HomeMy WebLinkAbout1859 PITCAIRN DR - Building Permits '70EssoFSMLOINO: 1859 PITCAIRN DR UMT: CITY OF COSTA MESA - BUILDING PERMIT
- chemetmiewmmmYOUNG, RAYMOND F
PERM NO: M 080481
'
ADDRESS YOUNG, CAROL D
1859 PITCAIRN DR PERMIT NO: M 080481 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
APPL.MMINIG ADORES& CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: OTH
ARCHITECT OR DONEEB: sic.NO.: JOB DESCRIPTION REPALCE WALL FURNACE SQ FT;
ARCH OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
cwuAcrprs,wu CRYSTAL AIR ( 714 ) 634-2593
cucm&ciowsMwio 11801 MAC STREET COMMENTS : CAP OFF GAS LINE FOR WALL UNIT/ REF M-79663
ADDRESS: GARDEN GROVE CA uc.xo.: 655036 *******iEi[*ersrsE************itxitar*at+r+r+Ex*iEi ******it**it******+ESE*(tx*********itstit**N*it*itit
92641 MMT: Z ONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affkm under penaly of perjury that I em licensed under provisions of Chapter 9 SETBACKS
( ng with Section 7000)of Dieeion 3 of the Business and Professions Code,and my license is in full force and effect.
mu No.:042006 uc.ums: 20 c, o.: 655036 EXP: 03 /97 MAIN BUILDING ACCESSORY BUILDING •-
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
D : INN -le OOnbBtlO LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
1 NER BUILDER DECLARATION:I hereby affirm under penaly d perjury that I am exempt from the Contractors license Law for the
'dbwig man Business and Ptfnasiots Code:Any co or county which requires a permit to canal,alter,improve. PARKING RE(Q PROV: PARCEL : 13938329 ZNE: REF NO:
endetil h,or repair any structure,prior to les issuance.eke requires the applicant for such pemto file a signed statement that he orate
PLANNING Not E S>
a licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Man 3 of the
Business and Professions Coded of that he or she is exempt therefrom and the bean for the alleged exemption.My violation of Sena >
7031.5 by any applicant for a permit subjects the applicant to a chit penalty of not more than live hundred dollars(09001). *******************************************************************************
❑ I.as owner ofthe property or MY°mpbye°s weh wages as their sole compens°tion,will do the work.and the structure is not intended DEVELOPMENT SERVICES REQUIREMENTS
or dieted ler sate(`^cion 7044.Business and Professions Code:The Contractors License Law does not apply to an ower of property
who builds or improves thereon,and who does such work himself or hand or through he or her own employees.provided that and
im....w.seretat btetdedcrderedloraele.n.howev«.the buiainp«inprw«mends°oldwehin«eyeardcomgatun.the ZONING APPROVED BY ; DATE:
ownerbolier will have the bora d prosing he or she did mat bold or improve for the propose of sale).
❑ I,aowner of the warty.am exclusively contracting wdh licensed contractors to construct the project(Seden 7044.Business and BUILDING APPROVED BY ; DATE:
Professions nsforCode:The Cannanore with ac ntra for Law does not apply to owner of gagmn License L builds«na.mvr thereon and whe
Professio Code p eCa tia a rsLice se L)w does W«ppll to the r fors peLaw).
❑ I am exempt under Section: B.&Re..for this reason: APPLICATION ISSUED BY; / DATE:
*********************************** S' ****************** 7F*'**
Dale: Owner: LEGALIZATION; N F E E SUMMARY STRUCTURAL S GMENT:N
I do hereby cettEy that I an.aware of and understand the requirements of Calomie Health end Safety Code Sections 25505,25533,and
a per• mramal«ryhapnti,dMnoocwemwulfwama(omleone)toedrommgywEh°adam.adaeemthetemptro«rof« BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for oonsWction«modificalionhamthe Ak QuanYManagernsd District Residential construction epplcatiarmera exempt from these PERMIT 13 . 25
Provisions.
