HomeMy WebLinkAbout3420 MEADOW BROOK - Building Permits�: 1
�' �
. CITY OF COSTA MESA � . �
� f BYILDING DIVISION
'`�� 77 FAIR DRNE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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�,��� FOR INSPECTIONS CALL: (714) 754•5626
PERMIT NUMBER: BC09-00259
PERMIT TYPE: B CqM60
Sub Type: ACCSTR
Jos ao�Ress: 3420 MEADOW BROOK CM '
APN: 93506025 - Zoning:�
STATUS: ISSUED
DATE ISSUED: 08/25/2D09
ISSUED BY: BJK
Sui4e/Unit: .
Vicinity: FLATANDSLOPEDROOF. � � �� . �Primary0cc: R3• �
ConstType: SQ. FT:: 0 Valuation: 535,000.00
SCOPE OF WORK: INSTALCATION OF A SOCAR ELECTRIC POW ER SYSTEM (24 PANELS) ON THE FLAT & SLOPED ROOF OF
AN EXISTING SFD. ELEC: 1:INVERTER, 1 BATTERY BACK-UP (INCLUDES CHARGE CONTROLLER), A/C & D/C DISCONNECT
(D/C BUILT INTO INVERTER), CONDUIT. . . � , .� �
OWNER: PHILLIAS, ELIZABE7H J- . . Address: WEBER, BRUCE R TR ' _ . Unif: COS7A MESA,
CA - , � - .. .. � .. � , - � ' : � .
Phone: - ., ` ��City/State/Zip: 3420 MEADOW BROOK , � . � ', ' ,
APPLICANT: DOAK, SEAN � �- . Address: - ' ' ' Unil: :
Phone: 949-417-0750 X114 -. . � . .- City/State/zZip: � - - � ,
CON7rtaCTOR: SUNWIZE TECHNOLOGIES License No. 890619 �
Phone: 949-017-0750 : �- Address: . 443 CORPORATE PARKUnit: - �- SUITE 202
Cell: - � � City/State: IRVINE, CA �� ZipCode 92606
ARCHITECT:
ENGINEER:
License No.
License No.
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: � $320.29
Building Fees: $492.75
Electrical Fees: � ' - - $126.80
Mechanical Fees: � $0.00
Plumbing Fees: $0.00
SMIP Residential: ,..-. $3.50
SMIP Commercial: $0.00
Bldg Std Admin Fund $2.00
TOTAL FEES: $945.34
"Refer lo fee receipls for all f¢es paid for project .
PHONE:
PHONE:
NOTICE: The work authorizetl 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 wdes, and all
required inspections and final approval must be obtained. FaiWre to obtain inspections and final approval will resWt in the expiration of this permit.
COOE71. INSPECiIONTViE DATE INTITIAlS COOEd INSPECTONTYPE �ATE. INTITIRLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
7266 Pool Spa Final 208 Final Plumbing -
200 Final Re-Roof �� 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Facfory Fire Place p20 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition p50 Final Building/Occupancy
�
WORKERS' COMPENSATION DECLARATION:
I hereby aff rtn under penalry of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to selbinsure for workers'
compensation, as provided for by section 3700 of Ihe Labor Code, for the
p�eA/olmance of the work for which ihis permit is issued.
GLry 1 have and will maintain workers' compensation insurance, as required by
section 3700 of t�e Labor Code, fa the pedormance of the v.vrk for which this
pertnil is issued. My workers' compensation Insurance carrier antl policy
numherare:
Cartier:� M�.f s'.,. � �.-,.._ 'i-�. ,,..o % ti c �/S/8
(inis sMim need �wt be mmdeteCrt the peima is valued a�t io�ne huntlred tla�lars (3f 00) w less )
Policy:Number �� G% � � � � T �
❑ I certi(y tha[ in [he peRormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree thal if I should
become subject ro the vrorkers' compensation provisions of Section 3700 of
the Labo ode, I shall forthwith compl lh these provisions
T /li-� �
Ap0licanl's Signalure `Date�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that I am licensed untler pmvisions of Chapter 9(commencing
wiN Section 7000) o( Division 3 of the Business antl Professions Code, and
my license is in full force and effect.
Cic: Jt^� �� 9 Class.#.
