HomeMy WebLinkAbout209 WELLESLEY LN - Building Permits •
CITY OF COSTA MESA
o5Q� BUILDING DIVISION
fr
)••- .t�", 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.00v
4 FOR INSPECTIONS CALL:(714)754-5626
PERMIT NUMBER: B11-00439
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 14139530 DATE ISSUED: 12/15/2011
ISSUED BY: MDM
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JOB ADDRESS: 209 WELLESLEY LN CM Suite/Unit:
Vicinity:
Squares: 2400 Valuation: $6,500.00
SCOPE OF WORK: 2,400 SQ FT RE-ROOF,TEAR OFF EXISTING ROOF,APPLY GAF TIMBERLINE COMP SHINGLES, INSTALL 1
LAYER 3OLB FELT, PITCH 4:12
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/lnspection Card
OWNER: GURAN JENNIFER/KOLLAR WESLEY Address: 209 WELLESLEY LN Unit:
PHONE: 714-240-2318 City/State/Zip: COSTA MESA,CA
-0 0439
APPLICANT: TERRY LIVINGSTONE Address: : Unit:
PHONE: 949-355-4749 City/State/Zip:
CONTRACTOR: NEWPORT ROOFING INC License No. 524454 •
Address: 177 RIVERSIDE AVUnit: PHONE: 949-645-0104
City/State/Zip: NEWPORT BEACH,CA 92663 CELL:
ARCHITECT: License No. PHONE:
r
ENGINEER: License No. PHONE:
FEE SUMMARY 7'
NS i Au_
Reroof Plan Check: $0.00 •.:;dr,:;Sc'
Reroof Permit Fee: $139.25
Reinspection Fee: $0.00 : o" Card
Bldg Std Admin Fund - $1.00
TOTAL FEES $140.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279 i,ut:
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day, Memorial Day,Independence Day, Labor Day,Thanksgiving Day and Christmas Day
•
: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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
: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.
CODE A. INSPECTION TYPE DATE Knits CODE INSPECTION TYPE DATE''.. . • INTIIIALS
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'.1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing ,,,I - `•
)200 Final Re-Roof 1 a o -I 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 _1
:204 Final Demolition 250 Final Building/Occupancy . :in()F.%.'r.,:holidays
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain workers'compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy I hereby certify that no excavation five(5)or more feet in depth into which a
number are: I person is required to descend,will be made in connection with work authorized
/"� L by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier: rr G «C �✓1 or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed if the permit is valued at one hundred dollars($100)or less)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should•
become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date
the Labor Code, I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds. or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant Qeed to file
my license is in fullat(
force and effect. 9 a registration form for acutely hazardous materials? 0 Yes 17. No
LicClass# L-' 3 (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
�Z//f��� each business which at any one time has on hand a quantity of acutely
nature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lenders Name: hazardous materials)? 0 Yes No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ttl No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ' No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes f,No
applicant for a permit subjects the applicant to a civil penalty of not more than (If-yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes Ell No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.).. information given ab is correct. I agree to comply with all state laws and
city ordinance in Hazardous Materials and Emissio
I:3 I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project(Sec. 7044,Business and /2 /Jf
/l(
Professions Code: The contractors License Law does not apply to an owner of sgnature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
1:3 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
Signamr Ovmer(s) Date
Signature Date /27<IA
306746(3107)
And10 Authorized Applicant Date
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Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations (Page 1 of 5)
. Project Ni b
Climate Zone N� I q of Stories
General information
Site Address:Ze/ We lies Icy LA Enforcement Agency: I Date: / 27/3-7;(
Building Type I�Single Family 0 Multi Family Circle the Front Orientation: N,E,S,AN,or degrees
606Project Type: 0 Alterations 0 Envelope D Fenestration Yptoof 0 HVAC
Conditioned Floor Area(CPA): 1
/ Replacement or Change Out 0 Duct Replacement 0 Water Heater
NOTE: This torn,is not in be used for Newly Constructed Buildings or Add il0IIS •
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- Insulation Values For Opaque Surfaces(for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
0 Opening of framed cavity alone-Alterations that involve the opening of the framed cavity o f a wall,ceiling, or_floor must install the
mandatory minimum insulation value per,¢150,for the altered assembly.Fill in Columns A-C and enter mandatory insulation value in Column H.
