HomeMy WebLinkAbout1874 FULLERTON AVE - Building Permits F CITY/OF COSTA MESA •
4 '
BUILDING DIVISION
>:�:�f,� A DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F 1 �l�er I PERMIT //
4•+� "' '/B06-00371
-`9Moaar�M. r
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.gu{LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1874 FULLERTON AV Status: ISSUED
Suite: Applied: 03/07/2006
Vicinity: ROOF Issued: 03/07/2006
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 42523420 Zoning:
Applicant: RON SELL
Address: 18032 LEMON �r
Phone: 714-528-1758 ISSUED BY:
YORBA LINDA,CA Zip: 92686
Owner: GILBERT,,EDWARD S JR _ .
Address 701 S LONDERRY LN � _ .
,. Phone:, . . .
ANAHEIM-HILLS;CA . - - Zip: - 92807 . . - ,
- _ _
Contractor: , SELL ROOFING'COMPANY - - • - . .
Address:, 18032 LEMON ',
Phone: 714-528-1758 .
, YORBA LINDA,CA
Zip: 926861' - License: 323842
' -",:7 '
•
:Arch Eng:
Address: Address: - - • - '
Phone: - Phone: '
Zip: ,License: . " - License:
- _ .< _
•
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL 1-LAYER OF 30#FELT,30 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE SHEETING AS
{, NEEDED.31 SQUARES INCLUDES ATTACHED GARAGE. -
e - ;• FEE SUMMARY '
Plan Check: $0.00 Calc Valuation: $8,100.00
Permit: $167.25 Claim Valuation: $8,100.00
SMIP Res: ' $0.81 .
'. SMIP Com: $0.00 . .
Other: $0.00 - .
Inspection: $0.00 7 •
Total: $168.06 " - - ,
. PLANNING &ZONING
SETBACKS . ,
MAIN STRUCTURE Front' .,0-0 ty-- . Rear " 070 . Left 070 . _ :),..-_Right 0-0
- . - -
ACCESSORY ,Front 0-0 ,Rear .. 0-0 ' - , Left 0-0 -, _ Right 0-0=, •
/
PARKING-\ `. Existing:1, 0. Required: 0 Proposed: 0
\' ,
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS /-1 I ; 3 CI
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: .
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
t ❑ I'h�ve and will maintain workers'compensation incur ce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
.--My workers'c ansa Insurance her and cy number are: r
(' a `S- !� 1 Policy Number: -n/,4 (p SS-
I ,(Thissection need not be completed if the permit is valued at one hundred dollars($100)or less.) `
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, gree the f I should become subject to the workers'compensation provisions of Section 3700 of the Labor Codee,,I shall forthwith
oomph/with these provisions.
i .y_/ ^O W
_Applieam'Slgnatures:'-?' *,- 2 sh{
Date:
WARNIND:FAILURE TOSECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
'TFWSAND pOLLARE(5100,0)3),IN ADDRION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby INaLl.am,licensundeLhpro • io95 yf,Ch (commencing with Section 7000)of Division 3 0l the Business and Professions Code,and my license is In full
-force and effect - ✓ x Class N n - C r 3) y
GontractoYs'Signeture: hrTEDImT
-� 110---3 —Q�
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.It,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes ❑No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or200 cubic feet of compressed gas at standard temperature and pressure).
._........_ pP presentbuilding occupantregistrationacutely ❑Yes 0 No
2 Does or will thea applicant or or future need to file a form for hazardous materials?
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. •
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,nave all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all e laws and cit ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for in •• purposes. gree o occupy or allow occupancy of any building authorized by this permit until final inspection.
9'exffjOur fLepah�n (�J 577%v 4
And/Or.Authodz77ed"Apppllilccaaamom-;.;� , �--'6ate — _
LODE I INSPECTION TYPE FATE INTRIAI& • CODE i" INSPECTION TYPE 'PATE` " INTTTIAI;!
1616 Fixed System Final Fire Prevention 206 Final Mechanical
•
1266 Pool Spa Final / 11 208 Final Plumbing
�
200 Final Re-Roof �Z 5--et (/h.-f/ 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place • 220 Final Planning Approval .
