HomeMy WebLinkAbout1793 HUMMINGBIRD DR - Building PermitsCITY OF COSTA MESA
BUILDING DIVISION
f DEVELOPMENT SERVICES DEPARTMENT
PERMIT PERMIT NUMBER
B98-01491
(714) 754-5273 • Fax (714) 754-4e56 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 1793 HUMMINGBIRD DR
Suite:
Vicinity:
Parcel Nunmber: 13962204 Zoning: R1 R1
Applicant: MALONE, SEAN
Address:
Owner: MATTHEVNS,"WES
Address 1793 HUMMINGBIRD DR-
COSTA MESA,CA
Contractor: A PLUS ROOFING
Address: 11237 SLATER AV
FOUNTAINVALLEYCA
Arch / Eng :
Address:
'Phone: 714-754-1000
Zip:
Phone: 714-435-1855
Zip: 92626 -
Phone:
Zip 92708
Licensed 675241
"Phone:
Zip:
License:
Status: ISSUED
Applied: 08/19/1998
Issued: 08/19/1998
SCOPE OF PERMIT
T/O WOOS SHINGLES, IN FILL SHAETHING, INST 2 LAYERS #30 ASTM AND US TILE ICBO #3523
5.8#SF.
Plan Check:
$0.00
Permit:
$174.75
SMIP Res:
$1.07
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$175.82
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
NOTES:
FEE SUMMARY
Calc Valuation:
Claim Valuation:
PLANNING & ZONING
Rear 0-0 Left 0-0 Right 0-0
Rear 0-0 Left 0-0 Right 0-0
Required: 0 Proposed: 0
$10,651.00
$10,651.00
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)'154-5626
k
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate o1 consent to salt -Insure for workers' Compensation, as provided for by section 3700 of the Labor Code, for the performance of the
Wo hich this permit is issued.
have and will maintain workers' Compensation insurance, as required by section 3700 of the Labor Code, for Bre performance of the work for which this permit Is issued.
My workers' compens Lion Insu rice Cartier and policy number are:
Cartier: - - Policy Number.
(This stiction need n;theperform
mpleted the permit is valued at one hundred dollars ($100) or fess.)
❑ I certify that in of a rk for which his pe it is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation lCalif ia, a d e e 1 aIfI suldb rae suhject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
co th thevi ' s
��—
plicant tore: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPSTION VERAGE IS UNLAWFUL AND SHALL SUaIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000), IN ADDITION TOTH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license%� andel provlsions,of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Proles si Cade, and my license is In full
fo IJc. N [v t/ /J 2Sd-L / /� Class N C
ontraclo Ignatu e: v �- Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued, (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to Construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($SOO).):
❑ 1, 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 appy 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 o1 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 contractors)
license pursuant to the Contractors license Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner 10 verified by drivels license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, I.B. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more teat In depth into which a person Is required to descend, will be made in connection with work aulhodzed 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 Pernit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII 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 soma exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of Compressed gas at standard temperature and pressure).
....................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Cade, 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).
..............................................'t,or.....................t'u.r'.....................u.p.a......e.e'd'.......................................'s'k-....nag'.....................-.........................................Iy.'h*...................................
3 Does or will the applicant or present or future bulltling occupant need to prepare anRMPP (Risk Management and Prevention Program for acutely hezartlous materiels)?
❑ Yes ❑ Na '
(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.
..............................................rexg Jr,e..........................................................................................o'Ca....................................................................._..................................................
4 Ii an RMPP Is presently required, has Section 25534 of the Celifomia Health and Safety Cade been fully complied with? ❑Yes ❑ No
.....................................l.....................-.-..............................................................-...........................................ct'o-Ih,,i,...a".p..........................................-...........,o.n.........................
5 Does or will the applicant u present or future building occupant require for the work which is the subject of this a plication eEEeNo for such construction or motlification
from the South Coast Air Quality Management District or from any other air pollution Control district or agency? � Yes u NO
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
...................................................................................................................................................................................................................................................................................
6 Vfll any part of the faGliry to Deconstructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
........................................................................................................................................................................................................................................................................I..........
7 If apermit from the South Coast Air Quality Management District or other air pollution Control district or agenLy is regwired 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 made44 ❑Ves ❑ No
...................................................................................................................................................................................................................................................................................
