HomeMy WebLinkAbout535 TRAVERSE DR - Building PermitsCITY OF COSTA MESA
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BlIILDING D/VISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
�. FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: M08-00123
PERMIT TYPE MECH STATUS: •- ISSUED
APN: 41802217 DATE ISSUED: 09/23/2008
ISSUED BY: RMD
JOB ADDRESS: 535 TRAVERSE DR CM
Vicinity: HALLWAY CLOSET
SQ. FT: 0
Suite/Unit:
SCOPE OF WORK: CHANGE OU7-FAU < 100K BTU LOCATED IN HALLWAY CLOSET FOR A SFD.
OWNER: WITSAMAM, RONALD L Address: 535 TRAVERSE DR Unit:
PHONE: � City/State/Zip: COSTA MESA, CA
APPLICANT: COONEY, SHAWN Atldress: 29736 AVENIDA DE LAS BANDERAS Unit:
PHONE: 949-589-2021 � Ciry/State/zZip: RANCHO SANTA MARGARITA, CA
CONTRACTOR: ALISO AIR INC
Address: 29736 AVENIDA DE LAS BANDERASUnit:
City/State: RANCHO SANTA MARGARITA, CA
CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: - $36.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FE�S: $38.30
License No. 526420
PHONE: 949-589-2021
� ZipCode: 92688
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NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requiremenLs under Califomia statutes and related
regulalions. (Ord. No. 92-28. § 1. 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAVS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTION$: In order for the work authorized under this permil to be considered legal, such work must compty with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and flnal approval will result in the expiralion of this permit.
40DE �, ixsrecnoN Trve pAT� �x�45 L4A€ iNsrEcnou r�ve _� a 9 �x,���Js
1616 Fixed SyStem Final Fire Prevention 208 Final Mechanical � �Ly_
1266 Pool Spa Final 208 Final Plumbing
200 Final R�-Roof 210 Final Electrical
201 Final8lock/Relaining WaP
202 Final Faqory Fire Place
203 Final SiOn
204 Final D�molition
212 Final Fire Prevenlion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I he2by alfirm under penalry of perjury one o( Ne (ollowinq Aeclarations:
❑ � have and will mainlain a tertificate of cOnsent to 581(-InSUfe for workers'
compensation, as provided for by section 3700 0( the Labor Code, lor the
pertormance ol the work for which this permit Is issued.
I have and vAll maintain v.orkers' compensation insurence, as required by
se tbn 3700 0l [he Labor Cotle, for the pertoRnance of lhe work !w which this
permit is issuetl. My workers' compensation Insu2nce carrier and policy
number are: I7G Nn
Cartier.� `lW�� rr�(,Tf�
(Thif sec0on neM rpl De mrpl¢letllNe pnnd is va4�eLC Jel a.re whunG.GeO Mlars (f 1(A�) a leas.)
PdicyNumber. WCZ"���-��Z�a rv 1(J
❑ I certify Ihat in the peAormance of the �wAc for which this pertnit is
issued, I shall not employ any person in any manner so as to bewme subjecl
to the workers' wmpensation laws of Califomia, and agree that if I should
becoma suhjecl to the workers' compensation provisions of Seclion 3700 ot
ihe L��Cp9CT�jt�elFlvnMM�ompy with these provi5ions.
Y �, - ��
�� pp��mssipn� te
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAFtS
($700,000�. IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provis�ons of Chapter 9(commencing
with Section 7000) of Division 3 of t�e Business and Prolessions Code. and
my license is in full torce and effect.
