HomeMy WebLinkAbout2250 PAMELA LN - Building PermitsI\
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
BUILDING PERMIT
Job Address: 2250 PAMELA LN
Suite:
Vicinity: ROOF
Parcel Number: 42237215
App�icant: CARACHURE, ARTURO
Address: 5951 CHERRY AVE
SUITE C
LONG BEACH,CA
Owner: RASTEDT, ALLAN R
Address 752 ST CLAIR
COSTA MESA, CA
Contractor: A.H.R. BUILDERS
Address: 5951 CHERRY AVE
SUITE C
LONG BEACH, CA
Zip: 90805
Arch :
Address:
■
Zoning:
Phone: 562-422-1183
Zip: 90805
Phone:
Zip: 92626-4314 �
Phone: 562-422-1183
License:� 694101
, Eng:
Address:
Phone:
Status: ISSUED
Applied: 01/30/2003
Issued: 01/30/2003
ISSUED BY: � C�
Phone:
�
Zip: License: License:
_ SCOPE OF PERMIT_
RE-ROOF OVER REMAINING 1 LAYER, ASPHALT, CLASS A. 2,100 S.F. FOR RESIDENCE ONLY.
Plan Check: $0.00
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Lek 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0-0
Right 0- 0
$3,400.00
$3,400.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapectlons and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446�4616/00�
WORKERS LOMPENSAnON DECLARAnON: � �
I hereby aHirm under penelty Of perjury one ot the following tleGaretion5: �
❑ I have entl will maintain e certificate ot consent to self-Insura tor workers' compensation, as providetl for by seclion 3700 oi tha Labor Code, tor the pertortnence ol Ihe
�nrk tor which this permit Is i5sued.
.� I have end will meintain workers' compense�ion insurance, as raquiretl Dy sectlon 3700 of the Lebor Code, lor ihe peAortnance of t�e work tor whic� Ihis pertnit Is Issuetl.
My worker5' compense�ion Insurance carner antl pollcy number are: -� /
Carrier. S�Ai�- �--i ]/� � i PolicyNumber: � f'OOS f-� O
(This sectlon need nat be comp/efed i! the perm/f is valuetl et one hundred dollers ($100) or less.) . ..
❑ I cenity Ihat in the pertormence ol the work for which �his pertnit is Issuetl, I shall not employ any person in any menner so as to became sublect to the workars'
compen98tlon lew9 of Cellfomia, end agree Ihet ii I should become sub�oct to ihe workars' compensatlon provislons ol Sectlon 3700 of the Lebor Code, I shelllorihwith
comply wilh these provisions.
Applicant Signature: � oe�a: � —> — a3
WARNING: FAILURE TO SECURE WORKER ' MP BRiION WVEMGE IS UNLAWFl1L AtJD SHALL SUBIECT AN ENPLOVER TO CfUMINAL PENALTIES AND GVIL FlNES UP TOONE HUNpRED
T110USPNDDOILARE(510p.000�.INADDITlO TO IECQSTOFCOMPENSATION,OAMAGESASPHOVIOEDWRINSECTION3]O60FTHELABORODDE,IPIrEqEST,ANDATTORNE`fSFEES.
LICENSED CONTRACTORS DECLARATION:
I, I hareby aMirtn that I am licensed under provisions ol Chapter 9(commencing with Section 7000) of DMsion 3 ot Ihe Business ary�Professions Code, antl my license is In tull
� force end aNect. Lic. a Cless a {S., C—z ��_
ConirectorSSigneture: Date: l- �D �ns
CONSTRUCTION LENDING AGENCY:
❑ I �ereDy attirm that there is a conswction lentling agency br ihe peAormance of Ihe work for which Ihis permit is issued. (Sea 3097, Civil Cotle). .
Lender's Name: Lentlets Address:
Signe�ure: Date: i,
OWNER•BUILDER DECLARA710NS:
I hereby eHirm thet untler penelry of parjury thet I em EXEMP7 FROM THE CON7RAC70RS LICENSE LAW far the tollowing reason (Sec. 7031.5, Business end Professlons
Cotle: Any ciry or counry which requires a permit to conslrucL elter, improve, demolish, or repair eny strucWre, pnor to its issuance, also requires the appliwnt for such permit
to file e signed stelement Ihat he or 5he 15licen5ad pursuent to Ihe O�ovisions of Ihe Contractors License Law (Chepter 9(commencing with Sectlon 7000) ot Divislon 3 ot the
Busine5s entl Prolessions Cotle) or that he ar she is exempt therefram antl the basis for Ihe ellegetl ezemptlon. Any violation ot Section 7031.5 by eny epplicant for e pertnit
subjects the applicant to e cMl panalry of not more than fiva hunAretl Aollars ($500) J:
❑ I, as owner ot the Droperry, or my employees with wages es their sole compensation, WILL DO THE WORK, entl the structura is not intendetl or otteretl tor sale (Sec.
7044, Business antl Professions Cotle: The Contractors Llcense Lew does nol apply to an owner of properry who builds or improves thereon, and who tloes such work
himselt or herselt or t�rough his or her own employees, provided thai such improvements are not Intended or offered tor sale. H, however, tha builtlinq or Improvement is
sold within ona year oi completian, the owner�builder wiil heve Ihe burden of proving that he or sho tlitl not build or improve for puryose of sele.). '
❑ I, as owner at the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prolect (Sec. 70a4, Business antl Profassions
Cotle: The coniractors License Law does not epply to an owner of pmpetly who 6uilds or Improves ihereon, antl who coniracts tor such pmject with a coNractor(s)
license pursuent to the Contractors License Lews.).
