HomeMy WebLinkAbout1917 CHURCH ST - Building Permits 0ycN MFsq CITY OF COSTA MESA
�, BUILDING DIVISION
4A74:. 77 FAIR DRIVE, COSTA MESA,•CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaCa.Oov
FOR INSPECTIONS CALL:(714)754-5626
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PERMIT NUMBER: BC12-00334
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES ALT DATE ISSUED: 06/05/2012
ISSUED BY: RMD
JOB ADDRESS: 1917 CHURCH ST CM Suite/Unit:
APN: 42626114 Zoning: , ,
Vicinity: 'Primary OC&
Const Type:V-B SQ. FT: 0 Valuation: $6,000.00
SCOPE OF WORK:LEGALIZE WORK DONE WITHOUT PERMITS. REMOVE SIDING IN FRONT OF AN APARTMENT BUILDING.
REPLACE WITH STUCCO. INSTALL 2 TANKLESS WATER HEATERS ON THE OUTSIDE OF THE BUILDING AND 2 OUTLETS
FOR AUTOMATIC SPRINKLER SYSTEM.MISC GAS PIPING AND WATER PIPING. NO OTHER WORK AUTHORIZED BY THIS
PERMIT. REF:
C12-0463
OWNER: BOITANO,COMANIC Address: 407 1/2 JASMINE AV Unit:
Phone: City/State/Zip: CORONA DEL MAR
APPLICANT: SILER,JOSH • Address: 20701 GOSHAWK LNUnit:: •
Phone: 714-969-1768 City/State/Zip: HUNTINGTON BEACH,CA
CONTRACTOR: PACIFIC COAST BUILDERS License No:672362
Phone: 714-969-1768 Address:20701 GOSHAWK LN Unit:
Cell: City/State: HUNTINGTON BEACH,CAZipCode92646
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: $0.00
Building Fees: _ $125.25
Electrical Fees: $25.70
•
Mechanical Fees: $0.00
Plumbing Fees: $59.05 •
SMIP Residential: $0.60
SMIP Commercial: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES: $211.60
"Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - 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 following Federal holidays:
New Years Day,Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day
•
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 inspections and final approval will result in the expiration of this permit.
COOE I INSPECTION TYPE MTF IN1111ALS CODE 1 INSPFCTION TYPE •a ��,r
1616 Fixed System Final Fire Prevention 206 Final Mechanical w (7i 'Mai
1266 Pool Spa Final 208 Final Plumbing /kis
r��I //
200 Final Re-Roof 210 Final Electrical J L
201 Final Block/Retaining Wall 212 Final Fire Prevention •
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign - 222 Final Site yy1
204 Final Demolition 250 Final Building/Occupancy 1 r r
WORKERS'COMPENSATION DECLARATION Owner ID verified by drive tcense. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's Liatise Nos, Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code. for the
performance of the work for which this permit is issued. •
O 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. M workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number argue^I`l• 4n� /' person is required to descend,will be made in connection with work authorized
/alien v\`t n' _ v t f15 / 0
by this permit,and that no building structure,scaffolding.falsework,a demolition
l� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sector neetlLr,fy eagh� a at wren edmea�/}�(woo)aless.) 2,Art 2,Sec.341,Title B,California Administrative Code).
PolicyNumber: ( " r-or_ O`''
❑ As owner-builder, I will not employ anyone to do work which would
❑ I certify th , the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall of x ploy any person in any manner so as to become subject such person has a permit to do such work from the division.
to the work: s' c. pen aws . California, and agree that if I should
become s .ject . - worker .... - sation provisions of Section 3700 of Applicant's Signature Date
the Labor ode, . all forth 'th these pro
Division of Industrial Safety Permit Number:
• god W.nfe S.gnature=Ar—
ate` HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNI : FAILURE TO SECURE WORKERS COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS U. •WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
• 00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Sectio 000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my licen f • full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
/
Lic,# II ,Class.#. 8 (Section 25533 of the California Health and Safety Code, with some
C----- QTi`7/� '�-w exceptions, requires registration with the Costa Mesa Fire Department by
®/�.I / l each business which at any one time has on hand a quantity of acutely
— Cont F'tor :gnature W cP tem-., hazardous materials equal to or greater than a weight of 500 pounds, or a
-�'r"------ volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CON -UCTION LENDING AGENCY: temperature and pressure).
■ hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
pe ormance of the work fa which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve. demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code
that he or she is licensed pursuant to the provisions of the Contractors requires that the requested
information be furnished on applications for
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the non-residential building permits).
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars(5500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application.have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. (If'yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for control officer).
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Dale
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to -nter upon the above-described property for
inspection p .oses. I agr-- not to occupy or allow occupancy of any building
authorized'this perry til final inspection.
* a ori own
Signature Dale '%
(7 - ?.-2-
3057-46 pion
,Anars urrionzed Applicat.,--- ale
CITY OF COSTA MESA
osl"~F BUILDINGeDIVISION
tofl)•• ,..��A. �n 77 FAIR DRIVE,COSTA MESA,CA 92616 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.qov
t
1�n� • FOR INSPECTIONS CALL:(714)754-5626
PERMIT NUMBER: 812-00161
PERMIT TYPE B_ROOF2 STATUS: ISSUED
•
APN: 42626114 DATE ISSUED: 07/18/2012
ISSUED BY: RMD
JOB ADDRESS: 1917 CHURCH ST CM Suite/Unit:
Vicinity: APARTMENT
Squares: 2000 Valuation: $3,000.00
SCOPE OF WORK: LEGALIZE A REROOF DONE WITHOUT PERMITS FOR A 4 UNIT APARTMENT,APPROX 20 SQUARES. ROOF SHALL
COMPLY WITH FELT REQUIREMENTS FOR A 3:12 PITCHED ROOF;COMP SHINGLES INSTALLED.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s)is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachmentw/Inspection Card
OWNER: BOITANO,COMANIC Address: 407 1/2 JASMINE AV Unit:
PHONE: City/State/Zip: CORONA DEL MAR
APPLICANT: SILER,JOSH Address: Unit: :
PHONE: 714-476-3044 City/State/Zip:
•
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: Unit: PHONE:
City/State/Zip: • CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $83.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00 •
TOTAL FEES $84.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day,Memorial Day, Independence Day, Labor Day,Thanksgiving Day and Christmas Day
NOTICE; The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28.§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
Not E, I1ISPECIIONTYPF DATE INTIAL$ ;ODE' INSPEC11ON TYPE DIA =ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final n'•. ^ 208 Final Plumbing _
200 Final Re-Roof / tZ � ' 441.3 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
011
di
WORKERS'COMPENSATION DECLARATI Owner ID verified by dnvense. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: DriverslLicense No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verificration o1 Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sedan need not be competed to perm!is valued at one hundred doears( 100)or iess)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall n.1 employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the worker- ompensation laws of California, and agree that if I should'
become subj to the workers' compensation provisions of Section 3700 of
the Labor C..:•I shall forth.comply with these provisions r•/ I Applicant's Signature Date
....„.11.S-.- �1 )v I Division of Industrial Safety Permit Number:
ApPli m''ignature / U 111 HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARN! . FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UN • UL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑Yes 0 No
Lender's Name:
(Section 25534 of the Califomia Health and Safety Code provides that the
Lenders Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
That he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes',the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
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 8. (If#yes', attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
o I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Proj-ions Code for this reason: the City of t ossa Mesa to enter upon the above-described property for
inspection p/rpo • I agree not to occup • allow occupancy of any building
�; _ authorized •r • ani it final ins.• ion.
_ _a:IL.
of Legal rnmer(s) Date Vim?— r 2.
