HomeMy WebLinkAbout1783 HAWAII CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.8Ur 4LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1783 HAWAII CI
Suite:
Vicinity.
Primary Occ: R3
Parcel Number: 13957215
Applicant: ROGERS,MIKE
Address: 2626 NEWPORT BL
COSTA MESA, CA
Type of Construction: V -N
Zoning:
Phone: 949-548-1645
Zip: 92627
Owner: HEBERT, NATALIE
Address 1783 HAWAII CIR
Phone:
COSTA MESA, CAI
92626
Contractor: PETRONELLA ROO G
j R
Address: 2626 NEWPORT BL
Phone:9-548-1645
COSTA MESA, CA
Zip: 92627 License: 460707
Arch Eng:
Address: Address:
Phone:
Zip: License:
ISSUED BY:
Status: ISSUED
Applied: 09/12/2006
Issued: 09/12/2006
Phone:
License:
SCOPE OF PERMIT
TEAR OFF SLOPE AREA ISNTALL 1/2" CDX 1-30 LB ON A 4:12 SLOPE AND 50 YEAR COMP. SHINGLES CLASS A. SPUD OFF THE FLAT ROOF
AREA AND INSTALL SPRAY APPLIED POLU URETHENE FOAM. -
FEE SUMMARY.
Plan Check: $0.00 Calc Valuation: $8,500.00
Permit: $167.25 Claim Valuation: $6,500.00
SMIP Res: $0.85
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.10
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
RRIP 2
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
246646 (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 far workers' compensation, as provitled tar by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
ve and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for the performance of the work for which this permit is Issued.
M workers' com ensation Ins�ur nce car er antl policy number are: _
Carrie S' -A � �t-" LJ Polic mbar �` 7o. — 60
' section need not a complefed i/the permit is valued at one huntlretl tlollars ($100) or less.)
❑ I certity that in the performance of the work for which this permit is issued,I shall not employ any person in armor so as to become subject to the workers'
co sa n laws of Califo ia, and afire that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
mply wi these provis s. �/ �/
WA :FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE NYAWFUL AND SHALL SUBJECT AN EM VE IMINAL PENALT 5 AND VIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,00D), IN ADDITION TO THE COST OF COM=E ATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICAeffe
CTORS DECLARATION:
I hem licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 usmess an PT fessions Code, and my license is in full
forcss N
C 2 06
CO UCTION LENDING AGENCY:
❑ 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).
Lender's Name: Lender's 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 driver's license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 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? ❑ 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).
.......................................ii................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ 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 and Safety Code been fully complied with? ❑ Yes ❑ No
............................. ..................................................................................... ..... ....................................... ........................................................................................................................................................................... .............. -..........................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a�ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No
(Section 65850.2 of the California Government 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 ❑ No
(It "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 prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
................................att............erti..........................niplitin...............................................................11ut................trol..offi..........................................................................................................................................................................................
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 COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply 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.
Sign re Of Lega wner Date
Z d6
Amd/Or Authcffjz Ap ant to
CODE ll, INSPECTION TYPE DATE IWITIAL CODE INSPECTION TYPE DATE INITTIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 0 210 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
PROJECT ADDRESS: 1783 HAWAII CI UNIT:
OWNER'S NAME: CHURCHYARD, JAMES NOHL FLOOD: AE -37
ADDRESS: PARKER, ALBERTA J
1783 HAWAII CIR
COSTA MESA,CA 92626
540-5002
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: SANTIAGO A/C, INC. (714)998-1600
ADDRESS: 231 W. BLUERIDGE AVE.
ORANGE CA 92665
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
CITY 015269 �STATEuc.:269496 O�X,P: 08/95
4p Signature: `�� �"
OR RS'COMPENSATIONDECLARATION: I hereby affirm that l have a certificate of consent to self -insure or a Certificate of Workers'
pensation Insurance. or a carried copy thereof (Section 3800. Lab. C).
`OLICYNO.: W94 7102180 EXP. DATE: 07/01/95
COMPANY: CALIFORNIA COMP
❑/ �¢p �died copy is t1hereby form
.shed. Q Certified copy is filed with the city
, Building Division..
