HomeMy WebLinkAbout318 SYDNEY LN - Building PermitsY
f�0.1ECTR00flE5S: 3IB SYDNEY LN unir: CITY OF COSTA MESA — BUILDZNG PERMIT . �
owxcn•sxame: EVERGREEN ASSOCIATES
t aooeess:ATT; JIM LOCKER PERMIT NO; H 058712 PLAN CHECK NO: N . ,
323 SYDNEY LN .
COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE; STR PURPO5E; ALT
(714)646-6f57
AHCMIENGINEEfl: AEG.NO.: JOB DESCRIPTION : T/O EXISTING ROOF, APPLY FIBGLS,SHINGLES SQ FT: 6,800
i RUOflESS: IINIT:
CLAIM VALUE: 6,800,00 CALC—VALUE; 6,800,00 GROUP OCC; R-3 /M-1
PEflMITTEE: CRANK HROTHEAS ( 714 ) 548-5569 ' o
ADDNESS: iZEI COMMERCIAL WAY *�*******�e**�***D*****��***�t**i�****D�t**�t*�****�r�t*�t*�t�rr*x�x�*�r�***�t�t**�r*�r*�t+t�t�t��r�t�r
COSTA MESA CA 92627
LILENSEO CONiHpCT08 DECNBRTION: I hereby allirm thai I am iicense0 under p��ns oi C�apter 9(commencing with Section Z � N I N G R E Q U 1 Fi E M $ i� T$
7000) ol Oivsion 7 0� I�e Business an0 Pmlessions Coee. my license is in f I e antl e 1ecL S£ T B A C K S
arru .00 993 $TRiELIC.:4�867 c
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING
� oate � � siq�awr FRNT: FT IN REAR• FT IN FRNT: FT IN REAR; FT IN
WOPREflS'COMPENSRTIONOECIAflATION: I ifirmtha�lhaveacenificareofconsenttaself-insurearacetlificateofWorkers' L$FT: FT IN RGHT: FT IN LEFT; F'Z' IN RGHT; FZ' TAI
Compenuiion �an)ce. � a�� i� elu� I�ection 3800. Lao.�l / O 1/ 9 3
POIICY NO.: E%P. ORTE:
con+rnxr:STATE FUND,y� PARKING REQ• PROV: PARCEL; 93519006 ZNE; REF NO:
❑ C i�etl copY is AereUy Iumishe0. L'� Ceni�iea copy �� �ih tne y eviiaing Divisron. � PLANNING NUTES>
>
�Z� Z ikifMifkltiEifitifitififiliEititk�fkitiEiEitikiFiPiti6lFititifiFkitkitifitikififikikitkitifiE4itif�tiEilitiEiFiFititiFiEitlEitlEiEitififikiFititiFiFiF
oa�e pooi��� . D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N�T S
E%EMPTIONFflOMWOPI(EBS'fAMPENSRTIONOELUBATION: (Thi55ec1ionnee�no�bewm0�eteEillllepermili5laronehunUreA�510�a1e55�.
I Certi�y I�a� in I�e pedorman[e o� the work ta� whic� ihis permi� i5 issuetl. I s�all not emDloy any p¢rson in any manner w as �o become ZON I N('i APPROV ED B Y DATE :
su�jecllo Ihe Workers' fAmpensation LawS ol Califomia. l�
oate: sqnawre: BUILDING APPROVED BY : DATE;
NO7ICE: Ii. aner making inis aeclaratian, you snoul0 betome subject b tne Workers' fAmDensation o�wisions al the Labor �''
Coee. you musi mnnwim comoiy �tn sucn Provisians or inis oermit shai� �e aeemeo revokeo. APPL I CAT I ON I SSUED HY : DATE ; '�/ %2
LONSTHUC710NLENUINGRGENCY: Ihere6yaffirmthattnereisaconsVuctionlenEingapencyfarlheperformanceoit�eworkior ********************** ********** **
w�ich ��is permil is i55ue0 �Section 3097. Civ. C�.
