HomeMy WebLinkAbout3423 MEADOW BROOK - Building PermitsApplicant to iill in a11 spaces except those witnin heavY bortler Iines antl sign all approv�iale declarations. `
� CiTv.o� COSTA MESA ' CONSTRUCTION'PERMIT PER N !,� jT!R'ACT NO�y. ' � LOT NO. �UNIT NU: � ' ; • t 1 � ' r � ''`
'3`!��[��'`'cp.�w�Q� � 7,; + 8467 ,6%27/86 , 19''ii8 �TL
"'Project Addreis ' � � . X � S � a , � � , , ' - , . •
AppliCdnt�SMailingAddi255 � l��G, S , TYPEOFCONSTRUCTION NEW �ADD ALTERATION REPAIR ' ' - ' � �
� � • O CONVERSION. ❑ DEMOLISH O OTMER ' � ' � , � � - �
Owner'sName ��1�i/) E-Q . • .. Phone%Sy qz% i t �_. _ . _ _. _ A.P.#. _ . _ - � . _ _ �� _.A. Zone, �.'. .
i , DESCRIPTIONOF ORK/USEOFBLOG.' S�=���W�1�-
Address ��y2 ��%�i��L%W (��/C � ' �� �h%� � ' � S Main Buildin9: ~ ' Accessory Building; � I
' Arch/En � � � . � .E � i . ! i - . . Z
g. � ' LicenseNo. � � � TVPEO PERMIT GRADING FOUNDATION 7�aUC'TURAL T Front�, , , . , , p
� Add�¢55 � � � . ❑ TENANT ❑ ELECTRICAL� ❑ PLUMBING ❑ MECHANICAL i s qear • ' : � K `� ' r. '� � , { N
' Contractor'sNeme��f..l� `1Ky�—IG�i'CC � Phone-�.'..SX�/• � �'oTHea � ' � ; ' � ' ' 'p _ -- —. _ .. _ . .. .�. _
� ' ' � ' PROJECT DESCRIPTION � 5Q. FL , ' � ocCUPANCV � ' � C - 'Right " i ' �'- . , � ' "� N
Address (mailing) � � ' � . ' , ! ' , C'
_,� '� �/��^J• � ' CONSTRUCTIONTYPE � VALUATION.$ ��'�.0� g Left i G � � � � . � . , R
City License No. `�' / 201vE GRADING CU. VDS. ACRES - - - '
UCENSED CONTRACT00. OECLARATION � ' " - PIOg. R2f. # .� ' P3�ki0g R2q./P�Ovided � E
� I hereby affi�m ihat I am licensetl untler provisions Of Cbart¢r 9(commencing Remarks: ���� � � � Pldnniny NOt¢5: ' � � � � � � n
� witn:section ]000)�of Division 3 of tfie Business antl;Pwfessions Cotle, antl ' �' T
my lioenz¢ i5 in fa{y}otce antl eftect. ' , � • - - � � � " ' ' ; � . ' ' - �
U S � -' - � - S
Licen�e C�ass �� cense N�_-� � � . � _
Dare 17 5'q t � �� ';PLUMBING i FEES � � • � i
� WORKERS' COMPENSATION DECLARATION � . : ' ' � � -, , -� � - �ELECTRICAL �� � � � FEES �
I� hereby affirm tnat 1 nave a certiticate of consent to 5elf-ireure or a cerbticzte % ' Bar Sink '. � , ShowCrs ; � o � �
� s'�Uorkers' Compensation InSurance, br a'certitietl copy thereof (Section � , _ , .,. . � �
-<-�, lab. C.) � . , � . � eackflow Preventer Service Sink . . AuromaticWasherv . Trznsformer`� 15 50 KW �. � i
I vJiicy No. EI W �/ Q/ ' COTpany �� C (�y� � Backflow Irrigation � Sewer Ca � .,� � � ' � - ,: ' -� W + KW ; � �
�-T-r� , P - ConstructionPoleSub
�Certifietl copy �s hereby fumishetl. � � � . ' ' '
-Ee[if ietl is� �with the city B i ivision. ' Bathtubs � . ' � Sewer Connection � � Cookmg Unit , Meter ❑up to 100 amps' '
Date' �' ��� �� APPlicant�� IL�i � . . - ' . -
EXEMPTION FROM WORKERS' COMPENSATION DEC ARATION � Cld�ifi2�5 . - .$012� COII¢ct0l5 � � Di5hWd5h2� � ' M¢Le� ❑ov¢� 100 amp5 .
