HomeMy WebLinkAbout405 19TH ST - Building Permits� �
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��pMs9 BIIILDING D/VISION
>� •� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.w.us
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� FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BX11-00118
PERMIT TYPE B MISC STATUS: ISSUED
APN: 11734150 DATE ISSUED: 05/02/2011
Zoning: , ISSUED BY: RMD
JOB ADDRESS: d05 E 19'1'li S�T�CM�y� Suite/Unit:
Vicinity: ROOF T�^rt, Primary Occ: �- . Const Type :??
SQ. FT: 0 Valuation: E9,800.00
SCOPE OF WORK:
INSTALLATION OF A 22 PANEL ROOF MOUNTED 5.02 KW SOLAR PHOTOVOLTAIC SYSTEM WITH 1 INVERTER, SERVICE
PANEL
UPGRADE TO 125A, MISC EL EQUIP, DISCONNECTS.
OWNER: TRACEYAMLEY
City/State: COSTA MESA, CA
Phone: 949-722-1293
APPLICANT: GOLBERSON-LABM, SONIA
City/State: �
Phone: 510-414-8120
CONTRACTOR: SOLARCITY CORPORATION
Address: 2265 S GRAND AV
Ciry/State: SANTA ANA, CA
Zip Code: 92705
ARCHITECT:
Phone
ENGINEER:
Phone
FEE SUMMARY
Building Plan Check:
Building Permit: �
Electrical Permit:
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
Address:: 405 E 19TH ST
Zip Code: 92627
Address:
Zip Code:
License No. 888104
Phone 714•290-9521
$117.81
$18125
$92.60
$0.98
$0.00
$1.00
License No.
License No.
Cell:
Unit
UniC
Unit:
TOTAL FEES $393.64
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3N812010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the foilowing Federal Holidays:
New Years Dav. Memorial Dav. Indeoendence Dav. Labor Dav. Thanksqivinq Dav and Christmas Dav
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspeclions and fnal approval vrill result in lhe expiration of this permit.
GpDEt, INSPECTONTYPE ORTE INiITIRL COOE/ INSPECTIONTYPE �RTE IN1111RL5
1618 Fixed System Final Fire Prevention 206 Final Mechanical
t266 Pool Spa Final 208 Final PlumDing
200 Final Re-Roo/ 210 Final Electriwl
� vn,��—
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site r�
204 Final Demolition 250 Final Builtling/OCcupancy � �✓ ���
WORKERS' COMPENSATION DECLARATION�
I hereby aKrm under penalty of perjury one of the following declaratio �
❑ I have and will mainfain a certificate of consent to selFlnsure for vrorkers'
compensalion, as provlded tor by section 3700 of the Labor Code, for the
pertormance o( ihe vrork br which [his permit is issued.
❑ I have and wiil matntain workers' compensatlon insurance, as required 6y
section 3700 of the Labor Code, for the performanca oF the work (or which this
permil is issuetl. My workers' compensation Insurance carrier and policy
number are:^
�Carrier, ��1.[V'a. �wQ}�Caa/"�
(This setl'.cn nePOrol be wm�.Netetl ANepermAis valuetl al one nuiu4etl cbUars I510J) aless.)
Poic�Number: ah�"3�b�'S��—
❑ 1 certify that in the peRormance ot the woAc for which this perMt 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 subje 6 Ihe wo �rs' wr p� sation provisions ot Section 3700 of
the Labo e. I h811 1 A co 'th these provisions. '
1
iwm's'Si" awre 0 iE'"
WARNING: FAILURE T CURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,006), IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS
PROVIDEO FOR IN SECTION 3706 OF THE LAHOR CODE. INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm tbat I am licensed untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Busirtess antl Professions Code, antl
my license is in fuil force and eHect.
I:(c.,#��"' ss ��Qr(.`��e� 13
r- 1� -
nlraclor ignaNr D le" '
ONSTRUCTION IENDING AGENCY:
❑ I hereby a�rtn that there is a wnstructbn lending agency for the
pedormance of the v.ork fa v.hich this permit is issued �Sec. 3097, Gvil Code).
