HomeMy WebLinkAbout2760 LONGWOOD CT - Building Permits 11'x' CITY OF COSTA MESA
BUILDING DIVISION
o, ►
• o ...." . DEVELOPMENT SERVICES DEPARTMENT PERMI MBER
1101411 PERMIT 5-01371
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.iBUJLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2760 LONGWOOD CT Status: ISSUED
Suite: Applied: 08/16/2005
Vicinity: MASTER BATHROOM Issued: 08/16/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number 13952614 Zoning:
Applicant: MAHAN, KARL
Address: 14342 TROPICANA /
Phone: 714-402-8453 ISSUED BY:
HUNTINGTON BEACH,CA Zip: 92647
Owner PERRY, ART
Address 2760 LONGWOOD CT -
3
Phone: e
COSTA MESA,CA <� �,. .'•••,••-• Zip: 92626-4763
Contractor BEACH FRONT TILE °,
Address: 14342 TROPICANA
Phone: 714-402-8453 t1
HUNTINGTON BEACH,CA
x a �
Zips 92647 . License: 832811 t,
Arch '-• Eng:
Address. -• - • Address:
Phone: ! Phone
Zip License: ` �" �z License a
SCOPE OF PERMIT'
INSTALLATION OFA NEW TILE SHOWER TO REPLACE AN EXISTING IN THE MASTER BATH AT Al SFD <*'-
NO OTHER WORK AUTHORIZED WITH THIS PERMIT
'i✓tl� 3
FEE SUMMARY '`°
Plan Check: $0.00" • -
Calc Valuation -$6,000.00
Permit: ;';`$125.25 Claim Valuation: xaa $6,000.00
:SMIRRes: ''$060 a, ,a,•, ,
SMTP Com $0 00
Other. .
Inspection: .$9.00
Total $125:85
• F
"(PLANNING,&=ZONING
SETBACKS'', •, •
MAIN STRUCTURE Front 70„0 Rear '0 02. _ Left "0-6' DRi ht 0-0,
ACCESSORY g 1k'Front 07,0 '.„Rear 0 0 Left 0 0 Right 0 0 • s r
PARKING Existing: 0 Required 0 Proposed . "0`
c kg
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12.21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS' \ ) ( y
WORKERS'COMPENSATION DECLARATION: J
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carder. Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
certify that in the performance of the work for hich this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of alifomla,and agree t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these r Scan /� /�
A`pliccent.Slgnature:_ /til! _ Dater �6 111 —O
WARNING:FAILURE TO SECU W ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000),IN ADDmON TO THE CL/51 OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 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 Professions Code,and my license is in full
force and effect.Lin 1.32 g// / Cass c— S•
Conirectors'SIg� C.7 #7"J4 1 Date: 5r-/C-05—
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is Incensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document.i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
Oyes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all stale laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow
occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owners) //� 0�bate
(Or A
AOduthorizetl Applicant_ rJJ r,Date�-
L
;ODE it INSPECTION TYPE DSIE INTRIALS CODE INSPECTION TYPE PATE INTRIALS
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 Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
iY CITY OF COSTA MESA
4 BUILDING DIVISION
F ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
J. PERMIT
a.oso 05-00630
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.PLLOMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2760 LONGWOOD CT Status: ISSUED
Suite No Applied: 08/16/2005
Issued: 08/16/2005
•
Vicinity: MASTER BATH
Parcel Nunmber: 13952614 -
Applicant: MAHAN, KARL
Address: 14342 TROPICANA ISSUED BY: _:704 "1".
Phone: 714402-8453
HUNTINGTON BEACH,CA :;Zip 92647 ,"£:2
r` a.
