HomeMy WebLinkAbout2775 TERN CIR - Building Permits •
0 Ss. CITY OF COSTA MESA
`w SA,d BUILDING DIVISION
h' ��:a�� DEVELOPMENT SERVICES DEPARTMENT
.t gri4PERMIT PERMIT NUMBER
%°r�oaaam�o • 698-02143
Ve
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2775 TERN CI Status: ISSUED
Suite: Applied: 11/30/1998
Vicinity: Issued: 11/30/1998
Parcel Nunmber: 13948132 Zoning: R1 R1
Applicant: JASON GREER
Address:
Phone:
Zip:
Owner HILLEY, ANDREW P
Address HILLEY,AGNES
COSTA MESA,CA Phone:
2775 TERN CIR Zip: 92626
Contractor: ACTION FIRST ROOFING SERV
Address: 07472 SLATER AV
Phone: 842-9122
HUNTINGTING BEACH CA Zip: 92647
License: 688649
Arch/Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT •
T/OFF AND REROOF 2350SF RESIDENCE W/COMP SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $7,700.00
Permit: $137.25 - Claim Valuation: $7,700.00
SMIP Res: $0.77
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
Total: $138.02
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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)754-8626
•
DECLARATIONS4,2
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My worker/compensation Insurance carrier and policy number are: �/�Z 1'9—
(This
Geco CS Policy Number: �O � J !
(This section need not be completed if the pemrit is valued at one hundred dollars(S100)or less.)
❑ I certify that in the performance of the wo 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, nd agre tat if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions,
Applicant Signature: J )J • C Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MID SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES 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 ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed U er s' o hapter 9(commencing with Sac' 7000)of Division 3 of the Business an ro(p95ieps Code,and my license Is in full
force and effect.Lic.x P 1 /n/�� � /]/ Class N ' /
Contractor's Signature: no J J4C ' ? FT's")/- Date: 14 30 qy
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant toe civl 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 structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend, will be made in connection with work authorized by this
permit,end 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 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health end 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meat the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: _ Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
Correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for rn pection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
r t Legal Owner l L +SSZ _9(
`--� •
nd/Or Authorized Applicant Date 'r�/UX
CODE I INSPECTIONTYPF PEE INIIDAIS CODEl INSPFCTIAN TYPE DATE IMMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /� 208 Final Plumbing
200 Final Re-Roof ,5- 2 2'- C f 6 �
L(. 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
2446-46
ADDRESS OFBUILDIND: 2775 TERN CI DMT: CITY OF COSTA MESA — BUILDING PERMIT
ONNEWS NAME IF KNOV/N: HILLEY, ANDREW P PERM NO: B 084915
ADDRESS: HILLEY, AGNES
IL
2775 TERN CIR PERMIT NO: B 084915 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
APPL.YAWNS ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT ORENWlEER: Lia NO.: JOB DESCRIPTION : T/OFF BUR Sr REROOF W/BUR SQ FT: 2, 900
ARCH.OR ENG'S ADDRESS: WIT:
CLAIM VALUE: 2, 900 . 00 CALC—VALUE: 2, 900 . 00 GROUP OCC: R-3 /U-1
CONTRACTOR'S NAME: LUKE ROOFING ( 714 ) 633-8798 1
CONTRACTORSMMUND 448 S MONTGOMERY COMMENTS: X
ADDRESS: ORANGE CA UC.ND.: 672569 **;ESE********RkaE;A;E*Hr*******+Ew*HE************; ***;r;e;r;A;E; *;H**RE********;c*;E;E***********
92667 DMT: Z ONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby elfin under sanely d perjury that I am(.. .,•u • provinces d Chapter 9 SETBACKS
(commencing with Section 7000)d Desert 3 of the Business and Professions Code .my lice e• in r/- . and effect,
Ce C.NO.: ;A i 8 UC.CLASS: C-39 LIC.N. • ,256 / XP: 08/97 MAIN BUILDING ACCESSORY" BUILDING
sale; / 1"-- 'firc«Nea«: �� .ltalle FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN AGHT; FT IN
W R BUILDER DECLARATION:I hereby affirm under penally d perjury 1 ern exempt from the Contractors License Law for the
mason(Section 703,sBus:b„and PmfessanaCode:Anycit•/!. My which requires a name,toconstrue.alter.improve, PARKING REQ: PROV: PARCEL: 13948132 INE: REF NO:
demolish,or repair any structure,prior to its essence.also requires the:..' : for such permit to fib a signed statement that he or sheC5
e licensed pursuant to the prwLmons d the Contractors License Law(Chapter 9(commencing with Section 7000)d Division 3 d the PLANNING N TE S>.' -
Business and Professions Code)or that he or she is exempt therefrom and the baso for the alleged exemption.My violation el Section > ..
