HomeMy WebLinkAbout2981 TEAKWOOD PL - Building Permits :111L� ,., • CITY OF COSTA MESA
t
�' OC BUILDING DIVISION
). •l , H DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
Ota PERMIT
-`" nstr60� B05-02285
(714)754-5273 • Fax(714)754-4856 • tielLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite: Applied: 12/14/2005
Vicinity: REAR OF YARD Issued: 12/14/2005
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 13921226 Zoning: R1
•
Applicant: LISA ZOSCAK
Address: 24512 BRIDGER RD V4
Phone: 949-338-1489 ISSUED BY:,
LAKE FOREST,CA Zip: 92630
•Owner LEYBA, ED GABRIEL
Address 2981 TEAKWOOD PL
Phone: •
COSTA MESA,CA Zip: 92626
Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA '•
Address: 24512 BRIDGER RD e
Phone: 94•,-44;6
LAKE FOREST,CA "++�„
Zip: 92630 License: 4403 In:
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
• SCOPE OF PERMIT
355SF INGROUNG GUNITE POOL AND SPA(STANDARD PLAN#SP-97-001)WITH SLIDE FOR SFD.
FEE SUMMARY
Plan Check: $274.33 Calc Valuation: $27,500.00
Permit: $422.05 Claim Valuation: $27,500.00
SMIP Res: $2.75
SMIP Corn: $0.00
Other $0.00
Inspection: r $0.00
Total: $699.13 •
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front •10-0 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
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes an 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
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 applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in expiration of this permit.
FOR INSPECTIONS CALL: (714)7545628
2446-46(WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: • r
I hereby affirm under penalty of perjury one 01 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
rk 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.
Myrl�e yyympe ion Insu nce carrier and policy number are: I l✓ ^�,lJ
Carrier: no / Al Policy Number: 7s-T3 o •
(This section need no a completed if he permit is valued at one hundred dollars($100)or less.) - ... .. . .
❑ I certify that in the odor ance of the work to; hich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation law of I fo 'a,and agree t' If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these ro n 1 ( -O`'
Applicant Signature: Date: '/�^4LII'/!' _
WARNING:FAILURE TO SE URE RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),I 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 affirm that I am ticns:•u •er• ovl '•ns of Chapter 9(commencing with Section 7000)of Division 3 of the Busin rofes ipn C ,and my license Is in full
force and effect.Lic.# 4 i b Class#
Contractors Signature: gr/�� I Date:
P I/
CONSTRUCTION LENDING Av/NCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: 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•orishe is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safely 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 0 No
(Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑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 germit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the Califomia 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"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
B (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
i v; aftega;ewner(s)
y-
nd/er Authorized Applicant `Date
CODES INSPECTION TYPE DAIS INTRI/,IS CODES INSPECTION TYPE D1 Irma
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 'V QUO -�A� 208 Final Plumbing •
200 Final Re-Roof 210 Final Electrical
201 • Final BIocWRetaining Wall 212 Final Fire Prevention •
202 Final Factory Fird Place • 220 Final Planning Approval
•
203 Final Sign 222 Final Site
204 Final Demolition • . _ ' 250 • , Final Building/Occupancy- -
-46
POOL AND SPA REQUIREMENTS
The following information is required in a clear and legible manner. All information shall be complete and on
the plans.
,
Three sets of plans showing all of the following with measurements shown from property lines, buildings,
patio covers or other structures.
1. Name,address, phone number of owner.
2. Name, address, phone number,type of license of any contractors or subcontractors.
3. Pool and/or spa location.
4. Equipment location.
5. Gas and electrical meter locations.
6. Overhead service lines and serving pole location.
7. Type of gas and electrical conduits to be used.
8. Size of main electrical service (if less than 100 AMP, service is probably inadequate and will have to
be upgraded to minimum City requirements.)
9. Rating (horsepower, voltage,amps)of all electrical equipment.
10. BTU rating of gas heater.
11. Distance and size of gas line.
12. All electrical outlets within 15 ft.of pooVspa.
13. Capacity of spa(spas only).
14. Handrails, ladders, slides and diving boards(if any).
15. Location and details of solar panels (if any).
16. Location of doors and windows within 5 ft. of pooVspa.
17. The type of construction—gunite,poured concrete,prefabricated fiberglass or other.
18. The pool dimensions, including the depth and adequate cross-sections drawn to scale. •
19. Computations, stress diagrams and other data sufficient to show the correctness of plans; including
reinforcing steel schedule and details.
20. A statement by the applicant concerning the anticipated nature of the soil under and around the pool
structure (expansive, moderately expansive, non-expansive). (A soils report may be required by
Building Division prior to permit issuance.)
21. The Engineer's wet ink signature is required on pool plans and calculations.
22. All semi-private pools and spas shall conform to California Administrative Code Title 24
handicapped requirements (hotels, motels, recreation areas for lease to public or publicly funded
projects).
23. Where a permanently installed pool is constructed, at least one 120 volt receptacle shall be installed a
minimum of 10 feet and not more than 15 feet from the inside wall of the pool and shall be protected
by a ground fault circuit interrupter.
24. Indoor installation of spas and hot tubs,receptacles shall not be closer than five(5) feet to spa/tub.
25. Receptacles located within twenty(20)feet of a spa or hot tub shall be G.F.C.I.
26. Receptacles for spa/hot tub motors shall be G.F.C.I. protected.
27. Comply with Costa Mesa City ordinance 93-12 requiring protective barriers, fencing and/or
• enclosures.
1039-46 (REV.7/98)
GENERAL REQUIREMENTS
1. If capacity is 750 gal. Or more, backwash and P-Trap shall be installed.
2. All P-Traps shall tie in at lower terminus of house drain.
3. If permanent fill line is not installed, nearest hose bib shall have an anti-siphon valve.
4. All PVC shall be 18 inches underground.
5. PVC gas lines shall be tested at 60 P.S.I.
6. Pressure test required on entire system(35 P.S.I. air test or water fill) prior to back fill.
TYPICAL SETBACK REQUIREMENTS
t.
Equipment: 4 ft. from property line
4 ft. from doors/windows
4 ft. from attic vents
18 inches from house/garage
Pool/Spa: 5 ft. from property line
5 ft. from structures
1. Overhead Edison drops shall be installed per NEC 680-8 (see attachment).
2. It shall be unlawful for any person to install, remove, alter, repair or replace any plumbing, gas or
drainage piping or any fixture, swimming pool heater or treating equipment in a building or
premises without first obtaining a permit to do such work from the City Building Division.
3. Clarification or additional information may be obtained by telephone: (714) 754-5273, between
8:00 a.m. and 4:30 p.m.
FENCE AND GATE REQUIREMENTS (see attached)
•
103946 (REV.7)98)
1
.. . 7.---2--S—d t "^n
yy
RICHARD LUIZ
5071 LOYOLA AVENUE
WESTMINSTER, CA 92683
Report of Special Inspection
Project Name & Add ress - Tt n -
__.--
Inspection Types) Gunite
Inspection Date(s) t S t) [ ] Periodic [ XXX ] Continuous
Describe Inspection Made, including Locations: Inspection of the swimming
- jv _.... @ the above address on --( , -O(e,
p �
.s'. Tests Made: C—"` 'b C&)1% ttt- L�!V,:We— ttiv 1- ldltlL1
Total Inspection 'Time Each Day: .
I . .
Date ?v; -{D(O
`
. Hours 1 '^C` Z- I
Lest Items Requiring Correction, include uncorrected items previously listed
Comments: •
To the best of my knowledge, the work inspected was in accordance with the Building Department
approved design drawings, speck icatio and applicable workmanship provisions of the U.B.0
ex:cept as 'noted abov
Signed: Date. —t6s--C
I .C. B .0, #
Pri.ro. Full Name: Richard T. Luiz Registration No. 1075691-49 Concrete
C0,1[49 1.-t C-# 12,50
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, j -may„ CITY OF COSTA MESA
`G BUILDING DIVISION
>4 ,. ..` DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER
l;t WNW.MI t PERMIT
� r_
la,�' E05-01301
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite No Applied: 12/14/2005
Vicinity: • Issued: 12/14/2005
Parcel Nunmber: 13921226
•
Applicant: LISA ZOSCAK n/��
Address: 24512 BRIDGER RD ISSUED BY: `
Phone: 949-338-1489
LAKE FOREST,CA Zip 92630
Owner LEYBA, ED GABRIEL
•
Address 2981 TEAKWOOD PL i .
