HomeMy WebLinkAbout913 VAN NESS CT - Building Permits�
CITY OF COSTA MESA
� o "'F,, BIIILDING D/VIS/ON
i� � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us
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� FOR INSPECTIONS CALL: (774) 754-5626
�"'"`°� PERMIT NUMBER: P09-00107
PERMIT TYPE PLUM
APN: 41808341
JOB ADDRESS: 913 VAN NESS CT CM
Vicinity:
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
08/26/2009
BE
SCOPE OF WORK: PLUMBING PERMIT TO CHANGE OUT WATER HEATER SAME LOCATION
OWNER: JANG, HENRY L Address: 913 VAN NESS COURT
PHONE: , City/State/Zip: COSTA MESA, CA
APPLICANT: ARNAUDOV, MARTIN , Address: .
PHONE: 515 779 2989 � City/State/zZip:
CONTRACTOR: CALIFORNIA DELTA MECHANICAL INC License No. 811114
Address: 6052 E BASELINE RD UNIT 155 PHONE: 800•898-0008
City/State: MESA, AZ , ZipCode: 85206 . CELL: 866-692-5273
ARCHITECT: License No. PHONE:
ENGINEER: Litense No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35.80
$35.80
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: �ERMIT 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 vnth all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiration of this permit.
GODE II. INSPEC710N TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roo(
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
D� INiRIA�S CODE/ INSPEC710NME
206 Final Mechanical
208 Final Plumbing
' 270 Final Electncal
212 Final Fire Prevenlion
220 FinalPlanningApproval
222 Final Site
250 FinalBuilding/Occupancy
ORTE IN�
9 s
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of the follovnng declarations:
❑ I have and will maintain a certifcate o( consenl to sel4lnsure for workers'
compensation, as provided for by section 3700 ot the Labor Cotle, for the
p ormance of Ihe work for which this permit is issuetl.
I have and will maintain v.orkers' wmpensation insurence, as requiretl by
sec' n 3700 of the Labor Code, (or the pedormance of Ihe work for which this
pertnit is issued. My wnrkers' compensation Insurance carrier and policy
number are: ` ,�.�—�
Carrier �7 R� f�. F� 1" 1�
� ' `(T�issedqnnee0irol�eco/m+d�eteddlh9epertnrt2avaluetlalonelruntl�edCdlars(5100)orless)
PolityNumber. �b � 7p �7
❑ I certify ihat in the pertormance of the work for which Ihis permit i5
issued, I shall not ploy any person in any manner so as to become subject
to the workers' mpensalion laws o( Califomia, and agree thal if I shoultl
become sub�e to the vrorkers' compensation pmvisions of Section 3700 of
the Labor , I shall lorthwith compiy vnth these provisions.
.��� �O �
/ Ap01iwn1's$ignaWre � Dale
WAR'pl(NG FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS YNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE L4BOR CODE. INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRAC70RS DECLARATION:
I hereby a(firm that I licensed under provisions ol Chapter 9(commencinq
vnth Section 7000 f ivision 3 of the Business and Prolessions Cotle, and
my license is in f I f�rce antl eHect.
i O.
�Lic.# a � �� Class'# ��
�-26 `�g
GonVacmr's Signalure Date
CONSTRUCTION LENDING AGENCY:
❑�I hereby aKrtn that there is a constructbn lending agency for the
perfortnance of the work /a which this pertnit is issuetl. (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
SignaWre Dale
OWNER-BUILDER DECLARA710NS:
I hereby aKrm thal under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe (ollowing reason (Set. 7037.5,
Business and Professions Code: Any city or county which requires a permit to
consiruct, alter, improve, demolish, or repair any slrucWre, pnor to its
issuance, also requires the applicant (or such permit lo (le a signed statemenl
that he or she is licensed pursuant to the pmvisions of the Contractors
License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the
Business and P�ofessions Code) or that he or she is exempt �herefrom antl
the basis for Ihe allegea exemptioa Any violation o( Section 7037.5 by any
appliwnt for a permit subjecls Ihe applicant lo a civil penally of not more than
five huntlretl tlollars (5500).):
❑ I, as ovmer of the property, or my employees with wages as iheir sole
compensation, WILL DO THE WORK, and the structure is nol intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of pmperty who builds or improves
thereon, and who tloes such work himself or herself or through his or her ovm
employees, provided Ihat such improvements are not intended or oftered for
sale. If, however, the building or improvement is sotd vnthin one year o!
completion, the owner-builder will have the burden of provinq that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The cont2ctors License Law dces not apply lo an ovmer of
property who builds or improves thereon, and who contracts fw such project with
a contracta�s) license pursuant to the Contractors License Lavrs.).
