HomeMy WebLinkAbout2064 MEADOW VIEW LN - Building Permits/
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mes��DING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
.lobnddress: 2064 MEADOW VIEW LN
Suite:
Viciniry:
Primary Occ: R3 . Type of Conslruction: V-N
Parcel Number: 42201217 Zoning:
npp�icant: KREUTER,SUE
Address: 2064 MEADOW VIEW LN
COSTA MESA, CA
Owner. KREUTER,SUE
Address 2064 MEADOW VIEW LN
COSTA MESA, CA
Contrector: - �
Address: � . " �
Zip:
Arch :
Address:
Phone: 714-293-5785
Zip: 92627
Phone: 714-293-5785
Zip: 92627
Phone:
License:
Eng:
Address:
Status: ISSUED
Applied: 03/24/2006
Issued: 03/24/2006
ISSUED BY: " `
Phone: Phone: �
Zip: � � . License: � -- License:
� SCOPE OF PERMIT
OPEN A 4X6 AREA IN A NON BERAING WALL BETWEEN THE KITCHEN AND LIVING ROOM. WORK DONE WITHOUT A PERMIT
, FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $eoo.00
Permit: $23.50 Claim Valuation: $soo.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: , $0.00 - ---- - -
Inspection: $0.00
Total: $24.00
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY , Front 0- 0; �
'.; '
PARKINGV �, , Exisiin :" ;0..
PLANNING.& ZONING
Rear ' 0- 0 Left 0- 0 ,
� Rear 0- 0 Lefi 0- 0
� '�Required: 0 . � Pr000sed: 0
Right 0-0
Right 0-0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for ihe work authorized under ihis peimit to be considered legal, such work must comply with all applicable codes, and all
requlred inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION: ' ,
I hereby attirm under penalry of perjury one of ihe tollowing declarations:
❑ I have and will maintain a cetlificate oi consent to selbinsure for workers' compensation, as provided for by section 3700 oi the Labor CoOe, for the pertormance of Ihe
work fo� which this permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by sedion 3700 of ihe Labor Code, tor the peAormance oi the work tor which this pertnit is issued.
My workars' compensation Insurance carrier and policy number ere:
Cartier. Policy Number:
(7his section need not be completetl il fhe permit is valued et one hundred dollars ($100) or Iess.J
❑ I certity that in the pertormance ol the work tor which ihis permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensatlon laws of Califomia, entl agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHPLL SUBJECT AN EMPLOYER TO CFIMINA� PENALTIES AND GVIL FlNES UP TOONE NpNORED
TYKKISAND OOLLAPE (5100.0OO�.IN ADDRION TO THE COST OF COMPENSAiION, DAMAGES AS PROVI�ED FOR IN SECiION 3]O60F THE LABOR CODE, IMEREST, AND AiiORNE`fS FEES.
LICENSED CONTRACTORS OECLAPATION: '..
I hereby aNirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and ettect. Lic. # Class a
Coniractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that there is a consiruction lending agency for the pertormance of the work for which Ihis pertnit is issuetl. (Sec. 3097, Civil Code).
Lentlefs Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARA710NS:
I hereby affirm ihat untler penalry of perjury ihat I em EXEMPT FROM 7ME CON7RAC70RS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Professions
Code: Any ciry or county which requires e permit to consimct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant for such permit
to tile e signetl statement ihat he or she Is Ilcensed pursuant to the provisions of ihe Contractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 ot the
Busineu an0 Professions Code) or ihat he or sha is eaempt Iherefrom and the basis for the alleqed exemption. Any violation o} Section 7031.5 by any applicant for a pertnit
subjacis the applicant to a civil penalty oi not more than five hundred dollars ($500).):
❑ I, as owner ot Ihe pmperty, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl Ihe stmcture is noi intended or oNered for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does noI apply to an owner of proparty who builds or improves Ihereon, antl who does such work
himself or hersetl or through his or her own employees, providetl �hat such improvemems are not intended or ottered for sale. If, however, the building or improvement is
sold within one year of wmpletion, the owner-builtler will have the burden oi proving ihat he or she ditl not build or improve for purpose of sale.).
