HomeMy WebLinkAbout1092 GLEN CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 1092 GLEN CI Status: ISSUED
Suite No Applied: 06/03/2005
Issued: 06/03/2005
Vicinity:
Parcel Nunmber: 42203156 .. ". - _ ISSUED BY:
Applicant:
TOM FREULER
' FEE SUMMARY
AMT
Address:
6074 KINGSBRIAR DR\.�
Trap Primer,,,/ ' ; ' ; - _
$0.00
Urinal ,ii/ V �,
ANAHEIM,CA - -: Phone:
714-970-6789--%11
-
AMT
i
ALMA AV SUITE 270-� Zip -
_92807
$23.50 -
Laundry Tub / Washer
.--
-
Backflow, irrigation ,
\ >. $0.00 0
Landscape Irrigation
" $0.00 ":
' 0-
BackflowPre'venter"
x•,$0.00 0
P-Trap$0.00
$0.00
0
Bathtub; �,�
v$0.00 0
Pressure RegulAtor, °�.� ;�,t,
Owner:
PATT.ERSON:.BRAD
Clarifier System
$0 00, 0
Process+Piping (per 10 ft)
$0 00
0
Connect (Ice Soda etc)
Address
1092 GLEN CIR
$0 00
;.,0
Dental Units \
� $0 00� 0 j
��0
,, Septic Tank
V ..
',0 ,,- st $
Phone:
.,949-650-9079
-`,Sewer Cap.for Demo
$000
COSTA MESA, CA Zip:
"62627
$0.00 0 Sewer Connect
$0.00
°0 -.
'.
Drain, Rainwater\\�Z
\`�$0 00,; 0
., C1Sewer Private Line
$0.00
-�
Drain, Roof ���
,
r�•- _ I -� 1��.
o
..
[Contractor:
Contractor
TOMS QUALITY PLUMBING ,
-Smk,Z bar,' �"- _
- $0:00
-0 -
Expansion Tank
���$0.00 ��?0
Sink, commercial --_- "--
Address:
' 6074 KINGSBRIAR:DR
Gas Earthquake Valve
1$0:00;x, 0-:
-
j,. 'Sink, Floor_
.$0.00
$0.00 -
•, 0
Gas (1-4 outlets)
$0.00
ANAHEIM, CA. - Phone:
714-970-6789LN
} -
Gas (Over 4 outlets)
PALMA AV SUITE 270 Zip:
92807
A -
`
- -- License:
823548- - -
.Spa (private) '\V' ,--�
:$0.00---`
0�' C
Gas Service
$0.00 0
`- Spa (public)_
$0.00
0,%� '-
Interceptors (Grease, Oil) $0.00 0
SCOPE
OF PERMIT
"'. REPLACE GAS YARD LINE.
' FEE SUMMARY
AMT
Sump Pump i��Y�
Swimming Pool;%,
$0.00
Trap Primer,,,/ ' ; ' ; - _
$0.00
Urinal ,ii/ V �,
$0;00
AMT QTY'.
$0:00
AMT
OTY
ISSUE FEE
$23.50 -
Laundry Tub / Washer
, $0.00"
0
Backflow, irrigation ,
\ >. $0.00 0
Landscape Irrigation
" $0.00 ":
' 0-
BackflowPre'venter"
x•,$0.00 0
P-Trap$0.00
$0.00
0
Bathtub; �,�
v$0.00 0
Pressure RegulAtor, °�.� ;�,t,
$0.00
0
Clarifier System
$0 00, 0
Process+Piping (per 10 ft)
$0 00
0
Connect (Ice Soda etc)
' $0 00,E 0
Receptors'; -1' - , °�
$0 00
;.,0
Dental Units \
� $0 00� 0 j
��0
,, Septic Tank
$0.00',
',0 ,,- st $
Dishwasher \_�`��
$0.00
-`,Sewer Cap.for Demo
$000
0
Drain, Floor
$0.00 0 Sewer Connect
$0.00
°0 -.
'.
