HomeMy WebLinkAbout2527 BACK BAY LOOP - Building Permits CITY OF COSTA MESA
% BUILDING DIVISION
f (� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
A, FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: P07-00437
•
PERMIT TYPE PLUM STATUS: ISSUED
. .DATE ISSUED: 06/29/2007
ISSUED BY: RMD
JOB ADDRESS: 2527 BACK BAY LOOP CM • Suite/Unit <. •
Vicinity: UPSTAIRS BATRHOOM - %
SCOPE OF WORK: REMOVE A SHOWER/TUB AND REPLACE W/A SHOWER AND CHANGEOUTTOILET TOILET IN
UPSTAIRS BATHROOM FOR'SFD,, <
.I •
OWNER: VITARELLI,.MARY K TR ,, . Address: ' ..618 HARRISON STREET,
PHONE: 949-646-4338 City/State/Zip: FRIDAY,HARBOR,WA ,
APPLICANT: SWEENEY,ALLEN - ' • Address:
PHONE: 714-264-7746 City/State/zZip:
CONTRACTOR: ALLEN L SWEENEY CONSTRUCTION • - License No. 792640 .
Address: 15041 CAMPILLOS• PHONE: (714)264-7746
City/State: LA MIRADA,CA ZipCode:_90638 - — - CELL: - ,
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE: $43.10 •
TOTAL FEES: $43.10
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE/ INSPECTION TYPE IN1711AL$ CODE! INSPECTION TVP: DAT INTIIIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 1-31-Or.�
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 r\ •
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivt nse. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the foimuwing declarations: Driver's License No. 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. • . .
Err 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. 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: t�� person is required to descend,will be made in connection with work authorized
Cartier: �� 7:1
by this permit,and that no building structure,scaffolding,falsework,or demolition
(This section need not be competed Ree perm4 s valued art me hundred dbrars($1o0)or fess.) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp
2,Ari 2,Sec.341,Ttle 8,California Administrative Code).
PolicyhNumber: 17 32- 7
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 not 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 workers' compensation laws of California, and agree that if I should
become subject to the worke ' ompensation provisions of Section 3700 of Applicant's Signature Dais
the Labor .' . orth h amply with these provisions.
/i/ 6�187a7 Division of Industrial Safety Permit Number:
Applira• ss. More Date
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAIL •E TO SECURE WORKERS'COMPENSATION----..
NCCOVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CML 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.A- ?i-. 26' a Class It-- TS (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
/ '��r %e �7 each business which at any one time has on hand a quantity of acutely
ir to 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
CONSTRUC- e N LENDING AGEN . . 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
Lender's Name: hazardous materials)? ❑Yes ❑No
(Section 25534 of the California 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 Dale
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 ❑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 furnished 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? ❑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
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 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 t0 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 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 l inspection.
/`�r�I�•ter(s) tete
Signature Dale `/� _sr
7
3057-46(3/07) Andlor..red Applicant /
CITY OF COSTA MESA
BUILDING DIVISION
F y NI. 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754.5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us
°. FOR INSPECTIONS CALL: (714)754-5626 ‘07-00809 PERMIT NUMBERi
PERMIT TYPE B_MISC STATUS: ISSUED
DATE ISSUED: 06/29/2007
- ISSUED BY: RMD
JOB ADDRESS: 2527 BACK BAY LOOP CM . . :Suite/Unit:`=
Vicinity: UPSTIARS BATHROOM ' • < • ' Primary Occ, . ; Const Type:??
SQ. FT 0 - - Valuation: ;. ; ,$8,600.00
ti 7
SCOPE OF WORK: BUILDING PERMIT FOR'DRYWALL WORK FOR SHOWER CHANGE OUT-AND-FRAME WORK FOR
SHOWER. . , ;7
T.
