HomeMy WebLinkAbout833 17TH ST - Building Permits-=��'i S 1TTH STRF:a'T ---bS3
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` 1 � CITY OF COSTA MESA � �
BI/ILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-0856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B09-00098
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 42410203 DATE ISSUED: 06I0812o09
ISSUED BY: BJK
JOB ADDRESS: 833 W 17TH ST CM , Suite/Unit: _
viciniry:
Squares: 2200 Veluation: " ' $8,900.00
SCOPE OF WORK: REROOF, MANSARD PORTION OF A MULTI-UNIT COMMERCIAL/INDUSTRIAL"BLDG. 2200 SQ FT
NOTE: NO WORK ON FLAT PORTION OF ROOF� �
OWNER: WHITMAN,RICHARD�BTR��� Address: 15RAPHAEL .� ' � ' ,
PHONE: , , , - , �, , � � . Cily/State/Zip: MONARCH BEACN, CA ,.
APPLICANT: HURLEY, RICK - � Address: 23251 PERALTA DR
PHONE: 714.951-6724 , .�. - � � City/State/Zip: LAGUNA HILIS � , ' : , -
CONTRACTOR: HURLEY ENTERPRISES
Address: 23251 PERALTA DRUnit:' �
City/State/Zip: LAGUNAHILLS - �92653
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
�Q.Q�
$167.25
, $0.00� � �.
$1.00 '
$168.25
UNIT R
License No.
License No. �
License No. 314183
PHONE: 714.951-6724
CELL: ,
PHONE:
PHONE:
Unit:
Unit: :UNIT R
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
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 wmply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
COOER. INSPECTIONTYPE � INTITIpL GOOEp INSPELTIONTYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �� 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Flnal Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Flre Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Builtling/Occupancy
, ,
WORKERS' COMPENSATION DECLARATIO :
I hereby affirm under penalry of perjury one of [he following declaralions:
❑ I have and will maintain a certifcate of consent to self-Insure for workers'
compensation, as provided for by section 3700 of Ihe Labor Cotle, for the
peAormance o( the work for which [his p�rmit is issued.
G�—'I have and will maintain vrorkers' compensation insurance, as required by
section 3700 of the Labor Code, for the perfortnance of [he vrork for which this
pertnit is issued. My workers' compensation Insurance carcier and policy
numberaCia,�w�� �� � 0
tCarrier:+z ���
(Tnissecfronneedrwt-E�e/ro�mWered�th,e(penn�a vedatonehund.eddd�ars(StoOJaiess)
PolicyNumber. Ov �3u ��
❑ I certify [hat in the performance vf the vrork for which this permit is
issued, I shall not employ any erso� in any manner so as to become subject
to the workers' pensa n laws o( California, and agree ihat it I should
become su � ct�to he wor e' compensation provisions f SecY n 3700 of
the Labor , I all forth � compl with ihese provisi s. �^
� V
pvlicanfs Si lu e•- �ate
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENAITIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
AT�ORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000) o( Division 3 ot the Business and Professions Code, and
my license is in fu! force nd�ftp,St.
Lic.:#.. �� � _ ��55 � � C. - 3
C mr's S�gnaWre Da e�,
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm that there is a construction lending agency for the
pertormance of the work fp which this permi[ is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OW NER-BUILDER DECLARATIONS:
I hereby aNvm ihat under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Protessions Code: Any city or county which requires a permi� to
construct, aller, improve, demolish, or repair any simcture, pnor to its
issuance, also requires the applicant for such permit to f le a siqned stalement
that he or she is licensetl pursuant to the provisions of the COMrectors
License Law (Chap�er 9(commencing wilh Sec[ion 7000) of Division 3 of the
Business and Professions Code) or lha[ he or she is exempt Iherefrom and
lhe basis (or the alleged exemption. Arly violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more ihan
five hundred dollars ($500�.):
❑ I, as owner of the property, or my employees with vrages as iheir sole
compensation, WILL DO 7HE WORK, and Ihe structure is not intended or
oRered for sale (Sec. 7044, Business and Pmfessions 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 hersel( or throu9h his or her own
employees, provided that such improvements are not intended or oftered tor
sale. If, however, the building or improvement is soltl within one year of
completion, the owner-builder will have ihe burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construct the projec[ (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply ro an owner o(
pmpeAy who builds or improves [hereon, antl who contracts !or such project with
a cont2cta(s) license pursuant to the Contrectors License Laws.�.
