HomeMy WebLinkAbout1066 MISSION DR - Building PermitsCITY OF COSTA MESA
BUILDING DIVISION
>A 77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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FOR INSPECTIONS CALL: (714) 754.5626
PERMIT NUMBER: BC10-00299
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 07/09/2010
ISSUED BY:
JOB ADDRESS: 1066 MISSION DR CM
APN: 14157108 Zoning: ,
Vicinity: REAR YARD
Const Type: V -B
SQ. FT: 578
Suite/Unit:
Primary Occ:
Valuation: $2,000.00
SCOPE OF WORK: DEMOLISH A 578 SF IN -GROUND GUNITE POOL AND CAP ELECTRICAL, GAS LINE AND WATER CAP.
OWNER: PHAM TIEN
Phone: 949-293-2846
APPLICANT: PHAM TIEN
Phone: 949-293-2846
CONTRACTOR OWNER -BUILDER
Phone:
Cell:
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address: 1066 MISSION DR
City/State/Zip: COSTA MESA, CA
Address: 1066 MISSION DR
City/State/zZip: COSTA MESA, CA
Address: Unit:
City/State:
License No.
License No.
$0.00
$69.25
$41.70
$0.00
$19.60
$0.50
$0.00
$1.00
$132.05
License No. 000000
Unit:
Unit: :
ZipCode
PHONE:
PHONE:
'Refer to fee receipts for all fees paid for project
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3118/2010 - PER CMMC Sec. 13-279
Monday thru Friday -7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
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: 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.
CODER. INSPECTION TYPE DATE INTmALS CODER INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical �LI'
1266 Pool Spa Final 206 Final Plumbing
200 Final Re -Roof 210 Final Electrical 7 — 1 am
201 Final BlockJRetaining Wali 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,'HM
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
❑ 1 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 Insurance carrier and policy
number are:
Carder:
(This seaman need rpf Oe oandefed d thepermd u valued al are hundretl Mrlars (5100) akss )
Policy Number:
CW -1 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 sh I orthwilh kywith these provisions.
caro
;can's Signature LD;ue- '
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 DOLLARS
($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. #
Contractor's Signature
Class #
CONSTRUCTION LENDING AGENCY:
❑ 1 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).
Lender's 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
fiiv�vee/ hundred dollars ($500).):
LiAr�ras owner of the properly, 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
properly who builds or improves thereon, and who contracts for such project with
a contractors) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:-
_
305746 (3107) l�
Owner ID verified by driver s licenyse. /Ye❑ No_r /
Driver's -License No.
s
Verification of Ownership by (type of document, i.e. - property tax ill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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.
Applicant's Signature Dale
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? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? []Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 purpose I agree not to oyycopy or allow occupancy of any building
authorized b this p it until au n pection.
(gnat gal vnerls)
And/a Authorized Applicant Dale
0
City of Costa Mesa Bui(ding Division
Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # !kC(Q-6o2Rq
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at I ()� f0 ML�(`dVl
We are providing you with an Owner -Builder Ackn wle gment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
�1-;l,understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
1 M,2. -I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
331 understand as an "Owner -Builder" I am the responsible party of record on the permit. 1 understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
`�4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
�` L§',l,,understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
_�A7. l.understand under California Contractors' State License Law, an Owner -Builder who builds single-family
d'esidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
12�8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable
for-a_n financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
r` 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal
Reven a Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
t&10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand
Iam the party legally and financially responsible for proposed construction activity at the following address:
. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
inform -at n I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to veritkthe properter's signature.
Date 0
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2
• \'�.i��.n xniw V'1Tv'1 l 1.� �i..lel /
1066 MISSION DRIVE, COSTA MESA CA 92626
ALAN J. JESSUP, P.E.
Consulting Geotechnical Engineer
Registered Professional Engineer 24432 Silver Spur Lane
California NOTICE OF INSPECTION Laguna Niguel C6
Phone/Fax (949) 446-9650
Project No.
Job
-71
a h�i t/ - "
Type of Inspection: Continuous FootingSpread
Friction Pile Swimming Pool
p
of Inspections Covered by This
E
62is
Caisson
A�e
The undersigned has observed the excavations listed above on the referenced property and
same were excavated in accordance with recommendations in the preliminary report and the
Building Code of the /l
(1) Office; (2) Client
by:
z Moo,
Alan J: Jessrip/,P: E.