❑ I am ezempt under sec. Business and Professions Code lor Ihis reeson:
Signeture: Date:
Owner ID venfied by dnvefs license. ❑ Yes ❑ No Drivefs License No.
Verificetion of Ownerehip by (type of document, i.e. - property tex bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PEHMIT CERTIFICATION:
E:pires:
❑ I �ereby ceniy that no excavation five (5) or more fee� In dep�h Into which a person is required to descend, will be matle in connection with work euthonzetl by this
pertnit, end that no Duildinq siructure, sceMoltling, falsework, or tlemolitlon or tlismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Califomia Atlministrative Code). ,
❑ As owner-Eulitler, I will not employ anyone to do work which would reduire a pertnil Irom the Division ol Industrial Sefery, es notad ehove, unless such person has a
pertnit to do such work trom the tlivisian.
Signature:
Division of Industdel Safery Permit Number:
Date:
CERTIFlCA7E OF COMPLIANCE AND AUTHORVA710N OF ENTRY: I certity under penalry ot perjury lhat I heve read Ihis application end state ihet ihe inlortnation given is
correct I agrea to compy with all stata laws entl ciry or0lnances relating to building consWction, end eu�horize representatives of ihe Ciry of Costa Mesa to enter upon the
ebove-descri6ed propeny for inspection puryoses. I egree not to occupy or allow occupancy of eny building euthorized by Ihis permit until finel inspection.
cooe ".
7616
72fi6
Flzetl System Final Fire Prevention
Pool Spa Finel
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolition
P97F INTRIALS
%� ,Ij /��
Date
�— 7'a .— D � .
Date
CODEA INSPECTIONTYPE
206 Finel Mechanical
20B Flnal Plumhing
210 Final Elettntal
212 Finel Fira Preven�lon
220 Final Planning Approval�-
222 Finel Siie -
250 Final Builtling/Occupency
PS7E I[�96$
AGP�7cant to fill In all spaces wit�ln
CITY OF COSTA MESA P MIT NO.
CONSTRUCTION PERMIT � - .3ro �II
Addrea
Phone
License No.
boraer lines ana sign ��I approo��ale aeclaralions.
TRACT NO_ 'LOT.NO: - BLDG. NO.
TVPE OF CONSTRUCTION "
❑ NEW ❑ AOD ❑ ALTERATION
�O REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER ' � '�
DESC PT�ON OF ORK
Address
Contractor ones • TVP OF PERMIT1 ' "
AddfCu 5¢. ' f.:j $f . � GRAOING Cr FpUNOATION � STRUCTURqC
iLICENSED CONTRACTOR.DECCARATION ����7ENAIJT-OELECTRICAL ❑�WMBING �❑MECMAP
�1 horeCy alfirm th:.t I am IICdnS¢tl �untlm p�ovislOns O( Chdrtlr 9(COT- , �
menting with section 7000) ol DIVISion 3 0/ the BusinOss antl ❑ OTNEF ��
�Professions Cotle, antl my ���enso Is in full force antl etlact. pROJECT DESCRIPTION.
iLlcensLe Clas.s� �'�.� Lice No '
Date�.�J�c 519natu '� ' � 5�. �. � � '_ . . ^ ��
WORKERS'�COMPENSATIONDECLARATION . __ OCCUPANCV � fCONSTRUCTIONTVPE �
I hereby attirm that I have a ter[ifltate of tonzent to Self-insure or a VACUATION -�`�Z.� ZONE ���Z
�CP��itifdte of Wolkefs' ComP¢nSdtlOn InSUranCB, Or a C¢rllflOtl COpy - - _ . . _�
' bf (Sectlan 380Q 1a0. LJ. .GRADING CU. YDS. ACRES
/ No. " " COmOany ' -
VCertltieticopyisherebyPomishetl. .. . _ _.� . REMARKS:�'� . _ _. _ .
❑ Certitie0 copy 6 tiled with the dty BuilGing Division. ..
EXEMPTION'FROM'WORKERS' COMPENSATION DECLARATION -- ' - -' �'- - - �
(T�Is 5ectiOn p¢etl not be com0�etetl if the permit is for_one_hunUrM -- - �
(E100� or less�. ( ' � , - - ' "" " "
I certi(y that in the performAnce ot M�ue a for which tbis per iz
ISfueE, I shall riot ¢mploy atlY Par irf'n an Tann¢r so t to b e�"PLUMBING -� "' PLAN CHECK
suDjeCl t%o he .W�o�r�ke�rz.' Gompen o LawS � U' r
Date�y�-n�cignature ' BATHTUBS SHOWERS- -� -
NOTICE: It after making [his tle<ar wn, you ShoWU become subject -TOILETS �, „ - URINAlS " •'
to Ibe Worker5' Compensation provi5ions ol th¢ Labor Cotla, you�must �
torthwlth comply with such provisions or Ihis permit shall �e deemetl LAVATORIES DOVB�E LAVS -' �' '
�evoketl._. . .
