HomeMy WebLinkAbout2316 HALF MOON LN - Building PermitsINSULATION CERTIFICATE
This iS to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at
< _-: .,.
�,,��� �'�yALF MOON LANE-P,�HS3-TRACT 16600-COSTA MESA
°�'�"' LOT-12
CEILINGS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-19 6-1/2"
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning
GENERAL CONTRACTOR: SHEA HOMES
�
THICKNESS: R-13 3 1/2"
LICENSE#
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2
BY: �,��Y� I��,d�Larv� TITLE: PRODUCTION ASSISTANT DATE: 02/07/2006
ANNETTE PATTERSON
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at
HALF MOON LANE-PHS3-TRACT 16600-COSTA MESA
LOT-12
CEILINGS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-196 1/2"
W ALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning
GENERAL CONTRACTOR: SHEA HOMES
�
��r���
SCHMID INSULATION CONTRACTORS, INC.
THICKNESS: R-13 3 1/2"
LICENSE #
LICENSE #221517 C-2
BY: �n� � TITLE: PRODUCTION ASSISTANT DATE: 02/07/2006
ANNETTE PATTERSON ^
�s�r��ac
�AIR GONOITIONING INC.
"D
Site Address
2316 HALF MOON LANE
1. BUILDER INFORMATION
Shea Homes
603 S. Valencia Avenue
Brea, CA 92823
Installation Certificate : Residential CF-6R
Unit:- ('Z
INSTALLING CONTRACTOR:
2. PROJECT 1NFORMATION
DISTRIBUT'ION TYPE
Flexible Ductwork in
Attic and Between Floors
PERMIT #
SUBDIVISION: HalfMoon Lane
CITY: COSTA MESA
COUNTY:ORANGE
WESTPAC AIR CONDITIONING
DUCT OR PIPING R-VALUE
Flexible Duc[work Will have a
R-Value of 4.20 or Better
I, the undersigned, verify that the equipment listed in the category above my signature is the equipment installed and tha[ the equipment
meets or exceeds the requ'vements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or
more efficient than the equipme�t specified on the Certificate of Compliance submitted to demonstrate complience with the Energy Efficiency
Standards for residential buildings.
3. HEATING INFORMATION
HEAU PG �MAKECT HEM DEL�IT AC AF� FF. HEC� C� IP HLOADG
Fumace Lennox G40UH-48B-090X 80%
4. COOLING IN�ORMAT[ON
COOUING MA�KECT C MODEL#OR ACTUELREFF. COOA ACITY [P HLOADG
A/C Lennox 13ACD036 10
The building design heat loss and desi� heat gain rate have been determined using a method specified in Section
150(h) of the Energy Efficiency Standards, and are two of the criteria used for equipment sizing and selection.
5. THERMOSTAT[C EXPANSION VALVE (TX�:
Thertnostatic Expansion Valve (or Commision approved equivalent) is installed and access is provided for inspection.
6. SUBMITTED �Y:
YES Q NO Q N/A Q
WESTPAC AIR CONDITIONING
Signature Installing HVAC Contractor Date
See 190 23rd St. for add'I
paperwork covering entire tract.
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c$��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92676
.lob Address: 2316 HALF MOON LN
Suite:
Vicinity: LOT 12
PrimaryOcc: ' R3 Dwellings/CongRes<10
Parcel Number: TPN00522
Applirant WILLIAMS, GARY
Address: 1450 N. TUSTIN AVE
SANTA ANA, CA
Owner: SHEA HOMES LTD
Address 603 SOUTH VALENCIA AVE
BREA, CA
Contractor: OW NER-BUILDER
Address:
Zip:
TypeofConsWction: V-N
Zoning:
Arch : WILLIAM HEZMALHALGH
Address: WILLIAM HEZMALHALCH ARCHITECTS INC
SANTA ANA, CA Phone: 949-250-0607
2850 REDHILL AV STE 200
Zip: 927055543 License:,�,G12920r';�
LOT 12
PLANS 3A
CONSTRUCT 1693 SF 2-STORY SFD
MODEL 4236 (ANSI UL127 WILL BE II
�,aY21.�
SEE PA-03s47/l;;16600{�„
'� Com:
Other:
Total:
1„�4�Y3.75
>$17.41
$0.00
$0.00
$0.00
$1,660.9i
67- 0
0- 0
0
�•�Rear 43-0
Rear 0-0
Reauired: 4
Phone: 714-2459760 X19
Zip: 92705
Phone: 714-985-1300
Zip: 92823
PhOne:
License:
PLANNING 8 ZONING
Left 50- 0
Lek 0- 0
Pr000sed: 4
ISSUED BY:
SF AND 983 SE
OOR LAUNDRY
Calc Valuation:
Claim Valuation:
Right 10- 0
Right 0-0
Status: ISSUED
Applied: 01/24/2005
Issued: 04/04/2005
FIREPLACE
$na,oss.so
so.00
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia s�atutes and related
regulalions. (Ord. No. 92-28, § 7, 12-21-92) .
EXPIRATION: This permit shall automatically ezpire and become void it work is noi commenced w�thin 1 BO days, or il work is suspended or abandoned
1or a period o1 1 BO tlays.
INSPECTIONS: In order lor the work authorized under this peimit to be considerad legal, such work must comply with all applicable codes, and all
requlred inapectlone end 11na1 epproval must be obtained. Failure to obtain inspections and final apP�oval will result in the expiralion ol ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
�rswo I�vwl
WORKERS' COMPENSATION DECLARATION: " �
I heraby aHirm un0er Penaliy o� pequry one oi IDe following tleclara�ions:
❑ I heve antl will maintain a ceni�icate ol conseN to sell�lnsure for workors' compensa�ion, es pmvitled �ur by seclion 3700 0l ihe Labor CWe, lor the pertormence of I�e
work for which �h�5 Vermii is issuetl. ,
❑ 1 navo anG will l�aimain workeK Compensalion in5ur3nCe, as required by SeC�ion 3700 Of Ihe Labof COtlO. �or I�8 perlormanCe o� lhe work lor w�it� Ihis pennit i5 iSSued.
My wurkers' compen53tion Insurance carrier antl policy number ere:
Carriar Policy Number:
(TNs sectiun nenU nuf be comploted rt f�e permrt is velued ef one hundretl dollais (S 100J or less.)
❑ I certity Ih9I in Ihe poAormance Ot I�e work for w�ich Ihis Oermit is i55uetl, I shall nol employ any person in 3ny manner so as Io Cecome Subjecl to ihe work9rs'
compensation luws ol Caliiomia, antl agre9 lnai il I ShoulC become sublect lo Ihe workers' compensation provisiuns of Ser.iion 3700 0l ihe La�or Cone, i s�all toMwith
comply witn in�se pwvisions.
ApG�icent Signatwe: Date: _
W�NNiNG: FAIWRE TO SECUPE WORKERS' CtMAGEN5r1TION COVERAGE IS UNLAWFUL AND SHALL SUfl1ECT AN EMPLOYER TO CRiMINAL PENALTIES �ND GVIL FINES UP 10 d�E HUNDRED
TMO�SMID DOLLARE �5100.GW�.IN AD�ITIIXJ TO T/IE COST OF GOMPENSATIpJ, DAMAGES AS PROVIDED FOR IN SEC110N 3�060F THE UBOq CODE, IMEREST,ANpATTOHNEYS FEES.
LICENSED CON7RACTORS DECLARATIUN:
I �eroby aflirm I�aI I am licensetl untler pmvisions o� Chapler 9(commencing wuh Seclion 7000) ol Division 3 0l Ihe Busine:'s
IOrce antl etlecL Lic. � Class �
Contraclor's Signawrnr Daie: .��
CONSTRUCTION LENOING AGENCY:
❑ I hernby attinn ���at mere is a consvucbon IenAing agancy br t�e pertormance of the work for
Lenoer's Nama: Lentler's Atltlress:
Signaiure: .+��
OWNER-BUILDER PECLARATIONS:
I heraby aflirm thel u��Uer penatly ot perjury Ihat I am ExEMPT FROM TT1E
Code: Any city or county which requires a permi� Io [onslmct, alter, impmw
m blo a signetl sletefnenl �nat ha or sna is licensetl Oursuanl to lhe provisiC
Business antl Prolesaions Cotle) or that �e or sne is e.emD� t�erefrom'9nC
suo�ecls Ina appliCani �0 a civil penal�y ol not more tnan tive nuntlre0 CWIa`ia
f- 'i' -� "9
❑ I, as owner ot Ihe propetly, or my employees wilh wages as tlielr fde
7044. Businns5 antl Pmlessions Cotle: The ContractorsLldense LnwC
fimwH o� her5e�i os ih�ough his or he� own employee5(piVvMBt! ihai:
sdd withln one Vear ol comple�ion, t�e owner-Duiitler wUl fiare�ih0 bur
-m��..�:.,,� �
❑ I, as owner of i�e pm0eny, am E%CLUSrvELY CONTRACTNC WIT
Code: Tne conuac�ors Licensa Law.does not apply tn an uwn'er ol pm
license FursuaN �o tne Conlraqore Lkbnsa Laws.) °�� ya� ;� �
❑ 1 am exemp� untlar soa !�=��•`•+t>�'� �>� 1FF 1Pg;YBusiness ai
Signawre: IC'�i�"'�'�,, :vi'_� �4"�i.^::���.{{�
OW�BfIDVCf111BCDYdfIVEf9�IIC8098.���O.�B9� Q',id0�#�)
L'': r" , a'. =. .�.-'e � 7 f.... . 3
Venlicaiion ol Ownefship py,(typ9,o1_Cq7irrignY,l.e. - p�pp9tlyt'ar Dill or tlee
DIVISION OF INDUSTRWLSAFETY PERMITCERTIi1CATION:
�' �„'" ( JI ::,-.'m�
� I horeby cenity Ibat no exWvation five (5) or more leel ln tle0�� into
Dermit, ano iha� {w h�ulding stmcture. scatloltliny �falaeviak, or den
341, litle B, CalHomia AOminislralrve Cotle�. �; -:�ia �� z
, or r6pair�'arry simcwre,"prjoF,to Its issuance
��ontrgclwn Llcense La✓.(Gliepter 9 (commer
br t' Bllepe8 exem}p,tion.!/U�y violation ol S
��"�+'`'�� 7"�•:`a�.•�
r� #
iion, WILL• DO�7ME WORK,,eno tne stmdun
)ply Ib en_'oWlief�pi pl0pe/ly�who Duilds or iml
oemenh ata rot'vkan6aE o� ofleretl tur Sale.
�ing Ihet he or�ilie dd ria builtl or improve fo
' ,r
iD COHfRACTORS tc'constmcl tne Vrolnct
miltlSI�Ci.hiprov0s Neieon, and who cnnlrac�
, `+»ia'!',
�ons Efotlo'�w Nis reason:
.. I:i'u�i�zi.'3;� Ud�B: _
my hcense is in lull
31.5, Business and Protessions
35 the apP�icam to! Sucn parmi�
3c�ion 7000� ol Division 3 of Ihe
.5 by any applicani lor B permit
idetl or otleretl lor sale (Sec.
�on, antl who tloes suc0 work
ine builtlmg or improvumen115
sala.).