Geotechnical Engineer, GE 439
EsCivi
F\�l Engineer, RCE 18431
E<
No. 439
PROJECT. ADDRESS: 1066 MISS ION DR UNIT:
.OWNERjS NAME: IMOTO KENJI ,
ADDRESS: 1066 AISSION DR
COSTA MESA,CA 92626
ARCH/ENGINEER: 545-8364 REG.NO.:
ADDRESS: UNIT:
PERMITTEE: NANCY IMOTO (714)545-8364
ADDRESS: 1066 MISSION DR
COSTA MESA CA 92626
LICENSED CONTRACTOR 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 Cotle, and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a Carl of Workers'
Compensation Insurance. or a certified copy thereof (Section 3800. Lab. Q.
POLICY NO.: EXP. DATE:
COMPANY:
❑ Certified copy is hereby Tarnished. ❑ Certified copy is filed with the city Building Division.
le. Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($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 WorkersCompensation Laws of California.
Date: Signature:
NOTICE: If. after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor
Code. you must fpnhwdh comply with such provisions or this permit shall be deemed revoked.
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 (Section 3097, Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit t0 construct, alter, improve, demolish, or
repair any structure, pilar to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' Slate 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 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 (Section 7044, Business and Professional Code. The Contractors' State License Law
does not apply to an owner of a properly who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve
for the purpose of sale).
I. as owner of the property. am exclusive)y contracting with licensed contractors to construct the project (Section 7044, Business
L) and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contraclor(s) license pursuant to the Contractors' State License Law). I am aware
that proof pl their Worke's Compensation insurance should be provided to me.
am exempt under Sectio BP7044 8. 8 P. C.
r this reason. A WO OWNER
'4ete: Owner: ' I
1111b"v,�,�,�'e�r'dy that I aware of and understand the requirements of CaliforniaHealth and Safely Code Sections 25505, 25533, and
2or any I rt mlding occupant wtlllwill not (circle one) need to comply with said Slate co0es and the requirements for a
uclipn or mo -taboo from, a Air Duality Manageme t Dishicl. Residential construction applications are exempt from
h - Applicant: 1
'f cerhty that I a Ie read is application and state Thal the above information is Correct. I agree to comply with all city and county
mdi0a0 sand Stale a relating bulltling cpnsiruc,ion and hereby amid ze represent1 atives of this city to enter upon the above mentioned
properly lar inspeclmn purposes.
-ale: Signature: l ` I l
—DPiver's License or Spill Security p:
1641-46 White—Building: Green—Cotle Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 059936
PERMIT NO; B 059936 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE; STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF RESHT. REROOF W/COMP. SQ FT: 2,500
CLAIM VALUE: 2,500.00 CALC-VALUE: 2,500.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
PARKING RE& PROV: PARCEL: 14157108 ZNE; REF NO:
PLANNING N TES>
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY _ DATE:
APPLICATION ISSUED BY• DATE:
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LEGALIZATION:N F E E I M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54.0050
PLAN SMIP/NON-RES
ISSUE FEE
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 54.50 0.00 0.00 54.50 54.50 •00
REVENUE DIVISION TOTALS--> COLLECTED: 54.50 OVER/SHORT; •00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
54.00 .50
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I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 2,500.00
END OF FEES,
sCONSTRUCTION AND PLANNING -
POOL &:[
I
APPROVALS Permit
Date
Inspector
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. P e•Undrgrnd.C�
53. Steel Reinforcement
yS,t;l
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Ftrj�l Condet•lity-Undrgrnd.
54. Forms
gid• Etktrreel Cond09FtJt(drgrnd.
55. Electrical BondingX. `y
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56. Rough Plumbing & Pressure Tei
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57. APPROVAL TO COVE R-GUPt
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58. Eiectrical Conduit-Undrgrnd. o_+
GB.cEoundation
59. Gas Pipe, 0 Undrgrnd., Test 0
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9. Water Pipe-Undrgr-Ftd.
