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Home My WebLink About3430 TIMBER LAKE - Building PermitsF CITY OF COSTA MESA ° BUILDING DIVISION � . � DEVELOPMENT SERVICES DEPARTMENT E98-00468 � � � PERMIT PERMITNUMBER �� (714) 754-5273 • Fax (774) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite Na Vicinity: 3430 TIMBER LAKE LOCATED AT SIDE OF 3430 TIMBER LAKE Parcel Nunmber: 93506052 App�icant THRAILKILL, ALLAN Address: owner: PHILLIPS, ELIZABETH J Address %LAU, DORIS CEE .. DALY CITY,CA . - 30 PAIRWAY DR � � Phone: 714-753-9711 Zip Phone:..._ ,. , � Zip: 94015 � _ , Contrecror. SUNDOWN GGHTING INCORPOR Address: 00012 MAUCHLY ISSUE FEE - Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fizts Recept Outlets , . Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors to 1hp Motors to 10hp Motors�to 50hp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg sign circuits Temp Pwr Pole Intermed Pole IRVINE CA Phone:''.714 582-6255 Zip: :92718 �;- � � �icense: 47967T � � 0 � ' SCOPE OF PERMIT STATE HEALTH AND SAFETY CODE SECTION 116049.1 PUBLIC POOL GFCI. INSPECTION � $22.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $2.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $D.00 so.00 $D.00 $0.00 Quantity FEESUMMARY Temp Dist System / Lighting Busway /100 tt � _, -- - Standing Section ' � � `- .- Misc Electrical Equipment - Transformers up to 1 kva/kw ................u'p to'10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw . ..................over 100 kva/kw , Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Canductor � � � Circus ( gen or ride) � Circus (mech ride or lights) � - Christmas Trea Stand � . � Fireworks Stand� - � � Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED C � D Applied: O5/29/1998 Issued: OS/29/1998 ' - Quantity , $0.00 0 . $0.00 0 $0.00 0 , $0.00 0 $0.00 0- $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 . 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 Eo.00 0 $0,00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES, E24.00 COMMENTS / SPECIAL CONDITIONS 1 ; � 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 Inspectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe ezpiration ot ihis permit. FOR INSPECTIONS CALL: (774) 754-5626 � WOHKERS' COMPENSATION DECLARATION: I hereby eXirtn under penalry ot perjury one ot the following declaretians: ❑ I heve and will melntain a cenNicate of consent Io selt-Insure for workere' compensation, es provitletl for by seCtion 3700 of ihe Labar CoOe, tor Ihe pertartnflnce of ihe woAc }or whlCh this pertnit is issuetl. � I have an0 will maintein workers' compensalion insurance, as requirea by seclion 3700 of tha fabor CoCe, for the pertortnance of ihe work for which ihis pertnit is i55ue0. M worke �m/pens1ation Ins-u%r %c�e cerrier e tl li number are: �%� / ''7 Cerrier:Y �T/A/l P --hl�j3(� �� PolicyNumber: `�YG��V��o�G�/ (ThIs sectlon nee�not be comple(�e permif is velued et one hundred dollers ($700) or /ess.) ❑ I certify thet in the pedortnance of iha work for which Ihis permit is issued, I shell not employ any person in any manner so as to become subject to �he workers' compensatlon laws of Celitomla, an egrae Ihet it I should become subject to the workers' wmpensation provisions of Sectlon 3700 of the Lebor Code, I shall tonhwith wmply with Ihese proh lo%% s. ��y /J C,�� AppllcantSigneture: �p�Y1y 6�. L"��' �.