Owner: PERRY ART
Address 2760 LONGWOOD CT u'^ s'at�
�. ., •Phone
COSTA MESA, ,• "Zip: 92626-4763 , - '
•Contractor. BEACH FRONT TILE
Address. 7-.14342 TROPICANA
•
Phone "2;7.14-402-8453
HUNTINGTON BEACH,CA Zip r`92647
License 832811
72"2: ."' SCOPE OF PERMIT' ":5
INSTALLATION.OF A NEW TILE SHOWER TO REPLACE AN EXISTING IN A SFE)
REF 1305 01371:
k
;,1.SHOWER - r,... u ;�, .. ,., �. }
No OTHER WORK AUTHORIZED WITH THIS PERMIT:
'FEE SUMMARY
AMT QTY ' AMT QTY a :'. A AMT QTY
ISSUE FEE`�,;- 1;. $23 60 :.Laundry Tub/Washer ' - $0 00- 0 Sump Pump" � $0.00 0
Backflow irrigation y$0 00 r^, 0 Landscape Irrigation $0.001 :.`0t ri, ' Swimming Pool $0 00 0
Backflow Preventer '1'40.00 ' ':0 "P-Trap �° - $0.00 ` 0 '" 't: Trap Primer %"� ,..$0.00: 0
Bathtub ' "i'$0.00 6 . Pressure Regulator $0.00 - 0 i:ux Urinal i -- "-, $0.00 0
Clarifier System $0 00 0 ' Process Piping(per 10 ft) ,$0.00 0 - Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) x$0 00 <,-0 -;" Receptors ".$0 00 -, ,0 Vacuum Brkr Bkflow(5+),- $0:00 0
Dental Units'; $0.00 -0 - Septic Tank $0.00 0 Wash'Basin > f ..:$0.00 0
Dishwasher $0.00. 0 • Sewer Cap for Demo $0.00 0 Wash Basin Set a o $0.00 0
Drain,Floor. ,: $0.06? -.0 s Sewer Connect "'` $0.00 0 Waste and Vent System r, $0.00 0
Drain,Rainwater �.$0 00 - 0`� Sewer Private Line ' . $0 00 , 0 Water Closet(Toilet) ,7'•,"$0.00 0
Drain,Roof 1.4,.$000 0.< .Shower ; $980,''.I ;y Water Heater/vent '-Q. $0.00 0
Drinking Fountain $0.00, d.0 k'Sink bar -: 2�` $0 00?2" 0 ",: Water Piping(Inst or Rep.) $0.00 0
Expansion Tank • $0000 t t,Sink commercial t $000 0 . Water Re-pipe $0.00 0
Gas Earthquake Valve $000 ,":?0 .';Sink,Floor>+•,. i$000 =-'0 • r Water Service $0.00 0
Gas(1-4 outlets) 'i'r$0.00 70 .,:;Sank kitchen;'�'""`* $0.00'. '0 • Water;Softener . $0.00 0
Gas(Over 4 outlets) $000" •2'10 Sink•service/mop "! $0,00 ;..0," • OTHER` $0.00
Gas Repipe $0.00 '.0 .- Spa(private);- ,_-;;$0:00` 0 ':'VIOLATION"- -` $0.00
Gas Service $0.00- 0 Spa(public) $0.00, " 0 - .PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.001,/ s. REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0 a� i .'�,":�'
r *ars" TOTAL'CALCULATED FEES: $33.30
COMMENTS/:SPECIAL CONDITIONS
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS O t
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed II the permit is valued at one hundred dollars($100)or less.)
�(�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,and agree at If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisl 5.
AppltcarrSlgnaWre`--T-<pr
Detej -Vat or
WARNING"FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 oLthe.Business and Professions Code,and my license Is in full
force and effect.Uc.# • 3 // // ,ctaass.I —
C
COOtracto?sSf�dre: _ �Ie-'a ',2r - e23
CCONSTRUCTION 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,CM Code).
Lenders Name: • Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIALSAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation;certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apper mit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes L]No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
8 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
n&Or.Authorized.Applicannt // �j P r r-Date ,
;ODE ft, ly$PECT10NTYPE DAIF INTmAL$ OODE# INSPECTION TYPE ;AIF INRRAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical 11 1 1, _
1266 Pool Spa Final 208 Final Plumbing 6�1&C
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204• Final Demolition 250 Final Building/Occupancy
-- . . . . . . . Applicant to fill in all spaces except those Within,heavy border lines and sign all appropriate declarations. .
