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HomeMy WebLinkAbout1088 GLEN CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 .lob Address: •1688, 'GLEN Cl Suite No Vicinity: Parcel Nunmber: 42203158 Applicant: BOOTH, JOHN Address: Owner: Address CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT P98-00512 PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT ` Status: ISSUED Applied: 06/24/1998 Issued: 06/24/1998 �Phone-=4 -- -� Zip:AAS"NEIL_._`. �V 1 1.�+- ij�� ''- f jam% �-Phone: Zip: 92627 voncraccor:s nr=vv�n+v v,uv+vSTRUCTION / r✓/ /� //&_// /Address: / 428 S MO TGOMERY WY AV/ Phone: 4-639-0300 ORANGE, CA._ ' ; 'Zi 92668 �.i..1�License. u451478 Arch lEng: l l+�'� 1 Address: ) �'' _ l� Phone �I:+cense �1 II _ �� III �1{\� SCOPEOFL-1-BAR-Sl B ISSUE Backflow Preventer/- Bathtub \��_% Clarifier System t Connect (Ice,Soda,etc) Dental Units �\ ' Dishwasher �\ Trap F Urinal -: AM if / $O:C Drain, Floor • " •,•••• r.. MT/ CITY J CITY( ��\Sewer Private Line � � � $0.00_�=0.c ,.' ,Water Closet (To �'�/O �j-.Sho4ae'r "��.,� laundry Tub /Washer _$0.00,,Lo 0 Landscape Irrigation $0.00 0 0 1 P -Trap h „h $0.00 0 0 i Pressure Regulator,t $0.00 0 0 Process Piping�(perl0!ft), x$0.00„ 0 0` 0\C eP ptors'��J �)tVJ {�r'�$O ; O,,,, �� \ Sink; Floorr-� ;'r.'- r_:'�$o.00 --',0 �- Watar-Service `kitchen r SSe tic Tank ;, OO n'0�A $0.00 rS"e,r Cap;for Trap F Urinal -: AM if / $O:C Drain, Floor $0:00 J/>0 A\Sewer Connect �,'��'(r,A$0'00 i, Kr!�j fj'Waste°and Vent ��//'0-� Drain, Rainwater '- $0.00 ��\Sewer Private Line � � � $0.00_�=0.c ,.' ,Water Closet (To �'�/O �j-.Sho4ae'r "��.,� Drain, Roof -,$0.00 _$0.00 ��,-., .$0.00 ?'0'= �1Wate _Heater/y+ �' Drinking Fountain �0 /" Sink, bar-- -_-�-� -_ -_ $8.75"'1 Water Piping'(I'm Expansion Tank $0.00\ 0 (� i Sink,- commercial $OAO-; 0�� ,� ��:. WaterRe-pipe Gas Earthquake Valve $0.60.- ; O,,,, �� \ Sink; Floorr-� ;'r.'- r_:'�$o.00 --',0 �- Watar-Service `kitchen Gas (1A outlets) $0.00 " 0 ;- 'Sink,l ` ' ,( _= $0.00 0. -J "Water Softener Gas (Over 4 outlets) $0.00 0 �; --' ;-Sink, service/mop-��'„ " , .$0.00 0 OTHER Gas Repipe $0.00 , 0 -`Spz (private)•.....- ,. _,.$0.00 -" VIOLATION Gas Service $0.00 0 Spa{public)'_=_r $0.00 - 0- PLAN CHECK Interceptors (Grease, Oil) $0.00 0 -- - - "- REINSPECTION Interceptors (Sand Auto ) $0.00 0 COMMENTS I SPECIAL CONDITIONS .W(5+)/1,j $0.00 $0.00 $0.00 ystem $0.00 �tj/ $0.00 it $0.00 or Rep.) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $15.25 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 C•) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. INSPECTIONS CALL: (714) 7545526 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one Of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 o1 the Labor Code, for the performance of the ��.,/ work for which this permit is Issued. VAl I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued e e hundred dollars($f00) or toss.) ❑ 1 certify that in the pedorma f t w for w is Ihis permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif 1 e ould become subject to the workers' compensation provisions of S tion 3700 of the Labor Code, I shall forthwith CO ase Provisla /� �� Applicant Signat ``Date: -FAILURE TO CU NOW COMPEN TI ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLDTG CRIMFtTO INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR St ), 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 undo of Ch 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force . N Classp Contrsctors Sign ure: fY>:a: CONSTRUCTION Ll G AGENCY: ❑ 1 hereby affirm at there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 ($500).): ❑ I, as Owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as Owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an Owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Cade for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownershiti b (",of +document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY-PERYMV ERTII (CATION: ❑ I hereby certify that no excavatlon Fiv Of$ ore 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, scaffOldifig, falsework, or demolition or dismantling thereof, wit be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative.C,P* r ❑ As owner -builder, I will not employ anyone d'tto do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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). ...........................................................................................................................p.re'.a're.'a.n-...-.-......-.-.'s-.-.-.-......-.-.-.-.-...-........-....a..-........m.-....-.-....-..-.-..-.-........-..-..........-....-....-....-.. 3 Does s, will the applicant or present or future building occupant need to prepare en 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 It 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 aemit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes 8 No (Section 65850.2 of the California 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 tram 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? ❑Vas ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinancesretgting to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection pu es. I a not U c py or allow occupancy of any building authorized by this permit until final inspection. Sign a e Date r Authorized Apprean Date l:gDE L awimplagiV DM INTMA 5 CODES INSPECTIONTYPE gA7j INTITA 1616 Fixed em Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re -Root 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 2G4 Final Demolition 250 Final Building/Occupancy 2466-46 ADDREWO!'BUILDING: 1088 GLEN CI UNT: ONNERS NAME IF ID'N" ALDRICH, THOMAS NEIL "GORE"' 1088 GLEN CIR COSTA MESA,CA 92627 548-1425 "PL. MUM ADDRESS: MlflffECTORENGNEER: CRAIG STANSE Uc'NO" C MR. OR ENG:S AUDREss: 4 WESTPORT UNIT. CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: E 086787 PLAN CHECK NO: N, CONSTRUCTION TYPE: PERMIT TYPE: ELL ' nr -1103 *94ff"0111100121 ANAHEIM CA 92808 CLAIM VALUE: CO"T"ACTOR's N"ME: NEWLAND CONSTRUCTION (714)639-0300 PERM NO: E .086787 GOVT; N SUPP: N PURPOSE: ADD 489SF 2ND FL ADD ABOVE GARAGE, 26SF DECK SQ FT: CALC—VALUE: GROUP UCC: R-3 / CONTRACTORS MUM 428 S MONTGOMERY WY COMMENTS: KITCHEN REMODEL IN 1ST FLOOR RE:B86786 AODREW:ORANGE CA uaND_ 451478 92668 UNT. Z O N I N G R E Q U I R EIM E N T S LICENSED CONTRACTORS DECLARATION: I hereby elfrm undo Mr..:4( Wq that I am licensed under provisions d Chager 9 S E T B A C K S (commencing with Senior )coo) d Division 3 d the Buainees end ProIe, aha my license I. in full face and shed. CITY U0. NO" 032 07 LIcCuss: B LIC5 4 788 EXP: 08/98 ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- 7FRNT: FT IN REAR• FT IN FRNT: FT IN REAR: FT IN oat°: c°rLEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION: I hereby affirm under penny d perjury that I am axempi from the Contractors License Law for the Witmer, nesun (Section tarts Business and Professow code: Any city Or county ahich umpires a More M