�1� Date: � ��_Cd� WARNINO: FAILURE TO SEWRE WORKERS' COMPENSATION GOVEFAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOVER TO CRIMINA� PENALTIES AND CIVIL FINES UP TOONE HUNDRED i1KKISAND DOLURE (510D,000), IN PDDITION TO THE ODST OF GUMPENSATION, DPMAGES AS PROVIDED f-0R IN SECTION 3IO60F THE LABOR CODE, IMEREST, M!D FTTORNEI^S FEES. UCENSEDCONTRACTORSDECLARATON: I hereby efiirtn that I em licensed u'nd'�e pfr vi�° u torce and efled. Lic. a� Coniradors Signature: (commancing with Sactlon 7000) of Division 3 of ihe Business ana P�fofessions Coda, entl my license is in full Class x ( -/ G �� DatB: �'�-C/' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn �thet there is e consiruction lentling agency tor tha paAortnance ot the work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lentlers Name: � Lendefs Address: SignaNre: � � Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn Ihet untler penalry ot perjury Ihat I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business end Protassions Cotle: Any ciry or counry which requires a permit ro wnsiruct, alter, improva, tlemolis�, or repair any structure, prior to its Issuance, elso requires the epplicant for such permlt ro file a signed stetement that he or she is licensad pursuant to �he provisions of Ihe Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Pmteuions Code) or Ihet he or she is exempt iherefrom ana t�e basis for Ihe allegetl eaemption. Any Noletion oi Section 7031.5 by any applicant tor e permit sub�ects Me applicant to e clNl penfllry of not more than five hundred dollars ($500).): ❑ I, es owner ot tha praperry, or my employees with wages as their sole compensation, WILL DO 7HE WORK, antl ��e structure is not intentled or oHered for sale (Sec. 7044, Business end Protessions Cade: The Contrectors License Lew does not epplY to an owner at properry who Duiltls or improves thereon, entl who does such work himselt or herself or ihrough his or her own employees, provitled that such improvemems ere nat Imentletl or oReretl for sele. If, however, t�e hullding or Improvement Is sold within one yeer oi completion, the owner-builtler will have ihe burden of provinq ihat he or she did not build or improve tor purpose of sale.). ❑ I, es owner of the property, am EXCLUSIVELY CON7RACTING WfTH LICENSED CONTRAC70RS to construct Iha pmject (Sec. 7044, Business entl Protessions Code: The wntrectors License Law tloes not appy to an owner ot property who builtls or improves Ihereon, end who contracts for such prqect with e conirector(s) license pursuant to the Contractors License Laws.). ❑ I em exempt untler sec. Business antl Professions Cotle for this reason: � Signature: Date: Owner ID verified by drivefs license. ❑ Yes ❑ No Drivers License No. Expires: Venficetlon af Ownership by (rype of documenL i.e. - properry taz hill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: . � ❑ I hereby certity that no excavetlon five (5) or more feet in depth Into which a person is requlred to descenq will be mede in connactlon wit� work euthonzetl Dy this pertnit, antl Ihat no builtling siruClure, sCettoldinq, falsework, or tlemolition or dismantling thereof, will be more than ihirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle 8. Celifomla AtlminlstreGve Code). ❑ As owner-builder, I will not employ enyone to tlo work which would raquire a pertnit from the Division of Industnal Safery, es noted ebove, unless such person hes a pertnit to do such work from the tlivision. � Signature: � Date: Division of Industnal Sefery Permit Num6er. CERTIFlCATE OF COMPLUWCE AND AUTHOR¢ATON OF ENTAY: I certity under penalry of perjury that I heve read this application end state that the intormetion givan is correct. I agree to comply with all stata laws and ciry ordinances relating to building consWction, and authorize representatives of the Ciry ot Casta Mesa to enter upon the ebove-tlescribed property for inspection puryoses. I agree not to occupy or allow acupancy of any building authorized by this pertnit until fnal inspection. COpE �. INSPECf10NTYPE �S¢ II{�LS 1616 Fixetl Sysiem Finel Fire Prevention 1266 200 201 202 203 Pool Spa Final Finel Re-Rooi . Finel BIocWRetaining Wall Finel Fedory Fire Plece Finel Sign 204 Fnel Demolition 2d4&48 � 2 � ��Sr Date` CODEI IHSPECTIONTYVE . 