CITY OF COSTA MESA PERMI I NO. • TRACT NO. LOT NU. BLDG.NO. .2I DS P I /13 f B4
CONSTRUCTION PERMIT �� jQ'ZQ� •�' % 6.D0 < TL
i'Project Address 2/60 .Longwood ,Ct. - - . - - ' ' '
1 ' - TYPE OF CONSTRUCTION H NEW U ADDU ALTERATION LI REPAI R
Applicant's Mailing Address ❑,CONVERSION ❑ DEMOLISH ❑ OTHER - A.P. # • • I Zone '
1� Owner's Name Diane Shaw Phone 241-7180 ., DESCRIPTION OF WORK
`N Address 2760 Longwood Ct. Costa !Mesa 92626 - 'S Main Building: ' . Accessory Building: O
• .. I - - TYPE OF PERMIT U GRADING ❑ FOUNDATION U STRUCTURAL I _ E Front . N
1 Arch/Eng. • License No. IT! TENANT CI ELECTRICAL El PLUMBING III MECHANICAL . B Rear
Address - El OTHER A • N
y G
Contractor's Name Culligan Water Cond. 'phone 750-2233 PROJECT DESCRIPTION SQ. FT. _ OCCUPANCY C. Right -
Address
(mailing) 1911 'S. Manchester Anaheim 92802 CON ST RUCTION TYPE VALUATION $ g Left E
ZONE - GRADING CU.YDS. ACRES - Q
City License No. __ _ _ Ping:Ref.# Park $ U
LICENSED CONTRACTOR DECLARATION Remarks: ' Parking Req./Provided
I hereby affirm-that I am licensed under provisions of Charter 9 (commencing ' " . R
with section 7000) of Division 3 of the Business and Professions Code,and . 'Use of Building: '
my license is in fu(l torte and effect. 168763 - M
License Class 1.7J ,` Licens: No. / PLUMBING FEES Planning Notes: i -
Date -� Signature .j' •� E
/ 1R KE RS'COMPENSATION DECLAR• ION' '-` • Bar Sink ' Showers - T
:reby affirm-that I-have a certificate of consent to self-insure or a certificate -
Workers' Compensation Insurance,or a certified copy thereof (Section _Backflow Preventer Service Sink : -�- - - ' '
3800, Lab. C. Backflow Irrigation Sewer Cap • L- • -ELECTRICAL FEES i
�B518 Gallagher-Basset _
Policy No. - Company - -
Certifietl copy Is hereby fuThies hed. Bathtubs Sewer Connection Automatic Washer. •. Transformer 0 15-50 KW
1.),
8Certify dcopyIs sledwithcity Building Division. ,Date //9-.5- '/ Applicant `�'f�Afau', ..-v'1c-G-./ Clarifiers Solar Collectors Construction Pole Sub. ❑ 50+ KW;
EXEMPTION FROM WORKERS'COMPENS ION DECLARATION Dishwasher '1(This section need not be completed if the permit is for one hundred ($100) or Solar Piping , -- Cooking Unit Meter ❑up to 100 amps. ' '
less)- r - :I certify:that in the performance of the work foras lch this permit is Issued, I Drinking Fountains Solar Tank Di• shwasher Meter ❑over 100 ampsshall not employ any person in any manner so as to become subject to the , - ` - ' -Workers'Compensations Laws-of California- - , Floor Drains Swimming Pool w/Spa Dryers ❑Gas •❑ElectricSub Panel'Date Signature I' NOTICE:C oafter making this declaration,you should become subject to the Floor Sinks.' ' '_ "Urinal - 'Pari -- - '" - •Motors 00-1-HP ❑1'/z 8- •Workers' Compensation provisions of the Labor Code, you must forthwith - - _- - .
comply with such provisions-or this permit shall be deemed revoked. Gas Service • Outlets Water Closet ^» F.A.U. • Inc:Solar ❑g-15 HP 016-15+ .I
CONSTRUCTION'LENDING AGENCY i -
I hereby affirm that there Is a constructiomlending agency for the performance Interceptors - Water-Heater; Fixtures - :Microwave - '
of the ,work for which- this permit is;issued (Section 3097 Civ. C':)_ - - -
-
Lender's Name- - Kitchen Sink Water Service " - Device Boxes Pole Light :,
T.
