HomeMy WebLinkAbout212 SALMON DR - Building Permits �' ' CITY OF COSTA MESA
BUILDING DIVISION
044t
F • 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
tl• PERMIT
P"° ee
""j0 E05-00088
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 212 SALMON DR Status: ISSUED
Suite No Applied: 02/07/2005
Vicinity: Issued: 02/07/2005
Parcel Nunmber: 42533320
•
Applicant: ROTH, DAVID JOHN TR EMI ISSUED B
Address: L&DOROTHY C ROTH TRUST
SANTA ANA,CA Phone:
1694 ORCHARD DR Zip 92707
Owner: ROTH, DAVID JOHN TR EMI
Address L&DOROTHY C ROTH TRUST
SANTA ANA,CA Phone:
1694 ORCHARD DR Zip: 92707
Contractor:
Address: .
Phone:
Zip: •
License:
SCOPE OF PERMIT
REPLACE EXISTING DROP METER AND PANEL-SAME LOCATION.
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 $30.50 1 Misc.Conduit $0.00 0
Service to 1000a $0.00 • 0 "Misc.Conductor - • $0.00 0
Service over 1000a , , $0.00 _"0 -" L Circus(gen or ride) $0.00 , /0
Motors to 1 hp $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 $30.50 1 Plan Check Fee - _ $0.00
Pole Light Pkg $0.00 0 - Reinspection Fee' - $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $84.50
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)7545626
2446-46(6/00)
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:
Carrier: Policy Number:
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ 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 the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
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 DOLLARE($100,D00),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.# 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).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($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.). '
%�f, ,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
ode: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-Bm exempt{ynder sej. �j Business and Professions Code for this reason:
iigpature:_ //]/2
Owner ID verified by drive77s license. 171424 ❑No CD r 5 License NQ.� /Ex—Sr ) /34/021Verification of Ownership by(type of document,i.e.-property tax bill or deed): Y 1 Y 7
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:
I 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 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 Califomla 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? ❑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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul 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? 0 Yes 0 No
..._
8 (If yes-,attach certificate of complianceefrom 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 p operty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this p rmit ntil final inspection.
- — / 3
� 17
��gnatureSaLegal.Owner(s) M Date
And/Or Authorized Applicant Date
CODE t INSPECTION TYPE PATE 1NTITIAL$ QODE( INSPECTION TYPE pAu )LECs
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing •
200 Final Re-Roof 210 Final Electrical 1�1/ J!tli/�7 /LU
201 Final Block/Retaining Wall 212 Final Fire Prevention Ola�i�Gf:1,/f/
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
'd OWNER ROTH. R. J. L - 1-9-68
JOB ADDRESS 2JP_Bal mon Way_= BUILDING PERMIT NO. 27994
eQQ GENERAL CONTRACTOR
4 Guaranteed H(DPS Detached Garage _
AP No. 117-143-11 LOT 4 TRACT 973 DESCRIPTION FIRE ZONE of WORK
VALUE $ 1,860.00 _
INSPECTIONS Signature Date GROUP ,T TYPE V ZONE R-2
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWSR fl
ROUGH WIRING -( r� `� ""/p 3-�y. P' Heating and Vent.
