HomeMy WebLinkAbout283 LILAC LN - Building Permits •
CITY OF COSTA MESA
BUILDING DIVISION •
q Ikr,./II 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
a. FOR INSPECTIONS CALL:(714)754-5626
,
PERMIT NUMBER: M08-00166
PERMIT TYPE MECH STATUS: ISSUED
APN: 42615111 DATE ISSUED: 12/23/2008
ISSUED BY: RMD
JOB ADDRESS: 283 LILAC LN CM Suite/Unft ''; .
Vicinity:
SQ. FT: 0 •
SCOPE OF WORK: MECHANICAL PERMITjTO INSTALL A NEW KITCHEN HOODWITH DUCT WORK FOR A KITCHEN
REMODEL. REF#: B01-00449:` ." -
OWNER: RANKIN, ERIC S s, _Address: 283 LILAC Unit
PHONE: ". ` -- _City/Slate/Zip., ` COSTA MESA CA 'V . •
APPLICANT: CHRIS KING s r Address r 29592 ANA MARIA.LANE Unit:
PHONE: 949-249-5512 t City/State/zZip: LAGUNA NIGUEL, CA -
•
CONTRACTOR: CHRIS KING CONSTRUCTION•INCs License No: 1800201
Address: 29592=ANA MARIA LANEUnif _ r j -". • .PHONE:' 948-249-5512
City/State: LAGUNA NIGUEL'' CA ZipCode: 92677 - CELL:._- )• "
•
MECHANICAL PERMIT-FEE SUMMARY
MECH ITEM FEE: -'. •• - x$34.15 - -
PLAN CHECK FEE:
INVESTIGATION FEE:
REINSPECTION FEE: $0.00; . -
•
TOTAL FEES: $34.15
•
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. .
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.
CODE/ INSPECTION TYPE DST 'MIALS CODE I INSPECTION TYPE DATE,q INT1ML
1616 Fixed System Final Fire Prevention 206 Final Mechanical 149—
1268 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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive. ...ense. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: . . Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' "Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feel in depth into which a
number are: rt. I person is required to descend,will be made in connection with work authorized
Cardec % FE- F(NI) by this permit,and that no building structure,scaffolding.falsework,or demolition
(This sector need not ec�te4(thee a valued at one hundred dollars less) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
71 D 2,An 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of gpplinnfs Signature Date
the Labor Code yshall forthwit ply with these provisions.
/7 7 'n
�1g Division of Industrial Safety Permit Number:
Ap inn s Signature Date /' HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be fled with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building nrrnpant need to file
my license is in full force and effect. 22 a registration form for acutely hazardous materials? 0 Yes 0 No
Lica# G %Lee/ Class# ,5 (Section 25533 of the California Health and Safety Code, with some
�� . �L• /2- 73'o, exceptions, requires registration with the Costa Mesa Fire Department by
.....-•--! / each business which at any one time has on hand a quantity of acutely
gra 17—s Si.Te Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish. or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
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 information be furnished on applications for non-residential building permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption, Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for .
sale. If, however, the building or improvement is sold within one year of control officer). .
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify.that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ 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 hot apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:'I
a contractors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: . 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 or Lega Owner(s) Date
Signature Date �' /2__ 2^7� -�' ))
305746(3/07) !/...:= ! VC
A :
I 1
.
CITY OF COSTA MESA
9 BUILDING DIVISION
o, �
> L •,,,x. " r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F r (A I PERMIT
O. .o eP B01-01343
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 283 LILAC LN Status: ISSUED
Suite: Applied: 08/29/2001
Vicinity: RESIDENCE ONLY Issued: 08/29/2001
Parcel Number: 42615111 Zoning:
Applicant: KING, CHRISTOPHER ISSUED BY:
Address: 23911 STILLWATER LN - - .
Phone: (949)249-5512
LAGUNA NIGUEL,CA . . Zip: 92677 -
Owner: RANKIN,.�ERIC'S .
Address 283 LILAC LN'. . - - N
. - . Phone:
,,COSTA MESA,CA Zip: 92627 -
Contractor: CHRISTOPHER KING CONSTRUCTION
Address: 23911 STILLWATER LN
Phone:, (949)249-5512 -
LAGUNA NIGUEL, CA
Zip:. `92677 " License:-. 586530 ^�� '
Arch : - /� Eng: - .
Address: _ Address:
- ' . .Phone: Phone: '
Zip: • •- License: -' License:
' SCOPE OF PERMIT
REROOF RESIDENCE ONLY:T/b, 1/2"PLYWOOD SHTG, PER MFGR,SPECS,APPLY 30-YEAR COMP SHINGLES. •
1600 SQ FT
- . FEE SUMMARY
' Plan Check: $0.00 -.- -- ' - ' Calc Valuation: , $4,700.00.
Permit: $111.25 i" - Claim Valuation: $4,700.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00 • • ..
•
Total: ' $111.75
" 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
fora 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 !
2446-46(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
V'�ark for which this permit is issued.
have and wilt 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 workers'compensation Insurance carder and policy number are: •
Carrier: 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 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 prods' ns.
Applicant Signature: Date: e/2t10//�J
WARMNG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AAD CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100000),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:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.0 Class#
Contractor's Signature: Date: e/ --7/a/
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).
Lender's Name: Lenders 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 the 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 pens+
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,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 drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,Le.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feel 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,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:
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 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).
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 California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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? 0 Yes LJ 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 Califomia 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 Califomia 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 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.
