HomeMy WebLinkAbout1709 ORCAS DR - Building Permits As _
9 CITY OF COSTA MESA
4 •
BUILDING DIVISION
> ��' ;• ,� - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�t011141
PERMIT
- ,P{,a 1603-00456
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1709 ORCAS DR Status: ISSUED
Suite: Applied: 03/21/2003
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 03/21/2003
Parcel Number: 13918207 Zoning: Rt R1
Applicant: COFFEY, BRIAN ISSUED BY:
Address: 2428 NEWPORT BLVD _dr,.
UNIT 5 Phone: (949)722-8846
COSTA MESA,CA Zip: 92672
Owner: TERRY, JODY
Address 1709 ORCAS DR
Phone:
COSTA MESA,CA • Zip: 92626 _
Contractor THE ROOFING SPECIALISTS
Address: 2428 NEWPORT BLVD
UNIT 5 Phone: (949)722-8846
COSTA MESA,CA
Zip: 92672 License: 734068
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
RESIDENCE AND ATTACHED GARAGE:T/0 EXISTING PITCHED AND.B.U.R. (ROCK&HOT MOP); REPAIR SHTG AS NEEDED,APPLY 2
LAYERS 30#FELT, REOOF WITH"30-YEAR COMP SHINGLES"ON PITCHED ROOF AND"MODIFIED RUBBER"ON FLAT ROOF.20 SO
PITCHED,6 SQ ROCK
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,180.00
Permit: $125.25 Claim Valuation: $5,180.00
SMIP Res: $0.52
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.77 •
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
IDECLARATICAs , L
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
rk 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'/�corn ensation InrSura/ncp rrier and policy number are: / _
Carrier: �( N f v/U Policy Number: • /(9� 7 7
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
El 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 Ca'fornia,and agree at If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr si s. i
Applicant Signature: Date: ) J — —0,
WARNING:FAILURE TO SECURE WORKERS'COM NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED'
THOUSAND DOLLARE($100,000),IN ADDITION TO E MST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37080F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed underrovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business-. d Professio Code,and my license is in full
force and effect.Lic.It 7 7" 0(:(, c/q Class C-2
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(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.).
El I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. El Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 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? El 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).
es or will
the applicant
plc..t..r present
..o.f.t future ul in
2 Does or will the applicant or peor building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑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 PreventionProgram for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the Califomia 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 El No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L I 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 AUTHORtZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
i Of Legal Owner(s) Date
AI r Authorized Applicant Date
;ODE II INSPECTION TYPE BATF INITIALS ;ODE T INSPECTION TYPE BATE INTIRALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final (( ) sf 208 Final Plumbing
200 Final Re-Root /"2c "7 210 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
,^u rn I`
V — F I� �Applica Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
F COSTR MESA CONSTRUCTION uc ioN PERMIT ilffill
P MI O. TRACT NO. . LOT NO. UNIT NO.
ect Address 170 9 O rea S r• 2S�/� 33 6, (ri � 2106 8/27/86 140.32 TL
Applicant's Mailing Address -SooM1/e : ,.[i TYPE OF CONSTRUCTION _J NEW DD U ALTERATION U REPAIR
Owner's Name - OL.1.. .ck '-'O)C Phone C �/F faro 2 _1 'CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# ]�, t] /tl 1 /`, _ I Zone k/
// DESCRIPTION F WORK/ SE OF BL G. r ! C.xt ( �
Address t70 9 p,rras .Dr- -' AJ,A Rr( c,/1 f1�,S}, /� t9 0 , (�/� Fz tp y� S Main Building: Accessory Building:
Z
Arch/Eng. License No. TYPE OF PERMIT,-v LJ GRADING 1nOUNDATION L7 STRUCTURAL E Front r ((,,..,,..((//••..((,},,--ll//5�,J/��__��� 0
Address ..tt (� (� '❑ TENANT LJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear / N
Contractor's Name OW IvAir Phone(a9/ 't? 7 JQ OTHER Pc-3
r PROJECT DESCRIPTION SQ. FT. 94.87 OCCUPANCY yCC Right �7 ' G
Address(mailing) 'CONSTRUCTION TYPE Ad/�tlillN VALUATION 53 Se5. p(J•s'� $ Left s *39•� / • .
