HomeMy WebLinkAbout3226 MINNESOTA AVE - Building PermitsCITY OF COSTA MESA
�o�""'FSQ BUILD/NG DIVISION
.
F� .. ,. �, 77 FAIR DRIVE, COSTA MESA, CA 92626 •(71a) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us
� ` � FOR INSPECTIONS CALL: (714) 754•5626
�"°^�"° ' PERMIT NUMBER: P11-00103
PERMIT TYPE pLUM
APN: 13908207
JOB ADDRESS: 3226 MINNESOTA AV CM
Viciniry:
SCOPE OF WORK: REPLACE 40 GALLON WATER HEATER.
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:
OWNER: BENNETT, LOIS M TR Address:
PHONE: CitylState/Zip:
APPLICANT: ATANASOV, STOIL Address:
PHONE: 866�92•5273 City/State/zZip:
CONTRACTOR: CALIFORNIA DELTA MECHANICAL INC
Address: 1235 GRAND AVENUE
City/State: SPRING VALLEY, CA ZipCode: 91977
'ARCHITECT: License No.
ENGINEER: License No.
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ISSUED
0 6/1 512 0 1 1
KJB
3226 MINNESOTA AVE
COSTA MESA, CA
License No. 811114
PHONE: B00-898-0008
CELL: 866-692-5273
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35.80
$35.80
PHONE:
PHONE:
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, § i, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTfONS: fn order (or the work aulhonzed under this permit to he considered legal, such work must comply with all applicable codes, and all
required inspections and £nal approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
COOE i. INSPECPONTYPE ORiE INTRIpLS C00 J INSPECTIONiYPE DRTE IN7I71RLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical `��
1266 Pool Spa Final 20B Final Plumbing �L�� ��
200 Pinal Re-Roof 210 Final Electncal
201 Final Block/Retaining Wall 272 Final Fire Prevention
202 Final Factory fire Plac¢ 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/OccuOancy
WORKERS' COMPENSATION DECLARATION:
I hereby atfrm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificale of conSeN to Self-InSure for vrorkers'
compensation, as provitled for by section 3700 of the Labor Code, lor the
pertormance o( Ihe work for which this permit is issued.
❑ I have antl will maintain workers' compensation insurance, as required by
section 3700 0l lhe Labor Code, (a the peAortnance o/ the vrork for which this
permit is issued. My workers' compensation Insurance carrier antl policy
number are:
Cartier. �a-Fe, Fu h
lrrvs sec+on neea ror ee m/�mp-47rro e v�ie7 penw u vaWed ar are nwq.ed row,s (siao7 a�ess l
Policy Number: � in —I / �.C.3
❑ I certify that in the peAormance of the work (or 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 �hat i( 1 should
become subject to the workers' compensation provisions ol Sec�ion 3700 0!
the Labor C e, I shall,forthvnth comply with ihese provi ions.
AM � 5 � �
Applitanl's 9gnature Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HOUSAND DOLL4RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND
ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions o( Chap�er 9(commencing
wilh Seclion 7000) of Division 3 0( the Business and Professions Code, and
my license is in full forcfe, antl eNect.
Lic. # � � �`I Class # 3
�S ��
mlracta's Signalure Date
CONSTRUC710N LENDING AGENCY:
❑ I hereby affirm that there is a construcibn lending agency !or Ihe
peRortnance of the v.ork for wfiich this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lentler's Atldress:
S�gnawre Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalry of perjury that 1 am EXEMP7 FROM 7HE
CONTRACTORS LICENSE LAW /or ihe following reason (Sec. 7031.5,
Business and Pro(essions Code: Any city or tounry which requires a permit ro
wnsWct, alter, improve, tlemolish, or repair any struc�ure, prior to its
issuance, also requires the applicant lor such permit to fle a signed slatement
Ihat he or She i5 liCenSed pUrsUant lo Ihe pmvision5 of Ihe ContraUors
License Law (Chapter 9(commencing vnth Settion 7000) of Division 3 0l the
Business and Professions Code) or tha� ne or she is exempt therefrom antl
the basis lor the alleged exemption. Any violalion of Section 7031.5 by any
applicant tor a permit subjects Ihe applicant ro a civil penalty ol not more Ihan
five hundretl dollars (5500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intentletl or
offered for sale (Sec. 7044, Business and Professions Cotle: 7he Contractors
License Law does not apply to an ovmer of property who builds or improves
Ihereon, antl who does such work himself or hersel( or lhrough his or her own
employees, provided that such improvemems are not inrenaetl or oNered for
sale. If, however, the building or impmvement is sold within one year of
completion, the owner-builder will have I�e burden of proving that he or she
tlitl not build or improve for purpose of sale.).