CONSTHUCTION LENDING AGENCV 'KIT.SINKS "' ' ' DISHWASFiERS
I hereby af/irm t�at there is a conslruction lentling agency br the per- SERVICE SINKS . SUMPS -
formance of the work tor wbic� this permit ii istuetl (Sectlon 3097 ° �
Civ: C:�. - -- - --- - ' '- ' • - PLOOR SINKS � FL000. DRAINS � �
Lenaer's Name
Lentler'S Atldress ORINKING FOUNTAINS- I ' '' ''
OWNER BUILDER'DECLARATION - � INTERCEPTORS CLARIFIERS - �
I hGr¢by aHirm thdl I am exemP� �/om the CAntrattOr'S Lic¢nie Law for
(h¢ followin9 I¢d500 ($¢CHOq�7031.$ Bu5i�C55 antl Professions CoOe: «y�Mr„��Nr onni - o�Touo --- -- -
for
to '
tor a permit
�han fivc huntl
1, d5
equires a permit lo tonstrutt, aller,
'SIlUCI11/Q PIIOI IO Il5'ISSIId11Cl� di50 f!-
rmit to ille a signed i[atement that ha
i5ions of tne�ContractorY Ucense Law
Sectlon ]000) of Oivision 3 of the
Or that he is OxOmpt lherofrom and'lh0
. Any vlolation of Snttlon ]031.5 by
ojutts thp appliwnt to a clvil penalty
tlollar5 (5500).
Gontractor•s License Law tloes noq appry to an owner o� a properry
who builtl5 or Improv¢s ther00n, antl who tloes sucb work �Inisell or
Mrau9M1 M1is own employees, p ovitletl thdt suGh ImprovCmentS a/e not
IntentlCtl or oileretl for Salm I�r, howeveq [M1a Uuildin9 or Improvomant
is soltl wilhin one year O/ COmPleliOn, the owner wlll have llm bur0en
of proving he tlitl no( builtl ar improve br the purpose ol sale).
�-I,-as ownor�oi-the� proPerty,-�am uzclusivety CAntractin9 with
licensetl contractors to construct cne pro)ect (Saction 7049, Business
antl Prolessions Cotle: T�e�CO�lrattor's LlcOnse Law Coei not apPly Lo
an Owner of property wh0 builtls or ImprOVCs lher¢on, antl wM10 con-
tracts trom such-projacts-wl�h a conVactor(s) IICBinutl-pursuant lo
the Contractor'S License Law�.
❑ I am ezempl unaer'Section �- - - B. & P. C for lhis
thal I M1ave reatl this
wrrec ree lo
s aws rmat�ng to
WATER SERVICE - ALTERATION
Gi155ERVICE OUTLETS
WATER HEATERS`-' BTU OUTPUT
SEWERCONNECTIONS '-' '
SOCAR TANK " '- COLCECTORS
$OLAR PIPING SVS. �
'ISSUEFEE �
MECMANICAL aLAN CNECK
HEATING SVSTEM 0-]00,000 BTU_
AND DVCTING � 100,000+�BTV _
REFRIGERATION 0-]00,000 BTU_
SVSTEM --' 100,000�+BTU_
BOIlERS BTV
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MU�TIPLE
Signat ' Date a-�Y'S -
Drivers' Lic or 55 �
�,� -- ISSUE FEE - - -�
CMF 0865-46 White-Builtli�9; Unary-Appliwnh Pink�Accounling; Goltlenrotl-Assessor
c��
a
6337 5/25/82 64.02 TL�
A.P.3F /�GJ�IOrL�/—1
ZONE yIi % PLNG.REF.
PKG.
H PARK
DVEDBV yl . II�
SPECIAL
�.T . _ '__ .__ � "
ELECTRICAL' - ' "- -- cCArvYHECK -� - " I" " �
- '�GENERATOR " 0-1 KW_1-10 KW
,TRANSFORMER . 1
-' ' APPLIANCE 10�50 KW_50 + KW ' '
'�MOTORS�" p-I HP-=310"HP ' --
'(INC.SOLAR) �-]0-SOHP_-SO+HP � - �
"�FIXTURES'-' OOTLETS SWITCHES"" :,_ -
�
GAS TUBE SIGNS ' �"' " ' ' - ' �
POLE LIGHTS " ' '- - - ' ' - '-
I
POLES METERED SUB �
PANEL$ ��' MAIN � SUB -
�SERVICE -' ' ' - ' AMP' " '
. . . .. . . . _ , I
. - _ _ ' � . � _ . � .
i ' ISSUE'FEE "' ' ' ' ' ' - '
'APPLICATIONAPPROVED'BV- 'Of1TEr
SUMMARV OF FEES , , (,•• I
BUILDING-' �j� ..�� /�
PERMIT §��j�.��1,._�{L. r� $MIP' a.� 'E_4L� �
PLANCHECK b_G�..]...SL(� PERMIT- '
+ '- " ' ' ' - --'. ^ ISSUANCE- �S- -
'PLUMBING S ; +. � � '
-GRADING 'E.' �
PLAN CHECK E , \' .
ELECTRICAL $ ' - $ "�
'MICROFILM_§�� � �
PLAN CHECK ' § "�} ' . . �.�.