Date: Apgnant: 25% SMIP/NON-RES
WORKERSLAN
COMPENSATION DECLARATION:I herebyaffirm underPSSU
penallydperjtryonsdmemlbw;ageederatierr: ISSUE FEE 22 .00
❑ !have and will maintain acenifbate oconsent tosetliruw°for workers'compen°tlion.asprakedfor bySedion3700of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code. d
omaneuewokl«wNhmmbe
spesaed. TOTALS----> 13 . 25 22 . 00 0 . 00 35 . 25 35 . 25 . 00
❑ I have and el maintain wakes'compensation insurance,as required by Sedan 3700 of the Labor Code,ler the performance d the
«kl«www.penter: ed.Mrw«k«+'eqmpenaatdn nsaez.mm.r.napaaymame«.n: REVENUE DIVISION TOTALS--> COLLECTED : 35 . 25 OVER/SHORT: . 00
Canter:
•
Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed E the panne is for one hundred dollen(51001 or less.) 35 . 25
t] I certify that in the pedormance of the work for which this name is issued,I shall not employ any person in any mann so as to
ifli e subject to the workers'compensation laws of Calif ' , agree Net R I should became abject to the waken' *******************************************************************************
pen,aion� �of ion 3700 d the Labor Code,I a f whh oomph with those provisions. I N D I V I D U A L F E E B R E A K D O W N
ate: Apgcant
ling:Fdos le SWIM wodres'compensation coverage fa unlawful,and shall subject an employer tocdndted penamq and TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SWI fines uV to one hundred thousand dollars(Sfa4OWA At addition to me coal of compruatbry damps as provMad for In
s«Non37OSoym aborCode,dntrasl,andaromay�fess. MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 13 . 25 13 . 25
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penaly Of perjury that them e a canatnsaion lending agency for the END OF FEES
performance of the work for which this pea is issued(Section 3097.Civ.C).
LENDERS NAME: r�r�
LENDER'SreADDRESS: EXP
Iv.JID E��
I certify that I have neat this app mon and ante that the above irrepresentatives
is conedt agree to comply with all nab and county ordinances
E jrjyir ti'1� IAN/�
and see laws retrain to buildig construction and hereby authorize representatives d the city to enter upon the abovamemioned property IVJyy V
for inspection purposes.RALPH BELL DATE - - 01 00219334-00219334 T 0 T 35.25
Pmt Name DATE: 11/18/95 TIME: 10:45
Date: 6l t$ FcC
Sp ure of /Apent/Applican rear
(5151-46,WP) Whits-Buildiq&Safely;Green-F Appicant:Pink-Revenue;Goldenrod-Assessor
- CONSTRUCTION AND PLANNING •
�a APPROVALS Permit # Date
Inspector
PO SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or -Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVALTO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, C Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK*-
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final '
12. Sewer Cap
63. Heater & Vent -Final
13, Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping ❑Gas GOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas ❑ 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
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
-
51. CERTIFICATE OF OCCUPANCY
No Date
CA
,aa,r
ti Applicant 10 fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA , f0r'[RUCTIDN PERMIT PERMIT NO. TRACT NO. LOT.NO. UNIT NO
Project Address /`7
Applicant's Mailing p.ddresM .�.�,,'' q .
Owner's Name �f.N•'v!�/ •�� S Phone �L�JI
Address
Arch/Eng. V1 License No.
Address 7J a, '�(���%st I 1vl/%i.✓l% ¢
Contractor's Name M � �5�-�''holne
Address (mailing) T -v% �0-'t I)/�'7
City License No. 6cy6/"7-/
LICENSED CONTRACTOR DECLARATION !
I hereby affirm' that, I am licensetl under provisions of Charter 9 (commencing',
with section 7000) of Division 3 of the Business and Profession; Code, -and
my license is In fullire antl effect.
Ucens-ef Cf s Lice
Date J''[/� n� Signature -44
WORKERS' tOMPENSATION DELL/ RATION '
I hereby affirm that 1 have a certificate of consent to self -insure or a certificate:
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab.[ U/✓/TS/Sn4r�
1(Policy No. /--r"n'8S Compan/yJ
V4Cert if certified
scopy is d.
filed withreby rthe hc city Buil i9 g Dlvisio
Date � Applicant—q�i/� r �_�^�—+�
EXEMPTMPT O�RKERS' COMPENSATION DEC LARATIO,Y
(This section need not be completed if the permit is for one huntlred�l$100) or
less).