construct, area, improve, PARKING REQ P RO V ; PARCEL: 42203158 Z N E : REF NO demolish, or raper any structure, Mor to its Issuance, also requires the applicant la such permit to file a signed m sweent that he or aha is licensed pursuant to the provisions of Ne Contractors License Law (Chaper 9 (commencing wtth Setlion 7000) of Marion 3 d the PLANNING NOTES > Business ark prdossums Cods] or thst he or she b exempt therefrom and the basis for the alleged exemption. My violation of Secion 7031.5 by airy applicant for a pamssubjetla the applicant to a dvil penalty d but orae then five hundred ddlars(5500DV ❑ I, as owner of the properly or my empfoyees wilh wages as tha r sob compensation, will m IM wale. and the structure Is rust intended T errollerelfor eab(Section 70<4, Busumas and Pmlesevw Code: TheCogracton License Law close nor apply to an owner d propend 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 who builds a improves thereon, and "a does such soak dmself or herself or through his Or her own employee°, provided that such improvements are out intended m offered for sale. B, however, the building or nnpewemeu is sold within one year of completion. the ZONING APPROVED B Y DATE: oweanbuilder bill have the burden d proving M or she didnct build or improve for tea purpose d sale). - ❑ I, as memer of the ropenY, sat axcitwivehy, contreaeq valb licemed conlreclae ro mnstru l IM protea (Sadism 7014nd ., ond Business a professions Cod°: The C nlmclas License Law mnd W ea rust apply to an owr property who ida tm s provas Ilwawho BUILDING APPROVED BY DATE: convects fsr such protea° with a mntrmar(s) licensed moms to the Connecta° License Law). - ❑ Iamesamytunder Section: S.AP.C..Wbis eon: =' APPLICATION ISSUED BY: DATE: I noruC Date: comer�•''######################3€i�i�Fis##iFifisisi i�i� iFisiFaFiFis########## ## I do barmy comity that I am aware d and understand IM requirements d California Ileenh ane Safety Coda Sect on zs5os. us33, and LEGALIZATION : N F E E S U M M A R Y STRUCTURAL SEGMENT : N mier ?5531. and that I or any Mure Widbp occupant will / will nor (circle are) Mad b campy with sad mete meas and the requirements ler aMmnfmmtmnionormadifimtbnhomlMA, oars)yRteregementDiarid.flesWaNidcanaruaionappiceliawenezemgimmthw BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE' SMIP/RES GRADING 'mrsi ^' PERMIT 40. 30 Dora: Applied: X 50% SM I P /NON —R E S WORKER'S COMPENSATION DECLARATION: I Mraby affirm under penalty of perjury aro of the fddwiN emtlarstoea: PLAN i [31have ane will merman a certificate d consent to saf-insure for wafcers'mmpenaation, as provided for by Seddon 37M d the Lana ISSUE FEE 272,00 Cade. for the 7ditMak wforwNchthispommI. Issued. BUILDING—DICT— > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ IhavemkwtLmaintain worken'mmpnwationinsurance. asrequi olbySwim3t00dM°Labor C . for the pedamernoeofthe TOTALS ---- > 40.30 22.00 • 0.00 62. 30 62.30 .00 wok la which this permit is brood. My wcrkars' compensation insurance comer ark pdiw number ere: Carrier: REVENUE DIVISION TOTALS--> COLf2CTED: 62.30 OVER/SHORT: .00 policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 1((jA section neaenrMcomp adfdIMpeeurisJO,onehundreddodesI$IWIorlase) 62.30 J I. I codify that in the padormance d the wok for which this Mean I. a. I awl) rho employ any pawn In any manner Iso es to .� become subject to tFor10he, wmbws' mmpensalion Is wa m cetiromi or agree at if I d becan subject to the worYan' Date: a (M `rd Seam 37M d tea Lauda cede. I Ito wnn a pry � o. pm.;®ans. OJ I N D I V I D U A L F E E B R E A K D O W N pgicau' +: Warming: Fallon M sscun wortws'consumation cuvsWer la unMwM, and study subject an employes lip cdeteal penaMu and TYPE QTY D E S C R I P T I OWN UNIT COST TOTAL COST civil fleas W N cos hodnd thousan0 dollen (S1M=1 M sddldcn N Me Mat of rompansefbry commits as Mov/ded ler /n Section 37MofMeLabor Cape, Interest spot aMmeysfses. ELE 14 FIXTURES, LIGHTING _ .1 ST 20 EA. 1.00 14.00 CONSTRUCTION LENDING AGENCY: I Mreby affirm under penally of perjury that than is a construction brkimg a,mo, for the ELE 20 RECEPT/OUTLET `"•�•1 ST 20 EA. 1.00 20.00 Md«m.dthe a for whichtheFrmfiabaued(Saaknx .Cv.0). ELE 2 RECEPT/OUTLET ('ADDITIONAL EA. .65 1,30 LENDER'S NAME: 1. LENDER'S ADDRESS: I��- ELE 5 RECEPT/SWITCH p.•'1 ST 20 EA, 1.00`, q�._r ,.,,.S, 00 END OF FEES e, I candy that l here reed this apgoation sea Nate that the above information is toes. l ahom to mmpywith all"aly and county ordinncee •� 91JAN and state laws adding Io Wi' construction ark hereby aulfna¢e reprournative; d this dyb must upon the shwa-nrernoned propendfor inspection Wrpeses. .E RY BO HPd m 2 91998 \. Date: -a� -9 OF, COSTA MESA / nature d Owner/AganUApgcenVContreaor •� (k I /\ U'i' ' /�I (515145.WP) WhM-Suildn, B Safety: OnemFle; Canary-Apgmu; junk-Ravenue; Godemo�Asaeua / CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # 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 1 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7.' Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO�DECK 11. Property Sewer Line & House Conhection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final r 14. Rough Plumbing Final 65. Electrical -Final '�, sir;:.-.-• ;_� �_ �� 15 ;Rough Electrical -Conduit 16.-Rough'Electric Wiring - Q 66. Solar System -Final 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 APPROVALS Permit # ` 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ' _ 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe;Rough & Test - 72. Underground Flush 24. Roof Framing - 73: Undergrnd. Storap Tank OGas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75, Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing & Siding 771 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: 3-30-98 Wo I ProB�rss _ 34. Final Heating & Air Conditioning 1 35. Final Gas Pipe' -Test, . 36. Hood or Canopy - - - 37. Final Factory Fireplace. ' 38. Final'Plumbing - 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. BaERcflow Preventer 43. Backflow Irrigation - - 44. Landscape Irriqation System - - - 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date r 4 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT P RMIT NUMBER E98-01099 V (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1088 GLEN CI Status: ISSUED Suite No Applied: 10/16/1998 Vicinity: GARAGE Issued: 10/16/1998 Parcel Nunmber: 42203158 Applicant: SANDERSON, PAUL Address: 428 S. MONTGOMERY WY ' Phone: 714-639-0300 ORANGE, CA Zip: 92868-4015 , Owner: ALDRICH; THOMAS NEIL Address 1088 GLEN CIR - - - --° - Phone: " "COSTA MESA,CA". - Zip: 92627 contractor:'! NEWLAND�CONSTRUCTION Address:-" '428 SMONTGOMERY WY' Phoned -714-639-0300 - , t - ORANGE, CA 92668 ' ,Zip:_ License: 451478 SCOPE OF PERMIT " UPGRADE SUBPANELTO 200 AMPS "SUPPLEMENTAL TO E98-00059." FEE SUMMARY 'Quantity Quantity ISSUE FEE $6.50 - - Temp Dist System / Lighting. • $0.00 0 Temp service test $0.00 '- -Busway M 00 ft - _ - $0.00 0 Res. a/c package $0.00 - - - Standing Section $0.00 0:"" New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0' New Res(3+units)• $0.00 0 Transformers up to 1 kva/kw . $0.00 0, Pool / Spa , , $0.00 0 ................up to.10 kva/kw $0.00 "10 Lighting Fixts $0.00 0 ... ._.......... up to 50 kva/kw $0.00 -' ,0 Recept Outlets $0.00 0 ................. up to 100 kva/kw $0.00 ''"0 1; Switches . - $0.00 0 ..................over 100 kva/kw $0.00" , 0 Non Res Appl .