HomeMy WebLinkAbout902 HYDE CT - Building Permits�oonessaem�ou+c: �vc nxLn �i
w�mEasruueiFaawx: REYES, JON R
, ADURE55: 9OZ HYDE CT
�� COSTA MESA,CA
;. \ 754-1321
MPL. WUl1NG 1DDPES4:
IPCNRECTOPFNfiNfEP:
urcx. on eac.�s �ooxess:
92626
UNT:
uc. xo:
uxT:
ca+meaamsw� NOCK PLUMHING ( 714 ) 895-1246
carmecToxs�uw�c 11610 SEABOARD CIR
�oonEss: STANTON CA ���, 707775
90680 ��
UCENSED COHfHRCTOHS DEC�AHRTION: I heraby aflim urder panely d per'ryry tlwi l em Ireiuetl urder poviaben d Cheqer 9
(commena�g wiih Section ]000 M Dimion 3 d Ihe Businass and Prafesvona Coda end m licanae is in lull /orce and eHed.
cmuc.No.:05038�i uccwss: C-36 uc.No.: 7677�75 EXP: 02/97
oe�<: 3- 2—"2 °t � ���,.d�: ��,� I�Lu /�t ���1� I�-
OWNEN BUIlOEP DEttANATION: 1 hareby eifiim uiWer parely d parNrY �� I em exemq Irom tM ConbaUpa Liceree law (a IM
Idbwvp resson (Sadion 1031 5 Buainess arM Proleuiom COEe: Rny c1y a munly which reQuiras e parmil lo conavun, eM1ar, improve,
�dsh, or reper any aliuclure, prior ta ns'saueMa, e6o repuires iM applirent la euch parmn to fib e egiroE sletement thm M a aM
enseE W�s�a�� �o �� M�sb^s d �he Coniretlore Lioense Lew �Chepter 9(mmmendfp wilh SeWion ]000� ol Divivion 3 W the
.'wsa end PrWesaionn Code� ar thm he or eM ia uemq therehom enE iM beais la tha elleped uemqion. My videlion al Seaion
iu31.5 by eny epplirani for a parmil wbpds iNe epplicenl lo e tivil parelry d nd mae Ihen iNa hundred dollen �5500�).
� I,eaownerdiMpmpanyamyempbyeasxvnwepesaviheiwlammpanation,willdothexroA,endtheaiiucturaundintanEeE
or ortered r« sele (secimn 1aa. eusinem ena arolx:lons code: m. cem.mors �icense law eoes nm wW �o � awrre,a wwaro
wno d,wa « mp� ma�. �d .no aoaa:��n �x w��n o, nena� «mro�,an na a ne, o� amoiw�, m�aaa inm eucn
�mo�wemama �,a �� �ma�eee «one,�a m� aeia. n, i,�,�,ac ma n��ame « �mo�mam n sad .mnm � v�, d�d��, ina
owiwr-buiker xi0 Mva tM W Men d povino � w she EW iwl Wik a impwa lor tM puryoae d aele�.
� 1. ea omrer d the propeM. � exdumely oontrea�p wnh limnsed conlreclon b congrud iM prqae (�� ��. Buainasa end
vro�eamos coe,�, rna com,enon Lca�sa lew aoea �a ew�r �e e� ownm a worom wno w�n+ a imwo+m �nei.o� ene .Nio
cnmrecm la wrh pqects wnh e mnredor(e) IicenxC Wnuani lo IM Canireawe Licrose lew).
� I am e�emq uMar Section�. B. 8 P.C., Im th'n raeson:
Date: Owner:
� eo nereM cenM umi � am eware d e�d uMersta,d �he rea���a��s d celLanie Hmm� ene sefmr code smore 25505, u5a'i, erd
YS.N, end thm I n eny future WilEing owpen� will / wtll nd (dreb one) need �o rompN w�h eeid e�ete codes eM IM repuiremenp br
epermillwcansvuciionamadArationhwniheRi u�STy.l�aregementDimritl.pesiAenlieleonsliuclioneppirmiwueroe�amqfmniheea
proWsione.
Daie: � Applicanl:
WOPKEq'S COMPENSATION OECURATON: I heraby alfiim uedm pareliy d perjury aia d ihe lolbwirp detive�uen:
� IlievevWxilmeinleinecenXira�edmnaenllosall-inwrel«vrorkerscompenee�bn,eaprovidedfwby5aqion3)OONtnaLebor .
coea, m, me wn�<a m ma.wn io..w:�n m�s w�u � �n�ea.
