HomeMy WebLinkAbout1610 MYRTLEWOOD ST - Building Permits 4`O 9 CITY OF COSTA MESA
is
BUILDING DIVISION
$ •.,,' 41 $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
d0 PERMIT
J604-00791
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1610 MYRTLEWOOD ST Status: ISSUED
Suite: Applied: 04/26/2004
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 04/26/2004
Parcel Number: 13919329 Zoning: R1 R1
Applicant: HERMAN, DAMIEN ISSUED BY: ki9C,c____
Address: 4050 1/2 BROTHERTON
Phone: 909-371-0514
CORONA,CA Zip: 91719
Owner: VUKOJEVICH, ROBERT M
Address 5629 VIA CORONA
Phone:
LOS ANGELES,CA Zip: 90022
Contractor: HERMAN ROOFING
Address: 4050 1/2 BROTHERTON
Phone: 909-371-0514
CORONA,CA
Zip: 91719 License: 348265
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.APPLY SHEATHING AND COVER WITH 30 YEAR COMP.INCLUDES RESIDENCE AND ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,200.00
Permit: $125.25 Claim Valuation: $5,200.00
SMIP Res: $0.52
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.77
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 . Right 0-0 -
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty 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 thi‘permit Is issued.
❑ I have and will mai tin 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'compo• atlo nsurance car'.'nd ..licy number are:
Cartier: \ • \ Policy Number:
(This section need not be completed if the pe it is valued et one hundred dollars($100)or less.)
.c:)5(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 subject to the workers'
compensation laws of California,and agree th If I should become subject to the workers'compensation provisions of Section37
�offtth�e1L ,r Code,I shall forthwith
comply with(hese provision Date: cj ' 7o/ y
Applicant Signature: ��F + V
WARNING:FNLURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 Profession Code,and my license is in full
force and effect.Lie.# '56-7_ CS- Class# C 3 t '
Contractors Signature: 1. �C>' Date: �I' 2<„/
CONSTRUCTION LENDING AGENCY: 111 ut (J
O 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: Lenders 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 penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered 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 property,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 under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 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:
1 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? 0 Yes ❑No
(Section 25505 of the California 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 Cale 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 aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes S No
(Section 65850.2 of the California Govemment 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 a permit 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 prescnbed by California Health and Safety Code Section 42303 been made? ❑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 COMPUANCE 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 with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
(t_t/,ç,,
nature Of Legal Owner(s) T to707Ot Uthorizad-Applicant
SODS 0 INSPECTION TYPF PA7F INTITIALS CODE E INSPECTION TYPE PATE ILLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � I,/ 208 Final Plumbing
200 Final Re-Roof y 30-04 T '-�4' 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
OSTA MESA CONSyTRyJU�CTION PERMIT I PERMIT NO. TRACT NO. LOT NO. UNIT NO. 0964 /` ��I .
Project Address lei/0 1-1?
