HomeMy WebLinkAbout432 OGLE CIR - Building Permits4`OSTN MpS9
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BlIILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.costamesaca.aov
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: M11-00118
PERMIT TYPE MECH
APN: 42514320
JOB ADDRESS: 432 OGLE CI CM
Vicinity:
SQ. FT: 0
SCOPE OF WORK: FAU CHANGE OUT. 36K BTU. SAME LOCATION
OWNER: BOWEN, ANDREA L
PHONE: 949-63'i-0659
APPLICANT: ZAMORA, CARLOS:
PHONE: 818-735-7676
CONTRACTOR: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWYUnit:
City/State: YORBA LINDA, CA ZipCode: 92887
,4
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
�PLAN CHECK FEE: . $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: ' $0.00
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TOTAL FEES: $38.30
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STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
11102I2011
KJB
Address: 432 OGLE CIR Unit:
City/State2ip: COSTA MESA, CA
Address: Unit:
City/State/zZip:
License No. 799170
PHONE: 714•777-7777
CELI:
NOTICE: The work authorized by this permit shall comply wiih all applicable handicap access requirements under California statutes and related
:7egulations. (Ord. No. 92-28, § 7, 12-21-92)
'�EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
'INSPECTIONS: In order for the work authorized� under this permit to be considered legal, such work must comply with all applicable codes, and all
� iequired inspections and fnal approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
fADEt. INSPEC110NTYPE QATE INTRIA�¢ fiOD�j INSPECTIONTVPE �[ DR �l N
1616 Fixed System Final Fire Prevention 206 Final Mechanical J� ��/— f at �
;1266 Pool Spa Final 208 Final Plumbing
'Z00 Final Re-Roo( 210 Final Eleclrical
p �,
;201 Final Block/Retaining Wall 212 Final Rre Prevention
202 Final Factory Fire Place 22o Final Planning Approval
.`203 Final Sign 222 Final Site
204 Final Demolition 250 Final 8uilding/Occupancy
�
WORKERS' COMPENSA710N DECL�.RATION:
I hereby aKrm under penalty�o( perjury one of the following declarations:
❑ I have and wili maintain a certifcate 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
ction 3700 of the Labor Code, for the pertortnance of the vrork (or which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: �/I I
---Caffi2C /V BV�v�RJ/(/�
(Thissecfion ip(bewmdetedRthepertnit�svaluetlatonehv�retldollars(8f00)orless)
'.P.olicy Numtier: ) � i4��j(i(0'LX� �
❑ I certify ihat in Me peAormance of lhe work for which this permit is
issued, I shall nol emplo person in any manner so as to become subject
to the workers' com nsation laws of California, and agree that if I should �
become su6ject to e workers' compensalion provisions of Section 3700 of
the Labor Code, I all forthwith omply with these provisions.
��"2'�i
Aooll nfs Sipna ure Date
WARNING: FAILUR TO SE RE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND ALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR W SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEWSFEES.
LICENSED CON7RACTORS DECLARATION:
I �ereby affirm that I am licensed under pmvisions of Chapter 9(commencing
wi�h Section 7000) of Division 3 of ihe Business and Professions Cotle, and
my license is in full force and eHect. ��/
Lic. # � Class # V ��
- �121
onVac�or's ig ure Date
CONSTRUCTIO DING AGENCY:
❑ I hereby affirm that there is a construction lending agency for lhe
peAortnance of the vrork for which this pertnit is issued. (Sec. 3097, Civil Code).
Lendets Name: _
Lender's Address:
Date
OW NER-BUILDER DECLARATIONS:
I hereby affrm Ihat under penalty of perjury lhat I am EXEMPT FROM THE
CONTRACTORS LICEN$E LAW for the (ollowing reason (Sea 7031.5,
Business and Professions Code: Any city or counry which requires a permit [o
consirucl, alter, impmve, Oemolish, or repair any stmcture, prior to its
issuance, also requires the applicant for such permit to fle a signed statement
that he or she is licensed pursuant to [he provisions of ihe Contraclors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Profession� Code) or that he or she is exempt Ihere(rom and
the basis for �he alleged exemption. Any violation of Section 7037.5 6y any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve hundred dollars (5500�.):
❑ I, as owner of the property. or my employees with wages as their sole
compensalion, WILL DO THE WORK, and Ihe 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 s4ch work himself or herself or thmugh 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-buiider 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 consirud the project (Sec. 7044, Business and
Professions Code: The contracmrs License Law does not appty to an owner of
property who builds or improves thereon, and who contracts for such project with
a conlraclo�(5) license puryuaN to ihe Contractors License Laws.).
❑ I am exempt under aec.
Business and Professiong Code for this reason:
305]-06 �3I0])
• ,
Owner ID verifetl by driver's license. ❑ Yes �`No
Driver's License No. Expires:
Verifcation of Ownership by (rype of document, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ i hereby certify that no excavation fve (5) or more feet in depth into which a
person is required b tlescend, will he made in connection with worrc authorized
by this permiC and that no building sWcture, swflolding, falsewnrk, or demolition
or dismanUing thereof, will be more �han lhirty-six (36) Feet high. (Chap. 32, Grp
2, Art 2. Sec. 341, Tide 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Induslrial Safery, as noted above, unless
such person has a permit to do such work from the division.
