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Home My WebLink About2792 WAXWING CT - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesaBLECTR I CAL PERMIT Job Address: 2792 WAXWING CI Suite No Vicinity: ATTIC AREA Parcel Nunmber: 13962126 Applicant: BANK, BLUE Address: 1351 E POMONA .Phone: 714-560-0700 SANTA ANA, CA - Zip 92705 Owner: CHAMBERS,THOMAS'WILLIAM AND MIA CARLA Address TR _ COSTA MESA, CA Phone: 714-241-7303 2792 WAXWING CIR, Zip: 92626 Contractor: SWIFT SERVICE CO Address: 1351 E POMONA Phone: 714-560-0700 SANTA ANA, CA Zip: 92705 License: 725240 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recepl Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 03/05/2007 Issued: 03/05/2007 ISSUED BY: SCOPE OF PERMIT ELECTRICAL PERMIT TO CHANGE OUT AND RELOCATE FURNACE FROM HALLWAY CLOSET TO ATTIC AREA. REF#: M07-00122 WORK TO INCLUDE: 1 LIGHT FIXT, 1OUTLET AND -1 SWITCH. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $1.10 $1.10 $1.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Quantity Temp Dist System / Lighting $0.00 0 Busway/100 ft" $0.00 0 Standing Section $0.00 0 Misc Electrical Equipment S0.00 0 Transformers up to 1 kva/kw ' $0.00 0 ................up to 10 kva/kw $0.00 0 .................up to 50 kva/kw $0.00 0 ........ ::..:.... up to 100 kva/kw $0.00 0 ...........:(...:.over 100 kva/kw $0.00 0 Low VoltageEquipment$0.00 0 Low Volt Wiring System / Ckt $0.00 0 Misc. Conduit $0.00 0 Misc. Conductor '$0.00 0 Circus ( gen or ride) $0.00 0 Circus (mech ride or lights) $0.00 0 Christmas Tree Stand $0.00 0 ' Fireworks Stand "$0.00 - 0 Other Electrical Fee $0.00 ' Investigation Fee - $0.00 Plan Check Fee $0.00 Reinspection Fee '$0.00 TOTAL CALCULATED FEES $26.80 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) 7545626 2"6.46(600) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. �My workars'=compensation Insurance carder and policy number are: rCarler:1 Policy.Number: - L,-S.4 T_I41 i G U( ,Z O 6 OU � l(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 cartity that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisio - Appliccant Sipneture: ate 3 A D % WARNING: FA(LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT ANE LOYER TO CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITICN TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION NOS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provislons of Chapter 9 (commencing with Section 7000) of Division 3 of ththe,Business and Professions Code, and my license is in full fa[ 6tfBCL:Lic. k /�� -2 Li U [Class,# �tra�s'Signaturw 7L� — Z. Dat`'-'=:— CONSTRUCTION LENDING AGENCY:r ❑ 1 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cade: 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. It, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Data: Owner ID verified by drivers license, ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Cade). ❑ 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 e permit to do such work from the divislon. 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Cade 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 al 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? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .. .......................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes 11No (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 II an RMPP Is presently required, has Section 25534 o.. the California Health and Safety Code been fully complied with? ❑ Ves ❑ No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication e$$ertnit for such construction or modification from the South Coast Air Quality Management Distrst rict or from any other air pollution control district Or agency? Yee L.l NO (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................................................................................................................................................................................................................................................... ......................................................................................... 6 Will any Den of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................._.............. ......_.__._..........................................................................__..._..................—......................._—._.............................—____......._...__......................... ...... _......... _.............. _............ _.............. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................................................ o,ri.........................................._........m.'t...................................................................tr"ol....................................................................................._..............................................._........................................................... 8 (II yes", amach certificate of compliance tram the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. 