HomeMy WebLinkAbout1084 GLEN CIR - Building Permits0
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lob Address: 1084 GLEN Cl
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Status: ISSUED
Applied: 06/24/2003
Issued: 06/24/2003
Parcel Number:
42203160
Zoning:
' COMP SHINGLES "
APPROX 2000 SO FT
Applicant:
PANIAQUA, ROBERT A
FEE SUMMARY �.
ISSUED BY:
Address:
1084 GLEN CIR
$83.25 Claim Valuation: 82,400.00
�. SMIP Res: -A:
$0.50
'SMIPCom: .''•;
$0.00✓= -
Phone:
949-631-5471
Inspection_:,'
'-$0:00
Total:
,
COSTA MESA, CA,
Zip:
92627
owner:
PANIAQUA, ROB_ ERT A
:I, �X
Address
084 GLEN CIR
Phone:
i -COSTA MESA, CAS' -
Zip:
92627
,-
Contractor:
'OWNER -BUILDER
-
Address:'
-
Phone:
Zip:
License:
000000.
,
Arch
-. ..
..
Eng:
- -.
Address: -
> `
Address:
,
-- - �, Phone:
Phone:
Zip:
- License:
License:
SETBACKS,
MAIN STRUCTURE -Front 0-0, Rear - 0-0
ACCESSORY Front \,0- 0 Rear 0-0
PARKING Existing: ''0, Required: .0
PLANNING & ZONING
Left 0-0 - Right 0'0
Left 0-0 Right 0- 0 ,
Proposed: 0 '
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2446-46 (N00)
- "SCOPE OF PERMIT ,
_ TING OOD ROOF, -1/2" PLYWOOD SHTG, FELT PER MFGR'S SPECS, APPLY "40 -YEAR
REROOF RESIDENCE AND ATTACHED�,T_/O EXISW
-
' COMP SHINGLES "
APPROX 2000 SO FT
FEE SUMMARY �.
Plan Check: '°
$0.00 - Calc Valuation: 82,400.00
Permit:
$83.25 Claim Valuation: 82,400.00
�. SMIP Res: -A:
$0.50
'SMIPCom: .''•;
$0.00✓= -
Other.
- ,
`;-x,$0.00
Inspection_:,'
'-$0:00
Total:
$8i 75
SETBACKS,
MAIN STRUCTURE -Front 0-0, Rear - 0-0
ACCESSORY Front \,0- 0 Rear 0-0
PARKING Existing: ''0, Required: .0
PLANNING & ZONING
Left 0-0 - Right 0'0
Left 0-0 Right 0- 0 ,
Proposed: 0 '
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2446-46 (N00)
DECLARATI ONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this pernil is issued.
❑ 1 have and will maintain workers' canpensation 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 carder and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ 41 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 Labor Code, I shall forthwith
comply with these provisi S.
Applicant Signature: ' Oiao�ka ), / Date: a6 4y:' 2
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIOIN COVERAGE ANILAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WO6 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. Llc. N Class N
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 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).
Lander's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Licensa 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 awn 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 LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt der sec. Business and Professions Code for this reason:
Signature: /)6�',— //qdt�� Date: A 0— b
Owner ID verified by drivers license!' Xyes ❑ No Driver's License No. �% Expires: y
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Cade).
❑ 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
pernit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
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 builtling 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 a plication a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes J No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
........................_..................... .......... ........................................... ..................................................................... ....................................................... -........................................................................I.....................
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 apermit 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 (II yes". attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
ed scnbed properly for inspection purposes. I agree not to occupy or allow occupancy of any building authorized y this permit until nal inspection.
Signature Of Legal Owner(s) ` Date S
And/Or Authorized Applicant Date
CODE 0. INSPECTION TYPE PATEINTMAL5 CODE INSPECTION TYPE LIS¢, ItIlIDALi
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
y��
200 Final Re-Roof -L� - ' 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
R
( ��:: • 1
UILDER
VERIFICATION
if X31
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion and require the return of, an
owner -builder verification.
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.
I. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. t`'l Yes ❑ No
2. 1 (havethave not) signed an application for a building permit for
the proposed work.
