HomeMy WebLinkAbout2813 LA SALLE AVE - Building Permits p 6� CITY OF COSTA MESA
/It:
BUILDING DIVISION
H �1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
• PERMIT 1 / P05-00241
V
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2813 LA SALLE AV Status: ISSUED
Suite No Applied: 04/07/2005
Issued: 04/07/2005
Vicinity: WATER HEATER �p�`t
Parcel Nunmber: 14167210
- ISSUED BY: � �'/\/
Applicant: NOCK PLUMBING ,
Address: 11612 KNOTT ST
SUITE 217 Phone: (714)895-1246 • . ,
GARDEN GROVE,CA - Zip: 92841
•
Owner ANDERSON,JEAN M TR „
Address 2813 LA SALLE AVE -
. i.
Phone: _
_ -
COSTA MESA,CA Zip: 92626 "
Contractor: NOCK PLUMBING '
Address: 11612 KNOTT ST- • '
'SUITE 217. Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
' License: 707775
_. - / - -
SCOPE OF PERMIT -
WATER HEATER CHANGEOUT.
: - - FEE SUMMARY • - -
AMT QTY AMT ' QTY - - AMT QTY
ISSUE FEE - $23.50 Laundry Tub/Washer .$0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation _• $0.00 , 0 Swimming Pool' : $0.00 : 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer - $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 • Urinal . . - $0.00' 0
Clarifier System -$0.00 0 Process Piping(per10 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'•'- - '- 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)/ , , $0.00 0
Drain, Roof - v $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 WaterRe-pipe/" - $0.00 0
Gas Earthquake Valve . $0.00 - 0 - Sink,Floor • $0.00 0 . -Water Service', " $0.00 0
Gas(1-4 outlets) N$0.00'_ 0 - . Sink,kitchen_ . $0.00 - : 0 • - ..'Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 ..0' OTHER $0.00
Gas Repipe $0.00 0 Spa(private) , , .$0.00 0 _ .VIOLATION $0.00
Gas Service $0.00 0 - . Spa(public) '$0.00 0 : i-- ' PLAN CHECK $0.00
Interceptors(Grease,Oil) _ - REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0 - - "
TOTAL CALCULATED FEES: $35.80
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
fora period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS ( ) (l
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
r, I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
r,dMy,wo r r Ion I u e c r policy number are:
,Carrier: ,1n(A I G I I IVbI p 01 lis olioy.Num_peril l I ell
/s
(This sect n need not a completed(it the permit is valued at one hundred dollars($WO)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 3709 of the Labor Code.I shall forthwith
comply with these provisions. 61-1-6
7 I �;
Applicant Signature: GDete? N/ ill//1
.WARNING,. REJTQ. ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),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 lice ternsisions of Chapter 9(commencing with Section 7000)of Division 3 of lhe.Su mess aryd)r sions Code,and my license is in full
force and effectf ig# Clasrk ( �l
Contractor'sSgnature: s��, r°�te; (s0-31-e J
1. -T'. .. _
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. ❑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,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 ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 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 end pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation.certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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 LI 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 ❑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.
^r.tuje'• :galOwne ) zit
T-eOS
And/Or'AtilhbdZed"Applicant (Dale'4,_moi:
;ODE I INSPECTION TYPE DAIL INTlJALE CODE k INSPECTION TYPE RAIL INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical _C� -�/7
1266 Pool Spa Final 208 Final Plumbing ' I 'a5"
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
ADDRESS OF BUILDING: 2813 LA SALLE AV UMTo CITY OF COSTA MESA — BUILDING PERMIT "-- --
INmERSNMIEIFIw6wII:ANDERSON, JEAN M TR PERM NO: P 076569
ADDRESS: 2813 LA SALLE AVE
COSTA MESA,CA 92626 PERMIT NO: P 076569 PLAN CHECK NO: N GOVT: N SUPP : N
APPL•MAIUNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTB
•
ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : C/O WATER HEATER SQ FT:
ARCH.OR ENa'S ADDRESS: WIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
CDNmACTDRSNAUE: NOCK PLUMBING ( 714 ) 895-1246
CONTRACTOR'SMAJUNG 11610 SEABOARD CIR COMMENTS : X
ADDRESS: STANTON CA uCND.: 511971 *S6SE************** *S6**** FSE*****Sk****AE**********x56********fr*SL+k*SESE*iE**HESE*+t*******
90680 6Mt Z ON ING R E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penahY of perjury that I arm licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)of Division 3 d the Business and Professions Code,end my license is in full force and effect.