'�MECHANICAL 'E -' - . TOTAL.FEE;B' _ {
PLAN CHECK �E -- � LE55 AD-'� • �
�VANCEPC $_
/' / I
. _ , , _ FINAL FEE $ b`7" oL
CONSTRUCTION AND PLANNIj�IG���� � � � POOL & SPA � - -
APPROVALS Permit# � Date Inspector -qppROVALS . Permit# Date Inspector
1. Temporary Electrical Service or Pole - - 43. Pool & Equipment �ocation ` • • - ' - • � • �' ` • • - -
. Soil ipe-Undrgm � 44. Steei Reinforcement - -
3. Electrica� Cony7uit Utility_U�drgm _ 45. Forms �
4. Electrical Contluit-Undrgrn 46.. Electrical Bonding . � - - �
tee ein orce � 47. Rough�Plumbin & Pressure Test ' -� � -
6. Electrical UF�R Grn � ' 46. APPROVAL TO COVER-GUNITE - - �� - --
7. Footings 49. Electrical Conduit-Undr rn �
8. Foundation 50. Gas Pipe„ � Undr tn, Test �' ' � �
9. Water Pipe-Undrgrn ._. 51. Backwash Lines P-Tra � �� nd? rn - " - "
10. Structura� Floor System 52. APPROVAL TO DECK ""-""- �'"'--"- � '
11. Property Sewer Line & House-Connection , 53. Backwash & Rece tor-Final '" � �
.. 12. Street Sewer C,onnection � ' 54: Heater & Vent-Final - '
13. Rough Plumbing ' ' - - �
14. Rough ElectriC-Conduit - - -56. Electrical-Final -
15. Rough ElectriaWiring � - 57. SolarSystem-Final '
16. Rough Heatin & 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 Sheathin .. � ' , . , . � , . r•., �
22. Fremeand Flashing 5 z NOTES:
23. Insulation " ' ' � " -
24. Lathing & Siding � � - - - - �
25. Drywall Nailing � � ��
- 26. Plaster Brown �at '
27. Electrical Power Meter-Final • � � � -
28. Final�Electric �
29. Final �Heating & Air Conditioning • �
30. Final Gas Pipe-Test. ' � �
; 31. Final Plumbing. ' - - � ' -
' 32: Water Service-Final- _ � �' '
� �33. �' Gas $ervice,Final � � - ' '
� 34. Solar pomestic=Final •-�• " ' � '� - �' • �
35.- Landsca e S rinklin S stem ' "
36. Sound Attenuation � �
37. Handicap Regulations � � �� �� • ' �
� 38. FINAL STRUCTURE & BUILDING .�j (J '
� 39. Special Requirements Completed �
40. Electric Release to Edison
- 41. Gas Release t0 Southern California Gas Co. � �
' 42. CERTIFICATEOFOCCUPANCY
� No.' Date . ,
�
,; No�$
� �f r/�ii� 3=o G o�
, �. L/NE' � %�OIt.tP�%
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e
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a. k�,f' ,���C:,� y'rS• �'� � u.x. ��PI 30��2 oe. 32�i6
.3. S�d�.:.y �y y'rs' I
r rus „2jr��v l8' E.l^r.�'R.
"_owr,:dt wa�� �fi�86Ce.rs. pp,,� � kA�cu �iST
_%i�.�+�sd 4�: 7 h� K 3�'.r.�fw 41-� S
�VE,2.. iS /85. FEtT i
— - -- ---�.
-- - - -� s � , _ ,�
�� .
��PR�i' E�
�/ of Go,$ie Mesa Buiiding Dept.
THESE PUNS MU57 BE ON JOB Ai ALL TIMES
MAKE NO GHANGES WIiHOU[ PRIOR APPROVAL
OF DEPf.
THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL
OF PLANS HND SPECIFICATIONS SHALL N0T BE CONSTRUED
TO BE A PERMIT FOR, OR FN APPROVAL OF, ANY VIOLATION
OF ANY OF THE PROVlSIO�S OF THIS CODE. NO PERMIT PRE•
SUMING TO GNE AUTHOHITY TO VIOIATE OR CANCEI 7HE
PROVISIONS OF THIS CODE SHALL BE VAUD, EXCEPi IN SO
FAR AS THE WORK OR USE WHICH IT AUTHORiZES IS 4AWFUL
TNE ISSUANCE OF A PERMIT BASED UPoN PUINS AND
SPECIFICATIONS SHAIL N07 PREVENT THE BNLDING OFFICIAL
FROM TNEREAFTER REQUIRING THE CORRECTION OF FRRORS
IN SAID PLANS AND SPECIFICATIONS OR FflOM PREVENTING
BUILDINC OPERATIONS BEING CARRIED ON THEREUNDER WHEN
IN VIOLATIOY Of THIS CODE OR OF ANY OTHER ORDINANCE
OF THE CITY. ^
�TRUCTURAL APPROVAL ONLY
SEPARATE PERMITS ARE REQUIRED
FOR ELECTRICAL, PLUf1161NG,
HEATING, VEf�TILATiNG AND
REFRIGERATION WORK
P���6� # �3 - .36 q/
7HIS NUh16ER NUST ACCOMPANY
ALL INSPECTION REQUESTS
FOR BUILDINGS YlHE,�e PERSO;�S ARE TO
BE EMPLOYcD, l'iE t_ �;ES7 THA7 7HE i
SiAiE OF C4L:; �.,Ik DlVISION OF ;
INDUS7RIpl S',FET? c= CONSULiED FOR i
ADDI710NAL REQUIRGYIENTS.
��!� �������
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aie ..:e .a: �a ��. n�...�
,� J?4� _ ,..... . .. 'tt..
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n.,+,+.,N a0 S•4i21'�C
Hpplmant [o hll m all spaces wrtmn neavy eoroer unes ana agn an appropna�e oenaratmns.
, GTY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. ' BLDG. NO. - ' '
CONSTRUCTION PERMIT C�'3 ''' 7068 6/08/BB ` 8.00 '
Projett Address � Z t, ��`: �� "- " . - .
,$a � a TYPE OF CONSTRUCTION . .