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre
305]-46(3/01�
� ,
Owner ID veri�ed by dri r's license. ❑ Yes ❑ No
Drivers License No. � Ezpires:
Verifcation of Ownership by (rype of document, i.e. - property [ax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more feel in depth into wfiich a
person is requiretl to descentl, will be made in connection vrith work authorized
by this permit, and that no building sWcture, scaffdtling, falsework, or demolition
or tlismantling thereof, will be more ihan ihirty-siz (36) fee[ high. (Chap. 32, Grp
2, AA 2, Sec. 341, Tile 8, Califomia Administ2tive Code�.
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division of Industnal Safety, as noted above, unless
sucb person has a permit to do such vrork from the division.
Ap0licanCs SignaWre Date
Division of Indushial Safety Permit Numbe[ _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre builtling 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 Heal[h and Safery Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Departmen[ by every business which has at any one time during a repoRed
year a quantity of hazardous matenals equal to or qreater 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 preseM or future builtling occupant need to file
a registration form �or acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safety Code, vrith some
exceptions, requires regislration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acu[ely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at standard
temperature and pressure).
3. Does or will ihe applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require ihe preparation, certifcation and
filing with the Fire Departmen[ of an RMPP by businesses which are required
to register acu[ely 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? ❑ Yes ❑ No
5. Does or will [he applicant or present or (u�ure building occupant require for
the work which is the subject of lhis application a permit for such construction
or modification from the South Coasl Air Quality Management Disirict or (rom
any other air pollution control dislnct or agency7 ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that Ihe requested
in(ortnation be fumished on applications fa noo-resitlential builtling permits�.
6. Will any part of ihe facili�y �o be conslructed under Ihis permi[ 6e within
1000 feet from the outer boundaries o( a school? ❑ Yes ❑ No
Qf'yes", lhe tacility must meet the requirement of Sections 25534 and 42303
of [he California Health antl Safery Code).
7. If a permit (rom the South Coast Air Quality Management Distnct 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. pf'yes", attach certifcate of compliance from the appropriate air polWtion
conirol oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and siate that
the information given is correct. I agree ro compry with all state laws and city
ordinances relating to building conswclion, and authonze representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection pur es. I agree not to occ py or allow occupancy of any building
authorize< Ihis ermit until fnal ins clion.
Si lure dl Ownerfl )/ / �p^�
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An or'Aul�onzedApPhc n Da�ei
"''�0iB101D�0` 833 W 17TH ST
fyMER9NWE1FI0qMlt BOURGEOIS HARRY D TR
"D°"�` 335 A WOOGLAND PL
COSTA MESA,CA 92627
�P� ���� 645-3544
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ARCII OH ENO.'S ADDRE59:
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C0N1"'�T0"'""� MESA ROOFING ( 714 ) 548-3012
°aN1""CT0"'�'""'0 843 W 17TH
i0°"�A COSTA MESA CA �"�- 564151
92627 u"T:
UCENSEU COMN�CTONS OECLAR�TION: I Mroby eflim uMer perWy d pwjwy Ihtl I em licanetl imder pwidone ol CMqa 9
(commmidrq �mh Ssctian 1000) d Oivi+un 9 d Ne Buei�wro eM PMmeom Cods. aM mY 4mnw e in IW Mn end elletl.
cmuc.no.:035681 uc.cuss: C_39 uc.No.: OS/96
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a MareE ror ods (Soct'v� ]ou. Bw'uro aM P�dwmon+Code: Ths Cam�mon liorue law� dae� rca ePM'to en owmrd propeny
who buib tt in0�+� ihetcn. md Ma Ame turh xvk IimfeM a MnM v Uvq� he a her orm xnpb/saa. pw'detl IhM euch
im0���xaa sa nol iruaded w d1�eE la ub. tl. Mwewr. ihe dntl"up a inpwnnav o wk wGhw ar Y� N wmdaion. iM
owner-0urY�r xiq hws tM diN�n d peMip M a kw did rM Wdd a'unpv.e In IM piryroe d �ele).