$0.00 0 Low Voltage Equipment $0.00,- 0 Res Appl $0.00 . 0 Low Volt Wiring System/ Ckt $0.00" 0" % Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a ,$0.00 -, ,,,0..° - Misc. Conductor - :,x$0.00'- 0 _ Service over 1000a" $0.00 0 Circus ( gen or ride) ' < ,' $0.00 0 Motors to Ihp $0.00 0 - ` Circus(mech ride or lights) $0.00, 0 Motors to 10hp _ $0.00 0 - , Christmas Tree Stand $0.00 ' 0 i Motors to 50hp $0.00 0 Fireworks Stand $0.00 -0 ' Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp '$0.00 0 Communication drops $0.00 - 0 Investigation Fee " 10.00 Sub panel to 200a $27.25 1 Plan Check Fee '. $0.00 Pole Light Pkg $0.00 0 " . - Reinspection Fee $0.00 Sign Circuits $0.00 0 - Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $33.75 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS 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) 7645626 A DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have aril 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. ❑ 1 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' compensatio`o�_nsurenco mer and policy number are: Q Carrier: (✓�Z r'5 ` t `A" f)(,P�+� Policy Number. (This section need not be completed i1 the permit is valued at one hundred dollars ($100) r less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws Califon and a that If become subject to the workers' compensation provisions of Section 3700 of the La r Cotla, I shall forthwith comply with these ra Isleds�%�J� (°\ Applicant Signature: (A. _ X JC�w- &a Dale: �C2 116 y� WARNING: FAILURE TO SECURE WORKER$' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($10),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 ur)der 5; vi of Cb�pter/ (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. H 1-r' .J / T/ Class q Contractor's Signature: > c Date: CONSTRUCTION LENDING GENCY: ❑ I hereby affirm that Cher 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: Signature: a e: OWNER-BUILDER DECLA ATIONS: hereby affirm that under pen ry of pon. at I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which Ui 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 LICENSED CONTRACTORS to constmct 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, T111e 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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 a1 standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building ocaDent 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, cenification 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 aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes a No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). .................................................................................................................................................................................................................................................................................... 6 Will any pan 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 Alr Quality Management District or other air pollution control district or agency Is reGwired 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 office(). 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 above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig ure 9FLegal Owners) 1 fate �/ g AndQr AUthwded Applicant —� Dat CODE r. INSPECTIONUT PPE IIATE INi1D6L5 CODES INSPECTION TYPE DATE Ri®AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re Rcof 210 Final Electrical 201 Final BlocWRetaining Well 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 2"4 d 9 w ADDRESS OF BWCGNG: 1 0 8 8 GLEN CI I UNIT: w NEaAuMrgioxi: ALDRICH, THOMAS NEIL Is .'"MDRESS. 1083 GLEN CIR '` COSTA MESA,CA 92627 548-1425 APPL. MMUNG ADDRESS: h ARCNITECTORENINEER: CRAIG STANSE uG NO, C PICK OR DIGS MDREW: 4 WESTPOR.T UNIT. ANAHEIM CA 92803 COMMTORSNAME: NEWLAND CONSTRUCTION (714)639-0300 CONfRACTOR'SMNLING 428 S MONTGOMERY WY ADDRESS: ORANGE CA uc.m.: 451478 92668 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby affirm order penalty of perjury that I am (canned undo provision of Chapter 9 (commenting with Search 7000) of Division 3 of the Bueinam and professions Code, end my license is in full broe ad offers. C" UC. NO.:032Q8,0�7�7�uc.cuss: B UC.NO.: 51�47,8D EXP: 08/98 Dste: [ _�_ / 3 Contractor: A//�At� OWNER BUILDER OECURATION: I hereby affirm ware penalty of perjury that I an exempt firman the Contractors License Law Ito Ihe Idlowmg reason (9e tion 7031.5 Buranxi ad Proleesins Coda: Any city or county which requires a some to construct, dter, improve, demolish, or repair airy sinews, prior to its issuance, also requires the applicant lot such ower it to fib a signed war mem that he err ahs Me Iieenne pursuant to the wommers at the Contractors Licenm Lew (Chapter 9 (commencing with Soda, 7000) d DNbon 3 d floe Rumored; end Natadcm Codel or that he or she is exempt therefrom and the basis Ito the allayed exemption. My violation of Section 7031.5 by any applicant for a perms eubjeos the applicant m a wit penalty d net more than rive hundred dollars (55001). ❑ ! L as owner r the mepsny«coy employesewvh wepes.m their eels Covemdion,win e a wok, errs they to an a land intended wobudd oeels(Sectionlad. and ram errs Protesaono Coda:The Cwnreaore License Lewdoesraapplylet,bwnerdwd such who buddy « Mnpraal i thereon, and who does e. 9 wok Mmesn b handl w through he a her ownhin oras ea provided (het such improvarrhems we Tal intended la drered for are. sloe W n the Wild Ming or nwas far ou b ser within one year d compaion, ger wrer-0uiMer will neve the budm d proving he w aha did ra WiM w unwove Ito the puroesa of eels). ❑ I, as owner of the property. am exclusively, contrasng fifth licensed contractors to construct the project (Section 7W. Business and Professors Code: The Contradon bconse Lew does ra apply to an owver of property who buiMe or manservant thereon rest who, convects for tooth prgergs with a awareness) licensed pureuard to the Cornmeal Licarue Law). ❑ I am exempt under Section: 8,11 P.C., for this reason: Date: , owrar: I ao hereby that I cors I am aware d and upieretmd the requirements d Mani to cNeplh cors sdely coda Sarsiona a os, mucin ane a m5 fw that I or any /inure buidirp occupiers tMA will / oil low (otrob ora) coed to comply with veld state codes and the requ'vemerna Mr epermilfwmmvuctionwmodiDmlionhwntMAiai yreTl�aapanam Dimkf.RmNwhtielconnrudion appiratiomere exampttmmtMae Dela: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby affim under penalty of perjury ora of the fdcwinp dxfadbns: ❑ I have arhd oil