3. 1 have contracted with the following person (firm) to provide the proposed construction:
Name
Address City
Phone ( ) Contractor's Lic. No.
4. 1 plan to provide portions of the work, but 1 have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( ) Contractor's Lic. No.
5. t 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
IN2-a6 (REV. 959)
- _ Applicant
to fill in all spaces except those within heavy border Ines and sign all appropriate declarations.-
' CITY OF COSTA MESA_
CONSTRUCTION PERMIT
1 _ 8��6 9�24�H1♦
8776.,-
. PERjv11157
NJ 5
TRACT NO.
LOT NO.r
BLD . N
Project Address _
Applicant's Mailing Address �•� �'�p�
Owner ,Name LJHTR ! STE S, Phone .6ZiJ-Jl�
`TYPE OF CONSTRUCTION NEW -LJ ADD LTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER -
,DESCRIPTION OF WORK - t
A•P, #- Zone • -
E
-
Main Building: Accessary Building:
Z
Address - _SGl -
re
TYPE OF PERMIT 'GRADING FOUND ION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
_0 OTHER •' -
, PROJECT DESCRIPTION SG. FT. OCCUPANCY
`'
CONSTRUCTION TYPE VALUATION $
-
T
Front
O
N
Arch/Eng. License No.
B
A
Rear
I
N
Address -
T r� _ .YU/dPrSiJG'/o�--��
Contractor's NameTXyr• /1�� ho�ne
lis7o <'io,6az�G� �' rrJ
Address ling) / XBn.�
C
_
Right .. �'
G
S
Left
E
-Ping. Ref.# Park. Fees $
G
UI
License
City License No.
ZONE GRADING CV.VDS: ACRES '�
Remarks:
Parking Req./Provided
LICENSED CONTRACTOR DECLARATION
1hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is In full fare antl effect.
Licens�e Cl p ss' — License
'
Use of Building:
R
E
PLUMBING
FEES
- -
9 Notes:
ME
Signatur
�ERS' OMP NSATION DECLARATION
"• ""'ebyfaffirm that I have a certificate ofconsentto self-insure or a certificate
"�ol"Workers- Compensation Insurance,, or a certified copy thereof (Section
Bar Sink - Showers 1
N
Backflow Preventer Service Sink
-
, T
- - - 'S
3800, Lab. C.)
Backflow Irrigation Sewer Cap
ELECTRICAL FEES
- '
Policy No. Company
BCertified copy is hereby furnished.
Bathtubs Sewer Connection
Automatic Washer' Transformer ❑ 15-50 KW
Certified copy is filed with the'city Building Division.
Date Applicant
❑ 50+ KW
Construction POIe Sub.
Clarifiers Solar Collectors
-
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
Dishwasher Ce Solar Piping
Cooking Unit Meter LD up to 100 amps '
less).-
certify that in the Performance of the work for which this permit is issued, 1
-
DrlOking FOUntains Solar Tank
-
Dishwasher - Meter ❑over 100 amps
shall not employ any person in any manner so,as to become subject to the
Worker Pe i n Laws of Calif r i -
-
Floor D}ains • Swimming Pool w/Spa
Dryers ❑Gas : ❑Electric Sub Panel
Date _i��Si9nat ure hroula t(.1/
NOTICE: If,1af er.m king this declaration, you houltl pEcoi sublect 4o the
Workers' Compensation provisions of the. Labor Code,, you must forthwith
Floor Sinks' Urinal f
Fan - Motors 00:VHP ❑1%-8' '
Gas Service Outlets Water Closet
_
` F,A.U. Ina Solar ❑9-15 HP ❑16-15+
comply with such provisions or. this permit shall be deemed revoked.
CONSTRUCTION LENDING'AGENCY -1.
