HomeMy WebLinkAbout968 PAULARINO AVE - Building PermitsCITY OF COSTA MESA �
BUILD�_K-f-DIVISION '
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.w.0
�, �' FOR INSPECTIONS CALL: (714) 754-5626
�°"mF PERMIT: NUMBER B08-OA143
PERMIT TYPE B_ROOF2
APN: 14172222
STATUS: ISSUED
DATE ISSUED: 0510612008
ISSUED BY: . CAC
JOB ADpRESS: 968 PAULARINO AV CM Suite/Unit:
vicinicy: .
Squares: 0 Valuation: 55,500.00
SCOPE OF WORK: TEAR OFF INSTALL'I/2' CDX 730 LB FELT AND 40 YR CLASS A COMP SHINGLES
OWNER: KOGA, YOSHIOTR "
PHONE:
APPLICANT: CHUCK VILIA
PHONE: 949• 650-'1079
CONTRACTOR: R C I ROOFING COMPANY
Address: 240 WALNUT STUnit:
City/SWte/Zip: COSTA MESA, CA 92627
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspectiqn Fee:
TOTALFEES
$0.00
$125.25
$0.00
5125.25
Address: 968 PAULARINO-AVE
City/State/Zip: COSTA.MESA, CA
Address: 1923 CHURCH ST
City/Sfate/Zip: COSTA MESA, CA
I�:U]:IXI
License No. ..
License No.
Unit:
Unit :
� i i: j
License No. - 704392 • '
949• 650-1079 �
CELL:
PHONE:
PHONE:
NOTICE: The work authorized by this permil shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must compry with alt applicabie codes, and ali
required inspections and Fnal approval must be obtained. Failure to obtain inspecGons and final approval will result in the expi2tion of this permit.
COpE�. INSPE�ONTYVE D�TE IXTiIRLS 4QD�FI� INSPEClIONTYPE QATF �NTRUlS
1816 Fixetl System Final Fira Prevention 206 Final Mechanical
1288 Paol Spa Final . �/ 208 Final Plumbing
200 Final Re-Root �` J� � 210 Final Eleclriwl
201 Final glocWRetaining Wall 212 Final Fire Prevention
202 Final Fadory Fire Place 220 Final Planning Approval
203 Final Si9n 222 Final Sile
204 Final Dem0lition 250 Final Building�Occupancy
WORKERS' COMPENSATION DECLARATI01 Owner ID verified by dri .icE ❑ Yes ❑ No
I hereby affirm under penalry ofaeryury one of Ne �ollowing tlecla2tions: Driver's License No. Expires:
❑ I have and vrill maintain a certificate of wnsent to self-Insure for workers' ,_�Ve�cation of Ownership by (type of tlocument, i.e. - pmperty lax bill or tleed):
compensation, as provided for by section 3700 of Ne Labor Cotle, for the
pedormance of lhe work for which Ihis pertnit is issued.
I have and will maintain workers' canpensatbn insu2nce, as requiretl by
seclbn 3700 01 lhe Labor Code, for the peAortnance of the v.ork fw which this DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
is issued. My workers' compensation nsurance wrrier and policy ❑ I hereby certRy that no exwvation five (5) w more feet m depth inio wfiich a
u r are: person is required to descend, will be made in connection vrith w+ork authorized
` by this permit, antl thai no building structure, scaffdding, false�wrk, or tlemolition
Carrier: �Gt \� or dismantling Ihereof, will be mOre Ihan Ihirty-six (36) feet high. (Chap. 3.2, Gry
�e petetl hepemNkvaN etarenuntlretlWNars(5f00)alass.)
� ��/1 '�� _�� 2. M 2. Sec. 341, Ttle 8, Califwnia Atlminislrative Code).
umber. l.J
i ❑ As owner-builder, I will not employ anyone to do work which woultl
❑ I cehify that in the perfortnance of the work for which this permit is �equire a permit from ihe Division of Industrial Salety, as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
lo lhe vrorkers' compensation laws of Calilomia, and agree that i! I should
beco bject_` 1 vrorkers' compensation provisions o( Section 3700 of qppliwnl's SignaWre Wie
abor Cotle, I sh I foAhwith comply with Ihese provisions.
