HomeMy WebLinkAbout987 TRABUCO CIR - Building Permits(714) 754-5273 • Fax (714) �54-4856 • www.ci.costa-mesa.ca.us
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Job Address: 987 TRABUCO CI
Suite No
Vicinity:
Parcel Nunmber: 42205213
PLUMBING PERMIT
Applicant: SANCHEZ, JENNIFER
Address: ' �� �� "� -
. . ' �'r � � Phone:
Zip:
/,.
Owner:. �SPITZ, JAMES.D�
Address 887 TRABUCO CIR
, �, _ Phone:
� . � � � COSTA�MESA, CA Zip: 92627
Contractor ��AFFORDABLE'WATER HEATERS.&'PGUMBING,
,
. Address: , �24707 SAN FERNANDO RD" ' .
_ , ; ' � - , � �- Phone: (661)259-7t31
' - SANTA�CLARI7A, CA Zip: 91321
' • ' License: 627368
i .
' Arch / Eng : , � , . , .
Address:
REPLACE 40 GAL GAS WATER
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 04/10/2002
Issued: 04/10/2002
ISSUED BY: uV �
�� �
Phone:
Zip: � -
License: _ . _ _ �-��
EEE SUMN
���� � AMT� QTY
ISSUE FEE ���` ` . � $23.50���� �� r -=. r_ n- Laundry Tub /-Washer "
Backflowirrlgation, $0�.00 �`0.. . �, Landscape-Irrigatlon
8ackflow Preventer � ��$0.00 �'0 � P-Trap '�
Bathtub � $0.00 �' 0 �'� ".� Pressure Regulator �
Clarifier System �, $0.00" � �0 • � � �'- Process Piping (per 10 ft)
Connect Qce,Soda,etc) �� '$0.00 0 , , � Receptors �
Dental Units . 30.00 0 Septic Tank
Dishwasher � 50.00 - 0. ,� Sewer Cap for Demo
Drain, Floor ' 50.00�, �0 � �Sewer Connect
Drain, Rainwater 50.00 0 Sewer Private Line
Drain, Roof 50.00 �0 . � , Shower
Drinkin9 Fountain 50.00 0 �_ � Sink, bar
Expansion Tank 50.00 0 �Sink, commercial.
6as Earthquake Valve 50.00 0 � Sink, Floor ' �
Gas (1-4 outlets) 50.00 0 Sink, kitchen
Gas (Over 4 outlets) $0.00 0 Sink, service/mop
Gas Repipe $0.00 0 Spa (private)
Gas Service 50.00 0 Spa (public)
Interceptors (Grease, Oil) 50.00 0
Interceptors (Sand Auto ) 50.00 0
RY , ` `� , �,
,-G;/ r /
AMT � `raTY � ''��; � �,�AMT
$0.00: '.0� � ��-^'--Sump-Pump i - !%�$0.00
-$0.00 0 � �� �Swimming Pool � . j,$0.00
$0.00 0 , ' :. Trap Primer � " �. � $0.00
$0.00 0 �; � Urinal % ;!i . / ;• ; � $0.00
$0.00 -0 -. Yacuum Brkr Bkflow(1-4) $0.00
$0.00 0 � .� Vacuum.B�kr Bkflow(5+) $0.00
$0.00 0 �.�-Wash Basin; � i� $0.00
$0.00 � 0-� � -� � Wash Basin Set $0.00
$0.00 0� , � Waste and Vent System 50.00
50.00 0 ' �' Water Closet (Toileq $0.00
$0.00 0 _ � � Water Heater / vent $12.30
$0.00 , 0� - %' - - Water Piping (Inst or Rep.) $0.00
t $0.00 � � .0 � � - Water Re-pipe 50.00
$0.00 0 Water Service $0.00
$0.00 0 Water Sokener $0.00
$0.00 0 OTHER $0.00
$0.00 0 VIOLATION $0.00
$0.00 0 PLAN CHECK $0.00
REINSPECTION $0.00
TOTAL CALCULATED FEES: 535.60
COMMENTS I SPECIAL CONDITIONS
QTY
0
0
0
0
0
0
0
0
0
0
�
0
0
0
0
�NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and ralafed
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for Ihe work authorized under this permit to be considered legal. such work must comply with all applicable codes, and all
required Inspectiona and final approval must be obtained. Failure to obtain inspections and (inal approval will result in lhe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaae�+e �eroo�
WORKERS'COMPENSAnON DECLARATON: —
I hereby ettirm under penelry of perjury one of Ihe following declaretions: �
❑ I heve end will meintain a certificate of consent b seN-Insure br workers' compensation, as provided for by section 3700 ot the Labor Cotle, br the pertortnance of the
work for w�ich Ihis permit is issuetl.
