HomeMy WebLinkAbout363 GENOA LN - Building Permits�' CITY OF COSTA MESA jr�
ost" F, B!/ILDING DIYISION
i�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
:
� FOR INSPECTIONS CALL: (714) 754-5626
��'""� PERMIT NUMBER: E09-00079
PERMIT TYPE ELEC STATUS: ISSUED
APN: 43914245 DATE ISSUED: 0410112009
ISSUED BY: RMD
JOB ADDRESS: 363 GENOA LN CM Suite/Unit: .
Vicinity: REAR OF HOUSE - � . - � � � � _ -.. -
SCOPE OF WORK: UPGRADE SERVICE PANEL TO 200 A, SAME LOCATION AT REAR�OF HOUSE. �' �-
OWNER: GARDNER, CIAY AND CHERYL Address: 363 GENOA CN Unit: �- .�
PHONE: 714-866-0480 - � , _ . City/Slate/Zip: � COSTA MESA; CA , �.�.
APPLICANT: GARDNER, CLAY �- , � � � Address: 363 GENOA LN Unit:
PHONE: N4-866-0480 - , � . - City/State/zZip: - �COSTA MESA, CA � '
CONTRACTOR: OWNER-BUILDER License No. 000000 ��
Address: UniC . . ' . PHONEi .- - , � - - �� -- � •
CitylState: ' . . � ZipCode:_ � = . .� � . .CELL: , -
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection F�e $0.00
TOTAL FEES $54:00, "
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, 72-2i-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must wmply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to oblain inspections and fnal approval will result in the expiration of this permit.
CO�EI'. INSPEG710NTYPE DATE INTTALS COOE� MSPELTIONTYPE DATE INTlneis
1616 Fixed Systerri Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing ��
200 Final Re-Roof 210 Final Eiectrical
20i Final BIocWRetaining Wa0 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final BuiltlinglOccupancy
WORKER3�COMPENSATION DECLARATION:
I hereby aKrm untler penalry of perjury one of the (ollowing declara�ions:
❑ 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
peAormance of Ihe work for which this permil is issued.
❑ I have antl will maintain vrorkers' compensation insurance, ss requiretl by
section 3700 of the Labor Code, for the peAortnance of lhe wvrk for which this
pertnit is issued. My vrorkers' wmpensation Insurance carrier and policy
number are:
Carrier.
(This serlun need iat be wmdetetl R Ilte pe�m� is valvetl a1 one �untlretl cb0ars (5100) prless )
Policy mber:
�I certify lha[ in the pedormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
to the vrorkers' compensation laws of Califomia, and agree ihat if I should
become sub� ct to the vrorkers' compensation provisions of Section 3700 ot
the or de, I sh e with comply vrith these prov�ns. �
y � ature �aR,?-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm lhat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business antl Professions Code, and
my license is in full force and eHect.
Lia # Class #
Comractor's SignaWre Oa�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn ihat there is a construction lending agency (or the
pertormance o( the �nork fa which this permit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm �ha� UndBr pEnal[y of perjury that 1 am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7031.5,
Business antl Professions Code: Any city or counry which requires a permit to
consWct, alter, improve, demolis�, or repair any slrucWre, prior to its
issuance, also requires the applicant (or such pertnit to fle a signed statemenl
that he or she is licensetl pursuant lo the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Pro(essions Code) or that he or she is exempt therefrom antl
the basis for the alleged exemption. Any violation of Section 7037.5 6y any
applicant for permit subjects the applicant to a civil penalty of not more than
five hu d dollars ($SOO�.j:
t^as�ovmer of the property, or my employees with wages as their sole
wmpensation, WILL DO TNE WORK, and the sWcture is not intendetl or
offered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law does not appiy to an ovmer of property who builds or improves
Ihereon, and who does such vrork himself or hersel( or through his or her own
employees, providetl that such improvements are not intendetl or oftered for
sale. If, however, the building or improvement is sold within one year of
complelion, the ovmer-builder will have the burden o( proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct lhe project (Sec. 7044, Business and
Professions Code: The coniractors License Law dces not apply to an ovmer of
pmperty vfio builds or improves Ihereon, and who contracts for such project with
a cont2cta(s) license pursuant to the Contrac[ors License Laws.).
❑ I am exempt untler sec.
