HomeMy WebLinkAbout3221 IOWA ST - Building PermitsCITY OF COSTA MESA
��p~Fsq BUILDING DIVISION
t
i� ` � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • wvrx.ci.costa-mesa.ca.us
�. FOR INSPECTIONS CALL: (714) 754-5626
"�°°b�^�' PERMIT NUMBER: E10-00268
PERMIT 7YPE ELEC
APN: 13910109
JOB ADbRESS: 3227JOWA-ST C
Viciniry:
STATUS: ISSUED
DATE ISSUED: 11/05/2010
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORH: ELEC7RlCAL PERMIT 70 UPGR4DE SERVICE PANEL TO 200A FOR SFD.
OWNER: GERNAZIO, ROSALIE M Add25s: 3227 IOWA ST Unit:
PHONE: City/State/Zip: COSTA MESA, CA
APPLICANT: MAHAFFEY, BILL
PHONE: 949-2953965
CONTRACTOR: WILLIAM THOMAS MAHAFFEY
Address: 2381 FOXDALE AVUnit: PHONE: 562-6913461
City/State: LA HABRA, CA ZipCode: 90637
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL �EES $54.00
Address: Unit:
CitylStafe/zZip:
License No. 616110
CELL:
NOTICE: The work authorized by this permil shall comply vrith all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 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.
C0� INSPE�nONTYPE ORTE INTI11RL5 COOEO INSPECiIONTYPE DATE INTITIRLS
1616 Fixetl Sysiem Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing y"
200 Final Re-Roof 210 Fina� eiectnwi X I I' %�"� G�
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Plannin9 AOProval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I �ereby affrm under penalry of perjury one of the following declarations:
❑ I have antl will maintain a certifcate of consent to self-Insure for workers'
compensation, as provided (or by section 3700 of the Labor Code, for the
pertormance of the vrork (or which lhis permit is issued.
❑ I have and will main�ain vrorkers' compensation insurance, as required by
section 3700 of [he Labor Code, tor the peAormance of Ihe vrork for which lhis
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Cartier.
(TN5 seGion neetl iwf Oe mmpleletl atne perm4 u valued at are nund.etl W9ais (5100) w less.�
Policy Number:
���
�� I certify that in the pedormance of the vrork for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to lhe vrorkers' compensation laws of California, and agree that if I should
become subjecl to Ihe workers' compensation provisions of Section 3700 0(
the La r Code, I shall (orth ith comply with Ihese provisi ns.
y�� ,�
� ��AOW 1's51g f� _le_
WARNING: FAILURE T SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
A7TORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm �ha[ I am licensed untler provisions of Chapter 9(commencing
wilh Section 7000) of Division 3 0! the Business and Professions Code, and
my license is in (ull force and effect.
C"�— �
Lic; #' —' d Glass # -
� O
CONractw Sign�e Date�
•
CONSTRUCTION LENDI AGENCY:
❑ I hereby affirtn that there is a construclion lending agency (or the
peAormance of the v.ork fa wfiich this pertnit is issued. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Atldress:
SgnaWre
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalry of perjury Ihat I am EXEMP7 FROM THE
CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5.
Business antl Pro(essions Code: Any ciry or counry which requires a permit to
conslruct, alter, improve. tlemolish, or repair any structure, Dnor to its
issuance, also requires Ihe applicant lor 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 therefmm and
the basis for �he alleged exemption. Any viola[ion of Sec�ion 7031.5 by any
applicant (or a permit subjects the applicant to a civil penalty o( nol more than
five hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees vnth wages as their sole
wmpensation, WILL DO THE WORK, and the strucNre is not intentletl or
oHered for sale (Sec. 7044, Business and Professions Code: The Coniractors
License Law does not apply to an owner of property vfio 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 ar improvement is sold within one year of
completion, the owner-builder will have the burden of proving that he or she
did not builtl or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACT�NG WI7H
LICENSED CONTRACTORS to construct lhe project (Sec. 7044, Business and
Professions Code: The contractors License Law does, not apply to an owner o!
property who builds or impmves thereon, and who contracts for such project vrith
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Slgnamre
309�<6 (YO])
Owner ID venfied by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation ot Ownership by (rype of tlocument, i.e. - pmperty taa bill or deed):
�DIVISION OF�INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hefeby certify that no exCavalion five (5) or more (eet in deplh into whiCh a
person is required to descend, will be made in connection with wurk authorized
by this pertnit, and that no building structure, scaffdding, falsewurk, or demolition
or tlismantlin9 Mereof, will be more than thirty-six (36) (eel high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Atlminist2tive Code).
