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Home My WebLink About1095 GLEN CIR - Building Permits(714) 754-5273 • Fax (714) 754-4856 Job Address: 1095 GLEN CI Suite No Vicinity: Parcel Nunmber: 42203150 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT P98-00401 ra:lsucmalaa:l 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Status: ISSUED c Applied: 05/27/1998 it. Issued: 05/27/1998 Applicant: EMEROSE, JOHN QTY Laundry Tub /Washer -$0.00'-'-0 Address: Landscape Irrigation - 0 P -Trap $0.00 0 Phone: 714,641.1545 $0.00 0 Process Piping (per 10 ft) $0.00 Zip' Receptors $0.00 Owner: URBAN; WILLIAM COTR . $0.00 0 Sewer Cap for Demo Address 1095,GLEN CIR Sewer Connect."1 -''x- $0.00 '.0 Sewer Private Line . ,. .. $0.00- Phone: Shower _ - $0.00 0 COSTA MESA,CA . ; ' Zip: 92627 0 Sink, commercial $0.00 0 Sink, Floor $0.00 0 Contractor:,. C AND R'DRAINS INCORPORAT 0 Sink, service/mops Address: " 01525 MACARTHUR BL (� $0:00 0' Spa (public) $0.00 0 Phone;' - COSTA MESA CA :'Zip:, -'92626 --'License: 531746 A 'D . -Arch l Eng: Address: ' Phone: ' Zip: License: V ` SCOPE OF PERMIT REPLACE EXISTING GROUND GAS LINE.. --- FFF SI IMMARV,� / r - ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etcj Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $22.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $8.75 $0.00 $0.00 QTY COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $30.75 '111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 -AMT' QTY Laundry Tub /Washer -$0.00'-'-0 $0.00 Landscape Irrigation $0.00 0 P -Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank . $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect."1 -''x- $0.00 '.0 Sewer Private Line . ,. .. $0.00- 0 Shower _ - $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 0 Sink, kitchen $0.00 0 Sink, service/mops $0.00 0 Spa (private) 1 $0:00 0' Spa (public) $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $30.75 '111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 AMT Sump Pump" _ - $0.00 Swimming Pool - "' $0.00 Trap Primer Urinal. " - ,-,,$0.00 Vacuum-Brkr Bkflow(1-4)'. $0.00 .Vacuum Brkr BkFlow(5+) $0.00 Wash Basin $0.00 Wash Basin Set $0.00 " Waste and Vent System $0.00 Water Closet (Toilet) $0.00 "Water Heater / vent $0.00 Water Piping,(Inst or Rep.) $0.00 Water Re -pipe $0.00 Water Service $0.00 Water Softener $0.00 OTHER $0.00 VIOLATION $0:00 PLAN CHECK $0.00 REINSPECTION $0.00 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $30.75 '111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 x DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to seg -Insure for workerscompensation, as provided for by section 3700 o1 the Labor Code, for the performance of the work for which this permit is issued. R--IL—have and will maintain workers' compensation insurance, ae required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compen tion Insurance canter and policy number are: Cartier: �//1y/7 �.US• P -rt t&zci, � Policy Number. (This section need not be completed if the permit is valued atone hundred dollars ($100) or less.) `- ❑ 1 cenity, 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 Califomi ,end agree that Ii I should be subject subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these r visions Applicant SignatureDate: s/ %'!ate WARNING: FAW ILUR CURE WORKERS' MPENSAT^ ON COVERAGE IS UNLAWFUL AND SHALL SUeJFCT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL)4 100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and aged. Uc. M 3 1-7 Class q C� 3 Cx7 ' Contractors Signature: Date: %—Sk CONSTRUCTION L NDING 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). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penaltyof 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 Ls Ilcansed 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 (S500).): ❑ 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 thi&Whis 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 imp ution.the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). [3I, as owner of the propMy,,,%KWEXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License La"wfifoesrnot apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to Ilia Contractors Ucense Laws.). ❑ I am exempt under sec. %*"'I1!`T ft' Business and Professions Code for this reason: r Signature: Date: Owner ID verified by drivers license. ❑ Yeses?�❑ 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 cartity that no excavation live (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 6, 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 2DO cubic feet of compressed gas at standard temperature and pressure). .............................................................................................................................................................o.................-.-........-sm-.................................................................................. 2 Does or will the applicant or present or future builtling ocapant neetl to file a regislretion forth 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 feel of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .......................................................................................................................................................................................................... .- ........ 