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Home My WebLink About3330 WYOMING CIR - Building Permitsa PFOJECT AOOflESS: j 3 3 O WYOM I NG C 1 UWNEPwNpME: HY.NRY� JERRY J �. auoxess: HENRY MARIAN R 3330 �7YOMING CIR COS'CA MESA, CA 759-6201 APCMIENGINEEB: RDUqESS: UNIT: 92626 flEG.NO.: UNIT: PEflMITTEE: CHAMPION ROOFING ( 213 ) 259-0451 RODflESS: 3 Z S% VERD UGO L,A. CA 90065 LICENSEO CONTFRCTOR OECLRNATION: I hereUy affirm �ha I am I seA unUer D�ovisions ol Chapter 9(commencing with Sec�ion 7000� ol �ivision 3 olihe Business antl Professions CoOe. an y li e se is in lulllorce an0 eflect. cirruc.:04/217 5 TatEuc.:47.9481 — �ele* /� �l— Signaiure: _ WOFNE S' C�710N OECIAHATION: I hereby aifirm Ihat have a cenificate of consem m selbinsure or a cetlificate of Workers' Compensalion Insurance. or a certilieC coDY thereol �Section 3800, Lab. C�. raucrxo.:1250297 E%P.ORTE: OS 1/92 comraxv: STATE FUND ❑ Cetlified copy is hereDy fumi5�e0. � Cerlilied copy i ith the cii ui ' l�. q -BefB: � // Applicant E%EMPTI N FflOM WOHREflS' fAMPENSFTION OFCNflRTIQN: Qhis se ' neeA no� �e completetl i� Ihe permit is �ar one huntlre0 ($1W) or less�. I ce�ify Ihai in the peAormance of �he work for which Ihis permi� is issueq I s�all not employ any person in any manner so as to become su�iec� to Ine workers' Compensalion LaxS of Calitomia. Da�e: Signalure: NOTICE: It, a�ter making ihis Oeclaraiion, you should becom SuDled �o Ihe Workers' Compensation pmvisions o� �he La�or Code, you musl fart�with campry with such provisions or �hi permi� shall be tleemetl revoked. CONSTPUCTION LENOING AGENCY: I hereby a��irm that �here is onSlmclion lentling agency �or the pedarmance ol t�e work for which ihis permii is i55uetl (Section 3097. Civ_ C�. LENUEH: FODNESS: OWNEfl BWLOEfl OECLAflFTION: I hereby affirm I�at I am exempt imm t�e Contracmrs' State License Law tor the lollovnng reason (Seclmn 7031.5 Business antl Professional Code: Any ciry oi coun�y which requires a permit b consimc�, alter, improve, 4emoiish, or repair any slmc�ure, Drior �o ils issuance, also requires Ihe apP�ican� �or such permit to file a signetl statemen� Iha� he/she is licensetl pursuanl to Ihe pmvisions ot t�e Comracmrs' S1aIe License Law (Chapter 9(commencing with Sec�ion 7000) of Division 3 0� �he Business anU Pmiessions Code) or Ihal �e/she is e�em0< <here�mm antl �he basis for t�e alleBed exemption. My violation of Sec�ion 7031.5 6y any aDDlitani for a De�mil SUbletii �he applicanf �0 a Civil penalry ol noi mare ��an live �untlretl tlollars (E500). I, as owner oi �he proDehY or my employees wi�h waAes as Iheir sole compensa�ion, will do the work, and Ihe ❑ s�mc�ureis nolinlen0ed oroHeretlforsale�5ection 7044, Business and Pm�essionalCoOe' The Conlrac�ors' S�a�el.icense Law tloes not aDPly lo an owner o� a pwpe�y w�o builtls or imOroves t�erean, and who does suc� wo�k �imselt/herselt or t�rough �is or her own employees. O�ovidetl tha� such improvemen�s are no� int¢nded or ofle�ea lor sale. tl, however lhe building or impmvemen� is 5o10 vn�hin one year ol completion, �he owner will have I�e burden ol provinA he/she Oitl not bui10 or impmve for Ihe purpose of sale�. I, as owner a� Ihe pmperty, am exclusively con�racting wi�h licensed con�ractors to constmct �he pmlec� (Sedion 7044, Business ❑ antl Pmiessions Coae: The Conlractors' State License Law Oces not aDDly to an owner oi pmperty who UuilOs or imD�oves Ihereon antl who comracts br such pmiecis with a commcmqs) license Dursuam io tAe CamractoK State License Law�. I am aware ihat proof af I�eir Worker's Compensation insurance should 6e O�oviaed to me. � I am exempl untler Section: 8. 