HomeMy WebLinkAbout2869 EUROPA DR - Building Permits •
OWNER SHAW, C. DATE DEC 1 B 1963
JOB ADDRESS 2169 Europa Dr. BUILDING PERMIT NO. 21186 • - -
GENERAL CONTRACTOR Con tinental Constr. VALUE $626.00
AP NO39-455-12 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Com. B1.Wall
I ECTIONS Signature DATE GROUP , TYPE III ZONE M.
Se– SPERMITS ISSUED
SUBCONTRACTOR
Gas DATE NUMBER
Water
Rough Corn. Rcfrig. 0 Air Cond. 0
Rough Heating
Rough Plumbing
Miscellaneous .
Prop. Swr. Line 0 House Con. 0 St. Swr. 0
Sprinkling System
Construction Pole
Underground 0 Power ❑
Rough Wiring
Trenches Forms 0 Steel Reinf.f e� ./.4--/%-3
Floor System ff
Bond Beam 0 Steel Reinforce L1 4. /,a/6/tL
Sheathing
Frame and Flashing
Lathing—In O Out
'r sster, brown coat
i`•:-lfrig. 0 Air Con. 0 Final
''Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final -kijA yPeAC A /S 410
OCCUPANCY
Form BU4-6M-2-63—S-B P 03-11 AC
OWNER PACESETTER WEST JOINT VENTURE DATE 3-22-63
JOB ADDRESS 2869 Europa. Drive BUILDING PERMIT NO. 19108
GENERAL CONTRACTOR Andros Land Company VALUE $ 22,592.00
AP No. LOT 24 TRACT 4348 FIRE ZONE DESCRIPTION OF WORK res att gar
V -°ECTIONS Signature DATE GROUP 1&J TYPE V ZONE RI
S. /= H y+/7- j PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water 'hang.Rough om. ❑ Air ond. ❑ .
Rough Heating /• / . 1? -/c-6) 772.- SLE .iii �///-1,3 / ,.2 —
Rough Plumbing -�
Miscellaneous " , � ""�• / ,_ ,2-G.3 Q:7+ —
Prop.Swr.Line House Con. 0 St.Swr. ❑ /, ' ?
'1`- �i��'�i3 y, tom-" ZL.�.� c-�y C/ lo-/.�-fa,J `3 `�2�
Sprinkling System - 0
Construction Pole
Underground 0 Power ❑ �v7 d 1/144"
Rough Wiring (C1/,673 12J,Z1�1/L.cewcI&t, /o-174"(.3 -2CG/o —
Trenches Le- Forms [Q' Steel Reinf.--p ny_ft
Floor System Q-4"413
Bond Beam 0 Steel Reinforce 0 .
Sheathing //' d''./-G,
Frame and Flashing X71,, 6-,Z .-4r-
Lathing — In Ya- Out J---- 'J`9<- ?
plaster, brown coat 1C A_2 J'^
frig. 0 Air Cond. 0 Final -
-seating, Final 6./J/- 4-j4/-(I
Plumbing Fixtures, Final 417-#7 2--1-44-6 >
Final Gas Test /- 63 rON,le,
Electric Fixtures, Final ad qI;ZZi-G5Building, Final
OCCUPANCY
FORM 8114•5M - 7.51
7G CITY OF COSTA MESA
,1, BUILDING DIVISION
I �) 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
aror.a�o�
PERMIT NUMBER: BC09-00189
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: GRN2_RES DATE ISSUED: 07/02/2009
.ISSUED BY: BJK
JOB ADDRESS: 2869 EUROPA DR.CM Suite/Unit:.
APN: 13945512
Vicinity: PHOTOVOLTAIC ROOF-TILES • -. :- "Primary Occ: R3
Const Type: V-B `SQ:FT:' .:- 0 Valuation: • $20,000.00
••
SCOPE OF WORK: INSTALLPHOTOVOL-TAIC SOLAR TILES ON A SFD UNDER CONSTRUCTION.
1 INVERTER, 1 MISC EQUIP, 1tCONDUIT •
•OWNER: WOODS FAMILY TR Address: 2869 EUROPA DR Unit:
•
Phone: - - - City/State/Zip: COSTA-MESA,CA _.
_APPLICANT: RUBEN MUNOZ ' • / . "• Address:
Phone: 714.437.0800 >_ .,City/State/zZip: •
CONTRACTOR: CENTERSTONE'CONSTRUCTION•INC - Lice se No -817047
•
Phone: 714-437-0800 '�"'"' Address: 3500:W LAKE CENTER.DRUnIti ' - UNITE
Celt: .F City/State: SANTA ANA,CA - _ - 'ZipCode 92704
ARCHITECT: - ' - Llcense'No. • PHONE:'::
ENGINEER: JOHN D BAYNE- 4+.i.• License No.C32046 - , :PHONE:-
.4
COMBINATION PERMIT,FEE.SUMMARY
Building Plan Check: $208.81 - J
Building Fees: _. t, •$321.25 ; =
Electrical Fees: . 5$90.40
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund $1.00 .. . • I -
TOTAL FEES: $6.21:46
—Refer to fee receipts for all fees paid for project -.—• - -
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION,
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.
CODE t. INSPECTION TYPE DATE INTITIALS COLEY INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final BloWRetaining W all 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA -"
%ft. BUILDING DIVISION
Fµ AIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
.4�. FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: BX09-00096
PERMIT TYPE B_MISC STATUS: FINALED
APN: 13945512 66 DATE ISSUED: 05/06/2009
Zoning: R1, co(
ISSUED BY: KJB
JOB ADDRESS: 2869 EUROPA DR CM Suite/Unit:
Vicinity: Primary Occ: Const Type :??
SO. FT: 0 Valuation: $3,825.00
SCOPE OF WORK:
85 LINEAL FT OF POST TENSION BLOCK WALL. PROTO II WALL SYSTEM. REF: G09-00004
OWNER: WOODS FAMILY TR Address:: 2869 EUROPA DR Unit
City/State: COSTA MESA,CA Zip Code: 92626
Phone:
APPLICANT: WOODS, HAL Address: Unit:
City/State: Zip Code:
Phone: 714-437-0800
CONTRACTOR: CENTERSTONE CONSTRUCTION INC License No. 817047
Address: 3500 W LAKE CENTER DR • • Unit: UNIT B
City/State: SANTA ANA, CA
Zip Code: 92704 Phone 714-437-0800 Cell:
ARCHITECT: License No.
Phone
ENGINEER: C J ATKINSON License No. S4055
Phone 480-774-1700
FEE SUMMARY
Building Plan Check: $63.21
Building Permit: $97.25
Electrical Permit: $0.00
SMIP Residential $0.50
SMIP Commercial $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $161.96
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
OE r. INSPECTION TYPE DATE INTmALS CODED INSPECTION TYPE
DATE INTmALS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall •3123/(01 212 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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by .
section 3700 of the Labor Code,for the performance of the work for DIVIS firwhich this OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I ;p- -.if that no excavation five(5)or more feet in depth into which a
number are: perso ..•j tl•.. •escend,will be made in connection with work authorized
by thi' F.rtni.tty„f; y.,. ;Iding structure,scaffolding,falsework,or demolition
Carrier: or di ntling " � r• '• �, '- .n thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed dthe permit is valued al one hundred dollars(5100)or less)
2,Art 2,Sec. . ,,f� •,'
y ministrative Code).
Policy Number: 1
0 As owner-build- ' • .: ploy anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Div • Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
Contractors Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
O I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of properly who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
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 8. (If"yes",attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa. to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
• authorized by this permit until final inspection.
Signature of Legal Owner(s) Date
Signature Date
3057-46(3/07)
And/or Authorized Applicant Date
CITY OF COSTA MESA
BUILDING DIVISION F09-00084
v ,($ 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
V. We ` FOR INSPECTIONS CALL:(714)754-5626 •
•
FIRE SUPRESSION PERMIT
Job Address: 2869 EUROPA DR Status: ISSUED
Suite: - - - Applied: 06/16/2009
Vicinity: SFD . . Issued: 07/08/2009
Parcel Nunmber: 13945512 Zoning: R1 R1-
Applicant: GERLETTE, ANDREW
Address:
Phone: 714-666-8450
Zip:
Owner: WOODS FAMILY TR
Address 2869 EUROPA DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: RESIDENTIAL FIRE SYSTEMS INC
Address: 2871 E VIA MATRENS
Phone: 714-666-8450
•
ANAHEIM,CA Zip: 92806
License: 786965
SCOPE OF PERMIT
INSTALLATION OF 36 FIRE SPRINKLER HEADS IN CONJUNCTION WITH THE 3290SF NEW GREEN
2-STORY SFD WITH AN ATTACHED 621SF GARAGE.REF:BC09-00087
FEE SUMMARY
Plan Check: $72.31 Calc Valuation: $4,434.00
Permit: $111.25 Claimed Valuation: $4,434.00
Other: $0.00
Total: $183.56
its.y k agecv0
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE I INSPECTION TYPE 0ATF, IMTITIAL@ CQOEf INSPECTION TYPE peg INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical p
201 Final Block/Retaining Wall _ 212 Final Fire Prevention p`2-p.,�r 91
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: • Owner ID verified by driver's license. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
corn ensation, as provided for by section 3700 of the Labor Code, for the
p ormance of the work for which this permit is issued.
Q 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation fine(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
C 1 by this permit,and that no building structure,scaffolding,falsework,or demolition
Carrier( Sr0. 1 U/ld or dismantling thereof,will be more than thirty-s' (36)feet high. (Chap.3.2,Grp
(TMs van need rn pt be
sodium
permss vaMed at ass kindred cb�ars(Stool u-less) 2,Art 2.Sec.341,Title 8,California Administrative Code).
Rolicy.Number: OO Z / t o" z6197
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
the Labor Code,I shall f›• wit. •' • • h these provisions. Applicants Signature Date
7/1/29 Division of Industrial Safety Permit Number:
App* 's • core Date, HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: .• LUR - ECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLA • •ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No
Lic.SR 78696. ' 'Class#Th C� (Section 25533 of the California Health and Safety Code, with some
''// exceptions, requires registration with the Costa Mesa Fire Department by
7/141 each business which at any one time has on hand a quantity of acutely
Qdrs Signature LDatez 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
CONST R ON LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement
(Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars(5500).): of the California Health and Safety Code).
❑ I, as owner of the property. or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If'yes", attach certificate of compliance from the appropriate air pollution
employees. provided that such improvements are not intended or offered for •
control officer).
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ 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 Signature Dale
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contracta(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature or Legal Owner Dale
Signature Dale 7/EA09
a09-46(dol) Andbrsed Appnrant
CITY OF COSTA MESA
. 9 BUILDING DIVISION
Fi �l 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • vww.ci.costa-mesa.ca.us
0. Ira - FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: BC09-00087
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: GRN2_SFD DATE ISSUED: 05/22/2009
ISSUED BY: BJK
JOB ADDRESS: 2869 EUROPA DR CM Suite/Unit:
APN: 13945512 Zoning:R1, ,
Vicinity: NEW GREEN SFD Primary Occ: R-3
Const Type: V-B SQ. FT: 4060 Valuation: $357,581.00
SCOPE OF WORK: 3290SF NEW GREEN 2-STORY SFD WITH AN ATTACHED 621 SF GARAGE . REF: G09-00004 ELEC: 3290 SF
DWELLING: GARAGE ELEC:3 LIGHT FIXTURES,8 OUTLETS,2 SWITCHES, 2 MOTORS TO 1 HP; MECH:2 FAU < 100K BTU,3
FIREPLACES, 1 HOOD W/DUCT,4 VENT FANS,2 APPLIANCE VENTS, 2 COMP 3-15 HP; PLUMBING:2 BATHTUBS, 1
DISHWASHER, 1 GAS EARTHQUAKE VALVE, 1 GAS OUTLET(1-4), 1 GAS OUT(5 PLUS), 1 GAS SERVICE, 1 LANDSCAPE
IRRIGATION,2 LAUNDRY TUB/WASHER, 3 SHOWERS, 1 BAR SINK, 1 KITCHEN SINK,6 WASH BASINS,4 WATER CLOSETS, 1
WATER HEATER(TANKLESS), 1 WATER SERVICE
OWNER: WOODS FAMILY TR Address: 2869 EUROPA DR Unit:
Phone: City/State/Zip: COSTA MESA,CA
APPLICANT: WOODS,HAL Address: Unit: :
Phone: 714-437-0800 City/State/zZip:
CONTRACTOR: CENTERSTONE CONSTRUCTION INC License No. 817047
Phone: 714-437-0800 - Address: 3500 W LAKE CENTER DRUnit: UNIT B
Cell: - Eity/State: SANTA ANA,CA ZipCode 92704
•
ARCHITECT: HAROLD G WOODS JR License No.C12071 PHONE:714-437-0801
ENGINEER: ROBERT M VOLPE . License No.C25116 PHONE:949-305-4700
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $396.27
Building Fees: ,$2,438.55
Electrical Fees: $299.20
Mechanical Fees: $220.90
Plumbing Fees: $281.95
SMIP Residential: $35.76
SMIP Commercial: $0.00
Bldg Std Admin Fund $15.00
TOTAL FEES: $3,687.63
**Refer to fee receipts for all fees paid for project
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE!. INSPECTION TYPE DAL INTITIALS COPES INSPECTION TYPE , DATE JTUL
i
1616 Fixed System Final Fire Prevention 206 Final Mechanical L e
1266 Pool Spa Final 208 Final Plumbing •■�/j�] �%/
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 4
203 Final Sign 222 Final Site
9 �I
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code. for the
performance of the work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by
s ion 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: y ( person is required to descend,will be made in connection with work authorized
ry. 1 f W n./I vw,t ),A1 S • c0 • by this permit,and that no building structure,scaffolding,falsework,a demolition
'Waffler: vV fl f I7 ,�• or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need �Jbe led a the mind is valuedar one hundred 4Ears( lao)or less.) 2,Aft 2.Sec.341,Title 8,California Administrative Code).
PoliNumber: f IP 9000 I rT3 Q $D1' 0 As owner-builder, I will not employ anyone to do work which would
O I certify that in the • ormance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
' issued, I shall not em. .y a person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' .• pensa on laws of California. and agree that if I should
become subjeo the . kers' compensation provisions of Section 3700 of Applicant's Signature Date
the Labor Cod:� si.II fo hwith comply with these provisions.
