HomeMy WebLinkAbout3432 MEADOW BROOK - Building Permits�_ _ _ ' ADP���ant to fill in all spaces excepl those wit�in heavy barEer lines anE si9n all approptiate tleclara[ions.
_ " ' _ - - . _. .f . . . . .
CITY OF cOSTn MESa CONSTRUCTION,PERMIT ' PERMIT NO.. � TRACT NO. LOT, NO. UNIT NO. I 93$ I I/OBIB4 ., 8.00 ' TL�
_ ` c .
ProlectAddress �il13� ��i�iiDl]CfX_�"i�t�00�C� - C.� ' ' ' . - ' .
Applicant'sMailingAddress ����b °�(Y�nn�.�+�� TYPEOFCONSTRUCTION � rvEw ADD. ALTERATION REPAIR �
, S. 2 . "`n�j ��� p�pne - ❑ CONVERSION ❑ DEMOLISH O HER_ ' q,p,# r ' ' � � � ZonB
Owner'sName��+�� �'+��tt DESCRIPTIONOFWORK/USEOF�BLDG. �
Address �'�+s.���`� '�R �� �' � ' . ' ' ' ' '- ; . _ . � : S Main Building:� - Accessory.Bwiding: " Z
Areh/Eng.' License No. � TVPE OF PERMIT ❑ GRADING� �FOUNDATION STRUCTURAL - T Front - " - �- O .
Address � � - - ❑ OTHERT �LECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear . ` - " ' ' > � ' y N
� 1
Contracror'sName � Phone - � - - C Right ' � � - i ' N
. �'_ . PROJECT DESCRIPTION; 5Q. FT. -� � oCCUaArvCv K G
Address�mailing) _ � CONSTRUCTIONTVPE rVAWATION$ ' S Left � - • . � . � ` � � � � . R
City LiCenS¢ NO. - I � ZONE � GRADING CU. VDS. ' ACRES i ' E�
UCENSED CONTRACTOR DECLARATION ' ' - Plny. R¢i. # • Pd�king RCq./P�Ovid¢d '
Q
I hereby,alfirm tha[ I am litensetl untler provi5ion5 of.Gharter 9(commencing Remarks: ; . � ' . . Pl3nnlOy NOtES: � � � M
with section ]000) of Division 3' of the Bu5ine55 antl Prof¢SSions Cotle, antl ' ` T
my license is in full �orce antl'effect. • , ' � , � � � � . ' � ' � -
�icen��g �Class� C- ' - Li se 3����� ' ' � � '' . ,
S.
,:�ate�i2— Signature • - , � ' PLUMBING � � FEES � � - �
„�u�RKERS'COMPENSATION DECLARAT.ION BarSink � Showers � � � ' ELECTRICAL � FEES
;y-7ereby affirm that I have a certiflcate ot consent to self-insure o� a certificate � '
""of Workers' Compensztion Insurance,'or�a certifietl mpy thereof (Sectlon' - � gackflowPreventer " " - 'ServiceSink ' ' ' � — � — - � --
3Boo, Lab. C.) � � �p i Aummatic Washer - . Transformer ❑-15-50 KW -• �
Poliry Not�cP` c�o1Qq�..,� CompanJ�4(17� p('t�4\:CR.C� gackflowlrrigation • SewerCa ' ' � . ❑ 50+KW '
(17c p Construction Pole Sub.
Certifietl capy is bereby furnishetl. ' � , � ' i
Certifietl copy is filetl with the city Builtling cpw''isi � Bathtubs � ' Sewer Connection Cooking Unit � � Meter ❑up to 100 amps ��
ate APPlicant - z .� -� . � � .
��EXEMPTION FROM WORKERS' COMPENSATION DECLARA710N Cld�l(iC�S SOId� COIICCLO�S �� Di5hwB5hCf � M2[C� ❑over.100 amps
(Thissection neetl not be completetl if the permit is for one huntlrEtl ($100) or Di5hWa5h¢f i '
less). � � . , � Solar Piping. ' ' Dryers• �Gas ❑Electric i Sub�panel •
I certify �tha[ in the pertormance of tM1e work tor which thi5 Oerm�t is i55uetl, I , ' ,
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank ' � Fan .' � Motors �0-7 HP �1 h'8
Worke�s' Compensation Laws of California. � � , _
Date ' ' Signature ' • � Floor Drains � � Swimming Pool w/Spa � F.A.U. IncSolar �9-15 HP �16-15+ �
NOTICE: It, after makinq this tleclaration, you snoultl become subject to the • _
Workers'� Compensation provisions-ot�the-Labor Cotle, you must forthwith FloorSinkS - Urinal - � � • �Fixtures - - - -- - :Microwave-- -� � ' -
comply with Such provisions� or„thi5 permit shall be•tleemetl revoketl.
CONSTRUCTION LENDING AGENCV � � � G25S¢NiC¢ ' :Outlets� .Water Closet � Device Boxes Pole Light
I he�eby affirm that there i5 a mn5tru[tion lentling agency for the pertormdnce
of th¢ work for which, thi5 permit is' i55uetl ,(Section 3097 Civ. .CJ � - ', J �
L.entler's Name - '- ' - Interceptors __ ' Water Heater ' Outlets Range � �
Lentler's AGtlress - � Kitchen Sink - Water Service Switches Sign '
OWNER BUILDER DECLARATION �� `- � " � � � , . .
I hereby atfirm that I am exempt irom the ConVactoYs� Cicense Law for,the Lavatories - ' � Garbage Dispasal ' Standing Sections
following reason (Section �031.5 Bu5ine55 antl Profe55ional Cotle: Any city or
county which requires a permit [o construct, alier, improve, tlemolish or repalr P-Trap ' � • ''
any structure, prior to its.issuance, also requires.me applicant for such permit Generator �0-5 KW OS-15 KW Trash Compactor
�� b tile a siqnetl,statement that he/she is licensetl pu�suant to the provisions of RoOf D�di05 ' �
;�„`.�e Contractor's License Law (Chapter 9(commencing with Section 7000) of ' ^
��";ivisiOn 3 of the�. Bu5ine55'antl Professions CoOe)_o� that he/zhe is exempt _ _ . .