8 P. C. lui �his reason: �ate: Ownec I do hereby cenity that I am aware ol an0 unaerstantl Ihe requirements oi Calilomia Health an0 Safery Coee Sections 25505, 25533, and 2553a antl iha� I or any IUWre bmlding occupani willlwill nat (circle one) neetl Ia comDly wi�h said s�a�e codes and the requiremeni5lor a permi� for con5lmclion or modificaiion iwm the Fir Ouality Managemen� Distric�. flesitlential cons�mction aDPlica�ions are eaempt irom these provisions. oate: Applicanll I �ere�y cetlify��at I have read Ihis apPlica�ion antl slate thai h a oveinforma�ionis wrrec�. I agree b camply wi�h all ciry and county orAinancesantlsrolelawsrelalingtoUuiltlingmns�mcti ntlh eby hor¢erepresentativeso��hisciry�oenterupan�heabove�mentione0 pmpetly lorinspection purposes. —Be1e'. � Z SignaWre � oriver's �icense or Socia� Sewriry e: t6at�a6 White-9uilCino'. Green—Cotle EnlorcemenL Canarv—Aoollcam; Pink—Revenue: GolQenrotl—Awessor CITY OF COSTA MESA — BUILDZNG PEAMIT PERM NO; B 055� PERMIT NO: B 055877 PLAN CHECK NO; N GOVT'; N SUPP: N CONS'TRUCTZON TYPE; V—N PERMIT TYPE; STR PJRPOSE: ALT JOB DESCRIPTION ; T/OFF RERROF W/COMP SQ FT: 1,500 CLAIM VALUE; 1,SOO,OU CALC—VALUE: 1,500.00 GROUP OCC: R"-3 / COMMENTS: SMORE DETECTOR RE�UIRED IN THE HOME - iEaEififlfiPif�1(�iFjElEiFiFiFiEIEiEifiEiF3fjF3FiE�)fifif 1EifiElfiEiFi'riF3E3E3f�iFifiFjEiEjfiEiEiEiFiFiE�EifiFifaFiE#jf#�EiFifiEiFifiEiFiEiE3ilE1E-0EiEiFifaeif Z O N Z N G R E Q U I R E Ni E N_ T 5 S E T B A C K S ------------ MAIN BUILDING ----- FRNT: FT IN REAR: FT LEFT: FT IN RGHT; FT -- --------- ACCESSORY HUILDING --------- IN FRNT: FT IN REAR: FT IN IN LEFT: FT IN RGHT: FT IN PARKING REQ • PROV; PARCEL; 13961112 ZNE; REF NO: PLANNING N�3T'ES>, ��. � if if if iE iE 1f 1E it if iE iE if iF if #1E 1E iFlF 7E if �IF iF iF iF if if iE �lE 1F if iE if� If it iE !E 1F �lEif �)F lE �F if 1f iF iE if if !F IF i! iF it 1F iE �1f !E iE IE iF 1E ie ie iF iF �f 3E iF iF if 1F iE iF iE iE 1f IE 3E D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N-',T S /,�„ ZONING APPROVED BY DATE: � BUILDING APPROVED BY : _ DATE: ri APPLICATION ISSUED HY: • DATE; I�� _ if iE iE iE jF iEiF 3E 1FlF If iE 3f i(,if 3f iP if iE if iE it3F7F3FiFiFiF3F if3F3F3EiF'iF3f TF3F £iF3F�FiF3F3F�f3i3F 3f iF'iF3F if iE iE iE iE 3F �E If 3f iE 1E iE iF IEiE3E iE iF iE iEif if iE�lf )F If lE iE �1E 1E aE if k jE 3E jf 1k �)f k iF ik k k i4 iF iF it fE 3f 3F 3k iF 3f k it iF M iE iF iF iEiE iP ik iE i! if ik iE if if iE ib iE iE iE if� iE if iE ie if �F lf iF 3E iE ii if iF �k LEGALIZATION;N F E E S II M M'A R Y STkUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC 1dECHANIC FIRE SMIP/RESy GkADING PERMIT 35.00 ,50,� SMIP/NON..—RES ISSUE FEE ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID � D00 TOTALS----> 35.50 0,00 0,00 35.50 35.50 % REVENUE DIVISION TOTALS--> COLLECTED: 35,50 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING P,LAN—CHECK 35,�0 .J� �y �f 1F iE iE if iE 3E±E 3E iE 3f �FiF ik 3f if 1E iF # if if if 1F iF iE iE 3(� if 1E if if iE iE �E iE if iE iE if iE 3f 3E if 3F 3F iE iE iE if 3E �k if if 3F iF if fE 3f iE iE �E �F 1E 3E iF iF ik If jf i} iE 3E iE iF iE i4 �f jE if I N D I V I D U A L F E E B R E A K D O W N � TYPE QTY D E S C R I{� T I O N UNIT COST TOTAL CO3T �� r ; SFR, 1500 REROOF BY VAi,UE RESIDENTIAL NOZONE 1,00 �� 1•,500.00 � � END OF FEES �' � � � � fl. �,�2cEV3115� / :�'. C�JNSTRUCTION AND PLANNING- ` POOL 'A � APPROVALS Permit # ' Date Inspector AppROVA�LS Permit # Date Inspector Y. Temporary Electrical Servibe