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Home My WebLink About384 16TH PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 384 16TH PL Suite: Vicinity: Parcel Number: 42519212 Applicant: SCOTT JOHNSON Address: Owner: BLANCO, DOLORES TR Address 384 E 16TH PL #A COSTA MESA, CA Contractor: SIERRA PACIF,IC ROOFING Address: 400 E 25TH ST UPLAND,CA Zip: 91784 Arch : Address: Zip: Phone: License: Zoning: Phone: 909-538-7454 Zip: Phone: 2ip: 92627 Phone: (909)982-6611 License:- 627233 En9: Address: TlOFF AND REROOF 3000SF DUPLEX W/BUILT-UP Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: 50.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS � �- MAINSTRUCTURE Front . 0-0 � Rear 0-0 ACCESSORY Front 0- 0 Rear 0- 0 PARKING Existin : 0 Required: 0 NOTES: FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 ISSUED BY: Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 Stalus: ISSUED Applied: 02I19I2002 Issued: 02/19I2002 Phone: License: S $3,000.00 $3,000.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Callfornia statutes and related regulations. (OM. No. 92•28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced withln 180 days, or Ii work is suspended or abandoned lor a period ol 180 days. INSPECTIONS: In order for ihe work authorized under this permil to be considered legal, such work must comply with all applicable codes, end ell required Inepectlo�e end final approvel must be obtained. Failure to obtain Inspec�ions and finel approvel will result in the expiretion of thls permit. FOR INSPECTIONS CALL: (714) 7545626 04&48 (B/00) y � � WORKERS' COMPENSATION DECLARATION: I hereby aRirm under penalry of perjury one oi the following dedaraUons: � ❑ I heve end will maintain e certiticaie ot consent to selt-Insure tor workere' wmpensation, es provided br by section 3700 af the Labor Code, tor Ihe peAortnence ai the / wOrk for whith IhiS pertnii is issued. �Y I have entl will maintain rkers' compensatlon insurance, az required by sectlon 3700 0l ihe Lebor Cotle, tor the peAo�mance of the work tar wNch ihis pemut is issued. �� My ��rkLers'�Q m�pens i Ins ance carrier and policy number are: / Carrier: .YI .�i �P � LL� ` PolicyNumber� Z�� a� (Thls section need not be Oletetl i/ Ne permif is valued et one hundred dWlers (5100) ar leu.) ❑ I certify that in tha peAortnance of Ne work lor whic� this pertnit is issueQ I shall not employ any person in eny menner so as to become subject to the woMere' compensation Iaws ot Califo la, end egree that II I should become subject �o the workerslwmpensation pmvisions oi Section 3700 of Ihe Lebor Cotle, I shell lorihwlth comply with Ih85e provisio . q Applicant Signature: Data: � /� / /� WAHNINO: FAILURE TO SEWRE WORKERS' WMPENSAiION COVEMGE IS UNLNWFl1L AND SHNL SU6IECT AN EMPLOYER TO CRIMINAL GENr1LT1E5 aND CML FlNES UP TOONE MUNDRED TMOU54ND OOLLARE (5100.OW). IN ADDITION TO THE ODST OF OOMPENSATION, OAMAGES AS PROVIOED FOR IN SECTION 3�O60F THE IABOR CODE, INrEREST. AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn thet I em licensed under proNsions of Chapter 9(commendng with Sectian 7 ) of Dhnslon 3 ot the Businejsf end Proles5ions Cotle, entl my license is ln full torce entl eNect. uc. a �/J 2'71- Class a ` 3 4' Contwctor'sSignewre: �'Zij � Dete: 2/i S/�- CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that Ihere is a construciion landing egenry lor Ihe pertortnance of 1he work tor which t�is permit is iuuetl. (Sec. 3097, Civil Cotle). Lentlers Name: Lentlels Atltlress: Siqnature: � Date: OWNER-BUILDER DECLARATIONS: I hereby aflirm lhet untler penalty of perjury Nat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW lor the tollowing reeson (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires e pertnit to canstruct, elter, Improve, tlemolish, or repair any structure, pnor to its issuance, elso requlres the eOD�� or such pertnit to file a signed statement that he or she is licensed pursuant to �he provisions of ihe Gontractors License Lew (Chapter 9(commendng with Section 7000) ot Division 3 ot Ne Business antl Profeuions Cotla) or that �e or sha is exempt therefrom entl tha Desis lor tha ellaged e:emption. Any violation oi Section 7031.5 by any applicant for e pertnit subjects ihe epplicant ro a civil penalry at not more than five hundred dollars (5500).): ❑ I, as owner of ihe properry, or my employees with wages as Iheir sole compensatlon, WILL 00 THE WORK, end Ihe swciure Is not intended or oMeretl far sale (Sec. 7044, Business and Prolessions Code: The Contrectors License Law tloes not apply to an owner of properry who Duilds or improves ihereon, and who does such work himself or herselt or t�mugh his or her own employees, O��tletl Uat such improvemen�s ere not intended or oflered for sale. If, however, the building or impmvement is sold within one year oi completion, Ne ownervbuilder will have the burtlen of proving that he or she tlitl not builtl or improve for purpose ot sale.). ❑ I, as owner ot the property, am EXCLUSIVELV COMRACTING WRH LICENSED COMRACTORS to construa the prolect (Sec. 7044, Business antl Professions Code: The contrectors License Law does not appty to an owner oi property who builtls or Improves Ihereon, and who wnirects lor such project with e coniractor(s) licensa pursuani to the Contractors License Laws.). ❑ I am exempt under sec. Busine55 and Profe55ions Code tor this reason: Signature: Date: Owner ID verilied by dnver5license. ❑ Yes ❑ No Drivets License No. Venfication ot Owners�ip by (type oi document, i.e. - Oroperry taz 6ill or tleetlj: Expires: OIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I hereby ceniy thet no axcavation live (5) ar more feet in depih into which e person is required to descend, will be mede in connection with work euthoAzetl by Ihis pertnit, end that no building swpure, scafloltling, falsework, or tlemolition or tlismantling thereof, will be more than t�irty-six (36) leet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Calilomla AAministrativa Cotla). ❑ A5 owner-builder, I will not employ anyone to tlo work whlch would require a permillrom the Division ot Industrial Selery. as notetl above, unleu such person hes e permit to do such work irom tha tlivision. SignaWre: Date: Division of Intlustrial Selery Pertnit Number. CER7IFlCATE OF COMPLIANCE AND AlfhiOR¢ATON OF ENTAY: I certity under penalry of perjury t�et I heve read this application entl state that the informalion given Is wrrea. I agree to comply with ell stete laws and dry orCinances releting to builtling consiruction, end authodze reD�esentatives ot ihe Clry ol Casta Mese to enter upon the ebove-described properry lor inspection purposes. I egree not to oauDY or allow occupency of any building euthonzed by Ihis permit until final inspection. SI ra Ot Legal Owner(s) Date / / �-/i5'�� And/Or Authonzed ApPlicanl `" �� Date - - � � COOE t• INSYECTIONTYPE 1fi16 Fixetl System Finel Fire Pravention 1268 Pool Spa Finel 200 Finel Re-Roof 201 Finel Blxk/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion cooer iNsvecnoNnae 206 Finel Mechenical 208 Finel Plumbing 210 Final Electdcel 212 Finel Fire Preventlon 220 Final Plenning Approval 222 Finfll Site 250 Finel Builtling/Occupancy Q� It�dL$ AOD�icant to fill in al1 soaces exeeot those within heavy bortler lines ana slgn all avProoriate tleelantions. CITVOF�COST�A MQE�S/A Cp NSTR TtON PERMIT PER I N� /� � y TRACT NO. LOT NO. � UNIT NU. Pro ct Address L� ( 15 16 �Fu.�S-Ce / Applicant's Mailing Address TVPE OF CONSTRUCTION rvEw ADD A�7ERATiOrv REPAI R Owner'S Name '��T� Phone�y$�� 6� � CONVERSION ❑ DEMOLISH ❑ OTHER A p �6 DESCRIPTION OF WORK/USE OF BLDG. Address SF1'�^'�v S MainBuilding: E Arch/Eng. LicenuNo. TVPEOFPEfiMIT GRADING FOUNDATIOrv S7RVCTVRAL T Front. Addre55 - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear E��Y�� ❑ OTHER %� Contractor'sNam C phone C Right Address (mailing) �7 -��-�p' �"� �„1/1' �+1Z �F � �%�iC ��"� PROJECT DESCRIPTION 5Q. FT. oCCUaANCv K OUftvO � CONSTRUCTIONTYPE VALUATION$ g LeFt City LiCenSe NO. ZONE GRADING CU.Y�S. ACRES p��g, Ref. # LICENSED CONTftACTOR DECLARATION I hereby atfirm tnat I am licensetl untle� provlsions o1 Cha�ter 9(commencing ftemarks: Plannin9 NOtes: with section 7000) of �ivision 3 of [he Business antl Professions Cotle, antl my license is in full tqr,ce antl ettect. License Class c-d-� License No�F�/3�lzY Date��'`7- � Signature WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certifi[ate of Con52nt [o zelf-insure or a c¢�tificate ot WoJr.kers' C)omppenwtion Insurance, or a cert/it�ietl co�p(y, ythereof (Section nnnol�ie1'YNd."J%OI�J/d "I� company !