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Home My WebLink About1811 TANAGER DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa 9bTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1811 TANAGER DR Suite No Vicinity: Parcel Nunmber: 13963109 Applicant: DERLETH , MIKE. Address: 578 WASHINGTON BL MARINA DEL REY SUITE 207 Owner: BURKE, WILLIAM M Address 1811 TANAGER DR COSTA MESA, CA Phone: 310-827-8664 Zip 90292 Phone: Zip: 92626 Contractor: DERLETH CUSTOM CONSTRUCTION INC. Address: 578 WASHINGTON BL MARINA DEL REY Phone: 310-827-8664 SUITE 207 Zip: 90292 Quantity License: 830190 SCOPE OF PERMIT ADD 31 SF NEW 180 SF REF B06-00394 23 LIGHTS, 6 OUTLETS AND 10 SWITCHES ISSUED BY: Status: ISSUED Applied: 05/18/2006 Issued: 05/182006 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) i 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 expiraticri of this permit. FOR INSPECTIONS CALL: (714) 7545626 244r,46 (WOO) FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 it $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) 50.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kvalkw $0.00 0 Pool / Spa ' $0.00 0 ................up to 10 kvalkw $0.00 0 Lighting Fixts $24.19 23 .................up to 50 kvalkw $0.00 0 Recept Outlets $6.60 6 .................up to 100 kva/kw $0.00 0 Switches $11.00 10 ..................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 1 hp $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 $65.29 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21.92) i EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. ` INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiraticri of this permit. FOR INSPECTIONS CALL: (714) 7545626 244r,46 (WOO) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the fallowing declarations: ❑ have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which pemrit is issued. and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My w rkers' ompensation Insurance carder end policy number are: %� 7 O _ O O Carrier: �iA-tE F✓^v9 oli umber:oo�"-' section need not be Completed it rhe permit is valued at one hundred dollars ($IOD) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith cant Slgnatur ,� O C WAR RE TO SECURE WORKERS' COMPENSATIIXd COVERAGE IS UNLAWFUL AND SHALL SUBIE a.O CRIMINAL PENALTIES AND CIVIL RNES UP TOONE HUNDRED THOUSAND DOD-ARE ($100,000), IN ADDITION TO TME CAST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED C ACTORS DECLARATION: 1 here inn m license Q�^3 r provi 'ons of Chapter 9 (commencing with Section 7000) of Division 3 of th ss anr? 'Qfessions Code, and my license Is in full force . Lic. q h 5 ass a L� 1 Co r lure: CONSTRUCTION LENDING AGENCY: ❑ 1 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 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.). ❑ 1, 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. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in Connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-Six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Pernit 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? ❑ 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 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 farm for acutely hazardous materials? ❑ 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ Na (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 RAI 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 Coda been fully complied with? ❑ Yes ❑ No ......................................... __.............................................................................. _... _................................... ..................... _.............................. _.................................. ___.... _...... _....................... -................. ...__.................. __............ __............. 5, Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication a Ppermit for such Construction or modificallon from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? ❑ Yes ❑ No (11 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 California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ........................................................... ........................... ............................................................ _............. ............................................... _............................ .................. _..... _..._..._............................................ _............................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 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. 1 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. i atur Legal Owner(s) Date S- 9�- And/ orlzed App CODE 1. INSPECTION TYPE P6SE INTITALS CODE# INSPECTIONTYPE PAN IIS 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 BlocloRelaining Well 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 (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1811 TANAGER DR Suite No Vicinity: Parcel Number: 13963109 ISSUED BY: Applicant: DERLETH , MIKE. Address: 578 WASHINGTON BL MARINA DEL REY Phone: 310-827-8664 SUITE 207 Zip: 90292 Owner: BURKE, WILLIAM M Address: 1811 TANAGER DR Phone: COSTA MESA, CA Zip: 92626 Contractor: DERLETH CUSTOM CONSTRUCTION INC. Address: 578 WASHINGTON BL MARINA DEL REY SUITE 207 Phone: 310-827-8664 Zip: 90292 License: 830190 SCOPE OF PERMIT ADD 31 SF NEW 180 SF REF B06-00394 1 KITCHEN HOOD FEE SUMMARY Status: ISSUED Applied: 05/18/2006 Issued: 05/18/2006 Quantity Repair/ Alt Absorbtion Unit $0.00 Quantity ISSUE FEE $23.50 0 Inst FAU <100 k BTU $0.00 0 Inst FAU >100 k BTU $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $10.65 1 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers> 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Healer $0.00 0 FEE SUMMARY Status: ISSUED Applied: 05/18/2006 Issued: 05/18/2006 Quantity Repair/ Alt Absorbtion Unit $0.00 0 Repair/ Alt Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors /Absorption Systems Up to 3 hp 1100 k BTU $0.00 0 3 To 15 hp/500k BTU $0.00 0 15 To 30 hp 11,000 k BTU $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Boilers Up to 3 hp $0.00 0 3 To 15 hp $0.00 0 15 to 30 hp _ $0.00 0 30 to 50 hp $0.00 0 Over 50 hp $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 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) I EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is si spended 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 2"6-46 tsrool DECLARATIONS WORKERS' COMPENSATION DECLARATION: -I I hereby allinn 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 far which this permit Is Issued. I nave 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. worker pmpensatlon Insurance carrier and policy number are: 6 �� O O ardor. E U�%O Policy Number. 00;1- l 20 action 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 pason in any manner so as to become subject to the workers' tom enation laws of California, and agree that it I should become subjecLtolhe-work tion provisions of Section 3700 of the Labor Code, I shall forthwith " h these pro �� l� 0 / icant Si re: _ Date: b WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby a at I am licensgQ ppder provisions of Chapter 9 (commencing with Section 7000) of Dims' f the Business,$nd Professions Code, and my license is in full force a e 'c. N .f 3 (i �1 0 Class N LS Go ctor to: (� at.. CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affair, 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: 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 Profession 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 provision 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).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the struclure is not intended or of Brad 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 of Brad 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 Lew 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. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ 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 feet of compressed gas at standard temperature and pressure). .... .............................................................................................................................................. ....................... ....... _...................... .... ......... ............... ............................................................... ........................... ............................................................. 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some excepllons, 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 a�ppplication a Permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agencyt L_I Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................._..._..................................................................._..............................................._....._.._......................................................._...................................._....... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "Yee, 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? [:1 Yes ❑ No ................................. _......................................... ___...._..._.___._.._................... __.............................. _................................ 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nOl Owner(s)Date 5-��- D6 Authoriz CODE I. INSPEcnONTYPE QATT. UAL$ CODE I INSPECTION TYPE g 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof - 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1811 TANAGERDR Status: ISSUED Suite No Applied: 05/182006 Issued: .05/182006 Vicinity: Parcel Nunmber: 13963109 Applicant: DERLETH , MIKE. ISSUED BY: Address: 578 WASHINGTON BL MARINA DEL REY Phone: 310-827-8664 SUITE 207 Zip: 90292 Owner: BURKE, WILLIAM M Address 1811 TANAGER OR Phone: COSTA MESA, CA Zip: 92626 Contractor: DERLETH CUSTOM CONSTRUCTION INC. Address: 578 WASHINGTON BL MARINA DEL REY Phone: 310-827-8664 SUITE 207 Zip: 90292 License: 830190 SCOPE OF PERMIT ADD 31 SF NEW 180 SF REF B06-00394 1 KITCHEN SINK FEE SUMMARY AMT QTY AMT QTY AMT OTY 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 R) $0.00 0 Vacuum Brkr Bkaow(14) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkaow(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 Conned $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 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califoinla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) I EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is i uspended 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) 7545626 244648 (moo) DECLARATIONS L 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' compensatlon, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. y workers' �pF�ation rance cc rner and policy number are: 6-7-70 OO I TCC !-'UNC olicy mbar: OO� (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these {/ Applica re' WA RE TO SECURE WORKERS' COMPENSATNRS-COVERAGE IS UNLAWFUL AND SHALL SUBJECT IN RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU AND DOLLARTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. L1heKbS;.:ff,!