HomeMy WebLinkAbout1788 PENINSULA PL - Building Permits / �4W MF r CITY OF COSTA MESA
4� q BUILDING DIVISION
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•(,,4"`�- � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
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M04-001R7
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1788 PENINSULA PL Status: ISSUED
Suite No Applied: 04/16/2004
Issued: 04/16/2004
Vicinity: REAR SFD
4/11
Parcel Number: 42452120 ISSUED BY: ,AWA
Applicant: GARZA, AMY
Address: 8 FALLBROOK
Phone: 949-552-5612
IRVINE,CA Zip: 92604
Owner BETLAN, SANDRA L
Address: 1788 PENINSULA PL
Phone:
COSTA MESA,CA Zip: 92627-4592
Contractor: WEST COAST HEATING AND NC
Address: 8 FALLBROOK
Phone: 949-552-5612
IRVINE,CA Zip: 92604
License:814471
SCOPE OF PERMIT
REPLACEMENT OF A CONDENSER AND COILS WITH A NEW 3.5 TON CONDENSER(A/C UNIT)AT
THE REAR OF AN EXISTING SFD. .
1 COMPRESSOR 3-15 HP/500K BTU
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
•
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 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 $27.15 1
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
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
2446-46(6/00)
DECLARATIONS '
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
aji_ 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 wo erre'ccom nation urance car' r and policy number are: /�j 5^J
Carrier: CJ l,(,( Policy Number 7`1 I V
(This section need not be compl fed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the p- • ance of the wor r which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation la . of C:IIIornia,and gr hat if I should become subject to the workers'compensation provisions of Sectiggii 3700 oflthe Lab Code,I shall forthwith
comply with the :provi ons. �� / I 0 /I
Applicant Signature: i Date: l/. La
( LAY
WARNING:FAILURE TO URE WCOMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000),INA ITION TO THE COST OFCOMPENSATION.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 licen d u d r Prpvdsiyn of Chapter 9(commencing with Section 7000)of Division 3 of the BusineAs and Pro essions Code,and my license Is in full
force and effect.Lie.a I "t / Class a -ab
Contractor's Signature: a_ '1- Date: .� L ( Lp / O y
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).
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
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O 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 Coda: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 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. Wes ❑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,faisework,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 db such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I 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
sh of the California Healthdu and reported
Cotler a requires,with some exceptions,that a tOBusiness gr Plan bfiledigh the Costa Mesa Fire volume Department g lions,
rbusiness0which has o anyr one time asta a rd p aa quantity of re).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? 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? 0 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 pan 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 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 ell 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 inspecti n purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
re Of Legal Owner(s) Ca
r Aut ori d Applicant Die D
CODEINSPE
6 RiEfFixed Sysrfatem gd)& 11rtrtIALfl 206 Final Mechanical ��
1616 Fixed System Final Fire Prevention 206 Final Mechanical O E
1266 Pool Spa Final 208 Final Plumbing P
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
•
Pt ECT ADDRESS: UNft
-; OWNEHRNAME: 1 788 PENINSULA PL 4:•-..,, CITY OF COSTA MESA - BUILDING PERMIT PERM NO: G 051671
KAUFMANN E BROAD •
ADD•RESS: 180 N. RIVERVIEW DR PERMIT NO; G 051671 PLAN CHECK NO: 01250-91 A GOVT: N SUPP : N
