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Home My WebLink About3444 PLUMERIA PL - Building Permits; � CITY OF COSTA MESA � MFS BYILDING DIVISION '4�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wvw.ci.costa-mesa.ca.us t �� FOR INSPECTIONS CALL: (714) 754-5626 � PERMIT NUMBER: P09-00097 PERMIT TYPE PLUM APN: 41217809 JOB ADDRESS: 3444 PLUMERIA PL CM vicinity: STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 08I17/2009 BJK SCOPE OF WORK: COPPER REPIPE TO EXISTING PLUMBING FIXTURES 8 1 WATER SERVICE IN A SFD. OWNER: PHONE: APPLICANT: PHONE: ROTHROCK, KATHERINE EHINGER, GREG 877-547-9001 Address: 3444 PLUMERIA PL Ciry/State/Zip: COSTA MESA, CA Address: 979 TROVITA DR City/State/zZip: CORONA, CA CONTRACTOR: AMERICAN EAGLE COPPER REPIPING License No. 918998 Address: 979 TROVITA DR PHONE: 877-547-9001 Ciry/State: CORONA, CA ZipCode: 92881 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: 50.00 $43.10 $43.10 NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be wnsidered legal, such work must comply with all applicable codes, and all required inspections and flnal approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiration of this permit. �Et INSPECTIONME O�7E IN1111AL5 LOOEt INSPEGTIONTYPE ORTE INTITIRlS 1616 FixeA System Final Fire Prevention 206 Final Mechanical yc 1266 Pool Spa Final 20B Final Plumbing 0��_�_%j�l 200 Final Re-Roof 2t0 Final Electricai '� 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolilion 250 Final BuildinglOccupancy WORKERS' COMPENSATION DECLARATION: I hereby aKrm untler penalry of perjury one of the following dedaretions: ❑ I have and will maintain a certifiwle of consent to sel4lnsure for workers' compensation, as provided for by section 3700 0( the Labor Code, for the pertormance of Ihe vrork for which this permit is issued. ? I have antl will maintain workers' compensa[ion insurance, as requiretl by s tion 3700 0l the Labor Cotle, (w the peAormance of t�e work lor which this pertnit is issued. My vrorkers' compensation Insurance carrier and policy number are: �-Carrier 57�z ��P � k ,.� J � (T�issecfronneetliro(bewmple(etl�Ifhepermrtisvalue0alonehuntlietltlolldrs(5100)orlessJ Folicy�Number. D D� G sp q�_ Zo o �-1 �� I certify that in the peAortnance of [he vrork for whic� ihis permit is issued, I shall not employ any person in any manner so as to become subject to Ihe workers' compensation laws o( Califomia, and agree lhal if I should become subject to lhe vrorkers' compensation pmvisions o( Section 3700 of the abor Cotle, I all forthwi[h comply with these pmvisions. ��- /�7 ' � l AppIK2 �Ignalure pale) WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES.UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSEO CONTRACTORS DECLARATION: I hereby af(irm tha[ 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 (ull force antl eHect. rCic.-p• � r � ' c�ass�#�� i ' ) 7 _ Convacmr's newre � Da�e"i � CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm that Ihere is a construction lending agency for the peAortnance of ihe work !or wfiich this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Adtlress� Signalure Da�e OWNER-BUILDER DECLARATIONS: I hereby aKrm Ihat under penalty of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW (of the (olloWing fea50n (SBC. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to constmct, alter, impmve, demolish, or repair any stmcWre, prior to its issuance, also requires Ihe appliGanl (or suGh permil to f le a 5igned stalement that he or she is licensed pursuaM to the provisions ol the Contrecrors LicenSe Law (Chapter 9(commencing with Section 7000) o! Division 3 of the Business and Professions Code) or �ha� he or she is exempt Iherefrom and the basis !or the alleged exemption. Any violation of Section 7031.5 by any applicaN (or a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the strudure is no� intended or offered for sale (Sec. 7044, Business and Professions Code: The Convactors license Law does not