HomeMy WebLinkAbout2405 NARBONNE WAY - Building Permits\ � t
• � CITY OF COSTA MESA ' S
° BUILDING pMS10N �
, _ �
� DEVELOPMENT SERVICES DEPARTMENT
� ., _ n4n_n1925
•� � PERMIT PERMIT NUMBER
(714)754-5273 • Feu(714)754-4856 gUILDING PERMIT nFAiRDRIVE,COSTAMESA,CA92626
�obAddress: 2405 NARBONNEWY
Suite:
Viciniry:
Parcel Nunmber: 43914341
,4pp�icant: HANSEN, DUKE
Address:
Zoning:
Status: ISSUED
Applied: O6/24/1998
Issued: O6/24/7998
Phone:
Zip;
Owner. MCILWEE, KAREN� i � _ � _
Address 2405 NARBONNE%� � � � " ; � : �
/'./�� . '� � . Phone: � � . � - � A
COSTAMESA;CA '� � � _ - - Zip: 92627 _ � �� �V ��\
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',/�i , , , � -' . . _ -�- ;' i - '` �i �� .
Contractor � ROSS�& BARROWS:INC. ` � .-., � � � / �� ��
Address. �� �00260 E. ALTON AV- ���� �-� � " ` '
. i � , ' �: ;�i� ., . • , ; . � . � �_
� � /, Phone: A �; : � ��� �.
��;��' SANTAANA-CA%� Zip: 92707 ��",`\�• �
� �li � /.i. � V , . �
� ��� j; , ��,��' License:'327802 \- .� � .
Arch'/ Eng' : " . , �, , ' . . ' ' �
i�..� , .,
�Address: � � � /� ,. . _ . . .
, " - �� � _ - � . . ,
- - .. � _ , ".�Phone'. .. �
.. , % � � � , . .. . � ,
. .'Zip:- .. ..
. ���:- � . a - �
. � _ . � . . ��' / � _ License:- . _ . . . ,
, -.. , _ - - - . .�.
� � , SCOPE OF PERMIT � � , � �
REMOVE EXIST BUR OVER THE GARAGE AREA & REROOF WITH BUR.�� �
� . A'�, �
�+� j � � � � .. .� . � . - � i
. .� . , . , , . ' `.�_ . . � � . � �
'� � , � FEE SUMMARY ��
Plan Check: � � $0.00 � - ,', Calc Valuation: � Ssso.00 �
Permit: . $34.75 . -- �-` ; ' ' ' • Claimed Valuation: $sso.00 �
SMIP Res: '; $0.50 - ' •%, .
SMIP,Com: $0.00 ,! , -
`, Other: $0.00 ` _-,{ _
Inspection: ��$0.00 � -- - y', , � �
�
` ��� ;�" , . ,�
�Total: $35.25 �
:�� � ,. , ,',
- � � `� ;^ � � PCANNING & 20NING _ i
_ � ��: _; � � .��
�: � �ti; r� , .
SETBACKS,- _ . � , / %'
. '' ���i
MAIN STRUCTURE Front 0- 0, � �� �Rear� ��0- 0 L'eft- �� 0- 0- -�Right �. 0• 0- , �
, � - . . , , . - - . , ��
ACCESSORY Front 0-0�� � ;�Reai- 0-0 Left 0-0 Right � 0-0 '
. � , . - - .�� , .
PARKWG ExistinA:� _o _ Required: o ` Pro osed: o �
NOTES:
EXPIRATION: This pertnit shall automatically explre and become void if work is not commenced within 180 tlays, or ii xrork is suspended or abandoned
tor a perfod of 180 days. ' � ' �
INSPECTIONS: In ordar for the work authorized urxler this permit to be considered legal, such work must compty with ail applicable codes, and ell
requlred Inepeetlone end flnal approval must be obtained. Feilure to obtain Inspeclions and Onal epproval wlll resutt in the expiration of this pertnit.
FOR INSPECTIONS CALL: (710) 7545828
WORKERS' COMPENSATON DECU1RA710N: .
