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Home My WebLink About2947 JAVA RD - Building Permits(714)754-5273 • Fax(714)754-4856 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: 2947 JAVA RD 13925206 LORIE GLOVER CITY OF COSTA MESA � �' B!/ILDING DIYIS/ON DEVELOPMENT SERVICES DEPARTMENT, PERMIT owner: FRIEDERSDORF, DIANE Addr@ss 2947 JAVA RD COSTA MESA, CA PLUMBING PERMIT Phone: 714-241-1414 Zip: Phone: Zip: 92626 Contractor: COAST ROOTER PLUMING HEATING & AIR CONDITIONING Address: 2737 S CRODDY Arc1� / Eng : Address: SANTA ANA, CA WATER HEATER CHANGE-OUT. ISSUE FEE Back9ow irrigation BackFlow Preven(er Bathtub Clarifier System Connect Qce,Sotla,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Dnnking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlels) � Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $o.00 50.00 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Phone: (714)241-1414 Zip: 92704 License: 529127 Phone: Zip: License: SCOPE OF PERMIT FEESUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $Q.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00. Sink, service/mop $0.00 Spa (private) $0.00 Spa {public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS PERMIT NUMBER P00-00172 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04/11/2000 Issued: 04/11/2000 ISSUEDBY: ^�T SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bktlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping Qnst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 $12.30 50.00 $0.00 $0.00 $0.00 so.00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES: 535.80 Qn 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is noLcommenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectiona end flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 WORKERS' COMPENSATION DECLARATION: F I hereby ettirm untler penelry of perjury one ot Ihe Iollowing deCleralions: ❑, I have antl will meintain a cartilicate of consent lo selbinsure tor workers' wmpensation, as provitletl for by sectlon 3700 of the Lahor Code, tor Ihe pedormence of the work for which this portnit Is issued. ' �I have and will maintain workers' compensetion insurence, as requiretl by seqion 3700 ot the Labor Code, tor the pedortnence of tha work for which ihis permit is issued. My work rs' cn�pen�tion Insprance cardar end poliry number are: . � �/ O q p Carrier. 1 ' 0��'7 ) Policy Numbec IY DI OB 6 O O! ^/ (Ihis section need nof be comp/eted i7 the pe ii( is ve/ued at one hundred Oollers ($f00) or /essJ ❑ I certify thet in Iha pertottnance oi the work br which this permit is issued, I shall no� employ eny person in any mannar so es to become subject to the workers' compansatlon laws ol Celilomia, and agree that il I should become su6ject to the workers' compensation provisions of Section 3700 of the Lebor Cotle, I shell forthwith, comply with these provisions. ) Applicant SignaNr�'� Date: �'I I � b l �ro �� WARNINO: FAILUPE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWPUL AND SMALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND QVIL FlNES UP TOONE HUNDRED THOUSAND DOLLAFE (5100,000�, IN ADDfTION TO THE ODST OF WMPENSATION, DMNGES AS PROVI�ED FOR