❑ I, as owner of lhe property, am EXCLUSIVELV CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044. Business and
Pm(essbns Code� The contractas License Law dces not apply to an owner o(
property who builds or improves thereon, and who cont2cts (w such project with
a contractor�s) license pursuant to Ihe Conl2ctors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Ovmer ID verifed by drive� _ ecense. ❑ Ves ❑ No
Driver's License No. Expires:
Veriflcation of Ownership by pype of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more feet in depth into wfiich a
person is requiretl to descend, will be matle in connec�ion with work authorizetl
by this permit, and that no building swcWre, scafldding, lalsework, a demolition
or dismanlling thereof, will he more ihan thitly-six (36) feet high. (Chap. 3.2. Grp
2. An 2. Sec. 341, Title 8. CalifomialWministrative Code).
❑ As ovmer-builder, 1 will not employ anyone lo tlo work which would
require a permil from �he Division of Industrial Salery, as noted above, unless
such person has a permit to do such work from Ihe tlivision.
Applicanl's SignaWre
Division of Intlustrial Safety Permil Num6e[ _
HAZARDOUS MATERIALS AND EMISSIONS CER7IFICATION:
7. Will �he applican� or present or fuNre building occupant need to file and
certi/y a Business Plan for emergency response to release or threatened
release ol a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Calilomia Heallh and Safery Code requires, with some
exceptions, that a Business Plan be Netl vrilh the Costa Mesa Fire
Depahment by every business which has at any one time dunng a reportetl
year a quantity ol hazardous materials equal Io or greater Ihan a weight ol
500 pountls, or a volume of 55 gallons. or 200 cubic (eet ol compressed gas
at stantlartl temperature antl pressure�.
2. Does or will the applicant or present or fulure building occu0ant need to file
a registralion form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 0! the Cali(ornia Health antl Safely Code. with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business whith at any one time has on hand a quantity of acutely
hazardous malerials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standartl
IemperaWre and pressure).
3. Does or will Ihe applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management ana Prevention Program for acutely
hazardous materials)? � Yes ❑ No
(Section 25534 of the Cali(omia Health antl Salery Code provides Ihai Ihe
Cos�a Mesa Fire Department may require Ihe preparation, certification and
filing with ihe Fire Departmenl ot an RMPP by businesses which are requiretl
to register acutely hazartlous materials with �he Fire Department.
4. 11 an RMPP is presently required, has Section 25534 0( Ihe Cali(omia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or IuWre builtling occupant require for
the vrork which is �he subject of this application a permit for such conSlNcliOn
or modifcali0n Irom Ihe South Coast Air Ouality Management DisVict or from
any other air pollution contml tlisMct or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Calitomia Governmenl Code requires that the requested
infortna�bn be fumished on applicalions lor rqn-residential buiWing pertniis).
6. Will any part of Ihe (acili�y lo be conslructed under this permit be within
t0001ee1 from the outer boundaries of a school7 ❑ Yes ❑ No
Q! yes", Ihe lacili�y must meet the requirement of Sections 25534 anC 42303
of the Calilomia Health and Safety Cotle).
7. If a permit Irom the South Coast Air Ouality Management Dislnct or olher
air pollution control district or agency is required for the work which is Ihe
subject ol ihis application, have all of Ihe disclosures prescnbetl �y Califomia
Health and Salety Cotle Section 4230a been matle? ❑ Yes ❑ No
B. pf "yes', atlach certificate o/ compliance trom the appropriate air pollution
coNrol o(ficer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury t�e
information given above is wrrect. I agree to wmply wit� all state laws antl
city ordinances regartling Hazardous Malenals antl Emissions.
Signalure
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty ot perjury that I have read this application and state Ihat
the informalion given is correcL I agree to comply with all state laws antl city
ordinances relating ro building construction,.and authorize represenWtives of
the Ciry of Costa Mesa to enter upon the above�escnbed property for
inspection purposes. I agree not [o occupy or allow occupancy o( any Duiltling
authonzed by this permit unlil final inspection.