I hereby eifirtn under penalry of perjury one oi the following declaratlans: � '
❑ I heve end will maintein e certlficate oi consent to selbinsure for workers' compenselion, es providetl for Dy section 3700 of tha leDor Cotle, for tha peAarmenca of the
work tor whiCh this permil Is issued.
�I heve entl will maintein workero' compensation Insurenca, es requiretl by sectlon 3700 ot the Labor Code, for the pertortnance of tha work for which this pertnll is iuued.
My workers' compens tion Ins nce cerrier end policy number ere:
Cerrier. �Sl �%� �['�✓� - , POIIcyNumber.
(lhls sec0on neetl not be comp/etetl il Me Oerm/t /s ve/ued at one hundretl Collers ($ f 00) or less.)
❑ I certify Ihet In ihe peAormence of the work for whlch this permit is issued, I shall no� empby eny person In eny manner so es to became sublecl 10 1he workers'
mpensetlon laws oi Celifomie, and egree thet if I shauld become su6�ect to the warkers' compen5etion praWsions of Sectlon 3700 oi the Lebor Coda, I shell forthwith
I/�/ply with Ihese pro/v�p n���p / �J p�/
A plic I Signature: _ �_i � /n / l� e(9--� v � �i % ` C /
WARNINO: FAILURE TO SECORE WORKERS' CdAPENSPTION COVEMGE I5 UNUWFUL AND SHALL SUBJE EMPLOY TOf. IMINAL PENALTIES MlO qVIL FlNES UP TOONE MUNDRED
THOUSAND DOLLARE (5100,000), IN AD�ITION TO THE COST OF COMPENSATION, DAMFGES AS PROVIDED R IN SECTI ee6F TNE LABOR CADE, INTEREST, M1D ATTORNE`f5 FEES.
LICENSED CONTAACTORS DECLARATION:
I hereby ettirtn ihet I am IicenseO under provisions ot Chapter 9(commencing with Section 7000) at Dl�nslan 3 of Ihe Business antl Professlore Cade, end my license is in tull
toroe ana ettect. Lic. q Cless q
Conlredols Signeture: Dale:
CONSTRUCTION LENDING AGENCV:
❑ I hereb aXirtn that Ihere is e consiruction lending agency for the perfortnance of ihe work for which NIs pertnit is issued. (Sec. 3097, Civil Code).
Lend Lenders Atltlress:
at �- oate: _ ^ L
�-
OWNER-BUILDER DEGLARATIONS:
1 hereby eftirtn that under penalry at perjury that I em E%EMPT FROM TlIE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business anA Prolessians
Code: Any ciry or counry whic� requires a permit to consiruct, alter, lmprove, demolish, or repelr any siructure, prlor to Its issuance, also requires the applicant for such permlt
ta flle e signad stetement Ihet he or sha Is licensed pursuanl lo Ihe pmvisions at the Coniractors License Lew (Chepter 9(commencing wlth SecOon 7000) of Divlslon 3 of ihe
Buslness antl Professions Cotle) or t�at he or she is exempt iherefrom end the basis tor the elleged axemptlon. Any Wolatlon ot Section 7031.5 by any applicant tor e permit
subJeds the epplicant to e civil penelry of not more ihen five �untlretl tlollars ($500).):
❑ I, es owner of the properry, or my emplayees with weges es thelr sole compensetlan, WILL DO 7HE WORK, end ihe structure Is not Intanded or offered for sele (Sec.
7044, Business and Professlons Code: The Conirectors License Lew does not epply to en owner o1 property who Duilds or improves Ihereon, end who tloes such work
himself or hersetl or ihrough hls a her own employees, provltletl that such Improvements are no� Intended or otteretl tor sele. It, however, Ihe Duilding or improvement is
sold within ane year of completlon, Ihe owner-bulltler wlll have tha burtlen of proving ihet he or sha did not bulltl or Improve for purpose of sale.).
❑ 1, es owner ot the praperry, em EXCLUSIVELV CONTRACTING WIiTI LICENSED COMRACTORS lo construct the project (Sec. 704a, Business anA Profeuions
Code: The coniraclors License Lew doas not eppty to en owner of pmperty w�o bulltls or Impmves thereon, flnA who contracts tor such project wich a contrector(s)
Iicensa pursuant to the Contrectors License LewsJ.