❑ I, a5 owner of ihe pm0erty, am EXGLUSIVELV CONTRACTING WITH LICENSED CONTRACTOFS to consiruct ihe project (Sac. 7044, Business entl Professions
Cotle: The contractors Llcense Lew does not apply to an owner oi propeny who builtls or Improves thereon, and who conirads for such project with a conhactor(s)
�I' ense pursuani to the Contractors License Laws.).
am exem untleIr�sa . Business and Professions Code for Ihis reason:
Signawre: �y,,,.�� C1,11 �1. � _ D a: _
Owner ID verifietl by tlnver's license.
Veniication of Ownership by (type ot
❑ No
i.e. - property tax bill or tleatl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity ihat no exwvation fiva (5) or more feet in depih into which a person is required to descend, will be made in connection with work authonzetl by this
permit, and that no builtling stmcture, scaflolding, falsework, or demolition or dismantling ihereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, T�de 8, California Admini5�rative Code�.
❑ As owner-builder, I will nol employ anyone to do work which would require a permit from the Division ot Intlustnal Safety, as noted ahove, unless such person hes e
permit to tlo such work from ihe division.
SignaWre: Date:
Division ot Indusirial Safery Permit Number.
CERTFICA7E OF COMPLIANCE AND AUTHORIZATION OF ENTHY: I cenity under penalry of perlury Ihat I have read this application and state that t�e information given is
correcL 1 agree to compry with all state laws and city ordinances relating to building consimction, antl au�honze representatives ot ihe City of Costa Mesa to enter upon tha
above-descnb r perty for ins ctt�purposes. I yp not to occupy or allow occupancy of any building authonzed by �hi�rtnit until finsl inspe��ion.
f / ,��G� !_
Z ---c_�VCJ
Sig atur f egal Ow er(s) Dat��
And/OrAuthorized Applicant Date
CQOE 1. INSPECT�OHTYPE
7676 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Blxk/Retaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
� IN L CO�,FI INSPECTIONTYPE
_ 206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Final Builtling/Occupancy
pRTE INTRULS
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C�i � C.� �� ����y D��
OWNER-BUILDER
VERtFICATION
A ciry or-county, which is'rcyuired to give notice pursuant ro Section 19830, shall attach to such notice, and,
as a condition precedent to issuing a building permit, reyuire the completion and require the retum of, an
owner-builder verifiwtion.
A[tention Property Owner: � , �
An 'owner-builder' building permi[ has becn applied for in your name and bearing your signature.
Please complete and re[um this informatiun in Ihe envelupe pruvided a[ your eadiest opportunity �u avoid
unnecessary delay in processing and issuing your building permit. No buildine pennit will be issued until ihis
verification is received.
I. I personally plan to provide Ihe major labor and ma�erials for conswction of the proposed
property improvement. ❑ Yes ❑ No
� (have ave not) ....V--�-�� signed an application for a building permit fur
h�c-p�roposed work. _
3. I hxve cantracted with the following persnn (lirni) to provide the proposed conswction:
Namc
Addresti
Phonc (
City —
Contractur's Lic. No.
4. I plan to pruvidc ponions of the wnrk, hul I have hired the folluwing person to coordinale,
supervise and provide lhe major work:
Namc
Address _
Phone ( )
City _
ConVactor's Lic No.
S. I will provide some of the work but I iiave contracted (hired) Ihe following persons to
provide the work indica[ed:
Namc
vu2a5 IREV. 9/9P)
Address
Phonc Type of Work
R . �
�
I hereby affirm that I have received a copy of the infortnation set forth in Section 19830 of the State
of Califomia Heal[h and Safety Code and have completed [he above informa[ion [o the best of my personal
knowledge, in compliance with [his Sta[e law. ,
/� �
Signed: ��C 4 A ��� Date: � �-C ��'V
�
Name: � U `� L.. K �"'e�ll1��,(�'
� (Printed or Typed)
C.D.L.# � �
For mare in[ormation call City of Costa Mesa Building Division at (714) 754-5273.
iaz-�s taev.a�ee�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Viciniry.
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
Contractor:
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa,
LigMing Fixts
Recept Outlets
Switches
Non Res Appl .
