HomeMy WebLinkAbout3117 TAFT WAY - Building Permits of MFS CITY OF COSTA MESA
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04 7 m• &1200 P.O. BOX 1200
Via. DEVELOPMENT SERVICES DEPARTMENT
A� POROT80‘ �•
October 24, 1994
Dear Costa Mesa Property Owner:
In reviewing past permits, we find that work has been done on your
property located at 3117 Taft Wax. Permit No. B64255• for a roofing
permit. The permit is valid for 180 days from issuance or your
last inspection, per Section 303 (d) of the 1991 Uniform Building
Code. Should we not hear from you within 10 days, your permit will
expire as stated herein and additional fees will be required to
finalize the permit. Failure to final a Building Permit could
possibly impact the future sale of your property.
To activate the above permit, please follow these steps:
1. Telephone (714) 754-5626 or 754-5627 .
2. Request an inspection; state address, permit number, and type
of inspection.
3 . Be sure to have working smoke detector's as required per
Section 1210 (a) of the 1991 Uniform Building Code.
4. Have an adult present at the property at the time of
inspection to provide us access.
Should you have any questions regarding this process, please
contact me at (714) 754-5273 .
Thank you for your cooperation.
Sincerely
deaa 9I '''I
•1 anda Huapaya
• Pit Processing Sp- alist
77 FAIR CRIVE
Building Division(714)754-5273 • Code Enforcement(714)754.5623 • Planning Division(714)754-5245
FAX (714)556.7506 • TDD(714)754-5244
I I PROJECT OWNEfl'AS NAMEONANE::
3117 TAFT WY UNIT: v CITY OF COSTA MESA
PERM N
BUILDING PERMIT O; B 064255
34
ADDRESS: ROSZKOWSKI, KAZIMIERZ
ROSZKOWSKI, EVA PERMIT NO: B 064255 PLAN CHECK NO: N GOVT: N SUPP : N
3117 TAFT WAY
COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT:
JOB DESCRIPTION : T/OFF, RESHEATH 6 REROOF W/COMP SHING. SQ FT: 4 , 400
PERMITTEE: CLAIM VALUE; 4 , 400 . 00 CALC—VALUE; 4, 400 . 00 GROUP OCC: R-3 /
ADDRESS: ROOFING CONCEPTS ( 714 ) 645-7518
A6457 BEACH ST q (� '7 COMMENTS : SMOKE DETECTORS ARE REQUIRED AS PER U.B .C. 1991 ,
CCA cp dAs�t p ******** ********************* �E�r+r� *****t********+ *4****�F*+F�EEE*****x*****�Esr�E+F***
LICENSED CONTRACT; OE RATION: I hereby affirm that I am licensed unite isr per 9(commencing with Section
70001 of Division 3 of the Business and Professions Code.and my license is in lull force and effect. Z ONING R E Q R EMEN TS
CITY UC.: 0 7 4 STATE LIC.:441271 CLASS: S E TB AC ,S,
7-Ths'Date: .30--V3
signature: � iCll �L MAIN BUILDING ACCESSORY BUILDING
WORKS COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent o self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800,Lab.Cl. LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICYNO.: 1282254-93 EXP.DATE: 10/01 /94
COMPANY: STATE FUND—, PARKING REQ: PROV: PARCEL : 4221:8-108 ZNE: REF NO:
❑ Certified copy is hereby furnished. LX Certified copy is filed with the Bu ding Division. PLANNING NOTES>
91 - 73 � citya� %.
Date: 3U Applicant *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred MOO)or less). DEVELOPMENT SERVICE, 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 issued.I shall not employ any person in any manner so as to become
subject la the Workers'Compensation Laws of California.