Business antl Professions
rojecl wi�h a conlraclo��s)
]escenQ wdl be made in connection with work eWhoriae0 by t�is
will be more than IOuty�sis (36) leet hig�: (C�ap. 32, Grp 2, Art 2, Sec.
❑ As owner-buildw �I'wiA nol employ anyone to tlo work�wtnp� w0uk require a permii from Ihe Division ot Intlusirial Sale�y, es noietl aGove, unless sur,h person hus e
permit io tlo SUCh wotk irom the tlrvisiai� � �� �-.
� y
Siqna�ure: �. f��.-.+ �: 1 �,v:Jw'�.% o: �r r� 5+'^ � Dale:
f;'-a1'1.- Ii,ti" ��•'�-�,+'��` l
,,_..-i Fn,.- t,�:�:•� . '
6ivisionoflntlustriaf�561sryPeimitNumber."<=r� •M�;r�
,+ ._� a-:r
MAZARDOUS MATEA��ILS�AND EMISSIONS CERTIFICATION:
r.
I W ill ihe appllcan� or�WeaBnt Or,qiUire bu�ding occupam neatl lo lile entl cenity a Business Plan lor emergenry response to release or �hrealenetl releaso of a �azertlous
. _. _. i...".. .
ti
7
ISection 25505 oi;�he Ca�ifomje�.Hea�tli,and Satery Cotle requires, wM some eacoptions, IDat a Business Plan be lihatl wil� ihe Cosla Mesa Fire Depatlment by evury
business which has ePeny one:tlme during a ieponetl year a quantity of hazartlous matenals equal to or g�eaier tnan a weight ol 500 pountls, or a volume ot 55 galbns,
m 200 cuo¢ tee� Ot eompressetl gea et stan�artl temperature and pressure�.
........._. . .......___.._.�.�_._` _ ........ ... ...._ .... ... ............ . .............. ..... .......... ..... . . ... . ... ... . ............ ...
Dces or will me aUGucenror presenl or luwre 6uiltling occupant need to file a regislmuon form lor aculeiy hazarUous matenals7 ❑ Ves ❑ No
�. t.r a.
ISeclion 25533 0l Ine'Celifornie�Health antl Safety Cotle, with some eaceplions, reqwres registration wilh Ihe Cusla Mesa Fire Oepariment by each Eusim�ss which eI any
una Iirt�e has un nanC:e,qunn�ity of aw�e�y hazartlous maleriuls equal to or greu�er Oian e weigni ol SW pountls, or a volume ot 55 gallons, or 21p Nbic fuel o�
compressea ga> at slanoartl lemperature antl pressure�.
................................. . ........... _...................................................................................._.........................................,,..................................................._...._........,............................................................................................................_.......
Goes ur will Ihe aVOhcam or O�esent or tuture builtling occupant need to prepare an RMPP (Risk Management antl Prevention Yrogram br aculoly haiartlous malerialsJ7
❑ Y'uti ❑ Idu
iSnction 2553a o� i�e Calnomia Health and Safery Cotle D�o��des ihai Ihe Costa Mesa Fire Departmenl may require Ihe pre0aration, certiliwtion and tilinq with Ihe Fire
Depanment ol an HMPP by buslnesses w�ich are repmretl to register acutely �azardous materiais wilh the Rre Departmeni.
.......... .. . ... ............. . . .._........ .............. .. . . . . .... . .. . .. .......... ... ......... ...
............ . . . .. ...... . .... ....
. ..... . .. ..
It an NIdPP is presemly requuetl, nas Section 25534 ot t0e Calilomia Health and Salety Coae been lully comphotl wiN? ❑ Ves ❑ No
,.... ............ . . ............ . ........ ..... ..... .. ............. . ...._ .. ..... ....... , ........... ........... .. .. ..
Uuns oi will I�e applicant or presunl or fuwre builtling occupaN requve tor t0e work whith is the sub�ect ol �pis .ap plica�ion a permi� for such consvucuun or motlihcaeon
Irom Inn Soutn G�asl Air Uualny Managemenl Oislnc� or tmm any other air pollution caniml disina or agency� u Ve� �J No
ISacuon 650502 M me Calitornia Govemmen� Cotle reqwres IOai �ne reque5ietl inbrma�ion be lurnishetl on applicaiions lor nornresitleniiel buil0ing permiis).
......... .. .............. .... ._........._ , ..................., ...._..... . ........... . .
............. _..._.._ .........,..... . .. ... ..... .
Will ai� ......... .. . . ....._.... .......
V Va�S ol 0�e lactliry b be wnstmclatl untlea this pe�mit be wrthin 1 WQ leet hom the nuta� Doundanes ol a school? ❑ Ves ❑ No
�II'yes", If�e �ar.ility musl mee� Ine reqwremenl o� Sections 25534 antl 42303 0l Ihe Calitornia Heall� and Safety Code).
...................................., ............................._.........,.._.......... .........................................................................._......_............................_...............................__............_..........
� ....._. ............................................_..................._...................,
II a parnul �mm ��e South Coasi Air Ouality Management Districl or other air pollution control dis�ncl or agxncy is requiratl tor Ihe work which is Ih� sublect ol ihis
apuhcauun, na�o au of Nx disciosures prescn�ea by Calibmia Health antl Satery Cotle Seciion 42303 �aen made7 ❑ Vas ❑ No
..._........... _ ....................................................._......................__..... _....._.......................__.............................._................................................................................_....................._................_.............._.............
. .....................................
pl yes', eua<n Gendwate ot compbance Imm Ilro apD�oP�iate au pollulion conirol oHiceQ.
CEHTIFICATG OF COMPLIANCE: I ceniy �na� untler penalry ol perjury V�e informatian given above is coneCt. I agrea 10 compty wi�h all staie laws and ci�y orainances
�egarUing Hazartlous Mamnals and EmiSsionS.
S�gnawre: Uato'
CERTIFICAtE OF COMPUl�NCE AND AUTMORIZATION OF ENTAY: 1 CBNty uatler penal\y ol perjury tha11 have reatl this spplication antl slale Ihat the information given is
correcl. I agree lo cOmpry wi�b all slale laws entl n�y ortlinances rela�ing to Ouiitlmg consimction, antl dul�orire rapreSeNatrvas ot Ihe Gty al Cosle Mesa to enter upon ihe
above�aescnbetl pmpeny for ins0ec�ion purposes. I agree not to occupy or allow occupancy ot any builtlmg authorized by Ihis permit until linal inspoction.
cooe ,. IHSVECTIOH�Vk
1616 Fiietl:3Wt� I
Fire
203
2oa
Signalure OI Legul Owneqs)
And/Ur Auillor¢etl ApPhcaiV
Wall
U�iE IN I�j CODE � INSPECTION TVPE
Q�!u �n*�us
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesaELECTRICAL PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 2316 HALF MOON LN Status: ISSUED
Suite No Applied: 09/30/2005
Vicinity: Issued: 09/30I2005
Parcel Nunmber:
TPN00522
Applicant: GARY WILLIAMS �
Address: 1450 N TUSTIN AV ISSUED BY:
.-Phone. 714-245-9760 X19�.
BREA, CA '.�.. " �Zip�, 92823 � " � -'���` . . "
_ ,�
. �� Tm�°� ,_
Owner. SHEA�HOMES LTS -. „ �'`` ' ° - ��� `
Address 603 SOUTH VALENGIA AVE � - " � - -- - ' �<�'° ;.�?, �_.'< I-.. �,-a-,
� . - ',�"Phone: 714-985•1300 `, _ .
BREA. CA � _ti, ~ Zip: 92823 _ .
G,. 4. 4.. ��
�
Contracror: �OWNER-BUILDER �
Address: � :�:'�� ,
� .
�., ;; Phone : �
r^.�� Zip
��:`,`- ��� . License: 000000 ` � ' � -
� `s- - � �
� � �-,�
'¢' ' � "" _ " �`" SCOPE OF PERMIT
S.F.rI
� _UL;t�
+ � ELE(
THE
�� �ISSUE FEE
�" Temp service test �'°
� Res. a/c package
New�Res (1=2 umts) ,
NewyRes (3+umis) ��
Pool / Spa
Lighting FoAs �� �� )��'
ReceplOutlets `.
Switches ��
Non Res Appl�� .,
Res Appl
Service to 200a
Service to 1000a --
Service over 10002
Mo�ors to 1hp .
Mofors to 10hp �`
Motors to SOhp -
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
r,:���,. �� . „ � ;.�.
3 S F 2-STORY SFD WITH 483 S.F. ATTACHED GARAGE. WORK TC
�R 983 S.F. FOR THE 2ND FLOOR AND INSTALL A FIREPLACE, MC
ICALTO INCLUDE.t9693�S.F.; 4 LIGHT FIXTURES, 40UTLETS; AND 2`SWITCHES.
tAGE � = '- � �_ e z � ;< ,' t i: : � ��.
, . -. - ... �-s� �. . _ �.z., - -- -
_,.,
���'� �= Quantiry � �
$23.50 - � . . . .
" $O.OQ_'`�" � . ` . -
$OAO' �"' ,
- $94:81�..�:�.: 1693
$0.00' "�� 0
-$0.00..��, 0
. $4.4D �..� 4
$4.40 4
$2.20 2
• $0.00 �= 0 � .. ..
'$O.00�t _ 0�_ ���.
, $0.00; .. : ----� -. . . .
$0.00`. . 0 .-:.. ".� .•
�" : ,,..., $0:00 � 0 --,.
- �$0.00� 0. _ '
� $0.00 � 0 --� �
$0�.00 ` � -0
. . � $0.00 �, ��� :�
_. .$0.00 =-`0� �
$0:00', .: 0.: ..
$0.00 -. 0 ' �
$0.00 ' 0 ���•.
$0.00 0. `� .
$0.00 0
$0.00 0
FEE SUMMARY ', "'�' � � �'
_- - QuanUry _ .
- =-Temp�.Dist System / Lighting'ay , $0.00 �. �, 0 � -
� - - Busway7700ft ° - -- " $000'�- 0�:
StandingSection , $0.00 - � 0 �'" ..
Misc Eledrical Equipment $0.00 -- 0 � r; s,. _
Transformers up to 1 kva/kw $0 00 � 0 .
..... ::.up to 10�kva/kw i$0 00 �r 0� �� r
..up to 50 kva/kw '$0 00 --�� 0 �: ,- �
.. . .... :........up to 100 kva/kw �$0.00�-�: 0 .-;_ -
...�:...`::...t.�.over 100 kva/kw $0 00 i;.^'- 0
- --. � Low Voltage Equipment $0.00 ",<-- 0 .-.: ,
-. Low Volt Wiring System / Ckt- - $0'.00-' 0 • --: � �
� "`�:MisaConduit - . $0.00 . 0 ' "
' "Misc. Conductor. �� - . .$0.00 • 0 '
� `�:.Circus ( gen;or {ide) �- ' $0.00 -0 -
'- Circus (mech iide or lights) - $0.00-- 0 -
'�- �.��Christmas TreeStsnd- $0.00---- 0 -
� - Fireworks StanC . " $0.00 - - 0
� � �� � Other Electrical Fee, � � �$0 00 `
<. - � �
. Inyestigation Fee �� �$0.00
- � Plan Check Fee -:> ° "" � .'�$0:00
�� �����•�ReinspeclionFee ,� --"$0.00
�� �����TOTALCALCULATED�FEES 5129.31
COMMENTS I SPECIAL CONDITIONS
NOTICE: The work authorized by lhis 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
requlred Inspeetions and finel epproval must be obtained. Failure to obtain inspec�ions and final approval will result in the expiration of this permit.