' ConuaclorsSignawre Da�e� j
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrm that there is a consWction lendinq agency for the
perfortnance of Ihe work fawfiich this permit is issued. (Sec. 3W7, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affrm that under penalty of perjury [hat I am EXEMP7 FROM THE
CONTRACTORS LICENSE LAW for [he following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construc�, alter, improve, tlemolish, or repair any s[ructure, prior to its
issuance, also requires the applican[ tor such permit [o file a signed statement
that he or she is licensed pursuaN to the provisions of lhe Contracrors
license Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Code) or [hal he or she is exempt therefrom and
the basis for [he alleged exemption. Any violation of Seclion 7037.5 by any
applicant for a pertnit subjects the applicant to a civil penalry of not more than
five hundretl tlollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO 7HE WORK, and the stmcWre is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builtls or improves
[hereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvemenls are not intended or offeretl for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of proving Ihat he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business and ,
Professbns Code: �The contractors License Law dces not apply to an owner of
property who builds or improves thereon, and who cont2cts for such project vnth
a cmtradw(s) license pursuant ro the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signalure Oate
305]-a6 �0ro])
r :.�'4
Ovmer ID venfed by tlriver's license. ❑ Ves ❑ No
Driver's License No. Expires: '
Venfcation of Ownership by (type of tlocument, i.e. - propeny tax bill or deed):
�IVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: `
❑ I hereby certify Ihat no excavation frve (5) or mwe (ee� in depth into which a
person is requiretl to descend, will be matle in connectbn vAth work authonzed
by this permit, and ihat no huilding structure, sca(fWtling, falsework, or demolition
or tlismantling Ihereof, vnll be more than �hirty-su (36) (eet high. (Chap. 32, Grp
2, Art 2, Sec. 347, Title 8, Califomia Adminis�ra�ive Code).
❑ As ovmer-builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safery, as notetl above, unless
such person has a pertnit to do such vrork from the division.
AO�litdnfs SignaWre Dale
Division of Intlustrial Sa(ety Pertni[ Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
t. Will the applicaM or present or future builtling occupant need to fle and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of lhe Califomia Health and Safety Code requires. with some
exceplions, lhat a Business Plan be filed with the Costa Mesa Fire
Departmenl by every business which has at any one time tluring a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressed gas
at standard tempereture and pressure).
2 Does or will the applicant or present or future building occupant neetl to fle
a registration torm tor acu[ely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 0( t�e Califomia Health and Safety Code, with some
exceptions, requires registration wim the Costa Mesa Fire Department by
each business which a[ any one time has on hand a quantity of acutely
hazardous malerials equal ro or greater than a vreight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet ot compressed gas at standartl
temperature and pressure).
3. Does or will the applicanl or present or (uNre building occupant neetl �o
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous ma[enals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provides that Ihe
Costa Mesa Fire DepaRmen[ may require Ihe preparation, certi(ca�ion and
filing vrith the Fire Department of an RMPP by businesses which are requiretl
[o register acutely hazardous matenals with ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complietl with? ❑ Yes ❑ No
5. Does or will [he applican[ or present or fuNre building occupant require for
the work which is the subject of this application a permit for such construction
or modifcation (rom the South Coast Air Qualiry Managemenl District or (rom
any other air polWtion conirol district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requestetl
infortna�ion be fumished on applications for non-residential building pertni[s).
6. Will any part of ihe facility to be consWctetl under this permit be wilhin
1000 (eet from the outer boundanes of a school? ❑ Yes ❑ No
(If'yes", [he facility mus[ meet Ihe requirement o( Sections 25534 and 42303
ot Ihe CaliFornia Health and Safety Cotle).
7. If a pertnit from the South Coast Air Quali[y Management District or other
air pollution control disMct or agency is required for the vrork which is the
subject of this application, have all of [he disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certi(y that untler penalty of perjury the
information given above is correct I agree to comply with all slate laws antl
city ortlinances regarding Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRv: 1
certify under penalty of perjury thal I have reatl lhis application antl state that
the infortnation given is correcL I agree to comply vnth all state laws and city
ordinances rela[ing [o building cons[ruction, and authorize representa[ives of
the City of Costa Mesa ro enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed by IhiS permit until final inspection.
5' naWr el Ate
_ � �'/ �S' o
AnElo�Au@o�izetlApplirant _ _ ��pale' _
�
%� . � __ . � ; _ �,
. � ' �BCD�-�� ���
PROFESSIONA[.
COMMUNITY
o v o � MANAGEMENT
April 29, 2009
BRUCE R WEBER
3420 MEADOW BROOK
COSTA MESA CA 92626
Re: VILLAGE CREEK ASSOCIATION, INC
5010251 3420 MEADOW BROOK_. . _ _ __
Dear Homeowner:
The Board of Directors for the Village Creek Homeowners Association has reviewed and
approved your plans for installation as specified in the agreement and plans.
Please be reminded that approval is .based on conformance to the Village Creek
Homeowners Association CC&R's. This approval does not release you from obtaining
other necessary approval and/or permits, if applicable.
� Thank you for adhering to the submittal requirements for the Viliage Creek Homeowners
- Association. Your cooperation is appreciated.
Sincerely,
FO THE BOAR AF DIRECTORS
Co ey Buehier, CCAM
Community Manager
cc: Board of Directors
23726 Birtcher Drive Lake Forest, Califomia 92630-7 7 71 (949) 768-7261
www.pcmintemet.com
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I T
Pq0.1ECT POOHESS: 3 Q z O MEADOW BROOR
OWNEfl'SNRME: VILLAGE CREER H.O.A.
