date • aQi 3(p albOt Cove a t.j' Applicant to fill in all spaces except those within heavy border Ilnes and sign all appropriate declarations. icy �0 T MES✓✓ALL' CONSTTRU TIO VEER MIT 6�� I P@ �AIT��7 /0 TRACT NO. LOT NO. UNION � AP # 2one ' )ict A dress _ �NI� ,4-4 8 ,a�-/�` r1 S Main Building: Accessory Building: ) tJ �•1,2 TYPE OF CONSTRUCTION ❑ NEW U ADD U ALTERATION REPAIR E Front 12 OApwner's Mails 1- Address 4 ❑ CONVERSION 0 DEMOLISH 0 OTHER 1 T ,N Owner's NameAL -� ' i L. �� ���' 's :ne ESC�RI}IPTI•O,N OF W, RK/US14F{B2LDG•/gy C_ 4zx.i7a.cic — gRearAddressw &'/a r(.e� Y • 9 9Arch/Eng. �I V'Iv License No. TV E OF PERMIT GRADING ❑ FOUNDATIOI 0STRRUCTUL K'�L ht G Address 0 TENANT 0 ELECTRICAL 0 PLUMBING fII MECHANICAL S LeftIR 0 OTHER / Ping. Ref.# Parking Req./Provided E Contractor's Name �../ .=•r__4/ '"�/a . Phone ee E -'7 • � / , .) r PROJECT DESCRIPTION SO. FT. OCCUPANCY `$ Planning Notes: a Address(mailing)l-a L' 1�i � . !J ^7` �� M J CONSTRUCTION TYPE VALUATION 5 T City License No. /S��.°� ZONE GRADING CU.YDS. ACRES S.i LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: I - . with section 7000) of Divisio• 3 of the Business and Professions Code,and AI my licen is i full force and I ec t '1 ELECTRICAL FEES Licen I • Li. n-- oo. .)--641.W-1 ,e 5 : IC_3 71. 0 e Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORK RS' OMPENSATION DECLARAT 0 Bar Sink Showers Construction Pole Sub. ❑ 50+ KW I hereby at firm that I have a certificate of consent to self ns re or a certificate •V� of Workers' Compensation Insurance, or a cer ' sed c ("crept a eaten Cooking Unit Meter pup to 100 amps \V 3800, Lab. / l Backflow Preventer Service Sink e -`�� / • Dishwasher Meter Dover 100 amps Policy No. p��! Comp a �- Backflow Irrigation Sewer Cap N1(.'.T,�Cerlili dicopy is hereby .furnished. Dryers ❑Gas ❑Electric Sub Panel I/Gperli I d toll d with the city n. Bathtubs Sewer Connection i N. !Date_ if Applicant �e Fan Motors 00-1 HP 01%-8 I EXEMPTI N F OM ORKERS'COMPENSATION • LARATION Clarifiers Solar Collectors (This section need not be completed if the permit is f.,.ne hundred ($100)or Dishwasher Solar Piping 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, 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. Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE: If,afle' making this declaration, you should become subject to the — - 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. Switchesr CONSTRUCTION LENDING AGENCY Gas Service Outlets Wales Closet 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 Clv. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Water Service Generator ❑0.5 KW ❑5.15 KIN Trash Compactor OWNER BUILDER DECLARATION 1 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 renters r es a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays prior structure, prior to its issuance, also requires the applicant for such permit 'o file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains e Contractor's License Law (Chapter 9(commenting with Section 7000)of ' vision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee J $15 Issue Fee $ 3 1 ierefrom and the basis for the alleged exemption. Any violation of Section .. _ . . • 7031.5 by any applicant for a permit subjects the applicant to a civil _ 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 I $15 Issue Fee Zoning Approved By Date compensation, will do the work, and the structure is not intended etl n ractord 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 properly who builds or improves _ ___ G �� -. i thereon, and who does such work himself/herself or through his or her own Hood or Type I ❑ Application Issued By _ ��a, - oat: • _ - — employees, provided that such improvements are not intended or offered for Boiler ���'�'—' sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ SUMMARY OF F ES r 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 $ 0 I, as owner of the broperty, am exclusively contracting with licensed con- Duct-Structural Ref4geration 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 who Duct-Ventilating P0.100,000 BTU 0100,000 BTU 13' po PLUMBING $ ISSUANCE $ builds or improves thereon. and who contracts for such oroiects with a con- U tractor(st license pursuant to tne Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration PLAN CHECK 25% $ NE R�V-r�'.C. ^$ proof o11 their Workers Compensation insurance should be provided to me. ELECTRICAL $ g „' GRADING • .r) I. ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG* Fire Dampers i e•-. PLAN CHECK 50% $ MICROFILM -S... - Date Owner He ng System& Ducting Registers Q- MECHANICAL $ -51 • E $ c!. '9‘ 41 I hereby certify that I h �fj� read this application and state that the above J0-100,000 BTU 0100,000 BTU /$ dU PLAN CHECK 25% $ (I e/ oQRp Information is correct. II to comply with all city and county ordinances ( 1VT'Q and state laws veldt'rg 'iding construction, and hereby authorize repre- sentatives of this c ty ten upon the above-mentioned p •P art or Inspection purposes. ) ' 1/O I1� r1;_ Cos_•. -�9"• Signature '••�iIISAt D.te s a a / �L� C�•1 L Drivers' License or 55 g v 0865-46.rev. 5/88White - BulIdine. anary - Applicant: Pink -Accounting; Goldenrod - Assessor ' • CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole. 52. Pool & Equipment Location 2. Soil Pile-Undrgrnd. 53. Steel Reinforcement 3rElectrical Conduit Utility-Undrgrnd. 54. Forms 4' Electrical Conduit-Undrgrnd. 55. Electrical Bonding • 57.Steel•Reinforcement 56. Rough Plumbing & Pressure Test 6.• Electrical UFER.Grnd. 57. APPROVAL TO COVER-GUNITE 71. Footings 58. Electrical Conduit-Undrgrnd. a: Foundation • 59. Gas Pipe, 0 Undrgrnd., Test 9: Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer:Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing " 65. Electrical-Final 15. Rough Electrical'.Conduit 66. Solar System-Final 16. Rough,Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical-T Bar Ceiling .- 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20: Rough Factory Fireplace - • APPROVALS Permit # 21. Ducts, in:Structure • . 70. Underground Hydro 22. Ducts, Ventilating • • 171. Product Piping 0 Gas 0 Oil - 23. Gas Pipe-Rough & Test • 72. Underground Flush - 24. Roof Framing 73. Undergrnd.Storage Tank O Gas ❑Oil ' - 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame arid-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 Biown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED '• • 33. Final Electric Notes: 34. Final Heating & Air Conditioning J(((Z jg(,c 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • • • 51. CERTIFICATE OF OCCUPANCY Vo. Date _ I • ./ •, /21 �ato°t (/�`sC. Applicant to fill in all spaces except those within heart I order lines and sign all appropriate declarations. ^ , y , OF cos?, .MESA ONS2TRU TION P ; QIT,/`• PERMIT NO. 9 3�� TRACT NO. LO1 NO. U;141. NO. I CITY (\d/ `� LC_ A.P. fig- Zone projot: AAress �1 i� S Main Building: Accessory Building: q cant's Mailing Address 93&I A Cr et r•-/ T''' / q TYPE OF CONSTRUCTION •C1/4NEW "U ADD U ALTERATION PAIR p' -. . 0 CONVERSION ❑ DEMOLISH 0 OTHER ,./ T Front •p Owner's Name y/�'ylk�� Phoned c//�1 G• DESCRIPTION OF WORK/USE OF BLDG. t 'fTr3 3z 0 �r j A Rear N Address TYPE OF PERMIT 0 GRADING U FOUNDATION El C Right IN Arch/Eng. License No. K Left G Address 0 TENANT OELECTRICAL 0 PLUMBING 0 MECHANICAL s R ) 0 OTHER Ping. Ref. # Parking Req./Provided E Contrac ' - P one(Qn7297 c1- M. PROJECT DESCRIPTION SO. FT. Y SO OCCUPANCY 3 PlanningNotes: O Address(mailing)_}- Zi P-r,rt-r- i� m!stgstv�!► M _ ' mt.. CON ST RUCTION TYPE VALUATIONS City License NO. - - "t L'J - • T ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION //yyTT 1 'I T I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: r�/'1 AR t{ I ON I 1J e with section 7000) of Division 3 o1 the Business and Professions Code,and ( L r• ELECTRICAL FEES my license is in full force and effect. Q r ri qS ID License Class License No. D �( ?{` '3O V J Date Signature PLUMBING ( FEES Automatic Washer Transformer 0 15.50 KW WORKERS'COMPENSATION DECLARATIONConstruction Pole Sub. 0 50+ KW Bar-Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate /� of Workers' Compensation Insurance, or a certified copy thereof (Section )y wuKmg Unit ' ,r-1 Meter 'Klp 10 100 amps �� 3800, Lab. C.) Backflow Preventer Service Sink �i'� F4— Policy No. Company Backflow Irrigation Sewer Cap Meter Dover 100 amps BCertified copy Is hereby furnished. Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant_ Fan Motors❑0.1 HP ❑1'/,-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit Is for one hundred (S100)orDishwasher SOtar Piping 'Fi+F•'}T Inc.Solar 09.15 HP ❑16-15+ less). - I certify that in the performance of the Work for which this permit is issued,I Fixtures shalt not employ any person in any mann r so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' CrLaws of Cn a Cali/or Device Boxes Pole Light Date �r 'f e -•-t----Y Floor Drains Swimming Pool w/Spa 9 NOTICE: If, ter making this declaration,you should become subject to the L- Outlets Range 6/1-7 Workers' CO pensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 111 3 00 comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCYSwitches Sign Gas Service Outlets Water Closet L / •SU I Hereby affirm that therewhiis a permit ssue Sefor the performance C¢ of the work for which this permit is issued (Section 3097 Civ. C.) Interceptorsrj� Garbdg¢Disposal Standing Sections / Water Heater Y'ts Lender's rvamc Generator 00.5 KW 05-15 KW Trash Compactor Lender's Address Kitchen Sink Water Service p ' OWNER BUILDER DECLARATION ' �/ / I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash ( A/.�s�� &Ceh.f� /f*Jr' following reason (Section 7031.5 BusIness and Professional Code: Any city or — 2-6-016 ��s T.J� 2.1-- any which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays w y T xe .0 33 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 the Contractor's License Law(Chapter 9(commencing with Section 7000) of /isW ' Division 3 of the Business and Professions Code) or that he/she Is exempt Reinspection Fee $15 Issue Fee L therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil ee natty of not more than five hundred dollars($500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS: L I I, as owner of the property or my employees with wages as their sole Reinspection Fee I $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 Date ' License Law does not apply tO an owner of a property who builds or improves thereo and who does Such work himself/herself or through his or her own Application Issued By at: 1 empi. ees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0 1 sale I, however, the building or improvement is sold within one year of corn- Canopy Type II 0 SUMMARY OF FE Me on, the owner will have tne burden of proving he/she did not build Or Im- Duct - Under Ground p ye for the purpose of sale). BUILDING PERMIT $ • SMIP $ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration 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 who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING 5 ISSUANCE $ builds or improves thereon.and who contracts for such oroieCts with a con- tractors) license pursuant to tne Contractor's License Law). I am aware thatExhaust System proofpinsurance shouldbe ProvidedD Multiple 0 System I PLAN CHECK 25% $ ENERGY P.C. $ 1 of their Worker's compensation to me. Repair/Alteration ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers E LE CTRICAL $ ¢• 7S` GRADING $ 434 t PLAN CHECK 50% $ MICROFILM $ Date p Owner 49-SHeating System& Ducting Registers MECHANICAL $ TOTAL FEE $ 1 hereby c rtify that I have read this application and state that the above DO-100,000 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- TeptallveT of Ihib city to enter upon the above-mentioned pr perty for . Inspection pur r// p Drivers' Signature �- n...ao-oa:e O v.Z $ 3 • , Drivers' License or SS q/ Reinspection Fee $15 Issue Fee ah „ vaa While . R,aininn. ran..., - . arrvv,ntino• rInldenrnrf . acceatn. \r CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit #_ Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - - 52. Pool & Equipment Location • , ' 2. Soil Pipe-UndrgrniI. - 53. Steel Reinfotcement . 3.,Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • 5. Steel Reintorcenient 56. Rough Plumbing& Pressure Test 6.• Electrical UFERrGrnd. 57. APPROVAL TO COVER-GUNITE 7..Footings 58. Electrical Conduit-Undrgrnd. • 8. Fburidation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,0 Undrgrnd. i10. 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.fElectrical-Final 15. Rough Electrical-Conduit lar System-Final 16. Rough Electric Wiring 9/41' Fencing& Access Approval 17. Rough Wiring Sign �o/ 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 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0Gas 0011 25. Roof Sheathing ` 74. Overhead Hydro 26. T-Bar'Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation • 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coat ( 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 1 . �/"-�/�/'/I 80. FOOD CERTIFICATE ISSUED 33. Final Electric /1 sett t✓'�" Notes: 34. Final Heating & Air Conditioning -. rt 35. Final Gas Pipe-Test 1 36. Hood or Canopy + 37. Final Factory Fireplace • 38. Final Plumbing r 39. Water Service-Final i 40. Gas Service-Final - ' 41. Solar Domestic-Final 1 42. Backflow Preventer f 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 , r No, Date - - 1 1 ��