HomeMy WebLinkAbout3124 LINCOLN WAY - Building PermitsPROJECT ADDRESS: 3124 LINCOLN WY UNIT:
OWNER'S NAME: BVACH PARRIE M
ADDRESS: 31`24 LINCOLN WAY
COSTA MESA,CA 92626
ARCH/ENGINEER: 546-4075 flEG.NO.:
ADDRESS: UNIT:
PERMITTEE: NOCK PLUMBING (714)895-1246
ADDRESS: 11610 SEABOARD CIR
STANTON CA 90680
LICENSED CONTRACTOR DECLARATION: I heresy alarm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 0l the Business and Professions Code. and my E is in full larce and effect.
CITY L� 01I5,,0 3 STATE LIC.: 511971 LASS: C 3 6
_Oat-=-[-�-_6 Signature: _
WORKERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a cenilicate of consent to selWasure in a certificate of Workers'
Compensation Insurance. or a climbed Copy thereof (Section 3800. Lab. Q.
POLICYNO.: 116799290 EXP. DATE: 03/01/92
COMPANY: STATE
❑ Ceraied copy is hereby furnished. O( Candied copy is filed with the City Building Division.
Jte1 Applicant:
`EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (ft section need rod be completed it die mml istw one hundred (5100)or less).
I cenly that in the performance of the work for which this pemut is issued. I shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of California.
Date: Signature:
NOTICE: If, after making this declaration, you should became subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith comply with such provisions of 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
which this permit is issued (Section 3097. Gv. Q.
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Stale License Law for the fallowing reason
(Section 7031.5 Business and Professional Code: Any city of County which requires a permit to construct, alter, improve, demolish, or
repair any structure, prior to its issuance. also requires the applicant lot such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis lot 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 live hundred dollars (5500).
I, as owner of the property or my emVloyees with wages as their sale compensation, will do the work, and the
❑ structure is not intended or offered for sale (section 7044, Business and Professional Cade: The Contractors' Slate License Law
does not apply to an owner of a properly who builds or improves thereon, and who does such worn himself/herself at through
his or her Own employees, provided that such improvements are not intended or offered lot sale. 11, however the building or
improvement R sold within one year of Completion, the Owner will have the burden of proving harsh, did not build or improve
lot the purpose of sate).
I,as owner of the property. am exclusive Contracting with licensed contractors to Construct the project (Section 7044, Business
11 and Prolessions Code: The Contractors' state License Law does not apply to an met of propartwho builds or improves thereon
and who contracts for such projects with a comm (s)license pursuant to the Contractors' Slate License Law),I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section: B. 5 P. C.
for this reason:
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any luture building Uccupaol wiNwiB not (eirtle one) need to comply with said state codes and the requirements lot a
permit for construction or modification from the Air Oui Management District. Residential construction applications are exempt from
mese provisions.
Date: Applicant:
I hereby certify that l have read this application and state that the above information is Correct. I agree to comply with all city and county
0rdmances and state lays relating to building construction and hereby authorize representatives of this city to enter upon the above-menlionetl
property lot inspection purposes.
Signature:
License or Social Security w:
Applicant Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 052659
PERMIT NO: P 052654 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION CHANGE OUT WATER HEATER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT: FT IN
REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
PARKING RE •
PROV:
PARCEL:
14165239
ZNE:
REF NO:
PLANNING N TES>
>
*Bf 1E**RF IF IE*iEif Bf*Bt**iE*it*iEx******BE*■**iE**k*iF iE Re RE*BF Be BE***BE
Bf*MBFiE k iE iE*if***BE iP BE*k*BE Rf iEk Xt Re BF*iP BP
D E V E L O
P M E N
T S E R V I
C E S, R
E Q U
I R E M E N T S
ZONING APPROVED BY
DATE -
BUILDING APPROVED BY :
APPLICATION ISSUED BY: / t Y \
ie BE BE iF*iE BE if iE iE iE 4F i:k *Be ie*3FiE** ��'
if iF Bf iF RE BFRf*iF iE BP BF 9P M BF BP*****iE Rf if RE iE***%iF aE***iF RF RF Bfff 1F`BF iE iF Rf BEiE IE XF
LEGALIZATION:N F E E S U l� M A R Y
PERMIT BLDG PMT PLUMBINNGG ELECTRIC MECHANIC
2 00
'5Y
PLAN
ISSUE FEE 3.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS ---- > 2.00 3.00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
5.00
DATE:
iF # 1E iE ie iF
IN * iF * * R K iF iF iF KiFifiF if 3f iF iFiE iF K iF if
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON—RES
TOTAL PAID DUE
5.00 5.00 .00
5.00 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CHECK
BE 1E Bf kiE*kiE*MBE*BF Bf***iF*iE BE**Bt M iE*MiE BE BF kBE BE BF,t iEk*REBF BF BE aE BE*iE Re*iF 9E BF iEiE**IF iE BE***ick*iE BF BE iF BP iP RF BF BF iE iE *aF*
I N D I V I D U A:L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 2.00 2.00
END OF FEES
DATE*`;,
CONSTRUCTION AND PLANNING
POOL A
,
APPROVALS Permit #r Date
Inspector
APPROVALS Permit #
Date
Inspector
'.. Temporary Electrical SerJre; or Pole ,u
52. Pool &Equipment Location
2. Soil Pipe-Undrgrnd. _ Ma
53. Steel Reinforcement
al Condut lity�rgrnt
;t , Etectri it d
54. Forms
4.4;"Ele vical Conduit: ndrgrnd. a
55. Electrical Bonding
ReinforcemF�t`-
56. Rough Plumbing & Pressure Test
14i yctrical UFEiii'rnd.