8 (If yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
vgre
PLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
ply with all state laws and city ordinances relating to building Construction, and authorize representatives of the City of Costa Mesa to enter upon the
pro for in sp rposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
SouawaiDl sArxivu) _Daleie /yr i
rAtimon " pplic m Dateel///�`�
CODE -L INSPECTION= BDmA65 CODES INSPE0TI0N TYPE DATE INTNIAS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /�� /� 208 Final Plumbing
200 Final Re -Roof 8� 210 Final Electrical
201 Final Slock/Retaining Well 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
244640
a
CITY OF COSTA MESA
BUILDING DIVISION /�
DEVELOPMENT SERVICES DEPARTMENT
PERMIT P MITNUMBER
E98-00900
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
,lob Address: 989 VICTORIA ST
Suite No
Vicinity:
Parcel Nunmber: 42244204
Applicant: GRANT, NORMA
Address:
Owner: ISH -LIMITED PARTNERSHIP
Address P0"80X'5652'"�
,SAN CLEMENTE,CA:
C ntr t r
" Phone:" 949-548-0130
Zip:
Phone: 949-548-0130
Zip: 92674 "I
Status:
ISSUED
Applied:
08/24/1998
Issued:
08/24/1998
o aco.
Address:
-
-
IN
r
Phone:'
.. zip"-
yLicense: `
-
-
SCOPE OF PERMIT
"
G.F.C.I. POOL INSPECTION AS PER STATE HEALTH & SAFETY CODE SECTION 116049.1.
-
"
FEE SUMMARY'
'Quantity
),�*
Quantity
ISSUE FEE
$22.00
I I
-.-- Temp. Dist System/ Lighting..
$0.00
0
Temp service test
$0.00
-.- - _
- - Busway /100 ft 1 - - - -
$0.00
0 ,
Res. a/c package
$0.00-
-
- - Standing Section'
$0.00
0 "
New Res (1-2 units)
- $0.00
0
Misc Electrical Equipment
$0.00
0'
New Res (3+units)
$0.00
0
TransformerS.up to 1 kva/kw
$0.00
0 '
Pool / Spa
$0.00
0
............:...up to 10 kva/kw
$0.00
10 ,
Lighting Fixts
$1.00
1
.................up to 50 kva/kw
$0.00 ,`
0
Recept Outlets
$0.00
0
: . ................. up to 100 kva/kw
$0.00
0
Switches
$0.00
0
..................over 100 kva/kw
$0,00'
r
0
Non Res Appl
$0.00
0
,� - Low Voltage Equipment
$0.00
0
Res Appl
$0.00
0
Low Volt Wiring System/ Ckt
$0.00"
0
Service to 200a
_$0.00-�
-..0'
"- �. -Misc. Conduit - -
-$0.00
0 -
Service to 1000a
$0.00
0
- Misc. Conductor -
$0.00
0
Service over 1000a,
$0.00
0.
Circus ( gen or ride)
$0.00
0
Motors to 1 hp
$0.00
, 0
Circus (mech ride or lights)
$0.00
0 -
Motors to 10hp
- $0.00
0
Christmas Tree Stand
$0.00
- 0 ,
Motors to 50hp
$0.00
0
Fireworks Stand
$0.00
0
Motors to 100hp
'$0.00
0
Other Electrical Fee
$0.00 -
Motors over 100hp
$0:00
0
Communication drops
$0.00
- 0
Investigation Fee,
$0.00
Sub panel to 200a
$0.00
- 0
Plan Check Fee
$0.00
Pole Light Pkg
$0.00
0
Reinspection Fee
$0.00
Sign Circuits
$0.00
0
Temp Pwr Pole
$0.00
0
TOTAL CALCULATED FEES
$23.00
Intermed Pole
$0.00
0
COMMENTS / SPECIAL CONDITIONS
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) 7545626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carder and policy number are:
Carder: Polity Number:
(This section need not be completed If the permit is valued atone hundred dollars ($100) or less.)
❑ 1 cer ity that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license Is In full
force and effect. Lic. N Class B
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirn that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors Uoense 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).):
❑ 1, 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.).
❑ 1, 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 contraclor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property lax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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, lelsework, 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 hes e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safely PermN Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future bullding 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 feel of Compressed gas at standard temperature and pressure).
.......................................................................................................................................................................................oua......................................................................................
2 Does or will the applicant or present or future building occupant neetl to file a registration lortn for acutely hazardous metenels? ❑ Yea ❑ 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, hes 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 plicatlon aermit for such construction or modification
agency?
from the South Coast Air Quality Management District or from any other air pollution control district or Yes a 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
(if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
...................................................................................................................................................................................................................................................................................
