HomeMy WebLinkAbout203 WELLESLEY LN - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PEIT,jVO._ TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONS�T/Rc1CTION PERMIT _ J//�/yyCC{{JJ(( A.P.# Zone
•,-Project Applicant's Address .2D3 C!/r// 7 �E L c.- `( r ' S Main Building: Accessory Building:
Mailing Addr 55 / TYPE OF CONSTRUCTION H NEW LI ADD 14GALTERATION H REPAIR E Z
y2 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Front 0
Owner's Name /ft!//i Gds O Phone eESCR IPTION OF WORK/USE OF BLDG D. t- ` de'• Rear N
Address .•• t AA.--' 4 . . ..1 -.
TYPE OF PERMIT U GRADING . FOUNDATION 111 STRUCTURAL C Right N
Arch/Eng. License No. ,y K G
ip
Address ❑ TENANT ❑ ELECTRICAL NLUMBING Ell MECHANICAL ' g Left
��' El R
Contractor's NameG ...417:.4. SA-et♦. Phone 1019// I Ping. Ref.# Parking Req./Provided E
/ PROJECT DESCRIPTION SQ. FT. OCCUPANCY PlanningNotes: a
Address(mailing) 7/ ::,a i _700 M
J/�� CONSTRUCTION TYPE VALUATION$ T
City License No. 4,11C s�`'-� ZONE GRADING CU.YDS. ACRES I S.
LICENSED CONTRACTOR DECLARATION ��,Q } � ��J�j
hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: V `� 1--/1��-lf / lk-Ai.-•!_.Aracr !
r. with section 7000) of Division 3 of the Business and Professions code, and
G-� ELECTRICAL FEES
my license is in Lull force and effect.
Q" License Class • ens¢ N2
----. Date!j^1-147 Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
— WORKERS'COMPENSATION ECLARATIONBar Sink Showers Construction Pole Sub. 050+ KW
�.. I hereby affirm that I have a ertificate of consent to self-insure or a certificate
cis r' Workers' Compensation Insurance, or a certified copy therebf (SectionCooking Unit Meter Duo to 1 t a amps
Lab. C.) / / Backflow Preventer Service Sink
•
y No. company . Backflow Irrigation Sewer Cap _ Dishwasher " Meter ❑ov- 100 amps
Certified copy is hereby furnished. Dryers ❑Gas. ❑Electric Sub Pa-'I
ertified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date!-gyp / Applicant 9 t%_ T e Fan M• ors 00-1 HP 01X-8
EXEMPTION FROM WORKERS'C PENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred ($100)or Dishwasher • Solar Piping F.A.U.
less). Inc.Solar 09-15 HP ❑16-15+
I certify that in the performance of the work for which this permit is Issued I Fixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:It,after making this declaration, you should become subject to the - Outlets Range
Workers' Compensation provisions Of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY j Gas Service OutletsfroSwitches Sign
I hereby affirm that there is a construction lending agency for the performance Water Closet -•'----i9
of the work for which this permit Is Issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
-
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
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 Laundry Trays
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 ' 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 Reinspection Fee $15 Issue Fee $ 3
tr.-Orem and the basis for the alleged exemption. Any violation of Section
.5 by any applicant for a permit subjects the applicant to a civil
,ty of not more than five hundred dollars ($500). DEVELOPMENT SERVICES REQUIREMENTS:
I- i, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will do the work, and the structure is not intended or offered - r lit for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date 7 1 11p{=�®J"A%(j
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 Boiler Hood or Type ❑ Application Issued By Date -J
employees, provided that such improvements are not intended or offered foryP
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I,as owner of the property�am exclusively contracting with licensed con- Duct-Structural Refrigeratl System PLAN CHECK $ PERMIT
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 00-1 ,000 BTU 0100,000 BTU PLUMBING $ 9 • ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con-
tractor(s)
license pursuant to me Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 tem Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation Insurance should be provided to me, ELECTRICAL $ GRADING $
0 lam exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date _ Owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,0 T PLAN CHECK 25%
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 to enter upon the above-mentioned property for
Inspection purposes.
Signature Date
Drivers' License or SS$t Reinspection Fee $15 Issue Fee $ 3 'i- ' ' •7�P1a;:6 '.T _
_ .n. _ .... .•. T_id_: a.o
1 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL ' -PA
APPROVALS Permit# Date Inspector APPROVALS Perifl�t# 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 •
r .
