HomeMy WebLinkAbout2776 TERN CIR - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
pIT.Y OF COSTA/M/ np CONST.R/t"fC�yT/IOiN PE MIT PER T NO TRACT NO. LOT NO. UNIT NO. A P # Zone
Project Address PC'/%� Te�N `!` �ar�c. COS S S S Main Building: Accessory Building:
Applicant's Mailing Address L /4.,/ - TYPE OF CONSTRUCTION H NEW H ADD U ALTERATION H REPAIR , E Z
IT CONVERSION ❑ DEMOLISH ❑ OTHER T Front O
Owner's Name ..• .--•/ �� Phone . • '0 DESCRIPTION OF WORK/USE OF BLDG. 1 B Rear - N
Address
Arch/Eng. License No. TYPE OF PERMIT H GRADING USOUNDATION U STRUCTURAL C Right G
Address ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL S Left R
�•1A2/-S uU eiAJ(,P Phonenn n ❑ OTHER I Ping. Ref.# ParkingRe /Provided E Contractor's Namn T /ot"3�%Q Req
7 PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) �3 / -� r Planning Notes: M
��y))ppr/ CONSTRUCTION TYPE VALUATION$ T
City License No. <7 7J ZONE GRADING CU.YDS. ACRES RELEIVtu DEC 2 b 1989
LICENSED CONTRACTOR DECLARATION ' / /( �' ) /7 / J�1^ C ./j S 6 1 ��' S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing nRemarks://)STA[-LC 9 1L/p1T/2 A 8 -£'C
with section 7000) of Division 3 of the Business and Professions Code, and ELECTRICAL FEES
JQ my license is in full f•rte . d effect. •��.�S/ ,-�S {tel q -d rN y n e- .�,-•.
Ucense CL zs Lice Se „ / PLfU"M`BfIYN'-G�•/• �V�V V�/`^•�[ FEES
- /lei l/ Automatic Washer Transformer 0 15.50 KW
Date �. Signature -••
/
innitEK• RS' 0 PENSATION DECLARATIONConstruction Pole Sub. •
❑ 50+ KW
'eby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers
Yorkers' Compensation Insurance, or a certifed copy thereof (Section Cooking Unit Meter Cup to 100 amps
A :3e00, Lab. C. (///•� Backflow Preventer Service Sink
V Policy No. ( d YLJ Company CA1)E/2 Backflow Irrigation Sewer Cap Dishwasher ' . Meter Cover 100 amps
5)2filified copy is hereby furnished. Dryers ❑Gas DElectric Sub Panel
Cerjjijted pp 5 sled with the city B iiIci �q.,qi ylsion. / ,�j Bathtubs Sewer Connection
Date //o7 n Applicant L /j/C/ > y�i.UMfal�L Fan Motors❑0-1 HP ❑1'h-B
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred ($100) or F.A.U. Inc.Solar 09.15 HP 016.15+
less). Dishwasher Solar Piping
I certify that in the performance of the work for which this permit Is issued, I Fixtures Microwave
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank •
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:If,after making this declaration,you should become subject to the Outlets
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range
comply with such provisions or this permit shall be deemed revoked. Switches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign
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.) Interceptors Water Heater �1 Garbage Disposal Standing Sections
Lender's Name O�
Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
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
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
Asian 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
refrom and the basis for the alleged exemption. Any violation of Section
k 31.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
Li I, as owner of the property or my employees with wages as their sole Reinspection Fee ` $15 Issue Fee $ 3Zoning Approved By Date
compensation, will do the work,and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES , Building Approved By Date
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 • Application Issued By Det
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II O ' SUMMARY 0 FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
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 • PLUMBING $ 176,6) ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con- ENERGY P.C. $
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration I PLAN CHECK 25% $
proof o1( their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date Owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ OTO✓
-
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,00087 PLAN CHECK 25% •
information is correct. I agree to comply with all city and county ordinances $
and state laws relating to buildigg construction, and hereby authorize repre-
sentatives of thi city to qn to pQn the above-mentioned property.,for ,rf
Inspection pur ;f1 J /- � Date 1 Or�"t+
Signature (,(/ -
Drivers' License or SS ���
Reinspection Fee $15 Issue Fee $ 3 01 00051583-00051583 TOT 5.00
0865-46,rev. 5/88 White - Building; Canary - Pink -Accounting; Goldenrod - Assessor DATE: 01/11/90 TIME: 10:20
CONSTRUCTION AND PLANNING POC SPA
APPROVALS Permit# - Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
t _ ,
2: Soil Pipe-Undrgrnd. 53. Steel Reinforcement
i
1 Electrical Conduit Utility-Undrgrnd. 54. Forms
r
4.;Electrical Conduit-Undrgrnd. 55. Electrical Bonding
:.5.,Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 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 & 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 0 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