60. Backwash Lines, P -Trap, O Und�rnd.
10. Structural Floor System
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61. APPROVAL TO DECK
11, Pffdperty Sewer Lin44' House Connection
62. Backwash & Receptor -Final
12. Sewer Cap a
63. Heater & Vent -Final
-
13. Roof Drains '0
64. Plumbing System - Final
14. Rough Plumbi45
65. Electrical -Final
15. Rough Electric;•1-Conduit
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66. Solar System -Final
16. Rough Electri'i-C"iring
67. Fencing & Access Approval
17. Rough Wiring S41n
68. APPROVED FOR PLASTERING
18. Rough Electric -T liar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning_
FIRE DEPT. REQUIREMENT
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=Lb1. CERTIFICATE OFxOCCUPAN V
No. Date
CITY OF COSTA MESA
BUILDING DIVISION
OWNER -BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner -builder verification.
Attention Property Owner:
An 'owner -builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. 1 personally plan to provide the Tajor labor and materials for construction of the pro-
posed property improvement. Yes ❑ No
2. 1 (have/have not) RAJ 1!5 signed an application for a building permit for the
proposed work.
3. 1 have contracted with the following person (firm) to provide the proposed construction:
Name—
Address
ame—Address
Phone (
City
Contractor's Lic. No.
4. 1 plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name —
Address
City
Phone ( ) Contractor's Lic. No.
5. 1 will provide some of the work but I have contracted (hired) the following persons to pro-
vide the work indicated:
Name Address Phone Type of Work
t hereb irm that I have received a copy of the information set forth in Section 19830 of the State
of California He th and Safety Code and h ve completed the above information to the best of my per-
sonal knowledge,I in compliance w' this S ate law. 66
Signed: ^^/( Date: ( l
Name:
754-5273
1042e
�fx
OWNER CORNELIUS) J. W. DATE 3-t1-63
JOB ADDRESS 1066 Mission Br. BUILDING PERMIT NO. 1870
GENERAL CONTRACTOR Blu Haven POOls VALUE $3,000.00
AP No.141-571-08 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Pvt.SWiM POOL
INQPECTIONS
Signature
DATE
GROUP J TYPE III ZONE R-1
E
SUBCONTRACTOR
PERMITS
ISSUED
Gas -
3 Zil-G3
DATE
NUMBER
Water e57"g2�D/r,wss-?G
Rough Com. Refrig. ❑ Air Cond. ❑
'
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line ❑ Honpe Con. ❑ St. Swr. ❑
Sprinkling System
yf
HJT
f
Construction Fole
Underground ❑ Power ❑
Rou h Wiring
Trenches ❑ Forms ❑ Steel em.
Floor System
Bond Beam ❑ Steel Reinforce [D -
S
1-26
Sheathing
Frame and Flashing
Lathing — In ❑ Out ❑
Plaster, brown coat
/1
❑ Air Cond. ❑ Fina
Final
Plumbing Fixtures, Final
Final Gas Test
-—
_
Electric Fixtures, Final
-_
`
Building, Final
OCCUPANCY
E RECEIVED
iss;oF
MAR 8 1963
OSTA MESA BUILDING -SAFETY DEPARTMENT
FINANCE DEPT.
P. O. BOX 317 COSTA MESA, CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely
APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING
For Office Use Only
BUILDING
V
ADDRESS/% ��-V
6ALIFORNIA
RECEIPT NO. P M T NOO
COSTA -MESA.
`
REce r ew=H ietvH� D ISSUE
OWNER ��. 1 l,Ntir�E�l'-c.l-c.�
MAIL ff��
ADDRENO %l
ADORE68 (V
ADDRESS O.L.:'�✓)"�J
FIRM
TEL.
ZONE TYPE 71EGROUP.
CITY NO.
APPROVED
ARCHITECT TEL.
BY DATE
1�
OR ENGINEER N
A ,\
ZONING
-
wr ss
E NO. UBE new
1�\vvl
/
E DI
Pune '1/ auamrva
'
CONTRACTOR _ �'�^�"-,�/ i
�q' / /C-Cl•�-
LEGAL
DESCRIPTION
ADDRESS q'�
CITY
A. P. NO.
NOTE: NO EAV E OVERHANG SHALL BE LESS THAN
LIC..
90' TO SIDE Q REAR P. L.