❑ I am exempt under sec.
Business and Professions Cotle for this reason:
305]-4fi(3I0)�
Owner ID verified by driver's license. ❑ Yes ❑ No
Dnver's License No. Expires:
Verification o! Ownership by (type of document, i.e. - property Iax Dill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlify Ihat no excavation frve (5) or more feet in depth into which a
person is required to descenQ will be made in conneclion vrith work auNonzed
by �his pertnit, and lhat no builtling s[rucNre, scaffdding, falsework, a demolition
or dismantling thereof, will �e more ihan ihirty-six (36) (eet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, TUe 8, California Administ2tive Code�.
❑ As ovmer-builtler, I will nol empioy anyone to do work which would
require a permit fmm the Division of Intlustrial Safety, as noted above, unless
such person has a permit to do such vrork from Ihe division.
APo�����'s Sie�awre Da�e
Division o( Industrial Safely Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need ro file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous materialT ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceptions, that a Business Plan be filed vrith the Cosla Mesa Fire
Departmen[ by every business which has a[ any one time during a reported
year a quantity of hazardous materials equal [o or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feel of compressed gas
at standard temperaWre and pressure�.
2. Does or will the applicant or present or fu[ure building occupant need to file
a registration form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the Cali(ornia Healt� antl Safety Cotle, vnth some
exceptions, requires regisiretion with the Costa Mesa Fire Depariment by
each business which at any one time has on hand a quanti[y of acutely
hazardous materials equal to or greater than a weighl of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre antl 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 0l the California Health and Sa(ery Code provides thal lhe
Costa Mesa Fire Depariment may require the prepara�ion, certifcation and
filing wilh Ihe Fire DepartmeM of an RMPP by businesses which are requiretl
to register acutely hazardous materials with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 0l the California
Health and Safery Code been (ully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require for
Ihe vrork which is the subjec[ pt Ihis application a permit for such construclion
or modifcation fmm the Soul� Coast Air Qualiry Management District or Gom
any other air polWtion coNrol tlistnct or agency? ❑ Yes ❑ No
(Section 658502 ot the Califomia Govemment Code requires that the requested
infortnation be lumished on applications fa noo-residential building pertnits).
6. Will any part of the (acility to be consWcted under this permit be within
1000 feet from the outer bountlanes ot a school7 ❑ Ves ❑ No
(I( "yes", the lacility must meet the requiremen[ of Sections 25534 and 42303
of the California Health and Safery Code).
7. I( a permit from lhe South Coast Air Quality Management Disirict or other
air pollution control disMct or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescribed by Calitornia
Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance fmm the appropriate air polNtion
contml officer).
CERTIFICATE OF COMPLIANCE: I certi(y that under penalry of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury Ihat I have read Ihis application and state that
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building constmction, and authorize representatives of
the City o( Costa Mesa ro enter upon me above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
�.
SignaWre 1LegalOwner(s) Date
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llC@ISED COHIP►CTOPS DECLAPATION: � he�eby ffi14m �ntler De�afY M pe�jury ttmt I em licermed urAx P�� a Cheplx 9
(mmmarciip wilh Sx1ian 10W) d Oivrsion � d Ne Bumm» eM PMesuons COEe. aM mY ��a o in lull brce eM elletl.
