HomeMy WebLinkAbout2301 Harding Way - Building PermitsINSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, Califomia Administrative Code, Title 24, State of Califomia, in the building located at
'�, Q r HALF MOON LANE-PHS3-TRACT 16600-COSTA MESA
LOT-1
CEILINGS: '
TYPE Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-19 6-1/2"
W ALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning
GENERAL CONTRACTOR: SHEA HOMES
�
THICKNESS: R-13 3 1/2"
LICENSE#
SCHMID INSULATION CONTRACTORS, INC. LICENSE #221517 C-2
BY: ,����� �� TITLE: PRODUCTION ASSISTANT DATE: 02/07/2006
ANNETTE PATTERSON
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at
HALF MOON LANE-PHS3-TRACT 16600-COSTA MESA
LOT-1
CEILINGS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning THICKNESS: R-19 6 1/2"
WALLS:
TYPE: Fiberglass Batts MANUFACTURER: Owens/Corning
GENERAL CONTRACTOR: SHEA HOMES
BY: TITLE:
SCHMID INSULATION CONTRACTORS, INC.
THICKNESS: R-13 3 1/2"
LICENSE #
LICENSE #221517 G2
BY: ���� TITLE: PRODUCTION ASSISTANT DATE: 02/07/2006
ANN T7E PATTERSON
y�y�����i;s�r��ac
S(�j�AIR GONqfTIpNING ING.
..p � �..
Installation Certificate : Residential CF-6R
Site Address
2301 HALF MOON LANE Bidg: - Unit: -}
1. BIDLDER INFORMATION
Shea Homes
603 S. Valencia Avenue
Brea, CA 92823
INSTALLING CONTRACTOR:
2. PROJECT INFORMATION
D[STRIBUTION TYPE
Flexible Ductwork in
Attic acid Between Floors
PERMIT #
SUBDNIS[ON: Half Moon Lane
CITY: COSTA MESA
COUNTY:ORANGE
WESTPAC AIR CONDITIONING
DUCT OR PIPING R-VALUE
Flexible Ductwork Will have a
R-Value of 4.20 or Better
I, the undersigned, verify that the equipment listed in the cazegory above my signature is the equipment installed and that the equipment
meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or
more efficient thah the equipment specified on the Certificate of Compliance submitted to demonstrate complience with the Energy Efficiency
Standards for residential buildings.
3. HEATING INFORMATION
HEAU PG MA�AUKECT �M DEL�IT ACT�UE FF. HECTING� � IP HLOADG
Furnace Lennox G40UH-60C-110X 80%
4. COOLING INFORMATION
COOLING MANUFACT COMPRESSOR ACTUAL EFF. COOLING E UIP HEATING
E U(P. MAKE MODEL # SEER CAPACITY LOAD
A/C Lennox 13ACD048 ]0
The building design heat loss and design heat gain rate have been determined using a method specified in Section
150(h) of the Cnergy Efficiency Standards, and are two of Ute criteria used for equipme�t sizing and selection.
5. THERMOSTATIC EXPANSION VALVE (TXI�:
Thermostatic Expansion Valve (or Commision approved equivaient) is installed and access is provided for inspection.
6. SUBMITT�D BY:
YES Q NO � N/A Q
WESTPAC AIR CONDITIONING
Signature InstalGng HVAC Contractor Date
(714) 754-5273 • Fax (7/4).754-4856 • www.ci.costa-mesa€Lc�.TRICAL PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
2301 HALF MOON LN
A
ELECTRICAL METER PEDESTAL
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Status: ISSUED
Applied: 04/26/2005
Issued: 04/26/2005
Applicant: DE WITT, DANIELLE - '- "' .:'<';." --..
.. , - �.:z..:>.,."',-=... . r�-......, ISSUED BY:
Address: 665 BREA CANYON RD ��,,!;��--' ; - - � _ - - .� � j,-�w- _ - _ -
,r -_,�. �-'Phone: 909�594 2341 . � �� � - �< .
WALNUT= CA t' � � "� �� Zip 91789 � % � i� ' ``� � . ''
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owner ' SHEA HOMES LTD �''%r - � ' � * ` �� � •.
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Addressir '�'si� " A� �� - � �.��
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���Contracror--tSHASTAELECTRICLP � .-
" AiJil�ess: 665,`BREACANYONRD "'` �-' � � � � � �`,•�� ,�, ,
<,� � � , ,.,� -_,
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''V � ` -, . �WALNUT, CA� i� f � � ��' Zip.� � 91789 — - . t : � ` ",
. . _ . � "� � � . .. . � . „ � �. �.
�: � License:683876 t `
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'' " ` SCOPE OF�P.ERMIT - `
� • ira,; -� -- ; l ,-,: � ,
�' �, •ELECTRICAL-PERMIT FOR NEW METER�;PEDESTACFOR"SHEA HOMES°.�. , ., , � . , -- � �?' �
, ., ., , .� .k_.. ..... .. _� _.. .,. .. . _.
� �} � . - < �� �� FEE SUMMARY �,' � �',: � i �
�
, ._. .. _ , �Quanfity-. �A� ; -.�� �i d'L; .i � Quantiry '!, �l` ., �
FdSSUE�FEE � � �$23.50 . - ��Temp Dis6System l.Lighting �"� $0.00 0 � ; �
r
'Temp service test �. � � � $0.00 � " ' � '" ' Busway /100,k ��� - ��� � . $0.00 0 - � / -� - i ' '
Res.a/c,package� �� �$0.00 , Standing,Section � 50.00 0 ,-„r,' � �'�'t
New.Res (1-2 units). � , $0.00 - 0 Misc Electrical Equipment ` $0.00 0 �.�'"� � � � �
New Res (3+units) � � � $0.00 0 Transformers up.to .1 kva/kw $0.00 0� ;�' ` l `� ` �
Pool / Spa�.. ��, ,�� ` �� � $0.00 0 ..........up to 10 kva/kw $0.00 � ^� �" '
_- ,_....,
,%p/,` _'., � ; -. r
Lighting Fixts ' `� , �'." ' $0.00 0 .. „=';� � t.'� :.::.........up to 50 kva/kw $0.00 :i3Oj � . � �' ,
Recept Outlets � �'� 1 ,$0.00 0 ' �� `- � ........._�`....up,to 100 kva/kw 50.00 "� � � �
z _ , � �" -- .,, .. _ ; ; �,0 �-, - . .
