HomeMy WebLinkAbout2420 MISENO WAY - Building PermitsOSTa MF
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� � CITY OF COSTA MESA • ," �
' � BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: 608-00015
�
PERMITTYPE B_ROOF2��.���� Z-) STATUS: ISSUED
APN: TPN00143 � 3� DATE ISSUED: 01/17/2008
pATE ISSUED BY: RMD
JOB ADDRESS: 2420 MISENO WY CM
Vicinity: GARAGE ROOF
Squares: 400
Suite/Unit:
Valuation: $2,085.25
SCOPE OF WORK: TEAR OFF (E) ROOF MATERIALS AND INSTALL 4 PLY BUILT UP-ROOF SYSTEM WITH ROCK ON 4 ATTACHED
GARAGE ROOF UNI7S, APPROX 4 SQUARES. �
OWNER: BACK BAY GARDENS
PHONE:
APPLICANT: SIMMONS, DEBORAH
PHONE:
CONTRACTOR: HIRSCHMAN, RP AND SONS INC
Address: 9582 HAMILTON AVEUnit:
Ciry/State/Zip: HUNTINGTON BEACH, CA
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
TOTALFEES
$0.00
$83.25
$0.00
$83.25
Address:
CitylStatelZip:
Address: R0840718
City/State/Zip:
SUITE 281
License No. �
License No.
License No. 781923
PHONE: 714-960-8329
92646 CELL:
PHONE:
PHONE:
Unit:
Unit:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-26, § 1, 12-21-92)
EXPIRATION: PERMI7 EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure fo obtain rnspections and final approval will result rn !he ezpiration ot this permit.
COUE N. INSPECTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final .
200 Final Re-ROof
201 Final BIocWRetaining Wall
202 Final Factory Fire place
203 FinalSign
204 Final Demolition
UATE IN1111AL5 LOOEN INSPEClIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 FinalPlanningApproval
222 FinalSite
250 Final Bu'ddinglOccupancy
DATE IN7111AL5
WORKERS' COMPENSATION DECLARATION: �
I hereby affvm unde�penalty a1`perjury one ot 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 [he Labor Code, for the
pertormance o( the work for which this permil is issued.
❑ I have and will maintain workers' compensation insurance, as required by
sectbn 3700 of the Labor Code. (or the peRortnance of the work for which this
permit is issuetl. My workers' compensation Insurence carrier antl policy
number are: _/
Carrier:_ S'ip %� �(J/v �
(Tlirs sec(qn neea not be mmpleted �d7lhe permd is valuerl �at 7one nuntlred Collars (St00) or IessJ
�P`D�icY�Number: ���J,1— �� V
❑ I certify Ihal in [he perfortnance of [he work for which [his permit is
issued, I shall nol employ any person in any manner so as to become subject
b the workers' compensation laws of Califomia, and agree that if I should
become subject to lhe workers' compensation provisions of Section 3700 of
th�e"�abor Code, I shall,{orthwith comply with these provisions.
,tSCaJr�-���iim.,-�� i / 1'7/U,�
App N's5iynaWre Date
�— � �
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL 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, INTEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm lhat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 0( the Business and Professions Code, and
my license is inh full (orce and eftect. /�
Lic.# � �d � 7� Class#� v�
_ �t % ,D
" �r_Gp�l.e.l� Jen infn.�,
Conlractor's Signawre Da e
� _—� L— —?
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm [hat lhere is a cons[mctbn lending agency for the
peAortnance of the v.ork fa vfiich this pertnit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
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 ci[y or county which requires a permil to
construct, alter, improve, demolish, or repair any stmcture, prior to its
issuance, also requires the applicant (or such permit to file a signetl statement
that he or she is licensed pursuant to Ihe provisions of [he Contraclors
License Law (Chapter 9(commencing with Section 7000) ot Division 3 of the
Business and Professions Code) or Ihat he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7037.5 by any
applicant for a permit subjecis the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of [he property, or my employees wilh wages as their sole
compensation, WILL DO THE WORK, antl the stmcNre is no[ intendetl or
oKered for sale (Sec. 7044, Business and Professions Code: The Conhactors
License Law tloes not apply to an ovmer of property who builds or improves
ihereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or oflered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have lhe burden of provinq that he or she
tlid not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The coniractas License Law does not apply to an owner of
property who builds or improves thereon, and who coniracts for such project with
a cont2ctor(s) license pursuant to the Contractors License Laws.).