1 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 stale that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Owner(s) Da 3 s v _lNnci/CFr Authorized Applicant— r^ �_Dtot CQOE 0. INSPECTION TYPE rft QdTE INTMALS CODE[d INSPECTION TYPE gdjF INTMELSi 1616 Fixed System Final Fire Prevention 206 Final Mechanical ' 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Ccoupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2792 WAXWING CI Suite No Vicinity: ATTIC AREA Parcel Number: 13962126 Applicant: BANK, BLUE Address: 1351 E POMONA SANTA ANA, CA MECHANICAL PERMIT Phone: 714-560-0700 Zip: 92705 Owner: CHAMBERS,THOMAS WILLIAM AND MIA CARLA Address: TR Inst FAU >100 k BTU $18.20 COSTA MESA, CA -". Phone: 714-241-7303 Inst / Rep. Recess Wall Htr 2792 WAXWING CIR Zip: 92626 Contractor: SWIFT SERVICE CO $0.00 Address: 1351 E POMONA Factory Fireplace $0.00 Hood w/Mech Exhaust Phone: 714-560-0700 VAV Box SANTA ANA, CA Zip: - 92705 $0.00 Appliance License: 725240 ' ISSUED BY: Status: ISSUED Applied: 03I05I2007 Issued: 03/05/2007 SCOPE OF PERMIT MECHANICAL PERMIT TO CHANGE OUT AND RELOCATE FURNACE FROM HALLWAY CLOSET TO ATTIC AREA. REF#: E07-00174 WORK TO INCLUDE: 1 FAU >100 K BTU AND 1 GAS PIPING. _ ISSUE FEE $23.50 Inst FAU <100 k BTU $0.00 Inst FAU >100 k BTU $18.20 Repair / Alt Cooling/Heat $0.00 Inst / Rep. Recess Wall Htr $0.00 Refrig Sys <100 k BTU $0.00 Refdg Sys >100 k BTU $0.00 Gas Piping $6.15 Factory Fireplace $0.00 Hood w/Mech Exhaust $0.00 VAV Box $0.00 Vent Fan /Single Duct $0.00 Appliance $0.00 Fire Dampers $0.00 Smoke Dampers $0.00 Inst or Relocate Appl Vent $0.00 Air Handlers < 10000cfm ., $0.00 Air Handlers > 10000cfm , $0.00 Floor Furnace $0.00 Floor or Suspend Heater - '$0.00 FEE SUMMARY Quantity _ Quantity _ Repair / Alt Absorbtion Unit $0.00 0 0 _ Repair/ Alt Refrigeration Unit $0.00 0. 1 Ventillation System $0.00 0 0 Evaporative Cooler $0.00 0 0 Commercial Incinerator $0.00 0 0 Domestic Incinerator $0.00 0 0 Compressors /Absorption Systems 1 Up to 3 hp / 100 k BTU $0.00 0 0 -' '-3 To 15 hp / 500 k BTU $0.00 0 0 15 To 30 hp / 1,000 k BTU - $0.00 0. 0 30 To 50 hp / 1,750 k BTU $0.00 0 0 Over 50 hp / Over 1,750 BTU $0.00 0 0 Boilers 0 Up to 3 hp $0.00 0 0 3 To 15 hp - , . $0.00 0 0 .. , 15 to 30 hp % .. $0.00 0 0 - 30 to 50 hp $0.00 0 Over 50 hp,� ! - $0.00 0 0 Other Mechanical Fee - 0 Investigation Fee _ $0.00 -Plan Check Fee - $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $47.85 COMMENTS / SPECIAL CONDITIONS NOTICE: The workauthorized 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 244646(6=) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: -Carder: iv A /in .7. In D rPolicy Number:- t., SA Tsmi 000,2 06 C7'j I (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that It I should become subject to the workers' compensation provisions of Section 3700 ofthe Labor Code, I shall forthwith comply with these provisions. ��JJJ _ / WARNING- FAILURE TO SECU4E WORKERS' OOMPENSATIOA COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSANDD RE ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affinn.that.l.am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full 'force antleftect'Lic'l Z� Class s_ 2.0 r.=- Contractcrs'Signatuie: Data: -; 3 S p� CONSTRUCTION LENDING AGENCY: ❑ 1 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: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more 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 then thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Cade). ❑ 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 matenal? ❑ Yes ❑ 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). ................................................................._........................................................................_._..........................._.............................................................................................................................................................................................I.......... 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mess 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). ......................_................._........................................._...__.._..._......._.._........................._...___.......................__..........................._.........................__....._.__._.__.__........._.._........................_..1-y- .._........._. sit-..._..........._ 3 Does or will theapplicant or present or future building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ IJo (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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ._....................._..................................................... ..... ... .............. ..... ... .............. ........................ _....................._..._..........................__.............................................._.................................... ... .......... ............. .__........ __............ _. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes l.J No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................