�] � neve end a;e meimei� walaen wmaenaetion Ireurenw. s�ea���.d W sxrian a�ao a ine lesar cae., ro. �ne vanama,ce d �ne
.onr«.,nw�m�sw�amn.�e.Mr.a���ti�.°Fi'°`�`A�.`i`���naow�w��me�.�e: EXPIRES
c'm°' 09/01/96
Policy Number:
.s secfion rreeE iwt be comF�ed / fM P�R u lw are hunLreE dolbrs (4fOJJ w lev.l
❑ I cerliy � in Ne pMamaMe d Iha w«k for whch Ihie pe�mn is iuued. I ahell iwl employ enY Va�n in eiry menner m av to
becoma subjxi io �he warkaes' compansetion lexe d Celilpnie, enA epree ihm il I slwuld becoma eubjee ta tM xvhsa'
cwnpenae�ian pioviaan M Sedion 3)00 d iM lebor LoCe. I h mFp r�X !oe powiwu.
o�a: 3' t—�1 —� � .��:���� �
Wem/np: F�llun ro�xuro wohwi comperwtlon rovereys Is un a%wTul, antl aM1s/I �ub/xt an smployw ro cAMrul psn�ltlsa aM
clvll nnsi �q ro ons hu�tlretl thousslM doller� (Sfpp,000), In eMlHon ro ths m�f ol compsluatbrt ��Om sa provltls! br In
Sxtlon J]06 0l Ms Labor Cotle, Interest, erM ettomey i/esa.
CONSTPUCTON LENDING AGENCY: I hereby eHim unEer paneM d parNrv �� ��e b e consuuabn kMi�g eganty br IM
peAormenm d iM work lor whiM iha perml u bsueE (�� �]. CH. C).
�ENDEP'S NM1E:
LENOEA'S ADDFESS:
I cenity ihet I heva read Ihis apvlratim end nete IAeI ihe ebave in/ormetbn is mrtea. I epree ia cwnply with ell dy enE wuMy oNineM.ea
eM n�qe lews relelmg lo Wildip tron vWion vd hereby eWMr¢e reqasanlatives dihe aty lo enter upon IM ebwe�memionetl pmpe/y
i«'"�°°°w"""'°°s's. RON NOCK
Pnm Ne e /f� ^� �
s \ � / �. Deta: 7�2�
Sq /AgenUNppicen rada
Whne-Buikiq 8 Sefety: GreerFb: Caneiy-Appir.anl: Rnk-Revenue; OONen�o�A+smwr
CITY OF COSTA MESA — BUILDING PERMZT
PERM NO: P 076926
PERMIT NO; P 076926 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE; OTH
JOB DESCRIPTION ; DISHWASHER C/O ISQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
I
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT i
**� +�+�***�*+��*+�****�*�������*x ****�r**�***+�+� ********�t*+�+t �*�**********x�***�*+�x ** **
Z O N I N GS ERTEB�AUCIKRSE M E N T S �
------------ MAIN BOILDING ---- ----- -- ------ 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: 91808203 ZNE: REF NO:
PLANNING NOTES>
i
iE 3E 9E �E 9E iE 9E iE 9E 3E iF aF �E iE 3E iE aE iE iE iE ik iE i(� * iE iE iE iE 3E iE iE iE iE iF 3f if iE 1E'If iE jE'IE 3E'� iE �E if iE M ik fE �E iE 1E iE aE 3E if 1f ik iE iE �E �E �IF if if iE 3E jE iE 3f i(� iE jE * iE if iF
D E V E L O P M E N T S E R C' 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 HY:
LEGALIZATION:N
BLDG PMT
PERMIT.
PLAN
ISSUE FEE
BUILDING—DIV—>
TOTALS---->
F E E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
7.00
25�
20.00
FIRE
DATE: /
DATE: 20 �U
iEiEaE3EiEiEaEiF 3E iEiE
STROCTURAL SEGMENT:N
SMIP/RES GRADING
SMIP/NON—RES
PERMIT ISSUE PLAN—CHECK' TOTAL PAID DUE
7.00 20.00 0.00 27.00 27,00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27,00 OVER/SHORT: .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
2%.��
3E IElE 1E jE 9E df iE 3f 1E 1E �E �E IE 1E 1E 1E k 1ElE 1E �E iE iE iElE aE iE iE if iE iE 1E if 3E 3E �f iE 3E dE iE iE IE iE iE iE �E if IE iE iF iE 1E 1f 9F if iE if 9E iE 1E 1E iE iE iE 1E 1E 3E dE iE iE 3f 1E 1f �f {E jE 1k IE
I N D I V I D U A L F E E B R E A K D O W N
QTY D E S C R I P T I O N
PLU 1 DISHWASHER
END OF FEES
' ��
UNIT COST TOTAL COST
%,Q� %,��
8x 00?0'r'?:ii—i];t203231 7��eT �^.Or�
DArE: D3� 2%�?`: t rY,�': d?; 1 � '
'
CONSTRUCTION AND PLANNING
�`APPROVALS Permit #
.`
1. Temporary Electrical Service or Poie
2. Soil Pipe-Undrgmd. .' -
•3. Electricaf Conduit Utility-Undrg�nd.