❑ I am exempl untler sec.
Business and Professions Code for this reason:
J
Owner ID venfied by tlriver's , .❑ Yes ❑ No
Driver's License No. � Ex�ires:
Verification of Owne�ship by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certrfy that no excavation (rve (5) or more feet in tlepth into wfiich a
person is required to descend, will be made in connec[ion with work authonzed
by this pertnit, and thal no building slrucWre, scaffdding, falsework, or demolition
or dismantling thereof, will be more than thidy-six (36) feet high. (Chap. 3.2, Grp
2, Atl 2, Sec. 341, TUe 8, Calitomia Administrative Code).
❑ As owner-builder, I will not employ anyone ro do work which vroultl
require a permit from the Division of IndusMal Salery, as noted above, unless
such person has a permit to do such work (rom Ihe division.
Applicanfs SignaWre
Division of Industrial Safety Permil Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant neetl to file antl
certify a Business Plan for emergency response [o release or threatened
release of a hazardous malerial? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(ety Code requires, with some
exceptions, tha[ a Business Plan be filetl with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of 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 standard temperature antl pressure).
2. Does or will the applicant or present or fu[ure building occupant neetl to f le
a registration form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Cali(ornia Health antl Sa�ety Code, with some
exceptions, requires registration with Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acu[ely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic fee� o( compressetl gas a[ standartl
temperature and pressure�.
3. Does or will Ihe applicant or present or fuNre building occupant need ro
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Sec�ion 25534 of the Cali(omia Health antl Safety Code provides that the
Cos�a Mesa Fire Department may require �he preparation, certifcalion and
fling with the Fire Department of an RMPP by businesses which are required
to register acutety hazartlous materials with [he Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Sa(ery Code been (ully complied wilh? ❑ Yes ❑ No
5. Does or vnll the applicant or present or (uture building occupant require for
the work which is the subject of this application a pertnit for such constmction
or modification from the South Coast Air Qualiry Management District or from
any other air polWtion control district or agency? ❑ Yes ❑ No
(Sec�ion 65850.2 0( the Califomia Govemment Code requires �hat the requested
infortnation be fumished on applications for non-residential building pertnits).
6. Will any part o( Ihe (acilily l0 6e consWctetl under this permil be wilhin
1000 feet fmm the outer 6oundaries of a school? ❑ Yes ❑ No
(If'yes", the facility must meel the requirement of Sections 25534 and 42303
of Ihe Cali(ornia Health and Safery Code).
7. If a permit from the SouN Coas[ Air Quality Management DisMct or other
air polNtion con[ml dislric[ or agency is required for the work which is the
subject of this application, have all of the discbsures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certifcate of compliance from the appropriate air polWtion
wnirol OKcer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury the
information given above is correct I agree to comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions.
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 vnth all state laws antl ciry
ortlinances relating to building consWction, and authonze representatives o(
the Ciry 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 fnal inspection.
� /J�1I SI9^aWreo(Lega, wner�s) D te
Slgnawre Date RV�O��� nM��r�n �
JOAA6 (3/0]� '� � �� � �
CAntllorAvl otlEedA001icant p31e - - _
� _____.
.