Business antl Pro(essions Code for this reason:
+�.�..�_ -�./ `�
' t4fi52 re ^"- Ci-4-Da�e��"'._ _ _
305]A6 @I0�)
Owner ID veri(ed by ❑ No . . q �{
DnvEG's.Lcen`seNo. E� zpires: �/� 1� 1J
Verifcation of Ownership by (rype o( document, i.e. - p or pert�'tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cert'rfy that no excavation fve (5) or more (eet in tlepih into which a
person is required Io descend, will be made in connection with vrork authorized
by Ihis permit, and that no building s[rucWre, scaffdding, falsework, or demolition
or dismanHing thereof, will be more lhan thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to tlo work which woultl
require a permit from lhe Division of Induslnal Sa(ety, as noted above, unless
such person has a permit to do such work fmm the division.
APO������'S $ignalure
Division of Industrial Safery Pertnit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or Wture builtling occupant neetl lo file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous matedal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, ihat a Business Plan be fded with the Costa Mesa Fire
Department by every business which has al 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, or 200 cubic feet of compressetl gas
at standard temperature and pressure).
2. Does or will the applicant or present or fuWre building occupant need lo file
a registretion fortn (or aculely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health antl Safery Code, with some
exceptions, requires registration with Ihe Costa Mesa Fire Department by
each business which at any one time has on hantl a quantity ot acutely
hazardous materials equal ro or grealer than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cu6ic Feet of compressed gas at standartl
temperature and pressure).
3. Does or vnll the applicant or present or fuWre building occupaM need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of [he Califomia Health antl Sa(ety Code provides that [he
Cosla Mesa Fire DepaAment may require the preparation, certification and
filing wilh the Fire Depariment of an RMPP by businesses which are required
to register acutety hazardous matenals with the Fire Department.
4. 1( an RMPP is presen[ly required, has Section 25534 of the Califomia
Health and Safety Cotle been fully complied with? ❑ Yes ❑ No
5. Does or vrill the applicant or present or future building occupant require for
the work which is the subject of mis application a pertnit for such construction
or motlification trom the South Coast Air Quality ManagemeN DisMct or /rom
any olher air polWtion control distnct or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Cotle requires that the requested
information be fumished on applications for rwn-residential building pertni�s).
6. Will any part of the facility to be constructetl untler ihi5 permit be within
1000 (ee[ from the ouler boundanes of a school? ❑ Yes ❑ No
Qt'yes", ihe facility must meet the requirement of Sections 25534 and 42303
o! the Calitomia Health and Safety Code).
7. I( a pertnit from lhe South Coast Air Qualiry Management District or other
air pollution control district or agency is required for lhe wrork which is the
subject ot chis application, have all of ihe disclosures prescribed by Califomia
Health and Safety Code Seclion 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certifcate of compliance from the appropriate air pollWion
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is cortect. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre 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 state laws and ciry
ordinances relating to building consWction, and authonze representatives of
the City of Costa Mesa to enter upon the above-tlescribetl property for
inspecti rposes. I agree not to occupy or allow occupancy of an builtling
autho � y this un[il final inspection. I �
nat [ oCl Owner(s) r03f�.tn'
l.F...�
AnCbr Authonzed AOO���anl
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of Costa �Vlesa Bui� i� 1�ivisiojz
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
�'vur+��R �l�eL.����/��i���������
Permit #
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listin yourself as thz builder of the
property improvements specified at <�ir� � ��� �/Ac1J� ,�C`T.?� 1���
VVe are providing you �t�ith an Ovmer-Bu— I�der Ac no�vledgment znd Informzticn Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as ihe
Owner-Builder. We wi�l not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this torm to us at our ofticial address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitling
aulhority. ,
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each sta ement belo�v to signi(y you understand or ve�I(y�his inlonnation.
��. i understand a frequent practice of unlicensed persons is to have lhe property owner ob(ain an "O���ner-
Builtfer" building permit that erroneously implies that the property owner is providing his or her ov,�n labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. Niy
homeowner's insurance may not provide coverage for those injuries. I am wiiliulty acting as an Owner-Builder
and am aware of lhe limits of my insurance coverage for irjuries to workers on my preperty.
> I understand building permits are not required to be signed by property o�a�ners unless !hey =rs
r onsible fo� the construction and are not hiring a licensed Contractor to assume this responsibilily.
I understand as an "Owner-Builder" I am fhe responsible party of record on the permit. I understand that
I y protect myself From potential financial risk by hiring a licensed Contractor and having thz permit fiied in his
or her name instead of my own.
I understand Contractors are required by law to be licensed and bonded in California and to list their
lic e numbers on permits and contracts.
I undefstand if I employ or otherwise engage any persons, other than Califomia licensed Contractors,
an the to[al value of my construction is at least five hundred dollars (5500), induding labor and materials, I may
be considered an "employer" under state and federal law.
Z I unde�stand if I am considered an "employer" under state and federal law, I must register �a-ith lhe state
an federal govemment, withhold payroll laxes, provide workers' compensa[ion disability insurance, znd
contribute to unemployment compensation for each "employee." I also undersland my failure to abide by thesz
laws may subject me to serious financial risk.