Switches , $0.00 0 � .... over400 kva/kw $0 00 �� j,- 0 " . ,
Non Res Appl� ;A ;� � $0:00 -� �..� 0 t 3 - � ` Low'Voltage Equipment � y;�-_ $0�00�% 0 : - � � "�
Res Appl �.^ /� $0:00� , 0 � �; � � , LovJ-VOIt Winng System / Ckt� ;50.00 0 ' �. -
Service to 200a r� �� $30 50� � 1 v,� � MisccCondmt , c - r" $0:00 �/� 0 ,"} /� �
Service to 1000a� S�� � ��.$0.00 ��O��a �' Misc..Conductora � Fr � j $0.00� C;Oj �/j �
Service over 1000a . �' $0.00 �� � O�T=- � � ` "� � - �rCvcus ( gen or ride) - .•';� , $0 00�' V C 0 �. ,
Motors to 1hp ��,,� � $0.00 l � �,� 0�� - _ �Cirws.(mech'ride orJights) r ,��;$0.00/ � 0!�' �
Motorsto�tOhp �y-_y$0:00 / �,',0�-.. ,• �--�ChdstmasTreeStand .$0.00'� ;0, .
Motors to SOhp �' $0:00 �, ' J'; 0 �i. Fireworks Stand:iC'� ��'$O.OQ!� 0�� �
Motors to 100h `•��$0.00-, � '�'0 � - ' -' � ; -. �" �� ' ---0ther EleotricaPFee`•�� � � '
P � S $O.00r'' :
Motors over 700hp $0.00=� 0` ' ; "' � ' � � i ' � r� � t�% !/�' .�
Communication drops $0.00 � '� �'0 � -- -�' �, "- �Investigalion Fee'' � �'�%�$0.00
Sub panel to 200a 50.00 •� 0- m-t< __ ' Plan Check Fee -;: ���.�'-�.; -"� $0.00
Pole Light Pkg 50.00 0��+�,. .- ':: RelnSpeCtiOn:Fee"� ^ 50.00
Sign Circuits $0.00 0 � � -�-.` . :-_ - .� ---- '
NOTICE: The work authorized. by this� permit shall comply with all applicabla handicap access requirements under Califomia 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
� requiredlnspeedona and.finel�apprrnal must be oWained. Failure to obtain inspections and.tinal approval will result in the expiration of this permit.
FOR INSPECTIONS CALL:. (714) 7545626�
zuase (a�ao)
WORKERS'COMPENSAnON DECLARAnON: � " � � �
I hereby attirtn untlar penalry oi perjury one ot the following tleclarationsi "" ' - �� � ' ' ,'
❑ I have entl will maintain e certificate ot consent to sel4lnsure tor workers' compensetion, es providetl for hy section 3700 0l the Labor Code, for Ihe pedortnance oi the
work fOr which this pertnit is issue0. ' - ' � � ,
�_`have antl will maintain workers' compensatlon insurance, es required by section 3700 of the Lebor Code, for the pertortnance oi tha work tor which Nis pertnit is issuetl.
My workers' compensatlo Insurance wrrier entl olicy number are:
�nrri . ' - n PoGc�j Ntimber._ C e �I -� o� e�j '
�fiiS'section need no omp/e e' he pe rt is va/ued af e huntlred Uollars ($100) or /ess.) ���� � �
❑ I cetlify th m tha peAortnance ot t work�for which t1y pemiit is issued, I shell not employ any persdn in any manner so es to become subject to the workers'
compe ation la s ot Celifomia, a eqree that If I s 6NA become subject to t�e workers' compensation pro�f�tion 3700 oy�he Lebor Code, I shall forthwith
comp with t provisions. . A� ' ��
App�CeN ignatu Bata: . n�v b u Z C D`" J r, r-� G
W,ARN...*+��
MIG: AILURE TO ECURE WO 1 S' C iSATIIXJ COVERAGE IS UNLAWFUT AND SW1LL SUBJECT AN EMPLOYER TO CRIMIWIL P NALTIES ANO CIVIL FlNES UP TO ONE HUNDRED
TiIOUSPN �OLLARE (51 ADDI ON TO THE COST OF COAAPENSATION, DAMAGES AS PROVIOED FOR IN SEGTION 3]O60F THE UBOR CODE, IMEREST, AND ATTOqNE1^S FEES.
I hereby aHirrl`
force entl affect.
of Chapter 9(commencing with Section 7000) ot Division 3 of the Business end Pmfessions Cade, entl my license is in full
CONSTRUCTION LENDING AGENCY: �
❑ I hereby aMirm thet ihere is a consiruction lending agency for the pertortnance of Ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Code).
Lenders Nama: Lentlels AAtlress:
Signawre: Date:
OWNER•BUILDER UECLARATONS:
I hereby eHirtn that under penfllry oi Derjury ihet I am EXEMPT FROM THE CONTRACTOHS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professlons
Cotle: Any ciry or counry which requires a�permit to construct, elter, improve, demolish, or repair any siructure, pnor to its issuance, also reduires the epplicant for suc� permit
to tila e signed statemem that he or she is licensed pursuant to the pmvisions of �he Contrectors License Lew (Chapter 9(commencing wit� Section 7000) ot Division 3 of ihe
Busineu and Protessions Code) or ihat ha or she is e:empt theretrom antl Ne besis for the alleged e:emption. Any violation of Section 7031.5 by any applicant for e permit
subjects the epplicant to a civil penelry oi not more than five hundred tlollers ($500).):
❑ I, as ownar ot the property, or my employees with wages es their sole compensation, WILL DO THE WOFiK, antl t�e siruciure is not intended or oHaretl for sele (Sec.
7044, Business and Professions Cotle: The Contractors License Ww does not apply to an owner of pmperty who 6uiltls or improves thereon, and who does such work
himsetl or hersefl or through his or her own employees, pmvided that such impmvements ere not intendad or ottered tor sele. If, however, ihe building or improvement is
sold within one year of wmpletion, ihe owner-builder will have the burtlen oi proving ihat he or she did not build or improve for purpose oi sale.). �
❑ I, es owner oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 70d4, Business antl Professions
Coaa: The contrectors License Law tloes not epply to an owner ot propeny who builds or impmves thereon, antl who contracts tor such project with a contractor(s)
license pursuant to the Contractors License Lews.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID venfied by drivefs license. ❑ Ves ❑ Na Drivers License No. Eapires:
Venfiwtion of Ownership by (type of document, i.e. - pmperty tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certify ihat no excavation tive (5) or more teet in depih into which a person is required to descend, will be mada in connection with work authonzed by Ihis
pertnit, and that no building sirucNre, scattolding, falsework, or demolition or dismamling ihereof, will be more than �hirry-six (36) feet high. (Chep. 32, Gry 2, Ar12, Sec.
341, Title 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ enyone lo do work which would require a permit from the Division of Industnal Sefety, as notetl above, unless such person hes e
pertnit ta do such wark from Ihe Civision.