&. ue of Le W.+ner�s� Da =_
Signawre Date /S /�
�057-a6 �10]�
And/orAolM1onze�AppliWn� • �ale
i
3
(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIF ORIVE, COSTA MESA, CA 92626
BUILDING PERMIT
SQURES
JobAddress: 3226 MINNESOTAAV
Suite:
Vicinity: RESIDENCE & ATfACHED GAR4GE
Parcel Number: 13908207
npplicant: KAISER, MIKE
Address: 928 CHEYENNE ST
COSTA MESA, CA
owner BENNETT, tOIS M TR
Address 3226 MINNESOTA AVE
COSTA MESA, CA
Contractor: KAISER ROOFING
Address: 928 CHEYENNE ST
COSTA MESA, CA
Zip: 92626
Arch :
Address:
Zoning:
Phone: (714) 979-5314
2ip: 92626
Phone:
2ip: 92626
Phone: p14) 979-5314
License: 682897
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 09/04/2007
Issued: 09/04/2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF: T/O, APPLY OSB SHTG, 1 LAYER 3Qq FELT, APPLY 25-YEAR "ELK PRESTIQUE II" COMP SHINGLES. 25
Plan Check: $0.00
Permit: $12525
SMIP Res: $0.54
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.79
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0. 0
Rear Q 0
Reouired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0• 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0. 0
Right 0- 0
55,400.00
85,400.00
NO710E: The work aulhorized by ihis permit shall comply with all applicabla 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 it work is suspended or abandoned
foi a penod of 180 days.
INSPECTIONS: In order for Ihe work authorized under this permit to be consitlered legal, such work musl comply with all applicable codas, and all
requlred Inapectlons and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
xaaaae (rwo)
WORKERS'COMPENSAnON DECLARAnON:
I hereby ettirtn under penelry ol perjury one ot the following tleUaratlons:
❑ I heve end will m�intein e certilicete of consent to self-Insure lor workers' compensatlon, es provided for 6y sectlon 3700 0l the Lebor Code, tor the pertortnence ol the
/�'ark lor whlch Ihu.pBrmit Is IssuBa.
[j I �ave entl wlll malntain workers' compensatlon inwrence, as requiretl Oy seclbn 3700 0l NB Lebor Coda, far the peAartnance ot Ne xrork far whkh fhl5 pertnil is issuetl.
My workerec' cam n�tion Insurance carder enC pollcy num6er ere: ^ G�' O�O /���
Cartler. J#-/�-�� � r�l Poliry NumDer: � o
(71rts sectlon need not be completetl il Ne rmit Is va/uetl ef one hundred tld/ers (3100) or less.)
❑ I certlty thet in the peAormance oi the work lor which this pertnit is issuetl, I shell not employ any person in eny manner so es to Decomo subject to t�e workers'
compensetlon laws Of Celllomle, and egree Ihel il I shoultl become sub�ett to Ihe workers' crompensatlon provlslons of Sectlon 3700 of lhe Lebor Cotle, I bhall torthwlth
cnmpy wlth these provisions. /�� Q
Appllcant Slgna�ure: �/�� Dete: `� Cl _ ��
WARNINp: FAILURE TO SECIIRE WOiiKERS' COMPENSATION COVERAGE IS UNUWNL AND SHALL SUBIECT AN EMPIOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLRRE (5100,000), IN ADDRION TO THE COST OF fAMPENSATION, DAAINGES AS PROVIUED FOR IN SECTION 3]OB OF THE UBOR CODE, IMEREST, ANO ATTORNEY'S FEES.
LICENSED COHTAACTORS DECLARATION:
I hereby eXirtn that I am licensed under provLsions of Chapter 9(cammencing wlth Sectlon 7000) of �ivision 3 ot the Business end Prafesslons Code, entl my license is in full
folte entl eHBti. Lic. M Class M
ConlradaYs Slgnatura: Date: ' �i— ��
CONSTRUCTON LENDING AGENCY:
❑ I hereby ettirtn that t�ere is e construction lending apenty lor the peAortnence of the work tor w�ich t�is pertnit Is issued. (Sec. 3097, Civil CaAe).