LENUEN: iF1Ei!lEiE�lkitfFiEftfEiflFitifififif3fifiliF3EiFiE�fiEiFiEiEiE�IkiEiFiFlEifiFiF3EifififiFif iflEiEiklfiFiEiElfiEikifiEik3F�1FiFlElE1Eil�-1fif�fifiEiflFifi4if
nooness: LEGALIZATION;N F E E S U M M A R Y STRUCTURAL� SEGMENT;Y
OWNEB BUILOEB OECUHATION: 1 her¢Dy aflirm Ihal I am exempl hom Ihe Contraclors' Siaie �icense �aw ior me �o��owin9 reason BLDG PMT PLUMB ING ELECTRIC MECHANIC FIRE SM I P/RES GRAD ING
(Section 7031.5 Business antl Pm�essional Cotle: Any ciiy oi coumy whicA requires a Oe�mi� lo constmc4 al[er, impmve, Oemolish, or PERM I T 9 �. D O 6$V
re0air any s�mcture. prior to its issuance, also r¢puire5 ihe aDPlicanl �or such permii Io lile a 5igne0 itaiemen� Iha� he/She is Iicen5e0 SM IP /NON��R$$
pur5uani to Ihe pmvisions ol the Con�mciori' Slale license Law (C�apler 9(commencinq wilh $ec�ion 7000) ot Division 3 oi ��e Business PL�
and Prolessions Cotle) or Ihal he/she is exempt Iherelrom and Ihe basis lor Ihe allege0 eaemption. Any violation o� Section 7031.5 by ISSUE FEE
any apPl¢anl �or a Oe�mil sublects the aOPlicanl �o a civil penal�y ol noi more �han live hundretl 4oilars ($500�. ;
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID " DUE
i, as owner oi me o�oPeny or my empioyees witn waoes as their soie compensaiion, vnll do �he wonc, ana tne TOTALS----> 90. 68 0. 00 0, 00 90. 68 90. 68 �� , 0�
❑ simt�ure is no� inrendetl ar oflered lar saie (Set�wn 7044, 9u5ineu and Pmleuional COtle: T�e Contractors' State Litense Law
Ooes not apply lo an owner ol a pmDerty who 6uila5 nr impmve5 ihereon, anA who Ooes such wnrk himsel�/�erull o� Ihrough l
his or her own emD�oyees, pmvitlea mai such imD�ovemems are nat intenJM or onered for sale. IC howwer tAe builamg or AEVENUE D I V I S ION TOTALS--> COLLECTED ; 9 0. 68 OVER /SHORT • 0 0
impmvemenl is so10 vn��in one year oi completion, ihe owner vnll tuve t�e �urden ol prodng he/she tlitl not huild or impmve $LDG PMT PLUMB I NG EL ECTR I C MECHAN I C F IRE SM I P/TOT GRAD ING PLAN—CHECK
m� me uu�nose oi uie�. 9 0, � 0 , 6 8 �
1. as owner ol �ne o�operty. am exclusively contrac�ing with IicenseA coniractors ta constmct ihe pmiect (Section 7044, Business '
❑ aMProfessimsCotle: T�eContractors'StateLicenseLawaoesnotap0lyiaanownerolproperrywhobmlasorimprovestAerean *******************************************************************************
and wh0 COnlratl5 �Or Sut� D�We��s vnill a mnlratior�5) IitenS¢ pur5uanl Io 111e ContraC�ofS' State License Law�. I am aware
mat o�oa� oi tneir warker•s Comoensauon insurance snoum oe o�odnea to me. I N D I V I D U A L F E E B$$ P. K D O W N
1
� I am exempi unGer Setlion: B. 8 P. C. /
iorinisreason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
� �,
oaie: a+�e�: SFR 6800 REROOF BY VALUE AESIDENTIAL NOZONE 1, 00 �. 6� 800. 00
I tla �ere0y cerlity �hat I am aware of and un0ers�antl Ihe requiremen�s o� Califomia Healih antl Safery Cotle Seciions 25505. 25533, and END �F FEES .'
