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1101 VALLEY CIR - Building Permits
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT ,lob Address: 1101 VALLEYCI Status: ISSUED Suite No Applied'. 05/16/2002 Vicinity: Issued: 05/16/2002 Parcel Nunmber: 42203120 Applicant: PENSO, JOHN ISSUED (3Y: Address: 4522 EISENHOWER DR Phone: (800) 503-2666 ANAHEIM, CA Zip: 92809 Owner:' ATKINS, ALONZO JR Address - 1101 VALLEY CIR ' Phone: COSTA MESA, CA Zip: 92627 Ep�� Contractor: ECONO AIR Address: 4522 EISENHOWER DR ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ANAHEIM, CA 'Phone: (800)503-2666 Zip: 92809 License: 445220 SCOPE OF. PERMIT REPLACE AND MOVE FAU TO ATTIC, 10 DUCTS AND ADD NEW A/C. INSTALL 2 BATHROOM VENTS. COMMENTS / 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 24 646 (600) FEE SUMMARY Quantity - Quantity $23.50 Temp Dist System / Lighting $0.00 0 $0.00 Busway /100 ft $0.00 0 $0.00 Standing Section $0.00 0 $0.00 0 Misc Electrical Equipment $0.00 0 $0.00 0 Transformers up to 1 kva/kw $0.00 0 $0.00 0 ................up to 10 kva/kw $0.00 0 $1.10 1 .................up to 50 kva/kw $0.00 0 $1.10 1 .................up to 100 kva/kw $0.00 0 $3.30 _ 3. ..................over 100 kva/kw - $0.00 0 . $0.00 _ 0 Low Voltage Equipment $0.00 0 $0.00 0 Low Volt Wiring System / Ckt $0.00 0 $0.00 0 Misc. Conduit $0.00 0 $0.00 0 Misc. Conductor $0.00 . 0 $0.00 0 Circus ( gen or ride) $0.00 0 $0.00 0 Circus (mach ride or lights) $0.00 0 $12.30 1 Christmas Tree Stand $0.00 0 $0.00 0 Fireworks Stand $0.00 0 $0.00 0 Other Electrical Fee $0.00 $0.00 0 $0.00 0 Investigation Fee $0.00 $0.00 0 Plan Check Fee $0.00 $0.00 0 Reinspection Fee $0.00 $0.00 0 $0.00 0 TOTAL CALCULATED FEES $41.30 $0.00 0 COMMENTS / 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 24 646 (600) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 --t work for which this permit is Issued. IDE], 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. �� y woorkers' com enyation Prance c mer and Icy number are: } Carder: r �/ Polity Number: �� OJ a L �V %7ilis section need not be completed If the permit is va ed atone hundred dollars ($100) or less.) ❑ 1 certify that in the performance of tho wort whic h' permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia, d a r� at if I uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provision Applicant Signeture:� 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 DOUARE ($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 h=y.afffrm.thatISm 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. » �" d Class q L Contractors Signature: 7 t CONSTRUCTION LENDING AGENCY: ❑ 1 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 for a permit subjects the applicant to a civiI penalty lof not more than five hundred dollars ($500).): ❑ I, as owner of the property, orpy,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, em 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 contractors) 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 drivers license. ❑ Yes ❑ No Drivers 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, 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 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? ❑ Yes ❑ 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). ..........._................................................................................................................................................_............... _.__.... .._............... ....................................... ......................... I ................................................... ..................................................... 2 Does or will the applicant or present or future building Occupant need to file a registration forth 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 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 Califomia 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 plication a(LgyrNgt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes J No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................................................................................................................ fi 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? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 6 (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. 1 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 ell state I.gws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectio rposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. I Of Le tQwner(s) D e —And/Or'Authorized-AppOcant r Date CODE I. INSPECTION TYPE DATE INTRIALS CODE r INSPECTION TYPE DATE IIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Root 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/O=upancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1101 VALLEY CI Suite No Vicinity: Parcel Number: 42203120 Applicant: PENSO, JOHN Address: 4522 EISENHOWER DR ANAHEIM, CA Owner:-ATKINS, ALONZO JR Address: 1101 VALLEY CIR COSTA MESA, CA Contractor: ECONO AIR Address: 4522 EISENHOWER DR ANAHEIM, CA MECHANICAL PERMIT Phone: (800)503-2666 Zip: 92809 Status: ISSUED Applied: 05/16/2002 Issued: 05/16/2002 ISSUED BY: Phone: � Y Zip: 92627 .Phone: (800)503-2666 Zip: 92809 License: 445220 SCOPE OF PERMIT REPLACE AND MOVE FAU TO ATTIC, 10 DUCTS AND ADD NEW A/C. INSTALL 2 BATHROOM VENTS. 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 24 6-46(6/00) FEESUMMARY Quantity Quantity ISSUE FEE $23.50 _ Repair/ Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $14.80 1 Repair / Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 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 $6.15 1 Up to 3 hp / 100 k BTU $0.00 0 Factory Fireplace $0.00 0 - 3 To 15 hp / 500 k BTU $27.15 1 - Hood w/Mech Exhaust $0.00 0 - 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 $14.50 2 Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $10.65 1 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $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 $96.75 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 24 6-46(6/00) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 _ 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 pertonnance of the work for which this permit is issued. My workers' 7-"nsaf. Insure career and policy number are: I CaIrrier. �Policy Number. %6Q•?��6L� L(This'section need not be completed ff the permit is valued at one hundred dollars ($100) or less.) �l ❑ 1 certify that in the performance of the work f h' is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, an gra I ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Appficantstgnature: — WARNING -FAILURE TO SEC W ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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 ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: jherebyaffkm that-l-am.licensed u r ovi 'o of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod it my license is in full force and effect. Lic. N a-a'O Class M C! O • C,77-- / Contractors Signature: r Date: i� 1-4, �u CONSTRUCTION LENDING AGENCY: ❑ 1 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).): ❑ 1, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, I.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, ialsework, 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? ❑ Yes ❑ 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 forth 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 greeter 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 materiels with the Fire Department. ........................................................................................................................................................................................................................................................................................................................................................................................... 