203 Final Sign _ 222 Final Site
204 Final Demolition250 Final Building/Occupancy
/ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 7279 7/23/85 _ .000 TL
CITY OF COSTA MESA CON TRUCTION PERMIT- - PERMIT NO. TRACT NO. ; LOT NO. .UNIT N6- - - '
Project Address ///leit-f'O.(% g✓e' ! _ '
Applicant's MailingAddress /S�3 l� �� %t% ,4-vf7 J. TYPE OF CONSTRUCTION NEW ADD' ALTERATION' REPAIR 'S _ I ,
-��P1 �• g - -+ ❑•CONVERSION .❑ DEMOLISH ❑ OTHER ' - '•y p #' - I Zane I
Owner's Name /Q'+QODUe�• n7-��A11 /C�.S // ph6r1��-���0 DESCRIPTION OF WORK/USE OF BLDG.' (
Address �0'uOX,C37A fl/f'f/dC.,� ( "iR 901-{o6s- _ - - S Main Building: Accessory Building: , ,
Arch/Eng. ' - - /License No. • TYPE OF PERMIT ❑ GRADING fLLI/FOUNDATION- E.STRUCTURAL I E Front - i V_ 1 - r0
Address - '/` • -•
❑ TENANT, ❑,ELECTRICAL. Ila(PLUMBING ❑ MECHANICAL •' B Rear - - • N
-�[G�tr2 /b i / lA"2- ❑ OTHER • . . - r- A I I
Contractor's Name/n f 6�!✓ 24/1 Phone •�`rl0 - -
/ q{ /WAhd, PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right , G
;Address(mailin91 �S3� 'l:Cf.�.%.fJ(7J.�U - •
�r/ .58. CONSTRUCTION TYPE VALUATION$ ;S Left i R
City License No. .7 ZONE GRADING CU.YDS. 'ACRES Ping. Ref.# Parking Req./Provided
6) • LICENSED CONTRACTOR DECLARATION -- e _ - Q
vt/1 I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks: 'Planning Notes: 4 .- M
with section 7000)'of Division 3 of the Business and!Professions Code, and - • T
my license is in full force and - fact 1 . t . .. S
•
U dense Class Lice-se y - - - - - - - - - - - - - - - ,
Date __ Signature n _ / ,,.:x_, _ . . . PLUMBING , - ' FEES l • i
- •WORKERS' COMPENSATION DECLARATION Showers ,
I hereby affirm that I have a certificate of consent to self-insure or a certificate • ELECTRICAL : -FEES
f Workers' Compensation Insurance, or a certified copy thereof (Section .Service Sink - - a
ar - ' Automatic Washer: I - - - Transformer-0 15-50 KW'
)800,--Lab. C. ,/c .. _ ...- •
Policy No. �'s'O �U • I Company��-4!///P I'S 5 Sewer Cap P : Construction Pole'Sub. 0 50+ KW, •
Certified copy is hereby furnished. • i -
•
�CerY ietl cop}' is filed with the city=i i din• Divisiy /. ,Bathtubs Sewer Connection ; ■, Cooking Unit %% Meter Dup to 100 amps
Date /-3-QC APPlican• S.........:0.4: Y- ��... •
EXEMPTION FROM WORKERS'COMPENSATION D CLARATION Clarifiers Solar Collectors Dishwasher / S Meter Cover 100 amps : , i
(This section need not be completed if the permit is for one hundred ($100) or 111. '
less).- .Dishwasher - i' Solar Piping ' I _ME Dryers OGas ❑Electric - IllSub Panel; i
I certify that in the performance of the work for which this permit is issued, I •
shall'not'employ any person in any manner so as to•become subject to the Drinking Fountains Solar Tank Fan - i
Workers'Compensation Laws of California. Motors❑0-1 HP ❑17-B
.Date ' Signature Floor Drains . Swimming Pool w/Spa ' F.A.U. Inc Solar 09.15 HP 016-15+ '
'NOTICE:If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks , Urinal - Fixtu!¢s - -
comply with ,such, provisions or this permit shall, be deemed revoked. - - - - Microwave - -- -
CONSTRUCTION LENDING AGENCY - Gas Service' Outlets • Water Closet Device Boxes
I hereby affirm that there is a construction-lending agency for the performance POI¢ Light
of the work' for which this permit is issued (Section 3097 Civ. C.) Interce tors - - , Water Heater • ,4
Lender's :Name I ' - - P . 00 Outlets Range , •
Lender's Address ' ' - •- ' - - Kitchen Sink I 1 Water Service ,
OWNER BUILDER DECLARATION - - - _ Switches Sign'
I hereby affirlrl that I am exempt from the Contractor's License Law for the' Lavatories Auto-Wash Garbage Disposal Standing Sections l
following reason (Section 7031.5 Business and Professional Code: Any city,or. - •
county which-requires a permit to construct,alter,improve,demolish or repair P.-Trap ' ' 1 Laundry Trays' - ' ' Generators❑0-5 KW 05-15 KW Trash Compactor any structure,-prior to its issuance, also requires the applicant for such permit P ,
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law (Chapter 9(commencing with Section 7000) of '
' Division 3 of the Business and Professions Code) or that he/she-is exempt .