crfruc.No.:uJV.9&b uccu�ss:C-36 uc.No.: -����—� EXY, VLI78
Dma: ' �%% CaNrada: �-�`��
NEN BUILDEN DECIAHAiION: I henby dfi�m urMer penely d perlury thal I em exemq Irom iM Conlretlore Licenea Lew Iw ihe
'�IlowinB �aeaon (SMion )031.5 Bueineae end P�eae�ona Cade: Aery eIY a ooun�y whith �eyuirm e pe�nA �o eonsVucl, elle�, imyova,
imolsh, or repair eny el�udure, pbr b ils 68�erca. ebo requires tM eppli�anl Iw auch permil lo Rb e sip�wd eWameM �het he a aM
. lieemad punueni to iM peovisiona d tM G��redoro Lieertu lew �Cheqer 9(eommeiaip x'nh 9epion ]000) d Div'e'wn 3 d ihe
Busiewav eM Rdeaione Code� w Ihel he a die u exemq IhereM1am eM �he bnes la �he elbped mempion. My viole�un W Sedion
1031.5 Ey eiry epplinnt ta e permu eubpae �he epWi�aM �o e cvil peblry d m� mpe ihan frvs huMmA Adle�s �5500]).
❑ I.esowmrdtheqopenyamy«npbyaecxvhwapesm�M1eiedeoompenaelion.WlEONexoM.eM�heswcfurecmliMeMed
w M«ed M eek (Sacibn laa. Busirod eM PMeasbns Code: The Camreuan Liwu.lewdaee �q1aPOHto en own« a qoprry
who Wlde or inpmvea therean, ud who does euch xork IimneM w henatl a Nrwph hc a her own emplqeee, pmvked ihet euch
improvementa me not inleMed a dlared lor eab. N, however.lhe buiNirp w inpovemeM b eoN wnhin wre yev d aompblon, iM
owner�buiXler will heva the burcbn d D�'�^B � a she did �wt build or improre 1« iM Wm�e d eele�.
❑ I. en owner d iM O��Y. ��duivdY �nlredip Milh IiceneeE contrecWrs to wnsVup tM prol� (Smion 101d. Buaimee eM
Pmfexime Coda: The Conlradon LicMea Lew does ml epply lo an ovmer at pape�lY ��itle or impwes tho�eon eM who
conlrecle lor wxh piajatls xvh e mMrs'�a(*) Icenaed punuenl lo IM Conlretlara L'v.s�ua lew).
❑ I am eaemq uMer Seabn: 8. 8 P.C.. M �hn �eawn:
Dete: Oxner
i eo ne�M �en�ry me� i em a.ma d e�d u�eee�eiena me �ea��rem<oa a c��omie Heenn d,e seieir code sm�. zssos. usa�, ena
Y5556, enE ihel I a eny INure W iWinp ¢wpM� �II / will �(arch ona) neeE to mnply wYh uid me�e mdm eM iM reQuiremaim br
epertnnlormnavunionwmodifiratimhmmtMAv ue�y -enapemenl�ietna.ReeidaMielmiut�ud'pnepplmlionaereuamplmmlMee
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W ORKEX'S COYVENSATON DECLAPATION: I heraby elfiem �Ms ps�My d pe�j�vy ma W Ihe lopowi�q detleretom:
❑ I here uM xil meinlan e r.Mi'rete d ca�l to eMireun M wpken' compema�on, n pwiEeA In by Semon 3]00 W IM LeEa
Cada, lu tM pMwmaree d iM xwk la� �h iho parmn u avueE.
�i n....�d �e �ma.�.on�,� co�w�•�on �,reMe. m rea���.e W s.ao, o�ao a me ieeo, codo. r« ino oe�k,menoe a m.
work for wfiich Ihis permil is i»ueE. My waMere compenselion inwrenoe rarier vM pdiry number era:
c��.: �uLLE�E EXPIitES
� PdicyNumber. Nwr a a en�- G9/O1/98
(iha sMion neM rxxW canpbfed / t�s pamd is /w are hurMrad ddlers /$1WI a laa.)