411 % /14 1 aG) Division of Industrial Safety Permit Number:
'�..i` rwre --_D to G/ ( HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE Tin SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No
I/
Lit..tE / .ea Class._#_ , (Section 25533 of the California Health and Safety Code, with some
ER
� exceptions, requires registration with the Costa Mesa Fire Department by
as... H I each business which at any one time has on hand a quantity of acutely
C.93 t. '.sirre o`ate> 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
CONSTRUCTION LEN PING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issue (Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes El No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE S. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the properly, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the Work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No
thereon,and who does such work himself or herself or through his or her own
8. (If yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. It however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
•
❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
Q I am exempt under secthe information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described properly for
inspection purposes. I .• -- not to occupy or allow occupancy of any building
authorized by this .er it u til final inspection.
r, f/a.' I Owner(s) Par
Signature Date
3057-46(3/07) ��� Z_1
An•for`thonz,r'pplicant 0.te :Vf
4•1•111111ri
� w �r t
v CITY-OF COSTA MESA -
4t"q. BUILDING DIVISION
). • _,,laliThMit' A; : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�
tst "' I PERMIT B07-00062
J• righ
.et �}}►�}►d
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.dS aJ---'-G PPT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2869 EUROPA DR Status: ISSUED
Suite: Applied: 01/17/2007
Vicinity: Issued: 01/18/2007
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 13945512 Zoning: R1
Applicant: O'CONNOR, RAY •
Address: 2869 EUROPA DR
_ _ Phone: 714-414
COSTA MESA,CA 'Zip: .,92626 ISSUEDBY:
Owner O'CONNOR, FOREST R .EXTE E
Address 2869 EUROPA DR - ALL t,v A ED
Phone:
COSTA MESA,CA. " '
PER Zip: 92626 . '
Contractor: ' OWNER-BUILDER:,,._,, -_
R,' ,EXPIRES 3 it Z l'
, /�j� /, Phone: ,
,i./- If11)
/ " ZIP:' ' fit-' License: 000000 NL
'� %
/Arch :. MARCUS,'KEMMERER Eng: DATE,0 3 I
Address: -KEMMERER DESIGN ARCHITURE Address:
HUNTINGTON BEACH,CA Phone: 714-655-3139 Phone:
, 228 CREST AV -' '- -
:Zip: .92648 - -License: 'C29552 • License:
7 x- ' - SCOPE OF PERMIT
CONSTRUCT NEW 4261SF TWO-STORY SFD WITH ATTACHED 486SF GARAGE AND 27SF BALCONY.
` FIRST FLOOR:2209SFSECOND FLOOR:2052SF " ,\
REF:B06-01771 "
1.:...,": LI ' ' FEESUMMARY_I.- .. .
Plan Check: $0.00 - Calc Valuation: $azosol sa
Permit: . • $2,791.35 ,•-. Claim Valuation: $0.00
SMIP Res: '$42.09 _ ;. - -
. SMIP Com: i $0.00 - :.: :._,-_, ' ..
Other , $0.00 ,. -- ---- -- - '
�-.Inspection: • $0.00
Total: $2,833.44
N.;,‘ -, ."1t-PLANNING &ZONING
SETBACKS V�t,
MAIN STRUCTURE Front. 0-0 ',,—' 'Rear. 0-0 Left 0-0 c -- Right 0-0
ACCESSORY, - Front ,0=0 ' ' H-. Rear 0-0 Left 0-0 Right 0-0
.A -
PARKING „Existing:'/ 0 ' Required:. ''..-0c., _ .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 i ,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(WOO)
1.1111110.
DECLARATIONS
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
•
❑ I certily,that.in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
�'mmpensation'laws of California,a gree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. /) /'7
J1pP .g1.719;—�/
IicanYSi nature: -
G::.- r,ni
THOUSAND
FAILURETOf SECURE WORKERS'ITIOCOMPENSATIONTT COMPENSATION,
UN,DAMALANASHRLLID SUBJECT AN EEMPLOYER76OFTHE ABOR CODE.INTEREST.
CIVIL FINES UP rOTONNEEESDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3]060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of :usiness and Professions Code,and my license is in full
force and affect.,_Lic.s N
- : ure: _ �:a.1 4,...
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: • Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
'0„:2,as owner of the property, i my employees wages as their sole compensation,snotply WILL DO THE WORK,and the structure Is intendeder , offeredo for sale(Sec.
/
7044:'-Business and Protessions.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 iii or,her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold viithin'orie'year of colt tied...he 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 Licenie'Lawdoes 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'Contiacter's License Laws.).
O I am exempt under ec�yy Business and Professions Code for this reason: r)
•
Signature'... '/t!/,a""
Expires:_ /)
Verification of Ownership by type of document,i.e.-property tax bill or deed).
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
presently
q e has
2 3
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Calitomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all statelawsand city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pro e� 1iorLpurposes.I agree not to occupy or allow occupancy of any building authorized by this permit unti final inspection.
Mature'Of.Legal'Owner(s)T'' " ( Datez,,f
t -
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE I INTRML$ CODE I INSPECTION TYPE PALE INIITIAL$
•
1616'2-Fixed System Final Fire Prevention 206 Final Mechanical�� ---
1266/Pool Spa Final n ^'-"7 208 Finalg !my? �
200 FinalRe-Roof77 I �� 210`�Final it
/I I( �
201r,.._ Final Block/Retaining Wall ' f_ 212 Final lire Prevention
202 Final Factory Fire Place �-� 220 Final Planning Approval
203 Final Sign 222 Final Site
•
204 Final Demolition 250 Final Building/Occupancy _
•
F CITY OF COSTA MESA
4 BUILDING DIVISION
>'e-•r, ; 4i$ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t• 1w�sa
4. � PERMIT E06-01508
44)4P o a al so at
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2869 EUROPA DR status: ISSUED.
Suite No Apptied: 12/15/2006
Vicinity: NEW SFD Issued: 12/15/2006
Parcel Nunmber: 13945512
Applicant O'CONNOR, RAY
Address: 2869 EUROPA DR
Phone: 714-414-7805 ISSUED BY:
COSTA MESA,CA - y,,',.<,- I< Zip 92626
Owner: O'CONNOR,.FOREST R ON
r���j ��j
Address 2869 EUROPA DR 11 1 ,T1y�
/COSTA MESA,CA/ 1 Zhpone: 92626 ALLO \• L
PER •
Contractor: OWNERBUILDER AddressEXPIRES (l r
�;=�;
Phone:-" EXPIA.L ,
• c
1, License:'000000 '
DATE / r . / i
SCOPE OF PERMIT •
CONSTRUCT NEW 4261SF TWO-STORY SFD WITH ATTACHED 486SF GARAGE AND 27SF BALCONY.
' ' FIRSTFLOOR:2209SF SECOND FLOOR:2052SF
< REF:B07-00062(AND 606-01771) ,
- 1 RES 4261SF NEW SFD, ,
/ % GARAGE:6 LIGHT FIXTURES,8 OUTLETS,2 SWITCHES,;1 MOTOR TO 1,HP •
i .r / ,I , It - L i' „ A�
-- RELOCATION OF-POOL/SPA-EQUIPMENT: I POOL/SPA- - - '
.FEE SUMMARY
Quantity -- ' _--- -ir -- - Quantity
ISSUE FEE - " " $23.50 • "`- - Temp-Dist System/Lighting $0.00 0
,Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0 .
New Res(1-2 units) $238.62 4261 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $49.50 1 up to 10 kva/kw $0.00 0
Lighting Fixts \'\$6.60 6 :- -up to 50 kva/kw $0.00 0
Recept Outlets ' $4.40 4 r� - up to 100 kva/kw $0.00, 0
Switches • ,�� <_ x,$2.20 . 2 •' over 100 kva/kw - $0.00 " 0
Non Res Appl - ' $0.00*, "'- - '0- . - Low Voltage Equipment - •' $0.00 0
Res Appl -;,$0.00 0 -Low Volt Wiring System/Ckt, $0.00 0
Service to 200ai- $0.00 - . 0 Misc.Conduit ' $0.00 0
Service to 1000a ',/, $0.00 _ -0- Misc.Conductor $0.00 0
Service over 1000a . �, ,, , $0.00-• 0 - Circus(gen or ride). $0.00 0
Motors to lhp $4.75 ,' .` - 1 : Circus(mech ride or lights) - • $0.00. 0
Motors to 10hp 'N x$0.00" I i 10; - _; Christmas Tree Stand $0.00 0
Motors to 50hp N -. $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp ----$0.00-, 0• " Other Electrical Fee ' $0.00
Motors over 100hp $0.00c. _ 0
Communication drops $0.00 N-0 -Investigation Fee ' $0.00
Sub panel to 200a $0.00 <0- - - . _ Plan Check Fee $0.00
Pole Light Pkg $0.00 0- - -- r: ,Reinspection Fee $0.00
Sign Circuits $0.00 0 - -
Temo Pwr Pole $0.00 0 TOTAL CALCULATED FEES 5329.57
•
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 i spended 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(6100)
DECLARATIONS -
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cede,for the performance of the work for which this permit is issued.
My workers''compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not S completed it the permit is valued at one hundred dollars($100)or less.)
L3—i;cenify iiiin the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and ogre that If I shhhQQQuuuId become subject to the workers'compensation provisions of Section 3700 f the La or Code,I shall forthwith
comply with these prroWsions. J ��i'� / _ (x J\
plicant.Signat tUW3. J ' ` Date:--..
WARNINGrFAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPEOYER/O CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WOE.INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.M Class If
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects.the applicant to a Civil penalty of not more than five hundred dollars($500).):
1-❑ l,-as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I.as owneyof the properry,-am•EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code The contractors L 1panse.Uaw does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuantto thed:olibactors License Laws.).
❑ I am exempt under •
a A® Business and Profe sio s `ode to/thi _reason: �)
Signatu`re:,---. . 4 f 4 - . - fDate::• . �- t� al/
Owner ID verified by drivers cense. ❑Yes ❑No No. " ' LExpires:-3-45-457
Verification of Ownership by(type of document,i.e.-property tax bill or deed):i
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a'
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health end Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
__._ o_..r._ _ __... l_._._...
3 Does or will the epplipanl or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 It an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this,a,ppplication aEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for in ction. rposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Ig11Al re_OtLagal.Owner(s)—"""--'- Date-�_
And/Or Authorized Applicant Date
CODEI INSPECTION TYPF DATE INTIALU CODE* INSPECTION TYPE RAE INIIRALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical(` \ _
12662Pool Spa Final T 208 Einat Plumbing
1 O
200,/ Final'Re-Root -- � �� 210 F'ulalE col )
261 / Final Block/Retaining Wall 6 (� I r� !l/j r' 212\IFInal Fire Prevention' K( • j /.
� l t � (� k i 11 A �f . I \� ' ,) r n �l � ��V -
202 Final Factory Fire Place 220 Final Planning Approval
\ LJ
203 Final Sign
222 Final Site
204 Final Demolition 250 Final Building/Occupancy _
4`,5fg M 9 CITY OF COSTA MESA
BUILDING DIVISION
F ,41
Jr� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
!Twit PERMIT M06-00861
-Nbestanst Ile
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2869 EUROPA DR Status: ISSUED
Suite No Applied: 12/15/2006
Issued: 12/15/2006
Vicinity:
Parcel Number: 13945512
Applicant O'CONNOR, RAY - ISSUED BY:
Address: 2869 EUROPA DR • - "
,= - Phone: 714-414-7805
COSTA MESA,CA- Zip: 92626
Owner: ,O'CONNOR, FOREST R Q
Address:- 2869 EUROPA DR EXTENSION
Phone:
' COSTA MESA;CA, Zip: 92626 ALL® -
D
Contractor: OWNER-BUILDER
Address:- , / PER
Phone: EXPIRES .3(( / Mt
Zip:
, . License:000000
SCOPE OF PERMIT EjXP
- , CONSTRUCT NEW 4261SF TWO-STORY SFD WITH ATTACHED 486SF GARAGE AND 27SF BALCONY.
/ FIRST FLOOR:2209SF SECOND FLOOR:2052SF '
DATE 0 1
\, REF:607-00062(AND 806-01771) , \
2 INST FAU<100K BTU, 1 GAS PIPING,2 FACTORY FIREPLACES,4 VENT FANS/SINGLE
,/ . DUCT,HOOD W/MECH EXHAUST,2 COMPRESSOR 3-15 HP/500K BTUTA/C)
• RELOCATION OF POOL/SPA EQUIPMENT: 1 INST FAU>100K'BTU'.
- FEE SUMMARY . '
' Quantity:_' _ - " Quantity
ISSUE FEE $23.50 •- . . . . - _.' _ Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $29.60 V 2 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0
Repair/Alt Cooling/Heat, $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 =. Compressors/Absorption Systems -
Gas Piping `,S.,., $6.15 1 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace ' '-' '. $21.30 2 3 To 15 hp/500 k BTU - - $54.30 2
Hood w/Mech Exhaust , ' ',' $10.65 - 1'-- - 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box ' '$0.00 ' 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct ,,,,,,\ $29.00 4 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance " - --. $0.00 0. - . - Boilers
Fire Dampers , A '"i 1; $0.00'< 0,- y . '- Up to 3 hp '" ' ' ' " . ' $0.00 0
Smoke Dampers v'v, / $0.00,, 0 - -' '-- _ 3 To 15 hp - ", - $0.00 0
Inst or Relocate Appl Vent ' , : .$0.00 ' 0- - - - 15 to 30 hp $0.00 0
Air Handlers< 10000cfm`. "A $0.00',',0- . 30 to 50 hp - - $0.00 0
Air Handlers> 10000dm $0:00 . 0 _ ' Over 50 hp $0.00 0
Floor Furnace . - $0.00 0 . , - Other Mechanical Fee
Floor or Suspend Heater ' -$0.00:- 0 - Investigation Fee $0.00
- - - Plan Check Fee - $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $192.70
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
fora period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must co 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
2446-48(WOO)
DECLARATIONS' •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Cartier. Policy Number
(This section need not be completed i/the permit Is valued at one hundred dollars($100)or less.)
—Pcertily,ttiat in.the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
L--compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with tprovision. n
rpplicani ate: - �• it
A Y=
WARNING:FAILURE TO SECURE WORKER P COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPL VER TO CRIMINAL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full
force and effect.Lic.N Class N
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a Civil penalty of not more than five hundred dollars($500).):
�❑ ras owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
r•--7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale,If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business end Professions Code for this reason:
Sign2tuJe;' — -- - �
Expire
-^ �rS fj I
Verifidation'of Ownership by(typeofdocument,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 'I hereby certify that n0 excavation five(5)or more feel 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,lalsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and 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 akermit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? LJ Yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for s tion p se .I agree not to occupy or allow occupancy of any building authorized by this permit;fi Inspection.
Si nature Legal.Owner(s) ate
And/Or Authorized Applicant Date
CODE t INSPECTIONTYPE OATS !MALS CODE* INSPECTION TYPE DAIS INTmALS
1616/"/`Fixed System Final Fire Prevention ,.rte 206 Final Mechanical
12fi6✓ Pool,Spa Final�///��� r 7`-'� " / I �- 208 Finalikinbih
200 if El
Final ReiRool (/ 7�-�� �� I 1 Final Electrical ',/7
201 Final Block/Retaidiog Wall 1 1 _� I in ! r- 21p�AI Final Firje Prevention ���� '�i��
202 Final Factory Fire Place '220 Final Planning Approval 1 ! V
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
Ms CITY OF COSTA MESA
:. ti°� BUILDING DIVISION
°y �'A PERMIT NUMBER
F 1 esp.: I DEVELOPMENT SERVICES DEPARTMENT
V.