Ownef Phone ❑ NEW ❑ ADD ❑ AITERATION - ' �
Address - - - — - � � REPAIR ❑ CONVERSION ❑DEMOLISH
❑ o7HER ZONING REGULATIONS � •
' Arch/Eng. - � ' License No. - - . A P � -
DESGRIPT ON OF WORK ' -'
Addre55 ZONE PLNG. REF. � �
t
-Contracmr ? ' � Se Phone ( �7ypEOPPERMIT " oN Tp gU i DiNG - �
$ETBACKC LST. P0.0PE�TV LINE'
Address �.��j �'- ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL SIDE VARD' -
LICENSE� CONTRACTOR DECLARATION ' � ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA L5EOE VAR ' -
I hereby aftirm that I am licensetl untler provisions of Charter 9(com- � q�GHT ' -'
mencing with section 7000) ot Division 3 ot the Business antl ��� OTHER
Professions Cotle, a tl my license n full torcc antl� eftect. REAR VARD (TO P/L)
�G�_ PROJECT DESCRIPTION
LicenSeClass��/�� , icense o�� - � PKG.SPACEREq. PROVIDED
Date �^— L^i� Signatu SQ. FT. .
WORKERS' COMPENSATION DECLARATION OCCUPANCV_CONSTRUCTION TYPE STREET WIDTH PARK FEE $
I hereby afflrm that I have a rertificate ot consent to self-insure or a VALUATION - ZONE Z�NING APPROVED BV . DATE
certlfiw[e of Worker5' Compensation Insuranc¢, Or a CertlfieC copy .
'wsxeof (Section 3800, Lab. C.). GRADING CU. VDS. ACRES SPECIAL EONDITIONS:
=��cY No. ComPany ' ' - _ . .. .
-��-{Ce�tltietl copy IS he�eby (umishCtl. REMARKS: . . .
❑ Certifietl copy is filetl with the city Builtling �ivision. , ' . - ,. .
EXEMPTION�FROM WORKERS' COMPENSATION DECLARATION' ' ' �� "
(This secHon neetl not be completed if the.permit is for one hundretl. . �� "
($300) ar Iess1. . �� � -' - - -
. I certify that in.tM1e performance of tM1e work for which this permit is
I5sue0, I shall not employ any perso ny manner so as to become . PLUM8ING - PLAN CHECK ' ELECTRICAL � PLAN CHECK
subject t thy Q wo�r_k�ers, C 9mpensat,� Law o; Cylif�a,i O . ' . ____ _, �- _ _
Datef6 SI natur -�� �. BATHTUBS SHOWERS _
NOTICE: If after making this tleclaration, you shoultl bemme subject TOILETS � URINALS '' - - GENERATOR '" 0-1 KW_ 1-30 KW�
to th¢ WOrkers' COmpenSatlon provisions of the Labo� CoCe, you must � TRANSFORMER �
forthwlth comply with such provisions or this permit shall be tleemetl LAVATORIES DOUBLE LAVS ' - APPLIANGE 30�50 KW_SO+KW ' '
. �evOketl. . . _ .. . __
CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS ' MOTORS 0-1 HP=1-30 HP -
I hereby atfirm that there is a constructlon lentling aqency for the perv SERV ICE SINKS SUMPS" - " ' �(INC. SOLAR) 30-50 HP -50�t HP
formance of the work for whicb this permit is issuetl (Section 309�
Civ.'CJ. - - "- FLOORSINKS F�OORDRAINS FIXTURES - OUTLETS SWITCHES" -
Lentler's Name
Lentler's Atltl/ess � DRINKING FOUNTAIN$ � � GASTUBE SIGNS '' -
OWNER BVILDER �ECLARATION ' '' � INTERCEPTORS CLARIFIERS - POLE LIGHTS "
I he�eby atti�m that I am exempt from the ContraC[or'S Li<¢nze Law for '
the followinq reason (Section ]031'.5 Buslness and Profe55ion5 Cotle:' SWIMMING POOL � PTRAP ' ' ' ' ' '
Any city or county whith requires a permit to const�uc[, alter, POLES METERED SUB
improve, tlemolBn or repair any structure, prlor fo If5 issuance, also �e- yyqTER SERVICE ALTERATION � PANELS -- MAIN ' ' SOB
quires the ap4licant for such permit to file a siqnetl slatement that he
'is licensetl pursuant to the provisions of the Contrattor's License'Law- GASSERVICE' OUTLETS ' � SERVICE ' AMP
(Chapter 9(cOmmencing with Section ]000) of Division 3 of the -
"'�ness antl Professions Cotlej or that he Is ezempt theretrom'antl the" y�qTER NEATERS BTU OUTPUT � -
fo� lhe alle9¢tl exemption. Any violation of Se<tion ]031.5 by - a
appliwnt for a permiYsubjects the'appli<ani to a civil penalty SEWER'CONNECTIONS ' � � � ' " ' '
�. .mt more than five hundretl tloliars (g500).