❑ 1 em evempt undar sec. Business antl Professlons Code for this reason:
SlgneWre: ' Date:
Owner ID veritied by tlnvefs Iicensa. ❑ Ves ❑ No Driver's License No.
Vedflcatlon oi Ownership by (rype ol dacument, i.e. - praperty tex bill or deetl�:
DIVISION OF INDUSTRIAL SAFETV PERMfT CERTIFlCATION:
Ezpires:
❑ I �ere6y ceniy thet no excevation five (5) or more teet In tlepth into whlch a person is required to tlescend, will be mede in connection wlth work authoAzed Dy this
permit. antl thet no bullding sWdure, scettolding, telsework, or demolition or Alsmentling t�ereot, will be more Ihen thirty-six (36) feet hlgh. (Chap. 32, Grp 2, Atl 2, Sec.
341, 7111e 8, Calitomia Administrefiva Code).
❑ As owner-builder, I wlll not employ anyone to do work which would requlre e pertnll irom the Division of IntlusMel Sefery, as noted above, unless such pereon hes e
pertnit to tlo such work Irom �he division.
Signeture: Date:
Division of Industnal Satery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHOHQATON OF ENTAV: I certify under penalry ot perjury that I heve read this applicetion and state Ihat the information given is
cortecc I egree to comply wlt� all stete laws flnd clry ordlnances relating to 6uilding construclion, and authonza representetives of the Ciry of Costa Mesa to enter upon �he
abovadescribed property for inspectlon purposes. I agree nol to occupy or allow occupanq of any building authorized by ihis permll until final inspedion.
Sipneture
4QpE I. qSPECTON TYPE ��
1818 Fixed System Finel Fire Prevenlion
1266 Pool Spe Final
200 Flnel Re-Roof
201 Finel BIocWRetaininq Well
202 Final Fectory Flre Plece
203 FInalSign
204 Final Demoll0on
2d4&s8
� �g ��
7-/D-f3 �
LppF� INSPECTONME
206 Final Mechanical
208 Final Plumbing
210 Flnal Elecirlcal
212 Flnel Fire Prevention
220 Finel Planning Approval
222 Final Site
250 Finel BuildindOccuoanc
�
Ibml.ic
PNOJECT qO�flESS: 2 e] O S NARBONNE WY
OWNEfl'SNAME: PIERCE, MARK
ADOPE55: z4OS NARBONNE WY
COSTA MESA,CA
pHCHIENGINEEP:
R�OflESS:
1 � —{ UNIT:
926I27 I
NEG.NO.:
UNIT:
PENMITTEE: NOCK PLUMBING ( 714 ) 895-124fi
aooness: 11610 SEABOARD CIR
STANTON CA 90680
LIGExSEo CoxTflACTOP DECUHRiION: I nereUy aHirm rtWl I am IicenseA un0er provisi0ns al Cnapter 9(commencinB wiln Section
7000� ol Orvismn 3 0l t�e Business ane Pmlessions Cotle. and my license is in lull force and eliem.
ciTvuc.: �503� 6"(srnreuc.:51197 cuss: C- o
�e: �_.]�_'��e�.�_ Siqnaiure: _
EFS' OMPEN�AilONOECIABATION: IAereUyaflirmthatllWveacenificalealtonsenitosell-insureoracertiliWteoiwarker5'
Compensation Insurance. or a certihetl copy inereof ISeclion 3800, laE. CI.
eoucvNo.: 1167992-93 eze.oare: 03/O1/9A
icpmvaNv: STAT E
U Cenified coOY is hereby �umished Q Cenifietl cap ii a with the cirv.eu' inp Division.
�
�aie'. � ADDlicant: �
E%EMPiIONFXOMWOflKEHS'fAMPEN5ATI0NOECtAMTION: (iltisSecWnneetliw�GecompktetlilNeperrtntis�monehu�rea�411p�orie55�.
I ceRify �ha� in �he pedormance oi t�e wark for which I�is Oarmi� is issueU. I 5hall nal ¢mpioy any person in any manner so as to become
sublec� la ihe Workers' Compensa�ion �aws of Cali�ornia.