, �i;.a .1 PERMIT P06-01073
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2869 EUROPA DR Status: ISSUED
Suite No Applied: 12/15/2006
Issued: 12/152006
Vicinity:
Parcel Nunmber: 13945512
Applicant: O'CONNOR, RAY
Address: 2869 EUROPA DR ISSUED BY:
Phone: 714-414-7805
COSTA MESA,CA ,-, - Zip: 92626
Owner: O'CONNOR, FOREST R EXTENSION
Address 2869 EUROPA'DR`
- -, ./ . - / - Phone: - - - ALLOWED
ED
'COSTA MESA,CA --r ; Zip: 92626 PER
n n
Contractor: OWNER-BUILDER EXPIRE$'/ct
Address:'
Phone:
Zip:
License: 000000 EX.P�
SCOPE OF PERMIT DATE
(...,7
' CONSTRUCT NEW 4261SF TWO-STORY SFD WITH ATTACHED 486SF GARAGE AND 27SF BAL N .
FIRST FLOOR:2209SE SECOND FLOOR:2052SF
REF:607-00062(AND 606-01771)
3 BATHTUBS,1 DISHWASHER, 1 GAS OUTLET(1-4),2 GAS OUTLETS(OVER 4), 1 LAUNDRY
TUB/WASHER, 1 SEWER CONNECT,3 SHOWERS, 1 KITCHEN SINK,1 SERVICE/MOP,5 WASH
' BASINS,3 WATER CLOSETS,2 WATER HEATERS, 1 WATER SERVICE, 1 GAS SERVICE
RELOCATION OF POOUSPA EQUIPMENT: 1 SPA, 1 SWIMMING POOL
• - FEE SUMMARY '
AMT QTY .- AMTS QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00,' 0 Swimming Pool $60.75 1
Backflow Preventer'' ,$0.00 0 P-Trap - $0.00 0 Trap Primer $0.00 0
Bathtub, $29.40 3 Pressure Regulator $0.00- 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) -$0.00 0 Receptors'- $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units'- $0.00 0 Septic Tank $0.00 0 Wash Basin $49.00 5
Dishwasher -' , ' $9.80-' 1 Sewer Cap for Demo $0.00 '0 Wash Basin Set $0.00 0
Drain,Floor $0.00>' 0, . - - Sewer Connect $24.65 1 . ' Waste and Vent System $0.00 0
Drain,Rainwater' $0.00 ' 0 . Sewer Private Line $0.00 0 Water Closet(Toilet) $29.40 3
Drain,Roof $0.00 0 , ' Shower $29.40 3 Water Heater/vent $24.60 2
Drinking Fountain $0.00 , 0 ., Sink,bar $0.00 0 Water Piping(Inst or Rep.) $9.80 1
Expansion Tank ',` ` $0.00'- -0- .Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve '"`-$0.00' 0 'Sink;Floor $0.00- 0 Water Service $9.80 1
Gas(1-4 outlets) , ' $6.15 1 - -Sink,kitchen $9.80 1 Water Softener, $0.00 0
Gas(Over 4 outlets) $2.20 2 ' 'Sink,service/mop $9.80 1 OTHER $0.00
Gas Repipe $0.00 ' 0 Spa(private) , $30.25 1 VIOLATION $0.00
Gas Service $9.80 1 - Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 - - - REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0 - -
-TOTAL CALCULATED FEES: $377.90
rK aaaari C /COCPI AI rnklne-rin me
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 sucref<led 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
2448-46(EV00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carder and policy number are:
Carder: Policy Number:
(This section need not be completed If the permit is valued at one hundred dollars($100)or less.)
g�I:ce tiny that in the performance of the work for which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agrthat if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
compignath these.provlslons,.�/J //C'�G✓v"'" �� (/ /
Mpplice tm
comply
//,-yy/n`
'WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND not ARE($1031:00).IN ADDrTION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Uc.# Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: {' Date:
OWNER-BUILDER DECLARATIONS:
• I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city Or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the'applicant to a civil penalty of not more than five hundred dollars($500).):
✓❑ s owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec., Business and Professions Code for this reason:
Signature:`-'f i' ; -1Z 'C Cjte iyam_
Ex ir_p_es: rh't�',f
Verification of Ownership by(type.of document.i.e.-property tax bill or deed): L�"—�
Ti
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8.California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons. or 200 cubic feet of
compressed gas at standard temperature and pressure).
3
Does ....____r well tplica
p --- i_
❑yes or Nont or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 10 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is me 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 (II'yes".attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the
above-described !rope day,ecti• purposes.I agree not to occupy or allow occupancy of any building authorized y this permit u0til)i al inspection.
r'/G'_ O J
- ,Lure.• .LegalOwner(s),.- Date -
And/Or Authorized Applicant Date
CODE 1 IKS.EFS 9HIYPE PAIL ItmnAo sonic INSPECTION TYPE PAIS gfRTULE
161 6Fixed System Final Fire Prevention ' 206 Final Mochanical
1286 Pool Spa Final 2088 ciinal.Plumbing
( 6 r1_;\2[61 Final Electrical i t 7 1 SV
200 FinalRe-ROOf 'n h /� 1 ( I Ir '
201 FlnafBIPCWRetalning Well n_
( r �r�-',` f ���} 212 Final Fire Prevention ` -- N
� : � �/ � 220 Fllnal Plannin v - I
202 Final Factory Fire Place C7 g Approval �� 'v
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Bullding/Occupancy
i�'i CITY OF COSTA MESA ;
.f,� BUILDING DIVISION
0.:l' �i DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER
1. 1 ty� • PERMIT B06-01580
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.caBUILDING PERMIT � -A DRIVE,COSTA MESA,CA 92626
9. "
Job Address: 2869 EUROPA DR
' T ' Status: ISSUED
Suite: 1rJ„y; Applied: 09/20/2006
Vicinity: �s,„1. Issued: 09/20/2006
Primary Occ: R-3 Dwellings/Cong Res<10 'prn. of'�:'stru. �' : V-N
Parcel Number 13945512 -,,11r..,1,, J Zoning: R1
•'' q y,
Applicant: O'CONNOR, FOREST R /
Address: 2869 EUROPA DR
Phone: ISSUED BY: /
COSTA MESA,CA _ - Zip: 92626 -
-moi .
Owner: O'CONNOR, ,FOREST R --
Address 2869 EUROPA DR " - -
i - - Phone: _ - -
COSTA MESA,CAN , - .Zip: . 92626 �-N
Contractor:. ;OWNER-BUILDER N /
Address: ' '77 %" -
�
Phone: -
��
/ , I Zip: N //! "51.-" License: 000000 `
;Arch : Eng:
Address� Address: '
Phone: _ Phone: "
/ ' - - /\ 'r ..' .
' �Zip: ' ' r. - „ License: �� . ,License'
-" SCOPE OF PERMIT - - '
DEMOLISH EXISTING S.F.D.DUE TO EXTENSIVE FIRE DAMAGE.APPLICANT WILL CONTACT A.Q.M.D. PRIOR-TO DEMOLITION.EROSION
CONTROL WITH SANDBAGS AND DUST•MUST BE CONTAINED.
, i .FEE SUMMARY
Plan Check:, _ $45.01 „j, , ; ;. I:Pi '� .f ._`, . Calc Valuation: $2,000.00
' Permit: $69.25Claim Valuation: ' $2,000.00
SMIP Res:' ' $0.00 A
SMIP Com: . $0.00 J �,' i,
t`,, . Other:; ` $0.00 - ��� .'�'
' ` Inspection: $0.00 ' " ` '
Total: $114.26
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front ,0-0 Rear'' 0-0 - Left 0-0 Right 0-0 .
ACCESSORY Front- 0-0>,N Rear 0-0 Left 0-0 Right, "0-0
PARKING ' NvExistmq 0N. Required 0 Proposed: 0
v� �� - = /
��N ,,,///^1),-N --1-=.1> _
=A ori
�-2
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
2446-48(WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: r
I hereby affirm under penally of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier end policy number are:
Cartier: Policy Number:
(This section need not be completed ll the permit is valued at one hundred dollars($100)or less.)
-9-1_.:certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of th bor Code,I shall forthwith
comply with these provisions.
App `t.Slgnehme:--• ' d ��, v i_al: ,�4Aff //2 v D ‘
W,ARNI FAILURE TO SECURE WO COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED
THOUSAND DOLJARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: 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 fora permit
subjects the applicant to a cMl penalty of not more than five hundred dollars($500).):
r ❑ as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s)
—licpse pursuant to the Contractors License Laws.). //
` 0 1-am exempt under sec. Business and Professions Code for this reason: afreo /.rt ,.././%
r,sI�gn'aturai y< i)K,,'ri...."7A-sV nataa
r���T�
•caner ID verified by drivers license. 0 Yes 0 No -; livers License No' �� xpires: q�f/U.f//J/
Verification of Ownership by(type of document,I.e.-property tax bill or deed
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _ _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en 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_aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential budding 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"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
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 stale laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pe for pection��gree not to occupy or allow occupancy of any building authorized by this permit until final insspe icn.
afr
'Signature Of Legal Owner(s)-----s......?
r/ 'Date
And/Or Authorized Applicant Date
CODE f CI TYPE PATE MAL$ CODE( VISPECRON TYPE PATE =AU
1616 Fixed System Final Fire Prevention 206 Final Mechanical '
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place . 220 Final Planning Approval
203 Final Sign ��/� 222 Final Site •
204 Final Demolition /—30"-697 �Ceit 250 Final Building/Occupancy
�j0!„,, CITY OF COSTA MESA
U D DIVISION °`
O .
f• :,,;'"� exist?, " e-b': O ENS WACES D ENT PERMIT NUMBER
. Y' IT
k ,,,,,O� "' P06-00776
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2869 EUROPA DR Status: ISSUED
Suite No Applied: 09/20/2006
Issued: 09/20/2006
Vicinity:
•
Parcel Nunmber: 13945512
_, (iX„."/
Applicant: O'CONNOR, FOREST R . ISSUED BY:
Address: 2869 EUROPA DR -
c, %, Phone:
COSTA MESA;CA G ' Zip: 92626 -
,/�', -
Owner: O'CONNOR, FOREST R ' '
Address /2869EUROPA•DR\ . . _ - - _ - . _
\. i. - -Phone: -
7 ' '-'COSTA MESA,CAI_:. ,.-- Zip: 92626
-
Contractor: OWNER-BUILDER .
/ Address: //,- ',1
"� , Phone: - '
.., Zip: ,
7 License: 000000 .
.-
7/. -
SCOPE OF PERMIT
DEMOLISH EXISTING S.F.D.DUE TO EXTENSIVE FIRE DAMAGE.APPLICANT WILL CONTACT
A.Q.M.D.PRIOR TO DEMOLITION.EROSION CONTROL WITH SANDBAGS AND DUST MUST BE
CONTAINED.REF.:B06-01580 N
�' PLUMBING TOINCCUDE:'CAPSEWER.-_� 1,' ,
N FEE SUMMARY
v ' AMT QTYAMT 'QTY AMT QTY
ISSUE FEE $23.50 ' '-" Laundry Tub/Washer - ,$0.00" 0 - Sump Pump $0.00 0
Backflow irrigation • $0.00 0 -'• Landscape irrigation - - $0.00' 0 - Swimming Pool $0.00 0
Backflow Preventer $0.00 0 '' ' P-Trap - $0.00 0 Trap Primer $0.00 0
Bathtub , $0.00 0 ' Pressure Regulator ,$0.00 0 Urinal - $0.00 0
Clarifier System $0.00 0 ' Process Piping(per 10 ft) ' $0.00 0 _Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc), : $0.00 0 Receptors - $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units ' `, $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher ' ,''$0.00 0 Sewer Cap forDerno $9.80 1 Wash Basin Set $0.00 0
Drain,Floor . $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater . $0.00 0 SewehPrivate Line $0.00..•, 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 . Shower $0.00 0 Water Heater/vent ' $0.00 0
Drinking Fountain - $0.00.`f,,0 I' ' Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 ' '0� Sink,commercial' ' $0.00 0 Water Re-pipe - $0.00 0
Gas Earthquake Valve • ($0.00 0'\' ',, Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets), , , $0.00,'.- 0 ,1:.-;,1„ Sink,kitchen $0.00 0 - Water Softener $0.00 0
Gas(Over 4 outlets)",A "$0.00/f'-0- -Sink,seniice/mop ''', $0.00 0-- =OTHER $0.00
Gas Repipe • $0.00 0 .I-, 'Spa(private)' - $0.00' - 0 "VIOLATION $0.00
Gas Service
�� i 0.00 ` > 0, ! - Spa(public) - . $0.00 0 PLAN CHECK / $0.00
Interceptors(Grease,Oil) '40:00-. '0 'i, , % _ ., - `REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00- ''-0 "J'
i TOTAL CALCULATED FEES: $33.30
- i
------COMMENTS I SPECIAL CONDITIONS ' "
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically,expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448-46(WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.) -
C-. I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and a e th If 1 should become subject to the workers'compensation provisions of Section 3700 of the Lab r Code,I shell forthwith
Comply with these provision /
acadt.=g�ner. G�✓Y2.------ Dater_ y///�i�J "
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPtOYERYO CRIMINAL PENALTIES OVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.0 Class 0
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).): •
as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project wit yntractor(s)
' license pursuant to the Contractors license Laws.).
--n-, 1
_lam exempt under sec. - Business and Professions Code for this reason: Z,yLc., / iA A/Al
gn .ZAII -
/ /xpires: ak '
Verification of Ownership by(type of document,i.e.-properly tax bill or deed
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
• 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure),
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes 0N
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
_......_ch c _ n...
5 Does or willo the applicant orpresent a or future building occupant at y efor the work which. me subject ruts application e0armit for such amstructlon or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-resIdential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for'nspecti purposes.I agree not to occupy or allow occupancy of any building authorize by t,:.;permit til 'nal inspection.
7 l �, ���
Slgnature;Of Legal Ov�rmer(s) ari Date
And/Or Authorized Applicant Date
BODE I, INSPECTIONTYPF DATE ?MLA CODE 1. DIRECTION ME atig ICAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing -poo I 'S"?
