HomeMy WebLinkAbout156 YORKTOWN LN - Building Permits g<55171% k CITY OF COSTA MESA `
,`y I. BUILDING DIVISION
F I 'nen;" 1 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
;Ice. 9-01244'bongo 9-01244
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• BUILDING PERMIT
Job Address: 156 YORKTOWN LN Status: ISSUED
Suite: Applied: 0810911999
Vicinity: Issued: 08/09/1999
Parcel Nunmber: 41916525 Zoning:
Applicant: CORNELL. LORETA ISSUED BY: OS-
Address: 10415 SLUSHER DR - . .
Phone: 562-906-7773 -
SANTA FE SPRINGS,OA. . Zip: 90670
Owner JOVANOVICH, MIROSLAV "
Address %MR,'-MIROSLAV JOVANOVICH ' - '
-COSTA MESA,,CA. Phone:
/.• /156-YORKTOWN LN "' - - Zip: 92626
EXP R D,
Contractor. AMERICAN;HOME IMPROVEMENT DATE " 13'
/Address: 10415 SLUSHER DR
i
-I,/ , ' -; Phone:. 562-906-7773 '
SANTA FE SPRINGS,CA
Zip:: 90670, License: 721379 .
Arch - - - . . • ' Eng:
/
Address: - - Address: - ,
- 'Phone: - - Phone:
-
', Zip: - , License: License:
/ ` • SCOPE OF PERMIT
REPLACE EXIST. LIVING ROOM WIMDOW WITH VINYL WINDOW OF THE SAME SIZE. `
FEE SUMMARY ,
Plan Check: . $0.00 , Calc Valuation: . ssoo.00
•Permit:. , $23.50 . Claim Valuation: $500.00
SMIP Res: •. ' $0.50 - - - •
SMIP Com: $0.00
' Other. ' $0.00 _
Inspection:, , •. $0.00 - .
Total: $24.00
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)754-5626
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'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My work,'compensation Insurance carrier and policy number are:
Carder: hcM--kM fr jW Policy Number: CHI'QOk-I1f{q-o
(This section need not be komplefed if the permit is valued et one hundred dollars($100)or less.)
❑ 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'
compensation laws of Califo I= and agree that if I should become subject to the workers'compensation Ions of Section 3700 of the Labor Code,I shall forthwith
com. .'. . .vis'•n
an Stan ignature: 'S Date: 2)-9—1 6I
ARNING:FAILU:- •SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
• •• •-E1510g000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICEN • •• :ACTORS DECLARATION:
ereby affirm that I a licensed under provisions of Chapter 9(commencing with Section 7000)of Divis'• of the Bus •ass and Professions Code,and my license is in full
for effect.Lic.# 2-1 31 Class 4 —b
ontractors Signetur:. _`• (Date: i '01
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,CMI 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).):
❑ I,as owner of the property,or my employees with wades 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? ❑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 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 ❑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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ii Yes 01 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 Duality 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.
\_.(1)I $igpp�re If Legal Owner(s) Date- Date
Da
CODE t INSPECTION TYPE PLff INTmAIS BODE/ INSPECTION TYPE PATE INTITM4E
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
•
CITY OF COSTA ESA CON TRUCTION PERMIT PER TRACT NO. LOT NO. UNIT NO.
Project Address T' ..t. a . A e ' P S?19 - LI
Applicant's Mailiinno Addressre /5V3 ( . tfnu1 at stn TYPE OF CONSTRUCTION LI NEW' ADD H ALTERATION U REPAIR
t 'UV R Phon$% 504&'9/ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# • Zone
Owner's Narm� DESCRIPTION OF WORK/USE OF BLDG.
