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Home My WebLink About249 VIRGINIA PL - Building Permits CITY OF COSTA MESA BUILDING DIVISION fAµ l 77 FAIR DRIVE,COSTA MESA, CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • 1111141• FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: BX07-00097 PERMIT TYPE B_MISC STATUS: ISSUED DATE ISSUED: 08/28/2007 • ISSUED BY: RMD JOB ADDRESS: 249 VIRGINIA PL CM "r: : ? .'Suite/Unit: Vicinity: THROUGH OUT UNITS A AND B • Primary O,cc Const Type :?? SQ. FT: 0 Valuation: $7,000.00c SCOPE OF WORK: 12iWINDOWS CHANGE OUT LIKE FOR LIKE,'NO.CHANGE?IN HEADER FOR DUPLEX UNITS A AND B.,WORKTO INCLUDE 6 WINDOWS CHANGE.OUT FOR:EACH UNIT. WINDOWS SHALL MEET 1997•UBC.EGRESS REQUIREMENTS. OWNER: HOLLIS„HOPE VIEIRA TR - Address:: 9851 LAMPSON Unit City/State: GARDEN GROVE, CA j Zip Code: - 92841 Phone: APPLICANT: HERNANDEZ, JOHN- Address: 2220 E ORANGEWOOD Unit: City/State: ANAHEIM, CA Zip Code: 92806 Phone: 714-397-6558 CONTRACTOR: WIN-DOR INC .;; License Noi 5.45553 Address: 2220 E ORANGEWOOD; Unit: City/State: ANAHEIM,-CA' - • Zip Code: 92806 Phone. 714-385-1202 . Cell: 800-457-2826 ARCHITECT: • License.No. • Phone ENGINEER: License NO. ' Phone FEE'SUMMARY Building Plan Check: $0:00• • Building Permit: $139.25 Electrical Permit: $0.00 SMIP Residential .$0.00 SMIP Commercial $0.00 $0.00TOTAL FEES $139.25 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE S. INSPEct10N TYPE DATE IN1111ALS CODE INSPECTION TYPE DATE IN1171ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electricpl 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 7-S 07 - f WORKERS'COMPENSATION DECLARATION: \- ' • ' Owner ID verified by drive. se. ❑Yes El No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 EDI hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized /� �/ by this permit,and that no building structure,scaffolding,falsework,a demolition Cartier:] L A44n/n /NS r or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (Thlssedion need not be completer/f the permil is valued al one hundred dollars($100)or less.) 2,Art 2Sec.341,Title B,California Administrative Code). Policy Number: 73-9//780-o/-0 3 L---. 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Lab o e,I shall forthwith ccoo2ply with these provisions. 8 -2-g--i Division of Industrial Safety Permit Number: 12 AO= azure Lyn HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes El No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Lic-#— • f lass.#.J ,�-C/7 (Section 25533 of the California Health and Safety Code, with some V— or r� exceptions, requires registration with the Costa Mesa Fire Department by .� 'a8-/ each business which at any one time has on hand a quantity of acutely fr Con`ctor c••.ure-' tDaate-- J 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 CO'STRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? CIYes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the Califomia Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for control officer 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 ' CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I. as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. 1JCENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that El I am exempt under sec. _ • the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. ignature• regal• •. Date Signature Date ' �/ al. 28-1 3057.46(3/0]1 �jl Mtlb u0n ed Applicant ( Date / . VV �J� 1n I., , ` ...-,L„ Customer Name: �tL\� -X l 0 eGik u_.___. ii ; t :/O piton ( t rrS cis J . Custom Window / Door Lay-Out Form or • •• House Lay-Out Form L_ i i I , 1 , acc) `At I %2. .60-k2E:(-) XC.). tft.- , I .1_,L1 .f5t,, i i .