Appliwnfs Signature
Division of Industrial Safety Permit Numbec _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to file and
certify a Business Plan tor emergency response !o release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Heaith and Safery Code requires, with some
excep[ions, that a Business Plan be fled with Ihe Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous ma[erials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressed gas
at standard temperature antl pressure).
2. Does or wiil Ne applicant or present or future builtling occupant need to file
a regisVation form for acu�ely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Healih and Safeh Code, with some
exceptions, requires registralion with the Costa Mesa Fire Depariment by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weigh� of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stan0ard
tempera�ure antl pressure).
3. Does or will the applicant or present or fu�ure bUilding occupant need to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Heallh and Safery Code pmvides that the
Costa Mesa Fire Department may require the preparation, certifcation and
fling with ihe Fire Department of an RMPP by businesses which are requi�ed
to register acutely hazardous materials with the Fire Depariment.
4. If an RMPP is presentty required, has Section 25534 of the Califomia
Healih.and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or (uWre building occupant require for
the work which is �he subject of this application a permii (or such constmction
or modification from the Soulh Coast Air Qualiry Managemenl Distnct or from
any other air polWtion control tlisMct or agency? ❑ Yes ❑ No
(Section 658502 of [he Califomia Govemment Code requires that the requested
infortnation be fumished on applications for noo-residential building pertnits).
6. Will any part of the (aciliry to be constmcted under ihis permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", Ihe faciliry must meet Ihe requirement of Sections 25534 and 42303
of the Caiifomia Health and Safery Code).
7. If a permit fmm Ihe South Coast Air Qualiry Management Disirict or other
air polWtion conlrol distric[ or agency is required for the work which is lhe
subject of this application, have all of the disclosures prescribed by California
Heallh and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach ceAifcate o( wmpliance from the appropriate air pollution
control offcer). �
CERTIFICATE Of COMPLIANCE: 1 certify tha� untler penalty of perjury the
information given above is correct. I agree to compty with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
Dale
CERTIFICATE OF COMPLIANLE AND AUTHORIZATION OF EN7RV: 1
certiry under penalry of perjury ihat I have read this applica[ion and slate ihat
the information given is correcL I agree to compy with all state laws and city
ordinances relating to building construction, and authorize representalives of
Ihe City of Costa Mesa to enter upon the above-described property for
inspectiort purposes. 1 agree no� ro occupy or allow occupancy of any builtling
authorized by fiiSpermit until fnal inspection.
�
ignaWreofLeg IOwn r(s) �ate
.%' ��'711.a��
� Q/orAu�b rizetlPpplicd � Data
Simplified Pres.crintivc CertiTr�ate of Comnliancc: 2008 Residentia! HVAG'li�lterarions CF-IR-AL,T-H'VAC
�l '�( ! �
SiteAddr s� Ertforcemen/Agersq�: Ua(e: Permilk:�
�Z Uqle n��r� <,�yad �or-Ia�t�.r�, i� zu�
E ui ment 7� List Minimum E�cienc Condi[io�ed Floor Area Them+ostat �
Packaged Unit
� Furnace m AFUL� Q COP
❑ Indoor Coil SEER_ Q HSPF Served by syscem �'Setback
/`��I sf (ffnot alr«dyprefen; murt bc inamlltdJ
CondensingUnit EER_ QResistance
8 Other
1. Equipmenl Type: Choose [he equipmeni being instnlled if morc than oce sys[em use ano[her CFI R-ALT-FIVAC for each system.
2. Minimum Gyuipmenl ERciencies: 13 SEER, 78%AFUE, 7-7HSPF for typical msiJentizl syslems.
HERS V ERIFICATION SUMMARY Listed bc1oH� ere tluee HVAC alteration Options. 77�e inttaller decidcs what work is being
done and pickS one o( the appmpria[e Options. Each Op[ion lists [he HERS measures lhat must be conducted. A wpy of the forms shall
be left on sire for final inspection and a copy givcn t0 Ihe homeowmer. At final, the inspeclor vcrifits �hai the work lis[ed on this form
was in fact the worA complcied by the ins[eller. The inspeaor also verifies [ha[ each appropriate CP-6R end regi5tered CF-4R fom�s (no
hand filled CG-42s allowed) are filled out and sfgned. Beginniug Ocrober l, 2010, a registered copy of the CF-1R and CFfiR shall
also be an site for final ins ection.
1. HVACChangeout Required Forms:
• All HVAC Equipment CF-6R Cortns: MECH-04, MCCH- 25-FIERS
ro laced CF-4R forms: MECH-25
• CondenserCoilandlor
• Indoor Coil and /or CF-6R forms: MECH- 25-HEFLS
CF-4R fortns: MECH-25
• Fumace
For Split Systems: RC, CCA > 300 CFM/ton, TMAH
For Packa ed Units: No testing required
❑ 2. New HVAC System Required Forms:
• Cut in or Changeou� with CF-6R Corms: MECH-04. MECH- 25-HERS
new duc�s: (all new ducting CF-4R foems: MECH-25
and ali new e ui mcnt)
For Split Systems: RC, CCA> 300 CFM/mn,'f'MAH.