� aooeess: 3429 TZMBER LAKE
COSTA MESA, CA 92626
553-1876
FHCH/ENGINEFfl:
'�. PDDRESS:
xec.xo.:
UNIT:
UNIT:
veeminEe: pETERSON ROOFING t 714 ) 979-7111
aoonEss: 3006 ENTERPRISE
COSTA MESA CA 92628
LICENSEO GONTHACTOfl OECIANATION: I hereby aliirm Iha� I am lic¢n5e0 untler provisions ol ChaD�er 9(commencing wit� Seclion
7000) o� Oiasion 3 ol Ihe Business antl Pmtessions Code, an0 my license is in lull �orce antl eflecl.
c�.rucc.J:045445 STpTELIC.:6O%B•I? �a '
Date: ��y��� � Signalure: � �
WOflREflS' COMPENSRTION OECLABIITION: I hereDy atlirm �hai I h a certilicale oi consen� lo self-insure or a certifi a�e o� Workers'
Campensalion 5f{rN{cj ar a Cenifi �yoDY Ihereot (Sec�ion 3800, Lab. �.
POLILY NO.: � V L+ j 7 7—� �+ E%P. URTE: 4� O S I9 4
LOMPFNY: STATE FUND
❑ Certi�ietl copy is hereby tumis�e0. � Certitietl capy is filee with ihe ciry Builtling �ivision.
Ja�e'. ` Ap0licanC �
E%EMPTIO FBOM WOBHEPS' COMPENSATION OECIABAT10N: Rhis se ion neea not he complele0 if ihe permit is far ne huntlred (E700) or leu�.
I cetlify I�al in I�e pedormance o� Ihe work for whic� Ihis permit is issuetl. I shall no� empioy any person in an manner so a5 to hecome
sub�ect to Ihe Workers' Compensation Laws ol Califomia.
Date: Siqnature:
'�. NOTICE:II, alter making ihis tledaration, you s�ould become su�lact m the Workers' Compensation p �visions oithe Labor
Cotle. you must forihwil� comply wiih such pmvisions or ��is permi� shall be deemeA �evoke0.
CONSTPUCTION LENOING AGENCY: I here�y atlirm �hat Ihere is a coretmc�ion lentling agency lor I�e D ormance ol �he work for
w�ich this permil is issueA (Section 3097. Civ. C).
LENOEfl: �i
aooness:
OWNEB BUILUEB DECLAflFTION: I hereby aflifm �ha� I am ¢xempi Irom �he COntrat�ors' $tate License Law �or the tollowing reason
(Sec�ion 7031.5 Business antl Pmlessional Cotle: Any cily of counry whic� re0uires a permii lo cons�mc�, al�er, impmve, Oemolish, or
repair any SimcWre. prio� Io ils issuance. also requires the applicant �ar such Oe�mit to �ile a SiAned s[atement thai he/she is licensed
pursuam to ihe pmvisions o� ��e Contracmrs' Sta�e License Law (Chapler 9(cammencing with Section 7000) o� Oivisian 3 of the Business
antl Pmlessions Cotle) or Ihai �e/s�e is exem0� �nerelrom and Ihe basis for Ihe allegetl exemp�ion. Fny viola�ion of Section 7031.5 �y
any applicant for a permi� su�le��s ihe applicant to a civil penal�y ol no� more Ihan five �untlretl Oollars ($500).
I. as owner of ihe Omoeny or my emplayees with wages as iheir sole compensation, will Oo ihe work, and the
❑ slructureis notintenAed oroffereU brsale�Section 70a4. Business antl PmfessionalCode: The Coniractors' Stale License Law
Ooes not apply lo an owner ol a OmDe�Y w�o builtls or impmves tAereon, an0 who tloes such work himself/herseA or Mmugh
Ilis or her own employees, pmvideA Ihat such improvemenis are not intenUed or oneretl tor sale. If, however ihe 6uilding or
impmvemen� is soltl wi�hin one year ol comple�ion. ��e owner wili have lhe burden o� D�oving �e/she tli0 noi builtl or impmve -
lor I�e purpose of sale�.
I, as awner oi Ihe pmpeny, am exclusively conVacting wi�h licensed contrac[ors �o constmc� �he pwlec� �Sec�ion 7044, Business
❑ and Pm�essions Code' The Cantractors' Sla�e License Law Does not appty ta an owner a( proDehY �To builtls or impmves Iheteon
and who conttacts �or such prole��s wilh a conlrac�or(5) license pu�suant Io t�e CanVac�ors' S�ate License Law�. I am aware
�ha� pmol ol iheir Warkefs Compensa�ion insurance should be pmviaee �o me. .
� I am exempt untler Sec�ion: B. 8 P. C.
for this reason',
�aie: Ownec
I tlo hereby cenity inai I am aware ol and un0erstand �he requiremenis oi Calilomia Heal�h and Safery Code Sec�ions 2550.5. 25533, antl
25534 and ihal I ar any WWre builaing accupanl will/will no� (circle one) nee0 io comply wi�h saitl state cotles antl ihe requiremenis �or a
permil for consimction or moadicalion Irom Ihe Air �ualiiy Managemenl DiSUic�. fle5i0en�ial constmc�ion applica�ions are exemp� fmm
Ihese pmvisions.
