HomeMy WebLinkAbout2826 FRANCIS LN - Building Permitsjr
� .....T .
Suite:
Vicinity: BEDROOMS
Primary Occ: R3
Parcel Number: 14133201
npp�icant: NEPPL, LINN S
Address: 2826 FRANCIS LN �
COSTA MESA, CA
Owner: NEPPL,THOMAS J& LINN S,
Address 2826 FRANCIS LN
COSTA MESA, CA
Contracror: O W N ER-BU I LDER
Address:
Zip:
Arch :
Address:
Phone:
Zip: License:
Type ot Construction: V-N
Zoning:
Phone: 714-434-4898
, , Zip: 92626
Phone: 714�34�898
� Zip: � 92626
Phone:
License: 000000
Eng:
Address:
ISSUED BY:
SCOPE OF PERMIT
INSTALL 2 NEW WINDOW OPENINGS IN BEDROOMS FOR A SINGLE-STORY SFD.
FEE SUMMARY
Plan Check: $0.00 ,- - . . . - Calc Valuation:
Permit: $97.25 ' `- Claim Valuation:
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Ezistin : p
PLANNING & ZONING
Rear � 0- 0 Left 0- 0
Rear 0- 0 Left 0- 0
Reauired: 0 � Pr000sed: 0
Right 0-0
Righ� 0-0
Applied: 09/07/2006
Issued: 09/072006
Phone:
License:
$3,154.00 �
$3,154.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspendetl or abandoned
for a period of 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requfred Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
taaa-ae �sioo�
WORKERS' COMPENSATION DECLARATION: � �v^( !
I hareby aftirm under penalry of perjury one of the following declarations: "
❑ I have antl will maintain a certificete of consent to self-Insura for workers' compensation, as provided for by section 3700 of the Labor Cotle, for the pertormence of tha
wark for which this permit is issued.
❑ I have antl will maintain workers' compensa[ion insurance, as raquired by saction 3700 of the Labor Code, for Ihe pertortnance of the work for which this pertnit is issued.
My workers' compensation Insurance carrier and policy numher are:
Carrier: Policy Number:
(This section need not be cromp/eted i/ the permit is valueU at one hundred dollars ($f 00) or less.)
❑ I certity that in Ne�pedormance of the work for which �his permit is issued, I shall not employ any person in eny manner so as m become subject ro tha workers'
�ompensation'laws of Calitomla, antl egree that if I should become subject ro the workers' compensation pmvisions ot Section 3700 oi ihe Labor Cotle, I shall fonhwith
comply with lhe5e provi5ion5. t � �7
ApPlicent�SignaNre:^--. gY�� CZ �-C �,—�i�Q ''Date: ` �%�� �
WARNING,FAILURETO SEOURE WORV�RS' COMPENSATIdJ W VERAGE IS UNLAW FUL AND SNALL SU&IECT AN EMGLOVER TO CRIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000), IN AODITION TO THE WST OF COMPENSATION, DAMAGES AS PFOVIDED FOR IN SECTION 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLAFiA710N:
I hereby affirtn that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full
force end eHect Lic A Class #
ContractoYs Signature: Date:
' CONSTRUCTION LENDING AGENCY:
❑ I hareby aflirm ihat there is a consiruction lending agency for the pertormance oi ihe work for which ihis permit is issued. (Sec. 3097, Civil Code).
LentleYs Name: Lender's Address:
Signawre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm t�at untler penalry ot perjury that I em EXEMPT FHOM 7HE CON7RAC70RS LICENSE LAW tor ihe following reason (Sec. 7037.5, Busineu end Professions
Cotle: Any city or counry which requires e pertnit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, elso requires ihe applicant for such permit
lo tile a siqnetl statement that ha or she Is licensetl pureuant ro the pmvisians of ihe Contractors License Law (Chapter 9(wmmencing with Sectlon 7000) of Division 3 of ihe
Business end Professions Code) or ihet he or she is exempt iheretrom end ihe basis tor ihe ellegetl exemption. Any violation of Section 7031.5 by any epplicant for a permit
subjects the applicent to e civil penalry of not more than fiva hundreA tlollars ($500).):
❑ I, as owner of the propeny, or my employees with wages as Iheir sole compensation, WILL DO TME WORK, ana ihe siructure is not intendad or ottered for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of property who builtls or improves thereon, end who does such work
himself or herselt ar ihrough his or her own employees, provided ihat such improvements are not intended or aHered for sale. If, however, the building ar improvement is
sold within one year of completion, the owner-builtler will have the burden of provinq ihat he or she did not build or improve for purposa of sale.). •
--�-'v
��I, as owner ot ihe propeny, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business end Professions
'�,:.�-Code: The contrectors License Law does not apply to an owner of property who builds or Improves thereon, and who coniracts for such pro�ect with a coniractor(5)
license pursuent to ihe Coniractors License Laws.).
Owner ID veritied by �driver's license. ❑ Yes ❑ No
eusiness end Professions Code tor this reason:
Date:�n- �% � �
DAveYs Llcense�No. Expires;�' �L� 0 7
Verification oi Ownership by (type of document, i.e. - property ta�c bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I heraby cetlify Ihet no excavation tive (5) or more feet in depih into which a person is required to descend, will be made in connection with work euthorized by ihis
permit, and ihat no builtling sirucwre, scalloltling, falsework, or tlemolition or dismantling thereof, will be more ihan thirry-six (3fi) feet high. (Chap. 32, Grp 2, Art 2, Sec.
361, Title 8, Califomia Administrative Code).
❑ As owner-builder, I wiil not employ anyone to do work which would require a permit from the Division of Industrial Satery, as notetl above, unless such person hes e
permit to do such work from the division.
Signeture: Date:
Division ot Industrial Satery Permit Number:
CERTIFlCATE OP COMPLIANCE AND AUfF10fiIZATON OF ENfAY: I certity under penalry of perjury that I have read this epplication and state ihat the infortnation given is
correct I egree to comply with all state laws and ciry ordinances relating to building consiruction, and authorize representatives of the Ciry of Costa Mesa to enter upon ihe
ebove-described propehy for inspection purposes. I agree not to oc�cu�pjy or allow occupancy of any building authorizad by this permit until final inspection.
