HomeMy WebLinkAbout3125 MONROE WAY - Building Permits. n
�" t CITY OF COSTA MES�!�.
� BUILDIN6 DIYISION
h � DEVELOPMENT SERVICES DEPARTMENT
° � PERMIT PERMI N MBER- /
�� V
698-01531
(714) 754-5273 • Fau (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 3125 MONROEWY
Suite:
Vicinity:
Parcel Nunmber: 14165274
BUILDING PERMIT
Zoning: R1 R1
Status: ISSUED
Applied: 08/24/1998
Issued: 08/24/1996
App�icant: KEPLAR, STEPHEN
Address: 3125 MONROE WAY
COSTA MESA, CA - �� i� ^- � Plione: ' . 774-036-1320
. .. .r �, . . _
-.-,r.=',- �_ -- �,Zip: 92626 -
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Owner: KEPLAR�STEPHEN, �� � '- �� % �.� ,`�
Address 3125�MONROE WAY . � ` - - � i �� �� �'�\����
COSTA NIESA CA � - ,= � , �: Phone -=714=436 1320�'� � ` ��;��`�
���i'�� �� � . ' Zlp: 92626 "��-. y; � ����i \��\
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Contractor:; � �ij .;;: �- ;�ti: � � ��: A� _�,
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` r ' SCOPE OF PERMIT
.i �� ' � yINSPECTORq TO OBSERVE SLAB SLAB IS CR4CKED SHROUGH-OUT
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„ , FEE SUMMARY r�,'
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RlanCheck: �.�$0.00 _r_� ��;,;5�,-.,._-----._
Permit: % $0.00 - - --- _ , ; -
,SMIP Res: �; $0.00 _ _ `
SMIP Com' .$0.00
��.• Other ', �i��,$0.00
Inspection: ; '-, �$0.00
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SETBACKS ' . � �' - � �� �� '
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MAIN STRUCTURE Front � 0- 0 �. Reer ''0 ,0 ` `- � -� Lefl �
ACCESSORY Front `0:0 � �� Rear 0-0- Lek
S3y
PARKING Ezistin : 0 Reauired: 0 Proposed:. 0
NOTES:
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--Calc Valuation: ,,:' � � - So.00
"Claim Valuation: ' .' r$o;oo
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EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is Suspended or abandoned I
for a period of 180 days.
� INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inepedlon :and final epproval must be obtained. Fai=ure to obtain inspections and final approval will result in the expiration of thfs permit. �
FOR INSPECTIONS CALL: (714) 7545626
�,
yypRKERS' COMPENSATION DECLARATION: � , �
I hereby affirtn under penalry of perjury ona ot the following tleclaretions: �
❑ I �eve entl will maintain e cerlificete of conseM to seH-Insure tor workere' compensation, es provided for by sedlon 3700 af the LeDor Code, for t�e paAormance of the
work far which t�is permit is issued.
� I heve and will meintein workers' compensation insurance, es �equitad aj sedlon 3700 of Ne Lebor Code, for tha peAortnance oi tha work far which this partnit is issuetl.
My workers' campensation Insurence cartier end policy number ere:
Carl�er; � � ' ' Policy Number:
(7hls secfion need nof be comp/eted il the pemtlt i5 �elued et one huntlred dollars ($700) or leu.)
� I certity ihat In the peAormance of the work for which this pertnit is issued, I shall not employ any person in any manner so as to become sub�ecl lo the workers'
compensetion laws of Celifomie, end agree thet ii I shoultl Cecome sub�ecl to the workers' compensetion provisions of Secllon 3700 ot the Lebor Cotle, I shall forthwith
comply with thesa pravisions. .
ppplicant Sfgneture: Date:
WppNING: FAILURE TO SECURE WORNERS' Q7MPENSATION COVERAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENAITIES PND CIVIL FINES UP TOONE HUNDRED
TTIpUSANO DOLURE (5100.000). IN ADOITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SEGTION 370G OF THE UBOP CODE, INfERES7, AND ATfORNEYS FEES.
LICENSED CON7RACTORS DECLARATION: �
I hereby eRirtn that I am Iicensed under provisians of Chapter 9(commencing wlih Sactlon 7000) oi Division 3 af the Business end Protessions Code, antl my license Is in tull
torod and ettect. li¢ M Class #
Contractofs Signature: Date:
CAHSTRUC710N LENDING AGENCY:
❑ I hereby effirtn ihat there is a construction lentling agency tor the peAormence of the work for which this pertnil is issuetl. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Atldress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I heleby eHirtn that under penalry ot perjury ihat I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business and Protesslons
Coda: Any ciry or wunry which raqulres a pertnit to construct, alter, improva, tlemolish, or repair eny siructure, prior to its issuance, also requlres Ihe epplicent for such pertnit
to flle a signetl statement that he or she is licensad pursuant m t�e prwisions oi the Cantrectors Ucense Lew (Chapter 9(commenUng with Section 7000) of Division 3 of ihe
Business and Professlons Cotle) or ihet he or she is eaempt iharefrom and the basis tor ihe alleged axemptlon. Any violatlon of Section 7031.5 by eny epplicant for a permit
subJecLv Ihe applicant to a civil penalry of not more �han five hundretl tlollars ($500�.):
❑ I, as owner of ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe structure is not intended or oHeretl For sele (Sec.