.0 Replacement of entire assembly-Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C. Fill in Columns A-J. .
Opaque Surface Details For the tuned portioned of Mass Walls see Furring Strips Construction Table below.
-A B C - D • i E • l • F C H I I - B- .J
Proposed S"n°t` Standard Values From JA4 Table
Framing Thickness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- .1A4 Table Cavity Insulation Assembly Assembly
ID' or Type' and Size2 Cr Other3 factor° Numbers R-value - R-Value Cell Values U-factor9
.
.
.Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
;Furring Construction table below.
1.For Tag/1D indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls,Floors,Slabs, Crawl Space,Doors and etc...Indicate the Frame type and Size:For
Wood, Metal, Metal Buildings,Mass, enter 2x4, 2x6, or etc...see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16"or 241"0C,-or Other.for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Sour Bale Panel and etc....
4.Based on the Climate Zone;enter the Standard U.factorfr'om Table 151-B, Car D for each different assembly Name ar type.
5.Enter the Table number that closely resembles the proposed assembly.
6. Enter the 17-value that is being installed in the wall cavity or between the r ming;otherwise, enter "0".
7. Enter the Continuous Insulation R-value for the proposed assembly; otherwise, enter "0".
A.Enter the row and column of the U-factor value based on Column F Table Number and enter the Assembly U-factor in Column J
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9.The Proposed Assembly(Hagar, Column.1, must be equal to or less than the Standard U-factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Only
A Is C D j E F C H • 1 1 J IC L M
Proposed Properties of Masonry and Concrete Added interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
Joint Appendix Table 4.3.5,4.3.6,4.3.7 Joint Appendix'Table 4.3.13
V C.
m 1 r- U
v. ,4 , ', _ G. r is:
'1
o g 6- v _ Final
Assembly 2-., D `c '.- a F o pc" ,�+a
m b _
Mass Name a' JA4 Table - u = E R u .e A c o - - Assembly
Type' < m -. L C 'Jr'? o c ry 4.9
Thickness Number' c = w c w _ e. c. r to U-facto Comment
f f 1 I 1 1
Regi•stratimm A4unher: Registration Date/Time: HERS Provider:
20(16'Residential Compliance Forms August 2009
Prescriptive Certificate of Compliance: Residential CF-1R-ALT
Residential Alterations (Page 3 of 5)
Project Name: I Climate'Lnne# #of Stories
ROOFING PRODUCTS (COOL ROOFS)§151(1)12
When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,0001 fit, whichever is
_less,the new roofing area ants!meet the roofing product"Cool Roof'requirements of§1520)1111,152(b)1H1i,or 152(b)111ii1.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof'requirements.Note:If any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Ernittance requirements for roofing products in
§118(i)are not applicable.Do not fill table below.
0 Cool Roofs Not Required in Climate Zones I-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
Wool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
ham 51b/ft2.
Alternatives to§152(b)IHi and §152(b)Hii,Steep-slope roof(pitch>2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr1t2•°F/Btu or atleast a 3/4 inch air-space is added to the roof deck
over an attic;or
❑ Existing ducts in the attic are insulated and sealed according to§151(f)10;or
❑ In climate zones 10,12 and 13,with 1 f12 of free ventilation area of attic ventilation for every 150 ftof attic floor area,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
❑ Building has at least R-30 ceiling insulation;or
❑ Building has radiant barrier in the attic meeting the requirements of§151(02;or
❑ Building has no ducts in the attic;or
❑ In climate zones 10,11,13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)111iii,Low-slope roof(pitch 5.2:12)
❑ Budding has no ducts in the attic.
Other Exceptions
0 Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
,0 Roof constructions that have thermal mass over the roof membrane with at least 25 lb/f12 is exempt from the below Cool Roof criteria.