For Packaged UniLs: No tesung required
� 3. New Ducts with Replacement Required Forms:
• Includes rcplacing or ins�alling all new CF-6R fortns: MECH-?5-HERS
ductingand/oroutdoorcondensingunit CI'-4Rtorms: MECH-25
and/or indoor coil and/or furnace. Not all
e ui mrnt chan ed.
For Split Systems: RC,.CCA >_ 300-CFM/ton, TMAH
For Packa ed Units: No teslin re uired
Contractor (llocumentetion Author's /Responsible Designer's Declaration Stn[ement)
• I ecrtify lhat this Certificare of Compliance documentation is accurate and comple[e.
• 1 am eligible under Division 3 o([he Califomia 13usiness and Protessions Code to accep[ responsibility Cor [he design identified on
this Certificam of Complianee.
� 1 ccrtify tha[ the energy Seatures and performance specifications for thc design identified on [his Certificate of Compliance cunform
ro the requiremen(s of Title 24, Parts ! and 6 of the Ca7ifomia Code of Re�ulations.
• The design feamres identified on [his Certificatc of Compliance are wnsistent with �hc informa[ion ducumentcd on other applicable
compliance (ortns, workshee[s, calcula[ions, plans and specificafions submitted [o [he enf emen agency Cor appro�el wilh the
rtnit a lication.
Namc: A�0( -� � . Signaturc: / //
1 //
Company: � . Daie: '
se�v! e I�RN, Cr�r (-2-zo(�
Address: 2�// �v. ��� l.icen5e: .7q��ZV
Ciry/State(Lip: V�v�� LG��� rA'%20, � Phone: 7 , l�
2005 Residentiaf Compliance Forms March 2010
G
(714) 754-5273 • Fax (714) 754-4856 • www.ci.cos�a-mesa.cBUILDING PERMIT �� FAIR ORIVE, COSTA MESA, CA 92626
Job /+ddress: 432 OGLE CI
Suite:
Vicinily: ROOF
Primary Occ: R-3 Dwellings/ Cong Res <70 Type of Construction: V-N
Parcel Number: 42514320 Zonin9:
Applicant: LACROIX, RAY
Address: 260 E. DEYER
SANTA ANA, CA
UNIT G
Owner: BOWEN, ANDREA L
Address 432 OGLE CIR
COSTA MESA, CA ,
Contractor. LACROIX ROOFING INC
Address: 260 E. DEYER
SANTA ANA, CA
UNIT G
Zip: 92707
Arch :
Address:
Phone:
Phone: 774-966-2691
Zip: 92707
Phone:
Zip: 92627
, Phone: 714-966-2691
License: 804988
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 03/30/2005
Issued: 03/30/2005
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 2 LAYERS OF 15# FELT, 30 YEAR COMPOSITION, AND REPLACE/REPAIR SHEATHING AS NEEDED.
2,800 S.F. INCLUDES ATTACHED GARAGE. --
Plan Check: $0.00
Permit: $111.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existin : 0
Rear 0-0
Rear 0- 0
Required: 0
FEE SUMMARY
Calc Valuation: Ss,000.00
Claim Valuation: Ss,000.00
PLANNING & ZONING
left 0- 0 Right
Left 0-0 Right
Proposed: 0
0- 0 -
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requi�ements undai California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPEC710NS: 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 ezpiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
eano-ac �vuu�
WORKERS'COMVENSAnON DECLARAnON:
I hereby ettirtn untler penatly of perjury one oi the tollowing decleretions:
❑ I heve end wil� meintein a certificete of cronsent to sell-Insure lor workers' compensetion, as provltled lor �y settion 3700 of (he LaDor Code, for the pertormence ot Ihe
work ior which Ihis permit is issued.
workers' cwnpensation Insurence, as requlred by section 3700 of ihe Lebor Code, for t�e pedortnance of Ihe work for which Mis pertnit is issued.
'ion Inys r��nce cerye r end policy number ere:
� %Zlnv7 i i,�I Numbe'r.^ /� 3S� d z— ZO(1 Y
npleretl H the pertnit is velued et ane hundred dollers ($100J or /ess.)
❑ I certily Ihat in the pertortnance ol Ihe work tor which Ihis pertnit is Issued, I shell not employ eny person in any manner so as to become subject to tha worknre'
compensation �aws of Celifamie, e d egree Ihet II I should become sub�ect to fha workers' compensatlon provisions of Section� of Ihe Lebor Code, I shell forihwlih
com�ply wit�h -tn•—ese provisions.