POR INSPECTIONS CALL: (714) 7545626
2aas-ae �aroo)
WORKERS' COMPENSATION DECLARATION: . . .
I hereby eflirm under penalty of perjury one of Iha tollowing declarations: ' ' .
❑' I heve end will maintain e certilicate of consem to self-Insure for workers' compensatlon, as pmvided Por by section 3700 of the Labor Code, for the pertormance of the
work tar which this permil is luuetl. ,
❑ 1 have end will maintain workers' compensetion insurance, es required by section 3700 ot ihe Lebor Cotle, for the peAortnance of ihe work for which this pertnit is issuetl.
My workers' compensatlon Insurance carder and policy number ere: '
Cerner: Policy Number:
(This secGan need not be comD/eted illhe permlt is velued et one hundred dollers ($100) or Iess.J . .
1G1 I certiy that in t�e pedortnance oi the worK for which t�is pertnit is issued, I shall not employ any person in any manner so as to become subject ro t�e workars'
�� compensetlon laws ot Califomia, and agree � t I e Id bewme subjea to tha workers' compensatlon provisions of Sgction 3700 of the Labo� Code, I shall torthwNh
comply wit� t�ese provi i ns. �/� �/
Applicent Signat . � Date: �� �.S
WARNINO: FAILUR TO SECURE �RKERS' �MPENSATION VERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLpVER TO IMINAL PENALilES AND GVIL FlNES UP TOONE HUNDRED
TMOUSFNDOOLLFR , ADORION TH ODMPENSATION,DMIAGESASPROVI�EDFORINSELTION�O60FTHEUBORCODE,INTEREST,ANDATTOHNEI^SFEES.
LICENSED CONTAACTORS DECLARATION:
I hereby aNirm that I am licensatl under provisions oi Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, antl my license is in full
force and eHect Lic. # Glass W
ContraqoYs Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aNirtn Ihat there is a construction lending agency for the peAormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby effirtn that under penalry of perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professlons
Code: Any ciry or counry which reQuires a Dermit to consiruct, alier, impmve, demolish, or repair any strudure, prior to its issuance, elso requires the applicant for such pertnit
to file a SlgneO stetement that he or she is IicenSeC pursuent ro the provislons ol Ihe Contractors License Law (Chepter 9(commencing with Section 7000) oi Dlvision 3 oi the
Business antl Professions Code) or that he or she is exempt Iherefrom and ihe basis for the alleged exemptian. Any violation of Section 7037.5 by any apP���ent for e permit
subjects the ap0�icant to e civil penalry of not m0�e ihan tive hundred dollars ($500).): ,
❑ I, es owner ot the properry, or my emD�oyees wlth weges es thelr sole compensation, WILL DO 7HE WORK, and Iha structure is not intentled or otteretl for sale (Sec.
7044, Business anC Professions Cotle: The Contraciors License Law tloes not apply to an owner of properry who builds or improves thereon, and who tloes such work
himself or hersetl or through his or her own employees, provitletl that such Improvements are not Intentled or oflered for sale. tl, however, ihe building or improvement is
sold within one year of comple�ion, the owner-builtler will �eve the burtlen of proving that he or she ditl not build or improve for puryose oi sale.). •
❑ I, as owner ol lhe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruct the project (Sec. 7044, Business antl Professions
Cotle: Tha comrectars License Law does na� apply ta en owner ot proparty w�o 6uilds or Impmves Ihereon, antl who cromracts tor such project with e camrector(s)
license pursuent to ihe COniraCtors LiCenSe LawS.).
❑ I am exempt under sec. Business and Prolessions Cotle for this reason:
Signatwe: �ate:
Owner ID veritied Dy drivafs license. ❑ Ves ❑ No Dnvefs License No.
Vedfication ot Ownership by (type of tlocument, I.e. - pmperty ta: bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
Expires:
❑ I �ereby certify ihat no excavation five (5) or more feet in depth into which a person is required to descend, will be matle in conneciion with work euthonzed by Ihis
pertnit, end ihat no building siructure, swNolding, falsework, or demolition or dismantling thereof, will be more ihan Ihirry-six (36) feei �igh. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle B, Celitomla Administretive Cod�)�
❑ As owner-builder, I will not employ enyone to tlo work which would require a permit from the Division oi Intlustnal Safery, as noted abova. unless such person hes e
pertnit to do such work tmm tha division.
Signeture: Date:
Divlsion of Industnal Safety Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AIJf}ION�TON OF ENTFiV: I cenify under penalry of perjury ihat I have read this application and state ihat Ihe information given is
wnect. I egree to comply wlth all steie laws and ciry ordinances relating to building construction, and authorize representatives of Ihe Ciry of Cosia Mesa to enter upon the
above-descnbed property lor inspection purposes. I agrce not to occupy or allow occupancy oi any building authorized 6y this pertnit until final inspection.
uw: ,
i616 Fixed System Final Fire Prevention
1268 Pool Spa Finel
200 Finel Ra-Roof
2Di Final BIocWAelaining Walf
202
203
Final Factory Fire Placa
Final Sign
204 Final Demolition
COUE� INSPECTIONttPE
206 Final Mec�anical
20B Final Plumbing
210 Final Electrical
212 Finai Fire PravaMion
220 Final Planning Approval
222 Final Site
250 FinalBuilding/Occupency
p8j� �NTRIRl3
(714) 754-5273 • Fa�c (714) 754-4856 • Www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 2316 HALF MOON LN
Suite No
Vicinity:
ParcelNumber: TPN00522
� � --� ISSUED BY:
App�icant GARY WILLIAMS _ '
Address: 1450 N TUSTIN AV - ,�• �- �' � "` - -
�- Phone: 714-245-9760�X19 ..
BREA. CA . .. . Zip � �� � �...92823 � . --
Owner. SH�EA HOMES,LTS � " : �� � � �"`
� -
Address '�- 603 SOUTH VAL&NCIA AVE . �� � - - ��` k �',.: ;'� . �. �
ig: �„. ° " - .
: ' � �' Phone: 714-985-1300 � �. : � , ,�w .-� , �' '
� �BREA CA - -- 2ip: 92823 .. .
l.
„ `, -:; ,;;'
Contractor OWNER BUILDER
� Address: ; . � � „� ,,,�,"��
- �� � � Phone'= . „_m.e. . ..
. , � . . .. .a:s'i ;
� - , e. ",� Zip: - - - '
- � -- - . .,. . License:�000000 � . - , -
� ' SCOPE OF PERMIT
� � � L07�12, PLANS 3A ��'��: �' �: . -. . � . . ` �
��"r � ` CONSTRUCT 1,6g3 S:F: 2-STORY SFD WITH 483 S.F. ATTACHED GARAGE��WORK TO ��� .-
`� �:INCLUDE 710�S.F. FOR 1ST FLOOR, 983 S.F. FOR THE 2ND FLOOR AND INSTALL A�a �� K'� -- �� �
_ FIREPLACE, MODEL 4236 UL 127. '� � i�"� �
... � �` ,d�. - � ,r _.. _ .
�� '' MECHANICAL TO INCLUDE�2 INST�FAU �a 100KBTU; TALT/REPAIR COOCING/HEAT, 1 '
'�- ' � FACTORY FIREPLACE, 4 VENT FANS,�1 PIRE DAMPER, AND 2 COMPRESSORS UP,,T03 HP '� '
��: a � . � . . , . .. . . .
Status: ISSUED
Applied: 09/30/2005
Issued: 09/30/2005
"`? FEE SUMMARY ,
�� _� ' , 3.�° -"�. Quantity - ' � � �` ". : tQuantitY .:
ISSUEFEE � � $2350. - � � � � - � � ' "Repair/AlbAbsoibtion�Umt �_' �., . �$000--�-0
InsfFAU-<100 k BTU .. - _ $29 60 � 2 "�"' - � �- Repair/Alt Refngeration,.UnR �i ,� � ;�$0.00 � 0� _ .
InstFAU>t00kBTU. _' -"��$0:00 ��0 � ����� Ventillation.System � `"T, �. ���.z ,,-$0.00 .0
Repair/Alt-Coolmg/Heat;-.; �.��,$�3.70 1 EvaporativeCooler �_ ��y•r/r--'- $0.00 0
Inst/�Rep.RecessWall�Hti'� �� �����`$0.00 0 Commerciallncineralor , -r $000 '0.
Refrig.Sys <100 k BTU ��� . }� $0.00 0 Domestli Incineralor $0 00 0`� �`�"
Refng'Sys >100 k BTU �'• � � � $0:00 0 Comoressors /Absorotion Svstems � - `
Gas Piping � - � $0.00 0 . -: Up to 3 hp / 100 k BTU :$0:00 0-
Factory�Fireplace� �� �� , . � $10.65 1 ,� : 3 To 15 hp / 500 k BTU � ' "$0.00 0-
Hood w/Mech Exhaust '�� -$0.00 0 � - � 15,To 30 hp / 1,000 k BTU ." $0.00. , 0-
VAV Box � ` ' � . ° ---� - $0.00 0 ` - �.� � ` . 30-70 50 hp-/ 1,750 k BTU , - $0 00.'� 0
Vent Fan / Single Duct � ": $29.00 �- 4_ -� " - - ; ;�m, �. Over 50 H�p /�Over 1,750 BTU ;_ - �� ^� $OA-0 °,;' 0
Appliance - '$000 0���` , Boilers . `"
Fire Dampers � " $7 25, 1 _ �, . � � �_, Up to 3 hp <�� - $29 40 � 2
SmokeDampers " � .��$OOOF"�0�;� �- 3To�15hp`--� .,, � `-$0.00 0
Inst or Relocate Appl Vent � - � $0.00 � 0 = , �, � 'y.. `> -, 15 t0 30 h'p �_ � - _ $0.00 0
Air Handlers < 10000cfm��:� ., . $0 00 . 0 ' � 30 to 50.hp :'-_� � -- i� • $0.00 0
Air Handlers > 10000cfm, - -��`� SO 00 - � 0- � � � -� Over 50 hp - , _ $0.00 0
Floor Furnace � P,; $0 00 ���0 �.� Other Mechanical Fee
Floor or Suspend Heater ';�r$0.00 0 ' Investigation�Fee'', � ^� $0.00
� � � � - e �- � P-lan Check Fee ��'� � �'�k' $0.00
_ � -Reinspeclion Fee : �� � $0.00
� _, . �',:n .
�" �a � - _;yTOTAL CALCULATED FEES 5143.10
COMMENTS / SPECIAL CONDITIONS
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 1 BO days, or if work is suspended or abandoned
for a penod ot 180 days.
INSPECTIONS: In order for the work authorized under this permil lo be considered legal, such work must comply with all applicable codes, antl all �
requlred Inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. I
FOR INSPECTIONS CALL: (714) 7545626 i�
2446d8 (N00)
WORKERS' COMPENSATION DECLARA'�ON: �
I hereDy eflirtn under penalry of perjury one ot Ihe tollowing declarations: _
❑ I have end wlll maintein e certiticate o� consent to self-Insure for workers'�compensetion, es providetl for by section 3700 of ihe Labor Cade, for Ihe pertortnence oi Ihe
work for which Ihis pertnit is issuetl.
