HomeMy WebLinkAbout975 LANSING LN - Building Permits�
�
CITY OF COSTA MESA
��pM�9 BlIILDING DIVISION
F�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
�"~°,^^°"' PERMIT NUMBER: B10-00340
PERMI7TYPE B_ROOF2
APN: 14172204
JOB ApDRESS
Vicinity:
Squares: 0
STATUS:
DATE ISSUED:
ISSUED BY
C975-L-ANSING-L-N-GM--`, Suite/Unit:
Valuation:
ISSUED
1'I/12/2010
BE
58,100.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF FOR HOUSE AND ATTACHED GARAGE. RE-ROOF WITH COMP SHINGLES APPROX 27
SQUARE5. COOL ROOF NOT RE�UIRED.
OWNER: TACHIKI, WILLIAM KEIJI TR
PHONE:
APPLICANT: SOUTH WEST ROOFING
PHONE: 213-046�3677
CONTRACTOR: SOUTHWESTROOFING
Address: 3972 S GRAND AVEUnit:
CitylState/Zip: LOS ANGELES CA 9003i
ARCHITEGT:
ENGINEER:
i:
FEE SUMMARY
Reroof Plan Check:
Fteroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
$0.00
$16725
$0.00
$1.00
Monday lhru Friday - 7:00 am thru 7:00 pm. SaWrtlays
New Years Dav. Memorial Dav. Indeoen�
a
Address: 975 LANSING LN
City/S1atelZip: COSTA MESA, CA
Address: 3972 S GRAND AVE
City/State/Zip: LOS ANGELES CA
License No.
PHONE: 213-046-0677
CELL:
License No.
License No.
EFFECTIVE 3N!
) am Ihru 6:00 pm.
Unit:
Unit: :
�. ,Y,.�.;
.`iv�-.�.., ..
626921
PHONE:
PHONE:
�
. _;
YIIYIV JCV. IJ'LIJ
irs - Sundays antl the following Federal holi
and Chrislmas Dav � � � • ..
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
. regulation5. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
� INSPECTIONS: In order for lhe 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. Pailure to obtain inspections and fnal approval will result in the expiration of this permit.
CODEp, INSpECTIONTYPE DATE INIIlIAlS CODEM INSGECTIONflPE �ATE ' 'IN1111AL5
i616 .Fixed Syslem Final Fire Prevention 206 Final Mechanical
�1266 Potll Spa Final 208 Final Plumbing
200 Fina� Re-Roof � � 3D I� �� 270 Final Electncal
.201 Fin81 Block/Retaining Wall 212 Final Fire Prevention
' 202 Fin91 Fac�ory Fire PlaCe 220 Final Planning Appmval
-203 Fin81 Sign 222 FinalSite � �
204 Fin81 Demolition 250 Final Building/Occupancy
�
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm untler penalty of perjury one of the (ollowing declarations:
❑ I have and will maintain a certifCale Of ConSent to 5e141n5Ure for worker5'
compensation, as provided for hy section 3700 0( the Labor Code, for lhe
peAormance of the work for which this permit is issued.
❑ I have antl vnll maintain wnrkers' compensation insurance, as required by
section 3700 0( the Labor Code, for the peAortnance o( the v.ork for which this
pertnit is issued. My vrorkers' compensation Insurance carrier antl policy
number are:�,T
Carrier: 7 i�T �N c� l�%
(Tnissecfionneetlmtbewmpl etldlhepe�mrtisvaluetlafonehuntlietl�llars(SiMJaless)
,� Policy Number: �/ y� —l/!�O i% —� 3 S
❑ I certify that in the peAormance oi the work for which Ihis permi� is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensa�ion laws of California, antl agree Ihat if I should
become su j to lhe workers' compensa[ion provisions o( Section 3700 of
the Labor o, I shall forthwith comply with [hese provisions.
o� Or//— /Z—/U
AOW����'s Signa�ure Da�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAN� DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn ihat I am licensed under provisions o( Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Prolessions Code. and
my license is in full force and eHect. �
X Lic. # � Z �ss # C�
,�/- /? ��J
Conva prSSignaWre ,x Daie
\
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn [hat [here is a construcibn lending agency for the
peAormance o! the aork fa which this pertnit is issued (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Address:
SignaWre Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury thai I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe follovnng reason (Sec. 7031.5.
Business and Professions Code: Any city or county which requires a permit to
construc�, alter, improve, demolish, or repair any struclure, prior to its
issuance. also requires the applicanl !or such permit to file a signed statement
that he or she is licensed pursuant to Ihe provisions of Ihe Contrectors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is eaempt Iherefrom and
the basis (or Ihe alleged exemp�ion. Any violation o( Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five huntlred dollars ($500�.�:
❑ I, as ovmer of ihe property, or my employees with vrages as their sole
compensation, WILL DO 7HE WORK, and the strucWre is not intended or
oHered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner o� property who builds or improves
thereon, antl who does such work himsel( or herself or through his or her own
employees, provided Ihat such improvements are nol imentled or offered for
sale. If, hovrever. the building or improvement is sold within one year of
completion, the owner-builder vrill have the burden of proving that he or she
tlid not build or impmve for purpose of sale.). -
❑ I, as owner of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to constmc[ the project (Sec. 7044, Business and
Professions Code: The contractas License Law does not apply to an owner of
propeM1y who builds or impmves thereon, and who contracts for such pmject with
a cont2ctw(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
w
Owner ID verifetl by tlriver's license. ❑ Ves ❑ No
Driver's License No. Expires:
�� Veri/ication of Ownership by (type of document, i.e. - properly tax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certily ihal no excavation (rve (5) or more feet in depth in�o wfiich a
person is required to descend, will be made in connection with work authorized
by �his pertnit, and that no building structure, scaHdtling, falsevrork, or demolition
or dismanlling thereof, will be more than thirty-six (36) feet high. (Chap. 32. Grp
2, Art 2, Sec. 347, TiUe 8, Califomia Atlministrative Code).