Date: Signature ZONING APPROVED' BY DATE:
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY •
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DATE:
CONSTRUCTION LENDING AGENCY: I hereby Vim)that there is a construction tending agency for the pertinence 01 the work for �y)�
which this permit is issued(Section 3097,Civ.C). APPLICATION ISSUED BY
: 1_ _ DATE: rta
LENDER:
ADDRESS: *************************************************3E********************* ** ****
AL
LEGALIZATION:N FEE ,SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER5sessand1PN: hereby Coe:r that I city
m of exempt frhin the uireartconstruct,
Law for imthe
ve.dem reason. r BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 reBusinessprand its issuance,Code: Any ctha county nt which requires a permit to gnildtstatesent,improve,eEmocen,or
repair any structure,prior to issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 72 . 0 •
. 5 0
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/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 far a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1E5001. ISSUE FEE '
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DI V—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structureis not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License law TOTALS----> 72 . 50 0 . 00 0 , 00 72 . 50. 72 . 50 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale. II,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED • 72 . 50'
OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC IRE S P/TOT GRADING PLAN—CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 , 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of 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 *************,***********.******************.*************************************
That proof of their Worker's Compensation insurance should be provided to me.
0 I am exempt under Section: B.a P.C. IND I V IDUAL F E E B R E AK DOWN
for reason: TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date: Owner:
I do hereby cedily that lam aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 4400 REROOF BY VALUE RE IDENTIAL NOZONE 1 , 00 4 , 400 , 00
25534 and that I or any future buitding occupant wdgwit not(circle one)need to comph with said state codes and the requirements for a ND OF FEES
Permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from C
these provisions. C X P l R `MD �'�j Tril
Date'. Applicant: V G_comi ate (n5/"_CtlOns� - 1 r
I heronherebyscertify d that I laws
s td this building
and stateothat are above informationsist correct. agree to complyterwith all city anddo county �� Q ' (�„'�'
Property
and ecap relating to builtlmg construction and hereby authorize representatives of this city to enter upon the above-mentioned w
properly for inspection purposes. " 1 `• E J
OSt* SEP fir
Date. S} 30-5'3 Signatwe:� � kS..... .."."... � __. �
Driver's License or Social Security a: � CITY OF COSTA MESA
Applicant:Pink—Revenue;Goldenrod—Assessor fig!
INSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4::Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steet Reinforcement - 56. Rough Plumbing & Pressure Test
6: Electrical UF ER Grnd. • 57. APPROVAL TO COVE R-GUNITE
7. Fgotings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
I, 10: Structural Floor System 61. APPROVAL TO DECK
, 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
`
I 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 QGas 0 Oil
23. Gas Pipe-Rough &'Test . '72. Underground Flush .
24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas ❑011
25. Roof Sheathing /O-q-_q 62(.44-- 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.-FIREPREV. FINAL
30. Drywall Nailing • - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION ; •
32. Electrical Power Meter-Final • i • 80. FOOD C _ATI FIC-ATE ISSUUE/,//ED -•
33. Final Electric , . Notei: 0*,f i'_€ / _`�1:1- $o S/y -
34. Final Heating& Air Conditionirdy C „• /d -/_6 -
35. Final Gas Pipe-Test '4
36. Hood or Canopy eXPI• _ ^ . • - -
37. Fine(Factory Fireplace rl� ----�I/ t I ��
ions .
38. Final Plumbing , 1 Q1 ,.
39. Water Service-Final ' _4' g •
.
40. Gas Service-Final � - . -
41. Solar Domestic-Final '
42. Backflow Preventer
43. Backflow Irrigation ' -
44. Landscape Irrigation.System - , - - - •
45. Sound Attenuation - • `
4,6. Handicap,Regulations -
47. FINAL STRUCTURE & BUILDING
1
48. ANAL PLANNING
49. Electric Release to Edison -- -
50. Gas Release to Southern California Gas Co _ - -
51. CERTIFICATE OF OCCUPANCY _
No. Date
PROJECT ADDRESS: 3117 TAFT WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; IB 0 /09!) /
OWNTR'SNAME:ROSZKOWSKI, KAZIMIERZ
ADDRESS:ROSZKOWSKI, EVA PERMIT NO; IB 070957 PLAN CHECK NO: N GOVT; N SUPP ; I
3117 TAFT WAY
COSTA MESA,CA 92626 CONSTRUCTION TYPE; V—N PERMIT TYPE: OTH SIR PURPOSE: OTH
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION ; TO REPLACE EXPIRED B-64255 SQ FT;
ADDRESS: • UNIT:
CLAIM VALUE; CALC—VALUE; GROUP OCC ; R-3 /
ERMITTEE'� AZIMIEREZ ROSZKOWSKI ( 714 ) 754-4132
aDORE • 3117 TAFT WY COMMENTS : SMOKE DETECTORS ARE REQUIRED AS PER U.B .C. 1991 .
