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HomeMy WebLinkAbout2033 PALOMA DR - Building Permits CITY OF COSTA MESA (40114. q BUILDING DIVISION Lt DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER m 1 PERMIT�; B02-01848 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. UI�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2033 PALOMA DR Status: ISSUED Suite: Applied: 11/13/2002 Vicinity: ROOF Issued: 11/13/2002 Parcel Number: 42625131 Zoning: Applicant: KRZAKALA, GARY ISSUED BY: :,i Address: 2600 N CANAL Phone: (714)997-9669 ORANGE,CA Zip: ' 92865 Owner: MUCCIA, FRANK Address 2033 PALOMA DR ' - Phone: - • COSTA MESA,CA - Zip: 92627-2116 - . Contractor: PREMIUM CONSTRUCTION Address: •2600 N CANAL - - Phone: (714)997-9669 ORANGE,CA - Zip: , 92865 License:- 492049 - Arch : Eng: Address: . Address: Phone: Phone: . Zip: • License: - - License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL SHEATHING, 15#FELT,40 YEAR,COMPOSITION ROOF.3,000 S.F. INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: t $0.00 - - - Calc Valuation: .- $6,000.00 Permit:. $125.25 Claim Valuation: . $6,000.00 SMIP Res,' $0.60 .- SMIPCom: ' $0.00 . "- -- Other: $0.00 - - Inspection: $0.00 Total: -$125.85 , PLANNING &ZONING SETBACKS i�c - cc -, .. , d - . . MAIN STRUCTURE Front 0-0 - Rear 0-0 ' Left 9-0 - Right - 0-0 �:� ACCESSORY Front ' 0-0 . ��`.Rear_ 0-0 ' . Left 0-0 Right 0-0 PARKING Existing: ' '0 . ''.Required: 0 . Proposed:- 0 , NOTES: 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 244648(6/00) DECLARATIONS (• • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Q?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'co peps�a�tion Insuran%carrier and policy number are: Cardo'E 'Sr'.IOC iCCi"-C P Iicyy D r: / 7 6' G i 7- CQ (Thu section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which s permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If . • Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. G Arpplicam'Signete �— Data:_ l �3 WARMNG: .%Jud'FAILURE TO SECURE WORKERS' / .TION COVERAGE IS UNLAWFUL AND SHALL SUSIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDRIO. T COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC11ON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS LARATION: • •I=by.afflrm.thatIam license under roylsions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full 'f andeffect.-Llc-i' Y Q," r f`s.a� ` ezt- Contractor' .Signature:= Date: !r/ 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). Lenders Name: Lenders 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).): ❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to en 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.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers 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: I 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? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aziermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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? 0 Yes 0 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 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Ow s) ate AndlOr.Aum 21i4a4 'Date CODE 0 INSPECTION TYPE PATE INTRIAUS CODE( INSPECTION TYPE PATF ROW 1818 Fixed System Final F' r ion 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 'rZ (Q — 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 . V • • A 4 q�q CITY OF COSTA MESA ¢�1�`� BUILDING DIVISION PERMIT MBER 1-1 ' DEVELOPMENT SERVICES DEPARTMENT PERMIT 00 00370 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,C A MESA,CA 92626 PLUMBING PERMIT Job Address: 2033 PALOMA DR Status: ISSUED Suite No Applied: 07/14/2000 Issued: 07/14/2000 Vicinity: ISSUED BY: Parcel Nunmber: 42625131 Applicant: MUCCIA, FRANCESCA S Address: 2033 PALOMA DR Phone: • COSTA MESA,CA Zip: 92627-2116 Owner: MUCCIA, FRANK& FRANCESCA S •„ Address 2033 PALOMA DR Phone: COSTA MESA, CA Zip: 92627-2116 Contractor: OWNER-BUILDER • Address: Phone: Zip: License: 0 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT REPLACE GAS MAIN FROM CURBSIDE TO RESIDENCE&INSTALL GAS EARTHQUAKE VALVE. 1 GAS SERVICE& 1 GAS EARTHQUAKE VALVE. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $11.00 1 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $9.80 1 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $44.30 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap•access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 Y • o WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR 000E,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: 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: Lenders 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 Busin ss 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 sub is 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: contractors License Law ..rs not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license •• uant to the Contractors Lir s' Laws.). ❑ I a e t d-r - . Al_ usin:ss and Professions Code for this reason: 4//‘/A + Signature: at / - . Afini4M7fli4 AU _—Y//'/ 00 • Owner ID verified bydrivers license I: Yes 0 No Drivers License No. Expires: ////(7 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 B,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? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes INo (Section 65850.2 of the California Government Code requires that the requested information be fumished 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 Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 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: C TIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is ct. I agree to complywithall state laws and city ordinances relating to building construction,and authorize representatives of t City of Costa Mesa to enter upon the a vg-described property f r ins pdc(on'• ••ses.I agree not tto occupy or allow occupancy of any building authorized thi;�ennit final inspection. �(�/(/AJ�/YfA✓�nif/ it/•I/Sig(1[attor-0 Leal Owner(s) //�� /T/, Date And/Or Authorized Applicant Date CODE I IWSPECTION TYPE DAIS 1NTITIALS CODES )NSPECTION TYPE PAIS INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical ,� 1266 Pool Spa Final 208 Final Plumbing 7-1'7 -co & f' / 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall - 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 • I. e1__7 t1 e- _""" eeda «�� L/wc&o ' OWNER-BUILDER It ` '-' 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. - ' • 1 i t•. \-t 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 provtdthe major labor and materials for construction of the proposed property improvement. Yes ❑ No 2. I (have/have not) 4+A-VE signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name to I 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 1042-46 (REV.9/98) Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. --________________ CITY OF COSTA MESA C�q�JJI��IISTRUC/T1ION PERMIT PER N ��'fy a. TRACT NO. LOT NO. UNIT NO. `A P IF Zone �- Project Address- 02033 P4LOMA -9464 2 �`' rr I S Main Building: Accessory Building: _ Applicant's Mallin Address .�s'33. ILJ. . /NCIIX/A '/ TYPE OF CONSTRUCTION U NEW u ADD H ALTERATION U REPAIR • E - Z e("b5L/3ND PhonfaVG-'7'/d H CONVERSION ❑ DEMOLISH ❑ OTHER T Front D Owner's Nam �Mb DESCRIPTION OF WORK/USE OF BLDG. ' A Rear N Address I Arch/Eng. License No. TYPE OF PERMIT El GRADING�❑ FOUNDATION ❑ STRUCTURAL I K Right G ❑ TENANT El ELECTRICAL L7 PLUMBING ❑ MECHANICAL S � Left - Address - • . R S Contractor's Name ✓AR/.S PLI{in I3hVG, Phone/7 2a-30 0 ❑ OTHER Ping. Ref.# Parking Req,/Provided OCCUPANCY FT. Q Add • ress(mailing} 533.• (///2 .(/l,)OoCil7 PROJECT DESCRIPTION SQ. Planning Notes: M V City License No. /o?t d CONSTRUCTION TYPE VALUATION $ (�' S �g89T LICENSED CONTRACTOR DECLARATION ZONE GRADING CU.YDS. 1 ACRES �ECt1VEO APR S. I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: //V S'T AL..,Ea to p---r� it A `n C7-rC 2 , e• with section 7000) of Division 3 of the Business and Professions Code,and (� my license is in full force . • effect. _n���' 2 — ELECTRICAL FEES ,`tb Licens- Cl.ss _ NP 2i76/4-9 Date - -7�1 Signature ayes. L ce(-� N a PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW V RKERS'COMPENSATION DECLARATION Construction Pole Sub. • 0 50+ KW 'eby affirm that I have a certificate of consent to self-insure Ora certificate Bar Sink Showers Workers' Compensation Insurance,- or a certified copy thereof (Section Cooking'Unit _ Meter [pup to 100 amps ' 3800, Lab. c, r/('� �J Backflow Preventer Service Sink .. - - Policy No. �Yd�p Company ECMLic.p Backflow Irrigation Sewer Cap Dishwasher f:,• Meter Dover' 100 amps. C�Jtif ietl copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel — rCeinie_Fogyjis filed with the city B4ih1j96 Diysioy. rl / Bathtubs Sewer Connection Date Y / n Applicant /`7C / (f/.GC.