-� ACTORS DECLARATION: m license n er rovi:Ions of Chapter 9 (commencing with Section 7000) o t e usiness'yn Professions Catle, and my license Is In full effect. Lic. A j =/ 0 Cltract — TRUCTION LENDING AGENCY: ❑ 1 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 Professlons 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.). ❑ 1, 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 drivels license. ❑ Yes ❑ 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: ❑ 1 hereby certify that no excavation live (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 B, 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? ❑ 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 feet of compressed gas at standard temperature and pressure). .._......................._._............................._................................... .............._...._—.._..................__..._.............._.__.._...................._...._.............. ___ _........ _............. ................. ._._............_............__..... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ._..................._.__._......................................................_....................................... _........................... _._.................. _.._........................ _......................... _------ .__...___._................ _.__................ _.......................... _......... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..........._................................._...._.___.................__._.__..................................._._.......................__.........................____....................._......................................................................._...._..................__............._................. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes [I No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisplication epp,emit for such construction or modilicatlon from Me South Coast Air Quality Management District or from any other air pollution control district or egency7 a � Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ......................_...... ............................................................. ................................................... _.__......................_......................__._...............___...................................................................... .......__._..............._............. _............... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (It yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................... _............. __........... _........................................ __.................. ..._............................ _...................... __.... _................................ _........ __................ _.................... _............. _................. .� 7 11 a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................._............................................................ _.....................................................__....................._.........................__.................___._......................................................_............... _._................ _............... _.... _......... 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ^ M� Sig a Of Le ner(s) / Date And/Or Au nt CODE I. INSPECTION TYPE 2AN- 111TITAL$ CODE INSPECTION TYPE RAN IHTMAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 3 S 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Well 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 VA Job Address ' 16 , 14s, Inspector's Name tJA t,,V Residence Address 'ECIAL INSPECTOR REGISTRATIOP Laboratory_6 2 V&-2 —2 I Address All licenses listed below must be currently valid and legible copy(s) and must be attached to this registration. DISCIPLINE L.A. COUNTY L.A. CITY ORANGE COUNTY OTHER CONCRETE (� DUCTILE MOMENT RESISTING FRAME REINFORCING STEEL PRESTRESSING STEEL WELDING HIGH STRENGTH BOLTING STRUCTURAL MASONRY REINFORCED GYPSUM CONCRETE INSULATING CONCRETE FILL SPRAYED ON FIRE PROOFING PILINGS, DRILLED PIERS, CAISSONS SPECIAL GRADING. EXCAVATION OR FILLING SPECIAL CASES UNUSUAL HAZARDS I hereby certify that I am qualified by training and experience to perform the inspections for which I hold the above listed Special Inspectors licenses, and will provide all certifications required by the City of Costa Mesa. I will inspect and certify the following procedures: �- /- Y' y f_ <f-10 A/V ( 11C <-. 4-- /I.k N 2_-T -Qs i I <-r-f TV 12 i l n N\ 6-r ►J , - � % - z �y • &�� I will certify not only to the job conditions but that they are in conformance with the approved plans. If at any time, progress occurs on the above mentioned job relating to my area(s) of responsibility, without my knowl- edge or approval, I will stop the jobs progress immediately with notification in writing to the job superintendent and notify the Building Division of the situation. A record of my tests and/9r inspections as agreed to above will be available upon request by the Building Division. Upon request I will submit a complete package of testing and inspection results. A letter certifying satisfactory completion wilVbe provided by me upon completion. if—Oe`a This (Plan Check and (Building Date CMF 1066.46 White- Building Division; Canary- Special Inspector; Pink -Developer REGISTERED DEPUTY INSPEC,OR NANCY GARDNER PH:Ir9II0� `` t SPECIAL INSPECTION REPORT Building Permit No.Joq No. Job Identification /Address General Contractor/ Address ZJ:# i U6X)E!� A )5 °'ub - Contractor/ Address Structural Engineer/ Address Swctural Engineer / Address ,-;�Q N V, TYPE OF WORK: REIN'MRCEDCONCRETE MASONRY PRESTRESSED CONCRETIi_ WELDING Sv�245�ILta' Date HI -TENSILE BOLTING GYPSUM CONCRETE Datc Re . 'O.T. TU1L IN TIMEOUT Miles e Code h iuti • • DESCRIMONOF • .. �iL '- -- �� ' ► — rcu. .i �- � ' — r.•r; - — ��. _' Datc Re . 'O.T. TU1L IN TIMEOUT Miles e Code h iuti All in,peeuuns based on minimum 0[4 hours & over 4 hours - 8 hour minimum. In addition, over 8 hours and Sat(rd; will he billed at time and a half. ' AT )ENF.Y'S FEES - If any action at law or in equity is brought to enforce or interpret the terms of this Contract, (tic prevailing party shall be entitled to reasonable attorneys fees, costs and necessary disburse me�tsa addition to any other rc)ief to which such party may �e entitled. CERTIFICATE OF COMPLIANCE Registered Deputy Building Inspector's certificate Signed by Inspector-JL11ol I / I k � p7� __ I.D. NO. &pLAl71k'i has been filed and it states that the above work was inspcicti by him and complies with iht provisions of the Buil i g Code applicable thereto. DEPT. ovsf-DG. & SAFETY CITY OF & f Respectfull'Submiued roved by. By Certified Special Inspection Nancy Gardner 5852 Raphael Dr., Huntington Beach, CA 92649 Pho-ie (714)-- - • Cax (7 Building Permit No.. Job Identification /Address _ General Contractor / Address Sub - Contractor/ Address Structural Engineer/ A'ddre Structural Engineer/ Addicss TYPE OF WORK: SPECIAL INSPECTION REPORT Job No. DEPT. OF BLDG.& AW ETY CITY OF . COUNTY OF Date__ REINI ORCED CONCRETE _ , MASONRY , HI -TENSILE BOLTING PRESTRESSED CONCRETE. _ WELDING GYPSUM CONCRETE WELDER :R ECU PT NUMBER WELDER __- RECEIPT NUMBER TIME OUT Mileage — Initials O1-- DATE OF INSPECTION DESCRIPTION OF WORK INSPECTED: "-:G fta ia u 3q ILl" btfjf STz t 52-7 'CCk� 2-05 VR.LLLa> -7II ;5+ker5F 6 5 � &�JW►1 HOURS Ram I Reg. O.T. TIME IN TIME OUT Mileage Code- Initials O1-- All inspections based on a minimum o(4 hours & over.4 hours - 8 hour minimum. In addition, over 8 hours and Saturday will he billed at time and a half. ATTORNEY'S FEES - If any action at law or in equity is brought to enforce or interpret the terms prevailing party shall be entitled to reasonable attorney's fees, costs and necessary disbursepreirt� other relief to which such party may be enthled. CERTIFICATE OF COMP Registered� Dep,u�t Bu !ding inspector's certificate Signed by I. D. NO. "J�( has been filed and it states that the provisions of the Building Code applicable thereto. DEPT. OF BLDG. & SAFETY CITY OF of this Contract, the in addition to any Inspector -"C/" V `CN above work was inspect d by him and compliesrwith the Respectfully /Su m ted By (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.S11LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1811 TANAGER DR Suite: Vicinity: Primary Occ: R3/U1 Parcel Number: 13963109 Applicant: JOHN MCNEELY . Address: Owner: BURKE, WILLIAM M Address 1811 TANAGER OR COSTA MESA, CA Type of Construction: V -N Zoning: R1 Phone: 714-444-4915 Zip: Phone: - 714-979-2046 Zip: 92626 ISSUED BY: Status: ISSUED Applied: 03/10/2006 Issued: 05/18/2006 Contractor: DERLETH CUSTOM CONSTRUCTION INC. Address: 578 WASHINGTON BL MARINA DELREY Phone: 310-827-8664 SUITE 207 Zip: 90292 License: 830190 Arch : Eng: STEVE AHUNA Address: Address: Phone: Phone: Zip: License: License: C34264 SCOPE OF PERMIT ADD 31 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD 31 S.F. TO IST FLOOR, NEW 180 S.F. FRONT PORCH, EXTEND PANTRY INTO EXISTING GARAGE AND ENTRYWAY INTO EXISTING PATIO, REMODEL KITCHEN. REMOVE WALL BETWEEN KITCHEN AND LIVING ROOM. PANTRY EXTENSION REDUCES INTERIOR GARAGE DIMENSION TO 18'-6", HOWEVER BECAUSE GARAGE IS A THREE CAR GARAGE, THERE IS STILL ADEQUATE AREA TO ACCOMODATE TWO CARS WITHIN GARAGE. EXISTING 2 STORY S.F.D. FEE SUMMARY Plan Check: $208.81 Permit: $321.25 SMIP Res: $2.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $532.06 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 30-0 ACCESSORY Front 0-0 PARKING Existing: 0 Calc Valuation: $20,000.00 Claim Valuation: $20,000.00 Rear 0-0 Left 0-0 - Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 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 DECLARATIONS A& 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 workfor which this permit is issued. I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. orkers' compensation Insurance carrier and policy number are: //�y ,f. nkT Carie STA HF_ ;(MAID 0b otic Number: d (6776 —2 0 O 6 Is section need not be completed if the permit is valued atone hundred dollars ($100) or less.) - ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith 02thes I A nt Sign e: `lata: AR 'LURE TO SECURE WORKERS' MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN R TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL -ARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby a at I am licensed under prov{"si ns of Chapter 9 (commencing with Section 7000) of Div a usiness anILPrDfesslons Code, and my license is in full forc nal. Lic. R T 0/ 0 Class N Y/ a $ — % CONSTRUCTION LENDING AGENCY: ❑ 1 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.). ❑ 1, 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. ❑ Yes ❑ 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: ❑ 1 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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) teat 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? ❑ 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 feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............................................................................................................................................................................................................................................................................................................................................................................................ 