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Home My WebLink About2083 MAPLE AVE - Building Permits ♦ Y�1-f.S/4; CITY OF COSTA MESA •'� BUILDING DIVISION :tt•t % DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER � ik . /f PERMIT `e P06-00577 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca..us. G PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2083 MAPLE AV Status: ISSUED Suite No Applied: 07/24/2006 Issued: 07/24/2006 Vicinity: Parcel Nunmber: 42213103 ' / Applicant: BOWER, JON ISSUED BY: .6/. Al Address: 10652 TRASK AV // Phone: 714-741-8384 GARDEN GROVE,CA Zip: 92843 Owner: BUNNEY, CLIFFORD G TR Address PO BOX 11024 Phone: 949-548-6045 COSTA MESA,CA Zip: 92627-1024 Contractor: COLE SERVICES ' Address: 10652 TRASK AV Phone: 714-741-8384 GARDEN GROVE;CA Zip: 92843 License: 718978 SCOPE OF PERMIT PLUMBING PERMIT FOR SFD. WORK TO INCLUDE:1 LAUNDRY TUBNJASHER, 1 PRESSURE REGULATOR,1 SHOWER,1 KITCHEN SINK,1 SERVICE/MOP SINK,'1 WATER CLOSET,1 WATER RE-PIPE AND 2 HOSE BIBBS 7/31/06:SUPPLEMENTAL PERMIT TO ADD 1 WATER HEATER FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $9.80 1 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) $9.80 1 Drain,Roof $0.00 0 - Shower $0.00 0 Water Heater/vent $12.30 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 $9.80 1 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 $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0- Sink,service/mop $9.80 1 'OTHER $19.60 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 Interceptors(Grease,Oil) $0.00' 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 , TOTAL CALCULATED FEES: $114.20 COMMENTS/SPECIAL CONDITIONS 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)754-5826 244646(6/00) DECLARATIONS • 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. 1•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 permitiis Issued. My rker^,.',Co�aps �}osurancert_er gn},pplicy number are: poli N or ?/ V 3 2 - s 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 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Labor Code,I shall forthwith comply with loess p '{lons. 7/7/ / N{raphSlgngjure: 9FA/Li7'J � 'sL WARNING:AlLULURE TO RE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED 7140USAND DOLIARE($100,000).IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thator. -I-a_ icons°�'n ?raptor 9(commencing with Section 7000)of Division 3 of the Busines�S�nclRro d my license is In full force end effect.toCr N� /I or ' was M (� G C Au,Tmm,tw s-Slgtmdrre.'r •(L.977- - (y e 7/2/ /5 CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: 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:My 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 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,em 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. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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(38)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: I 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 flied 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 torn for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end 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 H presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or willo the oast Air or present—or future buildingsoccupant other for toe work which is—the or of this a estion eggermit for such construction or Modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes LJ No (Section 65850.2 of the California Govemment 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 00 f feet from me outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and SafetyCode). 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 _ ❑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 COMPUANCE 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. Signature Of Legal er(s) 7 `Dgt pPeo 'ALitFiditted A •a79"' f/ g.te.(' QODE I, INSPECTION TYPE GAIL gill[IDI$ coon INSPECTION TYPt PATE WIIT1Al9 1618 Fixed System Final Fire Prevention 208 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing '" r dL__a 200 Final Re-Roof 210 Final Electrical ath, 201 Final Block/Retaining Well 212 Final Fire Prevention r 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupandy :1-11-±.4ifr, CITY OF COSTA MESA 44.a. BUILDING DIVISION >:i ,nr DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1.