�t have entl will maintain workere' compensation insurance, as requiretl by section 3700 of the Lebor Code, for Ne peAortnance of the work for whic� this permit is issuea. �
M d ers' compensatl surence card dpolicy num e: 1 (^ Q c (�r�
C r' c ��f1,��� Wi�'Nu'mber. _ l lV � l�� 7' �-+ G�
(This secHon neetl not be O/eted il the p�im/f is veWed et one hunereC dollars ($f 00) or less.)
❑ I certify Ihat in t�e Aormance oi the work tor which this pertnit is issu d, 1 shall not employ any person in any manner so as to become subject to iha workers'
compensetlon I s t Celifom' d egrae that II I should become su ect to tha workere' compensatlon provisions ot Se tion 3700 p Ihe Lebor Cotle, I shell forihwith
comply with se ovisions.
��-..-.�-_ � n O
ApPlicant Sign : + ��p ale:c=- :
WARNIN(3:F LURETOSE WORKERS'COMPENSATIONCOVERAGEIS WFULANDSHALLSUBJECTANEMPLOVERTOCRIMINAL ENALTIESA DGVILFINESUPTOONEHUNDRED
T/N)USAND RE(510D, ),INADDfitONTOTHECOSTOFCOMPENSATi GESASPROVIDEDFOPINSECTION3]O60FTHEL48 �RCODE,IPREREST,ANDATTORNEV'SFEES.
LICENSED CO ACTO S DECLARATION:
I hereby aHirm Ihal I am censed unJgr provi�5'�
q. _
CONS7RUC710N LEN[1
❑ I hereby attirm ihat
LentleYs Name:
Signature:
is
ns of C er 9(commencing with Section 7000) of Divislon 3 the Busin P fessio d my license is in full
J859 A`
te. --
lending agency for t e pe ortnance of the work for w�ich Ihis pertnit is issuetl. (Sec. 3097, Civil Code).
L ders Address:
Da[e:
OWNER-BUILDER DECLARATIONS:
I hereby eXirtn that under penalry ot perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu and Professions
Code: Any ciry or counry which requires a permit to constma, alter, improve, tlemolish, or repeir any structure, pnor to its issuance, also requlres the epplicent for such pertnit
b tile e signed stetement �hat he or she.is licensed pursuant to ihe provislons of the Contradors License lew (Chapter 9(commencing with Sectlon 7000) of Divislon 3 of ihe
Business end Professions Cdde),or�that�fie,or,she is eaempt theretrom antl tha basis for the alleged exemption. Any violation of Section 7031.5 by eny applicent for a permit
subjecis ihe appllcaM to a clvil penalry of no(more Ihan tive hundretl tlollars ($500).):
c;
❑ I, es owner ot Ihe properry, or my employees with wages es iheir soie compensation, WILL DO 7HE WORK, and Ihe structure is no� intentletl or ottered for sale (Sec.
7044, Business end Professions Code: The Contrectors License Ww dces not apply Io an owner of property who builds or improves Ihereon, and who tloes such work
hlmseN or hersell or through his or her own employees, provided ihat such improvements are not Intentletl or ottered tor sale. It, however, ihe building or improvement is
sold within one year of completion, iha owner-builder will heve ihe burden of proving ihat he or she tlid not build or improve for purpose of sale.).
❑ I, as owner ol lhe property, am EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Profeuions
Code: The contrectors License Law tloes not appry to an owner ol property who bullds or impmves thereon, and who contraas for such project with e contractor(s)
licensa pursuant to t�e Coniractors License Laws.).
❑ I em axempt under sec. eusiness and Professions Cotle for this reason:
Signawre: Date:
Owner ID verified by drivefs license. ❑ Yes ❑ No Drivers License No. E:pires:
Venficatlon ol Ownership by (type of tlocumem, i.e. - property ta�c blll or tleetl):
DNISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ��
❑ 1 hereby ceriHy Ihet no excavation five (5) or more feet in depth into which e person is required to descend, will be made in connection wlth work euthonzed by t�is
permit, and Ihat no building structure, scaHolding, falsework, or demolition or tlismaniling ihereoi, will be more than thitly-siz (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title 8, Celitomia Administretive Code).