__..—_..._................_.........._.__.........................._........__._....................._.__................................._.._._........................................_..._........................_............._._............._............_...... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ....._.......................................................................... __......... _................ ___.._____................................... _.... _.................... ____................................ ___.................... _..___................................. _........... ._._................. _........... __........ 6 (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. Signature Of Legal Owners / 4ate (-And/Or Authodz pplicant L— fDiat CODE f. INSPECTION TYPE gdjE ItIRT196$ CODE INSPECTION TYPE U 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 200 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.fflADING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2792 WAXWING CI Suite: Vicinity: Parcel Number: 13962126 Applicant: SEAN GURNEA Address: Zoning: R1 R1 Phone: 714-731-3425 Zip: Owner: WADSWORTH, WESLEY ALTON Address TR COSTA MESA, CA Phone: 2792 WAXWING CIR Zip: 92626 Contractor: WEATHERLINE ROOFING Address: 17662 IRVINE BL #2 Phone: (714) 748-9707 TUSTIN, CA Zip: 92780 License: 729560 Arch : Address: Eng: Address: ISSUED BY: Status: ISSUED Applied: 09/27/2000 Issued: 09/27/2000 Phone: Phone: Zip: License: License: SCOPE OF PERMIT T/OFF SHEATH AND REROOF 2500SF RESIDENCE W/COMP SHINGLES, SMOKE DETECTORS REO PER 97UBC. NOTES: 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 26x6-46 (6/001 FEESUMMARY Plan Check: $0.00 Calc Valuation: $6,000.00 Permit: $125.25 Claim Valuation: $6,000.00 SMIP Res: $0.60 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.85 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 26x6-46 (6/001 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this pernit Is issued. ❑ I have and will maintain workers' compensation Insurance, as required by sealon 3700 of the labor Code, for the performance of the work for which this permit is issued. My workgrps'�Icompensation Insurance carder and policy number are: —7 Carrier: %tXX.Owbe-rM. / Policy Number: WCzi O. -S 0O � / (This section need not be completed if the permit Is valued of one hundretl dollars ($ 00) or less.) ❑ 1 certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that it I should become subject to the workers�compensation provisions o1 Section 3700 o1 the Labor Code, I shall forthwith comply with these proylsi Applicant Signature: � Date: WARNING: FAILURE TO SECURE�RS' COM ENS COVERAGE IS UNLAWFUL AND SHALL SUBIEG AN EMPLOYER TO CRIMN4 PENALAS AND OVIL FINES UP TO ONE HUND D THOUSAND DOl1ARE t ), IN ADDIMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WO6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sectio) of Division 3 of the Business and Pfolos igns Code, and my license Is in full force and affect Lic. M O / Class a 7 Contractors Signature: Date: 7 Ik Co r CONSTRUCTION LENDING AGENCY: ❑ 1 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 affirn 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 penally of not more than five hundred dollars ($500).): ❑ 1, 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.). ❑ 1, 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 Ucense Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): 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 Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and comity a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 o1 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and . pressure). ......................................................................................................................................... .................... ............................. ..................................... __...................................................................................... ........................................ _........... ...... 3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................._...................................................................._...................................I....................... 4 If an RMPP is presently required, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication a ff,p mit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? N Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................ .......................................................................................... 6 Will any pert of the facility to be constructed under This permit be within t0001eet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .............................................................................................................................................._..............................................................................................................................................................................._