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication eppemlit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? I_1 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ......................................................................................................................................................................................................................................................................................................................................................................................... fi Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (It "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely 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? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 8 (If "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ig tura O wnegs) / Dat b And/Or Authorize plicant ate CODE• INSPECTION TYPE P9TE INTMAL$ 99DE1 INSPECTION TYPE DATE - INTrIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy P ADDRESS: 1811 TANAGER DR UNIT: OWNER'S NAME: BURKE WILLIAM M ADDRESS: 1811 MANAGER DR COSTA MESA,CA 92626 714) 979-3456 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: PDC (714)548-9884 ADDRESS: 1818 TANAGER DR COSTA MESA CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) ofPrnles - n 3 of the Business ane sions Code, and my license is in full force and effect. IC .: YLy sTATEuc.:6237cC 39 Dat Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of cc of to wit insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 3800, Lab. C). POLICY NO.: EXP. DATE: ^I reO cop is hereby furnished. ❑ Certified copy is filed with the city BuiNlikkivision. Date — Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This sectmn need not be completed it the m for one hundred j$100) or less). I cenify that in the performance of the work for which this permit is issued. I shall not employ any poll manner so as to become subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: It, alter making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must for lth comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby allure that there is a construction leading agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that 12M exempt from the Contractors' Slate License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing wish 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 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). I, as owner of the property or my em loyees with wages as their sole compensation, will do the work, and the ❑ structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon. and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. 11, 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 for the purpose of sale). 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Prolessions 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 Lonlractals) license pursuant to the Contractors' State License Law). I am aware that proal of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06568` PERMIT NO: B 065687 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION T/O , RESHTH 6 REROOF W/LITE TILE 4.OPSF SQ FT: 15,445 CLAIM VALUE: 15,445.00 CALL—VALUE: 15,445.00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UBC Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 13947907 ZNE: REF NO: PLANNING NOTES. k k k k k k kkkkkk keE.k k k k k k kk k k kk k k k k k k k k k kkk k k k k kkkkk kk k kk kkk k k k k k k kk kk k k k kk k k k k k k kkk D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N1T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: DATE: kkkk*kkk*kk*k*kkkk*kkk kkk*kkk*kkiFiF iH� k kkk k k k k k k kk kiE.lf k k kk k k kk kkkkk k k k k k k kilk k k k k kkk kk kk kkk k k kk k kk k kk k kkk k k k k k k k kkkkk LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 171.00 1,54' PLAN SMIP/NON,—_RES ISSUE FEE 61WOKE DtAlci �� BUILDING—DIV—> PERMIT I QE_ P L� E � TOTAL PAID DUE TOTALS ---- > 172.54 00 172.54 172.54 .00 REVENUE DIVISION TOTALS--> COLLECTED: 172,54 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING-rkAN—CHECK 171.00 1.54 k kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk,kkkkkkkkkk I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST Date: Owner SFR 15445 1 do hereby partly that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and 25534 and that l or any future building occupant will/will not (circle one) need to Comply with said state codes and the requirements for a permit Ior construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above iriation is torr¢ agree t,0 Cempfy with all city and county nil state laws relating to building construction and hereby authorim representatives o ! o enter upon me above mentioned property Ior nspeCllnn purrpppseS. Dat _ y- _Signature: Driver'sLicense orSocial Security Applicant: Pink—Revenue: Goldenrod—Assessor REROOF BY VALUE RESIDENTIAL NOZONE 1.00 15,445.00 END OF FEES r' 01 00153644 -0053645 T03T 172.`v DAVE: 0110144 TT4E: 1 :2 CONSTRUCTION AND PLANNING APPROVALS Permit ;` Date 1. Temporary Electrical Ser;: ..or Poie 2 £ori Pire-Undrgrnd. �3. r ;c:nr_Co--"tT_R'ItY•U^drg'_._- •4 Elec;nca' COnd'�a:J'tdrgr rid - 558. Electrical COI d.: t-,'d•grnd. --._ I(� --{ 53 /. Feat res I 60 ' 9. %'-ter P'Pe Undrgred. — T--- S;stem -- POOL t4 SPA APPROVALS Permit 0— I Date 52. Poo' S! Egwpment L ucat:on 53. Stam Runforcement 5:. Fcr'n -t -�-_- 56. Electrical Bnrd ng ^pe' S .•,.r L. -re & House COrl�ectlon 4. 5 _ - .ct •o. t — 16. r,eugh Eee:r c!:'' r. ng 7. I i8. !loLgh C:c:Tr rtl T Bar C, I, n- _ J --- Inspector I --1_ --_ 67. FCnc„g &t A^L Jss APprovil --: 68 AP'?C\,E-- GCR OLASTE1.AG -- —1-- 1 I - - t-----' -- FI-iE DEP i. REQUIRE:FEN I - -- j Z(� r7'. i)j_t .1 St u,ct.. __-_-- iJ Pny'?ougit & Test_ 77. UI_d, :-a•a i iu (-:,n„__ r 73 U d_nd 5 .'s.: T.nk'-Gas ,� 25. 'Roof 'I -h.nt -_-_-_ -. _— •t-� /7-q �it�(�'-74 Ov 1 -id It IL 76 a I° Ct U'dll EUh„- 7.8. _ tl^ nt ,e $:d.n,i� - TI FIXED Sail Ft.l F I_:AL ---I— --j----- - j 18. FIhLPREV iINP - - T --- ---- - - -- - - - -- - -- - ----- - 30 U'ye.a "'a �l.no I Hf. -TF1 DEPT. REQUIRFP:iE•'T 37_ F r� ,.' is cto, 1 8C.-F(JCD',A !4 c1E ISSUED _ - -t-- :3. -- - - - - - -Itur - - - - - 5 r P.pe T-st .--- �-=- ---- �- - --- --- -- - -- -- - .,8. I n o Co• -opt I -- --- -- 1 F - 5,' :Le _ l 47,,F' «AL �-RUCTURE 8, BUILDING -- I,.49. Eec;tnc halcase to Edison 5C. L:s P.et..}i to Southern Calrtc,,a GasCb 51. CERTIFICATE OF OCCUPANCY j No. --- Date _ - -- - 36 lROL.. i PI„r 7 no Pressu. e Test jj ^I -;-5-- 7 APPPCVAI. TC' (70"FR GUrr ITE i -- - - 558. Electrical COI d.: t-,'d•grnd. --._ I(� --{ 53 GGA Fa- L -d,i:- I_ Trst I 60 Dtc)cv.ash l:,i:s, P -Trop, C Undrgrnd — T--- 61. APP„OVA'- -0 OLCK ii5 E r c ca. ral I I --1_ --_ 67. FCnc„g &t A^L Jss APprovil --: 68 AP'?C\,E-- GCR OLASTE1.AG -- —1-- 1 I - - t-----' -- FI-iE DEP i. REQUIRE:FEN I - -- j Z(� r7'. i)j_t .1 St u,ct.. __-_-- iJ Pny'?ougit & Test_ 77. UI_d, :-a•a i iu (-:,n„__ r 73 U d_nd 5 .'s.: T.nk'-Gas ,� 25. 'Roof 'I -h.nt -_-_-_ -. _— •t-� /7-q �it�(�'-74 Ov 1 -id It IL 76 a I° Ct U'dll EUh„- 7.8. _ tl^ nt ,e $:d.n,i� - TI FIXED Sail Ft.l F I_:AL ---I— --j----- - j 18. FIhLPREV iINP - - T --- ---- - - -- - - - -- - -- - ----- - 30 U'ye.a "'a �l.no I Hf. -TF1 DEPT. REQUIRFP:iE•'T 37_ F r� ,.' is cto, 1 8C.-F(JCD',A !4 c1E ISSUED _ - -t-- :3. -- - - - - - -Itur - - - - - 5 r P.pe T-st .--- �-=- ---- �- - --- --- -- - -- -- - .,8. I n o Co• -opt I -- --- -- 1 F - 5,' :Le _ l 47,,F' «AL �-RUCTURE 8, BUILDING -- I,.49. Eec;tnc halcase to Edison 5C. L:s P.et..}i to Southern Calrtc,,a GasCb 51. CERTIFICATE OF OCCUPANCY j No. --- Date _ - -- - r PROJECT ADDRESS: 1811 TANAGER DR UNIT: OWNER'S NAME: BURKE WILLIAM M ADDRESS: 1811 MANAGER DR COSTA MESA,CA 92626 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: SNYDER L ASSOC ( 714 )f97-2709 ADDRESS: 1038 N TUSTIN 220 ORANGE CA 92667 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codeand my license is in full forces and effect. CITY LIC.:?q 3�L STATE LID: 6 3 817 4 -4f.?-_,ConTto Date: C7—zJ� �� Signature'._ WORXERS'COMPENSATION DECLARATION: I hereby affirm that I have a emhcaself-insure or a certificate of Workers' Compensation Insurance, or a certified cop thereof (Section 3800, Lab. C). POLICY xa.: 29093UNITB 7 EXP. DATE: 04/01/94 COMPANY: STATE 7 Certified copy is hereby furnished. Q Ceralied copy is filed with the city Building Division. Date: P__ It— 1) —1 Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This sectioneed not t completed fire permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issu d, I shalllwt employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: It after making this declaration, you should become subject to the Workers' Compensation' provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Slate License Law for the fallowing reason (Section 7031.5 Business and Professional Code. Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' Stale 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 .1 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the El 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 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 sate. If, however the building or improvement is sold within one year of completion, the owner wifl have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the property, am exclusive[ y contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code: The Contractors Stale License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a Contractors) license pursuant to the Contractors' State License Law),I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Dale: _ Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements fora permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions. Date'. Applicant. I hereby certify that I have read this application and state that the above information is correct. I ordinances and state laws relating to building construction and hereby author¢er sentaI as of It property for inspection purposes. Date9— 137:11 Signature. Driver's License or Social Security Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BP 06350" PERMIT NO: BP 063502 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU SPR PURPOSE: DEM ` JOB DESCRIPTION ; DEMOLISH POOL 6 SPA SQ FT: CLAIM VALUE: 1,000.00 CALC—VALUE; 1,000,00 GROUP OCC: R-3 / COMMENTS: FOR PLANS REFER TO PC#3033-93 Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 13963109 ZNE: REF NO: PLANNING N TES> > D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N-3 S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: �7 O lit APPLICATION ISSUED BY: P.- DATE: ############################################################################### LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 25,00 7.00 253 SMIP/NON—RES PLAN ,50 ISSUE FEE 20.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 32,50 20.00 0.00 52,50 52.50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 52.50 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 25.00 27,00 .50 ############################################################################### I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 SEWER CAP / DEMOLITION EACH 7,00 7,00 END OF FEES 01 00144966-00144968 T53T 5250 DATE: 08/13/93 TIME: 14:21 CONSTRUCTION AND PLANNING APPROVALS Permit# - Date Inspector POOL SPA 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 LIFER Grnd. 57. APPROVALTO COVER-GUNITE 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. 