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. -
Data Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith'
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING'AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
-nvision 3 of the Business and Professions Code) or that he/She is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
J31.5. by any applicant for a permit subjects the applicant to a civil
enalty of,not more than five hundred dollars ($500).
1, 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 'w le (Section 7044, 'Business and Professional Code: The Contractor's
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 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 com-
pletion, the owner will have the burden of proving he/she did not build or im-
rrove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor(s1 license pursuant to the Contractor's License Law). I am aware that
proof off their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section' B. & P. C. for this reason
Date
I hereby certify tha'
Information is CorreC'
and state 4P'IrSS
SenLaII VCs
inspectionP.
Signature
Drivers' Li
IF 0865-46, rev. 10/84
— Owner
I have read this application and state that the above
I agree to. comply with all city and county ordinances
to building construction, and hereby authorize repre-
t nonthe have -mentioned pro er y for
Date
G - 2Lf5-7/
.311
SUM ARV OF FEES
BUILDING PERMIT
TYPE OF CONSTRUCTION U NEW LJ ADD ALTERATION LJ REPAIR
$
D.CONVERSION, ❑DEMOLISH 1-1 OTHER
AP #
DESC,$�PTION OF OF BLDG.
$6'
7Z 1
22K/USE
J�E/f^I 00 Ff}MfL.-' )Qpp/lJ/i
S
Main Building:
TYPE OF PERMITGRADING LJ FOUNDATIONSTRUCTURAL
T
Front
S -y
E TENANT IJ ELECTRICAL L7 PLUMBING Ey MECHANICAL
B
$
OTHER _
~PROJECT
A
Rear
DESCRIPTION SQ. FT. OCCUPA/NCV
C
Right
` CONSTRUCTION TYPE VALUATION $ [f^•QOO
$
Left
ZONE GRADING CU.YDS. ACRES
Ping. Ref. #
.'Remarks:
Planning Notes: .
FLUB
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
t'
Kitchen Sink -
Lavatories
P -Trap' `
r..
Roof Crams ^._e
Reinspection Fee $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #W38
Heating System & Ducting
00:100,000 BTU ❑ 100,000 BT
Reinspection Fee 1 $15
White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
Issue Fee
Hood or Type ❑
Canopy Type It ❑
Refrigeration System
❑0.100,000 BTU 01100,000BT
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3
9522
Accessory
7/16/86 02.321-h
I Zone R. /' - -
'Parking Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑'15-50 KW
Construction Pole Sub. - ❑50+KW
Cooking Unit. -
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A. U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 00-5 KW ❑5-15 KW
Meter LJup to 100 amps
Meter Dover 100 amps
Sub Panel
Motors ❑ 0-1 HP Ell Y= - 8
Inc. Solar 09-15 HP Ell 6-15+
Microwave '
Pole Light
Range /
Sign
Standing Sections
Trash Compactor
FEES
A
ki
N
G
R
E
Q
M
T
S
I Reinspection Fee ' 1 $15 I I- Issue Fee I $ 3 4 I
DEVELOPMENT SERVICES REQUI
Zoning Approved By
Building Approved By
I - i& C96
$ O' SO
$
$ /!
2. -?2
SUM ARV OF FEES
BUILDING PERMIT
$
low
SMIP
PLAN CHECK
$6'
7Z 1
PERMIT
PLUMBING
.
$
• 00
ISSUANCE
PLAN CHECK
25%
$
J).S-0
ENERGY P.C.
ELECTRICAL
$
L�L. qO
PLAN CHECK
, 50%
$
0,7o
_GRADING
MICROFILM
MECHANICAL
$
00
TOTAL FEE
PLAN CHECK
25%
$•
oO
I - i& C96
$ O' SO
$
$ /!
2. -?2
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA .
APPROVALS Permit
Date
Inspector
u7
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
_
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
r
4. Electrical Conduit-Undrgrnd.
-
55. Electrical Bonding
v
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
i
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
B., Foundation
59. Gas Pipe, 0 Undrgrnd„ Test
t
' 9. Water Pipe-Undrgrnd.
.60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17, Rough Wiring Sign -
68. APPROVED FOR PLASTERING
18. Rough Ele trical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit# _
20. Rough Factory Fireplace
g%Z,�
C4*_7
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
$22-N"
Gl"
76. Dry Standpipe
,
28. Lathing & Siding
s 8b
D*
77. FIXED SYSTEM FINAL
-
..
