HomeMy WebLinkAbout139 LISA LN - Building Permits •
CITY OF COSTA MESA • K
• BUILDING DIVISION
> :j•.,,•. , DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
F 1 rAin
PERMIT T f B03-01488
(714)754-6273 • Fax(714)754-4856 • www.ci.costa-mesa.BgLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
c • •,\
Job Address: 139 LISA LN Status: ISSUED
Suite: Applied: 09/03/2003
Vicinity: Issued: 09/03/2003
Parcel Number: 43908112 Zoning:
Applicant: KAISER, MIKE
Address: 928 CHEYENNE ST _ ISSUED BY:
, Phone: (714)979-5314
COSTA MESA,CA Zip: 92626
Owner: WILLIAMS,BRIAN K
Address PO BOX 15214 • - - -
„ Phone: ,
NEWPORT BEACH;CA - Zip: 92659-5214
Contractor: KAISER ROOFING
Address: 928 CHEYENNE ST
Phone: .(714)979-5314
COSTA MESA,CA
Zip: 92626. .License: 682897
Arch : Eng: •
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF WOOD SHAKES.INSTALL SHEATHING, FELT AND-COVER WITH 30 YEAR COMP SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,900.00
Permit: $139.25 - • - Claim Valuation: $6,900.00
SMIP Res: $0.69
SMIP Corn: $0.00
Other: $0.00
•
Inspection: $0.00
Total: $139.94 • - '
PLANNING &ZONING
SETBACKS •
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY . Front 0-0 Rear 0-0 . Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES: - -
•
•
\'::
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§ 1,12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754.5626
2446-46(6/00)
DECLARATIONS I m
r
WORKERS'COMPENSATION DECLARATION:• •
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance canter and policy number are:
Carder: S1 1G • F4. Polity Number: Coo/ 6.2 S 2°G 3
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as tp become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Sectiod 3700 f th�r Code,I shall forthwith
- comply with these provi ' /k 3
Applicant Signature: ' a����77yy Date: (/l t
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.003),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Pr fesslon Code,and my license Is in full
forcet and effect,g atu e 0 �7] = Date: a . �3 IJ�
Contractor's Signature: f" Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city Or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit
subjects the applicant to a cWil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,Le.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 6,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
• (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 D❑oeYs or will thea applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 11 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a,,ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). •
7 If a permit from the South Coast Air(Duality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have allot the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: -Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
gya Signature Of Legal Owner(s) I 'f��Date
/ And/Or Authorized Applicant U/ Date
CODE I INSPECTIONTYPE RAIL 1110719ii CODES INSPECTION TYPE ?MATE IIiTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / 208 Final Plumbing
-W"--""
-.
200 Final Re-Roof q-Iry T/�"-3 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
_ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations-
CITV`OF COSTA MESA: IPERMIT NO. ` TRACT NO. ' LOT NO. BLDCrT�. '
C •
CONSTRUCTION PERMIT' pF• 2,-,27� - •
• . ' - `
5241 Ted .otU Yi , •
Applicant's Mailing AddressTYPE OF CONSTRUCTION` L I NEW .DD- LJ ALTERATION U REPAIR ' - _
Project Address 139 _Lisa Ln : - ❑ CONVERSION -.-11-1 DEMOLI H ❑ OTHER '8915 5/ 1-9/
i 15.50 tTl
-
Owner•sName ' Edward Sa.n'dgi a 648- 7103 DESCRIPTION OF WORK 1 Solar Domestic Htr -
•
ZONING REGULATIONS
.
