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HomeMy WebLinkAbout2869 TABAGO PL - Building Permits 4-�jt:L-' rr CITY OF COSTA MESA • � BUILDING DIVISION triSir, DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER PERMIT %meant' E05-00763 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2869 TABAGO PL Status: ISSUED Suite No Applied: 07/19/2005 Vicinity: Issued: 07/19/2005 • • Parcel Nunmber: 13933311 Applicant: SCOTT FARTHING ISSUED BY: Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA Zip 92627 Owner SMITH, GARY LEE Address 2869 TABAGO PL Phone: COSTA MESA,CA Zip: 92626 • Contractor: FARTHING DEVELOPMENT INC Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA - Zip: 92627 License:560875 SCOPE OF PERMIT ADD 126 S.F.TO EXISTING S.F.D.WORK TO INCLUDE: EXTEND EXISTING MASTER BEDROOM, RELOCATE GAS METER,CHANGE OUT WINDOWS THROUGHOUT S.F.D.AND REPLACE WITH DUAL PANE, VINYL WINDOWS TO MEET 1997 U.B.C.EGRESS REQUIREMENTS,ELECTRICAL AND PLUMBING WORK. REF.:B05-01195 ELECTRICAL TO INCLUDE:5 LIGHT FIXTURES,4 OUTLETS,AND 2 SWITCHES. 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 $5.50 5 up to 50 kva/kw $0.00 0 Recept Outlets $4.40 4 up to 100 kva/kw $0.00 0 Switches $2.20 2 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 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 2446413(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • o 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. ❑ 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars(5100)or less.) Ify 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,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith 3 comply with these provisions. t 7//y/DS Applicant,Signeture:; cDate: i . ETC—SECURE WORKERS'COMPEN COVERAGE IS UNLAWFUL AND SHALL SUEUECT AN E-lf�EcovER-TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED C AND DDOLLARE($100,000),IN ADDITION TO TH OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby-afflrmthatlam license pnger r o, p pier 9(commencing with Section 7000)of Division 3 of-the•Busines nd Professions Code,and my license Is in full n 'e ec. t# ��- -/O / �Iass;M. t or••r a,Drei (tea_ , j�i/0 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 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(5500).): ❑ 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 appy 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.). • O 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). o I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-properly tax bit 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). o 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 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 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 then 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 Safely 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 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 a ermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? 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). 8 Will any part 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 penally of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials end Emissions. Signature: Date: CERTIFICATE OF COMPUANCE 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Signature Of Leal ( Owner to/ �� 77 ' /e. Alit.A ' ,il etrAPAIiAO"�.� r.a te- ." - .- CODE/. WSPECT10N TYPE PIE IIWRALI CODEf INSPECTIONTYPF DAB BMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing `NO-06 200 Final Re-Roof 210 Final Electrical yNZ0 W 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bullding/Occupancy _ t3. CITY OF COSTA MESA BUILDING DIVISION > • P IT NUMBER , DEVELOPMENT SERVICES DEPARTMENT � I PERMIT M05-00541 444),ow (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2869 TABAGO PL Status: ISSUED Suite No Applied: 09/222005 Issued: 09/22/2005 Vicinity: Parcel Number: 13933311 ISSUED BY: Applicant: SCOTT FARTHING Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA Zip: 92627 Owner SMITH, GARY LEE Address: 2869 TABAGO PL Phone: COSTA MESA,CA Zip: 92626 RRIP Contractor FARTHING DEVELOPMENT INC Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA Zip: 92627 License:560875 SCOPE OF PERMIT FURNACE CIO FOR SFD REF#:6055-01195 1 INST FAU TO 100 K BTU AND 1 REPAIR/ALT COOLING/HEAT FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp!1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 - Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $52.00 COMMENTS/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 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 int expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(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. ❑ 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'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at 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 laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions / -1 '1 �) Appllcant.Slgnature:—• C i, , ' Date`--�� 7/??- WARNING:FAILURE TO S'- RE WORKERS'r.. - NSAI1ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE(5100,000),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 affirm that I am.liceAsed un er ro �99s hapter 9(commencing with Section 7000)of Division 3 of the Busineia and Professions Code,and my license is in full force end"effect..Lic.k ('J 5�� S / '----Class# �i7 Contractorgneture: _ /Date:. CONSTRUCTION LENDING AGENCY: L ❑ 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:An .:r tti •aunty 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 -c-r:'•'a.Cement 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'IF:' essions 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 a.:W:nt to aigvil penalty of not(more than five hundred dollars($500).): o'- ❑ aBusi of the pofr oriel: en wonth wages ais their sole compensation,snotly WILL DO THE WORK,and the structuresr is not Intendeder , offeredwo for sale(Sec. 7044,Business and Professions Cade: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 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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,Ad 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 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 0 No (Section 25505 of the California Health and Safety Cale 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 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 Quality Management District or from any other air pollution control district or agency? 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). 