—_ Division of Industnal Safety Permit Number.
�� � HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
W KERS' COM NSATION COVERP,GE �� Will the applicant or present or future building occupanl need to file and
IS UNLA D SHALL SUBJECT AN EMPLOYER TO CRIMINAL �ertify a Business Plan for emergency response to release or t�reatened
PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release ol a hazartlous material7 ❑ Ves ❑ No
($100,000), IN ADDITION TO THE CAST OF COMPENSP.TION, DAMAGES AS
PROVIDED FOR IN SECTION 9706 OF THE U180R CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSEU CONTRACTORS DECLARATION:
I hereby aKrm thal I am licensed under pmvisions of Chapter 9(commencing
with Section 7000) o( Division 3 ot the Business and Professions Code, and
my license is in full force antl eHect. j�
c. �# /'S `C, ��
_ .—�
Co ct ' na te
CY:
❑ I hereby affum that there is sWction lending agency (or ihe
peAortnance of the v.ork for wtiich this permit is issued. (Sec. 3097, Civil Code).
Lentler'S Name:
Lentler's Address:
SipnaWre
OWNER-BUILDER DECLARATIONS:
I hereDy aHirm that under penalty of perjury that 1 am FJ(EMPT FROM TNE
CONTRACTORS LICENSE LAW for the follrnving reason (Sec. 7031.5,
Business and Pm(essions Code: My city or wunty which require5 a permit to
conslruct, alter, improve, demolish, or repair any structure, prior �o its
issuance, also requires the applicant for such pertnit to file a signetl slatement
that he or she is licensed pursuant to Ne provisions o( the Contreclors
License Law (Chapter 9(wmmencing with Section 7000) o( Division 3 ot me
Business and Prolessions Cotle) or ihat he or she is exempl therefrom and
lhe basis (or the alleged exemption. Any violation of Seclion 7031.5 by any
applicant for a pertnit subjects the appliwnt to a civil penalry o( not more than
five hundred tlollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the swcNre is no1 intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contraclors
License Law tices not apply to an owner of property who builds or improves
thereon, antl who dces such work himself or herself or through his or her own
employees, provided that such improvements are not intentletl or offered for
sale. If, however, the building or improvement is soltl within one year o!
complelion, Ihe ovmer-builder will have the burtlen o( proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to conshuct the project �Sec. 7044, Business and
Professbns Code: The cont2ctors License Law dces not apply to an owner of
property who builtls or improves thereon, and who contracts fw such project wilh
a cont2ctor�s) license pursuant to the Contractors Ucense Laws.).
❑ I am ezempt under sec.
Business and Professions Code for this reason:
]OS)-06�10])
(Section 25505 of the Califomia Heallh and Sa(ety Code requires, with some
exceptions, that a Business Plan De filetl with tha Costa Mesa Fire
Department by every business v+hich has at any one time tluring a reponeC
year a quantity of hazartlous materials equal to or greater than a weig�t of
500 pounds, or a volume of 55 gallons, or 200 cubic feet ol wmpressed gas
at slandard temperature and pressure).
2. Does or will the applicant or present or future builtling occupant need to file
a regislretion (orm for awlely hazartlous materials7 ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
ezceptions, requires registration wi[h the Costa Mesa Fire Department by
each Dusiness which at any one lime has on hantl a quantity of acutely
hazardous materials equal to or greater than a weight o! 500 pounds, or a
volume ot 55 gallons, or 200 cuhic feet of compressetl gas al standard
temperature antl pressure).
3. Dces or will lhe applicant or present or fuWre builtling Occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provitles that the
Costa Mesa Fire Depanment may require the preparation, certification and
fling vrith the Fire Department of an RMPP by businesses which are required
to register aculely hazardous materials wilh lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Salely Code been tully complietl with7 ❑ Yes ❑ No
5. Does or will Ihe applicant or present or WNre building otcupant require for
the wark which is the subjecl of this application a permil for such consWctlan
or motlification from Ihe South Coasl Air Qualily Management Dislrict or from
any other air pollulion conUol tlistrict or agency? ❑ Ve5 ❑ No
(Sectbn 65850.2 of Ihe Califomia Govemment Code requires thal ihe requested
information be fumishe0 on applicatbns for norxesidential builtliiy pertnits).
