HomeMy WebLinkAbout964 GOVERNOR ST - Building Permits(714) 754-5273 • Fax (��a) �sa•aess • vnVw.Ci.CoSte-rt1B58.Ca.uS , 77 FAIH DRIVt, GUS IA MtSA, GA 9"Z6'Lti
Job Address: 964 GOVERNOR ST
Suite No
Vicinity:
Parcel Nunmber: 42242324
Applicant: NOCK, CANDY
Address: 11612 KNOTT ST �
SUITE 217
GARDEN GROVE, CA
Owner: INGRAM, DAVID A
Address 964 GOVERNOR ST
COSTA MESA, CA
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST
SUITE 217
GARDEN GROVE, CA
Arch / Eng :
Address:
PLUMBING PERMIT
Phone: (774)895-1246
Zip: 92841
Phone:
Zip: 92627
Phone: (774) 8951246
Zip: 92841
License: 707775
Phone:
ZiP ,
� . License: � � - _ �- -
SCOPE OF PERMIT
CHANGE OUT WATER HEATER
�,
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub � �
Clarifier System
Connect Qce,Soda,etc) �-
Dental UniLs � �
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
�AMT
$23.50
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
`$0.00
$0.00
$0.00
50.00
$0.00
50.00
FEE�SUMMARY
QTY AMT
Laundry,Tub / Washer , $0.00
0 - Landscape Irtigation 50.00
0, P-Trap �$0.00
0� Pressure Regulator . 50.00
0 Process,Piping (per 10 ft) $0.00
0 Receptors $0.00
0 " Septic Tank $0.00
0 Sewer Cap for Demo 50.00
0 Sewer Connect $0.00
0 Sewer Private Line ' 50.00
0 Shower $0.00
0�- - . Sink, ba� ' $0.00
0 - Sink, commercial $0.00
0 Sink, Floor - - $0.00
QTY
'0 . . _
0
0
0
0
0
0
0
0
0
0
0
0
0
Status: ISSUED
Applied: 11/04/2004
Issued: 11/04/2004
ISSUED BY:
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-0)
Vacuuin Brkr Bkflow(S+j
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (foilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
AMT
$0.00
50.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$12.30
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21•92)
EXPIRATION: This permit shall automatically expire end become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545828
zanaes �aroo�
WORKERS'COMPENSA�ON DECLARAnON: ' �
I hereby affirtn under penalty of perjury one oi the lollowing declarations:
❑ I have antl will meintai� e cenificate of consem to sell-Insure for workers' compensation, es pmvided for by section 3700 af t�e Lebor Cotle, lor ihe pertormance of the
�work for whlch Ihis peRNt Is issuetl.
I'.have antl wlll malmain work ' wmpensation insurence, as requiretl by section 3700 of Ihe Labor Code, for the pedortnance of the work for which Ihis partnit is issue
M work c t r}� cerne e o' n mber ere: �' [/
errier:Y���'� ► l l Policy Number: - `1 \ ���
(This.sectlon neetl nof be complefetl it the permit is elue af one hundr d dollars (§ 100) or less J �r �.�
❑ I certily thet in t�e pedormence of Ihe work for which ty5 pertnit is issued, I shall not employ eny per5on in any manner so as ro become sub�ect to ihe workers'
compensatlon laws ot Californ�i_e, �e ,�raeJY�t if I�1R>uld become su6�ec[ ro the workers' compensation provislons ot Section 3700 of the lebor Code, l shalt fonhwith
comply with these prov' iem.� �y � /,YU 1'��
Appli�Signeture: —� �� �—17�'—c� �� fDeta:� �'1��
WAPNINO:fAIWRE TO SECUFE WORREFS' CO PM ENSATIpN COVERAGE I$ IINIAWFUL AND SHALL SUBJECT AN EMPIOYER TO CPIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
T}IOUSAND DOLURE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PPOVIDED FOR IN SECTION�3%O6 OF THE LABOq CO�E, INTEREST. AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATON:
9(commencing with Section 7000) at Division 3 0l the Business
Date:
CONSTRUCTION LENDING AGENCV:
and my license is in full
❑ I hereby aHirm that the�e is e wnstruction lentling agency br ihe peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Adtlress:
Signaiure: _
Date:
OWNER•BUILDER DECLAflATIONS:
I hereby aHirm t�at under penelty oi per�ury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe lollowing reason (Sec. 7031.5. Business and Pmfessions
Code: Any ciry or counry which requires e permit to consimct alter, impmve, demolish, or repeir any sWCNre, prior to its issuance, elso requires Ihe epplicant for such pertnit
to file a signetl statement tha� he or she is licensed pursuent to the provisions ot the Contractors License Ww (Chapter 9(commencing with Sect10� 7000) of Division 3 of the
Business entl Protessions Code) or that he or she is e:empt therefrom and the basis for the elleged exemption. Any violetian of Sectlon 7031.5 by any epplicent for a permit
subjects Ihe appliwnt to a cl�il penelry of not more than five hundretl tlollars ($500).):
❑ I, as owner of the propeny, or my employees with wages as their sole compensa[ion, WILL DO TME WORK, and ihe structure 15 not intended or oHeretl for sale (Sec.
