HomeMy WebLinkAbout902 POWELL CT - Building PermitsPflOJECTAU0flES5: (jOZ POWELL CT
OWNEB'SNFME: MOORE, RICHARP H
, aooRess: N�OORE, KATHRYN L
902 POWELL CT
� COSTA MESA,CA 92626
AflCHIENGINEEP:
FDOflESS:
flEG.NO.:
UNIT:
UNIT:
PEHMITTEE: BILT—WELL ROOFING (719)758-3501
aooREss: 3JLO VERDUGO
LOS ANGELES CA 90U55
LICENSEO CONiflACTOfl OECIAHATION: I hereby alfirm Iha� I am licensetl un0er pmvisions o� Chapter 9(commencinp wit0 Section
7000� oi �ivision 3 0l t�e Business and Prafessions Cotle, antl my license is in full force an0 eitect.
cirvuc.:��. 458005 � -39 EXP:
Oa�e'. _� Signature: _ �
WOBKEH$'COMPENSATIONOECLAXATION: Iherebya��ir veacertilicateofconsenitoselainsureoracenilicateolworkers'
Comoensalion Insumnce. or a cendietl copy inereoi (Section 00. Lab. C�.
voucrxo.: i9937102984 EXP.OATE: O"]/31/9Q
comraNe CAL COMP INS.
] Cetlibetl copy is hereby furnished. Q; Ceni�ieA capY is file0 wiU the ci�y 6uilaing Oivision.
�aie: ApplicanL
E%EMPTION FPOM WOflNEHS' COMPENSATION OECUPpTION: (This sec�ion neetl comDleleO i� tAe perrrvl is for one hunEreO (5100) or less�.
I cerlity Ihal in �he DeMormance ol �he work lOr whith Ihis Dermi� is iss , 5 all not loy an rson in any manner so as to become
su�jecl Io I�e W rkers' ompensalion Laws o� Calitornia.
Oaie'. Signature:
NDT . I�. afier making ihis tleclaration, you shoula 6eco e ' o �he Wor ers' Compensation pmvisions o� �he Labor
Cotle. you musi forthwil� comply wiih such Omvisions or � i permii shall be tleemea revaked.
CONSTBUCTIDN LENOING RGENCY: I hereby aflirm �hat Ihere is a constmction lenaing agency for the pedormance o� �he wark for
which I�is permit is issuea ($etlian 3097. Ci¢ C).
LENDEN:
AOOXESS:
OWNEB BUILOEfl OECLANATION: I hereby atlirm �ha� I am exempi imm �he Contractors' S�a�e License Law fof �he PollowinB �eason
(Sec�ion 7031.5 Business ana Professianal Code: Any cily oi county which reQuires a permit Io conslmc�. al�er, improve, tlemolish, or
repair any simaure. Orio� to i�s issuance. also reQuires the apPlicant for such Dermit lo tile a signe0 statement that Ilelshe is Iicense0
pursuanl to Ihe pmvisions ol Ihe Comracmrs' Staie License Law (Chapter 9(commencing wiih Seciion 7000) of Division 3 oi the Business
and Pmtessions Cotle� or ihai helshe is eeemp� �heretmm anA I�e �asis br lhe allegetl exempiion. Any violation ol Seciion 7031.5 by
any applicaN �or a permil subjetls ��e applican� to a civil penalry o� noi more Ihan five hunUretl Oollars (5500).
I. as owner of Ihe pmDerty or my employees with wages as iheir sole compensation, will do ihe work, an0 t�e
❑ stmdure is not intentled or otferea lor sale (5ection 704a, Business an0 Pmtessional Cotle'. Tne Coniracrors' State License Law
Ooes not apply to an owner oi a DmOerty w�o Uuilds or impmves thereon, an0 who Ooes suc� work himseli/herseli or thmugh
Ais or her own employees. pmvideA Ihai SUCh impmvements are not imenAed of atlefe0 Iof Sale. If, �owever Ihe builAing or
impmvement is soltl wilhin one year ol completion. (he owner will have ihe burJen oi Dmving he/she ditl not builtl or impmve
� br the purpo5e Oi Sale�.