FOOR TRENCHES STEM FORMS I -ISTEEL REINF. 0 / iO R
07`r
BOND BEAM n STEEL REINFORCE r te-
SHEATHING (rrFRAME AND FLArS�HING / 2- A,'e�LATHING — IN 11 OUT I C- OPLASTER, BROWN COAT e_ 1
FINAL E �O
HEATINGRVENTREFRIG. AND A.C., FINAL i . 2fiAl' Ofilet. q-
Z6S gi7i1./
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL ,-/e•‘4.-
INAL `�gJ Y«'‘ .-
BUILDING. FINAL L.-9M tS7C hX
I 27994 I Jbxh00 273* ***mensA *13.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
•For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING 2/2 SW
r�� 0e,//per
ADDRESS
n�X t•/�L/ RECEIPT NO, PAREEINO2 ,/ /
COSTA MESA. CALIFORNIA J/lV 9
/ /� RICIIYjp DATE -W / OA¢ 6 piD ' /
OWNER Lc , ✓, 44 O�lj'� `,////� ((J( //} !/ �//2/}
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BUILDING
MAIL
ADDRESS S�/02 (./ .i/ ADDRESS /
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TEL. ._v ZONE TYPE GROUP
CITY /I/911*./21/-J Orr NO. //�/JJ :11/�,[y
ARCHITECT / J/ TELs�/��� BYAP
/ �_ - / DATE � (OV
OR ENGINEER e../.././ET /114Ae NO. /�
/Olo6� CO�SX�.,g ZONING /y/{n
ADDRESS f W. ZONE NO.01 /� / USE OP N[YN_ e
CONTRACTQRC�!/2, e/JJ'7r .(7tif in --4' '�I PLANE.[') BUILDING /7/
h e / DESCRIPTION Li / if •�Ul g / 3
GAL
ADDRESS
//0G4C%/7 f/ . 1/
CITYP//'Yl�)IE^/ ''St A7 Pie-) A.P.NO. I 7 I Y
, NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
ATE
LIC.NO. /7J 2NO,, 7-9/70p L 30'TO SID[61 REAR P.L
iJ ,
SIZE / I NOW ON LOT . Z EAVES
(U.B.C.REQUIREMENT).
OF LOT /OC11� ASV YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. 2 A/12:0"1ia)/C1I4-/C. (FROM C/L STREET) ^. IM•"µI
SETBACK LINE FROM / ? FRONT R /�1 irn F
L W frM/
CENTER OF STREIT 2•I� REAR YARD J f I 3
I I R.SIDE PT. Fr.
SIDE YARD I LEFT /*/ I RIGHT -
DESCRIPTION OF WORK L.SIDE PT. ( I FT.
NEW ALTERATION ADDITION REAR PT. r;PT.
DISTANCE BET. BET.MAIN&
MAIN BLDQ$, ACCESS.BLDGS.
REPAIR _MOVING - _NO.OF /DEMOLISH
V
BZLDING2° ?v ROOMS / �STORIESS / C.UU.P.* j^ APPROVED
EXTERIOR n
CO ER IN WAL-q rD 4') I CROVERING/�-'O `F BYPROV[D /�///��TE ty % 4
COVERING �. 111///VVV/ _s VV
USE OF BUILDING)AND WORK TO BE PERFORMED
-,-.F,"/-0*.te.-00,-.7 — i
SQ.PT.
O
I HEREBY ACKNOWLEDGE THAT I HAVE • TNI/APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS COR yyyyy��y��{{yyyy,• AGREE TO co .MPURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
li
PLY WITH ALL CITY O FIANCES AND LAWS REGULATING VALUATION
BUILDING CONCTR ON �j
SIGNATURE F 0e PERMIT FEE ... / p
PERMITTER /y + Jy/ G
E/ o PLAN CHECK $ ! ' a 1
AUTHORIZED AGENT
�... -.. •_ . - .: .•.....:. .r'r.... TOTAL FEE $ A3/S-
Cl
i ADDRESS OF BUILDING: 212 SALMON DR UMT: CITY OF COSTA MESA — BUILDING PERMIT
OWNER'S NAME IF KNOWN: ROTH, EMIL J TR PERM NO: B 074022
ADDRESS *ROTH, DAVE
1694 ORCHARD DR PERMIT NO: B 074022 PLAN CHECK NO: N GOVT: N SUPP : N
SANTA ANA, CA 92707714 ) 662-1979
AWL.SWUNGADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: REP
ARCHITECT OR ENGWEER: UC NO.: JOB DESCRIPTION : REPAIRS AS PER HOUSING CODE VIOLATIONS SQ FT: 300
ARCK OR EN'S ADDRESS: WIT:
CLAIM VALUE; 300 . 00 CALC—VALUE: 300 . 00 GROUP OCC : R-3 /
CONTRACTOR'S NAME
CONTRACTORS SWUNG COMMENTS: REPAIRS TO STAIRS, DECKING, HANDRAILS & GUARDRAILS
********AE**********************************************************************
AODREssNO ZONING REQUIREMENTS
SETBACKS S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaly of perjury that Ian licensed order provisions of Chapter 9
(commencing with Section 7000)of Division 3 d the Business and Professions Code,and my license is in MI forte and effect
CITY LIC.NO.: Mc.CLASS: LIC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Conmwoc _ LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby Won under penalty of perjury that I em exempt from the Contractor,License Law for the
'-dc vi g reason(Section 7031.5 Business and Professions Code:AM cry cr county which requires a permit to construct.alter.improve. PARKING REQ: P RO V: PARCEL: 42533320 Z N E: REF NO:
moreh,or repair and structure.pia to its issuance.also requires the applicant In such permit to file a signed statement that he or she PLANNING NOTES>
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 S exempt therefrom end the basis for the alleged exemption.My violation of Section >
7031.5 by and applicant for a permit subjects the applicant lo a chi penally dMil more then Me hundred defiers j$500]). )E1EiElE1E1E1EiE1ElE1E1E1E5Fif1E1E#iEjF*1E1k1E1E3F1E1F1EjE141F1E*iF1E1E1fifiElElE1F565EjE1E1E1El ***1ElE1E'1ElE if*IFlEjE1E1E1(IE*jE1E-0EiElEIE'1F'IE***
❑ I.as owner of the property or my employees with wages as their ode compensation,will do the no*.and the stnmure is not intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply to en Owner of property
who bolds or improves thereon,end who does such work himself or herself or through his a her own employees.provided that such
improvements we not intended aoffered fasit.i,howew,the building or improvement is solwilhin as yew or completion.the ZONING APPROVED BY DATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ Las owner of the propend,am exclusively contracting with licensed contractors to construct the proled(Section 7014,Business and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon end who
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). ^
M am exempt under Section! Pa.AP.C.,forthis OWNER—BUIL
W�BUIL ER APPLICATION ISSUED BY: DATE: ! /
//�J n �E*�E***AE�E�ESE*******dE�E�ESErt�E�E�F*SF�F*iE�ESE�E�EAE+EiEiE*** ^^tEdE*tE�Etl***** SESEiE***dE**�ESF ""^ate VIT**
e' ���"' Ow"ef fits LEGALIZATION: N F E £ S U M M A R Y STRUCTURAL SEGMENT:Y
hereby cenlfy that am aware d end understand the neguirema cCalifornia Health and Salary Code Sectbm 25505.25533.and
25534.and that)oranyhnure Wilding occupant will/aril not one)need to comply with said state codes and the requremensir BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
apeml foaaniroction or modification from the AkOueC�y amlpment Didrk.Residential wMnation applWkes en exempt lmm these
provisions. PERMIT 15 . 00 . 50
Dove Applicant: SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the fdbwing declarations: ISSUE FEE
❑ Ihaveadwilmamtaisatenymeleofconsenttoselfdnsureforworkers'cmpensation.opovdedforbySedS3TOOoftheLabor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the performance of Na work for whkn rola peminlaSued. TOTALS----> 15 . 50 0 .00 0 . 00 15J/50 15 . 50 .00
❑ I have and wed malntail workers'compensation insurance.as required by Section 3700 of the Labor Code.for the performance of the
work for with this permit is issued.MY workers'compensation insurance rsnier end Folcy number are:
Carder: REVENUE DIVISION TOTALS--> COLLECTED : 15 . 50 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
MS section need nit be comp/Wed r the prima is for one hundred days proof or Mae/ 15 . 00 . 50
❑ I may that In the performance of the work for which this permit Is issued,I shall not employ arty person In any manner e as to
become subied to the workers'compensation laws of Cafdmda,and Woe Mal if I should become surfed to the workers' *******************************************************************************
compensation provision of Section 3700 of the Labor Code,I shell lorlhwith campy with shoes provisions. IND IV IDUAL F E E BR E AK D OWN
Dale: Applicant:
Warning:Failure to secure workers'compensation coverage la unlawful,and shall subject an employe,to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil lines up to one hundred thou and dollars($104000),In addition to the cwt of compensation,damps as provided for In
Secda3706ofMeLaborCode,interest,andatromeyafaes. SFR 300 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 300 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this peal Is issued(Section 3097.ON.C).