"':`�'nerebom'antl -the basis for the alleged ezemption. Any violation of Section " - - , � .
� 7031.5 by� any� applican[ for a pe�mit Subjects the applicant to a[ivil � - ' .
,� enalty of nol more than five M1untlretl dollars ($500). " , �
I, as owner of the property o� my�employees with wage5 as their sole �•Reinspectian_Fee • i$15 i � Issue Fae4 , $ 3 , ,
compensa[ion, will tlo the work,'antl the structure is not intentletl or offeretl � Reinspection Fae , $15 Issue Fea ' $ 3
(or sale (Section,7044, Business anC Professional Cotle: The Contractor's , ' MECHANICAL FEES I
LicenSe Law tloes not apply to an owner of a property wM10 builtls or improves - .
thereon; antl who tloes such work himself/herself or tnrough his or her own . - � DEVELOPMENT SERVICES REQUIREMENTS:
employ¢es, provitletl that such improvements ale not intentletl or otteretl tor . BOi12Y ' ' � HOOd OI Typ¢ 1' ❑ ' ' �
Sale. It, howeveq lhe builtling�cr imp�ovement is soltl within one yea� of com- � Cd00py TypC II ❑ ZOlfing Appmv¢d By DatB �
pletion, the owner will have tne burtlen of proving he/she tlitl not builtl or im- Duct - Unde! Ground • - Building Approved By' Date
prova for the purpose ot sale). � , . �
❑ 1, as owner of the proDerty, am exUusively contracting with licensetl con- Duct -$tructural ' � Reffigeration System Applicatian ISSued 8y Dat��
[ractors to wnstruct the project (Section 7044, Business antl Professions Cotle: , . �—
The Contrac[or's License L.aw does not appry to an owner of.pronerty who Duct � Ventilating „ ❑0.700000 BTU ��100,000 BSU ' SUMMARV F FEES
builtls or imOroves thereon, antl who cont�acts for such projects wrtFi a con- � - _ -
tractor(sl license pursuant to the Contractor's License Law). I am aware tnat ' BUILDING PERMIT $ $MIP ' �$
praof of their Worker's Compensation insurance shoultl be provitletl to me. Exhaust System ❑ Multiple ❑ System Repair/Alterati0n ,
PLAN CHECK $ PERMIT
❑ I am exempt untler 5ection e. & P. C. for this reason . Firepl/Fact. BIt ICBO # PLUMBING ' $ � . ISSUANCE $
Oate Owner � • � � - Heating System & Ducting � ' PLAN CHECK 25% $ � ENERGV. P.C.- $
i hereby certify that-i have read tnis application and state that the above' '� ❑0-t00,0006TU �t00;000BT `', - � � ELECTRICAL . $�� GRADING $ �
informabon Is correct. I agree to comply wi[h all tlty antl county ortlinances l ' �
antl state Iaws relating to building construction, antl hereby authorize repre- , � PLAN CHECK 50% $ MICROFILM $
sentative f this city� to e r up the above-mentionetl property � for � � . �
� MECHANICAL $ TOTAL FEE $ _ �.,_��
inspectio ose � '. '
Si9nature ��� , ti � Date� Reins ec[ion Fee $75 lesue Fee ' • $ 3 PLAN CHECK 25% $
Drive�s' I' SS dk P
CMF 0865-46, rev.4/84 White - Builtling; Canary - Applicant; Pink - Accountinq; Goltlenrotl -Assessor
�
Applicant to fili in all soaces witnin neavy boraer lines
CITM OF COSTA�MESA -� PERM T NO. � � TRACT N
` �CONSTRUCTION PERMIT �- (�g�c �
alt apOrop�iate tleclarations.
LOT NO. � � � BLDG. NO.
� Pro]ect Atldres 3Z -� " TVPE OF CONSTRUCTION �
Own2� - "f ' -- PhonE ' ❑ NEW ❑ AOD ❑ ALTERATION
Addre55 �Z � — ❑ REPAIR ❑ CONVERSION' �DEMOLISH
4Arch/Eng�� ' ' ' ' LiCense No. " � � OTHER � �
AddrEsi ' � - - - . . DESCRIPTION OF WORK
Contractor � Phon�sFq�,Yp TVP,EOFPERMI7� - � . - � '
Addfe55 'Z p L� DvG�G ' ❑ GRADING �❑ FOUNDATION" -❑ STRUCTURAL
LICENSED CONTRHCTOR' �ECLARATI N � � -� ❑�TENANT ❑ EL'ECTRICAL OPLUMBING ❑MECHAN
I hereby atfirm that I am licensetl untler provisions of Charter 9(com-
menNng' with sectlon' 7000) of Division 3 of 'tne Business antl ❑ OTHER -
Professions Cotle, aprl my Iicense is In full force ana efiect. pROJECT�DESCRIPTION � .- . .
License Class �_� Lice se o.��7� .
Date Q� Z� � Signature � � - � SQ. FT. - _ .
WORKERS'COMPENSATION'DECLARATION ' -OCCUPANCV_CONSTRVCTIONTVPE
I hereby affirm that I �ave a tertificate of consent to self-insure or a VALUATION� 20NE -
certifiCdtC�Of Wo�k¢�5"Comp¢n5ation InSurance,br a certifietl copy -
thereof (Section 3800, Lab. C.). GRADING CU.�VDS. ACRES
Y No. -. . . . ComPanY �. . . . . . _. . _ . .
ertifietl copy iz h¢r¢by fumishetl. --- •- •� � • REMARKS:�- `
�Certifietl cOpy is tiletl with th¢ city Builtling Division.
E%EMPTION FROM WORKERS' COMPENSATION DECLARATtON ' - '� ' - "'
(This s¢Ction nee0 not be completetl if the�permi[ is for one huntlretl ... __ _. .. �. ._ .
($100) or leu). � '
I certify that in ihe�pe�tormance oLthe work for which thi5.permit i5 .