Lender's Address - - -. ' ' '
OWNER BUILDER DECLARATION - - ' Lavatories'• - - ''' 'r ' -
" - _ WaterSoftener . 3' OOi Outlets :Range
I hereby affirm that I am exempt from the Contractor's License Law for the' --- - . . - ,.. _ - - -
following reason (Section 7031.5 o Business and Professional Code: Any city or : P-Trap, •a Switches , ' .:Sign. '
county which requires a permitto construct,alter,improve,demolish or repair •, -
any structure; prior to Its issuance, also requires the pursuant
to t. such permit Roof Drains - - Garbage Disposal Standing Sections' '
In file a signed statement that he/she is licensed pursuant to the provisions of ) • - - - _
meContractor's License law(Chapter 9(commencing,with Section 7000)of• • • Generator ❑0.5 KW ❑5-15 KW Trash Compactor
lon 3 of the Business and Professions Code) or that he/she-is.exeti pt , 1
p #wefrom and the basis for the alleged exemption. Any violation-of Section - , -
•
enalt by any applicant for'a: permit- subjects the applicant to a civil ' 'Reinspection Fee •` $ 3' )0• - ' •
Welty of not more than five hundred dollars($500).: ' • ••• . I .. _ pe ' - $25. •• Issue Fee - - -
LJ I,'as.owner of the',property or my employees with wages as their sole Reinspection Fee • $25 Issue_Fee :$ 31
• compensation, will do the work, and the,structure is not intended or offered ' - - MECHANICAL . • '1 •FEES' --
for sale:(Section 7044, Business and Professional.Code:,The;Contractor's - _ PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner-of a property who.builds or improves , Boiler ' ' - , Hood or., Type I 0 . '
'thereon,(and who does such'work himself/herself or through his or her own - Cado Typet , Zoning Approved By - - ) Date ,•
employees, provided that such Improvements are not Intended or offered for ' py.; II, ❑ ! '
, sale- If, however,the building or Improvement is sold within'one year of com- Duct'-Under,Ground ' '. a -. ' Building Approved:By ' Date '
pletion, the owner;wlll-have the burden of proving he/she did not build or Imt - . •
rove,for the purpose of sale). Duct-Structural' Refrigeration System i '' ' Application Issued By ' ' Date
- . -LI I,as owner of the property, ain.exciusively contracting,with,llcensed con- ' `r`a
tractors td construct the project (Section 7044,.Business and Professions Code: a Duct-Ventilating ,. .. : . ❑0-100,000 BTU ❑100,000 BTU . , I I
doesSUMMARY OF FEES
The Contractor's License Law not apply to an owner of property who - - ' ' BUILDING PERMIT I$ 3•OO, -SNIP .$ f
builds or improves thereon,and who contracts for such projects with a con- ' Exhaust System ❑ •
Multiple ❑• System Repair/Alteration - . - '
tractor(s) license pursuant to the Contractor's License Law). 1 •^ _ PLAN CHECK` $ PERMIT -:
• ❑'I.am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG* , LJ. 0 j .ISSUANCE . $ - a
- - PLUMBING $ � '
Date ' - owner, • • - - ' - . - , Heating'System&Ducting ' • PLAN CHECK 25% $- - ENERGY P.C. •s -
I hereby certify-that I-have-read this application-and state+that the-above , ❑O-100,000 BTU ❑100,000 BTU--• , - — - - 1 •
- GRADING •{$ ••
information is correct. I agree to comply with all.city and county ordinances • - _ I ELECTRICAL :$ _ i
and state laws relating'to building construction,and hereby authorize repre- ' • .' - PLAN CHECK 50% $ MICROFILM •$
'sentatives of this,city to enter upon the above-mentioned property for , • - -
Inspection pur•os-s. ,' - ;, f m _ MECHANICAL . $ - TOTAL FEE $ 6.00 - '
Signature �/ ., / -Date 't- ' �C `� , - ,
' I Drivers' License ors- # - : Reinspection Fee $25• , .. Issue Fee $ 3 PLAN CHECK 25% $ •
CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor • - ,
r, -
•-CONSTRUCTION:AND PLANNING -. _ ' POP' :BA '_ ' r• " i ; "<<� Ty o
Date .• Inspector - - - - _ b Date .I'nspector.
.;APPROVALS Permit# - , APPROVALS Permit#-" -
1. Temporary Electrical Service:or Pole -52: Pool & Equipment Location .t'• - _ = - ,
-..,2•.; Soil Pipe-Undrgrnd. - _ ' . 53=•Steel Reinforcement: _ .` 7.-? `; I 4 ;