LENDER'S NAME:
•
LENDER'SmaADDRESS:tioE♦++ 0
I certify I have madthisfoapplication end n an that the above information Is coned.t pits m with allcityend county ordinancesroperty r /
and state laws relating.building coneuuabn end hereby authorise representatives d this Chyle enter upon the ebm'e menlblled propend
for inspection purposes. DAVE ROTH �( ����
Pd,�Name D�LTF+ + 01 00135435-00189436 TOT
_1025.,..—...
� / 67-0-f" , DATE: 0E/31/95 TItE: 15:22 15„`G
�Signal
"e49.
/ Dye:
S''ignnal ` w�Mgent/AppkeenUComredo
(5151 46.WP) ynnn. derma Safety:Green-is:Cagy-Appirenn:Pink-Revenue;GOldervodMaaor — —_ A
CONSTRUCTION AND PLANNING • POO_ a SPA
APPROVALS Permit# Date Inspector 1. APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52, Pool & Equipment Location
2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement •
3. Electrical Conduit Utility-Undrgrnd. 54. Forms _
4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding
5. Steel Reinforcement •- 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
•
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
( or
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil -
25. Roof Sheathing • 74._Overhead Hydra '•
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 PREV. FINAL. •
30. Drywall Nailing - - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION •
32. Electrical Power Meter-Final 801. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy -1
37. Final Factory Fireplace' - .
38. Finai'Plumbing .
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation .
44. Landscape Irrigation System - --
45. Sound Attenuation - •
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING -'
•
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co • • •
51. CERTIFICATE OF OCCUPANCY
No _ Date
ADDRESS OF DMLLIM 212 SALMON DR WIT: CITY OF COSTA MESA - BUILDING PERMIT
OWNERS NAPE IF IOlDat ROTH, EMIL J ..TR PERM NO: P 074053
ADDRES& BROTH, DATE e
SANTA
1694 ORCHARRDA7D7714 ) 662 1979 d S J PERMIT NO: P 074053 PLAN CHECK NO: N GOVT: N SUPP : N
- APPL.MAILING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: REP
4 ARCNIfECTORETCHER: UC.NO.: JOB DESCRIPTION : REPAIRS AS PER HOUSING CODE VIOLATIONS SQ FT:
ARCN OR ENG'$ADDRESS: UHT:
CLAIM VALUE: CAL C-VALUE: GROUP OCC : R-3 /
cONmACToWSNAm DAN DAWSON PLUMBING ( 714 ) 646-6720
ccenscOWs IMLDG 1564 ORANGE AV COMMENTS : REPAIR WATER HEATER
ADDRESS: C.M. CA uCNG: 554722 ******srK****+r+ ************ *K**sFIE******************ler******** **Ir***************
92627 WIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license' ' lug force and effect
CITY UC.NO.: LICMsS: C-36 uc_ ./ 47 EXP- MAIN BUILDING ACCESSORY BUILDING
// / �yJ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dae: y/ /f �5 O«" °° / I�" !�/( LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER B ILDER ECLARATION:I hereby affirm under penally of pe' that I am exempt the Contractors License Law for the
following reason(Smian 7031.5 Business and Professions Code:Any c a county which req bes a panne to conswc,affer.improve. PARKING REQ: PROV; PARCEL : 42533320 ZNE: REF NO:
=ow.,or repair any structure,prior to Is issuance,also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES>
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 hew she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant for a permit subjects the applicant to a rival penalty of not more than five hundred dollen[S500)). *******************************************************************************
❑ I,as owner of the properly or my employees with wages as their sole compensation,will do the work,and the stature a nal intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sac(`^tion 7044,Business and Professions Cade:The Contractors License Law does not appy loan Owner of popery
who beide or improves thereon,and who does herself work himself or hersor through he such
or her own employees,provided that
improvements are not Intended or offered forsale.II.however,the building or improvement S sold within one year of completion.the ZONING APPROVED BY DATE:
saner-builder will have the burden of proving he or she did no build or improve for the pe pose of sale).