4-Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Stee Reinforcement' '0 56. Rough Plumbing & Pressure Test .
6. Electrical UFERt.Grnd? ;, 57. APPROVAL TO COVER-GUNITE
7. Footings ' 58. Electrical Conduit-Undrgrnd.
8. Foundation • i moi N 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. ; •. 60. Backwash Lines,P-Trap, O Undrgrnd.
10. Structural Floor System ,r' 61. APPROVAL TO DECK
11. Property Sewer Line & House Chrinection 62. Backwash & Receptor-Final
12. SeWer Cap - -n 63. Heater & Vent-Final
13. Roof Drains " i) 4 I 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
X19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. RoughrFactory 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/Frameand Flashing - 76. Dry Standpipe
28. Lathiinn-& Siding 77. FIXED SYSTEM FINAL
f . .
29. Insulation 78. FIRE PREV. FINAL
( 30. Dry,'wall 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 (ft/:Q Ci
36. Hood or Canopy + •
37. Final Factory Fireplace •
38. Final Plumbing c(yq C112
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 CD - • -
51. CERTIFICATE OF OCCUPANCY _. •
•
No. Date
0589 8/01 /86 239. .. -r.
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - .
CITY OF COSTA ESA2 CO/Nn rS1TRU(CTION '(PERMIT PE T TRACT NO. LOT NO. UNIT N0. l • '
• Project Address '0 -/ 1J4/� k-te-,L•Q . ,1`f 78-3 3,i 61pppppp......(((((aIIIIII go '• I — - . .
TYPE OF CONSTRUCTION LJ NEW�ADD LJ ALTERATION LJ REPAIR r
Applicant's Mailing Address-r-� J . �'e� - ❑ CONVERSION El DEMOLISH OTHER '/)� •
Owner's Name 4J� r�'-t>`�� Phone��7S � DESCRIPTION OF WORK/USE OF BLDG. ''P'+��'a' �1'+• pP'Iti A.P.# �/-�'I acts- 2�__ Z°ri° Ig f
Address ' 50S Main Building:� • Accessory Building: '
Arch/Eng. License No. TYPE OF PERMIT LI GRADtt jING ❑ FOUNDATION STRUCTURAL T Front f l Pii.Q—o.( Z0
Address III 11:1 TENANT CI ELECTRICAL ❑ PLUMBING III MECHANICAL BTHERA Rear /2...-- N
Contractor's Namp Phone - -/
Address(mailing) PROJECT DESCRIPTION, SO. FT �/�}-� ocCU PANCV — C Right 25 /' /// N
i CONSTRUCTION TYPE —"!. .VALUATION$ {O ' S Left , /2 ( G
• City License NO. ZONE GRADING CU.YDS. ACRES - • R
LICENSED CON Nq y �/ Ping. Ref.# Parking Req./Provided •
E
I hereby affirm that I aDi lision 3 of th pBusine s and
ns code, nq Remarks:-AS U I 1 T p�. �a Q (as Planning Nines: e T
with section 7000) of Division 3 of the Business Professions code,and /�- 1 r—.. Ka
my license is in lull force and effect. _/ /t n��_ `. __- �L ell. S
License Class ' License No. • �Y1° vLc 1�hA?P.l� <%'+•�LL.�-•
Date signature -I FEES - '
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate . - ELECTRICAL' FEES
' Workers' Compensation Insurance, or a certified Copy thereof (Section L_
)0, Lab. C.) Backflow Preventer Service Sink Automatic •Washer Transformer 0 15-50 KW _ •
olicy No. Company Backflow Irri• gation Sewer Cap ❑ 50+'KW . • '
8 Certified copy is hereby furnished. Construction Pole Sub. ,
Certified copy is filed with the city Building Division: Bathtubs ' Sewer Connection Cooking Unit Meter Duo to 100 amps
Date ' Applicant - -
EXEMPTION FROM WORKERS'CO NSATION DECLARATION Clarifiers • Solar Collectors- Dishwasher , Meter Dover.100 amps
(This section need not be completed if • permit is o •ne .undred ($1.00)or - - - '
less). Dishwasher.- - 'Solar Piping pryers OGas ❑Electric -
�i' YSub Panel
I certify that in the performance oft •rk t° th s per, s issued,I
shall h emplo any person in an . ner s)� sec ,• ep •lec to the Drinking Fountains Solar Tank Fan ••
Work.. p 1 n Laws of Cal . .Motors 00-1 HP ❑1Y-8
Datep V Signatur- Is Asa t j .r - t .� A.� •
Floor Drains Swimming Pool w/Spa : F.A.U.
