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Home My WebLink About3064 JOHNSON AVE - Building PermitsCIT,'( OF. CCj�STA MESA B!/ILDING DIVIS/ON DEVELOPMENT SERVICES DEPARTMENT PERMIT ��a� �sa-sz�s • Fax (714) 754-4856 • www.ci.cosia-mesa.c BUILDING PERMIT JobAddress: 3064 JOHNSONAV Suite: Viciniry: Parcel Number: 14159207 Applicant: THOMAS, HESSE MARIE Address: 306d JOHNSON AVE COSTA MESA, CA Owner: THOMAS, HESSE MARIE Address 306Y JOHNSON AVE COSTA MESA, CA Contractor. KAISER ROOFING Address: 928 CHEYENNE ST COSTA MESA, CA Zip: 92626 Arch : Address: Zoning: R1 R1 Phone: 714-546-0729 Zip: 92626 Phone: Zip: 92626 Phone: (714)979-5314 License: 682897 Eng: Address: Phone: � PERMIT NUMBER f603-01786 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 10/15/2003 Issued: 10/15/2003 ISSUED BY: L ` Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF FLAT ROOF AND INSTALL BUR. TORCH DOWN. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Exi_stinp: 0 NOTES: Rear 0-0 Rear 0- 0 Required; 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation Righl 0- 0 Righl 0- 0 52.soo.00 s2,soo.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia 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 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under Ihis permit to be considered legal, such work must comply with all applicable codes, and all required inspectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration oi this permi�. FOR INSPECTIONS CALL: (714) 7545626 zaacas �eroo� WORK�iS' COMpENSATION DECLARATION: � ' I herebwaflirtn under penalry of perjury one oi the following deGaretions: � � 1 ❑ I have entl will maintain e cenificate of wnsent to self-Insure for workers' compensation, es provided br 6y section 3700 of the Lebor Code, br the pertormance of Ihe work lor which this pertnit Is issuetl. 1 ve entl will maintain workers' campensaGon insurance, as requiretl by section 3700 ot t�e Labor Cotle, for t�e peAortnance ol tha woAc for which this pertnit is issued. y orke1 s1' compensaHran Insurance carrier entl policy numher are: e� errier ✓7/i�E i r�lq�2 IicyNu er. �o'�' 00�6�r' O� ' sec(ion need nof be complefed 1! fhe permif is velued af one hundred dollaro ($100J oi less.J ❑ I certify ihat in the peRormence of the work for which �his permit is issued, I shall not employ eny person in eny manner so es to become subjact to �ha workers com sation laws ol Calltomia, entl egree that il I shoultl become sub�ect to the workers' compensation provislons ot Sectlon 3700 of the Lahor Cotle, 1 shell iorthwith these pr vit7ens. icant Signat e: � /� Dat � _ __ �a �S_ �� W ' URE TO SECURE WORKERS' WMPENSATION COVEMGE IS UNLAWFUL M1D SHALL SlIB1ECi AN E�O CPIM�NA� PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TFIOUSAND DOLL4RE (5100,000�, IN ADDITION TOTHE COST OF COMPENSATION, �AMAGES AS PROVIDED iOP IN SECiION 37060F THE IABOR WDE, IMEREST, ANO ATiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I h y irm hat I am liceys�d'2un��provisions of Chapter 9(commencing with Saction 7000) of Division 3pt�p Busin ss gntl Protessions Code, ana my license is in