HomeMy WebLinkAbout1021 PARKHILL DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 1021 PARKHILL DR
Suite No
Vicinity:
Parcel Nunmber: 42431311
Applicant: STEVENSON,JAN FREDERICK
Address: 1021 PARKHILL DR
COSTA MESA, CA
Owner: STEVENSON, IAN FREDERICK
Address 1021 PARKHILL DR
COSTA MESA, CA
Contractor: OWNER -BUILDER
Address:
Phone: 949-650-2693
Zip: 92627-4534
Phone:
Zip: 92627-4534
Phone:
Zip:
License: 000000
Arch / Eng
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
INSTALL NEW ABOVE GROUND SPA, BBC & FIRE PIT.
PLUMBING TO INCLUDE: 1 GAS (1-4 OUTLETS) AND 1 GAS REPIPE
Status: ISSUED
Applied: 06/08/2004
Issued: 06/08/2004
ISSUED BY: -o;wz_
CITY
AMT
FEE SUMMARY
0
AMT
CITY
0
AMT
ISSUE FEE
$23.50
0
Laundry Tub / Washer
$0.00
Backflow, irrigation
$0.00
0
Landscape Irrigation
$0.00
Backflow Preventer,
$0.00
0
P -Trap
$0.00
Bathtub
$0.00
0
Pressure Regulator
$0.00
Clarifier System
$0.00
0
Process Piping (per 10 fl)
$0.00
Connect (Ice,Soda,etc)
$0.00
0
Receptors
$0.00
Dental Units
$0.00
0
Septic Tank
$0.00
Dishwasher
$0.00
0 -
Sewer Cap for Demo
$0.00
Drain, Floor
$0.00
0
Sewer Connect
$0.00
Drain, Rainwater
$0.00
0_
Sewer Private Line
$0.00
Drain, Roof
$0.00
0
Shower
$0.00
Drinking Fountain
$0.00
0
Sink, bar
$0.00
Status: ISSUED
Applied: 06/08/2004
Issued: 06/08/2004
ISSUED BY: -o;wz_
CITY
AMT
CITY
0
Sump Pump
$0.00
0
0
Swimming Pool
$0.00
0
0
Trap Primer
$0.00
0
0
Urinal
$0.00
0
0
Vacuum Brkr Bkflow(1-4)
$0.00
0
0
Vacuum Brkr Bkflow(5+)
$0.00
0
0
Wash Basin
$0.00
0
0
Wash Basin Set
$0.00
0
0
Waste and Vent System
$0.00
0
0
Water Closet (Toilet)
$0.00
0
0
Water Heater / vent
$0.00
0
0
Water Piping (Inst or Rep.)
$0.00
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
2"6A6 16100)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: -
❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is Issued.
My workers' compensation Insurance carver and policy number are:
Carrier: Policy Number:
s section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
1 1 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'
li--compensatlon laws of California, and agree that It I should become subject to the Workers' compensation provisions of Section 700 of the Labor Code, 1 shall forthwith
comply with these provisions.
Applicant Signetum: �. ci'• I Date: _
WARNING:,FAILURE TOS CURE 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 COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. 4 Class s
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he Or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant tar a permit
Gacts 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.).
❑ 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.).
❑ 1 am exempt under se Business and Professions Code for this reason:
0
-Owner ID ve ied by driver's license. ❑ Yes ❑ No �Dnvees Lice_ nse No. Expires:' O
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant Or present Or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at anyone 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 forth for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic 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 It en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ 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? Yes 8 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 wort which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
6 (If'yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-desy bed proped fy or inspect. purposes. I agree not to Occupy or allow occupancy of any building authorized by this per it until final inspection.
