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HomeMy WebLinkAbout2506 LEHIGH PL - Building Permits CITY OF COSTA MESA ' ' A' 9 BUILDING DIVISION p).1'4AI; 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca0ov .�'.4 FOR INSPECTIONS CALL:(714)754-5626 '" PERMIT NUMBER: B12-00329 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 14142420 DATE ISSUED: 1 2/1 312 01 2 ISSUED BY: MDM JOB ADDRESS: 2506 LEHIGH PLCM Suite/Unit: Vicinity: - Squares: 2400 ' , - ,_ - Valuation: $8,500.00 SCOPE OF WORK: 2,400 SF RE-ROOF,REMOVE EXISTING SHAKE,INSTALL 1/2 CDX,30LB FELT,INSTALL GAF COMP SHINGLES,PITCH 5:12 NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s)is provided for verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card • • OWNER: HERBEL,BRIAN W . . -,Address: '2506 LEHIGH PL • Unit: PHONE: 714-849-6561 City/State/Zip: COSTA MESA,CA APPLICANT: GUY GALITSKI Address: Unit: : PHONE: 714-965-2387 - _, City/State/Zip: CONTRACTOR: G G ROOFING CO INC • License No. 364151 Address: 19792 POTOMACUnit: - PHONE: 714-965-2387 City/State/Zip: HUNTINGTON.BEACH,CA ,_ - 92646 CELL: ARCHITECT: • ' y" . License No. ' ' ' " • PHONE: ENGINEER: License No: PHONE: FEE SUMMARY , Reroof Plan Check: $0.00 Reroof Permit Fee: $167.25 - - Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 . TOTAL FEES $168.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010-PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays New Years Day,Memorial Day,Independence Day, Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE F INSPECTION TYPE DATE INTITIAtS CODE II INSPECTION TYPE RATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site _e! / s��/1 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATIO. Owner ID verified by d, license. ❑Yes ❑No I hereby affirm under penalty of perjury one of the rollowing declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership compensation, as provided for by section 3700 of the Labor Code, for the b Y(type of document,i.e.-property tax bill or deed): performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: _ '• person is required to descend,will be made in connection with work authorized c Carrier. TA-Cc' ��-'3`< by this permit,and that no building structure,scaffolding,falsework,or demolition (rnis section need not be cnmplefed lithe permit is valued at one hundred ddlars($100)orless.J 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). Policy Number: k 4(4 2 'z, ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety, as noted above, unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forthwith co ply with these provisions. ^� AFJ ` Z _ CC' Division of Industrial Safety Permit Number: plicanl's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: W ING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions,that a Business Plan be filed with the Costa Mesa Fire Department ATTORNEY'S FEES. 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 In LICENSED CONTRACTORS DECLARATION: volume of 55 gallons, or 200 cubic feet of compressed gas at standard I hereby affirm that I am licensed under provisions of Chapter 9(commencing temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license� is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lic.# Cl7CE c,e."7 ( Class# 2� (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑No Lender's Address: (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 Signature Date to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No 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 (Section 65850.2 of the Califomia Government Code requires that the requested Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business information be furnished on applications for non-residential building permits). and Professions Code)or that he or she is exempt therefrom and the basis for 6. Will any part of the facility to be constructed under this permit be within the alleged exemption. Any violation of Section 7031.5 by any applicant