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Home My WebLink About917 PAULARINO AVE - Building PermitsCITY OF COSTA MESA BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT �P98-00426 PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4856 pLUMBING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: 917 PAULARINO AV 41809111 NOCK,RON MAC LEAN, NANCY B Address 39350 VIA MONTERO - MURRIETA,CA Contractor: NOCK PLUMBING Address: 11612 KNOTT ST GARDEN GROVE . CA ArchlEng: Address: ISSUE FEE Backflow irrigation Backtlow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip AMT $22.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $o.00 $0.00 $0.00 � Phone: Zip: Phone: Zip: 92563 Phone:'714 8951246 Zip;�' 92841 . .. License: 707775 Phone: Zip: License: SCOPE OF PERMIT INSATLL DISHWASHER. FEE SUMMARY AMT Laundry Tub I Washer -$0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors . , �$0.00 Septic Tank - � $0.00 Sewer Cap for Demo � � $0.00 Sewer Connect � $0.00 Sewer Private Line ' $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, 5ervice/mop $0.00 Spa (private) $0.00 Spa (public) 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED �JN `� Applied: O6/02/7998 Issued: O6/0311998 Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7D?xfL FE� .��%� EXp D �,� ,, o EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned tor a period ot 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectiona and final approval must ba obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 X WORKERS' COMPENSATION DECLARATION: I hereby effirtn untler penalry of perjury one of the following declarations: ❑ I h entl wlll meinlain e certlflcate of cansent to selbinsure for workers' compensatlon, es provided for by sectlon 3700 0l tha Lebor Code, for the pertortnence of the rk for which this pertnit Is issuetl. I heve end will maintein workers' campensetion insurence, as required by sectian 3700 ot Ne Lebor Code, far the performance af tha work for which t�is pertnit is issueG. Myworkers'comp tlo InsurencecertlerantlpollqnumDerare: (� ��y2 //J Cartler. �f., (��i� PolicyNumber ( � / �TQ� (7/tls sectlon neetl not be comp/ete i! the pe Is va/ued ef one hundred dollars ($100) or /ess.) ❑ I certify ihat in the peAortnance ot the woM for which �s Oermit is issuad, I shall not employ any person in eny manner so es to become subjact to ihe workers' compensation laws of C Utomia, en gr �[ N I sh become subjed to t�e workera' compensation provisions ai Sectlon 3700 of the Lebor Catle, I shell forthwith comply with these prov' 6ns. / ? c�/,�/ ApPllcent Slgneture: H. Date: !7 �/�/ � WARNINO: FAILURE TO SE flE WORKER ' OMPENSATION COVERA�E IS UNLAWFUL AND SHFLL SUBIECf AN EMPLOVER TO CRIMINAL PENALTIES ANO GVIL FlNES UP TO ONE HUNDRED THOUSAND OOLLARE (5100,000), IN A�DITI TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3]O60F TME UBOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I here6y ettirm thet I em licensed undar force end ettect. Lic. # � Contredofs Slgneture: �L 7000) af Division 3 of Ihe Business end Professions Code, end my Iicense is in full Class q oate: b ' ' CONSTRUCTION LENDING AGENCI'•. ❑ I hereby effirtn ihat lhere is e construction lending agency tor the peAormance of ihe work for which Nis pertnit is issuetl. (Sec. 3097, Civil Coda). LentlefsNeme: Slgneture: _ OWNER-BUILDER DECLARATIONS: Lentlers Address: Date: I hereby aXirm that untler penalry at perJury thet I em EXEMPT FflOM TNE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Protessions Cotle: Any ciry or counry which reQuires a Dertnit to wnsiruct, alter, Improve, demolish, or repelr eny strucNre, pnor to its Issuance, elso requires the epplicant for such permit to file e slgnetl statement that he or she Is Iicensetl pursuant m the pravisions ot the Contrectors LJcense Lew (Chepter 9(commendng with Sedlon 7000) ai Divlslon 3 oi the Business entl Professions Code) or that he or she is exempt theretrom and the basis tor the allegeO eaemption. My violatlon ot Section 7037.5 by any epplicent for e pertnit subJecta the flppliwnt to a cMl penelry ot not more then five hundred dollars ($500).): ❑ I, es owner ot the property, or my employees with wages as thelr sole campensatlon, WILL DO 7HE WORK, end Ihe siructure is not iniended or oNeretl for sale (Sec. 7044, Business entl Professlons Code: The Contrectors lJcense Law does not epply to en owner of property who Ouiltls or improves thereon, end who does such work himseli or herself or through hls or her own employees, provlded that such Improvements ere not Intended or otteretl for sale. If, however, ihe bulltling or Improvement is sold within one year oi complelion, the owner-bulltler will �ave the burtlen ot proving t�et he or she did not build or Improve foi puryase of sale.). ❑ I, es owner ot the pmperty, em E%CLUSIVELV CONTRACTNG WfTH LICENSED CON7RACTORS to wnsiruct t�e D�oject (Sec. 7044, Business end Protassions Code: The contrectors License Lew tloes not apply to an owner of property who builtls or improves thereon, anC w�o contracts for such project with e wnirector(s) Ilcense pursuant to ihe Contractors Llcense Lews.). � ❑ I am exempt untler sec. Business end Prolessions Code lor this reason: Signeture: Date: Owner ID veritietl by drivers licensa. ❑ Yes ❑ No Drivefs License No. F�cpires: Vedflcetlon of Ownership by (rype of tlocument, i.e. - properry t� Dill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby cently ihat no excavetlon five (5) or more leet In depth into which e persan Is requiretl to tlescenA, wlll be mede in connection wtlh work authorizetl by t�ls pertnit, and ihat no builtling slructure, scattalding, talsework, or demolitian ar dismantling ihereat, will ba more than Ihirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 3at, Title 8, Califomla AaministretNe Code). ❑ As owner-bulitler, I will not employ enyone to do work which woula require a pertnit Irom Ihe DlWsion of Industriel Sefery, es notetl ebove, unless such person has a permit to do such work from iha division. Signeture: Date: Dlvlsion of Industrial Safery Permlt Number: CER7IFlCATE OF (:OMPLIANCE AND AIffHOR¢A710N OF ENTRY: I certity under penelry of perjury that I have reaC this appliwtion and state that the Information given is correct. I egree to comply with all stete lews and ciry orclinflnces relating to building construction, end authorize represenlatives of the Ciry of Costa Mese Io enter upon the aDove-described properry tor inspectlon purposa5. I agree not 10 occupy or ellow occupancy ot eny builtling authorized by Ihis pertnit until final inspection. COUE 1. INSPECTIONTYVE 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Finel Block/Retaining Wall 202 Finel Fectory Fire Plece 203 204 zaaee Final Sign Flnel Demolition ��3_Date Data COQEt v�svecnoxme peg �9V5 206 Finel Mechanlcel 20B Finel PlumDing y-a�-a k,� 210 Final ElecMcel 212 Final Fire Prevenii0n 220 Finel Planninp Approval 222 Final Sita 250 Final Builtling�Occupen�y _ l. ��.ti (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 9i7 PAULARINOAV Suite: Vicinity: HOUSE & ATTACHED GARAGE ParcelNumber: 41$09111 App�icant YOUNG, RON Address: 1207 N CITRON LN ANAHEIM, CA Owner: MAC LEAN, NANCY B Address 39350 VIA MONTERO Zoning: Phone: 714-635-0912 Zip: 92801 Phone: MURRIETA, CA Zip: 92563 Contractor: CARSON ROOFING AND INSPECTION Address: 1207 N CITRON LN ANAHEIM, CA Zip: 92801 Arch : Address: Phone: (714) 635-4912 License: 661526 Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: 02/27/2007 Issued: 02/27/2001 Phone: Zip: License: License: SCOPE OF PERMIT REROOF: T/O, REPAIR SHTG AS NEEDED, 1 LAYER OF 15# FELT, APPLY 30-YEAR GAF COMP SHINGLES. Plan Check: $0.00 Permit: $139.25 SMIP Res: $0.63 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.88 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: 0 NOTES: Rear 0-0 Rear 0-0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Lek 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0- 0 Right 0- 0 56,300.00 $6,300.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements untler California statutes and related regulations. (Ortl. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become vold if work Is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all raqulred inspeetlona and tinel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 754-5626 ?44&48 (8�00) WORKERS'COMPENSAnON DECLARAnON: � I hereby affirm untler penalry ot perlury one ol the follmving daderetions: ❑ I heve end will main W in e cerlititaie of CpnSgnt to 5etl-InSure lor worker5' compen5atlon, e5 proWded br by section 3700 af t�e Labor Catle, br t�e perlortnance o} Ihe �ork lor which this permil is issuetl. have end wiil maintain workers' canpen�¢tlo msurance, es repuired Dy soctlon 3700 of Ihe Lebor Cotle, for the pertormance of Ihe wark Ior w�ich-N7is pe�mit Ls IsweO, -- My workers�' m nsatioynsurexa cartie nA pollry number ere: 3 SYS 62 � p�� Cerrier. 6S l�. I� L _i�� PoO�y Number. � UCJ (TAis sect�on n n f be p/ete��f the pennit is valuetl et one �untlretl dWlers (S700J or less.) , � ❑ I canity that In the pertorm�ce ol the wbrk for which t�ls permit Is issued, I shall not employ any person in any mennor so es to become sub�ect to the workers' compensetlon laws oi C j mla, enC e� that It I shoulC Decome sub�ect to Ihe workers' compensation provisions ot Sectian 3700 of Ihe Lebor Catle, I shall farthwlth wmply with these provi 6ns. -I� ,��R 7 Appilcant Signeture: ! Date:'� � � �" � �- J'u v / WARNINO: FNLURE TO SECURE WORKERS' . ElJ$�TIpN CpV E IS UNUWFUL rW0 SNALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDiiED T/qUSrWD OplARE (5100,000�, IN ADdTION TO E WST OF NS�TqN, OAANGES r5 PitOVIDED FOR IN SEGTON 31O60F THE IAeOF CODE, IMEREST, PND ATTORNEY$ FEES. LICENSED CONTRACTORS DECLARATION: I hereby ellirm t�at I em Iicensetl under rovisions of C ter 8(commendng wlih Sectlon 7000) of Dlvision 3 of Ihe Business en],Pr�sslons Cotle, entl my Iicensa la In full lorce end eMect. Llc. x Class a /� Contrectors�SigneWre: �Date:-� Z.— B'd l � � CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm Ihat ihere is e conswction lentlinp egency lor the peAormence ol Ihe work for which Ihis permit is issued. (Sec. 3097, Civll Code). Lender's Name: Lentler's AtlOress: Signeture: oate: OWNER-BUILDER DECLARATIONS: I hereby ettirm that unCer penelry of perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Business en0 Professions Cotle: Any ciry or wunry which requires a permit b wnsWcL elter, improve, tlemolish, or repeir eny strucwre, prior to its luuance, elso requlres the epplicant br such pertnit to lile e si8netl stetemeni ihat he ar she is Iicensed pursuant to the provisions ot the Contractore Llcense Law (Chapter 9(wmmencing with Sectlon 7000) ot DMsion 3 ot Ne Business and Pmtessions Code) or thet he or she is exempt therefrwn and Ihe basis br the elleged e:emption. Any violatim of Sectlon 70.31.5 by eny eppllcant for e pertnit su�jects ihe epplicent to e civil penalry of not more t�an tive hundred dollers ($500).): ❑ I, as owner ol the property, or my emplayees vrith weges es their sde compensatlon, WILL DO THE WORK, entl t�e structure Is not IntentleC or otteretl far 5aie {Sec. 7044, Business end Professions Cade: 7he Conirectors License Law does not appy to an owner of property who 6uilds or improvas lhereon, and who daes such wwk �imseN or hereelf or through his ar har own employees, provitled Ihat such impmvements ere not intendea or oflered br sele. If, hawever, the building or impmvemem is soltl wit�in ona year of completion, Ihe owner-builder will have the burden of proving thai he or she did not build or improve for purpose of sale.). ❑ I, es owner of the praperty, em EXCLUSIVELY CONTRAC7ING WfTH LICENSED CONTRACTORS to consirutt the pmlett (Sec. 7044, Business and Professbns Code: The contradors License Lew tloes not eppty ta en owner of propeny who builtls or Impmves thereon, end who contracts for such projeci with a coNrecior(s) license pursuant to the Contraaors License LewsJ. ❑ I em e:empt under sec. Business end Pwfessions Code lor Ihis reason: Signawra: Date: Owner ID verifietl by drivers license. ❑ Yes ❑ No Drivers License No. Verlficatlon of Ownership by (type ol document, i.e. � property tes �ill or tleed): Expires: DIVISION OF INDUSTRIAL SAFETV PERM17 CERTIFICATION: ❑ I hereby cenily t�at no e:cavation five (5) or more feat in depih In�o whlch a person Is requiretl to