Signature Ot Legal Owners) �_, JIf L_Date-_
And/Or Authorized Applicant Date
CODE.. INSPECTION TYPE p9g INITIAL S CODE. INSPECTION TYPE QAC INTIiuLS
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 Well 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 1021 PARKHILL DR
Suite No
Vicinity: REAR OF PROPERTY
Parcel Nunmber: 42431311
Applicant: STEVENSON, IAN FREDERICK
Address: 1021 PARKHILL DR
COSTA MESA, CA
Owner: STEVENSON, IAN FREDERICK
Address 1021 PARKHILL DR
COSTA MESA, CA
Contractor: OWNER -BUILDER
Address:
Phone: 949-650-2693
Zip: 92627-4534
Phone:
Zip: 92627-4534
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
INSTALL NEW ABOVE GROUND SPA.
Status: ISSUED
Applied: 06/08/2004
Issued: 06/08/2004
ELECTRICAL TO INCLUDE: 3 OUTLETS, 1 MISC. CONDUIT, AND 1 MOTOR TO 10 HP.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2"646 (6100)
FEE SUMMARY
Quantity,
Quantity
ISSUE FEE
$23.50
Temp Dist System / Lighting
$0.00
0
Temp service lest
$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
....... ......... upto 10 kva/kw
$0.00
0
Lighting Fixts
$0.00
0
.................up to 50 kva/kw
$0.00
0
Recept Outlets
$3.30
3
.................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
$18.20
1
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
$12.30
1
Christmas Tree Stand
$0.00
0
Motors to 50hp
$0.00
0
Fireworks Stand
$0.00
0
Motors to 1 00h
$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
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2"646 (6100)
DECLARATIONS I \) Ii,
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penaltyof perjuryane of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workerscompensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this pemlit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars ($100) or less.)
4JJ I denity 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'
_7�—60mpensalion laws of California, and agree that if I sho Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Oden(SI nature: Z a---_ O` I �^ g aoo�
APP 8 'Date: ��.4.n-�
WARNING -FAILURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOU ARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. N Class It
Contractors Signature: Date:
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
suq(ects the applicant to a civil penalty of not more than five hundred dollars (5500).):
L•7-/�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. It, 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 am exempt If sec. Business and Professions Code for this reason:
Signature: o'" r—Datb -' 04"
Owner ID verified by driver's license. C1 Yes [INo !Drivers License No. ..�1Ezpiies: d
Verification of Ownership by (type of document, i.e. - property tax bill or deed): -"
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires. with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
..................................................................................on--.......-............b-tui.din...........................................file.....-................................-......................................................................................e............................................................................
2 Does or will the applicant or present or future builtling occupant need to file a registration forth for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of SDO pounds, or a volume of 55 gallons, or 2DO cubic feel of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
........................................................................................................................................................................................................................................................................................................................-..................................................................
4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ffmilt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ves 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 requlred 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? ❑Ves ❑ 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 Cartity 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-des/yribed property for inspe 'on purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) %%— Data
And/Or Authorized Applicant Data
CODE.. INSPECTION PECK YON TYPE gejE NI TITALLS CODE INSPECTIONTYPE DATE INTJALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 200 Final Electrical _
200 Final Re -Roof 210 Final lecMcalcal
201 Final Block/Retaining Well 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/Ociupancy
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 1021 PARKHILLDR
Suite:
Vicinity: REAR WALL
Parcel Number: 42431311
Applicant: SEMAS, CRAIG
Address: 2980 BABB ST
COSTA MESA, CA
Owner: STEVENSON, IAN FREDERICK
Address 1021 PARKHILL DR
COSTA MESA, CA
Contractor: OWNER -BUILDER
Address:
Zip:
Arch :
Address:
Phone
Zoning:
Phone: 949-289-9836
Zip: 92626
Phone:
Zip: 92627-4534
Phone:
License: 000000
Eng
Address
ISSUED BY:
Status: ISSUED
Applied: 07/15/2003
Issued: 07/15/2003
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 4 FT HIGH (8" X 8" X 16") SERPENTINE WALL AND 12'X 4' PLANTERS AT BOTH ENDS PER CITY STANDARDS FOR RETAINING
WALLS. 120 LF RETAINING WALL.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2"6-46 J6100)
FEE SUMMARY
Plan Check:
$99.61
Calc Valuation: $7,200.00
Permit:
$153.25
Claim Valuation: $0.00
SMIP Res:
$0.72
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$253.58
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
2"6-46 J6100)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury we of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 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:
Carder: 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 d agree that I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions / c �/ 2
Applicant Signature: / _ / Date: , L
WARNING: FAILURE TO SECURE WORKERS' PENSATION 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 COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 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. Lia # Class #
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
sub' is the applicant to a civil penalty of not more than five hundred dollars ($500).):
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.).