���. ��sZ�4 z O ��a55 � ezo 3
�Va�ipnaWre � � ��
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a cansWction lending agency tor the
peRortnance of Ihe Hork (p wfiich [his permit is �ssued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Ddie
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that untler penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the tollowing reason (Sac. 7031.5.
eusiness antl Prolessions Cotle: My City or CAunty whiGh require5 a pertnil lo
conslr�cl, alter, improve, demolish, or repair any sWCNre, prior to it5
is5uance, also repuires the applicaN for such pertnit to file a signetl statement
that he or she is licensetl pursuant ro the provisions of the Contractors
License Law (ChaDter 9(wmmencing vrith SBction 7000) of Division 3 0l lhe
Business and Professions Code) or that he 0� she is ezempt lherefrom and
Ihe basis lor Ihe allegetl exemption. Any violation ol Section 7037.5 by any
applicant for a permit subjects the appliwnt to a civil penalty ol not more Ihan
fve hunOretl tlollars ($500�.):
❑ I, as owner of the property, or my employees with v2ges as their sole
compensation, WILL DO THE WORK, and Ihe structure is not intended or
offered lor sale (Sec. 7044, Business and Pro�essions Cotle: T�e Contractors
License Law does not apply lo an ovmer of property who builds or improves
thereon, and who dces such vrork himself or. hersel! or through his or her ovm
employees, provided that such improvements are not intended or ofleretl lor
sale. If, however, the building or improvement is sold wilhin one year of
completion, the rnmer-Duiltler will have the bu�den ot proving that he or she
did nol build or improve for purpose of sale.�.
❑" I, as ovmer of �the property, am EXCLUSIVELY CON7RACTING WITH
IJCENSED CONTRAC70RS to conslmct the project (Sec. 7044. Business and
Professions CoOe: The contraclors License Law dces not apply to an ovmer of
property v.fio builds or impmves thereon, and wAo contracts ta such projecl vrith
a contraclor(s) license pursuant ro the Contractps License Laws.).
❑ I am ezempt under sec.
Business and Professions Code for this reason:
SignaNre
3057�d6(3/0])
Owner ID verifietl by tlnv�. _ iicense. ❑ Yes ❑ No
Driver s License No. Expires:
Verification of Ownership by (type ol document, i.e. - property lax bill or deetl):
DIVISION OF �INDUSTRIAL SAFETY PERMIT CERTIFICATION: �
❑ I hereby certify that no eacavation frve (5) or more feet in tlept� into �+Aiich a
person is required to descend, will be matle in connection with work auihor¢etl
by Ihis pertnit, antl Ihat no building slruc�ure, scaffdding, (alscw+ork, a demolition
or dismanlling thereol, will be more Ihan thirly-six (36) teet high. (Chap. 32, Grp
2. M 2, Sec. 341. Ttle 8, Cali(omia Atlministrative Code).
❑ As ovmer-builder. I will nol employ anyone ro do work which woultl
require a pertnit tmm Ihe Division ol Intlustrial Safety, as notetl above, unless
such person has a permit to tlo such work trom the Oivision.
Applipnl's SVpwWre Date
Division of Industrial Safely Pertnil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will �he applicanl or present or fulure building occupant neetl to file and
certify a Business Plan for emergency response to release or ihreatenetl
release of a hazardous material7 ❑ Ves ❑ No
(Section 25505 0l lhe Calibmia Health and Sa(ely Cotle requires, with some
exceptions, lhat a Business Plan be Netl vnth lhe Costa Mesa Fire
�epariment by every business which has at any one time during a reported
year a quaMiry of hazardous materials equal to or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic teet of wmpressed gas
at standard temperature and pressure).
2. Does or will the applicant or preseN or fuNre Duiltling occupant need to file
a registration form for acutely hazardous materials? ❑ Yes 0 No
(Section 25533 of the Califomia Health and Salety CoOe, with some
exceptions, requires regist2tion with the Cosla Mesa Fire Department by
each business which at any one lime has on hantl a quantity o! acutety
hazardous materials equal to or grealer than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet o( compressed gas at s�andard
temperaNre and pressure).
3. Does or will the appliwnt or present or (uNre builtling occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 0l the California Health antl Safety Code provitles ihat the
Costa Mesa Fire Department may require the preparation, certification antl
(ling with Ne Fire Depariment of an RMPP 6y businesses which are required
to register acutely hazardous malerials with Ihe Fire Departmen[.