Dale'. Ap0licant:
I hereby cetlity �hal I �aue read ihis aOVlicaiion antl state thal lhe a�ove informaiion is correcL I agree lo compty with all city and county
ortlinances antl sta�e laws relaiing lo buAding conslmclion antl �ereby aNhor¢e representatives o� Ihis ciry �o enter upon Ne ahove�meniionetl
pmpeny far insp¢tlion purrpose5. �__-��%/%.��
Da�e: � �9 I73 Signawre- � � �
briver's License or Social Security p: (�
1641-a6 Whne—Builtling; Green—Cotle EnlorcemenC Canary—AOPI¢ant; Pink—Revenue; Goltlenrotl—Assessor
CITY OF COSTA MESA — BITILDiNG PERMIT PERM NO: B 063407
PERMIT NO: B 063407 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE; V—N PERMIT TYPE; STA PURPOSE: ALT
JOB DESCRIPTION : T/OFF SHEATH REROOF W/COMP SHINGLES SQ FT: 3,700
CLAIM VALUE: 3,700.00 CALC—VALUE: 3,700.00 GROUP OCC; R-1 /
COMMENTS: SMORE DETECTORS RE� PERMIT INCLUDES 3422 6 3,�4�{24 ME,.��.�p Tpp. ��1�ua �
x�**�**�x***�**�r**x�********�rx� �**x��***�r***�r**tc�*******�I1F1��� V� I LV�VT'i*i�*
Z O id I N G R E Q U I R E M E
SETBA�xs REQU�fRED
------------ MAIN BUILLIING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING RE(�• PROV: PARCEL: 43506025 ZNE: REF NO;
PiANNING NiST'ES>
�� � �F�:
!E if if 1E if if iE �E 3f !f iF if if iE.1Elf if 1E 1E iE if iE 3E;Elf !E if i4 iE iE 1f iF iE 1ElE 3ElE iE iE if iF iE iE iE iF if if k�EiE iE �)f iE �E iE iE fF 1f 1f if if iE 1E �E iE it 1E if iEiF fF 1E ih iE1F iE iF iE if
➢ E V E L O P M E N T S E R V I C E S R E Q U I R E M E NbT S
ZONING APPROVED HY DATE: -
BUILDING APPROUED HY : DATE: -':
APPLICATZON IS'SUED BY: DATE: 8 R �
iFjfiE�F�f1EiEiE3Fif±fiEiflflJfiElE1ElfiEiFiliFiFiFiFiF'iF'iF'iiF�F3FiFiFiF3FiF'iFiF�FiF7FiF'iF ir7r�iFit1�F3F3F7FiFiFiElEiEiFlEiE1F*fflE X iEif
�lE iF if 1f iF ik iE iF iF iE if 1E �1E iE 1E IE iE �IEaE iE it iE iE if if iE iE iF if if it iF 1F iF iE it 3t ik iE if iFlf ik iF iE it iE �)h iFiE #1E dE if iF iE iE iE iE K� iE iE �F dE #E 3E if iF 9f'iE iElE iF iE if if if iE �E
LEGALI2ATION:N F E E S 0 M M A R Y STRUCTURP.i, SEGMENT:Y
<..--
BLDG PMT PLUMBING ELECTRIC MECAANIC FIiiE SMIP/RES GRApiNG
PERMIT 63.00 `�� .50
SMIP/NON—RES
PLAN ;�;,
ISSUE FEE
BUILDING—DIC'—> PERMIT ISSUE PLAN—CHECH TOTAL • PAID DiJE
TOTALS----> 63,50 0.00 0,00 63.50 63.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 63,50 OVER/SHORT• �0
HLD63P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOO GRADING PLAN—CHECH
3f iE �F �E iF iF jE iE � �E �E 3E iF If if 1f if if iE 3f if iE iF iF iF iE if iE iF �E fF �E 1E if dE it if iE if iE �f iE if iF iE iF iE fE iE if iE 1E iE iFlE iE ik 1E f(�!t iE iflE iElt 1t fF if iE iE iElF iF 1k iF 1F{F* *
I N D I V I D U A L F E E B R E A iC D„ O W N
TYPE QTY D E S C R I P T I O N UN�;� COST TOTAL COST
SFR 3700 REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
1.00 3,700,00
�
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O1,�1Q14bS47-00144593 Ti"JT 63.50 __
DATE: G8/09/93 TIh1E: 1i_15..------ �—
._1
r-
�pNSTRUCTION AND"PLANNING �
QPPROVALS Permit # - Date
t. 7emporary Electricat Service or Pole
2, Soil Pipe�Undrgrnd. '
3. Electrical Conduit Utility-Undrgrnd.
4. E�ectrical Conduit-Undrgrnd. •
5. Steel Reinforcement . .
6. �lectrical UFER Grnd.