Note: If no CRRC-I label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise,
Check the applicable box below if Exempt from the Roofin Products"Cool Rnof"Requirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Numhert << 2:12 >2:12 < 51b/ft2 >_ 51b/ft2 Type Reflectance'4 Emittance SRIs
-
❑ ❑ 0 0 04
r ,
❑ ❑ ❑ ❑ ❑4
❑ 0 0 0 04 '
❑ 0 0 0 ❑4
❑ ❑ ❑ ❑ ❑4
I. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolraofs.org/aroducts/search.nhn
2. Indicate the type of product is being used for the roof lop,i.e.single-ply roof asphalt roof metal roof etc.
I. If the Aged Reflectance is not available in.the Coal Roof Rating Council's Rated Product Directory then use the Initial Reflectance value front the same
directory and use the equation(0.2+0.7(pi,rtrtat—0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance,
4. Check box if the Aged Reflectance is n calculated value using the equation above.
' 5. Calculate the SRI value by using the SRI-Worksheet at httn://wwrr.energy.ca.gov/title24/and enter the resulting value in the SRI Column above and attach acopy of
the SRI- Worksheet to the CR-114.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in§1180)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other
Registration Number: Registration Date/Time: tIERS Provider:
2008 Residential Compliance Forms • August 2009
Prescriptive Certificate of Compliancc: Residential CF-11:-ALT
ResidentialAlrerrttiun,c (Page 5 of 5)
Project ]Name; Climate'Lone Y, 1 V of Stories
• HERS VERDI CAT]ON SUMMARY The enforcement agency should par special attention to the HERS Measures specified in this
chec/rhri belom. A completed and signed CF'-4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for this measure.
❑ YES 0 NO YES.In Climate Zones 2 and 9-16,if'more than 40 linear feet of new or replacement ducts are installer) in unconditioned
space,the ducts are to be sealed per(1 I52(b)IDin and the newly installed ducts ale to be insulated per 11151(e 1 0.
❑ EXCEPTION:Existing duct systems that are extended, which are constructed, insulated or scaled with asbestos.
❑ YES 0 NO YES:In Climate Zones 2 and 9-36,if the existing space-conditioning system(1-VAC equipment and ducting) is replaced,the
ducts are to be sealed per§152(6)1 Di.
❑YES 0 NO YES:In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced(including the replacement of the air handle),
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)IE.
❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
' .. ' ' 0 EXCEPTION:Duct systems with less than 401inear feet in unconditioned space.- . .._, . .. .
_ ❑ EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos.
Refrigerant Charge - Split System HERS verification is required.for this measure
❑YES 0 NO YES:In Climate Zones 2 and 5-15,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil, or the furnace heat
exchanger)a refrigerant charge measurement shall be verified per§152(b)1F. •
•
Central Fan Integrated (CFI)'Ventilation System and Fan Watt Draw
The ventilation requirements of§150(o)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
- 0 YES ❑NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced:the airflow and fan watt draw shall be verified per§+152(6)]Ci to meet the requirements of§151(f)7B.
1 Documentation Author's Declaration Statement
• I certify that this Certificate of Compliance documentation is accurate and complete.
Name:‘,..--r,
Signator'r/ G<c/rvy.j� tf -
Company: tDate:
/VC C 141 Zi ?f „I.---4, C • / 2//f/
Address: if Applicable 0 CEA or 0 CEPE
1 7 '7 —
/ (fefsf� �t.e_ (Certification ll):
City/State/Zip: Phone:
it,/ /f ege4c4 r4 f266,, ne-6rr_Of zt .
Responsible luildin(,Designer's Declaration Statement
• 1 am eligible under Division 3 oldie California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• 1 certify that the energy lenture);and performance opeci bealion::for the building design identified on this Getifleote of Compliance conform
to the requirements of Title 24,]'tats I and 6 of the California Code of Regulations.
• The building design features identified on this.Certificate of Compliance are consistent with the information provided to document this
building design on the other applicable compliance forms,worksheets,ca leolations,plan::and specifications.sobmitteri to the en'fureeinent
agency for approval with this huildine permit app!anti on.