❑ I heve and will main�ain workers' compensatlon insurence, as required by sectlon 3700 of tha Lebor Cotle, for ihe perfortnance of the work for which this pertnit Is issued.
My workers' compensation Insurence �errier antl policy num6er are:
Certier: Policy Number:
(Th/s section need not be completea i! the perMf is valued af one hundred dollars ($100) or /ess.)
ii� I certity that in Ihe Derformance of Ihe work for which th�'s�pe[)nil is issuetl. I shall not employ any person in any manner so es to become subject to the workers'
-r• �mpansatlon laws of Callfomla, el tl eBree that ii I; 6( �4come si ct ro the workere' compensetion provislons of Section 3700 of he Lahor Code, I s�ell forthwith
comply wlth IheSe pmvisions. `m� �/�� O�
Applicant Signeture: � Date:
WARNINO: FAILUFE TO S URE WO RS' MPENSATIO OVEMGE I UWFUL AND SMALL SUflIECT AN EMPLOYER TO CRIMIN PENALTIES AND dVIL FINES UP TO ONE HUNDRED
THOUSANDDOLLARE(5100, , DITI OTMECOST FfAMP TION,�PMAGESASPROVIDEDFORINSECTIIXJ3/O60FTHElABORCODE,IMEREST,ANDATTORNEI"SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn Ihat I em licensed under pro�isions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Cotle, and my license is In tull
force and ettect. Llc. M Cless A
ContrecioYs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirtn that there is e construGiion lending agency for Ihe pedormance ot Ihe work for which Ihis permit is issuetl. (Sec. 3097, Civil Code).
Lendefs Name: Lendels Address:
Signawre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn that under Denalry of per�ury ihat I em E%EMPT FROM THE CONTRACTOFiS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires e permit to construct, elter, improve, demolish, or repeir any structure, pnor to its issuance, also requires the epplicent for such pertnit
to file e signeC statement �hat he or she is I�censed pursuant to ihe provisions ol the Comractors License Law (Chapter 9(commencing with Sectlon 7000) of DlNslon 3 of the
Business end Professions Code) or Ihet he or she is exempt iherefrom and the besis for the elleged exemption. Any violation of Sadion 7031.5 by any apPlicant tor e pertnit
sub�ects the applicam to e civil penalry of no� more than five hundretl dollars ($500).):
❑ I, es owner oi Ihe property, or my employees with weges as Ihelr sole compensation, WILL DO 7HE WORK, antl the structure Is not intended or oHered far sale (Sec.
7044, Business anC Professions CotlO: The Contractors License Law dces not apply to an owner of property who builds or improves ihereon, antl who tloes such work
himseli or hersetl or through his or he! own employees, pmvided Ihat such improvameNs are not intended or oHared tor sale. tl, however, ihe 6uiltling or impmvement is
soltl within one year of wmpletion, thB owner-6uiltler will have ihe burtlen of proving ihat he or she tlid not build or improve for purpose ot sale.). �
❑ I, as owner of t�e properry, em EXC WSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Protessions
Cotle: The conirectors License Lew does not apply to an owner of proparty who 6ullds or Improves ihereon, end who contracts for such projact with a contractor(s)
license pursuant to ihe Contractors License Laws.).
❑ I em exempt under sec. Business and Professions Cotle tor this reason:
Signatura: Date:
Owner ID verifletl by tlnver's license. ❑ Ves ❑ No DriveYs License No. Eapires:
Vedficellon of Ownerehip by (type oi tlocument, i.e. - proparty tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PEFMIT CERTIFICATION:
❑ 1 hereby certify that no excavation tive (5) or more feet in depth into w�ich a person Is required Io descentl, will be made in connection with work authonzed by Ihis
permi�, and that no building sWcture, scaHolding, falsework, or demolition or tlismantling ihereof, will be more than �hirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle 8, Celitomla Adminlsiretive Gode).
❑ As owner-builtler, I will not employ anyone to do work which would require a permit from Ihe Division of Intlusinal Sefety, as noted above, unless such person has a
permit to do such work tmm Ihe division.
Signature: Dale:
Division of Industnal Setery Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTMORVATION OF ENTRV: I certity under penelty oF perjury that I have reatl this application antl stata Ihat Ne infortnation given is
correct. I egree to wmply with all state laws end ciry ordinances relating to builtling construction, and authorize represeniatives of the Ciry oF Cosia Mesa to enter upon ihe
above-descnbed property tor inspection puryoses. I egree not to occupy or allow occupancy of eny building authorized by this permit until final inspection.
PaIE iHrrtia�s
1616 Fixetl System Final Fire Preven(i0h
12fifi Pool Spe Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolition
� oat
� G�
ate
COpEt INSPECTIONTYPE
206 Final Mechanical � �
20B Final Plumbing
210 Final Elecirical
212 Final Fire Preven�ion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
PLUMBING PERMIT
,lobAddress: 2316 HALF MOON LN
Suite No
Viciniry:
Parcel Nunmber: TPN00522
Applicant: GARY WILLIAMS
Address: 1450 N TUSTIN AV
Status: ISSUED
Applied: 09/30/2005
Issued: 09/30/2005
. . - . ISSUED BV: �
:��..:::
^ '..Pfione 714245-9780X19�� �,x _
BREA.CA -: � " � ' . Zip:.'�92823
.. � 'y*='s � ...
Ownec SNEA HOMES,LTS '.
Address �� 603 SOUTN�VACENCIA AVE . � � � ` �� •';
�q -,' . �,. � � Phone: 714-985-1300 ,
�'"'�BREA CA�. - Zip: 92823 �
as.
� / ` L ��
%,r.
Conlractor: . OWNER-6U I LDER
��` Address: ' �
Phonei=- � - � -
. ... Zip. • , . , . , .
. � - - � License. ; 000000 � - '
' ��� . .. �.n� -
. ..:.�-s'.��� . - � . ., -
� - SCOPE OF PERMIT � s' '� =
'�, � �,
s LOT 12,"PLANS 3A _� _ "� - � �
��`CONSTRUCT ],693 S'.F. 2-STORY SFD WITH 483 S.F. ATTACHED GARAGE�.�:WORK TO�:.INCLUDE' 7]�
�'� �, S.F:-FOR 1ST FLOOR, 98&S:F. FOR THE 2ND FLOOR AND INSTALL A FIREPG4CE; MODEL 4236
.'a�, UL 127. � - - - ,s - '�` � d
,:
'� PLUMBING TO INCLUDE: 2�BATHTUBS, 1 DISHWASHER, 1�GAS (1-4.OU�TLETS); 3 GAS OUTLETS; �.�:'�
,;' (OVER 5), 1. LAU,NDRY TUBM/ASHER, 1 PRESSURE REGULATOR;--1'SEWER CONNECTION, 2 SHOY
1 KITCHEN�SINK,?,1 VACUUM BREAKER (1-0), 1 WASH BASIN, 2 WASH BASIN SETS, 1--WASTE AND
VENT SYSTEM;;3�WATER CLOSETS,�1 WATER'HEATER,��,1�� WATER PIPING, AND t WATER SERVICE
FEE SUMMARY
- -- AMT � � ,�����AMT � AMT ,�-,�QTY
ISSUE FEE ,-.-$23.50-> Laundry Tub / Washer �� $9.80: - 1 Sump Pump $0 00--::_' 0
Backflow;irrigation ��. �-- $0.00 - 0��. Landscapelrrigation """$0.00- '�0 SwimmingPool ; - $000` 0
Backflow�Preventer �z . $0.00 � `0'� P-Trap �.. $0.00 0 TrapPrimer $0.00` 0
Ba�htub-° �� $19.60 2 PresaureRegulator -$9.80 1 Unnal;",��, -' $0.00 0
Clarifier System $0.00 0 Process-Piping (per 70 k),: ;-. $0.00 0 Vaouum-8iki Bkflow(1-4)� $12.30 1
Connect(Ice�,Sodaetc)�:�., $000 .,,,0� Receptors-,� _ - $0.00 -.0 Vacuum�BrkrBkflow(5+) .�i$0.00 0
Dental Units ' $0 00 �', -0� � Septic Tank " � - $0.00 - - 0 � - . Wasli Basin �: : ��$9.80 1
Dishwasher - $9 80 �' =;1 =Sew,er Cap for Demo-; $0.00 0 �� ,__ . Wash Basln Set ;$19.60 2
Drain, Floor - ,., $0 00 ���� 0 -Sewei Connect $24.65 - 1 ' -- Waste and;Vent System' °r^ . $9.80 1
Drain, Rainwater � ��`'$0.00 ?� 0 , -:Sewer�Private Lme'�'•' � � $0.00 � 10 , . Water Closet (Toilep .,:. $29.40 3
Drain,Roof �$0.00�-" 0 :.$hower�- ,$19.60-�� �2 WaterHeater/vent $12.30 1
Drinking Fountain - - $0.00 �� - 0 � :-Sink;�bar`� + �' $0 00 -_' 0 Water Piping (Insl or Rep.) $9.80 1
Expansion Tank � -$0 00 .�• 0 `�3 s� Sink, commeroial ,$0 00,��� 0 Water Re-pipe� �`" $0.00 0
Gas EaAhquake Valve $0.00 �-0 �' ��� ,. Sink, Floor $0 00 0 �� Water Service� $9.80 1
Gas (1-4 outlets) $6 15 ` 1 ' "�-` �Sink, kitchen $9 80"=-a�' �1 's�, �� WatecSoBener $0.00 0
Gas(Over4oullets) $330'9°=<3. - ..-. Sink;"service/mop � $000-,-.�0 OTHER-� $Q00
Gas Repipe $0.00 -' � 0 "e�. � � Spa (private) , � $0.00�: �<:0 --='�YIOLATION $0.00
Gas Service $0.00 �0' ` �- � :-Spa (public) , � � $0.00��- � 0 ,.�>�PLAN CHECK $0.00
Interceptors (Grease, Oil) $0.00 0 .. , . •Fr;• � � REINSPECTION 50.00 0
Interceptors (Sand Auto ) $0.00 0 , � �
� �� � � � � � TOTAL CALCULATED FEES: bZ48.60
COMMENTS / SPECIAL CONDITIONS
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, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or ii work is suspended or abandoned
for a period of 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and finel approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of lhis permit.
FOR INSPECTIONS CALL: (714) 754-5626 j
266&46INW)
WORKERS' COMPENSATION DECLARA710N: � . ^ -
I hereby eRlrtn under penalty of perjury one ot �he following tleclaretions:
❑ I heve antl will maintain e cenificata ol consent to selFlnsure tor workers' compenseilon, as provided tor by section 3700 of t�e Labor Code, for the peAortnance of the
wOrk for whiCh thi5 Oermit i5 i55ued.
❑ I have antl wlll maintain workers' compensatlon insurance, as requiretl by sectlon 3700 of the Labor Cotle, for Ihe pertortnance ol Ihe work for which Nis pertnit is Issuea.
My workers' wmpensation Insurence carrier and policy number ere:
Cartier: Policy Number:
(This section need not be comp/eted /l fhe pertnit is velued et ane hundred dollars ($100) or less.)
