HomeMy WebLinkAbout559 PIERPONT DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cB��LDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 559 PIERPONT DR
Suite:
Vicinity:
Parcel Number: 41$02411
npplicant: NGUYEN, CUONG
Address:
owner: GALLOWAY, DONALD S TR
Address 559 PIERPONT DR
Zoning: R1 R1
Phone: 714-545E994
Zip:
Phone:
COSTA MESA, CA Zip: 92626
Contractor: VILLA ROOFING PROFESSIONALS INC
Address: 14351 EUCLID ST #E
Phone: (714) 545-6994
GARDEN GROVE, CA
Zip: 92843 License: 758361
Arch :
Address:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: OS/29/2001
Issued: OS/29/2001
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT "
TEAR OFF COMP ROOF. APPLY25 YEAR COMP SHINGLES. TORCH DOWN FLAT PATIO ROOF. INCLUDES ATTACHED
GARAGE.
Plan Check: $0.00
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
SETBACKS
_ _ FEE SUMMARY
MAINSTRUCTURE Front 0-0 � Rear 0-0
ACCESSORY Front 0- 0 Rear 0- 0
PARKING Existin : 0 Required: 0
NOTES:
PLANNING & ZONING_ .
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
$3.100.00
$3,700.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable cotles, and all
required Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in tha expiretion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446-461&/00)
WORKERS'COMPENSAnONDECLARAnON: �
I hereby affirm under penalty of perjury one ot the tollowing declarations: �
I h e and will maintain a certificete of consent to self�lnsure for workers' compensation, es provided for by section 3700 of the Labor Code, tor ihe petlormance of the
rk tor which ihis permit is issued.
I have and will meintain workers' com ensStlbn insurence, as requiretl by section 3700 of ihe Labor Cotle, for the pedormance oi the work br which this pertnit is Issued.
My workars' compen5atio�lq ure carti r nd poliry number are: / q /
Carner. ��� PolicyNum�er: _�h �7/l / �
(This section nee0 not be camplefed i! ermit is valued et one hundred dollers ($f 00) or less.)
❑ I certity ihat in the performanca of t work for which ihis permit is issued, I shall not employ eny person in eny manner so as to become subject to the workers'
compensation laws of Calitornia, e agrea that Ii I should becoma sub�ect to Iha workers' compensatlon provislons ot Secti 3700 ot t e Labor Code, I shall forthwith
comply with ihese provisions. ,/r� '
Applicant Signature: �� oe,a: �%a q V
WARNING: FAILURE TO SECURE WOFKE ^'�a-6� _P�EF�ATION COVER� E IS UNLAWFUL AN� SHFLISU&IEGT AN EMPLOVER TO CRIMINAL PENALTIES D CIVIL FlNES UP TO pJE HUNDRED
T/qUSAND OOLLARE (5100,000), IN ADOlfrzaaT�E COST OF COMPENSATIIXJ, DAMhGES AS PROVIDED FOR IN SECTION 3]C80F iHE L4BOR CODE, IIJ�EREST, PN� ATTORNEI^5 FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm ihat I am licensed un �ovision of C apter 9(commencing with Saction 7000) oi Division 3 of the Business d Pryfe �ons Code, antl my license is in full
force and eHect. Lic. # c�'S Cless # ' 3
Contractors Signature: Date:
,�
CONSTRUCTION LENDING AGEN :
❑ I hereby aNirm �ha� ihere is a consVuction lentling agency tor the pertormance of ihe work for which �his permit is issued. (Sec. 3097, Civil Cotle).