Name: Signature:
Company: Date:
Address: License:
City/State/Zip: I Phone:
Tor assistance or questions regarding the Energy Standards, contact the Lnragr Fl otlinc at:7-8011-772-3311(1.
e,,,,,, ,,,,,;„„ n„p.,n;,,,,.. t.mrfe r„.,,,,,',t,,,..
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PER N TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA�tMESA CONSTRUCTION PERMIT �/ A.P.# I Zone
' ProeetAddress aoa Went-slay 4'e'• Rzbz(, 7s- �j
I S Main Building: Accessory Building:
' Applicant's Mailing Address •I TYPE OF CONSTRUCTION LI NEW ❑ ADD Li ALTERATION U REPAIR E Z
SAM R AM CTIA 54o 66641 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front 0
Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. I B Rear N
Address Z.04 W ell Es Li L.4Ne. ..14, q t{.ye A I
Arch/Eng. !( License No. TYPE OF PERMIT U GRADING Li FOUNDATION LI STRUCTURAL I C Right G
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL s Left R
/'� ❑ OTHER Ping. Ref.# ParkingRe E
Contractor's Name V ` Phone PROJECT DESCRIPTION SQ. FT. OCCUPANCY ! Req./Provided Q
Address(mailing) Planning Notes: M
CONSTRUCTION TYPE VALUATION$ T
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION _ S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: •
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full force and effect. ELECTRICAL FEES
License Class License No.
Date Signature
PLUMBING FEES Automatic Washer Transformer 0 15.50 KW
WORKERS' COMPENSATION DECLARATION bar Sink Showers Construction Pole Sub. 0 50+ KW
I hereby affirm that I have a certificate of consent to self-insure or a certificate -
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
0, Lab. C.) -
,cy No. Company Backf low Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
Hpy Certified cois hereby furnished. -
❑ Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Dryers ❑Gas ❑Electric — Sub Panel
Date Applicant_ Fan
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Motors 001 HP ❑1'h-B
(This section need not be completed if the permit is for one hundred($100)or F.A.U. Inc.Solar 09-15 HP 016-15+
less). Dishwasher Solar Piping .
I certify that in the performance Of the for this per t is issued, I Fi%t Fixtures shall not employ any person in any ma�r so •• •eco bject to the Drinking Fountains Solar Tank • Microwave
Worker Cpp enya�ygq Laws of Califerni . – '
Date , /t7`1 Signature - - Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:11 f,after making this declar, 10 ,you shOUld become 5 bject to the
Workers' Compensation provisions of the Labor Code, you m st forthwith Floor Sinks Urinal Outlets Range
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCYWater Closet Switches Sign
Gas Service Outlets 9
1 hereby affirm that therewhiIs a permit lending agency for the performance _
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 - - 4
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 r-s�R`/-„ O Reinspection Fee
therefrom and the basis for the alleged exemption. Any violation of Section I GPts L11s e.l D 1 ejo j1 p $15 lune Fee $ 3
l.5 by any applicant for a permit subjects the applicant to a civil V
Ity of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
1, as owner of the property or .�•�i•cowas-- %� 'e ^e-"" Reinspection Fee I $15 Issue Fee $ 3
Zoning Approved By Date
i'raa+paweeE ., .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 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 ' Application Issued By Dat
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ 'Jr'
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground S ARV OF FEES
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System
tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ T PERMIT
The Contractor's License Law oes not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING $ S.00 ISSUANCE $
builds or improves thereon.and who contracts for such orolects with a con-
tractors) license pursuant to the Con a-or's ense Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensati.n it sura ce houid be provided to me. - GRADING $
0 I am exempt under section - B. . P.C.for his reason Firepl/Fact.Blt. ICAO# Fire Dampers ELECTRICAL $
W- , PLAN CHECK 50% $ MICROFILM $
Date "7"a�1 HeatingSystem& DuctingRegisters S.Owne��� y g MECHANICAL $ S.