Phone:
- COSTA MESA,CA Zip: 92626
Contractor: SWAN POOLS OF SOUTHERN CALIFORNIAcall' 1‘ I
Address: 24512BRIDGER RD
Phone: 949-859-846
LAKE FOREST,CA Zip: 92630
License:440333
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR 355SF INGROUNG GUNITE POOL AND SPA WITH SLIDE AND 2 OUTLETS
FOR FUTURE BBQ.
REF#:B05-02285
x' WORK TO INCLUDE: 1 POOL/SPA AND 2 RECEPT OUTLETS
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 - Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
• Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $49.50 1 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0
Switches $0.00 0 • 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 -.i • $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 TreeStand $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 $75.20
Intermed Pole $0.00 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 sus nded or abandoned
fora period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wit II applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penally of perjury one of the following declarations: -
0 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
`'ork 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 workers mptlon Insure ce carrier and policy number are:
Carrier:- G -ePolIty l Number: • , l l 1
Oils section need not be completed if e permit is valued at one hundred dollars 0100)or less.)
❑ I certify that in the p•r•rmance 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 aws•I'Califomia,and agre at III should become subject to the workers compensation provisions of Section 3700 of the Labor Cede,I shall forthwith
comply with lh se . • siys.I ^� /2/14 'O�
Applicant Signature: ' 1 �I'r ,L Date:
-.w—•e�
WARNING:.FAILURE T• -E Li ' ORNERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS 100,••. N 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 I' : ed'Jnnde.,r pr,ovi ns of Chapter 9(commencing with Section 7000)of Division 3 of the Busine . .•• -rote on Code,and my license is in full
force land effect?Lic.0-- 4();J�,/ A Class.q
Contractor's Signature: _ger: a • rDat i . ii..
�� 1r •
CONSTRUCTION LENDING •• NCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the 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 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? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time 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 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apgermit for such construction or modification
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? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑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-des gibed property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
'at .Or L al ner(s)
/1 I • i .i� _ i 191.4LI
r - 17 • irAuthorized-Appllcant.
con t. INSPFCTIONTYPE Illi GAM IALU POE INSPECRON TYPE RAZE It17IDAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
2006 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electricalal
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 •
1j'-1' CITY OF COSTA MESA
A -
•
BUILDING DIVISION
>re- p.. `1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
40/OA
f tsem iappoq, PERMIT
* ; 05-00721
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite No Applied: 12/14/2005
Issued: 12/14/2005
Vicinity: POOL
Parcel Number 13921226
ISSUED BY:
Applicant: LISA ZOSCAK
Address: 24512 BRIDGER RD -
•
Phone: 949-338-1489 •
LAKE FOREST,CA. Zip: 92630
• Owner LEYBA,ED GABRIEL
Address: .; '2981 TEAKWOOD PLPhone:
COSTA MESA,CA • Zip: 92626
Contractor: . SWAN POOLS OF SOUTHERN CALIFORNIA
Address: 24512 BRIDGER RD
Phone::949-859-8466 "6,, f,.
LAKE FOREST,CA . Zip: 92630
- License:440333 - -
SCOPE OF PERMIT
MECHANICAL PERMIT FOR 355SF INGROUNG GUNITE POOL AND SPA WITH SLIDE. -
REF#:B05-02285 .
- - WORK TO INCLUDE: 1-INST FAU GREATER THAN 100 K BTU
FEE SUMMARY
- Quantity Quantity
ISSUE FEE . $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU . $0.00 '0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $18.20 1 -- Ventillation System - " $0.00 0
Repair/Alt Cooling/Heat $0.00 0 - Evaporative Cooler - $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU ,$0.00 0 Domestic Incinerator $0.00 , 0
Refrig Sys>100 k BTU - $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 • 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box _ $0.00 0 30 T6 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct . $0.00 0 ' Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $000 0 - Boilers
Fire Dampers $0.00 0 , Up to 3 hp $0.00 0
Smoke Dampers i $0 00 ' 0. - 3 To 15 hp`- $0.00 0
Inst or Relocate Appl Vent $0.00 0 ' ` 15 to 30 hp $0.00 0
Air Handlers< 10000cfm , -$0.00 -0 `, 30 to 50 hp -,. - - - $0.00 0
Air Handlers> 10000cfm:- $0.00 0 - Over 50 hp $0.00 0
Floor Furnace - $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 .'.0.- r Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $41.70
COMMENTS/SPECIAL CONDITIONS
•
. r
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 suspends 7or
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 alI,,pplicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the piration of this permit.
FOR INSPECTIONS CALL: (714)7545626
2446-46(V00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
•
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
ork for which this permit is issued.
ilfrI 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 wtp�k—ersco�p ns Insurance carrier and policy number are: 1 1.�
CartII
Carrier: V'(dl Policy Number:
(This section need nol be comp efed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the perform nce of the work for ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation law of C omia,and agree the I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these ra • n /I (��/�
Applicant Signature: ,{.� Date: I>4 -( ✓S
WARNING:FAILURE TO S '('oj KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),yV,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 affirm that I am li 'n- •u Liz. o i i°.eof Chapter 9(commencing with Section 7000)of Division 3 of the Busi ro �°n e,and my license is in full
force and effect.Lic.A , a nt J Class ft O
Contractor's Signature: OZi /'q lk Date:
CONSTRUCTION LENDING AGEN -`/ ,(
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 aPPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes I..I No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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 ❑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-des ibed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
1
Si fur egggqO'�—er(s)
J���
Or razed Applicant L (2f I/ Tate'
1p�
�n
p00E1 1NSPECmON TYPE � ,pA� UITITIAL@ CODES INSPECTION TYPE �1 ' 11�
.1616 Fixed System Final Fire Prevention 206 Final Mechanical it. "W""l
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 • •
. CITY OF COSTA MESA
„0-111e4.;.
lam,,` BUILDING DIVISION
q DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
�
4y PERMIT
n�-I*P ro P05-00937
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite No Applied: 12/14/2005
Issued: 12/14/2005
Vicinity:
t
Parcel Nunmber: 13921226
Applicant: LISA ZOSCAK ISSUED BY:
Address: 24512 BRIDGER RD .
Phone:. 949-338-1489 '
LAKE FOREST,CA.HT . Zip: 92630 •
Owner LEYBA, ED GABRIEL
Address 2981 TEAKWOOD PL - y
Phone:
4
COSTA MESA,CA - Zip: 92626 eA.
•
Contractor. - SWAN POOLS OF SOUTHERN CALIFORNIA it ,
Address: 24512 BRIDGER RD
Phone: . 949-859-8466
LAKE FOREST,CA Zip: 92630 - -
License: . 440333
SCOPE OF PERMIT
PLUMBING PERMIT FOR 355SF INGROUNG GUNITE POOL AND SPA WITH SLIDE AND 1 GAS OUTLET •
-" REF#B05-02285 " - _
WORK TO INCLUDE: 1 GAS(1-4 OUTLETS), 1 PRIVATE SPA ANDA SWIMMING POOL.
• FEE SUMMARY
AMT QTY - AMT QTY AMT - QTY
ISSUE FEE -_-$2350. Laundry Tub'/Washer - $0.00 ' 0Sump Pump • $0.00 0
Backflow irrigation $0.00f 0 Landscape Irrigation $0.00 0 Swimming Pool $60.75 1
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub 4-. $0.00 ,:0' Pressure Regulator $0.00. 0 Urinal • . - $0.00 . 0
Clarifier System " • , $0.00 0, Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors _ $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater - $0.00 0 Sewer Private Line '$0.00 0 ,Water Closet(Toilet) $0.00 0
Drain,Roof- $0.00 0 Shower $0.00 0 - Water Heater/vent $0.00 0
Drinking Fountain $0.00 0. Sink,bar $0.00 0: Water Piping(Inst or Re_p.) $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) • $6.15 1 ,,, - Sink,kitchen $0.00 is 0 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) $30.25 1 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: $120.65
COMMENTS I SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations, (Ord.No.92-28,§1,12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended orabandoned
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 applica a codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: • ' ' • _ -
I hereby affirm under penalty of perjury one of the following declarations: -
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
)work for which this permit is issued.
A:
_ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance theorlifq,whlchis permit is issued.