�ate: SignaWre:
NOTICE: if. alter making t�is Declaration, you shoWa become suUlect to the Wolrcers' ComDensation provisions of t�e Labor
Cotle. you must Iannvnln comply wi�n such pmvisions ar ihis p¢rmil shan be aeeme0 revoketl.
CONSTPUCTION 1EN01NG RGENCY: I �ere0y al�irm �Aat �here is a conSVuc�ion IenOing agenty �or Ihe petlormance ol the work �or
which Ihis permii is issuetl (Seclion 3097, Civ. C�.
LENOEfl:
ADUPESS: �
OWNEfl BUIWEP UECLAflAT10N: I here0y a��irm IAa� I am exempl �mm lhe Contrattors' State License Law Por �he following reason
�Sec�ion 703t5 Business anA Pralessional Coae: pny city ol counry which repuires a permit in consimct, alter, improve, demolish, or
�eoair any slmcture, prioi to ils iuuance, also Rpuires ihe apDliWnt lor sucn oermit 10 lile a siO�eA statement Ihat hpJshe is licensetl
pursuanl ta ihe pmvisions ol l�e Contrauors' State License Law (C�apter 9(commencing with Section 7000) ol Division 3 of Ne Business
m0 Prolessions Catle) or inat ne/she is e�empi 1�¢refmm ana rt1e Uasis 1or �ne allepea exemption. Any Violatian ol Settion 7031.5 by
any apPlitani �or a permil SuUj¢tls lhe appliwnt lo a tivil penally 01 no� mOre Ihan �ive hun�a0 Aollars (SSIp�.
I, as owner ol ine o�openy or my employees wit� waAes as t�eir sole compensaiion, vnll Do the work, anA ihe
❑ struclure is not intenUeO ar offeretl for ule (Secuon 70na, Busineu antl Pmlessional Code: The Contractors' State License Law
tloes nol apply to an owner o� a D�opefiy who builds or impwv¢5 Ihereon. and who tloes sut� work himself/herself or �hmug�
�is or her own employees. pmvbea i�a� such imprmemenis are not intentleA ar olleretl br sale. II, however t�e buil0ing or
impmvement is so10 wit�in one year ol complelion, t�e owner will have ihe hurAen o� pwvinp �e/s�e Uitl noi bui10 or impmve
lor @e purpose ol sale�.
I, as owner al the D�operiy. am e�clusively comraminp wilh licensetl contracmrs m constmcl t�e project (Seclion 70aa, Business
❑ anU Pmiessions CoOe: Tl�e Camraclod S�aie License Law Oces noi appN to an owner o� pmperty wlro OuilOs Or improves Ihereon
3�d wh0 LOIIIfddS IDf SI1C11 plOjCQS wl�ll d COIIIfdCtOf(5� IiCPI15E DUf50dl1i �0 1112 �Altlfdt(Of5' $�d�C LICEfISE i.dW�. I dlll dWdfE
. t�al prnnf ol �heir Worker's Compen5aiion insurante S�oultl Ue pwvidetl IO me.
i� I am exempi waer Seclion: B. 8 P. C.
fof IhiS r¢d50n;
Oa�e: Ow'nec
I ao nereby cenily Ihat I am aware al ana unaerslana Ihe repuirements al Calilomia Healtn ana Safery CoOe 5¢ttions 25505. 25533, antl
2553d antl Ihal I or any WNre �uildinp acupan� wilVwill nol (circle ane� nee0lo wmply wilh 5ai0 Slale coGes antl ihe Bquiremen�s �or a
permi� lor consimc�ion or modilicaiion Imm �he Air Ouaiily Management Disirici. flesiaenlial conslmction apPlicalions are exempl imm
IIICSC pfON5i0t15.
Dale: AOOlicam:
I hereby cerlity Ihat I have rea4 ihis apPlication and sta�e Ihal ih ve in�ormatian is correcl. I aA�ee lo comply wilh all ciiy antl cowry
�manc¢santlslatelawsrelatingloGuildingcons�mc�ionan rehy'it�orizerepresenlativesolthiscirytoenterupontheahove-mentionetl
pmperly foi i peclion ourposes.