4 Ii 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 plication a Ppermit 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 LJ No (Section 65850.2 of the California Government Cade 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 feel 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 It 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 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 I xs end city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins ectio urposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si ! Of Legal Owner(s) Date � XS 07i And/OrAuthortzed-Applicant-1 t Date 7 CODE.. INSPECTION TYPE PAI& IHTmALS CODE INSPECTION TYPE JIM INITIAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy PROJECT ADDRESS: 2i PLACENTIA AV 211 OWNER'S NAME: ` 'E, PAUL rN{meg ADDRESS: SAME / ,/ /_ r icq to ARGH/ENGINEER: ADDRESS: REG.NO.: UNIT: PERMITTEE: LEHMAN ROOFING, INC, (714)850-9915 ADDRESS: 3444 W HARVARD SANTA ANA CA 92708 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Div; ton 3 of th usiness and Professions Code and my license is in full farce and effect CITY UC.: 642353 STAT(14996008 CLAS s: — 9 EXP; 08/95 Date'. /B � / � _ ' Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cenificate of consent to sell -insure or a cenificate of Workers' compensation Irr2'8'5q-9sfUr f111u p0IgrV5F4ction 3800. Lab. b 1 /01/95 ^DLICY No.: STATE FUND EXP. DATE: 'OMPANY: �( i Certified copyishereby furnished. LJ- Certified copy is 1 etl wi the city Builtling Division. Date ii' / ( 9` � Applicant:— RZ;; EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit isfA one hundred (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 ny manner so as to become subject to the WorkersCompensation Laws of California. Dale: Signature: NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State 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 penalty of not more than five hundred dollars ($500). r m with w a their compensation. will do the work and the s as owner of the property c y employees 1 ages s e sole p structure is not trended owner offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to employees, owner of a property who builds improvements are thereon, and who fere such work himself/herself or building r his ro her own employees. provided That such improvements are not intended de offered pr for sale. If, however the building ve improvement is soltl within one year of completion, the owner will have the burden of proving he/she did not bui10 or improve for the purpose of sale). I. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Elantl Professions Code : The Contractors' State License Law does not apply to an owner of properly who builds or improves thereon and who contracts lot such projects with a contractogs) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Workers Compensation insurance should be provided to me. ❑ I am exempt under Section: B. S P. C. for this reason'. Date: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from these provisions. Date: Applicant. I hereby cerhly that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction an mby authorize representative this city to enter upon the above-mentioned property for inspection purposes Signature' Driver's License or Social Security x: 164146 While—Building: Green—Code Enforcement: Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06939 PERMIT NO: B 069392 PLAN CHECK NO: N CONSTRUCTION TYPE; 5—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION ; T/O & REROOF W/BUILT—UP SQ FT; 6,200 CLAIM VALUE; 6,200,00 CALC—VALUE: 6,200.00 GROUP OCC; B-2 / COMMENTS; REROOF 5400SF COMMERCIAL BUILDING 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 ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; 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; 00000000 ZNE; REF NO: PLANNING NOTES> 1f 1f 1HfH 1F 1flflflf lH BH Bk BH BF iF iH Bf 1H Bt Bf EEEr it ff it it �H it at EB*�t*�t EH ar it �H*8t 8t**it ie it ie*et Et it Bt Et*it**�H*r**it it it it+t it**�t it it it Tt �t rpt it 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•T S ZONING APPROVED BY DATE; BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE: iF*1t 1i li if**BH iE iER:lH*BHlF Mif iH*iF iHk iH iB***4***BH iHiH iB ie iH iH iH iH*iF iH iH it*ae iH***B8**r**iF*iH*iH *it r it**ie iH*ie *iH iH**Et 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 90,00 PLAN ISSUE FEE BUILDING—DIV—> PERMI AN— T ISSUE PL CHECK TOTALS ---- > 91,30 0,00 0,00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 90.00 SMIP/NON—RES 1,30 TOTV-00VER/,�W: PAID DUE 91, 91,30 ,00 T r91.30k,a�yy,aa�, ©(�FIRE SMIP/TOT "NG PVAN `CHECK 1.30 if iH iE iH**Bfkkif iH if iH lE lf*iE*iH*Mlhif*kBt iH*ie iH iH*****iH*BH*Br kr*iH Bt*iH*iH BH****Bt*crit*fH iH iHk*ft it it it iH BH it itfH+HiH tt it ie 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 SFC 6200 REROOF BY VALUE COMMERCIAL NOZONE 1.00 6,200,00 END OF FEES V WOUPLICii RECEIPTat 01 001-59912-00169913 TOT 31.30 DATE: 10/19/94 'T16E; 15r:14 G S: CONSTRUCTION AND PLANNING-. P & SPA APPROVALS Permit Date - Inspector APPROVALS Permit# Date Inspector l i. Sergce or PolerV 52. Pool & Equipment Location Ellectrical 2. drgrnd. v.;, 53. Steel Reinforcement - r Electrical Corrc&u 'Otility-'Undrgrrrd'. 54. Forms 14 Electrical Conduu:Vndrgrndo- =1r 55. Electrical Bonding 5. Steel Reinforcenie4t oma 56. Rough Plumbing & Pressure Test t" `\ Electrical UFER,Grnd, c� '•'` ` •'' .., 57. APPROVAL TO COVER-GUNITE _ Footings "^ T -- 58. Electrical Conduit-Undrgrnd. r• ='r IS..Eoundation 59, Gas Pipe, O Undrgrnd., Test �^ " 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. structural Fioor System .., 61. APPROVAL TO DECK 11. Property Sewer Line & House'Corinection 62. Backwash & Receptor -Final j 12. Sewer CAP 63. Heater & Vent -Final 13. Roof Drains T7 J 64. Plumbing System - Final 14. Rough Plumbing r' 65. Electrical -Final 15. Rough Electrical -Conduit_ 66, Solar System -Final 16. Rough E1ectr2'Wiring 67. Fencing & Access Approval 17. Rough Wiring,Sign `L` 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOLi SPA SYSTE+NIS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' C r--�74. -rz x N C? Pen!nit# v r' - 26i- ROUgh'�acfci y Fireplace :. in �"1 ."+ C' I1APPROVALSJ nj b .•. 21wD6gts,u( SL ucttl C. t H 7 ""-r .. Jrou^+.y ,i 5 •+ n e'rgn Hy,�:Iro .. ' 22. DtfCts,�lfenti:atitt�. 77. Produc`j: f;Pjng Gras DOiI 23;;•Ga`Is,PiPer,-Rough &'#Test - Cr. Undergrour)Fu r - M 24ziRopf F,iamisg tr'o _ Ja•.73=Udergrd.Stot_7';ank' TyO Gas E'011 I ti 25. Rti6f Sathing ` `lD '��-�Y'(Q,' ; ' 74j gverhead°Hydro)•�` 26e T -Ear Ceiling (St`ructural) &,Jvlonocoat ♦ m ''011! i 75F• Dry Chemical �-1 * -+ r;\ a; 27;,Frame nd Flaslj mac` 'r r S y 7e Dry StaniikiCpe.-gym v T �• ..} uP' i r.r O _ 28: Lathin �& Sidinj, c^^,4 + fl; 9= >, 77; FIXED SlYST_F'Fa;FINA[i' -;-ra: %'29. Insulation ( 78�f FIRE PREY. FINL•yL �; ,- x � ;30. Drywall Narling rz e > { j r r- �1 +HEALTH7DEPTr. REQUIREMENT , Y Plastertrown Ceat< { j; * 79�FINAL I JS�ECTt�N .'31. ; trn. u , 32;•Electrical Power-Mett'5-Final y, a n; ( �+ * : ;80:+IFOOD CERTIFICATE ISSUED + Etgctrj,c.,1 Notes: -33'.LFinel en 34, \Find Hgatf Q & i4 Conditioning: ^35ilFirial Gas PC�-Te3i ! { I: + pl:i� a •� -, (-: r\n .-r 367. .,Hood 6�t+Canopy _�37:=Fin`al Factory Fire111ace,k IF I i V `.38. Final Plumbing .39. Water Service•Final+ - • G 1 I f, ' " �?' f c' G x -,,40. Gas Service-E;inal ; ,� ,... ; "• t^ j L° \ ` ,_�� ,i, �; '•' i:41. Solar Domestic -Final ll •- r G � � �a + + -t _ •� Ir• .1 --42='Backflow PreventeC F" ; =� rr - r-. _. 43. Backflow Irrigation V :� = W I u'H=� -. •-, 44. Landscape Irrigatian System; In i T i- {-J +',"[ l Imo' 0} r`j 11� C� `:45;:Sound Attenuation 46`.Handica`� Regulatigns i! ; P' ; a J a, , ri x '47:sfINAL5TRUCTURE&BUfLDING / R� � `[ 'i (V •- T48'Fla;ALPLANNING �� ry t"` t , * ^49r�f1ectric Release to EdisonV • b; ' = n50., -Gas Relapse to Southern CalilfQl�rlia Gas Co G'.- �' ry `-'"� ; ; .51. CER,TIFICATEOF;OCCUPANCY No. Date 0 Fi ADDRESS: 1101 VALLEY CI UNIT` . OWNER'S NAME: ATKINS, ALONZO JR ADDRESS: ATKINS JULIE 1101 VALLEY CIA COSTA MESA,CA 92627 722-1871 ARCH/ENGINEER: REO.NO.: ADDRESS: UNIT: PERMITTEE: ISLAND PACIFIC ROOFING (714)637-2493 ADDRESS: 2923 S. PULLMAN AV B S.A. CA 92708 LICENSED CONTRACTOR 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. vLIC.: 0 5'709 STATE t631472CLASS: ExP; 00/00 D e: Sign/� /lc� ORNERS'COMP NSATION DECLARATION: Iherpb a nn that l have a certificate of consent to sell -insure or a certificate of Workers' Compensation Insurance. or a certified copy mereo (Section 3800, Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be Completed it the permit is for one hundred (Sloe) or less). I decry 