HomeMy WebLinkAbout3447 MEADOW BROOK - Building PermitsCITY OF COSTA MESA �
; . •- �- BIIILDING DIVISION
JR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M08-00136
PERMITTYPE MECH STATUS: ISSUED
APN: 93506073 DATE ISSUED: 10/27/2008
ISSUED BY: KJB
JOB ADDRESS: �3"4,,"4_7_MEADO`W�BRO�OK CM� , Swte/Unrt
vicinity: _ , , ,
SQ. FT: 0 , ^ . ' . ... -
SCOPE OF WORK: CHANGE OUT FAU AND;A/C�UNITS. SAME SIZE AND LOCATION. �-� � '
OWNER: DILLON, DONALESE'-,% Address: ., %DILLON,.JAMES�C'� UmEPERRIS, CA
PHONE: 951-789-2532: r �; City/State/Zip: ` 15525 VIA-BARR.4NCA
ApPLICANT; TEJEDA, GEORGE �'' ' Address:•. ` 202 E`STEVENS AVE;`UmtiUNIT G �
PHONE: 714-708-3664 .• � , � ��City/Sfate/zZip::�-�'..SANTA�ANA,CA.�, - ,
;
- .�:�' _ + °' i'.
CONTRACTOR: COAST AIRE License No. 355425'`
Address: 202 E STEVENSUnit: UNIT G � � �-• - - � � � �- PHONE; . ��.7�14-706-3664 �`� �
City/Slate: SANTA ANA, CA �.-�, - ZipCode:, 92Z05 � - - � . . . : �- CELL: �. , � � . � . �
MECHANICAL PERMIT FEE SUMMARY _ ` .
MECH ITEM FEE: � �. �$53.00 - . ; . � - -
PLAN CHECK FEE: � " �-- �� $0,00 -
INVESTIGATION FEE: _ • ^_ � $0,00 _'��•- � - � -
REINSPECTION FEE: i .$0,00 -� � -�� ' � � - ,
TOTAL FEES: $53.00 -
• �:: ' �
Ld�� �.Ll.�r�
DATE ✓�' ��' ��
��� ,"��v`=�''
�
/Od� /Cfler �-z ,
sent : oyp�r�d
may iV�r+�,
NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) , � ' �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . , ��,
INSPECTIONS: In ortler for the work authorized under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obWined. Failure to obtain inspections and final approval.vrill result in the ezpiration of Mis pertnit. .
OD /. INSPEG710NTYPE DATE INTITIRL LOOE/ INSPECTIONIYPE; g�TF, INnm�s
1616 Fized System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
2oi ,FinaiBlock/RetainingWall
202 Final Factory Fire Place
203 FinalSign
04 Final Demolition
206 Final Mechanical
208 FinalPlumbing
210 Final ElecUical
212 Final Fire Prevyntion-
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION� '- ,
I herBDy aKrtn under penalry of perjury one of Ihe following CeUa2tions:
❑ I have and will maintain a certificat0 of consent to self-Insure (or worlcers'
compensation, as provided for by section 3700 of the Labor. CoOe, for the
eAortna ce of the v.ork for vfiichtfiis parmit is issuetl. -
have and will maintain v.orkers"cOmpensation insurance, as required by
ec � n 3700 of the Labor Code, for ihe pedormance of the woik for which this
pertnit is issued. My vrorkers' compensation Insurance cartier and policy
number are: ��y� � �
cGarrier�- ct.�
(ina seCon rieetl not be m/mp/e/tetl atne perma k varuea at me hunared ddWrs (St00) w iess.)
POlfcy�Number- D y(J �� �O 9
❑ I certify that in the pedormance of [he work for which this pertnit is
issued, I shall not employ any person in any manner so as to become subjecl
to the workers' wmpensa6on laws of Caffomia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Cotle h I forthwith comply with these provisOi s.�^
! /�
el�ppliran' Sigrelure... �Da�es�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST �F COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF TNE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 of ihe Business antl Pro(essions Code, antl
my license is in full force and effect.
