HomeMy WebLinkAbout3485 WIMBLEDON WAY - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.���LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
,lobAddress: 3485 WIMBLEDON WY
Suite:
Vicinity: ROOF
Parcel Number: 41204274
App�icant: SELL, RON
Address: 18032 LEMON
YORBA LINDA , CA
owner. ELLIOTT, FREDERICK
Address 3485 WIMBLEDON WAY
COSTA MESA, CA
Contractor. SELL ROOFING COMPANY
Address: �.18032LEMON � . -
YORBA LINDA , CA
Zip: 92686" .
Arch :
Address:
Zoning: R1 R1
Phone: (714) 528-1758
Zip: 92656
Phone:
2ip: 92626 .
Phone: (714)528-1758
License: 323842
Eng:
Address:
Status: ISSUED
Applled: 10103I2002
Issued: 10/03/2002
� : ����;�
- Phone: �� � 'Phone:
Zip: License: � � License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1/2" OSB, 2-3# FELT, DURALITE ICBO #2656. 2,700 S.F. INCLUDES ATTACHED GARAGE.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$167.25
$0.89
$0.00
$0.00
$0.00
$168.14
SETBACKS . .
MAINSTRUCTURE Front 0-0 � . Rear 0-0
ACCESSORY Front 0- 0 ' Rear 0- 0
PARKING Existinq: o ' Re uired: o
NOTES:
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
Lek 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
Ss,soo.00
$a,soo.00
I. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
� regulations. (Ord. No. 9248, § t, 12-21-92)
EXPIRA710N: 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
2d46-46 (6/00)
WORKERS'COMVENSAnON DECLARAnON: +
I hereby atlirm untler penalty of perjury one of the tollowing decleretions: �
❑ I have and will meintain e ceniticate ol consent to self-Insure for workers' compensation, es provitleC for by section 3700 ot Ihe Lebor Code, tor ihe pertormance of the
work tor which this permit is issued.
I have antl will maintain orkers' c mpensation insurance, requiretl Dy sectlon 3700 of Ihe Labor Code, lor Iha pertortnance of Ihe work for which this pertnit is issuetl.
y workers' compens carri e d policy ber ere: / /
C rriar: Policy Number ! � �O .b ���
(fhis section need not be complered i/ the permit is velued a( o hundred dollers ($100) or less.)
❑ I certify that in Ihe performance of �he work i r which this pe s issued, I shall not employ any Derson In any manner so es to become subject to the workers'
compensation laws ot Califomia, antl egr t at if 1 shoultl be e s e o Ihe workars' compensatlon provisions of Seclion 3700 of the Labor Cotle, I shall torthwith
comply with these provisions. y/� / �
ApplicantSignaWre: �•'" l Date: � ! �
WARNING FAILURE TO SECURE WORKERS' CAMPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIN4L PENALTIES AND CNIL FINES UP TOIXJE MUNDRED
THOUSAND DOLLARE (E100.000�. IN ADOITION TO THE COST OF COMGENSATION, OAMAGES A$ PROVIOEO WR IN SEGTION 3106 OF THE LABOR ((XbE, IMEREST, AND FTTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aRirtn t�at I am licensetl
force and eRecL Liu u �
Comractofs Signature:
with Section 7000) of Division 3 of ihe Business and Prpfessior�Cot{a, antl my license is in full
Cless a C: � �
Date: G — ( '-�
CONS7RUCTION LENDING AGENCV:
❑ I hereby attirm ihat lhere is a construction lending agency for the peAormanco of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lentlers Name: Lender's Adtlress:
Signawre: Date: �I
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn ihat under penelty of perjury that I am EXEMPT FROM THE CONTRACTORS IICENSE LAW for the toltowing reason (Sec. 7031.5, Business antl Professions
Code: Any city or county whic� requires a permit to construct, alter, improve, tlemolis�, or repair any strucWre, prior to its issuance, also requires ihe epplicant for such pertnit
to tile a signetl statement ihat he or she is licensed pursuant to Ihe provisions of Ihe Contractors License Law (Chapler 9(commencing wit� Section 7000) oi Division 3 of ihe
Business and Professions Cotla) or that ha or sha is exempt therefrom antl Ihe basis for the alleged exemption. Any violetlon of Sactlon 7031.5 by any applicent for e pertnit
subjects the applicant to a civil penalty of not more ihan tive hundred dollars ($500).):
❑ I, as owner oi iha propeny, or my employees with weges as iheir sole compensation, WILL DO THE WORK, and ihe stmcture is not intentletl or oHered for sale (Sec.