Lentler's Name:
Lentler's Adtlress:
Signamre �are
OW NER•BUILDER DECLARATIONS:
I hereby a�rm that untler penalry of perjury tbzt I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business anq Professions Cotle: Any cify or county vfiich requires a permit to
construct, alter, improve, demolish, or repair any strucwre, prior to its
issuance, also requires ihe appliwnt for sucb permit to file a signed statement
that he or she is licensed pursuant to the provisions ot the Cont2crors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt therefrom and
tbe basis for tbe alleged exemption. Any viWation of Section 7D37.5 by any
applicant for a pertnit subjects the applicant to a civil penalty of not more than
fve huntlred 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 ConUactors
License Law tices not apply !o an owner of propeRy who builds or improves
thereon. and wtto does such work himself or herself or through his or her own
empbyees, provitled Ihat such impmvements are not inrended or oRered far
sale. If, however, the buildtng or improvement is soltl vnthin one year of
completioq the owner-builder will have the burtlen of pmving that he or she
did not build or improve (or purpose of sale.).
❑!. as owner of the property, am EXCIUSIVELY CONTRACTING WITH
IiCENSED CONTRACTORS to wnshuct the project (Sec. 7044, Business and
Profess"nns Code: 7he cont2ctors Lfcense Law dces not apply ro an owner of
property who builtls or improves thereon, and who cooi2cts tor such project with
a cont2eta(s) license pursuant to the Contmctors License Laws.).
❑ I am ezempt under sec.
Business and ProFessions Code (or this reasOn:
]057-46 (9ro�)
Owner ID verifietl 6y tlri�ense. ❑ Yes ❑ No
Driver's License No. Ezpires:
Veri�cation of Ovmershfp by (lype of document, i.e. - property tan Dill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby ceM1ify lhat no excavation frve (5) or mwe feet in tlepth into vfiich a
person is require0 to tlescend, will be made in connecCqn with work au[horized
by this permit, antl that no builtling sWCWre, scaNdding, falsework, a tlemolition
or dismantling thereof, will be more than thiAy-siz (36) �eet high. (Chap. 3.2, Grp
2, Art 2, Sec. 391, rtle 8, Califomia Administrative Codej.
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Intlustrial Safety, as noted above, unless
such person has a pe�md to tlo such work �rom the Crvision.
ap0�����"s Signature
Division of Industrial Safety Permit Nomber. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Wilt the applicant or present or (uture huilding occupant need to file and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Secfion Z5505 of the Califomia Health antl Safety Cotle r0quires, wi(h some
exceptions, that a Business Plan be fled vrith the Costa Mesa Fire
Department by every business whicb bas at any one lime during a reported
year a quantity of hazardous materia�s equal to or greater than a weight of
500 pountls. or a volume of 55 gallons, or Z00 cubic feet of compressed gas
at standard lemperaWre and pressure).
2. Ooes or wiil lhe applicant or present or fuwre builtling occupant need to file
a registration form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 0( the Califomia Health and Satety Cotle, with some
ezceptions, requires registration with the Costa Mesa Fire Oepanment by
each business which at any one time has on hantl a quantity ot aculely
ha2ardous 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
tempe�ature and pressure).
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
�Section 25534 of the Calitomia Health and Safety Code provides that tbe
Costa Mesa Fire DepaAmeN may require tbe preparatioq certification and
filing �,rith the Fiie DepaRment of an RMPP by busiriesses which are requ'rzed
ro register acutely hazardous materials with the Fire Department.
4. I! an RMPP is presently requiretl, bas Section 25534 of ihe Califom�a
Health and Safety Cotle been fully complied �rrith? ❑ Yes ❑ No
5. Dces or will the applicant or present or future builtling occupaN require for
the wnrk wfiich is the subject of this application a permit for such conswction
or modification from the South Coast Air �uality Management Oistnct or from
any other air polWtion control district or agency7 ❑ Yes ❑ No
(Section 65850.2 of the Califomia Govemment Cotle requires that the requested
informalion be fumished on applications for non-residential building permits).
6. Wiil any part of the faciiity to be constmcted untler this permit he within
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
(If'yes", the facility must meet the requirement o( Sections 25534 and 42303
of the Calitomia Health and Satety Cotle).
7. If a permit from the South Coast Air Qualiry Management District or other
air pollution control disMcl or agency �s requiretl (or the work vfiich is the
subject of this appliwtio�, have all ol the disclosures prescribetl by Calitomia
Health and Sa(ery Code Section 42303 been made? ❑ Yes ❑ No
8. pf "yes", attach certificale ot compliance (rom the appropriate air pollution
contrW officer).