C.M. CA 92627 *******+E*ar ***aE*aE«**aE****aF*******aF*+caE**********+raE*****+c******+c*****************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9l commencing with Section ZONING R EQU IR EMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect SETBACK S
CITY LIC.: STATE LIC.: CLASS: EXP;
MAIN BUILDING ACCESSORY BUILDING
Date. signature: FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C),
POLICY NO.: EXP.DATE: PARKING REQ; PROV: PARCEL ; 42218109 ZNE; REF NO;
COMPANY: PLANNING NOTES>
0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. >
*******************************************************************************
Dale: Applicant: DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(8100)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 ZONING APPROVED B Y
1 to the Workers'Compensation Laws of California, //// �J : DATE; i
40,
3 / ?s Signature: Jam/ Z J W BUILDING APPROVED BY ; _
OTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE; _
Code.you must lonnwitn comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED BY; q Q
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ************************************** *******************DATE****`/ St 1 )
which this permitis (Section 3097.Civ.C). ************************************************************************ **** *
LENDER:
ADDRESS: LEGALIZATION ;N F E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/RES GRADING
PERMIT 30 , 00
(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 for such permit to file a signed statement that he/she is licensed SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 30 . 00 0 . 00 0 , 00 30 , 00 30 , 00 • 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 30 . 00 OVER/SHORT • 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for the purpose of sale), 30 , 00
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon .*************************************,**,****,**********************aF*************
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
• that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAKDOWN
I am exempt under BP-7044 p.g.
Mr this reason: SNYR�ER—BUILD A. TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
late / 3 / —9 S Owner; kQ2 Ia,L/we(Pc INS 1 BUILDING RE—INSPECTION FEE 30 . 00 30 . 00
,hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
SMOKE
K
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from r1(((�,/1' `� DET T
these provisions. E/, • O^
Dale: Applicant: REQUIRED
SE^UIRE��/D ...in
I hereby certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county 'I^1C (V(]
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
prorerty for inspection purposes. 'msz
01'L fir �oJcici) wi-/ DATE01/3 00175910-0017591095 TIME: TOT 30.00
OaL. !� ( Signature:
:river's License or Social Security N:
1641.46 Whne—Building,Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor 1
CONSTRUCTION AND PLANNING POOL& SPA
-rt. APPROVALS . Permit# Date Inspector APPROVALS Permit# Date Inspector
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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
B. Foundation 59. Gas Pipe, 0 Undrgrnd..Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK •
• 11. Property Sewer Line &House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18, Rough Electrical-T Bar Ceiling 11 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning I FIRE DEPT. REQUIREMENT
20.. Rough Factory Fireplace • APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating • 71. Product Piping 0 Gas ❑Oif
23. Gas Pipe-Rough& Test I 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 • - 7&. 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 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, Backf low Preventer • - j
43. Backflow Irrigation 1
•
44. Landscape Irrigation System • ' -
45. Sound Attenuation •
46. Handicap Regulations •
47. F INAL STRUCTURE &BUILDING .2,7 75- &
48. FINAL PLANNING
-49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co __
