HomeMy WebLinkAbout3013 GARFIELD AVE - Building Permits(7ta) 75a-5273 • Fax (71a) 754-4856 • www.cl.costa-mesa.c$y/ILDING PERMIT 77 PAIR UHIVt, GUAIA MCAH, GA tlLOLO
JobAddress: 3013 GARFIELDAV
Suite:
Viciniry:
Primary Occ: R3
Parcel Number: 14113432
Applicant: JERRY CLARKE
Address:
Owner: VANGUARD UNIVERSITY
Address
Contrac�or OWNER-BUILDER
Address:
Zip:
Arch :
Address:
. . . Zip: ..
Status: ISSUED
Applied: 02/14/2007
Issued: 02/14/2007
Type of Construction: V-N �,XPIRE
Zoning: � ����
DA'PE-��i
Phone: 71-556-3610 ISSUED BY:
Zip:
Phone:
License: 4 ' � -
Phone: 714-5563610
Zip: 92007-0387
Phone:
License: 000000
En9:
Address:
- SCOPE OF PERMIT
ADD TWO WALLS AND A WINDOW TO ENCLOSE AN ALREADY ROOFED AREA TO CREATE 104SF STUDY AREA.
FEESUMMARY
Phone:
License:
Plan Check: 5108.71 - Calc Valuation: sa,aoo.00
Permit: $16725 Claim Valuation: Sa,eoo.00
SMIP Res: $0.88
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00 �
Total: $276.84
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0- 0 Rear 0- 0 Left 0- 0 Right 0- 0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existina: o Reauired: o Pr000sed: 0
NOTICE: The work authonzed 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
tor a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end ell
required Inspections and (inal approval must be obtained. Failura to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
taaaea �e�ao�
WORKERS' COMPENSATION DECLARATION:
I hereby affirtn untler penalry oi perjury one oi the following declaratlons:
❑ I have and wlll maintain e certiticate of consent to seli-Insure tot warkers' compensatlon, es providetl for hy section 3700 of ihe Labar Code, for the pertortnence of lhe
work for which ihis permit is issued.
❑ I have and will maintain workers' compansation insurance, as repuired by section 3700 of ihe Labor Code, tor Ihe pertortnance ot ihe work for which this pertnit is issue0.
My workere' compenseNon Insurance wrrier and policy number are:
Cartier: Policy Number.
(Thts section need nof be comp/eted il fAe permit is velued at one hundred dollars ($100) or IessJ
❑ I certity that in ihe pertormance of the work for which this pertnit is issued, I shall not employ eny person in any manner so as to become subject to the workers'
compensation laws of Calitomia, entl egree that II I should become sub�ect to the workere' compensation provisions of Section 3700 ot the Labor Code, I shell forthwith
Comply with these provisions.
AppliCen� Signature: Da�e:
WARNING: FAILURE TO SECURE WORKEFS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000�, IN ADDfTIpJ T0 THE CQST OF CO/APENSATION, DPM4GE5 AS PFiOVIDED FOR W SECTION 3]O60F iHE LABOR WDE, IMEPEST, ANO ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I here�y aHirtn that I am licensetl under proNsions of Chepter 9(commencing with Section 7000) of Division 3 of iha Business and Professions Code, antl my license is in tull
forca and eHect. Lla N Class a
Coniractor's Signature: Date:
CONSTRUCTON LENDING AGENCY:
❑ I hereby ettirm thal there is a constmction lending agency for the performance ot the work for which this permit is issued. (Sec. 3097, Civil CodeJ.
Lendets Name: Lender's Address:
SiqneWre: Date:
OWNER•BUILDER DECLARATIONS:
I hereby alfirm Ihet under penalry ot perjury ihet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business entl Professions
Code: Any ciTy or counry which requires a permit to consiruct, alter, improve, tlemolis�, or repair any structure, prior to its issuance, also requires the epplicant lor such permit
to file e signetl stetement that he or she Is Ilcensed pursuent to the pmvisions af the Contrectors License Lew (Chapter 9(rqmmencing with Section 7000) ai DlNsion 3 of the
Business end Protessions Coda) or Ihat he or she is exempt therefrom and the basis for the alleged anemption. Any violation oi Section 7031.5 by eny applicant for e permit
subjecis ihe epplicent to a civil penalry of not more Ihan five hundred dollars ($500).):
❑ I, es owner of ihe properry, or my employees wl�h weges as thair sole compensation, WILL DO THE WORK, and the sirucmra is noi intended or oHeretl for sale (Sec.