My wor e 'co nsi•Ngn lnsuran a carrier and policy number are: I
Carrier: / A TI / Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the perfo -ance 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 .f 'I omia,and agree t t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these• ••s•
��. I��K/`� Date: 104'4Applicant Signature:
(J
WARNING:FAILURE TO S U' ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1••,000),7 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licen e. •-r pr•vis'• s ' Chapter 9(commencing with Section 7000)of Division 3 of the Busin s ofgasiats,8¢e,and my license is in full
force and effect.Lic.# a 4 Class#
Contractor's Signature: Winn Date:
CONSTRUCTION LENDIN A mr.'CY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: _ Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. . Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time 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 application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 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? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 It a permit from the South Coast Air Duality 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-d-scribed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Iftirtri ••� .- �� :• Owner(s) I9 4 1 �eJ�k
I
k And/Or Authorized Applicant Date
;ODE S.-.INSPECTION TYPE PATE INTTALS ODE* INSPECTIONTYPS PATE ILLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical •
1266 Pool Spa Final 208 Final Plumbing 1 .0 ‘+4A--'L
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 Bullding/Occupancy - • •
`� p MFS
• 9• CITY OF COSTA MESA
}N a 1• BUILDING DIVISION
f i "^ i PERMI UMBER
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
•gaI4„ o."`•
' 00-00258
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite No Applied: 06/28/2000
Issued: 06/28/2000
Vicinity: NEW OFFICE/KITCHEN .✓1
Parcel Number: 13921226 1 7-'
ISSUED BY: ' ,//
Applicant: JOHN GUTIERREZ
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA Zip: 90604
Owner: LEYBA, ED GABRIEL
Address: 2981 TEAKWOOD PL
Phone:
•
COSTA MESA,CA Zip: 92626
Contractor PRO BUILDERS EXPRESS
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA Zip: 90604
•
License: 737610
Arch/Eng:
Address:
•
Phone:
Zip:
License:
SCOPE OF PERMIT
1 VENT FAN AND 1 HOOD FOR 200 SF SINGLE STORY OFFICE ADDITION AND KITCHEN
REMODEL.
REF:B00-00971
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $41.40
COMMENTS I SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit/
FOR INSPECTIONS CALL: (714)754-5626 //
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
hW 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 workers'compensation Insurance carrier and policy number are:
Carrier: • Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Californi- : agree t if I s,+•Id ?me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provision ‘17-2A r7 /J
Applicant Signature: .../.(..e" / • _ v Date: (J r)CA�Dw
WARNING:FAILURE TO SE •'E WORKERS'COMPE >'iN COVERA •UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
LA
THOUSAND DOLRE($lO0,000),IN ADDITION TO THE COST OF CO./- ATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under revisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busin and Professions Code,and my license is In full
force and effect.Lic.q7 /-? -7 / ° Class#
Contractor's Signature: ' iie.r( Date: B',.,ZI'�0�0
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: 1'
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,Califomia Administrative Code).
❑ As owner-builder,I.will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? YesIP No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_--......__.__..-__._--_.___ -------_—
S ----____—
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 Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No
6 (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.
etude O eget wn s)• Date
And/Or A ed Applica Date
CODE I INSPECTION TYPE DATE 7MIRAE$ CODE' INSPECTION TYPE 1ATpg CF) A
1616 Fixed System Final Fire Prevention _ _ 206 Final Mechanical /O-1! `0
//
1266 Pool Spa Final 208 Final Plumbing / /I \ •
200 Final Re-Roof 210 Final Electrical VF• J
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
....
FS cm
4LD . CITY OF COSTA MESA
BUILDING DIVISION PE IT NUMBER
' DEVELOPMENT SERVICES DEPARTMENT
PERMIT
00-00971
M1`. ORRTEO� A
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite: Applied: 06/28/2000
Vicinity: OFFICE&KITCHEN Issued: 06/28/2000
Parcel Number: 13921226 Zoning: R1 R1
Applicant: JOHN GUTIERREZ ISSUED BY: S-0
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA Zip: 90604
Owner LEYBA, ED GABRIEL
Address 2981 TEAKWOOD PL
Phone:
COSTA MESA,CA Zip: 92626
Contractor PRO BUILDERS EXPRESS
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA
Zip: 90604 License: 737610
Arch : Eng:
•
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
200 SF SINGLE STORY OFFICE ADDITION AND KITCHEN REMODEL.
FEE SUMMARY
Plan Check: $441.19 Calc Valuation: $55.000.00
Permit: $678.75 Claim Valuation: $55,000.00
SMIP Res: $5.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,125.44
PLANNING &ZONING
SETBACKS
• MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all,
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. / '
FOR INSPECTIONS CALL: (714)754-5626 (.7
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
NO 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 workers'compensation Insurance carrier end policy number are:
Carrier: • Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance f 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 Califomi , d agree that if I shoul become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisio '7
Applicant Signature: .., / Date: f9 G'w �Lt6d
WARNING:FAILURE TO SE WORKERS'COMP TION COVE S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100000),IN ADDITION TO THE COST OF CO SATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# • _ Class# 13
Contractor's Signature: -...."4117 Date: —9 ^ •2 000
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the 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 end 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 ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: •
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑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 Cale 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 aPpermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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.
Ignature Le con (s)-. / D�ate2
'K And/Or nzed p C 2� O�
CODE r INSPECTION TYPE DATE INITIALS CODES )NSPECTION TYPE Ut PAR INITIALS
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 (2_(Lp
_-d2
244646
•
C.' 444 .
,4 9 CITY OF COSTA MESA
°N e BUILDING DIVISION
'F i kt DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
J 8i
PERMIT .
`OAeGgelEO,9t. P00-00339
(714)754-5273 • Fax(714)754-4056 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite No Applied: 06/28/2000
Issued: 06/28/2000
Vicinity: NEW OFFICE&KITCHEN ry�
Parcel Nunmber: 13921226 ISSUED BY: / '/
Applicant: JOHN GUTIERREZ
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA Zip: 90604
Owner: LEYBA, ED GABRIEL
Address 2981 TEAKWOOD PL
Phone:
COSTA MESA,CA Zip: 92626
Contractor: PRO BUILDERS EXPRESS
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA Zip: 90604
License: 737610 .
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
1 FLOOR DRAIN, 1 SEWER CONNECT AND 1 KITCHEN SINK FOR 200 SF SINGLE STORY OFFICE
ADDITION AND KITCHEN REMODEL.
REF:B00-00971
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $9.80 1 Sewer Connect $24.65 1 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: $67.75
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all'
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit./
FOR INSPECTIONS CALL: (714)754-5626
ti
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I 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 workers'compensation Insurance carrier and policy number are:
Carrier: • Policy Number:
(This section need not be completed if the permit Is valued of one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit Is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of Califo is and agree at if I s • Id•ecdme subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provi �J /� �v')
Applicant Signature: /-— i Date: 42/f a
WARNING FAILURE TO- CURE WORKERS'COMPE = ION COVERAGE• LAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,0001,IN ADDITION TO THE COST OF COMPEN'- ION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under•rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.R 7F 7sZ6 Class# /7
Contractor's Signature: i / /j ,- Date: 2f.�cto0
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 l am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts far such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date: •
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time 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 0N
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication agpermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: - Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
' above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ignatur f Le (s) 99 Date
vr19.2000�
And/ r orized Appli Date
OWE I INSPECTION TYPE, PALE INffALs CODE• INSPECTION TYPE DATE INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing )O`19 - "r-�1" A 71T
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
244e-46
4..0�5til 44_.
CITY OF COSTA MESA -
i ' BUILDING DIVISION PERMIT NUMBER
r �" DEVELOPMENT SERVICES DEPARTMENT
a. PERMIT • ✓ E00-00609
`JbORRTEO&
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2981 TEAKWOOD PL Status: ISSUED
Suite No Applied: 06/28/2000
Vicinity: OFFICE ADDITION/KITCHEN Issued: 06/28/2000
Parcel Nunmber: 13921226
Applicant: JOHN GUTIERREZ ISSUED BY: -IM
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA Zip: 90604
Owner: LEYBA, ED GABRIEL
Address 2981 TEAKWOOD PL
Phone:
COSTA MESA,CA Zip: 92626
Contractor: PRO BUILDERS EXPRESS
Address: 16002 RED COACH LN
Phone: (562)947-4335
WHITTIER,CA Zip: 90604
License: 737610
SCOPE OF PERMIT
26 LIGHTS, 17 OUTLETS AND 3 SWITCHES FOR 200 SF SINGLE STORY OFFICE ADDITION AND
KITCHEN REMODEL.
