HomeMy WebLinkAbout1792 PENINSULA PL - Building Permitsi
CITY OF COSTA MESA
s`p s,Q BUILDING DIVISION
i� 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: P11-00093
PERMIT TYPE PLUM STATUS: ISSUED i
APN: 42452121 DATE ISSUED: 05/17/2011
ISSUED BY: CAC
JOB ADDRESS: d.-7-92_PENINSUL'A P. L.CM Suite/Unit:
Vicinity:
SCOPE OF WORK: INTERIOR WATER REPIPE TO ENTIRE HOUSE. APPOVED PEX USE UNDER ALTERNATE MATERIALS
ALTERNATE DESIGN AND METHOD OF CONSTRUCTION
OWNER:
GAGNIER RANDY
PHONE:
909-953-0166
APPLICANT:
KEVIN TRUETT
PHONE:
818-535-1778
CONTRACTOR: REPIPE 1
Address: 23679 CALABASAS RD
City/State: CALABASAS, CA
ARCHITECT:
ENGINEER:
Address: 1792 PENINSULA PL
City/State/Zip: COSTA MESA, CA
Address: 23679 CALABASAS RD :SUITE 691
City/State/zZip: CALABASAS, CA n
License No. 927892,. I SUITE 691 PHONE: 818381-2627' ,
ZipCode: 91302 CELL:
License No. PHONE:
License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$33.30
$33.30
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE p. INSPECTION TYPE GATE INTITIALS CODE INSPECTION TYPE DD=TE �INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign - 222 Final Site '
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
1 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
Zpe rmance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
ction 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
are.
114rrn
ednott b.e�completed alhe permd a valued at one hundredcb/lars (six) or less r
Po e�2W EC OV
❑ I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if 1 should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwit omply with these provisions.
I I
poican re ate
WARNING: FAILU O SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL D SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES A CIVIL FINES UP T)) ONE HUNDRED THOUSAND DOLLARS
($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. /
Contra or' r Wre Da
CONSTRUCTION thatDINGt AGENCY:
❑ 1 herebyY[7�r(um that there is a construction lending agency for the
performance o he work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for Such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Date
3057-46(3/07)
Owner ID verified byv license. ❑ Yes ❑ 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, wiil 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.
Applicant's Signature
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 fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ 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 permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ 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? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: 1 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.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Si a gal Owners) Beate
I -
d/O!A bhcirt ate
11
Alternate Materials,
Alternate Design
and Methods of Construction
City of Costa Mesa
Development Services Department
Building and Safety Division
77 Fair Drive, P.O. Box 1200
Costa Mesa, California 92626-1200
(714) 754-5273 Fax (714) 754-4856
2�1 o 201-
Under
el Under the authority of Appendix Chapter 1, Section 104.11 of H& CA Building Code,'200 CA Plumbing Code,-= Mechanical Code
and 288 CA Electdcal Code, the undersigned request approval of alternate materials and methods of construction for:
201 n, /y
Project Name: JPG
A9 Date:
Project Address: U67 "L
Building Permit/Plan Check
:Code Requirement (Specify Code Edition and Section): ---*>
Alternate Proposed:
Evidence shall be submitted with this request to substantiate claims that the proposed alternate, in performance, safety and protection
of life and health, conforms to, or is at least equivalent to the standards contained in this code.
Requested By:
ARCHITECT OR ENGINEER (SIGN)
-BUILDING OWNER (SIGN)
',' rVin l �l/e't-s` Il(ikM DV G Pe-n%ir
ARCHITECT OR ENGINEER (PRINT) CONTRACTOR (PRINT) BUIL IN OWNER (PRINT)
2i$w.2
ARCHITECT OR ENGINEERS LICENSE NUMBER CONTRACTOR'S LICENSE NUMBER
Staff and Outside Plan Use Only
Consultant Plan Checker: Date:
Firm: Phone:
Address:
Staff Plan Checker; Date:
❑ Recommended Reason:'.
