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Home My WebLink About817 JENNIFER LN - Building Permits(714) 754-5273 • Farz (714) 754-4856 • www.ci.costa-mese.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 817 JENNIFER LN Suite: � Viciniry: HOUSE AND GARAGE ROOF . Primary Occ: R3 Type of Construdion: V-N Parcel Number: 41812116 Zonin9: R3 App�icant: PETRONELLA, MICHAEL Address: 2626 NEWPORT BLVD COSTA MESA, CA Owner. PRICE, DAVID GORDON Address 604 1/2 LARKSFUR CQRONA DEL MAR, CA Contractor: PETRONELLA ROOFING Address: 2626 NEWPORT BL COSTA MESA, CA Zip: 92627 Arch : Address: Phone: Phone: 949-548-1645 Zip: 92627 Phone: 949-720-9668 Zip: 92625 Phone: 949-548-1645 License: 460707 Eng: Address: Status: ISSUED Applied: 07/732006 Issued: 07/132006 ISSUED BY: v Phone: Zip: License: � License: ' SCOPE OF PERMIT TEAR OFF (E) ROOF MATERIALS, INSTALL 1 LAYER OF 30# FELT AND REROOF W/CLASS A 30 YEAR COMP SHINGLES ON ATTACHED HOUSE AND GARAGE, APPROX 27 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. , FEE SUMMARY Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.52 SMIP Com: $D.00 Other: $0.00 Inspection: $0.00 Total: $125.77 PLANNING & ZONING SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING xistin : 0 Rear 0- 0 Rear 0- 0 Reauired: 0 Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: $s,zoo.00 Claim Valuation: g5,2oo.00 Righ� 0-0,� Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and �elated regulations. (Ord. No. 92-28, § 1, 12-21•g2) EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced wlthin 180 days, or il work is suspendeA or abandoned for a penod of 180 days. INSPECTIONS: In order for the work authorized under thie permit to ba considereC legal, such work must comply with all epplicable codes, and all requlred Inspectiona end }inal epproval must be obtained. Failure to abtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL; (714) 7545826 z+ao-w law� WORKERS'COMPENSATION DECLARAnON: � , I hereby aflirm under penelry ot perjury one of the tollowing tleclaretions: ❑ I hava an0 will maintein a certificate ot consent to self-Insure tor workers' compensation, as provided lor by section 3700 of the Labor Cotle, far t�e peAormance oi the work-1ar �h this permit is issuetl. ' � ��heve entl will maintain workers' compensation insurence, as required by section 3700 ot ihe Labor Code, for Ihe peRormance ot Ihe work tor which this pertnit is issuetl. �� My work ' compensation In urenc wrder end policy number are: -Certiei''%�f�-�- ��/�� PoliCy_Numb_er �g�(S%��p'6 _(Thksect/on neeC nof e comp/etetl i! the permif is valued ef one hondred dollars ($/00) or /ess.) � C____� ) ❑ I certity t�at in the pertortnanca of t�e work for which this pertnit is issueQ I shall not employ any person in any menner m es to �ecome subject ro tha workers' compensayon laws of Califomia, end agree t�ef If I should become sub�ect lo tha workers' compensation provisions o15ecllon 3700 of Ihe Lebor Code, I shell larthwith comply with these prov/is ns. 9� / /� �AppI�LSigneture: ✓ � / 1 ��J�./-� r'Dete � �l /�� C� WARNING: FAIWFE TO SECURE WORKERS' COMPENSAjI ! CpVEPAGE IS UNLAWFUL AND SMAl1 SUBJEGT AN EMPLOYEH TO CflIMINAL PE TIES D CML FlNES UP TOIXJE HUNpqED TFKKISPND DOLLARE (5100,000). IN ADDITION TO THE C(+1ST OF COMPENSATION, OAMAGES AS PROVIOED WR IN SECTIIXJ 3']Ofi OF THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLAflAT10N: I hereby ettirm that I am licensed under provisions oi Chapter 9(commencing with