REF:B00-00971
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res. a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(31-units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $24.38 26 up to 50 kva/kw $0.00 0
Recept Outlets $18.70 17 up to 100 kva/kw $0.00 0
Switches $3.30 3 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 Wring 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 $69.88
Intermed Pole $0.00 0
/
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pe .
FOR INSPECTIONS CALL: (714)754-5626
L/
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: .
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I 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 workers'compensation Insurance carrier and policy number are:
Carrier: • Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the 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 Californi agree th t if I sh d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provision / ��d�
Applicant Signature: � / IAAF Date: (�
WARNING:FAILURE TO SEC WORKERS'COMPEN ON COVERA UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100000),IN ADDITION TO THE COST OF COMP ATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed nder p7ions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# 7"7 �(2 Class# .�
Contractor's Signature: .-•"*.% 67`i,K ) Date: C-o1®� o0
CONSTRUCTION LENDING AGENCY: �/
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
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(5500).):
O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3........ will
o.r- future
g occupant --.--t.._.p RM.... k Management
d...Pr_ g.. .__y_ at. as)?...
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
_.._ w.ill.t.. ._.__. ., .._t._. occupant
rquireo._which he subject
.. a.__o e._._.... .. const. modification 5 Does or will the applicantsirorQuality presentaor emen building o oat require for the work on rol is the district or agency?this a Yesestion aLPI Not for such construction or motlification
from the South Coast Air Management District or from any other air pollution control or � LJ
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
...... .. men District
or other pollutio.. hch. bect
7 Ifa a patron from tae Sohth Coast re Quality Management Heat hr d air pollution controln district 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? ❑Ves 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatu • •1}0.,e'O. er(s) Date
6 -z000
And/Or orized Applic-. Ar Date
CODE I INSPECTION TYPE DATE INTITIALS CODE. INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing I 1
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
2446-46
PRk*CTADD'ESS: 2981 TEAKWOOD PL UNIT: CITY OF COSTA MESA - BUILDING PERMIT rtnM NO; b UJ /171
OWNER'S ME: TURAY, EMERY LAWRANCE
ADDRESS: COTR PERMIT NO: B 057155 PLAN CHECK NO: N (20V1 ; N Suer: N
2-981 TEAKWOOD
COSTA MESA, CA 92626 CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T/OFF REROOF W/CLASS A COMP SQ FT: 4 , 935
ADDRESS: UNIT:
CLAIM VALUE: 4 , 935 . 00 CALL-VALUE; 4, 935 . 00 GROUP OCC; R-3 /
PERMITTEE: PETRONELLA ROOFING ( 714 ) 548-1645
ADDRESS: 2626 NEWPORT COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
COSTA MESA CA 92627 ###**********************## ######>Ex#FE#*####*###iE######NSE##yE#+F###*x*##*****##*x"
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
CITY LIC.: 032605 STATE LIc.:00460707 clAss: C 39
are: y^ 27 ' S'2 _ . ave Signature: / �` MAIN BUILDING ACCESSORY BUILDING
r FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
WORKERS'COMPENSATION DECLARATION: I hereby. a certificate of consent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
It Compensation LtimagR1 a. e¢copy thereof(S• •00.Lab C).
POLICY NO.: r rd 1 t. V V EXP.DATE: 1 2/0 1 /92
I COMPANY: GOLDEN EAGLE PARKING REQ: PROV: PARCEL; 13921226 ZNE: REF NO;
1 7 Certified copy is herebyebfurnished. C$ Certified copy is filed with the city Building Division./ PLANNING NOTES>.
/ �' 27- 9 2 ADDlican' �� r/-� #*#!E*****#****-IF*3E*##*#*#1F***#*##*#####***#***K*Bh****IE iE**iE*k**#*#***1F BF If•****1F 3EN#*
EXEMPTION FROM WORKERS'COMPENSATION OECLAR his section need not be completed if the cerrttl is for one hundred($100)or less).
D E V Ej L O P M E N T S E R V I C E S R E Q U I R E M E N T S
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
subject to the Workers Compensation Laws of Calitornia. ZONING APPROVED BY DATE; •J
Date: Signature: - —
NOTICE:If.oder making This declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. 4.. IP
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION I S$UED BY• ' ' (11-46.—...a\. DATE•
which this permit is issued(Section 3097.Civ.C). - ********#******k******: • ' • ' • • • ' '*; • • • • .. • • • • • ********** ' ' **
LENDER: ###*****#******#********************* ' can"xna***********************--3e#*********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 00 . 50
repair any structure.prior m its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-R ES
pursuant to the provisions of the Contractors'State license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
PLAN .
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 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----> 72 . 50 0 . 0 0 'r 0 . 00 72 . 50 72 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through 7.
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: '72 . 50 OVER/SHORT; ' 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
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
72 . 00 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ,,•
and who contracts for such projects MTh a contractor(s)license pursuant to the Contractors'State License law).l am aware #**#*******N•******#********************************************#***#***** *****
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 4935 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 935. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and 'END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District,Residential construction applications are exempt from
these provisions.
Date: Applicant:
x
I hereby certify that I have read this application and slate 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 representatives of this city to enter upon the above-mentioned
property for inspection purposes. f
Date: Y•27' 9Z Signamre;�l..=/ !;tr
• )RTE' 2;21 ';' -(nn-. -.T'T
Driver's License or Social Security •%
1641-46 While—Buildino:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POO.. SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
-r1. 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 UF ER 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 f'8-47.2- Cv 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 111
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 L/5-102-
48.
FINAL PLANNING •f
49. Electric Release to Edison Lam,. iQ., ,(� �y� �J�J/-
50. Gas Release to Southern California Gas Co "g"/Yr / v !,
51. CERTIFICATE OF OCCUPANCY -
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
i CITY 9F COSTA IyJIES - CONS RUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. ,
Project Address "`-' Q// -re-reek�.� Lt/UO�. M Z S r - 5048 3/31/87 7 IC1f1 c1 TL
Applicant's Mailing Address 'JAM-�•
TYPE OF CONSTRUCTION LI NEW LI ADD LI' ALTERATION U REPAIR
�4-nJl // CI CONVERSION CI DEMOLISH ❑ OTHER _._ - A.P.# - Zone '--
Owner's Name �7 Phone9-�-s�Y
DESCRIPTION OF WORK/USE OF BLDG.• .PLS to ft Ft:Ni1 of Furnace
Address a9a7 T9a ku�00et S Main Building: Accessory Building: .
,2/•LG 9 .L TYPE OF PERMIT El GRADING ❑ FOUNDATIO ❑ STRUCTURAL E Front '0
Arch/Eng. License No. T O
Address Q,�` ���Jj� .❑ TENANT ❑ ELECTRICAL ❑ PLUMBING .K MECHANICAL B - - , -N
?Ina r/LQ-f[� 971-9e 99 CI OTHER •
A Rear - ,r ,N 1
Contractor's Name 7 Phone
-7,L ,] PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right
1 �` Address(mailing) �7'Z,� �J'• f '��1'� P� K G
,,..1l.� QD/n�/. /� CON ST RUCTION TYPE VALUATION$ 5 Left 1: ;R
W City License No. •
Y' `C' `(' ZONE GRADING CU.YDS. ACRES I.1 ,E;
k LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided '
I herebyaffirm that I am licensed underprovisions of charter 9 (commencingr O'
V Remarks: Planning Notes: M I
with section full of Division 3 of the Business and Professions Code, and T •�
my license is in full haspP@nd effect. i'
I` License Cla s L4' -/- License N i2 6' 9 L _ ' is
30 7 C •
PLUMBING, - FEES. • . . _ i
'Date Signature '�_
WORKERS'COMPENSATION DECLARATION ' ' mar Sink. Showers ' ELECTRICAL • I FEE •
1 hereby affirm that I have a certificate of consent to self-insure or a certificate \ I
of Workers' Compensation Insurance, or a certified copy thereof (Section —
Backf Preventer Service Sink '
3800, Lab.�C•p)P �• �/ - - -• Automatic Washer- - - Transformer ❑ 15.50 KW - •}- — -
Policy No.J'L.s d777sJ�T e� omoony i-e--1'h&-• , Backflow Ir tion Sewer Ca 0 50+ KW
❑ Cercified copy is hereby furnished. • - p onstruction Pole Sub. i
t�Cerci/ie copy is filed with the city u ding D' ision. e_ - / Bathtubs Sewer Connection. Coo'•.. Unit Meter ❑up to 100 am.- I
Date' R/Dtel Applicant(,A j4_•
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwashe Meter ❑over 100 . ps 1
(This section need not be completed.if the permit is for one hundred ($100) or - . • Dryers ❑Gas ■Electric Sub Panel 1
less). Dishwasher _ Solar Piping �
I certify that in the performance of the work for which this permit is Issued, I '
shalt not'employ any person in any manner so as to become subject to the Drinking Fountains -.ler Tank •
Fan
Motors 20-1 HP ❑1'h-8 '
Workers' Compensation Laws of California- - I
.Date Signature Floor Drains Swi • in• -ool w/Spa F.A.U. In•. olar ❑9.15 HP❑16-15+ I
NOTICE: If,after making this declaration, you should become subject to the - ,
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Uri Fixtures '
comply with such provisions or this permit shall be deemed revoked. - .