7044, Business and Professions Code: The Contracbrs License Law tloes not apply to en owner of property who builds or improves thereon, and who does such work
himself or herseN or ihrough his or her own employees, provided ihet such improvemenis are not intended or ottered for sale. N, however, the building or improvemen� is
soltl within one year of completion, ihe owner-builder will �ave the burtlen ot proving that he or she did not builtl or improve tor Durpose of sale.).
❑ I, as owner oi the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions
Cotle: The contrectors License Lew does not epply to en ownar of property who builds or impmves thereon, end who contracts for such prolect with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I em exempt under sec. Business and Pwfessions Code br this reason:
SlgnaNre: Date:
Owner ID verified by dnver's licensa. ❑ Yes ❑ No Driver's License No.
Verificetion oi Ownership by (type oi tlocument, i.e. - propeny tex bill or tleatl):
Expires:
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in tlepth into which e porson is required to descend, will be metle in conneciion wit� work euthodzed by this
permit, and that no building stmcNre, scaHoltling, falsework, or tlemolition or disman�ling �hereof, will be more then ihiAy-siz (36) feet high. (Chap. 32, Gry 2, Atl 2, Sac.
341, Title B, Calitomia Atlminisirative Cotle).
❑ As owner-builtler, I will not employ enyone to do work which would require e Dermll from the Divislon of Industriel Sefety, es notatl ebove, unless such person hes e
permit to tlo such work from the tlivision.
Signature: Dete:
Division ot Industrial Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTMORIZA710N OF ENfAY: I certify under penalry ot perjury that I have reatl this application and state Ihat Ihe information given is
correct. I agree to comply with all state iaws and ciry ordinences relating to building construdion, and euthonze represenlatives of t�e City ot Costa Mesa to enter upon the
ebove-tlescribad property for inspection puryoses. I agree not to wcupy or allow occupancy ot any building authonzed by this permit until (inel inspection.
COOEI, IHSYECTONTYPE
1616 Fixetl System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Root
201 Finel BIocWRetaining Wall
202
203
Final Factory Fire Place
Finel Sign
204 � Final Demolition
O�TE �IJSLfl
COOE� INSPECTIONTYPE
206 Final Mechanicel
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final5lte
250 Final Building/Occupancy
f� ate �� Z_
Date
PA7E It�lLS
� Pfl0.1ECT �UDPESS: "j Q$ S WIMB I,EDON WY
awxee�sxeM¢: gREDERICK ELLIOTT
I �onness: gAMF.
545-1G46
�NCHIFNGINiEfl:
RODflE55:
flEG.NO.:
uxiT:
UNR:
PENMRTEE: FRFDERICK ELLIOTT ('714)545-164G
ROOBESS: - 3Q8S WIMALEDQNWY
C.M. CA 92626
IICENSEO CONTNICTOB �ECLAIW710N: I AereEy atlirm t�at I am licensetl unAer pmvisions ol Clupter 9(commencinq wi�h SecGon
7000) of Oivisiun 3 oi t�e Business anE Professions CaAe; anA my license is in tull lorce an0 ellect.
� CITY UC.: STpTE LIC.: C1A33: � �
Date: Sipnawre: � '
WOBIfEBS' COMPENBRTION OECUMTION: I hea6y atlirm Ihat I have a cetliliwte ol conunt to ulf-insure or a ceNficate ot Workers'
Compensation Insurance, or a cenifie0 copy thereof (Section 3800, LaU. CI.
