HomeMy WebLinkAbout308 PAIGE LN - Building Permits�
CITY OF COSTA MESA
(.��p~Fsq BUILDING DIVISION
i`�� �7 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
� FOR INSPECTI�INS CALL: (714) 754-5626 �
''°'�°'"" � � PERMIT NUMBER: P11-00069
PERMIT TYPE PLUM STATUS: ISSUED
APN: 43913217 DATE ISSUED: 04105/2011
ISSUED BY: KJB
_�.,.,.._.-�::.�-�---•-r,.,_..
JOS ADDRESS: 308 P_AIGE_LN_CM� Suite/Unit:
Vicinity:
SCOPE OF WORK: CHANGE OUT 40 GAL WATER HEATER, SAME LOCATION
OWNER: CU7SFORTH, DOUGLAS LEE TR Address: CUTSFORTH, MARY JANE TR NEWPORT BEACH,
CA
PHONE: City/State/Zip: 2227 WINDWARD LANE
APPLICANT: MCCLAIN, TONY Address: .
PHONE: 714-540-8400 City/StatehZip:
CONTRACTOR: PROSERV PLUMBING AND DRAIN License No. 798675
Address: 3012 ENTERPRISE ST UNIT F PHONE: 714-540-8400
Ciry/State: COSTA MESA, CA ZipCode: 92626 CELL:
ARCHITECT: �icense No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: 535.80
TOTAL FEES: $35.80
NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
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
required inspections and final approval must be obfained. Failure to obUin inspections and final approval will result in the expiration of this permit.
L D�E�. INSPEC110NTVPE O�i INifilALS COOEf INSPEG110NTYPE �FiE IN RL
1816 Fixed System Final Fire Prevention 206 Final Mechanical ,,%�
1266 Pool Spa Final 208 Final Plumbing X 5�� ('�� i1��(.lr
200 Final Re-Roo( 210 Final Elecvical
201 Final Block/Re�aining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Oemoli��on 250 Final Builtling/Occupancy
�
WORKERS' COMPENSATION DECLARATION: .
I hereby a(frm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to sel4lnsure for vrorkers'
compensalion, as provitlea for by section 3700 of the Labor Cotle, for the
�ormance of the work for which this permit is issued.
I have and will maintain wnrkers' compensatan insurance, as requiretl by
sectbn 3700 of the Labor Code, for the per(amance of the v.ork fa which this
permit is issuetl. My workers' compensation Insurance carrier and policy
number are: )
Carner C)��"� .% h.r
(T��ssMonneetlipl0e pereoAmepe�maareNetlalmenuMre0cb9ars(S�Oo)aless)
PolicyNumber: �7 6�)�Q��l'��0
❑ I cehi(y t0at in the pedormance of the wurk tor which Ihis permil is
issued, I shall not employ any person in any manner so as to become subject
to ihe vrorkers' compensation laws of Calilomia, antl agree that il 1 shoultl
become subject Io the workers' cwnpensation pmvisions of Section 3700 of
the} abor Code. I shall torthwith comply with these provisions.
�U+u, l�r � �"�'l1
Nppimnl's S�giaWre Oate
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed untler provisions ol Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Code, and
my iicense Mis in�/l/ull forJce and eeect.
Lic. tt /`7 df�% J Ciass tt C���,
�2t � f'1'1c�� `/' Y-/ 1
Crntracmrs SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a constructbn lending agency for the
peAortnance of the v.ork fa wfiich this pertnit is issued (Sec. 3097, Civil Cotle).
Lentler's Name:
Lentler's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affirtn that under penalty ol perjury that t am EXEMPT FROM THE
CONTRACTORS LICENSE LAW lOr the lollowing fea5on (SeG. 7031.5,
Business and Profe55ions Code: Any city or county which requires a permit to
construct, alter. improve, demolish, or repair any strucNre, prior to its
issuance, also requires the applicant lor such permit to file a signed slatement
Ihal he or she is licensed pursuant to the provisions o( the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business an0 Prolessions Code) or that he or she is exempt therefrom antl
the basis lor Ihe alleged exemption. Any violation of Section 7031.5 by any
applicant tor a permit subjects the applicant to a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as owner of Ihe property, or my employees with wages as their sole
compensation, WILL DO 7HE WORK, and the structure is not intended or
o%eretl for sale (Sec. 7044, Business antl Professions Code: The Contractore
License Law dces not apply lo an owner of property who builds or improves
thereon, antl who does such work himself or hersell or through his or her ovm
employees, provided that such improvements are not intended or oftered for
sale. II, however, the builtling or improvement is sold wilhin one year of
completion, the owner-builder will have t�e burtlen of proving ihat he or she
ditl not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to constmct the pmject (Sec. 7044, Business antl
Pro(essions Cotle: 7he contractors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts fw such project with
a cont2ctp�s� license pursuant to the Contractors Ucense Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
305]�a8(3/0]
Ovmer ID verifetl by driver'Slicense. ❑ Ves ❑ No
Driver's License No. Eapires:
Verifcation of Ownership by (type o( tlocument, i.e. - property lax bill or deed):
�1VISION �F INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavation frve (5) a more feet in tlept� into wfiich a
person is require0 to tlescentl, vrill be made in connection with v.ork authorized
6y this pertnit, and that no builtling sWCNre, scaf(dding, falsework, a demWition
or tlismantlinq thereof, vrill be more than Ihitly-sa (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 347, Title B. Calilornia FWminislrative Code).