Interceptors Water Heater,
-
i
.. Fixtures Microwave
I hereby affirm that there Is a construction lending agency, for the performance
of the .work for which this permit is issued —(Section' 3097, Clv. C.),
Kitchen Sink' - Water Service -
;e^
_
y Device Boxes Pole Light
Lentler's Name _
Lender's Ad Dress
OWNER BUILDER DECLARATION -
Lavatories
-
Outlets .Range
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 requires,a permit to construct, alter, improve, demolish,or repair
rany structure, prior to its-issuance, also requires the applicant for such permit I
a'signed statement that he/she Is licensed pursuant to the provisions of I
p—Tra p, ' - - _
Switches ' Sign
-
�Roof'Drains -
-
Garbage Disposal Standing Sections
y
❑0-5 KW 05-15 KW 'Trash Compactor 1
- ntractor's License Law (Chapter 9 (commencing with,Section 7000) of.Generator
A , 1'n 3 of the Business and. Professions Code) or that he/she is exempt
IJ'from and the basis for the alleged fora permit subjects the applicant to a exemption. Any'vlolation of Section
f a 5 by any applicant civil
penalty of not more than five hundred dollars ($500).
LJ 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 salet(Section 7044, Business and, 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
employyees, provided that such improvements are not intended or offered for I
sale. If, however, the buildingor improvement is sold within one year of com-
y
pletion, the owner will have'the burden of proving he/she tlitl not build or im-
prove tar the purpose of sale). -
LJ I, as owner of the property, am exclusively contracting1with Ilcensetl con-
tractors to-construct the project (Section 7044, Business and Professions Cotler
The Contractor's License Law does not apply to an owner of property who-'
builds or improves thereon, antl who contracts for such projects with a con-
tractor(s) license pursuant to'the Contractor's License Lawl. '
❑La m'exernpt under Section e. & P. C. for this reason
• '
Reinspection .Fee
,.
$251 Issue Fee or
S-3
I
,
,Reinspection Fee $25 Issue Fee' 1 .$'3,1
MECHANICAL I
FEES
:PUBLIC SERVICES REQUIREMENTS:
, ' 1
Zoning Approved By Date
.Building Approved By Date '
Date GT
- , .� ! Data I •2
Application Issued By �'t
_ _
Boiler, '� i ,
-
Hood or Type 1 ❑
Canopy s Type II ❑ yt
i _
_
{
Duct - Under Ground , !
Duct - Structural i
- -i
Refrigeration System ,1, ,-_
❑0-100,000 BTU ❑1_0.0,000 BTU
_ _ -
.._
i
_ _
Duct -Ventilating, _ __ _
T SUMMARY OF FEES
1 '
BUILDING PERMIT ' $ SMIP� • $
' PLAN CHECK ! $ _ ' PERMIT
PLUMBING .$ I ISSUANCE
ENERGY.P.C.�$ I f
PLAN CHECK 25% $ I - }_
s ELECTRICAL '$ GRADING I$
,
' MICROFILM •$ '
PLAN CHECK 50% -$ ,
i
MECHANICAL I ,$ I TOTALFEE '$ 1 •"
,
- PLAN CHECK 25% 1 $
Exhaust System ❑ Multiple ❑
System Repair/Alteration ' t-
Firepl/Fact. Bit. ICBG
Date owner '
certify that I have read-this application and state that the above 4
- Information is correct. I agree to comply with all city and county ordinances
Information
and -state laws relating to building constructlon,land hereby authorize re re-
sentatives ofi this' city ilFe - the above-mentioned r erty for
Inspectionp r + - ZO -
Signature - !/ Date
Drivers' License arSS - i
--
Heating System & Ducting
❑x100,000 BTU ❑100,000BT�
- - •- --^ 1 -- -- --i
-
-�•-
t
i
!
i
i
i +
1 ( r
Reinspection Fee $25 Issue Fee , $ 3
.CMF 086546 rev. 12/83 White- Builtling; Canary -Applicant; Pink -Accounting;
Goldenrod -Assessor
TL
CONSTRUCTION AND PLANNING•
POO' *,SPA
Date
APPROVALS Permit =/h
Inspector
j
APPROVALS-:. t_nit*
-'16ate�-�
16'spiicior
1., Temporary Electrical Service or Pole,
52: Pool &'Equip:rnent Location
2' Soil Pipe-Undrgrnd.
53? Steel Rgirif6rcernent
I Electrical doncluitililtility-pricirgri-id.