PoIItY NO.: EXP. O�TE:
^-0MPRNY:
Certifietl copy is hereby fumisheE. ❑ Cetlitiea copy is file0 vnt� t�e ciry Buildinp ONision.
Oate: Applicant: �
EIIEMPIION FPOM WOPNEBS' fAMPENSATION DECUNITION: RAis section neee nat be completad il the Oermit is for one hunAreO (E700) or less�.
I cenity ihat in the veAormance af t�e vrork lor wAicA ihis permit is issue0, I shall not amploy any persan in any manner so as to Uecome
su�lect to ihe W9rkers/,' Compensation Laws�bl Calilornia. . //
Date: �/�(��O I SlpnaWre: �'� '� /
NOTICE: If, atler maltinA tAis aeclaration, you s�ou10 6ecome sutject to t�e Workers' Compensation D�avisions al the La�or
COAe, you must farthwith wmD�Y �+t� suc� pmNsions or this permit shall be AeemeU mvoketl.
CONSTPUCTION LFN�ING RGFNCV: I heaEy atlirm ihat ihere is a cansiruction IenOinp aAency for tAe pedormance of tAe work for
whicn Inis Dermit is issueE (Section 3097, Civ. C�.
LENOEH:
aooeess:
OWNEN 9UIlDEP OECLAMTION: I Aere6y affirm ihat 1 am exempt trom tha Contracrors' State License Law for the followinp reason
(Section 7IXi1.5 Business antl Prolesslonal Coae:' My city ot counry wtiich mpuires a permit to wnsimct, alter, impmve, Oemolish, or
repair any sWCNre, pnor m its iuuance, alm requires the aDD���nt for suc� permit to lile a 5ipneE statement that he/she is Ikense0
pursuanl to IAe pmW4ons of tne Coniractors' Stata Licenu Law (C�apter 9(cammencinp with Seclion 7000) ol avision 3 oi Ine Business
anG Professions COEq or that hNshe is exempt t�eretrom anE Ne Easis br the alleOeG exemD�ion. My dolation ai Sectbn 7031.5 6y
any appliant lor a permit suojecis t�e aDPlicam to a dvil cenalry ol not mom tAan five �unEaE Aollars (5500�.
I. az awner o1 Ihe praperty ar rtry em IoyeeS vnih xapes az tAeir Sole campen5atlon, will Oo t�e wOM1. anE t�e
� simcture is wt inten0ea or oflereE br ule (�ctwn 70a4, Busineu antl Professmnal Cotle: Tne Contatlors' SWte Licenu Law
tices not aOUN to an wmer ol a properry w�o GuilEs or improves tAereon, a(M wtw Oaes suc� work himself/�erulf or t�mug�
�is or Aer own empbyees, proviOeO that wc� impmvements am not intenAeU or aflered /or sale. If, Aowever Ihe builtlinq or
, impiovement is saltl witNn one year ot completion, Ihe owner vnil Aave the Eurden oi pmNnq he/s�e Oi0 nat �uilE or impmve
, lor tne ourpose at ulel.
I, as awner of ihe pmpe�ty, am axclusively contractinp wit� Ilcense0 canlractars to wnstmct Ihe Orolect (Section 7044, 8usiness
.❑ anA Prafessions CoOe: ihe Cantractors' Siate �icense Law Eoes no� aDPM �a ��er ol properry who buAtls ar imDroves Ihereon
' and who controcts br such Drol��s wit� a coniracror(s) license pursuant to the Contrattors' State License Law�. I am aware
�i, t�at prool ol I�eir Worker'S Compensatinn insurance stwul0 be provi0e0 ro me.
�� I am exempt untler Section: B. 8 P. C. '
tor ttuc aasan: I/ .