Lentlefs Neme: Lentlefs Atltlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eflirm thot untler penely oi per�ury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor Ihe lollowinp reeson (Sec. 7031.5, Business antl Professlons
Cotle: Any Gry or counry which requires e permit to construct, elter, improve, tlemolls�, ar repeir any structure, pdor to ils Issuence, elso requires the epplicam for such permit
to Ille e signed stetement thet he or she ISlicensed pursuent to lhe provlslons ol the Cantrecrors lJcense Law (Chepter 9(commendng wlth Sectlan 7000) of Division 3 of t�e
eusineu end Professlons Cade) or thet he or she Is exempt therefmm entl t�e besls for t�e elleged e:emptlon. Any vloletlan of Sectlon 7031.5 6y any epplicant tor e Dem+1
sub�ects Ihe epplicant to e civil penalry oi not more than tive �unAretl Aollers (5500).):
❑ I, es owner ol the pro0erty, or my employees wi�h weges es �heir sola compensation, WILL DO 7ME WORK, and the strucWre Is not Intendetl or otteretl for sele (Sec.
70a4, Busineu entl Professions Cotle: The Contractors License Lew tlaes not appty to an ownar of property who bullds or improves Nereon, end wha does such work
himseli or hersell or through �Is or her own employees, provltled that suc� improvemenis are not Intended or otteretl for sale. II, however, the building or improvement Is
sold within one year ot completion, the ownao-builder will have Ihe �urtlen of proving t�at he or she did not build ar improve lor purpose of sale.).
❑ I, as owner ol the pmperty, am EXC WSIVELV CONTRACTNG WITH LICENSEO CONTRACTORS to construct (he pwject (Sec. 7044, Business and Pmfessions
Code: The contrectors Llcense Lew tloes not epply ta an awner ol pmpeny w�o builAs or Improves thereon, antl wno wmrects tor such projeci wlth e wniractar(s)
Ilcense pursuant to the Coniraaors License Lews.).
❑ I em exampi under Sec.
Signature:
Owner ID verlfied by drivers license. ❑ Ves ❑ No
Busineu end Prolession5 Code for this reason:
Vedlicatlon at Ownership by (rype ol daument, i.a. - property tax DIII or Ceetl):
Drivef9lJcen50 No.
Date:
Expires:
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
❑ I �ereby certity Ihet no axcavetion live (5) or more feel in depih into which e person Is required to descend, will be mede in connectlon wii� work euthodzetl by ihis
permlt, end thet no building siructure, sceNolding, falsework, or demoli0on or dismanUing Ihereol, will 6e mare then thirty-six (38) leet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Tlile 8, Celifomla Atlministrative Cotle).
❑ As ownerDulltler, I wlll not employ anyone to do work which would requlre e permit from Ihe Division of Industdel Safery, es noted ebove, unless such persan hes a
permit to do such work trom the division.
SignaWre: Date:
Divisian of Indusirlal Salery Permit Number:
CERTIFlCATE OF COMPLIANCE ANO AUTHORIZATION OF EMRY: I certify unCer penalry of perjury �ha� I have reatl ihis eD011catlon end state that the inlortnation given Is
correct I egree Io wmply wlth ell stete laws entl clty ortlinances relatlng to builtling cronstruction, end euthotlze representatives of Ihe Ciry ol Costa Mesa to enter upon the
ebove-dnscnbetl property for Inspection purposes. I egree not to occupy or ellow ocCupancy ol eny building euthorized by this permit until linel inspection.
� 'gneNre Ot Legel Owner(s) ^_` �.1at� /
Y /
AnNOr Aulhonzed Appilcent Date
�ODE I. INSPEC710NTYPE
7676 Fixed System Final Fire Prevention
1266 Pool Spa Final
200
201
202
203
204
Final Ra-Rool
Final BIocWRetaining Wall
Finel Fectory Fire Place
Final Sign
Finel Demolition
PAIE ItIIIDELS
GOUE 1 INSPECTION TYGE
206 Finel Mechanical
208 Final Plumbing
210 Final ElecMcal
272 Finel Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final BuiltlingiOccupancy
Q6�. 1tlImALS
\
\
�
AGClicant to flll In all spaees aacapt thosa wit�in �eavY �orEer Iines anE sign all appropriate tleelarations. _.
