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HomeMy WebLinkAbout2624 WESTMINSTER PL - Building Permits ,4T11 CITY OF COSTA MESA BUILDING DIVISION F • •,,,�' ',I DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER Ora PERMIT p 602-00474 ammo . (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 2624 WESTMINSTER PL Status: ISSUED Suite: Applied: 04/05/2002 Vicinity: Issued: 04/05/2002 Parcel Number: 43920114 Zoning: Applicant: CLAYTON, MATT ISSUED BY: Address: 262 WALNUT ST Phone: 949-631-1085 COSTA MESA,CA ' Zip: 92627 Owner RU DENSKI, JEAN A TR Address ,2624 WESTMINSTER PL , Phone: COSTA MESA,CA Zip: 926274643 Contractor: WATERPROOF ROOFING Address: 262 WALNUT ST Phone: (949)631-1085 COSTA MESA,CA Zip: 92627 License: 738880 Arch : • Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPEOF PERMIT_. REMOVE EXISTING BUILT UP ROOF, INSTALL 2 LAYERS OF FELT,APPLY 30 YEAR COMP SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,000.00 Permit: $83.25 Claim Valuation: $3,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $83.75 • • 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 2148-48(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 Niwo for which this permit is issued. ave and will maintain workers corn" urance,as ;wired by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. workers'compegsati u a r an Icy num.-r are: I/ (/ t t�Yr1�{1 (`�/1 (( Carrier: , I Policy Number: .8 - 0/ (This section need not be completed it the permit is valued at one hundred dollars($100)or Ies;.r. I-- 0 ❑ 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,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of theLapo�e,I shall forthwith w comply with the ,Dtoyi ' '�� U/ ( 7li Applicant Signature: �/��� W1TPS -- Date: WARNING:FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(SI00,O00),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 affirm that I am licensed under P1yona:.p vi f r 9(commencing with Section 7000)of Division 3 of the Business end 'asst and my license is in full force and effect.Lic.4 ( bi ' Class 4 � / Contractors Signature: ` Date: i V2 - 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.(Sec.3097,Civil Code). Lender's 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 end 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 contractor(s) license pursuant to the Contractors License Laws.). ❑ l am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's 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,faisework,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 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 material? ❑Yes 0 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). ..l....... i..... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves 0 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. 4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? 0 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? SO Yes 10 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 part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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 8 (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. `. nature ::: e •er(s) StD � 'i,/'i,o D � And/Orr -.. horized Applicant date CODE 4 INSPECTION TYPE OATS 2i2W & CODE( INSPECTION TYPE DAIS ILS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final208 Final Plumbing Li 200 Final Re-Roof -//-C"7 210 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/Occupancy fr9 A CITY OF COSTA MESA Py, . *, BUILDING DIVISION 1. 1 �•"^' DEVELOPMENT SERVICES DEPARTMENT PERMIT NU ER • °, ,,,,„•o PERMIT PO 0056 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT - Job Address: 2624 WESTMINSTER PL Status: ISSUED Suite No - Applied: 01/27/2000 Issued: 01/27/2000 Vicinity: Parcel Nunmber: 43920114 ISSUED BY: • Applicant: NOCK, RON Address: 11612 KNOTT ST Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 Owner: RUDENSKI, JEAN A Address 2624 WESTMINSTER PL - Phone: COSTA MESA, CA Zip: 92627 Contractor NOCK PLUMBING - Address: 11612 KNOTT ST ' Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 - - License: 707775 Arch/Eng: Address: - • Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGEOUT. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub - $0.00 0 ' Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors • $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink.Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen • $0.00. 