or Pole , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. ElecHical Conduit-Undrgrnd. ' 55. Elettrical 8onding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrital UFER Gmd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. S. Foundation � 59. Gas Pipe, Cl Undrgmd., Tpst 9. Wa[er Pipe-Uhdrgmd. • 60. Backwash l.ines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 71. Property Sewer Line & House Connection, 62. Backwash & ReceptorFinai 12. Sewer Cap � 63. Heater & Vent-Finai 13. floof Dreins 64. Plumbing Sys[em � Pinaf 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 � 78. Rough Electricai�T Bar Ceiling 69. POOL(SPA SYS7EMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factor�Y Fireplace APPROVALS Permit # 21. DuCts,in Structure 70. Underground Hydro 22. Ducts, Ventildting 71. Product Piping �Gas ❑Oil . 23. Gas Pipe-Rough & Test , 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank O Gas D Oii 25. Roof Sheathing �/21.�Z �W �-pverhead Hydro 26. T�Bar Ceiling (Structural) & Monocoat • 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe - 28. Lathing & Sid�ng- � 77: FIXED SYSTEM FiNAL 29. Insulation � 78. FIRE PREV. FINAL 30. Drywall Nailing � � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . , 79. FINAL INSPECTION 32. Electrical Power MeterFinal 80. FOOD CEPTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - � . 35. Final Gas Pipe-Test � 36. Hood or CanopY 37. Final Factory Fireplace ' 38. Final Plumbing � - , _ 39. Water Service�Final • � 40. Gas Service-Final 41. Solar pomesuc-Pinal 42. Backtlow Preventer � 43. Backflow Irrigation 44. Landscape Irtipation System . ,- 45. Sound Attenuation .. . 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING -L�,12 ��,�[_ S �� 48. FINALPLANNING �, , !/ c�v�� 49. Electric Release to Edison . 50. Gas Release to So�them Cafifornia Gas Cn ,'� " { 51. CERTIFICA7E OF OCCUPANCY No. Date AVO�icant to fill in all sDaces except ihose wit�in neavy Cortler lines ana sign all apvro0��ate Eeelantions. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. ProjectAddress �3�z0 �vpm�ha i•'li _ T Apr;licant's Mailing, �A^dvdress Od� Name �L r Phone Addresa 4 ArCh/Enq. License No. AddrE�s Coniractor's Nam q Phone � Addresslmailingl--;is�f>7 Uor_� i Cicy Licensr No y� LICENSED CONTRACTOR DECLARATION I hereby altirm lhat I am licensetl untle� Orovision50f Charte� 9(commencing wit� 5ection 7000) oi OivisiOn 3 Of Ih¢ Busine55 antl Prote55ions Cotle, antl my license is in full torce�n� tect. n 4� �.9�f8 I Datense,f�/�r� v�ctona��.n !Y�/N/1/1/I�Je No. ' 1 i �.+� WORKERS' COMPENSATION DEC �ATION I hereby aHirm [nat I nave a certificate ot mnsent [ elbinsure or a certitiwte ' Workers' Compenza[ion InSurance, or a certi/'etl coOY Ihereot (Sectlon 00, Lab (�/� /f � vol'cy No.��/�/D�� Company V`� � Cerli/ietl copy iz nereoy fumisnetl. Certif tl c D�Y�{ ilietl with tne city Bwltlin I Date P�j`�--- AOPlicant EXEMiT10�� F- OK M WORKERS' COMPENS TION D RATION (This section neetl not be completetl if tne permit is for untlretl (5100) or iess). I certify that in tne performance of che work for which this perm�t is issuetl I shall noc employ any person in any manner so as to become subject to t�e Workers' Compensation Laws of California. Date Si9nature NOTICE: If, aRe� makMg this tlecla�ation, you shoultl become su0ject to the Workers' Compensatlon Orovisions ot the Labor Cotle, you must forthwith comply with such orovisions or ihis oerm{t shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby affirm that there is a construction lentling agency for t�e performance