HomeMy WebLinkAbout1074 VALLEJO CIR - Building Permits •
' MF CITY OF COSTA MESA
BUILDING DIVISION
t• >••l ei DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. 1
PERMIT
J''�+roa,� B01-00371
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1074 VALLEJO CI Status: ISSUED
Suite: Applied: 03/21/2001
Vicinity: Issued: 03/21/2001
Parcel Number: 41205217 Zoning:
Applicant: NGYEN, CUONG - ISSUED BY:
Address: 14351 EUCLID ST#E -
Phone: (714)545-6994
GARDEN GROVE,CA Zip: 92843
Owner: TRAN,LONG
Address 1074 VALLEJO CIR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: VILLA ROOFING PROFESSIONALS INC �_ , /,3 littS ,'�
Address: 14351 EUCLID ST#E DATA
Phone: (714)545-6994
GARDEN GROVE,CA
Zip: ' 92843 License: 758361
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF COMP. INSTALL 2-30LBS FELT AND LIGHT CONC.TILE , ICBO 2656,5.8PSF.
• FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,800.00
Permit: $97.25 • Claim Valuation: $3,800.00
SMIP Res: $0.50
SMIP Corn: • $0.00
Other: $0.00
Inspection: $0.00 /
Total: $97.75
PLANNING 8 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
2446-46(6/00)
WORKERS'COMPENSATION DECLARATION:
[thereby affirm under penalty of perjury one of the following declarations: x •
❑ 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.
-1‹.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'com ensationIns rance carrier and policy number are:
Carrier: gei1, Policy Number: a?2S ro/
(This section need not be completed if the permit/s 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 per manner so as to become subject to the workers'
compens. •• - :Ionia,and agree •:t II I should become subject to the workers'c.11...- •. of Section 3700 of the Labor Code,I shall forthwith
•- .y with these provision .
4�licant Signature: .�� Date: 3 a
WARNING:FAILURE TO S - '•RKERS' ••- NSATI• COVE-, E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IVIL FINES UP TO ONE HUNDRED
THOUSA . .•._ 100,000),IN ADDITI•, COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED • •ACTORS DECLAR TION:
I he -• :'ir m that I am licensed und. prov' '.✓.1 ha. :r• commencing with Section 7000)of Division 3• • Ausiness and Professio s Code,And my license is in full
• and effect.Lic.# .../ S S . Class A :'
A ontractor's Signature: / �at - r'
1 CONS : - ON LENDING AGENC9`�
■ I hereby affirm that there is a construction lending agency for the performance of the w- for which this permit Is issued.(Sec.3097,Civil Cale).
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 td 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.).
o 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.).
O I am exempt under sec. _ Business and Professions Code for this reason:
Signature: Data:
Owner ID verified by driver's license. 0 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,end that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec.
341,Title 8,California Administrative Code).
o 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 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? ❑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 Califomia 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 application a Paermit for such construction or modification
from the South Coast Air Duality 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 pan 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 Nes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If 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 AIJ'THORIZATION.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 stato laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property 1 'nspection pu ses.I agree not to occupy or allow occupancy of any building authorized by this permit til final inspection.
