HomeMy WebLinkAbout1327 BAKER ST - Building Permits 1 CITY OF COSTA MESA
44:401101k11( BUILDING DIVISION
Y:j ,t. 011(4011 +1 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
t ��'%ag I PERMIT
05-01661
StveromTo se
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.Sk MLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1327 BAKER ST Status: ISSUED
Suite: Applied: 09/21/2005
Vicinity: REROOF APT BLDG Issued: 09/21/2005
Primary Occ: R-1 Hotels/Apts/Res>10 Occ Type of Construction: V-N
Parcel Number: 14119119 Zoning: R3 .
Applicant: BLANKS, JERRY ' '
Address: 17501 NORWOOD PARK PL
... ... ..Phone:,. 714-573-0155 ISSUED BY: _d a _
TUSTIN,CA -:Zip 92780- ,o1017/7� -
Owner PYROS, GREGORY GEORGE
Address 33 MONTECITO DR -
a, = Phone.
CORONA DEL MAR,CA ; - . Zip: 92625-1017 :
Contractor. PREMIER ROOFING AND-BUILDING CO INC
Address.`- 17501 NORWOOD PARK PL -
Phone: 714-573-0155
TUSTIN CA,,..- . - - -
." Zip: 92780 License: 634404 ,
,Arch : - Eng: -
•
Address: . Address:
- Phone: - ` ;`Phone:„
Zip: -'-‘,' .License: 'License:' "'
SCOPE OF PERMIT
w,. REROOF APT BLDG..T/0 EXISTING ROOF,2:12 PITCH 2:12 ROOF 27 SQUARES:INSTALL 2 LAYERS 15#FELT AND 30=YEAR COMP.
• °FLATE.ROOF 4 SQUARES: INSTALL-1'BASE 2 PLY AND ROCK WITH HOT ASPHALT.
,. i, FEE SUMMARY ,
,? Plan Check: $0.00 Calc Valuation: 8s,lso.00
>' i . Permit $167.25 Claim Valuation: - : $8,180.00
SMIPRes: _ 50.82 ",•:
SMIP Com: $0:00
Other: $0.00- . - -
`Inspection:. $0.00
Total: $168.07
.. - PLANNING &ZONING
SETBACKS
MAIN STRUCTURE' Front 0�0 Rear 0-:0„ Left 0 0'' . .Right "0-0
ACCESSORY Front 0-0 •.Rear 0.0 :Left 0-0 Right -0-0;
PARKING Existing: '0 -Required::: 0 Proposed. 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1,12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(6/00)
DECLARATIORS -
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
e 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' t
corn nnssaattlon Insurance der and pollllFy number are: �
cnrnBr^'s SMI L'"" i Policy Num� �_(i /ar: ��, hl M26(--9"/
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performa7 •of the work for which this reit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensationAplzWISigna� laws of Calif le,and agr at I sho ecome subject to the workers'compensation provisionsof Section700 of t e Labor Code,I shall forthwith
comply with these provisl`%r ^ / J2.-5
WARNING:FAILURE TO SECUR ' •-KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000 IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license. un.er provis'on of C apter 9(commencing with Section 7000)of Division 3 of the Business and Profe ions Code,and my license is in full
force and effect.LZ.-0 • . Qle ; —(
ConawctoCs Sign Dale:., e S-/�O
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: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031,5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). •
❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I em exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I 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? 0 Yes 0 No
(Section 25505 of the California Health end 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,ora volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 NO
5 Dees or will the applicant or present or future building occupant require for the work which is the subject of this application apeion_permit for such constructor modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 II 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
r • Legal Owner(s) D-Oe
A(tcVQr'ADthioilied App cant c.:
CODE/ INSPECTION TYPE QM • MALE CODE# INSPECTION TYPE MIK MEDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final LL 208 Final Plumbing
200 Final Re-Roof 0 � 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 _
ApprijcatoD
tei1P7a9spaces except those within heavy border lines and sign all appropriate declarations.