meintenh a cenffneM d acneant to eaffimure Ito workers' cwnpenmtian, m wovided for by Semon 3700 d the lab« Code, t« the pssmmnce d Ne work Ito wlich kb pecan ls ®tied. ❑ 1 have end oil maintain woken' ac mnmtion insurahm, m required bySection 3700 d the Labor Coda, f« the percrmawe d the oak fw whim thio perms b bvued. My w«Me% compemdcn intonnce mnbr errs pdicy number ere: Carie: Policy Number: ion need nor be co n detedY Ne pemt is for one hunend sprier, /51001 «less.) Lj I esnny the in the part. of the wok b which this pemn is . I shell not employ any pervon in soy manner so at to become subject to the mul compensation Is d Cold. agree it I e uM became subject to low workers' rompenaation pppovntau d Section 37x0 d the labor Code, 1 IM h ply prwmwm. Data Waming: Fallu s w secure wo rkers' cornparusdon coverage Is -vu and sIW/ subject an employer to criminal parmll surly civil Rees M None hundred thousand Adler /510(%=0 In moralism ro Me cost of rompenaatbn, r/amspes as provided for In Sson. 37M of the Labor Cede, Interest, and attorney's Nora. CONSTRUCTION LENDING AGENCY: I hereby affirm uMer penalty of perjury (het them is e construction bndsq agency ar ger penwmerae of the wok For whim Ohm penin is lstoea (Section 3097, Ch. C). LENDER'S NAME: LENDER'S ADDRESS: I cenify Ohm I have reed this a iplicruion and ride Ihd the above information i3 across. I agree to comply with at dry, and county ordinances andstate laws was ng to buiMYp gonavectbn end hereby aulhw¢e nptemntatives d this dry to enter upon IM above-mentioned txopary, for inspection purposes. T ARY Boo pant Date: s e of Cora/AgentrApp+canNcummal. (5151 <8 WP) White -Building & Safety; Green -File: Canary -Applicant; Pink -Revenue: Gddenroe Aseeemr CITY OF COSTA MESA - BUILDING PERMIT PERMIT NO: B 086786 PLAN CHECK NO: 05194-97 L CONSTRUCTION TYPE: PERMIT TYPE: STIR Bqt?_2a�/6 PERM NO: B 086786 GOVT: N SUPP: N PURPOSE: ADD JOB DESCRIPTION 489SF 2ND FL ADD ABOVE GARAGE, 26SF DECK SQ FT: 15,515 CLAIM VALUE: 70,000;00 CALC-VALUE: 55,272,62 GROUP OCC: R-3 / COMMENTS: KITCHEN REMODEE=.IN 1ST FLOOR Z O�I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: 20 FT IN REAR:; -,,..32 FT 2 IN FRNT: FT IN REAR: FT IN LEFT: 5 FT IN RGHT:-, 6 FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: YROV PARCEL: 42203158 ZNE: R2MD REF NO: PLANNING NOTES> SECOND STORY(472SF) ADDITION AND 17SF ADD, TO KITCHEN',AS PAF. >'T OF, -,REMODEL ON FIRST FLOOR, 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 ^� I'�=.S_TE: BUILDING APPROVED BY'Z: DATE: APPLICATION ISSUED BX:�IF DATE: iE iF ai-k jf lb iE N-dE*3t ih iE*dF*1E if RE?E j( -df if h �/.�'%jE RF3f?f �F iF kiE k -k iF 3E LEGALIZATION:N F E E S U M M _A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTR•ICZMECHANIC FIRE SMIP/RES GRADING PERMIT 612.25 '% f :'t 5.53 SMIP /NON -RES PLAN 397,96 .t ^ 1, ISSUE FEE !:, BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 617.78 0,00 : 3'97 :96 ° ;1015,74 1015.74 ,00 „ n REVENUE DIVISION TOTALS--> COLLECTED: 617.78 OVER/SHORT:00 BLDG PMT PLUMBING ELECTRIC MECHANIC -=FIFE SMIP/TOT GRADING PLAN -CHECK 612,25 5,53 INDIVIDUAV ,€' E E.,BREAKDOWN TYPE QTY D E S C R I P T I OiN.'' %; UNIT COST TOTAL COST SFR 489 DWE-TYPE V -WOOD FRAME -GOOD 81.50 39,853.50 SFR 26 RES -BALCONY EXTERIOR STt IRWAY 16.12 419,12 SFF. 15000 ALTER BY VALUE RES3DENTIAL NOZONE00 51-5,000.00 ,END OF FEES, JAN 91993 00 1 DE mm �Q�! y rl W ~'CONSTRUCTION AND PLANNING d• APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector ri. 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 LIFER Grnd. 7. Footings /// ' / y,�/Q� 57. APPROVAL TO COVER•GUNITE 58. Electrical Conduit-Undrgrnd: 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final ' I 12. Sewer CaP 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit - 66. Solar System -Final ' 16. Rough Electric Wiring - 67. Fencing &Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning .. FIRE DEPT. REQUIREMENT APPROVALS - Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 25. Roof Sheathing �jQ 73. Undergrnd. Storage Tank OGas -El Oil 74. Overhead Hydro 26, T -Bar Ceiling (Structural) & Monocoat - _ 75. Dry -Chemical 27. Frame and Flashing 7�� 10-- 76. Dry Standpipe „ 28. Lathing & Siding/ 29. Insulation 2 (S y • . 77. FIXED SYSTEM FINAL 76. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 33. Final. Electric.. - 80. FOOD CERTIFICATE ISSUED a,r �a 1 Notes: 3 p�j ri.V p/at//�Y <+-� I 34. Final Heating & Air Conditioning � 219,�'� � �n ��b�j� g•�+7 i%� /yam 6� 35. Final Gas Pipe -Test - 36. Hood or Canopy 37. Final Factory Fireplace - IT Z%�p ��✓_ _ 38. Final Plumbing �� ��, .•,(> "'� 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. FINALPLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51, CERTIFICATE OF OCCUPANCY No. Date STRUCTURAL TNSPECTION CONSULTANTS Inc. Mail: PO Box 840 f i ;', . Office: 1300 Aviation Boulevard Hermosa Beach, CA 90254-0840 J- Redondo Beach, CA 90278 ;(80OU5,09MIrM ('ii 00).49$-1979 E-mail operationss(a sic-incxom Fax (310) 376-5294 Building Depat Permit # 7 Project Name_ Project Addre& Owner's Name Address General Contractorf W ' L' / Phone Address Fax Site Contact Beeper Address Fax_ Office Contact Phone Engineering Name, in Seal Architectural Firm Address Name in Contact Fax TYPE OF INSPECTION; _Reinforced Concrete, _Gunite, _Prestress, _Grading, _Framing _Rebar, —I -Ii -Tension i -Tension Bolts, Anchors, `Structural Masonry, _Welding Other To the Building Official: Buildinglnspector: I hereby certify' that the following portions of the work at the above address which required Special/Deputy Inspection and for which I was employed to inspect, were inspected by me and comply with the applicable provisions of the Building Codes and the approved drawings: Inspector _(Print)__Z Inspector (Sign) HOURS: Verified By: (Print & License: Thurs, _Type: (Ct 1 /74- Date Sat, Sun 0G 70/19'98 10:37 714T�E7 _ _ _ --'K ATELLA FLY � _UlBER PAGE O7 L. 07 cJ Certificate to Of Conformance ('.� -tifirato 0417 1 .7 THE UNDERSIGNED NIANUFAC--URER HEREBY CERTIFIES that the structural wood products identified below and marked with a collective mark of Engineered Wood Systems (EWS) were man- ufactured in accordance with the spaoifications indicated below. f_yI ANSI Standard A190.1-1992, for Structural Glued Laminated ilmber 0 J'Q f.o e Jobt-ocation _. _-_ RL'1EVS_D)F, CA Custgrner's order No. _-_ _ _. _ _ Date 10/31/97NtlgrsOrderno. 