❑ As owner-huilder, I will nat employ enyone to do work which would require e pertnit irom the Oivision of Indusiriel Safery, as noietl above, unless such person has e
permit to do such work from the division.
SignaWre: Date:
Division of Intlusirial Safey Pertnit Number.
5
ARDOUS MATERIALS AND EMISSIONS CER7IFICA710N:
W ill the epplicant or present or tuture building occupent need to tile antl certiy a 8usiness Plen for emergency response to release or ihreatened release of e hazertlous
matedel? ❑ Yes ❑ No
(Section 25505 oi Ihe Celifomia Healih antl Safery Cotle requires, with some exceptions, that e Business Plan be filed with the Costa Mesa Fire Depertment by every
business which has at any one time tlunng a reported year a quantiry of hazardous matenals equel to or greater than a weight o1500 pountls, oi e volume of 55 gallons,
or 200 cuDic feet oi compressed gas at standa�0 temperature end pressure).
....................................................................................................................................................................................................................................................................................................................... ...................................................
Does or will Ihe epplicant or present or future building occupant neetl to file a registration torm for ecutely hazerdous matenals7 ❑ Ves ❑ No
(Section 25533 0l the Celifornie Health and Safery Cotle, with some exceptions, requires registratlon with Iha Costa Mesa Fire Department hy each business w�ich et any
one time hes on han0 e quantiry of ecutely ha�rdous metariels equal to or greater then e welght ot 500 pounds, or e volume of 55 qellons, or 200 cubic feet of
compressed ges a� stantlard temperature and pressure).
...............................................................................................................................................................................................................................................................................................................................................................................
Does or will ihe epplicant or present or hture building occupant nee0 to prepare an RMPP (Risk Managament and Prevention Program for acutely hazerdous materials)?
❑ ves ❑ No
(Sedion 25534 0l the Calitomia Heatth and Satery Cotle provides that the Costa Mesa Fire Department may require the preparation, certiticetion and filing with the Fire
beDeriment ot en RMPP by businesses which are required to register eatety hazardous materials with t�e Fire Depanment.
.. ...._ ............._....................................................._......................................................................................_._................................................ .._...........................................................................................
................. ..
Ii an RMPP is oresentiv reauiretl. has Section 25534 0l the Celifomia Health antl SafeN Code been fullv comolied with7 fl Yes fl No
will the appllcent or present or future bwltling occupant requlre tor tne work wnich Is lhe subject o� this a plication a pertnit for such consiruction or
South Coesl Air Duelity Managemen� Dislticl or from eny other air polWtion wntrol dlsltici or egencyl � Yes u No
65850.2 of the Califomia Govemment Code reduires that the requestetl infortnation be furnished on applications tor non-residential building pertnits).
wm eny part ot me tacmry �o oe consttuctea unaer �ms pertnrt oe wimin iwu iee� rrom [ne outer oounoenes ot e scnoorr LI res LJ Na
Qf'yes", Ihe faciliry must meet the requirement of Sections 25534 and 42303 oF Ihe Califomie Healih end Safery Cotle).
..............................................................................................................................................................................................................................................................................................................................................................................
Ii a permit irom Ihe South Coest Air Queliry Manegement Distnct or other air pollution contml district or egency is required for ihe wark which I5 ihe subject of Ihis
epplicetlon, heve all ot �he tlisclasures prescribed by Calltomla Health antl Safery Code Seclion 42303 been metle? ❑ Ves ❑ No
..............................................................................................................................................................................................................................................................................................................................................................................
(If'yes", anach certiticate ot compliance from ihe appropnete eir pollution conirol oHicer).
CERTIFICATE OF COMPLIANCE: I certity that under penelry ot perlury the iniortnation given ebove is correct. I agree to comply with all state lews end ciry ordinances
regarding Hazertlous Matenals end Emissions.
Signature: Dete:
CERTIFlCA OF COM� AND AUTHOR¢ATON OF ENfAY: I certiry under penalry of perjury that I have read this epplication and state that the information given is
conect. I e to com with II s;ate laws and dry ordinences relating to builtling construction, and authorize representatives ot Ihe Ciry of Coste Mesa to enter upon the
above- bed prope for inspection purpc�ces. I egree not to occupy ar allow occupancy of any buildinq authonzad by this permit until final insDection.
caoe �.