❑ As owner-builder, I will not employ anyone to do work vfiich would
requira a permit from the Division of Indusirial Safery, as noted above, unless
such person has a permit to do such work from the division.
Apoliwnfs SignaWre
DiviSion Of Industrial Salety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican� or present or fuNre building occupant need to file antl
certify a Business Plan for emergency response to release or lhreatened
release o! a hazardous matenal7 ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Saley Code requires, with some
exceptions, that a Business Plan be fled with Ihe Costa Mesa Fire
Department by every business vmich has at any one time tluring a reported
year a quanliry of hazardous materials equal to or greater Ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet ol compressed gas
at standard tempereture and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration fortn (or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Califomia Health and Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire DepartmeM by
each business which al any one time has on hand a quan�ity of acutely
hazartlous matenals equal to or greater than a weight of 500 pounds. or a
volume of 55 gallons, or 200 cubic feet of compressed gas at sfandartl
lemperaNre and pressure).
3. Does or will 1he appliwnt or present or (uture building occupaN need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safery Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
fling with the Fire Departmenl 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 0( the Califomia
Health ana Safery Code been lully complietl vnth? ❑ Yes ❑ No
5. Does or vrill the applicant or present or fuNre builtling occupant require (or
tlle wOrk vfiich is the subjecl ol �his applitation a permit lor such wnsiruction
or motlification from Ihe South Coasl Air Quality Management DisMct or fmm
any other air pollution control tlistrict or agency7 ❑ Yes ❑ No
(Section 658502 of the Cali(omia Govemment Cotle requires that Ihe requestetl
infortnation De tumished on applications ta non-residential building pertnits).
6. Will any part of lhe facility to be constructed under this permit be within
1000 feet lrom the ouler boundaries of a school? ❑ Yes ❑ No
Qf "yes", Ihe facili�y must meet the requirement of Sections 25534 and 42303
ot Ihe Calilornia Health and Salety Code).
7. I( a permit from the South Coast Air Quality Management District or other
air pollution control tlislrict or agency is required for the work which is the
subject ol lhis applicalion, have all of lhe disclosures prescribed by Califomia
Health and Safery Cotle Section 42303 �een made? ❑ Yes ❑ No
8. (If yes", attach ceni(wle of compliance from the appropriate air polWtion
control otficer).
CERTIFICATE OF COMPLIANCE: I certity thal under penalry ol perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions. '
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
certify under penalty of perjury that I have read this application and state that
the infortnation given is correcl I agree to comply wiN all state laws and ciry
ordinances relating to building construction, and authorize representatives of
Ihe 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.
�Sign/Narlu-'�re ai Legal Owneqs) Daie✓
/' I✓� �J��)
nalorA IM1orizedAOClitam Date
Alteralions
h
ncr. Residen[ial
Climalc
� "� 1 1 �
C F- t N-n LT
(Pa�e 1 of �)
N � qol'S�ries
I�hJ(�Ul' SO��JCI' UCl'Jllti For ihe furreJ purlimieJ nf 11�lass N'alls sec I�urrin;! S�rips Cnnsb�ucliun'I'��hlc heluH�. I
n H C I D � L�'� I� C I I I .I
Nore:
Assembly Name
mble bdo�r.
Thicl:ness,
Spacing. U- JA4 Table
or Other� factor° Number�
Insu/arlon R-value. see Page JA4-3
Values Prom JA4
Pramcd Continuous
Cavily Insulation
R-vuluc° R-Vnlue�
4-l. For calcnlo�ingJinred u•ollt ure
i. ror t ngnu mmcme me iaettrr)icanon rtnmr mar ma�cnes �ne aurmmg p�arts.
1. Indicate the Arsemblv Name or q�pe: Roof/Ceiling, N'u(Is. Floors, S(abs, Gmr/ Space, Ooors m�d e�c... lrtdicule in column G lhe Frnme
nmterial nnd Size: For N'ood, Meml, hleml Buildings, hlars, enrer 3xJ, 2xG. or e(c... see JA-1 for other possible Jrame Npe ussenrbfies.
3. En�er the lhickness jor ma.rs in inthes or Spncing benveen jramin� members emer; I6"or 34 "OC: or Orher for a!l mher assembfv dexriprion
snch as Concrete Sandwith Ponel, Spandref Ponel, Logs, Srraw Bale Pnne! and erc....