7044, Business and Professions Cotle: The ConVaciors License Law tloes not apply lo an owner oi property who builtls or improves Ihereon, antl who does such work
himselt or herseN or through his or her own employees, provitletl ihat such improvemems ere not Intended or oHered for sale. N, however, the builtling or improvement is
qsold within one year of completion, ihe owner-builder will hava the burden of proving that he or she did not 6uild or impmve for purpose of saieJ.
�� I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the pro�ect (Sec. 7044, Business and Pmtessions
J Cotle: Tha camractors License Law does not epply to an owner of propeny who builds or impmves thereon, entl who contraas tor such project with a conirector(s)
license pursuent to Ihe Coniray,mrs License Laws.).
❑ I em m t under C Business and Professions Code tor thi5 reason:
SigneN^re�. Dat`_ �
Owner I 7ied �y tlrivefs license. /O;Yes ❑ No orivers��` icense:rb. � E�re's: (�,.�.�Q�
Veniiwu of Ownership by (type of do uc ment, i.e. - propeny taz bill or deed): .
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON:
❑ I heraby certity Ihet no excavatlon tive (5) or more feet in depih into which a pe�son is required to tlescentl, will be made in connection with work euthonzetl by Ihis
permit, antl ihat no Duiltling simcWre, scaHolding, talsework, or tlemolition or tlismantling thereot, will be more than Ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Celitomia Adminisirative Code).
❑ As owner-6uilder, I will not employ anyone to do work which would require e permit from the Division of Industrial Sefery, as notetl ebove, unless such person has e
permit to tlo such work from the division.
Signawra: Date:
Division oi InduSirial Safery Permit Number:
CERTIFICA7E OF COMPLIANCE AND AUTHORIZA710N OF EN�RY: I certity under penalry of perjury that 1 have read this application antl state thet the information given is
correct. I egree to comply wit� ell state laws and city ordinances relating to building consiruction, end au�honze represen�a�ives ot �he Ciry of Cos�a Mesa �o enier upon Ihe
above-tlescnbed property for inspection purposes. I egree not to occupy or allow occupancy of any building authorized by this permit until finel inspection.
COUEY/ INSPECTIONTYPE �—�
1616 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Rooi
201 Final Block/Retaining Well
202
203
Final Factory Fire Place
Final Sign
204 Final Demolition
� INTITIRLS
CODEt INSPECTONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Site
Final BuildingiOccupancy
oate
�7. .�n � .'7
�'�'�J 1
�
� 1�"1
I
Job Address: 3013 GARFIELD AV Stams: iSSUED
Suite: Applied: 02/27/2007
Vicinity: FOUNbATION Issued: 03/Ot/2007
Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Constmction: V-N EDr
Parcel Number: 14113432 Zoning: �T�
npplicant: MIKE MOLINARO +���a� �
Address: 18226 MC DURMOTT
UNIT E Phone: 714-�1-7099
IRVINE, CA . ZiP: gpg�q ISSUED BY:
Owner: UNIVERSITY OF'VANGUARD
Address 55 FAIR-DR �
CA � � . Phone: � -
CM � , . Zip: 92826 , - �� .
Contrector. -PACIFIC WESTERN CONTRACTORS ,
Address: 18226 MC DURMO7T�,
� UNIT E . - Phone: 714-241-7099 , ," �
IRVIN�, CA . � �
Zip: 92614 � , License: 283195 � ' ,
nrch : Eng: ALAN J JESSUP
Address: Address: 24432 SILVER SPUR LN
� Phone: � . � � Phone: 949.448.9650
� . . LAGUNA NIGUEL, CA
Zip: . � License: 92677 License: 439
SCOPE OF PERMIT
'I,500 S.F. FOUNDATION REPAIR�TO S.F.D. -
�
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$117.81
$,a,.25 � ,.
$4.98
$0.00
$0.00
$0.00
$300.04
FEE SUMMARY
� ' - Calc Vafuation:
`� " � ' " Claim Valuation:
PLANNING & ZONING
SETBACKS � �'' �"�
MAINSTRUCTURE Front 0-0 Rear .0-0 - Left ��0`.0" -.. Right
ACCESSORY Front 0-0. � � Rear 0-0 Left 0-0 � I, Right
PARKING Existina: o Reauired: o Pr000sed: 0
�
r� �
0-0'. ^
0- 0
` � _ - i; �
� � . .
', .
; � ,.. ' .'.'
59,800.00
ss,eoo.00
NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-g2)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a periotl of 180 days.
� INSPECTIONS: In order Por the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
' required Inapectlons and final approval musi be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CAIL: (714) 7545626
nao-an �arw�
��
WORKERS' CCIMPENSATION DECLARATION: L� � . � - ��
I hereby affirm i;nder panaly ot perjury one ot the following declarations:
� I have an.l will meintain e certiticate ot consent lo sell-Insure for workers' compensation, es provided for Dy section 3700 of tha LaDor Code, for the peAormance of Ihe
w/ark tor �:hich this pertniPis issued.