ot tne work Por which this permit is issuetl (Section 309� Civ. CJ Lentler'z Name LenCeYs Atltlrezs OWNER BVILDER DECLARATION 1 hereby aftirm t�at I am exempt irom the Contractor's License Law for the lollowing reason (Section ]031.5 Business antl Protessional Cotle: Any city or cOunly whicb �equire5 a pe�mit lo construtt, alt¢�, improve, tlemOlish o� repai� any sVucture, prior to its issuance, also requires the aoP��ant for zucn permit lo tile a signetl statement that h¢/sh¢ is licensetl OurSuan[ to the p�ovisions ot the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Cotle) or that he/she is ezempt •from antl ihe basis for the alleqetl exemption. Any violation of Sectlon ,.S by any applicant fOr a pe�mit subject5 the applitant to a Civil ♦� �Ity of not more Ihan five huntlre0 tlollars (E500�. LJ 1, as owner ot the property or my employees with wa9es as their sole compensation, will tlo the work, antl the structure is not intentletl or offeretl tor sale (Section �044, Business antl Professional Cotle: The Contractor'S License Law tloes not appty to an owner of a proPerty who builtls or improves thereon, antl who tloe5 suth wo�k himself/herself o� th�oug� hi5 or h¢r Own employee5, provitletl tha[ such Imp�ovements are not inte0tletl or offeretl Por sale. II, however, the Duiltling or improvement is soltl witM1in one ycar ot com- pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- prove for[he purpose otsale). ❑ I, a5 owner of Ihe property, am exclusivety mntracting witn IicenSetl COn- tractors to construct the project (Section 7044, Business antl Professions Cotle: The Coniractor's License Law does nol apply to an owner of property wno builtls or improves thereon. antl who contracts for such omiects with a con- tractor(s1 license pursuan2 m[ne Contracror•5 License l.aw). I am aware that prooi of their Worker's Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section B. 8 P. C. for this reason Date owner 1 Itereby tertlty that I have r¢a information is wrrect. I agree to antl state laws relating to uiltlir sentallves ol t�is city t r inspac[ion purposes. Signature Drivers' License or 55 application antl state that [he above y wrth all city antl county o�tlinances Vuction, antl hereby authorize repre- the above-mentionetl property_for 3 ,.5- TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTH R DESCRIP710NOFWORK/USEOFBLOG. ��D � YIO ' TVPE OF PERMIT LI GRADING LJ FOUNDATION pLf STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 54.F7. � OCCUPANC CONSTRUCTION TYPE �S� VALUATION S ZONE GRAOINGCU.VDS. ACRES Remarks: /hYh�i. �M (�n� /111V)Y 1/� . � i1 A. Sink Preventer Irrigation Drinkin9 Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavarories P—Trap Roof Drains peinspection Fae � $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt �CBO �k Heating System & Ducting ❑ ai oo,000 sru O i oo,aoo peinspaction Fee � $15 OB65-46, rev. 5/BB � White - Builtlin9: Canary - Applicanh Pink � Accounting; Goltlenrotl � Assessor PLUMBING Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wesh Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System ❑0-700,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES A.P. qW S Main Building: E T Front A Rear C Right g Left Ping. Ref. # Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer � Transformer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas �Elec[ric Fan F.A,U. Fixtures Device Boxes Outlets $WISCI125 Garhage Disposal Generator �65 KW �5-15 KW Zone ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter �overt00amps Sub Panel Motors O0.1 HP O1 �- 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range Sign • Standing Sections - ' Trash Compacmr . Fee �$15 � � luue Fee ' ",. �$ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By FEES Building ApP/aved By Appliption Issued By $ 3 BUILDING PERMIT $ PLAN CHECK $ PWMBWG $ PLAN CHECK 25% $ ELECTRICAL $ P�AN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ N I N G R E a M T S. FEES aa OF FEESI/ ' � ;' G��-s �'� SMIP $� . ✓ "' — PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ — TOTALFEE $ 3�,5� oi nU037SII7-G2D3i9�3 3 �"w :` :_ i7nt�* };; if/t9 TIiiE' L?�.4 CONSTRUCTION AND PLANNING '� POOI SPA APPR�ALS` Permit# � Date Inspector p�ppROVALS Permit# Date Inspector e 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3. ,Electrical Conduit Utility-Untlrgrnd. 54. Forms 4. Electri.cal Conduit-Undrgrnd. �� 55. Electrical Bonding , 5. Steel Reinforcement -' 56. Rough Plumbing & Pressure Test - 6. �Electrical UFE�R'Grnd.� 57. APPROVAL TO COVER-GUNITE ' j, 7.-Footings . • 58. Electrical Conduit-Undrgrnd. S� Foundation , . 59. Gas Pipe, O Undrgrnd., Test 9._ Water Pipe-Undrgrnd. -� � �-', 60. Backwash Lines, P-Trap, O Undrgrnd. � lO�Structural Floor System � 61. APPROVALTO DECK 11 . Property Sewer Line & House Connection -• 62. Backwash & ReceptorFinal , -72. 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 Apprbval 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 1�8.. Rough Electrical-T Bar Ceiling 69. POOUSPA 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 O Gas ❑ Oil 23��Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing �_ 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing �+� ' � _ � • _74. Overhead Hydro . ' ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe 28. Lathing & Siding , 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. PlasterBrown Coat� 79. FINAL INSPECTION 32. Electrical Power'Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 9� 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer �, � ,. 43. Backflow Irrigation � � " 44. Landscape Irriqation System �, � 45. Sound Attenuation �� i . i',' 46. Handicap Regulations ' " "' , �, 47. FINAL STRUCTURE & BUILDING ^ _ � �3 9a 48. Special Requirements Completed ?,�.o ��ja J B-C �� 49. Electric Release to Edison �i` � 50. Gas R�lease to Southern California Gas Co _.� . 51. CERTIFICATE OF OCCUPANCY ' ^� 'J � No. Date �" , ADO�ieant t0 fill in all spaces except thoze wilhin heavy bortler lines antl sign all appropriate tleclarations. C1Tv oF'Cosra MESa CONSTRUCTION PERMIT ' Project Address � Applicant's Mailing Address, �� /� Owner'sName' �� Phone-2�2�ClJ-SV/ Address �— Arch/Eng. _License No. Address q Contracmr's Name hone'{�S'UJ�� Address (mailing) City License No LICENSED CONTRACTOR DECLARAT�ON I hereby af/irm that I am licensetl under Provisions ot CM1a�te� 9(mmmencing with section 7000) of ,Division 3 of the Business antl Protessions Code, antl my Ilcense is in f I e antl effect. License a Li Dete Si9nature WORKERS' COMPENSATION DECLARATION I hereby affirm tnat I have a certificate of consent to self-insure or a certiticate �of-Workers' Gompensation�insura.�{g, q[.