HomeMy WebLinkAbout212 WELLESLEY LN - Building Permits y 9 CITY OF COSTA MESA
40
BUILDING DIVISION
F ___,,rn DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT M06-00037
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
•
MECHANICAL PERMIT
Job Address: 212 WELLESLEY LN Status: ISSUED
Suite No Applied: 01/25/2006
Issued: 01/25/2006
Vicinity:
Parcel Number: 14139526
ISSUED BY:
Applicant: STEVE SCHNIERER
Address: 22911 SAVI RANCH PKWY
Phone: 714-719-1689
YORBA LINDA,CA Zip: 92887
Owner: FISHER, E ASHLEY '
Address: 212 WELLESLEY LN
Phone: 714-438-0004
COSTA MESA,CA Zip: 92626-6131
Contractor: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWY
Phone: 714-777-7777
YORBA LINDA,CA Zip: 92887
License:799170
SCOPE OF PERMIT
REPALCE<100K BTU FAU
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 • Compressors/Absorption Systems
Gas Piping $0.00 • 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
• Appliance $0.00 0 Boilers
Fire Dampers 50.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 - 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace / , 50:00 0 • ' Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $38.30
• COMMENTS/SPECIAL CONDITIONS
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)7545626
2446-46(6/00)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: ,
O 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
for which this permit is issued.
117. ave and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the nce of the work for which this permit is issued.
• orkers'compensation Insurance carrier and policy number are:
cM Ernp\oec .o
Cce etlac u..-, Polio r: 14 N.30(0o j So 3
(This section need not becompleted if the permit is valued at one hundred dollars($100)or less.)
In 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'
c 'on laws of California,and agree that if I should become subject to the workers'compensation nrgviaions of Section 3700 of the Labor Code,I shall forthwith
co ywith hese r ' ions. (/ �
A pli nt Si e: `Bete:.. l) 1�"/O(0
WARNING:FAILURE SECURE WO RS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALDES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLAR ($100,000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WOE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CO, : •CTORS DECLARATION:
I hereby. it,_:,:.- am licensed under provisions of Chapter 9(commencing with Section 7000)of Divisi..3 of the Business and Professions Code,and my license Is in full
force, .effect.Lic.u — 9 110 . . •
Co tract.i.....,;.,nnrrn. /t... rte-:ii�� sate: ws/C(o
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).):
O 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 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,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 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 ono 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). _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 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.
4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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? 0 Yes 0 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.
_a.d.nat a Of Legal Owner(s) Date
e. A a'rav' . _, I is el ate
CODE I INSPECTION TYPE PATE =ALS SODS( INSPECTION TYP( �— ,T/let
1616 Fixed System Final Fire Prevention 206 Final Mechanical 7 /in/}X�'),9�
1266 Pool Spa Final 208 Final Plumbing Fl /VI
200 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
ADDRESS OF BUILDING: 212 WELLESLEY LN UMT' CITY OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IF KNOAN: BLACKMAN, DONNA H PERM NO: B 085344
i DRESS: 212 WELLESLEY LN
- COSTA MESA,CA 92626 PERMIT NO; B 085344 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MAUNO ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF RESHEATH s REROOF W/COMP. SHINGLES SQ FT: 3, 200
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 3, 200 . 00 CALL—VALUE: 3, 200. 00 GROUP OCC : R-3 /
CONTRACTOR'S NAME:
CONTRACTORSMAUNO COMMENTS: SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY
ADDRESS: UC.NO.: ******************************** •Mie•**********************************'**********
LMT: ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter e SETBACKS
(commenting with Section 7000)of Division 3 of the Business and Professions Code,end my license s in full force and effect.
