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HomeMy WebLinkAbout1777 PANAY CIR - Building Permits • CITY OF COSTA MESA BUILDING DIVISION /MIT NUMBER 1. � ^� ' DEVELOPMENT SERVICES DEPARTMENT • a PERMIT '�m#' M99-00145 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1777 PANAY CI Status: ISSUED Suite No Applied: 03/31/1999 Issued: 03/31/1999 Vicinity: .(� Parcel Number 13912210 \ ISSUED BY: - Applicant: COOTER, LYLE Address: Phone: Zip: Owner SURBER, SIEGFRED I TR Address: 1777 PANAY CIR Phone: COSTA MESA,CA Zip: 92626 Contractor PACIFIC AIR COMFORT Address: 1327 S LEWIS Phone: (714)937-1333 ANAHEIM CA Zip: 92807 License: 500236 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT REPLACE EXISTING FAU AND NC WITH NEW UNITS. NEW 4HP MOTOR FOR NC UNIT. EzIck-0C3a_CpS FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $26.50 2 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 • Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES 48.50 COMMENTS/SPECIAL CONDITIONS Dos • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS ( ) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prow ions. Applicant Signature: / Date: �- I (�f WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE MST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# AcA o 1-7 ` Class k C--2-0 Contractors Signature: '1 Date: / , — '.? / — ISO CONSTRUCTION LENDING AGENCY: o I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:My city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit t0 do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: • Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state lavislend city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purpose's.II agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signe Of Legal Owner(s) Date 33f � � And/ r Authorized Applicant Date ;ODE I INSPECTION TYPE PAIS INTITIAL$ CODF( lNSPECTIONTYPE PdE JNittlAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical )QlfrOCI 4 ada,72 � 1266 Pool Spa Final 208 Final Plumbing l 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval . 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 CITY OF COSTA MESA s� BUILDING DIVISION rw,.�" .AI 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us I. POI . FOR INSPECTIONS CALL: (714)754.5626 .."s. ,DA• PERMIT NUMBER: BX08-00029 PERMIT TYPE B MISC STATUS: ISSUED APN: 13912210 DATE ISSUED: 01/25/2008 Zoning: R1, ISSUED BY: RMD JOB ADDRESS: 1777 PANAY CI CM Suite/Unit: Vicinity: BEDROOM AND DECK Primary Occ: Const Type :?? SQ.FT: 0 Valuation: $6,500.00 SCOPE OF WORK: • CHANGE OUT 2 SLIDING GLASS DOORS IN 2 BEDROOMS AND REPAIR DRY WROUGHT AND RESURFACE (E)2ND STORY DECK (WALK-ON)W/DEXATECH, LIKE FOR LIKE. OWNER: SURBER, SIEGFRED I Address:: 1777 PANAY CIR Unit City/State: COSTA MESA,CA Zip Code: 92626-2348 Phone: APPLICANT: SUBER,JAMES Address: 1590 PONDEROSA ST Unit: City/State: COSTA MESA,CA Zip Code: 92626 Phone: 949-285-9566 CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: City/State: Zip Code: Phone Cell: ARCHITECT: License No. Phone ENGINEER: License No. Phone FEE SUMMARY Building Plan Check: $0.00 Building Permit: $139.25 Electrical Permit: $0.00 SMIP Residential $0.00 SMIP Commercial $0.00 $0.0OTOTAL FEES $139.25 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE N. INSPECTION TYPE DATE INIRIALS CODE INSPECTION TYPE, DRi INTn1ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy to-27-of • WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivx .c6. es ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. ( (Expires:t 2- 1 Co - 1 Z ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This seam need nal 0a competed d the patina is valued et one hundred dollars(5100)aless) 2 M2 Sec.341,Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would CrI certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless d,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the • ers' •pensati•- aws of California, and agree that if I should be • e s bject '7 the .•rkers'compensation provisions of Section 3700 of Applicant's Signature Date Labor/Code) sh. • hwith •m• 'th these provisions. - is -056i Division of Industrial Safety Permit Number: al* - Affr `'Applicants signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: W •NTNG: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lic.fi Class# (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). I,,-as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other C mpensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044.Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for 8. (If"yes".attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. 