HomeMy WebLinkAbout2330 VANGUARD WAY - Building Permits (E103) c S CITY OF COSTA MESA .
►k. BUILDING DIVISION C-44-C/
t;I ""t"4 I DEVELOPMENT SERVICES DEPARTMENT
t. PK* • PERMIT PERMIT NUMBER
v7
P98-00814✓
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2330 VANGUARD WY • Status: ISSUED
Suite No E103 Applied: 11/04/1998
Issued: 11/04/1998
Vicinity:
Parcel Nunmber: 93865157
Applicant: HIGGINBOTTOM, RICHARD
Address:
Phone:
Zip:
Owner: TSCHOPP, GERALD S
Address 1626 S BARRINGTON AVE#7
Phone:
LOS ANGELES,CA Zip: 90025
Contractor: MACK SERVICES
Address: 2 MC LAREN
Phone: 714-457-8070
IRVINE,CA Zip: 92714
License: 404587
Arch l Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
REPLACE WATER HEATER.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $11.00 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
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
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
.�] I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cede,for the performance of the work for which this permit is issued.
VT My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
I certify that in the performance of the work for whi 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.' •ml., 'n•a• ee t ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
' these provi- •'s.- �/'
Icant Signature: Oa
t 7i
WARNING:F 0 SECURE WOR <"S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN E. • RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
E($100,0110),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
o-i•tee'— .- ��+,.
� ed under provisions of Chapter 9(commencing with Section 7000)of • islon 3 of the Business and Pr4fes ' ns Code,and my license is in full
rorce and effect.Lic # 7 O - :S - .S
Contractors Si! : . r/ YAW' Date:" C A`;
r--i
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).
Lenders Name: Lenders Address:
Signature: Date:
I
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 toe civI penalty of not more than five hundred dollars($500).):
O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any 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 Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business whldh 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 Califomla 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LU 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? 0 Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: _ Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
41 / I. a f a Of Legal Owner(s)
, !%a Viler fL
CODE I. INSPFc ' ' DATE EMMA CODE/ INSPECTION TYPE DATE IIRIDALS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing )1-5-9R
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
2448.46
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations•
• . '
CITY OF COSTA MESA PE MIT NO. TRACT O LOT NO. BLDG.NO. Jr;/ i/:...,,,.
CONSTRUCTION PERMIT I d —/O 3O o
y r ' .E-103
Applicant's Mailing AddressP•O•HOX 10843, BPV Mille; 90911 TYPE OF CONSTRUCTION EW L ADD LI ALTERATION U REPAIR A
Project Address Is7 a30 VA/.l(+:f1AI(D WAY . /03 ❑ CONVERSION LIDEMO ISH El OTHER
Owner's.Name N4uwo, r LANAI N6- LLD, Phone 13)...1741-0qDESCRIPTION OF WORK iNAnMINIU PE. 13
�( `� 1�' �.�/ZONING REGULATIONS/J .j
Address pa, ' Sox Ir�l743 AEvF-yQLy Phi-Ls �A 90z1 p3 TYPE OF PERMIT, .I5'GRADING I FOUNDATION 21STRUCTURAL A.P..* 4-( - /5f—3js ZONE Pn/ -
