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Home My WebLink About2331 Ticonderoga Way - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob Address: 2331 TICONDEROGA WY Suite: Vicinity: ROOF Parcel Number: TPN98078 Zoning: Applicant: BLANKS, JERRY Address: Phone: Zip: Owner: MONTICELLO HOA Address 150 VALLEY FORGE RD Phone: COSTA MESA, CA Zip: 92626-6544 Contractor: PREMIER ROOFING AND BUILDING CO INC Address: 17501 NORWOOD PARK PL TUSTIN, CA Zip: 92780 Arch : Address: Phone: (714)573-0155 License: 634404 Eng Address Phone: ISSUED BY: Status: ISSUED Applied: 08/16/2002 Issued: 09/23/2002 Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF FOR 2331-2345 TICONDEROGA WY. INSTALL 1 BASE, 4 PLY WITH HOT ASPHALT THEN FLOOD WITH ASPHALT AND ROCK. "MONTICELLO" Plan Check: $0.00 Permit: $307.25 SMIP Res: $1.81 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $309.06 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 FEE SUMMARY Calc Valuation: $18,100.00 Claim Valuation: $18,100.00 PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0 Right 0-0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within' 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 ?44&46 (6=) DECLARATIONS _% 1WW WCFRKEPiS' 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 perforna enco of the work for which this permit is issued. ' 51 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 pemlit is issued. y workers' compensation Insurance carrier and policy number are: r: Policy Number: his coon need net be tk.rn",a".nda6greo e prmit is valued at one hundred dollars ($100) or less.) certify that in the pethe work for which this per it is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws otIfI uld come subject to the workers' compensation provisions of $ectio) 3700 of the Labor Code, I shall forthwith comply with these pr0� ^7 Applicant Signature: ^ ��ate: J C/C% WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL L SUBJECT AN EMPLOYER TO CRIMII PENALTIES AND CIVIL FINES UP TO ONE HUNDRED ARE THOUSAND DOLL($100, ),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I h at I am)icensed der provisions of Chapter 9 mencing with Section 7000) of Divisio<3359Njusiness and Professions Code, and my license is in full rCe fl Ic. # Class # gn Lure: CONSTRUCTION LENDIN AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ❑ As owner -builder, 1 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 exceptlons, 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 apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..................................................................................................................................................................................................................................................................................................................................................................................... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No .............................................. .................................... .................................. ..................................................... ...... ............................................................. ...............................................................................1,........ .................................................... .. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a aernit 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? []Yes ❑ No (it "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 ..................... .. ................................................................................................................................................................................................................................................................................................................................................................... . 