S'•nature Of e•al h.ner(s) g/ Date
C
• Or • onzed Applicant Date
BODE I INSPECTION TYPE PATE INTRIAL$ CODE! INSPECTION TYPE PAIL Its
1818 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 10 - ( 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
CITY OF COSTA MESA
' 4BUILDING DIVISION
0> %�i �i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t. nik PERMIT
Itbib.o.Rmso 4'
a' B01-00449
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 283 LILAC LN Status: ISSUED
Suite: Applied: 04/05/2001
Vicinity: REMODEL OF EXISTING SFR Issued: 05/15/2001
Parcel Number 42615111 Zoning:
Applicant: KING, CHRISTOPHER ISSUED BY:
Address: 23911 STILLWATER LN -
Phone: (949)249-5512 ,
LAGUNA NIGUEL,CA Zip: 92677
Owner RANKIN, ERIC S
Address 283 LILAC LN
Phone: �3
COSTA MESA,CA Zip: 92627 •
VI;s
Contractor: CHRISTOPHER KING CONSTRUCTION t 4,A
erg
a.
Address: 23911 STILLWATER
Phone: (949)249-5512 ,
LAGUNA NIGUEL,CA �,
. 'i
. i
Zip: 92677 License: 586530
A.0DAlb-l
Arch : Eng: A*
Address: Address:• 0
Phone: _ ' Phone: �t
Zip: License: 9/07S.
' ` SCOPE OF PERMIT, d A :. - -
REMODEL SFR TO INCLUDE: REMOVE SIDINGAT FRONT OF RESIDENCE-AND STUCC E ,-i+ :�e, N�NING ,
FROM 616 TO A 12 FT OPENING,FRAME IN POCKET DOOR FOR EXISITNG MASTER BATH, RELOCATE AND 4%,'''- . -
FIXTURES IN MASTER BATH PER PLAN,ADD WHIRPOOL BATH IN MASTER BATH.CHANGE OUT WINDOW TO OD DUA -
GLAZE,CHANGE OUT EXISTING FRENCH DOORS TO NEW FRENCH DOORS,CHANGE OUT WINDOW TO poop At,: ' '
PATIO AREA,ADD 125 SQ FT PATIO IN FRONT OF RESIDENCE, REPLACE SINKS IN TWO ADDITIONAL BATHR�OOO11GG11S. /X" A ' Irs'
ADD SKYLIGHT IN THE KITCHEN.MOVE GARAGE-SIDE WALL INTO GARAGE AREA BY 2'TO INCREASE SIDE y .ffQ O`
SETBACK,CUTBACK OVERHANG ON ENTIRE DWELLING FROM MAX 2'TO FLUSH WITH DWELLING. POPA ^M1_L_{cT_ ,Y '
FACADE AT FRONT OF DWELLING TO MAKE FLUSH WITH PATIO. `II�� ,
MM-01-10 FOR 3'ENCROACHMENT INTO THE FRONT YARD SETBACK FOR A PATIO COVER/PORCH AREA.
FEE SUMMARY,-
Plan Check: $559.49 r:- Calc Valuation: $80,015.00
Permit $860.75 ' - • ',- ""Claire Valuation: woo
SMIP Res: $8 00 - fj .
SMIP Corn: v % $0.00 „.�v:_ /-- > / ,
Other:.y\\ $0.00 %%:'-,: , ,
Inspection: - $0.00 '
Total: $1,428.24 - ,
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 \.,(
2446-46(6/00)
•
DECLARATIONS 1-1 •
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 rs'compensation Insurance carrier and policy number are: _
Cartier. --" F(//110 744--• - «67
(This section need not be completed i1 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 the Labor Code,I shall forthwith
comply with these provisions
Applicant Signature:' — - Date:. s
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COSI OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that.l.am Iicens nd�er pr• ision f Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.beret - ,4 �� Class M-�e j {W/(-i
Conlrecldr's Signature:- ' � COate: Car/0y
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),
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 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.).
❑ 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: 1,
❑ 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 ❑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 greeter 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 Cale been fully complied with? ❑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? IP Yes LJ 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 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Cafifomia 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? ❑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 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.
I nature Of Le al Ow s) `sat��
And/O prized,p cant's-- a ate_.
CODE 1 INSPECTION TYPE all INTRIAL6 COOEE INSPECTION TYPE PLTE INTITIAL@
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 Well 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 \4v \
M6 • CITY OF COSTA MESA
BUILDING DIVISION
F �,,,z �' : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4 PERMIT E01-00386
%.a #
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 283 LILAC LN Status: ISSUED
Suite No Applied: 05/15/2001
Vicinity: REMODEL OF EXISTING SFR Issued: 05/15/2001
Parcel Nunmber: 42615111
Applicant: KING, CRISTOPHER ISSUED BY:
Address: 23911 STILLWATER LN
Phone: (949)249-5512
LAGUNA NIGUEL,CA Zip: 92677
. , 4 •
Owner RANKIN, ERIC S "'i •
Address 283 LILAC LN t 1 -�'rI i
y or
Phone:
COSTA MESA,CA Zip: 92627
Contractor: CHRISTOPHER KING CONSTRUCTION • • E3
Address: 23911 STILLWATER LN
iiP LAGUNA NIGUEL,CA Ph Zip: 9269)249-5512 O( h �I A7
License: 586530 -$
OS
t �
SCOPE OF PERMIT,' CST'
ELECTRICAL PERMIT-FOR REMODEL OF EXISTING SINGLE FAMILY RESIDEN iiiirrrriiii ' q 8'LI e
FIXTURES, 3 RECEPTACLE OUTLETS,4SWITCHES,&1 ELECTRICAL SERVICE-21.,1_..\ •\, 4.
