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HomeMy WebLinkAbout2033 LAURIE LN - Building Permits I ( p ' 44 CITY OF COSTA MESA 4 BUILDING DIVISION ► •q-Strt: - DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 41 4. Pligh . PERMIT � „fi+ P06-00225 *ty (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2033 LAURIE LN Status: ISSUED Suite No A Applied: 04/04/2006 Issued: 04/05/2006 Vicinity: Parcel Nunmber: 42619125 Applicant: CANDY NOCK ISSUED BY: Address: 11612 KNOTT ST V SUITE 217 Phone: 714-895-1246 GARDEN GROVE,CA Zip: 92841 Owner: GORDON, DONALD S TR Address 18871 VIA MESSINA Phone: 805-523-3188 IRVINE,CA Zip: 92612 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 CHANGE OUT FOR SFD. 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 50.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 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 2446-46(&00) DECLARATIONS' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the i ' work for.which this permit is issued. I/ "-lilt ve rid will maintain orkers'comp:nset.n insurance,a• required by section 3700 of the Labor Code,for the performance o workwhich I Is It is issued. ` rl rM YY s. .• ran e m�:I Er insurance, et are: K _Carries M.4 '�Aa , l�\\this Pd�Numbe�;, (This sec ton need not be comp eted if the permit is va u:d 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 a agree that If I should become subject to the workers'compensation provisions of$$$action 37pp7ppp of the L or Code,I shall forthwith comply with these provisi , /1 ApplicenLSignature• /�� Date:-'---`({'/` U WARNINOrFAIL E TO SECURE WO- RS'r,.'•P-ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOUARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby effirm'that l'em liven r 1 '. s of Chapter 9(commencing with Section 7000)of Division 3'ohthe.Business an r s ' s Code,and my license is in full force.andieffect..LIc.a - LClass a ? c Contractor's Slgnatur� !//i� Dater—C,C O � -01 - 1 �' �Y 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.). O 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Dale: 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 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 feel 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 feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject at this application aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes EUl 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 California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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. - .• - re Of Legal Owner(s) Data! n j—And/Or Authorized Applicant j —Date- !- -- - CODE if INSPECTION TYPE DATE INITIALS Cimat INSPECTION TYPE PAIL INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical C �j 1266 Pool Spa Final 208 Final Plumbing Ai.-Q51- o6 RN 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 • CITY OF COSTA MESA BUILDING'DIVISION i" 1 DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER 1. PERMIT / 05-00211 +1te4' "0aoamm (714)754-5273 •'Fax.(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE;COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2033 LAURIE LN Status: ISSUED Suite No A Applied: 04/26/2005 Issued: 04/26/2005 Vicinity: CLOSET IN HALLWAY • Parcel Number: 42619125 ISSUED BY: Applicant: LAURA YENULONIS' • • Address: 422 JENKS CI , . Phone: 714-998-4300 CORONA,CA - - _ Zip: 92880 Owner: GORDON, DONALD S TR • Address: 18871 VIA MESSINA Phone: IRVINE,CA Zip: 92612 Contractor: ALLIED PLUMBING - HEATING -AIR CONDITIONING Address: 422 JENKS CI - Phone: 714-998-4300 • CORONA,CA - Zip: 92880 License:610780 - SCOPE OF.PERMIT CHANGE OUT FURNACE FOR UNIT A. MECHANICAL TO INCLUDE: 1 FAU<100K BTU • FEE SUMMARY Quantity - - Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0' Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 • Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU , $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 - -Up to 3 hp/100 k BTU _ .$0.00 0 Factory Fireplace $0.00 0 • 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 .0. - 30 To 50 hp/1,750 k BTU • $0.00 0 Vent Fan/Single Duct $0.00 - 0: - Over 50 hp/Over 1,750 BTU ,- $0.00 0 Appliance $0.00 0 - Boilers - Fire Dampers $0.00 0. Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 -• 3 To 15 hp • $0.00 • 0 Inst or Relocate Appl Vent $0.00 0 • 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp • $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 - Investigation Fee $0.00 Plan Check Fee $0.00 'Reinspection Fee $0.00 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 ihwork,ls.not commenced:within 180''days,or if work is-suspended or abandoned 'for a period.of 180 days. INSPECTIONS: In order-for.the work authorizedunderrthis-permit to be,consideredi legal; such-work.must comply.with,all.applicable codes, and.all {requIred Inspeetlons-end:Hnal approval must-benbtainedi.Failure.to:obtain inspections:and final'approval will result in the expiration of this permit. FOR INSPECTIONS CALL::(714)754.5626' 2446-46(WOO) 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. ' c' ✓,nave 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. workers'compensation insurance carrier and policy number are: n tc l .OaFner:_7 �'�S CX 1 r-CT'('Q) \ C a)r— Policy Number:=ld "1'JOtn--I2'r O' (This section need not be completed it 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 law 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 visions. 11.x\I A�pRcen'I-S.ignature: Q^(\-lam Date:_ WARNING:FAILURE TO S RE W RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN A l0N 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 Busine s and Professions Code,and my license Is in full for>_end:effect.,Clc:er-T- \j Gciass A= e Co�r's.Sig tare__ ern.. c1 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: 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: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit 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 Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health 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 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. Signature Of Legal Owner(s) Date O..11A Q L'IQ ..-L I Q , 1- �O -OS nd/OcAuuthotized Applicant-- �–Date. BODE T INSPECTION TYPE " -9 ' INTmAL$ ' ' coon' INSPECTION TYPE • r �-y figr 1616 Fixed System Final Fire Prevention .. • 206 Final Mechanical ' 4 ,�i'X 1266 Pool Spa Final 208 Final Plumbing _G 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 4` CITY OF COSTA MESA BUILDING DIVISION • -i- e DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER t PERMIT 05-00212 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Addrest 2033 LAURIE LN Status: ISSUED Suite No B Applied: 04/26/2005 Issues 4_0r Vicinity: CLOSET IN HALLWAY '// Parcel Number: 42619125 - • ISSUED BY: ` Applicant: LAURA YENULONIS ' "Address: 422 JENKS CI Phone: 714-998-4300 CORONA,CA - Zip: 92880 Owner: GORDON, DONALD S TR • Address: 18871 VIA MESSINA Phone: IRVINE,CA Zip: 92612 Contractor: ALLIED PLUMBING - HEATING -AIR CONDITIONING Address: 422 JENKS CI -- Phone: 714-998-4300 CORONA,CA Zip: 92880 License:610780 SCOPE OF.PERMIT CHANGE OUT FURNACE FOR UNIT B. MECHANICAL TO INCLUDE: 1 FAU<100K BTU • • FEE SUMMARY • Quantity - - Quantity • ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit . $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 - "Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator • $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/:100 k BTU - $0.00 0 Factory Fireplace $0.00 0- 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU- $0.00 0 VAV Box $0.00- 0 30 To 50 hp/1,750 k BTU - $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU " $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 - Up to 3 hp - $0.00 0 Smoke Dampers $0.00 0 • 3 To 15 hp , " ., " $0.00 , 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp , $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp • $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee - $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 • 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(800) DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the • work for which this permit is issued. ' ® I have and will maintain workers compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: y.,�1 c Carrier: 7 L_1X\C� (PKYWQX`\C'dire Policy Number: . &X.' P'S^ ,I' -Q (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) O 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 I ws 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 the provi ions. n , Applicant Signature: 1&_11 Y -lA Date: y-a\D-O' WARNING:FAILURE TO SECURE WOR RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000),IN TION 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 licens d 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.tic.