CITY LIC.NO.: LIC.CLASS: LC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING —
Date: Contractor: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the
following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,eller,improve, PARKING REQ: PROV: PARCEL: 14139526 ZNE:E: REF NO:
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 "
r 'v licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Dnsion 3 of the PLANNING NOT ES->
usiness and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section :>
031.5 by any applicant for a permitsubjects the applicant to a civilpenaty of not more than free hundred dollars[S5001). ***********ie***r*******it*******ie***iF***dr*****************************x****ii*****
jil I.as owner of the properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended /••
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not appy to an Omer of popery D E 'V E :L O P M E N T SERVICES R E Q U I R E M E N T S
who bolds or improves thereon,and who does such work Mmseff re
or heat or through his or her own employees.provided That such '1 .:
improvements are not intended or offered toccata.It,however,the building or improvement is sok within one year of completion,the ZONING APPROVED -.BY '1/;
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). DATE:
❑ I,as owner of the property.am exdusively contradsg with licensed contractors to construct the project(Section 7044.Business and
Professions Code:The Conlradors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: !
contracts for such projeds with a contrador(s)licensed pursuant to the Contractors License Law). - ,/
• Iamexempt under sefion: B.6 P. , . this reason: • APPLICATION ISSUED BY: � " DATE: 1./.:.,
� '`2 a ',er: re _ / •I ' ��O't� **************.*.*********************** **tv******************** ae xxtvtr**
-eby certify that I am aware d and understand the requirements of California Health and Safety Code Sections Pcrn ,25533,and LEGALIZATION:Nom' F E E SUMMARY S TRUC TURA- 5 EGMEN T:ii
and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for
a permhforaostmction ormodificalion from the Air OuaBy Management District.Residentialconsttudion applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 87. 25 . 50
Data: Applicant: SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN
o I have end ail mantas a certificate of consent losef-insure for workers'compensation,es provided for by Section 37004 the Labor ISSUE FEE
Inde.fortepedemanammewakR«whihntspemaniesaed. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ maintainIhave and wit workers'compensation insurance,as required bySer icion3700oftheLaborCode,forthepemrmanceofths TOTALS-- —> 87. 75 G .OG 0 . vG 87. 75 87. 75 vG
work for which this permit is issued.My workers'compensation insurancecattier and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 87. 75 OVER/SHORT: . 00
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Tis section need not be completed if the permit is for one hundred dollars(51001 or lass.) 87. 25 . 50
0 I certify Ma in the performance of the work for*which this permit is issued,I shell nd employ any person in any manner so m to
become subjep to the wodters' smion laws d California.and agree the if I should become subject to the works& *.******************************..........*******************************************
compensation provisions of sectionn3700 3700 of the Labor Code.I shall forthwith comply with those provisions. INDIVIDUAL F E E BREAKDOWN
Date: Applicant: .
Warning:Feeley to secure workers'compenaaton coverage is unlawful,and shall atltlsct an employer to crlmlnal penalties and TYPE QTY DESCRIPTIO N UNIT COST 1 O 1 AL COST
civil fines up to one hundred thousand dollars($100,000),In addition to the cost of compensation,darner*as provided for In
Section 3706 of the Labor Code,interest,and atromey's ises.
SFR 3200 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 3, 200. 00
• CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097,Cy.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction and hereby authorize representatives ofthis city to enter upon the above-mentioned property
for inspection purposes.
DONA BLACKMAN 16-21-1997/12:58 PN/f87.75
e(r)r —a✓ 1tJiCA� Date: n �7 ( 7
IPERMIT:085344
signatLure /Agan Applinant/Contrector
.
(515146mm Whhe-Building&Safely;Green-Rle:Canary-Applicant;Pink-Revenue;GOldenmd-Assessor
COfjSTRUCTION AND PLANNING >: - POOL ?A
APPROVALS Permit # 'Date Inspector APPROVALS Permit 4 Date Inspector
1.Temporary Electrical Service or Pole ' 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement
-•a Electrical Conduit Utility-Undrgrnd. 54. Forms , •
I
' _;4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding - --
:15?Steel Reinforcement , 56. Rough Plumbing & Pressure Test -
�63 'ElectricalUFERGrnd, , 57, APPROVAL TO COVER-GUNITE I
_7 Footings .58. Electrical Conduit-Undrgrnd.