1616 iaetl System Final Fire Pr
1266 � ool SOe Final
2 Final Re-Raof
201 Finel BIocWRetaining Well
202 Final Fadory Fire Place
203 Finel Sign
204 Final DemoliUon
pd7E 1tIIIDA6$
CO�EI INSPECTIONTYPE -
206 Final Mechanical
208 Finel Plumbing
210 Finel Elec�ncal
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT T/ FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 987 TRABUCO CI
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42205213 � Zoning:
Applicant: BLANKS, JERRY ISSUED BY:
Address: 17501 NORWOOD PARK P� -, � -
� - Phone: (714) 573+0155
TUSTIN, CA �",� ' Zip: 92780 � �
/. /, ' . .
� ��. ,
Owner. SPITZ„JAMES�D �
Address �987 TRABUCO,CIR �� �
/- � j � � , ` � ! � ' - Phone:
� ��COSTA MESA, CA - " Zip: 92627
'; �' � �
� . � ..
Confractor: �FREMIER ROOFING AND BUILDING CO WC
'Address: 17501 NORWOOD PARK PL
Status: ISSUED
Applied: OS/07/2002
Issued: OS/07/2002
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� Zlp: � 92780 ` License: 634404
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Address: �
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Address:;. �- . � , _ _ „
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� �License: . . ,
� � , � SCOPE OF PERMIT_ _,
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REROOF: T/O EXISTING SHAKE ROOF; 7/16" OSB S11TG, 1 LAYER 30# FELT; A
1800 SQ FT ' � . . - .. . .
, . Plan Check:
Permit:
� �� SMIP Res: �
SMIP Com:
Other:
Inspection:
� . Total:
$0.00
$97.25
$0.50
$0.00
$0.00
$0.00
$97.75,;,
��.. � . ,
SETBACKS � � � � , - .
MAIN STRUCTURE F.rbnt 0-
ACCESSORY PronC 0-0
PARKING Existin :
NOTES:
K"30-YEAR COMP SHINGLES." � ' '
_• �.
�' - FEE SUMMARY ,- "' . � ,
- , - - ' Calc Valuation: ` ' S3,soo.00
� � � � Claim Valuation: „��: � � Sa,soo.00
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;
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0 � �- � � Rear �
� ' � Rear
0,� �� �Required:
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;'
IING -' �" i��'%i� /; ��
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_ . � - � � .i; " ��
0-0 Left 0-0.� Right��.,0-0-' ,'i"/
0. 0 Left 0- 0� Righl �� 0-'0; ���
, � � ii ;
0 Pr000sed: 0 �.
,.=�.. : ' ` . -
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia 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 inspectiona antl final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
ri..,�.,y�+u:n�
WORKERS' COMPENSATION DECLARA710N: � . - -
I hereby aflirtn under penalry ot perjury one ot the following tleclare0ons: ' �� ' �' � � '
❑ I have and will maintain a certificate ot consent to seli-Insure tor workers' compensation, as provided for by section 3700 of the Labor Coda, for Ihe pertormance ot ihe
work for which Ihh permii is issuetl. . .
nat
insurance, es requiretl by section 3700 oi the Labor Code, for the paRortnance of the work for which this pertnit is issued.
nd po�li7ry number ere: �j q /� '
���'/ Poliby Number: l"/ P J� � SS —� �
ialuetl et one hundred dollars (S700J or less.)
❑ I certify Ihat in the pedormanc ot iha work for which this p; it is issued, I shall not employ any person in any manner so as to become subject ro Ihe workers'
compensation laws oi Californ a, and agree Iha 'i I ul ecome suDject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forihwith
compty with these provision �
�icenl'�9nature: � Date: .�/�/O�
WARNING FAILUFE TO SECURE W 5' COMPENSAiION COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL ENALT ES AND GVIL FlNES UP TOONE HUNDRED
THWSANDDOLLARE�S100.000),IN DDITIIXJTOiMECOSTOFCOMPENSATIqJ,DAMAGESASPflOVIDEDFORINSECTION3lO60FTHELABORCODE,INTEREST,ANDAiiORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirtn ihat I am licensed un��prQvisip
force and eflect. Lic. #._ J���
with Section 7000) oi Division 3 ot the Business and Pro�f$s�sl'ons Code, and my license is in full
�Clas�. # i! `.1 7 � .
