HomeMy WebLinkAbout1954 CHURCH ST - Building Permitslir
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1954 CHURCH ST °�` CITY OF COSTA MESA - BUILDING PERMIT
�1YNER'SNWE6'° MINK MAXINE PERM NO: B 083947
/ "D0" 1954 CHURCH ST
PERMIT NO: B 083947 PLAN CHECK NO: N GOVT: N SUPP: N
kALroL.ewLneD ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STA PURPOSE: OTH
ARCHITECT OREMIIISBR: UC N°.: JOB DESCRIPTION : T/O SHEATH 6 REROOF W/COMP SHINGL SQ FT: 4 , 930
&RCN OR FLAG'S AOORESS: WIT:
CLAIM VALUE: 4 , 930 . 00 CALC-VALUE: 4 ,930 . 00 GROUP OCC: R-3 /U-1
C°NNIACTONSNMi' A PLUS ROOFING ( 714 ) 754-1000
Ct7 TBACT°RSVMLDI0 11237 SLATER AV COMMENTS: X
ADDRESS: FOUNTAIN VALLEY CA UCx°.: 675241 *************AE***+f*rr********At*rpt*********r*******At*********+t******+t**********+r
92708 "MT: ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby aim under penalty of perjury the 1 em licensed under proven d Chapter S SETBACKS
(commencing with Section 7000)of Oiroun 3 of the Business end Professions Code.end my license Is in lull force end sed.
CIlY UC.CLASS: UC NO
// 060847 c 39 675 41 EXP: 01 /98 MAIN BUILDING ACCESSORY BUILDING
D. . — cpmraar«: ,�_,��_ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
0 - :UILDER DECLARATION:I hereby affirm under penalty of perjury that I em exempt from the Contractors License Law for the
reason(Section 7031.5 Busier and Professore Code:Any sky or may Mich squires a permit to canna.ear.Inthrove,
doh,or repeimry aWcture,prior to its issuance.also requires tike applicant for such permit lo Ne a signedetdenent Mel he orshe PARKING REQ: ,r; PROV: PARCEL: 42626429 ZNE: REF NO: �,..
S licensed puisuanl to the proemde M the Connectors License Law(Chapter 9(commencing with Sedan 7003)M Divsion 3 d IM PLANNING NOTES>
0
fluidness and Professions Code(or that he or and a exempt therefrom and the basis for the alleged exemption.Any violation of Section f
7091.5 by any applicant for a Parma eubjeda the applicant to a civil penally M sot more than five hundred dabs 15500D. 1
*********************************************************************9E*********
❑ I,as owner of!he property or my employees with wages as that sole compensation,will do the work,and the structure is not intended
or ler sale(Section 7044.Business and nudes/dons de
es/ions Cn :The Contractors Owner ans. aw does naively to an ownof property D E V E7 L O P M E N T SERVICES R E Q U I R E M E N`,T S
who builds or improves thereon.and who does such work himself or herself or through he or her own employees,provided that such 4...-t
improvements are not intended or offered for sale.N however,the building or inprmormenl is sold within one yes d wmplelan.the
ownerbusis mg have thburden of proving he o shdld not build o improve for the Wrpee of ads). ZONING APPROVED BY DATE: I.,'
❑ I,as
The Corir usively eLLaw donwith licensed esno apply to enowmr'of proMconstrud obuildso ilprovesterean and7041. aand who BUILDING APPROVED BY : DATE: ` %�
contracts for eau protects with a maactor(s)licensed pursued to the Cmsam License Law). . - - - -.