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 comp)y 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 prope rj for inspection purposes. I a roe not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si Le wner(s)^ ate — And/ orized cant 7 Date CODE 0. QdT[ INITIALS CODE • INSPECTION TYPE 2M INTMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final � 208 Final Plumbing 200 Final Re -Roof 137 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ADDRESS OF euLDNc: 1 j1 11CU"11.1 t::UUA ONNEWS NAME IF KNOATk PERRINO, BESS J ADDRESS 1937 VISTA CAUDAL NEWPORT BEACH,CA on. "LING ADDRESS ARCNRECTORENMNEER: MR. OR M'S ADDRESS: CONTNACTOWSNA '. STOUT ROOFING INC CONTRACTORS MMIfiG P O 60X 4309 A ORM. DOWNEY 90241 UNT: 92660 uc. NO.: UNIT: (310)923-6775 CA MNo: 402536 ui LICENSED CONTRACTORS DECLARATION: I hereby alfem under pa d arjury Nol I am Inenmcl under p ions d Chapter f (mmmench, wt OSS y .j 7 )/d Dbown 3 d the Buelmm ere pMm ere de. a^dSY icon» e, in fu0lo d .4ad. clry uc. No.: uC.0 C 39 uc. 4U2 %,6 E' 1C l95� ,Data; � Contractor: INER BUILDE DECLA ATION: I hereby arum under penalty of perjury that I am asempt ham the C«rredon Law for Na ower, reason (Section 7031.5 Smben and Prop aona Code: Aw cry or county which ow ruee a panne 10 . alt«, improve, ramdoh. «rape/ any, atmdure, prior to its e,auapee, ado nauiree the epptieml for a,h panne to fib a signed stat that M or am is licemad Naloor it to the prw®ens of the C«nradon lioenee low [Chapter B (oomme«ing weh Sedion 7000) of Deem 3 of the Em'oeae mij Ademins Code) or that M or she o emor I therahom and the haus to the alleged mempinn. Any violater, of Sadie 7031.5 by any applicator for a Penne agenda, the appinant to a ctvi Penalty of not mon than We Mrld,ed do0ete IS500D. ❑ 1, m owe dine property, or my amployeea worn wpm as then solo cammpereation, eel do to work, ape the sa=nm ache branded «offered for seer (Seder 7000, BamvaeM Prdmsiom Cade: The Conuadore Liceme Lew close not applytom ower of property war baida «inprows thereon. and w1, does suds wank himsea «Mnel «Nn«,h he or her own empbysaa, pvklail thol are y impnpwmeda are not intended or dkred for eate. f. Mews. the bdM'ug «bnptovsnem is eold vethn m year of completes, the owner-0uUder eat have erne [mem d provng M d ape did ret hued «improve 1« int puppee d mer). ❑ I. m owner d erne proprly, ern mchnhwfy coniregitp wi1M1 lipenneed aMiratton to conarrW Ne pmpd (Sedan )000. Bushes end Froiaaorw Coda: TM Contractors License Lew dont not apply W an owner of property wee builds «'unptovr thereon erd ybo cm0ecu he s«N «ojads web a rvured«(s) lopostarl Wnnant to the Contractors Li.. Law). ❑ I am exempt under Soation: B. A P.C.. for UUa roman: I or, hereby teeny that I am peen of and uMrewd Ne rpucameno of California I h ape Salary Cade Sedi«w 25505. 75533, and 25530, end that I Or my Mure Witch, .,ant will I will rel (circle one) need to c«nply weh said alma rod. and the reRdeneole for apenne err ounetndiun«modifiwion nom tar Air pmgam at Chard. Residential oonelludion applications xe tempt Iran throe «oviaiona. Date: Applicant WORKER'S COMPENSATION DECLARATION: I hereby am under PanaXy of perjury one, d the 10110wip dadaetbm: ❑ I Mve ape veil maintain a cenificate d..I to saf.ineure for wankere companatlion. m «worded 1« by Section 3700 of the Lahr code, he tM ped. of Ne rah for h the, Fenno e, dMed. `-•� I hese and wit nartan waken' mmpenmMn inwranm, m npuind by Section 3700 d the Labor Code. err the ped«menu d the work I. which Nie .it is issued. My w«Fere wmpmamiin ineurmca carrier and po1'lay, number are: EXPIRES Pdp Number: M. sadlan mei nor be ttwFlpp y y they pamt o f«ma hurxbei dorho, Is, f«Na+.1 ❑ I artir Nat in int pM«merce d lar work M wT�icln Ihb panne is ehdl mt ampby my perm n mmmr m pa". to bec«m aublect !o IM workrs' rompensatlen lore d Calenmie, that 1 shOUM balms 10 IM urntDanuollen provisions d Sedan 37M d lar labor Cods. I ape It. 0111 M Uaee «pumas Dole: Mppi.: � f& .ate W.IM: F.H. no amen arotkwi opmpw rticn coveragb e TunMrN�( as