7044, Business antl Plo�essions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves thereon, antl w�o does such work
himself or herself or thlough his or her own employaes, provitled ihat such improvemenis are not intendetl or offered for sele. If, however, the builtling or improvement is
soltl within one year of completion, the owner-builder will heve the burden oi proving Ihet he or she did no� build or improve lor purpose of sele.). '
❑ I, as owner ot the properry, em EXCWSIVELV CONTRAC7ING WI7H LICENSEO CONTRACTORS to construct the projact (SecJ044, Business entl Pmfessions
Code: The conirecbrs ��censa Law tloes not epply to an owner ol property who builds or impmves thereon, and who contrects for such project wl�h a comractor(s)
license pursuent to t�e Contrectors License Lews.).
❑ I em exempt under seG.
Signature:
Owner ID ve�ified by tlrivefs license. ❑ Yes ❑ No
Business and Professions Code for �his reason:
Verification ot Ownership by (type of documem, i.e. - pmperry tex bill or deetl):
DIVISION OF INOUS7RIAL SAFETV PERMI7 CERTIFICA710N:
Driver's License No.
Date:
Eapires:
❑ I hereby certify that no exceve�ion five (5) or more feei in depih into which a person is required to descend, will be metle in connection with work auihonzed by this
permit, antl ihet no building s�rucWre, scattolding, falsework, or demolition or dismantling thereof, will be more ihen Ihiny-six (38) feet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title 8, CaiOomfe Adminisvative Cotle).
❑ As owner�buildar, I will not employ enyone to tlo work which would require a permit from the Divislon ol Intlustnal Sefety, es notetl ebove, unless such person has a
partnic to do such work from the tlivision.
Signature: Date:
Division of Industnal Safery 7ermit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I certity under penalty of perjury that I have read this application antl s�ate tha� ihe infortna�ion given is
correcL I agree to comply with all state laws and ciry ordinances relating to building construction, and euthodze repr85entaiives of the Ciry of Costa Mesa to enier upon the
above-described property tor inspection puryoses. I agree not to occupy or allow occupancy of eny building authorized by this permit until finel inspection.
COOE �. INSVECTIONTYVE
1616 Fized System Final Fire Prevention
1266 Pool Spa Finel
200 Finel RB-Roai
201 FInaI BIocWRetaining Well
202 Final Factory Fire Place
203 FinelSlgn
204 Final DOmolitlon
Q�jF INTRIALS
LODE� INSPE4DONTYPE
206 Final Mecnanical
208 Finel Plumbing
270 Final ElecinCal
212 Final Flre Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupency
Q� L*�1�
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�oonessaem�owc: 964 GOVERNOR ST
°Y'"ERs""'E'°'wow":INGRAM, DAVID A
"°o"Eu:INGRAM, JODY
� 964 GOVERNOR ST
��TA MESA,CA 92627646-8303
ARCXRECT OA FNtlNFEX:
�NCN.ON FNQ'S AUDNE54:
UC Iq.:
UNi:
wrr��.Zat.[•����y[�ya:r�rir+ri�i�e���,rE�i
PERMIT NO: B 077507
PLAN CHECK NO:
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR
JOB DESCRIPTION : T/O COMP & REROOF W/COMP.