57. APPROVAL TO COVER-GUNITE
-
:Tttings o-
58. Electrical Conduit-Undrgrnd.
Jz
9.i�oundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgmd.
60. Backwash Lines, P -Trap, 3 Undrgrnd.
a
10. Structural Floor System
61. APPROVAL TO DECK
11. PcopertV Sewer Liner& Ho -Me Connection
62. Backwash & Receptor -Final
12. Shwer Cap
_ 2
63. Heater & Vent -Final
C.
13. Roof Drains It v
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electri -Conduit
66. Solar System -Final
16. Rough ElectricWiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrii-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REOUIREMENT '
- -s
-s, 7C - - -
1APPRMVAtS3 ;C:Peralit # W
20%RoG�h Eacto� Fireplace S,r-. ¢ :
_
a`x >
1
_ r -
21, s, _Dui�Stryct ,.,; .... S
W
G t_ �. s
_ 0. Undergre tm' HAto ...
22: Oup, V2ntiAtinrq- C:S
a
S tt s>
X71, produc!7tping C7•(qs C?Oil
_
23.`;Ga�Pip�t q
Roh Vlest rg
y
Undergroustil Flu;fin * '
r•
`':;
-72.
24._Rots: Flaming ?_ ^_i_ '-
• J v
=
73yUndergrndtStorag�'fankflGas 00-il
4
25. Rogf SF aching , 'r ;;t
" C0
:,c VA r
74`-'OverheadYlydro�
26, Y-Q.T Ceiling (Stw tural) &-fi4onocoat
t. a7
a +
75sDry Chemical =
27' rame and FlashGrti"g`' �z�
;
� �z.v y
76' Dr Stan a
`
28. La (}ting$ Siding a i met s_
5
+:
77; --'FIXED SVSTEV.Sr�AU
.'
-'29. Insulatgn �.� S
I
x
n
78 FIRE PREY. FI�Qgl_
>.
i 30. DrywalrNailing int
.A
-i •c: •HEALTWDEPTi. REQUIREMENT
`31. Plaster 8•rowRCgat;, j
a
S rt.,•
„79�'�PTAL`IN�4.ECT10N
K
°_32�Electrica'1 PovyerQtenFinalI
p;1180o-FOOD
CERTT P PTE ISSUED
S33�Firia) E ctric d
7 T•
-:„
Nciles7/L 4� �o
`Rj34,-Fin, Hggting& Air? orsditign'�� r
;,
E �.
;z •` t�f^. .s S ��.
35;inai G;!`s Pide-Test x
1
r
t ;` :5 _
�r
ry
R
_
, :r+
,X36THo9d o�]Canopyrn
r
i
r
Z37S=Firi31 Factory FiF§_jaccz ;r
m
` t,
t"•
;y
a. ,o
t
*
.:38. Final Plumbing
^39: WaQr Service-Fina{ta'
' 4
y %
v fj�
•y. F'
tJ X
�,,40. Gas Service -Final to ,rtru ,S
t t*1
j x «,
p •, C) CU
5--41. Solar Domestic-FinalS
w4,;)r
42�Backflow Preventei
43. Backflow Irrjgatioo
0t44. Landscape Ciigatigp SVsteml- r
.i nl C
7,
p; is •-�::� ,i: ._.