apply to an owner o( property who builds or improves �hereon, and who doe5 suth work himself or herself or through his or her ovm employees, pmvided thal such improvements are not intended or oKered for sale. If, however, the builtling or improvement is so10 within one year of completion, t�e owner-builder will have the burden of proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner o( the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consWU the project (Sec. 7644, Business and Pro/essions Code: The contractors License Law does not apply to an ovmer of propeAy who builtls or improves lhereon, and vfio contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). � I am exempt under sec. Business and Professions Code for this reason: SignaWre J09-G6 pl0]) i Owner ID verified by driver's license. ❑ Yes ❑ No Dnver's License No. Expires: Verification of Ownership by (type of Document, i.e. - propeny tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: ❑ I hereby certdy Ihat no excavation frve (5) or more feet in depth inro which a person is required to descend, will be made in connecl'an with work authonzed by ihis permi�, and that no building structure, scaffolding, (alsework, or demolition or dismanUing thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2. Sec. 341, Title 8, Califomia Administra�ive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Intlustrial Safety, as noted above, unless such person has a permit to tlo such work fmm lhe division. Appli W n(s Signature Dale Division of Industrial Safety Permit Number HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or Nture building occupant neetl to fle and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 ot the Califomia Health and Safety Code requires. with some exceptions, that a Business Plan be filed with ihe Costa Mesa Fire Depatlment by every business which has a[ any one time dunng a reported year a quaMiry of hazardous materials equal to or greater than a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic (eet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or WWre building occupanl need to fle a registralion form for acutely hazartlous materials? ❑ Yes ❑ No (Section 25533 of the Cali(omia Health and Safety Cotle, with some exceptions, requires regislration with Ihe Costa Mesa Fire Depahment by each business which at any one time has on hand a quantiry of awtety hazardous materials equal to or greater than a weight of 500 pounds. or a volume ot 55 gallons, or 200 cubic feet of compressed gas at standard lemperalure and pressure). 3. Does or will the applicant or preseni or future building occupant neetl to prepare an RMPP (Risk Management and Prevention Program (or acutely hazartlous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safery Code provides thac the Costa Mesa Fire Department may require the preparation, certificalion and filing with the Pire Department of an RMPP by businesses which are required to regisler acutely hazartlous materials with the Fire Department. 4. II an RMPP is presently requiretl. has Section 25534 of lhe Califomia Health antl Safety Code been tully complied with? ❑ Yes ❑ No 5. Does or will the applicant or presenl or fuiure builtlin9 oCCupanl fequif0 fOf lhe work which is lhe su6ject of this application a permit for such construction or modification from the South Coast Air Quality Management Districl or tmm any other air pollution control tlistrict or agency? ❑ Yes ❑ No (Section 65850.2 oi me Califomia Govemment Code requires that the requested inlortnation be fumished on applications for nornresidential builtling permits). 6. Will any part of the facility to be consWcted under this permit be within 10001eet from the outer boundaries o! a school? ❑ Yes ❑ No Qf "yes", the facility must meet the requirement of Sections 25534 and 42303 of the Cali/omia Health antl Safery Cotle). 