IN SECTION 3lO60F THE LABOR CODE, INTEFEST, AND A7TORNEYS FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aHirm ihat I am licensetl under provisions ot C�apter 9(commancing with SectionJ 000) of Division 3 of Ihe Business and Protessions Cotla, end my license is in tull force and eeect. Lic. a S a�'i / a% / Class x C,3 �D � Contraciofs5iqnature:�—� z1 / Date: �i D%DO — L/ _� / /� � CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirm that there is e consiruction lending agency for �he peAormance ot the work for which this pertnit Is issued. (Sec. 3097, Civil Code). Lentler's Name: LentleYs Atldress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirm ihat under penalry of per�ury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit to construct, elter, improve, demolish, or repair any structure, pnor to its i55uance, also requires �he applicant for such permit to file e signed stetement thet he or she Is Ilcensetl pursuent to tha provisions oi ihe Contractors License Lew (Chapter 9(commencing with Sectlon 7000) of Divislon 3 of the 8usiness and Professions Code) or Ihet he or s�e Is eaempt Iherelrom antl the basis for the ellegetl exemption. Any violetion ol Sectlon 7031.5 by any ep0�icant for a permit subJacis Ihe applicent to a civll penelty ot not more ihan five hundred dollars ($500).): ❑ I, as owner of Ihe propeny, or my employees with weges es their sole compensation, WILL DO 7ME WORK, antl the strucWre Is not intentletl or otteretl lor sale (Sec. 7044, Business end Professions Cotle: The Conhactors License Law tloes not appry to an owner of property who builds or improves thereon, entl who tloes such work himself or �erseN or Ihrough his or her own employees, provided that such improvements are not intendetl or oRered for sele. 16 however, Ihe building or Improvement is sold within ane year of completion, Ihe owner-builder will heve the burtlen of proving thet he or she did not build o� improva tor puryose of sale.). ❑ I, as owner of Ihe property, em EXCLUSIVELY CONTRACTING WITM LILENSED CONTRACTORS to cronstruct the project (Sec. 7044, Business and Pwfessions Cotle: The contrecbrs License Lew does not epply to en owner of property who builtls or improves thereon, and who coniracis for such project with a coNractor(s) license pursuant to the Contractors License Lews.). ❑ I am exempt under sec. Signeture: Owner ID veritied by drivar's license. ❑ VB5 ❑ No Venfication Business antl Professions Code tor ihis reason: ot tlocument, i.e. � property tax bill or tleetl): Drivers License No. pate: Expires: DIVISION OF INDUSTRIAL'SAFETV PERMIT CERTIFICA710N: a ❑ I �ereby cetlify that no excavation MB,(5)'or more �eet in dep�h into which a Derson Is required to descen4 will be mada in connection wlth work authonzetl by Ihis permit, and Ihat no builtling slrucWre, scefloltling, falsework, or demolition or tlismantling thereof, will be more than thirty-siv (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Tule B, Califomla Atlministretive�Code). ❑ As owner-builder, I will not employ enyone to tlo work which would require e permit from the Division of Industrial Safety, es notetl above, unless such person has a permit to do such