City License No. (ZONE GRADING CU.YDS. ACRES /�� Ping. Ref.# Parking Req./Provided RE
' LICENSED CONTRACTOR DECLARATION '• /' D
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: 1. trA7: O� Planning Notes: '� /.t ii M
with section 7000) of Division 3 of the Business and Professions Code, and - /`
my license is in full force and effect. ,• , e, ,5 D/ . TS
License Class License No. ([� q 117
: Date Signature - PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink
treby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section .+ Backflow Preventer
_.,00, Lab. C.) Automatic Washer Transformer 0 15-50 KW _
Policy No. Company Backflow Irrigation 0 50+ KW _
8 Certified copy is hereby furnished. ConstrdctiOn'Pole Sub.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant • •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100)or . r
less). • Dishwasher Dryers ❑Gas ❑Eleatic Sub Panel
e I certify that in the performance of the wor • which this permit is issued,I -
-
- shall not employ any person in any m e as to be•n• •e subject to the Drinking Fountains Fan Motors❑0-1 HP ❑155-8
Workers' Corrtry�pensatipp Laws of Califor' • p " - -
• Date -T7-50.40 Signature i•._ . . . ` -. .• Floor Drains F.A.U. Inc.Solar 09-15 HP 01615+
NOTICE: If,after making this declaratlo r yo should become subje o the
Workers' Compensation provisions of t Labor Code, you must • thwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed evoked. • 2 Fixtures Microwave 0 90
CONSTRUCTION LENDING AGENC Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Clv. C.) I •
nterceptors Water Heater . / Outlets Range 0
Lender's Name
go
Lender.`5 Address Kitchen Sink Water Service - 2 Switches - 2,../.' SignO 80
OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash r
Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires.a permit to construct,alter,improve,demolish or repair P.
any structure, prior to its issuance, also requires the applicant for such permit Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of RoofDrainsthe Contractor's-License Law(Chapter 9(commencing with Section 7000) of .
'
the
3 of the Business and Professions Code) or that he/she is exempt -
-efrom and the basis for the alleged exemption. Any violation of Section •
31.5 by any applicant for a permit subjects the applicant to a civil
patty of not more than five hundred dollars($500). I $ 3
Ll I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee
compensation, will do the work,and the structure is not intended or offered 1 Reinspection Fee $15 Issue Fee $ 3
• for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves DEVELOPMENT SERVICES REQUIREMENT ''
thereon, and who does such work himself herself or through his or her own Boiler Hood or Type I 0 I/(.[�yI� (/� 1.
employees, provided that such Improvements are not intended or offered foryp Zoning Approved By ✓"v Date ' r
4 sale, If, however, the building or improvement is sold within one year of com- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or lin- Duct-Under Ground Building Approved By /{•) Date •
/�/���
' prove for the purpose of sale). V OI
0 I, as owner,of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tracors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00100,000 BTU 0100,000 BTU SU MARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ 0/ 00 SMIP $ 0.So
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ 32.az. PERMIT
0 lam exempt under Section (� B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers— PLUMBING $ ISSUANCE $
Date 8'- r'• - Owner `Y I`�. .. L -.{,L' L'_Jz� Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have readthis application and st that the above ❑0.100,000 BTU 0100,000 BTU ELECTRICAL $ Soo GRADING $
information is correct. I agree to comply with all city and county ordinances _
and state laws r- ing to building construction, and hereby authorize repre-
sentatives
PLAN CHECK 50% $ �r 00 MICROFILM $
• th lty to e • -r upon the .•ave-mentioned property for �s _
Inspection . ea. r_/1-€ MECHANICAL $ TOTAL FEE $ /4t0.32.
Signature •. .. // Date sD
Drivers' Lice - or SS# • & • Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,re . 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
CONSTRUCTION AND PLANNING POOL& SPA u;
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding n
5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. -�
8. Foundation ' 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. • - 60. Backwash Lines, P-Trap, 0 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 ` ' ,
•
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66.. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT ,
20. Rough Factory Fireplace .' APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating _ 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough&Test 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro /I
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe - '
28. Lathing & Siding 77. FIXED SYSTEM FINAL •
29. Insulation 78. FIRE PREV. FINAL • , '
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Q. 2- P 2 Notes: la.,
^'!34. Final Heating & Air Conditioning ! l9 �}35. Final Gas Pipe-Test ! /�9 it
36. Hood or Canopy I [� ( OkSl4tlfac4
37. Final Factory Fireplace
38. Final Plumbing
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
46. Handicap Regulations
i
47. FINAL STRUCTURE& BUILDING Q/ /8t Kt
48. Special Requirements Completed ( //// - �' I
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�°r -• lC:l! / '- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. is I
MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO.