❑ Not Recommended
Building Official/Fire Marshal Only
Approved
❑ Denied
❑ See Attachment
Reason:
Building Official: X1..1 'm it Date: 5-11— I'
Fire Marshal (if applicable):
Date:
I { RZ j,'6AjIAj5Lt PL
Ru 000a3
STRUCTURAL ENGINEER
1967 ROSEMARY PLACE
COSTA MESA, CA 92627
(949) S48-7144
REPAIR OF HOLES CUT IN 2ND FLOOR SHEAR WALL
RANDY GAGN/ER RESIDENCE
1792 PENINSULA PLACE - COSTA MESA, CA
REP/PE ! - CONTRACTOR
Date: - I
Designed by:
Sheet N I I of
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looi.I
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9 _ ..
C7 No. 1823.-{Ir�iT
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RESS
PAOWNE'S NAME 1792 PENINSULA PL ur4lr: 44
OWNER'S E: KAUFMANN & BROAD
aoid�s: 180 M. RIVERVIEW DR
SUITE 300
ANAHEIM CA 92808
AflCNIEN E: 921-0506 REG.NO.:
ADDRESS: MIKE WOODLEY Ci&RSO
180 N, RIVERVIEW D: 300
ANAHEIM CA 92808
PERMITTEE: KAUFMANN & BROAD (714)921-0500
aoofless: 180 N. RIVERVIEW DR 300
ANAHEIM CA 92808
LICENSED CONTRACTOR DECLARATION: I hereby affirm that am licensed under provisions of Chapter 9 (commencing with Section
70001 of Division 3 of the Business and Professions Code. and my license is in full force and effect.
CITY 104 894 STATE 3344 5 class:,p�_J. (�/�
Date. Signature: (JTZ-/-/-F�v�1i�-
WORXERS' C TAPE SATION DECLARATION: I hereby affirm that ve a certificate of consent to self -insure or a certificate of Workers'
Compensation Insurance. or a certihed copy thereof (Section JBO .Lab. C).
9LICYNO.: 4189-1090 EXP. DATE: 03/07/92
OMPANY: TRANS, IN
7 Carl Copy is hereby furnishedCertified is liled wu the city Building Orvisron.
_ i7(,�j/tJ�1
Odle: ADDlicant'
EXEMPTION F OM W flXEflS' COMPENSATION DECLARATION: (This se on need not be completed if the permit is for one hundred (5100) 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: If, after 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. Cry. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the fallowing 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 helshe 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 for the alleged exemption. Any violation of Section 7031.5 by
any applicant lar a permit subjects the applicant t0 a civil penally of not more than five hundred dollars (5500).
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' State License Law
1 tloes not apply to an owner of a progeny who builds or improves thereon, and who does such work himself/herself or through
his or her awn 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 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
Eland Pmlessions Code: The Contractors' State License Law das not apply to an owner of pros who builds or improves thereon
and wno contracts for such projects with a contractor(s) license pursuant to the Contractors' Slate License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Dale: Owner:
1 do hereby Certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Ounlily Management District. Residential construction applications are exempt from
these provisions,
Dale: Applicant:
I hereby certify that l have read this application and state
ordinances and state laws relating to building construi
property( too,, inr ectmn urur�poses.