O _ L Q /! 1/ y Y �^
Applicant:
4 l J(-_ l ivy�C ,
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less).
I eerily 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 WorkersCompensation Laws of California.
Date: Signature:
NOTICE: IL after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must frolm nh comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perlormance of the work for
which this permit is issued (Section 3097, Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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 helshe is lice ad
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) of that he/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 (5500).
I. as owner of the property or myempIoyees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale(Section 7044, Business and Professional Code: The Contractors' State 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 employees, provided that such improvements are not intended or oflered for sale. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving helshe did not build or improve
lar the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑
and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Date: Owner
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I ar any future building occupant willlwill not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District, Residential construction applications are exempt from
these provisions.
Date: Applicant:
Ihereby certify that I have read this application and stale that the above information is correct. I agree to Comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
ora ery fpr inspect ion purposes. �.�--•-� / �s
Dale' Signature: / Y ` 62
Driver's License or Social Security a:
1641 46 White—Building', Green—Cone Enforcement: Canary—Appficanl; Pink—Revenue; Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 06930:
PERMIT NO: M 069301 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: NEW
JOB DESCRIPTION ; REPLACE 4 TON A/C UNIT SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN
BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT; FT IN
REAR:
FT IN
FRNT;
FT IN REAR; FT IN
LEFT: FT IN
RIGHT:
FT IN
LEFT:
FT IN RGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
13957215
ZNE: REF NO:
PLANNING NOTES>
D E V E L O
P M E N
T S E R'' -V I
C E S
R E Q U I R E M E N T S
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY :
APPLICATION ISSUED BY:
##################################
LEGALIZATION:N F E E
DATE:
DATE:
#
rC
if sFiF'iF iF iFiF #iF 3FiFiF3r3F iFiF%iF'ie'±F# # # #DATE
S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 18.00
25� SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 18,00 15.00 0.00 33.01 33.00 .00
L --> Y
REVENUE DIVISION TOTALS COLLECTED: ._--33.0. OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
,3'3.00
###############################################################################
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N
MEC 1 INST FORC—AIR/GRAY FURN <= 100 K•BTU
MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H
END -.OF FEES
UNIT COST TOTAL COST
9.00 9,00
9.00 9.00
V
01 00165614-00i69619 T r—ET 33,00
DATE: 10/17/44 TIME: 08:43
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
P _ & SPA
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 UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Cond Uit-Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System i
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
APPROVALS Permit
20, Rough Factory Fireplace
21. Ducts, in Structure
70, Underground Hydro
22, Ducts, Ventilating
71. Product Piping ❑ Gas ❑ Ort
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank ❑Gas ❑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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
' 39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
,
August 31, 1987
To:
CITY OF COSTA MESA
CALIFORNIA 92 62 8-1 20 0 P. O. BOX 1200
DEVELOPMENT SERVICES DEPARTMENT
Building Safety Division
Business License Division
Communications
County Administration Office
County Clerk/Board of Supervisors
County Registrar of Voters
County Tax Assessor
Engineering Division (2)
Finance, Revenue Division
Fire Prevention
Manager, MID
Mesa Consolidated Water District
Newport—Mesa Unified School District (2)
Pacific Bell (2)
Police Department - Ping. 6 Research
Santa Ana Heights Water Company
Sanitary District Engineer
Southern California Edison Co.
Southern California Gas Co.
State Board of Equalization
Street Division
United States Post Office, Adams Avenue
United States Post Office, Santa Ana
Zip 4 - Santa Ana
File (2)
The City of Costa Mesa wishes to advise you that in revising street addresses,
the following addresses have been changed:
OLD ADDRESS NEW ADDRESS A.P. NO.
1781 Hawaii Circle 1783 Hawaii Circle 139-572-15
For your convenience we are listing the agencies above that we have notified
of the change. In addition to those listed, you are advised to notify your
correspondents of the change in order to avoid any possible interruption of
mail service.
Your cooperation in this matter is appreciated.