❑ As ovmer-builtler, I will not employ anyone to do work which would
require a permit tmm the Division o( IndusMal Safey, as notetl above, unless
such person has a permit to do such work from Ihe division.
Appllcanl'S SignaWre
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant neetl ro fle antl
certify a Business Plan tor emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health and Sa(ety Code requires, with Some
exceptions, that a Business Plan be filetl wiN the Costa Mesa Fire
Department by every business vfiich has at any one time during a reported
year a quantiy of hazardous materials equal to or greater than a weight of
500 pounCs, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperaWre and pressure).
2. Does or will Ihe applicant or present or future building occupant neetl �o (le
a registration form tor acutely hazardous matenals? ❑ Ves ❑ No
(Section 25533 ot the Califomia Health antl Safety Code, with some
exceptions, requires registration with ihe Costa Mesa Fire Depanment by
each business which at any one time has on hand a quantily of acu[ely
hazardous materials equal to or greater Ihan a vreigh[ of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management antl Prevention Pmgram tor acutely
hazardous matenals)? ❑ Ves ❑ No
(Section 25534 of the California Health and Safery Code provides thal the
Costa Mesa Fire Depariment may require the preparation, certification antl
fling wilh the Fire Department o( an RMPP by businesses which are required
ro register acutely hazardous ma[erials with the Fire Department.
4. I( an RMPP is presen�ly required, has Section 25534 of the Cali(ornia
Health and Satety Code been fulty complietl with? ❑ Yes ❑ No
5. Does or will the applicant or preseN or future building occupant require for
Ihe vrork which is the subject of Ihis application a permil for such construction
or modifcation (rom the South Coast Air Ouality Management Disirict or from
any other air pollution control tlistrict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
in(ortnation be fumished on applications for rromresidential building permits).
6. Will any part of the lacility to be consWcted under Ihis permit be within
1000 feet lrom [he outer boundanes o( a school? ❑ Yes ❑ No
(If yes", Ihe faciliry must meet the requirement of Sections 25534 and 42303
ot the Califomia Health antl Sa(ety Code�.
7. If a permit from ihe South Coasl Air Ouality Management District or other
air pollution control disMct or agency is required for the vrork which is Ihe
subject of Ihis application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certifcate of compliance fmm the appropriate air pollution
control offcer�.
CERTIFICATE OF COMPLIANCE: 1 cenify that under penally of perjury the
infortnation given above is correcL I aqree ro comply with all sWte laws antl
city ordinances regarding Hazardous Materials and Emissions.
Signawre oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury thai I have read this application and state that
Ihe information given is correcL I agree to comply with all slate lavrs and city
ordinances relating to building wnsWction, and authonze representatives ol
the City of Costa Mesa to enter upon the above-0escnbetl property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorizetl by this permil until fnal inspection.
/ � J/ � •Z — �� � Leeal Owner(s) Date
Dale / � ��,/
J051-06(3/0]) rnAut�wlze0A0PIiWnt � /� Dale� �
`
(714) 754-5273 • Fax (714) 754-4856 • www.ci.cos�a-mesa.ca.us 77 FAIF �HIVE, COSTA MESA, GA 92626
PLUMBING PERMIT
,lobnddress: 975 LANSING LN
Suite No
Vicinity
Parcel Nunmber: 14172204
Applicant: E J ELLIS
Address: 3801 LENAWEE AVE
CULVER CIN, CA
Owner: TACHIKI, WILLIAM KEIJI TR
Address 975 LANSING LN
COSTA MESA, CA
Phone: 310-838-0408 X120
Zip: 90232
Phone:
Zip: 92626-2820
Contractor: ORANGE COUNTY SERVICES 1NC DBA GEORGE BRAZIL PLU
Addr�ss: 3801 LENAWEEAVE �
CUWER CITY, CA
WATER HEATER CHANGE OUT
ISSUE FEE
Backflow irrigalion
Backflow Preven�er
Bathtub'
Clarifier System
Connect (Ice,Sotla,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas EaAhquake Valve
Gas (t-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
523.50
50.00
50.00
50.00
50.00
50.00
$0.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
' S0.00
50.00
50.00
50.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0�
0
0
0
0
Phone: 310-838-0408 X120
Zip: 90232
License: 679898
SCOPE OF PERMIT
FEE SUMMARY
AMT
Laundry Tub / Washer 50.00
Landscape Irrigation $0.00
P-Trap 50.00
Pressure Regulator 30.00
Process Piping (per 10 ft) 50.00
Receptors ' S0.00
Septic Tank 50.00
Sewer Cap for Demo 50.00
Sewer Connect $0.00
Sewer Privale Line S0.00
Shower 50.00
Sink, bar - 50.00
Sink, commercial S0.00