>45,�:'Sound Attenuation .lcF• tr
` T_ ("
- f-` z
z•s '''
r t -
S46'; Handicap Regulatigns
-
47 •FIN'AL STRUCTURE & BUTLDINGy
•
_ n
T
'
f •
C
48('FINAL PLANNING
o49aElectric Release to:Edison i
v
i
y
r }
Yz50,-Gas Release to Southern Cali,furpia Gas Go
I
I
- `'
,
_ G
V�
,51.+CERTIFICATE O.000UPANCY
4
:c
No. Date
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESAPERMIT
O.
TRACT NO. LOT NO. BLDG. NO.
CONSTRUCTION PERMIT
- 53o'L
TYPE OF CONSTRUCTION /
❑ NEW ❑ ADD ❑ ALTERATION
❑REPAIR ❑CONVERSION F1 DEMOLISH
❑ OTHER
9O�JO BIO%I61 6o(]Q
ZONING REGULATIONS
Project Address
Owner • f1 P h o n 7,5
AddreA tr_�Q��J
Arch/Eng.. ,-V' e -a -a Lice se No.
DESCRIPTION OF WORK
A.P. #
ZONE PLNG. REF. $
Address
Contractor Phone
TYPE OF PERMIT
❑.GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA
B
SETBACK C ST.
LIDF VARO
SIEDE VAR
Tp B�JI t�,ppING
PROPS RTV LINE
Address
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (com-
mencing with section 7000) of Division 3 of the Business and
❑ OTHER
RIGHT
Professions Code, a d my license Is In full forces a�n� d�peftEy4t.
REAR YARD (TO P/L)
—�
PROJECT DESCRIPTION
License Class Licen No;
SQ. FT.
PKG. SPACE REQ.
PROVIDED
Date ? -A O Signature -
WORKERS' COMPENSATION DECLARATION
OCCUPANCY_ CONSTRUCTION TYPE
STREET WIDTH
PARK FEE $
- -77
I hereby affirm that I have a certificate of consent to self -Insure or a
VALUATION ZONE
ZONING APPROVED BY
DATE
certlfleatb of Workers' Compensation Ins dance, or a certified copy
thereof (Sect] n 3 00, Lab. .).
'Icy No. / Company ^4
GRADING CU. YDS. ACRES
SPECIAL CONDITIONS:
_.f✓� -L
e��.,tt++ff led copy is hereby furnished.
REMARKS:
y Certified copy Is filed with the city Building Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed If the permit Is for one hundred
NoS$l0roMO) OY less).
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. _
BATHTUBS SHOWERS
Data
—Signature
NOTICE: If after making this declaration, you should become subject
TOILETS - URINALS -
GENERATOR0.1 KW_
1-10 KW
to the Workers' Compensation provisions Of the Labor Code, you must
TRANSFORMER
forthwith comply with such provisions or this permit shall be deemed
LAVATORIES DOUBLE LAVS
APPLIANCE 10-50'KW_50+KW
revoked.
KIT. SINKS DISHWASHERS,J 31 r12MOTORS
0-1 HP -1-10
HP
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the per-
SERVICE SINKS SUMPS
(INC. SOLAR) ' 10-50 HP
50 + HP
formance of the work for which this permit is issued (Section 3097
FLOOR SINKS FLOOR DRAINS I
FIXTURES OUTLETS
SWITCHES'
Civ. C.). -
Lender's Name
Lender's Address
DRINKING FOUNTAINS
GAS TUBE SIGNS
INTERCEPTORS CLARIFIERS
POLE LIGHTS
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License taw for
SWIMMING POOL P TRAP
'
the following reason (Section 7031.5 Business and Professions Code:
Any city or county which requires a permit to construct, alter,
POLES METERED
SUB
WATER SERVICE ALTERATION
PANELS MAIN
SUB
improve, demolish or repair any structure, prior to Its issuance, also re-
quires the applicant for such permit to file a signed statement that he
GAS SERVICE OUTLETS
SERVICE
AMP
Is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with Section 7000) of Division 3 of the
WATER HEATERS BTU OUTPUT
'
Business and professions Code) or that he Is exempt therefrom and the
'—Is for the alleged exemption. Any violation of Section 7031.5 by
SEWER CONNECTIONS
applicant for a permit subjects the applicant to a civil penalty
of more than live hundred dollars ($500).