Lenders Name: Lender's Atltlress:
Signature:
OWNER-BUILDER DECLARATIONS:
Daie:
I hereby aifirm ihat untler penalry of perlury Ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business end Protessions
Cotle: Any ciry or counry which requires e permit to constmct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires Ihe applicant tor such pertnit
to file e signed stetement ihat he or she Is licensed pursuant to the provisions of the Contracmrs License Law (C�apter 9(commencing with Section 7000) of Dlvislon 3 ot ihe
Business and Professions Code) or ihat he or she is exempt theretrom and fhe basis tor the elleged exemption. Any violation of Section 7031.5 by any applicant for a pertnit
subjects the epplicent to a civil penalry ot not more than five hundred dollars ($500).):
❑ I, as owner ol Ihe properry. or my employees with weges as their sole compensation, WILL DO THE WOFiK, and the structure is not intendetl or ottered for sala (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to en owner of property who builtls or improves thereon, and who tloes such work
himself or herself or through his or her own employees, provitled that such improvemenis are not intended or oHeretl for sale. If, however, the building or improvament is
sold within one year of completion, ihe owner-builder will have the burden ot proving that he or she did not 6uild or improve for purpose of sale.).
❑ I, as owner of the property, em EXCLUSIVELV CONTRACTWG WITH LICENSED CONTRACTORS to cons�mcl tha prolect (Sec. 7044, Business and Professions
Coda: The con�rectors License Lew does not apply to en owner of property who builds or Improves thereon, and who con�racis for such prolect with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am ezempt under sec. Business and Professions Code tor this reason:
SignaWre: Date:
Owner ID verifiatl by tlriver's license. ❑ Ves ❑ No Driver's License No.
Venfication of Ownership by (type of documem, i.e. - propeny taa bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
Expires:
❑ I hereby certify ihat no excavation five (5) or more feet in depth into which e person is requi�etl to tlescend, wlll be metle in connedion wit� work authonzetl by this
pertnit, and that no building simcture, scaHolding, felsework, or demolition or dismantling thereot, will be more than �hirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calltomia Atlministrative Code).
❑ A5 ownar-bulltler, I will not employ anyone to tlo work which would require e permit irom the Division of Indushiel Sefety, as noted ebove, unless such person has e
permit to do such work fram ihe division.
Signature: Date:
Division of Industnal Safery Pertnit Number:
CERTFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTHY: I cetlity under penalty ot perjury ihat I have read ihis epplication and state that ihe information given is
correct. I agree to comply with all state Iaws and city ortlinances reiating to building constmc�ion, and euthorize representatives of ihe City of Costa Mesa to enter upon the
ebove-descnhed property for inspection puryoses. I agree not to occupy or allow occupancy of any building authorized by ihis permit until tinal inspection.
CppE �, INSPECTIONTYPE
1616 FizeO System Final Fire Prevention
1266 Pool Spa Finai
200 Final Re-Roof
201 Fina181ocWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 , Final Demalition
OATE INTRIALS
� �/
�� �, � � �a�a
Date
CO�E♦ INSPECTIONTYPE
20fi Final Mechanical
208 Finat Plumbing
210 Final Electrical
212 Final Fire Preven�lon
220 Final Planning Approval
222 Final Site
250 Final Buiiding/Occupancy
DpT INTRIALS
CITY OF COS'
`Proiect Address
Address g�Y
ION PERMIT
ADv��cant to fiil'in all spaces exceD< ihose within neavy Oorder lines ana sign all apvrovriate tleclarations.
PF�fiM1T )VO� __� TRjPCT NO. LOT NO. UNIT NO.
i Arch/Eng. h���h`f/Y License No.
� � � � , �
Address
Contractor's Name ��n'� Phone
Address (mailing) �
Ciry License No. �
LICENSED CONTRACTOR DECLARATION ' �
1 hereby affi�m that 1 am licensetl untle� O�ovisions o( Cha�te� 9(commencin9
with section ]000) ot Division 3 of the Business antl Professions Cotle, antl
my license is in full force antl eftecL • •
License Class License No.
Date Signature
1 WORKERS' COMPENSATION DEClA0.ATION
�ereby aftirm that I have a certificate of consent to self-insure or a certi/icate
� Wo�keri' Compensation Insurance, o� a ce�titietl copy tne�eo( ($ection
.,B00, Lab. C.)
Policy No. � Company
8 Certifietl copy is hereby furnishetl.
Cer[Ifi¢tl copy is (iletl wlth the city Builtling OiJision.