Dal '. Signa�ure
er's license or Saiai 5 curity
i4ba6 Wnne—BmlOina� Green—Code Enlorcemen�: Canary—ApplicaN: Pink—Revenue: Goltlenro0—Nssessar
CITY OF COSTA MESA — BUZLDING PERMIT
PERMIT NO: P 066158 PLAN CHECK NO: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU
JOB DESCRIPTZON : WATER HEATER REPLACEMENT
CLAIM VALUE:
CALC—VALUE:
PERM NO: P 06615E
GOVT; N SUPP; N
PORPOSE: OTH
SQ FT;
GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED HY TFIIS PERMIT
**�r�r+�*�r*+r�r*+t�r*x-**�r*rt�r*x***i�+r*****x�****�t*+r*x�*ir**�tt�**x-�**�r�r�r**�r�x�****�r*+c�******x�**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDZNG ---------
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 REQ• PROV; PARCEL: 14167118 ZNE: REF NO:
PLANNING N6T'E5>
> _
�E if �f 1E if if if itlE iE iE iE?f ff iE �f �E if iE �E if �f �E 1E fE 1E if if i� #E fE if if it iE 1E �ElElf iE 1f iE #t fE �lk iE if it 7E fE 1E 1E if if 1! iE iF 1E jE 1E �f iE iF M ik iF if fE iE iE iE if �k iE fE if ��f iE
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 HY : � DATE;
APPLICATION ZSSUED BY: � �' DATE: � Z..� ��
iF1EiEiEikiM1iEikifiElF1E?EiffE3FiFiFiEifiEik MiE1EaEif�fiEiEifiE��A iEiE
jt iE ik iE j! iE iF iE iE �E 1E iE k!f iF it iE �E?f iE iE iE 1t if aF �f if iE iE jf �-iE iE %1t if 1E �E M if iE if iF if if iElf IF 1F 1f if iE iF if iF 3' �f if iE iE if iE 1f fE fE �)f 1E 1E jF * 9E i1 iE if iR if if if iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 7.00
25x SMZP/NON—RES
PLAN
ISSUE FEE 20,00
bUILDING—DIC�—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 7.00 20.00 0.00 27.00 27,00 .00
REVErJUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SAORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
2%,��
k k iE if iE k iflt it ff ik k if 1!� 1E k �F tt if it if if if if iE iE iF iE fE iE if 1E iE � ihlF iE if iF fE iE iF if if 1f !t iE k 1F iE itlf iE i! 1E it it �k it iE iE iE iE k if if ik 3f if fE k if if iF iF 1E if if iE
Z N D I V I D U A L" F E E B R E A K D O S4 N
TYPE QTY
PLU 1
D E S C R I P T I O' N
WATER HEATER AND/OR VENT
END OF FEES
UNIT COST TOTAL COST
7,�� 7,�0
OS QD155331-0015`831 T GT 2?.QO
OATE: 02/23/94 TIME: 09:5?
CONSTRUCTION AND PLANNING POOI & SPA
APPROVALS Permit # Date Inspecmr p,ppROVALS Permit # Date Inspector
t, Temporary Electrical Service or Pole 52. Pooi & Equipment Locauon
2, Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Coriduit Ut�lity-Undrgrnd. 54. Forms