Z5534 and tha� I or any IUNre bUilaing oCCuDani will/will nol (cirtle on¢) n¢eG l0 tOmply wilA 5aid Slate Co0e5 antl lhe requiremen�s br a �
permil b� conslmciion or mo0ilica�ion imm I�e Air Ouatily ManaAemen� Oislricl. FesiOeniul conSimciion apD����ions are eaemD� ��om
IAese pmvisions.
�aie: ApPliCanC
I hereb r�iry ��al I have read Ihis applica�ion antl sla�e �h I� a6ove inlormalion is correcl. e;.f com0ly with all city antl coun�y
ordin; ce antl5talelaw5relaiing�obwltlingconsimctionan e byauthoriierepresen�ative iSLTly�oenter { nihea�ove-menlioned
pmp Iy or in c�ion pur ases.
Oai � �Signalure: � f} f117^^''' '-1'�.�_. _.. _
a.
rver's icenseo�sa�aise�����va: anT<< .?:'"i,`?'? �'_,..... '_.-_
teat.a6 Wnite—Bmltlino: Green—Cotle En emenC Canarv—Aoolicant: Pink—Revanuo: GOldenro0—Assessor
_ CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit � Date Inspector APPROVALS Permit # Date Inspector
�` 1. Temporary Electrical Service or Po,le. 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. - �- . 53. Steel Reinforcement
"3. Electiical Conduit UtilitY-�1�drgrnd. 54. Porms
�.4. ElecTrical Conduit-Undrgrnd. . 55. Electrical Bonding '
'�5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
, 6.. Eiectrical UFER Grnd. . 57. APPROVAL TO COVER�GUNITE �
��: Pontings _ , ' 58. ElectricalConduit�Undrgrnd. '-
8�. Foundation � 59. Gas Pipe, O Undrgrnd., Test
' 9. Water Pipe-Undrgjnd. 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Structural Floor System � 61. APPROVAL TO DECK
11. Property Sewer 4ine & Hause Co�nection 62. Backwash & Receptor�Final
�2. SQ`^ie� CaP , 63. Hearer & Vent�Final
73. Roof Oreins � 64. Plumbing SYstem � Final .
14. Rough Plumbing " • 65. Electrical-Final
15. Rough Electricai�Conduii 66. Solar System-Final
76. Rough ElearicWiring 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPflOVED FOR PLASTERING
18. Rough Electripl�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Fact6ry Fareplace � �� , • � • - '� : APPROVAC$ ' � Perrhit # • �
,� - '.. , -
� ` .. -. . ,.
21.`Ducts, in Structure- ,. .. -.�. a:70. Undergrovnd Hydro �
22. Ducts, Ventitatingi: �%^ � Z� 71. ProducCPiping OGas OOiI
23..Gas.Pipe�Rough &i'Test � � � , � � ` 72, Underground FlusFi � ' .�
24�Roof Framing � F. �� ' J ` 73� Undergrnd, Storage,�ank'CI Gas ❑ Oil
25. Roof Sheathing ��' � ' - '� �� '- � � ' 74 _ Overhead �Hydro` ~ x
26. T-Bar Ceiling (StNctural) &�Monocoat •' _ � � 75. Dry Chemical ' .' -
27. Freme and Flashing . � - : 76. Dry Stand,pipe �� � ' � `
.28. Lathing'& Siding �. . i r - � 77�. FIXED SYSTEM FINAL• '
`29. Insulation '. z'� - � � " I r 7&. FIRE PREV. FIN6tL � - - -
30. Drywall_Nailing�-', , � � ' x - HEALTH DEPT. REQUIREMENT
,31. Plaster Brown Caat � . .. 79. FINAL INSPECTION .: _
� 32.-Electrical Power Mecer�Final :?' .'80.- FOOD CERTIFICATE ISSUED
33 Final Electric ' ' F � - ' , �
< < � � .' I. � � Notes:
34• Final Heating & Aii Conditioping � � . f c � � � , '
35: Finai Gas Pipe•TBst� � - •� ' ' " ' � •
:r �
. 36. Hood or Canopy . - - �. ;� � - - � � ,
37-Final Factory Fifeplace,. •• - � � � ' '