=�
. 3: Electrical Conduit Utility-Undrgrnd. - - - 54: Forms , _ _ -• :,t. _ :,;a
4. Electrical Conduit-Undrgrnd. - _ 55r Electrical'Bonding;.,-'- ',°' '= c� V
5. Steel Reinforcement , 56. Rough Plumbing,& Pressure'Te'st - e • ! i • .
6. Electrical UFER Grnd.
:57:.APPROVAL TO COVER=GUNITE- P. 42 - 2 -
7. Footings - 58:- Electrical-Conduit Undrgrnd._ «_ •
8. Foundation I 59. Gas Pipe,:0 Undrgrn8.,•Test" -
9. Water Pipe-Undrgrnd. _ _ 5 60. Backwash,Lines,P-Trap,_0 Und_rgrnd.•. - _ - : 2,' , 'I
K
10. Structural Floor System - 61. APPROVAL TO-DECK =:°: •".., FIf ..n. - •
11. Property Sewer Line & House Connection _ u 62. Backwash Receptor-Final_ _
12. Sewer Cap 63. Heater & Vent-Final .
13. Roof Drains - 64. Plumbing Systeim_Fi_nal • r - + r i
14. Rough Plumbing • - 65. Electrical-Final -1 - -- ' . _ L
I :
-15. Rough-Electrical-Conduit -- . . 66. Solar System=Final- -` -•' " -' "- -
r-
16. Rough Electric Wiring •
67. Fencing&Access Approvals a`- - ',is _ _ = --"
•17. Rough Wiring Sign . , 68. APPROVED FOR PLASTERING- , i '-, • -
18. Rough Electrical-T Bar Ceiling • : • 69.1 POOL/SPA SYSTEMS FINAL j F 14.: n v , ',
19. Rough Heating & Air Conditioning i i .FIRE DEPT,REQUIREMENT, ;_ i ; r. 1 :•i F
• 20. Rough Factory Fireplace , ' ' ; i APPROVALS; Permit# ': , - '
21. Ducts, in Structure . . 70. Underground Hydro• - I 1 ! ,
22. Ducts, Ventilating 71. Product Piping O Gas':'O Oil , 4 4,44 , i :a
. '23. Gas Pipe-Rough & Test 72. Underground Flush I , I 1 ! ^
• 24. Roof Framing- - - - i • i 73. Undergrnd.Storage Tank OtGas_0Oir i`., 111 1
25. Roof•Sheathing -
74. Overhead Hydror. r C. - . ( I
26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical - " •
-
. 1 •
:27. Frame and Flashing • 76. Dry Standpipe 1 .. - , - t I I
28. Lathing & Siding - 77. FIXED SYSTEM FINAL - =+ !
a : 3, i
29. Insulation 78.. FIRE PREV. FINAL 7 - i
30. Drywall Nailing ! . • : 1 HEALTH DEPT. REQUIREMENT 1 '
31. Plaster Brown Coat • ' 79., FINAL INSPECTION I ! • . -
32. Electrical Power Meter-Final , - 80. FOOD CERTIFICATE ISSUED • ' ! + :
33. Final Electric ... -_ , Notes:( S/274 .0 7 48/70 (eta. _ _-_I _ _•_
34. Final Heating & Air Conditioning I 1
35. FinalPipe-Test - _ - . _
, _
36. Hood or Canopy :' - e - -
37. Final Factory Fireplace ^^• . . - -r - - i _ •,; ; .
7 c - o; I - 9 j 1 F - . ., 'i
38. Final Plumbing J �r��b�d y ,' -
39. Water Service-FinalI • - • 1' -
r
40. Gas Service-Final : ' ' i Il' ' - .a F
. , + •+;
71
41. Solar Domestic-Final - } - ' -i-.•: - _ _ ' {• Y I I�,
42. Backflow Preventer �_ - ___ _i • _ ---, '_ xy , lit
o. i i 'f
43. Backflow Irrigation - = i - - r I
44. Landscape Irrigation System _ ; � . . 'y ; 01 --
44. ,, _ ,,
- -
•
45. Sound Attenuation - , ' '• I -i + _ ; - --i - i; "
46. Handicap Regulations 4 - • !• i j I.I V ' !' - I'
_ i
47. FINAL STRUCTURE & BUILDING' _. ! 1. ri ill
48. Special Requirements Completed; 1 i. - i. I ' ' Gl. u " •' " ro • `-
•
49. Electric Release to Edison ' • '
50. Gas Release to Southern California Gas Co , • 1 •i = ;,�;1 111 I '
51. CERTIFICATE OF OCCUPANCY
' No. bate - - )
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY
P.O.Box 1200
Costa Mesa,California
The Building located at /"rn.
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group /v� 'f 2-3 Occupancy.