6. Will any pah of Ihe faciliry to be constructed un0er Ihis permit be within
1000 feet fmm the outer boundaries o( a schod? � Ves ❑ No
(I! yes", the facility must meet the requirement of Sections 25534 and 42303
of �he CalifOmia Health antl Safety Cotle).
7. If a permit from the South Coast Air Duality Management District or other
air polWtion control dislrict or aqency is required for the work which is �he
subjact ol this applicalion, have all of the tlisclosures prescribetl by Califomia
Health antl Safety Code Seclion 42303 been madel ❑ Yes ❑ No
8. pf yes", attach certifcate of compliance from the apDropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty ol perjury the
informalion given above is correct. I agree to comply with all state laws and
cily ordinances regarding Hazardous Malenals and Emissions.
SignaWre Ddte
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty o( perjury that I have read this application and state Ihat
the infortnalion given is wrtect. I agree lo comply with all state lavrs antl city
ordinances relating to builtling consWction, and authorize representatives of
Ihe Ciry of Cosla Mesa to enter upon the above-0escribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorizetl by this permit until final inspection.
Sgnawre oi Legai Owneqs�
Anala A on ed Applidnl �D3
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�.�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 968 PAULARINO AV
Suite:
Vicinity:
Parcel Number: 14172222
Zoning: R1 R1
Applicant: MC CONNELL, MARY
Address: 20644 COHASSET - - - - . - . -
' Phone: 808-703-0482
CANOGA PARK, CA � Zip: 91306 ,
� �
Owner. KOGA, YOSHIO TR
Address 968-PAULARINO AVE � �� - �
� " ' . � Phone: .' .
.` COSTA MESA, CA Zip: 92626-2848
Contractoc C CANRIGHT CONSTRUCTION INC
� -
Address: 12920 E SUNNYSIDE PL
Arch :
Address:_
SANTA FE SPRINGS, CA
Zip: . 90670 �.
Phone:
Status: ISSUED
Applied: 08/21/2003
Issued: 08/21/2003
ISSUED BY:
Phone: 562-94E0516
License: 795746 - ,
; Eng:
Address:
Phone:
, � Zip: . - . License: license:
SCOPE OF PERMIT
REPAIR WATER DAMAGED DRYWALL IN�TWO BATHROOMS.' ' , ' � � � ' ' . � �
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: Ss,soo.00
' Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
` Totai:
$139.25
$0.00
$0.00
$0.00 '
$0.00
$139.25
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY � Front 0- 0 �
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
Claim Valuation:
PLANNING & ZONING
left 0- 0 Right 0- 0
Lek 0- 0 Right 0- 0
Proposed: 0
$6,500.00
NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
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
for a period of 180 days.
INSPECTIONS: In order for the work authorizad under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepections and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
...�
WORKERS' COMPENSATION DECLARATION: _
I hereby affirm der penalry of perjury one o� the following declarations:
❑ I hav ntl will maintain a certificate of consent to salf-Insure for workers' compensetion, es provitled for by section 3700 of the Labor Code, for the pedormance of ihe
w tor which tfiis permit is issued.
have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the pertortnanca of the work for which this parmlt is issued.
My wo rs' co De sm r1 ation Insurenca carner end policy number ere:
Cartier �fu�9' Policy Number: �jGa�� �
(This sectlon need nof be completed i/ the permit is valuetl at ane hundred dollers ($700) or less.) �—
❑ I certity ihat in ihe performance of tha work for which ihis permit is issued, I shall not employ eny person in any manner so es to become subiect to the workers'
compensation laws of Calitornia, and agree thet if I shoultl become subject to the workere' compensation provisions of Section 3700 oi the Labor Code, I shall forthwith
comply with ihese rowsions. � � ��^'' T�
Applicant Signature: � ,�c%7 �l � Q. Date: L �J
WARNING: FAILURE TO SECURE WORKER ' CQUPENSATION COVERAGE IS UNIAW FUL AND SHALL SUBJEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
T}IOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PqOVIDED FOR IN SECTION 3')O60F THE LABOR COOE, IMEREST, AND ATTORNEVS PEES.