70E4, Business end Protessions Code: The Contractors Lice�se Law does not epply to en owner of properry who builds ar improves Ihereon, end who tloes such work
himself or hereelf or through h�s or her own employees, providetl ihat such Improvements are not intendetl or oHered for sele. If, however, the builtling or Improvement is
soltl withln one year of completion, ihe owner-builder will have Ihe burden of proving that he or she tlitl not bulld or improve fw purpose of sale.).
❑ I, as owner ot the property, em EXCLUSIVELV CON7RACTING WITH LICENSED CONTRACTORS to Construct ihe project (Sac. 7044, eusiness entl Professions
Cotle: The contractors License Law tloes nat apply to an owrter oi prope0.y who 6uilds or improves thereon, and who contrecls tor such project with a contractw(s)
license pursuant to the Conirectors License LawsJ.
❑ 1 am exempt under sec. Business antl Protessions Code for ihis reason:
Signature: Dete:
Owner ID verified by drivers licen'se. ❑ Yes ❑ No Dnvefs License No. E:pires: -'
Vadfl�etion oi Owners�ip by (type of tlocument, i.e. - propefty tsx bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: _
❑ I hereby cenify that no excavetion five (5) or mora teet in tlepth into which a person Is raquiretl to descend, will be made in connection with work euthorized by this
pertnit, entl ihet no Duilding st�ucture, sceXolding, felsework, or tlemolitlon or dismantling thereof, will be more than thirty-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec.
341, Title e, Calftomie Administrativa Code).
❑ As owner-buildar, I wlll not employ anyone to do work which would requlre a permit Irom t�e Division of IntlusMal Satery, es noted above, unless such person has e
pertnit ta do such work irom t�e division.
Signature:
Division of Industnal Safery Permit Number:
Date:
11RDOU5 MATERIALS AND EMISSIONS CEPTIFICA710N:
Will the applicant or present or fuWre buliding occupant neetl to file end certify a Business Plan for emergenCy response to release or �hreatenetl release of a hazardous
materlal4 ❑ Yes ❑ No
(Section 25505 ot the Celitomle Health antl Satery Cotle requires, wilh some ezcepCions, ihat e Business Plan be tlletl with ihe Costa Mese Fire Depariment by every
business which has at any one time during a reponed year a quentity of hazerdous metenals equal to or greeter than e weight of 500 pounds, or a volume o� 55 gallons,
or 200 cubic teet ot compressetl gas at stantla�d tamperaNre antl pressure).
......................._...................................................................................................................................................................................... ................. .....................................
Does or will the ep0licent or present or future building occupent neetl to fila a registration form for acutely hazardous matenels7 ❑ Yes ❑ No
(Seclion 25533 of the Califomla Health and Safery Cotle, with soma exceptions, requires registration with ihe Coste Mesa Fire Depertment by each 6usiness whlch at any
one tima has on hand a Quantiry o1 ecutely nazertlous matedals equal to or greater Ihan e weight of 500 pounds, or e volume of 55 gallons, or 200 cubic feet ot
ss or wiil the a00�icant or present or
Yes ❑ No _
ictlon 25534 of the Californie Health
�ertment of an RMPP by businesse:
occupant neetl to D�epare an RMPP
for
efery Code provides that the Coste Mesa Fire Oepanment may require the preparetion, certificetlon entl filing with the Fire
are required ro register acutely hazartlous malenels with ihe Fire Depertmant �
..................................................................................................................................................................................................
25534 ot the Califomia Health and SafeN Code been fullv com0lied with? ❑ Yes ❑ No
5 lwes or wlll ine appucant or presen[ or mmre ounoing occupant reqmre ror me work wnlcn Is tne sub�ect of Inis e pucaban egermn tor such construc
from Ne South Coast Air Qualiry Manegement DisMct or from eny other eir polWtion control dis�rict or agency? � Yes L] No �
(Section 658502 of the Califomia Govemment Cotle requires Ihet iha raquestetl iniormation be tumished on applications iar nomresidential builtling pe
................................................................................................................................................................................................................................ .................
6 Will any pen of the faciliry to be consiructetl untler this permit be within 1000 feet from the outer bounGaries of a school? ❑ Yes ❑ No
(H yes', the feciliry must meet ihe requirement of Sedions 25534 and 42303 of the Califomie Healih and Safery Cotle). -
..............................._........................................................................,........................................................................_...............................................................