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- ' ; .. e
CITY OF COSTA MESA
� _ � BUILDING p/VISION
� DEVELOPMENT SERVICES DEPARTMENT
� . H�1S-O(i%8S
�� PERMIT PERMIT NUMBER
(774) 754-5273 • Fax (714) 754-4856 gUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 2420 MISENO WY
Suite:
Vicinity: ROOF OF GARAGE ONLY
Parcel Nunmber. 43914317
Applicant: HANSEN, DUKE
Address:
Owner: GOLpSTEIN, MARTIN
Address GOLDSTEIN, ANN
COSTq MESA,CA ,
2420 MISENO WAY
Contraaor: ROS$ 8 BARROWS INC.
Address: 00260 E. ALTON AV
SANTq ANA CA
Zoning:
Phone:
Zip:
Phone:
Zip: 92627
Phone:
Zip: 92707
License: 327802
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
REMOVE BUIIT-UP ROOF AT GARAGE ONLY. REPLACE WITH NEW BUILT•UP. 25L0. BASE & 2 15LB PLIES, GR4VEL
Plan Check: $0.00
Permit: $51.25
Other: $0.00
Inspection: $0.00
Total: $5^I.75
SETBACKS
ACCESSORY
PARKING
NOTES:
Front 0- 0
Front 0- 0
Exislina: p
Rear 0• 0
Rear 0. 0
Required: 0
FEE SUMMARY
PLANNING 8 ZONING
Left 0- 0
Lett 0- 0
Pr000sed: 0
Status: ISSUED
Applied: OSIOBI7998
Issued: 05I0811998
Calc Valuation: So.00
Claimed Valuation: Si,sos.00
Right 0- 0
Right 0. 0
EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
lor a period of 1 BO days.
INSPECTIONS: In order for the work authonzed under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required Inspectiona end final approvel must be obtained. Failure to obtaln inspections and final approval will result in the expiration of Ihis permit.
FOR INSPECTIONS CALL: (714) 7545628
WORKERS'COMPENSATION DECLARATON: •
I �ereby ettirtn untler penelry oi per�ury one ol the fallowing tleGaretions: �
❑ I heve entl will mainlein e cenlfcete of consent ta self�lnsure br workers' wmpensation, es proWCetl br by secUon 3700 of t�e LaDor Cotle, for the peAartnance oi ihe
work for whlch �his pertnit Is issuetl.
� I heve antl will meinteln workers' cortipensetion insurence, as require0 by se�lion 3700 of the Lehor Code, for the pertortnence of the work for which Nis pertnit is issued.
My workers' compensetion Inwrence cdrrler end policy numDer ere:
�camec �✓ITr� �.� n/� Policy Number. a y v- Q3l- u- o 0o L,J 6 Z.
(Thls sectlon need nof be complered ll the permlt �s veNed ef one nundred doners (St00) or �ess.)
❑ I certiy thet In ihe pertortnance ol iha work tor which this permlt is issuod, I shflll not employ eny peraon in eny mannor eo aq Io becoma subject to the workers'
compensation laws ot Califomia, end egree thet tl I shauld bernme sub�ect to the workers' compensatlon provlslons ol Section 3700 ai the Lebor CaCe, I shell larthwlth
compty wIN these pr ions.
