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Home My WebLink About3441 MEADOW BROOK - Building Permits� (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3441 MEADOW BROOK Suite No Vicinity: Parcel Nunmber: 93506070 Applicant: GLOVER, LORIE Address: Ownec PHILLIP, ELIZABETH Address % CORBINO, MICHAEL P COSTA MESA, CA 3441 MEADOW BROOK PLUMBING PERMIT Phone: 714-241-7414 Zip: Phone: Zip: 92626 Contractor: COAST ROOTER PLUMING HEATING & AIR CONDITIONING Address: 2737 S CRODDY Arch / Eng : Address: SANTA ANA, CA Phone: (714)241-1414 Zip: 92704 License: 529127 Phone: , Zip: License: SCOPE OF PERMIT WATER HEATER CHANGE OUT. ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifier System Conned Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 . 0 ' 0 0 0 0 0 0 0 0 0 ' 0 0 0 0 0 0 0 0 ISSUED BY: Siatus: ISSUED Applied: 11/03/2000 I ss ued: 17 /03I2000 FEE SUMMARY AMT QTY � � _�.AMT Laundry Tub / Washer $0.00� .��- 0 Sump-Pump� , $0.00 Landscape Irrigation $0.00 � .0� �.. -. Swimming Pool' , �� $0.00 P-Trap $0.00 �0�`- ;�'�"�� "TrepPrimer � � �, �,$0.00 Pressure Regulator 50.00 0 � � Urinal ' � - � $0.00 Process Piping (per 10 k) $0.00 0., "� �Vacuum B�kr Bkflow(1-0) �$0.00 Receptors 50.00 0 ,"� Vacuum Brkr-Bkflow(5+) $0.00 Septic Tank $0.00 ' 0 " � - ' Wash Basin � � ' $0.00 Sewer Cap for Demo $0.00 0 � Wash BasimSet %� $OAO Sewer Connect $0.00 0 �, Waste and Vent System $0.00 Sewer Private Line . $0.00 • b � , � Water�Closet (Toilet) $0.00 Shower $0.00 �0 . WaterHeater/vent $12.30 Sink, bar $0.00 0 � : Water Piping (Inst or Rep.) $0.00 Sink, commercial $0.00 0 � Water Re-pipe $0.00 Sink, Floor �$0.00 � 0 � Water Service $0.00 Sink, kitchen $0.00 0 Water Softener $0.00 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 COMMENTS I SPECIAL CONDITIONS TOTAL CALCULATED FEES: $35.80 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 C NOTICE: The work authorized 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: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned for a period o� 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, antl au required inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 2d46-4fi(6/00) WORKERS'COMPENSATON DECLARAnON: � I hereby aRirm under penalty of perjury one oF iHe following daclarations: � I have and will maintain a certiticate of consent to sell-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the perfortnance of ihe wark far which this permit is issuetl. �I have and will mainfain workers' compen58��on insurance, as require0 by section 3700 oi Ne Lahor Code, tor the perfortnance of the work for which this permit is issued. My work�j� com��p��ens//a��tion Insurance carher antl policy number are: (arrier: �11j C7 �1�� P ( , Policy Num6er: � J�� Z Y RU � rnis secnon eee noi be can /efed i the e ��5 velued et one huntlred dollars $100 or less.) ❑ I cenity that in the pedormance of the work for which this permit is issue4 I shall not employ any person in any manner so es to become suhject to the workars' compensation laws of Califomia, end agree Ihat if I shoultl become subjeq to the workers' compensation pmvisions of Section 3700 of the Labor Cotle, I 5hall tortnwith comply with these prov�isions—�� ApplicaN Signature� / l!