�I certiry that in the peAarn nce oi the work qrwhich this pertnit is iuued, I shall not amploy eny Derson in eny manner so as to bewme subjecl to Ihe workers'
compensation laws of C i omia, and egr3 h t it I sho ewme sub�ect to the workers' compensation provisions ot Section 3700 of the Labor Cotle, I shell forthwlth
II comply� with t 9'Rlbd, a s. , �/�� In r
App'cant SI na re: Date: � 7
WARNINO: FAI� E TO SECUR O ER$' COl�P NSATION RAG IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMI � PENALTIES AND GVIL FlNES UP TOONE HUNDRED
TqUSM1D E�E100, �,IN DRIONTrTHECOSTOF PENSATION,OAMAGESASPqOVI�EDFORINSECiIONffiO60FTHELABORCODE,IMEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby aHirtn that I em licensed under provisions oi Chapter 9(commencinq with Section 7000) of Division 3 of Ihe Business and Professions Code, end my license is in full
larce and eftect. Llc. k Class #
Conireqals Signature:
Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby affirm that there is a construction lending agency for ihe peAortnance of the work for which ihis pertnit is issued. (Sec. 3097, Civil Code).
Lendera Name: Lender'S Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eftirm Ihet untler Denalry of perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Protessions
Cotle: Any ciry or counry which requires a pertnit to wnstruct, alter, improve, demolish, or repair any strucNre, prior to its issuance, also requlres tha epplicant for such permit
to file a signetl slatement that he or sha is licensed pursuent b the provisions of the Conirectors License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 of the
Business and Professions Code) or Ihet he or she is exempt therefrom end the besis for the alleged e:emption. Any violation of Section 7031.5 by eny epplicant for e pertnit
subjects Ihe applicant to a clvll penalry of not more ihan five �undretl dollars ($500).): ,
❑ I, es owner ol the property, or my employees with wages as their sole compensation, WILL DO 7HE WORK, antl the structure Is not intended or oHeretl for sale (Sec.
7044, Business and Professions Cotle: The Conirectors License Law does not apply to an owner ot properry who builds or impmves thereon, and who does such work
himselF or herself or ihrou9h his or her own employees, provided ihat such improvemenis are not Intended or otteratl tor sale. It, however, the builtling or improvement is
soltl wit�in one year o1 completion, the owner-builtler will hava the burden of proving Ihat he or she did not build or improve for purpose oi saleJ. '
❑ I, as owner of Ihe property, am El(CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to constmct ihe project (SecJ044, Business antl Professions
Cade: The contractors License Law tloes not appty to en owner ol property who bulltls or Improves thereon, entl who coniracts tor such project with a comractor(s)
license pursuent to lhe Contractors License Lews.).
❑ I em exempt untler sec. Business and Profassions Code For this reason:
Signawre: Date: .
Owner ID venfied by dnvar's license. ❑ Yes ❑ No Driver's License No. E�ires:
Vedficaqon of Ownerehip by (type of Cocument. i.e. - properry tax hill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICATION:
❑ I hereby certlty that no exwvation five (5) or more feet in tlepih inio which e person is requiretl to Cescend, will be made in connection with work aut�onzed hy Ihis
permit, and that no building siructure, scaHoltling, falsework, or demolition or dismaniling Ihereoi, will be more than thiny-six (36) feet high. (Chep. 32, Grp 2, An 2, Sec.
341, Title B, Celifornia Administretive Code).
❑ As owner-builtler, I will not employ anyone to do work which would require a permit from ihe Division ot Intlusirial Satety, as noted above, unless such person hes e
pertnit to do such work irom the tlivision.
SignaWre: Date:
Division of Industnal Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND Alff}10RVA710N OP EMAY: I certity untler penalty ot perjury that I have reatl this application antl state that the information given is
correct I egree to compty with all state laws and ciry ordinances relating to builtling construction, antl authonze representatives of the Ciry of Costa Mesa to entar upon ihe
above-described property for inspection purposes. I agree not lo occupy or allow occupancy of any building authorizetl by t�is pertnit until fnal inspection.
SoOE �. IHSYECIIOHTYPE
1676 Fixetl System Final Fira Prevention
12fi6 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Well
202
203
Final Factory Fire Place
Finel Sign
204 Finfll Demolition
DA�F INTRIALS
COUE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Elec�rical
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 FinalBuiltling/Occupancy
�g ��
336��
, Southwc..,c nspect�on and' es�ng, nc.
10826 South Norwalk Blvd., Santa Fe Springs, CA 90670
(562) 941-2990 • (714) 526-8441 • Fax (562) 946-0026
TYPE OF
INSPECTION
REQUIRED
Job Atldress
Type
Inspecfor(s)
TYPE OF SAMPLE
Reinforced Concrete
Post iensioned Concrete
Reinforced Masonry
�,
LJ SirUcfural Steel Assembly
❑ Fire Proofing
❑ Asphalt
i
ArChiteCt
TESTS PERFORMED
SLUMP I/ nUANTITV IN SET
ADDITIONAL
❑ Qualiry control
❑ Other
ON SAMPLES
INSPECTION SUMMARY — IOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC.
INCLUDES INFORMATION ABOUT-AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBER, TYPE & IDENT. NO'S OF
TEST SAMPLES TAKEN: STRUCT. CONNECTIONS IWELD MADE H.T. BOLTS TOR�UED) CHECKED, ETC.
/rlr>�..---�� ti�.� ["]r ./1� r�.Y..� � '[� i-�l .iY1.�,�i�r'�. '� � r].It :'1� r--'�>�\v�� .
�
CEflTIFlCATION OF COMPLIANCE
I HEflEBY CEPTIFV THAT I HAVE OBSEAVED TO THE BEST OF MY KNOWLEOGE FLL OF THE PBOVE AEPOflTED
WOR�K �UN EFWISE NOTFO. I HHVE FOUN� THIS WOfiK TO COMPLV WITH THE APPAOVFD PlANS,
ECIFICAT101 , NDAPPLICABLESECTIONSOFTHE OVEBNIN WILDINGlAWS..
/
Q
� SIGNA7U 4F GISTEFEOINSPECTOfl
C�z r'2 1 C�'
SPECIALTV . N0. AGENCV
�
�
CONTINUED ON NEXT PAGE U � PAGE OF
TIME IN TIME OUT REG. HOUflS O.T. HOURS
All inspections based on a minimJm of 4 hours and over 4 hours � 8 hour
minimum. In addition, any inspection eKtending past noon hour will be an 8
hour minimum. ^ �. ;
Approved by
Projea Superintendem
WHITE - OFFICE COPY, CANARY - ACCQUNTING C�PY, PINK - lNSPGCTOR'S COPY, GOLDENROD -!O8 SITE COPY
( - �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT %� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2316 HALF MOON LN
Suite:
Vicinity: LOT 12
Primary Occ: R3 Dwellings/ Cong Res <10
Parcel Number: TPN00522
Applicant: WILLIAMS, GARY
Address: 1450 N. TUSTIN AVE
SANTA ANA, CA
Owner: SHEA HOMES LTD .
Address ; 603 SOUTH VALENCIA AVE
BREA, CA
Contracror. O W N E R-BU I LD ER
Address: � � � -
Status: ISSUED
Applied: 01/24/2005
Issued: 04/04/2005
Type af Canslruction: V-N
Zoning:
ISSUED BY: �'Y lXN
Phone: 714-245-9760 X19 -
Zip: 92705 , ` .
Phone: Z14-985-1300 �-
Zip: 92823 . , �
� - ..� Phane: , �
' _ � _,�, � � � .
Zip: . � � � License: 000000 , ' ' �- �,
Arch, : WILLIAM HEZMALHALCH " Eng: '
�Address: WILLIAM HEZMALHALCH ARCHITECTS INC J� Address: � �
SANTAANA,CA � Phone: 949-250-0607 - Phone: .
2850 REDHILL AV STE 200 . ..
Zip: 92705-5543 License: C12920 , License:
SCOPE OF PERMIT _
LOT 12 . . � , � '
PLANS 3A - " -
CONSTRUCT 1693 SF 2-STORY SFD WITH 483 SF ATTACHED GARAGE. FIRST FLOOR TO BE 710 SF AND 983 SECOND STORY.. A�
FIREPLACE MODEL ii4236 (ANSI UL127 WILL BE INSTALLED IN THE FAMILY ROOM; THERE WILL BE A 2ND FLOOR LAUNDRY ROOM.,
REF: G04-00010, . . � . � � . . . '
SEE PA-03-47(f-16600 . - � � � � '��- �� . � . - � . � .
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
5229.74
$1,413.75
$17 41
$0.00.
$0.00
$0.00
$1,660:90
.
SETBACKS
MAIN STRUCTURE Front 67- 0
PEE SUMMARY. � r � - �.
Calc Valuation: Sna,os5.so
- �-� ' Claim Valuation: � � " So.00
PLANNING & ZONING �
Rear 43- 0 Lek 50- 0
, Righ[ 10- 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 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
requlred Inspeetlona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaws �doo�
WORKERS'COMPENSAnON DECLARAnON:
I hareby eHirtn under per�elty ol perjury one of the following declaretions: '
❑ I heve end will meiP�ein a certificate ol consent to self-Insure br workers' compensatlon, as pmvided lor by section 3700 of the Labor Cotle, for the pertormence of Ihe
work for which this Permi� i5 i55uetl.
❑ I have end will meiRain workers' crompenselion insurance, as requlred hy SecHon 3700 af the Lebor Cotle, for the pertortnance of ihe work for which Mis pertnil is issuetl.
My woMars' compensatlon Insurence carrler end policy number are:
Carner. Policy NumDer.
^(Th-is �sectlon nee0 nof bB �mpleted il the pemrif is velued et one hundretl dollers ($100J or less.)
�.�hCertify that in ihe perfortnence ot Ihe work tor which Ihis permit is issued, I shall not employ eny person in eny mennei so as to become subject to the worknrs'
compensation laws of C lifomia, end egre � et if I should becoma sub�ect to ihe workars' compensation provisions of Sec�ion 3700 of t�e Labor Code, I shell forthwith
cwnplywiththese ro � ans.
� li I.�Sign uret ' Date�-�"� �.r0 $^
WARNING FAILURE T SECU W KERS' COMPEN TI COVERAOE IS UNLAWFUL NND SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND pVIL FlNES UP TOONE HUNDRED
hKKISANDDOLI.ARE( . �,INADDIiIONTOTHE TOFCp.IPEN5AT10N,DAMAGESASPROVIDEDFORINSECTION3)O60FTHELABORCOpE.IMEREST,ANDATiORNE1^SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn Ihai I am licensetl under provisions ol Chapter 9(commencing with Saction 7000) ot Division 3 0l iha Business antl Professions Code, and my licen5e is in fUll
torCe end efrett. LiC. 7t Cless x
Coniractor's Signature: Date:
CONSTRUCTION LEN�ING AGENCY:
❑ I hereby aRirtn thai �here is a consWc�ion lending agency for Ihe pedormanca ol Ihe work for whith this permit is i55uad. (Sec. 3097, Civil Coda). ,
� Lender's Name: Lender's Adtlress: �
ISignaWre: Date:
OWNER•BUILDER DECLARATIONS:
1 here6y aflirm that untler penalry ot perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor ihe tollowinq reason (Sec. 7031.5, Business and Professlo�s
Cotle: Any ciry or counry which reQuires a permit to construc6 eltar, Improve, demolish, or repeir any stmcture, pnor to its issuanca, also requires the applicant for such permit
to tile e signed statemenl thal he or she Is licensetl pursuant to the proNsions of lhe Contractors License Law (Chapter 9(wmmencing wii� Section 7000) ot DlNsion 3 oi �he
Business end Prote5siM5 Code) or thei he or she is e:empt �harefrom and ihe besis lor ihe ellegetl exemption. Any violation o1 Section 7031.5 by any applicant for a pertnit
sublecis the epplicant to e civil penelry of not more then five hundred dollars ($500).):
��I��s owner of the p�Weny. or my employees with wages as their sole compensetlon, WILL DO 7ME WORK, antl the simciure is not intenOeE or oHered for sale (Sec.