tlescenq wlll be mede In connection with work euthotlzed by Ihis permit, antl that no building suucture, sCaryoltling, falsework, or tlemolitlan ar dismanlling �hereof, will be more then ihirry-six (38) leet high. (Chap. 32, Grp 2, AM1 2, Sec. 341, Title B, Calilornia Administrative COCe). ❑ As ownervbulltler, I will not emplay enyone to do work which would require a permli from ihe Division of Industnel Selery, es nated above, unless such pereon hes e permit to do such work from ihe tlivision. SigneNre: Date: Division of Industrial Salery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAV: I ceM1ity under penelty of perjury ihat I have read t�is application antl state that the intormatian given is correct. I agree to comply with ell state laws end city ordinances relaling to building consiruction, anC authorize representatives of the City ol CaSta Mesa to enter upon the aDove-desSr{Ged properry lor inspection purppses. I agree not to acupy or ellow occupancy of eny building authonzed Dy this pertnit until linel inspection. COOE I' INSYELTIONT/iE" 1816 Fixed System Final Fire Preventlon 1266 Pool Spa Finel 200 Final Re-Raol 201 Finel BIocWRetaining Well 202 F��k] Final Pectory Fire Place Flnal Sign 204 Flnal �emoliiion Qe�. �e:i CODE I INSFEITON TYPE 206 Final Mechenicel 20B Finel PlumDing 210 Finel Electrical 212 Finel Fire Prevenlion 220 222 250 Finel Planning Approval Final Site Final BuildingiOccupancy � It� PP0.IECT p00flES5: 9 1 7 PAULAR I NO AV OWNEH'S NPME: MAC LEAN NANCY B aoosEss: 1645 BAYS4IDE DR CORONA DEL MAR,CA 92625 241-9586 AflCNIENGINEEfl: PEG.NO.: RDOflESS: UNIT: UNIT: PENMITTEE: nfOCI'C PLUMBING (714)R95—L2A6 aooness: 11610 SEABOARD CIR STANTON CA 90680 LICENSEO CONTflFCTOP OfCIABATION: I bereEy allirm lMl I am licensetl untler Omv¢ions ol Chapter 9(commen[inp wil� Seclion 7000� ol Drvision 3 0l Ine Business an0 Pmlessions Cotle. ana my license i5 in �ull Porce anU eflecL�� i� cmuc 050386ey �sTareuc.:51197i /7, e�ass: —36 D' e: . ^ � 0 � G_ Signamre: _�_/_� _ _ _ _ '� Z � — — 'WOBKEXS' COMPENSPTION DECIAPATION: I nereoy aHirm inat I have a cenilitate of to.,ent to sell-insure or a cetlilicale ol woBers' Comp¢nsation Insura o c til e copY Ihereol (5¢ciion 3800. Lab. . roucr no.: 11 ��1 � 9�'� � E%P. ORTE: 3� O S� 9 Z camvaxr: STATE 7 Ceniliea coDY is hereUy fumis�etl. IJS CenilieA capy a file�' • it� ihe ciiy B ii inp Oivision. loat¢: ��R� NpPliunt: � EXEMP710NFROMWOBKEBS'LOMPENSFTIONOECfABATION: QNssecoanne[dnolDemmD�-�Ni�theperm161mone�unEretl�5100�orles5�. I certify Ihai in Ihe perlotmante 01 Ihe work fOr w�ic� IhiS permit is issuea. I Shall not employ any Derson in any mann¢r 5o a5 to h¢tome 5u01e��o the Nlorker5' ComDEnsaUon law5 01 CaGlamia. �a�e: Si9nature: NOTICE: II, al�er makinB ��is Eeclarati0n. you slioula 6¢[ome suGiect ro I�0 WOMers CompenSa�iOn pmvivons of Ihe Labor CoOe. you muSl IOnhwil� comDN' �+�� su[h D�wrsions ot ttuS p¢rmii SAall Ce Oeemed revok¢0. CONSTNUCTION LENOING �GENCY: I here�y a��irm thai I�ere ¢ a construc(qn IBnGing agmry Ior Ihe pGAOrmar¢C 01 I�e work tOr whic� Ihis p¢rmit is iSSu¢0 �5¢tlion 3097, Gv. C�. LENOEfl: nooeess: OwNEN eUIIDEB OECIANATION: I nertEy affirm �nat I am exempi tmm ine Coniraciors' Staie License law loi 1ne follovring reamn (Seclion 70Jf.5 Business aM Profes4onal CoOe: Any ciiy ol counry whic� repuires a permil to construct, alier, improve. �emolis0. or rtDair anY 9mtlure. prio� Io �ts i55uant¢. alsp rcpuires I�¢ apDlipni lor Su[h permii (0 IiIE a 5i0^eC Slalemenl �hai hPJShe IS IiCen5e0 Oursuan� to Ihe provisions ol IOe Contranors' State Li[ense Law (Cluptu 9(wmmencinq vnth Seclion 7000) ol Division 9 al ihe Business ana Pmlessions CoOe) or t�at �e/sne is exemp� ��erelwm and ine Uasis for Ihe aOepeG eeemption. pny Wolation ol Sec�ion 7031.5 Uy any aoDlicantlor a permil suejKls ine aDOfitanito a Civil Denatly al not more Inan Irve hunEreA Oollars (35001. I, as awner ot Iha propeny o� my employees wilh waAes az ineir Wle comDenSalian, will tlo Iha work, antl Ihe ❑ vmclure is nol in�enEeE ar altereE lor sale (Section 70aa, Business anA Pmlessional Cade: T�e Comractori Siata Licensa Law Uoes not aDPly to an