Date: 4 �4lYO \ O,mer. ��+-� � �
I Oo herehy cenity itut I am aware of antl untlerstanC tAe reQuirements of Califomia Mealih antl Salery CoGe SecGo�S 25505, 25533, an
25534 anG t�at 1 or any future builGinp occupam will/will nat (circie one) neeG m comDly with saiA state cotles antl lhe requirements tor a
permit for construttion or mo0ilicalion imm Ihe Air Oualiry Management DisiricL Resitlential constmction applications are exempt irom
theu provisions. ,
Oate:� - ADPlicanC
I hereby cenity t�at I �ave rea0 tAis aDD�ication anA state Itwt Ihe above inlormation is correce I agree m comply with all ciry an0 counry
orainances aM state Wws relatinq to GuilGinp consimctlon anG �ereGy am�orrza re0�5entatWes ol this ciry ro enter upon lM abo�mentlanetl
pmpeM �or inspection purposes.
Date: ��� I� �iqnature: �� �
Driver's license ar Sociai Secunry x: ' ]<{ ^
1641-68 Wnite—BuilEing; Green—CaEe Enlorcemenl; Cenery—Applicanl; Pink—Revenue; GolEenrotl—Auessor
CITY OF' COSTA MESA — BUILDID!G PERMIT PERM NO: A 096801
PERMI'f NO: 0 046801 PLAN CHECK NU: 0347]--90'S GOVT: N SUPF: N
CON5TRUCTION TYFE: PERMII' TYPE: STR PURPOSii: ADP
JQII DESCRIPTION : LEC,ALSZG 353SP PA'PIO COVER SQ FT: ]5]
CLAIM VALUE: �,000.00 CALC—VAI,UG: 4,871.90 GROUP OCC; R•-3 /
coMMcrirs :
if iE 1E 1f §E 1E �E iEif fF 1F iE N� it iE i( if if if iE �lE iP �Ik k fE iElF fF if i(- iE !F iE !E if 3E it it iE iF �� 3E 3E If af iE iE 1f 3E iE it 1Eif If �%1f If k iE i@ �%�� 3F jf iE �F M if k iE �)F �lE �lE �iF?f d( i( if #
Z O N I N G R E Q U I R F. M r N T S
S L' T B A C K S
--------- MAIN BUILDING ---------- -------- ACCESSORY BUILDI�]G -�—�----- •
FRN'T: 21 FT IN REAR: 29 FT ID] FRNT: , FT IN REAR: FT Ild
LEFT: 2 F'T 6 I�l RGHT: 10 FT IN LEFT; FT IN RGHT: P1' ItJ
PARKING REQ; PROV: PARCEL: 41204274 7.NE: PDR— 121:F NO:
PLANNING NOTES> i'OR �ATIO COVGR, ONLY
�
iE iE if iE iE if it iF if if 1E �lf % N if �%iE iE je iE ## iE if if if iF iE k it iE Ik if k iE±E �(-1k if if if iE it ff!(� it iE N-ii iE if iE ?E 9(� it iF K if iE 3E # iE iE )E 3!-jP it ik i6 �1f k�74 �N i4 k it iE �f f4
D E V F. L O P M E N T 5 E R V]' C B S R E Q U I R E M E N T a
7.ONING APPROVED BY _____� __Cp.. �� __ _ DATF.: _ y��J
BUILDING APPROVED DY :_ __ ��"'f��, DA1'E: _
APPLICATTON ISSUF..D BY: i5 )a- DATE: 'ir—'t r�✓
* � *+t+r rt * �%� � * � *+�� i� � +� N� �� �� � ini[�'I�TfiF3FfTiF"4'TF'�iF ���FiF"i7'iF"fF�� * �r ie * �x� � �+e *ib'lF�f"iF�X�'i�"�e i� * *
iE i(� if iE �IE iE iE k i! ih Ih iF k� df ?f iE� iE N if� tiE # M�! if if %� if N it K� 96 iE iF ih i(-�E jf �1f iE # iE iE if �N-1E �E 3F # ik �(- %iE iE iF i!� �E it%iE K� iE iE iE if if ik if'il if iE if K if.•M .y. i�. {E N..7{
LEGALI7.ATION:Y F F� S, U M M A R Y ' STRUCTIIRAL SL:CMEMT:Y
F?LLG PMT PLUMI3IMC ELECTRIc_ ME�HANI:C FIRE SMIP/RES GFtPDIIdG
PERMIT ]44.00 .50
� sMiYir�oN-tt�s,_.