8 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 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign re Of Leg ner(s) Dale nd/Or'Authodz Applicant--—— ,.---. ., /Date , CODE. INSPECTION TYPE PAIS INTmALS CODE. )NSPECTION TYPE PATE alp/g1TlAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 'I'�'t Ui 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 q CITY OF COSTA MESA . BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER PERMIT P05-00557 4etwpomvine. (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2869 TABAGO PL Status: ISSUED Suite No Applied: 07/19/2005 Issued: 07/19/2005 Vicinity: Parcel Nunmber: 13933311 ISSUED BY: Applicant: SCOTT FARTHING Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA Zip: 92627 Owner: SMITH, GARY LEE Address 2869 TABAGO PL Phone: ' COSTA MESA,CA Zip: 92626 Contractor: FARTHING DEVELOPMENT INC Address: 904 DOGWOOD Phone: (949)500-2870 COSTA MESA,CA Zip: 92627 License: 560875 SCOPE OF PERMIT ADD 126 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:EXTEND EXISTING MASTER BEDROOM, • RELOCATE GAS METER,CHANGE OUT WINDOWS THROUGHOUT S.F.D.AND REPLACE WITH DUAL PANE, VINYL WINDOWS TO MEET 1997 U.B.C.EGRESS REQUIREMENTS,ELECTRICAL AND PLUMBING WORK. REF.:B05-01195 PLUMBING TO INCLUDE: 1 GAS SERVICE. 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 $0.00 0 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 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 2446-46(8'00) 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. 0 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) 131that 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. .7//9/&C /D �c— ruriS gsere: oats— S fMKTJRETO SECURE WORKERS' COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM-''.;i TO CfiIM1NAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1C0603),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I heteby.affirm.that.I am lice,se•under•rovision •f Chapter 9(commenting with Section 7000)of Division 3 of the Rusin and Professions Code,and my license Is in full n loe and�effact.Lie.N / / rY "" Signature;:% �r to- 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,CMI Code). Lender's Name: Lenders 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:My 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 drivers Ilgense. ❑Yes 0 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 feel 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 then 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 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 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 al 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 11 en RMPP is presently required,has Section 25534 of the California Health and Safely 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 end 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air(Duality Management District or other air pollution control district or agency is required for the work which is ififir 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 Of yes;attach certificate of compliance from the appropriate err 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • re Of Le.•1 er(s) to Alia 7 /� — An• ez:Aitt* 'replicant -----"'�„. _-,-.. �-.Rt,-6t__ CODE t INSPECOON TYPE BATE IL®9L5 C00E I INSPECTION TYPE PATE EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical �,( ,p 1266 Pool Spa Final 208 Final Plumbing y z0 t 1'JJ 1-- 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 Buil0ing/Occupancy CITY OF COSTA MESA BUILDING DIVISION >: •r,„,S DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER t' S I i PERMIT ro SL 04" B05-01195 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2869 TABAGO PL Status: ISSUED Suite: Applied: 07/19/2005 Vicinity: MASTER BEDROOM Issued: 07/19/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 13933311 Zoning: R1 Applicant: FARTHING, SCOTT ISSUED BY: Address: 904 DOGWOOD Phone: . (949)500-2870 — COSTA MESA,CA Zip: 92627 Owner: SMITH, GARY LEE Address 2869 TABAGO PL Phone: COSTA MESA,CA Zip: 92626 Contractor FARTHING.DEVELOPMENT INC Address: 904 DOGWOOD ' Phone: (949)500-2870 COSTA MESA,CA Zip: 92627 - License: 560875 Arch : Eng: L.P. LEAVITT Address: - Address: Phone: Phone: • Zip: License: License: 11792 SCOPE OF PERMIT - • ADD 126 S.F.TO EXISTING S.F.D.WORK TO INCLUDE: EXTEND EXISTING MASTER BEDROOM,RELOCATE GAS METER,CHANGE OUT WINDOWS THROUGHOUT S.F.D.AND REPLACE WITH DUAL PANE,VINYL WINDOWS TO MEET 1997 U.B.C.EGRESS REQUIREMENTS, ELECTRICAL AND PLUMBING WORK.TEAR OFF EXISTING ROOF.INSTALL 2 LAYERS OF 15#FELT,FIRE FREE PLUS LIGHT TILE,5.75 LB/S.F.,ICBO#5075,AND REPAIR/REPLACE SHEATHING AS NEEDED. ' FEE SUMMARY • Plan Check: $320.29 Calc Valuation: - $35,000.00 Permit: $492.75 Claim Valuation: $35,000.00 SMIP Res: $3.50 SMIP,Com: $0:00 Other • $0:00; • Inspection: ' $0.00 '. Total: $816.54; - , • PLANNING &ZONING SETBACKS I MAIN STRUCTURE Front 12 0' Rear 0-0 Left 10-0- Right '8-5 ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 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 2446-46(WOO) 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. ❑ 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'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) i t rgrtlty 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,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith Z comply with.these provisions. / / E:-- =WARNING:FAILURE TO SECURE(WORKERS'COMPENSA VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE rn OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice a nit vis>ior Chapter 9(commencing with Section 7000)of Division 3.of.ihetlusiness and Professions Code,and my license Is in full force and ect,Uc..kh* -... • -_. ! , /r pl�jy f n Siggatur - 2- �_ pets;�//9�0 S� 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 en 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 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,Califomia 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 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 Califomia 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 Calif omia 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No or illthe...pi..n.o.present... 5 Does he will the oast Air or Quality aor future building occupant at requirer for the work which is the subject a estion appermit for such construction or modification from the South Coast Air Oualiry Management District or from any other air pollution control district or agency? �Yes LJ No (Section 65850.2 of the Califomia 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? 