7. If a permit from the South Coast Air �vality Management DisMct or oiher air pollution control district or agency is required for the vrork which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach certi(cate of compliance from the appmpriate air polWtion control oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correcL I agree to comply with all slate lavrs antl city ortlinances regarding Hazardous Matenals and Emissions. SignaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry o( perjury that I have read [his application and state that �he in(orma�ion given is correcL I agree to comply with all s�ate laws and city ordinances relating to building construction, and authorize representatives of the Ciry of Costa Mesa ro emer upon the above-described property (or inspection puyrposes. I agree not to occupy or allow occupancy of any building authorizetlC�' v Permit until �al inspection. l_ �'_ i7—�e a reof�a�9 e� Daie � � AnElor puNonzeG ApP��u�n� � Date. � r � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 3444 PLUMERIA PL Suite No Vicinity: Parcel Nunmber: 41217809 Applicant: SZABO, KEVIN Address: 17390 MT CLIFFWOOD FOUNTAIN VALLEY PLUMBING PERMIT Phone: (714) 241-1414 Zip: 92708 Owner. ROTHROCK, KATHERINE Address 3444 PLUMERIA PL Phone: COSTA MESA, CA Zip: 92626 Contractor: COAST ROOTER PLUMBING HTG & A/C Address: 17390 MT CLIFFWOOD FOUNTAIN VALLEY Arch / Eng : Address: Phone: (714) 241-�414 Zip: 92708 License: 529127 Phone: Zip: License:. SCOPE OF PERMIT Status: ISSUED Applied: 08/O6/2004 Issued: 08/06/2004 ISSUED BY: WATER HEATER CHANGE OUT. . f - FEE SUMMARY � AMT QTY ' AMT .-QTY � AMT QTY ISSUE FEE �� $23.50 � Laundry Tub / Washer $0.00 "0 . . Sump Pump � $0.00 0 Backflow irrigation $0.00 0 - Landscape Irngation $0.00 0- Swimming Pool - 30.00 0 Backflow Preventer $0.00 0 P-Trap ,$0.00 0 Trap Primer - $0.00 0 Bathtub _ � � $0.00 0 � Pressure Regulator $0.00 0 Urinal � . " $0.00 0 Clarifier System � $0.00 0 Process Piping (per 10 ft) ,$0.00 0 - Vacuuin Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) �.$0.00 0 Receptors .. $0.00 0 � .'Vacuum Brkr BkFlow(5+) $0.00 0 Dental Units � $0.00 0 Septic Tank $0.00 0 � Wash Basin ;�' $0.00 0 Dishwasher �$0.00 0 - Sewer Cap for Demo $0.00 0 - Wash Basin Set' $0.00 0 Drain, Floor $0.00 0 Sewer Connect , $0.00 0 Waste and,Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Pnvate Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain,Roof $0.00 0 - Shower $0.00 0 WaterHeater/vent $12.30 1 Drinking Foun[ain $0.00 0 Sink, bar $0.00 0 . '. Water Piping (Inst or Rep.) $0.00 0 Ezpansion Tank $0.00 0 Sink, commercial $0.00 0 � Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor . _: _ " �$0.00 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if work is suspended or abandoned for a period of 180 days. INSPEC710NS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeations and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448.46 (fY00) � WORKERS' COMPENSA710N DECLARATION: � ' I hereby eHirm under panelty af perjury one af the following declaratlons: , ' , I heve entl wlll melntaln e ceniticate of consent m selbinsure for warkers' compensetlon, es provided lor by seaion 3700 0l the Labar Code, lor Ihe pertormence of t�e w�ic� this pertnit Is Issuea. I have end will main�ein workere' compensation Insurance, es required by section 3700 of the Lebor CoAe, lor the Derformance of the work for which this pertnit is issued. My workers' compensetlon Insurance carner antl pollcy number ere: Cerner. Policy Number: (Th secNon need not be complefed i/ Ihe p rmif is velued et one huntlretl tlollars ($ f 00) or less.) . . � I cenity that in Ihe paAormanc of the ork lor which thls permlt is issued, I shall not emplay any person in any menner so as to bew subject to the workere' compensetlan lews ol C fo�a, antl � grae that if I should becoma sub�ect to t�e workers' compensation provisions ol Section 3700 t e Leb Cotle, I hall torthwlth comply wlth these pmvisi Q Applicent Sipnature: Date: WARNING: FFILURE TO SECURE WO ERS' MPENSATION COVERAGE IS UNUWFUL rWD SIIALL SUBIECr