4. If an RMPP is presenlly required, has Section 25534 of the California
Health and Salety Code been fully complied with? � Yes ❑ No
5. Does or will Ihe applicant oi present or future builtling occu0ant require tor
me vrork which is Ihe suDjecl ol lhis application a permil for such wnstruUion
or modifcation from the South Coast Air Quality Management DisVic� or from
any other air polWtion control distnct or agency? O 1'es ❑ No
(Section 658502 0l the Califomia GovemmeN Code requires that the requestatl
infortnation be fumished on applitations lor rron-residential building permits).
� 6. Will any pah of Ihe faciliry to be conslructetl under lhis pertnit De within
7000 feet from Ihe outer boundaries of a school7 ❑ Yes ❑ No
(If yes', the facilily must meet Ihe requirement of Sections 25534 and 42303
ol the Califomia Health antl Safery Code).
7. If a pertnit (rom the South Coast Air Ouality Management Distriu or other
air pollution wntrol tlislrict or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach ceAilcate o� compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certi(y that �under penalry of perjury the
information given above is cortecl. I agree to wmply with all state laws and
city ortlinances regarding Hazardous Materials and Emissions. � �
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EN7RY: I
certify untler penally of perjury Ihat I have read this application and sUte t�at
the information given is correcl. I agree to comply vriN all sWte laws and city
ordinances relating to building construction, and auNorize represenlatives of
the City o( Cosla Mesa lo enter upon the above4escribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed by lhis permit until final inspection.
SigaaWre o! le Oa1e
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� AWM1o�¢e0 ApPlicanl � , _Oa e
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(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
JobAddress: 535 TRAVERSE DR
Suite No
Vicinity:
Parcel Number: 41802217
Applicant: TODD CHARLES TREMAYNE
Address: 1741 TUSTIN AV
Owner:
Address:
COSTA MESA, CA �
WITSAMAN, RONALD L
535 TRAVERSE DR "
COSTA MESA, CA
Contractor. TODD CHARLES TREMAYNE
Address: . 1741 TUSTIN AV `'l.A
COSTA MESA, CA
ISSUED BY:
Phone: 949350-5554
Zip: 92627
Phone:
Zip: 92626
Phone: 949350-5554
Zip: 92627
License: 879537
� SCOPE OF PERMIT
REPLACE FAU < t00K BTU AND FLUE PIPE.
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >700 k BTU
,Repair/Alt Cooling/Heat
Inst I Rep. Recess Wall Htr
Re(rig Sys <100 k BTU
Refri9 Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < t0000tfm
Air Handlers > .10000tfm
FloorFurnace �
Floor or Suspend Heater '
��
��_"
�A
$23.50
514.80
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
$7.25
50.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
Quantity
1
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System-.
Evaporative Cooler
C om merci a l I nci ne rato r
Domestic Incinerator
Comoressors / Absorotion Svstems
Upto3hpl100kBTU
3To15hp/SOOkBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp
3 To 75 hp
15to30hp
30to50hp
Over 50 hp
Other Mechanical Fee
Investi9ation Fee .
Plan Check Fee , �,
Reinspection Fee . ,
TOTAL CALCULATED FEES
COMMENTS I SPECIAL CONDITIONS
Status: ISSUED
Applied: 01I7812007
Issued: 01/18/2007
�uantity
50.00 0
ao.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
50.00
50.00
50.00
Sa5.55
NOTICE: The work authorized by this permit shall compty vnth all applicable handicap access requirements under Calitomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12•21-92)
EXPIAATION: 7his pgrmit shall automatically expire and become void il work is not commenced within 180 days, a il work is suspended or abandoned
tor 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
requlred Inspectlons and tinal approval must be obtained. Failure to obtain inspections and tinal approval will result in the ezpiration ot this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2046-48 (8�W)
WORKERS' COMPENSATION DECLARATION:
I hereby eHirm under penalry ot perjury one of the following 4aGaretions:
❑ I have end will mein�ain a cetli�icate oi consent to self-Insure tor workers' compansetion, as providetl for by sac�ion 3700 of �he Lebor Code, lor the pedortnente o� Ihe
work for which (his pertnit Is issuad.
❑ I have end will rrieintain woAcers' oompen5ation insurenca, as required by section 3700 0l ihe La6or Code, tw the porfortnance ol the work for which NI5 pertnit is issued.