7 If e Pertnit from ihe South Coest Alr �uelity Management Disirict or other eir pollutlon control tlistrict or agency is reGuired tar the work which Is
applicatlon, have all of the disdwures prescnbed by Celifomia Heelth end Setery Code Saction 42303 been matle? ❑ Ves ❑ No
(Ii'ves", ettach certiticata of compliance irom t�e apPropriate 9
CERTIFICATE OF COMPLIANCE: I certify that under penelty
regarding Hazardous Materials and Emissions.
.�
Signeture:
or
sublect
�ollu6on control otficer).
perjury the informefian given above is correct. I agree to comply with all state laws end city ortlinences
Date:
CEfi11FlCATE OF COMPLIANCE AND AUTHOROATION OF'ENTAY: I certify under penelty ot perjury that I have reed this eppliGation and state thet the information given is
corrB�i. I a to comply with all state laws and ci�y ordinances relating to building construction, and euthonze representatives of Ihe City ot Costa ese to enter upon the
aboVe- nb d rry tor' s ction purposas. I agree not to xcupy or allow occupancy of eny 6uilding authorized by this pe u til i I i on.
r/�,��� • �'%�'�i�`
�� Signeture OI Legal Owner(s) ate
f,pf�y INe_pEttIONTYPf
1676 Fixetl System Finel Fire PrevenHon
1266 Pool Spa Finel
ppp Final Re-Roof
201 Final BIocWRelaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Flnel Demolition
QAiF II�ALS
CQOE! INSPECTIONTYVE
206 Finel Mechenical
208 Finel Plumbing
210 Finel Electncel
212 Final Fire Pieven�ion
220 Final Planning Approvel
222 Final Site
250 Finel Building/Occupancy
Date
OAIE It�1S
:
' PflOJECT R�OBESS: 31 2 S. MONR06 W Y
OY}NEN'SNAME: t,ATON BONNIE L
RODNESS: 31 Z S �'iONROE: WAY
COSTA MESA,CA
540—i498
pflCH/ENGINEEN:
ROUXESS:
uxir:
92626
HEG.NO.:
UNIT:
PEXMITfEE: j{jjj�jlE SMITH PL"JM&SNG ( 714 ) 530-0700
AUOPESS: HOX i 8 3 �
W£STMIN5'fER Ctl 92684
UCENSEO CONTflACTOfl OELLABATION: I hereby ai�irm t� I am litensetl UnOer provisi0n5 0� p�er 9(commenCing wi�� SeCiion
7000) o� �rv�sian 3 al the Business antl Pm�essions Code, a y hcense is in WII torce and efl .
cirruc.: p55992 sTnreuc.:51259" cuss C-36_�l
�ate: � � � "'� SignaNre: _ _ �y,
WOPNEXS' COMPENSPTION DELLANFTION: I hereby aHirm t�at a a certificate o consent m selLmsure or a cerlificate of Workers'
Compensalion Insurance. or a certilietl copy Ibereo� (Section 3800. Lab. C�.
POLICY NO.: E%P. ORTE:
COMPIINY:
� Cer�i�ietl copy is hereby �umished. ❑ Certilie0 copy is filed with ihe ciry Builtling Oivision.
Oate: Applicant:
EXEMPTIONFqOMWOBNENS'COMPENSATIONOECIANRTIO � (Thissedmnneeanotbe mpl e iit�epermitisforonehunArW�4100�orless).
I cetlify �hal in Ihe pedormante of ihe work lor whith Ni5 e i� i5 issUetl, I shall no plo ny persOn in any mannef 5o as �o betome
sublec� lo ��e Workers' Compensation Laws ol Cali�omia
Oate�. � � � �' Signature:
NOTICE: II, aller making this tleclaration, you shoultl b u Iect Io I Workers' Co sation pmvisions o� I�e Labor �
Cotle. you must IortAwi�h campry with such D�ovisions or � permil shall 6e tleemetl reuoked.
CONSTBUCTION LENOING RGENCY: I hereby al�irm tAaU�ere is a consimc�ion Iending agency for �he pedormance of �he work lor
which Ihis permn is issued ($ection 3097. Civ. C�.
LENOEfl:
nooRess:
' OWNEP BUILDEP OECLFNRTION: I hereby aliirm ihat I am exempt fmm ihe ConiracroK State License Law for ihe fallowing reason
(Sec�ion 7031.5 Business antl Prolessional Cotle: Any cily oi counly which repuires a permit Io cons�mcl, ai�er, improve, tlemolish, or
iepair any 5tmciure. prior �o i�s issuance. also requires I�e applicant �or such permii �o file a signetl Slaiement lhal he/she is Iicen5e0
pursuant to Ihe prgvisitogs ol the Conlraclors' State license Law (Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business
and Prolessions Code 1r Nai helshe is eremp� �heretmm and Ihe Uasis for Ue alleged exemp�ion. Any viola�ion of Section 7031.5 by
any aDPlicant for a Dermit su�lecis Ihe apDlicant to a civil penalry of not more than Lve hunOreU tlollars (SSUO�.
