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HomeMy WebLinkAbout964 PAULARINO AVE - Building PermitsCITY OF COSTA MESA BYILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT. PERMIT ��ia� �sa-sz�a • Fex (�ia) �sa-aess JobAdtlress: 964 PAULARINOAV Suite: Vicinily: Parcel Number: 14172221 npp�icant: HAFEZ BOUAKAR Address: 2200 BALL RD C.M. Owner: BELL, THOMAS E Address 964PAULARINOAVE COSTA MESA, CA Contractor. Address: Zip: Arch : Address: Phone: BUILDING PERMIT Zoning: R1 R1 Phone: 800-945-2116 Zip: 92806 Phone: Zip: 92626 Phone: License: Eng: Address: PERMI��NUMBER � VB 0-00551 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 04I25/2000 Issued: 04I25I2000 ISSUED BY: ��,_ Phone: Zip: License: License: SCOPE OF PERMIT REMOVE SHAKE, INSTAI.L 1/2" CDX REROOF WITH COMP. SHINGLES. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Exislina: 0 NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0- 0 Right 0-0 $3,000.00 $3,000.00 NOTICE: The work authorized by this pertnit shall comply with all applicable handirap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is nobcommenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legat, such xrork must comply with all applicable codes, and all ��, required inspactlona and final approval must be obtained. Failure to obtain inspectians and final approvai wili result in the wcpiration of this permit. , FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSATION DECLARATON: _ 1 hereby attirtn untler penalry of perjury ona of the tollowing tleGaretions: • � I �eve and will maintain a certificate of consenl to selt-Insure tor workers' compensation, as providetl tor by sectlon 3700 of Ihe Lebor Code, for the peAormance of ihe work for which ihis permit is iuued. ' ❑ I have entl wlll mainfain workers' compensation insurance, as requiretl by section 3700 ot Ihe Labor Cotle, tor the peAormance ot Ihe work Iw which this permit is issuetl. My workars' cnmpensation Insurence carrier and policy number are: . Cerrier: Policy Number. (This section need not be completed i! fhe permi( is velued al one hundred dollers (5100) or Iess.J ❑ I certiTy �hal In the perfortnance of Ihe work tor which ihis permit is issuotl, I shall not employ any person In eny manner so as to become subject lo Ihe workers' compensation laws oi Calitornia, and egree thet if I should become subject to the workers' compensation provislons of Section 3700 of Ihe LaDor Code, I shall tonhwith camply with these provisions. Applicant Signature: Date: WAHNING: FAILURE TO SECUPE WOPKERS' CONPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECi AN EMPLOYER TO CRIMINAL PENALTIES AN� CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADORION TO THE O0.ST OF COMPENSAiION, DAhNGES AS PROVIDED FOR IN SECTIIXJ 3106 OF THE L/.BOR CO�E, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aNirm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe eusineu and Professions CoOe, entl my licanse is in full lorce antl eHect. Lic. a CIaSs N Comractols Signafure: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm thet there is a constmction lending agency for the pertormence of the work tor which ihis permit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lsnder's Address: � Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aNirm Ihet untler penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Professions Code: Any city or counry which