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 Duality 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 ❑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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signal _-.4 eget Own; ,- Y//f/G Date Date A d/O :.tuii ;!_‘P• ^Ili -. , CODE I INSPECTION TYPE DATE INTmALs CODE INSPECTION TYPE ' " DAIS 18TB7AI& 1616 Fixed System Final 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 �Y, 204 Final Demolition 250 Final Building/Occupancy tit,"t41010 A.FzI= Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. - 5) 14 3/0' /8$ ' TI CITY OF COSTA MESA - • - PE IT NO/./ •/ • TRACT NO. LOT NO. BLDG.NO. • - • , 'o lf, CONSTRUCTION PERMIT WO �' ? - • - • Applicant's Mailing Address hS ` TYPE OF CONSTRUCTION - LI NEW U ADD U ALTERATION U REPAIR I Project Address 's 1' (.,q 77A'krnor ^ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - , • - ' Owner's Name �'�_�t l A"N Phone S1 k39 3'I DESCRIPTION OF WORK _ ZONING REGULATIONS - - Address A t TYPE OF PERMIT U GRADING U UNDATION U STRUCTURAL A.P.* ZONE Arch/Eng.. License No. 0 TENANT 0 ELECTRICAL.: PLUMBING 0 MECHANICAL . PLNG.REF.REF.* - BUILDING ' . , . CFTRArle (-Li $T - - • Address ❑OTHER • - - TO BUILDING. REAR YARD (TO P/L) �AC\'F- t C -1$4.5\A �39'917o PROJECT DESCRIPTION SG: FT- OCCUPANCY PROPERTY LINE - - - ' Contractor's NamePhone' - ` p , - LEFT SIDE YARD RIGHT SIDE YARD Address(mailing) ' n591 4cN}`\C3N "Y-I • G'� CONSTRUCTION-TYPE - VALUATION$ - 114 °1• Q---: 6i[-) 5943 ZONA GRADING CU.YDS. •.ACRES !KG.SPACE REG. ' • PROVIDED , t'' I - License No. - LICENSED CONTRACTOR DECLARATION ' , Remarks: : 1 STREET WIDTH ,PARK FEE.$ a ' I.hereby affirm that I am licensed under provisions of Charter 9(commencing - , - _ with section 7000) of Division 3 of the Business and Professions Code,and • I - • SPECIAL CONDITIONS: I , My license is In full force and effect. j II I g CI O - ' I , License Class, _ ycense No. �S -1 D I PLUMBING I - ' ' . Date�- �+R -W� Signature - - J • �(� I�%I 5 Bar Sink Sewer Cap - ELECTRICAL 9^RKERS'COMPENSATION DEC ATION - I - - - - . • ?-areby affirm that I have a certificate of consent to self-Insure or a certificate • ! \' Automatic Washer • , Meter Dover 100 amps • x"^4•Workers'"Compensation 'Insurance,-or-a certified-copy thereof (Section' -�- Backflow.PraventeL . ._ '-I .._ _Sewer Connection'. . - .. _ .. - _ . - _ _ 3800, Lab. C.) f • Backflow Irrigation Solar Collectors - - Construction Pole ;Sub Panel _ Polley No. 01639 IP I I Company ' - Cooking Unit • - Sub Pole ' ' • B Certified copy Is hereby furnished. - i Bathtubs i Solar Piping ' • i ' Certified copy Is Wed with the city_Bulldl Dlv on. 9,r Dishwasher Motors 00-1 HP 01K� Date • -•1 N -F 5 APPliwnl ' ' r 4 �1su�c��- Clarifiers ' ; Solar Tank ' ' - - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION- - Dishwasher I { Swimming Pool w/Spa : ' Dryers_ OGas,-0 Electric- - �I nc Solar 09-15 HP"016=15+ "' • • (This section need not be completed If the permit Is for one hundred (5100)or ' • less). ( v Fan• - 1Microwave I 1 all, y•that In the performance of the work for which this permit act,uetl I 1 . Drinking Fountains Urinal , , - , • shall•not employ any person In any manner so.as to become subject,to the I - - F.A.U. 'Pole'Light Workers' Compensation,Laws of California,! , Floor Drains; i 1 Water Closet : - ' . ' Data ' Signature i ' I 1 Fixtures �' t i I • • NOTICE:If,after Making this declaration,,you should become dubject to,the, Floor Smks a_ -, _ _ / Water Heater-__- _! _ _1. ." _ Q 'Range ., Workers' Compensation provisions of the Labor Code, you must forthwith '• Device Boxes i , comply with. such provisions':or -this-permit'shall be'deemed revoked., I f '. Gas Service' •Outlets! -Water Sernce � _ 'Sign1 • CONSTRUCTION,LENDING AGENCY ' -- .I ' . 1 I hereby affirm that Mere Is a.construction lending agency for the'performance • , Interceptors; Is, ;~� , • -'� I y ' I Outlets j island mg Sections j j of the 'work for which'•this permit:Is•Issued-,(Section"3097 Civ C" ' - I , Lender's Name ' ' ' ' Kltchen�Sink' A - 1 - Switches •Trash Compactor - I , Lender's -Address I ' -' I I S� i Garbage Disposal I 1 i i OWNER,BUILDER DECLARATION • ! v I '- - Lavatories 1 I hereby,of firm that i am exempt.from the'Contractor•s.License LBW for the. - ., . , - Generator 003 KW 05-15 KW ' ) following reason (Section„7031.5 Business and Professionai'Code: Any city or. P-Trap y - • -- . - • + I county which requires a permit'to construct,alter,improve,demolish'or repair : , - . Y • Transformer • , ' 015-50 K W any structure, prior to Its ce, also requires the applicant for such permit • , Roof Di-ami; - - . I ' to file a signed statement that he/she is licensed pursuant to the provisions of. - -- 050+KW. • , ' Reinspection Fee r,e Contractor's License Law(Chapter 9(commencing with,Section 7000)of 1 v °r ) R>e $15 Ision'3 of the.Business and Professions ptie),or that he/she is exempt i Showers - / _ _ ' Reinspection.Fee _ $15 efrom and the basis for the alleged exemption. Any.violicant to Section , Meter Oup to 100 amps .taus Fee. 5 3 �— .031,5 by 'any applicant for.a'rerm (ecls the applicant to, a. civil ; , l .. - 1 I _ chatty of not more than five hundred dollars(E500)i Service Sink• 1 • - Issue Fee $ 3 Zoning Approved By ^ Date • LJ 1,-'as,owner of the -property •or, my employees with'wages'as their sole ' - _ - - i .. i compensation will do the work,and-the structure Is not Intended or offered ' . - . MECHANICAL I . ' , Application Approved By I 'Data for sale'(Section 7044, Business and Professional Code: The Contractor's _ t ( y3 I ' License Law does not apply to-an owner of a property'who builds or Improves . Boi Her : I Refrigeration System ) Q - 2 O thereon, and who does such work himself/herself or through his or hot own 1 -- .Application issued By - (� Date c./ '-�11 ' employees, provided that such Improvements are not Intended or offered for Duct=.UnderlGrou nd • ❑0-100,000 BTU ❑100,000 BTU . sale. If, however, the building or improvement is sold within one yeahof corn- , SUMMARY OF FEES - ' elation, the owner'will have the burden of proving he/she did not build or im- - - r , rove for the purpose of sale). ' . - • , j 1 : Duct-Structural I , System Repair/Alteration `BUILDING PERMIT $ " SMTP • I $ 1 U 1, as owner of the property, am exclusively contracting.withilicensed con- i ' tractors to construct the-project (Section 7044,Business and Professions Code: • i Duct-Ventilating I ;PLAN CHECK. $ PERMIT- I i 7. -The-Contractor's-License Law does not-apply to-an owner of--property who-- • • _ O Q ISSUANCE r I' $ ' - L� builds or Improves thereon,and who contracts for such projects with a con- .