UNT:
coNm�crararuue:CENTURY ROOFING COMPANY ( 714 ) 968-3233
CONf11ALTOR4MAlIAlU g662 DOLPHIN DR
Ii00flEA4:H,H. CA uc.ra.: 674019
92646 uHr:
LICENSEO CONfNRCTOP4 DECLAHR710N: I M1eby dlim uMa penely d pxjury tlW I em IiromM uMx pro.ieiane d CMqer 9
(mmmend'p wilh 6xton ]000) ol qvubn ] d �he Bwi�wn enC Pmlaeions COEe. ud mY �� b In tull taro W aMaG.
cmuc.r+o.059104 uc.cuss:C39 uc.No.:674019 EXP: OS/96
oma: �^� �ll,� c�«: �
OWNEP BUILDEP DECLAXRTION: I Mraby elfum uMx perely W peeju�y �hm I em uamp tmm iM Camreeas Lieeme Lew lor Hro
Idlow'uq rseaon (Sa�fion ]0.'11.5 Bua'viaa end Rolaeebiu COEe: �M cry a munry xfiirl� rpu'vp e qrmil �o coneWct. el�w. imwova.
+emoluh, or ropei eny ebudun, piior io �� evueM.e, ebo repuirea iM eppl'vsn� In euch pe�mn lo fila a aqr�eE steiemem thet M w eM
i��d w�� w �ne ao�e�. w� com�m«. uoe�.e �w Icneq� s(��u wnn s�o� �000) d aVe� a d�b
,usimsa end PrWeveiom Code� a iMt ne a ehe is uemq tAerehwn vM �ne basie /a Ne ellepW naemqion. My v'Wmion d Seabn
]031.5 M enY aPdireM la a Vemu� �uMw++ Ihe aGWicent b a dW V�Y d nd more ihan Me IiunEred EoOen It`.A011�
� �. B! ONTMf G� 1�1! pIVCO�Y IX T)' BIII�lB= W1�1 W9QGf 8f ��1Bf Df.�! MIIIOlIIfB�1011. Mt0 bJ 1�M MOI�t. BIIQ I�M fINCI1IR G MI NIBIIQB'�
or oMarad for Wa (Seciwn ]Oaa, Buairea ard Prdesaiona Code: TM Canveqon Liceiva Lewdros ro� epplyto en ownerd D�PaM
who buida a inqovm Ihaeon, eM w1w doea sutli xvk IimeeO a hene� ar Ihraph he orinr own empbyee�, pwkW tMi wch
'mqwemant� ere nd intended n oHertd la ub. tl. Mws.er, �M buitlirp ar inprwemau e�old wnhin ona yw d mmplelM, iM
oMmer�WiNer will heva �he WMen d pwiiq he w dro did nd buiN « impo.a lor iM W�poee d seN).
� 1. ea ax�r d tM O�ro�v. em ud�+eM controeYq wdh IicemeE canuacwn �o m�so-un Ne w4ea (Seaion ltw. Bueirima arN
Peol sbm coEe: The Lmtreaan lieenx law does na xoDN Io en owror d P�W�Y Ma Wilda «'une�'u ihareon and who
comrazvn Iw miM qqea� wilh e caqredw�n) liumed pursuent io tM Cantiatlore Limnse Lewl.
� I em erempt uMm Secuon: B. d P C., br Nia ieeaon:
D Owenr
PERM NO: B 077507
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT; 1,875
CLAIM VALUE: 1,875.00 CALC—VALUE: 1,875.00 GROUP OCC; R-3 /U-1
COMMENTS: REROOF RESIDENCE
iF iE iE 1E i! iE if if iElE iF iE if if iE iE �F if if iE iE if iE �f 1E 1E �E iFlE �E fE if 3E fE iE iE iE iE iE iE iE 3E iE 3E �)E 1E �E iE 3E 3E 1F 1F iE iE iE 1E 1E iE ff �E �E 1E iE iE 9E 3E �E 1E if if iE IE fE iE 3E iE i616 if
Z O N I N G R E Q U S R£ M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCES50RY HUILDING ---------
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: 13920407 ZNE: REF NO: ''
PLANNING NOTES> ,
>�.
fE iE iE 3E 1E 3ElE 3E if iElE 3E iF iE 3F iE 3E iE �E 1E 3ElE fE 3E �E 1E 3E fE iElE IE k�Ih IE 1E 1f 9E 1E �E �E iE 1E'IE 1ElE 1E iE 1E 1E 1E if df iE if iE if iE iE dE 9E 9E 3E 3f'N�lf !E!k 3E fE iE iE iE �E iE aE Ik 3E * iE
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
I'
„'.
/�
ZONING APPROVED BY ; _ __ ____ . DATE: �
ILDING APPROC!ED BY
/.
