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HomeMy WebLinkAbout1217 MCCORMACK ST - Building Permits M 4 441.1S4) `5Tp MF 9 - CITY OF COSTA MESA BUILDING DIVISION /1-SPA.i ___ DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER f I w.._•n.os l PERMIT t 'Pia 02-00983 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1217 MC CORMACK LN Status: ISSUED Suite No • Applied: 10/30/2002 Vicinity: REAR YARD Issued: 10/30/2002 Parcel Nunmber: 14163351 Applicant: JACOBY, MICHAELIS ISSUED BY: _ Address: 1580-4 N BATAVIA - Phone: (714)974-3004 ORANGE,CA Zip: 92867 Owner: HUANG, BINGHENG Address 1217 MC CORMACK LN • Phone: COSTA MESA,CA Zip: 92626 Contractor: TOTAL COMFORT SPECIALISTS Address: 1580-4 N BATAVIA ' Phone: (714)974-3004 ORANGE,CA Zip: 92867 License: 676628 SCOPE OF PERMIT REPLACE AN EXISTING FAU(66,000 BTU)AND ADD AN NC UNIT(HP-3):COMPRESSOR TO BE LOCATED IN THE LEFT REAR YARD AREA AT AN EXISTING SFD. 1 MOTOR TO 10 HP REF: M02-00480 NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 . 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 " Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $12.30 1 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 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 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS ( `} ( WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. -I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'lIcompensation nsurance carrier and policy number are: Carrier: Lin,•-Ana -1) 1H1vvA �,t,,,.-(Ey 61) Policy Number: Sa A)6 3 6L (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: I '`sT--- WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOL-ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm 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 effect.Lic. tth7( Class If C -, Contractors Signature: Date: /a- 7J 7— CONSTRUCTION CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. -thin Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,Califomia Administrative Code). ❑ As owner-builder. I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑Na (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No _._ ___.i_ _.. __ ..._ modification 5 Does he will the tcAir u present or future bustling occupant at y other for the work which the subject cf this a estion a0 Nnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all stele laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date BODE I INSPECTION TYPE PATE iicma Sgout INSPECTION TYPE PAM VOLS 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy F`D601 Mac 9 CITY OF COSTA MESA • sh BUILDING DIVISION >• ' nn' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT E02-00983 eftgt ° (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1217 MC CORMACK LN Status: ISSUED Suite No Applied: 10/30/2002 Vicinity: REAR YARD Issued: 10/30/2002 Parcel Nunmber: 14163351 Applicant JACOBY, MICHAELIS ISSUED BY: Address: 1580-4 N BATAVIA Phone: (714)974-3004 ORANGE,CA Zip: 92867 Owner: HUANG, BINGHENG Address 1217 MC CORMACK LN Phone: COSTA MESA,CA Zip: 92626 Contractor: TOTAL COMFORT SPECIALISTS Address: 1580-4 N BATAVIA Phone: (714)974-3004 ORANGE,CA Zip: 92867 License: 676628 SCOPE OF PERMIT REPLACE AN EXISTING FAU(66,000 BTU)AND ADD AN NC UNIT(HP-3);COMPRESSOR TO BE LOCATED IN THE LEFT REAR YARD AREA AT AN EXISTING SFD. 1 MOTOR TO 10 HP REF:M02-00480 - NO OTHER WORK AUTHORIZED WITH THIS PERMIT. FEE SUMMARY • Quantity - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3•-units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 - 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $12.30 1 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 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 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLAR`AYIONS ll I , , WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit Is Issued. ArAy have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Innysurance C/artieerr and policy number are: r� Carrier: I vtn..�un.-�J / •fin f1.✓` 6--`^ir(� Policy Number: '.5 34(6J— 1.00 (This section need not be completed if the permit is vafu at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these proviso . Applicant Signature: Date: fo'.5‘i"`xl- WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm 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 effect.Lic.