Sincerely,
'e. �L
1=S. LEE
Planning Intern
JEL:kdm (F-1-24)
cc: Ms. Alberta Parker
3124 Bermuda
Costa Mesa, CA 92626
Building Division (714) 754-5626
Code Enforcement/Business License (714) 754-5234
77 FAIR DRIVE
Planning Division (714) 754-5245
/ // CITY OF COSTA MESA REQUEST FOR OCCUPANCY
Q
TRACT NO. 6 �l DATE % ^ 2 % /
LOT NO. 32 -
ADDRESS
ZADDRESS � R ) S�2 [2�0
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he -she -they)
(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
Developer an
representati
B
Len
Cl�
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CITV.OF COSTA �M EES,cA7 CON'S'TRUCTION PERMIT PERM O. TRACT NO. LOT NO. UNIT NO.
Project Address -i r7 ( -;, ?, 4t A WW A I I�' / 9a.q
Applicant's MailinO Address `I 'Ira _T&_P[ nI✓ni 6-17r) TYPE OF CONSTRUCTION U NEW U ADD LJ ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH 1_1OTWyES�R, A.P.
#
Owner's Name �G Phone DESCRIPTION OF WORK/USE_OF BLDG. ge_rl�
Address �_ -.
Arch/Eng. License No.
Address
Contractor's Name 1 Phone
Address (mailing) gtaae L`a rP_t^f�l�I MM p(i 1-f 17b
City License No. � ��U 11't L
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. ( l
License Class License No. ---1 Os
Date —AQ — Signature
"ORKERS' COMPENSATION DECLARATION
nueby affirm that I have a certificate of consent o seJ Insure or a Certificate
A Workers' Compensation Insurance, Or a ce 8fr copy thereof (Section
3800, Lab.CC
Policy No. ompany T
❑.Certifietl copy is'hereby furnished. /
erJ die copy.y.5 (l'led with the city Bl i d' ivisi n.
Dale \ _��JVp Applican
EXEMPTION FROM
BWORKERS' C P NSATION D ARATION
(This section need not be completed if the permit Is f o huntlr¢d ($100) or
less).
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 t(te
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for 'which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
�e 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
'=Ykerefrom 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
enalty 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 (Section 7044, Business and Professional Code: The Contractor's
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
employees, provided that such improvements are not intonded or offered for
sale. If, however, the building or Improvement Is sold within one year of com-
pletion,
the owner will have the burden of proving he/she did not build or Im-
prove ver the purpose of sale).
❑ I, afos owner of the property, am exclusively contracting with licensed con-
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
builds or improves thereon, and who contracts for such projects with a con.
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date
I hereby certify that
information is correct.
and state laws relating
sentatives of this city
inspection purposes
Signature
Drivers' License br S
IF 0865-46, rev. 10/84
Owner
have rea
I this application and state that the above
comply with all city and county ordinances
g construction, and hereby authorize repre-
upon the above-mentioned property for
TYPE OF PERMIT (J GRADING &1 FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUM ING F-1MECHANICAL
❑ OTHER -j
PROJECT DESCRIPTION SQ. FT. _ _LS_ OCCUPANCY_
CONSTRUCTION TYPE VALUATION $ 3[
ZONE GRADINGCU.YDS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P -Trap
Roof Drains
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBG #
Heating System & Ducting
❑0.100,000 BTU El 100,000
Reinspection Fee
White - Bui Ing Canary -Applicant; Pink - Accounting; Goldenrod - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
1:10-100,000BTU 0100;000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
S Main Bwldl
E
T Front
B Rear
A
C Right
K Left
Ping. Ref. #
Planning Notes:
3584 1/21/80
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. ❑ 50 + KW
Cooking Unit Meter ❑up to 100 amps
Dishwasher Meter ❑over 100amps
Dryers ❑Gas ❑Electric Sub Panel
Fan Motors ❑01 HP ❑ 1'h - 8
F.A.U. Inc. Solar 09-15 HP 016.15+
Fixtures Microwave
Device Boxes Pole Light
Outlets
Switches
Garbage Disposal
Generator 110.5 KW ❑5-15 KW
Standing Sections
Trash Compactor
$ 3
�
Reinspection Fee $15 Issue Fee
FEE$
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By 1
Building Approved By 1
Application Issued By [
sum /MMMp7kV,,OE FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGY P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
$ 3
63.50 TL
FEES
$ 3
$ 'So
Z
O
N
I
N
G
R
E
Q
M
T
S
(CONSTRUCTION AND PLANNING
APPROVALS '.Permit'#
Date
Inspector
POOL & SPA
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 - t
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVALTO 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, 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
APPROVALS Permit #
'
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 00il
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:
f{ -•�
34. Final Heating & Air ConditioningA
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
'
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE&BUILDING
Q 303 /Q� VOL [1
Cl/
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
,��
PROJECT ADDRESS: 1783 HAWAII CI UNIT:
OWNER'S NAME: CHURCHYILRD JAMES NOHL
ADDRESS: PARKER ALAERTA J 7,0
1783 HAWAII CIk ID
COSTA MESA,CA 92626
540-5022
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: PROFESSIONAL ROOFING (714)968-1278
ADDRESS: 10076 LOS COYOTES CT
FTN VLY CA 92708
LICENSED CONTRAC OR DECLARATION: I hereby affirm that 1 am licensed under pro ins of Chapter 9 (commencing with Section
7000) of Division 3 the Bu iness and Professions Cade. and my he a is in fu f cc apd effect.
