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Home My WebLink About1114 VALLEY CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1114 VALLEY CI Suite: Vicinity: Parcel Number: 42203112 Zoning: Applicant: SANDRA & BEATRIZ ALSINA Calc Valuation: $6,500.00 Address: 1114 VALLEY CIR Claim Valuation: $6,500.00 SMIP Res: $0.65 Phone: 949-631-6482 SMIP Com: COSTA MESA, CA Zip: 92627 Owner: SANDRA & BEATRIZ ALSINA Address 1114 VALLEY CIR Total: $139.90 Phone: 949-631-6482 COSTA MESA, CA Zip: 92627 Contractor: Address: Arch : Address: Phone: Zip: License: Phone: Eng: Address: ISSUED BY: Status: ISSUED Applied: 06/05/2000 Issued: 06/05/2000 Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF 1/2" OSB 30L13S FELT AND 30 YEAR COMP. SHINGLES TO INCLUDE ATTACHED GARAGE. NOTES: 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 commences 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 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,500.00 Permit: $139.25 Claim Valuation: $6,500.00 SMIP Res: $0.65 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.90 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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 commences 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 (i P DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' Compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($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 t0 become subject t0 the workers' compensation laws of California, and agree that if I should become subject t0 the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERSCOMPENSATION 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 ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. M Class k Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). 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 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) ,�!iCense pursuant to the Contractors License Laws.). ,❑ 1 am exemCpt ul of r sec. Business and Professions Code for this reason: Sinature: gg$6 �-_ ' Verification of Ownership by (type ofotl current, 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). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ 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). mat_---.... 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 aterials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? byes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it 'yes", the facility must meet the requirement Of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (if 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above -describe raparty for inspe ion purpose I age not to occupy or allow occupancy of any building authorized by this permit until final inspection. - Z . �i Signature Of�er s)__.l ? Date) �And/Or Authorized Applicant Date CODE JI, INSPECTION TYPEAp UNTLRI� CODE r INSPECTION TYPE g_ATgNTLrtIALSS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final— 208 Final Plumbing 200 Final Re -Root ^ Z -0 Q� 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 2"6.46 January 12, 1968 City ob Costa Mesa Bu.itd.ing Dent. P.U. Box 1200 MAIN OFFICE SANTA ANA 4214 W. Westminster Ave. P. O. Be. 536 Santa Ana, California 92702 Ph. 714-531-0240 Attention: Ed Hv tackA Gentlemen: C. KIDDER President BRANCH OFFICE CAMARILLO Dawson Drive P. O. Box 176 Camarillo, California 93010 Ph. 805-482-9831 We tequeht petm.iaa.ion to .instatt ABS-DWV- ptast.ic waate and vent hyztem .in aeeotdanee with WaP.O.A. .instat-ation standards .iaaued 565-65, Th -i4 tequeat iA (got Tract 64 -3 -in .the city o� Costa Mega, CaFijonnia. Very ttuty Youth' PLUMBING CONTRACTORS INC. ?r✓-�'��-�,..,.� �.�,�,,G-ems W-iEtiam Combe Genvmt Supt. WWC/ht P" C. KIDDER !..