requires e permit to constmct, alter, improve, tlemolish, or repair any stmcture, prior to its issuence, also requires the applicant tor such permit to tile a signed stetement ihat he or she is Ilcensed pursuam to the provislons ol the Contractors License Law (Chapler 9(commencing with Section 7000) ol Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and Ihe basis tor �he elleged exemption. Any vlolation of Section 7031.5 by eny epplicant for a permit sub�ects the epplicant to a civil penalry ot nol more than five huntlretl dollars ($500).): ❑ I, as owner of the properry, or my employees with wages as iheir sole compensation, WILL DO THE WORK, entl the siructure is not intendetl or ofleretl tor sale (Sec. 7044, Businass and Pmfessions Code: The Contractors License Lew does not apply to an owner of property who builtls or improves thereon, antl who does such work himself or herself or ihrough his or her own employees, provided that such improvemenis ere not intanded or ottered for sale. If, howaver, the building or improvement is ,.,C sold within one year of completion, the owner-bullder will have the burden of proving that he or she did not build or improve for puryose oi sele.). y� I, as owner of the property. am EXCLUSIVELV CONTflACTING WITH LICENSED CONTRACTORS to constmct the pmjecl (Sec. 7044, 8usiness end Professions �Code: The contractors License Law tloes not epply to en owner of pmperry who builtls or impmves thereon, end w�o contracts tor such project with e contrector(s) license pureuant to the Contractors License LewsJ. _ sec. � ❑ No Business entl Professions Cotle tor Ihis reason: Verification of Ownership by (type of document, i.e. - pmpeny tax 6ill or tleetl): DIVISION OF INDUSTRIAL SAFETV 7ERMIT CERTIFICATION: ❑ I hereby cenity that no excavation Ove (5) or more feet in depth imo which a person is require0 to descend, wlll be made in connection with work euthonzed by ihis pertnit, antl that no builtling swcWre, scattolding, talsework, or demolitlon or tlismantling Ihereol, will be more then thirry-six (36) taef �igh. (Chap. 32, Gry 2, Art 2, Sec. 341, Tile B, Calibmia Adminisire�ive Code). ❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Indus�rial Salery, as noted above, unless such person has a permit ta do such work irom the Division. Signature: Date: Divisian of Intlustnal Sefery Pertnit Num6er: CERTIFICA7E OF COMPLIANCE AND AU7HORIZA710N OF ENTRV: I certify under penalty ot perjury ihat I have reed this application and stete that the information given is correct. I agree to comply with all state lews and ciry ordinances rela�ing to building consimction, antl au�honze representatives of Ihe Ciry of Cos�a Mesa to enter upon Ihe ebove-described proDerry for inspection purposes. I agree not to occupy or ellow occupancy ot any building authorized by Ihis permit unlil Ilnel inspection. 40oE L INSPECTIONTVPE 1616 Fiaetl System Final Fire Preventlon 1268 Pool Spe Final 200 Finel Re-Roof 201 Final BIocWRetaining Well 202 Finel Fectory Fire Place 203 Final Sign 204 Final Demolition 24t&4s QAjE f[i�QJs�$ �! INSPELTIONTYiE 206 Final MechaniCel � �.�.