HomeMy WebLinkAbout2907 BAKER ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIH UHIVL, GUb I A MCbA, UA VZOZO
PLUMBING PERMIT
Job Address: 2907 BAKER ST
Suite No
Vicinity:
Status: ISSUED
Applied: 07/19/2005
Issued: 07/19/2005
TOTAL CALCULATED FEES: $35.80
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244646(6=)
ISSUED BY:
Parcel Nunmber. 13926213 . _ -
Applicant: CANDY NOCK;;-
_ i
Address: 11612 KNOTT ST
/
SUITE'217'- - "\ t- 'Phone: -(714)895-1246
GARDEN GROVE,CAf �� - r Zip -92841
Owner: LARSON, DAVID 'FRANCIS TR
,'Address 2907 BAKERST
Phone: s'
COSTA MESA, CAZip: :92626
Contractor: NOCKPLUMBING
Address: 11612 KNOTT STs
' SUITE 217 ', - Phone: (714)895-1246
GARDEN GROVE; CA Zip: 92841
\
License: 707775 - -
-
r
%i< \SCOPE OF PERMIT'
WATER HEATER CHANGE OUT, SAME LOCATION -',.,\
�'•,. ,
_
" -FEE SUMMARY
- AMT QTY AMT
QTY
�`, -
AMT
QTY
ISSUE FEE :', $23.50 / Laundry Tub /Washer -$0.00',
,0
Sump Pump ; j; �;
$0.00
0
Backflow irrigation\, '�`v, $0.00 0 ' Landscape lrrigatlon $0:00"
'0-
Swimming Pool 4$0.00
0
Backflow Preventer *x';$0;00 0' P -Trap -_ $0.00
0
Trap Primer
���
,$0.00
0
Bathtub v,$O.00 0 Pressure Regulator s'-4 .$000
0
Urinal/l�
$0:00
0
CIanfler System' - $0.00, o Process Plying (per 10 ftj �$0 00
0
Vacuum.Brki, Bkflow0-4)
$0:00
0
Connect (Ice;Soda,etc)� t $6.06 � 0 Re(eptors! ` , r,a n, $6.00 'vo
`'.:
Vacuum -Bike Bkflow(5+)
f$0.00
0
Dental Units \.\\ $0 00, 0 3, ,�,,, „ Septic Tank ( $0.00
(,0 ,, . ra'^,,,,Wash Basin
' . $0.00
0
Dishwasher ',A�,v $0.00 -vo,.� - '<Sewer Cap for Demo.," x$0.00
0 -
�,WasnBasin Set
$0.00
0
Drain, Floor �. `-� x10.00 10 - ;Sewer Connect �r $0.00
0,
y� ;Waste and Vent System`
$0.00
0
Drain, Rainwaters �\,$0 00%? 0 �� Sewer Private Line $0.00
0
; %i Water Closet (Toilet); ;
$0.00
0
Drain, Roof V�-� $0.00 ;�-0,� Shower - ,a $0.00
_ 0
Water Heater?vent ;
$12.30
1
�
Drinking Fountain �� " 10.00 � 0Sink; bar-" , , _ $0_00 _
__
0
.�'IWater Piping (Inst or Rep.)
$0.00
0
Expansion Tank \�$0.00 "J O ' � '-Sink, commercial - _ '$0.00
0
', A'Water Re -pipe,,''
$0.00
0
Gas Earthquake Valve \-$Oi00,-, 0-, �� -,Sink, Floor $0.00 -
• 0 �
�, `Water Service
$0.00
0
Gas (1-4 outlets) $0:00�'�0 t.i •, , Sink, kitchen, `, '-'.-_;� �� -;'"$0.00 '-
0 `
Water Softener
$0.00
0
��'� �: -. _r
Gas (Over4 outlets) $0.00 _,0,, Sink, service/mo p`-� I $0.00 c
1
-0_.J
$0.00
_
Gas Repipe $0.00 0,,,,- . �� Spa (private) %:-;AV:-,- 1 iso -00 • -"0
-''!