7. Footings
6. Foundation _ � •
9. Water Pipe-Undrgrnd. .3
i0. Scructural Floor System
17, property Sewer Line & House ConneMion �
12. Sewer CaP . . . .
13. floof Dcains "
74. Fough P�umbing �
75. Rough Elettrical-Conduit
i6. RoughElectricWiring . �
17. Rou9h Wiring Sign
18. Rough ElectricaLT Bar Ceiling
79. Rouqh Heaiing & Air Conditioning
20. iiough Factory Pireplace ' �
21. DuCts, in.Structure i .. • . �
ZZ, QuCts, Ventifating' � •
�
23..Gas Fipe-Rough & iesc „
24, i7oof Framing � " �
25. Roof Stieathing . � �Y-i
26. Y�Bar Ceiling (StructuralJ & Monocoat
p7, Frame and Flashing .
28. l.athing & Siding ' '
29. Insulation . � �� .
30. Drywall Nailing ,
3�. Plaster Bro�yn, Coai, .
32, Electrical Power Meter•Final
33. ���al EleMric . ; ��
34. Final Heating & Air Conditioning •
35. F�nal Gas Pipe�Tes't ,
36. Hood or Ca�opy .
37. �inal Factory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
qt. Sola� DomesTic-Firial,i "
4z, gackflow Preventer,�
43. 6ackflow Irrigatio� ;�'�
. 1
�44. Landscape I.rigation SYtem � .�
r „
45. 5ound Attenuatio� � ,
. 46. Handicap Regulationi �,
47. �INA�STRUCTU��&B�JILDING .
48. FINAL PIANNINC� �
49. �Electric Release to,Edison '
.50'. Gas Release to Southern Calitornia Gas Co
51. CERTIFICAtE OF OCCUPANCY
No. Date
�' _
3
POO� A
Inspector APPROVALS Permit # Date Inspector
- 52. Pool & Equlpment Location
53. Steel Reinforcement •
54. Forms
�
� 55. Electrical Bonciing
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER�GIJNITE
58. Electricat Cqnduit-Undrgrnd.
59. Gas Pipe, O�U�d�gr�d.; Test � .
60. Backwash Lines, P�Trap, Q Undrgrnd.
67. APPROVAL TO DECK �
62. �Backwash & fleceptor�Pinal �
63. Heater & Vent-Final
. 64. Piumbing System - Final
65. Electricai-Final
� 66. Solar System-Final
67. Fencing & Access Approval
" ' 68. APPROVED FOR PLAS7ERING
69. POOL/SPA SYSTEMS FINAL
- FIRE DEPT. REQUIREMENT
' ' ' ' APPROVALS�• " Permit # : , ,
, ,�
� � 70. Underground�Hydro •
77. Product Piping � Gas O,OiI
: � 72. Underground Flush,• � � � � �
' �73. Undergmd. Srorage Tank O Gas ❑ Oil
% �� 74. Overhead Hydro
75. DrY Chemical
� . 76. Dry Standpipe
"i "� 77: FIXED SYSTEM'FINAL . �
� 78. FIRE PREV. FINAL � �
` i � HEALTH DEPTt REQUIREMENT
'�.. i � 79. FINAL INSPECTION ,
',. � ' 80. FO00 CERTIFICATE ISSUED
i i . � Notes: � �
�
�
' I 7-7-� i-
i
`��d� � ,:i
PflOJEtT POOflESS: 3 Q z O hIEADOW HROOK uxir:
OWNEfl'S NFME: VILLAGG CREEK HOMEOL7NERS
aooness: ASSOCIATIUN
3429 TIMBER LAKE
CM VA 9267.6
•AFCHIENGMEEB: (;HESTER CARVILLE ' aec.xa.: C18305 .
ADOBESS: 7 J 2 Q ARMOUR S T uxiT: '
S,D. CA 92111'
PEflMiTTEE: PHOENIX ENTERPRISES INC. ( 213 ) 690-9559
RDDPESS: . QiS COMERCIAL WAY
LA HABRA CA 90631
LICENSEU GONTflPCTOfl DECLAPATION: I hereby atlirm thai I am hcensetl untler pwvyWyyy'ons oi Chapter 9(commencing with Sec�ion
�0001 of DivOo=oal—� �he 9us=ness an� Pm�e3i9ns Code, and my Iicense i��� eH���
crtruc.: qq sryicuc.: 76639
oa�e: y � � Si na�ure: _
WOXKEBS' COMPENSAYION UECIAPATION: I hereby al�irm �ha� have a Cetlihcaie o COnsent �o Self-in5ure or a cehil(ta�e of WOrkers'
Compensaiion �nsy[ancQ� 3.certifieU copy �hereol (Section 3B00. Lab. C�.
7LICY NO.: W/ U V� S�I E%P. DRTE: O 7 I O 1 I 9 S ,
COMPIINY: CA COMP 6 FIRE
� Ce�ifieg copy is here-y tu�yshetl. ❑ Cetlilietl copy is �ileA wi�h �uildi ivisipn.
�� �
i O
Oa�e: Applicant:
E%EMPTION FBOM WOBtlEBS' COMPENSRTION DECLAflATION: Qhis seclion need no� be completetl i� I�e permit is for one AunOre 5700� or less�.
