HomeMy WebLinkAbout1621 MINORCA DR - Building Permits I •
p
CITY OF COSTA MESA
a
BUILDING DIVISION
> •.,.•. ,. DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER
PERMIT 05-01373
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SWILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1621-,MINORCA DR Status: ISSUED
Suite: Applied: 08/16/2005
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 08/16/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 13928304 Zoning:
Applicant: GRANT, SCOTT ,
Address: %GRANT CONSTRUCTION
NEWPORT BEACH,CA Phone: 949-476-5038 ISSUED BY: ./J, a
20371 SW CYPRESS ST Zip: 92660-0716 /�/
Owner: GRANT, GORDON SCOTT
Address %GRANT CONSTRUCTION7ic
NEWPORT BEACH CA' = '=„R Phone:
20371 SW CYPRESS ST :Zip 92660-0716,
Contractor: OWNER BUILDER
Address � L.'. r " 4‘
$ e Phone
Lp• , ' � License: 000000
Arch - Eng:
Address: - Address: d i"
Phone: „h; • Phone; ,
,License: License.' _
SCOPE OF PERMIT u"
REROOF.RESIDENCE AND ATTACHED GARAGE:T/O EXISTING ROCK ROOF,REPAIR/REPLACE SHTG AS NEEDED V NEW FASCIA,2
LAYER 15#FELT,APPLY 30 YEAR;GAF TIMBERLINE COMP SHINGLES.APPROX 2000 SQ FT PITCH 2 512- _ j , a 1t`-
FEE SUMMARY
Plan Check: m $0.00 4 '- „ 3 Calc Valuation .$,4,000.00
_ -
Permit: Claim Valuation :� a,o`oo.00
SMIPRes $0 50 4` ,g
SMIP„Corry
$0 00
Other �$0 00 >.< '
Inspection: •
Total '$97.75 .-
• ;PLANNING &'ZONING
SETBACKS
<` ' �,�, ,tom 9 °" s t - 31
MAIN STRUCTURE Front 0- Rear 0 0 > Lefty0 0 - Right 0 0 < •
ACCESSORY Front 0-0 0 + Lefty 0-0 '. Right 0-0 •
PARKING `•Ezistinq: 0 3 0_ ;y;;,Proposed-` 0
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646(6/00)
DECLARATIONS
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penally 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.)
certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner s0 as to become subject to the workers'
compensation laws of lifomla,an gree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro sl
Applicant Signature:;— Date: - ...-
WARNING:FAILURE TO SE RE WORKERS'COMPENSA ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE (TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5I00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,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.a Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: ___ _ Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally of not more than five hundred dollars($500).):
ar71
- 7 4 ,owneriof s the orty, o ode: ee wont wages ais their sole compensation,snotply WILL DO THE WORK,and the structuresimIs not intendederoffered 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 properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt Business and Professions Code for this reason:
;Signatures-
,ei.Y.�- --� rDetb G /. —0 5
Owne71 verifi d by drivers license. �[]Yes 0 No Driver�Licepse.Plo: � -
Verification of Ownership by(type of document,i.e.-properly 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? ❑Yes 0 No
(Section 25505 of the Califomia 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 end 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 apermit 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? ❑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 aermit 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? 0 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 a. a to comply with all state laws and city or Inness relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-d:. ..ed prope y for inspecti. I not to occupy or allow occupancy of any building authorized by this permit until final inspection./6---
r1 s #� an. /6— 4--
Sig -Of'Legal.Ow r(s) -Date
And/Or Authorized Applicant Date
CODE 0 I1I5PECTION TYPE PATE I1Mm46 CODE( INSPECTION TYPE PATE IKEDAL1
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof J�r lar°5 210 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
L
'§ ria OWNER—BUILDER
y VERIFICATION
•
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion and require'the return of, an
owner-builder verification •.
Attention Property Owner: •
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will he issued until this
verification is received.
I. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. ' Yes ❑ No
2. I (have/have not) ket4A < signed an application for a building permit for
the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address City
Phone ( ) Contractor's Lic. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
-------
1042-46 )REV.9/98)
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my personal
knowledge, in compliance with this State law.
Signed: 4014art. i42is54f 4,17itV Date: (/ 11— C s
Name: xb0/✓ CC S
iC it /t ll Lit
(Printed or Typed)
C.D.L.#
For more information call City of Costa Mesa Building Division at(714)754-5273.