Drain, Rainwater\\�Z
\`�$0 00,; 0
., C1Sewer Private Line
$0.00
0 l
Drain, Roof ���
$0.00 -0�
A\.Showery 'r i .,�
$000
0' --
Drinking Fountain ��
Drinking
`$0.00 Of
-Smk,Z bar,' �"- _
- $0:00
-0 -
Expansion Tank
���$0.00 ��?0
Sink, commercial --_- "--
0 -�
Gas Earthquake Valve
1$0:00;x, 0-:
-
j,. 'Sink, Floor_
.$0.00
$0.00 -
•, 0
Gas (1-4 outlets)
$0.00
Sink, ' `, Sink, kitchen
1$0.00 L-
} -
Gas (Over 4 outlets)
$0.06-V 0,,�_
�LSink, service/mop`
$0.00 t'0''-
10
Gas Repipe
$9.80 -1-_-'---
.Spa (private) '\V' ,--�
:$0.00---`
0�' C
Gas Service
$0.00 0
`- Spa (public)_
$0.00
0,%� '-
Interceptors (Grease, Oil) $0.00 0
Interceptors (Sand Auto ) $0.00 0
TOTAL CALCULATED FEES: $33.30
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
no
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) 7545626
2"646 (6/00)
AMT
Sump Pump i��Y�
Swimming Pool;%,
$0.00
Trap Primer,,,/ ' ; ' ; - _
$0.00
Urinal ,ii/ V �,
$0;00
Vacuum Brkr.Bkflow(1-4)
$0:00
Vacuum brkr Bkflow(5+)
,' $0.00
Wash IBasin-`' •'
-$0.00
Wash Basin Set "'
$0.00
.Waste andVent Systern'� ;
$0.00
Water Closet (Toilet)'% ,
$0.00
Water Heater'/ veno/ /
$0.00
Water Piping (Inisf or Rep.)
$0.00
Water Re -pipe �,
$0.00
Water Services
$0.00
Watei Softener
$0.00
OTHER"
$0.00
VIOLATION
$0.00
PLAN CHECK
$0.00
REINSPECTION
$0.00
TOTAL CALCULATED FEES: $33.30
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
no
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) 7545626
2"646 (6/00)
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 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My workers' compensation Insurance carder and policy number are:
Carder: Policy Number:
(Th section need not be completed it the permit is valued at one hundred dollars ($100) or less.)
I certify that Inttq permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Californiaa agree that It l s o d become subject to the workers' compensation provisions of Section 3700 of the Labor Cade, I shall forthwith
these provisio
want Signal e: ✓ Date: I 97 1_' 3 .615
ARNING: FAIL TO SECURE WO (ERS' CO 1PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
E (st OD,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 hereb�t I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professio"� Code, and my license is in full
force an a c. If Cl is
Contrsct -Signet re: �,/d i _ (o • ,8r 4��
r
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code).
Lenders 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 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 Ucense 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 contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
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 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 e
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 tiled 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 then 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 cublc feet of
compressed gas at standard temperature and pressure).
.
......................._...........__......__.........__......._......................_____._........................................................................................................................................................................................................................................................................
3 Does or will the appplicant 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_........._.........._..........p_.....en_.......q_.................................................4'ii'.................................................................................................................................w,ii..................................._.............................._..........._....................._...........
4 If an RMPP is presently required, has Section 25534 of the California Health end Safety Code been fully complietl with? ❑Yes ❑ No
5 froea or will the applicant or present or future building occupant require for the work which is the subject ofc This aU Yes
agermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? [] Yes LJ No
(Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits).
.........._..........._............_..........._..............................................ie"d,............................._...................ithi......................................._.._____._—_._.____......................__..... ......._._......................_...................... ..-............_.............
6 Will any part of the facility to be constmcted under this permit be within 1000 feet from the outer bountlflries of a school? ❑ Yes ❑ No
(It yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
..._........__........._........fro-i...............
.......................................................................................istr...............................................................-r-o-I...................___.----
................._................_................_..........._.........................._.............._.hi.....
7 If a permit from the South Coast Air Oescw1 Management District or other eir pollution control district or agency is requiretl for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No
8 (If yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: 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.