My workers' rnmpensalion Insurence carnor end policy number ere:
Certier. Policy Num6er.
(Tn/s sect/on need not �e complefetl il (ne Oermif Is valued ef one hundred dWlaro (St00) or less.)
❑ I certlty that in �pe peAortnenca ot Ihe work br w�ich this permit is issued, I shell not employ any person in any manner so a5 to become subjaCt to Iho workere'
compensation lews ol Celltomia, end egree Ihat If I should become suDject m the workere' compenseiion pmvision5 01 Section 3700 af Ihe Labor CoOe. I 5ha11 fotlhwith
comply wl�h I�eSe prmdsions.
Applicant Slgnature: Dai9:
WARNING: FAILUPE TO SECURE WORKERS' GY)f.IPEN5ATI0M WVERAGE IS UNUWFU� Mlp SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED
TYKK15M1D DOILARE (5��.�). �N �RION TO THE C06T OF COMPENSAiION. DMMGES �5 PROVIDED FOR IN SECTION 31080F THE UBOR COOE, IMEFEST, AND FTTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I �ereDy eNirm that I am Ilcens��d�pryv�s�
CONSTRUCTION LENDING AGENCV:
❑ I hereby attirtn tbet there is a construction
Lendels Neme:
Signature:
OWNER-BUILDER OELLARATIONS:
8(Commencing with Sectlon 7000) of Division 3 ot I�e Business�d P�rolO ions CoAo, entl my litense Is in full
Cless.N^
�� .�D-(e '�� Zi7
pedormance of the work for which �his Oermit is issuetl. (Sec. 3097, Civil Catle).
Lender's Adtlreu:
Date:
1 hereby eHlrm that under penelty ot perjury that I em EXEMP7 FROM TNE CON7RACTORS LICENSE LAW tor Ihe following reason �Sec. 7031.5, Busine55 and Protesslons
Cotle: Any uty or couP�y whic� reqWres e permit to construct, elter, improve, tlemolish, or repair eny 5trucWre, pnor to its iuuanca, also requires the aOPlicent for such pertnit
to tile e signetl slatement thet he or 5he is licensad pursuent Io the pmvisions ol tha Contracmrs License Law (Chepter 9(commencing with Section 7000) ol Divislon 3 of the
Business and Profess�a�s Code) or thet �e or she is ezempt iherelrom antl t�e basis for ihe alleged exemplion. Any violation of Section 7031.5 by eny epplicant lor a pertnit
subjects the epplicant to e civil penelty of nol more then five hundrad dollers ($500).):
❑ I, es owner of Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, entl the struciure is not intentlatl ar oNered for sale (Sec.
7044, Business and Professions Cotle: The Comraaors License Lew dces not apply to an owner of propeny who builds or improves thereon, end who tloes such work
himself or hersel� or Ihrough his or her own employees, providetl that such improvements are not imantled or offered �or sale. If, however, the building or improvement is
sold within one yeer ot complation, the owneo-builder will have Ihe burden of pmving ihat he or s�e did not build or imDmve for purpose ol saleJ.
❑ I, as owner of th9 p�o0erty, em E%CIUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct iha project (Sec. 70a4, Business and Professions
Cotla: Tne contractors License Law tloes not appy to an owner ol pmperty who builds or improves Ihareon, and who contraas for such pmjact with e tontractor(s)
license pursuant to �he Contractors Licensa LawsJ.
❑ I em exempt under sec. eusiness and Professions Code for this reason:
Signature: Date:
Owner ID verifietl by tl��er's license. ❑ Yes � No Dnvers License No. Expires:
Verification at Owners�ip by (ype ol Aocument, i.e. - properry tex Dill or deed):
DIVISION OF INOUSYAIAL SAFETY PERMIT CERTFICATION:
❑ I hereby certify Ipel no excavetlon Ilve (5) or more �eet in depth into whic� e person is required to Oescentl, wlll be matle in connection with work au�ho�zed by Ihis
pertnit, entl t�at no �uiltling strucWre, scaffoldinp, falsework, or tlemolition or dismantling t�ereoi, will be more then thirty-six (36) leet high. (Chap. 32, Grp 2, An 2, Sec.
