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HomeMy WebLinkAbout1790 PITCAIRN DR - Building PermitsApplicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESABMIT P NO. TRACT NO. LOT�ryryO. BLDG. NO. CONSTRUCTION PERMIT OF 1%o© 4008 11`i TYPE OF CONSTRUCTION ❑ NEW ADD ❑ ALTERATION V S it 6252 IJ./.1.6/61. 88.3_8 Project Address 1770 ( 4 AtAeAJ ZAff Owner L(_( S (A_,tO -1- none Address -( ( (QN ❑REPAIR CONVERSION ❑pEMOLISH ❑ OTHER ZONING REGULATIONS Arch/Eng. License No. DESCRIPTION OF WORK TYPE OF PERMIT KSTRUCTURAL A -P' 41 /J9 - ZONE— B SETBACKT 34 / - / PLNG. REF. 41 Tp BUILDING 7 7i PROPE♦7TV LINE AddressaZZW-coM' Contractor E'S% CA E Phone /% Address E, Z E' ❑ GRADING ❑ FOUNDATION ❑ TENANT ELECTRICAL ❑PLUMBING ❑MECHANICSIEpE YARD LICENSED CONTRACTOR DECLARATI N I hereby affirm that I am licensed under provisions of Charter 9 (com- V - ♦ Y RIGHT I b meriting with section 7000) of Division 3 of the Business and ❑OTHER Professions Code, and my license is in full forceanj effect. REAR YARD (TO P/L) % PROJECT D SCR�D TION Class ansa No. Sq. FT. p .��r, &�[--a//C��O''NNS'�•SgTRUCTION ^ \ PKG. SPACE REO. STREET WIDTH �� PROVIDED '� PARK FEE $ Dtense Date Signature WORKERS' COMPENSATION DECLA ION OCCUPANCY TYPE I hereby affirm that I have a certificate of consent to self -insure or a VALUATION LA6042 ZONE ZONING APPROVED BV Lr DATEII > C� certificate of Workers' Compensation Insurance, or a certified copy - ireof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: 'Cy NO. Company Certified copy Is hereby furnished. - REMARKS: ❑ Certified copy Is flied with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred Orthat less ' S$ce1Oort) n s. fy one manta the work for which this permit PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK issued, I shall not employploy any person in any manner so as to becomee not subject to the Compensation Laws of California. BATHTUBS SHOWERS Date Signature NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR O -I KW_1-10 KW to the Workers' Compensation provisions of the labor Code, you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10.50 KW -50 + KW revoked. - KIT. SINKS DISHWASHERS MOTORS 0-1 HP -1-10 HP CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency, for the per- SERVICE SINKS SUMPS cy r- (INC. SOLAR) 10-50 HP 50 + HP formance of the work for which this permi CSeis Issued (ction 3097 -FLOOR SINKS DRAINS - FIXTURES OUTLETS SWITCHES Civ. C.).r , . \ Lender's -Name .1 FLOOR _ \ f. Lentler's Address `� � DRINKING FOUNTAINS ,. -_.NG , s GAS TUBE SIGNS OWNER BUILDER DECLARATION `- � I herebyy affirm that I am exempt from the Contractor's License Law for -INTERCEPTORS - CLARIFIERS \- .s `\ POLE LIGHTS SWIMMING POOL P TRAP the followln9 reason (Section 7031.5 Business and Professions\Cotle: Any city or'cqunty which requires ld, permit to construct, ;alter, POLES METERED SUB SERVICE ALTERATION -PANELS MAIN Improve, demolish or repair any structure, prior to Its issuance, also re -WATER quires the applicant for such permit to file a signed statement that h¢ '+ SUB is licensed pursuant to the provisions of the Contractor's License law GAS SERVICE OUTLETS SERVICE AMP Papoer 9 (commencing with Section 7000) of Division 3 of the - `ess and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS _ 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 SOLAR TANK COLLECTORS _ sole compensation, will do the work, and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SVS. ISSUE FEE QQ Contractor's License law does not apply to an owner of a property ISSUE FEE APPLICATION APPROVED BY DATE who builds or Improves thereon, and who does such work himself or through his own employees, provided that such improvements are not, MECHANICAL PLAN CHECK SUMMARY OF FEES 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 did not build or Improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDING O•�0 ❑ as owner of the property, exclusively contracting wloh AND DUCTING PERMIT § $MIP - $ T n project Business licensed contractors to construct the 100,000 +BTU PLAN CHECK § �.