�Ihave e`ui will maintain workers' compensation Insurance, es requtretl Dy sectlon 3700 ot Ne Labor Cotle, lor Uie peAormance oi the wortc for which Nis pertnil is issuetl.
��Myworke's' com0ansatlon�5urence carner and pollcy number ere:
Polity Number.—a � 2 � � ^
onehundreddollars($100)orless.) �—�;__�_,
❑ I ceRity t�a� in ihe peAortnence of the work lor which this permit is issuetl, I shall not employ any person in eny manner so as to become subject to tha workers'
compensation laws of Celitomia, an� agree thet if I should become su��ect to the workers' compensation provislons of Section 3700 0l ihe Labor Code, I shall fonhwith
complywiththes ion5.
ApplicanLSlgnet ru e: ���— f-J---� Date:+'r-3 /�U�
WARNING. FAILURE TO SECURE WOHI(EPS' COMPENSATION COVERAGE IS UNLAW FUL AND SHALL SUBJECT PN EMPL�EA TO CFiIMINAL PENALTIES AND pVIL FlNES UP TO pJE HUNDRED
hIOUSANO DOLLAqE (S10D,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECTION 3]O60F THE IABOR COOE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirtn that I am Iicensetl untler provisions ol Chapter 9(commencing with Section 7000) of DiNsion 3 ol�ihe�Busine5$ and Professions Cotla, end my license Is in full
�_.._.r._u__.-��._.._.. '1 oD /G.� I...___i /(
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm that ihere is e consiruction lending agency for the peAormence of ihe work for which this pertni� is issued. (Sec. 3097, Civil Code).
Lentler's Name: Lendels Address:
Signeture:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aHirm ihat untler penelty of perJury ihet I em E%EMPT FROM THE CON7RACTORS LICENSE LAW for tha tollowing reason (Sec. 7031.5, Businass entl Professions
Code: Any ciry or counry which requires e permit to conslruct, elter, improve, tlemolish, or repair any sWcture, prior to its issuance, also requires Ihe epplicant tor such permit
to file a slgned stetemant Ihat he or she Is Iicensea pursuant to t�e provisions of the Conirectors License Ww (Chapter 9(commencing with Sectlon 70W) ol Division 3 of ihe
Business entl Professlons Code) or ihet he or she is exempt therefrom end the basis tor the alleged exemption. Any violetion of Section 7031.5 by any epplicant tor e permit
subjecis lhe applicent lo a civil penalry at not more then five huntlred dollars ($500).):
❑ I, as owner of ihe pmperty, or my employees with weges as their sole compenselion, WILL DO THE WORK, and the structure is not intantletl or otlered for sele (Sec.
7044, Business end Protessions Code: The Coniractors License Law tloes not epply lo an owner of property who builds or improves thereon, end who does such work
himselt or herseN or ihrough his or her own employees, pravitletl that such Improvemenis ere not imende0 or oNered for sale. If, however, Ihe builtling 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 tor purpose ot sele.). '
❑ I, as owner oi ihe prOperty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo conslrucl Ihe project (Sec. 7044, Business antl Protesslons
Code: The wntractore License Lew Aoes no� apply to en owner ol property who builtls or improves thereon, end who contratls tor such project wit� a contractor(5)
license pursuant to ihe Contractors License Lews.).
❑ I am exempt untler sec. Business anA Professions Code for this reeson:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ Na Driver's License No. Ezpires:
Venlicatian of Ownership by (type ol tlocument, i.e. - property ten bill or deed):
DIVISION OF INDUSTRIAL SAFETY PEFiMR GERTIFICATION:
❑ I hereby cetlity ihat no excavatlon five (5� or more feet in depih Into which e person is requiretl to tlescenq will be matle in wnnectlon with work euthonzetl by iNs
permil, antl that no building structure, scaRoltling, talsework, or demolition or dismantling thereof, will be more then thirty-six (36) feet high. (Chep. 32, Grp 2, Ar12, Sec.
341, Title 8, Califomla Atlminisiretive Code).
❑ As owner-builder, I will not employ anyane to do work which would require a pertnit irom the Division of Industnal Sefary, es notetl above, unleu such person has e
pertnic to do such work irom the tlivisian.
Signature: Date:
Division oi Intlustrial Sefery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORPATION OF EMRV: I certify under penalry of perjury that I heve read thls eppliwtion end state U�at the informatlon given is
correc�. I agree to comply with all stete laws entl ciry ortlinances relating to building construction, and authonze representatives of ihe Ciry oi Cwta Mesa to enter upon ihe
above�descnbed property for inspaction purposes. I agree not to occupy or allow occupancy ot any building au�horized 6y this permit until finel inspection.