7501.5 Wane applicant l«epermH abpctalhe applicant toecrvlf penalty more than five hundred siders MOM
*******************************M**SEM 4E dk*Mit**M**************************'*********
❑ I,as owner of the properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended D E V Ea. L U P M E N T SERVICES R V I l' E S R E U I R E M E N T S
or offered f«sae(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property Q
who bolds or improves thereon.and who does such work Meisel or herself or through he or her own employees.presided that such
improvements ere net intended or offered(or sails f,however,the building orinprwementissold within one year ofcompletion.the ZONING APPROVED BY DATE: -
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sae).
-
❑ I.as owner of the property.am excusive&contracting with licensed contractors to construct the project(Sedco 7041.Business and •1
Professions Code:The Contractors License Law does not aptly to an owner of provenly who wilds or improves thereon and who BUILDING APPROVED BY : DATE: '
contracts for as proieds with a contractor(s)licensed pursuant to the Contractors License Law), ti. ! rill� q
m � 1
❑ laexempt under Section: B.aP.C..forthisreason: APPLICATION ISSUED BY: DATE;
Date: Owner: ************************************* * *************************- :f w• **
Ido hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,P55'73.and LEGALIZATION:N F E E SUMMARY STRUCTURAL 'E GM EN T:Y
25534,and that I or any future building occupant will/wit not(circle one)need to comply wlh said state codes and the requirements for
a parmitformsirlMionor modification horn the Ar Ouaky Management DetctResidential wmtntlionappeCatias era exempthwn these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
prevision'. PERMIT 74 . 75 . 50
Date: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN
o Have and wilmaintain acanifrmeoconsent loself inanby
mforworkers'compensatioasprovidedforSedian3700oftheLabor ISSUE FEE
Code,f«the pedoms edmaworkf«wNnmpermit issued.
BUILDING—DIV > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
o I have and wil maintain workers'compensation insurance.as required by Section 37E0 of the Labor Code.br the performance of the TOTALS----> 75. 25 0 . 00 0 . 00 75 . 25 75 . 25 . 00
work for which this permit is issued.My woken'compensation insurance caner and policy number we:
Caner $TATE FTJNn EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 75 . 25 OVER/SHORT: . 00
Pricy Number 445—QnrlMTT11A 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need nor he completed a the permit is For one hundred doers(51001 or less. 74 . 75 . 5 0
0 I certify that in the performance of the work for which this permit is issued,I anti• e ./' co.: _. In any manner es to
become subjed to the wooers Compensation laws d Caliromia,and Pg;AY," dm
l ' m (... f- aped to the w«ka ***
s' *********************************************** *****************************
crops ..—pm a d 3 50 d ma abor code, andl '�yy I N D I V I D U A L F E E BREAKDOWN
ate: "/ �! Applicant: , /
wen g:Failure eSWUM workers'comperuaroncoversgsIsunlawful, •rap sespactenwnployermulMnlpenalfaand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
clv nes w to one hundred thousand dollen($t00,000),In aWltron ,. ,e cost of compensation,deneps as provided for In
Hon 3706 of the Labor Code,Interest,and attorneys fees. SFR 2900 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 900. 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a Conpnlden ending agency for the END OF FEES
performance of the work for which the perms is owed(Sedion 3097.CH,C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify than I haws read the epplcatice and date that the above inf«meticn is coned.I agree to comply with all any and county ordinances
end state laws relating to building construction and hereby authorize representatives of the city to enter upon the above-mentioned properly
for inspection purposes.
if
WI LI 'M COLT 4' 09-29-1337/11:45 N 1/:/7.2;3
set
Print Name - i /w,a 1,11 -LI:.:'art
As,
Date: 9 fl. PEiS,I ;l as41.5
ig :-tire ol a . Ap1Err• I.•or
(5151-46.WP) White-Building A Safely Green-Ale:Canary-App5canC Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING t - & SPA
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
_h
1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
4. 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 G'rnd. 57. APPROVAL TO 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 &AcceS$approval
17. Rough Wiring Sign 68. APPROVED FQ.gt'PLASTERING
18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - - r _ FIj2E�DEPT. REQUIREMENT ..