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coNrecb b�uN D�4b� �h e aor+reaM�) Icamed P�uaN m tM CaMreaas �iwa leyi.
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Deb: ApplceN:
WOPKEP'8 COYPpl9�TON DECLARATION: I MrWy dfirtn urka peroEy d pryvy aw d Ns IoOoninp detlertliwa:
� Ihmmlwime'vitenacWkMdauuanitoWliMmbrMdken'm�qa�tan.mpwidadtabySWim9'lOOdiMLeEa
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n" .�i>w:wcmwmmem�.a.Mv.9.k«.'�'mi�°`��parwy�n«�..: EXPIRES
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becan aEjW to IM xorks�' mnpwnetian bvs d Caltlomie. W
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Deie: �� �— �S ApplicanL � �—
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aw nn.. w ro a�. nu,dnd �mu,.b dwrn lt�a4aooA ��+�n ro m. ce.i er eomo.n..don wmso.. u povw.e ror in
9�cl/on ]]06 0l tln l�Dor COW, Infwt, �nL �rtom�y'� I�u.
CON4TRUCTION LENDINO ��ENCY: I Iweby effi�m uMer paiuM1y d perjury Ilut iMn u a mut�utlion WMinp yanry M Ns
performeMa d IM wM Ip MiiN ihe pwml u uwed (�� �l. CW. Cl.
LENDER'S NMIE:
LENOEB'9 �DDHE44:
I cerltly �IW I hm nd Nu epplieNim eM eN� Ihel �he ebov� Inlamdion la conw. I pna to compy with �tl cry eed wumY adirw�oe�
yN �tae lexs Mqip ro buildiq oontruGbn and Mreby eNhor¢e rapmnteliuea d IM aryb W x upon iM eEwe.memionsd p�opeity
lor iroC�ian ND��. _ ._ _ . _ _ _ _ _ . .
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CITY OF COSTA MESA - BUILDING PERMIT
PERM NO: B 075119
PERMIT NO: B 075119 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: I-FR PERMIT TYPE: STR PURPOSE: OTH
SOB DESCRIPTION : T/OFF REROOF W 3PLY CLASS A CAP SHEET SQ FT: 8,695
CLAIM VALUE: 8,695.00 CALC-VALUE: 8,695,00 GKOUP OCC: B-2 /
COMMENTS: REROOF WITH 3PLY CAP SHEET57 Sl�OARES
*�*�*x�*����***x��r�x�***�*�r+�***�**x�*+�+�**�* x��**�**+��+�+�*�r�x�*�*+�*�*x�*x*x���r*�r*x�***+�
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 HUILDING ---------- --------- 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: 42410203 ZNE: REF NO:
PLANNING NOTES>-
.� " ,
iF 1E ik if IE iElE if 1! iklE 1E iE fE fE IE,iE fE IE iE iE iE �)E �E 1F 1f if !E iE iE 1E 1E �ElE 1E iE 3E �F fF 1E iE iE iE fE 1E If iE iE iE iE iE iE �E iE iE iE iE iE af if 1E �E iE iE iE iE 1E 1E �E 1E,iE ik 1E 1E 1f if iE 9E iE
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
1
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : UATE: ��
APPLICATION ISS[fER� �Y: i DATE: I'I ;�����
iEiEiFiEiFiEiFiFihiEiFifiFiFiFi4iFiri�i�iFiF�3. . 1EififiFifiFiFiFi4K�iF {E
LEGALIZATION:N.• E E E S U M M A A Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 108.00
PLAN SMIPiNp3-RES
ISSUE F'EE 8
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK Tc� TA� �+ATL� DUE
TOTALS----> 109.83 0.00 0.00 i09.n lU9,b3� ��p�g
REVENUE DIVISION .TOTALS--> COLLECTED: lt)'�.i? `al"�!£�'S���ft ,��
��S�L��i�BN�M� I�L��[��iNt��� �Ei,�E�C�TRitC Mt�Ei�+tdii" �F'iit�E '�M4�f�8�� GRADING PLAN-CHECK
�
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�-.