I, as owner of �he pmperty. am exclusively conlracting with licensetl conVactors to constmc� �he prolec� (Section 7044, Business
❑ antl Pmfessions Cotle'. TAe Contrac�ors' Stale License Law tloes nol apDly to an owner ol pmDetly who Uuilds or improves Ihereon
antl who coniracts lor such pmlecis wilh a conVactoqs)license pursuantto �he ConVac�ors' S�aie License Law�. I am aware
t�at pmo� of t�eir Worker's Compensa�iun insurance shoultl be pmvitled to me.
I� I am exempt under Sec�ian: B. 8 P. C.
lo� Ihis reasOn:
Date: Ownec
I tlo hereby certify �hat I am aware of ana unaerstan0lhe reQuiremems ol Califomia Healih an0 Safery CoOe Sections 25505, 25533, and
25534 antl Iha� I or anY �Nure builtling occupan� will/will nal (circle one) neetl to comply with saitl s�a�e cades antl �he requiremen�s �ar a
permM1 lor wnslmc��an or modilication imm Ihe Air Oualily Management �iSVict. Fesidential conSVuction aDDlicalions are evempt tmm
these omvisions.
Date: Applicanl:
I here�y cei��ty�hat Ihave reatl Ihis applica�ion ana s�a�i
ortlinances and slalelawsrelaiing�o building conslNclion
PfOPEf�Y �Of I11 pECII PIIlP0525.
Dale: Signaiure'
to comply with all city antl county
to enter upon the a�ove-men�ione0
oriver's License or Social Securiiy
164L46 White—Bvilaing: Green—Coee Enlorcement; Canary—Applicant: Pink—Revenue; Goltlenrod—Assassor
�
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B Oo793�
PERMIT NO: B 067937 PLAN CHECK NO:� N GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOB DESCRIPTION ; T/OFF 6 REROOF WITH COMP. 6 BUR IN bACK SQ FT: 1,100
CLAIM VALUE: 1,100.00 CALC—VALUE: 1,100.00 GROUP OCC; R-1 /M-1
COMMENTS: SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM S HALL[4AY
*��*�*�c***�*�-��?�***�*****�r�*��x**�*****r��c***�+��-*�c-*���c*********�r****��*+�*x�*x��
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ----
FRNT: FT IN REAR: FT
LEFT: FT IN RGHT: FT
-- --------- ACCESSORY 6UILDING ----�----
IN FRNT: FT IN REAR: FT IN
IN LEFT; FT IN RGHT; FT i�1
PARKING REQ; PROV; PARCEL: 000�0000 2NE: REF NO:
PLANNING NOTES> •..
