HomeMy WebLinkAbout1754 IOWA ST - Building Permits r 1
CITY OF COSTA MESA
,g -7r BUILDING DIVISION 'P - .
F• �✓� }' 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
a. fes FOR INSPECTIONS CALL: (714)754-5626
%�.n PERMIT NUMBER!' E08-00349
PERMIT TYPE ELEC STATUS: ISSUED
APN: 13906105 DATE ISSUED: 08/27/2008
ISSUED BY: RMD
JOB ADDRESS: 1754 IOWA ST CM Suite/Unit:
Vicinity:
SCOPE OF WORK: UPGRADE SERVICE PANEL TO 200A FOR A SFD.
OWNER: RISS,JOHN H Address: 1754 IOWA ST Unit: •
PHONE: City/State/Zip: COSTA MESA, CA
•
APPLICANT: RISS,JOHN H Address: 1754 IOWA ST Unit: _ -
PHONE: - City/State/zZip: COSTA MESA,CA
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: Unit: PHONE:
City/State: ZipCode: CELL:
•
ELECTRICAL PERMIT FEES
Electrical Plan Check Feer $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
ScgoE 4, INSPECTION TYPE, D)!I INTInAL$ CODE( INSPECTION TYPE DATE INTmA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 1J V
200 Final Re-Roof 210 Final Electrical VA �� 2l.
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 _
if •
WORKERS'COMPENSATION DECLARATION. Owner ID verified by driv, rise. es ❑ No
I hereby affirm under p Ity of perjury one of the following declarations:
t Driver's License Na Expires: /O/.3/79
0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property lax bill or deed):
compensation, as provided,for by,section 3700 of the Labor Code, for the -
performance of the work for viMich this permit is issued. • .
❑ I 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This section need not oe completed tithe perms is valued at one hundred dollars($500)or less)
2,Arl 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
;p I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Date
the La ode,I shall forthwith comply with these provisions.
08/Z to /cr
Division of Industrial Safety Permit Number:
Appli nc'a Ps Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one lime during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.fi Class rt (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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for whicll this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes iiNo
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the COntractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the Califomia Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK. and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044. Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
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 8. (If'yes",attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer). .
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury.the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws.and
r l I, as owner of the property' am EXCLUSIVELY CONTRACTING WITH
City'ordinances regarding Hazardous Materials and Emissions. ' i''
'LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to ari bwner of Signature • Date '
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:
a contractor(s)license pursuant to the Contractors license laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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
author fthis pe n until final inspection. p�274D�
f� / 9 �.
61 J�/j/ /Sg /ur `� O z7l0Q `e Signature of Legal Owner(s) Dale
nature Date
3057.461 /07)
And/or Authorized Applicant Dale
r
{
::: etre, 06 Ca 7lteda &dear y tattoo* .
OWNER—BUILDER
rt." ��11 C
VERIFIATION
Address:1 / 7 Sc/ 2 t c ci- .Cos4t it CS°\CS 4 Z Zj Permit#:
A city or county,which is required to give notice pursuant to Section 19830,shall attach to such notice,and,as
a condition precedent to issuing a building permit, require the completion and require the return of, an owner-
builder verification.
Attention Property Owner:
An `owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will be issued until this
verification is received.
U. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. ❑ Yes Cg No
2: 1 (have/have not) lig'Fe signed an application for a building permit for
the proposed work.
3. 11 have contracted with thefollowing person(firm)to provide the proposed construction:
Name Kok fP¢uQi
Address City
Phone ( ) Contractor's Lic.No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone( ) Contractor's Lic.No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
1042-46 (Rev.11/04)
V c
w
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of
California Health and Safety Code and have completed the above information to the best of my personal
knowledge, in compliance with this State law.
Signed: d I_/�/ Date: 0t�/Z770l5
Name: vbk t2 ‘a
I S S
(Printed or Typed)
C:DZ,#OR S.S. #
For more information call City of Costa Mesa Building Division at(714)754-5273.