I cetlify ��al in Ihe pedormance oi Ihe work lor which �his De�mil is issue4 I s�all noi employ any person in any manner sa as lo become
Subleci lo Ihe Workers' Compensa�ion Laws of Califomia,
Daie: Signa�ure:
NO710E: If, after making ihis Oeclaration, you should become sublect ro the Workers' Compensation pmvisions oi the Labor
COAe. you mu5i forihwilh comply wilh such provisions ar Ihis permi� shall be deemed revoked.
CONSTNUCTION LENOING FCENCY: I hereby alfirm ��at I�ere is a consimc�ion lending agency tor �he pertormance o� the wark lor
whith Ihis permiiis iEsued (Set�iOn 3097, Civ. G�.
LENUEH:
IIDDHESS:
OWNER BWLOEN UECLFBFTION: I �ere0y aifirm Ihat I am exempt Irom Ihe Contracbrs' S�a�e License Law �or t�e following reasan
(Sec�io�7031.5 Business ana Pm�essional Code: Any ciry ol cowry which requires a permil �o con5imct, alter, impmve, Oemolis�, or
repair any slmclure. prior lo iIs issuance. also requires ihe ap0lican� for such permit �o �ile a signea sla�emeni thai he/she is Iicense0
pursuam Io ihe provismns o� �he Contraclors' State License Law (C�apter 9(commencing with Section 7000) o� Division 3 0� the Business
antl Pmiessions Cotle) or Iha� �e/she is exemp� ��ere�mm antl I�e basis lor �he allege0 exemp(ma Nny viola�ion ot Section 7031.5 by
any apphcanifor a permit subie��s ine applicantlo a civil penalty ol not more �nan hve nundretl tlollars ($500�. �
I. as owner ol ihe D�operty or my empIoyeBs wiN wages as t�eir sole compensalion, will do the work, and I�e
7 stmcmre is not imentled or ofierea lor sale (Semion 7044. Business antl Professional Code: 7he Contractors' S�ate License Law
tlois no� appty �a an owner ol a pmpetly who �uiltls or impmves �hereon, and who does such work himsel�l�erseli or t�muAh
his or �er own employees, provitletl �hat such impmvements are no� intentletl or o��eretl �or sale. I�, �owever [he building or
impwvement is sola within one year of como�etion. ine owner will have �he burtlen ot proving helshe ditl not build or impmve
lor Ihe purpose ol sale). - .
i, as owner ol Ihe D�operty, am exclusively contracting with licensetl con[raciors ro consimct Ihe pmlec� (Sec�ion 7044, Business
❑ an0 Prolessions Cotle: The Coniractors' State License Law tloes no� apply Io an owner of pmperty who bui105 or impmves lnereon
antl who coniracls �or such prolecis with a contrac�ar(s) license Dursuanl lo Ihe Contrac�ors' S�ate License Law�. I am awar¢
t�at prooi of tlieir Worker's Compensalion insurance 5�ou10 be pmvi0etl to me.
� I am exempt untler Section: B. 8 P. C. �
�lor this reason-
Date: Ownec
I do hereby cetlify Ihat I am aware al antl unaerstantl Ihe requirements oi California Heal�h and Safery Code Seciians 25505, 25533, ana
25534 and Ihai I or any iNure builtling occupanl willlwill nal (circle one) neetl �o comply wiih saitl staie co0e5 antl ��e reQuiremen�s for a
permil for canslmc�ion or motlilicalion imm ��e Air Ouahry Management Disirict. flesi0eniial consimc�ian apDlica�ions are exempt �mm
��ese pmvisions.
�ale. ADPlicant: _
I hereby <er(ilythai I have read Ihis applicalion an� 51aIe Ihat�
ordinances antl stale laws relaling Io �udding cons�mction antl he
pmper�y lor inspec�ion purpases
�a�e. /2� � �� Signamre:�
orive�'s License or Social Secuniy x: �%$$
i5 co cl. I agree to comply with all cily and
nta s oi this ciry �a en�� ihe a�ove-me
1646a6 Wbiie-9uiltlmg; Green—Cotle EnlorcemenC Canary—Applicant; Plnk—Revenue: Goldenmd—Assessor
CITY OF COSTA MESA — BUILDING PERMIT FERM NO';.B OSUSB`
PERMIT NO: B 050587 PLAN CHECK N0:.00134-91 A GOVT:'N SUFP: N
CONSTRUCTION TYPE; V—N PERMIT TYFE:.STR . P(JRFOSE: REP
JOB DESCRIPTION : REPAIR SETTLEMENT DAMAGE SQ FT; 143
CLAIM VALUE: 14,300.00 CALC—VALUE: 14,300,00 GROUP OCC: R-3 /
COM,yENTS: BUILDING SETTLEMENT REPAIR/FOUNDATION '
* 3F iF dE iE �1E iE lE ib ii� �lE iE 9E IF 1F if IF iF if iFlE iEif iE fF iE i!� �If N� iE iF �E # iF af �lk iE iE if !f If iF iE IE iE 1E �Elf jf if iE 1F 3F jE iFlf if iF 3f jElF jF iE lElE �IE �IF iF �F ah iE if �E iE �lF iE ih �If if
Z O N I N G R E Q U I R E M E N T S'
5 E T B A C K S
LEFT: F'T. IN RGHT: FT IN LE — ACCESSdRY BUZLDiNG -----=---
MAIN B LDING
FRNT: FT IN REAR: FT TN� FRNT: FT IN REAR: FT iN
FT: , FT IN RGHT: FT SN
R�KING REQ • FROV: PARCEL;•93506124 ZNE: R2 REF NO: '
PLANNING NZ7TES> FOUNDATION REPAIR, ' .