for a 1000 feet from the outer boundaries of a school? ❑Yes ❑No permit subjects the applicant to a civil penalty of not more than five hundred (If"yes",the facility must meet the requirement of Sections 25534 and 42303 dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for 8. (If"yes", attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.I, as owner of the LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Business and Professions Code for this reason: 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 Signature nate And/or Authorized Applicant Date 3057-46(3107) Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA ME_SA CJOINSTRUCTION PERMIT - PERMIT NO. TRACT NO. LOT NO. UNIT NO. • Project Address /!!b LS , Applicant's MailinAddress, rest� .�8//k2 26. W_/ltt/�I/1V/c.rcrt TYPE OF CONSTRUCTION LI NEW DD_ U ALTERATION LI REPAIR 7flll7 I t /DP/AL DI 710014.. ^8 Owner's Name �/�wl/ Phone / 4/7r� ❑ CONVERSION ❑ DEMOLISH OT R A p # q/../ / OI�Lr7G/C fO q 9T/A � f// C / !�'ya 7 — RQ Zone 2� 6-5(4 Gi-f (c«F DESCRIPTION OF WORK/USE OF BLDG. Address /���,� G p.7 S Main Building: . �_ Accessory Building:/570c..- /7 // (i-) Arch/Eng. L/-f lie S ,-• 5.1%- S License NO. 'fQ/ C-s3 L' TYPE OF PERMIT 0 GRADING 0 FOUNDATION RUCTURAL - E Front !^ 40 �� _ O Address ( 2-2. !7/% 4'K in ❑ TENANT 0 ELECTRICAL 0 PLUMBING ❑ MECHANICAL B Rear N ' l Contractor's Name �SlI�C�' Phon cf ❑OTHER A / V �� - I Address -nazis �` /7L��'� 2 �r�o� PROJECT DESCRIPTION 50. FT. OCCUPANCY C Righty �� • �� G 7 N `� gp pCONSTRUCTION TYPE VALUATION$ K Left G V City License N .. 7 c.1 J 4 s--6' $ �� f4 1044/1-z6-----C-‘41-9 ZZONE GRADING CU.YDS. ACRES Ping. Ref.# Parkn Re E LICENSED CONTRACTOR DECLARATION - g q./Prov'ded/ 0 I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /j'�Q�� C(/�z� (Mad /. 4.7,cl Planning Notes: a <1. / .�J��7/L Part -CEJ 7�Lfii✓` •M with section 7000) of Division 3 of the Business and Professions Code,and f/LTlser� 7/i/r+F- yy,A` ' • T ' my license is in full fort:/,nd effect. �c �/ Licen • Class Pe a , ,'y+•.,,, o. P C.rJ ✓ • S Date �M Signature SS/ L.' PLUMBING • FEES WORKERS'COMPENSATION DEC ARATION Bar Sink Showers • ELECTRICAL I FEES hereby affirm that I have a certificate of consent to self-Insure or a certificate - • of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service 3800, Lab. C-) _ _ acow _ Automatic Washer ' Transformer 0 15.50 KW Policy No. Z 0 Com </ panyt'7C p---7,4A40 Backflow Irrigation Sewer Cap Construction Pole Sub. 050+KW • -[1,Certified copy is hereby furni hed. /7 i . �I[LCerti�fiGd yty glide/With the city Bup igry Divi ' Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100-amps Date ,5 A/ 0/ Applicant �( - EXEMPTION FROM WORKERS'COMPENSATION 0 LARATION Clarifiers Solar Collectors DishwasherMeter Clover 100 amps - _ _ (This section need not be completed If the permit is for one hundred ($100)or ' '- less). - Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel ' I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains • Solar Tank ' Fan Motors 00-1 HP ❑1 X-8 Workers' Compensation Laws of California. • Date Signature Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE: If,after making this declaration, you should become subject to the Inc.Solar 09-15 HP ❑15.15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - Fixtures - comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets c Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light - of the work for which this permit is issued (Section 3097 Clv. C.) Interceptors Water Heater , , Lender's Name - Range Lender's Address - Kitchen Sink• - Water Service , Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or - 9 P Standing Sections county which requires a permit to construct,alter,-lmprove,demolish or repair P-Trap Laundry Trays 'Generator ❑0-5 KW❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains °the Contractor's License Law(Chapter 9(commencing with Section 7000)of - , '51=',ivision 3 of the Business and