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Home My WebLink About1106 MISSION DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1106 MISSION DR Suite No Vicinity: Parcel Number: 14156238 Applicant: GALL, ANDREW G JR Address: 1106 MISSION DR _ Phone: 715-957-0696 COSTA MESA, CA Zip: 92626 Owner: GALL, ANDREW G JR Address: 1106 MISSION DR Phone: COSTA MESA, CA Zip: 92626 Contractor: OWNER -BUILDER Address: Phone: Zip: License: 0 ISSUED BY: SCOPE OF PERMIT REPLACE OF A FAU & INSTALLATION OF A NEW A/C UNIT IN AN EXISTING SFD. I UBST FAY < 100K BTU & 1 COMPRESSOR UP TO 3 HP/ 100K BTU FOR AN A/C UNIT Quantity ISSUE FEE $23.50 Inst FAU <100 k BTU $14.80 1 Inst FAU >100 k BTU $0.00 0 Repair / Alt Cooling/Heat $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >I 00 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Meth Exhaust $0.00 0 VAV Box $0.00 0 - Vent Fan / Single Duct $0;00 -0 Appliance - $0.00 '0 Fire Dampers - $0.00 - -0 , Smoke Dampers $0.00. 0 Inst or Relocate Appl Vent $0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers> 10000cfm $0.00 0 Floor Furnace - $0.00 0 Floor or Suspend Heater $0.00 0 Status: ISSUED Applied: 07/17/2001 Issued: 07/17/2001 FEE SUMMARY Quantity -- Repair/ Alt Absorbtion Unit $0.00 0 Repair / Alt Refrigeration Unit $0.00 0 Ventillation System $0.00 0 Evaporative Cooler $0.00 0 Commercial Incinerator $0.00 0 Domestic Incinerator $0.00 0 Compressors /Absorption Systems Up to 3 hp / 100 k BTU $0.00 0 3 To 15 hp /500 k BTU $0.00 0 " 15 To 30 hp /.1,000 k BTU $0.00 0 " 30 To 50 hp / 1;75O k BTU ', $0.00 0 - Over 50 hp /Over 1,750 BTU',' $0.00 0 Boilers -- - ,Up to 3 h -F, '% ,. 1 3 To 15 hp - - .';$14.70 $0.00 0 15 to 30 hp $0.00 0 30 to 50 hp $0.00 0 Over 50 hp - $0.00 0 Other Mechanical Fee Investigation Fee $0.00 Plan Check Fee '" _ $0.00 Reinspection Fee - $0.00 TOTAL CALCULATED FEES $53.00 COMMENTS / SPECIAL CONDITIONS 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 2x4646 (6=) DECLARATIOMS 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. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Later Code, for Ne performance of the work for which this permit is Issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed it 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 It 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: WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECRON 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. # Class # Contractors Signature: Data: 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). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 subje the applicant to a civil penalty of not more than five hundred dollars ($500).): 1, 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.). ❑ 1 am axe uonr Business and Professions Code for this reason: Signature: �i 7� _ Dale: Owner ID verili byns . (❑ No Driver's License No. Exp res: Verification of Ownership by (type of document, .e. - property tax bill 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, An 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? ❑ 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 Califomla 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 compiled 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 e�lplication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 5 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? ❑ Ves ❑ No (It '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 proscribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ......................................................................................................................................................................................................................................................................................................................................................................................... - B (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. Iggg99Hpppree to corn with all state I�vs and city ordinances relating to building construction, and authorize representatives of the Ctry of Costa Mesa to enter upon the above-dgSC be rD for imilppectig( du/posep. I agree not to occupy or allow Occupancy of any building authorized by thIrm� until ^final I pection� llQ/l Ignaturre Of e •/YOwn (s) And(Or Authorized Applicant Date CODE #. INSPECTION TYPE PAIS RITTIAL CODED IR$PECTION TYPE r] 2m INTITIIALQ 1616 Fixed System Final Fire Prevention 206 Final Mechanical / '�O �0 1266 Poot 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 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT B98-00885 PERMIT PERMIT NUMBER (714) 754-5273 • Fax (714) 764-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1106 MISSION DR Suite: Vicinity: Parcel Nunmber: 