Res Appl
Service to 200a
Service to t000a
Service over 7000a
Molors to 1 hp
Motors to �Ohp
Motors to SOhp
Motors to 100hp ��
Motors over 100hp,
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
2064 MEADOW VIEW LN
42201217
KREUTER,SUE
2064 MEADOW VIEW LN
COSTA MESA� CA
KREUTER,SUE
2064 MEADOW VIEW LN
COSTA MESA, CA
a
LEGALIZE WORK�DONE WITHOUTA
$23.50
$0.00
$O.tlO
$0.00
$0.00
$0.00
$0.00
$8.80
$6.60
$0.00
$O.tlO
$0.00
$0.00
$O.tlO
$0.00
$0.00
$0.00
� � $O.tlO
'/ $0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
Quantity
Phone: 714-293-5785
Zip 92627
Phone: 714-293-5785
Zip: 92627 .
Phone:
Zip:
License:
E'
FEE SUMMARY
0
0 „
0 -
� -p--=-'..-----
8
6
0
0
0
0
0
0
0
_ to
�
�<�-�,�0 _ . � .
�0
0
0
0
0
0
AND 6 SWITCHES.
Temp Dist System / Lighting
Busway 1100 ft
Standing Sedion
Misc Elecirical Equipment
Transformers up to 1 kva/kw
................up to 10 kvalkw .,
.-..-......."_.....up to 50 kva/kw '
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Chrisimas Tree Stand
Fireworks Stand ` � �
Other Eledrical Fee
Invesfigation Fee
Plan Check Fee
Reinspection Fee
Status: ISSUED
Applied: 03/24/2006
Issued: �3(24/20a6
ISSUED BY:
Quan�ity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0 '
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 " 0
$0.00 0
$0.00 , 0
$0.00 0
$0.00 0
30.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 538.90
COMMENTS 1 SPECIAL CONDITIONS
NOTICE: The work authorized by tMis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ortl. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the worH authorized under this permit to be considered legal, such work must comply with all applicable cotles, antl ali
raquired InspecNona and final appraval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. I
FOR INSPECTIONS CALL: (714) 7545626
�.» � ��„�,�
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirm untler penalry oi perjury one ol ihe following declarations:
❑ I have and will maintain a certificate ot consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for ihe pertormance of the
work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required 6y section 3700 oi the labor Cotle, tor the pedortnance of ihe work for which this permit is issuetl.
My workers' compensation Insurance carrier and policy number ara:
Carrier: Policy Number.
(This section need not be comp/eted i! fhe permit is valuea et one huntlretl dollars ($100) or less.)
❑ I cenity Ihat in Ihe pertormance of ihe work for which ihis permit is issued, I shall not employ any person in any manner so as to bewme subject to the workers'
compensation laws of Califomia, antl agree that ii I shoultl become subject to the workers' compensation provisions ot Section 3700 of ihe Labor Code, I shall torthwith
comply with these provisions.
Applicant SigneWre: Date:
WAFNING: FNLURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUT AND SHALL SU&IECT AN EMPLOVER TO CFIMINAL PENALTIES NND CIVIL FlNES UP TOIXJE HUNpRED
THOUSAND OOLLARE ($100.000). IN ADDITION TO THE COST OF CAMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, ItJrEREST, AND ATTORNEVS FEES.
LICENSED CON7RAC70RS DECLARATION:
I hereby aflirm that I em licensed untler pmvisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Pmfessions Cotle, and my license is in full
brce en0 eNecL Lic. N Class p
Comractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that Ihere is a constmction lending agency for the performance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lentlefs Neme: Lender's Address:
Signature: Date:
OWNER•BUILDER DECLARA710N5:
I hereby aHirtn that under penalry of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7037.5, Business antl Prolessions
Code: Any ciry or county which requires a pertnit to wnstruct, alter, improve, tlemolish, or repair any siructure, pnor to its issuance, also requires the ep0licant tor such permit
to tile a signetl statement ihat he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencinq with Section 7000) of Division 3 of the
Business and Prolessions Code) or that he or she is e:empt therelrom and Ihe basis for the alleged e:emption. Any violation ot Section 7031.5 by any appliwnt for a pertnit
subjecis the epplicant to a civll penalry ot not more than five hundred dollars (5500).):
❑ I, as owner of ihe properry, or my employees wi�h wages as their sole compensation, WILL DO THE WORK, antl the structure is noi intended or ottered tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply �o an owner of property w�o builds or improves ihereon, and who does such work
himself or hersell or ihrough his or her own employees, provided ihat such improvements are not intended or oHered tor sale. If, however, ihe building or improvement is
sold within one year of completion, Ihe owner-builder will heve the burden of pmving that he or she did not builtl or improve for purpose of sale.).