❑ 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 un sect Business and Professions Code for this reason:
—yam
Signature: Date: x
Owner ID verili y drivers license./�}<'T Yes ❑ No Drivers License No. _� Expires: —/0.
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
................................................................................................................................................nt--...aa.........file..........................................fo.r.................................................t-eri........................................................................................................
2 Does or will the applicant or present or future builtling occupant need to lite a registration Corm for ecutety hazardous materials? ❑Vas ❑ No
(Section 25533 of the Celifomia 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).
...........................................................................................I..........,,"'." 1 11 ... .. .................... .............. ............... 11 .............................................................................................................................................................................
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 en RMPP is .presently required, has Section 25534 of the California Health and Safety Cade been fully complied with? ❑ Yes ❑ No
.....
.............................................................. ............................................................................... .... .......................................................... .... ....................................... ............ ............... ... .... ........... .... ........... -..................................................................
5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication appermit 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 ❑ 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? ❑Ves ❑ No
...............................................c-e...................................ian...e.-f-r-o...................................................................................................................................................................................................................................................................................
e (If "yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. 1 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature al Owners) Date
7-�! -aV
AKWOr Authorized Applicant Data '
CODE #. INSPECRONTYPE WMAILS COGEN INSPECTION TYPE DALE INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
���i.-,,_��
201 Final Block/Retaining Wall 1.1--�J—` 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
• TI -0S SKETCH 6 FOR INFORMATIONAL PURPOSES
ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING
AN ACCURATE REPRFSFNfAMON OF ]HEIR PROPERTY
IN CASE THE SHAPE AND SUM DO NOT CORRESPOND
WITH THE INFORMATION PROVIDED ON THIS S=.
DIVISION OF BUILDING SAFETY
CITY OF COSTA MESA
By _
This el of plans and specific ti
maki any charges orehe:a:ions
and afely, Chy of Costa thsa.
The tamping of t is plan and
of th violation f any provi
The. , plans and perms shall e
Wor' is not com enced and r a
APPROVED
ors f ',ST be kept on this job at all lines d is u7 nls'rdul to
onsameWittqutwridenpemissionfrom the Division of 'i',
e Cal 5:iPl ,Ln b neob:pennitortobeanapprc.'
ons I any::ity of Costa Masa Ordinance and/or State la .
coir by lirMlation and become null and void if the building r
• SOLID WALLS/FENCES BETWEEN 2'6.6 GIN HE]GHT SHALL
BE SMACK AT LEAST 10' FROM FRONT PROPERTY LME.
• SOLID WALLS/FENCES SHALL NOT MC® 2' b' IN HE3GHT
WITHIN 10 OF THE FRONT PROPERTY LME (NOT CURB LINE).
• VERIFY DISTANCE FROM CURB TO PROPERTY LANE
AND SHOW ON PLAN. VERIFICATION FROM THE CfiYS
ENGINEERING DIVMON 15 REQUIRED. CALL. (714) 754,5W
FOR INFORMATION.
141LD 10k
'lv I
�
v ��' �-bj s
%v
RE SOCw CE
RE9DEMCE �"`�
AP
VE
CITY F
OTA MESA
PLANNI
G DIVISION .
`--`--°SiFBdEET-T-G-
LDG.-DEPT: ftQ.
—NOT
–DEtET16NS
OR CORRECTIONS SHALL
APPROVED BY
THE PLANNING DIV.
REET
–7 _ r
BY:
DATE:
BLOCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION
Cement Coping Optional
Channel Block With 1.3/8$6
Horizontal Top of all
Fences
For Fences 5' ar Less
Ven. Ban 3/8"¢ at 4' -0" O.C.