�- Exhaust System 0 Multiple 0 I . ' • . ' PLUMBING • $ r tractors) license pursuant to the Contractor's License Law). • b I 'PLAN CHECK l $ i GRADING . $ 1-am exempt under Section ( t B.& P.C.for this reason , 1 Firepl/Fact.Bit.ICBG { - $ .. , - ;, ,ELECTRICAL $ • 1 • ' Owner • - Heating System&Ducting , MICROFILM $ ' - • •PLAN CHECK'- Date i hereby certify that li have read this application and.,state that the above ( I. 00-100,000 BTU 0100,000BTL $ - information incorrect- I-agree to comply with all City,and county ordinances -- - $ - I. TOTAL;FEE , $ ' -and state laws relating to building construction,and hereby authorize repre- • - Hood •or, Type( ❑, ' , MECHANICAL I ' sentatives of this ci to nter upon the above-mentioned property forReinspection Fee' $15 , , LESS - , ' inspection purposes • I Canopy' Type II ❑. I I I PLAN •CHECK- V' I py ADVANCED PC ' $ ' Signatum '•/ Q P ,i / Date ,�-4 d -•r1 3 . , , ' '..r'� ` Registers , Issue Fee $ 3 I ri V Drivers' License or 55 ' I I ' FINAL FEE. $ ` CMF 0865-46'rev'12/82• White-Building;Canary'APPlicanh Pink-'Accounting;Goldenrod-Assessor - - - - -• ' - - - - -- -'- ' - - --”' - - -'-- '' - . - •- --- : - - •- , C' CONSTRUCTION AND P.L NING 7 ,, '• ,--.. POC°°%�'+tSPA . - - ' Q'AJ7 _ , Date - :Inspector Date• Inspector' , ,APPROVALS . Permit#� - '-APPROVALS Permit+ • I 1. Temporary Electrical Serviceror Pole = `• ' „ .1 = 2'- ,'5Pool.&;Equipment Location '2.' Soil Pipe-Undrgrnd, `s : ' <- `., ` , ' ` 53. Steel Reinforcement :3. Electrical Conduit.Utility-Undrgrnd. , .1 '-. _ • >' __54, Forms' - - 4.IElectrical Conduit-Undrgrnd.-i' i • ' ▪. .7, -55 Electrical Bonding - ; = : 1-5.;Steel Reinforcement i ,' , - ;56 Rough_Plumbing& Pressure Test - • '6.; Electrical LIFER Grnd: -' - - 57I,APPROVAL TO COVER-GUNITE . - 7. Footings P�-t I i r F-.. t b'= - 58. Electrical:Conduit-Undramd. - - 1 ;; B.`Foundation _- '; '. t - ' 59.'Gas Pipe,'O Undrgrnd'.,Test , i ; 9. Water Pipe-Undrgrnd. . r A , 1 =. .60.`Backwash Lines,P-Trap, 0 Undrgrnd. - - f:' 10. Structural FloorjSystem =.v• ` : , .61. APPROVAL-TO DECK - : 11..Property Sewer Line& House Connection' , - . ,,62.E Backwash & Receptor-Final 12.;Sewer Ca =n Cap - _ E. - 63..Heater &Vent-Final . . 1 Roof Drains ' i 13. • - ' 64. Plumbing System - Final - 14. Rough Plumbing ' ' * - - c65.-Electrical-Final • - ' : • 15.'Rough Electrical-Conduit1 -7--- 1' r, I I r i I , , 66; Solar System-Final __ - " - - . . 1'6.,;Rough Electric Wiring . . i '1 i _ - .. - ' .. --. I, _ I _ , l'..-::::-7-4, fi _ - � 67:67:: -Access Appioval� �, -172-Rough'Wireng Sigri ' I I 1 'Ir. ,, 1__ � = ; • ' c 1..` I68. APPROVED.FOR PLASTERING 1 18.'Rough Electrical-T:Bar Ceiling I; I ; ,; i I ' ;691, ..PO.OUSPAISYSTEMS FINAL - - . I 19:Rough Heating & Air Conditioning '; 1 1 • , FIREDEPT. REQUIREMENT - 20. Rough Factory Fireplace ' ',' I , ' . . APPROVALS Permit*' 21.. Ducts,in:Structure ' 1I I I I ' 1 '70, Underground Hydro :22. • Ducts, Ventilating_ , ; i „ I I, ' I , 1 71. Prod�uctPiping:0 Gas D OiI • 1-2:t'. Gas Pipe-Rough & Testi 1 I , I ),,.0 172. Underground Flush '247tRoof Framing • 1 2 ' I ,� t I i I,c�;�• , i ^ '�� �,a , , - I-, 173, Undergrnd.�Storage Tank O Gas,O Oil , 25..Roof Sheathing , ` ,y',�,t' ' t<, I c ;r I ` - 74: Overhead Hydro - , - . . -,26. T-Bar Ceiling(Stiuctural),& Mon'o'coat , ,' I _. � ` I ' ; I 75'. Dry Chemical 4 , II ri:27. Frame and-Flashing = , I II ; I ` i I i • ' I I i 76. Dry Standpipe, 28.N Lathing& Siding , I ( I I,n 11 I . 1 j 77. FIXED,SYSTEM FINAL. , F. 29. Insulation`. i • l ! j I ' I , , 78. FIRE PREY. FINAL J30.' Drywall Nailing i i m I 't • 1 1I Notes -Aria •- 311.Plaster Brown Coat' 1 i ' ili iT I I I _ I --- - _ --32.''Electrical Power Meter-Final i{ II 1 I � I I I ( • • 33..Final Electric I_ , _ , - _ Il _', . 1- .I .r.._ _ 1 ' �. I_ ;„ _.__ f U _ _ , - 34. Final Heating& Air-Conditioning I , I I , I e • I. . , i _ ,- ' v, t I 35. Final Gas Pipe:Test'- • , I TI of j 4" i" 1f I., Im i • ; _ - .. - 1 I - 36. Hood onCanoPY i - 1-; I t I , I I I ;51 I I ;I _ - 37. Final Factory Fireplac ' '- I cl i i.. _ ! =. 1 i': I 1 I . , ' j ` 38. Final'Plumbing i' of- ' 3L8.63 I� I : I , 39. Water Service-FinalIi ' . l ; 40. Gas Service-Final I 41. Solar Domestic-Final 1 I I 1 t__ , _ _! , _I 1 _ ___ _ _ $ ' 42. Backflow Preventer,.i I I ,, , _ ._ I I__1_ _ ' • 43. BackflowIrrigation r , , {r; - . , , . I . c r - ,LL ,,.. . -. ,1 ' I I I -I 'I I , , '- 44. Landscape Irr,igation•System; I :il- - , 1 . ' --,1 `,4 ' I ' - 45. Sound`Attenuationej? . I II 'I , i I I° I '' 1 I t';1 '' I k , r. � 7 I �.. ,. 1 � I. 46. Handicap Regulatiorisi 1 ,- I , i jr 1 I I I I 1 I _ •- ' 47. FINAL STRUCTURE& BUIILDING,' I:. I I•: 1 I ' ', • J. 48. Special Requirements Completed , ' I , 49. Electric Release to Edison I ; _ '_I _ � _' . ._ __ _ -- _i__ - . - • - h 50. Gas Rele'aselto Southern California Gasp° I I 1 . ; I ' i - • ': / 51. CERTIFICATE OF OCCUPANCY , . _ IJ _ .. _' H. - __-f. ;-- L_:_. : NoDate • I I I I .- -.+ 1_.. .-r . ,-- _ _ ..L__, _l_ . _ ._1_ - _ -_ _1__. - . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA• 'lyTR UCTIQN PERMIT PERMIT NO. �� TRACT NO. LOT NO. UNIT NO. �P # I Zone Project Address 1� O N Cao PL 350 r S Main Building: Accessory Building: Applicant's Mailin Address 5A tilt' S j TYPE OF CONSTRUCTION Li NEW U ADD U ALTERATION ❑ REPAIR E Z Wit CI CONVERSION ❑ DEMOLISH ❑ OTHER T Front - O Owner'ri_— GA 4Y .SMI T N Phone�9f 9 DESCRIPTION OF WORK/USE OF BLDG. B Rear N Address}?_' -q Ant• TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION U STRUCTURAL I C Right _ N Arch/Eng. License No. rr��7�� K • G Address El TENANT aLECTRICAL El PLUMBING El MECHANICAL S : Left R Contractor's Name 0/B Phone ID 'OTHER . PIng. Ref.4 Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: Address(mailing) CONSTRUCTION TYPE VALUATION$ M CityLicense No. T ZONE GRADI NG CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION Hereby affirm that I am licensed under provisions of Charter 9 (commencing 'Remarks: S SI ��� r17 ss• w with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ELECTRICAL FEES License Class License No. — Date - Signature PLUMBING I FEES Automatic Washer Transformer ❑ 15.50 KW WORKERS'COMPENSATION DECLARATION Construction Pole Sub. ❑ 50+KW 'hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar$ink $hgWef$ ' Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps ,800, Lab. C.) Dishwasher Meter ❑over 100 amps • 8 Policy No. Company Backflow Irrigation Sewer Cap — Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant Fan Motors❑0-1 HP ❑1'h-B EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit Is for one hundred ($100) or Dishwasher Solar Piping F.A.U. less). Inc.Solar 0915 HP 016-15+ I certify that in the performance of the work for which t s per R is issued, IFixtures Microwave shall not employ any person in any ma r so as to ome bject to the Drinking Fountains Solar Tank worPkers' on7gepc--- a.ive llpSi a Device Boxes Pole Light Dat -/1 d/f ws of CalifC Floor Drains Swimming Pool w/Spa g NOTICE: If,after making this declaration,yo hould beta a subject to the Outlets Range Workers' Compensation provisions of the La or Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Water Closet Switches Sign Gas Service Outlets 9 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.