I, as owner of ine propeny or my emyloyees wilh wages as iheir sole compensation, will do tAe wofn, antl �Ae
❑ slmcWre is no� imen0e0 or ol�eretl �or sale (Sec�ion 70a4, Business and Pmfessional Code: The Contrattors' S�ate License Law
Aoes noi ap01y lo an Own¢r o� a pmpeny who �uilds or imDmves fhereon, an0 Wh0 tloes suCh work himself/her5elf or [hmugh
his or her own employees, provitlee ihat such improuemenis are notintendetl or offere0 for sale.lf. Aoweverihe huittling or
impmvement is sold within one year of completioq the owner vnll have ihe burtlen ot pmving he/sAe tlitl not build or Improve
lor the Durpose oi sale).
I, as owner oi the pmpenV. am eKCWsively coniracting with Iicense0 conirac�ors to consimct the pmject (Section 7044, Business
❑ antl Prolessions Cotle-. The Con�rac�ors' S�aie License Law aoes no� aDPly to an owner ot Dmpe�y who bmlds or impmves ��ereon
and who contracts for suc� prole��s wi�h a cnnvamor(s) license pursuan�to Ihe ConlraclorY Sta�e License Law�.l am aware
iha� proai of lheir Worker's Comyensation insurance shoul0 be provitled �o me.
� I am exempt un0er Sec�ion'. B. 8 P. C.
for tnis reason:
Oate: Owner.
I tlo hereby cetlify I�at I am aware af and waers�and �he mQuiremenis ol Calitomia Nealt� antl $alery COAe Sec�ions 25505, 25533, antl
2553a antl �hal I or any WWre builtling ocapant will/will nm �circle one) neeJ m compty wi�h saitl s�ate cotles and Ihe reQuiremen(s for a
permil �or constmc�mn or modificaiion imm Ihe Fu Ouality Managemenl DisVict. ReSiaeniial construction applications are exemD� �mm
Ihese piovisions.
Oa�e'. Fpplicanl'.
I �ereby cerlity Iha� I have reatl Ihis application antl sla�e �� t abave in�ormation is c e L I agree �o comply with all ciiy an0 counry
ortlinancesanes�alelawsrela�ing�abuilaingcons�mc�ionane ere aN�orize� r[enta tlhi5ciry�oenteruponiheabove-mentione0
pmpetly lor ins�pec��io�n purposes.
�aie: �_yt}_ � `� Sigwmre:
oriver's License ar Sacial Securily x:
164t�d6 Whde—Bmltling: Green—Cotle Enbrcemenl; Canary—Applicant; Pink—Fevenue', GolOenmtl—Assassor
; CITY OF COSTA MESA — BUILDTNG PERMIT PE�M NO; P �5710�
PERN,IT NO: P 057103 PLAN CHECK NO; N GUVT; N SUPP: ;V
CONST'RUCTION 'PYPE: PERMI'P TYPE; PI,U PURPOSn: OTH
JOB DESCRIPTION : PRV FOR WATER HEATER SQ FT:
CLAL�I,VALUE: CALC—VALUE: GROUP OCC; R-3 /
�
COMMENT5: PRV TO UATSIDE
ifdEiF�!-iF�If�dEjf�X4j(��1f�lE�X�iF�C��If�k�)F�K-�K�fit�f�K-�7f�3ficifiE-k�IficiE��7E3f�1E�Ki(�1(dE�kif�%K�iE3E�IEie�iF�c�IfiE�1FiF3EdEaF�1FiE1EiF�k�iE#�IE�IEiFi4�x�Kibif�%kif#iF -
'L O N I N G R E Q U I R E M E N T S
sEraAcxs
------------- MAIN BUILDINC, ---------- --------- ACCESSORY BUILDiNG ---------
FRNT; FT IN REAR: FT IN FRh7'; FT IN REAR; FT Z;�
LEFT: FT IN RGHT; F"f IN LEFT; FT IN RGHT: rT IN
PARKING REO� PROV; PARCEL; 14165274 ZNE; REF NO;
PLANNING NbTCJi
i
x�r*���e**�**xx���*�ux��*�x��**��r��*�*�x�*�*x*�*��r������r**�x**�x�*�c*��**�c�r�**x+� ���t�
D E V E L O P M E N T 5 E R V I C E S%^. R E 2 U I R E M E 1� T S
, Q.