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 3 1 1 7 TAFT WY UNIT:
0 OWNER'S NAME: ROSZKOWSKI,31KAZIMIERZ CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06425_
c
ADDRESS: ROSZKOWSKI, EVA PERMIT NO; B 064255 PLAN CHECK NO: N GOVT: N SUPP : N
3117 TAFT WAY
COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: OTH
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : T/OFF, RESHEATH & REROOF W/COMP SHING. SQ FT: 4 , 400
PERMITTEE: CLAIM VALUE: 4, 400 . 00 CALL—VALUE: 4, 400 .00 GROUP OCC: R-3 /
ADDRESS: ROOFING CONCEPTS ( 714 ) 645-7518
657 BEACH ST COMMENTS: SMOKE DETECTORS ARE REQUIRED AS PER U.B .C. 1991 ,
r F('4n GG9(, ***********************************************4**it+f***************************
LICENSED CONTRACTOR.DEE RATION: I hereby affirm that I am licensed unde7"pOvisi6ns'bl� per 9(commencing with Section
70001 of Division 3 of tot Business and Prolessions Code.and my license is in lull force and effect. Z O N I N G R E Q R E M E N T S
CITY LIC.: 0 7 4 STATE LIC.: 4 4 1 2 71 CLASS: / S E T B A C ,,S._
�� Date: — Signature: e,_ 'xre,MLa MAIN BUILDING ACCESSORY BUILDING
WORKS S'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT• FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 7800.Lab.C). LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICYNO.: 1282254-93 EXP.DATE: 10/01 /94
COMPANY: STATE F.UNL�-, PARKING REQ• PROV: PARCEL : 422L810.9 ZNE; REF NO:
❑ Certified copy is hereby furnished. LX Certified copy is tiled with the city 8u ding Division. PLANNING NOTES>
-_
Date: - 3v- 93 Applicant: �� **********************************************;«**IE*****************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: This section need not be completed if the permit is for one hundred(5100)or less).
I certify that in me performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become D E V E L O P M E N T S E R V I C E- Sr R E Q U I R E M E N T S
%ublect to the Workers'Compensation Laws of California. -Z
Date: Signature: ZONING APPROVED BY DATE:
•
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APP ROVED BY
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. 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(Section 3097.Civ.Cl. APPLICATION ISSUED BY; DATE:
LENDER: *********************************************************************** ** ****
ADDRESS:
LEGALIZATION:N FEE .S U M M A R Y. STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION:andIPN: I sihereby
naldI am exempt frwhin theContractors'arStateonsense Law for imthe
ve,dem reasonr BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
repair n 7031.5 stc Business and issuaince, Code: Any city of county nt for u requires a permit to construct,alter,improve,demolish.or
Pursuant
any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that ne/she licensed PERMIT 72 .00 . 50
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 for the alleged exemption.Any violation of Section 7031.5 by PLAN SMIP/NON—RES
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7644,Business and Professional Code: The Contractors'State License Law TOTALS————> 72 . 50 0 , 0 0 0 • 00 72 . 50 72 • 50 . 00
does not apply to an owner of a property who bmlds or improves thereon,and who does such work himself/herself or through _
his or her own employees, provided that such improvements are not intended or offered for sale.If.however the building or
improvement is sold within one year of completion.the owner will have me burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED; / ']2 , 5 0 OVER/SHORT: . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC IRE S P/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 • 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon •
and who contracts for such projects with a contractorla)license pursuant to the Contractors'State License Law).I am aware *************************************.*4***********w**********************************************
that proof of their Worker's Compensation insurance should be provided to me.