_ C,
• REF:601-00449 - ._ - -- _ -- - - _ vt% ' Il ,
• FEE SUMMARY; ��9\ik/„
Quantity - Quantity ' - •
ISSUE FEE $23.50 Temp-Dist System/Lighting $0.00 ,:0i,
Temp service test $0.00 _ r, Busway/100 ft $0.00 -'o; , ,
Res.a/c package $0.00 . _- Standing Section $0.00 - 1 0
New Res(1-2 units) " $0.00 0 • . • " - Misc Electrical Equipment $0.00=j'. 0 /
New Res(3+units) ' '$0.00 0 - Transformers uptol kva/kw $0.00 0
Pool/Spa $0.00 �, 0.' - - up to 10 kva/kw' tj77
^ ','_$0.00' 0 - ,
Lighting Fixts $5.80 8' - up to 50 kva/kw $0.00 0
Recept Outlets. ' $3.30 - 3 : - '' :up to 100 kva/kw;: j$0.00 ,= ',0 /
Switches - '7, = $4.40, <-\:'- ::4,,,,,,-.. - ' ° over 100 kva/kw'". ' $0,00.\/"'.0 /
Non Res Appl $0.00 --.6.7--:_ ' Low Voltage Equipment""-" .- $0,00 0 - "
Res Appl '$0.00 - 0 I - : Low Volt Wiring•Systern/Ckt � -s&oo",/ 0 '
Service to 200a $30.50' "1 Misc.Conduit" C :$0.00 " - 0„.
Service to 1000a $0.00' - " 0 Misc.Conductor , - $0.00 " 0
Service over 1000a $0.00- 0 Circus(gen or ride) • $0.00 0
Motors to 1 hp $0.00' . 0 Circus(mech ride or lights) ', $0.00 0
Motors to 10hp $0.00 0 ' '. Christmas Tree Stand -$0.00 0
Motors to 50hp $0.00 0 _ • Fireworks Stand,;- ; $0.00 0
Motors to 100hp $0.00 0 - - -Other Electrical Fee $0.00 ,
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $70.50
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No. 92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned )
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and''all/
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit!
FOR INSPECTIONS CALL: (714)754-5626
24as4sIv00)
DECLARATIONS •
WORKERS'COMPENSATION DECLARATION: '
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
__/ work for which this permit is Issued.
M -I Have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Ceworkers'compensation Insurance carrier and policy number are:
,c5:971-n- (��1,/,,`'�� (-Policy Number:. -1062-
(This section need not be completed i/the permit is valued at one hundred dollars($f 00)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 provisi
Applicant Signature I Date: =• CAj/0
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100.000),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:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the.Business and Professions Code,and my license is in full
force and effect.Llc..a � , $ Class it. $'y'/
Contractors Signature:- • --,'"'"1.7"."-- ,- Date: c/jr/U/
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).
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 penally 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,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 properly 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 unbar 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.-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.ownei-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 ❑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 end Safety Code been fully complied with? El Yes El No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a_aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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 ❑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,
' nature Of Le r(s) Date
//`S��
c— And/Or Auth ze pplicant L. al to-�2-
CODE 0 INSPECTION TYPE PAIL ItTTTJA65 CODE. INSPECTIONTYPE PAIE INTmAL$
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing •
200 Final Re-Roof 210 Final Electrical ^'lrt_'
OP
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
CITY OF COSTA MESA
4BUILDING DIVISION
. rf' ,
S •
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
FI _ii
tPERMIT
,
kOR>em•o`'e P01-00291
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 283 LILAC LN Status: ISSUED
Suite No Applied: 05/15/2001
Issued: 05/15/2011
Vicinity: REMODEL OF EXISTING SFR /
Parcel Nunmber: 42615111 - ISSUED BY: '%`
Applicant: KING, CRISTOPHER
Address: 23911 STILLWATER LN ,
Phone: (949)249-5512 ,
LAGUNA NIGUEL,CA Zip: 92677 -
Owner: RANKIN, ERIC S
Address 283 LILAC LN
Phone:
COSTA MESA, CA Zip: 92627 .. ` �9
m p6 ►.
rs , A ( ,
Contractor: CHRISTOPHER KING CONSTRUCTION v- .
Address: 23911 STILLWATER LN D
Phone: (949)249-5512 •
LAGUNA NIGUEL,CA Zip: 92677 ♦1D
- _ _ . E ' IYy''_
License: 586530
] R
Arch / Eng: -. - _ .-_ . . - _ eC0 Ll���
Dag
Address: - Phone: �j »�j� -
��--`�y Y��� 4.
�D
- -- - --ZIP: -_ ALIO
License:
il
SCOPE OF PERMIT ,;` i ' -
PLUMBING PERMIT FOR REMODEL OF EXISTING SFR. INSTALL 1 P-TRAP, 1 4Rt! ,1, •
. 1 KITCHEN SINK,4 WASH BASINS, 3 WATER CLOSETS,& 1 PRIVATE SP,X� �L O
REF: B01;00449 . - 7 '
f;
'FEE SUMMARY' -'
AMT�� QTY �,OTY � AMT QTY
ISSUE FEE $23.50/ ,' Laundry Tub/Washer $0.00 ' 0 . �- Sump-Pump/ ,/'-'7 /,./ $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 $9.80 1 -‘. Trap Primer, $0.00 0
Bathtub $9.80 1 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 " , I Receptors . $0.00 0 - .-Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 ' 0, - • Septic Tank . - $0.00 - 0 :' Wash Basin $39.20 4
Dishwasher $0.00 0 -Sewer Cap for Demo $0.00 _ -0 ,-i = - "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) $29.40 3
Drain,Roof $0.00 0 Shower $9.80 1 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 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 $9.80 1 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) $30.25 1 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: $161.55
NOTICE: The work authorized by this permit siGOMMANATS ASi GIAL Cn NDIT#0L4S 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.