.NOTIC If,after making this.decla"t? n,you s • Id"beoom bject to the AInc.Solar ❑9-15 HP ❑16-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Y Fixtures 80
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY se
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.) InterceptorsWater Heater
Lender's Name S Outlets • Range /- CO
Lender's Address Kitchen Sink Water Service • 1-. Switches . Sign •-
OWNER BUILDER DECLARATION -
, I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash •
Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing 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 i •
the Contractor's License Law(Chapter 9(commencing with Section 7000) of ROOF Drains
' Division 3 of the Business and Professions Code) or that he/she is exempt - - . - -
^erefrom 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 - .
alty of not more than five hundred dollars($500). .
•
•
U��
as owner of the property - -- Reinspection Fee I $15 Issue Fee $ 3
f� will do the work,and the structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3
S*..
or-sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
1/4-,6/ License Law does not apply to an owner of a property who builds or improves
-
employees,
mploy, and does such work himself/herselfemsror nhis or her own DEVELOPMENT SERVE REIO REMENTS:
emplo ohoverprovidedt that such improvements are not intended or oftl for Boiler Hood or Type I 0
/ W/•may'/ 0-/-8e,
sale. If, however, the building or improvement is sold within one year com- Canopy Type II ❑ • • Zoning Approved By Date e_ a
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground • Building Approved By - A - Date_2•• L�s�
Lirove for the purpose of sale). 5.11./D 8�1
I, as'oWrier of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By '• Date D
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 ❑0-100,000 BTU ❑100,000 BTU
builds or improves thereon,and.who contracts for such projects with a con- 'SUMMARY,OF FEES , . / rAA
tractor(s) license pursuant to the Contractor's License Law). I am aware that - Exhaust System ❑ Multiple ❑ System Repair/Alteration - BUILDING PERMIT $ �' SMTP _ . $ I.YV
proof of their Worker's Compensati•- insurance shout' a provided to me. PLAN CHECK $'• / • PERMIT
0 1 am exempt under Section- Illk '.C. r reason Firepl/Fact.Bit. ICBG# Fire Dampers - ISSUANCE ' $
dr �_. /O r 9 .- - PLUMBING $.
Datk • own- ' iii_ r .•I /' v� . _ Heating System&Ducting Registers - - i ENERGY P.C. $ -
PLAN CHECK 25% $ •
I hereby certf tha I'hay read h m.-y with
state that the above 00-100,000 BTU 0100,000 BTL
ind in is erred. I .r- to com•.y with .11 city and county ordinances ELECTRICAL $ Do 'GRADING $ -
and state .ws •labor Up ping co•str i•n and hereby authorize repro- MICROFILM $
segtatives of t•is ci to ter p.n ••ov.-mentionetl Opel or PLAN CHECK -50% $ / -00
inspectio u es h �•� • �1 'q
r / MECHANICAL $ • ' TOTAL FEE $fV !.
• Signetyr•INIOA.• I I _r i
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; •ink -Accounting; Goldenrod - Assessor .
�.