Use of Building Towrtl^cuse w/attached coracle
Legal Description P-P.J%139-521-01. Lot 14
(See reverse side for Metes and Bounds)
Building Permit No 4=.C7u Electrical Permit No. 48394 Plumbing Permit No. Tgq,43
Number of apartments —0— and/or guest rooms_ —U—
ISSUED TO: BuildingOfficial--
by
Date ae7F.'^`:c:... 2.., i:.-7
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 306 lel U.B.C.
Form BU 34 Rev. 11/70
. .'= 151.00 TI.
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR Shicl.., rtAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVE V PERMIT
For Applicant to Fill in Completely— Use Ink Only (.f 4 9 2 7 0 -. - •.
BUILDINGi't #A4 A.P.NO. 139-521-01 .
ADDRESS 2791 Placentia Rill BUILDINGIt l4
OWNER OR ADDRESS n791 Placentia Via FI
• TENANT R & W Development UNIT OR. y�
MAILING SPACE NO. ,�J /
ADDRESS 188 E. 17th St .
TEL. 1U /
TR1ra4792 LOT 14 BLK.
CITY Costa Mesa NO. 642-421£ NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER United California Bank X..
BRANCH 4667 MacArthur OWNER R & W Development
ADDRESS Newport React? CA VALUE
ARCHITECT Granpada Design TEL. USE Townhouse Dwelling $37 , 899
OR ENGINEER brOUp NO. 492-447 \ a
•
ADDRESS 143 Ave. Granada, San Cleme I PONE PDR-LD, TYPE V GROUP I
CA APPROVED Q
CONTRACTOR R & W Develo.ment BY DATE �p w
ADDRESS 188 E. 17th St .
CITY Costa Mesa NO. 642-421£
F STATE CITY APPROVED SETBACKS
LIC.NO. 379731 LIC.NO.
4.1 SIZE NO.OF BLIX.S. (FROM C/L STREET)
Ow OF LOT 2 . 95 Acres NOW ON LOT O FRONT 33Citir.
a USE OF •, ,,
I1
EXISTING BLDG. OC
R.SIDE 3 FT.
CA / n.
Separate permits are required for L.SIDE C oL •
electric,plumbing and heating work. REARd
�`7J FT.
I.W. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
E! •
Townhouse Attach awaiting - DATE
I APPROVED APPROVED •,R(Ay_
b DATE O /I 4I frD
..I _By awe
L •
ird
a I hereby acknowledge that I have read this application and statem
N
tx that the above Information is correct and agree to comply with - riOLl) FOR SPECIAL REL,tUU<L:NfCN I J
R. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of m r�
tt4 the State of California. 1607 garage SG ft. 2 RAN.
SQ.FT. ec sq. N U\
,3 I hereby certify that I am properly licensed as a contractor under a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR at N
Chapter 9, and that such licenses are In ful force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempt from t .ro Ions of t.,r-t- : of California Business VALUATION I PERMIT FEE l r e
and Professions D' cion 3 r. :r 9. $ / / m A`
• PLAN CHECK $ ��1 A `\1
Signature of 99 / O
Permittee �..Y� I/_.�/iY - $ —O— TAX $ F
Author' :. Agent Date SF .e..." U
TOTAL PAID $ 151. 00
78. 15 Tl
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR S'1; RAL PERMIT
P.O.BOX 1200. COSTA MESA,CALIFORNIA 92626
RECEIVED BY PERMIT
4€ 270
q 270
For Applicant to Fill in Completely — Use Ink Only
.BUILDING Etat4 A.P. NO. 139-521-01
ADDRESS 2791 Placentia Plan A - BUILDING „,_,,, t ##14
OOENER OR
R & W Development
27PlI.,acentia Plan #A
UNIT OR
MAI LING
ADDRESS 188 E. 17th St. SPACE NO. .
TR.NO. LOT BLK.
CITY Costa Mesa ' NO. 642-4218 107 2 14
NEW I ADD ALTER REPAIR MOVING DEMOLISH
LOOiION
LENDER United California Bank
X
BRANCH 4667 MacArthur OWNER R & W Development
ADDRESS Newport Beach4 CAI VALUE 37
ARCHITECT Graada Design TEL. • USE Townhouse Dwelling $ /i3
OR ENGINEER iii VUP ND, 492-4470
ADDRESS 143 Ave. Granada, San Clemente ZONE PDR-LD TYPE V GROUP I
CA APPROVED
CONTRACTOR R & W Development BY DATE
ADDRESS 188 E. 17th St.