Appllcant Signature: � � �.�� Dete: � � 4 �
WARMN6: FNLURE TO SECURE WORKERS' OOMPENSATION WVERAGE IS UNLAWFUL AND SHALL SUflIECf AN EMPLOVER TO CRIMINAL PENALTIES AND pVIL FlNES UP TO IXJE HUNDRED
TFIOUSMD OOLLARE (5100.WU). IN ADDITION TO Ty+E COST OF COMPENSATqN, DAM4GES AS PRU�DED FOfi IN SECfIIXJ 3NB OF 1HE LABOR COOE, INfEREST, M!D ATTOpNEVS FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y eitirtn thet I flm Iicensed under provigions of Chapier 9(commendng vrith Saction 7000) of Division 3 of the Business end Protessions Cotle, antl my license is in tull
torce and etteM. LJc. M Class q '
ConVactofs Signeture: Date:
CONSTRUCTION LENDING AGENCY:
0 I hereCy eNirtn Ihet lhere Is e constructlon lending egenty for Ihe peAormance of Ihe work for which Ihis pertnit is issued. (Sec. 3097. CINI Code). �,
Lentlefs Neme: Lender's Address: �
Slgnature: Date:
OWNER•BUILDER DECLARATONS:
I horeby eHirm t�at under Denelry of per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the lollowing reason (Sec. 7031.5, Business entl Prafesslons
Cotle: Any Ury or counry whicti requires a permit to constmct, elter, Improve, demWish, or repair any structure, pdor to Its Issuence, elso requires iho applicant far such pertnit
ta Ille e slgneG statement thel he or s�e b Ilcbnsed pursuant to Ne provisions oi the Contrectors Llcense Lew (C�apter 8(commendng with Sectlon 7000) ol Divislon 3 of the
Business end Professions CoOe) or t�et he or she is ezempt therefrom anC �he basis tor Ihe elleged exemption. Any vialation oi Section 7031.5 by eny epplicent for e permlt
sub�ecLs Uie epplicant to e Gvil penelry of not more ihen five �unOretl Collars (5500)J:
❑ I, es owner of Ihe properry, or my empl0yees with weges as thelr sole compensation, WILL DO TME WORK, entl t�e structure I5 not Intentletl or ottared for sale (Sec.
7044, Business flntl Professions Code: The Contractors License Law does not apply to an owner ot pmperry who bullds or improves thereon, entl who tloes such work
himself a� herselt or Ihraugh his or her own employees, praNded ihat such improvements ere not Intentletl or oNereC for sale. If, however, ihe Dulltling or Improvement is
sold within ona year of completion, the Ownao-builder will have the burden of pmWng thet he or sha did not build or impmve tor purpose of sele.).
❑ I, es axner of the D�operty, em EXCWSIVELY CONTRACTiNG WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business entl Professions
Coae: The contrectors License Lew tloes noI epply to en owner ol property who bui105 or improves t�ereon, entl who contracts for such pro�ect with a contrector(s)
Ilcense pursuent to the Contrectors Llcense Lews.).
❑ I am axompt under sec. Business antl Professions Catle tor this raeson:
Signature: Dete:
Owner ID vorllleG by drivefs license. ❑ Ves ❑ No Drivets License No.
Vedficatlon at Ownership by (type of document, I.e. - property taa bill or deed):
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
Explres:
❑ I �ereby certlty t�at no e:cevation Ilve (5) ar more feet in Aept� inta wMch a person is reduired to descend, will be metle In connectlon wlth work eut�odzetl by t�ls
pertnil, end Iha� no huildinp structure, sCeHolding, felsework. or tlemolition or tlismantling thareol, will be more then Uirty-six (38) feet Mph. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Celllomia AtlminislretNe COae).
❑ As owner-bullder, I wlll not employ enynne to do work which wouttl require a partnit iram Ihe Dlvision of IntlustAal Safery, as noteG e0we, unless such person hes e
pertnit to do such work from the dlvisian.
SigneWre: Date:
D'Msion of IrWustnal Safety Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUTMORIZATON OF ENTRV: I certiry untler penelry ot perjury thal I heve reed thls epplication end stete Ihet t�e Infortnetion given is
corroct. I egrea lo comply wit� all stete laws end ciry ardinences releting to building construction, entl authodze represenletives ol the Ciry o1 Costa Mesa to enter upon the
above-descriDed properry lor Inspectlon purpases. I egree not to occupy or ellow occupanry ot any building euthorized Dy thls pormlt until linal inspectlon.
/� �/ l�neture OI Legal Owner(s) � �_ � �eja
KJ i y
MNOr Authorized Applicant Date
yQpFJ, INSVECTIONME
1676 Flxed System Flnel Fire Preventian
1266 Pool Spa Final
200 Flnel Re-Roof
201 Finel BIocWReteining Wall
202 Finel Feaory Flre Place
203 FInalSipn
204 Flnal Demdlllon
26a8a8
� IN��
C-� y'9 g �
eooe� ixsveenoxme
206 Flnel Mechenicel
208 Finel PlumDing
210 Finel Electriml
272 Final Fre Preventlan
220 Finel Plenning Approvel
222 Finel Site
250 Flnel Bullding�Ocapancy
Gdg U�lL4
�/ o8O Applicant to flll In all ipaces exCept tnose within neavy Eortler Ilnes anC sign all apOropriale tleclarationi.