.-OTHER"�
=VIOLATION
$0.00
Gas Service $0.00 0 .,--,Spa
$0.00 .-,0,
PLAN CHECK
$0.00
Interceptors (Grease, Oil) $0.00 0 ' _ -. .";--�_ >�"
REINSPECTION
$0.00
0
_
Interceptors (Sand Auto ) $0.00 0 - --- -- -- ---
TOTAL CALCULATED FEES: $35.80
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244646(6=)
lC
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit Is issued.
My w mpen atl Ins rance r e d um�erpre: /�
Center ��/ .[� I Pol'I INugtW 1+.1 ��
(Th s section need not be completed it the permit Is v /ued atone hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of a Labor Code, I shall forthwith
comply with these provisions. ^- 12
_� 9
AppI it Sigin �Y7 I l
WARNING: FAILURE TO SECURE W RS' COMPEN TION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLIARE ($tDD,cOD), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affinn thatJ am livensad ujn( 7D�p�lsl of Chapter 9 (commencingwith Section 7000 of Division 3 of the Bus"" r fessions Code, and m license is in full
force and ect. Ic. a __ I( / 1 I I p ) Glaseyn � t y
tractor's STg_a3uie%
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lander's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sac.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale:).
❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
Permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title S. California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
..................................................................................................................................................................................................................................-....................................................................
...................................................s e
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
.............................._....................................................................................................... .... ........................... .................................... ............................. ..................................... ............... ................. ...............................................................................
3 D❑oYes,
r will th❑e applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materiels with the Fire Department.
........................................................................................................................................................................................................................................................-..............................................................._................._.......
4 Ii an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑No
.
...........................................................................................................................................................................................................................................................................................-....................................................................................... _ .....
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes a No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
............................................................................................................................................................................................................................................................ ..........................................................................................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
........... ................................................. ............................................................. -............................ __............................ -..................... __............................................................. -.._.__... _............................ _.................. ....__.................. __.
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
...........................................................................................................................................................................................-........... ...............I....._................................................. _........................
B (If yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cartity under penalty of perjury that I have read this application and state that the intortnation given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspecfion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatur__ _al Owner(s)
And/Or-Authorizedl.PWicant,m,,....-._. Date
CODE It. INSPECTION TYPE PATfi f INTMALS CODE 41 INSPECTION TYPE 2AM ILLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final 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
�C!1
CITY OF COSTA MESA
BUILDING DIVISION
� DEVELOPMENT SERVICES DEPARTMENT '/898_00964
PERMIT PERMIT NUMBER
(714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2907 BAKER ST Status: ISSUED P-cb
Suite: Applied: 06/04/1998
Vicinity: Issued: 06/04/1998
Parcel Nunmber: 13926213 Zoning: R1 R1
Applicant: GRABLE, BETTY
Address:
Phone:
Zip:
Owner:
LARSON, DAVID FRANCIS TR
Address
2907 BAKER ST
'
Phone:.
COSTA MESA,CA - /
Zip: 92626
-
Contractor:
SPECIALTY ROOFING CONTRACTORS
Address:
6152 SIERRA'PALOS -
-
-� ,
Phone: 714-725-0500
IRVINE, CA
Zip: 92612
Licenser 449292
,
Arch / Eng :
• -
Address:
Phone:
.'
License'-
SCOPE OF PERMIT
T/O EXISTING & REROOF WITH COMP
SHINGLE.
FEE SUMMARY
Plan Check:
$0.00
-
Calc Valuation:
$3,600.00
Permit:
$87.25 —
Claimed Valuation:
$3,600.00
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
-
Inspection:
$0.00
Total:
$87.75
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0
Left 0-0
Right 0-0 '
ACCESSORY
Front 0-0 Rear 0-0
Left 0-0
Right 0-0
PARKING
Existing: 0 Required: 0
Proposed: 0
NOTES
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. '
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance o1 the
work for which this permit is Issued.
❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier. Policy Number
(This section need not be completed If the permit Is valued at one hundred dollars ($100) or less.)
❑ 1 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 workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Sectio 3700 of the Labor Code, I shall forthwith
comSign iture- fe provisions.
