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Home My WebLink About538 STURGEON DR - Building Permitsg� AGPlitant to /III In all ipaces except thosa within �eavy EorEer IIneS anE si9� all aDCropriate Eeela�atiOni. PE IT NO. THACT NO. LOT NO. UNIT NO. p cOS7A MEZS,Qq CO TRUCTION PERMIT �7� A.P. � zo�a _t Address �J V � �'-'� S eU`�'� �(�' " � S Main Building: Accessory Building: ' Applicant'SMailir�g�Addreu �,a �'rU�:�� Zf�(� TVPEOFCONSTRUCTION NEW AOD ALTERATION REPAIR E Z �71 am ? �� Gy�3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � _ ' T FrOnt p Owner'sName T �'� Phone_ Y ___-„ �(`.Q,{�,,,4` l�� ,('L,,, g N DESCRIPTION OF WORK/USE OF BLDG. Rear Address �� 5�'�.�.'t"Sr✓u� ,�,��_6 Q .. �e Ll� A I Arch/Eng. Lic2nse No. TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL � K Aight G AddreSS ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g� Left Controctor's Nam � `LL �' Phone .� �o�' ��OTHER t Ping. Ref. � Parking Req./Provided E PROJECT DESCRIPTION 5c1. PT. � oCCUPANC � Add�e551mailing) � '� CONSTRUCTION TVPE VALUATION $� Planning Notes: M �I T Cily License No. �� I l ZpryE GRAOING CV. VDS. ACRES LICENSED CONTFA�TOR DECLARATION S' I hGreby at(irm thdt � am licensetl unUer provislon5 Of Charter 9(commencing Remarks: wit� seclion 7000) ot DiviSiOn 3 Of the BuS��eZt and Professions COtla, antl my Iicense is in lull �� and etiect. �.1�! ' , ELECTRICAL FEES License Class LicenSe No. b Automatic Washer Transformer � 15-50 KW Date ��.'$ 5'g t y✓riLr � PLUMBING FEES WORKERS'COMPH�`15ATIONDE LARATION ConstructionPoleSub. OSO+KW I her¢by affirm that I have a certificate of tOnSent to salt-insure o� a C¢rtlfiwte Ba� Sink $hOW¢R - of Workers' Compsnsation Insurance, or a certitietl copy thereof (Section Batkflow Preventer Service Sink Cooking Unit Meter Qup to 100 amps 3800, Lab. � 1 • Policy No. �� 7�aCo pany ��✓'� a'T'Q�� Backflowlrrigation gyy,�e��P Dishwasher Meter ❑over100amps n�}'�`.ertifiea copy is nereby furnisned Dryers ❑Gas ❑Electric Sub Panel � certifietl op�' }i filetl with the c' ui tlid Dlvi ' Bathtubs Sewer ConnEction -' Date �_� /� ��[L— APP�� Fdn E%EMPTION FROM `MORKE0.5' O PENSATION DECLARATION Clarifiers SOldf COII¢Ct0�5 MOfOfS OO-1 HP O1 h� B (Thissection neetl no� be mmpletea if the permit is for one huntlr¢tl ($]00) or F.A.U. ' iess . Dishwasher Solar Piping Inc. Solar �9-75 HP �16�15+ I certi(y that in the per(ormante oi lhe work tor which this perm�t is issueQ I Fixtures zhall not employ ar�Y person in any manner so as [o become subject to lhe Dfinking FOuntains Solar Tank MiUo�Ydv2 Workers' Compensat�on Laws of California. Date Signatura Floor Drains Swimming Pool w/Spa Device Boxes Pole light NOTICE: If, after makinq this tleclaration, you shoultl become suDject fo the WOrkers' CompCnSatlOn pfovl51on5 Of Ihe LdbOr Cotle, you must fOltllwith DUtIEtS � Rd0 ¢ Floor Sinks Urinal 9 comply witlt such P/ovisions o� tnis pe�mit shall b¢ tleemetl �evokea. CONSTRUCTION LENDING AGENCV GasServiee �Ut12t5 W2L2�CI052L Switch¢5 $ig� I hereby affirm tha[ there is a construction lentling a9enty for the parformance of tne work for wnich tnis va�mit is issuetl (Section 3097 Civ. CJ Interceptors Water Heater Garbage Disposal Standing Sections L¢ntler's Name Lentler's Atltlress Kitchen Sink Water Service .. Generaror 065 KW �5-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm lha� i am exemp[ irom the Lontra<tor'S License Law for [ne LavatOries AutO-Waih following reason (Se«ion 7031.5 Buslness antl ProfeSsional Cotle: Any citY or county which requires a permit to construct, alter, Improve, tlemolish or repair P—Trap Laundry Tra�s any structure, prlor to its issuance, also requires the applicant for suth permit to file a si9nea statement that he/she Is licensetl vursuant to tM1e provisions of Roof Drains � the Contractor's LiGe�Se Law (Chap[er 9(commencing wi[h Sectlon 7000) of Division 3 of tne 6usiness antl Professions Cotle) or that he/she is exempt Reinspection Fee $15 Issua Fee there/rom antl lhe basis tor the allegetl exemPtlon. Any violation o( Section $ 3 �031.5 by any apPlicant for a permit zuDjects the applicant to a civil enaib ot not more than tive hunared aonars (E500). 