4. Electrical Conduit�Undrgrnd. _
5. Steel Reinforcement: - �
6. Etectrica� UFER Grnd.
- 7. Footings - �
-8. Foundation �
9. Water Pipe�Undrgrnd.. ��
10. Structura� Floor Svstem '
it. PropertySewer Line&HouseConnection�
12. Sewer Cap .
73. Roof Orains ��,
74. Rough Plumbing �
15. Rougfi Electrical�Conduit �
16. Rough EleCtric Wiring � �
77. Rough Wiring Sign •
18. Rough Electrical-T Bar Ceilin9 ,
19. Rough Heating &-Air Conditioning
20. -Rough F9ctory Fireplace , :
21. Ducts, in Structure. •
22. Ducts, Ventilating; i �
23. Gas Pipe•Rough & Test _
24. Roof Framing '
25. Roof Sheathing
26. T•Bar Ceiling (Strucfural� & Monocoat
27. Frame and Fiashing :
28. Lathing & Siding_„' �
29. Insulation
30. Drywall Nailing � �
31. Plaster Brown Coat � �
32. Electrical Power Meter=Final
33. Final Electric. -
34. Final HeSting & Air ConditiOning
35. Finai Gas %'ipe�Test
36. Hood or Canopy •
37. Final FaciorY Firepiace _
38. Final Plumbing -
39. Water Service-Final �
40. Gas Service-Final �
41. $olar pomestic-Final
42. Backfiow Preventer
43. Backflow Irrigation � �
44. Landscape Irrigation System _
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electrie Release to Edison
50. Gas Release to Southem Califomia Gas Co
51. CERi'IFICATE OF OCCUPANCY
Date
POO L PA
Date Inspector APPROVALS Permit #
� 52. Pool & Equipment Lacation �
r
53. Steel Reinforcement
54. Forms -
55. Electrical8onding -
56. Rougti Plumbing & Pressure Test
57. AAPROVAL'f0 COVER�GUNITE
� 56. Eiectrical Conduit-Undrgrnd.
� 59. Gas Pipe, � Undrgrnd., Test
60.. Backwash Lines, P�Trap, � Undrgrnd.
61. APPROVAL TO DECK -
. 62. Backwash & Receptor-Finai ' �
� � 63. Heater & Vent-Final � .
64. Plumbing Sysiem - Final �
65. Electrical�Finai �
66. Solar SYstem�FinaV
67. Fencing & Access Approvalirl
-' 68. APPROVED FOR PLASTERING
i
69. POOL/SPASYSTEMSFINAL�
� . FIRE DEPT. REQUIREMENT
-, APPROVALS.� Permit#
� 70."Underground Hydro
� 71. Product Piping O�Gas � Oil
" 72. Underground Flush
� � �� 73. Undergmd. Smrage Tank O Gas ❑ Oil
' 74. Overhead Hydro �
" 75. Dry Chemical
76. Dry Standpipe ; ' -
� � � 77. FIXED SYSTEM FiNAL
78�. FIRE PREV. FINAL ��
� �NEALTH DEPT. REQUIREMENT
� 79. FINAL INSPECTION
86. FOOD CERTIFICATE ISSUED
� Notes: �
\�
Date Inspector
� .i
�
_ +
�
�
�unness a em�axa: REYES ,�•�70N ii Y
wn�asx.aEiriwowr+: 902 HYDE CT
mo�ss: COSTA MESA, CA �
754-1321
�vr�. uuuxc �oowess:
92626
i
uHr: CITY OF COSTA MESA — BUL-LDING PERMIT
PEAMIT NO: P 076926 PLAN CAECK NO: ' N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PI:U'
UiCXRECT Ofl F!ltlNFFN: UC. NO.:
�RCN.OHENG.'S/�DDNE55: ' UNT:
coNm�crarsruMe: NOCK PLUMBING (714?895-1246
caxm�croesxuur�c 11610 SEP:BOAAD CIR
STANTON CA 707775
�ooness: 9 0 6 8 0 � N0
• uxr:
LICENSED COMt�HRCTO�F.7SqpO0)ECLARATION: I M1ereEy a�llisrmi, eupnddm penaby d pe�ury� tphmy�yI Jem licenaed uMJm�(psoviaiaerre(�pdy,Cheqm 9
CRYLCaNO�V��.7iSbd�C.CL155:�—Jb P C� 0' ///�uiain�XY!� VLI9%
oe�a ✓7'Z�1 °tt— �o�„�a: i�1c�� �Lv.tii'3r�tlG 1�
OWNER BUILDEfl DECLAFATION: I hareEy eifirtn unEer penelY d perN�Y �M1� � em axemq Imm �M ConVeqon liceme Law la IM
following reeson (Sec�ion 1031.5 Buane�s arM Praleaeiona COde. Any ciy a couMy wfiitli reyuirm e peimil io ooruvucl, eller, impove,
molsh, ar repsi eny stmnura, prbr �o ns'ssua¢e, eho ray�ires ihe epplirani Iw wch pem�il lo file e sipned sletement ihet he or ahe
licemed W�a��� lo Iha prwidma d tha Contraeorm Lice�ae Lew �Chep�ar 9(mmmencrip wilh Sedon )000) d Divieion 3 0l Iha
Businesa eM PrWeasions Code� or thet he or she is examq ihaehom eM I�e bmie /a �he elbgeE eaemqian. My violetion d Sedion
loat s q� any epplicani /or a perma wbjects �he epplicam io a�� varel�y d iwl m«e ihan fHe nurdred dollas �SSOOp.