206 Final Mechenical 208 Final Plumbing 210 Finel ElecMcel 212 Final Fire Prevention 220 Finel Planning Appraval 222 250 Final Site Pinel Builtling/OccuDanty �jf. INTT�1 e Ic� reaecTaooeess: 3430 TIi'4BER LAKE OWNEfl'SNRME: VILLAGE CREEK H2O.A, aoosess: 3429 TiMB£R LAKE S� COSTA MESA, CA 92626 APCH/ENGINEEH: 5 5 3— 1� 7 6 AOOPESS: NEG.NO.: UNIT: UNIT: PEHMITTEE: IjElERSON ROOFING ( 7? 4) 979-7111 aooxess: 3006 ENTERPRISE C'(1STA p � (� p UCENSED CONTBACTOq OECIAflRTIONMY�re6y atfirm iha� I am licensed unOeCr pmvisions oi�apler 9 �commencing with Sec�ion 70001 0l Div�sion 3 n� IM1e Business antl Pro�essions Code, antl my license is in �ull �orce and elleCl. cm uc.: 0 4 5 4 4 5 STRTE LIC.:6 O.� g 7 z cu�ss: �a�e: Signature: _�� WOBNE ' CN ENSATION OECLANRTION: I hereby affirm �hal I �ave cenificate ol consent m sel4insure or a cenificate oi Workers' Compensaiion Insurance, or a ceni�ietl capY �hereo� (Sec�ion 3800, Lah. C�- aoucreo.:1021355-93 EXP.ORTE: O4�OS�94 comraNv: STATE FUND ❑ Cenifie0 caDY �s hereby lumishea. 4 Cenifie0 copy is f•ile�0 with ihe ciry Build gAwisie p Dale: /� � /— / � APPlitanL� J�"�� <J��C=��4G.i�-YY�C) E%EMPTION FHOM WaflNEPS' fAMPENSRTION OECNMTION: Qhis sectifiAneeA nat Ue complete0 if tAe permit is far ane hunOrM (5100) or iew�. I cenify IAat in ihe pedormance ol ihe work for which this permit is issueQ I shall not emDloy any Dersan in any manner so as to become sublect Io ihe Workers' Compensation Laws of Calilomia. Daie�. Signature: NOTILE: iL after making this detlaration. you sAould become subject to tAe WOBers' Compensation provisions of the La6or COUe. you must fonhwiih compiY w��h such pmvisions or �his permit shatl be tleemed revokeA. CONSTPUCTION LENOING RCFNCY: I hereby a�hrm �hat �here is a conslmc�ion IenAing agenry for the peAormance of Ihe work �or which Ihis permil is i=_sued (Seciion 3097. Ci¢ C�. LENOEP: AO�flE$$: OWNEN BUILOEN OELNPFTION: I hereby affirm Ihat I am exempt irom the Comrac�ors' S�a�e license Law �or the following reason (Section 7031.5 Business an0 Pmlessional Cotle'. Any ciry of county which reQuires a permit to constNct, alleL improve, tlemolish, or repair any Slmc�ure. prior �o i�s issuance, also requires �he aDPlican� for such permil Io lite a signetl statement �hat �e/she is licensea pursuam m the pwvisions o� �he Conlraclors' State license Law (Chapter 9(commencing with Sec�ian 7000) o� Oivisian 3 0� the Business antl Pmlessions Catle� or thal he/she is exempt therelmm an0 the 6asis lor the alleged exemption. Pny viola�ion oi Sec�ion 7031.5 by any applicant �or a permii suElecis �he applicant �o a civil penalry o� not more IAan �ive �untlretl dollars (5500). I. as owner ol ihe OroDehy or my employees with wages as iheir sole comDensation, will ao tAe work, an0 ine ❑ simcture is not imen0etl or olfered for sale (Section 7044, Business ana Pmfessional Code: The Coniracrors' State License Law does no� apD�Y �o an owner of a pmDetly w�o builtls or im0�oves �hereon, and who does such work himself/hersel� or thmuAh his or her own employees. pmvitle0 �hal suc� impmvemenis are no� imendetl or oflereA �or sale. If, however Ne building or impmvement is sold wiihin one year ol completion. �he owner will have Ihe burtlen af pmving he/she ditl not huiltl or impmve for Ihe purpose oi sale�. I, as owner