I
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ally
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
244646(6/00)
•
DECLARATIONS fl I ( •)
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
ork for which this permit is issued.
LV 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 workers'compensation Insurance carrier and policy number are:
r -Carder: y S-t i-FL)AiO PolicyNumber "(`f/06 a
L -(This section need no be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these Drovi • '
r Applicant Signature: .sae Date:— 74e.
L
'WARNING:FAILURE TO RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($l00,000),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:
I hereby affirm that 1.am license under rovisions of Chapter 9(commencing with Section 7000)of Division 3 of.the Business and Professions Code,and my license is in full
force and effect.L1c.qQ S- t Klass# .✓' 5 Hi
Contractor's Signature:. - Date:- S!/S/o'/
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).
Lender's Name: Lenders 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 sale(Sec.
7044,Business and Professions Cole: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 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(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,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:
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 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 feel 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 en 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 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 ba within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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.
/,SSI aee Of Le w (s) Date
/ y /�
Hitft d sant - - r,Date_�
BODE I INSPECTION TYPE UTE INTRIALS CODE INSPECTION TYPE PATE INTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical 1 ,,
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof _ 210 Final Electrical �����7""
�
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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
Jc— PERMIT NO. TRACT NO. LOT NO: 'UNIT NO. l '
...)TY OF COSTA MESA CONSTRUCTION PERMIT
Z.rl L/LA6 �,t/c , S 2s Ss . �P r aSL/ t .
1 ;4113 9/30/B6 . i9.50 TL
Project Address Gn - 1'�G� } 1
Applicant's Mailing Address Z.11 r L/L/1 G. 1-N' TYPE OF CONSTRUCTION , NEW U ADD ALTERATION torsi EPAI R' % '•
1966-f 1111 CONVERSION LI DEMOLISH O OTHER (�.;NO , /J'/ - // • -. I !J 7
Owner's Name NE�.Q Np L$pN • phone ?� P•P # - Zune rtr��
Zfj3 L/LAC .LN. DESCRIPT ��,,ggK,[USEOFBL,D�i
Address - �Sr� % LSA "gsrk�� ! S Main Building: Accessory Building: ,
Z
I Arch/Eng. - License No. TYPE OF PERMIT GRADI G ❑ FOUNDATION ❑ STRUCTURAL ' T Front, , _•
O
I
❑ ELECTRICAL'❑ PLUMBING g.MECHANICAL g - , N
Address a �j q ❑ TENANTd-� Rear •
Contractoir's Name A Eifa--rn6Il /A/PA-Art Phone `Go-no ❑ OTHER _ ' . I ' K_3 'C' Right -
i PROJECT DESCRIPTION SQ."Fj�8700 J�^1f / -
Addresslmailing) �O `�••1 •[-�"/L�C LI✓, ._ _'/ I - • OCCUPANCY, K _ • _ G
0 Z /✓66 • , ; CONSTRUCTION TYPE VALUATION'S � �0 • s Left I i R
City License No. • • ZONE ,GRADING CU.YDS. ACRES ) E
LICENSED CONTRACTOR DECLARATION /�� ,p ,, ; Plog. R¢F.# /� Park ing.Req./Provided + I .
I hereby affirm that I ani licensed under provisions of Charter 9 (commencing Remarks: C.o�/ .- GL455; ,4 — 0✓& jc op '. ,ka /_. ' • Planning Notes: `i, . , • : M
with•section 7000)'of Division 3 of the Business and Professions Code,and / T •�' A�' �/ T
my license is in ful for e and effect. Z Z /Z 3Of* FILT/ — Prix/ .//etelft/N✓G I .