Date 1 7 !l Signature:
Driven License or Social Security •: ;
is correct. I agree to comply with all city and county
natives of this city to enter upon the above mentioned
16<t-06 While -Balding: Green -Code Enlorcenni Ganary-Ap, ioanC Pink -Revenue; Goldenrod -Assessor
CITY OF COSTA MESA - BUILDING PERMIT I PERM NO: G 05167
PERMIT NO: G 051672 PLAN CHECK NO: 01240-91 A GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: ELE MEC PLU STR PURPOSE: NEW
JOB DESCRIPTION SFD AND GAR SQ FT: 2,537
CLAIM VALUE: 1,996.00 CALC-VALUE: 146,817,30 GROUP OCC: R-3 /M-1
COMMENTS: REF PLN -CK 234-89 A
Z O N I N G RE Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: 18 FT IN REAR: 10 =T IN FRNT: FT IN REAR: FT IN
LEFT: 12 FT 5 IN RGHT: FT IN LEFT: FT IN RGHT: FT ;N
PARKING REQ: PROV: 2 PARCEL: 42451121 ZNE: PDR- REF NO: PA -88-40
PLANNING NOTES> SINGLE FAMILY DETACHED RESIDENCE WITIi ATTACHED 2 CAR GARAGE,
> 5 OPEN PARK W rSPACE/UNIT PROVIDED, P, E & F
iF#lEaf#iF+i#3:}'.Tf.i(*-a(##}F##'#3ii:#####iE#ie##le f4 ie?F##ir ii?i}#3E#lF3e}#y#if##jr##ii•Y.•RR###3e}#K'A.##ir Y•#####4
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.7' S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY DATE:
APPLICATION ISSUED111 DATE:
• r rr. ... r R :}#K34
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LEGALIZATION:N F E E U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ET'CTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 804,00 37.50 69,86 32,75 14,68
253 503 252 SMIP/NON-RES
PLAN 130,65
ISSUE FEE 3,00 15,00 15.00
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS----> 958,79 33.00 130,65 1122,44 1122,44 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 1112,44 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
804.00 40,50 84,86 47,75 14,68 130,65
##KK -##K -K ak#Y##Y.###i!•#.)r####K.####K#####iE#3r#9E########K##ie'4 K##}. KK•K#9( 9i
INDIVIDUAL FEE BREA KIr"COST
W
TYPE QTY D E S C R I P T I O N UN TO: COST
SFR 1996 UWE-TYPE V -WOOD FRAME -GOOD ,888 ] 'l 19913' <G 00
SFR 76 RES -BALCONY, EXTERIOR STAIRWAY 13,80 1,048.80
SFR .465 RES -GARAGES TYPE V �` 049 50
ELE 1996 NEW RES BLDG FOR 1 OR 2 UNITS/ SQ FT th OF COSTA MESA' 69.86
MEC 1 !NST FORC-AIR/GRAV FURN <= 100 K, BTU 9,00 9,00
MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9,00 9.00
MEC 1 GAS PIPING SYS 1 - 4 OUTLETS 3,00 3,00
MEC 1 GAS PIPING SYS 5+ OUTLETS PER OUTLET .75 75
MEC 1FACTORY FIREPLACE 6,50 6,50
MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 4,50 4,50
PLU 2 BATHTUB 1,00 4,00
J
CONSTRUCTION AND PLANNIN
�PPROVALS Permit # Date
Inspector
P`7t"& SPA
APPROVALS Permit #
Date
Inspector
1 Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas OOil
25. Roof Sheathing
S s
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
L
I�W_&/o
76. Dry Standpipe
28. Lathing & Siding
�+(�
77, FIXED SYSTEM FINAL
29. Insulation
L
L
78. FIRE PREV. FINAL
30. Drywall Nailing
li �j
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
ye
C,
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
tlbrjl
��
36. Hood or Canopy
✓G
37. Final Factory Fireplace
C' Q>
38. Final Plumbing
C -I /)
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
'Z
48._ELN;4L-P-L9I�Ff1NGr'?•r.. �;. �?
�' icS`7;_
� -
--
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PRJ7tCT ADDRESS: UNIT:
OWNER'$ NAME:
ADAMS:
PERMIT
NO: G
051672 PLAN CHECK NO: 01240-01 A
PAGE: 2
r
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1ER?t yL. }•.N iE%ac#x.###iE i(BF 3E#3i��
ARCH/ENGINEER: REG.NO.:
TYPEQ
TY
D E S C R I P T I O N UNIT
COST
TOTAL COSI'
ADDRESS: UNIT:
PLU
1
DISHWASHER
2,00
2,00
PEO
PLU
1
SHOWER
1.00
1.00
REss:
ADDRESS:
PLU
1
SINK, KITCHEN
2,00
2,00
PLU
4
WASH BASIN
2.00
8,00
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
PLU
3
WATER CLOSET ( TOILET)
2 00
6 00
7000) of Division 3 of the Business and Professions Cotle• and my license is in full force and effect.
PLU
1
WATER HEATER AND/OR VENT
,
2 , 00
.