(This section neetl not be completetl if the pe�mit Is fo� one huntlretl ($100) o� , � �� ' � ' '' ,
less): ' , , , . . Dishwasher- � _ Solar Piping _ j " ' � � Dryers .�Gas '�Electric Sub Panel , ' ' �
I certiTy [hat in the pe�to�mance of the wo�k (o� wM1ich this �permR i5 i55uetl, I, ' - - �� ",'
shall'not employ any person in any manner so as to become subject to the • Drinkiog Fountains � Solar Tank • Fan � �. �� � Motors �0-i HP �1'/a- 8 '
Workers' Compensation Laws of Califomia. • . ,. _ '
Date - � Signature ' � FloorDraini - Swimming Pool�w/Spa � F.A.U.' ' �� InaSolai �9-15 HP �76-75+' '
NOTICE: If,ptte� making, this tlecldration, you.5houltl become subject to the _ ,_ __ . _. -
Wofkers' Comp¢nsation provisions of the Ldbo/ Cotle, you must tofthwith . FIOOf SinkS - ' UliOdl � Fixtuf¢5 �
mmpty with Such� p�ovisions o� this permit ihall be tleemetl revoketl. Micro'wave, -
� CONSTRUCTION,L'ENDING' AGENCV � - � ' I � '
Gas Service � Outlets Water Closet i Device Boxes Pole Li ht
I hereby a(firm'that�there is a construction lentling agency for the periormance . . : . 9
of the work for'which this permiG is issuetl (Section 3097 Civ. C.) ' � , , , ' - � . , . ,
Interceptors Water Heater � Outlets ' � Ran e
Lentler's Name i i 9
_ Lenaer'sAadress � �' � . 'KitchenSink.�. . _ .�WaterServicef __i_ Switches �- -- - • - -
� OWNER BUILOER DECLARATION � � Sign".'
I hereby affirm thaLl am exempt �from the Contractor's License Law; for tne � Lavatories . Auto-Wash • • Garba e Dis osal . ' '
followinq reason (Section 7031.5 Business antl Professional Cotle: Any 2ity or 9 P t Standing Sections ,
� county which requires a permit to construct, alter; improve; aemolish or repair ' p-Trap � � ' Laundr �Tra s � ' ' � �
i any structure, prior tolts issuance, also requires the applicant tor such permit �. � � Generetor �0-5 KW 05-15 KW Trash Compattor
to tile a Slqnetl statement that he/she is licensetl puisuant to the provisians ot ' i � �
Roof Drains �
the Contractor's License Law (Chapter 9(commenting with Section 7000) of ' i � � • '
.�Oivision 3 of the 011510255 antl Protess�ons�Cotle)-o�.that he/she is exempt - � � - ---- - - - - -- �- � -- - � �- � - � -
=from antl the ibasis tor the allegetl, ezemption. Any viola[ion of Section � 1' � . ' , �
.5' by any applitant tor a permit subjects tM1e applicant to a civil ' '
i .Ity of not more than five nuntlretl tlollars ($500). � , . ,
LJ I, as owner ot rthe property or my empioyees with wages as their sole ReinspBc[ion F¢e• $15 � �55ue Fee $ 3 ,
mmpensation, will Oo the work, antl the structure is not intentletl or otferetl Reinipection Fee $75 ' luue Fee ' $ 3
for sale (Sectiom 70a4,' 6usiness,antl �Professional Cotle:'The Contractor's - - � . ' MECHANICAI � FEES ' ' �
License I.aw tloes nol apply to an owner o( a property who builtls o� Improve5 ' . ,
tnereon, and who tloes such�work himsen/herself or through his or her own • � , � 'DEVELOPMENTSERVICESREQUIREMENTS: � . ! -
employees, provitletl that such improvements are not ihtentletl or offeretl tor BOiler � • Hood or Type I'❑ � _ . 7_
' sale:•If, nowevcr, the builtlin9 or improvement is sold within one year ot com- ' Canopy Type 11 '❑ 2oning Approved By DL' � Data ' L ��
� pletion,-the:owner wilY have tM1e burtlen o� provin9 he/She tlitl not build or im- � D�tt - Und2� G�Ound � � -
1° rove for the purpose oi sale). �� � � � , � ' Building Approved B; 'Date �/ 2
� �/�
��,I, as owner:oPthe. property, am exciusively contractin9 with licensetl con- Duct -Structural . � Refrig¢ration System ; '' ,Application Issued By ' �` � Dat �
[ractors to conit�uct the p�oject (Section 7044, Busine55 antl Professions Cotle: ' , '
' The'Cmtractor's License �aw does not apply.to'an owner of property who � Duct - Ventilating � � ��-100,000 BTU ❑100,000 BTU '� � " , � �: , SUM pgy F.FEES - �
builtls o�iimproves the�eon; antl wM10 contracts'tor su<hproj¢cts with a mn- � �- - , . � � ` �` ;�
tractor(s)picense pursuant to ihe ContractoNs License �aw). I am aware that - ' � BUILDWG PERMIT $, � �-+� SMIP ' $' ��
� proot of their Worke�'s'Compensation:insu�ance Shoultl be provitle0 to me. Exhdust$y5t2m ❑.Multiple❑ SystemRepair/Alteration ; . -� ;
.� � � � ' _.PERMIT � '
❑ I xm eicempt untler Section �B. & P. C: for this reason'" . Firepl/Fact. BIL-ICBO # ' ' Fire Dampers ' �. . f- ?LAN CHECK '$ ' i. �SSUANCE •� $' �'
" " • � PLUMeING ' $ , � - ±
Date� owner ' Heating System & Ducting ' Registers � 1 •• ' . ' � '- - � ' " ENERGV P'.C. ,$ ' �=
' ' ' ' - PLAN'CHECK �. 25/0 $ _
{ . I hereby ceitify�ttiat`I have,reatl this application antl state tnat the abo've ❑P100,OOOBTU �100,OOOBT .r ELECTRICAL - $, � � .GRADING - �$ � �'• ' '
intormation ¢ correct. I agree to comply with all city antl munty ortlinances ' " - . , ' .
antl'state laws rela to tiuiltl 9'construction, antl hereby autnorize repre- � - � -''� PLAN CHECK 50% $ ' MICROFILM � $�
. sentatives�of i ity _ en r upon' the aboJe-mentionetl property'tor � , ' -. • • � , : � , ' � �.
ins0ectiOn pur s - " ' p
t MECHANICAL $ TOTAL F'EE �$ �
Signature' Dat ��Z�_0_+�. ' - - � � '� � � . - - . � �,
1 , Reinspection Fee ��15 � � Issue Fee •i � $ 3 PLAN.CHECK - 25%� $ , � , � I
� Drivers' Lice se�oi 55 � ' . �
'_ ' ' -. _ . . . . .- . . . _ ..�_. .._ _.... .. _ ._ .. "' _ _".. .
CMF 0865-46,_rev. 10/84 White - Builtling; Canary - Applicani; Pink - Accountlng; Goltlenrotl - qssessor �
` ..
H
CONSTRUCTION AND PLANNING � POOL & SPA �� m
' f� Date Inspector Date Inspector
APPROVALS .Permit# -APPROVALS Permit# . .
_ �
1: Temporary Electrical�Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. � � , 53. Steel Reinforcement ' � ,
3. Electrical Conduit Utility-Undrgmd. 54. Forms , � � ��
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4'. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . �'
�
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5..Steel Reinforcement - ' ' 56. Rough Plumbing & Pressure Test �
. �
6. Electrical UFER Grnd. ' , 57. APPROVAL TO COVER-GUNITE •�
7. Footings . .� 58. Electrical Conduit-Undrgrnd. � m
8. Foundation .� , � - 59. Gas Pipe, � 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 & Flouse 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 � i'
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 OGas ❑Oil ,
23. Gas Pipe-Rough & Test 72, Underground Flush
� 2A. Roof Framing. . 73. Undergrnd.StorageTank OGas OOiI ���
25: Roof Sheathing . 74, Overhead Hydro � �
26: T-Bar Ceifing (Structural) & Monocoaf 75. Dry Cfiemical . . �
27. Frame and Fiashing - � � 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:'FinabPlumbing � � � �� � ; ,.'
�
39!�Water Service-Final � " � � �
40. Gas Service-Final � �": �-'� '-
'r.
41. Solar pomestio-Final - ��' � � �'.�. •. "'
-42. Backflow Preventer , i�,�, � - •� � .,= > � �%. �
.
�43. Backflow Irrigatiori - . � � ' "' '� �. � ' � �
' 44. Landscape Irrigation System �.. - � _'� - � '. . .