o� Ihe propetly, am exclusively con(rac�ing wi�h licensed conVaclors to consimc� �he pmlect (Section 7044, Business ❑ antlPmie55ion5Coee: T�eContractors S�a�eLicenSeLawdoe5nolap0lytoanownero/pmperiy whobmltlsorimpmves�hereon antl who coniracis for such pmiecis wi�h a contracmr(s) license pursuam to Ihe Comracmrs' State License Law�. i am aware Ihat pmo� af ��eir Worker's Compensa�ian insurance should be pmvided �o me. � I am exemp� un0er Seciion: B. 8 P. C. 1or this reason� Date: Owner I ao hereby cenify Ihat I am aware o� an0 un0erstand t�e requirements o� Cab�arnia Heal�� an0 Sa�ery Cotle Sections 25505, 25533, antl 25534 anA Iha� I or any future 6uil0ing occupan� will/wlll nol (circle one) need lo compty wi�h saia 51aie codes end Ihe requiremeNs �or a permil far consimc�ion or motlilication Imm �he Air Oualiry Managemen� OiSlricL Resitlential constmction appli[ations are exemp� Irom �Aese pmvisions. I Oaie: Npplitanl: � I �ereby cetlily Ihat I have reatl ihis apPlication and sta�e thal ihe above inlormation is correcL I agree to compty with all ciry and county Iortlina�es and s�alelavrsrela�inglo 6uilding conslmclion antl hereby auihor¢erepresen�aliv q � i ci to en�erupon��e above�men�ionetl pmDeny �or in50eclion purpoCses. /7 Oale: �� — / � Signaiure: �✓ �J��aC�� Oriver's license or Social Secwily a: *� . t6aLa6 Whi�e—Builtling; Green—CoUe Enlarcemen�; Canary—ApplicanL Pink—Revenoe; Golaenrotl—Aaessor C�TY OF COSiA MESr? - BUILP2NG PEAMIT PEftM NO: B 063399 PERMIT NO: H 063399 PLASd CHECK NO: N GOVT: N SUPP; N C6NSTRUCTiON TYPE: V-A� PERMIT TYPE: STR \` PURPOSE: ALT JOB DESCRIPTT_OR� : T/OFF SHEATR REP.t70F W/COMP SHINGLES 5Q FT: 9,600 CLAIM VALiJE: 4,500.00 CALC-VALUE: 4,600.00 GROIIP vCC: R-1 / COMMENTS; SMOKE DETECTOAS REQ, PERMIT INCLUDES 3432 3434 6 3936 TIMBER LA �t�t�i�t�*t�**t�*�r*�;e*�c�r*i�+ri�*�i�**��r��rtfri�*it*�*�t�+r�i[�±��t;�*it�rx-��*�**t�rt**�r*i�**x�xx��e�r**x��ir*�r , Z O N=� GS EATEBQAUCIKRSE M E N T�MOKE DE�'ECT,OI� ------------ MAIN BU�LDIAIG ---------- --------- ACCESSORY BC�r'�Jt{-l� - r'RNT: FT IN REAR: F? IN FA3dT: FT IN REAR: FT �ZN LEFT: FT IN RGHT: FT SN LEFT: FT IN RGHT: FT ' IN PA3KZNG REt• PROV: PARCEL: 93506052 ZNE: REF NO; PLANNING N�TES�j> G ' # if 3e r iE #�}F #+F 3F 3F if ii !f aE # 3E iF IF iE #!E # iF 3F # N- ff iF 3clF iE �� a: ?4 iF iE #?F 3F?E 1E?E'r. � iF%#; if it 3F �1E iE �E �'t �E iF 9F iE i[� iE iE 3(-jF i(� 1E iE iE 9E Ifi * iE 9[- 3F it iE iE iF iF D E V�E..L d P M E N T S E R V I C E S R E Q U I R£ M E NrT S ZOTIING APPROVED BY DATE: HUSLDING APPAOVED BY : DATE: �� !i � APPLICATION ISSUED BY: 4� DATE: 1�;�� 3 �lfkit�ifif�)FiEif�f3fiF�lf�ifit*iE�lfikiEiFaElf�iFiF3F'1F�riFTF7Fif?F3F3F7F�7F3F3F�FiF3�7f 3F iF7f iF�F'iF"#iF�7FifiFiki(�iFifiE�l(�iEi(� i i r iti(� iF iE iF iE iE?F iE 1E iE iE �E 3F iE iE iF jE if iE 3f iE jf iE iE if iF if iE if iE 3f it 3E iF �E iF * if it 3E # 1E iE iP if iE iE it iE it iE if iE�IF i4 i!-IE # iE �c- 34 iE �1F i! it iE 3E iF 3F if iE if iE iE #iP iE iE 3E iE LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SN_TP/RES GRADING PERMiT 72,00 ,50 SMIP/NON-RES PLAN ISSUE FEE BUILDING-DSV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 72,50 0.00 0.00 72.50 72.50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 72.50 OVER/SHORT: .00 HLD�ZP00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOO GRADZNG PLAN-CAECK 3E if if if iE iE jF±E if 1E iE jE 3F iE iF jE 3E �F iE iElf if iF iE iE iF jE iE iE iE iE 1E IE iE iE iE iE 3F iE it if if aE tE fE jE if iE iE 3E 3E 3F 1k jE iE jE �F iE iE k iEiE iE iE iF iE it iE it iF iE x if iE 1E iE iE iE iF Z N D I V I D U A L F E E B R E A K D 0 W N . TYPE QTY D E S C R I P T I 0 N UNIT COST TOTAi COST SFR 4600 REROOF BY VALUE RESIDENTiAL NOZONE 1,00 9,600.00 END OF FEES O1 00144`75-��14457b T O T ??,�0 �AiE: GS109/93 TII1E� 14:08 \ _ CO��TRUCTION AND PLANNING : ' ; - .