10 I, as owner of the LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relatin• o buildin• instruction, and authorize representatives of Business and Professio4Code r this reason: the Cit • Co - esaenter upon the above-described property for Insp. tion • rp ase-. I a. -i not to occupy or allow occupancy of any building horized •y i 'e .,t ntil final inspection. Sam. I a 5 _CtS' Jt"2l— 0� I`F�gnawre of Legal Owner(s) - Date Signature"_j •--Date_ dr 3057.46 I Andlor Authorized Applicant Date r DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS This Permit# Street Address: 1199' l�?'Ar`iAy �-1'X1.,1_ AP Number: 1. I (we), Stt_CFQ_t� �✓2.` � , declare that I am the Owner of Title of the above referenced real property, and that I (we)hereby authorize: Name: jfAwlc"j S)2 _ Telephone Number: 949- 24SS - 95(4, Str et Address: 1590 bN1D Otiff G7l 'City: CzSP v1lt °+ state: CAzips 2.62, to obtain permits in my behalf,as owner/builder,for 1 at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa,as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the pehalty of perjury that the foregoing is true and correct. Ta Co5TA .."'A Executed this 2.5 day of • x4-4014+42-J 20 0% , at O2Ar-4( E CcxiNT/ ,California. Print Name: f-.5706:-/Cr 5-et Aa�E- Signature: Date: L - - ZOOS Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 0779-46(rev.11/00) . `:•111. &ata 71244 ruin DeCtalest ja4 ' OWNER-BUILDER VERIFICATION Address: I�'�� I At.JP"/ C'QCLt _ Permit#: A city or county,which is required to give notice pursuant to Section 19830,shall attach to such notice,and,as a condition precedent to issuing a building permit, require the completion and require the return of,an owner- builder verification. Attention Property Owner. An'owner-builder'building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit.No buildine permit will be issued until this verification is received. 1. ? I personally plan to pro de the major labor and materials for construction of the proposed ..-property improvement. Yes No I. 2. ; I(havelliave not) fie signed an application for a building permit for the proposed work. 3. I have contracted with the following person(firm)to provide the proposed construction: Name Address City Phone( )- Contractor's Lic. No. 4. I plan to provide portions of the work,but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone( ) Contractor's Lic.No. • 5. 1 will provide some of the work but 1 have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1 10I24e6(Rev.11p01 (2)1Ye#9 2 EZb2L6b6b6 34I IIOACId9I 10 60 SZ ueC 405111 6►F 9 - CITY OF COSTA MESA BUILDING DIVISION > ruin-wen:, DEVELOPMENT SERVICES DEPARTMENT PERMIT N BER 110.4 `/s PERMIT JrF" 01763 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cags.ILUING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1777 PANAY CI U Status: ISSUED Suite: Applied: 10/10/2003 Vicinity: ROOF Issued: 10/10/2003 Parcel Number: 13912210 Zoning: R1 R1 Applicant: MC CARL, TIM ISSUED BY: Address: 126 COMMERCIAL WAY Phone: 949-548-5569 COSTA MESA,CA Zip: 92627 Owner: SURBER, SIEGFRED I Address 1777 PANAY CIR Phone: COSTA MESA,CA Zip: 92626-2348 Contractor: GARY REES DBA CRANK BROTHERS ROOFING Address: 126 COMMERCIAL WAY Phone: 949-548-5569 COSTA MESA,CA Zip: 92627 License: 736549 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE EXISTING ROOF. INSTALL 15#FELT,50 YEAR COMPOSITION SHINGLES, 1/2"CDX,&REPLACE SHEATHING AS NEEDED.2,400 S.F. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $11,295.00 Permit: $209.25 Claim Valuation: $11,295.00 SMIP Res: $1.13 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $210.38 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92.28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under This permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 244646(6/00) DECLARATIONS . WORKERS'COMPENSATION DECLARATION: ^ '1 I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My works co pensation Insurance ardor and policy number ere: Carrier: S -t C F ti.LI Policy Number: 1 12 b CTC Q — .:2 0 O (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the perform ce of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cali mia,an agree that If I should b me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi s. Applicant Signature: 0 Date: I dl 1)/ 4 3 WARNING:FAILURE TO SECURE ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANML FINES UP TO ONE HUNDRED THOUSAND DON LARE(Meow,IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pr visions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license Is In full force and effect.Lic.N 3L.