tull forc a . Lic. a 6 �e�a q[@' 7�' Co actor's ignature: �'� ��SSe� /O • /l'O_7 V" CONS7RUC710N LENUING AGENCV: ❑ I hereby aHirtn that there is e consiruclion lending agency for t�e pedormance of the work for w�ich Nis pertnic is issuad. (Sec. 3097, Civil Code). Lenders Name: Lendefs Address: Signawre: Date: OWNER-BUILDER DECLAFiA710NS: I hereby aflirm that under penelry ol parjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7037.5, Business antl Protessions Cotle: Any ciry or counry which reQuires e permit to construct, alter, Improve, demdish, or repair any siructure, prior ta its issuance, elso requires the epplicant tor such permit to file e signed statement Ihat he or she Is licensed pursuant ta Ihe provisions of the Contrectors License Lew (Chapter 9(commendng with Section 7000) 01 Division 3 of Ihe Busineu entl Professions Cada) or Ihet he ar she I5 exempl therefrom and Ne basis tor the elleged e:emption. Any vialation of Section 7031.5 by any epplicant tor a permit su6jects the epplicant to e civll penelry ol not more than tive hundred dollars (5500).): ❑ I, as owner ot the pmpeny, or my employees with wages as their sole compensation, WILL DO TME WORK, end Ihe strucWre Is not imentletl or oNered tor sale (Sec. 7044, Business end Protessions Code: The Coniractors License Law dces not apply to an owner of properry who builtls ar improves thereon, and who does such work himself or hersell or through his or her own employees, providetl Ihat such impmvements are not intended or oXered lor sale. If, however, the builtling or improvement is sold within one year of completion, the owner-builder wlll heve the burden of proving ihat ha or sha did not build or improve lor purpose of sala.). � � I, es owner of the property, em EXCLUSIVELY CONTRACTING WITH LICENSED LONTRACTORS to conslruct tha project (SeC. 7044, Business and Professions Code: T�e contrectors License Law tloes noI epply Io an owner of property who builds or Improves ihereon, antl who contracis lor such pro�ect with e contractor(s) license pursuent to the Contractors License Laws.). ❑ I em e:empt under sec. Business antl Pmfessions Code lor Ihis reason: Signature: Data: Owner ID venlied by ddver5liCense. ❑ Ves ❑ No Driver5 License No. Expir05: Vedlication ot Ownership by (type ol tlocument, i.a. - properry taa hill or deed): DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICA710N: ❑ I here6y certify that no excevetion five (5) or more tee� in dep�h into which e person is required to descentl, will be made in connec�ion with work eu�horized by Ihis permit, and that no huilding stmcWre, scaffolding, talsework, or demolition or dismamling I�areof, will De more �han ihirty�six (38) teet higR (Chep. 3.2, Gry 2, Ar12, Sec. 341, TiOe 8, Celilomia Adminisiretive Code). ❑ As ownerbuilder, I will not employ anyone to do work whic� would require a permit irom ihe Division ol Industnel Setery, es noted ebove, unless such person has a pertnit to do such work Irom lhe division. Signature: Date: Division of Indusirial Sefety Permit Number: CEHTIFlCATE OF COMPLIANCE AND AUIHORIZ4710N OF ENTAV: I certity