-1. Bnsed on the Climate Zone; enter the equivalen( U facmr jound in JA�J Table based on tAe R-1'al ue jrom Table 1 S!-B, C, or U
5. Enter the Tnble number thm c(ose(v resembles the proposed assemblv.
6. Enter the R-vnlue thnt is being insmlled in �he woll cavin� or beM•een the jraming; othenrise, enter "0".
Z Enter d�e Co�nimrous lnsu(ntimr R-vnfue for �he proposed assembh�; odienrise, enter "0".
8. Enrer the row nnAcolumn of(6e Ufa[!o� i'nlue based ott Co(umrt FTable A'umber arcAen�er �he Assenrblv Ufncmr in Cohmm J
9. ihe Proposed .4ssembh� U-(ncror, Cohmm J, must be equa! ro or less ihan dre Smndard U-%acror nr Cohmm F. In conmh�.
Furrin� Stri s Construction Table for Mass U�alls Onlv
A R C II F: I� G II I .I 1: 1. pl
Prnpn%cJ 1'ropertics of �lusunp• anJ Cnncrctc AJdeJ Inicrior or Gstcrinr Insula�iun
�\'alls Rrom Rcfcrcncc in Furring Spacc Gom Rdcrcncc
Jnint A �endi� TnMc J.7.5, J.3.G, d.7.7 Join� .\ �cnJix "1'aMc J.3.13
�`.' � � � ` n z `� U
Assembly i,.� j � o � �'"' ``o a�^v z_y v'� Pinal
Mass Namc ar 1A4 Tablc � ` � E o �- ' �— Asseinbl�•
Thickness� TV e° Number ¢> � v � LL c> �' < i �? �`�
Ud�ctor Commcnt
I
�Registration:Nuniber. �� - ' � . .Regis�ration.Date/Time,� � � � HERS'Proi�ider:
2006 Residentia% Compliance Fornu Morch ?0!0
H�'AC Sl'STEMS- HL•'ATWC
Minimum Duct or Piping Configurotion
HeatingEquipmenl Efficiency UiSlribulion Insulation �fhernio5tul (Centml,$plil.
l'v e and Cn acirv�='' (AFUG or HSPF) l'v e and Location' IL-\'alue l'vne Sn�ce. Packaee or Hvdrunicl
�
1. lndicme Hetning TjNn (Cenvo! Furnnc�, IVal1 Fivnace, Nem pim�p, Hoiler. Elecrric lfesismnce, erc.J
2. Electric resismnce hearing is aflo«�ed onh� in Componenl Package C, or excep7 �vhere elecVic hcuting is supplenren(nl (i.e.. if �ornl caprsim
<?/;11' or 7,000 Btu/Br efectric heating rs convolled br a rime-limiring device no� exceeding 3!I mimrtesJ. See §1 � l(b)3 exmption.
3. Rejer larhe HEHS her jcorion seciion on Page �J of the CF-I R-.iLT Form Jor uddi�ionnl reyuirements m�d check applica�b(e Laxes.
4. lndica�e Tvpe or Loca�ion (Duc�s, Nvdronic in Floor, Rndiators. e(c.J
tl VAC Sl'STEi�75 - COOLING
Minimum
EfTciency Duct or Piping Configuration
Cooling Gquipmenl (SEEWEER or Dislribulion InSulation l�hermo5tal (Cenval, Split.
T e and Ca acit ��' COP) T e and Location� R-Valuc 'I' e S.ice. Packa e or Hvdronicl
�
L lnditale Cooling Tvpe (A/C, Heat pump, Evop. Coo/ing, erc)
3. Rejer to �he NERS I'erifica�ion section on Page 4 ojthe CF-/R-ALT Form jor addirionn! reqnirements nnd d�eck app(icable boser.
3. lndicate Tvpe or Location C�h�as. Nvdronic m F(oor. Radraiors. eteJ
�1'ATER HEATING
List wn�er hea�ers and boilersfor both do�neslic hot water (�HIi�J heaters and l�vdro�iic space henring. /ndividun! dwelfing UPI�i' henters nrust be
gas a� propane fired. Hot water pipe insu(otion from the OHff� hearer m �he kitchen(s) and aa al! undergrom�Aho� wn�er pipes is reyuired in ul!
canmonent oacka¢es in al! tlinm7e =ones.
Estemal TanA
Water Fleater Type/Fuel Distribution Type Number In Tank Energy Fnetor or : Insulation
T e� ($tandard. Recirculating)' S��stein Ca aci[v ( al) l�hermal BfGcicncv R-Value�
S r�a
1. Lrdicate Tvpe (S�ornge Gas, Heat Pump, Instantanema, etc.)
1. Recrrcu(n(rngsvs(ems sen•ing multiple dwe/fing unrts shaf/ meei the recircu/a�ion requirenrents oj§/.i0(nJ. The Prescriptive requirements' do
no� nlfmv �he insm(lmion ofn recirculatittg ivaler healing tvslent for sing(e tAvel(ing uni�s.