3 DEVELOPMENT SERVICES RE�UIREMENTS: � I, as owner ot Ihe prop¢Ity oI my emp�oyee5 with wage5 a5 tll¢I/ sole RBinSpBttiOn FBB $15 ISSue FBB $ com0ensation, will tlo the work, antl the structuro is not intentlatl or otferetl Zoning Approved By Data for sale (Section 7044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES Building APP�o`red By Date �icense Law tloe5 nOt apP�Y to an owne� of a Property who builtls o� Im0/oves thereon, antl who tloes sucM1 work himsel(/herself or [hrough nls or he! own Applimt'on Iitued By — Dat / ¢mployees, provltled Ihat such improvements a�e not intendetl or ottar¢tl tor BDil2� HOOd O� Typ¢ I ❑ saie. If, nowever, tne builtlin9 or Improvement is soltl within one year of com- Canopy Type I I 0 SUMM V O PEES pletiOn, lhe owner `�'�� M1avG the burtlen ot provin9 he/she tlitl not builtl or im- Duct - UndE� GrouOd prove tor the purpose oi saie). `BUILDING PERMIT s l0 �D� SMIP $ .�� ❑ 1, as owner of the property, am ezclusively contrac[Ing with Ilcen5e0 <on- Duct- Structural Ref�igeration Syst2m lratto�sto con5[rud the Project (Section �044, Business antl Pro(essions Cotle: %PLAN CHECK $ PERMIT . Tne Contractor's License Law does not apply to an owner of property who Duct � Ventilating ❑P700,000 BTU ❑700,000 BTU builtls or imoroves tnereon. antl who contra<ts for such oroiects wlth a ron- ,"PLUMBING $ �SSUANCE $ tractor(sl license pdrsuani m me Contractors License Law). I am aware that Exhaust Syitem ❑ MWtiple ❑ System Repair/Alteration - P�N CHECK 25% $ ENERGV P.C. $ proot o1 their Worker's ComDensatlon insuranca shoultl be provitlea to me. ,ELECTRICAL $ GRADING $ ❑ 1 am exempt under Section B. 6 P. C. for this reason FirepqFact BIL iC60 # Fire Dampers MICROFI LM $ PLAN CHECK 50% $ 9 Date Owner � Heating SyStem & Ducting Registers ' MECHANICAL $_/�_' „�j I hereby certl/y tnat I have reatl this application antl ztate that tne above � ❑P700,000 BTU �100,OOOBT $ TOTAL FEE �✓� informat" rre«. I agree to como�Y witn all Uty antl county orainances PLAN CHECK 25% $ antl st e la s lating to builtling construction, antl hereby autnorize �epre-. sentaf es o k��ty to eot upon the above-mentloneG property �or� Inspe lio rpo5¢s, ^ p� Signat re Date / /�s�� ,� Drivers'• ce e or SS � - Applicdnq Plnk - ACGouniYng; GOltlanrotl - ASSe550r NSTRUCTION AND PLANNING � POOL & SPA PPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ',' 2. Soil PipG-Undrgrnd. ,' ' 53. Steel Reinforcement _ ' 3.'Electrical Conduit Utility-Undrgrnd. i 54. Forms 4. �Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement� 56. Rough Plumbing & Pressure Test � 6. Electrica,l UFER Grnd.' ' 57. APPROVAL TO COVER-GUNITE � 7. Footings � !� � 58. Electrical Conduit-Undrgrnd. I 8. ,Foundation �; 59. Gas Pipe, O Undrgrnd., Test �' 9. Water Pipe-Undrgmd. ' � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System � •� ' 61. APPROVALTO DECK 11. Property Sewer Line.& House Corjnection 62. Backwash & Receptor-Final 12. Sewen Cap �� 63. Heater & Vent-Final i : • 13. Roof Drains � � 64. Plumbing System - Final 14. Rougfi Plumbing � 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 18.' Rough Elearic Wiring 67. Fencing & Access Approval c� � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING .,t. 18� Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19r Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21 . Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush I 24. Roof Framing 73. Undergmd.StorageTank OGas ❑Oil j 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. Insulat�ion 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: �O � O v `C: 34. Final Heating & Air Conditioning ok'c �%�- ��<. 0 2. �- Z'�- �9 35. Final Gas Pipe-Test ' 36. Hood or CanopY 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preven[er % �y . � 43. Backflow Irrigation � 44. Landscape Irrigation System � ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING t z� 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co - j 9� CERTIFICATE OF OCCUPANCY , ,•'J . No. � Date - - _.?oPlieant to till in all spaces except those within heavY boraer lines ana si9n all aporapriate declarations. ��r COSTA �iESA CONSTRUCTION PERMIT ProjectF\ddress S38,Stur eon Dr. Costa Mesa ; Applicant:�MailingAddress 53$ Sturgeon DI. OSi3 V Owner'stvame Toan Duc Pham Pry�o 5+. �' Address ? 3 s S T u r g e o n U r. Costa Mesa y�� '� �. ArchlEng. �m �I��T� License No. ��%2 �(n� Address `�+13 First St. Suite B$�� Ana 92703 •• �_ Contractor's Nama��` Phone +—}'-zt++�+G' Address (mailing) . Ciry License No. - - LICENSED CONT0.ACTOR DECLARATION i� , I hereby affirm that I am licensed untler provislons of Charter 9(commencing � with section ]000) of Division 3 of the Business antl �rofessions Gotle, antl: my Ilcense is in full (orce antl ettect. � .�'- Y�•. License Class � License No. Oate Si9nature ' WORKERS' COMPENSATION DECIARATION !l� J�nereby af/irm Nat I have a certificate oi consent to selt-insure or a certificdte o/ Workers' Compensation Insurance, or a certifietl copy+Nereo( (Section . 3800, Lab. C.) � ' � , PoliCy No. Company � l' eCertifietl mpy Is hereby fumishetl. ' ' �Certifietl copy is (iletl with the city Bui In Oivi on. "�,��j�/ �. Date Applicant ',� ye[IY�" EXEMPTION FqOM WORKERS' COM ENSA�TION OECLAKATION�� ai � (Thissection neetl not be completetl if the permit is tor one huntlre0 ($300)`or � iess). � I certify that in tbe perto�mance of the work fo� which this pe�mit is ISSuetl; I'� � shall not employ any perzon in any manner so s to become subject'to the� , Workers' C�omp� n5� 0� laws of California ��/� -, Oale _¢_aILTZl�Signature � ��'r (634w� ` � � �NOTICE: �f, atter making tnis tleclara�n, you shOuld become subject to the Wo�kers' Compensation 0/ovisions of the Labo� Cotle, you must forthwith comply •with such provi5ions or tM1is permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby affi�m that�th¢re iz a mnstruction lentling agency for Ihe performance ot the work for •whicb is e,pU�t i i etl (Section 3097 Civ. CJ I..entle�'S Name � Lentler'zAdtlress �?3� �7uR�oN�OK _ ��ELE OWNERBUILDER.OECLARATION I hereby atfirm tnat�l'am exempt from the Conlracidr's�License Law for the tollowin9 reason (Section..7031.5 Business antl Professional Cotle: Any city or county which requires.a"permit to const�uCf, al[eq improve, tlemolish o� repair any structure, prior�to its issuance, also requires the applicant for such permit to file a sionetl statement that he/she is licensetl pursuant to the provisions of .� TYPE OPCONSTRUCTION LJ NEW C'9 aDD LJ AI.TERATION LJ REPAIR ' ❑ CONVERSION � DEMOLISH ❑ OTHER r� DESCRIPTIpN OF WORK/USE OF BL�G.T�O 'L�j��DRl�mS � � p-i�l�-. POYhG TVPEOFPERMIT�y GRADING�/ FOUNDATION $TRUCTURAL ❑ TENANT lJ ELECTRICAL LJ PLVMBING ❑ MECHANICAL '' O �OTHER - PROJEC7 DESCRIPTION 5(d. FT. ocCuaAN v ' , CONSTRVCTION TVPE �N -VALUATION $ ZONE � GRADING CU. VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation BdLhtubS Clarifiers'- Drinking Fountains � Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink ' Lavatories ,. � P-Trap� . "� �`, .. . _ Roof rains � , , ; therefrom antl the basis for Ihe allegetl exemption. Any violatlon o( Section � 'r � 7031.5 by any applicant tor a permi[ subjects tne aOPlican[ to a civil �dlty of not mo�e Ihan five huntlretl tlollarz ($500). � . I, as owne� o( the property ^^ ^-- �•"-.'