Sink, Floor 50.00
Sink, kitchen 50.00
Sink, servicelmop 50.00
Spa (privale) 50.00
Spa (public) 50.00
4TY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
StaWs: ISSUED
Applied: Oa179/2007
Issued: 04/19/2007
ISSUED BY:
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(t-4)
VaCwm Brkr Bkflow(5+)
Wash Basin
Wash Basin Sel
Wasle and Vent Sys�em
Water Cbset (Toileq
Water Heater I vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLA710N
PLAN CHECK
REINSPECTION
AMT
50.00
50.00
50.00
$0.00
50.00
50.00
50.00
50.00
50.00
50.00
S 7 2.30
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
TOTALCALCULATEDFEES: $35.80
QTY
0
0
0
0
0
0
0
0
0
0
7
0
0
0
0
NOTICE: The Work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 780 days, or ii work is suspended or abandoned
tor a period of 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such vrork must comply with all applicable codes, entl all
requlred inepeetiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIQNS CALL: (714) 75M5626
zaas�ss �rvoo�
WORKERS' COMPENSATION DECLARATION: _
I here0y ettlrtn under penalty of perjury ona of the following declarations:
❑ I heve entl wlll maintein e certificate oi consent to self-Insure for warkers' compensetion, es provideA for by section 3700 oi the Labor Cotle, for the perlormence o1 ihe
work tor which ihis permit is issued.
�_ I have anG wlll malntain workers' compensatlon Insurance, as requiretl by sectlon 3700 oi ihe La6or Code, for t�e peAormance of tha work tor which this pertnll Is Issuetl.
My workers' co�m –e1n-sation Insurenca�ardenr e�n�° Ilcy number ere: - /// ��.,/��7
"Cartier: 67/A%� r�%!V/,/ �IlcyNumber: `�'b—j���/�C-��/
'(fhis secHon need nof be completed il the permiNs velued af one hundre/tl do7llars ($100) or less.)
❑ I certify ihat in tha perfortnance ai ihe wark tor whi his3 ertni�.+ iSss §d, I shall nol employ any pereon in eny manner so es to become subject to ihe workers'
cnmpensation laws of Celifomla, end r e (1 6me s ject to the workers' compensetion proWslons of Sectlan 3700 ot Ihe Labor Cotle, I s�all forthwith
comply with these provisions. J � � /
ApPlicent Signature: Date: `L —��v�
� ._
� qPNINp: FAILURE TO SECURE WORKERS' COMPFJ SATION CpVEPAGE NUWFUL AND SHALL SU&IECT PN EMPIOVER TO CRIMINA� PENALTIES MID GVIL FlNES UP TO pJE HUNDRED
TFKKISAND Op1FRE (E1 W,000�, IN FDDfTION TO TM� WST OF COMPEN dJ, DAMAGES AS PROVIDED FOR IN SECiION 31080F THE IABOR COOE, INTEPEST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARA710N:
iby attirm Ihai l em Ilcensed
ena enea. uo. a
edols Slgnature: _
CONSTRUCTON LENDING AGENCY!
❑ I hereby ettirtn that Ihere is e construction
Lentlels Neme:
Signeture:
OWNER-BUILDER DECLARATIONS:
with Section 7000) of Division 3 oi the Business an�J ProJe5sigr+s Cotle, end my Ilcense Is In full
— �°�au» <'_—;3-�0
_ / Date: �=��j^l� '
peAormence ot Ihe work for which this pertnit is 155ued. (Sec. 3097, Civil Gode).
Lenders Address:
Date:
I hereby eHirtn ihet under penelty of per�ury �ha� I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business entl Protesslons
Code: Any ciry or counry which requires e partnit to construct, alter, improve, tlemolis�, or repeir any strudure, prior to Its issuance, elso requires the eppliwnt for such pertnit
to flle e signetl sletement Ihet he or she Is Ilcensea pureuenl to lhe provisions of Ihe Contrectors License Lew (C�eO�er B(commencing with Sectlon 7000) of DlNslon 3 of t�e
Business end Prolassions Code) or Ihat he or she is e:em0� theretrom antl t�e basls for Ihe elleged exemptlon. Any violatlon ot Section 7037.5 by any epplicent for e pertnit
suD�ects t�e applicant to e civil penelry af not more then five hundred tlollars ($S00).):
❑ I, es owner oi iha propery, or my employees with wages as �helr sole compensation, WILL DO THE WORK, and the structure is not intentletl or oflerad tor sale (Sec.
7044, Business and Professions Code: The Coniractors License Ww tloes not ep01y to an owner oi properry who builds or Improves thereon, entl who tloes such work
himself or herselt or through his ar har own amployees, pmvitled that such impmvemenls ere nat intended or oNered lar sale. If, however, the building or ImO�ovemant is
sold within ane year ot completion, the owner-builder will have the burden ol proving thet he or she did not builtl or imprwe lor purpose ot sale.). �
❑ I, a9 owner of lhe properry. em E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construcl the projact (Sec. 704d, Business end Professions
Cotle: The contreciors LJcense Law tloes not eppry to en owner ot pmpeny w�o 6ullds or improves Iherean, enA w�o contracts br such project wlt� a contractor(s)
license pursuam to ihe Conirectors License Lews.).