ILit:.#--� SS ,S CIaSs_#--- �—��
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�tra�� ' Slp�Wre le—_�
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a construcibn lentling agency tor the
peAormance of the v.ork fa wfiich [his pennit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
Daie
OWNER-BUILDER DECLARATIONS:
i hereby affrm ihat under penalry of pe�ury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe following reason (Sec. 7037.5,
Business and Professions Code: Any ciy or county which requires a permi� to
wnstruct, al[er, improve, demolish, or repair any slmcWre," prior lo its
issuance, also requires the applicant for such permit to fle a signed statement
thal he or she is Iicense0 pursuant to ihe provisions of the Contractors
License Law (Chapter 9(commencing w��h Section 7000) of Divisi0n 3 0( Ihe
Business and Pro(essions Code) or that he or she is exempt [herefrom antl
lhe basis (or lhe alleged exemption. Any �iolation of Section 7031.5 by any
applicant for a permit subjects the applicent to a civil penalty of not more ihan
fve hundred dollar5 ($500j.):
❑ I, as ovmer of ihe property, or my employees with vlages as I�eir sole
wmpensation, WILL DO THE WORK, and ihe strocWre is not intended or
oflered for sale (Sec. 7044, Business and Professions Code: The Conlractors
License Law does not apply to an owner of property who builds or improves
thereon, and who tices such work himself or hersel( or ihrough his or her own
employees, provided that such improvemenis are not intended or offered for
sale. If, however, the building.or improvement is sold vnthin one year ot
completion, lhe owner-builder will have the burden of proving tha[ he or she
diC not build or improve for purp,ose of sale.).
� I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construct lhe project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply to an ovmer of
property who builds or improves ihereon, 8nd who con[racis for such projec[ vrith
a coniractor(s) ficense pursuant to the Conlractors License Laws.). .
❑ 1 am exempt un0er sec.
Business and Pmfessions Code for this reason:
�Owner ID venfied by drive � Ves ❑ N
Driver's License No. .,pi �
VenfcationotOvmers�i b � '
p y(rype ot document,�.e. - property ,x bill or tleetl): �.�
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: � .
❑ I hereby certi(y Ihal no excavation Me (5) or more feet in tleplh into wfiich a
person is required to descen4 will be made in connection vrith work authorize0
by lhis permit, and lhat no building sWcture, scaFfdding, falsework, a demolilion
or dismantling thereof, will be more Ihan [hirty-su (36) feet high (Chap. 32, Grp
2. Art 2, Sec. 341, Title 8, Califwnia Atlminist2tive Code).
❑ As ovmer-builder, I will not employ anyone to tlo work which wou10
require a permit from the Division of Industnal Safety, as notetl above. unless
such person has a permit to do such vrork from Ihe division.
Applicanl's SlgnaWre
Division ot Industnal Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicanl or present or future building occupant need lo file and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, vnth some
exceptions, ihat a Business Plan be filetl with the Costa Mesa Fire
Department by every business which has at any one [ime dunng a re0o�ed
year a quantity of hazardous matenals equal to or greater ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feel of compressed gas
at standard temperaWre and pressure�.
2. Does or will Ihe applicant or present or future building occupant need [o file
a registra[ion form (or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Heallh and Safety Code, wiM some
exceptions, requires regisUation vrith [he Costa Mesa Fire �epartment by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weighl 01 500 pounds, or a
volume o( 55 gallons, or 200 cubic leet of compressed gas at standartl
temperature and pressure).
3. Does or will �he applicant or present or fuNre 6uiltling occupan[ neetl to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code pmvides Ihat Ihe
Costa Mesa Fire Department may require the preparation, certification and
fling with the Fire Department of an RMPP by businesses which are requiretl
[o regis�er acutely hazardous materials wilh Ihe Fire Depatlment.
4. If an RMPP is presently required, has Seclion 25534 of Ihe Califomia
Health and Safety Code been (ully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building cecupant require for
the work which is the subject o/ Ihis applicalion a pertnit (or such consWCtion
or modifcation trom ihe South Coast Air Qualiry Management District or from
any other air polWtion control tlis[rict or agency? ❑ Yes ❑ No
(Sec[ion 658502 0( lhe Califomia Govemment Code requires Ihat the requesled
infortnation be lumished on applications fa non-residential building pertni[s�.
6. Will any paN of the faciliry to be constNcted under this pertnit be Within
1000 feet from the outer bountlanes of a school? ❑ Yes ❑ No
Qf yes", the facilily must meet the requirement of Sections 25534 and 42303
o( Ihe Califomia Health and Safety Code).