20. Rough Factory FirOplace - • i - .5.,4_ -;APPljOVACS .. Peymit# r, •
- at 6 = -3 ` _
21. Ducts; in Structure r •• 4.-.: r - _ 2 70. .Undergrtrugtl Hgdro
22. Ducts; Ventilating - `
:, : f 71. Product'Pjping•OGas OOiI
23. Gas Pipe-Rough & Test S • *' - -c :."4. � 72. Undergr&?ind P,Msh- f
24. Roof framing ' rc ,$ ; 73-5Undergrrid.Storgga Tank• s O Gas 0 Oil
25. Roof-Sheathing 4. . //t?/'`y7- r 74 Overhead Hydro
26. T-Bar Ceiling (Structural) & Moondoat _ '' - _+ 15•Jury Chemical -, i
27. Frame and Flashing r ', 71 r _ - ' 76. Dry Standpipe
28. Lathing&.Siding F ' , 77; FIXED;SYSTEMtINA Ili; ,-- -
29. Insulation !` 73 FIRE PREV. FIN IL s •
•30. Drywall Nailing • , i �� _ -HEALTH DEPt. PEQUIR-EMENT
31. Plaster Brown Coat 4 < . - i I t ' 79. FINAL L PECTION r
32. 'Electrical,Power Meter Finalt r s '1 80y FOOD CERTIFICATE ISSUED-, x
33. 'ina6Electric - a 4 i, Notes: - "•^.
- . .r y k
34. Final Heating & Air Conditioning . (- ''
35. Final Gas Pipe-Test ,, . , • r r •
36. Hood or Canopy ' - *' ! 1 � - _ .
1 .tom ;I '-n I .
•
' 37. Final:Factory Fireplace` - _ s. • 14 r.; _ .
38. Fina(Plumbing • -' " rY _ • `
39. Water Service-Final ; • -
•
. 40. Gas Service-Final - S ' ^1 I t1 ' t4 ` V '
41. Solar Domestic•Final ` .. - a • -
, r t .
-
42. Backflow Preventer • e ,t '1 - • k
- t • t -'Ti - Id t r.
43. Backflow Irrigation , _• •
T.
44. Landscape IrrtgatiortSystem :: - -_ : r -: :• 7 - • . -
f ,.
•
45. Sound Attenuation', n t . .7. ;
46. Handicap Regulations - + �• - _ -
47. FINAL STRUCTURE & BUILDING /✓✓_i!/
�0 ../1 . ;•
48. FINAL PLANNING // - •
49'. Electric Release to Edison -. ;
50. Gas Release to Southern California Gas Co _ . ' . -
51. CERTIFICATE OF OCCUPANCY - .
No. Date
Applicant tnoo��fill in all spaces except those within heavy border lines and sign all appropriate declarations.
1 CITY OF COSTA aMEESA CONSTRUCTIO PERMIT PER iup3a7� TRACT NO. LOT NO. UNIT NO. 9706 J/O2/�L
//7S Dec du- J Spa;� TL
Project'Address '0 �1 GOy/
,Applicant's Mailing Address 0 e. J t l a. # (..� TYPE OF CONSTRUCTION H NEW H ADD H ALTERATION 1 REPAIR
• #3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name 6r���11"/y) Phone DESCRIPTION OF WORK/USE OF BLDG.
Address "c /" e-' S Main Building: Accessory Building:
I/ E Z
' Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front 0
Address o� {n} ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL BA Rear N
Contractor's Name I�7 .� I . 144nL.PhooneQ� V ❑ OTHER C Right N
Address(mailing) L 33 r- 7/ 0 �Il ' rJ m PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
g CONSTRUCTION TYPE VALUATIONS ___ S Left R
City License No. 6Q' 1'3 ZONE - GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
Q
I hereby affirm that am licensed under provisions of Charter 9(commencing Remarks: • Planning Notes: • RECEIVED APR 2 8 1988 M
with section 7000) of Division 3 of the Business and Professions Cotle, and T
my license is in full .nd effect. /
t� Lice ns' la- 4 / I I ce N•. 1 S
�o Date —1, �4 Signature F SJ K2 t_ • _ PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink • Showers ELECTRICAL FEES
\ I hereby affirm that I have a certificate of consent to self-insure or a certificate ,
if Workers' Compensation Insurance, or a certified co y thereof (Se ion Backflow Preventer Service Sink
800, Lab. C. n Automatic Washer Transformer D 15-50 KW
\ /� p ❑ 50+ KW
\ Policy No. 91"+r3� 0 Company Backflow Irrigation Sewer Cap Construction Pole Sub.
entified copy is hereby furnished.
\ Cert/fied ppy�5 filed with the city B 1 in o Bathtubs • Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date '!`f(O yQ (! Applicant 1
EXEMPTION FROM WORKERS'COMPENSATION DE LARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed If the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
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 Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California. - �_
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP al 6-15+
NOTICE: If,after making this declaration,you should become subject to the —
• Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
' comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097 jCly. C.) Interceptors / Water Heater ' P. Outlets Ran e
Lender's Name - / 9
Lender's Address Kitchen Sink Water Service
OWNER BUILDER DECLARATION Switches Sign -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator 00.5 KW ❑5.15 KW Trash Compactor
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 Roof Drains
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 - - —
'herefrom and the basis for the alleged exemption. Any violation of Section
)31.5 by any applicant for a permit subjects the applicant to a civil — '
analty of not more than five hundred dollars($500). $ 3 .