•—�—,,�+��� 1�,,208/ Final Plumbing '�� �' �2l0' Final Electrical 212 Final Fire Preven�ion 220 Final Planning Approval 222 Final Site 250 Final Building�Occupancy pAjE INTITIALS DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS 9h / /i�C/U(c9/�i /:{/O S �- '—T� Street Address Bldg. Permit # This Permit # 1. I(we), '"�D�''��J �. `l'�"' , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: �/�i��E�`L ,/,.1. (�ou���r� o � �/ys.2/r � Name Telephone No. �� � to obtain permits in my behalf, as owner/builder, for /` �����/ ivGi at the above referenced property. � 2. Should any person become an employee engaged in the improvement of the property, I(we) shall im- mediately 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 per- son, 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 penalty of perjury that the foregoing is true and correct. Executed this �- 5� day of 1� 19�'�� , at �v'� '""�h C lifornia. V wfi�,e,,,,,,a � � . 13e ll Printed Name - �- S- NOTE: This authorization does not grant authorization to pertorm the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. bi�lii, ��,:'i/.:%%/.p�l���il/.��/�� sr .ii mis-as (pev. 1/9t� C''.�;t�y o� L� ��2ea.a �u�:��i�uy Dir�i�a� OWNER-BU[LDER VERIFICATION - 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 retum of, an owner-builder verification. Attention PropeRy Owner. An bwner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this infortnation in the envelope provided at your earliest opportuniry to avoid unnecessary delay in processing and issuing your building pertniL No buildinQ pertni[ will be issued until this verification is received. l. I personally plan to provide the major labor and materials for cons[ruc[ion of [he proposed property improvement. ❑ Yes ❑ No 2. � 4. I (have/have not) _ the proposed work. I have contracted with the following Name signed an applica[ion for a building permit for (firm) to provide the proposed constmction: Address �90(1 �� �/�� /es�7 City .�q�.H-� Phone (8po )��/S�/�T� _ Contractor's Lic. No. Sn��a � 1 plan to provide portions of the work, but 1 have hired [he following person to coordinate, supervise and provide the major work: Name Address Phone ( Ciry _ Contracror's Lic. No. 5. I will provide some of [he work but 1 have convacted (hired) the following persons [o provide the work indica[ed: Name Address Phone Type of Work 1042-46 (FEV.9/9B) 1 hereby affirm tha[ I have received a copy of the infortnation se[ foRh in Sution 19830 of the S[ate of Califomia Heal[h and Safety Code and have completed the above information to [he bes[ of my personal knowledge, in compliance with this State�l�w. Date: '1'� ZS � Name: �"v"l /l J �_ ✓7 e �� (Primed or Typed) C.D.L. # QR S.S. #:' For more information call City of Costa Mesa Building Division at (714) 754-5273. � , / 1062-66 (REV. gg8) PflOJECTA00PE$S: C�6q PAULARINO AV � OWNEfl'SNAME: BELL THOMAS E RODflESS: (364 �AULARINO AVE COSTA MESA,CA 92626 714) 641-9499 AflCH1ENGMEEP: RODNESS: NEG.NO.: UNIT: UNIT: venminee: RENAISSANCE ( 714 ) 578-0090 aooeess: 130 N, GILBERTST FULLERTON CA 92633 UCENSED CONTPACTOfl OECLABATION: I �ereUy aifirm Ihal I am Iicense0 untler pwvisions o� ChaD�er 9(commencing wilh Sec�ion 7000� a� Division 3 ol the Business antl Pmlessions Code. antl my license is in full force anC ellecl. ruc.: 052006 srnreuc.:qg0375 cuss: B EXP: 11/94 .Oa : � — � � � � `� Sipnaturel�.�—�—� �'r"� OBREBS' COMPENSATION DELIABaT10N: I hereby affirm thal I nave a cenificale o1 conseni to self-insure or a cenificatt ol Warkers' Compensa�ion Insurance, or a cetlilied copY ��ereol (Seciion 3800, lab. C�. voucrNo.: PC3907173 EXP.ORTE: OA�31I9S comPnxr: REPUBLIC �Cetlilied copY is hereby �umishetl. �.' Cetlilied copy is �iletl with ��e ciry BuilEing Oivision. ;q -��.