3. The er�err�al wn(er hen(inR rnnk nnd prper sha(l be insu(ared io meer rhe requiremenrs ojFl ��(jJ.
—__'_'.___'__.___---.._..�—'--..__._'._'_______, _-_'""."' ___ . ._ . _. _. _.. _
RegistrationT'umber._ - " Registrgtion�Date?ime_.. -� .HERSYro��ider. �
?008 Residen7ia! Compliance Forms A4arch ?0/0
IIIsKS VERI I' ICATION SUd1i�L�R1' 17�e enjorcemem agencvshould pa.i�specia! ntten�ion m d�e llERS'dleusures s{xcified rn �his
checklisr be(om. .I rnmp(e�ed nnd sighed CFaR Farm for all �he measures specified shnl/ be subnrined m d�e bui(dr��g inspec�ar before fin�!
Duct$C:Illn�!STeSling HF.kSverificationisrequiredforlhisnre��sure.
❑ l'ES ❑ NO YF.S: In Climate "J.ones 2 and 9-16, if mom than 401inear leet ofnew or replacement ducis arc installed in unconditioned
space, the ducts are to be sealed per § 152(b)I Dii and lhe ncwly insmlled ducts ure lo be insulatcd per ¢ I51(Q 10.
❑ ESCEP7lp\: E�isting Jucl s�slems �hat are e�IcndeJ, which are cnnslruc�cJ, inzulaicJ nr �r.JeJ wilh usbes�ns.
❑1'I:S ❑NO YES�. In Climale Zones 2 and 9-16, if the esisiing space-conditioning srslem (1-IVAC cyuipmcnt and ducting) is repluccd, thc
duc�s arc tu be sealed per § 152(b)I Ui.
❑1'ES ❑�O YF.S: In Climate Zones 2 and 9-16, i(the e�isting FIVAC eyuipmenl is repluced (including lhe rcplacemem of lhe uir hundler,
ouldoor condensing unit of a split system, cooling or healing coil, or the fumucc hw� eschanger) ihe duc�s are �o be
senled per §152(b)IE.
❑ 13\CEI'7lp\: Duct srstems ihat arc dacumcnicd Ia hurc bccn prcriuush� sc:dcd cnnfirmcJ through IIEItS
verificaliun in uccurdanee �vi�h procedures in �he Neferenee NesiJenlial AppenJi> RA3.
� E\CEPTIfjN: Ducl sysiems wilh less �h�n JO linenr fee� in uncundiliuneJ spuce.
n E\CEP71p\:G�istin�ductsvstemscnnstruc�ed.insulaleJnrscalcJ�ei�husbes�os.
Refrigeran[Charge-Sp1itS,ystem HERSverifica(ionrsrequiredjord�isnrensure.
❑ l'ES ❑ NO 1'ES: In Climate Zones 2 and 8-I�, when the existing FNAC equipmcnt is replaced (including thc replucemcnt of the air
handler, outdoor condensin� unit of a split sys�em A/C ur hwt pwnp. cooling or he�ting coiL ur the Furnacc hea�
exchaneer) a refrieerant charee mnsurement shall be verified oer & 152(611 P.
Centrol Fan Integrated (CFI} Ventilation System and Fan Watt Draw�
The ventilation reuuirements o(&I50(o) do not aoolv to esistine residential homes.
Ducted Split Sys[ems - Air Conditioners and Heat Pumps: Airflow HERS verificntinn is reyuiredfor thrs measure.
❑ YES ❑ NO 1'E5: ln Climale Zones 10 [hrough U, when the e�isting space-wndilioning system (HVAC equipment and ducting) is
renlaced, the airflow and fan eztt draw shall be verified per § 152(b)I Ci �o mcet �he rcquirements of $ I51(�7l3.
Documenta[ion Author's Declarafion Statement
• I cerlifr Ihal �his Certificale uf Cum liance documenta�ion is accurelu unJ cum dcic.
Namc: �/y��� � Signawre: �YvI�n� .
� 1 � l��-�+'f n / ' l`�v
Company: Date:
�rate r,� mb;
Addn:ss: ��/Z /�� r IfApplicablc CGAor CEPG
C�ll �'" ��� (CettifcalionH):
City/Slatc2ip: ^_� � n Q'L� I'honci/v�yo'��
W]/L� \9' /Lv ��
Rcsponsible Ruilding Designer's Declaration Sta[ement
• I am eligible unJer Division 3 of the Cali(omia Business and Professions Code to uccept responsibility I'or the building dcsign identiGed on
ihis Cenifica�c of Compliance.
• I eertify that the ener&v fealures gnd perfortnance specifications for the building design idenli�ied on this CeniGcale of Compliunce confomi
to thc requiremcnts o(l'idc ?Y 1'ans 1 and 6 of the Califomia Code ot Regulations.
•'1'he building design fcaturcs identificd on this Cenificam of Compliance are consistent �vith ihe informmion provideA tu dncument this
building design on the olher applicable complianee fortns. ���orl:sheels, calculaliuns, plans:md specifications submitted tu the enforcemenl
u�cncv fur a ruvul �viih this buildin ermit a licatian.