�� .rroridont JVYdrrY7i MAIN OFFICE BRANCH OFFICE SANTA ANA CAMARILLO 4214 W. Wartminstar Ava. Dawson Driro I P. O. Box 536 P. O. Box 176 Santa Ana, California 92702 Camarillo, California 93010 Ph. 714-531-0240 Ph. 805-482-9831 Januax. y 12, 1968 City o6 Co4ta Meda BuiZd.ing Dept. P.U. Box 1200 Attention: Ed NoaAach4 Gentlemen: We fceuue4t petm.i44.ion to .in4taCt ABS-DOIV- pZa4t.ie wa4.te and vent system in aeeofLdance with W.P.O.A. .in4taUat.ion 4tandakd4 .ibaued 565-65. Th.i4 /Leque4t .i4 Jot Tact 6483 .in .the city ob Costa Mesa, Catijonn.ia. Veny tkuty Voutz, PLUMBING CONTRACTORS INC. w.iUiam Combe Genenat Supt. WWC/4 E January 12, 1968 City o5 Costa Meda P.U..Box 1200 Costa Mesa, Catiorn.ia. Attention: Bu.iCd.ing Dept. GentCemen: We .the owner and genuia.Q contractor oS tract 3.483, .in the city oS Costa :tfesa, ,hereby netease the city o5 any t.iab.it.ity or respon.ib.itity .in connection with ,the use o� approved p2ast.ie pipe and !itt.ings to be. used {nor drain, vent and waste Unes in houses to be .in this city. Very truty,yours, . I January 12, 1968 City o5 Costa Mesa, P.O. Box 1200, Costa Mesa, Cat.iSvmiIa. Attant.ion: But.td.ing Dept. Genttemen: We the owneh and geneta.e contractor, o; tract :6.483, .in the city o4 Costa bfesa, hereby netease .the city oS any t.iab.it.ity on rezpon.ib.iZity .in connection with the use o/ approved ptast.ie pipe and �it-tinga to be. used Jor. drain, vent and waste tines .in houses to be .in this city. Veay truty yours, "aw r . (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1114 VALLEY CI Suite: Vicinity: Parcel Number: 42203112 Applicant: SANDRA ALSINA Address: 1114 VALLEY CIR COSTA MESA, CA Zoning: Phone: 949-631-6482 Zip: 92627 Owner: SANDRA & BEATRIZ ALSINA ' Address 1,114 VALLEY CIR Phone: 949-631-6462 - COSTA MESA, CA Zip: 92627 Status: ISSUED Applied: 04/13/2001 Issued: 04/13/2001 ISSUED BY: Contractor: Address: Phone:- , : Zip: / License: �.. P Arch Eng: Address: - Address:" ' Phone: - / Phone:�� Zip: License: - License: - —j SCOPE OF PERMIT d LEGALIZE TWO 1'X3' WINDOWS INSTALLED FACING VALLEY ROAD.' FEE SUMMARY Plan. Check' $15.28_ _ Calc Valuation $aJoo.Oto Permit: $23.50 ' t Claim Valuation: Vy ` 400.00l SMIP Res: $0.50 SMIP Com:. $0.00 Other: `$23.50 ` inspection: $0.00 ��l -� Total: $62:78' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration. of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46(6/00) PLANNING&ZONING SETBACKS\,,,\ '-1�� MAIN STRUCTURE Front' -'0-0 Rear 0 0 c L '� Left 0-0 Right 0 0/% ACCESSORY Fronh ;0- 0 Rear -0-\0 Left 0- O. -. {- Right''. <%0- 0 �\ PARKING Existing: --0- Required: 0 Proposed' ,, , 0' ` NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration. of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46(6/00) DECLARATIONS 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 work for which this permit is issued. ❑ I have and will maintain Workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be complefed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 cedity that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERSCOMPENSATION 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 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. Llc. F Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 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 lot such project with a contractot(s) license pursuant to the Contractors License Laws.). Im exam t under c. Business and Professions Code for this reason: Ign e' (/= Owner ID verified by drivers license. Yes ❑ No ver's L' nse No. � Cores: _Sl'.3 —O Z— Venfication of Ownership by (type ot'�t, i.e. - property tax bill or dee DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes Q No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). . ....................................................... ................................................................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ 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. ..... .................................................25.......5...34...........of th............................................................................................................................................................. 4 If an RMPP is presently requiretl, has Section e California Health and Safety Code been fully complied wi.........Clth? 