HomeMy WebLinkAbout1113 VALLEY CIR - Building PermitsJob Address:
Suite:
Vicinity:
Primary Occ:
Parcel Number:
1113 VALLEY CI
RESIDENCE AND ATTACHED GARAGE
R-3 Dwellings/ Cong Res <10 Type of Construction: V -N
42203114 Zoning:
Status:
ISSUED
Applied:
05/11/2005
Issued:
05/11/2005
Applicant: LEE, MIKE -- -
_�,- ISSUED BY:
Address: 301 N OBERLE PL - ; ,rte � � - � ---..'.�"-'c „%.�- ;�,.., .
Phone: x(949) 635=9054`_-
PLACENTIA,CA7j��= `Zip: t92870
Owner: PURSLEY'JOSEPH-W�
Address 11d� VALLEY CIR_�
Y'.: Phone
l /COSTA MESA,,CA �� - Zip:. 92627
Contractor ROOF,ING'STANDARDS
-Address:? 301 NOBERLE'PL
-,.Phone: (949) 635-9054
a _ PLACENTIA, CA
Zip:'- 92870/ I '..License: 741302 'o't.,
`Arch Eng:,
t
Address. / � "�� � �'�Yy fC �9 _ - Address: ( �
-
, ✓, -
Phone"-- Phone
�. 'Zip- !/✓ ..,,,-License: v License:
,fT '?I V //?� SCOPE OF PERMIT r - '� 6r i I� ;
' REROOF RESIDENCE AND ATTACHED GARAGE T/O EXISTING CAPuSHEET ROOF:AND INSTALL'NEW SINGLE-PLY-MODIFIED�CAP SHEET.
. l r� ,' 4,__ r • ,V
20 SQUARES i I
fi .�,,FEEtSUMMARY-.
l
PlaniCheck $0.00 Calc Valuation 1 $4,900..
.fit . Permlt $111.25 '— Claim Valuation ;/,�/ „$asoo:oo,'
'SMIPRes: $0.50 /
SMIP Com:', $0.00
Other:- : •$0.00 i
Inspection:/ '$0:00
Total $11175"/
.N - r- Cc _ ;a✓ ;� L�'-ti �.ii" jam! 5 } .
SETBACKS"" H.LHNNINCi &LUNINCi 'y� <
r /
MAIN STRUCTURE -Front, 0-0 .Rear 0 0- '-_Celt_ _0);.0- '�Right,�0-0i��//�j'
ACCESSORY Front�0 0. 1 1Rear0 0;-� Left It -0-0( \{\'�i Right0 OJ
. ,t
'r r . ✓� � �� �, � 1� l� � �/.,
PARKING
Existing: 0 -, Re wired. 0 ' • f \ ti P. r000sed:
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)
i EXPIRATION: Thispermitshall . automatically expire:andbecome voidif work is not commenced'.within. 180Aays,or i6work 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 anciJinat approvalmust be obtained. Failure:to.obtain inspectionsand-finallapprova[ will. result in.the expiration of this permit. li
FOR:INSPECTIONSCALL: (714)754.5626
2446-4e 16/001
DECLARATIONS
WORKERS' COMPENS TION DkLARATION:
1 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 provitled for by section 3700 of the Labor Code, for the performance o1 the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This se n need not be completed if the permit is valued at one hundred dollars ($100) or less.)
. I certify that in ttie 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'
compsnsallon laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith
comply with these provi s. _
Ap"'Ip�nl'.Slpnawre: ' �DatesT,--S���
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER'TO CRIA9NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full
force and effect. Lid- 130 Z A C n 6-3y
r n 0�
Contrector's•Signature: i Date: c/
V. � J—.'.'- f J
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, poor 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.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 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, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ 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).
it in ant need to file a registration form for acute) hazardous materials? Yes No
.........................................................................................I............... .... .. ....
2 Does or will the applicant or present or future building Occup g y ❑ ❑
(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
...4..........Department.
enRMPP._.........._....................