SUITE 300
ANAHEIM CA 92808 CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE MEC PLU STR PURPOSE: NEW
921-0506
ARCHIENGINEER: REG.NO.:
ADDRESS: MIKE WOODLEY C1 tlN�30 JOB DESCRIPTION : SFD AND GAR SQ FT: 2 , 119
180 N. RIVERVIEW DR ' 300
PERMITTEE: ANAHEIM CA 92808 CLAIM VALUE: 117, 438 . 00 ,CALC-VALUE: 119, 681 , 40 GROUP OCC: R-3 /M-1
ADDRESS:TEEKAUFMANN f. BROAD ( 714 ) 921-0500
180 N. RIVERVIEW DR 300 COMMENTS: REF PLN-CK 234-89 A
ANAHEIM CA 92808 **>F>F****4**r* * '*** **** *****x*** ***** **vr*aM-****trim' ;:*********T6r**N-*rt• ***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7. ONING R E Q U I R E M N 1 -
y
7000)of Dimsion 3 of the Business and Professions Code,and my liter • in full force and effect. SETB A C K S^
CITY LIG.: a4 • sTAreuc.`334495 3-i i
Dale'. / Signature: % - - .1 1 MAIN BUILDING ACCESSORY BUILDING
' WORKERS'r I MPE ATION DECLARATION: I hereby affirm that I hav/ertificate of consent to self-insu e or r certificate of Workers' FRNT: 10 FT IN REAR: 1.7 FT IN =RNT: FT IN REAR: FT IN
L Compensation Insurance.or a certified copy thereof(Section Mt L .CI. LEFT: 5 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT; FT IN
DLICYNO.: 4189-1090 EXP.DATE: 03/07/92
COMPANY: TRANS, INS PARKING REQ: 2 PROV: 2 PARCEL ; 42452120 ZNE: PDR-- ' REF NO': PA-88-40
0 Cemfieticopy':hereby4rnishetl. C CertiO cpm isfiledvmthecityBpildingDivision. PLANNING NOTES> SINGLE FAMILY DETACHED RES WITH ATTACHED 2 CAR GARAGE. 5
- (�j/�/ > OPEN PARKING SPACE/UNIT PROV, 20 '- LONG DRIVE PROV, P, E & F
Dat4647.414 e'. Applicant: llx ****.ii.:(.*******y-***IF********************3f*****4********************it*k•*3F*'%w****Y.3:
EXEMPTION FRIM WOR RS'COMPENSATION DECLARATION: (Thi 'on need not be completed if the permit is for one hundred($1O0)or less). 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
I certify that in the performance of the work for which this permit issued.I shall not employ any person in any manner so as to become - _ -
subject to the Workers'Compensation Laws of California. 7ON NG APPROVED BY - ' DATE:
Date: Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE;
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ��
APPLICATION ISSUED BY: r -_ _� __
which this permit is issued(Section 3097,Civ.C). '�r. DATE• O�`4,'{�
LENDER: *******3r'.:}**M.+4*.lt+f***%?/.****)%**Yir***Y*4F*if*# ' if**YrK*x?i.*.?i-*a;.a:?f*Y**?(**3•:**i!.*?!.a:***.a�.ai***Y.:«
ADDRESS: LEGALIZATION:N F E E S ' M M A R Y STRUCTURAL SEGMENT: Y
OWNER BUILDER DECLARATION: thereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELEC IC MECHANIC FIRE SHIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or , 5 0 3 9 . 6 .
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 709 . 50 50 39 32 .L/ 11 . 97
pursuant to the provisional the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% 50% ' 5% SMIP/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by PLAN 115. 30
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 3,00 15, 00 15 , 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
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 TOTALS----> 850 . 11 3 3 , 0 0 115 . 30 998 . 41 9 9 8 , 41 , 0 0
his or her own employees, provided that such improvements are not intended or offered for sale.II, however the building or
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED • 9 9 8 , 41 OVER/SHORT: ,0000 0
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 709 . 50 - 42 . 50 71 , 39 47 . 75 11 , 97 115 . 30
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a Coniracior(s)k[ens°pursuant to the Contractors'stale License Law).l am aware {**_w..***********44**********ie****************;it******+tie***********a(-*<*******il**.«**
that proof of their Worker's Compensation insurance should be provided to me.
I am exempt under Section: B.E.P.C. I N D I V I D [ �L �' E E BREAKDOWN
for this reason: TYPE QTY DESCR5 119,p .T' I--0\T UNIT COST TOTAL COSTi
Date: Owner: JW'!
