HomeMy WebLinkAbout222 WELLESLEY LN - Building Permits 4 a
CITY OF COSTA MESA
fro� Ws., BUILDING DIVISION
F8 .,1 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
u. FOR INSPECTIONS CALL: (714)754-5626
°s°°°°^' PERMIT NUMBER: BC10-00447
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 10/18/2010
ISSUED BY: BE
JOB ADDRESS: 222 WELLESLEY LN CM Suite/Unit:
APN: 14139524 Zoning: , ,
Vicinity: Primary Occ:
Const Type: V-B SQ. FT: 154 Valuation: $9,500.00
SCOPE OF WORK: 154 SQ FT ADDITION OF OCCUPIABLE SPACE BY ENCLOSING THE BREEZEWAY AREA BETWEEN THE
GARAGE AND THE RESIDENCE. RELOCATE WASHER AND DRYER FROM GARAGE TO THE ENCLOSED AREA. PLUMBING TO
INCLUDE NEW SINK,LAUNDRY,AND ADD GAS OUTLET. ELECTRICAL TO INCULED 8 RECEPTACLES,4 LIGHT FIXTURES,4
SWITHCES AND
EXHAUST FAN. NO NEW BATHROOMS OR BEDROOMS.
OWNER: SCHAACK,STEVE AND COURTNEY Address: 222 WELLESLEY LN Unit:
Phone: 858-229-3944 City/State/Zip: COSTA MESA,CA
APPLICANT: SCHAACK,STEVE AND COURTNEY Address: 222 WELLESLEY LN Unit: :
Phone: 858-229-3944 City/State/zZip: COSTA MESA,CA
CONTRACTOR: OWNER-BUILDER License No. 000000
Phone: Address: Unit:
Cell: City/State: - ZipCode
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
•
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $117.81
Building Fees: $181.25
Electrical Fees: $38.90 -
Mechanical Fees: $30.75 - -
Plumbing Fees: $49.25 •
SMIP Residential: $0.95
SMIP Commercial: $0.00 •
Bldg Std Admin Fund $1.00
TOTAL FEES: $419.91
**Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010- PER CMMC Sec. 13-279
Monday thru Friday•7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited 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 S. INSPECTION TYPE DATE INTITIALS CODE r INSPECTION TYPE DATEy INTI ALS p
1616 Fixed System Final Fire Prevention 206 Final Mechanical `/!` I —.J'- 1
1266 Pool Spa Final 208 Final Plumbing X 1 — ' --I/ d P
200 Final Re-Roof 210 Final Electrical - 3 —I( 0-
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site �L t r 1�I /�
204 Final Demolition 250 Final Building/Occupancy A I-•t- I I P tOLI OD'
K
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driab
vers nse. VYes 0 No
I hereby affirm under penalty of perjury one of the following declarations: CDriver's License No. Expires:K_K_M�C.�-�I
El 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 o dee ):
compensation, as provided for by section 3700 of the Labor Code, for the-
performance
heperformance of the work for which this permit is issued.
Q I have and will maintain workers'compensation insurance,as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Gm
(This section need not be completed if the permrt is valued at one hundred collars(5100)or less)
2,Art 2Sec.341,Title 6,California Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
Q 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? 0 Yes El 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 need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes El No
Lic.# Class# (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
Contractor's Signature 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).
O 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
Lender's Name: hazardous materials)? ❑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
7" OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑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? ❑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 ❑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).
y 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? ❑Yes ❑ No
thereon,and who does such work himself or herself or through his or her own S. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
control officer
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
A. -K,,,/ city ordinances regarding Hazardous Materials and Emissions.
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 Signature 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
❑ 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
inspect' n purposes. I gree not to occupy or allow occupancy of any building
author a is per It u I final inspection.