� I em e:empt under sec.
Signatura:
Owner ID verifietl by tlriver's license. ❑ Ves ❑ No
Business entl Protessions Code for this reason:
Venlication of Ownership by (type ol document, I.e. - property tau bill or deed):
Driver's License No.
Dete:
Expires:
DIVISION OF INDUS7RIAL SAFE7V PERMIT CER7IFICATION:
❑ I �ereby cenity Ihal no excavetion five (5) or mora teet in depth into which a pereon is requiretl to descenC, wlll ba mede in connection wilh work euthorizetl by Ihis
pertnit, and that no building struciure, scattoltling, talsework, or tlemolition or Olsmantling thereoi, will be more then thirty-slx (38) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, T1Ile B, Celitomia Administra(ive Code).
❑ As ownerDuilder, I will no� employ anyone to do work which would require e permit irom ihe Division of Industnel Sefery, as noted a6ove, unless such person has e
permit to tlo such work tmm Ihe division.
Signature: Date:
Divislon ol Indusinal Safery Permit Number:
CERT1FlCAlE OF COMPLIANCE AND AUTHORIZATON OF ENTHV: I cenity under penelry of perjury that 1 �ave read this eppllcation and state that the infortnatlon given is
correct I egree to comply wlih all state laws and ciry ortlinences relating to bulltling consWction, antl authodze representetives of the Ciry of Costa Mese to enter upon Ihe
ebove-descn6ed pmpertyJor inspeqtion purposes. �gree not to occupy or ellow occupency of eny building authorized by this permit until Finel inspection.
LO�E�. INSPELTIONTYPE � P,IE �
1678 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Flnal Re-Roof
201 Flnal BIocWReteining Well
202 Final Fadory Fire Place
203 Finel Sign
204 FinalOemolilion
COOE 1 INSPECTION TYVE
20fi Final Mechanical
208 Final PIum6ing
210 Finel Electrical
272 Flnal Flre Prevenilon
220 Final Plflnning Approval
222 Final Site
250 Final Building/Occupenq
QS¢, INiff1AL3
� �
' , Ao7��Gnt to fill In all sDaeas a:eeo< <�ose witnin neavy EorEer Iines an0 si9n a11 apProoriata eeclarations.
CITY OF COSTA MESA . � _ pE IT NO. � � TRACT NO. LOT NO.� BL . . ' • .
CONSTRUCTION PERMIT " ' �,^ � - ' � �
AppIICBnt'SMeili Address _ , � TVPEOFCONSTR CTION NEW ADD AITERATION Rev.a�R - � � � ' , -D398 6/15/83 �t5.50 • Tl
Project Address ��� � `� �"�� •' � - �- ❑ CONVERSION ❑ DEMQ LIS ❑ O7HER � ' - � ' � �
Owner'sName �A�:WI �TCiG�1L� PhOnA�'��b DESCRIP710NOFW�C1r__1� �!-��r L.��-. �C � Z NI G. E ULATI N� '
�.rr�.P 1.�\P . �� �Z1�"�..
Addfeu TVPEOFPERMIT GRADING' FOUNDATION •STRUCTURAL A.P.qY+ ZONE � � �� � �
Afch/Eng.. LiCe�p NO. ❑ TENANT ❑ ELECTRICAL O PLUMBING ❑ MECHANICAL , ' � � BUILDING �,
C � . PLNG.flEF.�
Addreuj � ��� ' � �O �OTHER - � TO BUILDING - '
� '� '- . . . �. . , PE V IN REAR VARD (TO P/U '
Contrector's Nam �pn � " PROJECT DESCRIPTION St2. FT. �- � OCCUPnrvGv
' Q CONSTRUCTIONTVPF ' � �VAIUATION$ LEFTSIDEVARD RIGHTSIDEVARD �
AcHresslmailingl3b � . , - � - � ZON�' GRA�INGGU.VDS. - ACRES PKG.SPACEREQ. � � PROVIDED ,
License No. � , ,
GCENSED CONTRACTOR DECLARATION - Remarks: � � , STREET WIDTH " PARK FEE.$ �
. I hereby atflrm that I am Ilcensetl unGer Drovislons ot Charter 9(commencing ' _ .
with section 7000) oT Dlvislon 3 of the Busineis antl Rofessians Cotle, anG � � , � SPECIAL CONDITIONS: � �
my Ilcense is in (ull fo aj�Q fect. (�'` ' � . .
l�censp Ci�sF ` ry. Licens��o���3 `�`� � � PLUMBING - ' � � ' � � , . .