1042-46 (REV.9198)
ADDRESS OPBWLGM 1621 MINORCA DR WIT: CITY OF COSTA MESA — BUILDING PERMIT
IDwrmsNmmoom, GRANT, GORDON SCOTT PERM NO: P 073741
.:DRESS GRANT, MARIA IRENE
1621 MINORCA DR PERMIT NO: P 073741 PLAN CHECK NO: N GOVT: N SUPP : N
06TA MESA,CA 92626545-4669
APPL:SWUNG ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : RELOCATE WATER HEATER SQ FT:
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
CONTRACTORS NAME:
CONTRACTORS MMIRTG COMMENTS : RELOCATE WATER HEATER
ADDRESS VG NO.:
RE4E3E9E4E4E****9H*4E4f4E4E963E****9E4E4E4E3E♦E9E4E4f3E4k4EiE4E4E#4E9E4E9E4E4f♦E4E4E4E4E*******9E4E************9E4E4E****4F*
WAD ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Rection 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.
Cm LIC.NO.: LIC.CLASS: LIC.NO.: EXP; MAIN BUILDING ACCESSORY BUILDING
FRNT : FT ' IN REAR: FT IN FRNT : FT IN REAR: FT IN
Date: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under Penally of perjury that I am exempt from the Contractors License Law for the PARKING REQ: PROV: PARCEL: 13928304 INE: REF NO:
following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,Mier,improve,
demolish,or repair any structure.prior to its issuance,also requires the applicant for such peto file a signed statement that he or she PLANNING NOTES>
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the
5usiness and Professions Cafe)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > .---a
rv'.,31.5 by any applicant for a permit subjects the applicant to a civil penally of not more then five hundred dofa's IS500I). 4E 4E 4E 4E 4E 4f*4 4H if sE 3H*4E 4E*4E*3E 4E 4E 3E*4E 314E*4E 3E*#*4E 9E 9E 9E**9f#4E 4**3E 9E 4 9E 9-4(•#3E**4E**9F**4E*3E 9(-4E 4E 4 sE 4E*3k 3E*3E if 4E 9f#4E*
-"'i. I.as owner of the property«my employees with wages as their sole compensation,will do the work.and the stnoture is not intended DEVELOPMENT S E R V I C E S"--- R E Q U I R E M E N T S
or offered for saki(Section 7044.Business and Professions Code:The Contractors License Law does not apply to en owner of propend
who builds or bnproves thereon,and who does sure work himself or herself or through his or her own employees,provided that such
improvements are not intended or offered forsale.0.however,the building or enpmvernem is sold within one year of completion.the ZONING APPROVED BY r-- DATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.as owner of the property,am exclusively contracting with licensed contractors to construe the project(Section 7044,Business and BUILDING APPROVED B Y . '` r DATE:
Professions Code:The Contractors License Law does notapply to an owner d propend who builds or improves thereon end who - ,yes
contracts for such projects with a contractor(s)licensed pursuant to the C.���_trfff�aiii.ctiiiors License Law). DATE- 1 C
a I. exempeunderSection:BP7044 B.AP.C.,fathsn, : _�i ', GUI s R APPLICATION ISSUED BY: (� ,, �. . . . ,.
_ _ ............#..4E.4E.3f4E.4E#4E4f3E.4E.3E.#.. 3E iF# ..#469f3E.4E.4f9E.#4E.3E.#3E.4E.4k • • 3E9E
• 0 ° / .0 , LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
d• ereby certify that I em aware of end understand the requirements of Moms Healthland S.ely Code Sections 25505,25533,and
,and that)or any future building occupant will/wilt not(circle one)need lo comply with nate coder and the requirements for BLDG PMT PLUMBING ELECTRIC ,, MECHANIC FIRE SMIP/RES GRADING
a permitforconstruction or modificationfomtheASOumityManagement District.Residential construction eppiralions are exempt from these PERMIT 12 , 00
pr
Dale: Applcan: 25% 'i' w SMIP/NON—RES
PLAN ' ' . 4'
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE 20 . 00
❑ Ihave and veil maintaacertfsd
atemnsenconsent for workers'compensation.es provided for by Section 3700oftheLabor BUILDING PERMIT ISSUE PLAN}CHEC
bK TOTAL PAID DUE
Coda,for the performance othewoAbrwnbnthkipemitbapea. TOTALS----> 12 . 00 20 . 00 ' 0/0'0 32 . 00 32 . 00 . 00
❑ I have end will maintain workers'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the 7.
