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Home My WebLink About2872 MIGUEL LN - Building PermitsV_ AVo��ant to fill In all spaces except those wilhin neavy oortler Ilnes ana si9n all aporooriate tleelarations. CITY,OF COSTA'�Q) E ONST�Ry�U�C(�TION PERMIT PERDMT NQ� , _ TRACT NO. LOT N0. UNIT NO. Proje�i'rddress ��/• �• \V`�� l�p�icant'sMailingAddress �y�y �✓b.'\iMO T�Ul�ro Owner'sName �1 �'t� Phone Address :S � 'mR Arch/Eng. Licenu No. Address n Coniractor's NamP�C 4� � DU'LM phone • �� Addresslma'I'nol—La7i- C-lOrl�Y+"�O �V�i�)��¢. City License No. ��-3� LICENSED CONTRACTOR DECLARATION I here�y affirm that I am licensetl untler provislons ot Charter 9(commencing witn sec[ion ]000) of Division 3 of the Busineis antl Professlons COEe, antl my license is in f r�e antl etfect. /. Licens Clazs Lice N . �� Date��"U Signdture WORKERS' COMPENSATION DECLARATION I nereoy affirm that I nave a certificate of mnsent to selt-insure or a certificate o( workers' Compensation Insurance, or a certitietl cooY there ((Sectlon '90. LaC. .��— �7� /'" .�• �4'�iG/M� cy No. Com any Certifietl copy is hereby fumishetl CertiSietl pf�, i AI tl� with the " y tlin �vision. Date /�/' �" �� n APP�� EXEMPTION FROM WORKERS COMPENSATION DECLARATION (This sec[ion neetl not be completetl if th¢ permit is for one huntlretl ($300) or less). I certity that in tne pertormance of the work tor which this perm�t is Issuetl, I shall not em0loy any person in any manner So as fo b¢Com¢ SubjeGt t0 the Worker5' Compen5ation l.aw5 ot CalifOmia. Date Signature NOTICE: If, a(ter making Ihis tleclaration, you shoula become subject to Ne Workers' Compensalion provisions of the Labor Cotle, you must forthwltn comply wilh suth p�ovlsions o� tnis Oe�mit SM1ali be tleemetl �evoketl. CONSTRUCTION LEN�ING AGENCV 1 hereby a/flrm Ihat Ihere is a constructlon lentling a9ency for the oeriormance of the work for wnich tnis oermit is issuetl (Section 3097 Civ. C.) LenCer's Name Lentler's Atlaress OWNER BUILOER DECLARATION I hereby affirm Ihat 1 am exempt from the Contractor's License Law for the following reason (Sectlon ]031.5 Buslness antl Protesslonal Cotle: Any tity or county which requires a permlt to construct, al[er, improve, tlemolish or repalr any structure, prior to its lssuance, alto requires lhe applicant tor such permlt to file a si9nea statement that he/she is liconsetl purzuan[ to the provisions ot the Contractor's License Law (Chapter 9(commencing witb Sectlon 7000) of Division 3 of lbe Bu51nes5 antl Professions Cotl¢) or that ne/She is exampt theretrom antl the ba5i5 tor th¢ allegetl exempHon. Any v101ation of SectiOn Z�31.5 by any applicant (or a permit subjecti the applicant to a civil ,,Cy,s�lty of not more roan five huntlretl tlollars (5500). �`,�iy„�o, as owncr of the prOp2rty or my emplOye¢S with wage5 d5 Ihel� sole cinpenw[ion, wlll tlo lhe work, antl the structure Is not IntentleG or otferetl for sale (5¢clion 7044, Buslne55 and Protessional Cotle: The ConlraG[o�'S LicenSe Law tloes nol appry to an owner of a property who bulltl5 Or Imp�ove5 thereon, antl who tloes such work himtelf/herselt or tnrough his or nar own employees, provitletl that sucn imOrovements are not Intentletl or oHeretl for sale. I/, howevet, [M1e �uiltling or impwvement Is soltl wlthin one yea� oi cOm- pietion, tne owner will nave the burtlen ot oroving he/she tlitl not bulltl or Im- prove for Ihe pur0ose ot