7. 'If a pertnit trom the South Coast Air Quality Management DisMct or other
air pollution contml district or aqency is required for the work which is Ihe
subject of this applicatioq have all of the disclosures prescnbed by Califomia
Health antl Satety Code Section 42303 been made� ❑ Yes ❑ No
8. (If'yes", attach certifcate of compliance from the appropriate aii pollution
control oKcer). � �. �
CERTIFICATE OF COMPLIANCE: I certify that under penallyof perjury the
infortnation given above_is correct. I agree to comply wilh all state lavrs and
city ortlinances regarding�Hazardous Materials antl Emissions: � � �`
Dale '
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF�ENTRY: I
certify under penalty of perjury that I have read this applica6on antl state that
the informa[ion given is cortec[. I agree to comply with all state laws antl city
ordinances relating to building cons�ruclion, and authonze representatives of
[he City of Costa Mesa [o enter upon the above-tlescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this pertni[ until final inspection. ,
� Si vre of Legalp wner(s) � ale
SignaWre - Oate (}(`J .'Z_"� 0
305]J6(1�O1) r�ntl 'AulhotlzeEg pl�wM Oale—
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�
- � . CITY OF COSTA MESA , ' • � '
OstNMps9 BV�L��NV �II,S��N �
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F�,,.. `. � 77 FAIR �RIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
�. ' FOR INSPECTIONS CALL: (714) 754-5626
�`°°-�°�` PERMIT NUMBER: E11-00070
PERMIT TYPE ELEC
APN: 42613214
u
JOB ADDRESS: 188�MERRILL.PL�1C�M -.
vicinity: �``�e�'��gf� �
SCOPE OF WORK: TEMP. POWER POLE
OWNER: MEYER, SCOTT AND L.AUREL
PHONE:
APPLICANT: MEYER, SCOTT AND LAUREL
PHONE:
CONTRACTOR: OWNER-BUILDER �
Address: Unit PHONE:
City/State: ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
� Electrical Permit Fee: $47.00
Reinspection Fee $0.00
TOTAL FEES $47.00
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
04/18I2011
CAC
Address: 188 MERRICL P� Unit: �. �
City/State/Zip: COSTA MESA, CA � �
Address: 188 MERRILL PL Unit: �
City/State/zZip: COSTA MESA, CA �
� _ ��.
. `2 ; _s.6 i.; t� F �.
License No. 000000
CELL:
. . .'' i;
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
iegulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE 1. INSPELTION ME DRTE INTITIALS CODEN INSPEG110N TYPE �ATE IN➢71qL5
1616 Fixed System Final Fire Prevention 206 Final Mechanicaf . �
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical �J- 9i� Q/�.8�
2oi Final BIocWRe�aining Wall 212 Final Fire Preven�ion
202 Final Factory Fire Place 220 Final Planning Approval
r .
203 Final Sign 222 Final Site �' � ` �
204 Final Demoli�ion 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION�
I hereby affrm under penalry of perjury one o( the following dedarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'
compensation, as pmvided for by seclion 3700 of [he Laboi�Code.�for lhe
performance of the work tor vmich this permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 0( [he Labor Code. for the perfortnance of the work (w wfiich this
permit is issued. My workers' compensation Insurance carrier antl policy
numDer are:
Carrier.
(Tha secfion neetl �wr be completetl dtne permrt is valued at one hundretl tlollars (St00) ai less.)
Policy Number:
� I certify that in the pedormance of [he work for which lhis pertnit is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation lavrs of California, and agree lhat if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply vrith [hese provisions.
Applipnfs SignaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
(5700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrtn that I am licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pmfessions Code, and
my license is in full force and effect.
LiC. # . . _ CIa55 #
Conhanor's Signalure Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
peAortnance ot the v.ork fa which this pertnit is issued. (Sec. 3097. Civil Code).
Lenders Name:
Lender's Address:
SignaWre Date
OWNER-BUILDER DECLARA710NS:
I hereby aKrm Ihat under penalty o/ perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5.
Business antl Pro(essions Code: Any city or county which requires a permit to
construct, alter, improve, tlemolish, or repair any strucNre, pnor to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant lo [he provisions of the Contractors
License Law (Chapler 9(commencing with Section 7000) of Division 3 of the
Business and Protessions Code) or [hat he or she is exempt [here(rom and
the basis for Ihe alleged exemption. Any violalion of Section 703L5 by any
applicant for a permit subjects the applicant to a civil penalty ot not more than
fve hundred dollars ($500).):
❑ I, as owner of the properry, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl the structure is not intended or
offered tor sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not appty ro an owner of properry who builds or improves
thereon, and who does such work himself or herself or through his or her ovm
employees, provided that such impmvements are not intended or otfered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner-builtler will have the burden ot proving that he or she
did not build or improve for purpose of sale.).