shell stub an employer he «htnef wvMae ape dM nem W ro am h«rdlM Mpussrd ddW (ffao.DDDA a add/tlpn ro Ns cwt al romperuadoR derreglee m nvMed roc In 9Ktlm J7P6 of fns Gator CORS /Mermt and atronNYY Iwo CONSTRUCTION LENDING AGENCY: I hereby phi" under Penalty of perjury Ind there o a rnrmruann lending grenpy for the padrmence of IM wan Aor +etch the permit is weald (Sedion 301)7. Civ. C). LENDER'S NAME: LENDER'S ADDRESS: 1 cedlfy that I have nasi this application and dale IM1ol the above br«matbn e, need. I apple, to pormy will, alt my ape worry ordnennus ape area laws relate, 1. buRiag cont' oGnwe and hereby aWe«ua napeamtalivaa of the ply lo W. upon the above-meniMad «-Priv «/mor nn perpa ea. D/,a)LENE BUP.FORD „n ! (515148 WPI Ware-BuiMig & Seat, GreerRb: Crary-Awiomt: Pink -Revenue: Gddenro6 Avamwr CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 072602 PERMIT NO; B 072602 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE: PERMIT TYPE: SIR PURPOSE: OTH JOB DESCRIPTION ; T/OFF, SHEATH E REROOF W/COMP SHINGLESH SQ FT; 2,924 CLAIM VALUE: 2,924,00 CALL -VALUE; 2,924.00 GROUP OCC: R-3 / COMMENTS; SMOKE DETECTORS ARE REQUIRED PER 91 UHC Z O N I N G R E Q U I P. E M E N T S S E T B A C K, S ZONING APPROVED BY BUILDING APPROVED BY APPLICATION ISSUED BY; ,t+t#xxxxxx##4xx�#x#xx,txx+txxxx'ie��tTtx�'xx3F'+rzF+ x�,t��x+t+.t#xx.-# LEGALIZATION:N F E E S U M M A P. Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 54.00 PLAN ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTALS ---- > 54,50 0,00 0.00 REVENUE DIVISION TOTALS--> COLLECTED• BLDG PMT PLUMBING ELECTRIC MECHANIC 54,00 DATE: DATE. 2 DATE; 3� 9 xx##xxx##.nkat. xxx+/9� STRUCTURAL SEGMENT:Y SMIP/P.ES GRADING .50 SMIP/MON-RES TOTAL PAID DUE 54.50 54,50 .00 54,50 OVER/SHORT;00 FIFE SMIP/TOT GRADING PLAN -CHECK ,50 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C P. I P T I 0 N UNIT COST TOTAL COST SFR, 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 2,924,00 END OF FEES 01 00133137-0018313E TCOT DATE: 05/:71/96, TIME: 11:43 MAIM BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; FT IM REAR; FT IN FRNT; FT IN REAR; FT IM LEFT; FT IN RGHT; FT IN LEFT: FT ICJ RGHT; FT IN PARKING REQ: PROV; PARCEL: 41916406 ZNE: REF NO: PLANNING NOTES> D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.T S ZONING APPROVED BY BUILDING APPROVED BY APPLICATION ISSUED BY; ,t+t#xxxxxx##4xx�#x#xx,txx+txxxx'ie��tTtx�'xx3F'+rzF+ x�,t��x+t+.t#xx.-# LEGALIZATION:N F E E S U M M A P. Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 54.00 PLAN ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTALS ---- > 54,50 0,00 0.00 REVENUE DIVISION TOTALS--> COLLECTED• BLDG PMT PLUMBING ELECTRIC MECHANIC 54,00 DATE: DATE. 2 DATE; 3� 9 xx##xxx##.nkat. xxx+/9� STRUCTURAL SEGMENT:Y SMIP/P.ES GRADING .50 SMIP/MON-RES TOTAL PAID DUE 54.50 54,50 .00 54,50 OVER/SHORT;00 FIFE SMIP/TOT GRADING PLAN -CHECK ,50 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C P. I P T I 0 N UNIT COST TOTAL COST SFR, 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 2,924,00 END OF FEES 01 00133137-0018313E TCOT DATE: 05/:71/96, TIME: 11:43 CONSTRUCTION AND PLANNINL APPROVALS Permit # Date ' - Inspector J L &SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &.Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test ; 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE t 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd,60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK-- _ 11. Property Sewer Line & House Connection 62, Backwash & Receptor-Final 12, Sewer Cap - 63. Heater & Vent-Final ' 13. Roof Drains 64. Plumbing System . Final 14. Rough Plumbing ' 65. Electrical-Final , 15. Rough Electrical-Conduit 66. Solar System-Final f" , 16. Rough Electric Wiring 67, Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiliog 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditio6ing FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping 0Gas 00il - 23. Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing '- - - 73. Undergrnd. Storage Tank OGas 00il 25. Roof Sheathing 6-{p- C�y� 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL , 29. Insulation.' - . _ 78. FIRE PREY. FINAL 30. Drywall Nailing- HEALTH DEPT. REQUIREMENT 31. Plaster Brqwn Coat 79.. FINAL INSPECTION - - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service:Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ! ��..�'�,G✓`l� 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date " PROJECT ADDRESS: UNIT: OWNER'S NAME: 2331 TIMNDEROGA WY ADDRESS: Lalli HAZEL M 2$31 TICONDEROGA WAY l" COSTA MESA,CA 92626 1 ABCHIENGINEER: ( 7 1 4) 5 4 0 4 0 7 4 REG.NO.: ADDRESS: UNIT: PERMITTEE: ADDRESS: SKYLIGHT SPECIALTIES (714)645-8645 7�r�660 W 17TH ST ��••�� oQ �qT-7 37 LICENSED CONTRACTOrtt DECLARATION: hereby affirm That am ticP� a un Tlrtd,isiodsb Nap(er (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my I' dose is ii lull for and ¢Ifect. CITY LIC.: STATE LIC.: C S: 027519 95551 Date: ys�_p f 3.95551 Date _ WORKEB�OMPENSATION DECLARATION- (hereby affi allhavea ate of enUa self -insure cenilicale of Workers' Compensation Insurance. or a certified copy thereof (se 3800. Lab. ). POLICY 0638915-91 /Is 04/0 COMPANY: n� Certified ^•-��i tl lu Certifiethe it Division. Date: Zf $ �9v� Applica EXEMPTION FROM WORKERS' COMPENSATION GECIAflAIa of be completed if the permit is for one hundred di or less). I penny that in the performance of the work far which 1 snail not employ any person in any manner so as to become subject to the WorkersCompensate n Laws of California. r Date: Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the fallowing reason (Section 7031.5 Business and. Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors Slate License Law (Chapter 9(commencing with Section 7000)at Division 3 of the Business and Professions Code) or that he/She is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). I, as owner of the property or my emvvloyees with wages as their Sole compensation, will do the work, and the Elstructure 6 not intended or offered for sale (E 7044, Business and Professional Cade: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himselbherself or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however the building or improvement is sold within one year of completion. the owner will have the burden of proving he/she did not build or improve tar the purpose of sale). I, as owner of the proper. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ 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 with a contractors) license pursuant to the Contractors Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C. for this reason: Date: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and 25534 and that I or any tutors 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: I hereby certify that I have read this application and state that ordinances and state laws relating to building construction and h properly for inspection purposes. Date: 7 Z S-9/ Signature' Driver's License or Social Security F: 1641-46 While—Burldmo: Green— ily with all city and county upon the above-mentioned Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO: B 053061 PLAN CHECK NO: 02734-91 L CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR JOB DESCRIPTION : ADD 22"X46" SKYLIGHT (ICBG#2469) PERM NO: B 0530611 GOVT: N SUPP: N PURPOSE: ALT SQ FT: 495 CLAIM VALUE: 495.00 CALC-VALUE: 495.00 GROUP OCC: R-3 /M-1 COMMENTS: NO CUT RAFTERS O4IE iE i4 * iF # 9f IF dFi4.)E 94 # 14')49f 9f .)f dE 94U4 3F i4 if # iE 9F dE 9E iE TF 94 # if * 9E 94 df 94 nE iE .)F iF d(.N.*.)E 9E .� * dF1f if iE 1E 9E g4;E ie .)E 9f 9FiE d4.)E iF ic.� 1E 94 BE N�.