� POOL & SPA. _ , APPROVAIS Permit #' Date Inspector APpROVAIS Permit # Date Inspector 1. TemporarY Electn'cal Service o Pole � 52. Pool & Equipment Location , 2, Soil Pipe�Undrgrnd. �• � - - � 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �� 4. Electrical Conduit-Undrqrnd. - �, "" 55. Electrical Bonding 5. Steei Reinforcement - -. - 56. Rough Plumbing & Pressure Test - 6. Etectrica� UFER Gmd. � � 57. APPROVAL T6 COVER�GUNfTE 7. Footings 58. Electrical ConduirUndrgind. 8. Foundation _ 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. � . 60. Backwash Li�es, P�Trap, � Undrgmd. ' 70. Structura� Floor System �- 61. APPROVAL TO DECK i t. Proper[y Sewer Line &'House Connection _ 62. Backwash & ReceptorFinal � 12. Sewer Cap , . 63. Heater & Vent�Final 13. Roof Dre�ns .. 64. Plumbing System - Final 14. Rough Pl�mbing � - � 65. Electrical�Final � 15. Rough Etectrical-Conduii 66. Soiar System-Finaf 16. ftough Electric Wiring 67. Pencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR P�ASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ' ' ' � APPROVAL$ ; Permit # _ 21. Dutts, in Structure � . �. 70. Underground Nydro � 22. Ducts, Ventilating ' '' 77. Product Piping O Gas ❑ Oil 23. G�as Pipe�Rough &�l'est , � 7z, Underground Fiush� � � 24. Roof Framing�� ' � �' • � ' " 73. Undergmd�.�Stora9eTank �Gas ❑Oil 25. Roof.Sh�a[hing � . � . �� $��:ts 74..Overhead Hydro � 26. T-Bar Ceiling (Structuraq & Monocoat � ' 75. Dry Chemical ' 27. Frame and Flashing � �6. Dry Standpipe � 28. Lathing & Siding �� •'� ' 77.' FIXED SYSTEM FINAL ' 29. Insulation �� j ' 78. FIRE PREV. FINAL 30. Drywall Nailing � I HEALTH DEPT. REQUIREMENT r 31. Plasier Brown Coat ' i � 79. FINAI INSPECTION r 32. Electrical Power Meter-Final ' � � �80. POO� CERTIFICATE ISSUED 33. finat Etectric � � � , � ' Notes: . 34. Final Heeting & Air Conditioning' ' � ' 35. Final Gas PiPe-Test I ` . ' 36. Hood or Canopy • � , j � 37. Fina'I Factory Fireplace ' �, �' , 38. Final Plumbing ' !' � ' 39. Water Service�Final � �. ' ' 40. Gas Service-Final � ! , . ' 41. Solar pomesiicFinal i � , 42. 6ack41ow Preventer � � � , � 43. Backflow Irrigation �� . 44. Landscape Irrigation Sy`stem � � -� . - ' A, ^ 45. Sound Attenuation �ti ;�� , ' ' 46. Handicap.Regulations� � � �-� . - 47. FINAL STRUCTURE�&:BII��CpING � Z2-a ��f- . 48. FINAL PLANNING j-- � • : . . � 49�. Electric Release to Ediso� �� -. 50. Gas Release to Southeirr-Califomia Gae Co ! , � . 51. CERTIFICATEOFOCCUPANCY No. Oate JY�V 11l•1DGf� LKf�G PH0.IECTROOAF55: VILLAGE CREEK HOMEOWNSRS OWNEP'SNAME: ASSOCIATION noonEss: 3429 TIMBER LAKE CN VA 92626 UNIT: AflCHIENGINEEH: CHESTER CARVILiE qEG.NO.: `18jOS� 7922 ARMOUR ST pDDflESS: S, D. - ' CA 9 2 1 1 1 UNIT: PHOENIX ENTERPRISES INC, (213)690-9559 PEBMIITEE: Q], S COMERC IAL WAY ' � aooness: LA HABRA CA 90631 LILENSEO CONipqCTOfl OECWHRTION: 1 hereDy allirm ��al I am licens aer mvisions ot Chapter 9(commencinA wilA Section 7000) oi �i�d� ��usiness and Pmfe�i0f�"jCa1Pj O�tl my lic e m �orce ana eflecl. t�� CITY LI��TE LIC,: � �r . i, i Daie'. Signa�ure: _ (1� WOBNEBS' Wp�pE{!,Sp�pq pEGLAqpTION: I hereby afli n Ihal I have a ictp oyco5uP �o selbinsure or a ce dicate ol Workers' Compensaiion I!