'
�*x�+��*��**+��**+��r*�r�*�*�rf�#**���*�� *x�+��*��*�u�rx-�*�r**�x�*�*��r���***+��r�t�*iri!�E*��;-�r*�r+*�c
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
ZONING APPROVED-BY DATE: '�
BOILDING APPROVED HY : DATE: ��;
APPL,ICATION ISSUED BY: ��S'� DATE: _—�E��/`��`'
iE3M1iEif3EifiEiF�cjEiF�Fifjt'iEiE3litiE3c3E9(- �rt � �fiFrFiF%3F+f�3FiF��'tFTiF�F3F%ieTriEiFitiEiEjEitifiFiEiF�� r-., jEiF
if iE * iE ic 3F iE if !E iE iE iE iF iE iF iE it±f ih iF iE if if iF iE 3E 3E 9t 3f it iF 9f it iE jf iE 3E iF i! iF iF 9E 3f iE iE �)E iE i6 iF i6 iF iE iE #� iE if iE iF jF iF iF if dE iF iF iF iF iE iE iE iE %� iF i6+E iE �E 3F IE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT FLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 27.00 ,50
SMIP/130N—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID UUE
TOTALS----> 27.50 0.00 0.00 27.50 27.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27.5� OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
27.00 .50
ik iF fE iE �)E!F if iF iE iE �lE )F iE IF iE iF iE'�E iElE iE iE X• iE iE iE it iE fE # iF iE iElf if iE # 3E iE iE iE �E iF%1c if jE iE iE �f iE iE iE iE 3E 3k iE iF i4 #�)F iE iF iF # ik iE iE �F iE 34 iE fP it k iE iF 3F i(�
I N D I V I D U A L F E E B R E A K D O W N �
TYPE QTY D E S C R I F T I O N UNIT C'OST TOTAL COST
SFR 1100 AEROOF BY VALUE RESIDENTIAL NOZONE 1,00 1,100.00
END OF FEES
V
O1 00163776-00153777 T�J�T �;,;p
OATE: D7/it/94 TI11E: 11:27
COdfS�UCTION AND PLANNING POG_ .Y SPA
APPROVALS Permit � Date In:pector qPPROVAIS Permit � Date Inspector
� .- 1 .-
t Temporary Electrical Servi��.or Pole � �' S2. Pool & Equipment Location ,� �
i' ::
2. Soil pipB�Undrgrnd. :%w* '/;l 53. Steel Reinforcemeni /�f,
3. Electrical Conduit Utility-Undrgrnd. �' S4. Porms .�
4. Electrica� Conduit-Undrgrnd. 55. Electrtcal Bonding
5. Steel Reinforcemene 56. Rough Piumbing & Pressure Test
6. Electrica� UFER Grnd. 57. APPflOVAI TO COVER�GUNITE i
7. Footings 58. Eiectrical Conduit�Undrgrnd. .
8. Foundat�on - �" � __� 59. Gas Pipe, 17 Undrymd., Test '!:
�
9. Water Pipe-Undrgmd. '; � 60. Backwash Lines, P�T�ap, � Undrgrnd. .,;' �
10. Structural Fioor System i=�: �` 67. APPROVAI TO DECK �--`l+� t'
77. PropertV Sewer Line & House'Cannec.ion t�i� 62. Backwash & Receptor�Final ^"`
, '�r,.:
12. Sewer Cap '' 63. Heater & Vent�Final �:,
73. Roof Drains �� i J 64. Plumbing System - Final �+%
74. Rough Plumbing 65. Electrical-Finai
1' i
15. Rough Electricai�Conduit . 66. Solar SVstem-Pinal .
76. Rou9h �lectric Wiring 67. Fencing & Access Approvai
17. Rough W�ring Sign 68. APPROVED FOR PLASTERING
78. Rough Electricai�T Bar Ce�ling 69, POOVSPA SYSTEPAS FINAL /
19. Rough Neating & Air Conditioning PIRE DEPT. REQUIREMENT -
20. Rough Factory Fireplace APPROVAIS Permit � �
27. Ducts, in $tructure ; 70. Undergrpund Hydro
22. Ducts, Ventilating 77. Product Piping O Gas D Oil
23. Gas Pipe-Rough & Test 72. Underground Fiush
24. Roof Framing 73. Undergrnd. Stora9e Tank G Gas � Oil
25. Roof Sheathing 7 l�Ll(.J �(,,r� 74. Overhead F1Ydro
l
26. T-8ar C¢�ling (Svuct�ral) & Monocoat 75. Dry Chemical � �
27. Frame and Fiashing . 76. Dry Standpipe �
28. Lathing & Siding � 77. FIXED SYSTEh1 �INAL
29. Insulation � 76. PIRE PREV. PINAL
30. Dry�vall Nailing HEALTH OEPT. REQUIREMENT
31. Piaster Brown Coat 79. FINAL INSPECTION
i
32. Electric2l Powzr Meter�Final 80. FQOD CERTIFICATE ISSUED
33. Final Eiectric Notes:
34. Finai Heating & Rir Condition�ng
�
35. Final Gas Pipe-Test � �
36. Hood or Canopy ,
37. Final Factory Fireplace -- f
38. Final Plumbing �
39. Water Service�Final
40. Gas Serv�ce-Final �
41. Solar pomes[icFinal
42. Back4low Preventer � �
43. Backflow Irrigation '- .,
44�. LandscaPe Irrigation System
45. Sound Attenuation .
46. HandicaP Regulations
ev. viro,at STRUC7URE& BUfLDlNG � (` � .
48. FINAL PLANNING _..
49. Electric Release to Edison -
S0. Gas Release to Southem California Gas Co -�
51. CERT{FICATE OF OCCUPANCY ,
No. Date .
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„ �.� ' , ;�:•uT ::c�. 10445 :�,�•r�� December 4, 1980 i �
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'',.)1DDR�SS 9O2 POWeII Court�Costa Mesa, CA 92626 _____
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' Develop:rr.n[ Serv.icc:: ilep.i:'t:xn[ s `r�'
n� : ,
�'-•� � Plannin���Division � � � � � "`'"�'�
��` Gity of,i.osta Mesa � ._. � . .. ' �`trr.�-.�:<-
;as- _......--- - ---___ .- __. s.
>•'i' " 77" !:'air �ri� e . �
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r"," -Costa 21esa,. CA 926"'6: ��'`,'s7.:
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' '-At[ention: .Nr. Pau] Dudlcy ,;,
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, �.!„' Dear "ir. [hiclley: ',
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t:- •Please be,aware [hat [he undersigned are avare tha[ n certificatc� of occupaney w�;ti,;�,
�:'';• ::. .on the-nbwe_:referenci:d lot and untt is bcin�;,rcquc>ted prior [o [he entlre '.:d°='.''; `
� .:
;,��: ,� �- [iact and its��streets,and.cor.unon areas bein� r'ompleted and accepted by [he ,, r °'�b
`w;'' ' City of Costa Mesa. �;'t..
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�'a''� �(SICtv1TUP.E 0 PURC'.t.1S'-R.j- — . � � � �� � . �
� .� BY���� . ��� . _ _ . . '!n .
t .�.c 1'�C__ _�
+� ',. , � . .(,�`IC�IJR�.OF DIVLLOPf:l2 ic:D OR �_ i '
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CONSTRUCTION AND PLANNING - POl . SPA
APPROVALS Permit # Date Inspector qppROVALS Permit #
t. Temporary Electrical Servi�e or PoJe;ti 52. Pool & Equipment Location
2._ Soirl Pipe�Undrgrnd., �•+ '"a`< � 53. Steel Reinforcemen[
- �'L c�
� � . .� ti'-... m . -�i�
,,,:3;= le�ttncal Cond�iit:.Cltdrty-0ndrgrnd�'' 54. Forms
_� . � �
�":Y3!*ERctcical Conduif=Undrgrnd. - 55. Electriral Bonding
;=,�15�..$t'E�I�ReinforcenienT - 56. Rough Plumbing & Pressure Test
;nc6;-`E�I�Ct�ical UFEA�Grnd. '- 57. APPROVAL TO COVER�GUNITE
�=`7T,�oo�inls �� �' 58. ElectricalConduit-Undrgrnd.
� . _
' - 8.'Foundation , 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe�Undrg�nd. , . 60. Backwash Lines, P-Trap, O Undrgmd.