-0,1 . (,I U . -4145 , ) +`0 t I t 1 ‘ x`-I \.0. ‘vM' `-11/417 ` % :-,xU =ECU A XGh ', 14` • ( OUTSIDE / STREET ) Please circle one Note: Please be informed that all drawings are from outside of the home looking in. We, Win-Dor, Inc. will manufacture the window(s)/door(s) according to the specifications as stated above. Customer Signature: ..____- . --____ ----- -----Date: Salesperson Signature:^ _-----.--___- - - - ----- ---- Date: 6 I x r ,A \ �!1 �C 4Y /�, (F A i;-' ®� Customer Name: — ----,*, -:,*(3. __ ., n , Phone ,- / Custom Window / Door Lay-Out Form or . House Lay-Out Form �__, I 1 11 i 1:i .:2-r3-1,2_3. ' . -y:3 -1 1 I-- - ' - ( 64)0 � • Su 1• . ; I 1 C-VI Y� • -\N VII . ci- 1 i / ..:Th U T 1 , Lig . f; / co 3- .! : .rh : ; i , , ....._ ic. 2±161 \I sic iYlic�1 -A-)1 . �)Y11-1 Fp • ( OUTSIDE / STREET ) Please circle one Note: Please be informed that all drawings are from outside of the home looking in. We, Win-Dor, Inc. will manufacture the window(s)/door(s) according to the specifications as stated above. Customer Signature: Date: • Salesperson Signature: _______._ Date: • `p , CITY OF COSTA MESA 4 BUILDING DIVISION > i ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER VPERMIT �, PO4-00470 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 249 VIRGINIA PL Status: ISSUED Suite No A Applied: 07/07/2004 Issued: 07/07/2004 Vicinity: IP ISSUED BY: / /� Parcel Nunmber: 42607115 /j — Applicant: HODGES, JAMES JR Address: 1675 SUPERIOR'AV ". - - Phone: (949)548-5558 "_ COSTA MESA,CA ' Zip: 92627 - ' - _ - - i- Owner: HOLLIS, HOPE VIEIRA TR Address 9851 LAMPSON , Phone: GARDEN GROVE,CA Zip: 92841 - . • Contractor: JOE CARLOS PLUMBING Address: 1675 SUPERIOR AV- - Phone: (714)548-5558 COSTA MESA,CA Zip: 92627 License: 385443 . . " • Arch / Eng: - ' Address: _ ' Phone: _Zip: _ _ . -License: - - SCOPE OF PERMIT • REPLACE GAS LINE FOR UNIT A IN AN EXISTING DUPLEX. - - 1GAS REPIPE , - ' NO OTHER WORK AUTHORIZED WITH THIS PERMIT. , - ,..- _ . FEE SUMMARY AMT OW AMT QTYAMT 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 Preventen� ' , $0.00' 0' - '=P-Trap , " $0.00 . 0 Trap.Primer ' / $0.00 0 Bathtub . -$0.00 0 , Pre'ssure=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 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar - $0:00 0 Water Piping(Inst or Rep.) $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 2446-46(6/00) DECLARATIONS ( ) - n) 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 others'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. -My workrs'co,p�e-ns Ins ranee carrier aan3y olicy number are: 3 n /' .Cartier. \ J `re. �J Policy Number: O �1`�U��`C 0 (This section need not be completed N t permit is valued at one hundred dollars($100)or less.) ' ❑ I certify that In the performance of the ork for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la.: • .i•mla,=n/:gree that if I should become subject to the workers'compensation provisions of action 3700 of the Labor Code,I shall forthwith comply with t e provis• \\ ^ ^ - 0 qApplicant Signator." 1 �i a: Date: v / WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE is UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOI I ARE($100,000), ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CO NTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licen .•rd= ProvisE•as�.of Chapter 9(commencing with Section 7000)of Division 3 of the Busin an rofessions Code,and my license Is in full force and effect.Lic.it • 4 C 1 Class# Contractor's �''T Signature: Tat_ Date: / - - OM 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). Lenders 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:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of docum t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Cale). ❑ 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 Califomla 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? 