OWNER: VITARELLI, MARY K TR - Address: '618 HARRISON`STREET Unit:
PHONE: 949-646-4338'' _ ,- .City/State/Zip: FRIDAY HARBOR,'WA
APPLICANT: SWEENEY,ALLEN .,. I , • - Addresss: .--Unit:.' " r - -
PHONE: 714.264.7746 ., City/State/zZip: ,
CONTRACTOR: ALLEN L SWEENEY CONSTRUCTION" ,.- ^,. _- License No. 792640 r `_ .
Address: 15041.CAMPILLOSUnit: PHONE: -- (714)264.-7746 - - ' -y I i r
City/State: LA MIRADA',CA .t4:1. . ZipCode: 90638 i CELL: , •
-
.
ARCHITECT: License No. . • - - PHONE:
ENGINEER: License No. - " •- .,,:?`.PHONE!,,'.
MISCELLANEOUS PERMIT FEE SUMMARY; ; .
Building Plan Check: $0.00 - _ w -,..'.,.;:,-..�,.;•�
Building Permit: .ji, . $167.25 q
Electrical Permit: $0.00
Other Fee:
SMIP Residential ..-$0.00 - �'� •
SMIP Commercial
TOTAL FEES - $167.25
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE* INSPECTON TYPg au INWMAL$ CODE* INSPECTION TYPE pn g 1N11AL$
1616 Fixed System Final Fire Prevention - 206. - Final Mechanical 4,
1266 Pool Spa Final 208 Final Plumbing / -31-"0�{! Ci-
200 Final Re-Roof 210 Final Electrical /7
•
201 Final Block/Retaining Wall 212 Final Fire Prevention /7
•
202 Final Factory Fire Place 220 Final Planning Approval //
203 Final Sign 222 Final Site //-T
204 Final Demolition 250 Final Building/Occupancy h-`�t C
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivt nse. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the foeuwing declarations: Driver's License No. _ Expires:
❑ 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. •
®/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. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet h depth into which a
number are: person is required to descend,will be made in connection with work authorized
farrier:_ 52L1% by this permit,and that no building structure,scaffolding.falsework,a demolition
�� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This seem need not be completed Jibe permit is valued at one hundred avers(S100)c less.)
2,Art 2.Sec.341,Title 8,California Administrative Code).
Policy:Number [ 7 7L 7 Y y
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 not 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 workers' compensation laws of California, and agree that if I should
become sub - t t• e workers' • sensation provisions of Section 3700 of
the Leb0 orf', 6a •-h,. ly with these provisiop Applicant's slgnmure Dale
• / ree.-2- 6/.21/a7 Division of Industrial Safety Permit Number:
A icaM'•_g .ire -OaIe HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILU- TO SECURE WO`ERS COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFU AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CML 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
ATTORNEYS 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
- /a�
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
/err " ' .gent re / 'ate 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
CONSTRUCTIO A ENDING AGENC : 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 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 0 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 Califomia
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
that he or she is licensed pursuant to the provisions of the Contractors informalction 65850.2furnished othe onCnlifomlic Government not Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be applications fa 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? ❑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 properly 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
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
❑ 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 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 fin.I inspection.
10
Signature Date //r ,gerls Car
305746(3/07) &"dra:Au•red Applicant •.le.
9 2. 7 31 m
F-._J Applicant to fill In all sp ces except those within heavy border lines and sign all appropriate declarations. `\•
_ CITY-OF COSTA M CI ' TRUC �, P R• PERMIT NO. TRACT NO. LOT NO. UNIT NO.
l.. IL A. o-O 0 8 a�h^PD 1217 I X2527
Applicant's
nt'sAdMat' U REPAIR
Applicant's Mailing Address --^4R"�e" TYPE OF CONSTRUCTION U NEW ADO U ALTERATION
•
/'LCD `' ❑ CONVERSION ❑ DEMOLISH ❑ OT /i''�/, �7 / k)2
Owner's Nafi� �i 1a31�3�y'e A.P.# �T JAI 1 G� '� �j ! None �7� G-
DESCRIPTION OF WORK/USE OF BLDG. /.