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 Electrica6T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑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 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. .FOOD CERTIFICATE ISSUED 33. Final Electric - Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 1 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. .Gas Service -Final 41. Solar Domestic,Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 3-2 J_cj,66w� 48. FINAL PLANNING 49, Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date CITY OF C STA MESA DEPARTMENT OF rUBLIC SERVICES aMIT `\ APPLICATION AND PERMIT FOR WORK DESCRIBED BELOW NO. VENDOR NO. _ Address or Location at Work vE/C Date s-13 -93 Type of Work to be Done Start Date. r' - t — S Permit Not Valid After S. ` I — `7 IL (Expiration Date) Plan No. Contractor's Name 51t' Y A'C S AsscbCi� Address /3¢/ 45 'VA CA4C&A�Qa Telephone No. (Day) ?5i7- 290 (Night) SYS- 270 6 City & State bd's 6y± rs 9LL -;L State License No./Class %-3Fi�'/ ¢ " C Z ;I- City Business License No. Applicant's Name 5A,16/2/1ER 0 lkuoc'161'2: Address Ss1»Iw� Telephone No. Developer's Name Telephone Na Name of Insurance Co. 41a-12vFwJ &>H4« Insurance Can. No.(s) 24 -Hour Emergency Contact ,-jez t, -CA,1,,7� Telephone No. , 5 !7'7— Z Jv S FEES PERMIT APPROVED FOR CITY ENGINEER Bond $ 48 HOURS MINIMUM REQUIRED. Cash Deposit s 6t_ FOR PROCESSING PERMIT By op Issuance s_ 7 S _ n Date ACa000t N III Z_I Gi 0 G' Inspection S Underground Servide Alert ID No. TOTAL S Parrinim , snail Contact the City Inspector's office (7545025) at least 24 hours prior to Commencing any work, Failure to obtain proper inspections prior to commencement of runs may be muse for its relation. THIS PERMIT WITH APPROVED PLANS MUST BE ON THE JOB AND AVAILABLE TO CIT/ REPRESENTATIVES AT ALL TIMES. You are guided by Municipal Coos Sections 1-33. 15.25, 1547, 1577.1, 15-39. and 15-411 THE UNDERSIGNED PERMITTEE HEREBY CERTIFIES: 1. That ail work shall be performed In accordance with Ins Standard Specifications for Public Works Consimcdon (latest edition): Standard Drawings of the City of Costa Mesa: special agency provisions: and all applicable laws and ordinances. 2. Control of traffic snail COnfovO to the Work Area Tril Control Handbook (W.A.TCH.) (Latest edition). The bsrtmnM shall furnish and%or install all signs lighb- barrimdes, muffic Control or wanting devices, flagmen and flashing arrow bard. The perminse shall obtain approval of the Transportation Services Engineer for all street closures. astcurs. tum rsstncnons. parking prohibitions and methods of accommodating traffic The permmee snal) mostly Emergency, Fire and Police semens and resrdenis or businesses iweny-lour (24) hours in advance of any access limitation or traffic restrictions. 1 That a maximum W lans(s) may be closed if necessary ro perform work within the public light of way during the fours of 5:30 am. - 3:30 p.m. Monday through Friday as long as traffic can be maintained in each direction with flagmen unless otherwise approved by the Transportation Services Engineer. 4. Thai throughout all phases of construction the work site shall be kept Clem and free of rubbish, debns and dust and drainage shall be mambst ed. SUB IECT TO THE NOTES BELOW: 1. Cary will provide inspection between 7:30 a.m, and 3:00 p.m., Monday - Friday (except on City observed hotldays) 2 Prior to placing Portland Cement Concrete or Asphalt Concrete (A.C.), the following will have been inspected and approved; native and imported auOgrsdes and fortes E. Flyasn is not allowed a; a cement substitute. 3. Curb and guner shall not be removed on the day prior to a weekend or a Qty observed holiday. 4. Fill in areas len by Cum and guns, removal flush with the adjacent pavement on the same day that removal occurs. S. Bore under all streets. cums ano gunem, sidewalks. cross-guners and driveway approaches. Tunneling is not allowed. 11 Open e=avauons must be backfilled or plated with spikes and A.C. backed around sages curing nonworking hours. 7. Sidewalk snail be constructed par City of Costa Mesa Standard Drawing No. S Driveway approach snail be constructed per City of Costa Mesa Standard Drawing No. 9. No traffic allowed on Concrete for minimum of seven days for curing. Sea traffic control above. 10. Trench companion and vsurtaang small conform to City of Costa Mesa Standard Drawing No. 813. 11. Trenches exCeeCing live (5) fear in depth require a permit from the Division of Industrial Safety. State of California. 12. Pennines shall pay for all S.E.. Compaction and materials tests deemed necessary by Ins City. 13 All trenched shall W Permanently patched within ten (10) days of completion of work below suograde. 14. Pennines snail provide the City with Ward drawings of permitted work before final inspection by the City. 15. Perini understands and agrees to the hold -harmless agreement required by CMMC Section 15-27 and printed on the reverse of this application. is. Other: NOTICE: Contractor must nolly, me following Utility Companies two working days before staving work: Costa Mesa Sanitary District Mau Consolidated Water District (714) 631.1731 (714) 631.1200 INSPECTION RECORD I UNDERGROUND SERVICE ALERT Toll Free - 1.600-422.4133; Atter Hours 6 Holidays . (r14) 731l (213) 621-3111 Insati Of Remros CERTIFICATE OF INSPECTION I hereby Certify that the sheat work allowed by Int$ permit has been con- structao according to Ina plans and speofimtons and I hereby accept the wank In this manner. 0113-62.. irso I certify I have read and understand all of the above and that all statements made are correct and complete. Whir - Imapaticn'. Canary - Engineeimg. Pink - Rnar¢e: apoucam s Synatwe Date Geiearima - 4poncam 3 COPIES OF SKE-TCHES OR PLANS ARE REQUIRED PRIOR TO PERMIT ISSUANCE `A q y(0 / THIS APPLICATION BECOMES A PERMIT WHEN APPROVED AND VALIDATED YY 4- v Ri Applicant to fill in all spaces except those within heavy bonder lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION-PERMI,I Project'Address ,Applicant's Mailing ALLddress �.53,Q L' .� /Ai2n �A Owner's Name J/1A�0�� C.J�/r�� Phone!29'Z-yi> Address Arch/Eng. License No. Address ..__yy// Contractor's Namel,A/'�A/'�5 �NM%7I4Jt AQ'Phone-212-"-1i/-d Address (mailing),/S i� �-t-�/7 JndII. 4114,AP/nn City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force antl effe. License Class l/ ctLicense Jv N. Date - - 2-`L ^ Signature/�/� WORKERS'COMPENSATION DECLARATION 1 hereby affirm that.1 have a certificate of consent to self -Insure ora certificate f Workers' Compensation Insurance, or a certified copy thereof (Section 18001 Lab. C I Policy No. .o 4��S�0 Company Cerified copy is hereby furnished. Cat tie dvn_. filed with the citt��din D_i visj�n f Jia{/ / Date - / Applican_/ ,EXEMPTION FROM WORKERS' COMPENSATIO N DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less).. certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation l provisions of the Labor Code, you must forthwith comply with such provisions or this -permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the - following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor'sLicense 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 any applicant for a.permit subjects the applicant to a civil nnalty of not more than five hundred dollars ($500). LJ 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 (Section 7044, Business and 'Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and _who contracts for such projects with a con- tractor(s) license pursuant -to the Contractor's License: Law). I am aware that proof of their Worker's Compensation insurance should be Provided to me. ❑ 1 -am exempt under Section B. & P. C. for this reason Date Owner I hereby' certify that Ilhave read this application and state that information is correct. I agree to comply with all'City and county and state' laws relating to building construction, and hereby authc Sentatives of this city to enter upon the above-mentioned pro inspection purposes. / h Si t r /L.(/�' .,l X.-/( �r-rf, 't Date 'D - 1.642 3/24186 5.0; -TI, TYPE OF CONSTRUCTION LJ NEW LJ ADD L ALTERATION LI REPAIR ❑ CONVERSION 1-1DEMOLISH❑ OTHER A.P.# Zone DESCRIPTION OF WORK/USE OF BLDG. - S Main Building: - Accessory Building: TYPE OF PERMIT GRADING ❑ STRUCTURAL FOUNDATION E T Front Z O ❑ TENANT El ELECTRICAL 1:1 PLUMBING ❑ MECHANICAL B N ❑ OTHER A Rear SUMMARY OFTEES $ $ $_sZ '(�C'L $ $ $ $ $ I C Right - - N PROJECT DESCRIPTION SG. FT. OCCUPANCY G CONSTRUCTION TYPE VALUATION $—' S Left R ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided E Q Remarks: Planning Notes: NI ED IINiI L is 5 - - 8 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories - P -Trap Roof Drains Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural , Duct - Ventilating Exhaust System El Multiple ElFirepl/Fact. Bit. ICBG # Heating System & Ducting 1-10-100,000 BTU ❑ 100,000 BTI 9na u e �,� -_ �� I I Reinspection Fee I $15 Drivers' Li IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - P Showers - Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type 1 ❑ Canopy Type II ❑ Refrigeration System 00-100,00013TU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole S Cooking Unit Dishwasher Dryers ❑Gas ❑E Fan F.A.U. Fixtures . Device Boxes Outlets Switches Garbage Disposal Generator El D-5 KW ELECTRICAL Transformer ❑ 15-50 KW ub. ❑ 50+KIN Meter ❑upto'100amps Meter Dover 100 amps lectric Sub Panel Motors 00-1 HP O1%-8 Inc.Solar 1:19-1'5 HP ❑16-15+ Microwave 1 Pole Light Sign Standing Sections 5-15 KW Trash Compactor FE $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Dated Dates�LsTC BUILDING PERMIT ' PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OFTEES $ $ $_sZ '(�C'L $ $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ $ 3 CONSTRUCTION AND PLANNING - APPROVALS Permit # Date Inspector POOL & SPA 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 LIFER Grnd. 57. APPROVAL T0 C0VER-GUNITE t' 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. Structural Floor System 61. APPROVAL TO DECK -11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final ' 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18'. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning i FIRE,DEPT. REQUIREMENT APPROVALS Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping []Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 1:1 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 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe -Test 36. Hood -or Canopy - 37. Final Factory Fireplace 38. Final Plumbing e � (,o 39. Water Service -Final ' 40. Gas Service -Final -� 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - - 45. Sound Attenuation - 46. Handicap Regulations. 47. FINAL STRUCTURE .&BUILDING 48. Special Requirements Completed '• 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF F OCCUPANCY No. Date - - - - `' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA CONSTRUCTION /1./��PERMIT PERgM�rj� �gQ� TRA�C�fI�. LOT NO. UNIT NO. Project Address (6( pp�� tl -i� TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Applicant's MailingAddress ❑ CONVERSION ❑ DEMOLISH ❑ OTF�R AP # Owner's Name �'�i6 Phone �� DESCRIPTION OF WORK/USE OF BLDG. O -VZ t Address 14a.�.'