CONSTRUCTION LENDING AGENCV:
� I hereDy affrtn that thera is e conswction lantling agency for the pertortnance oi Ihe work for which ihis pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Neme: Lenders Address:
Signature:
Data:
OWNER-BUILDER DECLARATIONS:
I hereby ettirtn thet under Denelry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Business entl Pmfessions
Cotle: Any ciry or wunry which requires a pertnit to construct, alter, improve, demolish, or repair any strucWre, pnor to its issuanca, also requires tha applicant for such pertnit
to file e signed statemem that he or she is licensed pursuant to the pmvisions ot the Contraciors License Law (Chepter 9(commencing with Section 7000) ot Division 3 of the
Busineu end Professlons Cotle) or that he or she is exempt tharefrom and the basis tor t�e elleged exemption. Any violation of Section 7031.5 Cy any applicant for a pertnit
subjects the epplicant to e civil penalry of not more than tive hundred tlollars ($500).):
❑ I, as owner of ihe property, or my employees wl�h wages es iheir sole compensation, WILL DO 7HE WORK, and the structure is not intentled or ottered tor sele (Sec.
7044, Business end Professions Cotle: The Contrac�ors License Law does not apply to an owner of pmperty who builds or improves Ihereon, and who tloes such work
himsetl or herself or Ihrough his or �er own employees, Drovided ihat such improvements are not Intendetl or oNered tor sale. If, however, ihe building or Improvement is
sold within ona year oi completion, the owner-builder will have the burden of proving ihat he or she tlid not build or improve tor purpose ot sele.).
❑ I, as owner oi the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business entl Professions
Code: The contractors License Law does not apply to an owner oi properry who builtls or Impmves thereon, and who contracts for such prolect with a contrector(s)
license pursuam to the Contractors License Laws.).
❑ I am exempt under saC. eusiness and Protessions Code tor thi5 reasOn:
Signature: Date:
Owner ID venfied by drivefs license. ❑ V85 ❑ No Drivers License No.
Venfication of Ownership by (type of tlocument, i.e. - property ta�c bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
Expires:
❑ I hereby certity ihat no exwvetion five (5) or more feet in depth into which a person is required to descend, will ba made in connection with work eut�onzed by this
permit, antl Ihat no builtling sirudure, scalloltling, falsework, or tlemolition or dismantling thereof, will be more Ihen ihirty-si: (3fi) feet high. (Chap. 32, Gry 2, Atl 2, Sec.
341, Ttla 8, Califomia Atlministretive Cotle). •
❑ As owner-builtler, I will not employ anyone to tlo work which would require a permil irom lhe Division of Industnal Safety, es notetl above, unless suc� parson hes a
permit to tlo such work irom the tlivision.
Signature: Date:
Division ot Industnal Safery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AIfTMORIZATION OF ENTRV: I certi(y under penalry of perjury that I have reatl this epplication anC state ihat the intormation given is
correct. I agree to comply with all s;ate laws and ciry ordinances relating to bullding construction, entl authonze representetives oi the City of Costa Mese to entar upon ihe
ebove-descnbed property for inspection purposes. I agree not to occupy or allow occupancy oi eny building euthorized by this pertnit until finel inspection.
COUE t. INSPECTION9IPE
�1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Finel Re-Foof
201 Final BIocWRetaining Wail
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolition
P9g 1[�ID96fl
�
GODEt INSPECPOHTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final BuiltlingiOccupancy
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-- Applicant [a fill in all spaces except t�ose within �eavY
:ITY.OFCOSTA ESA__.G NS 15UGIIU/N/ �r�trcMlTl , PF rtin TRACTNO. :
Proiect Address � �/ ' � 1
,_____ - a - --#�
ApplicanYs Mailing A dress -
Owner's Name /� Phone ��
Address �� �%µ P/ .
ArchlEng. License No. -
�
Address
Conttacwr's Nam� ' P�ne
Address (mailing) —2
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby atfirm that I am Iicensetl untler provisions oi Charter 9(commencin9
with section ]000) of Division 3 of the Business antl Pro(essions Cotle, antl
my license is in I t r e antl eftect. .�_ � �,�Air
Licens lass Li n5e ����lL1X'"/
�.y�_�_�c�
Date " Si9natur
RKERS'COMPENSATION DECLARATION
reDy atfirm that I have a certificate of consent to self-insure or a certificate
JJorkers' Compensation Insurance, or a certifietl copy thereof (Section
�800, Lab. C. Q¢ .[�
Policy No.��'�'(; (J CompanyCS�'/C" �
ertifietl coOY is �ereby furnishetl.