❑ I, as owner of Iha property, am EXCWSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to constmct the project (Sac. 7044, Business end Profassions
Code: The contractors License Law tloes not apply to an owner ot pmperty who builtls or Improves t�ereon, and who conirads for such prolect with a coniractor(s)
� license pursuant to the Contractors Licanse Laws.).
sec.
Business and Pmfessions Code for �his reason:
Owner ID verified by dnver's lice�se. � Yes ❑ No �
Venfication of Ownership by (type of document, i.e. - property taz bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
No.
❑ I hereby certity ihat no excavation five (5) or more feet in depih into which a person is required to descenq will be made in connection with work authonzetl Dy ihis
pertnit, and that no building siructure, scaffolding, falsework, or demolition or dismantling thereof, will be more than ihirty-sia (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, TiUe 8, Calitornia Administretive Cotle).
❑ As owner-builder, I will not employ anyone to tlo work which would require a permit trom tha Division of Indusirial Safery, as noted above, unless such person has e
permit to do such work from ihe tlivision.
Signature: Date:
Division ot Industrial Satary Permit Number.
CER7IFICATE OF COMPIJANCE AND AUTHORWITION OF ENTRY: I certify under penalry ol perjury that I have reatl this application and state Ihat ihe information given is
correct. I agree to comply with all state laws and city ordinances relating to huilding consWc�ion, and authorize representatives of the Ciry of Costa Mesa to enter upon Ihe
�above-descn6ed operty for/i�nsp f urposes. I agr e not to occupy or ailow occupancy of any building authorized by Ihis permitIun�til final insp^ection.
/�lY . /4-Q--��� � �`L �7t�
�g a Of L (s) � ate
And/Or Authorized Applicant
COOE I. INSPECTONTYPE
1616 Fixetl System Final Fire PreveNion
1266 Pool Spa Final
200 Final Ra-Roof
201 Final 81ocWRetalning Well
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolition
DATE N�il Q 0 � LNSPECTIONttPE
206 Final Mechanical
208 Final Plumbing
210 Final Electriwl
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
f�1TE INTRI�LS
-2 a6 �
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.
�:
(714) 754-5273 • Fex (714)
CITY OF COSTA MESA
BUILp/NG pIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
JobAddress: ZOB4 MEADOW VIEW LN
Suite:
Vicinity: SEABLUFF CANYON-UNITS 2064-2070
ParcelNunmber: 42201217
Applicant: KLAKOVICH, DAVID
Address: 7045 HITES COVE
MARIPOSA, CA
Owner: SEABLUFF CANYON HOA
Address
Contractoc PONDEROSA ROOFING
,Address: 7045 HITES COVE
� MARIPOSA, CA
Zip: 95338
Address:
Phone:
Zoning:
Phone: 209-742-5779
Zip: 95338
Phone: (949)631-9083
Zip: 92627
Phone: 209-742-5779
License: 615531
Eng:
Address:
i . '�
PERMIT NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
StaWs: ISSUED
Applied: O6/29/1999
Issued: 06/29/1999
ISSUED BY: w�.
Phone:
,� � �Zip � License: Zip: License:
, � SCOPE OF PERMIT • �
� TEAR OFF EXISTING WOOD SHAKE ROOF. INSTALL 1-LAYER OF 30# FELT & REROOF WITH CLASS'8' WOOD SHAKES �
(71 SQ.). . �
� 4-UNIT BUILDING: 2064-2070 MEADOW VIEW LN. AT SEABLUFF CANYON. � '
Plan Check: , $0.00
Permit: $312.25
�SMIP Res: $2.20
SMIP Com: $0.00
Other: $0.00
Inspection: ' $0.00
Total: $314.45
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORV Front 0- 0
PARKING Ezistin : 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
PLANNING 8 ZONING
Lefl 0- 0
Left 0- 0
Proposed: 0
,
i
Calc Valuation: $zz,000:oo
Claim Valuation: 8zz,000.00
Right 0- 0
Right 0- 0
NOTICE: The work authorized by this parmit 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 180 days, or if work is suspended or abandoned
For a period of 180 days.