31. Plaster Brown Coat `, 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:/ 30-io hOGL7Er/oalE-LEFrGgeo - LED
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing - � "/�• - G�
39. Water Service-Final ^i
40. Gas Service-Final
41. Solar Domestic-Final':?
42. Backflow Preventer ,
43. Backflow Irrigation
44. Landscape Irrigation'System
45. Sound Attenuation
46. Handicap Regulations r
47. FINAL STRUCTURE'& BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co /7)
51. CERTIFICATE OF OCCUPANCY •� "'
J w
No. Date '
MAY - 24 - 91 FRI 1 2 .. 28 F A A 7 1 4 — 9 E. 9 -ljp! 5 F _ 0 1
ji 1
I1
•
'RAINPROOF - 0 1
•ii' `
1111 LIC. i 557.494
6
b 714 -253 -9702
• 213- 594-5527 '
`FAST GUARANTEED SERVICE '
•
ii •
t��_ C egg 7a. 414k, %,
.-t .....61-1...0- a,1649 c,-1 fz. . �
rAto_e 'C'. --71/ /u l...s. ,l.a i_e/ A77czeize . S
•
- i Ca-/-742-4-(.69-c‘i-k.t.e.,_,
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1 i tte,"---- . IIS •
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ur/f p
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. Y
P MIT NO. TRACT NO. LOT NO. UNIT NO. .
CITY OF COSTA MESA C�O7•N�S�TRUC�T�}ON PERMIT %� � A.P.# Zone
Project Addiess�k til 7lP -Thad e• /� _ "'5 3
A --11 7 TE.en) a E TYPE OF CONSTRUCTION ❑ NEW CJ ADD Li ALTERATION S Main Building: Accessory Building: Z
Applicant's Mailing Address G' ❑ REPAIR
�D] ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front 0
Owner's Name�16E�lf,e !\ LE Phone�b�'aSDESCRIPTION OF WORK/USE OF BLDG. B Rear N
Address C27'16 -Tr-Ro the, eos'rA Meat A;eh. LI I A I
Arch/Eng. License No. TYPE OF PERMIT GRADING ❑ FOUNDATION LI STRUCTURAL C Right G
Address _
'/J`
LI TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S , Left R
ED OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCY Ping. Ref.# Parking Req./Provided E
Contractor's Name Q
Address(mailing) ,/ Phone - - Planning Notes: M
CONSTRUCTION TYPE VALUATION$ — - - T
City License No. ZONE GRADING CU.YDS. ACREC S.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: '
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full force and effect. ELECTRICAL FEES
License Class License No.
Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
WORKERS'COMPENSATION DECLARATION Construction Pol¢Sub. • 050+KW •
iereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers -
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
J800, Lab. C.)
Policy No. Company Backflow Irrigation Sewer Cap Dishwasher • Meter Clover 100 amps
8 Certified copy is hereby furnished.
—
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel
Date Applicant Fan -. Motors 00-1 HP 011/2-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred($100) or F.A.U. Inc.Solar 09-15 HP 016-15+ •
less). Dishwasher Solar Piping
I certify that in the performance of the work for which this permit is issued, I ...
Fixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank .. Microwave
Workers' Compensation Laws of California. Device Boxes
Date Signature _ Floor Drains Swimming Pool w/Spa Pole Light
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 Outlets Range
comply with such provisions or this permit shall be deemed revoked. Switches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign
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.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
—
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
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
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 I r r 2. '
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
-.rCivision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee 1 $ 3 I
,:1Therefrom and the basis for the alleged exemption. Any violation of Section
-
031.5 by any applicant for a permit subjects the applicant to a civil
malty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
I
U I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered
Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Dat
License Law does not apply to an owner of a property who builds or improves - 1�s�� �/] � �Q/�
thereon, and who does such work himself/herself or through his or her own Application Issued By Date
employees, provided that such'improvements are not Intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0
Diction, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground SUMMARY OF FEES
ICfor the purpose of sale). BUILDING PERMIT $ SMIP $
py I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK
tractors to construct the project (Section 7044,Business and Professions Code: $ �1/ PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $
builds or improves thereon. and who contracts for such oroiects with a con- .� ISSUANCE $
tractor(s) license pursuant to tne Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of' their Worker's Compensation insurance should be provided to me. -
ELECTRICAL $ GRADING $
I] l am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date owner �,o�rtO Heating System& Ducting Registers MECHANICAL ��J
I hereby cert fy that have read this application and state that the above 00-100,000 BTU 0100,000 BTL $ TOTAL FEE $ s�
information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws relating to building .nstrUCtion, and hereby authorize repre-
sentatives of t/is city to e terms,.on_the above-mentioned propert for
Inspection purer -5. /y1
Signature -I' !.i `_-_�� Datev U - •
_
Drivers' License or SS Reinspection Fee $15 Issue Fee $ 3 Cl 00015952-00015952 TO5.00
DATE: 10/03/88 TIME: 11:16
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POG. a SPA -4 -
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1 f Temporary Electrical Service or Pole 52. Pool & Equipment Location
• i
2 Soil Pipe-Undrgrnd. 53. Steel Reinforcement
7. Electrical Conduit Utility-Undrgrnd. 54. Forms
4-Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
.162 Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
71 Footings . -. 58. Electrical Conduit-Undrgrnd.
•
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9: Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. •
Ort
10. Structural Floor System 61. APPROVAL TO DECK
11.-.Property,Sewer Line & Nouse Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
I .
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 0 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
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 /O.6 t'i? trio
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing /3-6-gds L6.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
e
48.(Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date
4HOJECT ADDRESS: 2776 TERN CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 051771
OWNEK's NAME: RICE, EUGENE A
ADDRESS:
2776 TERN CIR PERMIT NO: B 051771 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: 966—1.828 REG.NO.:
ADDRESS UNIT: JOB DESCRIPTION : T/OFF REROOF W/CLASS C MED. SHAKES SQ FT: 8, 370
PERMITTEE: CLAIM VALUE: 8, 370 , 00 CALL—VALUE: 8, 370 . 00 GROUP OCC: R-3 /
ADDRESS: RAINPROOF ROOFING ( 714 ) 536-8702
369 P.O. BOX COMMENTS: SMOKE DETECTOR(S) REQUIRED IN THE HOME
TF+c
HUNTINGTON BEACH CA 92648 ******** **** c****te?EaE�t,E+4*�FkP *Tree*is-***aF*****x?FM*sir;+ 4(** . ;>EiM.M4Fa:4OM-a:+t•*M•::M.*x>FxH.:*)i; T:
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
70001 of Orvrsron 3 01 the Business and Processions Code,and my license is in full force and effect. SETBACKS
CITY LIC.: 0c 94% STATE LIC.:55749 cus: 39
DaIe:...VA/ �! Signature: - MAIN BUILD—TNG ACC ESSORY BUILDING ---
/ WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate I consent to self-insure or a certificate of workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 38011.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: + 182447-90 EXP.DATE: 04 /01 /92
CC� MPANY
O : STATE FUND PARKING REQ: PROV: PARCEL : 13948136 ZNE: REF NO:
'Y' Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Building D PLANNING NOTES> ..
-a/- 9, >
Date: ADDlitant:}95'!v^�lJ. *****it** F***ic*****49 *r.lc**iE**ii****dF**?E*9F**iF**}*******u.**i:****>'**Y***,301 X?E*moi***3i*?.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIO : (This section need not be completed if the perm)is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENTS
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. • ZONING APPROVED BY DATE• _
Date: Signature: '
NOTICE:If.atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : r - DATE: '
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 APPLICATION ISSUED B Y: DATE: . P?''
which this permit is issued(Section 3097,Civ.C). ****-*ac**.**a:**************** -*1e**k*3fWt*r***}:hkv,. £*k *Y*+'*}:* 142:4},*7F>
LENDER: ***********N.*****'HE**M*****M*1F*********14—*****k.,*'***?!.x*.1i.*******If*** -*}**}******
agOREss: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 108 . 00
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed . 84
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON--RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE -
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 108 . 84 0 , 00 0 . 00 108. 84 108 . 84 I . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.II,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 108 . 84 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 108 . 00 . 84
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law). l am aware *,*******le-*V(di.**********)(•*********T,;*.****Ae******ie****.**IF te*•1i.**R.3r.*}:le-ee***•h'•****'*i-*'s:**eA
that proof of their Worker's Compensation insurance should be provided to me.