Oate Applicant
E%EMPTION FROM WORKERS' COMPENSATION OECLARATION '
(This section neetl not be completetl if the permit is for one huntlretl ($300) or
less).
I certify that in the performance of the work for which this permit is issuetl, I
shall'not employ any person in any manner so as to become subject to the
Worke�s' o pe tion laws ot Calif ia.
Date �_ Signature
NOTICE: It, after aking this tleclaratiorr�, you�_s�oultl come s jec[ to the
Worker5' COmp¢nsation provisions of the Labo�-Co0 you mu t to�thwith
mmply wilh 5uch provisions o� this pe�init Shall be tleemetl revok¢tl.
CONSTRUCTION LENDING AGENCV � '
1 he�eby aHitm tha[ [here is a conztrucfion lentlinq d9enGy !or Ihe performant¢
of the work tor whiU this permit is issuetl (Section 3097 Civ. CJ
Lentler's Name
L¢lltl2!'S /idCf¢55
OWNER BUILDER bECLARATION
1 hereby aRirm ihat I am exempt irom the ConVactor'S License Law for the
tollowin9 reason (Section ]031.5 Business antl Professional Cotle: Any city or
munty wM1lch �equire5 a permit to construct, alter, improve, tlemolish or repai�
any structure, prior to its issuance, also requlres the applicant for such permit
to file a signetl statement that he/she is licensetl pursuant to the provision5 0(
the Contractor's License Law (Chapter 9(commencing with Section �000) of
��'.yision 3 of. the-Business antl Professions Cotle) or that he/she is exempt
"' refrom, antl the basis fo� the alle9etl. exemption. Any violation of Section
����"31.5 by any ap0licant for a permit subject5 the applicant to a civil
'��e alty ot not more than five huntlretl tlollars ($500).
I, as' ownar of thet property � ' -�
�br� will tlo the wo�k, antl the SVucture is not intentletl o� otferetl
or �sT ale (Section 7044, Business and Protessional Cotle: The Contractor's
- License. Law does notapply to an owner oi a pwperiy who builtls or improves
'. thereon, antl wh0 tloes such work himselt/herself or through hls or h¢r awn
employees, provitletl that such improvements are not intentletl or offeretl tor
sale.lf,.howeve�, tne builtling or improvement is soltl within one yea� ot com-
� pletion,-the owner will have tM1e burtlen ot proving he/she tlitl not builtl or iin-
.`prove for the purpose of sale).
❑ 1, as own¢r Of [he property, am ex[lusively contracting wlth licensetl con-
Hactors to construct the project (Section 7044, Business antl Professions Cotle:
The ContraCtor'S License Law tloes not apply to an owner ot property who
' bySiids o� imoroves thereon, antl who contracts for such projects witn a con-
. Gjcto�(5)'bcense pu�suant to the Contractor;s Llcense Law). I am aware Ma[
oroor oi their Worker's Compensation insurance Shoultl be provitletl to me.
❑ 1'am exempt untler Section B. & P. C. tor this reason
- . . , i.. .. /
CI
Date I�»-Y 1�_.
I nereby certi(y that I ha
in(ormation is correcL I ac
antl state laws relating to
5entative5 ot this city to
'in5pection pur ses.
Signature ��'�
Drivers' License or 55 �
wnscrucemn, ana nereoy aumor¢e �ep�e-
upon the above-mentlonetl1 -pro/�p¢rty, for
� Date_�y���_
TYPE OF CONSTRUCTION LJ NEW� U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER �
DESCRIPTION OF WORKNSE OF�BLDG. -��k� ` n"�����
��r9 /.2 i
TVPEOFPERMIT LJGRADING LJFOUNOATION L15TRUCTURAL
❑ TENANT � ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
� ❑ OTHER ' /%) .