sale). ❑ I, as owner ot the pro0erty, am exclusively contracting with licensetl con- tracrors to construct [he prolect (Section �044, Business antl Professions Cotle: The COMractor's License law does no[ ap01y to an owner of proper[y wbo builtls or imoroves thereon, antl who conVacts tor such oroiects witn a con- tractor(s license pursuant co cne ConVactor'S License Law). I am aware tM1at proof o� th¢ir WorkeYS CompenSaHon Insu�ance Shoultl be provitletl to me. ❑ I am exempt untler Section B. 3 P. C. tor [his rea5on Date Owner I hereby tify tnat I have reatl tnis application antl state tnat the above inPormati n is rrecL I agree to mmpry wit all city antl county ortlinancez antl stat la relatin9 to build conztr On, antl h¢�eby authorize rep�e- Sentative his city lo en p bove-mention¢tl prqperty fo� inspecti n rp sas.n/1 /`,jd� Signatu V �'` Date Driver5' Licerise or 55 " � � ` � ' "� 0865-46, rev. 5/88 TVPE OF CONSTRUCTION LJ NEW LJ ADD Ll ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT�EQR,,,��G QESCRIPTION OF WOPK�US� OF BLDG. '`�"�` � L««-- __ TYPEOFPERMIT LIGRADING IJ FOUNDATION LJSTRVCTVRAL ❑ TENANT ❑ ELECTRIfj.L ❑ PLUMBING ❑ MECHANICAL ❑ �OTHER Y��fVo k' PROJECT DESCRIPTION SQ.FT. OCCUPAN v CONSTRUCTION TYPE VALUATION $ �n t ZONE GRADING CU. VDS. ACRES Remarks: Sink Preventer Irrigation iking Fountains �r Drains �r Sinks Service �UtICLS Kitchen $ink Lavatories P—Trap Roof Drains Reinspection Fae � $15 Boiler Duct � Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO �k Heating System & Ducting ❑ 0.100,000 BTU O 100,000 Reinspection Fee � $75 White - Builtling; Canary - Applicant: Pink - Acwunting; Goltlenrotl - Assesso� Showers Service Sink Sewer Cap Sewer Connection $Oldf C.OII¢cLOfS Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑o-ioo,000sru ❑ioo,000 System Repair/Alteretion Fire Dampers Regis[ers laue Fea A.P. vl� S Main Building: E T Front A Rear C Right g . Left Ping. Ret. # Planning Notes: FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposel Generator �0�5 KW �5�15 5 3 $ 3 Zone Accessory Parking Req./Provided ELECTRICAL Transtormer ❑ 15�50KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Su6 Panel MotorsOO-1 HP OiX-8 InaSolar �9-15 HP �16-75* Microwave Pole Light Range Sign .,'�"� Standing Sections � Trash Compactor " Reinspectian Fee �$15 � � Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: � ZoninB APProved By 8uilding Approved By �� FEES � _� Data _Date , _ i Z �1' O N 1 N G R E � M T S. SUM V OF FEES BUILDINGPERMIT $ ��•OD SMIP � $ ' SO PLANCHECK $ �'��PERMIT '-� � PLUMBING $ �SSUANCE $ PLAN CHECK 25% $ ENEFGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ O�SO PLAN CHECK 25% $ � ot 000z29rs-aoo22v2p i'�� r . . DAYE: 12/20;� TFi�E: ii.:39 �. � COA±STRUCTION AND PLANNING POOL & \ ��ABPROVALS Permit # Jate Inspecto� p�ppROVALS Permit # Date Inspector 7 1� Temporary Electrical Service or Pole ' 52. Pool & Equipment Location �� 2. Soil Pipe-Undrgrnd. � . 53. Steel Reinforcement '� � 3.'Electrical Conduit Utility-Undrgrrid. '' 54. Forms � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. 'Steel Reinforcement i 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grrid.' • . � 57. APPROVAL TO COVER-GUNITE • 7. Footings ' .. 58. Electrical Conduit-Undrgrnd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test -, 9. Water Pipe-Undrgmq, � ' 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Linet& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap :, � 63. Heater & Vent-Final � i 13. Roof Drains ' �i 64. Plumbing System - Final 14. Rough Plumbing ! 