work from tha tlivision. Signature: Date: Division oi Industrial Sefety Permil Number: CERTIFlCATE OF COMPLIANCE AND AllTHORIZA7ION OF EN7RV: I cartify untler penalry oi perjury ihat 1 have read this application antl state that the infortnation given is correct. I egree to comply with ell state laws entl city ordinances rela�inq to builtling construciion, entl authonze representatives oi the City of Costa Mese to enter upon ihe a6ove-descnbed property for inspection purposes. I agree not to occupy or allow occupancy of any building au�horized by this permit until flnel Inspection. C�aWre Ot Legal Owner(s) � Date � ioln.o i � AnNOr Authonzed Apphwnt � Date CODE �. INSPECTIONTYiE � Qdff. IMI11RL5 1616 Fiaed System Finel Fire Prevention 12fi6 200 201 202 203 Pool Spa Finel Final Re-Root Final Block/Retaining Well Final Fectory Fire Place Final Siqn 204 Final Demolition 2448.<8 yOpE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Finel Elecirical 212 Finel Fire Prevention 220 FinelPlenning Appro�el 222 Finel Site 250 Final Building/Oaupancy PAIE IrrtmuS Y� i \ �.� PflOJECT FODPESS: z 9 4'� JAVA RD OWNEN'SNRME: WILLIAMS JOHN E aooxess: 2 9 y � JAV� RD COSTA MESA,CA • pflCN/ENGINEEX: RUORE55: UNIT: 92626 XEG.NO.: UNIT: PEflMITTEE: MGM CONTRACTORS ( 714 ) 760-7696 ` AOOflESS: 38 �%'�IS••I•0 RSM CA 92668 LICENSEO CONiPACTOB OECLAHhTION: I hereby ailirm �hat I am Iicense0 unaer provisions ol G�apler 9 �commencing wit� Section 7000) oi �rv�sion 3 oflhe Business and Pmlessions Cotle. antl my license is in lullforce antl e�fect. cinuc.:0 4S L$yj sTnreuc.:621479/� cuss:7p Dale: V ` � Signature: —; / �N� WONNEBS COMPEN ATION OECLARATION: I hereby aflirm �nal I have a ceni�icate oi consen� to sell�insure or a cetlificaie ol WOBers' ComDensalion Insurance. oi a cenilietl coDY �hereof (Section 3800. LaD. C�. POLICY NO.: ' E%P. UATE: COMPANY: � Certitied capY is hereby Iumishe0. ❑ Certified copy is �iletl wi[h �Ae ciry Building Division. Oaie: ApplicanL EXEMPTION FflOM WOflNEPS' COMPENSA➢ON DECIABATION: (This section need noI De comple� A tAe permit is Ior ane hunareU �5100) or less). I cerlity that in Ihe Dedormance af the work lor which t�is permit is i55uea. I sha not e��nnn I any person in any manner so as to become subjecl Io ihe orkers' ort�D�aiion Laws ol Cah�omia. ��/� / ., oa�e: �3 � �7 SignaNre: NOT E: II. aR r making IhiS Declaraiion, yau shoulU become su�le�� o the Wofkef5' ComOensa�ion provisions of Ihe labor Catle. you must farthwilh comply wilh such pmvisions or Ihis permit shall he deemetl revoketl. CONSiPUCTION LENOING AGENCY: I hereDy affirm that there is a consimction Iending aAency lor Ihe pedarmance of the work for which ihis permit is issuetl (Section 3097. Civ. C�. LENOEN: AU�HESS: OWNEP BUILOEN DECLANA710N: I hereby allirm t�at I am exempt Imm ihe Coniracmrs' State License Law for t�e fallowing reason �Section 703t5 Business and Professional CoOe: Any cily ol caunry whic� reQuiBs a permi� �o cons�mct, al�er, impmve, Oemolish, o� repair any simcNre, p�ior to its issuance. also requires ihe apDlicant for such permit ta file a signetl statement thal helshe is licensed pursuam m the pmvisions ol Ihe Comracmrs' S�aie License Law (Chapler 9 �commencing wi�h Section 7000) oi Oivision 3 o� the Business and Pro�essmns Code) or�hal he/she is exempt Iherelmm and �he basis br the alleged eKemp�ion. Any viola�ion oi Sec�ion 7031.5 by any apP�icant for a Dermit sublec�s Ihe appliwnl Io a civil penal�y ol no� more Ihan tive hunOred doliars �E500). I, as owner ol ihe propeny or my employees with wages as their sole compensation, will Oo ine work, antl ihe ❑ stmcmre is not intenAeO or ofieretl lor sale (Secaon 70a4, Business ana Pmfessionai Cotle: The Coniractors' State license Law does noi apply �o an owner ol a pwperty wh0 OUiltls or impmve5 �her¢on, and wh0 tl0e5 Suth work himself/herseli Of �hroUgh �is or her own employees. O�ovided Ihai such impmvemenis are not in�entletl or oHerea lor 5aie. II, however ��e buil0ing or impmvemeni is soltl wiihin ane year oi tomple�ion, ��e owner will �ave Ihe burden of prOving �¢/5he tlitl not build Or improve � for Ihe Durpose of sale�. I. as owner oi the pmperiy, am exclusivel9 canUac�ing wi�h licensed contractors to constmct the D�ole�� (Sec�ion 7044, Business ❑ and Prolessions Cotle'. The Coniracmrs' State Licenre law Coes noi apply �o an mvner ol pmpeM who Ouilds or improves Ihereon antl who coniracls for suc� D�ole��s wi�h a conlrador(5) license pursuani lo Ihe Conirac�ars' S�ate License Law�. I am aware Nat pmo� of Iheir WOBeYs Compensa�ion insurance s�oultl be pmvided to me. � I am e�empl un0er Sectwn'. B. 8 P. C. lor �his reason: �ate: Ownec I Do here�y cerlily Ihat I am aware ol ana undersland Ihe reQuiremen�s af Calilomia Healih and Safery Cotle Sec�ians 25505, 25533, antl 25534 antl Ihat 1 or any IUWre builtling occupan� will/vnll not (circle one) neetl �o com0ly with said state coAes and �he reQuirements for a permii �ar conslmdion or moadica�ion imm the Air Ouali�y Management Dis�ricl Resitlenlial constmciion apDlica�ions are exemp� from Ihese pmvisions. Oaie' FpplicanP. I �ere�y cenify Ihal I �ave reatl Ihis applica�ion antl 5taie tha� �he above in�ormalion is correcL I agree to camply with all ciry antl county or0inance5anA5iatelawsrelating�obuiltlingconslmc�ionandherebyauthorizerepresentavs Ihisciry�oenterupontheabove-mentioned properiy lar ' spec�io purposes. oaie: � U 5iqnamre: ��, �, Driver's icense r Sociai Securiiy x: 16<ba6 Whlte—Bwltling: Green—Cotle Enior<emenL Canary—Applicanl: Pink—Revenue; Goltlenmtl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; H 056'74` PERMIT NO: B 056795 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : T/O EXISTING, REROOF W/CLASS "C" SHAKE SQ FT; 2,500 CLAIM VALUE: 2,500.00 CALC—VALUE; 2,500.00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTOR(S) RE�UIRED IN HOME. ��I"1�T��`��R +t*�t*it*�t�t*x-�t*�t***�*�t****u�*r**** **x-i�+t�t�c-*�r*fr+r**�t*�*+t�*+ti��r*+t �taF # 2 O N I N GS ERTEBQAUCIKRSE M E N T S R EQUIR E D ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REU• PROV: PARCEL: 13925206 ZNE; REF NO: PLANNING NC5TE5> ) iF �lf �IE iFlF 3E iE ik if if iE �lf iF iF 1E iE if iE it iE�f iE �f if iF iE i! �If It 36 iF iF it if iE iE if iE jf iF 3E iE 1f iE if it #�IF�IE iF lE �IE 1E 3t iF iF �IE if iF if if �lE i6 iF �iE iP �lE iF 14 �E iE iElE jF af 3E if iF �lE