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
•
MF CITY OF COSTA MESA
44 BUILDING DIVISION
>;�,,,'r,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�. i� PERMIT B06-01771
41/4b4viongro le
DUILDINO r CRMIT
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.Ld.ue 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2869 EUROPA DR Status: ISSUED
Suite: Applied: 10/18/2006
Vicinity: FIRE DAMAGED SFD Issued: 12/15/2006
Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N
Parcel Number: 13945512 Zoning: R1
Applicant: OCONNOR, RAY
Address: 2869 EUROPA DR — /
Phone: 714-414-7805 ��
COSTA MESA,CA - Zip: 92626 ISSUED BY:
/Owner. O'CONNOR,-FORESTR ',
Address 2869 EUROPA DR 1
;':„;: Phone:'
COSTA MESA,CA Zip: 92626
Contractor ',OWNER-BUILDER i`" ^ - 1 (�� d�
Address:— / �� -i 9 ' '''DATE:
/ , Phone:
Zip: �!/ice License: 000000 OLhd A6 C W l d✓'•
600(011-
!Arch :' MARCUS:KEMMERER Eng: ALI REZAEI ,
Address: KEMMERERDESIGN ARCHITURE Address: 2082 S.EAST BRISTOL
' - HUNTINGTON BEACH,CA Phone: 714-655-3139 - " : SUITE 206 Phone: 949-975-1328
228 CREST AV • - - -
Zip:_ ,92648`_x-- ,, _Licenser'C29552 _92660 License: C41068
„- a SCOPE OF PERMIT -
•RE-CONSTRUCT FIRE DAMAGED PORTIONS OF EXISTING 2-STORY SFD.TOTAL REMODEL REQUIRED DUE TO THE EXTENT OF THE FIRE DAI
• 1ST FLOOR INCLUDING GARAGE-2,695 SF
2ND FLOOR INCLUDING DECK-2,079 SF , / -
FEE SUMMARY -
' Plan Check: $1,475.86 - '\. Calc Valuation: $327,279.70
' Permit $2,270.55 _, t - ,.) 'Claim Valuation: $250,000.00
SMIP_Res: , , $32.73 - - - ' ..
SMIP Corn: . $0.00 y
Other: $0.00 ,
Inspection.. yv $0.00 -_
, Total: $3,779.14
SETBACKSN : . -
MAIN STRUCTURE Front 0-0 ";---_-.S\-•;,,, Rear 0 0_ Leff' 0-0 Right 0-0 '
/ „ i� VAC . -'
ACCESSORY. ;Front,/ 0-0' -Rears-.-_0-,,0� Left B-,0- Right 0-0.0 " / "
PARKING Existing: -'0 , 1/Required: 0 - Proposed: c"... -/
'
y ti: VI,
R k
V ;:
w4,
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(WOO)
DECLARATIONS .
WORKERS'COMPENSATION DECLARATION: .
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed If the permit is valued at one hundred dollars($100)or less.)
.)4lI certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree I if I should become subject to the workers'compensation provisions of Section 3700 of the Labor e,I shall forthwith
comply with these provisions. /�'7 dJ -‘1.1.-0 /C/gtl
Applicant Signature: T � / ,�•^ n^ \ Date: / ` L
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(5106,000),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 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Uc.N Class N
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
gia 1I,as owner of the properly,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 properly who builds or Improves thereon,and who contracts for such project will)a contractor(s)
license pursuant to the Contractors License Laws.). 2 —IS
/.� /
�II em exempt under sec. Business and Pr.fes 'on Code •r t
�
//./ Expires: .8'—,2-01
Verification of Ownership by(type of document,i.e.-properly tax bill or deed): - -- - /
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the 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).
sen._ future building
need
_ — _ _ als? ..._...._...._._._. _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No � '
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Doesenor will the applicant or present or future building occupant need ma
to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
s)?
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 It 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 akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes IJ 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 e conconstructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property tpspectio0 purposes.I agree not t�occupy or allow occupancy of any building authorized by this permit until final i0spgction.
7.
Signature f3f'Legal Owner(s) - ' Date_ 7 7
And/Or Authorized Applicant Date
PADS t INSPECTN)N TYPE gAg MALI COOSIt INSPECTION TYPE OlAT RIMS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing _
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
{r. 203 Final Sign 222 Final Site y02-i8S(AIS) .a.........r ..,.J3',o.:1 n...
204® Final,Demoliiion `_,.., r„ „w•ca„•250 t.Final Building/Occupency�,��,
.....
....
0 ' rr CITY OF'COSTA MESA
BUILDING DIVISION
;�. 'u PERMIT NUMBER
t 1 ��- t DEVELOPMENT SERVICES DEPARTMENT
PERMIT
B06-00340
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.gCNLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2869 EUROPA DR Status: ISSUED
Suite: Applied: 02/28/2006
Vicinity: THROUGH OUT HOUSE Issued: 02/28/2006
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 13945512 Zoning: R1
•
Applicant: DEAL, DUKE
Address: 2750 SIGNAL PARKWAY 0.1°Phone: 562-528-8000 ISSUED BY: �/
SIGNAL HILL,CA — .; �- - --Zip: - 90755_
Owner: O'CONNOR,"FOREST R
Address 2869 EUROPA DR -
Phone: _
COSTA MESA,CA Zip: 92626'
1Contractor: iHAR-BRO"ING -j
Address Y 2750 SIGNAL PARKWAY
Phone: 562-528-6000 N . 4._
' . SIGNAL HILL,CA rip 40'
/yip: 9075512207 License: 258441 '(
Arch' - Eng:
, Address: - Address:
.; - Phone:- • ��- Phone:
Zip: _• / /License:-'� _ _ _. - License:
•
SCOPE OF PERMIT
NON STRUCTURAL DEMO OF FIRE DAMAGED MATERIALS FOR SFD. - 7
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
' FEE SUMMARY • - '
Plan Check: $0.00 Calc Valuation: $2,500.00
Permit: ' $83.25 Claim Valuation: ; $2,500.00
i
SMTP Res; ; $0.50
SMIP Corn: $0.00 —
Other: $0.00
Inspection: $0.00
Total: $83.75
7.
".� PLANNING &ZONING
SETBACKS . -
MAIN'STRUCTURE Front 70=0 Rear 0-0 Left- 0-0 • Right 0-0
ACCESSORY'S /Front 0-0 - - ,Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: , 0 Required: '0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes 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
2448-4e(WOO)
DECLARATIONS ' r H ..
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: .
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work.for.which this permit is Issued.
I.have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which Nis permit is issued.
1 Myw ers'compensation� ✓Insurance carrier anndd,p�olliicyyfumber are: /�
Carrier/50 nor/ wu- P ' Number:—�% �1
-(Riffs section need not 1N! T"' gds /D�f1
repleted of the permit valu at one ndred dollars(5100)or less.)
❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of ' •mia,a a that cold become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply With pro )
Appli Slgnatur Dat
e:f Com" z —
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOILARE($100.000).IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I em licensed nd r r visions of Chapter a(commencing with Section 7000)of Division 3 of the Busine and Professions Code,and my license is In full
force.and.effecL.Lic.0 ‘Ciass'a / -
c«aractorsSignatuure:— 4.4 Pd� oaie:C.-
TO-OG
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:�•o-�'!
I hereby affirm that under penalty of perjurythat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city.occounty which requiresla•permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
f•
❑ I.aS owliec of•{ha roperty,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
-JO�yBosinealane rOldWions'Cgde:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herselLp ji idugh,11.5 or her own(employees.provided that such improvements are not Intended or offered for sale,If,however,the building or improvement is
sold within ode ye?rbf completio ,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify tnat 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feel high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Celifomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which hes at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑NO
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Celifomia Health and Safety Code been fully complied with? ❑Yes ❑No
...._ ._.._.. �._.__ 'for
—.____
5 Does or will theapplicant or present or future building occupant require for the work which is the subject of this application upend for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If yes'.the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I sanity under penalty of perjury that I have read this application and state that the intonation given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
7 Sig a Of al Owner(s)
AndSOrAuttiorized Applicant. -
coos i INSPECTION TYPE PAU RIIOSIS OW it INSPECTION TYPE' QLIE EiTIIMI&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
•
204 Final Demolition 250 Final Building/Occupancy
coli a CITY-I&COSTA MESA
• . ► BUILDING DIVISION
:14:1;t"1,,, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMB R
F t Pia t PERMIT
os tintumnsu do , : • 06-00162
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 9262\
ELECTRICAL PERMIT \
Job Address: 2869 EUROPA DR Status: ISSUED '
Suite No Applied: 02/28/2006
Vicinity: Issued: 02/28/2006
Parcel Nunmber: 13945512
Applicant:ddressDEAL, DUKE V/�
Address: 2750 SIGNAL PARKWAY ISSUED BY: (//V��)
Phone: 562-528-8000
SIGNAL HILL,CA Zip 90755
Owner: O'CONNOR,'FOREST R
Address 2869 EUROPA DR
Phone:
.COSTA MESA ,CA ,; `- Zip: 92626
Contractor: HAR-BRO INC
Address: 2750 SIGNAL PARKWAY - ,
' /� " Phone: 562-528-8000
SIGNAL HILL,CA Zip: 90755-2207
License:258441 '
SCOPE OF PERMIT -
TEMP POWER POLE FOR NON STRUCTURAL DEMO OF FIRE DAMAGED MATERIALS FOR SFD.
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
REF#:B06-00340
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 _ - Busway./100 ft $0.00 0 ,
_
Res.a/c package $0.00 - -Standing Section $0.00 0 . .
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0.
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 ' 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl . $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a '$0.00 ' - '-0 Misc.Conductor $0.00 0 •
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 . 0 ,
Motors to 1hp , , , < $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 . '; 0 Christmas Tree Stand .$0.00 0
Motors to 50hp $0.00' 0- Fireworks Stand $0.00 0
Motors to 100hp \ -$0.00. 0 . Other Electrical Fee $0.00
Motors over 100hp $0.00.. 0 -
Communication drops -•'$0.00 ' - 0 Investigation Fee $0.00
Sub panel to 200a $0.00. 0 Plan Check Fee "$0.00
Pole Light Pkg $0.00 - 0 ' • Reinspection Fee $0.00
Sign Circuits $0.00 . - 0
Temp Pwr Pole $23.50 1 TOTAL CALCULATED FEES $47.00
Intermed Pole $0.00 0
nnuu our. a once,.Al newt-um-wt.
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(6Aa)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have.and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
- V)ork for,which this permit is issued.
IXI�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.
V My w5a?;
Gd�eerrss'corn salon tnsurance-ca�rrierr and policy number are:
Carder .J.��' 'pzKdJOl r/ �1c�f�r/fKIT� �+'1' PolicyNuniber fl /cO�g
(71r15 section need not be compler tithe permit Is valued et one hum ars()y{00)or less.) t�
r
❑ I certify that in the performan of the work t which his permit Ls issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation of Calif ' ,an gra hat if I ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall forthwith
comply with these provisio
Applicant'lgnature- Date:' 7..." e..-/c-C962
WMWINGrFAILURE TO SECUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(SI 000 ).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 hereb affirm that I am II ensed under ro • 'o s of hapter 9(commencing with Section 7000)of Division 3 ot-the.Busin a • Professions Code,and my license Is in full
force and a attic.p _ • `Class#1_
C StraUbrs Signatua: Data.�c-s�-'�O-OG
or
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097.Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 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 t0 the provisions of the Contractors License Law(Chapter 9(commenting 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 toe 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.). •
❑ I,as owner of the property.am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors license Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors license Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ,.
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the 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 0 for acutely hazardous materials? Yes 0 No
(Section 25533 onf the CalifornianHealthaacutely dafe Code, mth some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
quantity equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Celitomia Health and Safety Code been fully complied with? ❑Yes ❑No
- .._ _.._...__i.__ _.._j._..__.. ___._ .__... ._.
5 Does or will the oast Air or QualityiMa a emen busting ocfrom at any other for the work ntrol the district or this a ptiestbn apertnit for such construction or modification
—
from the South Coast Air Management District or from other air pollution control or agency? �Yes LJ No
(Section 65050.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
B (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Ali Ai Y
/• rwner(s) Date
'ff_ ` 230
� rAn•rOr AuthorizedApplicant"-"'-'-`- _ t atdTh
CODE t INSPECTION TYPE - ' DPI€ INIRII LS CODE( INSPECTION TYPE PATE MALI
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing //It O ,
200 Final Re-Roof 210 Final Electrical d[/(
201 Final BlockrRetaining Wall 212 Final Fire Prevention S
202 Final Factory Fire Place _. 220 Final Planning Approval —
203 Final Sign 222 Final Site
•
204 Final Demolition 250 Final Building/Occupancy
. ADDRESS OFMALCOM: 2869 EUROPA DR OMT: C'L.TY OF COSTA MESA — BUILDING PERMIT .
frh#xaNAME DAT4owrb0'CONNOR, FOREST R FLOOD: AE-46 _. . . . PERM NO: B 081947
cma%O' CONNOR, PATRICIA S
• 2869 EUROPA DR PERMIT NO: B 081947 PLAN CHECK NO: 00951-97 A GOVT: N SUPP: N
"OSTA MESA,CA 92626
APPL.NAILING ADDRESS CONSTRUCTION TYPE: V—N PERMIT. TYPE: STR PURPOSE: ADD
•
ARCHITECT OR ENGINEER: uc NO. JOB DESCRIPTION : ADD 217 TO FRONT OF HOUSE SQ FT: 617
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: 10, 000 . 00 CALC—VALUE: 13, 137 . 90 GROUP OCC: R-3 /
CONTUM1iGa NMN. COMMENTS: ADD 217SF TO FRONT OF HOUSE
CONTRACTORS ****dEkkiE*iEiEdE161Eit*iEkgEiEiEiElf/EdEtEdtt ****kiElEki6IE*1EiEkiEiE****+E16aliEiEiEIEkiEIEM***IEkifitl6iEkdE16iE1E1EiEi ***
.OoaEs4 uc ND: OM, ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby Slim under penaly of psjtay ea weaken am Toned ander eaken d Chapter 9 SETBACKS
(commencing with Section 7000)d Dirvim 3 d the Busiest and Professions Code,5d my boons is in h0 force and owl.