�/' Date: l�i � �� WAFNING FAILURE ECURE WORKER ENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOILAFE �$100,000), IN ADDITION TO THE �T OF COMPENSATION, OAA+AGE$ A$ PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE. IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm Ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business and Professions Code, and my license Is In full forca entl eHect Lic. k �ri� n7 %�� Class # C� i0 Coniractor's SignaWre:� T Date: „� �2 � O O CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm ihat ihere is a consiruction �entling agency for the pertormance ot the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lentlers Adtlress: SignaW re: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirm Ihat under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any city or counry which requires a permit to conswc6 alter, improve, demolish, or repair any struaure, prior to its issuance, also requires the appliwnt for such permit to file e signed statement tha� he or she Is licensed pursuant to Ihe provisions ot ihe Coniractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Cotle) or that he or 5he is exempt iherefrom and the basis tor the alleged exemption. Any violation of Section 7037.5 by any applicant for e parmit subjecis ihe applicant to a civil penalty of not more ihan five hundred dollars ($500) J: ❑ I, as owner of !he property, or my employees with wages as Iheir sole compensation, WILL DO T}IE WORK, antl the s�ructure is not in�ended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law dces not apply to an owner of property who builds or improves thereon, and who does such work himsetl or herselt or Ihrough his or her own employees, provided ihat such improvements are not intended or oHeretl for sale. If, howaver, Ihe building or improvement is sold within one year of completion, the ow�er-builder will have ihe burden of proving that he or she tlitl not build or improve for purpose of sale.). ❑ I, as owner ot iha property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe project (Sec. 7044, Business and Professions Cotle: The contractors License Law does not apply to an owner of property who builds or improves ihereon, and who contrects tor such project with a contractor(s) license pursuant to the Contractors License Wws.). ❑ I am ezemp� undar sec. Signawre: Business and Profassions Code for ihis reason: Owner ID veritietl by dnvefs license. ❑ Yes ❑ No Drivefs License No. Verilicetion of Ownership by (type oi document, i.e. - pmperty tax bill or tleetl): Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT GERTIFICATION: ❑ I hereby certify iha� no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work euthorizetl 6y �his permit, antl Ihat no building siructure, scanolding, falsework, or demolition or tlismantling Ihereoi, will be more Ihan ihirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Trtle B, Califomia Atlministrative Cod�). ❑ As ownerbuiltler, I will noi employ anyone to tlo work which would require a permit irom the Division of Industrial Safery, as noted above, unless such person hes e permit to do such work fram the division. Signature: Date: Division of Industnal Safery Permit Number: CERTIFlCATE OF COMPIJANCE AND Al7THOf±�TON OF EN7fiY: I certify under penalty of peryury ihat I have read this application antl state that Ihe infortna�ion given is correci. I agree to compty with all state laws and ciry ordinances ralating ro builtling constmction, antl aui�onze representatives of ihe Ciry of Costa Mese to enter upon ihe above-tlescnbad property lor inspec�ion puryoses. I aqree not to occupy or allow xcupency of any building authonzed by this pertnit until final inspection. Signat egalOwner(s) Date - _ � /��AU And/ r Aulhorized Applicant Date COOE �. INSPECTONTYPE 1616 FixeE System Final Fire Prevention 1266 Pool Spa Final 200 Final R8-Rool 201 FinaV &ocWRetaining W all 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition fj�jF INTff1AL5 CO�E;1 INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final