HomeMy WebLinkAbout2557 WESTMINSTER AVE - Building Permits ADDRESS OF BUILDING: 2557 WESTMINSTER AV DM: CITY OF. COSTA MESA - BUILDING PERMIT
OUNERSNAMElFtWOBM: ADAMS, ARCHIE DALE TR .4-PERM NO: B 079976
ADDRESS: 2557 WESTMINSTER AVE
.3 COSTA MESA,CA 92627 PERMIT NO: B 079976 PLAN CHECK NO: N GOVT: N SUPP : N
548-8208
" ApPL.MMUNOADORESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : REROOF OVER WITH FIBERGLASS SHINGLES SQ FT: 1 , 952
ARCH.OR END'S ADDRESS: WIT:
CLAIM VALUE: 1 , 952 . 00 CALC-VALUE: 1, 952 . 00 GROUP OCC: R-3 /
mwmaarome ROY CHAFEY ROOFING ( 714 ) 636-1747
COMRACTORS MMUNG 9692 LUDERS AV COMMENTS : REROOF 1950SF RESIDENCE W/FIBERGLASS SHINGLES
ADDRESS GARDEN GROVE CA uC.NO.: 556624 *RE*************AEAEM-*****************REiEDtRE********+ERE ****+E**+t******x-atRt-it-REat***aERE****
92644 UMT: Z ONI NG REQUIR EMEN TS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I ern licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in tut force and effect.
CITY LW.No.: 025615 uc.cuss: C-39 LIC.NO: 55667 P• 07/97 MAIN BUILDING ACCESSORY BUILDING
Dale: 10/1s = FRNT: FT IN REAR:
IN RGHT: FT IN FRNT:
LEFT: FT IN REAR:
IN RGHT: FT IN
Contractor: p�'7 LEFT: FT FT IN FT FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that 1 am exempt from the Co as a Lawlor the
following reason(Section 70a1.5 Business and Professions Code:Any city or county whim requires a pend to construct,altar,improve, PARKING REQ: PRO V: PARCEL : 43919113 Z N E: REF NO:
. 'widish,or repair any structure.aria to its issuance.also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES>licensed pursuant to the provekm of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 a 63
.ualness and Professions Code(or that he or she is exempt therefrom end the basis for the alleged exemption.MY vioW ion of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than flee hundred dollars R500D. *******************************************************************************
0 I.as owner of the properly or my employees wfh wages as their sole compensation,will do the work,end the structure is not intended DEVELOPMENT SERVICES R E Q U I R E M E N"•T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owners propend
who bolds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such
improvements are not intended or offered for sale.I.however.the building or inprovemw is sold within one year of completion.the ZONING APPROVED BY DATE:
ores-builder will have the burden of proving he or she did not buil or improve for the purpose of sW),
❑ I.as owner of the properly.am exclusWah,contrading with licensed contractors to concatud the projed(Section 7044,Business end BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of property wile builds or improves thereon end who
contracts for such projects with a contracdor(s)licensed pursuant to the Contractors License Law).
:-.t.-;NK,-
.
\�n
APPLICATION ISSUED BY: #Y DATE: I
❑ 1 am exempt under Sxtim: B.a P C..ler this reason: O 1\ * l
*********************************************** ******************************
1-
Date: Owner:
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify Dor 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 will/will not larcle one)need to comply wih said state codes and the requirements for
a mama fon mnstmction or modificationfrom the Aiou dByylraagement District.Residential commrwioneppimlbns are exempt from them BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE. SMIP/RES GRADING
provisions. PERMIT 62 . 25 50
Date: Applicant: SMIP/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby aJam under penalty of perjury one of the following declarations: ISSUE FEE
❑ Ihave and wimaintanacertificate aconsent toeet-insure for workers'compensation,asprwkledfor bySen3700ofthLabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL 'PAID DUE
coda,falneped«maaealhewdfawmhmiapennieimued. Section TOTALS----> 62 . 75 0 . 00 0 . 00 62 . 75 62 . 75 . 00
Irl and have M will maintain workers'compensation insurance,as required by Section 3700 d the Labor Code,for the performance of the •
�i work for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 62 . 75 OVER/SHORT: . 00
Policy Number: 446-96UN1T00241 01 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need nor be compered d the penal is our one hundred dollars($tool or lees.) 62 , 25 . 50''❑ I certify'hat in the performance a the work for which this permit is issued.I shall nor employ any person in any manner so as to
become sublw to the workers'compensation laws of California. and rise that it I should subject to the workers' *******************************************************************************
compered' Anne aw
saofshall 37gothe Leben code,lshall t n mm./ ' INDIVIDUAL F E E BREAKDOWN
O Dam: I U I —7 Appticanl: _ _ _
7 Warning:FeUub to secure worker•compensation coverage Is unlawlm,and shall subject an employer to anmam penalties mrd TYPE QTY DESCRIPTIO NUNIT,•;COST TOTAL COST
civil fines up to one hundred thousand dollars(SI00,000),In addition to the cost of compensation,damages as provided for In
Section 3705 of the Labor Coda Interest,andeltomey's fees. SFR 1952 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 • 1 , 952 . 00
CONSTRUCTION LENDING AGENCY:I hereby affin under Penalty of Perky that then is a construction lensng agency for the END OF FEES
performance of the work for which this permit is issued(Sedion 3097.Cie.C).