LICENSED CONTRACTORS DECLAHATION:
I hereby attirm ihat I am licensed untler provisions of C�apter 9(commencing with Section 7000) of Division 3 of the Business�nd Protessions Code, and my license is in full
torce end eaect. ua s �% 5��, class a �L�
Contrectors Signature: ��Z/�L��( !% ��� � Dete: — 7 1 ,h7
CONSTRUCTION LENDING AGENCY:
❑ I hereby aNirm ihat there is e consimction lending agency tor ihe peAormance oF the work for which this permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: LenAefs Address:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirtn that under penalty of perjury that I am EXEMP7 FROM THE CONTRACTOHS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires a permit to construct, alter, improvo, demolish, or repair any structure, pnor to its issuance, also raquires the applicent for such permit
to file a signed statement that he or she Is licensetl pureuant to Ihe provisions of Ihe Conirectors License Lew (Chapter 9(commencing with Sedion 7000) ot Division 3 of the
Business end Professions Code) or ihat he or she is exempt t�erefrom and the basis for the allagetl ezemption. Any violetion of Section 7031.5 by eny applicant for e pertnit
subjects Ihe epplicent to e civil penalty o� not more ihen five hundred dollare ($500).):
❑ I, as owner oi ihe property, or my employees with weges es their sole compensation, WILL DO TME WORK, and tha strudure is not intentlatl or ofrered for sale (Sec.
� 7044, Business and Professions Code: The Contractors License Lew does not apply to an owner of properry who builds or improves thereon, and w�o tloes such work
himself or herself or ihrough his or her own amployees, provitled Ihat auch improvemenis are not intentled or offered tor sale. If, however, ihe building or improvement is
sold within one year of completion, the owner-builder will have ihe burden ot proving that he or she did not build or improve for purpose ot sale.). •
� I, as owner of Ihe properry, am E%CLUSIVEIY CONTRACTING WI7H LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Professions
Cotle: The contrecrore License Law tloes not apply to en owner of propeny who builtls or Improves thereon, and who conirects for such project with a contractor(s)
license pursuant to the Conirectors License Lews.).
❑ I am exempt under sec.
Signature:
Owner ID verifietl by driveYs license. ❑ Yes ❑ No
Business and Professions Code for this reason:
Veriilcation of Ownership by (type of tlocumenL i.e. - property tax bill or deed):
Driver's License No.
Date:
Expires:
DIVISION OF INDUSTRIAL SAPETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excavation tive (5) or more feet in depth into which e person is required [o descenq will be mede in connection with work euthonzed by �his
pertnit, and ihat no builtling siructure, scaHoltling, falsework, or demolition or dismantling ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle 8, Celifornia Adminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a pertnit from ihe Division of Intlusiriel Satety, as notetl ahove, unless such person hes e
pertnit �o tlo such work trom ihe division. .
Signature: Date:
Division of Intlustrial Safery Permit Number.
CEHTIflCATE OF COMPLIANCE AND AUTHORIZATION OP EMAY: I certify under penalty of perjury that I have read this application and state ihat lhe infortnation given is
correc�. I agree to comply wilh all state laws entl ciry ortlinances relating [o building construction, and authoriza representetives of the Clry of Coste Mesa to anter upon ihe
ebove-described property for inspection purposes. I agree not to occupy or sllow occupancy of any building authonzed by Ihis permit until tinal inspection:
r�Stgnat�§ Of egal Owner(s) � �/ Da�e ��
�G�Gi /rl � �
� And/Or Authonzed Applicant Date �`�
COUE �. INSPECTONTYVE
1616 Fixetl System Final Fire Prevention
1268 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202
203
204
Final Fectory Fire Plece
Finel Sign
Final Demolition
Q�¢ INTRIALS
CO�E I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finel Building/Occupancy
P�
�
.mu
Applieanl to Iill in all spaces axcept t�ose wit�in �cavy DorEer Itnes anE sign all apo�opriate eeclarations.