❑ I, as owner of the property, or my employees witb wages a5 their SOLAR TANK �COLLECTORS � - - ' � � '
.sole.compensation„will tlo.the wo�k, antl Ihe slruCturE is not Intentletl _ __ _ _,
or offeretl for sale. (Section ]044. 6usiness antl Professions Cotle: The SOLAR PIPING SVS. �SSUE FEE ' -
Con[rattOr's Lit¢nse Law tloes.not,appry to an owne� of a property �
wM10 builtls o� impwves thereon, antl wha tloes su<h work himself or ISSUE FEE APPLIGATION'APPROVED BV - ' DATE
th�ough.his own employees, provitletl tttat such imp�ovement5 are not
intentletl or ot(eretl for sale. If, howeve�, the builtling or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES
is soltl wifhin one year of completion, tM1e owner will Itave the burtlen
of proving he tlitl not builtl or improve for the purpose ot sale). BUILDING- '-" '
❑ I,- as owner of -the property,- am exclusively contracting with HEATING SVSTEM Od00,000 BTU PERMIT $ SMIP g'-
AND DUCTI NG
licensetl ronlraclors to tonsttuct tbe project (Section ]044, Business 100,000+BTU PLAN CHECK S PERMIT
antl H'ofessions Cotle: The Cont�actor's Licenze Law tl025 not apply to - - - ISSUANCE $�
an owner of prOperty who builtls or improves Ihereon, antl who mn- REFRIGERATION 0-300,000 BTU PLUMBING $
tracts �ftom such projects with a contractor(s) Ilcesnetl-pu�suant to SVSTEM ' - - - - �GRADING $
Ihe Contracror's License l.aw). 300,000 + BTU PLAN CHECK $ , �
❑ I am exempt untler Se[tion B. & P. G(or tfii5 gOILERS BTU EIECTRICAL $ � �� , ,�-$ . ,.
reason - � MICROFILM$-
Date Owner SVSTEM REPAIR, ALTERATION P�/�N CHECK S - TOTAL FEE $'�
MECHANICAL, $ ' '
I hereby certify that I have reatl this application and state that the above EXHAUST SVSTEM MUI.TIPLE' . '. � LE55 AD- �'
�intormation is mr�ect. I agree to mmply with all city antl county PI.AN CHECK $� VANCE PC $_
ortlinances antl st ws �elatinq to construction tl ner¢by authOrize � '� , . , ,.
representativ of [his' city to enter up0�- e-above mentionetl" '' �- ' ��
property r�specti6n�p� 5e5. /� � p��� , FINALFEE E •Q� �
Signatur �� � �ate �11(C
DriverY �icense or 55 � �SSUE FEE � � - - - - . -
CMh UtlbS-nb Wpf(e-Bulltling; Canary-Applicanq nnK-qccounong; uoipenroa-�asseswr
CONSTRUCTION qND PLANNING / POOL & SPA, •. - � .
i�.�� � . , . - .
Date Inspector '� � �rr Date,_ Inspector
APPROVALS - Permit # - APPROVALS Permit # •
`
t. Temporary Electrical Service or Pole 43. Pool & EquipmenttLocation -� -•' ��' � J� •'� � J• � �-� -�
. Soil ipe-Undrgrn 44. Steel Reinforcement � �
3. Electrical Conduit Utilijy-Undrgrn �� 45. Forms
4. Electrical Conduit-Undrgrn ,�_46: ElectricallBonding - '
. tee ein orce `` 47. Rough Plumbin &-Pressure Test ' - � ' � � �-���•' ` '
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE • • � �� � '`�
7, Footings � 49. Electrical Conduit-Undr rn � � � •
8. , Foundation . 50. Gas Pipe, ❑ Undr m, Test � - - -
9. Water Pipe-Undrgrn � 51. Backwash Lines P-l7a' `� � ri r'rn -�
10. StructuralFloorSYstem 52. APPROVALTODECK" � `"""'''r" •-`'` �-"��u
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-Wirin - � -- • 57. Solar System-Final
i 6. Rough Heating &�Air Conditioning -- � Fencing & Access Approval
17. Ducts, in Structure 59. qpPROVED FOR PLASTERING
� 18. Ducts, Ventilating � - - ..>, � �;. ,,;_„ ,, � � v 1
19. Gas Pipe-Rough & Test �- � " 60. POOL/SPA SYSTEMS FINAL .� y
20. Roof Framing � � ' ' �
27. Roof Sheathin � .
22.. Frameand Flashing NOTES: ' ' '
23. Insulation �
24. . Lathing & Siding ' -
25. Drywall Nailing �
26. Plaster Brown Coat � � - -
27. Electrical Power Meter-Final - �
�28. Final Electric � j�
29. � Final.Neating,& Air Conditioning.. , .,..� _`. . ' �
30. Final Gas Pipe-Test ' . - ,
. 31. Final Plumbing
32. �'Water Service-Final ' '
33. Gas Service-Final �
34. $olar pomesticFinal � -
35. Landsca e S rinklin S stem '
36. Sound Attenuation
37. Handicap Regulations • � -
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed �
40. Electric Release to Edison - � '
41. Gas Release to Southem California Gas Co. -
42. CERTIFICATE OF OCCUPANCY ' - -
.. No. Date � - _
!
�-- � - � �� � ' - �`=
OWNER
JOB ADDRESS
G�=`iRAL CONTRACTOR
�,s �:�
A; ��;;;. LOT
I � SPECTIONS
SOIL
iGAS
W ATER
'ROUGN PLUMBING
PROP. SWH. LINE Q MOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH MEATING ANO AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUND � POWER �
ROUGH WIftING
TRENCHES � FORMS � STEEL flEINF.
FLOOR SYSTEM
BONO BEAM � STEEL flEINFORCE ❑
SHEATHING
FRAME PNO FLASHING
LnTuiNG — IN ❑ (
PI iR, BROWN COAT
BUILDING, FINAL
SPFLIAL FEOIIIREMENTS
DATE
SUBCONTRACTOR
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35994
111L 12-73CM5°001591� ����*6.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant [o Fi// in Comp/etely
RECEIVED BV OATE RECEIVED DA E ISSUED
BUILDING i � ���
ADDRES�eZ O . � L/ Fi
PERMITC� P.�
OWNER p � A.P. NO. �b / % .