�iYs4.e] Fan Motors❑0.1 HP ❑1'/:-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors' • • _ (This section need not be completed if the permit is for one hundred ($100) or • F.A.U. Inc.Solar 09-15 HP ❑16-15+ less). Dishwasher Solar Piping - I certify that in the performance of the work for which this permit is Issued _ Fistures ! Microwave shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Workers' Compensation Laws of California. Device Boxes Date Signature Floor Drains Swimming Pool w/Spa ,- - Pole Light NOTICE:If,after making this declaration, you should become subject to the Outlets Ran Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal I comply with such provisions or this permit shall be deemed revoked. ¢ 9- Switches CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) T Garbage Disposal Standing Sections Lender's Name Interceptors -/ Water Heater GQ v Lender's Address - Kitchen Sink •Water Service Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash . 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-Trap Laundry Trays - any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains - •e Contractor's License Law(Chapter 9 (commencing with Section 7000) of vision 3 of the Business and Professions Code) or that he/she is exempt - Reinspection Fee $15 Issue Fee $ 3 ..erefrom 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 enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: • - Reinspection Fee I $ 3 I, as owner of the property'or my employees with wages as their sole pe ! $15 Issue Fee _ Zoning Approved By Date compensation,' will do the work, and the structure is not intended or-offered -- for saleseW oe ap lyito an and aProfessional Code: The Contractor'smroves MECHANICAL FEES Building Approved By Dat '�! License Law does not pBusi es owner of a property who builds or improves - thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type 0 Application Issued By _ _. Dat employees, provided that such improvements are not intended or offered foryp sale. If, however, the building or improvement is sold within one year of cam- Canopy Type II D. SUMMARY OF FEES • p , the owner will have the burden of proving he/she did not build or im- Duct- Under Ground prove for the purpose of sale). - BUILDING PERMIT $ SMIP $ 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System CHECK tractors to construct the project (Section 7044,Business and Professions Code: PLAN $ PERMIT The Contractor's 'License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU PLUMBING $ �vb - ISSUANCE $ builds or improves thereon. and-who contracts for such oroiects with a con- - __ • tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System D Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ _ proof of their Worker's Compensation insurance should be provided to me. • GRADING $ ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers ELECTRICAL $ PLAN CHECK 50% $ MICROFILM $ • Date Owner - Heating System&Ducting Registers • MECHANICAL $ - • TOTAL FEE $ �U I hereby certify that 1-have read this application and state that the above ❑0100,000 BTU ❑100,00OBTIl-- - PLAN CHECK 25% information is correct. I agree to comply with all city and county ordinances - - $ • and state laws relating-to building construction, and hereby authorize repre- - ' sentatives of this city to en err upon the above-rrlentionetl property for inspection pu o s.lag/A/ - Signature �A- WLC Date���� • - • Reinspection Fee $15 Issue Fee $ 3 ACCOUNT 'r: 6130740C3! ' Drivers' License or 55 - - 0 0080 1701 0005113 - +�i]j 1 i 3' 0865-46,rev. 5/88 White - Building; Canary - Applicant; Plnk -Accounting; Goldenrod - Assessor 04/26/39 01 CA TEPT 7.0C \ \ CONSTRUCTION AND PLANNING - PC 9 SPA 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 :t 3. Electrical Conduit Utility-Undrgrnd. . 54. Forms 4. Electrical Conduit-Undrgrnd. 'I 55. Electrical Bonding 5. Steel Reinforcement " 56. Rough Plumbing & Pressure Test i, 6. :Electrical UFER Grnd. ( - 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. ` ,t 8.