Address - S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION Z
��-I�� ❑ STRUCTURAL T Front 0
Address ❑ TENANT ❑ ELECTRICAL LlPLUMBING ❑ MECHANICAL B Rear N
Contractor's Name ''L a)C, • Phone 22-013/2J. C7 OTHER A
C Right N
Address(mailing) 1J 5� L)PUetc PROJECT DESCRIPTION SQ. FT. OCCUPANCY K O
�e•] CONSTRUCTION TYPE VALUATION $ Left
S R
City License No. alt ZONE GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION _ Ping. Ref. # Parking Req./Provided
0
I hereby affirm that I am licensed under provisions of charter 9(commencing Remarks: Planning Notes: �p} (�A M
t,� with section 7000) of Division 3 of the Business and Professions code, and .RECEIVED SEP 3 0.1988
}l `my license is in full/tn-rc: . d effect. '_( n T
r`l'V Licens: Ia s `- a Lie rio.d/��t�J / S
Date ' '.°•Ear Signature law _ / , .///L PLUMBING FEES
WORKERS' COMPENSATION DECLARATION I
'hereby affirm that I have a certificate of consent to self-insure or a certificate
Bar Sink Showers ELECTRICAL FEES
Workers' Compensation Insurance, or a cer fed copy thereof (Section Backflow Preventer Service Sink
30, Lab. C.�'y/(�//j� /� Automatic Washer Transformer ❑ 15-50 KW
Policy No. t/'/C1 7Cl Company V�"-- Backflow Irrigation Sewer Cap Construction Pole Sub. - 0 50+ KW
El$ertified copy is hereby .furnished. t
Date r£ fed c py k d with the city Bu7/'t��• DIv•�yslPpn ��,y�,�ts Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps . • --
Date 0-75 7 Applicant .0c":71, (��L ^^^�✓"' •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter [lover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or Dishwasher
less). Solar Piping Dryers ❑Gas ❑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 Motors 00.1-HP ❑1'Fi-8 ' •
Workers' Compensation Laws of California. .
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. .
09-15 HP ❑16-15+
NOTICE: If,after making this declaration, you should become subject to the — - - -
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 t Water Heater el 60 Outlets Range -
Lender's Name '
Lender's Address - Kitchen Sink Water Service SwitchesSign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator 00-5 KW 05-15 KW '
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 - -
"refrom and the basis for the alleged exemption. Any violation of Section
11.5 by any applicant for a permit subjects the applicant to a civil
,alty of not more than five hundred dollars($500).
LI 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 c $ 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 ❑ Zoning Approved By Date
sale. If, however, the building or improvement Is sold within one year of com- - Canopy Type II 0
plebe t
the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Date r_
prove for the purpose of sale). Building Approved By
❑ I. as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES .
builds or improves thereon, and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ System Repair/Alteration I BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ PERMIT
❑ am exempt under Section B.& P. C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ �.�� 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 BT GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to me pon the above-mentioned proper[ or
inspection purgA41 / /, 9.n 2� MECHANICAL $ TOTAL FEE $ �6O •
Signature f�4f ` ♦
Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
U 1 00017082-00017082 TOT 5.00
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor DATE: 10/14/24 TINF: 1104
CONSTRUCTION AND PLANNING POOL& SPA
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 c.
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd!
8. Foundation 59. Gas Pipe, 0 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 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 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 _l
35. Final Gas Pipe-Test
36. Hood or Canopy •
•
37. Final Factory Fireplace
38. Final Plumbing I-" 'q L/C0
39. Water Service-Final
40. Gas Service-Final '
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
1
.44. Landscape Irrigation System -
. 45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48. Special Requirements Completed •
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co - •
51. CERTIFICATE OF OCCUPANCY - ' 1
•
No. • Date - T
I
ADDRESS OF BUILDING: 156 YORKTOWN LN UNT: CITY OF COSTA MESA — BUILDING PERMIT
OWNER'SNAMEPr IQW*1: WINE, ROBERT R PERM NO: B 073486
r'- -"-cDDREss: 1933 REPUBLIC AVE
COSTA MESA,CA 92627 PERMIT NO: B 073486 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR CRO ER: UC.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 2, 999
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: 2, 999 .00 CALC—VALUE: 2,999 .00 GROUP OCC: R-3 /
CONTRACTORSNAME: STOUT ROOFING INC ( 310) 923-6775
CONTRACTORS MAKING P 0 BOX 4309 COMMENTS: SMOKE DETECTORS ARE REQUIRED PR 91 UBC
ADDRESS: DOWNEY CA uc.ND.: 402536 ***t**************************** ************4E*********************************
90241 WIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing wish Section 7000)of Division 3 of the Business and Profesdo ode.and my license is in full fort • •effect.