-41 is PERMIT P06-00577 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cNLuMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2083 MAPLE AV Status: ISSUED Suite No Applied: 07/24/2006 Issued: 07/24/2006 Vicinity: Parcel Nunmber: 42213103 Applicant: BOWER, JON ISSUED BY: Address: 10652 TRASK AV Phone: 714-741-8384 GARDEN GROVE,CA , Zip: 92843 Owner: BUNNEY, CLIFFORD G TR , Address PO BOX 11024 N Phone: 949-548-6045 ' COSTA MESA,CA Zip: 92627-1024 1 Contractor: COLE SERVICES , Address:. 10652 TRASK AV , " Phone: 714-741-8384 GARDEN GROVE,CA Zip: 92843 . License: 718978 SCOPE OF PERMIT PLUMBING PERMIT FOR SFD. ' WORK TO INCLUDE:1.LAUNDRY TUB/WASHER, 1 PRESSURE REGULATOR,1 SHOWER, 1 KITCHEN, SINK, 1 SERVICEJMOP SINK, 1 WATER CLOSET, 1 WATER RE-PIPE AND 2 HOSE BIBBS FEE SUMMARY • AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 -$9.80 1 Urinal $0.00 0 Clarifier System' $0.00 0 Process Piping(pelt 0 ft) $0.00 0 Vacuum Brkr Bkfldw(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) $9.80 1 Drain,Roof $0.00 0 Shower r $0.00 0 Water Heater/vent $0.00 0 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 0Water Re-pipe '. " -$9.80 1 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 $9.80 1 Water Softener . - $0.00 0 Gas(Over 4 outlets) 50.00 0 Sink,service/mop ' $9.80 1 OTHER $19.60 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 Interceptors(Grease,Oil) $0.00 0 ' REINSPECTION ' ' $0.00 0 Interceptors(Sand Auto) ; '$0.00 - ' '0 _ _ • - , / . TOTAL CALCULATED FEES: $101.90 COMMENTS/SPECIAL CONDITIONS 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)754-5625 2446-48 Wool DECLARATIONS ., ' , 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 or whi�l,ths peenit LS issued. My workers ygRmppu n Insur 9 C§i(ipr_§r)d policy number are: /1 9 7 ,Cardec n need // It (/�r it/� policy Number / �s section need not be completed if the permit Ls valued at 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with these pr Ions. /' Applicant Signature: Lala: 7/z qi/oC WARNING:FAILURE TO RE WORKERS'OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT MI EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN AOWRON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37E6 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am llcens:re •E.r p e tsi9'l's of Chapter 9(commencing with Section 7000)of Division 3 of the Businessn¢DrdessJafisLode�arW my license is In full force and effect.tic.N I /IJ Class q� L C Off/ /C, l b Contractor's ntractofa Signature:' a ,-Date: 7/z ci /o 6 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: 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 wages as their sole compensation,WILL DO ThE WORK,and the structure Is not Intended or offered for safe(Sec. 7044,Business and Professions Code:The Contractors Ucense 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 Drivers 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(38)feet high.(Chap.3.2,Grp 2,An 2,Sec. 341,Tule B•Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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 Califomia 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). _. i...._____._ -0 ..., 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑Ves ❑No (Section 25533 of the Califomia 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 Doss or ante applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (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 Califomia Health and Safety Code been fully compiled 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? l�Yes LJ No (Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building pertmts). _ e...._.nstruc--__._......_within —_ — No— -6 Will any pan of the facility to be constructed under this permit De within 1000 feet from the outer boundaries of a school? ❑Ves ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). 