29. Insulation
78. FIRE PREY. FINAL
30. Drywall Nailing
3 8(y
J)
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-Testy�
36. Hood or Canopy
/�
4 B(, 4 LgPrF A)01scA Da
37. Final Factory Fireplace
JD-7-2?6
Ljen
rta (M1VixR_ Z94- 2441. L.IF.{71
38. Final Plumbing
F.;'k 0 Ar -
39. Water Service-Final
"
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
i
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
'
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
_
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. -Date
INSULATION CERTIFICATION
1859 Pitcairn Costa Mesa
Number and Street
Subdivision
Lot Number
DESCRIPTION OF INSTALLATION
ROOF
Material
Thickness (inches►
EXTERIOR WALL
Material Fiberglass
Thickness (inches) 32
CEILING
Batt or Blanket Type Fiberglass
Thickness (inches)621
Loose Fill Type
Minimum Thickness (inches)
Area Covered M2)
FLOOR,ELEVATED
Material
.Thickness (inches)
FLOOR,SLAB
Material
Thickness (inches)
Width (inches)
FOUNDATION WALL
Material
Thickness jinctesi
Brand Name
Thermal Resistance (R Value)
Brand Name J -M
Orange
County
Thermal Resistance (R Value) 11
Brand Name J—M
Thermal Resistance (R Value) 19
Brand Name —
Number of bags Weight per bag lb.
Thermal Resistance IR Value)
Brand Name
Thermal Resistance (R Value)
Brand Name
Thermal Resistance IR Value)
Brand Name
Tinermai Resistanw M Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administrative Code).
Forcier Construction Company B-1 #270785
General Contractor (Builder) License Number
October 14, 1986
Signature and Title Data
�Jf.97f1F4 -i s y,— Qg)1, itrrTr,,)&J a939
Sub Co trs or (Insulation Applicata) License Number
Signature and Tltl Dan
PROJECTA ,RFS S: 1859 PITCAIRN DR UNIT'
oWNER,'xnmE: YOUNG, RAYMOND F
�ADORESS: YOUNG, CAROL D
1859 PITCAIRN DR
COSTA MESA CA 92626
ARLHIENGINEER: 714) 241-1`745 REG.ND.:
ADDRESS: UNIT:
PERMITTEE: ALUMINUM ROOFING SPEC (714)558-0678
ADDRESS: 1529 MCFADDEN
SANTA ANA CA 92705
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
CITY LIC.: ,STATE LIC.: 5 2 3 0 4 3 IASS: /• w
Dat �—`_ Signature:
RKFBS' COMPENSATION DECLARATION: I hereby affirm that I have a cerificate of consent to Self -insure or a certificate of Workers'
Compensation Insurance. or a derailed copy thereof (Section 3800. Lab. q.
POucYNO.: 046-94UNIT03117 EXP,OATE: 01/01/95
COMPANY: STATE FUND
0 Candied copy is hereby furnished. Q Certified copy is filed with the city Building Division.
da� ApplicanC
EX TION FROM WORKERS' COMPENSATION OECLARATION: Qhissechon need notbecompleted ifthe permitisforone hundred (S100foriess).
edify Thal in me 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 WorkersCompensation Laws of California.
Date: Signature:
NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code, you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097. Civ. C).
LENDER:
ADDRESS: T/OFF FLAT GARAGE SUDE &
REROOF W/COMP. SHING
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure, prior to Its issuance. also requires the applicant 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
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penally of not more than live hundred dollars (x500).
I, as owner of the pmpeny or my em loyees with wages as their sole compensation. will do the work, and the
structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law
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. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a comractor(s) license pursuant to the Contractors' State License Law). I am aware
that proof of their Workers Compensation insurance should be provided to me.
❑ I am exempt under Section: B, A P, C.
for this reason:
Date:
I do hereby cenify that I am aware of and un
25534 and that l or any future building Occup
permit lot construction or modification from
these provisions.
Owner:
Cleveland the requirements of California Health and Safety Code Sections 25505, 25533, and
ant will/will not (circle one) need to comply with said state codes and the requirements fora
the Air Ouality Management District. Residential construction applications are exempt from
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct. l agree to comply with all city and County
ordinances and state laws relati0g to building Construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes.