Elecirical 212 Final Rre Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupency QdiF. It�:S �L'0`l"(%f ✓'• �f � . lr � t � �� OJECi RODPESS: 3 Q 4 1 MEADOW BROOK OWNEfl'SNRME: �IlLLAGE CREEK H.O,A, aooeess: 3429 TIMBER LAKE COSTA MESA, CA 92626 553-1876 AflLHIENGINEEN: ROOflESS: NEG.NO.: uxrt: UNIT: PEpMmEE: pETERSON ROOFING ( 714 ) 979—'7211 aooeess: 3006 ENTERPRISE COSTA MESA CA 92628 LICENSED CONTBACTOB DECIABATION: I here�y atlirm Ihal I am licensed un0er pmvisions of ChaD�e� 9(commencing wi�h Seciion 7000) of Oiv�sion 3 oi Ihe Business antl Pmlessions Cotle. an0 my license is in �ull foree antl eHec�. ciTruc.:045445 STATELIC.:CO%H%Z u�ss: C-39 - Date: � � �% � � � SignaNre: _ — . WONRENS' COMPENSATION UEClAXl1T10N: I hereby al�irm ��al t have a i�icate ol conseN to self�insure or a ceni�icale af Workers' '�. Compensa�ion �s�ragcql. o� j june� c�ov mereo� (Sec�ion 3800, lae. �i4 / 01 / 9 4 � POLICY NO.: E7(P. OATE: comenxr: STATE FUND ❑ Gertilietl capY is hereDy lumishetl. � Ceni�ietl copy is �iletl with the ciry Builtling Division. i �j �a�e: � r � / � APDIiCanf. EXEMPTION FNUM WOPREBS' COMPENSRTION OECUNATION: (ihis ' n nee0 not be comDleleO if ihe permit is lar one hunOred �8100� or less�. I ce�ity Iha� in Ihe petlormance oi �he work lor whic� Ihis pe�mi� is issuetl. I shall no� employ any person in any manner so as to become subjec� to the Workers' Compensaiion Laws of Califomia. �ate: Signature: NOTICE: If. aiter making this declaration. you shoul0 become su6lect to ihe Workers' Compensation pmvisions oi Ihe �abor Cotl¢, you mus� fort�wi�� comply wiih SutRpmvision5 or lhi5 Dermi� Shall be OeemeO revoketl. CONSTPUCTIDN LENOING AGENCY: I hereby a��irm t�al there is a cons�mction lending agency for lhe pertormance oi the work lor w�ich �his permit is i=suetl (Sec�ian 3097. Civ. C). LENDEfl: AOOHESS: OWNEfl BUILOEP OECURATION: I hereby a��irm that I am exempt Imm [he Con[racmrs' S�a�e License Law �or the �ollowine reason �Set�ion 7031.5 Business and Pro�essional Code: Any ci�y o� counly whic� requires a permii to consimct, al�e1, implove, Oemolis�, or repair any slmCiure, prior to iis i55uante. also requires �h¢ applitant �ar such permil ta lile a 5ignea Slalement [hai he/She is licensetl pursuam Io �he pmvisions of Ihe Comracmrs' Slaie License Law �Chapier 9(commencinp with Section 7000) of Division 3 0l the Busineu and Pmlessions Co�e) or tha� he/she is exempl Ihere�rom and Ihe basis for Ihe alleged exemp�ion. Any viola�ion o� $ection 7031.5 hy any apDlican� �or a permil su6lects �tle apPlicanl Io a civil Denal�y ol not more �han �ive hunUreO tlollars (5500�. I. as owner o� �he pmpetly or my employees with wages as their sole compensa[ion, will do ��e wark, and Ihe ❑ stmclure is nol imenaetl or oflereA �or saie (Section 7044, Business antl Professional Code: The Coniracrors' State License Law tloes not apDly Io an owner oi a pmperty wha buiids or improves �hereon, antl who tloes such work himseli/herSeA or IAmug� his or her own employees, pmvitletl t�a� such impmvemen�s are no� in�entle0 ar ofleretl for sale. I�, however ��e buil0ing or impmvemem is so10 wi�hin one year o� comple�ion, Ihe owner will �ave Ihe burtlen o� Dmving Ae/she did no� 6uild or impmve �or Ihe purpo5e ol sale). I, as owner of Ihe propeny. am exclusively camracling wiih IicenseA confrac�ors to consimt� �he Dmleci (Sec[ion 7044, Business ❑ antl Pmfessions Code: T�e Contracmrs' State License Law Ooes nol apply to an owner oi pmpeny who hudds or imD�oves ihereon anG who comracls lor such proW��s with a conVactor(s) license pursuan� lo the Con�mctors' Sta�e License �aw�. I am aware ��at proo� a� Iheir Worker's Compensa�ion insurance shoulA �e omvitled Io me. � I am exemp� untler Seciion: 8. 