9 I am exempt under Section: B.6 P.C. INDIVIDUAL FEE BREAKDOWN
monis reason: TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date: Owner: ar
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and SFR 4400 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4, 400 . 00
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 ), ND OF FEES
permit for construction or modification from the Air Duality Management District,Residential construction applications are exempt from _
these provisions. EXP ( RED -
Date: Applicant {{7te k1'•5{A2L'1;Cns� 1
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 ,�tiJ7P. ( '. '''�
if
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned )�/1
property for inspection purposes. \, I 11
'�
l� SEP 3
Date: 5' 3U—S 3 Signature: o����G'� � DON
t --
Driver's License or Social Security a:
CITY OF STA ','':(ESA
POOL & SPA I
'r/ 9NSTRUCTION AND PLANNING = t
APPROVALS Permit -
Date InspectorAPPROVALS Permit fir- 4 Gatr f::;sf-ctor
7 1. Temporary Electrical Service o: Pole • 52. Pool & Equipment Location
2. Sat Pipe•Undrgrnd. - 53. 'Steel-Reinforcement 1
- --
3. Electrical Conduit Utility-Un�d+grnd. 54.i Forms' -_- - ---- -`^-
4. :Electrical Conduit Undryrnrl, -- __-..-.-_.� 55. Electrical Bonding ---- --l�-y-
5.' S;ec l7einforcema.a 56, Rough Plumbing & Pressure Te::
am •
u. F.Irctrtcal UFEr',.Grnci. - - 57. APPROVAL TO COVER-uUNITE - '
7. Footings 58. Electrical Conduit•Undrgrnci. _-_
8. F,ounnct:on 59. Gas Pipe, 0 Urdrgrnd., Test •
_ 9-. Water Pipe-Undrgrnd. 60.;Backwash Lines, P-Trap, 0 Uudrornd ---��
16. Structural Floor System .._ 61...APP ROYAL TO DECK -_----------`
Propel t• Sewer Lire: & House Connection - �" "-_-"- __.v_� i
11, / - -- 62.`f3:mkwash&,fiecoptorsFinal --
12, Sewer Cap - I -63. Heater & Vent-Final -.-.__.___.__ _-__
-
• 1
13, Root Drains - 64."Plumbing System • Final __---,y---- -Y~
14.- Rough Plumbing - 65. Electrical-Fina
____ -___---___ -_- __ _r_____
to I\ce .Jb ctectricu,.Cortoua 66. Solar.System-Finat
1 u,- Houdn Electric Wiring 67. Fencing &Acce:s Approval -- _-�-
17 Ro:L.n 't;iring Sion ,- 68. APPROVED FOR PLASTERING -
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ( r
15 Routh Heating & Air Conditioning - _ _ FIRE DEPT. REQUIREMENT • "
20. Rough Factory F:rePiacc ' • ' APPROVALS'. Permit •ist _`_�
H.
21, Ducts, in Structure • 70. Uridergrounu Ffyoro
22, Ducts, Ventilating, t ` ' 71. Product Pitm}g C1'Gis 07011
23. Gas Pipe-Rough &'Test . __-.-.- '.72. Underground Flush
24. Root Framing • '73. �Jndergrnd. Storage Tank n Ga•, i J('
2i.. hoot Siteatfens . , /C1_L�_-i 5 ti.14. -- 7d, Overhead Ileum i _ _
2ti. T•Ear,Culin9 (__ructural) & Monoguat_r -t T. •' ' 75.TEN/ Chemical ._-. ___'-_ __-_.._ .__.
•
27 Flame a,A Fleitmig r "
-- - Iii. Dry Standpipe F'r_.,. ��
•
26. Latning & Sluing •• •• • • 77. "FIXED SYSTEM FINAL -' -
29, Inculadon ., i 'I. - 78. FIRE PREY. FiNAi: r . • .
30 ,Drywall Nailing - I . r HEALTH DEPT,•FtEQUiREa,i_NT -
1. Master Rrown Co,st 79. 'FINAL INS
,, t t,l lO,d
.32. Electrical.Power MeterFinal 80. FOOD C iRTII ILATE ISSUED ra
33, Final Electric . _ , Notes. �r�� _ ,�� si __ �$N _ �•1
._:__- _ -�_ _._- - -_ ._- _- ,. _._..t
34, Final Heating & Air Conoitivrlir9 • ! ,moi- /0.•1
35. Final Gas Pipe-Test __ , ------_.-.---- '---
30. Hood of Canopy
- - -_,
k , - - -
- a ° frD --- --
--------- -
3
7. Ei,tat Factory Fireplace ��0 'Plit
-17-----.1-7-eI / l _,35. tonyng
_-f,i Stvti 'J C;atet -ruml _._._..._.__
I_,,,15bet v." i rtJ. - .. - -.. ...