License Cl 5s • �• ' Lice a- •
No. _ 4 S_
Date �� Signature �� �- _- , _ PLUMBING • FEES : • L - • i
c WORKERS'COMPENSATION DECLARATION • , Bar Sink• . , '- " Showery - ' • -
M ' hereby affirm that I have a certificate of consent to self-insure ora certificate _ _ - ELECTRICAL FEES
�/ Workers' Compensation Insurance, or a'certified copy thereof (Section Backflow Preventer' ' Service Sink •
JO, Lab. C.} , Automatic Washer , - Transformer 0, 15-50 KW
( policyNo. — WC oo.296,1 Com an A/Af /ON tot pi -
•
d c pan; Backflow Irrigation . Sewer Cap ' - - - 0 50+KW
\ l • Construction Pole Sub. -
�Certified copy is hereby with-the
_ • - - - ' -
1 Cer fiegscopy f1pled withthe city B 'ly tl' ,g Divisi / 4.4./azar Bathtubs ! - Sewer Connection Cooking'Unit Meter Cup to 100 amps ;
ODate >V^ ry Applicant }�[L(/L/ C - - - -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors I • Dishwasher _ Meter Dover 100 amps j
(This section need not be completed if the permit is for one hundred ($100) or —
less). Dishwasher -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 theDrinking'FOuritains . Solar Tank ' Fan
Workers' Compensation Laws of California. l s - Motors❑0-1.HP ❑1'/x:g _
Date - Signature ' Floor Drains Swimming Pool w/Spa „ ' F.A.U. -
NOTICE: If,after making this declaration,,you should become subject to the, 7 Inc.Solar ❑9-15 HP ❑18.15+
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 Pole Light s I hereby affirm that there is a construction lending agency for the performance - g -
, of the work 'for: which this permit is issued (Section 3097 Civ. C.) I - -
Interceptors Water Heater Outlets
- Lender's Name O�jj Range '
-Lenders Address S.� - ,_- Kitchen Sink 'Water Service. _ - Switches - - ' - -
OWNERBUILDER'DECLARATION • - - 'Sign- ' -
I hereby affirm that-I am.exempt from the Contractor's License Law for the Lavatories ' . Auto-Wash -
Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
' county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0.5 KW ❑5-15 KW Trash Com actor
any structure, prior'to its'issuance, also requires the applicant for such permit , P
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 - - - -. _ . _ . -
xrefrom'and the basis for the alleged exemption. Any violation of Section , t • . , t
' 31.5 by any applicant for a permit subjects the applicant to a civil
natty 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 I $15 ' , Issue Fee $ 3 -
• ,
•
compensation, will do the work,and the structure is not intended or offered ' - Reinspection Fee , '! $15 Issue Fee • , - $ 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 I
' ' thereon, and who does such work himself/herself or through his or her own • t - - 'DEVELOPMENT SERVICES REQUIREMEN / [j �r� �y
I employees, provided that such improvements are not intended or offered for Boiler Hood or Type ❑ ZoningA roved By / C.0 --” Date .9 30 '1
sale. If;however, the building or improvement is sold within one year of com- Canopy Type II ❑ pF LLL
'pletion, the owner will'have the burden-Of proving he/she did not build or im- Duct- Under Ground 1 •
rove for the purpose of sale). Building Approved By - 'Date �3Q
•
-"U 'I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural •Application Issued By - Date
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 •]fJX?IS1_lI.I.Nj.IIIa..L....sbuilds"or improves thereon,and'who contracts for such projects with a con- - 1 t- SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware,that Exhaust System'0 .Multiple ❑ ' c ' BUILDING PERMIT $. �9. 00 1SMIP I - - $ - D.Sp•'•
proof off their Worker's Compensation insurance should be provided to me: _ �' _ '
0 Tam exempt under S•ection ' ' 'B.& P.C..for this reasons _. Firepl/Fact:BIC-ICBO# - •,Fire Dampers : - - PLAN CHECK $ PERMIT
_ PLUMBING - • - $. - _ - ISSUANCE _ $ __
• Date' • owner• ' • _ Heating System& Ducting, , 'Registers r - - PLAN CHECK ' 25% $= ENERGY:P.C. $ r '
I hereby certify'that.I have read this application and state that the above ❑0-100,000 BTU ❑.100,000BT - I . ELECTRICAL $
' information is correct. I agree to comply with all city and county ordinances • . - ' ' ' GRADING t
t and state laws relating'to building:construction,and hereby authorize repre- ' " - - - ':MICROFILM ' 5- =
sentatives of this city to-,enteyyy won. the afaovetnentioned .property ,for- PLAN CHECK 50% $ Q
t in gnatuan.PurPoseS.// yr, p��
Reinspection Fee ' $15" _ Issue Fee -' - - -$ 3 - I PLAN CHECK 25% $ +
CMF 0865:46;rev. 10/84`White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
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. I 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
6. Electrical UFER 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 7 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. Ga Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . - 73. Undergrnd.Storage Tank ❑Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical t--
'27. Frame and Flashing - 76. Dry Standpipe - +
28. Lathing & Siding 77. FIXED SYSTEM FINAL I '
•
29. Insulation 78. FIRE PREV. FINAL • I.
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 4
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace - - -
38. Final Plumbing . • •
39. Water Service-Final
•
40. Gas Service-Final • •
41. Solar Domestic-Final• ,
'42. Backflow Preventer
43. Backflow Irrigation • • •
44. Landscape Irrigation System
45. Sound Attenuation • ,
s
46. FINAL Handicap STRUCTURE
7/4 i •
• -:
•
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
No._ ,_ Date
•
•
Add to Permit #172b
OWNER ppR 1 L
DATE 11-9-b1
IRVING JORDAN SE ,
JOB ADDRESS 283 Lilac Lane BUILDING PERMIT NO..15829
GENERAL CONTRACTOR,Owner VALUE $ 3,000.00 rm,
AP No. LOT 28 TRACT 3856 FIRE ZONE DESCRIPTION OF WORK Cony.gar.to fan
INSPECTIONS Signature DATE GROUP I TYPE V ZONE R-1
Soil PERMITS ISSUED
�. SUBCONTRACTOR DATE NUMBER
r
Rough Corn. Refrig. ❑ Air Cond. 0
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. ❑ St.Swr. 0
Sprinkling System
Construction Pole
Underground ❑ Power 0 _ ��
Rough Wiring 'G-(.A f/- .7Ce➢' vn C�t:,l //,-;274. 4 3 it —_�
Trenches ❑ Forms ❑ Steel Reinf. 0
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing
Frame and Flashing J.5 p.- f/- / C.
LI 7
Lathing — In 0 Out 0 _
Plaster, brown coat
Refrig. 0 Air Cond. 0 Final
Heating, Final
F Sing Fixtures, Final.