-aa ApPlicani ��� ("�C�� E%EMPTION FflOM WOBREPS' COMPENSATION �ECLAPRTION: (iN5 Secldn neeE nol OB complele0 iI Ne permt i5 �a ane 1mnEretl (5700) W kss�. I cetlify Ihal in Ihe OedDrmante o� Ihe wOrk lOr wAich t�is permit is i55Uetl, I Shall noi emDloy any person in any mann¢r 5o as to beCome Subleti Io t�e Workers' COmpenSaiion Laws Of Calilomia. Daie: SiAnature: NOTICE: II, allei maNing t0is Oeclara�ion, you shoultl become su�lec� �o ��e Workers' ComDe���ion pmNsions of Ne La�ar Cotle, you must �ortAvnlA comply wi�A suc� O�ovisions Or IAis permi� shall G2 Geemea revokeE. CONSTPOCTION LENOINC RGENCV: I hereby allirm thal Ihere is a consimc�ion lentling apency for the Detlormance ol Ihe work lor whic� �his permil is i=sue4 �Seclion 3097, Civ. C�. LENOFfl: FODPE55: OWNEH BIIILDEP DECIABFTION: I herehy affirm Nat I am exempt tmm �he ConVactors' State License Law for ihe followln0 reason (Seclian 7Q31.5 Business an0 Pml¢ssional COCe: Any city o� COunry whic� reQuir¢5 a permil �a conSVuct, alllr, im0�ove, tlemoliSR or reDair any slmcture, prior to ils issuance. also reQuires tne apDlicant for sucA Dermit to file a signeA statement �nal helshe is Iicense0 ou6uani Io Ine 0��'iaons ol I�e Coniractor5' Siate License Law (Clidpter 9(fAmmencing wilA Seclion 7000) ol UviAon 3 ot ��e BuSiness an0 Prolessions Cotle� or Ihat �e/s�e is exempi ��eretmm and t�e Oasis lor Ille alleAetl eKemption. Nny viotalion ol Section 7031.5 by any apPlicani �ar a De�mi� su�lecis Ihe applican� ta a civil penalty o� noi more ihan live hunEreO Oolla�s (5500). 1. as owner of ih¢ pmpeny or my empIoyees wilh wages as �neir sole comDensation. will tlo the wofn, antl �he ❑ slrudurt is nol imentleC or ollerea lor sale (Section 7044, Business antl Pmlessional Coae: The Conlractors' State License Law Oaes not apDly lo an owner of a propeny wAo 6uiltls ar impmves thereon, and who COM sut� vrork himsell/hersell ar thmuAll his Or h¢r own employe¢5. pmvitle0 ��al Suth impmvemenls are nol in�entle0 or oflereE lOr sale. II, howev¢r lhe builEinp or improvemem is solU wi��in one year of completion. �he owner wi0 have rtle burtlen of pmving he/slle Oid not build or impmve lor Ine purpose of salel. I, as awner oi the pmpeny, am e�cWsively contracting wit� Iicense0 conVacbrs Io consimc� �he pwleq (Seciion 7DOa. Business ❑ and Pmi¢55ions CAGe: The CAnlraC(Or5' Slate License Law aoes not aDP�Y ia an owner ol D�operty who Gmlas or impmves thereon ane wno conlracis foi sucA Dmlecls witn a fAntraclar�s) license pursuant to the CAnlractort' State License Law�. I am awdre Ihat pmo� ol Iheir Worker'S Compen5aiion insurance shoulU �e pmvia¢J la me. � I am eKempi un0er Seciion: B. 8 P. C. tor Ihis reason' Oa�e: Owner. I tla hereby cetlily �hat I am aware ol antl untlerstand Ihe reQuiremenls of California Health and Salely Cotle Sections 25505. 25533, antl 2553d ana��al laranylulure builtling occuDanlwilVwillno� (circle one� neeC to camO�Y wi�� sai0 s�a�e codes anU the requiremenislor a permn br consimqion or modilica�ion �mm I�e Air �uahry ManaAemen� Oistrici. fleSiQentNl conSVuctian apDlicaiions are exempt �mm 1�¢S¢ p�Ovi5i0n5. �a�e'. ApplicanP. I M1¢reby cerlily I�at I have rea01�i5 a001icalion antl state �ha� ��e above informaiion is carrttl. I aqree to compty wil� ali ciry and counry orEinarKes an0 s�ale laws rela�ing lo �uilding consimciion anU nereCy