HomeMy WebLinkAbout1941 PELICAN PL - Building Permits CITY OF COSTA MESA
ea," ,@ BUILDING DIVISION
f a �l 077 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
°o4,4•44, PERMIT NUMBER: E10-00280
•
PERMIT TYPE ELEC STATUS: ` - ISSUED •
APN: 13948172 DATE ISSUED: 11122/2010
ISSUED BY: RMD
JOB ADDRESS: 1941 PELICAN PL CM Suite/Unit: , ,
Vicinity: `;. _.- a., -
SCOPE OF WORK: ELECTRICAL PERMIT TO UPGRADE SERVICE PANEL TO 200A FOR SED.
OWNER: KAUFMAN KELLY K Address: 1941 PELICAN PL Unit:
PHONE: 949-254-1330 City/State/Zip: COSTA MESA,CA
APPLICANT: MAGGIO, ROBERT Address: Unit:
PHONE: 951-830-9260 City/State/zZip:
CONTRACTOR: ROBERT SCOTT r!1G1 ,License No. 835543
Address: 120 HEADSTALL CTUniC ' PHONE: 951-830-9260 t1=
City/State: NORCO, CA ZipCode: 92880 • . --` CELL: d' :
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
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: 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 R. INSPECTION TYPE DATE IN1111ALS CODES INSPECTION TYPE DATE INTnnALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical X Iz _to- Ib
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign •' �' ` 222 Final Site
r. .
204 'Final Demolition .- .T .. . , 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driv- dense. ❑Yes D No
I hereby affirm under penalty of perjury one of the following declarations: - • Driver's License No. Expires:
0 I have and will maintain a certificate of consent to self-Insure for workers'. Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by •
section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
LGe`rier Sfby this permit,and that no building structure,scaffdding,falsework,or demolition
or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(Thissection need not be Dredd a n is valued al one hundred dollars(5100)a less)
Nay-Number: /3� 2,Art 2Sec. 341,Title B,California Administrative Code).
/O• 7 in-G
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the La II forthwith comply with these provisions.
If gala Division of Industrial Safety Permit Number:
Apitiea^I gnature Dnte_^ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my lice is i II f 281 effect. a registration form for acutely hazardous materials? ❑Yes 0 No
LiY,S#'A CJ25s-#�G-/ (Section 25533 of the California Health and Safety Code, with some
I- /
e. TL /d exceptions, requires registration with the Costa Mesa Fire Department by
/Leach business which at any one time has on hand a quantity of acutely
�nlradard nature Date , hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work fcr which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors (Section n be5850.2 furnishedf Califomia Govemment Code requiresbuilding thnt the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information on applications for non-residential permits).
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
El I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec. 7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
i:] I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
•
ig atur al Owners) Date
Signature Date /Pa-2S(
3057-46(3/07)
L—AndlorAulnod ' ppllranlz�y, (_ WIe
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. 5241 I /09/;;b 4I r J:S 1•�,
CITY OF COSTA MESA CONSTRUCTION PERMIT - PERMIT NO. Q TRACT NO. LOT NO. UNIT NO. , -
Project Address /97/ f'5 4r.D�r 01./i4CR C ) fin- l l • �7� I_`3 .
.
:011.2.2_4_,44C TYPS. �. - TYPE OF CONSTRUCTION NEW ADO U ALTERATION' U REPAIR 1 p���/ -
Applicant's Mailing Address / ❑ CONVERSION El DEMOLISH El DTHE A p # 1 V - /I G I -- '7Z , - . ' Zona '�I'
Owner's Name /�R J.{ lu fF'TS c v Phone 5.31--1-1-i/ �j a' 1 cJ [ `T C/
_Me/
/744
��� // -DESCRIPTION OF WORK/USE OF BLDG. , ,4, Z_' /CiDQ C. ,
Address p PAAC'i= - ���� S Main Buildi11ngLL: p1' Wp?'.-4_a& Accessory Building:
Arch/Eng. - .--- EC /6'C/16// License No. -- - • TYPE OF PERMIT El GRADING t!d'FOUNDATION ❑ STRUCTURAL T Front ca -etio d d I•IFje o
Address ❑ TENANT El ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - N
Contractor's Name /2 ` c2/Yc,147fr Phon&siZ 1iJ T ❑ 'OTHER / �9/ ! A / I
Address(mailing)A 3-3 3 /A,Ck. 4l/i Ar jq. PROJECT DESCRIPTION SQ. FT.3ic OCCUPANCY C RightN
C,..,^ K SiCJI i G
/ / / q / CONSTRUCTION TYPE VALUATION§ 't-M/ $ Left Lf( -
City License No. tea G+ . 7 r R
LICENSED CONTRACTOR DECLARATION ZONE - GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
I hereby affirm thatI am licensed underprovisions Charter 9 (commencing Remarks:
I with section 7000) of Division3 of the Business and ProfessionsCode, and IC 7/ - 95 Planning Notes: �a 5� M2 < In.-411/7-42- M
90 my license is in f II f ce and eft •� g _ T
License Class <� - - cense NnL..J O J - • S
VJ Date/-7c k i Signature C ,77a_a� a o. PLUMBING FEES _
(V WORKERS' COMPENSATION DECLARATION Bar Sink Showers
, ..1 hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
0 15-50 KW
3800, Lab. C. �1 q'' -' Automatic Washer Transformeri
Policy No. hO2-1(C7 W�1 Company 'I'1 (�� Backflow IrrigationCap Construction Pole Sub.