Arch/Eng. Cl-Alel` f-Pk-. The-License No. C-..PS-7A 0TENANT r 'ELECTRICAL ' -PLUMBING ^ .MECHANICAL I1_DING
/1 C �s ♦ �/ PLNG. REF.#7f (93--JIn 7�)I��{gerir rtt ST
Address �I C' SA I�ICeNre_ 'Bt I-.A gamic( ❑ BOTHER TO BUILDING � .may �sy-t
t/Contractor's Name �- c rz c.Pi/, • Phone PROJECT DESCRIPTION S I I'O O PROPERTY LINE (veil/ REAR YARD(TO P/L) Ee i I
p`±. TION$ 6CY K_ _ I
`---- CONSTR CTIONTYPF �s-. � I N12. VALUATION$ � I Coo. LEFT SIDE VARO�glr� �f�GRIGHT SIDE YARD A••�'pc / 0j boa
Address(mailing/
(t1) +
ZONE 1`-3 GRADING CU.YDS. SITE ACRFS PKG.SPACE REQ. 5 C PROVIDED a 5
of
License No. _
LICENSED CONTRACTOR DECLARATION Remarks: s� /T/Ft 6 STREET WIDTH + PARK FEE$ 88/ .5/
I hereby affirm that I am licensed under provisions of Charter 9 (commencing B LID G - UNIT L�3 I i F-- •
� - e
with section 7000) of Division 3 of the Business and Professions Code,and SPECIAL CONDITIONS: U NUR SItIAL REQUIREMENTs7; L Y'`i'�yni I
My license is In full force and effect. •
_,�,a'-n n it ' cru tin oil ION.,
!9 ., f n /x If�"1 ted'
License Class License No. PLUMBING
Date Signature / Bar Sink Sewer Cap ELECTRICAL s J
WORKERS'COMPENSATION DECLARATION .- - }� y's u/✓1
'ereby affirm that I have a certificate of consent to self-insure or a certificate / Automatic Washer Meter Dover 10O'amps I
Workers' Compensation insurance, or a certified copy thereof (Section Backflow Preventer / Sewer Connection -
_aoo, Lib. C.) Backflow Irrigation Solar Collectors Construction Pole / Sub Panel
Policy No. Company ' _ / Cooking Unit Sub Pole •
8 Certified-copy Is hereby furnished. • r'•.'Bathtubs - Solar Piping -
Certified copy is filed with the city Building Division. Dishwasher / Motors, 0-1 HP ❑1'/,-B
Date Applicant Clarifiers Solar Tank /
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher • Swimming Pool w/Spa / Dryers I�Gas ❑Electric 'Inc.SOlar 09-15 HP 016-15+
(This section need not be Completed if the permit is for one hundred ($100)or / - - !
less). DrinkingFountains Urinal .L(( Fan Microwave
I certify that In the performance of the work for which this permit is issued, I p
shall not employ any person In any manner so as to become subject.to te - / F.A.U. Pole Light 4,' / '
workers' Compensation Laws of California. Floor Drains' Water Closet_
Date Signature / Fixtures• /
NOTICE:If,after making this declaration,you should become subject to the Floor Sinks / Water Heater • Range •
Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with such provisions or this permit shall be deemed revoked. 61 Gas Service . / Outlets / Water Service l� Device Boxes {_ Sign
CONSTRUCTION LENDING AGENCY Outlets
I hereby affirm that there is a construction lending agency for the performance_ • Interceptors ti Standing Sections
of the work for which this permit is issued -(Section 307Civ. C.) Trash
Lender's Namo Kitchen Sink - e✓ - _/ Switches Compactor
ONer's Address - .-Lavatories cb\
"t.;2. Garbage Disposal
OWNER BUILDER DECLARATION .J y jVV"\i ����•///
I hereby affirm that I am exempt from the Contractor's License Law for the P-Trap �.+1, Generator 005 KW 05-15 KW
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve, tfo demolish or repair __ �N// Transformer 015-50 KW
any structure, prior to Its Issuance, also requires the applicant for such permit - Roof Drains' C.�""
•
to file a signed statement that he/she is licensed pursuant to the provisions of ❑5U+KW