I hereby certify that I agree-..+ this application and state that the above -❑0-100,000 BTU 0100,000 BTL TOTAL FEE $
information is correct. I agree to comply with all city and county ordinances - PLAN CHECK 25% $
and state law dial'•• to building construction, and hereby authorize repre-
sentatives of is 'ty to en er i pon the above-mentioned property for
Inspection pu ••ses.Signatu - !..... it:,.._ -.�.� Date.2-7•2".22"-ten
Reins action Fee $15 Issue Fee $ 3 Of OOD2687d-0002d875 TOT 5.ui
Drivers icense or SS �� ��� p
DATE: 02/23/89 ?InE: 09:.2
0865-46,rev.5/88 White - Building: Canary -Applicant: Pink -Accounting; Goldenrod -Assessor
• 9 -F 7
CONSTRUCTION AND PLANNING POOL"
;4tPPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole !' 52. Pool & Equipment Location -- -- ✓
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement•
t >
3.,Electrical Conduit Utility-Undrgrnd. .t• 54. Forms
4':•Electrical Conduit:Undrgrnd. 55. Electrical Bonding
6: Steel.Reinforcement 56. Rough Plumbing & Pressure Test - y,•'
(%- Elecfricpl UFER-Grnd. 57. APPROVAL TO COVER-GUNITE ,� J
7.- Fort(' Ings' --�.. 58. Electrical Conduit-Undrgrnd.
Foundation 59. Gas Pipe, 0 Undrgrnd!, Test
t,
9. Water Pipe-Undrgrnd. 74. 60. Backwash Lines, P-Trap, 0 Undrgrnd. •-' -•
10;-Structural Floor System - 61. APPROVAL TO DECK !�_ •
11 Property Sewer Line & House Connection t 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13t+Roof.Diains 64. Plumbing System - Final
14::Rough"Elumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
H7. Rough Wiring Sign 68. APPROVED FORPLASTERING
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 D;Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing - 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing 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 3/23/119 ceo
36. Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing 3/2.S/YI (,0
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final ,
42. Backflow Preventer : , I
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 •0
OWNER COLLEGE 'PARK NO. II DATE 9-26-57 _
JOB ADDRESS - 209 Wellesley Lane BUILDING PERMIT NO. ' #5769
( ERAL CONTRACTOR Harbor Construction VALUE $ 12)400.00
AP. No. LOT 35 TRACT3187 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar.
_GROUP I & J TYPE V ZONE R1 PLAN NO. 5750
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel Like- _/0j/6/S7 ,
Floor System
Steel Reinforce Chimney Re-Rod _
Bond Beam
Frame and Flashing A.-5- _-JA-All •-.1 7
Lathing, In Out 85-&-e- g/-,$'7
Plaster, brown coyt ,, ,A e•/ /f I-Si-3'P •
Underground soil'sic g W/G Pipe T GSI/U-/S-S7
Top Out -
Furnace 1 M H-S_/>_yb 37 , /�.s xsce eng - /o-3/-57 //9,57 ✓ .
Gas Vents 1
Rough Plumbing 40.MA,. e,.ri-Q-,c,r • . 9-x(0-57 /// S7 ✓
C€roul. Septic Tank
F r&Swr. Linee4House CoWPii ST.�w,r. //- 7-S/ ,(Y rfA%LL m 2f-s7 L/ 7.27 r
S $kling System
Heating Final /t7//-S '//o-(-,P , f
Plumbing Fixtures, Final /14;9-5 S /1'/H -byid 5"Y Nn
Final Gas Test / S -ib-se
Ii.
Construction Pole _
Underground Power i 1Rough Wiring I Jy
/b- /91.r 4,.-,-.., . ATP-4 . /2-9-5-7 ST*
,
Fixtures, Final _ 7y`5
OCCUPANCY .t._Rt._
Form 210-5M-1-57
r"
5750 FEE RECEIVED
SEP 1 3 1957
COSTA MESA BUILDING DEPARTMENT FINANCE DEPT.
P.O.BOX 317
COSTA MESA. CALIFORNIA CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDI
ADDRESS 209 VIFLLESLEY LANE BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY V
�M .
RECEIPT NO. PV n V
OWNER COLLEGE PARK No. LL �
MAIL RECEIVED BY DATE RECEIVED DATE ISSUED
ADDRESS 21 I6 So . MAI N ST. ,,--1.-.T-,-77-"7->.„7--,S 7 SEP 2 6 1997
TEL. BUILDING
55577
CITY SANTA ANA . CALIF . No.KIADDRESS
ARCHITECT LIC.