bb 9 Sewer 0 50+KW
Ce c py is hereby furnished. '
sniff 0.cc yfiled with the city Bing I •iqn/�4� Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps -
Date I 1 0 Applicant• f/EXEMPT ON ROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors , Dishwasher Meter Clover 100 amps I
(This section need not be completed if the permit is for one hundred ($100) or - -
less). Dishwasher Solar Piping' r Dryers ❑Gas ❑Electric Sub Panel -
I certify that in the performance of the work for which this permit is issued I - - •
'
shalt not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00.1 HP 01'h--8
Workers' Compensation Laws of California. _
.,Date - Signature - Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE: If,after making this declaration, you should become subject to the Inc.Solar ❑9.15 HP 018.15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. • - - Microwave
CONSTRUCTION LENDING AGENCY Gas Service ' Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) -
Interceptors Water Heater Outlets
Lender's' Name Range
Lender's Address • Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION 9
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county welch requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW
_any structure, prior to Its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • -
the Contractor's License Law(chapter'9(commencing with Section 7000) of - ,
Division 3 of the Business and Professions Code) or that he/she is exempt •
herefrom and the basis for the alleged exemption. Any violation of Section '-
1031.5 by any applicant for a permit subjects the 'applicant to a civil
- enalty of not more than five hundred dollars($500). '
I, as owner of the property or my'employees with wages as their sole Reinspection Fee I $15 Issue Fee ' $ 3
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee ' ! $15 Issue Fee' $ 3
-for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her ownDEVELOPMENT SERVICES REQUIREME TS: ,
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 , I'
sale. If, however, the building or improvement Is sold within one year of cum- • Canopy Type H ❑ Zoning Approved By DC "K Date --�T�/i
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved BY Y+n Date I ' P,
prove for the purpose of sale).
Strac0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural • Refrigeration System • - , Application Issued By ✓' Date I 83--
tractors
tors to construct the project (Section 7044,Business and Professions Code: ..
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating , 00-100,000 BTU 0100,000 BTU SUMMARYOF FEES
builds or improves thereon, and who contracts for such projects with a.con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ Z 5,00' SMIP $ •O
0
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ • Ile• Z sC/• PERMIT
0 I am exempt under Section -- B.& P.C.for this reason Firepl/Fact BIL ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date owner Heating System& Ducting Registers
I hereby certify that I have read this application and state that the above ❑0-100,000.BTU 0100,000 BT _ •
PLAN CHECK 25% $ ENERGY P.C. $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL . $ GRADING $and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 5096 MICROFILM ' $
sentatives of this cit r/t/t- enter upog/-theme agpye-mentioned/'property for $ ' I
Inspection purposes.(%C-' '—/ J// ( 1 /^mfr • MECHANICAL - $ TOTAL FEE $ �T I . �5
Signature Lf Date Reinspection Fee $15 Issue Fee , $ 3 PLAN CHECK 25%' $ •
Drivers' License or'§S - -
CMF 0865-46,rev. 10/84 White - Building: Canary - Applicant; Pink-Accounting; Goldenrod - Assessor _ - -
I: i
CONSTRUCTION AND PLANNINGPOL y SPA
APPROVALS Permit# Date• Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
. 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement • "/v/$ y ell
u 56. Rough Plumbing & Pressure Test
6. Electrical UFER-Grnd.', (/ I 57. APPROVAL TO COVER-GUNITE
, 7. Footings ' / /311 /�y,"�' 58. Electrical Conduit-Undrgrnd.