I N D I V I D 0 A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFC 8695 REROOF BY VALUE COMMERCZAL NOZONE 1.00 8,695.00
END OF FEES
� .�. � _
��T . . .. - ... �T._':J �.
� CONSTRUCTION AND PLANNING � P��' 'PA '
� APPROVALS Permit# �Date Inspecior AppROVALS Permit# Date Inspector
I
1. Temporary Electrical Service or Pole 52. Pooi & Equipment Locatiom
2. Soil Pipe•Undrgrnd. ' � 53. Steel Reinforcement �
.3.�Electrical ConduirUtility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. �� 55. Electrical Bonding
5, Steel Re�nforcement 56. Rough Plumbing & Pressure Test �
"'�6.� Electriwl UFER Grnd. 57. APPROVAL TO COVER-GUN�TE
'�7. Footings �� - � 58. Electrical Conduit-Undrgrnd. i �
"� 8: �Foundation - � � 59. Gas Pipe, O Untlrgrnd., Test �
r 9. Water Pipe-Undrgmd. , 6p. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
il. Property Sewer Line & House Connection 62. Backwash & Raceptor-Final
12. Sewer Cap 63. Heater &� Vent•Final .
13. Roof Drains � 64. Plumbinp System � Finaf �
14. Rough Plumbing � 65. Electrical�Final �' '
15. Rough Elearical-Conduit ': ' 66. Solar System�Pinal i ,
16. Rough Electric Wiring . 67. Fencing & Aceess Approvai '
17. Rough Wiring Sign � � . 68. APPROVED FOR PLASTER�NG :�
18. Rough Electriral-T Bar Ceiling � '
69. POOL/SPASYSTEMSFINAL
79. Rough Heatinq& Air Conditioning _ . FIRE-DEPT. REQUIREMENT .
20. Rough Factory Fireplace ��, .�, "' APPROVAiS - Permit #�
21. Ducts, in Strucwre'. "' ^ � " 70._UndergKqund Hydro
.�
22. Ducts; Ventilatin9�� � .� r- 77. Product�Piping OGas OOiI
23. Ges Pipe•Rough & Test ' '= ° � � 72. Under9round Ffush :
24. Roof Framing � ` ,� F ' � 73. Undergmd. Storage Tank � Gas ❑ 0�1
25. Roof'Shea[hing y• � !1-�� , �` �/�,�}j� 7d. Overhead HYdro
V_, ^'
26. T-BarCeifing (Struttv_rap & Monocbat �_ - :' � . 75;-Dry Chemicai. •
27. Fcame and �Piashing. �� . 76. Dry Standpipe: ': �-� ,
28. Lathing &.Siding � ; � � � �' � 77, FIXED SYSTEht PINAL
29. Insulation - _ •� 7$. FIRE PREV. FIN�AL
� 30. Drywall Nailing - � : � �HEALTN DEPT. REQUIREMENT
��31. Plaster Brown Coat�� ' � s•"?• 79. FINAL,INSPECTION
�32. Electrical Powzr MeterFinai �s '' 80. F000 CERTIPICATE ISSUED
, -
33. Final Electric . � � . ' Notes: - •
34. Final Neating & Air Conditionirg - ' ', ' ; :
35. Final Gas Pipe=Test. � • -
�=36. Hood�orCanopy ' � . � � . �, �- ,
� 37. Final FaMory FireplaCe .. . , �. -
'38. Pinai-Piumbing " •�.,'. ; ' • -. . "
�39. Water Service-Final �. � . � � - �
40. Gas Service=Final � �`
�41. Solar pomesticFinal ' - � � - -.
42. Backflow Preventer . � . .
43. Backflow irrigation . y � � -
44. Landscape Irrigation SYstem � . � � - J - _ �
45. Sou�d Atlenuation � �.� �
46. Handtcap Regulation4 , . -
47. FINAL STRUCTURE & BUIL'DING // p.�_�`�
j��1�
48. FINALPIANNWG � � � , -
49. Elearic Release to Edison � , �
50. Gas Release to SouthBrn California Gas Co '
51. CEFTIFICATE OF OCCUPANCY '
No. Date
C�
f `� a
AOP���ant f0 fill in all ipaces excep� those wit�in,�eavy DorEer Iines an0 si9n all appropriata Oeclarations.