7 II 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
...................................................................................................................................................................................................................................................................................
B (If yes", attach cerliflcate of compliance from the appropriate air pollution conuof officer).
CERTIFICATE OF COMPLIANCE: I certiN 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 Emissfons.
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.
Si!r Of Leg ner(s) n , Date
rAulhonzed n
COOS I. INSPECTION TYPE am If®ELS CODES INSPEC11011 TYPE DATE 1ti11M
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 91 48
201 Final 81wit/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 BuildinglOccupancy
2446-46
a' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT
Project Address aaoltn9
Applicant's Mailing Address
Owner's Name ` Phone _
VVVm))) Arch/Eng. License No.
( Address _
f-(1 Contractor's Name
Address (mailing) *W-500 'sf'K1f)Cl6]O
Q City License No. 3;L \Ck3-
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of rhater 9 (commencing
with section 7000) of Division 3 t e Business d Prof 1 ns Code, and
my license is in full forctind eff t.
License Class `� No.
Date Signaltur
WORKERS'COMPENSATION CECILATI N
'hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation .Insurance, or a certified copy thereof (Section
3800, Lab. C.)
Policy No. Company CI'r't'
HCertified copy is hereby furnished.
Cert if sea s fiI it with the city Building Division. Cat -'r
ate Applicant 1 f n C
EXEMPTION a OM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
less):
Cert ify'that in the Performance of the work for which this permit is'iseuetl,
shall not employ any person in any manner so as to become subject to the
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 I 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
'.he 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
.herefrom 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
nnalty of not more than five hundred dollars ($500).
' 1, as owner of the property 0, 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 intended 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-
rove for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed con.
tractorsto 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-
traclor(s license pursuant to the contractor's License Law). I am aware that
proof V their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date - Owner -
I herety certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and state laws relating to bundin construction, and hereby authorize repre-
sentati o this city t enter u on the above-mentioned property for
inspectionpo a .^ /-�
Signature MQ� Date \V—
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks -
Gas'Service Outlets
Interceptors -zo
Kitchen Sink
Lavatories,
P -Trap
Roof'Drains -
Reinspection Fee I $15
Boiler ' '
Duct - Under Ground
Duct - Structural `
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBO =#-
Heating
Heating System & Ducting
00-100,000 BTU ❑ 100,000
III
Drivers' License of SS 9F - - I I Reinspection Fee
CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15
9812 10/10/B4
Accessory Building:
8.00
-Tia
TYPE OF CONSTRUCTION LJ NEW ADD LJ ALTERATION LJ REPAIR
Cl CONVERSION ❑ DEMOLISH D Of HER
A,P, # '
DESCRIPTION OF WORK/USE OF BLDG.
Automatic Washer
Construction Pole Sub.
'
S
Main Builds
TYPE OF PERMIT 1-1GRADING❑.FOUNDATION F-1STRUCTURALT
Front
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
B
Rear
❑OTHER
A
Solar Piping
C
Right
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Fan
CON STRUCTION TYPE VALUATION$
S
Left
ZONE--GRADINGCU.YDS. ACRES
Ping. Ref.#
Remarks: -
Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks -
Gas'Service Outlets
Interceptors -zo
Kitchen Sink
Lavatories,
P -Trap
Roof'Drains -
Reinspection Fee I $15
Boiler ' '
Duct - Under Ground
Duct - Structural `
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBO =#-
Heating
Heating System & Ducting
00-100,000 BTU ❑ 100,000
III
Drivers' License of SS 9F - - I I Reinspection Fee
CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15
9812 10/10/B4
Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S.
IMBING
8.00
-Tia
Showers
Zone .
Service Sink -
Automatic Washer
Construction Pole Sub.
Z
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S.
IMBING
FEES
-
Showers
ELECTRICAL FEES
Service Sink -
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW - --
El 50 + KW
Sewer Ca P
_
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Solar Collectors
Dishwasher
Meter Dover 100 amps
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel '
Solar Tank
Fan
Motors L10-1 HP 01 vh-B
Swimming Pool w/Spa
F.A.U.