Namc: Signawre:
Company: Ualc:
Address: Liccnsc:
Ciiy/Smtc!/.ip: Phonc:
For n,v.ris�unce or qucuions regnrding the Eiter��• Stnndards, co�imct (he Euerg�� /lotline nt: 1-800-771-3300.
�Hegistrntion Number: Regisvatiwr D�fe/Time: � HEILS Provider:
1005 Residential Compliance Forn:s d4arch 1q10
(714)754-5273 • Fax(714)754-4856
Job.4dtlress: 308 PAIGE LN
Suite:
Vicinity:
Parcel Number: 4391321 �
Applicant COOTER, LYLE
Address: 23015 DEL LAGO
CITY OF COSTA MESA
BUILDING DIVIS►ON
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Zoning:
PERMIT NUMBER
I B99-01739 "
'77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 10/27/7999
Issued: 70/27/1999
ISSUED BY: C��
Phone:�� pi4)583-1858
LAGUNA HILLS CA , " ' � � Zip: - 92653 . . .
Owner. BRITHANYWOODS HOA
Address 2227 WINDWARD LN' � " � " . � -
, r- ;i %�, ', � � Phone: _949-583-7858 ' �
�� NEWPORT-BEACH, CA - - � Zip: " 92660 _ � ' _ � ,
i., � j
Contractoc ' PRO-TECH WEATHERPROOFING
, �. .
Address: � 23015 DEL LAGO " .
. � - � Phone: p14) 583-1858 �
- LAGUNA HILLS CA
" Zip: 9265&" '� License: 620476
Arch :
Address:
Zip:
Phone:
�. License:
. : . . ' : . ' Eng:
Address:
Phone:
'� �License: � .
SCOPE OF PERMIT
� -� REROOF OVER EXISTING SHAKE WITH STONE CAOTED STEEL METRO SHAKE, ICBO# ER 5212, 1.4LBS. TO INCLUDE
UNITS 310, 312 , 374. ; � .
Plan Check: , $0.00
Permit: $27925
SMIP Res: $1.70
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $280.95
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY , Front 0=0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Re uired: � 0
FEE SUMMARY '
- , 'i
,
,
PLANNING 8 ZONING
Calc Valuation:
Claim Valuation:
e
Left 0- 0 Right 0- 0-
Left 0- 0 Right 0- 0
Pr000sed: 0
$17,000.00
$n,000.00
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, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and becoma void i( 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
requlred Inapeetlona and flnal approval must be obtained. Feilure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSATION DECLARATON:
I hereDy eftirm under penalty ol perJury one ol the lollowing tleclarations: '
❑ I heve entl wlll melntain e certilicate of consent ta selFlnsure for workers' compensetion, es provitletl tor by section 3�00 0l Ihe Lebor Cotle, for �he pertormence of Ihe
! wark for which Ihis permit is issuetl.
�� I have antl will meintaln workers' compensation insurence, as required by section 3700 oi the Lebor Code, for Ihe pertortnance of the work for which this pertnit is issued.
`My workers' compen llon Insurence carn %j�tl policy number are: �` /� �
Carner. �L � %,%'�O �ff POIICyNumber.J �lJ" �Tl/
(This section need not be camp/eted il the permif valuetl a! one huntlretl dollers (5100) or /ess.)
❑ I certily that In the peAormence of lhe work lor which this permit is iuued, I shell nol employ eny parson in eny manner so as to become subject to the workers'
compensation laws ot Celifomia, end e9ree that it I should become subject to ihe workars' compensetion provisions of Section 3700 of ihe Lebor Code, I shall fonhwith
cA�ihese provisionsX / 2�
nt Signa re: -
W l/RE TO SECUPE W RKERS' COMPENSATION COVER4GE IS UNL4WFUL AND SHPLL SUBJECT AN EMPLOYER TO CHIMINAL PENALTIES AND CML FINES P TOONE HUNDRED
THOUSANDDOLLARE($100,000),INAODRIONTOTHECOSTOFCAMPENSATION,DAMAGESNSPFOVIDEDFOFINSEGTIqJ3]O60FTHELABOflCODE,If�frEREST,ANDA ORNEV'SFEES.
IICENSED CONTRACTORS DECLARATION:
licensea untler provi�io�s oi Chapter 9(commencing wi[h Section 7000) of Divis' usiness and Professions Code, and my license is in full
Lic. N
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm thet there is a consimction lending egency for the pedormance of the work for which ihis permit Is issued. (Sec. 3097, Civil Cotle). -
Lender's Name: Lenders Atldress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirm ihat untler penelry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor Ihe following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, tlemolish, or repeir eny simcture, prior to its issuance, elso requires ihe appiicant for such permit
to lile e signed statement Ihei he or she is licensetl pursuant �o ihe provisions ot the Contrac�ors License Law (Chapter 9(commancing with Sectlon 7000) ot Division 3 ot ihe
eusiness antl Protessions Cotle) or thet he or she Is e:empt iherefrom and Ihe basis for the eltaged exemption. Any vloletion of Section 7031.5 by eny epplicant for a permit
subJects the applicant ro e civll penalty oi not more than five hundrad dollars ($500)J:
❑ I, es owner ol ihe properry, or my employees with wages es Iheir sole compensation, WILL DO THE WORK, entl the structure is not intended or oHered tor sale (Sec.