autlwrae representaiives ol Ihis ci�y �o enier upon Ne a6ove�mentionetl pr ny lor inspection pwDoses. oaie: �� ��'�y Sipnamre: ��— �— Oriv 'slicenseorSocuiSeariiv+� W�ne—Builtling�, Green—CoOe Enlarcemenl: Canary—AppLcanl; Pmk—Revenue; GolEenroE—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06883" PERMIT NO: B 068832 PLAN CHECK NO: N GOVT: N SfIPP: N CONSTRUCTION TYPE: V-5 PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION ; REMOVE SLIDING DOOR 6 RPLACE W/FRENCH DR SQ FT: 2,000 CLAZM VALUE; 2,000.00 CALC—VALUE: 2,000.00 GROUP OCC; A-3 / COMMENTS: REMOVE 6 REPLACE AT HACKYARD �r*�rx�r���r�x*� x���+��r+rx�r**x���r�r**x�r��*�*x*�***��*�r***��x�r�*�**�e�e***+r**�r� �*��r���*�r+�* Z O N I N G R E Q U I R F. M E N T S S E T B A C K S ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 14172221 ZNE; REF NO: PLANNING NCSTES> > iE i! iE jf iE if it iE iE if it iE iE iE iE �f iE iE dE �f fE iE it iE iE �E iE it iE iE if iF iE it iE iE it if iE i1 iF iE if ik iE iF if iE i! iE iF iF iE 3k �E �E ft it if iE ik iE iF iE 1E if iF if iF it iE 1E ik if iF iF iE if iE D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S 20NING APPROVELI BY DATE: BUILDING APPROVED HY ; DATE: " APPLICATION ISSUED HY: DATE: Z **+r*�*x�ir*�r********�t*** *�r*�*�r**x��r'�^7�71F����� iEiEiliEiFilifiFiEiEfEiEiEKiEiElEifiEifiEifiFKiFififitlflEiFiElElkiEiElEiF4lfiFiFiEiEiEiE1F�FiFiPifiFiEiflEifaEififiF3EM1EiEiEiEiEiE3FfE*lfif iFififikiF LEGALZZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 45.00 ,50 SMIP/NON—RES PLAN ISSUE FEE BUZLDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 45.50 0.00 0.00 45.50 45,50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: f— 45,50 OVER/SFIORT: .00 BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING PLAN—CHECK 45,00 ,SO iE ik it iElF 1E iF fF jf ff 1E i!!E fE ff 1E if !f aE %� iE 1! ik ik if i! iE k iE iE if if i!!! iE iE iE i! i! M!k it iE f! iE iE i! k fE iflE 1ElE iF iF if iE if iE i! if if if iE iE iF if jF iE iE iE i! iE i! f! iE i! k if I N D I V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 2000 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 2,000,00 END OF FEES O1 00167518—p0167519 TG 7 ¢�,gp DATE: 09/12/94 TIYrE: 09:42 CONSTRUCTION AND P�ANNING APPROVA4S Permit # Date L Temporary Electrical Service�er Pole • � 2. Soil Pipe�Undrgmd. . ' 3. Electrical Conduit Utility-Undrgrnd. -' 4. Electrical Go�duit-Undr9rnd. 5. Steel Reinforcement 6. Electrical UFER Gmd. 7. Footings � 8. Foundatio� . .� 9. Water Pipe-Undrgrnd. • 10. Structural Floor System � 11. Property Sewer Line & HousEConnection _ 12. Sewer Cap , [ 73. Roof Drains 14. Rough Plumbing 15. Rough Electrical-Conduft i6. Rough Electric Wiring 17. Ro�gh Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Heeting & Air Conditioning 20. Fough Factory Fireplace . �, 21. Duccs, in Structure , 22. Ducts, Ventilating 23. Gas Pipe-Rough & Tes[ 24. Roof Praming � � 25. Roof Sheathing 26. T�Bar Ceiling (Structuraq & Monowat 27. Frame and Flashing � !� 28. Lathing & Siding 29. Insulation ' 30. Drywall Na��ing 37. Plaster Bro4vn Coat 32. Electrical Power MeterFinal 33. Final Electt:c 34. Fina� Heat�ng & Air ConditiOning � 35. Final Gas PiPe-Test 36. Hood or Canopy 37. Final Facta�Y Fireplace 38. Final Plumbing 39. Water Service�Final 40. Gas Service-Final 41. $olar pomesiicFinal 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape irripation System 45. Sound Aitenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING /L�- 48. FINAL PLANNING 49. Eiectric Re�ease to Edison 5�. Gas Release 2o Southem Califomia Gas Cn 51. CERTIFICATE Of OCCUPANCY Dace e POO L A :^. Inspecto� APPROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical8onding 56. Rough Plumhing & Pressure Test 57. APPROVAL TO COVER�GUNITE 58. Electrical ConduirUndrgrnd. 