' Address- '' Same •
•
. TYPE OF PERMITI^'fI�❑ GRADING • FOUNDATION ❑ STRUCTURAL _ A.P,gib ZONE
Arch/Eng. License No. ID TENANT y ELECTRICAL LUMBING ❑ MECHANICAL - PLNG. REF- /k BUILDING
// SFraAr tr r,. CT
I Address Cp• ❑•OTHER . ' ' . - TO-BUILDING -
'Cal Style B U 1 1,d a YRone 639-'766 2PROJECT DESCRIPTION SO. FT.' OCCUPANCY • PROPERTY LINE , REAR YARD (TO P/L) ,
Addre bt( as Name' - LEFT SIDE YARD RIGHT SIDE YARD-
1 1744 W . Katel la Unit # 1 CONSTRUCTION TYPE VALUATION -
nddress(maihng) Drange • 372846 \
�t� 1ZONE - GRADING CU,YDS:: ACRES 15 KG.SPACE.REO. PROVIDED
�Y License N., •__ - - - -
• LICENSED CONTRACTOR DECLARATION Remarks: - I t r - STREET WIDTH PARK FEE$ .
I•hereby•af firm that I am licensed tin.�����---aaJ.,,p,•visions of Charter 9 (commencing — ,
with section 7000) of Division 3 of :us) ess and ,ofessions Code,and SPECIAL CONDITIONS: , r '
my license is in fulkbltr skind effect.
License Cfa s ��i e; �� 7 846 PLUMBING •
•
Date 5/ 8�"8� Signature ��r _ ' Bar• Sink' Sewer Cap : •
. • ; - ELECTRICAL '
WORKERS'COMPENSATION DECLARATION , ,
'hereby affirm that-I have a certificate of consent to.self In . or a certificate .' - -Backflow Preventer - -- -•-Sewer Connection - - Automatic Washer _ _ .Meter Dover 100 amps '
Workers' Compensation Insurance, or a certified l c.•y ereof (Section - • - Construction Pole Sub Panel ,
J0, Lab.��C1,) Backflow Irrigation Solar Collectors • - ' ' t
Polity IVo.�12068782' ' C, •n ' I t F,U nd • "' - /''per,' Cooking Unit Sub Pole / 1
• Certified copy Is hereby furnished. I , I . . Bathtubs 1 , Soler Piping . gem
'4./ I ' 1G I
ertifie cy y s with the cit :ul I Isl... 1 Dishwasher , Motors 0-1 HP 0115-8 1 )
Date / tr�I✓ Applicant VW .LM-/1�• '• _ ,..jfiers • / Solar Tank , 1 )
EXEMPTION F ROMWORKERS'COMPENSATIO DECLA• ION i , - - Dryers ❑Gas"�'❑Electric",' Inc.Sol5r t09-15'RP"016-15+";
(Thissection need not be completed if the permIt is fpr{one h ($100)or ' : Dishwasher . ` . Swimming Pool w/Spa 1 , • •
1
, less)•. 1 1 ; I 'Microwave • ; I l
DrinkingFountains Urinal 1 ' Fan,
1 certify that in they per mance of the work for which this perm is issuetl I i •
' shall not employ any person In any manner so as to become subject to the - 'F.A.U. , Pole Light I I • i
• Date rs' Compensation,Laws of California. . 1 ' , Floor Drains 1 I ' Water Closet i I 1 1 L i
I Date' Signature I : I - I Fixtures I I y; Banda
r-NOTICE!if,after making this declaration, you•shouldyome subjeorthwihe -' Floor Sinks -_. .---4----t-.- ,Water.Heater- ; -•.{. t__..� i_- v. 9-.,.�,.• _-, • -
Workers', Compensation. provisions of the Labor, Code, dee ist forthwith, i _ v Device Boxes
comply with, such provisions or this_permIt ,shell be 'deemed revoked - i Gas Service 'OuHets Water Service - I Sign', 1 j 1 ,
'i Ch NST0.Uirm that(LENDING AGENCY ctio 1 i • Outlets ' ' I I ! '
1 I Stan ling Sections I i
1 hereby affirm there Ira construction lending ag(Sectf r theiperformance , •' ! Interceptors i C
1 of the work for which-,this.•permIt is 'issued (Section .3097- Civ, C , , - - - • —' i
1 - • j _ „ Switches ; I ,Trash Compactor • I •
! Lender's' Name ' ' i - _ - _ t Kitchen Sink • �' -
•
Lender's' Address, - ' ' i ,
1 , Lavatories', ' •' • t Garbage fJ isposal • t
OWNS R'BUILDER DECLARATION: I • • _ • _ tt'
I following
that I am:exempt from ss and ntractor'i License Law for the I - I Generator 00 5 KW 05-15 KW i '
following reason ( ices ane7031-,5 Business and Professional Code: Any city or , . P-Trap' - • . r ' . ' . . '