CITY LIG.NO.:0 038 UC.CLASS: C-36 LD.NO.: 51 97 EXP: 02 /97 MAIN BUILDING ACCESSORY BUILDING ---------
71 qL Contractor
jet,
t-'M3i � i : FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
/ I LEFT: _ FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
ER BUILDER DECLARATION:I hereby affirm under penaky d perjury that I am exempt from the Contractors License Law for the
lowtmg mason(Section 7031.5 Bushess and Professions Code:Any county requires a permit to oonetmd,alter.improve, PARKING RE PROV: PARCEL: 14167210 ZNE: REF NO:
demolish.or re*any structure,prior to its issuance.also requlres the applicant for euch permit to Ne a signed statement that he or she Q
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>
Business end Professions Coded or that he or she is exempt therefrom and the basis dor the alleged exemption.Any violation of Section >
7031.5 by any applicant fora permit cut oda the applicant toacivil penalty dltd more than Me hundred dellen j$500]). ******W9E**********M W 9E W9i9b M WRi1i W 9E 9E W 969E*9h 9E 9i W***************************************,*
❑ I,as owner d the properly or my employees with wages as their sofa compensation,will do the work.and the structure is not intended
or offered for sale(Section 7044,Business and ProfessonsCode:The Contractors License Law does not DEVELOPMENT V E L O P M E N T S E R V I C E S • R E apply to an owner of property Q U I R E M E N T S
who bolds or improves thereon,end who does such work Nmeef Or herself or through his or her own employees.provided that such
improvements are not intended or offered for sab.If,however,the building or improvement is sold within one year of completion, ZONING APPROVED BY DATE:
owner-builder will have the burden of proving he or she did not build or improve dor the*thee of sale).
❑ I,as owner of the property,am exclusively convading with licensed contractors to construct the project(Section 7044,Business and
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law).
❑ I am exempt under Section: B.&P.C..for this reason: APPLICATION ISSUED BY: DATE: 6
Date: Omen ************************************** *************************** *
I do hereby certify that I am aware d end understand the requirements of California Health and Safety Code Sections 25505,25533.and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
25534,and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements ler
a permit for constmotion or modification from the Al . y anagemeni Diatnd.Residentialmndm ructionappicatioru aexempt from Nese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 7 . 00
Date: Applicant 2 5% S M I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penaAY of perjury one of the following declaration,: PLAN
❑ Ihave and witmaintain acenikateof consent tosellnsure for workers'compensation,as provided labySection3706dthe Labor ISSUE FEE 20 . 00
Code,fortheperformanceotheworkfowNchthispermitisissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
pI have andwin maintain workers'compensation insurance,as required by Section 3700 ofthe Labor Code,for the performance of the TOTALS----> 7 . 00 20 . 00 0 . 00 27 . 00 27 . 00 . 00
work for which this permit is issued.My waken'compensation insurance cruder and policy number are:
Carder: STATF EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 27 . 00 OVER/SHORT: . 00
Policy Number: NWr32L111110 09/30/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need nor be completed/the permit is for one hundred dollars(6100)01 less) 27 . 00
❑ candy that in the pedomance of the work for which this permit is issued,I shall not employ any person in any manner so es to
me subled to the workers'compensation law.ol Califanb, that' hould become subject to the "wk."' *************************************************.****************BE***d64L.*{t..N.i(.****
mpen.ation cions Section 3700 of the Labor Code.I shth campy M e provisions. j N D I V I D U A L F E E B R E A K D O W N
e' 7z1rhhs Applicant:riming:Failure to secure workers'compensation coverage Fsun/Awful,and shall subject an septley«dcNrNnalp«nmsa and TYPE QTY D E S C R I P' T I O N UNIT COST TOTAL COST
civil fines apt to one hundred thousand dollars(51040001,In addmon to the cost of compensation,damages as provided for/n
Section 37osofthe Labor Labor Code.Interest,and aftonwy'a fan. PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
padormance of the work for which this permit is issued(Section 3097.Ge.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have mad this application and sate that the above information is correct.I agree to comply with all city and county ordinances
and state laws relating to building construction end hereby authorize representatives of this thy to enter upon the ebove'mmtioned popery
for inspection purposes.