7044, Business and Professions Code: Tha Contractors License Law tices noI apply to en owner ol property who 6uilds or improves thereon, antl who tices such work
himself or �ersell or through his or her own employees, providetl that such improvemenls ere not Intended or ottered for sale. If, however, the building or improvement is
sold within one yeer of completion, tha owner-builder will have Ihe �urden oi proving ihal ha or 5he did not builtl or improve for purpose of sale.).
❑ I, B5 owner of ihe property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS �o consiruct ihe prolact (SeG. 7044, Business and Professions
Code: The contrac/ors License Law does noI epply to en owner of property who builds or Improves Iheraon, antl who conlracts for such project with a contrecbr(s)
licensa pursuant to ��e Comractars�icense Laws.J.
❑ I em exem ntler sec.
Business and Professions Cale for this reason:
Owner D ven' by�ar's license. ��'�Ves ❑ No Driver's.License No.
Venfication oi Ownership by (rype oi tlocument, i.e. - pmperty tax bill or deed): ����
DIVISION OF INDUSTRI�L SAFETY PERMIT CERTFICATION:
❑ I hereby certily ihai �o ezwvation five (5) or more feet in depih into which a peroon is required m descend, will be matle in connection with work authonzea by ihis
pertnit, antl t�at no �uiltling structure, scattoltling, falsework, or demolition or dismantling thereof, will he more Ihan ihirty-siz (36) feei high. (Chap. 32, Grp 2, Ar12, Sec.
341, Title 8, Califomia Administretiva Code).
❑ As owner-builtler, I will not employ enyone �o tlo work which would require a permit from ihe Division of Industnel Safery, as notetl above, unless such person has a
permit to tlo such work tmm t�e division.
Signature: Date:
Division oi Intlustnal Saf�ty Pertnit Number.
CERTiFlCATE OF COMP�IANCE AND AUfHORVA710N OF ENTRY: I certify under penalty ol perjury ihat I �ave reatl ihis application antl slate l�a� Ihe information given is
wrrect I agree to comply w��h efl �stete laws an0 ciry ordinances relating to building consiruclion, and aulhorize rapresemetives ol ihe City ot Costa Mesa to entar upon Ihe
above-de cribed prope ,y �or ��e lfon purposes. I egree nol to occupy or allow occupency of any building authorized by thig permi until linal inspection.
`�/'r�o �'
Sign,f re;0f. �az,O�wner(s) Date-'< „?
COOE �. INSVECTIOHTYPE
1616 Fixea System Final Fire Prevention
1266 Pool Spe Finel
200 Final Re-Rool
201 Finel8locWReta�ning Well
202 Final Factory File Place
203
204
Final Sign
Final �emolition
DITE ni
LOOE 11 INSPECTION TYPE
206 Finel Mechenical
200 Finel PlumDing
210 Finel Elecirical
212 Final Fire Pre�ention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
QAiF IMTRV�l4
C?� � C'',oQta ��leQa �� Dir�i�
OWNER-BUILDER
VERIFICATION
A ciry or coumy, which is required to give notice pursuant to Section 19830, shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion.and require the re[um of, an
owner-buildcr vcrification.
Alten�ion Property Owner:
An 'owner-builder' building permit has br;en applied for in yuur nnme and bearing your signature.
Plcase complete and remm this in(ormation in �he cnvelupe prnvided at your earliest opportunity �u avoid
unnecessary dclay in processing and issuing yuur building pennil. No buildine Dertnil will be issued unlil thix
verification is receivcd.
I. I personally plan to provide Ihe major labor and materials f�or conswction of the proposed
property improvement. � Yes ❑ No
2. I(have/have not) }�ii�� signed an application for a building permit fur
Ihe proposed work.
3. I h�rve contracted with thr. following persun (�irni) to provide the proposed eonstruc[ion:
Name
Addretiti
Phonc (
City —
Contractur's Lic. No.
4. 1 plan tu pruvide portions of the work, but I have hired the �bllowing person to coordina�c,
supervise and provide Ihe major work:
Namc
Addretic
Phone (
City —
Contracror's Lic. No.
S. I will provide some of �he work but I i�ave cuntrac[ed (hired) Ihe following persons ro
pru��ide the work indica[ed:
Name
iMZa6 (RFV.9/9P7
Address
Phonc 7'ype of W'ork
(7/4) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2316 HALF MOON LN
Suite:
Vicinity: LOT 12
Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction; V-N
Parcel Number: TPN00522 Zoning:
Applicant: CORTEZ, JEN
Address:
_ . , � � Phone: .714-245-9760 X19,
" , � � Zip: . -,. '
; '
ISSUED BY:
Status: ISSUED
Applied: 01/24/2005
Issued: 04/04/2005
Owner. SHEA HOMES LTD� " , � � . � -�
Address 603 SOUTH VALENCIA AVE , , - � " ' � � � ` ��
\
� ' _ - �Phone: 774-98&1300 ,� � . ,
� BREA, CA � Zip: 92823 � � � � ' ��
� �
. -" ','' . , �.. \
Contractor: � OWNER-BUILDER � - ' �����`
�, : .. '
Address' - = ,., � , � ;
, ,
��% . Phone: �,� -
, , , . ... �, . �.
� , , , . � � � � � .
� Zip: ,� 7License: 000000 , . � '
. �
nrch : WILCIAM HEZMALHALCH _ ,_ , Eng: .
' Address: WILLIAMHEZMALHALCHARCHITECTSINC�/ Address: , �� ' � -'
. SANTA ANA, CA .` Phone: 94&250-0607 ' ' Phone: �
2850 REDHILL AV STE 200 � �
�
.Zip: 92705-5543 , . License: C12920 � License: � �
, , ., . . � .. • � ,�.
SCOPE OF PERMIT
LOT'12 . . � . . - .-_. '-. _ . � _
PLANS3A � _, _ ' __ � �• /� � —; ' . . ,
CONSTRUCT 1693 SF 2-STORY SFD WITH 483 SF ATTACHED GARAGE. FIRST FLOOR TO BE 710 SF AND 983 SECOND STORY..-A �
FIREPLACE MODEL #4236 (ANSI UL127 WILL BE INSTALLED IN THE FAMILY ROOM; THERE WILL BE A 2ND FLOOR LAUNDRY_ROOM:
�REF: G04-00010, PA-03-47/T-76600 . � . , . " . . � -
- . _ � - - - , '� . ` -
' FEE SUMMARY
Plan Check: $229.74 ' Calc Valuation: ', Sn,a,os5.so
Permit: $1,41375 � Claim Valuation:" 50,00
SMIP Res: � S17.41 � �
SMIP Com: $0.00 �
�
Other: $0.00 � � : . _ ' � '
Inspection:. $0:00 � �� , ` _ '"���
� , , _ ��:.� . % � �
' - _ ; %i ,
Total: $1,660.90 � � � � �
� , � r `� - i
/
PLANNING & ZONING. " � � "
SETBACKS ,, � � � - � �
MAINSTRUCTURE Front 67-0, -,� Rear 49-0 � ��. Lek � 50-0 ,�, Right� 1Q-0' �"
ACCESSORY Front 0-�0 -, >'� Rear 0-0 � Lek 0-0 - � Right�� 0-0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days. '
INSPECTIONS: In order tor the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons 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) 7545626
244fi-46(6/00)
WORKERS'COMPENSAPON DECLARAnON:
I hereby ettirtn undar penelty oi perjury one ol the following declarations:
❑ I heve end will mei��ein e certificete of consent to sell-Insure for workers' compensetlon, as provided lor by section 3700 of the Labor Code, for ihe pertormance of the
work for which IhiS Oertnii is issued.
❑ I heve end will maiqiein workers' compensetion insurence, as required by section 3700 ot ihe La6or Code, for the pedormance of t�e work br which ihis permit is issuetl.
My workers' comp0�se[ion Insurence certier entl policy number ere:
Cerrier: Policy NumDer. �
( s sectbn neeC not bB comp/e il fhe parmit is velued et one hundred dollars ($100) ar less.)
�I certily that in the c ol the ork for which this permit is issued, I shell not employ eny person in eny manner so as to become subject to the worknrs'
rnmpensetion I 9 0l ' a, and e ree �hat It I should become subfec� to �he workers' compensetlon prwisions o1 Section 00 o Ihe Labor Code, I shell lotlhwlth
�comply_witht s o ---
/ /O�Applicent Signetur : Date: �
WARNING: FAILURE SEA1 ERS' COMPENSATION COVERAGE IS UNIAWFUL PND SHALL SUBIECi PN EMPLOYER TO CRIMINAL P QTI AND CIVIL FlNES UP TOIXJE HUNDRED
TTqUSAN�WLL4 (5100 ,INA TIONTOTHECOSTOFCOf.IPEN5AT1IXJ,0AMAGE5A5PROVIDEDFOPINSECTION31p60FTHELABORCODE.INiEFEST,qNDATTORNE`/'SFEES,
LICENSED CONTRACTORS DECLARATION:
I hereby attirm thai I am licensed under proNsions ot Chaptar 9(commencing with Sectlon 7000) of Division 3 of tha Business and Protassions Code, and my license is in tull
force and aflect. Lic. M Class a
Contractors Signature: Date:
CONSTRUCTION LENU�NG AGENCY:
❑ I hereby aHirm ihat �here is a conswction lending agency for the pedormance ot Ihe work for which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lenders Name: Lentler's Address:
, SigneWre: Date:
OWNER•BUILDER DECLARATIONS:
I hereDy affirtn that untle� Penalry ot perjury ihet I am E%EMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Protessions
Code: Any dry or county which requires e pertnit to ConStrutt. elter, impmve, demolis�, or repeir any stmciure. Drior to its issuance, also reQuires the applicant for such permil
to file e signetl stetement thet he or she Is Ilcensed pursuent to the prodslons ot ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the
Business end Professions Code) or thet he or she is ezempt Iherefrom end the besis for Ihe elleged e:emption. Any violation ot Section 7031.5 by any applicaM (or a pertnit
5ubjeCts the epplicant to e civil penalry oi not more ihan five hundred tlollers ($500).):
❑ I, es owner ot ihe property. or my employees with weges as their sole compensalion, WILL DO THE WORK, antl the structure is not iniended or otteretl lor sale (Sec.