................................I.......................... 7 If a parnit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..........................................................._._._._........................._..................................._.............................................................................. ............. ................................................................... _................................ .... ...................... B (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. Signature Of Legal er(s) � 9 Da O<% n r Applicant Date CODE I. INSPECTION TYPE QAjF INTFLA S COPES INSPECTION TYPE PATE lum 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �7 208 Final Plumbing 200 Final Re-Roofr�. 210 Final Electrical 201 Final BlocklRetalning 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. CITY OF COSTA MESA _SCONSTRUCTION pPP�EE.RMIT Project Address na"DL �QXVil CIC, WSL C -Q.. Applicant's Mailing Address'\inODf'](�(`l1vCh Owner'sName Phone Address�,�-- Arch/Eng. License No. Address c••' Contractor's Name—r S-�v�-,.• 7't"xG tine' \ Address (mailing)^ City License_ No. 3 d \Q3 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions o (commencing With section 7000) of Division the Business tl Professio s ode, and my license is in full orce and a ect. ru License Class - i nse N . 0 Date 10 — to Si9natur WORKERS' COMPENSATION DEC RATI N 'hereby affirm that I have a certificate of consent to self -insure or a certificate I Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Percy No. lJ7Cp Loo—VALl3 Compan ��b n�tc itch 8 Certified copy is hereby furnished. Certified cc Vis filed with the'city Buildina.Biyi Date Applicant �D EXEMPTION ROM WORKERS' COMPENSATION DECLARATION. (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California., Date iSignature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of 'the Labor Code, you must forthwith comply with such provisions or this permit shall be. deemed revoked. 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 (Section 3097 Civ. C.) Leader's Name' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of 7uvision 3 of the Business and Professions Code) or that he/she is exempt rerefrom and the basis for the alleged exemption. Any violation of Section ;031.5 by any applicant for a permit subjects the applicant- to a civil enalty 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of Sale). 1, as owner of the property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does -not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractors) license pursuanttothe Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city toter upi the above-mentioned property for inspecti yWoI s Signature V d � _Date NIZI Drivers' S5 z CMF 0865-46, rev. 4/84 TYPE OF CONSTRUCTION LJ NEW } ADD LJ ALTERATION LJ REPAIR Z ❑ CONVERSION ❑ DEMOLISH OHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMI IJ GRADING LJ FOUNDATION U STRUCTURAL ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT.OCCUPANCY— CONSTRUCTION CCUPANCY— CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES Remarks: Bar Sink Showers Backflow Preventer - Service Sink Backflow Irrigation Sewer Cap Bathtubs i Sewer Connection $ Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa $ Floor Sinks - - - Urinal 25% Gas Service Outlets. _ Water Closet - $ Interceptors Water Heater Kitchen Sink - Water Service $ Lavatories 50% P -Trap $ Roof Drains $ TOTAL FEE ' $ Reinspection Fee $15 I I Issue Fee I $ 3 I 1 MECHANICAL FEES Boiler Hood or Type 1 ❑ Duct - Under Ground Canopy Type 11 ❑ Duct - Structural Refrigeration System Duct - Ventilating 1:10-100,000 BTU ❑100,000 BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT . I Reinspection Fee I $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 A.P. # S Main Building:' E T Front A Rear C Right K Left Ping. Ref. # Planning_ Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 9807 10/10/84 Zone Buildinq: ELECTRICAL Transformer ❑ 15:50 KW ❑ 50+KIN Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator ❑0.5 KW 05-15 KW Meter Uup to 100 amps Meter ❑over 100 amps Motors 00-1 HP 1:11 h - 8 Inc. Solar ❑9.15 HP El 16-15+ Microwave - Pole Light Range Standing Sections Trash Compactor Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By'� 8,00 TL, FEES $ 3 Z O N I N G R E Q M T S. SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ S.nO GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE ' $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNINGPOO APPROVALS Permit# Date Inspector SPA APPROVALS Permit 4-' Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 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 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 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 75. 