�45: Sound Attenuation �
. �� ' '�. � - ,
� 46. Handirap Regulations " . ' : - :°' � `,
47. FINAISTRUCTURE&BUILDING �' , � � � � !� �'
. _ , l,� : C,
48. Special Requirement5 Completed ' � , ,_ - �� ,
;�
� 49. Electric Release to.Edison �. � ` � � • ' � � - -- �
50. Gas Release to Southern California Gas Co '� ' ^,
,,
51. CERTIFICATE OF OCCUPANCY � - �
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AP�'ROVED
� CITY CO A MESA
PIANNING DEPT.
wuecr ro e�no. cat n0.
dY D���MM p�� lo `z7-k(v
DIRECfO! O� KANNINO
L i ✓ix�b .Po�!
N�o iPAfTE.QS r--
Mesa Building
iNESE PUkS MUST BE ON JOB �CT ALL T14CAE5
I AiMCE NO CHAN6g W(►f{OUT PRfOR qpPROVAFi
C� DEFf,
iiHE ;ISSUFNCE OR G{?qNTING OF A PERMq DR APPROVAi;
OF PCqyS HND SPECIFlCATIONS SHALL NOT BE COYSTRIIED,
TO BE A pERMIT FOR, OR qN AFPROVAL Of, ANY VIOVi710N
OF ANy pF THE PROYISIONS OF iHIS CODE NO PERMIT PR6e
SUhlIN6 70 C,IVE AUTHORITY TO VIOLATE OR CAYCEL iHE
�D�RSIINVS OF 7HiS CODE SHALL BE VALID, EXCEPT IN. SO
FAR IlS THE WORK OR USE WNICH IiAU7HORIZES IS LAWF,UL'
SKYLIGHT THROUGH
CATHEDRAL CEILING
,� .�
37 x�/b Bristolite
Skylight
I.C.B.o. 2469
2"x4" Curb
n
STRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE REQUIRED
FOR ELECTRICAL. PLUMBIN6, •
HEATING, VENTIIATING AND
REFRIGERATION WORK
��:�
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TNI3 NUiVii�ER h1UST ACCCi�%iFANY
^—� '—'S: tCTiGPd RE�L'ESTS
FOR BUILOINGS M�HEFE ?En50'�:S Afle TO 9E
E�FPL�YE0. �vE S�JGGES? THkT �iY�E: STAtE OP
CALIfOflNIA QIVISION OF I'ditL'STN!A! SAFETY
BE CONSUITE� FOR ACOITIUNAL
HEQUIHEMENTS.
Metal Flashing
& Waterproofing
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SKYLIGHT ADDITION FOR�
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VILLAGG CRE-EK HOlvf[01VNERS ASSOCIATION
Post Otficc C�ox 4708 '
Irvine, California 92716
(7l4) 250-1876
iNDE�1NIFICATION AND HOLD HARMLESS AGREEMENT
The undersigned hereby agrees to indemnity, defend and hold harmless
the Villa�e Creek Homeowners Association (and such other persons or
corporations as may be designated by the Association) ior any and all
obligations, loss, liability, darnages, claims, suits or demands of ernpJoyees,
agents and all other persons arising out of or incidental to the
addition ot a skylight in the roof
to m y property at 3423 Neadok� Brook
Costa A4esa, California. This shall be inclusive, but not limited to, injuries/ .
disabilities, death, incurred whi{e in, on, or about the subject premise oi
installation wor!<.
The undersigned hereby ac4<no�vledges that he, his assignee and future
buycrs of this unit are solely responsible for the above stated installation,
• ��ti,;�n inCludcs any future niciintenance. lf at any time this installation
causes damage to any part ol the abov� listed unit or damage to any
surrounding units, the ow ner o[ this unit will be solely responsible for all
costs to rcpafr.
The undersi�ned has selected a licensed contractor of his choice to provide
this installation.
The undersigned also aFrees to provide a copy o1 this agreement to any
assignee or future buVcr of lhi5 unit. SuUject Cu agreertient and witnessed
attest to all condi[ions herei.n, the Snstalla 'on is hereby approved.
KENNETH W. FOWLER ��E� � �J o✓
NAME (Print j ' IGNA1'URk
PfiYLLIS M. FOWLER
NAML iPrint
.
�, i
� -I L,. �C L � , � . , {� U-C�w,
SI NATURE
�. ��� �� �.
IYf1 T E
dreo�r��nue....