Ap�1lcHfil' IgnS � ature:=, `%•^. . ater.^�' ���/ s^
WAR�NINGfFRI RE YO SECUFE WORKERS' COMP ATIpJ COVERAOE IS UNLAWFUL AND SNALL SUBIECT RN EMPLOYER TO CRIMINAL FENALTIES AND CIVIL FlNES UP TOONE HUNDPED
i/l(%1SANDDOLLARE(S1pJ,000�,INADOIl10NTO ECOSTOFCOMPENSATION,ORMAGESNSPROVIOEDFORINSECTION3)O60FTHELABORCODE,IMERESi,PNDATTORNEI^5FEE5.
IICENSED CONTqACTORS DECLARATION:
1 hereby aflirtn thal � am lice�sqtl underA rovisions o� Chaplat 9 SCommenGng wilh SacUon 70�0� ol Olvlslon 3 �iness atW Pro�t ssions Code, arW my license is in tull
twca�ana'enec%.iio.'a"�:LS'0�7�'f� ,G�ess'Y C37 ff(G
'C°on�ctoisSiqnatV�e.^"". *- � ' �_Qgfe'�%' � 31) b f
CONSTRUCTON LENDING AGENCY:
❑ I hereby aHim+ ��at there is a construction lentling egency tor Ihe pedormance ol ihe work for wMch ihis permit is issuad. (Sec. 3097, Givil Code).
Lentler's Neme:
Signature: _
OWNEH-BUILDER DECLARASIONS:
Lendar's Address:
Date:
I hereby eltirtn that untler penelry of perjury Ihat I em E%EMPT FROM TNE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business en0 Professions
Code: Any ciry or c0unry which requires e permit to Construct, elter, Improve, tlemolish, or repeir eny slmcWre, prior to its i5suance, also requires the applicant for such pertnil
to file e signad stet6ment thet he or she Is Iicensed pursuant lo the provisions of ihe Conlractors license Lew (Chepter 9(wmmencing with Section 7000) of Dlvision 3 ot the
Business end Professions Code) or thet he or she Is ovempt �herelrom end �ha besis lor ihe ellege0 e�emption. Any violetion oi Section 7031.5 by eny applicent for a pertnit
subjects the epplica�� �o e civil penalry ol not more Ihen Ilve hundred dollars ($500).):
❑ I, es owner ot the property, or my employees wit� weges es Iheir sole compensation, WILL DO THE WORK, antl ihe structure is not intentletl or otferetl for sale (Sec.
706a. Business end Protessions Cotle: The Conirectors Licanse Law dces not eppty lo an owner of propeny who builds or improves thereon, end who does such work
�imsell or �er5ell or Ihrough his or �er own employees, pmvidetl I�at such improvements ere not intentletl or otleretl for sale. II, however, the builtling or improvement is
soltl wit�in onB year of completion, ihe owner-builder will have the �urden ol proNng Ihat �e or she tlitl not build or improve for purpose of sale.).
❑ I, es ownar of ihe properry, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to wnsimct ihe project (Sec. 70d4, Busineu anE Protessions
Catle: The coPtrectore License Law does not epply Io en owner ot pmperty w0o builds or Improves thereon, antl who contracts for such project wlth a conlraclor(s)
licen5e pursusni to iha Coniradors Licensa LBws.).
❑ I em exampt undar sec. Business end Professions Cotle lor ihi5 re9son:
SigneWre: Date:
Ownar ID verified by dnver's license. ❑ Ves ❑ No Drivers License No.
Venticetion ol Ownership by (type of tlocument, i.e. - O�operty tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
Expires:
❑ I �ereby certify that no excavation five (5) or more leei in tlepih into which a person is required to tlescentl, will be matle in connection with work authonzetl by this
pertnit, and Iha� no builtling swcNre, scaRolding, talsework, or tlemolition or dismantling thereof, will be more lhan t�irty-sia (36) feet high. (Cnap. 3.2. Grp 2, Art 2, Sac.
347, Titla 8, Calilomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone m do work which wauld require e permit tmm the Division ol InOustrial Safery, as noted above, unleu such person has a
permit to do sUch work irom t�e tlivision.
Signamre: Date:
Division ol Intlusirial Salery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF EHTAY: I certity under penalry of per�ury thet I have read ihis application antl state that t�e inlormation given is
wrrect. I agree to Wmply wl�h all state lews entl city ortlinances releling to building consiructlon, anA amhodze representatives of ihe Ciry ot Casfa Mesa to enter upon the
above-described D�oPerty br inspection purposes. I egree nat ta accupy ar allow occupency ol eny building eulhorized by Ihis permit un�il final inspection.
yUUE t.