MAIL /J ,/ BVILDING
ADORESS � U 6 �C/ U O �y `� �+DDRESS
TEL. TRACT LOT BLOCK
CITY NO.
CONSTRUCTION���fi� y� L S�//. W A D A P
LENDEF /�
BRANCH _ /'I
OWNER Q � . //U
ADORESS VAWE B.O
ARCHITECT TEL S O� L$
OR ENGINEER
FIRE
ADDRESS ZONE TVPE GROUP
� APPROVED /J/ �
CONTRACTOF � 6� BV �� DATE �
ADDRESS �� /�/(O /1 Hv.QS S ZONE NO.OF USEOFNEW
TEI. p�p,� gUILDING
CITYi �) � C NO.s —i �il � � LO� /��a/�}��
$TATE CITV �'AROS APPROVED VARDSAPPROVED
UC. NO.e%� 1 j L LI0. NO. MAIN BUI�DING ACCESSOflV BUILDING
SIZE / NO.OF BLOGS. (FROM C/L STREET)
OF�OT - NOWONLOT ROfYT FT. SFT.
USE OF
E%ISTING BLDG. FT. FT
512E OF NO. OF
NEW BLDG. ROOMS STORIES L.SIDE FT. FT.
EMERIOR WALL ROOF �9
COVERING COVERING REAR FT. /FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS. BLDGS.
� VAR.3k DATE
L U � � C.U.P.# APPROVED
APPROVE v E'
I hereby acknowletlBe that I heve reatl this application and staie � 15
that the above information is correct and a8rae [o comply wlih
all laws reOulaNnB builtling conshuction, antl I shall not amploy
ony perwn in violation of the workmun's compansatiOn laws Of
the Stete ot Calitornia. �
b
I hereby cerUfy thot I am properly Iicensetl as a convactor untler SQ. FT. o
[he State of Califamia Business antl Professions Cotle, Divisicn 3, THE AMOUNT SHOWN VNDER VALUATION IS FOR j
Chapter 9, antl cha� such licenses are in tull force antl eftect, or 1 THE PURPOSE OF ES7ABL4SHING A PERMIT FEE ONLY: m
am exempt from tlie provisions of the State of California Business �� �
antl Protessions Code, Division 3, Chapter 9. VALUATION y
PERMIT FEE $ �
SIB^a[ure of� /] � � � m
Permittae (����j/� § � PIAN CHECK 5 a
Authorizatl Agent � LL
TOTA� FEE $
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PA10
Al1G-4-72cnsa�� 387* ****12.61
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOH BUILDING PERMIT
For Applicant to Fill in Completely
R C IV D BV OATE fiECEIVED DAT I UE
BUILDING � _Z'�''y �
ADOFESS '1'2 o Pamela Lane
OWNE(7 ��Y J•. Ward Co, A.P. NO. IS"� ��1-� � PER I . r]
J
MAIL 1']0� WestctiFf Drtve BUILDING r��Sa � EL L UE
A�DRESS ADDRESS
CITV Ne ortBeach nT,o.`�646-022 TRACT �10T33 BLOCK
CONSTRVCTION
LENDER
BflANCH \ ^ /^_
OWNER � �J WARI! Kl
ADDRESS - . VAWE
ARCHITECT Roy Kiter rE�54$-5244 �� s
OfiENGINEER N
FIRE
ADDRESS 211 Walnut St, Newport Beach ZONE TVPE GROVP
APPROVED
CONTRACTOR BV DATE
ADDRESS
TEL. ZONE '` P�� � BUILDING E"�j-(c� I�Lj-�
CITV NO. �-�
STATE CITV YAROSAPPROVED VAROSAPPROVEO
IIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BVIIDING
SI2E NO.OF BLDGS. (FFOM C/L STREET) �J
OF LOT 54 x i6qi�io/96.LS NOwON LOT � ROM FT. 1 FT.
USE OF None � � V T. FT
E%ISTING BLDG.
512E OF NO. OF
NEWBLDG. ROOMS STOFIES L.SIDE FT. FT.
EXTERIOR WALL WOOd ROOF
COVERING COVERING REAR % FT. FT.
USE OF,p UILp ING ANT�RFORMED pISTANCE BET. BEf. MAIN &
liCFJIEX W_"' MAINBLOCS. ACCESS.BLDGS.
VAR.aW DATE
c.u.P..wZf'-7-1-'� i� APPROVEO (�- S� 71�
PLAN 2 �ROVED (�� 6 !q/�/7
�A 'f5
I heraby acknowletlBe that 1 have read this apPlication antl state �
that tha above intarmation is cor�ect and apree to comply wlth
all Iaws regulating building consttuction, anG I shall not employ � A�
any Dersan in violatlon ot the workmen'S compensation laws of
the State of Califomie. /�/� _ -- --
I hereby certify that I am properly licensed as a conttactor untler O� SQ. FT.
tha Stata of Calitornie 9usiness antl Professions Cotle, �ivisicn 3, THE MOUNT SHOWN UNDER VALUATION IS FOR
Chepter 9, entl that such licensez are in full torce and efiect, or 1 THE PVFPOSE OF ESTABL6HING A PERMIT FEE ONLV:
am exempt trom the prov { ns of Steta ot Calitornia Business VALUATION
antl Professions Co i sio � a ter 9. w PEFMIT FEE $
SIB^etura ot I /Af.�/// �{ � .-
Permittee $� /l/./(�( PLANCHECK$
r � / l! r�
AvMorizetl ABent ./ ' ��
7 TOTAL FEE $
%� � 3503�
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.0.80X7200 COS7AMESA,CALIFORNIA92626
For Applic�r7ll in Completely
BUILDING ll�i—_ 1 i
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MAIL
ADDRESS
CITV
CONSTRUCTION
IENDER
BRANCM
A�DRESS
ARCHITECT
TEL.