CODE �. INSVECTIONTYPE
1616 FixeC System Final Fire Prevention
1266 Pool Spe Finel
200 Final Ra-Root
201 FInaI BIxWRetalning Wall
202 Finel Factory Fire Place
203 Finel Sign
26a Final Demolition
n-T _'—
P� I[�LS
�
COOE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electncal
212 Final Flre Prevention
220 Finel Planning Appravel
222 Final Site
250 Final Builtling/Occupancy
oate
p7.\i�I:inIr.lFj
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicanf:
Address:
3013 GARFIELD AV
14113432
JERRY CLARKE
Et��'� l�'-�o� �
�t�+r
�Phone: 714-556-3610
"" Zip 92007-0387
Owner: UNIVERSITY OF VANGUARD
Address . ; � -
� � , � � '
Contractor:
Addressi
i . : �
Phone: 714-556-3610 - ��
Zip: 92007-0367 �
OWNER-BUILDER
Phone:
Zip:
� � _. LiCense:000000
'- �?�.. .�
SCOPE OF PERMIT
REF BO6-0 121 � �
1 LIGHT 1�FAN 1 SWITCN 4 OUTLETS
ISSUE FEE
Temp service tegt
Res. a/c packag�
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting FiMs � '
Recept Outlets , .
Switches
Non Res Appl , -„
Res Appl
Service to 200a
Service to 1OOOa
Senice over 1000a
Motorsto.lhp � �
Motors to 10hp , �
Motors to SOhp
Motors to 100hp , � ,
Motors over 100hp
Communication drops, ; ,
Sub panel to 200a � �
Pole Light Pkg .
Sign Circuits
Temp Pwr Pole
Intermed Pole
Quantlty
$23.50 �.
$0.00 -
$0.00
$0.00 0 ,
$0.00 0
$0.00 �- 0 -
$1.10 ' 1
$4.40 4
$1.10 . 1
$0.00 0
$4.75 1
$0.00 0
„ _ $0.00 0
�$0.00 0
$0.00 . 0 .
� $0.00 . � 0 ,
- $0.00;.�' 0
' � $0.00 �; .; a, 0
� � �$0.00 - �...0,
'$0.00 , � ' 0 ,
$0.00 � 0
. � $0.00 % - � 0 ,
. $0.00 . � 0 �
�,$0.00, ���0 �
$0.00: ��� 0 � .
�':
/�
�
FEE SUMMARY
. �- Temp Dist System / Lighting
8usway /100 ft
Standing Section
Misc Electrical Equipment
7ransformers up to 1 kva/kw
- � . .. ................up to 10 kva/kw �
� � .................up to 50 kva/kw
...............:.up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
� �Misa Conduit
, Misc. Conductor
' � Circus ( gen or ride)
Circus (mech ride or lights)
� Christmas Tree Stand - "
. Fireworks Stand
Oiher Electrical Fee
" � Investigation Fee
Plan Check Fee
Reinspedion Fee
Status: ISSUED
Appiied: 02/742007
Issued: 02/14/2007
ISSUED BY:
Quantlty
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00, 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 534.85
COMMENTS / SPECIAL CONDITIONS
� • :. �
NOTICE: The work authorized by ihis permit shall compty with all applicable handicap access requiremeMs under California staWtes antl related
regulations. (Ord. No. g2-28, § 1, 1241-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In qrder for the work authorized under ihis 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 ihe expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
2aas-as (s�oo)
WORKERS'COMPENSAnON DECLARAnON: .
I hereby attirm untler penalry of peryury one ol the following declaretions: � �
❑ I have antl will meintain a certilicete ol consent to self-Insure for workers' compensation, es provided for by section 3700 of ihe Labor Cotle, br ihe pedormence oi ihe
work for which thi5 permil is issued. .
❑ I have antl will meinWin workers' compansation insurance, as required by section 3700 ot the Lebor Cotle, for the perfortnance of t�e work for which ihis pertnit is iuue0.
My wakers wmDensation Insurante carrier e�xf policy number ere:
Cartier. Poliry Number.
(This section neetl nof be comple(ed i! fhe permit is valuetl ef one hundretl tlollars ($100) or /ess.)
❑ I certity that in ihe peAortnance ol the work for which this pertnit is issued, I shall not employ eny person in any menner so as to become subject to tha workers'
compensetlan lews of Celitomle, entl egree thal If I shoultl bernme sub�ect to the workers' compansation provisions ot Section 3700 of the Labor Code, I shall lorthwilh
cnmply with these provisions.