❑ l am exempt under Section: B.A P.C..tor this reason: APPLICATION ISSUED BY; DATE: EMIR
Dale: owns: **************.*******tt********************** * ** ************** *
I do hereby certify that l am aware d and understand the requirements of California Health
and Safety Code Sections 25505.25533.and LEGALIZATION:N F E E SUMM RY S TRUC TURA SEGM NT:Y
a 534,permit
thatlerany Mundatnpotehe AiiRywN red(gern.n dbaumWywihsaid daemdunsthe
exemitamrtse for •
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
pr4,and that or ionan Moreibuiliinha .pant u�iit nor(cads onei nue to com b/cona.,th adion etas coeioaeaee requirements
prevision. PERMIT 99 . 75 . 50
Date: Applicant: SMIP/NON-RES
WORKERS COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of IM following dedarsons: PLAN
o I have evat mmaintaina certificate d consent to self-insure for workers'compensations'
Code. dmas,provided for by Swaof the 13700Labor ISSUE FEE
d
Ce.forthepoencedmeworkforwi:wn:scomaisissud. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ Ihave and MImainleiuwork ecompesaunanurance,sa(pd
(*puked Section 3700of the Labothe TOTALS----> 100. 25 0 . 00 0 . 00 100 . 25 100 . 25 . 00
X
work for which this pre is issued.My workers'compensation insurance carrier and policy number are:
•
Carrier: QT;Tr PT114D EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 100. 25 OVER/SHORT: . 00
• Polly Number: 285 97UNIT1080 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed f the panni is for one hundred dollen ISrooj as less) 99 . 75 . 50 •
❑ I certfy that in the performance M the work for which this perms o m ,I then not employ any preen in any manner ens to
become subject to the workers'compensation laws of California I should pact to the workers'
ionprowems of Section 3700 of Labor Code,I shall) with � *******************************************************************************
e: 7-29-- 97 *coin i I N D I V I D U A L F E E B R E A K D O W N
amino: spun to secure waters'compensation coy g.h unlawful,and shall subject an«nPloyerronln6rWPraldro ane TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
c 11 fl W to ism hundred thousand dollars($7°G9mA In strllrbn to the,rot of compensation.earrugp a provided for In
Sic 3706 0l the labor Cob,Intros(and atbmay'5 Mas.
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of parjmy that then is a eonarmlon lending agency for the SFR 4930 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 4 , 930 . 00
pormance of the work for which thispanne is issued(Section 3097,Cir.C). END OF FEES
d
LENDER'S NAME:
LENDER'S ADDRESS:
I certify the I have reed this application end dale that the above information is correct.l agree to comply with all thy and countyordinances
and state lows slain b building construction and hereby authorize repaeentahee of this city to enter Won the shote-mentbnd properly
/to ice...'.,purpoe a.
a•EAN M• ONE 67-29-1997/11:11 AM/$100.25
Aire"
lame:7�7f—/a7, PERMIT:
'C 083947
•
�
Sgnature• Own. can((/q�red
`•(5t5t4e WP) White-Building r-RIb- anary-Appkal:Pink-Revenue Goldenrod-Assessor
I _ w
CONSTRUCTION AND PLANNING j - . . Pt;<< & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # - Date Inspector
t
1. Temporary Electrical Service or Pole , - 52. Pool & Equipment Location
2. SoilPipe•Undrgrnd. ''o '53. Steel Reinforcement
'3, Electrical Conduit -Utility-Undigrnd. 4 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. '
•i $.-Foundation 4,r1.: a • 59. Gas Pipe, 0 Undrgrnd., Test '
• . •-, .
9. Water Pipe-Undrgrnd.A_ 60: Backwash Lines,..PTrap, 0 Undrgrnd.
10. Structural Floor System ` ' t 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' i 67. Fencing & Access,Approval ; i
17. Rough Wiring Sign - 68. APPROVED FOR-PLASTERING
18. Rough ElectricaCiT Bar Ceiling' - • 69. POOL/SPA SYSTEMS FINAL -
19. Rough Heating-81 Air Conditioning FIRE DEPT. REQUIREMENT
- -- 4 p1-.4=I- T' 'v
20, Pougi Factor Fi,Ep'iace C- ' : fl -!APPRtVAC -S' Permit# ' '° -
t <* r+:-. .i. S 7'4 4--.c- _ , ..: -.
21. butts, in:Struvture,k t •• ra.- 4: S "J -4 *i70. `nderground H4dro 4:
At
22. Ruct9; Ventilaring�;f* !J=: S 21 34 71. Product Pi m OGas Oil
wS D t; t .. .P 9
23. Gas P_ipe•Rougfi & Test !ti:., ' r... T -C :',II, , 72, Underground Flush- 4.. %- -
24. Roo(Framing^ i YJ i. > j m. , 1. 73z Undergrnd.Stora aTan ❑Gas U' Oil
]]]111 Q • � - kt
25. Roof She�thin `" `s ,t ;
9 s .q 5_,/,....47_ (p(,,f�-' 74:4verhead�HYdro.