crrruc.No.:059377 Llc.cfAss: C 39 LIc. 025 6 E/ 10/95 MAIN BUILDING ACCESSORY BUILDING
` n� / �� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
�2ae con'°" !d LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I ant exempt from the Contractors '•-nae Law for the
following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,alter.improve, PARKING REQ: P ROV: PARCEL: 41916525 Z N E: REF NO:
'coolish,or repair any stricture,prior to its issuance.also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES> -
icensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of Division 3 of the
elness and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than fie hundred dollars 135001). *******************************************************************************
❑ I,as owner of the properly or my empkvyees with wages as their sole compensation,will do the work,and the structure S not intended DEVELOPMENT S E R V I C E S R E Q U I R E M E N 'T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en Owner of property
who bolds or improves thereon,and who does such work Nmseff or herself or through he or her own employees,provided that such
improvements are not intended or offered fcrsale.If,however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
owner-builder will have the burden of proving he Or she did not build or improve for the purpose of sale).
❑ I.as owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business and BUILDING APPROVED BY : DATE:
Professions Coda:The Contractors License law does not apply to an owner of property who builds or improves thereon and who
contracts for such projects with a comrworls)licensed pursuant to the Contractors License Lew).
❑ Iamexempt andenSection B.apc..for this reason: APPLICATION ISSUED BY: DATE:
********************************** ..** . ***************************
Date: Owner: LEGALIZATION:N F E E U M M A R Y STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and
25534.and that l«any future building occupant will/will not(circle one)need toempty with said slate codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit fwmnstructionormodifcationhorntheAs Ouabty Management District.Residentisl construction appications are exempt from these PERMIT 54 .00 . 50
provisions.
Date: Applicant; PLAN SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE
o Ihaveand MImaintain cenditateoconsent to self-insure for workers'compensaton,aaprowbyeain
iedfors370Dathe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
ode.tor the performance mtnaw«sf« :
wnthis pemniaissued. TOTALS----> 54 . 50 0 . 00 0 .00 54 . 50 54 . 50 . 00
I have and wit maintain waken'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the
ork for which this parmil is saund.MYw«kare'r�Wpgnyg)igg insurance corder and policy number are: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: . 00
Carrier, '00i449C4.u000468`7 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Policy Number: 54 .00 . 5 0
.cis section need nor 6e completed d the permit is for one hundred dollen 1s109j or less.)
o I codify that in the performance of the work for which this permit is ,I shall not employ any person in 'y manner so as to
become subject to the workers'compensation I ws of Califomi. •nee t Itshsulprbecom /ect to 1 . workers' *******************************************************************************
compensation provisions of Sect 3700 of r Code,I ah. / INDIVIDUAL F E E BREAKDOWN
` Dale: //� 2 / 9 compensation
Applicant: / / .. ' � .
Ing:Failure to secure workers compensation coverage le unlawhrl,and shall subject an employer to cc/ Ipenaroes and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollar.(3104000).In addition to the coat of compensation,dame is provided for In
Section 3706 of the Labor Code,Interest and attorney's fes.. SFR 2999 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 2, 999 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a consnuction lending agency for the END OF FEES
performance of the work for which this perm1 is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have mad this application and state that the above information is correct.I agree to comply with an dry and county ordinances
and state laws relating to building construction and hereby authorize representatives of the city to enter upon the above-mentioned properly
for inspection purposes. DARLENE B URF I '.)
Print Name
—aye-9
ignore 0 DwnedAgent/AppicannConlract« r
Date: 01 E? 071.12-001$71:3 09.:15
9:TOTj5 Gf �Q
r.
DATE! v7r?J!9S 7fi":E; 09.15
(5151-46.WP) White-Building&Safely;Green-File;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
!CONSTRUCTION AND PLANNING POOL PA
APPROVALS Permit# I Date Inspector- - APPROVALS ' Permit # Date Inspector
!. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - •
ca
,.- `Electrical Conduit Utility•Undrgrnd. 54. Forms
lectrical Condv_rt-UFrdrgrnd. 55. Electrical Bonding `
t•"Q
_`tgen4-&arteel Reinforcement 56. Rough Plumbing & Pressure Test T .