•
1042-46 (Rev.11/04)
ADDRESS OF eaLalq: 1754 IOWA ST r UMt: CITY OF COSTA MESA — BUILDING PERMIT
D"��SNMfE1°MOWN: WILLSON, RICHARD E TR FLOOD : AE-37 PERM NO: B 073727
i• A0D"ae. 46 TIDEWIND
IRVINE,CA 92715 PERMIT NO: B 073727 PLAN CHECK NO: N GOVT: N SUPP : N
854-8742
ARL.MAILING Amu: CONSTRUCTION TYPE: V-5 PERMIT TYPE: STR PURPOSE: 0TH
ARCHITECT OR 04301ER: 1CN% JOB DESCRIPTION : T/OFF REROOF W/COMP. SHINGLES "LEGALIZE" SQ FT: 4 , 150
ARCH.OR ENG.'S ADORESS: UMT:
CLAIM VALUE: 4 , 150 . 00 CALL—VALUE: 4, 150. 00 GROUP OCC: R-3 /
COenUCTarsNAIIE: ASSURED ROOFING PROF. ( 714 ) 546-2221
COMRACTOWSMAILIN3 3750 W. WARNER COMMENTS : WORK WAS DONE WITHOUT A PERMIT
Lomas: SANTA ANA CA uc.ND_ 680293 -**+E•***********"-****************x**********x* **x*****x*+ *+t+ ***** *****+t•ac-** -*+t+e
92704 WMT: Z ONING R E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby dim under Pandy d perjury Net I am licensed under provisions of Chapter 9 S E T B A C K S
(....•endng with Section]000)of Division 3 of the Business end Professions Code,and my kceetse is in full fav end effect
' L ."0.: 064127 "Las' C-39 Li "' 8029 A E 01 /96 MAIN BUILDING ACCESSORY BUILDING
/1-5reg 4,c) .P�� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
emit: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
•W• P BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am etampl from the Contractor'license Law for the
' •reason(Section]D315 Busies*and Professions Code:Any cfya=MY which maims a Perm"to construct der.impr0ve. PARKING REQ: PROV: PARCEL: 13906105 ZNE: REF NO:
demolish.a repai any stnctue.prir 10 is issuance,also rewuires the applicant la such pen*to file a signed aatement Net he a she
is licensed pursuant to the provisions of the Contractors License Law IChapler 9(cotnmendng with Sedion]000)of Derision 3 d the PLANNING NOTES> • -.
Business end Professing('Code]a that he or she is exempt Naelmm and the basis for the alleged exemption.MY violation of Sedan >
70315 by any applicant for aperms subjects the applicant too civil penalty of not more than fine hundred ddMsiS500j). *******************************************************************************
❑ I.m owner d the properly or my employees with wages es their sole compensation,w11 do the work,and the structure is not intended
or offered for sae(Section 7044.Business and Professions Code:The ContrmasLicense Law does ndapplyloan Owner dPrapeny DEVELOPMENT SERVICES REQUIREMENT' S
who builds or improves thereon,and who does such work Noise or hersel a through his or her own employees,provided that such
improvements are not intended or dieted for sale.II,however,the building or'enprovemet is sold within one year of compldion,the ZONING APPROVED BYDATE: '
w
oner.builer wilt have the burden d porpoise he or she did not build or improve for the porpe d sale).
❑ I,as owner of the properly,am eadtmwly°entrrfnp with licensed contractors to comtrud the project(Section 7044,Business and
Professions Code:The Corwadon d
License Law does not apply to an owner progeny who builds or improves thereon and who BUILDING APPROVED BY : DATE:
convects for such projects with a contrsda(s)licensed pursuant to the Contractors License Law). •
•
m
❑ lamexempt under Sect : B.AP.C.for this reason: APPLICATION ISSUED BY: 1'� DATE: 4 )—
*************************************** * ************************* : **
Dale: LEGALIZATION:Y F E E SUMMARY STRUCTURAL ' EGMENT: Y
I do hereby may that I son aware d and understand the requirements of ediania Health and Safety Code Section 25505,25533,and
25534,and Pell or any More building occupant, g will/conot(circle one)need m comply with said state codes and the requbements for
a perm"la construction Of Mariaern Aiion hothe siy ampemW District.Residential caWMun applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
pr010100101. PERMIT 144 . 00 . 50
Dale, Applicant fl SMIP/NON RES
WORKER'S COMPENSATION DECLARATION:I herebya/frm under penalty of perjury one of the following dedardia": PLAN t
❑ I have and veil maintaincedWn d ceconsent to tWI-insure(or worker'
compensation,as provided for by Section 3700 d the Labor ISSUE FEE A.