❑ As owner-builder, I will not employ anyone to tlo work which would
require a permit from the Division of Intlusirial�Sa(ety, as noted above, unless
such person has a permit to do such work from the�di'vi5i0n:
Appllcam's SignaWre
Division of Industrial Safety Permit Numher _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicani or present or tuture builtlin9 occupant need to file and
certity a Business Plan for emergency response to release or Ihreatened
release Of a hazartlou5 matenal? ❑ Ves ❑ No
(Section 25505 0( the Cali(omia Heatlh and Safety Code requires, with some
exceptions, iha[ a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 qallons, or 200 cubic feet of compressed gas
at standartl temperature antl pressure).
2. Does or will the applicant or present or fuWre building occupant need to file
a registration (ortn for acutely hazardous ma[erials? ❑ Yes ❑ No
(Sec�ion 25533 of lhe California Heallh antl Safety CoCe, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hantl a quantiry of awtely
hazardous materials equal to or greater than a weighl of 500 pounds, or a
volume of 55 gallons, or 200 cubic fee[ of compressetl gas at standard
temperature and pressure�.
3. Does or will lhe applicanl or present or future building occupaN need to
prepare an RMPP (Risk Management antl Prevention Pro9ram for acutely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Health and Safety Code provides thai [he
Costa Mesa Fire DepaAment may require Ihe preparation, certification and
fling with the Fire Department o( an RMPP by businesses which are required
to regisler awtely hazardous materials with [he Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Calitornia
Health and Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or vnll the applicant or present or future builtling occupant require for
ihe work which is Ihe subjecl of this applicalion a permit for such wnstruction
or modifcation (rom the South Coast Air Quality Mana9emeN District or (rom
any other air pollution control dislrict or agency? ❑ Yes ❑ No
(Section 65850.2 of lhe Calitomia Govemment Code requires that the requestetl
infortnation be fumishetl on appliwtions ta nornresidential building permiis).
6. Will any part of Ihe facility to be constructed under Ihis permit be wi�hin
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the (acility must meet the requi�ement o( Sections 25534 antl 42303
of the Calitornia Health antl Safety Code).
7. If a permit from the South Coast Air Quality Managemenl District or other
air polWtion control district or agency is required for the vrork 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
8, pf'yes", attach certificate of compliance fmm Ihe appropriate air polWtion
control oKceQ.
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correcL I agree to comply with all slate laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury Ihat I have read this application and stace that
Ihe infortnation given is correcl. I agree to comply with all 5tate laws and city
ordinances relating to building construction, antl authorize representatives ot
the Ciry of Costa Mesa to enter upon me above-described pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorizetl by this permit until final inspection.
% S/i� Wre o! LeB�I Own (s) 21e
Gn, 6��° � � '/ �
�= �—
AnElorAutbon e� pli n �DJ¢—'
�
ADolicant to fill in all spaces ex<ept those within heavy Eoraer Iines anG sign all appropriate tleclarations.
CITY OF COSTA MESA TCONSTR�rUC+TION PEFiMI I
Project Address 3 7� �`� �'�%' J�.
Applicant'sMaili�ggAddress �2�%Z�w'Q ST COSl�4- /7%�{a
� Kas�,t1E /�7. b'6�CiuA7-io
Owner's�Name Phone
Address ���� rowf+ s7' e.ot7ro- MJsA- ��•
Arch/Eng. License No,
Address �' � �
Convacror's Nama �� Phone
.Address (mailing)
City License No.
LICENSE� CONTRACTOR DECLARATION
I hereby af(irm that I am licensetl untle� provi51on5 of Charter 9(Comm¢ncing
with section 7000) of Dlvlsion 3 of tne Business antl Professlons Cotle, antl
my license is in full force antl effect.
License Class License No.
Date Si9nature
WORKERS' COMPENSATION DECLARATION
' hereby affi�m that I have a certificate of <On5¢nt to selt-insu/¢ or a ce�titicate
{ 1;'.�� Workers' Compensation �Insurance, or a certitietl copy thereot (Section
�:'"'J0, Lab. C.) .�,
� Policy No. Company
eCertifietl capy is hereby furniSheC� J
Certitietl copy is tiletl with the city Builtling Oivision.