Professions Code) or that he/she is exempt - ' ' herefrom 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 Reinspection Fee I $15 Issue Fee $ 3 ' compensation, will do the work, and the structure is not intended or offered - - Reinspection Fee I $15 Issue Fee 1 $ 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 T e 0 1 DEVELOPMENT SERVICES REOUIREME TS' employees, provided that such improvements are not intended or offered for yp // '' 11/� sale, If, however, the building or improvement is sold within one year of cam- • -- - Canopy Type II 0 Zoning Approved By 4 'Y/ W� Date pletion, the owner will have the burden of proving he/she did not build or int- Duct-Under Ground . 7 t Building Approved By 1% Date. prove for the purpose of sale). / 0 ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 0• A%\ Da , tractors to construct the project (Section 7044,Business and Professions Code: t: ' The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 1 ❑0.100,000 BTU ❑100,000 BTU - MAR a F FEES builds or improves thereon, and who contracts for such projects with a con • • - tractors) license pursuant to the Contractor's License Law)- I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUIL 01 lil'ER $ SMIP $ • proof of their Worker's Compensation insurance should be provided to me. _ _ ' ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLA I E PERMIT __ _• _ C, ISSUANCE $ Date Owner - Heating System& Ducting Registers N C $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BTI...-:- - GRADING $ • information is correct. I agree to comply with all city and county ordinances r.L�E"� I A $ and state laws rete n9 jo build g co (ruction,and hereby authorize repre- P4�rd�CH K 50% $ MICROFILM $ sentatives of thi t to the above-mentioned roperty f-pr / `iY/ Inspection purpo / / �0 A��/.("Y� ,__, • M H ICAL $ ' TOTAL FEE $ Signature / / Date .41/ / Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ • • CMF 0865-46,rev.10/84 White - Building: Canary -Applicant; Pink -Accounting; Goldenrod - Assessor _• 'CONSTRUCTION AND PLANNING PC. . &SPA i Date Inspector I Date Inspector "'APPROVALS Permit# p I • APPROVALS Permit# - p"" I 1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location• • 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement ;3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms • , • •"4. Electrical Conduit-Undrgrnd. ` I 55. Electrical Bonding 5. Steel Reinforcement' * C f474t 1. itkvi 56. Rough-Plumbing 81 Pressure Test ' 6• Electrical LIFER Grnd. - 57%. APPROVAL TO COVER-GUNITE 7. Footings • /��b//l"I .� .58. _Electrical Conduit-Undrgrnd. • 8. Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. . ' - - 60. Backwash Lines, P-Trap, O Undrgrnd. • - • 10. Structural Floor System ,' - 61. APPROVAL TO DECK .,11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap p 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 D 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 f•. - Notes: ajd6K usakksti. MwY�.R.tJt41%... 34. Final Heating & Air Conditioning rl 35. Final Gas Pipe-Test : • Ig-941 36. Hood or Canopy /gam:/! n �..1-_// .L•••'-- r 37. Final Factory Fireplace • 7/1. -wG�o-,�(� re�ee� /:/JC ,, • 38. Final Plumbing , • J r • _ • 39. Water Service-Final T' 40. Gas Service-Final AS 41. Solar Domestic-Final • - 42. Backflow Preventer 43. Backflow'Ircig - ation - - • 44. Landscape Irfigation System 45. Sound Attenuation i - _ 46. Handicap'Regulations . • I , 47. FINAL STRUCTURE & BUILDING • r?7/3j3y /3047 i 48. Special Requirements Completed 49. ,Electric Release to Edison . -- - - •- -- 50. Gas Release to Southern California Gas Co ' . ' i , •51. CERTIFICATE OF OCCUPANCY No. Date • - _ _ _ - - • - PROJECT ADDRESS: 2506 LEHIGH PL UNIT: 0 CITY OF COSTA MESA — BUILDING PERMIT PERM NOr P 04'6174 ` : OWNEWSNAME:.ROBERT E., SIMINGTON • • - ADDRESS: SAME AS ABOVE PERMIT NO: P 046174 PLAN CHECK NO: N GOVT: N SUPP : • N - • - CONSTRUCTION TYPE: PERMIT TYPE:' PLU, m PURPOSE: OTH 714 /540-0110 m .. , ARCH/ENGINEER: REG.NO.i JOB DESCRIPTION ' : WATER REPIPE SQ FT: ' ,ADDRESS: UNIT: - ' CLAIM VALUE: CALC—VALt7E: • GROUP OCC: R- 3 /' •`. PERMITTEE: CC COLE 'PLMG. & HTG . , ( 714 ) 645-1161 • - AOOREss: - 2280- NEWPORT BL COMMENTS: • , CM CA 92627 ****: :e** *fE******air**X *x-** ***u*******+ **aL*** ****X**;E**XX******* *** X* X*r*.