CRY UC.NO.: UC.CLASS: UC,NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalY d perjury that I em ernpt from the C«a«dan License law be the
folioed-4J reasn(Secton 70315 Buskers and Professions code:Am cey«county Meth requital a Pane 10 maoudt dr.kprove. PARKING REQ: PROV: PARCEL: 13945512 ZNE: R1 REF NO:
demSaih.«repaaysWdix.'ld«dbewnwe.ehorpUDaa the epplimml«rrhpfl to Ma a signed"am"lhel M«she PLANNING NOTES>. ROOM. ADDITION TO AN EXISTING SFD. (MAX. 217 SQ. FT. ) -
e licensed Nathan to the provisions d the Contractors License Law(Chapter 9(commencing wish Sedan 7000)d Division 3 d the ',�
Business and Professions Code)or gheo and a exempt Ihcdom and the beml«the alleged exemption.Anyvoldon of Sewn •> LOCATED. .20 FT. FROM FRONT/ 5 FT. FROM SIDE,
7031.5 by any impotent for a permit rbjeds the awplicanl to a civil penalty d lid mon than fan hundred dollen 155OOp. **************4 iE 1E dE***if it N.4 Mika.iE dE iE*iE MS,M ie k iE if k Mal it dE dE dE*N.dE iE de iE 4E*SEM iE M********************
❑ I.cows el the property«my rnchl ee with wagesestheiade compensation.ova do the work and the is not Wended D E V E'L O P M., E;.N T SERVICES R E Q U I R E M E -N,sT; S
or offered o sale(Seam 7)44.Biomass end Prtled«e Coda:The ContractorsLicense Law doe lid apply to a owner d property •
who bids or improves thereon.and who does such work tensed or honed or through he Or hat own nWlokees.provided that such • tea / A•�
rnPwenwte re to orndad«awedI«eate.n.rowers.the bddbngOfintra.meteeedd wbwr me Yew 000kdnn.d» ZONING APPROVE.`D' BY - -:'•+ I. 'C/.. kGP DATE: 3•x'(0'
owneotSer wl have the bonito d proving ha or she did lid bcAM Ce opov Me The Mame d ads). 2 / Q
X❑ Ino the«wedy,emetth N wmredii9"°hWrnednroe«ors to wan the project(Sedbn 7044•Buses and BUILD ING APPROVED BY' : 5 ('7�-, DATE: —(o— /7
Professions Code:The Contractors License Law does rhe apply M n ower d property who bit C.enprovea threat and van - ...
contrails o such projects with a merrf«(s)licensed pursuant to the Gamna«.Limes Law).
❑ temexemplwdel • B.°suer:s APPLICATION ISSUED BY: ". / -- - DATE: J" —97
7� ,y s�; /z *****CATION1t ISSUED ****#iFiEiEiEiFiEMiEiEiEiEiEtEkiElfiEiEiE1 *** * ##**4*kM%#iklEiElkiE#*** kiEiElF***
X Dtle: cQSSjy !5ev/mOwwer: (� �/h/'��� LEGALIZATION: N F E E SUMMARY •
STRUCTURAL-'SEGMENT:Y
((„ I do hereby Mina Nim aware cit and rdrstand the nnryonm and Sally Cods-Sections 25505,25533.and
25534,and Putt l« owe bnidig°anoint wit/wit not kimb one)need wish said state coded and the requirements o BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for o unncdan or mod-Aeolian horn the Ar w3�G�wgrnm Dimro. el onmauuon appamiom we exempt horn dosewo+dna. PERMIT 212 . 25 11 . 31
Date: Applicant: PLAN 34 . 49 ', n SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury ane of the lobowsg deddstloa: ISSUE FEE
❑ Ihaseendedmabdak,a medicos canoe N4mror�compensation, «Iay
as 7OOcIheLabbs BUILDING—DIV—> PERMIT ISSUE PLAN= CHECK TOTAL PAID DUE
Cods,forperformance d
the work kl :dh mis pawin
permit i. d. TOTALS----> 213 . 56 0 . 00 .-.';34 . 49 248 . 05 248 . 05 . 00
❑ Maya and ml mantas write.'cconpeetlon insurance,as necked by Aedkrn 3700 d the Labor Coda,o the pM s.e d«mthe
w«kt« hklh me
with e issued.
wfare'odnpnminsuranceiinsurancems and porky 9ny rmnwe:Canis
REVENUE DIVISION TOTALS--> COLLECTED: 213. 56 OVER/SHORT: . 00
pdxy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC:" FIRE SHIP/TOT GRADING PLAN—CHECK
NOsection needs be completed tithe pane is for one hundred doaan/Srm«llass.) 212 . 25 - 'X. 't• 1 . 31
NO I certify that in the performance of the work for which this permit is eyed,I shall rn not new cry prs anyrs n as
subject to
mato v i
becomesubjectth
to e compensationrs'compensationlaws d da.CaW« Nr e eawe I shoed bsoled to IM workers' iE1ElE/E1E1E1EiE*1EiE1E1E lE4**iEiE1E*iEiE iE**tE1EM1E iE1E1E*/E**if.df#1E1EiEiEiElE*iEiEi6*If1E161ElE*1E**1E*iE6EiE*iE1EIEiE 4e ie iE*#****1E
m 'sed oftheLaborCode.l Cdnpywmm I N D I V I DUAL '•`f- FE ,E BREAKDOWN,
Warning: unto works'aompenudon coverage is unlawful. Iaddict nemployer m«Imralpenal9a and TYPE QTY DESCRIPTION. UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(IfOGOOOA In sadden to cost of corrtprwtlot,damage as provided for In
Section 3706o1the Labor Code,interest.end auomrysInd SFR 217 DWE—TYPE V—WOOD FRAME';' —AVER 58 . 70 12, 737 . 90
CONSTRUCTION LENDING AGENCY:I hereby infirm under panty d perjury Ihm there is a construction landing agency for the SFR 400 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 400 . 00
performance d the work for which the permit is issued(Section 3097,cur.C). END';.OF FEES
LENDER'S NAME: r
LENDER'S ADDRESS:
I candy that I have read this app&ratnn and mas thtl the above Information a cared.)pre to comply with d ray end county ordinanme4 '
and state laws relating leading idig constructionli
ion d hereby authorize representativesthis city et this to enter upon the above-mentioned Proper, I•'- )
for inspection PsPoeesRAY O' CONNOR
///qqm �\f ////))) 12 03-86-1997/83:29RCPiq:01'0 03081
/� (/ // Dtle:� • r f
ipmwn d OwcedAgewAppkmnvcontrad« ', / PERMIT -081941
if
(5151'4.WP) White-Butdig A Safely;Green-Fie:Canary-AppicN:Pink-Revenue:Goldenrod-Assessor
7
.
�
/ CONSTRUCTION AND PLANNING •' PO.._ & SPA
a - Date Inspector ' Date Inspector
APPROVALS Permit# APPROVALS Permit #
' 1. Vemporary Electrical Service or Pole ' • 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
- - -
- 3.'Electrical Conduit Utility-Undrgrnd. 54. Forms a
4
- .:E�ctrical Conduit-Undrgrnd. 55. Electrical Bonding _
• F. '7-z
_. Steel Reinforcement .-77 6e✓Q 56. Rough Plumbing & Pressure Test
TS._Ele4.ctrical UFER Grnd. c 57. APPROVAL TO COVER-GUNITE c,
•
7.-Footings t(i Q'7 aid& 58. Electrical Conduit-Undrgrnd. ' -,
8:"Foundation Z
q i- ep 4/{l. 59. Gas Pipe, 0 Undrgrnd., Test
- 9. Water Pipe-Undrgrnd. _GL 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 :*1 • 65. Electrical-Final
15. Rough Electrical-Conduit r " 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 - �,A _ FJRECDEPTLTREQUIREME�VT „...e
20., Rough Factory Fireplace rr s., . ,•, x 2 APPROV-4'eS:c- Permit # -- -•
T
21.-Ducts, in_Structure* S - 'El 70:_Underground eiydro r
22. Ducts, Ventilating y - 4 •• . Produceriping'OrGas ❑Oil
-
23. Gas Pipe-Rough Si Test - ? E. s T . 72. Underground Flush" x _ _
aming r-' ._ .. 11: - s T 4 -
24.-Roof Fr
�• _ ,• cc; ,.,, .. . Undergrnd.Stgrice„Tant0Gas GOif
25. Roof Sheathing 1, �' r)-. 7-4.-Overhead Hydro-
26.-T-Bar Ceiling (Structural) &ivlinocoat •> a f5. Dry,"Chemical t - -
27. Frame and Flashing - /-77 %, . u 76. Dry Sta' 'dpipd-
28. Lathing& Siding-a. c' _ C(*ye7=c? I tG"/jp�j -� j5. FIXED_Sa'STENCFINAL
1.
29. Insulation 111 /"�'�67//�� _
- 'c=, 7; 6 ' '�8. FIRE PREY. FINAL i
30. DrywallJIailtng =,. ,., GTE-P----97 G r _ it HEALjki DEFTT-'REQUIREMENT
31. Plaster Brosvn.CoSt* = ?^T 6-" j --97 -'- 79. FINAL'INSPECTION '- _
32. Electrical.Power Me",ter=Final - .: ` A rr 81i. FOOD CERTIFICATE [.SSUEO �.
- �L,. u 4 ... :a
33.rFinatElectric• K '-da' '' Notes: 7017 ' r 7: 'Z
c C *"
:
34.:Finel Heating:& Airfccuir'tlitionfn �g= T f. ' '`
35.-Final Gas:Pipe-Testa ., +. _ p /]�z� _ -.-
.- /�/7_/y�
36. Hood or-Canopy = _ ' �"'; :: r ,�. r -`- l-G "G"r6 c. B�-r 74- `/'K/_'
37. :Final Factory Fireplace,, - r __
;, 38..Finit.Plumbing `^'' ` _
39.-Water Service-Final- - •-.>. .-•
a
•
40. Gas Service-Final ' '*- - - " T - tt
41. Solar Domestic-Final .. . - T `-" _ s
42. Backflow Preventer * - - -. ;-
. ---i - . . _ - _
43. Backflow Irrigation --- - - c - .
44. Landscape Irrigation SysterrP7C r - • '^ ^ - = 1: t ' ra = -
45.Sound Attenuationt m -, - _
.-. _ '. - -. . _ K
46. Handicap Regulations - -'fes;' - ,
.47.-FINfSL STREbCTURE & BUILDING I - _
t- r
48.J=INAL PLANNING -- �t - -
49.=Electric Release to Edison s,.. -..z. . :- '
}
-
50.:Gas Release to Southern California Gas Co 1' - _ ' .
51. CERTIFICATE OF-OCCUPANCY -
No Date
•
ADDRESS OF SOLOING 2869 EUROPA DR Dom: CITY OF COSTA MESA - BUILDING PERMIT
ONNENB NAME IFlCM1:O' CONNOR, FOREST R FLOOD : AE-46 . PERM NO: M 081949
ADDREss:O' CONNOR, PATRICIA S
2869 EUROPA DR PERMIT NO: M 081949 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626 I9 - b
APPL.SWUNG MOM, CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: ADD
ARGIIfECT ORIBWIEEk UC.NO: JOB DESCRIPTION : ADD 217 TO FRONT OF HOUSE SQ FT:
ARCK OR Dal ADDRESS: UMT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
CONTRACTORS NAME
CONTRACTORS HAULM COMMENTS : ADD 217SF TO FRONT OF HOUSE / REF B-81947
ADDRESS: 11C 1C *******************************************************************************
gMT, ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Slim under penalty of m tensed perjury that I am w der provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 d the Businen and Professions Code,and my Dense is in tip tom end effect
CRY LTC.NO.: UC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dans: Conlreaoc LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that!me exempt from the commian Lowe Law to the
bikeway reason(Section 7031.5 Buskins and Professions Code:Any city or many wend,requires a permit to construct aper.Improve. PARKING REQ• P RO V: PARCEL: 13945512 Z N E: REF NO:
• iemolun•or repel any structure.prize toes issuance,also rewiresthe applicant for such parol to fie a signed statement that he or she PLANNING NOTES>
a licensed pursuant to the monitions of the Contractors License Law(Chapter 9(commencing with Sed911 7000)of Derision 3 of the
Business end Professions Code(or that he or she is exempt therefrom and the basis for the aged exemption.Any violation of Sedan err, >
7031.5 by any applicant toe a permit subjects the applicant to a cid penalty of not mote than Des hundred dollars 1f503D. *******************************************************************************
❑ I.aaowner ante PlOPenyormyernptmeeswmwa9ee ere their sole compensation.will do the wadi.end the structure is not intended D E 'V E L O P M E N T S E R .V ICES REQUIREMENTS
or offered for sale(Section 7044,BusinessContractorsanot end ProfessionCode:TTe Lbee Law doe,nappy mesa),to an burner of mesa), -
who brads or inpeowon.e thereand who does such work lensed or herself o herself though his or her own employees.provided that such
m
impeoveern d
are rot intended or awed for sale.P.Winner.the building or inpmveenerds sold within ane year ammpetan.0e ZONING APPROVED BY DATE:
xoower dulder wilt have the hoiden d proving he or she did not build or improve to the purpose of sae). -
I.aowcerd the prmeny.amexduaimmnvma9 with liceaed coaacsse tan theproed(Swan 7°44.Bun."end BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Lew done net apply to an on of popery who builds or improves thereon and who
contracts w truth projects with a mnreaot(s)teased pursuant to the Contractors License . y -/ -97��
❑ Ianexempt uderSeaon: ( �J B.a P.C.,for thenason 74.4' APPLICATION ISSUED BY: DATE: 3 (0 /
�7 / � ****iE******sidtdt3EiE5EitiEitfifil6itdt� ****+f****iFiFiF+fiESFiFdFkEdE* SEtF****iEiE****iEiiiEtAkEdt****tEtF***
Oats: fes/ Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby that I a aware d and understand the reglirements d CaUmnia Heath and Slay Code Sections 25505.25533.end
asv..and Mid laany haunt Leading ooam.relwill yveil qpint one)needmcomply wn said aa.codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
•permit for construction or maddralan from the AsDuality Management Draw.Residential mutoo
nn appicaan we exempt from w
n Oe
previews. PERMIT 18 . 75
Date: 25% SMIP/NON-RES
PLAN
WORKERS COMPENSATION DECLARATION:I hereby elfin under penalty of perjury ass of the following declarable: ISSUE FEE 22 . 00
o Ihave and almaintain acart/cafe dcanasta tose5+nsurehvwodm mmpwaao,eaprovidedfow
bysan3703of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Cods. mthe°°d°mm°"edmesock yawhich aimed' TOTALS----> 18 . 75 22 . 00 0 .00 40 . 75 40 , 75 . 00
❑ I have and wit meerar workers'compensation insurance,a required by Section 3700 of the Labor Code,w the performance of the
work for which this pane is issued.My workers'oompenWon'ubsnnce canis and po&y number we:
Canty: REVENUE DIVISION TOTALS--> COLLECTED: 40 . 75 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed l the peon)is fur One hundred dollars MOO)or Amy 40 . 75 ..