❑ I, es owner W Ihe propany or my empbyees vNh wapes as �M1ei eo�e companaeiion, xill da Me v.wk, aM �he al�uc1ure e rat intandeA
or oltered M aele (Seciion ]OM. Buzrosa arM Profeasions CoEe: TM Comrepon licenae lew dma not epplyta en ownerd propeM
wlw WiEs or vnpmves ihereon, eM who Eoes euM woM �+mseH w heneX or thraph he or her own em0loyeee, provided the� auch
improvamante era rwi imafMed «oHered lor aele. H, Mwavx. �ha buiNirg w'vnprovemant u edd wilhin orre yeer d oomplet'on, iho
ow�wr.Wiker vnll M1eva Ine WNm M o�'ina � or sM Ck nd Wik w improve fa tM purpone d eebl.
� I. es oxnar M �he propeM. �%'�n��N ��renig wAh liwnaed conirecvon ta conmrua tM piqeq (Saeun )pa1. 9uyir�ms eM
PMessions coda: rM Con�redae Licensa law Eoes rN� evWY �o en ownar d MWa�Y who buiN. « impoves thereon ene wtw
cnnveW Iw auN pqeda wi�h a conlredorp) IcenseE pursuenl lo �he Conlredma Liceree Lew). .
� I em eRemq uMer Secian: 8. 8 P.G..1« thie reeson: �
H
Dela: OwnU:
I do heeaby eanily thet I em ewve d ud uMarsteM the requirememe d CelAomu HeeXh end Selety Cotle Seelbns 25505, 25533, eM
255�C. aM Ilal I a eny tNure builCi�q oecupenl will I will nW (d�cb are) neaE lo comply w1h sek sfele wdea eed IM mquiremenls br
epermnlamnstrunionamadifira�ionhwntheRi a�y.anapementOMritl.qsvdemielmngruqnneppketiomereexemptiromtheae
ww�isbns. .
oate: � nao�kenc
WOqKEN'S COMPEN5ITION DECL�flATION: I hereEy aifi� uedw penelty M parjury are ot �ha /ollowi�p Catleretom:
� I have and wil manten e cenMicme d mraent io asM�inw�e �a waken' wmpensNion, m prarideJ tor by Seeion 3100 d the Lebor
coea i« in. reno�« oi �na woa iw wwon m�: v�^n ��. �„�a.
� i n� �e �;� �m�..wk�� wmo�sm� ��a�,�n. d„Qu�nd M s<e�m a�ao d me �enw code, ia ma reno,me�ce a m.
work fa which ihu parmit is issued. My worken' ��n�����.�� �e �i� ��mca. �,a: E X P I RES
. va v�N�mea,: -�crie^.j� i 4 3$ ^=� 0 9/ O 1/ 9 6
(m�s exrro� �eea �a ae mmderee e rne ce�a �e �w o�a n���d.ed ea�ers Isiool o. i.ss.l .
❑ I cenN ��� �he pertormance d iM wwk iw whch tNia permn ie iaeueE. I ehell na employ eny pereon in eny merma » es b
bacome subl� �a �� ��rs canpeneation lews d �e���ie, erk egree �IIW,41 ehouM become aubjea to Ihe xoherm'
comve�m�p� o��s or san� a�oo a ma iamr code. /i on n canaN •+�A•� vro�.�a. �� �
o�a: 'J� T'% —% 6 novia�n:l� ��L—
Wam/ng: Fallun ro aroun wo�lrori rompeiu�tlon rnwrps b vnbwNl, entl �full iubJ1ct an wr�p/oYx ro ctlM�ul penalHs� anC
elvll 9rpa up ro om �vitlretl Touurd Celbn (Sf00,000), In etltll0on ro Ms co�f ol rompenaa0oq Lameps u prodtlW br /n
Sxtlon 3]O6 0l Ihe Labor CoOe, Inten�t, antl ettorney i/M+.
CONSTRUCiION LENOING AGENCY: I MreEy �rm unEer penelry d perlury Ibel Ihem ia e mnstmaion lending e9ancy lor tM
peNormarKe d ihe work br whiW ihe pem�! is'ssueC (Seaqn J09), Ciu. C�.
LENDEP'S N4ME: . �
LENDEP'S RDDPE55:
I cerlM tAm I heve reeC �hia applketbn ud me�e ihet I�e ebova inlwmation is corted. I aB� �o compy wnh ell rnY �d muntY ordinenc»
end nt¢le lews releimg to buiknp mnwuaion eM Mreby aulhorrze re0���e�ivea M ihia dy lo enler upon Ihe ebove-mentuned papeity
�o""'°a°'°"o°'o°'e'. RON NOCK �
� Pnnt Neme .