54, Form's
4. Electrical Conduit-bincIrgrrid.
55`.= EIe&ricaF.6&n_dIing
es
Z
5. Steel Reiniorceme nj
56:. Rough Plumbing & Pressure Test
6: Electrical LIFER Q
57.0 VER-GUNITE.
.APkOVA:LTO-C
7. Footings
58° Electrical C6ndurt-Undrgrnd<' .
8. F6undation
59. Gas Pipe, O, Unclrgrdd., Test_'
9. Water Pipe-Undrgrnd.
n -e rap," - rj rgrn
60. Backwas es,_P El 0 d' d
10. Structural Floor System
61. APPROVAL-T&IDECK
11. Property Sewer Line & House Conrie - ction
62. Backwash'& Receptor_ -F inal
12. Sewer Cap
-63. Heater &-Vent-Fin_al
13. Roof Drains
..64. Plumbing.System_-Final
14. Rough Plumbing
65. Electrical -Final -z
15. Rough Electrical -Conduit
-66. SbI9_rjS9stern_-FinaI
16.. Rough Electric Wiring
67., FiirFciffg& Access App roval"
.
17. Rough Wiring Sign
8
6 APPROVED EOR PLASTERING'
8. Rough Electrical -T Bar Ceiling
69. Po6LJSPA Sy'_'STEMS,Fil\!AL
19. Rough Heating & Air Conditioning
t FIRE DEPT.;REQUIREMENT'
APPROVALS Pe.rmii+ --------- L_
20. Rough Factory Fireplace
21. Ducts, in StructureIV
70'r Underground Hydro
22. Ducts, Ventilating
171.1 Product Piping 'El Gas"00il
:23. Gas Pipe -Rough & Test
72.1 U6dergr und Flush'
I
-24. Roof Framing
173. Unclergrnd. Storage Tank.0'Gas- doil-j
i
25. Roof Sheathing
74., Overhead Hydrb
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry!Chemical
7.-
27. Fr6me and Flashing
76. Dry Standpipe
8.
2 Lathing & Siding
.77. FIXED SYSTEM FINAL
29. lnsulatio�n
78. FIRE PREY. FINAL
30. Drywall Nailing
HEALTI-IbUT.REQUIREMENT�'
31. Plaster Brown Coat
79. FINAL INSPECTION
i
32. Electrical Power Meter -Final
80.1 FOOD CERTIFICATE ISSUED
33. Final Electric
I
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
41.
36. Hood or Canopy
37. Final Factory Fireplace
t t: T
38. Final Plumbing
/o/MN
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
,45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
I!
49. Electric Release to Edison
60. Gas Release to Southern California Gas Co
M. CERTIFICATE OF OCCUPANCY
N Date
_J--�
C OF COSTA MESA REQUEST FOR OCL—ANCY
TRACT NO.
LOT NO. /
ADDRESS Zoeel
DATE Y'11- / 7
The developer of the above entitled tract desires to sell the above set
forth lot prior to the.time that the tract has been completed and its streets
r
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he -she -they) -(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
BY
RECEIVED
CITY
OF
COSTA
MESA
Pi
"N'JI^!C
DEPT.
1977
AM PM
71819Ailli12il1213A516
A
rurcxaser /
Developer and or-auEhorized
representative)-
�A%
p
r
OWNER R & W
DATE
GENERAL CONTRACTOR J Rey Const Co. DESCRIPTION of WORK Res. wlatt. Gar.
AP�L5-1- LOT TRACT 9105 FIRE ZONE VALUES �R_inn .nn
SUBCONTRACTOR
PROP: SWR. LINE LJ HOUSE CON. IJ-Jr9fi
1.7,�A�,71
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING'
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER C]
ROUGH WIRING
y/t% HOGtin Gnd ant.
TRENCHES FORMS STEEL REINF.
FLOOR SYSTEM
i
110140 >;l /
BOND BEAM STEEL REINFORCE F7
A
SHEATHING
FRAME AND FLASHING
s
LATHING — IN OUT.( -I
PLASTER, BROWN COAT
7177
$T CTURAL, FINAL
NG, vEN T., REFRIG. AND A.C., FINAL
^SPL GING. FINAL AND GAS TEST
.Z
ELECTRIC, FINAL
17
BUILDING. FINAL
—%
9105. , - -
7 42743
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
C... A....1:.......