# �j\ Q'1,��'� 'f,, Class# r.a-O Contractor's Signature: \ M .. V g.wcu Date: y-2Is-ns 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: ❑ 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,end that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied wiwith?0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aermit 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 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (II"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 (II 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. Signatur Legal Owner(s) Date QA 1 nGt ern-Sl f rc'c- y alo- ct. nd/Or Authorized Applicant Date CODE/ INSPECTION TYPE - - PATE " INITIALS ' ' 4 CODE! INSPECTION TYPE 1616 Fixed System Final Fire Prevention ' • 206 Final Mechanical - 3 ,J ' I<gE 439 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof • 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final'Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 5111 44es CITY OF COSTA MESA 4 BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER 0• PERMIT B03-01656 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2033 LAURIE LN Status: ISSUED Suite: Applied: 09/30/2003 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 09/30/2003 Parcel Number: 42619125 Zoning: Applicant: BRANNON, THOMAS L ISSUED BY: Address: 15161 LAFAYETTE ST Phone: (714)897-8147 WESTMINSTER,CA Zip: 92683 Owner GORDON, DONALD'S TR Address 18871 VIA MESSINA Phone: IRVINE,CA Zip: 92612 Contractor: BRANNON'S ROOFING Address: 15161 LAFAYETTE ST Phone: (714)897-8147 WESTMINSTER, CA Zip: 92683 License: 609940 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF SHAKE ROOF. REPAIR/REPLACE SHEATHING AS NEEDED,APPLY FELT AND COVER WITH 40 YEAR COMP SHINGLES.APPROX 3500 SQ. FT. INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 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 Existinq: 0 Required: 0 Proposed: 0 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 end 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(WOO) 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 ork for which this permit is issued. I have and will maintain w ars'co pensati Insurance,as req f d by section 3700 of the Labor Code,for the performance of the work for h thi pe is i ued. My workers'corn ho Insure W arner a policy number., f ZZZ U ?— `� Carrier: - . V . d Policy Number: (This section need not a comp! ted it the permit is valued et one hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued,I shall no(employ any person in any manner so as t become subject to the workers' compensation laws of C fornia,and agree that if I should become subject to the workers'compensation provisions of Sectio 3700the LaborCode,I shall forthwith comply with these ro ' o s. � l! Applicant Signature:laws Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,OW),IN ADDmON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION:/� it I hereby affirm that I am lice se Oaf . �e er 9(commencing with Section 7000)of Division 3 of the Business a cern: -'on Code, nd my license is in full force and effect Lic.atu e • II// Classat : x q go 0.3 Contractor's Signature: � Date: 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 properly,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 em exempt under sec. Business and Professions Code for this reason: Signature: Date: . Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,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 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 Califomia 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 Safely Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IID Yes No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 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 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,end 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. ��Signator Of Legal Owner(s) 0 $0/ I/OD;15ta/ uthorized Applicant Deo CODE i INSPECTION TYPE PATE INTITIALS ;ODEA INSPECTION TYPE PAM IBrlTIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final } 208 Final Plumbing 200 Final Re-Roof /Ot/� v` '/'spii/ 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 51111 plc CITY OF COSTA MESA BUILDING DIVISION •' ,I•�9 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER v. typar r!C PERMIT ' „e ,e`' P01-00024 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2033 LAURIE LN Status: ISSUED Suite No Applied: 01/18/2001 Issued: 01/18/2001 Vicinity: Parcel Nunmber: 42619125 ISSUED BY: Applicant: STARK, CHRIS Address: Phone: 818-407-1247 Zip: Owner: GORDON, DONALD S TR Address 18871 VIA MESSINA Phone: IRVINE,CA Zip: 92612 Contractor: ALAP ASSOCIATES GP Address: 7229 VARNA AVE Phone: (800)444-8865 NORTH HOLLYWOOD, CA Zip: 91605 License: 771905 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGE OUT. 