Si re al darts) Date
nt Date
CODE I. INSPECTIONTYPE DAIS 114TmALS CODEC INSPECTION TYPE gag ISS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining 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
BUILDING PERMIT
Job Address:
1092 GLEN Cl
Status:
ISSUED
Suite:
NGUYEN, CUONG
Applied:
10/15/2002
Vicinity:
RESIDENCE AND ATTACHED GARAGE
Issued:
10/15/2002
Parcel Number:
42203156
Zoning:
$0.00 _ -Calc Valuation:
Applicant:
NGUYEN, CUONG
SMIP Res;
ISSUED BY:
Address:
14351 EUCLID ST #E
Other:
$0.00
Inspection:
$0.00
Phone:
(714)545-6994
GARDEN GROVE, CA
Zip:
92843
Owner:
PATTERSON, BRAD
Address
1092 GLEN CIR
-
-
Phone:
-
COSTA MESA, CA
Zip:
92627 _.
Contractor.-
VILLA ROOFING PROFESSIONALS INC
Address:
14351 EUCLID ST #E
-
Phone:
(714)545-6994 ,
GARDEN GROVE, CA
Zip:.
92843 " ",/
License:
758361
Arch - Eng:
Address: ' Address: -
Phone: - - ` Phone:
Zip: License: - License: -
SCOPE OF PERMIT
REROOF: T/O WOOD SHAKE ROOF, 7/16" OSB SHTG, 1 LAYER 15# FELT, APPLY "30 -YEAR COMP SHINGLES.- 18 SQUARES
Total: $97.75
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right_ , 0- 0
ACCESSORY Front0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING . Existing: 0 Required: 0 Proposed: 0
NOTES
$3,100.00
$3,100.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 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
?"646 (6/00)
FEE SUMMARY
Plan Check:
$0.00 _ -Calc Valuation:
Permit:
$97.25 Claim Valuation:
SMIP Res;
$0.50
SMIP Com:
$0.00 - - -
Other:
$0.00
Inspection:
$0.00
Total: $97.75
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right_ , 0- 0
ACCESSORY Front0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING . Existing: 0 Required: 0 Proposed: 0
NOTES
$3,100.00
$3,100.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 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
?"646 (6/00)
DECLARATIONS C)
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 of the Labor Code, for the performance of the
work for which IMS permit is Issued.
I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Ins�ure /ca carder and policy number are:
Carrier: GJ /��� Policy Number:
(This section need not be completed if the permit Is valued of one hundred dollars ($100) Cr less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and a roe that become subject to the workers' compensation provisions of Section 3700 of the Labor Code. 1 shall forthwith
comply with these provisions.
Applicant Signature: _ � uy� Data:
WARNING: FAILURE TO SECUREWO BE IS UNLAWFUL AND SHALL M&
SUBJECT AN EMPLOYER TO CRIMINAL PELTIES AND CIVIL FINES UP TO ME HUNDRED
TFISDDOLLARE($100,000), TO ECOSTOF PE
KKANNSATION, DAMAGES AS PROVIDED FOR IN SECTION S06OFTHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed uncle rgyisions of h ter 9 (commencing with Section 7000) of Division 3 of the Business and Profe sions Code, and my license is in full
force and effect. Uc. N � Claw »
Contractor's 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).
Lender's Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby offlrtn 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 of 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).):
❑ 1, 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 Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. - Expires:
Verification of Ownership by (type o1 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, Title B, 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 at standard temperature and pressure). -
2 Does or will the applicant or present or future building occupant need to file a registretion form for acutely hazardous materials? ❑ Yes ❑ No ...
(Section 25533 of the Califomia 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).
......_...................................................................... .................................................................... ................. .............................................. ................................ ................... ..................... ........... ................................... ................................. I..................
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 11t�0
(Section 25534 of the California Health and Safety Cade 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 en 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 ofthis 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 ❑ No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
............................................................................... ............ ....................................................................................................................................... ........................................ .......................I...........................