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,ppplicat ? LJ ion a ffrmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agencyYas LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................................................................................................................................................................................................................................................................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .......................................................................................................................................................................................................................................................................................................__.........................................I........... 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 13(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 slate 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 props for insct . purposes. agree no occupy or allow occupancy of any building authorized by this permit until final inspection. G� 4� C/-/ 3 0 1 Signature Of Legal O D And/Or Authorized Applicant Date CODE 1. INSPECTION TYPE DATE INfmALS CODE1 INSPECTION TYPE DATE INTmALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Bleck/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �T 204 Final Demolition 250 Final Building/Occupancy ' (/ S uX 1 WIAVOW F x15-7 . STkFEE -T MEy AM -D 11 �KI S v 5ctnfx � / 1 a Nfw W14001 DIVISION OF BUILDING SAFETY CITY OF COSTA MESA APPROVED 37 _ /�K Date 9 I !T,is set of plans and specifications MUST be kept on hs job at all times and II is unlawful i. wake any changes or alteration on same wktw written permission from the Division of Buildin, rd Safety, Cdy of Costa Masa. he stamping of this plan and specifications SHALL NOT be had to pend or to be an approv- A the violation of any provisions o` any City of Costa Mesa Ordinance and/or State la. 'itsse plans and permit shall expire by lunation and become null and void It the building k n,� rthr9n�r.�d ae6 ❑'eln!94Md active Pe! t IBC $303 (d) Qhln 180 c! NOTE ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIVISION 0 "PROVED CITY OF COSTA MESA PLANNING DIV. SUUBJJ/ECT�. TO BLDG. DEPT. REO. BY C/ATE �r 3 /D i ADORESSOPBUIIDINO: 1114 VALLEY -CI OWNEs"KAMEIRNNOMINCAPLES, MARK ADMIN:CAPLES, DEE ANN 1114 VALLEY CIR COSTA MESA,CA ADPL. MAHJW OMEN: ARCHITECT OR ENGINEER: UMK OR ENG.'S ADDRESS: UNIT: 92627 LNC. NO.: UNT: coNTRAcTorsnual:COAST ROOTER & PLUMBING CONIRACMITSAlum 2737 S CRODDY ADDRmSANTA ANA CA 92704 LICENSED CONTRACTORS DECLARATION: I hereby affirm urder penalty d perjury, than ( ending with Section )OWI d Divisor S d the Business end PMesaion�Code erd rrYL .NO,p45140 uD.CLASS: C-36 uc.ND452�1 (714)241-1414 uGm, 529127 uNT: D hal I am V.sed under a d Chapter, 9 my lit is in full e d eNed. 22 91 06/97 FR BUILDER DECLARATION: I hereby affimh under panel, of unuro pdrjury IMt I sembt from the Corhise s licee Law 1« the g reamn (Sso im 7031.5 Business and Professions Cade: AM coy or county whits Aquinasa permit to construct, eller, improve, h, or repair any structure, prior to its issuance, also rertuirea the applicent for such permtl to fib a ei9na l statement that he or she is lironsed i suenl to the provisions of the Contractors License Law (Chapter S (cammerving, with Section TOW) of Division 3 of the Business ard Processors Codel m that M or me a exempt Iherahorn strict IM bees for the allaged exemption. Any violator d Sedion 7031.5 by any applawol for a perms subjects the applicant to a civil penalty of no, mora than two hundred aware (Vimf). ❑ 1. as owner dthe propenr«my amVwyess with wages, as thei.de a«rpersaton, wit do the wo&. are the amesum i, net amended or offered for sale (Section Tab. Business end Prdesmons Code: The Contractors lime Lew does nal apply