❑ I oenA' � in Ne pMamence d IM w� ��+'M1� the pwmn ia ieauetl. I ahell na employ ury penon m ary meniror eo n io
becane wbja .ia iM xv ere' canps�*e�ion �ex+ d Celilomie. end apme thm A I Mwk become wdptl to IM xa�twe'
comPe�ion owiom W etlion 9]00 M IM Lebor COEe. I ahdl /onhxilh wAh Ihau .�.. /��
Dme� APdKam: � � \
�
erning: Fellun fo sxuro workeri rompeMatlon mverap� la unNwlul, antl shv/l wb�xf en employsr fo u/Mlul penelHs� eml
clvll fira� up ro ons huntlred MouuM Soll��+ (SfOq000), M etlJ/tlon b Ms roaf ol rompxustlory demsys� e� prov/Cetl br In
Sxtlon 3106 0l Ms LWorCotle, Irrterut, e� ettomsyi /w�.
CONSTflUCT10N LENDINO AGENCY: I haeW elfirm uMer penely d parjiry thel ihare u a omvrveion kMirq epeM.y lor iM
p,n��e d me wnc �«..tia� �nb v�� a en,ed cseeo� aoe�. ca. cl.
LENOEN'S NMIE:
LENOEX'S ADDRE55:
I cenity thm I heve reeE Ihis apqicelion eM etde �he� Ma ebova iMormetion ie cnnad, l epree lo cwnply xil� ell ary ad couMy adinencea
end stele levn releiiq ia building conslrudion Md hereby auihorrze rapraeanlalivea dthia cty lo an�er upon iM ebove-menloned propeity
/or insv�ion ourrosas.
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CONSTRUCTION ANO PLANNING � PdG��&.SPA
APPROVALS Permit # Date Inspector � AppROVALS Permft # Date Inspector
i. Tamporary Electrical Service Qr Pole 52. Pooi & Equipment Location , �
2. Soil Pipe-Undr9rnd. �� = 53. Steel Reinforcement ' ..
c.
, '.53� Electrical Conduit;�,t�fity-Un�grntl. 54. Forms . �� �
�
� �:r4> Electrical Condu i-.idrialrgrnd. �- 55. Electrical Bonding
��.''`�. Steel Reinforceii��z�� 56. Rough Plumbing & Pressure Test
��:� _ Electrical UPE 57. APPROVAL TO COVER-GUNITE
� 7'.� Footings �S �y � 58. Electrical Cond���Undrgrnd. '�
�a ��iv �a �• �
$..: Foundation �� ;� �D � 59. Gas Pipe, O U�icJr�rnd., Test �
9. Water Pipe•Undrgrnd. �y 60. Backwash �ine^ W-Trep, O Undrgrnd.
•-� r�i:_�
.1
70. Structural Floor Svstem �� 67. APPROVAI. T@ECK
: 71. Property Sewer Lina& House_Eonnection 62. Backwash & R�fle¢tor-Fir�l� " �
72. Sewer Cap „� . 63. Heater & Vent�Finai
13. Roof Drains �- . "64. Plumbing System � Final �
74. Rough Plumbing�` � '�? 65. Electrical�Finai _
15. Rough Electriral�Coiyiuit .. h 66. Solar System-RP:ta'F ��
1
16. Rough Electric Wirin`q� � ;� i 67. Fencing & Acc�S;ApProval'�
17. Rough Wiring SigP ;y 68. APPROVED Ff�IR�PLASTERING '
✓..