¶9�q11 (� Class 4 C— 3 9 Contractors Signature: •L,C) [y .R Date: 1 COI i6l 0 3 CONSTRUCTION LENDING AGENCY:` f' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,end who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No .....c..t..r..r..e.t... 5 Does or will the applicant or present or future building occupantm require for the work which is the subject age of this D estion apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application end state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ergarLe ner(s Date(��dpew_ yvtl t 3 tOf d/Ori7t6dzed Applicant 1f Dat CODE I INSPECTIONTYPE 28.1E INTTRALS CODE. INSPECTION TYPE DEL RIIIDELS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /p 208 Final Plumbing 200 Final Re-Roof i("fell � 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy �Jt� CITY OF COSTA MESA y°tai BUILDING DIVISION PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT F PERMIT 0roww Jet99-00265 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT . Job Address: 1777 PANAY CI Status: ISSUED Suite No Applied: 03/31/1999 Vicinity: Issued: 03/31/1999 Parcel Nunmber: 13912210 may) ISSUED BY: ) Applicant: COOTER, LYLE Address: Phone: Zip: Owner: SURBER, SIEGFRED I TR ,Address 1777 PANAY CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: PACIFIC AIR COMFORT • Address: 1327 S LEWIS Phone: (714)937-1333 ANAHEIM CA Zip: 92807 License: 500236 SCOPE OF PERMIT REPLACE EXISTING FAU AND NC WITH NEW UNITS.NEW 4HP MOTOR FOR NC UNIT. Nkgq-oo/A5• FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 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 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $11.00 1 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES S33.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS / NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 1 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shell not employ any person in any manner so es to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi na. dr Applicant Signature: /✓ Date: WARNING:FAILURE TO SEW E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOtLARE(5100,0011).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.It -s7.70 zT t Class a - (' 7 co Contractor's Signature: Date: !n -fit '— P' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and fling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Cade been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this aaUptication a ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? ❑Yes 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 11 a permit from the South Coast Alr Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materiels and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permh until final Inspection. Signature Of I Owner(s) Date And/0 uthorized Applicant Date MEL 185PECTION TYPE PAIEE UMW COOE4 INSPECTION TYPE PATE =AA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing C -99 /��/��{/ 200 Final Re-Roof 210 Final Electrical i q ___ ___ 201 Final Block/Retaining Wail 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 PROJECT ADDRESS: 1 777 PANAY CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT v a am evtu: a u.,n 2M OWNER'S NAME: SURBER SIEGFRED I ADDRESS; 1777 PANAY CIR PERMIT NO: B 053124 PLAN CHECK NO: N GUVi ; i\-1 3u?P: i' COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH 454-5952 ,, ' ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REROOF 2400SF RESDI & GARAGE W/SHAKE ROO SQ FT: 7,000 so ADDRESS: UNIT: CLAIM VALUE: 7, 000 . 00 CALC—VALUE: 7,000 . 00 GROUP OCC: R-3 /M-1 PERMITTEE: SELL ROOFING ( 714 ) 993-3328 in n ADDRESS: 17072 ROSEBUD COMMENTS: ICBG#4595 Icy"—.` 7 r ' YORBA LINDA CA 92686 �E*+E******+Ex*>ESE*IE****�E�E +e*�E*Ir �E�E*>t�E>E*�c*�c ***�E>E*******�Ex*+E* rr 'EaE eicae '. LICENSED CONTRACTOR DECLARATION: I hereby aflirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS ����y (� 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S �,_�.,�� I j F Ir,,,• CITY LIC.: 03 68 STATE LIC.: 32 842 LASS: MAIN BUILDING ACCESS..04.4 3UILDINC Date: ? d�9 Signature: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN WORKERS'COM ENSATI DECLARATIO : I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation lrismie65 4tiltp oipy thereof(Section 3800.Lab.t).4 /0 1 /9 2 POLICY NO.: EXP.DATE: COMPANY: PLANNING PARKING REO• PROV: PARCEL: 13912210 ZNE: REF NO: PLANNING NOTES> Certified copy is hereby furnished. Bodiedion copy is filed With i Building Er . > *******************************************************************.1E********** Date: 1/3 b9 Applicant' 2 DEVELOPMENT SERVICES R E Q U I R E M E N 'T S EXEMPTION ERORKE COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become ZONING APPROVED BY • DATE: sublect to the Workers'Compensation Laws of California. Date: Signature: BUILDING APPROVED BY : DATE: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor / / Code.you must mnhwim comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED B Y: DATE: 1 b/ �j CONSTRUCTION LENDING AGENCY: thereby affirm that there is a construction lending agency for the performance of the work for ******,**.