I.understand under California Centr2ctors' State License Law, an Ov✓ner-Build?r who builds single-family
re ' ential structures cannet legally build them wilh the intent to offer them for sale, unless all v,ork is performed
by licensed subconUactors and the number of structures does not exceed four within any czlendar year, or ail of
the work is performed under contract with a licensed general building Contractor.
� i I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for ny financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the �vorkmanship or materials.
1 of 2
�
� .-9: I understand I may obtain more informalion regarding my obligations as an "employer" irom the Inlernal
Revenue Service, ihe United Stales Small Business Administration, lhe California Deparlment of Benefil
Payments, and the California Division of Indusirial Accidents. I also undersland I may contacl Ihe Cali(ornia
Contr2ctors' State License Board (CSLB) al 1-800-321-CSLB (2752) or www.cslb.ca.gov for more iniormalion
about licensed conlraclors.
�6-1 am aware of and consent to an Owner-Builder building permil applied for in my name, and understand
that I am the party !Pgally and financially re=pon=ible for proposed cons!ruc!ion zcti:�ily zt the folle::�ing address:
3�3 [��oA C�-�E C�c�r�w ��-✓k- G-i�-
,�. I agree thal, as the party legally and financially responsible tor lhis proposed construclion aclivity, I vrili
abic}� by all applicable laws and requirements that govem O�vner-Bui!ders as well as employers.
I agree to nolify the issuer of this form immedia;ely of any additions, delefions, or changes to any of the
infor fion I have provided on this form. Licensed contractors are regulaled by laws designed fo protect the
public, If you contract wilh someone who does not have a license, the ConUactors' State License Board may be
unable to assist you with any financial loss you may suslain as a result of a complaint. Your only remedy against
unlicensed Conlreclors may be in civi! court. R is also importan[ for you to understand that i( an unlicensed
Contractor or employee of lhat individual or firm is injured while working on your property, you may be held
fzb!e for damages. If you cb:�in a permit as O•.•.•ner-Builder and v:ish to hira Ccntractors, you will ba responsible
(or verifying whether or not those Contractors are properly licensed and the status of their workers'
compensalion insurance coverage. � �
Befors a building permit can 6e issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verificafion acceptable to the agency is required fo be
presented when the permit is is, ued to verify t properYy owner's signature.
!Signature of properly owner � CDa!e:-- _. I���
"fOiE: TiiE IGiiG'vvir� AUL`iG�lZoiiO(1 FGi�71 IS f6GU!(cCI i0 u`@ comp(eiad b'y tl�e propeiiy owi;ar unly wiian
designafing an agent of the propeRy owner fo appfy (or a construction permit for the Owner-Euilder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, lhe execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file lhe documents
necessary lo obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I decla�e under penalty of perjury that I am the property owner for ihe address fisted above and I personally filled
out the above informalion and certify its accuracy. Note: a copy o/ fhe o�vner's driver's license, iorm
notarization, or other veri(ication acceptable fo (he agency is required to be presented when the permit is issued
to verity the properly nwner's signature.
Property Owner's SignaWre:
Date:
2 Of 2
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 363 GENOA LN
Suite:
Vicinity: UPPER FLAT PORTION OF CONDO & ATT GAR
Parcel Number: 43914245
Applicant: HANSEN, DUKE
Address: 260 E. ALTON AVE
SANTA ANA, CA
Owner: BACKBAY GARDENS H.O.A.
Address 960 CALLE AMANCER
SAN CLEMENTE, CA
Contractor: ROSS & BARROWS INC.
Address: 260 E. ALTON AVE
SANTA ANA, CA
Zip: 92707
Arch :
Address:
Zoning:
Phone: (714) 557-7440
Zip: 92707
Phone: (949)498-1129
Zip: 92673
Phone: (714)557-7440
License: 327802
Eng:
Address:
Phone:
ISSUED BY:
. Status: ISSUED
Applied: 06/19/2001
Issued: O6/19/2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF FLAT PORT�ON OF EXISTING CONDOMINIUM AND AITACHED GARAGE (30 SQ). TEAR OFF EXISTING ROOFING ,
& INSTALL NEW BUILT-UP ROOFING. � �
' PERMIT TO,INCLUDE 363, 365, & 367 GENOA LN. , �_ . • , , , .
�
Plan Check: $0.00
Permit: $167.25
SMIP Res: ' $0.89
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: ; $168.14. � � . ,
SETBACKS
MAIN STRUCTURE Front --� 0- 0, " Rear �0- 0
ACCESSORY Front 0. 0 '� Rear 0- 0
PARKING Existina: o Required: 0
NOTES:
FEE SUMMARY
Calc Valuation: ��
Claim Valuation: .