8..Foundation ( / v 59. Gas Pipe, 0 Undrgrnd.,Test ,
9. Water Pipe=Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System i 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.E Rough Electric Wiring 67. Fencing & Access Approval
17.•Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# .
21. Ducts, in Structure • 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test - 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25.,Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame•and Flashing • 76. Dry Standpipe
28. 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 I. ,
39. Water Se?vice-Final
40. Gas Service-Final
-
41. Solar Domestic-Final
42. Backflow Preventer i - '
43. Backflow Irrigation -
44. Landscape Irrigation System i
45. Sound Attenuation i
46. Handicap Regulations • - .
47. FINAL STRUCTURE & BUILDING / '/ r'/ '�•�/�
48. Special Requirements Completed +
49. Electric Release to Edison - ,i
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY -
•
No. Date
Pfl0JELT ADDRESS: 1941 PELICAN PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 065264
OWNERS NAME: WATSON, PAUL A
ADDRESS: 1941 PELICAN PL PERMIT NO: B 065264 PLAN CHECK NO: N GOVT; N SUPP : N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: OTH
t540-1822
. ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF W/COMPOSITION SHINGLES SQ FT: 5, 100
ADDRESS: UNIT:
• /I CLAIM VALUE : 5, 100 , 00 CALC-VALUE: 5, 100 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: AERO—THERM CONSTRUCTION ( 714 ) 646-3953
ADDRESS: 289 LILAC LN COMMENTS: SMOKE DETECTORS REQUIRED PER 1991 UBC, REROOF 2850SF RESID/GARAGE
COSTA MESA CA 92627 ##**##########*#####*###########*###*********************#*********************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R EQU IR E M E N T BSMOKE DETECTOR
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITYLIC.: 049015 STATELIC.: 393321�/A� CLASS:/Jr/39'
Dale: /Z-- t f) Signature:_lZtac.r._Ge 4.474.7,24.--I MAIN BUILDING ACCESSORY BUREQUIRED---
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certiticate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3600.Lab.C). LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
POLICYNO.: 01CC987009-3 EXP.DATE: 10 /05/94
COMPANY: DAVCO PARKING REQ: PROV: PARCEL: 13948172 ZNE: REF NO:
J Certified copy is herebyrefurnished. ® Certified copy
� i
is filed with the cityBuildingDivisionp��yL'_ PLANNING NOTES>
Date. Applicant: a **#*#*#**#*####*#**#************#***#*#*#***##***#*##**#****#***#*#*****###****
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less), DEVELOPMENT SERVICES REQUIREMENT' S
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. ZONING 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. ` r
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE: V'I /6 (C
which this permit is issued(Section 3097.Civ.C). **************************#****************,c—*:V#,.F*******************$$3,#V1i-V.T **
LENDER: *****************************************#********************##****.*****##****
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE . SMIP/RES' ' GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 81 . 00 . 51
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 SMIP/NOIsI—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 P LAN - r
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
❑ structure nerooilf the heetloperlyrorfmyalemployees with wagesass their slencompecaTonCwit
ado the work,License Law BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID , " DUE
TOTALS----> 81 , 51 0 . 00 0 , 00 81 . 51 ' 81 . 51 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.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 TOTAL S--> COLLECTED: 81 , 51 OVER/SHORT; 00
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 81 . 00 . 51r
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon
and who contractsfor such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **********************************4***********************.**********4**********
that proof of their Worker's Compensation insurance should be provided to me.
❑ am exempt under Section: B.&P.C. I ND I V I D U A L F E E B R EA K D O 14 N
for reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: SFR 5100 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 100 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and 'END OF FEES
25534 and that or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements fora ...
permit for construction or modification from the Air Oualrty Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: • '
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
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
s/ property for inspection purposes. _ 01 001:n2O3t1—OO 132031 T o E T 31.51
Date `
: —k—en Signature: �C �K� DATE: 12/09/73 TIME: 16:52
•
Driver's License or Social Security*:
the 146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
•
CONSTRUCTION AND PLANNING POt ' SPA
APPROVALS Permit m Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole
p 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 Condu,t•Urdi lrnd711.