i -'8. Foundation r 59. Gas Pipe, 0 Undrgrnd•,.Test
,r9' Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. '
• 10. Structural Floor System - ' 61. APPROVAL TO DECK
11. •Property Sewer Line & House Connection . 1 62. Backwash & Receptor-Final
12. Sewer Cap - - ; 63. Heater & Vent-Final •
13. Roof Drains _ . - ' 64. Pluinbing System - Final ".
14. Rough Plumbing �y 65. Electrical-Final ,
15. Rough Eiectrical-Conduit 11. - •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
w ^. k i- yid -, i11-: K I--i
20. .Rough Factor.V Fir lace I r. I :[i* •-=3 T t. ,- •D y', ,rAPPI VAL`5;' Pec1mit# 14r
21. Ducts, in;Structura;k i _.. i;,> k :S -f' T. eli JF ,{
. „ _ - '=' _" ' 7Q.' P.Inder�f--is Hydro k
22. Ducts, Ventila in '"ir ' { "- I5, 'g' l' - T,_
.� 9,a i 7 .z •y ry . ,� 71. Product;Ri kung [.leas O OiI
23. Gas P_ipe.`Rough & Test i tic KIT: ,,' '-: Dr - 72. UndergrdLnd FFesh•n r •- -
� =24. Roof-.Framing. g i ,.-i --4 ,i . -! I> j Izr � y
ir, 'r :> i ; ;4.4 •- 73; Undergrtd.Sto:re,7ank:❑Gas0-1511 K
25. Root-..Sheathing ;r`,s y /0.-122-174 -Overhead Hydr&
26. T-Bar Ceiling {Strr tural) & Monocoat * ID 17 ,n 7C, Dry Chemical _.-3- ' ' ,-i it
MA, II/27. Frame and Flashing"r 'j,>;,'- Y 'r izt c76. Dry Standpipe -3n r:
; 28. Lathing &Siding .-'t: ,' yi. w• ' I I tr 77, FIXED SXpTE.f.171NAL.:
29. Insulation -'- s, -� c •• k �" I I It 78 FIRE PREY, FINAL k ?'
_ _ S V. : ._ 3 .. '
•' 30. Drywall NailirTg 2^ J v .. I lk i HHALTIE`�DEP7:'REQUIREMENT
-s 31. Plaster Br •c-own-Coat f. I ,Tilt, : ( I k r., 79:' FINAL ItISPECTK3N .k •_
32.•Electrical-Powar Wier i V 'u I lit 802FOOD CERTIF=LATE I S(JED_ r;
ry l 4 i r k :T) I w fr; t ^ :L f ,:1 )
r 33. i'inat.Electrrc-, ,.rt ,r I a 1t Notes: 7 '7m r i 1 V.T)
- ,.
' r i 1: h 1i ,s _�.,. ,'> _
'r 34. Eina-;Heating-1 Az Conciitionirtg._ ,
, _ _• .. -t '-1 Y Ti. K t> I 1 �)' S, 1 'y 4 t. 'J.
,C Y, .. '1 7 p In
35. Final"Gas.Pipe;Testa k D.::: „ r I I i;: - ,7 _ ;; „ion
o 36. Hootor'Canopy _ is I7 I ;r'-; -: K T I Ic Z. < In c ." .�
v,k , r n ..tF z: _r_, ic n i7'7
.., _ 1 I; TI I f )-, ) r
7 37. Einar_Factory FirepI ce - ; 5,:r, k I IF y . .;; 1
38. Final.Plurnbing -'t ,u f'v i `' '-) i
i �/: :-.-1 - f '
-• 39. Wate'r'•Service-Final'" T. rn I I IrI. "o ••:-,
40. Gas Service-Filial 7,y. .1 S n,- S r :r) i 1i' -•ui-
i Y _ . , .V 7, I' III
41. Solar Dornesta;Fid?' t. ;' •' =' Ir .,
J
42. Backflow`_Preventerj. i is Z: • e. 7 :-i
61- ` is
a-%-
c �a-,p J f
--43. Backflow':Irrigatio ,'0 e .r ; k - ,
44, Landscape Irr atianrSystem u ;„ � Ic 'ri r-' -.y ^ J •ti _K i
..-r To icy c 'S D :it::
5. Sound Attenua
4tion i. -,...1; E 17 1
,t - M
t
64.6. Handicap.Reguiations - j 4 ..r e ' z, - -'
47. !FINAL STRUCTURE & BUILDING /�..' f)►�‘�% _ _
4g. F,INAL PLANNING d . Vl: . }y ' r F -
-
•
49. 'Electric Release to Edison - I -
50. Gas Release to Sou-diem California.Gas Co i. I :, - - 7 t
I - - - :- - - v .'u - • e.