clTYuc.: 05 X331 WJ_Euc.:5608�cy)(sp:X_"
WORKERS' COMPENSATION DECLARATION: I hereby
Compensationy5y[aqpp, ce�
t e copy thereof IS
POLICY NO.: lU7E J��
COMPANY:ITAT
❑ Cerolieeddry isher y f miished. ff Cendied
�J
mt ve a cendicate onsent to sell -insure or a cenificate of Workers'
on 3so3,_ ab. �1.4 / 9 3
EXP. E:
y itf dv with }pe ci uil g Division.
if the permit is for one hundred ($100) or less).
any person in any manner so as to become
subject to Te Workers' Compensation Laws of California.
Date. ll Signature:
NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must lorthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' Stale License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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 fife a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/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 penally of not more than five hundred dollars (3500).
I. as owner of the property or my amyyloyees with wages as their safe compensation, will do the work, and the
El structure is not intended or offered far sale(Section 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property no builds or improves thereon, and who does such work himselUherself 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 will have the burden of proving he/she did not build or improve
for the purpose of sale).
1, as owner of the property. am exclusive] y contracting with licensed contractors to construct the project (Section 7044, Business
Eland Professions Code: The Contractors' Slate License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section: 0. S. P. C.
for this reason:
mm
Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533. Iff and
25534 and that l or any future building occupant willfw not (circle ane) need to comply with said state codes and the requirements for a
permit for construction or maddication from the Air Quality Management District. Residential construction applications are exempt from
these provisions.
Date:
I hereby certify that
ordinances and State
property for inspect
Applicant:
n and state that the above
Driver's License Ir Social Sectnty a:
164646 White—Building: Green—Gade Entorcemem:
I agree to comply with all city and county
fds city to enter upon the above-mentioned
Mink—Revemoe: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 05825C
PERMIT NO: B 058250 PLAN CHECK NO: N GOVT': N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF REROOF 800SQ FT WITH BUILT UP SQ FT; 1,600
CLAIM VALUE; 1,600,00 CALC—VALUE: 1,600.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR REWIRED IN THE HOME
##aH##TE#+�##*#E�#*###;�•#�H#�H#�:x###�####*#*#*;'rye##*�u�#>E##
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING RE • PROV: PARCEL; 13957215 ZNE: REF NO:
PLANNING N TES>
###iF########IE###############Ni6##*ye#####yr#h'#1F###########i!•#yi•#Y.ii#######"iF iE####?~##N#
D E V E O P M E N T S E R V I C E S R E Q U I R E M E K -T S
ZONING APPROVED BY DATE: (?