-� certifietl copy thereof (Section 3800, tab. C c9qy�/'L3 Policy No. COTPany � �n µ,,ertilietl opy is hereby nishetl. , � JLJ cert� �e opy is tiletl with the city B� �v' on. / Date�_ Applicant ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl if the permit is io� one huntlretl ($100) or less). , ' I certify that in the performance ot the Work for which this perm�t is issuetl, I stlall not employ any person in any maPner So as to become subject to the Worke�s' Compensation Laws ot Califomia. Date Signature 'NOTIGE: If, after making this declaration. You shoultl become 5ubject to tne Workers' Compensation provi5ionsbf the Labor'Cotle, you must Porthwith comply with such provisions or this permit shall be tleemetl revoked. , CONSTRUCTION LENOING AGENCV ' ' � ' ' � 1 herety affirm that there is a construction lendin9 agency for tne performance ot tne work for which tnis permit is issuetl (Section 309� Civ. C.) LPntle�'s Name Lentler's Atltlress OWNER BUILDER DECLARATION � I hereby affirm that I am ezempt f�om Yhe Contractor's License Law tar the followin9 reason (Section ]031.5 Busine5s and Professional Cotle: Any city or county which requires a permit to construct, alteq improve, tlemolish or repair any structure, pri0r to its issuance, also Yequires the applicant tor such permit �to file a siqnetl statement that he/she is licensetl pursuant ta the provisions ot' the Contractor's License Law (Chapter 9(�ommenan9 with Section 7000) of _.pivision 3 of the Business antl ProfessiJns Cotle) or that he/she. is exempt ;?'�.¢erefrom antl the basis for the alle9etl 2zemption. Any violation.oi Section ��"'031.5 by any applicant for a permit subjects'the applicant to a civil '�benalty of not more than irve huntlretl tlo�lars($500). , � ❑ I, as owner of the property or my employees with wages as their sole compen5ation, will tlo the work, antl the structure i5 not intentletl or otteretl for sale (Section 7044, Business antl profeSzional Cotle: Tne Contractor'S - License Law tloes�not apply to'an owner ofia property who bwltls or improves thereon, antl who tloes such wo�k himsclf/herself or through nis or� M1er own empbyees, provitletl that such improverr�ents are not intentleG or offeretl for � sale. If, boweveq the builtling or improvSment is soltl within one year of com- . pletion, the owner will have the burtlen Of provin9 he/she tlitl mt builtl or im-' p�ove for the pu�pose ot sale). ' ' ' ❑ I, as owner of the property, am exUUsively wnt�acting with licensetl con- tractorsto construct the pro7ect (Section 7044. Business antl Professions Cotle: The Contractor'S License Law tloes-not apply.to an owner of property.who builtls or improves [hereon, antl who conVacis for such projects with a con- � tractor(s) license pu�suant to the�Con[racior's License Law). 1 am aware that proof of their Worker's Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason . Date Owner, _ 1 hereby certity that I h5ve reatl this intormation is correcL I a9ree to comp antl state laws relating to builtlirig wn sentatives o this city to enjer. upoi inspectian r o5 n /lm+�� Si9nature �� —_— � ( P _ ee CMF 0865-46, rev. 10/H4 White - Builtling; Canary - Applicanh, Pink - Accountin9; Goltlenrotl - AsseSsor $75 PLUMBING Sfiowers Service Sink Sewer Cap Sewer Connection Solar Coilectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Gdset ' Water Heater � Water Service . Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System �00-100;OOOBTU �100,000 System Repair/Alteration � Fire Dampers Registers , Issue Fee $_3 FE $ 3 Automatic Washer Construction Pole Su6. Cookin9 Unit � Dishwasher � . � Dryers ❑Gas ❑Elec Fan � . F.A.U. , Fixtures. Device Baxes OutIeYS Switches Garbage Disposal � Generamr DO-5 KW C Fee 3579 G�2'=/35 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps �� Meter ❑over100amps - Sub Panel Motors OO-1 HP 01'/: - 8 Inc.Solar 09'15 HP 016-15+ Microwave Pole �ight ' ' � Range C { - l . FEES ; Standing Sections , 5 KW Trash Compactor , $15 Issue Fee ' ; $ 3 DEV ELOPMENT SERVICES REQUIREMENTS: Zoning Approved By � euilding Approved By ' � SUMMARY OF FEES ' , . BU�LDING,PERMIT : $ SMIP $ � PLAN CHECK � $ PERMIT � PLUMBING � $ � �ISSUANCE � $ PLCN CHECK 25% $ ENERGY P.C. $� ELECTRICAL $ GRADING $ � - � PLANCHECK �50%' $ ' ' MICROFILM � $ � MECHANICAL � $ _ TOTAL FEE $ �D � PLAN CHECK 25%� $ ' . � • Z O N I N G R E Q T S _ � R;.