. TRACT NO. LOT NO. UNIT NO. 5741 9/22/87 7.00 •TL
CITY OF COSTA MESA CCON STR .T IAN PERMIT PERMIT NO. P
itao .o
•
Project Address e Jr/• N41^- I(/" '
Applicant's Mailing A•dress N - •o,4TYPE OF CONSTRUCTION NEW ADD Li ALTERATION H REPAIR
❑ CONVERSION ❑ DEMOLISH El OTHER A.F.# Zone
eat...Owner's Name eat... Go PO Pho a•_ —
DESCRIPTION/Ix?WORK US OF BLD
Address iia 7 Ma al- Jr' ',tau � oh S Main Building: Accessory Building: Z
Arch/Eng. License No. TYPE OF PERMIT GRADING CJ FOUNDATION U STRUCTURAL T Front 0
Address ❑ TENANT ❑ ELECTRICAL g PLUMBING ❑ MECHANICAL B Rear N
Contractor's Nam- O# — Ph e 7 r�� CI OTHER A - I
• S% r� %T ,� PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) Left
6 j CONSTRUCTION TYPE VALUATION$ $
City License No. ZONE GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION 2--F4/
�j Ping. RCf.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 25 2_4(f/ ' Planning Notes: M
with section 7000) of Division 3 of the Busines -nd Professions Code,and
my license is in full for axl et - t. . T
License,Cl ss / Lik` � -nse 'At .4 S
Date fir Signature W� r✓' PLUMBING FEES
WORK RS' OMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
, ' Iyereby affirm that I have a certificate of consent to self-insure or a certificate
Wor rs' Co s-nsatio• Insurance, or a certified copy thereof (Section
Backflow Preventer Service Sink
.00, a C Automatic Washer Transformer 0 15-50 KW
Poli No. ./ 0411.-142/1-$5... C•• patty G_ Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW .
• ertified copy is hereby furnished. \
Ti Certified copy is filed with the city Building Division. Bathtubs , Sewer Connection Cooking Unit - Meter Cup to 100 amps •
Date - Applicant
EXEMPTION FROM WORKERS'COMPENSATIO •ECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps ,
(This section need not be completed if the permit Is •r one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that Int a performance oft h thi permit is issued, I
shall not mploy any person in any r 0 bec.me subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 011/2-B
Worke n Laws of Cali
Date - ' Signature N•410/./Li .� Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTIC If,of er making this declarati. , rshouid bec• e subject to the -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet 2u' Device Boxes Pole 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.) Interceptors Water Heater Outlets Range
Lender's Name
Lender's Address - - Kitchen Sink / Water Service PLO i 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
any structure, prior to its issuance, also requires the applicant for such permit y Generator 00-5 KW ❑5.15 KW Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains •
the Contractor's License Law(Chapter 9,(commencing with Section 7000)of
nivlsion 3 of the Business and Professions Code) or that he/she is exempt •
refrom and the basis for the alleged exemption. Any violation of Section .
11.5 by any applicant for a permit subjects the applicant to a civil ,
' natty of not more than five hundred dollars($500).
❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee ` $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 FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ Zoning Approved By _ -_ _ - Date
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved ByI Date 9/'ZL� •
rove for the purpose of sale). - ` C31
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 FEES
builds or improves thereon, and who contracts for such projects with a con- _
tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ _ SMIP $
proof of their Worker's Compensation Insurance should be provided to me. Exhaust System ❑ - Multiple❑ System Repair/Alteration .
-- PLAN CHECK $ -- PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt.ICBG# Fire Dampers _ PLUMBING $ 1 .D D ISSUANCE $
Date Owner Heating System&Ducting Registers PLAN CHECK 25% $ • ENERGY P.C. $
I hereby certify that I have read h s application and state that the above 00-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
information is co • t. I agree to c rr ply with all city and county ordinances '
and state laws r lati •• g cc nstruc'on,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of the t ••n th' above-mentioned r pert for
inspection purpo -s. / •Yb
.SignatureECHANICAL S TOTAL FEE $ 7
'Drivers' License or SS
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor
1 CONSTRUCTION AND-PLANNING POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1 Temporary Electrical Service or Pole 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER 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 I • 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 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 1. 1