�., + �I �1pow— S Main Buildin Arch/Eng. N �h'i1 S License No. Address (Contractor's Name x -'I .i Lt4 (gae,II j'' Phone�l -l-ed -Address(mailing) b� Ll [-7 /y /'"l��i[d'F W{CJ 1a City License No. (LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Prof e cions Code, and my license is in full j1or� effect. q O Ucensg C s k_- Lice s No. C/ Date I Signature WORKERS' COMPENSATION DEQ A ATION - I hereby affirm that 1 have a certifica of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C � .a �1 Gr% t� Policy ab "� 2 Company 5I �' r ` f `^ tJ ❑ Certified copy is hereby furnished. ertified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the Performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm thapthere is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he/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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own ern ployecs, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code; The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 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 ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of t 1 lty to e u'pon fihe above-mentioned or ery f r ins ecron ur p1ss.\ p Ct`CJi` Signatu�;�Lt I — Date 6779 10/05/87 15,00 TL . I Zone Bar Sink Backflow Preventer Backflow Irrigation Bathtubs rinking Fountains loor Drains loor Sinks as Service Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT Re' ct F Rei (� SS F 1 1 ron ee rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Showers Eg. T ..___--- Front Z O N I N G R E TYPE OF PERMIT ��/❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL Ll TENANT IJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL El iLEEF-I S¢C�[i-lc�..t F("�� A BOTHER FEES PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES C Right K $ Left Ping. Ref. # Parking Req./Provided Remarks: Planning Notes: Q M Sewer Connection T S PLUMBING FEES Meter ❑up to 100 amps Bar Sink Backflow Preventer Backflow Irrigation Bathtubs rinking Fountains loor Drains loor Sinks as Service Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0.100,000 BTU ❑ 100,000 BT Re' ct F Rei (� SS F 1 1 ron ee rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Showers ELECTRICAL FEES Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KW Sewer. Cap Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter Dover 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel - Solar Tank Fan Motors 1:10-1 HP ❑1%- 8 , Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ Urinal Fixtures Microwave Water Closet Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal Standing Sections Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor J$3 Issue Fee Reinspection Fee $15 Issue Fee $ 3 1ANICAL FEES SER VICES Zoning Approved By Building Approved By Application Issued By UIREMENTS: Date _/h. �_�Dat:,,, ��(J Dat Hood or TypeI ElDEVELOPMENT Canopy Type I I ❑ Refrigeration System E30-100,000BTU ❑100,000 BTU BUILDING PERMIT PLAN CHECK PLUMBING / 2 PLAN CHECK ELECTRICAL P LAN CHECK 50% MECHANICAL 1 I PLAN CHECK 25% $ $ $N $ $ $ SUMMARY OF FEES i SMIP $ PERMIT IS UANCE $ ERGY P.C. $ •O GRADING $ MICROFILM $ TOTALFEE $ lS,ob System Repair/Alteration Fire Dampers Registers Issue Fee _ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector . . POOL & SPA 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 UFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footingst 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Wafe 'Pipe-Undrgrnri. - 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit,# - 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas LD Oil 23. Gas Pipe -Rough & Test 72. Underground Flush r .24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ 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 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION •. 32. Electrical Power Meter -Final 80: FOOD CERTIFICATE ISSUED�I 33. Final Electric Notes: 34. Final Heating & Air Conditioning :a 35. Final Gas Pipe -Test p"f 36. Hood or Canopy 3T. Final Factory Fireplace -_ 38. Final Plumbing ' v 39. Water Service -Final - - 40. Gas Service -Final 41. Solar Domestic -Final , 42. Backflow Preventer -� .T '143. Backflow Irrigation --' - '•.y' i • 44. Landscape Irrigation System 45.;Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - r 48: Special Requirements Completed ` 1 s r 49. Electric Release to Edison ! - 50. Gas Release to Southern California Gas Q) _. 51. CERTIFICATE OF OCCUPANCY No. Date r ' Applicant to fill in all spaces except those wlthir CITY OIF COSTA MESA' C co uc e p D ;The Contractor's License Law aces not apply to an owner of property who builds of Improvesthereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). ' . ❑ Lam exempt under Section B. & P. C. for this reason I l ' TRACT 'CONSTRUCTION PERMIT 6r Firepl/Fact. Sit. ICBO # employees, provided that such improvements are not Intended or offered for Improvement Is Sold Applicant's Mailing Address - I Project Address2� , TYPE OF CONSTRUCTION LJ NEI ❑ CONVERSION 11DEMOLL1 Hs, Sale. If, however, the building or within one yearof com- pletion, the owner', will have the burden of proving he/She did not build or im- Owners Name ' I T--�s"L2P-� Phone :. DESCRIPTION O WORK ___FF $Old i7 5 �r-,rove for the purpose of Sal¢)' I ' ". I Address, S i T�gv aced 6X�- GRADING TYPE OF PERMIT GLJ RADING l ❑ TENANT ❑ ELECTRICAL Arch/Eng. License No. CMF 0865-46 rev. 12/82 Pink - Accounting; Goldenrod - Assessor REAR YARD (TO P/U heavy border lines and sign all appropriate declarations. IADD UALTERATION REPAIR. OTM 9 19 Issue Fee $ 3 6r O 0 'Date NI G ELATI - "- FOUNDATION 4 STRUCTURAL PLUMBING; ❑ MECHANICAL G A. P. qW ZONE IsYt L PLNG.REF. #' - .BUILDING ILI ACV �h c� �+ y LDING � 4 TO ILLY' P PE V IN REAR YARD (TO P/U - ' OCCUPANCY VALUATION $%009-12-12— 1G CU.VDS. ACRE $ LEFT SIDE YARD ) RIGHTSIDE YARD taw, ClD� PKG. SPACE, REG. PROVID oI /_Z PIPPS STREET WIDTH .—�' RK FEE $ $.s� sO - SPECIAL CONDITIONS:rpilz ' PLAN CHECK IMBING PERMIT Sewer Cap ELECTRICAL ISSUANCE Sewer Connection' - — ' Automatic Washer •Meter ❑over 100 amps- - Solar Collectors Construction Pole Sub Panel , $ Solar Piping Cooking Unit Sub Pole . PLAN CHECK Solar Tank Dishwasher Motors 110-1 HP 01y,-8 $ . S_w_imming Pool w/Spa Dryers ❑Gas OElectric - Ina Solar 09-15 HP 016-15+ TOTAL FEE Urinal Fan Microwave Water Closet F.A.U. Pole Light ' Water Heater � � Fixtures - Ran e i 9 • Water Service -- Device Boxes Sign •- Outlets Standing Sections - Switches Trash Compactor Garbage Disposal Generator 00-5 KW 05-15 KW Transformer 015.50KW 050+ KW Reinspection Fee $15 ' Issue Fee -. $ 3 Nerngeratlon system ` OO-t00,D008TU ❑100,000BrU System Repair/Alteration ' I Reinspection Fee, $15 Issue Fee , I $ 3 Meter ❑up to 100 amps Issue Fee $ 3 Zoning Approved By ` 'Date Application Approved By V"2- c� �+ y (Date Application issued By •`, 'Date SUMMARY OF FEES :BUILDING PERMIT $.s� ) SMTP j ! I"[, $ PLAN CHECK $ PERMIT jPLUMBING$ ISSUANCE $ PLAN CHECK $ GRADING $ ;� 1 .ELECTRICAL. $ $ PLAN CHECK $ I MICROFILM $ . MECHANICAL $ TOTAL FEE $ ' PLAN CHECK $ LESS ADVANCED PC - �l $ I FINAL FEE' I $ 93.3 ?+'CONSTRUCTION AND PLAN ING - .. POOL 'A Date '-APPROVALS �, Bermrt,#? 'I nspector - APPROVALS -Permit Date Inspector _ ' .1. Temporary Electrical Service or -Pole - 52. Pool &E quipment Location - Y cn : - -i? !Soil Pipe-Undrgrnd:n. 53. Steel Reinforcement .: •3:Electiical Conduit Utilitv-Undrgrnd:t- '. 754. Forms ;-_ 4� Electrical Conduit-Undrgrnd, I 55:• Electrical Bonding - _ - ' S: Steel'RemfOrcamem• ; , t • -. 56. Rough Plumbing& Pressure Test r -'6: (Electrical UFER'Grnd.� °-:, 2 - 57, APPROVAL TO.COVER-GUNITE, 7. Footin s ` g � ; '58^ Electrical Conduit-Undrornd. - - ' 8. Foundation 'i '59. Gas Pipe, a-Undrgrnd:; Test _ 9. ,Water Pipe-,Undrgrnd. i_ '`60. Backwash Lines, P -Trap, O Undrgrnd. - 10. Structural Floor System - ; u _ 61. APPROVAL TO�DECK 11, Property Sewer Line & House Connection ". 62. Backwash & Receptor -Final - 12. Sewer Cap ,. •`,! =•r 63. Heater &.Vent -Final.. 13. 'Roof;Drains i. ! 64. Plumbing System - Final 14. 'Rough Plumbing' • - - •65. Electrical -Filial . 15:'Rough'Electrical:Conduit' '" ' - ;' .-I------ - 66.• S31ar System -Final 1 �16.,RoughElectric Wiring , • . .- ._ i67. Fencing & Access Approval - - 0"17. ;Rough.WiYing Sign ''^' 68 APPROVED FOR PLASTERING ' 18: 'RougfiElectrical=T;Bai Ceiiipg` .'• ', - �, ' _ 69. POOL/SPA SYSTEMS FINAL 19: RougH Heating &jAir-Conditioning ' ' FIRE DEPT.. REQUIREMENT 1 APPROVALS; , Permit # ' 20. Rough Factory Fireplace' -' i 21. D ucts,.in`Structure' .' Underground Hydro 70' - •';22,!Ducts,Ventilating;_ 1 ;: �' 1 J1.1Product Piping ❑Gas GOil ,' :Pipugh & Te_st •,r• i 23. Gas.e-Ro i X72.. Underground Flush 24.�Roof;Frafining; E rPP % ''* '+I' ' 73. Undergrnd. Storage Tank OGas gOil i 25. 'Roof•Sheathing ; ; _ i•'%I = I �P�b �:�,e 74. Overhead Hydro ,26. `T -Bar Ceiling (Structural). &'Monocoat 75. Dry Chemical 27. Frame and Flashing _ 76.E Dry Standpipe a 28. jLathing &Siding; e i• 77. FIXED SYSTEM FINAL a 29. Insulatiori „ '' r _ I ,78. FIRE PREV. FINAL -, 30. �DrYvval)�Naili!1 I I %-//ng 9� Notes• _8'3 GGiO /� "31.;Plaster Brown Coat;• 1- n - j 32.!ElectricalPower Meter -Final" i ! f • fo ` If _ -gj o'%" r is` 33. !Final Electric I _ m 34. Final Heating &;Air, Conditionind i; i c 35. Final Gas!'Pipe=Test' 36. Hood or Canopy- anoPY--37. 37.Final Factory Fireplace', 38. Final Plumbing 39. Water'Service-Final 40. Gas Service -Final 41. Solar Domestic -Final _ 42. Backflow Preventer 43. Backflow Irrigation' •: ! I - r - .. � - 44. Landscape Irrigation System r 45. Sound':Attenuaion- 46f Handicap Regulations 47.. FINALS TRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Releaseto Edison! 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOFFOCCUPANCY .", l .. No � � Date 16 UCTION PERMI Frol�ct AdQ—ss r�_,Lh� APPIidlitti's Maifng''A/ddress • /3s9/ oC t �y. e5�-C "s . 5"961, Owner's fAme(7�L xL ��t� C1�54/,P 2-7 Phone - - di A7\l/Eng. License No. hAddress Contractor's Nam'L%eye (�E/.L �iir/rr�5[Il hone.��, %S 1 Address (mailing) D a'Jn�zeFras•/L i ty�i��%Eif/ City License No. LaC W LICENSED CONTRACTOR DECLARATION I hereby affirmsthat I am licensed under provisions of Charter 9 (commencing with section 7000) Of Division 3 of the Business and Professions Code, and y license is in full force and effect. License Class Len a o,On e o. d H6 Date'? /O-,�7 _ Signat WORKERS' COMPENSATIO CLARATION' 1 hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) I Policy No. Company (1• a Certified copy is nereby turn i sh¢ Certified op s tied with the di Building ONisi Date—�--- APPIi<an� UEXEMPTION FROM WORKERS' O PE NSATION DECLARA ION (This section need not be completetlN he permit is for one hundred ($100) or less). I certify that in the performance of the work for Which this permit is issued 1 shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such PrOvisions or this permit shall be deemed revoked. 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. C.) Lender's Name Lender's Address OWNER BUILDER IJECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which req uirds a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Chatty 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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who tloes 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 com- pletion, the owner will have the burden of proving he/she did not build or im. prove for the purpose Of sale). ❑ I, as owner of the Properly, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(eI license pursuant to the Contractor's License Law). am aware that proof off their Worker's Compensation insurance should be Provl ded to me. ❑- 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read this application and state that the above nformation is correct. I agree to comply with all city and county ordinances and slate ws relati n9 to building con tructi on, and hereby authorize repre- sentative o this citY to en er O the above-mentioned Property for inspection Poses. Signat lir O � Date ?