Issuetl, I shall not empl0y any pe�son In any manner so as to become PLUMBING- ' � PLAN CHECK
5ubject to the Workers' Compensation Laws of California. . _
Date Signature BATHTUBS � SHOWERS
NOTICE: It atier making this tleclaration, you shoultl become subject TOILETS �. URINALS �
to the Worker5' Compen5ation provi5ion5 of tne Labor Code, you must .
forthwith comply with suth p�ovi5ions or this perrtlit shall be tleemed LAVATORIE$ DOUBLE LAVS ��
rewk¢tl. - � - � - ' " � KIT.SINKS ��DISHWHSHER$
CONSTRUGTION LENDING AGENCV
I be�eby affirm that th¢re is a COnst�uction lentling agenty for the per- SERVICE SINKS ' SUMPS � � �
formance of tne work for which this permil is Issuetl (Section 3097
Civ. C.). -� ' � � FLOOR SINKS FLOOR DRAINS
Lentler's Name
Lentler'S Atltlres5 DRINKING FOUNTAINS �
OWNER BUILDER DEGLARATION �- � - INTERCEPTORS CLARIFIERS
I nereby affirm that I am exempt fromihe Contrattor's License Law for �
the Pollowinq-reason'(Settion ]031.5 Business antl Professions Cotle: SWIMMINGPOOL P�TRAP ' '�
Any city or county wM1icM1 �equires a permit to con5truct, alteq
Imp�ove, tlemolish or r¢pair any struttu�2. Prio� lo its issuance, al5o re- yyqTER SERV ICE ALTERATION
quires the applicant for such permlt to file a signetl statement that he
is liGensetl'pur5uant to the�pvovisions of the Con[raCtor'S License Law GASSERVICE OUTLETS
(Chapter 9[tommencinq with Section 7000) of Division 3 of the "� "
B���fiess antl Prdessions Cotle) or [hat he is exempt thereirom antl the yyqTER HEATERS � BTU OUTPUT
for [he allegetl exemption. Any violation of Section 7031.5 by
pplicant fo�/a pe�mit subjects the applicdn[ to a'pivil penalty SEWERCONNECTIONS -
,t more than five huntlretl dollars ($500).
[� I, as owner of [he property, or my ¢mploye¢s with wages as their $O�AR TANK � � COLLECTOR$
sole compensation, will tlo the work, antl the st�uctu�e iz not intentletl _,
o� otfe�etl fo� sale. (Section 7044, Business antl Aofe55ion5 Cotle: The $OLAR PIPING SVS.
ContractoYs License Law-tloes noY apply to an owner of a property. , _ _ .
wM10 builtls or Improves thereon, antl wM10 tloes sucM1 wnrk M1imself or ISSVE FEE
[hrough his own employees, provitletl tha[ sucn improvements a�e not
intenaetl or otieretl tor sale. If, however, the builtling or improvement MECHANICAL PLAN CHECK
�is soltl within one year of complefion, Ihe owner will have the bu�tlen
of proving ne tlitl not builtl or improve for the purpose of sale). HEATING SVSTEM .0-100,000 BTU
� I, as owner of tM1e property, am exclusively con[racting with AND OUCTING '
` licenietl con[raclors [o construCl the project (Section �044, Business 100,000 + BTU
��antl Professions Cotle: The Contractor'S Llcense�Law tloes not apply to
an owne� of property who builtls o� improves the�eon, antl who con- REFRIGERATION 0-300,000 BTU
e tracts from such projects with a contractor�s) licesnetl pursuant to SYSTEM " '� ' `
�[he Contractor'S License �aw). 300,000 + BTU
❑ I am ezempt unCer Section B. & P. C. for ihis
/^ _ BOILERS BTU
'\ reason '
Oi Date ' - Owner SYSTEMftEPAIR,ALTERATION
that I have reatl lhis appliGation
Correct. I agr2e to compty H
n[er upon
antl state ihat tne above EXHAUST SVSTEM MULTIPLE
��.th all City anG county - �
�n, and hereby authorize �
the abov�e7 me tloned
Si9nature ��.-771, 1 Date D Z
Drivers' License or 55 � ' ' i55V E FEE -�
CMF 0865-46 White-Builtling; Canary-APPlicant: Pink-Accountin9: Goltlenrotl-Assessor
`y .
r
'_' ' "_ 'j�t�'. �' ``���".fi.�� �
, ZONING REGULATIONS
�A.P.# ' �,-i� . � .
ZONE PLNTGp. REF. � -
SETBACKC l_5 . PROPEIRTVNLINE
SIDE YARO - _
A �5 IDE VA - - - -
RIGHT
. REAR VARD (TO P/L)
PKG.SPACE REp. .PROVIDED
STREET WIDTH � PARK FEE $
ZONINGAPPROVEDBV DATE
SPECIAL CONDITIONS:
1
8.00 TL
GENERATOR - 0-1 KW=�1-10 KW
TRANSFORMER �
APPLIANCE 10-SOKW_50'+KW '
MOTORS ' 0-1 HP_1-10 HP� ' _, -
(INC.SOLAR) 10-50HP=50+HP �
FIXTURES OIITLETS' SWITCHES ' "
GP.S TUBE SIGNS- " " " ' '
POLE LIGHTS '- ' ' ' ' " " '
PANEL$ - MAIN SUB .
SERVICE ' '- """ ' "� AMP' r' -
����� _ _ . .. �- rT:.—
'APPLICATION APPROV ED BY ' DATE
SUMMARY OF FEES , �
BUILDING' - � -
�PERMIT $ . . . SMIP' , .'_$ � -
PLAN CHECK S PERMIT . � ��
� � � ISSUANCE $
�PLUMBING S GRADING E �
PLAN CHECK $�� � � � �
O• ' .. $.