Signature: Date:
Division oi Intlusirial Safery Permil Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIIATON OF EMAY: I certity under penalty ot perjury that I have reatl ihis application and state that tha information given is
correct. I agree Io compty with all state laws and ciry ordinances relaiing to building consiruction, and authoriza representatives oi the Ciry of Casta Mesa to enter upon �he
ebova-described property tor inspectiogput�. I agree not lo occupy or allow occupancy of eny building authorized by ihis permit until finel inspec�ion.
CODE I.
1616
1266
200
201
202 .
203
204
... :- -. .... , �... . . .�� . .
Fizetl System Final Fire�Prevention
Pool Spa Finel
Final Re-Roof� �
Final BIocWRetaining Wall
Final Factory Fire Place ,
Final Sign
COUE �
206 '
208
210
212
220 ' �
222
25
INSPECTIONTYPE �
, Final Mec�anical
Final Plumbing
Final ElecMcal �
Final Fire Prevention
•. . � PDIE,., 1[�ELS
Final Planning Approval �
Final Site
Final Building/Occupancy
. • TI-
(7�a) 75a-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job nddress: 2301 HALF MOON LN
Suite:
Vicinity: LOT 1
Primary Oca R3 Dwellings! Cong Res <10 Type of Construction: V-N
Parcel Number: TPN00503 Zoning:
Applicant: WILLIAMS, GARY
Address: 1450 N. TUSTIN AVE
SANTA ANA, CA "
Owner:
Address
Con tra cro r. O N/ N E R- B U I C D E R
Address: � � �
Phone:. 714-245-9760 X24
Zip: 92705 � -
Phone:
Zip:
Phone:
Status: ISSUED
Applied: 01/31/2005
Issued: 04/18/2005
ISSUED BY: ``v
Zip: - ' License: 000000 �
Arch : WILLIAM HEZMALHALCH - Eng: �
Address: WILLIAM HE2MALHALCH ARCHIT.ECTS INC �/� Address: . ,
SANTA ANA, CA � . . , Phone: 949-250-0607 � � � . Phone:
2850 REDHIL� AV STE 200 - .
Zip: 92705-5543 License: C12920 License: �
SCOPE OF PERMIT
LOT 1 . • . _� .- . . - , '
PLANS 28 _ .. . , _ , - . . - . . . . . .. .
CONSTRUCT 2560 SF 2-STORY SFP WITH 449 SF ATTACHED GARAGE AND 72 SF PORCH. FIRST FLOOR WILL BE 1225 SF WITH 1335 SF
SECOND FLOOR. A FIREPLACE MODEL #4236 (ANSI UL127) WILL BE INSTALLED IN THE FAMILY ROOM; THERE WILL BE A 2ND FLOOR
LAUNDRY ROOM. . -
REF: G04-000�0, PA-03-07, T-03-O6 " � � � � - - �
SEE PA-03-07/T-�6600 � � � '
Plan Check: $30527
Permit: $1,878.55
SMIP Res: . $25.76
SMIP Com: $0.00
Other. ' $0.00
Inspection: $0.00 ,
Total:� $2,209.58
� ..
SETBACKS
MAIN STRUCTURE Front 12- 0
FEE SUMMARY' .
Calc Valuation: / "
- Claim Valuation:
, - Rear 13- 0
PLANNING & ZONING
Left 10- 0
�. . i
_ �
� '�
f2ight 5- 0
5257,575.34
50.00
NOTICE: The work authorized by this p�rmit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days. ,
INSPECTIONS: In order for the work authorized under this permit to be considerad legal, such work must comply with all applicable codes, and all
required Inspectlons 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
zaas-as �woo�
WORKERS'COMPENSAnON DECLARAnON:
1 hereby ettirtn under penalty ot perjury one oi the following declaraUons:
❑ I have entl will maiPiain e certificete ot consent to sell-Insure for workers' compensation, as pmvided for by section 3700 of the Labor Code, tor ihe pertortnance of the
work tor which this pertnit is issuea.
❑ I have and will maiNtain workers' compensation in5urence, es requiretl by section 3700 oi the Labor Code, for the pertormance of the work for which [his pertnit is issuad.
My workers' compAnsatlon Insurence cerrler end policy num6er ara:
Cartiec Policy Number.
(TTis secfMn neeC no[ bB �p�efed il the permit is velued ef one hundred dollers ($100) or IessJ
}certiy that in the pedortnance ot the work For which Ihis permit is issued, I shall no� employ any person in any manner so as to become subject to the worknrs'
compensetion IawB o� Celifomia, end egre ei il l shoUld become sub�ect to �he workers' compensation pmvisions of Sedion 370� of ihe Lebor Code, I shell (onhwl�h
compty with these p�a ' s. .
aM3ignaNre oate: ��/��G�.i�
��
ING: FAJ� ILURE T SE WO (EFS' WMPEN 1 COVERApE IS UNLAWFUL AND SHALL Sl1BJECt AN EMPLOVF$jp,pgIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE NUNDPED
iANDDOLL4RE(510p.000),INA DIiIONTOTNEWSTOFCOMPENSATIIXJ,DAMAGESASPRpVIDEDFORINSECTION3lO60FTHELABORCqDE,IMEREST,ANDATTORNEV'SFEES.
LICENSED CONTRACTaRS DECLARATON:
I herehy attirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 ot the Business and Protessions Code, and my license is in full
force antl eHecL Lic, y Class a
Contractor's SignaNre: Dete:
CONSTAUCTON LENUING AGENCY:
❑ I hereby affirm that there is a construction lending agency br ihe pedormance ol the work tor which this permit is issuetl. (Sec. 3097, Civil Cotle).
Lentlers Name: Lender's Addrass:
Signature: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby attirtn that untle� penalry of perjury thet I am EXEMPT FHOM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires a pertnit to construct, alter, improve, dsmolish, or repair any structure, prior to its issuance, also requires tha appliwnt for such permit
to file a signeC siatemeni thet he or she i5licensed pur5uent b lhe Orovisians ot Iha CoNractors License Lew (Chap�er 9(wmmencinq with Seciion 7000) of Dlvision 3 of the
Business entl Protessions Cotle) or thet �e or she is exempt therelrom end the besis tor t�e ellegad ezemptlon. Any violation of Section 7037.5 by any applicaN for a permit
subjects the epplicant to e civil penalty ol not more ihan flve hundred tlollars ($500).):
`��-4�a�5 owner of the p�operry, or my employees with weges es thelr sole compensation, WILL DO THE WORK, and the strucWre is noi intendea or oMeretl for sale (Sec.