8 P. C. far ihis reason: Oate: Owner: . I tlo here�y cenify Iha� I am aware of ana unaers�antl �he requiremen�s of Calilomia Health antl Sa�eiy Cotle Sections 25505, 25533, an0 25534 ana �ha� I ar any Iuiure �uiltling occupan� vnlllwill not (circle one) need to compty wi�h saitl state cotles and the reQuiremenis for a permi� lor consimction or modilication immihe Air �uality Managemen� Ui5lrict. Residential constmc�ion applica�ions are exempl �wm I�ese pmvisioni �ale: NOPlican�: I hereby cetlity Iha� 1 have reatl �his apDlicalion and slale Ihai Ihe above in�ormalion is correct I agree Io comply wi�h all ciry an0 counry or4inancesanas�atelawsrelating�o�uAdingconslmctionantlhere�yauthorirerepresemaf t1' ciry�oen�erupont�ea�ove-men[ioned pmperty lorinspection purposes. � oa1e: ��I J /� SignaWre'. \v�� ower's �icense o� sociai secu�iry n: 164La6 White—Builaino: Green—Cotle EnlorcemenL Canarv—Aoolicant: Pink—Revenue: Goldenrotl—Assessor CITY OF COSiA MESA — SUILUISdG PERMIT PERM NO: B 0634�4 PERMZT NO: 063404 PLAN CHECK NO; N GOVT: N SOPP; N CONSTRUC I N TYPE: V—N PERMZT TYPE: STR PURPOSE; ALT JOB DESCRZPTION : T/OFF SHEATH REROOF W/COMP SHINGLES SQ FT: 9,600 CLAIM VALUE; 4,600.00 CAiC—VALUE: q,600.00 GROliP OCC: R-1 / COMMENTS• SMOKE DETECTORS REC�7 PERMZT INCLUDES 3443, 3445 S �3v447 MF � �� **�r��****�**xx��r*�*tt***** �**S+�E*T*BQA*C*K*S*�c*�*xx�*��V�� y � �`��'�` Z O N Z N G ft E U I R E M E N ------------ MAIN HUILUING ---------- -------- ACCESSORY'9DILDI�N RED ___.� FRNT: FT IN REAR: FT ZN FRNT; FT IN REAR: FT IN LEFT: FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN PA.RIiSNG RE • PROV: PARCEL: 93506070 ZNE: REF NO: PLANNING N T'ES> .7 � � iE iE iE iE if 3F �E jE 1E iE iE iE iE �E iF 1E iE iE 3E 3f iE 3f !F iE if iE 1E 3E 1E iE 1E iE if it iE iF # iE iE iE jE 3F iE dE if iE iE k iFlE 3E 1E IE 1E �E iE it iF 1E iE iE �E iF if iElE �E i! iFiF �E it iF iE 9E �F ik 1E iE D E V E�L O P M E N T S E R V Z C E � R E Q U I R E M E N�T S ). ZONZNG APPROVEIl BY DATE: "" BUILDING APPROVED'BY : DATE• ,n i_��i��iMlii iF it iF 3E iE iE if if iF �E �E i! iE {f iE fF 1E 1E iE LEGALIZATION:N BLDG PMT PERMIT 72,00 a* iFiF��F�FiF3F iF�i�iFiF x x iF'�F3Fi'r��3E7F�F iFiE7E�F iF�F i(� iE tF itD * i�[� * if *iI�F��fE it fE �E 1E if 3E 3F 1E iF?E 1E iE 1E iE it jE fk iE if k iE 1E 1E iE �F ik iE if 1E �f iE it k iF iE if iE iE if it if 9f-iF iE iF iE if !! iF if if'iE iE if jF it iE if iF �E if F E E S U M M A R Y STRUCTi7RAL SEGMENT:Y PLUMBING ELECTRIC MECHANZC FIRE SMIP/RES GRADZNG .50 SMIP/NON—RES PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 72,50 0.00 0.00 72.50 72.50 ,00 REVENUE DIVZSION TOTALS--> COLLECTED: 72.50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTFtIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK %2,00 .5� iF if iF 1E iE 3E iF iE �E iE 3E iE �F iE iE 9E 3FlE iE if * 1F af i4 iE iE 9E 1E iE it iE iE #E iElE �F iE 1E �)E �E iE �E iE 3E 1E iE iE �1E iE iFiE iE 3E iE iE iE 1E iE iE #t 3f iE iF if iE 1F iE iE jF jE iF 1E iF iE iE if 1E iE it I N D I V I D U A L F E E B R E A A D O W N TYPE QTY D E S C R Z P T I O N UNIT COST TOTAL COST SFR 4600 REROOF BY VALUE RESIDENTIAL N020NE 1.00 4,600,00 END OF FEES O1 001445g3-001445g4 To7T 7:.50 DAiE: Q3/04/93 TltIE� 14�10 � � - - - CONSTRUCTION AND PLANNWG - POOL A � APPROVALS Permit# Date Inspector p�ppROVAIS Permit# Date Inspector t. Temporary Electrical Serviceor Pole � 52. Pool & Equipment Location � �' . 2. Soil Pipe�Undrgind. � � 53. Steel Reinforcement � 3. Electricai Conduit Utility-Undrgmd. 