HomeMy WebLinkAbout2617 WESTMINSTER PL - Building Permits IADDRESS OF BUILDING: 2617 WESTMINSTER PL WIT: CITY OF COSTA MESA — BUILDING PERMIT
aWNErcsNAME IFaaWN: HUB BARD, JULIA J PERM NO: B 075451
ADDREss 2617 WESTMINSTER PL
;Al COSTA MESA, CA 92627 PERMIT NO: B 075451 PLAN CHECK NO: N GOVT: N SUPP: N
1APPL.IIMUNDADDRESS CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF RESTH & REROOF W/COMP SHINGLES SQ FT: 5, 290
ARCH.OR ENO's ADDRESS: WIT: CLAIM VALUE: 5, 290 . 00 CALC—VALUE: 5, 290. 00 GROUP OCC : R-3 /M-1
CONTRACTOR•SNAME: PERFECT COVER BURNS ( 714 ) 434-1566
cONmrsroasMMuxB 3303 HARBOR BL COMMENTS : SMOKE DETECTORS REQUIRED PER 91UBC
ADDRESS COSTA MESA CAua401235 **********+t*** -**sESERF*****�E*�E*M-RER(-�E*sESE*********x-�E**�E*+F******* -x-***+B**+ESEx-***�E*iE***
92626 a.. UNT: D-5 Z ON ING R EQU IR EMEN TS
U N' D CONTRACTORS DECLARATION:I hereby affirm under penaly of perjury that I ant licensed under provisions of Chapter 9 S E TB ACK S
me .ig with Section 7000)of Division 3 of the Business and Profession Code.and my license bin full force and effect.
rryLI•.No.:065069 uc.cuss: B uc.No.: 401235 EXP: 05/96 MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
ate: — as Contractor: n..••••� LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OW R BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the
fog, ng reason(Section 7031.5 Business and Professions Code:Any city or county whim requires a permit to construct,aller,improve, PARKING REQ: P RO V: PARCEL : 43920105 Z N E: REF NO:
•olsh.or repair any structure,prior to itsnnatant natantalso requires the applicant for such permit to file a signed statement that he or she PLANNING N TES>
ensed pursuant to the provisi les d the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the >
nen and Professions Code)or that he or she s exempt therefrom and the basis for the alleged exemption.My violation of Section
7031.5 by anyapplicant for a permisubleda the applicant to a civil penalty of not more than five hundred dollen(5500)). *******************************************************************************
❑ I.as owner cf the property or my ern/nese with wages as their sole compensation,will do the wick,and the structure lens intended DEVELOPMENT SERVICES REQUIREMENTS
«offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to an owner of propen
who butts or improves thereon,and who does such work limseff or hersel or through his or her own employees,provided that such
improvements are not intended or offered for sate.V however,the building or improvement is sold within one year of completion,the ZONING APPROVED' BY DATE:
owner-builder will have the burden of proving he or 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 and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who
contracts for such projects with a amhador(s)licensed pursuant to the Contractors License Law). -
p
❑ lame=emua«Section: B.aPc.f«thbreason: APPLICATION ISSUED BY: DATE- �i qir-
*************************************** * ** ******************** eV—V VE**
Date: Owner LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby candy that I am aware of and understand the requirements of California Fleaffh and Safely Code Sections 25505.25533,and
25534,and thatforanyfuturebuildigauupentwill/wilnot(circleone)needlocomplywithsaidsalecodesamdtherequiremenleler BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification from the AiirOu My anagement District.Residential omenwion applutias are exempt from these PERMIT 81 . 00
provisions. . 53
Date: Applicant; ' SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under PLAN
penanydperjury omeathe fdlowinv eeclpetions: ISSUE FEE •
❑ Ihaveandwilmaintainaconnical.ofconsenttoseff-insure for workers'compensation.as provided for bySetion370DdtheLabbor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL 7 PAID DUE
Code.for the ped«manceof the work for wi:chm® m
petisissued. TOTALS----> 81 . 53 0 . 00 0 . 00 81 . 53
I have and wit maintain workers'compensation n insurance,as required by Section 3700 of the LaborCode,for the performance of the 81 . 53 . 0 0
i]
waif«whghthlepomitbbsed.Myw«kessr�ymecqnderandpdTnamberae: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 81 . 53 OVER/SHORT: . 00
Carrier:
Policy Number:
1421822-35 04 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
.•hi- -: on need not be completed ithe panne is for one hundred dollars 131001«less.) 81 . 00 . 53
not
I .:om that sujectthen t performancethe compensation
ompeakfon laws of thispermitinuagreethtieI shy oulanyd come in subject mannertsouto *******************************************************************************
•: oma hatted the workers' the work for which th permmit is and agree the D I plo y perso in any o the workers'
co penes On provisions of Section 3700 of the labor Cob,I shawl forthwith comply with those provisions. INDIVIDUAL F E E B R E A K D 0 W .N . .