341, Tltle B, Calltomia Administretive CoAe).
❑ As owner-buildel. I will not employ enyone to do work which woultl require a permit Imm l�a Division of Industnal Safety, es notetl ebove, unleu such pereon hes e
parmit to tlo sucn work Iwm the tlivision.
Signature: Date:
Division ol Intlustrial Selery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AUiHORAA710N OF ENfFiV: I cenity untler penalry of perjury Ihat I have reaA thi5 application antl state that ihe infortna�ion given is
correct. I egree to wmply with ell stete lews entl dry oNlnances relating lo Dullding consiruction, an0 authodze representetives ol lhe Ciry ol Costa Mesa to emer upon the
above-tlescribed property fo� inspection pu . not to occupy o� aflow occupancy of eny building authorizetl by iMs permit until final inspaciion.
COUE �. IHSVECTOXtYPE
�676 Fl:etl System Final Fire Prevenlion
1288
200
201
202
203
204
Pool Spe Final
Final Re�Root
Final Block/Ro�aininB Well
Final Factory Fira Place
Finel Sign
Finel Demolltion
Dah
i — \-`d _ p
COpE� INSYECTIONTYPE `,.— ( ��
206 Finel Mochaniwl �"" ��� ��O 6N �NK
20B Final Plumbing
210 Final Electricel
212 Finel Fire Preventlon
220 Final Planning Appro`/al
222 Final Slie
250 Final Bullding/Occup9ncy
PHOJECTAD�XESS: S3S TRAVERSE DR
OWNER'SNAME: WITSAMAN, RONALD L
aooaEss: 535 TRAVERSE DR
COSTA MESA,CA 92627
ABCN/ENGINEEfl: � 714 � 546-8601 flEG.NQ:
noosess:
UNIT: �
\
,r
\�
uxir:
PEHMITTEE: HRRNNON' S ROOFING ( 719 ) 567-3454
aooness: 15161 LAFAYETTE STREET
WESTMINSTER CA 92683
LICENSEO CONTflRCTOfl UECLABATION: I here0y af�irm �ha� I am licensetl under D�ovisions ol C�aD�er 9(commencing with Section
7000� ol Oivision 3 0� �he Business and Pmlessions Cotle. antl my license is in full lorce antl elfect.
cirruc.:05 654 sTaTeuc.:609940 c�ass: C39
oaie: � —�� — 9 �ignamre: _ _ _ _
WOBKEBS' COMPENSRTION OECLABATION: I �ereby aflirm Iha� I have a ceM1ilicate ol consen� lo selbinsure or a certilica�e ol Workers'
Compensa�ion Insurance. or a certified coOY �hereo� (Section 3800. Lab. C).
POLICYN0.:1'z2'18Ja—f,3 E%P.URTE: OSIOSI94
comraNr: STATE FUND
❑ Cenifietl coPY /�s hereby /fu�mished. j�Q Cetlifie0 copy is file with t�e city Buil4inA Division.
Oate: �—/�' / � ApplicanC J ���%A�� !
E%EMP710N FBOM WOHHEBS' COMPENSATION OECLABRTION: (ihis sectian need nal be comple�etl if ihe permit is lar one hunOreO (5700) or less�.
I ceriify I�at in �he petlormance af the work lor whic� ihis permi� is is5ue0. I shall nat employ any person in any manner so as to Gecame
subiect �o �ne workers' Compensation Laws oi Caiilomia.
�ale: Signaiure:
NOTICE: I�. afler making this Aeclaralion, you shoulJ 6ecome suble�< <o the Workers' ComDensalion provisions ot �he LaUor
Code. you mus� Iort�wiih comply wiih such provisions or ihis permit shall be aeemed fevoketl.
CONSTBUCTION LENOING RGENCV: I here6y af�um Ihat �here is a cons�mclion lentling agency �ar lhe pedormance of t�e work �or
w�ich Ihis permil is issued (Section 3W7. Civ. C�.