Inc. Solar ❑9-15 HP El i6-15+
Urinal --
- Fixtures
Microwave. -
Water Closet
Device Boxes
Pole Light i
Water Heater
Outlets
Range
Water Service
Switches'
Sign
Garbage Disposal
Standing Sections
-
Generator ❑0-5 KW ❑5-15
KW Trash Compactor
Issue Fee
$ 3
Reinspection Fee
$15 Issue Fee $ 3
iANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date
Application Issued By Date /
CType 11 1:1Type I' ❑
Canopy
Refrigeration System
❑0100,000 BTU ❑100,000 BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$ SMIP $
$ PERMIT
$ ISSUANCE $
$ .ENERGY P.C. $
$�j'�,� GRADING $
$ MICROFILM $
$ TOTAL FEE $ A go
$
System Repair/Alteration
'
Issue Fee
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit 4# .i-G�
Date
Inspector
POS .tr SPA,
.APPROVALS Permit#
Date
-Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. `
53. Steel Reinforcement
J
3. Electrical'Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
-
56. Rough Plumbing & Pressure Test
6.ti Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7, Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. 'Structural Floor System
-
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains I
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 Electriral-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 ❑ Oil
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
30
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. Special Requirements Completed
49. Electric Release to Edison -
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. DATE DATE 19AdyI497Z
LOT NO. .75Z
ADDRESS /793 lwn�►��sB..Po 1��Q
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 -65 (was or er11=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
RECEIVED
CITY OF COSTA MESA
PLANNING DEPT.
JUL 10 1972
AM
7181911001112111213141516
representative
BY L A'V 1Ed%EJ%4L�
Lender
SER FIRST Los Angeles Corp. DATE 12-14-71
InR AnDRFSS 1793 Hummi.nab3rd Drive BUILDING PERMIT NO.. 33965
AP No.
INSPECTIONS
SOIL
GAS
WATER
ROUGH PLUMBING
PROP. SWR. LINE Q H01
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR
SUBCONTRACTOR
ROUGH WIRING I I Il Hewing and Vent.
TRENCHES L FORMS L STEEL REINF.
FLOOR SYSTEM
BOND BEAM [1 STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT
PLASTER, BROWN COAT
_ �r 3¢-
9EC 111-71PA`L00 6R11 ti:f
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECEIVED BY
DATE RECEIVED
/Z^ 14 %
DATE ISPUE
BUILDING
ADDRESS 1793 Hutlmlinghird Drive
'
PERMIT NO.
OWNERFIRST LOS ANGELES CORPORATION
A,P.N
MAIL
BUILDING /
ADDRESS #1 WILSHIRE Q WAND
ADDRESS
CITY LOS ANGELES CA. NM25-7341
TRACT 6 1 S S
/
LOT 3 %BLOCK
CONSTRUCTION
NQ DEMOLISH
LENDER
BRANCH
OWNER &rV�I
ADDRESS
VALLW
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ARCHITECT
ORENGINEER ( ' TE L
870-51
/ $
FIRE
ADORE552 4 E. CHAPMAN FULLERTON
ZONE TYPE'`' GROUP
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CONTRACTOR BUCCOLA COMPANY
BA?PROVED
DATEA —,
ADDRESS 4501 BIRCH STREET
T,4111
EL
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NO.OF
USE OF NEW
CITY NEWPORT BEACH 54o-8833
/
PLANS
BUILDING
STATE CITY
YARD APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO. OF SLOGS.
IF ROM C/L STR EET)
6 S
900 t;
OF LOT . Pt • NOW ON LOT
FRONT FP
FT.
USE OF
EXISTING BLDG.
R. SIDE
FT
SIZE OF 18f 61 NO.OF 14NEWBLOG. X
ROOMS STORIES --
L. SIDE FT.
FT.
EXTERIOR WALL STUCCO
COVERING
CO VOERING S I1iS
REAR FT.
FT.
USE OF BUIL WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS. SLOGS.
ADD ONE BDDITIONAL CLOSET TO HOUSE
C URP #
APPROVED
UNDER CONSTRUCTION
APPROVED
/
I hereby acknowledge that I have read this application and state
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
the State of California.
I hereby certify that I am properly licensed as a contractor under
SO. FT.
THE AMOUNT SHOWN 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 1
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
VALUATION_
and Professions Co 3, Chapter 9.
PERMIT FEE $
CHECK $ / �
Signature o �-
Perm ittae /cif �L/l��.l,! J�1
$PLAN
Authorized Agent
�J of
TOTAL FEE $-Z " "
LEE Jemes V DATE 1517-1
,JOB ADDRESS 1793 Humminabird Dr. BUILDING PERMIT NO. X5867
GENERAL CONTRACTOR Owner Bldr. DESCRIPTION of WORK Patio Cover
AP No.iZo.Rpp_nh I.OT TRACT FIRE ZONE . VALUE$ 700.00
SUBCONTRACTOR
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING Heatino and Vent.