CITY OF cOSTA ONST UCTION PERMIT
Project Address
Applicant's Mailing Address � � I
Owner's Name � � r0 ho e/a�d
Address
Arch/Eng. ' r � L'ce No.
Address 0O 0 � '
Contracror'sNam 7 � � P�� �F
Address (mailing) � _
City License No.
LICENSED CONTRAGTOR DECLARATION
I hereby aflirm tnat I am licensetl untler provisions of Charter 9(commencin9
with sec[ion 1000) of Dlvision 3 ot Ihe Bu5ine55 antl Prof¢Ssions Cotle, antl
my license is in tW or<e ana effect. /
Licens'e� /CIl�as.s . icens�e ��No.�l Q��
DateJQf� Si9nature '' /(��FSG7
WORI�ER COMPENSATION DECLA IOrv�
I nereby alfirm that I have a certiticate consPyR to 5elf-insure or a certifica[e
' Workers' Compensa[lon Insurance, or a certifietl copy thereof (SectiOn
100, l.nb. C.)
rolicy No. Company
eCertifietl coOY is hereby furnizhetl.
Certifietl copy is tlletl with the city Builtling Divlsion.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl no[ bC cOmpletetl it the permit i5 for one huntlretl ($300) or
less).
I tertify that in the pertOrmance o� tbe wof ( fo h Ihis p¢fm�t i5 i55uatl, I
shall nol em oy n pe�son in any ma r to com¢ subjeG[ [o the
Worker5' e Laws of Cdli(Or
Date Signature �
NOTIC 1, af r making this tleclaration, shou bec me subject to tne
Workers' Com ensation provisians ot [he bo� tle, you must forthwith
comply with such provislons or this mit all be tleemetl revoketl.
CONSTRUCTION LENOWG AGENCV �
1 nereby aiilrm that there Is a conscruction lentling a9ency for the performance
of ihe work tor wnicn this perml[ iz issuetl (Section 309� Civ. C.)
Lentler's Name
Lentler's Atl�ress - � �
OWNER BUILDER �ECLARATION
I hereby affirm that•I'am exempt from the Contractor's License Law for the
following reason (Sectlon 7031.5 Business antl Professlonal Cotle: Any city or
county whiGh require5 a p¢rmit to con5(ruc[, alteq ImO�ove, tlemolish o� repair
any structure, prior to its issuance, alzo requires the appli<an[ for such permit
[o tile a signetl stalem<nt thal he/She Is IicensCtl pursuant to tbe provisions of
tne Contractor•s License Law (Chapter 9(mmmencing with Se<tion 7000) o(
Division 3 0( the Business antl Protessions Cotle) or that he/5ne is exempt
'herefrom antl the ba5i5 for the allegetl exemption. Any viOlation of SeC[ion
031.5 by any appliCant to� a permit subjects tlte applicant [o a clvil
enalty of not more Ihan five huntlretl tlollars ($500).
❑ I, as owner ot the OrOp¢rty o� my lmployees with wdg¢5 as their sOle
compensallon, will tlo the work, and lM1e slructura is not IntenCetl or offeretl
lor wle (Section 7044, Business antl Protessional Cotle: The Contractor'S
License Law tloez not apply to an own¢r Of a Orop¢rty who builtls or improves
thereon, antl who tloes such work himself/nerseH or tnrou9h M1is or her own
employees, provitletl U�at such improvements are not intentletl or offeretl for
Shce. If, howevEr, the bulltling ov improvement is Soltl within One year of Com-
pletion, tho owner will have the bu�tlon of proving he/she tlltl not builtl o� Im-
. rove for the purpose of sale).
� I, a5 Own¢r of the prOpe�ty, am ¢xclusively Conl�actinq with IlcenSed con-
tractors to cons[ruct the project (Sec[ion 7044, Busines5 antl�Proteszions Cotle:
The Contractor's License Law tloes not apply to an owner oi property who
builas or Imoroves thereon, antl who conVacts Por such projecis wltn a con-
tracror(sl ucense pursuant ro the Cantractor's Licanse Law�. I am aware that'
proof o( their Worker'S Compensation Insurance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date —
I hereby certi
IlliOYRIdI�00 �5
antl state laws
sentatives of
Inspection our
Si9nature �'
Driver5' LIceM
1F 0865-46,rev.