65. Electrical-Final 15. Rough Electriral-Conduit 66. Solar System-Final 16. Ftough Electric Wiring 67. Fencing & Access Approval ' 17- Rough Wiring Sign �68. APPROVED FOR PLASTERING �78. Rough Electrical-T Qar Ceiling 69. POOL/SPA SYSTEMS FINAL 19' Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.. Rough Factory Fireplace APPROVALS Permit # 21 r DuCts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywa I Nailing .• � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. 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 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer __ 43. Backflow Irrigation ' 44. Laniiscape Irripation SYstem F ',') '•' 45. Sound Attenuation E X P 1 R E � \ 46. Handicap Regulations �t1COm I8t �S 47. FINALSTRUCTURE&BUILDING _ ` 7 [ S�8 . 48. Special Requirements Completed . � 49. Electrie Release to Edison • � 50. Gas Release to Southern California Gas Co , , ' ` 51. CERTIFICATE OF OCCUPANCY ��. . � No. Date � ..; r Property address R0�1F COVERING CERTIF�i,ATION Owner �� `�� Contractor "G j� r`` � ( ✓'� ,� . Permit No. a�� J S� State Contractor License Number �� a�i �� Classification �- 3 S I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering ai the above address in conformance with Chapter 32, and Section 1704 of the 1979 Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the manufacturer. ❑ I further certify that I am the owner of the property. (Owner-Builder permittee only). ❑ I further certify that I am: ❑ Owner of sole proprietorship company ❑ Full partner of the company L�mited partner of the company fficer of the corporation I certify that as an authorized officer or agent of tf�e company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shal! deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Received 6y Building Division � Z- •Zl� � IqfNa Oam Space for Notarial Sbtement for aul�orizatl alflea� or a9ent ChtF p990-46 Wnite - BuilGing Div.; Canary - Contractor; Pink - Owner cal- p�G aoo�;,, � Company or Corparate Name Name C_OS Data �5�'%2 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA M68A. CALIPORNIA For Applicani fo Fill In Complefely TYPE OR PRINT AooRe�ss28 2 Mi el Lane COSTA MESA. CALIFORNIA 1 MAIL 1 SIZE OP 88TBACK LINE PPOM 20 eeerten op era¢sr 38 � 1�� REAR YARD � SIDE YARD I LEFT �.O � I RIGHT S� S DESCRIPTION OF WORK Lot 6�, T��2�,E�I�.ED �✓ SEP111�6p-_ FINANCE DEPT. CITY OF COSiA MESA APPLICATION FOR PERMIT BUILDING Fo� Offlee Use Only � I n �/7� � I I �Jcr GOSTA MESA. CALIFORNIA ZONING � ZONE / I NO. OF ; I U6! OP N6W �_ �� PLAN9 �� pU1LDING � 1 ; i LHOAL . . . � � . ...� YARDB APPROVED ccermw uHe er.� 0 $BUZILDING5o,X52�Xo" ROOMS 7 STORIES 1 � Nd//' EXTERIOR WALL St.UCCOIROOF comp• p COVHRING COVHRING Vlll Area �61 S F USE OF BUILDING ANP WORK TO BE PERFORMED ce Garage Area 111�1 S F w/attached garage Covered Porch area 29 S F 1 HEREBY ACKNOWLEDBB TXAT I XAVB PEAD THI6 APPLIWTION TXE AMOUNT 9MOWN UNDER�VALUATION 16 POR THE AND BT�TE THAT THE ABOVB 19 CORPGCT AND AOP68 TO CON• �pUPP088 OP ¢BTABLIBHIN6 A PERMIi P8H ONLY. PLY WITX ALL CITY OPflINANC89 AND BTATB LAW6 REOULATINO eU�LDINa CONeTrtucT�O�+. VALUATION SIGNATURB OF �'ERMIT FEE S .�� PERMITTE p�� C "J $ 17,963•�� P�N CHECK $ �� AUTHORIZED AGEN ' r � TOTAL FEE 7z�SO