Saction 7000) oi Division 3 of ihe Business and Pmtessions Cotle, end my license is in tull CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirtn that there is a construdion lending agency tor the peAormanca ot the work tor which this permit is issuad. (Sec. 3097, Civ,l Cade). Lendefs Neme: Lendels Atltlress: SigneWre: OWNER-BUILDER DECLARATIONS: Da�e: I hereby aNirtn thef under penelry of perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business end Professions Code: Any cily or counry which requires e permit to constmct, alter, improve, demolish, or repair eny siructure, prior to its issuance, elso requires the epplicant lor such permil to flle e signed statement that he or she Is Iicensad pursuent to the provlslons ot ihe Contrectore License Law (Chapter 8(commencing with Sectlon 7000) ol Dlvislon 3 ot Ihe Business end Proteulons Cotla) or thet �e ar she Is ezempt theretrom and the basis lor the elleged exemptian. Any vlolation ol Section 7031.5 Dy any epplicant far e permit subjects t�e epPlicanl lo a civil penalty ot not more Ihan live hundred dollars (5500).): ❑ I, as owner of ihe properry, or my employees with weges as their sole campensailon, WILL 00 THE WORK, entl Ihe struc�ure is not intended or otteretl tor sflle (Sec. 7044, Busineu and Professions Code: The Conlractors License Law does not apply to an owner of properry who builds or improves iheraon, and who tloes such work himsell or hersetl or throug� his ar har own employees, providetl thet such improvemenis era not intended or aHeretl lor sale. II, however, Ihe builtling or Improvement is soltl within one year oi completion, Ihe awner�builder will have tha burden of proving that ha or she did not builtl or improve tor purpose of sale.). ❑ I, as owner ot the pmperty, am E%CLUSIVELY GONTAAGTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Busineu antl Pmfessions Cotle: The contractors Llcense Lew does not epply to en owner of pro0erry who 6ulltls or Improves thereon, and who coNrects lar such project wlih e contrecror(5) license pursuant to ihe Contractors License Lews.). ❑ I am ezempt under sac. Business and Professions Code for Ihis reason: Signature: Date: Owner ID verifietl hy tlrivers license. ❑ Yes ❑ No Driver's License No. Verification ol Ownership by (type ol daument, i.e. � property ta�c 6ill or Aeetl�: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ I hereby certify Ihat no exwvation tive (5) or more teet in depN into w�ich e person is required to descend, will be made in conneciion wiN work euthorized by ihis pertnit, end that no building strucWre, scaHoltling, talsework, or demolition or tlisman�ling �hereot, will be more than ihirry-si: (36) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 347, Ttle B, Califomia Admini5tralive Cotle). ❑ AS owner-builder, I will not employ enyone to do wOrk which w0uld require e Dermit from lhe Division of Industriel Sefety, es noted ahove, unless such pereon hes a permit to tlo such work from the division. Signature: Date: Division of Intlusirial Setery Permit Number: CERTIFlCATE OF COMPIJANCE AND Al7THORIZATION OF EMRY: I cenity untler penalry of perjury that I have read this application and state that the intormetion given is correct I egree to comply with ell state laws entl ciry ortlinances relating to builtling consiruction, end au�hodze representatives ol t�e City ot Costa Mesa to enter upon ihe ebove-descnbed properry tor inspection purpases. I egree not to occupy or ellow cecupency of any buildinq authonzed by this permit until final inspection. COOE �, INSPELTIONTYPE 1616 Fi:etl System Final Fire Preventlon 1266 Pool Spe Final 200 Finel Re-Rool 201 Final BIxWRetaining Wall 202 Final Factory Fire Placa 203 Final Sign 204 Finel Demolition - �"' ` ' , I Applicam- P� 1f�9L5 -z -e �- COUE 1 INSPECTION TYPE 206 Final Mechenical 20B Final Plumbing 210 Final Elec�rical 212 Final Fire Preventlon , 220 Final Planninp Approval 222 Final Site 250 Final Builtling/Occupancy PAII L�LS . :. C�ts r.