AN EMPLOYER TO CRIMINAL PENALTI 5 AND CIVIL FlNES U TOONE HUNDRED TFKKISAND DOLLARE (5100,000), IN ADDITIqJ THE CQST OF COMPENSATION, �AAWGES AS PROVIDED FOP IN SECTIIXJ 3�06 0F TME LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby afllrtn that I em licensed under provisic force and eflect. Lic. a� ContractoYs SigneWre: GONSTRUCTION LENDING AGENCY: of Chepter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions a, and my license Is in full Class # /,� � Oete: /J� ❑ I hereby aHirm that there is e consiruction lentling agency tor the pertormance ol ihe work br which t�is permit is issued. (Sec. 3097, Civil Coae). Lendefs Neme: Lander's Atltlress: SlgnaNre: OWNER-BUILDER DECLARATONS: Data: I hereby eNirtn thet untler penalry at perjury thet I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Busineu end Professions Cotle: Any ciry or county which requires a pertnit to construcl, elter, improve, tlemolish, or re0air eny structure, pnor to Its issuance, also requires the applicant for such permit to file e signetl statemem that he or she is Ilcensad pursuent to Iha provisians o1 the Comractors License Lew (Chepter 8(commencing with Sedion 7000) of Divislon 3 ot iha Businass end Prolessions Gode) or that he or she Is exem0� �herefrom and the basis tor the alleged exemption. Any dolatlon of Sectian 7031.5 hy any flpplicam for e permit sub�acts the appllcant to e civil penalry of not more ihen five hundred dollars ($500).): ❑ I, as owner ol Ihe properry, or my employees with weges es their sole compensation, WILL DO TME WORK, entl the siructure Is no1 intendetl or oflered for sele (Sec. 7044, Business end,Professions Code: The Con�ractors License Lew does not apply to an owner ol properry who builds or improves thereon, end who tloes such work himself or herself or ihrough his or her own employees, provided thet such improvemems are not Intended or aflered for sale. H, however, Ihe building or impmvemenl is sold within one yeer ol completioq the owner-buiider will have the Ourden of proving that he or she did no� build or improve lor puryose of saleJ. ' ❑ I, as owner of the properry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the proled (SecJ044, BuSiness and Prolession5 Cotle: The contrecrors Licansa law does not appty to en owner of propeny who builtls or Improves thereon, antl who contwds tor such project with e coniractor(s) license pursuent to the Camractors License Lews.). ❑ I em ezempt untler sec. Business and Protessions Code tor this reason: Siqneture: � Date: Owner ID verified by drivefs license. ❑ Yes ❑ No Drivels License No. Veriflcation ot Ownership by (rype ol document, i.a. - proparty tex bill or deetl): DIVISION OF INDUS7RIAL SAFETV PERMfT CERTFICATON: Expires: ❑ I hereby certiy that no excavetion five (5) or more feet In tlep�h Into which e person is required to descenq wlll Ue mede In connection with work authodzed by Ihis permit, end Ihai no bulitling structure, scaflolding, falsework, or demolition or dismantling thereoi, will be more Ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, 71t1e B, Califomle Adminisirative Code). ❑ As owner-bulltler, I will not employ anyone to do work which would require a permit trom the Division ol Intlusirial Sefety, as noted above, unless such person hes a permit to do such work tmm the division. Signature: Data: Division of Indus�rial Sefery Permit Number. CERTIflCATE OF COMPLIANCE AND AUTHORIZATON OF ENTAV: I cenity under penalry ot peryury I�at I have rea0 this application and state that the infortnation given is correct. I egree to comply with all state laws end city ordinences relating to Duilding construction, and euthorize representatives of tha Ciry of Costa Mesa to enter upon Ihe above-descnbed D�aPerty for inspection purpases. I egrea not to occupy or allow occupancy of eny building authonzed by this permit un�il tinal inspection. CODE �. INSPECTIONTYYE 1616 FIxeC System Final Fire Preven�ion 1268 Pool Spe Finel 200 Flnel Re-Root 201 Finel