herefrom and the basis for the alleged exemption. Any violation of-Section - i , i
031.5 by' any applicant for a permit subjects the applicant to' a civil i 1
enalty of not more than five hundred dollars($500): - - ■ -- $ 3 , • i
IDI, as 'owner of-the property or.myemployees with wages as their sole Issue Fee
compensation, will do the work,andthe structure is not intended or offered • Reinspection Fee I $15 Issue Fee '$ 3
for sale (Section 7044; Business and Professional Code: The'Contractor's' . . - MECHANICAL FEES( .
License Law does not apply to an owner of a property who builds or improves _ _
thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: i
employees, provided that such improvements are not intended or offered for Boiler 4 Hood or Type I .❑ - - •
sale. If, however, the building or improvement is sold within one year of com- .- Canopy Type II ❑ Zoning Approved By Date
'• pletion, the owner will have the burden of proving he/she did not build or,im- ' Duct-Under Ground • - Building'Approved By • - Date_
prove for the purpose of sale).
- I ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By _ _ - • `J-IitA' Data
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100.000 BTU 0100,000 BTU ' SUMMARY OF FEES '
builds or improves thereon, and who contracts for such projects with a con- - ' I
tractors) license pursuant to;the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration I BUILDING PERMIT $ SMIP , • '$ ' '
' proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ • PERMIT i 1
❑ I am exempt under Section B:&P.C.for this reason Firepl/Fact.Blt. (CBO# Fire Dampers. PLUMBING S-O$
■• o'+LT ISSUANCE $
•
.Dates i • Owner • - • Heating System& Ducting ' Registers ( PLAN1 CHECK 25% I$ ENERGY P.C. $ •
'.l herebyfcertity thathaveread,[his application antl_state that the above.. ❑0.100,000 BTU 0100,000 BT _ - - ELECTRICAL $ •
GRADING: $
information isicorrect. (•agree to comply with all city and county ordinances '
and state laws relating to building construction, and hereby authorize repre- I PLAN CHECK 50% '$ , MICROFILM ,$ '
-sentatives of this city to ent r up the' above-mentioned property for I l r
Inspection Pm'mr�ses.
Signature/pu'r/'/ SLC-/�- g� //t-rl/aa Date/J"3' 3 I MECHANICAL $ TOTAL FEE $ a� i
Drivers' License or SS# ` -/- Reinspection Fee $15 Issue Fee $ 3 PLIAN CHECK 25% $ i
CMF 0865-46,rev.10/64 White- Building;-Canary -Applicant: pink -Accounting; Goldenrod - Assessor ' ' - - - —
CONSTRUCTION AND PLANNING POOL ..SPA
Date Inspector • - ' - Date Inspector
APPROVALS Permit# - •APPROVALS Permit#
1. Temporary Electrical Service or Pole 52. Pool Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
-c3. Electrical Conduit Utility-Undrgrnd. . 54. Forms .
4. Electrical Conduit-Undrgrnd. . . 55. Electrical Bonding - '
5. Steel Reinforcement - 56. Rough Plumbingt Pressure Test •
.. 6. Electrical OF ER.Grnd, e57. APPROVAL TO COVER-GUNITE .