SOLAR TANK COLLECTORS -
1, as owner of the properly, or my employees with wages as their
sole compensation, will do the work, and the structure is not intended
or offered for sale. (Section 7044, Business and P(ofessions Code: The
SOLAR PIPING SYS.
ISSUE FEE
Contractor's License Law does not apply to an owner of a property
ISSUE FEE
gPPLICATION APPROVED BY
DATE
who builds or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not
MECHANICAL PLAN CHECK
SUMMARY
OF FEES
intended or offered for sale. If, however, the building or improvement
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).
HEATING SYSTEM 0-100,000 BTU
BUILDING '
PERMIT $
SMIP $
❑ I, as owner of the property, am exclusively contracting with
AND DUCTING
licensed contractors to construct the project (Section Business
100,000 +BTU
PLAN CHECK $
PERMIT
d es not
and Professions Code: The Contractor's License Law does not apply to
U
ISSUANCE. $
a
owner o/ property who Or improves (Hereon, and who ton-
REFRIGERATION 0.100,000 BTU
PLUMBING $
a contractor(s) Ilcesnetl pursuant to
tracts with a
tracts from such projects
SYSTEM
- -
GRADING $
the Contractor's License Law).
).
100,000 +BTU
PLAN CHECK $
❑ I am exempt under Section - B. & P. C. for this
BOILERS BTU
ELECTRICAL $
$
reason
SYSTEM REPAIR, ALTERATION
PLAN CHECK $
MECHANICAL $
MICROFILM $
TOTAL FEE $
Date Owner
I hereby certify that I have read this application and state that the above
EXHAUST SYSTEM MULTIPLE
LESS AD -
information Is correct. agree to comply with all City and county
PLAN CHECK $
VANCEP PC IS
ordinances and state laws relating to union, and hereby authorize
construction,
representatives o tM10 c y tO enter upon the above mentioned
property f ectlOn eqs s„
::�_fl
60
�rp
Signature L•c�'+`� ate �G
ISSUE FEE
FINAL FEE E
Drivers' License r SS - _
CMF 0865-46 White -Building: Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
G
CONSTRUCTION AND PLANNING
APPROVALS Permit #
POOL & SPA '
Date Inspector APPROVALS Permit # Date Inspector
1.
Temporary Electrical Service or Pole
43.
Pool & Equipment Location- - -
2.
SoilPipe-Undrgrn•
44.
Steel Reinforcement -
3.
Electrical Conduit Utility-Undrgrn
45.
Forms
4.
Electrical Conduit-Undrgrn
46.
Electrical Bonding
5.
Steel ein orce
47.
Rough Plumbing & Pressure Test
6.
Electrical LIFER Grn
48.
APPROVALTO COVER-GUNITE
7.
Footings
49.
Electrical Conduit-Undr rn
8.
Foundation
50.
Gas Pipe, ❑ Undr rn, Test
9.
Water Pipe-Undrgrn
51.
Backwash Lines P -Trap.❑ Undr rn '
10.
Structural Floor System
52.
APPROVAL TO DECK
11.
Property Sewer Line & House Connection
53.
Backwash & Receptor -Final '
12.
Street Sewer Connection
54.
Heater & Vent -Final
13.
Rough Plumbing
- -
14.
Rough Electric -Conduit
•56.
Electrical -Final
15.
Rough Electric -Wiring
57.
Solar System -Final
16.
Rough Heating & Air Conditioning
bb.
Fencing & Access Approval
17.
Ducts in Structure
59.
APPROVED FOR PLASTERING
18.
19:
20.
Ducts, Ventilating
Gas Pipe -Rough &Test
Roof Framing
60.
POOL/SPA SYSTEMS FINAL
21.
22.
Roof Sheathing'
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
,/071
32.
Water Service -Final
33.
Gas Service -Final
34.
Solar Domestic -Final
-
35.
Landsca e 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 declaration,.
CIPY OF COSTA MESA CONCyTRUCTIPN PERMIT
Project Afldress 3�a ,� / g ^SCO/�✓ �(/
Applrcant's Mailing Address
Owner's Name Phone
Address
Arch/Eng. License No.
Address
Contractor's Nam /'� C A]S hone
Address (mailing) a 63
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force d effect. �.{ Q (,1
License CI s I License No. `S� r s _1
Date - S Signature
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a Certificate of consent to self -insure or a certificate
,f Workers' Compensation Insurance, or a certified Copy thereof (Section
800, Lab. C.) -
Policy No. I Company
H
Certified copy is hereby furnished.