fil /� Daie:��2� �
.. � sie nnye�unpoucenvCa�veaa ,
JOB DE5CRIPTION : BISHWASHER C/O
CLAIM VALUE: CALC—VALUE:
PERM NO: P 076926
GOVTC N SUPP: N
PURPOSE: OTH
SQ FT:
GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
�r�t**'*+r*�r*�r�#***+r**#*+rx�+��r�r*x x��r�r*x**x�*x*�r�r�r�r*****x�x**�r�r�t*x�**�r*�r�r+r**x�x�*#*+�***�x*xx�
Z O N I N GS ERTEHQAUCZKRSE M E N T S
-- — -------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING ----=----
FRNT: FT IN REAR: FT IN FRNT:' FT IN REAR: FT II`1
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT jt`1
PARKING REp • PROV: PARCEL: 41808203 ZNE; REF NO:
PLANNING NiSTES>
� .
fF iE iF iE'lE 1E i81E iE i! iE if iF if'IE IE iE3f iE if 1f 1f 1f 1f 1f iF 1E iE iE if if'IF if 1E ii'#1E ih'1F iEif #ih iF iF 1E iEiE1f i41E IE iEiE iE iF�lf 1F #1F iE iF if 1f iEif 1E 14 if 1EiF'If IE iE if M' 1FiE iF
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:
HUILDING APPROVED BY i DATE:
APPLICATION ISSUED BY
1(' iEiEiF# 1F iF if' iF �IF iF if iF# 1f IE iF1Ei1f iF 1E
LEGALIZATSON;N�
BLDG PMT
PERMIT
PLAN
F E.E S U M M A R Y
PLUMBING ELECTRIC MECHANIC
% , 0 �
25Y
DATE:' � 2�'/ t7
STRQCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON-RES
ISSUE FEE 20.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 7.00 20.00 0.00 27.00 27.00 � .00
REVENUE DIVISION TOTALS'--> COLLECTED: 27:00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
. ' ' 2%.00 � � .
if if iF'lE if if iE 1E* if # 3E iE 1ElE fE')E 1E if iE 1E-0E iE iE iE 1f 1E iF iE 1f'lE 1E 1f 1FiEif If iE�)f!f 1f if 1EiEiF if 1F iF iE 1f iF ih 1f iE iE'k iE 3F �lE 1E iE'1f iE i(' if'1E if 1E'1F1Eif'1FiF#'If 1E dF iE 1E
I N D I V I D U A L F E E H R E A K D O W N
QTY D E S C R I P T I O N
PLD 1 DISHWASHER
(5t5tdeWP) Whno-Buildiip85a/ely`Greer�-FIe;Cenery-Ap t;Fnk-Revenve;GoldenmE-Asaasaor _ '
END OF FEES
UNIT COST TOTAL COST
7.00 7.00
Di UO2QS23.l-002�823! T 4 T 17.QQ
DATEs 03/27l9$ 7LhE: 09:17
I
S
'
OJECiPODflE55: �jO2 HYDE CT
OWNEP'S NRME: RAYNOR, ANDR£W GERALD
nooAess: 902 HYDE CT
COSTA MESA,CA 92626
FflLH/ENGINEEN:
aooaess:
flEG.NO.:
UNIT:
uxiT:
PEHMITTEE: DILT—WELL ROOF AND MATERI ( 719 ) 739-1288
aooxess: 3310 VERDUGO ROAD
LOS ANGELES CA 90065
LICENSEO CONTRACTOB DELNflRTION: I hereby aflirm Iha[ I am Iicen5e0 untler pmvi5ion5 oi Chapter 9 �commencing with Sec�ion
7000) ol Oiv�sian 3 at Ihe Business antl Pm�essions Cotle, antl mY license is in �ull force and eflect.
cinu�390�T�:458005 c�nss � �9 EXP; OS/95
Oate: y SignaWre'.
WOflREPS'COMPENSATIO �ECLANATION: Iherebya��irm certdiCaleo�tonsentlu5e14in5ureoracetli�ica�e0lWOrkerS'
Campensation Insurance or a certdie� copy Ihereol (Section 3800. Lao. C).
aoucvNo.: Wyj)1U24tl9 E%P.OATE: U%/1-j/g9
COMPPNY: CAL COMP
❑ Certitied copy is �er by Wmishetl. � GertifieA capy istilcd wi� qe-eit Buil ' Oivision.
Ja�e: "� ApplicanP.
E%EMPTIONFBOMWOPKEflS'COMPENSFTIONDE0.APPTION: (Thi55ec�ionn¢e0no�b¢tomple�etlil�hepermili5�oronehunUretl�5100�orh55�.
I cetlify iha� in Ihe pedormance of �he work lor which �his permit is issuetl. I shall not emDloy any Derson in any manner so as lo become
sublec� lo �he Workers' Compensalion Laws of Califomia.
Oate: Signa�ure:
NOTICE: I�, atler making this tl¢claration, you 5hout0 become subjec� �o lhe Workers' Compen5ation pmvisions a/ �he Labor
CoOe. you musi lotlhwil� compty wiih such provisions or ihi5 Permi� shall Ue tleemetl revoked.
CONSTflUCTION LENOING AGENCY: I hereby a��irm t�at Ihere i5 a con5tmc�ion lentling agency for the p¢dormance ot Ne work �or
whlch �his permlt ls i56ued (Saction 30W, Giv. C).