Cer ' ie = 'S filetl witM1 the city B' 'n i j8i9��1�
Oate Applicant �( �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thlssection neetl not be mmpletetl if [he permit Is for one huntlretl ($100) or
Iess).
I certify that in the performance Of th¢ work far which this pe�m�t is issued, 1
snali not employ any pe�son in any manne� so as t0 beGom¢ subject to th¢
Workers' Compensation Laws o( California.
Oate Si9nature '
NOTICE: If, afte� making this tleclaration, you should become subject to the
Worker5' Comp¢nsation provisions ot the Labor Code, you must fortM1with
cOmply with such p�ovisions or thiz permit Sha1P be tleemetl revoketl.
CONSTRUCTION�LENDING AGENCV
I hereby afFl�m that there is a cons(ruction lentlinq agency fOr the parformanG¢
of tM1e wo�k to� which tM1is pe�mit is issuetl ($ection 3097rCiv. CJ
Lentler's Name
Lentler's Atltlress �
OWNER Bl/1LDEN OECLARATION
I hereby atfi�m that I am exempf trom ihe ConVaclor's LicenSe Law fOr the
following �eason (Section 7031.5 Business antl Professlonal Cotle: Any city or
county which requires a permit to wnstruct, alter, imorove, tlemolish or repair
any st�uctu�e, prior [o its is5uance, also �equires the applicdnt for iuch pe�mit
to tiie a signed statement that he/she is licPnsed pursuant to the'provisions of
�e Contractor's�License Law (Chapter 9,(mmmencing with Section ]000) of
�ision 3 of the Business antl Prote55ions Cotl¢) Or that be/she i5 exempt
erefrom anE the basis for the allegetl exemption. Any violation of Section
. J31.5 by any applicant for a permit subjects the applicant to a civil
�enally of not more [ban five hunaretl tlollars (g500).
I, as owner of Ihe property or my employee5 with wages as their Sole
wmpensation, will do.tne work, ana the structure is not intenCed or offeretl
for sale (Section 7044, Business anG Pro�essional Cotle: The Contractor's .
LicenSe Law tloes not apply to an owne� ot a pwperty who builtls or improves
fhere0n, antl who tloes Such work Itimself/herself or [hrOu9h his or hEr own
employees, provitletl that such improv¢ments are not intentletl or o(fe�etl to�
sale. If, however, the building or improvement is soltl wiihin one yea� of com-
r wi 1 h v he bu�tlen ot rovin he she tlitl not builtl or im-
I ti n the owne I a e t
pe o , P 9 /
prove for the purpose of sale).
❑ I, as owner of tM1e property, am exclusively contracting with licensetl con-
nactors to consV uct the project (Section ]044, Business antl Professions Cotle:
The ConVactor's License Law does not apply to an owner ot property who
builtls or improves [hereon, antl who contracts for such projects w�th a con-
tractor(s) license pursuant to [he Cont�actor'S LicenSe Law). 1 am aware tha[
p�oof of their Worker's Compensation insu�ance shoultl be provitletl to me.
❑' 1 am exempt untler 5ection �� B. & P. C. for this reason
Date
Siqoature
Drivers' L
— Owner
I have reatl this application and state that the above
I a9ree to comply with all city antl county ortlinances
to buildinq construction, antl M1ereby authorize repre-
'to enter.upon the above-mentionetl /p�ro�p�ertyf�foQr
����� oate_� i/=�(L
lines an0 sign all aporopriate eeclarations.
DT NO. UNIT NO.
,� 9!0 ' ,
TYPE OF CONSTRUCTION �NEW ADD ' ALTERATION EPAIR
'❑ CONVERSION ❑ DEMOLISH. O OTHER, 1 _ q.p, # ,
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
TVPEOFPERMIT GRADING��/�p urvoa.TiOrv ❑STRUCTURAL , T Front .