26. T-Bar Ceiling (Strutt*nal) & Morro�goat i_ a "U �'• 76J.. Dry Chemical _ .3 't --' ..7 `
J _
27. Frame and Flashing ` �.0 = t u _
t ,>,:•.. .� ,a , 76. Dry Standpipe . wi A in
28. Lathing & Siding I. %t '-'-,t,,:• x +: 5- •• , `-4 774 FIXED SYSTEm:FINAc ,, C
29. Insulatio u 78: FIRE PREY. FINAL I > >'
_
t -?
430. Drywall Nailing 4 ^ 'A. f., i S -.,h t8ALTH'DEPT.'REQUIRREMENT
-,31. Plaster BfSwn Coat :tr. ,- ; r:.-. if ; •• 79.' FINAL IbISPECTION J -
32. Electrical ?wrier Meter:Fi_nal •u I' ": 8Q'.,t� FOOD CERTIFICATE I�S,yED_ �,
33. FInal.Elegiric ' 12n 1 to T -Ii rn
_i. z, a,' ir _ Notes: -t -3t4
-
6 34. Final Heajing& Air £onditioning S c 'r * 6C : . t• .- '•'
r - 1 M it • _ 'K ;3 - .4 '.ri
35. Final"Gas Pipe`-Test : r,n ';: ' *t r 'Y .:v
-36. Hood-or GanopY -:w *": - _£ -`O 4. cC"
,
- 37. Fjnal,awry Firepla+ m ce X •_ r r, t,.' r
r .
.38. Final Plumbing ,v I: S
-
Z, 1 . r- yr x
39. Water Service-Final r _ `t �t•t :* X _
• t - t' _
•
4 40. Gas Servi'c'e-Final .,t , 4-..-r ' * m :o rr•:. I
-7-41. Solar Domestic-Finan S <' •' ` I t` <t.' '
42. Backflow Preventer A.
:j 1.' `• :r x - -, - .1. O +
-43. Backflow Irrigation r - ft 4 _.
•44. Landscape lrrigationlSystem .m r t- -- 7- N •N r .- .•
�._. . rr ,
- ` :l
-' -
45. Sound Attenuation ' " ti .t. + '" ' . • - ; •
rn n -litc. .r f., • r .
46. Handicap Regulations is -I c, 1 • _. e
- r Tlir•
47. FINAL STRUCTURE & BUILDING Q`�_~Q Nos t
48. FINAL PLANNING.•: -. _L___;._:_
� ..; / •-•,t• "; c•-•
rL - f-
t. i N f ., I C. •
49. Electric Release to Edison - t. i. T1. '3 c-
. 'k _ --i'' t
50. Gas Release to-Southtern California Gas Co , - . •1 .1
.- , . =-'-7
_51. CERTIFICATE OF OCCUPANCY r • -� ..7c -
No. Date
I
ADDRESS OF WEEMS: 1954 CHURCH ST °NTi A CITY OF COSTA MESA — BUILDING PERMIT
OWNER'S NAYS IF IOC%Th MAXINE MINK PERM NO: B 08439'
'mats 1954 CHURCH ST
A PERMIT NO: B 084397 PLAN CHECK NO: 03457-97 S GOVT: N SUPP: N
i APDL IwIdgAWRESA COSTA MESA CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: SIR PURPOSE: ALT
ARCHITECT°RFNfCIEfm LC.NO.: JOB DESCRIPTION INSTALL 200SF PATIO COVER ICB05038 SQ FT: 1 , 300
C. ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 1 , 300 . 00 CALC—VALUE: 1 , 300 . 00 GROUP UCC: R-3 /
arnacTwaum WEST COAST CUSTOM ROOMS ( 714 ) 594-7547
CDORACTORS MIMIC 786 PINE FALLS AV COMMENTS: X
AaDRE9s: WALNUT CA uexD: 471619 *;r•***************************************************+ *************;E******N****
91789 UIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:thereby affirm under pesky of penury that I am ancient ruder prorioona of Chapter P SETBACKS
lammerldg nth Section 7000)of Drain 3 Of the Business and Pmlessio,Code.and my Scree is in tuft force and effect.