***,****.****,*************,******,**, *,********,*******,*,*******, *kkkk 333ff---iF**tfi}ter** which this permit is issued(Section 3097.Civ.C). LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E S U M MAR Y STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM I P/RES GRADING PERMIT 90 . 00 7 0 (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or reoair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'Stare License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE any applicant for a permit subjects-the applicant to a civil penalty Of not more than five hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation. win do the work, and the TOTALS----> 90. 70 0 . 00 0. 00 90. 70 90 . 70 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided-that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 90. 70 OVER/SHORT: 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 90 . 00 .70 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: The Contractors'State License Lawdoes not apply to an owner of property who builds or improves thereon *-****-***********.***-****.*.**.*****..***.***.*****.***********.********,*..**.**.***.)E**.***.**.**. and who contracts for,such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner'' SFR 7000 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 7, 000. 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification Nom the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: 01 60093414-0009.3414 TG.k1 I hereby certify that I have read this application a state that the above i • alion is correct.4J,ree to omply with all city and coup DATE: 07/33/91 1 IIlE: 12 i ht ordinances and stat aws relating to building con ruction and hereby au . presentatives of T city'` L upon the above-menlio d property four iinnssper ion p/uA'iooss�es.. / Date: / '/—f� Signature: 1 Driver's License Sod I Security n: D. 00093415—M393415 C70/0093415 t X_ET 't 1641-46 White—Buildng;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor DATE: 07/30!91 TM: 12:47 re CONSTRUCTION AND PLANNING POO ?A APPROVALS Permit# _ Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms .4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7.. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap • 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure - 70. Underground Hydro 22. Ducts, Ventilating • 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashirtg 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREV. FINAL 30. Drywall Nailing I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I I 79. FINAL INSPECTION 32. Electrical Power Meter-Final I 80. FOOD CERTIFICATE ISSUED 33. Final Electric i Notes: 34. Final Heating & Air Conditioning ' . 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace • - z 38. Final Plumbing 39. Water Service-Final - 40. Gas Service-Final 41. Solar Domestic-Final - - 42. Backflow Preventer ' - ( I - - 43. Backflow Irrigation • 44. Landscape Irrigation System . , 45. Sound Attenuation - - - 46. Handicap Regulations - - : . ;. 47. FINAL STRUCTURE & BUILDING 1V\°1i 48. FINAL PLANNING . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ( , 51. CERTIFICATEOF OCCUPANCY No. Date • LONG BEACH INSPECTION B MATERIAL ENGINEERING 3310 AIRPORT WAy 90806 4263355 LONG BEACHI •A\ CHEMICAL 6 PHYSICAL ANALYSIS 636-2386 )LOS ANGELES) 8286432 !ORANGE co I Twining Laboratories RESEARCH 8 ENVIRONMENTAL TESTING SANTA ANA 1514-0 N HARPER ST 92703 JEFFERSON 1-2045 CORROSION RESEARCH & ANALYSIS 5% lad March 10, 1966 Examination: SC66-1337 ' ' °UNI 1i. �l 1 LL12 • COMPRESSION TESTS ON roman CYLINDERS �O 4, Jos. ::. Henley • REO O 1973 P,etaport Blvd. MAR 141966 Costa „esa, California CC (illy 01 CostaB mesa PROJECT 20 x 36 Ct;i;i Pool for D_:. rte: BuildLnB �l ADDRESS 1,'77 Panay Circle, Costa Mesa [`/'�_ ' SAMPLE FROM 1 - Bottr Center Line ,#2-Side wall shallow e9 i#3 - Bond Beam - deop end ' ARCHITECT CONTRACTOR Tibor Gymese Blue Haven Pools ENGINEER' SUBCONTRACTOR - - - Four Star Gunite SPECIFIED MIX - 1 STRENGTH 2,000 psi DATE CAST 3-2-66 SLUMP Size 611 x 12" DATE TESTED ,-/- 'W' 3-9-66 3-9-66 "HOLD" - CYLINDER NO. 1 2 3 1 - 2 - 3 COMPRESSION 7-Day 7-Day 7-Day TOTAL LOAD, LBS. 86,500 70,000 82,000 POUNDS PER SQ. IN. 3,060 2,b76 2,900 COMPLIANCE 7_e.ay test complies with specifications. MADE BY DELIVERED BY RECEIVED ON • CYLINDERS des. 14. Penley Jos. H. Henley 3-3-66 DISTRIBUTION: Jos. i:. Henley Blue Haven Pools Four Star Gunite / 9 t%sta Mesa i1ds. Dept. ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL. PROPERTY OF CLIENTS. AUTHORIZATION FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS, OR EX- TRACTS FROM OR REGARDING THEM IS RESERVED PEND NG OUR WRITTEN APPROVAL A5 A MUTUAL PROTECTION '[ CLIENTS. THE PUBLIC AND OURSELVES. ytp_MF CITY OF COSTA MESA oP 6`• CALIFORNIA P. O. BOX 317 oraccalani �, ' .; i „• aFROM THE OFFICE OF THE PLANNING DEPARTMENT Dr. & Mrs. S. Surber May 9, 1966 1777 Panay Circle Costa Mesa, California • Dear Pool Owner: The Costa Mesa Planning Department has been notified of the completion of your swimming pool. So that your pool will be a safe one and for the purpose of advising you of your responsibility regarding the requirements of the Costa Mesa Municipal Code, we quote Section 9298.9: 1. No swimming pool shall be constructed closer than five (5) feet to any property lines, measured from water line of pool. 2. No swimming pool shall be constructed tinier any electric power lines or on any electric power easement. 3. No swimming pool shall be constructed unless the yard surrounding such pool is completely enclosed by a fence six (6) feet in height and has a self-closing and locking type gate or gates. This courtesy letter is directed to you so that you will be aware of our ordinances and can make a complete safety check of pool area. Sincerely AAS^ William L. Dunn Director of Planning F Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA/M�ESA COMISTRUC/TILLLI ON PERMIT PERMIT NO. T C NO LIZ. UNIT NO. Project Add- - 4/ 7 U-,44v4-n ..��ci2at. b3y`k1t9 ` O� \e�p ,/'-` ` l Applicant's lliinTn9g,Address --••��5/�T17�/Jr[ �j� TYPE OF CONSTRUCTION ❑ NEW U ADD U ALTERATION U REPAIR Ow/ner's Name 0'�Flai)^LX. al ae'P 545 7qZ/ 0 CONVERSION 0 DEMOLISH 0 OTHER A.P.# I+2_•_ 1 + inn- 1 .To;98s \1 /"�'L hone DESCRIPTION OF WORK/USE OF BLDG. 1` — Address r S Main Building: ,,.ct,C,.t,.,JAAccessory Building: �; it Arch/Eng. License No. TYPE OF,PERMIT 0 GRADING U FOUNDATION 0 STRUCTURAL T Front co 8" ,re- 0 Address ❑^TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear Wig 11 W "•^" N �1 ❑ ,OTHER A I Contractor's Name L'l Phone C Right N Address(mailing) PROJECT DESCRIPTION SQ. FT. - OCCUPANCY '^ I � g - CONSTRUCTION TYPE VALUATION$ t\Wc'� S Left ss 4101 r• .-1— s �/' G City License No. R ZONE GRADING CU.YDS. ACRES Ping. Ref.# 1 Parking Req,/Provided E LICENSED CONTRACTOR DECLARATION - w Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing "'Remarks! CR S l� . k a O R � Planning Notes: / 5�a t (y��, M with section 7000) of Division 3 of the Business and Professions Code, and _JJv LE 'a0 y"`•'�i, (® �` my license is in full force and effect. • T rK�`-1 License Class License No. - $ Date Signature PLUMBING ' FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure ora certificate : I Workers' Compensation Insurance, or a certified copy thereof (Section Backf ServiceSink low Preventer .800, Lab. C.) . Automatic Washer Transformer 0 15-50 KW Policy No. Company _ Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+KW 8 Certified copy is hereby furnished. , • Certified copy is filed with the city Building Division. • , .. Bathtubs Sewer Connection Cooking Unit Meter pup to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION .' Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed If the permit Is for one hundred($100) or - • less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued I shall not employ any person in any Ma r so s to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1'f.-8 DateWorker iqe pion Laws of Califo - - /1 ❑ Date 9/ r�ri Signature L�L��Lsa•0 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 9.15 HP ❑16-15+ NOTIf,after making this declaration,you should become Subject to the I Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes PoleLight -1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name - Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION - I hereby affirm that 1 am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/she IS licensed pursuant to the provisions of 'RODf Drains - the Contractor's License Law (Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she Is exempt 'herefrom and the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure Is not intended or offered - Reinspection Fee I $15 Issue Fee S 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICESREQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I 0 /f'1) 6esz sale. If, however, the building or improvement Is sold within one year of com- - Canopy Type II ❑ Zoning Approved By Date lplolion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date i, elpve for the purpose of sale). -- �p o I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By e'Datt1v-N ',tractors to construct the projectSection 7044,Business and Professions Code: 1 The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES I builds or Improves thereon, and who contracts for such projects with a con- proof license pursuantrk 'sto the Contractor'sninsurance License Law). I ov aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ �� SMTP $ C)•--- proof � props of their Worker's Compensation insurance hould be provided toea me. __ PLAN CHECK $ I S c PERMIT LI I am exempt under Section F P 1.