1616
1266
Fixetl System Final Fire Pravention
Poal Spe Final
200 Flnel Re-ROo�
201 Finel Block/Reteining Wall
202 Finel Factory Fire Place
203 Final Sign
204 Finel Demolition
uAiE INTIiI�LS
COpE 1 INSPECTION TYPE
206 Final Mec�anicel
20B Final Plum6ing
210 Final Eleclrical
212 Flnal Fire Pre�ention
220 Final Planning Approval
222 Finel Sile
250 Finel Building/Occupency
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(714) 754-5273 • Fax (714) 754-4856
• CITY OF COSTA MESA � ._
BUILD/NG DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Job Address: 432 OGLE CI
Suite No
Vicinity:
Parcel Nunmber: 42514320
Applicant FANDRICH, REESE
Address: 1526 NEWPORT BL
COSTA MESA, CA
Owner: BOWEN, ANDREA L
Address 432 OGLE CIR
COSTA MESA, CA
Contractor: EARL'S PLUMBING INC
Address: 1526 NEWP0f3T BL
Arch / Eng :
Address:
COSTA MESA, CA
PLUMBING PERMIT
Phone: (949)642-1756
Zip: 92627
Phone:
Zip: 92627
Phone: (949)642-1756
Zip: 92627
License: 217657
Phone:
Zip.
License:
SCOPE OF PERMIT
REPLACING GAS LINE FROM METER TO 5 FIXTURES.
ISSUE FEE
BackFlow irrigation
BackFlow Preventer
Bath[ub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas EaAhquake Valve
Gas (7-4 outlets)
Gas (Over 4 outleis)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$23.50
50.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
$0.00
30.00
50.00
$6.15
31.10
$9.80
$0.00
$0.00
50.00
QTV
FEE SUMMARY
AMT
Laundry Tub I Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank $0.00
SewerCapforDemo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
PERMIT NUMBER
77 FAIR DRIVE, CdSTA MESA, CA 92626
Status: ISSUED
Applied: 07/71/2000
Issued: 07/11/2000
ISSUED BY:
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr BkFlow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOIATION
PLAN CHECK
REINSPECTION
AMT
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
$0.00
$0.00
90.00
50.00
50.00
50.00
50.00
$0.00
So.00
TOTAL CALCULATED FEES: 540.55
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
.�7
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This perrnit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period o� 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapeetlone end flnal approvel must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKEFS' COMPENSATION DECLARATION:
I �ereby attirtn undar penalry of per(ury one of the lollowing tleclarations:
❑ I have end will maintain a cedifcate of consent lo sel4lnsure for woBers' compensation, as provitletl tor by section 3700 of ihe Labor Code, tor iha pertormance of the
� work for which this permi� is i9sued.
I have antl will mainWin workPrs' compensation insurance, as requiretl by sectlon 3700 ot the Labor Code, for ihe pertortnance ot the work for which Ihis pertnit is luued.
My workers' compensation In9urance carrier entl policy number are:
carrier.
(lhis secfion need no( be
❑ I certify that in Ihe-
nrousnrvo
LICENSED CONTRAC'
I hereby aRirm ihat I am
force and ettect Lic. x
e( one
eh IhiS
Palicy Number:
100) or /ess.)
is issued, I shell not employ eny person in eny manner so es to become subject to the workers'
subject to the warkers' compensation provislons of Section 3700 of ihe Labor Cotle, I shall forthwith
oa�e: 7 — // —G G
1PENSAi COVERAGE IS UNLAWFUL AND SHALL SUB1ECi AN EMPLOVER TO CPIMINAL PENALTIES AND GVI� FINES UP TOONE HUNDRED
THE W5T OF COMPENSATION, DNMGES AS PROVIDED F-0F IN SEGTION 37060F THE LABOR CODE, IMEREST, AND ATTOPNEY'S FEES.
wlih Section 7000) of Division 3 af tha Business and Professions Code, and my license is in full
Cless q
CONSTRUCTION LENDING AGENCV:
❑ 1 hereby attirm Ihat there is a Gonsimction lending egency tor ihe performance of the work for which Ihis permit Is issued. (Sec. 3097, Civil Coda).
LentleYs Name:
SignaNre: _
Lender's Address:
Date:
OWNER-BUILDER OECLARA710NS:
I hereby aHirm that under penalty ot perjury that I am E%EMPT FROM TME CON7RACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or couMy which reqUires a permit to cons�ruct, elter, improve, damolish, or repeir any simcture, prior to Ils issuence, elso requires �he appllcant for such permit
to tile a signetl statement ihat he or she is licensetl pursuant to ihe provislons of Ihe Contrectors License Lew (Chepter 9(commencing wlth Section 7000) of Division 3 oi Ihe
Business antl Professions Coda) or Ihat �e or s�e is exempt iharefrom antl �he besis for iha allegetl exemption. Any vlolation of Sectlon 7031.5 by eny applicant for a permit
subjects the applicant to a civil penalty of not more ihan Ilve huntlred dollars ($500).):
❑ I, as owner ol the propeny, or my employees with weges es iheir sole compensation, WILL DO THE WORK, end Ihe structure Is not intended or otteretl lor sale (Sec.
7044, Business and Professions Cotle: The Contractors License Law tloes not apply to en owner of property who builtls or improves ihereon, and who does such work
himself or herself or through his or har own employees, provided ihat such impmvements are not intended or oHered tor sale. If, however, ihe 6uiltling or improvement is
sold within one year of comple�ion, the owner-builder will hava the 6urden of pmving ihat he or she did not builtl oi Improve fo� purpose oi sele.).