ELECTRICAL $
PLAN CHECK $ _MICROFILM E -
MECHANICAL $ ` � TOTAL FEE $
LESS AD- '
PLANCHECK E" VANCE'PC 1_� '
, � ^V' '
. 6 • � �
, .. FINAL FEE S -
CONSTRUCTIONANDPLANNING POOL&SPA � �� - � � �- ,
Date • Inspector � - = � - � Date � Inspector
APPROVALS Permit # , APPROVALS - � Permit # �
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location� �--� - � - �- �
Soi ipe-Undrgrn •- � ' � 44. Steel Reinforcement � - " �
, 3. Electrical Condwt Utility-Undrgrn 45. Forms � - ' �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding - '
. tee ein orce � ,. 47. Rough Plumbin & Pressure Test
6. Electricai UFEF Grn ' 48. APPROVALTO COVER-GUNITE '
7. ootings ,. 49. Electrical Conduit-Undr m- "'
8. Foundation ' � � 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undr m 51. Backwash Lines P-Tra ❑ ndr rn ' '
10. Structural Floor System • 52. APPROVALTO DECK' �
11. Property Sewer �ine & House Connection - 53. Backwash & Rece tor-Final
12. Street Sewer Connection ' ' � . 54. Heater & Vent•Final
13. Rough Plumbing � � � � -
14. Rough Electric-Conduit � � �56. Electrical-Final •
15. Rough Electric-Wiring "- -- �- � 57. Solar.System-Final H ' �
16. - Rough Heating'& Air Conditioning � encing & Access Approval •
17. Ducts in StructUre ' ' • APPROVED FOR PL'ASTERING
18. Ducts, Ventilating ' .
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
� 20. . Roof Framing . - ' � - � ' � � � ��
21. Roof Sheathin - � � . ' -
22. Frame and Flashin NOTES: �
23. Insuiation ' ' �
24. Lathing & Siding ,::,.
25. Drywall Nailing � ' � �� - -
26. Plaster Brown Coat � "' �
.f
27. Electrical Power Meter-Final ' - ' � � • � •"'�t•- `" ' � �-
28. Final'Electric� _21-G .� - ��� !:S �
29. Final Heating & Air Conditioning . � � � ' � � "�,*
� 30. '-Final Gas�Pipe-Test � ' - - ,�'" ' � '" � -�;
31. Final Plumbing , � � � � Y�
32. Water Service-Final ' � �
33. Gas Service-Final ' " ' � �
. 34. Solar pomesticFinal ' ' � � �" �'
35. landsca e S rinklin S stem � ' � -'' ' '
36. Sound Attenuation � �
37. Handicap Regulations � � '� � �
38. FINAL STRUCTURE & BUILDING .Zz _�i �� �, '
39. Special Requirements Completed � �- -
40. Electric Release to Edison � � � " � ' �
41. Gas Felease to St�uthern California Gas Co. �
42. CERTIFICATEOPOCCUPANCY
� No Date
OF COSTA MESA
STRUCTION PE
A'ddress
Addiess
AGP��eant [o fill in all ipacei wilhin heavy Go�Eer lines antl zign all appropriate Eeclarations.
PERMIT NO. � TRAGT NO.' � LOT NO. -BLDG. NO.
MIT �'� �
� � --
eay 2 ' TYPE OF CONSTRUCTION
„o Phone J-f �o ❑ NEW ❑�ADD ❑ ALTERATION
;�y. ^ ' - - �REPAIR ❑ CONVERSION ❑DEMOLISH
�LicCnS¢ NO. ' ❑ OTHER�
. .. . . . DESCftIPTIONOFWORK F/�s.� /i<_S
Contractor yy -�,�5� � � " - � "' phorie 55 • TVPE OF PERMIT �
:Add�255 p . E (LQ , 5�(�.I�p N -��GRADING �,❑ FOVNDATION �STRUCTURAL
�ICENSED CONTRACTOR DECLARATION ^ � �- - �- Q TENANT ❑ ELECTRICAL ❑PLUMBING �MECHAI
I h¢reby affirm tM1at I am litens¢tl untler provislons of Chdrter 9(com- v "� �
me0Gln9 with� 5¢ction 7000) of Division 3 O( the"Bu5ine55 antl ❑ OTHER �
Protessions Cotle anG my Ilcense is in fuu force antl eifecL pROJECTDESCRIPTION, ' � � - -
LiCense qa55 ' Li en5e No. �f
Date� . p � 21 � 9/ Si9nature " _ ' SQ. FT. '. /'L�_i� . _ . . .
WORKEiiS' COMPENSATION DECLARATION -^' -- ��CCUPANCVye� CONSTRUCTION TVPE
I hereGy affirm that I have d C¢rtifiGate of consent t0 self-in5ure or�a /cpp p
certiticate of Workers' Compensation 'Insurance, or a certitietl copy VALUATION ZONE
thereof (Sec[lon 3800, Lab. C.). ' GRADINGCU. VOS. ACRES
:y No. Company -
Rrtlfietl copy is h¢r¢by fu�nishetl- - - --- REMARKS: •' ' - � ' �-
A1C¢rtitiEtl cOpy is filetl with ih¢ City Builtlinq DivislOn. ,
EXEMPTION FROM WOHKERS' COMPENSATION DECLARATIOIV � -- �
(This secllon neetl not be completetl� if the permit is tor one hundretl .. . .
(E100) or les5�. � ' ' ��'
I certi�y that m Ihe,performanGe of the�work fo� whiGh this permit Is . ,
issuetl, I shall not employ any person in any manner so as to�become PLUMBING'• -� PLAN CHECK �
Subj¢ct to the Wo�kers' CompensatiOm�Laws of Cali(ornia. - •--
Dat¢ Signatu�e BATHTUB$ SHOWERS
NOTICE: If after making this tleclaration, you shoultl become�sutiject ' TOILETS �' URINAl.S � �
to the Workers' Compensation provisions ot the Labor Gotle, you must �� _-.
forthwith comply with such provisions or this permit shall be tleemetl LAVATORIES DOUBLE �AVS
revoketl. - - . - . . . .. . - - _ . . _ ..
CONSTRUCTION LENDING AGENCV KIT. SINKS DISHVJASHERS
I hereby af(irm Ihat�there,is a construction lentling aqency far the per- SERVICE SINKS , ��. ).'SUMPS -
'formance.of the �workVor which<tbis permit''is�,issuetl:(Section _3097' -
Civ.C.). . ` z � FLOOR.SINKS_��. �"�FLOORDRAINS ^
Lenaer•s ivame $�'rE' ��12�.`"'.I+�+S�PvY-�LL -�-�-
Lender'S Atltlress ';� � �i�� �+�=^�- �aQ'. �•DRINKWG.FOUNTAINS', � �
OWNERBUILDER DECLARATION " ��� INTERCEPTORS CLARIFIERS
I hereby affirm lhat I am ex¢mpt trom the Contractor'S License Law for �
t�e following reason (Section ]031.5 Business antl Pmfessions CoOe:' SWIMMING POOL P TRAP �� � --
Any city o� county which requires a pe�mit to construct, alter,
improve, Gemolish or repair any siruc[ure, prior to its issuance, also re- y�qTER SERV ICE ALTERATION
quires [hC applicanLfor such_permit to file a,signetl statement tha[ h¢
is licensed pursuant to the provisions of the Con[ractor'S License Law GAS SERV ICE OUT,LETS
(Chapter 9(commencing wilh Section ]000) of DiviSion 3 of the
R��SinesS antl PrWessions Cotle) or that he is exempt [herefrom antl [he yyqTER HEATERS � BTV OUTPUT � -
' for the allegetl exemption. Any violation of Section 7031.5 by
applicant for a permit subjects the applihant to a civil penalty SEWERCONNECTIONS �� �
.ot more than five huntlred tlollars,($500).