^^: -- •`-'- -"�e Reinip¢Ction Fee 'prnpenfelieR, will tlo the work, antl the structure is not intentletl or ofteretl for sale (Section 7044, Business antl Professional Cotle: The Contractor's License Law tloes not apply to an owner oi a property who builtls or improves [hereOn, antl who tloes such work himself/he�self or through his o� her own BOil2! emPloyee5, provitletl that such Improvements are not intentletl or offe�etl for salo. I(, howaver, tM1e builtling or improvemen[ is sottl within one year nf cnm- pletion, the owne� will have the burtlen of proving he/she tlitl not builtl or im- DuC[ - UOd2� G�o�nd prove for the purpose of saleJ. - ❑ I, as owner of the property, am exclusively contracting with licensetl con- Duct - Structural Irac[ors lo ConSV uct lhe project (Section 7044, Business antl Protessions Cotle: The Contractor's License Law tloes not apply to an owner of property wno Duct - Ventilat��g builtls or imo�oves tnereon, antl wno contracts for such projects with a con- $15 tractor(5) license putsuant�to the �Contractor'S licen5e Law). I am awa�e that Exh3U5YSy5t¢m', ❑ MUltipl¢ ❑ proot of their Worker'S Compensation insurance shoul0 be,provitletl to me. � ❑ I am exempt untle� Section B. & P. C, fo� Ihis veason Firepl/Fact. Blt: ICBO # Date -� owner - Heating System D I hereby certify that I have reatl t is application antl state that the above ❑0-700,000 information is correct. I a9r¢e to w ply�wi[h all city antl county ortlinances antl state laws relating to building mnstruction, antl hereby authorize repre- : sentatives f this city t en r upon the above-mentionetl Oroperty for inspection o rp es. - Sigoature ✓ Dale�� Drivers' Licen e or 55 � % Reinspec[ion Fee CrotF OB65-46, rev. 10/84 White - Building; Canary - Applicanh Pink - Accounting; Goltlenrotl - Aszessor 00,000 $15 :� �-a� MBING ShoWerS Service Sink Sewer Cap Sewer Connection Soiar Collectors Solar Pipin - � Solar nk imming Pool w/Spa � Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee IANICAL Hood or Type I ❑ Conopy Type I I ❑ iefrigeratio stem �0-� , OOBTU ❑100,000 Sysrem Repair/Alteration �' Pire Dampers Registers ' Issue Fee FEES $ 3 0 $ 3 A.P. # S Main Buildi E T Front 8 Rear A C Right K Left S. Ping. Ref. # Planning Notes: 324"s' 4/16;8= � ��-{ JZ^L,--+ � Zone ' Accessory Building: ' Z O �i N I � i/ . N � � Z �� . G H Parking Req./Provided E Q ) , ! . 4'j? � Qi M )0 1.1ZS+� r3i7RF'i r s Automatic Washer Construction PoleSub. Cooking Unit � Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures '. Device Boxes Outlets Switches Garbage Disposa Generator -5 KW � ELECTRICAL Transtormer ❑ 15-50 KW ❑ 50+KW Meter ❑up Lo 100 amp5 Meter ❑over100a ' Sub Panel Motors -1HP�ih-8 .Inc olar �9-15 HP 016-15+ icrowave ' ' �Pole Light Range �- � Reinspection Fee I $15 DEVELOPMENT SERVICES q�Q 2aning Appraved By ' � �4 �� Building Approved By -__�S� Appliwtion luued By Standing Sections Trash Compactor r lisue Fee �� VTS: � FEES $ 3 S'U'M�MARCV �OF FEES � �j BUILDING�PERMIT $ � SMIP $ 'n�0 PLAN CHECK $ � PERMIT PLUMBING $ ISSUANCE $ PLAN�CHECK 25% $ ' ENERGV P.C. $ ELECTRICAL $ GRADING S _PLANCHECK 50% $ MICROFILM S +�,�� % MECHANICAL $ . TOTALFEE $ � PLAN CHECK 25% $ '�� 3'v"�' � � CONSTRUCTION AND PL�ANNING POOL & SPA • . �� APPROVALS Permit# ' Date Inspector p�ppROVALS Permit# Date '"Inspector . 