mvner ol a pmpeny wtw Om1Us or imprwes t�ereon, an0 who Oaes sw� work himsell/Aersell or IhrouOh his or her own employe¢5. p�oviE¢a I�al suc� improvemenis are nol intend¢a or ollere0 lor sale. II, however IAe UuilAing or imOmvemenl is 5010 wil�in one year 01 Cam0lelion, Ihe owner will have �he �uraen ol D�ovinp he/s�e aia nol builA or imOmvc lor Ine Durpose of sale�. I. as owner ol the pmperly, am exclusively rontracting wiih licensetl conlratlors t0 conslmct IAe pmlecl (Sec�ion 704a, Business ❑ antl Prolessions CoOe: The Comraciors' Slate Licens¢ �aw Qoes nol apDN �o an owner o� proDehy w�o �ml0s or im0�oves Ihereon an0 who tonVatis lOr suc� Omlet�s wil� a tOnVattor�s�lit¢n5e Dursuan� io Ih¢ Canlratlor5' SIa10 LitenSe Law�.l am aware I�at Dmol al IAeir WOMeYs Comp¢n5ati0n insurance sMuIG Oe pmvitle0 la me. � i am eeempi un0er Section: B. 8 P. C. lor i�is reason: Date: O+vner. I ao �ereDy cerldy I�a� 1 am aware al an0 unAerslan0 th! requiRrtrenis of Califomia Mealih anG Safety CoOe SectiOns 25505, 25533, ana 25534 an4 ��a� I or any fwure �uilUing acupant wiMNll wi (drde one) aeetl to camON ��h ui0 state aEes anA ��e requiremenis lor a permil for consVuttion or mo0iliwlion �mm I�e Nr OuaLiy Managem¢n� OiSirkt, fl¢vdential mnsVuction appliaiions are exempl �mm I�ue pmtisions. �aie: Applicanl: I h¢re6y Ceiliiy I�ai I Iwve reaC IN5 aDVlicalion anG Slate Ilui I�e aDove Intormalan is wrrttL I apree l0 tOmpty wilh all tily antl mUnty ardinancesanAslatelaws�elalinqlobuiWinqconslruaionaM�ereEyamnorizereDres¢ntai softliiscilV�oemeruponihea�ove�mentionea pioperly lo� inspecli0n purpposes /�i �atg:_�I'O=4' Si9nawre:�r /!/�L�I�� Dii�er's Lirense or Sociai Security x: 16aLa6 While—BVJdmg; Green—CoEe En�orcemenl Canary—ApplicanL Pink—Revenue: GOICenrotl—Assessar CITY OF COSTA N.ESA — BUILDING PERMIT PaRMIT NO: P 05227'1 PLAN CHECK NU: N CONSTRtICTION TYPz: V—N PzRM2T TYPE: PLU PERM NO: P 05227� GOVT: N SOPP; N PURPOSE: OTH JOB DESCRIPTZON ; CHANGE OUT WATER HEATER SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 / COMMENTS• SMOKa DzTECTOR RE�iUZRED IN THE HOME ih7EiEifiFifihi(�iEiF3fif�3i�ifififiFif-3Fif�(-iFiEifiEifif if3Eif3E�li�iE7Pjf�EifaflFifiFK�j(�1FifiEifiFk�3E1E3fiFifi(�iPK1f�FIF+EiFK�aFK�i(�ifi(�3FiE+FiFii�iF�(-iFiFif Z O N I N G R E Q U I R E M E N T S S E T B A C K 5 ------------ MAIN BUILDING ---------- --------- ACCESSORY BIJILDZNG --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REA.=t: FT IN LEFT; FT IN RGAT: FT IN LEFT; FT IN RGHT: FT IN FARKING REO• PROV: PARCEL: 91809111 ZNE: REF NO: PLANNING Nf3TES> � iF iF if 1f 3f �1f if if if 3! i'r 3E iF i61f iE Y IF if it 3f iE if IE N� iE i(� lf 3t 1E 3(� 3h i(� 1E iF lh if iF iF iE 1F �F iF 1f iE �lf 3(!iM1 K� iE i4 K if lE 1F M� v. 3f- # iF if v jp;� iE 3E f(� iE iF ?4 i(� �� %� K� M� 7F af iE ik D E V E L O P M E N T S E R V I C E S R E Q U I R E'M c N T S ZONING APPROVED BY DATE: BUZLDINV APPROVED HY : DATE; / APPLICATION ISSUED BY; `' DATE: (o r�� aI-iEiFiE+EiEiFi6iFiflfif+FiE1kN'I{'if'1fifIFIF ... . . . � iElFihiFli�iEYiFif+ET[7FS� if'Y +F iF �lE k 3'r iF 1E iE ik af af if if 1� iF ik IE iF iF ih Y� 3F if iE iE 1E iE if±f 1E if iF iE iE 1E iE �1f iF if iE aE 3(• 1(� i(� N� iF 1f M� if �f V.� iF If�lE i: lE �E 7f iF iE 1E iE aF �1F?E if 16 3f fF ?(� iE 1F 1E M� %�-lf iF iF iF LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT Z�SY SMZP/NON—RES Pr AN ISSUE FEE 3.00 HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 2,00 3.00 U.00 REVENUE DIVZSION TOTALS--> COLLECTED: BLDG PMT PLUMHING ELECTRIC MECHANIC 5.00 TOT00 SA00 D00 S.UO OVER/SHORT: .00 FIRE SMIP/TOT GRADING PLAN—CHECK �N� iF iF iF iE aF ik Ik i(� if )f IE if %� N�)f IE IP iE % k 3(� IE if if iElf �e IF fF iF IF iF iF iF iE iE 3E iF if if 3F 7! ih i(� iF k 1E if iE if if Ik if �f i( # if� If #�1( iF fF fE iE 74 %� Ih R 1f iE 3F iF K• K� 7F i(� 3F i I N D I V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R Z P T I O N UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR VENT 2,00 '1.00 END OF FEES Gi OIILi,9t,ii—G1iG2?63t �s_�� i.ti.