� I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl
Professbns Code: The contractas License Law does not apply to an ovmer of
propeny who builds or improves ihereon, and who contracts for such pmject with
a contracta(s) license pursuant to the Contractors Ucense Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
n � ��
� �1
� � � SignaWre ate
9BS!-t6 (3I0])
Ovmer ID v� ri ic I��/ st /ny No
Driver's Li nse No. % ' Expir s: � ��
Verification.o( Ownership by (rype of documen[, i.e. - propen etl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby ceridy that no excavation frve (5) or more (eet in tlepth into which a
person is required to descen4 will be made in conneclbn wilh wvrk authonzed
by this pertnit, and Ihat no building slruclure, scaffdding, falsework, or demolilion
or dismantling Ihereo(, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, AA 2, Sec. 341. TiHe 8, Califomia Administra[ive Cotle).
❑ As owneo-builder, I will not employ anyone to do vrork which vrould
require a permit from lhe Division o( Indusirial Safety, as noted above, unless
such person has a permit to do such work (rom the division.
' AOPliwnl's SignaWre Dale
Division of Industnal Safety Permit Number: _
HAZARDOUS MATERIAIS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant neetl to fle and
certi(y a Business Plan tor emergency response lo release or Ihrea[ened
release of a hazartlous malerial? ❑ Yes ❑ No
(Section 25505 of the Cali(omia Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with t�e Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity of hazardous matenals equal lo or greater than a weight of
500 pounds, or a volume oF 55 gallons, or 200 cubic feet of compressetl gas
at standard temperature antl pressure).
2. Does or will the applicant or present or future building occupant need ro file
a registra[ion torm for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 of lhe California Healih and Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire Depanment by
each business which at any one time has on hantl a quantiry of awtely
hazardous ma�erials equal to or greater Ihan a weight of 500 pountls, or a
volume ot 55 gallons, or 200 cubic feet of compressed gas at standartl
temperature and pressure).
3. Does or will Ihe applicant or present or future builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 0( the Califomia Health and Safery Code provides [hat Ihe
Costa Mesa Fire DepaAment may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
ro register acutely hazardous ma[erials wilh the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health antl Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future builtling occupant require tor
the vrork which is the subject of Ihis application a permit for such consVuction
o� modifcalion from the South Coast Air Qualiry Management District or from
any other air pollution control distnc[ or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires t�at the requested
in(ortna�ion be fumishetl on applications fa non-residential building permits).
6. Will any part of the (acility to be consWctetl under this permit be within
1000 feet /rom the outer bountlaries of a school? ❑ Yes ❑ No
(If yes", the faciliry must mee[ [he requirement of Seclions 25534 and 42303
of the Califomia Heal[h and Safery Code).
7. If a permit from the South Coasl Air Qualiry Management DisMct or other
air polWtion control dis[rict or agency is requirea for the work which is the
subject of this application, have all of the disclosures prescribed by Calitomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qi'j�es", at[ach certifica�e of compliance from the appropriale air polWtion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify thal under penalty of perjury t�e
infortnation given above is co�ect. I agree to comply with all stale laws and
city ortlinances regarding Hazardous Materials and Emissions.
Sgnawre Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION oF ENTRY: 1
certify under penalty of perjury that I have read this application antl state that
lhe information given is correcL I agree to comply vnth all state laws and city
ordinances relating to builtling construclion, and authorize representalives of
[he Ciry of Cosla Mesa to enter upon the above-tlescribed property for
inspection es. I gree not to occupy or allow ocwpancy of any building
au[horize by this it until fi I inspection.