CITY OF COSTA MESA�
CONSTRUCTION PERMIT
Project Address � � %
Applicant'sMailingAddreu: ��ZG MiNNeso;A
Owner'sName 1s- 'BE/'//I�Fl6 Phone�`+4�'�9�
Address -�yZ6 /�'i//✓/1/ES�%�iQ (e aS'y.V /3'%E's'rQ
Arch/Eng. Licanse No.
Addrass ''.,�o�O
Contrector's Nam A� A E Phone l.,c��9
AddresslmailinglLY�%� �E.S�%�/LAG 'fllQK /.�l�A.de'l/I/�
City License No, nnF�� 6�
LICENSED CONTRACTOR DECLARATION
1 M1ereEy afflrm thdt I am IICanSetl untlar proW51on5 ot Chdr[er 9(commencing
with section 7000) of Divlslon 3 ot tha Businesz antl Profezslons Cotle, antl
my Iicense Is in full force antl eifact.
LJcensa Class C z � Iz�canse Na. �
Oate 't' X "�u Si9nature
W00.KER5' COMPENSATION DECLARATION
-�;�ereby d�firT that I Ilava a cefHticate ot con5ent to SeINnSUI¢ Or a c¢ftificate
. Workers' Compensatlon Insurance, or a certlfletl copy thereof (Sec[ion
?",�tr'410. Lab. C.)
von�v Nry�C,'��IIdi7!?NJQ coma,,,r fi E�ii�A
.� Cerrt�f etl copPY is fi�tlbwithrthe cltY W tlA9�l�lslo�. �rv7���
Date � �` —Y APPlitant (%�j
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sectlon neetl not be completeG if the parmit I5 for one huntlretl (5300) or
less).
I certify that In tM1e pertormance of tha work for whlch thls perm�t is issuetl I
shall not employ any person in any manner so as to bacome subjact to t�e
WOrkers' CompensatlOn LawS Of CalHornla.
Date Signature
NOTICE: If,iafter making thls tleciaratlon, you sboultl become sub�ect to Ihe '
Workers' Compensatlan D�ovI510ns of the Labor Cotla, you mu5t fOrthwltn
comO�Y w��h, suc� provisions or this Dermlt ihall be Ueemetl revoketl.
CONSTRUCTION IENDING AGENCV
I nereby affirm that thara I5 a constructlon lentling aganty tor the pertormance
of the work for w�ich MI5 permlt I5 Issuetl (Sectlon 3097 Civ. CJ
LentlBr'S. Name
Lsntler'S Adtlre55 �
OWNER BUILDER DECLARATION
I hereby affirm that I am ezempt trom the Gontractor's Llcensa Law for the
Inllnwinn .aamn ICnctlnn J0315 F�¢Iness antl Prnfesil�nal fetle: Anv citv or
consVucq a¢er, ii
. atso reaulres the
�`,-.=i'�,efrom antl tha bazls }or tha allegetl exemptlon. Any vlolatlon of Soctlon
' 1:5 by any appllcant tor a permit sub7ect5 th¢ apD���ant to a clvil
��5�—� ��alty of not more than five huntlretl tlollari (E500).
LJ I, as owner of tha'pro0erty or my employees wlth wages at tnelr sole
coTp0n5dtlOn will �O fhB wofk, dn� the'StruGtu/8 IS not IntanEetl o! offeletl
for sale (Seefion 7044, BuSiness antl Profeislonal Cotle: The Contraetor•5
LICBnse Law tl085 nat apD�Y to an owner of a D�operty wn0 bulltls or Improv05
tnereon, antl who tl085 SUGh work hlm5elf/herself or throu9h his or har own '
employ ees, provlEaa tnat such ImOrovements are not Intantle0 or ofterea tor �
ule. If, howavar, the Gulltling or Improvemant is 5oltl within ona year of com-
platlon, fhe owner wlll have the burtlan ot provin9 he/she tlitl not bulltl or Im-
Qrove for lhe purpose o1 sale).
LJ I, as owner of the proparty, am ezclu5ively tontratting wlth Iicensetl con- �
trattorstd constructthe proje<t (Section 7044, Businesz antl Profeislons Cotle:..