. Owner
have reatl this application antl
apree to comply witM1 dll city a
6'buiitlido ro <buction. antl he
upon
TYPE OF CONSTRUCTION ' LxJ rv
❑ CONVERSION ❑ DEMdust
DESCRIPTION OF WORK/USE OF
TYPE OF PERMIT �- LJ GRADiNi
❑ TENANT ❑ ELECTRICAL
❑ OTHER
PROJECT DESCRIPTION 5�. FT._
'�I�1 ADD LJ ALTERATION LJ REVAIR
J OTHER A p #
_DG. STbl2f�6-E ADD/ OAI
� S Main Bu
FOVNDATION STRUCTURAL T FfOnt
PWMBING ❑ MECHANICAL 8 Rear
A
C Right
OCCVP NCV
CONSTRUCTIONTYPE � VALUATION$ DO -� g Left "
,20NE GRADINGCV.VDS. ACRES PIng.Ref.#
Remarks: �Q 1\ �. , y._ L y. ' PldMing NO'
Sink
Preventer '�
Irrigation
Clarifiers � '�
Dishrvdsher
Drinking Fountains
Floor Drains
Floor Sinks
GasService ' Outl
Interceptors
Ki[chen Sink
Lavatories .
P—Tra
Re6f Dreins
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct-Strucmral . . -
Duct - Ventilating •
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. IC80 #
Heating System & �uctin
❑0.100,000 BTU O}B ,000BT
Reinspeetion Fee
White - Bulltling: Canary - APplicdnt; Pink - Accountin9: Goltlenrotl - AsseszOr
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar k
S ming Pool w
Urinal _
Water Closet
Water Heater
Water Service
A uto-W ash
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Retrigeration Syste
❑0.100,00 ❑100,OOOBTU
� m Repair/Alteration '
Fire Dampers
Registers
laue Fee
$ 3
$ 3
Automatic Washer
Consvuction Pole
Cooking Unit
Dishwasher
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$WI[C�ICS
Garbage Disposal
Generator �0.y
i-
lecttic
—� " __� - \ /
9761 6/ I S/'7 I �:',5^ • T'
Parking Req./Provided
ELECTRICAL •
Trensformer ❑ 15�50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter, Dover 100 ps �
Sub Panel �
Morors 61 HP O1 :4 - 8
In olar �9�75 HP 016-75+
icrowave
Pole Light
Range•:
, Sign '� '
Standing Sections
15 KW � Trash Compactor
r�
� Reinspection fee � $15
DEVELOPMENT SERVICES REQI
Zoning Approved By �
Building Approvad By �
Appliption laued By
Issue Fee
FEES
$ 3
SUMMARV OF FEES " � ,7O
BUILDING PERMIT $ �•-�'� SMIP ,$
PIAN CHECK g 5.733 pERMIT
PLUMBING $ �SSUANCE $ ,
PLAN CHECK 25% $ ENERGV P.C. 3
ELECTRICAL $ GRADING $ �
PLAN�CHECK 50% $' � MICROFILM $
MECHANICAL $ TOTALFEE $, 3/ 3-�3
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA _
APPROVALS Permit # Date Inspector qpPROVALS ��Permit # Date Inspector
1. Temporary Electrical�Se'rvice or Pole 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. '. ' 53. Steel Reinforcement �' ' � �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms�'
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd�� - � 57' APPROVAL TO COVER�GUNITE
7. Footings � ,• �• _ '�8�'� J ` '58. Electrical Conduit-Undrgrnd. �
S. Foundation l _ ��' �� 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd -+� �, 60. Backwash Lines, P:Trap, O Undrgrnd. -
10. Structural Floor Systemt 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap �y 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 ' � '
i 6. Rough Electric Wiring " 67. Fencing & Access Appioval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriral-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 O Gas ❑ Oil '�
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing , 73. Undergrnd. Storage Tank O Gas ❑ Oil ,