�----�p44: Business and Protessions Cotle: The Contractors License Law does nol apply to an owner of property who builds or improves thereon, an0 who does such work
himselt or heroelf o<<hroug� his or her own employees, pmvided Ihat such improvements are not intended or otteretl for sale. If, however, the building or improvement is
sdd within one yeer oi completion, the ownerv6uilder will heve Ihe burden oi proving that ha or she did not build or improve for purpose of sale.).
❑ I, as owner of the p�Werty, em EXCWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business antl Professions
Cotle: TTe wntreciors License Lew tloes noi apply to an owner ol pmperty w�o builtls or Improves Ihereon, and who contracts tor such pmject wit� a coniracior(s)
license pursuant to ��e Contractors License Lews.).
❑ lam
Owne710� � nfi by �/iver's license.
Venfication ol Owners�ip by (type of
_ Business and Professions Code for lhis reason:
Dete'—
❑No Dri�s�Licensa�No.�^'� �� ' xpires:-�G,� ��
i.e. - property tax hiil or deed):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hareby certiy that no excavation five (5) or more feet in tlepih into which e person is required to descenq will be made in wnnection with work authonzed hy this
permit, end that no building sWCNre, scaHolding, lalsawork, or tlemolition or dismantling thereoi, will be more than ihirty-si: (36) feet hiqh. (Chap. 32, Grp 2, Art 2, Sec.
347, Title 8, Calilom�a Admini5lrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division ot IndusMal Safery, as noted above, unless such person ha5 a
permit to do such Work from �he division.
Signature: Date:
Division of Industrial Saiery Permit Number:
CERTIFlCATE OF COMCLIANCE AND AIJTHORIZA710N OF ENTAY: I cenity under penally of perjury ihat I have reatl this eppiicalion end stale Ihat Ne inlormation given is
correct. I agree o comply wilh all st te lews and city ordinances relating ro bullding consimction, end euthonze representatives of Ihe Ciry of Casta Mesa to enter upon �he
above-descn property or in �p � purposes egree nol !o occupy or allow occupency ol eny building authorized by Ihis perm/ily/� itl fm ins0ection.
. .. — �/ / ��
I e��Oh � a140wner(s): r:=. �'�ate ,
AnNOr Authorized Applicent Oate
LOpE �. INSPEL710N TYPE
1616 Fixed System Final Fire Prevention
1286 Paal Spe Finel
200 Final fie-Rooi
201 Finel BIocWRetaining Wall
202 Final Factory Fire Place
203 Finel Slgn
204 Final Demolition
PZ.iF �NTITIALS
COpE I INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevan�ion
220 Final Planning Approval
222 Finel Sila
250 Final HuilGinglOccupancy
D�TE INTRIALS
(714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa�a.�TRICAL PERMIT n FAIR DRIVE, COS7A MESA, CA 92626
L
Job Address:
Suite No
Viciniryi
Parcel Nunmber:
2301 HALF MOON LN
LOT 1
TPN00503
Status: ISSUED
Applied: 04/27/2005
Issued: 04/27/2005
npp�icant WILLIAMS, GARY `_`,;: ,; ��:,j�:n.,;. �.:-.,� ISSUED BY:
Address: 1450 N. TUSTIN AVE. _ �,if. � �- ,", - , � - � '-�
y ,,; �, �.
� ,ri ;, �� - Phone � , � . z
SANTA ANA CA i � ` � '� Zip 92705 � .,�� i � � �! � - '•.
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Owner ' SHEA HONIES LTD "%'/ � - ��� � �� i. , \ i � ��
k �' :r/ t�: 5 � Y `�/i!c'� ,/'� , � A 1 / °�\\
� Address , :, '_-� .i,��' � - �. ,,'J/ � ��_;�A
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l�Contracroc-���OWNER-BUILDER I ' � ��'�''���` �` �
Address �,='/ r i ..- 'r xr. - - . .. , , _ �. ���, ti, - ' � _
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' � � �' Ur { !' � +c. ^ License: 000000 ��'� �` ;�" - � ` - ` ' ' - � •
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, ��� � �. ., r lv �-r , j SCOPE OF PERMIT � -� , -�, ' _, f �- - � ,
, . ; �LOT 1/PLAN 2B „ /' .. _ . . _ _. .. � ,, C: _ . e�l " � � . . ' i - i .
, ,_ �� ELECTRICAL PERMIT FOR NEW 2560 SF SINGLE FAMILY RESIDENCE FOR "SHEA HOMES INSTACL � � t �,
�`'2 LIGHT�FIXTURES 3 RECEPTAC'lE OUTLETS, & 1 SWITCH IN GARAGE, AND'NEW RES A/C- ' �'� I
._ _ — ;PACKAGE.. . . . - > �. r' r. _ ` ;, ., - , . -' 1 � _ J .
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;'I - :,�REF:B05-00166 � " � � - _. , . rNr --, . . r-f�£ r f ',���'
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FEE SUMMARY `- _ / � � � , _ '
� �,� � Quantity � Quantity ; „ ; •
ISSUE FEE� � ;, $23.50 ' `;�;, �'-Temp.Dist System / Lighting $0.00 ii;i0 � ' , " �
Temp seryice test . 50.00 - ,.. , BuswayY.100 ft $0.00,; iiA '
Res. a/c package .' `$54.50 � Slanding Section,.� . $0 00 !� 0 �, ��'� �
New Res 1-2 uniLs $143.36 2560 � Misc ElecVical E w ment.� " M.$0 OOf 0��= ��
( ) , � y:d , . . . Q P S"''s7,=.. , � - � . .