54. Forms. • 4. ElecVical Conduit-Undrgrnd. � 55. Electrical Bonding 5. S[eel Reinfo�cement . 56. Rough Piumbing & Pressure Test � 6. Electrical UFER Gmd. 57. APPROVAL TO COVER-GUNITE , 7. Footings 58. Electrical Conduit�Undrgrnd. 8. Foundation ' S9. Gas Pipe; O.Undrgrnd.-, Test � 9. Water Pipe-Undrgmd. - �. 60. Backwash Lines, P�Trap, O Undrgmd. 70. Scructural Floor SYstem . ' 61. APPROVAL TO DECK . it. Property Sewer Line & HouseConnection � 62. Backwash & Receptor�Final , 12. Sewer Cap . . 63. Heater & Vent-Finai '' 13. Aoof Drains � 64. PWmbing System � Fina1 � 14. Rough P�umbing ' � 65. Electrical-Final 15. liough Electrical•Conduit 66. Solar System-Final _� i6. Rough Electfic Wiring 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69. POOUSPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. FiEQUIREMEN7 � � � • • 20. Rough Factory Fireplace ' � � APPROVALS � ' -Permit # , . 27. Ducts, in $tructure � - � � . � � 40. Underground Hydro � � 22. Ducts, Ventilatirig � � 71. Product Pip:n9 O�Gas � Oil 23:.Gas Pipe�Rough & Test , , . . . • � 72. Underground Flush , . . � 24. Roof Framing '- �. 73'.��Undergrnd.StorageTank OGas ❑Oil 25. Roof Shea[hing � � � � .-q� � (N � �4. Overhead Nydro � 26. T�Bar Ceiling (Structurall & Monocoat ' -�� 75'. Dry Chemical � ' 27. Frame and Flashing � �. 76. Dry Stand{iipe � � 28. Lathing & S�ding � . . 77.�� FIXED SYSTEM'FINAL 29. Insulation �� - � �• 78. FIRE PREV. FINAL . 30. Drywall Nailing I �� • HEALTH DEPT-. REQUIREMENT 31. Plaster Brown Coat � � � �. 79.'PINAL INSPECTION , 32. Electrical Power Meter-Final � � � �• • 80. FOOD CERTIFICATE ISSUED 1 I I ' � � 33. Final Electric � , � i �� Noies: . , 34. Final Heati�9 & Air Conditioning � � � i• 35. Final Gas Pipe-Test . � i � � ` ' , 36. Hood or Canopy � � � i � � 37. Final FactorY Fireplace � I- �. � . ' � - ` 38. Finaf Plumbin9 ' � i ' 39. Water Service�Final � � � I � 40. Gas Service-Final , � 41. Solar pomesiic-Final ' � � � ( 42. Backflow Preventer�� ( �� 43. Backflow �rrigation� ' 44. Landscape Irrigation'rSY57C.m � , � , � 45. Sound Attenuation� � ',�' ' 46..HandicapRegulations "'� 47. FINALSTRUCTURE�UILDING �1,7_olrif ��GL as. FINA� PLANNING �,M � � � � a9. Electric Release to.Edison � � � . � �50. Gas Release to Southem Catifomla Gas Co � � • . 51. CEftTIFICATE OF OCCUPANCY N0. Date PBOJECT PUOBESS: j i 4 S MEADOW BkOOK uxiT: OWNEH'S NFME: VILLAGE CREEK HOMEOWNERS aooaess: ASSOCIATION 3429 TIMBER LAKE � CM VA 92626 11flCM/ENGINEEH: CHESTER CARVILLE� flEc.No.: C18305 aooness: 792z ARMOUR ST uxiT: S.D. CA 92111 PEflMITTEE: �HOENIX ENTERPRISES INC. ( 21 3) 690-9559� aooaess: 411 COMERCIAL WAY LA HAHRA CA 90631 LICENSED CONTBpCTOB OECNNATION: I hereby affirm �ha� � am �icense ntler pr isions of Chapter 9 Icommincing with Semion 7000) of �ivision 3 o�ihe Business and Professions Cotle, anU my lic in full ce antl eflect. �� c�rruc O50` �8/} sr,euc.:376639 �� %�/'''// 'J�� Oate:��—(��— Signamre: _ _ _ _ _ �../C�e�! �/ � WON Efl$' COMPENSRTION OECLAflFTION: I hereby affirm �ha� I have a cenitiCa�e o� ConSenl l0 Selbinsure or a Ce�ifitafe of Workers' Compensa�ion J2w�apc� o{ y.c¢nitietl copy �hereol (Seclion 3800. Lab. LI,� � O 1� 91 POLICY NO.: CAVCOMP & F I RE E%P. DRTE: V ,yC,OMPpNY: YJ Cetlifietl copY is here�y Wmis ed. ❑ Certilietl copY is '� i l[ , ity Buil�ing Division � �aie'. _ � ApplicanC _ E%EMPT ON FHOM WOflREPS' COMiEN5ATI0N UECLAPATION: (This section neetl na� be completetl i� the perrml is �orone GreE (5700) or less�. I cetlity Ihat in Ihe pedormance of Ihe work lor which �his permi� is issuetl. I s�all not employ any pefson in any manner so as to become sublec� lo the Workers' Compensatmn