7044, Business end Professions Cotle: The Contractors License Lew does not apply to an owner of property who builds or improves ihereon, and who dces such work
himself or herseN or through hls or her own employees, provided that such improvemems are not intendetl or oNered for sale. If, however, Ihe builtling or improvement is
sold wit�in one year of completion, the owner-DuilAer will have ihe burden ot proving ihat he or she did not build or improve for purpose of sale.).
❑ I, es owner of tha property. am E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS ta construct the pmjed (Sec. 7044, Business and Professions
Cotle: The comractors License Law does not appy to an owner ot pmperry who builds or impmves thereon, and who comracis tor such project with a coniraaor(s)
license pursuent to Ihe Coniractars License Lews.).
❑ I am ezempt under sec. Business antl Professions Cotle for Ihis reason:
SignaWra: Date:
Owner ID venfietl �y dnver's license. ❑ Yes ❑ No Drivefs License No.
Venfication of Ownership by (type ot document, i.e. � property tau bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
E:pires:
❑ I hereby certity thet no eacavation five (5) or more feet in depth into which e person is raqulred to descend, will be matle in connection with work aut�onzed by this
permit, entl thet no building simcture, scaRolding, talsework, or demolition or dismamling ihereol, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calitomia Aaminisirative Cotla).
❑ As owner-builder, I will not employ enyone to do work which woultl require a permit irom the Oivision of Intlustrial Sefety, es noted above, unlass such person has a
permit to do such work imm the division.
Signature: Date:
Division of Indusirial Salety Permit Number.
ICERTIFICATE OF COMPLIANCE AND AU7}10RIZATION Of ENTRV: I certify under penatty of per�ury ihat I heve read Ihls application antl state ihat the intormation given is I
correct I agrae to comply with all state laws and ciry ordinances relating to building construction, and au�horize representatives of ihe City of Costa Mesa to ente� upon the
above-descdbetl propeny tor inspection puryases. I egree not to occupy or allow occupancy ol eny bulltling authonzed by this permit until final inspection.
COOE �. INSPELTION TYPE
1616 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Ra-Root
201 Finel BIocWReteining Well
202 Finel Factory Fire Place
203 Finel Sign
204 Final Demolition
2648-dfi
pRTE I RL
40DE� INSPECTIONTYPE
206 Finel Methaniwl
208 Final Plumbing
210 Finel Electricel
212 Finel Fire Prevantion
220 Finel Planning Approval
222 Finel Site
250 FinelBuilding/Occupancy
I'7il��l:illlkl4j
� x/Q P� �'b� Aov�icant to fill in a11 spaces except those within heavy eortl�
PER ' TRACT NO.
CIrY OF COSTA MESA�y CONS UCTION PE MIT `��� [� �: '
Ptoject Address ' d a :k-� ✓ • '
Applicant's Mailing Address � � ' TVPE OF CONSTRUCTION NEW ADD
❑ ❑ ❑
lines antl si9n all appropriate tleclarations.
�
DT NO. UNIT NO. �
ALTERATION LJ REPAIR
(. CONVERSION �EMOLISH OTHER Ap # �
Owner'sName r � � ��o�e-tTT���� DESCRIPTIONOFWORK�USEOPBIDG. � _
Address
Arch/Eng. License No.
Address
Contractor'sName - Rhone�Y� S��
Address Imailing) . �' fLN �/'Q
Ci[y License Na.
LICENSED CONTRACTOR DEC ARATION
I nereby affirm that I am licensetl untler provislons o( Charte� 9(commencing
with section ]000) of Division 3 of the Buslness antl Professions Cotle, ntl
my license is in iWl t rce ana etfect. �
License Clas � -� p e o.�
Date Signature
WORKER CO PENSATION DECLAR TION
/� •¢reby affirm [hat I have a certifica[e of consen[ to selM1insure o� a certificate
`�. Workers' Compensation Insurance, or a certifled copy thereot (Section
� ..800, Lab. C.)( f,�
� Policy No. C.LLSG� ComP nY
8 Certifie copy is hereby furnishetl.
Certif c 5 etl with the city 'n9 n.
� Da[e _ Applicant
o no[ oe compietea rt me pe mrt is w� one n mrea �gluu) or
the pe�tormance of tne�yro fo� which th� m�t is Issuetl, I
r anv oPrm� �n anv M� er z asdo c ro subiec[ to the
Date
NOTIC If; �ft�r maI(ing t�is tleclaration, y u shoultl b'�c e subjecl to� [he
Workers Compensation provisions o( the bor Cotla, y u must torthwith
comply with such OrovisiOns or [his permit Shall b Ceemed revoketl.