county which requires permit to construct,alter improve,demolish o - , - Transformer 015-50 KW , I 1 •
•:any structure;prior to Itt that
he/sh iso requires the applicant'for such permit • . Roof•DrainS , . . I I ' I 1 i 1 -
, to file a signed statement that he/she is licensed pursuant to the:provisions of ' ' - -, -. , , ; I 05U+KW ' - Reinspection Fee 1 $j5
• the Contractor's License Law(Chapter 9 o ommenC or,withlhection:7000)Of r - I $15 I _
•.[/ivislom3 of the*Business and Professions' Code) or,[hall he/she is'exempt Showers • - Remspection.Fea
',refrom-and the basis for the alleged exemption:Any violation of,Section • _ _ Meter Oup to 100 amps - Issue Fee! $ 3 '
','",,,,,,11:5 by-any applicant for--a•permit subjects$500)he applicant to a•civil „ ! - " -_
malty of not more than five'hbnOreo dollars($500), • I• Service Sink , Issue Fee .; j $ 3 Zoning Approved By - Date •
.0 I,las owner of the'property or my employees With wages,as theft' sole ' - . . t ' y ;
compensation will/do the work,and the structure'is not intended or offered - _ , 'v , , MECHANICAL - ! .S-/p, -$3
for sale'(section 7044, Business'and'Professional Code: The.Contractor's j r- - ' Application Approved By - ;Data _
- License Law does not apply to an owner of a property who builds or Improves • Boiler t _ Refrigeration System i i -O '�
thereon,land•who'doesl such work himself/herself Or through his or her own ,' • I 1 i Applisatipn Issued By �� R Date -�� O'
. employees, provided that such Improvements areinot Intended or offered-for Duct-Under'Ground •
- ❑0.ioo.000 BTU ❑ioo,o00BTU' _ - •- 1
• sale. 1/, however,the building or improvement Is sold wlthih one year-of com- - ' SUMMARY OF FEES , I '
' pletion, the owner'will have the burden of proving he/she did not build or Im- ' . • i ' '
rove for the purpose of sale). ' I - . r - • Duct-Structural t ' System Repair/Alteration BUILDING PERMIT $, , SMIP , j $
U I, as owner of the property,am exclusively contractingewith licensed con- I
_tractors to construct the project(Section 7044,Business and Professions.Cotle: _.h. Duct__Ventilating - _ _ _ _ - 1 •_ PLAN CHECK' $ - •T ' PERMIT I I
' The Contractor's License Law does not apply to an owner of property who • , I ' ' :,1 ,OD • ISSUANCE $
builds or Improves thereon,and who contracts for such projects with a con- • ' Exhaust System 0 Multiple❑; PLUMBING $ ,
tractor(s) license pursuant to the Contractor's License Law). i - • PLAN CHECK $ � GRADING • I $ ''
0 1 am exempt under Section B,& P.C.for this reason ' • Firepl/Feet-Alt. ICAO# • j i 1 i I
' Date owner• - - - ' Heating,System& Ducting • ELECTRICAL $ 1
- - I ! ' MICROFILM $
-I-hermationr0 ha •Irh ve read this-appiication and state that the-above-" : 00-100,000-BTU•0100,00o BTL- - -- ,.PLAN CHECK $
information I co roc i red to co ply with all cityand count ordinances I ' I - I - ' t $ 1 TOTALFEE:' $ I •
and state la r ati t buil•-:• c•nstructlon,vand e,nanraby auth•rize repro- r , •.MECHANICAL i
Hood or Type I 01 ; Reinspection Fee' $15 PLAN CHECK - LESS
sentatives of Is c • r the above•mentlone Op t or . ,
1f ADVANCED PC I $ /-t
' inspection o - '� 51 / r Canopy TVpe II 0' I , •
� $ r �(/
Signature - •
� U ' Registers • I Issue Fee j '$ 3 I I /C
'
! Drivers' License or:SS# •����� - -� - / • ! FINAL FEES 1 $ ,
CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor - - '" "' - '_-" - "' "- "' - ""-
, .