` t,i, reason Firepl/Fact.Blt. ICBG dk Fire Dampers �1r(Ta.Zn Ail at..„s• PLUMBING $ ISSUANCE $ Date Owner r/mss�.- "�',.• Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. S I hereby cerci that I have read this eppl' . Ion and state that the above 00.100,000 BTU 0100,000 BTU— ELECTRICAL $ GRADING S information is correct I agre- to comply i h all city and county ordinances - and state laws rel.AL, to b ildi • onstr - .n and hereby authorize repre- — PLAN CHECK 50% $ MICROFILM $ 83` sentative5 of thi Ct. `.-., t. •i a '. ;la;.ve-mentioned pro ert for 1 inspection pure.�,� ' 1 rMECHANICAL $ TOTAL FEE $ 4- Signature 7li. -Accounting; Goldenrod - Assessor ' CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector T.;Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. • 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GIINITE 7. Footings t 3 7 lyindi 58. Electrical Conduit-Undrgrnd. • 8. Foundation:'. • • 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final - 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL- 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# • 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas O,Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: tc--3 34. Final Heating&Air Conditioning �� L�7///// �/J ( ' 35. Final Gas Pipe-Test D G1" r -.:- 36. Hood or Canopy •37. Final Factory Fireplace 38. Final Plumbing 39:Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations • -47. FINAL STRUCTURE & BUILDING � / . 48' Special Requirements Completed (Y 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. ` i Date PARTY WALL AGREEMENT THIS AGREEMENT, made and entered intoothis /�1IY day of (.PL7" , 1983, by and between d /a v /749--61(() v /749--61( $ct hereinafter referred to as "LAND (WIER", and cit J)OCIS do D hereinafter referred to as "ADJACENT PROPERLY OWNER". It is hereby agreed that a party�J wall will be constructed on the property line between /1117 /77 44(4 7 (S (02-4 4W, AtIF}y Cl�CC..� (Address of Adjoining Properties) in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Boots G2)c\ , Page gof Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach - IN WITNESS WIEREOF, the parties have entered into this Agreement the day and year first above written. YetIAND'—L tere CJ �J�O ADJAN. PRCP34v OWN E R /A (Signature) (Sig • ure) c=5;! 6-.c2.Et� S� ..— LEN S/.f/< � &(c6541�r 1p., sla 2 Name ('typed or Printed) - ( •-• or • anted p777(Typed,,or Of c?L-,� / CD-s7251 Ael,csA- , C'/4 R'z6 zp /779 A/47 C.; (7- (Address) (Address) • CO14- IT SA-/ 0/3-75-- z1 . • (NOTE; Please see reverse side for notary's statenent) LIMITED STATEMENT OF RESPONSIBILITY Bldg. Permit # TO WHOM IT MAY CONCERN: This Permit # • /777 .0 g-Y Cr ec& Street Address AP Number I, 45r�� , as Owner in Title of the above referenced property, do hereby authorize: '12,JT nAnrci_ tc Sym 4752.- Name Telephone No. Street Address A- Mk-454- c LAA City State e, / Zip to obtain permits in my behalf, as owner/builder, for ,840c, atthe above referenced property. Should any person become an employee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. ET'. `t-(2BcaZ - 11c7 13 197'P Printed Name Date f�. 9 . J� Signature 0779,46,rev.6/87 uwNta SUg3ER. DR. & MRS. S. DATE p-p_66 JOB ADDRESS - J'anay,'Circle BUILDING PERMIT NO. 25168 GENERAL CONTRACTOR Blue Haven Pools DESCRIPTION OF WORK Private Pool Al' No. 139-;22-10 LOT TRACT FIRE ZONE VALUE $ 2,600.00 INSPECTIONS Signature Date GROUP J TYPE III ZONE R-J. Soil PERMITS ISSUED Gas 9/r- 3 f/_// SUBCONTRACTOR Date I Number I Signatt - Water _Y Plumbing ilea 7A7 Rough Plumbing QQQ r e,_€19 ‘Q-.2-GGA Prop. Swr. Line 0 House Con.0 Sprinkling System Miscellaneous ern, Y-.4.-S° Zdyr®C . Rough Heating and Air Conditioning T 6 4/ '.49 X74 Underground 0 Power 0 tar. (O&LK, Rough-Wiring iter zy/O.GC Heating and Vent. ,:Y Trenches Py Forms 0 Steel Reim.Pd , rt- f-2y- �,1•" e' Floor System L I sa,Sm4 N• Bond Beam 21— Steel Reinforce X-2h%/ `.w„_,,�av<°' ��nl' Sheathing �� .0'80.11C4, l Frame and Flashing Lathing— In 0 Out 0 - Plaster, Brown Coat Structural, Final Electric Heating, Vent., Refrig. and A.C., Final W0,9" ,tfLU.M..-4 o -..2_x61-2 �'�j,3j Plumbing, Final and Gas Test,r� -o e - le�0`"' I Electric, Final i G� Building, Fina �" MI 25168 CITY OF C IS EA MESA COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 82620 FEB 2 1966 • For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR -RINT ',Bii,D;j' °CO j / o 4i_t i[.a 11 BUILDING / ADDRESS RECEIPT NO. i. COST `y�MESA. lCALIF•RNIA _ I LV2 E OWNER / J i/t�,J pia I- r �,�E • _, R. 1..., er .a. MAIL _��^\\\\n' v ..