LENDER'S NAME:
LENDER'S ADDRESS:
• I costly that l have read this application and mate that the above information is correct.I agree to comply with an oily and county ordinances
and state laws relating to building corauudion and hereby authorize representatives of this city to enter upon the above-mentioned property '
la inspection purposes. ,-
,OY CHAFEY 1
pd a 01 00217157-00217158 T CE T 62.75
/uofO�) Dale: 0 / DATE: 10/15/95 TIME: 13:07
9 Signature or Oa"e A mew
(5151-45.WP) White-Buildig 8 Safely:Green-Re:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING _ • POO 'PA
APPROVALS Permit# Date Inspector APPROVALS Permit # 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 .I ,. 1
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test {I
6. Electrical UF ER 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 - tt
16. Rough Electric Wiring - • 67. Fencing & Access Approval'
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22, Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
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. 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
69-17--94- iJ, /G (
44. Landscape Irrigation System _ / / G ,, �/Y ��-/�,K�-/
45. Sound Attenuation - (6/2.A eg L,:r'C C,dHY��'��•"�j
46. Handicap Regulations !!G G
47. FINAL STRUCTURE & BUI LDING G/9:21 tb &t [pvl,t
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 2517 WES'iMINSTJ•R AV UNIT: CITY OF COSTA MESA - BUILDING PERMIT rnnr. iW; n vj, »..
OWNER'S NAME: ADAMS, A 11A:.E "
ADDRESS: 2557 WESTMINSTER PERMIT NO: • E 059338 PLAN CHECK NO; N veva ; IN Durr ; ii
COSTA MESA, CA 92627
CONSTRUCTION TYPE: 5-N PERMIT TYPE; ELE PURPOSE; OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ABOVE GROUND PORTABLE SPA 1NS;'AA,LATION SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC; R-3 /
PERMITTEE DALE_ ADAMS ( 714 ) 548-8208
ADDRESS: 2557 WESTMINSTER AV COMMENTS: ABV GRN1 PORT SPA
COSTA MESA CA 92627 3(3E-XXi(X-iFX1E)EXi(-)(Xi(9eX•X#irXX-XX3(3(X##iEX-Xi(Xif3FicXiE%#i(#If),E1FE3E3E1(X??lFy#)E#)(iE****k#)ElfXX#Rj(1(*X-1(-0Ht
LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUI REMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
MAIN BUILDING ACCESSORY BUILDING
-
Date: Signature: FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT; FT IN LEFT: FT 1N RGHT; FT IN
Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C).
POLICY NO.: EXP.GATE: PARKING REQ. PROV: PARCEL; 43919113 ZNE: REF NO;
COMPANY: PLANNING N 'TES>
Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. >
********%***)E#3e,X3t*******-1 *********3E*3E XSe******************lf-3(-3***********k#*fl-St** E
Date: Applicant: DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5700)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 ZONING APPROVED BY
subject to the Workers'Compensation Laws of California, (r\ a ,.n : DATE
—7— Date: /D `-Z`T 2' Signature: NC(,/i �C1r%�k.•t.o BUILDING APPROVED BY ; ///` DATE:
NO Icy:N,afterstmaking this declaration,wiyou should become subject the Workers'msrevoked.Compensation provisions of the Labor � Y
Code.you must G comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED B Y
•CONSTRUCTION LENDING AGENCY: hereby allirm that there is a construction lending agency for the performance of the work for .� �'• Li:�� DATE• �J ��/QQQr`�
which this permit is issued(Section 3097.Civ.C). iE#3E3EX•*#JE3E1EiE#ik3EJEX3E1EiFffi6iE '. x..:x -7111111.,:x .r . . n, 'A rr x zersr/xu x„.7.„. r u x***1E K.3E#-X#*-*/ t. ., k
**********1 *****)(•**1h3F***************X-3t** -#1F#1E-7.-1E1EX****)(•if****-X-4HE X#fFi(-3(-#k)4********
ADDREss: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
OWNER BUILDER DECLARATION: I hereby allirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 11 00
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,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 50•C
SNIP/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 15 , 00
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($503). BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
I, as owner of the property or my employees with wages as their sale compensation, will do the work, and the TOTALS----> 11 , 00 15 . 00 0 . 00 26. 00 26 . 00 . 00
❑ 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 properly 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 sate.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED ; 26 , 00 OVER/SHORT; 00
improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
for the purpose of sale).