PROJECTDESCRIPTION Sc�FT ����'r � ocCUaANCV�
CONSTRUCTIpN'TVPF VGI_l1ATION$ 3.CJ9
ZONE° _ GRADINGCU.VDS. ACRES—
Remarks:
1�
Bar Sink -
Backflow Preventer
Backflow Irrigation�
Clarifiers
Dishwashef � �
Drinking�Fountains
Floor �rains
Floor Sinks �
Gas Service Outlets
Kitchen Sink
Lavatories
Roof
Showers
Service Sink .
Sewer Cap ' '
Sewer Connection
Solar Coilectors
Solar Pipin9
Solar Tank
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tray
w/Spa '
A.P. # � �
S Main Building:
E
T Front.
ARear � � �
C' Right���/('��
g Left � �a
Ping. Ref. #
Planning Notes:
� ConstructiomPoleSub.
� Cookin9 Unit �, �
� Dishwasher - ,
' , Dryers ❑Gas ,�Electric
Fan ; '
� P.A.U..• , ,
Fixtures
Device Boxes �
Outlets
/ �_
Reinspection Fee $15 Issue Fee , , $ 3
Boiler
Duct- UnderGround
Duct - Strucmral
Duct- Ventila[ing
Ezhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting �
❑0-100,000BTUO10 BOBT
Fee � $75
9F'OB65-46, rev. 10/84 White - Builtling; Gannry - Applicant; Pink - qccounting; Goltlenrotl - Assessor
Hoodor Typel ❑
Canopy Type I I ❑ �
i'
Refriqeration System � �
❑0-100,000 BTU" OO,OOO BTU
System R ir/Alteration
F" ampers
Registers, .
' laue Fee $ 3
Garba9e Disposal
Generator �0.
�_
9906 I/OB/87 �3.as TL
� Zone
Accessory Buildin9:
_ Z
' O
f N
� I
' N
, G
, q
� ' Parking Req./Provided � E
� M
I $
ELECTRICAL . .
Transformer ❑ 15-50 KW
� SO+KW
' Meter ❑up to 100 amps
Meter ❑ovei 100 a s
Su6 Panel'
5KW
�1ReinspectionFee ! $15'
�DEVELOPMENTSERVICESREQUIR
2oning APProved 8y
Building Approved By �
Momrs -7 HP LJ 1%- 8
Inc. ar �9-15 HP �16-15+
icrowave � �
Pole Light '
Fange
S19�
Standing Sections
Trash Compactor � �
Issue Fee
� � ,SUMMARVOF.I
� BUILDINGPERMIT $� �S�
� PLANCHECK ' " $ �.�-$�`%3
PIUMBING � $..
� PLAN CHECK 25% $
_ ELECTRICA� $�
PLAN CHECK 50% $
� MECHANICAL $
- , PLAN CHECK 25% $
a
$ 3
SMIP $' �S�
PERMIT
ISSUANCE . $ � '
ENERGV P.C. $
GRADING $ �
MICROFILM. $ -
TOTALPEE $ 73•93
CONSTRUCTION AND PLANNING � POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS 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. EleciricalUFERGrnd.- 57. APPROVALTOCOVER-GUNITE �
7. Footings Z� G/✓ 58. Electrical Conduii-Undrgrnd. � �-
S. Foundation S u 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. StructuralFloorSYstem., 61. APPROVALTODECK
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 Sysiem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign . 68. APPROVED FOR PLASTERING
18. Rough Electriral-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 O Gas ❑ Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 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: �� y �G ��,� �v � ' N
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy
i
37. Final Factory Fireplace
38. Final Plumbing � "
39. Water Service-Final
40. Gas Service-Final '
41. Solar pomestic-Final
42. Backflow Preventer �
43. Backflow Irrigation ,
44. Landscape Irrigation System -
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING G,�,/ �
48. Special Requirements Completed
49. Electrie Release to Edison - .
50. Gas Release to Southern California Gas Co ;'�,.
r
51. CERTIFICATE OF OCCUPANCY
� .
No. Date . '
�R ROOF CONNECTION
D�TAILS
CONT SOLID BLOCK
LEDGER
RqFTf�
� ;�,: •�. ;: < ��
.kf � � '-�;a� - ..