INSPEC710NS: In order for ihe work authorized under this permit to be considered legal, such work must comply with ell applicable codes, and all
requlred inapectlone and final epproval must be obtained. Failure �o obtain inspections and final approval will result in ihe expiration of �his pe�mit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARAnON: . -
I hereby aflirtn under Denalry of Oerjury one of ihe tollowing declarations: . � • ,
❑ I have and will meintain a certificate oi consent to setl-Insure tor workers' compensalion, es D�a��detl tor by saction 3700 ot the La6or Code, tor the peAortnance of Ihe
work far which this pertnit is issued. , , ,
❑ I have and will maintain workers' compenution insurence, as requiretl by secGon 3700 of ihe Labor Code, for the performance of ihe work for which this pertnit is issueH.
My workers' compenution Insurence carrier and�policy number ere: I� �� I'��
�
ce��a�: <S�T/f/— �/ PolicyNumber:
(7his section need not be completed i/ the permif is velued at ane hund�ed dollers ($100) ar less.) .
❑ I certity Ihat in the pedormance of the work for which this permit is issued, I shall not employ any person in eny menner so as to become subject to t�e workers'
compensation laws of Celifornia, and agree that it I should becrome subject b the workers' compensation provisions of Section 3700 of ihe Lebor Code, I shall fort�with
comply with thesa provisions.
Applican� Signe�ure: Deta:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFIIL ANO SHALL SUflIEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNORED
TMOUSAND DOLLARE (5100,000). IN ADDITION TO THE dJST OF CAMPENSATION, OAMAGES AS PPOVIDED FOR M SECTION 3IW OF THE LABOR WDE, INTEREST, ANO ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aHirm Ihat I am licensed u r rovisi ns of Chapter 9(wmmencing wiih Sec�ion 7000) of Oivision 3 of the Business antl PrQ1 sions Code, end my license is In tull
brce end ettect. Lic. x S� Class # � c3 �
ConiracbfsSigneNre: Data: �z — Ci �
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirm Ihat there is a consiruction lending egency tar the pedarmance of t�e work for which this Dermit is issued. (Sec. 3097, Civil Code).
Lendefs Neme:
Signawre: _
OWNER-BUILDER DECLARATIONS:
Lentlefs Address:
Date:
I hereby aNirm that untler penalry ot perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Busineu end Professions
Code: Any ciry or counry which requires a permit to consiruct, alter, impwve, demolish, or repair any sirucNre, prior to its issuance, also requires Ihe applicaN for such pertnit
to tile a signed statement ihat he or she Is licensed pursuant to the provisions ot ihe Conirectors License Lew (Chapter 9(commencinq with Sectlon 7000) oi Division 3 of the
Business and Protessions Code) or that he or sha is ezempt therefrom and the basis for the alleged eaemption. Any violation of Sedion 7031.5 by any applicant for a permit
subJects the epplicant to e civil penalry oi noi more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and the slructure is not intentletl or otfered for sale (Sec.
7044, Business and Protessions Cotle: The Contrectore License Law tloas not apply to an owner of property who builtls or improves thereon, and who tloes such work
himsell or herself or through his or her own employees, provided thet such improvements are not intendetl or offered for sale. If, howavar, the building or improvement is
soltl within one year of completion, ihe owner-builder will have the burden of proving Ihat he or she ditl not builtl or improve for puryose of sale.).
❑ 1, as owner of ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct t�e project (Sec. 7044, Business end Protessions
Cotla: The contractors License Law does not apply to en owner ot proparty who builtls or improves ihereon, and who contracts tor such project with a contrector(s)
liCen58 pur5uant Io lhe COMractor5 Litense LawS.).
❑ I am eaempt under sec. Business antl Professions Code for Ihis reason:
Signature: Date:
Owner ID venfied by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Venficetion of Ownership by (type oF tlocument, i.e. - properry tex bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby cetllty that no eacavation tive (5) or more feet in depth into which e person is requiretl to descend, will be made in connection with work authorizetl by ihis
permit, end that no building stmcNre, sceflolding, falsework, or demolition or dismantling Ihereof, wlll be more ihan thirty-six (36) feet hlgh. (Chap. 32, C�ry 2, Art 2, Sec.
347, Trtle 8, Califomia Atlministrative Code).
❑ As ownerbuilder, I will not employ anyone to Co work which would require a permit from ihe Division of Intlustrial Safery, as noted above, unless such person has a
permit ta do such work from the divisian.