- - Microwave - _ - _ .�.- __
CONSTRUCTION LENDING AGENCY- ' Gas Service Outlets ater Closet . 1 Device Boxes I
I hereby affirm that there is a construction lending agency for the performance _ Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors / Water Heater Outlets
Lender's Name / Range I
Lender's Address ' Kitchen Sink Water Service - SwitchesAii I
OWNER R OEC LA RATION 1
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 Garbage Disposal ections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 0.5 5-15 KW Trash Comac❑ ❑
any structure, prior to its issuance, also requires the applicant for such permit - p I I
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 Roof Drai• _ I
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 • . I
p5natty of not more than five hundred dollars($500). I V
Ll I, as owner of the property or my employees with wages.as their sole Reinspection Fee $15 3
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 .. •
DEVELOPMENT SERVICES REQUIREMENTS: I .
' employees, provided that such improvements are not Intended or offered for Boiler -iHood or Type 0
sale, I1, however, the building or improvement is sold within one'year of com- Canopy Type II ❑ Zoning Approved By Date •
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By ' Data_
prove for the purpose of'sale). K�j
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By /1 IC_ ' Date 5/�/ e?
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 ❑o-100,000 BTU ❑100,000 BTU SUMMARY OF FEES I
builds or improves thereon, and who contracts for such projects with a con- 1
tractor(s) license pursuant to ,the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP ' $ I
. proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
•
0 lam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ 1
Date owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I
I hereby certify that I-have read:this application and state that the above I 'M0-100,000 BTU 0100,000 BT GRADING $ I
Information is correct. I-agree to comply with all city and county ordinances ' - a o ELECTRICAL '$
and state,laws relating to building construction, and hereby authorize repre- - MICROFILM $ I
sent. enter-_ Pon the above- ent.•ned property for PLAN CHECK 50% $
I.-•ect'•n • rposes, i )
SF _ MECHANICAL $ 7 • TOTAL FEE $ 7 • o 0
ignature �1 _
• Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ '
CMF 0865-46,'rev.10/84' White- Building; Canary +' 1—
Applicant; Pink '-Accounting; Goldenrod - Assessor - -- ' - - -
_ _. .
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool& Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement
,- 3. Electrical Conduit Utility-Undrgrnd. 54. Forms'
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure-Test ,
6.. Electrical UFER Grnd. - 57. APPROVAL TOCOVER-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
17.4 Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rdugh 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-BarCeiling (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: ,s6-4 7 ten 032Let
.°
L, °
34. Final Heating & Air Conditioning /2.1-07 C.4+>•tee. 4s Pfet ZA'3 umc L O
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 '
i
49. Electric Release to Edison "• •
50. Gas Release to Southern California Gas Co ' ' .
51. CERTIFICATE OF OCCUPANCY • ,
No. - Date 2 _ _ - •
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. _ _
CITY OF COSTA MESA; _ � • pE IT NO ' / 'TRAC NO. LOT NO., - t BLDG.NO. - _
CONSTRUCTION PERMIT - 4 3 T �.a as ' • •
�• ➢636 ' 4/2r /U3 64. 12 TL
' Applicant's Mallin! Address ,,���• '1 A - a IC - C A/. ' TYPE OF CONSTRUCTION EW ADD U ALTERATION U REPAIR • • •
Project 'Address / '_ 'SF, J�p ii. C /'f ❑ CONVERSION ❑ DEMOLISH. ❑ OTHER - " '
Owner's Nema �C +7-r�nA Phone - Oyu DESCRIPTION OF WOR
[nfi/e�F/w / y ��L` / ,17�o co✓s,�� / - - ZONING REGULATIONS
Address +rLY�� -/ �•/'il' kilo.5' ��/' TYPE OF PERMIT U GRADING U FOUNDATION LJ STRUCTURAL A.P.qy j39-:? l a- 2.G ZONE R i .
Arch/Eng. License NO. ❑ TENANT, ❑ ELECTRICAL -❑ PLUMBING 0-MECHANICAL -PLNG. REF.# ' • , I BUILDING
- - Scr9arx rn $T •
Address L_ �z� ❑ OTHER - p TO BUILDING , •-�
✓ ���S�/ PROJECT DESCRIPTION SQ. FT - ] ' OCCUPANCY PROPERTY LINE REAR YARD (TO P/L) p(S
Contractor's Name O 141"/-01/15-4 -- Phone '��� yyµ�/.�s
Address(mailing) - r-rD• LEFT SIDE YARD / 11 • RIGHT SIDE YARD / (Litt',
� G/LC.�
CON STRUCTION TYPE I/ ` VALUATION$ I�J7O.'- •�- 9 ( ,
License NO. __ ZONE GRADING CU.YDS. ACRES PKG.SPACE REQ. PROVIDED _
•
LICENSED CONTRACTOR DECLARATION Remarks: STREET WIDTH - PARK FEE'$ —__ -
I 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 SPECIAL CONDITIONS: �,GD GOT --Q —
/ �
my license.is In full force and effect. . , - ' .
License Class : _ License No. PLUMBING •
Date- ' Signature - I
•'+ORKERS'COMPENSATION DECLARATION Bar$ink Sewer Cap ELECTRICAL
sereby affirm that I have a certificate of consent toself-Insure or a certificate - Backflow Preventer ' -- Sewer Connection - Automatic Washer . Meter_❑over 100 amps . _
A Workers' Compensation Insurance, or,•a certified-copy thereof (Section
Construction Pole
3800, Lab. C.) Sub Panel •Backflow Irrigation Solar Collectors;
Policy No. Company • _ Cooking Unit - .Sub Pole
9 Certified copy is hereby furnished. ' - Bathtub's Solar Piping -
Certlfled copy is filed with the city Building Division. , Dishwasher Motors' ❑0-1 HP ❑1 Ya-B
7.Date Applicant - - - ' Clarifiers _ Solar Tank - -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dryers ❑Gas ❑Electric Ina Solar 09-15 HP 016-15+
Dishwasher + SwimmingPooi w/S a
' (This section need not be completed if the permit is for one hundred (5300)or _ P less). , Fan • ( Microwave
I shall:
certify,that In the performance of thework for which this permit is issued, I Drinking Fountains Urinal ' . _
shall:not employ any person In any m net so'as toy9com subject to the ' I F.A.U. . Pole Light Workal Go yyy""an_s""a""tlop,,LaWsof Califo C" ' '• p • Floor Drains , Water Closet_ 9 ._ 1
Datelytry /J/�Slgnature :!/yj'l,L}- C -� r Fixtures
NOTICE:If after making'this declot ion, you-should!become ubjectto the -- Floor Sinks ' ---- : - Water.Heater-- . - •37
- - .- - -_- - - Range _ , _
Workers" Compensation provisions. f the Labor Code, you must forthwith •
Device Boxes
comply with such .provisions or,.this 'permit 'shall be deemed, revoked. Gas Servic2' Outlets •- Water Service : - - Sign '
CONSTRUCTION LENDING AGENCY - -
•
I hereby affirm that there Is a'constructlon lending agency.for the performance' . interceptors ' - - Outlets S• tanding Sections e
' of the work. for which 'this• permit is issued _(Section 3097. Civ. C.) - - •
Lender's' Name - ^ '- - -' . - ' Switches.' Trash COT '
�� Kitchen Sink pac[or
Lender's Address' - „ . I Garbo a Disposal ! ' •
•
OWNER.BUILDER DECLARATION, - ' - - - Lavatories • _ 9
I hereby affirm that I am exempt from the'Contractor's License Law for the '- 13.--Trap _ Generator 00-5•KW ❑5-15 KW : ,
following reason (Section 7031.5 Business and Professional'Code: Any city or }
county which requires a permit to construct,alter,improve,demolish or repair - , - Transformer ❑15-50 KW I •
'
any structure, prior to its-issuance, also requires the applicant for such permit Roof Drains - Ito file a signed statement that he/she is licensed pursuant to the provisions of , - ❑50+KW
i Ape Contractor's License Law(Chapter 9(commencing with Section•7000)of - . - - : 17. 'Reinspection Fee $15' •
ivislon 3 of the Business and Professions Code)-or that he/she is•exempt - Showers r - ' Reinspection Fee ' $15 .