1 - Gas Test
Electric Fixtures, Final is //
�/, rf,7 /
Building, Final
obis �`YL
OCCUPANCY 'T 9 e• 46-72v `2"d 15829
FORM BU4-5M - 7.61 •
1q .38. 9 FEE RECEIVEu-
52NOV 9 1*'
COSTA MESA BUILDING-SAFETY DEPARTMENT ‘41-
FINANCE DEPT.
P. O. BOX St/ COSTA MESA. CALIFORNIA •
CITY OF COSTA MESA
•
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING .� / -� BUILDING
ADDRESS LC) S 6.//7 � �' A 1 c,
COSTA MESA. CALIFORNIA For Office Use Only
_ern'
7 I F/. ^ :`,.. 14-71-S..-
L 2 A I RECEIPT NO. �PJe T N
OWNER (�� ) �.F. i ITh
MAIL ��\ RECEIVED BY Ont RECEIVED D/A/TE 1p7
SUE
ADDRESS �)�-[ !'C r<� �,4)._,f)-, 1/�l f.ln- i!_ o i DA / '
".
BUILDIN ^J,
CITY Neil A r704.--(Rt-,,i'0-4, NO.417:':�':���� ADDRESS 713 I l &c- LBI V��
ORCHITENT R . , 1;'C �: II r�i. COSTA MESA. CALIFORNIA
OR ENGINEER 7.. �. eS�: tIA%�i,�TAVNO(--/11,44-79
/ /
ADDRESS Ij{J/ 1> CI•I,R�,<y�-- -I•�[t GIP.. ZONE i TYPE GROUPJ.-
)
CONTRACTOR { OW-her APPROV� f//41-6/
BY GATE
ADDRESS ', -, e( ,'ih .1 ' c- . ZONING
•
CITY A //il_�/ V7'i yAON ' 1 ,....-z
NPLOANL
BU
W
STATE .2 LEGAL
LIC.NO.�,.G - EO. /_ /{ JiDESCRIPTIO7f /O(�1
oz, 6J-
SIZE 77 :� /-I NO. OF BLDGB` /
OF LOT c ( ) x J / l� NOW ON LOT / A.P.NO. \ 1, .�J/\
USE OF • I YARDS //,(J
EXISTING BLDG. 5 /�./L)'`Q AJ' ����'''7]pp . APPROVED LLOW n �I)
SETBACK LINE FROM ;'/ ,I / EAR YAR I,�I. FRONT(CENTEft LINE BT.)- F v/J ( IN.
CENTER OF STREET AII"'///---Y4 I� .I q
SIDE YARD LEFT /9 I I RIGHT /.sr- R.SIDE Apl FT. `Il Y\ IN.
DESCRIPTION OF WORK [/\,\W"
�/ L.SIDE t/ F . - IN,
i NEW II ALTERATION I f� II ADDITION I REARpY FT. , IN.
REPAIR I II MOVING I DEMOLISH I \ YPROVE
BBr DATE /`6f
BUILDING NO. OF ! 0 it---9-6/��J
SIZE ROOMS STORIES ��,
EXTERIOR WALL I ROOF
COVERING COVERING
US • BUILDING ANDIViIO$K TO BE PERFORMED .
a aL I A
(3 ) v
i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF tie //Q\ (.�// PERMIT FEE $ /0
PERMITTEE ^^I-+ v �K"rl. `-"'!��""I_ m_
/�J/J ` j $ �Oc o[ CO PLAN CHECK $ 'a
AUTHORIZED AGENT �'&fk.�,«, (.(/.F444i � l p
TOTAL FEE
I
OWNER ,T(7 nAN,TRIITNG ,%��J/ DATE 6-1-61
JOB ADDRESS 283-289-297 Lilac 0`-'vr�---- BUILDING PERMIT NO. 1462].
GENERAL CONTRACTOR C. W. White _ VALUE $ 600.00 -
AP. No. •_ • •• LOT TRACT FIRE ZONE DESCRIPTION OF WORK 13l nrk rpt.,wal1
INSPECTIONS DATE_I GROUP TYPE ZONE R-11
Underground Soil U.G. Water PERMITS ISSUED
I' 'rground Gas — SUBCONTRACTOR DATE NUMBER
ead Water and Gas
Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test _
Construction Pole
Underground Power
Rough Wiring �
Trenches t - Forms //Steel / fir–
— (,-- 7-S
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing
Frame and Flashing
Lathing, In Out
F r, brown coat I
1 ging Fixtures, Final _
Electric Fixtures, Final
Building, Final d ��' -y –
OCCUPANCY 1'
Form 210-3M-4-5914621 14621
ti
. . �- C;tFEE RECEIVED
o. JUN 1 1861
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. 0. BOX 917 COSTA MESA. CALIFORNIA
- CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
%%TV az 3 -028V/-x297 `L:I /VA
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. PPERMITNO
OWNER re 441\ -JO,G'c49/1( •
I I ' 7 b �
MAIL �O`O O. RECEIVED SY DATE RECEIVED DATE ISSUED/
ADDRESS ��^�^ /yLp.r - (� 1µ ` ' � 'I '�� �d �'VI .
L
CITY �t24 L-s._ /eta) 1NG
��.U�/Uil �Y�F1 ADDRESS
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER N o A/2 NO.
ADDRESS •
FIRE
�/,� ),5 / FIRE TYPE GROUP
CONTRACTOR C C . I F /14//A/ / APPROVED DATE
ADDRESS /O 5-S-2- V` AEuLIV GeU✓I' 2t4 ZONING
��+ / TONER /)�� NO.OF ^ USE OF NEW - .