X
Applicant Signature: 4 � _Defeo
WARNING: FAILURE TO SECURE WOR TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND OOLLARE (5100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busmand roJessions Code, and my license is in full
force and effect. L1c. a ,CMss _ �`/%
Contractor's Signature:_ �c-� Det /2 L�
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any dry or county Which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ 1, cue owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Lew does not apply to an owner at property who builds or improves thereon, and who does such work
himself or herself or through his or her Own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is
sold within one year o1 completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Cade for this reason:
Signature: Data:
Owner ID verified by driver's license. ❑ Yes ❑ No Onvers License No. Expires:
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more lest In depth Into which a person Is required to descend, will be made In connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Cade).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
perrnit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII the applicant or present or future bullding occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight at 5DO pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration torte for acutely hazardous materials? [I Yes [3 No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mass Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
....._.............................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
((Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
.........................................................................................................................................................................................................................................
4 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been tufty complied with.. (I Yes ❑ No
....................................ppli.............................futu........ ........................uire..........................ich I.............. jest... f thi.......plic. tion.......rini....................nstructi ............... ific tion..
5 Does or will h applicant or present or future building occupant require for the work onlch is the subject c this a plication a�ernit for such construction w modification
from the South Coast Alr Quality Management District or from any other air pollution control distract or agency? � Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
....................................................................................................................................................................................................................................................................................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
....................................................................................................................................................................................................................................................................................
7 If a rrmit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
appl cation, have all of the disclosures prescribed by California Health and Satery Code Section 42303 been made? ❑ Yes ❑ No
....................................................................................................................................................................................................................................................................................
8 (If yes', mach cortiticate o1 compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. 1 agree to cornply with all state laws and city ordinances
regarding Hazardous Materials and Emlamons.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certity under penalty of perjury that 1 have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for Inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign Legal Owners) De
Zy -
ndl0L �pliccaanl r
CODE E. INSPECTIONTYPE LOBE! INSPECTION TYPE pct IBTTRAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof Q2 210 Final Electoral
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
244846
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CIT -00F COSTA MESA CONSTRasICTIION PERMIT PERNP NO. g� 8, TRACT NO. LOT NO. UNIT NO.
Prof
ject Address a%r0 %
Appl icant'i� fling Address t/'Q+ TVPE OF CONSTRUCTION LJ NEW L1 ADD LJ ALTERATION LJ REPAIR
Ownt'i�'s Name �U/ a /_ •~ Phone % 1:1CONVERSION El DEMOLISH ElOTHER q p #
Address
,Ale -f /�,Qk�yL S DESCRIPTION OF WORK/USE OF BLDG.
Arch/Eng. License No.
Address
Contractor's Nam Phone
Address (mailing) --
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is in full force and effect.
License Class License No.
Date Signature
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
1800, Lab. C.)
Policy No. Company
e
Certified copy is hereby furnished.
Certified copy is filed with the city Building Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100 or
ess).
1 certify that in the performance Of the i-{ hit is rmit' I
Shall not emplo any p¢rson in an anner so tett to [ate
Worker o ws of Ca1, r
Date Signaturo
NOTICE: If, atter ma ting this tlecla anon; you shoo ecome subject to the
Workers' Compensation provisions Of the tabor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 309T,.ICiv. C.)
Lender's ,Name _
Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, Improve, demolish or repair
any Structure, prior to its issuance, also requires the applicant for Such permit
to file a signed Statement that he/She is licensed pursuant to the provisions of
the 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
1031.5 by any applicant for a permit subjects the applicant to a civil
nmalty of not more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure Is not intended or offered
for sate (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement iS sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or Im-
Kr ve for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed can.
ractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
buildS or Improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation Insurance Should be provid me.
L3 am exempt under Section--��-- Be& P. C. f anon
Date
have
Inspection pu
Signature M
Drlvers' Lic se or SS
ite that the above
county ordinances
iv authorize reore-
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Fee
Boiler
Duct- Under Ground
Duct - Structural
Showers
S
Main Bmldl
Automatic Washer
Sewer Cap
Construction Pole Sub.
E
Cooking Unit
TYPE OF PERMIT L1 GRADING
11 FOUNDATION LJ STRUCTURAL
Solar Piping
T
Front
❑LTEN ANT ❑ ELECTRICAL
❑ PLUMBING ❑ MECHANICAL
F.A.U.
B
Fixtures
❑ OTHER
Device Boxes
Water Heater
A
Rear
Switches
Auto -Wash
Garbage Disposal
C
Right
PROJECT DESCRIPTION SQ. FT.