❑ TENANT ❑ ELECTRICAL lJ PLUMBING ❑ MEGHANICAL � ' 6 Rear
' ❑ OTHER � ' � A
PROJECT DESCRIPTION 5q. FT. oCCUaarvcY - C Right
K Left
CONSTRUCTIONTVPE -VALUATION$ $
ZONE GRADING CU. VOS. ACRES p�ng. Ref. #
rtemarts: , � Planning Notes:
Sink
Preventer
Irrigation
Dishwasher
Drinking Pountains
Floor Drains
Floor Sinks �
GasService Outlets
Interceptors
Kitchen Sink ' " -"
P—Trap
Roof Drains
Reinspection Fee $15
�
Boiler
Duct� Under Ground
Duct - Structural
Duct - Ventilating �
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0.100,000 BTU �100,OOOBTI
Reinspection Fee ' $15�
CMF 0965-46, rev. ]0/84 Whiie - Builtlinq; Canary - Applicanh, Pink - Acwunting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar�Collecmrs
,SolariPipin9
Solar Tank
Swimming Pool w
Urinal
WdIEf C�052I
Water Heater
Watei Service
Auto-Wash
Issue Fee
Hoodar Typel ❑
Canopy Type 11 ❑
RefrigeFation System -
❑0-100,000 BTU 0100,000 BT
System Repair/Alteration � '
Fire Dampers � � '
Registers
laue Fee
FEES
$ 3
$ 3
_. _ I Zone '..
Accessor.y Building:
ELECTRICAL �
Automatic Washer � Trensformer ❑ 15-50 KW �
Construction Pole Sub. . . � 50 + KW
Cooking Unit Meter ❑up to 100 amps
Dishwasher Meter �over 100amps
Dryers ❑Gas ❑Electric . Sub Panel ' �
'Fan Motors �0-1 HP � i'h - 8
F.A.U. ' Inc.Solar �9-15 HP �16-15+
Fixtures Microwave
Device Boxes Pole Light -
Outlets Range
Switch¢5 ' � Sign � '
Garbage Disposal . Standing Sections �
�Generator �0-5 KW �5�15 KW Trash Compactor
Fee �$15 � � Issue Fea
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Building Approved By ,��
FEES
$ 3
Z
O
N
I
N
G
R
E
�
M
T
S
� SUMMARV OF FEES
BUILDING PERMIT $ SMIP $ -
PLAN CHECK . $, PERMIT �
PLUMBING $ � ISSUANCE ' $ .
PLANCHECK-25% $ ` ENERGYP.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ �'�(j
MECHANICAL $ TOTALFEE $,��
PLAN CHECK " 25% $_ _ . �
� �7orn8�Q9, rinc: +.t:�P
CONSTRUCTION AND:PLANNING � . . . . ' POOL & SPA �
APPROVALS Permit•# Date . Inspector � qppROVAI:S Permit # Date Inspector.
1,. Temporac��Electrical�Se�vice or Pole � 52. Pool & Equipment Location '
i�
2. Soil Pipe-Undrgmd. . - 53. Steel Reinforcement � •
3. Electrical Conduit Utility-Undrgmd. 54. Fo�ms � �
4. Electrical Conduit-Undrgrnd. . , 55. Electrical Bonding '
5. Steel Reinforcement . � 56. Rough Plumbing & Pressure TestC.S
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd. .
8. Foundati tn . -� - �- 59. Gas Pipe, O Undrgrnd., Test y �
9. Water Pip�� ndrgmdi' �- � '- 60. Backwash Lines, P-Trap, O U�dFgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK ��
11. Property Sewer Line &-House Connection 62. Backwash & Receptor-Final ��
12. Sewer Cap . 63. Heater & Vent-Final LL'
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 FINA�
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 O Gas ❑ 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 (Structurel) & Monocoat � ' Z5. Dry Chemical _ �
27. Frame and Flashing - 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ;
;
31. Plaster`�Brown Coat 79. FINAL INSPECTION � '��
•32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED t,�
33. Final Electric Notes: � ^
r�,.
34. Final Heating & Air Conditioning _ . ��
35. Final Gas Pipe-Test
36. Hood or Canopy . ' _
37. Final Factory Fireplace - � � � � �
38. Final Plumbing t� /(��'(' � � + ' '� ' t'� '
39. Water Service-Final . . . � ',
40. Gas Service-Final • � -'�
�
- 41. Solar pomestic-Final . i - +�
' • �
� 42. Backflow Preventer � . � . � � �
� 43. Backflow Irrigation , � ' ' '� �
tii.
44. Landscape Irrigation System - ' , " � �, ��
��45. Sound Attenuation ' ' , f"'"�
46. Handicap Regulations � � � ' . �.,�
47. FINALSTRUCTURE&BUILDING � - � ' " �- �
48. Special Requirements Completed ' �� � ;�' � -,
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co � -�
51. CERTIFICATE OF OCCUPANCY •
No. Date . L ,t � � � � � �
\ \, '
_ ... .--- . ...- �- . . - . . _ , . _ .