PI.AN 93.60
ISSUL FEE
BUILDING—DIV—> !'I:RMIT ISSUE PLAN—CHECK TOTAL PAID .� DUE
TOTALS----> 194.50 0.00 46.710 191.30 19'1..30 .00
RtiVErIUF. DIi�ISTOhI TOTALS--> COI,I,EC1'ED: 191.30 OVF.R/SHORT: .00
BLDG PMT PI,OMDING ELECTRIC MECHANIC FIRE SMIP/T01' GRADING PLADI�CHCCF:
1A4.OQ .50 4G.II�
1E fE �' iE iF fE jC� if iE # if ## K� 3E if N if ?E k ik # 3E iE if if # if iE if # iE'�1E ##!E dE iE 3E # M k 3f iE � if iE �1E 3E 3E � jE 1f� if 3f Y, if iE iE-iE 1f # if 1E iE if-iE :4 3f iE14. �E 3(14 N� 3f 1E Y 3E
i PI D I V I D U A L P E E D R B A K D O T4 A]
TYPE QTY D E S C R I P T I O PI UTIIT COST TOTP.L COST
SFR 353 RES—PATIU CQl'L'R—POS'P & TRELLIS
ED1D OP FEES
� �
EXPI�,ED
Incomplete Inspectie��,� `�;
� ��
Oate _- Sig � �' � �
` �`
� � r
1J.tiU 4,f371.40
01 000577E�—Op0577E5 TCiT 19+.30
DATE: 04/04/90 TIhE: p9:s3
CONSTRUCTION ANDPLANNING POl .SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r
_ �:
2. Soil Pipe-Undrgrnd. �' _ 53. Steel Reinforcement �" -�
J.
3. Electrical Conduit Utility-Undrgrnd. �� 54. Forms �-. "
4. Electrical Conduit-Undrgrnd. 55. Efectrical Bonding _
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test .-
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE ,.
7. Footings � a.�- ( �, �._ �/ 58. Electrical Conduit-Undrgrnd.
� 8. Foundation �" 59. Gas Pipe, O Undrgrnd., Test '-
��
9. Water Pipe�Undrgrnd. �' 60. Backwash Lines, P�Trap, O Undrgrnd. '
10. Structural Floor System 67..APPROVAL TO DECK ��S
11. Property Sewer Line & House Connection � r 62. Backwash & Receptor�Final �� -
M1
12. Sewer Cap ' 63. Heater & Vent-Final � ��
-# �
13. Roof Drains �� ���
64. Plumbing System - Final �
14. Rough Plumbing 65. Electrical-Final �y '
15. Rough Electrical-Conduit 66. $olar System-Final `�
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
16. Fough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPflOVALS �. Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating � 77. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framin9 � 73. Undergrnd.StorageTank OGas OOiI
25. Roof Sheathing .. 74. Overhead Hydro
26. T-Bar Ceilin9 (Structurap & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � , 77. F�XED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT .
31. Plaster Brown Coat 79. FINAL INSPECTION ,
32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heatinq & Air Conditioning ._ �:•,���-' ��
35. Final Gas Pipe-Test '
36. Hood or Canopy " ' -
37. Final Factory Fireplace • '` .
38. Final Plumbing , � �
39. Water Service�Final . �
40. Gas Service�Final ' ' .
47. Solar pomestic�Final �
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation SYstem .