— %�
Signal egal er(s) Dal
ntllor AulM1onze4 Appll�ant Dale
PPOJECTAOOflESS:. 349% %�E��w B���j( UNIT: �
OWNEfl'SNRME: VILLAGE CREEK HOMBOWNERS .
aooRess: A�SOCI•ATION
3429 TZMBER LAKE
CM VA 926Z6
ANCH/ENGINEEH: CHESTER CARVILLE . wEc.xo.: C18305
nooxess: 7922 ARMOUR ST uxir:
S,D. CA 92111
' PEflMITTEE: PHOENIX ENTERPRISES INC. ( 213 ) 690-9559
aooAEss: 411 COMERCIAL WAY
LA HABRA CA 90631
LICENSEO CONTflFCTOfl DECLAHPTION: I hereby affirm thal I am b setl untler pmvisions oi CAapter 9(commencing with Section
7000) ol Division 3 0� Ihe Busmess antl Pmfessions Code, and m� c se i n'�ull �orce and e �
ciTvuc � �s rJa_e}ic.:376639 c s+R ^
�ate:. � SignaWre: V��
WOHKEHS' COMPENSATION OEClANl1TI0N: I here�y affirm ihat I �ave a cenificate of consent to sel4insu or a certificate oi Workers'
Compensation�r� c rlifietl co I�ereoi (Section 3000. La�.
°OLICY NO.: W��D ��� DY ' E%P. DFTE: 7IO � I 91
�fOMPANY: CA COMP & FIRE
�`J Cerlili d copy a �ere�y turnis ea. ❑ Cetlitie0 copy is �ile e i uiltling �ivisio
Date: _���_ APPlicanC � . .
ESEMPiION FROM WOFRERS' COMPENSATION OECIAflAiION: (This Sec�ion need no� he tompleied if Ihe permit is lorone hunOreA (5100) oNess�.
I cenify ihat in �ne pedormance ot ihe work 1or which Ihis permit is issued. I shall not emDloy any person in any manner so as to eecome
su�jec� lo Ihe Warkers' Compensation Laws ol Califomia. �
Date: Signature: '
NOTICE: If. after making Ihis Declaraiion, you should Decome sublect lo Ihe Workers' ComDensa�ion pmvisions of the LaOor
�Code. you musl fohhwilh compty with suc� pmvislons or this permit shall be Jeemed revoketl.
CONSTflUCTION LENUING AGENCY: I hereby aHirm �ha� �here is a toretmc�ion lending agency �or the pertormance o� Ihe work tor
which Ihis peimi� is issued �Sedion 3097. Ci¢ C�.
LENUEN:
PDONESS: , � ' - '
OWNEN BWL�EB OECIAPATION: I here�y aflirm Ihai I am exemp� imm Ihe Contrac�ors' S�aie License Law br Ihe tollowing reason
�Sec�ion 7031.5 8usiness antl Pmfessional Cotle�, Nny ci�y ol coun�y which requlres,a permi� to constmct, al�er,�improve. demolish, or .
repair any s�mqure. OriOr tu its i5suance, als0 requireSlAe applitan� lOr 5uth permi� �o file a Signetl Sia�ement ��at helslte i5 liCensed
pursuant Io Ihe provisions oi �he Contractors' S�ale license Law (Chap�er 9(cammencing wi�� Seclion 7000) o� Oivision 3 oi ��e Business
antl Pmlessions Cotle� ar ihat heishe is exempt therefmm and ihe basis br the alleged exemption. Any violation ol Section 7031.5 6y
any applicanl lor a permii sublecis Ihe aDP�icanl to a civil penally of not more �han live huntlretl Oollars (5500).
I, as owner oi IAe pmpeny or my'emploVees with wages as Iheir sole compensation, will tlo �he work, an0 t�e
� stmcWre is not inten�ed or oifered lor saie (Section 7044, Business ana Pmfessional Code: The Contractars' State License Law
� Ooes no� apply �o an owner O7 a property w�o huilds or impmve5 th¢reon, antl who Ooes SUt� work him5ell/hersel� or thmugh
his or her own employee5, pmviAe� Ihal suCh imD�ovemeNs are no� in�en0e4 or Oiterea i0r Sale, I�, however t�e building or
improvemem is sola wilhin one year a� campletion. Ihe owner will have �he buraen o� pmving Ae/she ditl noi �uild or impmve
lor Ne purpose of sale). '
I, as owner o� the pmperly, am exclusively conVaciing wilh Iicense0 conUac�ors Io con5lruct ��e Drojeti (Section 70da, Business
❑ and Pmtessions Code- The Con�raclors' Sta�e License Law Aoes no� aDPly Io an owner of pmpehy w�o builds or improves Ihereon
antl who canlrac�s lor such Dmlects wi�h a contractoqs)license pursuan� Io the Coniractors' S�ale License Law),I am aware
t�a� prooi ol Iheir Worker's Campensa�ion insuiance shoultl be pmvided lo me.
i� I am exempt untler Sec�ion. B. 8 P. C.