D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY , BUILDING APPROVED BY : APPLICATIOtJ ISSUED 3E iF k iF1f iFlF�14 if �F ik if if if 1E af If iE IE jF 3k iF * fF iE if if IE iE fE iE If iE if if iFiF iF LEGALIZATION;N BLDG PMT PERMIT 54.00 PLAN ISSUE FEE DATE: DATE: DATE; 3��_ iF±E�EaEikitiEiFafif �e iFiE �E�FiFiFiEifiFifatiE�Fif �f 3F ifif3tiEififiEiFiEiE�FiEjEifiE�lFiPif3fiFiFiEIEiFiEiEiFifiEiPiEiFak F E E S O M M A R Y STRUCTURAL SEGMENT;Y PLUMHING ELECTRIC MECHANIC FIRE SMIP/R55� GRADING SMIP/NON—RES;. ... �, BUILDING—DIV—> PERMIT ISSUE PLAN—CHECA TOTAL PAID �• DUE TOTALS----> 59,50 0.00 0.00 54,50 59.50 .00 % REVENUE DIVISION TOTALS--> COLLECTED; 54,50 OVER/SHORT; ��.00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 59,00 ---� .50 if �t 3f iF iE iE if iE 14 iFiF IE jEiE iE iF IE jE iP 3f ik iE iF if iF M iE iP aE 1E �f iE ik 3F K iE iF iE if if it it it if if 3E iF iE iE iF if iE iE iF iF iE iFiE iE iE iF iF-lf iE iE ik it if iE iE iE iE if aF �E iF iE if iE I N D I V I D U A L F E E H R E A I( D O W N / TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 2500 REROOF BY V�LUE RESIDENTIAL N020NE 1,00 2,500.00 �. .' � END OF FEES E X P i R<E ctions Incomplete In..f� uate ��3.�a-- S'g —_"'""....- 'j I�� I9 v � , CONSTfi'JCTIOI� AND PLANNING �" P00 SPA APPROVALS Permit # ' Date Inspector qppROVALS Permit # Date Inspector 1. Temporory Electrical Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' � 53. Steet Reintorcement - 3� �Electrical Conduit Utility-Undrgrnd. 54. Forms 4. El�ctrital Condui[�llndrgrnd. 55. Electrical Bonding 5...Steel Reinforcement " 56. Ro�gh Plumbing & Pressure Test '6• Elecvicai UFER Grnd. 57. APPROVAL TO COVER�GUNITE _ 7. Footings -' �' 58. Electrical Conduit-Undrgrnd. 8. Foondation �. �� 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgmd. � 60. Backwash Lines, P�Trap, O Undrornd. 10. Structural Floor System 61. APPROVAL TO DECK ' 71. Roperty Sewer Line�& House Connection _ 62. Backwash & Receptor-Final � 12. Sewer Cap i� - 63. Neater & VenrFinal 73. Roof Drains �z• 64. Plumbing Svstem - Final 14. Rough Plumbit�8 65. Electrical�Fi�al 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Eieetric Wiring 67. Pencing & 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. �Roygh Factdry Fireplace ' � � - � " "� ' APPROVA�LS� �Permit # 21.�DuCts, in Structure' . ' .. - . = ,70. Underground Hydro -= 22. Ducts, Ventitating_ . - ;71, Product Piping �G`as QOiI 23. Gas Pipe�Rough & Test '. � = . 7z, Underground Flush � � ' -` 24. Roof Framing �� - � � 73:�Undergmd. Storage Tank � Gas ❑ OiI 25. Roof Sheathing ` �- ' _ ''74„Overhead HYdro , � 26. T-Bar Ceiling (Structurall & Monocoat + - 75. � Dry Chemicai - � 27.,frame and Flashing . 1 � �, ' 76. Dry Standpipe � - � 28. Lathing_& Siding . .*��' i f� � 77.' FIXED SYSTEM;F�INAL . `29. Insulatiqn . � `' � � � � � 78=: FIRE PREV. FINAL � . - 30. Drywall-Nailfng �- � � � � ' HEALTH+DEPT: REQUIREMENT � 7 :-31. Piaster Scown Coa�t � , � � ' � .79: `FINAL INSPECTION : � ' 32. Electrical-Power Meter;Finali � y�ti � � • F 80.. FOOD CERTIFICATE ISSUED 33. Finai Elect�ic ' f - � � Notes: � y � ' _ �34.