under penalry of parjury that I have reatl this eOPlication entl state that ihe infortnation given is correct. I egree ro comply wilh ell state laws and ciry ordinances relating to huiltling conswction, and euthorize representatives ot Iha Ciry of Costa Mesa [o enter upon Ihe ebove-descnbed property tor Inspection purposes. I agree not to occupy or allow occupancy of eny building authorized by Ihis permit un�il tinal inspection. CODE �. �Nsvecnoxnre 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Ra-Raol 201 FInaI8locWReteining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition o"n INTIfIRLS (.� L�'�V) � COOEI INSPECTONTYPE 206 Final Mechanical 200 Finel PlumDing 210 Final Electricel 212 Finel Fire Preventlon 220 Final Planning Approval 222 final Site 250 Finel Building�Occupancy QdIE L�LS PqQIECT ROUNE55: 3�T 6 4 .1 OH NS �N AV OWNER'SNAME: �•xOVAS, 3�S5E MARTE nooeess: g064 JOAN�ON AVF COSTA N�s'A,CA 92626 FflCNIENGINEEH: � 1 Q 5 4 6- U 7 2 9 aooncss: HEG.NO.: uxir: uxrt: PEPMITTEE: �OI,A PLUMHING (714)895-1246 aooness: � 1610 SEAE6A7�ll ClR STANTON CA 90680 LICENSE� CONTBACTOP DECIAPATION: I �erehy a�lirm Ihal I am licensee unAer Dwvi5ion5 0l C�apier 91�ommencing wiih Section 7000� ol DiWsan 3 0l I�e Business ana Pmlessions Coae, dnA my license is in lull force anG eflecl. ci,rucy.:_ �U�50386 STATELIC.:r�l� (j'11 - a-c�us�s: �-36 Oate_-S{sc�-Q��':, SiAnaWre: �'D�'� �'t.t�_ - WOflKEH3`COMPENSRTIDN OECLANaTION: I hereby aftirm thal I have a cerlilicate ol tonsent lo sel4insure or a cenilicate of Workers' Comoensation insurance. or a renilieU coDY �nereoi (Section 9800. Lao. C). eoucrNo.: t1o79929U EXP.OATE: Q3/OLI9Z COMPpNY: STA1.'^.1 � Cetlilietl copy is �ereby Wmis�e�. � Cehifietl copy is fileU /w�iU the city BuilOing �ivision. 'Dai�� '�1.— ApPlican�: /i[%iM•t �� l,r�-�C � EXEMPTION FflOM WOfl8Efl5' COMPENSATION OECIABRTION: Qhis 5ection neetl not be com0leteA ii @e perm� is for one hu�red ($100) ar less�. I cerlity tha� in Ihe pedormance af Ihe work tor which this permit is issued. I ahall noi emDloy any person in any manner so as to 6ecome su�jeci �o �he WorkeR' ComDenSaiion Laws o� Calilomia. Date: Signamre: NOTICE: If, atter making �his Oeclaration, you shoWd 6ecome suhlect to �he Workers' Compensation pmvisions of tAe LaUar COAe, you mu51 torihwil� mmply with such pmvisions or �his De�mi� s�all be tleemetl revokea: CONSiflUCTION LENDING AGENCY: 1 �ereby allirm �hat Ihere is a consimction lending aAe��Y �or ��e Oetlormance ol Ihe work �or wnicn mis Dermn is issuea 1Sec�ion 3097. Civ. C). LENOEX: aouncss: OWNEfl BUILOEfl DECIAflATION: I hereby a�lirm I�ai I am exempt Imm IOe Conlrac�orY S�aie License Law lor Ihe lollowing reason (Seclion 7031.5 Business an0 Piofessional Cotle: Any cily of couniy whic� requires a permillo con9mci, alter, im0�o�& Oemolis�, or repai� any slmtlure. prior Io iIs issuance. also repuires IDe applicant for such Dermil lo lile a signetl s�atemen� iha� �eJshe is Iicense0 pur5uani lo the D�ovisions ol ihe Conlraclors' Slate License Law (ChaO�er 9(commenung wit� Seclion 7000) ol Division 3 0l Ihe 8usine55 ana Pmfessions