Date: �IF� ' I G Applicant:
ng:Fellunto secure working'rompenntloncoverage bun/swlul,end shalHub/sefenemployer tocdMnelpenaMuand
TYPE QTY D E S C R I P T I O N o� UNIT COST TOTAL COST
c v/Gnu up to one hundred fhodund dollars(5100,000),In addition to the cost of compensation,damages we provided roan
/�
Section 3706 of lits Labor Coda,interest,andattomeyl hoes. SFR 5290 REROOF BY VALUE RES 7ti L NOZONE 1 . 00 5, 290 . 00
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there b a construction lending agency for the iJE' EES ,
performance of the work for whim tits permit is issued(Section 3097.CS.Cl. _ s.,y
LENDER'S NAME: t,1...c.; ' aSck s*
LENDER'S ADDRESS: �� � /'iA
\,\.,,,...„/. :)
I •
slate that have mad this applicationg and ate thate the above information is torted.I agree lo comply with all dry and count'ordinancesoPerl ...3" /
and alae laws relating to building construction and hereby authorize representatives of this thy to enter upon the above-mentioned propoM `
for inspadi°n purposes. MALCOM HU'__ S DR7syh D ell
`/. ,
•
Print Name —. 41 01 001q5i5130C1-••&F'. - 5;
Dale: f. I 4:4C
Signature of Owner/Agent/Anti Cont)..r .
(5151 48 WP) White-Building 8 Safety;Green-Ale;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
• CONSTRUCTION AND PLANNING POOH ;PA
L PROVALS 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-GUN ITE •
7. Footings 58, Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
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. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing f'`.� 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. Root Sheathing /275--41C- 6(4-64- 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 lZ -ll 9- &tett c - eeAl
44. Landscape Irrigation System , G � c _///at/a--
45. Sound Attenuation b//5/74 /kt- tls- I I // 4,4*46. Handicap Regulations /o/Z$ fr 4/. •ri' i_,., can
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
/'
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY'OF COSTA MESA CONSTRUCTION PERMIT PER"�T NO. TRACT NO. LOT NO. UNIT NO.
Project Address 2617 Westminster Place r3 g 9(eV j
Applicant's Mailing Address 5142 Bolsa #104 TYPE OF CONSTRUCTION El NEW El ADD 7d ALTERATION U REPAIR
Owner's Name Julia Hubbard Phone 645-6046 El CONVERSION El DEMOLISH ❑ OTHER A.P.# Zone -
Address 2617 Westminster Place DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building:
Z
Arch/Eng. License No. TYPE OF PERMIT ElGRADING ❑ FOUNDATION U STRUCTURAL E Front 0
Address El TENANT ❑ ELECTRICAL idd PLUMBING ❑ MECHANICAL B Rear N
Contractor'sName_AMERTC.AN HOME SERVTCFSPhone 891-1780 ❑ OTHER AI
A )� PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing/ 5142 a 772.-/Z---,
. 7 I K Cs
Glf��!/ I!!J C- CON ST RUCTION TYPE VALUATION$ S LeftR
City License No. ZONE GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking RCq./Provided
Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and T
my license is in full pr antl effect. r a
tLicense,Classs_n9 — � ice se 56 3 D�W ANCRO 1T _ - t 4 S
Date 4 G� O Signature lr�� a PLUMBING I FEES
WORKERS'COMPENSATION DEC LA RATIO Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of cons to self-Insure or a Certificate
Workers' Compensate n Insurance, or a c rtified Copy thereof (Section Backflow Preventer Service Sink
0, Lab. Automatic Automatic Washer Transformer 0 15-50 KW
'Policy No. C ny Bush. TeNormand Ins, Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
® Certifi d opLv y is hereby furnished. ��p�cY
Cer ' e= fi the city 9 DHOMF SERVICES Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date pplicant
EXEMPTION FR M WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or
less). 1 Dishwasher Solar Piping a 00 Dryers ❑Gas DElectric Sub Panel
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 Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-B
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. - Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors . Water Heater Outlets Range
Name an 9e
-
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Disposal Garbage
following reason (Section 7031.5 Business and Professional Code: Any city or 9Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she Is exempt —..-
trefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the, applicant to a civil
:laity of not more than five hundred dollars($500).