..........._.._-
is
.-is
presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ NO
............................... ................... .............. ..................................... ...... ....................... .......................................................................................................................................................................... -....................... ..... _.............................. I...............
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li 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).
......................................_............................................... __............-......................................................... .... ................................................................................................................. -................I................................................ -..............._........
8 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 distract 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
............................... ......... -........... _........... _............ _.......................... ........................ ............................................................................................................................... .................................................................................. .............................. ........
B (If yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si rat r L ner s at
AndlO,Authdrzed Applicant4o�s Irp tai'
CODE If INSPECTIONTYPE -" - gdTE "" N CODE I INSPECTION TYPE gAIE - 1NT2)D♦ALg
1616 Fixed System Final Fire Prevention - 206 Final Mechanical
1266 Pool Spa Final T 208 Final Plumbing - -
200 Final Re -Root Jr' �e.- 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
ADDREss op 9MLGIrlD: 1113 VALLEY CI uNT:
om+ERS NAME IP IOpWN: PURSLEY, JOSEPH W 14
ADDRESS: 1113 VALLEY CIR
COSTA MESA,CA 92627
548-3071
APP.: IUUUNG ADDRESS:
ARCNITECTORENGINEER: UC. N .:
RCN OR Elli ADDREW; UNIT:
CONTRACTON'SNAME NOCK PLUMBING (714)895-1246
CONTRACTOBSMNUNG 11612 KNOTT ST
ABOREss: GARDEN GROVE CA Mill 511971
92641 UNIT: 17
LICENSED CONTRACTORS DECLARATION: I hereby adkm under Pendry of perjury Met I am licensed under Ix holme of Chex« 9
(commenMtg with Section 7Do0) of Dylson 3 of the Busines, end Professions Code, and my fioanm is in lull force end edea.
CITY UC. NO, 050386 UC -CLASS: C-36 LIC.NO.: 5.,}q1 ^197]1 EXP: 02/96
Dale: 2% Contractor: tl / �M(7/Aj:&,
OWNERBUILDER DECLARATION: I hereby affirm under Penely of perNry than I uns
n exempt from the Contract. licee law for the
fdbw'vpso
reason (Section 7031.5 Bmkwa And Profmsbns Cade: Any city or runty which requim a permit to construct, akar, improv,
demolish, or repair any structure, par to 0 0"ance, also squires the applirerd he such perm t to Rb a signed susemanl dw he orahs
is licensed Wreuent to the p wase d me Contnaon Lica se law (Chapter 9 (mmmenang with Swian 7000) of Dyieim 3 of the
Business and profession Code] or than hP or she is exempt therefrom and the basis for the alleged exemption. Any violation of Sectio^
7031.5 by any applicant for a permit subjects the applicant to a sed Penalty of M muse then Me hundred ddlare (5.500]).
❑ I. as owner of the p ,,my or my ampkryeee with wagon as their eche mmpernarbn, will do the work, end the evuctum is M intended
or 011e scl for sale (Section 7041, Bea^ece and Prolessbna Code: The Comramon License Lew does nal eppy to sit owner d property
who binds or improves thereon, and w1p does such xwk himself or Moself or Mrarph his or her own employees, provided tum such
improvements are not intended or offered for sets . N, however, the ImMin; ar mpwsmerd is sold within ace Year of mmplofion, the
ownw4uikler will have the burden of pmeirp M or eke did rot build or improve fru the purpose of sale).
❑ t m owner of the property, un mduPvdy oontrwiq with licensed conNxMore to corodud the prajed (Semon 7(14, Business end
Prolessm a Code: The Contractors LCenm Lew dose rel apply to en metes, of popery who Wu a impw'pereon %hand who
contrxN b such papas with a cons slims) Irarwed pursuant to the Contnctan Ltceroe Lew).
