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HomeMy WebLinkAbout1779 TANAGER DR - Building Permits / .._ CITY OF COSTA MESA °cis ,6 BUILDING DIVISION Fs 'l a 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us �4 _°I FOR INSPECTIONS CALL: (714)754-5626 %....-„,;004PERMIT NUMBER: E11-00005 PERMIT TYPE ELEC STATUS: ISSUED APN: 13962403 DATE ISSUED: 01/05/2011 ISSUED BY: RMD JOB ADDRESS: 1779 TANAGER DR CM Suite/Unit: Vicinity: SIDE OF HOUSE SCOPE OF WORK: ELECTRICAL PERMIT TO UPGRADER SERVICE PANEL TO 200A,SAME LOCATION SIDE OF HOUSE FOR A SFD. OWNER: ARNOLD,TERRY DARLENE Address: 1779 TANAGER DRIVE Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: ROANE,JEFF Address: Unit: PHONE: 714-604-9570 City/State/zZip: CONTRACTOR: ROD EDWARDS ELECTRIC License No. 598403 Address: 17172 BOLSA CHICA RDUnit: PHONE: 714-604-9570 City/State: HUNTINGTON BEACH,CA ZipCode: 92649 CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $54.00 Reinspection Fee $0.00 TOTAL FEES $54.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28, §1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE N. INSPECTION TYPE ORIF minims CODEA INSPECTION TYPE DATE IN1n1AL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .ALD ��— )\ Mn 200 Final Re-Roof 210 Final Electrical lr 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure.scaffdding,falsework,a demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feel high.(Chap.3.2.Grp (Thsscion need not be completed e the perms is vakredat are hundred doears(Si ))or less) 2 Aril Sec.341.Title B,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above.unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor C•• y—forthwith comply with these provisions. /moi/ �• • WU Division of Industrial Safety Permit Number: /ppliwnl's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARN G: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons.or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in ful orce and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.1(40 i_ Q Class# C_/Ol (Section 25533 of the California Health and Safely Code, with some y exceptions, requires registration with the Costa Mesa Fire Department by �/ l�� i each business which at any one time has on hand a quantity of acutely : r.cto gnature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). O I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for 8. (If"yes", attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and 0 I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contracta(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 ol.Legal0wner(s) Da Signature Date - / 7-C/1 3057-46(3/07) LAndlor Au enzed Applicant Date co9 CITY OF COSTA MESA • lalsBUILDING DIVISION •, •, ,I = DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER 4. 11111411 : PERMIT E02-00394 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1779 TANAGER DR Status: ISSUED Suite No Applied: 05/14/2002 Vicinity: KITCHEN Issued: 05/14/2002 Parcel Nunmber: 13962403 Applicant: BRADNER, GEORGE T ISSUED BY: _W_______ Address: 2015 S STATE COLLEGE Phone: 714-939-6227 ANAHEIM,CA' Zip: 92806 Owner / ARNOLD, TERRY DARLENE Address 1779 TANAGER DRIVE Phone: COSTA MESA,CA Zip: 92626-4864 ' Contractor: LE GOURMET KITCHEN • Address: 2015 S STATE COLLEGE BL • -Phone: 714-662-0696 ANAHEIM,CA i " Zip: 92806 " License: 743983 - SCOPE OF PERMIT KITCHEN REMODEL. REMOVE APPROX 2 FT OF NON-BEARING WALL BETWEEN KITCHEN AND DINING ROOM AREA TO MAKE ROOM FOR NEW KITCHEN ISLAND:NO OTHER STRUCTURAL WORK AUTHORIZED BY THIS PERMIT. ELECTRICAL WORK TO INCLUDE: 16 LIGHT FIXTURES, 12 OUTLETS,8 SWITCHES. REF:1302-00676 • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 " Standing Section $0.00 0 • New Res(1-2 units) .$0.00 0 Misc Electrical Equipment $0.00 , 0 ' New Res(3+units) .$0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 . __ '0 up to 10 kva/kw $0.00 0 Lighting Fixts $17.60' 16 up to 50 kva/kw $0.00 0 Recept Outlets $13.20 . 