,
Cit�r of Costa Mesa Building D p
�Jj�TAIL � DATE 1
QY�/L={
;HESE PlANS PAUST 3r ON 1C8 P.T ALL TIIA� 5
nD GHANG�S ViiTHOUT F€;pR AFPROVAI F
�1 ; LANS h
!� 'kR�d;l ��
HF f4.0'
C 0 N T: U7 ri0°'
LEDGER'
, �vr+icri i,,
i THE
;PLCIPIG
- i �rn 1:
'�
. . ��o
, �i,
��pPr�ar
s�c�s n�raurm�rr
BUILDITdG SF�fiEPY DIVISION
OWNER: �2N��� S. 6/��oW��
ADDRESS:S�G P�E2PaNr 'D�z. C�r,s�f� w�Es�
�!
OR C.:A"'I!QG GF P. P:FfdIT CR 4PP C."�.!'�F
G•^'CR �'9`•�CL� �=T,E�CO�`��'"TRUE 7ZBR4:'
�""GRIPS'�OR �J01ST'� Fr��'N � � ANY OF
pf hHANGER`�''��'"."�� �'r.:.SJMIN iiOGIVE
"�I,iit uc �����_EL THE F�:Gd�SIOn � OF THIS
�„ - ''�9'i i^+>O F.tR �S 7hIE WO K OR USE
yr.izes�qFT 1
CE Or :°�RIT E.4'.7 UPON Pl ;j3��(`j•O
� SHAII NOT n:_'°N, i'+E GUIIDWC OFfiCIAI
ER iEQUIfiINC, iHE Cl dREC(10�•1 OF RRCRS IN
g f8'yPp��pi�%i•5-��r;:�;G E��R1 Pf dVEN11NG
4��N�'`t�^Xz ��+RR�cu url�l� EUN CR WHFN
v Isl.�z]DE�Ii oF AIJY OiHER ORDI �AI�CE Of
10" OR LIGHT WEIGNT ROOFS
ONLY CONNECTION DETAILS
2��X FACIA-MIN.REO.
RAFTER
APPROVED METP.L
HANGER
DETAIL 3
AC
SEPARATE Ytnmi i a H�< <��u�"'
FOR ELECTRICAI. PLUMBING,
RAFTERS ��"{'�}�qIGFRA
ORT, PORCH OR PATIO
SUPPORTIN EIt1N�--
SPACING �SPAN°}'�� '��
12"O.C. QHI�6,:���0.1[eR P
16" 8' �0.�' INSPE�i
24" 6'-6"
32" 6�_���
48" -0" '
12�� � FL�'6N1'_(���iva uCHEf
i 16�� � Et��lilY'r�]�.V�E isc nni
32"
..a��
)�SEU
t s.
Y'�x8"'" 24" '�—TS' =6"-
32" 13'-6"
48" 11'-6"
4"x6" 24" 17'-0"
32" 15'-0"
36" 14'-0"
4"x8" 24" 21'-0"
32" 19'-0"
36" 18'-0"
48" 16'-0"
4"x10" 32" 22'-0"
36" 21'-0"
48" ZO'-0"
72" 17''0"
WORK
PATIO COVER
TYF PLANS
DATE � � '� � �
PHONE � � I 4- � �> -14%r:
LIC. N0.
PHONE�
TERS ppPROVED FOR
ROOF COVER OF gUILDING PERMIT
GLASS, ALUN. By Date
iT1;�x"�!.nPAi���
r.; ��euESTsza��
_------
__.__-.48 � �
_"Z„ 6�� ��
rffia0rv� ARE 7�L6GE
ThiA'f THE STI�4dF
� INOL'STflIAI 5��'iY
oR aooiti4gat
Z��xB�� 24��
_� 32��
48"
NEADERS
SPAN
9 � =6��
8� _���
6'-6"
�� _6��
14'-6"
LZi �Di�
L���Qn
19'-0"
15'-6"
13'-6"
LICHT WEIGHT ROOF ONLY
SIZE : POST SPACING
4x4 6'-0"
4x6 ' 9'-0"
4x8 12'-0"
4x10 15'-0"
CARPORT, PORCH OR PATIO
SIZE POST SPP.CING
4x4 5'-0"
4x6 B'-0"
4x8 10'-0"
4x10 12'-6"
GENERAi. NOTES;
1. These plans must be
kep[ on the job a[
all time during
construction.