u _ 377( (0
Ignatu a Of Le I Owner(s) Date
•-.r•r Authorized .nt Date
CODE# , ' Y1•.AA' INTRIALS CODE( IIISPECTIONTYPt DATE INTITIAL
1616 Fixed System inal Fire Prey- ion _ 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
_ PROJECT ADDRESS: 1074 VALLEJO CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 068595
OWNER'S NAME: HOHMANN, DAVID P
ADDRESS: HOHMANN, DEBORAH PERMIT NO: B 068595 PLAN CHECK NO: N GOVT: N SUPP : N
1074 VALLEJO CIR
COSTA MESA CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; ALT
714 ) 754-5`195
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T/OFF REROOF W/ COMP . & BUR SQ FT: 5, 100
ADDRESS: UNIT:
CLAIM VALUE; 5, 100 . 00 CALC—VALUE: 5, 100. 00 GROUP OCC: R-3 /M-1
PERMITTEE: LINNERT ROOFING, INC. (714 ) 632-1900
ADDRESS: 2851 LA CRESTA COMMENTS: REROOF GARAGE W/BUR & HOUSE W/COMP . SMOKE DETECTORS ARE REQUIRED
ANA CA 92806 **+ex**sE+r+Esr*Fl***+r***+r*********sE***** ESE*x*******+E*************y6******kE***SEs6sE**yEyEsk-
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
70001 of Division 3 at the Business and Professions Code.and y license is in full force and effect. SETBACKS
CITY LIC.: 06260 STATE LIC.: 66431 cuss C39 EXP; 05/95
.. ��'-- MAIN BUILDING ACCESSORY BUILDING
r. fz31ty Signature_ FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
� KER CDM NSATION DECLARATION: I hereby alfir that I have a certificateGof consent to self-insure or a certificate of Workers' LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
Compensation fiilgpoer.oSacerlitid-copbtbereof(Section 3800,lab. U 5/0 1 /9 5
POLICY NO.:COMPANY;
GOLDEN EAGLE
EXP. PARKING REQ; PROV; PARCEL; 41205217 ZNE: REF NO:
9 Certified copy is hereby furnished. LJ•Certified copy is 'ed with the city Building Division. PLANNING NOTES>
4 *******************************************************************************
6 ! appecan- DEVELOPMENT SERVICES REQUIREMENTS
MPTIO FRD WORKERS'COMPENSATION :-1'•._-1 . —. . ..::...•ted if the permit is for hundred($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 ZONING APPROVED ED BY
subject to the Workers'Compensation Laws of California. DATE:
Date: Signature: BUILDING APPROVED BY ;
0/120
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE:
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. O
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION 2 S S UED B Y: DATE: I
which this permit is issued(Section 3097,Civ,C). ***'N'**************************"1("N' ***** ********************** **
LENDER: ****************************************** ************************* ********
ADDRESS: LEGALIZATION:N F E E SUM R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC'`,,MECH9C 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 81 . 00 i . 51
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is Scented SM I P/NON—RES
pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN O
and Professions Code)on that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500).
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECKAL PAID DUE
I. as owner of me property or my employees with wages as their sole compensation, will do the work, and the TOTALS————> 81 . 51 0 . 00 0 .00 • SSSSSr51 163 . 02 —81 . 51
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law `,
does not apply to an owner of a property who builds or improves thereon,and who does such work himsell/herself or through //��
his or her own employees.provided that such improvements are not intended or offered for sate.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• L" 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 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE MTOT GRADING PLAN—CHECK
lox the purpose of sale). 81 . 00 IVV.JJ�JE,
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business -y S 1
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds Law).oves thereon ******************************************************SESF***********************
and who contracts for such Contract with a e License
license pursuant to the Contractors'State license I am aware fffFFF iiikkk
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E. E B R E Act K D 0 14 N
o I am exempt under Section: B.b P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 5100 REROOF BY VALUE RESIDENTIAL .NOZONE 1 . 00 5, 100 .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 Duality Management District.Residential construction applications are exempt from f
these provisions. EXPIRED
Date: Applicant' "Incomplete InspectiGas . ,
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county 1
ordinances and state laws relatinglobuilding construction and he by authorize representatives of this city to enter upon the above-mentioned /
property for inspection purposes, � 7/1 7%* Sig 01 00166517-00166518 TE]T 81.51
Cale.l 2S-Cit Signature: DATE: 08/23/94 TIME: 13:31
.. -... i____
Or rs License or Social Securily`A:
1641.46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
4
't )CONSTRUCTION AND PLANNING POO. SPA
Date Inspector Date Inspector
liAPPROVALS Permit# APPROVALS Permit #
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 i - • • ' 56. Rough Plumbing & Pressure Test
• 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
• 7..Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test
_
9. Water Pipe-Undrgrnd, - 1 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 DGas 0Oil
•
23. Gas Pipe-Rough 81 rest 72. Underground Flush
•
24, Roof Framing 73.'Undergrnd.Storage_Tank 0 Gas 0 Oil
25. Roof Sheathing 'ca-2Lf-C,i 0 w IQ- 74. Overhead Hydro
26. TBar Ceiling (Structural) & Monocoat75. Dry Chemical
27_ Frame and Flashing76. Dry Standpipe • .