_
-" POOL I
CONSTRUCTIONAND PLANNING DateI _Date • inspector
1.
Inspector ti APPROVALS Permit# �"7a-�� APPROVALS Permit#
1_ Temporary Electrical Service or Pole 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
.
. 3: Electrical Conduit Utility-Undrgrnd. 54. Forms - ,
4. 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test .
6: •Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE- _
7. Footings 58. Electrical Conduit-Undfarnd.. . .
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, D 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_TRough 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
09. Rough Heating & Air,Conditioning FIRE DEPT. REQUIREMENT - •
-
•20. Rough Factory Fireplace . APPROVALS Permit# ' r,
•21. Ducts,in Structure 70. Underground Hydro
-22. Ducts, Ventilating- 71. Product Piping 0 Gas 0 Oil
- 23.,Gas Pipe-Rough &Test72. Underground Flush •
-24. Roof Framing - 73. Undergrnd.Storage Tank O Gas D Oil '
•
25. Roof Sheathing 74. Overhead Hydro . I
• • 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 Notes: .
31. Plaster Brown Coat b-/-e3 /o-�f - „� ,
32. Electrical Power Meter-Final •
i� I y, -, I
Cd_�eD/h- ' u,+s' �O�l1v2�� .,/mii
33. Final Electric _ -
34. Final Heating & Air Conditioning --2¢ --' ,�,i �r�sv Go/So-Vs,
/1JYc7��
35. Final Gas Pipe-Test r lT,AG'�4_-
r.ex - ''
36. Hood or Canopy
37. Final Factory Fireplace -
38. Final Plumbing
39. Water Service-Final -
40. Gas Service-Final
41. Solar Domestic-Final Gt9,-,�l r -
42. Backf low Preventer F/ ,
43. Backflow Irrigation •
44. Landscape Irrigation System _ .
45. Sound Attenuation -
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed .
49. Electric Release to Edison • -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,
•
No Date •
,h b LF CL'STn
Mtchanical Division
Building Deportment
Name: g d �i9UNO//eR S
! Approved ._a2— Dot/.: Z( t Date: Rep.flleC+C �j//1/e02
FEASIBILITY STUDY
(Home) _ (Job)
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Address : /)Gellr Address : MC ij,rfid/✓
City: /1/.j/r-r, 2 • City : (3_roit aril '
Phone: j{-• 2/3'/v/r7/0;ip: Phone: Zip:
Map Key. Z/7-Q9%0ge Map Key:
(Tao T yf3o)
W. S. No.
Units : Bdrms: '7 Gal : /Fe _ Coll : ( }) (F)
HWH No. : / Size: 00 No . Jkt(s) : / Stories: Crane---
Roof
ranesRoof Ty : SA/4n" Cond: 9'0, Slope : /8° Att .Acc. :
St . Tank Sz. : a - FL. ch-L Placement : //y 11-",•79•5"-
Elect . Dist . : 7,p ' Pipe Run : /jp ' Shed Sz. : ///A .