*,. LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Cham : 9(commencing with Section • ZONING REQUIREMENTS 7000)of Division 3 of the Business and.Professions Code,and my license is in full force and ee:,. S E T B A C K S • art uc.: 006748 STATE uc.:37558c cuss: c-', • • MAIN BUILDING • • • '7 �i /� ---- --- ---- ------ ---- ACCESSORY BUILDING ----- -- -- - ---- -- -- Date: ( ' ZQ'7 CL Signature: /- .����`•= FRNT: FT IN REAR: FT IN FRNT: FT . IN REAR: FT IN ' WORKERS'COMPENSATION DECLARATION: I hereby a•' - have a certificate of cone• ose11-insure or a certificate of Workers' LEFT : • FT IN RGFIT: FT IN LEFT: FT; • IN RGHT: FT • IN Compensation Insurance,or a certified copy thereof(Section 3300,Lab.C). POUCYN0.: 46001608-90 EAP.DATE: O1 /O1 /91 COMPANY: STATE FUND - • PARKING REQ: • PROV: PARCEL : 42516201 ZNE: REF NO: MO a Certified copy is hereby furnished. E Certifierr the city Buildin: rivision. PLANNINC NOTES'> MINft. > Date' z - 7----/'1-6 Applica t: .\ - = - . �.- )t ************************************************ .**************************+.tis** - � E%EMPTION FROM WORKERS'COMPENSATION DECIARATIO : - „ need not be completed if the permit is for one hundred(5100)or less). D E V E L O P M E N T• SERVICES -,E Q U I R E M E N T ' S 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. ZONING APPROVED B Y . DATE: — Date: • Signature:- .. • NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED $Y :- . '1' DATE: __ Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: • L, DATE: Z, /ya _ which this permit is issued(Section 3097,Civ.C). ********************** 0" -a*************************DE'3F3eit iF*17** LENDER: • ********iE****iE*********************iE**************3E**************************** ADDRESS: . LEGALIZATION:N F E E S U M M A R Y STRUCTURAL - SEGMENT:N • OWNER BUILDERDECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT' PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING • (Section 7031.5 Business and Professional Code: Any city of county which requires a•permit to construct,alter,improve.demolish,or PERMIT •-. - . ' . 2 ,00 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed _ Ir$ ,- pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business ,2 'SNIP/NON—RES' and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by P LAN - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ' ISSUE FEE 3 . 00 . •• , , I, as owner of the property or my employees with wages as their sole compensation, win do the work, and the • BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—- - -.>; . 2 . 0 0 3 . 00. 0 " 00 5 . 00 . 0 0 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 employees,provided that such improvements are not intended or offered for sale.If,however the building or ,REVENUE DIVISION TOTALS——> COLLECTED: 5 . 00 OVER/SHORT• . 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve forehepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 5 . 00 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ' ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ' such 'State License Law). l am aware *************************************************************************X-*iE**3( that proof of their Worker's Compensation insurance should be provided to me. ! IND I . V I' D U A L F E E BR E A' K D O W N • • ❑ I am exempt under Section: , B:8,P.C. for this reason: • TYPE • QTY' DESCRLPTIO N UNIT COST TOTAL COST Date: ' Owner. PLO 1 WATER RE—PIPE 2 . 