LENOEfl:
AOUHESS:
OWNEN BUIL�EH DECLAflATION: I hereby aflirm thai I am exempi fmm �he ConVac�ors' State License Law �or �he following reason
(Section 7037.5 Business ana Pmfessional Cotle'. Nny ciry of county which requires a permit to consimct, alter, impmve, aemolish, or
re0air any StrucNre. prior�o its issuance, alm repuires t�e applicant �or such permi� Io lile a signetl statemen� �hat he/she is licensetl
pur5uantlolhe pmvisions oflhe Conlraclors' $lale License Law�Chapler9�commencing wilA Sec�ion 7000)of0ivisian 3 otihe Business
antl Pmiessions Cotle) or I�at he/she is exemp� �herefrom and �he basis for the alleged exemption. Any violaiion oi Sec�ion 7037.5 by
any apPlicam �or a permi� su6jeci5 Ihe apDlicani �o a civil penalry oi noi more �han �ive �untlred dollars ($500).
I. as owner af I�e Ompetly or my ¢mployees wi�h wages as Iheir 5ale compensa�ion, wiil Ao �he work, antl I�e
❑ s�mc�ure is noi intenAeO or oHere0lor sale (Section 70a4, Business and Pmlessionai Cotle: The Contracmrs' Slaie License Law
tloes not apply to an awner at a D�aDe�y who builtls or impmves �hereon, and who �oes such work himselt/hersel� or �Amugh
his or her own employees, pmviae0 Ihal such improvements are not in�entled or ollere0 lor sale. I1, however [he huilding or
improvemen� is sold wi��in one year o� comDleiion, Ihe owner will haue the burden oi Dmving he/she tlid not builtl or impmve
lorlhe purpose ol sale�.
I,as owneroilhe pmpetly.am exclusivety conlrac�ing withlicensetl conVacmrs m consimc��he pmlec��5ection 704d, Business
❑ and Pm�essions Code: The Conirac�ors' Slaie license Law tlaes not apply Io an owner ot pmpeny who builds or impmves �hereon
antl who conirac�s �ar such pmlecls with a con�ractoqs)license pursuan�io Ihe ConVactors' S�ate License Law�. I am awa�e
Ihal pmo� o� iheu Worker's Compensation insurance shoule be pmvided to me.
� I am exempl under Sectwn: B. 8 P. C.
lof IhiS f¢d50n:
Date: Ownec
I do hereby cetlity Ihal I am aware of and untlerstantl ��e requiremenis ol Cali�omia Heal�h anA Saleiy Code Seclions 25505. 25533, antl
25534 antl ihal I or any fuWre builaing occupanl will/wilt noi (circle one) need Io comply wi�h SaiU state cotles antl Ihe requirements lor a
permit lor con5imciion or moddicalion Imm I�e Air Ouality Management OisVicl. Re5i0ential cons�mction applications are exempi hom
mese pmvisions.
Daie'. Applicani:
I hereby cedily ihal I have reatl �his apPllwtion an0 61aie Ihal Ihe above Inbrmation I5 correcL I agree �o camply with all cily antl county
ortlinances anA slaie laws rela�ing ta �wltling conslmciion an� hereby aut�orize represenla�ives ol this ci�y �o enter upon Ihe above�men�ianed
pmperly /for' ymspecimn purpose
�ale: / / � � � � $ignalure: /� /y/�X�?�/ � ��
od�er's License oi Sociai Sead�y +:
t6aY46 WOne—Bviltling; Green—CoOe Enlorcemenl: Canary—ApplicanC Pink—Revenue: Goltlenrotl—Assessar
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 063917
PERMIT NO: B 063917 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: S—N PERMIT TYPE: STR PURPOSE; ALT