FROM THEREq���R���RING THE. CUHktGuun �, �,
!N SAID P�qryS qND SPEqFICqTlONS OR FROM
BUIlDING OPE(;µTIOFiS BE1NG Cq�1� �
IN VIOLqiIONOF TH1S COD, ���TING I
" OF iNEp� � OR Of ANI�C TH��NDFQ Wd��
_.._,_,��1� OTHER 080lNqry�
�'^--,�„�._
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PFOJEC7 AOOHESS: 3 4 z� MEADOW BROOK UNIT:
OWNEH'SNAME: VILI,AGE CREEK HOMEOWNERS
aooeess: ASSOCIATION
3429 TIN,BER LAKE •
CM VA 92626
pBCHIENGINEEB: CHESTER CARVILLE REG.NO.: CLB3OS
� RODflESS: '] 9 Z Z ARMOUR S T � uxiT:
S,D. CA 92111
PEFMITTEE: PHOGNIX ENTERPRISES INC, (213�)690-9559�
aoosess: 41T COMERCIAL WAY
LA HAHRA CA 90631
LICENSEO LONTflACTOfl DECIANATION: I here�y alfirm Ihal I am licensed untler isio o� Chap�er 9(commencinA w��h Seciion
7000� ol Division 3 0l ihe Business and Professians Code, and my license is i II rce effecl.
cirruc.: 5 g TTeuc.:376639 �
�: �Date: �� ' �SignaWre: — — — _ �
WOflREPS' COMPEIY� RTION UECIABATION: I here�y ailirm �ha� I ha e a certifica�e oi consem to seli-insure or a cenificat i Workers'
Compensation Insurance. or a certifietl copy ihereof (Section 3000. Lab. C).
voucv No.: W'10 0 3 5 4 EXP. DATE: 0�% � �/ 9 1
comvaNr: CA COMP 6 FIRE ' ///���
� Cenl�ie copy is he by li 's� Cenifietl copy is �iletl wit y Bui i Division. � //
� ��
�a�e: � ApDlicani'
E%EMPTION FBOM WONRENS' COMPENSPTION OECIAflPTION: (This seciion nee0 not be compleleA il�he Oermi� is for one hunaBe ($100) or less�.
I cetlily Ihat in the petlormance al Ihe work for which I�is permi� is issued, I shall not employ any person in any manner so as to become
sublecl lo t�e WorkeR' Compensation Laws o� Cablomia.
Daie'. - - Signa�ure: ' '
NOTICE: If, afler making �his Declara�ion, you should become sublect lo the Workers' Compensa[ion pmvisions af �be Lahor
Cotle. you mus� fort�wi�� comply wil� such pmvisions or Ihis permit shall be tleemed revaketl.
CONSTPUCTION LENOING pGENCY: 1 hereby af�irm tha� �here is a constmClian IenOing agenCy fof the performante oi �he work br
which Ihis permi� is issuea (Section 3097. Civ. C�.
LENOEfl:
li AODBESS: , ,
OWNEB BOILOEB OECLAPRTION: I �ereGy a��irm t�at I am eKempt fmm Ihe Conlraciors' State License Law for the following reason
�Semion 7031.5 Business and Pmlessional CoOe: Nny ciry of couniy w�ich requires a Dermi� m consimct, alter, impmve, Aemolish, ar
repair any slmcWre. prior Io its issuance. also requires Ihe applicani �ar such permii ta file a 5igne0 sta�emen� �hat helshe is licensetl
pursuam m �he pmvisions ol lhe Con(ractors' Siate License Law �Chapter 9(commencing wi�� Sec�ion 7000) o� �ivision 9 0� Ihe Business
antl Pm�essons Code� or that helshe is exempt there�mm antl Ihe basis lor ihe alleged exemption Any Nolaiion of Sec�ion 7031.5 by
any applican� �ar a permi� sublec�s the applicant �o a civil penalry oi noi more �han five huntlre0 dollars ($500). . �
I, as owner of �he pmpetly ar my employees wi�h wages as their sole compensa�ion, will tlo lhe woB, antl lhe
❑ simclure is not intenaetl ar oneretl �or sale (Section 7044, Business antl Pm�essional Cotle'. The ConVac�ors' Sia�e License Law
does not appty to an owner o� a pmperty who builds or improves �herean, antl who �oes such work �imsel�/hersel� ar Ihmugh
his or her own employees. pmvitlea thai such impmvemenis are no� in�ende0 or oflered for sale. If, however the building or
imD�o�ement is sola wit�in one year of completion. ihe owner will have Ihe hurAen oi proving he/she tlid no� �uiltl or improve
�or ��e purpose ol sale�.