7 If a permit from the South Coasi Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this appl(catlon,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (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. Sign re Of Legal -7 0s 7/. J�at% i y _ r,AuthorizedAppllcant �(DDate .(� CODE T, IN$PECTION TYPE PATE IMIA0 CODE! INSPECTIONTYPE PATE tbaffiAla 1816 Fixed System Final Fire Prevention 206 Final Mechanical • _ 1266 Pool Spa Final 206 Final Plumbing �^ 200 Final Re-Roof FI Electrice 201 Final Block/Retaining W.4 - v.r�/ 2 — -r. al Fire P n Nor 202 Final Factory Fire Place 220 Final Pla ng Approval 203 Final Sign 222 Final Site 204 ' Final Demolition- • . : - - - - 250 Final Building/Occupancy • Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. \\ CITY OF COSTA MnESAp2CONSTRUrCTIO� PERMIT PERF 9 TRACT NO. LOT NO. UNIT NO. Project Address ego p.'7 n�!�j�'`e. )fy'�/P�f[�.` � " rJ�// 8375 'gg ' 5 0^ IL Applicant's Mailing A dress 1�1/f l49 // jaJa° / TYPE OF CONSTRUCTION LI NEW U ADD U ALTERATION LJ REPAIR farm • inn '—^ `0",I TL Owner's Name t Phones { El CONVERSION ❑ DEMOLISH El OTHER A.P./V. Zone DESCRIPTION OF WORK/USE OF BLDG. Address f S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADING UAOUNDATION LJ STRUCTURAL E Front Z Arch/Eng. License No. �/ T O Address ❑ TENANT ❑ ELECTRICAL PLUMBING 0 MECHANICAL B Rear N Contractor's Nam. nn 44/ 4 .� _di II ' Phonelpp ❑ OTHER A C Right N Address(mailing) f.-3 3 /• /.ei 1, H LW PROJECT DESCRIPTION 50. FT. OCCUPANCYK r/� CONSTRUCTION TYPE VALUATIONS S Left R G City License NO. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E a 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: LIVED APR — 5 �[]rs� M with section 7000) of Division 3 of the Business and Professions Code,and s7a my license is in full force and effect. T Licen Cla s License No. 41 7e - S Date Signature 0 44 ' / i— PLUMBING FEES Sr r Fr.a_•� WORKERS'COMP NSATION DELLA' l•N Bar Sink Showers lereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Pao .d0o; Lab. C. /� �ps �r �x r� M/ Automatic Washer Transformer 0 15-50 KW 1 Policy No. �9/f73 y!1 Company `.1...17114e + Luft/\ Backflow Irrigation Sewer Cap ❑ 50+ KW _ Construction Pole Sub. __Certified copy is filedherefuthe ed. Cert�ifj'ed copy is fit3d with the city B g pi 1)i n. Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps \ Date f ,IO Applicant {N//LA Clarifiers Solar Collectors Dishwasher Meter Date c'ttio NS'-4_WORKERS'CO I N E hundred TtdYIP-0~• Dover 100 amps (This section need not be completed if the permit is for one h ($100)or less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued,t shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0.1 HP Ell 4-8 Workers' Compensation Laws of California. _ Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09.15 HP 016-15+ 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 Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance - 9 of the work for which this permit Is issued (Section 3097.Civ. C.) Interceptors Outlets Range Water Heater Lender's Name ' 9 Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION • - _ I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Disposal Garbage following reason (Section 7031.5 Business and Professional Code: Any city or 9Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000) of •ivision 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section 331.5 by any applicant for a permit subjects the applicant to a civil — -. eenalty of not more than five hundred dollars($500). LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee 1 $15 Issue Fee $ 3 compensation, will do the work, and the structure Is not Intended or offered - - . Reinspection Fee $15 Issue Fee 5 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 ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date pletlon, the owner will have the burden Of proving he/she did not build or im- Duct- Under Ground Building Approved By Date prove for the purpose of sale). 