25. Roof Sheathing - 74. Overhead Hydro ,.
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical '
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL •-
29. Insulation 78. FIRE PREV. FINAL •'
30. Drywall Nailing HEALTH DEPT. REQUIREMENT (;
31. Plaster Brown Coat 79. FINAL INSPECTION I; is . •
+11
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ;'• (/ "' `'
I•
33. Final Electric Notes:
4-23-u'7 f'!'a o+rf Noi.re. Gte4
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test (' ,
36. Hood or Canopy ' !'• 1.
1 )
37•'Final Factory Fireplace 'r I • ;- y
38' �
Final Plumbing 'nig '- •� '1 I ''-
39. Water Service-Final f' , i -
40. Gas Service-Final •i . I• . _ -'2 ,
•'in. Solar Domestic-Final � -
-
•
-1.42. Backf low Preventer I - .Id •'
j '%
"
143. Backflow Irrigation I .V'y 'rI / '
1,44. Landscape Irrigation System _, ; • , ! . 1 1- I1
:r,A5. Sound Attenuation l ! •� .`• .{ I 'i
I, ,!.
I'46: Handicap Regulations .;° • .1. 1 ,1
i
47. FINAL STRUCTURE & BUILDING I:i , .t_,; 'Cr':
s
48.-Special Requirements Completed ''- - I ; -
C:•' Ir
49. Electric Release to Edison it._ f,- '
50. Gas Release to Southern California Gas Co - '.•f
51. CERTIFICATE OF OCCUPANCY '
No. Date -
1 .
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 4835 6/13/85
PER ITN TRACT NO. LOT NO. - - - .. 5o00 Tl
CITY OF COSTA MESA CONSTRUCTION PERM R &.�;O� UNi�vo.
�((11 . Project Address 33 /C{�y�/1n�,Ker �• "` it... 4 �yU
((��';,�Y� Applicant's Mailing/l^lddr 1sl� 7 r/uL'�'yf1VWn ')Fr'H/ t`.�C��(�1�//J' TYPE OF CONSTRUCTION U NEW U ADD L I ALTERATION 'tJ REPAIR
vv Owners Nam¢ r dA/Og Phone_a.L.�( ,2 // ❑ CONVERSION ❑ DEMOLISH 0 OTHER A.P.4/6 Zone
I U y DESCRIPTION OF WORK/USE OF BLDG.
IAddress S Main Building: Accessory Building: Z
--- Arch/Eng. License No. TYPE OF PERMIT U GRADING r-U/FOUNDATION U STRUCTURAL T Front 0
•
Address 0 TENANT ❑ ELECTRICAL ......a4 PLUMBING 0 MECHANICAL B Rear N
Contractor's Nam
/ / 0 OTHER A
C Right — N
�� / -' . ./I/I Il�one PROJECT DESCRIPTION 5Q. FT. - OCCUPANCY K G
Address lmailing) ,70 /3S .A-- )1/1)1/1/ • CONSTRUCTION TYPE VALUATION$ S LeftR '
City License No. ZONE GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
Q
I hereby affirm 7 that I am licensed under provisions f Charterroi (commencing Remarks: Planning Notes: • NI
with section n full of Division 3 of the Business and Professions Code, and - T
my license is in full f• - r tl effect. � • "
License C .5- - Sv. LIcen o, i • - S.
Date / Signature /.4.v_! .//a . • PLUMBING FEES
WORKER"COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
' 'hereby affirm that I have a certificate of consent to self-insure or a certificate - '
I Workers' Compensation Insurance, or a certified copy thereof (Section Backf low Preventer Service Sink '
4800, Lab. C gotta y, ( •
Automatic Washer.• Transformer 0 75-50 KW
Policy No. C/S Lnn �I Company //!U Backflow Irrigation 0 50+ KW
fu Y 9 Sewer Cap Construction Pole;Sub.