45. Sound Attenuation °' �
� �
46. Handicap Regulations E X P I R E D
47.FINALSTRUCTURE&BUILDING �, I�COfTI ete i1SpCC10
t
48. FINAL PLANNING ' r-� Vate �/ Slg �.� ��
49. Electric Release to Edison � '
s
50. Gas Release to Southem California Gas Co � �� � _
i � M'
51. CERTIFICATE OF OCCUPANCY
No. Date
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COSTA MESA BUILDINGSAFETY DEPARTMENT APPLICATION F�lI?�6TR�1L�'II[{�+IL`�ERMI'Fe�•81 T�Le
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 �y ' '
RECEI VEy pY PERMIT � �„ � � � � � �
For Applicant to Fill in Completely - Use Ink Only
ADIDRESS 3485 Wimbledon Way
OWNERORwimbledon Associates
TENANT
MAIIING 14'�Q Jamboree FiC{.
ADORE55
cirv Newport Beach N�40-6800
coNsraucrio�mperial Savings & Loan
LENDER
BRANCH Pasadena
ADDRESS (1 �. Lake Av2.
ARCHITECT _ _ _ . . TEL._ _ _ __ _
CONT
ADDRESS
c�rv Newnort Beach N�64U-bif
STATE � CITV
uc.No. 273g75 uc.No.18873
SI2E NO.OF BLDGS
OF LOT NOW ON LOT O
USE Of
Separa[e permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOR�
PRD�New Construction
Single-family dwelling
I hereby acknowledpl �hat I hava reatl this appllcation end state
that tha abova informetion is correci and apree io comply with
all laws repulating builtling construction, antl I shell not employ
any permn in violetl0� of the workman's companaation laws of
Me State of Californi9.
I hereby centfy ihat I am properly licensetl as a contrector untler
Me S[ate of Californle Business antl Pwfessions Codu, Divisiun 3,
Chepter 9, end that sNch licansas are in full torce end effect, or I
em ezampt trom the p�ovisions ot the Steta of Celitornia Business
and Profassions Cotle, Division�hapt 9.
Sip^ature Of
Permittee –•
o� . Z � . a'�%
Authorizetl Apent Date
A.P. NO. � ��— O T os ���
ADDRE55 3485 Wimbledon WdY
UNITOR $
SGACE NO.
TR,NO. l_p7 BLK.
1�2%5 8
NEW ADD AITER REPAIR MOVING DEMOLISH
X
�sE PRD
ZONEPpR-L T
APPqOVED
BV
APPROVEDSETBACKS
(FROM..��.: "o�+^.vcT)
Assoc.
VALUE
• s
DATE I
PLiiNNING ACTION -�
Z�. —lD�� 7 APPROVED � ��'�S
caP ov
dQLD FOR SPECIAL REo ntT�
THE AMOUNT S4iOWN UNDER VALUATION IS FOR
THE PUFPOSE OF ESTABLISHING A PERMIT FEE ONLV:
VALVATION PERMIT FEE E 3� f
PLAN CHECK S
$y?� 3�o TAX = .�
TOTALPAID a�D9_A/
AGP��cant lo fi11 In all
CITY OF COSTA MESA
CONSTRUCTION PERMIT
Address
wltnln neavy eortler lines ana sign all approoriate tleclaratior
TRACT NO. ' LOT NO. BLDG. NO.
}TyVjPE OF CONSTRUCTION
1�' PhOne /�EW ❑ ADD ❑ ALTERATION
� ❑ f3EPAIR ❑ CONVERSION ❑DEMOLISH
License NO. ❑ OTHER
DESCRIPTION OF WORK
LICENSEO CONTRACTOR DECLAH'ATION '� �
I hereby afflrm that I am Iicansetl untler provlsions ot Char[er 9(com-
mencin9 wi[h section 7000) of Dlvision 3 of the 8uslness antl
Pro/essions Cotle, antl my Ilcense is in full torc antl elfect.
LJcense Class � �'1 License N��•
Date���-4 � Si9ndtur —� �
WORKERS' COMPENSATION DE RATION
I htreDy affirm thai I have a cerl fl ale ot con5enl to sel(-Insure or a
certiflwle Of Workers' Compensa n Insurance, or a cerUfletl copy
tnereot �Sec' n 0 Lab. C.). �–�� /,�..�,'�
MIIcy�No. Companyd.+T^����.iiu��
'er{Itietl Copy is hereby turnishatl.