�� ooxess: g17 JENNIFER LN rs x�Me.PRLCE nooeess:.c,AM� AS AHOVE RNCN/ENGINEEfl: �UONESS: flE0.N0.: UNIi: � UMR: PENMITTEE: EARLS PLUMbING ( 714 ) 772-3470 aoox¢ss: 1533 W. LINCOLN ANAHEIM CA 92801 uCENSEO CONiMC7oN oECUMTION: I hereGy affirm tnat I am licensea under pmvivans ai C�apter 9(commencinp with Section 7000) ol Division 3 0l tAe Businrss an0'Prafessions CaUe, an0 rtry licenu is in iWi forco aM eflect. ciTruc.:005938 �"TEuc.:217657 �u�:C-36 Oate: ' Sipnature: WOPKEHS' COMPENSRTION OECUMTION: I here0y aflirm ihat I have a ceNiicate oi consent to setf-insure o� a certitiwte of Workers' ComOensation Insurance, or a cenifiM wpy IAereol (Seciion 3800, LaG. C). roucr xo.: 0 4 8 4 0' �xr. oere: 10 / O 1/ 9 0 cornvnxr: B EAV ER Certifietl copy is �ereEy fumis�e0. � Certified coDY �s filed wtt� Ne ciry BuilOinA Division. Oate: FppbcanC E%EMPIION FNOM WONKEXS' COMPENSIt10N OECIAMTON: (IAis ucoon need not he mmplete0 il ihe permil b lor one hundreG (E100) or less�. '� I certiy ihat in ihe petlormance of Ne work tar wNch t�is permit is iuuetl. I stull wt employ any person in any manner so az to become ' suUject to t�e workers' CamDenutian Laws of Calitamia. Date: Signature: NOTICE: If, after maknq this UecWraGon, you should Oecome su6jm ro t�e Workers' ComOensatbn pmvisions of the labor COAe, you must IonAvnt� comply with such pmdsions or this De�mit shall 6e AeemeU revoketl. CONBTNOCTION LENOING 11GENCY: I Aere6y affirm ttul ihere is a rnnslnKtion lendinp aAenry for the pedormance of Ne work for whichthis permit is iuueE (Section 3097, CN. C�. LENOEN: RDOflESS: OWNEB BUIILEN OECIAMTION: I hereby atlirm tliat I am eKempt imm the Contractors' State License l.aw for the tollowinp reason (Section 7037.5 Business antl Prolesslonal Code: My ciry of counry w�ic� reQuires a permn to construct, atter,'impmve, Oemolish, or repair any simctura, Dnor ta its issuance, also reQuires I�e aDDliwnt lor such Dermit to file a signetl s�atement Iha� �e/s�e Is licensea pursuant Io the prodsions al t�e Cantracmrs' State �Icense Law (Ctupter 9(rnmmencinp with Section 7000) ot Division 3 oi Ne Business an0 Pmfeuions COAe) or ihat he/s�a b exempi IAerefrom anE the Dasis lor the altepeA exemptian. My violalion ol Section 7031.5 hy any aOPlicant far a.permit suElects �he apDliwnt to a civil penalry of not more than five AunareA Oollars (5500). I, as awner al Ihe pmperry ar my emyloyees wic� wapes u their sole compensation, will Uo Iha work, anG 1he ❑ simcture is not inten0e0 ar offere0 for sale (Section 7041, Bus�ness anE Pmlc�sional Catle: T�e Coniractors' State Licensa Law c si. aoes nol apON �o an ormer ol a pmpeM � �uilOs or Improves ��erton, an0 wAo tloes suc� woM �imsell/�erself or t�roug� his or Aer ovm employees, 0��4� �� suc� imprwements am not intentleA or offere0lar sate. 11, however the buildinp or im0�orement is w10 wit�in one year ol crompletion, t�e owner will have t�e Durden oi D�a�nB �ushe Oid not bui10 or improve for Ihe purpose