25. Roof Sheathing' 74. Overhead Hydro . .�
26. T-Bar Ceiling �Structural) & Monocoat : 75. Dry.Chemical � ��� . '-
27. Frame and Flashing 76. Dry Standpipe - • -
28. Lathing & Siding 77. FIXED SYSTEM FINAL n � .
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 Faaory Fireplace •
38. Final Plumbing �
39. Water Service-Final
40. Gas Service-Final �
41. Solar pomestic-Final .
42. Backflow Preventer - - �
43. Backflow Irrigation � �
44. Landscape Irrigation System .
45. Sound Attenuation `� ' �
46. Handicap Regulations -
47. FINALSTRUCTURE & BUILDING � �i
48. Special Requirements Completed � . '"
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co �
51. CERTIFICATEOFOCCUPANCY . �
No. Date _
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COSTA MESA BUILDING-SAFETY DEPAI
P.O. BOX 1200 COSTA MESA, CALIFORNIi
For Applicant to Fill in Completely
ADIDRESS � � �' � �S�
OWNEF rj(JM S S7�CLfi/.IiQ/
MAIL (��D E/'�L �
ADDRESS„�
��T� L�c��� r3�t
CONSTRUCTION
LENDER ONG
BRANCH
ADORESS
ARCHITECT �J M. WAT
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ADDRESS /�/ j / /7/j0/� ��
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CONTFACTOR BG(i/v'eF'
ADDRESS
CITV
STATE
LIC. NO.
SI2E
OF LOT Io � Y 3��
USE OF �j,
EXISfING BIOG. A��R�/7�✓� —
SIZE OF ; �p�/ I� NO.O
NO.
TEL.
NO.
CITV
LIC. NO.
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NO.OF BLDGS. ./
NOW ON LOT '�
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AT(1RIFA /
ROOF /q
COVEFING l'OHPr
C TO BE PEFFORMEO
�''; -��•7��`;' Ot' n�,�, . • � .!, `.
APPLICATION FOR BUILDING PERMIT
�i� 1� /�.l�Y i AT/ �E/ f� /,�TE 4-5UI
f�/
OwNER LtIC•
03
VALUE
FIRE // /
ZONE � TVPE GROUP
APPROVED
gy ATE �'
ZONE �, NO.OF USE OF NEw
PI,AK> � BUILDING ,�' �
YARDS APPROVED VARDS APPF
MAIN BUILDING . ACCESSORVB
aW
BET. \ I BEf. MAIN &
y�
1 hareby acknowlatlge thut 1 have reetl Mis npplication antl state
that the above informetion iz correct antl agree to comply with
all laws ragulaUnB builtlin8 constt�etion, and 1 shall not employ
any person in violation of Me workman's compensation laws oi
[he State of Cali(ornia. �� 6 �
I hereb carNf Mat I am � SQ. FT. o
V y p�Ope�ly licensatl as a tonitactOr untle�
t�e Stata of Calitornle Businass end Profassionz Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOfi �
Chapter 9, aptl t�et such licensas ara in full torce antl eftect, or I ITiE PVRPO6E OF ESiABLISHwG A PERMIT FEE ONLV: m
em exampt from Ue provisionsof thaState of Cel(tornie B�siness � %% ¢
entl Protossions Cotla, �ivizion 3, Chapter 9. VA�V ATION pERM1T FEE 9 I� �� �
]
Slpneture of �J m
Permittae � $ PL4N CHECK $�`�. S� E
�y /y o
� / LL
Authorized Apant OJ��D/ TOTAL FEE 3/ D� �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant ro Fill in Completely
aui�oiNc �2 �� •�
ADDRESS f
OWNER � /� �
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ADDRESS
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LIC. NO.
SIZE
OF LOT
USE OF
EXISTING BLDG.
'N-Q� � /l�Ltit.� N� S�1
�T'
TEL.
NO.
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TEI.
NO.
pTV
LIC. NO.
NO. OF BLDGS.
NOW ON LOT
SIZE OF NO. OF
NEW BIOG. ROOMS
EXTEflIOR WALL ROOF
COVEFING COVERIN
USE OF BVILDING AND WORK TO BE P
�
!7
I hareby acknowletlBe that 1 have reatl this application and itate
thet the above informatian is corract and agree to comply wi2h
nll lews re8ulating builtling eonstruction, antl I shall not employ
eny pe�son in viOlalion ot the workman's compensation laws of
Me State ot Calitomia.