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct Ihe pro�ect (Sec. 7044, Business antl Professlons
Code: The contractors License Lew does not epply to en owner of property who 6uiltls or improves Ihereon, antl who conirects for such project with e contractor(s)
license pursuant ro the Contrectors License WwsJ.
❑ 1 am exemp� under sec. Business antl Professions Cotle lor ihis reason:
Signature: Date:
Ownar ID verified by drivers license. ❑ Ves ❑ No Drivers License No. Expires:
Varification of Ownership by (type of document, i.e. - propeny �ax bill or deed):
DIVISION OF INDUSTRIAL SAFET�' PERMIT CER7IFICATION:
❑ I here6y ceriity �hal no excava�ion live (5) or more leet in depth into w�ich e person I5 requiretl to tlescentl, will be matle in connection with work authorizetl by this
permiL and that no builtling s�NCWre, scattolding, telsework, or tlemolition or dismantling thereof, will be more ihan thirry-six (36) teet high. (ChaD� 32, Grp 2, Art 2, Sec.
341, Title 8, Celifornia Aaministretive Code).
❑ As owner-builtler, I will not emp�oy enyone to tlo work which would require e permit irom ihe Division of Intlustrlel Salety, as notetl ebove, unless such person has a
pertnit to tlo such work tmm ihe division.
SignaNre: Date:
Division of Indusirial Safery Permit Number:
CERTFICATE OF COMPLIANCE AND TON OF ENfAY: I certify untler penalty of per�ury ihat I have read ihis application and state Ihat Ihe information given is
correct I agree to comply wi state laws end dinences relating to building constmction, end euthonze representatives o� Ihe City ot Casta Mesa to enter upon the
abova-descn6ed pro a r inspection pur agree not to occupy or allow occupancy oi any building authorizetl by Ihis pertnit untll Ilnal inspection.
CODE t. INSPECTIONTYPE
7616 Pixed SyStem Final Fire PrB�ention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BbcWRataining Well
202 Final FeCtory Fire Place
203 Final Sign
204 Final Demolition
2448 O6
QAjf, f�$ �d INSPECTIONTVVE
206 Final Mechanical
20B Final Plumbing
210 Finel Electricel
212 Finel Fire Preveniion
220 Final Planning Approvel
222 Final Site
250 Final Building/Occupancy
Date
�. � .�w
1.! I ,.�.►
,�
Aoo���ant to fili in ali spaces except thoze wit�in neavy EorOer lines and sign all approvriate eeclarations.
CITI%OF COSTA M'/ESA�i ,C.,O!NST/IR�U.CTION nP.E.'R�M.,IT PERf�6jT NO. _ _ _ TRACT NO. LOT NO. UNIT NO.
� Project Address '7'.3�C. (iYe L;/�Fi [..�.�R �%��'.Xc-
Applicant's Mailing Address �m� �g��c—�-
Owner's Name Phone 91�'�"L��
Address �•3•2 �/E �//'C�L' G�OS/YP /�/P-YL �4.
Arch/Eng. License No.
Address —
Contractor's Name Phone
Addresslm�l'ngl
City License No.
LICENSED CONTRACTOR �ECLARATION
I hereby aHirm that 1 am licensetl untle� provislons of Chdrter 9(commencing
wi[h section 7000) of Divi5lon 3 of the Business antl Protessions Cotle, antl
my licenze is in full force antl etfect.
Lic¢nse Class License No.
Da[e Si9nature
7RKER5'COMPENSATION DECLARATION
�ereby afflrm that I have a certiticate of consent to selNnsure or a certificate
of Workers' Compenwtion Insurance, or a certifietl <opy thereof (Sectlon
3800, Lab. C.)
Policy No. ComOany
eCertiBetl copy is nereby furnishetl.
C¢rtifletl copy is filetl with the city Builtlin9 Division.
Oat¢ Applitant
EXEMPTION FROM WORKE0.5' COMPENSATION DECLARATION
(This section neetl not be completetl it the permit is for one huntlretl (E100) or
less).
I certity that in [he PerfOrmance of the wo�k tor which lhi5 perm�t i5 isSueU, I
shall not employ any pe�son in any manner so a5 to become zubject to Ihe
Workers�' Cp p n Laws of CalifOr� �e
Date 'l/���� Si9na[ure //'// Q ��
NOTICE: If, afier making this tleUaration, you shoultl become subjeci to the
Wo�ke�s' Compensation provisions o� the Labo� Cotle, you must torthwith
comply with such provisions or this permit shall be tleemetl revoketl.
CONSTRUCTION IENDING AGENCV
1 hereby af(irm that there is a construcfion lentling agency for the perto�mance
o( ihe work for which this permit is issuetl (Sectlon 309� Civ. C.)