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 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 DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I 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 cr.w 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, Myvlorkers'compensation l Insur ce carrier and • meej policy number are: yy�J Carrier:—� n59 � f— /i ,ca ,P-olicy� N ber:=A;,)tv ''-f-f- 7 `F I _(This.sectiorl need not be completed if the permit is valued at one hundred dollars($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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith pcomth these provisio g ,Applicant Signature - Date 7—? — '" WARNING:FAILURE TO SECURE ,Op.—S •. • N a ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE NORED THOUSAND DOLLARS(S1O0,000),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 affirm that I am licensed under provisions of Che�ppterr9-(commencing with Section 7000)of Division 3.of.the-Business and Prr fejio Code,and my license is in full force and effect..Licr#-� e i 2 2 5 L/Class# < -J Co�ctor's.Signature:., r1 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.(Sec.3097,Civil Code). Lender's 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 contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's 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 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 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 material? 0 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). _ res._...t...oruurebui"—'occupant file a...rgist.rationac -r .ma_.r.ia ?....'- ------_._ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? Yes 0 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. _._._-.. - .... esti the H._, Safety n-full. ............. 4 If an RMPP is presentlyre wired has Section 25534 of California Health and Safet Code been fullycomplied with? qY P ❑Yes ❑No ...5.....-. oes,... ...t- t or building .. ...ire... -- _._... 5 Does or will the applicant or present aemen isi occupant at y other for the work ontch districtis the subject age of this application aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control 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). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries or a school? ❑Yes In 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? 0 Yes ❑No 8 (If ryes",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 Owner(s) Rate —� e '_ I And/O,Authorized'App' CODE N INSPECTION TYPE DATE INTITIALS CODE N INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 2 1266 Pool Spa Final 208 Final Plumbing J)�` —RR- 200 . 1 iY200 Final Re-Roof 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/Occupancy 2446.446 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA NSTRUC ION PER IT D PERMIT NO. TRACT TRACT NO. LOT NO. UNIT NO. ' . 5623_ 1-/ 1 4/65 .5.0;0 TL, • Project Address Olb 4 (jL�l in.14 r / I ' P! -7bSs" / TYPE OF CONSTRUCTION IJ NEW U ADD U ALTERATION LI REPAIR / Applicant's Mailing Adpyress r• - Owner's Name K ILEC Q./�(� S i Phone ❑ CONVERSION CI DEMOLISH ❑ OTHER A.P.*, Zone DESCRIPTION OF WORK/USE OF BLDG. Address saaer14.1. - S Main Building: Accessory Building: Arch/Eng. //� License No. T 0 !/I'[7 TYPE OF PERMIT. ❑ GRADING FOUNDATION ❑ STRUCTURAL Front Address: _ El TENANT CI ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N Contractor's Nam e_p t Phone Sons ❑ OTHER A I 03 Address(mailing) /' P4. nlf{� ..TrCllite• 4t_- '7o!!/'I PROJECT DESCRIPTION SQ. FT. OCCUPANCY - CK Right - N G CONSTRUCTION TYPE VALUATIONS S Left L City License No. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E ( 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 ful force and effect. - T License Class Lice• O. r Date— — O' Signature / - At a PLUMBING FEES A WORKERS' COMPENSATION DECLARATIO Bar Sink Showers I,hereby affirm that I nave a certificate of consent to self-Insure or a certificate ELECTRICAL FEES f Workers' Compensation insurance, or a certi copy hereof (Section Backflow Preventer Service Sink " " .800, Lab. C.