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 50.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS I 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 2446-46(6/00) rrnirrrunmEimummomm. 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 2/ rk for which this permit is issued. It ave and will maintain workers'com), sation i . ran :. as required by section 3700 of the Labor Code,for the performance of the work fo�Nch this permit Is Issued. My workers'compen: n nsuran4(car`-,a •policy umber are: TY Cerner: IL s Policy Number: , ,• ` (This section need not be completed it(haft rmit is •at one hundred dollars($100)or less.) ❑ I certify that in the pe•- •-n,_ • they o; fo - this permit Is issued,I shall not employ any person in any manner so as to beco subject to the workers' compensation laws• ytar.--- ee that I should become subject to the workers'compensation provisions of Section 370 pf the LabIr Code,I shall forthwith comply.with.these• • IOOpj 1` Applicant Signature Date: 1 �I WARNING:FAILURE TO SECUR=WOR '•S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND Cl L FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),I, .••ITION TO THE COST OF COMP ATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: • I hereby affirm that I am licensed under• ions. • 4' - encing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect..Lic It � -' •, commClass N Contractor's Signature) I - Date: V/ Fel (7 CONSTRUCTION LENDING A• ❑ 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 then 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: O 1 hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑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 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 Califomia 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 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes J No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 COMPLIANC •• : • ' •N 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 :II state la s - ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for i .pection• rpo .• agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ir,Asr . • • ized Applicant nr/ 4• Date CODE f INSPECTIONTYPF DATE INTIM S CODER INSPECTION TYPE DATE ufTrnALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical /1 pp.. p 1266 Pool Spa Final 208 Final Plumbing n-?" Sw�01 Y 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 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA •- PERMIT NO. TRACT NO. LOT NO. BLDG.NO. - - - ' ' CONSTRUCTION PERMIT el -79.5-1 ' Project Address ,„..e, A LI i p. L n�. TYPE OF CONSTRUCTION 9745 12/18/81 • 5.00 TI. Owner(1 rte d.O f`.) ,,. 5 Phone7h?...atal ❑ NEW 0 ADD 0 ALTERATION _ -- - - Address c Dia. E y.)_I A P+r. 1 n. . 0 REPAIR 0 CONVERSION ❑DEMOLISH gt.../ Arch/Eng. License No. 0 OTHER ZONING REGULATIONS DESCRIPTION OF WORK A.P. 9f • . Address - ZONE PLNG. REF. Contractorar, C. r J ' ,c7' f/ rr,. Phone W3ca.1_77o TYPE OF PERMIT BUILDING TO BUILDING SETBACK CIL ST. PROPERTY LINE Address 1,«I Al j-crbnnit Ppa, ,(s .0 nn(6rn},' 0 GRADING 0 FOUNDATION 0 STRUCTURAL LOETYARD . LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL ❑PLUMBING ❑MECHANICAL, SIDE YARD I hereby affirm that I am licensed under provisions of Charter 9 (corn- RIGHT mencing with section 7000) of Division 3 of the Business and ❑ OTHER Professions Code, and my license is in full force and effe t. REAR YARD(TO P/L) Sag PROJECT DESCRIPTION --15.-1License Class ' ice nah No. gifsPKG.SPACE REQ. PROVIDED Date h'- Signature r‘-a..-n- SQ. FT. _ WORKERS'COMPENSATION DECLARATION OCCUPANCY—CONSTRUCTION TYPE STREET WIDTH PARK FEE$ I hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY DATE certificate of Workers' Compensation Insurance, or a certified copy- _n, thereof (Sectio 3000, Lab. C.). GRADING CU.YDS. ACRES b SPECIAL CONDITIONSt:.;1 lryyg-" Policy No.me 'hereb/1 Company '�"C- �' [ G�+ GV �� •r 'edified copy Is hereby thr he i REMARKS: L�'tsVC edified copy is filed with the city Building Division. ^ , ..EMPTION FROM WORKERS' COMPENSATION DECLARATION D�1E ,- (This section need not be completed if the permit Is for one hundred ' ($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 PLUMBING PLAN CHECK -, ' ELECTRICAL PLAN CHECK - subject to the Workers Compensation Laws of California. - L)W LLlNt. GA HA6E - Date Signature BATHTUBS SHOWERS I 50 FT SO FT NOTICE: If after making this declaration, you should become subject. TOILETS URINALS \ r'7 GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you mustTRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS /a / -) APPLIANCE 10-50-KW 50+ KW revok¢tl. KIT.SINKS DISHWASHERS e 11.