_51i. CER3IFICATE OF OCCUPANCY r *I >
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
well •
- PERMIT NQ. UNITO
. TRACT NO. LOT NO. N .
CITY• OF COSTA MESA CONSTRUCTION PERMIT (U,) T N 697 7/ I9/Ba 50071 TI_
Project Address ala U32l I P 51 PA-.1
TYPE OF CONSTRUCTION LiNEW LiCJ ADD ❑ ALTERATION REPAIR )
Applicant's Mailing gpddres5 f
1�la CIL Mel.01 Phone gig ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.p,# Zone
Owner's Name 'q�� DESCRIPTION OF WORK/USE OF BLDG.
Address cainti S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING El FOUNDATION ❑ STRUCTURAL T Front ZO
Address • p l� U Q,�' /T/� ❑ TENANT ❑ ELECTRICAL LI PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name glib V1 ,Ib� Phone Ksgq ps- ❑ OTHER A 1
`/n /. }� �,t s�I/(�lL/�1y��/�J PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) O� US/vC/t `^r✓� ` CONSTRUCTION TYPE VALUATION$ S Left G
City License No. S ZONE GRADING CU.YDS. ACRESR
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
n my license is int I ., e and effect. RECEIVED 'J U L 1 9 "'S S
V' License CLss - I / ic•n +
-
Qo Date - Signature INSAII, / _ .%STI PLUMBING FEES fes`
( WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate :. ELECTRICAL FEES
r1 if Workers' Compensation Insurance, or a certified,copy thereof (Section Backflow Preventer Service Sink 0 15-50 KW
:coo, Lab.s�)/ yJ� {,,.� Automatic Washer Transformer
Policy No. ('i/S � )(Tin 1 Company Rt't ci- , Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
�c�ertified copy is hereby furnished. /VI
_2 Certified c y Is filed with the city B Id' D'vi o .t�� Bathtubs Sewer Connection Cooking Unit 4; Meter ❑up to 100 amps
EateXE P IO F ApplicantRs _
•
EXEMP ION FROM WORKERS'CO P NSATION DECLARATION Clarifiers Solar Collectors Dishwasher r- Meter. Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or ' - . �'
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I -'
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan --z•
Workers' Compensation Laws of California. 'Tr Motors 00-1 HP 0114-8
. Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration,you should become subject to the Inc.Solar ❑9-15 HP 016-15+ .
Workers' Compensation provisions of the Labor Code, you must forthwith . Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave •
CONSTRUCTION LENDING AGENCY Gas Service -Outlets Water Closet _ Device Boxes '
I hereby affirm that there is a construction lending agency for the performance - ^- Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater /�JOutlets
Lender's Name • - _. _ _ a//4i '" Range
•
Lender's Address - Kitchen Sink Water Service _ Switches Sign
OWNER BUILDER DECLARATION • `
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - . i
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal.,, 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 i
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains •
-the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt .
:therefrom and the basis for the alleged exemption. Any violation of Section .
. ab7O31.5 by any applicant for a permit subjects the applicant to a civil _
"penalty of not more than five hundred dollars($500). I 6
IJ '
I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee 3$
compensation, will do the work,and the structure is not intended or offered - _ Reinspection Fee I $15 Issue Fee. - $ 3 •
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own ,--,
• DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I
sale. If, however, the building or improvement is sold within one year of com- - -- Canopy Type II 0 Zoning Approved By . Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground - Building Approved By Date
prove for the purpose he of oe). 9_ /r—
0 t rs Owner tr thet property, am t 7 44, contracting ing with licensedioncon- Duct-Structural Refrigeration System Application Issued By (✓Y-�/�A7 Dat
The
t construct the project (Section 7044, to
Business and of property
Code: _-_ ,
buil Contractor's License Law does noteraapply to an owner je is hta wno Duct-Ventilating _❑0-100,000 BTU 0100,000 BTU '� SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with acon-
tractor(s) license pursuaritto the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration - BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ T-5(J V ISSUANCE $
Date owner Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that-the above 00-100,000 BTU 0100,000 BTL.— • - -- GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating tot building construction,andhereby authorize per repot PLAN CHECK 50% MICROFILM $
astate
es this city enterupon the n,above-mentioned property for $
inspection purp0 s
Signature /✓l{�i ' , / . 0 1 Date -2. 3 MECHANICAL $ TOTAL FEE $
Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
-\CMF 0065-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
•
CONSTRUCTION AND PLANNING' _ POOL ,,. SPA , -
li APPROVALS Permit# Date .Inspector APPROVALS Permit# - Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. •
- 53. Steel Reinforcement
3: Electrical Conduit Utility-Undrgrnd. ' 54. Forms •
-4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding
-.5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings .58. Electrical Conduit-Undrgrnd.