Laws of Cali�orma. . �ate: Signamre: ' NOTICE: If, alter making Ihis Oeclaration, you ShoNa become sublet� b �he WOBers' Compensa�ion O�ovisions o7 ��e Labor Code. you mu5i �ohhwith compty with suc� provisians or �his permi� shall be tleemetl revoketl. CONSTflUCTION LENDING AGENCY: I hereby aflirm ihat ihere is a consimction lending agency for the pedormance of t�e work br whith I�is permit is issued (Setiion 309Z Civ. C). LENOEF: 11DOPESS: � CITY OF C05TA MESA — BUILDING PERMZT ,FERM NO: B PERMIT NO: B 05063A PLAN CHECK NO; 00076-91 A GO, , ; N CONSTRUCTIUN TYFE; V—N FERNIT TYPE; STR . PURPOSE:; REP JOB DE:SCRIFTION : REPAIR SETTLEMEI3T DAMAGE � ' SQ FT; 143 CLAIM VALUE; 14,300.00 CALC—VALUE; . ,14,300,00 GROUP OCC; R-3 1 COMMENT5: BUILDING SETTLEMENT REPAZR/FOUNDATION ' 1E )F 3E 3E IF iF 1E dE iF 1E iE 3F i6 If iE IF �E N� 3E 3E iE 3E iElE �E 3E iE iF �f IE *�If iF ik �E 3E jE 3E IF iF 3F if iE if fE jF # if� if iE �E iE IE iF 3F iE 3F �E iE iE iE k lf 3E iF �f iF iE 3F iF iF 3E !E �1F iF iE K� iF iF � Z O N I N GS ERTEB�AUCIK�SE M E N T S ----------- NAIN BUILDING --------= --------- ACCESSORY BUZLDING -- ------ 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 REO• PROV: PARCEL: 93506124 ZI3E; R2 REF NO: PLANNING Nt5'I'ES>. FOUNDATION REPAIR. ,?. iF iF lE iE iE iE 1ElE ff 1E iE aF lE if if aF iF iP iE 1f 1E 3E iElE 3E iE iE if !F iF if iE iE 1f �F iE if iF iE 3f iF iE if if iF 9E 3E �E 1E �1F i4 iE iE 3E )E iE M� iF?f iF �E 3E iF If i6 iE iF if- )f 1E If iE 1E If fE If iF If i! 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 ZONZNG APPROVED BY (�n L.. � DATE: Of.l 5�ll BUILDING APPROC'ED HY : U/ t� iJ�i DATE: APPLICATION ISSUED BY: DATE;��;� ififiEik*jEiEiE�fdE)fiE3hiEiPiFif3ElE#iEiF �� ifif�fiE3f)f3FiFiE�1F #b�E afiEiF�l�IFiFiE�lEif��1E1EiEiFiE�lElEiFiFlf*3FiFiEiFiFif3E�lFiFiEiF�lEiEiEiF3 fifiEiElfif3flk1flEiFiElEif�1(�3EiEiElEi6lF1E#fiF9Fi(-if3flf*1ElfifiElEifihiEiE1F�1ERif LEGALI2ATION:N F E E S U M M-A R Y STRUCTURAL SEGMEA3T;Y OWNERBUILOEflDECNBATION: Iherebyaffirmlhallamexempllrom��eContrac�ors'S�a�eLicense.�aw�onne�onowingreason BLDG P�T PLUM$ING E CCTFiIC MECHANIC FIRE Sh1IP/RGS GRP.DIN(�i (Seclian 7031.5 Business and Pmfessional Code: Any ciry ot coun�y which requires a permit �o con5imc�, alter, impmve, demolish, or P ERM I T 1 6 Z, � � . ' 1, 0 0 repair a�y simcmre. nnor �o its issuance. aiso reQutres tne appucam �or sucn permit m iiie a signed statement inai ne/sne is iicensea _ �� - SMIP /NON—RES oursuant Io the provisions o� Ihe Comramors State License Law (Chapler 9(commencing wrth Secuon 7000) ot Drvrsion 3 0l the Busmeu pLAN ,- 2 6: 3 3 and Pwiessions Code) or Ihal he/she is exempl �herelmm antl Ihe Gasis tor ��e allegetl e�emption. Any violation ol Sec�ion 7031.5 by ' any applican� lor a permil sub�etls Ihe applicant Io a civil penalty of not more ��an��ive huntlrea dollars ($500). ISSQE FEE � i. as owner ai me vropeny or my emvioyees with wages as iheir sale compensaiion, wiu ao ine work, antl tne HUILDING—D`1V—> PERMIT ISSUE PLAN—CHECH �❑ stmciure is not imenaea or ofteretl for 5ale (Seciion 70a4. Business and Pm�essional Codef The Conlrac�ors' Slate License Law TOTALS-- --> , 16 3, 00 0, 0 0 2 6. 3 3 tloes no� appry to an owner o� a pwpeny who builds or impmves4herean, and w�o tlaes such work himsel�/hersel� or Ihrough � �� nis or ner own emp�oyees, pmvieetl mat sucn imorovemems are not incenaed or o��ered �or sale. IC however ihe builaing or REVENUE D TV2S ION TOTAL:i --> COLLECTED • impwvemem is so�d wi�hin one year o� comp�e�ion, �ne owner win nave me burtlen ot pmving he�she eia no� huim or impmve H LDG PMT PLUMB I NG ELECTR I C MECHAN Z C for Ihe purpose of sale). . 