CERTIFICATE OF COMPLIANCE: I certtfy that under penalty o( perjury the
information give� above is correct, I agree to comD�y wlih all stale laws an0
city ordinances regartling Hazardous Materials and Emissions.
CERTIfICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
ceBfy untler penalry oF perjury that I have reatl this application and state that
the in(ormation given is correct I agree to comply vrith all state laws and ciry
ordinances relating to building constmction. antl authorize representatives ot
Ihe City of Costa Mesa to emer upon the above-described proDeny tor
inspection purposes. I agree rwt to occupy or allow occupancy of any building
authorized by this permit until final inspection.
�llgr��N �e Fk2g21 i ¢ Date
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;./�OONRSOFBNlDWO: QOS E 7.9TA ST
',�'E"s""'E"�w� DE WILDE, RICHARD A TR
�' �°p� 405 E 19TH ST
COSTA MESA,CA 92627
847-3709
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��"�T�� ADAMS ROOFING ( 714 ) 963-1740
COMHRCTOHSMYIlNO z1382 DOCKSIDE CI
�o� HUNTTNGTON HEACH CA ��� 524341
92646 u�:
110EN5ED COMXRCTONS UECL�P�TION: I Inrtby elfrm uMer perely d per'ryry Mm I em Iiw�ueE uder pa'vbn d Cheqs B
(eommendn0 wnh Saction )000) d Oiwun 9 d Ta Bu�man end Pmlroelaa CaEe. end mY fearee u m lidl brea eM efletl.
cmuc.no.:041p4622 uc.cuss:C 39 uc.No.:�41 EXP: 12/97
Dme: `/��/ / � Caarma:
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OWNEfl BUILDEF OECLAFRTION: I MnEy etNm uMer penely W perjury ihn 1 am ewnq ham Ihe Comradm lironee lew la IM
Idbvnq nemn lSedion ]031.5 &re'vwee eM Prdmaiona Code: My ciY n cauMy wh'xA reqWree e pemiil to aonslryct. Ms. impws.
Mmd'eh, or repei eny nructure, pia io ns ewence, eho requiree tM eppli�ant la wch psimu to file a ei0�� ewemeni Met M ar �M
i IironceE punuent io the Ormrieime d tM Conirmora lir<rua law �Gheqer B(commeMiiq wilh 3aqion ]000) M 0'vcion 3 of Rr
.uainav eM Ndeeaiwu COAeI ��� � or ehe n exemq IherMvn enE Ihe betis In tha eDepeA exemqion. My violMon d Setlian
�oals M env rop��� r« a w� wbi.� �n. mp�� �o. dxl yenetly ai �wl mae �han ibe hiu�d�aa ad�an �Swop.
p i.d�.,amao�wm�mv«�ww.....n�.+..ma:.de�ro�.m�..aimub�.�ew.w„�xw.:�a��a.e
«oRaeC I« role (Sec�im ]DU. auuroa eM Pmlmavu CaEe: TM Comreaaslioerua lawdow rwt eWN loen owner a papery
wlq WiOa a inpwea IM1dson. and Mn doss �Wi wak hineetl a hxsN a tlrou0h he alwr ovm emO�NM�. D�'�d Ihm wrA
'vnqownMs are nal iMenEetl a dMd la eeb. tl. lpwew. �M Widi'q a inpiv�anwX o wid vrilhM arYw d comWe�un. tlr
ownerWitler wiA Mva �M burden al D�'NO he or eM dtl nd dtitl a imP� lor tM puryma M seb�. '
� I. m owror d �M pw�Y. em e�tluwwlY oonireenY wilh �icmeed canvectm ro canW W 1he V�Wb (Sw'vn ]Ou. &nirme md
wd.,,w�e coa: rna com,mo�, u�.e ta. eo. m wcN a«� ow�.� a wowm wno w�m o. �ww« m..� �d wno
conneds 1« wrh prq«fa wiih e mmreeor�e) fcermA punuem �o tM Contreaore limnae lew).
� I em eaemq u�Mer Seetion: B. 8 P.C.. M N'v esavon:
Dme: Ownr
i ao n,�,nr �r u,d i� awe,e a�e �e«.w�e e,s �w��o a cw� �en �a s.�.n coe. seo�. asas. zssx�..m
?553a. erq Nn I w ury Mura buJtiry owqent will / wil rwi (acle ane) nsed b mmWy wih vaid Ma codw aM tM ipinamama lor
a psnN la mml�uclion a ma difimtian ham iM Ai�arupmwM Divritl. M�NaMid mM�utlion eppk�etion ua ezemq hom Nw
,.a;.�..