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.E FINAL INSPECTION 32. Electrical Power Meter -Final 80, FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. -Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Cu 51. CERTIFICATE OF OCCUPANCY No. Date i PR�SiECT ADDRESS: 2792 WAXWING CI UNIT: 0 OWNER'S NAME: WADSWORTH WESLEY A ADDRESS: 2792 WAXWING CIR COSTA MESA,CA 92626 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: COASTRIDGE ROOFING (714)557-6048 ADDRESS: 2480 FAIRVIEW RD COSTA MESA CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full three and effect. CITY LIC:. A 4 9 912 STATE LIC.: 5 4 1 1 9 0 CLASS: 039 Dale: i' Z 7 Signature: _ _ WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have ificale of consent to Sol,- < elf- Gyre or a candidate of Workers' Componsation Insurance, or a certified Copy thereof (Section 3800. La . C). POLICY NO.: EXP. DATE: COMPANY: C1 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). I certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California Sz % Date: �—p/� Signature: /E I eQ Z^�z NOTICE: 11. alter making this declaration, you shoal became subAct to t orkers' Compensauch provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work tar which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law lot the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing win Section 7000) of Division 3 of the Business and Professions Ca l or that he/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 live hundred dollars (3500). I, as owner of the property or my employees with wages as their sale compensation, will do the work, and the 13 structure is not intended or offered for Sale(Section 7044. Business and Professional Code: The Contractors' State 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 employees. provided that such improvements are not intended or oflered for sale. If, however the building or improvement is sold within one year of completion. the owner will have the burden of proving he/she did not build or improve lot the purpose of Sate). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7614, Business Eland Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for Such projects with a conlraclinds) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker'S Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Dale: Owner: I do hereby burbly that I am aware of and understand the requirements of California Health and Safety Code 25534 and that I or any future building occupant vwiNvnll not fell One) need to comply with said state codes permit for construction or modification from the Air Duality Management District. Residential construction ap these provisions. Sections 25505. 25533, and and the requirements for a plications are exempt from Dale: Applicant'. I hereby certify that l have read this application and state that the above information is correct. I agree to comply with all pity and County ordinances and slate laws relating to building construction and hereby authorize representatives of Iha ci 1Qenter upon the above mentioned properly to, inspection purposess / Dale'. 9-z 7 —G''—X Signalure." (/ Drivers License or Social Security n: 1641-46 While—Building: Green—Code Enforcer l: Canary—Applicant: Pink—Revenue; Goloenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 064163 PERMIT NO: B 064163 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH JOB DESCRIPTION T/OOF 6 REROOF 2800SF W/ WOOD SHAKES SQ FT: 2,800 CLAIM VALUE: 8,500.00 CALL -VALUE: 8,500,00 GROUP OCC; R-3 /M-1 COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UHC 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 ---------- --------- ACCESSORY 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: 13962126 ZNE: REF NO: PLANNING N TES> > MMM M M k k kM M k k k M kM MitM M MMM M k kkM k k M MMMk M k k k kith MM MM M kM ick kM MM k kick MM k M M MM k M k k MM M M MM k ick D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N -T S ZONING APPROVED BY BUILDING APPROVED BY : DATE: DATE: APPLICATION ISSUED BY: DATE:,��) it if it it iEk it it kit it iE M iE it Mit it it it iE iE it it it iF it it it it Mitts kkkkkkMMMMMkMMkMMMMMMMMMkkMkMMM Mwk Mk kMMMMMMMMM LEGALIZATION:N F E E S U M M A R Y STRUCTURAL/SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 108.00 ,85 SMIP/NON-RES PLAN ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 108.85 0.00 0.00 108.85 108.85 .00 REVENUE DIVISION TOTALS--> COLLECTED: 108.85 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 108.00 .85 it itM Mit it it it it it it it it kit kiE it it iE it it it itMMkMkkkkkMkkMMMMMMMMMMkkMkMMMMMMMkkkkMMMMMMkMMMMMMMMMkM I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 8500 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 8,500.00 END OF FEES SMOKE DETECTOR REQUIRED et 00147720-00177721 TCET 108.85 DATE: 07/27/93 TIME: 10:59 CONSTRUCTION AND PLANNING POO. SPA I I APPROVALS Permit Date Inspector A -Uate APPROVALS Permit A -- Inspevtor ! 1. Temporary Electrical Servie• or Pole 1. 52. Pool & Equ ;+mcnt LjC, t o i 2. Soil Pipe-Undrgrnd_ 53. Steel Reinfo•ce-r,t 54. Form: Eiectrlcal ConQuft Llhty Undrgr-d. 4 4 Electrical Condu,t•U ,d,gr :d. 55, Electrical Bord ng 5.