I�SiprlaWre_.,,,..--�.:s !B"'Deta _-�.. /l t
3057-46(3N7. 1}""- 11
Anck Authorised Appkantt ISE
•
/l Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
/ ' CITY Of COSTA MESA CONSTRUCTION PERS I� PERM NO TRACT NO. LOT NO. UNIT NO. 9160 6O (f/'r.11 /62 $gip BO IL
Project Adrress /777r�/,/ viz c 33 /8./
__1: :licant's Mailing dress / Y 7 AIfCree•Cr C/rregz',� .TYPE OF CONSTRUCTION LI NEW LI ADD H ALTERATION REPAIR
.pi ❑ CONVERSION ❑ DEMOLISH ❑ OT a,, A p,# I Zone
Owner's NameQ �'.Qy 0/�r Phone�6'�fj DESCRIPTION OF WORJK/ SE OF BLDG. t 1 00 F COPT( "
Address en 9 co/IA-4A- ,DA• costo ties cat,',A6,14 'r t> �f/� S Main Building: Accessory Building: Z
Arch/Eng. License No. TYPE OF PERMIT LJ GRADING U FOUNDATION Li STRUCTURAL T Front o
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB Rear N
❑ OTHER
Contractor's Name -S �e�/�4 Phone 4-r?--47,047 ,�j C Right N
ROJECT DESCRIPTION SQ. FT. //'OD 4;(fit OCCUPANCY G
Address Imailinglnes7l// .yC/2SS�' C/12 ✓/NL 9 / �' / �y�r K Left
!�2- CON STRUCTLON TYPE _ VALUATION $ 9!/•—• S R
City License No.19 / ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm thatQ am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: - M
with section 7000) of Division 3 of the Business and Profess/ 'o ions Code, and S
my license is in full force and effect. �^
License CI ss s ^- i ense No /! V
•
Date y._ jr Signature . .41 -- PLUMBING FEES
i
WORKERS'COMPENSATION DELLA=ATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate •
I •, of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
` �� ! Automatic Washer Transformer 0 15-50 KW
3800, Lab. C m �..y L G
Policy No. 6/ (4Z p7 Company �;ire Backflow Irrigation Sewer Cap Construction Pole Sub, 0 50+ KW -
Certified copy is hereby fthnished.
- Cer f' dso y is filed with the city B m Divisipn- Bathtubs 'Sewer Connection - Cooking Unit Meter Dup to 100 amps -
Date � 2 ant ¢�I /LOO 6
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION 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 DElectric Sub 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 the Drinking Fountains Solar Tank • Fan ' • Motors 00-1 HP ❑1'h-8
Workers' Compensation Laws of California. -
Date _ Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP❑16-15+
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 FixturesMicrowave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device BoxesPole Light •
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name Interceptors Water Heater Outlets Range
•
Lender/s Address Kitchen Sink Water Service Switches • Sign -
OWNER BUILDER DECLARATION
I hereby affirm that'1 am exempt from the Contractor's License Law for the Lavatories Auto-Wash
Garbage Disposal Standing Sections •
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator 00-5 KW 05.15 KW .Trash Compactor
any structure, prior'to Its issuance, also requires the applicant for such permit
a file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
r le Contractor's License Law(Chapter 9 (commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section • '
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES
License Law does not apply to an owner of a property who builds or improves _ ---
4-
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not Intended or offered foryp Zoning Approved By Date
sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type II ❑
prt
e the owner willhave the burden of proving he/she did not build or Ina- Duct- Under Ground Building Approved By Date
prove •
for the purposee of sale). -
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 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 00-100,000 BTU 0100,000 BTU SUMMARY OF EES
builds or improves thereon,and who contracts for such projects with a com (
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ 3 • Q SMTP $ - •SO
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ _ PERMIT
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBING $ ISSUANCE $
Date' Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
i I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
Information Is correct. I agree to comply with all city and county ordinances
and state laws relating • buildin• construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this ciy'to ente• pon the above-mentioned property for �� sy
inspection purpos j dar / - .�.s,o'i MECHANICAL $ TOTAL FEE $
- Signature ,✓ _ _ ' Date ��' �0 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or SS �� ��
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS •Permit.# Date Inspector APPROVALS Permit #_ Date Inspector
. T
1emporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
l
3. Electrical Conduit Utility•Undrgrnd. 54. Forms
4. Electrical Conduit-Uqdrgrnd. 55. Electrical Bonding
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 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
r
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 OGas ❑Oil
23. Gas Pipe-Rough& Test 72. Underground Flush ,
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil r' '
25. Roof Sheathing 74. Overhead Hydro •
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical I 1 •
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 • 1 ' -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •.Y