�C�-Q�C� -(/'—`— �/�%�� �o
.,Signature fLegalOv+ner(s);^�^ ' �date J
��
And/OrAuthonzed Applicant Date
COOE M. INSPECTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final8locWRe[aining Well
202 Final Fadory Fire Place
203 Finel Sign
204 Final Demoli[ion
D�TE irnnu�s
i i
"m� - %G
CODEt INSVECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 final Builtling/Occupancy
URTE 1�{�
DiVISION OF BU1L•DING SAFETY rt
�CITY OF COSTA`MESA
A P P R O�V.E D
By � �% o�e--�-I—�--u—
Thts set a p�ar�s and MUST be keyl on nus jon at au nnes and a's urdaeiN b
m�many d�es a a�r�as m asre wiAat'�fien pertrissian kan Ihe �iviaian d8�ianp
and Sekfy. CdY d Costa �lesa
ThestenpigofMspanand " ' SHAILMOTbaheldtopwmbarobeanappor�
ot tlie vioWtion ot any provisiais ol any Gty of Costa Mesa Ordinance anNor State laa
Tlkte pmns aiM pertra sna� e�ue hy 6mdatbn aiM becane nuA ard void it the diil6�g a
.a1c o na amnaiom ad mapVairod adire ver UBC 53031� wciii 16o mys d issuaps
�6�Ou
�/X6 /7e�DeRs �ni0 I
k�A�G Si�Ds
TO Qe 90�e0
G'a" �
� y.o ,�
as" 7'0
9 0„
b'o'=
' �si,N9
\'l �
�.n..
i 6 'o' ,
' � �p„ a8„
�3�a,
� _ . `�% �a-�� ,�
� �
<
�� °� �� �?%da �i'uuP�i�c� �uuiv,�a�
OWNER-BUILDER
VERIFICATION
der `ss: � � �� ��uK �5 (iR "� � Pcrmit #:
A city or county, which is required ro give notice pursuant ro Section 19830, shall attach to such notice, and, as
a condition precedent ro issuing a building permit, require the completion and require the remm of, an owner-
builder verification.
Atten[ion Property Owner:
An `owner-builder' building pertnit has been applied for in your name and bearing your signamre.
Please complete and rewm this inforniation in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building pemiit. No buildine oermit will be issued until this
verification is received.
� I personally plan ro provide the major labor and materials for construction of the proposed
property improvement. ❑ Yes �} No
2� have ave not) l/�� �/� signed an application for a building permit for
the proposed work.
�I:have contracted with the following person (firm) to provide the proposed construction:
Name ��e (r �or-�r'c. 2ep:4 ce...1e.-�.'�
Address r� zY �.5'�tiF�er' �✓e Ciry (-04�.�: ^(/u l(�y
(� ) � q�l3� i
Phone !V � 7 S`�" Y�fa d Contractor's Lic. No.
4. I plan to providc portions of the work, bu[ I have hired the following person to coordinate,
supervise and provide the major work:
Name __
Address
Phone (
City —
Convactor's Lic. No.
1 will provide some of thc work but 1 have contracted (hired) the following persons to
provide the work indicated:
Name Address Phonc Type of �Vork
tOC2�46 (Rev.ill04)
(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626
BUILDING PERMIT
JobAddress: 2826 FRANCIS LN
Suite:
Viciniry:
Primary Occ: R3
Parcel Number: 14133201
Applicant: LYON, CHRISTOPHER
Address: 2826 FRANCIS LN
Type of Constmction: V-N
Zoning:
- Phone: 714-444-4491
COSTA MESA, CA Zip: 92626
Owner. LYON, CHRISTOFHER AND MARLENA
Address '2826 FRANCIS LN �
COSTA MESA, CA
contraccor: OW N E R-BU ILD ER
Address:
Zip:
ArCh ;
Address:
Phone:
Phone: 949-933-3306
Zip: 92626
Phone:
License: 000000
Eng:
Address:
Status: ISSUED
Applied: 07/07/2005
Issued: 07/01/2005
ISSUED BY: // �t �
� �
Phone:
Zip: License: License:
SCOPE OF PERMIT
REF EXPIRED BUILDING PERMIT 52009. FEES CHARGED AS PEf2 ED PETROS BASED ON THE ORIGINAL PERMIT FEE.
Plan �heck: $0.00
Permit: $0.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $0.50
SETBACKS '
MAIN S7RUCTURE Front 0. 0
ACCESSORY Frorit 0-0
PARKING Existin : 0
NOTES:
Rear 0. 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
So.00
So.oO
NOTICE: The work authorized by ihis permit shall comply wi�h all applicable handicap access requiiements under California statutes and related
regulations. (Ord. No. 9248, § 1, 72•21•92)
EXPIRA710N: This permit shall automatically expire and become void it work Is not commenced within 180 days, or if work is suspended or ebandoned
for a period oi 180 days.
INSPECTIONS: In order for the work authorized under thig permit to be considered legal, such work must comply with all applicable codes, end ell
raqulred Inepectlona end final epprovel must be obtained. Failure to obtain Inspections and tlnal approval will result in tha expiration of lhls permit.
FOR INSPECTIONS CALL: (714) 754-5626
taa5-ae (srool
WORKERS'COMPENSATON DECLARArON:
I hereby eHirtn under penelry oi perjury ane of the tollowing deGaretions:
❑ I heve end will meintaln e certiilcate ot consem to setl-Insure lor workers' compensellon, es proWded tor by sectlon 3700 0l the Lebor Code, tor the pertortnence of the
� work for w�ic� t�is permit Is issuetl.
❑ I hava end will maintaln warkers' compensation Insurance, es required by sectlon 3700 ot ihe Lebor CoOa, for ihe peAormance of tha work for which Nis pertnit is issue0.
My workers' compensetlon Insurance carrier and policy number ere:
efale
�"_'
❑ I cert Ihat in the pertarmance ot the wodCfor which Ihis permit is issuetl, I ahflll n mploy any person in eny anner so es to become subJect to Ihe workers'
co nsellon lawe of Cellfomie, end e 4e Nat ii I s�oultl becoma sub�ect to t�e orkers' compensatlon pr sions of Sectlon 3700 of ��e Latwr Code, I sheli toMwlth
l�y with Ihese provislons.
Ap �ni5lpnaWre: � 1e�
W INO: FFILURE TO SEWiiE WORI(ERS ENSATION COVEMGE IS UMAWFUL O SNRLL SUBJEGT AN E OYER TO CRIMINqL PENALTIES AND qNL FlNES UP TO ONE HUNDRED
DDOIURE�S100,W0),INADDff10fJ THECOSTOFOOAIPENSATI(1N,DAMAOESASPROVIOEDFORINSECTIIXJ3IWOFTMEUBORCODE,INTEFE5T,RNDATTOHNEY5FEE5.
ED CONTRACTORS DECLARATION:
eHirm thet I am Ilcensetl untler proNs ns ol Chapter 8(commenUnp wi Sectlon 7000) ol Divlslon 3 al Business antl Prolessions Cotle, entl my Ilcense Is in fuli
tl� uc. a -s�
CONST(7UCTION LENDING AGENCV: /
❑ I hereby eflirtn that t�ere Is e constructlon lending egency tor the peAortnance of Ihe work for which ihis pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lendere Namo: LentleYs AdGress:
Signeture:
OWNER-BUILOER DECLARATIONS:
Date:
I hereby eHirtn ihet under penelry o1 perjury that I am E7(EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business antl Protessions
Cotle: Any dry or counry whicli requires e pertnit to construcL elter, imprwe, tlemolis�, or repair eny sWcture, prior to its Issuance, elso requires the appliwnt for such pertnit
to file a slgneA statemenf that he or she is Ilcen5e0 pursuant to Ne D����g a� �he Contrenors License Lew (Chapter 9(commendng with Secllon 7000) of Dlvision 3 of Ne
Business end Professions Cade) or Ihat he w she is eaempt Neretran eiM Ihe beslv for the elleged exemptlon. Any Wdatlon of Section 7031.5 by eny epplicant for e pertnit
subjecis the epplicant to e Gvil penalry o1 rwt more than Me hundred ddlars (5500j.):
❑ I, es owner of the properry, or my employees with weges es Iheir sole compensatlon, WILL DO THE WORK, and the strudure Is not IntenAeA or otteretl for sale (Sec.