BIaWRetaining Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Final Demolition PAg I[�dki SODE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Electrical 212 Finel Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Finel Bullding/Occupancy Qdlf. It�LS Job Address: 3444 PLUMERIA PL Suite: Vicinity: ROOF Primary Occ: R3 Dwellings/ Cong Res <10 Parcel Number: 41217809 Applicane RO7HROCK, KATHERINE Address: 3444 pLUMERIA PL COSTA MESA, CA Owner: ROTHROCK, KATHERINE Address 3444 PLUMERIA PL COSTA MESA, CA ' Contractor: OW NER-BUI LDER Address: Zip: Arch : Address: Phone: �Zip: License: Slalus: ISSUED Applied: 01/02200� Issued: 01/02I200) Type of Conslruction: V-N Zoning: R1 / Phone: 714-540-5939 Zip: 92626 ISSUED BY: Phone: Zip: 92626 Phane: License: 000000 Eng: Address: Phone: License: , SCOPE OF PERMIT TEAR OFF EXISTING RqOF. INSTALL 1 LAYER OF 30# FELT, 4:12 PITCH, 50 YEAR ELK COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED. 32 SQUARES INCLUDES ATTACHED GARAGE. ' ' , FEE SUMMARY Plan Check: $0 00 � Calc Valuation Sii o00 00 Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $19525 $1.10 $0.00 $0.00 $0.00 $196.35 SETBACKS �� MAIN STRUCTURE Fron� � 0. 0 ACCESSORY Front � 0-0 PARKWG Existina: o PLANNING & ZONING Rear 0- 0 Left 0- 0 Rear 0- 0 Lefl 0- 0 Required: 0 Proposed: 0 Claim Valuation: si�,000.00 Right 0- 0 Right 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements undar 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 1 BO days. . � INSPEC710NS: In order for Ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlons and final approval must be obtained. Failure to obtain inspections antl final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (71q) 7545626 2446�46 (N00) WORKERS' COMPENSATION DECLARATION: . • I hareby aflirm under penalty oi perjury one of the tollowing declarations: � ❑ I heve end Will main�ain a certifiwte ot consent to seli-Insure for workers' compansa�ion, es provided for by section 3700 of tha Labor Cotla, for the pertormence of �he work for which this permit is issuetl. ❑ I heve entl w�� maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Cotle, for ihe pedormance of the work br which ihis permit is issuetl. My workers' compansation Insurance carner and policy number are: . Carner: Palicy Num6ec (This section need not be completed il the permit is velued af one huntlretl dollars ($100) or less.) �. I certity that in tha peAormance of the work for which Ihis pertnit is issued, I shall nol employ any person in any manner so as to becoma subject to ihe workers' compensation laws of Califomia, antl agree th t it Isj�ould become ubject to ihe workers' compensation provisions of Section 3700 0l the Labor Code, I s�all fonhwith comply with the �yqns�� ,V � ��_ ( ,1 /�f , M,� IiceniSi natu � . a;r(a va-i<ri ii�rn✓ C_ �� %L�� APP � 9 ��` JLY Date; WARNINO:�FAICURE TO�SECORE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ON HUNDRED TTIOUSAND DOLLARE (5100,000). IN ADDITION TO THE COST OF CAMPENSATtON, DAMAGES RS PqOVIDED FOR IN SECTION 31O60P THE LABOR COOE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTAACTORS DECLARATION: 1 hereby aNirm tha� I em licensed untler provisions of Chepter 9(commencing with Section 7000) of Division 3 of t�e Business antl Professions Cotle, and my license is in full �, force and eflecL Lic. # Class # �� Comrector's Signa�ure: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirrti thal there is a consiruction lending agency for Ihe pedormance of the work tor which ihis permi� is issued. (Sec. 3097, Givil Cotle). Lentlers Name: Lentler's Address: SignaNre: OWNER-BUILDEP DECLARA710NS: Date: I hereby aflirm ihal under penalry ot perjury Ihat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any city or Gounty which requires a permit to constmct, alter, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires ihe applicant for such permit to tile a signed ste�ement that he or she is licensed pursuent to the pmvisions of the