Existing Pipe Sz. : I " Slab. Sz. : r///,-
Collectors: 2- y//0 l/ Racks : aA,a fZoJ �
4 Wood: ) ,
Pump Size: //jog/QS-Al° Control : C-3d Passive :
Special : W pgp /,&Ciri//✓f' ge�reccn
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PROJECT ALORE55: •a 139 LISA LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F' 051b.�F '
OWNER'S NAME: UERRY, ALBERT R JR TR
ADDRESS: 2417 SANTA ANA AVE PERMIT NO: P 051628 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92627
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
ARCH/ENGINEER: 714 642-3856 REG.NO.:
JOB DESCRIPTION : COPPER REPIPE SQFT;
ADDRESS: UNIT: M •
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
PERMTfTEE: FRED KELL ( 714 ) 638-5420
ADDRESS: 12691 ADRIAN CIRCLE COMMENTS: COPPER WATER REPIPE
GARDEN GROVE CA 92640 *x**** **** Ex : E.xa*x******st.> .x..y:*;Ea4x-rc4F ->F*>E *Nr.•>E*>Exatx*>x*** **x>EtE*xa **x-xws*.*%****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUIP EMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect SETBACKS e
CITY LIC.: 018046 STATELIC.:333963 CLASS: C36
� --
Date: `". ° • 9/ Signature:_ WMAIN BUILDING — ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: thereby affirm that l have a certificate of consent to Self insure or a certificate of Workers' FRNT: F T IN R EAR: FT I N FRNT: FT IN R EAR: FT IN
Compensation Insurance.or a certified copy thereof(Section MOO.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE: o
, .COMPANY:• PARKING REQ: PROV: PARCEL: 43908112 ZNE: REF NO:
7 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NO T ES>
>
Date: Applicant: 3E r. 1f16+i-;'r****iii*ie****1c**********lf******#*** ***** . ***}s3F*k3F***tP)i**3rd}'. .i;.3;}*x.aacx***
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S E R V I C E S•.', R 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 i hall not employ any person in any manner so as to become
Date ,to±the Workers'Compensation Laws of Caature. ZONING APPROVED BY e
Date:cf- f • - r1 Signature: I 4 o DATE:
, NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY - 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 A,
* *44)4 *r'**** DATE: �` --4 v ---f/
which this permit is issued(Section 3097.Civ.CI. **44.44 * *4446* xx
*** pr x�c . i±4tcoir*
LENDER: **3 ************44**t A,A•**a:.*.>i:*****N'**4444+ .` .*is*#iF*x**.Y-li.*****i4***1e*r*3*iA#P47i#?Fx4!..0*4444
ADDRESS: LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the tofowing 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 4 00
repair any structure.prior to its issuance.also requires the applicant for such permit to Zile a signed statement that he/she is licensed •
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business :25t 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 PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE E 3,00
I. as owner of the property or my employees with wages as their sole compensation, wit 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 TOTAL S————> 4 . 00 3 , 00 0. 00 7. 00 7 . 00 • 00
does not apply to an owner of a property who bolds or improves thereon.and who does such work himseltmerself or through
his or her own employees.provided that such improvements are not intended or offered ler sale.II,however the building or
improvement is sold within one year of completion.the owner win have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 7. 00 OVER/SHORT• . 00
forthe purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 7, 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner 01 property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to.the Contractors'State License Law).I am aware *.****.****.x'}**********.)E***};*******{(>*363t*1t*****-f6*******f:'**)M•..**.*o6**-**34*-1^*y.iF*******y.
that proof of their Worker's Compensation insurance should be provided to me.
❑ am exempt under Section: B.&P.C. I N D I V I D U A L F E E B R E A K D O W N
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST'
Date: Owner PLU 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
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 END OF FEES
permit for construction or modification from the Air Duality 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 I
ordinances and slate laws relating to building construction and hereby ae representatives of this city to enter upon the above mentioned
prop �on inspection purposes. ,�/
Dale(on-/B ' I-I Signature: f/
_ 1 C n;T^C3E.•`;7,3-0D:r C7iI76 C f
J4/1[1?1 T_f1E: Gr;.,;
Driver's Uteri Social Security a:
1641.46 While—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor •
• 'a8 I
CONSTRUCTION AND PLANNING POG . SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date "Ir pector
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. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation t • 59. Gas Pipe, O 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 63. Heater & Vent-Final •
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 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 i' 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
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing yf14'q( Cib
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 •
e-
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
L./MICR / VAIL
JOB ADDRESS 119 Lisa Lane BUILDING PERMIT NO. 37617
GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Triplex w/att.Gar.