OR En—'NEER NO. 'COSTA MESA, CALIFORNIA
FIRE
ADORcos UI
/j 7 31C ZONE
///, /y/y_y/ A{/ �'ITY LIG. / ZONESI PLNO
ANS TYPE / GRO
CONTRACTOR,1Y"" L��^.qi[� NO., v
TEL. APPROVED
ADDRESS _ NO. BY DATE
LEGAL
LOT
C z p DESCRIPTION NO. 3 / _ BLOCK TRACT'] 187 CORRECTIONS
A.P.NO.
SIZE / NO.OF BLOCS.
OF LOT 60 x I I C) NOW ON LOT ///---''
USE OF
EXISTING BLDG. '7fL
SETBACK LINE FROM
CENTER OF STREET Sd REAR YARD 311
SIOE YARD RIGHT 9 LEFT 5
DESCRIPTION OF' WORK
NEW X ALTERATION ADDITION
REPAIh MOVING DEMOLISH
BUILDINGI 2LL NO.OF
S ROOMS STORIES
EXTERIOR WALL ROOF
COVERING _COVERING I
USE OF
BUILDING RESIDENCE & ATTACHED
GARAGE I
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
SIGNATURE OF/� PERMIT FEE S 3 Q
PERM ITT l+nLl FG E_ RARK Nn
't PLAN CHECK $ A3
// S 12,)400.
AUTHO-Z•.G NT ' TOTAL FEE S VL( — vs.:
OWNER JOHNSON, Marlin C. DATE 6-11-62
JOB ADDRESS 209 Wellesley Dr. BUILDING PERMIT NO. 17202
( ORAL CONTRACTOR Airflo Alum. Awining Co. VALUE $ 3111:00
Aa No. 1111-395-30 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Alum.Patiopr
INSPECTIONS Signature DATE GROUP J TYPE IV ZONE R-1
Soil I PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. 0 St.Swr. 0
Sprinkling System
Construction Pole
Underground 0 Power 5
Rough Wiring •
Trenches 0 Forms 0 Steel Reinf. ❑ a, / -0-7
Floor System
Bond Beam 0 Steel Reinforce 0
Shegathing
V,?`;:'. and Flashing
Lria'ng— In 0 Out 0
Plaster, brown coat
e rip 0 Arnim
Heating, Final _
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final 4-n "t .-09
OCCUPANCY
FORM BU4•5M - 7.61 17202
11202 EEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT �' JUN 419$2
P. O. BOX S17 COSTA MESA. CALIFORNIA ' FINANCE�FFDEPT.
For Applicant to Fill In Completely APPLICATION F-OrRTPER`TvIIYOSTA MESA
TYPE-1COR PRINT BUILDING
ADDRESS BUILDING �b 7 �LA_f...5 14 y0 ft-
..nrT.^. COSTA MESA. CALIFORNIA�{v� For Office Use Only �(.Q�
OWNER / , cS%L'SA C I J Y't/Jj G al I RBCEI T NO. I PIRA1 X112
MAIL N _ ei / G SLJ_CY f1f , REc4 BY ( &— RECEIVED DATE I— -(t
ADDRESS ,-CI �p ( Y l/ q I R ITka '7/ 4:--
CITY CC 5'T0-1 ni ESA NO)KI'S4e31 ADDRESS / WFf-E.OSL.F y pR I
ARCHITECT / Vy'��� TEL
OR's;^INEER�•FI 43—OW�D� No. 0}� COSTA MESA. CALIFORNIA ,
ADIIS6 L-INGDinI Aol. . ,SA/hp 41u; FIRE
A /� ` ZONE TYPE GROUP !q '
CONTRACTOR / ( f LO ALUM. AWN/AG CO APPROVED O/� TE / ./
ADDRESS I '30 / A. e-Rf.N5NAid t3t✓D ZONING
CITY YYN 11
GARP FN A xoNin .