•
1
CONSTRUCTION AND PLANNING r POOL&SPA
APPROVALS Permit# Date In•spector APPROVALS Permit# Date Inspector a
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 • S
6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE
a
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 Facto'ry 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 ❑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 J
41. Solar Domestic-Final
42. Backflovv Preventer ' -
43. Backflow Irrigation
44. Landscape Irrigation System •
45. Sound Attenuation -
46. Handicap Regulations /1 1
47. FINAL STRUCTURE & BUILDING 3/ / -st
$ .."(f;-"n
9% s> S n.[J/ L T
48. Special Requirements Completed
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�M(�E ((��C��ONN((STLLRUY,s+C+TIOR/�PERMIT�p��tRMIT�tO'z I TRACT NO. LOT NO. UNIT NO. A P # —, Zone
Project Address ,� V11QI1t7IQr1 WaY1Q Mesa - t r S Main Building: Accessory Building:
Project
Mails Ad ress 11 TYPE OF CONSTRUCTION 7,NEW IJ ADD H ALTERATION U REPAIR
ApplicLP�Q �t�rt Irk h ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front / O
Z
Owner's N e r,t t &I.. ar o Phone GGT6V re�'�0,� I B f+ N
�.�i n 'I,n7I�51�� po Pl+t„ - DESCRIPTION OF WORK/USE OF BLDG. A Rear I
Address tl "� IA/C I l I'tf' El
TYPE OF PERMIT ❑ GRADING LJ FOUNDATION STRUCTURAL C Right N
Arch/Eng. License No. ,ZSTRUCTURAL G+
Address f '• ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL l�r. $ i LeftR
IIII'' A [ ❑ OTHER Ping. Ref.# Parking Req./Provided E
Contractor's Name �� . �W' '��C •ne �D3 +11�% -10x7
q f I e IP
PROJECT DESCRIPTION SQ. FT. 2.7 0.1� OCCUPANCY Thi i PlanningNotes: a
ddrescens(mailing) B W �' I G;` 2 { M
�,. yy�p CONSTRUCTION TYPE VALUATION$ - 310T
City License No.L� (_'( o eosrQ ii. ZONE GRADING CU.YDS. ACRES S,
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks: to $ h ) MA 'n DKI p1(lp (Net- ,Qfff___•�t I
with section 7000) of Division 3 of the Business and Professions Code, and `•l
my license is in full f• c • effect. //.s�s 1/1//s��/y �� A ELECTRICAL FEES
Liven-� Cl. I . _ _ � 1 a I . • 06624 IW 1\mom 3905
i Automatic Washer Transformer 0 15-50 KW
Date (���� Signature i.t�IlAn�i PL MBING FEES
WORKERS'COMPENSATION DECLA-{T •N 40 Construction Pole Sub. 0 50+KW
I hereby affirm that I have a certificate o consent to -insure or a certificate Bar Sink Construction .
Workers' Compensation^Insurance, or a certified Op ther of (S ction Backflow Preventer Service Sink Cooking Unit Meter Duo to 100 amps
.0, Lab. Cola G O�O� S y company 711AT�- YIA Backflow Irrigation Sewer CapDishwasher Meter Dover 100 amps
Policy No, p y g �_
BCert"fietl_cRpXi�hereby furnished. ' /� Dryers ❑Gas ❑Electric Sub Panel
Cerf/ilie¢1(B;Ji lsffiled with the city Building • e.•. P v. Bathtubs Sewer Connection
Date V//d'I✓✓((�•�7 Applicant • pi 1 `,' Fan Motors 00-1 HP 01%-B
EXEMPTION FROM WORKERS'COMPENSATI!N DECLAiD' ION Clarifiers Solar Collectors —
(This section need not be completed if the permit s for one h, •red ($100) or Dishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP 01615+less). _
ues
I certify that in the performance of the work for which this permit is issued, I Fixtr
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California. Device Boxes
Date Signature Floor Drains Swimming Pool w/Spa Pole Light
NOTICE: If,after making this declaration, you should become subject to the e
Outlets Ran
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal g
I comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign
1 hereby affirm that there is a construction lending agency for the performance - '
1 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
`' _
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
followinguntwhich e (Section to5 Business nstru and, Professional Code: Any city or
county r ctuprior requires
a permitissuance,
c ,construct,alter,improve, such
or repairmiP-Trap Laundry Trays
any era gre, p rtar m its thhe/, also requiresicestheesuanto for rovi permit
toh file a signedtstatement that hapte Is licensed pursuant to the provisions of Roof Drains
the contractor's ei Busi Law (Chapter 9s onCode)(commencing with Section 7is x)of
Division 3 of the basis sis fo and Preged ext Codon or that he/she exempt Reinspection Fee ! $15 Issue Fee $ 3
`2.i1(a1.5om ann the cfor the alleged txsmjects ey pinofa Section
,-*. .6 by any applicant for a permit subjects the applicant to a civil
,fatty of not more than five hundred dollars ($500). 3 DEVELOPMENT SERVICES REQUIREMENTS:
:.:.r.❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ Zoning Approved By Date
compensation, will do the work,and the structure is not intended or offered -
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date
License 14w does not apply to an owner of a property who builds or improvescA
thereon, a,id who does such work himself/herself or through his or her own Boiler Hood or Type0 Application Issued By T Date__ )
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- Canopy Type II 0 SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground ^^1v
prove for4he purpose of sale). BUILDING PERMIT $ 1°3c/u SMTP $ l.�
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
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 BTUPLUMBING $ ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof o// their Worker's Compensation insurance should be provided to me. $ GRADING $
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLAN ELECTRICALCAK 50% $ MICROFILM $
Date Owner Heating System& Ducting Registers MECHANICAL $ 43 T 0
I hereby certify that I have read this application and state that the above 0o-100,000 BTU 0100,000 BTL TOTAL FEE $
information is correct. I aur:- to comply with all city and county ordinances PLAN CHECK 25% $
and state laws relating o iding construction, and hereby authorize repre-
sentatives of this city t• :r upon the above-mentioned rope ty fei•
inspection purposes.