CITY 17 �G • _ -� PLANS I BUILDING /ii /A /
STATE 3 / GAT
LIC.NO. Q / S O. C"C ✓ aO yO DESCRIPTION / 24 T.44 -Si/
-,-yj I
SIZE �j NO. OF.BLDGS. - [� 6
OF LOT �-CO Z{ O-- 7S I NOW ON LOT A.P.NO. 1) �1 M / 5- - D
USE OF YARDS EVES
EXISTING BLDG. jflA //iWe. 2Iii( APPROVED ALLOWED WED
SETBACK LINE FROM (CENTER LINE ST.)
CENTER OP STREET REAR YARD FRONT LFT. IN.
SIDE YARD.'LEFT I RIGHT R.SIDE —` FT. IN.
DESCRIPTION OF WORK /IN.
L.SIDE /y,/ FT. �P/)f
NEW I ✓ALTERATION I II ADDITION REAR - -� FTL` "/ " • I
IVMOVING II DEMOLISH I APPROVED . 'I O . DATE /� /
REPAIRI Gn/ L.
BUILDING NO. OF 0--2-91
SIZE ROOMS STORIES
EXTERIOR WALL - COI ROOF
COVERING
USE OF BUILDING AND WORK TO BE PERF RME�
//.e-"dinn-� w� CR. -2 '
IIhQ ec1D—
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE AB•VE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY- CES AND STATE S REGULATING
BUILDING CON Ass N. VALUATION
SIGNATURE O,0 40 ti p i I 1 PERMIT FEE $ 9
PERMITTEF • N
B_
$ �I PLAN CHECK $ --� `;
AUTHORIZED AGENT 6/7/0 �/ z
G�,/// TOTAL FEE $ 0
PPR 1 1 1962
7.
OWNER IRUNG JORDAN-
JOB J DATE 3_0=211-61JOB ADDRESS j3 T,i"laC LaAe ${:P-S 15G7/+��
BUILDING PERMIT NO._1572O - _.
GENERAL CONTRACTOR ownerVALUE $ 7 ,QIp.1)O
AP No. -1.1 8_150_09 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add cpt.& stor.
INSPECTIONS Signature DATE GROUP j TYPE V ZONE R-1
Soil PERMITS ISSUED
C SUBCONTRACTOR DATE NUMBER
\ r
Rough Corn. Refrig. o Air Cond. ❑
Rough Healing
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. 0 St.Swr. 0
Sprinkling System
Construction Pole
Underground 0 Power ❑ -
Rough Wiringa 1(""2-7 ./ /tt,,,-,.d'.6-- e,- -124t t.-/him ^-
,<"'_"e--1,.,�
Trenches E Forms E .. Steel Reinf. 0 1)2 tf_3,- cf.
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing C /f-- /7-- 61
Frame and Flashing
Lathing — In 0 Out 0
Plaster, brown coat
Refrig. ❑ Air Cond. 0 Final
Heating, Final
F 'ling Fixtures, Final
Gas Test
Electric Fixtures, Final ea ,cz.se p, cvl.u_. `^ 'x %t (,z..,/ 4
Building, Final ~6.. 3/3/ .%
OCCUPANCY t - r
FORM BU4-5M — 7-61 ,r/1 n g/7/S1rer /s8 19 0.2-47-411 . I 15720
FEE RECEIVED'
i517`r0 OCT 241031
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. 0 U./- 1
P. O. BOX 317 COSTA MESA. CALIFORNIA .^J
CITY OF COSTA MESA VVV
For Applicant to Fill In Complertel�yyl� APPLICATION FOR PERMIT
TYPE OR PRINT„�r -`f`ag aps BUILDING �r`Y�V(�r
BUILDING 2 '3 ✓ r ' . .. n� \
ADDRESS tie*
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. I P LIT NO.
OWNER .. /frr 4P". 7c?
MAIL � •
,
ADDRESS ® Y� %2py. / / RECEyDIY PAT; BE? DATA !RJR/yip� -6L/OZ
/�/,v R Y��.G..0.J.. NEO!1I/ (p-/JP I� BUILDING 3 P .(J
CITY ADDRESS Z LJ Y 'I QO
/ �( �C {104-1/�Q..
ARCHITECT �/
oMe+w«R .LdI 6 < /n R9+ ✓1' /W.; COSTA MESA. CA 'IFORNIA
ADDRES41.M1Y��G 4. FIRE
qZONE TYPE(((��� GROUP !/ 1/�
CONTRACTOR /�. y�„n- rr�.pCa/a vi 'C✓ APPROVED ✓ DATE/O 7/(�
ADDRESS T3 :�.�5 Cite 'J-1• /), 4ONING ^
�/I ��//� //�� 20N NO.OF y 8E OF NEW t`l-�”
/
CITY ! 1/eW y(/V !V•C'er aI � e 4 E./ PLANS UILOING C -2
STATE
NO.€2 3Z7 NOTELM G- 0 ?I / LEGAL 1/)) �-1- .s i �7" 4/111.6)``��
DESCRIPTIONII 4 't, v,tj
SIZE 4 _C 7 / NO, OF BLOGE.
OF LOT JAS O V� / �! NOW ON LOT I A.P.NO i/6 ----4-(:) - CD C/ I G
USE OF /l // ,� YARDS ! EVES - 1
EXISTING BLDG. W G `�'
,�}( .4_,/s APPROVED ALL WED
CENTER OFSETBACK I NSTRE TE M T�/ REAR YARD /i- FRONT(CENTELINE aT ' /( //FT.