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 sublecl to the orkers'�C9ompensation Laws of California. ate '"I Signator � OTICE: 1 . afte making this declaration, yo put become subject to the Workers' Compensation provisions of the Lahor ode, you must forthwith comply with such rpv5ions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency for the performance o1 the work Ior Which this permit is issued (Section 3097, Civ. Of LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that) am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code'. Any city of 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/she is licensed pursuant to the provisions of the ContractorsSlate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) 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 penally of not more than five hundred dollars (65130). I. as owner of the property or my a layers with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sate (Section 7044, Business and Professional Code: The Contractors' Stale 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 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 will have the burden of proving he/she did not build or improve for the purpose of sale) - I,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Cade: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contradicts) license pursuant to the Contractors' Slate License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C. for this reason: Dare: Owner I do hereby Certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential Construction applications are exempt from these provisions. Date: Applicant: I hereby Certify that I have read this application and state that the above information is correct. l agree to Comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned r0 rIy Int/infs ¢ction urpo5es te: z✓� Sip������ Driver's License or Social Security p: 164146 While—Building: Green—Code Enforcement; Canary—Applicant: Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 069361 PERMIT NO: B 069361 PLAN CHECK, NO; N GOVT; N SUPP: N CONSTRUCTION TYPE: 5-N PERMIT TYPE: SIR PURPOSE: ALT JOB DESCRIPTION REROOF OVER WOOD SHAKE W//COMP, SHINGLES SQ FT: 2,500 CLAIM VALUE: 2,500.00 CALC-VALUE: 2,500.00 GROUP OCC: R-3 /M-1 COMMENTS: DETECTORS IN BEDROOMS & HALLWAYS 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 ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT; 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; 42203105 ZNE; REF NO: PLANNING NOTESb, 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 NIT S ZONING APPROVED BY DATE; BUILDING APPROVED BY DATE; /!y1 APPLICATION ISSUED BY: (''� DATE: L.?_'GA L'4A I'l rani. hl r- L a Y rlr Lu "•= A SEGMENT:Y Lr.i A IZAT!ON -h4 PERMIT PILIi54106 iH1T rIC1lY!pt(<]F3 mt,DfTFlI!_ Ms Ht!Nvf FIRS 8m Ir%Rz5 L=TEES.L:IN0 4 06 50 PLAN SMIP/NON-RES ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL _ PAID DUE TOTALS ---- > 54,50 0,00 0,00 54.5( 54.50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 54,50 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 54,00 50 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 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 2,500.00 END OF FEES / 01 00169818-00169819 T CDT 54,50 DAT'EL 10/14/94 TIME= 16:04 --------Z - r ,�r CONSTRUCTION AND PLWINNING APPROVALS Permit #>_ Date 'Inspector POOL & SPA 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 Urdrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &House Connection 62. Backwash & Receptor -Final ' 12. Sewer cap s 63. Heater & Vent-Fina4 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 16, Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping []Gas 00il Nil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas ❑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 Electric 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 + f 45. Sound Attenuation Handicap Regulations F47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING -- 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy CITY OF COSTA MESA CONSTRUCTION PERMIT 1 Project Address C ill 1 - Applicant's Mailing Address l 0h 22 T :O I .'iy^ u- G.C. Owner's Name L-1 i' A='rl11S Phone—/22 