al sale). I, as owner ot t�e pmDerty, am exclusively contractinp wit� Ikense0 coniractors ro wnsimct the Dmjec� (Section 704d, Buslness ❑ and Proleuims COGe' The Contactors' Siate Lke�e Law Aou mt appry to an wmer of prope wlio Wi105 or improves thereon � CITY OF COSTA MESA — BOILDING PERMIT FERM NO: P 044640 PERMIT NO: P, 049640 PLAN CHECK NO: N GOVT: N SUPP• N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: NEW JOB DESCRIPTION : WATER HEATEA • SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: / COMMENTS: ��r�rx*�r*****��r***�******�x��***�**�*+� x�+r�+t***+�+t�r�*�*��r�+�rt****+�*�r�**x�+fat***�r�rat�***� Z O N I N G� R E Q U I R E M E N T S ' S E T II A C K S ------------ MAIN BUILDING --------- --------- ACCESSORY BUILDING -------- FRNT: FT IN REAR: FT IN FRNT:. PT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN FARKING REqUIRED: PARKING PROVIDED: PARCEL: 14154218 ZONE: PLANNING NOTES> . . � _ . .. _ . . ._ . . . ._ . . . it iE iE ik iE iE iE ik iE it iF if it iF 3E iE iE if iE * iE fE iE iE �E �E jE iE fE iF iF �E iE iE 1E �E ff if 1E if iE if �k * iE iE jE iEiE b iE iE iF 9E 1E �E k iE i(� ik it iEiF �E �E iE if it if iE iE fE fE 3t iE 3E iE 1f iE D E V E L O P M E N T S E R �r I C E S;�• R E Q U I' R E M E N T S ZONZNG APPROVED BY DATE: • BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: r DATE: �—# iE3E�Ei(�1l3EiEifikifiklEitiEfEiEfElEiEiEiE3E . �ftif�fiEiFMiFiF�EiF it 1t if iE it i! iE if 1E 3E �k M iE iE iE iE 3E d! ik it iF 9t ik 1f iE if it ft iF iE !k it iE ik iF it 1E �E �E iE iE iE 1f iE iE iE iE iE ik if iE if iE iE �E IE iE 1E * iE iF if ik iF iE i! iE if �)t i! it iE �E iE K iE ik iF k* LEGALIZATZON:N F E E. S U M M A R Y STROCTURAL SEGMENT:N BLUG YMT PLUMBING ELECTRIC MECIiANIC FIRE SMIP/RES � GRADING PERMIT 2.00 zsi PLAN ISSUE FEE ` J.UO DOILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTALS----�> 2.00 ' 3,00 0.00 REVENUE DIVISION TOTALS--> COLLECTED:, BLDG PMT PLUMDING ELECTRIC MECHANIC � , 5.00 � SMIP/NON-RES TOTAL PAID DUE S.UO 5.00 .OU 5.00� OVER/SHORT: .00 FIRE SMIP/TOT GRADING PLAN-CHECK anOw�ocontraci5for5uchDrole��t�acontnctor(s)IicenSeDursuanitotheContractors'SlateLicenseLaw�.lamawara **{E�..��.*�.�.*.7�k.�.**�.�.*�.�.*.�{�-*{E�{-.7�*..��*.*.*.***�.*.*..7�*.*..�.y.*K..µ..�.�.*.x.K.y;*.*.**.k*..�{tK.*K.****�.*.*.**�.*.*.*..�.* mat praa� al iheir war�er's Campensauon insurznce snomo oe prm�aee ta me. � � I N D I V I D U A L F E E H R E A K D O W N � I am exampt unCer Sectlon: B. 8 P. C. �orinisreamn: TYPE QTY' D E S C R Z P T I O N UNIT COST TOTAL COST oare: PN10' PLU 1 WATER HEATER AND /OR VENT • 2. 00 2, 00 I do Aere6y ceriity that I am aware ol and un0erstanA the requiremenis of Calilomia Healih and Safery Coae Sections 2550.5, 25533, anA END O F F E E S - � � 25534 anU I�at I of any Iuiure Uuil0in0 a�Pani wiIIMvT noi (Girqe one) nEed Io fAmply vrit� SaiO Siate cOEes anOlhe reQuilem¢n�5 �of a . . . permit for cons�mctian or rtaEiliwtlon irom ihe N'r buallry ManaAement OisMct. Hevdential constmction apDlicatlons are exempt Imm . . Ihese pfouisions. � , , � ' Date: Applicant I hereGy urtiTy tAat I have reae IAis aOP�ication an0 state Ihat tAe aCwe inlormation is carrect. I aAree to compty with all ciry an0 counry or0inances anU siate lavrs reWtinp to buil0irry cwisWction anE heretr/ aNMriie reD��ntaUves of this dry ro emer upon t�e aEovartrentioned pmperry for inspection purposes. Date: � ' SipnaWre: Driver's ticensa or Social Secunry 0 � 1641-68 Whita-6uiltlinBl Grean—COCa Enlo¢ement; Canery—Ppplicam: Pink—Revenue: GOIGenroO—Assessor �'t t7V'D;Sba`-R^04s;oj �-t'3 ; C�iTt '1�!Zz�:;� . _i,F': . � '� �� CONSTRUCTION AND PLANNING' , POC SPA �' Date Inspector ' Date � Inspector APPROVALS Permit # APPROVAIS Permit # " 1. �Temporary Electrical Service or Pole ^ 52. Pool & Equipment Location �2.