work for wisich this permit is issued.My workers'compensation insurance carrier ranier and policy number axe:
Carrier: REVENUE DIVISION TOTALS--> COL/LEC-TED ^o— 32 . 00 OVER/SHORT : . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
'This section need not be completed d the permit is for one hundred dollars(stool or lass) 32 . 00
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 wbjed to the workers'compensation laws Of California and agree that D I should become subject to the workers' ***3**4E***3E3E*3E3E*4E*3E*4E4f4E*4E*4E*3E****9i* E.**4f3E3E***�1E*4E3E*9E*4E3E314E**********4E***4E464f3E**4E*4E*4E
compensation provisions of Section 3700 of the Labor Cale,I shall forthwith comply with those provisions. I N D I V I D U A L1, F 'E -E' BREAKDOWN
Dy1/1 Dale: Applicant: 1 4' v^l
Warning:Failure to secure workers'conwensation coverage is unlawful,and shall subject an employer to criminal penalties and TYPE QTY D E S C R I P T I 0' N _ UNIT COST TOTAL COST
civil lines up to one hundred thousand dollars(5100,000),In addition to the coat of compensation,dangers as prorlded for In /
Section 3706 of the Labor Cods,Interest,and attorney's fees PLU 1 WATER HEATER AND/OR VENT' 7---� 7 . 00 7 . 00
• CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the PLU 1 GAS PIPING SYS OF 1. TO 4f OUTLETS 5 . 00 5 . 00
performance of the work for which this permit is issued(Section 3097.Civ.C). END,,---,OF) FE-ES
LENDER'S NAME: . 'K I •
^
LENDER'S ADDRESS: r \4:_
I certify that I have read this application and state that the above information is coned.I agree to comply with all ply and county ordinances '3, ',J
and state laws relating to building construction and hereby authorize representatives of this thy to enter upon the above-mentioned property \
for inspection purposes. GORDON GRANT ,/- �' ' .
wore
/l"✓/%`iisib Dale: IJ (°'7/ 01 0018E112-00108112 TOT 32.00
e Signatur o1 1!,Ma.: . uContrafa 1 'T
DATE: 03/10/15`TICEt 14:50
(5151-46.WP) White-Building 8 Safety:Green-Ate:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor .
.
/
COPSTRUCTION AND PLANNING .- .1 - POOL & :
A1/ROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
iJ Temporary Electrical Service or Pole 52. Pool & Equipment Location '
^2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
•-3. Electrical Conduit Utility-Undrgrnd. . - 54. Forms.
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
•
• 5. Steel Reinforcement c., - 56. Rough Plumbing& Pressure Test i
•6 Electrical UFER Grnd. - - 57. APPROVAL TO COVER-GUNITE l-;
7. Footings 58. Electrical Conduit-Undrgrnd.
•St'Foundation 59. Gas Pipe, 0 Undrgrnd_Test
9`.Water Pipe-Undrgrnd. . 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System ,, 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final
12. Sewer Cap 63, Heater & Vent-Final
13. Roof Drains - - c. - 64. Numbing System - Final
14. Rough Plumbing - ' 65. Electrical-Final .
15. Rough Electrical-Conduit - -- 66. Solar System-Final
16. Rough Electric Wiring • 67. Fencing & Access Approval i
17. Rough Wiring Sign _ - • 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Cohditloning FIRE DEPT.REQUIREMENT
20. Rough Factor Fireplace ' _7„.: 4F _' • ;._; ; APPfj_OVAI,S?` Permit# -
21. Ducts,in.Strutture ; ' •• • * _ t _ - 70._Underground Hydro ' I
22. Ducts, Ventilating u . - , . . 71. Product Piping O Gas O Oil
23. Gas Pipe-Rough& Test <- • t • 72. Underground Nosh I
24. Roof Framing' - "z, t y T'' _-, a . 73. Undergrnd.Storage Tank O Gas ❑Oil I
25. Roof-Sheathing u -.. . v . - - -'t 74. Overhead Hydro_
26. T-Bar.Ceiling (Structural) & M'gnncoat - „ - 75: Dry Chemical - . I
27.'Frame and Flashing . - - _" • -K 76. Dry Statidpipet-•'- . . I
- 28. Lathing&Siding. x ;t .7-.1f4 . '• • ' 77. FIXED•SYSTEM FINAL _ - I
29. Insulation •
= 78: -FIREPREV. FINAL ' T •_ -
30. Drywall Nailing .r•lr '- ' ' -•-HEALTH DEPT. REQUIREMENT
.
- 31. Plaster Brown-Coat; r • _ ._ 79. FINAL INSPECTION '
r_
32. 'Electrical.`Power Meter-Final }. - ' 80'.r FOOD CERTIFICATE ISSUED-
. a +•. 4 _ - .