10. Structural Floor System ' w . 61. APPROVAL TO DECK
11. Property Sewer Lin� & HoLse Conrtection 62. Backwash & Receptor-Final
12. SeJ✓,er Cap y �:, .�. . 63. Heater & Vent-Final
13. Roof Drains '� 64. Plumbing SYstem - Final
. ct I
14. Rough Plumbi�g `� 65. Electrical�Final
15. Fough Electrical-Conduit 66. Solar $ystem-Final
16. Rough Electri�Wiring 67. Fencing & Access Approval
77. Rough WiringSign 68. APPROVED FOR P�ASTERING
18. Rough Electric�l�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- -- ' � . C� �ut- ::: :.. -- i-
20:?Ro�u�h Eact6"ry Fireplace � `= nt �'"• �'' �� !� r � "APPROVA �5>vpeFfiit # �^ - '-'
- tc .s �-. - e � � a: o: �-+- 'r� �
.i r� � '�.. � - T:�: � �r . �-.. i .� ,
21_`Dutts, in; Str,�ctu�e� .. .. r-�� ' ' �,r :• .70. I:IndergroUnd Hy�lro
22. Ducts. Wpntilatir5g? � �=S �K `��' �t ?71. Produc'T�,F§�p1ng Clt��as C;�OiI
� .? i '+. '1 f.l !-+y. X "
23`.;�Ga4�Pip;�;Rough &'.Test i �' �� � i^.'x �; . -`i � � ' _°
� :r, ,• i. �.� r->. c; .: x:.� .+72• Undergroynd Flus�fi_, �;
2M-'Rol4f Fiaming .ln��� � FF� ^I� �K �� u �� J�� * ��73=Undergrn2.Stor3(7e',Tank'�OGas ❑011
. ti rC i-.} x .>, X
�' :x ; pi :. �q rr. (J �`.:.. x . �. v i-� - r.
25. R f Sti�athing ,y , � �. ' '
�$. :r • r � y �,t: t �7�jOverhead�Hydro'i" r
26��T-8ar Ceilin91S9r-uetural) Be�Monocoat V .� '_ '� ��r, � 7�F,Dry Chemical H��� $�' �-% 3
27";Frame a�nd FlashmQ. `��� n r. y�:� � 76. Dry Stan�ipe h7i�: '` �' �''
. �28._� Lathinq$ Siding�7.e �i � 1V;CG u, x : ,:i :; �•�� .. � V.
� J !, . . 77;ti FIXED i'�TENj�E��AL'-
. �., r.
�'29. Insulat- n �' `� " .. .. �' �" '`' * » � ' :+. M
to y_t ;� .. ,.:. 78�-FIRE PREV. FINPqL � r c� �,+
-='30. Drywall Nailing �',V; J � a�� r�+4•�+ ���HEALTWtDEPTr.RiEQ{fIREM
c- .�,,
.Z31. PlastertBTown Cnst�._ `S i cT�*' t ,. �: i�79`�F�NAL�NJS�,ECT�N .� �-'�' �
��32��Electrical Power M¢teT�-Finali ��� :• i�_ _,� r�+tri80;tFOOD CERTIFICJUTE 19S�U D�_
.�
Date I Inspector I
33�Firi2lElgctric " ,., ti *''� �"'No:es:fZ�'�6-�J7j=, �i0-�N�E:Y'f?H'!7E- �EGT-
,j34-;Firj I Heating&:Aii: opditiori�g % � � :r �,,Q,�_ :[,,.p�,=�� t ,� _
`35'.Final G�s Pi'Pe-Te'sY ul �-1 .r � x � ' �� ' �^" • '*' �'.-,
� -,, , -, _ : 3 a t I'Xo_-oFr/E t�o'm� -C,F�:r c.oQ-o - G �
,,�.3fi'�'Ho,od or CanoPY.S�. :-J`�' i - _. : � - � � .
.,
-37-'Fin'a�l Factory FiFe�lac�� ! � y �= �� ��� �-`':� ��� C
! �
�.-.38. Fiqal Plumbing ;>,� `�; t� .. ,. u� �� " _ :L q;
:�39. WaTOr Service-Finak ' � w �t i i n �r� a".