,ertl/ietl copy is filetl with the city Builtling Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sectlon neetl not be mmplotetl If the permit is lor one huntlred
(E300� or less).
1<ert fy that m the performance of the work for which tnis permi[ is
Isiued, I shall not employ any person in any manner so az [o betome
Subj¢Ct t0 the Wo�ke�5' CompensatlOn Laws ot Califo�nia.
Date Si9nature
NOTICE: It atler making this tleUaration, you shoultl become sub�ec[
to [ne WOrkerz' COmp¢nsation prOvizlOns ot [he Labor COtle, you mu5t
fOr[hwith comply with Such provl5lont o� tnis pe�mit Shall be tleemetl
revokatl.
CONSTRUCTION LENDING AGENCV
I hereby a(tirm lhat there is a constructlon lentling agency tor tne per�
forman<e ot [he work for whith this permit is issuetl (Sectlon 3097
Civ. C.).
Lentler's Name
Lentler's Atldress
OWNER BUILDER DECLARATION '
I hereby affirm ihat 1 am exempt Irom the Contrac[or'S LlcenSe Law for
lh2 (OIIOWIl1g lEd5011 (Se<tion 7031.5 Business dtld Professlans Cotle:
Any city br county which r¢quir¢5 a permit to ConStruct, alter,
improve, tlemolish or iepair any structure, prior to i[s issuance, also re-
qWr¢5 th¢ dppliwn[ for su<h p¢rmit to file a signetl siatement tltat he
is Iltens¢tl pursuant to th¢ prOvi5ion5 of the ContrdctorY l.iCenSe Ldw
(Cnapt¢r 9(mmmencing wi[h Settlon ]000) ot Division 3 of the
Business anC Pro(ession5 Cotle) o� that he is exempi th¢r¢trOM antl th¢
ba5is for the alle9¢tl exemption. Any violation of $ection 7031.5 by
av �plicant fo� a permil subjeGts [h¢ appliCant to d dNl Oenal[y
o .more than five Ountlretl tlollars (5500).
L. a5 owne� ot the O�oPerty, or my employees witb waqes as their
sole compensation, will tlo tha work, antl ihe sVucture is not Intentletl.
Or offeretl for SdIC. (52Cti00 7044, BIISip¢55 dOtl R'O(¢SSi0�5 COtl¢: Th¢
Coniractor's License Law tloes not apply to an owner o/ a property
who builtls o� imp�oves tM1e�eon, antl who tloes such wo�k bimself Or
Ihrough h15 own employees, provbetl that such improvemenls a�e nol
in[entletl or ofteretl tor sale. If, howeveq ihe builtling or Improvemen[
is soltl witnin ono yea� of completion, the owner will haw tne burtlen
of D�ovinq he tlitl not builtl or ImprOve fo� the pu�posa of sdle).
❑ I, as Owne� of Ih¢ prOpCrty, am ¢x[lusively contraClin9 with
Iicensetl contractors to construct the project (Section 7044, Business
antl Protessions Cotle: The Conlracto�'s License Law tloe5 not apply to
dn owner of property who builas o� improves Ihereon, dntl who con-
tracts from such projects with a contractor(s) licesned pursuant to
the Contracmr•s �icense Law�.
❑ I am exempt untler Seclion B. & P. C. for [hi5
reason
Date - Owner
I hereby certity that I have reatl thiz applica[ion antl siate that tne above
Informalion is correct. 1 a9ree to COmply with all tlty antl cOuniy
ortlinanc25 antl State laws lelating to cOnstruttion, dntl h¢reby authOfi2e
r¢prese ta[ives Of thi5 c}i .y�`o Bnt¢r upon the aoove mentionetl
proper�(n� inspe[[}pn��purqbjes. . � � � ,
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL LUMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION
SQ. FT.