CITY LIC.NO.: LIC.CLASS: UC.NO.:
044005 B x 1�M1�9� EXP : OC /00 MAIN BUILDING ACCESSORY BUILDING
Date: Contractor: 1 t. 1► ^ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penny of perjury that I am exempt from the comma Lew fa the
hr� yi , toitand qode:heapunty uuires l °dMaternal'alter.improve.
orrepair pia s issuance, requires tapplicant forwhpSich ntt0 file a signed heor.* PARKING REQ: PROV: PARCEL : 42626429 ZNE: R2—M REF NO:
is 4cenesd pursuant to the provisions d the Contrm sLienee Law[Chaptr9(commencing with Section 7000)of Dweion3 of the PLANNING NOTES> CONSTURCT 200 SQ. FT. SECOND STORY ALUMINUM PATIO COMER WITH
Business end Professions Coded or that he or she is exempt therefrom and the bent for the alleged exemption.Any violation of Sea > SOLID ROOF ON AN EXISTING DECK. v'
7031.5 b1 any rnpticanl fore permit subjects the applicant toadvil penally dnot rfireold
more then e hundred en 185001). ********************************************************************dAl-
or
''lf*******i(*
El 1.as ower dM properly r themy empby/swith wages as their sole compensation.will do the work,and the structure is not intended
coffered for sale(Section 7044,Business and Professions Code:The Contractors License Lew do not apply loanownr ofpmpedy DEVELOPMENT SERVICES REQUIREMENTS
who bolds or mosses thereon.end vola does such work linnsad or herself or through hi r her own emplvws,prided Ihat such ..!.
improvements
bel der will havetheba�niMWpprovinig heered for b«'eM id notthe
bubWbuilding
rimprove fp«neemporpoee�wet one y'atdcanpbtian'tM ZONING APPROVED BY DATE:
o I,ea owner of the property.em exclusively contracting with licensed contractors to comma the project(Section 7044.Business and
Professions Cods:TM Contractors License Law do not apply to an own d property who build r Impor«thereon and who BUILDING APPROVED BY :
11/.6
/ DATE: 'I
contracts for such projects with a mmrarorle)licensed pursuant to the Contractors License Law). p
❑ lemexempt underSection: B.AP.C.,for thsreason: APPLICATION ISSUED BY: S, % DATE: E /
Date: Ower: ********w*******SE*************vf st* ********** +F**rFh**************** * rF..re **
I do hereby certify Matt am aware of end understand the requirements of CaliforniaHealth end Safely Code Sections 25505,25533,and LEGALZZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
25534.and that I or any future building occupant will/all not(circle one)need to comply with said slate codes and the requirements for
a permit for construction or modification from the Ai u3Sty�rsgmaa District.Residential construed*apcIctlaro an sterna these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provision. PERMIT 43 . 00 . 50
Date: Applicant: SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under prudy of perpry one Olen Iotowing dedarsas: PLAN 27 . 95
CII have and wit maintain a seaman 01 es casto gel-insures'e for wakecompensation,as provided kg by Section 3700 of theabor
tISSUE FEE
Code.for the rwork
permit ahound. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ Ihave and wImabaenworkers'aompnationvnUrrCe,asrequired be Section 3700dthe Labor Code,for Uaprformrlwdw TOTALS----> 43 . 50 0 . 00 27. 95 71 . 45 71 . 45 . 00
X work for which this pent a issued.My wons
Workers'canpensaticninsurance canand policy number are:
Carder: ''AIA EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 71 . 45 OVER/SHORT: . 00
Poky Number.
UCC113269575 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need nal becompleted'm.peon evtor one tum&sd dare woolaleee.) 43 . 00 . 50 27. 95
❑ I may that in the rmarae of the work for which this prmi )awed.I Nag nal employ any person in s any manner ea as to
become subject t workers'comD+nsatan laws cl Csfdamja,and a bat t I should become djed to the*odors'anprptj8' cl 3700 of the Lebo Code. aWIIf - comply with those o" ***********iF*******************************************************************
C.7 Oa (//4,2 INDIVIDUALApplicant: F E E BREAKDOWN
Warning:Failure to sac Noreen'Cogorsadon coverage Is unlawful,and shell subject an employer to criminal pennies and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
caval on..W to one hundred thousand dollars($t04000),hi addition to the cost of compensadon damages as provided for In
Secilcei 3706 of Use Labor Cd IMe,nLrd.dten. SFR 1300 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 300 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that thew a a construction lending agency for the
performance which mance of the work tedwi13110K1(5190:111
pet b 3097,Cb.C). END OF FEES
LENDER'S NAME
LENDER'S ADDRESS:
I certify that I have read this application end slats that the above information is coned.I agree to campy with as city and county ordinances
and state awe relating to building construction end hereby authorize representatives of this cityto enter upon the above-mentioned property
for inspection purposes.