0 I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered -- - _ - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - - MECHANICAL FEES •
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. It, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale).
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat: AKlLiw
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 Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be Exhaust System 0 Multiple 0 System Repair/Alteration
p provided to me. I �PLAN CHECK $ PERMIT
0 l am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ . ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify hat I have read this application and state that the above ❑0-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is -f rect. I agree to comply with all city and county ordinances
and state law iTT lacing to buildin• construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of , i to -nter ..n the above-mentioned property for
inspection p / ��
Signature ���/ / �
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ - _ T•C1 1 "_yu
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION ANDPLANNING POOL& 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 COVERFjUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 'I . 59. Gas Pipe, 0 Undrgrnd.,Tg'st
9. Water Pipe-Undrgrnd:' 60. Backwash Lines,P-Trap, C Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK r_•
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fiat
12. Sewer Cap 63. Heater & Vent-Final -
13. Roof Drains 64. Plumbing System - Finals
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. FIED 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 �13o/g0 LED
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 Co
51. CERTIFICATE OF OCCUPANCY
No. Date _ .
ADDRESSaBUILgh'O: 2617 WESTMINSTER PL uxr: CITY OF COSTA MESA - BUILDING PERMIT
OWNER'SNAYE IF KNOWN: HUBBARD JULIA J PERM NO: B 0'75451
ADDREss: 2617 WESTMINSTER PL
COSTA MESA,CA 92627 PERMIT NO: B 075451 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.MAILg1G ADDRESS: CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF RESTH & REROOF W/COMP SHINGLES SQ FT: 5, 290
ARcx.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 5, 290 . 00 CALC-VALUE: 5, 290 .00 GROUP OCC: R-3 /M-1
CONTRACTOR'S NAME: PERFECT COVER BURNS ( 714 ) 434-1566 ,
CONTRACTOR'S MMUND 3303 HARBOR BL . COMMENTS; SMOKE DETECTORS REQUIRED PER 91UBC
+E
COSTA MESA CA 401235 '*****'*4**+ESE***x** ** ****# *********** *****#+t+E*asHSE+E#**+r*+r****** ***+t+r*******
ADDRESS: 92626 MC' D-5
ZONING REQUIREMENTS •
u , SETBACKS
LIOES D CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
I
mencing with Section 7000 of Division 3 of the Business and Professions Code and my license is in full force end effect.
fTYI-1J.NO.: 065069 UC.CLASS: B 11C.NO: 401235
EXP: 05/96 MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: /1 .2 -I -CI7 Contractor: . ...-.S.-----... LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Ceratseors License Law for the p
IdbGim reason(Section 7031.5 Business aha Profession « m
Coda:Any city county when requires a permit to nhPARKING RE
Q1 atter,improve, Q
dish.or repair any structure.Prim to is issuance,also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTPROV: PARCEL: 43920105 ZNE: REF NO:
NOTES>
tensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the >
usiness and Professions Code)or that he or she is exempt therefrom and the basis for the alleged violationexemption,Any of Section
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 04 mere than live hundred dollars[S5001). *******************************************************************************
t ❑ 1,as owner of the properly or my empkryees with wages as their sole compensation,will do the work,and the structure is nit intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not appy to an bwnerd properly
who builds or improves thereon,and who does such work Nmseff or herself or through he or her own employees,provided that such
improvements are rot intended or offered for sale.If.however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
( owner-builder will have the Burden of proving he or she did not build or improve for the purpose of sale).