:1 'Electrical UFEl}nd. 57. APPROVAL TO COVE R-GUNITE _
'7; Footings Sn 58. Electrical CondiiiCUndrgind. •
X8. Foundation t' a. 59. Gas Pipe, 0 Udd�rnd., Test
,G -
9:: Water Pipe-Undijdd.'I 60. Backwash Lines,FTrap, p Undrgrnd.
a _
10. Structural Floor System 61. APPROVAL TO DECK_ _. '
11. Property Sewer Line& House_-Cerinection 62. Backwash & Receptor-Final ,
, '
12. 5:ewer Cap I.: 63. Heater & Vent-Final -
13. Roof Drains ,. 64. Plumbing System - Final
14, Rough Plumbing.-_ ""j 65. Electrical-Final
a.
15. Rough Electrica++<Coauit - , 66. Solar System-FiL.nal �.- ;,
16. Rough Electric?)irij • 67. Fencing & Access-Approval- •
17. Rough Wiring Sign ' 68. APPROVED FOf3PLASTERING
18. Rough Electrica(T Bar Ceilin- S'
9 � 9� X69. POOL/SPA SYSTEMS FINAL
19. Rough Heatino & Air Conditto(ing _ FIFIE EPT-UiEQUIRENIENT
20.10 ugh F to Fir<2 lace �C y M* APP f DVA1;yy;J Pe�i`mit# 's > -
21..aucts,in-Stratum* •• • •• 4.c . �I ' _ 70.'Zindergr�ntl dro x
22..Ducis, Vttil ing.i, j * C c; C b++' c' 71, Produeliiping-E as D Oil
23."dasPipe-Pot & Test _ ms .v = C cX - 72. Underground Fttinh` ' = - •
24.-RoofeFrSfiinq' s'< x ' > G �.* 73 Undergr'd.Stall; D Gas ❑-Oil
25. Roo)-Sh®thing ?i* G i`J.-GSA 7 j- 6WPx 7i Overhead Hydrr_J x
26."Tar-BCeiling (Strttcr�,ural) & Wgacoat * :, L 7;: pry CheErical &_-_---3 : -' a
r -.
27. roma aad Fiashipg> o.%t� * c i- X 76. Dry Stan"0r3rPe1-'G
Y 28. Lathing'&Si�yng ..:i c-, `, �, ar ' 71rj FIXEDShsTEfi4FINA'-,-, ,- '
' 29. Insulation •V1*• r •• •• I c7.1. FIRE PREV. FINIAL * 7-7' '
30. Dryevall iSfilit'` < -x• l t r `i 1-1EALT DEP '.'REQUIR &EMENT
ar�g _ * E-. c
-. 31. Plaster Bcowrr.Co tlr S ' :,2' i j I ' n• 79�. FINAL IN PECTtON *
`� 32. :Electrica+'Povr1'r t r'Final ; ..4, EU' FOOD CERTIFY-I,CATE rKSUED-r a:
- 33. inal-Electri . -1: rr 1 < ` r-;, i t* Nat7 c7es: l-i71 - 0 m
N 34 ..'Fina£Heafino AlIConattioniggS '4.1 * * X S "x .., S "o
� .. _
35. fi.nialGasPipeTest•x � J •i * r j + --r
^
.11'_ a. * CL �• 36. HooZhor Canopy O
7. 7.7 _ �
-.
•
- 37.,Finat..Factory Fireplace z• , ,--•- •+ F * s
s.38. FinatsPltinibing =* rt' * j
-,4. " l
39. Water SeFyiceJinal .1.! f 4
• I -t ;. a. •- ;:S
� r r,
r --. . , -
>? 40. Gas Servia-Fr_mal ' .1 ch-2" s' "• - -
„ 41. Solar Donjestic-Fina. .. Y � 4` - -• -
42. BackflowtPreventer* - :t; r - I x t^ ->,_.
2 x ^ r,S S ? *. ,.r:.. -e •-••* -
43, Backflow Irrigation* > x t. * c * Cl -
_
c44. Landscape IrrigatiortSystemXr'C * 21a a G* Cr' SU :1t * rtl c
' x SCS * Q r' r t. E z L C x * S F
T15. CSaund A,ttenoation* * n m al« F c. .,' ' • F-., x
• Se. Handicap•RegulatIons * * c^ .S CO S *
-. * c 44/5-
* C AC Gi t t L i) a *
47. -FIN&L STR1'ICTUR & BUILDING / -/q j r/Q(,.i * lit--t *r, t �.