AP No.119-Ok0-22 LOT 2, TRACT FIRE ZONE VALUE 5581 A7CcuO-
IN CACTIONS Signature Date TYPE V GROUP H & II ZONE it
{x ,
Sc-.2 5/-72.---7.ry • PERMITS ISSUED
GAS SUBCONTRACTOR
Date Number I Signature
WATERAiq/C /; //I�DL/ q Plumbing •
ROUGH PLu BINNG` ( 7°,h714 t T----Re-7Y- 09 /-,B 5/-� „,, /2-.17-73 (<<f781 ..----
PROP. SWR. LINE ❑ HOUSE CON. cd f'/-Ia 3}-r/7'r/ :121-;�/ „A-tee 3-p2/-75 s,2 6
SPRINKLING SYSTEM A �t6 /,j fe/t6 �
MISCELLANEOUS !O /J/f`
ROUGH HEATING AND AIR CONDITIONING 14 5: -/ -7di
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0 "A�7
ROUGH WIRING A3r C-V41 Heating and Vent.
TRENCHES ❑ FORMS El STEEL REINF. - -L-'j IF' & c rj7 � di, -4-7S /o790
FLOOR SYSTEM ��`/-/'i-7sL
BOND BEAM ❑ STEEL REINFORCE n
SHEATHING ' / e-r7-Ant 7f'
FRAME AND FLASHING, - E. �j- 7 '
LATHING - IN [AV-OUT j ' %/�(,� �_ 9,
PLASTER, BROWN COAT /44`-� /2!!!*
STRUCTURAL, FINAL ,N4` /' FllptlriC
HEATING; VENT., REFRIG. AND A.C., FINAL /.J 6 -1-/�q an.-Teed/ / e:, .2-p o
r,of 36 97 0-----
PLUMBING FINAL BUILDING,IC FINALIL AND GAS TEST y�j/r(�,(( q'a c� {,/ 2
PA
oV ?8-7 CP
-774****66.59
37617 4671-Z
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PP I l/�ATION FOR BUILDING
For Applicant to Fill in Completely r({ PERMIT
a
q I r� RE TJ,BV OpIVED D TE ISS ED
BUADILDING DRESS 1 Jq LISA. �/3lNl+ //-`1Y-23
' 4- er-
! �S / �' IT NO.
OWNER (C QNP CJ(PCt�0( /� N C A.P. NO. J��'�Q[�.� '��LZ 6 1 7
MAILBUILDING 1
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ADDRESS i LISA LANG-
ADDRESS /v {�. OC 4 et(Sr-1.-- --Cr t�272 �j
IL O CITY re 4 Jitedrf NOL6y,�rms.- VTRACT . 2-LOT ft BLOCK
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a CONSTRUCTION / N W AD TER REPAIR MOVING DEMOI LSH
O N LENDER Oe.-N N
_ID BRANCH {,/} �--.I' I e '
J CO OWNER 1\It H A l--)�`•W CL L. [ N C
a W ADDRESS /'si
_ A VALUE yQ/j/7y Y
CO-CO ARCHITECT TEL. USIEM� Pellainzs F 1 $t7 O 7'7(/
Ja OR ENGINEER (76e.G/fV' NO I rr
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W 2 ADDRESS ZONEPE GROUP H .J
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APPROVED 7V�/�J
mO CONTRACTOR (t/y fjx BY DAT ((vy'' /
Z
J lL ADDRESS
W w TEL 7.2-2__ZONE NO.OF�j USE OF NEW pia
CI= CITY NO. PLAN$ G_- BUILDINGt fc CN`GMTti
Z 1-
W- O STATE CITY YARDS APPROVED YARDS APPROVED
jCC R ,,,Z6---/‘LIC. NO. I ,,,Z6---/‘ / LIC.NO. MAIN BUILDING T ACCESSORY BUILDING
SIZE NO.OF BLDGS. (FROM CIL STREET/
OF LOT I NOW ON LOT U' FRONT 4'f-01T. FT.