Dace APplicanf
EXEMGTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl nof be completetl if the permit is for one hunaretl ($100) ar
less). �.
I certify Ihat in [he per(o�mance ot th¢ wo ,rK tor whith Ih , perm�t i5 i55uetl, I
shall not employ any person in any nrYer so (o be me subject tQ.the
Worker o�7pen i Laws oi Calit i.
Date �!�' 1G- � Si9nature
NOTICE: It, after making this Oecla�atio � you zhOultl become suE^ to tne
Workers' Compensation provisions of the Labo� Cotle, you must fo� ttwitn
comD�Y with sucn provisions or this permit snall be tleemetl voketl.
CONSTRUCTION LENDING AGENCV
I hereby a(firm lhat there Is a construction IenCing agency tor the performance
of the work tor which this permit is issuetl (Section 309] Civ. G.)
Leneer's Name
Lentler's Atltlress
OWNER BUILDER DECIARATION
I hereby affirm that I am exempf from the Contractor's License Law tor the
following reason (Section ]031.5 Business antl Professional Cotle: Any city or
county whiU requires a p¢rmit to constru<t, alte�, improve, Cemolish o� repai�
any structure, prior to its issuance, also requlre5 the applicant for such permit
to file a signetl statem¢nt Ihat he/she is Iicensetl pu�suant to the p�ovision5 of
the Contractor's License Law (Chapter 9(commencing with Section �000) of
^�vision 3 of tne Business antl Professions Cotle) or that he/she is ezemp[
`2.'�
CONSTRUCTION AND PLANNING POO' rPA + -
�
APP6iOVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector
1. Temporary Electric8l Service or Pole '52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement "'
3. !Electrical Conduit Utility-Undrgrnd. - 54. Forms n I��
4..�Electrlcal Conduit-Undrgrnd. 55. Electrical Bonding � �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ''
6. ,Electrical UFER Grnd. 57. APPROVACTO COVER-GUNITE �' ;'
7. Footings � �� � 58. Electrical ConduibUndrgrnd. � ''
8. �Fou�dation ,� 59. Gas Pipe, � Undrgrnd., Test � '
I
9. Water Pipe-Undrgrnd. ' , 60. Backwash Lines, P-Trap, O Undrgrnd. ,; ��
10. Structural Floor System � 61. APPROVAL TO DECK j
11. Property Sewer Line & House Connection �� ' 62. Backwash & Receptor-Final I
12. Sewer Cap � i 63. Heater & Vent-Final � � �
13. Roof Dreins �� -�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 Elgctrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20: Rough Factory Fireplace APPROVALS Permit #
i
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, V�ntilating 71. Product Piping �Gas ❑Oil
�23.�Gas Pipe-�iough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar CeiYing (Structural) & Monocoat 75. Dry Chemical
27.4FrameandFlashing � 76. DryStandpipe
28. Lathing &Siding 77. FIXED SYSTEM FINAL '
29. Insulation - ', 78. FIRE PREV. FINAL
30. Drywall Nailing � . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat _ 79. FINAL INSPECTION - �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' � Notes: �� � .
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test .'� '
36. Hood or Canopy �
37. Final Fa'ctory Fireplace �-
38. Final Plumbing � �
3g. Water Service-Final � ' , �
40. Gas SerJice-Final ' -
41. Solar pomdstic-Final �
42. Backflow Preventer , , , �
i
43: Backflow Irrigation • '
i
44. .Landscape Irrigation`System
45�. Sound Attenuation �.' � ,
4B. Handicap Regulations �' � �
47. FINAL STRUCTURE & BUILDING 1 ZS .� 0 �
48. Special Requirements �ompleted
49. Electric Release to Edison ( �y ��
50. Gas Release to Southern California Gas Co ,_ �� �_
51. CERTIFICATE OF OCCUPANCY • . � � �
No. Date � �
�
_�
TYPICAL 6�� CONCRETE BLOCK FENCE
.
Cement Coping Optional -�
Channel Block With 1-3/8�
Horizontal Top of all
Fenees
For Fences 5' or Leu
Vert. Bars 3/8"� at 4' -0" O.C.