3894—C_ '( PRooi LOADED E:TD JOINTS Signature riue_ CUALITV CONTROL V Company `nQ_S80R0 LU%ISER CO. _ Address _ SPRINGFIELD. OREGON pate 11/17/97 IT IS HEREBY CERTIFIED that the structural glued laminated timber production of the above-named manufacturer which carries a collective mark of Engineered Wood Systems (EWS) is subject to regular audit by Engineered Wood Systems, such audit consisting of the inspection with reasonable frequency of the manufacturing process, with adequate sampling to verify the quality of glulam construction and the adequacy of glue bond. by ____�� -- Thornas G. Williamson Executive Vice President ENGINEERF0 W000 SYSTPMS A REIATFD 0oRPORATION OF: APA -THE ENC NEERED WOOD ASSOCIATION 'Q/ i ay_ 10: 37 _-= 367 ' KATELLr, =L' - _' Ih15EP, PAGE 113 rI � J � Number TO CERTIFICATE OF CONFJRMANCE NO, DATED [� Job Nana — -- Il� ,i 1) � Job location-- Cu9tomeriOmar Nc�_ Daiad i is Ordur Na. The following identifies the members and gives the basic specifications that were used on tnis;ob: Lumber Species' --_—_ hSomGer M . Appearance Ic!entl6caltan 0`sm;ry - _ -_ S;.a _ Cgmbinalion - 7r G dde (,fm.y. eamr M uaidf ioi uperAcof ossa PtieF,�ca.l vrCD 5*SiEn�3 � A RELATED CCkiPOPAitON Cf PMEPiV N P-v'I��pC A55[��gi tib; ADDRESS OF BUILDING,- 1038 GLEN CI UNT: OWNER'SNANEIFUMNIIN: ALDRICH, THCMAS----flEIL ADDRESS: 1088 GLEN CIR COSTA MESA,CA 92627 548-1425 APPL. Y/JISlO AWRESS ARCHITECT OR ENGINEER: CRAIG STANSE UC. NO: C MICKORM.'SMDREss: 4 WESTPORT DNT' ANAHEIM CA 92808 coNmtcTalrs xAME: NEWLAND CONSTRUCTION (714)639-0300 CONTRACTORS Muuha 428 S MONTGOMERY WY ADDRESS: ORANGE CA ucno.: 451478 92668 UNT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under Minsky of perjury that I am licensed under prover. of Chepler 9 (Mmmerrdnq with Section 7000) of Diviabn 3 of the Bush. end Po " em" de, end my license le in full force end effect. cmuc.No.:O 2807 uc.cuss:B uc.N.: 51 78 EXP: 08/98 oda: I - COdmot= OWNER BUILDER DECLARATION: I hereby affirm under musly of perjury that I am scamp, from IM Contractors License law lar 1M Idbwng reason (Section 7(y)l S Business and Professions Code: Any cry or county "icti ratli es a stank to construct. after.'anPrOye. demolish, or repair any, structure, Mor to m i mance, me, reeuires the arse iam for such panmll 10 fib a signed sblsorm the heor she is licensed Wreuem to IM «om wmm of the Contract. Litems Lew (Chapter 9 (c«nmenalq with Seo ion 7001 of Diveion 3 a IM Bum. end Robert oro Codel a due he or she is —Pt Iherehom and the belle for the Alleged exemption. MY vbbildn of Section 7031.5 by my eppliMnl for a permit subjects the applicant to a civil penalty of M more than rive hundred dollars jS59OB. ❑ I, es owner of the property or my employees with wages m their mole compensation, will do the work, and the m enure is not intended or offered for sale (Section 7044. Business and Professions Code: The Contractors Lionise Law does not appyto an ownerd properly, whe builds or initomme thereon, and wtro does such work himself or herself or duough M or her own employees, provided that such impro ements we not inlende l or offered for sob. 1, however, the Wilding or imProvemed m sold within One yam of completion, the owns-bwyw will heve the burden of provirp he or she did not Wile or improve for the Wrpme of weld). ❑ I. as owner of the Popery, sm axdrsimuy mntrmi g with hoansed coermlore to construct the project (Section 7044. Business and Professions Code: The Contmotom License Law does rwl appy to an owner of property who Wilda or imeroves the. and who contracts for then protects Mh a cedrodor(s) licensed Mrsuml to the Commodore License law). CITY OF COSTA MESA — BUILDING PERMIT v` PERM NO: P 086789 � PERMIT NO: P 086789 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ADD JOB DESCRIPTION : 489SF 2ND FL ADD ABOVE GARAGE, 26SF DECK SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / COMMENTS: KITCHEN REMODEL IN IST FLOOR, RE:B86786 Z O N I N G R E Q U I R E M'E N T S S E T B A C K S ------------ 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 RGHT: FT IN PARKING REQ: PROV: PARCEL: 42203158 ZNE: REF NO: PLANNING NOTES> > n 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: ❑ Iwe..mpuMe, Secr n: S. A P.C.. for this n: APPLICATION ISSUED BY Dae: LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N I do hereby caniy Oat I am aware of and understand the re iumimamm of Cali mita Neat and Sdaty Code Sectors 2s505, Rema. and 25531, and tial I or my future buibinp oxupant will I will ml (circle one) reed to comply with mid days mdes and the requirement; for apermaf«mnstmaionormadihrationh the Ai u-6Tyyl�anapemenl Didrid.RmNentid canctrWbn mplcevsens emmlt rmmthma BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING prmsmmmi. PERMIT 8,75 ode: Applicant 25% r SMIP/NON—RES WORKER'S COMPENSATION DKLARATION: I hereby affirm under Ministry of perjury ane of the fdbwing deWrmons: ❑ I heve fond he mermen a of tk s d oonaent Ih this t kc issued. compenWion, es provided 1« by Section 3700 d the labor Code. for the p.domanmce a the Welk f« wlicn told penia ire issued. ❑ I have and will mdntan workere' Mmpmmtion insurance, m required by Sepias 3700 a the Labor Code for tM pMor m d tM work for whits this permit Is weued. My wakes' compensation insurmca carder and policy number ane: Gander: Policy Number: (This section need nor he ownpbbd if the perm] hs nor one hundred dabs i OI«bre) I oedlfy that in the pedormarce of the work for whish this permit "uep, I e Iwljh— Applicant my permit in mY manner m m to become subject la the workers' companmlimn lase a Cdilom' m W 'id become cabled to IM wodrom' Mm mu�pjQvi�0so1 Sppwn 37M of the Labor Cab, I ah 1 find vith pig gwai«a. Dde:1 / `O0V/7y Wem/np: Fellers M senium workes, rompauetlan coverage is -vMA and shall sub/ect en employe to «Imlrul peneRles end civil tinea IS, W oro humored tMusend dollen fsfOQOOOL fn eddltlon to the roar on rompematlorl, domugee se provided for In Section 3705 of rhe Lobar Cods, Internal ed aMrn's Ms. CONSTRUCTION LENDING AGENCY: I hereby erfim under Mnahy a perjury the there is a oMmmdion bndinp agency for the Pedommce of the sack for which this peml is Issued! (Seclon 3097, Civ. C). LENDER'S NAME: LENDER'S ADDRESS: I cediy that I have mad this application and ode the the above information is Mnecl. I "ma to oompy with At city and oounty aminenoae and mute laws reletin basks" Mmtruson end hereby authorize representatives a this Aly to enter upon the above mentioned papery for inapepim pun es TERRY BOOTH Date 5,grst VAwhowwConlmdor DATE: DATE: Z�Cc1(S (5151- 'Wp) WMo-Buibip A Soley: Gree AI.: Cmey-APAcent: Pink- lmwnue: GoNenrod-Air. PLAN , ISSUE FEE 22,00 �) BUILDING—DIV—> PERMIT ISSUE PLAN7_CHECK TOTAL PAID DUE TOTALS ---- > 8,75 22,00 v —0.00 30,75 30,75 ,00 nit REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 w BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30,75 I N D I V Z 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 TOTAL COST PLU 1 SINK, KITCHEN til I 8,75 8.75 END OF FEES 4DI FJ' AN 2 f9 1998 Ali'( U j sago as9ES.A . �� �ICONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA - APPROVALS Permit # 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 47. Footings- 58. Electrical Conduit-Undrgrnd. P. Foundation 59. Gas Pipe, D Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, D Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK , 11. Property Sewer Line & House Connection 62. Backwash & Recentor,Final- 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains - 64, Plumbing System 'Final - 14. Rough Plumbing.' 