rtified copy is hereby thehed. ,
Certiff rgpy is filed with the city ild' I siren `- / Bathtubs Sewer Connection Cooking Unit 'p Meter ❑up to 100 amps
Date K�/tl/, / Applicant .0yC/ L •
EXEMPTION FROM WORKERS-COMPENSATION DECLARATION • Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps'.. i '
y� (This section need not be completed if the permit is for one hundred ($100)or Dishwasher
J less). Solar Piping Dryers ❑Gas ❑Electric ,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 • FanMotors 00-1 HP ❑1 X-B
Workers' Compensation Laws of California, -
•
. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ i
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 Fixtures • - -'
comply with such provisions or this permit shall be deemed revoked. MicrOw2ve
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance \ Pole Light
of the work for which this permit is,ISsued (Section 3097 Civ. C.) Interceptors / -Water Heater ts
Outle
Lender's Name Range
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
-
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories . Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or ;Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays. Generator 00-5 KW❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit • Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
"'vision 3 of the Business and Professions Code) or that he/oho Is exempt •
- ---.
ierefrom and the basis for the alleged exemption. Any violation of Section '
•
031.5 by any applicant for a permit subjects the applicant to a civil -
enalty of not more than five hundred dollars($500). '
I, as owner of the property or my employees with wages as their sole Reinspection Fed I '$15 Issue Fee • $ 3
compensation, will do the work,and the structure is not intended or offered Reinspection Fee ` $15 Issue Fee • $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - - MECHANICAL FEES
License Law does not apply to an'owner of a property who builds or improves _ _ __ _ _ _ _ -
thereon, and who does such work himself/herself or through his or her own .--. DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I '
sale. If, however, the building or Improvement is sold within ono year of cpm- Canopy Type II 0 Zoning Approved By nate
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By _ Date
prove for we r of the of sale). /��r\ /
❑ s owner of the the property, exclusively7044, sinesscontracting with licensedioncon- Duct-Structural Refrigeration System Application Issued By Cate sP
tractors t actor'construct eroject (Section BtoSIne and Prof property
who
The Contractor's shenLicense Law does not apply to an owner je is hta who Duct-Ventilating - ❑0.700,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon; and who contracts for such projects with acon-
tractor(S) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $
proof oftheir Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration
��ED Lam exempt under Section B.6 P.C.for this reason Firepl/Fact.BIC PLAN CHECK $ PERMIT ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting Registers
PLAN CHECK 25%- $ ENERGY P.C. $ '
I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BTL - ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances - ,
and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM •
$
sentatives of this ci to enter upon the above-mentioned property for
inspection pur,J• / - MECHANICAL $ 510--0
Signature 007 ``1_
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
^MF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING . - POG `SPA -
' APPROVALS • Permit# Date Inspector APPROVALS - Permit# Date Inspector ,
1. Temporary Electric& 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. Elecfrical'Bonding
5. Steel Reinforcement • . 56. Rough•Plumbing & Pressure Test
6.,ElectricalUFER Grnd. • 57. -APPROVAL TO COVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd. .
8. Foundation' 59. Gas Pipe, 0 Undrgrnd., Test -
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .
12. Sewer Cap _ ' 63. Heater & Vent-Final -
' 13. Roof Drains - - 64. Plumbing System - Final _ •
14. Rough Plumbing - 65. Electrical-Final .
15. Rough'Electrical-Conduit • - • . 66. Solar System-Final • - •
-
16. Rough Electric Wiring - ' 67.' Fencing & Access Approval - .. . .
•
' -17. Rough Wiring Sign - - - . - - 68. APPROVED FOR PLASTERING
•
.• 18. Rough-Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' •
20. Rough Factory Fireplace APPROVALS. • Permit#
21. Ducts, in Structure • 70.' Underground Hydro
• 22. Ducts, Ventilating • 71. Product Piping 0 Gas '❑Oil
• 23. Gas Pipe-Rough & Test 72.. Underground Flush
.24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
, 25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
.
27. Frame and Flashing . • ' 76. Dry Standpipe .
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing . , HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
, 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33, Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test -
•
36. Hood of Canopy - . -
37. Final Factory)Fireplace . .
38. Final Plumbing Wsklic Lao
39. Water Service-Final '
40. Gas Service-Final ,
41. Solar Domestic-Final ,
42. Backflow Preventer .
43. Backflow Irrigation -
•
" 44. Landscape Irrigation System � . .