7044, Business end Protessions Cotle: The Contractors License Lew does not apply to en owner of properry who builds or improves t�ereon, end who tloes such work
himsetl or hereelt or through his or her own employees, providetl t�at suc� imprrnemenis are not intended or oHered for sale. If, however, Ne building or imprwement is
soltl wit 'n one yeer af campletion, the owner-�uilder will have Ihe burden of proving t�at �e or she did not build or improve tor puryose of sele.). �
❑ I, es n af the praperty, am EXCLUSIVELY CONTFiACT1NG WITII LICENSED CONTRACTORS to conswct Ne pro�ect (Sec. 7044, Buslness and Professians
e: wntrecbrs ' nse w Aoes not appty to en ownar of pmperry who builds or Impmves thereoq end who contracts tor such pro�ect wit� a contractor(s)
icen pu uent to ih Contr ro License Laws.).
I em 1 unC sec. Business enA Professions Code lor this reason:
newre: � O
o river iCen56. Y ❑ No Driv s Uten99 N hgy: — —
Venlication of Ownership by (rype oi tlaument, i. .- property lez 6111 or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON:
❑ I hereby cenity that no ezcavatlon five (5) or more teet in tlepth Into whlch e person Is requlrad to descend, wlll be metle In connectlon wlih work euthodzed by NIs
pertnil, end Ihet no building sirudure, scallolding, telsework, or tlemolitlon or tllsmantling thereof, will 6e more Ihen Ihirty�six (36) feet high. (Chep. 32, Grp 2, An 2, Sec.
341, Tltla 8, Calllomla AOmlNsiraNve Code).
❑ As owner-bullder, I wlll not employ enyone to tlo work which woulC repuire e pormit Irom the Divislon ol Industriel Selery, es notetl ebove, unless such person has e
pertnit lo do such work fmm Ne tlivision.
Signeture: Dela:
Divislon oi Industnal Salary Pertnit NumDer.
COUE �. INSPECfIONTYPE QAIE Q�ALi
1818 Fixed System Final Fira Preventi0n
1268 Pod Spe Flnel
200 Finel Re-Roof
201 FIneI BIocWRetaining Well
202 Final Fectory Fire Place
203 FIneI5lgn
204 Finel Domolltlon
COOEI �xsveenoxirve
208 Final Mechenicel
208 Finel Plumbing
210 Finel Electrlcal
212 Finel Flre Preventlon
220 Finel Plenninp Approval
222 Finel Slle
250 Flnal Bulldinp/Occupancy
PAg
• �
Q�ELS
�
N
S
F
C
m
f"
a
7
�
.�
x
�
a
O
C
a
Z
W
S
3
�COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CAL�FORNIA 92626
For Applicant to FHI in Completely — Use Ink Only
BUILDING �%L /
ADDRESS �!/V YCi �-��
OWNER OR n�, ` /- ����N � /�
TENANT ,y ��d �
MFILING ���� �j� n�G/S
ADDRE55 /`/�. �,
CITV��/��SA N�LS�e'�i
t%i-�di
CONSTRUCTIONC�GCL/Z�%y �ClG/�
LENOER /
BRANCH �� ��O2A.VC� /�
ADDRESS �j' G...
ARCHITECT TEL �
OR ENGINEER -� N /O`
ADDRESS��O � �O�tilK �'rO. /Y�'I�J
--�
CONTRACTOR v�/�� /�K�LQF�
(
ADDRESS
TEL.
GITV NO.
STATE CITY
LIC. NO. LIC. NO.
SIZE � NO.OF BLDGS
OFLOT�%xs6x(?�'x/vg NOWONLOT I
USE OF �
EXISTING BLOG. �D/y/�
Separate permits are required for
electriq plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
P�u. . B
APPLI ATION FOR STRUCTURAL
Ir4Vl� G/I�./Fil
4ECE PERMIT '
N° -
A.P. NO. /�� — 33� — O
AODRE55 L C} Z(p � - vC
UNIT OR
SPACE NO.
.Q �� � I LOT O /
S CJ �
NEW ADO ALTER REPAIR MOVI
I CZ (3 f 'rl
V V (�
v
�N w `
V
BLK. N
DLISH �
OWNER /-rT�/G. M1 • / ojLiCGCN•
VSE ��G%Q I L�Dy VALUEBL/ v�
�
,,,.,� _ r.,o� �! ,.o,,,,e P— 3
APPROVED
BV
, !Z
APPROVEDSET
(FROM GL STR
PLANNING ACTION
DATE
J u ��
DATE
APPROVED
�
i hereby acknowletlpe t�at I have read this epplicaiion antl state
that the ebove information is correct antl aprae to comply wiih
all laws �ae�ieii�e builtlinB connructian, entl I shell not employ
eny person in viotation of Me workmnn'a compensation lewa of
Ma Stata of Californle. �O
I hereby cenify that I am properly Iicensetl es a<onttactor untler 5�. FT. ,
the Staia of Californla Business entl Professions Cotle, Division 3, THE A OUNT SHOWN UNDER VALUATION
Chapter 9, antl that such licanses are in full force and effect, or I THE PVRP06E OF ESTABL6HING A PERMIT FEE
am exempt from tha p vlsions ot the 52axe o Galifornia Business
enGProfassionsCotle rvision3, haptar9 VALVATION PERMITFEE S S
Sipna[�re ot PLAN CHECK $ �.
Parm�(ttee � a 5�,�32� TAX S
Au[horizotlABan[ Date 6 � TOTALPAID E _�'
t
m
n
i
m
J
m
e
4
m
m
0
f
U
OwhER PAUL R. THOREEN
DATE 6-15-81
cas
SUBCOMTRACTOR
W �TER Pfumbin
AOUGN FLUMBING
aAOP. SWF, �INE � j NOUSE COM.
SPNINKLIN(i $YS1EM
rn�SCELL�ME0U5
AOUGN NE�11MG AMO M R CONDITIOMING
UNDEAGAOUNO � I POWEA
AOUGa WIP�INGc � T�
TNFufH�S �/ Pllwuc I I
BOwp BE�M � i STEEL REINFOFCE
SME�rHiwG y�
�S�ME atlD CUSMING l—�
L�1�iML — IN �'� OUT ` '
PVSiEA. BAOWM COAT
$TAJCiJF��. f IM�L
ME�T�MG. vEMT., HEFRIG, �ryD A.C„ i
�IUMBING FINI.I ANU GAS «$T �
EIEC*PiC, �iN�L
BWLOir�G, ��H��
SPEC��L FEOU�AEMENTS
UiLL�'Y HOtiitED. G�S i1 ELECT. I
CMF O<86�4G �PV <)
a
52009
�
i�YY OF CO
��
AVPi��ant to fill in all s
��,SA PERMIT NO.
PERMIT y
�� .
Arch/Eng. - - ' License No.