Signature..
License or Social Security a:
164146 White—Bwldedi Green—Cotle Enforcement: Canary—Applicant; Pink—Revenuo: Galdenmd—ASSeSS01
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 067521
PERMIT NO: B 067521 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-5 PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/O RESHTH & REROOF W/ALUMINUM ALCOA SQ FT: 6,500
CLAIM VALUE: 6,500,00 CALC—VALUE: 6,500,00 GROUP OCC: R-3 /M-1
COMMENTS: REROOF ALUMINUM ROOFING ICBO # 3147 " SMOKE DETECTORS RE?JUIRED "
Z O N I N G R E Q U I R E M E N T S
S E T B A C Y, S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REO• PROV; PARCEL: 13938329 ZNE: REF NO:
PLANNING N TEE>
>
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
BUILDING APPROVED BY
APPLICATION ISSUED BY:
################################
LEGALIZATION;N F E
BLDG PMT PLUMBING
PERMIT 90,00
PLAN
ISSUE FEE
DATE;
DATE:
DATE: >
########## ##
�q M A R Y STRUCTURAL SEGMENT:Y
MECHANIC FIRE SMIP/RES GRADING
65
SMIP/NON-RES
BUILDING -DIV->
PERMIT
T.!Slj
N LAN -CHECK
TOTAL PAID
DUE
TOTALS ---- >
90,65
Cb,00
0,0090
90,65
.00
REVENUE DIVISION TOTALS-->
COLLECTED:
OVER/SH{'�T:
00
BLD90PM0T0
PLUMBING
ELECTRIC
MECHANIC,
FI E IP, TA
PLAN -CHECK
I N D I
V I D U
A L F E E
B R E A,
TYPE QTY
D E S C
R I P T
I O N ��
]NIT COST
TOTAL COST
r�
SFR 6500
REROOF
BY VALUE
RESIDENTIAL
NOZONE 1,00
6,500.00
END OF FEES
01 00162018-00162019 TOT 90.65
DATE: 06/09/94 TINE: 11:24
cc'.JSTRUCTION AND PLANNING
-, APPROVALS Permit # Date
Inspector
POO. SPA
APPROVALS Permit #
Date
Inspector `
�i
I. Temporary Electrical Service or Pole
52. Pool &Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
I
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67, Fencing & Access Approval
17, Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit?F
r
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
I
22, Ducts, Ventilating
71. Product Piping CI Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
25. Roof Sheathing
!! GG
73. Undergrnd. Storage Tank O Gas ❑ Of
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
'
27. Frame and Flashing
76. Dry Standpipe
I
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY, FINAL
'{
30. Drywall Nailing
31. Plaster Brown Coat
HEAil.TH DEPT. REQUIREMENT
79. FINALI1.'G8PECTION
tom-
32. Electrical Power Meter -Final
33. Final Electric
34. Final Heating & Air Conditioning
_ _v
80. FF;.11,0 FRTIFICATE ISSUED
?��
t�o
35. Final Gas Pipe-TestL;,_`'�
36. Hood or Canopy
37. Final Factory Fireplace
A
38. Final Plumbing
39- Water Service -Final
1
J�
40. Gas Service -Final
41. Solar Domestic -Final
y.r 1
42. Backflow Preventer
43. Backflow Irrigation
=t If
y`-
44. L-andscape krigation System
'tet
45. Sound Attenuation
-
46. Handicap Regulations
'
47. FINAL STRUCTURE & BUILDING
r
48. FINAL PLANNING
49. Electric Release to Edison
'
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy borderlines and sign all appropriate declarations.
CITY OF COSTA MEA CO S RUCTIONN DrDRAIT PER NO. TRACT NO. LOT NO. UNIT NO.
Project Address ! /" � %^L( (Yr
Applicant's Meiling Address
Owner's Name __�/jJ Phone pl.[J�5
Address%e.
Arch/Eng. License No.
Address
Contractor's Nam Phone
Address (mailing) S) )
City License No (.O 2 1
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full borce and effect.
License CIs e se
Date Signature
'ORKERS'COMPENSATION DECLARATION
lereby affirm that I have a certificate of consent to self -insure or a certificate
r Workers' Compensation Insurance, or a certified COPY thereof (Section
3800, Lab. C�',�L�I(%%, /'/I �1
Poli<Y No. _! 1_9 1 . d 7 Company LC
ertified copy is hereby furnished.