- Soil Pipe-Undrgrnd.., .. 53. Steel Reinforcement � ` 3.�Electrical Conduit UtilitY-Undrgmd. �- 54. Forms � �'4.�Electrical Conduii�Undrgmd. � 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. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgmd. - 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structurol 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 -. � 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical�Conduii 66. Solar SYstem-Final � 16. Rough Electric Wiring 67. Fencing & Access ApProval 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Elettrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19._Rough Heating & Air Conditioning _ . . �� .FIRE_DEPT. REQUIREMENT t _ 20:,Rough Pactory Fireplace _ � - � t 'APPROVA4&� . �Permit # � - � 21._"Dut(s, inStructure' ' - � ' "? �' _ 70. Underground' Hydro � 22. _Ducts, Ventilating ' " ": x c71 . Product Piping � Gas ❑�Oil 23."Gas.Pipe:Rough & Test J � -� �,. � �-,72, Underground Flush' ' �, . 24. Roof Framing � - - �••73.' Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing �, ' " � �- 7q, pverhead Hydro 26..T-Bar Ceiling (Structuraq &'Monocoat t�, >+ .� 75: Dry Chemical _ 27r�Frame and Flashing � . ` � i' 76. Dry Standpipe '- _28. Lathing�& Siding � ? � � �� 77,- FIXED SYSTEM FINAL� �- ' 29. Insulation ' r .. 78;. FIRE PREV. FINAL � .. 30. Drywall�Nailin9 -. .. . . _ , , ,HEALTH DEPl`. REQUIREMENT � 31. Plaster B�own Coat' � " i '. r 79. FINAL IIVSPECTION �. -32.-Electrical Power Meter-Final � '0 � . �� . SO:�POOD CERTIFICATE ISSUED` � ;;�33`Final Electric " �_� � � � ' Notes: � � _ � � 34_Fina� Heating�& Air Conditioning y. ,` � _ , - 35: Final Gas Pipe-Test� � � t -� �'� ^, - - " � � ' �36. -Hood or Canopy ' - -. �� " _ .- , ,_37.•Final Pactory Fireplace' - - ' - • • - a - � 38. Final Plumbing . i I_ 3 L,�' ` " � ��39. Water Service-Final �. �� • � � � i9 "40. Gas Service-Final . �- , - . • � - � ., �41. Solar pomesticFinal' - - � � � * - ' � � 42. Backflow Preventer - ` ' . " �. 43. Backflow Irrigation . - �� ' - '� _ :�.44. Landscape Irrigation Sysrem ' � � - • _ � • � • _ � 45.`Sound Attenuation �, • - "� '� " ' � � - . ' '46.� Handicap Regulations � . - ' _ � -�47. FINAL STRUCTURE & BUILDING � • � ' � -� 48r FINAL PLANNING � , ' :.•� ' � - - ' - . � 49. Electric Release to Edison • ' "�j � ; .,. � .. 50. Gas Re�ease to Southem Califomia Gas Cn � � r�" � /•v' '51. CERTIFICATE OF OCCUPANCY �:� - No Date AOP��ant to fill in all s0aces except those within �eavy borCer lines anC sign all approoriate tleclarations PERMIT N. TRACT NO. UNIT NO. CITY�F COS7A ES ONSTRUCTION PERMIT � n.v. # zone . Project Address � � � L� _ E Main Building: Accessory Building: Z TYPE OF C�NSTRUCTION NEW AOD ALTERATION REPAI R ApplicanYs Maili/Q/g Address _ ❑ CONVERSION ❑ DEMOLISH ❑ OTNER ' 7 F�ont � Owner's Name /—��CP Phon DESCRIPTION OF WORK/USE OF BLDG. B Rear N Address - � A I Arch/Eng. License No. T OF PERMIT GRADING�—� FOUNDATION STRUCTV RAL I K Right G Address -7/I NANT ❑ ELECTRICAL LJ PLVMBING ❑ MECHANICAL '. $� t R Contracmr's Name Phone %�,7�/%!) ❑ O R PI . Ref. # Parking Req./Provided E Address (ma'I' g1 �tL_�� PROJECT D RIPTION SQ. FT. OCCUaANCV M A //l)n/1�./l.