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
SFR 161 1 RES--TYPE $JOy�S -GOOD 69 . 00 i 11 , 15 9 , 0 T
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 5 FR 76 RES-BALCC Ftll�ll I LZ ti T AY 13 . 80 1 , 048 . 80
permit for construction or modification from the Ac Quality Management District.Residential construction applications are exempt from SFR 432 RES-GARAGES TYPE V 17 . 30 7, 473. 60
these provisions. ELE 1611 NEW RES BLALi,�IR R T'NITS/ SQ FT . 03 56. 39
NEC 1 INST FORC- RbUJWA1t4A= 100 K BTU 9 . 00 9 . 00
Dale: Applicant: NEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00
9 . 00
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county MEC 1 GAS PIPING SYS 1 - 4 OUTLETS 3, 00 3 . 00
cif[finances and silo laws rel ting to building cons, • . uthOrrze represents i s of this city to enter on eabove-mentioned NEC 1 GAS PIPING SYS 5+ OUTLETS PER OUTLET . 75 . 75
property for bang ,roses. MEC
LJ(�J FACTORY FIREPLACE 6 . 50 6 . 50
Date' y 7 � Signature: ► G11�f C NECMEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4 , 50 4 . 50
Driver's License or Social Security 4:
PLU 2 BATHTUB 2 , 00 4 . 00
1641-46 White-Dwldmg:Green-Code Enforcement; anary-Applicant.Pink-Revenue:Goldenrod-Assessor ri
416
CONSTRUCTION AND PLANNING PPA SPA
APPROVALS Permit# - Date Inspector APPROVALS Permit # Date Inspector
. ). 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 UF ER 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
0 16. Rough Electric Wiring 67. Fencing & Access Approval
`7. Rough Wiring Sign 68. APPROVED FOR PLASTERING
1'8:'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 S�i1151 V L 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 111 75. Dry Chemical
27. Frame and Flashing ' V� 76. Dry Standpipe
28. Lathing & Siding I� Ve, 77. FIXED SYSTEM FINAL
29. Insulation Wit e,014 78. FIRE PREV. FINAL
30. Drywall Nailing UPtV t IC" HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat tP l3. &Roe
tt.1l779. FINAL INSPECTION
32. Electrical Power Meter-Final
kit\ 80. FOD CERTIFICATE ISSUED
33. Final Electric �� Notes:
34. Final Heating & Air Conditioning V4j( LO4
35. Final Gas Pipe-Test wry
36. Hood or Canopy
37. Final Factory Fireplace c-4-q( c-C)
38. Final Plumbing ria! LEP
39. Water Service-Final 'q/ (ig0
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 Y q Jal r 9 t
48. Fj.NAL-2aANIMINGSs= ' :G7C? Cyt:),04 ),
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
_ i
1� PROJECT ADDRESS: UNIT:
OWNER'S-NAME: '
ADDRESS: PERMIT NO: G 051671 PLAN CHECK NO: 01250-9: A PAGE; 2
+ a FBFK}e1EN}E.X}r#X}'.Xact!eaE!F1eiM1 .>:iE16R3FBF******16-***0- Ef.:X.Y./iF****7b4K***Y.NK%M.X}5}Xie#X•N#X}EY-3 **til MMX*
ARCHIENGINEEfl: REC.NO.: TYPEQ TY DESCRIPTIO N UNIT COST TOTAL COST
ADDRESS: UNIT:
PLU 1 DISHWASHER 2, 00 2 . 00
PERMITTEE: PLU 2 SHOWER - 1
00 ADDRESS: PLU 1 SINK, KITCHEN 2, 00 2 . 00
PLU 4 WASH 3ASIN / 2 . 00 8 . 00
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section pia U 3 WATER CLOSET ( TOILET) / 2 . 00 6. 00
7000)of Division 3 of the Business and Professions Code.and my license is in fun force and effect. PLU 1 WATER HEATER AND/OR VENT
CITY LIC.: STATE LIC.: CLASS: 2 . 00 2 . 00
PLU 1 WATER SERVICE
2 . 00 2 , 00
Dale: Signature: PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2, 00
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' PLU I GAS PIPING SYS 5+ OUTL-PER OUTLET , 50 50
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). PIU 1 GAS SERVICE 2 . 00
. 00 2 . 00
EPPOLICY NO.:
COMPANY; EXP.DATE: PLU 1 SEWER, BUILDING / TRAILER 5 , 00 5 . 00
END OF FEES
❑ Certified copy is hereby furnished, ❑ Certified copy is filed with the city Building Division.
Date: Applicant: '
EXEMPTION FROM WORKERS'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
subject to the Workers'Compensation Laws of California.
Date: Signature: .
NOTICE:II,alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
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(Section 3097.Civ.C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis far 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(Section 7044,Business and Professional Code: The Contractors'Stale License Law
�rj
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 ate not intended or o0ered for sale. II.however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale),
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 Law does not apply to an owner of properly who builds or improves thereon
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.
