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HomeMy WebLinkAbout1581 MINORCA DR - Building Permits i 1 . t • • rt.,. CITY OF COSTA MESA BUILDING DIVISION F r„ .�I• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J PERMIT �•' P03-00799 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1581 MINORCA DR Status: ISSUED Suite No • Applied: 12/05/2003 • - Issued: 12/05/2003 Vicinity: Parcel Nunmber: 13929506 ISSUED BY: Applicant: JANET SCOTT, '' Address: . Phone: 714-953-6300 Zip: , ./ / / �`.. .��. Owner:" SCHOETTINGER, PAUL Address 1581 MINORCA DR Phone: COSTA MESA,CA Zip: 92626 w Y�\Y] Contractor: CULLIGAN WATER . _ j�% 79r 11 Address: ' 502 S LYON ST -. - � a Phone: 714-750-2233 . Op„')" . ' SANTA ANA,CA Zip: 92701 License: 663091 - . Arch / Eng: , - . .. - . . _ . . . , Address: • Phone: ' ' Zip: - _ -_ ' License: - r • SCOPE OF PERMIT ' WATER SOFTENER - _ ''`FEE'SUMMARY - AMT - N QTY " AMT QTY. _ - AMT QTY • ISSUE FEE.v' $23.50 • -' Laundry Tub/Washer $0.00 0'.r_ •''- Sump Pump , '$0.00 0 Backflow iMgation; $0.00 0 Landscape Irrigation ' $0.00 0 Swimming Pool , ./, $0.00 0 Backflow Preventer , .$0.00 0 P-Trap $0.00 0 Trap Primer , , $0.00 0 Bathtub $0.00 0 Pressure Regulator, $0.00 0 Urinal " $0.00 0 Clarifier System $0.00 , 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(ice,Soda,etc) ' $0.00 . 0 - Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units ,$0.00 0 Septic Tank $0.00 0 Wash Basin , / $0.00 0 Dishwasher '$0.00 0 'Sewer Cap for Demo $0.00 0 Wash Basin.Set $0.00 0 Drain, Floor $0.00 • 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 - Sink,bar $0.00 '-0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial - '$0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS fl (-1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. 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 permit is issued. My workers'compensation Insurance carrier and policy number are: A �l p Carier: .�L)12-( C. 4 $Q/n (oKtCA/Ll -a- S U�-�L Policy Number: LOCO-B9 70 7606 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agr e that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro 'cions. Applicant Signature: r �C/�-c��t Date: ( g o WARNING:FAILURE TO SECURE W ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S10Q000),IN( DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am livens d u der provijsip9s of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect Lic.# 0%/ Class# ('-S — Contractor's Signature: e C L • - ' c.A.14 s- i \VM1 I- Date: 2 d,'' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec.2 • Business and Professions Code for this reason: Signature: - / Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No y (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Rppplication aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Legal Qwger(s) - 7 i 1//S to And/Or Authorlfd Applicant _moi--' Date pODE 1 INSPECTION TYPE g>!IE INTITIALI CODES INSPECTION TYPE • RITm/LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 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 FC • "s - CITY OF COSTA MESA 0 a� •i BUILDING DIVISION ( DEVELOPMENT SERVICES DEPARTMENT �• PERMIT ERMIT NUMBER S°"°°°"" P98-00918 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 •• PLUMBING PERMIT Job Address: 1581 MINORCA DR Status: ISSUED Suite No Applied: 12/31/1998 Issued: 12/31/1998 Vicinity: Parcel Nunmber: 13929506 Applicant: GWIN, DAN Address: W/ADEE PLUMB&HEAT Phone: 213-290-8100 Zip: Owner SCHOETTINGER, PAUL & MELISSA Address _ COSTA MESA,CA Phone: 1581 MINORCA DR Zip: 92626 • Contractor: ADEE PLUMBING & HEATING Address: 05457 CRENSHAW BL Phone: 800-554-5858 LOS ANGELES CA -Zip: 90043 License: 240186 Arch/Eng: Address: Phone:. • Zip: License: SCOPE OF PERMIT GAS RE-PIPE