o am exempt under Section: B.&P.C. I N D I V I D U A L F E E B R E A K D O W N
ronnis reason: TYPE QTY DESCRIPTIO N UNIT COST •=TOTAL COST
Dale: _ Owner: '
do hereby certify that am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 8370 REROOF BY VALUE R ES I D EN I AL NOZONE 1 , 00 8„370. 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from ,
these provisions. ,
•
Date. Applicant' _ .,�v , /
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county aY/
ordinances and stale laws relating to building construction and hereby au•tnz representative of this j to enter upon the above-mentioned
property for inspection purposes.
_9—/ �^
—^ Signaludr �/ •r _ 01 000n.,.S?-7Gt,F`.93 ris ,
Do Do er's� r Social Security
Pink—Revenue;Goldenrod—Assessor '
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service oi 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection i 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 O Gas 0 Oil
25. Roof Sheathing �..2J-q'% 6atAY- 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 i' 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
1 -
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 / �%f�
V. FINAL STRUCTURE & BUILDING ,24Ø,c;;jia -)
t s'�" Pd.6 ,-
49. Electric Release to Edison •
50. Gas Release to Southern California Gas CoAr7
51. CERTIFICATE OF OCCUPANCY i
No Date
Lot 11
Tr 5781 94034 CITY OF COSTA IESA
f COSTA MESA BUILDING-SAFETY DEPARTMENT MAY 11 1965
P.O.BOX 917 COSTA MESA,CALIFORNIA
For Applicant to Fill In Completely Atty9k0 F PERMr
TYPE OR PRINT 14tIlaill
euILDING For Office Use Only
ADDRESS 2776 Tern Circle
RECEIPT NO. )411T O.
COSTA MESA, CALIFORNIA 4�I 6A1
RECK CT DRECf/VED/ DATE ISSUED
OWNER Pemba Subdividers, Inc . -Vitt Cr- PimI q lost
MAIL AUOLRES9S 2:72 -1-Pa \ CR-
ADDRESS 2S50 Mesa Verde Drive _ FIRE
�j �' T
CITY Costa Mesa NO. 5490395 ZONE 7 TYPE GROUP -t-z
APPROVED
ORENGINEER E .G .Kaltenbach No'5478046 BY DATE
1823 E . 17th St . Santa Ana ZONING UG��.�j�
ADDRESS
ZtyI I NO.OPfI I UeBUILDE01l�
PLANS
CONTRACTOR Pemba Subdividers, Inc .
DESCRILEGAL PTION S f I� 5711
f ,nf i/Pt
ADDRESS 2850 Mesa Verde Drive
CITY Costa Mesa A.P.NO. ./ '
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE NO. 187318 To TEL 5490395 90'TO SIDE @ REAR P.L
LIEAVES
SIZE .
OF LOT 72x136 I NO.OF BLDGS. O ALLOWED (U.B.C.REQUIREMENT)
NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM CLSTREET)
SETBACK LINE PRO61 '
��A.11<, FT.
CENTER OF STREET 20 I REAR YARD 61 ' FRONT FT.
SIDE YARD LEFT 111 I RIGHT 111 R.SIDE 11 FT. FT.
DESCRIPTION OF WORK L.SIDE //I FT. FT.
NEW X ALTERATION ADDITION REAR l7 / FT. FT.
DISTANCE BET. BET.MAIN ft
REPAIR MOVING - DEMOLISH MAIN SLOGS. ACCESS.SLOGS.