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � � ` 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings �.-S`�iL s`{ k�7r.s / � 58. Electrical Conduit-Undrgrnd. __ 8. Foundation _ 59. Gas Pipe, O Undrgrnd., Tesi �� 9. Water Pipe-Undrgrnd. ' � 60. Backwash Lines, P-Trap,.O,Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ��- � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains 64. Plumbing System - Final •� 14. Rough Plumbing 65. Electrical-Final 15. Rough Electriral-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 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test - 72. Underground Flush � 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing � � 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing �� 76. Dry Standpipe -• 28. Lathing & Siding ,� � �� 77. FIXED SYSTEM FINAL • 29. Insulation (o �� G 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown CoaY " 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning S .r� - SG o k � 35. Final Gas Pipe-Test ��$G �r p, 36. Hood or Canopy t� _p /� � f `0 � f`��!lic� (�GT"(" � rN Q�C �! 37. Final Factory Fireplace � E. JJ. @' 38. Final Plumbing 39. Water Service-Final �� ' � ^7 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation . � _ 44. Landscape Irrigation System - 45. Sound Attenuation - 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING � • 48. Special Requirements Completed � • 49. Electric Release to Edison �� ` 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date � �^ 1� CityofCostaMesa INSULATION CERTIFICATION� BuildingSafetyDivision � 3 F� S 1 �otJ �tz _��s rt�. �,l�c�a- oR��G� Number and Street City County �32 Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF Material Brand Name Thickness (inches) Thermal Resistance (R Valuel EXTERIOR WAL4 /� Material �/YS[1�l4�`/On/,!`�� C%�d/�grandName Thickness (inches) Thermal Resistance (R Value) CEI LING Batt or Blanket Type � �� Brand Name Thickness (inches) Thermal Resistance (R Value) Loose Fill Type Brend Name Minimum Thickness (inches) Number of bags Weight per bag Ib. Area Covered (ft2) Thermal Resistance (R Value) FLOOR,ELEVATED Material Brand Name Thickness (inchesl Thermal Resistance (R Value) FLOOR,SLAB Material Brand Name Thickness (inches) Thermal Resistance (R Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R Value) DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings 1located in Title 24 of the California Administrative Codel. General Contrectar (Builder) License Num6er � �iran.�(�('� ,�� /ol.uaa l� �S, !98'� Signature and Title ) ` Date CMF 1306-46 Sub Contractor (Insulation Applicator) License Number Signature and Title Date � AOP��ant to till in all soatts except those wilnin heavY �ortler lines anO sign all apv�opriate tleelarations, CITV OFrCCSfiCMESA CONSTRUCTnION P� )Vll � Project Address %�� 2 ✓'S'� �A� , Applicant's Mailing Address �' '�r/ �r P�� -i%� � Owner's Name 7�'� ��G �um� PhOne � S— �f � Address �'Q�/'2P� Q.� �07lP/ Arch/Eng. � License No, Address � Contractor's Nam Phone Atldress (mailing) City License No. LICENSED CONTFACTOR DECLARATION I her¢by affirm that I am licensetl untl¢r provisions ot Charter 9(commencing witM1 section ]000) of �ivision 3 of the Businezs antl Professions Cotle, antl my license�is in (ull force antl eftect. License Class License No. Dale Signature WORKERS' COMPENSATION DECLARATION I hereCy aHirm that I have a certificate oi consent to self-insure or a certiticate of Workers' Compen5ation Insu�ance, o� a certifietl cOpy [hereot (Section 3800, Lab. C.) �% Policy No. Company ❑ Certifietl Capy is M1e�eby furnishetl. ' ❑ Certifietl copy is filetl with Ihe ciry Bulltling �ivision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (Thissection neetl mt be completeG if the permit is fo� one huntl�etl ($300) or less). !