Xgj I oeniy that in the performance of the work for with this permit Is issued,I ehei not employ any pan.it any maw ee a to
Laconia subject to the workers'compensation taws o Cations. and agree that i I sherds become subject to the workers' *******************************************************************************
compensation provisions a !ate/o.370�//p the else Code.l'nau tense m/o./°/p/mos / INDIVIDUAL F E E BR EAK D O'I W N
SIDate: ✓ /( ! / APplkenl: / .4 �er .44// `,
Warning: wemsac workaa'conpawd"canng.leunlewyu(and shall subject an.n oyer tocdmnel penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil sena up to one hundred thousand dollen($200.°°°),h'addition to the cost of conpw..tbn,*Magasa pr
ovided for In
Section 37°softhe Labor Code lnfac
a. and.hom.ys ».. MEC 1 INST/RELOC RECESSED WALL HEATER 13 . 25 13 . 25
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjn).that then is e construction ending agency for the MEC 1 GAS PIPING SYS 1 - 4 OUTLETS 5 . 50 5 . 50
performance d the work for which this perms is Issued(Sedan 3097,CW.C). END OF FEES
LENDER'S NAME
LENDER'S ADDRESS:
I certify that I have reed this application end date that the above information is cava.I agree to came/with MI ray and Count/Ordinances
and stale laws relating to budding construction and hereby authorize repmenatives of this city to enter upon the eboe'nentoned pnopeny
f° inspection 0°D°"RAY O' CONNOR
03-86-1997/83:38 PM/f40.75
iielir . 0 RT:0 8 0949
�( / _ v /1 Date, _44_.7, PERMIT:081949
(1 a owmertroaho-.. ..ern
(5151J5.WP) White-Bairn&Seely.Genn-RI,:Ceary-Appian:Pink-Parente:Goldenrod-Assessor
CONSTRUCTION AND PLANNING P00 SPA
APPROVALS Permit #
Dale Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility•Undrgrnd. ' 54. Forms
4.tElictrical 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-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 m 65, Electrical-Final '
1:15. Rough Electrical-Conduit -, , 66. Solar System-Final • •
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
s
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .
19. Rough Heating& Air Conditioning �•_I/t �1 _(2.3m _ FJREUDEPT.REOUIREMEN_T - _
r.
20.-Rough Factory Fireplace 'r.. ,_`c'• u a- I� ;_•1•JIT' APPjiOVACS-,', Permit # t ~ �'
21.•-Ducts,in-Strrictu�e' '^� - ' _c _ 70,�ndecgtound Hydro r•
ts, Ventiratin9. r,
G , t
22.-Du a - v x tr 71. ProducCPiping O�Gas O Oil
23. Gas•Pipe-Roogh& Fzst 7:S 5;� A O;i ,S• tit 72, Underground Pith -•
24.'Roof Framing -'' -- '•:;; }. - :F. -7 ,_�: ';'. 7.-8, Undergrnd.StotapeTana OGas OOil
25. Roof'Sheathing - G . - * - -• 11" [4. Overhead Hydrpt., .
26._T-Bay Ceiling (Strtic)ural) & Monpcoat * _ _ e r-y 75. Dry Chemical r_,� - .;'t
-.z - "•
27..Frame and Flashing ^G r T ' 76. Dry Standpipe^r * _
28. Lafifing& Siding- }; ' _ - a = .. 71. PIXEL YSTE{W'FINA'L_ =,j-
29. Insulation 7 • 38. FIRE PREV. FItTAL ` ' C
30. Drywall,Bailing ^•n 6_, * �. i �7HEALTkI DEPT-RE75UI�1F,MENT
.,
31. Plaster Blown Coata, ca. - - .t I a - 79. FINALUNSPECTION - -
32. wM
._Electrical Poer e4eY-Einai IS `'� I Y r aFOOD CERTIFICATE jSSUEQ r,'-
33.-Final Electric * - �* G >x ^ r, Notes: - �.r? f-Z
/
34.. Final Heating_& Air Cgritlitianmg= ,C 407 : M1 s1 l L i'••• .... `: -
35:Final Ga]:Pipe-Testa Tll4.
36. Hood or Canopy Z - ' '-e - * ; _ _ s _ _ r -- _
37.:Final.Factory Fireplace:: .--, -
. < - ` - _ r_
r r
Finp:Plumbing „_c- ` a "-' -2 :- - _
38.
39. Water Service-Final, r - - - ,, "
- 40. Gas Service-Final - ^' ' r ' s _ -
41. Solar Domestic-Final " - : ' :: - - ` .
42. Backflow Preventer' * r = L = C -
.- _ s .--i I. + _ a - --
43. Backflow Irrigation .- -" a c• �•
44. Landscape lirigation System tT. r cr 7 7 C" - _ -
-45.Sound Attenuation - r - _ _ -• '{
46. Handicap Regulations T r T.
i
_47.-FINAL STRUCTURE& BUILDING .,. �- ' ' • -
48.7.FINAL PLANNING" * • ' ^- s
•
49. Electric Release to edison , ..
, - J
50.:Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - -
No. Date
ADDRESS Of MALONO: 2869 EUROPA DR am l" CITY OF COSTA MESA - BUILDING PERMIT
aMNERINAMEIFIQC**Q'CONNOR, FOREST R FLOOD: AE-46 PERM NO: E 081948
A O' CONNOR, PATRICIA S
2869 EUROPA DR PERMIT' NO: E 081948 PLAN CHECK NO: N GOVT: N SUPP: N
' .COSTA MESA,CA 92626
APPL.MOM ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: ADD
ARCHITECT ORNIDOIEER: UC.NO.: JOB DESCRIPTION : ADD 217 TO FRONT OF HOUSE SQ FT:
ARCH.OR ENDS ADORERS: WIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC : R-3 /
CONTRACTOR'S MATS:
CONTRACTORS RAORIO COMMENTS: ADD 217SF TO FRONT OF HOUSE / REF B-81947
ADORES& LIG NO. ****************************************************************46**************
urn: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby elm under penally d penury that lain Bronso under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)d Dhekn 3 d the Business end Professions Code,and my I Mee e in hon forts and effort.
CITY UC.NO.: lIC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby deem under Sealy d perjury that I am ant from the CaYrtlm Lfoense Lew for we
70313'cawing PARKING REQ: P ROV: PARCEL: 13945512 Z N E: REF NO:
demolish.or repel any sweetie,prior to is issuance.also requires the epfd for such period to Ne a signed statement that he o she
S licensed pursuer.'lo the provisions d the Connectors License taw IChepte 9(ammenhap with Section TM)ol Division 3 of the PLANNING N TES>
Business and Professions Code)or that he or she S exempt Iherehm end the basis for the alleged esenpkn.My notation d Section >
7031.5 by any eWBmu for•penny subjects the apparent to a dui penally of m more ton,five hundred Miss tS500D.' *******************************************************************************
❑ Lesowne,0ItimM el7a imp=Plow &with wages aatheir este mmpeadph,all do the and the etrWlve a not Bladed DEVELOPMENT S E+.''R V IC ES REQUIR E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Connecta*License Law does m apply MenMaar el property
who Wide or inproves thereon,and win does such work tinsel or herself or through he Of her own employees.provided that such l
***merits are ned aolbredwI.'row
fae. «er.Ne bavprove
inga innea aesdwehnnneYew dcompldrn.to ZONING APPROVED BY j.' DATE:
ownerhutl•r sill have the burden d proving he or she did no build or improve for the purpose d sale). l I
-] 1,as°wePi the°ropery.emo 'rely nonndn°wimhce combeot°rs lo� atnn te*rgaICSection 7.34.i.....—•Bu°b°°eend BUILD ING APPROVED BY : r= DATE:
Professions Code:The Comedos License taw does not rawly to an owner d property who builds or improves t..........-.win
contracts for such projects with•mmr°dor(s)licensed pursuant to the Contractors License Law). .r -7
❑ ism JI Pl molar/ 8.a P.C..for this l i; APPLICATION ISSUED BY: "3 DATE: ," ( -9
Dale: 5 G 57 Owes: , / uyyb ___—. *****************4E***********4E#**4 4E4E**********4E4** iF iEiEiFiE4f4E4EiE4E4Ei *** 4E4E4f*** 4f4E
/S/ee/wsry�/���. LEGALIZATION:N F E "E . / SUMMARY STRUCTURAL SEGMENT:N
Ido hereby IthO em aware d and understand the requirements d Cesium Map Safely Code Sediom 25505.25593.and / i
25534,and IMI I o any future Wilding occupant will/wit nd(axleone)need to oompppYYY with said slate codes and the requirements for
a permit for consultation modiamien from the A.Quuay lranagenent District.Residential construction amlcationsare exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provefon• PERMIT 59 . 50
Dona Apgeev: 502 SMIP/NON-RES
WORKS SR' COMPENSATION DECLARATION:I hereby affirm under penalty of perjuryoned the
efollowing declarations: ISSN
IUILE FEE 22 . 00
o lode.and eerfimnc of the wdomeeito h this
permit
issued. mpenaatnn.nProrkad for by Section 9Trwdtne Labe BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
chey,ane,fix the prfamrn.dOhe work la which w.p.mdi.iqu ed. TOTALS----> 59 , 50 22 .00 . 0 . 00 81 .50 81 . 50 . 00
❑ I have and w'maintain workers'compensation 'compinsurance,as required by Sedan 3700 d the Labor Code,for the performance of the
work for which the pyre is issued.My woken'eemponWion'srnance center and OSSA number are: - •
Carrier: REVENUE DIVISION TOTALS--> COLLECTED : 81 . 50 OVER/SHORT: . 00
Policy Norther BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
�lI
(This section mad OW be comwaed I the semia tor Rpm o
r one hunched Ins.) 81 . 50
NE I may that in the performance of the work for which this panty'e issued.I shall not employ ea Poison n any manner m es to
become subject to the workers'=sponsdion laws ofCddornb. and tat Sl should exams steed to the workers' **************4E4E******4E*********4E**********4E**********4E*********4E**4F*****4E***4E*
compensation provisions Section 3700 of the tem Cud''I shall, ply with°"'°cru ns ^ IND I VIDUAL F E E B R E AK DOWN
Date:,C 2 Appfva: �'` ///
Warn! one
wolbws•nrrywaeon coverage is ulIbn and aeyl/fcon an employer to rrlmlralpenames and TYPE ,QTY DESCRIPTION UNIT COST TOTAL COST
doll re hundred thousand dollars(SI00,0001 n a tddOn a the c»I of aNrpwu•Ibm damages to provided ler M
Salon 3706 of the later Cdea,Interest,ad•tfomaylaa ELE 7 FIXTURES, LIGHTING 1 ST 20 EA, 1 .00 7 . 00
CONSTRUCT1GN LENDING AGENCY:Hereby affirm ander peaty d perjury that wee is a conanason lyhdog agency for to ELE 6 RECEPT/OUTLET ; 1 ST 20 EA. 1 . 00 6 . 00
performance dthe work for vhimthis pent isesed(Section 3097.Civ.C). ELE 3 RECEPT/SWITCH 1 ST 20 EA. 1 . 00 3 .00
LENDER'S NAME ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 27 . 25 27 . 25
LENDER'S ADDRESS: ELE 1. MISC APPARATUS NOT LISTED REQ PERMIT 16 . 25 16 . 25
I MON that I have read this apecanon and ase that to above Sometime CORN.I agree to comply with al any and may ordinances END OF FEES
and stale laws'trg to building comonmh and hereby authorize ze npamadives d la city to enter upon the aboe-mMened parry
for inspection prpoes AY O'CONNOR
PEkMT3:BP9458Dale: 4(
areq,..A°erat .. :T. rtla
(5151<6.WP) Whee-Buadig 8 Safely:Orwv-Flo:Canary-Appica t:Pink-Revenue;Oddenod-Assessor
. - CONSTRUCTION AND PLANNING < - - POu._ & SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1.,Temporary Electrical Service or Pole 52. Pool & Equipment Location r .
2. Sc,l Pipe-Undrgrnd. 53. Steel Reinforcement
-3. Electrical Conduit Utility-Undrgrnd. 54. Forms
¢_•Electrical Conduit-Undrgrnd. 55. Electrical Bonding -
:.t -Stael Reinforcement 56. Rough Plumbing & Pressure Test
"- 6•_E&ctrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
'-7F Footings 58. Electrical Conduit-Undrgrnd.
' 2--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 r 65. Electrical-Final • '
45. Rough Electrical-Conduit '` 66. Solar System-Final
j,6. Rough Electric Wiring (5"; /-?7 1 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 C c -_ _ F.�$E,DEPT..REQUIREMENT r _ r�
ti
20. Aou�h Factoc� F replace ^i a.�,- a* n.- ,. APPTOM$S_F, Permit # - t-
_ '- - S _- ^'f -
21.-Ducts,ir--StriFctut&' " -' F1 a " - C' '--"' '- 70.1-UndergrotF!d Hydro
22. Ducts,Venti(atin ° -:S - S C ‘• i 4
fca: a ,e r c -.< r 71. Produd'piping_O-Gas ❑Oil
3
23. Gas•Pipe-Rough & Test 7..."S-1; . tr. 7. ' C' i- 72. Undergrouncl Ftush n
24.-Roof Framing' - •'-1 i _ - ,-,:, • 7 ; Undergr"ad.Stert2eTank DGas GOiI
J
25. Roof•Sheathing -'.1 r ti - _ - r~r, r71,74. Overhead Hydir- '
ir
26. T-Bar Ceiling (Strpcfurap &tiliinocoat o - -• c* 71 Dry Chemical _� - - -
27..Frameand Flashing. 3. _ s c - r,_;:**, 76. Dry Stapifpipei? _ _ _ _ -
28. Lathing&Siding )a _ r '* 75; FIXED�`-S' STgAL
FIN . - - -
29. Insulation _ ._ S I x a FIRE PREV. FIFiAL ;, -
30. Drywall Nailing /..,•; _ * r I t '; r HEALTH DEFFT EQUIRENIENT_
31. Plaster Brown Coat S '- 'a , < - 79. FINAL TTI
NSPECON _ _
32.-Electrical Power Mn;eF-Final . a • r ,} r` : FOOD CER TI0ICA'1'E ISSUED - -
" 33.cfinai•Electric ,..r T h-a 7 rot_es:l� - -gl';. `OC(C IOd1-5 �.•f` Li Xed
�? 34. FinaFHeStin�:,& ATr'Cop lltiohing` `-�' , S '-` r ' - - -
35.-Final Gds'Pipe-Test,: G - .. .c r. '„ ^ ' vxc C- * r ,
36.Hood or-Canopy _:1 ^ T' ' ' :, !, z £ - r ;
_ G[. i - is _. ..
37. Final-Factory Fireplaces • F.�-, < n x
38. •Fini1 Plumbing - '• ' i =
-' ef r,39. Water Service-Fin • A i , , - * T T-.-+
: 40. Gas Service-Final * '-t rgt-rr. s I ' a
C.1- --- A i-. • o f
41. Solar Domestic-Final •• ri - -l•.. -
yC.
42. Backflow Preventer' - * 1r- -
tS _ _ - t _ - .. - - _ _
43. Backf low Irrigation;. -:' - a. -
44._Landsc(pe IFrlgatiofi Systerre37-. T '1: =f ' _1 tx _ ' �` * `
• _ C a C r .•
-4- 5.-Sound Attenuation, -. .▪ ? t, ` • 7 ''" E t•- a c • -C
46. - Handicap Regulations - r x a:: " 7._
-47.-FINAL STRt7CTUfE & BUILDING " _ ti - - -'
48.?FINAL PLANNING "- T -• r;' R t• r ..
r n' t I • ' i� S -r .