� � -
38. Finai Plumbing � . � .- j i i �� �.
, _
39. Water Service-finaf � � ' � ' ` -
� � !r -
40. Gas $ervice-Final = , ' � � i.. � �o c �. . �
- 41. Solar pomesiicF�nal � • � -
42.'Backflow Preventer � .. . �: �
43. Backflow �rrigation � , � ' �
44. Landscape Irripation SYstem �- � _ - .. � _ • �
� 45. Sound Attenuation ''"� ' - - = � ; ' �
'46. Nandicap R'egutations - ' � ' � '; . " _ , �
47..PINALSTR�UCTURE&BUILDING 9',:� �'i �'wb, �- �' �(•(
S� l�e �.- o �-
48�. FINAL PLANNING �. � Z� � � � % ���
-49. Elearic Release to Edison � � �,� ` �
50. Gas Release to Southem California Gas Co � I�! I- '� ' -.
51. CERTIFICATEOF.00CUPANCY . , : --
No. Date
�
6eptemher 4, 19s2
City of Costa �1esa/ f1uil�iing Dept.,
F�ir Drive
Costa MeGa, CA., 92627
RE: F.inal Inspecti.an - Rernaf
Perm!_t Nas. BO5P_712 and B05R713
ATTN: Inspection Dept.,
Dear Mr. Inspector;
This is tn confirm that a11 smoke detectors are in nperatinn
conditi.on in 6uildi.ngs 311 and 318 ❑n S�dney Lane .in the
Ci_ty of Costa P1esa.
S;.ncerely,
Evergreen Estates
P y : /� 2 a`��' �����
l
.7(ies �ocker, Presi.dent
.
� � Applicant to fill in all spaces exce0� those within neavY bortler lines ana sign all approoriate tleclarations.
CITY OF COSTA�. 7MESpA NSTRUCT O PERMIT PERMIT NO. TqACT NO. LOT O. UNIT NO. D �
r A.P. # � Zone
U���`�% �J J
Project Address i'� � 4 � _ S Main Building: Accessory Building:
ApplicanYs Mail�ng Addr e� TYPE OF CONSTRUCTION ivEW AOD ACrEaA71oN REaal R E Z
❑ CONVERSION ❑ DEMOLISH OTHER T Front p
Owner's Name � Phone�� DESC I TIO�yrO WOF�K7��%�S�E/� F Bf� G. ' I A Rear N
Address �I %�lT�/f?✓i B'✓� ����0� )f/`"/'��i�'- �/' U�N% sttlr.� I
Arch/Eng. / License No. TVPE OF PERMIT ❑ GRADIIVG LJ FOUNDATION ST UCTURAL I C Right N
K G
� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . S Left
R
Address E
CF: ❑ oTHER Ping. Ref. # Parking Req./Provided
Contracror's Nam P T Phone �� pROJECT DESCRIPTION 5(�. Fr, oCCUPAN v n
Address (mailing) � Planning Notes: ry�
�i T
CONSTRVCTION TVPE VALUATION $ �
City LiCense No. Z J' ZONE GRADING CU. VDS. ACRES S.
IICENSED CONTRACTOR �ECLARATION .
1 hereby atfirm that I am licensetl untler provisions of Charter 9(commencing Remarks:
with section 700 of Division 3 of the B siness ana Professions Cotle, antl ELECTRICAL FEES �
my license is m orce antl effect. ��
Licens I ' e e No ',, �/
oate � 5iqnature PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW
WORKERS' COMPENSATION D CLARA Bar Sink ShoWerS ConStfuctiOn Pole SU6. � 50+ KW
I he�eby atfi�m that I have a certificate ol nsent to Selt-insu/e or a certificate
oi Workers' Compensation Insurance, or a certitied copy thereof (Saction Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.)
Policy No. Company -��� F���'r� Backflowlrrigation SewerCap Dishwasher Meter ❑over100amps
�Certifietl copy is hereby furnishetl, ! Dryers ❑Gas ❑Electric Sub Panel
6erL e�j y' 1" tl with the tity " ing ' r' ��fn. Bathtubs Sewer Connection
Dafe ��`� � � Applicant F2n
E%EMPTION Ff10M WORKERS' C MPENS D CLARATION
Clarifiers Solar Collectors Motors �0-1 HP �1 %- 8
(This section neetl not be completetl if the per it is Tor one huntlretl ($100) or Dishwasher Solar Pipin9 F�A�U� Inc. Solar 09-15 HP 016-75+
less).