Dme: Appfra�a:
WOXKEP'S COMPENSIITION OKL�flAT10N: I haroby elfum uMer penelry W payuy ans W iM Idbw'up ErWelune:
� I hew enA xil meinten e cMdiub al mneant lo eeMiroure M Mvlcere' compnwion, m qavidaE lor by Satlian 9100 d the lebor
CaM, la IM pertmmnce d Ns xork la wNch I�is pe'mil b ivued.
_['l � ne».ne Mi� mequei, Mw�w.• oomw�on Imurenc.. m na��.d M swbn a)m a Ne labor coe.. r« �n. w�«menm a in.
�� wwk ta whidi iA� M��'v ivueA. MY worken' mmPa�ion ieuurvr.e wrwr md V�Y wmber as:
c� S�TATE FUND EXPIRES
PNry Number. 1{(�� a- 0 3/ 01 / 9 7
�iNs waron nrd na M ewnab�ee I uro w�! u M mre h�oMIM daden If1w1 n 1m.)
� I mnN � in tM p«Imnenee d �M woM tor r.Tch tA'u pamw is mwd. I kutl M omplq eery paaan m vy menMr o n b
bsconr eubpf �o tM workme' campenWian lern d GlEmue. eM pml il I bxme wRjwf b �M xvAr�'
mmVm/�(et qwiniom W Sqon 3100 d the labar Cada, I tlW/I f�on�oomp�y tiA'�mHebns.
Dms: �//d��'� Appl'ram: "Y"
WemNp: F�Nun ro Neuro woiken'ronparu�tlon eov�rps l� unl,w�/ul, �ntl �hll �'tl/�ct en rrployw ro crlMrW p�neltls. vM
NHI 11riu ey b om h�rtlrotl UpYwd EWdn (t10qOP0A M�611tlon b M� easf o/ romp�u�fbM1 E�rrup� u provltlM br In
S�ctlm �108 0l tlro Le6orCob, lirt�nst ��m+mry'� Ira
CONSTAlICT10N LENpNO ROENCY: I hmeEy elf�m ivMer psaXy d pei�ry Ilw �Mn o e mrot�wion MM"vp e�pM.y b Ns
pertoemenos d IM Mqk la v.fiid� Iliw pxmi o unnd (`�� ��. Giv. C).
LENDER'S NAYE:
LENOEN'S MDFE54:
I canity Ihe� I hme raad Uia eppliWpn aM pets tM1m tha abwe iMormation b tarrW.l ep�ae �o ewnply xilh eA dy eM muMy adine�me
eM ewa lewe relmcp to Wik'vq camburtion eM hereby euNor¢e n0���e�N� d Ihb dry W eMer upon tM eEwe�mentioned propeM
/« impedian purpocea.
ADAM T} ORIN
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(5�51�e6.WP) W�as���q85eley.OraemFb:Cervryr�Od�:�k-Rewnue:0okenmE-Nweeor
CITY OF COSTA MESA - BUILDING PERMIT
PERM NG; B Ofi1568
PERMIT NO: B 081568 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE; OTH
JOB DESCRIPTION : REROOF W/COMP OVER WOOD SHINGLE SQ FT: 2,950
CLAIM VALUE: 2,950.00 CALC-VALUE: 2,950.00 GROUP OCC: R-1 /
COMMENTS: RESIDENTIAL REROOF
iE iE if 1E iE iE iE �E 3F iE it ik iE it if-iE iE iE if iE iE iE 1E iE iE iF if iF iE iE iE iE iE i(� iE iE 1E iE iF if IE �E iE IF if �E iE i4 iF jk iF if iE i4-IE iE if iE iE iE 1E 1E iF iE iE i(-iE iF iE iE k i't iE iE 3E if N If iE
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 F2EAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARXZNG REQ: PROV: PARCEL: 11734150 ZNE: REF NO:,�
PLANNING NOTES>
� ::
iE1EfF1E1EiEIEiE1EiEIF1EiEiFifiEfE�)f-If1Eif1E1EfE1(�iFlhiFitlFitiF%itRrticieiFX�%X %X % 1C %X K>: %X Y. X K� X X X%%%X X X%%�%�1{iE�E�)tifiEiElE1E1Eif
D E V E L c7 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: 2•'/O•�7
iE iE IE 1E ik 1E iF iE if !E!E jf IE'lE 1E IE 1ElE 1E f(� ik if iElE 7E aE if !f if 1f 1E iE���*'�E
LEGALIZATION:N F E E S U M M A R Y STROCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE � SMIP/RES GRADING
PERMIT 74.75 �_ SO
.- SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUfi
TOTALS----> 75.25 0.00 0.00 75.25 75.25 .00
REVENUE DIVISION TOTALS--> COLLECTED: 75.25 OVER/SHORT: 00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT� GRADING PLAN-CHECK
74.75 .50
lE1EIEIElFififlEiEiEiF1F1EiE1EfEiFlElklEiElEik1f1E1EfEiFlkf(�IkiEiflEiElEiEiE1E1ElEiElklEifiEihiElElEiElEiElfiElEikfEfF�Efhif3FiElfiEfEiEiEiElEikiEiElElE1EiE#
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 Z P T I O N ONIT COST TOTAL COST
SFR 2950 ALTER BY VALUE RESIDENTIAL NOZONE 1�.00 2,950.00
END OF FEES
0@-IB-1997/81:23 PM/475.25
RCPTq:01-A801855
PERMITe081568
� CONS7RUCTION AND PLANNING
APPROVALS Permit #
� t. Temporary Eiectrical Service or PoVe ��.
2. Soil�Pipe•Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Und�grnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings � .
8. Foundation --
9. Water Pipe-Undrgrnd. �
10. Structural Floor System '
11 . Property Sewer Line & House Connectio�
12. �Sewer Cap �
13. Roof Drains �
14. Rough Plumbing � -
15. Rough Electrica�-Conduit
16. Rough ElectricWiring
17. Rough Wiring Sign
18. Rough ElectricaL7 Bar Ceiling
79. Rough Heating & Air Gonditioning
20. Rough Factory Fireplace �� .
21. Ducts, in Structure
22. Ouctr, Ventila2ing
23. Gas Pipe•flough & Test
24. Root Framing "
25. Roof Sheathing
26. T-8ar Ceiting (Structurat) & Manocoat
27. Frame and Flashing
28. Lathing & Siding _
29. Insulation �
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Mecer-Finai
33. Final E�eciric
34. Finai Heating & Air Conditioning �
35. Final Gas Pipe•Test .
36. Hood or Canopy -
37. Final Factory Firepiace
38. Final Plumbing �
39. Water Service-Final
40. Gas Service-Final �
41. Solar Oomestio-Final
42. Backflow Preventer
43. Backflow Irrigation . �
44. Landscape Irrigation System -
45. Sound Attenuation
46. HandiCap Regulations
47. FINALSTRUCTURE&8U4lD1NG Z_
48. FINAL PLANNING
A9. Electric Release to Edison
50. Gas iielease to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
Date � Inspector
POO� �PA
APPROVAI.S Pe�mit # Date 4nspector
52. Poot & Equipment Location � � �
53. Steel Reinforcement " '
54. Forms
. 55, Electrical Bonding
56: Rouqh Plumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
58. Electrical Concluit-Undrgrnd.
59. Gas Pipe, C Undrgrnd„ Test .
60. Backwash Lines, P�Trap, O Undr9r�d.
61. APPROVALTO'DECK �
62. Backwash & Receptor-Final
-63. Heater & Vent�Final . '
64. Piumbing System - FinaL'
65. Electrical-Finat
66. Solar System�Finai
67. Fencing & Access Approval
• 68. APPROVED FOR P�ASTERING. �
69. POOL/SPASYSTEMSFINAL -
FIRE DEPT. REQUIREMENT
� APPROVALS Permit #
70. Underground Hydro
77. Product Piping aGas �Oi1
72. Underground Flush
73. Undergmd.StorayeTankt7Gas �Oif
74.-0verhead Hydro
75. Dry Chemical
76. Dry Standpipe '
77. FIXED SYSTEM FINAL.
78. FIRE PREV. F�NAL
NEAITH DEP7. REQUIREMENT
79. FINAL INSPECTION .
80. FOOD CERTIFICATE ISSUED .
Notes:
Z
0
0
Aoo��cant to fill in all spaces within neavy boreer lines antl sign all aoProD��ate aeeiarations.
