HomeMy WebLinkAbout156 19TH ST - Building Permits yin M CITY OF COSTA MESA
4� 9 BUILDING DIVISION
F"�,,,x' ,11fSII DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
Ia PERMIT
14. P06-00244
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 156 E 19TH ST Status: ISSUED
Suite No Applied: 04/102006
Issued: 04/10/2006
Vicinity:
Parcel Nunmber: 42603102
Applicant: SHERMAN, BRIAN ISSUED BY` r.
Address: 30300 PUERTO VALLARTA �,/ ""`
Phone: 800-727-0977
MENIFEE,CA Zip: 92584
Owner: TASS, RICHARD
Address 156 E 19TH ST �1T
Phone: 714-775-3609 R{Y-L
COSTA MESA,CA Zip: 92627-2831 titi"
•
•
Contractor: ALL STAR WATER HEATERS INC DOS g a
Address: 30300 PUERTO VALLERTA
Phone: 800-727-0977n^
MENIFEE,CA Zip: 92530 OW.,M"
License: 812894
- SCOPE OF PERMIT
CHANGE OUT WATER HEATER,SAME LOCATION FOR SFD.
FEE SUMMARY
AMT ga AMT QTY AMT
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0' Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors - $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank 50.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
' Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial - $0.00 0 Water Re-pipe $0.00 0
• Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 • Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 '0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
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
244646(6/00)
. ,
DECLARATIONS'
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
-jlhave 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 Ls issued.
My.workers''cop�p nsation Insuran carrier and policy number are:
r ro0 d 7 zine leia-(/' POIIcy,N / 71/ 7-197
-(This section need not be completed if the permit Is valued at one hundred dollars(5100)or less.)
-Wefartifylhet in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
✓comply with these provisions.
Appllcant'Slgneture7% _��=!�7�'r✓ Date: v_
WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE($1X,000),IN ADDmON 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 tic sed un er provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busine and_professions Code,and my license Is in full
forea.end effect�Lic.I g/2&9 Class pl C J G.
Contractors Signature:; - _ - Date: )L/—/0- 0 6
t
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(5500).):
❑ 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.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 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,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 W III 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 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No .
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any •
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature end 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 0 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 California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_.._._...t Air
.._ ualit____nage__.__ ..is required
for ..._.__.
7 a permit fromn the South Coast Quality edManagement CaliforniaDistrictHor other air pollution control district3 agency is required for the work which is the subject of mis
application,have allot the disclosures prescribed by CelifoHealth and Safety Code Section 42303 been made? 0 Yes 0 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 AUTHORRATION 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.
Srtnature Of Legal Owner(s) Date
I,/-/O -06
rAndlOr Authorized Applicant
cOOE I INSPECTIOH TYPE OAIL INTmAL5 CODE INSPECTION TYPE 181E MALI
1816 Fixed System Final Fire Prevention 206 Final Mechanical n_ p p
1266 Pool Spa Final 208 Final Plumbing 7-i[7'O L
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Well 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
`- ' CITY OF COSTA MESA --
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
11,14 PERMIT tB03-01924
SbftttRinso
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.% LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92826
Job Address: 156W 19TH ST Status: ISSUED
Suite: 518 E Applied: 11/05/2003
Vicinity: ROOF • Issued: 11105/2003
Parcel Number: 42603102 W :27-17-0/
Zoning:
Applicant: TOM SAYER ISSUED BY:
Address: 19562 DITMAR LN -
Phone: (714)593-9840
HUNTINGTON BEACH,CA Zip: 92646
Owner: TASS,.NATALIE P '
Address 156 E 19TH ST
Phone: 714-775-3609
COSTA MESA,CA Zip: 92627-2831
Contractor: UNDER COVER ROOFING
Address: 19562 DITMAR LN -
Phone: (714)593-9840
HUNTINGTON BEACH,CA
Zip: 92646 License: 687961
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: - License: License:
SCOPE OF PERMIT -
TEAR OFF EXISTING ROOF. INSTALL 15#FELT AND 30 YEAR ELK COMPOSITION.WILL NOT REPLACE SHEATHING.2,400 S.F.FOR
RESIDENCE ONLY.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: 54,500.00
Permit: $111.25 Claim Valuation: $4,500.00
SMIP Res: $0.50
•
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00 -
•
Total: $111.75 -
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
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
fora 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(600)
E,
DECLARATIONS S e
WORKERS'COMPENSATION DECLARATION: 1"
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 leci led.