I cartify that in [he performance of the work tor which this pevm�t is issuetl, I FixtU�25
shall not employ any person in any manner so as to become subject to the D� g ai Sola� Tank Microwave
Workers' Compensation Laws of California.
oate Signature Swimming Pool w/Spa � Device Boxes Pole Light
NOTICE: If, after making this tleclaration, you shoultl become subject to t Outlets Range
Workers' Compen5ation provi5ions of the Labor Co , you must forth 1 SinkS Ufinal
comply wiN such provisions or this permit s be tleemed v tl.
CONSTRUCTION LENDING AGENCV GaSSeNiCe O (5 WatefCloSet SWitches Sign
1 hereby atfirm [hat there i5 a mnstruction len agency for ormd
of the work fo� which this pe�mit i5 i5 tl($e n IOt¢�C¢Pt0 Water Heater _ Garbage Disposal Standing Sections -
txntler�s rvame Generator �0-5 KW �5-15 KW Trash Compactor
�entler's Adtlress — ink Water Service
OWNE0. BUILDER DECLARATION �
I hereby aftirm that I am exempt from the Cont License Law for the avato 5 � Auto-Wash
followinq reason (Section 7031.5 Business antl Pro ional Cotle: Any city or
county wnich requires a pe�mit to const�uct, alte�, improve, tlemolish o� �epair —T L2undfy T�dyS
any structure, prior to its issuance, also requires the applicant for such permit
to file a si9netl statement that he/she i5 licensetl pu/suant to the provisions of Of
the Cm[ractor's License Law (Chapter 9(commencing with Section 7000) of
Division 3 of the Business antl Professions Cotle) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
theret�om antl the basis tor the allegetl exemption. Any violdtion ot Section
]031.5 by any applicant for a permit subjects the applicant to a civil
penalty ot not more than tive huntlretl tlollars (5500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS: ,
❑ 1, as owne� ot the property or my employees with wages a5 thei� sole ReI115pBt[ion FE¢ $15 ISSu¢ F¢¢
compensation, will tlo the work, antl the structu�e i5 not intentletl or offe�etl Zoning App�OVed By DdtB
for sale (Section 7044, eusiness and Professional Cotle: The Contractor's - MECHANICAL FEES Buildin9 Approved By Date
License Law tloes mt appty to an owner of a property who builtl5 or imp�ove5
thereon, antl who tloes such work himseli/herself or throu9h his or her own Boiler Hood or TYPe I ❑ �1PPlication Issued By Date
employees, Orovitletl that sucM1 improvements are not intentletl or offeretl tol
sale. It, howeveq tne builtling or improvement is soltl within one year of com- Canopy Type II ❑ ' � SUMMARV OF FEES
pletion, the owne� will have the burtlen Ot p�ovin9 he/she tlitl not bwitl or im- DUCt- Und¢� GfOUOd
nrove tor the purpose of saie). BUI LDING PERMIT $ SMIP $
I� as owner of the property, am exclusively contracting with licensee con- Duct-Structurai Refngeration System PLAN CHECK $ PERMIT
mnstruct the project ($ecLon 7044, Business and Profe55ions Cotle:
actor's License Law tloes not apply to an awner of,property who Duct- Ventilating ❑0-100,000 BTU ❑100,000 BTU PWMBING $ ISSUANCE $
improves thereon. antl who contracts for such oroiects with d ron-
license pursuanc to rne Conttactor's License Law). I am aware tnat PLAN CHECK 25% $ ENERGV P.C. $
' p tneir Worker's Compensation insurance shoultl be prov�tletl to me. Exhaust System ❑ Multiple ❑ System Repair/Alteration
ELECTRICAL $ GRADING $
❑ I am e empt untler Section B. & P. C. for this reason Firepl/Fact. BIG iC80 # Fire Dampers MICROFILM '. $
PLAN CHECK 50% $
Date Owner Heating System & Ducting Registers MECHANICAL $
OOOBT TOTALFEE $
I hereby certify that I have rea his application antl state that the above ❑0.100,000 BTU 0100, PLAN CHECK 25% $
information is mrr agree to mq w all city and county ordinances
antl state laws r 1 ting to builtl� c9�r ti�� anT1! hereb authorize repre-
sentatives of t is �ci to+e C p n t e%6tYc��pention tl prope�ty for
inspection pu a s (t �S Z�-�S
Signature J� �F� e .