A iv) I �` °C ,431/(1
�V SignaW of Legal Owner(s) ate
Signature ate
30 7-46(3/07) And/or Authorized Applicant Dale
511111.
h"'"R9 CITY OF COSTA MESA
BUILDING DIVISION
f • ,,,, t, ,. DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER
PERMIT ,
', 02-01162
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 222 WELLESLEY LN Status: ISSUED
Suite: Applied: 07/26/2002
Vicinity: Issued: 07/26/2002
Parcel Number: 14139524 Zoning:
Applicant: MARTINEZ, BEATRIZ ANTONIO ISSUED BY: /
Address: 222 WELLESLEY LN
Phone: 714-545-8059
COSTA MESA,CA Zip: 92626
Owner MARTINEZ, BEATRIZ ANTONIO
Address 222 WELLESLEY LN
Phone: 714-545-8059
COSTA MESA,CA Zip: 92626
Contractor:
Address:
Phone:
Zip: License:
Arch : - Eng:
•
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF, INSTALL NEW SHEATHING AS NEEDED.COVER WITH 30 YEAR COMP SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,800.00
Permit: $125.25 Claim Valuation: $5,800.00
SMIP Res: $0.58
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.83
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)7545626
24443-46(WOO)
DECLARATIONS 1
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
❑ I have and will maintain workers'corn.:nation insurance,as required bisection 3790 of the Labor Code,for the performance oft e 1{ork r which this permit is issued.
My workers'compensation I r: •: .Z.I die and of• n �• are: II
Carrier: ., Policy Number:
(This section need not be oomph ed II fh:permit is val :d at one hundred dollars($100)or less.)
ertity that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of C Iilornla,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr ions. �h _ �j f
Applicant Signature: / Ly-Cs r b, Date: 2 (-0/02___
WARNING:FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($10,003),IN ADDITION TO THE rnfT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
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: Lenders Address:
Signature: Date: _
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 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
Zts the applicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is riot 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 properly,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 properly 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 u sec. / Business and Professions Code for this reason:
Signature: r CII VaI•e a' Date: 717.1010
Owner ID verified by drivers license. A s 0 No Driver's License No. xpires:
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,Califomia 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 e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
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 Cale been fully complied with? ❑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 apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end 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 ir.z:ction p •osee.I agree not to occupy or allow occupancy of any building authorijed by t is permit until final inspection.
-and L LaI - /_ 02-
Signature Of :gal Owner(s) Date
And/Or Authorized Applicant Date
CODE 1 INSPECTION TYPE PAIS IN1rIALS CODE I INSPECTION TYPE PATE Its
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing -.
200 Final Re-Roof 9--to--02_ (.)-- -7.: 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
\I
PROJECT ADDRESS: L22 WELLESLEY LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05151E
OWNER'S NAME: FOSTER LORI TR
ADDRESS: MARTINEZ BEATRIZ ANTONIO PERMIT NO; B 051514 PLAN CHECK NO: 01098-91 S GOVT: N SUPP; N
222 WELLtSLEY LN
COSTA MESA, CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; 0TH
(714 ) 545-5311
• ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 51 LIN FT OF RCMU PROPERTY LINE WALL SQ FT: 51. .
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE; 1, 020. 00 GROUP OCC: R-3 /M-1
PERMITTEE: BEATRIZA, MARTINEZ ( 714 ) 545-5311
ADDRESS: 222 WELLESLEY COMMENTS• SMOKE DETECTOR(S)�iv.�E �EREQUIRED IN HOME,
COSTA MESA CA 92626 4,.:******* * ****xX�xx ***TT** **** ****>t***4TH*x**x,e±H*m-*******;********* **x*+H*aT
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Signature: MAIN BUILDING ACCESSORY BUILDING
AKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
wmpensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP,DATE:
COMPANY: PARKING REQ: PROV; PARCEL: 14139524 ZNE: RI REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING N TES> 102 L.F. 6FT. HI . BLK, WALL BUILT ON PROP. LINE,
> ( 51L F. `ASSESSED TO ADJOINING PROP. OWNER)
Date: Applicant. *-**********x*************x***4Ex*****K*****3F*****x******1E*************K**x***x*K
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E R V I. C E S REQUIREMENTS
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 J -� /
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY ,• J *a DATE:
Date: Signature: fir
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ;_Aj�� DATE; `l/�
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. v
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• : /r DATE•
which this permit is issued(Section 3097.Civ.C). *********************3e �'fe ( 'a
LENDER: ******S*************.********************* *****i/,-x.*iE***ii********-********lE******
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT•:Y
OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code' Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 27. 00 . 50
repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
SMIP/NON`RES
1 Professions Code)or That he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 1.7 . 5 5
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or myemployees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID • . DUE
vpv9pTOTALS----> 27, 50 0 . 00 17, 55 45. 05 45. 05 - . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/heiseli or through
•
his or her own employees,provided that such improvements are not intended or offered for sale.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 45, 05 OVER/SHORT; , 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ''/ 5 1 7 5
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon --
and
and who contracts lar such projects with a contractor(s)license pursuant to theContractors'State License Law).I am aware **************'***-*************************#************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
m I am exempt under Section: B P 70 4 4 B.8 P.C. ..