Address � . - -
Phone
within neavy Dortler lines ana
�v
Atldress '
LICENSED CONTRACTOR DECLARATION
I hereby aftirm that 1 am Ilcensetl untler provislons of Charter 9(com-
mencing wlt� sectlon -1000) of Divislon 3 of. the Buslness antl
Professlons Cotle, antl my Iicense is in full force antl etiect.
Lltense Class Llcanse No. �
Date Signature '
WORKERS'COMPENSATION DECLARATION �
I hereby affirm that I have a certiticate ot consent to ulf-Insure or a
certlticate ot Workers' Compensation �Insurance, or a certl/letl copy
thereof (Sectlon 3800, Lab. C.).
Mlicy No. Company —
'ertitied copy Is hereby furnishetl.
:ertitietl copy I5 filetl with the city Builtlinq Oivislon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be. tompleted if the permit 15 far one hundretl
��(E300) or less). �
I Certlfy tM1at In th¢ per(ormanCe ot tlte work tOr whith this perTit I5
I5511¢tl, I Shall nOt empl0y dlty p¢r5on In any mannel so as to become
subject to the Workers' Compensation Laws of Cdlifornia.
Date Signature
NOTICE: If atte� making this tleclaratlon, you shoultl b¢come subject
tc the Workers' Compen5ation prodisions of the Labor Cotle, you must
forthwltn Comply wi[h sUCM1 proW5ion5 or this p¢rmit Shall b¢ tleertl¢d
revoked.
CONSTRUGTION LENDING AGENCV
I hEt¢by affirm that th¢r¢ is a ConSlruCtlOn I¢Otling agency (or the per-
fo�mance ot the wo�k fo� which [his permi[ Is issu¢tl (SeGtion 309]
r.iv. c:I. '
L'entler's Name
Lentler's AtlGress
OWNEH BUILOER OECLARATION -
I hereby atfirm that I am ezempt trom.[he ConVactor's License Law for
Ine following reason (Settion 7031.5 Business antl Professions Cotle:
Any city or county which requires a permit to construct, alter,
improve, tlemolish or repalr any structure, prior to its issuance, also re-
quires the applicant for such permit to tile a signetl statement that ne
Is licensetl pursuant to the provlsions of the Contrac[or's License Law
(Chapter 9(commencing with Section 7000) of Dlvision 3 ot the
Business antl Professions Cotle) or tnat ne is exempt therefrom antl the
Casis for tM1e allegetl exemption. Any violatiOn of Section ]031.5 by
' appliwnt tor a permit subjects the applicani to a clvll penalty
�I mOr¢ than five huntlretl tlollars ($500).
., as Owner O/ thE prOperty, o� my employees wi[M1 wages as t�ei�
sole compensation, will tlo the work, antl the structure is not intentletl
or offeretl for sale. (Section ]046, Business antl R'ofessians Cotle: The
ContractoCS License Law tloes not apply ro an owner ot a property
who builtls or improves thereon, antl who tloes such work himsei( or
throu9h his own ¢mployees, providetl that sucn improvemen[s a�e noi
intentletl or offeretl for sale. If, however, tM1e builtling or improvement
6 soltl within one year ot completion, the owner will have [he burtlen
of proving he tlitl no[ builtl or improve fo� the pu�pose of sale).
❑ I, a5 owner Of the property, aT exclu5ivety con[racting with
litensetl contractors to construct tne projett (Section ]044, Business
antl Professlons Cotle: The Conlractor'S License Law tloes not apply to
an owner of property who builds or improve5 thereon, antl who con-
tracts from such projects wiih a contractor(5) licesnetl pursuant to
the Contractor's License l.aw).
❑ I am exempt untler Section B. & P. C. for this
reason � /�
Date !L; O .!�_� —
I have reatl this applica[ion antl state that the above
ect. I ag�ee to comply with all city antl coun[y
laws rElat g to cOnst�uctlon, dntl hCreby autho�iz¢
this cit to enter upon the above rpentionetl
Signature - ^ Date �
Drivers' License or 55 � �
CMF 0865-46 White-Builtling; Canary-Applicant; Pink-Accountin9:
all apD/o0riate tleclaration
LOT NO. �BLDG.NO.
TVPE OF C,O�/NS7q UCTION
�O NEW IGAOD' ❑ ALTERATION' �
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTIONOFWORKL%aWArT/A%/[ GAnI%Lv KAt.
— G(/rrAi/�l� GFr/L/—� Kooa.
TVPE OF PERMIT ' - �
❑ GRAOING,�,� ❑- FOUNDATION ❑ STRUCTURAL
.OTENANT L7ELECTRICAL ❑PLUMBING � ECHANII
❑ OTHER
PRO�ECT DESCRIPTION�
SQ. FT. `r� 0 _ .
OCCUPANCV_CONSTRVCTION TVPE
VALVATION ZONE
GRADING CU. VOS. ACRES
f2EMARKS:
PLUMBING
BATHTUBS
TOIlETS •
LAVATORIES
KIT.SINKS �"
SERVICESINKS -
FLOOR SINKS
DRINKING FOUNTAINS
�INTERCEPTORS
$WIMMING POOL
WATER SERVICE
WATER HEATERS
SEWERCONNECTIONS
SOLARTANK
PLAN CHECK '
SHOWERS
URINAL$
DOVBLE LAVS
DISHWASHERS
SUMPS
FLOOR DRAIN$
CLARIFIERS
PTRAP
ALTERATION
OUTLETS
BTU'OUTPUT
COILECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLANCHECK
HEATING SVSTEM G100,000 BTU_
AND DUCTING 100,000 + gTU _
REFRIGERATION 0-300,000 BTU_
SVSTEM 100,000+gTU_
BOILERS BTU
SVSTEM REPAI R, ALTERATI ON
EXHAUST SVSTEM MULTIPLE
ISSUE FEE
-ASSE5501
7892 10/22/BI
ZONING REGULATIONS
A.P. �
ZONE PLNTGp. R�E/F. p# .