0 I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 0 Date /) �M! 7 60y 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 BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ C PERMIT S 0 1 am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ S. DC) 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 0o-100,000 BTU 0100,000 BTL 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- sentatives of thiscity Signature // ,,f / Date city to enter upon t • above-mentioned property for inspection purpo�+ 3 -r(/ [p� MECHANICAL $ .TOTAL FEE $ � Drivers' License or SS It ! _- . .. CMF 0865-46,rev.10/84 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL&SPA Date Inspector APPROVALS Permit Date Inspector APPROVALS Permit# 1. Temporary Electrical•Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure"Test r: 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings r , 58. Electrical Conduit-Undrgrnd.. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test, 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Ditdrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final :••' 12. Sewer Cap 63. Heater & Vent-Final I • 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 .�I- 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 O 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 - 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 4/2718& 6-ED 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 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY r - No. Date I - OWNER BUNNY, CLIFFORD DATE 5-�-69 JOB ADDRESS 2083 :pie Avenue BUILDING PERMIT NO. 30215 GENERAL CONTRACTOR California Patio Supply DESCRIPTION of WORK Patio Cover AP No. 115-311-37 LOT 21 TRACT F. F. FIRE ZONE VALUE $450.00 I', ?CTIONS Signature Date GROUP J TYPE IV ZONE R-2 S0I� SUBCONTRACTOR PERMITS ISSUED GAS Date I Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. U SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING � �//' Heating and Vent. TRENCHES R OMS 0 STEEL REINF. El 4./'1,�,I e „sill-A;l/6 9 FLOOR SYSTEM r BOND BEAM L^I J STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN ri OUT n PLASTER, BROWN COAT $T 'TURAL, FINAL Electric H IG, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL �y�,/w� BUILDING, FINAL /3/r/ '-''4 PAID 3O215KAY -2-69cn$A00 130 a*****5,00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �'j //qy/fin RECEIVED BV D,STE RREECEIVED DATE ISSUED BUILDINGS 13 / /7 �s/e. /Io& Bim, �J—f7z V9 i� d_/_� ADDRESSn' J/"I/, `� �t �• s �s 1O. 0 OWNER I • /� ,l T/Lb I uAi 4y A.P. NO. / 6---- /— S / I P JMJIMAIL BUILDING /�ys•� ADDRESS _ I i 4/14 % J ' ADDRESS ‘7423 !�[z j t Z - W ui �/J, TEL 0 0 CITY -OSfiQ, //le4 q NO.=�0.46, --TRACT `•R� al BLOCK ZZ �A Q CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH O t LENDER • am � •� N JD BRANCH e ,4h e/+ �./� JN (�� OWNER A,�/ mm ADDRESS �rQfll w x�/lE/dLSA/f�/ `-J d A6��1 �J ,VALU l'54--d J Q ARCHITECT4, [ TEL ib,f USE (, $ d(J N OR ENGINEER /nt (2 Alf fi/t/adil NO// /"f/IOVf !�/��/� ,y i - FIRE WCC ADDRESS,(/ fi)e�'j A ttr iia - \"/,[a ,ii 4 ZONE TYPE - "(`GRO/UPP Sys/ 9 JZQ CONTRACTOR Jfi, 41/ Qr�u,,i I d1Q BY APPROVED /�� TEV ` ��j CO Z ✓✓✓ a l f !' J cc ADDRESS / _ • . . L A a A,� W w • TEL ZONE NO.OF USE OF Qe{[/y/ = PLANS BUILDIN ARDS ZF- CITY We Cher)late h NO. -INDo aAPPROVED YARDS APPROVED at,toCC LIC. NO./19,._) [ic/(o 47- l LIC.NO. /170 0 Lij—0 STATE CITYY tMAIN BUILDING ACCESSORY BUILDING 0 O / (FROM C/L STREFSI SIZE OF LOT 2Lj X (j I NOW ON LOTS i 4, FRONT 'Jo FT.U 7L FT. USE OF C• a^ ///� rs 1� EXISTING BLDG. ^tel. F. _g,SLOE cY•V' FT. FT. I— SIZE OF NO.OF j�I / 2 NEW BLDG. Li k (A ROOMS / STORIES / L.SIDE 1G y/4A.f FT. Q EXTERIOR WALK nn z;�1 ROOF / .y/� ! ' V COVERING a Pb QfA ICOVERI NG 19l'(/iYI REAR `J% FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& Q. a MAIN BLOCS. ACCESS. BLOCS.. Q / ti 17 A i n 41C.U.P. DATE j9PPROVED I— APPri Z It b/w iid - ROVED DATE -C--a "r/f 0 VI hereby acknowledge that I have read this application end state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shell not employ I— any person in violation of the workman's compensation laws of eM the State of California. co ZI hereby certify that I am Properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: I10 [ am exempt from the provisions of the State of California Business and Professions Code,Division 3,Ch 9. VALUATION ow� ry /� wlt PERMIT FEE $ .5 - t/"V O Signature of / if / - `� e. �c5 �V _ o al Permittee $ D PLAN CHECK $ E i u. Authorized Agent / TOTAL FEE $ • (l M