Certified copy is filed with the city Building Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(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 subject to the
Workers' Compensation Laws of California.
,.Data Signature
'NOTICE: It, after making this declaration, you Should become Subject to the
Workers' Compensation provisions of the Labor 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 which this permit is issued (Section 3097 Civ. CJ
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisionsof
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
therefrom and the basis for the alleged exemption. Any violation of Section
'031.5 by any applicant for a permit subjects the applicant to a civil
6n3
Ity of not more than five hundred dollars ($500).
1, as owndr 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, (Section 7044, Business and Professional Code: The Contractor's
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
employees, provided that such improvements are not Intended or olfered for
sale. If, however, the building or Improvement Is sold within One year of com-
pletion, the owner will have the burden of proving he/she did not build or im.
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors t6 construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of properly who
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
proof of their Worker's Compensation Insurance should be provided to me.
❑ I,am exempt under Section B. & P. C. for this reason
Date Owner
Ihereby certify that 1 have reap
information is correct. I agree to
2862 --5/13/85 1507 TL
TYPE OF CONSTRUCTION LJ NEW LI ADD LJ ALTERATION LJ REPAIR
Zoning Approved By
Building Approved By
Application Issued By
❑ ❑ ❑
Date
Data
Dat
CONVERSION DEMOLISH OTHER
A P #
Zone
DESCRIPTION OF WORK/USE OF BLDG.
-
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 2511
PL.,N CHECK 50%
MECHANICAL
PLAN CHECK 25%
$
$
$
$
S
$
$
$
SUMMARY OF FEES
SMIP
PERMIT .
ISSUANCE
ENERGY P.C.
I •Od GRADING
MICROFILM
TOTALFEE
$
'
$
• $
$
$
$
S
Main Building:
Accessory Building:'
E
Z
TYPE OF PERMIT 11 GRADING LJ FOUNDATION U STRUCTURAL
T
Front
O
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
B
N
_
❑ OTHERA
Rear
I
C
Right
- -
N
PROJECT DESCRIPTION SO. FT. OCCUPANCY
K
G
CON STRUCT10N TYPE VALUATIONS
-
S
Left '
- -
R
ZONE GRADING CU.YDS. ACRES
Ping. Ref. #
Parking Req./Provided
E
Q
Remarks:
Planning Notes:
M
S
Sar Sink
3ackflow Preventer
3ackflow Irrigation
3athtubs
Dlarifiers
Dishwasher -
Drinking Fountains
Floor Drains '
Floor Sinks
Sas Service Outlets
Interceptors
Kitchen Sink -
Lavatories
P—Trap
Roof Drains -
Reinspection Fee $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
❑0.100,000 BTU ❑l 00,000 BT
rivers' License r 55 # I I Reinspection Fee I $15
\ CMF 0865-46, rev. 10/84 White - Building; canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Issue Fee
Hood or Type 1 ❑
Canopy Type 11 ❑
Refrigeration System
❑0-100,000BTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3
Automatic Washer
- Construction Pole Sub.
f Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec'
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator ❑0.5 KW
Reinspection Fee
ELECTRICAL FEES
Transformer- C1 15-50 KW - -
❑ 50 + KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors 00-1 HP (11 'A - 8
Inc. Solar 09.15 HP 1116-15+
Microwave -
Pole Light
Standing Sections
15 KW Trash Compactor
l
$15 Issue Fee $ 3
REQUIREMENTS
Zoning Approved By
Building Approved By
Application Issued By
Date
Data
Dat
'
-
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 2511
PL.,N CHECK 50%
MECHANICAL
PLAN CHECK 25%
$
$
$
$
S
$
$
$
SUMMARY OF FEES
SMIP
PERMIT .
ISSUANCE
ENERGY P.C.
I •Od GRADING
MICROFILM
TOTALFEE
$
'
$
• $
$
$
$
S 3flELECTRICAL
$ 3
I CONSTRUCTION AND PLANNING
'.APPROVALS Permit # Date
Inspector
POOL _. SPA
APPROVALS . Permit #
Date
Inspector
7.' 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.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6• Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8: Foundation IL
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
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
APPROVALS Permit#
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing -
73. Undergrnd. Storage Tank OGas 0Oil
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
'7 J(o �j.
Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
'
37. Final Factory Fireplace
38. Final Plumbing
39, Water Service -Final
40. Gas Service -Final
,
41. Solar Domestic -Final
42. Backflow Preventer
43. 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 On
51. CERTIFICATE OF OCCUPANCY
No. Date
f
- Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
9128 3/1 2/„5
F ,9ST.ANESA �JCONSTRUCT/ION PERMIT
Project Address Vl y f A/COLAI ' e
PERMIr NO
l/.r -7q-
TRA o.
Lo
uNltplo.
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
El CONVERSION ❑ DEMOLISH OTHE�
DESCFJIPTION OF WOR K(IISE OF BLDG.-/1/i17Y,s7 0- +,✓
l,vr/
_
Applicant's Mailing ddress'%/l .��/'�da/✓5•/ //
Owner's Name � '�// r/ACA Phone �G-Y07s"
Address •3/"ly `/�<<'�'t'�/moi/
A.P. eL Zone
I
S
Main Building: Accessory Building:
Arch/Eng. ��� s ��•✓ Licen No. C'3GJ �
Address A r �L1Us/T/%/a
TYPEOFPERMIT GRADING
El TENANT ® ELECTRICAL
❑ OTHER
PROJECT DESCRIPTION SO.
CONSTRUCTION TYPE
ZONE
FOUNDATION STRUCTURAL
V PLUMBING ® MECHANICAL
_
FT. �• / OCCUPAN V
_
VALUATIONS-1��`�-�—
GRADING CU.YDS. ACRES-
T
Front
Z
B
Rear /
N
1
Contractor's Name N Phone SaJ3' YS �/
Address (mailing) 62,3 Lsa7 'tos.✓ST' lz /t�sf' �o
City License No. 3
LICENSED CONTRACTOR DECLAR TION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full fo a and effect.
No yj�
A
C
flight
N
K'
S
/
Left
R
Ping. Ref. # rking Req,/Provided
E
Remarks:Planning
Notes: 0 0 (
M
_
T
S
License Class
Date ✓�/__ Signature
PLUMBING FEES
Bar Sink
1 Showers 'Z,
ELECTRICAL -
FEES
WORKERS' COMPENSATION DECLARATION
affirm that I have a certificate of consent to Self -insure or a certificate
�t Workers' Compensation Insurance, or a certified copy thereof (Section
CIO,
800, Lab. C.) -
Backflow Preventer
Service Sink
Automatic Washer.
Transformer ❑ 15-50 KW
Baikflow Irrigation
Sewer Cap_
Policy No. -' -Company
eCertified copy is hereby furnished, -
Certified copy is filed with the city Building Division.
Construction Pole Sub.
❑50+KW
Bathtubs
Sewer Connection
Cooking Unit
Meter INp to 100 amps
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(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 wh lch this Permit is Issued, I
shall not employ any person in any manner so as to becom s bject to the
Workers' Co�n gge�-nsatlonya of Calif orgia. /S� /��
Clarifiers
Solar Collectors
Dishwasher
Meter Dover 100 amps
Dishwasher Solar Piping
Dryers ❑Gas [].Electric Sub Panel
Drinking Fountains Solar Tank
Fan - Motors ❑0-1 HPD 1 % - 8
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc. Solar ❑9-15 HP ❑16-15+
Date 3,L ) Signature �A/la//-Ci TYf'- /�---•-�
Si
'NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or this permit shall be deemed revoked.
Floor Sinks
Urinal
5 Fixtures
Microwave
Gas Service Outlets
Water Closet
Device Boxes
Pole Light
9
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which tNs permit is issued (Section 3097 Clv. C.)
Lentler's• Name /✓ice �i.✓i%•r
Lender's Addressf&lam -;''d'��^/r�/
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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
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
to file a signed statement that be/she is licensed pursuant to the provisions Of1�pecthqm
Fdlheref rom an it the basis for the alleged exemption. Any violation of Section031.5 by any applicant for a! permit subjects the applicant to a civil
nalty of not more than five hundred dollars ($500). LLLLLLJJJJJJ1,asOwner of the property or my employees with wages as their sole
compensation, will do the work, and the structure 1s not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
Law does not apply to an owner Of a property who builds or improvesFEESthereon, and who does such work himselilhersell or through his or her own
Provided that such improvements are not intended or offered for
If, however, the building or improvement I5 sold Within one year of Com-
D etlon, the owner Will have the burden of proving he/she did not build or im-
prove forhe purpose of sale).