O 'I.as owner or the properly.am exclusively contracting whh licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY : DATE:
j Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and wiw M
contracts for such projects with a contractor(s) pursuanContractors licensee pursuant to the Contractors License Lowy APPLICATION ISSUED B Y: lQ DATE: )
o len exempt under Section: 8.8 PC..for this reason: {f*************************1E************i1-0EittK** **********4********** **
t . Date Owner LEGALIZATION:N F E E SUMMAR Y . STRUCTURAL SEGMENT:Y
• I 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 l«any future buiklirgoccupenl will/will not(circle we)need M comply with saidmme codes and the requirements or BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
R a permit for construction or metier-Alien horn the Ar QualityManagement District.Residential construction appliesices are exempt from these
PERMIT 81 .00 . 53
pros sions.
PLAN
Date: - /wheat/wheatSMIP/WON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE • .
o I have and wil maintain a cedificate of consent to sell-insure for workers'compensationas provided for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for the performance Of the work for which this pent is issued. TOTALS----> 81 . 53 0 .00 0.0 0 81 . 53 81 . 53 • . 00
] I have and will maintain waxen compensation insurance,as required by See d th
3703 e Labor Code,for the performance of the
w«kf«which thisParmnainetMS"tits&glPrth2Ins "erand
pdrynumber
sit
EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 81 . 53 OVER/SHORT: .00
CarriPotty 142182 55 04 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
Policy Number:
tiro}}; pionneednotbecompleteddthepermiisforonehundreddollars(St00)orbas.) 81 .00 . 53
❑ I�n MNthatin the performance of the work for which this permit is issued,lshall not empty any person in any manner so as to *******************************************************************************
j be bled to the workers'compensation laws of Calrfamia, and agree that R I should become subject to the workers
(
o pensahon provisions of Section 3700 of the Labor Code,l shall forthwith comply with those provisions. I N D I V I D U A L F E E BREAKDOWN
Data t• I Cf S Applicant: ./'4,�
Wen7lg:Failure to secure workers'compensation coverage) unlawful,and shall subject an employer to ClhMM/paMINOHnd TYPE QTY D E $ C R I P T I O N UNIT COST TOTAL COST
Secl oM4rpmone bborrCoreouurest,and Jd (S10tey'slees addition to the cost of compensation,damages as provided for In SFR 5290 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 5, 290 .00
Section s7up of the Laudedde.Interest,end etmne 0),ea.
• CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a conmmsaion lending agency for the . END OF FEES _ '
performance of the work for which this perms is issued(Section 3097,Civ,C).
LENDER'S NAME:
LENDER'S ADDRESS: /
I drWythat eta1havereadIha apngconstNice u construction
aboveinformationrepresentatives
t.tagree 1t comply upoth nall abardwtionadlrope'rly
and state laws urpose to building wnetrugon entl hereby authorize representatives of this cry to enter upon the above-mantbrnd properly
for inspection\--",----‘,11
MALCO_� ----_UR S l\ ' •
1�Tn�-Print Name 01 00195651-00195652 TOT 81.53
( ' - —� / Det„ �� `9 DATE: 12/01/95 TIME: 14:40
Signature of Owner/AgenuApphcanf ont�or
(5151-46.WP) White-Bpilding 8 Safely;Green-file:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor •
C"'' ' HUBBARD, Julia "^'L 3-19—/b
E'JOB ADDRESS 2617 WParminatnr plana BUILDING PERMIT NO. 41438
GENERAL CONTRACTOR Owner/R1 dr DESCRIPTION of WORK Arid Redrnom
yAPr._Io.119-163-05 LOT TRACT FIRE ZONE VALUE E 2,400.00
" g.t. ;CTIONS Signature Date TYPE V GROUP T ZONE 12-1
iSGt'--` PERMITS ISSI�ED
GAS SUBCONTRACTOR
Dote I Number I Signature
WATER •
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE n HOUSE CON. fl
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING ,
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0
ROUGH WIRING — y\c. 5-w Heatin. and Vent.