54ATE� •3�
NO. NO. �S �e /' ✓
EAVES
SIZE I rvO. Ora LOOS.
(r0
ALLOWED (U. B. C. REQUIREMENT)
OF LOT NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OP
MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
.`
(FROM C/L STREET)
SETBACK LINE FPOM // / /
W
FRONT FT. FT.
1,
`{�
CENTER OF STREET .meg REAR YARD
V
I / 1
R. SIDE FT. FT.
61DEYARDI LEFT RIGHT
N
DESCRIPTION OF WORK
L. SIDE Fr. Fr.
Z
�I
NEW ALTERATION ADDITION
REAR FT. FT.
u'
DISTANCE BET. BET. MAIN S
D=
MOVING DEMOLISH
MAIN SLOGS. ACCESS.BLDGS.ILDING
kR
VAR.# DATE
dZE
y NO OF
�/1
ROOMS STORIES
C. U. P.# APPROVED
a
EXTERIOR WALLI ROOF
APPROVED
�
_/ 3
/
COVERING COVERING
BY
DATE V
Q
USE OF BUILDING AND WORK TO BE PERFORMED
l.1
11,1
UnD.
C
ffi O
SO. FT.
HE AMOUNT SHOWN UNDER VALUATION IS FOR THE
I"
F �.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM
URPOOR OF ESTABLISHING A PERMIT FEE ONLY.
•�
O
PLY WITH ALL CITY ORDINANCES AND BTATH WS REGULATING
_
C
VALUATION
�.�
BUILDING CONSTRU ION.
SIGNATUREOF
J
PERMIT FEE S
`q',
i
m
O-0
CHECK S
,. ,la
PERMITTE _^~t
SPLAN
Z
v IJ
AUTHORIZED AGEN .
S mC C
L
TOTAL FEE
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING
ADDRESS
COSTA MESA, CALIFORNIA
FEE RECEIVED
(�
Lot 48, Tract L12oF�NVCI 3DPPT. SEP 111961 0"
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
/Im
IT
RECEIPT NO. PERMIT NO.
OWNERe.
'ii �I+ 1—.l`-
MAIL
RECI BYI D/ IV D DATE 188UED�"
ADDRESS
!S — / I SEP ii �Qn1
TEL•
BUILDING
CITY N o.n r u 2 2 oADDRESS
ARCHITECT TEL
COSTA MESA. CALIFORNIA
.
OR ENGINEERngrpOrptjonNOQR 1)122
6
FIREZONE TYPE '" GROUPTRACTORMnnnn
[ADN
APPROVED
BY DATE
•
ZONING
ADDRESS 800 Coast
ZONE
NO. OF
USE OF N �LLl'
CITY
.1
PLANS ��
I
"BUILDIN
STATE TEL.
98808 No: OR
LEGAL
v -
34220
NOSIZE.
GEO.A.L' N
5
No, OF BLDoe
none
F LOT 1409 1'
Now ON LOT
A P NO.
USE OF
EXISTING BLDG none
YARDS EVES
APPROVED ALLOWED
SETBACK UK. PROM C C 1 I {
J5
[CENTER UNE. HT.)
CENTER OF STREET REAR YARD
FRONT FT. IN.
ILEFT
(RIGHT
SIDE YARD I
I
R. SIDE 6 FT. IN.
DESCRIPTION OF WORK
L. SIDE V FT. IN.
NEW I XX I ALTERATION I I ADDITION i
REAR 37—c FT. IN.
I I I I
(.f/ q
REI MOVING DEMOLISH
APPROVED
S DATE
BUILDINGNO. OF
1611
49-
SIZE 01X ROOMS STORIES 1
EXTERIOR WALL StuCCO I ROOF comp.
Living area 1467 S F
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
family rasidence
Garage area 476 S F
w/attached garage
Covered Porch etc.
I HEREBY ACKNOWLEDGE THAT I HAVE READ "IS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COM-
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY,
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
VALUATION
BUILDING CONSTRUCTION.
SIGNATURE OF 00
PERMIT FEE S
(/
CHECK �J
PERMITTE
s16,084-00
By
PLAN S
5h,00
AUTHORIZED AGEN K/✓
TOTAL FEE s
/Im