��(apEy o7 �7�,t�ilie0 cop ihereof �Section 3000. Lab. �� 11 P7 � 'OLICY NO.: CA COMP 6�IRE EXP. �RTE: �OMPANY: ❑ Cetlih d copy I5 hereby �umis�etl. ❑.Certified copy is file �he Building Dlvlslon. / i� /�, � �aie: , �� i qpplicanL — � ✓'� E%EMPTION FflOM WOBKEBS' COMPENSATION OECLABRTION: (This seqion need noi Oe compleietl it Ihe permi� is for one hunEred (3100) or less�. I cenity thai in ihe,performance oi I�e work for whic� this permi� is issued, I shall na� employ any person in any manner so as Io hecome ' su6iect to Ihe Workers' Compensation Laws oi Calitomia, . �a�e. SignaWre'. NOTICE: II, aller making �hi5 deClaralion, you S�oultl become suble�� lo Ihe WOMers' Compen5aii0n pmvi5iDn5 0� �he Lahor Code, you musl lorthwi�h comply wi�h such pmvisions or �his permi� shall be aeemeA revokeA. CONSTBUCTION LENOING RGENCY: I hereby afiirm ��ai Ihere is a conSVuclion lentling agency br ��e pedormance o� Ihe work �or' which �his permi� is issuetl (Sectian 3097. Civ. C). lENOEfl: aooness: . - ' OWNEB BWLOEH UECLAPRTION: I hereCy atiirm Ihat I am exempi irom �he ConVaciors' State License Law �ar Ihe �011owing reason (Section 7031.5 Business antl Professional Cotle: Fny city ol counry whicA reQuires a permi� to cons�md, al�et, improve, Oemolish, or repair any stmc�ure, prior to ils issuance. also requires t�e ap0licant lor such permit �o �tle a signetl Slatemen� tha� he/she is licensetl pursuan�io�he pmvisions olihe ConVac�ors' S�ate License Law�Chapter 9�commencing wit� Sectian 7000)of�ivision 3 oi�he Business antl Pmtessions Co�e) or Ihat ne/sne i5 exempt inerefrom an0 ihe basis for Ihe alleged exemption. Any violation ol Section 7031.5 by any applican� �or a permit sublecls Ihe applican� to a civil penal�y at no� more �han �ive huntlred tlollaB ($500�. I. as owner ol the O�a�erty or my employees wiih wages as IAeir sole compensa�ion, will do the work, antl �Ae 7 siructure is not inten0etl or oHereA for sale (Section 70a4. Business antl Pmlessianal Cotle: T�e Contractors' Sta�e license Law ' Ooes not apply to an owner of a vmpeny who builtls or impmves ihereon, and who Ooes sucti work nimseltlnersell or throuAh his or her own employees. pmvitled tha� such im0�ovemems are no� inientled or o��ere0 for sale. If, however Ihe 6uilding or impmvement is soltl within one year of complelioq Ihe owner will have the bwden af pmving he/she tlid not huild or impmve forihe purpose of sale). , � I, as owner of ihe propeny. am exclusively coNracling with licensed coniraclors to consimct the D�olect (Section 704d, Business ❑ and Pm�essions Catle: The Conlractors' S�aie Lirense Law tloes not appiy lo an ovmer ol pmperty who budUs ar im0�ove5 ihereon antl wlw conlracts lor such pmlec�s with a conlraclor�s) license pursuanl Io �he ConVaclors' State License Law). I am aware thai Drool oi Iheir WOrker'S Compensalion insurance Shoultl be pmviUeO to me. , � I am erempt under Semion: 8. 8 P. C. for inis reason: oaie ow�e�: I oo hereby cendy inat I am aware oi and understana ihe requiremenls of Calilomia Healih anA Salety Coee Sections 25505, 25533, antl 25534 ane Ihai I or any �uture builtling occupanl will/wiil noi (circle one) neetl �o comply vnth saitl Sla�e co0e5 antl the reQuiremenis tor a permillor con9mc�ion or modilica�ion imm �he Air Oualily Managemem ois�ricl. flesi0eniial cons�Nction apDlications are exempt �mm Ihese provisians. Oale'. ApplicanL _ � �eieby cerlily��at I have reaa ihis aDD�ication and stale Ihat ordinances ind Slalelarrs relaiinglo �uiitling consimction anU n pmperlY i r ins� tlion Ourpos � �ale.