For Fences Higher Than 5'
Vert.Ban 3/8"� at 32" O.C. �
Fill Cells Solid With Grout
Where Steel Occurs
Reinforcing Steel SAall
Conform to Sec.A-1539
A.S.T.M.
A�I Steel to be Lapped
24" or to Code
NATURALGRADE
TWO 3/8"� BARS �1
CONTINUOUSTOP • I
& BOTTOM � -�.{
AOm=.STEEL MUST BE TIED IN
P.LACE AT TIME OF TRENCH
Permit �# � -36 22 S
NUMBER MUST ACCOMPA
ALL INSPECTION
D�
� .. •
� . . . .� � . � e ♦.. .
F-�—WIDTH � iu io v.�. mHn.- � p
p" " � SEE CHART � ,
� �9 BELOW ' ��� �♦ .
�
o eL� � �
. 3 �
� ��" 7
2..
Y
FOOTING REQUIREMENTS CHART
� GENERAL- NOTES
MORTAR: p�e Part Plasfic Cement, and
TAree Parts Sand
GROUT: One Parf Cement TNee and
One Halt Parts S�and
COPING: One PcH Cement, Three
Parts Sand
CONCRETE: Well Mized 1:2-I/2:3-I/2
Max. ot 7- I/2 Gal;ons of
Water Per Sack of Cement
GROUT MAY BE POURED FqOM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELIS AND AHEASOF HORI20NTAL REIN�
FORCEMENT SHALL BE CLEAH, CLEAN &
5"� EflF�OF ALl MORTAR DEBRIS, ETC.
' �� �� ,.T: ; � f:�. �'-�-�.`�_
� �' I'�s ..: ��'
�ty of Co`r•' esa Buiiding rJept.
' . —�----'_' — —�._ DA7E � �r�i 19��
NO fHANANS ir,u� i gc pN JO� AI' ALC 77ME5 MA,•{E
GEJ WlTHpI�i poiCR APPP.O�/ql pf DEPi
DEPTH OF EARTMTCOTH'
'iNE��� 3,T�NE_HEIGTH OF FENCE �
�bW�QOT�'fOM�(OFSF FOFci, G
'. �L'.1Ns�+..� �r t�IFI..A710N5 $H4lL NOI �� JR hp'P,OVqI OP
'ERMIT fOR. pg AN T.ppp�yA� OF FNv fie CON� ic�UED TO 6E 4
Hc PHpVI51Gv<qc 7M:i ` �•'^Jq'Ir uJ_A� �
AUTFIORIP.' TO Y!Oi/iili CR DE. Stl%A�,�'t`REI fr.I,L.NG 70'y OF
LODE $Hqll 6'F. \'A,I,p GPNCcI THE Pi<OVISICN$ GiVE
H'HIChI li • r,Y�EI'7 i': �O p/�.q AS iHF �nino�OF^THI$
hJ7iiC)Roc[ �. �..__..
IME ISSUtWCE CP A PCBMIi gqSfD UPON PtANc 4ND
CI'IrG�¢�.. c c
"4�1l•<�• ,r•�"p •.•�tn�r�r� "• e ��F2 BUILDING CFF'
._.,... _ _ . [..., ., . . i . _ �CIAL
i1Ji! ...�.• ..�a`� `�,':r-�ili:Fll,p;d n�T�CNO�fP,ROH51N
WIOTH 14�� . . . . . . . . . . . 14�� . . . . . . . . �,V .,12„j'•. (1°ECr.pr:i.. aU)Jr'C:,Hh'i 12+� :a:a.i ret.ven�riN�
i T:p� G'r iMiS �'. Ei' •16j i`'`REUNDER Vl4EN
THICKNESS . . . . . . 10��. . . . . . . . . . . .IO�� �.+,i'-��g�1'. . _ . . .--�EOn"OF.AtB �;hiFFORDINANCEOf
DEPTH OF EARTHTOOTH . . . 24" . . . . 20"
f � :.,.,1,6��_.,. 12 '
SPACING OF EARTHTOOTH. . 12� . . . . . . . . . . .14� . . . . . . . . . . . 16�. .f-�y ..'.""'"`"" .-f6=-
City of
Buildin
Costa Mesa,
g Departmen
�EVhSEP ND�. B2
OW4ER5 N4ME: _ _ _ _ _
California �OB A�DRESS _ _ _ _ _ _ _ _ _ _ _ _ _ _
FERMIT NUMBER:_ _ _ _ _ _ _ _ _ _ _ _ _ _
tSIGNATURE: _ _ _ _ _ _ _ _ _ _
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It is hereb� agreed that a party r+�ll will be constructed on the
praperty line beb+een
3�a s
fn the City of Ccsta t7esa, Canty of Orange. State of Califnrnia, as per map
reooxded in Bodc . Page of Miacellaneous Naps, in the affice a� the
Canty Aeoorder a� said Co�nty. �e party aall ehall be permitted �o encroad�
IN WI��'SS �t�REOF, the parties have entered into this Agree�ent the
day ard year fisst above written.