—•ON NKK
/ as 0020i:_'-G3201327 Tor 27.30
�. ]�'�/!'jL DME: 02/7./:9:. TIME: XC:O4
Date: ` `^
Signature of Owner/"Applicant/Co,Zt:
• a.
(5151-46.WP) White-Buildkg&Sal, :Green-Fite: Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING ,' POOL & SPA
APPROVALS Permit Date Inspector APPROVALS Permit#
Date Inspector
1. Temporary Electrical Service or Role . • 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 _ - --�.
6., ElectricalUFER;Grnd. 57. APPROVAL TO COVE R-GUNITE
7..Footings c 58. Electrical ConduitUndrgrnd. _
8. Foundation59. Gas Pipe, 0 Urrcirgrnd.,Test j ' - )
. 9:-Water Pipe-Undrgrnd. - -_ 60. Backwash Lines,P-Trap, Q Undrgrnd.
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 & Acces' Approval
. s I .
17. Rough Wiring Sign 68. APPROVED FOkR:PLASTERING • ;
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - •- Ff55E,DEPT. REQUIREMENT
20. Rough Factory Fireplace = - _ _ . s :.APPROVAL-"S, r Permit # " - -
21. Ducts;in Structure!_. _ - .70. Underground Hydro
22. Ducts, Ventilating - - - ' '71. Product-Piping O Gas ❑- Oil
23. Gas Pipe-Rough& Test _ - _ 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof,Sheathing - y ;. 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monacoat _ _ 75. Dry Chemical _ "ic
27. Frame and Flashing - : , 76. Dry Standpipe a-
28. Lathing & Siding . - - 77: FIXED SYSTEM FINAL_ '-
r.
29. Insulation- - - '• 78. FIRE PREV. FINAL - -
30. Drywall Nailing ! -' - - HEALTH DEPT. REQUIREMENT
31. Plaster Brown goat - - _ ' -79. FINAL INSPECTION . : __ -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED-
33. Final-Electric . .- Notes: 1
34. Final Heating& Air Conditioning ' ' a a - _ •- -" . -
I 35. Final Gas Pipe-Test - J y _ ., . i -
a ,. •
36. Hood;or Canopy ,-
37. Final Factory Fireplace ` ` -
38. Final Plumbing •• - jig?V' IU „ . - - ~
j 39. Water Service-Final t • -
yI
-
40. Gas Service-Final - t•
I -
141. Solar Domestic-Final - - - _ =
42. Backflow Preventer
'1 43. Backflow Irrigation • - •
44.. Landscape Irrigation System _ ' '.• - ' _ - -, - '
45. Sound Attenuation - - • - r.'
- _
1 46. Handicap Regulations - - _
r
47. FINAL STRUCTURE & BUILDING - ,
148. FINAL PLANNING - ',
149: Electric Release to Edison
50. Gas Release to Southern California Gas Co `
51. CERTIFICATE OF OCCUPANCY
S. Date
_ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ _ _
CITY.OFCOSTA MESAv CONSTRUCTION,PERMIT PERMIT NO. TRACT NO. LOT NO." 1 :UNIT NO. ..