�� $� ! �river's License or Social Secumy x: is wrrecL I agree Io comply wilh all cily and coun�y nlatives pl't�ciry lo enter u0on the above-mentioned t6aLa6 W�iie—Bmldmg; Green—Cotle EnlorcemenC Canary—Applicanl; Pink—Revenue; Goldenrotl—Assesmr CZTY OF COSTA MESA — BUILDING PERNIT n" ` PERMIT NO: H 050615 PLAN CHECK NO: 00096-91 A CONSTRUCTION TYPE: V—N � PERMIT TYPE; STR FURPOSE: REP JOB DESCRIPTION ; REPAIR SETTLEMENT DAMAGE , SQ FT: 1'43 CLAIM VALtJE; 14,300.00 CALC—VALUE: 14,300.00 GROUP OCC: R-3 / COMMENTS: BUILDING SETTLEMENT REF'AZR/FOUNDATION � � k 1f ik iE # iE it if 1E * it iE If iF 3F iE ik iE IF 3f iE iE iE if iF iE jE jE iE iE 1k �Yr 1F iE if if 1F if iEiE 3F if if If if 1ElE if iF 1F iF if iE iE 161f 3E iF iE iF 1F iE iE 1F k iE �lf IE If 1E IE #!E It iE iE j4iE iE Z O N I N G R E Q U I R E M E N T S S E T B A C K S ' ------------ MAIN BUILDING ----------- -- — --- ACCESSUAY BUILDING --------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN• LEFT: FT IN RGHT: FT. IN PARKING REQ• PROV; PARCEL: 93506124 ZNE: R2 REF NO: PLANNING Nt7TES> FOliNDATION REPAIR, � � i lf if if )E if jF iF if if �lE fk * IF i(� if lE iF 3f fF iF 3f !4 iE iE iE jE iE iF �!f iE iE 3FiE 3f iE iE 3E iF jf iE if �f if 1E iF �F iE iF iE �E iF IF iE !F �lF if If lE �F 1E I(�iE iE iE N� if N-1E iE !E iE 1E 1! iF 3P 1E iF 3E �1E D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E N•.T S ZONING APFROVED BY � �-- � � DATE; O%/S `�/ $UILDZNG APPROVED HY ; �f� "�.",.� DATE: / APPiICATIOtv ISSUED HY:� *��*x***��r**�*�**��*�+�� iP i! iF �%� 1E iE �E ib iE dE iF 3f if �k i't If If 3f iE iE if If �f LEGALIZATION;N F E E S,U M M A R Y BLDG PMT PLUMHING ELECTRIC MECHAI3IC i�FiFiF if IP #�lE jf iE M� �3(� aE�SF£ IE 3f )E 3E �E iE if iF iF iF?F if if IE �E±f 3F if 3f 3E 3E it �E iE 1E iE if STRUCTURAL SEGMENT:Y FIRE SMIF/RES' GRADING PERMI'P 162.00 1,00 SMIP/NON—RES PLAN 26.33 IS5IIE.FEE � HUILDING—DIV—> PERMIT - ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 163.00 O,DO 26,33 189,33 189.33 .00 REVENUE DIVISION TOTALS—.—> COLLECTED; 189.33 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANSC FIRE SMIP/TOT GRADING PLAN—CAECH 162,00 • 1,00 ' 26.33 �f if iF iE iF iF �E if iF )f iE ie iE 1f !f if iF 3E 1E 1F iE !f iF �E iE 14 iE iE iE if if iE-)E if aE #E if iE iF 3f !k 1F 1F iF iP iE IE�1F aE iP iF iE iE iF if iE iF if 3E if iF iE iEiE 1F iF iF if iF iE iE 1E �F 1F #E 16 iF 3E if .' I N D I V I D U A L F E E B R E A K D O W N TYFE QTY D E 5 C R I P T I O N UNIT CO5T TOTAi COST SFR 193 STRUCTUFtAL BY VALUE PER y100.00 END OF FEES � 100,00 ' 14,300,00 �l�7E��y�23/9j`�""��3 �`a_e'� �!d'3.3b TIh7c': 1f:04 , CONSTRUCTION AND PLANNING � ' �& SPA� 'APPROVALS Permit#T Date Inspector qppROVALS Permit# Date Inspector. i" 1. Temporary Electrical Service o� Pole - i � .- 52. Pool & Equipment Location ,� . 2. Soil Pipe-Undrgrnd. � � r 53. Steel Reinforcement � 3., Electrical Conduit Utility�U� cJrgrnd. �,� 54. Forms - 4. Electrical Conduit�Undrgrnd'.�� -� 55. Electriwl Bonding �� S..Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6. �Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE � � 7. Footings �� - 58. Electrical Conduit-Undrgrnd. :��' 8.. Foundation •' r� ,� 59. Gas Pipe, O Undrgmd., Test i�� ';:-� ' 9. Water Pipe-Undrgrnd. �'�� !.� �" 60. Backwash Lines, P�Trap, O Undrgrnd. � r r'^. / . . / / o il '' `1 _. :10. Structural Floor System� �: -� � 67. APPROVAL TO DECK �� 11. Property Sewer Line &.Hous�Connection �.. 62. Backwash & Receptor-Final � 12. Sewer Cap 9 ' � �63. Heater & Vent-Final '-j 1 13. Roof Drains � j-�` ^� 64. Plumbing System � Final ��' 14. Rough Plumbing �! - � 1� 65. Electrical-Final � 75. Rough. Electrical�Conduit ;�., �%' ^ 66. Solar System-Final -� � . , 16. Rough, Electric Wiring �� ti� 67. Fencing & Access Approval ,( 17. Rough Wiring Sign / ` 6$, APpROVED FOR PLASTERING � 18. Rough Electr;cal-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'OGas �Oil 23. Gas Pipe�Rough & Test � _ _ ' „ � 7Z. Underground Flush � . , 24. Roof Framing • - � ••• 73. Undergrnd. Sror,age Tank O Gas ❑ Oil 25. Roof Sheathing � , , . . ' 74. Overhead Hydro � � , 26. T�Bar Ceilin9 (Structural) & Monocoat � � ` 75. Dry Chemical . ' � 27. Frame and Flashing �,.... • _ , 76. Dry Stand`pipe: � ." 