Tne Contractor'S Ucansa Law does not appry to an owner of pro0erty who �
builtls or improves thareon, antl who contracts for such projecti with a con-
tractor(s)Ilcense pursuantto Ihe Contractor4 License Law). '
❑ I am exempt untler Sectlon B. 6 P. C. tor thls reason
Date Owner
I hereby certlfy that 1 have reatl inis appllcatlon antl state that tha abova
Information is corract. I agree to comply wi[h all city antl county ortlinances
antl sta[e laws relating to builEing conitructlon, antl hereby authorize rapre-
sentatives of t�is U[y to anter, upon the above-mentloneC Groperty for
InSDectlon purpo 5 � p t a 36'�
. _....... .._.
m - i2-�s6
TVPE OF CONSTRUCTION LJ NEW U ADD L`J ALTERATION LJ REGAIR
❑ CONVERSION ❑ DEMOLISH OTHER
DESCRIPTION OF WORK � —t' !'�
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING � MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5(i. P7. oCCUPANCV_
CONSTRVCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES_
Remarks:
Sink
Preventer
Irri9ation
�rinking Fountains .
Floor Dreins
Floor Sinks
Gas Service Outlets
InterceptOrS
Kitchen Sink
Lavatories
P—Trep
Raot Oreins �
Reinspeaion Fee I �$25
Boiier '
Duct � Untler Ground
Duct-_Ventilating �.
Exhaust System ❑ Multiple ❑
FirepVFact. Blt. ICBO �
Heating System & Ducting
❑ 0.100,000 BTU O 7 00,000 8T
Slgnature a e
Drivers' ucense or 55 � � '� � � I I Reinspec[ion Fee I $25
CMF 0865-46 rev. 12/63 W��te - Bulltling; Canary - Appliwnt; Pink - A«ounting; Goltlenrotl - Assessot
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
laue Fee
Hood ar Type I ❑
Canopy Typell ❑ �
Refrigeretion System
❑0.100,OOOBTU ❑100,OOOB'
System Repair/Alteration
Iswe Fea
FEES
$ 3
$ 3
A.P. ;W
S Main Building:
E
T Front
A Rear
� Fight
gLeft
Ping. Ref. �`
Parking Req./Provi�
Plannin9 Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F,A.U.
Fixtures
Device Boxes
Outlets
Switches
Garba9e Disposal
Generator �0.5 KW C
7114 3/26/B4
Zone
�sory Building:
Park.Fees $
ELECTRICAL
Transformer � 15-50 KW
❑ 50+KW
Meter Dup to 100 amps
Meier �over 100amps
�
� Reinspection Fee I $
PUBLIC SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By -�
Sub Panel
Motors �0.1 HP �1 Y, - 6
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
laue Fee
70[7
'$ 3
Z
O
N
I
N
G
R
E
Q
U
1
R
E
E
N
SUMMARV OF FEES � �
BUILDING PERMIT $ ' SMIP� $
PLAN CHECK $ � PERMIT �
PLUMBING �$ ��UANCE $
PLAN CHECK 25% �$ � ENERGY P.C. '�$ �
ELECTRICAL $ ' GRADING $
PLANCHECK 50°b $ � �J �1�j MICROFILM $ 7 /��
MECHANICAL , $ � �� TOTALFEE $ �
PLAN CHECK 25% $ - . _. _ _
T
' rCONSTRUCTION AfJD PLANNING � POOL' 'A _ � � - . .
-�'APPROVALS Permit# ' Date Inspector p�ppROVALS. - Permit#�� ' Date Inspector T
^' 1,. Temporary Electrical Service or Pole 52.' Pool & Equipment Location � ,` .
��2.� Soil Pipe-Undrgmd. 53.�Steel Reinforcement �. � -
, 3.. Electriral 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. APPROVALTO COVER-GUNITE .
7. Footings, � - 58� Electrical Conduit-Undrgrnd �, �• �
8. Foundation' , 59. Gas Pipe, O-Undrgrnd.-, Tesc' .. � .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.. .
10. Structural Floor System 61. APPROVAL TO DECK �- . _
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final :
12. Sewer Cap � 63. Neater & 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 . 68. APPROVED FOR PLASTERING �' '� � i
18.' Rough Electrical-T Bar Ceiling 69.� POOL/SPA SYSTEMS FINAL ' .
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 1 .
� 20:' Rbugh Factory Fireplace � APPROVALS , Permit # ' �
21. Ducts, in Structure 70. Underqround Hydro . -
� 22. Ducts, Ventilating � 77. Product Piping 0 Gas ❑ Oil •; ' .