1ENOEH:
AOONE55:
OWNEF BUILUEfl oECLNBBTION: I hereby afiirm I�at I am exemP� hom ihe Conimctors' Stale License Law for Ihe following reason
�Section 7031.5 Business and Pmtessional Cotle: Any ciiy of coun�Y whic� requires a permit to consimct, alter, impmve, Oemolish, or
repair any simcture. Drior to its issuance. also reduires the apolic9nt for such permit to file a signe� statemenl ihal he/she is licensetl
pursuanl to Ue pmvisions a� Ihe Comracmrs' State License Law (CFlap�er 9(commencinB wi�h Sec�ion 7000) o� Divisian 3 0� the Business
antl Protessions CoOe� or Ihal he/she is exempt therelrom antl the basis br t�e allegetl exemption. Any violation ol Section 7037.5 by
any apDlicanl for a permit suble��s Ihe applicant lo a civil penalty o� noI more t�an hve hunAreA AollaR (SSf10).
I, as owner o� Ihe pmperty or my emyloyees wiih wages as Iheir sale compensa�ion, will Ao the wo�k, antl ihe
❑ s�mcture is not imendetl or offered lor sale (Seclion 7044. du5ine55 an0 Pm�e55ional COOe: The Con�raC�ofs' S�ale LiCense Law
aoes nai apply b an owner ol a properly who �uilas or in�Pmves �he�eoq and who does such work himseltl�ersell or thmugh
�is or her own emDloye¢5, D�Ovided iha� SUth impmvemEnfs are nol inlen4e0 or otlere0 tot 5ale. Ii, however ��e bUilding or
improvement is soltl within one year o� comple�ioq the oWner will have the 6urAen of proving he/she tlid noi buila or impmve
for the purpose of sale). ' '
I. as ownerof the pmpenv. am exclusively coniracting wiih Iicense0 contracrors to consimct tne pmiect (Section 7044, Business
❑ antl Pm�essions Cotle'. The ConVaclors' S�a�e License Law does no� aDDly �o an owner o� property who 6uilds or improves thereon
ana who contratis br Suth pwletls wi�h a tonVat�or(S�licen5e pursuani to Ihe COnirac�ofs' S�a�e Litense Law�. I am aware
Iha� proof al �heir Workefs Compensation insurance shoi�ltl be pmvided �o me.
� I am exemD� under Section: B. 8 P. C.
for Ihis reason:
Date: Owner:
I tlo here�y cetlify tha� I am aware o� and untlersiana �he requiremen�s o� Califomia Heal�h anU Safety Cotle Sec�ions 25505, 25533, antl
25534 and �hal I or any future builtling occupan� will/will no� (circle one) ne¢tl to compty wi�h SaiU s�a12 code5 an0 i�e reQuiremenis lor a
permit lor wn5imclion ar modifica�ion Imm Ihe Air �ualiry Managemenl DisVict. Fesitlential cons�mc�ion applications a�e eKemp� �mm
Ih¢5¢ provisions.
Date: Np0licanL �
I hereby certilytha� I have reatli�is applicaiion antl state t�atthe 2i
ordinances antl slaie laws relating b builaing conslmc�ian and hereby
pmperiy lor insp ction p rposes.
�a�e: Signamre:
Onvefs License o� Social Securily M:
is CorreC�. I agree to tompty with all tity an0 Counry
mafjyes o� lhis city m enter upon �he above�memione0
=>
t6at�a6 Whiie—Bwltling�, Green—Coae Enlorcemenl'. Canary—Applwant; Pink—Revenue;
CITY OF COSTA MESA - BUILDING PEAMTT PERM NO: B 068000
PERMIT NO: B 069000 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION : T/OFF 6 REROOF WZTH COMP, 6 BUR IN BACK SQ FT: 1,100
CLAIM VALUE: 1,100.00 CALC-VALUE: 1,100,00 GROUP OCC: R-1 /M-1
COMMENTS: SMOKE DETECTORS ARF.ftEQUIREB IN EVERY BEDROOM & HALLWAY
******�*��**�c� �****�**�*�-��:u�*�c����*��*+�*�r****��*��:-x;�*��**;�***�****�***�*x****�*
Z O N I N GS ERTEBQAUCIKRSE M E N T 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
PARKZNG REQ: PROV: PARCEL: 41808203 ZNE: REF NO;
PLANNING NOTES>
' ! .' .