14156238 Zoning: Applicant: GALL, ANDREW G JR $0.00 Address: 1106 MISSION DR Total: $112.83 Phone: COSTA MESA,CA Zip: 92626 Owner: GALL, ANDREW G JR Address 1106 MISSION DR Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: License: Status: ISSUED rkb Applied: 05/21/1998 Issued: 05/21/1998 Arch / Eng : . Address:.. .. _. Phone: Zip: License: SCOPE OF PERMIT T/O EXISTING & REROOF THE HOUSE AND GARAGE WITH COMP. SHINGLE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,800.00 Permit: $112.25 Claimed Valuation: $5,600.00 Other: $0.00 Inspection: $0.00 Total: $112.83 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0 Right 0-0 Proposed: 0 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 WORKERS' COMPENSATION DECLARATION: I hereby affmn 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. ❑ 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' compensation Insurance carder and policy number ere: Cartier: Policy Number: (This section need not be complotod it the permlt is Valued at one hundred dollars ($100) or less.) ❑ 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 shall forthwith comply with these provisions. Applicant Signature: Date: 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 DOU ARE ($100,1100), 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. Uc. # Class # Contractor's Signature: Date: 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). 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 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 (Sac. 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.). 1, 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 contractors) license pursuant to the Contr ctors License Laws.). ❑ I am exemptu e Business and Professions Code for this reason: - 1 Signature: Date:) 1 1 Owner ID verified b driVe_44 lic se. r 0 Yes[INo Driver's License No. / Expires: Verification of Ownership by (type of document, i.0property, 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, Callfomla 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? ❑ 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 Costs Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then 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 (Sectlon 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 a plication apeimit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................. 8 Will any pan 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 ah�ermit from the South Coast Air Quality Management District or other air pollution control district or agency Is reaulred 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? [3 as ❑ No .................................................................................................................................................................................................................................................................................... 8 (If'yes", attach cortiticate 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 corect. 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 p);pparry)er ins pe I p sLl agree not to occupy or allow occupancy of any buildingauthorizedby this perrmit until finalmsp�Ction. —10 7 / �gne u Legal r(- � D— lam" L And/Or Authorized Applicant Date CODE If. INSPECTION TYPE BATE INTITA CODES INSPECTIONTYPE DATE D✓TIDAlS 1616 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 Well 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Buili ing/Occupancy 244646 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address //O(a12Zs5i/CH .UN• Appiicant's Mailing Address : ,a Owner's Name Phone Address Arch/Eng. License No. Address r Contractor's Nam Phonelo Z20 Address (mailing) 4 M�(..r+.. (`p: Uin6 a. City License No. 30 93 5 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provi slons of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force anrd effect. License p License K;� y g JCdg ' L}' eJJ lyo. y6 y��t 7 DateY YY Signature t JLc16 /l�+ /�/�•�•!�/tw•�/ WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self 4nsure.ona certificate Workers' Compensation Insurance, or a certified copy thereof (Section )0, Lab. C.) olicy No. if CompanyY ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Dates/ Applicant Y EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). certifv that in the Performance of the work for which this permit is issued, I Workers' C99mpe[[11s Ion Laws of Califor�l Dare Y %(L /Y Signature 1.0 /+. A NOTICE: If,after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith 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's Name . Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or,,repalr any structure, prior to itSLissuance, also requires the applicant for such permit to file a signed statement' that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing, with Section 7000) of Division 3 of the'Business -antl Professions Code) or that he/she is exempt t"refrom and the basis for the alleged exemption. Any violation of Section .,.5 by any applicant for a permit. subjects the applicant to a civil .''.', -elty of not more than five hundred dollars ($500). '?'1, as�owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional, Cotler The Contractor's License Law does not apply to an owner of a property who builds or improves thereon,and who doessuch work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I- ' I, is owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant tolthe Contractor's License Law). Ell,am exempt under Section B. & P. C. for this reason Date - Owner I -hereby certify that I have read this application and state that the abbve- lnf_.tInn it rnrrprt i noree to comely with all city and'county ordinances TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION a REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK S Main Building: E TYPE OF PERMIT GRADING yFOUNDATION ❑STRUCTURAL T Front El TENANT 11ELECTR'CAL 1 PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right KLeft CONSTRUCTION TV PE VALUATION$ S ZONE GRADING CU.YDS. ACRES ping. Ref. # Remarks: Parking Req./Provi' Use of Building: PLUMBING FEES Planning Notes: 3650 7/09/84 Zone Accessory Building: Park.Fees $ Bar Sink Showers I - $ 3 �ov ' Backflow Preventer- Service Sink Backf low Irrigation Sewer Cap Reinspection Fee ELECTRICAL Bathtubs Sewer Connection. $ 3 Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. 11 50+ KW Clarifiers Solar Collectors Dishwasher Solar Piping - Cooking Unit Meter ❑up to 100 amps Drinking Fountains Solar Tank Dishwasher Meter ❑over 100 amps Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel Floor Sinks Urinal - - - Fan Motors 001 HP E11% - 8 Gas Service 'Outlets 1 WatenCloset F.A.U. Inc. Solar 09-f5 HP E]16-15+ Interceptors i Water Heaterdo Fixtures - Microwave Kitchen Sink Water Service Device Boxes Pole Light Lavatories - - - Outlets I Range P—Trap Switches Sign Roof Drains - $ 3 Garbage Disposal Standing Sections Generator E10-5 KW E15-15 KW Trash Compactor _ n Fee I $25 I Boiler Duct - Under Ground Duct -Structural Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO Heating'System & Ducting E10-100,000 BTU ❑ 100,000 BT Signature ' �' case-- ieoio i Drivers' License or SS Reinspection Fee $25 CMF 0865-46 rev. 12/83 White-Building;Canary-Applicant;Pink- Accounting; Goldenrod - Assessor 50U - O N I N G R E Q U R E M E N T ME Issue Fee .' I - $ 3 �ov Reinspection Fee $25 Issue Fee . $ 3 iANICAL FEES PUBLIC SERVICES REQUIREMENTS: Zoning Approved By f Building Approved By Application Issued By Date Date jam' nate_2r�1 r� Hood or Type El_ Canopy Type It ' - Refrigeration System - 00-100,000 BTU 0100,000BTU i- j . BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ $ $ $ $ $ SUMMARY OF FEES SMIP PERMIT 5,00 ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE - j $ ;$ $ $ $ $ System Repair/Alteration - - - - Issue Fee $ 3 E t CONSTRUCTION AND PLANNING APPROVALS ; Permit# Date - Inspector" - - - \ -< : ., ,- POOL & - "- - .APPROVALS; Permit 'Date. Inspector,', - .�. ' 1. Temporary Electrical Service or Pole - 527 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.. - e ,57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd.:-- 8. Foundation 59. Gas'Pipe;'❑ 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 Drains 64. Plumbing "System,-Final e-_ _ 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 APPROVALS Permit # _ �; �'_ • . 20. Rough Factory Fireplace 21. Ducts, in Structure 70.* Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping O Gas -'D Oil 23. Gas Pipe -Rough & Test 72i Underground Flush: 24. Roof Framing 73.Undergrnd. Storage Tank 11Gas ❑Oil 25; Roof Sheathing 174. Overhead Hydro '• 26. T -Bar Ceiling (Structural) & Monocoat X75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing & Siding ° 177., "FIXED SYSTEM FINAL .29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat I ,79.' FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ,Notes: 34. Final Heating &'Air Conditioning 35. Final Gas Pipe -Test _ - '- 36. Hood or Canopy 37. Final Factory Fireplace - - - 38. Final Plumbing /SI,g'$ L - -' r 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System 45. Sound Attenuation- - - - - D 46. Handicap Regulations - - 47. FINAL STRUCTURE & BUILDING ;. r 48. Special Requirements Completed ` , i ' •' ' ` `" ` 49. Electric Release to Edison . +- ' - - ,- I 50. Gas Release to Southern California Gas Co i i •: 51. CERTIFICATE OF OCCUPANCY No. Date' _ - --+ -- - -- i ------'---- - t-..