to an ownerd property wM Wks o, knpromes thereon, ard wbo done with work himself or herself or Ilaatlph he or her own emplo es, provkeci I etch im«warnenle we ml wended! «offered 1« sale. If, however, the building «improvement is add within one year of campbton, the owner4wiler, whit Mme the When of pwviN he or she did rr Wil «improve for the WTme of sail). ❑ I, as owwr of the propeM, me exclusively, pmtradkp with licensed sono mos to canmud the ponied (Sedco 7d+, Bainssa ard Ptolwwwa code: The Ccntwctors L;cansa Law dose not apply w an own« of proper, who Wile or imprwm IMre«t ane who corvazb for such propels with a conhoss t r(s) boemee ptrsuarht to the Connectors Licane Law). ❑ I am exempt under Section: B. d P.C., for this wasm: Duna: Owes,: I do hereby mriy mat l we aware of ard wdemtard the requirersom of CaN«nia )led h are $story core Sections 25505. u , ard 25530. db that I or any Mus Wiling o«vparht wit I wit nal (cimJe one) need w c«npy with said ode codes ane the requtremmb for aperm fm« l ctim«maeir�ma IMAs u�y mpmsm Dimid.Rml«tid mmrwln appimi«sas exempt lmnthese «w a me. Dale: Applicant WORKER'S COMPENSATION DECLARATION: I hereby affir urdar penalty of perjury one of the Wow, deduetiow: ❑ thaw arddl mdmekhe ofthasdoor whico this worst 6 ma.teera'rompensalon,npwlee f«by Sevum 3>W dtM labor Code. for the penormarwe d Ms work f« wlhich Mia perms a ®sed. -.Il I hese era wii maimen schen' wmpxselion irsurer�ca. n rayuired by Salim 37D0 d Me lab« Cade. ver IM performaMa a the i�" work I« whM Mb p«mlt ®muad. MY w«karv' canPe^waio^ irousnca tamer end po4ry number era: Caner: CALIF COMP EXPIRES Palicy NumMr: G961112844 01/01/97 (Thi. aw nen need trot he c«nplebd If the perm# is ver one handed dollars 1$100] or less.) I — OsI in the pedmwwre d IM woM1 for whoh the permit b law l N cot empty Y on n any marvw ss, n Iw euged to its wwtns' rornpeneatian levee d Calewde, ra e R I aha l b me sabpd to IM waMes' 1Q� dons ion 3TW d IM lab« Coes. eMA I d wits a pr 'sone. we W /ny: Fe9uro b eseuw wpnkere'rompenutlon rovenpe b tole (a Wll subled an employer fp pdMrl peneltlu ane c vll gone W w one hundred fhpusrrd da/Nrr (SfdgdoyA In sedltlon ro s twit or rorrpensafbry darrNgpe u provWad for In RUCTION LENDING AGENCY: I hereby Own order penally of perjury Ihel there e a con smaiim boding agency ver the arm of the work lot which the panni is m a sul (Section 3097, Civ. C). LENDER'S NAME: LENDER'S ADDRESS: that I haus wadi this application sad deb that the shows information is corral. I times to a«nply with all ply end county ordinances e lawn talalog to Wildr, conabudion and hereby authorce Npreaerhtadves of this ply to enter upon the ebo w-wa dorwd property 'ctimNrmmR0RT LISBY s.4 (51511 .WP) Whh,%ildrg A S dry; Gwsn- ilex; Carry -Applicant; Pwk- wmus; Goldenrod-Amww r CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P 080929 PERMIT NO: P 080929 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION WATER HEATER CHANGE—OUT 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: 42203112 ZNE: REF NO: PLANNING NOTES> > **9B iB IE iE dE �t-N-�iF rE*�kx-�B+t***iF air �E at �L*yk****�-x-*�L-�B*�r-*alt*x-yr-it-it rE It it i�iE x-*i9**i(-t9 x -x -fir -*it at �E***rt*�r-iE it xNL-****�k 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: e�DATE: )E dE 1E if IE dE 1B 9E*iE*1E*dE iE 9B if df iE RE iE iE��F3f�� 3f��is��iF In 9f if iEdEdE Sit 1E 9E iF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SE MENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 11.00 25% SMIP/NON—RES ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 11.00 22.00 0.00 33,00 33.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 33.00 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 33.00 **iE RE*iE IE *♦E iE iE iE 9E yE 9E IE*Rh*RE*1E*db if *RE dF RE iE iE dE dE iF 9E iE iE NE Rf *iE****1E*iE*iE 1E 9f iflE*iE iE lB alk lF ♦E air K-iE )E 9E**9E*iF*eE if RF iS 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 PLU 1 WATER HEATER AND/OR VENT 11.00 11.00 END OF FEES EXPIRED DAY'E 01 00221297-00221297 T 0 T 33.00 DATE: 12/19/95 TIME: 15:30 CONSTRUCTION AND PLANNING.