t �Proj(ectAddress • Tr�L� • /. G Sc. /fie f8 asa23 - 1 �l t •
:2857• 19/10/86 18:00 ' TL
' Appficint's Mailing Address r 9�� CO . / q 72' C' �� TYPE OF CONSTRUCTION •. U NEW ❑;ADD ❑ ALTERATION 1C1.R EPAI R - i
I •' ❑ CONVERSION' ❑ DEMOLISH ❑ OTHER _ •_ A.P.# _ _ _ _ - __�_ -
1 Owner's Name /11- CI 4.✓'S n:n i Phone �'7XTW' DESCRIPTION OF WORK/USE OF BLDG. - '
Address � .�/r3 "- Sa re- Ci Vvt - ' . - I S Main Building: Accessory Building: •
Arch/Eng:• I •
License No. •
TYPE OF PERMIT ' ❑ GRADING ❑ LI
FOUNDATIONE Z
STRUCTURAL T Front' D
Address •
• , D TENANT; ❑ ELECTRICAL,❑ PLUMBING ❑• MECHANICAL B Rear ' s • N
{� A _ I
1- _ obi,' , y_y( OTHER P le _
Contractor's Name Wr2•✓1 Q c-I r. u Fr - 5 Phone G`/J /"a fret, .0 Rfight - r - - N
• Address(mailing) ) -w�7 ! • / l'Vl PROJECT DESCRIPTION SQ. FT.2/ OCCUPANCY K • ' G
•,,� �y / -, , CONSTRUCTION TYPE ''VALUATION,$ ..5-7:,O?)-- s Left • t I R
City License No. ZONE , GRADING CU.YDS. ACRES ' i I E
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# I Parking Req./Provided '
`' hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: .-- •
•
- Planning Notes: — •
( I I M
'/�\ with section 7000)•of Division 3 of the Business and Professions Code, and • T
my license is in full force and effects, (,, -. 1....f/�f'T 1
License Class • ` �J / License No. , r p `/ /. > • _ _ $
Date 9----/O --ifte Signature I t '7 /G t�' PLUMBING .FEES c
WORKERS'COMPENSATION DECLARAgatty. . t Bar Sink - Showers ' ' - - ELECTRICAL• _ FEES -O
hereby affirm that 1 have a certificate of consen insure ora if:cote •
\ of Workers' Compensation Insurance, or a certified copy,thereof (Section Backflow Preventer • Service Sink
3800, Lab. c. '/ 7 �- J - • Automatic Washer - - Transformer`❑ 15-50 KW - _
Policy No. /,3 -4. 76 Company .S4 le /7K-. �C •
Backflow Irrigation -
- Sewer Cap ' - -❑ 50+KW LL
1' _ - - Construction Pole Sub.-c. - -
A. 9 certified copy is hereby furnished. _
Certified copy is filed with the city Building Division. Bathtubs •Sewer Connection COOkIng.Uei[ Meter. ❑up to 100 amps
Date Applicant _ - ' _ - —•
f
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' Clarifiers. - • Solar Collectors Dishwasher _ ' , . Meter 1:1 over.100 amps •,
(This section need not be completed if the permit is for one hundred ($100) or - -. - - -
less). Dishwasher., - • Solar Piping - - Dryers ❑Gas DElectric Sub Panel '
I certify that in the performance of the work for which this permit is issued, I •- - - -
shall not employ any person in any manner so as to become subject to the Drinking:Fountains Solar Tank , Fan Motors 00-1 HP 01.1/2:-8 ' '
Workers' Compensation Laws Of California. - - •
Date' ' Signature • Floor Drains Swimming Pool w/Spa ' ' F.A.U. - -" '
NOTICE:If,after making this declaration,-you should become subject to the • - --- -•
Inc.Solar hg -
HP;❑16-15+ _•
• Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. - • - - - Fixtures Microwave -
CONSTRUCTION LENDING AGENCY Gas'Service Outlets •
Water Closet Device Boxes i •
I hereby affirm-that there•is a construction lending agency for the performance -
Pole Light
•
•r of the work ,for..Which this permit. is Issued (Section 3097 Civ. C.) '
S. Interceptors ' I - WateY'Heater I Outlets
' Lender's Name - _ • __.- _- - 1 Range I -
-Lender's Address• - •- -• • • - Kitchen Sink. -- Water Service -- - ' • , i - - Switches • -"' -- - ' '
OWNER BUILDER DECLARATION - g
, , I hereby affirm that-f.am exempt from:the Contractor's License Law,for the I Lavatories • Auto-Wash '
following.reason (Section 7031.5 Business and Professional Code: Any city or - i Garbage Disposal Standing Sections -
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Lau ntlry Trays Generator ❑0-5 KW ❑5-15 KW Trash�Com acto•
r
•
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 •I , ' i
the Contractor's License Law(Chapter 9(commencing with Section 7000)of •
'Division'3-of the Business and-Professions Coder Or•that he/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 - •
LI .nalty of not more than five hundred dollars($500). -
I, as owner of'the property or my employees with wages as their sole Reinspection Fee $15 • � ; I Issue Fee $ 3 ' - `
' compensation, will do the work,and the structure is not intended or offered - Reinspection Fee .rl $15, Issue Fee • - • , $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL, I 'FEES
License:Law does not apply to an owner of a-property who builds or improves _ _ _ _ -_S___ - -
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 ❑ -� 7
sale. If, however,the building or improvement is sold within one year of com- - -- - • Canopy• ' Type I ❑ .Zoning Approved By • _ Date -
, pletion, the-owner will have the burden of proving he/she did not build or im- Duct-Under Ground I ' - Building Approved By Date_ • l
prove for the purpose of sale). - r /
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System• ' . - Application Issued By - u" • . Date ���� �10•
tractorsto 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 • ' ❑0-100,000 BTU.0100,000 BTU - - $U A Y F FEES .