Code,f«theped«manceofthewakforwtichthispendisissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL ''I . PAID DUE
❑ I have and wit meintanwalws•compereation insurance.as required by Section 3]w o to Labor Code,for theeedormanco o the TOTALS----> 144 . 50 0 .00 0 . 00 144 . 50 . 144 . 50 . 00
X work ha which this permit is issued.My workers'compensation insurance caner and policy number we:
Caller: STATF FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 144 . 50 OVER/SHORT: . 00
Policy Number. —1375544-95 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOTE GRADING PLAN—CHECK
section need dw«aPbredrNepem" aone hundred edaMrstaDlalsas.) 144 .00 50
O I coney th t bis the Perlonunce of the work for which this mit b' ad,I shell nit employ any person A any manner so as to
become subject tithe compensation laws d California agree Nat S I .to IM workers' *******************************************************************************
cornp°rmlanGprovta (/wySkeerct�ion 3700 of the Labor Code, wvn.oh/nom v"h INDIVIDUAL F E E BREAKDOWN
Date: Applicant: 17 / -
Waming:Faun to aacw workers'compensation ',lawful,and shall subject an employer to criminal penaltie,and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil ansa rig to one hundred thousand dollars(mama% addition to the cost of compensation damages as provided for In
Section 37050,the Lalc,Code,Inleaal.end attorney', SFR 4150 REROOF BY VALUE RESIDENTIAL NOZONE 1 ..00 4 , 150 . 00
CONSTRUCTION affirm LENDING AGENCY: I herebybnn under penalty penurythen
y that e a construction lending agency Na END ( m��E DETECTOR
performanced the work fa Medi this nt pea issued(Section 3097,Cie.C).
LENDER'S NAME: c/��1 1
LENDER'S ADDRESS: REQUIRED ' /
I certify that read
that I have this application and state that the above information is cored.I ague to comply with all city and county ordinances
end state lows relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly
for inspection purposes. Cl 0O18yn67-^1'13£042 TOT _ . 'i
JIMMY BRERETON [% DATE: C".'.)":'': TINE: 10x5
Print N: �>•_ (/��/�!
f/4 / �� Date: /J '�
Sig .1 or'of e"'T Spoken (/
(5151-4B WP) WhiuraMing&moi. ;Oxen-Fite. .pfun;Fink-Revenue:Goldenrod-Asses=
CONSTRUCTION AND PLANNING ; POOL ., SPA
APPROVALS Permit ti Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 1
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement l
. 3: Bectrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ,
=5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6:-Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. -
8. Foundation - - 59. Gas Pipe, 0 Un'drgrnd., Test '
9. Water Pipe-Undrgrnd. = 60. Backwash Lines;P-Trap, 0 Undrgrnd.
10. Structural Floor System 3 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
12. Sewer Cap63. Heater & Vent-Final
1.3. Roof Drains - 64. Plumbing System - Final: '
14. Rough Plumbing 65. Electrical-Final - •
`
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring I 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FQR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - * , . FIRE DEPT.REQUIREMENT
20. Rough Factory Fireplace - - APPROVALS- `_ Permit #
21. Ducts, in Structure 70. Underb'rourid Hydro
22. Ducts,Ventilating • - - • 71. Product Piping❑Gas f Oil
23. Gas Pipe-Rough& Test - - 72. Underground Flush
24. Roof Framing - - - 73.. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Mono-coat '_ - 75. Dry Chemical
27. Frame and Flashing - 76. Dry Stan$Ipipe -
28. Lathing& Siding , r 77. FIXED SYSTEM'FINAL
29. Insulation . - - 76; 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. Fina( Electric - • Notes: -
-r
34. Final Heating& Air Conditioning _ •
35. Final Gas Pipe•Test - • • -
' 36. Hood or Canopy - - - ' - - r'
37. Final Factory Fireplace I -
38. Final Plumbing ' - { , . • _ .,
39. Water Service-Final r - ,
. * ._.
40. Gas Service-Final _ - - .
•
41. Solar Domestic-Final ' - - by
.
42. Backflow Preventer '- < q5- geed tc
43. Backflow Irrigation - • n• Ftflog,! - 6 k,
44. Landscape Irrigation System - - . •
45. Sound Attenuation . . - - •
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING fQ-/�g5e(, .