CONSTRUCTION LENDING AGENCV
1 herety affirm tnat there is a construction Ientlln9 agency for the performance
of [he work for which this Oermit is issuetl (Section 3097dCiv. C.)
Lender's Name
lentler'S Aatlresz � �
OWNER BUILDER OECLARATION �
I nereby affirm that I am exempt from the Contractor's License Law for the
following reazon (Section 7031.5 Business antl Protessional Cotle: Any ciry or
rounty which requires a permit to const�uct, alter, improve, tlemolish or repai�
any sVucture, prlor to its issuance, also requires [he applicant for suCh permit
to file a signetl slatement that he/shE is Ilcensetl Ounuant to the prOvisions of
the ConVactor's License Law (Cnapter 9(commencing with Sectiom7,000) of
Division 3 of the Bu5ine55 antl Professions Cotle) or that h¢/She'I5 exempt
the�efrom antl the basis to� the alleged exemption. Any viOlation of $ection
7031.5 by any applicant tor a permit subjects the applicant to a civil
penalty of not more Ihan five huntlretl t1011ars ($500).
❑ I, as owner ot the property or my employees with wa9es as thei� sole
mmpensation, will tlo tne work, antl the structure is not Intentletl or ofieretl
tor sal¢ (Section 7044, Bu5ine55 antl Prote55ionai Cotle: The Contractor's
License Law tloes not apply to an owner of a property who buiitls or improves
thereon, anG who tloes such wOrk himself/h¢rself�or through his or her own
empioyees, provitletl that such imp�ovements a�e not intentletl or offeretl for
sale. It, however, ihe builtling or improvement is soltl within one yea� of com-
plelion, the owne� will have the burtlen o/ proving he/she tlid mt builtl o� im-
prove fo� the purpo5e Of sale).
❑ I, as owner of Ihe property, am exclusively cont�acting with licensetl con-
trac[ors to construct the project (Section 7044, Businezs antl Protessions Coae:
The-Contractor's License Law tloes not appry to an owner ot property who
buiitls or impraves thereon, antl who contracts for such projects with a con-
tractor(sl license pursuant to tM1e' ConVacior's Litense Law). I am aware that
proof of ttleir Worker'S Compensation Insurance SM1oultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for tnis reason
Date _
I hereby certi
information is
dlltl S�d�2 �dWS
zentatives of
inspet[iOn�
Si9nature
Drivers' Licens
IF 0865-46, rev.
— Owner
I have reatl this application antl state that tne above
I a9�ee to complY with all ci[y antl counry ortlinances
to builtlin ruction, antl hereby authorize repre-
Qto etj2 uppn tn� above-mentionrtl prgperty,tor
� ' S Main Bwlding:
TVPEOFPERMIT GRADING FOUNDLITION STRUCTURA� T Front
❑ TENANT ❑ ELEGTRICAL �PLUMBING � MECHANICAL ' B Reaf
❑ OTHER . %�
PROJECT DESCRIPTION 54. F7. oCCUaArvGY � � C Right
CONSTRUCTIONTYPE VALUATION$ S Left
ZONE GRADINGCU.VDS. ACRES� PIng.Ref.#
Remarks: �t /i/L .�� Cn ,��li O;r i� . Planning Notes:
Sink
Preventer
Irrigation �
rinking Fountains
loor Drains
loor Sinks
asService ' Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains .
Reinspaction Fee � $15
Boiler
DuCt - Under Ground
Duct-Siructurel �
Duct - Ventilating
Exhaust SYstem ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑0-100,OOO.BTU �100,OOOBT
peinspeMion Fee � $15
White � BuilCing; Canary - ApplicanL Pink - Accountinq; Goltlenrotl � ASSe55or
Showers
ServiceSink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Tank
Swimming Pool w/Spa
Urinal
'Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Type 1 ❑
Canopy Type I I ❑
Fefrigeration System �
❑o-ioo,000aru ❑ioo,000eT
System RepaiNAlteration
Fire Dampers
Registers
luue Fae
Auromatic Washer
Construction Pole Sub.
Cooking Unit"
Dishwasher
Dryers ❑Gas ❑Electric
ZonB _
' Accessory Building: '
Z
O
N
I
� N
G
R
Parking Req./Provided � E
Q
M
T
S
ELECTRICAI
Trans/ormer � ❑ 15-50 K W
❑ 50+KW
Fan .
F.A,U.