. � Ior ihis reason: ' .
�a�e. � Ownec
I do hereDy cetlilY Iha� I am aware oi ana untlersiana Ihe requiremenls o� Calitomia Heallh and $afety Catle Sections 25505, 25533. antl
25534 and that I m any future builaing occupant willlwill no� (cirde one) nee0 �o comply wilh SaiU s�ate codes and ��e requiremen�s �or a
permil �or �conslmclion or mo0ilica�ion Imm �he Air Ouabry Managemenl �i5trici. Re5i0enlial cons�mction applica�ions are exempt �mm
IAese pmvisions. ' ,
Oa�e�. ppplicant:
I hereby cer�ily Ihat I have reatl Ihis applicalian antl slale Nat the ab i r ion is wrrecL I agree to comply wi�h ali city a ounry
ordinance5antlstatelawsrelaiinglobwldingconstmc�ionantlhere�� ut riz .preSenla�ivesofthis ' Ioenterupantheabo -menlionetl
pmperly f inspectian purpos/e�� �
Date: _ L I_L— SignaNre:
�river's �icense oi Socia� Security x:
i6At-46 Wbiie-6utl0ing'. Green—Cotle EnlorcemenL Canary—Applicam: Pink—Revenue: Goltlenmtl—Assessor
' CITY OF COSTA MESA — DUILDING�PERMIT PERM NO; B 5:3�I
PERMIT NO: B 050635 , PLAN CHECK NO'; 00079-91 A C,cS�Z�v�'DP�
CONSTRUC'PION..TYPE: V—N � PERMIT TYPE: §TR I�URPOSE: RHP
SOH DESCRIFTION : REPAIR S,ETTLEMENT.DAMAGE . SQ FT; 193
CLAIM VALUE: 14,300.00 CALC—VALUE; 14,300,00 �GROUP OCC: R-3 /
COMMENTS; BUILDING SETTLEMENT REPAIR/FO[JNDAT30N
xx x*�r**�r�**u*�**x�r�x*�cx*x���*�r��**��t�x x�r�c-**�r��*�****�t�t*�rx**u��tu���*��r*x�rx�����**�
Z O N I N GS ERTEB�AUCIKRSE M E N T S
� ':
------------ MAIN BUILDING ----------' --------- ACCESSORY BUILDING ---------
FRNT: F'I' IN REA.�2: FT �IiV' FRNT�; F't IN AEAR: FT I13
LEF,T; FT IN RGHT: FT IN LEFT; FT IN RG3T; FT IN
PARRING REp • PROV; PARCEL:�935061?.4 ZNE: R2 REF NO;
PLANNZNG N(ST'ES> FOUNDATION REPAIR. . ,
� .
iE * iF �ElE aE if 1E �F iE �F iF IE iE iE if jE 3f It iF iF iE if 3F iF if jk �E iF �F �!f iE 3E �f iE �JF iE iE jE 1f iE fE if ff 3f aF iE if iE �E iE iF iF # 3f al. y,. {F #'-jf iElE RiE iE iE ii iF iF k�lE aE 1E 3f if iE if if ii
D E V�E L O P�M E N 1' S E R V T C E S R E Q U I R, E M E N<T S
ZONING APPROVED BY ;� � �� , � DATE; O// S� I
/
bUILDING APPROVED'HY : w ��— � �"V' DATE:
APFLICATION ISSOED BY: DATE: +�
jE 1E IF af IE jF jE 3E iE �lE 3E 9E iF iF 3F jE �E )E iF �F IE 1E �F±E 3E 3E 3F fE 3k if 3F 1F3�ap �
�tiF�1f3ElFi(�3E�1E#E3f-ifif3E�lEiF3FiEiElEiFiFiEifiFif#1fdEiF1(�%�ifjEifiFiE�1E EiEiE�EfF3EaEjEiFiElFiFiElPiE3(�iEjEif3fififi'tjE7f1EiFlkiF.i4iFiFiE�IFiFiElE3E3F3Fif
LEGALIZATION:N F' E E '� U M M A k Y. STRTICTURAL SEGMENT:'Y
SLDG PM1" PLUMHING ELEC IC MECHANIC FIRE SMIP,/RE$ ' GRT�pI,yG
PERMIT 162.00 r� �" 1,00
: - ' SMIPlNON—RF.S
PLAN 26.33� • '
ISSUE FEE
BUILDING—DIV—> PERMIT�'ISSUE PLAN—CHECK TOTAL PAID UUE
TOTALS----> ifi3,00 0.00 26.33 109:33 189.33 .00
REVENi7E DIVISION TOTALS--> COLLECTED; 109.33 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN—CHc':CK