41 Solar Do nestCFinat . --�
• J.,
'42. Eackflor: Prevent-Jr -'---, .. - ---------.__-- ----I
•
13. Eackllow Irrigation '- ' ^v-------'- )
44. Landscape Irrigation S•tstem .. .. _ : - . l
45 Sound Attenuation - • • - -
Handu,a
an, h.Rdgur;:,.ins ,
47. FINA LSTRUCTURE & BUILDING --95- kt#440. .: • - ..• ,
48 FINAL PLANNING
,
99. 'Electric Release to Edison - _-_ - ----_-.,�- -_,-_-___4
50. Dat Release to Southern California Gas Col-- .
- - '---- _-----
i f
51. CERTIFICATE OF OCCUPANCY l • ---- --__ . ' --'- , •-'---- 1
0. Date _ I
' _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 6094 8/10/U4 r1n(1 1
CITY OF COSTA MESA • . PEWIT NO TRACT NO. LOT NO. 'BLDG. N r—%
CONSTRUCTION PERMIT ` 1-1-(o 53 H
Project Address 7 -
TYPE OF CONSTRUCTION NEW LI ADD LJ ALTERATION LJ REPAIR
Applicant's Mailing Address , ❑ CONVERSION Cl DEMOLISH ❑ OTHER A.P.# I Zone -
Owner's Name R. /1/els OhPhone-IVO -37)? DESCRIPTION OF WORK • S Main Building: Accessory Building: Z •
AddressE O
TYPE OF PERMIT ❑ GRADING 0 FOUNDATION ❑ STRUCTURAL T Front -N
Arch/Eng. License No. ❑ TENANT ❑ ELECTRICAL l3a PLUMBING ❑ MECHANICAL B I
A Rear • N
Address M / //�� // ❑ OTHER
Contractor's Name" L Pain Os,.{q 'bee i:.c Phone Ss9-9809( PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Rig •ht G
Address(mailing) 9 m7 keen a-J./ � .ft,4,e re CON ST RUCTION TYPE _- VALUATION$ S Left E
City License No. JV 755 ZONE GRADING CU.YDS. ACRES Ping. Ref.# Park.Fees $ . Q
1/ �7- LICENSED CONTRACTOR DECLARATION U
Remarks: • Parking Req./Provided I
QO I hereby affirm 7 that) I am licensedion of th provisionsBusnf Charter i ns(cend Use of Building:
R
) with section 7000) of Division 3 of the Business and Professions Code,and 9� E
0.,._, my license is in full force and effejt. M
v_ License CI ssi C — s•• icon e No. ' PLUMBING - FEES' Planning Notes:
j Date ?/ /ty Signature -.-���-� - N
\yl Bar Sink Showers
WORKERS' COMPENSATION DECLARATION T
I hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink - S
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) n 'y ' Backflow Irrigation Sewer Cap • ELECTRICAL .FEES
Policy No. 6-CS 2/9,01 Company Re,at/
.L.l?S(�- `
BCertified copy is hereby furnished. �/ Bathtubs Sewer Connection Automatic Washer- Transformer 0 15-50 KW
certified copy is filed with the city Building D'vl inion, / 0 50+KW
Date If/3 15'1 Applicant Q.[P...,.- I'Y14Kh Clarifiers Solar Collectors Construction Pole Sub.
EXEMPTION FROM WORws of California.. 00 amps
MION DECLARATION •Floor Solar Piping Automg Unit Meter ❑up to 115-50 K
(This section need not be completed if the permit is for one hundred($100) or
less). DrinkingFountains
I certify that in the performance of the work for which this permit is Issued, I Solar Tank Dishwasher - Meter Dover 100 amps
shall not employ any person in any manner so as to become subject to the -
Workers' Compensation Laws of Floor Drains • Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Date Signature - •
NOTICE: If,iaf ter making this declaration,you•should become subject to the . Floor Sinks Urinal •- ■a ■
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 ■• 016-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater - ' x/4,4¢,, 'Z • 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
Lender's Address Lavatories •
OWNER BUILDER DECLARATION Outlets .Range
I hereby affirm that I am exempt from the Contractor's License Law for the P—Trap reason (Section 7031.5 Business and Professional Code: Any city or p • _ Switches Sign
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 Roof Drains . - Garbage Disposal Standing Sections
to file assigned statement that he/she is licensed pursuant to the provisions of .