ZONING APPRUVED BY ✓1 DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY; _ �
lE �Jf 9e iF iE-1F ii iF if if iE-%%�?f 3(� iE 1F iE iE iE 3f 3h
3E iF !E iE iE %� i( 3E ±F iF iE N� it jE Yf fE iE !f iE X-!E fE fE 1E ii �IE ff ?E # ff 3E �% K� if ?F Ik iP iF it
LEGALIZA'I'ION;N F E E S
BI,L�G F'MT PLtJMBING ELECTR�
PERMIT 225�
DATE:
DATE ; d4Z3�-�
�����t�*�t�t*x���txxx,�xxxR�rt*
jf iF if k#?E%if it 3E # k iE iF iE it k ih If if #' iF 1F 1P if iE ie IE �f i4?E N� IF i� if #)f K�
M M A R Y STRUCTURAL SEGMENT;t4
MECAANIC FZRE SMIP/RES GRApING
SMIP/NON—RES
PLAN
ISSUE FEE 3.00
BUILDING—DIV—> PERNIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 2,00 3:Q0 0.00 5.00 5.00 ,00
REVENUE DIVISION TOTALS--> COLLECTEDv S.UU OVER/SAORi: .Op
BLDG FMT PLU,�iDING ELECTRIC MECiIANIC F.T.RE SMIP/TOi GRADLNG PLAN—CHECK
5,00
iF �F �f jf iF iF 3E IE iE iE �F iF iF iE if iE 1E iE jF jf 3f 1E )F if iF iE af if 1� # iE if iE 3F iE 3t iF iE iE iE 34 if iE iE jE iF jF aF iE iF jE 7f %� iE iE�F 1E Y� 3(� iFlE �E?E iF R iE IF 7f * 1E 3E �F iE R iF iE i� *�
I N D I V I D[1 A L F E E B R E A K D O W N
TYPE QTY D E S C R l P T I O N UI�IT COST TOTAL COSr
PLU 1 WATEk HEATER AND/OR VENT 7.,00 2.pp
END OF FEES
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� CONSTPoUCTION AND PLANNING - ' � . POOL _ dPA , � `
' APPROVALS Permit# '- - Date Inspector APpROVAIS Permit# Date� Inspector
-..
1. Temporary Electrica� Service & Pole � 52. -Pool & Equipment Location� �'
i t �.
2. Soil Pipe-Undrgrnd. .� -�� '` �53. Steel Reinforcement r� �
,: ��
� 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -. ,�
4. Electric�� Conduit�Undrgrnd�� 55. Electrical Bonding ' _ . ���
5. Steel Reinforcement �. . 56. Rough Piumbing & Pressure Test
6. Electrical UFER Gmd. � . 57. APPROVAI TO COVER-GUNITE
7. Footings � - 58. Electrical Conduit-Undigmd. �
8. Foandation t � Y�-_ � 59. Gas Pipe, O Undrgrnd., Test � "- �.
` �- - . � - . , . „
9. Water Pipe�Undrgrnd. �' y� 60. Backwash Lines, P�Trap, O Undrgrnd. \'�,
70. Structural Floor System �; 6 61. APPROVAL TO DECK . t-�,;:
11. Property Sewer Line & Houie"Connection .,p !� � 62. Backwash & Receptor�Pinal �i"0
�
12. Sewer Cap . - _� , � 63. Heater & VenrFinal _-�\ _
7 3. Roof Drains �- •, `,i 64. Plumbing System - Final �;�
14. Rou h Plumbin � �
g 9 ` t-:; ti. y. 65. Electrical-Finai , ��i,
15. Rough Electrical-Conduit 0� ;- � 66. So�ar System-Pinal
16. Rough Electric Wiring � 67. Fencing & Access ApProval
17. Rough Wiring Sign . 68. APPROVED FOR P�AS7ERING
18. Fough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditionin9 . FIRE DEPT. REQUIREMENT
20. Rough Factory Firepiace � . APPROVALS Permit #
27. Ducts, in Struct�re • 70. Underground Hydro
22. Ducts.Ventifating . 71, ProductPipingOGas ❑Oil
23. Gas Pipe�Rou9h & Test 72. Underground Flush
24. Roof Ftaming . 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing �4. Overhead Hydro
26. T�Bar Ceiling (Struct�ral) & Monocoat 75. Dry Chemical.
27. Frame and Flashing � 76. Dry Standpipe ,
28. Lething & Siding 77. FIXED SYSTEM FINAL
29. Insulaiion ; 78. FIRE PREV. FINAL
30. Drywall Nailing , HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat � �_ 79. FINAL INSPECTION �
32. Electrical Power Meter-Pinal� , � ,' 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 Q� C.Qi(i
39. Water Service-Finat - � ��
40. Gas Service-Final '
41. Solar pomesticFinal , . �
42. Backflow Preventer ���
43. Backflow Irrigation .
44. Landscape Irriqation System
45. Sound Attenuation �
�46. HandicaP Regulations
47. FINAL STRUCTURE & BUILDING ,
48: FINALPLANNING ��
43. Electric Release to Edison �,J '
�,
50. Gas Re�ease to Southern California Gas Co � ��' '.
�v
51. CERT1fICATE OF OCCUPANCY -
No. Date
OJELT A?^7HE55: 31 � 5 NONRO$ WY
OWNEfl'Sxarn¢: Ef�TON, BONNiE L
aooeEss: ;a125 M4NROE W�1Y
COSTA MBSA,CA. 92626
540-1488
FflCMIENGMEEP: PEG.NO.:
ROUXE$$:
uxiT:
uxiT:
PEPMITiEE: SANDKAMP ROOFING ( 714 ) 542-1742
aooness: 129 N SULUVAN
SANTA ANA CA 92703
UCENSED CONTHpCTOH �ELIAFATION: I hereby altirm �ha� I am licensea under pmvisions oi Chap�er 9(commencing wilh Sec�ion
7000) ol �iv�sion 3 of Ihe Busineu antl Professions Cotle, antl my license is in full lorce and ettect.
cirruc.:041fi43 sraTeuc.:362896 �c: �
oa�e �/—'�O —aj 2 Signatur� �
WOFKEflS'COMPENSATIONOECiANAiION: IherebyaHirm�hatlhaveacertificaleof senitosetl-insureoracenificateofWoBers'
Compensatian Insurance, or a cehified coOY �hereo� (.$ection 3800. La�. q.