. � ,
iE 3F iF k 3F if if 3f 3F 3f 1F If 3E iF iE #f iF iF If if If iF if If 3E i(� iF iE if if IE if iE !f �f IE�E 3E iE iFlE iE iE 3f iE 3F iF if iF if iE iF aF iE iF if iF iF �Elf 9f K� 3E �E iE iF if N� �1(��3E.jE iE Ik iF 1E if 1F k�)f
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N"T S
ZONING APPROVED BY __ ��J � DATE; ri I � S�l/
' � ^��
BUILDING APPROVED BY : l..i DATE:
APPLICATION ISSUED BY: DATE:
iEi(��f3Ei6ikiFifiE3F1E1EiE3fiFiEiEiE3fiFiEiE�iF� . �7FiEifIE�fIf1EiF�lEiE.�F�3FiF�F3FiEil�
iEiE3fitiE�lE1EiE�1FlflEdfiEiEifiEiFlFiFiF3fifi(�iF�1ti(�if1E�1E�F �i �IElE iEiEiEitlEifiFlEIE1E�lfifjEit3F1EiE1EiEiE�1EiE1FjEiEiF�lf�iEff3f;3fiEiF#if�if�ElFif3f
LEGALIZATION:N F E E U M M A R Y STRUCTURAL'SEGMENT:Y
i .
BLDG PMT PLUMBING ELE RIC MECHANIC FIRE SMIP/RES GRADING
PERMIT' 162.00 — 1.00
' • .�'' SMIP/NON—RES
PLAN � 26.33
ISSOE FEE • '
BUILDING—DIV—> � PERMIT ISSUE PLAN—CHECK TOTAL PAIU DUE
TOTALS----> 1,63.00 0.00 26.33 189.33 189.33 .00
REVENUE DIVIS'ION TOTALS--> COLLECTED: 189.33 OVER/SHORT; .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECH
162,00 = � 1.00 26.33
' iE ik IF 3f IF if iF 3E iE iF iE iE iF 1FlE if if ik 3E iE iF If� 3E iE iE iE aF 3F 3F iE iF iF iE 3F 3E 3F iE aE fE 1f iE jf IF �f fF if iE ff iE if !E lE �E if �E ik iE iE iE If !E )f �E iF 3F iF if iP if 1E if iE 3f if iFlE aE 1E if
Z N D I V Z D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 143 STRUCTIIRAL HY VALUE PER $100,00 100,00 14,300,00
_ . END OF FEES '
V .
�i nao�s�a�-c�ne�Q�4s� ; �,� ieq....;
Q-:TF: oir2ais? TEt{E: i':az
CONSTRUCTION AND PLANNING .- �
APPROVALS Permit # Date
i. Temporary Electriwl Serviceor Pole, ���A
2. Soil Pipe�Und�9rnd. • ��- `+
f.. �.,
3. Electrical Conduit Utifity-Undrgrnd., � .
4."ElectricalConduit-Undrgmd'•��� �
5. Steel Reinforcement �
6. Electrica�.UFER Grnd. � �
'� 7. Footings ' - ' '
� 8. Foundation� �
9. Water Pipe-Undr9rnd. p . �
/t.�+_ .Y�
10. Structural Floor System; ,f ��! _ � ��
„_ � . !?
11 . Property Sewec Line &�H��se Connection r%%
1�2�. Sewer CaP . - „�.� ' t> �
13. Roof Drains �� ^ � ��
14. Rough Plumbing /� �'�
/'�• / �,
15. Rough Electrical-Conduit �� H. (i1i
16. Rough Elearic W����g � ' 4',� ,
� � � i � �-
17. Rough Wiring Sign �` �%'��
�
18. Rough Electrical. T Bar Ceiling , �
!
19. Rough Heating & Air Conditioning -
20. Rough Factory Fireplace - "� �+� . • -
�
21:�Ducfs, in Structure. . " '
22. Ducts, Ventilating ` � �
23. Gas Pipe�Rough 8i Test ,
24. Roof Framing ' � �' �
25. Roof Sheathing - .� '. � . '
26. T-Bar Cei�ing (Structural) &�Monocoat '
.ti -
27: Frame and Flashing; ' �
;..
�.�.