OCCUPANCY
KLeft
CONSTRUCTION TYPE
ZONy GRAOINGCU.YDS.
VALUATION $
ACRES
$
Ping.
Ref.
Remarks:
Planning
Notes:
rj
PLUMBING FFFS
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Fee
Boiler
Duct- Under Ground
Duct - Structural
Showers
Service Sink
Automatic Washer
Sewer Cap
Construction Pole Sub.
Sewer Connection
Cooking Unit
Solar Collectors
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Solar Tank
Fan
Swimming Pool w/Spa
F.A.U.
Urinal
Fixtures
Water Closet
Device Boxes
Water Heater
Outlets
Water Service
Switches
Auto -Wash
Garbage Disposal
Laundry Trays
Generator ❑0.5 KW E35
3086
Zone
Accessory Building:
2
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors ❑0-1 HP ❑ 1 h - 8
Inc. Solar ❑9.15 HP ❑16-15+
Microwave
Pole Light
Range
Standing Sections
KW Trash Compactor
$15 Issue Fee $ 3
MECHANICAL FEES Reinspection Fee $15 Issue Fee
Hood or Type ❑ DEVELOPMENT SERVICES REQUIREMENTS:
Canopy Type I I ❑ Zoning Approved By
Building Approved By
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICED #
Heating System & Ducting
❑ 0-100,000 BTU ❑ 100,000
Reinspection Fee I $15
CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Refrigeration System
CIO-100,000BTU 0100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee 1 $ 3
FEES
$ 3
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP
$
PLAN CHECK
$J�
PERMIT
PLUMBING
$
Do ISSUANCE
$
PLAN CHECK 25%
$
ENERGY P.C.
$
ELECTRICAL
$
GRADING
$
PLAN CHECK 50%
MECHANICAL
$
$
MICROFILM
TOTALFEE
$
$ S•OD
PLAN CHECK 25%
$
CONSTRUCTION AND'PLANNING
APPROVALS Perm t'#
Date
Inspector
POOL &SPA
APPROVALS Permit #
-
Date
Inspector
1.ATemporary Electrical'Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
'
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings V -
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd..,
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
_
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning y
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
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 OGas OOil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT �'•
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final �•r
80. FOOD CERTIFICATE ISSUED
••
rn
33. Final Electric L'
Notes: is
34. Final Heating & Air Conditioning
"•
35. Final Gas Pipe -Test •�
(.��-��
(�j)
_
36. Hood or Canopy
37. Final Factory Fireplace
38..Final Plumbing
(-j�j ytj
lJkq
• 39. Water Service -Final
�f
0 1:
' 40. Gas Service -Final
-
r 41. Solar -Domestic-Final
:42. Backf I' w, Preventer
43. Backflow Irrigation
J
?'44. ,Landscape Irrigation System
,.
45. Sound Attenuation
,; '✓
46. Handicap Regulations
t `
r
47. FINAL STRUCTURE & BUILDING
48,'Special,Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
1:
51. CERTIFICATE OF OCCUPANCY
No. Date. _
4
O—ze—DU
JOB ADDRESS 2907 BaKer Ave • BUILDING PEJIMIT N0.
GENERAL CONTRACTOR Blue Haven Pools VALUE $ Z�
INSPECTIONS
DATE
4nuergruuuubou7,Try u.U. water }Qrl 1--W—GD
Underground Gas Y -3/ -Ge SUBCONTRACTOR
PERMITS ISSUED
DATE NUMBER
Overhead Water an Gas
Rough Heating
RoughPlumbing l'i /^ o
Miscellaneous
a ..?
Prop. Swr. Line I Housdon. I SL Swr.
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test S
Construction Pole
Underground Power S M-/ -
RoughWirin
Trenches Forms Steel -
Floor System
Steel Reinforce Chimney Re -Rod
Bond Beam —J - - o
Sheathing
Frame and Flashing
t
Lathing, In Out
Plaster, brown coat
Plumbing Mxtures, Final
Electric Fixtures, Final
OWNER WRIGLEY. RICHARD AUG 1 0 1961 DATE 9-12-60
JOB ADDRESS 2907 baker Ot• AUG 1 4 1962' BUILDING PERMIT NO. 1200b
GENERAL CONTRACTOR Champion Fence Co, VALUE $
AP. No.113 2-13 LOT TRACT FIRE ZONE DESCRIPT101;1,OF WORK Block
INSPECTIONS DATE I GROUP J TYPE ZONE
Unaergrouna oou U.U. rraier SUBCONTRACTOR
Underground Gas ---
PERMITS ISSUED
DATE
NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing
Miscellaneous
1
Prop. Swr. Line House Con. St. Swr.