1 (� / I (A420D [� 3 2_9 o 8
Applicant's Mailing Address 2^ r LLQ_i•-4-C pL/ 'A,4` Coj(,;)_ TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION 51 REPAIR r '
Owner's Name Mitt L/N6 v `c PA-44 bile t r(Q�4 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Address /tie my •�y�frrl7G0 cos 7f /JArti-
S `/02/ DESCRIPTION OF WORK/USE OF BLDG. Pe-—frna
[my /m- / � e b
S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT LI GRADING U FOUNDATION IIqq�f E Z
g US:STRUCTURAL T Front• . O
Address . V gejv ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear N
AERO-277,W o NSuL#rT� ao• " OTHER
Contractor's Name Z C �L4N� ,t��¢�• r PROJECT DESCRIPTION Sq. FT. Z.fl C OCCUPANCY C Right - - G
Address(mailing) ��4 �L� �-(/) P� K
L S/ CONSTRUCTION TYPE VALUATION$ 32,.00 s Left • R
City License No. IP ZONE GRADING CU.YDS. - ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
Mitt
per/ v1 c! rein
^��y�(et./4
Ce A• tannin Notes: 0
with section 7000) of Division 3 of the Business and Professions Code, and �'//'/�}y�/' P�r'S• .(ruvD s/+f/•1�6� wlTl{ ! '///a/Cu t 9 M
my license is in full force a•d ffeCt. ;2-Z�I r) 4'717 /"[0 /L�/ $
License Class II^ �L `O. L ��(/-[ / ria' I
Date — • Signature . /(P�/. �z PLUMBING FEES
l WORKERS'COMPENSATION DECLARATION Bar Sink - Showers /
C lereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance or a certified copy thereof (Section
^�1��Q�S1 Backflow Preventer Service Sink
..800, Lab. C. ) J Automatic Washer Transformer 0 15-50 K t
Policy No.73'" We'•�Z Company .�R• • Oq/ W I •� Backflow Irrigation Sewer Cap7 0 50+
(Certified copy is hereby furnished. / DOn$trllctlOn Pole Sub.
Cerli opyii sled with the city Bvil ng DiviS ,�/ Bathtubs Sewer Connection Cooking Unit Meter ❑up to r0 amps
Date (� X15 Applicant tact %VLRRLC��CCC����
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collect Dishwasher . Meter 0. -r 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Pi • g Dryers ❑Gas DElectric Sub P. el
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 subject to the ' Drinking Fountains Sol ank Fan •.tors❑0-1 HP ❑1'/z-8
Workers' Compensation Laws of California.
Date Signature Floor Drains -wimming Pool w/Spa F.A.U. Inc Solar❑9-15 HP ❑i6-15+
NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions Or this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes POI¢ LI ht
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit Is Issued (Section 3097 Civ. C.) Interceptors Water Heater ts
Outle
Lender's Name - Range
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disl+ Standing Sections
county which requireija permit to construct,alter,improve,demolish or repair P-Trap Laundr Trays
any structure, prior to its issuance, also requires the applicant for such permit YGenera + 00-5 KW 05-15 KW Trash Compactor
to file a Signed statement that he/she is licensed pursuant to the provisions of Roof rains I--
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
')ivision 3 of the Business and Professions Code) or that he/she is exempt .
ierefrom and the basis for the alleged exemption. Any violation of Section
031.5 by any applicant for a Permit subjects the applicant to a civil •
penalty of not more than five hundred dollars($500).
OI, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered - - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL • FEES •
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ I Zoning Approved By Date -777/62.7
prove f r th owner will have the burden of proving he/she did not build or Im- Duct- Under Ground Building Approved By X-44-
% V ' ' DateL
sU I. for the purpose of sale).
O I.as owner-of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who • Duct-Ventilating ❑Q1DD,DDD B ,ODD BTU
builds or improves thereon,and who contracts for such projects with a con- _- SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware that —Exhaust System Multiple - BUILDING PERMIT $ 2R • 00 SMTP $ O• So
❑ ❑ S
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ lam exempt under Section— B.8. P.C.for this reason Firepl/Fact.Blt. ICBO# .........-77---. Fire Dampers _ • . •
PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducts Registers
PLAN CHECK 25% $❑0100,000 BTU 100, ENERGY P.C. $
000BTL
I hereby certify that I have read this application and state that the above GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to ant r u on he ove-mentioned property,l/y O,
Inspection port, •� 7-1-
- MECHANICAL $ TOTAL FEE $ 2 O . SO
Signature L�•( Date (�
Drivers' License or 55# ' -- • ' Reinspection Fee j $15 Issue Fee $ 3 PLAN CHECK 25% $ •
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor
•
CONSTRUCTION AND PLANNING • POOL & SPA
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑ 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 64. Plumbing System - Final
•
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL•
•
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
r y
20. Rough Factory Fireplace APPROVALS Permit# - • .-
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
I '
28. Lathing & Siding 77. FIXED SYSTEM FINAL',.
29. Insulation 78. FIRE PREV. FINAL �' tj .
30. Drywall Nailing HEALTH DEPT.-REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION _'�!,'• _
r.