TRENCHES ❑ FORMS (—] STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING .�
LATHING — IN OUT
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING. FINAL AND GAS TEST (—I
FINAL
BUILDING, FINAL
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COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
OWNER,JA,j"&7S V. LCC
MAIL
SAME
ADDRESS
y], TEL.
CITY �,Ovr/fl Acm+ NO.
CONSTRUCTION
BRANCH
ADDRESS
ARCHITECT 1- / 1 .. TEL.
ADDRESS
CONTRACTOR
ADDRESS
CITY
TEL.
NO.
STATE
CITY
LIC. NO.
LIC. NO.
SIZE
NO. OF SLOGS.
OF LOT
NOW ON LOT
SIZE OFNO. OF
NEW BLDG. �� r' ROOMS STOF
EXTERIOR WALL ROOF
COVERING COVERING
US_E OF BUILDING AND WORK TO BE PERFORMED
I hereby acknowledge that I have read this application and state
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
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Divisicn 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
Signature
Permittee ,l� ••pf%d V
Authorized Agent
PAID {•t; k:Yi:
353- 7.
APPLICATION FOR BUILDING PERMIT
RECEIVED
ED
] /N�
A.P. NO. 13 I� CalJ�
" 7UILDINGADDRESS�yTRACT
!BLOCKW
ADD
A
MRECEIVEDISS
OWNERFIRE
ONE UP
APPROVED
BY DATE
ZONE
NO.OF
PLANS )L,
USE OF NEW ci
BUILDING
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
IFROMC/LS E 1
RONT
FT.
FT. J
FT.
--••�� !/
L.SIDE Id'FT..
FT.
REAR _-FT.
FT.
DISTANCE SET.
MAIN BLOCS.
BET. MAIN &
ACCESS. BLOCS.
VAR.*
C.U.P.#
DATE
APPROVED
R
APPROVED 6
nATP
Srgre
7Ak
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
$O
PERMIT FEE S
PLAN CHECK $
TOTAL FEE $
33862
' COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
U_:?(LFor Applicant to Fill in Completely / D,4 -lei
BUILDINC
ADDRESS
OWNER
':8V 12-71�FPnIlr,,:00 60q *f ***17fj.5C
APPLICATION FOR BUILDING PERMIT
:EIVEDBV I DATE RECEIVED DATE ISS ED
PERM
BUILDING
MAIL
ADDRESS!
ADDRESS
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TRACT
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OWNER
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ADDRESS
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OR ENGINEER N `O
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STATECITY
YARDS APPROVED
YARDS APPROVED
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LIG. NO. LIC. NO. Q
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO. OF BLDCaS.
(FROM C/L S�TJg)EET)
OF LOT BOO NOW ON LOT
j
ROM J "'fT.
FT.
USE OF
EXISTING BLDG.
R. SI FT.
FT.
SIZE OF// /' /� I �] n
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NEW BLDG. 12i tQ .'J ROOMS / J STORIES
L. SIDE FT.
FT.
EXTERIOR WAL
ROOF
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COVERING
COVERING
REAR V FT. t-
FT.
-
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USE OF BUILDING AND WORK TO BE PEQFORMEOJ
DISTANCE BET,
BET. MAIN &
1
a
MAIN BLDG$.
ACCESS. SLOGS.
Q
VAR. #
DATE
O
C.U.P.#
APPROVED
NAPPROVED
6-n
DATE .2_
z
UI
hereby acknowledge that I have read this application and state
D FOR SPECIAL
REQiIREbENTS
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
F„
any person in violation of the workman's compensation laws of
N
the State of California.
m
z
I hereby certify that I am properly licensed as a contractor untler
O. FT.
o
THE AMOUNT SHOWN UN R VALUATION IS FOR
ER
the State of California Business an Professions Code, Divisicn 3,
Chapter 9, and that such licens ar m full force effect, or I
THE PURPOSE OF ESTABLI A PERMIT FEE ONLY:
am exempt m the pr isio oft a State of Ca f0 nia Business
VALUATION
and Profen Ion Cotle, isio 3, C apter 9.
PERMIT FEE $ D Q
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D
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9 J
Signature o
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Permittee
$ //j)_ '�'/V/
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PLAN CHECK $ / "�
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Authori Agent
7F S0
V
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TOTAL FEE $/