Signature: Date:
Division of Industrial Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTRY: I certity under penalry of perjury that I have read this application and state that ihe infortnation given is
correct I agree to comply with all state lews antl ciry ordinances relating to building consirudion, and authonze represeniatives ot the Ciry ot Costa Masa to emer upon the
above-described properry for inspection purposes. I agree not to occupy or allow occupancy oi eny builtling authonzed by this pertnit untll final inspection.
CODE �. INSPECTIONTYVE
7616 Fixad System Final Fire Prevenfion
1266 Pool Spa Final
200 Final Re-Rool
201 Finel BIocWRetaining Wall
202 Finel Fec�ory Fire Plate
203 Final Sign
204 Final Demolition
2468ds
Ij�jf, INTITI�LS
6-2s DaJ�
Date
CODE� INSPELTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Findl SI�B
250 Final Building/Occupancy
P�g
1�
Cl'PY Ul� CULI., tdP;::A 1/L4Ul:P1' l�'��L 4UUUIY.1lC7
T(iACP N0. I DD I S LGl'�? �-- j-�. �
IAT N0. � /
nnn�sa 20(04 M�eol.d.oul UCe�.J (�y�2
Tp,O Qavelopei' O! Che obova ontitled traat deeiree to eell tt�e above.aet forth
� lOt yriOr Lo the timo th�t the trsct hae bean c�pleted end iCe etreete
�cceytnd by the City cf Coeta Meea.
� The undereigned� by executing thie �reement� scknovledgee that (he-ahe-they)
f �vae or ware) advised that thie tract haa
aot been given flnal inepeetion nor hee it been sccepted by the City of Coata
� Mee6 ea haviAg aaaaplled Mith the conditlons of approval which were lmposed by
j';,tho oity at the time the flnal tract may w�s �pproved.
�; � �'
i
�. Yse City aest�es no liabillty 'for the entorcement of tha conditione neceseary
�' fo� aPProval other thaa those conditions yrotected by surety bond.
�,.
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7 •
,,. TpC�yaderalgnea egreao to indemniry und hold tha city he.rmleae Prc� as�y claim _
�. repultirig ip aamogo or poroonel in�ury to the undersigned by reason ot the
;" alOremaIItioaod unc0myleted condition. The undereigned acknowledgee [ha[ thie
egtoee�ent ie cqada eolely for the beneEit of the ciey and doea not inure to
CAp banafit oP the underoigaed or any of c4em.
RECEIVED
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JUL 5 -1979
PM
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I GREAT WESTERN
BY ' N-AS66GIAiiAI
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� CITY,OF COSTA MESA ,
BUILDINGSAPETY DEPARTMENT
POST IN COIdSPICUaUS PLACE
OW THE JOB
A.P. NO.
DATE ISSUED
PERMIrT NO.,S ;t '�—
BUILOING ADDRE55 / "
2064 Meadow Viex Lane
TRACT LOT BLOCK
10018 17
�� NEW ADD ALTER REPAIR MOVING DEMOLISH
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�=,'F.ront Yd,`��_�-Side Yd. Ru�� C���' Att•Rear-'�10'
� � �. ;: . '' Side Yd. R L' Rear -'? `"-
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_:�,: BUILDING INSPECTION RECORD .-,� ,.`.,
;•'�,TO.KEEP-BUILOING PERMITS VAGD,,WORK MUSTcBEo-:
�+'��`MENCED WITHIN' 60 DAYS WITH-�ROUTINE INSPECTION:
'', LEAST EACH 120 DAYSTHEREAFTER UNTIL COMPLETED:.:
�, _ � ".. . CTR11(`TIIGAI ' .. �'�i=' �
Trenches. � "' �"
Forms' .:" " " " " " .c._.
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FloorSYstem"""'." ''"""�'..:"'`r.:"_
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Steel Reinf :......:::..... -'�'
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Sheathin '�� � '
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Frame and Flashia9 ": : "-+""""""""
Insuletion''"""' '-� c "
ltetFiin9' ""' '_.. ;eC�Y��tu'
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�DrY Wall Nailing _ . R � �
Plezter, Brown Coet � - �,,;
SoundAttanuation..:..__.�.. �- '"
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Hendicep ReguleLon !.�_-. �
'`�i �'. FINAL, ;
PLUMBING : ,,�,,. ��'
,�.a
Soii' � --- �
� �.... ' - �.�z � ' i -,i f � x 3. . T`-r' �
underpround Weter -• -
�Rough Plum6ing . "'. . p'�":�'I
•- - f
Prop"Sewer,-Line e�d}Houae CAnn� � � ^. -0'.