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
•
33. Final Electric Notes: r
-9�-YI. �os N�ReAoy year � G
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy .'.'t.
11 -
37: Final Factory Fireplace ) ,< <
It
38.Final Plumbing 4 L• .1 „"
39.1/4ater Service-Final / •'
7 4- `.
40. Gas Service-Final - - - 4
�1 a
41: Solar Domestic-Final ?it
r '
42; Backflow Preventer ) ,.. 4
43 Backflow Irrigation 4
44. Landscape Irrigation System i
45 Sound Attenuation I :^ •
)- e.
46. Handicap Regulations
474, FINAL STRUCTURE & BUILDING 7/17/s7 /�� '44 7- „1
48tpecial Requirements Completed
49. Electric Release to Edison •
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
•
No. Date
I •
- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PER T NO. • TRACT NO. LOT NO. UNIT NO.
��.. STA M�Sq,`�O TRU TION PERMIT 5465 9/17/67 5900 TL
I Address (NO sr le. o d K3D a 9a 1I�/
,`f�'t+c_ — TYPE OF CONSTRUCTION LI NEW U ADD LI ALTERATION LJ REPAIR f
. 'Applicant's Mailing Adyr�y��ss 6 l� —J ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone
Owner's Name / r t� n�l _Phone DESCRIPTION OF WORK/USE OF BLDG.
Address 1 / r �. S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING FOUNDATION LI STRUCTURAL E Front O
Address /��/ p,, �j/� /� ❑ T•ENANT 111 ELECTRICAL 4d PLUMBING ❑ MECHANICAL OTHER B Rear N
Contractor's Name '/ {' LLt t'j�- `���!.�jty Phone ��>,'��lQy� —
C Right N
Address(mailing) `QJ1ji 3 3 �/ y Ph F �/a w PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
Q CONSTRUCTION TYPE VALUATION$ S Left
R
City License No. ZONEI GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION - Ping. Ref.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: N1
with section 7000) of Division 3 of the Business and Professions Code, and " ' T
my license is in f , ;Fr ce and effect.
•
Li cen layr_ 'cen a N',Ana 01. a, - (a` � sr
V� ^ s
Date •ale' taer Signature Ara �� ^ • PLUMBING FEES RECtiVE
WORK RS'COMPENSATION D CLARATION Showers -
'f.hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Si•nk
ELECTRICAL FEES
i Workers' Compensation Insurance, or a certified copy thereof (S ction Backflow Preventer Service Sink 0 15-50 KW
3600, Lab. CS (y 1 - Automatic Washer Transformer
1 Policy No; 'Afyi Q � Company< Jf(� Backfldw Irrigation Sewer Cap . Construction Pole Sub. 0 50+ KW
Q. ertified copy i hereby furnished.
• i Cer d c p .ylgtl with the city {M�di,��vl n. Bathtubs Sewer Connection Cooking Unit Meter [pup to 100 amps
Date P I R / KERS'C KM y 4
EXEMP i n ROM WORKERS'd OMh ATION DECLARATION Clarif iCrs Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or '
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued
shall not employ any person in any manner so as to became subject to the Drinking Fountains 'Solar Tank Fan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California. _
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9.15 HP ❑16.15+
NOTICE: If,after making this declaration,you should become subject to the - - --
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole
' I hereby affirm that there is a construction lending agency for the performance Light
of the work for which this permit is issued (Section 3097 Civ. C.) interceptors ' Water Heater a — Outlets
Lender's Name Range
• Lender's Address - • Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap LaundryTrays r
y Generator ❑0-5 KW ❑5-15 KW Trash Compactor
any era Signed
priorattom its hat he/, also requiresicesthe tcto applicant for srochvi ionspermit p
to file a Tactor s Lcense t that he/she is pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9s(commencing with Section 7 x) of