the Contractor's License Law(Chapter 9(commencing with Section 7000)of 'Reinspection Fee $15•
•>Islon 3 of the Business and Professions Code) or that he/she Is exempt Showers ,\ as jssr' • ee $15
ir'a /
efrom and the basis for the alleged exemption. Any violation of Section Meter Nup to 100 amps Issue Fee $ 3
a '.1.5 by any applicant for permit subjects the applicant to a-civil �� _
malty of not more than five hundred dollars($500). Service Sink \- nue Fee $ 3 Zoning Approved By Date / �•'
I; as-owner of the property or my employees with wages as their sole ----
compensation will do the work,and,the structure is not intended or offered ' ' Barr.NICAL _ 1S I
for sale (Sec/ion 7044, Business and,Professional Code: The Contractor's - - - --— Application Approved By 7q,/O/ - 'nate /� -a
_.-_ -• - - - - -. - - Application Isiued Byi /% ./ -30 -��
License Law does not apply to an owner if a property who builds or improves Boiler Refrigeration System
thereon,'and who does such work himself/herself or through his or her own Pp Date
• employees, provided that such improvements are'not intended or offered for ❑0.100,000 BTU 0100,000 BTU
' sale, If, however, the building or improvement is sold within one year of cold- Duct-Under;Ground ' SUMMARY OF FEES
ple on,the owner will have the burden of proving he/she did not build or im- - 31
r ve for the purpose of sale). Duct-Structural - System Repair/Alteration BUILDING PERMIT $ ' 19.E SMIP $ �--
as owner of the property, am exclusively contracting with licensed con- //
rac rs to construct the project (Section 7044,Business and Professions Code: T Duct-Ventilating- _ ._ • . PLAN CHECK $ PERMIT • •
The Contractor's License Law does not apply to an owner of property who ' ISSUANCE • $ -
' builds or improves thereon,and who contracts for such projects with a con- • Exhaust System 0 Multiple 0 ' PLUMBING $
' tractor(s)license pursuant to the Contractor's License Law). •
PLAN CHECK $ GRADING $
❑ I am exempt under Section B.& P.C.f•r this reason � / Firepl/Fact.Bit.ICBG# 1 $
Date PWt �L kret rLY/ !"'rt'��. fELECTRICAL $
Owner i�C�i�' eting,System& Ducting MICROFILM $ -
I-hereby Corot that I have read this application and state t 1t the'above 0-100,000 BTU 0100,000 BT1y�l - . - - -, . . PLAN CHECK , $
information is correct. I agree to comply with all city and county ordinances ,,{ I I •
-MECHANICAL $ TOTAL FEE , $
and'state laws relating to building construction,and hereby authorize repro- , Hood or Type I CA
sentatives of this t,{y to� enter n e Bove-mentioned�.pprr/oyppertt yy for YP Reinspection Fee $15 LES$
inspection purfr """"", / / Canopy Type II ❑. PLAN CHECK $ • ADVAt10ED PC $ -
Signature r Date
Drivers' Llceitse or 55 - �� - Registers I Issue Fee $ 3 FINAL FEE $ �����I
CMF 0865-45 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor I
_ __ '. _ __ -- - -- _ __ POOL - A - - -- . _ _ _
_ ..
• 10ONSTRUCTION:AND PLANNING. - ' - - - -
` • =' - Date • Inspector ` - Date - Inspector
APPROVALS permit# - - :,APPROVALS -: Permit'# - - _
il- Temp"orary Electrical Service or:Pole_ ' I• -- 52[Pool & Equipment Location - •
io 3: Soil Pipe-Undrgrnd. : s' •,;, _ I >; 53:-Steel Reinforcement • .. - '
;,.-; p' Electrical Conduit Utility-Undrgrrid. --j; - - -. 54.'Forms - - _ ,
0 4t Electrical'Conduit-Undrgrnd, ' 2i7 - '-_7 ":•r.' 55r Electrical Bonding ;
5" Steel'Reinforcement' ' ' -1 .: '- o - . ;° ` - - 56. Rough Plumbing &Pressure Test '