I. as owner Ol lhe prope�y. am exclu5ively ConVatling wilh IiCenSeO cOnlfat�ors Io tOnslmt� �he pmle�� ISet�ion 7044, BusinEss
❑ an0 Pmfessions Cotle: The Coniramors' Siate License Law tloes not aDPty lo an owner oi OroDenY who builtls or impmves thereon
and who conVac�s lor such projecis wiih a conVac�or(s) license pursuanl �o Ihe Caniractors' Slaie License Law), I am aware
�ha� pmo� o� their WoBer'S Compensa�ian insurance shoWd be pmvitletl to me.
� I am exemp� untler Seciion: 8. 8 P. C.
lor Ihis reason'. . '
Da�e- Owner
I tlo hereby ceniry Ihai I am aware o� antl untlerstantl Ihe requiremems ol Calilomia Heal�h and Safety Cotle Sections 25505, 25533, an0
25534 anA Ihat I ar any Imure builtling occupant willlwill no� (circle one) nee0 b comply wilh said slate codes an0 �he reQuiremems br a
permil lor cansVuction or moadicalian Imm �he Air Ouality Management DisVicL Resideniial conslmciian apPlica�ians are exempl irom
ihese pwuisioni _
Daie: Avplicam:
I nere�y ceridy ihal I have reatl Ihis appbcalion antl 5�ale Ihal lhe a�ove
artlmances and slate laws relating to Duiitlmg conslmction and ltere�y anih
pm0erly lor in50 lian urpas
1</ �
Oale-. _{� � � SignaWre: _
�river's' icense or Social Secum�a:
correcL I agree to co wilh all ci�y and
iliveso7�hiscilyio r poniheabove-me
i64L46 White—Bmltlmg; Green—Gatle EnlorcemenC Canary—Applicam; Pink—Revenue: Goltlenrotl—Assessor
CITY OF COSTA MES� — BUILDING PERMIT PERM NO: H 050591
FEAMIT NO: B 050591 PLAN CAECK NO; 001�0-91 A � GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N' � PERMIT TYPE; STR PURPOSE: REP
JOH DESCRIPTION : REPAIR SETYZEMENT DAMAGE SQ FT: 143
CLATM VALUE: 14,300.00 CALC—VALUE: 14,300.00 GROUP OCC: R-3 /.
COMMENTS: BUILDING SETTLEMENT REPAIR/FOUNDATION �
***�t*****x***�tx*******�t********+��*�***�t*******�t*�r�r�r�a�*u*u�*f�****�**�tx*****�*at�r�r�
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 .
--�---------- MAIN BUILDING ------- -- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR; ' FT IN FRNT: FT SN REAR: FT IN
LEFT; FT IN RGiiT: FT I13 LEFT: FT IN RGHT; FT IN
PARKING REp • PROV: FARCEL: 93506124 ZNE; R2 REF NOc
'PLANNING NiSTES> FOUNDATION FtEPAIR.
. � � . . . . . _ _ . .
IE 1E iE if if 1E iE 3E iF-1F 3f-!F iE iE iF iE if �IE iE iE iF if 1f -7E if I6 iF 3f ih !E iE �lf 3F 1E iE �1E 1E iE it 1E if iE iE iElE iE lE iE fE iF if iF if iE iE 3E iE IE iF # iE iF iF 3f iF if 1E iF 3f,�1E �t lE if iF N� 3f )f �lE if
D E V E L O P M E N T S E R V I C E S R E Q U Z R E M E N T S
ZONING APPROVED BY �-i ��—• —�}�— — , DATc,; 07/.S``i /
• � :
HUILDING APPROVED HY ;' (�,( i DATE;�
4�r .