� � %� � ,t,
PLANNING 8 ZONING� � � � � �. � � �
��
�`
LeR � 0-0� �, � Righl -0-0
� -Left- 0-0�-� - Right�-"�0-0
Pr000sed: � 0 - -
�
sa,asz.00
sa.asz.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 inspeetiona and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
taas-481&00)
WORKERS'COMPENSAnON DECLARAnON: — �
I �ereby affirtn under penelty of perjury one of the following tleclarations: �
❑ I have antl will maimain e certificate of consent to self-Insure for workers' compensation, as provideG br by section 3700 ot tha LeDor Cotle, for Ihe pertortnence of the
work tor whiC� this pertnit is issued.
� I have end will meinWin wOAcers' compensation in5urenca, as requireA Dy sectlon 3700 oi the Lebor Code, tor ihe pertortnance of Ihe work for which Ihis pertnil is Issuetl.
�— My workers' compensatlon Insur ce carner antl policy num6er are:
Certier. - .i i�'� � J� �ll ;- Poli�y iJumber. � y� — �� O J�ipJ
(This sectlon need nat be comp/eted H fhe rmit /s ve/ued af one hundred dollers ($700) ar less.)
❑ I cenify that in Ihe peAortnanca of Ihe work for which Ihis permit Is issuetl, I shall not employ any person in any manner so as to become sublect to tha workers'
compensation laws of Califomia, end egree that ii I should become sub�ect to the workers' wmpensetlon provisions of Section 3700 of the Labor Code, I shell iorthw%h
comply with Ihese pr i ions. /`
Applicant SiBneture: k ��.�� � Data: C`) —/ '�/ — O/
WARNINO: FNLURE TO SECURE WORKERS' WMPENSATION COVEMGE IS UMAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
TFqUSAND OOLIARE (5100,000), IN ApDITION TO THE COST OF CAMPENSATION, DAMAGE$ A$ PROVIOED FOR IN SECTION 3]W OF THE LABOR WOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CON7RACTORS DECLARATION:
I hereby aXirtn that I em Ilcensetl untler Orovisions of Chapter 9(commencing with Saction 7000) ot Division 3 of iha Business antl Professions Code, end my license Is In full
�orce ena eRecCLic. x '� ciaes ». � .�—.� y
ContreIXOYs Signature: L 7 �.� /— �Date: ����F
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirm Ihat ihere is e wnstruction lending agency for Ihe pertormance ot the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby atfirm Ihet unGer penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons
Code: Any ciry or counry w�ich requires a pertnit b construct, alter, improve, tlemolish, or repair eny siructure, prior to its issuance, also requires the applicant for such permil
to file a signed statement that he or she is Iicensed pursuant to the provisions of the Contrectore License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 oi Ihe
Business and Protessions Code) or that he or she Is exempt therefrom and the basis Por the alleged e:emption. Any violation oi Section 7031.5 by any epplicant for e permit
sub�ects Ihe applicant to e civil penalry of not more than five hundretl tlollars ($500).):
❑ I, as owner of Ihe property, or my employees wlih wages as their sole compensation, WILL DO TME WORK, and the structure is not Intendetl or ottered lor sale (Sec.
7044, Business and Pmfessions Coda: The Contractors License Ww does not apply to an owner of properry who builds or improves iheraon, end who does such work
himself or herself or throug� his or her own employees, provided ihat such improvements ere not intended or ottered for sele. If, however, the builtling or improvement is
soltl within one year ol completion, the owner-bullder will have the burden of proving that he or she did not build or improve for Durpose of sale.).
❑ 1, as owner ot ihe properry. am E%CLUSIVELV CONTRAC7ING WRH LICENSED CONTRACTORS to Conslruct the project (Sec. 7044, Bu5in85s and Profe55ions
Code: The contrectors License Lew tloes not apply to en owner ol pmperty who builtls or Improves thereoq end who coniracts tor such project with a contrector(s)
Ilcense pursuam to the Coniractors License Laws.).
❑ I am exempt untler sec.
Signaiure:
Owner ID venfied Dy tlrivers license. ❑ Yes ❑ No
Busineu and Protessions Code for ihi5 rea5on:
Verification of Ownership by (type of document, i.e. - property ta�c bill or deea):
DIVISION OF INDUS7RIAL SAFETV PERMIT CER7IFICATON:
Drivers License No.