Lentler's Name
Lentler's ACtlress
OWNERBUILDER �ECLARATION
I hereby atiirm that I am exempt trom the ConVactor's License Law for the
following reason (Section 7031.5 Business antl Proteszional Cotle: Any ciW or
counry whith requi�es a permit [o cOnst�uct, alt¢r, improve, tlemOlish o� repair
any s(ructure, prior to its izsuance, also requires the applicani for such perm�t
b file a signetl statement that he/she is licensetl pur5uan[ to tM1e provisions ot
e Contractor's License Law (Chapter 9(cammencing witn Sectlon 7000) of
vision 3 of the Business antl Professions Cotle) or that he/she is exempt
.�erefrom an0 the ba5i5 for [�e allegetl exemptlon. Any viOlatlon ot Section
]031.5 by any applicant tor a permit subject5 the applicant to d clvil
QeJ�alty of not more than /ive huntlretl tlollars ($500).
�I I, as owner of the p�operty �
I�tiut, will ao the work, antl the structure is not intentletl or otteretl
for Sale ($ection ]044, BuSinesS dntl Profe55ional Cotle: The COntract0/'s
License Law tloes not apply to an owner of a property wno builtls or imo�oves
thercon, ana who tloes sucM1 work himself/herself or through his or her own
employ¢es, provitletl that sucM1 im0�ov¢ments are not Intentletl or otteretl f0/
Sal¢. If, howev¢r, the builtling or improvement is SOIE wlt�in on¢ yea� ot com-
D�eHon, lhe owne� will have Ihe burtlen of proving he/sh¢ tlitl not build or iT-
prova for [he purpose of sale).
❑ 1, as owner ot the property, am exclusively contractin9 with Iicensetl con-
t�acto�s to construct the 0/ojec[ ($ection ]044, Buslness antl Profe55ion5 Cotle:
Tho Contractor's License 1dw tloes not apply to an owner o( prooerty who
builtls or improves thereon, antl who mnVacts for such projecis with a con-
traclor(57 license pursuant [o the ContractoYs License Law). I am aware tM1at
proof of th¢ir Worke�'s Compensation insurance shoultl be provltletl ta me.
❑ I am exempt untler Section B. & P. C. for thls reason
D t O -U���
I nereby certify that I have reatl this application antl state that the above
Information is correct. I a9ree ro compty with all city antl coun(y ortlinances
antl state laws relating to builtlin9 construction, antl hereby authorize repre-
5entatives of this city to enter upon [he above-mentlonetl ¢prQ perty for
Inspection P�f.Bo��UQ� �// �,( „_ _� s�4�/��/Q7
Si9nature _(� .
TVPE OF CONSTRUCTION LJ NEW IJ ADD LJ pqLT/E RATION la1 REPAI R
❑ CONVERSION ❑ DEMOLISH � OTHER //�"h/�n��%7en'�'
DESCRIPTION OF WORK/USE OF BLOG.
TYPE OF PERMIT LJ GRaDirvG IJ FOVNOATIorv LJ SraUCTURAL
❑�y TENANT ❑Q 'E�L,E^CTRICAL ❑ PLUMBING ❑ MECHANICAL
IChOTHER //(/v/�
PROJECT DESCRIPTION SQ.FT. OOO ncciipnNrv
CON STRUCTION TVPE VALUATION $ �
ZONE GRADINGCU.VDS. ACRES—
Remarks: � n/qni.ni. nwnr�.n tZ,..n/„ ..�.�.L� ....//. G
Preventer
Irrigation
rinking Fountains
loor Drains
loor Sinks
25 $CfVICC �IIL�CtS
Kitchen Sink
Lavatories
P—Trap
Roof Drains
PLUMBING
$hOWEfS
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
FEES
Reinspection Fae I $15 I I Issue Fae I $ 3
Boiler
Dut� - Under Ground
Duct - SVuctural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
�0-700,000 BTU �100,OOOBTi
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
Oo-ioo,000sTu ❑ioo,000
System Repair/Alteration
Fire Dempers
Registers
A.P. #
S Main Buildi
E
T Front
e Rear
A
C Right
K Left
S
Ping. Ref. #
Planninq Notes:
7203 3/2� /8�7 .
Zone
Accessory Building:
Parkin9 Req./Provided
ELECTRICAL
Auromatic Washer Transformer ❑ 15-50 KW
Construction PoleSuh. � 50+KW
Cooking Unit Mete� ❑up to 100 amps
Dishwasher Meter ❑over 100amps
Dryers �Gas ❑Electric Sub Panel
Fan Motors �67 HP �1 Yh - 8
F.A.U. Inc.Solar �9-15 HP �i6-15+
Fixwres Microwave
Device Boxes Pole Light .
�ULICLS
Switches
Garbage Disposal
Generator �a5 KW �5-15 KW
Sign
Standing Sections
Trash Compactor
Reinspection Fee $15 I I luue Fee
FEES ��
DEVELOPMENTSERVICESREOUIqEMENTS:
2oning Approved By
Building Approved By
Aooliption laued Bv ^
peinspection Fee � $15 � � laue Fee � $ 3
CMF 0065�46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor
54o5Q iL
2
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUMMA OFFEES O
BUILDING PERMIT $ �0 SMIP $ ' S
PLAN CHECK $ PERMIT �
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ � 'SD
PLAN CHECK 25% $
,CONSTRUCTION AND PLANNING . POOL & SPA
�APPROVALS �P.ermit# Date Inspector qppROVALS Permit# Date Inspector
. � �
1%,Temporary Electrical'$er'vice or Pole • 52. Pool & Equipment Location � � .