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring _ 67. Fencing & Access Approval - 17. Rough Wiring Sign 68: APPROVED FOR PLASTERING - 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT APPROVALS, Permit # 20. Rough Factory Fireplace - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas 000 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D Oil 25. Roof Sheathing - - 74. Overhead Hydro 26. T. -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe , 28. Lathing &.Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30- Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat, 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric , Notes j{ - I $ tj 1 RSIA8 Pitt lI 34- Final Heating & Air Conditioning ea R-ECTLcL�+�c_rmC- I C 35. Final Gas Pipe -Test '. 36. Hood or Canopy 37. Final Factory Fireplace , 38. Final Plumbing - �o�`l���f ((�� yJii 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. FINAL PLANNING 49. Electric Release to Edison Gas Release to Southern California Gas Co L51.50. CERTIFICATE OF OCCUPANCY Date 0 ►j AOORESSUPBUILDIria: 1038 GLEN CI uMr; n• -'Lire .. Flat01YN: ALDRICH, THOMAS NEIL slr ADDRESS: 10 8 8 GLEN C I R COSTA MESA,CA 92627 548-1425 APPL. MAILING ADDRESS ARCHITECTORENGINEER: CRAIG STANSE LLC.NO.: C ARCH. OR ENG.'S AGGRESS: 4 WESTPORT uNi: ANAHEIM CA 92808 coNmAcTowsNAm. NEWLAND CONSTRUCTION (714)639-0300 CONINACTORSMAILING 428 S MONTGOMERY WY ADDREssORANGE CA uc.No.: 451478 92668 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby afam under pety of Mqury that I am licensed under yroAslen. at Chapter 9 (cvanmeaharq wnh Section 7000) of Division 3 of the Butiess and Profession. Code, and my ricersss is in full to. and effect. CITY LIC. NO, 032800j7LIC. CLASS: B UC. NO.: X51,4780 EXP: 08/98 Date: 1 .-. C 8 Contactor: O N OY.[.Y`-- OWNER BUILDER DECLARATION: I hereby affirm under pnaly of perjury Ina I ser aempn from the Conrado. Licems Law for the following meson (Section 7031.5 Business and Probations Cale: Any city or county which muim a permit to aasron, after, improve, Ismolsh, or repair any structure, prior to its Issuance, a en resuim the applicant fa such permit to Rb a signed statement Met he -am r licensed pursued to the provisions of IN Contractor. License Law [Chaser 9 (commence, with Section 7000) of DNbion 3 a the Busicas r end Prclessioru Code) or that he w she s exempt Harahan and IM bees far Use staged exernpu n. Any siaatian of Section 7031.5 by any applicant for a Permit subjects the applicant to a evil penalty of out more than We hundred dollen 155001). ❑ I, as ower of the popray, or my employees wlh wages as (heir sole mmpneation, will do the work, and the mucture is net intended a offered fa We (Section 70,16. Busimee end w Proleasne Code: The Contractors License Law came cat e apply loan swmer d Property who Wide or inProiea thereon. end who does such wok Normal or herself or through his or her own employees, prowded the soon impmement. are rat intended or offered for sub. t, however. IM Wilding or inpao. soma in; sob some ane year of mmplwim, Me ce.4huikler will M. the Wrden of proving M or she did not Wild w improve far IM purpohe of sale). ❑ L as ower of the property. are eadh®vely oetrmi t; wkh licensed convenors to construct the paojea (Sadiron 7044. Businros and Professions Coda: The Contractors Licenses Law des riot appy to an ower of property who Wilda or improves thereon and wM comrocs ler such projects with a conheaon(s) Icerwd pursued to the Contractors License Lew). ❑ I am exempt under Section: B. S P.C., by this reason: Date: Owner: I do hereby cooly that I am .were of and underabnd the nseuiremema of California health and Safely Code Sealons 25505, 25533, and 2553x, end that I or any Mum Wilding ocament will I will M lamb om) mad to comply with said state .dee and the apuiremens for u pnnHlorcanstructionermndifiraticn ham Ma A'vuunty F.�enegemem District. Reeidemiel mnaruaion eppYretvuere exemglrom Mme ptosisbru. WORKER'S COMPENSATION DECLARATION: I hereby affirm under pasty d perjury one of tlw mUmmng dedandoad: ❑I have end will mans a certHicsa of Consent to self inwre M waken cdnpasation. as prmnded lar by Section 3700 of the lobar Code, for the performance of IM work for which this permit s issued. ❑ I Lave and will mamas wmrkere' ampnaetion imurence. as required by Section 37M of the Labor Code, for the Performance of the work la which this prmft is armed. d. My worker' mmpneaion insurance carder and policy number are: Carder: Palsy Number: I This section need opr be com hated y the pear) is for oe hundred dollars ISIOOI or baa.) 1 I cert'ly Dol in IM pedormerwe d the wok for which Ins permit is d, Mal ml employ any Peron in any manner su a to become, subject to the workers' oompnsatian laws of Caibm an agree Ina X I ehoub became subject to the waMare' campana{atbn Praisipm a 3700 d the labor Code. I Ila wile ply these provisions. Dae: L !�$ [ APpliraM: ��%LI� Wamlrp: Failure ro secure wainari compemagon pve a he Is unlewful, and shall s14lecf ea employe, to CdnSel paelfies and Civil fines ter to one hundred tiwusarld dollen (S1OO,000A In addition a the cat of rompsruatbn, derrsi as; prevldsd ler In Section 37M of the Labor Cods, Insert and attcmay's tees. CONSTRUCTION LENOING AGENCY: I hereby ander under Penalty d nalperjury that there is e oonmrWion lending agency for ft performance, of the work M which his pad is issued (Seasn 3097, Cs. C). LENDER'S NAME LENDERS ADDRESS: I ceoity that I Mve reed this decked. and state Iha the shave Information is cormct. I ager to comply with a1 any and coumy ordimaana and Sue kora raatig to Wildip ion and hereby actomoe representatives d this jury to em«upon the above-mamioned property for inepeaion prposee.T R B 0TH staeastrur d Owner mwAppcanX.ntrmtor (515146wP) While-Buibiq d Safety: Green-Fle; anery-Applcm, Pmk- smue; GaMenrod-rleroew im °'s --- 6)003ZZ✓` CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 086788 PERMIT NO: M 086788 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: ADD JOB DESCRIPTION 489SF 2ND FL ADD ABOVE GARAGE, 26SF DECK SQ FT: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / COMMENTS: KITCHEN REMODEL IN 1ST FLOOR, RE:B86786 Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ 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: 42203158 ZNE: REF NO: PLANNING NOTES> > D E V E L O P M E N T S E R V•1 C E S R E Q U I R E M E N T S ZONING APPROVED BY l DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: ,,-1 S41 ~ DATE: l LS( LEGALIZATION:N F E E S U M M A R Y STRUCTURAL�SEGMENT:N BLDG PMT PLUMBING ,ELECTRIC MECHANIC FIRE SMTP/RES GRADING PERMIT 16.25 25% SMIP/NON—RES PLAN ISSUE FEE 22,00 BUILDING—DIV—> PERMIT ISS = PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 16.25 22.00 0.00 38.25 33.25 .00 REVENUE DIVISION TOTALS--> COLLE ED: 38.25 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECH NIC FIRE SMIP/TOT GRADING PLAN—CHECK .25 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 TOTAL COST MEC 1 RELO FORC—AIR/GRAY FURN > 100 K BTU 16,25 16.25 END OF FEES ® h a 1 ff c t 9BU. OF COSTA MESA CONSTRUCTION AND PLANNING AAPPROVALS Permit # Date Inspector. POO' . SPA APPROVALS Permit # 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. S. Foundation 59. Gas Pipe, O-Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P=Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12, Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final. 