8. Foundation . 59. Gas Pipe, El 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 Connection62. Backwash & Receptor-Final
.12. Sewer Cap 63. Heater & Vent-Final -
13. Roof Drains 64. Plumbing System - Final •
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final - " .
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough'Wiring Sign 68. APPROVED FOR PLASTERING •
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough-Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing , . . 73. Undergrnd.Storage Tank 0 Gas 0 Oil
• 25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding - 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE 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: /Z-45--A. ten- C.0/Lf . c1.0
34. Final Heating & Air Conditioning 4-1- C44- c.0 ._ AS p6a .243 U PC. L.ED
35. Final Gas Pipe-Test .
-
36. Hood or Canopy •
-
37. Final Factory Fireplace,
38. Final Plumbing t CANCELLED IAN 1 3 1987
39. Water Service-Final
40. Gas Service-Final -
41. Solar Domestic-Final T'
<! -
42. Backflow Preventer - 'T '
-
43. Backflow Irrigation -
-
44. Landscape Irrigation System . =7
45. Sound Attenuation
46. Handicap Regulations ' "
•
47. FINAL STRUCTURE & BUILDING :
•
48. Special Requirements Completed; ., • - I I
49. Electric Release to Edison •-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date -
-OWNER COLLEGE PARK NO. b DATE 9-26=57 _
JOB ADDRESS 212 Wellesley Lane BUILDING PERMIT NO. 5773
GENERAL CONTRACTOR Harbor Construction VALUE $ 11,200.00
AR No. LOT 39 TRACT3187 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar.
GROUP 1 & J TYPE V ZONE R1 PLAN NO. 575b
PERMITS ISSUED
I 'ECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Trend—Tr—#-0 Steel grit/ /0-2 -Sy
Floor System -
Steel Reinforce Chimney Re-Rod
Bond Beam -
Frame and Flashing r rz k la.-/ R-4.7
Lathing, In - Out L! j2E / -3 -S-y
Plaster, brown c9At/.-, /.,., E---6-4L'/O -.IV
Underground sod c„VcjW/G Pipe TFsst /O-19 6 J
Top Out _
Furnace 4,.4'C /244-s7 JZ%T'17tt 2 `�_...-g. /P-?/-S7 /! 5071-1 +.—
Gas Vents i/
Rough Plumbing /V/in /1-,'-S-7 f/i1',1r eert . in- 2- —4"-7 1 1 2412 w/_
Cesspool Septic Tank
Prop. Swr. Lin/House ConVI_St.IS$,g?S f/-fc,-S7 f .y (iw �14tI— /d—02Y-57 //r7 3/
Sprinkling System /A as
Heating Final /r/#-S 4/-2-1-3-S" pin
Plumbing Fixtures, Final Al Yr q/-ii'Sr _
F1,''.'.,,Gas Test /.6- /N/F< H-n-1-Y f 7
t `ti`-'uction Pole n,/
Un,. .. M
Underground Power 1 1f
Rough Wiring I7 /,.-/(..47 /3sseee,. 9JJt, /2 -9- -'J 27447 4.----- /
Fixtures, Final j.- (j...e/7.t/'� I Y
'OCCUPANCY Ai m/ /_/l.l8
Form 210-5M-1-57 .