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Water Service _ Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION C n - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Sf"I,/ Le ,JLI. ..a If Do following reason (Section 7031.5 Business and Professional Code: Any city or ,rr q � county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry TraVs I gLe,. ,C. 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 t� the Contractor's License Law (Chapter 9(commencing with Section 7000)of iJ -livision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee ! $15 Issue Fee $ a 'erefrom and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil 0 l alty of not more than five hundred dollars ($500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS: I, as owner of the property or my emWefeds with wages as their sole Reinspection Fee I $15 Issue Fee 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 11:3:/ate License Law does not apply to an owner of a property who builds or improves te{1 thereon, and who does such work himself/herself or through his or her own Boiler HOOd Or T ❑ Application Issued By at employees, provided that such improvements are not Intended or offered for yp¢ sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 BTUPLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such orolects with a con- ENERGY P.C. $ tractor(s) license pursuant to the contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration I PLAN CHECK 25% $ n proof of their worker's Compensation insurance should be provided to me. ELECTRICAL $ `�D .p {� GRADING $ ❑ I am exempt under Section .& P.C.for this reason Firepl/Fact.Blt. ICBG 4 Fire Dampers PLAN CHECK 50% $ MICROFILM $ Date -a,c fr Owner Heating System& Ducting Registers MECHANICAL $ •O I hereby certify that I have r ad this ap cation and state that the above ❑O-100,000 BTU 0100,000 BTL TOTAL FEE $ � a Information is correct. I agree r• comply Ith all city and county ordinances PLAN CHECK 25% $ and state laws. elating to bu'ting co str <tlon, and hereby authorize repre- sentatives of s city to •r er • n the above-mentioned pr party for Inspection •. Signatu IV Date Drivers' License or Is 4c . Reinspection Fee $15 Issue Fee $ 3 01 00012916-00012916 TOT DATE: 08/25/88 TIME26.00 • 0865-46,rev.5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor � 11:18 CONSTRUCTION AND PLANNING POC . SPA i APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector K 1. Tempo-pry Electrical Service or Pole 52. Pool & Equipment Location i 41 2. Soil Pfipe-Undrgrnd. • ' • 53. Steel Reinforcement ::-'j 4.:. "' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' _ y •%� 4. Electrical Conduit-Undrgrnd. -).- 55. Electrical Bonding .f 15: Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6• Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE ` 2.- 7: o4ings i/ 58. Electrical Conduit-Undrgrnd. -��; r 1Fo :,i. a/Foundation . 59. Gas Pipe, 0 Undrgrnd•`., Test .9: Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trip, 0 Undrgrnd. .+., .r 10. Structural Floor System .;` l • 61. APPROVAL TO DECK i 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final rit J 12. Sewer Cap ' _ - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final ,.' 14. Roiglh Plumbing 65. Electrical-Final -'! 15. Roilgh Electrical-Conduit 66. Solar System-Final 116. Rough Electric Wiring 67, Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING r 118. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • ,19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 26. Rough Factory Fireplace APPROVALS Permit# :11 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating • 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test .• 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing •t 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing76. 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 E3-2e1.4 ., 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • i 43. Backflow Irrigation . • 44. Landscape Irrigation System • 45. Sound Attenuation �, -/ 46. Handicap Regulations / 47. FINAL STRUCTURE & BUILDING • '4 • 48. Special Requirements Completed 49. Electric Release to Edison f 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY -' ' No. Date •, Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. T ACT L NO. UNIT NO. s CITY OF COSTA MESArryyCONSTRUCTION PERMIT� �lM A.P. �k [� ' �'� • •' ' Zone le Project Address d�7 TAfSf//n ��C� SPE -" S Main Building: Accessory Building: I , TYPE OF CONSTRUCTION NEW ❑ ADD U ALTERATION I� REPAIR Applicant's Mailing Address E ///'''111♦ Z a ,p /1.I ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T Front D Owrlbr's Name OAA i'l STN Phon222g p2-G�f� DESCRIPTION OF WORK/USE OF BLDG. ' A Rear , N A Ard A!/y,ng?� /- wLA-2 - License No ' /f1 3 TYPE OF PERMIT ❑ GRADING U FOUNDATION ❑ STRUCTURAL K •Right �, G Address' //0 )- i L ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left 5R / 3.306. ❑ OTHER Tj•� Ping. Ref.# Parking Req./Provided E Contractor's Narm • i // ' d✓ _ p - PROJECT DESCRIPTION SQ. FT- a e j/ OCCUPANCY -a �1 Q Address(mailing) 3�3 nA'&tf�TE� Planning Notes: If/ M 9 CON ST RUCTION TYPE VALUATION $ OM City License No. �I b 6 ZONE _ GRADING CU.YDS. ACRES 1- T LICENSED CONTRACTOR DECLARATION I S. I hereby affirm that I am'licensetl under provisions of Charter 9 (commencing Remarks: iD/s +L ' '75'--g�s with section 7000) of Division 3 of the Business and Professions Code,and 1 l *- _5 itmy license is in full IIlce add ffect- '/ ELECTRICAL FEES Ucensy Clas ` 5 -�� - Lirenso-N� 3/Y-z>n Date(p- - Signature PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW t WORKERS'COMPENSATION DECLARATION Pole Sub. ❑ SO+ KW hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ❑u to 100 amps Workers' Compensation Insurance, or a certifi d copy thglegf (Section Backflow Preventer Service Sink Cooking Unit Meter p p ^ .oOQ Lab.