� lanning Notes: CONSTRUC N TVPE VALUATION $ City Liten N � — ZONE GRADING CV. VDS. ACRES n T LICENSED CONTRACTOR DECLARATION S' I hereby affirm that I am licensetl untl¢r provisions o( Charter 9(commencing Rema�ks: `� � — � �� * with section ]000) ot Division 3 of the Bu5ine55 antl PrOfe55ion5 Cotl�ey antl my license is in tu fo antl etfecL . f1/n/_ i� ELECTRICAL FEES �( Y(/�._I Licens CI�s} � /L'J/// p5�e No. PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW Date �FjL 5'g t (,LGLfd�� WORKERS' COMPENSATION DECLARATION CO�StfUctiOn POIE SUb. � 50 + KW �eby atfirm [M1at I have a certiticate o� consent to self-insure or a certlticate Bar Sink ShOwe�s Jorkers' Compensation Insurance, or a cer 'etl copy Ihereof (Section Backfiow Preventer rvice Sink Cooking Unit Meter ❑up to 100 amps �0. Lab. G�yr�i/( '} _ � Policy No. �..�ra��i Company Backflow Irrigation Sew Cap Dishwasher Meter ❑over 100 amps �rtifietl mpy is her¢by fumishetl. � * . DIy¢f5 ❑Gas ❑EIECt�iC Sub PdnEl Certy' �' tl 5�opy/'cyJ etl with the cityP�w/�/�.1�rl mg ivisyon /% Bathtubs Sewer C nec n oate�/ d'j' Applicant ,C�—P� /��-(.�� Fan Motors �0-i HP � 1%- 8 EXEMPTION FROM WORKERS' COMPENSATION pECLARATION Clarifiers Solar Coll 5 (Thissection neetl not be completetl if tbe permit is for one huntlred ($100) or F.A.U. less�. Dishwasher Solar P' ing Inc.Solar 09-75 HP 01fi-15+ I certify that in the pertormance of the work for which this permi� is issuetl, I Fixtures sna11 not employ any person in any manner so as to become subject to the Drinking Fountains Sol Tank Microwave Workers' Compensation Laws ot Calitornia. oace 5iqnature � Floor Orains imming Pool w/Spa Device Boxes Pole Light NOTICE: If, a�ter making this tleclaration, you shoultl become subject to the Outlets Workers' Compensation provisions of the I.abor Cotle, you must forthwith Floo� Sinks � Urinal Range comply with such p�ovisions o� thi5 pe�mit zhall be deemetl revoketl. CONSTRUCTION LENDING AGENCV G25$¢fviC¢ �UtIEtS Wdt2�C105¢t $witch25 Siyn I hereby affl�m that the�e is a const�uction lentlin9 agency to� the performdnC¢ of the work for which this permit is issuetl (Section 3097 Civ. C.) IntCrceptOfS � Wate� HeatCf Garbage DiipoSal Standing SeCtions Lentler's Name �enaers Aatlress Kiahen Sink Water Service Generetor �0-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION 1 hereby affirm Lhat I am exempt from the Contractor'S License Law for the l.avatOries Auto-WaSh followin9 reason (Section �031,5 Business antl Professional Cotle: Any city or munty whicb �equire5 a pe�mit to wns[ruCt, alte�, improve, tlemolish or r¢pai� P—T�dp Laundry Tra'ys any strucSure, prior [o its issuance, also requires the applicant for such permi[ to file a signetl statement that he/she is licensetl pursuant to the provisions ot ROOf Orains tnP Contractor's License Law (Chapter 9(commancing with Se<tion 7000) ot �on 3 of the Business antl Professions Catle) or that ne/she is exempt Reinspection Fee $15 Issue Fee 'rom antl the basis for the allegetl exemption. Any violdtion of Section $ 3 . 