SETBACK C/L ST. PROPE�RTVn
�IDE VARD
EF
c�nrvadlS .. _
'. REAR YARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
ZONING APPROVEO BV
SPECIAL COND�TIONS:
� ,
ELECTRICAL
r��
PROVIDED
PARK FEE
PLAN CHECK
50�. FT.���u �� 5(]. FT. �
GENERATOR 0-1 KW_1-30 KW _
TRANSFORMER
APPLIANCE 10-SOKW_SO+KW_
MOTORS 0-1 HP_1-10 HP _
�(IN0. SOLAR) 10-50 HP 50 + HP _
FIXTURES � OVTLETS SWITGHES
GAS TUBE SIGNS ' ' �
POLE LIGHTS
14,25 TL�
PANEL$ - MAIN SUB
SERVICE - AMP
ISSUE FEE
APPLICATION APPROV ED BV -� DATE
SUMMARV OF FEES
BUILDING
PERMIT $ SMIP S_
PLAN CHECK $ PERMIT
PLUMBING g ISSUANCE $_
GRADING $_
PLAN CHECK 5 � y �
ELECTRICAL $1�_9_-` $
PLANCHECK $ MICROFILM $_
MECHANICAL $� TOTAI_FEE$_
PLAN CHECK g LE55 AD�
VANCEPC $_
, v�r
FINAL FEE y /
, _�
CONSTRUCTION AND PLANNING � POOL & SPA � ��
i �, r• - � ..c� Date Inspector • Date - Inspect�r -
APPROVALS Permit # APPROVALS Permit #
1. Temporary Electrical Service or Pole .�� 43. Pool & Equipment Location �
2. Soil ipe-Undrgrn 44. Steel Reinforcement � •
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn �
8. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor System 52. APPROVALTO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection � � 54. Heater & Vent-Final
13. Rough Plumbing -
14. Rough ElectricConduit - �56. Electrira6Final
15. Rough Electric-Wiring 57. Solar SYstem-Final
16. Rough Heating & Air Conditioning � encing & Access Approval
77. Ducts in Structure 5. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing - -
21 . Roof Sheathin ' �
22. Frameand Flashin -
NOTES:
23. Insulation
24. Lathing & Siding �
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric I L3 G� B� �k0
29. Final Heating & Air Conditioning (6/Z �`/ �,Fa� - ' •
30. Final Gas Pipe-Test ���
31. Final Plumbing � '
32. Water Service-Final '
33. Gas Service-Final
34. Solar pomestioFinal ' �
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations '
38. FINAL STRUCTURE & BUILDING " ��
39. Special Requirements Complefed
40. Electric Release to Edison •
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY '
No Date
(714) 754-5273 • Fe�c (714) 754-4856 • www.Ci.COsta-mesa.Ca.u3 77 FAIR OFIVE, GOSTA MESA, GA 92626
, BUILDING PERMIT � ,
JobAddress: 2826 FRANCIS LN
Suite:
Viciniry: ROOF
Parcel Number: 14133201
Zoning:
Applicant: JEFF LEHMAN
Address: 2415 MARGARET DR
, . Phone: (949) 6463571
NEWPORT BEACH, CA Zip: 92663
1
Owner: LYON, CHRISTOPHER AND MARLENA
Address '2826FRANCIS LN
i
. , Phone: 949-9333306
COSTA MESA, CA - Zip: 92626
Contractor. J S L ROOFING INC
Addre55: 2415 MARGARET DR
Arch :
Address:
Phone: (949) 6463571
NEWPORTBEACH,CA
Zip: 92663 License: 747706
Phone:
Eng:
Address:
' � Status: ISSUED
Applied: 08/30/2004
Issued: 08/30/2004
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 30# FELT, 30 YEAR COMPOSITION SHINGLES, AND REPLACE/REPAIR SHEATHING AS
NEEDED. 3,000 S.F. INCLUDES ATTACHED GARAGE.
Plan Check:
Permik
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$167.25
$0.83
$0.00
$0.00
$0.00
$168.08
SETBACKS.
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: 0
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lefl 0- 0
Lefl 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0-0 ',
$8,300.00
58,300.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In ortler for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectione and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
. FOR INSPECTIONS CALL: (714) 7545628
2446d8�N00)
. .
WORKEHS'COMPENSAnONDECLARAnON:
I hereby aXirtn under penalry ot perjury one ol lhe following deGeretions:
❑ 1 heve end will meintain e certilicate ot wnsent to selt-Insura tor workero' compensatlan, es provlCed lor by seIXlon 3700 oi ihe Lebar Cotle, for the peAortnance of ihe
work for which t�is permit is issuetl.
❑ I have and will maintain workers' compensatim insurence, es required by section 3700 of the Lebor Cade, for the perfortnence ol the work for whic� this pertnit is issued.
My workers' compensatlon Insu�ence cerner entl policy number ere:
Cartier.
(Thls section need nat be c
ihat in the per
sation laws of
with Ihese pra
TMOUSAND DOLLARE
velued af
oNess.)
Policy Number:
'work lor whic s Dertnil is Issued, I shall not employ eny person In eny menner so es ta bewme subject to ihe workers'
eprea tha � oultl become suC�ect to the workere' compensatlon provislons ol Sectlon 3700 of the�, I shall torthwith
' Dete: D �
�PEN VERApE IS UNLAWFUL M!D SHFLL SUBJECT PN EM�CRIMINAL PENALTIES AND CIVI� FlNES UP TO ONE HUNDREO
JTHE TOFCOMPENSATION,OAMACaESASPROVIDEDFOqINSECTI0N�O80FTHELABORCOOE,IMEREST,PNDATTOHNEI^SFEES.
LICENSED CONTRACTORS DECLARATION:
am licensetl untler provisions of
Section 7000) af Divislon 3
Code, end my Ilcense Is in tull
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm ihat Ihere is e construclion lending agency tor the partormance ol the work tor which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lendefs Name:
Signeture: _
OWNER-BUILDER DECLARA710NS:
Lendefs AtlCress:
Dete:
I hereby ettirm that under penelty of perjury Ihat I em EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for Ihe lollowing reeson (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requlres e permit to constmct, elter, improve, tlemolish, or repeir eny stmcWre, prior to its Issuence, also requires the epplicant tor such permit
to ille e signed stetement that he or she Is Ilcensed pursuent to ihe provlsions oi the Contrectors License Lew (CheD�er 9(commencing wlth Sectlon 7000) of Dlvislon 3 ot ihe
Business and Professians Code) or that he or sha Is ezempt therefrom an0 ihe besis lor the ellegetl exemption. Any vloletion of Sectlon 7037.5 by any epplicent tor e permit
sub�ects the epplicent to a civil penalry af not more then flve huntlretl tlollers ($500).):
❑ I, as owner oi tha property, o� my employeas with weges as Ihelr sole compensatlon, WILL DO TME WORK, end ihe siructure Is not inten0etl or oHeretl for sale (Sec.
7044, Business and Professions Code: The Contrectors License Lew tloes not apDly to an owner of property who builds or Improves thereon, and who does such work
himsalt or herself or through his or her own employees, provided ihat such improvements ere noi Intendetl or oHered for sele. If, however, Ihe bullding or Improvament Is
sald within one year ol completian, the owner-builder will have the burtlen oi Droving thet he or she did not build or improve for purpase ot sale.). •
❑ 1, as awner af the Oroperty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the pro�ect (Sec. 7044, Business and Professions
Code: The con�rac�o�s License Law tloes not apply to en owner ol property who bulltls or ImproveSlhereon, entl who contracts lor such project wil� e contrector(s)
. licensa pursuant to ihe Contrectors License Lews.).
❑ I am exempt untler sec. 8usiness and Professions Code lor this reeson:
Signature: Dete:
Owner ID verified by dAvefs licensa. ❑ Yes ❑ No Drivels License No. E:pires:
Vertlication of Ownership by (type ot documenL I.e. - property tez bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby certify ihat no ezcevetian tive (5) or more leet in depih into which e person Is raquirad ta descenA, will be made in connectlon with work auihorized by this
permit, and tha� no building structure, scaHolding, felsework, or demoli0on or dismaniling thereof, will be more then thirty-six (36) tee� high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle B, Calilomia AdmiNstrative Code).