4. Electricai Conduit-Undrgmd. 55. Electrical 8onding
5. Steei Reinforcement 56. Rou9h Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNiTE
�. Footings 58. Electrical Conduit�Undrgrnd
B. Foundation 59. Gas Pipc, f� Undryrnd., Test ��
9. Water Pipe-Undrgmd. 60. Backwash Lines, P� irap, C Undrgrnd.
10. Structural Floor 5vscem 61. APPROVAL TO DECK
i t. Property Sewer Une & House Connection 62. Backwash & Receptor�Final
� 12. Sewer Cap 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing System � Pinal ,
14. Rough Plumbin9 65. Electrical�Final�
15. Rough Electrical-Conduit � 66. Solar SVstem-final
16. Rough Electric Wiring � 67. Fencing & Access Approval
17. Rough Wiring Sign 6$. APPROVEO FOR PLASTERING
78. Rough Electrical-'� Bar Ceiling 69. POO V'SPA SYSTEAIIS FINAL
79. Rough Heating & Air Cor,ditioning FIRE �EPT. REQUIREMENT
20. Fou9h Factory Fireplace APPROVAIS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventiiaung 77. Product Piping G Gus ❑ Od
23. Gas Pipe�Rough $ Test 72. Underground Flush
24. Roof Framing 73. Underymd. Smraye Tank � Gas ❑ Od
25. Fioof Sheathing 74. Overhead Fiyciro
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. Drywali Nailing HEALTH OEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPGCTION
32. Electrical Power MeterF�nai 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: L /
�-'-�� �/_/��.Z=�l- �.F�
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test '
36. Hood or Canopy
37. Final Fac:ory Firepiace
38. Pinai Plumbing _C-�'
39. Water Service-Final
40. Gas Service-Pina4
47. Solar 6omesticFinal
42. Backflow Preventer
43. Backflow Irrigation '
44. Landscape Irrigat�on System
45. Sound Attenuation
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING
48. FINAL PI.ANNING
49. Electric Release to Edison � �
50. Gas Release to Southern California Gas Co
57. CERTIFICATE OF OCCUPANCY
No. Date -
18527 AGPlieant to flll in all spaces within
CITY OF COSTA MESA ' PERMIT NO.
CONSTRUCTION PERM17 p .� -r'/.�9
Address
Address
bortler lines antl s19� all aporoorlate aeelarations.
TRACT NO. LOT NO. �BLDG. NO.
TVPE Of CONSTRUCTION
PhOne ❑ NEW ❑ ADD ❑ ALTERATION
979-0710 ❑REPAIR ❑CONVERSION ❑DEMOLISH
LiC2n5e No. ❑ OTHER
DESCRIPTIONOFWORK � WafPY }1E
co�«a�to�Generat inscallation
Address $ WB3t B V .� j,�. -
LICENSED CONTRACTOR DECLqRATION
1 heroby aifirm that I am IlcanSetl untle� p�ovl51on5 Of Chd/[e� 9(Com-
mancing with section 7000) of blvision 3 of the Business antl
Professions Cotle, antl my ❑cense is in full forre antl eHect.
License CIasS 36 ,,,�e No. 151839
Date a�S �5 F Slgnature �� '�%�����A—
WORKERS•COMPENSATION DECLARATION
I hereby affirm that I nave a tertft�ca[e o/ consent to self-Insure or a
certifiwte of Workerz' Comp¢nSdUOn Insurante, or a certlfietl copy
thereot (Sec ion 3 00, Lab. C.).
PoliCy No. Company State COR1'��I
❑ Certlfietl copy is hereby turnished.
� Certltietl copy is filetl wi[h the city Builtling Division.
EXEMPTION FROM WORKERS' COMPENSATION DECIARATION
(This settion neetl not be completetl if the permit is for one huntlretl
(E100) or less).
� cert(fy that In the p¢rtOrmance of the.work for which thi5 pe�mi[ i5
issuetl, I shall not employ any person in any mdnner so as to become
subject to the Workers' Compensation Laws of Glifornla.
Ddte Signdtur¢
NOTICE: If after making this tlecla�ation, you shoultl become subject
to th¢ WO/kers' Compen5dtlon ptovi5ion5 0( lhe Labor Cotle, you mvst
to�thwith cOrtlply wi[h SUch p�ovi5iOn5 Or this pe�mii shall be tleemetl
rovOk¢tl.
CONSTRUCTION LENDING AGENCV
1 nereby aftirm tha[ there is a con54uttlon lentling agency for the per-
�orman<e of tne work for whith this permit Is issuetl (Section 309]
Civ. C.).
�entler's Name
Lentl¢�'s Atltl�ess
OWNER BUILDER DECIARATION
I hereby atflrm thal I am exempt irom tha Contractor'S Llcense Law for
Ihe tollowina reason ISection 70315 Ausiness antl Professlons Cotl¢:
city or COunty whiGh �eqWres a
Bu51ne55 antl Prof¢55lons Cotle) or lhat h¢ Is exampl therefrOrtt dntl lM1C
basls for tne alleged exemption. Aqy violation of Settion 7031.5 by
any appllwnt for a permit subject5 Ihe applicant to a civil penalty
oi not more tban five huntlretl tlollars (E500).