. CITY OF COSTA AE��RUCTION PE MIT PER T 'N/O. TRACT NO. LOT NO. UNIT NO. A P# Zone
Project Address L (J , "��� S Main Building: Accessory Building:
�� TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E Z
Applicant's Mailing Ad ress � Front
u ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � T O
Owner's Name , U%%�I.( U Phon DESCRIPTION OF WORK/USE OF BLDG. A fiear N
Address
TVPEOFPERMIT GRADING OVNDATION STRUCTVRAL �i C Rlght N
Arch�Eng. License No. � ' K G
Addreis ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL S Left R
��_ �� ❑�OTHER Ping. Ref. #` Parking Req./Provided E
Contractor's Nam � Phone Q
r� PROJECT DESCRIPTION SQ. FT. OCCUPArvCV Planning Notes: � M
Address (mailing) � _— .,
3 CONSTRUCTION TVPE VALUATION $
CiIyLiCeMPNn � 20NE GRADINGCU.VDS. ACRES �� � � T
S.
LICENSED CONTRACTOR DEGLARATION
� I hereby allirm that I dm licensetl untlet provi5iOn5 of Chart¢r 9(Commencing Rema�ks: r /��
wilh seclion 7000) of DlriSlon 3 of the Business antl Prote55ion5 COtle, antl
my II<ense is in iw or e antl eHecL ���/� ,.n ELECTRICAL FEES
�icens la Li e� N �K� � Automatic Washer Transformer ❑ 15-SO KW
Date Signature � PLUMBING FEES
WORKERS' COMPENSATION DECLARATION Const�uction PoleSub. � 50+KW
%: ' �eby aifirm tnat I have a cerUticate ot consent to selt-insure or a tertificate Bar Sink Showers
� 'orkers' Compensation Insurance, or a cer fietl mpy thereof (Section CoOking Unit Mete� ❑up ro 100 amps
�, �ab. C.) �j /�j{ Backflow Preventer Service Sink
Poiicy rvo. ����✓ Company/��LAUG 2 Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps
� �rtifietl copy Is heretiy tumishetl. Dryere �Gas :DElectric Sub Panel
C�}'Cert�}fetl w s tiiea witn tne aty B I Qi99 Dy'�' si n.�J/' Bathtubs Sewer Connection
Date K�'�� Applicant �/'� L��LE'J����'Q . Fan
EXEMGTIONFROMWORKERS'COMGENSATIONDECLARATION Clarifi¢f5 SOIarColleCtofS MotorSOPiHPO1'h-8
less�ssection neetl not be comoleted ii the permit is for one huntlretl ($100) or Dishvrdsher Solar Piping F�A�U� Ina SOlar �9-15 HP 016-75+
I certify thal in lhe PerfOrmance oi the work tor which thi5 p¢rm�t is i55Uetl, I FI%[ul¢S
shall not employ any pe�son In any mann¢r so as t0 become subject to the Drinking Fountain5 5012� TBnk MiC�OWdv2
Workers' Compensation Laws of California. Device Boxes
Date Si9nature FlOor Drains Swimming Pool w/Spa " Pole Light
NOTICE: If, after making this tletlaration, you shoultl become subject to the Outlets Renge
Workers' Compensation provi51on5 of the �abor Cotle, you must forthwith Floor SinkS Urinal
comply with such p�ovi5ions or tnis pe�mit snall be tle¢metl �evoketl.
CONSTRVCTION LENDING AGENCV GaSServic2 OUtletS WatefCloset Switches ' Sign
I hereby a�fl�m tltat there IS a<ons[ruction lentling agency for the pertormance .