- i i 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. I personally plan to provide the major labor and materials for construction of the pro- posed property improvement. O Yes ❑ No 2. 1(have/have not) proposed work. signed an application for a building permit for the I have contracted with the following person (firm) to provide the proposed construction: Name 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 Phone ( City 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 I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my per- sonal knowledge 'ry compliance with th s S ?e a /]e Signed: JA 444 A b,,7 Date: ` 2—� t Name: �-nj2-g,�7-ti- �� [— L-- TS� (Printed or Typed C.D.L. # or S.S. # 1042-46 754-5273 1y JOB ADDR Cr GENERAL f_\@�AP No, a 7 Owner DESCRIPTION OF WORK int. alt. O 10 . LOT _ TRACT FIRE ZONE VALUE $0.00 I ECTIONS Signature Date GROUP J TYPE V ZONE RI So.. SUBCONTRACTOR PERMITS ISSUED Gas ` Date Number ,Signature Water Plumbing Rough Plumbing Prop. Swr. Line 0 House Con. El Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 Rough Wirin&Z-2. - Heating and Vent. Trenches 0 Forms 0 Steel Reinf. '0 _ Floor System Bond Beam p _ _ Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, Brown Coat S' -tural, Final Electric I. ng, Vent., Refrig, and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final _ Building, Final -9,i,/ �. �l rE COSTA MESA BUILDINGSAI M DEPARTMENT P.O. BOX 1290 COSTA MESA. CALIFORNIA 92026 For Applicant -to Fill In Complotoly- 'TYPE OR PRINT S-• ADDRESS COSTA MESA. CALIFORNIA STATE USE OF NO. OF OLDos. DESCRIPTION OF WORK 1 HEREBY ACKNOWLEDGE THAT.1 HAVE READ AND STATE THAT THE ABOVB.IS CORRECT AR PLY WITH ALL CITY ORDI NANCL�ND ETArE BUILDING CONSTRUCTION. , 1 /I CITY Cr v ; A A DEC 20 1965, ' . -• �I �I PE _• Y• for Offln'.Uro Only .. ••• RECEIPT NO.J,t�4 MAIN SLOGS. R[CK1 BY D R[C[IVKD CAW HISUEED {_ APPROVED T a BUILDING -- - ADDR9fQ FIR[ FON[ TYP GROUP / APPROVBD UNDER VALUATION IB FOR THE BY DATE ZONING z E NO. ofustorm c cdu� PLAN CHECK 3 FunE EUILDI LEGALT(� _ 3 DEECRIPDON ^'L! , A. P. NO. — �G NOTE: NO EAVE OVERHANG SHALL BE LESS THAN SO' TO SIDE S REAR P. L. EAVES ALLOWED (U. B. C. REQUIREMENT) YARDSAPPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/L STRE ) FR NT IT. R. Slim FT. L. SIDE alAfr. FT. DISTANCE BET BET. MAIN S MAIN SLOGS. ACCESS. SLOGS. VAR. DATE C. APPROVED APFROV[D Lc - ,,.MAT. C DAT[ G SQ. Fr. THE AMOUNT SHOWN UNDER VALUATION IB FOR THE WRPOSE OF ESTABLISHING A PERMIT FUM ONLY. VALUATION ,j jDD � PERMIT FEB PLAN CHECK 3 TOTAL PEE 10-1,7-66,4.;P( i's'I'll", Inspected and-found-the garage,panelled with mahogany, floor tiled a4 ceiling'+e( osed,with ;he exception of about 31 across the At froof`[he"garage. -The-panels across the front of the garage are removable'(fasten_ed with hooks on the top and bottom). The..garage �. -door remains usable. They have pingpong tables in-this room and--use- ` It fori.a-childuren's playroom.- It is my. be that this can be used for a garage whenever re- quired. 1 COSTA MESA BUILDING4AFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDING ADDRESS 110(, Mj SSi nom" COSTA MESA. CALIFORNIA FEE RECEIV�E,. Lot 38, Tract 4204, Plan 2-11 SEPI �✓ FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only OWNER Mesa Del Mar Develonment Co. RECEIPT NO. ;r -,IT N0 MAIL p ADDRESS 3300 E. Coast Hi hwa RKCK1 O BY D 81/V8 DATE ISSUED CITY Corona del Mar Calif q No. -OR 34220 BUILDING ADDRESS HITECT ORENGINEERMacco Cor oratiozM.OR 34220 COSTA MESA. CALIFORNIA ADDRESS 3800L FIRE ZONE TYPE GROUP CONTRACTOR MAorn CnrporatAnn APPROVED BY DATE ADDRESS 3800 E Coast a ZONING ZON NO. OP UHK OF N81F, CITY �.- I PLANE BUILDING/ I STATE TEL.NO. - NO. I7 / taGAt I� ` [ 2 4 Lo T v DESCRIPTION C� OF LOT 62O S F I NOW ON OF OT none A. P. NO. USE OFYARDS EX1871NG BLD O EVES APPROVED ALLOWED 86TBACK LINE PROM ceNTER OP .r119 1611 REAR YARD 261611 (CENTRR LINK BT.) FRONT //7 FT. IN. SIDE YARD ILEFT 71 (RIGHT 71 r/ R. SIDE / FT. IN. 7 DESCRIPTION OF WORK L. SIDE FT. IN. INEW IXX ALTERATION II ADDITION I REAR Z G FT. 6 IN. REPAIR I (MOVING I II DEMOLISH I APPROVED Lu/,4,2DATE '/'40 •( BUILDING r NO. OF SIZE 481X711 ROOMS 6 STORIES 1 Living Area 1349 S F Garage Area S F EXTERIOR WALL AROOF COVERING St11CCYYCOVERING comp. USE OF BUILDING AND WORK TO BE PERFORMED ng 1P faMj1;E rpsidence w/attached garage Covered Porch etc. I HEREBY ACKNOWLEDGE THAT I HAW READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AHD AGREE TO COM. PLY WITH ALL CITY ORDINANCEP AND STATE LAWS REGULATING THE AMOUNT SHOWN UNDER VALUATION 15 FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION $ 11.I,786.00 / PERMIT FEE S �`� BUILDING CONSTRUCTION. SIGNATURE OFTE ment Co PERMIT ) PLAN CHECK $ / 7'� D.. "J TOTAL FEE 5l.00 AUTHORIZED