167..00 ' 1.00 26.33
iE iE 3E #F if 1E if j(-�7f iE !E ih #E if if iE i4 iF �f if� IE iE iE iE iE IE%!f iE IElF �)f if IE 3E 1E #f iE iE iE iF If- iF iE iE iE-1(- # iE 1E iE iF if lE iE iF )f 1E 1E X� 3E iE iE ff 3f �1F 1E lFiF iE iE'/.� iF IE if 1f i41E iF
I N D I V I ll U A L F E E B R E A K D U W N
TYPE QTY D,E S C R I P T I O N ' UNIT COST TOTAL COSi
SER 143 STRUCTURAL HY VALUE PER 5100.00 100.00' 14,300.00
END OF fiEES,
0
ni OQ�?�°?'-0007EE�v '� ?c i 'S�.'.
DAT'c:��J3/23/i; TIPiE.'_t{}.-i: -- y - —
CONSTRUCTION AND PLANNING �
APPROVALS Permit # =" �
1. Temporary Electrical SerJice�or Pole
2. Soil Pipe-Undrgrnd. .i�
3. Electrical;Conduit Utility-Undrgrnd.�'
4. Electrical Conduit-Undrgrnd..-
5. Steel Reiri4orcement
6._Electrical UFEFt Grnd. -
7. Footings � .-
8. Foundation '+ %h
i
, 9. Water Pipe�Undrgmd. � �� �i%,
�
10. Structural Floor System "%��'
11. Property Sewer Line & House Connection
l2. Sewer Cap . � '
��
13. Roof Drains " � �
. i
14. Rough Plumbing ' f% �-�
75. Rough Electrical-Conduit I��
16. Rough Electric Wiring �
17. Rough Wiring Sign
78. Rough Electrical-T Bar Ceiling
19. Rouc�h He2ting & Air Conditioning '
20. Rough Factory Fireplace �
21. Ducis, in 5t'ructuie.
22. Ducu, Ventilating '
23. Gas Pipe-Rough & Test
24. Roof Framing - � - �
25. Roof Sheathing '� �.
26. T-Bar Ceiling (Structural) &�Monocoat.
27, freme and Flashing ' '
Date
' fi
28. Lathing & S�ding .-i • � -
�29. Insulation , . �
30. Drywall Nailing • - �
31. Plaster Brown Coat; , . �
32. Electrical Power Meter�Final �
, 33'. Final Electric ' . '
.34. Final HeaUng & Air Conditioning ^
35.. Firial Gas PiPe-Test' '
36. Hood or�Ganopy ' . .
37. Final Factory Fireplace • �
38. Final Plumbing - � � �
' 39. Water Service=Final �
, 40. Gas Service-Final . . . . .
41. Solar pomestic-Final
�
42. Backflow Preventer . .
43. Backflow Irrigation � •
44. Landscape Irripation System � ,
45: Sound Attenuation -
, 46. Handicap Regulations � ,
47. FINAL S7RUCTURE & BUILDING
46. FINAL PLANNING `
_49. Electric Release to Edison
, 50. Gas Release to Sou'thern California Gas Co
51. CERTIFIGATEOF.00CUPANCY
Date
.. 1 _&SPA
Inspector pppROVALS Permit # Date
�
r �
. ;
� : i
52. Pool & Equipment Location
53. SteeV Reinforcement
54. Forms
55. Eiectrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
� 58. EVectrical Conduit-Undrgmd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash lines, P-Trap, O Undrgrnd.
67. APPROVALTO DECK
62. Backwash & Receptor�Final
63. Heater & Vent-FinaV
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING �
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
- �APPROVAL'S� � Permit#
�70. Underground Hydro
� 71. Product�Piping � Gas ❑ Oi1
� 72. Underground Flusfi �� �
��� 73: Undergrnd. Storagz Tank � Gas ❑ Oil
, 74.- Over,head Hydro � .