- .�..+ I f 3 ADDRESS rry'�n, TEL. FIRE C� CITY NO. ZONE E �; GROUP ////�� ARCHITECT cD, r �- TEL APPROVED A , DATE 1-1 2-- 6.C• OR ENGINEER T as., �.- NO. f �, ZONING ' ,y ADDRESS - Z. No.of USE OF nEw i' IP �,� PUNS 7� eunoia j ' CONTRACTOR -�• ,, 1^`•- ,uut{/�7� ' // .yam'/ ADDRESS I aaaa J/] Ter p.i LEGAL DEGCRITON _ 9, I V / It . . - city ( 9 ( `ate , A.P.NO. ! 3 C OVERHANG H SST .NO. .� �l-/ NOT w l / it. 30•TO SIDE a REAR P.E: NO EAVE SHALL BE LESS THAN SIZE OF LO ! N `�/l :L,7 NO.OFSLDOE. ALLOWED (U.B.C.REQUIREMENT) 5 USE OF /` �3 GY Gs 1' NOW ON{AT YARDS APPROVED YARDS APPROVED EXISTING BLDG. t MAIN BUILDING ACCESSORY BUILDING {PROM c/I-STREET) - SETBACK LINE FROM FRONT FT. CENTER OF STREET REAR YARD `^. SIDE YARDI LEFT I RIGHT R.SIDE FT. SFT. f. DESCRIPTION OF WORK L SIDE PT. i SFT. , NEW ALTERATION MM. REAR FE. FT. I DISTANCE BET. BET.MAIN& -• - MAIN BLD - ACCESS.BLDOB. REPAIR MOVING DEMOLISH BUILDING I C1/ / NO.OF VAR.# DATE SIZE tJ A 9 ROOMS STORIES ' C.U.P.# APPROVED im EXTERIOR WALL ROOF APPROVED -"D COVERING I COVERING BY .1 •ATE - v V USE OF BUILDING AND WORK TO BE PERFORMED ' N HOLT/ FOR cIEnnI w d>t•lArtt OCC)/../ , di , , . SQ.FT. O I HEREBY ACKNOWLEDGE THAT I HAVE READ APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT A GREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. R1 PLY WITH ALL OI ` 1rANCLE AND STA S REGULATING VALUATION DO BUILDING CONBT:''T N, • SIGNATUR-ie, ' PERMIT FEE PERMITTER V F OO / (19 5 00 PLAN CHECK S C+ u' AUTHORIZED AGENT , E, If O P TOTAL FEE $1�"- OWNER SJRRRR STwmr,D) nil. DATE 3-15-66 , JOB ADDRESS 1777 Panay Circle BUILDING PERMIT NO. 25397` GENERAL CONTRACTOR Owner-Builder DESCRIPTION OF WORK Block Wal (Community) AP No. 139-122-1n LOT TRACT FIRE ZONE VALUE $ 502.00 INSPECTIONS Signature Date GROUP J TYPE III ZONE R-1 Soil PERMITS ISSUED Gas SUBCONTRACTOR I Date I Number I Signa Water _ Plumbing _ 4 Rough Plumbing Prop. Swr. Line 0 House Con.C0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power 0 I Rough Wiring Heating and Vent. Trenches 4 Forms 0 Steel Reinf..p IOW 3/yT Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing—In 0 Out 0 Plaster, Brown Coat Structural, Final Electric Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final Building, Final __ _.aed 'di/6G. 25397 MESA �' se COSTA MESA BUILDING-SAFETY DEPARTMENT CITY 1 j�OF C OS IA MESA _ .__. P.O. BOX 1200 COSTA MESA, CALIFORNIA 92816 • For Applicant to Fill In Completely . AFPLIC9P►ION tlR RMIT TYPE OR PRINT BUILDING[/' �, BUILDING ADDRESS P/ N R C r L IP . LrS I my —SEC , - • • .7 , • I,z. - / alkali,- lkali, 4 L /Irk • BUILDING // R MAIL - NO if ADDRESS (/ / 7 A/FI`/ �� ADDRESS 17, 7 P A IV R/- CI ! C / s' • FIRE c F CITY C nil NO ZONE F i) GROUP .: ARCHITECT TEL BYPROVED // DATE OR ENGINEER NQ. (J � �i ONING F�Lai ADDRESS .� /��q n la PLANS BUILDINGust or /r. �� / CONTRACTOR VW IV r E.A d'4 r LEGcRAL lmoN Lot /6 ‘ 6(336 3 ADDRESS Du :. A.P.NO. / / —le) 1 — / O CITY NOTE: NO SAVE OVERHANG SHALL BE LESS THAN - STATE TEL 30'TO SIDE a REAR p.L._ LIC.NO. NO. i " EAVES SIZE I no.or SLDGS. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON Lot YARDS APPROVED YARDS APPROVED • USE OF • MAIN BUILDING ACCESSORY BUILDING 7 EXISTING BLDG. - • (FROM C/L STREET/ 51 SETBACK LINE FROM R•NT PT. CENTER OF STREET REAR TARO Wog YARD I L.EPT RIGHT R.$IDR PT. O PT. DESCRIPTION OF WORK L BID PT. 6 PT. NEW ALTERATION ADDITION REAR PT. FT. 1 -. DISTANCE BET. BET.MAIN a REPAIR MOVING DEMOLISH y MAIN BLDGS. ACCESS.BLDGS. •.." BUILDING NO.OF VAR, DATE SIZE ROOMS STORIES C.U.P.# APPROVED iii / L :+ EXTERIOR WAIL. I ROOF COVERING `: APPROVED() / ��J �. •ATE 3�I1 12 v COVERING ��(1 /'/{'/ 3. USA OF 1 b BUILDING AN!?W ,qRE TAE PERFORMED yI _ A. D � / y ,, , cr. / frT PT. 1 I HEREBY ACKNOWLEDGE TNAT.I HAVE READ TICS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 2 AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO CON. - PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. c. PLY WITH ALL OTT ORDINANCES AND ST TE LAWS REGULATING VALUATION BUILDING CONSTRUCTIONN /.� V V PERMIT FEE SIGNATURE OF -?� ,•M "-/• '• O�/ E PHRMITTHP '//l^ I' o • AUTHORIZED AGE /1 / TOTAL FEE $ 5 / • OWNER GILLFSPIEr MR. & MRS. R. DATE SEP 2 2 19M JOB ADDRESS 1777 Panay Circle BUILDING PERMIT NO. . 22893 •- GENERAL CONTRACTOR F4•ank W. Sallee VALUE $ 27,400.00 p AP No.139-122-10 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Res. Rat.Gar. 1 INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R1 Soil ,4 lts //-/2-4.4- PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water _ /7 `".Y - -- - Rough Com. Refn ❑ • ' Cond. 0 �-�^ Rough Heating �,/ (/ _C(�� 4 .0, InPfic_Rougr(/C��'/7i�E�ti Prop. Swr. Line -House Con. EySt. Swr. ❑ -7.