For Fences Higher Than 5'
Ven. Ban 3/8-0 at 32" O.C.
Fill Cells Solid With Grout
Where Steel Occurs
Rcuifnrung Steel Shall
Conform to Sec.A 1539
A.S. T.M.
All Steel to he Lapped
24" or to Code
NATURAL GRADE
TYPICAL 611 CONCRETE BLOCK FENCE
LL
TWO 3/8"C BARS I.^
CONTINUOUS TOP I
6 BOTTOM WIDTH
GENERAL- NOTES
MORTAR: One Part Plastic Cement, and
Three Parts Sand
GROUT: One Part Cement Thee and
One Half Ports Sr and
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Well Mixed 1:2-1/2:3-I/2
Mos of 7-t/2 Gallcns of
Water Per Sack of Cement
GROUT MAY BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CE LLS AND AREAS OF HORIZONTAL REIN
FORCEMENT SHALL BE CLEAR, CLEAN 6
FREE OF ALL MORTAR DEBRIS. ETC.
s 5EE CHART • °
H Ofati ST EEI MUST BE TIED IN 8E LOw UE L'TII (I' C 4RTHTCOTHH
PLACE AT TIME OF TRENCH , I I/] THE HEIGTH OE FENCE
INSPECTION s • •• I -GrLOW BOTTOM OF FOOTING
LLI j., 3
e� ID" -1 27SCALE: 1/2n= I'
FOOTING REOUIREMENTS CHART
WIDTH
14"
14.1 . 1
12',
12..
THICKNESS
10
10"
8"
8"
DEPTH OF EARTHTOOTH
24"
20"
16
12''
SPACING OF EARTHTOOTH
12'
14'
16'
16,
BUILDING DIVISION
•• �a �?Zeda b'u�iy �cvcQioct
ONE
RETAINING WALLS
2 M3 BARS —
M3 BARS 24" O.0
6" CONCRETE
MASONRY
WALL ALL CELLS
FILLED SOLID
WITH GROUT
OMIT HEAD
JOINT IN FIRST
COURSE AT 32"
O.C. FOR WEEP
HOLE
POUR FOOTING
AGAINST
UNDISTURBED
NATURAL SOIL
�— 0
MIN.
GRADE
Jill =_ III =III=III.II
IF SURCHARGE
OCCURS WITH THIS
DESIGN, THE TOE
OF THE SLOPE MUST
BE SET BACK A
MINIMUM OF 2'-0"
2 N3 BARS
N3 BARS 24" O.C.
2..
6" CONCRETE MASONRY
N3 BARS
WALL — ALL CELLS
>i
FILLED SOLID
f
WITH GROUT
0
a
OMIT HEAD JOIN IN
FIRST COURSE
2 #4R
CONT
32" O.C. FOR WEEP MOLE
2..
N3 BARS
024" O.C.
N
L
2 #4R
CONT
2' -0 -
GRADE
n=m
_ • o
2 #4 BAR
N 1--T
r—
POUR FOOTING I 2'-0"
AGAINST j
UNDISTURBED
NATURAL SOIL
2'-0"
MIN.
r— GRADE
A
INT. ,
�I N
NOTES:
1. Retaining wall shall be grouted solid.
2. Reinforcing splices in masonry shall be lapped not less than 15", in concrete not less than 12".
3. Omit mortar at head joints of first course at 32" o.c.
4. Mortar shall be no leaner than 3 to 1.
5. Inspection required prior to grouting cells.
6. Retaining walls greater than 4'-0" in height or with surcharge loads other than shown above shall be fully
engineered by a licensed engineer.
7. Retaining walls with standard concrete block walls or fences of any materials constructed above, shall be
fully engineered by a licensed engineer.
8. A survey of the lot may be required by the building official to verify that the structure is located in
accordance with the approved plans (1998 CBC, Section 108.1).
SPECIFICATIONS:
CONCRETE: 2000 psi at 28 days.
BLOCK: Grade N, Type 1 A.S.T.M. C-90.
REINFORCING: Grade 40 A.S.T.M. A615.