—&J—P7 -. .... ,nau-spaces except those within heavy border lines and sign all appropriate declarations. f3 Y 1to (0 3 jo TYPE OF CONSTRUCTION 14NEw LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # 7 -DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GRADING - FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATIONS �i Z�� S Left - ZONE GRADING CU.YDS. ACRES— Remarks: CRES Remarks: 25" 4,L14/1 O F 1? LSA Planning Notes: Al Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Diinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 130-100,000 BTU ❑ 100,000 BT Rei ct F se or 55 if nspe ton ee Drivers' CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Showers Service Sink Sewer Cap , Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES 1421 7/::/-- - G /;_/.•—G — �9 T Zone R' 1 Accessory Building: ' Park rea r 2' M- ;eld_ : (0y brrirkuy-d Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Generator 005 KW 05.15 ELECTRICAL Transformer El15.50 KW ❑ 50+ KW Meter ❑up to 100amps Meter ❑over 100 amps Sub Panel Motors 110.1 HP ❑1%-8 Inc.Solar 09-15 HP 016.15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor eL ..79/ FEES Z O N I N G R E Q $ 3 FEES Reinspection Fea $15 1 1 Issue Fee $ 3 DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: wi C� Date7—,,3`Q Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% ay SUFE $ $ $ $ $ $ $ $ kNNf��ss qqqq�� ES ,SO SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ C/ TOTALFEE $ $ 3 CONSTRUCTION AND. PLANNING APPROVALS Permit# Date Inspector POOL & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings Sv�(�. 1 ��- 58. Electrical Conduit-Undrgrnd. 8. 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 II 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil,., 23. Gas Pipe -Rough & Test 72. Underground Flush 1� 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 0Oil 25. Roof Sheathing 74. Overhead Hydro .I 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE 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. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 9. Electric Release to Edison - Q 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ., NAM Applicant to fill in all spaces CITY OF COSTA MESA CONSTRUCTION PERMIT- .. Address Project Address 11151% Atm\ {iC OF� Owners Name Phone Address Arch/Eng. License No. Address i.,..��p Contractor's Named L �x��i lA'\A� Phoneme 10 Address (Trailing) IISSS E.�'C1l E� QI(Jee— G2 �! E License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In full far antl effect. Ucense Classop _ s No. Date 2!e- Signature WORKERS' COMPENSATION DE A ON tereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section z00, Lab. C. ucy Ncis) _46CISZ8 Company . Certified copy Is hereby furnished. �r Cc tIV, CAR Is filed with the <ity,8 it g DI 1, Date YYSS 6S Applicant CCC"`-��---•.. acs EXEMPTION FROM WORKERS' CO'blialki4SATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or ess)'. 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 subjectto t6 Workers' Compensation Laws of California. Dale Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provl slons of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this' permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to its Issuance, also requires tie applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's Ucense law (Chapter 9 (commencing with Section 7000) of livlslon 3 of the Business antl Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violationofSection 331.5 by any applicant for a permit subjects the applicant to a civil Entity 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 (Secilon 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon,,and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of com. pletion, the owner will have the burden of proving he/she did not build or Im- owner'of the property, am to construct the oroiect (Se uupiu5 or improves inemon, and wno convacu tar sucn projects wnn a con. tractor(s) license pursuant to the Contractor's License Law). ❑ I_am exempt under Section B. 6 P. C. for this reason Data Owner Drivers' License or I I I Registers Building; Canary _Applicant; Pink - Accounting; Goldenrod - A 00-100,000BTU 0100,000BTU System Repair/Alteration Reinspection Fee $15 Issue Fee $ 3 A. P. sP PLNG. REF. yW TO BUILDING PROPERTY LINE LEFT SIDE YARD PKG. SPACE RED. STREET WIDTH SPECIAL CONDITIONS: Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Disposal Ir 00-5 KW 115-15 KW mer ❑ 15-50 KW ❑5U+ KW BUILDING RIGHT SIDE YARD PROVIDED . PARK FEE $ Meter Ltover 100 amps Sub Panel Sub Pole Motors 00-1 HP ❑1'f,-8 Inc.Solar 09-15HP 016-15+ Microwave Pale Light Range . Sections Reinspection Fee 3.40 TI - I Meter LJup to 100 amps I Issue Fee I $ 3 I Zoning Approved By _ Date Application Approved Byyy�� Date Application Issued By A Date SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ . PLAN CHECK $ GRADING $ ELECTRICAL $ .sS $ PLAN CHECK $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK $ LESS - ADVANCED PC $ - i FINAL FEE, $ cn-- ? ONSTRUC.TlftAND PLANNING• 'i x._•. . , y --- - �o POOL. .TA - -- - - - ,= - O' '- s ,. - _ - c,..:rDate - a ^ SAPP4ROVA LS ci Permit,# -InsPector " - APP.ROVALS Permit Date - .Inspe"ctor ,;' z: !1- TemporaI Service orLPole t ";; 3i `' _ ^ ; :(52.^ Pool &-Equipment Location " - - / _ �� 2! 'Soil Pipe-Undrgrnq;-4 , t i - 1 0 '-. 53; Steel Reinforcement - I - 3. Electrical Condult.l'Jiility Undrgrrid� j •7� ;.D I54 Forms- ^' 4: ElectricalCondu,t.Undrgrn,� -•'" c 55 Electrical Bondin - - - 5[ SteellReinforcement '' i, ' n? '= = ;� _ ;56. Rough Plumbing & Pressure TestJ. . 6: !Electrical LIFER Gr._nd.i I' = '•,! } 3; ^ �;.', r%. 57: APPROVAL TO COVER-GUNITE. ^ 7. Footings I' i . 58. Electrical Conduit-Undrarnd. - � y 8. Foundation 1 - ( '�"� I ; '� 1 << •_ ' �59. Gas�Pipe;.� Undrgrnd., Test - t , _! J' , 1 , F _ , 9. Water Pipe-Undrg'rnd. L ..'.60. Backwask Unes, P- rap, 0 Undrgrnd. - , 10. Stiucturat Flgor System ` '`- ',l ; „ ^ =' ` 61. APPROVAL TO'DECK 11. Property Sewer Line"&iHoluse'Eonnection. a-•'aE ° 62. Backwash ,& Receptor -Final 12. Sewer Cap I - = 1 { ; ,1 I I c •63. Heater &-Vent-Final - -_ 13. iRoof Drains ; I t' �- i ' 9 i 1 64. Plumbing.System:- Final .� 14. RoughPlumbing!- 165. Electrical -Final - �615.-RoughElec`(ical--Conduit'.--,---�(-'-".66. Sotar,System-Final -16. Rough Electric f ` !� 9 9•� ( t r! -_ 67. Fencing &%Access, Approval - 1 .;f �_ , " "Rough N/iring:Signr ` ` ! .^. i l7. - . ! l .68 ' APPROVED FOR PLASTERING J 18. RoughElec[iic`al-- gar, Ceiling (' `{ �': I %• I i' j69.� P•OOLUSPASYSTEMS FINAL 19. Rough,Heating.&'Air tondWon ing 11 ! � 'FIRE DEPT.IREQUIREMENT. '� APPROVALS ; Permits# - 20. Rough Factor=y Fireplace I ! ( „ 1 , i ! i 21.'Ducts;in Sti6ccture= .70.' Underground Hydro •C22. Ducts, Ventile'ting :: ., !� f, i I ' ' 71.' Product Piping O Gas 000 :.23. Gas.Pipe-Rough & Test j j, Ih �• -- I - �- , 72.; Underground Flush _ ' _ ! 1- r24.,Roof Framing < < I ` II � ,.I^ !�o � .1; ❑ Under rnd.StorageTank 0Gas Oil 9 Ite'i ! f 173.' 25. Roof Sheathing ; ! it ; ! ! �,' i I,r I>� F = { ' i .74: Overhead Hydro - !;.-� _ - 26. T -Bar Ceiling (Structural) &,MonocoetY I ! r. I i '�. ^ ! 175.! Dry Cheiniral - ' 27. Frame and Flashing,76., Dry Standpipe - .. 28.' lathing &-Siding; 77i FIXED SYSTEM -FINAL ?9JInsulation a i f �� 1 }-- i I j X78. FIRE PREY. FINAL t-30 Drywall Nailing , > I f! ! ! I I !Notes ! 31. ,Plaster Brown Coat - - 32. Eiectrical'Power MeterFinal 33.;Final Electric _ �L J _ i 34. Final Heating &(Air ConditioninPg f~ i I i i I ' I' i' , 35. Final Gas Pipe -Test -1 c 36. Hood or'Canoi,4,., 37. Final Factory'Ni dipiacen- _ 38. Final Plumbing I 39. Water !Ser,vice-Finali 0 40. Gas Service -Fina, i 41. Solar Domestic Final 42. Backflow P,revente a f ';r. j ' ! i •_ ! _ _ _ 43. Backflow Irrigation ! 1 4> ") c • " `' .r ? - � I a i 44. Landscape Irn,ation=S,ystem 45. Soundi 7 4tenuition - , r• .' '`• _. 46. Handicap Regulations I I i I '' ' i I - 1 ,' i :^ ! 1 _ 47. FINAL STRUCTURE & BUILDINGL 48. Special Requirements Completed 49. Electric Release,to'Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE'OF OCCUPANCY i * No I' Date l ij _ Applicant to fill In all spaces except those within heavy border lines ani' sign all appropriate declarations. 'CITY OF CNTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. 8FP 28 d 1. �I 1 `1 Projar .gess —I V ( I •_A_f-.�''s--sC'y-� Apnt's Maili1ng1Address ,. s, Owner's Name IALIJA 1"4 N.AV_A--e Phone �19 -� . Address 12W I1 T/''�--1 /"L -t '�L- (-&-STV, KESA- Arch/Eng.. Ci my, t S r --License No. Itol rbc Address - ^_ Et'C�AG7 P (AA"Ili 6gC7(C- Contractor's Nam ll t�fL% U� i yei Cf" Phone �—ks-oc Address (mailing) rt'L_LC�I R I�IS'SIO \iIt�O . City License No. d 3292-Y _ LICENSED CONT ACTOR DECLARATION l dhrn that I am licensed under provisions of Charter 9 (commencing. with section 7000) of Division 3 of the Business and Professions Code, avid my license is in full force��pp effect. License ss Cr- LiceseNo 44 b94o Date Signature WORKERS' COMPENSATION DE ATION ' hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section alio. Lab. D'��ZSio— Company S-riff't� Ktf 19 Policy No. �I 8 Certified copy is hereby furnished. Certified copy is filed with the city B Itlb9 v Ilia, i�1 �,•t••�, Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -- (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is Issued I shall not employ any person in any manner so as to become subject to t6 Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for �� WWhich this permit is issued (Section 3097 Civ. C.) Lender's Name NO1•--1� Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil 3 enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law tloes not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for Sale. If, however, the building or improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively Contracting with licensed con- tractors to Construct the project (Section 7044, BnSlness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Con. tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason 8 Accessory Building: Poon, 5PA ELECTRICAL FEES 0 o V TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION L REPAIR ' ❑ 1:3DEMOLISH ❑ G R Parking Req./Provided CONVERSION OTHER -" A.P. # DESCRIPTION OF WORK/USE OF BLDG. T S Solar Tank u N%T � PO a Spm OC Main Build! Urinal E Water Closet TYPE OF PERMIT GRADING L FOUNDATION STRUCTURFF_ •T .Front ��/ 1:1EJ TENANT ELECTRICAL I.'J" PLUMBING F-1 MECHANICAL l B Switches Sign ❑ OTHER A Rear Generator ❑0-5 KW 05-15 KW Trash Compactor C Right PROJECT DESCRIPTION SO. FT. OCCUPANY f CONSTRUCTION TYPE VALUATION$ ]O .0—rD �° S Left ZONE GRADING CU.YOS. ACRES PIng. Ref. # Remarks: C 3 _ Planning Notes: Refrigeration System ❑0-100,000 BTU 11100,000BTU Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee 1 $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Date Owner Heating System & Ducting I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,0006 - information is correct. I agree to comply with all City and county ordinances and state laws relating to building construction, and hereby authorize repre- Senlatives of this city to enter upon the above-mentioned age ty for inspection pur os - 1 Signature \ Dale Reinspection Fee $15 D C SS IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9564 Zone /`( r Accessory Building: Poon, 5PA ELECTRICAL FEES S' -to brd o V I . 