45. Sound,Attenuation p .
46. Handicap Regulations - .
47. FINAL STRUCTURE & BUILDING ' •
48. Special Requirements Completed ' , - '
49. Electric Release to Edison - I -
50. Gas Release to Southerri California Gas Co , ' •
p I
I51. CERTIFICATE OF OCCUPANCY _
No. - Date .. -__ .i ,
_ __
- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ —�---
CITY OF COSTA'MESA CON TR CTION PERMIT P RMIT NO TRACT NO. LOT NO. UNIT NO. 7E E -i I i_"
Project Address • 4 �x/ ,`_ / U REPAIR
/. 408 ?lip 5/. /4/E ,/ ftR!G4 • .TYPE OF CONSTRUCTION LI NEW ADD LI ALTERATION •
'Applicant's Mailing Address
CD CONVERSION ❑ DEMOLISH OTHER
timer's Name GO 0•5 Phone - - � A.P.# /y,-' 191 — I? Zone . RI-+
• I /3a� /may „ DESCRIPTION eF WOR USE OF BLDG.
Address /' �"�• _ e irk �L ii /ate%S /H S Main Building: Accessory Building:
Z
Arch/Eng. License No. , TYPE OF PERMIT GRADING FOUNDATION IQ- STRUCTURAL T Front �lG�t�� 0
/Address / z� ❑ TENANT M ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear 75/ N
Contractor's Name6 C eadff�a'1� ,//4 hone 67f 2 . , ❑ OTHER- A I
����,�QQ •r' T,rb / PROJECT DESCRIPTION X" OCCUP{yps�CV K Right ��� _ G
Address(mailing) -7K� /s/ ��'eQ/. '!C- lir 9_2443 -1
CONSTRUCTION TYPE VALUATION$v s Left S/ R
City License No. C�,al 1480 /�' 7 ZONE GRADING CU.YDS." ACRES -
LICENSED CONTRACTOR DECLARATION • . -• rrr•••sss�• Ping. Ref.# Parking Req./Provided E
0
1 hereby affirm that I am licensed under provisions •7 Charter 9 (commencing, Remarks:• /'/ a75 R�/� �,.,,, Planning Notes: Q � � ••o �� M
with section 7000) of Division 3 o t•- s Mess • �1 Professions Code, and r ( """•"""`� _ n�
my license is in full •rce and •ffe , -954. a "9 X4. ^'-- I , _a - S
T
License I G �•_� LS;•se No ,e 1 -
Date it Signature a�an .f _rr PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-Insure or a certificate - • ELECTRICAL FEES
.Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
Automatic Washer Transformer 0 15-50 KW
olicy No. Company ��- •• .f'' Backflow Irrigation Sewer Cap - Construction Pole Sub. ' ❑ 50+ KW
B / 00
Certified copy Is hereby furnished.
Certified copy is filed with the city Building Division. - Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
Date Applicant -EXEMPTION FROM WORKERS'COMPENSATIO DECLARATION Clarifiers Solar Collec - 5 - . Dishwasher > Meter Dover 100 amps
(This section need not be completed if the permit i •r one hundred($100)or - -
less). g-
Dishwasher Solar B. ng - I Dryers Gas DElectric Sub Panel
I certify that int a performanc: of h• wo • ith t permit is issued,I / '�
shall note plo any person i .ny an t to b• e subject to the -. Drinking Fountains S• .r Tank Fan
Worker's' /pp y�gtjpn Laws o' - i .rni. / / .t Motors❑0-1 HP ❑1'/x-8
Data_' - /{' os'/ ' Signa re, �' do/Asri - - Floor Drains Swimming Pool w/Spa • F.A.U. Inc.Solar 09-15 HP 016-15+
NOT/ If, iter (raking this dec - •n,you should •e-• • subject to the — - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal I Fixtures Microwave 2,p
comply with such provisions or this permit shall be deemed revoked. - -
CONSTRUCTION LENDING AGENCY Gas Service Outl- Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance -
Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors •
Water Heater
Lender's Name p �r - i Outlets Range i2
Lender's Address ' ' Kitchen Sink .