4 It an RMPP Is presently required, has Section 25534 of the California Health and Safety Cade been fully complied with.. ❑OYes No ....................................ppli.............................futu....buil............................uire..........................ichI...............ject............ plp...................m......r -......co construction .atio... 5 Does or will the applicant u present or future building occupant require for the work which Is the subject c this a plication eppennit for such consimcllon 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 Code requires that the requested information be furnished on applications for non-residential building permits). ..................................................................................................................thi-in'l 000'fe..tfrr. t'h'...... 'outer 8 Will any pert of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No (11 yes", the facility must meet the requirement o1 Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................... 7 If a Permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollutlon control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the intomlation 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 cartify under penalty of perjury that I have read this application and slate 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. Signal IOwn Date An Or Authorized Applicant Date CODE 0. INSPECTION TYPE 2AM Ills CODE# INSPECTION TYPE Itm INTMALS 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 Blmk/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 244616 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob Address: 1095 GLEN CI Suite: Vicinity: ROOF Parcel Number: 42203150 Applicant: BURKE, MICHAEL Address: 1653 SUPERIOR AVE COSTA MESA, CA Owner: URBAN, WILLIAM COTR Address 1095 GLEN CIR Zoning: Phone: (949)642-7222 Zip: 92627 Phone: COSTA MESA, CA Zip: 92627 Contractor: LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE COSTA MESA, CA Zip: 92627 Arch : Address: Phone: (949)642-7222 License: 349686 Eng Address Phone: ISSUED BY: Status: ISSUED Applied: 09/23/2002 Issued: 09/23/2002 ,rT-Im Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1/2" OSB PLYWOOD, 30# FELT, 30 YR COMPOSITION SHINGLES, 1,700 S.F. INCLUDES ATTACHED GARAGE. 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 2"",46 (6/00) FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,884.00 Permit: $111.25 Claim Valuation: $4,884.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE. Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Leff 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"",46 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby rlifirM 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. 3�_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. i My workers' mpensatloo�+ Insurance yarder aryf policy number are: �yfr carver:-+ .S vrl? ("�Gu✓� J[uuC� erdicyNumtier.,��G� (This section need not be complete i/ the permit is valued of one hundred dollars ($100) or less.) ❑ 1 certify that in the performance of the wort r which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cali clnV. e e t it I uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these p1otis q pC� Iran $grla4Ya:-a' fUate:-•w // ,J Q �- WARNING: FAILURE TO SECURE Wf7 (ERS' COMP NSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT AN EMPLOYER TO CRIMI PENAL IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3105 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: dr licensed under provisions of pter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full cea`nd effect. Llc. f l ''Glass -x - —_3 . CDrltracioYssignat0re: 8ate:T CONSTRUCTION LENDING AGE CY:— ❑ 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: Lender's 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).): ❑ 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 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, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. 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 registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomla 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 loot 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 ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ._.........._............._._........__............._..........._....................._._........._..... _-'..._._.._..._.................................................................................... ........ _.........._.......................................-..........................._...... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ONO ............................_........... _........... ....................................... _.............................. ............_.........._.... ... _............ .... -_............ ............................................... ..._................................... ....................................... ............... .................. I._........ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! Ll Yes J No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .....................................-.._................................................................................... .......................................................................................................................................................... .......................................................................................... 