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 a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'lyes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE 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. 1 I : . e Of Legal Owner(s) Or ( Date An• Or Authorized Applicant Date rnnE• INSPEcno TYPF gag INTITIAL$ CODE* IN$PECTIONTYPt peg llt]IDa6fl 1616 Fixed System Final Fire Prevention _ _ 206 Final Mechanical '/ A.. 1266 Pool Spa Final 208 Final Plumbing 7 9 Y T r/ 200 Final Re-Roof 210 Final Electrical PP 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 • _. __ _ ._• - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - _ • 5035 . 6111'06- �„i- — PERT-NO. TRACT NO.i LOT NO. UNIT NO. , CITY OF COSTA MESA CONSTRUCTION PERMIT// . Prdect Address yg'V/1/12g//1/A'.//i. _0/0/t - i ;la?Vj • 1 I • / �[ / TYPE OF CONSTRUCTION U NEW LI ADD H ALTERATION LJ REPAIR ' Applicant's Mailin�/gess /<.�-�'Zrl 1-///n d/// ' liva A.I - • ❑.CONVERSION ❑' DEMOL.ISH ❑.OTHER - Owner's Name /9//Ai.9 e i/e /' Phone��/--.3 G�� ` - A•P.# X _ Zone. /�/y- -‘)19/7/"---1"?' n / • DESCRIPTION OF WORK/USE OF BLDG. Address, {U?.4//✓ n%"T'6//, 926,4c ;- License $ Main Building: Accessory Building: Z • E Arch/Eng. License No. . :TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL; T • Front O Address' • s i 7 ❑:TENANT ❑ ELECTRICAL ❑ MECHANICAL N 7 , -,0C-20.: ❑iOTHER - - ,. I A Rear • • I ' Contractor's Name//'/'- ,`Pr---/s/s�,01/11A if l^ :- /"Phone77 , // ��I/ PROJECT DESCRIPTION SQ. FT._ _. OCCUPANCY C Right I G Address(mailing)/S3� •4i./I .r A i e A/All 4/1a-A r, 0 /vr-r `� , K Left- - ' 31 I • �t: CON ST RUCTION TYPE VALUATION$ $ , R City License NO: J ZONE - - GRADING CV.VOS. ACRES E LICENSED CONTRACTOR DECLARATION • • ± _ - Ping. Ref.# ` Parking.Req./Provided • Q , I hereby affirm that I am licensed under provisions of Charter 9 (commencing rq Remarks: • i Planning Notes: `IVSD - M with section 7000) of Division 3 of the Business and Professions Code, and - .. -' 1.{ T my license is in full force and effect. _ • - , {� ,��L License Class (-1.--3 L License,No:�I ICS,-S 7 - pe ��• 2 M . - $ "� Date 7.-f`f-1-"C, Signature/(/K%4/ L �'`/1Z1i//J ' - .. , , • , PLUMBING I , ' ' FEES I�CCF�V�1� zs ' • WORKERS' COMPENSATION DECLARATION / •y - - - IY **Y5 ME Lt / t ��++t \ ' hereby'affirm that I have a certificate of consent to self-insure or a certificate BarSink - Showers ELECTRICA Lss�VO. , •FEES ' Workers' Compensation 'Insurance, or a certified copy thereof.(Section Backflow Preventer Service Sink C 400, Lab. C.) - -- - Automatic Washer . Transformer 0 15.50 KW- Policy •No. 'f/ 2�d Company/ aPi4 I/GT i.f/$> Backflilw Irrigation Sewer Ca - I ' • ❑ SO+KW , P Construction Pole Sub: Certified copy Is hereby furnished. .. • . . - r Cert� )tied,�CCo�py,Is filed with thelcity undine Division.. �, � . Bathtubs ' • 'Sewer Connection - . • - Cooking Unit' - i 'Meter Cup to 100 amps ' ' Date Y'-/Y'E'(-. APPlicant�ln/AP2_ K - . EXEMPTION FROM WORKERS'COMPENSATION DECLARATION r Clar,iiier5 - 'Solar Collectors • - Dishwasher. Meter Dover 100 amps (This section need not be completed if the permit is for one-hundred ($100)or - - ' • less). . , Dishwasher _ Solar Piping, - Dryers_❑Gas ❑Electric • . Sub Panel - I I certify that in the performance of the work for which this permit islissued, I - - • ' shall not employ any person in any manner so.as to become subject to the ' I Drinking Fountains -Solar Tank . Fan ' Motors❑0-1 HP ❑1%-B - • • • Workers':Compensation'Laws of California. !;f - -, - - " - .,Date I Signature • - Floor Drains • ' i Swimming'Pool w/Spat F.A:U. _ _ 'Inc.Solar• ❑9-75 HP 016-15+ -NOTICE:-If;after making this declaration,you-should become subject-to the - " -- ." ' Workers' Compensation provisions of the Labor Code, you must forthwith ' —Floor Sinks ' Urinal , Microwave comply :with such provisions or this permit'shall be deemed