Applicam Signatu�e: Date:
WAfiNING: FAILURE TO SEWRE WORKERS' COl.IPENSAiION COVEMGE IS UNLAWFUL AND SHAl1 SUBIECT AN EMPI.OYER TO CRINJNAL PENALilES AND CNIL FlNES UP TOONE HUNDRED
THOUSAND DdlAFE (5100,000�, IN AODRION TO THE WST OF COl/PENSATION, OAMAGES AS PROVIDED FOP IN SECiION 3]Ofi OF THE LABOq CODE, IMEFEST, PNp ATTORNEY'S FEES.
LICENSED CONTAACTORS DECLARATION: � ' .
I hereby aNirm IhAt I em licensed under provisions of Chapter 9(commencing wil� Section 7000) of Division 3 0l ihe Business and Professions Cotle, and my license is in full
force and eflect. Uc. N Class a
ConlrectoYs Signa�ure:
Date:
CONSTRUC710N LENDING AGENCY:
❑ I hereby aHi� Ihal there is a consimction lentling agency lor the pedormance oi the work for which this permit is issued. (Sec. 3097. Civil Cotle).
Lenders Name: Lender's Atltlress:
Signatura:
OWNER-BUILDEA DECLARATIONS:
Date:
I hereby aXirm ihe� under penalty of perjury that I am E%EMPT FROM TME CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or county which requires e permit to consimct, elter, improva, demolish, or repair any stmcture, prior to its issuance, aiso requires ihe applicant for such permit
to file e signed siS�emenl ihat he or she Is licensetl pureuent to the provisions ol the CoNrectors License Law (Ghapter 9(commencing with Sectlon 7000) ol Divislon 3 of Ihe
8usiness antl Pro�essions Code) or Ihet he or she is exempt therefrom and the basis for ihe alleged e:emption. Any violetion of Section 7031.5 by any applicam for e permit
su�jects the appliGent to a civil penelty of not more than live hundred tlollars ($500).�:
❑ I, as owner of �ha propeny, or my employees wlih wages as their sole compensa�ion, WILL DO THE WORK, and ihe struc�ure is not intandetl or offeretl lor sele (Sec.
7044, 8usiness and Protessions Cotle: The Contrectors License Law does noi apply to an owner ot propany who builds oi improves thereon, antl who doos such work
himsetl or hdrselt or th�ough his a her own employaes, provitled ihat such improvemenis ere not intended or oflered for sale. If, however, ihe builtling or impro�ement is
�soltl within one year of complotion, the owner�buildor will have the burtlen ol proving that he or she did nol build or improve for puryose of sale.).
I, es owner P� the pro0erty, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (SeC. 7044, Business antl Prolessions
/ ` Code: The Eoniractors License Law tloes no� epply Io en owner o� prOpetly who builtls or Improves �hereon, antl w�o con�racts for 5uch projeC� wil� a toniractor(s)
license pursuent to the Conir�tors License Laws.).
❑ I a z � under Business and Prolessions Code lor Ihis reason:
na • `,�/�,�
Own D erified by dnvels Iicense0� es ❑ No Drivers i se No. _ Enpires: (o b��
Veni at n of Ownership by (type o/ tlocumem, i.e. - pmperty tax bill or tleetl): �
DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION:
❑ I hereby cerlity ihat no excavation five (5) or more feet in depih inm which e person is required to descend, will be mede in connection with wark euihonzatl by lhis
pertnit, antl Ihat no building slrucWra, scaHoltlinq, lalsework, or demolition or dismantling thereof, will be more than ihiny-six (36) �eel high. (Chap. 32, Grp 2, An 2, Sec.
341, Title e, Celilarnia AAministrative Code).
❑ As ownerbUilder, I will not employ enyona to do work which would require a permit from the Division of Industnal Salary, as notetl ebove, unless such person has a
pertnii to do such work from the tlivision.
Signature: Date:
Division ot Industdal Setery Permit Number:
CER71FlCA7E OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I cenity under penalty of perjury ihat I have read �hls application and state Ihat ihe inbrmation given is
correct. I agree to comply with ell state laws entl ciry ortllnances relating to Ouilding cons�ruction, and authorize representatives of the City ol Costa Mesa to enter upon Ihe
ebove-described p�operty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permil until final inspection.
took/�. ItlSPEFIl4tl3TPE PAIE INiIiIRLS
1616 Fixed SyS�em Final Fire PreveNlon
1266 Pool Spa Final
200 Finel Re-Roof
201 Finel BIOGk/Fletaining Well
202 Final Fedory Fire Place
203 Final Sign
204 ,_ _ .Final Demoli�ion
tOpE� INSPECTIONTYPE
206 Final Mechanicel
208 Final Plumbing
210 Final Electrical
212 Final Fire Preventian
220 . Final Planning Approval
222 FinalSite
250 Final Builtling/Occupancy
Date
D� INTffULS
.� CITY OF COSTA
. Pmject Address —
,,.Applicant's Mailing
ir
AVo�icant to tlll in all soaees except thoze within neavy boraer lines antl sign all apvropriate Oeclarations.