ZI P, 1 Address 11 V--' Cil-IC1^ a M2=111—'r Arch/Eng. License No. Address Contractor's NameF—"""`^ rl —�'^=- Phone'='=7 Address (mailing) 10422 TrTi61- Ay -nn- G]-YC^n (3rnv City License No. 666`: LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under pray:s of Charter 9 (commencing with section 7000) of Division of u5iness a Professions Code and my license is in full force and et ect. I License Class 1 :censeNo. - Date�,�1D/£,'4 Si9natrire / WORKERS' COMPENSATION DE9A,.1ARATI hereby affirm that I have a cer to of consent to self -insure or a certificate Workers' Compensation Insu nce, or a certified copy thereof (Section 300, LaqJ2. .) /000x_ Na 61 on-?1�-. Pd.— � icy �CQQ i ==-_ company Certified copy is hereby furnished. Cert iJ ie c 0y,15 filed wit h.t he city BuiltliP9 Diviygn Dale`-/ lit9ii7 Applicant A—dr9'3 t 1Lr. -.-1i„a{;l -i EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person.in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lentling agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of rhe Contractor's License Law (Chapter 9 (commencing with Section 7000) of ision 3 of the Business and Professions Code) or that he/she -is exempt efrom and the basis for the alleged exemption. Any violation of Section ,1.5 by any applicant for a permit Subjects the applicant to a civil ndlty of not more than five hundred dollars ($500). ❑ 1, as owner of the property or my em Ployees with wages as their Sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/Perself 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 com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con. tlactorS to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or -improves thereon, and who contracts for such projects with a con. tractor(51 license pursuant to the Contractor's License Law). I am aware:that proof off their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C� for this reason Date wner I hereby certify stat l�d this'd AAtion and state that the above Drivers' License or SS mining c u uuy aumoriZe repre- enler up, abyye-mentioned property for lines and sign all appropriate declarations. 2501" U Reinspection Fee $15 Issue Fee $ 3 AANICALFEES DEVELOPMENT SERVICES REQUIREMENTS:I TYPE OF CONSTRUCTION 1:1 ON LJ NEW HADD ALTERATI ❑ CONVERSION ❑ DEMOLISH ❑ OTHERA DESCRIPTION OF WORK/USE OF BLDG. _ _S � REPAIR p # ,Zone - Main Building: • Accessory Building: TYPE OF''PERMIT GRADING FOUNDATIO•N STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER T Front Refrigeration System B A Rear ' 00-100,000BTU 0100,000BTU PROJECT DESCRIPTION SQ. FT. OCCUPANCY— CONSTRUCTION TYPE VALUATION $ 'ZONE GRADING CU.YDS. ACRES C Right S Left Ping. Ref. # Parking R q./Pro 0 Remarks: - Planning Notes: DT€i��iyAVK __ • ;' .PLUMBING "FEES MECHANICAL $ TOTALFEE $ 5oa Bar Sink Showers Issue Fee $ 3 ELECTRICAL _ FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW _ 050+KW Backflow Irrigation Sewer Cap Bathtubs - Sewer Connection Cooking Unit - Meter ❑up to 100 amps Clarifiers - Solar Collectors . Dishwasher - Meter ❑over 100 amps Dishwasher Solar Piping ' t Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank - Fan Motors00-1 HP 1:11'A-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors 1 Water Heater 0C Outlets Range ' Kitchen Sink Water Service - Switches - Sign ' Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 1 Issue Fee $ 3 Q Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting E10-1 00,000 BTU ❑ 100,000 BTi Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Z O N I N G R E Q M T S Reinspection Fee $15 Issue Fee $ 3 AANICALFEES DEVELOPMENT SERVICES REQUIREMENTS:I .Hood or Type ❑ Canopy Type 11 ❑ - Zoning Approved By 'Date Building Approved By Date Application Issued By Dat If Refrigeration System 00-100,000BTU 0100,000BTU . SUMMARY OF FEES BUILDING PERMIT $ SMIP $ -- PLAN CHECK $ af�ER MIT PLUMBING $-l.•fSSUANCE PLAN'CHECK 25% $ ENERGY P.C. $ ELECTRICAL .$ GRADING $ - PLAN CHECK. 50% $ MICROFILM ,$ System Repair/Alteration - Fire Dampers Registers - __ MECHANICAL $ TOTALFEE $ 5oa Issue Fee $ 3 PLAN CHECK •25% $ - _ r _ CONSTRUCTION AND; PLANNING (APPROVALS Permit# _ rDate - Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary -;Electrical Service or Pole 52. Pool & Equipment Location t 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,UFERGrnd. 