�J I, as owne� of the property, o� my employee5 with wa9es as thei� SOLAR TANK COLLECTOR$ �
sole compensation, will tlo the work,�antl the structure is not intentletl.
or offeretl Por sale. (SeCtion �044, Business antl F'ofessions Cotle: The SOLAR PIPING SVS. � �
Cont�actor's License Law tloes nOt apply to an owner of a property ., -_
who builtls or improves [M1ercon, antl who tloes such work M1imself or ISSUE FEE
through hiz own employees, p�ovitletl thal such improvements a�e not
intentletl or o(feretl for sa1e. If, however, the builtling or improvement MECHANICAL PLAN CHECK
is soltl within one year of completion, the owner will have the burtlen - -
of ptovinq he tlitl not builtl o� improve fo� the purpose of sale). HEATING SVSTEM 0-100,000 BTU
❑ I, as owner of the property, am'exclusivety contracting with qNDOVCTING
licensetl COOSYdCSOIS LO COfISVOCI II1C pI0�2CI ($CCt1011 J044. BU51�1255 ]OOr000+BTU
antl Professions Cotle: The Contractor's Cicense Ldw tloe5 not apply to
an owner of property_who builtls or improves thereon, antl who con- REFRIGERATION 0-300,000 BTU
t�acts f�om suth projects with a conVactor(s) IlceSnetl'pursuant'to $VSTEM � � ' � ' " ' '
the Contractor's �icense Law). 100,000.+gTU ,�1;
❑ I am exempt untler Sectlon � � B. & P. C. tor�this '
� BOILERS BTU
red5on -' '
Date ' Owner' - - _ SVSTEMREPAIR,ALTERATION
I hereby tertify that I have reatl this application antl sta[e tM1atthe above EXHAVST SVSTEM MUITIPLE
information is Correc4 1 agr¢e [o comply with all city antl ounty
ortlinances antl state laws re tln to construction, antl nereby a tnoriz
�epr¢sen[ativ of this y enter upon the above ntion tl
property fa nsp t}''°� ses.. .. . .... {( / ry ..
Signature ,y � (� ' Oate V Z 0
Drivers' �icense or 55 � ISSUE FEE"
CMF 0865-46 White-Builtling; Canary-Applicant; Pink-Accounting; Goltlznrotl-Assessor
� .
. �776 .8/21 /Bil"'` �.. .: 29e37 TL'
ZONING REGULATIONS ' • - �
P. 9F •
REAR VARD (TO
PKG. SPACE REQ.
ZONING APPROVED BV
SPECIAL CONDITIONS:
ELECTRICAL
REF: � '
BUILDWG "
JPERTV LINE�'
�GROVIDE� '
PARK_FEE $ �
DATE
� . ' •
PLAN CHECK �. � I
GENERATOR 0-1 KW_1-10 KW _
TRANSFORMER
APPLIANCE� � 30-50 KW'=50 + KW _
',MOTORS ' 0-1 HP_1-10 HP _
'(IN0. SOLAR) 30-50 HP 50 + HP'_
FIXTURES OVTLETS �-SWITCHES �
GAS TUBE SIGNS '-
POLE LIGHTS � �
SERVICE
SUB
AMP
ISSUE FEE _- , '
APPLICATION APPROVED BV ' ' " DATE"
SUMMARV OF FEES. � '
BUILDING - .' L'7+
PERMIT b����r/� SMIP.� � E .7�/
P�ANCHECK $-4—�L PERMIT :'
�ISSUANCE $ - '
PIUMBING 5 . GRADI�NG $
PLAN CHECK $ �
' " ` $
ELECTRICAL $ . . '
PLAN CHECK g • � MICROFII:NI $ '
,MECHANICAL $ ' ' TOTALFEE $
LESS AD-
PCAN CHECK § ' VANGE PC $_ '
_ . . FINAL FEE $a2• 3 7
CONSTRUCTION AND PLANNING POOL & SPA . � \ ' : � � _ ' . ' - � _ _ ~' ' .•
APPROVALS Permit # Date Inspector pppROVALS. . � Permit # �� ^' `�� ' - Date � Inspector
1. Temporary Elpctrical Service or Pole �-('� ' - 43. Pool & Equipment Location �- � -. -- '
Soil ipe-Undrgrn � � � .. � ' 44. Steel Reinforcement � '
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn � 46. Electrical Bonding -
tee ein orce 47. Rough Plumbin & Pressure Tesi . l.
6. Electrical UF�R Gm 48. APPROVACTO COVER-Gl1NIT.E '
7. Footings � 49. Electrical Conduit-Undr rn � � �
8. Foundation_ _ -� � � 50. Gas Pipe, ❑ Undr m Test - �
9. Water Pipe-Undrgrn ' • 51. Backwash Lines P-Tra �� ndr rn '�
10. Structural Floor System 52. APPROVALTO DECK -
. 11. Property Sewer Line & House Connection 53. • Backwash & Rece tor-Final
, 72. Street Sewer Connection '' - 54. Heater & VenbFinal .