�cgel Remforcv!n r"5 156. Rough Plumb,ro & Prussure Test_ _ i Z-I1--_-5dgctncal UFER GiPd - 57. APPROVAL TO CC`,FR Cil"•.i-E , 58. Electr,ca'. Curdu t urd•••r..:. -••t7--�Fgotings -' _ 59. Gas P.pe, UIL' V" .1 , -I'! kourdaticn - �9. \Yater Pipe-Undrgir.d. 60. Backwash L.nc . P Trac, L, .I'•- ! - lb. Structural Floor System 61. APPROVAL TO UE CK 11. Property Sewer Line 8, House Connection 62. Backwash & Receptor Fina' 63. Heater & Vent -Final 12. Sawer Cap 13. Roof Drains.o _ 64. Plumbing System F_nal_-__- 65. Electrical,F.ra! - 66. Solar System -F n,. -� 14. Rough Plumbing 15. Rough Electrical-Conda�t- 9 t- 16. q Rough Electric Wiring 9 I 67. Fencing & Ace•ss Ai•ry o.• _� ---� I ---_ i7. Rough Wiring Sign I 68. APPROVED FOR ." LAo',ERI1 G 69. POOL/SPA SYSTE^'S FINIAL �• 18 Rough Electricai-T Bar Cei rg FIRE DEPT. REOUIRFfV.'ENT i 19. Rough Heating & Air Condit.on;ng i +APPROVALT PC.:.rit 20: 9ouyh Factory Fireplace - :.:+ r 21; put_*s. ir}-Structure, `•�- _ •70. Undcrcrccnxr Fftict_--- _ 1i - 22. Oucts, Vzntilatlrig -- _ -71. Prcduc(�in ng (+p" •, - --- - -I -- -�-- - 23` Gas Pipe -Rough i to:t 1 r rt -1 r • 172. Undergro'�LnF us;•,- 737'Undcrgrr.9. Smrt. ,; T_ d< I- G,, 24 _Roof Framing __ • J " , � 74. Overhead Hvdrr-, - - - ---- ---- 25. Roof Sheath ` 0 /,t, - 9 „� e--�t/Z�q3 26::T-BarCeiling (Strumurah &iblanocoat + 75- Dry Chemical _ --------- ----- -- -- -- 76. Ory Stant!;iipe 1J .11 27. Fre(ne and Flash irlg } - 77^ FIXED SYSTE_•''� F!NAL`- - - 28. Lathing:,& Siding + t -.` .. ' v 29. Insulatibr 76cFIRE PREY F16;A{ HEALTH -DEPT.- REOHIRLF;E:•'T 33. D,yv:a II Na, tng ' - , c Lr 31. f'aster aowaCoat` .,. --- -f' !r 180-•: ,. 79. FINAL G'. COC CERT;FI^,A-f SS:� J .- c 'r' �� 32c E'.ectncy Power 1leiet-Fi^ul I 33-Firwl Ele.FtriC ` �34. Fmof Heeting;& %1!r Ld grtbr,ru -- --' - - -� 35.'F.nat G�4 Pi p2 TEt. I- = =- - - Ta ' n n• _ _ e r- - - - - r` - ;po. Ncgd or CaropV -t -. I_ -} - - W. F. -.al Facto•y F•tG'aC ! '}I _ :, �., ' - -- -- - ... - - ---- F ... Final Plumbing '39. Water Service=Fir._gN •, --- - ----------------- o' - T- - r ,40. Gas Servyce- naL ; ;r ,• r - s• 41. Solar Dberiestic-Kir:elY i, 42, Backflow Preventar 43. Backflow Irrigation~ - t ,44. Landscape I"igaW System- f - - _-t ti �-i- ---- - -- 45. Sound Attenuation _- -- I-.-= --T - --- - -- -- - 46.,Handicap. Regulations I {r ---- - ----- --- - _ 47. -FINAL STRICTURE & BUILDING 48. F;1NAL PLANNING .• '. � Ag. E ectric Release to Edison _a jP. -Gas Release tD Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY. - No. Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2792 WAXWING CI Suite No Vicinity: Parcel Nunmber: 13962126 Applicant: KAMINSKY, PAUL Address: 11612 KNOTT ST GARDEN GROVE, CA PLUMBING PERMIT ISSUED BY: Phone: (714)895-1246 Zip: 92841 Owner: WADSWORTH, WESLEY ALTON Address TR COSTA MESA, CA Phone: 2792 WAXWING CIR Zip: 92626 Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Arch / Eng : Address: Phone: (714) 895-1246 GARDEN GROVE, CA Zip: 92841 License: 707775 WATER HEATER CHANGE OUT. QTY Phone: Zip: License: SCOPE OF PERMIT Status: ISSUED Applied: 06/24/2002 Issued: 06/24/2002 FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 Gas Service $0.00 Interceptors (Grease. Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY Phone: Zip: License: SCOPE OF PERMIT Status: ISSUED Applied: 06/24/2002 Issued: 06/24/2002 FEE SUMMARY AMT QTY AMT QTY Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower $0.00 0 Water Heater/ vent $12.30 1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $35.80 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) 7545626 2a 64616001 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need hot be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify lha pe o nce a wo��i for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensa on laws of Calif r rid a (ee that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, shell forthwith CO mply with these ovl n o / / Applicant Signature; Date: �� WARNING: FAILURE TO SECURE WORKERS' PENSATN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDr TOTHE CO OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION.Tros OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLAR ON: 1 hereby affirm that Icensetl tl pr visi s of Ghapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and affect. Lic, q Class q Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a constr tion I ing 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 7010) of Dhrslon 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 Cade: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, 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 coniractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ 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 e 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? ❑ Yes ❑ No (Section 2550$ 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? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mese 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 2DD cubic feet of compressed gas at standard temperature and pressure). ............................ ..._............................ ...... _.... .......... ................................................................................... -.......................................................................................................................................... .......... __............. ......_................................... 3 Does or will thh 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 .. presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject a this plication aPemit for such construction or modification from the South Coast Airir Quality Management District or from any other air pollution control district or agency.+ � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..........................................................cili............................tru,'..led-....................................................'h"m................................................................................................................El .......................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....................................................................................._.......................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ................_.__....... .......... ..___.......__............. ...........___......_.._........__._......................_...__._.............................................._............._.___.._.....—__............__........__............_. .... _.........._.................. B (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: CERTIFlCATE OFP E 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 agre comply wit all s laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-desc' ed pro7077 erty insp tic purr ses. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. lSign Lure Of L I Owners) , l // to/And/Or Autho' ed Ap Iicant � Date CODE I. INSPECTION TYPE QL1jE INTRIALS CODE INSPECTIONTYPE 2&31:. IiiLITIAL$ 1616 Fixed System Final Fire Preventi 206 Final Mechanical �j 1266 Pool Spa Final 208 Final Plumbing �' 30 –O vi Q 2DO Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Buildmg/Occupancy PROJECT ADDRESS: 2792 WAXWING C IUNIT: OWNER'S NAME: WADSWORTH, WESLEY ALTON lSrl ADDRESS: TR 2792 WAXWING CIR COSTA MESA;,CA 92626 ARCHIENGINEER: ADDRESS: REG.NO,: UNIT: PERMITTEE: NOCK PLUMBING (714)895-1246 ADDRESS: 11610 SEABOARD CIR STANTON CA 90680 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 01 the Business and Professions Code, and my license is in full farce and effect. rcl wr c.: 05 3 6 STATE LIC.: 5 197v? CLASS: C 6 a Signature: A/ WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a cenilicate of Workers' Compensation Iysyrapce.,ppL� cp�thed coppy thereof (Section 3800. Lab POLICY NO.: 1��/y�L-79 EXP. DATE: 3/01/95 COMPANY: STATE . ,yy _ 1 Cendied copy, s hereby furnished. ff Certified copy is lil"ith the city Buil Ig ion. 7i Applicant: ( S ' _EXEMPTION KCOMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred (3100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. Date: Signature'. NOTICE: If. alter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Codeyou must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit rs issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the ContractorsState License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/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 (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and no does such work himself/herself or through r his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or f' improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I,as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Slate License Law). I am aware that proof of Ihelr Worker's Compensation insurance should be provided to me. E)I am exempt under Section: B. 8 P. C. for this reason. IDate: Owner. do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant willlwill not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: ApplicanP. I hereby certify that I have read this application and state that the above information ordinances and slate laws relating to building construction and here9y.a;ihomre repress rf U Signature: License or Socral Security x: I agree to comply with all city and county this City to enter upon the above-mentioned 164146 White—Building: Green—Code Enforcement: Canary—AOplicari Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 06670 PERMIT NO: P 066704 PLAN CHECK NO: N GOVT: N SUP:: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: T JOB DESCRIPTION INSTALL WATER HEATER SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT 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 ---------- --------- ACCESSORY 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: 13962126 ZNE: REF NO: PLANNING NOTES> TETE BE iE iE BE iE iE 1E iE TE TE BE TE TE BE 1E BE TE iE TE 1E TE TE TETE JE K BE JE TE 1E 1E iE TE 1E 1E 1E TE lE TE BE Tf TE iE iE BE iF eE Tf TE TE Bf k TE TE iE TE iE iE TE BE Bf 9f TE TE TE Bf TE TE TETE Bt BE k fE TETE iE D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE - APPLICATION APPLICATION ISSUED BY: DATE: TE iF 1E♦E iE TE TE iF TE*if TF eE kiE EE BF TE IE lE** *iE TE TE TE TE ♦E TE TE* TE 1E 1E iE iE TE iE iE iE TE TETE iF 1E TE TE M TE TE BE BE TE TE lE TE % TE Tt TE TE TE !! 