Address a4� /�' LS I ir� _ E Main Building: �Q'j�T Accessory Building: Z
Arch/Eng /I''$�U/✓f�� License No. TYPE OF PERMIT ❑ GRADING LG FOUNDAT ION LJ STRUCTURAL T Front a�.Qa 0
Address -.---- ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BOTHER A Rear 5 / N
Contractor's Name
Oh
Address(mailing/ Q Phone PROJECT DESCRIPTION 50. FT80 r OCCUPANCY Rs / K Right 1^�� G
CONSTRUCTION TYPE VALUATION$ / Oro - $ Left G� R
City License No. ZONE GRADING CV.YDS. - ACRE'S Ping. Ref.# Parking Req./Provided - E
LICENSED CONTRACTOR DECLARATION Q
1 hereby affirm that I am licensed under provisions of Charter 9(commend • Remarks: T,t¢(�[w Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code d _ ryl/lrr..v ��
my license is in full force and effect. �j�� //v �/ T
Dcense Class License No. - (� TV V ^ - • S
Date_ Signature PLUMBING FEES ,
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self- ure or a certificate ELECTRICAL FEES
I If Workers' Compensation Insurance, or a certifle• opy thereof (Section Backflow Preventer Service Sink
.BOO, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
8 Certified copy Is hereby furnished.
Certified copy is filed with the city B •ing Division. Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
Date Applicant
EXEMPTION FROM WORKERS' .MPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher _ Meter Clover 100 amps
(This section need not be comple • if the permit is for one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that In the •erfor Ce of the work for which this permit is issued, I
s all not emplo per-.n in any m �r so as to become s - • t• a Drinking Fountains Solar Tank Fan
rk . ion .ws of Calif - - •
Motors 00-1 HP 01% B
At Signatur _ - Floor Drains Swimming Pool w/Spa F.A.U. Ino,Solar 0915 HP ❑1615+
ICE:It, -f�-r • •king this de ration r• / out• become su• . e
orkers' Comp' .tion provlsi. s of t or Code, you m • h Floor Sinks
comply with - ch provisions or thi- permit shall be dee rev•'ed. Urinal Fixtures Microwave
CONSTRU ION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes '
I hereby . rm that there is a construction lending agency for the performance Pole Light
of the ork for which this permit is issued (Section 3097 Civ. C.) interce tort Water Heater
Land, s Name •- / P Outlets Range
Le-•er's Address Kitchen Sink Water Service Switches Sign
• NER BUIL'CER DECLARATION
I hereby affirm thafiam exempt from the Contractor's License Law for the Lavatories Auto-Wash Disposal Garbage
following reason (Section 7031.5 Business and Professional Code: Any city or —
9Standing Sections
county which requiresa permit to construct,alter improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW❑5.15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit _ - Pa
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
Division 3 of the Business and Professions Code) or that he/she is exempt
'•erefrom and the basis for the alleged exemption. Any violation of Section '
131.5 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 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
thereon, and who does such work himself/herself or through his or her own _- - - DEVELOPMENT SERVICE/��Rp/�1QUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ ZoningApproved ByL�-Iq•. /—LL—SO
sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type II ❑ pP Date
elation, the owner will have the burden of proving he/she did not build or Im- Duct' Under Ground
er
r for the purpose of sale). Building APProved By Date //z z �Q
ro
Qom., , s owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
r/t actors 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 ❑0.100,000 BTU ❑100,000 BTU SUMM RY OF FEES _
builds or improves thereon,and who contracts for such projects with a con- C7
' tractor(s) license pursuant to the Contractor's License Law). I am aware that ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ 7• 00 SMTP $ • S
proof 0/ their Worker's Compensation Insurance should be provided to mo. Exhaust System p y p
- PLAN CHECK $ 17• SS PERMIT
0 I am e pt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire DampersI PLUMBING $ ISSUANCE $
Da 11. r3 8 Ow - ✓ s/ / C All -�} Heating System& Ducting I Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read '�s replication a d stet)/•, 4- above 00.100,000 BTU 0100,000BT $ GRADING $
Information is correct. I agree to compl with all city and nanceyys ELECTRICAL
and state laws relating to building construction, and hereby a thorize repro PLAN CHECK 50% $ MICROFILM $
sentafiv,. o this • y t• •nter upon the a••v, menti pr party r
Inspa ./.7..•1R ooset. //�� MECHANICAL $ ��
Si•- NRIr _ tea_ e T TOTAL FEE $ 45.