P MIT NO. TRACT NO. . LOT NO. UNIT NO.
Owner's Nam�e) h-�- � � � Phone t�`� �^S1�z13'
Address �i � �[1I +Q�.` l.'� �� 5 ' UJ�'ST1y �v���"
Arch/Eng. License.No. ��� �9 �'
Address u
ConVacror'sNam Cm Phone{ �� ./�t
P,ddress Ima'I'nnl ����F�O �o � f a` 1:.� l ft�•2. �jT J.a1 pS�
City license No. 3�,� S
LICENSED CONTRACTOR DECLARATION .
I he�eby affi�m tnat I am licensetl untler provi5ion5 ot Charte� 9(commencing
with section ]000) of Oivlsion 3 of the Buslness and Protessions Cotle, an
my license is in full fo e antl etfect. � � �
License Cla}� .�' c�se��l5cy �i��_
Date i:' �"'r 5'9 I �'
WORKERS' COMPENSATION DECLARATION
I hereby aHirm tnat I have a certificate of consent to selt-insure�or a certiilcate
r ". Workers' Compensation Insmance, or a certifietl copY thereof (Settion
�00, ab. C.)
ol' No.�A0�5i4y'3�Company��TE ��al"'�
l Certified copy is hereby (umishetl. p/�
e' ietlFo y is fileyw�th the city guilqi Zv iauL.^, �/ � //
Dat�.�L� APP!�fantV-r- �/— �� / 4�v"c�'�
EX MPTION FROM WORKERS' CO NSMPE ATION DECLARATION
(Thizsection need not be completetl if the permit is Por one huntlretl ($300) or�
�iess).
I cerlliy that in the performance of tM1e work for whith thiz perm�[ is issuetl, I
" shali not empioy any person in any manner so as to become subject to the
�.ap Workers' Compensation Laws of Califomia.
1 Date $ignaWre
'NOTICE: If, after making this declaration, you shoWtl become subject to the�
� Workers' Compensation provisions of the Labo� Cotle, you must forthwith
comply with such provi5ions or [his permlt snall be tleemetl �evoketl.
_I CONSTRUCTION LENDING AGENCV _
`� I hereby atti�m tM1at there is a construction lentling agency to� the pe�formance
of the work for which this � permit is issuetl (Section 3097 Civ. CJ
�ender's Name �
Lentler's Adtlrezs
OWNE0. BUILDEH UECLARATION
I hereby affirm tnat I am exempt from the ConVactor's License Law for the
following reason (Section 7031.5 eusiness antl Profess�onal Cotle: Any city or
county whith requires a permit to const�uct, alteq Imptove, Oemoli5h or repai�
any structure, prior to its issuance, also requires the aoP�icant for such permit
to file a signetl statement tbat he/she is licensetl pur5uant to the p�ovi5ion5 of
the Contractor's License Law (Chapter 9(commencin9 with Section ]000) of
Division 3 of the Businesi antl ProfessiOns Cotle) or tha[ he/she i5 exempt
'•efrom antl tM1e basis for the allegetl exempfion. Any violation oi Section
� 5 by any appli[ant to� a permi[ subjects lhe applicant to a civil
Ity oPnot more [ban five huntlretl tlollan ($500).
L� 1, -as owner of the properTy or my employees with wages a5 thei� sole
rompensation, will tlo the work, antl the structure is not intentletl or offeretl
for sale (Section ]044, Bu5ine55 antl ProfesSional Cotle: The Cont�acto�'S
License Lzw tloes not appry to an owner of a property who builds or improves
thereon, antl who tloes such work himselt/herself or tnrough his or her own
employees, providetl that SUCh improvements are not intentletl or otfered for
sale. If, however, the builtling or improvement i5 soltl within one year of com-
pletion, the owner wlll have the bu�tlen ot proving he/she tlitl mt builtl or im-
p��,ovE fOr tM1c pu�poSe Ot saleJ.
lJ 1, as owner of the property, am exclusively contractin9 �+�<h licensetl con-
Vacto�s to consbuct the D/oject (Se[tion ]064, Business antl Professions Cotle:
The Contractor's License Law does mt apply to an owner ot property who
builtls or improves thereon, antl who contracts tor such projects witn a con--
tractor(Sl lic¢nse pursuant to the Con[racto�'S License Law). I am aware that
proot of their Worker's Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Secilon B. & P. C. for thi5 reason
Date Owner
I hereby certify that I have reatl this application antl state that the above
information Is mrrect. 1 agree to comply with all olty antl county ortlinances
antl state laws relatinq to builtlinq constructlon, antl hereby authorize repre-
sentatives of this city to enter upon the above-mentione0 property for
inspectio�ourposes.