Cert" ietl.c y is filetl with the city Buil m vis o
Dale Apo licant —��� �1/� ��
EXEMPTION kROM WORKERS' COMPENSATION DECLARATION
(This section n@ed not be completed if the permit is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Dale Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there Is a construction lending agency for the performance
of the work for which this permit Is Issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the'
following reason (Section 7031.5 Business and Professional Code:.Any city or
county which requires a permit to construct, alter, improve, demolish or repair
anystructure, prior to its issuance, also requires the applicant for Such permit
to file a signed statement that he/she is licrnsed pursuant to the provisions of
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
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 (Section 7044, Business and Professional Code: The Contractor's
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 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 com-
Pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
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
proof of their Worker's Compensation Insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date
I hereby certify that I
information is correct. I
and state laws relating I
sentatives of t cit
inspection put s.
Signature
Drivers' License or SS #
Owner
have read this application and state that the above
agree to comply with all city and county ordinances
I building construction, and hereby authorize repre.
nto enter ugpon the above-mentioned property for
1nF_
�—
CMF 0865-46, rev. 10/84 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
Issue Fee
I $ 3
Reinspection Fee
$15 Issue Fee
$ 3
1ANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved ByData
Application Issued BY_
y
'
Date
Dat
Hood or Type ❑
Canopy Type I I ❑
Refrigeration System
00-100,000 BTU ❑ 100,000 BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$
$ -
$ . 0 67
$
$
$
$
$
SMIP $
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING $
MICROFILM $
TOTAL FEE $
ma
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit '+
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1: -Temporary Electrical. Service or Pole
52. Pool &Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement `r
t
3. Electrical Conduit Utility-Undrgrnd.
54. Forms `
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & PressuretTest
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings S_
58. Electrical Conduit-Undrgrnd:,J
1 8. Foundation
ni
59. Gas Pipe, O Undrgrnd., Test^
�.I
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, [I Uhdrgrnd,
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping OGas []Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas O 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
i
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
Z ZQ1%
<
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
.
47. FINAL STRUCTURE & BUILDING
/
48. Special Requirements Completed
49. Electric Release to Edison
,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
LruNlrirta IAlll uH1L• r co oo _
JOB ADDRESS 1859 Pitcairn Drive BUILDING PERMIT NO. 2949
GENERAL CONTRACTOR Virgil E. Miller DESCRIPTION OF WORK Add Bedrnnm
AP No l 39_183-9 LOT TRACT FIRE ZONE VALUE $ 3,350 00
INSPECTIONS
Signature
I Date
GROUP T TYPE V ZONE R-1
S
_
SUBCONTRACTOR
PERMITS ISSUED
G
Date Number I Signature
Water
Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con. •0
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring
G
Heating and Vent.
Trenches ® Forms ® Steel Reinf..El
i G6
Floor System.�
Bond Beam ❑ SteelReinforce ❑
Sheathing
Frame and Flashing
pyfj
17/1, _ 6 s
Lathing —InE Out E]
1c
J--?
Plaster, Brown Coat
`% ✓
4 -}"-UF
Structural, Final
Elec 'c
H, -"ng, Vent., Refrig. and A.C., Final
F Ting, Final and Gas Test 0
Electric, Final
Building, Final....
.,/(p•
-.---.
4
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1299 COSTA MESA, CALIFORNIA 921129
For Applicant to Fill In Completely
TYPE OR PRINT
COSTA MESA,
'HITECT T!L
NOI %R NO.
ADDRESO
CITYATE
•�C/ `l��s���
LOC.. NO.%�LONp�
SIZE -"C / / I NO. OF I
OT
OF L}/� Now ON
USE OF
U622NG BLDG—
BW
LDO. t/
BHTBACK LI PROM n RKAR YAR
CRNTRR OP BTI , A
HIDE YARD I LQFT RIGHT
DLSCRIPTION OF WORK
WAR
i
f
I HERESY ACKNOWLEDGR THAT.1 HAV[ READ THIS APPLICATION
AND STATE THAT THE A11gPVE 1, CORRECT AND AO ES TO COM.