78. Rough Electrica'i�f Bar Ceiling , 69. POOUSPA SYST'�MS FI-NAL
19. iBougk? He�tir}g�& fjirkCondition{c�g� �rr,. k �� i� ,Z�t � ir Fbfl��i�fiPTi�iEQUIR:EMEN7 �r
' I'J '7N;T� 1*i K �>+ '7
20.'Rout�U F�tor�CFi�piace i Si:' �x" �k :S i-+ -'.«i APP�V9S'[�'S��" Pe'rmit# .K '�' .�
� i-� .% i 1-:� :S .k t-� �'7 '7't � .SI 7`Z ni 't�
27. �uct� in�, tr Uf�:t � •. .• '-+:S .K , • i�- �-� �
� �:K i 'Si-+ �r i� i. �,ki 70.t�Jndergr�ar.td � dro ��
22. Quctfl V€�iatilaLngV:� � i�'� _r i7 `t O iyk � ]�, produ ��i�ing�S�.i,�'ias (�Oil
23. Gas P.ipey�ou t � '��s '« :n �r �
� �� i �r�^ ,�s�� � �X �r :S�e � 72. Undergra�Ad Fjiis .r �N
24. �iooi FreRning ,, e ' ir `�� ;> �� �� �� 7 Undergr �d. Storoge Tanl� O Gas O Oil
25. ��oo(��$he�thing �:K � ` J�t'7 '7 I� �j.k 7� Overhead Hydr,3.• .«
26. �irBar..Ceiting (StruCtpral) & fV�dII�oat e O .� �7�K 7� Dry Chc�ical �^1� �* �� � �
27. F4 arr� a�� Flashin R I�i�� r,, :N ��:t � �:. ��in:� :K - is
��J �. ��� i-.i*f�� �T r :N�t 76. Dry Sta�P�Pe�;-� . k�7 �V ,a
.�
28. LatFiin9 �Siding � t� �j��j- �;, � ..�t 777 FIXED�9Y�5TEWt�NJA �� �� n�
29. Insulatio,t� �:K 'S •• :k K Y � i 'i�7 't '� �r �
�U h t' �� 6 S t �Sb� �RE:J�REV. F.�tv�L �: r.
30. Orywall fYpiling �� t i-� �K �� � .5i�iv ���Vi$ALT.H DEPi'. REQUIREMENT
.l•� H 1 1'
. 31. Plaster B�4wr�,�°a`�:K � ;'�i,r, .� Y" 79. FINAL ��I.S�ECT,�QN r:� t_
� H- ! 1 . .F W 1 _+�_11--K-
32. ��jlectrica ov�er t�qter��faai i .�: ` t BCh FOOD CERTIF�CATE ISSi'JED+
i � -
'7 .R Ir, � �_ .t • Y 1 .- �7 '7M R'7 �� iT1 �'
33. Fina'�lei�ric• 3�r r� ��-�i� i� k i; r f�q,4es: .Z �*1:'1 t �
� 34. ;fpna ^ eayi^g.�: At� 'Qtjditioning' j� �k '> 1 r n H j-. � .t � ' �
"1 I Y M
� 35. f9nal Gaf-Pipe=Test �r =^ •• �'� � � 'Z�� '7�-. �t i*� p.,.Q . - r• '
I-.'.K �� :k Y 1�7 , ••(1 1' R7
r 36. �Nooi�or Canopv ���e '�. i i �� �� �1 �t � kx �n x�� x �� �-� ��-
� , . , . - , � _ * ;:t
y 37. Pinal'Factory Firegl�ce.,'= � �^�"' �n K ,�� k � •4 � ,•" r �----
�T k
11 �I 1 • ,q '
� 38. Final-�lumbin9 rX y;r; i .a �L. ;� t� i� i� 'x
- J'v{ i..
� 39. Water Service-Pinat� �z 5_' i r i: K` :� :x
H�.r i� .r � v �..�� • �tr i*7
z 40. Gas Service-Final ;ti '� ,-�;�j� jr �� " � t i .,� • �+�;g �r ,2
�At. SolarpomesticFinalr � i*i �k r ir y�v r,^ :r.;q ,�
- �_ 1..: �i; �K '� K i-� �� i k 'C
^ 42. Backflow Pre �ter '� ;� � �� ; � . "� .'' `
.�j :k �ti H 'k �-� .K 1=� �T7�� �Y i-.
43. Backflow Irrig,'ation �} 'Yu r '�'^ ;�, � �V R ;; �,
- '7
,.. �, :.�T!i� �,� :R�TI - � � wid . i/
4�7. ��jandscap�, Irr�qation,.System ��.�;,, �� �p , .y y•t� ; � g �� )�� �r ,5 .