✓ MOTORS 0-1 HP_1-10 HP CONSTRUCTION LENDING AGENCY Al I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS - IY (INC.SOLAR) 10-50 HP 50+ HP - • formance of the work for which this permit is issued (Section 3097 ` ' Civ. C.). FLOOR SINKS FLOOR DRAINS e/b p)V/ • FIXTURES OUTLETS - SWITCHES - Lender's Name i_ Lender's Address DRINKING FOUNTAINS -INTERCEPTORS CLARIFIERS /s1�f GAS TUBE SIGNS - OWNER BUILDER DECLARATION' r POLE LIGHTS I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professions code: SWIMMING POOL P TRAP - � LUNS I HUL 1 luN Any city or county which requires a permit to construct, alter, POLES METERED SUB improve,demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB quires the applicant for such permit to file a Signed statement that he is licensed pursuant to the provisions of the Contractor's License Law GASSEA-V-1G OUTLETS ' -4/ — SERVICE AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the _ - Business and Professions Code) or that he is exempt therefrom and the_ --WATER HEATERS - BTU OUTPUT — -`. - - basis for the alleged exemption. Any violation of Section 7031.5 by_ - an" applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS at more than five hundred dollars ($500). as owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS - ' s...., compensation, will do the work, and the structure is not intended _ ' or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE ' Contractor's-License Law does not apply to an owner.of a property APPLICATION APPROVED 8L, DATE who builds or improves thereon, and who does such work himself or ISSUE FEE through his own employees, provided that such improvements are not s intended or offered for sale- If, however,the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES • is sold within one year of completion, the owner will have the burden of proving he did not build or improve for the purpose of sale). BUILDING ❑ I, as owner of the property, am exclusively contracting with HEATING SYSTEM 0-100,000 BTU PERMIT $ SMIP .$ AND DUCTING licensed contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to ,r\ ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ On tracts from such projects with a contractor(s) licesned pursuant to SYSTEM 100,000,+BTU PLAN CHECK .$ - GRADING $ ' the Contractor's License Law). , ❑ I am exempt under Section B.& P.C.for this BTU ELECTRICAL $ $ reason PLAN CHECK $ _MICROFILM $ Date Owner SYSTEM REPAIR,ALTERATION TOTAL FEE$ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ PLAN CHECK $ -LESS information is carred- agree to comply with all city and county VANCE PC $_ representatives and state ity/relating to w). 1propertythis upon the above mentioned ' ignatr fo_Ljn"5P§ctlo ,poses. i2— , — FINAL FEE $ Signature( .�� �,-��� Date �t-�- Drivers' License or SS s ." ISSUE FEE • - CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor S CONSTRUCTION AND PLANNING POOL&SPA , APPROVALS " ' Permit# Date Inspector APPROVALS Permit# Date Inspector • 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - w 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing& Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation 50. .Gas Pipe, ❑Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines, P-Trap, ❑ Undrgrn ' 10. Structural Floor System - 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection- 0 54. Heater & Vent-Final 13. Rough Plumbing - . 55. Plumbing System -Final 14. Rough EIe`ctric-Conduit - . . -- ' - '56. Electrical-Final 15. Rough Electric-Wring 57.- Solar System-Final 16. Rough Heating & Air Conditioning 58. Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing . . 21. Roof Sheathing - 22. Frame and Flashing • NOTES: 23. Insulation 24. Lathing & Siding • 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating &Air Conditioning - - - 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT / TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA /CnONSyTRUCTIQN PERMIT •1 7S/ • 5152 10/ 14/86 ' 5e00 -TL Project Address {-+lAp.��1IryI1P/il',- ^�f— ` �� Cpl I Applicant's Mailing ddress p t I LQv"Y42M QJ4 TYPE OF CONSTRUCTION ' LI NEW LI ADD ❑ ALTERATION ' i REPAIR Pn`/ /(aago) ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P,# Zone Owner's Name N1-/Y��r/I,te' Phone O/"/ O�`1V DESCRIPTION OF WORK/USE OF BLDG. ' Address • l✓L'u Milt ) - • S Main Building: Accessory Building: E Z Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING�DUNDATION ❑ STRUCTURAL T Front O Address //�l //11 / 'rye n�1 ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL BA Rear N t. Contractor's Name ' �/t- -��j/! .