Reinspeaion Fee $15 luue Fee $ 3
Drivers' Li nse or 55 �
0865-46, rev. 5/88 White � Builtling; Canary - Applicant; Pink - Accaunting; Goldenrotl - Assessor
CONSTRUCTION ANDPLANNING POOL& SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
r„
1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location
2. Soil Pi e-Undr rnd. �
�P 9 ,�r 53. Steel Reinforcement .
3. Electrical Conduif Utility-Undrgrnd. +� 54. Forms .-
4. Electr�cal Conduit-Untlrgmd. 55. Electrical Bonding
.5. Steel Reinforcement 56. Rough Plumbing & Pressure Test `�
6.' Electrical UFER�Grnd. ,� 57. APPROVAL TO COVER-GUNITE ,
7. Footings , ! � � 58. Electrical Conduit-Undrgrnd. . �
8' Foundation � . •� � 59.��as Pipe, O Undrgrnd., Test _
sr -
9.- Water Pipe-Undrgrnd. � .�60. BaIXc,�kwa,�h Llnes, P-Trap, L7 Undrgrnd.
10, Strucwral Floor System 61.�APPIj(3VAL TO DECK �"
11. PropertY Sewer Line & House Connection + 62:-Backwash & Receptor-Final '"
12. Sewer Cap �� � • 63Ff�leaY2r & Vent-Final
13. Roof Drains , • �64. �Plumbing System - Final �
� z.,, .,
14. Rough Plumbing''' y 65:;Electrical-Final .
75. Rough Electrical-Conduit '�66. Solar System-Final
r. .
16. Rou h Electric Wirin '��,' � .r' T.�s
9 9 �� �, 67. FenCirig &r� ccess Approval
17. Rough Wiring Sign '�' .�, '::� 1-•.�
�_�.�,''�c. 68. APP,ROV�DFOR�PLASTERING
18. Rough Electrical-T Bar Ceiling �,._�� 69. POOL/SP�qtiYSTEMS FINAL
19. Rough.Heating & Air Conditioning r?�,�,��� pIRE,DEP�T•. REQUIREMENT
20. Rougli Factory Fireplace �:.��^� APPROVA'LS7�fi'xPermit #
,:. .,S ., y,
21. DuCts,•in�Structure 4d't"S+ 1��., �
� .�.��, 70. Und��Yound HYdro
22. Ducts, Ventilating ���L �'� 71. P��duct�Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
- 24.. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25: Roof Sheathing ' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27,. Frame and Flashing 76. DrY Standpipe
28. Lathing'&tSiding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
31. Plaster Biown Coat�. 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-7est
�.36. Hood or CanopY '
.37. Final Factory Fireplace
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
� 41. Solar pomestic-Final
' 42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to 5outhern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER
,, JOB AC
� GENER
fl�APNo.
GAS
W�TERu Yy
ROUGN P UMBING�
PROP. $WR. LINE MOUSE CON.
SPRINK�ING SYSTEM
N
1 ROUGM NEATING �ND �I
UNOERGp0UN0 [] POWER
HOUGH WIRING
BOND e
SHERTI
FRAME
PL�STEq, BAOM'N CO�T
STRUCTURRL. FINRL
NE�TINC, 4ENi., REFRIG. AND A.C., FINAL
PLUMBING. FIN4L AN� GAS ?E$T
FINRI
oii��ll�4f. CIY�I
DATE
TRA[T fIREZONE YALUE
-%i
SUBCONTRACTOR
>�•� _ .. �'ti'�ivJG
� � COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applican[ to Fill in Completely — Use Ink Only
BUILDING p/ �`Sy�^`��� � �
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OWNER..I�PI{�/
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CANSTRUCTION
BRANCH
ADDRE55
ARCHITECT
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APPLICATION FOR STRUCTURAL PERMIT
RECEIVEDBV DATERECEIVED �oTFiacucr
BUILDING
ADORESS `,
— TRACT
TEL. S /
NO.