AT Cf TION FOR STRUCTURAL PERMIT
79.6
vx um vwy
REC E V
DATE RE EIV D
/}mal.,
_I Oa.7 ��bbb
DATE ISSUED
1 NGJ
BUILDING'
ADDRESS lO
OWNERR & W Development
A.P. NO. �! `
PERMIT N
MAIL 1
ADDRESS 88.E. 17th.St.
BUILDING
ADOREssI .,
CITY Costa Mesa, Ca. NOI.642-4210
TRACTq 10�
LOT BLOCK
LOVINQ
ENDER Cal. Fed. Savings & Loan
NEW
ADD
ALT R
P
M
BRANCH 5670 Wilshire Blvd.�p.y
OWNER yr�w[GN�
ADDRESS LOS Angeles, Ca. 90036
W a-rrCra�" $38 Ian
USE
ARCHITECT DMA Assoc. TEL731-2161
OR ENGINEER NO.
ADDRESs17621 Irvine B1vd,Tustin,Ca.
T
zo NE YPE GROUP 1 -
CONTRACTOR J. Ray Construction CO.
APPROVED
By DATE
ADDRESS 188 E. 17th St.
TEL •f10
CITY Costa Mesa, Ca. NO. 421
i/ /a
CMZ+
NO.
NA'.r.
PLANS
USE OF NE
BUILDINGS G�
STATE CITY
LIC. NO. 126426 LIC. NO.
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
SIZE p NO.OF BLOC'S.
OF LOT 40.94 X 111.2 V NOW ON LOT O
(FROM C/L STREET)
FRONT FT.
FT.
USE OF
EXISTING BLDG. O
R. SIDE
FT
Separate permits are required for
electric, plumbing and heating work.
L. SIDE FT.
FT.
REAR /V FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
MAIN SLOGS.
BET. MAIN &
ACCESS. BLOCS.
Single Family Dwelling W/
t—'ro
CURPWe-76—n�
APPROVED
Attached Double Garage
APPROVEDOLDtp
/2-L -i
L
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and i shall not employ
any person in violation of the workman's compensation laws of
the State of California.
1 hereby certify that I am properly licensed as a contractor under
the Stateof California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In f II force and effect, or I
am exempt from th ro felons of he ata of California Business
and Professions C rviSlon 3; Ater 9.
Signature of r
Permittee
D /47
SO. FT. (J
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
2
$ 3 g 10-D
/
PERMIT FEE $
PLAN CHECK $ 0_4
TAX $ r
Authgr ed Agent
TOTAL PAID $ r
i�
Cw.
a
h
5
F
C3
40� '71Z6
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill ir�Completely — U_se Ink Only
BUILDING /M / - _ I /
OWNER
MAIL
ADDRESS
CITY
CONSTRUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT
OR ENGINEER
ADDRESS
CONTRACTOR
ADDRESS
CITY
STATE
LIC. NO.
SIZE
OF LOT
USE OF
EXISTING BLDG.
TEL.
NO.
FEL.
VO.
CITY
LIC. NO.
NO. OF SLOGS.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
Pi�Li
r _7 7f,cl'< ' L8 a
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY I DATE RECEIVED DATE ISSUED
PERMIT NO.
A.P. NO.
BUILDING
ADDRESS
TRACT Q
LOT BLOCK
W
ADD A
PMEMOLISH
OWNER
LUE /
USE V$
FIRE
ZONE TVP GROUP
DATE
NO.OF
PLANS
USE OF NEW
BUILDING
kRELD
PROVED
LDING
YARDS APPROVED
ACCESSORY BUILDING
REET)
FT.
FT.
R. F
FT.
FT.
FT.
VA. 9P -L DATE
/L.CD LG/iL. • IiL/Jl/ I C URP.+ I APPROVED
APPROVED
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workmen's compensation laws of
the State of California.
I hereby certify that 1 am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
Signature of
Permittee _
Authorized Agent
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION PERMIT FEE $
PLAN CHECK $
TAX $
/ TOTAL PAID $