26/!O// N G R Parking Req./Provided E Dishwasher Meter ❑over 100 amps Q M T S Showers ELECTRICAL FEES Service Sink Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. El 50+KW Sewer Cap - Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher Meter ❑over 100 amps Solar Piping Dryers ❑Gas ❑Electric Sub Panel Solar Tank Fan Motors ❑0.1 HP [Bfh - 8 Swimming Pool w/Spa OC F.A.U. Inc. Solar E39 -15 -HP ❑16.15+ Urinal Fixtures Microwave Water Closet Device Boxes Pole Light Water Heater Outlets Range Water Service Switches Sign Auto -Wash Garbage Disposal Standing Sections Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Pool zfete" f Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 iANICAL FEES DEVELOPMENT SERVIC S UIREMENTS: Zoning Approved By Date fprg� g Building Approved By Date Application Issued By Date Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU 11100,000BTU - SUMMARY OF FEES BUILDING PERMIT $ 86,50 SMTP $ 0-76 PLAN CHECK $ 52. 2,3 PERMIT PLUMBING $ An 0 ISSUANCE S PLAN CHECK 25% $ O • 7.5_ ENERGY P.C. $ ELECTRICAL $ 12--00 GRADING $ PLAN CHECK 50% $ Y/�.5n MICROFILM $ MECHANICAL $ TOTAL FEE $ L/_ALO PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers • Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE A416 7. Footings 58. Electrical Conduit-Undrgrnd. FW47 8. Foundation 59. Gas Pipe, kndrgrnd., Test. /c( y 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-TrapK_Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL Q i 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ,... 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - 36. Hood or Canopy 1 _ If 4-7 _ 0 -tJ C 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation % 46. Handicap Regulations E 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 149. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • •� r• • n• as is THIS AGREEMENT, made and entered into this a R day of IM,by and between b,�� kShmroa� R�rJ�� he nafter referred to as "LAND OMER" , and hereinafter referred to as "ADJACENT PROPERTY QdNrV It is hereby agreed that a party wall will be constructed on the property line be in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Bo*,;2�, Page_ of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS WiEREOF, the parties have entered into this Agreement the day arca year first above written. k"Box"R121:7 (Signature) a re n d, Name (Typed or Printed) J8// (Address) ADJACENT PROPERTY OWNER (Signature) V-J-��VOr V4,LLQ Name (Typed or Printed) -�.o•� 12c� (Address) (NOTE: Please see reverse side for notary's statement) STATE CF CALIFORNIA ) ss. O NTY OF ORANGE ) AT before me, the undersigned, a Notary Public in and for the County of Orange, State of California, personally appeared ]mown to me to be the person(s) whose names) is subscribed to the within instrument arca acknowledged to me that (he/she/they) executed the same. WITNESS my hand and official seal. Signature Name (typed or printed) STATE OF CALIFORNIA ) ss. OXNTY OF ORANGE ) P1 (SEAL) before me, the undersigned, a Notary Public in and for the County of Orange, State of California, personally appeared i known to me to be the person(s) whose names) is subscribed to the within instrument and acknowledged to me that (he/she/they) executed the same. WITNESS my hand and official seal. (SEAL) (Signature) Name (typed or printed) D�i!.1 THIS AGREEMENT, made and entered into this /�� day of 1997 IM , by and between hereinafter referred to as "LAND OWNER", and �K NGW4A-P, Jekhsov) hereinafter referred to as "ADJACENT PROPERTY OKNER". It is hereby agreed that a party wall will be constructed on the property line between 1'l/ � �uJ 9�—/Yzs 4 - in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Bookgq , Pag�//�of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS WHEREOF, the parties have entered into this Agreement the day and year first above written. IAND OWNER (Signature) /� shl?ron . 064-Pke Name (Typed orPrinted) /Sl/ I a �t a Bey pr. (Address) (Signature) lbohakct P jc-s hsoy� Name (Typed or Printed) 18 15 I r - (Address ) (NOTE: Please see reverse side for notary's statement) STATE OF CALIFORNIA ) ss. ODUNTY OF ORANGE ) on before me, the undersigned, a Notary Public in and for the County of orange, State of California, personally appeared ]mown to me to be the person(s) whose names) is subscribed to the within instrument and acknowledged to me that (he/she/they) executed the same. WITNESS my hand and official seal. Signature Name (typed or printed) STATE OF CALIFORNIA ) ss. COUNTY OF ORANGE ) (SEAL) on , before me, the undersigned, a Notary Public in and for the County of Orange, State of California, personally appeared known to me to be the person(s) whose names) is subscribed to the within instrument and acknowledged to me that (he/she/they) executed the same. WITNESS my hand and official'seal. (Signature) Name (typed or printed) (SEAL) V0 Y /• • h' 712. 101 THIS AGREEMENT, made and entered into is -19 9 day of 19 7 lam, by arra between hereinafu referred to as "LAND CHER", and Qq, lq— // ;i or hereinafter referred to as "ADJACENT PROPERTY OWNER". It is hereby agreed that a party wall will be property line between on the in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Book, Page_ of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS V*=OF, the parties have entered into this Agreement the day and year first above written. LAND OWNER ,g&� /� (Signature) a roh X.r Name (Typed or Printed) l8/l larra9er Dr. (Address) l F h� 4yrWiyt�r (Signature) 0 NDae (Eyd MrNinte d M 0 )a, (Address) (NOTE: Please see reverse side for notary's statement) SiIMTE OF CALIFORNIA ) ) ss. OOU'NTY OF ORANGE ) Nut before me, the undersigned, a Notary Public in and for the County of orange, State of California, personally appeared known to me to be the person(s) whose name(s) is subscribed to the within instrument and acknowledged to me that (he/she/they) executed the same. WITNESS my hard and official seal. . Signature Name (typed or printed) STATE OF CALIFOINIA ) ss. CCUNTY OF ORANGE ) 570 (SEAL) before me, the undersigned, a Notary Public in and for the County of Orange, State of California, personally appeared known to me to be the person(s) whose name(s) is subscribed to the within instrument and acknowledged to me that (he/she/they) executed the same. WITNESS my hard and official -seal. (SEAL) (Signature) Name (typed or printed) •- X20 2pF Twining Laboratories of -:Soubrazn t2a40"ia, .9=. 3310 Airport Way / Mailing Address P.O. Boa 47 / Long Beach. CA 90801 / (213) 426-3355 / (2131636-2386 / (714) 828.6432 TESTING BRANCH OFFICE: 1514 D North Susan Street / Santa Ana CA 92703 / (7141554.2645 Examination: SC87-7745 COMPRESSION TESTS ON GUNITE CYLINDERS Steve Gallina 1455 Flower Fullerton, California 92633 PROJECT WILLIAM BURKE RESIDENCE ADDRESS 1811 Tanager, Costa Mesa ARCHITECT CONTRACTOR Owner ENGINEER SUBCONTRACTOR Bernard C. Adams Arco Gunite Co. SAMPLE'FROM mix DATE CAST DATE TESTED SPECIMEN NO. COMPRESSION TOTAL LOAD, LBS. POUNDS PER SO. IN. 28 -DAY AVERAGE, PSI COMPLIANCE SIZE: SPECIMENS Swimming Pool 7-19-87 7-26-87 1 7 -Day 86,000 2,700 SLUMP 6-3/8" x 11-5/8" MADE BY S. Gallina #313 DISTRIBUTION: Steve Gallina - 3 -Ce6ta Mesa Bldg. Dept./Scott Priegel SPECIFIED STRENGTH SIZE 8-16-87 2 28 -Day DELIVERED BY J. Johnson Permit #BEP 28804 2,000 psi 6-3/8"x 11-5/8" 8-16-87 3 28 -Day RECEIVED ON 7-21-87 Chas. B. Locke ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS AUTHORIZATION FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS. OR EXTRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR 'WRITTEN APPROVAL ASA MUTUAL PROTECTION TO CLIENTS, THE PUBLIC AND OURSELVES. 33012 .-r design structures I buildings B E R N A R D C A D A M S civil engineer 11022 acacia pkwy, suite a garden grove, californla 92640 • phone (714) 636-0294 plans • specifications November 3, 1988 Building Dept. City Hall Costa Mesa, Calif. This will authorize Wm. N. Burke to obtain copies of any plans on file related to thesite at 1811 Tanager Dr. Costa Mesa, Calif. that bear my name. Sincerely, B.C.ADAMS Civil Engineer #10183 a..tar: shall be Tye S, 1 pt portland cement, ; to " par me putty to 2, parts sand by damp loose volume to .sum of cement and lime used. br Grout: shall be composed by volume, of one part portland %_ comet and three parts sand to which may be- added not more . than 1/10 part lime. Sufficient water shall be added to produce a consistency for pouring without segregation of constituents of the grout. In grout spaces larger than'4 Inches in both horizontal dimensions the grout may oontain an addition of pea gravel equal to not more than two parts bk 'volume of, cement used. Min grout strength 2000 PSI'.Q 28 days'.' . C. Admixtures: No admixtures may be used and if plastic cement Ss used, not more than 1/10 part by volume of cement may be ' used with portland cement when approved by Engineer. d'. Masonr, Units: Load bearing units shall be Grade Atconfor-m- '8 ]ne T.h. Designation C-90 and In addition the gg 0 Quality Control Standards of the Concrete Masonry Associ:a-;• tion. e." Mssonr Construction: 1 - masonry shall be built to preserve the unobstructed.. vertical continuity of the cells to be filled.. Walls " and cross webs forming such cells to be filled shall be ' fullbedded In mortar to,prevent leakage of grout. All i head (or end) joints shall be solidly filled with mortar' _, A_. r: to a distance in from 'the face of wall or unit not less than thickness of the longitudinal face'shells':. Bond shall'be provided by lapping units in successive dertl-, cal courses or by equivalent mechanical anchorage. All d.'•- ' joints In lintles shall have all web members solid. -� bedded in mortar. 2. Vertloal cells to ke.filled shall have vertical align- '•`' �:•` d. ment sufficient to maintain a clear, unobstructed con-, ' r tinuous vertical cell measuring not less=`than"two triches by three (2" z 3.")