162,00 ❑ I, a5 owner ol �he propetly, am exclusively contracting wi�� licensed conVacfors to cons�mct Ihe pmlec� �S�eclion 7044, B M1iness . 3 TUTAL PAID DUE lfi9, 33 1II9, 33 .00 189,33 OVEk/SHORT; 00. FIRE SMIP/TOT GRADING PLAN—CHEC1( 1,00 Z6.33 anUProfeSsion5Co0e. TheConVactars lateLicenSeLawtloeSnolapplytoanownerolproperlywhobuAsorimprovesiereon *****��**�*�***��*�****�****************#****�*******�**�**�********�*****�**** and who coniracis lor such prolects wilh a coniractor�s) license pursuant to Ihe Coniraclors', S�ate Litense law�. I am aware iha� pmo� o� iheir warker's comDenseiion insurence showe be vmvinee m me. Z N D I V 1 D l7 A L F E E B Ii E A K D O W N ' � I am exemp� un0er $ec�ian: B. 8 P. G � � m�tnisreason: TYPE QTY D E S C R`i P T I O N UNIT COST TOTAL COST oate� ownec � $FR do �ereby cenily Ihat I am aware ol an0 unaerstantl Ihe requiremen�s of Califomia Healih and Sa�ery Code Sec[ions 25505. 25533, antl 25534 ana Ihat I or any fuiure builaing occupant will/will noi (cimle one� neetl to compty wi�h saitl state co0e5 and ihe requiremenis �or a permil br conslmclion or modificaiion imm Ihe Air Oualily Management �isirict. qesitlen�ial constmciion applicaiians are exempl tmm - these Omvisions. / �a�e. Rpplicant _ I hereby cerOfy that I have reatl ihis apohcation antl slate tha� ordinances antl Slale IavA relating Io builtling consimction an� 1 ` pmPerry or insp�uroos� Dale: SignaWre 1 orivefs License ar Social Securiiy n: maUon Is carrecl. I agree to comply with all ciry represema�ives o� ihi�ypo en�er upon �he aboy I6<1-a6 Whl�e—BuJtling�, Green—Cotle EniorcemenL Canary—Appl¢an�; Pink—Revenue: Goltlenrotl—Assessor 143 �STRUCTURAL BY VALUENDpOF PEES'00 ' 100.00 19,300,00 0 ' V i Q1 0007390b-4�G7S9U&' `�`?J'f ?�9.3s DATE; ^.2/23f9I TI�E; IC�:SS � CONSTRUCTION AND PLANNING " P` "`$ SPA Date Inspector Date Inspector� APPROVALS Permit # " � APPROVALS Permit # �. 1. Temporary Electrical Service'o� Pole � �_, .52. Pool & Equipment Location 4 2. Soil Pipe-Undrgrnd. �� ?-. 53. Steel Reinforcement �'�� 3. Electrical Conduit Utility�Undrgrnd, . 54. Forms - ' 4. Electrical Cortduit-Uadrgmd"` � 55. Electrical Bonding =-. 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test - 6. Electriwl UFER Gmd. - 57. APPROVAL TO COVER�GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. '. 8. Foundation � J� �y� 59. Gas Pipe, O Undrgrnd., Test . y�= 9. Water Pi e�Undr rnd. �:�j �� p g ' i, � �� 60. Backwash Lines, RTrap, O Undrgmd. +' 10. Structural Floor System �;;� � �} 61. APPROVAL TO DECK � �- 11. Property Sewer Line & House Connection -.� 62. Backwash & Receptor-Final � 1�2. Sewer Cap . ,_� ; ' 63. Heater & Vent-Final .r- 13. Roof Drains � � �%, � 64. Plumbing System � Final r� �' 74. RoughPlumbing �; :.f 65. Electrical-Final' �� 15. Rough Electrical-Conduit�- '� �� . 66. Solar System-Final �"CJ ' i6. Rough Electric Wiring ,y° ��! 67. Fencing & Access ApProval / 77. Rough Wiring Sign �' �� ' 68. APPROVED FOR PLASTERING / 18. Rough Electrical-T Bar Ceiling �� 69. POOL/SPA SYSTEMS FINAL /. 19. Rough Heating & Ai� Conditionin9 � FIRE DEPT. REQUIREMENT i� 20. Rough Factory Fireplace ' : -�� _ , +� APPROVALS � Perinit # , 21.'Ducts, in Structuce•. �� ' � � �70. Underground HycJro � 22. Ducts, Ventilating ' • � 71. Product,Piping O Gas � Oil 23. Gas Pipe-Rough &�Test ' . - 72. Underground Flusli�-� .' � 24. Roof Framing ', ti- � ' 73.-,Undergrnd:Storage,Tank OGas OOiI 25. Roof SFlea[hing . � . , ` �74, Overhead Hydro' � `� . 26. T�Bar Ceiling IStructurat} & Monocoat � � 75= Dry C�emical � � . 27. Frame and Flashin9� •. „ .� 76. Dry Siandpipe �� .' 