a rivers' LI - se f #
Pink -Accounting: Goldenrod - Assessor
'CONSTRUCTION AND,PLANNING • . POOL& SPA
I ('� Date Inspector Date Inspector
.APPROVALS Perrmt # APPROVALS Permit#
1./Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms I
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 't r 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.~ 57. APPROVAL TO COVER-GUNITE ,
7. Footings a./hof t S 's' 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 1:
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 OiLi
25. Roof Sheathing 74. Overhead Hydro - t ,
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical '
27. Frame and Flashing 76. Dry Standpipe •4
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
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final ElectricNotes: �y w g7 / , � �u�
34. Final Heating & Air Conditioning
....
35. Final Gas Pipe-Test (-
36. Hood or Canopy
37. Final Fa5tory Fireplace - .' '
38. Final Plumbing -
39. Water"';Service-Final '
,- , 4o. Gas Service-Final .
)•41 41.,Solar Domestic-Final .
' ''! 42.'BackfIow Preventer
/L?
/x,143.. Backflow Irrigation - �� - -
t - i� .
v
44. Landscape Irrigation System - -
7
(J 45.,Sound Attenuation
'46. Handicap Regulations ,.
47. :FINAL STRUCTURE & BUILDING /l// 4k ^'
. 48. Special.Requirements Completed ""
49. Electric,Release to Edison
59.-Gas Release to Southern California Gas Co
51. CERTIFICATE OF-OCCUPANCY ..• t,• •
No. • Date - -
- .
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 086(!_ _4l09J85 - ma TL
CITY OF COSTA MESA �/CO ST UCTION PERMIT PERMIT NO.
' _� ' TRACT NO. LOT NO. UNI NO.
Project Address Sz / (/J'(p`,''s'- 1 "� 5 f�ty `J l 7 Y_
/ t TYPE OF CONSTRUCTION 'YJNEW LI ADD LI ALTERATION U REPAIR Z/ - '
Applicant's MailinggA,d_dr�ess' �3� r• Pam t' .�FQ
Owner's Nam" //_La� l-�/rr^'^' r1. rsr.., ,//))
CI CONVERSION CI DEMOLISH El OTHER •
A.P-4/6 - ZonePone V, DESCRIPTION OFWORK/USE OF BLDG.
Address /07 2-- S'. P6"- /�4�'.tLi' it 2-02 t 1 /j�. H S Main Building: Accessory Building:
Z
Arch/Eng. - License No. • TYPE OF PERMIT -LI GRADING LI FOUNDATI�OONII/'❑ STRUCTURAL T Front 0
Address //q � y!• // 1:11 TENANT ❑ ELECTRICAL ❑" PLUMBING C MECHANICAL A Rear N
Contractor's Name vei't/IMk Phoria 3/ L�{s` ❑ 'OTHER yl Jr1-`j __ \\
3 a PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G
Address(mailing) �1- C-' • Q -e" AftK ,
U
O7Y7/ p^ - - CONSTRUCTION TYPE VALUATION$ - S Left R
City License No; (( O77 ZONE GRADING CU.YDS. ACRES
Ping. Ref.# .. Parking Req./Provided - E'
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I.am licensed under provisions of Charter 9 (commencing Remarks: - Planning Notes: NI
with section 7000) of Division 3-of the Business and Professions Code, and • - T
m9 license is in full force anq effect 34s- 7C/- - i • _ S
License Cla s -LQ L^iS'enis�/No.