New Res (3.units)t �$0�00�� � , 0 t, - v �7ransformers�up�to 7. Rvalkw ��T$0 00 ,,.,�0 r�,'��
Pool/Spa A,�� ��� �$0.00���� 0�_ =�` ��updol0kva/kw'-� $OOO��.Q ,+�f
Lighting Fixts � -� � $2.20 � � `�2`.4 - - ... ...up�to 50 kva/kw�, � $0.00 �' Or /�`,�' �, �
Recept Outlets , ��?,, � $3.30:.� � 3�"n � �� ..up to 100-kvalkw�' �80.00;,A �0 i��� � �
Switches - � $1 10 � � 1 �� � ... o'ver'-_900_kva/kw ,� � . �$0 00�;' 0 ij'�-
Non Res Appl �` � � 30 00 � . -0-._. "-. � Low VOltage�Equipment ��\ -$0 00 � / 0' ,-
Res Appl � - -�$0,00'� �� � 0 _ • t - Low Volt Wiring System / Ckt 1 � �SO 00 �: /�,0 � �
Service to 200a \`$0:00� -� '_ 0 ;'r, ' • l �=`• ' - Misa Conduit �' � � �� �0;00 �. ' 0
; �� .i�.,. )�V:
Serviceto1000a $0.00`-`, 0 i`�'-� MisaConductor,.��,_i ,./,g0.00' 0
Service over 1000a $0.00 �� �--'^:--0 �• � _ `� �.Circus ( gen or dde) _ ; i?�'', $0.00 0
Mators to thp $0.00 `-.. 0_7. s- Circus (mech ritle,o�lights);,-"` $0.00 0 . �
Motors to 10hp $0.00 0 - -- _ '' . ' � _= Christmas;TreeStand-' � $0.00 0
Motors to SOhp $0.00 0 - -.." F.ireworks Stantl �� $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
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 inapeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
�I FOR INSPECTIONS CALL: (774) 7545828
zate-�e �aroo�
WORKERS' COMPENSATION DECLARATION: � ' ' -' �
I hereby attirm unaer penalty oi perjury one oi the following declarations: ' , ,
❑ I have entl will malntain a certificate of consent to self-Insure for workers' compensetion, as provitletl tor by section 3700 0l Ihe Labor CoOe, for the perfortnence of tKe
wark lor which Ihis permit is iuued. , � �
❑ I hava antl will maintain workers' compensation insurance, as required by section 3700 of the Lahor Code, for ihe pertortnance of ihe work lor which this permit is issuetl.
My workers' compensatlon Insurance carder enA pollcy number are: �
Carner. Policy Number:
(This secNon need not be completed il the Dermit is valuetl at one hundred dollars ($100) or less.)
�I cenify thet in ihe pertormance of the work for which this pertnit is issued, I shall nol employ any person in any manner so as to become suDject to the�workers'
wmpensation laws oi Calitornia, end agree tha ' hould beco e sublect to ihe workers' compensation provisions ot Sec " n 3700 of Ihe Lebor Code, I shell tonhwith
comply with these provi � s.
� Y a�Jo�
Applicant Signatura: Dete:
WARNING: FAILURE T SECUR OFjI RS' COMPENSATIO DVE E IS UNLAWFUL AND SMALL $UBJEGT PN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED
THIXISAND DOLLARE , IN ImDR10N TO THE COST ENSATIqJ, DAMAGES AS PROVIDED F-0R IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND FTTORNEY'S FEES.
LICENSED CONTRACTORS DECLAFiATION:
I hereby aHirm ihat I em licensed untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 of Ihe Business end Protessions Code, end my license is in full
force end eflecL Lic. # � Class N
Contredor's SignaWre: Date:
CONSTRUCTION LENDING AGENCY:' � .
❑ I hereby aNirm that Ihere is a consiruction lentling agency for lhe peAormance of Ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lendefs Nama: Lendefs Atldress:
Sipnalure: Date:
OWNER•BUILDER DECLARATONS:
I hereby e%Irm Iha� under penalry of perjury that I am EXEMP7 FROM 7ME CON7RAC70R5 LICENSE LAW for ihe tollowing reasan (Sec. 7031.5, Business antl Protesslons
Code: Any ciry or counry which requires a pertnit to consirucL alter, improve, tlemolish, or repair any structure, pnor to Its issuance, elso requires ihe eppliwnt foi such partnit
lo file e signed statement that he or she is Ilcensetl pursuam ro ihe provislons of the Contradors License Law (Chapter 9(commencing with Section 7000) of Dlvislon 3 ot ihe
Business and Professions Code) or ihet he or she is exempt iherefrom end t�e basis tor ihe elleged exemption. Any violation of Section 7031.5 by any appllcant for e pertnil
subjecls the applicent m a civil penalry ot not more Ihan five hundred dollars ($500).):
❑ I, as owner of the properry, or my employees wlih wa9es es their sole compensatlon, WILL DO THE WORK, and the siructure Is nol intentletl or oflaretl tor sale (Sec.
7044, Busineu and Professions Code: The Contractors Licanse Law dces not apply to an owner of property who builds or improves thereon, end who does such work
himsetl or hersetl or thwugh his or her own employees, provitled Ihat such improvements are not intendetl or ottered for sale. If, however, the builtlinq or improvemeN is
soltl wiihin one year ot comple�ion, t�e owner-builder will have Ihe burden of proving Ihat he or she tlid not �uiltl or improve for purpose of sale.). �
�1, as owner oi the Droperry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Professions
Catle: The contractors License Lew tloes not apply to an owner ot pmperty who 6uild5 or Improves thereon, and who contracis for such project with e contrector(5)
license pursuant to the Coniractors�jcAnse Laws.).
❑ lem
Owner I verifie y tllfvers licensa.
Venlicaii nership by (rype of
Business antl Professions Cotle tor this reason:
� 0 No Dnvefs License No.
i.e. - property �ax bill or deed):
Expires:
DIVISION OF INDUSTRI/LL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certity tha� no exwvetion five (5) or more teet in depth into which a person is required to descend, will be made in connection with work aut�onzeC by ihis
pertnit, end Ihat no building siructure, scaHolding, talsework, or demolition or dismantling thereof, will be more than Ihirty-six (36) feei �igh. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Ttle B, Celifomia Atlminisiretive Code). ,
❑ As owner-buil0er, I will not emplay enyone to do work which would require a permit irom the Division of Indusirial Sefery, es notetl ebove, unless such person has a
permit to da such work from ihe tlivision.
Signature: Dale:
Division of Industnal Safery Permil Numbar:
CERTIFlCATE OF COMPl1ANCE AND AUT}IORIZATON OF EHTAY: I ceniy under penalry of perjury ihat I have read this application antl state that ihe inlortnation given is
correct. I agree ro compty with all state I nd ciry ortlinances ralating to building construc�ion, and authonze represematives of t�e Ciry of Costa Mesa to enter upon the
above-describ properry tor inspecC � ses. I agree t to occupy or allow occupancy ot any huiltling authonzed ihis p mi� until final inspection.