1913-46 (REV, 6/01)
DECLARATION OF AUTHORITY
Street Address:
1. I
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
k02\ 1y
referenced real property, and that I (we) hereby authorize:
Bldg. Permit #
This Permit #
AP Number: r
declare that I am the Owner of Title of the above
Name: &`W Telephone Number: 15i1 -Z89- 7 A13413n
Street Address:: z (�CJ� c, e*-63�
City: 6��ts YUl.F5 State: CA, Zip:��'LP,
to obtain permits in my behalf, as owner/builder, for f r C�1LLs3117Nf\11Y�1 �d
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Workers
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. 1 agree to indemnity 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. 1 declare under the penalty of perjury that the foregoing is true and correct.
Executed this 1— day of 3;J W 20 e)5 , at �B�j�ci f r X14 , California.
Print Name: 1 V e i'`SO rte.
Signature: 1 �
Date: T/
�7
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.
077946(reO 1100)
ZSOWNER IMPERIAL SAVINGS & LOAN
JOB AC
GENER
AP
INSPEC
solL
No.
DATE12-2-70
LOT 17 TRACT 7043 FIRE ZONE VALUE S
INTIONS
Signature Date
GROUP TYPE
—
ZONE
SUBCONTRACTOR
_
PERMITS ISSUED
cns
Date Number Si nature
WATER
Plambin
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING
Heating and Vent.
TRENCHES [:) FORMS [:J STEEL REINF.
3.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN OUT
PLASTER, BROWN COAT
STRUCTURAL, FINAL
Electri,_
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
_
ELECTRIC, FINAL
BUILDING, FINAL
• 1
h. • �%.r'1n�
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant tg_Ej4 in
BRANCH
ADDRESS
ARCHITECT
f
OR ENGINE
ADDRESS
ADDRESS
CITY /_,
STATE
LIC. NO.
SIZE L
OF LOT
USE OF
EXISTING BLDG.
SIZE OF
NEW BLDG.
EXTERIOR WALL
COVERING
USE OF BUILDI)
TEL.
NO. G
CITY
LIC. NO.
NO. OF BLOCS.
NOW ON LOT
PERFORMED
;5—a
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and 1 shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed ase contractor under
the State of California Business and Professions Code, Divisicn 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the provisions of the Sta California Business
and Proles' Divisio ChaIW9.
Signet a of
Permittee
OEC-2-70cwsA00 152 0*****5.00
APPLICATION FOR BUILDING PERMIT
gn II.Y E BV DATE RECEIVED
Vg ,Mo?-
NO.
DATE ISSUED
o
P M T
DING
rAADDRESS
TRACT Q
LOT BLOCK
JADD
OWNER
S
LUE /fQ
$
FIRE/
ZONE TYPE GROUP
APPROVED
BY
J7� e
AT/
ZONE
NO. OF
PLANS
i—
USE OF NEW //��� ��J
BUILDING lJC/ ft -0
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
(FROM C/L STREET)
RONT FT.
FT.
L. SIDE FT.
FT.
REAR FT.
FT.
DISTANCE BET.
MAIN SLOGS.
BET. MAIN &
ACCESS. SLOGS.
VAR.*
C.U.P.#
DATE
APPROVED
APPR VE r !
nATE/
I f
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT PEE ONLY:
VALUATION
$ �!`(,p
.•JJ
=�
PERMIT FEE $
PLAN CHECK $
TOTAL FEE $ r^
516
Gf�
�pJ7 COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
Paco
OEC -7. 70�p$p00 167*
Til For Applicant to Fill in Completely
APPLICATION FOR BUILDING PERMIT
RECEI EO BV
DATE pECEIV ED
/^ 2d
/ b
BUILDING r
ADDRESS
OWNER F /�. Ogg/
A.P. NO.
MAILADDRESS
AODRESS (r U
/OaBUILDING
q
NO. 17.7 �OTRACT/D
/J TCITY
J LOTCONSTRUCTIO
W
IR OVI
OEE
LENDER
BRANCHOWNADDRESSARCHITECTTEOR
ZONE TVPE G
ENGINEERFIRE
ADDRESS �Z /Q O / , /�
APPROVED
CONTRACTOR
BY DATE
T
ADDRESS -
ZOf { '
yam,
NO. OF
PLANS
USE OF NEW G(J r
BUILDING r
TEL.