the Contractor's License Law(Chapter g(commencing with Section 7000)of • Generator 00-5 KW ❑5-15 KW Trash Compactor 1
Division 3 of the Business and Professions code) or that he/she is exempt I • _ - - - -
•
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 ' - 3 '
•
penalty of not more than five hundred dollars($500). Reinspection Fee $25 Issue Fee • - $ ', •
• I, as owner of, the property or my employees with wages as their sole MECHANICALReinspection Fee $25 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered • . FEES
for sale (Section 7044, Business and Professional Code: The Contractor's _ PUBLIC SERVICES REQUIREMENTS: i
License Law does not apply to an owner of a property who builds or improves .Boiler I Hood or Type I 0
thereon, and who does such work himself/herself or through his or her own Zoning Approved By Date
employees, provided that such Improvements are not Intended or offered for Canopy Type II 0
sale. If, however,the building or improvement is sold within one year of com- Duct-Under Ground _ Building Approved By 1• Date
',lotion,the owner will have the burden of proving he/she did not build or im- -
rrove for the purpose of sale). Duct-Structural t Refrigeration System - Application Issued By - : Date •
O I, as owner of the property, am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU ,
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES ,
The Contractor's License Law does not apply to an owner of property who BUILDING PERMIT $ SMIP $ , •
builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration '
tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT
O 1 am exempt under Section B.&P.C.for this reason Firepl/Fact.Blt. ICBG# C ISSUANCE $
PLUMBING $ -�•
Date Owner Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT - - ELECTRICAL $ GRADING $ -
information is correct. I agree to comply with all city and county ordinances ,
and state laws relating.to building construction,and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $
sentatives of-this city'to enter upon the above-mentioned property for ' •
- pp
Inspection pa o gc. 27 152:90 MECHANICAL $ TOTAL FEE $ �•
Signature G ltS
Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK 25% $ '
•
CMF 0865-46 rev.12/83 White-Building:Canary-Applicant:Pink-Accounting:Goldenrod-Assessor - ..
CONSTRUCTION AND PLANNING - - POOL &SPA c - I ''
Date Inspector ' ' Date . InspecttorI
APPROVALS Permit# APPROVALS Permit#
' 1. Temporary Electric& 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. 55i Electrical Bonding'- -: - , ;
5_ Steel Reinforcement ;-i; 56- Rough Plumbing & Pressure Test - f , s
6: Electrical UFER Grnd : ' 57. APPROVAL TO COVER-GUNITE, . , 1.;,-;
7. Footings - - 58. Electrical Conduit-Undrgrnd. - -
8. Foundation - - 59. Gas Pipe, 0 Undrgrnd.,Test -
9. Water Pipe-Undrgrnd. : 60. Backwash-Lines,P-Trap, 0 Undrgrnd.-
10. Stfuctural 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 - z - 64. Plumbing.System - Final - •
14. Rough Plumbing , - '65. Electrical-Final'
15. 'Rough Electrical-Conduit - , - -,66- Solar System-Final'l'- - 1- . . - . - - -
16. Rough Electric Wiring - 67. Fencing& Access Approvals. _
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' ' - . . -
_
'18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMSF.INAL - -
19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT , • .. e
• 20. Rough Factory Fireplace APPROVALS . Permit#
21. Ducts, in Structure 70. Underground Hydro
I
22. Ducts, Ventilating 71.' Product Piping ❑Gas 0 Oil
23. Gas Pipe-Rough & Test , 72. Underground Flush • ,
24. Roof Framing 73. Undergrnd.Storage Tank D Gas 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 , l ,
29. Insulation • 78. FIRE PREV. FINAL ' r '
30. Drywall Nailing HEALTH DEPT. REQUIREMENT i
1. Plaster Brown Coat 79. FINAL INSPECTION '
2. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
�3- Final Electric Notes: r ;
34. Final Heating & Air Conditioning
-i ! - •
35. Final Gas Pipe-Test k -
36. Hood or Canopy - . -1
37. Final Factory Fireplace r . , I i ` I ' -
38. Final Plumbing p/ 1y ( /J • I
39. Water Service-Final . -
40. Gas Service-Final • •
41. Solar Domestic-Final -
-r. _: - , ,
42. Backflow Preventer _ - •
43. Backflow Irrigation • -
44. .Landscape Irrigation System -.