r (''' /// / n / ` UNIT NO.
lett. �.ress' 1(?/) ''t. rni f^: 11,, , �� �J {/Y" .7.� b ���� � L...t . — _ ' i - /. 7/ I • r c ' It
' a' Applicant's Mailing Address, i r. •�.,r^ 'TYPE OF CONSTRUCTION NEW 'Ld ADD H ALTERATION H REPAIR r
r "r ) ,// r/i ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P,# J3• y /8) n 7 Zone A
.Owner's Name` 1< .- v. . : L Phone • DESCRIPTION OF WORK/USE OF BLDG. •K • I
_ • Address 'I".. 1. ."'. • s, 7 ..s v1 A '+ i. . , ,% ' ,-„4 . /r,!:// A - d r-�i(( ' /' - , n S Main Building: Accessory Building:
Arch/Eng. Z
' _License No. TYPE OF PERMIT ❑ GRADING ❑� FOUNDATION L�1 STRUCTURAL E Front ; !� . • ,�• • O
Address - ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear C- A ,J ../''''.- N
- Contractor's Name rf •z• �+` Phone ^/J' ."i"'"' ❑ OTHER 1 �- CK Right 7 " - N
PROJECT DESCRIPTION SQ. FT r'7 ,g1' A7 OCCUPANCY v'
'Address mailing) CONSTRUCTION TYPE •11"I '+•4 _✓ VALUATION$ i X111/ "✓ s Left 'r. ± -7y ') / - G
R
City License No. ZONE GRADING.CU.Vbs. ACRES 44 Ciu�
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req,/Provided ' E
• I hereby-affirm that I am licensed under provisions of'Charter 9 (commencing Remarks: �G1 s Q / • Q
, lvwith section 7000) of Division 3 of the Business and Professions Code, and - ���-1" ' � ' 1 / /��✓ Planning Notes: M
,f my license is in full force and effect. 2 '. . 6.,§,#- � s . T
•
s -License Class License No, - /'I $
I Date Signature ., ' ., k - PLUMBING FEES _
WORKERS'COMPENSATION DECLARATION Bar SinkShowers
' hereby affirm that I have a certificate of consent to self-Insure Or a certificate ��i ELECTRICAL FEES
' Workers' Compensation Insurance, or a 'certified copy thereof (Section Backflow Preve�ter Service Sink
-800, Lab. C.)
Automatic Washer Transformer 15-50 KW
Policy No. Company' Backflow Irfigation Sewer Cap0 50+ KW '
❑ Certified copy is hereby furnished. " Cookie POI¢Sub.
❑
Certified copy is filed with the city Building Division. \i/ Bathteb+s Sewer Connection {„(z, Cooking Unit - Meter ❑up to 100 ampsI. -
Date Applicant �(f+
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - v�- Clarifiers - Solar Collectors t-' Dishwasher Meter Dover 100 amps
(This section:need not be completed if the permit Is for one hundred($100)or - - _. -
` less). Dishwasher . . Solar Piping • Dryers ❑Gas ❑Electric Sub Panel •
I certify that in the performance of the work for which this permit is issued,I r
shall not employ any person in any manner so as to become subject to te Drinking Fountains Solar Tank - Fan
_ Motors 00-1 HP 01'4-8
`
Workers' Compensation Laws of California- , '• -
sDate - f- Signature - r 41 Floor Drains / Swimming Pool w/Spa
1 -NOTICE:If;after making this declaration,you Should becomesubject1to the F.A.U. Inc.Solar 09-15 HP 016-15+
t. -Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal • Fixtures
comply with such provisions or this permit shall be deemed revoked. 2 / Microwave J
CONSTRUCTION LENDING AGENCY •` Gas Service Outlets r '
Water Closet Device •Boxes Pole Light• I hereby affirm•that there is a construction lending agency for•the performance J 9
of the work for which this permit is issued (Section 3097 Civ, C.) Interceptors Water Heater •'• Outlets 7
Lender's Name. /( 1(lA� v /• Range (� .�f
,Lender's Address l! - - ---1 Kitchen Sink Water Service - J
OWNER BUILDER DECLARATION Switches Sign v SQ
I hereby_affirm that I am exempt from the Contractor's License Law for the Lavatories ' Auto-Wash 9' Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or ' ^ - 9 P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap • „ Laundry Trays . • Generator 00-5 KW 05-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Y' Trash Compactor •