12 up to 100 kva/kw $0.00 0 Switches $8.80 8 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 "0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 - 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $63.10 Intermed Pole $0.00 0 • 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 24464e(6/00) • DECLARATIONS 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 wo for which this permit Is issued. ave 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: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the w• for whic 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,.•,:e th• f I .hould•.come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. , - Applicant Signature: r-� � Date: 6 -1 Lf WARNING:FAILURE TO SECURE WORKERS'COMPENSATI•,"•VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST•F COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provi ' of Ch...,r 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.k / Class 4 Contractor's `Signature: �y' /9 Date: '5-1 1' CONSTRUCTION LENDING AGENCY: O 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 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 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 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 INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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 e 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 hes 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? 0 Yes ❑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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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 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 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 pu •• =s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. :. ate / y / And/Or A .•rized Applicant Date CODE I INSPECTION TYPE PAIL 2fIID915 MEI INSPECTION TYPE PAIL HEW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing Y�� 200 Final Re-Roof 210 Final Electrical m Ci it 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 / p CITY OF COSTA MESA ~ hp. BUILDING DIVISION Y4 • DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER Ft • PEWIT 444 #.4602-00676 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1779 TANAGER DR Status: ISSUED Suite: Applied: 05/14/2002 • Vicinity: KITCHEN Issued: 05/14/2002 Parcel Number: 13962403 Zoning: R1 R1 Applicant: BRADNER, GEORGE T ISSUED BY: Address: 2015 S STATE COLLEGE _ Phone: 714-939-6227 - ANAHEIM,CA . " Zip: 92806 •" Owner: ARNOLD,TERRY DARLENE . , ' Address 1779 TANAGER DRIVE - Phone: COSTA MESA,CA Zip: 92626-4864 . . Contractor: LE GOURMET KITCHEN Address: 2015 S STATE COLLEGE BL Phone: 714-662-0696 ANAHEIM,CA Zip: 92806 License: 743983 • Arch : - -- • Eng: Address: Address:• ' ' Phone: - - , . Phone: Zip: License: License: SCOPE OF PERMIT _ KITCHEN REMODEL. REMOVE APPROX 2 FT OF,NON-BEARING WALL BETWEEN KITCHEN AND DINING ROOM AREA TO MAKE ROOM FOR NEW KITCHEN ISLAND.NO OTHER STRUCTURAL WORK AUTHORIZED BY THIS PERMIT. ' - - FEE SUMMARY ' Plan Check: ' " $0.00 . . - - Calc Valuation: $7,000.00 Permit: $139.25 Claim Valuation: $7,000.00 SMIP Res: $0.70 SMIP Corn: $0.00 Other: $0.00 , Inspection: $0.00 . Total: $139.95 , 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 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 244446(&OO) DECLARATIONS j 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 sectiono0 of the Labor Code,for the performance of the work for which this permit is issued. y workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at 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 to become subject to the workers' compensation laws of California,:ay -- j�jy- d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. /i � 5 _ I ; j /r[3 / Applicant Signature: '�1 Date: T U WARNING:FAILURE TO SECURE WORKERS'COMPENSATION , ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000),IN ADDITION TO THE COST 0 rrrr PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro ' ions of C.