�i/tb�P Ph ye,lig'J t/O� LI OTHER C Right - N • Address(mailing/ �'1J.1/ -Cr_ lo�.�j • PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G �^ / CONSTRUCTION TYPE VALUATION$ $ R City License No. C l/ S - ZONE -- GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking(� Req./Pr vided. E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ill lie: �. 1 a_ • ,— `. u, Planning Notes: ; RLCLIVLU V Cl IC1�' • M with section 7000) of Division 3 of the Business and Professions Codeand -- �- _ — • ' my license is in ful f.r ' and effect- T License Clas _ .. LI e, o i a - • $ Date n Signature tray - I I MIPT K.— PLUMBING " FEES - rw N."••• WORK RS' COMPENSATION DE • RATION Bar Sink Showers - _ I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL' FEES 1 of Workers' Compensation Insurance, or a Certified copy thereof (Section Backflow Preventer - • . Service Sink - IIIIIIIIIIIIIII. 3800, Lab. ///��� Automatic Washer Transformer 0 15-50 KW >olicy No. �CRB�-�' � company ��,+1/f/ �, Backflow Irrigation • ■ Sewer Cap Construction Pole S• ub. 0 50+ KW • : E��cCertified copy is hereby furnished. 1_ C I e ..cry is filed with the city B i is.oibt Bathtubs VIII' Sewer Connection IIIIII� • Cooking Unit Meter Duni to 100 amps Date MP �Q�/' Applicant PN •DELLA "k � EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers . Solar Collectors Dishwasher Meter Dover 100 amps - (This section need not be completed if the permit is for one hundred ($100)Or , less). Dishwasher ElSolar Piping - . Dryers ❑Gas DElectric Sub Panel ' I certify that in the performance of the or 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 ❑0-1 HP ❑tA,.B • Workers' Compensation Laws of California- ' - _ Date Signature ' Floor Drains . Swimming Pool w/Spa I_ ' ' F.A.U. NOTICE:If,after making this declaration,you should become subject to the Inc.Solar ❑9-15 HP 016.15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks , Fixtures , comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets ■ e . I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) ' Interceptors �• ^ Lender's Name p �� _ rK Outlets Range - Lender's Address Kitchen Sink II Water Service . Switches - Sign OWNER BUILDER DECLARATION - ' I hereby affirm that I am exempt trom•the Contractor's License Law for the Lavatories . Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal • Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap ill LaundryTrays any structure, prior to its issuance, also requires the applicant for such permit • y Generator ❑0-5 KW ❑5-15 KW Trash Compactor r . to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains 1111IIIIIIIIIIIIIIIIII( 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 - - r 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 malty 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 1 Issue Fee $ 3 ompensation, will do the work, and the structure is not intended or offered - - Reinspection Fee I $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 _ ____ thereon, and who does such work himself/herself or through his or her own Hood or Type I 0 ' ' DEVELOPMENT SERVICES REQUIREMENTS: . employees, provided that such improvements are not Intended or offered for BoilerZoningApproved By - sale. If, however, the building or improvement Is sold within one year of cam- Canopy Type II 0 ipp - - Date pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved ey Date rave for the purpose of sale): - - /,_[/ I, as owner of-the property,am exclusively contracting with licensed con- Duct-Structural .Refrigeration System Application Issued By I - Date ��'� ' Q•t"f tractors to construct the project (Section 7044,Business and Professions Code: • The.Contractor's License Law does not apply to raft such owner iofe property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU _ SUMMARY OF-FEES . builds or improves and who contracts for such projects with a con- • , tractor(s) license pursuant Yo the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System;Repair/Alteration - BUILDING PERMIT $ - SMTP $ - ry��. • proof of their Worker's Compensation insurance should be provided to me. I _ " 1 PLAN CHECK • $ PERMIT ❑ I am exempt under Section B.'& P.C.for this reason . Firepl/Fact.BIt. ICBG# . Fire Dampers PLUMBING I $ ISSUANCE $ Date ' Owner -• • • • - Heating System & Ducting ;Registers ' - IIIIIIIIIII, • PLAN CHECK 25%. $ I ENERGY-P.C. $ ' I hereby 'certify that I have read this application and state that the above �. 