01 tha wo�k tor which this De�mlt is issuetl (SectiDn 3097 Civ. C.) G2fb2y¢ Di5p0521 Standing Sectwns
Interceptors � Water Heater �
�entler�s Name Generator 00.5 KW �5-15 KW Trash Compactor
Lentler's Atltlress Ki[chen Sink Water Service
OWNER BUILDER DECLARATION
I he�eby atfi�m lhat I am exempt irOm the Cont�actor'S License Law for the LdVdtO�i¢5 AUtO-WeSh
followin9 reason (Sectlon �031.5 Buslness ana Professional Cotle: Any city or
county whicn requires a permit to construct, alter, improve, Cemolish or revatr p-Trap Laundry Tra'ys
any struclure, prio� to it5 Isivance, alm require5 [he applican[ for Such pe�mit
to file a signetl statement tnat ne/sM1e Is licensetl pursuant to Ihe provisions of Roof Drains
the Conlractor's Li<ense Law (Chapter 9(commencing wi[n Section ]000) of
I-' '-ion 3 ot the Business antl Professions Coae) or that he/she is ezempt Reinspection Fee $15 luue Fae $ 3
'rom and tne ba5is for the allegetl exemption. Any violation of Sectlon
5 by any applicant for a pe�mit subjects the aOPlicant to a civil
e��alty oi not more than five huntlretl tlollars ($500). 3 DEVELOPMENT SERVICES REQUIREMENTS:
� I, as owner af the O�opCr[y o� my employees with wa9e5 as their sole RBinSpBttiOn F80 $15 ISSUB FBB $
mmpensation, will tlo [ha work, antl [he structure is not intentletl or offeretl , Za���g APProved By Date
fo� sale (Section 7044, Buslness antl Professional Cotle: The Contractor's MECHANICAL FEES Building Approved By
License Law tloes n0l apply lo an owne� of a property who bulltl5 or iTprove5 Dete %��
thereOn, antl who tloes such wotk himselt/herself or lM1rougM1 his or her own Appliption Issued 6y Dat
em0�oyee5, prOvidea thal Sucn Improvemen[s a�e no[ intentletl or offe�eC tor BOil2f HOOd O� Typ21 ❑ ��
wle. 1/, however, tne builtling or Imorovement is solC within one year oi com- �nopy Type II ❑ SUMMARV OF FEES
pletion, the owne� will have the burtlen ot proving he/She tli0 not builtl or Im- �UCt � Und2� i�ifOUnd
prove tor tne ourpose ot saic). BUILDING PERMIT $ SMIP $
❑ I, as owner oi Ihe provmty, am exUusively mntracting with licensetl con- Duct-Structural Refrigeration System P�AN CHECK $ PERMIT
tfactors to con5[ruct the Oro�eC[ (SeCtiOn 7044, Business antl Profession5 Cotl¢:
The Contractor's �icense Law does not apply to an owner of property who Duct- Ventilating ❑0-100,OOOBTU ❑100,000 BTU P�UMBING $ ���� ISSUANCE $
builtls or imDroves thereon. antl who cont�act5 fo� sucn o�oiect5 wltn a con-
tractor(s1 bcense pursuan� m ine ConVactors License Law). I am aware thai Exhaust System ❑ MW[iple ❑ System Repair/Alteration PLAN CHECK 25% $ ENERGV P.C. $
proof o( their Wo�ker's ComPensation Insutance Shoultl be provitletl to me. ELECTRICAI $ �'iFADIN(�i $
❑ I am exempt untler Section e. & P. C. for this reason Firepl/Fact. BIt. ICBO dk Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date Owner Heating System & Ducting Registers MECHANICAL �
I hereby certify that 1 have reatl tnis aoP���ation antl state tnat tne above ❑0�100,000 BTU �100,OOOBT $ TOTAL FEE $ Q
intormation is mrrect.'t a9ree lo <ompty with all tity antl county ortlinances PLAN CHECK 25% $ �
antl ilate lawi �¢latin9 lo builtling con5tructlOn, anA herGby autho�ize repre- ,
5¢ntativ¢s ot thls city ro en er pon [,�n[iOnetl o erry tor
Inspection purp z
Sfgnature � t� � � �
Driverz' License or 55 3` - � - Reinspection Fee $15 Iwue Fee $ 3
O 1 00055319-OQ055:i 19 T rt T s nn
0865-46, rev. 5/BB White - Builtling; Canary - Applicanh Pink - Accounting; Goltlenrotl - Assessor �R�E% Q3�02�90 TIME: 14C�3
. --..�.. -. . .... . .: i.... .. �_ �� �^..�-.r'�.... . i . .. _ . . � , i. � . .