J
45. Sound ARenuation � 'y�� •• :k in i*f ��7.K � �r 7' C • �� +�
i� .'� �t �t IT1 ••�.K , .i i i-,!� ..rl :A
��6. Ffanc�cap'fiegulation�s 's .. r �,S � r � iT7 O � :j x
4�7. F1NA1 STRUCTURE & BUILDING * �� _ I � �x � �7' "k i�
•,t �-, ir�r e ' e : .; �7 :k O
48. F�N L PLANNING" ����+ k�`' . , '' �
J � .k 1 Y �: 1 .�J iU S .k 1
G9. �lectvm Release to Edison i :i ` i: t ^S •�� ��
t �7 o i-. 'X (1 -
;�,0. Qas f3�lease to Souttjem Califor��Gas Co :K 4t � 5 '�o l i �t, t.
i. CERTIFICATEOF CCUPANCY �
No. Date -
PflQIECT A�OflE55: C) i j VAN NESS CT
OWNEP'SNFME: TARRABE, PHYLLIS ANN
nooeess: g 1 3 VAN NESS CT
COSTA MESA,CA 92626
APCH/ENGINEEH:
AUOflESS:
HEG.NO.:
UNIT:
UNIT:
PE"MinEE: g2LT—WELL ROOFZNG ( 714 ) 758-3501
aooness: 3310 VERDUGO
LOS ANGELES CA " 65
LICENSEO CONTflALTOfl �ECLFPATION: I �ereGy aHirm lhal I am Iicen5e0 untler pmvi ions ol C�ap�er 9(cam np wit� Section
7000� ol Oirsion 3 0l t�e Business anU Pmlessions CoOe. and my licenu is in �ull �orc ntl ettecl.
c uc.: snT uc.:4580 _
� �-/-9
Dale Signamre:
OflNEflS' COMPENSATION OECLAflATION: I AertOy afiirm Iha� I �ave a te�ifita�e oi can5eni l0 Se - te�ifica�¢ ol WOrkers'
Compensaiion Insurance, or a rerti6etl copy t�ereol (Section 3800. LaD. C�.
aaucrxo.: W937102489 E%P.OATE: O%I3SI9�I
COMPANY: CAL COMP INS.
❑ Cerlifie0 copY is hereby lumishe�. Q Ceriilietl coDY �s file0 wilh t�e ciry Building Oivisi .
D�_ /I ') � �/ —�� ADPlicani: ,
�1(EMPTION FBOM WOflNEflS' COMPENSAiION OECLPflAiION: (Thi55eclion nee0 n0� 6e tompl¢Ie0 il �he permi� is AreO (8100) or less�.
I cehity Ihai in ��e pedormance of Ne work lor which �his permit is i55ue0. I s�all no� employ any person in any manne� 5o as lo hecome
Su01e�� �o Ihe Worker3' Compensa�ion Laws ol Caldomia.
Oaie: SiBnature:
NO7ICE: Ii, anet maitinq inis aeclaration, you snoul0 �ecome subject to t�e WOMeR' ComDensation prm'isions at Ine labOr
Code. you musl foNivnt� comply wi�� suc� pmvisions or iNs p¢rmii s�all he Ueem¢d revoke0.
CONSTNUCTION LENOING RCENCY: I �ereUy allirm l�at Ihere is a tonslmction lending a0enty �Or I�e Oedotmante al lhe work tar
w�ic� Ihis Oermii is �SsueE �Seciion 3097, Civ. C�.
LENDEN:
AODHESS:
OwNEN BUILOEB oECLAHR7lON: I nere�y aflirm Inal I am eaemo� ��om ine Cantractor5' Stale �icense Law for the followinp reason
�Section 7031.5 Business ana Pmfessional Catle: Any city o� caunty which rtquires a De�mi� lo conslmcl, al�er, impmve. Oemolish, or
reoair any stmcture, v�ioi to ns issuance, also reQuires the aoolicant lor sucn permit to file a signed statement Ihal he/sAe is licensetl
pursuant io Ihe provisions of I�e Contracmrs' State License Law (Chapter 9(commencing wit� Section 7000) of �ivision 3 0l Ihe Business
ana Prolessions Cotle) ar Ihat he/she is exempt Ihereirom an0 �he basis lar �he allegeA exempiion. Pny viola�ion ol Section 7031.5 by
any applican� �or a Oermil sublec�s �he applicant to a ciuil penally o� not more Ihan live hunOreO Uollars (5500�.