CITY OF COSTq MESA - r MIT NO. ACT NO.' LOT NO. �BLDG. NO.
CONSTRUCTION PERMIT �DOvIO � Z
Addrea /jiDS� /% �.ST. C�oS�4 /I7G�r
Arch/Eng. � � License No.
Address ' -'
Contrac[or Phor
Addreu
I �ereby atfirm lhat I am IlcenseG untler provlslons of Charter 9(com-
mencing wltb -secUon ]000) 01 Diviston 3 of the Business anC
Pf0}BSSI005 COtlO, dptl Ty IICBOSB IS lel fUll (OK! dOtl lf�BCt.
Llcense lass 4cens —
Date � 519na[ur
WORKERS' COMPENSATION 'ECLARATION
1 her¢by aHitm tnal I have a Certl/ICate o( COni¢nl t0 self-Insuro or a
tortHlwt! O/ Work8r5' COmp8n5dUOn Insurdnte, Or a cerUfietl caOY
tnereof (Section 3800, Lab. C.).
P^'�cy No. ComDany
artliletl copY �s hereby furnl5h¢tl. '
.artitletl copy Is fiiatl with the clty Builtling Divlslon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
�Thls section neetl np� ba completotl It tha permil Is tor one hunGrea
53001 or lessl.
Cert(fy thdt in tha p�rforrtldnCR Ot Ih0 wolk fOf wt11C11 th15 p¢rmit IS
ISSuetl, I shall nOt erryPloy any pal5on In any rttdnn¢r 50 az t0 bGGome
Sub�Btt t0 tha WorkOrz COmp¢nsdtlOn ldws ot Cdlltotnla. _ -
Date Si9natura
NOTICE: If atter makin9 thli tletlaraUon, you shOUIC become subject
to tne Workurs' Compensation provlslons ot tne L,abor Cotle, you must
forthwlth Comply wi�h suth provl5iOn5 Or thls perTit shall be tleemetl
/OVOk¢tl. � ,
CONSTRUCTION LFNDING AGENCV
1 hereby aftlrm that [here is a tonstructlon lentling agency for [he per-
tOrmant¢ Ot [h¢ wOrk iOr whiCh Ihls permit ii ISsuetl (Seclion 3097
Civ. C.).
Lentl¢�'s Ndm¢
Lentler's Atltlress
by afnrm tnat i am exempt from the Contracror'S Licenu law for
�Ilowing reason (5¢�(ion ]031.5 Business antl Prolesslons CoOe:
dty or COunty whith r¢qWr¢s a pe�mit t0 con5trutt, al[e�,
VE. tlET0�15�1 OI fCpd11 dfly StIUCfU�G, pNo� IO ItSISSOdOC¢, d150 �2-
� the appllcant for such permit t0 file a signetl s[alement [hat �e
n5etl purzuan[ to the prOviSiOns ol th¢ ContrdttOr'S Litense Law
�ter 9(commeqcin9 with Section 1000) of Dtvision 3 of Ihe
Css antl PfOfM5iryn5 Cotlej o1 Ihdt hG is ez¢Tpt tllef¢flom antl [he
for the alle9etl exemption. Any vlolation of Section ]031.5 by
ppliwnt tor a permit subjacts the applicant to a civll Penalty
more than livy huntlretl tlollars (5500).
as owner ot lhn ornoertv_ �, m., o�+��^..^^...:•^ ....^^. -. .�-i.
Convacior's Uconse �yy,� tloes not appry to an owne� o� a propGrty
wh0 builtl5 or imprOy¢5 [her¢on, antl who tloes Sucn work himself or
lhrough his own empioyees, provitlatl that such improvements are not
In[Gntletl Or oHeretl fo� Sale. II, howGvlr, [he bUil4ing or Improvemenl
Is solE within ono year of completion, the owner will have lhe burtlen
of proving h¢ dIU qot bulltl o� improv¢ fOr th¢ pUtpose o( sale).