Signature j''-,
1 DATE: 07/07/89 Tlrp• .2.19
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
... .l t, •I - r--
CONSTRUCTION AND PLANNING POOWA
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 Electrical Conduit-Undrgrnd. I 55. Electrical Bonding
5, Steel Reinforcement T' 56. Rough Plumbing & Pressure Test
6.-Electrical UFEB Grnd. 57. APPROVAL TO COVER-GUNITE .
7.' Footings _ - 58. Electrical Conduit-Undrgrnd. •
8:tFoundation _ 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 � !(i • •_ •
63. Heater & Vent-Final
13.,Roof Drains • -- 64. Plumbing System - Final
14. RoughPlumbirfg, 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 i• 72. Underground Flush
24. Roof Framing , - •r , a 73. Undergrnd.Storage Tank 0 Gas 0 Oil
`.25. Roof Sheathingr 74. Overhead Hydro
_•
26. T-Bai Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frage 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' r-' 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 _
1
44. Landscape Irrigation System •
•- V
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING / �jd Ct
48. Special Requirements Completed / <
49. Electric Release to Edison fff L-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date - "
•
COSTA MESA BUILDING DEPARTMENT ' EE RECEIVED
t
i
AEU P0. BOX 317 / I 82498249COSTA MESA CALIFORNIA 12 195a "
--- -FM IE I it FOR APPLICANT TO IN
C.L. OF STREET'S c (FioQ$/ FAt�=--==— ,�/ yJ' '
4v At4. BUILDING ADD: SS Cie-A-; r v /�� v l
PROP LINE \ CITY ,); � ; Owner is' 4 /
��- = - - - k�a
r 10 FT. FOR 60 FT. STREET 12 FT. 61N. FSR PL%::;:sl. ' pt��yl: " Mail A••�es ----� -/-_ . 47
50 FT STREET i F i i0 etc DE�iT REQ, I /
*i I ity /.y. - I4 11S Ph. o.
Bract siga.,4
_,AN TECn. dA ontracto�� �iv� Ph. N. c
- -- ---,-----. _
�� -Ar-till'ddres - 2 .
50 liFRONT/.3 State Lic. No. 7 7 -7:..11.„
r
50 FTA Ww IX Size of Loi 6 � k'1/ P No.Ani- d
y" S ?)
WI \ N Setbacks: C/L Street Rear ��—
m
us -I ¢ a Side Yard - Right �/ Left `' -�//
I- r ___a. v Type of Fence 1 2- ` / � -,7
LL W'V'C ALLEY OR PROP. LINEN CI CS
0. 614
11.17 ••`. iV I hereby acknowledge that I have read this application and state
Ord-
ti rc a= 3 y . t I that the above is correct and agree to comply with all City Ord-
i ct N' W \ .c finances and State La , regu • 'fiat buildin construction.
`ti �' I Signature .
,i ""moi -/ 10 I of Permittee - �.-�..�L
}, o FT
Agent
37 61N.
FOR OFFICE USE ONLY
FT w N i 1 40
II
J �S` i FT , JPermi82t No.49
�
d
K _ 60 FT ST. Recei d by Date Received
_ Date Issued
I50 F T. S T. i . t I I /02 -/2 -i5 /� - 42-S-5
PROP LINE -- - t'' VALUATION
C
—-��— — 0 // PermitFee $o
$ //02' 17-C7Plan Check $ OA/e
C.L. OF STREETS J - TOTAL FEE $
MAXIMUM 4 Ft FENCE MAY BE PLACED ON DOTTED LINES -- - ---
MAXIMUM 6 FT FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS
OWNER STUART, J. DATE 12-12-58
JOB ADDRESS 203 Wellesley Drive BUILDING PERMIT NO. 8250
GENERAL CONTRACTOR Fencemasters, Inc. VALUE $ 168.00
AP. No. LO-15 TRACT 3187FIRE ZONE DESCRIPTION OF WORK Redwood fence
GROUP TYPE ZONE PLAN NO. 8250
IN_. ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod _
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat //Tr
Underground soil WIG Pipe Test (/
Top Out
Furnace 'Car ! � ��
Gas Vents rot
Rough Plumbing _ / /
Cesspool Septic Tank
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating Final
Pb:,.;;,,,ting Fixtures, Final
Test
Coti's[ruction Pole
Underground Power
Rough Wiring
Fixtures, Final
OCCUPANCY
Form 210-5M-1-57 8250
OWNER COLLEGE PARK NO. 4 DATE 9-26-57 _
JOB ADDRESS 203 Wellesley Lane BUILDING PERMIT NO. #5770
GENERAL CONTRACTOR Harbor Construction VALUE $ 11,200.00 _
AP. No. LOT 36 TRACT 3187 FIRE ZONE DESCRIPTION OF WORK Res. Watt: gar.