❑ I.as owned thepropety.am exclusively contraajee withtensed contractors to coney«d the projed(Section 7044.Business and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not appy to an owner of properly who builds or improves thereon and who I
contracts ler such projects with a oontrector(s)licensed pursuant to the Contractors License Law). \/•,r
❑ I am exempt under Section: B.AP.C..I«tis reason: APPLICATION ISSUED BY: DATE: `�
******************************************** ********************** *********
Dale: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby amity that I am aware of end understand the requirements of California Neagh and Safely Code Sections 25505.PAST,.and I'
25534,and that i«any Murebuilding occupant will/wit not(circle one)need to comply with said state codes aMtM requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a perm)for construction or modificationfromthe A)Quality Management District.Residential construction apple/dons ere exempt from these •
provisions. PERMIT 7 . 00
Date a : 25% V'
SMIP/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE 20 . 00 ..--
❑ Ihave and wil maintain acertified.)oconsenttoseffinsurefawater; m
c«npeetion.asprovidedfor byStarer370oameLabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
code.I«mapedamencedlMw«kt«w hmispemnisi„ued. TOTALS----> 7 . 00 20 . 00 " 0 . 00 27 . 00 27 . 00 . 00
❑ I have and wit maintain workers'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the
work for which this perm)S issued.My workers'compensation insurance rapier and potty number are:
Carder: REVENUE DIVISION TOTALS--> COLLECTED : 27. 00 OVER/SHORT: . 00
PdicyNumber: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not becompleted I the paint is for one hundred dollars f$tXJ or Jess.) 27 . 00 ' t'
❑ !sanity that in the performance of the work for which this perm)is iasu I
1°'
sewsha101 hnsoemploy beproermsoen win anytent?:roetn:swoarakserto
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bac«ne1wtoiser•'ocm700aettohehderaC.I forth h.. . aI INDIVIDUAL•
F
E E BREAKDOWN
Date: � Applicant:
Warning: unto hunrowptocompensetlorcoverage
Iaunlit Aand shall s • • ner to penalties and TYPE QTY DESCRIPTIO- N UNIT COST
TOTAL COST
civil fines up to one hundred thousand dollars($104,000),Inadd! n to the CM oy co •
entastlon,damages as provided bet In .1
Section3706ofteLaborCode,Interest,andstbney'slees.
PLU 1 WATER HEATER AND/OR 'VENT 7 . 00 7 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there S a constmsion lending agency for the END OF FEES
performance of the work for which this perma o issued(Section 3097.Cb.C). . '7
LENDER'S NAME: r v/
LENDERS ADDRESS: 1I'
I certify that I have read this application and stale that the above information is correct.I agree to comply with ell city end county ordinances E XPIRE134�r
and state laws relating to building'mastodon and hereby aahor¢e representatives of this city to enter upon the abo -mentoned propertyUU VV
f«nnsped541
�rposes. DAN DAWSON
DATE
I 11 /^/
/ r' \ 01 00139634-00189634 TOT 27.00
Signal re- • -/Agent/Appican r, rector
Date: 'jjJ���"J DATE: 09/06/95 AIME; 10:51
)5151-46 W') White-Building&Safely:Green-Ale;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
0
CONSTRUCTION AND PLANNING POG _ SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date (pspector
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 •,�
Q. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
•1
.7. Footings 58. Electrical Conduit-Undrgrnd.
d. 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 OGas OOil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . . 73. Undergrnd.Storage Tank 0 Gas O Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural} & Monocoat 75. Dry Chemical j-r
27. Frame and Flashing 76. Dry Standpipe
„.„.4
28. Lathing& Siding 77: FIXED SYSTEM FINAL
• 29. Insulation • 78. FIRE PREV. FINAL • t
-rt.__.
30. Drywall Nailing -HEALTH DEPT. REQUIREMENTI-H
31. Plaster Brown Coat 79. FINAL INSPECTION c"--4
32. Electrical Power Meter-Final • 80., FOOD CERTIFICATE ISSUED 'C'
33. Final Electric Notes: ict
34. Final Heating& Air Conditioning 1-
c-b_n-2�zus
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation •
44. Landscape Irrigation System '
45. Sound Attenuation . . .
•
46. Handicap Regulations `
47. FINAL STRUCTURE & BUILDING
- 48. FINAL PLANNING •
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date