28. Lathing & Siding • � "� � t � i ^��. � 77.- FIXED SYSTEM F,INAL' . - 29. Insulation . � ` � � �� ' . 7g. FIRE PFEV. FINAL -� 30. Drywall Nai�ing `, � `" � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat, - .' _ � 1 � �� ,J9� PINAL INSPECTION � 32. Electrical Power Meter-Final � � � •80.'.FOOD CERTIFICATE ISSUED . f 33.`Final Electric � . ' � . ` � Notes: ' � . r �_ -34. Final Heating & Aic Conditioning�. . . � j ' ' - . '�� /� G �A� ->� � � � 35. Final Gas Pipe�TesY ' ' �. � � ` CG(� `��3D � 36. Hood or Canopy • . . j � ��. � _ �_ 37. Final Fattory Firepldce " � I � . . ' 38. Final Plumbing ,• . � � j� � 39: Water Service�Final• � � � _ ' ; - 40. �Gas Service-Final . . �� f : . � t 41. Solar OomestioFinal� '� � � j' ` '� `' 42. Backflow Preventer, _ , ' j �. �. � ' : � 43. Backflow Irrigation� � � ' � � , � 44. Landscape Irrigation System• , ,. . ,. . _ .� 45.�Sound Attenuation ' ' ' ' � . . • 46. Handicap Regulations � . " , � 47. FIIVALSTRUCTURE&BUILDING �V•(� I I .�' 48. FINAL PLANNING � � � , .. 49. Electric Release to Edison � I I+ > . I I 50. Gas.Release to Southern California Gas Co . � , � , , 51. CERTIFICATE OF.00CUPANCY . � < i � No. Date OWNER STATE-WIDE Developers, Inc. DATE JOB ADDRESS 3 Me ow Broo BUILDING PERMIT N0. 41801 GENERAL CONTRACTOR � ame DESCRIPTION of WORK es, w a , garage i �qs ` SUBCONTRACTOR WnTER Pl�mbin ROUGH PLUMBING . �/I�J/. I. �L� .. _ n i „- SPRINKLING SVSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CONDITIONING TEMPORARV SERVICE OR POLE UNDERGROUND � POWER � ROUGH WIRING FLOOR SVSTEM BON� BEAM � STE $HEAiHING FRAME AN� FLASHING LFTMING — IN i P�ASTER,BROWN COAT STA 'RAL, FINRL HEA ,�VENT., REFR PLUMBING", FINAL HND ELECTPIC,FINAL BUILOING, FINAL z . a cwj ZQ ON am J7 J � Q w CI J • 4] J Q U N Z ¢ W � p. W W2 J Q m Z J � W w 0 z� w� N � 70 F z Q �.: J a a Q O N Z O F- U � � F N z � 41R�� COSTA MESA BUILDING-SAF P.O. BOX 1200 COSTA MESA, For Applicant to Fid in eui�oiNc3441 .. . .. , PRIV I ;1AY 1 z-7fi�M�:O� 764�` tr.:'<210.��i APPLICATION FOR BUILDING PERMIT RECEIVED BV DATE RECEIVED naTc issui OWNER State-Wide Develo ers, Inc. A.P.No. '-ao=c MAIL qDIDRIE S -31�Y'� AooRess 9461 Grindlay arv Cypr25s No�826-4550 TRACT$S`• CANSTRUCTION N W A D A BflANCH ADDRESS ADDRESS17848 SkyPark Blvd Irvine coNraACTORState-Wide Developers, Inc. AooRESs 9461 Grindlay CITV Cypress No.`�826-4550 LTC.NO. ZL47�O LICyNO. OF LOT 12.093 dCl'05 NOW ON LO S O USE OF EXISTING BLDG. SIZE OF NO. OF NEW BLDG. ROOMS STOAIES EXTERIORWALLP�aStGa�" ROOF Shake COVERINC COVERING USE OF BU�LDI • D WOFK TO BE PERFORMED New construction-Condomini I hereby acknowledpe thet I have reatl this application antl state that the ebove intormation is corract entl a8ree to comply with all laws regulaiing builtling construction, and I shell not employ any person in violafion of the workman's compensatian laws ot the State of Californie. I hereby certify that I am properly Iicensetl as a contractor untler the State of Californie Business antl P�ofessions Cotle, Divisicn 3, Chapter 9, antl that such licenses are In full torce end affect, or I am ezempt trom Me provlsions of the State of Calif rnte Business antl Professions Cotle, Divislon 3, Chapter 9. te-Wide Developer Inc. Signature � Permlttee A�.ho�,�ad oaa�t Vice President OWNE FIRE ZONE APPROVED ZONE 2z C P YARDS A MAIN BI DISTANCE BET. MAIN 84DG5. VAR.# � _ HOLD FOR �Onoo � DATE OF USE OF NEW NS Z BUILDING VED VAR�SAI BET.I ACCE' OATE i�—� — =22-7 1254 sn.FT. J-655 THE AMOUNT SHOWN UNDER V AlUAT10N THE GURPOSE OF ESTABLISHING A PERMIT FEE VALUATION 3�0 � PERMIT FEE $ • PLAN CHECK $ �' � 0 W 0 R � ¢ � N � E o` LL