�—/1 r'1l 1 Automatic Washer Transformer ❑ 15.50 KW P licy No. s� `Sd`tq�0 Company - +. •.. Backflow Irrigation 0 50+ KW f 9 Sewer Cap Construction Pole Sub. Certified copy is hereby furnished. . • 1 Cerfifietld copy tilled with the city B 'din• •ivisio ' Bathtubs Sewer Connection Cooking Unit • Meter ❑up to 100 amps Date )— f S Applicant / �/ _ - EXEMPTION FROM WORKERS'C•MPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100)or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is is ed, I shall not employ any person in any manner so ys to be subj o the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8 Worker). C�ytps tion Laws of California // - Date OO Signature lr�/ �Ca. • .Floor Drains Swimming Pool w/Spa F.A.U. IncSolar 09-15 HP 016-15+ NOTICE:If,after making this seclarSf ion, you should become subje t to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave - - - comply with such provisions or ,this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service 'Outlets, Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance 9 of the work for whl h permit is issued (Section -3097 Civ. C.) Interceptors Water Heater 2.-� Outlets Range Lender's Name /J9/�t9 Lender's Address - Kitchen Sink •- Water Service Switches Sign • OWNER BUILDE D ARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or ' county which requires a permit to construct,alter,improve,demolish or repair P—Trap - any structure, prior to Its issuance, also requires the applicant for such permit - - - Generator ❑0-$KW❑5.1$KW 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 - ' herefrom 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 +eenalty of not more than five hundred dollars($500). 3 Ll I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee • $ 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 ❑ sale. If, however, the building or improvement is sold within ono year of com- Canopy Type II ❑ 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 Data rove for the purpose of sale). t ----- Th I� o I, as'owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued Byy' Dat 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- tractors) license pursuant'to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ lam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG 4 PLUMBING $ 5-.CCIISSUANCE $ (�/A� Date Owner + Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 0o-100,000 BTU D100,000 BTL - GRADING $ Information is correct. I agree to comply with all city and county ordinances ELECTRICAL S - and state laws relating to building construction,an• ereby authorize repre- $ MICROFILM S sentatives of this city t• a up.• -• ab0 entloned property for PLAN CHECK 50% �/� Inspection purposes. J ' ) MECHANICAL $ TOTAL FEE $ / 'w Signature /� / , �/ Date /�! '� • Drivers' License or SS* , Reinspection Fee $15 Issue Fee $ 3 PLAN.CHECK 25% $ - CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor CONSTRUCTION AND PLANNING POOL 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 . 4. Electrical Conduit-Undrgrnd. „ 55. Electrical Bonding 5. Steel Reinforcement • i 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. r 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 - r - . 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 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 `Oiler czo 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 4467 FEE RECEIVED COSTA' MESA BUILDING DEPARTMENT P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. FOR APPLICANT TO FILL IN APPcItPPFITPFAPERMIT ADDREISR 726.2 f WAS-,4-,tiin/SY'eft PA BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO, OWNER 'dpi/ r G- .5-7Cir Pl-/6N.S 9SiAL. MAIL J p^l /� RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS /O v (! CC ('�/(� Teo N� 9,-cad--S7 rJ v/ TE�L./1 BUILDIN CITY 73q . g31. Nr, iy7Sm ADDRESS ARCHITECT LI OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE ADD r ZONE}E ���� �L TY LIG. =DN/� // NO NS PE ' / GROUP I( , CONTRALTO R be NO. //j P v TEL. APPROVED / ADDRESS NO. BY DA _ LEGAL LOT , DESCRIPTION NO. /�/ /LOCK TRACT/7 72 ��y(7r�y A.P.NO. // / "' // 5 7 �i i tU �J / SIZE ^ No.OF BLOGR. CITY OF COSTA MESA OF LOT / Z X No NOW ON LOT PLANNING DEPT. USE OF • SUBJECT TO G. DEPT. REG. EXISTING BLDG. � I CSETBACK LINE FROM / / -4;23-ENTER oP STREET 0 REAR YARD r DATE SIDE YARD RIGHT u/7 / LEFT .5"/, PLAN DESCRIPTION OF WORK _ NEW X ALTERATION ADDITION REP/. MOVING DEMOLISH BUILDINGif � oO ROSNO. STORIES SEXTERIOR IZE WAL1{,4/I q,p ROOF COVERING .J/ / y VG-CDyCOVERINNG dcm Po BUILDINGEW Si,�/.f /4rr.7JI) t 1 /J pwf•L%;NC -. 794 0 /a A /S/oo A'� //J/ �[T� RRAA0 4.37, As =� I HBV ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL / CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC• TION. VALUATION u SIGNATURE O/> PERMIT FEE S o2 a PERMITTEE r ` I [� g /7 74-‘ r PLAN CHECK $ / j AUTHORIZED A / . / � 1 TOTAL FEE 5 932, -- Ver' rs 1. P:13(1, -3311,1M111.1. • A231ATZ0;1`10 11 • 3`. i . . . • ..,.. ,.,..t. ,L4 ..:._ Owuti--170-&-e-kj t-i. t. .� .0oi - , ..s. • • . I s