-•ter• r ommencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# / / `/ Class it Contractor's Signature: " pr, rC _.. Date: S 't o - CONSTRUCTION LENDING AGENCY: 1 C.1 ❑ 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 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 driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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,Califomia 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 ❑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 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 pplication apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ Yes D 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? ❑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 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 .urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /t 5.. �;j/ mac.. :rs ` i Date© a Coo And/Or A rorized Applicant Date CODE I INSPECTION TYPE DATE tNTFTIAI$ CODES INSPECTION TYPE RAIL =ALS 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 ' 4 204 Final Demolition 250 .Final Building/Occupancy .m, `501F 9 CITY OF COSTA MESA , �. BUILDING DIVISION F �- ( DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 ' PERMIT ' „ingT60 1P02-00295 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1779 TANAGER DR Status: ISSUED Suite No Applied: 05/14/2002 Issued: 05/14/2002 Vicinity: KITCHEN • Parcel Nunmber: 13962403 ISSUED BY: Applicant: BRADNER, GEORGE T Address: 2015 S STATE COLLEGE Phone: 714-939-6227 ANAHEIM,CA Zip: 92806 Owner: ARNOLD, TERRY DARLENE Address 1779 TANAGER DRIVE Phone: COSTA MESA,CA Zip: 92626-4864 Contractor: LE GOURMET KITCHEN - Address: 2015 S STATE COLLEGE BL • Phone: 714-662-0696 ANAHEIM,CA Zip: 92806 License: 743983 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT KITCHEN REMODEL. REMOVE APPROX 2 FT OF NON-BEARING WALL BETWEEN KITCHEN AND DINING ROOM AREA TO MAKE ROOM FOR NEW KITCHEN ISLAND.NO OTHER STRUCTURAL WORK AUTHORIZED BY THIS PERMIT. PLUMBING TO INCLUDE:CHANGE OUT OF KITCHEN SINK. REF: B02-00676 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $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) $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 $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect - $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 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) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 -0 TOTAL CALCULATED FEES: $33.30 NOTICE. Thu wuik authuntd by this permit shall wm I with all d liable Inamdica a .esa nequirementa under California statutes and ralatuJ regulations.(Ord.No.92-28,§1, 12-21-92) COMMENTS/SPECIAL CONDITIONSct 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 2446-48(6/00) DECLARATIONS 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 ha a 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. workers'compensation Insurance carrier and policy number are: ardor: 11 Policy Number: (This section need not be completed if the permit is valued at 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 to become subject to the workers' compensation laws of California,a . ,. , ..: hould become subject to the workers'compensation provisions of Sectlgggggq3700 of he Labor Code,I shall forthwith comply with these provisions.' / ' 0 Applicant Signature: ������„ Date: (�J� WARNING:FAILURE TO SECURE WORKERS'COMPENSATI• COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES D CML RIVES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE.S, OF COMPENSA'nON,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATIO • I hereby affirm that I am licensed uncle •ovisions y hapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.# // A a Class N Contractor's Signature: A�27 lam! Date: ' LT l OD ____ LENDING AGENCY: V ❑ 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 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.). O 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,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 WIII 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 Califomia 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? 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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 B (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. I1f10 '''):'e :•al.Owner(s) p • An. ate•uthorized Applicant Da . cODE# INSPECTIONTYPt PATE ILIIMpiLe ODE INSPECTION TYPE MI EMMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical (�n 1266 Pool Spa Final 208 Final Plumbing .. 