APPLICATION ISSUED BY; DATE.:
if aE aE iE iE iE if lE �f iE it 3f if iF IElf �f iF If jF 1F iF C� � .. . . . 7E iE i4 iE if K if IE iE i4���{(� jf
3FaFlEiFif�flfifiEifklFlEiFiFiEiEiEif3EiFiEitlF#ififlf�E1E1F� � iE�f�FiEiFiE3fiE1FiF�ElFifiFiFifiFif9EiEifi(��f�iEiE-IElEiE3Fif�EiElflfiffF3FlElf�lEaf3E3E
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING EL'CTRIC MECAANIC FIRE SMIP/AE5 GRADING
PERMIT 162,00 1,00
PLAN 26.33 SMIP/NON—RES
ISSUE FEE ' ' '
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK ' TOTAL PAID DUE
TOTALS----> 163.00 0.00 26,33 189.33 189.33 .00
REVENUE DIVISION TOTALS-->' COLLECTED: 189,33 OVER/SAORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
162.00 1.00 . 26,33
if 1F iE iF If iF iF if iE iF iE )f !E 3F af aF iF iE jf �E iF iF �1f if IE 1E if 3E �1F iF lf %if 3f * 3F If 1f 3f jF 1f iF ik ik 3F IF ik if i£ If iF �f !E iElF �F 3F # iE !E K� iF iF jE jF 3F i4 iE 7E if )E iF iE �E 4 3f �1ElF 3E
I N D I V I D U A L F E E H 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 STRUCTURAL HY VALUE PER 5100,00 100,00 14,300,00
END OF FEES
� �? i14C7s753—ailC3'r's?55 �"C3�'
t1p1'E: 01133/r1 iTf1E: 1':44
CONSTRUCTION AND PLANNING PwL & SPA
APPROVALS Permit # � Date Inspector qppROVALS Permit # Date Inspector
f
1. Temporary Electrical Service or Pole: �� � 52. Pool & Equipment Location `�
.i
2. Soil Pipe•Undrgrnd. �' � . 53. Steel ReinforCement
3. Electrical Conduit Utility-Undrgmd. ,- � 54. Forms !
�� 4: Electrical Conduit-Undrgrnd!, ��'- 55. Electrical Bonding .�
' 5. Steel Reinforcement, 56. Rough Plumbing & Pressure Test
�: 6.- Electrical UFER Gmd. y 57. APPROVAL TO COVER�GUNITE �
' 7,. Footings - ' 58. Electrical Conduit-Undrgrnd.
� 8. Foundation � , 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. i�. -�l 60. Backwash Lines, P-Trap, � Undrgrnd. t�!�
10. Structural Floor System �� _ rj �� 61. APPROVAL TO DECK 4 I � A
:-->
11. Property Sewer•Line &,Houie�Conne�tion %' 62. Backwash & Receptor-Final -
_ : �-
7�2. Sewer Cap .,_ . �i . - ' 63. Heater & Vent-Final "i
13. Roof Drains - �_ i �� 64. Plumbing System � Final � ft
14. Rough Plumbing �,�` ��.'� 65. Electrical-Final ✓,��
15. Rough Electrical-Condu� ., '� ,�i �/'' �/'�
� ,� � 66. Solar System•Final i
16. Rou h Electric Wirin ��� , '� �
9 9 (,/ �? 67. Fencing & Access ApProval �
17. Rough Wiring Sign '� �� 68. APPROVED FOR PLASTERING /
18. Rough Electrica.l,-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Neatin9 & Air Conditioning � � - FIRE DEPT. REQUIREMENT
20. Rough Factory Fi}eplace ;,i � - � • APPROVALS�,� � Perinit # ,
21. Ducts, in�Structure . � _ � - 70. Underground:Hydro
22. Ducts, Ventilating. � ' � . �'' ^ 77, Product Piping O Gas ❑ Oil
23.� Gas Pi e=Rou9h & T,est L' _ . , ' - ' '
� P . 72. Underground Flush;,�
24. Roof Framing - •� ' ' = - ' `73:' Undergrnd'Storage�Tank � Gas ❑ Oil
25. Roof Sheathing - . '; � j . - � �7q."Overhead Hydro� � .
26. T-Bar Ceiling (Structuraq & Monocoat _' • = �-•�- • 75. Dry Chemical = ' � �
i
27. ,Frame and flashiqg. ' . - j_ . , 76.+D'ry Standpipe J . ' - �.
28. Lathing & Siding' '• . .-y : �, •: � . � ; ; 77, FIXED SYSTEM;FINAL' .,
`29. Insulation ". . ,� � " - � � � I f . � 78.. FIRE PFiEV. FINAL •c
.�30. Drywall.Nailfng ' - � � ! ; HEALTH'DEPT: REQUIREMENT
i
�31. Plaster Brown Coat, .., � , I I ��_ .;, ,79� �FINAL INSPECTION . ' '
. 32. Electrical Power Meter-Final • -. � � {- s�80. FOOD CERTIFICATE ISSUED -
,
33. Final ElectriG � ; - � " j Notes: ' ' , , ',
;,34. Finaf Heating & 9ir Conditioning, � � � � -- `� - -� • �
�' /i t. n ii - � /
35. FinalGar�Pipe-Test;._'= , ; ' �I ; ; ����� / � �/
36. Hood orCanopy�'- . • ' . -. - � + - � � ` ' , � /
i
37. Final Faaory Fireplace ; ' ` ' { ' ; ' �` ' -
�
38. Final.Plumbing .�r �: � . � � . .. `� i . . : ,
39. Water Service-Final' • ' � ' �' • • '
�t > . y
- 40. Gas Service-F�nal � � • " . .. � i �- ' _ . , -
41. Solar pomestirFinal ' ' - � � � - �
i I i, - .