� o_3-y�..w,,., rQ:#:-.4,4.___. /� • I Sprinkling System „ trrtl 7a,3.t44• o , _ - Q 31.3,66- !.(/3— .1,5 �J ti Construction Pole $ &Jzi Cf nil ,-� (/--La-Cf Il(2 70 3 Underground 0 Power 0 r _ _ Rough Wiring /Ica, T 1.T -227. .fj�.-•c-0 __/-�� fl 3 _ Trenches l©� Forms c'l' Steel Reinf. C]=- /pf/ f�^!,��f Floor System Ze/ /�/ _/�✓ Bond Beam 0 Steel Reinforce 0 ',yr,TSheathing Frame and FlashingLathing — In QJOut ?Plaster, brown coat Refrig. 0 Air Con. 0 Final Heating, Final 44127tj-oS Plumbing Fixtures, Final MIS- .1-9-4-5-- Final =9-G-rFinal Gas Tesvr /t4f-S 3-9-er Electric Fixtures, Final w2-i T/L C7' Building, Final 4 - 1-/2-Cy OCCUPANCY • . Form 13U4-5M-3-63—S-B P 22891 111,41 a 22893 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT AVG '3 1 1964 Oy" P.O.BOX 817 COSTA MESA.CALIFORNIA FINANCE DEPT. \ For Applicant to Fill In Completely APP[IaTigNCRRAP - 1777 �7 TYPE OR PRINT BUILDING ADDRESS/7j 7teQ/1/Q e If ni e �� For Office Use Only /�/' RECEIPT NO. PScER��A�LT�NQ COSTA MESA, CALIFORNIA 6 �� RECB B RE DAT SSU D CIO f,�i l/Ps,��` e C �3r -•�a�� OWNE / �J ry ,� - /� MAIL ADORE / / / J /✓ Cee a ADDRESS J&77 2/2 bee/ /2 .� /, �' t 1 CITY/¢// ate4 6a/f6/1)1°NO yetI�i FIRE 4. /�// �I �/� /� TEL{'�(J q{/I ZONE TYPE GROUP AR ENIGINEER/'ry-Z?// /Y I Aid 7:ro 73 B PROVED dJ1 I DATE " t...5----?.? J /� / 0-e440 ONING 1 ADORE39 7 6� .u�/�1�/// �[ � ZQN8 PLANS ^ / BUSE OF UILDING NEW ,,,n CONTRACTOR/Mg K K 6A-/'4 e e 'k r v I I �^ J� �f ( �) / -ESCRIPTION L a f /6 6 IR 93 63 ADDREESSS.J/`�` ,[l/L /�}J/�/�y;-'rice � /} /` l j (/�/ CITY` O S / !l /M I t2 s /T A.P.NO. t 3 T ^ / p( Q - / `� 1 - NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE /I y a TEL. T Q/g't 90"TO SIDE et REAR P.L. p SIZE �j7 S -Y 14'X I NO.OF SLOGS. EAVESALLOWED (U.B.C.REQUIREMENT) OF LOT�j] X j J; 99 NOW ON LOT /J� YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/LLSTREET) SETBACK LINE FROM FRONT •T 1J FT. FT. CENTER OF STREET REAR YARD ✓ SIDE YARD I LEFT I RIGHT R.SIDE 3n. PT. DESCRIPTION OF WORK L.SIDE Scr-1r.C/ rat/ �1 i/ X REAR i /lye 1. 5 NEW ALTERATION ADDITION Lf l • DISTANCE BET. _ BET.MAIN& REPAIR J �JMOVING 4EMQLISH MAIN BLOCS. ACCESS.BLDGS. V BUI NO.OF SIZE J Z. ROOMS /^S/TORIES//, I CAU.P.# APPROVED EXTERIOR WALL/ I ROOF ,J/5//V i/+J APPROVED - �. 4/4 //j j COVERING ' 6 IG USE OF BUILDING AND WORK TO BE PERFORMED `'-"C J i iii L 477 & til4 / 6t ,,ICKNOEDGE THAT 1 HAVE READ THIS APPLITIONTHE AMOUNT SHOWN UNDER VALUATION IS FOR THEet THAT THE ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.ALL CITY ORDINANC88 AND STATE LAWS gBGULATINGVALUATION )5 ' ONBTR _ 4 � pERMiT FEE $E OP EZED AGENTa ......., Y TOTAL FEE 6�J fa 0 ft:I COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIOI$FIfe:�, R18Y0[41ut�PERMIT-24 550 TL P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •. . • - .- -- _ RECEIVED BY $PERMIT 1s g 48233 f.gi , For Applicant to Fill in Completely /— Use Ink Only /�j 4 1V ✓"_ `/g/ADIDRESS /77 7 CPnN'9 sC,,e A.P.NO. /3 /^ /2 2 — /O . \ 'O TENANT L3 ie J o /C 6J/C�/C ADDRESSG{I-777 ��/!/Jc / I Com, UNIT OR I MAILING SPACE NO. ADDRESS TEL. TN S LOT // /s 1BLK. CITY NO. CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER Y /� 1 BRANCH /� i " �V 12. it re_ OWNER IC (!. ���-r, ADDRESS USE 1.) USE �* JP/ UES 6 Cro ARCHITECT TEL. OR ENGINEER NO.• /,{�� T DDRESS ,,//JJ tt//�� ys� ZONE /1 'YPE .0 GROUP .J CONTRACTORCUI�UwA Ott Jvi co APPROVED n� DATE / - - er ADDRESS TEL. CITY NO. E-. STATECITY APPROVED SETBACKS LIC. NO. LIC. NO. fal SIZE NO.OF BLDGS. (FROM C/ 5-TEE SOF LOT NOW ON LOT FRONT Q USE OF CFT. EXISTING BLDG. R.SIDE �+ FT. (a F Separate permits are required for L.SIDE ///0 FT. G electric,plumbing and heating work. REAR g2 4 FT. - [t7 USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION - GI Q PAT CUVL' n/� _ DATE APPROVED A / (� 9 r —FLY I DATE /I - 2! I:4 W 0 I hereby acknowledge that I have read this application and state h. r4 that the above information is correct and agree to comply with A. all laws regulating building construction, and I shall not employ 5 Z any person in violation of the workman's compensation laws of 12 clii Y the State of California. At//JJ��JJ JliG/SO. FT. N I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION I FOR to Chapter 9, and that such licenses are In full force end effect,or 1THE PURPOSE OF ESTABLISHING A PERMIT F N am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ e and Professions Code, Division 3,Chapter 9. Signatur. o /'1 / / if PLAN CHECK S �4J LL Permittee .......a% tLsaa $ ja orJV V TAX $ � U Authorized Agent Date ` TOTAL PAID $ �.