_ �
: T • n �� � _ ~: .r i.i
.;.40. Gas Service�Final ; �,.� ,r,:-�,' S �� c��� . '� "_ :^��,'_
fi
541. Solar pomesticFirrel^ •• �� G• �5�= r-+
_ � =� :. , x �r �:7 r. 1 ;�
�42�.SBackflow Preventei," ;j :`'' � � �. i� �"c� •�'� N
43. Backflow Irlagatiotf� +�SS . �-�: " ir,�=. �. p � ��
. � ti �1' li ,r
,`�,.�44. Landsca e ui_ atiYn S ste l�`'e, r _ .� fi- �,�, -,L ��..
. P l� a g. v rrr, �,; r.. x . in ' �.� �:� ,. . �c .:;, a r. -,
'�.45'=�Sound Atteouation t-�r � !T' * % - �l != *� � �-' - r_-- � t::� -b - "
t�l 'r. tr�. �.Y. � CT �S� (.•:' x.
�..`�,46`Handic�p R.egulati$ns r t� " '' .. ..% �� �� ;� '� ;_� ',•a '
�47�FIN�.�STRtJC7URE&BUtLDING J Rx y iti `s � r
._ r�. '„� i c a: s_
48�FINAL PLANNIN� ; =;�. ; ,» � r `" ,'; y -
_.49`.'�Electric Release to,Edison � �� �- � � � � �
- � x r <f •(:
�50._Gas.Release to Sou�hem California Gas Co T ' ' ' - `�'" ' `'"
I � - ,� � - -� � ': ',. ' ;� ; _ o;n � �C7 .;
"'51. C��iTIFICATEOF:OCCUPANCY :,.'�; ; �,, �h,� ;� ..�; F� �
No. Date
PPOJECT AOOflE55: 9 O 2 POWELL CT
OWNEX'S NPME: MOORE, RICHARD H
aooeess: MOORE KATHRYN Lti,
902 PbWELL CT 'K,
COSTA MESA CA ' 92626
714 557-34�2
FPCHIENGINEEfl: flEG.NO.:
qooxess:
UNIT:
uxir:
PEPMITTEE: NOCK PLUMBING � ( 714 ) 895-1246
, ADONESS: S16SO SEABOARD CIR
STANTON CA 90680
LILENSEO CONTflACTOB UECIANAT10N: I hereby alfirm �Aa� 1 am Iicen5e0 untler provisions ol Chapter 9(commencing wiih Seqion
7000� ol �ivision 3 of �he Business anA Professions Code. and my license is in lull lorce antl efle .
cirruc.:05038p6� STATELIC.:SSI9%S //n c�u�ss: C— 6
�ale: � Z� 3' L V SignaWre'. �
W08RE85' COMPENSRTION OECLABATION: I hereby alfirm that I have a cenilicate of consent to sel4insure or a certificate ol Workers'
Compensation �s�ascr�� �u�t�o cooY �hereol ISectian 3800, Lab. �.3 / O S/ 9I
POLICY NO.: E%P. DATE:
'comraxv: STATE �(
� Ce�ified capY is here6�y fu�mished. L"1 Ceriilietl copy is filetl wilh �he city Building Division.
�ate: �� � ^ � _ L " APPlicant: __ .�r�-- _.
E%EMPTION FNOM WONNEBS' fAMFEN5RTI0N OELUHRTION: Qhis seciion neeU nm Ue com0leie� il Ne permit is lor ane �unOreO (St00� or less�.
I cenily ihal in Ihe oedormance o� Ihe work for which ihis oermit is issue0. I sAall not employ any person in any manner so as lo become
Subletl lo I�e Wo�kers' ComOensalion LawS o� Calilomia.