TRENCHES ❑ FORMS 0 STEEL RE INF. rd A T• is(24 _
FLOOR SYSTEM
BOND BEAM In STEEL REINFORCE •
SHEATHING aA..;^ - - . --
FRAME AND FLASHIN - a;:nag �l.. --
al
LATHING — IN [h ir���
OUT { ' 'r1��ii'-r) � ==
PLASTER. BROWN COAT (
Y _Aii "e
STRIrTURAL, FINAL Electric
HE , VENT., REFRIG. AND A.C., FINAL /Pf � /��4• (f,at-Z Yp`337/
PLUrwoING, FINAL AND GAS TEST n ( 1 /
ELECTRIC, FINAL /Q 1C- /4`A•
BUILDING, FINAL RLC. ,+�"/tea
4143E UNa 36. 0
:aC,R 19-76„1-00 941* **** 5
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• 'PL, A r ON FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely-Use Ink Only
BUILDING �/ / /',�,/� /�(� // R:C',1„ .J�- DATE RECEIVED E ED
��
ADDRESS �tlO� es Jp� �/]` �� �,—// 31_ '] IY'
OWNER /7' ✓(,J//4 g//�j/.�n71� A.P. NO. IIq—ti (p3yy-'OS PERMIT NO.
MAIL BUILDING
ADDRESS Z.G
ADDRESS aSri wC�
s / 7 lwe3?M/w4TeYL /x �'�1�1T> I�r1
CITY `d.s 4 (A-IeSA NO.An" /)�, TRACT/771 LOTS BLOCK
CONSTRUCTION NEW AD[J ALTER REPAIR MOVING- DEMO/ISH ,
LENDER ,\3C{`
BRANCH �, 1� yy�� -1- 1' ('��r
OWNER Ivl FES “kx9,(-�
ADDRESS /,' A� VALUE 1
OR ENGINEER JARCHITECT ��k� /N" 1///- NO.PccS S J7J USE `t-' \ ��/(((///��, - ,
!' �/I�,�1� �- FIRE
' ADDRESS -7 X c e - Q „.., ST b"sh,..t, ZONE �YPE f_..--GROUP r
APPROVE /9���
CONTRACTOR �'^C_.t�(///'e// BY C DATE /
ADDRESS / 7'r�.k/"/`�V ins ./�- Z/p/NE NO.OF 2 USE OF NET
CITY &OA- I (L/9% NO.TE / c�7 Z(a (•-� ' P� C._ BUILDING
.F. STATE CITY YARDS APPROVED YARDS APPROVED
gLIC. NO, LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W S12E �^� NO.OF BLDGS. (FROM C/L STREET)
6, OF LOT 60 v I e/7 V I NOW ON LOT / FRONT Pm FT. FT.
Q USE OF /�
.I EXISTING BLDG. ��'s- 7" R.SIDE C FT. FT.
VI
H Separate permits are required for L.SIDE—. FT. FT.
electric,plumbing and heating work. ( p7
A - REAR Ill t_ FT. FT.
I.W. - USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
MAIN BLDGS. ACCESS.BLDGS.
,q-)P/-r//»✓( / _ VAR.#
C.V.P.# DATE
APPROVED VEDQ
� ,I Ir
l� /L �_ /
/n` AP tEc .
. g kb DATE 3- 1 q -�lra
0 I hereby acknowledge that I have read this application and state n
N
a. that the above information is correct and agree to comply with m
6, all laws regulating building construction, and I shall not employ '
Z any person in violation of the workman's compensation laws of
d
WS the State of California.
I hereby certify that I am properly licensed as a contractor under
/6 SO. FT. co
the State of California-Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro
Chapter 9, and that'such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the rovisions of the State of California Business ,/�J a
VALUATION PERMIT FEE $ /y
and Professions Code, ivision 3,Chapter 9. - -� el
/j s/ red CHECK $ /� o
Permse of at.•;/s('/„'""�_- h.