FEE SUMMARY AMT QTY AMT -QTY - AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump - $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer ' $0.00' 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal - ' $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft)- $0.00 -0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Sodaetc) $0.00 0 Receptors - $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank , $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0:00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 • Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 - 0 OTHER $0.00 Gas Repipe $8.75 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $30.75 COMMENTS/SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 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 permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.R Class q Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale,If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2.Sec. 341,Title B,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes ❑No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE D AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with II ate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri property for in tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. re Of toga!Owner(s) %� — / And/ r Authorized Applicant Date CODE I INSPECTleNTypE DATE ILLS CODE! INSPECTIONTYPE DATE DIImal5 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 206 Final Plumbing 1yr/�/q9 I 200 Final Re-Roof 210 Final Electrical _ 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 2446-46 PROJEg ADDRESS: 1581 MINORCA DR . UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 0589 /9 OWNER'S NAME: THOMPSON, DANIEL R • ADDRESS: THOMPSON, PATRICIA A . PERMIT NO: B 058979 PLAN CHECK NO: N GOVT; N SUPP: N 1581 MINORCA DR • COSTA MESA, CA 92626 CONSTRUCTION TYPE: V-N PERMIT TYPE: SIR • PURPOSE: ALT 979-2264 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLES SQ FT; 2,000 ADDRESS: UNIT: CLAIM VALUE: 2, 000. 00 CALC-VALUE; 2,000. 00 GROUP OCC: R-3 / PERMITTEE: MOONLITE ROOFING CO ( 714 ) 848-9300 ck ADDRESS: 17573 SANTA CRISTOBAL COMMENTS; SMOKE DETECTOR RUIRED IN THE HOME FOUNTAIN VALLEY CA 92708 ************************** ************ *+FBF******x***********x* **********TF**** N 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 tuft force and effect.qi CITY LIC.: 0567F5% STATE uc.:6233�2 cuss: 039 S E T B A C K S C.ci-(Cr) -QrQ Signature: A/ V-110 C-7 --9 `� MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: thereby affirm man have acendicate of consent to selamsu oracertificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C). IN POLICY NO.: EXP.DATE: . COMPANY: PPARKING ARKIIGGREQ. PROV: PARCEL; 13929506 ZNE: REF NO: D Cenilied copy is hereby furnished. 0 Certified copy is filed with the city Building Division. > • :..> Date: Applicant: *******************X'*********************************************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DE VEL OPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become r subject to the Workers'Compensation Laws of California N.-} i es. 3 ZONING APPROVED BY . DATE: fir: . q- (omaer Signature ~11 i BUILDING APPROVED BY , - DATE: NOTICE:It,after making this declaration,you should become subject to the Workers' revokes Ion revisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ' t 2--- CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: - DATE- which this permit is issued(Section 3097,Civ.C). ************************* ***** ***** - - . ******************** * ** LENDER: ******************************************* ********************************** ADDRESS: LEGALIZATION:N F E E S U M MAR Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RESe/ GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 45. 