HomeMy WebLinkAbout1349 GARLINGFORD ST - Building Permits•• CITY OF COSTA MESA '
F BUILDING DIVISION
FA 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
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PERMIT NUMBER: BX07-00294
PERMIT TYPE B_MISC
STATUS: ISSUED
Zoni14102114 D O/2007
ng: R1, ISSUED BY: BK
JOB ADDRESS: 1349 GARLINe
Suite/Unit:
Vicinity: EAST GARAGE WALL "":' Primary Occ: Const Type :??
SQ. FT: 0 Valuation: $3,500.00
SCOPE OF WORK: REPAIR DAMAGE,TO EAST WALL OFAN ATTACHED GARAGE. WORK INCLUDES MINOR FRAMING,
LATH AND PLASTER, ETC NO
OTHER WORK AUTHORIZED WITH.THISPERMIT.
OWNER: CROSKREY, VICTORIA M Address:: 21251 CYTHERA Unit
City/State: MISSION VIEJO, CA. - Zip Code: , 92692-5916
Phone: - -
APPLICANT: CHRIS FLANAGAN
City/State: COSTA MESA, CA`_
Phone: 714-7674446
CONTRACTOR: OWNER -BUILDER
Address:
City/State:
Zip Code:
Unit:
Address: 1349 GARLINGFORD ST Unit:
Zip Code: 92626 --,:
License No. 000000
Phone
ARCHITECT: -
Phone
ENGINEER:
Phone
FEE SUMMARY
Building Plan Check:
$0.00
Building Permit:,
.. $97.25
Electrical Permit:.
$0.00
SMIP Residential -
$0.00
SMIP Commercial
$0.00
$O.00TOTAL FEES
$97.25
License
Licens
Cell:
„.".INUI? FP,r1iY11NG,
Unit
3
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: 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 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.
CODES. INSPECTION TYPE DATE INTMALS CODES INSPECTION TYPE DATE INTITIALB
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 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 Demolition 250 Final Building/Occupancy `�— ”
WORKERS' COMPENSATION DECLARATIONS*
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.
❑ I have and will maintain workers' compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(This section need not be completed d the permd is valued at one hundred collars (5100) or less )
Policy Number:
4 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 workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the r Code, shall forthwith c n with these provisions.
IZ ��re
Applicilint'a Signature qbte
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), 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 affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lic. #
Contractor's Signature
Class #
Date
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).
Lender's Name:
Lender's Address:
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. If, 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
ICENSED 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 contracla(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
rgnature ' / �le
3057-46(3107)
Owner ID verified by driv Ic Yes ❑ No
Driver's License No. Expires: 1 0
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify (hat 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 pennit, and that no building structure, scaffolding, falsework, a 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.
Applicant's Signature
Division of Industrial Safety Permit Number:
Date
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. 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? ❑ Yes ❑ 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, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(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? ❑ 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 a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ 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 ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California 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, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: 1 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.
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 city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
/ 1 @lature I wner(s) Date I
C ��lJ Z O 0
And/or Authorized licant ate
DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
3 `1 `1 L --1N x C, it c, i,zJ . S l
r
ft C 0 okf O 5
referenced real property, and that(&e) hereby authorize: ''^^
Name: C l Y vJ 1 (OL _ Y\ n U
Street Address: ) 3
Bldg. Permit #
This Permit #
AP Number:
declare that I am the Owner of Title of the above
Telephone Number: I LL — y �1 ✓ �U
City: fir/& ku 6, State:
to obtain permits in my behalf, aown /builder, for
at the above referenced property.
zip72-6 Z�b
2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. 1 agree to indemnity and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. 1 declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of
077 16 (rev.t 1100)
20 . at
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf.
California.
•l•�I�WiIW i:Nl�a DGUCdioss
r
all
l
-_ OWNER -BUILDER
VERIFICATION
` li�NlQ,� tNCz
,Address• Permit #•
�, or 7'ti�?rr i
,1
1 �
A city or county, which is required to give notice pursuant to Section 19830, shalllattach to s6ch notice, and, as
a condition precedent to issuing a building permit, require the completion and require the return of, an owner -
builder verification. Y'
Attention Property Owner:
An `owner -builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permit will be issued until this
verification is received.
r �4-1 personally plan to provide the major labor and materials for construction of the proposed
property improvement. n1Yes ❑ No
��•2�'""I av /have not) signed an application for a building permit for
Elie proposed work.