Da�e: Signalure�, � ' '
NO710E: it, aiter making ihis tleclaration, you should become su6lect to the Workers' CamDensation D�ovisions of Ihe LaOor
Cotle. you musl Iorlhwiih COmpty wil� SUCh pmvi5ion5 Or lhi5 pefmil S�ali be OeemeU fevakeA.
CONSTflOCTION LENUING RGENCY: I �ereDy ailirm ��al ��ere is a constmc�ion lentling apency lor Ihe Dedormance ot Ihe wark lor
which Ihis permil is issuetl (Senion 9097. Civ. C�.
LENDEfl:
p00HESS:
OWNEB BWLDEB UECUBFTION: I AereOy aflirm inat I am eKemp� Imm Ihe Contracmrs Stale License Law lar �he following reason
(Seciion 7031.5 Business and Pwlessional CoOe: Any cily ol counly w�ic� reQuires a permii �o con5imd, alter, imprave, tlemoli5h, or
repair any S�mciure, prior to iis issuante. also requireS Ih¢ applicani �or Suth permii to lile a SiAned Sla�emeni �hai he/She i5liCen5e0 �
pursuant to the pmvisions ol ihe Coniracmrs' State License Law (Chapter 9(commencing with Section 7000) of �ivision 3 of Ihe 6usiness
anU Pmle55ion5 Cotle) Or Ihai he/S�e is exemp� Ihereirom antl Ihe basi5 for I�e allege0 exemp�ion. Any violation 01 $et�ion 7031.5 by �
any apDlicant lor a Dermit subiecls ihe apDlicant to a civil oenalty of nol more ihan live huntlretl tlollars (5500).
I, a5 awner OI Ihe pmpe�y or my employees wi�h wages as Iheir 5ole cOmpensa�i0n, will tlo �he wOrk, antl I�e
❑ stmcmre is noi imenaea or oiferea for sale (Secuon 7044, Business antl Pmlessional CoOe: The Contractors' S�ate License Law
does not apply to an owner oi a pmpeny who Ouilds or impmves ihereon, anA who tloes sucA wark himsell/hersell or IhrouA�
Ais or her own employees, provitleA Iha� such impmvements are nol intenAed or ollered for sale. II, however ihe building or
impwvemenl is sold wit�in one year of complelion, Ihe owner will �ave ��e �urden o� pmving he/she did nol build or impmve
lor ��e pwpose o� sale�.
I, as owner ol �he pmpeny, am eKclusively comracling wiih I¢ensetl cantrac�ors Ia cans�mci ��e prole�� I���ion 7044, Business
❑ anU PmIe55i0n5 COAe: Ttle Coniraclors' Slaie License Law tice5 no� apply lo an owner o� pmpeM w�o UuiltlS Or improves ��erean
antl w�0 conlratis lOr SUch p�ole��s wifh a conlraclor(5) license pursuant Io Ihe Coniratlor5' Siale LitenSe LaW). I am aware
I�al proo� of Ihcir Worker'S Com0en5aiion insurance shoultl be pmvidetl �o me.
� I am erem0� untler Seclion: . B. 8 P. C.
�or I�is rea5on:
Date: Owner. ' -
I tlo �ere�y cenily thai I am aware of anA understana Ihe reQuiremenis ot Cablomia HeaVh and Safery Code Seclions 25505, 25533, antl
2553a antl t�ai I or any lumre builtling occupant will/will not (circle one) nee0 io compty with saitl state cotles antl I�e repuirements lor a
permit lor consimction or mo0ification Imm ihe Fir Ouality Management Disinct. p¢siCential consimction appiicaiions are e�empt irom
��ese pmvisions.
Da1e: AppiicanL
I hereby cetlAy I�al I �ave reatl I�is aDPliCalion and S�aie Ihal l�e abave inlOrmalion i5 torretl. I agr¢e �o comply wilh al� Cily and counly
ordinances antl statelawsrelatmglo huiltling constiuction antl hereby author¢ereD�esentativesalt�is cirylo enleruponlhe above�menlianetl
Omperty �or inspection Duprposes.