��C))) �� • 1 Policy No.7/9 frn//3 Company va..1 �1 � Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps — ifietl copy is hereby furnished. • Dryers ❑Gas ❑Electric Sb P �i� _.-4.4-•Certifiegcco lied with the city :0 Iain• i0 - Bathtubs Sewer Connection uanel Date '/- Applicant A a - a4_ _...(I , u/ Fan EXEMPTION FROM WORKERS'COMPE SATION DECLARATION Clarifiers Solar Collectors Motors 00-1 HP 011/2-R (This F.A.U.sectio hissection need not be completed if the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U. Inc.Solar 09-75 HP ❑16-15+ leseI c - rtify that in the performance of the work for which this permit is issued I Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. - Date Signature Floor Drains Swimming Pool w/Spa 3 oa Device Boxes - Pole Light NOTICE:If,after making this declaration, you should become subject to the e Outlets Ran Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9 comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction le ding agency for the performance of the work for which this permit i issued (Section 3097 CIV. C.) interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address eintbe2 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 tag l-• ti 3V aa.) 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) ofs.-. Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee ! $15 Issue Fee $3/ erefrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil - enalty of not more than five hundred dollars ($500). DEVELOPMENT SERVICES REQUIREMENTS: ▪ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By 3411fr Date b 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 �—G` _ License Law does not apply to an owner of a property who builds or improves JP __- _ _ ___ _ l _y thereon, and who does such work himself/herself or through his or her own - ' Application Issued By PicsDater employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 ! sale. If, however, the building or improvement is sold within one year of corn- Canopy Type I I 0 pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground SUM A V OF FEES prove for the purpose of sale). BUILDING PERMIT $ 1 •0D SMIP $ • ES- o I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK 3 • `0 tractors to construct the project (Section 7044,Business and Professions Code: $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100 0 BTU PLUMBING $ O Q ISSUANCE $ builds or improves thereon.and who contracts for such projects with a r-nn- tractor(s) license pursuant to the Contractor's'License Law). I am aware that Exhaust System 0 Multiple 0 System Repo' fetation PLAN CHECK 25% $ • 1 r ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided'to me. - ELECTRICAL $ �.dJ GRADING $ ❑ I am exempt under Section • B.&•P.C.for this reason Firepl/Fact.Bit. ICBG# Fir mpers -• PLAN CHECK 50% $ ) 45% CO u MICROFILM $ Date Owner - Heating System& Ducting Registers I hereby certify that I have read this application and state that the above ❑o-100,000 BTU ❑100,00 l MECHANICAL $ TOTAL FEE $ 306-.20Information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ _ and state laws -lating to b i1 construction, and hereby authorize repre- sentatives of 'is city to er-- on the above-mentioned property or - Inspection p �/ es -- f c'• - 'Signature Asy I./ ii,it,' 1-"--./ Date -� Drivers' License or SS IF ./ Reinspection Fee - $15 Issue Fee $ 3 -• 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor - 01 00006294-000062933 TOT 305,20 %I C,' POC SPA • , CONSTRUCTION AND PLANNING I - v • I Da7te Inspector Date Inspector A`PRdbA�l S ,g,P>:rmit# / /� APPROVALS Permit# rr 1. Temporar 'Eectrical Service or Pole �• y 52. Pool & Equipment Location '7/t�� 2. SoiillrPip Undrgrnd.• �� ,�' 53• . Steel Reinforcement' %v . Electrical Condwt•Ufility-Undrg nd. Q / 54. Forms Z .;04 a i r, .v. 1. r 4�Elec^trical Condu��-Undrgrnd. i� 55. Electrical Bonding , uii LI/ 5. Stee. �Reinforarcem..ent 56. Rough Plumbing & Pressure Test f 011.4)i II •I 't n,. 6 Eleccttfical/UF R Gsnc ` 57. APPROVAL TO COVER-GUNITE l 74 ogngs :.Ji 4• �'r' 58. Electrical Conduit-Undrgrnd. 6f a 'v . I/• n.� r s... g 1..1 S�IFoundation_ ; Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. 4757 4/1 6/82 41 .75 TL' CITY OF COSTA MESA ' PER,�^IT NO. TRACT NO. LOT O. BLDG.NO. .. CONSTRUCTION PERMIT (� 3 308 4000 Project Address aftL9�i�l�, O //7A a TYPE OF CONSTRUCTION' Owner f .•r/) 1 44L,�.g1 /" Phonefig.ef/y 0 NEW 0 ADD 0 ALTERATION -Ai.l1 Address effeir Akipce,�x g_t l - / 0 REPAIR 0 CONVERSION ❑DEMOLISH ,13 fA -Y'- ZONING REGULATIONS Arch/Eng. License No. 0 OTHER /1 / e- _ - _ Address9 ' - _ DESCRIPTI OF WORK 103 / /A�et-, A'F''i♦< � 'S'^ /` e)ijT ZONE -PLNG. REF.yr 11 Contractor-J/M _4/,/fn the- PhoneL5A'$7 TYPE OF PERMIT I,.,/ Lj - BUILbI (G IL�ING - ' Address /0 �,• Z w• _ . ❑GRADING I c OUNDATION &STRUCTURAL SIDE YARD S7!_T. �O.1 ,R. tC coPERELINE 44 LICENSED CONTRACTOR D 'L•RATIOS - - EFT ❑ TENANT ❑/ELECTRICAL ❑PLUMBING ❑MECHANICAL SIDE YARD CL f'lt-'+-sem+% f-s— I s I hereby affirm that I am licensed under provisions of Charter 9 (corn- I - RIGHT 4) rnencing with section 7000) of Division -3 of the -Business and ❑ OTHER - -. - X21 wl v- �- Professions Code and my license is in full force and effect. REAR YARD(TO P/L) r�csl�Y /J 9JJnnnrrr444---sss...,,, PROJECT DESCRIPTION Licenie Class Licenye fyy. PKG.SPACE REQ. PROVIDED [weQDA71L{47,61 Signature ✓ re ri • SQ.FT. -9 � STREET WIDTH PARK FEE E. WORKERS'COMPENSATION D CLARATION - - OCCUPANCY #J17‘ � CONSTRUCTION TYPE 1 I hereby affirm that I have a c tificate of consent to self-insure or a VALUATION #J q7S.-ZONE ZONING APPROVED BY ( F-' DATE�,// g7 certificate of Workers' Campo sation Insurance, or a certified copy - - - - - "////// (/ 'eof(Section 3800, Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: a•-No. 1 Company �•ti COS.14YJ.L.00I� ' _ _ _ __. - - . - -r Certified copy is-hereby furnished. - - - - - REMARKS: 0 Certified copy is filed with the city Building Division. „ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - - -- - - - _ ' (This section need-not be completed if the permit is for one hundre • •d ($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 PLUMBING , . PLAN CHECK - 'ELECTRICAL • PLAN CHECK - subject to the Workers Compensation Laws of.California. - - - UW tLLINb 0A HA4t Date Signature BATHTUBS SHOWERS 5O FT. SO FT - ” ' NOTICE: If after making this declaration, you should become subject TOILETS - URINALS'-" - - - ' - ' GENERATOR 0-1 KW_1-10 KW - it to the Workers' Compensation provisions of the Labor Code,you must - _ _ TRANSFORMER_ forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - ;APPLIANCE 10.50 KW_50+ KW - revoked.