2 00
CITY LIC.: STATE LIC.: CLASS:
PLU
1
WATER SERVICE
2 00
,
00
Data: Signature:
PLU
1
GAS PIPING SYS OF 1 TO 4 OUTLETS
2,00
2.00
WORKERS' COMPENSATION DECLARATION: I hereby affirm that l have a cenificate of consent to self -insure or a certificate of Workers'
PLU
1
GAS PIPING SYS 5+ OUTL—PER OUTLET
50
: 50
Compensation Insurance. or a Certified copy thereof (Section 3800. Lab. Q.
PLU
1
GAS SERVICE
2 , 00
2 00
L(CY NO.: Ek P. DATE:
PLU
1
SEWER, BUILDING / TRAILER
5,00
5,00
COMPANY:
END OF FEES
Cemlied copy is hereby lumished. ❑ Candied copy is tiled with the city Building Division.
Date: Applicant
EKEMPTION FROMWORKERS' COMPENSATION DECLARATION: (This section need not becompleted it the permit is for one hundred($100)orless),
I certify that in the performance of the work lot 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: If, 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 ContractorsState 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 lot such permit to file a signed statement that helshe 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 for the alleged exemption. Any violation of Section 7031.5 by
any applicant lot a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I, as owner of the property ormy am levees with wages as their sole compensation, will do the work, and the
;_J structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law
\C does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered lot sale. If, 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 prupeny, am exclusively contracting war licensed contractors to construct the project (Section 7044, Business
❑ and Professions Cotle: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon
and who contracts lot such projects with a contraptor(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.
❑ 1 am exempt under Section: 8. 8 P. C.
far this reason:
Date: Owner:
I do hereby eenity that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant wiNwill not (circle one) need to comply with said state Codes and the requirements for a
permit for construction or modification from the Air Dually Management District. Residential construction applications are exempt from
late. provisions, APR 1 7 1991
Date: Applicant:
1 hereby certify that I have read this application and state tical the above information is correct. I agree to Comply with all city and county
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned �JJU Of COSTA MESA
property tot inspection purposes. t
Date: Signature:
Driver's License or Social Security x:
164146 White—Buuding: Green—Code Enforcement: Canarv—Applicant: Pink—Revenue: Goldenrod—Assessor
As
!CONSTRUCTION AND PLANNING
1 stPPROVALS Permit #
Date
Inspector
P & SPA
APPROVALS Permit #
Date
Inspector
' 1 Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe.Uodrgrnd.
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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas OOil
-
25. Roof Sheathing -
.74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
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
Developer/
Address:
CERTIFICATE
OF COMPLIANCEENT OF SCHOOL FACILITY FEES +
NEWPORT -MESA UNIFIED SCHOOL DISTRICT
Telephone Number:
Tract/Parcel and Lot Number(s): /,3�`/l 11, q,4 LL4 qZ
f'7.V_EE7-
Location of Project: LL57%�MF,SfF
Number of Square Feet of
Residential Space 7g7q x $1.50 Total
1,
Number of Square Feet of
Commercial and
Industrial Space
x $0.25 Total
Commercial/Industrial Project is:
(Check One)
Mini -storage
Motel
Preschool
Movie Theater
Bank
Auto Repair
Racquet/Health
Neighborhood Shops
Hospital
Warehouses
R & D
Large Office
Heavy Industrial
Hotel
Office Bldg.
Regional Shops
Medical Office
Restaurant
Light Industrial
Office Park
Fast Food
The provisions of Government Code Section 53080 are not applicable.
This certifies that the above-named Developer/Applicant has paid school
facility fees in compliance with Government Code Sections 53080 and
65995.
Checks are to be made payable to Newport -Mesa Unified School District.
Business Manager
Newport -Mesa Unified School District
The above representation as to square footage is true. Developer/
Applicant agrees that if it is later determined that such representa-
tions are not true then this certificate shall automatically terminate
and the approp iate City/County shall notifieedd..