Signatur Dat�
Drivers' License or 55 �
CMF 0865-46, rev, 30/84 �
l�� �OYO
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ GONVERSION ❑ DEMOLISH ❑ OTHER,�—�A q.p, #
DESCRIPTION OF WOflK/USE OF BLDG. -�o,� S Main Buildi
TVPE OF PERMIT�y /❑ GRADING FOUNDA7iON STRUC7URa� T Front
❑ TENANT LJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf
❑ OTHER A
P�OJECT DESCRIPTION 5q. PT. pCCUPANCv � � R�9ht
K
���40NSTRUCTIONTYPE ���`�' VALUATION$�PY�O S Left
ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: �fy,�y_ v,n —'��-j�V��,� � .pyy�� PlanningNotes:
Sink
Preventer
Irrigation
Drinking Founiains
Floor Drains �
Fioor Sinks •
Gas Service Outlets
Interceptors
Kitchen Sink -
Lavatories
P-Trap
Roof Drains' .
Reinspection Fee
Boiler
Duct - Under Ground
Duct - Snucmral
$15
Exhaust System ❑ Multipie ❑
Firepl/Fact Bit. ICBO #
Heating System & Ducting
❑ 0.100,000 BTU O 7 00,000 BT
Reinspection Fee � $15
ite - Building; Canary - Applicant; Pink - Ac<ounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
.SO�df (�.O��QCLOfS
Solar Piping
Sola� Tank
Swimming Pool w
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays '
Issue Fee
Hood or Typel ❑
Canopy Type 11 ❑
Refrigeration System
❑0-t00,000BTU ❑100,
System Repair/Alteration
FireDampers �
Registers
!
laue Fee
$ 3
FE
$ 3
Automatic Washer �
Construction Pole $ub..
Cooking Unit
Dishwasher
Dryers ❑Gas ❑ElecY
Fan
F.A.U.
Fixtures
Device Boxes ,
Outlets
Switches
Garbage Disposal
Generator �0-5 KW ❑
Fee
.. 9104 8/26/�35
Zone
Accessory Building: .
Parking Req,/Provided
ELECTRICAL
�Transformer �•15-50,KW
❑ 50+KW
Meter �upto't00amps
Meter �overi00amps
Sub Panel��
Motors �0-1 HP �,7`% - 8
InaSolar �9-15 HP �16-15+
Microwave
Pole Light� '
Range "
; Standing Sections
5 KW � Trash Compacror
$15 luue Fee
DEVELOPMENT SERVICES REQUIR
Zoning Approved By
Building Approved By �
' S�MMA V OF FEES
� BUILDING PERMIT $ � SMIP �
PLAN CHECK $ '� PEfiMIT
� PLUMBING $ � �SSUANCE
- PLAN CHECK 25% $ �� ENERGY P.C.
. ELECTRICAL $ �• OV GRADWG �
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE .
PLAN CHECK 25% $
i%s::
FEES
$ 3
s ^ 5�
2
O
N
I
N
G
R
E
Q
M
T
S
, .._ ..._
. .. ,
' COfSSTRUCTION AND PLANNING- POOL R=�SPA '
� APPROVALS Permit# Date Inspector pppROVALS Pe. .# Date Inspector.
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, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � 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 �
74. Rough Plumbing 65. Electricaf-Final .
15„ Rough Electrical-Conduit 66. Solar System-Final
16.- Rough Electric Wiring - LI 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. ProducY Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Fraining 73. Undergrnd. Storage Tank O Gas ❑ Oil
� 25. Roof Sheathing - 74. Overhead Hydro
26. T-Bar CeiVing (Structural) & Monocoat 75. Dry Chemical
27. FrameandFlashing � 76. DryStandpipe
28. Lathing 8� 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 Heat�.ing & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or C:anopY � �
37. Final Factory Fireplace
38. Final Plumbing
39. Water�Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer � '
43. Backflow Irrigation � � �. _
�.
44. .Landscape Irrigation System
45. Sound Attenuation � ,
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING Y�b' �y/��
48. Special Requirements Cortlpleted � •
49. Electrie Release to Edison � � '
50. Gas Release to Southem California Gas Co . �
51. CERTIFICATEOFOCCUPANCY • '
No. Date `
OWNER DAIff,II`I, MR
Reinf.