�❑ I, a5 ow�¢� Of tM1e p�ope�[y, am excluSiVBly COnt�acting with
IlcenSetl con[ractors to construct [he prolect (Sectlon 7044, Business
antl Professlons Cotln; Th¢ Contrdtt0�'s Llcense Law tlOtS n0[ app1Y to
an owner o! proparty who builds or lmprovcs thereon, antl who Wn-
trac[s from suth prOjects wlth a contractor(s) Ilcesnetl pursuant to
ttie Contractor's Licehse Law). �
� ❑ I am exempt untle� 5¢�(Ipn B. S P. C�or tttis
� �GdSOO
Dato Owner
I �ereby certify thdl 1 hdve r¢ad thli appllwtion antl Stala thal [h¢ dbOve
I In/ormaUon I5 COrreqL I a9ree t0 comply wilh dll Clty antl COunly
n ortllnances antl state laws relatlng to constru<tlon, antl hereby autnorize
�� ropresentative�Y�uf Shii tlty ,yo enter upon lhe above mentlonetl
DtiverS' Litenso or 55 � � -
CMF 0865-46 Whl�o-Builtling; Canary-Applica ; Plnk�Accountin9;
TVPE OF C,�ON�STRUCTION
❑ NEW L7ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTIONOFWORK,�� %2
TVPE OF PERMITJ
❑ GRADING�J Ld FOUNDAT�IO/JV �STRVCTURAL
❑ TENANT lll ELECTRICAL IJPIUMBING ❑MECHqry1CP
❑ OTHER
PqOJECT DESCRI ION `,
$Q. FT. � � � �{.S I�
OCCVPANCY O STRVCTION TVPE Fa@�
VALUATION ONE
GRADING CV. YDS. �2 ACRES
PLUMBING PIANCHECK �
BATHTU85 SIiOWERS
TOILETS ' • URINALS �
LAVATORIES DOUBLELAVS--
KIT.SINK$ DISHWASHERS
SERVICESINKS �/ � SUMPS �
FLOOR SINKS FLOOR DRAINS
DRINKING FOUNTAINS �
INTERCEPTO(35 CLARIFIERS
SVdIMMING POOL P TRAP -
WATERSERVICE ALTERATION
GASSERVICE OUTLETS
WATER HEATERS BTU OUTPUT
SEWERCONNECTIONS
SOLARTANK ' �GOLLECTORS'
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL vU+rv CHECK
HEATING SVSTEM 0-]00,000 BTU
ANDDUCTING IOO,OOO+BTU
i3EFRIGERATION 0-300,0009TU
SVSTEM � : �00,000+ BTU —
BOILERS BTU
SVSTEM REPAIR,ALTERATION
EXNAVSTSVSTEM MULTIPLE
ISSUE FEE
-Hs5¢55or
7960 7J01/BI
VING REGULA710NS
t PLN�
REAR VARD (TO P/L)
PKG. SPACE REp.
STREET WIDTH
ZONING APPROVE��
SPECIAL CONDITIONS:
ELECTRICAL " '
203027 TL
�,
PARK FEE 5
PLAN CHECK
GENERATOR' 0-1 KW_1-30 KW �
TRANSFORMER
APPLIANCE 10-SOKW_SO+KW�
MOTORS 0-1 HP_1-10 HP �
(INC. SOLAR) 30-50 HP 50 � HP _
FI%TURES � OUTLETS 7 SWITCHES'
GAS TUBE SIGNS-
POLE IIGHTS - ' —
PANELS MAIN' SUB ' � '
SERVICE - - AMP
APPLICATION APPROVED BV DATE
SUMMARV OF FEES
BUILDING /��
PERMIT S_�7%•J O $MIP E�y-/�--
PLANCHECK $�g.�' 2 PERMIT -
ISSUANCE E
PLVMBING S GRADING S
PLAN CHECK S '
ELECTRICAL 5 S
MICROFILM S
PLAN CHECK - E
MECHANICAL S TOTAL FEE E
LE55 AD-
Pt_ANCHECK § VANCEPC S_
FINALFEE S?o�.27�
CONSTRUCTION AND PLANNING .. ' .�POOL & SPA ` �
APPROVALS Permit # Date Inspector qpPROVALSJ � Permit # Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
il ipe-Un rgrn 4. Steel fieinforcement � ' �
3. Electrical Conduit Utility-Undrgrn "'' � 45. Forms '
4. Electrical Conduit-Undrgrn - 46. Electrical Bonding
. tee ein orce ; • 47. � Rough Plumbin & Pressure Test
6. Electrical UFER Grn ' 48. APPROVALTO COVER-GUNITE
7. Footings � 49. Electrical Conduit-Undr rn
B. Foundation �• 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn ' 51. Backwash Lines P-Tra ❑ ndr rn �
10.. Structural Floor System 52. APPROVAL TO DECK � ''' ' -- �
�11'i� !Property Sewer Line•& House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection . 54._ Heater & Vent-Final
13. Rough Plumbing . �
14. Rough Electric-Conduit • '�56.• Electrical-Finai�
15. Rough Electric-Wiring � 57. Solar System-Final -
76. Rough Heating & Air Conditioning � encing & Access Approval
17. Ducts in Structure ' APPROVED FOR PLASTERING '
76. Ducts, Ventilating � ,
19. Gas Pipe-Rough &Test - 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin �
22. Frame and Flashin NOTES:
� 23. Insulation •
24. Lathin & Siding -
25. Drywall Nailing �
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test. '
31. Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Finat
35. .Landsca e S rinklin S stem .