28. Lathing & Siding . . �i � .i� � 77. FIXED S`lSTEM FINAL . � 29. Insulation , .' �� I ' �. 7$, FIRE PREV. FINAL �- � � 30. Drywall Nailing � . � ; l� : HEALT,H DEPT. REQUIREMENT 31. Plaster Brown Coat, � ` I �� ' 79. FINAL�INSPECT,ION •' ' 32. Electrical Power�Meter-Final I � �• � 80. F000 CERTIFICATE ISSUED . 33. Final Electiic � , ' ' � . I I � ' '� Notes: - 34. Final Heating & Air Conditioning � i i � �- - , � 35. Final Gas Pipe-Test _; �� I , ' 36. Hood or Canopy - , , . � - .- .- - � 37. Final Factory Fireplace �- � � . � ' � 38. Final Plumbing ". � � , - � _ 39. Water Service-Final - - � ` , i . . . 40. Gas Service-Final'� . . ' I � ' .' .' ' 41. Solar pomestic-Final - � � ' I' ' 42. Backflow Preventer � „ � � �� , r ' � 43. Backflow Irrigation � � � � ' , 44. Landscape Irripation System � . , �_ - . ' . 45. Sound Attenuation � ' • � ' ' 1. � 46. Handicap Regulafions . � i ' : , 47.. FINAL STRUCTURE & BUILDING / l � '- • 48. FINALPLANNING . � ,., . '� � 49. Electric Release to Edison i I �, ' . , � 50. Gas Release to Southern California Gas Co , " I � � � ,, _ i 51. CERTIFICATE OF OCCUPANCY -, , , . . . � No. Date OWNER RTATF_WTDF ➢evelnj�rs� Tnc_ 4-28-76 JOB ADDRE55 ol�an m<..s.e.. TeLn BUILDING PERMIT N0. [.i ��z No.140=054=0I—'Y'OT TRACT 8858 FIRE ZONE VA SUBCONTRACTOR ROUGH PLUMBING PROP. SWR. LINE MISCELLANEOUS ROUGH HEATING AND RIR CONOITIONING TEMPORARV SERVICE OR POLE UNOERGROUND I-I POWER n FLOOR $VSTEM SHEATHING FRqME ANO FLASH LATHING - IN �C HEATING, VENT., REFRIG. ANO A.C., FINAL PLUM6ING. FINAL AND GAS TEST S z . �w (wj ZQ � N am J � J N Q W QI J J m Q U N Z a W ¢ d W tu Z J Q m Z J � w W �_ zF w� �O F z Q U J a a Q 0 F y Z O H U � � r y Z � '.__ !4,1..76 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant fo Fill in Completely OWNER State-Wide Developers, Inc. AooREss9461 Grindlay cirv (;yp GONSTRUCfION BRANCH ADDRESS ADDRESS �/Zy4b JK,� CONTRACTORStrlte• ADDRESS ]46� rjP�l ��T� Cv�ress s STATE LIC.NO. „Q��n O'F LOT 72,093 ac USE OF EXISTING BLDG. SIZE OF NEW BLDG. EXTEqIOR WALL aStE COVERING IOOd VSE OF BUILDING AND TEL. NO. k Blvd Irvine e DevelopQrs. Inc. V TEL. No.826-455 CITV �IC. NO. INO. OF BLDGS. NOW ON LOT O NO. OF ROOMS STORIES COVOERING Shake K TO BE PERFORMED dence w/att 1 hereby acknowletlBe that I have reetl this application entl stata that the abova information is correct entl apra¢ co comply w{M all laws regulating builtling construetfon, entl I shall not amplay any person in v(olation of the workman's compensation laws ot the Staie of California. I hereby cenify Met f am properly Iicensetl as a co�ttacfor uatler Me State of California B�siness entl Professions Code, Oivisicn 3, Chepter 9, antl that such licenses are in full torce an effect, or 1 am ezampt trom the provisions of the Statt of Califo nia Business and Professions Cotle, Division 3, Chapter 9. ,.. . �State-Wi de Devel9pe,�is nc. Permlttee _ Authofizetl anio ��-Zu5.6o '.i:1Y 13-7E��1z;�� 63i� ^�• APPLICATION FOR BUILDING PERMIT 4/2-Z// A.P. NO. / ¢O— OS BUILDING ADORESS 34�D TRACT�6`so W A D OWNER � use 1 R�r� FIRE ZONE TV APPROVED � /� % '. I PER�,IN�I.A 7'rn�Lt�c L4�t LOT � BLOCK. DATE ZONE NO.OF USE OF NEW 2ZG p P�� BUIL�ING � VARDSAPPROVEO VARDSAI � APPROVED HOLD FOR BET. MAIN & ACCESS. BLD DATE 1715 sn. FT. J-883 ; THE AMOUNTSHOWN UNDEF VA�UATION IS FOR ' THE PURPOSE OF E5TABLISHING A PERMrt FEE ONIv: Q VALUATION -w y ��Y��' PERMIT FEE $ 1 j / m PLAN CHECK $ I E /1 / /1 /�_ u