� ; � . ,�,,.
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3aas ro �� s'�
(Ad�ess)
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Aop��cant to llll In a1l spaces eacap� those witnln neavy eoraer Iines ana sign al1 aoProprlate tleclarations.
CITY OF COSTA MESA
CONSTRUCTICi1V PERMIT
Project Address Z pq
Applicant'sMailingAddreu. �Tp F/��%�'�yPSRY zQVIML
Owner'sName.GE,�NA21� vhone7$/';Z2�
Addreu ';%?_1 'f(7l/JA
Arch/Eng. � License Na.
Address
Convacror's Nam rA�-I F• CkYt.IG l�_Phona��f - i YN j
Address Imailing) �
City License No. � n a. S�S��
LICENSED CONTRACTOR DECIARATION �
I nereby aftirm that I am Ilcensetl untler provisions of Chartor 9(tommencing
wi[h section 7000) af Division 3 oi the Business antl Prafesslons Cotla, antl
my II<¢nse is In ful or<¢ antl etfect.
Llcen e CI s � cense N� ��-�
Da[e���� 5'9n t r �
�RKERS'COMPENSATION DECLARATION
:reby aifirm Nat 1 nave a certificate ot conse to 501Hnsure or a cerliilcate
. Workers' Compensation Insurance, or a certlfletl copy Ihereof (Section
3800, Lab. C )
Policy No. �� ��� Company STMi� C�tn•
Certitietl copy is hereby furnishetl.
e�j I) Ietl� cy PY �� f�ile0 with t�e cltY �� Ivisi .
Date�_� APPlicdnl
EXEMGTION FROM WORKERS' COMPENSATION LARATION
(Thissec[ion neeU not ba completed if tne permit is fa one nuntlretl (E100J or
less)
I certlty that in the pertormance oi the work for which th15 permk is ISsuetl, I
SM1all not employ any petson in dny mannlr s0 a5 to betOmG sub�ett t0 Ih¢
Workers' CompensaUon Laws of California.
Date 9gnaturc
NOTICE: It,iafter making this tleclaration, you shoultl bacome sub7att to the
Wofkal5' COmp8n5dtion plovl5ioni Of th8 L2bOr COtle, y0u muit for[hwilh
comply with sucn Orovisions or tnis permit shall be tloemed revoketl.
CONSTRUCTION IENDING AGENCV
1 he�eby aftlrm that the�e Is a const�uc[lon Ientling agoncy fo� [ha Oar}ormance
of tbe work for wh�p�thii permit is iisuatl (Section 3097 Civ. C.)
l.antlar's Name
�—
Lontlar's Atltlress
OWNER BUILDER DECLARATION '
I nere0y afBrm tnat I am exempt from tho Contractor's �Icansa Ww for the
following rea5on (Saction 7031.5 Bu5ine55 antl Professional Cotle: Any city or
•mun[y which rCqWres a permif to cOnstruCt, alter, improve, e¢molish or repalr
.any structura, prlor to its Issuance, also reqWres iha applicant !or such permlt.