❑ 1 son exempt under Section: B. A P.G., for this recon:
Date : Owns,:
I do hereby teddy thin I em aware, dud understand the,xuimments of CalEomia Health and Sally Coda Sec ioru ffi . 25533, and
25534, and Mat I or any latus buiding oaNpent will / will not Iamb me) need to comply with said date codes and IM requirements for
apertnit lametrvctionamodifimionhadthe ArarP wrxxol District. Restdential construction applications aA exempt from these
pwisxm.e
Dare: Applicard:
WORKER'S COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of Drs Idbwing detleratiorw:
❑ I haus cad W mermen a cwW"e d cemerd to sa4i m for sup ' comperwarbn, m prvMW (e, by SaMon 37M d the labor
Cab, for the pedomrence of the work for which this perms is issued.
I have and wil museum woreso' wmpensatbn insuar ce, as required by Secum 370p d the Labor Code, for the perlumuee of the
work for which this Mom is issued. My waken' compensation irreurexe center and policy number are:
Censer: CTATV EXPIRES
Pricy Number. Ii 7QQ`)—QS 03/01/96
(ibis sm,. need rep( he comp efsd N the perm, u b ms handed ddlan MMI or lege J
❑ 1 cenAy dust in the Womarce of IM wok for which this perm, is isaund, I Mall not employ any parson in any manrw sum to
becoms subject la the worlusn' cxnpenadiat lows of Cddomis, end agree dead d I ahouM become mblect to the waken'
compen sol daSection 9700 d the labor Cade, I Mall forthwith cony with 'alone.
DMus: ? T l S Applicant:/ /L
T
Wsil 0 FeNun ro axon sof rho i corNometlon covenps b dflo, 1, end Mall of op an employer ro iessAsconstruct novid des and
Stoll tinea up ro ons sW, Co fhouu,M dellen (Srrutys f, M add/don ro tM coy o/ ro r4exusfbn, Mmsyss m prov/dM for In
Sxtlm 3]06 alit tlrs Labor Cads, Interest and adamey'a Ism.
CONSTRUCTION LENDING AGENCY: I hoseby affirm under perully d perjury thin then u e mndruaion bndi, agency for the
'd.. 1, work for which this puma is maned (Section 3097. Cy. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I uses read this applicarim and trete Ihet the above information is cameo. I agree to comply with all c y and county ordinances
and slate laws rdetirp to Wiling construction anymeby authorize represenwivas of this city to enter upon the ebon-rnerdprred prop"
for inapt .,poses.
nM Name
[////=/ ,r\ Oats:
Sigmtun P M~/Ag.VAppkranV nom xx
(515148 WP) White-BuildN A Salary: Gann -fib: Gamy-Appkcant; Pink-Rmonue; Gddeney, AAw 9xr
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: P 071972 PLAN CHECK NO: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU
JOB DESCRIPTION : WATER HEATER CHANGE—OUT
PERM NO: P071972
GOVT: N SUPP:N
PURPOSE: OTH
SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
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:
42203114
ZNE:
REF NO:
PLANNING NOTES>
>
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.
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP!RES GRADING
PERMIT 7,00
258 SMIP/NON—RES
PLAN
ISSUE FEE 20,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 7,00 20.00 0,00 27,00 27,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
27,00
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 P, I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 7,00 7,00
END OF FEES
chi 00180714-00180714 T CIT 27,00
DATE2 34127/95 TIME: 011i
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
-L & 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 LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
'
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, D Undrgrnd., Test
9. Water Pipe-Undrgrnd. -'
60. Backwash Lines, P -Trap, Cl 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 JI
-
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
APPROVAL'S Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping El Gas ❑Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrri 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 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
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
d"It-ct Address f-/-'--
Applicant's Mailing A r
Owner's Nam/e[ l .Av
Address V
Arch/Eng.
Address u --
No.