00-100,000 BTU 0100,000137 _ - - - ' - GRADING $ Information is correct.-1 agree to comply with all city and county ordinances ELECTRICAL - $- and state laws relating to building construction, and hereby authorize repre- - - PLAN CHECK 50% $ MICROFILM $ sentatives'of this city to enter upon' th• -above-mentioned propert forfo _ Inspection'..y,•o i , Date a 62 SOV • - MECHANICAL S _ TOTAL FEE $ v" Drivers' en IA Reinspection Fee $15 . Issue Fee - $.3 PLAN CHECK 25% $ - Drivers' License or SS - �� ' 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. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms :1 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.r- - 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test t-.! 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Iiridrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 4.1 •r 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 O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: (o-$rq6 pea, 343 UPC GEt. 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. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co (' 51. CERTIFICATE OF OCCUPANCY No. Date _ OWNER SEWELL, Richard DATE 3_15_72 JOB ADDRESS 2033 Laurie Lane, A&B BUILDING PERMIT N0. 34345 GENERAL CONTRACTOR Same DESCRIPTION of WORK _Dials.MJatt.garages 4" ''o. LOT 8 TRACT 714 FIRE ZONE VALUE $ 32,000,00 II ECTIONS Signature Date GROUP 1&J TYPE V ZONE R2-CP SOIL Ai S3 5-7Y SUBCONTRACTOR PERMITS ISSUED GAS Date 1 Number 1-Signature WATER ROUGH PLUMBING ./ fi(J��� 6.40,71/ 1} i .1 5-/O- g fli4i � PROP. SWR. LINE OUSE�COJ_�Va' 11 17 G 7 A 3_ / / `/*7 SPRINKLING SYSTEM (n1� CLC. 2--- -I/ , ., t / A b � _ MISCELLANEOUS �A ROUGH HEATING AND AIR CONDITIONING /4-574 /-72/ TEMPORARY SERVICE OR POLE UNDERGROUND/0 POWER 0 ROUGH WIRINfi �n7 Si' 7Y eating and t. d kg TRENCHES IF FORMS 0 STEEL REINF. Q)a- �S 7 ` l/ ,, 4 'ec / i///T.,74: r i ...- FLOOR FLOOR SYSTEM c iC 0 r , it,,e, ase . 5-//) jj(J Q/ BOND BEAM In STEEL REINFORCE SHEATHING o; S /).2.-- FRAME tom FRAME AND FLASH �� -/ LATHING - IN OUT eak.e• ' �,, ey PLASTER. BROWN COAT 4,,n,e___ C /1 Y/ S YURAL, FINAL �''') a HL...,HG, VENT., PEFRIG. AND A.C., FINAL fr.L. tI ....r.27.... Ater `7' ''-'6".--7.4 as/a PLUMBING, FINAL AND GAS TEST n . {� 2 y, ELECTRIC, FINAL 'y'7Y htn sY/ii ..i V 3434515-7?z,OO 539* * *161.99 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT?-/S"7� For Applicant to Fill in Completely RECEIVED Y DATE RECEIVED Dr, ISSUED BUILDING � ^R �{G i /G %1 43• I I�.r/ 2 ADDRESS .<011..5,1 ^/T V PERMIT NO d _ OWNER fr V // A.P.NO. .34-4 J G4/! AMAIL DDRESS I/ 4� ADDRESS f BUILDING 2o33 AB LAOJE ea / �7�/IT// / (11 LAI7 TRACT 77/V LOT BLOCK Z / aU CITY C /3.0/G,t //lf�J Y` NO/92110S S ZQCONSTRUCTION NEW ADD Al TER REPAIR MOVING DEMOLISH a cn LENDER J N BRANCH OWNER R. .S WELL_ Q W ADDRESS ,/�[ 1,r� �J,G ��//� �}�� . ..2 ((/ $3^ / I, CO OARCHITECT R ENGINEER/14 ,C/ , /o f N07�O a 93� USE IIY�[,G!A/ l i� ALUE Jf/D/v/v 5 co / FIRE 77/1 E W K AO DR ESS Pen C �N ...„emir/r/ „e/ ma ZONE TVP GROUP:� a 111 APPROVED W Z CONTRACTOR A S(4/g•••/// BY DATE CO Z JY gc ADDRESS 77u �C7,&f'f ZW tit (��j/�L ZONE'', /� NO.OF n USE OF NE H CITY 0"'//7/ NE�72ri QZ�T PLANS L BUILDING W O STATE ��� j.. CITY YARDS APPROVED YARDS APPROVED Er(O LIC.NO. / LIC.NO. MAIN BUILDING As ESSORY BUILDIN SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT I NOW ON LOT FRONT 9, FT. FT. USE OF EXISTING BLDG. R SIDE SFT. / F I— SIZE OF NO.OF ZNEW BLDG. ROOMS STORIES L.SIDE S FT. 0 FT. EXTERIOR WALL I / ROOF / It V COVERING COVERING REAR O FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& d 0- _ MAIN BLDGS. ACCESS. BLDGS. '-1 is,„,,i,____,Q 4 VAR.* DATE Q iiC.U.P.#'- APPROVED APP 7 CO gY RO�FJLD dr • DATE /2-69621 9/ OI hereby acknowledge that I have read this application and state [[��l. 'J 1 '2s D that the above Information is correct and agree to comply with ¢ all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of 92 SQ. FT. / ✓ ��6 /TAX I— the State of California. al �r "v3 h m n I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN Lt/DER VALUATION IS FOR o Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: cc am exempt from the provisions of the State of California Business VALUATION to and Professions Code,Division 3,Chapter 9. PERMIT FEE $/OG/ N 7 Signature of /�1� ///y `T, ) m Permittee all it /\ (.�1��1i'L`�s..yl $ IV,. PLAN CHECK $ S—,/r 2-5- E u.�� nUbs) tUK SNt : AL KLQUIKtMia61 , 7c, `hpri Hga -- TOTAL FEE $ / `�/