��
CONSTRUCTION AND PLANNING POOi °�SPA �
APPROVALS Permit # Date Inspector qppROVALS F_..�iit # Date Inspector
t. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical ConduirUndrgrnd. � ' 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings ' 58. Electrical Conduit-Undrgrnd.
8. Foundation . 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, O 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 � � 64. Plumbing System - Final � .
14. Rough Plumbing 65. Elect�ical-Final . -
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
r t
'�"17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
18� Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINA�
!19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
?�0. Rough Factory Fireplace APPROVALS Permit #
��
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil
� 23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �� 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy .. • ..
37. Final Factory Fireplace
38. Final Plumbing GrQ (��i(J
39. Water Service-Final •�
40. Gas Service-Final ;._�
41. Solar pomesticFinal;'� �•) ,
42. Backflow Preventer ' � � '
43. Backflow Irrigation .-, .
44. Landscape Irrigation System
_:t .i
45. Sound Attenuation � �
46. Handicap Regulations: =. - �
n:.
47. FINALSTRUCTURE&BUILDING
:1
48. Special Requirements Completed
i;
49. Electric Release to Edison �: /;�
50. Gas Release to Southern California Gas Co ��'
51. CERTIFICATE OF OCCUPANCY �
No. Date . �
?40�4
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 91] COSTA MEBA, CALIFORNIA
For Applicanf fo Fill In Completaly
TYPE OR PRINT
BUILDING paularino Avenue
ADDRESS
COSTA MESA, CALIFORNIA �
ADDRE58 1304 W. Commo
��TM Fullerton
ORENiGENEER Walt Boder
71— 2110
44-6842
�iC.NO. S9Oi1�I NO. HZS—ZT1O
SIZE /O ,V/ � � ' I No.oRe�ooe.0
OF LOT [O �l NOW ON LOT
USEOF
EXISTING BLDO.
SETBACK LINE FXOM //E� �—i � �
�EFT 5 R16HT ' '
DESCRIPTION OF WORK
BUILOIN6
SIZE
EXTERIOR
u5E OF BU i LOINH AfiD WORK TO BE PERFOHMED
Tract 5340 — Lot 54
Plan 447E
R-1 Reaidence ��
1 HEREBV ACKNOWLEDGE THAT 1 H�VB READ THI APPLICATION
•ND STATE THAT THE ABOVE �8 COHRECT AND AOREE TO COM�
PLY WITH ALL CITY ORDINANC86 AND BTAT6 LAWe R66ULATINO
BUIL�INO cON6TqUCT10N. /
SIGNATURE OF ,���M1� � �`��^�y�_
PERMITTEF �
AUTHORI2ED A6ENT
CITY OF CDSrN M�SA
MAY 5 1965 ,
HHC81P� NO.
OATE ISSIIED
ZONING
NO. O II6E OF N J
PLANB� � I BUILOI�iOr/ R�
YARDS APPROVED
MAIN BUILDING�
DISfANCE BFT.
MAIN BLDGS.
VAR. #`
l
1ALL�F'LE85 THAN
U. B. C. REpU1REMENT
YARDS APPROVE�
ACCESSORV BUILDINO
i
F
BET. MAIN d
ACCE55. BLI
DATE
� N L� 7 SQ. Ff. 'y �% � wl e
TNE AMOUNT BHOWN IINOER VFLIIATION 18 FOR TH8 £
PURPOSE OP ESTABLIBHINO A PERMIT FEE ONLY. 0
VALUATION � m
PERMITFEE $ � � �
$19, �� � m
LA CHEC � ¢
/l 1� h 6