USE OF
EXISTING BLDG. R.SIDE S FT _ FT.
I- SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE S FT. FT.
VEXTERIOR WALL ROOF
_ COVERING I COVERING REAR L-� FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
fl
a MAIN BLDGS. ACCESS. BLeti.
a _ VAR.*
O2‘ �-Y W/Te Thar—a-
,. CUP G3-r1 (
l APPROVES
H
APPROVE 3�II TT _ IDI- _ C
V) _BY W�-V J DATE) `.. ' I`O
z HOLD FOR SPECIAL REQ
O
VI hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ []- tl_ a7-i
1- any person in violation of the workman's compensation laws of t�1,E[(y�(,JJ
C/) the State of California. m
=� az I hereby certify that I am properly licensed as a contractor under �/ 3 SD. FT. D o,-
the
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m
am exempt from the provisions of the State of California Business R
and Professions Cone, Division 3,Chapter 9. VALUATION ro
PERMIT FEE $ ry
3
Signature of //'� 959-
/r m
Permittee //Yl./-J l.�G/ $ 55 9/j PLAN CHECK $ g� E
/ o ^
Authorized ent u
TOTAL FEE '
3 '76/7 "WC 18-73- A 70O 6611 gin 165.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
P C ION FOR BUILDING PERMIT
For Applicant to Fill in Completely RE IV DATE RECEIVED
G (� / � DAT ISSUED
ADDRESSBUI1../.3 ( (.Ca. X61,L4 r -/ / /-il./ 73
OWNER A.P. NO. P v�ll �J/ /
BUILDING /" l / / /((oo
MAILDADDRESS �n l+(�( AO ii e
Z ADDRESS
WW TEL.
d U CITY NO. TRACT LOT BLOCK
ZNEW ADD ALTER REPAIR MOVING DEMO'ISH
CONSTRUCTION
O N LENDER X
am
_17 BRANCH d SC, y---
J N OWNER ([ 1OY LWe//rt. �'
m J ADDRESS / �. �] VALUE �_
m ARCHITECT TEL. - USE 2 lCx /r[(�-¢J-S
J Q OR ENGINEER NO.
UV) FIRE ,J.�
W2 ADDRESS ZONE YPE GRO/U/P r ` pr
0- w APPROVE /LT'
/ /,( J2
J O CONTRACTOR BY
DAT/ft
co Z
J CC ADDRESS
W W TEL. ZONE NO.OF USE OF NEW
0= CITY NO.
_ PLANS BUILDING
ZF
W U STATE CITY YARDS APPROVED YARDS APPROVED
GO K LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
D O (FROM C/L STREET)
SIZE I NO.OF BLDGS.
OF LOT NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. R SIDE FT. FT.
r
I— SIZE OF NO. OF
Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT.
ta.1 EXTERIOR WALL ROOF
_ COVERING COVERING REAR FT. FT. ,
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a
a MAIN BLDGS. ACCESS. BLDGS.
Q VAR.# DATE
0
C.U.P.# _APPROVED
I— APPROVED
0 /^
_BV DATE �o ,r
I— J
0
I hereby acknowledge that I have read this application and state
r that the above information is correct and agree to comply with_
CC all laws regulating building construction, and I shall not employ'
F any person in violation of the workman's compensation laws of:,
CO the State of California. m
,D
Z I hereby certify that I am properly licensed as a contractor under) SO. FT. o
the State of California Business and Professions Code, Division 3,c, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I --THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ez
Q
am exempt from the provisions of the State of California Business
and Professions Croft, Division 3, Chapter 9. _ VALUATION 71. i N
PERMIT FEE $
Signature ofm
Permittee $ PLAN CHECK $ E
`o
Authorized Agent [✓� U.
TOTAL FEE $ C