9-27-ea Gl v 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 • F 9 CITY OF COSTA MESA 4 BUILDING DIVISION > :r..aria 4. '__ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER %1 �- ( PERMIT J. V M02-00200 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1779 TANAGER DR Status: ISSUED Suite No Applied: 05/14/2002 Issued: 05/14/2002 Vicinity: KITCHEN Parcel Number: 13962403 ISSUED BY: Applicant: BRADNER, GEORGE T Address: 2015 S STATE COLLEGE Phone: 714-939-6227 ANAHEIM,CA Zip: 92806 Owner ARNOLD, TERRY DARLENE Address: 1779 TANAGER DRIVE Phone: COSTA MESA,CA Zip: 92626-4864 • Contractor: LE GOURMET KITCHEN Address: 2015 S STATE COLLEGE BL • Phone: 714-662-0696 ANAHEIM,CA - Zip: 92806 License:743983 SCOPE OF PERMIT KITCHEN REMODEL.REMOVE APPROX 2 FT OF NON-BEARING WALL BETWEEN KITCHEN AND DINING ROOM AREA TO MAKE ROOM FOR NEW KITCHEN ISLAND.NO OTHER STRUCTURAL WORK AUTHORIZED BY THIS PERMIT. MECHANICAL TO INCLUDE RELOCATION OF SOME EXISITING DUCT WORK,GAS PIPING AND 1 KITCHEN HOOD. • REF:B02-00676 FEE SUMMARY - Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillatlon System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00. -0. Compressors/Absorption Systems Gas Piping $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00- 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 .0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $54.00 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 WOO) DECLARATIONS • WORKERS'COMPENSATION DECLARATION: - • 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. ye 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: Carrier: Policy Number: (This section need not betompleted if the permit is valued at one hundred dollars($100)or less.) 0 I certify that in the performance of the 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,a + :•ree if I •ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with these provisions/.. //,'r' l� Applicant Signature: .l'..i A 4'i " Date: / -0 ' WARNING:FAILURE TO SECU' WORKERS'COMPEN f'ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TOTH-'/e T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under p•• Chapt: 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.# Amoi Class# Contractor's Signature: APS—,.1 ..�� Date: 'S"J 54 7 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 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 driver's license. 0 Yes 0 No Driver's 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 ❑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 fent 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 0f 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 en 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 application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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 ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 II 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 Califomla Health and Safety Code Section 42303 been made? 0 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 slate 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. „id atty'•f L:ry'•wner(s) Data •nd/•r A •.orized Applicant Date CODE t INSPFCTIONTYP[ PAM INTmAI' CODE! INSPECTIONTYPF UTE 1-27 $ 1618 Fixed System Final Fire Prevention 206 Final Mechanical -c) 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 PROJEOADDRESS: 1779 TANAGER DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06526E OWNER'S NAME: SIMON, BERNARD ADDRESS: SIMON, TERRY D PERMIT NO: B 065266 PLAN CHECK NO: N GOVT: N SUPP : N 1779 TANAGER DR COSTA MESA CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: NEW 714 ) 662-0696 ARCH/ENGINEER: YEOMAN ASSOC . REG.NO.: C-46363 JOB DESCRIPTION : T/O, RESTH. 6 REROOF W/CONC. TILE SQ FT: 8, 500 ADDRESS: 000000 UNIT: REDLANDS CA 92222 CLAIM VALUE: 8, 500 . 00 CALC—VALUE: 8, 500 . 00 GROUP OCC : R-3 / PERMITTEE: BERNARD SIMON ( 714 )662-0696 ADDRESS: 1779 TANAGER COMMENTS : SMOKE DETECTORS ARE REQQUIRED PER 1991 UBC. C.M. CA 92626 ***************************************************TE*************************** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU I R EMENTS 70001 of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: • Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'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 FR NT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.Cf. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: ESP.DATE: • COMPANY: PARKING REQ: PROV: PARCEL: 13962403 ZNE: REF NO: Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > •2. Date: Applicant: *********************************************************************'********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed'dhe ermit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N T S I certify that in the performance of the work for which this per ' is issued.I shall not emote an; rson in any manner so as to become subject to ale Workers'Compenion Laws of California, ZONING APPROVED BY DATE: .1. / Date: 9 4' Signathru: NOTICE:II,after making this declaration,you should come subject to the Workers' mpensalion provisions of the Labor BUILDING APPROVED B Y DATE: r Code.you must forthwith comply with such prowsion or this permit shall be deeme revoked. p., CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lendin agency for the performance of the work for APPLICATION ISSUED B Y; DATE: -I O�,I IJ which this permit is issued(Section 3097,Civ.CI. **************fit******************v, . * *******************************•*. *i*#�' 3F** LENDER: ************************#******##*******************************************#** ADDRESS: INSTALL CONC, TILE, LEGALIZATION: N F E E S, U M M A R Y STRUCTURAL SEGMENT: Y ICBG# 301 , 9 . 5PSF OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 108 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed $5 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 for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE 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 TOTALS————> 108 . 85 0 . 00 0 . 00 108 . 85 108 . 85 . 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.If,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: 108 . 85 OVER/SHORT: 00 for the 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 108 . 00 . 85 © and Professions Code: The Contractors'Slate 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).l am aware *..N.**..**..*.*.*.***.)F*..N..*..*.**.N.******.****.*****..N.***.**.*****.********,*********#*****1F*#******* that proof of their Worker's Compensation insurance should be provided to me. ❑ am exempt under Section: B.A.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 ` V � _9JO / ai ''' Date' Owner: I do hereby certify that I am aware of and understand the requirements of C kfornia Health and Safety Code.ections 25505,25533,and w SFR 8500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 8 , 500 . 00 25534 and that I or any future building occupant will/will not(circle one)nee•to comply with said state cot s and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management Di.trict.Residential coostructio applications are exempt from these provisions. Date: ApplicantSMOKE DETECTOR I hereby certify that I have read This application and stale that the above information is nett. agree to comply with all city and county /�p ordinances and state laws relating to building construction an ereby authorize represe es o this city to enter upon the above-mentioned REQUIRED property for inspection purposes l� >A 9 Dale: I)' , / Signaler 0 0 2 .•r 01 801`2.34—OJI`_03.'=i TCgT LT ..,. Driver's License or Social Security GATE: 12/79/93 T:! E•• Il"w:3g 1641-46 White—Building,Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor •CJNSTRUCTION AND PLANNING POt. _ & SPA -� APPROVALS Permit=rr Date Inspector APPROVALS Permits Date Inspector ' _ 1. Temporary Electrical Service or,Pole 52. Pool & Equipment Location i 2. Sof Pipe-Undrgrnd. 