3jl have contracted with the following person (firm) to provide the proposed construction:
Name J &nl) 0��RS (�y�(�� %��-
Address 211 (` he �°c /TY City LA -e_15 1--oti S t
Phone ( r)tl'� ` D 3-7 — 757S Contractor's Lic. No. 65 -N{ S7
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. 1 will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
1042-46 (Rev. 11104)
PROJECT ADDRESS: 1349 GARLINGFORD ST UNIT:
OWNER'S NAME: SEVENLISS SOPHIE I
�DBEss: 1349 GARL`iNGFORD ST
+ \.� COSTA MESA,CA 92626
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE ATKINS ROOFING (714)898-1169
ADDRESS: 7111 GARDEN GROVE BLVD.
� �IG: GR(�V CA 92¢41
LICENSED CONTflACiO 0 here y of nm that am licensed under provisions o Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Cade, and my license is in lull force and effect.
CITY LIC.: STATE LIC.: CLASS:
0/3 677 361441 C�
Date', 9 Signature: _ ._
WORKERS' COMPENSAT19 DECLARATION: I hereby affirm 1h ave a certifi a of consent to self insure ora certificate of Workers'
Compensation Insurance. or a certified copy thereof (Section 3800. Lab. C).
POLICYN0.:732692-91 EXP. DATE: 02/01/92
COMPANY: STATE FUND
❑ Certified copy is hereby furnished. Certified copy
/I K d with the city Building Division.
Date'. 111a // ,/ Applicant: /
EXEMPTION ER OM WORKERS' COMPENSATION DECLARATION. his sectionn� d not be completed if the fount is for one hundred ($100) or less),
I certify that in the performance of the work for which this permit is issuetf, l shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of California.
Date: Signature:
NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code, you must forthwith comply with such provisions or INS permit shall be deemed revoked.
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 (Section 3097. Car. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Cale: Any city of 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/she is licensed
pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant lot a permil subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
I, as owner of the property of my em loyees with wages as their sole compensation, will do the work, and the
1-1 structure is not intended or offered for sale (Section 7044, Busmess and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himselflherself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a conlr3Ctor(s) license pursuant to the Contractors' Slate License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Date: Owner
I do hereby fenny that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533, and
25534 and that I or any future building occupant wiNvdll not (circle one) need to comply with said state codes and the requirements for a
permit for construction or mortification from the Air Quality Management District. Residential construction applications are exempt from
these provisions.
Date: Applicant:.
I hereby certify that I have read this application and slate
ordinances and state laws relating to building construction:
property for in spec ion purpas
/ %
Data 2� Signature:
Driver's License of Social Security #:
matron is correct. I agree to comply with all city and county
representatives of this city 10 enter upon the above-mentioned
1641-46 Wh1e-13m0tlmg: Green—Corte Enforcement. Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 055234
PERMIT NO: B 055234 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/O OLD ROOF, REROOF W/HOT TAR SQ FT: 1,900
CLAIM VALUE: 1,900,00 CALC-VALUE: 1,900:00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME.
######3E#################i[•##lEWii�KE j5211MCfFiTOR
Z O N Z N GS ERTEBQAUCIKRSE M E N T S �J����� �,JC' Com/ I v
REQUIRED
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN
PARKING REQ: PROV: PARCEL: 14102114 ZNE; REF NO:
PLANNING NOTES>
>
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE: j
BUILDING APPROVED BY : _ , DATE;
APPLICATION ISSUED BY: DATE: aim
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT
43,00
,50
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING -DIV->
PERMIT
ISSUE PLAN -CHECK
TOTAL
PAID DUE
TOTALS ---- >
43.50
0.00 0.00
43.50
43.50 ,00
REVENUE DIVISION
TOTALS--> COLLECTED:
43.50 OVER/SHORT:00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/TOTT
GRADING PLAN -CHECK
.50
I N D I
V I D U A L F E E
B R E A K D O
W N
TYPE QTY D E S C R I P T I O N UNIT COST
SFR 1900 REROOF BY VALUE RESIDENTIAL NOZONE 1.00
END OF FEES
TOTAL COST
1,900.00
I
1W
CONSTRUCTION AND PLANNING
POOL 1A
APPROVALS Permit 4# Date
Inspector
APPROVALS Permit#
Date
Inspector'
1.mporary Electrical Service or Pole
52. Pool & Equipment Location
4
2. Soil Pipe-Undrgrnd. -, .,
53. Steel Reinforcement
-3. Electrical Conduit Utility-Ondrgrnd,'