' My w ers' pensation Insurance wrier and policy number are:
V‹.--
�‹—v
Car(This
/11
Policy Number:
(fnfs section need n t 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 to become subject t0 the workers'
compensation laws o California,and agree that if I should become subject to the workers'compensation provisions /o Section 3700 of the Labor Code,I shall forthwith
comply with these r islons.
Applicant Signature: Date: ) c) S
.WARNING:FAILURE TO CUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100, 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 Ilcer/��a LlDdpryroyisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busine anderofessions Code,and my license is in full
force and effect.tic.ll V /"f tf/ Class N S
Contractor's Signature: ,r / J Date: ///r,J 3
CONSTRUCTION LENDING AGE CY:
❑ I hereby affirm that there Ls 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 fora 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.
704-4,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 properly,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 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-properly 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,falsework,or demolition or dismantling thereof,will be more then 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 W III the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 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). _n _
-1"...-Does or will the applicant or present or future building occupant need to file a registratioform for acutely hazardous materials? 0 Yesy❑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 Flre
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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apernit for such construction or motlifica0on
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part oftfte facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_..oastpermIfpermit Quality by Califomia
a eal or Sr airtpollution ooncontrol 3istragency? is required for the work which is the subject of this
application,have all of the disclosures prescribed by Callfomia Health and Safety Code Section 42303 been made? 0 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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) 4% , Date
And/Or Authorized Applicant f Date
GOOF , INSPECTIONTYPE MALE KUALA gel:*II INSPECTION TYPE PAM 103:1A1,5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ,,,/ 208 Final Plumbing
200 Final Re-Roof /l Z"1 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Placa 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
,-..4 - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
e_ 12COSTA MfSA, CO�NSTRUCCTION PERMIT fj ^ Qa�s�g TRACT NO. LOT NO. UNIT NO.
15rolect Address /St C / T'L' 1 _ .
• Applicant's Mailing Address ,--7 s'7 arc- Nla'o, L./4 4.tb ;� TYPE OF.CONSTRUCTION 0 NEW IA ADD U ALTERATION ❑ REPAIR - ':Pfrs •, r^^ •^^
rl�a" ' - Phone-0,65,1 LI CONVERSION ❑ DEMOLISH ❑ OTHER q,p-$ - • Zone
Owner's NameDESCRIPTION OF WORK/USE OF BLDG.
Address `"s 4-iiy,c S Main Building: Accessory Building:
• E Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING 0 FOUNDATION 0 STRUCTURAL T Front o
Address • III TENANT ❑ ELECTRICAL .® PLUMBING MECHANICAL B Rear - N
Contractor's Name Fr£/y Ci�,c e. Phones•2` 3737 ❑ 'OTHER _
�,/ PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address lmailingl7 / / E� �/elov L n /JAI.h RYL
G
CONSTRUCTION TYPE VALUATION$ S Left -
City License No. Q 2-2-I6 2� ZONE GRADING CU.YDS. ACRES _ R
LICENSED CONTRACTOR DECLARATION - Ping. Ref.4 Parking Req./Provided - E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Cl
with. section 7000) of Division 3 of the Business and Professions Code, and - M
my license is in full force and effect. ,Z T
p License Class �' O LlcePse No.. S.
v Date Y"-e%- "I- signature � 4 9, •• PLUMBING FEES '
'lyeWORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
bf Workers' Compensation Insurance, or a certified copy thereof (Section .
Backflow Preventer Service Sink38 .-
p ) -�-• Automatic Washer Transformer ❑ 15-50-KW
Po1000y No. 6o7 Company � ik th Cg/N/ Backflow Irrigation Sewer Cap -' , ,Construction Pole,Sub. - •0 50+ KW
® Certified copy is hereby furnished.
Certified copy Is filed with the city a Ing�9�ivij�lon^ p ` Bathtubs Sewer Connection ' jf- 'Cooking Unit Meter Cup to 100 amps •
Date -9'-1 G Applicant •4 / -•+^ _ - `
EXEMPTION FROM WORKERS'COMPENSATION D CLARATION Clarifiers Solar Collectors ~ Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or -
less). Dishwasher : Solar Piping - Dryers ❑Gas ❑Electric Su• Panel
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 te Drinking Fountains Solar Tank S -mor s 00-1 HP 01%-B
Workers' Compensation Laws of California.