-Final Heating�& Air Conditioning - . � - ; _ 35. Final Gas Pipe-Test ,_� - ' ' - ' , ' - -, .36. Hood or CanoPY . i � . - - � . � N .. , �, � 37. FinAI Factvry FirepYace ' � � � , " ' ' � 38. Finat Plumding � � . � � _ 39. Water Service�Final � - . .c ' ,40. GasSer'vice-Final � , , { „ ! � - 41. Solar pomesticFinal � • " R � ,. 42. Backflow Preventer � ' � � . �� I � 43. Backfiow i�rigation - � - - - � 44. Landscape Icripatjon System �: , � . , . ' 45.'Sound Attenuation • � � • !9 46. Handicap Regulations•_' � � � � _ - �' 47. FINAL STRUCTURE�&'BUILDING � � E X P i R E D . � . �C"iRS�c6�19f15 48. FINAL PLANNING -. � � g�� 49. Electric Release 2p Edison . � �te � �" -� v SIg �- " - - 50. Gas Release to So4them'Califomia Gas Co , � , � ` , 51. CERTIFICATE OF OCCUPANCY i� , . ! No. Date '� � ApO��ant to /ill in all spaces exceot those witnin neavy nortler Iines ana sign all apprao��ate eeclarations. ciTY OF COS7 S C N TRUCTION PERMIT . Project Address _ . Applicant's Mailin ress � Phon � Owner's Nam � Address � Arch/Eng. License No. • Address — ,y Coniractor's Nam hod9�� Address (mailing) � �� Citv License No. . /� IICENSED CONTRACTOR DECIARATION OO(99� I hereby affirm lhal I am IicenSetl untl¢r proviSiOns ot Charter 9(commencing wilh seclion 7000) ot DlviSion 3 ot the BuslneSS antl Profes51on5 Cotle, antl mylicenzeisintull �e QyHect, i/i/�q/ �/ Licen�`jQ �� ; y ��' \ ` Ddle�%1�� SI9 � ` WORKERS' COM7ENSATION DECLARATION � I hereby aifirm that I have a cerllficate ot consent to selt-insure or a certifitate Workers' Compensation Insuranca, or a c¢rtifietl copy thareoInf '(Se/ttlon � 00. �ab. C.)�a`��li��/' L'L. li /�. i/.[J ✓olicy No. .j J(� Company �U�j../LC __� � Ce�leep.sopp��y; t IatlbwithrthehcitY/e ,�P1W�/� Date� /4 iT�� Applicant(, � EXEMPTION FROM WORKERS' COMPE ATION DECLARA N (Thissection n¢etl not be completetl it lhe permit is for one huntlretl ($300) or I¢5T). 1 certify �that in the performance ot tbe work (or which this perm�t is Issuetl, I sM1all. noc employ any person In any manner zo as to become subject to the Workers' Compensation l.aws o( Cali(omia. Date Si9nature NOTICE: I/, alter makin9 tnis tleclaration, you shoultl become subject to the Worker5' COmpenSalion provislon5 of Ihe Labor Cotle, you must torthwlth comply wilh suc� p�OviSiOns o� [hls pe�mit Shall De tleemeA �evoketl. CONSTRUCTION LENDING AGENCV 1 nereby alfirm inal there is a construcUon lentling agency for the performance of [he work for which this permil i5( issuetl (Section 309] Civ. C.) Lentler's Name Lentler's Atltlress OWNER BUILDER DECLARATION I hereby aflirm lhat I am exempt irom lhe Contractor's License L.aw for the following reason (Sec[lon 7031.5 Business antl Professional Cotle: Any city or counly wnich requires a permit to construct, alter, improve, tlemolish or repair any st�ucture, prio� to �it5 issuance, dlso require5 [he aOD��cant f0/ such po�mrt to file a sian¢tl statement that he/She I5 Iicen52� Pu�suant to tlte provisions of Division 3'of the Business antl Vrofessibns Cotle) or that he/sne is exempt e�e(rom antl the basis for tne allegetl exemplion. Any violation of Se<tlon 31.5 by any ap0�icant �o� a pe/mit Subje<ts the apPlicant to a civil malty ot nol more than five huntlred tlollars (E500). ❑ 1, as owner of the property or my