6 Will an ty p ..............................................................
y pan of the facili to be constmcted 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 It 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 (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 ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described prope T ins actio oses. I agree not to Occupy or allow occupancy of any building authorized by this emit until final inspection.
eget OW �� S late
A Or e r 7�� � Date
CODE.. INSPECTIONTYPE PATE INTIDSLS CODEll INSPECTIONTYPE DAM INUMUS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root �- 210 Final Electrical
201 Final Block/Retaining 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
C]TY;OF COSTA MESA CONSTRUCTION PERMIT '
Project Address Lpleio Cvjc •
Apphcant's Mailing AddresrrlrC
I
Owner's Name IX)
/) I I p Phone f
Address �T-t'3' r "' _ I
Arch/Eng.' License No. '
Address
Contractor's Name Ph ne
Address (mailing)
City License No. I I
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 fore and effect. I i
License I ice se I o.
Datfte Signature
WORKE S' COMPENSATION DECLARATION
`creby affirm that I have a certificate of consent to self -insure or a certiflcate
Norkers' Compensation Insurance, or a certified co y thereof (Section
Q. IL.'.�/ /
Policy No.�C�I�l7u�l� r7 Company co6y
1-�L�-�1:=]
p�-Iy,,edified copy is M1ereby fumished. (
lr9 Ce �{'� tiletl with the city/�//pil ',.p,/��r",%�isi�]n: I1 D�/
DatION
Applicant (,,cy �, "Ail
V J
EXEMP ION'FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
certify
e
I certify that ithe performance of the work for which this permit is issued,
shall not employ
y any person in any manner so as to become subject to the
Workers' Compensation Laws California.
Date Signature
NOTICE: C after making this ions of the L u r Cod , come ustf forthwith 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
hereby affirm that there is a construction issue agency for the 97, Civ. C.)
of the work .for which this permit is issued (Section, 3097r Civ. C.)
Lender's Name '
,Lender's Address
OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the
to file a signed statement that he/she is licensed pursuant to the provisions or
the Contractor's License Law (Chapter 9(commencing with Section -7000) of
givision 3 of the Business and -Professions Code) or that he/she,is exempt
i;arefrom 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
''realty of not more than five hundred dollars ($500).
;Ll I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
i
for. sale (Section 7044, Business and Professional Code: The Contractor's
License -Law does not apply to an owner of a property who builds or improves
thereon, and who does such work nimself/herself or through his or her own
employees, Provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
� shrove for the.purpose of sale).,
LI 1rt
', as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply ;to an owner of property who
builds or improves thereon, and who contracts'for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that.
proof of their Worker's Compensation insurance should be provided to me.
❑'1 am exempt under Section B. & P. C. for this reason -
,1 he-reby certify that.1 have read this application andlstate that the above
information is correct. 1 agree to -comply with all city and county ordinances'
,and state laws relating -to building construction, and hereby authorize repre--
1 I Signature M /11, I QA
Drivers"License or SS =
PERMI 1 O.
o"S1
TRACT NO.
LOT NO.
UNIT NO.•
I
:5760 4/d9/87
:5.00
TYPE OF CONSTRUCTION NEW LJ ADD, •ALTERATION REPAI
E] CONVERSION E] DEMOLISH El OTHER; ` _
DESCRIPTION OF WORK/USE OF BLDG. 1
'
R'
-
A.P.--
S
-
Main Building: Accessory Building:, '
TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL
.LJTENANT 43 ELECTRICAL IM PLUMBING ❑ MECHANICAL
❑ OTHER _ .._
PROJECT DESCRIPTION SO. FT. OCCUPANCY
CON STRUCTION ITVPE ,VALUATION$
ZONE GRADING CU. YDS. ACRES
T
FrontO
2
B
A
Rear - '
,
N
I
C
Right`"' "'�'- -` ' - -
"' -
N
S
Left I -
G
R
Ping. Ref.# P 'ngr Req./Provided s
E
Remarks:
'
- I
Planning Notes:,
/
Q
M
PLUMBING
FEES
Bar Sink ; 1, -
,Showers
IELECTRICAL-
FEES
Backflow Preventers -
Service Sink1
Automatic Washer
Construction Pole Sub.
Transformer 0,15 50 KW -
i .0.50+KW
=
Backflowlrrigation Sewer Cap-
-
Bathtubs' ..
Sewer Connection
- Cooking Unit,,Meter
❑up to 100 amps -
Clarifiers
Solar Collectors
Dishwasher _ '
Meter' ❑over 100 amps _
-
Dishwasher--
'Solar Piping,
Dryers ❑Ga's ❑Elecfric
Suh`Panel _
Drinking Fountains
Solar Tank j -
_
FanMotors
00-1,HP ❑i %; 8.