# ik iE 3@ iE # 9E iF ic iE if # fF iF iF 1F �lE if # iE iE iE iE 1E iE iE iE #!F iE 3f iE iF # iF �)E if i(� # i! iE iElf �E iElE iF jf iF 1E i: !E 1k �)t iE iE # 1E i4%i[� ff iE �)' 1E ie 3E ih iF� iE iE if jE N-dF i�- �If it
D E C� 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 HY DATE; �
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: �� DATE: �� Z-��
?FiE3FiE�ttifitiFibif9t#1FifjfiF#atiEtc�itiE-�t�xiciFtc-KiciE*�r9r..xD:iriEx-it-x�ir�rit�iriFf(-itreiFiFitit+ti:N�ifiE�tEt6iEifiF#itit ,fFjFiE�c-iEir�@iFic
it jE 3F iF il� iE jF 3F IE iE iF ff iE #- iE iF iE iF iE i4 # i4 iFlf iE iF k-i!� iF ie �M- # k# jf iF iF �%iE iE #�E iE fE i( �E iE iE )F 14 3c if if ih iE �F iE iF ia i�� iE �1E # iE 3E iF iE #�1E iPlE #±F iE-1FlE iE it iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 2%,00 ,50
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIC'->
TOTALS--->
PERMIT ISSUE PLAN-CHECK TOTAL PAID pUE
27.50 0.00 0.00 27.50 27,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 27,50 OVER/SHORT: ,OU
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHErK
27.00 ,50
iE iE iE iE iE 1E �1F iE ic if iF ia iE �IE iE iF �F iE #� if iE iE if * dF iE i(� i4 3E # iF 9E iE if- ff i:-if �IE iF iE iF �E iE iE jE if iE ic iF k 1: iF 3k �)f iE # iElE 3F K-iF dE iE 3E iE iF �E iE iF 1F 1E iE IE �)E it Y jf iE i!
I N D I V I D U A L F E E B R E A K D O W �1
TYPE QTY ➢ E S C R I P T I O N UNIT COST TOTAL COST
SFR 1100 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 1,100.00
END OF FEES
n:OCt'�'.'�.Y41-�Q2539§2 T4T ?7.59
DATE: 07/13/94 TI(1E: 12:55
CONSTRUCTION ANDPLANNING
APPROVALS Permit#
7. Temporary Electrical Service w, Pole
2. Soil Pip¢-Undrgrnd. ��
.r .
3. Electrical Conduit-Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcemenc
6. Electrica� UFER Grnd_
7. Footings
8. Foundation , i
9. Water Pipe-Undrgrnd. ,
10. SvucturA� Roor System � � '
11. Property Sewer Line & House Cannection
12. Sewer CeP � �
73. Roof Drains
14. Rough Piumbing
15. flough Electriral�Conduit
i6. RoughElectricWiring
77. Rough Wiring Sign
18. Rough Electrical�T Bar Ceiii�g
19. Rou^yh Heating & Air Conditioning
20. Rough Factory Fireplace
21. Duccs, in Structure
22. Ducts, Ventilating
23. Gas Piqe�Rough &�Tesi
24. Roof Frdming
25. Rooi Sheathing ?,
26. T-Bar Ceiling (Structural� & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Dry.vall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-rinal
33. Finai Electric
34. finai Heating & Air Conditioning
35. Finai Gas Pipe-Test
36. Hood or Canopy
37. Final FaGtory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
47. Solar pomestic-Final
42. Backfiow Preventer
43. Backflow irrigation
44. landscape irriGation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL $TRUCTURE & BUILDING 1
O
48, FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Q
51. CERTIF�CATE OF OCCUPANCY
lo. - ___ __. Date __- _.
Date
:/.
POOI !� .,rA
Inspector pppROVALS Permit #
52. Pool & Equipment �ocation
53. Steel Reinforcement
54. Forms
55. Electrical8onding
56. Rou9h Plumbing & Pressure T2st
57. APPROVAL TO COVER�GUNITE
58. Electricai Conduit�Undrgrnd.
59. Gas Pipa, f� Undrgrnd., Test
60. Backwash Lines, P�Trap, C Undrgrnd.
61. APPROVALTO DECK
62. Backwash & Recepior-Final
63. Heater & Vent�Final �
64. Plumbing System � Final
65. Efectrical-Finat
66. Solar SVstem-Finai
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOUSPASYSTEPASFINAI
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping L�Gas ❑Of�
72. Underground Flush
73. Undergrnd. Sioraye Tank L� Gas ❑ Oil
��.[ 74. Overhead HVdro
.
75. Dry Chemicai
76. Dry Standpipe
77. FIXEO SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH OEPT.REQUIREMENT
79. FWALINSPECTION '
. 80. FOOD CERTIFICATE ISSUEO
Notes:
Date � Inspector
,�'
i •'J
Tratt �Q yG� �' I Block
Builtling
Add,a�, 90� �.
Nea �
Owner �
AEdre55 �
City
Architect/
DesigneY
QEC1855
aty`
QPPLICATION FOR A BUILDING P '41T
� Lot �
�• ....11
CIO55 � � /( �
street (.i.�%�1�
7 (�.���/
y. ZIP /fb�'�hone $�.`f`'
License No.
Zip Phone
BUILDINGPERMITNO. Eiectricai
Permit No.
Plumbing ,
�� �� � Permit No.
Mechanical
Permit No.
Type of Projech ❑ New ❑ AI[er
❑ epair ❑ Convert ❑ Oemo ❑
A� Sup. Dist./
InSp. A�ea
Zone
EdVC YIO1. L
r Engineer Litense No.