for this reason: ALL WORK BY OWNER , /,/ TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date 3_7_4:74 7/ owner:f Arid 6 ., SFR 51 RES—CONCRETE BLOCK WALL / Fag. 20 . 00 1 , 020 , 00
I do hereby certify Mat I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES s;
)
25534 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 41
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. 4. E
EXFI
Date' Applicant 101E Inspections' I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county Income
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned \
property for inspection purposes.
�, _.-- S(g 9`"'�s CI. 00053369-0008.3311 TCtF :SQL:-
Datil: /_X ,jj Signature: /� �iY///` DATE; 04/0 /9 MF• 1.S
Dover's License or Social Security x. ,i /
----.•.+A White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor ✓✓✓ I
L.
POOL & SPA
CONSTRUCTION AND PLAN 3
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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
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 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 ❑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 / i 78. FIRE PREV. FINAL
30. Drywall Nailing ` _�- HEALTH DEPT. REQUIREMENT 'C
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 Y/
36. Hood or Canopy .'
37. Final Factory Fireplace
r
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final •
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System -1
. 45. Sound Attenuation
E`; f k2C:n;`0
46. Handicap Regulations Inc m .te in ttiMS
47. FINAL STRUCTURE & BUILDING ,•J- t Date ' /10
•48. FINAL PLANNING - i �' S'8- --- -
49. Electric Release to Edison ' ,� ' !-
50. Gas Release to Southern California Gas Co • ./1
51. CERTIFICATE OF OCCUPANCY -'
No Date
•r , 5756 I=
EE RECEIVED
•
SEP 1 3 1997
' 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 222 IY.j_ FSt_ LAN BUILDING
ADDRESS
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY �qy
RECEIPT NO. I ps}N5
•
OWNER COI_LEGE PARK No. IL U
RECEIVED BY DATE RECEIVED DATE ISSUED
MAIL
ADDRESS ? ILA, So . MAIN ST. C /�"J7 9/o7-S7 SEP 2 G 1957
CA
TEL.NO. K I 55 /77 BUILDING
CITY SANTA ANA . CALIF . ADDRESS
ARCHITECT LIC.
OR ENGINEER NO. COSTA MESA. CALIFORNIA
ADDRESS q 3 d5 FIREZONE
ZONE NO.OF TYPE '/ GROUP
// CI LIC. ' / I PLANS U ,f
CONTRACTOR .T, NO.- L - I 1 didj
/" TEL. APPROVED U]
ADDRESS NO. BY DATE
LEGAL
LT
LEGAL ON ryO0 L.I BLOCK TRACT ) IB / CORRECTIONS
A.P.NO.
SIZE NO.OF BLOCS.
OF LOT 6o X I 15 Now ON LOT
USE OF
EXISTING BLDG.
SETBACK LINE FROM O/ 1
CENTER OF STREET ii� Ai' REAR YARD 3fL il
SIDE YARD RIGHT 5 LEFT 5
DESCRIPTION OF WORK
NEW x ALTERATION ADDITION
REPAIR MOVING DEMOLISH
BUILDINGNO.OF
SIZE 1329 ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
I USE OF NEW Cer
BUILDING RESIDENCE &,OC
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. A VALUATION �J/)
SIGNATURE OF C
PERMITTEE AIOLLEGE PARK S . PERMIT FEE $ �V
` $ 1 1 , 200. PLAN CHECK $ /it
AUT Z GE T TOTAL FEE $ cit..? — f..r