PLICATION ISSUED BY
e�°' ILEGALIZATION:N F E E S U M M A R Y
I do heraEy cMiy iMt I em eware d eM uMe�steM �M reWiramenta d Caltwnie MeMh enC Seiery Code Sedione 255�5, 2553�, arM
2553a, erd �hm I a ary Mun buiMiip am�peN WI / vA rM (ercb ane) med io canply xth eaA aete oodm uM �he requiremenie M
aoa�nro�m�.wn�«moem��,n�,in.�s��mwm�a.a�ae�ud�m�,e�evw��.�..amq��m�n..e BLDG PMT PLUMHING ELECTRIC MECHANIC
oro�+s�s. PERMIT S9. SO
Dnte: Appiem:
WONKEP'S COMPENSATION pECLAH�TION: I Mreby dfiim uMx psml�y d pa�ury wr d Ne blbwiip dederetoru:
� I heve anE wi1 mvnien e ceMcde d ewueni �o veMimun 1« xaken' wmpemalion, m D���d �or M Sedion 3f00 d �he leba
COEa. ta iM peAamarr.e d Ns xak lu wlich Mu permu e eeued.
❑ inewenewme�m.:��.ona.•mmo�u�i�..�.e�.c�waMsee�me�aodu»i.eorcoee.m.inero�a�aine
wak Iw wM1ich tAia permil ia'usued. MY waken' compeneelbn imurarice wrim eM pdiq number are:
c�«:
Pd'cy NumDer:
,Tia s«tion neee rrd bs conde�e.f r tM pvmit u Ia ms nu�WleC Edlersll�ool a hvJ
}{[] I pnly Ou� in Iha petlormerea G IM woh Ia whcn tMa peimp b iaanE. I Nell ml empby em/ pereon in enY mennet eo ef Io
become wbjeq lo IM wvrFera' campenee�ion lew+ d CelEomia, �nd apron �IW il I ehaM barome aGjeq lo ihe xqken'
�w.��� ww�+om d sae�, a�oo a me �.e« wae. i wu imnwun oomcN .wn �.e wo.+:�.+.
oa,,: S� '`3 ' � L ^�s°^��� _
Wem/np: F�llun ro ucun wrksn'rompmutlon rowrep� Is un4wN1, �n! alull �,b/�cf en xnploysr ro cNMlul p�neMu �nC
C�Y�� �IM! 11p f0 MI IIVIdII� 1�104lIIY� (�Y/� (sioq000l. �n .de�rron ro m. ros� or con�oxu.non d..�.p.... po.wee ror �n
SxHon 9I06 0l Ms LWor Cotlq Infwu4 ��tl �rtomsy i/na
CONSTFUCTION LENDINO AGENCY: I Mnby �rm uMm penelly d perjury Ihet Ihere is e oomtiudion IaMinB epenty br �M
paAameMe d tM w�rk M whiM rt�e Oerml'n awed ISeeun �041. Civ. C).
LENDEH'S NI�NE:
LENOEF'S AODRE55:
I ceniy Ihel I t�eve reeE Inn epd�� � dde �I�ei Ne ebo.•e infamation c carea. I epree �o cwnply wnh ell cty vM counly oNinar�ces
enC 61fi�9 kvn relB�lllg lo Wikvq cM9trWbn W I�B�eby eNhpRe iap08Bn�B�NBf d I�V! Cly b BMN upOt11M 96WB.manlRlned popoM
im impeaion W�ro%��
RICHARD STERNBERG
Pnnl Nema ( 2 Q
Data: J� J \�
Signelure d Ownx/I�penURpplranUCaniraua
(5i5t.a6 WP) WAne-BuiMvg 8 Selery: Graert-Fle: Carery-AppFeni: Rnk-Ravewa: Goldenro�baeasor
NG—DIV—> PERMIT ISSUE PLAN—CHECK
----> 60,00 0.00 0.00
EVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
59.50
FIRE
DATE: ��
DATE: ��
���**�,�* 9 �*
STRUCTURAL SEGMENT:Y
SMIP/RES GRADING
50
SMIP/NON—RES
TOTAL PAID DUE
60.00 120.00 —60.00
60.00 OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN—CHECK
.50
if'1E'lE if if iE iE'IE iE if IE aE 1f �IE iE iE fE 3E iE iE iE iE dE IE 1E IE iF iE iE If 1E 1E iE'1E iE iE iE iF iE iF iE 1f 1E 16'!f if if 1E 1f if 1f iE ih iE iE ff iF if iE iF iE iE iF 1f if �E iE'1E iE 1f iE iE iE iE i(-iE iF aE if
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
SFR 1875 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 1,875.00
END OF FEES
��. - �'.- . � �- _. _^_"
_ �I. :�.. � . '�l•
COIsIS7RUCT10N AND PLANNING POOL ,PA .