48. FINAL PLANNING - v ! �"
49. Electric Release to Edison
50, Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 1754 IOWA ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P052111
- OWNER!NAME: WILLSON RICHARD E TR
ADDRESS: 46 TIDEG)IND PERMIT NO; P 052117 PLAN CHECK NO: N GOVT: N SUPP: N
IRVINE,CA 92715
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
854-8742
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALLED WATER HEATER SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: • GROUP OCC: R-3 /
PERMITTEE: EARLS PLUMBING ( 714 )772-3470
ADDRESS: 1533 W. LINCOLN COMMENTS: SMOKE DETECTOR(S) REQUIRED IN THE HOME
ANANHEIM CA 92801 ****************************** TE********RA+r****aE*********at***yF****** >E*******+P**
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: 005938 STATE LIC.:2176 cuss 6
��{{ Date: -26—� ' signature: MAIN BUILDING ACCESSORY BUILDING
G —WORKERS'COMPENSATION DECLARATION: Ihereby affirmthat Ihave acehcateolconsenttoself4nsureoracertificateofWorkers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
m
Compensation Insurance.Gr a certified copy thereof(Section 3800.Lab.8). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: U`A-11686 EXP.DATE: T/3/O1 /92 .
COMPANY: UNICARE PARKING RE • PROV: PARCEL : 13906105 ZNE: REF NO:
17 Certified copy is hereby furnished. EX Certified copy is filed with the city ddi Division. PLANNING N TES>
ate. 5-20 -9 1 Applicant. *******************************************************************************
EXEMPTION,FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(3100)or less). DEVELOPMENT SERVICES REQUIREMENTS
•
I certify that in the performance o1 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. ZONING APPROVED BY .
DATE:
Date: Signature: BUILDING APPROVED BY
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. r C y�y��
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• ) ,. •
DATE: *****
which this permit is issued(Section 3097.Civ.Ct. ************************** ***** *** ** *** *********************** TSA' ; **
LENDER: **************************************** . * ***********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2,00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5 Y SM I P/NON—RE$
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)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN .
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 , 0 0
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended orofteredtor sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2 . 00 3 . 00 0 . 00 5 .00 5 . 00 . 00
does not apply to an owner of a properly 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 REVENUE DIVISION TOTALS--> COLLECTED• C-—5 .00 AVER/SHORT• 00
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). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIPYTOT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with Licensed contractors to construct the project(Section 7044,Business . 00
❑ 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. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: owner— - PLU 1 WATER CLOSET (TOILET) 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wilwill not(circle one)need to comply with said state codes and the requirements for a
permit far construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. ,
Date: Applicant:
I hereby 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 building construction and hereby authorize representatives of this city to enter upon the above-mentioned 0I 0008242?—OLOS341/ p'e_ T
property for inspection purposes. [ATE: 05/30/91 I I E: t::: ?'
C —Date: -2 0 -915 Signature:Z 4 a
Driver's License or Social Security a:
1641.46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
r CONSTRUCTION AND PLANNING POOL .,PA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
-411. 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
S;,Steel Reinforcement. 56. Rough Plumbing & Pressure Test
'.-Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings ` 58. Electrical Conduit-Undrgrnd.
8. Foundation - • 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. :•• 60. Backwash Lines, P-Trap, 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 "
n
13. Roof Drains _ 64. Plumbing System - Final '
14. Rough Plumbing 65. Electrical-Final ,
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning _ _ FIRE DEPT. REQUIREMENT
20.'Rough Factory Fireplace : - ' 'APPROVAL$?'-% Pei-Mit # >'
21'Ducts, in Structure. • •• - . .t -.70. Underground'.Hydro •
22. Ducts, Ventilating•'- _ - `P 71. Productping 0 Gas O;Qil
•
23.-Gas Pipe:Rough & Test • _' .Z - . 72. Underground FWsti .