Oate b � SI9 t ���Z ' Bar Sink Sevuer Cap ELECTRICAL
WORKERS'COMPENSATION OECLARATION -
' 1 hereDy afflrm that 1 have a cartiflwte oi consent [O selti � a ora cartHicate ... . . . Automaiic W asher. . �Meter . over lOD smps
ot Workeri' C pensalion Insumnce, or a certiflatl' topy thereot (Sectlon , Backfl0w Prevent¢� SBw2� ConnECtiOn ' _ ' 1
3800, tab ) 1 -�1 _u',1 � , Backtlow Irrigation . t Solar Collectors • Construction Pole ; i �Sub Panel -
Policy No ��SL[SLI�' Qoj�pany �"�� �� � � , � Cookin9 Unit ' Sub Pole � �
,�CerHiletl copY Is hereby turnishatl. (J t ' � Bathtubs � $olar Piping , � . . . •
Ql/ie y�.{LL9tl with tha tl�f�$ uiltli}�g,� v{�� , � '
'6ata �O'���`"'� qpppcane ^ �+-+' `/` • Clarifiers SolarTank , , Dishwasher �Motors 04 HP ❑iX$
EXEMPTION�FROM WORKERS' COMPENSATION DE A ATION ' ! Dlihwashe� � � $wrmmin Po01 W/Spa � ' Oryers ❑G85 ❑ElCctriC � Inc.Solar•�9-15 HP 076-15+ � '
(T�Issection neetl not Ce completetl 1} the permit Is for�o � tlreG (f100) or 9 , ,
less): i . ' � . '. � � . Fan . i Microwave ' � �
� ' I cerHty tnat In the pertormance of the work for wn�ch tnis permR is issuetl I Drinking Fountains � Urinal
� snalP nof employ any Oerson In any manner so as to bacome subject. to [{�e _ -
, Workers' ComDensation�Laws o} �alifornia.! i Floor Dreins � Water Closet' � F.A.U. Pole Light � �
. Date Signature ' � �- - - � � Fixtures
NOTICE: If, after makirig this tletlaration, you shoUltl�become suoject to�the - ' Floor Sinks � -- WaterHeater - -- • . � ' - - --- � -- - Range —� ' � _ . i ..
Workers" Lompensatlon Orovislons of the Labor Cotle, you must. forthwit� , ' � , .
' comD�v wlt�' sucn orovisions or-thiz; Dermit snall be tleemetl revoketl. GasSErvice .Outlets WaterService •i Device Boxes i� ,Sign' ' ' ' �
�CONSTRUCTiION LENDING AGENCV ' j �' ' ' ' ' ,
� 1 �ereby alilrm tnat there Is a con5tructlomlentling agencyrfor thefperformance• InterCeptors � • � �� ' ' � �, ; r, OuUets � � Standing Sections � � .
oi the wark Ton which this� Darmit Is,issuatl (Seat�on 30BT Civ. CJ � r' , - . . ,
�entler's' Name ' � Kitchen Sink. � � ' . . �'�,, � Switches ' � ,Tresh Compacror �
• Lentler's Atltlress ' ' � � � � � � � � ' � �
�, OWNER�BUII.DERDECLARATION • ,' � - ' . I Lavatories. i • 1 %i � ' , GarbageDi5po5al �
I neraby�afflrm that I am exempt lrom the�ContiaCtoYs'Llcense Law tor the ' p-Tra ��n . Generator� �0-5 KW �545 KW ' ' � �
folloWinq reasOn (SectiOn 7031.5 Bu51n855 antl Profasslonal ICOEe: Any tlty or_ , P ' n, - ' _ - �
'� county which� requires a permit to construcN, alter Improva, tlemolish.orFepalr - . . _ Transfo�me� ' -
, any 5tructura, Orlor to Its Issuance.'also requlres t�e applicanffor zuch permlR ROOf Dreins � - ; � ❑15-50 KW .
� So flle a signep statement'that he/sne iz II<en5etl pursuant to Ehe provisions of � �, ' � ❑5U+KW�
' tha Contraclor's LJ<ense Law (Chapter 9 (commencl�9;w�th�5ection 7000) of • • ' ' ' ' ' ' . Reinspection Fee � , $15'
Divislon.3 of the Busineis anG Professions Cotle)'or that he/she is exempt � Show¢�5 �� � ' ' Reinspection.Fee � $75,
therefrom anE lhe-Oails for the allegatl axemption, .�Y ��olation of.SectlOn _, , , - ' Met¢r ❑up t0100ampi ' ' lauB Fee : �$ 3
7031.5 Dy any appliwnt tor.a�permit.subje<ts �he�applicant to a-civll � ' �. -
��enalty of not more t�an five hunAretl Collars (E500I• i � ;, • � `� Service Sink �, ' � � �. • Isue Fee ', � $ 3 , Zoning Approved By ' Date �
I, a5�ownar of the property o� my amployae5��"/��h Waq¢5 as [hei� sole . � -
comoensation will Oo the work, ana tne structure is not intentletl or otteretl '. � MECHANICAL . ' �� qpplication Approved By ate � � �
for sale-(Secflon 7044, Busine55� antl Vrotesslonal Cotle: The Contracror•s _ , , , p?
Ucensa Law tloes not applY lo an owner of a propeRY �'�o builtls or improves ; Boiler � � . Refrigeration System p lication Iuued B �e' �S�(J�J
� fheroOn, antl wno aoos sucti work hlmsalt/harself Pr through hit or har own . � ' Pp y ; � DdtB .