revoked. - CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a'construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) , Interceptors Water Heater dd^ Outlets ,Range Lenders Name 9 • • , , Lender's Address -- - -- - - Kitchen Sink '- - - ' - ' Water Service - - "-- - - • OWNER BUILDER DECLARATION Switches - Sign I hereby affirm that I am exempt from the Contractor's License Law for the ' Lavatories ' Auto-Wash ' following reason (Section 7031.5 Business and Professional Code: Any city or • Garbage Disposal t Standing Sections • • • county which requires a permit to construct,alter,improve,demolish or repair i P-Trap Laundry Trays Generator ❑0;5 KW❑5-15 KW Trash Compactor any structure, prior to its issuance, also requires'the applicant for such permit P ' , to file a signed statement that he/she is licensed pursuant to the provisions of - Roof Drains " • the Contractor's License Law (Chapter 9(commencing with Section 7000)'of - - - . _ _i. -- _. .. _ ._.. _ - . , Division 3 of the Business and'Professions•Code) or that he/she is exempt- - +refrom and the basis for the alleged exemption. Any violation of Section j -. j - • 31.5 by any applicant for a permit subjects the applicant to a civil ' . • 'nalty of not more than five hundred dollars ($500). I ' $ 3 ' 1 ' 0 I, as owner of the property'or'my employees with wages as their sole Reinspection Fee i I $15 Issue Fee r -• - _ _ compensation, will do the work, and the structure is not intended or offered 1 • ' - Reinspection Fee ' $15 . Ilssue Fee ,, $' 3 1 for sale (Secion 7044, Business and Professional Code: The Contractor's ' ,MECHANICAL . ' FEES r License Law does not apply to an owner of a property who builds or improves ' thereon, and who does such work himself/herself or through his or,her own _ DEVELOPMENT SERVICES REQUIREMENTS: employees, provided-that such improvements are not intended or offered for Boiler •• _ Hood or Type I ❑ ' _ t sale. If, however, the:building or improvement is sold within one year of com- - Canopy , Type II' ❑ • - Zoning Approved By - - '-Date plebe'', the owner Will have the burden of proving he/she did not build or im- ' Duct- Under Ground - Building Approved By �" Date ' grove for the purpose of sale). I _ • - /'� - S_/-3 � O I,•as owner of the property, ain'exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued'By -f l t /4J Date tractors to construct the project (Section 7044, Business and Professions Code; - _ "C�_ • 1 The Contractor's License Law-does not applto an-owner of property who ' Duct-Ventilating . 00)00,000 BTU ❑100,000 BTU ' - - r.t I - SUMMARY OF FEES • builds or improves thereon„antl who contracts for,such projects with a con- __ I - ' • tractors) license pursuant to the lCo ntractor's;Ll cense Law). I am aware that - _ -BUILDING PERMIT ' $ ' • SMIP i $' ' proof of their Worker's Compensation insurance should be I Exhaust System �' Multiple.❑ System Repair/Alteration ' - , - Prowded.to me.r _ - PLAN CHECK , $. ' - PERMIT • 2 I I am exempt under Section ,- - B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers ' , . . . . - _ PLUMBING $ S o-O • ISSUANCE_ • $- Date , 1 Owner' - Heating System& Ducting , Registers ' - PLAN CHECK 25% $ - - ENERGY P.C. $ ' I hereby certify that I:have read this application and state that the above ❑O-100,000 BTU ❑100,00013T - _ GRADING - $, - information is correct. I agree to comply with all city and countyordinances C I ' ELECTRICAL $ - . and state laws relating to building construction, and hereby authorize repro-- - - • - - ' ' ' • PLAN CHECK 50% $• - MICROFILM $'• - _ sentatives of this city to. enter' upon the above-mentioned property for -- , PLAN purposes. �� A Sys r / n/ _ _ MECHANICAL, $ - TOTA L.FEE $ J ' �•) . Signature ../11-4/7# C! /LQJ 'Date? -/t��^” I Drivers' License"or S5# _ - • Reinspection Fee ' $15 . Issue Fee , ' $ 3 PLAN CHECK ' 25% $ , ...