00 i 5 0r, repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed l SMIP/NON. ;RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN / 14 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE /• � /,', 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 or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> • 45 . 50 0 , 00 0 . 00 45. 50 1 45 . 50 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through 1 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, 45 . 50 OVER/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 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/T,OT GRADING/PLAN-CHECK far me purpose of sale). 45. 00 '.:50 , I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business t7 • ❑ 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).l am aware ****************************************'***iF'X**'X***i('i('**-IE******'X'**'***'."'"********* that proof al their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E BREAKDOWNE ..-- N ❑ I am exempt under Section: B. &P.C. e• for this reason: TYPE QTY DESCRIPTIO N UNITCOST /TOTAL COST ra Date: Owner: SFR 2000 REROOF BY VALUE RESIDENTIAL NOZONE %' 1 , 00 /' 2, 000 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Satety Code Sections 25505.25533,and END OF FEES .. 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a I' i permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from /.. these provisions. / Date: Applicant' r • 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 property lolot inspection purposes. (( �k 1�T1 -1"\0 . a2- Signalurel " x( 4 ` . ,.,. ,JJ�" C 91, Driver's License or Social Security a: 012255 12 5 7- 7• - .3 001 7-CGi-.35S_' � u ,,, 1641.46 Whue-Buildmo:Green-Code Enforcement;Canarv-Aoolicant:Pink-Revenue:Goldenrod-Assessor OMTE: 09110/Q2 LW: 10:Cs, • I CONSTRUCTION AND'PLANNING ! POt. s SPA - t Date Inspector Date Inspectors .-VAPPROVALS r Permit# ., - APPROVALS Permit # 1. Temporary Electrical Service or Pole :. . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 7', . 53..Steel Reinforcement _ ' 3. Electrical Conduit Utility'Qndigrnd- 54. Forms • i 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding - ' + 5.-Steel Reinforcement 56. Rough Plumbing & Pressure Test ' - ' 6. Electrical UF ER Gtnd. • • 57. APPROVAL TO COVER-GUNITE . '. 7., Footings - 58. Electrical Conduit-Undrgrnd. - , •_ . ca Foundation 59. Gas Pipe, 0a 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 - 13. Roof Drains 1 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 i ' 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; - - - . i 70. Underground Hydro •• - • 22. Ducts, Ventilating " - -71. Product-Piping OGas peal 23. as Pipe>Rough & Test < I. i 72. Underground Flush - 24.•Roof Framing •- - - •73.2 Undergrnd.Storage Tank 0 Gas 0 Oil - 25. Roof Sheathing - . '74:_Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 75: Dry Chemical 27. Frame and Flashing ; , r 76. Dry Standpipe 28. Lathing-at Siding77. FIXED SYSTEM FINAL 29. Insulation "' • I . • 78- FIRE PREV. FINAL 30. Drywall Nailing _ - -c: . , HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown CoatHI , , 79. FINAL INSPECTION 32. Electrical Power Meter-Final l • 80. FOOD CERTIFICATE ISSUED 33. Firial Electric ' • '----1---;3.' - Notes: 34: Final Heating & Air Conditioning - 1.c_ _ _ 35. Final Gas Pipe-Test - I-•- I I , - •36. Hood or Canopy- - r 37.-Final Factory Fireplace - ' - • - I IV 38. Final Plumbing . - I i 39. Water Service-Final s ..40. Gas Service-Final - - I ' 41. Solar Domestic-Final _ I i I. 42. Backflow Preventer - , t I 7-ft-q�`- � / ; - /�_ 43. Backflow Irrigation ( / j �7"�0� 44. Landscape Irrigation System - - - 45. Sound Attenuation - I 46: Handicap Regulations - _ 47. FINAL STRUCTURE& BUILDING '�-ZL1 ki'lli ..