to 111e a slgnetl statement that he/she is Iicensotl pursuant to tho provizions oi
� Con[ractor'S Licanse L.aw (Chapter 9(commentlng wlth Sactlon 7000) ot
ision 3 of the Buslness antl Professlons Cotln) or tnat hu/she is exemp[
�e��Om antl tne basis for the allegetl ¢xamptiOn. Any vlolation of $oction
.031:5 by any apD���ant 1or a pG/mlt�zubjetts tM1e applitant t0 d Uvil
�enalty of na[ moro than flve nundretl tlollars (E500). �
I, d5 Ownef ot tlle ptoperty Or my OmpI0y88T with wagei di thell Sole
componsation will Eo the work, antl t�e structuro is not IntonOetl or otferutl
for sale (Secfion 7044, Businezs anC Prote55ional Cotlu: Tha Contractor'S
LlcanSe Law tlo¢s not apply to an owner of a proporly who bulltls or Imoroves
[beraon, antl who doei suth work hlm5elf/hor5811 Or thrOugh hli Or her own
Omploy ans, prOvitletl thdt sutn Improvements ara nOt IntOntlotl or oilerotl for
sale. I1, �owever, tne bulltlln9 or Improvemint IS Soltl wllhin one year OI com-
pl8tion, Ihe own¢r will have tM1e burEen Of proving ne/sne UItl n0[ bulltl o� Im-
�rove for the purpoze of sale).
I, as own¢r of th0 prOp¢rty, am exclusively Contra<ting with Iitenietl COn- '
, traGtOrs tb construct tne project (Sectlon 7044, Husinnss antl.PrOfosSions Cotla:
ThB ConVattOr'S Littnse Law daes nOt app1Y to an Owner ot prOp¢rty wh0 '
bulltls or Improve5 t�er¢on, antl wh0 ContraCtS f0� Such p�of¢Cts wi[h a con-
tractor(s) Iicensa pursuant to tha Contractor'S Licanze Lawl.
❑ I am exem0� untler 5¢ction 6. y P. C. for this reason
Date Owner
I nereby cerfify that 1 have reaa'this appliWtlon antl state tnat tha above
information is correct. I agree to comply with all clty antl county ortlinances
and 5tate law5 relating to Euiltlin9 constructlon, antl here�y authorize repre-
sentatives of this dty enter upon lha above-mentlonetl property for
In50ectlon pu�pos
Signature � Date���
.� — ��G /'7� I 3(a`�15' I •Co I
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CpNVER510N ❑ DEMOLISH ❑ aTHER
� DESCRIPTION OF WORK S��L/GUT ��.! t�IN�AL M�ff�
TYPE OF PERMIT IJ GRADING U FOUNDATION IgSTRUCTUI
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq. FT. OCCUaANCv
CONSTRUCTION TVPE VALUATION $�
ZONE GRADINC�CU.VDS. ACRES—
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs '
Clarifiers
�ishwasher
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Lavatories '
P—Trap '
Roof Drains �
Reinspection Fae $25
Boiler
Dutt- Under Ground
Duct - Structural
Duct: Venlilating
Exhaust System � Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Oucting
❑0.100,000 BTU � 100,000 BT
D ' ' LI
� I I Rainspectionfea I $25
CMF 0865-46 rev. 12/83 White � Builtling; Canary - APpliwnt; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connxtion
$olar CAllectors
Solar Piping
Solar Tank
Swimming Pool wlSpa
Urinal
Water Closet
Wa[er Hea[er
Water Service
Isue Fee
Hood or Typel ❑
CanOpy Type II ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Fiepair/Alteration
Issue Fee
EES
A.P. qW �
S Main Building:
E
T Front '
A Rear
C Right
S �ef[
Ping. Ref. dp
n
Use of Building:
Planning Notes:
Automatic Washer
Construction Pole Su6.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
OuUets
7938 4/04/04
2one Q �
Accessory Buildin9:
Q ��
Park.Fees $
ELECTRICAI ,
Transformer ❑ 15�50 KW
❑ 50+KW
Meter LJup to 700amps
Meter pover 100 amps
Sub Panel
Motors�0.1 HP07h-8
Inc.Solar �9-15 HP �1&15+
Microwave
Pole Light
Garbage Disposal � I Standing Sections
Generator 00.5 KW �5-15 KW Trash Compactor
� �oa : T�.