BUILDING APPROVED BY DATE:
APPLICATION.. ISSUED BY;_��
DATE:
####yE#######•,****#'N-.###ic#ih lE##"..:#####N-i0####lf###*****3k'*#####y4#3E#i4#*yf•****###########
LEGALIZATION:N F$ E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC. MECHANIC FIRE SMIP/RES GRADING
PERMIT 37,00 ,50
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID :.,'
TOTALS ---- > 37.50 0.00 ,,'0.. 0,0 37,50 37,'50' .00
REVENUE DyQIfiLON--TOTALS--> COLLECTED'.',,' 37.50 OVER/SHORT;: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC,'. FIRE SMIP/TOT GRADING.PLAN—CHECK
37.00 .50
t
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1600 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 1,600,00
d END:OF FEES
EXPIRED
Incomplete Inspections -
03te -_ _.__ Sig ---
CONSTRUCTION AND PLANNING
APPROVALS Permit i�
r
Date
Inspector
POt._ eL SPA
APPROVALS Permit #
Date
Inspector
i. Temporary Electrical Serviceior Pole
f
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Elect, ical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit -Undrgrnd.
B. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60, Backwash Lines, P-Trap, O 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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O Gas 000
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd.StorageTank 1]Gas ❑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 PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter-Final
'
80, FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
_
7
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
OJ
48. FINAL PLANNING
49; Electric Release to Edison
@t
50. Gas Release to Southern California Gas Co
-
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 1783 HA14A I I CI
OWNER'S NAME: CHURCHYARD JAMES NOHL
ADDRESS: PARKER, ALhERTA J
1783 HAWAII CIR
COSTA MESA,CA 92626
540-5002
ARCH/ENGINEER:
ADDRESS:
UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 069302
FLOOD; AE -37
PERMIT NO: E 069302 PLAN CHECK NO; N GOVT; N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: NEW
REG.NO.:
UNIT:
PERMITTEE: SANTIAGO A/C, INC. (714)998-1600
ADDRESS: 231 W. BLUERIDGE AVE,
ORANGE CA 92665
LICENSED CONTRACTOR DECLARATION: I hereby alfirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
CITY 015264 STATE uc.:269496
CLAS08/95
g2�Signature: 6 -
Sz!NEAI hereby affirm that I have a certificate of consent to self insure or a candidate of Workers'
Compensation Insurance, Qr a certified copy thereof (Section NDO. Lab. C).
POLICY NO.: W94 /102180 EX P. DATE: 07/01/95
COMPANY: CALIFORNIA COMP
❑ Certified copy is hereby furnished. EZ Cenified copy is filed with the city Building Division.
Daal 10 11 —7 / %� � Applicant: -7-1` ty/ C,21"MPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less).
I cenity 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 WorkersCompensation Laws of California.
Date: Signature:
NOTICE: If. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shallfie deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097. Civ. Q.
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Cade) or that he/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 amyloyees with wages as their sole compensation, will do the work, and the
El structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State 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 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 will have the burden of proving he/she did not build or improve
for the purpose of sale).
I. as owner of the property. am exclusive] y contracting with licensed contractors to construct the project (Section 7044, Business
EJ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. & P. C.
for this reason:
Date'.
do hereby certify that I am aware of and on
25534 and that l or any future budding Occup
permit for construction or modification from
these provisions.
JOB DESCRIPTION : REPLACE 4 TON A/C UNIT SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
###############################################################################
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------
MAIN
BUILDING ----------
---------
ACCESSORY BUILDING---------
FRNT;
FT IN
REAR; FT
IN
FRNT;
FT
IN REAR; FT IN
LEFT;
FT IN
RGHT; FT
IN
LEFT:
FT
IN RGHT: FT IN
PARKING
REQ:
PROV:
PARCEL;
13957215
ZNE;
REE NO:
PLANNING
NOTES>
>
###############################################################################
D
E V E L O
P M E N T S
E R V I
C E S
R E Q U
I R E M E N T S
ZONING APPROVED BY
DATE:
BUILDING APPROVED BY : ^ DATE:
APPLICATION ISSUED BY: / DATE:
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 7,50
50% SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 7.50 15,00 0,00 22,5y 22,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 22,50' OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
22.50
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Owner: I ELE
derstand the requirements of California Health and Safety Code Sections 25505, 25533 ,
and
ant will/will not (circle one) need to comply with said state codes and the requirements for a
the Air Quality Management District. Residential construction applications are exempt from
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct. l agree to Comply with all city and county
ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property/ for inspection purposes.