Date:
E:pires:
❑ I hereby certify �hat no excavation tive (5) or more feet in depih into which e pereon is required to tlescen4 will ba made in connection with work euthonzed by Ihis
permi�, an0 thet no builtling swcture, scattolding, falsework, or demolition or dismanHing �hereot, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, A� 2, Sec.
341, Title 8, Califamia Adminisiretive Gode).
❑ As owner-builtler, I will not employ anyone to do work which would require e pertnit from the Division of Indusirial Satety, es notetl ehove, unless such person has a
pertnit lo do such work from ihe tlivision.
Signature: Date:
Division ol Indusirial Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUiHORIZATION OF ENiAV: I cenify under penalry of perjury ihat I have read this application antl state ihat the infortnation given is
conect. I agree to comply with all state laws antl ciry ordinances relating to building constmction, antl authonze representatives ot iha Ciry of Costa Masa to enter upon Ihe
ebove-described property for inspection purposes. I agree not to occupy or allow occupancy of eny building authonzed by this permi� un�il final inspaction.
� SI ture Ot Legal Owner(s) Date
�-----� 6 l �'--� r
�An[llOr Authonzed Applicant �--Date
COUE t. INSPECTONflPE
1676 Fixed Sysiem Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Raoi
201 Final BIxWReteining Wall
202 Final Factory Fire Place
203 Final Siqn
20a Final Demolition
p1TE INTRIALS
/� /
40pE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbinq
210 Final Etecirical
212 Final Fire Pravention
220 Final Planning Approval
222 Final Sita
250 Final Building/Occupency
PLiE IMITIALS
. AVP���ant to fill in ali spaas exceD� those within heavy bortler lines ana sign all appropriate aeclarations. , __„ . _ _, __ _.
PERM NO._ . , TRACT NO. LOT NO. UNIT.N6.�.: i � � � ' � ' � � , �
CITv,oF COST,u M�EJSA CONSTRUCTION PERMIT - - ,. , , , : ' .- � ; �
ProlectAddress '�L^-f � �-TP_.l�IDf� . �//I� � ' � �/'� ' . ' . ' ' . - . ' . _ • . �. - , . �., ` j3269 (0/31 /8� . „- � 54Q' �i:.
A�pplicant's�Mailing � ddress' - ' - � � ' . ' � TYPE OFCONSTRUCTION NEW ' ?DD; ALTERATION REPAIR � - �
- ' ^ i' ' ' '� CONVERSION O DEMOlISH �� OTHER � ' � ' . - • . 1 � � � ' -. _
. Owner's.Name ' Phone � . � ` _. , _ A.P..#" . � . . . . Zone
. - DESCRIPTION OF.WORK/USE OF BLDG.
' Address - l � �' ' . � � ' � � ' - - ' ' - � � - S 'Main Building:� ' � - ` � � � Accessory Building:'� � . ' ' `
' . . - ' ` � � .. ' ' �- . - ' � :_ ' . . :� _ ' ' E.� . - ': �Z
Arch/Eng �"" � - 'LicenSeNo � � ' TYPE,OFPEHMIT. 'GRADING �❑ FOUNDATION STRUCTURAL � ' T. Frant � ° i �_ ' ` t , �
i - ��- � ' � ❑ TENANT .❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' i g� - ^ - , � . . n'N
Address ' � ' ' . � 'Rear � �
c, ' .. � .. �- `' ."O�OTHER , -.. � . � � _ � =� � p ' - i . � � 1 �
Contractor's Name: • - ' hone ' � - � . � - � - - C Ri9ht ` � � - � ' N
P PROJECT DESCRIPTION sa. FT. �' oCCuaANCv
Address;mailing) ��1- 7 � � � ���, '• � CONSTRUCTIONTVPE � � VALUATION$ ; � S Left � �' , ' - � ! . - ' ' � ^ � { � �- R I
City Liceni? No � ZONE '�- GRADING CU. YDS: ,ACRES pjng. Fief. #' . � Parking Req./Provided � � E� �
LICENSED CONTRACTOR DECLARATION � . '� ' � � . Q �
' I hereby afti�m tha['I'am�licensetl untle� provisions of �Charte(9 (mmmencing . - ' ' � � � � ' �� ' ' . ' ' � , - '
� Remarks: . Planning Notes: , , ' � = I - ' M �
with iection 7000) of Oivision 3' of the Business antl Professions Cotle, antl '
my license Is in ( ,fpE antl ettect. ', �''e -�� ' _ , ' 1 � , � f � i ' , ` � T
LicenseClas�s �� ' ' ' ` .�����ens�jf1�, u'��ver� '• c � - '� : � ' . ' - � ' S
( oate ' '` / ` '' S'g t � -//�/'/ ` ' '.—�� . � �. � PLUMBING FEES � � � � � ..� � �� .