1F TE TE 1E * 1E Tf 1E 1f * k TF Tk if TE 1E 1f BE Tf 1E 1E 4 iE * TE k TE TE iE iE iE #E iE k BE BE TE iE TE iE TE TE iE iE * * iE * TE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 7.00 25% SMIP/NON—RES PLAN ISSUE FEE 20.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 7.00 20.00 0.00 27.00 27,00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 TE 1E TE 1f iE ♦E TE %R 7! TE iE 1E 1f Tf if 1E TE ♦E TE TE TE iE if 1E * TE iE TF TE TE TETE *!E Tf Tf Tf TETE Tt TE 1f TE iE 4 TE TE /E TE TETE 1E ♦f TE Tf ♦E 4 TE TE k TE TE TE TE TE TE 1E TE TE TE BE TF TE TE * TE TETE I N D I V I D U A L —F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR VENT 7.00 7.00 END OF FEES 01 00158495-00158485 Ti 27.00 J DATE: 04/06/94 TIME: 09:09 POOr_ & SPA CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector APPROVALS Permit# Date In 1. Temporary Electrical Service or Pole, _ _ 52. Pool & Equipment Location 2• Soil Pipe-Undrgrnd. -< 53. Steel Reinforcement I'llagtrical Conduit Utifity-Uncirgrna, 54. Forms • 4. Electrical Conduit. find rgr nd. 55. Electrical Bonding S. Stgel Reinforcgi`0W 56. Rough Plumbing & Pressure Test - S. Electrical UFERrnd. .- 57. APPROVAL TO COVER-GUNITE t 7. Footings - 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test , 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. - 10, Structural Floor System 61. APPROVAL TO DECK 11, Proporty Sewer Lipe & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 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/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ;APPROVA"LS ,),'Permit # - 20..Rough Factocy �lreplace ; 7 - - 21.- Ducts, in Sir uctt�{e; - 7 _-J. ' i70. C`htdeigroand Hy�ro - 22. Ducts, Ventilating - .� _ r ,71. Produci,'T'$ing QGas 0'Oi1 _ 21. Gas Pioe:Ro+& jest .72. Undergrot±nd FI sh, > d; 24. -Roof Framing �- i_. •• _ 0 + -737'Undergrnd. Storagg?ank ❑ Gas 0 011 25. Roof Shelithing74. Overhead `Hydro , 26. T -133f Ceiling (Stivcturall &-{vlonocoat r.' - 75.' Dry Chemical 27. Frame and Flashinc, -r r " t76.`"Dry Standpipe1. 28. Lathing & Siding=- _~..,:C -c - _ 77!- FIXED SYSTEM•FIWAL 29. Insulation r 78. FIRE PREV. FINAL r '30. Drywall Nailing .1 Fr JHEALTH*DEPT) REQUIREMENT 31. Plaster Blown Cq tr 'FI NA L IN$P E CT I VN - ,t; n, ,.79 r 32..:ElectricaFPower Mater+Finals J r ': I I �• - 180;•f00D CERTIFICATE ISSUED ' 33. -Final Ele4tric 34. Final Hoaxing`& 1 Jr.Conditioni q; 35. Final Gas'Pipe-Test' 36. Hood or Canopyro C'. - �• ' - I �' �_ •, �� X11 - � •� -1-! � Tom[ /tiYI"Z _ t� 37. Firiar Factory Fi*lacd._, `-• ` `-' fr i - ` ; , e 38. Final Plumbing a' - •• •• •_ �1•'�. - _ 39. Water Service -Final, i ` ' _ •_ 40. Gas Service -Final 41. Solar Domestic -Final'. •• _ _ 42. Backflow Preventers t 43. Backflow Irrigation' i 44. landscape Irrigation System,,.;• r 7 45. Sound Attenuation' _ o. r t' t=t 1114 .71 46. fiandicap'Regylatiops •' _ ;. "1 * ; .r, ,t -- 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING, 49. Electric Release to Edison case Southern California,Gas Co -. `o 51. CERTIFICATE Of. OCCUPANCY No. Date 33470 JUL 29-7iN s°002877* ***178.50 /COSTA MESA BUILDING -SAFETY DEPARTMENT ' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �� s For Applicant to Fill in Complete/ APPLICATION FOR BUILDING PERMIT RECEIVED BY TE RECEIVED D E ISS ED `�'y7/ ADDREBUILDING i�7.� SS Q1 % Z- w f N 619,01 P Q/:(! OWNER A.P. NO/ MAIL n/' /, /I, ADIDRE S-LDING YG(%C( W 1 R[ll.., Z ADDRESS W W W U TEL. CITY NO. 1 ,S LOT BLOCK ZZ Q _ N REPAIR O y LENSTRUCI'I LENDER am r - J � BRANCH LE _j (n m J ADDRESS VALUE / �•—-3 m Q ARC ARCHITECT TEL. S2U .3JDI N FIRE •-7�/ : 'j ZONE ' TYPE.J^GROUP1'VL� w2 ADDRESS <Lw ' APPROVED JIT J DATE OWCONTRAC JW T C3 Z / / J ADDRESS z= yj CITY NOL ZO NO. OF USE OF NE r PLANS BUILDING F //l `CITY W STATEf YARDS APPROVED YARDSfA2PPROVEDV N 2 LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING 7 O SIZE NO. OF SLOGS. (FROM C/L STR EETL. / OF LOT D NOW ON LOT FRO O FT. L FT. USE OF EXISTING BLDG. R. SIDE71 '-7 FT. FT. SIZE OF NO OF SFT. Z NEW BLDG. 6S ROOMS 2�STO IES L. SIDE / r FT. VEXTERIOR WAL - ROOF z , _ COVERING COVERING. REAR FT.- FT. JUSE fL OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& a f MAIN BLDGS. ACCESS. SLOGS. Q DATE O q� 9 � C.U.P. C.U.P. qW APPROVED ^ APPR VEP y / (/) b z O UI hereby acknowledge that 1 have read this application and state tIMMFOR SPECIAL RFOUTREMFNTC that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ H any person in violation of the workman's compensation laws of ,/ O �jQ N the State of California.��j; 19 o z I hereby certify that I am properly licensed as a contractor under SD. FT. i THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION am exempt from the provision f the State o California Business ' and Professions Cotle, Divi 3, Chapter 9 PERMIT FEE $ / at w (� (r O Signature of m E Permittee $ Nf! PLAN CHECK $ J / Authorize en /( `_ �� ✓ U/yt o TOTAL FEE