I. as owner of ihe D�oDeny or my emplayees wit� waAes as iheir sole compensation, will tlo ihe work, antl t�e
� simcmre is not intenAed aroiferea lor sale (Section 7044, Business ana Professional Coae: The Contractors' State License Law
Ooes no� applY to an owner 01 a pmp¢ny who �uilds or im0�oves Ihereon, antl w�o Goes suc� work �imsell/hersell or �Amugh
his or h¢r own employ¢es. prOviGeG ��ai SUG� impmvemenis are n0i intentled ar Otl¢re0 lar sal¢. I�, �owever I�¢ Guilding or
impmvement is soltl wrthin one year o� comple�ioq t�e owner will �ave Ihe hurAen o� Dmvinq he/she tli0 nol builtl or impmve
for Ihe Duroose of salel.
I. as owner ol i�e pmpeny. am eectusively coniractinp wit� license� contractors to cons�mci ihe O�alect (Section 707d, Business
❑ and Pmtessions Coae: TAe Comracmrs' State License Law does not appry ro an owner oi pmDe!ry who hml0s ar impmvw thereon
antl who contracis lor suc� pmjetls wil� a contractor�s)license pursuan� to t�e COntractors' $late Liten50 Law�.l am awaf¢
Ihat pwoi o� I�eir WOBer'S Compenuii0n in5urante ShaUltl be O�ovitleC lo me.
� I am evemD� unAer Section: B. 8 P. C.
for ��is reason:
Oate: Ownec
I ao �ereby cenily tnat I am aware ol antl unUerstanA ihe requiremenis oi Califomia Heallh anU Salery COUe Sections 2550.5. 25533, an0
25534 and ��at I or any future building occuDanl willlwill no� (circle one) need lo comply with Saitl s�a�e cotles anE �he reQuirements for a
permil for conslmciion or moddication Imm ihe Air Ouali�y Managemenl Oislrici. RevGential cons�mc�ion applica�ions are eremp� trom
Ihese pmvisians. ��
�aie: Applicanl:
I nereby ceriity I�at I �ave read Ihis aOPlication and s�ale Nat �he above information is « ecL I apree
ortlinances ana statelaws mlalingto builaing consimclion and hereby aulhoriierepresen�at es olihi
OrOp¢tly IorinSp¢tlian purpase5.
�G 'i—/ ._Clrl _.
wi�h all ciry an0 county
on Ihe a0ove�men�ionetl
�6imer's ��cense ar Salai Securiiy n: ��
I6a1-afi Whne—Buileing: Green—Cotle Enlorcemen�: Canary—ApP���anL Pink—qevenue; GdOenraE—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 067797 PLAN CHECK NO; N
CONSTRUCTION TYPE; V—N PERMIT TYPE; STR
JOB DESCRIPTION ; T/OFF 6 REROOF WITH COMP, 6 BUR IN BACK
PERM NO; B 067797
GOVT: N SUPP: N
FURPOSE: OTH
SQ FT; 1,100
CLAIM VALUE: 1,100,00 CALC—VALUE: 1,100,00 GROUP OCC: R-1 /M-1
COMMENTS; SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM 6 HALLWAY
�ri�***�r******+t�r***#**�r***i��r�r+r�r�-�c��**�r+��r#�r*#****#*�u�r+rwu*x��#+r�r���+�#**x��eu��x��##x�*���
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAZN BUILDING ---------- --------- ACCESSORY BUILDING ---------
F�iTdT; FT IN REAR• FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ: PROV: PARCEL; 41808341 ZNE: REF NO:
PLANNING NOTES>
>
itililiEiFiEititb#ikitifitiEikifiEkiliEiFfEi(-iEffiE#iEih#iEiliEititiElEiEfEiEikiEifitiEihiEiE#if#ft#ifiliFiEjEiEfE#iE#�lEifiEifi?'#iE##%iEifiFiF#
� D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N'1` S
ZONING APPROVED BY DATE:
HUILDING APPROVED BY : DATE; "
APPLICATION ISSUED BY: /� DATE: � p�'
*******�***x�**********�F�g�F��rr�iFT�iF� �" - �r��iFi���3F3FiF�riFTr��r��r*�*�t�r�r��ru-#��i�' iFir�r�F�F *k�
��*�r****x�****�r�t*�r*+t*+t***�*******�t*****x-�c-�*#*�*x�+r��+t+�**�+�***�+r+r�r�r***�#i +r�t#�*i�
�
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 27.00 .50
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DZV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 27.50 0.00 0,00 27.50 27.50 ,00
REVENUE DIC'ISION TOTALS--> COLLECTED: 27,50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
2�,�0 ,50
iEiEiElEiflEiElEililflifik#1E?fiEiflElEiEiliEifif###i!#1EiFiE#fElEiEitfliEifiEiFif#1Eik1E�E1f#iFih#ifilfE#1(�il�lfif#1f�(-�)E##�E1!##iflfiEiF##Y:
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1100 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 1,100.00
END OF FEES
O1 00365301—OOi63302 TQ T 2].50
DATE: 07/01/94 TIME: OE:54
�
CONSTRUCTION AND PLANNWG PGv� & SPA .