� 94.E # ie iK Z O N I N G RE Q 17 I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 41916408 ZNE: R3 REF NO: PLANNING NOTES> PROPOSED SKYLIGHT ABOVE THE EXISTING BATHROOM OF THE CONDO. > iE iE +4 �¢ If 8494 * � � �g4 iF iE 94 9F 1E i49f i(• if iE �¢ X4 * 14 i4 9414 � * #E aE�4949i IE if i4 141E eF �E �t �r � �E �E � fE �E �- aE �6 �¢ �E � * �R * �- * �L+¢ kE �¢ �F � ae k� at kF * �-i xx-ie �F D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N �.. T n ZONING APPROVED BY DATE: BUILDING APPROVED BY; _ DATE:per APPLICATION ISSUED BY DATE: 9E i4*iE iF 141E i4 I4IF rtiE IE 9E 9E *iE IE i4 i4*iE �iFiE iER**IE if i4 iE SEiFir t a iE i4 *9F 14 iE iF IE 9E 94 If i4 iE 9E iF i4 N-BF*Bf iF IE iE*1414 BF i4 *?F i4 iF i4*IF j4I4 BF IE 9E 1494 �! 4iE If 9F 9F**iF 14141E B4 14 94 1414*14}4149E TE i4.*d4 it 14143E 1414141E i4 Ie UE iE LEGALIZATION:N F E E S U M M A R Y STRU,C.TURAL SEGa`7iENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 15.00.50 SMI"! P/NON-RES PLAN 9.75 ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 15.50 0.00 9.75 25.25 25,.25 •00 REVENUE DIVISION TOTALS--> COLLECTED: 25.25 OVER/SHORT: •00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 15.00 •50 9,75 iE iF * Y iE iF 3f BE * iE BF 1E iE iE k iE iF k iE iF iE * * iE * 3E iE 9E if BE iE IE iF 9E IF iF kE * ♦E iE aE IE iE iE iE * 1E IE iF ie iF iE iE iE 8E ♦F 9F iE 0E * * 3F it iE lE 1E 1E * IF iE 1E iE IE IE iE 9F 1(-14 iF I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 495 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 _ 495.00 END OF FEES 01 CO0"+0r1-5U0i2 7.137 DATE: 07x125/91 Tlil V" 9 CONSTRUCTION AND PLANNING Date APPROVALS Permit # Inspector POL SPA APPROVALS Permit # Date Inspector 1. Teprporary Electrical Service c Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. r' 53. Steel Reinforcement r= 1 3' Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd, rl 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER 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. Etectrical-Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating -71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing - 74, Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulatioh r 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 i t Notes: - 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test ; /•7 ; - 36. Hood or Canopy t 37. Final Factory Fireplace .4 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. FINAL PLANNING .y 49. Electric Release to Edison %- (j rf ie,. 50. Gas Release to Southern California Gas Co • j ry; . 51. CERTIFICATE OF OCCUPANCY No. Date V"11s Wul JOB ADDRESS GENERAL CONTRACTOR AP Nn OCC]—n'Z-09 LAT Cr? TRACT q160 FIRE. ZONE VALUE $ l '�.2110.00 INSPECTIONS Signature Date GROUP I & J TYPE V I ZONE R -'g Soil - PERMITS ISSUED =' SUBCONTRACTOR I Date Number Signature Gas Water ( -C P umbin Rough Plumbing 0 Prop. Swr. Line 0 House Con. @-- Sprinkling System _ Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 Rough Wiring / ' U` -C- Heating and Vent. Trenches Forms Steel Reinf.f❑ a _� _ Floor System d Bond Beam 0 Steel Reinforce 0 Sheathing a 'p Frame and Flas ' / Lathing — In Out Plaster, Brown Coat Structural, Final Fjectrip_ Heating, Vent., Refrig. and A.C., Final Plumbing, Final an !� Electric, Final -6 Building, Final o-- e2� I- 27535 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92620 For Applicant to Fill In Completely TYPE OR PRINT m 2 3 3 1 I v�,nA1�P ce �n COSTA MESA, CALIFORNIA ® DESCRIPTION OF WORK 1 HEREDY A AND STATE PLY WITH I 5 HAV[ READ THIS APPLICATION CORRECT AND AOR[[ TO COM. AND STATE 1.11W0 REOUMYINO Ph IO r..._.1. SEP 13-67CH—SHOO 3113' 6 /.tel APPLICATION FOR PERMIT BUILDING For Office Use Only Rccnrt No. }�R� ry3 RiC[ly�+� ZONING EYILOiI 0. '-�o—o.3-7d SHALL OE LE66 THAN YARDSAPPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING L SIDE OFT. BR. GS. JOA I88SD[D� 7mw DATE eU1LDING ADORE" PIRE I • N UNDER VALUATION I8 FOR THE E OF [ETABU8NING A PERMIT FE[ ONLY. ZONE TYPE GROUP ZONING EYILOiI 0. '-�o—o.3-7d SHALL OE LE66 THAN YARDSAPPROVED YARDS APPROVED MAIN BUILDING I ACCESSORY BUILDING L SIDE OFT. BR. GS. BET. MAIN e ACCESS. BLOCS. DATE APPROVED DATE rVALUATION SQ.FTOUNT • N UNDER VALUATION I8 FOR THE E OF [ETABU8NING A PERMIT FE[ ONLY. ? PERMITFEB ro TOTAL PEE