�WOHKERS' COMPENSATION DECLARATION ; ga� Sink � • ShOw¢r5 � I !
� il heretiy atfirm that I have a certiticate of consent�to self-insure or a certificate � � � ; ELECTflICAL i FEES
�`w�f Workers' Compensation- Inzu�ante,�or a certifietl Copy ther¢ot.(Section _ ._y. _ � F - ...- _� -- � - - -- -.- -- - - , -�� � - - --.- - - . - �?
' Backflow Pre'venter --Service Sink � ,Automatic Washer, � � �Transformer
❑ 1550KW
'7800� Lab. / � `� j � ' � � � i . ,
`Poucy No. �r ��%��%�m/� Company ^� �� � Batkflowlrr��gation SewerCap ( ' . ConstructionPoleSub � ❑ 50+KW �
[]�¢erLnetl copy iz hereby fumishea. ' � , , ' � � Cooking Unit � 'Merer ❑u to 100 am s '
r� Certir c y iz tiletl with the city fi}�l� v opn. / w � , Bathtubs � � Sewer Connection
Date ��� . � 1 APPlicant �/� � I � 4�^-� � �/'r.-v , � . � �, P � P �
' E%EMPTION FROM WORKERS' COMPENSATION DECLARATION ' . Clanfier5 � � . Solar Collectors � �, { ! . ;DiShWasher_ ,� , .,, _ ♦Meter, �over 100 amps J „ ,
-- 1
(This section neetl noTbe completetl if the permit is for one huntlretl ($100) or �.�- - - - - ' ' ' i
less): i i ' � , . . Dishwasher � � $olar Pipin9 � ; ' �Dryers ❑Gas' �Elec[ric Sub Panel; •
I certify that in the performance of tM1e wo�k tor which this permit is issuetl, I ,
' shall:no[, employ any person in any manner so as to become subject to the ' Drinking Fountains Solar Tank ' � Fan �
Workers' Compensation �Laws ot Calitomia. � , � � Motors DO-1 HP � 1%- 8
. Date ' Si9nature � � � � � , Floor D�ains� � • Swimmin Pool w/S a � ' • . . " ,
''NOTICE: If, after making this tlecla�a[ion, you shoultl become subject [o the 9 P � F.A.U. - Ina SOId� 09-15 HF �is-15+
Workers' Compensation,Orovisions of.lhe LaCor Cotle,.you musi for[hwith FloofSinks - - � -Urinal' " � Fixtures ' ' Microwave � ' �
comply with such provisions or this permit .Shall: be tleemetl revoked. I
CONSTRUCTION LENDING �AGENCY ' ' � ' - ' Gas $erviCe 'Outlet5 Watef C1o5et � � ' _ Devite BoxeS � � I �
, I hereby affitm that there is a consGuction lentling agenq tor the �perto�mance � • j 'Pole Light � �
of tne work tor which this permit is issuetl (Section ,309] Civ. C.) - ' �
Lentler's' Name � Intercepm�s ! - - Water.Heater - . . � Outiets � .Range � - � ` - �
• Lentler's'Aatlress � � � � �� ' � � � Kitchen Sink - � Water Service $witches � . �
OWNER'BUILOEH �ECLARATION � ' � ' ' � � � _ . ' �Sigm � �
' I hereby affirm'that 1 am exempt from the Contractor's� License �aw for �the Cavatories: ' ,, Auto-Wash' � ' ! . ' '
.following reason (Section'703L5 Business antl ProfessionaPCbtle: Any city or. i� ' y Gartiage Disposal ; Standing Sections '
county which' requires a permit to construct, alter, improve, tlemolish'or reoab �" P-Trap � ,p Caundr� Tra s� ' ' �
any structure, prio� to it5 i55uancE, also requi�es the.applicant tor such pe�mit ' � Y � V: yGeneremr �0-$ KW �$-15 KW T�dSh COmp0ct0� �
to tile a signetl Sta[emen[ Ihdt he/sne i5 IicenSetl pu�suant to;tne piovision5 of� ' ' ._ ,� � . • . ' „ ��' �
Roof�Drains � � • - � _ � , , i
:�the Contractor's License Law�(Chapter 9_(mmmencing with'Section ]000) of � � � �
' Oivision 3•ot the;Business antl Professmns Cotle) or that he/she� is exemp[ ' _� -� � .