TEL.
CITY Costa Mesa NO. 642-4218
FI
— STATE CITY APPROVED SETBACKS
LIC. NO. 379731 LIC.NO.
SIZE NO.OF BLDGS. (FROM C/L STREET)
O. OF LOT 2.95 Acres I NOW ON LOT 0 _FRONT FT. .
a USE OF
EXISTING BLDG. R SIDE FT.
H Separate permits are required for L.SIDE FT.
G electric,plumbing and heating work: • REAR FT.
(W. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
a •
DATE
Q
Townhouse Attach vis
maa APPROVED
APPROVED
>. _BY DATE
..1
fy
QI hereby acknowledge that I have read this application and state • n
'a that the above information is correct and agree to comply with
Co all laws regulating building construction, and I shall not employ i.
Z any person In violation of the workman's compensation laws of m
• 617z the State of California. Garage 439 S4 ft.
3 I hereby certify that I am properly licensed as a contractor under 3'607 SO. FT. Deck 42 sq. ft. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses ar. in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e 1
em exempt from th- •rovisions o e State of California Business y
VALUATION PERMIT FEE $
and Professions C•i• Divis E Chapter 9. _ m
PLAN CHECK $ �S ..
Signature of i V
Permittee i L«C� $ 3 TAX
or / ' nr -/ V u
Authori -tl Agent Date` TOTAL PAID $ •7
7652 166.00 IL
COSTA MESA Bull JG-SAFETY DEPARTMENT APPLA.-7I( ION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COb,A MESA,CALIFORNIA 92626
RECEIVED BY PERMIT
For Applicant to Fill in Completely —Use Ink Only 49268
BUILDING II�� It g1Z A.P.NO. 139-521-01
ADDRESS 97g1 plarent ia Pilan pmBUILDING #
OWNER OR ADDRESS 279]. Placentia 9iaiti -#o�F
TENANT _ - e e II_
MAILING UNIT OR
' ADDRESS 188 E. 17th St . SPACE NO. — -
- . TR.1O . 792 LOT 12 BLK.
TEL.
CITY Costa Mesa ND. 642-421
CONSTRUCTION - ' ' NEW ADD LTER (REPAIR MOVING DEMOLISH
LENDER United California Bank X
BRANCH 4667 MacArthur
ADDRESS Newport Beach, CA OWNER R & W Development
VALUE
ARCHITECT Granada Design TEL. . USE Townhouse Dwelling $42 ,899
OR ENGINEER ro Up NO. 492-4471
ADDRESS 143 Ave . Granada,San Clemen - ONE PDR-LD /7YPE V GROUP 1 Q
CONTRACTOR R 8 W Development ement CA APPROVED . . - I DATE 6-1-8°ADDRESS 188 E. 17th St .
CITY Costa Mesa
TEL-
CITY
.-. STATE CITY APPROVED SETBACKS
LIC.NO. 379731 LIC.NO.
SIZE NO.OF BLDGS (FROM C/LLSTREET) -
C. OF LOT 2 . 95 Acres NOW ON LOT FRONT 33-171F T.
a USE OF
� L1.QC`
' EXISTING BLDG. R�SIDE cC_
VI '
Separate permits are required for L.SIDE /2-9 FT. 0 '
G electric,plumbing and heating work. REAR CP/FT.
1�., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q
GI
DATE
.� APPROVED
a
} Townhouse Attach Dwelling ARPYPRoveDau � DATE Sr-61T/FSO
CC
I.:( _
O.
I hereby acknowledge that I have read this application and state hULD FOR SPECIAL REQUIREMENT . C
that the above information Is correct and agree to comply with
C. all laws regulating building construction, and I shall not employ - si
Z any person in violation of the workman's compensation laws of e.
S the State of California. aT�++auge 4 33 S =
1805 SQ. FT. a1CL7Ily �3 S�. m V
I hereby certify that I am properly licensed as a contractor under
the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m fw
Chapter 9, and that s h licenses are In lull - ce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: V
am exempt from fCr• Isions of the - .f California Business
VALUATION PERMIT FEE
and Profession�*e vision 3,C .5 t9. $ /64-...-•• m ,
Signature of -cat �/ • PLAN CHECK s — o
Permit-to .4I'44
-/ �� $ TAX $ LL
or // —0— u
Aut •r ad Agent Date r / TOTAL PAID $
166 . 00
•
u