13. Rough Plumbing •
. 14. Rough ElectrioConduit �- . :56.� Electrical-Final
15. Rough Electiic-Wiring - "' - 57. Solar System-Final ' � � " �
� 16: Rough Heating &�Air Conditioning . - . encing & Access Approval �
17. Ducts in Structure - � APPROVED FOR PLASTERING - �
.16. Ducts, Ventildting � . _ ,
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
' 20. _ Roof Framing ' � ' . �
21. Roof Sheathin ' � . - � ' � � • . �
22. Framean .Z - / fi.l. NOTES: yd ! ,�j�S °o � �y./ yf,/E .O/LifA �
23. Insulation � �/ /� f � � q:r wrr•s.s'/ �Y //! "
24. lathing & Siding ' �r,Yt ' ! ! q i ' ' '
25. Drywall Nailing „T
26. Plaster Brown (;oat � � � � ' - - ;?�
27. Electrical Power.Meter-Final.. ' - � - - .
28. -Final Electric � � � � � ' - ' ' �
29. Final Heating & Air Conditioning � � � ' � ` " ' - �
� 30: . Final Gas Pipe-Test � .
31. Final Plumbing � -
32. Water Service•Final ' ' � - • �
33.�� Gas Service-Final � �� �
.
� 34. Solar pomesticFirial � � � � � ' � ' - `
35.'`Candsca e S rinklin S stem �•' � � ' �� - ' - � � � � '
36. Sound Attenuation �, •: • � S � � � � ' t
37. Handicap Regulations � � �
38. FiNALSTRUCTURE&BUILDING � � _ �� � � � .f,.
39. Special Requirements Completed � ' .
40. Electric Release to Edison � ' ' ' .:
' 41. Gas Release,to Southern California Gas Co. � � � ' -� � � �.
42. CERTIFICATEOFOCCUPANCY � �
'� �,- -'. � � � '
� ��No�` Date , - ,
��:�t ricev.�vw nn��n
PflOJECTFU0XE55: �,TILLAGE CREEK HUMEUWNER5
OWNEP'SNAME: ASSOCIATION
ADDNE55: 34Z9 TIMBER LAKE
CM VA 92626
IINIT:
CHESTER CARVILLE C18305
APCN/ENGINEEN: 7 9'1 '1 p,gMOUR ST FlEG.NO.: '
aooaess: 'S , D�. CA 9 211 1 uxiT: .
PHOENIX ENTERPRISES INC. (213)690r9559
PEPMITTEE: .,Q 1 S' COMERCIAL WAY
ADOflE55: LA HABRA� ' CA 90631 � �
UCENSED CONTBACTOF OECLABATION: I hereby a��irm ��a� I am 6c er pmvisions o� Chapier 9(commencing with Sec�ion
7000) of Di�i69 �0yt��usine55 antl Pmie$R�6fg19 90 mV' se' ' f� �orce antl efle
CRY LIt.: TR�: SS:
Oate: ~0�y Signamre: q�
Comqpenpa�io OIPk�f 4�4tN eI a�c%F�p eeTwp � Ihereoib(Seeti n 3800h Lab pj / i�tpol c��nt to seu�insure or a certificate oi Workers'
Vl 1
POUCY NO.: CA COMP & � IRE E%P.OATE:
�FOMPANY:
❑ Ce�ifie0 co is hereby lu� iSAetl. ❑ Certi�ied capy is �ile e ciry ing Di ision. �
Date: I`� -�'( APPlicanc�
E7(EMPTI4NiNOMWOflNEflS'COMPENSFTIONOECL4flFTI0N: �Thisseaianneetlna�becompleteEi�thepermitisiaronehundred�S100�orlen�.
I cetlify t�al m ��e pedormance of Ihe work lor which �his permi� is issued. I shall no� employ any Derson in any manner so as �o become
Subleci �o Ihe Nlorkers' Compensalion Laws ol Cahfomia.
Oate'. Signature'. � • ' - ,
NOTICE: I�, afler making ihis tleclaraiion, you shoultl become subjec� to ��e Workers' Compensation provisions o� �he Labor
Code. you must lohhwi�� comply wit� such provisions or this permi� shall be tleemed revoked.
CONSTflUtTION LENUINC AGENCV: I hereby affirm Ihat I�ere is a consimction IenOing agency lor lhe pedormance ol the work for
whith IhiS permil is issued �Setiion 3097. Civ. q. .
LENOEH:
aooeess:
OWNEB BUIIDEH OECLAPFTION: I hereby affirm Nat I am exempt imm �he Contractors' State License Law for ihe following reason
(Seciion 7031 5 Busmess ana Pro�essional Cotle'. Any ci�y o� coun�y which requires a permi� to cons�mct, alter, impmve, tlemolish, or
repair any slmcNre. priar lo i1s issuance, also requires �he apDlicani lor such permi� �o file a signeU sla�ement �ha� he/she is licensed
pursuant Io �he pmvisions o� �he Comractors' S�ale License Law (Chap�er 9(commencing wiN Section 7000) of Oivision 3 a� �he Business
anA Professions Catle) or Ihai he/she is exempi �herefmm and the basis for ihe allege0 exemp�ion. Any uiolalion ol Sec�ion 7031.5 by
any applicant lor a permit Sublecl5 Ihe applicant �o a civil penal�y o� �no� more than five �untlretl tlollars ($500).
I, as owner o� the pmpeny ar my employees wiih waqes as ��eir sole comDenSaiion, will do Ihe work, antl �he
❑ simcWre is na� imentlee or o��eretl �or sale (Section 70d4, Business antl Protessional Code: T�e Conirac�ors' Sta�e License Law
aoes nol applY lo an awner of a propehY who builtls or impmves �hereon, antl w�o does such woB �imselUhersel� or Ihmugh
his or her own empl0yee5, pmvided Iha� SUCh improvemen�s are no� in�endetl or otlere0 for 5ale. Ii, how¢ver ihe builtling Or
'mprovement is so10 wilhin one year af campletion, ihe owner will have ihe buraen of pmving he/she tlid not builtl or improve
lar Ihe purpose ol Sale�. .
I. as owner of the pmpeny, am excWsively conirading with licensetl coniractors to cons�rucl ihe pmlect (Section 7044, Business
�. '❑ an0 Pmlessi0n5 Cotl¢'. The ConVacmrs' S�a�e LiCense Law UoeS n0� appty �o an owner 01 D�oDerty who 6uiltl5 or impwves thefeon •
antl who conVac�s for such projecis wi�� a canVacmr(s)license pursuam m �he Comracmrs' Sta�e License Law�. I am aware
' Ihai proof ol ��eir Worker'S Compensalion insurance 51i0u1� be pmvitletl Io me.