builds or-improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to'the Contractor's License,Lzw). I am aware that i BUILDING PERMIT $ I / : SMTP $- '�J
proof of their Workers Compensation insurance should be provided to me. Exhaust System ❑ Multiple ❑ • System Repair/Alteration
, PLAN CHECK • $= ' PERMIT -
❑ I am exempt under Section - B.&.P.C.for this reason Firepl/Favi:Blt. ICBG# :Fire Dampers 1 ' . -•
PLUMBING $; SSUAN CE $
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 • - ❑(it 00,000 BTU 0100,000 BT - ELECTRICAL $,' - GRADING.- $ - - 1 •
information-is correct. I agree to comply with all city and county ordinances - '
and state laws relating to building construction, and hereby authorize repre- - • --MICROFILM-_ $ - - - ,
, sentatives of this,city to,enter upon' the above-mentioned property for - - _ -- PLAN •CHECK .'50% $ _
inspection purp'Se `p
Signature :<✓ _ `/.� - Date des- - _ • MECHANICAL, $ - TOTAL FEE $ :1 0` J
'Drivers' License Or SJr Reinspection-Fee ' I $15 • t - ' i Issue Fee • - $ 3 PLAN CHECK 25% $ • J/
/
CMF 0865-46,rev.10/84 White - Building; Ca
r� 9: nary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL&SPA
Date Inspector • Date Inspectc
APPROVALS Permit# 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 I
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - I
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation • 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Un lrgrnd. •
60. Backwash Lines, P-Trap, ❑ Undrgrnd.
• 10. Structural Floor System 61. APPROVAL TO DECK •
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
•
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit - 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19; Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts; in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush •
24. Roof Framing - ////• 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing q/'`/�� 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
39. Water Service-Final ••
•
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backf low Irrigation
•
44. .Landscape Irrigation System
45. Sound Attenuation f'
46. Handicap Regulations /
FINAL STRUCTURE & BUILDING 9/ 7
48. Special Requirements Completed ! ,'fy
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - - •
51. CERTIFICATE OF OCCUPANCY
No. Date _ _ _ _ -
OWNER MESA DEL MAR CO. DATE ' 9-10-63
JOB ADDRESS 2613 La Salle Ave. BUILDING PERMIT NO. 20523
GENERAL CONTRACTOR Macco Realty Co. VALUE $ 20,288.00 • • '
AP No. LOT 5 TRACT 5252 FIRE ZONE 3 DESCRIPTION OF WORKRes.&At.Gar.
INSPECTIONS _ Signature DATE GROUP I&J TYPE V ZONE Ri
Soil//G/d_3-0.4 V /1` PERMITS ISSUED
Gas DATE NUMBER
Water 6 (../o-7-G3P"1 t-6-tgv
Rough Corn. Refrig!❑ Air Cond. 0 _
Rough Heating £.v. h-,i-62 ?q9r�T t3c� mem 414a y..