POLICY NO.: E%P. DFTE:
CertilieA copy is hereby furmshetl. ❑ Certi�ietl coDY is liletl wiN the city Builtling Division.
Oate: NpplicapL
E%EMPTIONFROMWOPI(EHS'fAMPENSPTIONOECUIIATION: (ihissectionneednolUecompleleAilihepermitistaranehunAred�5100)arkss�.
I ce�ily iha� in Ihe pedormance ol �he wo�k inr which ihis permit is issued, I SAall no pla rson in any manner so as �o become
subleci m the Workers' Compensaiion Laws ol Cali�ornia.
Daie: �'�2f� �q.t Signaiure' ��
NOTILE: It, aiter making this Oeclaration, yau shpu�come subject m ih�ly��ensation D�ovisions of roe Labor
Code. you musl forihwith tomply wiih such prOvisions Or Ihis permi� 5hall I(ldeemed fevok¢tl.
CONSTflUtTION LENDINC RGENCY: I hereby attirm �hat �here is a conslmc�ion lentling agency for Ihe pedormance o� �he work lor
whith �hi5 permit i5 IUU¢d �Settion J097. Civ. C�.
LENUEfl:
nooeess:
� OWNEfl BUILOEN OECLPPRTION: I �ere6y allirm that I am exempt fmm t�e Coniractors' State License Law for the tollowing reason
I�Section 7031.5 9usines5 antl Prolessional Co�e: Any �i�y o� couniy w�ich requires a pe�mi� to cons�md, alter, impmve, demolish, or
repair any s�mc�ure. pnor �o i�s issuance. also requires ��e applicant for SucA permil to (ile a 5igned s�a�emen� �ha� hels�e is licensed
pursuan� to Ihe provisions o� ��e ConVac�ors' Slale LicEnse Law (Chapter 9 �commencing wilh Section 70W) ol Division 3 0l the Bus�ness
antl Pm�essions Cotle) or Ihat hefshe is exempt Ihereimm an0 �he basis �or Ihe allege0 exemption. Any violation ot Sec�ion 7031 S by
Iany applicant for a permit su�iecis ihe applicanl to a civil penalty ot not more tAan five huntlretl eollars ($5001. ' �
I, as owner ol the propeny or my employees wi�n wages as tAeir sole compensation, will do the woM, antl the
I❑ s�mcture is not intenaetl or otferetl 1or sale (Ser,iion 7044, Business and Pmiessional CoOe: The Cantracmrs' State License Law
tloes no� appty �o an owner of a pmperty who 6ui145 or impmves thereon, and who does such work himSelOherSeA or thmugh
�is or her awn emDloye¢5, O�ovidetl t�a[ sucp imD�Ovemen�s are n0� intentlea or O��ereA for Sale. If, Aow¢v¢r �he 6uilding or
improvement is sola within one year of completion, the owner will have ine burtlen ot pmving he/she ditl no� buil0 or impmve
lor ��e purpose o� sale).
I, a5 Dwner of �he pmp¢hy, am exclu5ively COn��aC�inA wi�� licensetl cOnVaC�ors �o ConS�mtUh¢ pmiec� (Section 7044, Busine55
❑ and Protessions CoOe: T�e Comracmrs' SIaIe �icense Law does not appW �o an owner o� pioPerty who builtls or impmves Ihereon
antl who coniracis �or such proleds with a cOnVacbr�s) license Dursuan� to Ne Coniractors' S�a�e License Law�. I am aware
�hat pmol of their Worker's Campen5aiion Insurance s�oultl be pmvi0ed lo me.
� I am exem0� under Sectian: B. 8 P. C.
for ��is reason'.
Date: Ownec
I do �ere�y cenity �hat I am aware ol ane un0ers�an0 Ue requiremems of Caii�omia Health antl Satery Code Sections 25505, 25533, antl
25534 antl ihat I or any future building occupant will/will not (circle one) neetl to comD�Y �+'it� Said slate cotles and the requiremenis for a
permi� �or canslmc�ian or moddica�ion Imm Ihe Fir Oqali�y Management DisVict. Fesidential consimction applica�ions are exemp� �mm
Ihese provisions.