• Water Service r1 , Switches -
OWNER BUILDER DECLARATION ' •J" Sign net,I hereby affirm that I am exempt from the Contractor's License Law for the Lavatorie Auto-Wash Garbage Disposal J
following reason (Section 7031.5 Business and Professional Code: Any city or - _ Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap .,,'Cl Laundry Trays , 'Generator ❑0-5 KW ❑5.15 KW 'Trash Compactor
any structure, priorrto its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of •
Roof Drains •1 -5• ' '
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 •
' -refrom and the basis for the alleged exemption. Any violation of Section
1.5 by any applicant for a permit subjects the applicant to a civil
Alty of not more than five hundred dollars ($500).
u I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee ` $15 Issue Fee $ 3
for sale (Section 7044, Business!and Professional Code: The Contractor's • MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves •
DEVELOPMENT SERVICES REQUIREMENTS:
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 ^^, �A
employees, provided that such improvements are not Intended or offered forZoning Approved By !.-11.J� I'•/// Date• o
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II .0 If //�
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By --,r Date
prove for the purposeftof oe). .- •• ry, 1•-i/— 7 .
0 I,as owner tr the property, am exclusively7 4contracting with licensed con- Duct-StructuralRefrigeration Sys Application Issued By „! Date O
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 a• :TU 0100,000 BTU SUMMARY OFF S '
builds or improves thereon, and who contracts for such projects with a con- 5 y( �•y�
tractor(s) ncense pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 -•stem Repair/Alteration BUILDING PERMIT $ - (/'..10 SMIP $ • 7
proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ ,,--17•1"•:..) - PERMIT •
0 1 am exempt under Section B.&
P.P.C.C.for this reason Firep l/Fact.Blt. ICBG# Fire Dampers PLUMBING $ SSUA NCE $
HeatingPLAN CHECK 25% $ ENERGY P.C. $
Date Owner System& Duc Registers • It
p-
I hereby certify that I have read thi- a•plication and state that the above 00-1 00,000 BT 2100,000 BTL - ELECTRICAL $ .l • �� GRADING $
information-is torr I a• .• : • •ly with all city and county ordinances
and state laws rata in•► . building c• s ucti•n, and hereby authorize repre- i PLAN CHECK 50% $ I - LEO MICROFILM $
sentatives of this cit •,o e • u•• the •bove-mentloned property for - -
inspection purposes , 4 /.t - _ MECHANICAL $ TOTAL FEE $ 7 I t
Signature ,•
/ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
J
J
•CONSTRUCTION AND PLANNING .POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 1
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. 'i Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVE R-GUNITE
7. Footings -• 1 58. Electrical Conduit-Undrgrnd.
8. Foundation ��Q 6/l."'777444 f�J� CT f" 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60.
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 /g� 6 / 66. Solar System-Final
16. Rough Electric Wiring `z{'/�f /✓ 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush •
•
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil '
25. Roof Sheathing
Shin (vet74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical
27. Frame and Flashing i1/40776. Dry Standpipe '
28. Lathing & Siding 77. FIXED SYSTEM FINAL ' '
29. Insulation S1/r1 4.id 78. FIRE PREV. FINAL • - ,
30. Drywall Nailing 666��� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat79. FINAL INSPECTION i
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
to�q/�r7 Cris" /a���/7J n�L.Cy �X-�-,f
34. Final Heating & Air Conditioning / 1/3/R 7 p:44:4.E' / uo�.f.Ta•r�-R .ioatka�t
35. Final Gas Pipe-Test g fait/ iid4L.[7�d1/1/L/5 }�t.1Z tat),
cN•
36. Hood or Canopy 9/x'3 _�, L " D?liar-ay.
�� �j`�ar ieG /
37-. Final Factory Fireplace ?CA,. lY
38. Final Plumbing
39r Water Service-Final ,
40. Gas Service-Final • - '
-H
x,41. Solar Domestic-Final - r •
• -
.'42. Backflow Preventer
43. Backflow Irrigation
44.. Landscape Irrigation System • ' ' . ' •
..45. Sound Attenuation '
•
46. Handicap Regulations . • .
•
47. FINAL STRUCTURE & BUILDING 10h1g7 G' IL/ ' ' N
48. Special Requirements Completed
•
49. Electric Release to Edison . -
f •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date -r
-
• 8989 I,=