A�PROYA�S Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Tempo�ary E�ectrical Sesvice or Pote 52. Pooi & Equipment Location
2. Soil PiPe�Undrgrnd. 53. Steel fteinforcement
3. Electrical Conduit UtilityUndrgrnd. 54. Forms �
4. Electrical Conduii-Undrgrnd. 55. Electrical Bonding �
5. Steel Feinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 56. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
r
9. Water Pipe�Undrgrnd. 60. Backwash �ines, P-Trap, O Uhdrgrnd.
70. 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�Finat
15. flough ElectricabCondurt 66. Solar System-Finai .
16. Rough Electric�Viriag 67. Fencing & Access Approvai -
17. ftough Wirinq Sign 66. APPROVED FOR PLASTER�NG
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Contlitioning FIRE 6EPT. REQUIREMEN7
20. Rough Factory Fireplace APPROVALS �Permit#
21. Ducts, in Structure - 70. Underground Hydro
22. Ovas, Ventilating 77. Product Piptng C Gas � Oil
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing - 73. Undergrnd. Storage Tank � Gas CJ Oil
25. ftoof 5heathing S'�..96 ��� 74. Overhead Hydro
•
2fi. T•Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical
27. Freme and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulat�on 78. FIRE PREV. FINAL
30. Drywall Naiiing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL iNSPECSION
32. Electrical Power Meter-Final 80. �FOOD CERTIFICATE ISSUED
33. Finai Eleciric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final �aMory Fireplace
3$. Final Plumbing .
39. 1Vater 5ervice�Finai ��
40. Gas Service-Finai
41. Solar pomestic�Final
42. Backtlow Preventer
43. Backflow Irrigation
44. LandswPe Irripation System �
45. Sound Attenuation
46. HandiCap Regutatlons �
47. FINA4 STRUCTURE & BUILDING ���� �� /
48. FINAL PLANNING
49. Electric Release to Edison ��
n
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
�I
AVP���ant to fill In all
CITY OF COSTA MESA PERMIT NC
CONSTRUCTION PERMIT �
Address V
Arch/Eng. License No.
Address
Contrecmr ' � Phor
a—
Address �U/ /I �.. /' e.� .w �i.�i-
witnin heavy borear Iines anC sign all aoPropriate tlaciarations.
TRACT NO. LOT NO. BLDG.NO.
1 h0reby atfirm that I dT IICBnzBE untl� provisions o/ Charlor 9(com-
mencin9 wltn sectlon ]000) ot Divlsion 3 of the BuSinass antl
PfOfB5510I15 COtl dOtl Ty IIC8058 IS IO 1UII fOfCB d00 � Ct.
Licen e Class �� en5a No�
Date � �' ��� Y� Signature �— •� �
WORKERS' COMPENSATION DECI_ARATION
I hereby at(Irm that I have a certiflcate of tonsent to self-Insura or a
certi(Itate of Workers' Compensatlon Insurance, or certi(letl copy
thereof (Se lon 38D0, lab. C.).
�-'�CY NO. 6 q / CAmOanY
ertlfietl copy is hereby lurnishetl. � �
.:ertif{¢tl CODY �5 fil¢tl with ihe city Bulltling Divi510n.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section naetl not ba tompleteE if tne permit is for one hunOretl
($300) or lessl.
I certify that in [he performance of the work for whlch thli permit is
Issuetl, I shall not employ any person in any manner so as to,�ecome
subject to the Workars' Compensatlon Lawz of Californla.
Date Si9nature
NOTICE: It after making this tleclaratlon, you s�oWd become sub7ect
to the Workerz' Compen5ation provisions ot tne Labor Cotle, you muzt
torthwlth comply with zUch provi5fOn5 Or thiz DGrTit Shall be tleemetl
revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby aflirm that there Is a constructlon Ientling a9ency for Ne per-
formante ot the work /or whith this permit is I5zue0 (Sactian 3097
Civ. C.)• `, '
LCntlef'S NdmG
�enCer's Atltlress
OWNER BVILDER DECLARATION
I hereby affirm that I am axempt irom th0 COntractor's �Icenie Law fOr
the following reason (Sectlon 7031.5 Builne55 antl Professlons Cotla:
Any cily Or <ounty which requlr¢z a pCrmil to consbu<t, altar,
Implove, tlGmallSh Or rGpalf any StlucturG, prlOr l0 Its ISSuance, a150 r¢-
qulr85 [h¢ ap0����� �o/ Such permit t0 /ile a slgnetl Statemenl Ihat he
Is �Icensetl oursuant to the orovlsions ot [�a Contrattor•s Llcense l.aw
•appllrant tor a permit subjetts t�e appliwnt to a Nvli panalty
ot more than five hunOretl tlollars (§500).