I ..Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar❑9-15 HP 016-15+
'NOTICE: If,after making this declaration, you should become subject to the -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal -
comply with such provisions or this permit shall be deemed' revoked. // Eixtures i -Microwave CONSTRUCTION LENDING. AGENCY - + Gas Service '' Outlets Water Closet
I hereby affirm that there is.a construction lending agency for the performance 1 Device Boxes Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater •
Lender's Name • Outlets Range 1
•
Lender's Address. _ Kitchen Sink " - Water Service Switches Sign
OWNER BUILDER DECLARATION . '
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbo Disposal ;Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or 9a P
county which requires a permit to construct,alter,improve,demolish or repair - P-Trap , • Laundry'Trays Generator ❑OS KW❑5-15 KW
-
- any structure, prior to its issuance, also requires the applicant for such permit t Trash Compactor •
' to file a-signed statement that he/she Is licensed pursuant to the provisions of • Roof Drains IJ fl'S C� q �J g_.��
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of /tiF/c /Yf T.A ' ,
: Division 3 of the Business and Professions Code) or that he/she is exempt , - - -_ - - ,
-erefrom and the basis for-the alleged exemption. Any violation of Section , • - - -
31.5 by any applicant for a' permit subjects the applicant to a civil _
natty of not more than five hundred dollars($500).. - - • '
O I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure Is not intended or offered - . Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL . FEES
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 Boiler Hood or type I ❑ •
DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for yP Zoning Approved By Date
sale. If, however, the.building or Improvement Is sold within one year of com- Canopy Type II El
•
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground •
Building,Approved By Date
prove for the purpose•of sale). - it-.14140
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System . Application Issued By f Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct- Ventilating ❑0-100,000 BTU ❑100,000 BTU •
- SUMMARY OF FEES
builds or Improves thereon; and who contracts for such projects with a con- - --� )
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration • " BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation Insurance should be provided to me. • • PLAN CHECK $. PERMIT r
❑ I am exempt under,Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG 4 Fire Dampers PLUMBING, $ 5•D� ISSUANCE $
' Date I Owner Heating System& Ducting 1 Registers _ PLAN CHECK 25% $ ' ENERGY P.C. $
I hereby certify that I have read this application and state that the above TL - ELECTRICAL $ '�l �D GRADING $
information is correct. I agree to comply with all city and county ordinances 1
and state laws relating to building construction, and hereby authorize repre- vr:ou //F ��G PLAN CHECK 50% $ MICROFILM $
sentatives of this city to ter upon the above-mentioned property for / ^� /(o
DO7�
inspection p 2Se.st_/ `</� // ' MECHANICAL $ 7• (li TOTAL FEE $ / U,f DO
Signature -1X) ( /
, •
• a
CMF,0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor
ONST..RUCTION AND PLANNING POOI WA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
41. 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, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent,Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final ••
15. Rough Electrical-Conduit . 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ❑Gas 0 Oil
23. Gas Pipe-Rough & Test - - 72. Underground Flush
24. Roof Framing _ _ 73. Undergrnd.Storage Tank 0 Gas 0 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 /^j-�]' A, Notes: •
34. Final Heating& Air Conditioning y/j7 Oce v(f e No yu„ r{. a c`� �W r� ‘
35. Final Gas Pipe-Test 1 /46` t..t 1WS I�j 1.4nn1 Pre !f5 r/
36. Hood or Canopy re-A. 7-2.3 elf 7�
37. Final Factory Fireplace '
5c61-5- r¢tv nriA fC'S 1 0 it et�f
38. Final Plumbing Y ate itd
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
i
49. Electric Release to Edison l
• 50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - .
No. Date - r
/
at
5396 F- E RECEIVED
COSTA MESA BUILDING DEPARTMENT `1-'C/ �r7— c
P.O.BOX 317 NANCE DEP(
COSTA MESA. CALIFORNIA rr''��yy ��FF rrppt� pp MMFFS�
FOR APPLICANT TO FILL IN ' APPLTGATIONTFC7RAPERMIT
BUILDING 1/45- C 9* a• BUILDING
ADDRESS (O
COSTA MESA, CALIF•RNIA FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
OWNER 3 5 c3
.