❑ I, as Owner ot the proPerty, or my employee5 with wd9¢5 a5 their
sole compensation, will tlo the work, an0 fhe structure is not Intentletl
or offeretl lor sale. (Sectlon 7044, �uslna55 antl Rotesslons Cotle: The
ContrdCtor'S License Law tloes not apply to an owne� of. a prOPerty
who builtls o� Improve5 lh¢reon, a�tl wM10 tloe5 Such work himself or
[hrough his own emplOY¢e5, Provitl@tl tnal Such improvements a�e not
Intentletl or of/¢r¢tl br SdIG. It, howeveq [he builtling or improvement
Is Soltl withln ona yea� of completiOn, th¢ owne� will have the burtlen
o/ provMg he tlitl nol bulltl or imProve for the purpo5e ot sale).
❑ I, ds owne� ot t�e p�op¢rty, dm exclu5lv¢ly Con[racting with
licensetl contractors to cansVuct the prolecl (Section 1044, BuSiness
antl Professions Code: The Contractor's Licensa Law tloes not appry to
an owner of property wh0 builtls Or improves ther¢on, antl who Con-
[racts from such pro�ects wlth a Coniractor(s) Iicesnetl pursuant [o
the ContraGtOr'S �icense Law).
❑ 1 am exempt untler SecOon B. 6 P. C. for this
reason
Date Owner
I h¢rEby certify Iha[ 1 have reatl thi5 dppliUtiOn antl sta[e thal the above
TVPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL EIPIVMBING ❑MECHAI
❑ OTHER
PHOJECT DESCRIPTION
SQ. FT.
OCCVPANCY_CONSTRUCTION TYPE
VALUATION ZONE
GRADING CU. VDS. ACRES
PLUMBING
TOILETS �
LA V ATO R I ES
KIT. SINKS
SERV ICE SINKS
FLOOR SINKS
DRINKING FOUNTAINS
INTERCEPTORS
SWIMMING POOL
WATER SERVICE
GASSERVICE
WATER HEATERS
SEWER CONNECTIONS
$OLARTANK
SOLAR PIPING SYS.
ISSV E FEE
MECHANICAL
PLAN CHECK
SHOWERS
U R I NAl_5
DOUBLELAVS
DISHW ASHERS
SUMPS
FLOOR DRAINS
CIARIFIERS
PTRAP
ALTERATION
OUTLETS
BTU OVTPUT
COLLECTORS
PLANCHECK
HEATING SVSTEM 0-300,000 BTU
ANDDUCTING 100,000+BTU
REFRIGERATION 0-300,000 BTV
SYSTEM 100,000 + BTU
BOILERS BTU
SVSTEM REPAI R, AITERATION
EXHAVSTSVSTEM MULTIPLE
information is correct. I agree to �ompty with all city antl county
orCinances antl stale laws relatinq to canslruction, antl hereby authorize
repre5entatives of [his city to enter upon the above men[ionetl
properiy to� nsy ect pu�po5e5.
5lqnature,�G' �`" - ��� Date�S Z6'Iy2,
Drivers' �icense or 55 � � ISSUE FEE
CMF 0865-46 WM1ite-Builtling; Gnary-ApO���ant; Pink-Accountinq; Goltlenrotl-Assessor
8718 6/21/82 • 6.00 TU
ZONE
�
SETBACK C/L $T.
SIDE VARD
L5EpFT
R�IGHTY�—
REAR VARD (TO P/LJ
PKG. SPACE RE�.
STREET WIDTH
ZONING APPROVE� BY
SPECIAL CONDITIONS:
PLNG. REF. �
PROVIDED
PARK FEE
ELECTRICAL PLAN CHECK "
SO- FT.