49.' Eleciric Release to Edison "• -
:50- .-Gas--Release to Southern California Gas Co ' �' ^ '- ' =''i
:51. CERTIFICATE OF-OCCUPANCY ' ` . _
No Date .
•
•
• ` I/- Y -'-"' ' Applicant to fill in all spaces except those with .n order lines and sign all appropriate declarations.
CITY of cosi-A MES' CONSTRUCTION PERMIT' PE N TRACT N0. LOT NO. UNIT NO. • Neill 15/06/86
• Project Address i • + - •1" + ♦ • = 07561 a g 3.11 s' Z 4 •• ,P, 1 . 30.75 ' IL
s • w TYPE OF CONSTRUCTION NEW U ADD U ALTERATION U REPAIR '� " - ' ' `
,/Applicant's Mailinp‘Address S-t ic7 -_-
ti.' � p ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ 4/ R. I
Owner's Name i�h CD CO n N (Phone's b� /%� •' DESCRIPTION OF WORK/USE OF BLDG. Sr� A'P'# 139 — y $s— /�- Zone
Address riaa111 ` ti V r ,S Main Building: P O0/.. Accessory Building:. .10 A
Arch%Eng. 1'"DA �1}h<'T 1License No. ^ •
TYPE OF PERMIT1q ❑
❑ GRADING U FOUNDATION STRUCTURAL T Front / `� 7b p(,/-1.D/P4 o 5- 7y (3‘--..13 (7 O
.1 L
Address 70 e %i o it. .. `u..) 41/4 vt J t- r*Q -.. + C� ❑
� . TENANT I/ sELECTRICAL ❑ PLUMBING MECHANICAL B Rear /� �r SiN
1 e�L'1'1'�=cp ❑ OTHER i A S TO Rear 'PI`• Z 7'b REAR PC ,1
Contractor's Name����Phonel.-7�1iC3 C Right '). $ I ' N
i -'. - PROJECT DESCRIPTION 5 F1T. OCCUPANCY
Address(mailing) Z b�9. w P.Y�o� 1't_�to S\Yl a1' n O s, •4 YJ Ls p K �� G
J1 CONSTRUCTION TYPE 1 QYt' U. VALUATION$ �4 00 $ Left s • / 0' R
City License No. •1J��� - • - - ZONE• GRADING CU.YDS. ACRE •
LICENSED CONTRACTOR.DECLARATlON-1 -' Ing. Ref.'/� Parking Req./Provided E
' I hereby affirm that I am licensed under provisions°of Charter 9 (commencing Remarks: (' 1 (� ���/// •
C 0
with section 7000)'of Plvision 3 of the Business and Professions Code, and - - ? I�bey 9 IDgS Potk �S9 t/}/�,3' Sr tanning Notes: S(NIMMIIVEj PD0 i- /SP4 M
-Cs."
my license is in' ull t c and.eff¢ct 3�-(O- rel.". ��,.� r �j /j 1� 5 !,t /7 m n ,` I'1 -f��r'o %' J,� - S
1 License Class _ -License No -( JV 's- 1? /\LII1 , -TAM s ,
Date)0-f-21 c yignature 1 �7.tyvia PLUMBING I 'FEES
WORKERS' COMPENSATIOMDECLARATION - -
I hereby affirm that I have a certificate of•conent to self.insuretor a certificate Bar Sink • Showers - - ELECTRICAL FEES
I workers' Compensation Insurance,'of-a certified copy thereof (Section BebkfIOw Preventer Service Sink • •
300, Lab. C. ej41 (s Automatic Washer - Transformer ❑ 15-50 KW
Policy NO.'i CSJ "�'. ..Company�.�0151 C1a�4 .-/'iSCe Backflow •
Irrigation Sewer Cap - 0 50+KW,- ConstructiorvPole Sub.
Certified copy is hereby furnished.. : 9 `.' �
Certified copy Is filed with'the clay t4ltl Ing,DvRlon: Bathtubs - Sewer Connection Cooking Unit Meter yup to 100 amps 00•
Date J0-1-Xd _Applicant ,l -•O •s�\�"A-�P� • - ' • 5•
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers - Solar Collectors •_ Dishwasher Meter Dover 10Oamps
(This section need not be completed iif the permit is for one hundred($100)or • • -
less). q. Dishwasher _ Solar Piping - Dryers ❑Gas ❑Electric Sub Panel
I certify that in the,performance of the work,for which this permit is issuedI '- - --
snarl snot employ any person in any manner so a5'to become subject to the-iDrinking Fountains Solar Tank Fan Motors 00-1 HP 01)4-8
Workers' Compensation Laws of California. , = t a ' -
Date, - Signafure I - ' . I�- + ` - - i -• Floor Drains ' ' I ,SwimmingPool w/S a 3 'C�
-NOTICE:If,after making this declaration, you should become subject to the p F.A.U. - Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks ' Urinal
i comply with such. provisions or this permit shall be deemed revoked. / Fixtures Microwave .
CONSTRUCTION LENDING AGENCY �j 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 ^^
Range
Lender's Name - i ..
Lender's Address N U�'�— - Kitchen Sink • Water Service -- - - - - -
OWNER BUILDER DECLARATION Switches Sign
I hereby affirm that I am exempt from the Contractor's License Law,for the Lavatories-- Auto-Wash ,
-
' following reason (Section 7031.5 Business and Professional Code: Any city or ' - Garbage Disposal Standing Sections
' county which requires a permit to construct,alter,improve,demolish or repair4. P-Trap ;l Laundr Tre s
any structure, prior.to its issuance, also requires the applicant for such permit V. Y Generator 00-5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of of -
the Contractor's License Law(Chapter 9(commencing with Section 7000)of Roof Drains ,
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 ' q
031.5 by any applicant for a permit subjects the applicant to a civil / LJf1 (�y 04 1 /.t uy/,.
1/ + 7 DO
endlty 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 S15 Issue Fee $ 3 —�
compensation, will do the work,and the structure Is not intended or offered —. 1 1
Business and Professional Code: The Contractor's MECHANICAL' Reinspection Fee $15 Issue Fee $ 3
for sale (Section' of apply
FEES
thereon,
Law does net aP ply to owner f a property who builds or improves __ _ __ _____ _ _
and who does such work himself/herself ot through his or her own - DEVELOPMENT SERVICES REQUIRE NTS:
employees, ever, that such improvements are not it hie or offered for Boiler Hood oType I 0
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 burtlen.Of proving he/she did not build or im- Duct-Under Ground '
rove for the purpose of sale). Building Approved By Date arfieg
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By Dat: I1�
• cLa ( t ,
The
7a0p4yBuosainnesoswannedr PorofpesrosipoensyCowdheo:
Duct-Ventilating 00-100 000 BTU 0100,000 BTU •
builds or improves thereon,and.who contracts for such projects with a con- SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware that' BUILDING PERMIT $- SMIP $
proof of their Worker's Compensation insurance,should' be provided to me. • Exhaust System 0 Multiple 0 System Repair/Alteration .
PLAN CHECK $ - -PERMIT ' -
❑ I ani exempt under section B.& P.C.for this reason. Firepl/Pett.BIL ICBG# Fire Dampers PLUMBING $ Fe t ID ISSUANCE $
Date _ Owner - Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ -
I hereby certify-that I have read this application and state that the above ❑O-100,000 BTU 0100,000 BT
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ ' I GRADING $
•and state laws relating to building construction,and hereby authorize repre- •• 4)• MICROFILM $
sentatives of is city to enter upon the above-mentioned property for _ - PLAN CHECK 50% $ cc
" inspection Pur s. 1` - Da O,_ Sr6 - MECHANICAL $ TOTAL FEE $ 3� els
\Drivers' i ��"' sT1.-.�-/'_$"
ReinspectiomFee i $15 Issue Fee $ 3 PLAN CHECK 25% $
`0665-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
I ,
-CONSTRUCTION AND PLANNING POOL&SPA
• APPROVALS Permit# • Date Inspector APPROVALS Permit#
Date/ Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location f 7/0/4,0
0/6.f�1�
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �//"
3. Electrical Conduit Utility-Undrgrnd. , 54. Forms •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 1fJ y fri, pg7
,
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test (1�/rG PIP
6. Electrical UFER Grnd. /0..),-44.>.90.257. APPROVAL TO COVER-GUNITE •
7. Footings :;, 58. Electrical Conduit-Uniicg440,1cwr oa`t la •
8. Foundation L9
59. Gas Pipe, 'Undrgrnd.,IlTest Or 0 O. PR
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. /o -'.c j.4j 9
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 FINIAL'
.
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 OiP
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd-Storage Tank-0Gas 0 Oil -
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • . - - I
27. Frame and Flashing 76. Dry Standpipe -
28. Lathing & Siding 77. FIXED SYSTEM FINAL .
•
29. Insulation 78. FIRE PREV. FINAL ' '
30. Drywall Nailing 1 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION l
32. Electrical Power Meter-Final 49.1s 80. F CERTIFICATE-ISSUED -
33. Final Electric N , nici 6 t-i,.enpa. tril-
34. Final Heating & Air Conditioning 1'0-X1_c,
35. Final Gas Pipe-Test - ' wt}/en SG ,r rn.AS /ria-*4 b l3 7o
36. Hood or Canopy / /
G/i/2G�' 1-17 II C.cc. .,..Fcrrc.. Op51- s
37. Final Factory Fireplace
rzci.. ci a ,:nom l3 1 hs set//
38. Final Plumbing raft +hs c....4 t nr.o/c pc-C.1 /,,h1. f '
397 Water Service-Final ,
/c-XnG UPC rtSnc.... 4 ....../is 1,1,3caiIIntl
40. Gas Service-Final /
41. Solar Domestic-Final �1 ,
/ 7 I+.r)S .fh coo 4 ei W 1 } b G'c. a..-na lay
42. Backflow Preventer .no Shrift tette n.s he:alse +
43: Backflow Irrigation ac4/ Sc t o.. lye J
r)at° racjpR 5 d Sc4
i
r
44. Landscape Irrigation System cc ti ,,,site lei r., t o.44/1c 1,0 r+•Ii s 1/ S - - - '
45. Sound Attenuation • �Q 1 Ay �, n�� `�, c� t •- 1 -
46: Handicap Regulations !t ��
47. FINAL STRUCTURE& BUI LDING -
•
48. Special Requirements Completed • - ..
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .,
51. CERTIFICATE OF OCCUPANCY „v
•
,No Date - •.
-7- 1/6 , — { •
- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
COSTA MESA= ON�TR T/1 , PERMIT.NO. TRAC NO. L T N UNIT NO., , 5132 10/14/86
Qr() �O ��l/L Ba as762' . 18 � ieD73 TL
Project Address '
Applicant's Mailin d e�5 TYPE OF CONSTRUCTION NEW ❑ ADD LI ALTERATION LI REPAIR
1 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER, �)
to Owner's Nam Phone 5W"77// / ♦ / /, ' A.P.# J�/-- L/55 - JQ Zone `�,/ _
(J /� ,,,,�� DE CRI• ION OF •• S OFB eG. - -�•-- .�
`+ Address �� T A/ ,1 (fl 'I/ /% i i A_70... 1-_ S Main Building: • anC(h�jt Accessory Building:
Arch/Eng. Nip- License No. TV' OF PERMIT 111 GRADING ` FOUND•(ION ). : TRUCTURAL • T Front O
• ❑ TENANT al! ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
Address - A Rear a(�
❑ OTHER ,/ •
Contractor's Nam- •� OA. -�TN%�10 Phone 537 s� . PROJECT DESCRIPTION SQ. FT.._ Ilya OCCUPANCY 4— ' K Right aR / G
Address(mailing) 47 1 2 - snit-. I FT.. 4- • p>_ /
+J 'CONSTRUCTION TYPE ,lam- VALUATION$ y� S Left '/ R
City License No. D�]�5013 • • ZONE ,GRADING CU.YDS. - ACRES
LICENSED CONTRACTOR DECLARATION ` //•^L Ping. Ref.# Parking Req./Provided E
•I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: '.rG� -//_ a I p / (Ant Planning Notes: - Q
with section 7000) of Division 3 of the Business and Professions Code, and - LJ` v `�¢[w s \\(/W \ 1
\ my license is In full force and feet. • 3 l // T
License Class .� I Licens- No. S
Date 40' Signature /x eine .. a a' . PLUMBING ' 'FEES a
WORKERS' COMPENSATION DECLARATION Bar Sink •
Showers ELECTRICAL FEES
4 'hereby affirm that I have a certificate of consent to self-insure or a certificate -
.f Workers' Compensation Insurance, or a certified Copy thereof (Section ':• Backflow PreventerService Sink
3800, Lab. C.) n/_3 Automatic Washer Transformer 0.15:50 KW
• Policy No. !S 10 ' Company / L(>•.. �r Backflow Irrigation _ Sewer Ca ❑'50+ Z1nl _
P Construction Pole Sub.
��E�]l Certified copy is hereby furnished.
`6a Cerjifieq pyts filed with the city B d'n ivi on//_ - Bathtubs' -. Sewer Connection Cooking Unit, , - Meter•❑up to 100 amps ; - . , „
•
bbate C' C b Applicant P[-Q)'j1 a1Ld _
EXEMPTION FROM WORKERS'COM ENSATION DECLARATION , Clarifiers . Solar Collectors -- . Dishwasher - s Meter Clover-100 amps'
I (This section need not be completed if the permit is for one hundred ($100) or - - - -
• less). Dishwasher . Solar Piping- - Dryers ❑Gas DElectric ' Sub-Panel - -
Icertify 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 T k Fan Motors❑0.1 HP ❑1 X 8,
Workers' Compensation Laws of California. _ -
Date Signature Floor Drains S • ming Pool w/Spa ' F.A.D. ( Inc.Solar ❑9-15 HP ❑16-15+
-NOTICE: If,after making this declaration, you should-become subject to the • — - - - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
' comply with such provisions or this permit shall be deemed revoked. I .