�Da1e' �/ 01 �� Signature:
Driver's License or Social Security n:
164 L46 White—Building: Green—Code Enforcement, Canary—Applicant, Pink—Revenue) Goldenrod—Assessor
1 MOTOR/POWR APPARATUS 1,1 — 10,0 HP
END OF FEES
7,50 7,50
01 00169618-00169628 T CET 22.ir
DATE: 10/17/94 TIME: 08:40
r
CONSTRUCTION AND PLANNING
APPROVALS Permit ,$
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
Inspector
t. 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 UFER Grnd.
57. APPROVAL TO COVER-GUNITE
I
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
I
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, O 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
I
13. Roof Drains
64, Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66, Solar System -Final
`
76. Rough Electric Wiring
67. Fencing & Access Approval
17, Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping ❑ Gas El Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas GOil
25. Roof Sheathing
74. Overhead Hydro
i
26. T -Bat Ceiling (Structuratl & Monoccat
75. Dry Chemical
it
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
33, Final Electric
2 Z0.V/
J
Q om"
80, FOOD CERTIFICATE ISSUED
Notes:
34. Final Heating & Air Conditioning
i
35. Final Gas Pipe -Test
36. Hood or Canopy
'
37. Final Factory Fireplace
1
38, Final Plumbing
1
39. Water Service Final
40. Gas Service -Final
41, Solar Domestic -Final
42. Backflow Preventer
i
43. Backflow Irrigation
I
44. Landscape Irrigation System
45, Sound Attenuation
46. Handicap Regulations
i
47. FINAL STRUCTURE & BUILDING
46. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51, CERTIFICATE OF OCCUPANCY
No. Date
Z .
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COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
bgvv7GCNSff,,0
26-0 739* ***159.75
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEI DJY
�TEr Fi[cCE�/F�D
//Y ./(f
DAISSUED
BUILDING
/ `
ADDRESS
PE
OWNER Apollo Development Corp.
_
A.P. NO.
1104 E.17th Street
BUILDING
ADDRESS1-�(,f/CITY
ADDRESS
Santa Ana NOL 547-9673
TRACT 6694
LOT 32
U. S. National Bank
W
AD
A
PAIR
MOVINQ QFMQ1 ISHX
LLEENDER�ION
BRANCH Main OfficeADDRESS
OWNER Apollo Development
190 S. Broadway, San Diego
Dwelling vALUS 17,700
ARCHITECT TEL
Kermit DOrius 675-1164
SE
OR ENGINEER
FIRE�T
ADDRESS 3111 2nd Ave., Corona Del Mar
ZONE TYPE GROUP b/
CONTRACTOR Apollo Development Corp.
APPROVED
BY DATE
ADDRESS 1104 E. 17th Street
TEL.
Santa Ana 547-9673
ZO
NO. OF -t —
PLANS
USE OF NEVI/ /
BUILDING r
CITY NO.
/
STATE CITY
YARDS APPROVED
YARDS APPR VED
LIC. No. 252549 LIC. NO. 1690
MAIN BUILDING
ACCESSORY BUILDING
OF OQ -�
SIZE 554 90
(FROM C/LST F ET)
OF LOT X NOW ON LNO.
FRONT FT.
FT.
USE OF
O
EXISTING BLDG. ---
ET.
FT
SIZE OF
2100 S.F. 9 2
NEW BLDG. ROOMS STORIES
L. SIDE FT.
FT.
EXTERIOR WALL Per
COVERING Plans
ROOF
COVERING Shin 1e
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN RLDGS.
ACCESS. BLDG$,
Construct new dwelling with
C. U.P.
f
APPROVED
attached garage.
APPROVED
or
I hereby acknowledge that 1 have read this application and state
HOLD FOR ST
E^I'�'^L RL U
" jgEMFN
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
U d L'
the State of California.
I hereby certify that I am properly licensed as a contractor under
"- SO. FT
THE AMOUNTS OWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
Professions Cotla ivicion 3, C 9.
VALUATION
/
and epter
PERMIT FEE $
Signature of
Permittee
$ (p 7
L
PLAN CHECK $ 143
Authorized Agent
TOTAL FEE S /15' / Q - �71 5