33. Final Electric Notes:
34. Final Heating & Air Conditioning .E._,.
35. Final Gas Pipe-Test
36,;Hood or Canopy 1'
3T._ Final Factory Fireplace ` I''
38: Final Plumbing / !,
39. Water Service-Final ._
40. Gas Service-Final • • ( �'
.
41. Solar Domestic-Final _ :. 1, '
42'. Backflow Preventer I ,t
i;43-Backflow Irrigation i,. I• I ,
i 44! Landscape Irrigation System I - �,
45. Sound Attenuation , ' • •
46., Handicap Regulations ' •• • • •
• l . r;
'47:.yiNAL STRUCTURE & BUILDING
12/12416
TYf.61D�/� -i - . l
v
48. Special Requirements Completed . -
49. Electric Release to Edison ,
i 5
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,'
No. Date - -
J
6003. FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT iI _ i 9 - 5 ti" "—
' P.0.BOX 317
• COSTA MESA. CALIFORNIA•
FINANCE TDEPT.
FOR APPLICANT TO FILL IN APP11ICAiTIOCNAFOSR PERMIT
NG ei( BUILDING
ADDRESS BUILDI / 4 /� !�/
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
J ' ' • RECEIPT NO. PERMIT NO.
OWNER &/ • �i6 1 L - ,401" 5 /IT7 V
RECEIVED BY DATE RECEIVED DATE ISSUED
ADDRESS , A ' /L=d . Aga - /.I-. - - // / - 7
y� �„ I , _ _ TEL/.� 0_C ^\I BUILDING
CItY ��f�j if J/ �'v(J(JLQ� NO ,%�7 ADDRESS
ARCHITECT —V.._ NO. COSTA MESA. CALIFORNIA
OR ENGINEER NO.
FIRE
ADDRESS L ZONE
CITY LIC. ZONEA NPOA NOS TYPE
GROUP
CONTRACTOR 0-1-1.7--1:---N-d0------- NO. /
TEL. APPROVED
ADDRESS NO. BY DATE
LEGAL LOT ' CORRECTIONS
DESCRIPTION NO.` It ,
BLOCK TRACT Jo 8,4/,
A.P. NO. I 3. � o it 0
SIZE � R �/ / D INO.OFBLOGS. / APPROVED
OF LOT ,i S` FLS. NOW ON LOT
USE OF CITY OF c6STA MESA
EXISTING BLDG.
SETBACK LINE FROM / PLANK!\u DEPT.
CENTER OF STREET REAR VARCb 'I 2..5SUBJECT TO BCIG. DEPT. REG.
•
SIDE YARD RIGHT 0-(_L.1 y CLEFT ,5 / A
DESCRIPTION OF WORK BY �X� � wiDATE - ' _
DLnN TI-CH Qiyy`_
NEW I ALTERATION ADDITION `
REPAIR ql MOVING DEMOLISH
BUILDING 8IX (�., I NO.OF / / -
SIZE ROOMS / STORIES
EXTERIOR WALJ/( ROOF
COVERING / &-C-Z-- COVERING /D-W-
VI _
USE OF NEW Arir._ \ R16-R0T_'"_"BUILDING A
C p` \2-Th' //NN,021 L
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 REGULATING BUILDING CONSTRUC•
TION. f� (^/ VALUATION 61-...0SIGNATURE OF l/ 1/_I () _ /� 1 (�vy�� PERMIT FEE $ A
PERMITTEE C/ rl_AIC.( � N __ "`)))
$ //A (�(J� .....
PLAN CHECK S
AUTHORIZED AGENT / =J � TOTAL FEE $ A Ate' VHF