54. Forms
- 4. Elelctrical Conduit-Undrgrnd. w
55. Electrical Bonding
,Steg1 Reinforce m,fT-
56. Rough Plumbing & Pressure Test
6. ElectricalUFER'Gind.
,
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 Electrici�kT Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS" :Per mit #
20. Rough Factory Fireplace
21. Ducts, in Structure:. .. ,
_
ro '
70. Undergro�nd}iydro
22. Ducts, Ventilating • -
'
_ r
77. Product Pipigg OfiSs OOiI
23.'Gas Pipe 9h & Rou T'st
€
_
-
72. Underground'Fluih .-
y
24.,Roof. Framing >"•
_
73.'Undergrnd.Storage Tank (D Gas 0 O8
25. Roof -Sheathing �'
, -
' .
74. Overhead Hydro -'
26.-T -Bar Ceiling (Structural) & Monocoat
1
75. Dry Chemical
27.'Frame and Flashing: :-•,�
'. _
`
76.,Dry Standpipe
28. Lathing & Siding
77. FIXED SYSj'EM.FyNAL
29. Insulation
78.;T -IRE PREY. FINAL -
:30. Drywall Nailing-
HEALTH DEPT. -REQUIREMENT
31. Plaster Brown _'oa`,t`'
79.`FINAL INI PCCTI(44
,.
32. Electrical Power Meter --Final
80. FOOD CERTIFICATE ISSUED
33. Final EleFtric `:' :
!
!�
Notes: _.
34., Final Heating & Air Conditioning
,i
35. final G4fPipe-Test'
36. Hood or`Canopy
^o q .
C.
37. ;Final'Factory Fire`pCace
38. Finab Plumbing
(�-• •
_. -
39. Water Service -Final
-
,40. Gas Service -Final
,
41. Solar Domestic -Final . ••
:'
c L
42. Backf low Preventer' v'
!
'
43. Backflow Irrigation, "•
'
,
44. Landscape Irrigation System45.
Sound Attenuation
4 n
46. Handicap Regylatiogs
.47. FINAL STRUCTURE & BUILDING
ti
t
- .r
48..FINAL PLANNING.'
49. Electric Release to Edison-
K..Gas. Release tQ Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill In all spaces except those
CITY OF COSTA MESA•
CONSTRUCTION PERMIT
Applicant's Mailing Address
Project Address ;/_30�
Owner's Name -�l/'/r�'CE� phone
Address9
Arc' l rl / License No.
Address
Contractors Nam hone
Address imailino' ."J 1�1�. 4—G' �' /%>>ZDi'�C!-_s�_��7
License No. __
LICENSED CONTRACTOR DECLARATION
Thereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professio Cotle, and
my license Is in full fgrcfand ojtoo /� - //l�L��
License Class/ cc.� sJ Y—_ Lice No- o"/ `
Date /� Signature ! � J
-ORKERS' COMPENSATION DECLARATION
reby affirm that I have a certiflcate.of consent, If4nsure or a certificate
Workers' Compensation Insurance, or is are,ty�( cctl�on
wIf Lab . C_),
/ Comp �cf
Polity N !, /G
Ce tied cop IS her by furnished
.
rtified y is IIs f h, s�'Ith the city midi WS
Dafe �� I vAppllcant
EXEMPT16N'FR0M WORKERS' COMPENSATION DECLARATION _
Fa 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.
Date Signature '
NOTICE: If, after making this declaration, you should become subject to the
Workers'. Compensation provislons,of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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 (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which reauires a permit to construct. alter. Improve. demolish or repair
,I�Aon ,J or the uusmess and Professions Ooael or. rnas na sne.ls exempt
-fort and the' basis for the alleged exemption. Any. viola Ion of, Section
i`5 by any applicant for -a permit subjects the applicant to a civil
Ity of not more than five hundred dollars ($500).
I, as 'owner of the property or my employees with wages as their sole
compensation willdo the work, and the structure Is not Intended or offered
for sale (Seclion 7044', Businessand - Professional -Code:. The Contractor's
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
employees, provided that such Improvements are;not Intended or offered for
sale. If, however, the building or Improvement Is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or Iry-
rove for the purpose of sale).