7. Footings - 58. Electrical'Conduit-Undrgrnd.
8. Foundation • . 59. Gas Pipe, 0 Undrgrnd.,Test
'9. Water Pipe-Undrgrnd. . - 60. Backwash:Lines, P-Trap, 0 Undrgrnd.
. J
•
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. Electrical-Final - '
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring , 67. Fencing & Access Approval •
17.,Rough Wiring Sign - 68. APPROVED FOR PLASTERING '
18.-Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air'CAnditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush •
• 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil - . '
25.'Roof Sheathing74. 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 PREY. 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 ElectricNotes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test • . -
36. Hood'or Canopy • , • `
37. Final Factory Fireplace - - _
38. Final Plumbingn ' .
39. Water Service-Final f/ -
40. Gas Service-Final '
41. Solar Domestic-Final -- - - - - - -
42. Backflow Preventer • - _ - _ .
' 43. Backflow Irrigation .- -
44. -Landscape Irrigation System - ,
•
45. Sound Attenuation . ' '
46. Handicap Regulations - � ,=
47. FINAL STRUCTURE &--BUILDING' '
•
48. Special Requirements Completed _ - - . -
49. Electric Release to Edison a - • ' t" -; -•I
' 50. Gas Release to Southern California Gas Co 1
51. CERTIFICATE OF OCCUPANCY . - - - -• -• - . ' -
No. • 1 - • Date. - .
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF• MyF�,SyA . CONST UC 10 PERM PERf��Cy/Tj NQ% �// TRACT NO. LOT NO. UNIT NO. 419 6 11 /15/85 5000 IL
Project Address /O-!9l � /l�r %n �. / /X•/• / r - l
Applicant's Mailing Addres TYPE OF CONSTRUCTION -U NEW ❑ ADD LJ ALTERATION LJ REPAIR •
p I- ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name `�r Phone l���G �9Ip2. A.P.# I Zone
\ /j/.r DESCRIPTION OF WORK/USE OF BLDG.
y`= Address � ' -�/(��' - S Main Building: • - Accessory Building: ,
V E Z
Arch/Eng, License No. • TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front .• O
Addr¢55 / p�1 /� -
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - N
Contractor's Name �'�t; /i`/ {J' Phonet4.1 7400) ❑ 'OTHER A • _ I
AROJECT DESCRIPTION SQ. FT. OCCUPANCY C- Right N
\ Address(mailing) /[�, Al- CON STRUCTION TYPE VALUATION$ K - G
7Left
City License No. ZONE - GRADING CU,YDS: •ACRESPing. R
LICENSED CONTRACTOR DECLARATION Ref. # Parking Req./Provided E
I hereby affirm that,I am licensed under provisions of Charter 9 (commencing Remarks: • Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and
my license is In f 7 f• rand effect. - - T
License .is + / 4. -c:ns: -•. l� - _ -
•
Date Signature f fl7W_ Jail& PLUMBING FEES ^ ,.
WORKERS'COMPENSATION DECLARATION - Bar Sink Showers ELECTRICAL FEES
'hereby affirm that I have a certificate of consent to self-insure or a certificate ,
f Workers' Compensation Insurance, or a certified'copy thereof (Section Backflow Preventer • .- Service Sink
,800, Lab. c,.)/ t /p ,, n Automatic Washer, • - .Transformer-0 15-50 KW -
• Policy No. Cyt-x7/(004/6 U Company RO yet- Backflow Irrigation Sewer Ca • ❑ 50+KW
P Construction Pole•Sub.
2ertified copy is hereby furnished. - - ' '
/Certili dopy is filed with the city/112)g Isi :pa.yBathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date !�ON Applicant (Y NSAT t �[/7(� •
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher .' Meter ❑over 100 amps
(This section need not be completed if the permit is for one hundred ($100) or i
'
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
1 certify that in the performance of the work for which this permit is issued, I - '
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑41 HP ❑1%-B •
Workers' Compensation' Laws of California. —
.Date • Signature Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE: If,after making this declaration, you should become subject to the _ Inc.Solar ❑9-15 HP ❑16-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks -Urinal - Fixtures -• - •- Microwave
comply'with such provisions or this permit 'shall be deemed revoked. _.