NO.
TEL.
CONTRACTOR
ADDRE55
TEL.
CITY NO.
STATE CIT V
LIC. NO. ' LIC. NO.
Si2E NO.OF BLOGS.
OF LOT I NOW ON LOT
USE OF
EXISTING BLOG.
SIZE OF NO. OF
NEW BLOG. ROOM$ $TORIE:
EXTERIOR WALL ROOF
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
ncT »-�?c�;M100 884 ��***139.OD
PLICATION FOR BUILDING PERMIT
EC V BV DATERECEIVED OATEISSVI
� b" _ - 40-1�",
A.P.NO.I ( �� �O � P�MS��
ADIDRE S ��� �A1Nt1-'� �f�/�
FIRE
20NE
APPR
ZONE � NO.OF
PL4N$ �
VARDS APPqOVED
MAIN BUILDING
(FROM GL STREET) .
VALUE
�
K
VSE OF NE�RIPLI
BUILDING
VARDS APPROVED
CURP.aK zE-�a-Y6 I APPqOVED
APPROVED /i i / 11 �
I �ore0y atknowletlBa thot I hav¢ reotl this aDP��caiion ontl s[nto
[hat Ma nCova Informetlon is corrocc antl opren to comply with
oll laws reguleHng bu(ItlInB conztructlon, antl I shall not employ
any person in viololion ot the workman's compansation lawf oi
the State of Celifomla. � �
I hereby certify Met I am properly Iicanmtl as a coniractar under
[he Siate of Calitornia Businass antl Professions Cotle, Divisicn 3, THE A O
Chapter 9, antl thet such licensez are In full force and effxt, or I THE PU M
am exempt trom tha rav i s ot the Stete of Californla Business VALUATION
antl Professione tl iv si , Chapter 9.
sie�em�e or I� ,
Permlt[ee �L 5
A�thorizetl ABant
&
VY m
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FT. o
f SHOWN UNDER VALUATION IS FOR �
OF ESTABLISHING A PERMIT FEE ONLY: m
¢
TOTAL FEE 5
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70
35592
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. 60X 1200 COSTA MESA. CALIFORNIA 92626
nr.t � 9-�2PF'°00 s9i,a� *t* �39.28
C4I5
LI ATION FOR BUIIDING PERMIT
For Applicant to Fill in Completely
RE EI ED BV IDATE RECEiVED DATE ISSUED
ADIDRESS �Z� � Z 2�� M/��L� 4�TM� - (O•—I �-� �I �O`I��"�Z
OWNER � K./�D `� ' A•P. NO. �E�L PE��I�L
MAIL ADDRIESS�YSO—�T�>T /J�i'�� 1�./�
ADDRESS ?
TEL. TRACT J� BLOCK
CITY NO.
CANSTRVCTION W A D P
IENDER
BRANCH
OWNER (1
ADDRESS VALUE
ARCHITECT TEL. SE ��CL��L � S eF�D
OR ENGINEER N
FIRE
ADORESS ZONE TYPE GROVP
APPROVE
CONTRACTO BY DATE O� � —
A�ORESS �
TEL. Z� E NO.OF n USE OF NEW
CITV NO.
1 � FLANS O'� BUILDING (� '
STATE CITY YbFlDSAPPfiOVED VARDSAPPFOVEO
LIC. NO. LIC. NO. N1AIN BUILDING ACCESS ING
512E NOAF BLDGS. (FFOM � F�ET)
OF LOT NOW ON lOT FRO fT. � �� FT.
VSE OF
EXISTING BLOG. ���FT. FT.
$IZE OF NO. OF �
NEWBLDG. ROOMS STORIES .SIDE FT. FT.
EXTERIOR WALL ROOF
COVERING COVERING REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCESS, BLIX'}S.
VAR.# / DATE /
�,. C.U.P.#'* '7'"�y�(� APPROVED 7 ��-�
' - APPROVEO ' /-' �/ 'L
�
I hereby acknowledge that 1 have reatl this application antl s[a[e
that the ebove informetion is correct and agrea 2o comply with �
ell laws re8�lating buildinp construction, and I shall not employ
uny parson in violation of the workman's compensation laws ot
[he State ot Califomie. / 'n
b
I heroby cer[ity tha[ I am prOp¢rly licensetl as a conttactor untler L SQ. PT, o
[he S[ntu of California Business antl Professions Cotla, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR �
Ghapter 9, antl that such licenses are In ��II force and effect, or I THE PURPpSE OF ESTABLISHING A PERMIT FEE ONLV: m
om eaempi irom �a � ovisi s of the Stete of California Buziness ¢
VALUATION /
antl Protessions o D isi n, Chapter 9. 7/� W
O PERMIT FEE $ �V/ �
Signaturo ot I �
m
Permiitee � P�AN CHECK $ � E
3 °� �
AuMorized ABent � LL
TOTAL FEE $