� DA7t: aG!1;/';1 TIi^.E: i1+u^'s CONSTRUCTION AND PLANNING POO. oPA APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utili[y-Undrgrnd. - 54. Forms - 4. Electrical Conduit-Undrqrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Condui[�Undrgrnd. 8. Foundation •' '-' 59. Gas Pipe, O Undrgrnd., Test " 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, O Undrgrnd. � 10. Structural Floor System 1' 61. APPROVAL TO DECK � 11 . Property Sewer Line & House Connection �_' 62. Backwash & Receptor�Final 12. Sewer Cap _� • 63. Heater & Vent-Final �' 73. Roof Oroins 64. Plumbing System - Final 14. Rough Plumbing • � 65. Electrital-Final '� 15. Rouqh Electrical-COnduit • "' 66. Solar SYstem-Final �' 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 18. Rough Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & A�r Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Strutture 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping O Gas ❑Oil 23. Gas Pipe-flough & 7est 72. Underground Flush 24. Roof Froming 73. Undergrnd.StorageTank OGas ❑Oii � 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling (Struttural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation , 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat �� ' 79. FINAL INSPECTION 32. Electrical Power Meter-Pinal �,. .80. FOOD CERTIFICATE ISSUED 33. Final Electric ± � ' Notes: 34. Final Heating & Air Conditioning �`� � � �� 35. Final Gas Pipe-Test .1,• 36. Hood or Canopy � . 37. Final Factory Fireplace � ' 38. Final P{umbing � (y,� � 39. Water Service�Final � � 40. Gas Service-Final ' 41. Solar pomestic-Finel 42. Backflow Preventer � 43. Backflow Irrigation 44. Landscape Irripation Sysiem 45. Sound Attenuation 46. Handicap Regulations - � 47. FINALSTRUCTURE&BUILDING " �f I 48. FINAL PLANNING �,�� 49. Elearic Release to Edison . �. 50. Gas Release to Souzhern California Gas Co ,. 51. CERTIFICATEOF,OCCUPANCY . No. Dace PHOJECTFOUHESS: (jl'� PAOLAR'�NO p.:� OWNEN'S NAME: MAC LEAN NANCY B nooness: 1645 $AY�IDE DR CORONA DEL MAR,CA 92625 AflCH/ENGINEEfl: '7' 4 1.'" y S R�1 FODNE55: XEG.NO.: UNIT: UN�T: PEflMITTEE: NUI.t� PLUMAING ' ( "714 ) 895-i7.46 ADDHESS: iSE�SO SE.�IHOARD CIR SiANTON CA 40680 LICENSEO CONTBAGTOP OECIABATION: I �ereEy allirm �ha� I am lic¢ns¢4 unaer O�ovisions af Chap�er 9 kommencing wiih Sec�ion 7000� ol �ivision 3 0� the Business antl Pmt¢Ssions Coae. ana my license is in futl Imce anC iilecl. ciTruc.: Q�03q� STAiELIC.:r)-�y�]1 ^ cuss: C-36 �Oate' � 4� ` 1�� SignaWre'�4�iet^A.i— WOflMEPS' COMPENSATION OECLABATION: I �ereby affirm Ihai I nave a certilicate oi consent m self-inmre or a cenilicate ol workers' Compensalion Insurance, or a cerlilietl coDy Ihereol �Section 3800, Lab. C�. . POIICYNO.: 11(j�]y9LyO E%P.OATE: O3IOSJ92 coMraxv: STATE ❑ Certihe0 copY /is �ereby lumished. [� C¢rtilied coDY �5 filetl »i�h fie ciry Building U/insion ///� �atq: � i � fi' � � �APVfican�`� �l� .Ai /� "' br E%EMPTION FPOM WOPREBS' LOMPENSATION UECIAflATION� (TNs stttion nee0 no1 be comple�ed il the pertnt is �or one hundre0 (5100� or less�. I certily tha� in Ihe Oehormance of the work �or which thi5 permi� is issued. I shall noi emplay any p¢rson in any manne� so as �o become sublect �o Ihe Worker5' ComDensalion Laws of Caiifomia. Date: SignaWre: NOTICE: Ii, alter making Ihis tleclaration, you s�ould Uecome subject �o �he Workers' ComDensa�ion pmvisions ot Ihe La6or Code. you must lorthwi�n comply wi�h sucn pmvisions or Inis oermit shall he deemeU revoked. CONSTflUCTION LENOINC AGENLY: I �ere�y a��irm t�ai Ihere is a conslmction IenOing agency tor �he pedormance oi Ihe work lor whidt IM1Is Dermit is i5suetl (SecUon 3097, Gv. C�. LENOEfl: FODFESS: OWNEP BUILUEP DECLABATION: I �ereby afiirm �hat I am exempi �mm IAe Conlraciors' Stale License Law �or Ihe faltowinA �eason (Section 7031.5 BuSiness anA PwI¢55ional COEe: My tily Of taUniy which repuir¢5 d p¢rmii l0 ConSimt�, al�ef, impmve, tlemolish, or repau any simcWre. Drior to its issuance. also reQuires Ine appliWnt lot such oermii �o lile a signea statement that helshe is IicenseA pursuanl �o �he pmvisions ol �he Comracmrs' State License Law (ChaO�er B(�ommencinB w��h Section 7000) ol Oivision 3 0l ��e Business anU Pmfessions Coee) or t�al he/she is exempi Ne21wm