� �• Parkm9 Spaces
p. Atltlress
�4 Struct
m •City Zip Phone Hei9ht
� LICENSED CONTRACTOR'S DECLARATION Park Fees Ve
�° Requiretl No
m I hereby affirm that I am licansed untler provisions of Chepter 9
t (commencing with Section 7000 ot Oivision 3 of the Business and Zonin9 Approvetl BY:
Protessions COtle and my license Is in full force antl ettectl. y
� licansNe Clas� �- 8 Lice� �Jumb�r 7
> Data,y�8-S� Conttattor_�j� �LAO�� Misc.
E Address s fA .i Provosed Use
LL CityantlZip. 9� �6 Pnones E-S�S��7 ofstructure
w CONSTRUCTIONLENDINGAGENCV
� I hereby aftirm that there is a construction lending agency fo� the p��
a performance ot the work tor which this permit is issuetl (Sec. 3097,
` Civ. C.1. Class
y Lendar's Name USEi
� Lentler's Atltlress
J OWNER-BUILDER DECLARATION
r I hereby affirm that I am ezempt trom the Conttactor's License Law 1�
1° for the following reason:
� ❑ I, as owner of tha property, or my employees with wages as their 2.
sole compensation, will tlo ihe work, antl the struc[ure is not
r in[ended or offered for sale, 3
3 ❑ 1, as owner of the property, am exdusively contracting with
licensetl contractors to conshuct the project.
�m., ❑ I am exempt under Sec. , 6&PC for this reason 4' '
�
a Dat. Owner_
E WORKERS' COMPENSATION DECLARATION Total Valuatlon
� I hereby attirm that I have a certiflcata of consent to solf-insure, Encroachment Permit I
or a certificata of Wo�kers' Compenution Insurance, or a cartified
C copy t�ereoL Gratling Pmt.
� �icy No. CompanY ReqWretl ❑Yez
�a Certifietl copy is hereby turnishetl. Q(pUE� �'JVE�E� Rouqb Gratling
C. Gerti i co is filetl with O�ange County, EMA. qpprovetl by:
a Date 8 � Applicant
CERTIFICATE OF EXEMP710N
FROM WORKERS'COMPENSATIONINSURANCE
(This saction neetl not be mmpleted if permit is for $100 or lessl.
I certify that in the parformance of the work for which this permit is
issued, I shall no� emplcy any person in any manner so as to become
sublact to xhe Wnrkers' Compensa[ion Laws of Wlifornia.
Dete Applicant
NOTICE TO APPLICANT: It, after making this Certiticate of Structural
Ezemption, you should become subject to the Workers' Compensation
provisions ot the Labor Cotle, you must torthwith comply with such Electrical
provisions or this permit shell be tlaemed revoked.
I CEFTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORR[CT. I AGREE TO P�umbin9
COMPLV WITH ALL COUNTV OftDINANCES AND STATE LAWS
FELATINGTO DUILDING CONSTRUCTION, AND HEREBV AUTH- Mechanir
ORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON
THE� $A.�BOVE ME/y� T//I�ONEDI'PROP RTV FOR INSPECTIO9N PUR- pre-Gra
s PO///.�A/!l\UYVi � � �p_�/ Inspec or
5
$
S
8
$
$
No. ot
$tofie5
C.T.
❑ Atltlition
Occupancy Pmt.
Spl. Pmt. No.
Vear
SIZE SQ. FT.
I ❑ es ❑ No
Gr tling
� Pm . No.
Date
PERMIT FEES
Plan Ch¢ck
SPeclal
Issue
AllSpeCes Within this 60X mus[ he COTpleted to proc055 Check BY: I Approvetl:
CMF•0335-46 (BU-28) rev. 6/80
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�uc2 :;e. 10445
LO'i N0. 3
DATE October 9, 1980 ;
ADDxESs 902 Hyde Court, Costa Mesa, CA 92626
Development Services Depsrt::ient
Planninb Division
Ci[y of Costa Pfesa
77 Fair Drive
Costa 24esa, CA 92626
Attention: Dfr. Paul Dudley
Dear 41r. Dudley:
Please be aware that the undersigned are avare that a cer[ificate of oecupancy
on the abwe referenced lot and unit is being requested prior to the entire
tract and its streets and cor.mion areas being completed and accepted by the
City of Costa Mesa.
BY � m r
(SICNAT • OF PURCf1ASE )
BY L�,� • l _
(3 GNA : OF �VELOPER AND OR
RIJ�i I'LED REPRESEh'TATIVE)
�
BY :
;SIG\AT OF LENDER)
/
1a
-�:
.�
OWNER LALON MILLER
AP No. 418—O8Z-030T 3 TRACT 1 0445 FIRE
ROUGH PLUMBING
PROP. $WR. IINE
ROUGN HE�TING ANO �IR CONDIT
UNOERGROUN� � POWER �
ROUGH WIRING
TRENCNES FORMS STE�L REIMF.
FLOOR SYSTEM
BONO BERM � STEEL NEINFOWCE n
SHEATHING
FRAME AND FLFSHING
u
PLASTER, BROWN COR
F
DATE S_�q_
SUBCONTRACTOR