JOB DESCRIPTION : T/O SHAKES,RESHEATH 1/2"CDX s APPLY COMP SQ FT: 3,500
CLAIM VALUE: 3,500.00 CALC—VALUE: 3,500.00 GROUP OCC; R-3 /M-1
COMMENTS; SMOKE DETECTORS RE�UIRED PER THE 1991 EDTION OF THE UHC
it*�r***it�rititit�r**x��r**ic�it�*x�**�r*it�- ititit**itit�ir�rQ+��f-�tit��tft**�rir**+t+��tft*�r**it***it�r*x-*r1�E�►+yx���{f11�-;�
2 O N I N GS ERTEB AUCIxRSE M E N T S L+�AQ�'� �t 1 C a v
J1b'ti
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILI7L������—
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGAT; FT IN
PARKING REQ • PROV: PARCEL; 41802217 ZNE; REF NO:
PLANNING Nr31'ES>
i
iE1E i!!liEiE iE iE iE iE �F±F if iE iE'1F iE iE �f iE iF if 1E �E iE if iE if iE iFiE if iE if iE if if if iE ib iEiF 1F iE iE 1E �1E iEiE iE IF 1E iE �F i4 �E iFlE if iE �F 1F iflf iE iElE k ff if iE if if if 1F if iE i� if
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 APPROVEb•BY DATE; •'
BUILDING APPROVED BY ; DATE: a
7
APPLICATION ISSUED BY:
DATE: /3 I
iklEiEiEiElEiEiEiElfiElElEiE�lEifififlfififi}�i-i7iFif�3F i��Fif3F� iF3FiF iFiE��iF�f3F�f3F�FiFitiEiEiEikiEiFitiE1E �IFik
iFiEiFiEiEiEiflEifiEiEifiElEiEiEikiEiE*�F1PikiElElEifiEiElEiEitiF3E�EiElEifiEifiFltiE ifif�lEiF3E1PfFiEiflklEiFiEiElEiEiFiEiEiEiEiEiEiE3EiFif1FlFiE1PlEiF3E
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL`SEGMENT;Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 :� ,50
SMIP/NON-RES
PLAN " y
BUILDINGEDIV—> PERMZT ISSUE PLAN—CHECF( TOTAL � PAID � DUE
TOTALS----> 63.50 0.00 0.00 63.50 � 63.50 � .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
63.00 .50 . •
iF �E 1E iE iE iE iE iE iE iE �f �E iE if 3F fE if iE if 3E if if iE if !E 1E iE 1E 1EiE iE if if �IE iE iF if iE iE �)f !f IE iE iE if iEiE if iF iF iF iE iE ik iEif 1ElE if IEiE iF iE �1F dE iE if if ftlE ik if iE iE if i4 jE iFlE
I N D I V I D U A L F E E B R E A K D 0 W N
TYPE QTY
SFR 3500
D E S C R I P T I O N
REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
�1,00 � 3,500.00
/r'
f�
.. �� . �
� '' .
D.i 0014672`-001467?6 T CoT 63,5f
�ATE: Q9/!3/93 iICtE: 10:10
CONSTRUCTION ANp PLANNING
APPROVALS Permit �
t. Temporaiy Electticai Service or Pole
2. Soil Pioe�Undrgrnd.
3. Elsc:ncal Conduit liUlity�Undrg�rd.
4, Electrfcal Conduit-Undrgrnd.
5. Steel Reintorcemert
6. E:ectricai UFER Gmd.
7. Fooi�nas
8. Foundat�on
9. Water P�pe�Undrgrnd.
70. Struct�ral Floor System
11. Prope�ry Sewer �ine & House ConnecUon
12. Sewer Cap ,
13. Root Drains
14. Ro�gh P;um6ing
15 Rou�h Electri�ai-Conduit
76. Rough ElectricNt3ring
i 77. Rough Wiring Sign
18. Rough Elecirical-T Bar Ceihng
19. Rough Heating & Alr Conditiomng
2C. Fiof,yh Fd�iory FnePlace '
2L Ducts,inStruccure � �� � '
22. DuaS, Ventilgting , � �
�
i
23. �Gas Pipe�Rough & Tesc � ,
24. Rpof Framing ' • '
25. Roof Sheathing �
i
26. T�Bar Cedinq fSttucw�all & ,".4or.ocoat
27. Frame 2,�d Fiasfiing .
28. LLthma'L' Siding . , .
, . ..
2°. Insulat�'o.n • �
30. D�ywali Nailing •
31. Piaste� Bio�vn Coat �
32: Eiectnc:., PoWer Pdete.�final
33. Final E�ec[nc �
34. Final Heating & Air Conaitioning '
35., Finai Gas Pipe-Test ..