,t Ifilbilialellilea 1(.7746/F> 0 88-25-1997/83:21 PN/971.45
dm Name . PERMIT:08i1-0811384
a /7 -084397
. Signature of O wnr/Agenl/Ap UCont a
t5151d5.WP) White-Building 5 Safety:Green-Ate:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL & SPA J
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 UF ER 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& Hot se•Cdnnection . 62. Backwash &Receptor-Final
12. Sewer Cap , 63. Heater & Vent-Final
13. Roof Drains 64'- Plumbing System - Final
14. Rough Plumbing JT 65. Electrical-Final
15. Rough Electrical-Conduit. t•' -
' 66. Solar System-Final
16. Rough Electric Wiring - - 67. Fencing & Access Approval
17. Rough Wiring Sign i... - ' 68. APPROVED FOR PLASTERING
18. Rough Electric&-T Bar Ceiling - • '69: POOL/SPA SYSTEMS FINAL •
19. RoUgh Heating&rAir 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
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 or Canopy
37. Final Factory Fireplace ,
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer •
--43. Backflow Irrigation
441. Landscape Irrigation System
45. Sound Attenuation '
46. Handicap Regulations •
47 FINAL STRUCTURE & BUILDING qG p Uf •
-
' 48. FINAL PLANNING •
-
' 49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51'i CERTIFICATE OF OCCUPANCY - _
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
CITY OF COST; (j]�E ONST UCTION PERMIT PER N //7 TRACT NO. LOT NO. UNIT NO.;
ProlectAddress '/,` ‘I V re. •
� H
I.33 l L�1��.C)l V\) - TYPE OF CONSTRUCTION NEW L I ADD ❑ ALTERATION H REPAIR
-Applicant's Mailing Address^ �• ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A.P.# I Zone .
Owner's Name j`\VhT tiV • Phone DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front 0
N
Address ^� ,'1 LI TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL A Rear • I
Contractor's Name _'-x V �1 L Phone )2«-,40(,/ ❑ OTHER - C Right - G
Address(mailing) lr�' • 0 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K -
V 7 CON STRUCTION TYPE VALUATION$ S Left R
City License No. �] ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. R¢f.# Parking Req./Provided E
D
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and ' i
my license is in full f. e ..d affect. n/>��/7 - �7. I7ba T
( icensi. I. , - kat
, •iG -e•No. / j RECEIVED 5�� 3 S
Date • Signature �r�. I Int PLUMBING 'FEES - •
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate Of consent to self-insure or a certificate -
of Workers' Compensation Insurance, or a c led copy thereof (Section Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW
3800, Lab. C.ky/('yt)O &OE(g 0 50+ KW
Q Policy No. l.lT dK Company /` Backflow Irrigation Sewer Cap Construction Pole Sub.
Certified copy is hereby furnished. • - .
C�r(Iflytlscgpy•}s filed with the city Bui Itc DI o* n e Bathtubs Sewer Connection • Cooking Unit Meter Duo to 100 amps
• Date`7-2 . Applicant r ,91. )LY.�/VALS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit Is for one hundred ($100) or .
less). Dishwasher ' Solar Piping Dryers ❑Gas ❑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 0o-1 HP ❑1 h-8
Workers' Compensation Laws of California. .
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 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 Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. •
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet 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 GI CO Outlets Range -'
Lender's Name
Lender's Address _ Kitchen Sink Water Service- - Switches ' •
OWNER BUILDER DECLARATION Sign
•
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Businefis and Professional Code: Any city or
ounty which requires a permit to Construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor .
ny 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 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 --
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 I
Lmalty of not more than five hundred dollars($500). $ 3
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee
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 com- 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 By Date / at
r,pt/
prove for the purpose of sale). / 7 CD
❑ 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-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation Insurance should be provided to me. _ PLAN CHECK $ PERMIT
0 l am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers• PLUMBING $ 1706 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 o comply with all city and county ordinances
and state laws relating to buil.ing construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this c' y t. ent.r �.il the above-mentionetl ro art f r •
inspection purple. / f2_ �' MECHANICAL S
TOTAL FEE $ lsoo--
Signature _ �]-
/ - - - _
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant: Pink -Accounting;Goldenrod - Assessor 01 00017090-00017090 TOT 5.00
DATE: 1f1/ib/RR TTMPn 19!Zn
CONSTRUCTION AN.PLANNING POOL &SPA
APPROVALS Permit:* APPROVALS 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-Undrgr.rld.