Cotle) or ihat �elshe is e�empt �herefmm an0 ine 6asis for t�e allegea exemption. Any violation ol Section 7037.5 6y any applicani lor a permii 5u�lec�5 the appliwnt lo a civil penally oi no� mare �han live �untlretl Ooll3rs (5500�. I, as owne� oi Ne pmpetly or my emplayees with waAes as Iheir mIe comDensation. will Oo Ihe work, and the ❑ slmclure is nol intend¢d or oflereA 1or ule (Section 7094, BusmeSs and Pmlessianal COAe: The Conirac�ors' State License Law Aoes not aDDh �o an mvner at a pmDeny who builAs or impmves t�ereon, ana who does such work himself/hersell ar IhrouAh his or �er awn employees. pmvitlea that such impmvements are no� intentlee or offereE lor sate. Ii, however ihe builaing or improvement is sold vn�hin one year ol complelion, Ihe owne� vnll have ��e Ourden oi pmving h¢/5he did no� builA orimprove br ihe ouroose of sale�. I, as owner ol Ihe pwpetly. am eK[lusivelp conVacting vnih IicenSed conlraciars lo canstmci �he projeci (Section 704d, Business ❑ and Pmicuims CoGe: The fqnVactors' Slale License Law tices noi appty �o an avme� ol OmpehY who Oui105 or impmve5 ihereon antl w�a cOnlraQs lor suc� D�olecis wiih a conlractor�s) license pursuan� lo Ihe fAntractof5' S�ate Litense Law�. I am aware Ihat prao� of Ineir Worker's Compensalion insumnce shoulU 6e pwvitletl to me. � I am erempl un0e� Seciion: 8. 8 P. C. for inis reason: Daie Ownec i do hereby cenily tnat I am aware oi and unUeistana ihe requirements ol Catilomia Healt� and Satety Ca�e Sec�ions 25505. 25533. ana 25534 an01ha1 I or any IUWre GuilAing occupanl willlwill not (circle one) neeG Io comply vnih saiA s�aie coaes antl I�e repuiremen�s for a permil lor conslmclion or moEiticaUon irom �he Air Ouality Managemenl Oistric�. fle5i0en1iai con5ime�ion applicaiions are exempl imm inese o�ovisions. Dal¢. Applitanl: � I here�y retli�y Ihai I �av¢ reatl �hi5 appliWiion and Slale Iha� Ihe above inlofmaiion i5 fArr¢tl. I a9ret Io Co pty wilh all Gily antl COUn�y ordinancesantlslateWvnrelaling�obuilAingconslmclionan0�erebyam�oriierepresen�alivesoi�Nsdiyloe upanlhea0ove�menlioned ' pmpetly lor in50e��ion(�p�urposes. ',� Oate' _�[-_�_��7'—�� Signature' _ v3/�,'y�_I�L �i oriver's Gcense or Socui Secumy .: � �641-afi White-9uil0ing: Green-Cotle EnlorcemenL Canarv-ApphcanC Pink-Revenue: Goltlenrotl-Nssessor CZTY OF COSTA NESA - BUIi�DI�iG FERN_Ti PERM NO: P 051�9 Pe.R�Ii �O: P 051548 PLAN C?iECK Nt?: N GOVT: N SiiPP; N CONSTRUCTIUId TYPE: V-N PER,�IT TYP�; FLU PiJRP05a: OTH J'Oo D:c;CRIPTTON : CHANGe. OUT WATcR HEATER SQ FT: CI.�ATM VALUc: CALC-VAI,UE: GROUP OCC; R-3 / COMMENTS: SMOISE llE'CECTOR RE�UTRED �f��Elf%i(?E�Yr�7kklEY.ifiPdp�IFiEiF��E#df#�9f�lfk�ki(�� #if��if�Ic�MitifY.�-If�lf�Edfi(if1(X.�%iFjEiE�Y...iYiF"Y,�it�l4ir�YaFaEiEiElFlfd(��7�if�i#�?EieiE�)fdf��-kX'#1E-lE Z O N I N G R E Q U I R E M E: N T S S E T B A C K S ------------ �AIN BUIi,DING ---------- --------- ACCESSORY BOIi,DING --------- FRNT: F'f ZN REAR: FT IN FRNT: FT IN REAR: FT ZN iErT: FT IN RGHT: PT IN I,EFT: FT I1. RGHT: rT IN PAR'f,ING REO• PROV; PARCEL: 14159207 ZNE; RE: NO; PLT,NNING NbTES> i 14 3F 1F ir ie ie 1F 3Pi iE # i!