28. Lathing & Siding •'- � - _ ' " � " '
'29. Insulation ` . ` " . '� � �
30. Drywall Nailing � `
-37. Plaster Brown Coat _ �
32. Electricai Powe� Metet;Final � •. i
33. Final Electric ' `•
. �
,- 34. Final Heating & Air.ConditioniRg , �. .
35. Final Gas,Pipe-7est - `
36. Hood orCanopy _-� • a' _• , :
37.�Final Factory Fireplace , � ' ��
38.: Final Plumbing .�, � �
39. Water Service-Final . '
40. Gas Service-Fin81 . . .
41. Solar pomesticFinal � " � -
42. Backflow Preventer '
43. Backflow Irrigation � �
44. Landscape Irrigation System_ � . ,
-45.�Sound Attenuation�- '
46.,Handicap Regulations �
47. FINALSTRUCTURE&BUILDING o
48. FINALPLANNING , � .
49. Electric Reiease to Edison
. 50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF,OCCUPANCY ,
Daie
A
- , _ & SPA
Inspector AppROVAIS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical8onding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
58. EleMrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undrgr�d.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT '
- � ' APPROVAL'S'� � �Permit #
, - � .70. llnderground.Hydro
_ �; ; t71. Product,Piping O Gas ❑�Oil
. -72. Underground Flushi�- - �
� ' ' '73. Underqmd'StoraaeTaok �Gas ❑Oil
Date � Inspector
� . � . �74. Overhead Hydro_ � .
' 75. Dry Chemical ' - •-
,� y , 76.� D�y Standpip`e � � `_ . '� 'r
'� �• . 77. FIXED SYSTEMtF_INAL`
' �l.
� �. x 78��FIRE PREV. FINAL � ,�
� I ' HEALTH�DEPT.REQUIREMENT
�_. ; .:.79. FINAL IN$PECTION � "
I �� �� SO.�FOOD CERTIFICATE ISSUED +
Notes: �
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., . . ;
� �,
' C '
� .
� ;
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I �-
' I I
. � � �. :
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�
OwNER STATE-WIDE Developers, Inc. DATE 4-28-76
JOB ADDR
GENERAI�
AP No. `(�
I 'C71(
so��
ROUGH PWMBING
P0.0P. SWF. LINE � HOUSE CON.
SPfiINKLING SVSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONOITIONING
UNOERGROUNO U POWEF
ROUGH WIRING
BONO BEAM U STEEL REI
SHEHTHING
FRAME AND FLASHING
LATHING — IN OUT
PLASTER.BROWN COAT
N iG, VENT.,
PLUMBING, FINAI
ELECTRIC, FINqL
BIIILDING, FINAL
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY�DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Fo� ApplicaM ro Fill in Completety
no�oa°es"s 3420 Meadow Brook
OWNER State-Wide Developers, Inc.
;;' AFSS 9461 6rindlay
GTY �,y�
CON5TRULTION
LENDER
BRANCH
ADDFESS
ARCHITECT
coNTancroa Stdt2-Wld2 DEVC1
AooREss 9461 Grindlay
arv Cypress
STATE
uc. No. 22471 �
OFEOT 12.093 acres �
USE OF
EXISTING BLDG.
SIZE OF NO. OF
OF
No`826-455�
Inc.
rTio.`' 826-4550
CITV
IIC. N�.
NO. OF BLDGS.
NOW ON l0T O
ROOF
COVERING Shake
R TO BE PEHFORMED
'4GY'13-76vair,00 753+� *_��`
�, s: 224.C�o
APPLICATION FOR BUIIDING PERMIT
FiECEIVED BV DATE PECEIVED ppTF ISSUFo .
6UILDING .�/1Z a
ADDRESS •-�`"�
APPpOVED
VALVE
OA
)NE NO.Of USE OF NEW
�QZ CY Pw� Z BUILDING �
VARDSAPPROVED VARDSAI
MAIN BUILDING .ACCESSQR�
ROM C/L STREETI
OI5TANCE BET
APPROVED
BET. MAIN &
I herebY acknowledga that I heve reatl this applfcaHon antl state
that the above informaHon is correct end apree to comply with
ell laws regu�ating builtling construction, entl I shall not employ
eny person in viotation of Me workman'z compensation laws ot
the State of California. 1
I hereby certity ihat 1 am proparly licansetl as a contractor unGer 1 381 Sn. FT. J-534
the State ot California Business antl Professions Cotla, Divisicn 3, THE AMOUNT SHOWN UNDER V
Chapter 9, and thet such licenses are In full force end affect, or I THE PUFPOSE OF ESTABLiSHING A
am exempt from the provisions of the State of Califo nle Buslness VALVATION
antl Professions Cotle, Division 3, Chapter 9. �..� �
State-Wide Developers, nC. 3����w PEflMITFEE
Stgnature
Perm�ttee � —�� $� P�p,N CHECK
AuthorizeaApent Vice President TOTAIFEE
�
O
ON IS FOR �
FEE ONLV: �
��� N
�� � 7
m
E
�„ `o
LL