to file a signed statement that he/she is licensed pursuant to the provisions of Roof brains I
the Contractor's License Law-(Chapter 9(commencing with Section 7000) of c / ,
-livision 3 of the Business and Professions Code) or that he/she is exempt - •
erefrom and the basis'for the alleged exemption. Any violation of Section _, - -r�
:31.5 by any applicant for a permit suPjects the applicant to a civil - ' '
enalty of not more than five hundred dollars($500)-
Cblerafrbwiier of,the&tprgperty or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 ' '
.compensation, will do the work, and the structure is not intended or offered - - Reinspection Fee ! $15 Issue Fee $ 3
for_sale-(Section.7044;FBdsiness and Professional Code: The Contractor's MECHANICAL FEES
License Law doesnot apply to an owner of a property who builds or improves
- hereon7and who'does-such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: ! • - i
employees, provided that such improvements are not intended or offered for Boiler Hood-or _Type I ❑ j ;
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# - Date Inspector
1. Temporary Electric& Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. -57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical,Conduit-Undrgrnd.
•
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test '
9. Water Pipe-Undrgrnd. - - 60. Backwash Lines, P-Trap, ❑ 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
14. Rough Plumbing i 65. 'Electrical-Final
15. Rough.Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring /51, 6G '9 67. Fencing & Access Approval
•
17. Rough Wiring Sign l ( / 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning , FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ❑Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush .
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED t •
33. Final Electric - t?� - -‘0get Notes: -
34. Final Heating & Air Conditioning 7 '
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
•
39. Water Service-Final
40. Gas Service-Final -
41. Solar Domestic-Final
42. Backflow Preventer - -
43. Backflow Irrigation -
44. Landscape Irrigation System
• 45. Sound Attenuation -
46. Handicap Regulations -
•47. FINAL STRUCTURE & BUILDING •
48. Special Requirements Completed - - • -,t
•
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
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. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. B' es 0 No
2. I (have/have not) Kay i 1 signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address City
Phone ( ) _ .. Contractor's Lic. No.
4. I 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 I will provide some of the work but I have contracted (hired) the following persons to provide
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 Heald Safety Code and have completed the above information to the best of my
personal knowled , in .om fiance ti �
� C Q-w' is State law. �
Signed: t
Date: " _�� -@(_
Name: -- C11.4 KL c&ITv\yS,lc
(Printed or Typed)
C.D.L. #or S.S. #
CMF 1042-46 754-5273
City of Costa Mesa INSULATION CERTIFICATION . Building Safety Division
/ 709 OrCctS J)f. C_c ��, l`1rSq ��dc. v.S �
Number and Street City County
i
Subdivision Lot Number
DESCRIPTION OF INSTALLATION
ROOF (r _1 f
Material KrAS+- FaC'C 4-tlbi't 15146 Brand Name too v tJI / ( E
l� I r R — 1 9
Thickness (inches)
EXTERIOR WALL ,t^
Material Kr2i a- ri --(I;CrC1 - , b tr5)G- M
S Brand Name G✓1 V I ) I e
Thickness (inches) 3rLit Thermal Resistance (R Value) P —1/
CEILING
Batt or Blanket Type Brand Name
Thickness (inches) Thermal Resistance (R Value)
Loose Fill Type Brand Name
Minimum Thickness (inches) Number of bags Weight per bag lb.