Date 3' Signatures AYX LI/�w- ' PLUMBING FEES
WORKERS' COMPENSATION DECLARATION Bar Sink • Showers ELECTRICAL 'FEES
' i hereby affirm that I have a certificate of consent to self-insure ora certificate
' f Workers' Compensation Insurance,'or a certified copy thereof (Section _ '. Backfin v Preventer - - - Service Sink - - - - -
,800, Lab. C.) (J I I /�rs -/J-/,/1 . Automatic Washer •Tiansformer 0 15-50 KW
Policy NO. P-3 J s� t� Company ycNv.+ Backf loin Irrigation Sewer Ca 0 50+ KW
O p -Construction Pole Sub,
Certified copy is hereby furnished.
•ir-Certif' d cop led with the city Buyyyym Diwi�"on / i Bathtubs • Sewer Connection Cooking Unit • Meter ❑up to 100 amps;
' Date -Z1e Applicant R7tf-- ILK/V 4-S'•• - -
' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION . Clarifiers Solar Collectors ' Dishwasher Meter (Dover 100 amps
(This section neednotbe completed if the permit is for one hundred ($100)or - _ - ' - --" - . -
_
less). Dishwasher 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 , 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 09-15 HP 016-15+
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 - I- - Fixtures "' - — -
-
comply with such provisions or this permit shall be deemed revoked. - Microwave
CONSTRUCTION LENDING AGENCY. Gas Service OutletsWater 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 Outlets Range
Lender's Name - - - - g
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' ( 9 P ,Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays - Generator ❑0.5 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 - - - ,
'Division 3 of the Business and Professions Code) or that he/she is exempt . - - -
herefrom 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 -_ -
LJnealty 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 f $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 _
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 for1Exhaust
Boiler • - Hood or Type I ❑
sale. If, however, the building or improvement is sold within one year of corn- - Canopy Type II 0
Zoning Approved By Date
pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under GroundBuilding Approved ey Dateprove for the purpose of sale), (,�❑ 1, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date f 1tractors 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 ❑0-100,000 BTU ❑100000 BTU SUMMARY OF FEES '
builds or improves thereon,and who contracts for such projects with a-con- i - •tractor(s) license pursuanlotheContractor's License Law), I am aware that System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $oofoftheirWorker'sCompensation insurance shuld
PLAN CHECK $ PERMIT '
• ❑ I am exempt under Section B.& P.G.for this reason Firepl/Fact,Bit ICBG# Fire Dampers PLUMBING $ SSS UANCE $
Date Owner / Hgating System& Ducting Registers PLAN CHECK 25% .$ ' ENERGY P.C. $ - '
I hereby certify that I have read this application and state that the above . 1l '40-100,000 BTU 0100,000 BTU Q8 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- MICROFILM $ _
sentatives of this city to enter u•o• the above-mentioned property for 1 PLAN CHECK 50% $
.inspection purposes. ( / l .3�/ -eS I - J �0 MECHANICAL $ 'I-00 TOTAL FEE $ $.00
Drivers' a•�•d L Reinspection Fee '1 $15 Issue Fee i $ 3 , PLAN CHECK 25% $ I. .00 '
Drivers' License or 55$ - 111
CMF 0865-46,rev, 10%84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
1.44746---
CONSTRUCTION AND PLANNING -• POOH SPA '`
APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector 1
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. T. 53. Steel Reinforcement
B.i Electrical Conduit Utility-Undrgrnd. - 54. Forms
4: Electrical Conduit-Undrgrnd. - 55. Electrical 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, E 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 brains • 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 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank E 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 j/9/,r LI-10
35...-Final Gas Pipe-Test
36. Hood or Canopy
37:'Final Factory Fireplace
38...Final Plumbing
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
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
tl .51. CERTIFICATE OF OCCUPANCY
No. - Date -