- y 2���--
Signature Ot Leya O�y r(s) � Date
V
And/Or Authorized Applicam Date
GODE �. INSPECTIONTYPE - ' '
7616 Fised System Final Fra Prevention
7266 Pool Spa Finel
200 Final�Re-Roof � � �
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 � Final Sign
204 Final Demolition
f�jE •• • INTITIRLS ' ••
�
'QQpF�� ' INSPECTIONTYPE • � '•
- 206 Final MeChanical
208 Final Plumbing
210 � Final Elacincal
�1
212 Final Fire Prevention
220 " �Final Planninq Approval � � �
222 Final Site
250 Final Building/Occupancy " �
PiE II�L$
(714) �54-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
2301 HALF MOON LN
LOT 1
MECHANICAL PERMIT
Status: ISSUED
Applied: 04/27/2005
Issued: 04/27/2005
ParcelNumber TPN00503 � � '��^'-�"-�,�=_��'�-=-=�•.-� _ ISSUEDBY: /�"`�
_ � �'ir- - - : _._.,, '• - -
f.'= .. . � -- -. ��
Applicant: WILLIAMS,.GARY i;i ` t�. � p �,r^} r�
Address: 1450 N TUSTIN AVE �x ,{� ` �, : � . , . � �, f �,. � � ,_ ' ,
7/� "_ i . i _ f ! �.? -`.�\
�� -,,- . � � _ J Phone: '
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{_ � ANTA ANA, CA ( �,. � . � �Zip ;_ 92705 - � \ �-:'; r �L,. � ` � � j y.�,`�,`
��.�._ '� .', ..� � //i.�,�"r" � ' � � � ���.�� -�! 'V"�<,�.
Owner SHEA HOMES LTD, �;� � ;' �'� ��;�\�`�
� Add,ress �� � i
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ACdress ��,�: ., : 1' r��.--.s>.,'- . .• , a` `� .
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License:000000 � -
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� � ' - = SCOPE OFPERMIT- —= '
3.y � .
, LOT 1/PLAN 26, . T's�I � ��J �• �� ki: rnm rr v �-v � �T . -� -. `;�� � .
�' ' ��. _` L � 1 .F ' ;.� i: e L' L �: � .-i '
'=:' MECHANICAL PERMIT-FOR NEW 2560 SF SINGLE FAMICY�RESIDENCE FOR "SHEA HOMES �" �_
', {,;';;,INSTALL 2�FAU'S�'I DUCTWORK, 2�FACTORY FIREPLACES, 6 VENT FANS, 2 FIRE DAMPERS; `-�`
: & 2 A/C CONDESORS. -;,, t,1 �.-,. - �"'
� . J�'./ h_F' � . . � ` \.�: 1/� . ' . t .lI �
'��REF:BOS-00166 ' - � � . - ==^-�' . '�� . -.. .,�
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', ' .u�� a� ' � , , �
ISSUE FEE '�. � ' �' �' $23.50
Inst FAU�1100 k BTU' � ��� � $29.60
Inst FAU >100 li BTU � SO 00
Repair/All`Cooling/Heat� �l \�$1370
Insl I Rep. Recess WalhHtr � ���
Refiig Sys <100 k BTU '�
Refrig Sys >100 k BTU ,= j;� �
Gas Piping � ��V " � . '���
Factory Fireplace . - ; � / `
Hood w/Mech Exhaust *,�_� �;��
VAV Box �
Vent Fad/ Single Duct , � .`:
Appliance �"
Fire Dampers � �'
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 10000cfm
'
FEE SUMMARY • , i " � ' ',' �,;
Quantity "� ._ _ - � � ri�'�� � Quantity
..Repair/AltAbsorbtionUnit ����,i,' t/�$0:001 0-i''
2 :'�,�.�� �''� RepaiUAlt Refrigeration Unit; i I��� �$0.00 /0
0 � Ven611ahon System ;. ' $0 00 �:0�
1 �� ���, Evaporative,Cooler � -IZ� ;�^ �000'a� 0
0,.�_ ,� � � '�Commercial.lncinerator;f,�-�'�i�ij' �.��' $000 �0
0 �'�- �,Domesllc Incinerato_r` � ,�/r,' � � ' $0-00 % 0
'�
5U UU . �0� �^, � ' �-Compre�, .
$000�;0�`,�� � �,� � �� .Upto31
121.30 2�� �, " �� ' " 3 T0;15-
$0.00`ti 0 = -.15 To r3(
�$000 ��0�;_� � �� �:.30�To'S(
��43 50 /j 6 ' � J - , � Over 50
�$0 00 � 0 `� f ' . � r;'_Bbders'�
I14.50,.2��� +� � ��-Upto31
$0.00��:-p-- ' -'' �. � `:.:.--3-To 15
50.00 �-'-0 `� �d -= � - 15 to.30
$0.00 0 �' - . -" . - � ,e 30 to�50
$0.00 0 � - - - -- Over-50
> / Absorphon Systems; !'> - / �, /
00 k BTU/ �� ;, /r � f�$��00 0
� ��. i $0.00 0
/;.1,000 k BT,U C`� ; ,, !�' S0.00 0
/ 1,750 k BT�U�^- ��' � �� ' $0.00 0
Over1,7508TU � �`' " $0.00 �0�
S`�� r % �
-1 ,//� i' ` 529.40 2
;�., so.00 0
'�`� � $0.00 0
.-� $0.00 0
$0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
iegulations. (Ord. No. 92-28, § 1, 12•21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 100 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
requlred Inspeetlona 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
zmses �aroo�
WORKERS'COMPENSAnONDECLARAnON: � - ' ' '
I here6y ettirm untler penalry oi perjury ona of the following tleclarations:- - � , � .
❑ I have antl will maintain a certificate of wnsent to self-Insure tor workere' compensatio�n, as pmvided for by section 3700 of the Labor Cotle, for the pertormance of the
work tor w�ich Ihis permit is issuad. ' - ' ' ' ' '
❑ I have anG will malntain woAcers' compensetion insurance, es raquiretl by section 3700 of Ihe Labor Code, for the peAortnance ot ihe work For whiU Ihis Oertnit Is Issuea. �
My workers' wmpensation Insurence wrner antl policy num6er are: ,
Carrier: Policy Number:
`(T/M1is sectlon need not be comp/e(ed i/ the permit is valued et one hundred dollars ($700) or /ess.)
$I I certity that in the peAormance of Ihe work tor which i�is pertnit is issuetl, I shall �not employ eny person in any manner so as to become suGject to Ihe workers' � "
�\ compensetion laws of Calitomla, entl agree th f should become subject to ihe workers' compensatlon provisions oi action 3700 of the Labor Code, I shall forthwith
comply with these pmv' ions. �l //
ApplicaniSignature: Date: d%/O�
Y� ,
WMNING: FAILURE T SECU W ERS' WMPENSATI GE IS UNUWFUL AND SHALL Sl1B1ECT AN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDFiED
THOUSANDDOl1ARE �.INAODRIdJTOTHECOS PENSATION,DnMnGESASPROVIDEDFORINSECilON3/O60FTHELABORCODE,IfJrEREST,ANDATTORNEYSFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm Ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business and Professions Code, and my license is in full
lorca and eXect. Lic. a Class M
ContractoYs Signature: Date:
CONSTRUCTION LENDING AGENCY: ' ..