RECEIVED
ECEIVEDBYDATE RECEIVED DATE ISSUED
MAIL
ADDRESS / � 3 � ZVL �om,V • . /—'cy,, / p/_�2` d� / r
- /7
TEL.
CITY /» "(4-4-4.-A-- NO�/ s// ADDESS
ARCHITECT LIC.
OR ENGINEER NO. COSTA MESA. CALIFORNIA I
FIRE
ADDRESS ZONE
CITY LIC. ZONE A , pzANB TYPE GROU 7....e_
CONTRACTOR( (JVIPjy NO. O/ -TEL. BYPROVED rN
ADDRESS NO. BY '' DATE
DESCRIPTION NOT / /jJl. CORRECTIONS
BLOCK TRACT /
L
LEGAL 7S
J c /
A.P.NO./ IS-b S(-Z T
SIZE j.;-1 (`], NO.OF SLOGS. APPROV!-3D 1
OF LOT • w P , / erg NOW ON LOT .
USE OF .4 R r
EXISTING BLDG. PLAN NC DEPT. t
SETBACK LINE FROM /J ,/JJJJ1 F r SUBJECT TO :10G. DEPT. REG.
CENTER OF STTREE'T` ` �(��M REAR YARD-6;
IS ,-//�' �..
SIDE YARDS" r'/ RIGHT /// / LEFT /7 9 ` #Elc O DATV� V..-S--"7c..1_
DE ION OF WORK / a( u--�'E -i jr�ry,-/j II_�
NEW ALTERATION I ADDITION
REPAIR MOVING \ DEMOLISH
SIZELDING �T O J 2 0 ROOMS STORIES
EXTERIOR WALL S ROOF .
COVERING COVERING
USE OF NEW
BUILDING raft.
%'/�c4.f ' /7 Q/�
i V
•
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATIBUILDING CONSTRUC-
VALUATION
SIGNATURE OF %,.. /(( /j//�. PERMIT FEE S• - ^�
,`w'[Yj
PERMITTEE_
n S / 9OD PLAN CHECK S .--,.AUTHORIZED AGENT l TOTAL FEE S 6 _+ BAF
1 t 47.50
43614 ;�—�.o0 1,6s
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 .
PP I C. I ION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely
�
Use InkcOOnllyfy�zRE 'I Et: D•TE RECEIVED
SS s. s
ADDRE ' ✓6 E-. Hv ,Qif )1 T 1 . t , _ '
OWNER FIRS. I� ,e � _,/ PERMIT NO.
1-.- HER TINS A.P. NO.
rte, BUILDING
ADDRESS /S4' e. 1�I-A ADDRESS/`� i9' sr
r.—� i., ��/{' LO'eV'". BLOCK
CITY COST/- MESA" No.. D60;7,2_, 1.9 - /! , 72
CONSTRUCTION Whig oOR F,nD —R^ L
NEW AD ALTER REPAIR MOVING DEMOI ISH
LENDER r'TT/�W /� r-7- �I�'7
BRANCH 3 //V/ i - /TNAtom" �1. ^ •
OWNER E9 G�_ #EI U
ADDRESS
I e VALUE
ARCHITECT pox nil bEle TEL. - — S �I\ ii • 5 Ss
OR ENGINEER ! /y NO. 30 /aS e//J T
ADDRESS • E g'/GROUP J(cc, --tomiit.niJ!"
CONTRACTOR t�1LL / &. COFF 329P6 DATE "' `
ADDRESS 7 : 1//CT1C/A
TEL. 20NE,1 NO.OF • ,/ -
CITY ' a&TA MESA NO. ....1_.-ii/ 3p. / 2 PLANs�J __Ii_al -
E^ STATE CITY •- • R• • YARDS APPROVED
LIC.NO. 3ZG16FC LIC.NO. MAIN BUILDINGACCESSORY BUILDING
J,�
iziSIZE INO.OF BLDGS (FROM KA ( /r// 4.. .
0. OF LOT NOW ON LOT •• i' O-y, (S0ILrG�
QUSE OF /
10. EXISTING BLDG. a • _ /Sfi /- 0 FT.
h T L/
F Separate permits are required for L.SIDE FT. O FT.
electric,plumbing and heating work. REAR /Fra L/ FT.
H] USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE ET. BET.MAIN&
Q • MAIN BLDGS. ACCESS. BLDGS.