1, as owner of the property, am exc luslvely contracting wlth'Iicensed con.
tractorsto construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who -
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 exempt under Section B. & P. C. for this reason
t
Date Owner
I hereby certify that have read this application and state that the above -
informatlon is Correct. i gree t comply with all city and county ordinances
andsstate laws relating t Puil ng coo\L uctlon, and hereby authorize repro:
and sign all approoriate declarations.
fes- 9606- 1 - 1 I
TYPE OF CONSTRUCTION- NEW LJ ADD 0 ALTERATION
❑ CONVERSION ❑ DEMOLISH ❑ OTHER '
DESCRIPTION OF WORK
TYPE OF PERMIT GRADING M FOUNDATION 0 STRUCTU RAI
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑,'OTHER
PROJECT DESCRIPTION SG. FT. OCCUPANCY_
CONSTRUCTION TYPE VALUATION $
ZONE GRADINGCU.YDS. ACRFS_
Remarks:
Sink
kflow Preventer
{ flow Irrigation
Floor Drains
-•'�"`�
Floor Sinks
REAR YARD (TO P/U
Gas Service
Outlets
Interceptors
0 Y
Kitchen Sink
PARK FEE $
Lavatories
P—Trap
Roof'Drains .
Construction Pole
Showers
-
Service Sink
Cooking Unit
Duct-'Under,Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Fiiepl/Fact. Bit. ICBO dk
Heating System & Ducting
1 ❑0}100,000 BTU ❑100,006 BT1
Hood or Typal 0
Slgriai ure--i"---- ICU ate//%/'O-7
Drivers' Llc Sa 55 >--- Registers
CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
REPAIR
9106 1 1 / 11-/'1" rte.. T'.
PLNG. REF. yP
eBUILDINGeTnnrr rn er
TO BUILDING
PROPERTY LINE
REAR YARD (TO P/U
LEFT SIDE YARD
RIGHT SIDE YARD
PKG. SPACE REO.
PROVIDED
STREET WIDTH
PARK FEE $
Sewer Cap
ELECTRICAL
Sewer Connection
Automatic Washer
Meter Dover 100 amps
Solar Collectors
Construction Pole
Sub Panel -
Solar Piping ,
Cooking Unit
Sub Pole
Solar Tank
Dishwasher
Motors 00-1 HP 01R-8
Swimming Pool w/S_pa�--'� y
,
Dryers ❑Gas ❑Electric
InSolar 09-15 HP 1116-15+
Fan
Microwave
Water.Clowt' ^� `I
i-.
P 1
F.A.U.
Pole Light
Water Heater'•- ./ �a—'s
- 1
Fixtures
Range -
-Water Service
'+
Device Boxes
Sign
'
Outlets
Standing Sections
_j
Switches
Trash Compactor
Garbage Disposal
-
Generator 00-5 KW ❑5.15 KW
I
-
Transformer 015.50KW
05U+ KW
Reinspection Fee $15
Reinspection Fee
$15
Meter ❑up to 100 amps
'Issue Fee
$ 3
Issue Fee
$ 3
Zoning Approved By
Application Approved By
gppliration Issued By
' Date
(� ' Date
�� Date
S
fANICALt
Refrigeration System
❑0-100,000BTU 11100,000 BTU;
BUILDING PERMIT $'
'PLAN CHECK- $��hy�'
PLUMBING $
PLAN CHECK $
ELECTRICAL $
PLAN CHECK $
MECHANICAL $
CHECK' $
SUMMARY OF FEES
SMIP
PERMIT
� ISSUANCE ,
- GRADING
MICROFILM
TOTAL FEE
ADVANCERPC
FINAL FEE
$
'
$
$
$
$
$
$ 7�
$
System Repair/Alteration
'
•
`
Reinspection Fee
$15PLAN
Issue Fee
1 $ 3
n'ICONSTRUCTION;AND;PCANNING''�
'`� _
POOL' 'PA
_ �`
'i r "'Date
-APPROVALS Permit #m - -
inspector
-
_'
,•AP-PROVALS Peril„t #
Date
--
Inspector
-
i1 Temporary Electrical Service or:Pole52:
-
r - -
P. &Equipment Location
-
- -
1r2? Soil Pipe-Undrgrnd.,"-• ; Y ,
v.
J37 Steel Reinforcement
'-
::� , I.-
-
a -3.; Electrical Conduit Utility Undrgrnd.
',54.` Forms
P, Elecfr.ical Conduit-UndrgrnQ
r55. Electrical'. Bonding
l i
5: Steel Reinforcement :;
I_ n
: - -.