6T Electrical UFER Grnd- . R ' `I-:' _ - •:.57:'APPROVALTO COVER-GUNITE • -
•
7. Footings . 1 1 I r 1 -_58. Electrical'Coriduit-Undrarnd. - - _
8. Foundation _ i _ f- , _ •� 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 : " -
11. Property Sewer Line;& House Connection m
_ - 62. Backh' Receptor-Final:-
e was & -
12. Sewer Cap 63. Heater &:Vent-Final '' - -
13. Roof Drains ' - , 64. Plumbing.System --Final • - - . .
14. Rough Plurfibing 1 ' ' : ' - - . . ' 65. Electrical-Final
aJ115i"Rough Electrical=Conduit-,--r-,- -,- - r - - ,--r .66 /SolarSystem-Final i -- -
;;•16. Rough;Electric Wiring I I t"J -,. '•-•:i ' ` I.� � , 1 :-.-,-,Ii. 67,.,Fencing & Access Approval
' 17. Rough Wiring Sign? ' I ' I' , I 1 : 1 , 1 4 I` 1, 08. APPROVED FOR PLASTERING . 4
18. yRough`Elect{ieal-T'Bar Ceiling, I - I' . i I • - I 69.E POO ./SPA SYSTEMS FINAL `
I! 19. RoughHeeting,& Air Conditioning ' 1 : 1 I I FIRE DEPT. REQUIREMENT-
' e 20. Rough Factory Fireplace, '• a 1 I APPROVALS -' `Permit#
21. Ducts,in Structure ' 70.' Underground Hydro -•�
t22. .Ducts, Ventilating • I i i I 71. Product Piping`OGas 0Oif
of 23. Gas Pipe-Rough&-T-est ` ,? , 1 i , 1.-72.'Underground Flush r"/
4 24. Roof Framing- • ; ;
Applicant to fill in alt spaces except those within heavy border lines and sign all appropriate declarations. 5601 I /14/85 %%e G 1.1
a CITY OF COSTA MESA. PERMIT NO. TRACT LOT NO. BLDG.NO. -
• CONVSTRI,tCTION PERMIT 1(09)41 (/ Ye O-UQ�
Project Address _ • V: i (box
C a E- 0 TYPE OF CONSTRUCTION IN NEW U ADD ❑ ALTERATION REPAIR Si)Applicant's Mailing Address PAD. (bQx 10:43• U. MI5 ❑ CONVERSION ❑ DEMO ISH ❑ OTHER/ A.P.# 79 - /C7l - Q Zone P-3
• Owner's Name L Sian i t .� k. • PhWn 0 DESCRIPTION OF WORK �' ( J Cr / / / --
�r� 1 - f S Main Building: Accessory Building: 2
Address P.0. BOK IQ843., ry ERL'j HILLS. •e4e0.�1 J TYPE OF PERMIT GRADING `: FOUNDATION 74 STRUCTURAL T Front A'�-�ch SZ N
Arch/Eng. CLARK- HEDRICK License No. C.-S 1 4 ❑ TENANT ® ELECTRICAL ® PLUMBING ® MECHANICAL B 1
U) Address II9C,C) SAN) UICENTE it•1 L.A., CA. SQQ49 ❑ OTHER A Rear A�� G�j/��
CO • //`` -�-�•� / N
s,/v Contractor's Name RI)I t LI �(CK Pho e3890-0(9 OCCUPANCY R-I/M-I C Right �� T 4P��p����,.` G
rI PROJECT DESCRIPTION SQ. FT. 1461 �^ R
i Addreulmailing) I185R�•yLA SPnIUG,E AU2,, I •A.9009.S CONST RUCTION TYPE �-N VALUATION$ A9 -71.1") $ Left 3 / 7 /2eArc,�rs/ - E
k- City License No. 'di- 3339"7 - ZONE _ GRADING CU.YDS. J ACRES Ping. Ref.#2,E9 -60 Park.Fees $ia�9� 39 O
00 LICENSED CONTRACTOR DECLARATION Remarks: Y— C 0E(-/ z
5 � — f� Parking Req./Provided - c-7 / U
I hereby affirm that I am licensed under provisions of Charter 9 (commencing / n R
with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: /Q - E.
my license is In full force and of ect. // _
Ucense Class nn __-1 r// Aecilse s PLUMBING FEES Planning Notes: M
Date II-iq-plf Signature E
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ROT P(1R SPFCI�+L REQU[REPdLN •l5 • N
T
'hereby affirm that I have a certificate of consent to self-Insure or a certificate Backflow Preventer Service Sink es
' Workers' Compensation Insurance, or a certified copy-thereof (Section - _
,800, Lab. C.) 'Backflow Irrigation - "• •
Policy No.