herefrom
3 of the sis and Professions xe Codon or that ais exempt
3and the basiscfor the alleged exemption. ey violationpict ofa Section
Penalty
any re aant for a permit subjects the applicant to a civil
0 I, a of not r more than five property hundred dollars($500).
❑ I, owner of the wo , my employeesctrwith wages d their sole Reinspection Fee $15 Issue Fee $ 3
compensation,ale (Section
will do the work, and the or scion is not intended Contractor's rd - Reinspection Fee I $15 Issue Fee - $ 3
for nse (Section 704ap ly to an and Prf a prop r Cotle: The mroves MECHANICAL FEES
-
thereon Law tl Oho does apply to owner f a property wro builds s or improves _ _ -
tpo andwho thsuch work himself/herselfs or through tende his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees,le. If, provided that such improvements eves are not tor year
of dc for Boiler Hood
ano or Type I 0
sale. If, hehowever,wthe building improvement of pro i sold within one your d rum- Canopy Type II 0 Zoning Approved By Date
prove the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
Prove for the purpose of sale).
0 I, as owner of thet the property,roject am exclusively contracting with licensediocon- Duct-SVuctural Refrigeration System Application Issued By Dat
hepors Contractor's aonst/u Len er Law (Session appl tBon innss o antl of pr pert Cade:
The s mproLicense Law does not ato an owner je is hta who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with aeon-
tractor(s) Repair/Alteration pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System BUILDING PERMIT $ SMIP $
proof oftheir worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 1 am exempt under Section B.& P.C.for this reasonFirepl/Fact.Blt. ICBG# Fire Dampers
—
—
PLUMBING $ S.CID ISSUANCE $
Date Owner Heating System& Ducting Registers ENERGY P.C. $
PLAN CHECK 25% $
i hereby certify that I haverread this application all and state that the above 00-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
information is correct. agree toicomply cost with all dy and uth irepre-
sentatives
state laws relating to building co ztruction and, hereby authorize Tepee- MICROFILM $
inspection of this cit to nter u
th Eve-mentioned property for PLAN CHECK 50% $ d
inspection pure (kJ�(DD'"p011 e MECHANICAL $
Signature
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND-tPLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1.-temporary ElectricarService or Pole 52. Pool & Equipment Location
•
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ,et
d
3. Electrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings i . r - . - 58. Electrical Conduit-Undrgrnd.
• 8. Foundation '- ' 59. Gas Pipe, O 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 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval •
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
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 Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 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. 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: (.((.88 G E/+rG4QA • L.tit, _
34. Final Heating & Air Conditioning ft t 4 G
v vnOtt. AS Pang S OPG .t tp:•,
35. Final Gas Pipe-Test "! / w
36. Hood or Canopy
37. Final Factory Fireplace ;
38. Final Plumbing .07/
39. Water Service-Final •
40. Gas Service-Final • I
41. Solar Domestic-Final ' . •
42. Backflow Preventer ' - ' •
.
43. Backflow Irrigation .
-
.,44. Landscape Irrigation System ' ,
45. Sound Attenuation . .
46. Handicap Regulations ' i I .
47. FINAL STRUCTURE & BUILDING • ' ! .
48. Special Requirements Completed • . . . - /
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -
ii51. CERTIFICATE OF OCCUPANCYNo. Date 1
OWNER ADAMS ACRE, INC. • DATE 6-3-59
•
JOB ADDRESS 1610 Myrtlewood st. BUILDING PERMIT NO. 948.9
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 15,571.00
AP. No. LOT
LW 2822 1822 FIRE ZONE DESCRIPTION OF WORKS•N/att•�''az'•
INSPECTIONS ,a444" DATE GROUP I & J TYPE V ZONE RI
Underground Soil0.j,7.dU.G. Water/Y}/-S G-'4-4-4 SUBCONTRACTOR PERMITS ISSUED
Underground Gas DATE NUMBER
Overhead Water and Gas ±
Rough Heating A04S -Y St/ •1/44-,ILi.- /f-;. 21. 7:-S2-7- 1 _rP '7
5y 'i/e ✓
Rough Plumbing P-7-&9 A. eiA, •% / /O-%-`i% /9 y_.