:lerefrom and the,basis for the alleged exemption. Any violation of Section J - - Meter ❑up to 100,amps Issue Fee: ' '$ 3 •
'7031.5 by any applicant for a permit subjects the applicant to a civil ' • ' •
e Ky of not more than five hundred dollars($500). - , Service Sink- Issue Fee $ 3 - - /l// J — - `d
r __- I _ _ rZonin9 Approved By '�/�G Date
•
as owner of the property or �s - -as-teeic.eie _ , ��e9 .•
mwsplsgsaYga will do the work,and the structure-is not intended or offered ' • MECHANICAL Application Approved By Date
for sale (Sec/ion 7044, Business and Professional Code: The Contractor's - '
License Law does not apply to an owner of a property who builds or Improves Boiler , Refrigeration System Application Issued By • '' f{/ZZ/83
thereon,'and who doos'such'work himself/herself or through his or her own PP Date
' employees, provided that such'improvements are not intended or offered for • ❑D-100,00013Tb ❑100,Oo0BTU
sale. If, however, the building or Improvement is sold within one year,of com- , Duct-Under Ground SUMMARY OF FEES '
Diction,the owner,will have the burden of proving he/she did not build or Im- - - '
ove for the purpose of sale). - - . Duct-Structural
DrrSystem Repair/Alteration 2BUILDING PERMIT $ ' .SO , SMIP $ O•C
LJ I, as owner of the property,am exclusively c •
ontracting with.licensed con-
'
tractors toconstruct the-project (Section 7044,.Business and Professions Code: _ Duct-Ventilating _ _ _ .. - - .. PLAN CHECK $ 2/ -12 • PERMIT
The Contractor's License Law does not apply to an owner of property who ' - ISSUANCE $
builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 - PLUMBING $ • , -
tractor(s) license pursuant to the Contractor's License Law)." PLAN CHECK $• _ • GRADING $
❑ I am exempt under Section B.&P.C.for this reason • Fifepl/Fact.BIL ICBO# - ' , $ . ,
Date I Owner, - : I . Heating'System&Ducting , ( 1 ELECTRICAL $ _
; MICROFILM $
-I' hereby-certify'that'l have read this-application-and-state that-the-above- -1' -- ❑0-100;000I BTU ❑100,000BT1 .. _ , _ _ ; $- PLAN CHECK; -
Information is correct. I agree to comply with all city and county ordinances �• TOTAL:FEE $
and,state laws relating to building construction,;and hereby authorize repro- . I MECHANICAL $
sentatives of kthls;city,to enter pon the above-mentioned property for ' Hood Or Type I ❑ I ,
I inspection Du p•ses: ar r ...iReinspection Fee $15 • LESS i !
17� �p• I Canopy. Type II 0 I I _
:PLAN CHECK' $• � ADVANCED PC •
••$ '
Signature �1/i.. a - i I
r Registers I- Issue Fee - $ 3 !
• 1. 1 I , ' FINAL FEE! . $ { Sq.(2.-•
%
CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor -
c� nCONSTRUCTION•AND:PLAN iNG.- _ ,• v u - POOL 3PA -- _' ' - - -
I- O 1 r •:Date Inspector r' o, - + .- , ' Date -Inspector. c
y .APPROVALS Perthie, ,^..APPROVALS-r Permit# '
rt 11,: Temporary.Electrical Service or'Pole ' ^ �. ^i , :'S2'PooI &:Equipment Location' r i '
E 2? Soil Pipe-Undrgrnd.• £ ;tit:cc' ° ,.a...-- •_c _ '53o Steel Reinforcement 1 - - ' . -
3? Electrical Conduit Utility-Undrgrnd. ;l; >o '54'- Forms' '
z n Electrical Conduit-Undrgrnd.. �_ 2 ` : �, •1 •'55._ ElectricabBonding ., _ .
•5; Steel Reinforcement I I ,; �; _ ' l i 7. ;; :.; -- ;56. Rough Plumbing_& Pressure Test-
a
6. 'Electrical LIFER Grndil j _ '• ' -'.°." . : E " 57',APPROVAL TO COVER-GUNITE • . ' , ... - ' -
7. Footings l I I ' -3 G �l� 58. Electrical)Conduit-Undramd.' -
i
¢LS�f
8. Foundation 59. Gas Pipe;;0-Undrgrnd.,Test`
9. Water Pipe-Undrgrnd. I ' . , ; ' _ - ; x60. Backwash Lines,,P-Trap, O Undrgrnd. `•'
10. Structural Floor System .:;,. : g
•• 61. APPIROVAL'TODECK , - i , , ,,- ,
11. Property Sewer Line & House'Connection - - it `;, : ,62. Backwash'&;Receptor-Final -
n' a: , i -
12. Sewer Cap - i - =63. Heater& Vent-Final .
13. Roof Drain's ' y '> • ' 64. Plumbing"System'- Final ' - , . °
• 14. Rough Plumbing • ' 65.' Electrical-Finan - • - '
-15. Rough-Electrical-Conduit 1- -' -- - I r CC-- l -T 1 X66:I Solar System-Final-" • - ; _ - -- -- " -
-016 'Rough Electric Wiring , _ I .., --_ ,;--I'- - 67tFencing &AccessrApproval - a `
'17. Rough Wiring Sign, w I •- I' 1' i _ _ ' ` ' - " I ' 68..APPROVED FOR PLASTERING '
18.'Rough Electrical-T;Bar Ceiling, ' r I i , 69.,POOL/SPA SYSTEMS FINAL ' I
„ 19.• Rough`Heating&'Air Conditioning 1 1 ' 1 I ^ 1 l : , FIRE DEPT- REQUIREMENT- _
e 20..'Rough-Factory, Fireplace j ` i I I ' ' I APPROVALS) Permit# •
21 Ducts,•-in$tructureti `" 4 1 ' I 1 '
_J 1 , 1 l 70.i Underground HVdro
•
, .'[22. Ducts, Ventilating : I ' I 1 I ; i i 71.'Product Piping 0 Gas 0 Oil
;23.•bas'Pipe-Rough&Tis( .� I I ;Q , i I- _i of n l
r
i � _ ,_ ,� ; 1 72. Underground Flush
24. Roof Framingi a,l � I a 1 .-, : -• ; , ' • _ •I 73.i Undergrnd.Storage Tank 0 Gas;O.Oil ,
25. Roof Sheathing " • , •• ' 1 - _ - 74. Overhead Hydro ,
I' 26. T'Bar Ceiling (Structural).& Monocoat - . I 1 '''- ; , • , -r 75.' Dry Chemical i - .