26 , 00
V I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon JE1EX-3f J63e1EiEX•3E3E3EiEX-K•3ElE##ie3E3F3E#*##3E3EiE3E3EX#XiEi(-363f•3Eifi6#3E3E3EX#3E3EK#3(3E#k1E1E1E3Ei(1EY34%3E3E##1r ih3E1E 1(#X3E IF3E
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under section: B.a P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
• 'n
`` Dale: /o - Z - Owner: &alit. t--i• ELE 1 MISC APPARATUS NOT LISTED REQ PERMIT 11 . 00 11 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the AirAir Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:- •
I hereby certify that I have read this application and state that the above intormation is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. Q�h.4 �;Q�
Date:10-9-- 9 2— Signatures a 22.4"4--0/ '4
Drivers License or Social Security♦: - -
1641-46 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POO SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # 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. IDI1/9y,AO-
B. Foundation 59. Gas Pipe, O Undrgrnd., Test ( 7
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ 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. f:oof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Dough 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 2,�/f!Z Q
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 ❑Gas 0 Oil
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 PREY. FINAL
30. Drywall Nailing I , HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ,,/ Notes:
34. Final Heating & Air Conditioning •
35. Final Gas Pipe-Test 4,
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. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
•
PROJECT ADE: 2557 WESTMINSTER AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05316_
OWNER'S NAME: ADAMS A DALE
ADDRESS: 2557 GESTMINSTER PERMIT NO: E 053163 PLAN CHECK NO: N GOVT: N SUPP: N
at COSTA MESA, CA 92627
CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPOSE: OTH
is ARCH/ENGINEER: 548-8208 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION ; UPGRADE METER 6 SUBPANEL SQ FT:
•
PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: /
ADDRESS: DALE ADAMS ( 714 ) 548-8208
2557 WESTMINSTER AV COMMENTS : X
((`` Mr� CA 9227 �k; * *** • -i�****Tr****yt'FF***E�****�6*�6*aE***x***x-** ****K90 *****N*x-******�6**+��cx*******
LICENSED CONTRALTO CrECLAAATION: I hereby affirm that I am licensed under provisions of hapten 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 0l the Business and Professions Code.and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS: SETBACKS
Date: Signature: -- MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance, or a certified copy thereof(Section 3800.Lab.C). LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ. :. PROV: PARCEL; 43919113 ZNE: REF NO:
Certified copy is hereby furnished. ElCenilied copy is tiled with the city Building Division. PLANNING NOES>
>
Date: Applicant: ****!i*********iF***)f************it**k****3f****iE******)Elf.li*** +4*******1:***aF*****.{(.y.f(.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred 87170)or less). DEVELOPMENT S :E R V I C E S REQUIREMENTS
I certify that in the perlormance 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. ZONING APPROVED BY , DATE
Date: Signature:
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : _ DATE:
Code.you must fonhwith 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 APPLICATION ISSUED B Y; DATE: '2>which this Permit is issued(Section 3097,Civ.Cl .*.*.*.***..*.**************.*.*.*.*******Itli**.****.***.******.******************* wxx C •. ..**
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Processional 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 tile a signed statement that he/she is licensed PERMIT 40. 50
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis tor the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15,00
p I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
'7C structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 40 . 50 1 5 . 00 0 . 00 55 . 50 55, 50 . 00
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 far 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 REVENUE DIVISION TOTALS--> COLLECTED : 55. 50 OVER/SHORT: . 00
for the purpose ol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 55. 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts far such projects with a contractor(s)license pursuant to the ContractorsState License Law).I am aware ****_*.***.*****,******************************************************************
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.&P.C. INDIVIDUAL F E E BREAKDOWN
for this reason:
• G / TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: 3 / I Owner: ft -v* ..-i
I do here /certify that lam aware of and understand the requirements of California health and Safety Code Sections 25.505.25533,and ELF. 1 SERVICES BELOW 600 V & BELOW 201 AMP 18 , 50 18 , 50
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 1 SUB—PANEL 11 . 00 11 . 00
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 1 M I SC CONDUIT NOT LI S T q REn PERMIT 11 . 00 11 , 00
these provisions. 7e; 0;per Eli p
Date: Applic nl: NI
I hereby certily that I have read this application d state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building co traction and hereby authorize representatives of this city to enter upon the above mentioned JUL 31991 E�J
property for inspection
gpropo'sesp. p /1 `/�y/Z��L/fri�.� / J,
DaleSoc��( / Signature: �(Th�/�/) J
Orly s License or Social Security a: CITY OF COSTA MESA
1641.46 Wfule—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
r
. CONSTRUCTION AND PLANNING . . POO. SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, ❑ 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
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
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. FINAL INSPECTION
32. Electrical Power Meter-Final / I /9 -1 80. FOOD CERTIFICATE ISSUED
33. Final Electric e/8 �i 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 I
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co I I.
51. CERTIFICATE OF OCCUPANCY
No. Date