APPROVALS Permit# Date Inspector APpROVAIS Permit# Date �nspector
i. Temporary Elecviral Service or Poie 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. Steei Rzinfo.cement
3. Electrical Conduit Utifity-Undrgrnd. 54. Forms �
4. Electrical ConduirUndrgmd. 55. Elecirical Bonding
5. Steel Reinfarcement 56. Rough Plumbing & Pressure Test
6. Electr�cal UFER Grnd. 57. APPflQVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8, Foundation 59. Gas Pipe, 0 Undrgrnd., Tesc
9. Water Pipe-Undrgrnd. 60. Backwash lines, P�Trap, V Undrgrnd.
10. Strucwral Floor Svscem 61. APPROVAL TO �ECK
7 i. Property Sewer Line & House Connection 62. Backwesh & Recepcor�Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumhing System - Final
14. Rough Plumbing 65. Electrical-Pinal
15. Rough Electrical-Conduft 66. Solar System-Final
76. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Siyn' � 68. APPROVED FOR PLASTERING
18. Rou9h Electrical�T Bar Ceiling 69. POOL,''SPA SYSTEMS FINAL
19, Rough Heating & Air Conditidning ' FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit �
21. Duc[s, in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping �Gas ❑Oil
23. Gas Pipe�Rough & Tesc 72, Underground Flush
24. Roof Framing 73. Undergrnd. Stora9e Tank O Gas ❑ OII
25. Roof Sheathing 7�p �L� ��b 74. Overhead Hvdro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chem;cai -
27. Frameand Flashing 76. Dry StanCpipe
28. Lathing & Siding . 77. �FIXED SYSTEM FINAL
29. Insulation 78. FIflE PREV. FINAL
30. Drytvall Nailing HEALTH DEPT. REQUIRE(v1ENT
31. Plaster Brown Coat J9. FINAL �NSPECTION
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Pinal Gas Pipe•Test
36. Hood or CanopY ' �
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations � �
47. FINAL STRUC7URE & BUILDING �!� g�/, �,w�L
'4
48. FINAL PLANNING �
49. Electric iielease to Edison �
50. Gas Reiease to Southern California Gas Co ,,
51. CERTIFICATE OF OCCUPANCV �
No. Date '
�
1RACT N0. 10445
LOT N0, 96
�
DATE Febrnary 25 19R0
ADDRESS 913 Van Neas Court, Coeta Mesa, California 92626
Development Services Department
Planning Division
City of Costa Mesa
77 Fair Drive -
Costa i4esa, CA 92626
Attention: Mr. Paul Dudley
Dear Mr. Dudley:
Please be aware th
on the above refer
tract and its str
City of Costa �
he und'ersigned are aware that a certificate of ::occupancy
d/]:o,t/and unit is being requested prior to the entire
and�co�on areas being completed and accepted by the
BY P� nr��
( G OF DEVELOPE AA'D OR
-AUTHORIZED REPRESENTATIVE)
BY
SIG ATURE OF �NDER)
��-',
r.tTl �= !tfilvn
�`��. �• �z; ,� r^
�Vh
�� ��� i � �
� 1u f; i�,�,.��.sigi546