-Foundation - 59. Gas Pipe, D Undrgrnd., Test 21 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 t - 62. Backwash & Receptor-Final 12. Sevber Cap 63. Heater & Vent-Final ., .91 13. Roof Drains I 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 C-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# • J • 211. 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 0 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 ,2 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION I32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED I 33. Final Electric Notes: 34. Final Heating & Air Conditioning - - 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing s77-4kII) r L 39. Water Service-Final ix fTS _ 40. Gas Service-Final ? i I t r1' _ 41. Solar Domestic-Final y T 42. Backflow Preventer :J . I . 43. Backflow Irrigation t7; - , _ 2 . 144. -Landscape Irrigation System ' 1/ 45. Sound Attenuation rt.; I46. Handicap Regulation% • 47. FINAL STRUCTURE & BUILDING i X46. Special Requirements Completed 19. Electric Release to Edison _ �., • ;0. Gas Release to Southern California Gas Co v 1. CERTIFICATE OF OCCUPANCY �•. Date �� -OWNER BAY HARBOR BUILDERS, INC. DATE 3-6-59 JOB ADDRESS 2033 Paloma Dr. - BUILDING PERMIT NO. 8784 GENERAL CONTRACTOR Bay Harbor Builders. Inc. VALUE $ 15,510.00 AP. No. LOT 7 TRACT 2992 FIRE ZONE 3 DESCRIPTION OF WORK Res. w att/gar. GROUP I & J TYPE V ZONE Rl ,, PLAN NO. 784 INSPECTIONS DATE SUBCONTRACTOR I , K PERMITS ISSUED 1\Z t" ,,,VDATE NUMBER Trenches Forms Steel %irelta J V \\ \J° V Floor System - _allinriarialligai Steel Reinforce Chimney Re-Rod 1bi . ,V✓ V\IA Bond Beam . .i fl FAIMVAI A/ .r II\ V\a Frame and Flashing i, / •B rila ,-. \ .C. .A I V A\ Lathing, In/p Out 0J14- -)i --0 'c (1" A ' Plaster, brown coat /314 -t 8 -S ' t\ ,l/'4D V bd' Underground soil • W/G Pipe Test r j Mt It 1\11C' Top Out a' V = ( \.,‘ Furnace • --f Gas Vents - / Rough Plumbing tAgrtifilliaVANWAMar • '—' • 1/ \r Cesspool Septic Tank MOMMEMINIMINIE / T Prop. Swr. Lida— Ho - Con. St. Swr. MUM c-, _ //7/ '7 1i-cc ym n 7 / Sprinkling System ' / / V/ I \ Heating Final •eye,,, 13.,Lw19 7, E!cif Erta4 d( — Plumbin. (Fixtures, FinaP. ° a1. L29'-3 n'V _ Final Gas Test <- _ Construction 'ole ( \I I Underground Power 11111111i , a Vi Rough Wiring ,[yAi` ,pi� A_ __ mmo=r 1: - Vr '; Fixtures, Final I , T 11 "/ N\ OCCUPANCY 1C AV /1u jab7 /t L. / v Form 210-5M-1-57 7 A 1 , •/..v I 8784 • 8784 rEE REL JVED COSTA MESA BUILDING DEPARTMENT fBAR 5 195 P.O. BOX 317 . FINANCE DEPT. COSTA MESA. CALIFORNIA CITY OF COSTA MESA • FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ADDRESS r O.f71,LEOAI4n Pedos7-197Y .je r. BUILDING • COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY n/l mss! RECEIPT NO. ypE O OWNER iA // 4) O/P fc//t./ tZ 7 G /l Y MAIL �f//%}7//�r'+/� r/.' < }''/^' RECEIVED Dv// _DATE RECEIVED_. DAT sS D�`}�+ ADDRESS,-//) / /ei/ /n �v E/ i. .'1../` / J5 - --cS 7 : / j CITY( rrA /14.5,9 THE /6/Sr ADDRESS 2. U l 3 -7:2°, ` O IM ARCHITECTLIC. OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE ADDRESS ZONE 3 ZONE NO.OF TYPE GROUP d CITY LIC. PU OF CONTRACTORI�//'�� NO. Aj J/ /tij _ADDRESS TEL. APPRO. EDS/ DATE 3 C } LEGAL LOT C//�J I'1� CORRECTIONS DESCRIPTION NO. / BLOCK TRAC2/ ]/-. A.P.NO. OELOT(// / /, NO.W OFOBGGTS. O APPROVED USE OF ©y� CITY OF t STA MESA EXISTING BLDG. w .. •,,,,• 1'.t'1T SETBACK CENTERDF LISERFROMEET ,�� REAR YARDW' / G.SUBJECT TO V I DEPT. REG. _ SIDE YARD RIGHT LEFT 91 DESCRIPTION OF WORK �d UAlt3 BY • PLAN TtCH. .---77 NEW E+ ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING NO,OF SIZE /y,��yS/�JL�IS_ /J ROOMS 7 STORIES EXTERIOR COVERING W//.�•f//t COVROOF ERINGVA/re I USE OF NEWi i 7 BUILDING ,s5-44..--_ 4 A,...i JLY 47,75/p.2 irc� ci//�rr/ 6-,vc "- The_Amount shown under valua!ion is for the I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND of esablishinD a pa:`^tt .C: Ay.STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL 6 CITY ORDINANCES A {DDD STATE L/// I REGUx''TING BUILDING CONSTRUC- '3.5—: G. TION. // �� 4 II . VALUATION �.I SI GNAT U R`..l�l.F I �%y�//Y/,�-� PERMIT FEE $ PERMITTEE / 3 ( t[ // $ /4S PLAN CHECK $ //-�.l�) AUTHORIZED AGENT ej� /4/a TOTAL FEE $ ....5:2.4-22 ver'