59. Gas Pipe, O Undrgrnd., Test 6Q. Backwa:h Lines, P�Trap, O Und•grnd. 67. APPROVALTODECK 62. Backwash & Receptor�Final 63. Heater & Vent-Final 64. Plumb�ng System � Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL;SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 7Q. Under9rpund H�dro 77. Produci Piping V Gas O Oii 72. Underground Flush 73. Underr�rnd. Storage Tank O Gas ❑ Oit 74. Overhead Hydro ' 75. DrV Chemical ' �(�� 76. Dry Standpipe � 77. PIXED SYSTEM FINAL � � 78. FIRE PREV. FINAL � HEALTN DEPT. REQUIREMENT � 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: /� Date Inspector �' i . � ApPlicant to fill in all spaees except tnase within heavy ooraer Iines ana sign au apD�opriate tleclarations. �'Y OF COSTA(p�(�ES� C NST�j�j�j777��� UCTION PERMIT PER N TRACT NO. LOT NO. UNIT NU. ProjeQ[ Address —1_� `1'�2 �,� f7 � � ApplicanYs Mailing ddress ��rJ ,� � TVPE OF CONSTRUCTION NEW ADD ALTERATION , REPAIR �p I I ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,�! Owner's Name � { � Phone ' Q�t ,^^ n/ DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi Address y b,yjlt' E Arch/Eng. License No. TVPE OF PEflM1T GRADING�/ FOUNDATION STRUCTURAL T Front AddreSs O TENANT ❑ ELECTRICAL Jd PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A Convacmr's Name P one ,/ c C Right PROJECT DESCRIP710N SQ. F7. oCCUParvCV Addrezs (mailing) V K 6 CONSTRUCTION TYPE VALUATION $ g Left City License No � I ZONE GRADING CU. VDS.� ACRES Ping. Re1. # LICENSED CONTRACTOR DECLARATION � I hereby affirm [hat I am licensetl untler provislons of Charter 9(commencln9- '�Remarks: Pldnniny NOL¢5: with section ]000) ot Division 3 oi the Buslness antl Pro(essions Cotle, antl . ' �- - my license is in full t g.p effect. � License s O 'ce s N Date Signature _ WORKE ' CO PENSATION DECLA ATION - I hereby affirm that I nave a certi(Icate oi consent to self-insure or a certificate of Workers' Compensa[ion InSurance, or a certlfietl c py th o( (SecCon �00, Lab. C . licy, No. ' � Company J�rtifieG co Y I5 (Iletlbwithrtne cRY � ii n B�Ce �'%��� a 9�1/t� Date Applicant p— EXEM ION WORKEf15'COMPENSATION�ECLA ATIR ON (Thi55ection ne tl nol be completetl it lhe p¢rmit Is to� One huntlr¢tl ($100) a� Iess). I cer[ify Iha[ in the pe�fo�mance o( the wo�k for whlch this p¢rmi� is issuetl, I shall not employ any person in any mann¢r So as to Oe<ome subject to [he Workers' Compensation Laws of California. � . Date Signaturc NOTICE: If, after makinq this declaralion, you snoultl became Subject to the Workers' Compensation Orovlsions of Ihe Labor Cotle, you must forthwith compry with such provisions or this permll Shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby affi�m ihat there is a const�uction lentlinq aqency for the pe�fo�mance of the work for which [his permit is issued (Sec[ion 309] Civ. C.) Lenaer'S Name Lentler's Atltlress OWNER BUILDEH OECLARATION 1 hereby atiirm that I am exempt irom the Contracfor's License Law for tne followinq reason (Section 7031.5 Business antl Professional Cotle: Any city or county whicn iequires a petmit to const�uct, alter improve, tlemoli5h or repair any Structure, prior to it5 i55uante, d150 requir¢S the applicant for such pe�mit to tile a signetl slatemen[ tha[ M1e/she is Iicensetl pu�suant to tne 0/ovisions ot the Contracror's License Law (Cnapter 9(commencing with Settion 1000) of Division 3 of the Business antl Piofessions Cotle) or that he/she is exemp[ therelrom antl the basis tor the allegetl exemplion. Any violatlon of Section '�31.5 by any applican[ for a pe�mit subleCtS tne appllcanl to a civil dlty of not more than tive buntlretl tlollars (5500). 1, as owner ot [he property Or my emPloyees wiih wages as their sole �..mpensation, will tlo the work, antl the structura is not intentletl or offerea for sale (Section ]044, Bu5ine55 antl PrOfessional Cotle: Tlte Coniractor'S License Law tloes not apply to an owner ot a property who builtls or improves thereon, antl who tloes such work himzelf/hersell or throu9h his or her own employees, provitletl lhat Such Improvements ara not In[entletl or offeretl for sdle. If, Oowever, the builtling or Improvement is Soltl wi[hin one yea� of com- pletion, the owner will have Ihe burtlen of provin9 he/she tlltl not builtl or im- prove for the purpose of sale�. ❑ I, ai owner Ot the property, am exclusively contrdGtinq with Iicensetl con- tractors to construct tne projece ISection ]044, Business antl Ro(essions cotle: The Contrat[oYs License Law does nol apply lo an owner ot p�operly who Ouiltls or improve5 [hereon, antl who cont�acts to� such OrojeclT with a con- fIdCSOI(5� IICEOSC pursuant to tM1e Contractor's L�CBOSC LdW). I dRl aware Ihat proo( o tneir Worker's Compansation insurance snould be provitletl to me. ❑ I am exempt untler Section B. & P. 0. Por this reason r Date Owner I hereby certify that I have reatl this application antl state information is Corr¢cL I agree to cOmply with all cily antl cou antl slate laws relating to builtling consVuctlon, antl hereby a sentatives ot this ci( to enter upon the above-mentionrA inspettlon pu�p ` \ Si9nature ^ ��_ Drivers' License or 55 � Bar Sink Backflow Preventer Backflow Irrigation Dish�,vdsher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee � $15 Boiler Duct-UnderGround Duct � Structural Ouct - Ventilating Exhaust System � Multiple Firepl/FacL Blt. ICBO # Heatin9 System & Ducting ❑0.100,000 BTU 0100,000 RainspeMion Fee � $15 CMF OB65-46, rev. ]0/84 White - Builtlin9� Canary - Applicant: Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink SewerCap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service A uLO�W BSh Laundry Trays laue Fee Hood or Typel ❑ Canopy Type II ❑ Refrigeration Sys[em 00.700,000 BTU 0100,000 System Repair/Alteration Fire Dampers Registers luue Fee $ 3 FEES S 3 5485 9/17/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Auromatic Washer Transformer ❑ 75-50 KW � Construction Pole Sub. ❑ 50+KW Cooking Unit Meter ❑up to 100 amps Dishwasher ' Merer ❑over100amps Dryers �Gas ❑Electric Sub Panel Fan Motors 067 HP 01 %- 8 F.A.U. Inc.Solar �9-75 HP �i6-75+ Fixtures Microwave Device Boxes � Pole Li9ht Outleis Range Switches Garbage Disposal Generator �0�5 KW �5�15 KW Standing Sections Trash Compactor I Reinspection Fee ' S15 I � Issue Fee DEVELOPMENT SEHVICES REQUIREMENTS: 2oning Approved By 'Building Approved By -t. Appliwtion luued Bv 5o0U TL , FEES S 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ � PERMIT P�UMBING $ ->` uC� ISSUANCE $ PLAN CHECK 25% 3 ENERGV P.C. 5 ELECTRICAL 5 GRADING 5 PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ �U PLAN CHECK Z5% $ Z O N I N G R E Q M T S CONSTRUCTION AND'PLANNING POOL & SPA� APPROVALS Permit�# Date Inspector� APpROVALS Peimit# Date Inspector :� ^ 1,. Temporary Electrical'Service or Pole , 52. Pool & Equipment Locatiom , 2. Soil Pipe-Undrgrnd. l 53. Steel Reinforcement '�` 3. Electrical Conduit Utility-Undrgmd. 