^ 1 certify tbat in the p¢rfOrmance of the wo�k (Oc which this permi{ is issuetl,-I shall not employ any person in any manner so as to become subject to the Workers' Compensation LawS of California. , � Oate $I9natur¢ 'NOTICE: If, after making ihis tleclaration, you shoultl become subject to the � Workers' Comp¢nsation provislons of the Labor Cotle, you must torthwith comply with such orovisions� or lnis permit, shall be tleeinetl revoketl. CONSTRUCTION LENDING AGENCV ' ' I hereby affirm that tM1ere is a construction lentling a9ency for the pertormance o( the work for whi ��{his' per is issy� tl tion 3097 Civ. C:) ' Lentler's Name �O� ��G `�H� Lentler's Atltl�eST y , � OWNE0. BUILDEH �ECLARATION I hereby affi�m that I am exempt trom the Contracto�'s License Law for th¢ followin9 reason (Se<[ion �031.5 Busine55 antl Professional Cotle: Any city or county which requires a permit to construct, alter, improve, tlemolish or reoair� any structure, prlor lo its issuance, also requires the applicant for such permit ' to file a si9netl'statement that he/sne is licensetl pursuant to the provisions af the Contractor's License Law (Chapter 9_(commencing wi[h Section ]000) of Division 3 of the eusiness antl Professions Cotle) or that he/she is exempt iherefrom antl the basis for tne alleqetl exemptlon. Any violation ot Section 7031.5 by any applican[ tor a permlt subjects Ihe. applicant to a civil �ey� Ity of not more than five huntlreG tlollan ($500). � I, as owner of tM1e prope/[y or my employ¢es with wage5 as thei� sole compensation, will Go lhe work, antl the structure is not intentletl or ofteretl �or sale (Se<tion �04a, Rusiness anC Professional Cotle: The Contractor's LicenSe Law tloe5 not apply t0 an own¢r of a properry who builtls o� impwves thereon, antl who tloes such work himself/herself or through his or her own employee5, provitletl Ihat such improvements are not intentletl o� ofteretl tot ' sale. If, however, [he builtling or improvement is soltl within one year oi com� pletioq [M1e owne� will have the burtlen Of proving he/she tlitl not builtl or im- �rOve for [he pu�po5e of sale). I, as owne� of the property, am xxclusively cont�aciing with licensetl com , t�actorsto conslruct tM1e pro�ect (Section ]044, Business antl Professions Code: -The CmGactor's License Law doe5 not appty [o an owner of property who builds or improves tnereon, antl who contracts for such projects with a con-' t�actor(sl license pursuant �ro tne Contractor's License Law). 1 am aware tha[ proof of their Worker'S Compensation insurance sltoultl be p�ovitletl to me._ ❑ 1 am eaempt untler $ection , B. 6 P. C. for thi5 reason � i hereby certify that I h 0 reatl tnis po�icatio antl st�hat the above in(ormation is correct. I agree to compty with all city antl wunty ortlinances antl 5[ate laws relatin9 to builtling COnstruG[ion, antl he�eby authorize repre- seniztives of tnis�city [o en[er upon the above-mentionetl property for inspettion pur �,.„.�� J p•� _ /1 / Si9nature �^"'� Date / �� Drivers' Licen or 55 � TYPE OFCONSTRUCTION LI NEW CgrADD LI ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � DESCRIPTION OF WORKNSE OF BLDG. T D �.D�--60�M� TVPEOFPERMIT� y� GRADING�t FOUNOATION STRUCTURAL� ❑ TENANT iy ELECTRICAL L�'F'LUMBING ❑ MECHANICAL ' -� OTHER PROJECT DESCRIPTION 5c�. C O N ST RUCTION TYPE_ ZONE Remarks: Z Bar Sink � Backflow Preventer '. Backflow Irrigation i' Bathtubs - Clarifiers � Jrinking Fountains Floor DrainS Flaor Sinks 3as Service I ntereeptorr Kitchen Sink . Lavatories ' P—Trap Roof Dreins Reinspection