�
City of Costa Meu %: �, Department
Post Office Box 1200
77 Fair Drive
I � � Costa Mesa, California 92626
� �19� � (714) 5565245
„4
CMF 0569-2
REQUESTFOR OCCUPANCY
(Single Family Residential or
Condominium Units)
Tract No. �� 9 � Date
�
R�E o E �,.�1�E D
p!i:hv,� xin
�F? 2? 19�'7
AM P�
"d�8i9il0illi12�1i � �415�6
�
9 zz-77
Lot No. ��
Address /�% %Rq b U c o C R, CoS�A �%7eSA
The developer of the above entitled tract desires to sell the above
sei forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he, she, they) .,�Q. (was or were��advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approvai which were imposed by the
City at the time the final tract map was approved.'
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless
from any claim resulting in damage or personal injury to the undersigned by
reason of the aforementioned uncompleted condition.
\
By 1 _..,.--"�j� �� /' �/" ' �����
Purchaser
B � �� � _
y
Developer and or Authorized
_ Representative �
BY
Lender
436 L9
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely - Use Ink Only p
BUILDING %— �
ADDRESS � S
OWNEF J.H. Gregory
AooAess 318� "G" Airway Ave.
CITV Costa Mesa' No'7�51-3850
LENDER`���at Western Savings RC �L�'c1.Y1
BRANCH S�S� Wilshire B1�/CI
ADDRESS Beverlv Hills. Ca.
TE
NC
f� � '
��r,s-�-77�=-`�0o sas;;- ,:x�220.+)0�
U,:�r
APPLICATION FOR STRUCTURAL PERMIT
RECEIVEDBV DATEPECEIVED ppTFISSUF❑
ADDRESS
�
FIRE
ADDRESS 1V z neacn li'd• ZONE �nv�r iu,�
APPqOVED
CONTRACTOR J.']'[. Gre �l� Constructio BY � OATE
ADDRESS �ZUI ���5�� Airwa Ave• -
ZON NO.OF� USE OF N
cirv COst Mesa oio�/51-38�o P�� BUILOIN
F STATE CITV �'ARDSAPPROVED VARDSAPPROVED
5� ��c. r,o. 285-981 ���. No. 008179 MAIN BUILDING ACCESSORV BUILDING
{y SIZE 5OO SCl f�Y. NO.OFBLDGS (FROM TRE )
L OF LOT a NOW ON LOT O FRONT FT.
a USE OF
� EXISTING BLDG. S FT. FT.
y /e,��� t
� . Separate permits are required for L SIDE � J FT. FT:
� electric, plumbing and heating work. REAR •`- Fr. Fr.
[.W.i USE OF BUILDING AND WORK TO BE PERFORMED DISiANCE BET. BET. MAIN &
Q� MAIN BLDGS. ACCESS. BLD('.S. 1
ain le Famil Res. vna.# � /,� DATE
..1 g Y C.U.P. � (y� APPROVED ��'� � �`
Q A
� APPROVED/'/� �
,.�.1 IT:''__' V�`� _ .,
� �r`" '-_ -"^�'{AI DCr11��nrnnrnr. �
pI heraby ecknowladge thet I heva reatl this application antl state 1 .�������tl v'
p$ that the above intormetian is correct antl agree to comply with �
m
a. all lews reguleting bulldin8 consttuction, antl I shall not employ
i
Wany petson in violation of the workman's compensation laws of - v
�, ihe State of California. Z�YO6 SQ. FT. J—��9 S • ft • �v
m
3 I hereby cartify that I am properly licensed as a contracto� undar ,
the State of Californla Business antl Profess' s Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9 d that such lic9ns a�e in t f0lce.a�tl aff¢ct, O� I THE PURPOSE OF ESTABLISHING A PERMIT F E ONLV: �
am ez pt fr the provision ot thy S e of Californla Businass VALUATION PERMIT FEE d
end Pr 4assions Code, Division , C'�{�c 9. . $ �
m
PLAN CHECI( $ � ^�
Signatur f ^7� �
Permlttee g 35 700��� TAx $ V LL
� �
U
Auihori ed _ TOTALPAI� $ D OD l
I
J.H. Gregory
�le Fam Res VALUg
BLOCK