O^
CON UCTION PERMIT PERMI O. ____ _ TRACT NO. LOT NO. UNIT NO,
CITY OF COST �ES/1�� aS��i '/
Project Addres5 .> � ���' �� e%� `,[t� y�
ApPlitant's Mailin Addr s � � ��� 7
Owner'i^Jame U S `� Phone �(p—ip1�
Address �� M I ��.YI � �A�(��/
Arch/Eng. License No.
Address " �� y�–�.�,�..
Controctor's Nem � � �T.�!/j.,7:tPqDne_L�2_.Ld.2S'
Address (mailing) �Sn�es��� �(� –�.� '�IT � �//[i •
Ciry License No. _L[srSP �..J (�
LICENSED CONTkACTOR DECLARATION
1 bereby aHl�m that I am Ilcensetl untler prOvi5iOn6 Of C�artCr 9(commenCi09
with seclion 7000) ot Oivision 3 of the Business antl Professions COCe, anC
my Iicense is in full for tl fect. ��-/�39
License CI s � nze o.
Odl¢_ $i9natura
WORKERS'COMGENSATION DECIARATION
1 neroby attirm [�at I have a certificate of con5en[ �o selt-inzure or a certHlcate
of Workers' Compensation Insuranc¢, or a certiff¢tl copy tbareof (Sectlon
'800, Lab. C.)��� � / / Company � � �. �
licy No. � l ��
� Certl'ietl C�opY i5 he�ebyl'Lhrthehc�ty tl�ij� i ion. //
Date APPlicant �'��( ���57»�/.
EXEMPTION ROM WO�RKERS"COMPENSATION DECLFRNTION
(Tnis seclion neetl not be mmplatetl if tne Oarmit �S for one huntlretl ($300) or
less).
I certily that in [h¢ Pe�fo�mance of the wo�k ta� Which thi5 perT�I IS ISzuetl, I
snall not employ any per5on in any manne� So dz to be[ome sub7ect lo the
Work¢rs' Compensation Lawz o/ Calltornia.
Date Si9nature
NOTICE: If, afier makin9 th6 aeclaraUon, you shpultl become sub)ect to the
Workcrs' Compensation Orovisions ol the Labor Cotle, you must ro�mwim
comply with sucn provlzians ar tnis oerml[ shall be tleemetl revoketl.
CONSTHUCTION LENDING AGENCV -
1 hereby allirm that there is a const�uttlon I¢ntling agency to� the perlormanC¢
of She wark lor wM1ich lnis permil Is issuetl (Sectlon 3097eCiv. C.)
Lentler's Name
Lontlor's AtlCress �
OWNER BUILDEN �ECLARATION
I nareby al/irm Ihat I am exempt f�om IhC ContYaclor'S UcenSo Lew to� th0
followin9 r¢ason (Section 7031.5 BuSincis antl PrOtessional CotlO: Any Uly Or
county w�lc� requires a permil to construct, alter, Impmve, Cemolish or re0alr
any sVucturo, ptlor to its Issuance, also requlres tha applicant tor such pormit
t0 file a slgnotl statem@nl that b8/Sh¢ Is IIca050tl pur5udnt t0 lbe prOvisioni 01
tho ConVactor's Llcense Law (Chapter 9 �tommeqcing with Sectlon 7000) ot
, Dlvision 3 Ot tne Busineis antl ProfesSiOns Cotlp) or thal he/She is exempl
'� Ihcrolrom antl the EaSis tot lh¢ allegetl exempHOn. Any violdllOn ot SC<tiOn
I 7031.5 Dy any appliwnt tOr a permit subjeC�S thG applicant t0 a clvil
;"�rnally oi not more than fiva buntlretl tlollars (SSbO�.