❑ I, as owner of the property, am exclusively Contracting with licensed con-
to construct the project (Section 7044, Business ano Professions Code:The contractor's License Law does not apply to r s owner of property who
Con -
or improves thereon, and who contracts for such projects with aeon-
tractor(, license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation Insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Interceptors
-
- Water Heater
Outlets
Range
9
Kitchen Sink Water Service
$witches'
r Sign
I LavatoriesAuto -Wash
Garbage Disposal '• Standing Sections
P -Trap Laundry Trays
Generator 00-5 KW 115-15 KW Trash Compactor
Drain
"
Fee
$15 Issue Fee $ 3
Reinspection Fee' $15 Issue Fee
$13,License
MECHANICAL
DEVELOPMENT SERVICES REOIf REMENTemployees,
i,sale.
Apprpved By � � Date
Building Approved By Data
Application Issued By - Dattractors
Boiler
-
Hood Or Type I ❑
Canopy Type 11 ❑Zoning
Duct - Under Ground
Duct -Structural
Refrigeration System
❑0100,000 BTU ❑100,000 BTU
'(x
Duct -Ventilating
BUILDING PERMIT $
r PLAN CHECK; $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
$U M� A�Rv� FEESabuilds
SMIP $
-71 -b3 PERMIT
_L nh ISSUANCE $
'1 . SCS ENERGY P.C. $
QQ GRADING $
_
'�� MICROFILM $
'�
TOTAL FEE $
z�-
—/
L
3. 3
Exhaust System ❑ Multiple ❑
System Repair/Alteration
_
Firepl/Fact. Bit. ICBO #Fire
Dampers
Date owner
I hereby certify that I have read thi application and state that the above
information is torr CV. I agree torcorrhrrr��gi ly with all city and county ordinances
and state la rel Og to buil Ing trpction, no hereby authorize repro-
sentatives Ity to/ r tt he ab e -mentioned propatity for
inspection/purp ) 7 /'
Signature' �� _ Date_
Drivers' Liens or 55 7f «/- /�/ -
Heating System &Ducting
00-100.00013TU ❑100,000BT
Registers
t
Reinspection Fee
$15
Issue Fee $ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit # Date
Inspector
POO. SPA
APPROVALS Permit #
Date
Inspector
J.- Temporary Electrical Service or Pole
52. Pool & Equipment Location
-
,;2. Soil Pipe-Undrgrnd.
(,6P
53. Steel Reinforcement
�3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
-
55. Electrical Bonding
5. Steel Reinforcement :
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
3
2N _S
57. APPROVAL TO COVER-GUNITE
7. Footings
r-
58. Electrical Conduit-Undrgrnd.
8. Foundation -S �J A''7
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
(!�S
L�
62. Backwash &Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. -Plumbing System - Final
14. Rough Plumbing
•S
(.�
65. Electrical-Final
15. Rough Electrical-Conduit -
66: Solar System-Final
16. Rough Electric Wiring
JC f K
c
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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
WWI
71. Product Piping 0 Gas ED Oil
23: Gas Pipe-Rough & Test -
72. Underground Flush
24. Roof Framing-
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - -
lS.l .-
.�
74. Overhead Hydro
26. T-Bar Ceiling (Structural) &'Monocoat
75. Dry Chemical
27. Frame and Flashing
slc
�S
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
DS
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
G/S
79.. FINAL INSPECTION
32. Electrical Power Meter-Final
80; FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
7 ` di<f
(tea
44
6
35. Final Gas Pipe-Test
36. Hood'or Canopy
To
37. Final Factory Fireplace
(1 0
38. Final Plumbing - .l
%� �,�
-
S L ir- SA46&J1Fe 1700 TF,.GTO/C. L•FV
39. Water Service; Final
40. Gas Service-Final }
41. Solar Domestic-Final'�A
42. Backflow Preventer
-
43. Backflow Irrigation
44. -Landscape Irrigation System
45. Sound Attenuation'
46. Handicap Regulations
47. FINAL STRUCTURE&BUILDING
4
��-
48. Special Requirements Completed
49. Electric Release to Edison
-
•50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF. OCCUPANCY
Fio - Date
-
City of Costa Mesa INSULATION CERTIFICATION, Building Safety Division '
3/� �J L-ifl ev lr~1 �asr�/�%ty
Number and Street city Coun
ROOF
Material
Thickness (inches)
EXTERIOR WALL
Material
Thickness (inches)
CEILING
Batt or Blanket Type
Thickness (inches)
Loose Fill Type _
Subdivision Lot Number
DESCRIPTION OF INSTALLATION
Jo'r
Minimum Thickness (inches)
Area Covered (ft2)
FLOOR,ELEVATED
Material
Thickness (inches)
FLOOR,SLAB /
Material - gNur
Thickness (inches)
Width (inches)
FOUNDATION WALL
Material
Thickness (inches)
Brand Name
Thermal Resistance (R Value)
Brand Name q /
Thermal Resistance (R Value)
1
Brand Name 1.4" / .�!