23. �Gas Pipe-Rough & Test 92. Underground Fl,ush � � �
24. Roof Framing 73. Undergrnd. Storage Tank O Gas'��Oil ` ,
25. Roof Sheathing 74. Overhead Hydro � -
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ! - - .
� 27. Frame and Flashing 76. Dry Siandpipe , �� -��
,
28. Lathing & Siding i 77. FIXED SYSTEM FINAL � ' �
29. Insulation � � 78. FIRE PREV. FINAL �
30. Drywall Nailing , HEALTH DEPT. REQUIREMENT �
� 37. Plaster Brown Coat 79. FINAL INSPECTION ,
32. Elecvical Power MeterFinal - 80. FOOD CERTIFICATE ISSUED ! -
,
33. Final Electric Notes:• '
34. Final Heating & Air Conditioning �
/l�s/�'s �K.o �
35. Final Gas Pipe-Test . - - . . � � ' ; _
36. Hood or Canopy � � � , , � � . • - " -
37. FinaLFac[ory Fireplace � . � " � . � • '
38. Final Plumbing � � � ' � . - � � �
39. Water Service-Final . ' � � �
40. Gas Service-Final � ' ' � ' � • � • '
41. Solar pomestic-Final - , , - - -
,' ._
42. Backflow Preventer ' � ' � � � � ' .
� , �
43. Backflow Irrigation � - • _ , , ' . , �
i .
44. Landscape Irrigation System � . � � �
45. Sound Attenuation � . , ' � . .�
46. Handicap Regulations � , I � .. _ �
47. FINAL STRUCTURE & BUILDING , j . - ,
i
48. Special Requirements Completed. �, � , � ' ���! `
49. Electric Release to Edison � � ' � - � -- � � - � • � � � . �
�
50. Gas Release to Southern Califomia Gas Co � � � � � ,��
i I
57. CERTIFICATEOFOCCUPANCY � ' - -- � - � � � � '.
., i
No. � � Date _ . . _ ' _ . . - � �
�AP No.139-082-0'T LOT
It�-�CTIONS
StY�"
�G�S"
«wnrca
) ROUGH PLUMBING
t
� PROP. SWR. LINE � HOUSE CON.
SGRINKLING SYSTEM
MISCELLRNEOUS
� ROUGH NERTING �NO AIR CON�ITIONING
�TEMPOR4RV SERVICE OR POLE
UNOERGROUNO � POWEN �
ROUGN WIRING
TRENCHES FORMS STEEL REINF.
F�OOR SYS EM
BON� BEAM � STEEL REINFORCE �
SHEFTMING
FRqME �ND FLnSHING
LATNING - IN �I OUT �
PLASTER. BROWN COPT
STRUCTURPL, FINAL
HEAT' '. VENT., REfRIG. ANO R.C., FINNL
PLII i, FINAL AND G�5 TEST n
ELECTRIC, FINAL
BUILOING, FIN4L
SPECIAL REOUIREMENTS
" ' V 11 (V
BUILDING PERMIT
RIPTION of WORK Patio Cwe:
ZONE vnLUEE 320.00
PE V GROUP .7
SUBCONTRACTOR
� � �- - 42445
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING��n / 1�{% %S .�
ADORESS _ ,Gf�
OWNER �_/LI I�.M/!/ � �
MAII „ _ i . n . ..� �_.–�– T/
CONSiRUCTION
LEN�ER
BRANCH
�' ADDRESS
ARCHITECT TEL.
CONTFACTOR (f/ /_/
ADDRE55
TEI.
CITY NO.
F STATE / CITV
� LIC. NO. �^ � LIC. NO.
{a7 SIZE / � / NO.OF BLDGS
0. OF LOT ,�j G%� // NOW ON LOT �
a VSE OF "�
� EXISTING BLDG. � /% /y ,
�
FSeparate permi[s are required (or
� electric, plumbing and heating work.
_L USE O UILD�NG•AND WO Kn'O 8 PERFORMED
� / � �
" I/ �
Q � .�
i
�
z
m
o.
Q I �eraby ecknowledge thnt I hava reatl this applicetion antl stata
� that th0 obOvo Information is tor�eci entl oB�ee tD cOmply wit�
d ell laws rapulatinp builtlinB �onftruttion, antl 1 shall not amploy
Z any perwn In vlolatian of the workman's companaaHOn lawf ot
� the State o( Califomia.