CONSTRUCTION LENDING- AGENCY •
• Gas Service - Outlets Water Closet' Device Boxes '
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors / Water Heater /9,0C Outlets Range
Lender's Name'"Lender's Address Kitchen Sink Water Service ,
OWNER BUILDER DECLARATION • - Switches •
Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories
following reason (Section 7031.5 Business and Professional Code: Any city or Auto-Wash Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays
any structure, prior to its issuance, also requires the applicant for such permit Generator ❑0-5 KW❑5-15 KW Trash Compactor
to file a signed statement•that he/she is Iicensed,pursuant to the provisions of t
Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt _
herefrom and the basis for the alleged exemption. Any violation of Section
031.5 by any applicant for a permit subjects the applicant to a civil '
`enalty of not more than five hundred dollars($500). .. '
•LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee , I $15 Issue Fe¢ $ 3
compensation, will do the work,and the.structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL FEES •
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or,through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement is sold within one year of com- -- - Canopy Type II ❑ Zoning Approved By • Date
' pletion;the owner will'have the burden of proving he/she did not build or im- Duct-Under GroundBuilding Approved By Date•
prove for the purpose of sale).
0 as owner of the property, am exclusively contracting with licensed con- Duct-Structural R Application Issued By .01,11--- Dat ��
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct- Ventilating CO-100,000 BTU 0100,000 SUMMARY OF FEES
builds or improves thereon,-and who contracts for such projects with a con- ' -
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ - •. BUILDING PERMIT $ SMTP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ - ! } PERMIT
❑ I am exempt under Section B.&P.C.for this reason Firepl/Fact.Blt. ICBO# • Fire Dampers PLUMBING $ r U(,, ISSUANCE $ •
Date owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify.that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL L $ GRADING $
information Is correct. I agree to comply with all city and county ordinances ELECTRICAL '
and state laws relating to building construction, and hereby authorize repre- - MICROFILM $ • '
sentatives of this city to enter upon the above-mentioned property for PLAN CHECK50% $
inspection p ..s- ! 7 / lj MECHANICAL /1 V •
Signature / A., ,_ _ ��. Date y $ TOTAL FEE $ ��(l
Drivers' License or SS# ..
Applicant; Pink -Accounting; Goldenrod - Assessor
• CONSTRUCTION AND PLANNING POOL_. SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
' 1. 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 Conduit-Undrgrnd. 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, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65: Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING •
'18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air-Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil •
25. Roof Sheathing - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat • 75. Dry Chemical
27. Frame and Flashing 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 547/¢e 7 L
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final • - -
42. Backflow Preventer
.43. Backflow Irrigation •
-
44. .Landscape Irrigation System •
45. Sound Attenuation -
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING •
- -
48. Special Requirements Completed
49. Electric Release to Edison - - , -
50. Gas Release to Southern California Gas Co
51. CERTIFICATEDF OCCUPANCY.
No. Date
CITY OF "TA MESA
f • PAR LES
Fee Payment, Receipt N2 l 0 2 2
Project Address / 7h, ��- --a_..? Park Area v
A. P. No. /17 —/a2 V— 7i
Building Permit No. 3 77e..5—
-
Owner's Name 4ec- /.0j P/' - 0---"La-\0f
Mailing Address c.2013, it GA-)•-- 'l da/g irs tegktc// 7A45
FEE
Single Family * No. of Units @ $338.27 =
Multiple Family ** No. of Units 4. @ S238.78 = V77• 'r
• Total Fee q77 --5,Z-
Planning
,
Planning Department Approval Date SAX/7,7 - By 4/j i��� ,
Applicant's Signature • le"— ‘--D 0- ---LlJ -
}
* City Ordinance 72-44 1p;
** City Ordinance 72-45 Had ILMI
BEGLINGER - Jones WAIt 3-8-74
JOB ADDRESS 1874 Fullerton Avenue, A&B BUILDING PERMIT NO. 37985
GENERAL CONTRACTOR Owner-SI dr. DESCRIPTION of WORK Duplgx w/att.garages
' P" ff7-174-18 LOT TRACT FIRE ZONE VALUE $ 47,200.00
1 _:TIONS Signature Date TYPE V GROUP (7r(,j ZONE R-7
o /v/ -5 it—.5 —7'E SUBCONTRACTOR I PERMITS ISSUED
GA5 a_t.. � I;A ;"J J,_A,'- Date Number I Signature
WATER /�f�s Plumbin• • /
ROUGH PLUMBING /� �3�j[�/.J y-'.' j�! SC-e7-7•! /C ��
PROP. SWR, LINE OUSE CON. i �/ "� 7 / _i-'el. �1r - -7f:T-f600,--
MISCELLANEOUS
gg/
SPRINKLING SYSTEM e, �1 ire, 5-, 7- f6GtD/
MISCELLANEOUS r ,��ww —� /
ROUGH HEATING AND AIR CONDITIONING YyL1' /-24'�j /Ito `s.�
TEMPORARY SERVICE OR POLE ', T ll p
UNDERGROUND ❑ POWER ❑ u
ROUGH WIRING ' A- -J TJ-/'?'j Heatin and Vent,
TRENCHES SI FORMS, STEEL REINF. is;, Ste./C•/U- / /zinc, V/- i-(7-)<, Jb '5/r.+
FLOOR SYSTEM - /'j�J�l�- Q SF-/2-?Sr' /
BOND BEAM 7 STEEL REINFORCE n ✓
SHEATHING r '30'w
FRAME AND FLASHINGtrv -V/rfit Sn3 `
S. -VF. 7r
[[
LATHING — IN im'«
OUT 19--- C,548.-"w
PLASTER, BROWN COAT �1
'TURAL, FINAL '''eee��� ,�,/ Eler ric - /�
4G. VENT., REFRIG. AND A.C., FINAL AIi 4i /1 i/: gl / 5- - . i ' - /0 %
PLUMBING, FINAL AND GAS TEST '" -,A�`'— , ,y�/Ir ' t
' ELECTRIC, FINAL ry—' /-I-/
BUILDING, FINAL /i'�7 Ln-)-j 1,7
corn'Al orniu orMcuTc 6 )/A A b_l/7
•
t'4FL-IRfl,
`0®6 z.119j9i F.1***146.50
. 379ZC
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 . -
A LIATION FOR BUILDING PERMIT
For Applicant to Fill in Completely /C
RE IV 9 DATE RECEIVED DATE ISSUED
BUILDING /77( I r Iv 3 _7 7g_
ADDRESS FUL-L-"'►'L. T
EsL t UC7E2_ J a i,7ES _
PAR,
/IyI�
OWNER A.P. NO. .�p,/� (\
MAIL BUILDING a74 �zianr✓ ST
--
ADDRESS.
ADDRESS ADDRESS /•�"'
LU
U TEL TRACT LOT BLOCK
CITY NO.
Z C CONSTRUCTION ' NEW ADD ALTER REPAIR MOVING OFMOLISH
I-
O- cn LENDER
•
Q. m
J o BRANCH . ��" �q ��
J R' EG'tn -. _ _ OWN vf+eS
CO -I ADDRESS q� VALUE
m ARCHITECT TEL. USE LJUpt-e?Cw/4cx'4*1c $
J Q •
OR ENGINEER NO. - .
N FIRE
w cc ADDRESS ZONE S I �d wAPPROVED
W Z CONTRACTOR BYi(...,44YPES.....--HGROUP
DATE ;3 ^Q -'�
JO
co
7,
J ,' ADDRESS
W WTEL. ZONE INO.OF USE OF NEW
O= PLANS BUILDING
Z CITY NO.
.-
WO STATE CITY YARDS APPROVED YARDS APPROVED
NCL LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING _
DO (FROM C/L STREET)
SIZE I NO.OF BLDGS.
OF LOT NOW ON LOT FRONT FT. FT.
USE OF •
EXISTING BLDG. FL SIMFT. FT. _
I- SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT.
VEXTERIOR WALL I ROOF -
_ COVERING COVERING . REAR FT. FT.
-I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. .BET.MAIN&
d a. MAIN BLOCS. ACCESS. BLDGS.
0
Q VAR.# DATE
O _ C.U.P.# APPROVED
I- • •
APPROVED
(n _ BY DATE
2
O I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ ///1
I-, any person in violation of the workman's compensation laws of �' 11-,I.