GENERATOR ' 0-1KW_1-lOKW �
TRANSFORMER •
APPLIHNCE 10-50KW_SO+KW
MOTORS 0-1 IiP_1-30 HP
(INC.SOLAR) 10-SOHP 50+HP
FIXTURE$ -OUTLETS $WITCHES
GA$ TUBE $IGNS
POLE UGHTS '
POLES METERED SUB
PANELS MAIN SUB
SERVICE ' AMP -
ISSV E FEE
APPLICATIONAPPROVEDBV DATE t/rf�
SUMMARV OF FEES
BUILOING
PERMIT $ +� SMIP S
PLANCHECK 5� PERMIT �
PLUMBING g �SSVANCE
. GRADING S
PLAN CHECK b
ELECTRICAL S a
MICROFILM $
PLAN CHECK S TOTAL FEE $� OO
MECHANICAL $ '
PLAN CMECK E �ESS AD- �
VANCEPC E_
FINALFEE E��oa
CONSTRUCTION AND�PLANNIN4 � POOL & SPA
APPROVALS Permit # �� ��^ Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location '
2. Soil ipe-Undrgrn 44. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrn - '� 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test � �
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE '
7. Footings 49. Electrical Conduit-Undr rn
8. , Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
73. Rough Plumbing ' � '
14. Rough ElectrioConduit �56. Electrical�Final
15. Rough Electric-Wiring 57. Solar System-Final
16. Rough Heating & Air Conditioning � encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18.' Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin
22. Frame and Flashing NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final '
28. Final Electric
29. Final Heating & Air Conditioning '�
30. Final Gas Pipe-Test
31. Final Plumbing - ¢-�9
32. Water Service-Final �
33.•� Gas Service-Final ' �
34. Solar pomestic-Final
35. Landsca e S rinklin S stem �
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATEOFOCCUPANCY
No. Date -
OwNEx DOYLE & SHIELDS Develo�ent Co..Inc. nA'rE
JOB ADDRESS
INSPECTIONS
SUBCON'PitACTOR
�
PERMIT NO.
��
- �s-��i
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFORNIA
For Applicant To Fill In Completely
TYPE OR PRINT
BUILDIN6 �l
ADDRESS �.t
COSTA MESA, CALIFORNIA .
owNenDo le & Shields Dev.Co i
ADDRHSB 831 So. Mancheste
�,rY Anaheim No 2P80
ARCHITECT TEL.
OR ENGINE6R Hal C• Tan N.
ZONING
�alth, „,.,,, UB80RN
Fullerton �une'' ewtni ,�
LHGAL Lot 147 Tract 343
DHBCPIRION �
A. P. NO.
n NOTE: NO EAVE OVERHANG SHALL BE LE66 THAN
LIG.rNO1S1�2S1/�B�1 NE�. PR Z—HOZ 30"TOSIOEBREARP.L.
ewves
OFLOT 33 X rJ3�rJ0 I���oPet�oe. ALLOWED (U.B.0.REqU1REMENT;
NOW ON LOT ��
YARDSAPPROVED YARDSAPPROVED
USEOF MAIN BUILDING ACCESSORY BUILDIN6
EXISTING BLD6.
(FROM WL REET)
BETBACK LINE FHOM
cervrew on erassr 2 O. S O� REAR YARD -- FR NT •� PT.
SIDEYARD� LEhT q��,�{{ R.SIDE V FT. P9'.
DESCRIPTION OF WORK L. SIDE �� Fr. �.
Same
FE�RECEIVED
dJ N 3 1963
FlNANCE DEPT.
APP��(fI�J Q����
BUILDING
For Office Use Only
RCC61'T NO. pBRMI
Y� DAT[q[C[IVjG �.
' s,i�eo�N 33X53 50 Ro°o°nis V STORIC:
EXTERIORWALL. I ROOF SN�N
�I HEREBY �CKNOWLEOOB TMAT I.AVB PEAO TH^8 APPLIGTI^N
AN� BT�1TE THAT THH ABOV6 19 CONq6CT ANO AONEfi TO COM.
PLY WITM ALL CITY OqDINANCBi AND YTATH LAWB P[QYLATINO
BUILDINOCONB RIICTION. n
A AUTHORIZEDA6fiNT
�
VAR. $R
THE AMOUNT I
' PURPOSH OP
VALUATION
�9, ��� °=�
�ATE
APPROVEO
�ATE �J ~
P'OQ� "
m
V�LU�TION 18 FOR TNH F
A PERMIT FEH ONLY. p
____ ' /�o-► «
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