75�_' Dry Chemical ' -
76. Dry $ta�dpipe � � ' �
77. FIXED SYSTEM FINAL
�� � 78�. FIRE PREV. FINAL
f; HEALTH DEPT. REQUIREMENT
�. 79'.'FINAL INSPECTION
� 80._ FOOD CERTIFICATE ISSUED
I
�' ' No{es: ' - . ,
. �
� _ _ .
( ..co-
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. `� � � ! �
Inspector
.l
�
�
�
i
OWNER STATE-WIDE Developera, Inc. DATE 4-28-76
JOB ADDRESS 3 7 Mea ow roo BUILDING PER�.11T N0. 41798
f.FNFRGI f(1NTRAfTf1R �BID@ I)FSfRIPTIf1N �i Wf1RK • p%g��� K��-
L ?CTIONS
SOIL
Gn5
WATER
PROP, SWF. LINE U HOUSE CON. U
SPRINHLING SVSTEM
MISCELLFNEOUS
ROIIGH HEATING AN� /+IP CONDITIONING
TEMPORARV SERVICE OR POLE
UNDERGROUNO � POWER �
ROUGH WIRING
fL00R SVSTEM
BOND BEAM �
FRAME ANO FLASHING
LATHING — IN Ol1T
PLASTER, BROWN COAT
5' i�qPL, F�NAL
H. IG, VENT., REFRIG. AND A
PLUMBING. FINAL AN� GAS TEST
ELECTRIC, FINAL
BUILOING. FINAL
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant ta Fill in Completely
BUILDING
OWNER State-Wide Developers, Inc.
MAIL 9461 G,.�ndlav
G f]!] R F55
aTv �.rl
CANSiqUCYION
BRANCH
ADDRESS
APCHITECT
No`926-4550
ADORESS 17848 SkyPark Blvd Irvine
coNTRAcroR State-Vlide Developers; Inc.
ADDRE55 ��V� �rindlay �
cirv Cypress No` 826-4
L C NO. 2247� J ' LICYNO.
OF LOT 12.093 aCY'BS NOW ON LO S
USE OF '
EXISTING BLDG.
SI2E OF NO. OF
NEWBLDG. ROOMS. STORIES
EXTERIOR W/aLL a5 er ROOF Shake
COVERING COVERING
USE OF BUILDING ANO WORK TO BE PERFOFMEO .
New construction-Condominiums
1 Residence w/att qar
P"'—� ;: 265.68
�aY 13-7E��,;:00 75C�;+ ::' �
APPLICATION FOR BUILDING PERMIT
EIVED BY DA7E RECENED �e.rc �saucn .
A.P. NO. /Cfb �(y.
BUILDING �/�J
ADDRESS =-�`f 77
FIF
550 Z�2 C� P�� 2 BUILDING EW
VARDSAPPROVED YARDSAi
MAIN BUILDING ACCESSOR'
(FROMGLSTREET) .
Q FONT FT.
Zi
L. SIDE FT.
REAR FT
DISTANCE BET. BET. MAIN &
I hereby acknowledBe that I have raetl this appllcaiion antl state
ihat the abo�e information i+ cormct and egree to compty w�th
all lews reB�latinp building consttuction, antl I shall not employ
any person i� ��olation of the workma� z compensation laws of
Me State of California.
I hereby cer��fy that I am properly licensetl as a contractor untlar
<he State o� Calitornia Business and Professions Code, Divisicn 3,
Chapter 9, antl that zuch licences are In �ull force and effect, or I
am ezempt trom the provisions ot the State of Ce Itornia Business
antl Protessia�s Code, Division 3, Chaptar 9.
_ State-Wide Develone+� Inc.
Permlttee �e
— ��
Authorizetl Agent
�
VAR. #
APPROVED //�.
RV li�I�
HOLD FOR
-)6
1715 sa.FT. J-783 ;
TNE AMOUNTSHOWN UNDER VALUATION IS FOR �
TME VURPOSE OF ESTABLISNING A PERMIT fEE ONLV: Q
VALUATION u) /�/% m
��` PERMIT FEE $ •— V �
, p m
$� PLAN CHECK $ E
II I /i � LL
TOTAL FEE