13I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work, and the structure is not Intended or offered - Reinspection Fee ( $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES •
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 Hood or Type I 1:1DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler
sale. If, however, the building or improvement is sold within one year of com- Canopy Type 11 ❑ Zoning Approved By Date
pletle n, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground .- Building Approved By ® Date
prove for the purpose of sale).
(3I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
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 Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
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• Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK S PERMIT /liL
❑ I am exempt under Section B.& P. C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ Sa0u ISSUANCE $ /S7p
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ _ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
Information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this cit to enter upo the L ab•- e-mentioned pro erty for q
inspection pure . A ....,..• 'i Date' ` �u' MECHANICAL $ TOTAL FEE $ 61.141
Signature
Drivers' License or SS
Pink -Accounting; Goldenrod - Assessor
I
CONSTRUCTION AND PLANNING POOL&SPA •
c:• Date Inspector Date Inspector
App ROVALs Permit-# APPROVALS Permit#
1.-Femporary'.Electrical;Ser"vice or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement co
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
•
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •Z
5. Steel Reinforcement 56. Rough Plumbing & Pressure,hest
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-G:UNITE
7. Footings . . 58. Electrical Conduit-Undrgrndtl
8. Foundatio r' 59. Gas Pipe, 0 Undrgrnd.,Tes(i)
9. Water PipejUndrgrhd. 60. Backwash Lines, P-Trap, 0'UAdrgrnd.'
10. Structural Floor System 61. APPROVAL TO DECK -�
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT i ;
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ;'r
33. Final Electric Notes:
34. Final Heating & Air Conditioning •i
35. Final Gas Pipe-Test
36. Hood or Canopy •
37. Final Factory Fireplace
38. Final Plumbing
676/139 LCD •
39. Water Service-Final ` '
40. Gas Service-Final
47. Solar Domestic-Final •
42. Backf low Preventer - - -
43. Backf low Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations "
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - •
51. CERTIFICATE OF OCCUPANCY
No. Date
Lot 7 94000
CITY OF COSTA MEP
Tr 5781
COSTA MESA BUILDING-SAFETY DEPARTMENT MAY 11 1965
P.O.BOX 317 COSTA MESA,CALIFORNIA
For Applicant to Fill In Completely ACl�IO�IF, PERM
TYPE OR PRINT Inas:,
For-Ofthu Gat Only
BUILDING
ADDRESS 2775 Tern Circle
RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA 911nQ(1
R[CEI BY REC IV[ DATE ISSUED
OWNER Pemba Subdividers, Inc . (°(eel env 1 _2 mRS
BUILDING 2 FRO
MAIL ADDRESS �� JG KIY C�
ADDRESS 2850 Mesa Verde DriveFIRE
�L
TEL. ZONE TYPE GROUP \ J
CITY Costa Mesa NO. 5490395
APPROVED
ARCHITCT
OR ENGINEER E .G .Kaltenbach WO:547804G BY DATE
ZONING `? _
ADDRESS 1823 E . 17th St . Santa Ana ' f^"+1/
ZO(- NO.OP /� USE OF Na��
`�� I PLANE / BUILDIN•0.1 I I A
CONTRACTOR Pemba Subdividers , Inc .
V— I r{Q��(``)
LEGAL LOIS) Crg 777/
ADDRESS 2850 Mesa Verde Drive DESCRIPTION
CITY Costa Mesa A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL.
LIC.NO. 187318 NO. 549039r 30"TO SIDE 8REAR P.L.
EAVES
SIZE OT 70x100 I NO.OFOLDGS.0
NOW ON LOT ALLOWED (U.B.C.REQUIREMENT)
OF L
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDIN ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L REE
SETBACK LINE FROM 20 22 ' FRONT FT. FT.
CENTER OF STREET REAR YARD
SIDE YARD I LEFT 10 ' I RIGHT 10 ( R.SIDE 1121 FT. PT.
DESCRIPTION OF WORK L.SIDE 1ID FT. PT.
NEW X ALTERATION ADDITION REAR V'1 /FT. FT-
-� DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDING NO.OF .I VAR.# DATE
SIZE 50x52 ROOMS 11 STORIES 2 _C.U.P.# APPROVED
EXTERIOR W/ ROOF APPROV
COVERING DI GACO COVERINGWOOdShing le BY ,.A_ DATE IS(Pi.._____
USE OF BUILDING AND WORK TO BE PERFORMED `_V>f.JC1.--
Single family / attached garage
RPotir 6 a234O FT.4QD J .2 Io c tioo
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION OCSO ry
BUILDING CONSTRUCTION PERMIT FEE 5 �-,
SIGNATURE OF 4
PERMITTEE f9Li" /7,4-,... 7 7J F
S 3/I 7%0 PLAN CHECK S 2
AUTHORIZED A T z E
TOTAL PEE S / . ✓