1 27. Frame and Flashing' - ' 5x$13 ;6'� i 76. Dry Standpipe •
r 28.�Lething&Siding ^ ., I ; l I p7. FIXED SYSTEM�F•INAL i -
29._f Insulation - ' -- - •
' I , 1i ; i I 1 ;78.; FIRE PREV. FINAL ' '
''30. Drywall Nailing > ' l ll I I I ; ; ,Notes: •
_ ';_31. Plaster Brown Coat -'y I �� 1 ; l i l � 1 1 I
- '-32. iElectrical Power Mete;-Final ; ; 1 i i I l ' ' I
n
33. Final Electric '' j • I
34. Final Heating&'Air.Co'nditioriing ' .'I I . F
., - ,r n n• ,. I
35. Final_Gas�PipeTest; ' , ' i - - „ I " - - -•
36. Hood or hanoPY;"' _ - ' i ' I I - I i - •I :
•
37. Final Factory Fiie_place' u I ' " i 1 ; ' • ; .
38. Final Plumbing 1 • _ 1 _ ,
39. Water Servide-Filnal. ' '
I ' I '
, . . 4
40. Gas Service-Final i I ' ' I 1 I
41. Solar Domestic-Final _, - _ _ _ -
•
42. Backflow,Preventer; c. i - - -r -1 - r - -
43. Backflow Irrigation) ' j ,
44. Landscape Irrigation System _ •
45. Sound Attenuation . I, I ; I I-'- 1 i , I 1 -i , , -
46. HandicaplRegulations I ! I I I 1 ' IH II 1 ' - '
47. FINAL STRUCTURE & BUILDING , , 5- )_155 • - 6 i • • _ • •
,
48. Special Requirements Completed I i 1 ":• I ,.
49. Electric Release'to Edison' I I i ' - ' t- ,
• 1
50. Gas Release to Southern California Gas 6 j , I i i i ' ! ; ., , r
51. CERTIFICATE OF OCCUPANCY ' ' I ' I i ' _ ' "
, /, . I ' i • I , ' t'---' - -i -"' 1-T` __ i ,_i- -
No, fi Date I i l �I' ` I
•
A
PATIO COVER DETAIL - 12/9/81 - NOT TO BE USED FOR SUNDECK, ETC. TYPICAL • JOIST ANCHOR
pe ..-..3.-..toSTATE--j-------4,,- C '
'tW+-
�n- rfx6 rF8 SIZE SPACING SPAN lippr---4111111!"4-.„-.
OVERHANG t2 M
RAFTERS: x�( p C :.y :.: 111'SL SPED F DRAIN-- Min. 114 •�, t •'_
r ? LEGTrPANT �MAXIMUM7i. ,�/•, tile) O
J 'may
i * CONTINUOUS - '
3/BxS�Logs 32% LEDGER pe
...-
Blocking rpj
f 4' "/r, MAXIMUM Predrill Ledger
Predrill Existing '/ti-3 Deep 411
i JOIST HANGER
or other approved methods NOTE USE REVERSE SIDE FOR PLOT PLAN.
�BEAMy of support • tie.
SATE SIZE RAFTER SIZE AND SPACING
No. 1 No.2
ALL LUMBER DOUGLAS FIR
41 CONSTRUCTIONGRADE FOR UBC STD.TABLE UBC STD.TABLE
�O 3/,6X2"-T-STRAPC25-21-J-6 25-21-R-1
'TABLE NO. 1 For open egg crate alumi- For solid sheathing.
I
I f tXZ'EPT AS Me72> num or plastic roof Shingles or built up
0 #2 OR BETTER FOR TABLE NO.2 covering. roofing.
i CSMAXIMUM SPAN SIZE SPACING MAXIMUM SPAN •
= POST-BEAM 17 2" 2"x 6" @ 12 o.c. 12' 0"
CONNECTION 15'7" 2"x 6" @ 16 o.c. 10'5"
•nD 13' 8" 2"x6" @ 24o.c. 8.6"
POST •
I 10' 11" 2"x 4" @ 12 o.c. -
ti _ -V -x6 " a e) . 9'.11" 2"x4" @ 16o.c. -
.6 8' 8" 2"x 4" @ 24 o.c. -
•-J SHOW SIZE SHOW SPACING
,1• la _ SHOW. LOCATION 'ON REVERSE SIDE, • ''
-
MATE 1 _ ..
DROP PATIO FLOOR
�- SLOPE TO DRAIN 2" max.@door �_ NOTE: FOR PROPOSED OR FUTURE ROOM,OR WHERE PATIO WALLS
(, ,i . _ s ., __.:;., THICK SLAB • r ARE TO BE BUILT. USE NO. 2 CHART ONLY.
i , . " • - FOR PROPOSED OR FUTURE ROOM OR WHERE PATIO WALLS
�— PUDDLED SAND FILL " .
',�K 2' "' s ARE TO BE BUILT SUBMIT COMPLETE HOUSE AND ADDITION
SK I Remove Grass And Weeds Down To Natural Grade PLANS FOR APPROVAL._
2"' '' I .• CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT
POS-I CITOR =I .*=. -. 7# GALLONS PER SACK CEMENT.
For Pipe on , Embed 1--12--I . . . . • - - -- - -
Pipe in F000tinggto within 3"of Bottom,a••
Provide detail of Flange or Weld Plate Scre ••• or Bolted to Frame. u
77 FAIR DRIVE INSPECTIONS: 754-5627
GMF 0012-46(BU 40) rev. 12/81 vI
WAAk I ca K " nog
5;6 ,r �,�� � l�ovsi, yc0r5 ."
/ �i i
1
Iw
IC\
• t �• c /z ' *s /a ' o I ; _ IIdViaY
`I ' ` pesT` /2 ' I °-1 c'ti C �/ 3.i
&1; .. z' f7aUs' C
II 3.l , •
• ' ; >
PAT/a c aa.
ri-ii— — —
- - - - � •
-c—
STRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE REQUIRED \
cn APPROVED® FOR E`_ECTR!CAL, PLUMBING,
N HEAT;i:G, .VELD ATING AND. U
O
I 11 City Costa Mesa Building Dept. y REFRIGERATION WORK '
sz
\ i.___—.DAT Z2 ! I\
THESE PLANS MUST BE ON JOB AT ALL TIMES ! I ���'�i1,1 -U' 3`t- Gp-r,.e,` t
h MAKE NO CHANGES WITHOUT PRIOR APPROVAI: THIS 'U,. ,R, A;COMP/ANY 'y
OF DEPT. ALL INSPEC,IJ:� ?EQUESTS APPROVED
THE I:3UANCE OR GRsNTING OF A PERMIT OR APPROVAL .1
t1) OF PLANS 4ND SPECIFICATIC:S I.L NOT BE CONSTRUED , CITY OF COSTA MESA ,
TO BE A P 'R,VIT FOR, OR 1' tri,'.1'L OF, ANY VIOLATION rU 14:,.,._U,. ,;; .,_ c PC f:SGNS ARE TO PLANNING DEPT.
OF ANY OF [HI FROV::.L°;s F. ID:, COOL NO PERMIT PRE, 1 GE 'nlikO:._U, .I ,1 :`DI'✓i THATT THE
HE SUBJECT TON ING DEPT. REG..SUMING TI GIVE AUIPORITI IT V.OLATE CR CANCEL THE . SI K i`i';
PROVISION; OF TEIIC cur: SMALL BE VALID. EXCEPT IN SO , :NDUSTEIAL S,FETY Si CONSULTED FOR ,�.
FAR AS THE WORK OR USE V,.:ICH IF AUTHORIZES IS LAWFUL. _ADDITIONAL REQUIREMENTS. BY Dtt- -=-/• - DATE„ 1?- 83
THE ISSU',NCE Cr A F:ib.tT BASED UPON PLANS AND - --- `_-.___ __ RANNINO'
SPECIFICAT ONS SHALL NUf I cVEI:T THE BUILDING OFFICIAL
FROM THEFEAFTER REQUIRING THE CORRECTION OF ERRORS -
IN SAID PUNS AND SPECIFICATION OR FROM PREVENTING
BUILDING EPERATIONS BEING CARRIED ON THEREUNDER WHEN I 70 ' C r'
IN VIULNI1EN(Jr m,e w .. _7�....'.; \
OF,THE CIIT'. n
. /
9854 JUL 13 1955
COSTA MESA BUILDING-SAFETY DEPARTMENT t I :11=21•
P.O.BOX 317 COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 2981 Teakwood Place
COSTA MESA, CALIFORNIA TOR OFFICE USE ONLY
OWNER Homes Valley Inc. 1
I RECEIPT NO. I PE@A}'j
�J/4IT
MAIL 1, L "- R6 E MEO 0Y 7—/--57
DATE RECEIVED ATE IISS5UECD�¢
ADDRESS l,19 E. 17th St. TT , /—� —9-5
CITY Costa Mesa TNO11811 9 BUILDING
5 ADDRESS
ARC'"TECT Carlson & LIC. COSTA MESA, CALIFORNIA
r OR (NEER NO.