U L
,. p _
Rough Plumbing& Pressure Test
_
„56.
6: Electrical UFER Grnd. - -
d
_ i-
J57T _APPROVAL TO COVER-GUNITE
7. Footings I - I . 'v
.o-.
,- _
`'
- 58. Electrical Conduit-Undrarod.
x.
n
,
8. ,Fdundation
59. GasPipe, O Undrgrnd., Test -
- , i.
9. Water Pipe-Undrgrnd. 1 - -
=" i
' .
X60. Backwash Lines, P-Trap, O Undrgrnd.
.-
10. Structural Floor Systemf'- .I
�'�,
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection'
?
i..
X62. Backwash&. Receptor-Finch
_
12. Sewer Cap63.
-
Heater &Vent-Final
13. Roof Drains i
t -'
.64. Plumbing System - Final
-
14. Rough Plumbing "''r `•
''
-
-65. Electrical-Final - - •
-
>`
.n 15'"RoiigH"Electrical-Co�nduit"r: ^
r I
;66., Solar'System-Final
r-•16. !Rough ElecYticlWiring,
67.. Fencing &Access Approval � • --
- ` r
-
I'17. (Rough Wirib'g.Si6n!
i _
168. APPROVED FOR PLASTERING
6 q _ .-
18.-)Rough Electncal;,T:&Iar Ceiling,
i'gg.
POOL/SPA SYSTEMS FINAL -
-
1-
19: 'Rough`Heating & Air Conditioning
FIRE DEPT. REQUIREMENT,
1
'
^
APPROVALS ' Permit #
20. IRough-Factory Fireplace I ; '' {
1
��
,-
21. IDucts,•in Si_ructure� ' ti '� t
I I I
' { i I
70.E Underground Hydro
6:22 rbucts, Ventilating
t
;71. Product Piping 0Gas ❑Oil
.23. Gas`.Pipe-Rough & Test 1
( t
i
72., Underground Flush
f
IC24. iRoof Framing 1
;W K 1 _ 1 c
. i :
73. Undergrnd. Storage Tank O GasOil
,.0
11 25.4Roof Sheathing f r `' '
;_ I a_ -
i -
74. Overhead, Hydro
-26. T-Bar Ceiling (Structural), & Monocoat
a
ff
)
1 _1
-
75.• Dry Chemical
A-, 11 i r t
E r
I
t
�27. Fran a and Flashing n �i ��
i !
!
76.1
Dry Standpipe . • i
i
28., thing' &Siding I �{ G
j
i.0 I
,774 FIXED SYSTEM.FINAL 4
Insulatiori r' �� I ;t 'I
i j
I 1
178: FIRE PREY. FINAL
'
-29
=30. Drywall Na-iling
{Notes:
G 31. Plaster Brown Coat-
! i
{
Ct-32. �ElectricaliPower Meter-Final-
{
inal Electric__
1�3%3,
34. Final Heating &'Air Conditioning
35. Final Gas Pipe-Testi''
36. Hood or Canopy= '1
37. Final Factory Frepla"ce . i y � N
im I i
` i i �
I � � - � � •
38. Final Plu(nbing , i I clt
1
_
I i
•
39. Water$erwice-Fiinall
li
i
,
I
40. 'Gas Silrvice-Final
41. Solar D'o-mes,tic-Final'
I 1 II -
i 1-'-
-t-'
'
42. Backflow-I. 'Preventer ,� I
43. Backflow Irrigation ;- •ti;a
i ; I . i i
•'
' = -
T
_
44. Landscape Irrigatton-System
I
�
45. Sound%Attentiatiori r I :,,: • ' I
1
I
1 1 -
46. Handica'lRegulation`si•',,yj {
fl is
I
•'I
'' - _
47. FINAL STRUCTURE&BUILD(NG�
48. Special Requirements Completed
I
49. Electric Rele'ase'to Edison,'
50. Gas Release to Sou{hern California Gas Co
1
51. CERTIFICATE;OFOCCUPANCY '_
I_-t _!_ -_'
+ -1 -
-
No I Date
P.&,tiIFIC INSTALLERS, INC.
205 Wept Pom
Sams Ara, GIHonMs 82702
State Lic. ��'` C-ity Lic. #
Date
Customer Name
Permit No's.
Types of Permits
City of
Department of Building and Safety
Gentlemen:
Please be advised that as of all work by
Pacific Installers, Inc., on the permit numbers listed above have
been cancelled.