- i c 4, zed � 48: FINAL PLANNING - L"'-'�!r �C..�� 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co I r--i. . - • 51. CERTIFICATE OF OCCUPANCY . I , No. Date • -DPLICATION. FOR A BUILDING PEr 'T I Tract 31/F7 Block Lot 3 BUILDING PERMIT NO. Electrical m Permit No. _ • Building - - Plumbing EL- '.... / S' r/ A/I/n�yCSL �— Permit No. eq Address /„ -"-os 7SD Cross Mechanical a Area Street i Permit No. O. m Owner 2 s 1--,57%,..",fi`,L TYPe of Project: ❑ New ❑ Alter ❑ Addition Address S G/ MIN �.ych 111 Repair CI Convert ❑Demo ❑ Occupancy Pmt. O/ A p Sup.Dist./ / �../ City �h..�^L Zip Phone Insp.Area . Architect/ !� Zone SPI.Pmt.No. Designer License No. • Setbacks P/L Front C/L St. Street Width Address Yards Left Right Rear City Zlp Phone Lave Proj. Left Hight Engineer License No. C Parking Spaces Required Provide Covered S. Address m City Zip Phone Struct No.of No.of Height Stories Family Y o LICENSED CONTRACTOR'S DECLARATION Park Fees _ Yes Fee m Required _ No C.T. Receipt m I hereby affirm that I am licensed under provisions of Chapter 9 L (commencing with Section 7000 of Division 3 of the Business and Zoning Approved BY: Date .. Professions Code,and my license is in full force and effect). Lice - Clas License Number / C /g _T � Dat:/ zYe Contractor :Ltd 1>/s. 14-5-fee IMisc. E Address / ' y.4) j(, • ,3,. A/,J / Proposed Use jL "'fk City and Zip S'- Mt't' (W ). Phone }�1006U of Structure en CONSTRUCTION LENYVING AGENCY 69 I hereby affirm that there is a construction lending agency for the El- performance of the work for which this permit is issued (Sec. 3097, Class TYPe Code Civ.CJ. Class Const. Year Th y Lender's Name USE/OCCUPANCY SIZE SQ. FT. E Lender's Address V `�/�/� OWNER-BUILDER DECLARATION • Im I hereby affirm that I am exempt from the Contractor's License Law 1. 1' for the following reason: 0 I. as owner of the property, or my employees with wages as their 2. C sole compensation, will do the work, and the structure is not .L. intended or offered for sale. 3 ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. it 0 I am exempt under Sec. , B&PC for this reason 4. ea a Date Owner • E WORKERS'COMPENSATION DECLARATION Total Valuation aI hereby affirm that I have a certificate of consent to self insure, Encroachment Permit Required ❑ Yes ❑ No or a certificate of Workers' Compensation Compensation Insurraan e, or a certified C copy thereg1r.J,.. ly./604 ail /v j 4// Grading Pmt. Grading a Policy Noa,iCompany f VVV""t"L Required ❑Yes ❑No Pmt. No. 0 Certified copy is hereby furnish d. a �9 Rough Grading 0. ❑ C if ie y is filed with Or Cou t E sw... m fir(} �qy ,1 EMM Approved by: Date Q Date L"/_ Applicant "//�✓ ✓ 3_ 7 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE Z (This section need not be completed if permit is for $100 or less). C I certify that in the performance of the work for which this permit is B issued, I shall not employ any person in any manner so as to become N subject to the Workers'Compensation Laws of California. PERMIT FEES Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $ Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply with such ElectricalSpecial provisions or this permit shall be deemed revoked. E nvest. $ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE Plumbing $ THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $ ORIZ EPRESENTATIVES OF THIS COUNTY T• ENTER UPON TH /j•:•rVE ME TIO ED PROPERTY FOR t•PECTI•N PUR- Pre-Grade FO/ L (4iii Inspection $ •.