- . _ . . .- ._ - - - _ KIT.SINKS DISHWASHERS MOTORS "0-1 HP 1-10 HP - CONSTRUCTION LENDING AGENCY - _ — - I . • Is I hereby affirm that there is a constructionlending agency for thevper- SERVICESINKSSUMPS '"- - (INC.SOLAR) 10-50 HP_50+-HP - .. .- formance of the work for Which this permit is issued (Section 3097 ,� - - - - Civ. C.). FLOOR SINKS FLOOR-DRAINS - ",FIXTURES" - - OUTLETS._"-SWITCHES- ' '- _ Lender's Name _ - - _ _ _ 5' Lender's Address DRINKING FOUNTAINS „ . ' _ _ . - GASTUBE SIGNS - - - -- OWNER BUILDER DECLARATION - - 'INTERCEPTORS CLARIFIERS I POLE LIGHTS - " - - -- I hereby affirm that I am exempt from the Contractor's License Law for I the-following'reason (Section 7031:5 Business-and-Professions Coder SWIMMING POOL "P TRAP _ _- Any city or county which requires a permit to construct, alter, - POLES METERED SUB I Improve,demolish or repair any structure, prior to its Issuance,also-re.- WATER-SERVICE ALTERATION' 'PANELS-" "- MAIN - SUB- quires the aps licant for such permit to file a signed statement that he - ` Is licensed pursuant-to the provisions of the Contractor's License Law -GAS SERVICE OUTLETS SERVICE - - AMP - (Chapter 9 (commencing with Section 7000) of Division 3 of the gessandProfessions Code)'or that he Is exempt therefrom and the WATER HEATERS - BTU OUTPUT ' - - - -- . '" - - ' for the alleged exemption. Any violation of Section 7031.5 by - ' . r' applicant for a permit subjects-the applicant-to-a civil penalty SEWER CONNECTIONS i - ' - - - " - • -- "- - . ' _ - - - - - - os not more than_five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages is their SOLAR TANK - COLLECTORS + - " ' "- -- - - - ' sole-compensation, will do the work,and the structure is not intended __ • ,, or offered for sale. (Section 7044, Business and Professions Code:The SOLAR PIPING SYS. . FEE -- ,' - , Contractor's License Law does not.apply.to an owner of a property - _ - - - 'APPLICATION APPROVED BY • - ' -' DATE who builds or improves thereon, and who does such work himself or ISSUE FEE _ • tnrougn hls-own employees,-provided that such improvements are not _ Intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK I SUMMARY OF FEES 1 is Sold within one year-of completion, the owner wilLhave the burden + __ of proving he did not build or improve for the purpose of sale). IBUILD I NG -' - - ^I,-as' owner of the property, am exclusively contracting with -HEATING SYSTEM 0-100,000 BTU _ ,PERMIT $_r�--1 f�� .'_SMIP - , $ . 5� licensed contractors to construct the project (Section 7044, Business AND-DUCTING 100,000 + BTU -PLAN CHECK $ /6 '2 Sr. PERMIT .'1 - - and Professions Code: The Contractor's License Law does not apply to - - - - - - - ISSUANCE $ - • - an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such projects 'with a- contractor(s) licesned pursuant-to SYSTEM - - - . ' - - - -- GRADING $ - ' the Contractor's License Law). 100,0001+BTU _ • +'- 'PLAN CHECK $ _ ' I- ❑lam exempt under Section - B.CP.C.Mr this - - $ ` BOILERS BTU 'ELECTRICAL $ s reason - - - ._. MICROFILM $ ' SYSTEM REPAIR,ALTERATION PLAN CHECK $ Date- - - Owner - - - - - MECHANICAL $- TOTAL FEE$. I hereby certify that I have read this application and.state that the above EXHAUST SYSTEM MULTIPLE • LESS AD- - ' information is correct. I agree to comply with all city and county - ,PLAN CHECK E- VANCE PC Si_ - ordinances and ate laws relating to construction,and hereby authorize + ' _ representatl/of this city t• e• - upon the above mentioned • Property fo nspection pur•. -. Dnpo LB.7S Signature - -� Date ge7���fl2e FINAL FEE $ • Drivers' ' ense or SS$ - ISSUE FEE - -- - - - CMF 0.65-46 White-Building; Canary-Applicant; Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING 63- ct�t y , POOL Si SPA ' APPROVALS Permit# - `-0 Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole • 43. Pool & Equipment Location • • - - - -- - - 2. Soil Pipe-Undrgrn 44. Steel Reinforcement . - - -- - 3. Electrical Conduit Utility-Undrgrn -- ' 45. -Forms - 4. Electrical Conduit-Undrgrn 46. Electrical Bonding . .- - 5._ Steel Reinforce . Qt'e �.n DS _s_ -_,2.g47. Rough Plumbing& Pressure Test - . . _. . . . _ 6. Electrical UFER Grn b 48. APPROVAL TO COVER-GUNITE •• - - - • _ - -_ - _ ' • - 7. Footings 4-R1•Pc j4 49. Electrical Conduit-Undrgrn - 8. Foundation- . _ 50. Gas Pipe, ❑ Undrgrn,Test • 9.. Water Pipe-Undrgrn _-_ - 51. Backwash Lines, P-Trap. 0 Undrgrn • - - - • 10.. Structural Floor System 52. APPROVAL TO DECK - ` - -. -• .. - . 11. .Property Sewer Line & House Connection 53. Backwash & Receptor-Final • ..12. . Street Sewer Connection_ - - ' • . - . 54. Heater & Vent-Final •• 13. _ Rough Plumbing - 55. Plumbing System-Final "' `- - ' - - 14. Rough Electric-Conduit - -- - - - 56. Electrical-Final • 15. Rough Electric-Wiling - - - - - 57. Solar-System-Final ' • 16. Rough Heating &Air Conditioning . _ . . b8. Fencing & Access Approval 17. .-Ducts, in Structure _ - 59. APPROVED FOR PLASTERING 18.- Ducts, Ventilating . . ' . . . . - - - • 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL - _ 20: Roof Framing , - 21. Roof Sheathing -.__ ' '_ p - - • 1 22:- Frame and Flashing . . - - -NOTES: S 4.ck - )3T Y"/`�_1,G r"b), 4 23,. r . •23. Insulation - . _ .- _ __ . _ . V . 24. Lathing &Siding _ _ _ - - . - 25: Drywall Nailing - _ . . - _ 26. Plaster Brown Coat - ._ , 27.. Electrical Power Meter-Final ._ _ - - .- ' 28. Final Electric - ._ _ _ . ' 29. Final Heating & Air Conditioning _ - - ' 30. Final Gas Pipe-Test - ' - ' ' 31.. Final Plumbing - _ ' . ' 32. Water Service-Final • - _ - ' 33.. Gas Service-Final 34. Solar Domestic-Final • - 35. Landscape Sprinkling System • • . 36. Sound Attenuation - • _ I • 37. Handicap Regulations • 38. FINAL STRUCTURE& BUILDING y-aq..FL p5 - • . 39. Special Requirements Completed ' ' ' 40. Electric Release to Edison " --- 41. Gas Release to Southern California Gas Co. ,. 42. CERTIFICATE OF OCCUPANCY - i No Date APPROVED City of Costa Mesa Building Dept oATE_�z— [ UC1URALAPPROVAL ONLY - -- AT Alt nMes BY-.-_-- APPROYAII THESE PLANS GEST THOUTI PRIOR MAKE NO CHANGES SEPARATE PERMITS ARE REQUIRED OF DEPT, FOR ELECTRICAL, PLUMBING, THE ISSUANCE SPECIflCATI(1NS G OHPLLLNOF A MITPNCONPS HEATING, VENTILATING AND OF PLANS REFRIGERATION WORK ED OR AN APP.:I:V�• TOY VIOLATION BE A PERMIT FOR, DF IDIS CODE. ND PIAN 0.R& OF ANY OF THE THIS OD VIOLATE DR APPROVED SUMING TO GIVE AUIHORt1Y TD WHICH IT AUTHORIZES 1S 118'M6' �Q��ury .