8. Foundation 59. Gas Pipe, L.74 Urdrgrrd , Test
•
9. Water Pipe-Ucdrgrnd. 60. Backwash L'nes,P•Trap1 L drernd 4-1
10. Structural Floor System 61. APPROVAL TO DE CK
11. Property Sever Lire & Ho..se Connection 62. Backe ash & Recc; :a• Fina•
12. Sewer Cap 63. Heater & Vent-Fin:
13. Roof Drains 64. Plumbing S;stem - F ^-1
14. Rough Plumbing ' 55. Electrical-Final
15. Rough Electrical-Conduit " 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing &Access Approval I
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceding 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 1I
22. Ducts, Ventilating 71. Product Fining 71 Gas Cl Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas i7O.I
25. Roof Sheathing 74. Overhead Hydrc
26. T-Bar Ceiling IStructurall & Monocoat 75. Dry Chemical ~'
27. Frame and Flashing J 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL ( ^i
29. Insulation 78. FIRE PREY. FINAL I _
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter•Final 80. FOOD CERTII-ICATE ISSUFD
33. Final ElectricNotes:
m.F_o � R gcxiF__,l _503
34, Final Heating& Air Conditioning �Ii-
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Firal Factory Fireplace
38. Final Plumbing
39. Mater Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer /f
43. Backflow Irrigation •:„.0 12-2-7-4?
3- _4.4-
44. Landscape Irrigation/Xstem vc*r--cam i
45. Sound Attenuation it
46. Handicap Regulations" 1f�11 ----
47. FINAL STRUCTURE E34:. t.DING 2
l -2_`x``13 ..i6 5 �-�/�t�Q £- f
I
48. FINAL PLANNING ttZ
49. Electric Release to EdiSdn ?`
50. Gas Release to South( Catf'ornia Gas Co -
51. CERTIFICATE OF OtC9UPANCY
No. :Tate
Lot 32 I 21851
FEE RECEIVED
MAR 3.1 1964
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT,
P.O.BOH 517 COSTA MESA.CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING For Office Use Only
ADDRESS 1941 Pelican Place
RECEIPT NO. FIJR�IrPYryG I
COSTA MESA. CALIFORNIA (� 11 ��''^VV1l
RICE 6O BY TE RECEIVED DATE ISSUED
OWNER Pemba Subdividers, Inc. ,-- - '-- y apo 1 A, I°t,c
BUILDING
MAIL 2850 Mesa Verde Drive ADDRESS
ADDRESS -- -- - - // _ 0
FIRE
CITY Costa Mesa, Cal. No 5490395 ZONE TYPE 1 GROUPIE I
AF"+ITECT E. Kaltenbach TEL 5478046 BBYPROVED DATE
C SINEER NQ.
1833 E. 17th St. Santa Ana ZONING
ADDRESS ZONEI
NO.OF I Dag OPNEW singl faM.
S 01R_1 PLANS 2 EDILDING W/ att gar.
CONTRACTOR'Owner
DESCRIPTION Lot 32. Tract 5289
ADDRESS
CITY A.P.NO. none
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATNO. 187318 TNEL
30"TO SIDE&REAR P.L.
SIZE 4 EAVES
OFLOT 85 0 • �� 5 NOW ONLOT Op ALLOWED (U.B.C.REQUIREMENT)
USE OF /LC/.33 �_Vjec,7 x/08, 0(1 YARDS APPROVED YARDS APPROVED
EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SETBACK LINE FROM 53T 35' FRONT
CENTER OF STREET REAR YARD
SIDE YARD' LEFT rJ t I RIGHT 6' R.SIDE Fr. -
FT.
DESCRIPTION OF WORK L.SIDE .`S`FT. FT.
NI A ALTERATION _ ADDITION REAR 3�+FT. FT.
II' DISTANCE BET. BET.MAIN B
MAIN SLOGS. ACCESS.BLDGS.
REPAIR MOVING DEMOLISH
BUILDING NO.OF n VAR.# DATE
SIZE 2, 481qyl` ,pp' ROOMS `� gry�a,1R'IRS 2 C.V.P.# APPROVED
COVERINGW OLO I�UCV I ROOF pY'fG�'"e BYPR D� (,� 6�
COVERING & >.ngle BY 04I 11,L�Lv1,� DATe �����
USE OF BUILDING AND WOIj TOB ER OR ED VV-- \T r�
Single family with attached garage. 17]-.\ -
House 2,030 sq.ft. a�
Garage 451 sq.ft. Plan 54-BR _ : 26,3 .FT. g 9602 a o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. D
PLY WITH ALL CITY ORDINANCES AND STAT LAWS REGULATING VALUATION 0
BUILDING CONSTRUCTION. / 9 N
SIGNATURE OF /� •
PERMIT FEE $ (� O
PERMITTE 44u /
s�/ �/ PLAN CHECK s J 5?-3-4
AUTHORIZE. ENT J/( �`
TOTAL FEE $ / C/s