00 2 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533;and ' END OF FEES ' 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a , permit for construction ormodification from the Air Quality Management District.Residential construction applications are exempt from , these provisions. • Date: • Applicant: - • I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county •• . •ordinances and state laws relating to building constru '•• • authorize represent.' . •is city to enter upon the above-mentioned - . . • .. . - - property r inspection purposes, - _ - '0- / e--) _ DateSigne1� . Driver's License or Social Security e: . . 01 00054462-00054462 T EJ T , 5.00 DATE: 02/20/90 TIME: 15:20 1841-48 White-Building;Green-Cade Enforcement:Canary-Applicant;Pink-Revenue;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. _ J 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6.TElectrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE • 7.-Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test , 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap,.0 Undrgrnd. . 10. Structural Floor'System , 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final 12. Sewer Cap , 63. Heater & Vent-Final - • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing - • 65. Electrical-Final - . 15. Rough Electrical-Conduit • 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval I 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - • APPROVALS Permit# 21. Ducts, in Structure _ 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test : , ' 72. Underground Flush , 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 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 PREY. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat •. , - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric • ' ^ Notes: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test c.,-,j 36..Hood or Canopy - 37. Final Factory Fireplace - . 38. Final Plumbing ' . - 1110 Lap 39. Water Service-Final - 41744 LIP'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 -2 48. FINAL PLANNING 49..Electric Release to Edison .j - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY D No. Date • Costa Mesa Building De¢artment APPLICATION FOR PERMIT . . 111 EAST 20th STREET nay c ^_J COSTA MESA, CALIFORNIA 2 / ®C) BUILDING 1 FOR OFFICE USE ONLY FOR APPLICANT/ TO IN Receipt No. Permit No. Address471 f0(� CGGI`C.��% l/ ; aI �v,X osta Mesa, CallfO ' a Received by Date Redd. Date Issued CNears 'Gei_5Le'// 5C0 Building $ / ero O. /21'�� Address Owner LOe7//* /YFt?t9 i¢T Costa Mesa, California Mail r� 9 Address nil, ea, Nearest / / Tel. Cross St. City ^-Q'i bt:?1 F-a yC. No.�Ur���j 7 Zone No.of Type ,/ Grou Architect or 2�6,/� Lic. , �� Plans I yp i' -.�'� Engineer No. Approved /J by Date idress i5/C/4Qe4? ",AN'-, �// c/7�/- //1Y/a-- l p city Lie CORRECTIONS Contractor k , 15-Ctegt'L(C.= City Lic. (�G Address fE.t�li',Lot ((l .d:C'�l ,t�Ce- 5 DescrLeiption l I No. Cly' I Block I Tract 22h �,; --� (Attach Metes and Bounds)r ,f1--Qk l j ��X YJ I No.of Bldgs. Size of Lot Now on Lot n r,:, i f Use of No.of No.oT � A Existing Bldg. I Families I Rooms S Setback Line from — / Rear Yard"s- Z Center of Street v G Side Yard gala__ —CITYOv QT !7 re DESCRIPTION OF WORK 1- �— •A —�A New I K I Alteration I I Addition I Repair I I Moving I I Demolish I Building ''// No.of / `ft',3..k-C"-Rooms C. Stories ,rior Wall Roof Ce.4/9/e„ Covering 9r e/&!0 I Covering 12',./„.-4/#14:-- APPROVALS Use of New ,/J y ,/� Building ,`4 ( ifQlGffVd .;y Foundation Location Inspector Date /� J o ✓✓ Forms,Materials, FCc.L�i .,.aco 5c Under-Pinning (----• Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that 1 have read this Application and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building construction. Lath.Ext. Signature of /t// ,e1-47. ,.,1— Permittee �� ,`7--- -- Plaster, Int. Authorized Agt. 2��7 ����4 Plaster,Ext. Valuation Permit Fee $ a7.--c Masonry Reinforced Plan $ /100101>e- ' Tota +I P? $ /, � Bond Beam Fee 7P? FINAL FIRM 204 S-RP 2M 0.94 c o .13 J c d. J co,tr z i O. Street PLOT PLAN Show location and distances from property line and between buildings.