emploYaes witli wages as their sole .compensation, will tlo th¢ work, antl the structure i5 not intentletl o� ofter¢tl for sale. (Sectlon ]044, Business antl Professional Cotle: The Contractor's License Law tloes not apply to an owner ot a property who bulltls or imorovas thereOn, antl who'tloes Such wO�k_him5elt/hers¢I/ ot [hrough his o� her own employees, provitletl tM1at such� Improvements ar2 not Intendetl O� o(teretl for sale. If, nowever, tne builaing or imorovement Is soltl within one year ot com- pletion, the owner will nave the burtlen oi proving he/she tlia not builtl or Im- prove for the vurposo ot sale). ' ❑ I, as owner oi the property, am extlusively contracting with Ilcensetl con- tfdCtO�5t0 COnSt�uC[ tM1¢ p�018Ct (Sec[ion 7044, Business antl Pwfessions Cotle: The Contractor's License Law does not apply to an owner of Oroperty who builtls or imoroves thereon. antl who contracts �or such oroiects with a con- tra<tor(51 Lcense pursuanc ro[ne Convactor's License Law). I am aware (hat prool ol their Wo�ker's Compensation insurance shoultl be prOvitletl to me. ❑ 1 am exempt untler Section B. & P. C. for this reason Date I hereby certify that.l information is correct. I antl State lawt elating � sentatives ot cit inspectlon pur . Signature DrivBrs' Litense or 5 � Owner _ nave reatl In 0865-66, rev. 5/88 Whi[ M ��0'7/ I . I I - TYPEOFCONSTRUCTION. ADD ALTERATION REPAIR ' ❑ CONVERSION ❑ DEMOLISH ❑ OT DESCRIR'GAN OFJGfDAK/LSE OF BLDG. ., � � • TYPE OF PERMIT LJ GRADING. LJ FOVNDATION LJ STRUCTV RAL , ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING .m"N1ccFntRfCR'C ❑ OTHER PROJECT DESCRIPTION SQ.F7. OCCUVANCV— CONSTRVGTION TVPE VALUATION $ ZONE GRADINGCU.YDS. ACRES_ Remarks: Sink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Sink Roof Orains Reinspection Fee � $75 Boiler Duct - Under Ground . Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # � �H ating System & Ducting 0.100,000 BT.0 � 100,000 BT Reinspection Fee � $15 A<counting: Goltlenrotl - Assessor Showers Service Sink . Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑� Canopy Type I I ❑ Refrigeration System ❑aioo,00aeTu ❑ioo,000 System Repair/AI[eration Fire Dampers Registers Issue Fee $ 3 FEES A.P. # S Main Buildi E T Front B Fear A C Righr S . Left Ping. Ref. # Plannin9 Notes: AU[Ofi1d21C 1N85hEI Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A:U: Fixtures Device Boxes � Switches Garbage Dispoul Generator 065 KW 2one Req./Provided ELECTRICAL � Transformer ❑ 15�50 KW ❑ SO+KW Meter Llup to 100 amps Meter ❑over 100 ampi Sub Panel Motors �0.1 HP �1 h�� 8 I na Solar � 9-7 5' HP � 16-15+' Microwave ' Pole Light Range O N I N G R E Q M T S. FEES Standing Sections-� 5 KW Trash Compactor i � Rainspection Fee '' $15 ' � Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approvad By � Building APProved By SUMMARYOF BUILDING PERMIT $ PLAN CHECK $ � PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ . PLAN CHECK 50% S .—�,y ,�� MECHANICAL. $ �•w PLAN CHECK 25% $ $ 3 SMIP $ PERMIT, ISSUANCE ' $' ENERGV P.C. $ GRADING $ : � MICROFILM $ � TOTALFEE $ / a� 01 C�023635-0002's685 T Cb x'' i?A1E: UI/OS/�9 TIfiE: 1D�48 .