14. Rough Plumbing 65. Electrical -Final -' 15. Rough Electrical -Conduit 66. Solar System -Final ' 16. Rough Electric Wiring - - _ - 67. Fencing &Access Approval -- - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical -T Bar Ceiling 69, POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil ,23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O Oil 25. Roof Sheathing _ 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34. Final Heating & Air Conditioning a cZy'%v ^, IV ... 35. Final Gas Pipe -Test - 36. Hood or Canopy 37, Final Factory Fireplace 38. Final Plumbing 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. FINALSTRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 41 CITY OF COSTA MESA REQUEST FOR OCCUPANCY TRACT NO. �(SS� DATE IAT NO. /--:3n p ADDRESS(�? Al EL/P 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 accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that I (he- he-they)—(iii)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. Wtl Wd LL6l 0 c�S cl vsiW ViS00 30 A110 03AI103N BY X� Purchhser Developer and or -a representative% / /7 D v" d CITY OF COSTA MESA CONST/R•UCTION PER/�ssMIT Project Address �0 g l.� .•(�L I Applicant's Mailing Address—� �.� �'+—�✓ 2 /1 Owner's Name _%n,'ank 41,A` -Phone Address Arch/Eng. _ License No. Address - Contractor's Name '� �,t P�I}tone 7 0 Address (mailing) Lao- /i! •' E�KI Cf _5_F City License No. 5 O $ 2— LICENSED LICENSED CONTRACTOR DECLARATION I hereby 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 far a and effect License Class License No. y J d• Date L 6 - iVSignature •U WORKERS' COMPENSATION O -LAR TION hereby affirm that I have a cer Cateof consent to self -insure or a certificate Workers' Compensation 12POrance, or a certified copy thereof (Section 500, Lab. C.) / /J Policy No.l1 'i �1-71CS3 {' .74,Kf nnpany .LA &1iu Q Certified copy is hereby turn ishe } Certified copya}A" ed with the city 13 iltl' Divi Date '�-(,"� ^ Applicant EXEMPTION FROM WORKERS' C PENSATION DECLARATION (Th is section need not be complete/the permit is for one hundred ($100) or less). I certify that in the performance f the work for which this permit is issued 1 shall• not employ any person in any manner so as to become subject to tie Workers' CompensationLaws of California. Date MSignature 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 this permit shall be deemed 'revoked. 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 (Section 3097 Civ. C.) Lender's Name., Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that 1 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. any structure, prior to its issuance, also requires the applicant for Such permit _to file a signed statement thathe/she is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 -(commencing with Section 7000) of -,vision 3 of the Business and Professions Code) or that he/She is exempt erefrom and the basis for the alleged' exemption. Any violation of Section )31.5 '.by- any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). '6 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 (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 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 im- prove for the purpose of sale). _ ❑ I. as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an, owner of property who builds or improves thereon. and who contracts for such oroiects with a Con- tractor(s) license pursuant to the Contractor's License Law). I am aware. that proof of their Worker's Compensation insurance should be provided to me, ❑ 'I am exempt under Section B. & P. C. for this reason Dale Owner. I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and'state laws rela r g to building construction, and hereby authorize repre- sentatives this Icy. enteln the above-mentioned prop ty 'for inspection u o Date 14, plicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations Zone Building: N li N G R Parking Req./Provided E Q M T S. TRACT NO.. LOT NO. UNIT NO. FEES Automatic Washer Transformer ❑ 15-50 KW _- Construction Pole Sub.- ❑50+KW Bar Sink Showers - Issue Fee_ r• Backflow Preventer .. Service Sink - 4ANICAL CookingUnitMeter ❑up to 100 amps - - Backflow Irrigation Sewer Cap - Dishwasher Meter E) over 100 amps S Main Buildh TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR E System Repair/Alteration ❑ CONVERSION ❑ DEMOLISH ❑ OTHE - - T Front -DESCRIPTION OF WORK/USE OF BLDG.- ; &A.i S,� r""Q B Rear -' Fixtures I Microwave A _ `PERMIT C _ TYPE OVGRADING LJ FOUNDATION STRUCTURAL - Gas Service Outlets Water Closet ,Right ❑ TENANT . ❑ ELECTRICAL -❑ PLUMBING ❑ MECHANICAL - S, Left }` .'❑ OTHER 11 Ping. Ref. # PROJECT DESCRIPTION SO. FT. OCCUPANCY * Planning Notes: CONSTRUCTION TYPE VALUATION $ Zs_n ZONE GRADINGCU.YDS.- ACRES Remarks:T^ R Y'� •3j C,e. -^•_ , Zone Building: N li N G R Parking Req./Provided E Q M T S. Roof Drains Reinspection Fee l ' $15 Boiler Duct- Under Ground Duct - Structural Duct -Ventilating I Exhaust System ❑ Multiple Firepl/Fact: Bit. ICBO # Heating System & Ducting 00.100,000 BTU -0100,000 Signature_ I Reinspection Fee x$15. Drillers' Li use or SS _ 0865-48, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ELECTRICAL ' FEES ' PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW _- Construction Pole Sub.- ❑50+KW Bar Sink Showers - Issue Fee_ r• Backflow Preventer .. Service Sink - 4ANICAL CookingUnitMeter ❑up to 100 amps - - Backflow Irrigation Sewer Cap - Dishwasher Meter E) over 100 amps Bathtubs Sewer Connection Refrigeration System - 'd0-100,000BTU 0100,00013TU_ Dryers ❑Gas ❑Electric Sub Panel - Clarifiers Solar Collectors System Repair/Alteration Fan Motors 00-1, HP 0 X'- 8 Dishwasher Solar Piping Fire Dampers F.A.U. Inc. Solar 1:19-15 HP 016-15+ -. Drinking Fountains Solar Tank - - Fixtures I Microwave Floor Drains Swimming Pool w/Spa _ Device Boxes Pole Light - _ Floor Sinks .. Urinal _ Outlets _ Range Gas Service Outlets Water Closet - Switches Sign - InterceptorsWater Heater _ - Garbage Disposal Standing Sections - Kitchen Sink - - Water Service Generator 00.5 KW ❑5-15 KW Trasfi Compactor' Lavatories - - Auto -Wash - Roof Drains Reinspection Fee l ' $15 Boiler Duct- Under Ground Duct - Structural Duct -Ventilating I Exhaust System ❑ Multiple Firepl/Fact: Bit. ICBO # Heating System & Ducting 00.100,000 BTU -0100,000 Signature_ I Reinspection Fee x$15. Drillers' Li use or SS _ 0865-48, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date' Building Approved By Date Application Issued By - Issue Fee_ r• $_gZoning 4ANICAL FEES Hood or Type ❑ - Canopy Type II ❑ - SUMMARY WFErs BUILDING PERMIT $.,'J:22 SMIP $, •SC% PLAN CHECK : $ ^ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $' ENERGY P.C. $ ELECTRICAL $ r 'GRADING $ PLAN CHECK 50°.6 $ MICROFILM $ MECHANICAL $ ^f , NOTAL FEE' $ �L SAO PLAN CHECK 25% $ Refrigeration System - 'd0-100,000BTU 0100,00013TU_ System Repair/Alteration Fire Dampers Registers _ *DUPLICATE RECCEI'PT* 01 00013739-00013740 TtI-T 72,50 DATE: 09/06/88 -TIME: 14:.31 Issue Fee $ 3 CONSTRUCTION AND PLANNINGt ' 'APPROVALS Permit # Date Inspector POG SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. ,�; �� ' 53. Steel Reinforcement 3r'Electrical Conduit Utility-Undrgrnd. •% 54. Forms - - 43 Electrical Conduit-Undrgrnd. 