Middlebrook
FIRE
ADDRESS Garden Grove ZONE
�
t& & Colegrove, TATE 167293 APPROVED
CONT A R Inc.LIC.NO. BY DATE
ADDRESS 419 E. 17th St., Costa Mesa ZONING
LEGAL LOT224 2822 ZONE1j I NO.OF I USE OF NEW /~V
DESCRIPTION NO. (BLOCK ITRACT PLANS •
BUILDING
A.P.NO. APPROVED // �J/n/_LL..
BY //t DATE !b l S -/
SIZE NO.OF BLOGS. YARDS G EVES /
OF LOT 70 X 115 I NOW ON LOT none REQUIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. FRONT CO FT. IN.
I
SETBACK LINE FROM 1 , [/
.. CENTER OF STREET 55 REAR YARD 42 R.SIDE FT. IN.
`/S
SIDE YARD I LEFT 5' I RIGHT 5' L.SIDE y FT. IN.
DESCRIPTION OF WORK n /J
X
REAR r FT. IN.
N; I % II ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
:Tr NG 1601 ROOMS 6 STORIES 1
EXTERIOR WALL ,,_ ROOF
COVERING sUCCO ICOVERING Rock
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence with ,
attached garage.
Plan 750 A
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.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTIIONN../�] VALUATION
SIGNATURE OF �// •� PERMIT FEE S.--515;130 ,
PERM ITTEE 1 i 4
7.�
$ 928
PLAN CHECK
•
AUTHORIZED AGENT Dike & C legrove, Inc. � �qJ
5) TOTAL FEE $ 5�'*�'� ASO
OWNER HOMES VALLEY. INC. DATE 7-9-59
JOB ADDRESS 2981 Teakwood P1. BUILDING PERMIT NO. 98714
GENERAL CONTRACTOR Dike & Colegrove, Inc. VALUE $ 1,928.00
AP. No. LOT 224 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar.
INSPECTIONS Nu-S DATE I GROUP T h ,l TYPE T7 ZONE Rl
Underground Soilj-2y.50.G. Waters 7-25-51 PERMITS ISSUED
Underground Gas SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating 141< 9-'tere/ Al-A e.e.7`���y��,-{�./� 7 r(-i4 4 //
Rough Plumbing 41'S 9-.2 s9 71-teit., alta . 7'.17•c 9_ 20zg_ v (/"I
Miscellaneous -�- /I.
Prop. Swr.`Line- Howe Con. St. Swr. )Afv //',. ,,
., G P.,�f— 7/3 o rJ"e/ / et C IF ,
Sprinkling System ' t
Heating, Final kat/2/l f9
Plumbing Fixtures ✓ 9,./9.51 _ _ l
Final Gas Test !SiAi/i _ 1�.19.-.0.413
Construction Pole
Underground Power
Rough Wiring /Yii1, ! 1 S Set .IeLVzl '=/D...,0 ails- 9-/U-5 9 /D/rn f
Trenches('//'(J- FormsA Steel/f 7-211 -51
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam t
ClSheathing j�Mi- '11/-1
1 Frame and Flashing 1pT (0-I -
' Lathing, In Out /7/- O-/
Plaster, brown coat A V (1-Y-5q
Plumbing Fixtures, Final //q.I/Q'2
Electric Fixtures, Final
Building, Final 1047
1 OCCUPANCY - t.4
Form 210-3M-4-5? 987
"^"^ DU Vi LthU'W. n r. UMIL i.i a7-w
JOB ADDRESS 2981 Teakwood Place BUILDING PERMIT NO. 2.93$9
GENERAL CONTRACTOR Larry G. Warlaumont DESCRIPTION of WORK Add Bedroom to Res.
AP No. 139-212-26 LOT 221 TRACT 2822 FIRE ZONE VALUE $ 5,000.00
N INSPECTIONS Signature Date GROUP I TYPE V ZONE R-1
i.SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
WATER Date I Number I Signature
ROUGH PLUMBING e / Plum bin
h uhir;tir, . a-p
s � -Lr/s3y 'i
PROP. SWR. LINE Q HOUSE CON. n
SPRINKLING SYSTEM
MISCELLANEOUS ,y
ROUGH HEATING AND AIR CONDITIONING {V" 5/2---O
TEMPORARY SERVICE OR POLE
UNDERGROUND 0 POWER ❑
ROUGH WIRING /f., LJ /7-5.& Heat'nq and V-nt. /
TRENCHES IA FORMS Q STEEL REINF. ® ,,Ofe //-1!"b7 A.,,,2____„...,,,, Lir l/_ S.6y,, v0.
FLOOR SYSTEM ire
BOND BEAM n STEEL REINFORCE n ,q/
SHEATHING 4,, ' h._,5-_,,g-
FRAME
._,5--'rFRAME AND FLASHING h�e�e�yl� /2-/C 'Er
LATHING — IN n OUT 4 /V//*ti /2-/1-6r
PLASTER, BROWN COAT th{.N 12-20-CC6
STRUCTURAL, FINAL //1 Electric
HEATING, VENT., REFRIG. AND A,C., FINAL j /7Jt. j��_ r.(��� /,�J-.4-(j�' ,e+/,'
PLUMBING, FINAL AND GAS TEST ' I '�@.*,y_(
ELECTRIC, FINAL �Z-2 E
BUILDING, FINAL / /2-Z J
SPECIAL REQUIREMENTS
NOV 19-68PAI?OO
29389 fh1941* ****7.7.0C
°
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
_ For Office Use Only
REISS
ADD •Z 74 7t4 K ween I'<.
RECEIPT No. I _ g7
COSTA MESA, CALIFORNIA Od�)III.024
Q I ..(p ! REC[IJ(M N-/9-&
DATE 6CE19;o 01-11 IRE [D;
OWNER /3I F. Komi-nry0 V-1\• ♦'"fi•[//.Y�i 9 !/O_ //-1 -mil
BUILDING M O /'�n//�O . / P
FIRE
litany 298/ t215'/Culoo p /24.
ADDRESS 41'jC Od
TEL. ZONE TYPE GROUP
CITY (-7_,,57.-A IY)�S/4 NO.
APPROVED [ (/�/
'RGINEER NO. BY d. ATE // l 7 A O
•NTNG 4L4-0--?<i
ADDRESS
IONINO.OP YS[OP N[W
PLANS BUILDING ey 49 A
CONTRACT•�R']�1. 1 1 6. ... i/�: _ L/ . •� T /7 p
ADDRESS AGK/� beniibS (/R( D[DCRIRI•� .q `I �I 2 Y�
CITY CST mi:S�4 A.P.NO. ! 3 / I Y �E'
QT NOTE: NO HAVE OVERHANG SHALL BE LESS THAN
STATS .21i/030 TEL
.4' / 2 24. SO'TO SIDE&REAR P.L.
EAVES
LIC.NO ���33 ✓7 �.J
SIZE 7o V / /S I NO.OP SLOGS.NOW ON WT I ALLOWED (U,B.C.REQUIREMENT)
OF LOT /� r
YARDS APPROVED YARDS APPROVED
USE OF / MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. po/y�L- (PROM C/L�CpT'Ry[�.[/T) �///.
RETRACE LINE FROM `/ FRONT /J.1!]']. tV•�-/•" FF.
CENTER OF STREET . o REAR YARD .J ,
IS- ♦ r '/s
SIDE YARDI LEFTI RIGHT �J ' R.SIDE .45 r. FT.
DESCRIPTION OF WORK _L.SIDE SEPT. FT.
/ II ALTERATION _ ADDITION
otX REAR dS r. FF.
1 JAIL DISTANCE BR. BET.MAIN&
REPAIR MQYIN¢ _DEMOLISH MAIN BLDGII, ACCESS.SLOGS.
BUILDING J•� �/•� NO.OP YAR.tR DATE
SIZE "20 1+'•Q ROOMS I pSTORIEI I -C.U.PP..#�yJ✓/ (/�/ APPROVED /
EXTERIOR WALLZvi UCCO I COVERING Rock
BYPLv v� I LYS . DATE //-19-GV
COVERINGDU v' may.!( 04
USE OF BUILDING AND WORK TO BE PERFORMED V - D
fle�ooa / /
4-D so.Fr. /LSO 4 A-62/ •
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. F15
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCT N. g/O
SIGNATURE -f �eveg _ PERMIT FEE e
PERMITTEE OFEl
WWLr A o
9
sL �i PLAN CHECK S W
�
AUTHORIZED AGENT
-. •.•R.qtr %v.;m.. :.::.... TOTAL FEE