?T-� I, as owner of tne properly or my'omploypes wi[h wa9es as their sole
:'Smpensa�ion, wiu Co tne work, antl lhc sVuctur¢ is not intentletl or olleretl
ftlr sab (Sectlon 7044, BuslnCss antl Profe55ioqal Cotle: The Cnn[�aclor's
Licenso Law tloes nol apply to an owner of a proper[y who builtls or improvas
lhcreon, ana who tloes such work nlmscll/nerselt pr throu9h nls or her own
employ ces, p�Ovitletl that Such Improvements ar0 nOt inlendetl or of�oretl lor
sale. If, howovar, the builtlin9 or improvomnnl is soltl within one year o/ com-
pletlo0, thu owner will have the bu�tlan Ot Proving h¢/She 010 not bUIIE o� Irh-
nrove ror me auroose o� saie>.
❑ I, as owner of the property, am axUusively contracting with Ilcensetl con-
IfdtlOts to conSVuct [h¢ prOjeci (SCttion �064, BUsin¢55 and PfO�e5510n5 Cotle:
Tbe Contractor's Ucense Law does not appty tp an owner oi pmperty who
builEs or improves thereon, antl who conhacts �or sucn projects with a con-
trdctar�sl Ilcense pulsuant to th¢ Contractor'S LlCense Ldw�. I aT aware lhat
pro0f O( lhMr Worker'S Compensation Inzurance snoultl be provitlatl to me.
❑ 1 am exempt untler Section B. & P. 0. lor thls reason
Date Owner _
1 herebvi certifv tbat I have reatl tbis
SignaWre il/// �✓
Drivtts' Litenze or SS �
aDove
TVPE OFCONSTRUCTION LJ NEW U ADD U ALTERATION LIREPAIR
❑ CONVERS�ON ❑ DEMOLISH ❑ OTHER A p#
DESCRIPTION OF WOFiK/USE OF BLOG.
S Main Buildi
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FrOnt
❑ TENANT ❑ ELEGTRICAL ❑ PWMBING ❑ MECHANICAL A Rear
❑ OTHER
PROJECT DESCRIPTION Sq. FT. oCCUPaNGv C Right
CONSTRUCTIUN TVPE VALUATION 5 S Left
ZONE GRAOINGCV.VDS. ACRES P�ng.Fi2f.'if
Remarks: Planning Notes:
Bar Sink
Backflow Preventer
Backflow trrigation
eathmbs
Clarifiers
�rinking Fountains
'rloor Drains
Floor Sinks
uas5ervice Outlets
Interceptors
Kitchen Sink
Lavawries
Roof Drains
Reinspaction Fae $15
Boiler
Duct - Under Ground
Duct � Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO �I`-
Heating System & Ducting
❑ o-� oo,oaa aru O � oo,000 sT
Reinspection Fee $ib
CMF 0865-46, rev. 30/84 Wnite - 9uiltling; Canary . qpp���nt; Pink - Accountin9: Goltlenroe - Asse55or
Showers
Servite $ink
Sewer Cap
Sewer Connettion
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool wlSpa
Urinal
Water Closet
Woter Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel
Canopy Type II
Refrigeration System
❑0-100,0008TU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
ES
5 3
ES
$ 3
Automatic Washer
Construction Pole Su6.