Floor Drains
Swimming Pool w/SpaF.A.
Ui
Inc. Solar ❑9-15 HP ❑16-15+
-'
Floor Sinks -
:Urinal
Fixtures
Microwave
Gas Service iOutlets
Water Closet
Device Boxes
Pole Light '
Interceptors
p 1
.Water Heater
Outlets ` -
'
Range '
Kitchen Sink ..
Water Service - -
-
Switches- -
-
-- - -
-Sign
Lavatories '
Auto -Wash
Garbage Disposal
Standing Sections
P—TrapLaundry
Trays
Generator ❑0-5 KW ❑5-15
KW
Trash Compactoir
Roof Drains '
(
Reinspect
$15
� Issue Fee
$ 3ion'Fee
�
Reinspection Fee
$15
Issue Fee _
' $ 3
-
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Z Approved By ` Date
Building Approved By Date
Application Issued By - Date
Boiler t
-
Hood or Type I ❑
Canopy Type 11 Eloning
Duct - Under Ground
Duct -Structural
Refrigeration System
00-100,000 BTU -0100,000 BTU
-
Duct -Ventilating
BUILDING PERMIT
- PLAN CHECK
PLUMBING
- pl?,N CHECK C25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
I PLAN CHECK 25%
'- SUMMARY
$ v _
$
$
$
$ i
$ - '
$ _-
$
OF FEES '.
SMIP $ - i -
ISSUANCE $
_ ..
-�ENERGV P.C.. $
-- 1
"GRADING $
MICROFILM _ $
TOTALFEE - $
`
Exhaust System ❑ Multiple,❑.
System Repair/Alteration
Firepl/Fact. Blt.ICBO,#
Fire Dampers -
Heating System&.Ducting _
❑0-100,000BTU❑100,00067
Registers 4,
_
-
t
-
_ 1
- -
Reinspection Fee
$15-
Issue Fee
$ 3
rev. 10/94 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor
TL
CONSTRUCTION AND PLANNINGPOOL
APPROVALS Permit =0
Date
Inspector
& 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
i
56. Rough Plumbing & Pressure T&st
'
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit•Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test j z
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, EI Unil�grnd.
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 ❑ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush '
24. Roof Framing
73. Undergrnd. Storage Tank ❑Gas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION -
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
-
35. Final Gas Pipe -Test
-
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
L.11154
_
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
49. Electric Release to Edison
,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
-
-
V
L__f OF COSTA MESA REQUEST FOR OC,. ANCY
TRACT NO. DATE
LOT NO.
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
(he -she -they) X1 4r (was or were) `XO J 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.
i
/ / Purchhser /
OWNER R & W DEVELOPMENT ' DATE 12-7,76
JOB ADDRESS 1092 Glen Circle BUILDING PERMIT NO. 42747
115-661-29 LOT g TRACT FIRE ZONE VALUE$ 40 080.00
I. :CTIONS
Si nature4-z
TYPE v - GROUP
ZONE
soiL
'r
SUBCONTRACTOR
PEP M S
Date Number Si nature
GAS
WATER ((tG /2• �o •7-
Plumbin
ROUGH PLUMBING
:,
.C.
/T j/
PROP. SWR. LINE HOUSE CON.elfLmr
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND El POWER ❑
ROUGH WIRING
G
yrdwi
Neetin On Vent.
TRENCHES Lj FORMS STEEL REINF,
e+
FLOOR SYSTEM
3
ale•
BOND BEAM STFEt-QerR/ORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT F�.
Pt•�TER. BROWN COAT
TUBAL, FINAL
H. .NG. VENT., REFRIG. AND A.C., FINAL
• Q
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
iL
z•
9'105
•...� 155S5((,, 42747�. 1C0#A MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
i�
11_44I� f: �-tr irV L.i_il
APPLICATION FOR STRUCTURAL PERMIT
.... r�PP....n... .o. u. ... wu.pm.cq — vx.un v.uy
RECEIVED BY
I DATE RECEIVED
D/QT I;SSfV E{l/..