'heretrom antl the basis fo� the all¢9etl exemption.'Any.violationrof Section , k � 1r' ' � _ , � i
031.5 by any applicant for a permit subjects the applicant [o a- civil
enalty of not more Ihan five liundretl tlollars ($500�. � � ' . � '-� • . - � � - � , '
❑ I, as owner ot� [he �property or� my employees with wages as their sole ReinSpeC[iOn Fee � �$15 � ISsue FBe ; �' $ 3 .+ '
� compensation, will do the work, antl the.structure is not intentletl or offeretl � ' Reinspectian Fee $75 Iuue�Fee , . i$ 3
for sale�(Section �044, Business antl Protessional Cotle: The Contractor's' - � MECHANICAL - - ` FEES
LicenSe Law tloes not apply to an owner of a property who builtls or improves �' '' - � �
� thereon, and who tloes such work himself/herseli or through his or her own � ' �� . DEVELOPMENT SERVICES�REQUIREMENTS: . , �
� employees, provitletl that sucti.improvements are not intentletl or offeretl tor BOileL � : - HOOd O� i Typ¢ I ❑� _� , . �
l sale. If, however, the builtling or improvement is soltl within one year of com- � � ' � C3nOpy . Typ¢ I I ❑� � ZOning App�aved By Date �
pletion, the owner'wiil nave the buraen of provin9 ne/she tlitl not build or im- � Duci - Under�Ground ' Buildin A roved B � ' Date � •
prove for the purpose ot salef. . � ' � ' ' , � .' , 9, PP ' Y � � � �
❑ I, as owner of the property, am exclusively contracting,with licensetl con- . Duci -$tructural ' �Refrigeration System • .: Appliratian IsSued By ' � � �' � Date_�����
' tractors to mnstruct the project (SeGtion 7044, Business antl Pwte55ion5 Cotle: ' ' - � �
: The eontractor4 License Law tloes not apply to an owner ot property who - Duct - Ventilating _ _ , � ❑0.100,000 BTU 0100,000 BTU _ �_ �- � ' , � SUMMARV OF FEES � �
� builtls'or improves thereon,'antl'who'contracts for such'praject5 with a Con- � _ . � �
t
Vactor(s license pursuan't to the Contractor's License Law). I am aware that � BUILDWG PERMIT i$ + � • SMIP' ' '$
rmf o� their Worker's Com ensation insurance showd be ExhausLSystem ❑ MWtiple �� System Repair/AI[eretion � � �
� p P provitletl to me. . . I
i � � � - PCAN CHECK $ PERMIT � � � t
, , L7 1'am exempt unaer Section e. & P. C. for this reason . � FirepUFact Blt. ICBO # � Fire Dampers ' � � pLUMBING . '$ V-� ' ISSUANCE �$ �
�
i Date ' Owner � ' ' Heating System & Ducting Registers � '� � � p�p,N CHECK 25% �$ � ' ENERGY P.C. � $
b hereby.�certify that I,have reatl thi5tapplicatiOn antl�state thnt4he above ❑0�100,OOOBTU-Ot00,000BT �-- - -- - � -- - - � ' $ i � ' � GRADING �$ �
iniormation is correct. 1 agree to comply with all tlty antl counry orainances i � ELECTRICAL j . , .
' antl stace laws relatin9 �o builtling construction, antl here0y authorize re0re- . I � ' PLAN CHECK 50% t$ MICROFILM '$ f
senta[ives o( 'tltis it to e ter .upon the above-mentionetl 0Lope�ty to ' : � . 1 � . ; � � �
inspectionp losl � � I � �/��j(� � ' MECHANICAL . $ ' TOTALFEE ;$ �����
� Signature ' � ' � _ � Date I 11 ` I I ' � , . . ' .
Drivers' Utense or 55 � � �T Reinspec[ion Fee $15 � Issue Fee $ 3� � pLAN CHECK � 25% �$ �
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applkant; Pink - Accounting; Goltlevotl - Assessor " `—___``
- CONSTRUCTION'AND PLANNING - " � P��� '�P' '
`- - Date Ins ector
� APPROVALS Permit #_ P APPROVALS Permit # Date Insp?ctor
(-1. Temporary Electrical Service or'Pole ' . - - 52. Pool & Equipment Location �.
� -
2. Soil PiPe-Undrgrnd. - 53. Steel'Reinforcement
3. �Elect'rical Conduit UtiliTY-Undrgrnd. " � � 54. Forms . '
��4. Electrical Conduit-Undrgrnd. , � � 55. Electrical Bonding ,�
-�5..$teel Reinforcement � � 56. Rough Plumbing & Pressure Test•
�, � -
-6: �Elect7ical UFER Grnd. � -. � 57. APPROVAL TO COVER=GUNITE .