❑ As owner-builder, I will not employ enyone to do work w�ich would require a permit from �he Division of Intlustriel Sefety, es notetl above, unless such person has a
pertnit to do such work from Ihe division.
Signature: Da�e:
Division of Industrial Sefery Permit Number:
CERTFlCATE OF COMPLIANCE AND AllTHO 710N OF ENTRV: I certify under penalry ol perjury ihat I have read Ihis epplication end state that Ihe information given is
wnect. I egree to mmpy/�+'Ith sll state laws n0 ciry ortlinances releting to builtling constructlon, antl authorize representatives of the Ciry of Coste Mesa to enter upon the
ebove-descnbed D�operry/or inspection pu es. I egree not to acupy or ellow accupency ol eny building authonzed by Ihis parmit until final insDection.
CO�E I,
1616
1266
200
201
202
203
Fixetl Sysiem Finel Fire Preventlon
Pool Spe Finel
Flnel Re-Roof
Finel Block/Retaining Well
Final Fectory Fire Plece
Final Slgn
204 Finel Demolition
Q� ��
��
�
CO�EI ixsrernoxnre
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Flnal Fire Prevention
220 Final Planning Approval
222 Final Siie
250 Finel6uiltling/Occupency
!7.IiiISY�iI.1F9
•
ADolicant to fill in all spaces except those within heavY Oortler Ilnes anC si9� all aOP�opriate aeclarations.
,` P M TR CT N LOT UNIT NO.
iIII�OFCOSTAIViE{S�,4��CONSTRUCTIONPERMIT ���G./.,� �tO�Z �'I � A�P�#
� Projec ,Atldress �s� Z� ����C f S , C o s �-7i- ckCSP ,
,
���^nlicant's rylailing Address l SA'wLC
^(iwM12r's Name GL) {%G �Vf2Ntjt/�(��Q,.Phone ya �' $
Atldress s�'Mt�
1
•Arch/Eng. License No.
Addresr �t�
Contr ctor's NameNCV (�/EST /iVl �O«-,} Phone 6'L" •82�8
Address Imailingl P� a./3u X ]�6 S �%!w J�r}N CRl, 'Y1G13
Ciry License No.' yR Z23
,LICENSED CONTRACTOR DECLARATION
I hereby aHirm lhat I am licensetl untler provisions of Cha�ter 9(commencing
with section ]000) oi Divislon 3 oi tbe Buslness antl Professlons Cotle, antl
my license Is in / forpe antl efiecL ��(J � L
License C�ass � icense No.��{ F�
Date ` ��� 5' t � —�
WORK �RS' COM�SATION D ARATION
I hereby aifirm lhat I have a certifica[e ot consent to self-insure or a certiflcate
n� Workers' Compen5ation InSurance, or a certifi¢tl copy there0f (Sectlon
70, Lab. C.)..c,
�y No. ��.�J/��S I Company' S� I�U✓�
�Certifietl <opy is hereby furnishetl. �1
Certifi d co y 5 flletl witlt the City�ninq Divislon.
Date • APPlicant--- �l-e h � 4B %��L /NL�G/L ST
EXEMP ION RO WORKERS'COMPENSATIONDECLAR TION
(This zection neetl nat be com0letetl it lhe permit fs for one huntlretl (E300) or
less�.
I cerlify Ihal in lhe P¢rfOrmance oi ihe work fo� wM1lch this pe�m�t i5I55uetl I
shall not employ any pe�son in any manne� so as to become subj¢ct to t�e
Workers' Compensation Laws of Califomia.
oate Signature
NOTICE: 11, after making tnis tleclaratlon, you shoultl become subje<t to the
workers' Compenution orovisions of the labor Cotle, you must tortnwltn
Comply wi[h such O�ovision5 or Ihis pe�mit Shall be tle¢m¢tl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby aifirm lhat tnere Is a conztructlon lentling agency tor the performance
o� the work lor which lhis permit is issuetl (Section 3097 Civ. C.)
Lentler•s Name
LenOer•s Atltlress
OWNERBUILDEft OECLARATION
1 hereby afiirm lhat I am exempt from the Contractor's License Law for the
following reason (Se<tion 7031.5 Buslness antl Professional Cotle: Any <ity or
<ounty which requires a Oe�mit to const�utt, alte�, improve, tlemolish or �epal�
any slrucWre, prbr to its issuance, also requires Ihe applicant for such permit
lo tile a signed Slatement that he/sh¢ is Iicensetl pursuant �o th¢ PrOvision5 of
Me Contractor's License Law (Chapter 9(commencin9 with Section 7000) of
Division 3 ot the Busine55 antl ProfeSSiOns Cotl¢) or tM1at he/She is exempt
therefrom antl tne basis tor the alleqetl exemption. Any violation of $ection
�3L5 by any applican[ tor a permit subjects [he applicant to a civil
ialty of not more than five huntlretl tlollars ($500).
; I, as owner of the property or my employees wifh wages as their sole
I[ompensation, will do the work, and the SVuctu�e i5 not intentletl or offeretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
I License Law tloes not apply to an owner of a pro0erty who builtls or improve5
I thereon, antl wM10 Coes such wo�k hlmself/he�selt or through hi5 or he� own
r employees, provitletl that such improvements are not intentletl or oiferetl for
sale. H, M1owaver, [M1e builtlln9 or improvement is so10 within one year of com-
pletion, [he owne� will have the burtlen of provinq he/she ditl not builtl o� Im-
prOve Yor[he pu�pose oisale).
❑ I, as own¢� ot Ihe property, am exclusively cont�acting with IlcenSetl con-
� tractorsto construct the Oroject (Section ]044, Business antl Profe55ions Cotle:
The ConVactoYs License Law doe5 nOt apply to dn owne� of prope�ty who
builtls or Imorovez tnereon. antl who conVacts for such oroiects with a ron-
tractor(51 Imense pursuant ro me Contrattor•5 t_icense Law). i am aware tnat
proof of their Worker's Compensation Insurance Shoultl be provitletl to me,
❑ I am exempt untler Sectlon B. & P. 0. br this reason
Date
I hereby cer[ily [
ifl is cori
an s ate laws rel:
Sentative5 of t�
InSp¢CtlOn p p05¢
Si9nature �
Drivers' LI en
rev. 5/8
55
_ Owner
I have reatl tnis a0����ation antl state t�at tne above
I agree to compry wi[h all city antl county ortlinancei
to lluiltling conztructlon, antl hereby authorize repre-
� to �n � upOn the above-mentionetl pro erty pfo9r
� Date •� Z'� 0 1
M .
TVPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑-DEMOLISH ❑ OTHER -r�,e'�
DESCRIPTIONOFWORK/USEOFBLDG.�E%�(=-•—� M�S]�
M•
TVPEOFPEflM1T GRADING � FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT. 3� oCCVaAN v�r
CONSTRUCTIONTVPE_��.___ VALUATIONS�ii
ZONE GRADING CU. VOS. ACRES_
Remarks: �C� FEL' //!. /�/ �. �O ZZ �
.�%.i� _��%� �Q I
Sink
Preventer
Irriqation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceprors
Kitchen Sink
Roof Orains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Svuctural
Duct - Ventilating
Exhaust System � Multiple
firepl/Fact. BIL ICBO #
Heeting Sysrem & Ducting
❑4100,000 BTU �100,000
Rainspection Fee � $15
White - Builtling; Canary - Applicant; Pink - Accounting; GOItl¢nrotl � AS5e55or
Showers
Service Sink
Sewer Cap
Sewer Connection
Solac Collectors
Solar Piping .