IT
Contraeto!'S 4.-A oo/- Phone..,,/-_(_.._t�7
Address (mailing) e���.'l,h
City License No. ,1 (�G D] 1 'd, (b oC(P,
LICENSED CONTRACTOR DECLARATION '
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my licen�p'fo,t.L IcSe l j[_pp{e{,�/No��ate/JW�/(,�"� `)RKECLARATION
.ereby affirm that I have a certificate of consent to self -Insure or a certificate
of Workers'' Compensation Insurance, or a certified .copy thereof (Section
polliiiccy No.'/�o(o7141- Si'G Company ? AC- Af^ VA)%�
8 Certified copy is lh'eedbwithrthehcty Bu Wing Divi
_/Z{
Date L I&
EX EM PTI N OM WORKERS' COMPENSATION DECLARATION
(This section 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 lending agency for the performance
Df 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
file a signed statement that he/she Is licensed pursuant to the provisions of
Contractor's License Law (Chapter 9 (commencing with Section 7000) of
ision 3 of the Business and Professions Cotle) or that he/she is exempt
...erefrom. 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, zs'ownei 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 (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/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 Com-
pletion, the owner wilFhave the burdem0f proving he/she did not build or im-
prove for the -purpose of sale)., .
❑ as owner of the property, am exclusively contracting with licensed.con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law doesnot apply to an owner of property who
builds or improves thereon, and, Who contracts for Such projects with a con-
tractor(s1 license pursuant to the Contractor's License Law). I am aware that'
proof ofi their Worker.'s Compensation insurance should be provided to me.
❑ Lam exempt under•Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read 'this application and state that the above
information is correct. I agree t0'COmply with all City and county ordinances
and state laws relating to building onstruction, and, hereby authorize repre-
sentatives , of -this city, to�efa).er.�yon the above-mentioned proper Y, tor'
Signature • �^
Drivers' License or SS �
\ CMF 0865-46, rev. 10/84 White - Building;
�plicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
PER T N p� / J�
TRACT NO.
LOT NO. 1
UNIT NO.
Zoning Approved By
TYPE OFCONSTRUCTION LJ NEW LJ ADO LJ ALTERATION LJ REPAIR
Date
❑ CONVERSION1:1 DEMOLISH ❑ OTHEGD''/
-
/
A.P. #
` _ _
DESCRIPTION OF, �^/oO FjK/USE�F §,j -DG.
/GRADIN�G}{�FOUNDATION
S
Main Buildi
TYPE OF PERMIT ' STRUCTURAL
T
Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
B
PLUMBING
❑ OTHER -
A
Rear -
i
PROJECT DESCRIPTION SQ. FT.DO OCCUPANCY
C
Right
♦q
CON ST RUCTIONITVPE VALUATION${.DD. V
K
S
Left
.ZONE GRADING CU. YDS. ACRES'
Ping. Ref.#
Remarks: - I
Planning Notes:
.TOTAL FEE $.
PLAN CHECK -25%.
$ -
PLUMBING
_FEES
Sink
Backflow Irrigation
Bathtubs
rinking Fountains
loor Drains
loor Sinks
as Service Outlets
Sink
Showers
Service Sink
Sewer Cap -
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
.Water Service
Auto -Wash
Laundrv,Trays
I I Roof Drains I I I Iit
Reinspection Fee $15
Issue Fee
Boiler Hood or Type I ❑
Duct - Under Ground Canopy Type l l ❑
Duct - Structural Refrigeration System
Duct - Ventilating - 1:10-100,00013TU'0100,000BTU
Firepl/Fact. Bit. ICBG#
Heating System & Ductin
El 6100,000 BTU 11106
n•`-��'� I LAW Fee
Applicant; Pink - Accounting; Goldenrod - Assessor
ILL
FEES '
Fire Dampers - - 'Fire Dampers
Registers'
Issue Fee $. 3
Automatic Washer
Construction Pole.
Cookinq Unit -
Fan
F.A.U. - ..
Fixtures
Device Boxes I
Outlets
Switches
Garbage Disposal
Generator 110 KW E15 15
8208 12%04/86 1 15e50 TL
Zone
Accessory Building:
Z
N
I
_. N
G
R
Parking Req./Provided E
Q
M
T
S.
ELECTRICAL _ FEES
Transformer ❑. 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors ❑0-1 HP ❑ 1 A- B
Inc. Solar E19 15 HP Ell 6-15+
Microwave
Pole Light ;
Range
Sign
Standing Sections
f Trash Compactor
I Reinspection Fee
I $15 I.