� employ ees, provitletl that su<h improvementz ara not intentlea or offered for �0.700,OOOBTU ❑100,OOOBTU �
. ssle. I/, howavar, the Eulltling or imorovement Is solC within one'year ot com- Duct - Under Ground , . � � SUMMARY OF FEES � � �
.ple[lon, tne awner;wlll have Ihe burtlen of proving �e/she Citl not DuilA or Im- . , • � -
i.�rove /or tha purpose m sale). � , �. Duct-Structural . System Repair/Alteration BUILDING PERMIT $� , t SMIP � .$
LJ I, as owner of the property, am axclusively con�racting with Ilcense0 con- '. , . ,
' tractors to wnstruct the'pro)e<t (Se<Uon 7044, Business antl Profeulons Cotla: Dutt _Ven[ileting_. _. _ _. � . ��PLAN CHECK' $ ' ' PERMIT '
The Contrattor'S License Law does not apply to a� owner ot prdDerty who � � ISSUANCE '$
� builtls or ImDroves tnereon, antl w�a contracts for such projects witn a con- � Exhaurt System ❑ Multiple 0� � ' � PLUMBING $. � ,
tractor(sj Iicense Dursuant to tne Contractor•s LlcenSe Law). : . ' ' GRADING $�
. � I am exempt unCer Sectlon � , e. 6 P. G(or Ih�s reason . Firepl/FaCt. Blt. ICBO 5� ' ' . •PLAN CHECK $ . ;$,
, . ELECTRICAL $ � •
Date . ' ' � Ownarv � � ' � � � � Heeting SyStBm & Ducting . ' �
� 1 hareby� cartlry that I' have reaC this applicatlon ane-ztate that ttie abow- • � �6100,000 BTU �100,0008 �� . PLAN CHECK $ MICROFILM �$
informatlon Is co cl. agree to comply with all dty�antl county ortlinances . � � : � ' � TOTAL;FE6 �$'
antl state laws r a Ing to builtlinq constructlon, antl hereby authorize rapre- , � . 'MECHANICAL $� . i
sentativas o tn Ut t enter upon the above-mentlonea property for � Hoad or Type I ❑� . Reinspection Fae ' S75 ' LE55 ' � �
. Cano ' T' e II ❑ 'r PLAN CHECK� $� �
'InspeCtlon P 85., �" ' . � . . � ' �
' S19nature �' � ' o5te �( ►3-$� � � . . � . , . . � ADVANCED`PC � $ .
� Drlvers' ucense or 55 qf — , Registers . � , Issue Fee $ 3 � . . " � • � , FINAL FEE' $ '� �
CMF 0865-46 rev. 12/82 Wnite • Builtling; Canary - APP��cant; Pink - Accounting; Goltlenrotl - Assezsor .
+ , ,,,� >� . t- . � t - ; POOL-& SPA �- - -- - � c --
'}��CONSTRUCTION:AND'PLANpp� NG; � r . ��, �� �,,_ - . . _
�> LqppROVALS rt. Permit# �/ �- - `Date - lnspector' � � �_ _ 'Date ' Inspector
� o - ;APPROVALS ���Permit#
i:Sim _ Q'�J. i�t.' ICJ_.IY� Y� .aYc .. �
'� ,1 Te"mporary Electrical Service or�Pol`e ' �' - � o �;' np T F'� �.'i52. Pool &`.Equipment Location . - - � � ' �
i n - ' - �
' iv 2! �Soil Pipe Undrgrnd` g, r <•; ~t �? � "'+� � S � -°� 53,-Steel Reinfoicement � �� � ' ^
-1. S' '1 ' I.cn_ n^ _ .. �.r_•.
`- 3: Electrical Condurt�Utilitv Undrgrnd, ` �,, a _ D "� � � �.54r-Forms? �r � ,� . � . _ � _
°1 4- Electr,ical Condwt Undrgrnd� `' -, ,. . � `_ _�� �' = " � � � '55`� ElectncaGBonding � . " ' � �, i _
'C�•i ' .�- r nr - ��
5, Steel �Reinforcement � ' •,, n `' � - - � ..r � � .-` `'� e -- r56^ Rough Plumbing & Pressure Test ;- � • •?^ � ! �
6: �Elecfricsl UFER G�nd:� �`� R = �� . . -7 , ` ' � ° �. : ' 57:; QPP,ROVAUTO COVER-GUNITE� - �:
7. Footings � � J � � ' r' c' '- � "+� .:58:� Electrical'�pnduiY-Undrarnd. . , •� �!� �,
�'. r - T� ��ro -�.:.�_ o ss. - o. - '•r�
8. Foundation . ; I I � ` - , ? i ' � ' ; 59. Gas Pipe,SO-.Undrgmd., Test � . ' . ' _
,
9.�•VJater, Pipe-Undrg�nd.'" � = , �� �;, "-! ��, '�; � - �;60. Backwash Lines,:P-Trap,��'Undrgrnd.� _ '
,
90. Struaural FloorSysteni � � � >" ��, ^'' �;, '' ;'61. APPiROVAL`TO_DECK •- _ " �;- -
11. Pi��'operty Sewer Linn& HouseConn"ection7 :• -; - ,,62. BackwBsli�&'Receptor-Final � _ , � ��,��, .-
12. Se'wer Cap; � �;, ' � � n-' _ � ''63. Heater ¥t Final "o=� � � . -�- ;�;
13. �Roof�Dl;ains j , ' " J . .. � ..' � -� � , . . .. �
� �Tj , G � ;'64. Plumbing_SYstem �Final j � �
14. Rough'Plumbing � ;, �. . � � � % ` ' 65. Electrical`Final'-� - � � - - ._.� �
�
.°� 15: Rough-Electrical=Co'nduit -"�' '�- ; � ---�" � - ��' -'66.' Sola�;Sysfem=Final � � � � - � �`'
� i,- �.. � �, �� I I� �
" ' .18� Rough,Ele mric,Wiring, ; i `' I � �I 4 t .; �:r � �_ � �; � •-; �;i � ,l � -'67.i Fencing &=Acce'ss�Approval - � � � � � - � � � ! -•