Miscellaneous -
Prop. Swr{Line H,tiuso'Con. St. Swr. /p 7'4 7,...t.,,,,,,,_ e,7f— 7 /3 o/S"9 /6-&-s'? V q /
Sprinkling System �� d^
// '
Heating, Final yds Ca2sD 0�
Plumbing Fixtures /a,7 '. 1 9' _ _t 'J
Final Te
Construction P olele
Underground Power
Rough Wiring GLC,. srt/.14/ ,eiA/V?a�ai-,7J1, 7-A---7- 9 W. 9 7
iv
Trenchese Forms V Steele-V id- ,/%/l
Floor System VV
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing /MN 'F'5- '51 _
Frame and Flashing I, 7-/9-51,
Lathing, In C% Out yf:L 5--2-4-51 _
Plaster, brown coat ?V?% 5-lir 51 \..—
Plumbing Fixtures, Final 111 ib-, 3- "<.
Electric Fixtures, Final
Building, Final P t0 -
OCCUPANCY /
Form 210-3M-4-59
9489 _,L1 R G .: ;� -
GMe" JUN 3 1959
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE QE°i.
P.O.BOX 317 COSTA MESA, CALIFORNIA
`II' Org. •r, -ICC..
f0R APPLICANT TO BLL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1610 Myrtlewood St.
COSTA MESA, CALIFORNIA fOR OFF/CE USE ONLY
OWNER Adams Acres Inc. RECEIPT NO. I -PERMIT NO.
MAIL 419 E. 17th St. RECEIVED BY DATE RECEIVED I CPATE I//I'SYsy
ADDRESS r L0)r Gi.•-- j 6.—J
CITY Costa Mesa TN0. 81159 DING
ADDRESS '
ARCHITECT Carlson & LIG. COSTA MESA. CALIFORNIA
OR ENGINEER Middlebrook NO.
ADDRESS & Garden Grove - ZONE Type LI Group ,� ;� SI-
CONTRACTOR C011legrvove,, Inc.L.
C NO. 167293 APPROVED BY DATE jf
ADDRESS 419 E. 17th St., Costa Mes ZONING
LEGALI LOT 1 1 9 �2822 ZONE/ NO.OF I USE OF NEW r�
DESCRIPTION NO. JJ- BLOCK TRACT PLANS BUILDING '.V✓i/' O
APPROVED
A.P.NO. BY DATE
SIZE [� NO.OF BLOGS.
OF LOT 60 JC 10k NOW ON LOT non REQUIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. nnne FRONT A-1) FT. IN.
SETBACK LINE FROM
CENTER OF STREET 501 REAR YARD 351 R.SIDE r FT. IN.
SIDE YARD I LEFT 51 (RIGHT 5' L.SIDE 1 FT. IN.
DESCRIPTION OF WORK
REAR CP-04 2 FT. IN.
NEW I X I ALTERATION I V ADDITION
REPAIR I I MOVING I. V DEMOLISH
BUILDINGNO.OF
S ZE 1560 ROOMS 7 STORIES 1
EXTERIOR WALL ROOF
COVERING StuCCO COVERING Shinu(�lP '
USE OF BUILDING AND WORK TO BE PERFORMED--
Single family residence with
attached double garage.
Plan 12013 - -- - -
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. VALUATION
SIGNATURE OFC-19(0_,./72,14 PERMIT FEE $36,00
PERM ITTEE 4 .y - --
$ 15,571 PLAN CHECK $18.00
AUTHORIZED AGENT nikP R. fin c,„,,,,„„, T.,,„ TOTAL FEE $54.00