54. Forms .�� 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �,'; � , 5. Steel Reinforcement 56. Rough Plumbing & Pressurc�-�st , 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GCJjVITE 7. Footings ' 58. Electrical Conduit-Undrgrnd;,,:; 8. Foundation 59. Gas Pipe, O Undrgmd., Test.� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line�&"House Connection 62. Backwash & Recepior-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 Condiiioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # • 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing .:73. Undergrnd. Storage Tank O Gas ❑ Oil � 25. Roof Sheathing ''74. Overhead Hydro ' � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . 27. Frameand 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: /D�,7 Y]. G��(,A�Q G F'j4 - 34. Final Heating & Air Conditioning ' ',�«., �g ��� �p�-- �pE� �,� 35. Final Gas Pipe-Test 3'(�/•iid' lYO �NE �vO�n�• L..E� 36. Hood or Canopy }I'�.�Y CA�GEL 95 AfR 2A3 vP,t („� 37. Final Factory Fireplace , � � � 38. Final Plumbing ' � � 39. Water Service-Final � ' •40. GasService-Final � ' � , 41. Solar pomestic-Final � - � � � � , � - ' i . '42. Backflow Preventer . _ � � . � . � , 43. Backflow Irrigation � - ; � � , I . ' � •' 44. Landscape Irrigation SYstem • ' . ' • � ' � �45. Sound Attenuation ' • . �� i 46. Handicap Regulations � _ ' ' � , ' . 47. FINALSTRUCTURE&BUILDING , . . - . � 48:�Special Requirements Completed , � . � 49. Electric Release to Edison � �' �� ' 50. Gas Release to Southern California Gas Co ' .� � .. � . 51. CERTIFICATE OF OCCUPANCY � � � � . . A No. Date .. 24� I i COSTA MESA BUILDING-SAFc�f DEPARTMEM' � P.O. BOX 917 C09TA M6BA, CALIFORNIA For qpplicant fo Fill In Completely TYPE OR PRINT eu��oiHo wooaess �p Pa a i A COSTA MESA. CALIFORNIA OWNER CC{y T+6II(I COm 8Tl � wooaess �304 W. Commonwealtli Ave. ��.�. Fu1lePton No871-25 OR EN1GEN ER �1$�1 Y Boder NOLS4�6` Bra �'uc.�No. �90417, No' 871-2710 SIZE e�o �//Q � I NO.OFBLO09. 0 OF LOT �Y /I NOW ON LAT LISE OF �3 O DESCRIPTION OF WORK SIZE V v �ii1 '6 ROOMB 8T RI89 1 COVER'INGWA�� `StuCCd COV�ERINO Shingle USE OF BUILqIryG AND WORK TO Bfi PERFORMEO T ac 5340 — Lot 55 Plan 612F R-1 Rgaidence I XEREBY ACKrypy/LEO6¢ TXAT I HAVB'RHAD TXIB AP�pUCATION ANO BTATE THAT iXE ABOVB IB COqftECT AND AOR�B TO COM. PLY WITH hLL CITY OROINAN 88 AryD 8TAT6 W9 q6QULATINO BUILGINO CONe{RU4TION. i SIGNATURE OF PERMITTE� � AUTHORIZED pGENT BU CITY 0� C�TA MESA MAY 5 ��5 For Office Use Only neceiwrrvo. � er ZONING F NO.OP U6EOFN T"1 MLANH � I pUiLDINQ- � � THAN .OWED fU. B. C. REQIIIREMENT YARD9APPROVED YARDSAPPROVED MA1N BUILDIN¢ ACCESSORY BUILDINB Rean � � F'r. OISTANCE BET. BET. 1 MAIN BLD68. ACCE VAR. � DATE /tii264 �. .C/6 Z" T m TH2 AMOUNT BHOWN UNDEP VALU�TION 19 FOq TXe F PUHPOBH OP HBTABLI9HINO A PERMIT FE8 ONLT. � VALUATION op � (^.� (Yt m �'(�� PERMIT FEE $ / � $ y /�.� `J � CHE � � O // .. TqTAl FEE $ /6,3 "