Q /L VAR.* DATE
20 ` Z 3 I CARVP C U.P.# APPROVED
7 APPRZya� ggipi
;' lider I • •TEl yr77
W
0 I hereby acknowledge that I have read this application and state !"7T0� F N
Ix that the above Information Is correct and agree to comply with Q$ SPF•rf m
C. all laws regulating building construction, and I shall not employ d. Kt
Z any person in violation of the workman's compensation laws of Qu +/las,,NITA.. 2
SSSW the State of California. ��:1
3 I hereby certify that I am properly licensed as a contractor under 04.0SQ.FT. w
the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business e
VALUATION PERMIT FEE E
and Professions Code,Division 3, hatter u,
PLAN CHECK § n
f
Signature o �r '. t /r
Permittee / § is260 �^
1 . On
d,( TAX § 513 U.
E
�
u
Authorized Agent TOTAL PAID $ ow'
r FAIU
436 13 .,tsi -7-nijjr 00 4151. ****514.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O,BOX 1200 COSTA MESA,CALIFORNIA 92626
LAr FOR STRUCTURAL PERMIT
For Applicant to F81 in Completely— Use Ink Only���,�s��.�, /� / R DATE RECEIVED DATTE ISSUED
G
ADIDRESS��,�rr I6Tom`' 7T E. /I'1 / /'1 �/ty. �`�/gry�_7--7'�
OWNER 1"l l\ Sr 1_ /7�R I�tFINS A.P.NO. /IfJ OSIO Pfl NA /
MAIL BUILDING
ADDRESS I S-6 E. ,9TY A/Lkif .ILDIESS jrCITY Q 05r7� M e.-SP NO. %G 77/ ///� / LOT/Iz BLOCK
CONSTRUCTION HA�7o� pr��/ NEW AID A ER REPAIR MOVING DEMOLISH
LENDER ctrl J/n�I` /� Cin V
BRANCH SA/VTA- r+AM-
OWNER LSTklCX E/Av3
ADDRESS _ �s / /,//,,,VALUE �'}--��
ARCHITECT ay p / TEL 631 USE // LiK t`-i'I S �'7p/
OR ENGINEER L, PA"- NO 3065
FIRE
ADDRESS /SEW r ZONE VPE GROUP
CONTRACTOR r 'I?�� ffSH (�Jj('U 2966 ` APPROVE DATES 7. 7
R
'` n
ADDRESS 2 VI aro RiA \^
/7 //�� ]� TEL. 631 > ZONEErt NO.OF 7 USE OF NEW..
CITY ( ACM M1✓S r7 NO. 3063 /� 2 PLANS BUILDING �� (\
F STATE ,.-, CITY YARDS APPROVED YARDS APPROVED
LIC.NO. 324 676 LIC.NO. MAIN BUILDING AC ESSORV BUILDING _ n(FRNM CAST yE�'f)
Kl SIZE NO.OF BLDGS. (/rJ(,
p. OF LOT NOW ON LOT FRONT l c% FT. � 1
yUSE OF / L/ 1 1
EXISTING BLDG. R.SIDE FTO FT
rn Ir/
FSeparate permits are required for L.SIDE Z6 Fir FT.
electric,plumbing and heating work. REAR r f/
3c- FT.// FT.
k USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
xt MAIN BLDGS. ACCESS. BLDGS.
ATE
G 12zg0 joaH AD.DITlO0 CARP. APR
//f��s� r/'� //n-_ C.U.P.# APPROVED ^J 7
>,' /i7�/{� V r/ Lit/ /YM1 --RV
APPROVE?../AAA' �/� ATE 3---1-f-C L
G
edt. •
0 e7
I hereby acknowledge that I have read this application and state 0 n
N
0. that the above Information Is correct and agree to comply with FOK ,c
m
all laws regulating building construction, and I shall not employ p i
Z any person In violation of the workman's compensation laws of FCIAt t.. o
the State of California. (-f////y it90
I hereby certify that I am properly licensed as a contractor under SQ. FT. lRE
r� 6 + A7pa_ a
,
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR S'D
9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ ef e
end Professions Code,Division 3,Chap r 9. n
Sig
nature e of $ AN CHECK $ D om= o
Se
- ir" "_-t'i�o U5J`' V TAX E SO u.
��/ G
Authorized Agent TOTAL PAID E _
�/ •.-