._ 3,. Cleanout openings shall be provided at the bottoms of ; - all cells to be filled at each lift or pour of''gi'out where such lift'or pour of grout is in excess,.af.:four ft (4') in helg.t. Any overhanging mortar or othrir ob- ` struction or debris shall be removed from'the`'insldes ' of such cell walls. The cleanouts shall=be sealed - before grouting, after Inspection. = 4. Vertical re'lnforoement shall be held in position et top and bottom and at 48" O.C. - 5. All. cells containing reinforcement shall be filled solidly with grout. Vertical cells containing rein- forcement shall be filled solldly with grout In lifts not, exceeding 48" 6. When the grouting is stopped for one hour or longer,. horizontal construction joints shall be formed by stok ing the pour of grout one and one-half inches (1 below the top of the uppermost unit. ] _- Workmanship shall be per C.K.A. Speci.flcatlons `Sect,lon BERNARD C. ADAMS' Gti W22� Floc Twvininq Laboratories of 4soudzzT2 Cay foga, _Y,c. 3310 Airoort way / Mailing Address P.O. Bo. 47 / Long Beach, CA 90801 / (213) 426-3355 / (213) 636-2386 / P 141 828.6432 TESTING BRANCH OFFICE: 1514 0 No"n Susan Street / Santa Ana CA 92700 / 17141554-2645 August 18, 1987 Examination: SC87-7745 COMPRESSION TESTS ON GUNITE CYLINDERS Steve Gallina 1455 Flower Fullerton, California 92633 PROJECT WILLIAM BURKE RESIDENCE Permit $BEP 28804 ADDRESS 1811 Tanager, Costa Mesa ARCHITECT CONTRACTOR Owner ENGINEER SUBCONTRACTOR Bernard C. Adams Arco Gunite Co. SAMPLE FROM Swimming Pool SPECIFIED mix STRENGTH 2,000 psi DATE CAST 7-19-87 SLUMP SIZE 6-3/8"x 11-5/$" DATE TESTED 7-26-87 8-16-87 8-16-87 SPECIMEN NO. 1 2 3 COMPRESSION 7 -Day 28 -Day 28 -Day TOTAL LOAD, LBS. 86,000 94,000 115,000 POUNDS PER SO. IN. 2,700 3,190 3,600 28 -DAY AVERAGE, PSI 3,400 COMPLIANCE 28 -Day tests comply with specified strength. SIZE: 6-3/8" x 11-5/8" 6-1/8"x11-5/8" 6-3/8"x11-3/8" MADE BY DELIVERED BY RECEIVED ON SPECIMENS S. Gallina #313 J. Johnson 7-21-87 DISTRIBUTION: Steve Gallina - 3 Ceete-"esa Bldg. Dept./Scott Priegel Chas. B. Locke ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS. AUT'-ORIZATICN FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS. OR EATRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR VIRRTEN APPROVAL ASA MUTUAL APOTcC71ON TO CLIENTS. -"E ?UBLIC AND OURSELVES. 130 1 CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO, 6663 LOT NO. /e> ADDRESS ABII %A/�+E� Iile DATE 0—/-7 �— The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he -she ey (was or ere advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. 1 Purchaser BY f/GC2?c.A Developer and','T-6r authorized representative BY Leff 1L 40004S7�1(/' W Lender PROJECT ADDRESS: 1 8 1 1 TANAGER DR UNIT: OWNER'S NAME: BURKE WILLIAM M aoDREss:181 1 `" 1ANAGER DR COSTA MESA,CA 92626 ARCHIENGINEER: POOL ENGINEERING REG.NO.: C47386 ADDRESS: 1332 N MILLER UNIT 201 ANAHEIM CA 92806 PERMITTEE: SNYDER 6 ASSOC (714)4797-2709 ADDRESS: 1038 N TUSTIN 220 ORANGE CA 92667 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force and effect. CITY LIC.: /y q STATE LIC.: 63817La B Date: / S Signature:—WORKERS' COMPENSATION DECLARATION: I hereby affirof c sent to self -insure or acertificateof WorkCompensation Insurance or a candled c Ythereof (Sectio POI NO.: 29093UNITt?57 EXP. DATE: 04/01/94 COMPANY: STATE L] Cuddled copy is hereby furnished. EX Cenitied copy is filed wi h e city B ddinngg Division. Date: tQIII / J Applicant: l EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This sect, needcompleted if the permit is for one hundred ($100) or less). I certify that in the performance of the work for whim This permit is is ed, I s II not employ any person in any manner se as to become subject to the Workers' Compensation Laws -of California., Date: Signature' NOTICE: If after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cade. you must foMwllh comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm mot there is a construction lending agency for the performance of the work for which this permit is issued (Section 309P Cil C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the ContractorsState 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or my employees with wages as their sole compensation, will do the work• and the El 1, 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 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 for the purpose of sale). I.as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Cotle'. 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' Stale License Law(. I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section'. B. 8 P. C. for this reason: Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533 , and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant I hereby certify that I have read this application and state that the above information is correct. I ordinances and state laws relating to building construction and hereby authorize represe tars of 11 property (for inspection purposes. Date: V �3 � If Signature: Driver's License nr Sncial sarurim 1641-46 Whne—Buddma: Green—Code to comply with all city and county to enter upon the above-mentioned Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 06350 PERMIT NO: B 063501 PLAN CHECK NO; 03033-93 S GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE- STR PURPOSE: NEW JOB DESCRIPTION ; 416SF SOLID ROOF PATIO W/3 SKYLIGHTS SQ FT; 1,073 CLAIM VALUE; 30,000.00 CALL -VALUE: 11,746.80 GROUP OCC: R-3 / COMMENTS: 65LF RETAINING WALL W/GLASS WALL ON TOP 27LF STANDARD BLOCK WALL Z O N I N G R E 0 U I R E M E N T S S E T BA C K S ------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: 73 FT IN REAR: FT 1 IN LEFT: FT IN RGHT: FT IN LEFT: 5 FT IN RGHT: 5 FT IN PARKING RE& PROV: PARCEL: 13963109 ZNE: R1 REF NO: PLANNING NOTES>t 6e HI BLK WALL (LEFT REAR). 7' HI MAX RET, WALL W/6' BLK S > TEMP GLASS (REAR/SIDE)• 41st SF PATIO COVER (REAR) D E V E L I M E N T S E R V I C E S R E Q U I R E M E N_''T S ZONING APPROVED' BY C4 DATE:)ab 31 CA S BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: I DATE: wt ############################################################################### LEGALIZATION:N F E E S U M M A.R Y STRUCTURAL SEGMENT;Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 135,00 1,17 SMIP/NON-RES PLAN 87.75 r ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 136.17 0,00 87.75 223.92 223,92 .00 REVENUE DIVISION TOTALS--> COLLEETED: 223.92 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC, HIRE SMIP/TOT GRADING PLAN -CHECK 135.00 �+"/ 1.17 87.75 I N D I V I D U A L F E E B'R E A K D O W N TYPE QTY D E S C R I P T I O.� UNIT COST TOTAL COST SFR 416 RES -PATIO COVER -POST L SOLID ,R&F 14.80 6,156,80 SFR 27 RES -CONCRETE BLOCK WALL- / FT. 20,00 540.00 SFR 65 RES -PILASTER WITH WC7OD,ETC BET4;FT, 10.00 650.00 SFR 65 RES -RETAIN WALLS OVER 6 FT /-FT. 60.00 3,900.00 SFR 500 ALTER BY VALUE RESIDENTIAL NO$ONE 1.00 500.00 END" 'OE FEES r r 01 00144963-00144965 Tli 223.92 DATE: 08/13/93 TIME: 14:20 �P' CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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 - " /� t- �L ��Z' / 6_6W 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings _ G? L33 58. Electrical Conduit-Undrgrnd. 8. 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 Electrica [-Conduit 66. Solar System -Final 16. Rough Electric Wiring - 67.- Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 001] 23. Gas Pipe -Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 2 �a ltr;'✓- 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing l 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric i Notes: 34. Final Heating & Air Conditioning I I( 35. Final Gas Pipe -Test vI 36. Hood or Canopy�v 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final C/�-��y,_ _ f 40. Gas Service -Final 41. Solar Domestic -Final " 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 3 li-44 4(,s/Gi 48. FINAL PLANNING _ 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 14fi0t'�O tel. R . PRESS URE TREATED SNAKES "4 31IS I. C. B. O: NO. -3' ILI HOOD,. � R -7.aRL P.O. Boz 970, WiflaWn, Oregon 37496 UNRAWRITERS' LASDRATD.RIES OF CAWADA usTEp C . ,Prepared Roofing Material (Shingles or Shakes) FORM 25 ASSUE NO. 865 C Classi9 0_ r C determned when applied in accordance .. ith insiTuctiom'snclud�d with this Rooting. NUMBER 1� GRADE4 These shakes meet all quality requirements for handsplit red cedar shakes as established by 24" x 112" Medium Resaws (600 mm x 13 mm) I w H AND EXPOSURE: Hands p IiLshakes should be used' .. N e e the slope or ,_pitcfiY'S sufficient to'insuregood Minimum recommended pitch is 1/6th or 4 -in -12 (4'• vertical rise for'eacIn 1211. (300 mm) horizontal run). recommended weather< exposure is 10" (250 mm) ,for - )0 m) shaken. V�q A PLICATIO0 Along the eave'-line, a 36•' (900 mm)wide I 1oR fing.�elt, is laid over the sheathing. The beginning or course at the eave line should be doubled. After each of shakes is applied .a 1a" (450 mm) �widejstrip pof roofing 1 laid rover the top•poriion of the shakes and extending:-oritoeJ rthe sheathing, with the bottom edge of hejfi-- -'" ddl itance.above the butt equal to twice Athe% 11 ,NAILING: Use two' hot -dipped zinc- coated nails for each shake, plat- ing them approxi- _ mately 1" (25 mm) from each edge, - and high enough , to' be covered an inch two the succeeding course. Nails should be "- long enough to penetrate at least '• 112 (13 mm) Into Individual shakes should he spaced apart about 1/44 sl-Teathing. (6 mm) to 34" (9 mm), to allow for possible expa nslon. These joints or "spaces-between-shakes5 ho'uld be broken or offset at least 114,z" (38 mm)-�-iri sdjacent e courses. i LITERATURE: Complete details regarding recommbnded,applidaiions and uses of handsplit shakes are given in literature available free of chergOrom—Red Ceder . Shingle 8 Handsplit Shake Bureau, 515 - 116t Ave 'N.E., Be lewa, WA 98004+ I OWNER 1ST LOS Angeles Corporation DATE 3_13_72 JOB ADDRESS 1811 Tanaaer Drive BUILDING PERMIT NO. -44259 A0 No. The Buccola Co. DESCRIPTION of WO LOT 10 TRACT 6663 FIRE ZONE VALUE$ 42.500.00 I. ECTIONS Si nota re Date GROUP I&J TYPE ZONE SOIL —-7Y SUBCONTRACTOR PERMITS ISSUED Date Number I Si nature GAS WATER lum in ROUGH PLUMBING i L PROP. SWR. LINE Q HOUSE CON. E] ;s SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING 47, 7Z— TEMPORARY SERVICE OR POLE UNDERGROUND POWER ❑ ROUGH WIRING/ r Hea in and Vent. TRENCHES C] FORMS STEEL REINF. .J.tC p FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING c. FRAME AND FLASHING LATHING — IN OUT PLASTER, BROWN COAT 'CTURAL, FINAL ING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL PLAN NO. 11C LOT NO. 10 Z . wa ZI. - Q am J7 J fn M J J m Q Z N Z (C w (C aw Lu Z JO m Z J � w w O= Z_ H LU W Cr 34 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ,• ?P-77PCAIL00 881* ***203.98 Cb^ J ICATION FOR BUILDING PERMIT For Applicant to Fill in Completely DAT R ED /(/ Dt�jE IS�,�t.E �' ' �J/J BUILDING ADDRESS // Tanager Drive�C �/ PERMIT OWNER lst LOS Angeles Corporation MAIL / O/t/ UE ADDRESS 1 Wilshire @ Grand riy'Nf16E/G CITY Los Angeles NDlb25ACT 6663 t LOT �D BLOCK CONSTRUCTION 1st Los Angeles CorporaBRANCH/nf/ST NEW ADD ALTFR1R9PAIR LENDER L. 6ADDRESS 1 Wilshire @GrandALUEORENGINE REarl G. Kaltenbach TE`'54"� $ FIRE p ADDRES�A823 E. 17th Santa Ana ZONE TV GROUP CONTRACTOR The Buccola CompanyBYPROVED DATE ADDRESS4 01 Birch Street TEL CITY Newport Beach NO. 540-�33 ZONE NO. OF PLANS pZ USE OF NEW CS• r'`r .4Tj BUILDINGafx CA STATE CITY D YS DING YARDS APPROVED LIC. NO. 14642 LIC. NO. 2104 MAIN BUILD ACCESSORY-BUILDING SIZE NO. OF BLOCS. (FROM C/L STREET) OF LOT 6 1 X 1001 NOW ON LOT O NT O FT. FT. c. USE OF EXISTING BLDG. FT, FT. NO. OF 966 ft 12 2 5 NIEWBLOG2 sq ROOMS STORIES L. SIDE FT, FT. EXTERIOR WALL ROOF Shingle g COVERING COVERING REAR -76 7 FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. SLOGS. �J Q / Q / / VAR.+ C.U.P. qp DATE APPROVED APPROV c DATE HOLD—MR SPECIA REQUIREMENTS 1 hereby acknowledge that I have read this application and state STti 7 - ' Mat the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that 1 em properly licensed as a contractor under SO. THE M NT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Divisicn 3, Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION and Profossiona Chapter 9.— PERMIT FEE $ (CCoodd.,��Djivviisiioo)n of �3,, Pernature mittee �—J�t7 �/C/s"iL �"'� $ %�5r�o �7 PLAN CHECK $ 44 Authorized Agent TOTAL FEE $ J