56713$- R9Company STATECOMP-Ms. Ft g Sewer Cap ELECTRICAL FEES'
❑.Certified copy is hereby furnished. Bathtubs Sewer Connection - • Lk CO 1' Automatic Washer - Transformer 0 15-50'KW . ( 00
�$Certifiep copy is filed with the city y/p� _
Date II-19'-8 Applicant t%• Clarifiers Solar Collectors Construction Pole Sub. 0 50+KW
EXEMPTION FRO141 WORKERS'COMPENSATION DECLARAT
Dishwasher Solar Piping
(This section need not be completed If the permit Is for one hundred ($100) or ,eo//�s�otje j/ �7 Cooking Unit l Meter �]up't0 100 amps Soo
less). - _
I certify that in the performance of the work for which this permit is issued, I Drinking Fountains Solar Tank ` Dishwasher - Meter Dover 100 amps / )O
shall not employ any person in any manner so as to become subject to the •
Workers;Compensation Laws of California. ' Floor Drains Swimming Pool w/Spa -( Dryers Gas ❑Electric Sub Panel 00
Date Signature •-
NOTICE: If,after making this declaration,you should becdme subject to the Floor Sinks Urinal 3 Fan ( Motors 00.1 HP ❑1'A-8 L.(OD
Workers' Compensation provisions of the Labor Code,'you must forthwith n
comply with such provisions or -this permit shall be deemed revoked. / Gas Service S Outlets- Os. Water Closet (D� F.A.U. • Inc.Solar HP 016-15+
CONSTRUCTION LENDING AGENCY I. t
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater Fixtures
/ 200 Z 'Microwave - L c(.
of the work fors �+p�c ntR`s•,Re1m1t is ssuep (��Hnr� g�97�v. C. I 0
Lender's Name WF�Fhf 1iM F115F� N61K1hiK�F l"jJ. ' ` Kitclien Sink •• - > Water Service • L}t)O Device Boxes Pole Light
Lender's Address 9lI 'UN)ON �l Ull 1)'CF 9�R I.C-rp ) �F 90
OWNER BUILDER DECLARATION 5ACRANEI,JTrI C 958,F7 ,2 Lavatories . , . / IdASH ti1i4LN041e (0 00 24 Outlets • Range
I hereby affirm that I am exempt from the Con ractor s License Law or the _ '1 •
following reason (Section 7031.5 Business and Professional Code: Any city or P-Trap - - 1 S`$witches Sign •
county which requires a permit to construct,alter,improve,demolish or repair — . - �Q
any structure, prior to Its issuance, also requires the applicant.for such permit Roof Drains •
• 1 Garbage Disposal ' Standing Sections
to file a'signed statement that he/she is licensed pursuant to the provisions of — - - -- -
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of I , • ' rt
�i c,ivision 3 of the Business and Professions Code) or that he/she is exempt „ - Generator 00-5 KW 05-15 KW Trash Compactor
' ...{{{',,,erefrom and the basis for the alleged exemption. Any violation of Section .