Oa�e:T�,7— � J � �" U Signamre: y��� �" "(�
Drl�ers �icense m 5ocia� Secunty �: �
t6aFC6 W�ite-8mltling; Green—Coae Enlorcemenl; Canary—AOPI¢anl: Pink—Ravenue: GolQenroO—Assessor
CITY"OF COSTA MESA — BUILDING PERMZT
PERMIT NO: P 050121 PLAN CHECR NO: N
-�•. ,. ,-� -,
��n�i•�or. �-Yn � sse�
CONSTRUCTION TYPE: V—N PERMIT TYPE; PLU PURPOSE: OTH
JOB DESCRIPTION ; AEPLACE WATER HEATER . SQ FT: ., .
CLAIM VALUE:' CALC—VALUE: GROUP OCC: R-3 / .
.
COMMENTS; REPLACE WATER HEATER —**MAIL IN PERMIT*� �
il� if Iflf 3E ff 1i �f 1E If ff iE iF If 1E�f IF1k �f �F 1f K iE �l(�1f IElt 1F �f If ff If if ik if if iF M if If If �f IF 1F jf 1f iEiF �f �E If ik If 1E IE 1E iF iE iF iE �E iF �E i(� aE 1F IF �Elf �E if if �f 1liE IE �f if if
Z O N I N G R E Q U T A E M E N T S
S E T B A C K S '
------------ MAIN BUILDING ----------. --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FANT; FT IN REAR: FT IN
LEFT: FT TN RGHT: ' FT IN LEFT: ' FT IN RGHT: FT IN
PARRING REQ• PROV: PARCEL: 41808303 ZNE: REF NO:
PLANNING NiSTES> :
i
iF �F �lE IF if �f if 1P k if 1f IE IF iF if If 1E iE if� if Ik 1f if iF �f iE �F M �f if �kfF If ii if iE iF !k If If �f !E IE M iE 1f,iE k If �k if iF k k iF 1E iE iF iE IE.if iE �E iE iE If If 1f �f iE iE if 1f If IF if iF if if
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 �
ZONING APPROVED BY ' ,DATE:
BUILDING APPROVED HY : DATE:
APPLICATION ISSUED HY:�� I"`�
kMlkaEif!lkltltM�fit�IfMlfMiFiflfiElfit F7E'iF'iF7
iFifiFiFiFiFMMMMNif3fMififlf�EKiF1EKIf1E11iEifiFMiEifNiflflF
LEGALIZATION;N F E E
DATE: �aJ `�'
�r�r*�r*�r**�r����**
iF iF if KiE1FM 4 iE 1flf if iF iE * M If aE iF IF1FiE IE if iF �E �E �E �E iE �IF iE 1!� iF IF if if iF iF1F if
S U M'M A R Y STRUCTURAL'SEGMENT:N
BLDG PMT PLUMBING ELECTRIC. HECHANIC , FIRE S'MIP/RES GRADING
PERMIT � 2 00 ' ' '
'l5Y . -I .• �• SMIP/NON—RES
ISSUE FEE 3,00 � ' �
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 2.00 3.00 '. � 0.00 5.00 5.00 .00
� 1
REVENUE DIVISION TOTALS--> COLLECTED:', 5.00 OVER/SHORT• 00
' BLDG PMT PLUMHING ELECTAIC MECHANIC�, FIRE SMIP/TOT GRADING PLAN—CHECK
5.00 _ < _
!f �F k it if M if iF M 1t ik k if if if ff 3t iE if 1k if if if if ik k 1E iE M if If !E 1flk ik af iE iE IF ft iF 1E 1E 1f i! if lEit iEiFlf if if iE 1k1f IE ik IE iF iFlF iFiE �IE iF if iE if iF iE if if !f iE �! iE if �t
I N D I V I D U A L F' E'E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT "�
END OF FEES
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