# c-bbLY Class# C—Zo Contractors Signature: _ � — Date: rep—SJ-0-1._ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under Sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. es 0 No Drivers License No. Expires: Verification of Ownership Dy(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions.requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this aapacation aermit tor such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Wilt any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? 0 Yes 0 No (If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date LODE/ INSPECTION TYPE MAT INTIMLS CO2Ei INSPECTIONTYPE QAIE EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof _ 210 Final Electrical 1 117I(2 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION Pt=RMIT (•PERMIT N0. TRACT NO. LOT NO. UNIT NO. ` ,f / �� 41�#s67 Project Address // /7 / /i..,^/2:41aG 49 r I NEWLI I U REPAIR • • 9489 7/ 16%86 i 8.00 TSL 7p f oto TYPE OF CONSTRUCTION LLLLI ADD ❑ ALTERATION "` Applicant's Mailing Address ! [ ❑ CONVERSION ❑ DEMOLISH EaOTHER Owner's Name •1.06 20 Si=// Phone 7rsi 236r A.P.# I Zone ' , DESCRIPTION OF WORK/USE OF BLDG. -Address /OJ', 117c l.'-�...r•s 71F[, 1/'/ • S Main Building: Accessory Building: .Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION I ,. ❑ STRUCTURAL E Front o 'Address ' • ❑ TENANT ❑ ELECTRICAL Cl PLUMBING Lid MECHANICAL B Rear N A II Contractor's Name 'Cr";cd it Yt itilf Phone 5-2-/-3?-1, ❑ 'OTHER - C Ri ht - N PROJECT DESCRIPTION SQ. FT. OCCUPANCY g •Address(Mailing/ •7 y/ '( N eel.C 14 f/,t4cn- 9063/ KLeft - _. - G CONSTRUCTION TYPE VALUATION$ S City License No. Lei"LZ- /G '2— ZONE GRADING CU.YDS. ACRES B LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / �{ {} p .d Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and 4 .e`�"•')�O (1tt.(� -G16•ca-f r"•�b M my license is in full force and effect. T I License ClassesCLicen a No. S Date•7—/H—if(- Signature `� C1 , le- Zes PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure'or a certificate ELECTRICAL ,FEES • of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - ' 3800, Lab. $l) p 7 f Automatic Washer Transformer ❑'15-50 KW . Policy No.//l�V 2' Company ' /2-fiL t Backflow Irrigation Sewer Ca ,0 50+ KW ' P Construction Pole Sub. Certified copy is hereby furnished.®'Certified c'IPy is pled with the city B Id ing/�nivision. - D , Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date` -i 'r —sV/ Applicant L✓aj C ff EXEMPTION FROM WORKERS'COMP NSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter . (This section need not be completed if the permit Is for one hundred ($100)-or �OVef 100 amps less). Dishwasher Solar Piping ' Dryers ❑Gas ❑Electric Sub Panel • I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan ' Workers' Compensation Laws of California. Motors❑0-1 HP 01%-8 Date Signature Floor Drains • Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ ' 'NOTICE:If,after making this declaration,you should become subject to the - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures - Microwave - - - c comply with such provisions or this permit shall be deemed revoked: ^ • CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light 1 hereby affirm that there is a construction lending agency for the performance 9 `�•0 of the work for which this permit is issued (Section 3097 Civ: C.) Interceptors tors Water Heater Outlets Lender's Name - - uRange , \ Lender's Address _ • Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION � Sign v\ I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section 7031.5 Business and Professional Code: Any,city or Auto-Wash • • Garbage Disposal ;Standing Sections • I county which requires a permit to construct,alter,improve,demolish or repair P-Trap • LaundryTrays any structure, prior to its issuance, also requires the applicant for such permit y Generator ❑0-5 KW 05-15 KW Trash Compactor • to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - the Contractor's License Law(Chapter 9 (commencing with Section 7000)of , Division 3 of the Business and Professions Code) or that he/she is exempt - therefrom and the basis for the alleged exemption. Any violation of Section , ;y?031.5 by any applicant for a permit subjects the applicant to a civil '+renalty of not more than five hundred dollars($500). ❑'I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered - - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - - - License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 • sale, if, however; the building or improvement is sold within one year of com- .