48. FINAL PLANNING* . R I �F "'• •`� * `' -
-k , t !* r: 7 is a * S •
9. IecCr'ic Bglea"se to qdison * r E* 2.^ if :n 2 , t <
o.
60. Cas-Belene to Southern Cahfornia'Gas fl * t j . E-- ••S ao -.ri ' is •
- s' . 'c'S .
-51. CERIIIFICATE OF OCCUPANCY * * •- vic, - -
No. Date
•
•
27793 NOV 13-67a—is-AO 537* ****90.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 02828 .
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE ORnn ',PRINT ��JJ BUILDING
ADDDRESS I V. -!rG'-rot rvt, V�-k2 for Ol EM UO. Only
EXEMPT NO. PAW NO.
COSTA MESA. CALIFORNIA 777 3
RECEIV - T DAT�'c VEDi DATE ISSUID
OWNER San VisSta Bldg. Co. / j / / NOV 1 5 SU
MAIL BUILDING
MAILADDR2249 Wanderer Dfive ADDRESS JJ
CITY San Pedro No4333-3320 ZONE TYPE v GROUP jar
ARCHITECT TEL BYPROVED DATE
r-TNGINEER Clif Olsten Np, 923-122
ZONING
,DRESS 9025 E. Florence DowneAt
' z•p NNo.OF URC OF NEW P 1�
Same 'PLANS BUILD].• 6 "' I L�
CONTRACTORp /� Ij� .(�
LEGAL /__•U-•/ J l 1/ate f>-Si6
ADDRESS Same O[RCRIrtION V��Y3� i �+-� lA
CITY Same A.P.NO. 'V-!.--7 l J /- -c
TEL NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE
SIC. NO. 30"TO SIDE H REAR a L.
EAVES
SIZE /7 *7 D I NOW O ALLOWED (U.B.C.REQUIREMENT)
OF LOT G_ 7
YARDS APPROVED YARDS APPROVED
USE OFMAIN BUILDING ACCESSORY BUILDING
EXISTING-BLDG.
(FROM C/,L/-STREETI
SErnACK uRBTBo- — FRONT Uri FT. PT.
CENTER OF STREET REAR YARD
tI
-
Items C0 FT. Fr. IV.'.
SIDE YARD LEFT RIGHT z
DESCRIPTION OF WORK L.SIDE 'O FT. FT. IL
LTA
N ALTS TION ADDITION REAR
— C) Fr. FT.
r DISTANCE BET. BET.MAIN e 0
REPAIR MOVING DEMOLISH MAIN BLDOB. ACCESS.SLOGS.
BUILDING NO.OF //// �I VM•�C DATE L I�-/3 Cd
SIZE ROOMS /I" STORIES (— C.O.P.# /I APPROVED V-/U U
EXTERIOR WA14/1, /' ',> ROOF �� /J APPROV -� Q
COVERING {�M,LIAO COVERING 1�-{6•C�( _ ST 1l/ A DATE/�3 0-6
USE OF BUILDING AND" WORK
,T11O�pBEE PERSORMED1 p, CU
I wacr-ter; `v-IL.I/X �t"tie 9 Vl
/\ Q
,/// 3ydst Fr. WO
I HEREBY ACKNOWLEDGE THAT.I NAVE READ THIS APPLICATION THE AMOUNT SHO NDER VALUATION IS FOR THE O Q
AND STATE THAT E ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF EBT WINING A PERMIT FEE ONLY. p
PLY WITH ALL C •RDINAHCES AND RATE LAWS REGULATING VALUATION 0 t
BUILDING CO ON. PERMIT FEE $ EI
SIGNATURE 0r.
E
PBRMITTE _ - _ ) //�
s// — PLAN CHECK 8 _ o '� SSC
AUTHORIZED AGi u / Q
TOTAi.FEE $ / 9 `.