Fixtures
Device Boxes
O utiets
Switche5 '
Garbage Disposal
Generator 00.5 KW �5-15 KW
Meter ❑up to 100 amps
Meter ❑over�100amps
Sub Panel
Momrs �0-1 HP �i'h -, 8
Inc.Solar �9-15 HP �i6-15+
Microwave '
Pole Light
Range
Sign
Standing Sections
Trash Compactor
$ 3
Reinspection Fea $15 luue Fee
FEES
�DEVELOPMENT SERVICES REQUIREMENTS:
� � Zoning Approved By
Building Approved By ��� _
Appliwtion Issued By / /) )
$ 3
FEES
$ 3
� SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK . $ PERMIT
PLUMBWG " $ � ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
P�AN CHECK 50% $ MICROFILM $ 7�
MECHANICAL $ TOTALFEE, $ �"Qv
PLAN CHECK 25%' $ �
pa GOO�i..'-:-`JJO�t+:� T6=` s'
,.. .. n ,�-, _ _ _ _. - '-
CONSTRUCTION AND PLANNING POOL & 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
3. Electrical Conduit Utility-Undrgmd. 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 Condyit-Undrgrnd.
8. Foundation - 59. Gas Pipe, O Undrgrnd., Test
9. Water Piqe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK �
t
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 � '
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑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 Ceilin9 (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 ..x'
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 �� G�
39. Water Service-Final
40. Gas Service-Final _
41. Solar pomestic-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 � � .
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY _ :,.
No. Date
I - '
� �... ,,� � �SLDG #
' COSTA MESA BUILDING-SAFETY EPARTMENT
p,p, gOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely - Use Ink On1y
BVIIDING /���_ � �L( � . �. n � �. I
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DEC-7-77��;,,,00 s�6<� �'�233.60
APPLICATION FOR STRUCTURAL PERMIT
RECEIVEDBV D/�TERECEIVED neTFissuFr
OWNEF Mariners $dV1RCJ5 & Loan ASSOC. A.P. N(�/
BUILDING
MAIL 1SLS W2StC11fP DY. ADDRES;
ADDRESS
CITY NewP�rt Beach No��642-4000 TR
CANSTRUCTION N W A
�FN„Fa Same as above �
BRANCH
ARCHITEI
OR ENGINE
ADDRE55
aooRess 1665 P1�
CITV Costa Mesa
STATE
uc. No. 336725
S12E
OF lOT �%dYlOUS
USE OF
TEL.
�
V. CO.
Ave.
TEL.
No.646-1164
CITV
uc. No. 14664
NO.OF BLDGS.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
Tntal IYnits — 4
ft.
e
RE
i�"L IPu'^�'
VARDS APPROVE',
MAIN BUILDING
K
DATE h ��D �
USE OF NEW �� `
BUILDING �
VARDS APPROVEO
ACCESSORV 6UILDINI
BET. MAIN &
1 hereby acknowladge that�� have reea t�aaa�icatio�%i and state HOLD FOR SPECIAL E�UIREMEN 15 m
thet the above informacion Is corract an egree to comply wlth �
m
all laws rapulattng building construction, antl 1 shall not amploy
any person in �iolation of Me workmen's compensation laws of m
the State of Gelifornla.
I hereby ce�tity that I am p�operly licansetl as a contractor untler SQ. FT. w�
the State of Ge��fornla B�siness antl Professions Cotle, Division 3, THE AMOUNT SHOWN UN�ER VALUATION IS FOR m
Chapter 9, and th h Iicenses ere in tull force and effect, or I l}iE PURPOSE OF ESTABLSHING A PERMR FEE ONLY: "�
am exempt fr ihe Or isio s o the $tate of 'fornia Business �O
VALUATION PERMIT FEE � a y„
end Professio s Cod ivisio 3, hapter 9. J�
/� PLAN CHECK $ m
Sipnature of �/�(�( {� m
Permittea � S' J O� �d U TAX § ` U�
V
Authorizatl Aqent TOTAL PAID y
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For Applicant to Fill io
cmr
CITY
STATE
UC. NO.
USE OF
E%RTNO
Separate permiu aze n
ekctNc, plumbing and
�
V�LOINO AND WORK T
— Uae lak
�
fOI
i worlc.
I Mroby aGknowlWpo tMt I Iw� r+etl fhN ppliaatbn aW WM
tlut dw �bor� Info�metlon b torroet aM prN te eomPM wle�
MI Iew� rpulstlrp bullE�rq conNu¢Non, nd 1 Mall not wnploY
any pawn In vlolstlon of U�s werkm�n'� eemp�nptlon 4�w W
tM Snto ef CslMorniw
1 h�rWV cMtHY Met 1 am OroW�1Y IlemeoO M� oo�meatw untla
Ma Steta o1 GlMorn�a Budnns �nA Vrotaaion� COM, DNhbn �,
Cn.pw s. .na snei wcn Ik�mea w In fuli }om arq �I}�cL w 1
am �xemPt from eha provNlem ot tM 8tw of ColMwnb Bwlmp
antl PrWwlont Cotl�, OhrlYon 3, CMpm 9.
Sipnatun of '
Ppmkw
AUMwIzeO Ap�nt
CROCI<ER i'ATi01'AL :
CQSTA PoiESA R1AlIV �..,',,. .H
APPLICA770N FOR SIRUCRIRAL PERMIT �/
RECEIVEDBY �OATE��RBCEIVED , i44 50 TL
7136 3/I '78 344 i0CK7{T
20NH
a�
U88 OF N
BlqLdlifi
BNOWN UNDBR V,
IP fBTABL6/p�q A
RMIT iHH
TAX
TOTAL
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