� q as owner of the property, ar my amployees wl[h wagos as their
sole companSatlOn, wlll tlo l�e work, antl tho structure is not intentletl
or oif¢retl 10r sal¢. (SeCtlon 7044, BUSinesz antl Pro1¢SSiOns Cotle: Tne
Cont�actoYs LI<Bnso Law tloe5 nOt apply lo dn Owna� oi a p�ape�ty
who bulltls or Improves Ihereon, antl who tloes suCh work hlmselt or
IhrOugh his own eTplOyees, provitlatl lhat such improvomonts arc not
Intended or otteretl tor zalo. If, howeveq the bulltllnq or impravemont
is soltl within ono year ot tompletion, tha ownor will hava the burtlon
of provin9 M1e tlitl not builtl or improve for tna purposa ol sala).
❑ I, as owner of ttle property, am excluslvely contractinq with
Ilcensetl conVactors to construct tne projoct (SacUon 7044, Business
antl Profaslons COUe: The Concrattols Llcense Law does not applY to
an owne� Ot property who bulltls o� ImprOv¢S Ihereon, dnC wh0 COn-
tlact5 trOm Such plo7eCt5 wl[h a ContraGtOf(5) IICGSnOtl puRUant IO
the Contractor•s LI<ense lsw).
❑ I am exempt untler Section B. 8 P. C. tor thl5
reason
Date Owner
I hereby certiy that I �ave reatl thi5 appllcziion antl Stdte thdt th! dbove
Intormatlon is COrr<ct. I d9ree t0 comply with dll City and COunty
ortllnances ana state laws relating [o tonstruction, antl hereby authorize
representativ¢5 of thl5 cityyy��� t0 8n(er pon th¢ abOv¢ m¢nliOnBtl
property for in ection �oses. {�/
Signature �• � Date //—y—r'
orivers' License or 55 qfi
CMF 0865-46 White-BWltling; Canary-Applicanq Pink-Ac<oun[ing; Goltlenrotl-Assessor
TVPE OF CONSTRUCTION
❑ NEW ❑ ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT
❑ GRADING ❑ FOUNDAT,I�O,�N ❑ STRVCTURAL
❑ TENANT ❑ ELECTRICAL VJ9lUM81NG ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION
SQ. FT.
OCCUPANCY_CONSTRUCTIONTVPE
VALUATION ZONE
GRADING CV. YDS. ACRES
REMARKS:
PLUMBING
BATHTUBS
TOIlETS
LAVATORIES
KIT. SINKS
SERVICE SINKS
FLOOR S�NKS �
DRINKING POUNTAI
�NTERCEPTORS
$WIMMING POOL
WATER SERVICE
GASSERVICE
PLANCHECK
SHOWERS
V 0.1 NALS
DOU6LE LAVS
DISHwA5HE0.5
SUMPS
FLOOR D0.AIN5
CLARIFIERS
PTRAP
ALTERATION
OUTLETS
SEWERCONNECTIONS
SOLARTANK COLLECTOR:
•SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL aLArv CHECK
HEATING SVSTEM 0-300,000 BTU_
AND DVCTING 100,000 * BTU _
REFRIGERATION 0-300,000 BTU_
SYSTEM 100,000 + BTU _
BO�LERS BTV
SVSTEM REPAIR,ALTERATION
EXHAVSTSVSTEM MULTIPLE
ISSVE FEE
�
`�"` 8063 II%09%81
��.,. � 1 _ . . _
A.P. q
20NE
0.EAR VARD (TO P/L)
PKG.SPACE REQ. �
STREET WIDTH
SPECIAL CONDITIONS:
ELECTRICAL
PLNG. REF. �
PARK FEE E
PLAN CHECK
GENERATOR p-1 KW_ 1-30 KW _
TRANSFORMER
APPLIANCE 10-50 KW_50 + KW _
MOTORS 0-1 HP_1-30 HP _
(INC. SOLAR) 30-SO HP SO + HP _
FIXTURES OUTLETS SWITCHES
GHS TUBE SIGNS
POLE IIGHTS
PANELS MAIN SUB
SERVICE AMP
APPLICATION /�PPROVED BY DATE
SUMMARV OF FEES
BUILDING
PERMIT S SMIP $
PLAN CHECK § / PERMIT
PLUMBING E �� (p� �SSUANCE S
GRADING S
PLAN CHECK 'E
ELECTRICqL E $
PLANCHECK g MICROFILM $
MECHANICAL E TOTAI FEE S