Oa�e AOP�ican�:
I �ereby cer�ily Iha� I have reatl Ihis applicalion antl s�a�e �hat the above in�orma�ion is correcL I agree to comply wi�� all ciiy an0 cawry
or0inance5 antl sla�elaws rela�ingto butlding consimc�ian and hereby aulhorize repre5en�aiive5 o�lhis ci�_ytp ¢n�¢�uponihe above-men�ione�
pmpeny lor inspection purpospes. �
Dale'. � � �C% "'� `'Z Signamr �
- �r
�river's �icense ar Socia� Securi�y x�
1641�46 W�ne—BUAdma�. Green—Cotle Enbrcem¢��; Canary—Aoolicanl:
Goldenmtl—Assesmr
CITY OF COSTA MESA — B(7TLDING PERMIT Y' NU: li � v�
PERMIT NO: B OS%079 . PLAN CHECK NO: N 1: n; : N
CONSTRUCTION TYFE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOH DESCRZPTION ; T/OFF' REROOFW/COMP 6 SKYLIGHT SQ FT: 5,400
CLAIM VALIJE: 5,400.00 CAI.C—VALUE: 5,400.00 GROUP OCC; R-3 /
COMMENTS: T/OFF REROOF W/ COMP—SKYLIGHT NICBO 2469
x�t�����****�x��**�*�*�t+t��r���***���� �� ��**�t*****�r*�tx*xrx***�t�rx���*�����*�**� *x•�t x���*
Z O N I N G R E Q U I R E M E N T S
S E T B A C' K S
------------ NAIN Bi7ILDING ---------- --------- ACCESSORY BUZLDING ---------
FRNT: FT SN R£AR; FT IN FRNT; FT I1J REAR; FT ZN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARKING REQ • PROV: PARCEI,; 14165279 `LNE; REF NO:
PLANNINV Nt)TES>
> �"
1F jf if fi� iE �lE if #�E iF �1F 3E iE iF iE �1E 3E iE it 3e i6 iE �k 1E # 3E iF iE %iF jF iE i4 �F iE 34 3E �E iF 3F iE aE 3F 9E iF �f iF �f k N� iF �E iE iE if 3P �4 iE 3F # iE iF 3F iE iE1E iE iFpeiF.if �E iE iE i� jf iE ik �lE
D E V E L O P M E N T S E R V I C E S R E Q [J I R E M E_ -N�T S
ZONING APPROVED BY DATE: `�'j.�^
BUILDING APPROVED BY ; DATE;, .
APPLICATION ISSUED —���� �'��
iF�Fx�3F�EiEifiE3EiEiFlfiEiFiE1F3e3E iFiEiEiF e �1F±t�1EiEiFiE�F�i�iE#
1E1E%fElfiEi(�if��lFifK-iEiFiE3EiFiiiE i'r�Fif�4�iFjEiEiE i'tififiEiElf�fcfEiEfEiEiF3PitiEiFlE7EieiFiFffiEiE�iFiF�4�ifi3'tiEiFiEjFiFiE�fiEif3fi(�
LEGALI2ATION;Y F E E U M M A R Y STRtiC'1'UFtAL' SEGMENT;Y
BLDG FMT PLQMBING ELEC dIC MECHANIC FIRE SMl"P/RES GRADING
PERMIT 162,00 •. 54
SM IP /h]ON—RES
PI.AN
ISSUE FEE
HUILD'ZNG—DIV—> PERMIT. ISSUE PLAN—CFiECR TOTAL PAID DUE
TOTALS----> 162.54 0.00 0,00 162,54 162,54 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 162.59 Oi1ER/SHORT; Op
BI�D62P00 PLDMBING ELECTRiC MECHANIC FIRE S�KIP/TOq GRADING PLAN—CHECK
1E if iE �1F-1E �lE ib aE %iF �1F iE 3F 3E if if iF iE iF iP��1E �E 1f i(� !F if iF 7P iE ih iE �lf �1f if �X� lE jF if aF �lf iF jF �h 3E 1F 1E # iF if iE �lE 3E iF �1f �le lE 3E 3E 7f iF it� iE �lE 1f ih iF iE 3(� lE 1(- iE iE iE iF iC y.3f �7E
I N D�'I, V I D U A L F E E B R E A R P O W N
TYPE QTY D E S C R� I P T I O N UNIT COST TOTAL COs;'
SFR 5900 REROOF BY VALUE RESIDENTIAL N020NE 1,00 5,400.00
" END OF' FEES
a��in�3a
�(��`��1�(7 ��01NS
oi no�i�2se-ootia��� -ro�f-e -
QRTE: 04,'2Z,'92 Tit«E: i4-4! �"
� CONSTRUCTION AND PLANNWG� - � POO� aPA , �
-APPROVALS Permit,# � Date Inspector APPROVALS Permit# Date �--Inspector
~7. Temporary Electrical Service o� Pole 52. Pool & Equipment Location �
_ . �.