� �.� 32. Jaz PERMIT and Professions Code: The Contractor's Law does a not apply to sLce(Section es not ISSUANCE $ Improves owner of property who builds or Improves thereon, and who ton- REFRIGERATION 0-100,000 BTU PLUMBING E tracts tracts from such projects with a contractor(s) Ilcesned pursuant to SYSTEM GRADING E the Contractor's License law). 100,000 + BTU PLAN CHECK E ❑ I am exempt under Section B. & P. C. for this r S6 $ BOILERS BTU ELECTRICAL $ reason PLAN CHECK $ MICROFILM E Date Owner SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE MECHANICAL § TOTAL FEE $ LESS AD. 1 hereby cert i that I have this application and slate that the above information Is correct. I agree to comply with all city and county Is agree PLAN CHECK E VANCE PC $ and state laws relating t construction, and hereby authorize -A repr,nta representaoive O his City o0 enter upon the above eniion¢tl Properly f i rl pYrPoses. /' / �y $Ignalu •. Date ISSUE FEE OY FINAL FEE $ 7� Drivers' Lice or SS � � CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # E-/ 00 Date Inspector POOL & SPA - APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole _ 43. Pool & Equipment Location 2. SoilPipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE- - 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P -Trap,❑ Undrqrn 10. Structural Floor System 52. APPROVAL TO DECK - 11. Property Sewer Line & House Connection - 53. Backwash & Receptor -Final _ 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing 55, Plumbono System _ Final- 14. - Rough Electric -Conduit :56. Electrical -Final - 15. Rough Electric -Wiring / _ u_ L 57. Solar System -Final 16. Rough Heating & Air Conditioning - - _Fencing & Access. Approval - 17. Ducts, in Structure 59. APPROVED FOR PLASTERING -18. 19. 20. Ducts, Ventilating - Gas Pipe -Rough & Test Roof Framing 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing Frame and Flashing„ 2 -Z NOTES:e\t 23. Insulation r -e 24. Lathing & Siding 25. Drywall Nailing (-/�/•$'� p r, rfv'cx.! 26. Plaster Brown Coat We c 27. Electrical Power Meter -Final e _ 28. Final Electric o - _ •L0 L4 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test _ =v 31. Final Plumbing - 32. 'Water Service -Final - 33. Gas Service -Final - 34. Solar Domestic -Final ' 35.- Landscape SprinklinQ System 36. Sound Attenuation _ 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING lo -ZI_ 39. Special Requirements Corimpleted - 40. Electric Release to t dison • • - - ' 41. Gas Release to Southern California Gas Co. 42. - CERTIFICATE OF OCCUPANCY No Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1790 PITCAIRN DR Suite: Vicinity: BLOCKWALL @ SIDE & REAR PROPERTY LINES Parcel Number: 13934110 Applicant: MURPHEY, CHARLES Address: 1790 PITCAIRN DR COSTA MESA, CA Zoning: R1 R1 Phone: (714)241-0855 Zip: 92626 Owner: MURPHEY, CHARLES & PATRICIA Address 1790 PITCAIRN DR COSTA MESA, CA Contractor: OWNER -BUILDER Address: Zip: Arch Address: Phone: (714)241-0855 Zip: 92626 Phone: License: 0 Eng Address ISSUED BY: Status: ISSUED Applied: 05/07/2001 Issued: 05/07/2001 Phone: Phone: Zip: License: License: SCOPE OF PERMIT 156 LF OF U HIGH BLOCK WALL, A PORTION OF THE LEFT SIDE AND A PORTION ON THE REAR PROPERTY LINES. Plan Check: $63.21 — -- Permit: $97.25 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $160.46 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: FEE SUMMARY Calc Valuation: $3,120.00 Claim Valuation: $0.00 PLANNING & ZONING Left 0-0 Right 0-0 - Left 0-0 Right 0-0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446i6 (6/00) I WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed i/ the permit is valued of one hundred dollars ($100) Orissa.) ❑ 1 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 forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: 1 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 farce and effect. Lc. q Class p Conlractoes Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this Permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under Penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ 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 em ex oder s Business and Professions Code for this reason: Signature:(Q • IANIZ4 dime. T Date' O / Owner ID verified by driver's license. Ye No r'DdGees License Expires: Verification of Ownership by (type of document, i.e., property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, TIIIe 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. Signature: Date: 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 filed 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 appplicant or present or future building occupant need to Prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ h10 (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 a plication apgermit for such construction or modification from the South Coast Air Quality Management District or from any other air Pollution control district or agency? Li Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................................................................................................................................................................................................................................................ 8 Will any pan 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 61 ........................................._.........._................__..................................._....__....................""..........................._...—_______......................_.................._.........................._...................... B s', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHOR12tTION Qi�ENTRV: I certify under penalty of perjury that I have read this application and state that the information given is corro . II�9too to comply with ggqIIII state II ws and city or (n ices relating to building construction, and authorize representatives of the C' y of Costa Mesa to enter upon the ab/ acttpp'p6�oses. I aqr a of to occupy or allow Occupancy of any building authorized by Thi it unt inal inspection. Signature Of Leg _wner(s) Date?_ } And/Or Authorized Applicant Date CODE f. INSPECTION TYPE lil INTMAL5 CODE. INSPECTIONTYPEgA� INITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 200 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final BlocWRetaining Well "2 B Z 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 CITY OF COSTA MESA PLANNING DIV. /0c �I ® NOTE ADDITIONS, OELETI(WS, OR CORRE^TIONS SHALL << ? a:i"tia� UtY? tNN BE APPRWEI B't ' Vorerll Utes IJevtCC— � 6v les MLA ,A2 i(, e 6- 1 -7 9D F?t fC(ti'rKil .UQ, Cosf� McSa7 Ct, 9z6 i DS VISION OF BITi,D1NU SAFE'1' Y CITY OF COSTA MESA APPROVED T,1rs set of Pka6dSPeCifICE p I ;r;. diOns MUST be kept on this job at all times and N is—unlawful d�fe dv. C tg"altaralbnonsamewithoNwrdten permissm :be staVLNofthis Plan and s D ` ' �0 6 3I ,f the violation of any provisions ofaany C of Costs MesabO�dle orae and/or b n State hese plans and permit shall expire by limilalicr, and become null and void if the buildinn :. ' is[ J s� .