8. Foundation 1 59. Gas Pipe, 0 Undrgrnd.,Test
•
9. Water Pipe-Undrgrnd.l_ 60. Backwash Lines,P-Trap, GrUndrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK 23
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 0 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) & Monocoal 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 ,re,
35. Final Gas Pipe-Test •
36. Hood or Canopy •
37: Final Factory Fireplace r � '
38. Final Plumbing /o-7-44Y te40 -
39. Water Service-Final •
• 40. Gas Service-Final •
l-
.41. Solar Domestic-Final •
.42. Backflow Preventer
43. Backflow Irrigation •
:44. Landscape Irrigation System - ^
45. Sound Attenuation
46. Handicap Regulations +, - - I
47. FINAL STRUCTURE & BUILDING - - - • t\•
48. Special Requirements Completed _ - -' •
49. Electric Release to Edison
•
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY •
•
No. Date
_ _ _______-----
1
\ 46706 V 4749 9112/78 135.52 IL,
ciab
COSTA MESA BUILDING-SAFETY DEPARTMENT ^/J 4749 9/1217.8 .f36a552—I
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 G749 STRUCTURAL
67 06 I A
APP l AN FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use [ Only
REC Q DATE RWIIV DATE ISSUED
BUILDING J954 /t ' 1 /{ W yL i; -021-79^-}
ADDRESS / `1 y� �jl�t(�'Ju�C NM� c ,\R � /�) /�.��_q �F�rq(ypCT�./�'�A /�
OWNER C c/7a ,L /ks t / se.N A.P. NO.//BUILDING 1T1 0�T "Ot.. I P/µI,IOI! 1C.
ADDRESS 075.15 RI e. Ave a ADDRESS / ','� Cgw,ecs4 sr
CITY cjeW gepck, 1.NOL1115-77C. TRACT LOT BLOCK
CONSTRUCTION c _ �. Iq 1r) rq SAvl� •• A_ . : Pa it sA• . • bo• k.
LENDER JFl 'j OP <> p�sy��s��/)) � � )
BRANCH As'nass o
ADDRESS OWNER n' �^,s
ARCHITECT TE 410.01-E //114.f/ $Q([/ ✓(/(J
/t l`,��rs j� '` / //J VALUE
OR ENGINEER j1N/JI G FJ�[�V Noss-71.21 I
FIRE
ADDRESS ZONE TYPE GROUP
�N4j CEA./
APPROVED
CONTRACTOR BY DATE
ADDRESS 27ai atEq#a gl_YID
CITY droflA teL A?#qe, NOLteds—S )� ZONE» ) PLANS C - BUILDING
ESTATE ''] CITY YARDS APPROVED YARDS APPROVED
5 LIC. NO. 9.),5557S LIC.NO. MAIN BUILDING ACCESSORY BUILDING
(FROM
h.
NO.OF BLDGS. 0
p. OIF ZE LOT yGx /57 I NOW ON LOT FRONT c2.S`FTTi FT. _
Q' USE OF ,rsf
„N.i EXISTING BLDG. R.SIDE ✓ FT, FT.
Cr)
F Separate permits are required for L.SIDE 70 FT. to FT.
CT electric,plumbing and heating work• REAR ^
is) ry_Sr FT, FT.
4 USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q izi (�//) n /la �j(, MAIN BLOCS..Yrs 'L ACCESS SLOGS. .s�j
C &Y��� /� DATE
C Vre RP.vR .�6A-T7 APPROVED10�/8— /f✓
} APPROVE s0 fro-
)-i
.a
R UL,t) FOR SPECIA•
L REQDATEUIREMENT.
O I hereby acknowledge that I have read this application and state in
p$ that the above Information Is correct and agree to comply with fre m
Q+ all laws regulating building construction, and I shall not employ //AØjZ any person In violation of the workman's compensation laws ofthe State of California. ,r 1
3 I hereby certify that I am properly licensed as a contractor under 3/IGsD SO.FT. 7_57 cmi
the State of California Business end Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, end that such licenses are In full force and affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY_
em exempt from the • •• sions:f the Chapter State of California Business VALUATION PERMIT FEE $ h
end Professions C,.: • isi
PLAN CHECK Ea
I 1i.0
Signature of /,
Permittee - //��J� /_ _Aar_ $, �� /- TAX E /r Q L �^
w Li
Auihor�:�Agont •` TOTAL PAID lie