� 7.�Footings ". "� � _ - 58. Electrical Conduit-Undrgrnd. - �
, 8.'Foundation . ' , • � ' 59. Gas Pipe, O Undrgmd., 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 � -� � r � � 64. Plumbing System - Final �
' 14. Rough Plumbing 65. Electrical-Final
75. Rough Electrical-Conduit 66. Solar System-Final
i 6. 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, �n Structure . 70. Underground Hydro
22. Ducts, Ventilating . 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �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. Electrital Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric . Notes: ' _ �
+ ,o i r
34. Final Heating & Air Conditioning • .o
d /¢ R y�
35. Final Gas Pipe-Test � - .
36. Hood or Canopy � � _ � " -
37. Final Factory Fireplace � � � . -
38. Final Plumbing ' • �` �
39. Water 5ervice-Final �
40. Gas Service-Final • .
41. Solar portiesticFinal , . , '
42. Backflow Preventer ' . ' ' �
43. BackfloW Irrigation ' �_ � '
44. .landscape �rriqation SYstem - � - �
45. Sound Attenuation � � - �
46. Handicap �Regulations - ' � � ; �
47. FINAL STRUCTURE & BUILDING � � ,.
48. SpeciaP Requiiemenfs Completed , � � � � , � , � �
�
49. Electrie Release to Edison � . ' ' � ' � + ' • , � � � . '
�
50. Gas Release to Southern California Gas Cn , � . ' � , • �-
51. CERTIFICATE OF OCCUP,ANCY. ' .' ,_ _ .. _ _ _. . �
� Nn. ' � Date � .. - - . • ' . . -- . . _ _ • . .
� '°g' �° �E�--RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT JUN 3 1963
P.O. BOX 2f] COBTp MEBA, CALIFOfiN1A
FINANCE DEPT.
For Applicant !o Fill In Complefely CIjY O�F��I�ROR PERMR
TYPE OR PRINT BUILDING
For Ofiice Use Only
ILDING � /� � G (� _^ ��
DRESS V �%� ��J �
RHCEIPT NO. I � `E[t
� COSTA MESA. CALIFORNIA /� � � Y
��r A n��. � vi, C�,`
ARCHITECT , C, I 0.yi
OR ENGINEER
e...,e«a �'%1 0 � l,(/t_c�' �
ADDRE88 , a V� �
CITY J �' w� �'
[ ¢Ive er
. r^
-0.
B DIN6
J� RESS �
F RB ^
���0 ZONE
APPROVED
r, ��o BY
.�t+�,. _� - I
LEOAL
LIC.TNO/`�/'YJ�- NO. Yl Y�D ��
SIZE 33 X, � V� G I NO.OPBLDOl.�
OF LOT �rvow oN LAT
USE OF _�
E%ISTINO BLD6.
B6TBACK LINH FROM >� �
cervrea oF eTxeeT O�/ " �% � REAR YA D
9IDfi YAR�I LEFT �— I RIGHT
DESCRIPTION OF WORK
DATE
ZONING
NO. OF U8[ OP NE
/LAN9� SIIILDII��
� -� /0 6 � a�3 ya
�
'E OVERHAN6 6HALL BE LESS THAN
YARDSAPPROVED
MAIN BUILDIN6
BUILDINB J � NO.OR -� / VAR.#
SIZE 3 K 3. J ROOMB RI68 v C. U. .
COVERINGWAL ✓�� E I COV�ERINl3 � hA' C BYP
60FB ILDIN6AfiDWOR�('jOB6Pfi}� ORM /�
p' Ct��c. w:Th aCUla .�t.� qa/
%ho�cl �% —
1 HEREBY ACI(NOWLEDOH THAT 1 HAVB RBAD THIi APPL�CATION
AND BTAT¢ TNAT TH8 ABOV6 Ie CORR6CT ANO AGRHQ TO COM.
PLT WIiX ALL c1TY OR�ItlAflC66 AND BiAT[ LAWG fl[OULATING
aWLO1N�CONBTRUGTION. / � ..
616NATURE �
PERMITTE '
AUTHORIZfiDA6GNT / , f`l• //�w(� .
YARDS APPROVE�
ACCESSORY BUILDING
BET. MAIN R
ACCESS. BL[
DATE
�� p, '
/'� a
6Q.FT. T� o
THE AMOUNT 8H UNDER VALIlATION IB FOR TXH F'
PIIRP086 OI HS LI6HIN0 A PERMIT FEE ONLv. 0
VALUATION /�7 m
PERMIT FEE $ GU � j
/ `/e � � m
$ � s � 3/ � ;
TOTALFEE $�r"
�
OWNER DOYLE &
�:'�
v�r n R(1R
Co.
Dev.Co
DATE 6-
�FIRE ZONE DESCIt:
DATE I GROUP I&J TYPE
SUBCONTRACPOR
WORK Res.w
ZONE R-2