Thermal Resistance (R Value)
Brand Name
Number of bags Weight per bag Ib.
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
Brand Name
Thermal Resistance (R Value)
DECLARATION
1 hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administrative Code).
%�o.va%�Sc�ile.ds.�t Cis/�.�rz�.xe,( ysao��
General Contractor (Builder) License Number
r dlUtiL• 7/6A�
Signature and Title Date
Licen Number ^v^r)A
16
6c
Date
CMF 1106-30
DO;'ALD SCHLENSKER
GENERAL CONTRACTOR
6263 13ATAAN ST.
CYPRESS; CA 9 53U
August 6, 1985
City of Costa Mesa
P. 0. Box 1200
Costa Mesa, CA 92628
Reference: 3124 Lincoln, Costa Mesa
Gentlemen:
Per instructions from your Inspector, the following corrections have
been made at the referenced address:
2% grade 4, first 5'
1% grade after,
flows to street
Very truly yours,
Do� �P.
Donald P. Schlensker, General Contractor
6263 Bataan St.,
Cypress, CA 90630
18763
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING
ADDRESS 124 Lutco�//�'la IYa
COSTA MESA. CALIFORNIA
FEE FEU� CEIVED
9 1963
FINANCE DEPT.
APPLICAT ONIYOR- PERMIT MESA
BUDDING
For Office Use Only
Loan
RECEIPT NO. PE M �
OWNER Orcidenta.l Comoantz
MAIL / o
22 #aaGOR. &vd.
RECEIV
BY I DATE RECEIVED DATE ISSUED
�F.1
ADDRESS
I p I C 1;
I u 10TE
Me4a 460 Q
BUILDING
CITY o.a NO
ADDRESS
ARCHITECT TEL.
OR ENGINEER NO.
COSTA MESA. CALIFORNIA
FIRE
II �/j
ADDRESS
ZONE
APPROVED
TYPE 4 GROU G"
61
jjJ �]
4e140 n
A.
CONTRACTOR(' Rea (,♦
BY
DATE
2907 Qenedtcf rapa &i-ve
ZONING
ADDRESS
ZONE )
RSI
NO.OF USE OF NEW S.w''"� ilq
I PLANS BUI/LDIN,Gp� 177
R / ' / /
CITY Be✓e�-L #ZU-4 aATElw�]•t(O nia
LIC. NO. 14% NO. R-6 4O
LEGAL
DEBCRI PTI ON
40/ "3'-/%��J T�'l / 17
SIZE
NO. OP BWGS.
OF LOT
NOW ON LOT
A. P. NO.
USE OF
EXISTING BLDG
YARDS
APPROVED
EVES
ALLOWED
SETBACK UNE PROM/, o
CENTER OF STRSET 4 REAR YARD 77
(CENTER LINE
FRONT
ET.)
r'C9 FT. IN.
(LEFT
(RIGHT
R.SIDE
L. SIDE
FT. IN.
) S FT. -- IN.
F2L_)LARD
DESCRIPTION OF
pIWORK
XIIALTERATIONI I
NEW II ADDITION
REAR .,
FT. IN.
REPAIR I II MOVING I II DEMOLISH I
ABPTPRCAA
DATE 2
BUILDING NO. OF `
7
SIZE ROOMS (J STORIES
EXTERIOR WALL
(ROOF d�lovd 8 Roc
COVERINGCO
COVERIN
UI�gIG PFORMED
.AN aOfaOcBU8F.aFB
1-am. aaa e.
�o
dam/
° ati4eelf dG a 1Mw/ a
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM.
PURPOSE
OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND BT E LAWS OU TING
VALUATION
BUIlDIN0 CON ON.
RIGNATURE O
PERMIT FEE S
PLAN CHECK S
PERMITTE�j
S �l %/
J40
AUTHORIZED AGE
0
TOTAL FEE