�_ .'r r CONSTRUCTION AND PLANNING � POOL ;PA 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 ConduibUndrgrnd. � 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd�. 57. APPROVALTO COVER-GUNITE 7. Footings 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 61. APPROVAL TO DECK 7 7. 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 77. Product Piping �Gas ❑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 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � . 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing 8-�-(-yZ �.,�.0 � ` 39. Water Service-Final . 40. Gas Service-Final 3-��t 41. Solar pomestic-Final ,'.,.y 42. Backflow Preventer :�' Yt? 43. Backflow Irrigation t�-i . ' 44. Landscape�lrrigation System �r'� 45. Sound Attenuation �,,, 46. Handicap Regulations ` y 47. FINALSTRUCTURE&BUILDtING . 48. Special Requirements Completed y 49. Electric Release to Edison � 50. Gas Release to Southem California Gas Co . 51. CERTIFICATE OF OCCUPANCY No. Date _, � , CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT N0. �•�Cj' � LOT N0. � 9 DATE % - Z S'� 7 � � � The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he-she-they) (was or were) advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. RECEIVED CITY OF COSTA MESA oi nn�vin�r, nFaT. �=� u i� 1971 � �� AM 7iS�9,11?:� 4niak.,.ii4i5�fi � / representiatiive Lender 1 Z . aU zC ON am J � J N Q W p] J J m Q U N Za w� aw wz J � m Z J p� w w � ZF w � N � �O � z a U J 1 d Q � � z � H U � � F N Z ?7 � _. COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 For Applicant to Fill in Completely BUILDING OWNER MO(IU13! Te MAIL ADDRE55 ZZO4 E. 17 cirv Santa Ana CANSTRUCLION LENDER U.S. Nat BRANCH M11I1 OfP A�DRESS I�JQ S. $T ARCHITECT Kermit Do IlF Ff�ll:INFFF CONTRACTOR O�La ADDRESS SdOle CITV S2i[1e ��c No. 252549 OFLOT 54 x 88 USE OF EXI5iING BLOG. OlOgy� IRC. .St.. TE 1' NO. y 31 �9.X1]S W2,y�$3II Dl2 TEL.� TEL. NO. CITV uc. rvo. 1690 'NO. OF B��DC3S. r.inw nni � nr SIZE OF 1�84 NO. OF 7 NEW BLDG. ftOOMS EXTERIOR WALL ROOF COVERING Per P�A.11S COVERING USE OF BV IIDING AND WORK TO BE PEF U 1 NO� —4'�OPA3DO�,�.O`# iFR* � 24.�� LqSA �� APPLICATION FOR BUILDING PERMIT FiECE1VE BY DATERECEIVED OATEISSUI � �� /o aa-7 BUILDING ADDRE55 �Y Residence NO. OF P�P,N$ ' VARDS APPROVED DSTANCEBET MAIN BLDGS. VAR.�C.U.P.#� — APPROVED I haraby etknOwletlBa tha[ I have reetl [his apPlica[iOn antl sta[e [hat Ma ebova information is correct end epree to comply with all lows regulatlnp bulltlinB comvuction, ond I shall not employ any parso� In violation of tha workmen'a compansetion lawa of Ma Stete of Califomfo. . � I hereby certify 2het I am pro0erlv licansotl as e convacror untler SQ. FT. � tha Stata of Cnl(fomiu Bu 'noss antl Professions Cotla, Divisicn 3, THE AMOVNT SHI Chapter 9, entl [hat such eenma are In hll for entl effact, ar I THE PURPOSE OF E am exempt trom the Dr Isions of he S Iifornla B�sin¢as V AlUAT10N antlProfesslonsCo ivieton , o r Signo[ura of � a �[�O� Permittoe 5 •� 7 Auinorr:aa Agom VAW$ �3 ZOO — i USE O E� BUtI.OING VARDS A BET. MAIN & ACCESS BLDGS. OATE �-� � /� APPFiOVED `.(i'V � ..,.r� � �-7--�� A TOTAL FEE C m 0 ION IS FOp ' FEE O/NLV: Q % �/ � � m 7 `j�3, D(� m E `o i� �.O LL