- ' 111 APPROVALS Permit # - -Date Inspector POOL & SPA - Date , 'APPROVALS - Permit # Inspector > 1. Temporary lElectrical_Service or Pole a 52. Pool & Equipment Location ` 2. Soil Pipe-Undrgrnd. " - _ ' 53: Steel Reinforcement 3. Electrical Conduit Utility-Uhdrgrnd.� - 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- I 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. - 60: Backwash Lines, P.Trap,,0 Undrgrnd, 10. Structural Floor System ` ` 61. APPROVAL TO DECK 11. Property Sewer Line & House Connectton, - -62. Backwash & Receptor -Final 12. Sewer Cap.- - -63. Heater & Vent -Final 13. Roof Drains - = 64. Plumbing System -Final-' 14. Rough Plumbing 66. Electrical -Final _ 15. Rough Electrical -Conduit - `66. Solar System -Final 16. Rough Electric Wiring - 67. Fencing & Access Approval " 17. Rough Wiring Sign68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. PO6USPA 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 0 Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il 25. Roof Sheathing - 74. Overhead Hydro,. i 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEMFINAL 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: 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 & SUILDtNG 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cv 51. CERTIFICATE OF OCCUPANCY No. Date �1eJ � V 0.� LrRs.roc S��•Teh 28111 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 - COSTA MESA, CALIFORNIA 92626 For Applicant to Fill In Completely v TYPE OR PRINT BUILDING Y / -a I ( ., 1 �� % 1 2 IAN -1,6 kOO 569* ****94.50. APPLICATION FOR PERMIT BUILDING For Office Use Only ZONING [ON[ =NS Sor UDOILDI[ORNO W N[W/�� ILAt�� I.C. M / k11A SAVE OVERHANG SHALL BE LESS THAN. NEI- 67 G E a REAR P. L. OBLDG[ (U. B. C. REGUIRBMENTI NOW APPROVED YARDS APPROVED ':E'-C6:� "? r:GTrG{T' BUILDING ACCESSORY BUILDING JG. .. �_L-STRE[T).>i .:'IROMr�nrBET 7i Ze rRSAR YA D - (•73Fr. ...... __ FT. RIoRC.. FT. `� FT. n• -'DESCRIPTION OF-WORK:-c:`r ,•:-r,; •L:HID -._. Pr --.,-�._ .-..Pr....,._.. 5rT. FT. NEW _ - TEMTI N ADDITI N- RBAR c. - T . -: -.6a - ' -.. DISTANCE MAIN BLD f, SET. ACCESS. BLDG .REPAIR "'k o'I BUIDING NO. or "vwR:#-,/-oZp ,-07-3'�a_� DATE � —ROOMS'. C. U. P. APPROVED EXTERIORWAZT,LnROOF, I APP�e�R,�. Y. r,�_- : /4 "a 'S� T U OP2l INeANDWPRKTOBEP RFQRJTOCOM. 0 7G! ^""�•� :-rte+ '-( - _ P. e --' FOR S?LCIF G REQ()t?- •d /%Jr'1e•,rHG.. -_ 1 CBY ACKNOWLBOO[ THAT I NAV[ READ THN' THH AMOUNT BROW ORDER VALUATION !G POR THEA STATE THAT THE ABOVE IE CORRECT ANG • PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.P WITHIALL-CITY(OROINANC[S NO STATE LAG VALUATION ^ BUILDINOCO UCTI N. PERMIT FEE vn SIGNATURE OP PERMITTE $ �9, 300 t, 4 AUTHORIZ[O AGENT TOTAL FEEJry- - _ ..Condi-tions: .\ _ • �' :.. _ .,c ! .. - - _ 1.- Use -Clas-s-,'C"i--(fire,-retardent-roofs)--only,-_:Treated wood-shingles : = ____acceptable.. Stucco under side of any eave liiies"thadt paralIell 'each: other r or--closer.fo-a-,.period, of k20'-or more:— - ---- 3, , Cne_ Class_"Q''Fire 4hydrant lo_cat_ed' within 300 feet of the further- est• property in"or on this Tract; as;tper Fire Department - - �tspecfications-.c-'--_:.��xy.- -- -: ; ;.; ;.•.-.----- ---- - � ,:� _'`.�,_- _ _-- ' All 'the requirements of_the -City.. Engineer,and_the Director-of C,� Planning imposed, on-Tentative Tract-hlap-:No. 64-83.c,_ i =r ;` 5-.- -Tree -,planting -co mpatible-with-th.e -are_a under direction. of the. Street Superintendent. j 6. Dedication ,of sufficient land behind sidewalk location-on,Street---� rA" for utility-easement-(street lights, fire hydrant, gas and water). ' \ r 7 • .'A11 .the requirement's' of the City; Engineer'_dated-9-26-67-.--: : - --- 8 A11--the requirements=of._the=Planning Department dated 10 6-67 - as revised by Council. ? 4L 1:, "Mt,cc _iAcmta:a[a i ' . � � to t oC'C:• �' [- Y J � < T` v Lt-ry F Y' A'.1 ; 74 - GI1.._ r .l_d! • —_-.11... I •• r.P x l. a u