µ � 3�a R,C�lC M4 .& -6 �j'� OF THIS CODE SHALL 6E VALID, EXCEPT 1 11 tr A/ _ _ /'_�(ry OF COSiNGTA MESA FAR PROVISIONSAS THE WORK OR USE THIS NUMB R F SI COMPANY THE ISSUANCE OF A PERMIT BASED UPON PLANS�0 ALL INSPECTIO,I'. riEOJESTS PL w Nsa oe. ammo To aao. oar. e� SPECIFICATIONS SHALL NOT PREVENT THE BUILDI P NG OFFICIAL FROM PLANS SR AND REQUIRING SPEG F CATIOI.U ORE FROM PB CTIOH OF ERR�� {Y' DATE— 6 ' Z Ma ��.a�� FOR BUILD- t. < rEFSONS • ARE TO na OF PUNNING BUILDING OPERATIONS BEING CARRIED ON OTHEUNDUF����WN BE E111POF : ..r SUZ^2ES.I THAT THE IN VIOLATION OF THIS CODE OR OF ANV OTHER OR01Oa� STATE OF -Si .IIA DIVISION OF 1 cc THE CITY. INDUSTRIAL S .FSE COi4SULTED FOR ADDITIONAL F,ELTUUEMEPITS. I 541 6"6acK(G t6 xit'> I 41/l}tY oR ncap.Esc RESIDENCE I.- RESIDENCE RESIDENCE W I[ RESIDENCE I-n \ ct I- to I / I Ao C4 " . i STREET LE 4 TYPICAL 611 CONCRETE BLOCK FENCE _ es Cement Coping Optional _� ft F I GENERAL- NOTES Channel Block With 1-3/8 0 Horizontal Top of all ' Fences MORTAR: One Part Plastic Cement, and Three Parts Sand t [I For Fences 5'or Less ____ Hf 1 I II ,1 GROUT : One Part Cement One Half Parts StThree and and Vert. Bars 3/8" Oat 4' -0" O.C.. o a. COPING: One Part Cement, Three A _ For Fences Hi her Than'5 -�0 Parts Sand Vert. Bars 3/8"Dat 3ZO.C.full?. a�yeti "9 } > w — CONCRETE: Well Mixed 1:2-1/2 : 3-1/2 tt r, ul g y AnQ = 1 ' I Max. of 7- 1/2 Gallons of Fill Cells Solid With Grout "" . >,Z Water Per Sack of Cement Where Steel Occurs s,��' ATZC.) '3 tri= >1 •' _. •- Reinforcing Steel Shall visa O• "„ ' fI GROUT MAV BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL Conform to Sec.A-15!39 TT:hI ,�--7�G ton, u o - OCCURS. A.S.T.M. Z- I It CELLS AND AREAS OFHORIZONTAL REIN- w an FORCEMENT SHALL BE CLEAR,CLEAN& All Steel to be Lapped 'iTACI-... -,..e-..u,sod - � — FREE OF ALL MORTAR DEBRIS,ETC. 24"or to Code C1 WAA$ {G ;OS6id:a..r Ili PROVIDE CLEAN-OUT AND INSPECTION HOLES AT THE BOTTOM OF CELLS CON- NATURAL GRADE TAINING VERTICAL REINFORCEMENT. <� �."�`, xO�d :9pV 1 ' ii "ii. ip BONDS SHALL BE PROVIDED BY LAYING ., . , \ ' - _ O BLOCKS IN STRETCHER COURSES SO THAT _ VERTICAL JOINTS ALTERNATE IN EACH �4.1.-t).2".,Cv/ p °. . p cu COURSE. 1-------W-078:71 BA RS �� °,y,!d '. s CONTINUOUS TOP • & BOTTOM / I • TO 16 0. C. MAX_ • .� l-�-WIDTH — . o —� p- SEEINFORC• . • ALL STEEL MUST BE TIED IN BELOW' e ' DE PTH OF EARTHTCOTH PLACE AT TIME OF TRENCH I I e I °• 1/3 THE HEIGTH OF FENCE INSPECTION. I- L j'f L• BELOW BOTTOM OF FOOTING. • I 3 . o" o' 7 2.. J SCALE: I/2° = I' FOOTING REQUIREMENTS CHART WALL HEIGHT 6 ' 5' 4' 3' WIDTH 14" 14" 12" 12" THICKNESS 10" 10" 8 " 8 " DEPTH OF EARTHTOOTH . . . 24" 20" 16" - 12" SPACING OF EARTHTOOTH. . 12' 14' 16' 16' OWNERS NAME: City of Costa Mesa, California PERMADDRESS:T - - - - - -- Building Department SIGNATURE: - _ _ FORM [V23-21A_P_ti^ dreg cwoucu %- Qeec/e COSTA`MESA BUILDING-SAFETY DEPARTM T / �� � L d r " ' / P. O. BOX 917 COSTA MESA. CALIFORNIA r "' .� �((6 V "A PT. For Applicant to Fill In Completely APPLICATION FOR PERMITME HYPE OR PRINT LA 11 v1 ovum M�tSA �BUILDING�!'/5(0111- _ BUILDING ADDRESS i_ b A MGAbA T,_. �\\. COSTA MESA. CALIFORNIA For Office Use Only OWNER Investors Marine Inc. I RECEIPT NO. 974r3;1 �O. -f p3' � MAIL L^^ '.' ^-- ..7, RE7 ED BY D I.V/ep DATE ISSUED 1961 ADDRESS 1600--ii 'act High y !/,(A� I (�'/I r-P,v\ (U` 'D cITY Newport Beach TEL. 1655 ADDRESS f' ".� ADDRESS ARCHITECTTEL. OR ENGINEER ame NO. p(� /VSC77COSTA MESA. CALIF IA S ADDRESS FIRE 1/ (� ZONE TYPE V GROUP ,7R I CONTRACTOR Mesa Verde Builders Inc. APPROVED U 1653 Minorca Drive BY DATE ADDRESS ZONINGv ZONHNO.OF USE OP NEW CITY Costa Mesa 1 I PUNS 'y' Bu1LDI L��y / STATE 181269 TEL. K1 9-0395 LIC.NO. NO. LEGAL (DESCRIPTION `'-�T-t. LI cC`6 it UY��''i,._ SIZE eT 1 X 921 no. OF 01.3080 OF LOT 4 NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM 401 10 I (CENTER LINE ST.) yy�� �_.� � �nI�/L CENTER OP STREET REAR YARD FRONT • //TAT. 0—�C. IN. SIDE YARD I LEFT 121 I RIGHT 101 R.SIDE / 0 FT. DESCRIPTION OF WORK L.SIDE / T. IN. • •�yy�� NEW I X II ALTERATION I II ADDITION I REAR ` */ /5 FT. Q/!.••-/G I IN. II APPROV. / REPAIR I MOVING I II DEMOLISH I BY • . M DATE'�' -a '(,/ BUIDNG1700 S q'Ft NOOO7 STORIES1 •F ShaeEXTERIOR WALLygiaing ROOF g O COVERING OC S 4UCCO COVERING s �g-se �']J USE OF BUIL INCA AND,WORK TOB PERFORMEDo�J /lD singe famiiy residence angaraged 4/11 Model No. •-► ____, Garage not attached 462 Sq.Ft. I HEREBY ACKNOWLP GE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT TH AS E IS CORRECT A AO EH TO CON• PLY WITH ALL CITY/ RDI ANCHS ND STATE REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRU I II /I VALUATION SIGNATURE OF v (1,1 IAA ki I iV`I• / //� /�/ • PERMIT FEE $ �{ / c PERMITTEE IIIIbb S;j VV� a . PLAN CHECK $ p/[V/�J `M AUTHORIZED AGENIS [/' TOTAL FEE S l /,...5M-- 0 ORM MESA BUILDING-SAFETY DEPARTMENT AUG 114-740-77001 220 d*****3.50 P. O. BOX 1200 Costa Mesa, California • PERMIT NO. PLUMBING PERMIT APPLICATION TRACT NO. RECD. BY I t 66023 • • CONTRACTOR "jA� .„.. /// ed LOT NO DATE ISSUED Address _5--.4.//`�al///�/{•r_'�2/„ f fBUUIILDINNG USE ' /j'iid I City i [..' Tel. No ��7( ADDRe`s�'fd�/ [x, i State License No. Class. COSTA MESA. CALIF NIA NEAREST w City License No. CROSSsr/2 je/7al12/1 lad H OWNER Q NUMBER TYPE OF FIXTURE OR ITEM FEE MAIL /1 �� Water Closet(Toilet) ADDRESS X� ? Bath Tub CITY TEL. N� an / V Shower I hereby acknowledge that I have read this application } Lavatory(Wash Basin) and state that the above is correct and agree to comply J Kitchen Sink with allCity Ordinances and State Laws regulating CLaundry Tub or Tray plumbing. w Service Sink ' I certify that I possess the above valid state of Cali- - fornia classification or I am the legal owner of the resi- Q Floor Sink .dential property described above, CC Floor Drain /� r// d Dishwasher Signature of / S ,/(Q�//. 4/ Permittee t.' 2 Drinking Fountain 4 II Urinal INSPECTION RECORD Garbage Disposal Automatic Washing Mach. HWater Softener 2 7 Water Beater& Vent / e70 CCCC Receptor 0- _ Swim Pool Filter System CC Gas System . . . Outlets D Lawn Sprinklers Installation or Alteration to Water Pining APPROVALS Back Flow Presenter to Prop. Sewer It. INSPECTOR DATE _ douse Sewer Co/man: un U/G Soil F Cesspool, Septic Tank _ U/G Water Services—Water 0 Gas 0 Miscellaneous Rough Plumbing Sprinkler System Gas Property Sewer Pool Receptor Filter System Pool Heater —Issuing Miscellaneous I,_uing Permit 2 00 I TOTAL FEE Ij. Ta Final Gas I Plumbing Final R-a -(S-7� Utility Co. Notified Y FORM nu-a+ BLDG. PERMIT NO