$IreeL SBwel Conn Y ' • �=T
�:�dB[Bf$lfViCB """":�"":.�:-r_....'".i0�s:5'••
SprinklingSystem � }�`
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Ges Te�t ", "' " ' . . ,. '.
_ t -�
5-•-'.� .......... ....
,:'c�,� . �. fii::^.J.�,�` •, .PINAL':-.�
� .,'; �, HEATING,�AIR-COND. AND REF
�Refr`. Lines,-Preaure Test' `=':�- - � -
yt,. . ._ „ ��. 3-��.
Ducts; UrMerBround =: ,_
' . . � � 1r`. -3:".
�Ducte,in Structure
�Ducu; Ventilating �. �, . - �
Rouph�Heafinpand.AvCond:� -�'"'�.���
_�{+n � � j'"_ ' `:. � F.INAL t:
r �X ;,� ELECTRICAL ,
a ha� -
Temporery Service or Pole .,�. - �
�Underground � : � `�.� .�.
�Power Meter ::._ � � k F,
Rough Winng ' "'. -- '.?c
L. � ,.
c . , FINAL..
`` :' "'Do not occupy tfiis project until�fin
�`; "�'�:���' � been made and occupancv 6asl
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inspection has� F'' r^"�
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!g aPProved , .. ,.,: •,��. `.
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�,;,,�'' 'Spetiel Requirements � = � : " ; �:,C
�",1'. OccuPenry . , _: . �
A•.
��` NOTICE ;. ; t:. .
�t=,w�24-hr. notifiyation required when the job; ii'ready for inspection. �You "
,,''must furnish PERMIT NUMBER and the•`JOB ADDRESS FOR EACH
RESPECTIVE INSPECTION. CALL 55fr5273.
' APPROVED PLANS SHALL BE.ON JOB AT ALL TIMES
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fdl in Completely — Use Ink Only
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#t'�,177�i 0000445945 " ��IA "' '-'"'
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APPLICATION OR STRUCTURAL PERMIT
ECEIVED BV . DATE RECENED nnTc isc�icn
OWNER The Gregory Company <..P. NO. �5 '
MAIL ^�18']-G Airwa AVe• AD' R'E 5
ADDRESS J y ��
CITV COSt� Pllesa NO. !S�-�38J � TRACT ]
BRANCH
AODRESS
ARCHITECT L.
_. T-Tarricnn�T.nronoi 7Kl_
-G Airwav A
CONTRACTOR Gre�or,y Construction Co.
ADDRES�IH7�G AlY�W3j/ AVe•
CITV Co5ta Mesa NOL7Sl—�H'-Y
L C No.285981 '� ����Na. oo817g
OF LOT �2 !' X992 � NOW ON LO S �
USE OF
EXISTING BLOG.
Separate permits are required for �
.electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
New condominium units with
attached garage
X I I I
OWNER The GrE
condo w at-
uSi—
FIRE •
ZONE T
APVqOVED
BV
� NO.OF
PLANS
VARDS APPROVED
6E7
VAR.
HOLD FOR
, �� ' ��.,m„ ,��.
LOTZ% BLOCK
garag��$ 46���
E V GROUP I&J
DATE
USE OF NEW
BUILDING
VARDS APPROVED
BET. MAIN &
ACC65.BLd
DATE
STE✓ ��_/�J
REQUIREMENTS
I hareby acknowledge thet I heve reatl this apPlication and state
Mat the abova i�tormation is correct antl agree io comply with
ell laws repuletl�g bulltling construction, antl 1 shall not employ
any oarson in vio�ation of Me workmen's compensation laws of '
the Stata of Cali'�omfa.
I hereby cariify <hat � am properly Iicense contractor untler SQ. FT. 6 a a
tha State Celifo�nie Business tl P of si s Cotla, Oivision 3, THE AMOUNT SHOWN UNDER VALU
Chapt 9, an the< such Iieen e I force and effact, or I THE PURPOSE OF ESTABIISHING A PERI
am empt tro the provisi o te of California Business VALUATION
and rofesslons Cotle ivi 3, h � 9. PERMIT FEE S
PLAN CHECK E
SIO�at of / '�p/ �M'�C
Pe�mittae $ /w (oO ^ TAX S
� �
Aut TOTALPAID E
n
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IS FOR m
ONIY: �
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