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet ' Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance - 9 ..
of the work for which this permit is issued- (Section 3097 Civ. C.) Interceptors Water Heater Outlets t Range •
Lender's Name • ' • • ! /'
-Lender's Address '- '• - - - - Kitchen Sink - • '- . Water Service - - - Switches "- • Sign - • - - . --
OWNER BUILDER DECLARATION I I '
,• I'hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' .Auto-Wash Disposal Garbage
' following reason (Section 7031.5 Business and Professional Code:,Any city or 9Standing Sections •
county,which requires.a permit to construct,alter,improve,demolish or repair P-Trap ' Laundry Trays Generator ❑05 KW ❑515 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 provisions of •
Roof D ins . - - _
• the Contractor's License Law (Chapter 9(commencing with Section 7000) of
Division 3-of the Business and Professions Code) or that he/she is exempt - -- - - - - ' ' • - ' '
, 2herefrom.and the basis for the alleged exemption. Any violation of Section • '
y"- l'`-'7031.5 by any applicant for a permit subjects the applicant to a civil ,
tpenalty of not more than five hundred dollars($500). / ! t
L.J I, as owner of the property or my employees with wages as their sole `r $15 Issue Foo $ 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 a
thereon, and who does such work•himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREME r�/
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑ ,.f /1/ /O./7% .'y{
sale. If,however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By �•�f A-/fii Date Y CJ�
pletion, the owner will have the burden of proving he/she did not build or Im- ^Duct-Under Ground 'Building Approved BY �+`•""�ri[y/ Date /La-•/ c/—$6
prove for the purpose of sale).
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration Sys Application Issued By Virs-L+-s /4,/ ` Ar
- Date (Ip-rv- g'6
, 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 ' ❑0.100,0 U ❑100,000 BTU SUMMARY OF FEES ' - •
builds or improves thereon,and who contracts for such projects with a con- , ,
tractor(s) license Pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ tem Repair/Alteration • - BUILDING PERMIT $ ' : �y` 5r SMTP - $ Se,
proof of their Worker's Compensation insurance should be provided to me. - I PLAN CHECK $ vZT PERMIT
0 I am exempt under Section B.& P.C.for this reason' Firepl/Fact.Bit. IC80# _l Fire Dampers PLUMBING $ . SSUANCE $
Date owner • Heating System& Du ' g Registers - PLAN CHECK '25% $'' • .ENERGY P.C. $ -
I. hereby certify that I have read this application and state that the above 00.100,0008 100,000 BTL -- - !� :GRADING $ .
information is corre --I agree to comply with all City and county ordinances - ELECTRICAL $ "'res
and state laws rely f g to building construction,and ereby authorize repre- - PLAN CHECK 50% $ 1'�0 MICROFILM' $ •
' sentatives of this r ty to enter pon the above-m ioned property or -gyp
inspection purpo _ , ,4;�-, Date Cr� - - MECHANICAL $ TOTAL FEE $ ,a` -a
Drivers' License or SS# Reinspection Fee $15 ' Issue Fee. I PLAN CHECK 25% $ ,
i
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
L1
•
;CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. SoilPipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .
5. Steel Reinforcement • 56. Rough Plumbing& Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash•& Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
' 15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring ,• 67. Fencing & Access Approval
i
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil •
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 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 Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric5-11Notes:/
34. Final Heating & Air Conditioning 12-(0(0 o� `y
35. Final Gas Pipe-Test l( l � _ Plat
l'�-O`---•tel.
36. Hood or Canopy Yom"'
37. Final Factory Fireplace r
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 4ste8
48.•Special Requirements Completed
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. 969'91 1 I/(],P�/8]_ I y,55 TL
CpVOF'COSTA ESq 'C('�ONSTRUCTI'ON PERMIT - PE IT O. TRACT NO. LOT NO. UNIT NO.
•
^ •fo)ect Address ad -1 �.7 Y d ` `-' ,
' TYPE OF CONSTRUCTION ' I_I NEW "ALTERATION
•
•
)))i Applicant's Mallin ddress _ U ADD H REPAIR
'.A / 0 I CON ��Y ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A.P.qy, Zone •
/ Owner's Name 7 _ Phone
r DES RIPTION OF WORK/USE OF BLDG.
Address : o p .0 1�0yQ 11 • At AP ' I- S Dv,- 4 C•+ - S Main Building: :Accessory Building:
Z•
Arch/Eng. ' • License No. TYPE OF PERM GRADING FOUNDATION ST-UCTU RAL E
T Front Q
' Address ❑ TENANT, ELECTRICAL• ❑ PLUMBING ❑ MECHANICAL B Rear • N
Contractor's Nam- IS.. . - A Phon /-I el a 1A ❑ OTHER . A 1
-L f31 c PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N'
Address(mailing) Z�iq -IP_6.-.... i$1Oh C ,..,
�� " 7 CON STRUCTI ON TYPE VALUATION$ $ Left
6 V R
City License No. - ZONE GRADING CU.YDS. ACRES Ping. Ref.# 'Parking Req./Provided • E
LICENSED CONTRACTOR DECLARATION - -
I hereby affirm that I am licensed under provisions of Charter 9 (commencIng Remarks: Planning Notes: a
with section 7000) of Division 3 of the Business and Professions Code, and Ni
my license is in full forte and effect. •� �� •
T
License Class �v 10 icense No705)9 0 PLUMBING FEES
I Date /--2 p Signature '/ - -
WORKERS'COMPENSATION DECLARATION -
I hereby affirm that.( have a certificate of consent to self-Insure or a certificate : Bar Sink - a Showers - ELECTRICAL FEES -
• of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow PreveOter Service Sink •
- - 1
• 3800, Lab. C.) '''moi p a Automatic Washer Transformer ❑ 15-50 KW
Policy No.4� I o`S ` �D Compapg�v tire A+'�r Backflow Irrigation - Sewer Cap - Construction Pole Sub.
0 50+ KW
DaCertified copy is hereby furnished. �jT-nZl, nl`Q1'
Certifieng co s filed with the city I �'�/)'� Bathtubs- Sewer Connection • - • Cooking Unit I Meter Dup to 100 amps
e' I_ -�'� . Applicant )i ft 1-. T YISt•s•‘
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • Dishwasher - ( Meter Clover 100 amps 7 '-Q
(This section need not be completed if the permit Is for One hundred ($100) or
Tess).. ' Dishwasher Solar Piping - . Dryers ❑Gas ••DElectric - 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'h-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 09-15 HP 016.15+
Workers' Compensation provisions of the Labor Code, you must forthwith . Floor Sinks • ' Urinal
, comply with such- provisions or. this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING' AGENCY Gas Service ' Outlets •Water Closet i Device Boxes
I hereby affirm that there is a construction lending agency for the performance : POIe Light
of the work for which t is permit is issued (Section 3097 Civ. C.) Interceptors' Water Heater Outlets
Lender's Name
I an'
�♦ U Range • -
,Lender's Address V ` _ Kitchen Sink. - Water Service' "s- - • _ _ _ f _-
OWNER BUILDER DECLARATION . Switches Sign
I hereby affirm that I am exempt from'the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or - Garbage Disposal Standing Sections
• county which requires a permit to construct:alter,improve,demolish or repair P—Trap '• Laundr ,Tra s
any structure, prior to its issuance, also requires the applicant for such permit y y . Generator❑0-5 KW ❑5-15 KW Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of •Roof Drains '
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that .he/she is exempt - - - - - - '
therefrom and the basis for the alleged exemption. Any violation of Section • \ _•
7031.5 by any applicant for a .permit subjects the applicant to a civil
I .
�e natty of not more than five hundred dollars($500), . $ 3 .. •
LJ I, as owner of the' property or my employees with wages as their sole Reinspection Fee $15 . Issue Fee
compensatlon,•will do the work,and the structure is not Intended or offered • - •
Reinspection Fee I $15 Issue Fee $ 3 j f
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 Tyrie I 0 -
sale: If, however, the building or improvement Is sold within one year of cons- Canopy . Type II ❑ Zoning Approved By Date -
pletion; the owner will have the burden of proving he/she did not build or im- ' Duct-Under Ground Building Approved By Date
move for the purpose of sale). •
LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat -
tractorslà 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 ' ❑6100,000 BTU ❑100,000 BTU- SUMMARY OF FEES -
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). am aware that Exhaust System ❑ Multiple ❑ .2 System.Repair/Alteration BUILDING PERMIT $ SMIP $
' proof of their Worker's Compensation'insurance should be provided to me. PLAN CHECK $ __PERMIT -
' ❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact,BIt: ICBO# Fire Dampers PLUMBING ' ,$ ISSUANCE $ - _•
Date Owner Heating System& Ducting Registers .. - PLAN CHECK 25% $- - ' ENERGY P.C. $ • '
. I hereby certify 'that I have read this application and state that the above ❑6100,000 BTU 0100.000 BTI - �0• S� GRADING $
information is correct. I agree to comply with all city and county ordinances - . ELECTRICAL - . $ • -,
and state laws relating to building construction, and hereby authorize repre- - r _ _ - MICROFILM '$;; - r -
PLAN CHECK 50% �$ i
I •
nspectios n puof this y to ante upon the above-mentioned. property for MECHANICAL $ TOTAL FEE . $ /�•
Inspection purposes(\ 1— ' '
Signature. /r IC= Y. �Twwv}4-sem Date )-1-2r7 Reinspection Fee .$15 -$'3 , PLAN CHECK 25% .
Drivers' License or SS �' p Issue Fee v. . $
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit _ Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace • APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro •
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
.•
25. Roof Sheathing 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 Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final6 80. FOOD CERTIFICATE ISSUED
33. Final Electric (vv 7 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 J '
46. Handicap Regulations - •
r
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. bate •
/~ _
ttt h(t.ULAVtU
.. I 19108 It/ MAR 2 2 1963
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
R.O.BOX 317 COSTA MESA.CALIFORNIA
•
CITY OF COSTA MESA
For Applicant to Fill In Comp j)ely APPLICATION FOR PERMIT
yc, V 4 f TYPE OR PRINT g°74BUILDING
p For Office Use Only
BUILDING ADDRESS �O 9 Z4- i- 1:112
COS�TAMESA," ALLIFFOjRNIA� �J
OWNER ,'t.��lA4t//,UCry, / ^✓ // 1
y.
MAIL /�
OWNERS r'.3 _a GL
FIRE
TEL. 5--S4 9ZONE I JAI
CITY Wict.aa_- NO. n 4 _ GROUP
Iir
'HITECT / / TEL. 9 7� APPROVEDBY
ENGINEER '7' LL NO.
ZONING
I
ADORE-.- : ^' _ A .d_. , L. �.- --/ T= iettp`rI'/'I IME a AVIV , 3 I.0
CONTRACTOR (4.22.1a--7_ /( .
ADDRESS /G yy) -;T .2/-2(�+oB'Le-+c- .(a2• '/ / � r nen:
t thoir'
CITY �i.eutz. �� .921 1' 4L__./ A.P.NO. _
/ NOTE: NO HAVE OVERHANG SHALL BE LESS THAN
LIC. TNO. �/7/0,c NO. 5E TEL -(7 9o39S 90'70 SIDE a REAR P.L.
/-T EAVES
SIZE
LOT / A )C�D 6 I NO.OF BLDGS. ALLOWED (U.B.C.REQUIREMENT)
NOW ON LOT 0 YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
SETBACK LINE FROMS--Ld O 53 3 FT. FT.
CENTER OP STREET REAR YARD
SIDE YARD I LEFT RIGHT
0 R.SIDE 9 FT. FT.
DESCRIPTION OF WORK L.SIDE FT. FT.
REAR -'St FT.
W K
1ALTERATION ADDITION
DISTANCE SET. BET.MAIN e
SLOGS.MAIN ACCESS.BLOGS.
REPAIR MOVING DEMOLISH
BUILDING ,/� NO.OP
DATE
SIZE �O PO (- ROOMS r STO,RIES/`O( I APPROVED
EXTERIOR WALL ROOF /0 "'" • :`,rA. igr -/--6
COVERING aLLCOVERING I -..air. .. BY in, DATE
USE
�OOF,BUILDING AND ORK TO BE PERFORMED`a w it
� r, - ,fed ./ . ,H/
sa
he ' ' ' . a I ansa.FT. ! so
yI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE Z
AND STATE THAT THE VE Is CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY DIN NCES AND STATE WS REGULATING VALUATION p
BUILDING CONSTRU ION /� N
SIGNATURE OF /
PERMIT $ e
PERMITTEE 1 - $0107 57� PLAN CHECK $ `� i o
CC// n �/ LL
AUTHORIZED AGENT TOTAL FEE /v O
•
Ca.
` 2I185 ' "..1-7--FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENTy �l
P.O.BOX 517 COSTA MESA,CALIFORNIA '• E��
FIIVANeE 13P16v"
For Applicant to Fill In CompletelyePLIC I R
•
. TYPE OR PRINT Bulk-DING
For Office Use Only
BUDIDLDRESS �ING • .St O c1/4 Ev ._ic.?,�
A
RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA %��
��t ��wl
DATE
�E�3 72T=� X63
OWNER
BUILDING �j/ q
MAIL -Z%Y�OI �0�-� ADDRESS l3 rE / �GlJ7,rY1✓�t
ADDRESSFIRE
\ - / y
TEL. ZONE // GROUP v
CITY C.a..X31-'tom
G SQA NO. I L
tHITECT TEL. BYFROVHD TYP_ DATE /2. �� 3�
ENGINEER
ZONING
ADDRESS �- r
CONTRACTOR
USE OF
CAST ,....
C..w-� . •^S 11� / I PLANS1
OF
1./"--1 BUILDING W
\`
� LEGAL OT' vt-7_4- -tn. 4-aft$
ADDRESS t- ' %. Z c _
\"� - . DESCRIPTION
A.P.NO. / ' .� Y
CITY OP.S<•ia • -
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE --Lilts
C Cr.
j NO ` C\�,�lst\ 90'TO SIDE ft REAR P.L. •
LIG.NO. �l \
EAVES
SIZE 6Q• 1 NO.OF BLDG,. ALLOWED (U.B.C.REQUIREMENT)
OF LOT 0'�-�'O IP E.,Q j3 NOW ON LOT \-
YARDS APPROVED YARDS APPROVED
USE OFMAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. r1.00m.
, (FROM C/L STREET)
SETBACK LINE FROM FRONT FT. FT.
CENTER OP STREET REAR YARD
SIDE YARDI LEFT I RIGHT R.SIDE FT. en.
0
•
DESCRIPTION OF WORK' L.SIDE FT. FT • iii..EW ALTERATION _ADDITION REAR FT. FT.
— DISTANCE BET. BET.MAIN S
MAIN SLOGS. ACCESS.BLDOS.
REPAIR MOVING DEMOLISH
BUILDING NO.OF VAR.# DATE
SIZE ROOMS STORIES C.U.P.# APPROVED
EXTERIOR WALL ROOF APPROVED ^,� /��
COVERING I COVERING BY ( / r//c�¢Te 1�"-�� ...-6.3
�eUSE OF BUILDING AND WORK TO BE PERFORMED I\/M1�/
G^L "r-Vp1----- Ill,,
M
SO.FT. 4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY 0 ES AND STAT[ LAWS REGULATINS
BUILDING CONSTRU N. VALUATION N
SIGNATURE OF PERMIT FEE $ D
B
PERMITTEE • �/
$ /�' 6 PLAN CHECK $ C G
AUTHORIZED AGENT
r7 y
f ,y TOTAL FEE $