O
N
I
N
G
R
E
U
U
i
R
E
E
S 3
Rainspection Fea $25 Issue Fee $ 3
FEES,
PUBLIC SERVICES RE�U REMEN
Zoning APP�o�ed By �ate4i- 3—k�i
Building Approved By �� — nac�A- —4-84
Applicetion Issued By Datw
SUMMARV OF FEES
BUILDING PERMIT $ � �D • �� SMIP �§ -SO
PLANCHECK $ 6'r� PERMIT
PLUMBING $ ' ISSUANCE $
PLAN CHECK 25°b 3 ENEFGY P.C. $
ELECTRICAL g GRADING $
PLANCHECK 50°,6 $ MICROFILM $
MECHANICAL $ TOTALFEE $ �7'��
$ 3 ' PLAN CHECK 25% $ . , � �
`-CONSTRUCTION ANDPLANNING . POO SPA
��APPROVALS Permit# Date, Inspector qppROVALS Permit# - Date Inspector
1.� Temporary Electrical $ervice or Po�e . . 52. Pool & Equipment Location -
♦
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement _ � ,
3�Electricdl Conduit Utiliry-Undrgrnd. � 54. Focros _
4. Elgctrical'Conduit-Undrymd. 55. Electrical Bonding . � _ �;
5. Steel Reinforcemerit :� 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.' ' - 57. APPROVAL TO COVER-GUNITE � '
7. Footings ^ �• , -' 58. Electrical_Conduit-Undrgrnd. '
B. Foundation • � 59. Gas Pipe, � Undrgrnd., Test _
9. Water Pipe-Undrgrnd. ' ' -�- 60. Backwash Cines, P-Trap, O Undrgrnd.
10. Struc`_tural Floor System , 61. APPROVAL TO DECK ,
11. Propeity Sewer Line & House Connection 62. Backwash & Receptor-Final -
12. Sewer.Cap . � � 63. Heater & VenbFinal -
13. Roof:.Di�ins ' � 64. Plumbing SYstem - Final - �
14. Rough P�umbing . 65. Electrical-Final � �
15..Rough Electrical-Conduit 66. Solar System-Final -
i 6. Rough Electric Wiring 67. Fencing & Access Approval -
1i. Rou�h Wiring Sign 68. APPROVED FOR PLASTERING �
78.� Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
i.
20. Rough Factory Fireplace APPROVALS � Permit #
21. Duc[s,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil �
23: Gas Pipe-Rough & Test 72. Underground Flush - '
24.'RoofFiaming 73. Undergrnd.StorageTank�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. Insulatipn 78. FIRE PREV. FINAL
30. Drywal4Nailing •� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �� 79. FINAL INSPECTION
32. Electrical Power Metei-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test - , '
36. Hood or CanopY - - .
37. Final Factory Fireplace
38. Final Plumbing . - � �
39. Water Service-Final . �
40. Gas Service-Final � "
41. Solar pomestic-Final � � •
42. Backflow Preventer , . .
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound.Attenuation �
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING G'
48. Special Requirements Completed � ' -
49. Electrie Release to Edison - • ,
50. Gas Release to Southern California Gas Co
�
51. CERTIFICATE OF OCCUPANCY - '
� -'
No. Date '
�
' `/ e JL.Y..7'��l
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 GOBTA MEBA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
COSTA MESA. GALIFORNtA
I MAIL
SIZE
OF LOT FjQ� 7�
USE OF
EXI6TING BLOG.
BeTBACK L�NB FROM
1
ZONE
R-]
���Q LE�AL
�E6CRI
OP BID66.
�rneeT Sii REAR YAftD 'Ji�
ILEFT S t I RIGHT S�
DESCRIPTION OF WORK
'EXTERIOR WALL I R
GOVERING stnr.r.n C
� USE OF BUILDING AND WORK
I,,.�.. _ �. .. .. . ._.
.�Cl � :J -1 4i- (c �%
�P�f�t,;.. JF;'1:
�'Q�A ��•jMF
APPLICATION' FOR PERMIT
BUILDING
For Offiee Use Only
RECEIPT NO, PERMIT_NO, _
COSTA MESA.
ZONING
NO. OF I U98 OR NEW
Puns q euao�xo �,
YARDS
APPROVED
tcer+rea une er.>
i HEPEBY ACKNOWLeDG¢ THAT I HAVE REAC THIB APPLIGTiON
AND BTAT¢ THAT THE ABDVE I8 CDRRECT ANG AGREE TO COM- TNE AMOUNT BHOWN UND6R VALUATION 18 FOP THE
PUIiP09E OF E8TA8L�SHING A PERNIT FEE ONLY.
PLY WITH ALL CITY OPDINANCE9 ANO BTATE LAWe REOULATINO
BUILDING CONBIRUCi'ION. VALUATION
SIGNATURE OF 1..�� PERMiT FEE $'� ��
PERMI7TE
IDike & Co�grove, Inc. '$ 15, 045 • PLAN
AUTHORIZED AGENT