❑ I am exempt under Section: B.&P.C.
for this reason:
Date: Owner: _`� ``
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and a
25534 and that 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 from the Air Ouality Management District.Residential construction applications are exempt from APR 1 ❑
these provisions. ( )J9�
Date: Applicant:
2:11 T
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county Y�E COSTA MESA
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property tar inspection purposes.
Date: Signature:
Driver's License or Social Security c:
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit #, Date Inspector
i. 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 OF ER 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 0Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
26. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. 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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
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. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
I
CITY OF G A„MESA
PARK FEES 001238
p qq Fee Payment Receipt
Project Address /')SUS I7' a, )'797 / 300 Penni50.../ 0/2.-ec.
A.P. Number 401ql5 / -20 � `1' a4 - Sal -aI j '-/d�f -OOa; _ a3 • zJa� -5/I -O/
Building Permit Number
Owner's
Owner's Name Kali, maW 4d an A� q Q,,,¢
Mailing Address/pO elver V I,a, •54.2A-0-, 300 AnetAti rn CA- I-2-L:/o
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76 =
- .
3-Bedrooms @ 1,205.67 = m
4-Bedrooms @ 1,545.62 = PR1 7 1991 .
5-Bedrooms + @ 1,810.50 =
Multiple Family **
Bachelor or Studio @ 474.37 = .CITY, OF COSTA MESA
1-Bedroom @ 573.18 =
2-Bedrooms @ 881.51 =
3-Bedrooms+ 4 @ 1,229.38 = 5 9/'7. 5'2-
Total Fee "I.*
Planning
7* 5?__
Planning Department rate A -1-09n4-0 - I:€2'�€A-,'
Applicant's Signature -///J
* City Ordinance 72-44 ** CI , Ordinance 72-45 ***City Resolution 78-116 BOSUN
�i.�}���
CMF 0174-30,rev.7/85 White—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant BOSU
•ERTIFICATE OF COMPLIANCE". / 061
PAYMENT OF SCHOOL FACILITY FEES
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
Developer/Applicant: F $1(JFYf3 ThP9Hf
Address : /50 ti • 2VEPVIEI.i) UE 5Th .?C7
Telephone Number : 7159-902/ -0500
•
Tract/Parcel and Lot Number(s) : /,3�?V/JJ q3) Liq
/ 14 .3 macer
Location of Project : : - 02s-77AFc4
Number of Square Feet of
Residential Space 7974 x $1 . 50 Total // 9/0/, CO
Number of Square Feet of
Commercial and
Industrial Space .x $0. 25 Total
Commercial/Industrial Project is : (Check One)
Mini-storage Motel Preschool
Movie Theater Bank Auto Repair
Racquet/Health Neighborhood Shops Hospital
Warehouses _ R & D Large Office
Heavy Industrial Hotel Office Bldg.
Regional Shops Medical Office _ Restaurant
Light Industrial Office Park Fast Food
The provisions of Government Code Section 53080 are not applicable .
This certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995 .
Checks are to be made payable to Newport-Mesa Unified School District .
Business Manager
Newport-Mesa Unified School District
The above representation as to square footage is true . Developer/
Applicant agrees that if it is later determined that such representa-
tions are not .true then this certificate shall automatically terminate
and the approp iate City/County shall he notified .
•
Date : 1 ./y45:// �_ u l� id,/ Dev - oper/Applicant
nr
a . . . A S. s:Stye fs .a e •T:'-‘3.-, tee
- 11±Sitit:±Z.ff-ef
.--i':41\? 8N FORM 116 _ 't7a
B1A FORM 1486 II
INSULATION CERTIFICATION fI
lb
N�
\Vi This is to certify that, in conformance with the current energy regulations (California Adminis- i
t ilk trative Code, Title 25, State of California') and approved plans, insulation has been installed in
..•\•I the building located at:
(!/ j COSTA MESA ORANGE I 7.