CITY NO.
STATE CITY
LIC. NO. LIC. NO.
YARDS APPROVED
MAIN BUILDING
YARDS A ROVED
ACCESSORY BUILDING
SIZE/ NO OF BLDGS.
OF LOT e i �Q �.dU NOW ON LOT Q
(FROM C/L STRE ETI
FROM SFT.
FT.
USE OF
EXISTING BLDG.
R. SIDE FT.
FT
SIZE OF
NEW BLDG. ROOMS STORIES
Z
L SIDE FT.
FT.
EXTERIOR WALROOF
COVERING uGGO.
COVE C v—
REAR FT.
FT.
USE OF Bu—LoING WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLDGS.
ACCESS. BLDGS.
/.i
_✓Y
VAR .#-7
C.U.P. gYfL�
DATE /
APPROVED6
APP /V
(]
I hereby acknowledge that I have read this application and state
Q
!: Mr
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
1 hereby certify that I am properly licensed as a contractor under
Jppy[-
U SO. FT.
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UND64 VALUATION IS FOR
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from t e rovlsions of the Sta of Ce lifornia Business
and Professlo otle, ivision 3, Ch r 9.
VALUATION
PERMIT FEE $ "
Signature of
Q Z S
Per lttee
S
'
PLAN CHECK $LD1
Author) etl A nnn�
TOTAL FEE $ / J
m
N
to
toE
LL
COSTA MESA BUILDING—SAFETY DEPARTMENT
' P.O. BOX 1200
Costa Mesa, California
O
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IUN 12-75ERID001017 0*****5.00
READY FOR INSPEC170N
r I r r
r , I
PERMIT NO.
TRACr NO. RECD. BY -1 1456
LOT NO. DATE ISSUED
BUILDING USE
CONTRACTOR GeneralInstallation
Address; 6558 6558 West Blvd.
City Los Angeles Tel. No.753-254-
Soo elSNS 1021 Park Hill Dr
State License No. 151839 Class.
COSTA MESA, CALIFORNIA
NEAREST
City License No. 3082
CROSS ST. t`
OWNER ,�
NUMBER TYPE OF FIXTURE OR ITEM FEE
MAiL grime f �•�
ADDRESS
Water Closet (•rnBet)
548-62r
CITY f' ���.. "� TEL. NO.
Bath Tub
Show.,
I hereby acknowledge that I have read this application
and state that tbe'.above is correct and agree to comply
all City Ordinances and State Laws regulating
plumbing.,
I certify that I possess the above valid state of Cah-
',forma classification or I am the legal owner of the resi-
:dential property described above.
t
Signature of T
Permittee ,
Lavatory (Wash Basin)
Kit.heo Sinkwith
Laundry Tub or Tray
5e,vic. sink
Floor sink i'
Floor Drain t�l1l
Dishwasher „( _.A ,
_
Drinking Fountain i
na)
Urinal
INSPECTION RECORD
Ga Disposal
Garbage r��l �� J'
Automatic Washing'Mach. k-•
Nater Soft.neu� C
Water Heater &'vini
Rece' tor�l i -
SwimlPool Filter System
Gas System ... Outlets
Lawn Sprinklers
Installation or Alteration
Water PipingAPPROVALS
Back Flow Prcventer
ft.
INSPECTOR DAT.
-Prop.Sewer
U/G Soil I I
Cess ..I Se tic Tank
U/G Water I 1
Services—Water O Gas O 1
Miscellaneous
Rough Plumbing
Sprinkler System
Gas I I
Property Sewer 1 1
Pool Receptor I I
Filter System 1 I
Pool Heater I I
Miscellaneous l l
Lssuing Permit 1 fla
TOTAL FEE
5100
Final Gas
Plumbing Final I`( S
1 Utility Co. Notified I
FORM CU -1A
BLDG. PERMIT NO. /V