PLY WITH ALL CITY 0�2 STATE LA REOYL9
BUILDING COHBTRUR N. Qz
SIGNATURE OF
PERMITTKR
AUTHORIZED AGENT
JUL 26-66 001471 A3****22.50
APPLICATION FOR PERMIT
BUILDING
For Office UKe Only
R[C[Irt NO.
PERMIT NO.
R[c[I O Y
DAT REC[I [D
I ISE
L
BUILDING
ADORE
FIRE
ZONE TYP ROUP
APPROVED
BY ATQ
z6j4imo
ZONE
NO. O► 7
, C�
USK of N[w
RUILDINO
%.LAI
LINIALDESCRIPTION Lo7� ae> �1-12 3
A. P. NO. I3 9-383 - Z9
NOTl: NO SAVOVlRHAN08MALL BE LQBH THAN
90• TO BID! I REAR . L-
EAVES EAVES
ALLOWED (U. B. C. REOUIRKMKNT)
YARDBAPPROVED
MAIN BUILDING
YARDSAPPROVKD
ACCESSORY BUILDING
( FROM C/L fTRKKTI
FR NT/KX C `._
PT.
R. SIDE I FT.
IT.
L SIDE 38 FT. f
FT.
REAR 36 FT. 3 i
FT.
DISTANCE B6T.
MAIN SLOGS.
BET. MAIN O
ACCESS. BLDGS.
VAR.*
C,
DATE
APPROVED
APFROVED If
ey lJ rf' .�
DATE
w
:4
•5�0 BG. PT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PURPOSE OF ESTABLISHING A PERMIT PER ONLY.
VALUATION 6"
�0
PERMIT PER /J
3�
TOTAL PKK
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING v_ f
ADDRESS
COSTA MESA. CALIFORNIA
FE RECEIVED
SEP 19 1962
HNANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only 17jQ/
�>� /-
RECEIPT NO,
I IM
OWNER iplOi i (/Ti
�
MAIL Ag /'
ADDRESS
RECEI EO 0Y I DATE RECEIVED
r DATE 189UEOq
S �9SL
TEL. �j,
CITY NL.
BUILDING
ADDRESS
AN ccr TEL'
COSTA MESA. CALIFORNIA
G�-�yg,�.�,
.INEER NO.
FIRE
ZONE TYPE GROUP,
,�}} ��JJ�� .
CONTRACTOR AA1F�p 1
APPROVED
BY DATE
1 /y!
ZONING
ADDRESS
ZONE NO. OF ^J USE OF NEW"'.' _X,_ 1 C/
RSI I PLANS (� I BUILDINGSTAW P� qY
LEGAL LG'%- 2O TO / / 3
'1
CITY ` �_�+ �- �/�/j
�/)J�'7
A:
LIC. NO. ( l.2 NO. J (J
DESCRIPTION /� J 1
A. P. NO.
SIZE
OF LOT D
NO. OF BLDGB.
NOW ON LOT
USE OF
aidL'•7
YARDS EVES
EXISTING BLDG.
APPROVED ALLOWED
SETBACK -NE FROCENTER �
(CENTER LINE ST.)ca
OP STR ETM REAR YARD
FRONT ✓ FT. IN.
SIDE YARD I LEFT �D
RIGHT Jr—
R. SIDE FT. IN.
DESCRIPTION OF WORK
L. SIDE /o FT. IN.
NE% I xII
ALTERATION ADDITION
11
REAR '� ( FT. IN.
APPROVED DATE
REPAIR ( II
MOVING I DEMOLISH
I
BUILDIN NO. OF
D
SIZE ROOMS STORIES
`LAleGr
IROVE
OOFO
VEWAL
RING
USE OF BUILDING/AND WORK TO BE PERFORMED
I D HEREBY ACKNOWLEDGE THAT I HAVE REATHIS APPLICATION
V THE AMOUNT SHOWN
AND STATE THAT THE ABOVE CORRECT A GREE Tq COM-
UNDER VALUATION IS FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLV WITH ALL CI O 1 8 RE LAT
VALUATION
Q�
BUILDING CO
SIGNATURE OF
PERMIT FEE S (J •'/�
PLAN CHECK $
PERMITTE
AUTHORIZED AGENT
TOTAL FEE