42. Backflow Preventer� �. .. I � f . � - .� ' •
43. Backf�ow Irr�gation ��� y i ` �- - �
:t' _
44. Landscape Irrigation System - . ' � f , . .. � .
45..Sound Attenuatiorc - , � "
-'46. Flandicap Regulatlons - . � �• , � . _ � _,_ .
47. FINAL STRUCTURE & BUILDING 0J- - -
48. FINAL PLANNING. � , - . 'r,
49. 'Electric Release to Edison �
-i '
50. Gas Release to Soufhem Califomia Gas Co � j `. ,. �.
51. CERTIFICATE Of�OCCUPANCY � -, ,. - .. ,
No Date
OWNER
ROUGH PLUmBIFG
PROP. SWR. LINE n HOUSE CON.
MISCELLANEOUS
ROUGH NEATING AND PIR CONOITIONING
UNDERGROUND U POWER
POUGH WIRING _
BONO BEAM U STEEL REINFORCE
SHEATHING
FR/ME AND FLASHeI�NG/
LATHING - IN r�! OUT
PLA`--F,BROWN COAT
STI ftAL, FINAL
HEAIirvG, VENT., REFfiIG.
BUIL01
FINA
FINAL
Inc. DATE 4_Z8_
BUILDING
( �0s.
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
�hY 13-?5cns��� 766e. �:t:�LS�.z�
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BV DATE RECE�VEO DA E IS
BUILDING �
ADDRESS B
/Z- //-a�jM ,. P.ERMIQ'��(�r]
OWNER State-Wide Developers, IIIC. A.P.NO. ¢O"-O$� o. �i �Je�7
ADDRESS94E%� 6rindlay BUILDING p �
MAIL AODRESS 3�iZ3 �piJ.13��a�
CIT�' Cypress No`�826=4660 TRACT ��� LOT BLOCK.
CANSTRUC710�`1 W A�
LENDER
BRANCH
OWNER
ADDRESS VALUE '�
°'.oA��� P i NE` 956-6610 $
AooREssl7848 SkyPark Blvd Irvine ZONE TVPE GROUP �
APPROVEO
CONTqACTORStatC�W�CIe DeVE�OPC�I'S� Inc. ar DATE
AooREss9461 Grindlay
TEL, ZONE P�� Z gUILDING Ew�� �
�,T� Cypress No. 826-4550 2�'P
LIC. NO. 2247� O CITV YARDS APPROVED YARDS APPRO D
LIC. NO. MAIN BUILDING ACCESSORY BVILDING
SI2E NO.OF BLDGS. (FROM C/L STREET)
OF LOT � Z,093 acres NOW ON LOT � FRONT FT. FT.
USE OF
EXISTING BLDG. T. FT
SIZE OF NO. OF
NEWBLDG. ROOMS STOFIES L.SIDE FT. FT.
COVEERINGALL Pla ter COVERING Shake RE�+R 3 FT FT.
USE OF BUILDIN WOFiK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDCS.
New construction-Condominiums C.0 P#��� - � qppqOVED ��5��
1 Residence w/att gar A�rRo�Eo � ,ZZ_�6
HOLD FOR E�?AL REQUIREMENTS
I heraby acknowletlga thet I �eve reatl this application antl state
that the above information is wrtact and aB�ee to comply witfi �1
ell laws regulating builtli�B �onstruction, antl I shall �ot employ
eny person in violation of the workman's compenseT�on laws of
the Stete of Calitornie. l0
I heraby cartify that I am properly Iicensatl as a contracior untlar sn. FT. -645 O
the State of Californ(a Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN UN�ER VALUATION IS FOR
m
Chapter 9, and that such licenses era in full force and etfect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: Q
am exempt from the prov(sions of the Stete of Cali rnia Businass
VALUATION
enC Professioos Cotle, Division 3, Cnepier 9. � � N
�� PERMIT FEE $ ♦ �
s�e�„�,a tate-Wide Develop , Inc. .3 ,O m
Permittee ._�� $'�.� PL,qN CHECK $ � E
AuthorizedAgent Vice President �
LL
TOTAL FEE $ �SO