70a4, Business and Professions Cotle: 7Te Conirectors License Law does not apO�Y �o an owner ot properry who builtls or improves thereon, and who aces suc� work
�imself or hersetl or thmugh his or her own employees, pmvidetl that such impmvemenis ere not Intended or ofteretl lor sale. N, however, the builtling or improvement is
sold within one yea� o� �mpletion, t�e owner-builtler will have the burden ot proving Ihat he or she tlitl noI build or improve for puryose oi sale.).
_ `
I, es owner ot iha e am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct t�e pmject (Sec. 7044, Business anC Professions
Cotle: The conir 1 icens w tloas not apply to en owner ol propeny who bWltls or Improves Ihereon, and who contracis for such project with a contracior(s)
license t �h Coniract s License Laws.).
❑_ I am z pt Business and Professions Code for this reasorr. -- ---
Signatur : /� '/
7Fvnirna� il7 /7 �r�/
Venfice ion 01 Owne ip y(rype of document, i.e. - propeny tax bill ar tleetl): � %—
DIVISION OF INDUSTRINL SAFETY PERMR GERTIFICATION:
❑ 1 �ereby certify thet no excavation tive (5) or more feel in depth into which a person Is required to tlescentl, will be made in connection with work authorized by this
pertnit, end ihat no building strucWre, sceflolding, talsework, or tlemolition or dismantlinq ihereof, will ba more ihan thirty-si: (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, TU8 B. CalifoTia Admini5�ra�ive Cotle).
❑ As owner-builder, I will not employ enyrone to do work which would require a pertnit from Ihe Division ot Intlusirial Safety, as nored above, unless such person ha5 a
permit to tlo such work irom the division.
Signature: Date:
DiviSion of IntluSlnal Sa/8h Permit Number:
CERT1flCATE OF COMVL1NdCE AND AUTMORVA710N OF EN7RY: I canify under penelty of perjury thel I have reatl this application and state Ihal the inbrmalion given is
wrrect. I egree to comply wl�h all sta�e laws enC ciry orainances relating to building conslmction, and authodze represen�etives of ihe City of Costa Mesa to enter upon the
above-described propetly �or in5pedi oses. gree not ta occupy or ellow wcupency ot eny building euthorized by this permit unlil linal inspection.
COOE I.
1616 Fixed Syste �e
1266 Pool Spa Final
200 Final Re-Roof
201 Flnel BIocWRetaininp Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
O�TE �� �QQ� INSPECTIONTYPE
�75� 206 Final Mechanical
V — v�� 1/'�208 Finel Plumhing
r�/ _/
f �� 210 Finel Electrical
212 Finel Fire Prevemion
220
222
250
Finel Plenning Approval
Final Site
Final Building/Occupancy
�IE �
.. . � ti. �� . '� . , .. a. �
DECLARATION OF AUTHORITY BIdg.Permit#
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS This Permit tt
Sheet Address:
AP Number:
1. I(we), .SF{C-fr 'fi.DMES �-' �' , declare that I am the Owner o( Title of the above
referenced real property, and that I(we) hereby authorize:
i
Name� � .
�
..
Street Address:
T n` 1
Telephone Number: 7�u � �C"I � . � 7L�)
Ciry: �� �t L��t71;9_ i State: ���� Zip: ����
to obtain permits in my behalt, as ownedbuilder, for ��+�t— �`�v�?-+ � T�Gi- 1 4(, p o
at the above reterenced property.
2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate o� that coverage to be filed wilh the Building Division of the City of Costa
Mesa, as required by State ot Califomia laws.
3. As ownedbuilder in fact, I understand and accept that my responsibitities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the Ci[y of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result oi work aulhorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this 3 day of �i�� 20 O,J� , at �QC—� , California.
r
Print Name: —�_.
Signature: J� QhN✓E��
Date: �� l��
Note: This authonzation does not grant authonzalion to perfortn the v.vrk as owner,
ii solely provides for limiled power of attomey to secure this permit in any behatf.
Oi➢9�a6 �rev.11100)
FP.OM :CI7Y OF COSTR MESP. FPX N0. :?14 754 485b Mar. 09 c0a5 04:57PM F1
✓r'"7" "D {.i-�.� I'/G�L �G�C�.ca�l� �L(fCQ[dIL
OWNER-BUtLDER
VERIFICAT(ON
A city or county, wliich is rcquircd ic� givc nuticc pur�uunt lo Scttion 19R70, shall attach to such notice, :mA.
as a conditinn precedent �o issuing n building permit, require �he completion anA myuire U�e rcwrn nf, an
owncr-buildr.r ventication.
nUcntion Praperty Ownec �
nn 'owner-builder' building {xrnut ha, bzzn applizd for in your name and bearng ynur signaNre.
Please complete nnd retum this inforination in the rnvelupe provided �t youf P.nrliP.�t n(��Mrtllni[V tu lvoid
unne�:ess:iry delay in preKessing und issuing your building prrmit. No buildin��ermit wfll tx issued until this
vr.riticaf.ion is receive<I.
I. I�u�rsnnally pl:�n tn provide Ihr. majnr I:�Mx and m;ite.rials Por cnnstn�ctinn of the pro(x�srd
pruperry improvernent. �i ,,Ycs ❑ No
2. I�iSJc �rve nut) >itined �m applicn�ion tbr a building permi� for
thc pio��iitcd wurk.
i. I 17avc cunlrxctcd wif.h �hc (ulluwin� pcesnn t I irrn) w provide•. Ihr. prupo�nd cnnslruction:
Namc
Addre_ss .. . (�'�y---
Phone ( ) Contractur's Lie. No. �.._..._...
4. I plan iu prnvide {x�niuns ollhr. wnrk. but I hnve hired the following person to c�n�dinaie.
supervisc �nd pr�rvidc thc rn:ijur wnrA: �
N:imc =%iEVE CALTi_E=I/ �0� -T�i�-%7Nf% <<%�—...._...
Addretiti Gti3. S� L�Gi%LNG�'c .�1.�. CitY � _....
�bonr (�il� ) 74 2� 2.,�'f4l Contractor's Lic. No. __...__----_
5. I will prnvidc SOme of �he wark bui I itavz i'unt�a�[ed (hi�rod) Ihr fulluwinE �xrs<ms In
pruvidr. Iht- wurk indicalr.J:
Nemc Address Phnne 'fypc of W'ork
�o : ,��:Ln�- �X 7/So�7S`f— �f�S�
I`��n n, 2..�
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTiFICATE OF COMPWINCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 ANO AB 181
To: ) Ciry of Costa Mesa
) City ot Newport Beach
( ) Couny of Orange
Applicant:
n
Address: �\
Telephone Number: � 1!'�f � aC�f �• �� l�( J
Tract/Partel and Lot Number(s):
Location af Project:
Number of Square Feet of:
Residential Space
Commercial and
Industrial Space
x 51.84
7� ,
, Q�C�� --��
CommerciaVlndustrial Projed is: (Check One)
_ Warehouse
R8D
_ Movie Theater
_ Mini-storage
_ Heavy Industrial
_ Regional Shops
_ Light Industnal
_ This project is exempt because
xS.30
_ Motel
Bank
_ Neighborhood Shops
_ RacqueVHealth
` Hotel
Medical Ofice
O/�ce Park
N� 5434
DisUid Receipt No.
Plan Check No.
� ��i�-�
Total � � O �� �r� 1—� — Y
Total
_ Preschool
_ Auto Repair
_ Hospital
_ Large Office
_ Ofice Bldg.
_ Restaurant
_ Fast Food
this ceRi4es thai the above-named DevelopedAppGcant has paid school fadkry fees in comp6ance with Govemment Code sections
53080 anq 65995. The Building Perrtils for this square footage in Mis proposed development may now be issued by your jurisdicBon.
Checks are to be made payable ta NewpoA-Mesa Uni6ed School Dishid.
ANM�c�d
The above representatlon as to square FooPage is tvue. App6cant aprees Mat if it is later determined that such representations are not
true, then this certificate shall automatically terminate and the appropriate C' Ceua shall be notlfied.
Date: � / O�
A M
Schaol Fces adusicd
Address
vn^_In;ll : I.y I A�
Rcv. p I : 2.3.05
Rcr. x2: 3J.05
Rcv. q3: 3.3 LOS
Rev. qi:
Rec. N5:
Rcv. pG:
'" 1 I ll�e Valuation - Plan I: 8225,194.22
� � V aluation - Plan 2�. $245.582.40
a�A S S O C 1 A T E S
....�,,..M.�+. ..,..�.. � ��o..�......e...... Valua�ion - Plan l: $1GJ.278.00
Lol Plan Livable
18 I 2..
19 2 2,•
22 3 I.f
SHEA - HALF MOON LANE - PROJECT FEE BREAKDOf67V
CITY BUILDING PLA
SFA PL4N CHECK CITY PLAN CHECK PERI111T FEES MEP PERMIT ONLY FEES FEE
Fl. Plan Check Fee Plan Check Fee Permir/SM/P Fees P/runbing I Mecdanica! I E(ectrica/ Rnad Fees
$S2S.42 $279.79 $1,744]I $538.08
$583.05 5305.27 $1.90431 �$538.08
$65920 $228.83 $1,425.52 , , 5538.OS
..:'. PRODUC6101V
..,2301 HaHMoon Lane I. .. 2 2.560.:..
�
s2303HaN�roonLane 2 I 2,312
HalfAbonLane 3 2 2,560
�ooa Cane 4 I 2,276
Ha�f Moon Lane 5 2 2,560
IlallMoon Lane 6 I 2,257
I-lall Moon Lane 7 2 2,560
HaBMoonLane 8 1 2,312
HallAfoanCane 9 2 2,560
a
Z37QHaNAbon Lane 10 I 2,276
2321'HallMoonLane Il 2 2.560
29f8Ha1/Moon Lane 12 3 1,693
2372.HaUMoon Lane 13 2 2,560
23fOHal/MoonLane 14 2 2,560
2308„yeNMoon Lane IS 2 2,560
2906 HaNMoon Lane 16 1 2,3 I 2
Y304 HaII hloon Lane 17 2 2,560
�186'23rdSlreer`- 20 2 2.560
�-.788 23iC Streel 21 3 1,693
2303.OranpeAvenue 23 2 2,560
2305.Oranpe Avenue 24 3 1,693
233)Oia+paAvenue 25 3 1.693
$220.76
$207.10
$220J6
$207.10
$220.76
$207.10
$220.76
$207.10
$220J6
$207.10
$220.76
$164.81
$220.76
$220.76
$220J6
$207.10
$220.76
$220.76
$164.81
$220.76
5164.81
$305.27
$256.15
$30527
$281.61
330527
$279.79
$305.27
$133.05
$305.27
$281.61
8305.27
$229.74
$305.27
$305_27
$305.27
$28433
$305.27
$305.27
08
$ I ,904.3 I
$1,784.58
$ I ,904.3 I
$ I,756.09
$1,904.3 I
$1,744.71
51,904.31
$826.24
$1,904.31
$1,756.09
$ I ,904.3 I
51.431.16
$ I .9043 I
$ I ,904.3 I
� I .904.3 I
$ I .773.24
$ I ,904.31
$1,904.31
$1.425.52
$1.853.01
$1,425.52
$1,425.52
TOTAL FEES : 56.921.63 $6,931.71 538,149.09
Total # o( Lots: 25
TOTAI MODEL SQ. FI' 6,510 Check #1 SFA PC fees: `� �� '�--.'.�`-3 pd.
ecn�i ��
TO7Al-PRODr$Q'Fft+'"�+51-237.• Chetk N2 Cip' PC (ees: �o�.� pal.