Fee T. OCCUPANCV N VALUATION $ _ GRAOINGCU.VDS. , ACRES_ Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimmin9 Pool wlSpa Urinal Outlets Water Closet - Water Heatei � • � Water Service � ' . Auto�Waih $15 BOiI¢r Duct - Under Ground , OuCi-StrUcturel ' � Duct - Ventilating Exhaust System � Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-100,000 BTU � 100,000 Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicanp Pink - Accounting: Goltlenrod - Assessor FEES laue Fea . ' � IANICAL Hood or Typel, ❑ Canopy Type I I ❑ - Retrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers i�2JI5LCf5 luue Fee 0 $ 3 FEES $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planninq Notes: Automatic Washer � Constructian Pole Sub. Cooking Unit D ishwasher Dryers ❑Gas ❑Electtic F.A.U. ' Fixtures Device Boxes Ouilets $WIiC�125 . Garbage Disposal Generator 00.5 KW 0 5oaa ��i�ias � , Zone Accessory Building: Z O N I N G R, Parking Req./Provided , E ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter ❑over 100amps - ",� Sub Panel Mators OO-1 HP O1'/: - 6 Inc.Solar. �9-15 HP �16 Microwave � Pole Li9ht ' I I; Standing Sections 545 KW � Trash Compactor -'� Reinspectian Fee �$75 I I Issue Fee DEVELOPMENTSERVICESRE�UIREMENTS: �Zonin9 APProved BY . Buildin9 Approved By l.//// -AppllCdtlOO ISSUBd BY 'L- � 5+ FEES $ 3 M T' 5' SUMMARV OF FEES ' BUILDING PERMIT $ SMIP $ � PLAN CHECK S PERMIT PLUMBING � $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL � $ �q�ry/ O� GIiADING $ PLANCHECK 50% $ �'�� MICROFILM $ 3./D MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ ' �_ \ CONSTRUCTION AND PLANNING POOL & SPA � Date Inspector Date Inspector -� APPROVALS Permit # APPROVALS Permit # l. Temporary Electrical Service or Pole 52. Pool & Equipment Location . Soil Pipe-Undrgrnd. , 53. Steel Reinforcement ,. Elec[rical Conduit Utility-Undrgrnd. 54. Forms _ 4. Elecirical Condult-Undrgrnd. 55. Electrical Bonding : 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �i 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE - �� 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Watsr Pipe-Undrgrnd. � 60. Backwash Lines, P-7rap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewsr Cap . 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough�Plumbing � SzyiL�L 1.�E0� 65. Electrical�Final 15. Rough Electrical-Conduit 66. Solar System-Final � 76. Rough Electric Wiring �,;;�� e 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. Ducte, Ventilating . -. 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test _ 72. Underground Flush 24. Roof Framing , 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing ' 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL ' 30. DryWall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICA7E ISSUED 33. Final Electric , (J � Notes: ' 34. Final Heating & Air Conditioning .,� 35. Final Gas Pipe-Test �/�� ' � 36. Hood or Canopy � . 37. Final Factory Fireplace • � 38. Final Plumbing . 39. Water Service-Final � 40. Gas Service-Final 47. Solar pomestic-Final ' 42. Backflow Preventer , � • � � 43. Backflow Irrigation � � - 44. Landscape Irrigation System 45. Sound Attenuation � � 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. SpeciTl Requirements Completed 49. Electric Release to Edison - , 50. Gas Release to Southern California Gas Co 57. CER7IFICATE OF OCCUPANCY , , , • No. Date . , '_ e _1 UL� g _ �c� g� j o W�f�M r i M� � GoN�fKN, L o T A�,oua�� c�l f� �+ To P-�Qur2��T 7a rq�q c�.l3.c Gi� P'i��. '10 .�R-a-D � N � . , ►� To�nl p'uc P++� M o,N N�R From the Dcsk of . . . WALLY LOUGI 2G555 JAN 30•67 0o as,# �*� 124.50 COS7A MESA BUILDINCrSAFETf DEPARTMEM P.O. BOX 12M COSTA MESA� CALIFORNIA Y2020 