/J
cats Carat SEABREEZE
1788 Peninsula Place IAT 43 TR 13224-3B
•
▪\ Street No. (I1 Aoa.el.) Street tM Naar Toa N.. I ` 1)
i I )
DESCRIPTION OF INSTALLATION I i!)
r� ROOFS I \
('\ Type of Material Manufacturer Thickness__R Value" /.1
OWENSCORNING
fEXTERIOR WALLS 1 j '
C.\ Type of Material FIBERGLAS BAITS Manufacturer FIBERGLASS Thickness 31" R Value•* 11 I ; ,
(Or Tad. Name)
C CEILINGS OWENS CORNING l>..,4
▪ \ BATTS: FIBERGLAS BAITS FIBERGLAS 6%" .19 �
''ee Type of Material Manufacturer Thickness__R R Value' _ Ir
:r0 (Or Tied. Maw) 11 c.5
�.I Sq. Ft. Coveted ,
,,,yyyyyy BLOWN:
( Type of Material Manufacturer Thickness No.Bags '
a \1 (Or Tad. N.w.) - 7
/ WL/Bag Sq. Ft. Covered R Value`•_ ',
r'. I FLOORS !�(
U% 1 Type of Material Manufacturer Thickness_R Value••_ • )
(a Tiede lima
T..\4! SLAB ON GRADE
h , Type of Material Manufacturer Thickness R Value i
(Or Tad. Nor)
',` Width of Insulation Inches I�%A
it FOUNDATION WALLS (if required) p\
\�; Type of Material Manufacturer Thickness_R Value
e j ; (a Tad. i.e.) \`.)
��.
(�� ! REMARKS (If desired)
Vii/ I
\ = General Contractor (Builder) KAUFMAN & BROAD—SOUTHEAST TI.I'C�(Yse Number '
i . By Title Oaf. ;fl)
il
Sub-Contractor (Insulation Applicator) Accent Insulation Company license Number 274283
(In.ul.bve, No.. It.l Maw "LAME" N sae s Crsd leer) Vt
. �� `;:
/� �!. 6-17-91
By /./� Title / Date I
i'c.litrn:. Ad�.i.i.tr.fis ca., Energy i...l.dve St..MN., drtrr. QaanT free s... 1t173 a Ili. NNllk ..d S.I.ty Cad. .( M Spero />>
\ 'C...live... Ilea .ee.lr:ve el M In.tll.tl.. a Iww4r:r., . sad a 4i(.rn:..
/'I swlv(.. M.. IV fowl..:..M.b.. Mf.11.d I. atf.rm..a. -a. O.
:'J ....Ini...h .4 M... nM.lati . 6.a1 M ...N...d rad seaweed by "Me rrnSsr. .( ww..xy r .i..11r sn:NC.Ive Mr • ...Ir w•. 1)
i`I' w. I...l.q.. oonwt t end byM. blonde. T.I. !r.:.1.Hw tr..lipw .M<fN \...1• ..✓.l. ..slaw' hawse. \w r .Mr read..(:.( `/
wad ...II b .rood r • rwt.la.... Ines., .IMI. M d.Nl:..."1 I..I4.. I. .NISI. M.1I b lowed by ..6 • balding d...nmvet
•:II ...bin M. w..aww .t Iger stir's _ .drm.m .erg, IM.I.nw
% 1'•g Wave I. M. ..wow. .. ea aglow a • morale( r bnl:M .•.•d.rls wtf11.A.d ewes(le 1M.Serer.'
i. WW W W r.(Merman a beef. fi....l.l..w save (Ii .a mw.•1r.. \
t
.bell ..t laded* way vele* (.r reflective balm./ iii
I Form 116 —47 BUILDING NEWS, INC. 3055 overly d Ave., los Angeles, GIN, 90034-1213187048711)
itForm 1486-6 BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC., 1571 Beverly Blvd, -12Los Angeles.Calif.90026131625-5771 Ii,)% \� w .w. w. w • .w !.r.• .w.. �✓. ✓.� �.. �+.,}, vim. `w, ..r, rNi
I
IIWA ENGINEERS
PYA
F 7390 in' 11 urst i ot,Suite 100
Fountain Valley,California 92708
(714)968-1221 •FAX(714)968-9286
July 26, 1991 . J.N. 207-05
City of Costa Mesa
Building Department
77 Fair Drive
Costa Mesa, CA 92628
Attention: Mr. Victor Clift
Subject : Fine Grade Certificate
Dear Mr. Clift :
I hereby certify that the fine grading for Lot 43 of Tract 13224
were graded as shown on the precise grading plans for said project .
. . ��
Llewellyn R . Incledon, R.C.E. 17593