, 31.5 by any applicant for a permit subjects the applicant to a civil -
enalty of not more than five hundred dollars($500). Reinspection Fee I $25 Issue Fee $ 3 2 ��Tt-{ I f K 2-on
I. as owner of the property or my employees with wages as theli sole Reinspection Fee $25 Issue Fee $ 3
compensation will do the work, and the structure Is not intended or offered ' • MECHANICAL FEES -
for salese (Section Business onand Professional Code: The Contractor's es PUR LIC SERVICES REQUIREMENTS:
thereon tan does not apply too owner if a property or who builds or Improves Boiler Hood or Type I ❑
and who does such work himself elf or through his or her own Zoning Approved By Date
employees, provided that such improvements are not Intended or offered for Duct-Under Ground Canopy . Type II ❑
sale. If, however, the building or Improvement is sold within one year of com- Application Approved By Date /
pietlon, the owner will have the burden of proving he/she did not build or Im- '
'grove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By ''''''4Jt Oat: 1 Art8 5-
LJ I,as owner of the property,am exclusively contracting with licensed con- ❑0-100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,BusIness and Professions Code: 3 Duct-Ventilating 1 (o CO SUMMARY OF FEES
Thee-Contractor-s License Law.does not apply to an owner of property who _ ] p
builds or improves thereon,and who contracts for such projects with a con- Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ g1Lt'3.C� SMIP $ - L1
•
tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ 2712.q S PERMIT
❑ 1 am exempt under Section B.& P.C.for this reason I Firepl/Fact.Bit. ICBG#2301 t• .4 00 $ . ISSUANCE $ I PLUMBING
Date • OwnerHeating System&Ducting PLAN CHECK • $ (,,-)c-, ENERGY P.C. $
I hereby certify that I have read this application and state that the above ' WO-100,000 BTU ❑100,000 BTU • �!� $ ' 34.7..o GRADING $
Information is correct: I agree to comply with all city and county ordinances - - - T 00 ELECTRICAL
and state laws rel ing to building construction,and hereby authorize repro- IG. O MICROFILM $
sentatives of t city to nter u on th above-mentioned property for PLAN CHECK $
inspection p s. p
Signature �.,r av Date_ r MECHANICAL $ 11.00 TOTAL FEE $ • (aZ7'S�
Drivers' License or SS qp - ` Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK • $ '3-S0
CMF 0865-46 rev. 7/83 White-Building; Canary-Applicant;Pink-Accounting;Goltlenrotl-Assessor - - _ _ -
•
CONSTRUCTION AND PLANNING - POOL ;PA
•APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1_:Te'mporary Electrical Service or Pole 52. Pool & Equipment Location
'2. Soil Pipe-Undrgrnd. 5,29/ 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms
4. Electrical Conduit-Undrgrnd. I 55. Electrical Bonding
5. Steel Reinforcement 3/11/ 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd., // 57. APPROVAL TO COVER-GUNITE
7. Footings yr/0- K.- 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 G%sd/t'r��P. 62. Backwash & Receptor-Final
12.,Sewer Cap i'� f 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
"OK eel 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 0045-- LAD FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace w 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 f�fGC/ (/LJ 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat (J� 75. Dry Chemical
27. Frame and Flashing /0/c/c 06 76. Dry Standpipe
28. Lathirig&Siding 77. FIXED SYSTEM FINAL
29. Insulation /OA OM. VC-• 78. FIRE PREV. FINAL
30. Drywall Nailing
Mpg{ (�� • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power-Meter-Finali ! Q' 80. FOOD CERTIFICATE ISSUED
33. Final.Electric 3�� /�(_/ Notes: 9/6-/f' conag q'„for c'e C,r/0
34. Final Heating & Air Conditioning /41/a jg£ ,j- Sia./8S _,.j-
35. Final Gas Pipe-Test 0-4,U?"
36. Hood or Canopy
37. Final Factory Fireplace /47/s( .4
38. Final Plumbing //2/y/ IfeC
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer •
. 43. Backflow Irrigation
44. ,Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ' a1/
48. Special Requirements Completed 6/% � •
•
49. Electric Release to Edison •
50. Gas Release to Southern California
Gasoo
/yC �J�J/
51. CERTIFICATEOCCUIWC
DattZ, Ydb •
City of Costa Mesa .
Development Services Department CERTIFICATE OF OCCUPANCY No. 001.556
Building Safety Division
P.O.Box 1200
Costa Mesa,California
The Building located at "130 17tvne.>>.a oten
has been inspected and found to comply withathe provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group 17-1 Occupancy.
Use of Building OnrAArminitlm
Legal Description 414_1 c1—f16
(See reverse side for Metes and Bounds)
Building Permit No G16247 Electrical Permit No.G16347 Plumbing Permit No. G16847
Mechanical Permit No. r16RA7 Number of apartments /and/or guest rooms
ISSUED TO: Building Officialv//. ��
NFwoort Landina Limit�rl
P O Box 10843 by
Beverly Hills. CP, 90213
Date G/
� /7 7 fo
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 1015-46 rev. 1/83 White-Owner;Canary-Numerical File;Pink -Bldg.Permit File