BUILDING NO.OF VAR.# DATE
SIZE 50x49 ROOMS 12 STORIES 2 C.U.P.# APPROVED
EXTERIOR WAµ, ROOF APPRO rL.4//I1 1//l L
COVERING Litt CCOI COVERINGWOodShingle BY �, 1 �� DATE / �g Vr-
USE OF BUILDING AND WORK TO BE PERFORMED
'intle famil attached :ara:e ►__
p1/I�/1 /
"i1A h 7 23 /G 6 SQ.FT. .3i o ar
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
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
BUILDING CONSTRUCTIO VALUATION mQ �� n
SI •
GNATURE OF yyy���''' ^/ PERMIT FEE $
PERMITTEE /%4-/ ry /.CS.,.^ �I �I lb f
$ 31, 4�� PLAN CHECK $ 1 7 Ai
rAUTHORIZED A T TOTAL FEE $ /-1 3
a
rc,w. nvivrwu
b JOB ADDRESS 2776 Tern Circle BUILDING PERMIT NO. 25049
GENERAL CONTRACTOR Owner–Builder DESCRIPTION OF WORK Community Block Wall
'( AP No. LOT 11 TRACT 5781 FIRE ZONE VALUE $ 100.00
t INSPECTIONS Signature Date GROUP ii: TYPE 77I ZONE R-1
Soil
SUBCONTRACTOR I PERMITS ISSUED
Gas Date I Number I Signature
Water Plumbing
3 Rough Plumbing
Prop. Swr. Line 0 House Con.0
4 Sprinkling System
Miscellaneous
Rough Healing and Air Conditioning
Temporary Service or Pole
), Underground 0 Power 0
Rough Wiring , / Heating and Vent.
Trenches lJ Forms 0 Steel Reinf.El VJf p/v/ate
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing—In 0 Out 0
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final
Building, Final _ -_-- ,maa /A5/66 __-
25049 CITY OFC S;A MESA
• COSTA MESA BUILDING-SAFETY DEPARTMENT DEC 3 0 1965
P.O. BOX 1200 COSTA MESA, CALIFORNIA 9282E -
For Applicant to Fill In Complotoly AFPLI)O[ FFRMIT
TYPE OR PRINT ll -jFj� ii3J
Fa;;
G.2776 T-�2yj
c �P For ONko Uro Only
ADDRESS RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA t5Q4S
) RECEIVED KM 9�E RECEIVED D�sY•MEll17
OWNER (267-rtc�QK- �O E, It- /dt3 dC A i_ 6 G
BUILDING
AD RESS a 776 n.,-,-, P, ,,,,0, ADDRESS
FIRE
/l ....tte� , /Q NEL ZONE TYPE ;Tr-GROUPCM ( DS'/L! M l SNCL NO. 471/47,2,7 7
ARCHITECT TEL APPROVED
BY' DATE
OR ENGINEER NQ.
ZONING j�
ADDRESSA' A ' /
/ =rig NO.OF ,.., USK or NEW
CONTRACTOR Stre / r PC
-/ PLANS BUILDING /?�� ��""
�LEGAL y/�� 7 •1 f+)I4SrVGC
ADDRESS OnCRIRIONJ9A' 1/ - ,-5
'/ X
A.P.NO. G
CITY
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE M. BO•TO SIDE&REAR p.L
LIC.NO. NO.
NO.OF BLOGB. EAVES
(U.B.C.REQUIREMENT)
OF LOT /OU /r�S / I NOW ON LCT
USE OF / YARDS APPROVED YARDS APPROVED
EXISTING BLDG. A0,rI MAIN BUILDING ACCESSORY BUILDING
-=' (FROM C/L STREET) /74-
7117.
SETBACK LINE FROM FRONT a "".17y'
CENTER or STREIT REAR TARO P'
R.SIDE FT, //
PT.
S/DE YARD LEFT RIGHT
IO
DESCRIPTION OF WORK L.SIDE FT, 0/ FT.
RBAR PI''
d' PT.
NEALTERATION ADDITION
W Y
DISTANCE BET. BET.MAIN&
REPAIR I MOVING DEMOLISH MAIN SLOGS. ACCESS.SLOGS.
BUILDING (((��� NO.OP VAR.# DATE
SIZE aYcc ROOMS STORIES C.U.P•#JJ j^1 APPROVED
EXTERIOR WALL 0 I ROOF �"�_�__ w ' AFFROVFIJJ /./1. 1 '" �• -�'
COVERING I,gym/',/, COVERING LOOT) tt ET //.II// /// TaJ1 JCEd�/2....-/DATE i �(3/
USE OF BUILDINGAAN�D WORK TO BEPERFO.f�MED / P.
_
ERSQ.FT.
I HEBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE O
• AND STATE THAT THE ABOVE IS CORRECT O AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEZ ONLY.
PLY WITH ALL CITY 0 AND W!REGULATING VALUATION
BUILDING CONSTRU ON —
GI
SIGNATURE OF PERMIT FEE $
PERMITTEF E
v �
s `' PUN CHECK W
AUTHORIZED AGENT
TOTAL PEE $ ----