PLAN CHECK S LE55 AD�
VANCEPC E-
�
6.00 TL�
FINAL FEE $ 0��
CONSTRUCTION AND PLANNIN POOL & SPA � � �
���^'� � � ••� � Date Inspector � Date Inspectcr
APPROVALS Permit # � APPROVALS Permit � � �
1. Temporary Electrical Service or Pole 43. Pool & Equipment L'ocation � •-�
2. Soil ipe-Undrgrn 44. Steel Reinforcement
3. Electri�yl Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding '
. tee ein orce 47. Rough Plumbin & Pressure Test
6. ElectriGal UFER Grn 48. APPROVAL TO COVEF-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation 50. Gas Pi e, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P-Tre ❑ ndr m
10. Structural Floor System 52. APPROVALTO DECK
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough plumbing
14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wiring 57. Solar SYstem-Final
i6. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts, in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof $heathin
22. Frame and Flashin NOTES:
23. Insulation / /
24. lathin &Siding .� /• // S� '� �'
25. Drywall Nailing
26. Plaster grown Coat
27. Electri�l Power Meter-Final
28. Final �lectric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test "
31. Final Plumbing �� /
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations�
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date
OWNER p, A. I
�J�O��B� A��DDRES�S �
GENERAL CONTftAI
t �. ti5-39'i-2
Ih,.-ECTIONS
SOIL
c�s
PAOP. SWA. LINE IJ HOUSE CON. LJ
SPRINKLING SYSTEM
MISCELLANCOVS
ROUGH ME4TING �NO �IR CONOITIONIN6
TEMPOR4AY SEp���E OR POLE
UNOERGROUNO ❑ POWEH �
HOUGH wIRING
TRENCHES FORMS STEEL REINF.
FLOOR SYSTEM
BONO BE�M rf STEEI REINFORCE �
SMEATHING
FRRME nN0 FLASHING
LPTNING - IN n OUT (�
Pl "TER. BFOWN C04T
fUR�L, FIN4L
HE.�ING, VENY�. AEFRIG. AND �.C., FINAL
PLUM6ING, ilN�l �ND WS TEST n
ELECTPIC,FiN�L
BUILOING, FINAL �
DATE
SUBCONTRACTOR
1t-19-79
PERMIT N0.
ose Existi
� ` 9_ ,.: •. _. �
� COSTA MESA BUI4DING-SAFETY DEPARTMENT
P.O. BOX 7200 COS7A MESA, CALIFOHNIA 92626
For Applicant to Fill in Completely — Use Ink Only
�BUILDING �!{i ��vG/LH/O/� i.�'
Abf1RFS5 6•T
FS
G4
W
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F
La
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3
OWNER
MAIL
�{// TEL.
CITV COfTA'/%'(S"� NO.
CONSiqVCTION ��
LENDER
BRANCH '-
ADDRESS —
ARCHITECT � TEL.
ADDRESS
CONTRACTOF �UI/+ / Y��'t �S�LI T C.B�
_�
ADDRESS yG3 G�vv�.���n.
CITV `OS�A i/CS4 N�GSfL-.
IIC. NO. ��� 5�(/ LICVNO. $;j
S I Z E i NO. OF BLOGS.
OF LOT NOW ON LOT
USE OF / � � �
EXISfING BLDG. j+� f �h � �✓
Separate permits are required for
electiic, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
W 4 /-f� S' -�
A.P. NO.
BUI�DING
ADDRESS
6955 II/19/79 36.50 TL
TION FOR STRUCTURAL PERMIT
BV DAT REC ED DAT ISS �
' �/ / % �/ /� %�
/,�-w �]��_Z P MIT O.
t6�
OWNER ,(/ " �6f � / �
eyC.1+ NALU
USE
FIRE
ZONE TVPE GF
} APPROVED
�/ • BV . DATE
�
E NO.OF
PLAN3�
V qOSAPPROVE�
MAIN BUIIDING
REAR �{3 �/`�FT
DISiANCE BET.