and Ihe DaSis lor ihe altegeU exem0�ion. Any violation of Section 7031.5 6y any apDlicanllor a p¢rmil SuOjec�S Ihe apD�icanil0 a[ivil p¢nally oi nol more �han five hUnCr¢d dollarS (5500�. I, as owner o� ihe pmpeny ar my emplayees vntA wages as tAeir sale compenution, will ao ihe work, anJ ihe ❑ stmcture is not intended or ollerea for sale (Section 70a4, Busineu anJ Pmlessianal Catle: The Coniraciors' State License Law does noi aOD�Y lo an owner o� a property w�o builds ar impmves Ihereon, and who doe5 such work himsell/herself or [hwuBh �is or �er own employees, Orovi0e0 Ihat suc� impmvemems are noi intentleG or ollereA for sale. If, �owever I�e Ouilaing or impmvement is soltl wil�in one yeat of completion. t�e owner will �ave Ihe Curtlen o� pmving helshe ditl no� Uuild or imOrove for ihe ourpose ol sale). . I. as owner ol lhe pmpeny. am eKclu9vely contracting witn licensed conirac�ors to wnsimct ine proiect (Section 7044, Business ❑ antl Pmlessions CoOe: The Conlraciors' Sta1C License Law Coes nol a001y �o an owner o� pmperty w�o bwlas or impmves lhereon ane who conirads lor sucn pwiects with a coniractorls) license purzuant to ihe Caniraclors' Staie License Law�. I am aware Iha� pmot oi their Worker'S CompenSation insurance s�oultl be proviaed �a me. � I am e�em0� untler Seclian: B. 8 P. C. br ihis reason: oale'. Owner I tlo hereby cenily ��a1 I am aware ol ana unaersiantl Ihe repuiremems ol Califomia Heal�h antl Salery Code Sec�ions 25505, 25533, antl 2553a anef tha� I or any fumre buitAing occupam vnlVwili not �cirtle one) neeC ro compty wi�A sai0 state wdes an0 t�e requiremenis br a permii for tonsimtlion or rtw�iliCalion imm Ih¢ Fu Ouabiy Managemeni Dislntl. flesiAen�ial COn9mclian ap0�italion5 are exempi imm Ihese pmvisians. Oale' AOP�icanC I hereby cetlity that I �ave reatl Ihis aDDlication ana sta@ Ihat I�e a�ove information is carrecC I agree to comDly with all city and cowry orOmanceSanOslalelawsrelalinglobuiltlingconslmctionan4here0yx�"hoi¢erepres¢nialivesofthisciryloenter n�hea�ove�menlione0 pmpetly lor in50ection purposes. [�� U "—'` Oatei �I n — � � Cgna�J�� odcer's ucense or Soc�al Sewrity n: 1641-46 Whne—Bwleing: Green—COUe Enlorcemenc Canary—ApplicanL Pmk—Revenue: Goltlenrotl—Nssessor CITY OF COS'fA MESA - BJSLUTNG PERMIT PERM NO: P 05170 PnRMIT NO: P 051709 Pi�AN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V-N PERMIT TYF:i; PLU FURPOSH: OTH ,708 DESCRIPTZON : CHANGn OUT' WATER i�EATER SQ F?: <:I�A]:M VALUE: CAIC-VALUE: - (,ROUP OCC; R-3 / COMMcNTS; 5MC)ItL DETECTOR RE�USRED �`` dFiEiE�Y��kif�ki��lEiEdfX1EK�F#iC��Y.�#�kiEifK��lf�kiE� �Y.iF1E�Y�#iif#�%iEk�lf��i(�%3E�le�iE#�M�k#Y,��?E�iiEk�IE��dE#�YE9f1EjEif��M%�)F�lf#FjEY1E•7(-i(•�N�V.�N��k��7F 7. U N I N GS ERTEIIQAUCxK�S� M E N T'S ----------- i?AIN BUZiDING ---------- --------- ACCcSSURY BUZLDING --------- FRNT; r1' ]:N REAR: FT IN FRNT: `rT TN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: ?i ZN RGiIT: FT 1'N PARKSNG Rr.Q: PROV: PARCEL; 41809111 ZNE: Rr.r NO; PLANhING NOTES> > 3E if #E if 3E t if ik }? # 1f Y.� ii f±� !f 3f ?( ?E iE N� 3(� 3F 1F 3E i%� # ib }:� i� If� u iE f: if * a�. iE�l(� it }:� 3E %3'r % 3F i(:3(� ii # If 3f �f iE 3:� i(� Y.� 3E } x}'.3'� 1'r K� 3e i'r 1E iF?i-ib jF �le *+'- iF * IF�K ?� D E V£ L O P M E N T S E R V I C c S'.� cZ E Q U I R E,K c N T S ZOhING APPROVED BY � DATE; HUlLDiNG APPROVED HY : , DATE: _ � t ri`:Lti'mi6=i�j T+��ii_:i-) tlR � ��' +.:, llATE: ��•/ k��3�Q-it�#�,�R�i�i��x�i�3F�iEStku�t�� £�x� *,c�e�,nnrr+a-�v��e-:-�-�,� a�t-z'3t'�-�rv��k�y.��x�x-�t��.x�;��,:�'�,�3r'� x• 4E#i3:�'!��?e;6iE�4'%st��'rtEk,'i�'t3:LL�Y.ti�fEirif#if¢'1'#.Itif+��.k.ir7F.��.'�.#.�:•��°�^'.:7/ i4;.ii.:-7,:!i�C�y¢.{:i:9ci.btEiEiek{�?;.K'�ki%�:3F#�RiFiE�i!-if�3k i�(_"*ALIZATION;N r F µ H 1-1 �. v! i� Y $1kUCTV1'ttAL SEGN?nNT;N BL�DG PMT FLUM�ING ELECTRIC MECfiANIC PIRL SMiF/RES GRADING PERMIT 1,OU 258 SMIP/NON-RE� PLAN ISSUE FEE 3,U0 � HUILDIA�G-llIV-> FEt,'tMIT ISSUE PLAN-CHECH TUTAL PATll Dt1E 1'UTAI,S----> .'. , 00 3, UO 0. OU 5. 