, tI
Sprinkling System
Heating, Final
Plumbing Fixtures
Final Gas Test
Construction Pole
Underground Power
Rou h Wirin
Trenches 1 -Forms Steel O --i -
Floor System
Steel Reinforce Chimney Re -Rod
Bond Beam
Sheathing
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Plumbing Fixtures, Final
Electric Fixtures, Final
Building, Final IYn,o� 7
OCCUPANCY I�
Form 210-5M-11-59 5-6 P 12808
T6 6
�Tpt 1
-j--1.73
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
FOR APPLICANT TO f/LL /N COMPIETUy
TYPE OR PRINT
BUILDING
ADDRESS ?-907 r 1. t g Q KV` JJ 5 F7
COSTA MESA, CALIFORNIA
MAIL
ADDRESS �'J �� /i 695-V
• '
TEL
CITY A �j NO.
h S sD a iss 6l L. a 'D
ONANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
:. BUILDING
fOR Off/CE USE ONLY
I RECEIPT NO. I PE
BUILDING
ennoccc
ARCHITECT
LIG
COSTA MESA, CALIFORNIA
OR ENGINEER
NO.
FIRE
ADDRESS
ZONE
TYPE GROUP
STATE
APPROVED
CONTRACTOR %
LIC. NO. f�J 77
BY
DATE
ZONING
ADDRESS
LEGAL
I LOT f�
(
11y�iJJJ
( 5�
ZONE
NO. OF
I
I UBE OF NEW
DesCRIFTION
NO. V
BLOCK
4RACT
R-1
PLANS 2
G
BUILDING
W all
bb
NONE
APPROVED
J�G
A.P. NO.
DATE
SIZE% p
�• 7
-BY/
1/
OF LOT ^ /
NOW ON LOTS
REOU RED
ALLOW D
USE OF
(CENTER LINE ST.)
EXISTING BLDG.
FRONT
LIFT.
IN.
SETBACK LINE FROM
�C 1
�•
CENTER OF STREET
REAR YARD J
R. SIDE
FT.
IN.
(,../�
I
�•
SIDE YARD LEFT ..J
RIGHT
L. SIDE
FT.
IN,
DESCRIPTION OF WORK
REAR
FT.
IN.
NEW
I ALTERATION I
ADDITION
REPAIR
I II MOVING I
II DEMOLISH
BUILDING170LNO.OF
/
SIZE ROOMS
EXTERIOR WALI,/,.r.4 -a1
ROOF
HSTORIES
COVERING 77 r
COVERING
V
USE OF BUILDING AND WORK TO BE
PERFORMED
I HEREBY ACKNOWLEDGE THAT 1 HAVE
READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION
IS FOR THE
AND STATS THAT TM ROVE IS CORRECT NO AGREE TO COM-
PURPOSE OF ESTABLISHING A PERMIT
FEE ONLY.
PLY WITH ALL iANCES AN STATE L 9 REGULATING
BUILDING CO RUCTI
VALUATION
SIGNATOR OF
�•
PERMIT FEE
PERMITTEE
U
PLAN CHECK $
11Iy
119—
/11.—
AUTHORIZED AGENT
TOTAL FEE 5
J
i. res,
age
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT /-�
I BUILDING
,,COSTA MESA. CALIFORNIA
AUG 221950
APPLICATION FOR PERMIT
BUILDING
For -Office Use Only
FA
RECEIPT NO. PERMIT O.
OWNER
jZd4
-q
MAIL n
ADDRESS ` O
ReGK VE
By IVEO ISSUED
L Ow
TEL.
BUILDING
CITY
NO.