5 by any applican[ for a permit subjects the applicant to a civil �nalty ot not more than tive huntlretl doiiars (5500). DE LOPMENT SERVICES REQUIREMENTS: LJ I, as owner oi the property or my emoloyees witn wages as their sole � Reinspe on Fee $15 Issue Fee $ 3 2onin pproved By Date mmpensation, will tlo roe work, antl the structure is not intentletl or offeretl for sale (Section �044. Business antl Protessional Cotle: The Contractor's MECHANICAL FEES Buildin8 proved By Date license Law tloes not apply to an owne� of a property who builtls Or improves thereOn, antl who tloes such wOrk himself/hers¢If o� th�ough his or he� own Application Ued By Date emp�oyees, p.ovitlea tnat sucn improvements are not intentletl or offeretl for Boil Hood or Type I ❑ zale. Ii, however, the builtlin9 or imorovement is soltl within one year ot com- Canopy Type II ❑ SUMMARV OF FEES pletioq lhe owner will have the burtlen of provin9 he/she tlitl not builtl or im- D t- Unde� Ground nrove tor tne purpose ot sale). BUILDING RMIT $ SMIP $ ❑ I, az owner ot the property, am ezclusively contractin9 with IlcenseG com ct-Structuial Refrigeratfon System PLAN CHECK tractorsto construct tne project (Section 7044, Business antl Professions Cotle: $ PERMIT The Contractor's License law does mt appry to an owner ot property who uct - Ventilating ❑0.100,000 BTU ❑100,000 BTU ISSUANCE $ builtls or improves thereon. antl who contracts for surn oroiects with a r.on- � PLUMBING $ Vactor(s) lmense pursuane to ene ConVactor's License Law). i am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteretion PLAN CHECK 25 $ ENERGV P.C. $ prao( of their Worke�'s Compensation insuranc¢ 5hou10 be provitletl to me, ELECTRICAL i�iRADINCi $ ❑ I am exempt untler Section B. & P. G. for this reason Firepl/Fact. Blt. ICBO # Fire Dampers pLAN CHECK 50°6 $ MICROFI LM $ Date Owner HeatingSystem&Ducting Regizters MECHANICAL $ TOTALFEE $� �%�. I hereby certify mat I have reaa this application antl state that the above ❑0-100,OOOBTU �100,OOOBT ' PLAN CHECK 25% information is correct. I a9ree to comply with all city antl county ortlinances $ antl state laws �elatin9 to builtling mnst�uttion, antl hereby autM1orize repre- sentatives ot his.city t8 en � upon the abOve-men[ionetl property for inspection pu b . /) q I (�ff ' , Signature . OateZ�C/ 0� � ' Drivers' License or 55 � ' — Reinspec[ion Fee $15 laue Fee $ 3 ' 0865-46, rev. 5/B8 White - Builtling; Canary - Applicant; Pink - qcmuniin9; Goltlenrotl - Assessor CONSTRUCTION AND PLANNING � POO' ? SPA irAPPROVALS Permit� Date Inspector qppROVALS �_.�nit# Date Inspector i 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. Foundation � . , _ 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe-Undrgrnd,. ' - 60. Backwash Lines, P-Trap. O Undrgmd. 10.� Structural Floor System � 61. APPROVAL TO DECK 1�7. Property Sewer Line & House Connection �. 62. Backwash & Receptor-Final 12. Sewer Cap � 63. Heater & Vent-Final � 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 6S. APPROVED FOR PLASTERING 18.�Rough Electrical=T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Aii,Conditioning FIRE DEPT. REQUIREMENT 2Q. Rough Factory Fireplace � APPROVALS % Permit # 21. Ducts, in Structure �, 70. Underground Hydro 22. Ducts, Ventilating ' ` 71. Product Piping 0 Gas ❑ Oil � 23. Gas Pipe-Rough & Test .� �72. Underground Flush 24. Roof Framing � �� 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathin . � , 9 / 74. Overhead Hydro c26:�T-Bar Ceiling (Structural) & Monocoat M1 �' 75. Dry Chemical E 27: Frame and Flashing f a 76. Dry Standpipe f � 2$. Lathing & Siding �' , 77. FIXED SYSTEM FINAL 29: Insulation � �`• 78. FIRE PREV. FINAL 30. Drywall Nailing f'� 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 Factory Fireplace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final � � r� 41. Solar pomestic-Final '. 