❑ I hereby affirm that there is a construction lending agency for the peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lentlefs Name: Lendefs Address:
Signeture: Date:
OWNER-BUIL�ER DECLARATIONS:
I hereby eftirm Ihet under penfllry ot perjury,that 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business anG Professions
Code: Any city or counry which requires a pertnit lo construct, alter, improve, tlemolish, or repair eny slrucNre, prior to its issuance, elso reduires the applicant for such permit
to file e signatl statement ihat he or she is licensad pursuant to the pmvisions of the Contradors License Law (Chepter 9(commencing wi�h Sectlon 7000) of DiWsion 3 ot the
eusiness and Profeuions CoOe) or Ihat he or she is exempt theretrom end the basis tor Ihe elleged exemption. Any violation of Seclion 7031.5 by eny epplicent for e pertnN
subjects the epplicant to a civil penalry ot not more Ihen five hundred dollars ($500).):
❑ I, as owner ot the property, or my employees with wages as their sole compensation, WILL DO THE WORK, end the siructure Is not intended or oHeretl tor sele (Sec.
7044, Business antl Professions Coda: The Coniractors License Law does not apply to an owner ot properry who builds or improves Ihereon, and who does such work
himself ar hersalt or ihrouph his or her own employees, pravided that such improvements ere not intended or otterad tor sale. If, howevar, the building or improvemen� is
�sold within one year of wmpletion, the owner-builder will have ihe burden of proving that he or she did not builtl or improve for purpase ot sale.). �
I, as owner ol the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RAC70RS to constmct the project (Sec. 7044, Business antl Professions
Code: The contractors License Law does not apply lo an owner oi pmperty who 6ullds or improves thereon, antl who contrects for such prolect with a contrector(s)
license pursuant to the Contractors LicegqeJ,.aws.).
❑ lem
Owner verified dn Ys license.
Venfi ion of ers ip Dy (type ol
Business antl Protessions Cotle for this reason:
Date: y e% •f� /
Driver's License No. Expires: �. ly 0�
property �ax bill or daed):
DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTFICATON:
❑ I hereby cartify Ihet no exwvation five (5) or more teet in depth into which a person is required to descend, will be made in connectlon with work euthorized by this
permit, end ihat no building structure, sceflolding, talsework, or demolition or dismantling ihereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, TiUe B, Celitomia Atlministretive Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from Ihe Division oF Indusinal Sefery, es noted above, unless such person hes e
pertnit to do such work trom tha division.
SignaNre: Date:
Division of Intlustnal Sefery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORVATION OF ENTHV: I certity under penalry oi perjury that I have reatl t�is application and state that the inlortnation given is
correct. I agre to comply with all state,! end ciry ortlinances relating to building construction, antl authonze represeniatives of t�e Ciry of Cos�a Mesa to enler upon Ihe
ebove-descr' d pmperry or ins ec6 6 oses. I agr iot to occupy or allow occupency of eny building authorized by is per t until final inspection.
� . , v %x-i%� �
Sionat e Of LeaaLO ner(sl � Da�e
COOE I, 'INSPECTONTYPE .•. . • , . . D�iI: ` . • ��TA�� •� .,
1616
1268
200
Fixed System Final Fire Prevention ' ' � � "
Paol Spe Finfll
Final Re-Rooi
201 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Final Demolition
Date
'�� INSPECTIONTYPE '-" ' - � � � ' ' Q�i g
206 Final Mechaniwl � - '��
20B Final Plumbing
210 Final Electrical � ' '
212 Final Fire Prevention � � �
220 � Final PleBning Appmval � � � � '
.a . _ , . . . . , � ,.
222 Final Site �
250 Final Buildinq/Occupency � � ' �� ' '
(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
2301 HALF MOON LN
LOT 1
PLUMBING PERMIT.
Status: ISSUED
Applied: 04/27/2005
Issued: 04/27/2005
Parcel Nunmber. TPN00503 -� ' _ � � � �� ��� `�
� . , . ��_�._'.-C�i.=�,_:o`;'��,�..., t ISSUEDBY:
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Applicant WILLIAMS� GARY✓��' � � � � � ; � � " � _� _, �
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Address: 1450 N TUSTIN AVE, � - � '. � '� , �,
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SANTA ANA: CA `�-' � � ": - � Zip: 92705 - - � � . . > , � �`���' = A
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Owner. SHEAHOMESLTD%�� � % \��,�
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�' � ',PLUMBING PERMIRFOR NEW 2560 SFSINGLE'FAMICY�RESIDENCE� F,OR."SHEA HOMES"'INSTALL 3 i- " �(
` . ��`��� BATHTUBS, 1 DISHWASHER,7'GASfOUTLETS,'`1'WASHER^1,PRESSURE�REGULATOR, 1 SEWER�. �' , t,' :
' , ' � CONNECTION, 3 SHOWERS, 1 KICHEN'SINK; 1�SERVICE SINK,,UP TO 4 VACUUM BREAKERS, 3��, � 1 - -� �
,. �. � WASH BASINS; 1 WASH BASW SET, 4 WATER CLOSETS;1 WATER HEATER; 1 WATER PIPING; &�1 ,: .�., J i; •�;�
- �� WATER SERVICE: ' - '�_ - , .�` r� � _ � -r � - � �
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� � FEE SUMMARY Z �, %
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• '�V !�'� AMT ; �` QTY „w ,��ts ' �r,. _ � ��� AMT�nQTY_ ,y�3y� � ;��/% .� ' , �."�AMT
ISSUE FEE ��; � $23 50 �,,�; � . . ?,.Laundry Tub / Washer � �O $9 80 1 � F �"" Sump Pump ' j -� $0.00
Backflow irrigation,�� � 50 00� �-0 �\�� �iLandscape-Irngahon � 't, $0 00 " :0 - � � rSwimming�Pool � ^� i 50.00
Backflow Preventer � `'� $0�00�',� 0'�' �`��P Trap �": ` " �- � ,$0`OOy p 0 ",y ��Trap.Prime�% � ����;� 50.00
Bathtub. �',� $29;40i �. 3 ` ` `Pressure Regulalor, � ° ; $9 80 � 1�� i %� j nnal !'1� li �� � $0.00
Connect ( ce,Soda etc) '�+$0�00 ''� %0 % `; ,'��Re�cepto siping (per 10 ftj_ '*$0�00-'"0 r~ \\�Vacuurii�6rkpBkflow(5+)) $50.00
Dental Units � 50.00 � . 0 � �; ,- _�Septic Tank � $0 00�--y 0"� �� �, �WasFi Basin�; '� $29.40
Dishwasher $9 80 �-` `_1 .. � Sewer Cap for Demo�, r;.,, ��$0.00 � A�J ��, Wash"Basin Set $9.80
Drain, Floor 50.00�� . � 0 �-.���. ' �Sewer�Connect - ' _ $24.65� ,:=7'y�..� Waste and Vent System $9.80
Drain, Rainwater $0.00 � 04��� - - Sewer Private Line�,`, . ! � , $0.00-�""0 �-?�Water Closet (Toilet) $3920
Drain, Roof $0.00 0 � - - - SFower . $29.40 . - 3-;%�'�; %Water Heater / vent $12.30
Drinking Fountain $0.00 0 ' Sink,�bar� � _' �: ���",;�_ �;30:00 '�b�-""� Water Piping (Inst or Rep.) $9.80
Expansion Tank $0.00 0 Sink, commerciaf� �-- ----�$0:00 ���{ 0 Water Re-pipe 50.00
QTY
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0
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0
1
0
3
1
1
4
1
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NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This pertnit shall automatically ezpire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order foi the work authorized under ihis permit to be considered legal, such work must wmply with all applicable codes, and all
requlred Inapeetionc and final approval must be obtained. Failure to obtain inspectlons and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545826
zme-ee �aoo�
WORKERS'COMPENSAnON DECLARAnON: " � � -
I hereby aHirm under penalty of perjury one of ihe lollowing declawtions:. �:'b ; . . ' . � . .�
❑ 1 heve antl will maintain e certificate ot wnsent to self-Insure tor workers' compensation, as provitled for by section 3700 oi tha Lebor Code, for the pertortnance ot t�e
work for which ihis permit is issue0. -' ' � " � ` '
❑ I heve antl will maintain workers' compensalion insuranca, as required �y section 3700 ot the Labor Code, for the pertortnance of t�e work for which UI5 pertnit is issued.