57. APPROVAL TO COVER-GUNITE 7. Footings,i 58. Electrical Conduit-Undrgrnd:"' 8. Foundation - 59. Gas Pipe, D Uncirgrdd., TesC! i 9. Water Pip,-Undrgrnd. - 60. Backwash Lines, P -Trap, D 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas D Oil 21 Gas Pipe -Rough & Te-st 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D 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 PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: s �(��9 GFifq- G,�� L �•� 34. Final Heating & Air Conditioning �„�7-QO•R�I(��j-• 1rj(.��Q�,� l�$ ��fZa 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. Special Requirements Completed 49. Electric Release to Edison ' 50.'Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date OWNER ATWOOD CADY rc DATE AP No. 422-031-20 LOT TRACT FIRE ZONE VALUE E 1 F r%R nn INSPEC IONS Si noture I Dote TYPE GROUP ZONE SOIL- SUBCONTRACTOR PERMITS IS5 D GAS Dote I Number Si nature WATER PI bin ROUGH PLUMBING _ �a PROP. SWR. LINE ❑ HOUSE CON. C] SPRINKLING SYSTEM MISCELLANEOUS III lb ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER t- ROUGHWIRING TRENCHES FORMS STEEL REINF. .0 Otin ond}nt FLOOR SYSTEM -• I1Ti BOND BEAM STEEL REINFORCE„ SHEATHING 6 FRAME AND FLASHING X p(^ ,-L LATHING — IN OUT pj'(� -•ti PLASTER, BROWN COAT -- STRUCTURAL, FINAL -_jp�� O HEATING, VENT., REFRIG. AND A.C., FINAL 6 3 _ PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL 0-1 14 BUILDING, FINAL '� - r - COSTA MESA B, iNG-SAFETY DEPARTMENT P.O. BOX 1200 s. _„TA MESA, CALIFORNIA 92626 4152 10/02/79 115.09 API _ ATION FOR STRUCTURAL PERMIT For Applicant to Fill inLDING Completely —Use Ink Only RECEIVED BY PERMIT NO 48904 1 ��J/� DIDRESS /O/ vV ( e- Cll''i AD7DRESS///tw A P NO.q7 O �� "^' WNER 4, - ENANT GYJ, [ADDRESS BUILDIN ADDRESS UNITOR SPACE NO. AILING /O r Ie �f�TR.NO. LOT BLK. � TEL.TY �' /, yI�%/�{L/ NO. �Z�ALTER REPAIR MOVING DEMOLISH NSTRUCTIONNDER BRANCH 4 />� OWNER (�(j ADDRESSLUE Q $ USEt,S� pf 0-/ $S38 ARCHITECT TEL. OR ENGINEER N 0. ZONE 41 TYPE GROUP ADDRESS [ADDRESS CONTRACTOR eezze APPROVED BY DATE V �J/ e-7-�,P` CITY `(- TNEL. /, O�j,2 STATE V r>-r� CITY LIC. NO. t+ ^� LIC. NO. APPROVED SETBACKS SIZE NO .OF BLDGS OF LOT NOW ON LOT (FROM C/L STRE FRONT USE OF �j EXISTING BLDG. vf j / DS FT. AT Separate permits are required for electric, plumbing and heating work: J L. SIDE FT. REAR USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION i2a 1A/ eIC14 DATE APPROVED APPROV - 2 — I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. Signature of Permittee SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ G.m� PLAN CHECK $ OCi /� �3� p $ TAX $ /.4047 TOTALPAID $ 0 or Authorit Agent Date 281. COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 - COSTA MESA, CALIFORNIA 92826 For Applicant to Fill In Completely TYPE OR PRINT . r COSTA MESA, CALIFORNIA T ARCHITECT NO. BUYBACK LIN[ FROM CENTER of STREET //✓ R[AR YARDD SID[ YARD I LEFT /- / RIGHT CV / DESCRIPTION OF WORK 4 / / K S7� ROOMS V7 STORIES � V�` jai COVjy/ COVERING &pV 0lL 1 HEREBY ACKNO' ANO TATE THAT PLY WITH ALL Cl BUILDING CONSTR AUTHORIZED AGENT RT 1 HAVE READ THIS APPLICATION :IS CORRECT AND AGREE TO COM. ICES AND STATE LA)Y2 REGULATING ,,6-6e ASA00 577* ***103.50 APPLICATION FOR PERMIT BUILDING For Office Use Only RECEIPT NO. �9RMy{1QBT r��1I0,. R[CEIV CYe pAT !MCitD�^'B/r !6 E�JsUIGHL�[VJD BUILDING /off ADDRESS FIRE C ZON! TYPE GROUP / APPROVED BY DAT! ZONING . iON[ NO. OP US[OP NEW � D[SCRIPNON � Vim• LL' O A. P. NO.. NOT[: NO SAVE OVERHANG SHALL BE LESS THAN BO• TO SIDE a REAR P. L. EAVES ALLOWED (U_ B.C. REQUIREMENT). YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING [PROM GL CI'R[R) FRONT PT. ('SFT. R. SID[ 75 FT. L. BIDSFr. �7 REAR /1 FT. FT. DISTANCE SET. BET. MAIN H: MAIN SLOGS. , ACCESS. SLOGS. VAR.*Y Y DATE( -L, 7 C. U. P. APPROVED PR p L�I / e X) _ • DATE i HOLD FOR SP 14L r r. -rl^ J ! v7 SQ. FT. 902 THE AMOUNT BROWN UNDH ALUATION 18 FOR THU PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION �I PERMIT FEE 5/� /UJ TOTAL FEE $ �S_