School (ee 51.84
�todel School Ftt 511,976.00 � Check # 3 BP Fees Alodels $5,074.54
Prod School Fee S9i,276.08 ".�r%�. Check # 4 BP Fees Prod $38,149.09
:TOTAL-SCNOOL�FEES��S106,'150:18r1•�� 1�
$0.00
$5
$538.08
$538.08
$538.08
5538.08
$538.08
$538.08
8538.08
$538.08
$538.08
$538.08
$538.08
DisL Fees
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
so.00 so.00 � s�s,asz.00 � so.00 �
Check #S - Road Fees: $13,452.00
Ckeck # 6-Sani�ation Dis�. Fees: 50.00
(Paid by Olson Company)
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mese��TRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
2316 HALF MOON LN
TPN00522
ZIEMANN, JOSEPH
665 BREAR CANYON ROAD
Phone: 909-646-7483
Status: I SS U ED
Applied: 12/012005
Issued: 12/O1/2005
ISSUED BY: �
WALNUT, CA Zip�.� rt91789,
.�s':: �..$'A '��:`�� t+ `�r � �
• � , a .. �,: ,s,4^.a
C
SHEA HOMES LTS ' � ` ?��
603 SOUTH VALENCIA AVE � �` � A r s�S �# �;-a
; : &�
e ' s«� �' _ 'r� -
�, .� � � e„^ �� , Phone 714-985 1300 ," �; �, � .
BREA CA ;��. '�'a` ` ZiP� ,sx 92823. __ Y., `. �: ` � 8 u'�.�€ ..
. ` ',A:. ��'S .
mt� . _ hM�S"s°�rJ� ' Y�1� .:''Ly, o�
-� SHASTA ELECTRIC LP ��'`� s .?
665 BREA CANYON�RD ' " �`
° Phone: 909-594-2341 � '� � ,
�,-,,,. _< ..�
" <WALNUT;'CA� Zip �,91789
�`� :- . License.683876 L� a.-�•...
`- - - ,�;� � -�
� ��� � ` s� ` ° �s � `�
� �f �
s � '� _. _ . . � 3 ..�, t� .. �, � � _�.
� ..fr �:s"' �
k j
; -_
iSUE FEE �p,�t;a-. �;,
New Res (1-2 uni
New Res (3+unit;
Pool/Spa _
Recept Outlets- y: `,I
Switches�' -. �� � �`
, �,.
Non Res Appl :���. � -
ResAppl - - �^�x
Servwe to`200a � .'� �
Service to 1000a ;
Service ovei,1000a � .:
Motors to 1hp�-_: . ;<x. •.
Motorsto70hp` `.•, -"�-'
Motors l0 50hp ;, �,
Motorslo�OOhp ';,� -�'•�.a
Motors over 100hp ' :v�'�
Communication drops � a '
Sub panel to 200a `�:? ° y
PoleLightPkg �`�"''
Sign Circuits `
Temp Pwr Pole 9
Intermed Pole
FEE SUMMARY
ir a�� � _ � • . n �r� r a �„
�Temp Dist System / Lighting� :��
a: _d ;'Busway /700 fl -��' , '�
,-:n",� .. �.�:'mz.. �"-:StandingS0t60n�: �„•�ae...
0 Misc Electrical Eqwpment
0„, �E Transformers,up to 7 kva/kw -:
0 � -� ¢ � up to;l0:kva/kw , . ��
';0.,.:. ,.. �,� '- ...up to 50 kva/kw' = '
� 0 � �.....&: �"r'..up to 100 kva/kw '.
0 ....... . �..over 100 kva/kw �
0 Low Voltage Equipment `
0 Low Volt Wirinj��$ystem / Ckt
0 .Misc. Conduit
0 Misc:,y¢onductor
0 � Cvcus ( gen or ride)
5
0 . �z; ;-.,.���Circus (mech,iitle�or lights)
�� � ��� ,� : � �� ��° a.
�'"� 0^•;: � InvestigalionPee'.-.� , ,y�„
° 0 � ��' � PIan;Check Fee r
' "0 " � ��� . . ,Reinspedion Fee �? "� `��
r �0�- , � , ::= > ;; �', 3
,1 '°'':-r r a>� �, ,T,OTAL�CALCUI.ATED FEES 6 54i
�,�sy � . � �; m_:�,
�' .
'w w�n: .. . . >`..,>P- �S ' � j ���_�',
� e 3-.� .0�.- v . a Y
n�„ - »
ilfY A ,,.t, Y ;i'::
0 h }
0 �;t ` �;z?
0 � ��
i
0 ''; $ , g,, :*,
p ` "�
�0�� x � � �
0 . �, ^
Y:'
0. �'` r� �
Q �` �?�
'O �.;;;
� ���� s't<:.�
0�
0
a
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-27-92) �
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
Por a period of 1B0 days.
INSPECTIONS: In order fo� ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspeetlona and final approval must be obtained. Failure to obtain inspections end final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 754-5626
2d4666 (6/00)
WORKERS' COMPENSA710N DECIARATION: .
I hereby aflirtn under penelry of perjury one oi ihe tollowing tleclarations: � r .\
❑ I have and will maintain e certificete of consent to seN-Insure for workers' compensation, as pmvided for by section 3700 ot the Lebor Code, for the peAortnance of Iha
w for which ihis pertnit is Issuetl.
I ha antl will maintain workers' compensa6on Insurance, fls required by sectlon 3700 of the Labor Cotle, for Ne peAortnance of the work for w�ich ihis pertni� is issued.
.�_-- work re' ompe atlpn Ins}�r�ce wrtier and pollcy number are: �,j-.�,.—�
Certie ��^-'� ! (/�-w��� . P.olicv�Numbar` �Q Li 3 � 5 �D �
section neetl nof be wmpleted i! the permit is velue0 et one huntlred dollars ($100) or less.)
❑ I certity ihet in ihe peAormence ot the work tor which Ihis pertnit is issued, I shall not employ eny person in eny mennar so as to become su6ject to the workers'
compensation laws of Calilomia, end egree that ii I should bacome subject to �he workers' compensation provisions of Sec[ion 3700 of the Lebor Code, I shall tort�wlth
comply with Ihese r slon� �, 1 2��� /� �
PqpNceniS�f ep�iure.� – Date: �
Y6a_ a' 7` :! i
W�iWING!FAILURE TO WORKERS' COMPEQ ATION C DE IS UNLAWFUL AND SHALL SUBIECr AN EMPLOVE ��ENALTIES AND GVIL FlNES UP TOIXJE HUNORED
TTqUSPNDDOLURE(5100,OW),INADDITIIXJTOTHEBBB COMPE SATION,�AMAGESASPROVIDEDFORINSECT10N31080FTHELABORCO�E,IMEREST,ANOATTORNEI^SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm ihat I flm Ilcensed under pmvisions of Chapter 9(commencing with Section 7000) of Division'3�p'o.�fi.F�e B'niness and PmFessions Cotle, end my license is in tull
ror . n,enec ic. a �GWes�M., ' O
Con�tor'�"�,s . nature: cr�! �'Ul • � Dai�_ ) � 'O � /7S
i
CONS7RUCTION LENDING AGENCY:
❑ I hereby ettirm ihat there is a construction lending agency tor the pertormance of �he work for which this permit is issued. (Sec. 3097, Civil Code).
Lende/s Neme: Lentler's Adtlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby efllrm Ihat under penalry of per�ury Ihat I em El(EMPT FROM THE CONTRAC70RS LICENSE lAW lor the fallowing reason (Sec. 7031.5, Business end Professions
Cotle: Any ciry or counry which requires a permit to wnswcL alter, improve, demolish, or repair any structure, pnor to its issuance, also reduires the epplicant ior such pertnit
to file e signed stetement thet he or she Is Iicensed pursuant to the provisions of the Contractors License Law (Chepter 9(commencing with Sectlon 7000) ot Division 3 ot the
Business and Protessions Code) or thet he or she is exempt therefmm antl Ihe basis for ihe elleged exemption. Any violatlon oi Sedion 7031.5 by eny appliwnt for e pertnit
subjects Ihe applicant to e civll penalry oi not more than tive hundred dollars (5500).):
❑ I, es owner of the properry, or my employees wlth wages es ihelr sole compensation, WILL DO THE WORK, antl the structure is not intendetl or oHered for sele (Sec.
7044, Business and Prolessions Code: Tlie Contractors License Law does not apply to an owner oi property who builds or improves thereon, antl who does such work
himsatl or harself or thwugh his or her own employees, provided that such improvemeNs are not Intended or ottered tor sale. I�, however, ihe builtling or improvement is
soltl within one year ot wmpletioq the owner-huilder will have the burden of proving that he or she tlid not build or improva tor purpose of sale.). �
❑ I, es ownar ot the properry, am E7(CLUSIVELY CONTRACTING WITH LICENSED CONTRAC70FS ro construct the project (Sec. 7044, Business end Profeuions
Code: The contractors License Lew does not appty to an owner oi property who hullds or Improves Ihereon, antl who coniracts tor such prolect with e contwcror(s)
license pursuant to the Contractors License Lews.).
❑ I am exempt under sec.
Signature:
Owner ID veniied by tlnvefs license. ❑ Yes ❑ No
Business antl Professions Code for ihis raason:
Veniicetion of Ownership by (rype of tlocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICA710N:
Driver's License No.
oate:
Expires:
❑ I hereby certify Ihet no ezwvation five (5) or more feet in tlepth into which a person is requiretl to tlescend, will be made in connedlon with work authonzed by this
permi�, and Ihat no builtling slruIXure, scaHolaing, falsework, or demolition or dismantling iheraof, will De more Ihen ihirty-six (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Ttle B, Califomia Atlministrative Code).
❑ As owner-builtler, I will not employ anyone to do work which would require e permit irom the Divisian of Industrial Sefery, as noted e6ove, unless such persan hes e
permit to da such work irom the tlivision. .
Signature: Da�e:
Division of Industrial Salery Permit Num6er:
CERTIFlCATE OF COMPLIANCE AND AUIHORVJUION OF EMAY: I certify under penalty of perjury that I have read this epplication antl state that the intortnation given is
correct. I egree �o comply with all state laws and ciry ordinances rela�ing �o builtling construction, and authonze representatives ol Me Ciry of Costa Mesa to enter upon the
ebove-described property tor inspection purposes. I agree not to occupy or allow occupancy of eny building authonzed by ihis pertnit until finel inspection.
CODE �. INSPECiIONTYPE
1618 Fizetl System Final Fire Preventlon
1266 Pool Spa Final
200 Final Re-Root
201 Flnal Block/Retaining Wall
202 Final Fadory Fire Place
203
204
Final Sign
Final Demolition .
Pag iHrnu�s
CODE� INSPELTIONTYPE
206 Final Mechanical
208 Finel Plumbing
270 Final Elecirical
212 Final Fire Preventlon
220 . Final Planning Approval
222 Final Site
250 Final,Building/Occupancy
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