I Issue Fee I $ 3 I
DEVELOPMENT SERVICES REQUIREMENTS: - -
Zoning Approved By
Date
Building Approved By
-
Date
Data t a •,.y.'�
Application Issued By
$UM
A Y FE ES
BUILDING PERMIT
,$
SMIP '- $� - •.�lJ
PLAN CHECK
$
.PERMIT
PLUMBING
_
$
- - ISSUANCE $
PLAN'CHECK 25%
$ --
- ENERGY P.C. $
ELECTRICAL
$.
GRADING $-'
PLAN CHECK 505C
$-
MICROFILM, $ -
MECHANICAL
$
.TOTAL FEE $.
PLAN CHECK -25%.
$ -
CONSTRUCTION AND PLANNING
^
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 UF ER Grnd.
57. APPROVAL TO COVER-GUNITE
' 7. Footings
58. Electrical Conduit-Undrgrnd. -
8. Foundation -
-
59. Gas Pipe, O 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
63. Heater & Vent -Final
13. Roof Drains_,
64. Plumbing System - Final
-
14.1 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. POO USPA 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 Cl Gas ❑Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O 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 PREV. FINAL
30. DrywallNailingHEALTH
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
--i
'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
•�
415- Sound Attenuation
. • �-
46. Handicap Regulations -
'
47. FI NAL 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
;Y -
8125
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOK 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill In Completely
TYPE OR PRINT
COSTA MESA. CALI
I
EFT 41 I RIGHT
DESCRIPTION OF WORK
B
I XPJhBY ACKNODOB THAT I NAVE READ
AN STATS TXA B ABOVE 1S CORRBCT'At
PLY WITH ALL C ORDINANCES AND STATE
BUILDING CONSTRUCTION._ - /%
AUTHORIZED AGENT
�2 /'
F
JAN'1&489!00583* ****90.00
APPLICATION FOR PERMIT
BUILDING,
for Office Use Only
REcsirt no.
LIC. NO.
RECE�s
SIZE
A
K
OF LOT
VVV"' 17
O
USEP
USEEXISTING
Y
BLDG.
SETBACK LINK FROM
EFT 41 I RIGHT
DESCRIPTION OF WORK
B
I XPJhBY ACKNODOB THAT I NAVE READ
AN STATS TXA B ABOVE 1S CORRBCT'At
PLY WITH ALL C ORDINANCES AND STATE
BUILDING CONSTRUCTION._ - /%
AUTHORIZED AGENT
�2 /'
F
JAN'1&489!00583* ****90.00
APPLICATION FOR PERMIT
BUILDING,
for Office Use Only
I
REcsirt no.
20 1 GJ
RECE�s
z
-a RE IV[D
'
pATB eLpyJgp,68
JHIY G p
BUILDING ♦♦ /�
ADD --
FIRE
Y
ZONE TYPE
GROUP /
APPROVED
BY
DATE
ZONING
ZONRNO. O—O R
:-O
USEOFNEW
/ �
_ BYILDING ���h
GCRILE
S PL.
D PDON
I &I j
A. P. NO.
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
SO' TO SIDE a REAR P. L.
EAVES
ALLOWED
(U. B. C. REQUIREMENT).
YARDS APPROVED
YARDS APPROVED
MAIN BUILDING
ACCESSORY BUILDING
(PROM C/L REST)
OI
FRONT FT.
FT.
9
R. SIDE
FT.
L. SIO FT
PT.
REAR FT.
FT.
DISTANCE BET.
BET. MAIN e
MAIN BLDQS,
ACCESS. SLOGS.
VAR.* -' —07
v,9
/
DATE (�,-z 7
C.U.P.
APPROVED
APPROD v
BY /
DATE -L9
HOLD PO. S
_IAL R QUi Eh4Eid7
o v 3 3
/ SQ. FT.
0
THR AMOUNT BNOWH UNDER YAIUI.TION t6 POR TN{
"'F," OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
G'd PERMIT FEE $ 6v -
TOTAL FEE
I