II � I am exempi under Seclion: . 8. 8 P. C.
lor I�is reason:
Date: Ownec '
I tlo hereby cenify thai I am aware o� antl unders�and �he requiremen�s of Calilornia Healih and Salery Code Sec�ions 25505, 25533, antl
2553A antl ihal I or any fuWre buil0ing occu0ani will/will not (ci¢le one) neetl Io comply wi�� 5ai0 state cotles antl the requirements for a
permii �or consimction or motlilication imm Ihe Fir Oualiiy Managemen� �istricl. ResiOen�ial consimction apPlica�ians are exempl trom
ihese pmvisions. , �
�aie: Fppliwnl: _
I hereby t¢rlilytha� I haveread Ihis applicaii0n and Slaie Ihal Ihe
or0inance5 antl slaie laws relaling to bmlding con5lruclion and herel
pmperly lor inF,ectiop Our(yAeY ,
�ale: �/��� �
�nver's License or Social Security a:
is CorreCL I agreeio tomply wit� all
t6a1�46 White—Bulltling', Green—Cotle Eniorcemenq Canary—ApplicanC Pmk—Revenue', Goldenmtl—Assessor
CITY OF COS'TA MESA – BUILD'ING PERMIT
FERMIT NO; B 050623� PLAN CHECY. NO: 00088-91 A
CONSTRUCTION TYPE; V–N PERMIT TYPE: STR
JOB DESCRIPTION ; REPAIR SETTLEMENT DAMAGE
n _
r
PiiRPOSE: REP
SQ rT: 143
CLAIM VALUE; 14,300,00 CALC–VALUE: ' 14,300,00 ,GROUP OCC: R-3 / '
COMMfiNTS: HUILUING SETTLEMENT REAAIR/FOUhDATION - '
***��********�t*�**�**�*��*****����x*******�rx���t***���a�x*x**�*�****x�********�*ui�� ,
Z O N Z N G R E Q U I R E M E N T S .
S E T H A C K'S '
------------ MAIN BUILDING ---------- ----,----- ACCESSORY BUILDING ---------
FRNT: FT' IN REAR; FT ZN FRNT; FT IN REAR: FT IN.
LEFT; ET �IN RGHT: FT IN' LEFT: � FT IN RGHT: FT IN
PARKINC REU• PROV; PARCEL; 93506129 ZNE: R2 REF NO:
PLANNING Nf31'ES> FOUNDATION REFAIR, , . � �
_ >
1E if 3f iElE iEaf iE jF �E iE iF iF �F iE ih iE iEif-lE iE �E 1E �lE iF 3F iE 3Fif ib iE if iE ik iE �E iF iF iE iE IE )E iE �E iF jE if iF iF if �1F 1E i!- ff iE IE fElf lE iE i(� iE iF 1E iE if if iF-IE iF 3E fE 3F iE fE iF if k ik
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 APPRdVED BY �j,a �1—T� DATE; O J.! S-`� 1
BUILDING APPROVED BY� : Iti ! L/� - DATE: -
APPLICATION I�SSUED BY• DATE:
IE if �iF if iE %� iE #)f dF if 1F iF iE iF iE if iF ff if IE % 3F 3E 1f !(� iE iF iF �1F iF jfiF3Fl�i�iF� iE iE
if*�f3E3k3F3'riE�lEltiEikiFififfEiE3EjEi6if)E9E1E1EiEif�iFifiE3fififlE3f�i E3E3Eif�3f7fiFlEaFiEiPifiEiF9EifN-3fjfihlE�lEiF1E�E3F3E�E�EifiE3E363EifiF%1EifIFiEiFiE
LEGALIZATION;N F E E S U M M A R_Y _ STRUCTUiiAL SHGMENT;Y
��. .
BLDG PMT PLUMBING E CTRIC MECHANIC FIRE SMIP/RES GRADING
PERMZT 162.00 1.00
_ � SMIP/NON–RES �
PI�AN 26, 33 ,
ISSUE FEE �
BUILDING–DIV–> PERMZT ISSUF. PLAN–CHECK TOTAL PAID Dt7E
TOTALS----> 163.00 0,00 76,33 189,33 189,33 ,00
REVENUE DZVISIf)N TOTALS--> COLLECTED; 1B9.33 OVER/SHORT; ,00
_ HLDG PMT PLUMBZNG ELECTRTC MECHANIC FIRE SMIP/TOT GRADING FLAN–CHECK
162,00 , 1,00 26,33
if if �E �li� iE iF iP iF�lf dF if If iF iF if iE iE if iE if IE iE iE IF �F if jf 3E af if if iF iF �E iE if jE if fF 3f iE iF iE iF iF if 3E iE iE iF iE iE iE iE If aE 3E iE if iF if i(� * iE IF iE iF iE iF iE af if if #E * 3(� iE jE jE
' - I N D I V I 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' STRUCTURAL BY VALUE PER 5100.00 100,00 14,300,00
, END �OF FEES ,
�1
a�, caaa�s�a-t��o�2935 ��
; DATf � till�3/9� ���
�
CONSTRUCTION AND PLANNING - P. - �& SPA �
Date Inspector Date Inspector
APPROVALS Permit # / APPROVALS Permit # .r...--
1. Temporary Electrical Servic�� Pole J y� 52. Pool & Equipment Location �•�
2. Soil Pipe-Undrgrnd. �� " ,��--� 53. Steel Reinforcement ��'
3. Etectrical Conduit Utility�ll.ndrgrnd. ,� 54. Forms af
. -
4. Electrical CpnduiGUndrgrnd. i-- 55. Electrical 6onding
�
' 5. Steel Reinforceme'nt , 56. Rough Plumbing & Pressure Test _
6. Electrical UFER Gmd. � 57. APPROVAL TO COVER�GUNITE �.•
7. Footings' • _ 58. Electrical Conduit-Undrgmd.
8. Foundation �� �!�' �j� 59. Gas Pipe, O Undrgrnd., Test �A�
9. Water Pipe-Undrgrnd, � I�� .'�' fjj 60. Backwash Lines, P�Trap, � Undrgrnd. %���
�10. Structural Floor System� - ,, ��n 61. APPROVAL TO DECK -
11. Property Sewer Line & House.Connection• r 1 62. Backwash & Receptor-Final �
� 12. Sewer Cap. , � r�: 63. Heater & Vent-Pinal '
, �
13. Root Drains � %�- i�
/� . � 64. Plumbing System - Final
14. Rough Plumbing �"�� �� �� � 65. Electrical-Final �
15. Rough Electrical-Conduit��� `�, � 66. Solar System-Final �
16. Rough Electric Wiring Gr�� : ;�� 67. Pencing & Access ApProval �� �
17. Rough Wirin9 Sign ' � 68. APPROVED FOR PLASTERING �
18. Rough Electncal-T 88r Ceiling / 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � ' FIRE DEPT. REQUIREMENT
- � :,�
20. Rough:Facmry.Fireplace ' ' : " '=� � APPROVACS ' Permit # •
1 _.