---- CMF 0665-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor ' CONSTRUCTION AND PLANNING - • - - -POOL &SPA , ' APPROVALS Permit# Date Inspector APPROVALS Permit# 'Date Inspector 1. Temporary Electrical Service or Pole - _ 52: Pdol & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms i 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement ` - 56. Rough Plumbing &:Pres ire Test . 6. Electrical UFER.Grnd: • 57. APPROVAL TO COVER-GUNITE .0 • 7. Footings 58. Electrical Conduit-Ondrgrnd. • • 8. Foundation I 59. Gas Pipe, 0 Undrgrnd., Test . 9. Water Pipe•Undrgr d. 60. Backwash Lines, P-Trap, O.,Undrgrnd. r . 10. Structural Floor System - 61. APPROVAL TO DECK !'' i 11. Property Sewer Line & House Connection - 62. Backwash & Receptor.-FinalW - 12. Sewer Cap • ' 63. Heater & Vent-Final': L3.1 13: Roof Drains - 64. Plumbing System - Final -� 14. Rough Plumbing . . .65. Electrical-Final 15. Rough-Electrical-Conduit 66. Solar System-Final ' 16. Rough Electric Wiring , 67. Fencing & Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit* 21. Ducts, in Structure • 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gs 0Oil 23. Gas Pipe-Rough &Test 72. Underground Flush - 24. Roof Framing • ' ' • 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 7,5. Dry Chemical 27. Frame and Flashing t`' 76. Dry Standpipe ' 28. Lathing & Siding - 73. FIXED SYSTEM FINAL 29. Insulation • - - 78. FIRE PREV. FINAL 30. Drywall Nailing , - HEALTH DEPT. REQUIREMENT ; 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter.Final 80. FOOD CERTIFICATE ISSUED ' 33. Final-Electric Notes: Olgj/ jif'*nor 34. Final Heating & Air Conditioning - ' 35. Final Gas Pipe-Test 36. Hood or Canopy • ,,p ,,/ ,s ;ay.? d 7G a. r e. Z 37. Final Factory Fireplace - - 38. Final Plumbing - 39. Water Service-Final - . . 40. Gas Service-Final ' - ' 41. Solar Domestic-Final' 42. Backflow Preventer • . - . . 43. Backflow Irrigation - 44. Landscape Irrigation System . - 45. Sound Attenuation 46. Handicap Regulations • • 47. FINAL STRUCTURE & BUILDING • - 48. Special Requirements Completed 49. Electric Release to Edison - • - • i 50.'Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • - - + No. - - - - Date - - - OWNER HOWLAND MRS.-&ThR, RICHARD J. DATE 5-26-60 JOB ADDRESS 249-249; Virginia P1, BUILDING PERMIT NO. 12115 GENERAL CONTRACTOR Shoreline Const. Co. VALUE $ 19}488.(0 AP.No.118-122-11 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Dup w/Att. Gar. I' ECTIONS t,.44E6 DATE I GROUP I & 11 TYPE V ZONE R44 1. .rground Soil 44../-5' U.G. Waterq ,r, . A . PERMITS ISSUED Underground Gas ••".2 „� SUBCONTRACTOR DATE NUMBER Overhead Water and Gas • Rough Heating ,y _ 7-/2 G.: Wt.._ ,,,,--_,S_ /v�c//J ..Q 5 •. /-s Rough Plumbing 1 2 , r , ti Miscellaneous Prop. Sv{r..in�Housd,6sn. St. :^jd QJ LO - ce1�t/4-C .244 to 3 '1.- I .P' I HSeating, Syltem ,Qp/- �• o Heating, Final �p, 'i fdu"LY'�/_",lrf' Plumbing Fixtures to �r 'O . A 91 Final Gas Test ]_�/nni :. _. ri Construction Pole Underground Power _ Rough Wiring y'T, F21 *Rl7 freaSi to 6 /4/-4'O 4,7 5—).K, `. Trenches orms Steel . '777 _ 0 Floor System Steel Reinforce Chimney Re-Rod Bond Beam S'--^thing , ala F— 6- i O a and Flashing— 5-,, rY2 C 7-- S- 0 L .ing, In Out`" , 070— . '. \ Plaster, brown coat _ Plumbing Fixtures, Final /L� ,� / n Electric Fixtures, Final t'' Z Building, Final `,,//'i. �.-) OCCUPANCY ""'v - W .. ... Form 210-5M-11-59 5-B P 1.2115 _/ _ . • • 12115 - `, t COSTA MESA BUILDING-SAFETY DEPARTMENT y R t U E I y E LI ._ P. O. BOX 917 COSTA MESA. CALIFORNIA 'I ...5--/9- r�_/9_ II��'' For Applicant to Fill In Completely APPLIC NC iNgliMIT • TYPE OR PRINT ��TBUD' e MESA 1- yii__ U( c (/u ...tADDRESS L/jC(r ill COSTA`MESA. CALIFORNIA� � j��j.� For Office Use Only OWNERI •& CMAIL1//MR uC Piti4 1•tO 5 / •` LAI(_- I4 RECEIPT NO. P[H /T