42. Backflow Preventer ' 43. Backflow Irrigation �,�� 44. .Landscape Irrigation System 45. Sound Attenuation '�` 46. Handicap Regulations f � 47. FINALSTRUCTUREBI�BUILDING 48. Special Requirements COmpleted 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date F � k] a Q � � � F C c*] F Q O .J a > r � a m 4 O � C. z W S 3 4� , � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CICLIPOR.'.',IA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ___ _ _ _ _ . � . � _ �. ,� OWNER MAIL ADDRE: CITV BRANCH R1Chard Sewell ADDRESS CONTRACTOR ADDRESS CITV STATE LIC. NO. 512E OF LOT TEL NO. eh oio`'642-490 St.. Costa Mesa TEL. NO. CITV LIC. NO. NO.OF BLDGS. NOW ON LOT Separate permits are required for elecVic, plumbing and heating work. USE OF BVILP�NG AND WORK TO BE PERFORMED 'FR -2-77¢�;�00 i ss-� *- * 15(.50 APPLICATION FOR STRUCTURAL PERMIT RECENED BY DATE RECEIVED neTc �cci ior FIR ?JQj7Jl9 ED 1 VALUE � ��PIP�ONS D I BUIVARD�APROVED DISTANCE 8ET avPRoveo iOL� FOf'. BEf. MAIN & I hereby eckn0�+ledee ihat I have �eatl th(s eppltcaiion end itete �+ that tha abova ��formation Is correct antl aprea to comply wlth � m all laws reBuleS��B Oulltlin8 conrtruction, antl I shall not employ i any person in ��olaiion of the workmen's eompensation lows of m the State of California. �j� - I hereby cert(fy that I om properly Ilconsetl as a conttactor untlar . FT. ��a(J N the Stata ot Celifornie B�sinass end Professione Cotle, Dlviaion 3, THE A OUNT SHOWN UNDER VALUATION IS FOR m Cheptar 9, and that such Ilcensas are In full farce antl effact, or I THE PUFPpSE OF ESTABLISHING �+ PERMIT FEE ONLY; � am axampt froR� the p�ovisions ot tha Stata o� Celifornia Businass VAlVAT10N d antl Profe55ions Coda, Dlvislon 3, Chepter 9. PERMIT FEE $ N S • ro PLAN CHECK $ ^� Signeturo of / � Permlttae ��aa� TAX E � a � U f A�thori AgB�t TOTALPAID E � F C. W a Q h y x F O � F Q O � 7 } � fY. W a O a 0. Z k7 'y. 3 �3 �3.3 COSTA MESA BUILDING-SAFETY.DEPARTMEN P.O. BOX 1200 COSTq MESA, CALiFORMA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ___ _ _ _ . _ . _ _. OWNER ��('] ADDRESS 136 Roc: CITV BRANCH ADDRESS ARCHITECT CONTRACTOR ADDRESS CITY STATE LIC. NO. z SIZE OF LOT USE OF S�S'22t TEL. �ii% NO. TEL. TEL. NO. CITY LIC. NO. INO.OF LB�OGS. NOW ON LOT Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WbRK TO BE PERFORMED W1 1 hereby acknowladBe thet � heve read this application and stete Net the ebova Information is eorrect antl aprea to comply with all laws reBuleting bulltllnB tonatruction, antl I shall not emplay any parson in violation of t}ie workmen's compensatlon laws of Me Stete of California. I hereby cerUty ffiat I em praperly licansetl es a contrector untler the Stata of Calitornia 6usiness antl Profewiona Cotle, Division 3, Cheptar 9, antl thet such licenses are in full force antl etfect, ar I em exempt from the provisi0ns of the State of Californle Businass entl Professlons Cotle, Dlvlzion 3, Chapter 9. Sle�eture of // /JJ / // I � Permittea �� v� C/( Au[horizetl AB vai� �+r�-9-��L,;;�OD so9 �i:*::233.uG APPLICATION FOR STRUCTURAL PERMIT FECEIVED BY DATE RECEIVED ❑prF iRcuFr BUIIDING ADDRESS TRACT VAIUE ZONE INO.OF I USE OF NEW PLANS BUILDING VARDSAPPROVED VARDSAPPROVED MAIN BUILDING ACCESSORV BUILDI VAR.�W I DATE C.U.P.qW PFPROVED APPROVED S�uv � m '� i u SQ. FT. t�v THE AMOUNTSHOWN UNDER VA�UATION IS FOR m THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLY: � VALVATION PERMIT FEE E a m PLAN CHECK $ ^� 0 $� TAX S LL f U TOTALPAID