._/I NO.NBOP .2-� BUILDmI U66 OF O1.NEW en En 0
uC Clint*.
STATE (� TEL. I,
LIC.NO. -{ ` 0 y S " NO.( A' I N 6// LEDAL �}-� 31 R 7 ;, 0 7 3s
DESCRIPTION 41S C2)
SIZE 5C I S I NOW ON LOTNO. OP S ' %( S' 0
OF LOT A.P.NO. ' q ' J•' / '�`-�
USE OF /1 S,Q N C� YARDS EVES
EXISTING BLDG. R APPROVED' ALLOW D
SETBACK CANE PRON I (CENTER LINE ST.) �'
CENTER Cd STREET �� REAR YARD)�� FRONT 7FTC �I.[ts 4 .�
SIDE YARD I LEFT 39 / I RIGHT S.$ / R.SIDE / FT. . IN.
DESCRIPTION OF WORK
L.EIDE ' g e FT. IN.
NEW I IIIA ALTERATION I II ADDITION 117'
REAR ///��� ( �_ / IN.
REPAIn I II MOVING I II DEMOLISH I APPROVED 4UI \DATE (2 j"` J ,
BUILDING 3a x O NO OF ! C T ft
SIZE ROOMS 5 STORIES
EX
EXTERIOR
WALL 57°C-CMI COVERING '^
USE O BUILDING AND WORK TO BE PERFORM D
�4v Th._ pa ri c _, o VEic iiii
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO CON- PURPOSE OP ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTIO VALUATION U
SIGNATURE OF A,�I �� PERMIT FEE S
PERMITTBF +�V�{ / /T/
Q ��AI \/��J/I}� S 3r /' PLAN CHECK $
AUTHORIZED AGENT 9 v•V �Y _� E
— TOTAL FEE $ �� n
COSTA MESA BUILDING DEPARTMENTIEE RECEIVE
P. 0. BOX 317 t" d _ e JbI 8250
COSTA MESA CALIFORNIA FINANCE DI T.I
t nr ur COSTA MESAFOR APPLICANT TO FILL
C.L. OF STREET l' �q/ .
I BUILDI c DRE :.' IC
PROP LINE — "mmC Ir h 7)
I Owner _ _.-��i i . /�
I-- -- -- int' •61F� OR -T" I �f��,
10 FT. FOR 60 FT. STREETMail �ddress ZC 3 .Eve �J� /lS���
`50 F STR EiTr Q:� � STA h ESA
PL ?in G DEVr. i City _ -a.2 ,---".46-.. Ph. No.
Si L,tECT TrB 6G. DEPr. REG. — - -
' I i J� Contract. er to- .,•• Ph. No.
WPM
6ATF �� Address 3 7/ &'
WPM. _. ° r`,5944`tal, 41
City Lic. No. j State Lic. No. / 7 / 473 OF PROP. I-
, — - - - - - - - - - -
50 FT w Cr Size of Lot 6 0 X / /I AP No.I O c - r2 i e 7
f 1- Setbacks: C/L Street Rear
z "� /
rc J p, Side Yard - Right Left
I- ----I 0 1 / J
to r a 0 Type of Fence _
LL ALLEY6.�RR(IPI� tP, LINE 00. a
L E d (I•/ I hereby acknowledge that I have read this application and state
J m Z that the above is correct and agre to comply with all City Ord-
U8 ?Jig) \ I Pinances anc,.Stt to Laws regulating build' construction.
1 U P.IL
t
I Signature \/'�� ,J /
11..., ( N` 10 I of Permittee ''�� -� � ,L1�L/�i�/0. f,4
FT I Agent
37 6 IN.
s FOR OFFICE USE ONLY
FT. W 40
Z FT I J Permit No.
I
o: 8250
0 60 FT ST Received� by Date Received Date Issued _
d 1 1 r /Z , /2 _S �'
50 FT. 3T. Y i � 1 C52--e)
I i
L - _/ —LINE -- - �` — t — _ _ —� VALUATION
Permit Fee $ -
m - $ / g• Plan Check $ Oft/ i
C.L. OF STREET---„. I I - 679
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