36. Hood or Canopy � �
37. Pinaf Factory Fireplace ;
38. Final Plumbing . �
" 39. 11'ater Service�Final
40. Gas Serwce-Final
41. Soiar po�hesticFinal '
� A2. Backflow Preventer
43. Backfbm� irngation
4C. Landsc�pe irriqatian SyStem .
45. Sound Attenuation . ,
46. Handicap Regulation� �; ;
i
47. FINAL STRUC7URE & 6`UI��ING �
48. FINAL PLRNNING- � '
49. Electric Release to Edisod
50. Gas Release to Southecn Califom�a Gas Cc
51. CERTIPIGATE OF,qCCUPANCY
No. Date
Date
POOL & SPA
Inspector qppROVALS Permit # Date Inspector
52. Pool & Equipment Location
53. Steel Remforcement
54. Forms ''
55. Electrical Bonding
55. Aough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit�Undrgmd.
59. Gas Pipe, O Undrgrnd., Test
60. Baclavash Lines, P-Trap, � Undramd. �
61. APPROVAL TO DECK
82. Backwash & Receptor�F�nai
63. Heater & Vent-Final
64. Plumbing SYstem � F�nai
65. ElontricabFinal (
6fi. So1ar System�Fi�al �
67. Fencing & Access Approvai (
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEPv",SFINAL
FIRE DEPT. REQUIREMENT
i'. APPROVF;! $ Permit,� _ ' i I
" 70. Underground Hydra
, ' 71. ProAuct Pipi�c� �J Gas 00�I I
• � 72. Undert�round Flush �
� ,73. Undergrnd,.StorayeTank C�Gus ❑0�(
,rQ,Gv'�i 74:.Overhead Hydro
75:'4'ry Chemical
76. Dry Standp�pe i
-- -�
"' 77.'�,FIXED SYSTEM. FINAL
-I i• 78. FIRE PREV. PINA� �
�I �
hIEALTH i7EPT. REQUIRENENT
� 79. FINAL INSPECTION -�
�
� 80. FOOD CERTIFICA7E �SSUE� �_�
� ��! - - �L
�' � Notes: � I
n
0
.�
PERMIT NO.
OF WOR'
V�...JE
SUBCONTRACTOR
' 24573
COSTA MESA BUILDING-SAFETY DEPARTMEr1T
P.O. BO%977 CGgTp MHHA� CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
ILDIN6 5 3 5`-I'.n aM-en,n�,1�
DRESH
ro
COSTA MESq, CALIFORNIA
�
i
■ STATH
U6E OF �^
EXISTIN� BLOO.
BETBACK LINH FROM
EF7 � I RI6HT
DESCRIPTION OF WORK
■ EXTERIOR
OPBL�09.
CITY OF COSTA MESA
AUG 19 1965
APPLICA710N FOR PER
rvo.
BUILDINO
ZONINCi
NO.OR UBeOP
�une�j eu��1
�eae�
'. NO. I�IVr IO X I/il�C�''by
'E: NOEAVEOVERHAN68HALLBELESSTHAN
TO 81DE B REAR p. L.
ES
.OWED �U.B.C.RE�UIRHMENT.
YARDSAPPROVEU YARDSAPPROVED
MAIN BUILDING ACCESSORY BUILOING
� VAR.SC
`L ■
I HEREBY ACNNOWLHOGB TXAT � H�VB RBAD THIB APPLIGTION
AN� 8TAT8 THAT TX8 I�BOVB IB CO CCT AND A H8 TO COY.
PLY WITH ALL C�T[ ORDINANCpg A!' 8TAT8 lAW BOUTATINO
BUILG�NOCONBTH d ION.
BIGNATURE OP G
PERMIITE
AUTHORIZED A6 NT
DATE
rxe AMOUNT BHOWN UNOBH VALYATION IB FOR TH8
PYPP098 OP 88TABL19XIN0 /� PBRMIT P88 ONLY.
VALUATION (yO �
PERMIT FEE
$" �/��� �•na