53. Steel Reirforc,'Tcnt 3. Electrical Conduit Util ty-Lnd-grnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumb rg & P'essure Test 6. Electrical LIFER Grnd 57. APPROVAL TO COVER•GUNITE • 7. Footings 58. Electrical Cor dud Und•grnd. 1 �l 4 8. Foundation 59. Gas Pipe, Urdrgrnd , Test 9. Water Pipe-Undrgrnd, 60. Backwash Un,..P-Tran, L:rdr.rrd. - 10. Structural Floor System 61, APPROVAL TO L'ECK ` 11. Property Sewer Line & House Connection 62. Backwash & Ri ceptur Final 12. Sewer Cap 63. Heater & Vent-F al • 13. Roof Grains 54. Plumb ng Si stem • F•^31 --t 14. Rough Plumbing 65- Electrical•Fina'l 15. Rough Electrical-Conduit 66. Solar System [mai 16. Rough Electric Wiring 67. Fencing & Ace's Approval i 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • 20. Rough Factory Fireplace APPROVALS Permit -it _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping f;Gas 0 Oil - -H 23. Gas Pipe-Rough & Test 72. Underground Flush -CO 24. Roof Framing 73. Undergrnd Storaie.Tank El Gas El 01 25. Roof Sheathing -2-1-c17 64. 74. Overhead Hydro int - . 26. T-Bar Ceding IStructurall & Monocoat 75. Dry Chemical "• i •r . 27. Frame and Flashing . 76. Dry Standnme :.la ' 1 • 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ; s r • 31. Plaster Brown Coat 79. FINAL INSPECT ION 32. Electrical Power Meter•Final 80. FOOD CERTIFICATE ISSUED lin 33. Final Electric Notes: 34. Final Heating & Air Cond,t'orlrg 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 1 40. Gas Service-Final _ I 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING bwg 48. FINAL PLANNING r ,T y 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PATIO COVER DETAIL 6/1 /67 TYPICAL JOIST ANCHOR rr i"wI STATE—`----...____� �ia'Z SIZE SPACING SPAN J.°j /Bi r• OVERHANG M II RAFTERS: ..y _i ..o---SLOPED FOR DRAIN I' STATE LENGTHSPAN % J - If , n �, 1 O . 0 MAXIMUM /s • . _ .._ CONTINUOUS 3/8's 5'Lags 32% LEDGER --.'� Blocking 1.,,___4' % MAXIMUM Predrill Ledger /� Predrill Existing 1/411Deep '4 iwwwwwwwwwwwwwer JOIST HANGER BEAM Or other approved methods of support • tie. NOTE USE REVERSE SIDE FOR PLOT PLAN. Tor', TH I STATE SIZE NO 1 RAFTER - CHART NO 2 ALL LUMBER DOUGLAS FIR FOR OPEN EGG CRATE FOR SOLID SHEATHING. �♦ ,1. 3/16X2"'-T-STRAP 'CONSTRUCT/ON' GRADE ALUMINUM OR PLASTIC ROOF COVERING SHINGLES OR BUILT UP a i SIZE SPACING ROOFING. i MAXIMUM SPAN MAXIMUM SPAN I X 17' 0" 2x6- I2°/. 15' 1s 2 16' 0" 2'x6` I6% 13' 3""_ Z POST-BEAM I 5' 0 2'x 6' 24% 10' I1 fCONNECTION 12' 0" 2`x 4" 12'% 9' U" 1 +; ^ I I ' 0" 2"x 4' 16'% 8' 8" POST 10' 0" 711 4' 24% 7' I" 1• (o x 6. q ' r NOTE : FOR PROPOSED OR FUTURE ROOM,OR WHERE PATIO SHOW SIZE SHOW SPACING WALLS ARE TO BE BUILT. USE NO. 2 CHART ONLY. l. SHOW LOCATION ON REVERSE SIDE. WIDER RAFTER SIZE MAY BE INTERPOLATED FOR 4 ; SPACING ONLY. Pint III DROP PATIO FLOOR FOR PROPOSED OR ;FUTURE ROOM OR WHERE PATIO -..— SLOPE TO DRAI)4 . e ' WALLS ARE TO BE BUILT SUBMIT COMPLETE HOUSE .° .... •. '.:: : ...:3T THICK SLAB `.:a ' r �_ la AND ADDITION PLANS PUDDLED SAND FILL w ,_ CT�w2G ' Remove Grass And Weeds Down To Natural Grade I 12' - CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT POST ANCHOR I I. .. . 71 GALLONS PER SACK CEMENT. For Pipe Post. Embed I"�'12 1 Provide 26 Ga G.I. Flashing At Wood Floor Const. COSTA MESA . BUILDING DEPT. Pipe In Footing. Provide Flange Or Weld Plate Screwed Or Bolted To Frame. 77 FAIR DRIVE 834-5273 CMF 00012-46 (BU 40) r C r ---- S ___ v. „..,„G •• s .05 7,G y (r1( r:7CI j J/w/� �1' S'AJ(Cr rA,•-,r/ Y / I APPROVED CITY OF COSTA MESA jr.: < PLANNING D€PT. GX sUBJE 7 70 BLDG. DEPT. REG ' pA,7/Jlv Ca 4�� J BY L ._,... DATE t 41-'7? DIlEc7O! OF PLANNIN0 1779 74,v4cf A )'4 •0 M 7:49 NAre2 3707// /39 — 61 _ a 3 j} p STRUCTURAL APPROVAL ONLY U SD City of Cosa . 1esa Building Dept, SEPARATE PER6IITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, BY DATETIZ Tv.7_/ HEATING, VENTILATING AND THESE PLANS MUST BE ON JOB AT ALL TIMES REFRIGERATION WORK OF 140 CHANGES WITHOUT PRIOR APPROVAL OF DEPT. / 1 THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL P((�� �- eTy # 'L 7 f3 OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED erl, ! v I TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION THIS NUMBER MUST hCCC,,,, A,.Y OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE- ALL INSPECTION REQUESTS ft SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL. f FDI+ L"IL01:;(k3 '::;«-':PERS01'S ARE TO , THE ISSUANCE OF A PERMIT BASED UPON PLANS AND I BE EI,'.F'_D:LD, t::: SU ZEST THAT THE ! , SPECIFICATIONS SHALL NOT PREVENT THE BUILDING CFFICML �$1„T: 0 u LIF ..l1 VISION OF I FROM THEREAFTER REQUIRING THE CORRECTION Of F4ROR5 1 'DUS7R:i+l. ° FET; F.i CC.'SILTED FOR i IN SAID PLANS AND SPECIFICATIONS OR FRO`, F,73CCTING I Nnp1Tl0 : l P Zn'J 9El'6E1ffo. i BUILDING OPERATIONS BEING CARRIED ON THERLC S ''IFN I _. _ IN VIOLATION OF THIS CODE OR OF ANY OTHER QaDIN:-LE OF THE CITY. "yV ., . 