00 5, 00 , 00 REVENUE DIVISION TOTALS--> COLLECiED• 5,00 OVER/SHURT• 00 BI�DG PMT PLUMBING ELECTRIC MECHANIC rIRE S,�iIP/TOT GRADING PLAN-CHECK J.00 ' ar. K� iF 3f if ie i�� 7E i iE N� 3i� i4 rf iF i% } it :�f if i4 �R IF iF IE 3f� i( K�l'� iE 3F If if ii� ii i'r Jf #+h �7i�-k� ii if 3i� i'r if ih 1F i( R�lE }'. 3E #'� 3�'� iE 1i�::� iF iF iE i'r li� i4 i4 K� }:� �!' #- }. j: jF ic 3E 1i� � 3F 1i� If I N D I V I D 0 A L F E E B R E A It A Q W N TYPE QTY D E S C R I P T Z O N UNIT COST TOTAi COST PLU 1 WATER HEATER AND/OR VSNT `1,00 2.00 END OF FEES �� OCREIS'J-v�DRo.�S 1_:' r `• �1 DFT�- Et4�3f}�9f �Ifi�: �n:?'. CONSTRUCTION AND PLANNING POOL ts SPA APPROVALS Permit# Date Inspeetor APPROVALS Vermit# Date Inspector 1. 7emporary Electrical Service or Pole 52. Pool & Equipment Loca[ion 2, 5oil Pipe•Undrgrnd. � p 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. �lecvical UFER Gmd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 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. Sawer Cap � � 63. Heater & Vent�Final 13. Roof Drains 64. Plumbing SYstem - Final - 14. Rough Plumbing � � 65. Electrical-Final - 75. Rough Electricai-Conduit 66. Solar SYstem-Final 16. Rough Elettric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground F1ush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil � 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceiling ($tructurall & Monocoat 75. Dry Chemical 27. F�ame and Flashing 76. Dry STandpipe 2S. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. D�Ywall Nailing '� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electriral 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 Faaory fireplace 38. Final Plumbing � I G,EQ � , 39. Water Service�Final 40. Gas Service-Final � 41, Solar pomestic�Final 42. 88ckflow Preventer 43. Backflow Irrigation , 44. �andscape Irripation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ; �, - 48. FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southem California Gas Co � 51. CERTIFICATE OF OCCUPANCY . No. Date OWNER BUCCOLA C0. JOB ADDRESS 917 P � AP No. 4I8-091—01 LOT �INSPECTIONS �SOIL \GAS WAiEA // C '"��il-. I �7 = �ROUGH PLUM6ING �PROP. 5'//A� LINE �, HOUSE CON. SPRINKLING SVSTEM fl ROUGN HEATING RND AIR CONDITIONING' TEMPORARY SERVICE OR POLE N�ER6ROUN0 � POWER � ROUGN WiqING � TRENCNES FORMS STEEL REINF. FLOOR 5y5TEM BONO 9E�M L STEEL REINFORCE ❑ SHEnTHING •e FRAME �ND FLASNING LATMING — IN OUT � PUST�q_ BRO'MN COAT DATE FIRE ZONE VALUE TVPE V GROUI �SUBCOHTRACTOR - ��i��. a�arri ��-:.. m+ir��a�a y�� /�'��'��7 i � �`r�' � r�w�c��iwdn� . . . ��e�� F-� � k7 O� a � .N.. S F 0 W F Q 0 �.d Q 7 r .� a w a O C L Z W � 3 _ 4JOI6 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIfORNIA 92626 For Applicant to Fill in Comple[ely — Use Ink Only BUILDING/� ADORES$ %/� �/� OWNER �� r � �-•� MAI4 i 1 r ln � _ .......-. � �--.1- CITV �vj`� Cpry$iqUCT10N BRANCH ADDRESS 0 ADDRESS�,� CONTRACTOR ADDRESS CITV STAYE �L LIC. Na. � SIZE OF �OT USE OF TE TEL. NO. CITV UC. NO. INO. O LBF�D(35. NOW ON LOT Separate permits are required for electriq plumbing and heating work. BVILDING AND WORK TO BE PERFORMED 1 horOby acknowletlpe that i have read this apPlication antl state t�at she above (nformatlo� Is corract entl aBrea to comply wlffi ell laws reBulatinp bulltling construction, entl I shell not employ ony person In violaHon or Mo workman's compensation laws of the S4eta af Calitornia. I hereby cerNty that 1 am proparly Iicensatl as a conbecwr untlar the Siute ot Caltfornia Business a Proteuiona Cotle, �Ivislon 3, ChapTar 9, entl t�ot such Ilce s r in tull fO�ce antl affoct, or I am exempt trom tha p ovlsi f t�o Scata of Caltiornio Buslnecs antl Plotasziona Cotla, iv I epter 9. Slenoture of Perm�2tee Authtlrizatl Agant � o-7f�'.;�J�� i 12.'y `... :: �b? nc APPLICATION fOR STRUCTURAL PERMIT ECEIVEDBV OATERECEIVEO p FIR�e�Fn � BUILDING ADDRES: OWNER FIRE DATE I� VARDSAPPROVED YAqOSAPPROVED MAIN BUILDING ACCESSOPV BVILDI iOM C/L ST ET 7M 'T. FT. il E �T. F7. i1DE � FT FT. _ 3� ,��/ AR FT. TANCE BET. BET. MAIN & VAR. #` C.U.P. y}s � --...�..� � � m i � � SQ. FT. �' '` � THE AMOVNTSHOWN UNDER VALUATION IS FOR 'N� THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e VALUATION PERMIT FEE E p N n � PLAN CHECK E m � O $ �� TAX $ I � U TOTALPAID b