FIRE
ZONE
APPFOVED
j BV
311A �� U ��.
CITV �7 � E—.�IZC.�V NQ:J �.,�
LIC. NO.�O� % 9 LIC�NOYJ �
SIZE NO.OF BLDGS.
OF LOT NOW ON LOT
USE OF
EXI5iING BLDG.
Separa[e permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hareby acknowletlBe thet I have reatl this appllcaiion and state
that the above Informetion is corract antl e0rea to comply with
ell laws repulating builtling consSructlon, enC I shall not employ
any person in violatlon of the workmen's compensation laws of
the Scate of Californie.
I hereby certify that I em properly licensetl as a coniracior untler
ihe State of California Businass antl Protessiona Cotla, Division 3,
Chapter 9, entl that sueh licenses ere in full force end effect, or I
am exempt from the proviatons ot the State of Calitornia eusiness
entl Professions Cotla, Divlslon 3, Chaptar 9.
�
Sie�ature of �%
Permittee �"'
Authorizetl Apent
ROM
VAR.
APPROVED � VARDSAPPFOV
DATE
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IS� SQ. FT. �I7 N
THE AMOUNTSHOWN UNDEfl VALUAT�ON IS FOR m
TNE PURPpSE OF ESTABLISNING A PERMIT FEE ONLY: �
VALVATION PERMIT FEE $ d
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n
$ ZLj ` PLAN CHECK $ �s'"}J a
JI��7. �O TAX $ L�(% �
u/ TOTALPAID § G�S
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill i Completely — Use Ink Only
RECEIVED 8V DATE RECEIVED DATE ISSUEO
BVIIDING
ADORESS
PERMIT NO.
OWNER A'P' N�'
MAI� BUILDING
ADDRESS AODRE55
TEL, TRACT LOT BLOCK
CITV NO.
CANSTRUCTION N W A A R P
LENDER
BFANCH
OWNER
A D DR ESS VALUE
AliCHITECT TEL. SE g
OF ENGINEER N
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADORESS
TEL. ZONE NO.OF USE OF NEW
CITY NO. P�� BUILDWG
STATE CITV �'ARDSAPPROVED VARDSAPPROVED
�IC. NO. � LIC. NO. MAIN BUILDING ACCESSOflV BUILDING
SI2E NO.OF 8LDG5. (FROM C/L STREET)
OF LOT NOW ON LOT RONT FT. FT.
VSE OF
EXISTING BLDG. 51 E FT FT.
Separate permits are required for �, sioe FT. FT.
electric, plumbing and hea[ing work.
FEAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED p�g{qNCE BET. BET. MAIN &
MAIN BLD('a$. ACCF.�. BLDGS.
VAR.qW DATE
C.U.P.3j'+ APPRpVED
APPROVED
I heraby acknowletlge that I heve read ihis epplication antl state
chat the above i�formation is correct and apree to comply with
all laws regulatln8 bulltlln8 construction, antl I shall not employ
eny person in violation of the workman's compensation lews af
che Stete ot Calitomia.
I hereby certify thet I am properly Ilcansetl as a contrector untler SQ. FT.
the Stam of Celifornle Businezs end Professions Code, Divislan 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chaptar 9, entl thot such Iicansas era In tull force entl affect, or I THE PVRPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am exampt from the provlsions of tha5tata of Callfornia Businass VALUATION PERMIT FEE S
end Professions Code, Division 3, Chepter 9. / ♦
PLAN CHECK E .
SlBneture of ���///
Permittee 5 /(/ TAX S
AuthorizedAgent � TOTALPAID $ �
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