ADDRESS
ARCHITECT
TEL
COSTA 4ErSA, CALIFORNIA
OR ENGINES
FIRE
ADDRESS
ZONE
TYPE GROUP
CONTRACTOR
APPROVED
BY
DATE OAC h.
ONING
ADDRESS 2
`
ZONE
NO. OF
USE OF NEW
CI
PIANS
I
BUHDIN6
PL.
�Q
LESALDESCRIF
r' �r q
LIC. NOSTAE .
NO.
SIZE
I
NO. OF SLOGS.
71
OF LOT
Now ON LOT
A. P. NO.
USE OF
YARD6
EVES
EXISTING BLDG.
APPROVED
ALLOWED
SETBACK LINE FROM
(CENTER LINK STJ
CENTER OF STREET
REAR YARD
FRONT
FT. N.
SIDE YARD ILEFT
(RIGHT
R. SIDE
FT. IN.
DESCRIPTION OF WORK
L. SIDE
FT. /:I N.
'
NEW I ' ,IIIDII ALTERATION I
II ADDITION I
REAR
L� FT. IN.
REPAIR II MOVING I
II DEMOLISH
A
SYPROVED
// DATE , Y
A%
,fi/
BUILDING 1 NO. OF
SIZE ROOMS
STORIES
EXTERIOR WALL (ROOF
COVERING COVERING "
USE OF BUILDING AND WORK TO BE
F MED
1 HEREBY ACKNOWLEDGE THAT 1 HAVE
READ THIS GTION
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT ANO AG E O COM-
PURPOSE
OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND
AR LAW RE LATINO
VALUATION
// A,Tj
-J
BUILDING 10
SIGNATURE OF
_PERMIT FEE S11d
PLAN CHECK S 0
PERMITTE
tp
Q !�
S
AUTHORIZED AGEN
/ ,1
O(! `/
TOTAL FEE
FA
12808
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING
ADORES. E
COSTA MESA CALIFORNIA
FEE RECEIVED
SEP 1219N
�S1NANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
1
OWNER
RECEIPT ND. / PHN�ITONON
MAIL Q ✓ fJ RHGE
ADDRESS 1' /�
VHD ! I R CEI .EO I �'Tfi IBByfiO.
/y_ 1/O
A L.
CITY S �_f !r TEL
BUILDI
ADDRESS
ti
ARCHITECT TEL.
OR ENGINEER NO.
COSTA MESA. CALIFORNIA
ADDRESS
FIRE
ZONE TYPE GROUP
/ II
CONTRACTOR C/'- I'a N IC
APPROVED DATE
ADDRESS
ON I N G
Z N
NO. OF
USE OF NEW
CITY
I
/ I
PLANS
BWLDI NO
I
STATETEL.
LIC. NO. ( NO. +Ot 4 4 17
LEOAL J le,
DESCRIPTION / V
SIZE�� •I NO. OF GLOSS.
_
OF NOW ON LOT
LOT
A. P. NO.
USE OF\p
TI
EXISNG BLDG. IIJJAj
YARDS EVES
APPROVED ALLOWED
SETBACK LINE FROM
(CENTER LINE ST.)
CENTER OF STREET REAR YARD
FRONT IN.
SIDE YARD I LEFT I
RIGHT
R. SIDE _FT. IN.
DESCRIPTION OF WORK
L. SIDE — PT-- IN.
IpI
NEW I LAALTERATION((ADDITION I
REAR FT. IN.
REPAIR I II MOVING I IIDEMOLISH (
BYDATE
BUILDING NO. OF
"
SIZE ROOMS STORIES
EXTERIOR WALL
ROOF
COVERING
COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
7
in - D
I HEREBY ACKNOWLEDGE THA 1 HAVE READ THIS APPLICATION
AND STATS THAT THE ABOVE IB CORRECT AND AGREE TO COM-
PLY WITH ALL CITY ORD( NO STATE (.AWS REDULAi1NG
THAMOUNT SHOWN UNDER VALUATION IS FOR THE
PURPOSE
POSE OP ESTABLISHING A PERMIT FEE ONLY.
VALUATION
n
BUILDING CONSTRUCTIO
SIGNATURE OF
PERMIT FEE $Cl
_
CHECK S
PERMITTE
$��PLAN
.�I
AUTHORIZED AGENT
L
TOTAL FEE
I
•