�- r..
2. Soil Pipe-Undrgmd. � 53. Steel Reinforcement � �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
:<
10. Structural Floor Sysfem 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. Fough 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 �Gas ❑Oil, �
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O 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 "r-
_.-.
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electriral Power Meter-Final � 80. FOOD CERTIFICATE ISSUED ' 'rti
i
33. Final Electric Notes: l�N��-� �y_�1��,�s � ��i �'''y"
34. Final Heating & Air Conditioning . . . ,-�'
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 pomestic-Final . �
42. Backflow Preventer ' �
43. Backflow Irrigation
'44. Landscape Irrigation System _ '
45. Sound Attenuaiion _ �
,� �
' 46. liandicap Regulations
47. FINAL STRUCTURE & BUILDING � Z � �/ ,�N . .
46. Special Requirements Completed �
49. Eleciric Release to Edison (
50. Gas fielease to Southern California Gas Co �
r
51. CERTIFICATE OF OCCUPANCY��
No. Date .� y
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILbER YERIFICATIAN
A eity or county, which i: required to B�� �otice pur:uant to Section 19830, thall attath to wch
notice, and, as a condition preadent to iuuing e building permit, require the mmpletion �nd require
the �etur� of, en owner�uilder verification. . .
Attention Roperty Owner:
An 'owner�uilder' building permit Aas been applied for in your name and bearing your signeture.
Piease eomplete end return this iniormation in the envelope provided at your earliat opportunity
to ewid unnecessary delay in processing and iuuing your building permit. No building permit will be
issued until this verification is received.
1. I perwnally plan to provide the maJor lebor and materials for conrtruaion oi the �poposed
poperty improvement. J� Yes L7 No
2. I (have/hrs�t)
proposed work.
tigned an applitation for a building permit for the
3. I here contracted with the fotluwing person (firm) to provide the qoposed consiruaion:
Name
Addreu
Phone �
City
Contractor't Lic. No
4. I plan to provide portions of the work, but I have hired the following perxon to coordinate,
supervise and povide the major work:
Name
Addreu
Phone (
Gty
Contreaor's Lic. No
5 1 will provide iome of the wnrk but I haoe oontracted (hired) the tollowing percons io provide
the work irdioted:
Name
Address
' Phone � Type of Work
1 hereby affirm that 1 have received a copy oi the information set forth in Section 18830 of the
State of California Health and Safety Code and have comD�eted the above i�formntion to the best of my
personal knowledge, in eomplisna with this $tate law.
Signed: . ��Dl es� O�dl,UP/I'C , Date: ��•.7.2���
Name: fi'/U��/l�� .C, rCJO��/(/
(Printed a Typed)
C.D.L. �or S.S. � ' ���,
CMF 1W2�46 754-5273
' � 6'749
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 31�
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING
ADDRE55
MAIL
ADDRE55
urv ide
nRCHirecr
OR ENGWE
ADDRE55
LEGAL LOl
DESCRIPTION NO.
A.P. NO.
32 o�le GYrcle
COSTA MESA. CALIFORNIA
� Hc�es� Inc.
?6 Newport Blvd..'
Beach Cal. No:OR
ans . .
& T_ Ota N� 6'
; Nei.rport Blva., costa
ITY LIC.
, 41. Koll Cons�. No. g
__ . __ _ TEL.
SIZE �fn
OF LOT p� ][
USE OF
E%ISTING BLDG.
SET9ACK LINE FROM
CENTER OF STREET
� I�+� ��C�r 49F,�
S �s- s g
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
��'���i I�'/ S� '�1 0 I M P.Y
BUILDING q //�
ADDRE55 �/J Z �� / C. �
COSTA MES�+. CALIFORNIA
r+o. Ox " —bb a�
TRACT 17l6
NO.OF BLOGS.
�ow o� �or None
REAR YARD I n
DESCRIPTION OF WORK
NEW p ALTERATION N ADDITION
REPAIR��MOVING IOEMOLISH
BUIL�ING - ROOMS STORIES
s�=E 2�6°
E%TFRIbR WAI�1 ROOF _.
3
ll
�.�s y ✓
OJ7^�' DATE S
CORRECTIONS
V
IG i/ .,.
i NEPEBV �CMNOWLEDGE TNwT I N�VE HE.�O TXIS APPIIQTION �ND
ST�TE TX�T TXE �OOVE IS CORRECT �NO �GREE TO COMPLY WITN �Ll �'�] �( �
CITV ONDININCES �ND ST�TE 1�W5 REGULwTING OVILOING CONSTNUC- �
iiON. VALUATION
SIGNATURE OF r�„� /� PER'niT FEE 5 ��j ^
PERMITTEE �%
/// 'J }/ PLAN CHECK S �Q �
S w o�Jlo
AUTHORIZED AGENT `� TOTAL FEE S � ���