Gpr1UP T_ & J TYPE V ZONE R1 PLAN NO. 5751
Ik_c'ECTIONS . DATE SUBCONTRACTOR PERMITS ISSUED
I DATE NUMBER
TrenchesPorms Steel Q54 /P//an
Floor System
1 Steel Reinforce Chimney Re-Rod
Bond Beam
_ Frame and Flashing• ,fY R>& /X•-/Jr `t.r
Lathing, In Out 8-4---6" -/.2 'g/-d•J
Plaster, brown cy,Rt p y a.--64" )- -Sit
Underground soil�W,-.LSW/G Pipe Testi.-S- /0-/6-62
Top Out
Furnace 44/1$ /2.-/G S7 hz.t e . , /0-g/-r_7 7]4'3A- A'''...--
Gas
Gas Vents 9
Rough Plumbing £no • /n - -2-)3 i /1/ 9 9 s.----
Cesspool
Cesspool Septic Tank /
Prop. Swr. Lin �L�iouse Coq.,�fJ•f�St.�Swf.S )/.)_,f/ ai/O-�y-^�' //7A� // • r
Sprinkling System
Heating Final 4i*'-S V-//1-' ) 75
P.,tt rtiing Fixtures, Final /N H-S v-ii-Ck•
t-':?tas Test /S /Y as u--ii-ST
Construction Pole
Underground Power •
./ 4 'I �^/f'/�J
Rough Wiring pr JZ--/$'_ P /.�i-wart_- }reit 1,..1-9-S7 .S-. y-9- V VIJI �Yl�
Fixtures, Final )
-OCCUPANCY ��j r-o / }�
Form 210-5M-1-57 I
A.
A.: FEE RECEIVED
.1 ..i.: 5751 •
SEP 1 3 1957
COSTA MESA BUILDING DEPARTMENT FINANCE DEPT.
P.O. BOX 317 CITY OF COSTA MESA
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING BUILDING
ADDRESS 203 WELLESLEY LANE
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO.
OWNER COLI FGE PARK No . 11 5770
MAIL / c RECEIVED BY DATE RECEIVED DATE ISSUED
A_D_DRESS 2 116 SO. MAIN ST. �.-�/ a
I -, -� ) SEP 2 6 1957
TEL. BUILDING
CITY SANTA AMA . CALIF. NO.K I 55577 ADDRESS
ORCHI LICZINE
OR JNEER NO. COSTA MESA. CALIFORNIA
FIRE
ADDRESS ZONE
IIS/ Y LIC. L62-5-
[_- ZONE NNO.OF TYPE GROUP
LANS
CONTRACTOR {^'1✓ itt NO. a627 �� 1/ �v
TEL. APPROVE ttt
ADDRESS NO. BY DATE
LEGAL LOTCORRECTIONS
DESCRIPTION NO. 36 BLOCK TRACT 3 187
A.P. NO.
SIZE NO.OF BLOCS.
OF LOT PUN 67 ;( I I Dj NOW ON LOT
USE OF . r
EXISTING BLDG. C
SETBACK LINE FROM
CENTER OF STREET REAR YARD 28 -
SIDE YARD RIGHT 5 LEFT 12
DESCRIPTION OF WORK
NE X ALTERATION ADDITION
REPAIR MOVING I DEMOLISH II
BUILDING NO.OF
SIZE 1379 ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF C
BUILDINGEW Ars IDENCE & BeTATACHED
GARAGE
I HEREBY 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
SIGNATUR OF COLLEGE PARK No . 4PERMIT FEE $ ���
PERMIT7.CE n
/7
t ��/ y S 1 I X200. PLAN CHECK $ �
AUT •- NT / / TOTAL FEES L ,,SA II'