2, $pil Pipe•Undrgmd. � � 53. Steet Reinforcement
� 3. Electrical Conduii Utility-Un�rgrnd. � 54. Forms
4. Electrical Cqnduit�Undrgrnd.- .�� 55. Electrical Bonding -
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. E�ectrical UFER Grnd. •• . - 57. APPROVA� TO COVER�6UNITE
7. Faotings - � 58. �Electrical Conduit-Undrgrnd. -
8. Foundation �, 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. - ' � � �� 60. Backwash Lines, P�Trap, O Undrgrnd.
10. St�uctural Floor System '.. '�� �, 61. APPROVAL TO DECK . ���
1 L Property Sewer Line & House Connection - �,,` 62. Backwash & ftecepmr-Final
`t.
12. SBWer Cap �,,,'� , i���.�� 63. Heater & VenrFinal �
13. Roof Drains ' '� � 64. Plumbing System - Final ��
14, Rough Pl�mbing �� 85. Electrical�Final ��I
75. Rough Electrical-Conduit L 66.-Solar System-final . •�
i6. Rough Elearic 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 Pireplace APPROVALS Permit # - �
21. Ducts,in Structure . 70. Underground Hydro �
22. Ducts, Ventilating ' -71, product Piping OGas ❑Oii
23. Gas Pipe-Rough & Test . 72. Underground Flush ,
24. Roof Fiaming � �. ; -73. Undergmd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing �� � - _ 74:.Overhead Hydro
26. T�Bar Ceiling IStructural) & 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 grown Coac ' � � 79. FINAL INSPECTION -'. .
32. E�ectrical Power Meter-Final � j • 80. FO00 CERTIFICATE ISSUEO
33. Final Electric � � � Notes: � .
�
34. Final Heating & Air Conditioning j' � �
� �r
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. Backtlow Preventer � �� .
{
43. Backflow Irrigation • -
44. Landscape Irriqation System - ' . � �
45. Sound Attenuation • • �
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING y�/yz _
48. FINALPLANNiNG
49. Electric Release to Edison
50. Gas Release to Southem Califomia Gas Co j . - -
51�. CERT�PICATE OF OCCUPANCY ; - - .
No. Date
-� � 18�24
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. 60X 917 C087'A MEBA, CALIFORNIA
For Appiieanf fo Fill In Complefely
TYPE OR PRINT
ADD E'ss 12 �loruo e�s wQ
COSTA MESA. CALIFORNIA'
�� FEa 1 s�i963�rLiJ
�fiN11P,�E DEPT.
CITY Of COSTA MESR
APPLICATION FOR PERMIT
BUILDING
For Office Use Onlv
TEL 'I` BUILDING �^j
CITY NO. '}(JO O ADORE55 e.� �� �
ARCH�TEcr rE�. " COSTA MESA. CALIFORNIA
OR ENGINEER NO. �
ADORE56 � FIRE �//-
ZONE TYPE ' GROUP -`�
CONIRACTOR (� V �1PPROVED .
BV DATE
AODRE55 Q O QRLVQ ZONING � '
CITY Q�IQJ[.(, ��/� Q�(„( Q�R�Q ZONE NO, oF U6E OF NEW S�� ���.
�' P�ANB Z IOYILDING4�/.yl
` /, W
STATE � TEL. R�CI S YO �ean� / �-�i- l
LIC. NO. �� 7 N0. DE6GqIPTION LQ • G� �� �} 3 6
SIZE I NO, OP BLD68. . �
OF LOT Now oH �oi p, p, NO.
USE OF YARDS EVES
EX16TING BLOG. APPROVED ALLOWED
B6iBAGK LIN6 FROM � /, � ICENTlR LINE BT.)
Gc�iea Oc aTxeei O REAR YARD '�`� FRONT FT. IN.
SIDE YARO I LEFT I RIGHT . ft. SIDE �i — FT. � IN.
DESCRIPTION OF WORK
L.SIDE S FT. IN.
NEW I X IIALTERAT�ON I IIADDITION I REAR ._ �/ � FT. IN.
REPAIR I IIMOVING I IIDEMOLISH I BYPROVEO � �' ^ DATE (-! /' ^
vV
SZE�,NG � ROOMS STORIES � .
EXTERIOR WALL C. I800F /p / O n / _/
o.Q - /i7lr'p � n °' - 3 � `,
1 HEREBY ACKNOWLE00¢ THAT � HAVE REAO THIB APPLIGTION THE AMOUM BXOWN UNDER VA TION 18 FOR TNE
ANO BTATE THAT THE ABOVe IB CORREGT AND AGREE i0 COM-
PURP09E OP EBTABLIBNING A PEpMIT iEE ONLY.
PLY WITH ALL CITY ORDINANCEB M1D 4TATE LAWB NEGULATIN6
BUILOINO GON9TRUCTION. VALLIATION '/
SIGNATURE OF PERMI7 FEE $ y'�r"
PERMITTE -^/ / y'/ ' �
$ r7 f"/� I J PLAN CHECK $ �/ S�� �
AUTHORIZED AGE �_ �� �_j C% O
TOTAL FEE � LL
��' 30