Permitte Sall, TAX $ 2/ eV g
L14i SC)
U
Authorized TOTAL PAID $
OWNER ROYALTY $EROICE CORP. • DATE 5-20-514
JOB ADDRESS 2617 Westminster Pl. BUILDING PERMIT NO. 254
GENERAL CONTRACTOR J. D. Doverspike VALUE $ 8,800.00
frLOT AP# 119-161-21 BLOCK TRACT 1. Dwelling & Garage
<1GROUP I TYPE V ZONE R-4 FIRE DISTRICT -4•42. 3_8j
PERMITS ISSUED
INSPECTIONS SUBCONTRACTOR
!ATE
DATE NUMBER
Footing Trench 31.1S31.1S22 /•Foundation Forms and Grade to Garage kby
,Rough Framing /GU/� h I
Plumbing,Rough to Slab Z.....-/'S of 8=
Plumbing,Rough Complete Zc—c-/J :Sr J �/. ,.�1/�?a _ - 3 e/
Temporary Pole Tn c/- 3
— f2
Wiring.Rough 'S
Heating, �Yi��11 , ff9'.LleG, _tel ate- /
'
/lff�
Heating,Rough 6-jS SY
Heating, Final ZGe---,-6 7—, s'tr24i-24, -cb• . - -r 3 941
Sewer et/ /lpt LL 4 >� yy/i R A `
Septic Tank or Cesspool C�I�J 6 � ..Le .yw��e(ttt. � ' ' "/b %
Lathing /-0 bur /u0 17 cy J
Plastering
.Plumbing,Final,Fixtures Complet —/ —.4
Plumbing,Final Gas Test 51 s 5C2# "1"•/yJ--fre"
Wiring,Final 9•/S/.f
Occupancy
./' ;/ S 1 --
Form
Form 210 G-H 1M 12-53 71
Costa Mesa Building Department APPLICATION FOR PERMIT-
STREET . . - ..
`BUILDlNG ' ,',i•
iCOSTA MESA, CALIFORNIA
• FOR OFFICE USE ONLY
•
FOR APPLICAN `T FILL IN .
Receipt No. Permit:
Building joy - /L yS SC 7'
• Address v( / _ %Co; G
Mesa, California C]R�eceiv jbyy t�-Da a Rec'�CL/ Date Issued
Nearest i/ - l GeiU, . `� /� I C 2-0-.7
Cross St. fl ,/" QijM. Building ��jj 7 , , l ��f�-�- //'
Address pC 17'V✓1D�Cez,t.,...en:-
MailOwner ''"` rf/�/w/ 4 "` " "I 1 Costa Mesa, California •
Address v I Nearest /jam _ 21
jligir Tel. Cross St. /// G`'�!/ 6.1,. G •
City .L,/ ✓ .A No. Zone / I No.o n>1+� Typ� I Group
Architect or Lic. I Plan d- I , L
Engineer No. Approve . !
' by ; Dale I
Address CORRECTIONS •
City Lic./ 4
racto.e4moi/fr1 /l em No. ('(f4 ' t 1
Ad. es- Ilse es, % ,4-et. 7.
I Lot +�' • ,..r^ ! /A � ( - �
Description I No, I Block I Tract t
' `.
(Attach Metes and Bounds) / GrC/ 7- � / ?.-/ ; R.01-a .-.-----------
, =J :
No.of Bldgs.
Size of Lot aealle/ I Now on Lot .. -.. _ _. _ _ _(.-;;Cir-- ! -j O
Use of I No.of I No.of . �1-7 7s
Existing Bldg. Families I Rooms E
Setback Line from Rear Yard __ -- - --- -" --- '- WON
Center of Street Side Yard F` 'I3 WON D
DESCRIPTIONiJ�IOF WORK CITY ;'tE"Cr _-. r
New I �l Alteration 1 I Addition I +
' Repair I I Moving 1 I Demolish
Building 7' _ Roof
Size /i�,y/ �, - Rooms S� is
Exterior all 7,417 - Roof
% _ APPROVALS
tering di � . I Covering ',in/
of New- //Mr 1 Foundation Location Inspector Date
Building Forms,Materials,
Under-Pinning
701. Frame: Fire Stops,
.e I _Lie _ Bracing,Bolts
-
Lath. Int.
• Z hereby acknowledge th, I have read this Application
and state that the e ! correct and agree to comply Lath. Ext.
with all City • �• d State Laws regulating
building cons -
Signatureof i ��r/►�• Plaster, Int.
• Permittee .accts geva A. A i....
Plaster, Ext.
•
Authort. Masonry Reinforced
O
Valuation - - Permit Fee $ 7. y 0 0
et
Plan Check $
Total 3 — Bond Beam
' $
Fee $ �J a FINAL
a 2
a
Street
- .. .
PLOT PLAN
Show location and distances from _
property line and between buildings.