- Cement Coping Optional Channel Block With 1.3/8 Horizontal Top of all Fences For Fences 5' or Less Ven. Bars 3/8" Oat 4' -0" O.0 For Fences Higher Than 5' Vert. Ban 3/8-0 at 32" O.C. Fill Cells Solid With Grout Where Steel Occurs Rclnforcing Steel Shall Conform to Sec.A 15-39 A.S.T.M. AIt Steel to be Lapped 24" or to Code NATURAL GRADE TWO 3/8"0 BARS CONTINUOUS TOP 8 BOTTOM 140421iSTEEL MUST BE TIED IN PLACE AT TIME OF TRENCH INSPECTION. TYPICAL 611 CONCRETE BLOCK FENCE y^ I- D^II A I OT H p SEE CHI L BELOW 0 FOOTING REQUIREMENTS CHART GENERAL- NOTES MORTAR: One Part Plastic Cement, and Three Ports Sand GROUT: One Part Cement Thee and One Half Parts hand COPING: One Port Cement, Three Parts Sand CONCRETE: Well Mixed 1:2-1/2:3-1/2 Max of 7-1/2 Goltcns of Water Per Sack of Cement GROUT MAY BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCURS. CELLS AND AREAS OF HORIZONTAL REIN FORCEMENT SHALL BE CLEAR. CLEAN Is FREE OF ALL MORTAR DEBRIS. ETC. H CF EARTHTCOTH V' THE HEIGTH OF FENCE IT -LOW BOTTOM OF FOOTING SCALE'. 1/2"- I' WIDTH 14" 14" . . . 12 12" THICKNESS 10" 10" 8" 8" DEPTH OF EARTHTOOTH 244 20" 16" 12" SPACING OF EARTHTOOTH 12' 14' 16' 16' BUILDING DIVISION tlr• I=� • THIS SKETCH 15 FOR INFORMATIONAL PURPOSES ONLY. APPLICANT IS RESPON51BLE FOR PROVIDING AN ACCURATE REPRESENTATION OF THEIR PROPERTY IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND WITH THE INFORMATION PROVIDED ON THIS SHEET. • SOLID WALLS/FENCES BETWEEN 2'-6'& 6' IN HElGfiT SHALL BE SETBACK AT LEAST 19 FROM FRONT PROPERTY LINE. • SOLID WALLS/FENCES SHALL NOT EAC® Y WIN HEIGHT WITHIN 10' OF THE FRONT PROPERTY LINE NOT CURB LlNE). 1 I K RESDENQ oem"DE bbl I I I I 1 I I I I I a C � a I� I RE9D£NCi RE9DENEl RE90ENCC RE90ENEF I I I I I I I STREET BLOCK WALL LAYOUT FOR BUILDING PERMIT PLANNING DIVISION • VERIFY DISTANCE FROM CURB TO PROPERTY LINE AND SHOW ON PLAN. VERIFICATION FROM THE CRY'S ENGINEERING DIMON IS REQUIRED. CALL. (714) 7545313 \ A� FOR INFORMATION. 1 I K RESDENQ oem"DE bbl I I I I 1 I I I I I a C � a I� I RE9D£NCi RE9DENEl RE90ENCC RE90ENEF I I I I I I I STREET BLOCK WALL LAYOUT FOR BUILDING PERMIT PLANNING DIVISION APPLICATION FOR A BUILDING PEP"'T Tract Block Lot BUILDING PERMIT NO. O6 C•i­CJ �— 5—o,65 ­3 % Electrical Permit No. Bud Building p I Address J � 9Q �Y�rtit r>1 Plumbing Permit No. Cross Street /,Qp/Y/S 9/-pl&4 VC✓dtf. Area /7%ejA ✓C)'C� t Mechanical Permit No. Owner /%Jf , y- /-'�,7vs_ Al- Type of Project: ❑ New ❑ Alter ditlon Atldress '� / Q TSG t p yt ❑ Repair ❑ Convert ❑ Demo ❑ Occupancy Pmt. �yy�up. CITY �' /r�CS A- Zip Phone A.P.APInsp. Dist./ Area Architect/ Designer License No. Zone SPI. Pmt. No. Setbacks P/L Front C/L St. Street Width Address Yards eft gh ear City Zip Phone ve ol. a l9 Engineer License No. Parking Spaces equ re Provide overs Address Strucl No, of No. of City Zip Phone Height I Stories Family LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 Park Fees H Yes Required No I C.T. Fee Receipt Zoning App ovetl By: Date (commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect), License Cl az License Number -21P%d 22 Date i�/ Contractor i.✓P_6 % �'✓-v rvc.{,t /fes jj r V cf l.. Atldress•?2 2 C. .P.c), far/ misc. il Proposed of Structur City and Zi p0✓c""`;;Y Phone 2201 Zfi ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Occ I Class JType^ Comt. Code Year � USE/OCCUPANCf SIZE SO. FT. Lender's Name — Lender's Address 1 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their 2. sole compensation, will do the work, and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with 3 4. licensed contractors to construct the project. ❑ 1 am exempt under Sec. , B&PC for this reason Detre Owner WORKERS' COMPENSATION DECLARATION Total Valuation Encroachment Permit Require ❑ Yes ❑ No I hereby affirm that I have a cartifica[e of consent to self-insura, .or acertificate of Workers' Compensation Insurance, or a certified copy thereof. Policy No Company Grading Pmt.Gradin Required ❑ Yes ❑ No Pmt. N r❑ Certified copy is hereby furnished. yp Certified c py is filed with Or1�an�qe Co un,�t.j.j'', EMA. /` / Data Y/e F- Applicant 1/�[ES�F (/✓.l rrr4a. Crxf 'et%I Rough Grading Approved by: Date CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section need not be Completed if permit is for $100 or less). 