BUILDING /�
,�(]
ADDRESS I.I,J"IZ C-�L- Gtz 1
..i 1 •+-
OWNER R & W Development
I I S�ss/•�I
A.P. NO.BUILDING
PER .II 7
'Yj
MAIL 188 E. 17th St.
r_^,v�—ha��
ADDRESS 1042 (2 GT..
ADDRESSTEL
yL490
CITY Costa Mesa, Ca. NO.642-421
((]]
TRACT 01
1_01'�5 BLOCK
CONSTRUCTIONCal. Fed. Savings & Loan
NEW
ADD ALTERREPAIR
LENDER
BRANCH 5670 Wilshire Blvd.
OWNS `VaALUE
ADDRESS Los An eles, 'Ca. 90036
L /y,
S 7 W/f,-1 IT ��'CALU$ Vo^
MJ
ARCHITECT TEL,
OR ENGINEER DMA Assoc: 731-216
ADDq ESS 17621 Irvine B1vd,T1lstin,Cfl
FIRE
ZONE f I T E GROUP
Js Ra Construction CO.
APPROVED
�
CONTRACTOR y
BV DATE
ADDRESS 188 E. 17th St.
CITY Costa Mesa, Ca. No�i42-4210
-'CrQ
NO. OF
PLANS,2
USE OF NEW
BUILDING
STACITYVMAIIN
NO.
RDS
LIC. 126426 LIC. NO.
BUILDIINGD
ACCESOSORY BUUILDING
SIZE 38 111.27 NO.OF BLDGS. D
(FROM C��STRE ETJ�s
X
OF LOT NOW ON LOT
FRONT c �� FT. 1�
FT.,
USE OF
D
7
EXISTING BLDG.
S ( FT
FT.
Separate permits are required COI
L. SIDE FT.
FT.
q
ZS
electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS. SLUGS.
Single Family Dwelling W�
Cugp#�-?& 178
AP
ROVED
Attached Double Garage
APPROVED
q ^1
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
IS f ioO
the State of California. '
I hereby certify that I am properly licensed as a contractor under
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of Coliforni usiness and Professions Code, Division 3,
Chapter 9, and th r s h I senses are In f II force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from h pr isions of ate of California Business
and Professions o e, vision ter 9.
VALUATION
PERMIT FEE $
PLAN CHECK
Signature of
Permittee C'
p�
$ U go
TAX
Authoris d Agent
,
TOTAL PAID $ 1
h-jq-_�_ *124
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Co pletely — Use Ink Only
RECEIVED BV DATE RECEIVEDDATE ISSUED
BUILDING
ADDRESS D
PERMIT NO.
OWNER
A.P. NO.
BUILDING
MAIL
ADDRESS f0
ADDRESS
TEL.
CITY NO.
TRAC LOT
BLOCK
CONSTRUCTION
W
ADD
A ER
PMOVING
nFMOI ISH
LENDER
BRANCH
OWNE
ADDRESS
VALUE,for��.
us r $
ARCHITECTTEL.
OR ENGINEER
FIRE
ADDRESS A
ZONE TV GROUP
APPROVED
CONTRACTOR r
BV DATE
ADDRESS
TEL.
ZONE
NO. OF
USE OF NEW
CITY NO.
PLANS
BUILDING
STATE CITV
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO. OF BLDGS.
(FROM C/L STREET)
OF LOT NOW ON LOT
FRONT FT.
FT.
USE OF
EXISTING BLDG.
IDE FT.
FT
Separate permits are required for
L. SIDE FT.
FT.
electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLOCS.
ACCESS. SLOGS.
VAR.+
DATE
s.
C.U.P.#
APPROVED
APPROVED
RV
DATE
�^
n
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply withm
all laws regulating building construction, and I shall not employ
i
any person in violation of the workman's compensation laws of
e
the State of California.
.
I hereby certify that I am properly licensed as a contractor under
SQ. FT.
a
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
m
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
e
and Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT FEE $
in
/
m
0
PLAN CHECK $
Signature of
0
TAX $
Permittee
$
V
f
U
TOTAL PAID $ ��
Authorized Agent