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
La undry T ra'ys
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeratlon System
�4100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fae
5 Main Building:
TFront Q
ARear S�
C Right (
S Left f �
Ping. Ref. #
Planning Notes: �
Au[omatic Washer
Construction Pole Sub.
Cookin9 Unit
Dishwasher
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator O65 KW C
Zone
Accessory Bui
ELECTRICAL
TrensfOrmer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors�0.1 HP�1Y.-8
Inc.Solar �9-15 HP �16-1
Microwave
Pole Light
15 KW
� Reinspectian Fee ! $15
$ 3 DEVELOPMENTSERVICES kREql
Zaning APProved BY � ��
FEES ' Building Approved By
II
Sign
Standing Sections
Trash Compactor
luue Fee
SUMMARV OF FEES
BUILDING PERMIT $ �7�. �0 SMIP
PLAN CHECK $ PERMIT
PLUMBING $ I��— ISSUANCE
PLAN CHECK 25% 3 ENERGV P.C.
ELECTRICAL $ �G GRADING
PLANCHECK 50% $ MICROFILM
MECHANICAL S � TOTALFEE
PLAN CHECK 25% $
N
I
N
G
R
E
�
M
T
S.
FEES
��
$ �
h �
�CO�TRUCTION AND PLANNING
APP UVALS �ermit # ' Date
i�
�,. Temporfiy Electrical Service or Pole -'� ;
2. Soil Pipe-Undrgrnd. �. -- "- l '
� :�1 � � �
• 3. Elec[rical Cond"uit Utility�Undrgmd `�� ��
' 4. flecVical Conduit�Und�grnd. -
� ��...__�.. , _----`"�
6: Electrical UFER'Gr,nd. � �
7� F.00tings �-
_ _ � S'����', t�
8� Foundation � � � � �
9. Wate� Pipe-Und�grnil. ' '� �
�
70' Structural Floor Sy.stem �
11 - PropertY Sewer Line & House Connection
12' Sewer Cap �' `
. /. .�,
13! Roof Drains ''
r
14. Rough Plumbing• :�
15. Rough Electrical-Conduit
�i6. Rough Electric Wiring
�17. Rough Wiring 5ign
�
:18. Rough E�ectrical-T Bar Ceiling •� �
�19. Rough Heating & Air Conditioning
`20. Rough FactorY Fireplace -� �
21. Ducts, in'StrucCure •�;�f � �
22. Ducts, Ventilating � ��
'23. Gas Pipe-Rough &�Test ,r� �J'
� -
24. Roof Freming �� - � �
25. Roof Sheathing • �
��
26. T-Bar�.Ceiling (5tructural) & Monocoat
27. Frame and Flash��9 (�,
�. � �
i
_28. Lathing & Siding '
29. Insulation /�
��
30. Drywall Nailing � j t�
, 1 . , �,:,, .
31. Plaster Brown Coat� � ��,
32. Electrical Powe� Meter-Final� i �
, �_
33. Final Electric r1
34. Final Heating & Air Conditioning
35. Final Gas Pipe-7est
�36. Hood or CanopY
"37. Final Factory Fireplace
�'38. Flnal'Rlumbing ���
139. Water Service-Final ,;
e
�40. Gas Service-Flnal '
41. Solar pomesticFinal
42. Backflow Preventer'
.
43. Backflow Irrigation
44. Landscape�lrrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
i
48. Special Requirements Completed
49. Electric Release to Edison
i
�50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Nn Date
i
Inspector
�2{ j�f� l.aE�
�
�
�� � �
POOL A
APPROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Fo�ms
55. Elecvical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Elec[rical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trep, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
J�6. Solar System-Final
�.�
"�7. Fencing�& Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
Z2. Underground Flush
73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
8Q,FOOD�;CERTIFICATE ISSUED
��� t;•I.
OK �
Lli9
pate
� ;
r .
� '
/
„ ',
� ' ��•,
,�, 5�=� , , .
� � 4 1_.34.8� :
CC75TA MESA BUILDING-SAFETY DEPARTMENT �Y.1. `��L � �0
P. O. 60X 977 COBTA MEBA, CALIPORNIA '
�bf g, ��.g,v� �a��,w� :
For Applieanf fo Fill In Comple+ely APPLICATION FOR PERMIT�� ��'� `
TYPE OR PRINT � -
BUILDING
AODRESS 2826 FranCis Lane .
COSTA MESA, G.4LIFORNIA FOi Office US@ QII�Y
RECEIGT NO. rg R I
OWNER Mesa Del Mar Denelo nt Co.. � . '�_vr� �
MAIL " REGE ED !V OATE RELENEP OA�T}E I66UED
ADDRESS ' � � I � � '� "t' d I �1 ��� O C
cirv Corona del-Mat � NOJR 34220 pDDRE55 2826 Francis IBne
AOR�C"'TENEER�CCO Corpoxation NojOR �ZPO � COSTA MESA. CALIFORNIA
ADDRE55 E C088C Hl F1W8 '�� FIRE - �/
ZONE TYPE �/ GROLLP � /
CON7RACTOR COLOIIB del Mar �CC� APPROVED .
BY �ATE
ADDRE65 3soo E, coasc a�shway ZONING
4--
f� ' ZONE NO. OF USH OF NEW
CITY yDiO�]$ del 'MaT I PLANB �'I BUILOIN� Q�/� �
6TATE TEL. , LEGAL
LIQ NO. NO. oescn�enoN
OF LOT d b O �/' . I NO. OP BLA68.
NOW oN LOT p, p, NO.
USE OF � YARD6 EVES
EXISTING BLDG. APPROVED ALLOWED
SETBAGK L�NE FROM ( � � (�NTlR LINC 9TJ il��. n'
CENYER OP 6TREET REAR YARO FRONT � FT. � IN.
SIDE YARD I LEFT / I RIGHT �/ R. SIDE �FT. IN.
DESCRIPTION OF WORK . �. S,oE /� FT. IN.
NE' I V II �+LTERATION I II A�DITION I REAR J� ��/ FT. IN.
REPAIR II IIMOVING I IIDEMOLISH I BYPROVED ,/� CO� DATE � �/�bC
l
BUILDING NO. OF �
SIZE ROOMS STORIE6 �
EXTERIOR WALL ROOF
COVERING ICOVERING
USE OF BUILDING ANO WORK TO BE PERFORMED ^ '
c. L G- �} y s, F'
�� E
I HEREBV ACKNOWLEDOE THAT 1 HA�e RERD THIB APPLIWTION � TX! AMOUM eHOWN UNDEft YALUATION �8 POR THE
AND 6TRTE THAT THE ABOVE I6 CORREGT A A6REH TO COM- pURP08E OP EBTABLIBHING A vERMIT PEE ONLY.