-� _l�� t - , � CONSTRUCTION AND PLANNING • POO 3PA - 'APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector 1� Temporary Electrical Service or Pole , 52. Pool & Equipment Location _ 2. Soil Pipe-Undrgrnd. • ',� 53. Steel Reinforcement �� . 3.� Electrical Conduit Utility-Undrgrnd. 54. Forms 4..Electrical Conduit-Undrgrnd. '' 55. Electrical Bonding 5.�Steel Reinforcement � , 56. Rough Plumbing & Pressure Test � 6. �Electrical UFER Grnd. : , 57. APPROVAL TO COVER-GUNITE ` 7. Footings � �� 58. Electrical Conduit-Undrgrnd. , 8. Fountlation ' . � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. .. 60. Backwash Lines, P-Trap, � Undrgrnd. . 10. Structural Floor System � ' 61. APPROVAL TO DECK 11. Property Sewer Line & Hvuse Connection 62. Backwash & Receptor-Final . 12. Sewer Cap . '. �' 63. Heater & Vent-Final 13. Roof Drains ' 64. Plumbing System - Final 14. Roujh Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final � 76. Rough Electric Wiring 67. Fencing & Access Approval �iT. 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. Fough Factory Fireplace APPROVALS �Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71 . Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 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. Insulation � 78. FIRE PREV. FINAL - 30. Drywall Nailing HEALTH DEPT. REQUIREMENT /� 31. Plaster 8rown Coat 79. FINAL INSPECTION + 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �, 33. Final Electric Notes: , 34. Final Hea[ing & Air Conditioning ��. �� n 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing �, 39. Water Service-Final i r1 � 40. Gas Service-Final +"�'1 41. Solar pomestic-Final �� 42, Backflow Preventer �-J � :7 43. Backflow Irrigation ,;�j 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. CERTIFICATEOFOCCUPANCY . . " No. Date vni�r.n 2(U JOB ADDRESS GENERAL COi !�l'.Mf✓ VAL SUBCONTftACTOR �- � . 25081 COSfA MESA BUILDINGSAFEfY DEPARTMEPR � P.O. 90X �� COSTA MESA� CALIFORNIA 92l20 For AppllcaM lo F►11 In ComplNe)y TrPe#'7�— �VILDINO � AU ADDftFYi COSTA MESA, CALIFORNIA C� 1 T ri � CONTfiA �H � l. � ILl +..C] . ADDfiEH S /�- � ) CITY 0.� ("11� AJ 8TA7! R .Z2�6 THL LIG. NO.»" N SIZE �Q/�x�1V1 NO OF LOT w+ KJ No� USE OR EXIBTINO BLDO. BHTBACK LIN6 PPON C8M8R OP BTRi I1RAR DIDB Y R PT RIOXT DESCRIPTION OP WORK ALTHRATION ADD REPAIR MOVINO DQM BUILDINO NO.OP 6IZE ROOMB ! EXTERfOR WAL4 ROOP �1 MeR6oY ACKNON'��DY� Tf1Ai.1 M�VI AH� eT�T6 TNwT T1� ASOVi.IB COqi PLY WITH �LL CIY�' OROINANC�i AryD GUILOINO COtl9TRYCTION. AUTMORIZ[C 166 TO COY- M[OYl/1TN0 cmt �F c rs MEsa Ar�I,TkSiJ 1kSit'PERA Only ZONIN(i �uw �] u�cor aou �• � c � -...-. / � ac� N0T8: NO !AV! OVERHANO GHALL E! Ll88 TXAN 90' TO HIDE 4 RPJ1H p EAVES ALLO W ED YARDf APPROVlD MAIN BUILDINO f FROM C/L�6'fR6i1 �RONT �j Z}T. . 'l VM• �j G YARDBAPPROVHD ACCH880NY BUILOINO DAT6 - ld-t a / � � ?.I� �G7eo. rr. iv 2'Q � TMt AMOUNT �XOWry t�NON VALUATION IB ROH TH8 � WAPobI OF iiTAGLIDXIHO A �iPY1T i6i ONLY. VALUATION �Q p� .ti,. �'�' � PHRMIT P86 �71J � � 2 7 94� y2�' � g �� TOT/tL PEE vnavr.n I•�7 LA1G O SS' CtC DESCRLPTION OF WORR � SUBCONTRACTOR '' � 7. CITY JF G;;� ;� t�LSA COSTA MESA BUIIDING-SAFETY DEPARTMENi � p (�[� ((S��'U P.O. BOX 1200 COSTA MESA, CALIFORNIA 92020 � �UN _l �JO[7