Rough Plumbing /2-6-G7 o.„, stP 1 i lay
Miscellaneous
Prop. Swr. Line 0 House Con. 0 St. Swr. 01:"..,, /) -2/-G3 2/a...-. e e OCT 2 8 1963 a Iowa. k
Sprinkling System /a" - 3-//-eV �he + i cm '3 If-'(d--4 IIIAV MW--a
Construction Pole V
Underground 0 Power 0 _ /� 1I�
Rough Wiring efl. , ()./3-C3 !/r-,e-le r 4.2-4.7-a, -
Trenches DJ/Forms 136"--Steel Reinf. to-7-`6.3'
Floor System M -0-63
Bond Beam 0 Steel Reinforce 0 _
Sheathing ✓i� f i1. -2--63
Frame and Flashing /cal ,2_/6_6g
Lathing - In (3r Out p— / ,NI ),.-30-69
Plaster, brown coat /°:.3-i i-2.6-Cy
Refrig. 0 Air Con. q Final
Heating, Final S !tii 3-l;7,-u y
Plumbing Fixtures, Final - 3-4'-C'y
Final Gas Test 'J1e r2 '- 3--/D-6v
Electric Fixtures, Final _rte _3_'Z -
Building, Final raw 3-IfcW 1
OCCUPANCY c 1
Form BU4-5M-3-63—S-B P
2052 • FEE RECEIVED
• COSTA MESA BUILDING-SAFETY DEPARTMENT SEP 1 o 1963
P. O. BOX 517 'COSTA MESA. CALIFORNIA FINANCE DEPT.
For Applicant to Fill In. Completely
CO COSTA MLICC ATION FORRSA
PERMIT
TYPE OR PRINT
BUILDING
ADDRESS 2B/3 .CLF SALLE Are-
-
COSTA MESA. CALIFORNIA_ - For Office Use Only
- Co.. I RECEIPT NO. I rsmY
11571
JI.I
OWNER Mesa Del Mar Development - 1!
MAILR CEI 'D .Y TE -- AY DATE ISSUED
c ADDRESS 3800 E. Coast Hi:hwa - - 't. e %- - . SEP 1 0 19[.
CITY Corona Del Mar, Calif . 3r.34220 AABUDDIE REING
OR ENGEINEER Macco Realty Co. 3r.34220 COSTA MESA. CALIFORNIA
ADDRESS 3800 E. Coast Highway FIRE-
ZONE TYPE�GROUk
CONTRACTOR Macco Realty Company APPROVED
BY DATE .
ADDRESS 3800 E. Coast Highway ZONING '
ZOIfH NO.OF I USE %F N•
CITY Corona Del Mar California ' R (PLANS IBUI :a �L . i , ,-
STATE 207343-SBS -1 TEL.
LIC.NO. q R-SR- NO. DEDALESCRIPTION Lot #5 - Tr=y t 5252
D
SIZE NO. OF SLD6@. /'�
OF LOT 72 x 93 NOW ON LOTEIOne A.P.NO. .--t\ ,.
USE OF .. YARDS EVES
EXISTING BLDG None APPROVED ALLOWED
CENTER OF STREETSETBACK LINE M 601 REAR YARD 18'101
'• � . C.
IN.
SIDE YARD I LEFT I I RIGHT I .IT R.SIDE C FT. C IN.
DESCRIPTION OF WORK
L.SIDE 5 FT. IN.
NEW II ALTERATION I II ADDITION I REAR /( FT 70 IN.
IIN...
REPAIR I II MOVING I II DEMOLISH APPROVE I{I LAAA... . (S y"'///J-I'
ye BY j�✓ DATE �J If-7-(�
Erin,6"x54'2" ROOMS 6 STORIES 1
woodROOF shale h
Livin: area 1896 a
EXTERIOR WALL Stucco COVERING shingle Garage area 483 Sf�
COVERING
USE,OF BUILDING AN WORN TO BE PERFORMED
Dingle Family R sidence w attached
game Plan #400-CR •
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 FE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION 41-0
SIGNATURE OF Mesa Del Mar .Development Co PERMIT FEE $ Q
PERMITTEE ry(Q[��/ _ / $ 20,288.00 PLAN CHECK $,)2 _
AUTHORIZED ANT /Xj//h -/ TOTAL FEE �r' AO ed
- O
/ r