55. Electrical Bonding i 5`. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. ElectricalR �G UFErni . i is 57. APPROVAL TO COVER-GUNITE t a Fpotings t I •`y 58. Electrical Conauit-Undrgrnd. 8'Foundation V' ? ( 59. Gas Pipe, 0 Undrgrnd., Test t 9l•Water, Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK I 1,1' Property Sewer Line ,& House Connection i 62. Backwash & Receptor-Final '. 12. Sewer Cap ' "t" �' .� 63. Heater & Vent-Final 13! Roof Drains t' n� f -1'' 64. Plumbing System - Final 1411 Rough Plumbing Y: 65. Electrical-Final 15. Rough Electrical=Conduit 66. Solar System-Final 11'6. Rough Electric Wiring 67. Fencing & Access Approval 17•. Rough Wiring Sign I /I1' 68. APPROVED-FOR PLASTERING 8. Rough EI ctrical-T Bar Ceiling v � 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough• Factory Fireplace rr i 27. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating �1 - 71. Product Piping'0 Gas 0Oil 23. Gas PipgRough & Test �',� a 72. Underground Flush 24. Roof Framing ��� _ ,73. Undergrnd. Storage Tank OGas 00il" 25. Roof Sheathing 74. Overhead Hydro -26. T-BafCeiling (Structural) &rMonocoat '� 75. Dry Chemical ' 27. Frame,and Flashing 76. Dry Standpipe 28. Lathing &,Siding - 77. FIXED SYSTEM FINAL 29. Insulation. 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Cod J 79' FINAL INSPECTION ' 32. Electrical Power`IV_leter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric :•I Notes:- 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy - 37. Final Factory Fireplace .. -. 38. Final Plumbing ' 39. Water Service-Final rAij 40. Gas Service-Final i 41. Solar Domestic-Final r t•.. 42. Backflow Preventer r i 43. Backflow Irrigation ;;�'•' '' 44. Landscape Irrigation System. 45. Sound Attenuation !i 46. Handicap Regulations - - •i 47. FINAL STRUCTURE & BUILDING �,• /J- 48. Special Requirements Completed 49. Electric. Release to Edison 50. Gas Release to Southern California Gas Cv LI I ' 51. CERTIFICATE OF OCCUPANCY No. Date OWNER R & W DEVELOPMENT DATE JOB ADDRESS 1088 Glen Circle BUIL[ i -UAI r uro�rTno � .. .. nve�oloTlnu _[ lunov _ . lig-661-29 LOT 3 TRACT9105 FIRE ZONE VALUES INSPECTIONS Signature Date 11 TYPE V - GROUP & J ZONE R2—CP SOIL SUBCONTRACTOR M ISS Gas Dafe Number Si noture WATER JJ -�2. ij 7G Pl um6in ' ROUGH PLUMBING /'1- O�t1L0 PROP. SWR. LINE ❑HOUSE CON. 7 SPRINKLING SYSTEM cr MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING •7 TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING TRENCHES FORMS Lj STEEL REINF. 0 eatinomdAant. FLOOR SYSTEM p BOND BEAM SHEATHING - f FRAME AND FLASHING ' LATHING — IN OUT 'ER, BROWN COAT ro -17-77 5. .CTURAL, PINAL HEATING, VENT., REFRI G. AND A.C. FINAL 12; 2D PLUMBING, FINAL AND GAS TEST S ELECTRIC, FINAL BUILDING, FINAL y 39105 0 i17 42745 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 F �d C7 For Applicant to Fill in Completely — Use Ink Only BUILDING108 G ` C�� ADDRESS �%© �js-ti-^,v OWNER R & W Development MAIL ADDRESS 188 E. 17th St. CITY Costa Mesa, Ca. No$42-421 CONSTRUCTION CA1 _ Fed. Savings & Loan BRANCH 5670 Wilshire Blvd. ADDRESSLOS Angeles, Ca. 90036 ARCHITECT DMA Assoc. EL731-216 OR ENGINEER TNO. ADDRESS 17621 Irvine B1vd,Tustin,C CONTRACTOR J. Ray Construction Co,. ADDRESS 188 E. 17th St. CITY Costa Mesa, Ca.; NO. -642-421 �CNO .126426 SIZE OF LOT 38 x j11.27 USE OF EXISTING BLOC_ O CITY LIC. NO. - NO. .OF BLDGS. NOW ON LOT. O Separate permits are required for electric, plumbing and heating work. UILDING AND WORK TO BE PERFORMED Single Family Dwelling w/ Attached Double Garage 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. I hereby certify that I am properly licensed as a contractor under the State of Californi usiness and Professions Code, Division 3, Chapter 9, and the su licenses are in f force antl effect, or I am exempt from e r isions of the ate of California Business antl Professions otl , Ivision 3, ter 9. Signature of I TION FOR STRUCTURAL PERMIT A.P. NO. 11�'—lQp BUILDING ADDRESS I i7 f'V'V i ..CE KFZ w1A-mt^,ran YAL c 1'5Dq DISTANCE BET. BET. MAIN & MAIN BL.DGGSS.�. ^^77// /.s pp ACCESS. SLOGS. VAR + DATE - APPROVED APPROVE J DATE IOL© FOP, 5PZEC1.;'.L RE A!LZ NT! N m i /eI 1717 SO. FT. ' '{ r THE AMOUNT SHOWN UNDER VALUATION IS FOR Dy THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ O N l m PLAN CHECK $ _ o /^ TAX $ LL U/ � _ U TOTAL PAID $ ,L� VPE T GROUP Y DATENO. FNF OF USE OF NEWPLANS BUILDING Affr.GAF­ PROVED LDING YARDS APPROVED ACCESSORY BUILDING REET)FT. FT. FT. FT. FT. FT. DISTANCE BET. BET. MAIN & MAIN BL.DGGSS.�. ^^77// /.s pp ACCESS. SLOGS. VAR + DATE - APPROVED APPROVE J DATE IOL© FOP, 5PZEC1.;'.L RE A!LZ NT! N m i /eI 1717 SO. FT. ' '{ r THE AMOUNT SHOWN UNDER VALUATION IS FOR Dy THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ O N l m PLAN CHECK $ _ o /^ TAX $ LL U/ � _ U TOTAL PAID $ ,L� C3 COSTA MESA BUILDIN SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to/yFill in Completely — Use Ink Only BUIILDING //lX . �IC.f. ---I - IJJ;l(in%3p fl, 1Hi1(19. lOTO APPLICATION FOR STRUCTURAL PERMIT PERMIT OWNER aLf�(/1,/ FT. � MAIL ADDRESS ADDRESS ADDRESS • t ADDRESS TEL. CITY NO. TRACT CONSTRUCTION NEW ADD BRANCH L. SIDE FT. REAR FT. FT. � USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLDGS. BET. MAIN & ACCESS. BLOCS. • t ADDRESS DATE I APPROVED ERMIT FEE $ V n PLAN CHECK $ 1 UE ARCHITECT TEL. $ OR ENGINEER NO. U TOTAL PAID E Apr ADDRESS TYPE GROUP CONTRACTOR rAPPROVED DATE ADDRESSTEL. NO. OF USE OF NEW CITY NO.PLANS BUILDING STATE CITY PPROVED YARDS APPROVED LIC. NO. LIC. NO. UILDING ACCESSORY BUILDISIZE TR EET)OF NO. OF BLOCS. LOT NOW ON LOT FT. FT. USE OF Separate permits are required for electric, plumbing and heating work. L. SIDE FT. REAR FT. FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. MAIN BLDGS. BET. MAIN & ACCESS. BLOCS. THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VAR.$ C.U.P.# DATE I APPROVED I hereby acknowledge that 1 have read this application and state that the above information Is correct and agree to comply with all laws regulating building construction, and 1 shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I 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 m i m SO. FT. m N THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION ERMIT FEE $ V n PLAN CHECK $ 1 M $za o LL f TAX $ U TOTAL PAID E Apr