I hereby certity that I am p�opeily licensed as a cOntracto� untle�
the State of California Business antl Protesslons Code, Divislcn 3,
Chapter 9, antl ther such licen5es are in full force antl aifect, or I
em exempt from tl�e provisions ot the S[ate ot California Business
entl Protessions Coee, Division 3, Chaprer 9.
Sipnature of y�� /� �,,, ^ i I � Q��
PermlttBe / Y�fA.I,�, ,uc� VV
Authorizetl ABent
PAI�OO 7�q� 68.66
:�r,T is-����,s�• w ���,<
TION FOR BUILDING PERMIT
pATE RECEIVED DATE ISSU
�0-/�J-%yl /2_ �_
BUILDING p ��
A�DRESS p
1 TRkACG�
OWNER
��o� M%�
FIRE
20NE
APPROVEO
�V
VALVE
FiL <
N�'1 IPLANS2, IBUILDING IN���
VARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDING
VAR.#
C.U.P.�
DATE
APPROVED
&
�
V m
b
SQ. FT. o
THE AMOUNT SHOWN UNDER VALVATION IS FOR
THE PURPOSE OF E5iABLISHING A PERMIT FEE ONLV: m
¢
VAIUATION m
�J PERMIT FEE S j
�J/� P S m
$ 'T���� PL,AN CHECK $ � �^ E
� `o
LL
TOTAL FEE $
.;,�,:^: � �5�
COSTA MESA BUILDING-SAFETY DEPARTMENT
v.o_ ROX 1200 COSTA MESA. CALIFOflNIA 92626
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APPLICATION FOR BUILDING PERMIT
Far Applicant to Fill in Comp/etely
RECEIVE DA RE EIVED DATE ISSUED
BUILDING �� ' �%
ADDRESS Sr �
/�/'a',/ y �f� PERM N .
OWNER /�/(/{v/i��(p � pI �'[Q A.P. NO.
MAIL BUILDING
ADORESS ADDRESS
TEL. TRACT LOT BLOCK
CITV NO.
CONSTRUCfION
LENOER
BRANCH
OWNER
ADDRESS VALUE
ARCHITECT TEL. E
OR ENGINEER
FIRE
ADORE55 ZONE TVPE GROUP
APPROVED
CONTPACTOR BV DATE
ADDRESS ZONE NO.OF USE OF NEW
TEL. p�qry$ BUILDING
CITV NO.
STATE CITY �'AR�SAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SI2E NO.OF BLDGS. (FROM C/L STREET)
OF LOT NOW ON LOT ROM FT. FT.
USE OF
E%ISTING BLOG. $ F
$12E OF NO. OF
NEWBLDG. ROOMS STORIES L.SIDE FT. FT.
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF,BUILDING AND WORK TO BE PERFORMED p�${ANCE BET. BET. MAIN &
MAIN BLDGS. ACCE55. BLDGS.
VAR.�W DATE
C.V.P.qW APGROVED
APPROVED
I ha�aby acknowlatlga that I �eva �eatl this epplica[ion antl sta[e
thnt tho ebove information is correct antl apree to comply with �
oll laws ragulating builtlinB �onsttuction, antl 1 shell not amploy
uny person in v{olatlon of Me workmen's eompensallon laws oi
the S[e[e of Celifornla.
I �eroby certity Not I am properly licansatl as a conttncror untler SQ. FT.
[he S[ata of Californie eusinezs anA Professions COtle, Divisicn 3,- THE .SMOUNT $HOWN UNDER VALUATION IS FOR
Chaptar 9, antl that sueh Iitenses ere in full (orce entl etfect, or I THE PURPO6E OF ESTABL6HING A PERMti FEE ONLV:
om axempt irom tl e provlsiOns of the Siato of Calitornia Business
VALUATION ���
antl Profazslons Cr�ae, Dlvlsion 3, Cheptar 9. PERMIT FEE $�� �
SIB�otura ot �
Parmittee $ � PLAN CHECK $
Authorizetl ABent � �i�
TOTAL FEE $