/�'TN�I �ertifietl copy is hereby fumishetl. Da(Qert;fie�cppy,is filetl wAPPI � Datej %� �� Drivers' License or SS � Bar Sink Backflow Preventer Backflow Irrigation Bathtu6s Clarifiers Dishwasher Orinking Fountains Floor Drains Floor Sinks Gas Service Outlets Int¢!c¢jltOfS Kitchen Sink Lavatories P-Trap Roof Drains Reinspection Fee � $15 Duct- UnderGround DUct - $tructurdl Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL BIL ICBO # Heating SYstem & Ducting �TA-100,000 BTU 0100,OOOBTI {ieinspection Fee � $75 CMF 0865-46, rev. 30/BG Whi[¢ - Builtling; Canary - Appllcant; Pink - ACGounting; Goltl¢nrOtl - HSse55or Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Hearer Water Service Auto-Wash Issue Fea Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑aioo,aooaTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Eleci Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0-5 KW C 1481' 12/14/87 Zone Accessory BuilAing: ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100amps Meter ❑over 100 amps Sub Panel Mators OO-1 HP �1 %- 8 Inc.Solar 09�15 HP �76�15+ Microwave Pole Ligh[ Sign Standing Sections 15 KW Trash Compactor � Rainspection Fee �� $15 � � Issue Fea DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Appraved By - � �ooa T� FEES S 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% g MICFOFILM 3 MECHANICAL 3 � �� TOTAL FEE S '� J� PLAN CHECK 25% $ Z O N I N G R E � M T S CONSTRUf,TION AND PLANNING POOL & SPA APPROVALS Perroit'# Date Inspector qPPROVALS 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 7. Footings 58. Electrical Conduit-Undrgmd� �� 8. Foundation . 59. Gas Pipe, O Undrgrnd., Test i_' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 70. Structural Floor Svstem 61. APPROVAL TO DECK 1 t. 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. Ducis, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71 . Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. RoofFraming 73. Undergrnd.StorageTankOGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry S[andpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION �. ` 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: 34. Final Heating & Air Conditioning �/s/f�y /J_/f7/_' �- i/� 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 pomes[ic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING . . 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . �1 No. Date . • 2300� `COSTA�MESA BUILDINGSAFEfY DEPARTMENT � P.O. BO%9fY COSTA M6BA� CALIFORNIA For Applleant to fill In Complafely TYPE OR PRINT aui�oiNc � Q` wooaess (J COSTA MESA, C LIFORNIA f /Ga'� !"�/„�c � y4 ; F. �� d, -/Y: f SIZE (�7� o. on a�ooei OF LO Now oN LOT USE OF EXISTING BLD6. � SETBPCK LINE FHOM eeNren oF sTnEtT REAR YARD S`' 61DE YARD LEFT �� RIGHT � , DESCRIPTION OF WORK REPAi� MOVINO'ON � DEMOL BH BUILDIN6 NO.OP SIZE Z �� ROOMS I� BTOR HH I EXTERIOR WALL I Rppp e GOVERING A�00�% COVERIN6 ��'� USE OF BUILDIIJG AND WORK TO BE PERFORMHD � I HEHEBY ACKNOWLEOGB THAT � HAyg RBA� TNIB APPI.ICATION FNO 6TATE TX�T TH8 ABOVE �8 CqqqgCT ANO AOqHB TO COM� PLY WITH ALL CITY ORDINANCBH AND BTATB LAWB fl86UUTINO BUILDINOCON9THURION. - SIGNATURE OF PERMITTE AUTMORI2ED AGENT ��F�E REC�IV�D flNR1�iCE��P14 � ��j� � �OS�TA MESA A C 10 OR PERMR BUILDING For OHice Usa Only BUIL�IN6 '3 ZONING OR _ Ue80PNCW L80AL YARDSAPPROVED MAIN BUILDIN6 DISfANGE BET. MAIN BLDGB. VAR. JC HOLD FOR Ci '� — r x 8HALL BE LE88 THAN (U.B.C.REQUIREMENT YARDSAPPROVED ACCESSORV BUILOINO �. r DATE • � so. Fr. 7� " THE AMOIINT BHOWN IINOER VALl1ATION IB POR THE _ PURPOSE OF fiBTABLI8NIN0 A PERMIT P88 ONLY. p VALUATION � aj m PERMIT FEE $ � � s � � �,S E= 3 � _ � / ! 7 •