Therefore, Pacific Installers, Inc., requests that the permits be
cancelled and that all prepaid fees be refunded.
This cancellation notice is advice to you that Pacific Installers,
Inc. has no respond ility for work accomplished under.permjts noted
at
C✓ CAN I
�ri ` �f -`�''
jpll�6 d
.
IV4 5( Y/
l
Very truly yours,
PACIFIC INSTALLERS, INC.
264 Rev. 7/83
Unit Manager
C11 Y C.
I;U:'ti'1j6j
OWNER
JOB ADDRESS
HALL OF FAME HOMES, INC.
DATE DEC 1 1 1962 --ommm
NG PERMIT NO. '
GENERAL CONTRACTOR Lifetime Residential Bldg. Corp. YALIIE $- 17a.Q75.00
P" No. LOT 3 TRACT 4355 FIRE ZONE DESCRIPTION OF WORK ReG.w/a++.-fln,-
It ,eECTIONS
Signatur
DATE GROUPI & J TYPE V ZONE R1
Soil
Gr/
_ -
SUBCONTRACTOR
PE MITS ISSUED
Gas
DATE
NUMBER
Water
-
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line ouse Con.St. Swr.
i
-1-6,3
f
, r
/,7— �-
• 1G _
/`
Sprinkling System
_
/
_�
Construction Pole
Underground ❑ Power ❑
Rough Wiring
_
3
/ v
Trenchescorms LB' tee ein .
Floor System
-
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Frame and Flashing
-Z-L-3
L `ng — In R- Out
1 :r, brown coat
,t`-ZQ' i
Refng. ❑ Air Cond. ❑ Final
Heating, Final
-7-3/-G7
Plumbing Fixtures, Final
--1S_
P-/ —
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX $17 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING 1341 ISN _fa��
ADDRESS TT
CO5TA MESA. CALIFORNIA
FEE RECEIVED
OEC 1 196?
Lot 31 Trac 4355 Plan 400-C
FINANCE DEPT,
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
Harbor Ball of Fame Homes, Inc.
RECEIPT NO. PER IT,
-Atl
OWNER
P.O. BOR 2066
RHCEIVED BY I DE1962
qE/EIVE_�I
AMAILDDRESS
/a DEC 1B1DATE
Santa Ana NpKI 9-220
BUILDING
CITY
ADDRESS
ARCHITECT Jamison TELNO544-0040
COSTA MESA. CALIFORNIA
OR ENGINEER
225 .IIDII St., Tustin
FIRE R
ADORES
ZONE TYPE GROUP (:�'N
1 e e�e�� Corp.
CONTRACTOR
APPROVED IV
BY DAVE
213 O•
ZONING
ADDRESS
CITY Santa Ana.
AO
NO. OF
PLANE Z
�-�y�
USE OP MEWyyra
BUILDING 5:. 3J+. /14•
r�
STATE _ 2OH6 6 TEL. KI 9-2204
LEGAL TT Y3s:s
LOf'
/
LIC. NO. NO.
DESCRIPTION 3
SIZE Woo, _ NO. OF BLDOS.O
OF LOT NOW ON LOT
A. P. NO.
USE OF - None
YARDS EVES
EXISTING BLDG.
APPROVED ALLOWED
SETBACK LINE FROM1
52 4S.
(CENTR LINK ST.)
E
S L
CENTER OF STREET REAR YARD
FRONT 'FT. IN.
E YARD I LEFT 51
I RIGHT 51
R. SIDE 'S FT. �- IN.
DESCRIPTION OF WORK-
L
s
L. SIDE FT. IN.
NEW X. I II ALTERATION IIADDITION I
REAR y`Sf FT.
IN.
REPAIR I II MOVING I DEMOLISH I
APPROVED DATE �C�J /•`i
SBZILDING 16081 ROOM6 STORIES 1
U
EXTERIOR WA ROOF
%laster
RING
COVERING Sbake
USE OF BUILDING AND WORK TO BE PERFORMED
Sin le.faamil esidence
Liv .
I HEREBY ACKNOWLEDGE T T 1 HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABO IS CORRECT AND AGREE TO COM-
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY O 1 CES AN ATE LAWS REGULATING
VALUATION
BUILDING CONBTRU N
SIGNATURE OF
^7
PERMIT FEE s 5 /
PLAN CHECK S •Y'///-/ d
PERMITTE
S /7 73
AUTHORIZED AGENT
TOTAL FEE