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (if 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 If a Permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ...................................................................................................................................................-....................................................................................................................................................................................................................................... 8 (If'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 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. azure Legal Owners) D %� ue rld/Of;AathorIZOd'Applicam �: ,..Date •'Y� CODE F. g�iE INTMAL5 CODE INSPECRONTYPE gag jKMML 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 'a 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 204 Final Demolition 250 Final Building/Occupancy 'Y OF COSTA MESA REQUEST FOR 01 ANCY 1 i TRACT N0. ?MS DATE r— LOT NO. L L ADDRESS y f ' 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)(wasor 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. h OWNER R & W Development UAlt 12-7-76 JOB ADDRESS 1045 Glen Circle BUILDING PERMIT NO. 42757 LKIY 1ION Dt WUKK Res w/Att. Gar E ZONE VALUE$ 43,650.00 .CTIONS SJuncture Date JITYPE - GROUP I & J ZONE R2—CP SUBCONTRACTOR I egamils Defe Iss ED Number $i velure GAS WATER /j _ - Plumbin ROUGH PLUMBING Z• U - C. 41 O PROP. SWA. LINE Q HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING TRENCHES FORMS TEEL REINF. -44?4:� ILII,-M�Vt w Hooting d Vjtnt. FLOOR SYSTEM O BOND BEAM STYll.Q�EG CE j, .7 SHEATHING 31-77 FRAME ANp FSHING LATHING "- IN OUT ' PI.-gTER, BROWN COAT TURAL, FINAL _ .W, VENT., REFRIG. AND A.C., FINAL • O� PLUMBING, FINAL AND GAS TEST fw i .77 1 71 ELECTRIC, FINAL BUILDING, FINAL.'J 9105 1.1 -W F7T27'_53 COSTA MESA BUILDING -SAFETY DEI P.O. BOX 1200 COSTA MESA. CALI FOR For Applicant to FID in Completely — Use Ink BUILDING . _tet I /' , � 1 0. f OWNERR & W Development 188 E. 17th St. CITY Costa Mesa, Ca. No642-421( CONSTnuc,nohCal. Fed. Savings & Loan LENDER g BRANCH 5670 Wilshire Blvd. ADDRESSLOS Angeles, Ca. 90036 ARCHITECT DMA Assoc. . TEL731-2161 ADDRESS17621 Irvine B1vd,Tustin,Ca. CONTRACTOR J. Ray Construction Co. ADDRESS188 E. 17th St. CITY Costa Mesa, Ca. NO.642-421( F STATE 126426CITY LIC. NO. - LIC. NO. SIZE NOBL96 OF LOT 36 X 96.47 NOW ON LOTS O Q USE OF r4+ EXISTING BLDG. o 14 FSeparate permits are required for C electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED Q 0 a Single Family Dwelling w/ Attached Double Garage a w Q1 hereby acknowledge that I have read this application and state 9 that the above Information Is correct and agree to comply with 0. all laws regulating building; construction, and I shall not employ Z any person in violation of the workman's compensation laws of the State of California. 1 3 1 hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, Chapter 9, and th ch Itcenses ere In ull force and effect, or 1 am exempt fro th yislons of th tate of California Business and Profs s Co' Divi I pter 9. Signature �;c� Irl-7r,T��.:�}Olt,li�,:• :a:�,�$,.55 AfPL4CAITION FOR STRUCTURAL PERMIT RE E V I DA E REIVEq DATE Q6/ 2' PE i �' A.P. NO.BUILDING �/] /� I G ADDRESS CDA'S WEN TRACT W - LOT B W AD JUE OWNER G VALU$ FIREUSEV OEIFOIV ZONE VPE GROUP APPROVE By DATE 10 j�tE 0. OF USE OF NEW FS, PLANS 2 BUILDING YARDS APPROVED YARDS APPROVED 'MAIN BUILDING ACCESSORY BUILDING (FROM R TREE 3 ONT FT. FT. R. SIDE FT FT �2 L. SIDE FT. FT. REAR ._+ FT. FT. DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. SLOGS. VAR *-J� DATE C.U.P. sW — —r! APPROVED APPROVE HOLD MR � PLMAL E,EQU11R2M': 1711 SQ. FT. - THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMIT FEE $ al PLAN CHECK $ y/' $ TAX $ .} TOTAL PAID E Y 'i 629 COSTA MESA BUILD NG -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Con letely — Use Ink Only BUILDING BUILDING ADDRESS /0/71--7TRACT ADDRESS APPROVED OWNER W A D MAIL ADDRESS OWNES TEL. CITY NO. CONSTRUCTION APPROVED BY LENDER BRANCH ZONE ADDRESS USE OF NEW BUILDING ARCHITECTTEL. YARDS APPROVED ACCESSORY BUILDING OR ENGINEER NO R. SIDE FT. FT. ADDRESS I FT. CONTRACTOR s ADDRESS CITY STATE LIC. NO. SIZE OF LOT USE OF I EL. NO. CITV LIC. NO. NO. OF BLDGS. NOW ON LOT Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED 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 California Business and Professions Code, Division 3, Chapter 9, and that such licenses are in full force and affect, 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 7r,PlIli 00 P.914 jtl,t r l cn.00 APPLICATION FOR STRUCTURAL PERMIT RECEIVED By I DATE A.P. NO. BET. MAIN & ACCESS. SLID VAR. 916- BUILDING ADDRESS /0/71--7TRACT C.U.P.# APPROVED APPROVED W A D fiRECEIVE OWNES sFIRE ZONE TYP APPROVED BY DATE ZONE NO. OF PLANS USE OF NEW BUILDING YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING %FROM C/L STREET) RUNT FT. FT. R. SIDE FT. FT. L. SIDE FT. I FT. DISTANCE BET. MAIN SLOGS. BET. MAIN & ACCESS. SLID VAR. 916- DATE C.U.P.# APPROVED APPROVED THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION PERMIT FEE $ s �1 PLAN CHECK $ $ TAX $ TOTAL PAID $ a J