.,"b �((���- � IL. N•7 /
SIDE YARD LEFT 'I / / RIGHT r R.SIDE C,' L�A" IN. V_
DESCRIPTION OF WORK
L.SIDE ������ ��I� FT. n�+� AIN.
NEW II ALTERATION I II ADDITION ',,t< REAR /-{i4-ea/ (`2 F0'A 4/gy m
REPAIR I II MOVING I II DEMOLISH I APPROVE `, {. //TT /
BY &% :7. TE'-TT J L
BUILDING `,��'��/ffffff NO. OF FAO
Si - t, Y
SIZE /MR BR ROOMS/CVd/O STORIES / f ::„..fridarlit. I`'h Ci I�-A I i V lr yf
EXTERIOR WALL-_fYfj /YII{'ROOF //qq �A' Y- �''" u i' ' "' •" ` "`COVERING I COVERING/✓4/N a-U-- OF BU D N AND WO- TO -E.'ERFORME - y p} nisi L I� 1
< i ' .f fJ,./ 9 M'IT_ "T�.i UJi`11� Il`ret+ �.. . R:11‘..
.ti b?u/ i,.°L° ti''tQC .`�
Tura / o \ Y' ,-1� J
• 'aC-.CL 's-- d ,C`Q�r��L 1 a - [/ Alti 1
( \ �fLJATE ,bJla. /L- -C ; t
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION T1NEr AMOUNTS / n1V COI 1iW
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PORPoSE-411.
BHMYN-WiOfR- A ATIO 18-POR-THE-1 `I
GP i AHLISHIN.. A PERMIT WEE 5RLtr ' I
PLY WITH ALL CITY ORDINANCES AND STATE /WE REGULATING
BUILDING CONSTRUCTION. - VALUATION e A
SIGNATURE OF H ✓�"` pv`PERMIT FEE $ N 1 A
PERMITTE / /� m_,;
%fj�//yf $ f ) 4:"../a-
PLAN CHECK $ 4/•m '; ' n
AUTHOR IZED AGE�4i!%�(/[a'i'`�\ .. / ~�.
\ TOTAL FEE $ /�-� Fo r•^
14369 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT gyCdPR 26°.231
P. O. BOX 517 COSTA MESA, CALIFORNIA D I[M1IANCE DEPT.
For Applicant to Fill In Completely CITY OFCOSTA MESAPPP Y APPLICATION FOR PERMIT
p TYPE OR PRINT BUILDING
ADDRESS 283 Lilac Lane
COSTA,MESA. CALIFORNIA For Office Use Only
OWNER Irving C... Jordan i RECEIPT NO. I A PERMIT-ND%
MAIL :3700 Newport Blvd. RECEI/Vq� BY D IV
RECEED DATEDAPI LESSUSED
ADDRESSvim- +.&
CITY Newport Beach NDIORBUILDING
38811 / ��"� 2. 3 la°i
ADDRESS
ARCHITECTER D. Southworth NEgii85161 COSTA MESA. CALIFORNIA
ADDRESS COS to NSeSa FIRE f / /�.,t
�^M `a _. _ ZONE TYPE 1 GROUR /
CONTRACTOR 1i1Y.f r ye3Gy-_!., APPROVED
BY DATE .
ADDRESS Same ZONING
ZONE I NO.OF USE OF NEW to
CITY _ ` I PLANS. I BUILDING ge _! ,
STATE TEL. 1- _ .,��_., & L'
LIC.No. Bl-8251{-7 NO. 0113 8811 LEGAL _ .a ���Yy•_ '
DESCRIPTION / �/' /J�
OF
`7�as x u 0 I NNOW DN LOT 0 A.P.NO. /[ D - /�o — o/F0/_
OF LOT 1177 �I J ,{{/7 � � �
USE OF iC�j t c 8 EVES
EXISTING BLDG, APPROVED S-cd�3 S ALLOWED
SETBACK LINE FROM , (CENTER UNE ST.) .,`/
CENTER OF STREET REAR YARD FRONT /7/ cFT. IN.
5
SIDE YARD I LEFT 19 I 011 I RIGHT 15 I 011 R.SIDE /// / FT. IN.
DESCRIPTION OF WORK / `/- FT. IN.
L.SIDE
NEW I X II ALTERATION I 22
II ADDITION REAR ,..QS FT. •._.,IN,
REPAIR I MOVING I DEMOLISH I APPROVED 1,/ LO( DATE 41`� ] �7
BUILDING NO. OFZ /fl �9
SIZE ROOMS 7 STORIES_ HOLD FOR SPECiAL'REQUIREMENTS
EXTERIOR WAIJ.tCOVE
UCO I RINGShingle$ NO FINAL UNTIL
COVERING J
USE OF BUILDING AND W RK TO BE PERFORMED 1. Dedication of spandrel
Res . w att. garage
2. Installation of rec. cidoualks
Plan #1615A I 1682 sq. ft.
J 642 sq. ft.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNTEF SHOWN UNDER VALUATIONMIS FOR THE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COM-
PURPOSE OP ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. I _ VALUATION I
SIGNATURE OF ce 11- " e, Or_I ]. PERMIT FEE $ 37.00 N
PER MITTEF' J-.,L 'V L'�nL.�'.1611--
t°`- $ 17,752 PLAN CHECK $ ll"R
P50 4'
AUTHORIZED AGENT `` ` TOTAL FEE 5 55.50 0