My workers' compensatlon Insurance carrier antl policy number are: '
Certier. Policy Number:
(7his secGon need not be camp/efetl i/ fhe permit is veluetl ef one hundred dallers ($100) or /ess.)
�I cenify that in t�e DeAormance of the work for evhich t js p`prmit is is'suetl, I shall not employ eny person in any mannei so es to tiecome subject to the workers'
compensetion laws of Calllomla, and egree that if s li Qbecoma subject to the workers' compensation provisions oi Section 3700 of ihe Labor Code, I shalllort�with
comply with these pmvis'
Appliwm SlgnaNre: Oate:
WAiiNINQ: FAILURE T SECURE W KE COMPENSATIIXJ COVERA IS U WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENAlT1E5 AND GVIL FINES UP TOONE MUNDRED
TMOUSMIDDOLLRRE� ,000 OD ONTOiHECOSTOFCOIAPE ,DAMAC.ESASPROVIDE�FORINSECTION3]OBOFTHELABORCODE,IMEREST,ANDATTORNEV'SFEES.
LICENSED CONTRACTORS DECLARATION: -
I hereby aflirm thal I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professlons Code, and my license Is In full
torce antl ettect. Lic. N Cless p
Contraaors Signawre: Date:
CONSTRUCTION LENDING AGENCY: , �
❑ I hereby aHirm Ihat Ihere is a consWction lending egency for ihe pedormance of ihe work for which ihis pertnit is issued. (Sec. 3097, Civil Cotle).
Lentler's Name: Lenders Adtlress:
Signeiure: Date:
OWNER-BUILDER DECLARATIONS:
I hereby atfirin thet untler penalry oi perjury ihet I am El(EMP7 FROM THE CONTRACTOqS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons
Cotle: Any ciry or counry which requires e pertnit to wnsiruct, alter, improve, demolish, or repair any swcture, prior ro its issuance, elso requires the epplicant tor such permit
to file e signed statement ihat he or she Is licensed pureuent to the provislons of ihe Contrectore License Lew (Chepter 9(commencing with Seclion 7000) of Dlvislon 3 0l Ihe
Business end Professions Code) or Ihet he or she is exempt iherefrom and Ihe besis for Ihe alleged exemption. Any violation af Section 7031.5 Dy eny applicant for e permit
subjects ihe epplicant to a civil penalry of not more Ihan five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages es their sole compensation, WILL DO THE WORK, end ihe structure Is nol intentletl or offered tor sele (Sec.
7044, Business and Professions Cotle: Tha Contractors License Ww dces not appiy to en owner of property who builds or improves ihereon, antl who does such work
himsetl or hersetl or through his or her own employees, provided ihat such improvemenis are not intended or ottered for sale. It, however, the Cuilding or improvement is
sold wit�in one yeer ot comDletion, the ownerbuilder will have the burden of provinq that he or she did not build or improve tor purpose of sale.). �
�I, as owner ot Ihe properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo consiruct ihe pwject (Sec. 7044, Business entl Professions
CoEe: Tha wntractors License Law does not ap ly to an owner of property who bWltls or Improves thareon, and who contracts lor such project with e contrector(5)
license pursuant to iha Comrectors Licen s.).
❑ I am exempt u r sec. B ess an0 Protessions Cotle for ihis reason:
Signature' Date: y� Si I1 �- . /
Owner verifietl by d ef license. � Ves ❑ o Drivers License No. � Expires: i, �Q�
Venfican of ship y(rype ot tlocument, i.e. - pmpe tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity thet no excavatlon flve (5) or more teet in tlepth into which e person is required to descentl, will be made in connection with work aut�onzetl by Ihls
permii, entl that no building sWcture, scaHolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, A� 2, Sec.
341, Tfle B, Celitomia Adminisirative Code).
❑ As owner-builtler, I will not employ anyone to do work which would require e permit from the Division of Indusirial Safery, as notetl above, unless such pereon has a
permit to do such work trom the division.
Signatura: Date:
Division of Industnal Safery Pertnit Number:
CERTIFlCATE OF CAMPLIANCE AND AUTy RIZA710N OF ENTRV: I certi(y under penalry of perjury Ihat I have read IhiS application and siate t�at ihe information given is
correct I egree to comply with ell state 1 tG ntl ciry ordinances relating to builtling construction, antl authorize represenlatives ot the ity of Costa Mesa to enter upon the
above-tlescnhed property for ins ec �o oses. I egree lo acupy or allow occupancy of eny building authorized by this dermit u I finel inspection.
� �i/„7� 6S-
Signaiure O gal Oy� r(s) Date
COUEI. INSGECTIONTYPE � " ' �
1616 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof - ' -
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
,
, p�g...... .,i i
" '�Qp�� INSPECTIONTYPE � � ` �
206 Final Mechanical
20B Final Plumbing
210 Final ElecMcal '
212 Final Fire Prevention
220� - �final Planning Approval
222 Final Site
250 Final Building/Occupency
. .. . PAIE I[�ELS
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