- Canopy Type II 0 Zoning Approved By Date proven, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground • Building Approved By Date prpye ,t the purpse osale). - ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By T Dat tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES • builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers • • PLUMBING $ ISSUANCE $ Date OwnerHeating System& Ducting Registers• PLAN CHECK 25% $ ENERGY P.C. $ • I hereby certify that I have read this application and state that the above / 00-100,000 BTU M100,000 BTL - • ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances et and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for • `1 u -� inspection purposes I f' _ Z MECHANICAL $ d I/ TOTAL FEE $ D U Signature _ ` ._ �_�� Date 7 l�G Drivers' License or SS# '� - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL 'A APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer.Cap 63. Heater & Vent-Final 13. Roof Grains - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 006 eat 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43:7:Backflow Irrigation • 44kLandscape Irrigation System 45.E ound Attenuation 46r.Handicap Regulations 47rFINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50:-.Gas Release to Southern California Gas Co 51FCERTIFICATE OF OCCUPANCY No, Date I OWNER HARBOR HALL OF FAME HOMES INC. DATE NOV 3 0 °62 JOB ADDRESS 1217 McCormack Lane BUILDING PERMIT NO. 18333 GENERAL CONTRACTOR Lifetime Residential Bldg. Corp. VALUE $ 19,055.00 AP No. LOT 83 TRACT 4356 FIRE ZONE DESCRIPTION OF WORK Res/Att.Gar. IN°r'ECTIONS Signature DATE GROUP I&J TYPE V ZONE R-1 Sc 44/ /t+� PERMITS ISSUED Gas -) u� - -G3 SUBCONTRACTOR DATE NUMBER Water _A- / _ Rough Corn. Refrig. 0 Air Cond. 0 7-=7T Rough Heating ivad i.• - /�_a�) /ad Rough Plumbing � "` . ..�T Miscellaneous Ld/ .2-A(e. itG ��- —����— �7 ._ i Prop.Swr.Linea House Con. 0 St.Swr. ❑leaf l,0„,or �.,�/ fy„�,� i a.,,2/-/,�3 3a'/(a .7 Sprinkling System """`�- 4-4 o tion Pole 42.01 ed_._a�3A-e2're, "j / _ //--77- z-, /J177/� _'4 Underground 0 Power 0 _ _ Rough Wiring ,fl 2•L0'6'3 4G°i nth ,th✓•� �'-' 43 .7csC Trenches lid Forms la- Steel Reinf. ❑ )9..../44,..62.- Floor yiy,,.(,yFloor System 3 r6 Bond Beam 0 Steel Reinforce 0 Sheathing2.- I-63 Frame and Flashing 2_22-63 Lathing - In 0 Out 0 /%/O. ).-3y.-G Plaster, brown coat /r4-y( 4)V-b 3 r 0 Air Cond. ❑ Final I. .ng, Final /t4_ L-/V-6? Plumbing Fixtures, Final /1�{.fc 6 /1-43 Final Gas Test/5— /II Lrry-63 Electric Fixtures, Final 5'7 L r,C3 Building, Final C /--/y-63 OCCUPANCY FORM BU4-5M - 741 1 R»o 18333FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT Lot 83, Tract 4356, an00-Eyov 30 196k P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APPLICATION FThRIEtIfOSTA MESA r/TYPE OR PRINT BUILDING BUILDING ADDRESS 1 C- I / 4 C C Corny ',Cie Zs, COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. E �Npt OWNER Harbor Hall of Fame Homes, Inc. I I /, --, 3 MAIL RECEI ED BY DATE RECEIVED DATE ISSUED ADDRESS P.O. Box 2066 l/ :3c-' 2..410p R n t:.=.- CITY Santa Ana NO.Ki 9-2231BUILDING ADDRESS ARCHITECT OR ENGINEER Jamison NE,44-0040 COSTA MESA. CALIFORNIA� (// ADDRESS 225 "D" St. , Tustin / ZONE YPE / GROUP!, py CONTRACTOR Lifetime Residential Bldg Cr—gEVPROVED DATE ADDRESS 2131 So. Artesia ZONING Santa Ana ZONER NO.OF USE OF HEW eCITY / I PLANS - I BUILDIN%tJ �•" LIC.NO. 208676 NO. KI 9-2204 DLEGAL ESCR •-�/ 0/ `1 e, 712\.• �.�UyI/ R- DEBCRIPTION ' SIZE V 60001 .1 NO. OF BLDGS.0 OF LOT NOW ON LOT A.P.NO. YL—a---T—L_-e_—_.-, USE OFNone YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK CENTER OFI LINEFROM501 REAR YARD 23.501 FRONT(CER LINE ST.) .5'0 FT. IN. 71 I 91 7 SIDE YARD LEFT RIGHT R.SIDE FT. IN. DESCRIPTION OF WORK _ L.SIDE 7 FT. IN. NEW I X V ALTERATION I V ADDITION I REAR Z /3 FT. v IN. V MOVING I V DEMOLISH I BYPROVED /O.Zr DATE /71170 y� REPAIR w e6 / BUILDING 1790 NO. OF SIZE ROOMS 10 STORIES 1 EXTERIOR WALLlas tet, VE I CORING Shake COVERING YY USE OF BUILDING AND WORK TO BE PERFORMED Single family residence ///774:: r., , J _ /796 P li/y/ 9, D' I HEREBY ACKNOWLEDGE .. T I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UttiDER VALUATION IS POR THE AND STATE THAT THE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY O'�• CEO AN LAWrGULATING BUILDING CONSTRUC ON VALUATION // SIGNATURE OF PERMIT FEE $PERMITTEF L R $ /1 &CC PLAN CHECK $ a/5 D= AUTHORIZED AGENTz - .,5 TOTAL FEE 5 9 -O n