�
17. RoughWiring Sign� ': ` i � � ' � �' ; } ' ; �68.� APPROV.ED FOR PLASTERING � ' - - `.
. �� C :ic,c��j �- i .
'. �18. �Rough'Electrical;T'Bar,Ceilingl � �' � : , , � � `; � � I ,� � ��, �69., P.00USPA SY$TEMS;FINAL � � % ' �
� i� 19•'Rough Heating &'Air 6ond.itioning 'i i�. c � ' f # � FIRE DEPT. REQLIIREMENT� ' _��
. = � � ' �
� 20. Rough Factorm Fireplace ` � !! � � � - � � , � ' ; APPROVALS � � Permit # � ' � ' , � ' • ,
a,f .- �..�. ., m ' p • , � • ' 1 � . - . .
., �21. ,Ducts„ar�;Structure�� .� � � ,� �: � i i � � I � 70.� Underground Hydro �; ,
� �:22. �Ducts, Ve�ntilating � ' �, , � �, ,i 1 � ! . ` i � �71.; Product Piping O Gas ❑ Oil � � �
� n,23. IG`as Pipe;Rough & Test " � i ��_ ii j T:...�.,_.� _ 1 --; T ; 72.; Underground Flush --�m � - - � --,-- i-� -� j - - -- . -
�
y �,�{24. �Roof F�aming' ! � �; ; � ,�4, �j.� � � �,c � :: � �q ��c � � ; - �, � Z3.� Undeigrnd. Storage Tank � Gas ❑ Oil, , ' ,
� 25. Roof Sheathing � . � � , tj ii � � = � �j ' o � � � - � � 74.� Overh�ead Hydro _ . � + . ,
�' �;.26. ;T-Bac Ceiling (Structural�� & Monocoat� � ; ;, I ; � �` �v � � � ; 75.� Dr;y Chemical � �: � • - `� � � � � - ; -
'� �. 27. Frame'and Rashing � � ' ' � ; � � ' � � `' � � � � ` - . - �, ,
., . i �, ' i � i� '� i� i {: 1 ' ( 76.' Dr�Y Standpipe f. i�
' � 28. �Lathing &�jSiding � � � . � ' � �� � f I � ! ;, I � � �77.� FIXED SYSTEM'FINAL �, , -
^ A 29. �Insulation `� v , Q '�i _+ i � !i , � � I i � ' JS.� FL,RE PREU,. FINAL ' _ ' i '
°iY'30.��Drywall Nailing � � . I � .� � � � � , I � �Nofes:'� _� � .: '� � � ' . �
'�31. Plas`teY Brown Coat ' I � �� �i --, �-� - i - j - �-, -, �- i -� -� -- -�- � � -- - � -�- � � - - - � - - -
.
� ��32. :Electiical Power MetervFinal ° i � ' � ' '
lu� C•1;<�. I I i � i � �Je.o
�, 33. �Final Electric i ' I ; � �;..;i � '.•:•. ',r � � i � ( � � � _ �
/!4
`= 34. FinalHeating&�Air�Conditioning � �41) � , � i � � � �' , ..
�, � i 1 i
�a ,�i � r. � �O V .i�r 'rt �O�.a _If: ' 1 - - . - 'n
35. FinalGas�Pipe'-Test� �I,� �,-* I �� � �„ -:� �i,�;. �� �.,,. � -I`.' � . , .. . ., . . -.
36. Hood or Canopy_�. .� � n ' � �,, ' � i � � - � " � ' i � � � J, � � ; i „ i � � ^ ' _ . _ _ ;
,
�� � ' � �„ �� ,i � �^' .l"1..� �i , . � ';� ,-• .. „ � _ �� ,
37. Final Factory Fireplace ;� 1 f o. :, i �; � � ; �' �� r ' ._ �_
38. Final Plumbing � � � I � �� i � : -' i � �,�� � � � � � 1 ' ' ' � '
n i �
h � '
39. Water Service-FiPal� � ! �I � � � � . � f ' � I � �, � " ' •
40. Gas Service-Final � � � I ,; j I; j 1 � i ' ; I �' �-, ' ' -
41. Solar poinesticFinal � � ' � � � ' � - � � � � _. ...
_ , . - � - - --.� . .