'JOB ADDRESS 1779 Tanager Drive BUILDING PERMIT NO. 38069 ^:GENERAL CONTRACTOR Custom Craft Masonry DESCRIPTION of WORK Blockwall AP No.139-624-03 LOT TRACT FIRE ZONE VALUE $ 500.00 • INSPECTIONS Signature Date TYPE III GROUP J ZONE R-1 SOIL PERMITS ISSUED GAS SUBCONTRACTOR \I WATER Date Number Signature Plumbing +ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER 0 ROUGH WIRING Heating and Vent. TRENCHES 0 FORMS 0 STEEL REINF. FLOOR SYSTEM^ BOND BEAM IJ STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT n PLASTER, BROWN COAT STRUCTURAL, FINAL Elertric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST in ELECTRIC, FINAL �I 1 BUILDING, FINAL cocriei ocnumcurNTS 4806 9 R 13 7PAIB00 4 5.50 COSTA MESA BUILDING-SAFETY DEPARTMENT IItl's' t,4 trz'<att P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely � PP TION FOR BUILDING PERMIT /77 ? T-ti 9ez• L/z/ RE EV D D.AT�F�EI�' DATEI ISSUED. BUILDING l d/7 ✓A I A /"D. ADDRESS / {� /� rip / 4t 31 Q OWNER 7 L y,ckSON• A.P. NO. 139 -lot O �!9 MAIL ADDRESS Yam✓✓s'C_ ' ADDRESS BUILDING 1�/7 j �?Welt W trt�Z Z Q TRACT tp lS IS LOT7 T BLOCK ��z��>> TEL. 0. Z CITY /+�^'G-` NO. ON CO DERUCTION N �tR - NEW ADD ALTER REPAIR MOVING DEMOI ISH LEam J D BRANCH - a J N e OWNER // m J ADDRESS VSE / ,/ �/ VALUE$ -m ARCHITECT TEL. 4j [�C�i ..., < OR ENGINEER NO. 6 to FIRE WCC ADDRESS - Z Q ZONE TYPE GROUP cl_Ly /��j' , ,, `�-- J O CONTRACTOR ✓C44.'-6YTL .e �J40• BY DATE E DATES �,3 —74 m .2304-6 fj A ((( J x ADDRESS #0 7 pct64— 6-e- w Lu / / TEL. r ZONA..., NO.OF USE OF NEW Z = CITY Pz�L No. I�JtQ. 1 l PLANS 2 BUILDING (eL� Lau_ STATE CITY YARDS APPROVED YARDS APPROVED y CC LIC. NO. ? / z 5-d LIC.NO. MAIN BUILDING ACCESSORY BUILDING D SIZE NO.OF BLD (FROM C/L STREET) [� OF LOT I GS. NOW ON LOT FRONT FT. 8 O FT. •} USE OF EXISTING BLDG. 1 CSS • R.SIDE FT, --ea— FT FT, H SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. "" FT. VEXTERIOR WALL ROOF _ COVERING ICOVERING REAR FT. FT. _�I J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& d d MAIN BLOCS. ACCESS.BLDGS. _ v • VAR.# DATE OQ (/GU / G r /1 C.U.P.# APPROVED I— A YC�XIy APPROVEDlam 0cs OZP 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 F any person in violation of the workman's compensation laws of KO/ (n the State of California. 0 Z I hereby certifytthat I am properly licensed as a contractor under S0.FT. o the State of California Business and Professions Code, Division 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: 9 II am exempt from tl'e provisions of the State o]'fCalifornia Business _�y� and Professions C Division 3,Chars( • VALUATION ATION r/_ m C PERMIT FEE $ N D Signature of -e m Permittee $ sTt°CO r PLAN CHECK $ E v ��/ o Authorized Agent S— u. TOTAL FEE $ OWNER Bernard Simon DATE 8/28/79 JOB ADDRESS 1//9 tanager Drive BUILDING PERMIT NO.48715 GENERAL CONTRACTOR Prevlos Uwner DESCRIPTION of WORK Legaife 1 r talcnTly AP No. e " -I LOT ' TRACT` • FIRE ZONE VALUE . II • " INSPECTIONS Signature Date TYPE V GROUP ZONE RI- SOIL uGAIL SUBCONTRACTOR GAS PERMITS ISSUED Date I Number J Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE I] HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND [ POWER u ROUGH WIRING I Heating and Vent. Li TRENCHES U FORMS STEEL REINF. ❑ FLOOR SYSTEM BOND BEAM STEEL REINFORCE n SHEATHING FRAME AND FLASHING - LATHING - IN Fl OUT n PLASTER, BROWN COAT FF�� STRUCTURAL, FINAL Elert,ic E )( P I R F y --- ) HEATING. VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST (i Incomplete In.'.peCtlOt'IS ELECTRIC FINAL 1975 8/28/79 66.51 TL COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIOlf FOR STRUCTURAL.PERMIT P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626 t'- REC 'PERMIT N° - 8'715 For Applicant to Fill in Completely —Use Ink Only 1 ADDRESS /779 .7.4.4".4 E A, D�/VE A.P. No. /'39 - 62.y— d3 OWNER OR ayADDRESS /1 7 /p TA'NQ �/< P4 TENANT F�`,40 S,^ON UNIT OR MAILING , SPACE NO. ADDRESS /'77/ rq,.