�/ / Z • Pre-Grade Permit , tFarure of Applicant or Agent r.ate Rec.No. $ Issue $ U 1 Plit Al wi )5 4'1 9zf All spaces within this box must be completed to process _Plan n I Issuance Check By: ( Approved: CMF 0335.46(BU-28) rev.6/80 1 COSTA ,MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED P.O.'BOX 317 COSTA MESA.CALIFORNIA/ //- j Tp FOR APPLICANT TO FILL IN COMPLETELY APPLY 791•rcTPERMIT TYPE OR PRINT MECOItSThj&$A BUILDING rf Drive WY ADDRESS . 1581 minorca Drive . COSTA MESA, CALIFORNIA " FOR OFF/CE USE ONLY RECEIPT NO. PERMIT NO. OWNER Diajlene; Inc. I 1 -1 i"Y n "1 MAIL RECEIVED BY DATE RECEIVEDQ""/�J (� DATE ISSUED ADDRESS 419 E. 17th Street LA //- ,S9!IiHV 6195,.; CITY - Costa mesa, Calif. Tryo:LI 81159 BUILDING ADDRESS ARCHITECT Carlson & LIC. COSTA MESA• CALIFORNIA OR ENGINEER NO. t3 lebruuk FIRE �/ ADDRESS Garden Grove ZONE TYPE ( GROUP O' Dike & Colegrove, Inc. STATE 167293 APPROVED CONTRACTOR LIC.NO. BY DATE ADDRESS 419 E. 17th Street, Costa Mesa ZONING LEGAL LO 31 }7 ZO ) { NO.OF USE OF NEW//�^�I// DESCRIPTION I NOT 39 BLOCK TRHCI T' I PLANS I BUILDING A.P.NO. APPROVED i V /' DATE LLLL/-3 '3 9 BY (1 / SIZE 1 No.OF BLDG YARDS OF LOT 701 x 100 Now oN LOT REQUIRED A LOWED USE OF None (CENTER LINE ST.) EXISTING BLDG. N FRONT $73 FT. IN. SETBACK LINE .OFN • CENTER OF STREET 531 REAR YARD 261 R.SIDE I FT. IN. SIDE YARD I LEFT 51 RIGHT 51 L.SIDE DESCRIPTION OF WORK • REAR 2.-6 FT. IN. NEW X . I ALTERATION II ADDITION I REPAIR I II MOVING I DEMOLISH • BUILDING NO.OF SIZE 1480 ROOMS. 6 STORIES 1 ' EXTERIOR WALL' ROOF COVERING stucco l COVERING rock e-A`""�' a USE OF BUILDING AND WORK TO BE PERFORMED /ry 3 Single family residence with /1 • attached garage ., Plan 730 A • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. VALDpTDN SIGNATURE OF �2PERMIT FEE $ 35.00 PERMITTEE $ 15,376 PLAN CHECK $ 17.50 AUTHORIZED AGENT Dike & legrove, Inc. . d TOTAL FEE $ 52.50 • COSTA MESA BLIILDII\ FETY DEPARTMENT APPLICATI 9y6STRUFaL PERMIT 29e00 TL : P.O.BOX 1200 COSTA L._..A,CALIFORNIA 92626 PS R E E V PERMIT" NO 50575 For Applicant toFillin Completely —Use Ink Only 1�I ADBUIDRESS LDING /.� ti I m,q MgtA A.P. NO. / �"Z g-a OWNER ORADESS /5U / Q TENANT L DRZ . .VOs T/.. e UNIT OR MAILING SPACE NO. ADDRESS SCIfix 'e 4n/i TR.Ne. LOT �7 BLK. TEL CITY p YEA NO. (fl 3/ a 0 CONSTRUCTION NEW ADD ALTER (REPAIR MOVING DEMOLISH LENDER 41 BRANCHOWN .°)1 a /-i�� �� ADDRESS - USE )r % / VALUE ��Dor ARCHITECT 7:-. TEL. i OR ENGINEER r Q X. NO. �'/w/ ADDRESS ZONE /CZ) TYPEk.3 GROUP / 1 APPROVED n CONTRACTOR V ii )51/4i ,jje(/etj.A BY DATE g`S ADDRESS` /4 7dt) .S N'Wti/Y td CITY ClvdC., NOI. S3/EG ea 5 CGt'v� Ce k. STATEIC. N / LIC. APPROVED SETBACKS LIC. NO. / > SZ C LIC.NO. tC� SIZE NO.OF BLDGS. (FRO Co'EET) s . Q. OF LOT NOW ON LOT FRONT o:4,411, et USE OF 2 !/ � EXISTING BLDG. — / R.SIDE_ �/�' 0 ,/. FSeparate permits are required for L.SIDE LI, /cFT/ 5/ o i electric,plumbing and heating work: �/ ,// �Q/pd ❑ REAR F F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION et ATE • < J�.•I� 1 1 u4'd Cnn dO r7 x a�. f APPR / - u�I Pig wt APPROVED //^y�..q�F9/tel `I X Y� APPROVEDG�^` _DATE 463-z `-V ea W 0 I hereby acknowledge that I have read this application and state O. that the above Information is correct and agree to comply with R. all laws regulating building construction, and I shall not employ .-i Z any parson in violation of the workman's compensation laws of w S the State of California. �/ /j��j��J I hereby certify that I am properly licensed as a contractor under _ the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR CO Chapter 9, and tha uc licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ;-0- am am exempt fro he p •visions of the Sta a of California Business VALUATIONPERMIT FEE $ / .� CO e and ProtessiOn O•- •/ ion p r OO rn Signature of / " t1/ PLAN CHECK $ s SO o Permittee _ """44WUU�wI��� $ ©DU TAX $ �51D u. or o yrs s V u Authorized Agent Date F =y —_tg TOTAL PAID $J9, tc ���lll