PLY WITH ALL CITY OROINANCE9 AND BTAT LAWe RlGULATING
Bu1tDIN6 coNBixU Tlo .� VALUATION . � .y
SIGNATURE OF ` ' PERMIT FEE $ T L. O�T%
PERMITTE p
`' ' . $'ty� D �7 � � � PLAN CHECK $ I D • �
AUTHORIZED AGENT � S �
TOTAL FEE
!._TY OF COSTA MES�.
CALIFORNIA G2826 P.O. BOX 1200
FROM TME OFFICE OF THE DIRECTOR OF BU�LDINO SAFETV
Project Address ���b �ip,�Gj �
Project Name
/,�! J
OWf1eLS Ndi112 IQUG- l ! •�i��Gn/ �
--�-
Owners Address s"�+rti �
R�rnut # S20 0
+ZL^- 4iA-IL/i/.1/�
City Use Only
O.mers Telephone S�� -/�/Y� L
r
I as Owner, ,. (strike out all
except one) do hereby a est that employrtent of any person, or persons, is not
anticipated at the time of seeking the above-referenced permit. In the event that
any person, or persons, are employed under the prwisions of this permit, I shall
imrediately cause a valid Certificate of Worlanens Cwr�ensation to be filed with the
Costa Mesa Building Division.
I agree to defend at my cxan oost, and to inde�nnify arrl hold harmless, the City,
its officers, agents and/or eng�loyees, frcm and against, arry arx] all liability,
damage, costs, losses, claims and expenses, howscever caused, resulting directly
or indirectly fran, or connected with the improvement under this permit.
I further state that I have read and fully imderstand the implications and re-
sponsibilities of the above statements, and will ccmply with all provisions of the
Contractors State License Iaw found under the Business arrl Professions Code,
Division 3, Chapter 9, of the State of California.
CMF 0777-46
6 2 ` ��
l�te
APPLICATION FOR A BUILDING PERMIT
EIecV ical W
Tract Biock Lot BUILDING PERMIT NO. permit tao. �
n
Adtltl9 � � / Plumbing '
esz �S /�. �l� �D/y� PermitNo. �o
' J /
��Sj4 cross Mecnanical n
Area L R Street �O��T� Permlt No. �
Owner � ` L /[iO �� TVDe of Project: ❑ New ❑ Alter ❑ Atltlition �
!l
Atltlress ❑ Repdir ❑ Convert ❑ Demo ❑ Occupanty Pmt.
��/ � ,�C i Lti,
�O,�TA /!'(FiJ/O �6Z6 ��O �Y SUP.Dist./
City Zi0 Phon A•P• Insp. Area
Arc 9lte<t/ // /_ N Zone SPI. Pmt. No.
[iE51 02� /1 �� Licenze No.
Setbacks P/L Front C/L St. Street W th
Atltlress
Varas Left Right Ear
CitY.�� � �GL ZiP Phone
` ave ro�, e ig .
Englneer �, ���T License No. J Y S
{� /� L .� �p�^ " Y21rt�lltJ jy3Cti ne4uiiCU iL�ivL �.U'�fi:::�
p AEtlr¢55 ��OV `- f O /LG I/O (/�l
To /� c� �� Strutt No. of No. f
67 City %vAs�J � 2�p(��Q Phone� ��6 Height Stories Fa ily
� LICENSED CONTRACTOR'S DECLARATION aark Feez Ves F e
� Requiretl No ��T. eceipt
m I hereby effirm that I am licensed untler provisions ot Chapter 9
t (^.ommencing with Seciion 7000 of Division 3 of t�e Business antl Zoning Approved BY: Date
Professions Cotle, entl my license is in full force and eftactl.
� �icense Class _ Litense Number
T Date ConVactor Misc.
E Atltlress PropoSetl Use
' ot Structure
'y, City end Zip Phone
� CONSTRUCTION LENDING AGENCV
d I �ereby affirm [het there is a consvuCtion landing agency for the
? pertormance ot the work for which t permit is }i fuetl ISec. 3097, Oca Type Cotle
' Civ. CJ. _ /( Class ConsL Vear
Lentlar's Name �FG"Cl,C(T> / e/G/L !/AtiK
d USE/OCCUPANCV SIZESQ.FT.
� Lentler's Adtlrezs f%� % NG .y c/57/`i F q
J OWNER-BUILDER DECLARATION
y I hereb affirm t 1'
y hat I am exempt from the Convactor's License Law
� o tha following reawn:
� �I, as owner o5 the property, or my employees with weges as their 2_
� sole tompensqtion, will tlo the work, antl the structure is no[
� intentletl or otteretl for sale. 3
� ❑ 1, as owner p} the property, em 0xclusively con[racting with
licensetl convactors to consbu t�e proje, .
d ❑ I am em t under Sec. tor this reawn 4�
_
Q Dete s Owner ' " Total Valuatlon
E AKERS' COMPENSATION OECLARATION
� I hereby aftirm �hat I have a certiticate ot consent m self-insure, Encroachment Permit R quiretl ❑ Ves ❑ No
or a certificate qf Wprkers' Compensation Insuronce, or a certitietl
C copy tnareoi�/NG JB3 Gratling Pmt. Gratling
� Po icy No �' Company _ Requiretl ❑ Ve ❑ No Pmt. No. I
�d Certitietl coPy is �ereby fumish¢d Rou9h Gratling �
d Certifi / co y is filed with Ora � y MA. qpp�ovetl by: Dat¢ �
a De�e Apu�icant 3
CERTIFICATE OF EXFMPTION �—
FROM WORKERS'COMPENSATIONINSURANCE Z
c
(ThiS section neetl not be completetl it permit is tor $100 or lessl. 3
I certify that in the performance ot the work tor hich [his permit is
issuetl, I shall noi employ any pers�r n any m�er so as to become 2
subject�/ty�t-h-/ef,W �orkers' Compensatj§rf.� Lg6rsy alifornia. PERMIT FEES
Dats�s� APPlicant _!'lFe.c / ,
NOTIEE O APPLICANT: If, ettar making this Certificate oi Structural S Plan Cbeck E
Exemption, you ehould become sublect to the Workers' Compensation
provisions of tha Labor Cotle, you must forthwith comply with such SPecial
provizions or this permit shall be tleemetl r¢�oked. ElectriW 5 ��VeSL y
I CERTIFY THA7 I HAVE READ THIS APPLICATION AND STATE p�umb� 9 E
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH qLL COUNTY ORDINANCES AND STATE LAWS
RcLATIN� TO BUILDING CONSTRUCTION, AND HEREBY AUTH� Mec anical E
OR12E� PRES@NTA71 'ES OF T IS COUMTY TO ENTER UPON
THE OV NT ED PR ERTY FOR INSP TIO PUF- pre Gratle
POS i //� / � ��/ In eclion s
/�
Si ture of pp�i t or . ent a[a Pr -Gratle E Permit s
r- �—en 9 Rec. No. Issue
Aa L ./N�,�.,. �
�rint Applicant'S/Agent's Name
All spac@y within this bon must be completed ta proeess Plan Issuance
Check By: Aporovetl:
CMF 0335-46 (BU48) rev. 6/80