28. 'Lathing& Siding77. FIXED SYSTEM FINAL
29. Insulation - 78.'FIRE PREY. FINAL
30. Drywall Nailing ®® HEALTH DEPT. REQUIREMENT
Plaster Brown Coat 79. FINAL INSPECTION 'I
32. Electrical Power Meter-Final 80, •FOOD CERTIFICATE ISSUED
33. E ? :i ::
inal z5Aei.
34. Conditioning35. -
36. Hood or Canopy
-74.03-- . _ a Grp
37. Final Factory Fireplace ,Q,r,, 1 n„ i2,-` 7!(fC'1 'te''''e- __ /
38. Final Plumbing C r ! ��"f/L�•'�
39. Water Service-Final • - +
i.
40. Gas Service-Final I .
41. Solar Domestic-Finals
i.
42. Backflow Preventer •
43. Backflow Irrigation '
44. Landscape Irrigation System
45. Sound Attenuation '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING _
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co --
51. CERTIFICATE OF OCCUPANCY
No. Date
. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY'OF COSTA MESA CONSTRUCTION PERMIT - PE 0 `I / TRACT NO. LOT NO. UNIT NO.
• Project Address ' ir '. ''LL- - _ /� _;33 YY JJLL f C y
Applicant's Mallin• Ad. ess / 7- , 7/� U(/(/� [//y�(� TYPE OF CONSTRUCTION LI NEW 0 ADD U ALTERATION I� REPAIR
Pho T�Cfq5...7 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# (Zone
Owner's Name y1.� DESCRIPTION OF WORK/USE OF BLDG.
Address c �/ r�/ I - S Main Building: 01 p001 rAccestOry-Buil9tng:TOT 5 .CC
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING�FOUNDATION ❑ STRUCTURAL T Front DATE: C3/1I/88 TIME: 08:49 0
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B N
Address n/J ,�J qo Rear
Contractor's Name`��1C r ,6,F Phone9��� ❑ OTHER A I
/7 v 79-6-,
-(— �/fn PROJECT DESCRIPTION SQ. FT- OCCUPANCY K C Right G
CityAddLicense( Q'� t!S .P hC /// CONSTRUCTION TYPE VALUATION$ s Left R
City No. ZONE GRADING OU.YDS- ACRES
LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E
nt-�� __ _ 0
I hereby affirm that I am licensed under provislon6 of Charter 9 (commencing Remarks: I•'!� ���---._ L �.=+�� Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and i '- -At:- -L•-v..a-/ t►�r
my license is in .. • a and effect. RECEIVED AUG 1 6 1988 T
Licens- •ass / i Li s�Jo./�4S/ S
f , Date , - lea�� � PLUMBING I FEES
(` , � r� Signature lea
rt
WOR •ERS' OMPENSATION DECLARATION 1[Bar Sink Showers
.\ iereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C) Backflow Preventer Service Sink
},-/lam s(/p Automatic Washer Transformer ❑ 15-50 KW
Policy No/Pt.-749447 Company r/./Ls"` / Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+ KW -
'• ertified copy is hereby furnished.
i.t. o filed with the cityer I Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date / Applicant
EXEMPTION
j/) �FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(This section need not be completed if the permit i5 for one hundred ($100)or
less). ' DishwashertrSolar Piping as QG Dryers ❑Gas ❑Electric - Sub Panel •
I certify that in the performance of the work for which this permit is issued, I '
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank . Fan
Motors ❑0-1 HP ❑1 X-8
Workers' Compensation Laws of California. _
Date - Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration,you should become subject to the _ Inc.SOlar 0945 HP 016-15+_
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit 4hall be deemed revoked. - Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
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
Lender's Address - Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash GarbageDisposal
following reason (Section 7031.5 Business and Professional Code:.Any city or _ P osal
Standing Sections
county which requires a permit to construct,alter.Improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for-such permit Trash Compactor
to file a Signed statement that he/she is licensed pursuant to the piovisions of Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section-7000)of
(vision 3 of the Business and Professions Code) or that he/she is exempt
lerefrom and the basis for the alleged exemption. Any violation of Section
.031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
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:
employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however,the building or improvement is sold within one year of com- - Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). Building Approved By —Date
O I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued ByDat
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 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) °cense pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple❑ System Repair/Alteration
ll
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.BIt. (CBO# Fire Dampers PLAN CHECK $ PERMIT PLUMBING $ 0-6.00 ISSUANCE $ 4
Date Owner Heating System& Ducting Registers ENEgRG'MP.b-lS$a (1FSAr GA
PLAN CHECK 25% $
I hereby certify that I have read this application and state that the above Doi 00,000BTU 0100,000 BT - $ qqqq j°Is�G9EP0�$[T ONLY
information is correct. I agree to comply with all city and county ordinances ELECTRICAL aiC11wTTvt AO EPOS NATIUNAL RANI
and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ M(CROELI M =$,
inspection
of this city to enter upo the above-mentioned pro p BARK HbbUUNT r. r y$84
Inspection ouryoy�s. .2 0 MECHANICAL $ ACCO-EdiAf1FEE30$ifrSV V
Signature (// D.� Date Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ 01 0019 001 00012253-00012253