MAIN BLDGS. '�
VAR. #'
1 hereby ackr�owledge thit 1 have reatl this application antl state
that the above informati0� is cor�ect and agree to comply with
all laws regulating buildin9 construction, antl I shall not employ
any person in violation of tfie workman's compensation laws of
ihe State of California. �/7 /
�.��0 $Q.I
I hereby certify that I am proparly licensetl as a contractor untler
the State of California Business antl Professions Code, Division 3, THE AMOUNI
Chapter 9, and that such licensas ere in full force and ettect, or I THE PURPpSE
am exempt from the prov�sions of the State of California Business VALUATION
antl Professions Code, Oivision 3, Chapter 9.
Signature of �� � ����,�� $ 2 37�.
Permittee ��� �
Authorized qent / /
USE OF NEW
6UILDING /
BET. MAIN &
ACCE55. BLD�
DATE
APPROVED
n
m
>
m
N
VN UNDER VALUATION IS FOR m
-ABLISHING A PERMIT FEE NLV: -
e
PERMIT FEE $ d
.00 N
m
PLANCHECK $ �B� o
TAX $ � �O LL
�
U
TOTALPAID $
ORANGE COUNTY BUILDING DEPARTMENT
� 636 North Broadway
' � � �iANTA ANA, CALIFORNIA ' � !
' FOR APPLICANT TO FILL IN
a""°'"� 964 Governor St. '
ADORE55
SCHOOL DIST. —
ORTOWN COBtQ Mesa RE
NEAREST
CROSSST. .SStAtP S'F.. ,
MAIL qg63 Wilshire Blvd.
AODRE55
=�r Beverly Hills No`CR 54361
ARCHITECT�o�in-McKerrache�p �
ENGINEER
ADDRESS 0 E.Walnut-Pasadena
ITRACTOR Balboe V18ta r�`+o'14-3291
ADORE55 6 Wilehire-Be cerly Hil
�ESCRIPTION NOT 7� BLOCK I TRAC�V /�
fATTACH METES B BOUNDS�
1 C NO. OF BLDGS.
SIZE OF LOT 7� ]C LOJ NOW ON LOT O
USE OF NO.OF NO.OG
E%ISTING BLDG. I Feraiueg I ROOMS
CENTERKOF'STREETM� 66 �/� P 4�EOE VARO 1 �1
DESCRIPTION OF WORK
NEW I xI ALTERATION I I AD�ITION I
REPAIRJj`{� I I MOVIN6 I I DEMOLISH I
SRE��J_]4 $O. P y. ROOMS J STORIE3 1
EXTERIOR WALL I ROOF oIIIDO
�pVERING gtUCC� COVERING ai�iinrzle
�OG NEW
�IDING Residence-att.Carnort
BUILDING '
ADDRE55 ,
SCHOOL �I�E
OR TOWN
NEAREST I
CRO55 ST.[
ZONE
APPROYED;
APPLICATION FOR PERMIT �
Y tl � � � � � � . _
FOR OFFICE USE ONLY
_ RECEIPT NO. �R�1,I�p�^
/ C/��o �' . . ,�
�.- .
HY I OATE REC'O. I DATE IS6UED
S-l�-
1
CORRECTIONS
.h. :'�'. .
. :._ � . � i.... i . �.
iIJ i�.. :� "�7����- ..{i
APPROVALS
FOUNDATION: LOCATION INSPEC
1 HEREBV ACKNOWLEDGE TMAT 1 HAVE READ THIS FORMS. MATERIALS, t
APPLICATION AN� STAT@ THAT THE ABOVE IS CORRECT UNOER-PINNING / FiIl
'AND AGREE TO COMP�Y WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS.
BRACING. BOLTS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. /
LATH.INT. �
SIGNATURE OF Ba1bOA. VSBtfl CO LATH. EXT.
PERMITTE
� � /) � PLASTER, INT.
AUTHORIZED AGT`. IJ �/ pLASTER, EXT.
V
e 11 p Persen�i FeE S//! MASONRY REINFORCED
VALUATION q Y'(,)30�00 p��n CHECK S�
� BOND BEAM
TOTAL /j /n
Feg � FINAL (tT/�, .
t �
1
LP
J
DATE.
O
A
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, '
, - - - - � - - - - ' -- :ti\�. . + .
STREET
PLOT PLAN
Show locotion and distances from
property line and between buildings.
��— �-- - — ..
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