Date: /6 �u it
Dever oper/Applplicant
ft
IWA ENGINEERS
17390 Brookhurst Street, Suite 100
Fountain Valley, California 92708
(714)968-1221• FAX(714)968-9286
July 26, 1991 .
City of Costa Mesa
Building Department
77 Fair Drive
Costa Mesa, CA 92628
Attention: Mr. Victor Clift
Subject: Fine Grade Certificate
Dear Mr. Clift:
J.N. 207-05
-T. hereby certify that the fine grading for Lot 41 of Tract 13224
were graded as shown on the precise grading plans for said project.
Llewellyn D'. incledon, R.C.E. 17593
BN FORM 116
BIA FORM 1486
INSULATION CERTIFICATION
This is to certify that, in conformance with the current energy regulations (California Adminis-
trative (ode, Title 25, State of (alifornia') and approved plans, insulation has been installed in
the building located at:
COSTA MESA ORANGE
al, c.v.v SEABREEZE
389$
in LO'T' 11 TR 13224-3B
Sb«I Fe. (11 A.il•N.) Sb.r IIt FrM 1r M•.
DESCRIPTION OF INSTALLATION
ROOFS
Type of Material _ Manufacturer Thickness R Valuee'—
EXTERIOR WALLS 0W&N1S 00RNING
Type of Material FIBERGLAS BA= _ Manufacturer FIBERGLAS Thickness 311" R Value" 11
(or Tray F..y
CEILINGS OWNS C=1 NG
BType of Material FIBERGLAS ManufadurerFIBII2GL.AS Thickness6 "�. R Value" 19
(A Tna. F...)
SQ. FL Covered
ti►OWN:
Type of Material Manufacturer Thickness No. Bags_
(G Toa R.. )
WL/Bag SQ. Ft Covered R Value ---
FLOORS
Type of Material Manufacturer Thickness R Value..
nk T..a. tr...I
SLAB ON GRADE
Type of Material Manufacturer Thickness—It Value"—
(o< T,•a• F•..)
Width of Insulation Inches
FOUNDATION WALLS (if reiluired)
Type of Material Manufacturer Thickness R Value**—
to, Ir.a. F...i
REMARKS (if desired) ---
General Contractor (Builder) KAUFMAN & BROAD—SOUTHEAST LTi?x Number
Sub -Contractor (Insulation Applicator) Accent Insulation ComDany License Number 274283
(SUft " SA11E" N ..• a CNwI �O.DCR)
By �/ ,(' // Title Date 6-24-91
1•C•IiIN.�I A/.i.:.w•ri« C•a6 F.•q/ t«d•F« fww1.1., I•[IN«.
..C�.II:.n«. Ye« <rI1N:« .1 M Ie.MIN:« •1 I...IN:«, • «<I
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«+M••r... .I l..:....FNI N .• MI I..e.•1 \..
ti I...I•w« .«PiPc«•1 by M. \.iIIN. This.•-:.a.N•. Mll:wa
u.1 ..NI \. I.r•a N • <...III...• 1•<NIN .I.FI. M 4..11:..,"1
(••\ ...« M 4.. ew n a1 M ...1•.wY .1 ..•aN1� r WµN
arew.. w h «...• a1 F•N. TF• ..N.1r...Iw 111 .1 r..r.M.
w.•.N.ra a1.N1 M NM.1..wr MN I.r «IIMI.I wdN.I
QQlrr 0... fN. 1103 •e M H." W SM." C.4 A h iwl.
.1 Gl:w..:..
"W ter. 6 .1 .aaw•.q N •:. «n:R<.F« A . N.rl/ a..
rF.sM \•.r. nIM, ..M.«I M.«, FW by •.FN MII...:•1
4....:e. h F.NwN• .\.N M 1.«M
rl•.. M <..•a..« .1 INM .«:rf M •4.i... .r.../ w«I.1:•.
Form 116 —m BUILDING NEWS. INC., 3055 Orerfeld An, Los Angeles, Calif. 90034-12133e70.9671
Form 1486—'D BUILDING INDUSTRY ASSOCIATION OF CAUFORNUI, INC, IS71 Beverly BM, Lot Angela. CrOI 90026--0110 US -5771
e