2. All framing to be
Douglas Fir #.2
grade minimum.
3. Rafters may no[
attach to facia ex-
cept for LOU roofs
as shown on detail�
201i roofs must use
a continuous ledger
attached as shown
on details O1 &�f2.
4. Light weight roofs
may a[tach to facia
for 14' span max.,
apans over 14' must
use a continuous
ledger as shovn in
details ii3
¢�BS
NOTE� SHOW AND DIMENSION PROPOSED
PATIO COVER �ND YARD AREAS
� � Cnv'
�_— I _—
N � �
. ' 9D' 8 �� �.,
I ��
: i ';A - - - � �IZ� ^ ~D... I
SEPARATe E
F0� EL C1
HcNs�:,� i,
RE�r iG
Y �" ^ �`� � �!
TFii� i'.�Ji e
AL' li �
�--.----�---- -
FOA BU11.�I�G �
APPRO_ �A_ ���Y
AITS ARE REDUIRE�
ICAL, P � 91NG.
ENT T G A '1
;f iIQN 1�ORK
�_ - -
i'„�;I;$-i ; ,��N12A�'a��
CT!41`� F�:QUE��S
_...��X:
'-- _ AT�Y
� � ,,a,tazoYs:�, rv �„�����
cauF�t�nia i. v�;�inv e�
. IHE CONSL L?E�7 �G
flEUUTAch9Efi S. Z
1
1�
' A`��ROVED
City of Costa esa Building C
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CITY OF COSTA MESA
BUILDING DIVISION
OINNER-BUILDER VERIFICATION
A citY or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, 2s a condition precedent to issuing a building permit, require the completion and require
the return of, an owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please Complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delaY in processing and issuing your building permit. No building permit will be
issued until ihis verification is received.
1. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. f�Yes ❑ No
2. I(have/have not) �U� signed an application for a building permit for the
pfoposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name —
Address City
Phone ( 1 Contractor's Lic. No.
4. I Plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City
Phone ( � Contractor's Lic. No�
5 I will provide some of the work but I have contracted (hired) the followi�g persons to provide
the work indicated:
Name Address Phone � Type of Work
I herebV affirm that I have received a copy of the information set forth in Section 19830 of the
State of California Health and Safety Code and have completed the above information to the best of my
personal knowledge, in compliance with this State law.
Signed: �� Date: � ` `'� ���
Name: � Lh4I I� � � (� �-�-D W/4 �
(Printed or Typed)
C.D.L. #or S.S. �
7545273
CMF 1042-46
vrvrv�rc M�SA ri�HGrift UAIt
A'"'o. LOT g TRACT ( S FIRE ZONE VALUI
II :CTIONS Si mturo Date GROUP I& J TYPE
soi� l, ��/
�AS -- 77�1 � f3•c.-�I .,,,o�:,� � R;.� � cn
W ATER
R�UGN PLUMBING �
PROP. SWR. LINE HOUSE
SPRINKLING SVSTEM
MISCELLANEOUS
ROUGH HEATING AND A�R CON
TEMPORARV SERVICE OP POL
UNOERGROUND � POWER
ROUGH WIRING
iRENCHES � FOftMS
F�DOR SYSTEM
BONO BEAM SYEEL RE
SHEATHING
FRqME AND FLASHING
HLi';.',�.,=�G, VENT., REFA�G. AND A.C., F
PLUMBING, FINNL ANO GAS TEST
ELECTHIC, FINAL
BUILOING, FINAL
J�ai 1s-c8°�'—°QUO 644� ***�90.00
COSTA MESA BUILDING-SAFETY DEPARTMEPR
P.O. BOX 7200 COSTA MESA� CALIFORNIA 92828 -