3 I horebvi certlty t�at I em proparly Iicensetl as a wnvocmr untlar
Mo Stete of Cnlifornle Business antl Professions Cotle, D(vislon 3,
Chopter 9, entl that such licanses are in full force ontl atiect, or I
am exempi from the provislons of the Scate ot Celltornia Bus(ness
antl Profassion Divislon 3, Chap<ar 9.
SI9�eture of � /
Permlttee - _
AuNorized ABa t
PAiO
wr ii-�E�„-�.00 9��:� **��t5.50
APPLIG�TION POR STRUCTURAL PERMIT
RECEIVEDBV . ATERECEIVED narcisci�cn
A.P. NO.% J% � CI�
BUILOING ��� t _
ADDRESS W
TRACT_� 2�
W A D ALTER
O—WN—ER ��z—z G f
SE / hl ( L/J 1..�
FIRE
ZONE TI
AGPROVED � �
� �r]I PERMIT NO.
, ll/
IIN ��7� '
IOT� � OCK
'�cJcs�it6 �-!1
� VALUE `� �7 i
NE NO.OF USE OF N
PLANS� BUILDING � �� �
VARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDI
F R OM G/IL $iFi E ET)
VAR. sW
BEf. MAIN &
ACCE$$.BLO
DATE
n
a
i
m
�/ S�SQ. FT. N
ME AMOUNT SHOWN UNDER VALUATION IS FOR m
THE PURPOSE OF ESTABIiSHING A PERM�T FEE ONLV:
�
ALUATION l PEHMIT FEE S ��— �
n
�1 pLAN CHECK E '^
,/'�'") 0
$ v� TAX b �� LL
f
U
TOTALPAID $ ���T/
�oT �5 - TRACY 62
�, � ��.��0
�
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 977 COBTA MEBA, CA4IFORNIA
Fo� Applteanf to Fill In Complefely
TYPE OR PRINT
wDD e�68 3226 M�NNESOTA AVENUE
COSTA MESA. CALIFORNIA
owNER KENKO� CONSTRUCTION CO.
MAIL
wDOREss � P4ACENTIA AVENUE
NEWPORY BEACH TELM
TEL.
oR K•W• Kol�
j �j j��ACENTIA AVENUE
NEWPOR7 BEACH �
6a�t95 TEL. MI '3�27
NO.
� _ _ � � I NO. OF B1dO8.
BUILDING
ADDRESS
FIRE
ZONE
APPROVEO
BY
zows /�
!/�
L80AL
F�� REC�I�ED
1��; s �3-��
FINANCE DEPT.
CITY OF COS7A MESA
APPLICATYOtJ FOR PERMIT
S"'"' ' ' ... .-...... .
BUILDIPIG
For Offiee Use Only
RECE�PT NO. ,�PCR�(� NC
DATE I66UEO
COSTA MESA. CALIFORNIA
ZONING
NO. OF �U6E OF NEW
Purva euao�Ny� /
66TB�CK LIN6 FROM � �j1� � «BNTQR LINE BTJ
cer+TeR oI BTReBT O REAR VARD �`r FRONT
� 5� � 5�
SIDE YARD LEPT RIGNT R.SIDE
DESCRIPTION OF WORK
L. SIDE
- � X �� ------ � �� ----. �
8B=IELDING �597.5sF ROOMS U STORIES '
EXTERIOR WALL ROOF WOOD SH I NGL E
COVERING GOVERING
USfi OF BUILDINC AND WORK TO BE PERFORMED
SINGLE-FAMILY RESIDENCE AND
ATTACHED GARAGE
1 NERHBY ACKNOWLPtlGB 1MAT 1 HAVE PHAD THIB APPUGT�ON
AND 9TAT6 TXAT THE ABOVE IB CORREf.T ANO AGp%6 TO COM-
PLY WITH ALL CITY O�INANC¢8 AN� BTATE LAWB RHOULATNO
OUI�DINO COH9TRUp(/�W� ///�
SIGNATURE OP ! I/ 1/ n . i1 /IM.7 �/
� AUTHORIZED
APPROVED
THC AMOUNT BHOWN UNDER VqLUAT10N IB FOR THE
PURPOBE OP ESTABLI9HING � PERM�T FEE ONLY.
VALUATION � /—
PERMii FEE $ ��
�lai �� 7 /� —
S PLAN CHECK S
« ,