- 33. Final Electric - _-0 I r Notes: ' +
s fizi Sizit
34. Final.Heating & Air.Conditioriing- - ?' sLT '
•
35. 'Final'GaS-Pipe,Test ' - Q��E ems` 1/_ . 41
' 36. Hood•or Canopy T. T - - !I] ,�/,�,t ,,�._, i 4 ��
A lam/- 1E-�'/Y��D=�-= %l Ai
- 37. Final Factory Fireplace: - . r-._ I • "
- 38. Final-Plumbing r 6 /I_/Q / ,
' 39. Water Service-Final ;e;, . t ,
•,40. Gas Service-Final t ril . 't --
41. Solar Domestic•Final' °" _ `'
42. Backflow Preventer , - ,X . . -.
l - -. ,. -
43. Backflow Irrigation - - ' . .
_ i
44. Landscape Irrigation System-' 'rz _ "-' - ' _ _ i 45. . - r. _ _ j
46. HandicapRegulations - R ' - - I
47. FINAL STRUCTURE & BUILDING J M r
.
48. FINAt. PLANNING:- �_- T I
cc
49. Electric Release to Edison 4. *2. -
50. Gas Release to Southern CaliforniaGas Co i _ - . - it
51. CERTIFICATE OF OCCUPANCY - -
i
No Date i
CITY OF COSTA MESA , ,
BUILDING DIVISION \
OWNER-BUILDER VERIFICATION I, i
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent to issuing a building permit, require the completion and require the
return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. personally plan to provide the major labor and materials for construction of the pro-
posed property improvement. Yes ❑ No
/��//0 I (have/have not) signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm)to provide the proposed construction:
Name
Address City
Phone ( ) Contractor's Lic. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted(hired)the following persons to pro-
vide the work indicated:
Name Address Phone Type of Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
of California HealthandSafety Code and have completed e above information to the best of my per-
sonal knowledge, i omplii nce wi t ' tat aw. Q� p
Signed: /(`/(�d16t/tfl/I Date: O ( 0 - ( S
Name: �fi/e b e N Sc .( � �✓�
754-5273 •
1042-46
1072;
COSTA MESA BUILDING-SAFETY DEPARTMENT FEE R,/ECEIVED
P.O.BOX 317 COSTA MESA. CALIFORNIA .e6" //--/-1.(/
Y
FOR APPLICANT TO FILL IN COMPLETELY AFlNAp t DEPT.
PP RMIT
TYPE OR PRINT � � ��
BUILDING
BUILDING
ADDRESS 1621 Minorca Drive
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. I TI'i! O7R
OWNER Pfaylene, Inc. -
MAIL 1 E. 1 th Street RECEI ED BY DAT RECEIVED DATE ISSUED
ADDRESS 4 9 7 — ,j y� "(1V R lecQ
CITY Costa Mesa, Calif. 71LI 81159 BUILDING
UIL eIN
ARCHITECT Carlson & LIC.
OR ENGINEER NO. COSTA MESA. CALIFORNIA
hjILaeb2 cul
ADDRESS Garden Grove Calif. • FIRE DirZONE TYPE GROUP
CONTRACTOR DColegrove, Inc. L IT:
NO. 167293 APPROVED DATE
ADDRESS 419 E. 17th St. , Costa Mesa ZONING
LEGAL LOT 3487 ZON NO.OF USE OF NEW�^////1111
DESCRIPTION NO. 49 I BLOCK . ITRACT I 1 / / IPLANS 1-' I BUILDING
APPROVED tit--
11 1111//// 9
A.P.NO. BY W L ( DATE //- -J 1
SIZE
OF LOT 70' X 100' I NO.OF BV'LDGtione YARDS `'—EWES
NOW ON LOT REQUIRED ALLOWED
USE OF (CENTER LINE ST.) �-�> -
EXISTING BLDG. None 'J FRONT 4 �/ FT. IN.
SETBACK LINE FROM 50I REAR YARD 251
CENTER OF STREET / R.SIDE �(/ FT. IN.
SIDE YARD (LEFT 51 (RIGHT 51 L.SIDE J FT. IN.
DESCRIPTION OF WORK REAR FT. 7 IN.
NEW I XII ALTERATION I II ADDITION
REPAIR I I MOVING I DEMOLISH I '
V.124-DING
ZIE DING lL 4rI NO.OF
ROOMS 7 STORIES 1
EXTERIOR WALL stucco
COVERING Stl1CCO INURING Rock
USI XBUILDING AND WORK TO BE PERFORMED "Pat.
S\ %le family residence with
at, ;*.hed garage '/ jiyl p
Plan 760 AR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTION.
/� �p // VALUATION
SIGNATURE OF l..A//V- 'Jc,/A . PERMIT FEE $36.00
PERMITTEE f/l.� r wl cf nn
$ 16,862 PLAN CHECK $18.00
AUTHORIZED AGENT Dike & Colegrove, Inc.
,���+ TOTAL FEE $54.00