1 certify that In the performance of the work for which this permit is PERMIT FE issued, I shall not employ any Person in any manner so as to become subject to the Workers' Compensation Laws of California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Pla Chec E Exemption, 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. Electrical $§ SP In tial est. plumbing E I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Mechanical $ RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABO E ENTION D PROPERTY FOR INSPECTION PUP. POSE$ C Q �O Pre -Grade Inspection $ Pre -Grade $ Rec. No. Permit $ Issue .gnat -re of 17 ant or Agent D/ate g iC.a Vrrere.4o nf'�rt,Cfr�� /' Print APPlicant's/A9�ar 's Name a � J lrt+Sl/r All spaces within this box must be completed to process Plan Check By: Issuance I-u.ncetl: CMF 0335-06 (BU -28) rev. 6/80 QOSTA MESA BUILDING.SAFETY DEPARTMENT P. O. BOX 517 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely COSTA MESA. CALIFORNIA FE RECEIVED L 311961 FALDEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only Rece1PT xo. CPe4iM1yy N�Qq. OWNER Pacesetter Jt. Venture MAIL RECEIVBD' I DATH RECHIV80 I OATS IBBUH ADDRESS 1653 Minorca l//.•��r�BY - - Costa Mesa TE BUILDING BUILDING CITY NO. ADDRESS ARr '.CT TEL. COSTA MESA. CALIFORNIA OR ,NEER NO. FIRE ADDRESS ZONE TYPE GROUP CONTRACTOR Mesa Verde Builders Inc. APPROVED BY DATE 1653 Minorca ZONING ADDRESS •!,. CITY Costa Mesa—` ZON NO. OF PLANS USE OF NEW 17R BUILDING STATE 181L269 EL Ki 9-0395 LEGAL /1-1-4 / /J/DOL DEBCRIPiION 1 / SIZE - I No. OP BLD OP LOT now ON LOT 0 A. P. NO. USE OF YARDS EVES EX19TING BLDG APPROVED ALLOWED SETBACK LINE FROM(CENTER 46 44 LINE ST.) CENTER OF STREET REAR YARD FRONT / O IT. IN. I I BIDE YARD LEFT 6 RIGHT 6 R. SIDE FT. IN. DESCRIPTION OF WORK —' L. SIDE (7 FT. N. I X II IIADDITION I NE1 ALTERATION REAR FT REPAIR II MOVING I II DEMOLISH APPROVED / ? N. DATE 7/`f/`� C, BUI DIHc1620 S 6 1 Rr9� .Ft. ROOMS STORIES EXTERIOR WALLStuCCO (ROOF Shake COVERING COVERING USE OF BUILEF19C AND WORK TO BE PER D Stanctara i,.Lan w. 62u Ba Attached garage 450 Sq.Ft. EBY. 1 HEREBY ACNNOW 8 THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IB FOR THE AND T THAT T 8 BOVE 8 CORAECT ND A RHE O COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL O IN 9 AND A LA RE LATINO VALUATION BUILDING COxBTR GT SIGNATURE OF (� PERMIT FEE $ PERMITTE '/ O7 / p $ f PLAN CHECK $ AUTHORIZED AGE TOTAL FEE .4— COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 i 081 9/11/80 6.0.50 TL APPLICATION FOR STRUCTURAL PERMIT RECEIVE Y PERMIT INTO 5- 6 5 5 N For Applicantto Fill Com pletely — Use Ink Only liin/ A P NO A DILDING DR ESS / 9O -//TG,AtY' BUILDING 1 OWNER OR I 1 TENANT ADDRESS MAILING ADDRESS /290 484 tI-r SPACE NO. r- BILK. CITY CS4, 4r1s- NO. NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER •� ADDRESS VAL E$6 7G qi ARCHITECT TEL. USE a OR ENGINEER �' , R �V ADDRESS ZONE TVP GROUP ��] ! /f CGy-r APPROVED By DATE _/I_ 60 CONTRACTOR IAe3b ADDRESS 3Z 7 C, TEL CITY y' _ NO. 99F91 -7G 2-f �% APPROVED SETBACKS L C NO. 96 LIC. SIZE NO. OF BLDCS. (FROM C/�,STY�EET) OF LOT NOW ON LOTFRONT r FT. VSE OF EXISTING BLDG. t,j IoiC�'/- FT. Separate permits are required for L. SIDES FT. electric, plumbing and heating work: REAR�r FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION o I-. DATE c� APPROVED 1 R Q APPR VE I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. S I hereby certify that I am properly licensed as a contractor under SO. FT. il the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ and Professions Code, Division 3, Chapter 9. SignaPLAN of CHECK S _20— / * 1. Permittee Permittee — $ U S �(! TAX $ or Authorized Agen a 9/r TOTAL PAID $