24.:Roof Framing - _ 7 - : -r - : "73:'Undergrnd.StoraaeeTank 0 Gas 0Oil
25. Roof Sheathing , _ 74,Overhead Hydro_, A
26. T-Bar Ceiling IStructurall &ivlonocoat _ • 75. Dry Chemical -
'
27. Frame and Flashing' i LL. ? - > t ., , 76. Dry Standpipe - t
• 28. Lathing& Siding • • ' - • >' • ^
• :. ! 77, FIXED SYSTEM;FINAL:
'29. Insulation .. , 78r,FIREPREV. FINAL '
;30. Drywall Nailing - • i _ _ •HEALTH.DEPT•. REQUIREMENT
' 31. Plaster Brown Coat . : 1 ‘-e',,',,
, " . ,.79' FINAL-INSPECTION
32.,Electrical Power Meter.-Final • • •80.JFOOD CERTIFICATE ISSUED
,33. Final EI'ectrid - 1 i , 'Notes:(,!,// tie*.riat/4OMgrFT
ZeG9Q0 -La
.34:-Final Heating.& Air.Conditioning-; 1 ; ^f. , -
35..:Final Gas Pipe-Test' Y' I I yj�t " 't; •
•36. Hood or Canopy •• .
37. Final Factory Fireplace,_ . ' ' ., ' ,
-38. Final Plumbing - : - • _ _ _ 77I2-frt cL0:
39. Water Service-Final r ' • '
;40. Gas Service-Final .} Y. . . . '
41. Solar Domestic-Final ' '' - r - ..
42..Backf low Preventer, 1 .F ->
43. Backflow Irrigation' 1 ` `•
ti .
44. Landscape Irrigation System; _ - -. _ c I. - :
'45..Sound Attenuation '
1.
146. Handicap Regulations - ' ' ' _
47. FINAL STRUCTURE & BUILDING • I '' ,'
•
48. FINAL PLANNING • I ' '
-49. Electric Release to Edison i 1 r. .
50. Gas Release to Southern California Gas Co ' I i -!:
51. CERTIFICATE OF OCCUPANCY • .
No. Date
UT 111 FEos,E RE �iVtu
IR 3722 ,
13161 pCT 24
•
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 311 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant fo Fill In Completely APPLICATION FOR,PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS -754- IOWA STREET
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. PERMIT NO.
OWNER K & E DEVELOPMENT CO.) INC.
1E9°11
d
MAIL
RECEIVED BY I g, �je �� I QI. 2®7 .
ADDRESS 1555 PLACENT I A AVE //Z°j Cyc,! VT ys
TEL BUILDI
CITY NEWPORT BEACH NOW 6-322_ ABUILDI NeG
111
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NO. /�
FIRE Qyn1 y�--
ADDRESS ZONE TYPE GROUP cl JVXJ{'
CONTRACTOR K W KUI I APPROVED
BY DATE
ADDRESS 1555 PIACFNTIA AVE ZONING O
ZONE NO.OF USE OF NEW Sings fart.
CITY NEWPORT REACH R-1 I PLANS I BUILDING W/ att gar.
LICND. 61195 TEL. MI 6-3227 LEGAL 2 T
EBORIPTION Trot T� . Tract 8Ct 9722
SIZE 60100 I RR EG I NO. OF BLDOB.O
OF LOT NOW ON LOT A.P.NO. nOnP
USE OF YARDS EVES
EXISTING BLDG. NONE APPROVED ALLOWED
SETBACK LINE FROM 50 1 22.51 mann LINE ST.)
Cj /,
ENTER OF STREET / REAR YARD FRONT L/ FT. IN.
I
SIDE YARD I LEFT 1 RIGHT b R.SIDE .(i FT. IN.
DESCRIPTION OF WORK
11
L.610E B FT. IN.
NEW I )( II ALTERATION I II ADDITION I REAR (�y)-- FT. C. IN.
REPAIR I LOVING I II DEMOLISH I ABY W. T.. n. /r 1/L^ DATE 10-21-60
BUILDIN�575.5AHSE RNO. OF OOMS 6 STORIES I l/JI/� IR
R
SIZE I
EXTERIOR WALL ROOF ROCK
COVERING STITCH I COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
SINGLE FAMILY RESIDENCE
AND ATTACHED GARAGE
FLAN 2-tl
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AN ATE REGULATING
BUILDING CONSTRUCT V UATI ON //
SIGNATURE OF ///n/ ot.PERMIT FEE $ !O ---
PERMITTEE r ��-P/ - /� 2".a/ j �/ n_
$ J. �1 PLAN CHECK $ 4
AUTHORIZED AGENT `` //J o
TOTAL FEE $ ✓ �J y