42. Backflow Preventer' ' I i � � , � - � -�' � I -' y ' -' .� _ � ._ �...: .� �� ^t . '
i. _ i '
43. Backflow�lr�igation� r� i� � ' ' f�'t - �" ` � � �; i -.i ~ ! � . ` . .
44. Landscape Irrigation System I � -�� � � , ��' � � ' � � j � � " �' � ' - L '
>.� :i I
�n � a. ' ^ , i , . . � . .. .
45. Sound�� Attenuatwn ;, � � ; ` I ', � � , • I �- I �� � � � i � '' '' i ' � w � � -
46. HandicaP� Regulations� i � � � ' ''c . 1 i � � i ' � ' i . • .. � - �- ^ �'
47. FINAL STRUCTURE & BUILDING ' : � ! � - I u, � � . i � ; � � ! � ' .
i
48. Special R.equirements Completed, � � � _ � � � ' � 1 � � ' ' � I � , ,
d i i � I i � i
49. Electrio Release � o Edison � � il i- --r� -� -� - - i-� � - 7-� �'-''`i'--� ` ' ' � n �
50. Gas Release to Southern Celifornia Gas Co j I ! � � .i � � �' "� � ' i
i � � i
51. CERTIFYCATE OFiOCCUPANCY I. i_ af _ . . _.� -r. � � �-, _ _ . , � ,
No �� ,� � : I Date � � ."� 1 I � , ,
n..-i: - 2� .� -i-. i. _ 4:.,,,» _ -,... . }. - i' - � '�.- _`-"'--- - .
7
�.
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�� s �' si ���TA �9��A
' Division
IA=cn a^ i :a
Guilding. Cepartment
Rpp;ove�
�S
� _ .
Peranit ;� ��y-��
THIS NU'�!8ER h1Usr a:,COA,�pqNY
a�� �NSPecriov r,:p�::srs
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CeNT
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Fs-9 raeeze �Euso�t
NOT waT=_n
� TO
P�ES�DEdCE
lVE
'/PRESS REt�EF VFL4E
. • 24004
COSTA MESA BUILDING-SAFETY DEPARTMEM
P.O. BOX 91] COSTq MEBA, CALIFONNIA
For Applican! to Fil1 In Complefely
TYPE OR pRINT
BUILOIN�
ADDRES9 Lansin I+BIIC
GOSTA MESA, CALIFORNIA
OWNER CCW Land Com D
ADDRESS 1304 W• CO�pOIIAQ81t.i1 AVB•
CITY �� CDSTA MESA
MAY 5 1965 r
�1l
�LI�I�1�R PE
fOr Offica USe Only
R6C81Pf NO.
�.e�v� o�re� —
GITY Fullerton' rT,oP7S�271O Z�NE TYPE GROUP �
ARCHITECT TE BYPROVHD DATE
ORENGINEER k'alt Boder No�44-6842
ZONING
ADDRESS 18368 E. 4th St. Tuatin
ZO 6 / NO. OP U6! OF N!W
•IJ�N9 BUILDIN
CONTRACTOR B fi B O B ii0 IRC .�
ADDRHSB 1304 W. Cowmonwealth Ave. �cRirtion �
��TY Ful l erton Cal i f� A• P• NO. —
NOTE: N06AVEOVERHAN65MALL STHAN
LIC.TNO. 190417 Np' 8'(1—Q'j1O 90" TO BIDE B REAR P. L.
EAVES
OFLOT O � O O I No.one�oos. ALLOWED (U.B.C.REQUIREMENT.
NOW ON lAT Q
YARDSMPROVED YARDSAPPROVED
USEOF MAIN BUILDING ACCESSORYBUILDIN6
EXISTING BLDG.
( FROM C/L STREET ' '
6ETBACK LINB FROM �O FR NT O�� ��
cerviers ov OixEhT REAR YARD � 0
I � I � N.610E '�FT. FT.
DESCRIPTION OF WORK
g II 1LTEiiATIOu I II �nn
COVERINGWAL�t'llCCO I COVERIN6 St11II11Q
USE OF BUILDINO AND WORK Tb BE PERFORMED
Tract 5340 — Lot 44
Plan 612A
R-1 Reaidence
I XEREBY ACKNOWLE�OE TX�T I N E pEAp TXI APPLIC�TION
AN� BTATB THAT TH8 ABOVB 19 CbRRECT AND PEE TO COM�
PLr w�TH wLL cliY ORD�NANC88 ANG 8TAT8 LA 8 RfiOUL/�TINO
BUILOINO CON9TPYCTION.
61GNATURE OF ` �� �K��_
PERMITTE
AUTHORIZED A6ENT
OISTANCE BET.
MAIN BLDGS.
VAR. iC
BET. MAIN S
ACCESS. BLI
DATE
� 7
i.�i?�4. �. dD L" "�' �
THE AMOUNT eHOWN UNUER VALUAT�ON IB FOR TH8 F
PURPO6H OP E9TABL18HIN� A P2qMIT FEE ONLY. �
VALUATION � �� � q
PERMIT FEE S j
d 3 m
s 2/ ��� � c e 3 i o
x
TOTAL FEE $ � � �
t