27. DuMs,,in Structuce . � •��' 70.�Underground Hydro �
22. Ducts, Ventilating �� • • :� 71. ProductPiping'O�Gas :OOiI
23. Gas Pipe-Rough ffi Test i �_ n� 72. Underground Flush_ ".-
24. Roof Framing - '� . ,�- � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing " - '," � - ''" , ' 7q,; Overhead HYdro � .
26. T�Bar Ceiling �Structurap &�Monocoat -^ 75.. Dry Chemical * -.
r
27. Frame and Flashin ' � ' � ` ` �' '
9 j, :• 76. Dry Staniipipe'. � . _
28. Lathing & Siding• .. . �- . � `: 77, FIXED SYSTEM FINAL�
29. Insulation` ' ; '� .. � � � � �� . 78, FIRE PREV. FINAL -- . ��
30. Drywall Nailingi �' I. I (� HEALTH DEPT. REQUIREMENT
f 31. Plaster Brown Coat . � I I f; ' 79. FINAL'INSPECTION �" �
32. Electrical Powe� Meter�Fina( . � I� I �• -� 80. FOOD CERTIPICATE�ISSUED "
33. Final Electric ' � � I �. �,� " `' Notes: " " .
34. Fi�nal Heating & Air Conditioning •� � �� � , - _
� � i .� - �"� .t� � - � i .i �
35. Final Gas Pipe-Test . ' - ;I ' � �� ; - �
'�r
36. Hood or CanoPY � .. � - . . I E - . _ , . � - .
�_
37. Pinal Factory Firepl8ce ' � � �-' ' � ; � '
38. Final Plumbing .� � � � .� . _
� �:
39. Water Service-Final ' � t � - � ` '
� . � �.
40. Gas Service-Final., - � � -„ �
I {: ` �;
41. Solar pomestic�Final � " - � � �' • .r
42. Backflow Preventer ' _, " � � � ,. . - . . , �
43. Backflow Irrigation � � ' ' - � ' � �
44. Landscape Irripation System. .� . . � ", -
45. Sound Attenuation '� ' � ' ' � . - - .
,j �
46. Handicap R,egulations ` � ' � , �
47,. FINAL STRUCTURE & BUILOING QV ' i- •.
48. FINAL PLANNING � � �! .
49. Electric Release to Edison � f• .
i f .
50. Gas Release to So,uthern California Gas Co . � ' ," , .
51. CERTIFICATE OF pCCUPANCY ., ,- „- �
No. Date �
;
r 41786`
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Campletely
ADDRESS 3432 Meadow B �
OWNER State-Wide Develo ers, Inc.
MAIL 9461 Grindla.y
AODRESS
CITv 4YPrB5S No.
BHANCH
ADDRESS
ADDRESS 17848 SkyPark Blvd Irvine
CONTRACTOR State-Wide Developers
AODRESS 9461 Grindlay
CITV Cypress No.`826-4550
LIC.NO. 224��0 LICVNO.
SIZE NO.OF BIDGS.
OFLOT 12.093 fiCie$ _ INOWONLOT Q
USE Of
EXI5TING BLPG.
SIZE OF NO. OF
NEW BLDG. flOOMS STORIES
EMERIOR WALL a er ROOF
COVEFING �� COVERING Shake
USE OF eUILDING AND WORK TO BE PERFOFMED
1 Residence w/att aar
Na�!: �
�'4Y' 13-76cri�.0� 7�.f9r. �:r,t ZSB.� i
. APPLICATION FOR BUILDING PERMIT
RECEIVEDBV DATERECENED nnroicciu
4/2-2//-
A.P.NO. lCG�6S
BUI�DING
ADDRESS ��3`�
TRACT �rS'SZ
LOT
�
X
OWNER �� � (I�/i
VALUE Q
S
FIFE
ZONE TVPE � GROUP j R
APPROVED
gy DATE
20NE NO.OF USE OF NEW/L(7 4!
22 C� P�� 2 BUILDING
YAROS APPROVED VARDS APPRO ED
MAIN BUILDING. ACCESSORV BUILDII
(FROM C/L STqEET)
RONT Z 3 FT. FT.
FT
L. SIDE FT. FT.
FEAR G FT.� FT.
DI5TANCE BET. BET. MAIN &
VAR. #
HOLD FOR
DATE
� PPPFiOVED/�
i //C/Ji/ ......� YI/7 ��
I hereby ack�owledBe ihat I have read this application antl state
tha[ the ahe+e informaiion is correct antl agree to complY H'Ith
all laws re8ulating builtlin8 construction, antl I shall not employ �
any person in violation of tha warkman's compensation laws ot
the State of Calitornia.
I hereby cartify that I am proparly Iicensed es a conbactor untler ���O SQ. F
the State ot Galifornia 6usiness end Protessions Cotla, �Ivisicn 3, THE AMOUNT
Chapter 9, antl that such licenses ere in full force a tl effect, or I THE PURPOSE (
am ezempt from tha provisions ot Ne State of Cal ornla Businass VALUATION
�antl Professions Code, Division 3, Chepter 9.
State- Wide Devel pei•, Inc. ��.
Signature !
Permittee $
AuthorizedABant Vice Presiden
W
0
VA�UATION IS FOR �
A PERMIT FEE ONLV: m
¢
m
E $ I � �
�
K $ r �O E
�� �a �
LL
$ �