€ .4-C=ax p, TR.NO. LOT �BLK. CITY CO-C7:4 C4 Sur zG NOL 7Z1 9 7..+8 �� NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION `']\I LENDER BRANCH ,��,��e rrr��� OWN -I�--T� �7 Qww ADDRESS USED ��b ( a7W�E ARCHITECTEENGINEER TEL. OR ENGINEER NO. N ADDRESS ZONE / YPE �� GROUP /�/j�/ CONTRACTOR r4 AP e ��� BYPROV ED DATE vUP/iQ/ /7 f7.4 7/d Co t'Ert l / ADDRESS TEL. CITY NO. F STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. SIZE wS^ (FROM C/L STREET)�/( 414 OF LOT X /U t7 J NOW ON LOT NO.OF BLOCS. / FRONT A-* .4ro RX/S7/.VF Q USE OF Al$/q� �fL EXISTING BLDG. �- Sty.%rs yE.va£ R.SIDE S FT. tO F Separate permits are required for L.SIDE •% FT. electric,plumbing and heating work. REAR /S— FT. GIQ USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION —r—CGAL/ ea EJ As-rr�F /14-7ro Govt 4 . n J/s DATE n �'( APPROVED Q 1 r ROVED DATF .. f (�8/7 q I C W . a0 I hereby acknowledge that I have read this application and state r Qj that the above Information is correct and agree to comply with B. all laws regulating building construction, and I shall not employ i Z any person In violation of the workman's compensation laws of 2 W the State of California. m 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. to the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR t0 Chapter 9, and that such licenses are In full f•rce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt froj he provisions of the ate • California Business VALUATION PERMIT FEE $ and Profession j de, Division 3,Chap 9.I • , a0 Signature of f� PLAN CHECK $ Z' et, 2 e 2 Permittee II / .Q / r SCJ Sir kii ' $ 7Sod TAX E . J / t2 Authorized Ag- t Date` .'= • TOTAL PAID $ rG., ! U 27 4 33713 . // R /2 , , - - 1971 COSTA MESA BUILDING-SAFETY DEPARTMENT P,6,BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FORBUILDING PERMIT For Applicant to Fill in Completely • BUILDING 77 �(//�t RECEI�[.FD BV DATEREQF�IVED ,DATEISSUED ADDRESS 7 / / 9 ±QAI JA re-, /Uz'LC-(l-¢� /�6.:1///1 C/j �O(/' 7 o —57-7 �n� n �o np r .... PERMIT NO. OWNER tF.fetcr A.P.NO. g 1/4- MAILDBUILDING 777 ADDRESS � 2Q SO/4Z% ADDRESS / , Z W W ////��]� NEL. .Z/3J TRACT 6/ry LOT r BLOCK HIt_U CITY / Q�Q/� NO. Z 2 Q CONSTRUCTION NEW • AOD ALTER REPAIR MOVING DEMOLISH 0 gp LENDER 1.,/ J D BRANCH t/ c7//J�,9-� OWNER w /r CC W ADDRESS T �fy,, J Q AR EN(NEE ,/n� ' /� 11,,,. //A,NO. ,QTD`SISL USE /�/ /�"/V VALUE 4102�OOD U N flY i �l��L,C�t.(�V-�a-(-La . V FIRE / Q r / GROUP PiW 6 ADDRESS p^C:)L/dc �(,aCOel�t A ZONE TYPE I Q.Ly W Z APPROVED J O CONTRACTOR 1,1„0_0,.... ��_ l�M.-.n...r� BV DATE Z Lfs 0 f 14-ch:J., Lr- �" W w• ADDRESS W ZON- NO.OF USE OF NEW -�7., N. =y� 0= 1Y.lt_ n TEL f/ (�(; PLANS a BUILDIN a O"� Z F CITY�O.(i Iw JL NO.5Tn'8d3 ♦ . 4. /// �. , W0• STATE , // // ^ CITY YARDS APPROVED YARDS APPR.VED j O LIC.NO. `'te, 4L R LIC.NO.raO g-3 MAIN BUILDING ACCESSORY BUILDING SIZE / NO.OF BLOCS. (FROM C/LSTREET)/J/ OF LOT ,9 S r jC /O Q I NOW ON LOT ( / FRONT ..5.1) FT. d t.. FT. USE OF EXISTING BLDG. R.SIDF 1/4nFT, FT. I- SIZE OF pC// / d/ NO.OF q r Z NEW BLDG.�7(O6 ROOMS // STORIES 2- L.SIDE l7 FT. FT. Q EXTERIOR WAIL.� ROOF /' + V COVERING .i& C.LO (COVERING REAR ply FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& CI. . Cir 0,E Tie_ MAIN BLDGS. ACCESS. BLOCS. Q a VAR.* DATE O C.U.P.* APPROVED ~ APPROVED /O - /f/` 7/ Z �Y DATE ` o , HOLD FOR SPECIAL RFOUmnifirwrr U I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with ¢ all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of y he State of California. 9'44 SQ. FT.Lj / / co ? (9 I hereby certify that I am properly licensed as a contractor under //J(� o the State of California Business a • Professions Code, Division 3, THE AMOUNT SHOWN S(J DER VALUATION IS FOR i Chapter 9, an• hat such li en in full force nd effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 2 am exempt f the proof on State of C Orilla Business VALUATION 2 (/ 0 m and Professio ode.Diton .ptar 9. PERMIT FEE $ /3 7---� j Signature of f/ ,/ / vV / to Permittee Azaf v $ Vc2500 PLAN CHECK $ (p 7 90 o i Authoriz-. gent ac/ u ` TOTAL FEE $