Cookin9 Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0�5 KW C
�: �� 8/! ' /:_7 r��
Zone
Accessory Building:
Z
O
N
I
N
G
H
Perkinp Req./Providetl E
�
M
T
s
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter �up to 100 amps
Mecer ❑over 100 ampz
Sub Panel
Motors �P7 NP O 1 Y, - 8
Inc,Solar 09-15 HP �16-15+
Microwave
Pole Light
Ron�je
Standing Sec[ions
5 KW Trash Compacmr
FEES
I Reinspection Fee I$15 I I Iss�e Foe I $ 3 I
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approvad By Data
Application luued 8y Data —//-527
SUMMARY OF FEES
BUILDING PERMIT 5 SMIP S
PLAN CHECK $ � PERMIT �
PLUMBING $ ISSUANCE 5
PLAN CHECK 25% $ ENERGV P.C. 5
ELECTRICAL S GRADING S
PLAN CHECK 50% $ � MICROFILM 5
MECHANICAL 5 TOTAL FEE § � DO
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permii # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ,M
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 4::
5. Steel Reinforcement 56. Rou9h Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER,�iUNITE
7. Footings 58. Electrical Conduit-Undrgkfd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap,�,�i Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .r�
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof Dreins 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. SOlar SyStem�Final
76. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in S[ruc[ure 70. Undergraund Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Under9round Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structura�) & 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
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 /�Y7 L�J
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. FINALSTRUCTURE&BUILDING � �
48. Special Requirements Completed
49. Electric Release to Edison
'50. Gas Release to Southern California Gas Co `��
51. CERTIFICATE OF OCCUPANCY
No. Date _
Co..Inc.
JOB ADDRESS 24�
GEN�RAL CONTAACTOR
DA
S
Gas
r�y
I3.
naT� 6-3-63
BUILUING PERilIIT N0.
VALUE 3 19_1�17.00
SOBCONTI2ACTOR I DATE
�
. /4707
COSTA MESA.BUIL - EfY DEPARTMENT
P. O. BOX 31] COBTA MESA, CALIFORNIA
For ApplicanT fo Fill In Completely
TYPE OR PRINT
i�oiN� �y, �Q lYLI�Q�{'1�'Ci
�RESS
COSTA MESA. CALIFORNIA
� MAIL
FE RECEIVED
dUN 31yb3
F;NANCE DEPT.
�`� �F COSTA MESA
APPLICA OR PERMR
BUILDING
For Office Use Only
R6CEIPT NO. � jlp3µl�qp.
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� .CAT@R6CEIVED- pAT€�SSU
1-=-,� i., JUrvo 1��3
; Hdl C. Tan TEL. �� �' BY DATE
Nu . 281�
100 W. Commonwealt er on ZONING
CITY `Same
LIC.rNO. �.SZ��LSO�B�1
OFLOT 33 x 53.50
USE OF
EXISTING BLDfd.
N6
Z no. oF I ue[ oF rvE
PLANB am�oino�/
1
DEBCRIIRION Lot 123 Tract 3433
A. P. NO. �
IiOTE: NOEAVEOVERHANCiSHALLBELE55THAN,
R Z� HOZ O ��� TO SIDE @ REAR P. L.
EAVES
n0. OF e�Dae. ALLOWED ( U. B. C. REQUIREMENT
NOW ON LOT ��
YAROSAPPROVED YARDSAPPROVED
MAIN BUILDINO ACCESSORY BUILDING
/ FROM C/L STREET )
T L V. 5 V� REAR YARD
EFT '— . . I RI6NT �– –_
DESCRIPTION OF WORK
YAR. $�
{ 2 C. U. P.
L � APPRO�
1 HEREBY ACKNOWLEDOH TXAT 1 XAYH qE�b TXIB APPLICATION
ANO 9TATE THAT TH8 ABOVE 18 CORRECT ANO A6RE6 TO COM.
PLY WITH /LLL QTY ORDINANC88 AND iTATS LAWB R6GULATING
BOILOINO CONSTRYCTION. ��,/ p ) '� qqq
SIGNATURE OF ��7„ p./ � )�, ��
PERMITTE .Q....ti(LN �
AUTHORIZ6DA66NT i�r
THE AMOUNT 6
PIJRPOSE OF 1
VALUATION
�/9,��� `�
BET. MAIN Q
ACGESS. BLI
DATE
� 3�0 "'
UNDER VALUATION IB FOR THE
ISHING A PERMIT FEE ONLY.
PEFMITFEE S G7J ��/]�
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