-
45. Sound Attenuation - - -
46. Handicap Regulations _ •• •' 1 I r .
47. FINAL STRUCTURE & BUILDING -
48. Special Requirements Completed ' , ' I - '
49. Electric Release to Edison - ` - -, -" '- - ' .
50. Gas Release to Southern California Gas Co , ' -
51. CERTIFICATE OF OCCUPANCY - ' - - - - - - - -
No. Date ' - r
2130FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN i 7 1984 `,
P.O.BOX 317 COSTA MESA.CALIFORNIA rrII��FINnnAFFNCE((�� DppEPMMTFF4��4'
For Applicant to Fill In Completely APPl7CAlYaNC98R P�R7vTIAT
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING �
ADDRESS 3117 ma t Way RECEIPT NO, 2 I yr.
COSTA MESA. CALIFORNIA VK YV(U
R[CHIV OY Dry Tr,/[ IDAT[ISSUED
JAN 1 6 1964
OWNER l CNorthgate Hnmes BUILDING o
D R
AESSLJ939 Las Flores ADDRESS
CITY Fountain Valley NE16792 FIRE
ZONE TYPE GROUP v9 9/Q
O.
APPROVED
ORARCHENIGIN TECT ER C.
Hiller N07X+52007 BY DATE
AnaheimZONING111* I l�
ADDRESS LONE I NO.OF UB80FN+ 1I
W,_. I PLANS ��'�BUILDI/li II /
CONTRACTOR Bon S Pr Const r TTS_ Yynt//A11 •'`
}5939 Las Flores `ESC` /4".147.03---t /1/de oS
ADDRES DESCRIPTION
CITY Fountain Valley A.P.NO,
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL. 50•TO SIDE 8 REAR P.L.
LIC.NO. 215049 NO. �j`�1 6792
Ir EAVES
SIZE OT 603E102O2 NO,OF BLOBS. O
NOW ON LOT ALLOWED (U.B.C.REQUIREMENT)
OF L
YARDS APPROVED YARDS APPROVED •
UUSE
X SOO NG BLDG. 00 MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACK
OF LINE BTRHEV PR r5O 501
REAR YARD 33 FRONT COPT. y.� FT.
/
SIDE YARDI LEFT 5 I RIGHT 5 R.SIDE J PT, FT.
DESCRIPTION OF WORK L.SIDE S FT. F•r.
i
REAR 33.25 FT. FT.
NEW X ALTERATION ADDITION
DISTANCE BET. BET.MAIN 3
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDING NO.OF (/ VAR.# DATE
SIZE 1259 ROOMS -J STORIES 1 C.U.P.# 'I" APPROVED
EXTERIOR WALL ROOF APPROp `/- L
COVERING SLUG • COVERING • •• - BY 7" Add .� GATE 1- 7
USE OF BUILDING AND WORK TO BE PERFORMED KI/ '
single fam, res, w.att. gar.
/343BQ.P ,_1- - 42o ' ' -T cr
I HEREBY AC. •WL=•'. THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE HAT THE A•• ': I: .•RRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH LL CITY ��CSS A D STATE LAWS REGULATING VALUATION �/ o 0m
'
BUILDING .ONSTRU PERMIT FEE $ `J- O 0
PERM SIGNATURE�F PJ • 00 4)0 G
E E
v
AUTHORIZED AGENT /-rl B O0 a
TOTAL FEE 5 71.2