OCCUPANC V_ CONSTR V CTION TV PE
VALUATION ZONE
GRADING CV. YDS. ACRES
PLUMBING
TOILETS
LAVATORIES
KIT. SINKS
SERVICE SINKS
PLANCHECK
URINALS
DOUBLE LAVS
DISHWASHER$
SUMPS
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTRAP
WATERSERVICE ALTERATION
GASSERVICE OUTLETS
WATER HEATERS BTU OVTPUT
' n., u/ f a i e
SOLARTANK
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL
HEATING SVSTEM
AND DUCTING
REFRIGERATION
SVSTEM
COLLECTORS
PLANCHECK
0-300,000 BTU_
300,000 + BTU _
0-300,000 BTU_
100,000 + gTU _
BOILERS BTU
SYSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
Drivers' Li s or 55 �__ �, ISSUE FEE
CMF OB6 -4 Whi[e-Bullding; �anary-Applican[; Pink-Accounting; Goltlenrotl-ASsessor
A.P. �
ZONE
REAR VARD (TO P/L)
PKG. SPACE REp.
STREET WIDTH
SPECIFL CONDITIONS:
ELECTRICAL
PLNG.REF.
PROVIDED
PARK FEE E
PLAN GHECK.
GENERATOR 0-1 KW_1-10 KW _
TRHNSFORMER
APPI_IHNCE 30-SOKW_SO+KW_
MOTORS 0-1 MP_1-10 HP _
(INC. SOLAR) ]p-50 HP 50 i HP _
FIXTURES OUT�ETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
PANELS MAIN SUB
SERVICE AMP
ISSUE FEE
APPUCATION APPROVED BV �./� � OATE
SUMMARV OF FEES
BUILDING
' � PERMIT E
PLHN CHECK E
PLUMBING $ ' �V
PLAN CHECK S
ELECTRICAL S
PLAN CHECK $
MEGHANICAL S
PLAN CHECK 5
SMIP E
PERMIT
ISSUANCE S
GRADING E
E
MICROFILM §
TOTALFEEE
LES$ AD�
VANCE PC S
FINAL FEE E `� !�
T�
CONSTRUCTIpN AND PLANNING ' POOL & SPA . '
APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
1. Temporary Electricai Service or Pole 43. Pool & Equipment Location
2. Soil ipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn � 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electriral UFER Grn 48. APPROVAL TO CQVER-GUNlTE
7. Footings ' 49. Electrical Conduit-Undr rn
B. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 57. Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVALTO DECK
11. Property Sewer l.ine & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing .7-/�{-S/
14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final
76.� Rough Heating & Air Conditioning • encing & Access Approval
77. Ducts, in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frame and Flashin NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Cqat �
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & qir Conditioning
30. Final Gas Pipe-Test "
31. Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem �/�/�S/
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison -
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date
OWENS-CORNING
Fiberglas
�lanket Insalateon
The contractor named below certifies that the Owens-Corning Fiberglas
Blanket Insulation used carries the NAHB Research Foundation, Inc. label
for assured thermal performance and that the Blanket Insulation is in-
stalled in conformance with current energy conservation regulations,
California Administrative Code, Title 25, State of California, in the building
located at:
Sireet
�
Number
Exterior Walls
Owens-Corning Fiberglas Blanket Insulation
Ceilings
Owens-Corning Fiberglas Blanket Insulation
Floors
Owens-Cornin Fq iberglas Blanket Insulation
Foundation Walls
Manufacturer Type
rQ o� %S
Tract Number
.�/ " �i
Thickness R-Value
�„ �
Thickness R-Value
Thickness R-Value
Thickness - R-Value
,
General Contractor License No.
,gy TiNe , Date
(Slgna W re7 j�_
Insulati ontractor_ ��- ��n 1�,/ �/� License No. �����5
By �'���� _ _ Title V /"� Date
1 oamre>
� Homeowner Copy (White)
State Copy (Vellow) .
Builder Copy (Pink)
Pub No. 16�BLfi995-A" � Litbo m U.S N.. July 199) �
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Fiberglas Tower, Toledo, Ohlo 43659