� ir �:� ff� R f'r'lf' ii� Jt iF Y� #r 3E # If� if iE IE IF �f w-iE iF Y. if iE ff if 9i Y ff K� %�+E if N' 1F 1F #'7E iE if 3E } i�� #'� �%i4 +E }#�� 3i- iF if�+b if le 7E iF ii• 3e DFli fF a 3F if ?f D E V E L O P M H N'P S E R V I C E S. : R E Q U T R E N, E N T S ZUNING APPROVED BY DATE; BUILDING APPROVED HY ; - DATE; AFPLICATION ISSUED bY: `��'�� J�vQy `' �N��1E1EIf7F1f3FY•1FiflEii��V•�f�Y.Y�1fie#�df��%#�Ci7F RTiF � ii�-)E.I(..7(. k. } N� �IM1 if 7f N� 1c �' 1f• ff T i! 4 Y� If� % M� iE%1Flf i(�'r'r 1E i' i(� k� �Y.� if iE X� iF 3f �161f iF iF iE �1F ii� Y� '� 1p ti LcGALIZATION;N F E E S U M M R BLDG PMT PLliMH�NG ELECTRIC MECHANIC PaRMT_T :.' . 00 258 PLAN ISSUE r=r. 3.00 DATE: ¢��—�� it'�P'sYF'iFlr'� �r IF �f M' Y.' if' K i(' Y. R`R'it'1t` iE i( if'1E l'� �i� 3't i: IF �lf Y� 7i i'.''� i'� ii� �F 3c N� }'� �3e �3f jf� �le i[� )f� k• if 3(� iE 1F Y STRUCTU�Ai, SEGN,ENT:N FIRL SMIP/RES GRADItiG SMIP/NON-�RE:S BUIiDIN�-DLV-> PBRNIT ZSSilE PLAN-CHECK. TOTAL PAID DIJE TO'PALS----� 2.00 3,00 0.00 5,00 5.00 ,4U REVENUE LIC'ISION TOTAI.,S--> COLLECTEll: 5,00 OViR/SHORT; ,00 B.LDG PMT FLJN,B:ENG ELiCTRIC MECHANIC =IRE SMIP/TOT GRP.DING PLATd-CiiECK S.UU if i'r 3E 1F i�� %� lf X� If iE �f� iF±P } 3r ii i(� # if �1F ib K� ?(� k iE if 1t� k IF iE 3F iF ac %3f 3e .l"� Y� # �� li� 1h iE #� a..1f i(� 3f -IF k df �lE �% }� iF fi� if )F k# iE li� 3e < 1'r �(� f(� i!� K if� �� k.'vi K� N� �li� ii If� ?f I N D I V I D U A L r E E A R e. A K D O W 1v TYPE QTY U E S C R Z P T I O N UNIT COST TOTAL COST PLU ] WATER HEATER AND/OFt C�ENT 2,00 2,00 EiVD O. : G: J .. ?.�t„'1L�_:S1%� n �;'_ ��r.:_ ?3�.i -�{ T�1�_; �y�,'y: CONSTRUCTION AND PLANNING ' POOI 1PA . APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector K. 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location "` � 2. Soil Pipe-Und�grnd. t c.� 53. Steel Reinforoement '. 3. Electrical Conduit Utility-Undr9rnd. 54. Forms 4. Electrical Conduit-Undrgrnd. � 55. Elect�ical Bonding - ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAI TO COVER�GUNITE �7. Footin9s 58. Electrical Conduit-Undrgrnd. 8. Foundation � . 59. Gas Pipe, O Undrgrnd., Test '. 9. Water Pipe-Undrgrnd. ' , 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Floor System � 61. APPROVAL TO DECK ` 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap . 63. Heater & Vent�Final "� 13. Roof Drains � _ 64. Plumbing System - Final . 14. Rough Plumbing . 65. Electrical-Final � 75. Rough Elec[riwl-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access ApProval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventiiating 71. Product Piping OGas OOiI 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil � 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe 2S. Wthing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. flEQUIREMENT 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 � - i 35. Final Gas Pipe-Test � 36. Hood o� Canopy � � 37. Final Factory Fireplace ' 38. Final Plumbing / G� (�(, 39. Water Service-Final 40. Gas Service-Final - 41. Solar Oomestic-Final 42. Backflow Preventer 43. Backflow Irrigation � 44, Landscape Irripation System � 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING -� 49. Electric flelease to Edison � 50. Gas Release to Southern California Gas Co . . 