36. Sound At[enuation - '
37. Handicap Regulations
' 36. FINAL STFUCTURE & BUILOING -- fL� G
39. Special Requirements Completed
40. Electric Release to Edison �
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY .
No Date
- y�� 34535
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
for Applicant to Fill in Completely
BUILOING /�j
ADDFESS Q �✓' � • ( / �
OWNER 4 G CONS�NC �ION �
MAI l
Z ADDRE55 2%00 eY$04! �0�
d z c�Tv C'a5�m N�s a No� SN6 oj7e
ZQ CONSTiiUCT�ON
O N LENDER
am
,J � BPANCH
J N
m J ADORESS
m ARCHITEC7 LP NEL G% Z
J N Oli ENGINE R
U Q /
W� ADORESS 3Z�j L W OrT f
W ��
a 1
JO CONTRACTOR wQyNt O 5 Y✓!/1a
m Z ,,(
w � ADDRESS '3OO �. PW DY/
ZF CITV Pw Or^� aC NOL6'/2-IS�
w � STATE CITY
y([ LIQ NO. —� LG C Z LIC. NO.
� � SIZE NO.OF BLDGS.
OF LOT S, yQ �(% NOW ON LOT /
USE OF � / �
E%I5TING B4p(�, . 0✓3
H S12E OF Z NO. OF
Z NEWBLDG. bE f' FOOMS STORIES
V COVEROINGALL yCCO COVOERING SnIN I�
J USE OF UILDING AND WOFjK jQ�E PERFORME
a
a - w (9u�1 ��:.
Q
�
F"
N
Z
O1 hereby ac4nowledga that I heve reatl this application antl state
� thet tha abOve informotion is correct end aBree to comply wlih
� ell laws regUlating builtling consnuction, and I shall not employ
F„ any person in violation of the workmen's compensatlon Inws of
y the State ot California.
? 1 hereby certify thai 1 am properly licensetl as a conttector untler
the State ot Calitornia Business entl Professions Co ivisicn 3,
Chepter 9, antl ihat such licenses ara in tull force d e fect, or I
am exempt trom the provisions of the Stete of Cali rni Business
entl Profession CoA�e, Divislo , Chaptar 9.
Sipnatura of ' ` J � ��
Permittee ��
AuNorizatl qgent
reio ,t� ir,r�
���e -5-7zt„�,,.00 ise� 6.19
APPLICATION FOR BUILDING PERMIT
RECE E- V DA E R CEIVED DA E ISSUED
-'72 �j 1�7�-
•y `, PERMIT NO.
A.P.N .�I/ �7I" I�7_
BUILDING , � � � / �
ADDRES—�/ �
��°FRACT/ /K • L(]T� flLnCK
OWNE
FIRE
ZONI
APPF
N�/ NO.OF �
1 PLANS i
YAROSAPPROVED
DISTANCE BET
MAIN BLDGS.
VAR. �
C.U.P.ak
VALVE
�
USE OF NEW� �'��
BUILDING �
YAqDSAPPROVED
ACCESSOPV BUILOING
FT
BET. MAIN &
a
/G 6sa: F� .�oG.�ea�,� o
THE AMOVNTSHOWN VNDER VALUATION IS FOR �
THE PURPOSE OF ESfABLISHING A PERMIT FEE ONLY: a
¢
VALUATION �p
PERMIT FEE S �
J
/f m
$ L / ZOO PLAN CHECK 5 � E
`o
LL
TOTAL FEE $