Drivers' Liens or SS
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor yV "v
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
(..•••1
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •
5. Steel Reinforcement 56. Rough Plumbing & Presstre Test
6. Electrical LIFER Grhd.. • 57. APPROVAL TO COVER:GUNITE
e i
7. Footings :; �' 58. Electrical Conduit-Undrgrrid.
8. Foundatidn 59. Gas Pipe, 0 Undrgrnd.,lest
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap,.0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK yJ
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. ISOOL/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 11Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro d �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. D5y Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL le•.
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT14 i
31. Plaster Brown Coat 79. FINAL INSPECTION •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •�
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing ?-7-}/Y L CD
39. Water Service-Final '
40. Gas Service-Final 'i
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation t%.
44. Landscape Irrigation System •
45. Sound Attenuation
46. Handicap Regulations ✓�
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date
2Ybbb PLAID
JAN -7-69fN< 00 217* ****25.5(
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92826
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS 1074 Valleio Circle
RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA
n�
RECEIVED DATERECEIyg L YBS
OWNER Heltzer Enterprises-Costa Mesa /a-"`6-bd 3 SOY
MAIL BUILDING /O7/ Mgr sea)
ADDRESS 144 South La Brea AvenueFIRE ADDRESS T /GGE'A'Cs�I'( .AJLC.��
cry Los Angeles 90036 ri 936-110)4 ZONE #3 TYPE-7r GROUPZ4 J
ARCHITECT TILS (7147 APPROVEDAY DATE
OR ENGINEER Frank Gonzales No. 3 -68 8 J
1336 E. Chapman Avenue ZONING
ADDRESS Orange, California 92668
ZONE NO.orI u.EorNEW Has. w/
CONTRACTOR George J. Heltzer & Assoc.
Rl I PUNS 2 BUILDINGArtarh.Garase
LEGAL
ADORES, 144 South La Brea Avenue
DESCRIPTION Lot 60. Tract 6637
CITY Loc An1es_ California 90036 A.P.NO. None
ge
NOTE: NO NAVE OVERHANG SHALL BE LESS THAN
LIC. 201098 TQ. 936-1104 SO•TO SIDE$REAR P.L.
SIZE I NO.OP BLDGS. VES
ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT 0
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE FROM
CENTER OF STREET REAR YARD 22 I FRONT 0 PT. FT.
SIDE YARD LEFT 161 I RIGHT 51 R.SIDE (Fr. FT.
DESCRIPTION OF WORK L.SIDE /moto PT. Fr.
NEW X ALTERATION _ ADDITION REAR �{ PT. FT.
DISTANCE SET. BET.MAIN a
MAIN BLDG'S, ACCESS.BLOCS.
REPAIR MOVING DEMOLISH
BUILDING NO.OF VAR.# DATE
SIZE ROOMS STQRIE$ 1 C.U.P.* APPROVED
EXTERIOR WALLLA/
/
COVERING stucco I COVERINGWOOd shingle. Br ROOF APPROVED ATE�y '3G' 6 ")USN OF BUI LDIMS AND WORK TO BE PERFORMED ��� P.
Dwelling and Attached Garage ro
Plan 401E - Lot 60
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT ONO UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. ,i3A
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
BUILDING CONSTRUCTION. �. PERMIT FEE $ 67�/f
SIGNATURE OF N.
PERMITTEE /' - /7A-fa C� O 6-O 4
/ $ PLAN CHECK $ ar
AUTHORIZED AGE 0 ' �1m [�
\ i / t TOTAL FEE $ V 67 4