51. CERTIFICATE OP OCCUPANCY No. Date ADolicant to fill in all spaces except those within heavy oortler Ilnes ane sign ali aoo�oo��ate aeclaratlons. CITYOFCOSTAMESA CONSTRUCTIONPERMIT Projec[ Address 3nFd .lnhns�n Ave. Applicant's Mailing Addreu 541 i F Ld Pdllild Owner's Name �'+],� Hesse `�h��G Phone 546-0729 Address —3Q54 Johnson Ave.—Costa Mesa 92626 Arch/Eng. � License No. Address Convacror's nlame�BQ—�RP7AAICE. INC. phone ��9-�868 Address (mailingl �+41 i R, La Palma - Anaheim 92II07 Ciry License No. A0702 LICENSED CONTRACTOfi OECLARATION " 1 hereby affirm tbat I am littnsetl untler provisionz of Charte� 9(rommencing . with section 7000) oi �ivision 3 of the Business antl Professions Cotle, antl my Iicense is in full force antl etiect.//^�� License Class _ `( sa�Lticense .� oate 1�14�$8s'B t ��(ilLlii WORKERS' OM ENSATION DECLARATION � ' hereoy aHirm that I nave a terlificate of consent to self-insure or a certl/icate 1 ' Workms' Compansation Inw�ance, o� a certlfietl Copy Iher¢of (Section ��+ d00, lab. C.) Policy No. �4—nH3�2 compa�vHOmeland 1 Certi(ietl copy is hereby fumis�etl. //y•�� [�� - � Ce�tifietl mpy is filetl with the city Builtling Division.LJ�lL'1'-�Q�G(N" oace �—z�.1,._/;./$f?_apoiicant[��(}EY)RMANCF� TNC. EXEMVTION FROM WORKERS'COMPENSATION DEGLARATION (Thiz se[[ion neetl not be mmplele0 if lhe Oermit is fo� One huntlretl ($100) or less). I certify Ihal in lhe pe�formance ot tbe work for wttich this perm�i i5 iSSuetl, I sM1all not employ any pMson in any manner 5o as lo become subject [o the Workers' Compen5ation Laws of CalitOmia. Oate Signature NOTICE: It, afler makin9 tnis tlecla�atlon, you shOUltl become Subject to l�e Workerz' Compensation provi5ion5 ot the 12bo� Cotle, you muit for[hwith comply with su[h prOvision5 or Ihis pe�mit snall De tleemetl �evoketl. CONSTRUCTION LENDING AGENCV I M1e�eby affirm tha[ there is a mnstruttion lentling a9ency fo� tne Oe�formance ot [he work for which this permi[ is issuetl (Sec[ion 309] Civ. CJ LPntler's Name L.entler's Atltlress OWNER BUILDER �ECLARATION I hereby affirm that I am exampt from the Contrattor's License �aw for the followin9 rwson (Se<tian 7031.5 Business antl Grofessional Cotle: Any dty or Counly which r¢quires a pe�mit to construct, alteq improve, Gemoli5h or r¢pai� any StruCWre, p�io� to it5 iSSuanC¢, also �equires the applicant tor SucM1 pe�mlt to file a si9netl slalement that he/The is licensetl pur5udn[ to the provisions o( the Contraclor'S License Law (Chapler 9(commencing wilh $ectiOn ]000) ot '�ivi5ion 3 of Ihe Business antl Profe55ions Cotl¢) or that he/she I5 exemp[ - �relrom antl the basis for Ibe allegetl exemption. Any violation of Section 31.5 by any applicant fo� a permit subjects the applicani to a civil F�nalty of not more tM1an five huntlretl tlollars ($500). LJ I, as owner ot tM1e property o� my empioyees with wage5 as their sole compensation, will tlo the wo�k, antl the st�uctu�e i5 nOt intentletl o� offeretl to� wle (Section ]044, Business antl Professional Cotle: The Contractor's License l.aw tloes not' appty to an ownet o! a property who builtls o� imp�ove5 thereon, antl wM10 does sucM1 work himseH/herselt or through his or her own employee5, provitletl tnat such improvements are not in[en0atl or o(feretl for sale. If, hOwever, tbe builtling or improvemenl Is soltl within One year o( com- plelion, the owner will bave the burtlen Of proving h¢/she Gitl not builtl or Im- prove forthe purPosa of5ale). ❑ I, as owner of tM1e prop¢rty, am exclusively cont�acting wi[h IlcenSetl con- [�actor5lo cOnst�uct lh¢ proj¢cl (Section ]044, Business antl Ptofes5ions COtle: The ConVactor's Llcense Law does not apply to an owner ot property who builas or improves thereon, antl who contrac(s (or such projects with a con- tractor(s) iicense pursuant to tne Contractor's License Law). I am aware that proot ot tbeir Worker'S Compensation insurance shoultl be provitletl [o me. ❑ I am exempt under Section B. & P. C. �or tnis reason Dace Owner I hereby certity lhat I have reatl this application antl state that the above 1010fflldtlOn i5 COlI¢Ct. I dql2C t0 COfilPly WIIYI dll CI[y dntl C011llly altllOdnC25 antl state laws relating to builtling construction, antl hereby authorize repre- sentatives o 's city t0 en[ � u Op�e-menlionetl ProPertY fo� inspection r ses � Ol/14/88 Signature Date Drivers' License or 55 � / ��— TYPE OF CDNSTRUCTION LJ NEW LJ ADD IJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH � OTHER CIiANGEOCIT AP # D£SCRIPTION OF WORK/USE OF BLDG. $lOCj1F' fam>>}� YPS- S Main Building: TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL T FrOnt ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING � MECHANICAL B Reaf ❑ OTHER A PROJECT DESCRIPTION 5q. FT. OCCUVANCv C Right CONSTRUCTIONTVPE VALUATIONS S Left 20NE: GRADING CU. VDS. ACRES p�ng. Ref. # Remarksi Planning Notes: ar Sink ackflow Preventer ackflow Irrigation athtubs larifieis ishwasher rinking Fountains loor Orains loor Sinks Showers Service Sink Sewer Cap Sewer Connection Solar Collec[ors Solar Pipin9 Solar Tank Swimming Pool wlSpa Urinal .ias Service Outlets Water Cioset Interceptors Water Heater Kitchen Sink � Water Service Lavatories Roof Drains Auto Wesh FEES ReinspeMion Fee � $15 I I Issue Fee ' I $ 3 Boiler Hood or Type I ❑ Duct � Under Ground �nopy Type I I ❑ Duct - SVuctural pefrigera[ion System Duct-Ventilating ❑0.100,OOOBTU ❑100,000 Exhaust System ❑ MW tiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting Registers �0-100,000 BTU 0100,000BT Reinspection Fee I $75 I � Issue Fee � �,�' CMF 0865-46, rev. ]0/B4 White - BuilOing; Canary - ApPllcant; Pink � Accounting; Goltlenrotl - Assessor Automatic Washer Construction-Pole Su6. Cooking Unit Dishwasher Dryers �Gas ❑Electric Fan 4376 I/29/pi t;��; Zone Accessory Building: Z O N I N G R Parking Req./Provided E 9 ° M T S ELECTRICAL F.A.U. I' � U Fixtures Device 8oxes Outlets $WI[CfICS Garbage Disposal Generator �0-5 KW �5-75 KW Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter �over100amps Sub Panel Motors �0-1 HP 01'f, - 8 Inc.Solar �9-15 HP �76-15+ Microwave Pole Light $Ij�l Standing Sections Trash Compacmr Reinspection Fee �$15 � � Issue Fee DEVELOPMENT SERVICES RE�UIREMENTS: 2oning Approved By Building Approved By Appliwtion laUed By � FEES SUMMARV OF FEES � BUILDING PERMIT $ SMIP - ,$ PLAN CHECK $ PERMIT PIUMBING S ISSUANCE $ -� PLAN CHECK 25% 3 %� ENERGV P.C. $ ELECTRICAL $ �" GRADING $ PLAN CHECK 50% $ � "�'/� � MECHANICAL 5 �TOTAL FEE. $ PLAN CHECK 25% $ '; ;� POOL & SPA CONSTRUCTION AND�PLANNING.; � . �� ,r Date Inspector !•� Date Inspector APPROVAL$ Permrt:#�-.- ',.APPROVALS Permit # +: 5 !, . l.i;Temporary,`Electrical�Ser,vice or Pole�� 52. Pool & Equipment Location �:. 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement t .:; ::i 3. Electrical Conduit Utility-Undrgrnd. 54. Forms "'' .., 4. Electrical Conduit�Undrgmd. �� 55. Electrical Bonding v-; 5. Steel Reinforcement �' 56. Rough Plumbing & Pressure%T�est . �.._ 6., Electrical UFER Gr.nd_, 57. APPROVAL TO COV�R-GCINITE � , 7�?Foot.ings " 58. Electrical Conduit�UndrgrndM" 8,�Foundation 59. Gas Pipe, � Undrgrnd.)�7es�'j .� 9;� Water Pipe-Undrgrnd. 60. Backwash Lfnes, P-Trap,iO�Pl,ndrgrnd. 10. Structural Floor System 61. APPR�VAL 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 74. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17 : RoJgh, Wiring Sign 68. APPROVED FOR PLASTERING � da q i8.. Ftough 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 ��2. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 Coai 79. FINAL INSPECTION i 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �' 33. Final Electric Notes: L� �BB ��'�'�,4Q,0 (,E•� t�' 34. Final Heating & Air Conditioning �(�f'� �,�Q,yhl'r' '�P{R�f� 14$ O P a 00�� .:. 35. Final Gas Pipe-7est V��, L,�, J 36. Hood or Canopy . 37. Final Factory Fireplace • 38. Finai Plumbing - ,. 39. Water Service-final 40. Gas Service-Final � � r ' 41. Solar pomestic-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 51. CERTIFICATE OF OCCUPANCY ' No. Date � . .,. � ` , 17032 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. HOX 917 C08TA M68A. CAIiFORN1A For Applicanf io Fill In Complelely TYPE OR PRINT BUILDING 3o6v S/-��..ro.r Arenue ADDRESS COSTA MESA. CALIFORNIA � � 8�� OF LOT USE OF EXI9TING BLDG. 96T9ACK LIN¢ FpOM CBNTEP OP BTREBT Gir'. � SIDE YARD I IHFT % � DESCRIPTI BUILDING ' SIZ2 2 EXTERIOR WALL COVERING USE OF BUILDIN t CR.- NO. OP BlDGB. � RIGHT r% � OF WORK NO. OF 1 HeRBBY ACKNOWLHO68 THAT 1 XAV6 P6AD TH19 MPIJC ANO BT�TB TH�T TN6 ADOVH IB CORRECT A � AORE6 TO PLY WITM �LL GIT,Y ORDINANC88 ANO BT lAWB REGUL em�oiHo consNfiGrnow. . . _ / ,/ AUT� rtE �ECEs�l�� uiHr 17 ,96�• �FINl11\CE DEAT. :,, � oF cosTa m�sa APPLICATION FOR PERMIT BUILDING For Office Use Only 0.ECEIPT NO. P�Nry �� 7 er I n��ey2 I o�re ieeu c �� MAY � i 19F7 3064 ohnson Avenue COSTA MESA. CALIFORNIA APPROVED ZONING ZON�j NO. OP UB! OP NEW SA� .�j� A /1 �I I PLANB � BUILDINO I�AA✓ W LE6AL _ .. u � _� 1. / � � , tceHTea une er.> 3z —�� TXE AMOUM PURPO88 OP $ 19,�55.00 EVES IN. IN. �— IN. Z IN. e J /7�6t ( 7F >�f / UNDlR VALUAT�ON IB FOq TMH IBHINO /� PHRMIT FEE ONLY. PERMIT FEE $ w��/ ' PLAN CHEGK $ //�,J