Area Covered (ft2) Thermal Resistance (R Value)
FLOOR, ELEVATED
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
FLOOR,SLAB
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administrative Code).
p?r,
eral Contractor(Builder) License Number
/40144 C C�cur(tc!` 9 -9 -g&
` Signature 'd Title ` Date
7ca
Sub Contractor(Insulation Applicator) License Number
Signature and Title Date
CMF 1106-46
•
OWNER MESA VERDE ESTATES DATE 12-9-58
JOB ADDRESf-709 • 13'. 01-c- 'as it I Li ti BUILDING PERMIT NO. 8196
GENERAL CONTRACTOR L. G. Robinson VALUE $ •15,1495.00
AR No. LOT 61 TRACT 3115 FIRE ZONE DESCRIPTION OF WORK Res & Att/gar
GROUP 1 & TYPE ZONE Al PLAN NO. 8i96
• PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER -
Trenches (i Forms I/ Steel ,j4, 5 /g-2S-A' -
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam ��
�irif
Frame and Flashing �� J,r 'i? �
j + ,a ,S
Lathing, In Out C/�i� tf (-
Plaster, brown coat �y ..4--if,= .J
Underground soil 7<-f W/G Pipe Test/11/5 /Z_Z',_St
Top Out /1"/'!US ---77-2e1 /
Furnace 61-422,4-A-17 jYr/ Jr-/3 S9 ✓ `p
Gas Vents I� /` 0 �"\
Rough Plumbing /rte? 3--,6 s .4-25,1 A.0., _� ,c . [o_-/a-$,s' /6, 7 //✓
Cesspool Septic Tank - I -
Prop. Swr. tine Hoard//Con. St. Swr. NY/pt-it /7.1.4.4...,...6.-6,425, - 114 t m 15-2 /0 /II
Sprinkling System A�'
Heating Final /✓TS 49-7-4--....4*Plumbing Fixtures, Final it�j¢S ci-Zet-CO i
Final Gas Test I S 44-/C ii-2-H-3(j ''f 1
Construction Pole i
Underground Power , ! / /
I I
Rough Wiring _ - I.- /.fti . ' / c1- 6- I/ V \, '• ,l 1
Fixtures, Final -4./ U-.77-C, _ `4i 1 ,
OCCUPANCY 4.64-5 y-yq y?; V
Form 210-5M-1-57 I
. - 8196 , rra E C�9 VEuCOSTA MESA BUILDING DEPARTMENT DEC 9 1958
P.O. BOX 317 FINANCE DEPT.
COSTA MESA, CALIFORNIA
CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ADDRESSDI1709 Ortas Dr. BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY -
RECEIPT NO. gin/NO.
OWNER Mesa Verde Estates O [ / Y
RECEIVED BY •
DATE RECEIVED _ DATE ISSUED
MAIL ADDRESS 170I Gisler St. .)'} '7 J S-f� -f_ /} _ y_ si'
TEL. BUILDING
CITY Costa M4s8 NO. 1(1 5-1751 ADDRESS
ARCHITECT LIC.
OR ENGINEER J.R.Shel ley NO. C-2170 COSTA MESA. CALIFORNIA
•
FIRE
ADDRESS Long Beach Ge 9-0908 ZONE
ZONE A NO.OF TYPE GROUP
CONTRACTORL.G.Robinson CITY NOO. 1123 PLANS ,.� -7-" sc. J
ADDRESS 1701 Gisler St. TNO. Ki 5-1751 QyPROVED DATE
LEGAL LOT 61 CORRECTIONS
DESCRIPTION NO. BLOCK TRACT 3115
A.P.NO.
VELOT 100 NO.OF BLOCS
OF LOT X NOW ON LOT nOna
USE OF
EXISTING BLDG.
SETBACK LINE FROM 509+
CENTER OF STREET REAR YARD 20'+
SIDE YARD RIGHT 5E+ LEFT 50+
DESCRIPTION OF WORK
1-,
NEW X ALTERATION ADDITION ,
REPAIR Y3nr MOVING DEMOLISH 1
SZIEDI NG 1560 Sq.Ft. ROOMS 6 STORIES I
EXTERIOR ROOF
•COVERING WALL STUCCO COVVERINGASPhO It & Rock
USE OF NEW
BUILDING Residence & Attached Gatage
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CA ION AND
STATE THAT THE ABOVE IS CORRECT//A�AO AGREE TO CO%PLY WITH ALL
CITY ORDINANCES AND STATE LAW.'REGULATING BU LOIN CONSTRUC•
TION. AA ,I'-//� VALUATION 0 p
SIGNATURE
E OF Ai.�r /J -4 PERMIT FEE 5 `-;5
PER NI Leh �/ O
s / 7.9� -- PLAN CHECK $ /7- S�
AUTHORIZED AGENT l 7 TOTAL FEE S 0a .CO '.
\\