FEE RECEIVED
5'754 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
BUILDING BUILDING
ADDRESS 212 %.7ELLESLEY LANE
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. 5'x"73
OWNER COLLEGE PARK NO . 11. J
MAIL �T / RECEIVED BY DATE RECEIVED .DATE IS(SU
ADDRESS 21 16 SO . MAIN ST . .0 '-A02 'S S2 " �57
TEL. CCC ,.7 BUILDING
17
CITY SANTA ANA . CALIF . NO. I< I 1 ) 1 ADDRESS
ARCHITECT LO. COSTA MESA. CALIFORNIA
OR ENGINEERIC.
FIRE
ADDRESS 73 6P ZONE
J 2pNE PLANS TYPE GROUP O�
. LIC. �y PLANS
CONTRACTO/�FI /(/�L,`j/ NO.- 21v
TEL. APPROVED
ADDRESS NO. - .i/d27
dJ`� BY DATE
LEGAL LOT CORRECTIONS
DESCRIPTION NO. 39 BLOCK TRACT-tier'
/q"
A.P. NO.
SIZE NO.OF SLOGS.
OF LOT 6'I X I 1 5 NOW ON LOT
USE OF
EXISTING BLDG.
SETBACK LINE FROM
CENTER OF STREET 5. REAR YARD 35
SIDE YARD RIGHT 5 LEFT 5
DESCRIPTION OF WORK
NEW x II ALTERATION I ADDITION \^
REPAIR MOVING DEMOLISH
BUILDINGNO.OF
I ���
SIZE ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF NEW ��{T A77��
BUILDING RESIDENCE & -9.
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
SIGNATURE OF /� II�� PERMIT FEE 5 ��-
PERMITTE •
C• G - PARK ND . LL (/
PLAN CHECK S / r
S II ,200.
dor sir
AUTHO-r /GE'T L/f TOTAL FEES fi�f
PAI
COSTA MESA BUILDING—SAFETY DEPARTMENT • min 15-74Lns7001283 d*****3.5O
P. 0. BOX 1200
Costa Mesa, California
PLUMBING PERMIT APPLICATION •
ATPERMIT NO.
—WS TRACT NO. RECD. BY X03
CONTRACTOR_ 4,pj t . dowse / / / LOT NO. DATE ISSUED
Address 75 Lj 1 /U � ,��p/t� nB/UILLDING USE [f_, z I
CiS�f�� .,& t4O7J %el. N� ADDRESS XA 9. & n �f 7
ADDRESS t1DO I/V
State License No. Class. COSTA MESA. CALIFOR
NEAREST
CI to City License No. CROSS sr.
I— — OWNER CU f rJe,�'(.tekarIR/ICI
< NUMBER TYPE OF FIXTURE OR ITEM FEE MAIL
o •
Water Closet(Toilet) ADDRESS • ""�� qq�� ^J
J Bath Tub GMT' � gM/.t.../ TEL. NO./.�Jn q/ { I/.
Q Shower
I hereby acknowledge that I have read this application
Lavatory(Wash Basin) and state that the above is correct and agree to comply
} Kitchen Sink with all City Ordinances and State Laws regulating
ECEC Laundry 'tub or Tray plumbing.
I certify that I possess the above valid state of Cali-
tu Service Sinka. fornia classification or I am the legal owner of the resi-
O Floor Sink dential property described above.
EC Floor Drashin a , ^• A0 �}3
1 Dishwasher Signature o/ lh". J`C{�JI 3Y'
Permittee
Z Drinkin Fountain a
UJ Urinal
= Garbage Disposal INSPECTION RECORD
Automatic Washing Mach.
F' Water Softener
2 / Water heater fi Vent I ,•j I
CC Receptor
d Swim Pool Filter System
CC Gas System . . . Outlets
7 Lawn Sprinklers
O Installation or Alteration —_-
Water Piping
N Back Flow Preventer APPROVALS
N Prop. Sewn_ ft. INSPECTOR DATE
= House Sewer Connection U/G Soil
I-- Cesspool, Septic Tank U/G Water
Services—Water 0 Gas 0
Miscellaneous Rough Plumbing
Sprinkler System
Gas
, Property Sewer �
Pool Receptor �
Filter System
Pool Heater
Miscellaneous
Issuing Permit 2 00 r
I Final Gas
TOTAL FEE Ll Q 15 -6Final
Final Utility Co. Noti ;C.Q s^(6 R�/
fied w /
PORN eµ.24 BLDG. PERMIT NO. ,�/