(n the State of California. CO
b
Z I hereby certify that I am properly licensed.as a contractor under SQ. FT. o
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F E ONLY: N
am exempt from the provisions of the State of California Business t[
VALUATION /
and Professions Cncie, Division 3,Chapter 9. IT FEE $
J
Signature of ..-00
Permittee $ PLAN CHECK $ E
/ o
Authorized Agent Lf/CEJ LL
- - - TOTAL FEE $
A _
s PAIL, c •+. ( 4�
==R 19-7h,;., 00 758n- �r::ri:-76.55
379B5 •
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For A.. '-ant to Fill i •o pl-tele ')'PL CATION FOR BUILDING PERMIT
' ' �{7♦ LJEs ' �3 � • / �� DATESSU
BUILDING o •
a J
ADDRESS ':. ib /tea
��/�1 t. /� `�e� r+ PER
OWNER 1/43x2 ,Li `•kGe-1A—'- .30 LiF S {� A.P. NO.I I7-2 , -/![� -,w-)rrT/ of
MAIL / no�, W. ` ` op J V./ BUILDINGDRS t�h: xis II`L U, ` 64.'*I
ADDRESS L_ L ADDRESS Oh: N 6'*I.
a.o CITY ki ta_m?wa ba. &c - TNOb7.70S TRACT 37 / L0131 BLOCKC
z < CONSTRUCTION NEW I ADD ALTER I REPAIR I MOVING DFMOI ISH
Z Q
O 1- LENDER
am •
,J D BRANCH t , t/ /, '
JV) - - - OWNER "tbt Li I.IG-L-f2 --J0 I1/4,3 e_S
Q W ADDRESS 1�/JA /�
CO m ARCHITECT TEL O.f"1^�Q�) I'1, USE PLEX / T tf•tIZ LUE I-7��1
J Q OR ENGINEER-MIA-M(444'22 ,.,� 1.(]1E�U/L Wil..-
w2 ADDRESS 1VJ L 1) e_..-Wfhr -PC-, 3 C6D T• ZONE YPE� GROUP1 „ 10_W APPROVEDLLL ...�//,/(J Z CONTRACTOR OWt4It_� BY DATE 3.4.-- r-t
m Q ADDRESS sprme.�. Ars A-PjO'/G _ _ i
W w TEL. ZOry/g/ NO.NS USE OF NEW
Z
Or CITY 1\ NO. I� /C a PLANS BUILDING /i,P ./
F / c/ % ✓!
1110 STATE CITY YARDS APPROVED YARDS APPROVED �^�/
in O LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
SIZE /r�� NO.OF BLOCS. �/+. (FROM C/L STRL(�/}')
OF LOT �L!Yom '�� I NOW ON LOT X-.+ FRONT ca PF-• FQ_/thr4lErrItzi OF r
EXISTING BLDG. R_SIZE $ FT. FT.
I- SIZE OF Z /1 ..v Ill NO.OF I
Z NEW BLDG. J �•t ROOMS C-11/�STORIESES�,I t, L.SIDE � /FT. FT.
o COVERIOR ERING ALL EX f % I ROOF COVVERIN(A A ht-).,y- REAR(,�� FT. FT.
-
-I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1 MAIN BLDGS. ACCESS. BLDGS.
0- //p%�� r���-� � � � J�
Q AP'-1_ k tn-a Com- - 4/V PLE;)<- VAR.# APPR
ATE
O C.U.P.# / APPROVED
APPROV60,�/ ,rt (J- Z (fit . /'
N �V 1�V/ /� DAT y
z • HOLD FOR SPECIAL ; :a: ,',,; ,
0
~ I hereby acknowledge that I have read this application and state r �r
Dthat the above information is correct and agree to comply with Olt
all laws regulating building construction, and I shall not employ
I- any person in violation of the workman's compensation laws of
to the State of California. m
z /'}.� 0
I hereby certify that I am properly licensed as a contractor under SO. FT. -�v-.[/ o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
tc
am exempt from the provisions of the State of California Business
and Professions Cone, Division 3,Chapter 9. VALUATION r0
Q� PERMIT FEE $ D
Signature of �-(�a . ! '�// IC
m
Perm lttea , �C.i� ��'� $ !L /PLAN CHECK $ /3 IC s
• 7 I-
Authorized Agent I it
TOTAL FEE $