DATE JUL 1 3 1964
'.E ZONE 3 DESCRIPTION OF
GROUP I TYPE V
SUBCONTRACTOR ,�
7ocu�
,
�• ` � ?_25£��
COSTA MESA BUILDING-SAFETI' DEPARTMENT
P.O. BOX 1200 � COSTA MESA, CALIFORNIA Y9L2E
For Appllcant to Flll In Complatoly
TYPE OR P/R/INT
BUILDINO �O/� / ' . L; �ld
ADORESD va�•r•
COSTA MESA, CALIFORNIA
OWNER �. �/yJ.r. o�e� E a_�i /e�
MAIL rJ0i3 �Q�frG��
ADDR88Y
cirr 'o t� M e rct r��'
No.
I^CHITECT TCL
%
i969 Ho' /±Z"Looiv
r�o. or �tow. L
O � rew ex �ar
c¢rewcw une �nor �-
C8HT8P OF YTR[R RGR YARD
SIDB VARDI L[FT � I RIOHT 'r
DESCRIPTION OF WORK
�BUILDINO —� NO.
SIZE ROC
EXTERIOR WALL
�%�rpla�e
,
1 N6P6BY ACKMO 6 TMAT 1
�xo arwre rx�T rxc eovs u
PLY W�TX ALL CITY O DINANCiO
au��n�no coHeraurn n.
SIGNATUREOP �(
PERMITTfiF
AUTHORIZiDAQQNT /
FEE RECEIVED
FINAbCE30E�T
GTY OF CO�TA MESA
APPLICATION FOR PERMIT
BUILDING
FOr OffFce Uae Only
� ,ZONING
HO.O� YYtO�H[W
•IAHf GYIlDIMO
I, 7Z. 2
�- 13 -
�H OV[RMAN6 SHALL BE Ll88 TMAN
YARDBAPPROVEO
MAIN BUILDIN6
--� -- vwa.#
6TORIp ^_ C. u. P.
MPROI
IHQ TO COM•
RIOULATINY
rxe wxouxr e
•URP096 OP I
VALUATION
s s� °w
�
YAROS MPROVBD
ACCES80RY BUILOIN6
c�re
DATE • �l �fC`
a
m
�
. �
�
R VALIIATION 10 !OR TN6 � j
O A P6PMIT P68 ON�Y. 1�
�— �D al
MIT FHB p
C
...-..�.-., a �� 4�.
LOT 7Z , LTRACT 4P Z
:��, '> ��:�5�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MHBA. GLIFORNIA
For Appliconf fo Ffll In Complefely
TYPE OR PRINT . �`'.%e'w�c t
COSTA MESA CALIFORNIA
'ADDRESS �rjrj�j PLACENTIA AVENUE
..,�„ NEWPORT BEACH TEL.M�
61ZE /
OF LOT [t� �
USE OF
EXISTING BLOG.
S8T6ACN UNt FROM
' NO. OP`BIDGB.
0
OF
EXTLRIOIi WALL ROOF
GOVERING COVHRII
USE OP BUILDING AND WORK TO BH
S-INGLE FAMILY RESIDENC
GARAGE
�EE RECE11lED
� SEP 271961
FINANCE OEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
R6GEIPT NO. PERMIT NO.
� �.F�r
ReceWEo_ev I o�� eT�� owle i89UFa
i�� Str 2( id i
BUILDING
ADDRESS
COSTA MESA. CALIFORNIA
ZONING
ZON¢ NO.OF U8H OP NHW S�'�y
R`( PLAN9 Z BUILDINO ��.a-F
r`.aq
Le6AL —�,�- %� Ti� �/ z
o¢acw�erinu
YARDS
APPROVED
� �� IC6NT6R LINH 8TJ //
RD3o 8 FRONT ^7�
� n ��
R. SIDE
K L. SIDE S
ON I REAR 3n
.I6H I APPROVED ��ln'_
BY N
9/z6
1 H8R6DY ACKNOWLEDGE THAT 1 XAVB RH�D TXIB APPLIGTION 7HQ AMOUNT BHOWN UNOER VALIIATION 18 FOR TH6
AND 9TATE THAT TH6 ABOVE 19 CARR6CT AND AOPEe TO GOM• pUqP08E OP QBT�BLI9HIN6 • PERMIT FEE oNLY.
PLY WITH ALL CITY OFDINANCEB AND BTATH LAW6 NE6UI.�T�NO
BuitDlNa CONeTRULTION. VALUATION `
SIGNATURE OF / PERMIT FEE $ � 7 `
PERMI7TE � �Q��� � `'7
S // ' PLAN GHECK $ /// J �
AUTHORIZED AGHNT L,�-� �-�,