Contracbrs License Law (Chapter 9(commencing with Section 7000) oi Division 3 of the Business entl Professions Code) or ihat he or sna is exempt therefrom and the basis for the ellegetl axemption. Any violation oi Saction 7031.5 by any epplicant for a permit sublects the epplicent to a civil penalry of not more ihan five hundred dollars ($500).j: ❑ I, es owner o� the properry, or my employaes with wages es iheir sole compensation, WILL DO THE WORK, and the simcture is not intentled or oflered tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who dces such work himself or herself or thmugh his or her own employees, provided ihat such improvemenis are not intended or ofleretl for sale. If, howaver, Ne building or improvement is soltl within one year oi complation, tha ownar-builder will hava the burden ot proving that �e or sha did not build or improve for p�rpose of sale.�. � I, as owner o� �ha property, am E%CIUSIVELV CONTRACTING WITH LICENSED CONTRALTORS to construcl the project (SecJ044, Business antl Pmfessions �. Cotla: The cOntradors License Law tloes no� apply �o an owner o� pmpeny who builds or improves �hereon, antl who contrac�s br such project wi�h a contractor(s) license pursUant to the Contrectors License Wws.). I�� Owner ID ve7ietl ny tlnver's license. Ventication oi Ownership by (type of Business antl Professions Code for �his reason: �S ❑ No �Oriv`ers License No. i.e. - propeny tax bill or tlead): �— DIVISION OF INDUSTRIAL SAFETY PEflM1T CERTIFICATION: ❑ I hereby certify iha� no excavation five (5) or more fee� in depih into which a person is required to descend, will be made in connection with work authorized by ihis permit, antl tnat no building siructure, scaHolding, talsework, or demolition or dismantling Ihereof, will be more than ihirty-six (36) teat high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomia Atlministretive Code). ❑ As owner-builtler, I will not employ anyone to do work which would require a permit imm Ihe Division of Industrial Safety, as noted ebove, unless such person hds e permit to do such work from Ihe division. Signature: Date: Division of Intlustnal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUT}fORIZA710N OF ENTHV: I cetlity under penalry of perjury that I have read this application and slate Ihat the information given is correct. I agrea to Compry with all state laws and city ordinances relating m builtling consimction, and authorize representatives of ihe City of Cosla Mesa to enter upon the a ve- r e r i pec � rposes gree not to occupy or allow occupancy of any building eut orized by ihi permi un�il fin ection. ��I�� t� � ��fP�-�; �I.OU �Signature Of Legal Owner(s) �Date AncUOr Authorized Applicant Date CODE F, 7y$p�{TIONT�'GE 1616 Fized System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Foof 201 Final BIocWRetaining W all 202 Final FactOry Fire Place 203 Finel Sign 204 Final DemPlition �AjF INTRIALS �/ ��'%1 `/� COOEX INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fira Prevantion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �[F INTIiI TRACT N0. / '� S �� _ , : , - . IAT N0. �/ � - ADDRESS L L - '� ,. . DATE � Q � �� The developer of the above entitleu-,tract desires to sell the above set ti. forth lot prior to the time that the tract has been-6ompleted and its streets �..,�_ accepted by the City of Costa Mesa. +�� -_ . '- �... __ ._ _ _. .-_.. The undersigned, by executing this agreemen:�, acknowledges that (he-she-they) % (was or were) �-A� advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. e The City assumes no liability for the enforcement of the conditions necessary for approval other than.those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City hatmless from any claim resulting in damage or personal injury to the undersigned by reason of the afor�entioned uncompleted condition. PLANNING DEPARTMENT P.O. Box 1200 Costa fvlesa, Ca. 92626 �= 3 -� �i�� '; 3S � A \_ �/A1 BY ��'�'t- ��-�'% �/��c„21= %C' �l Developer and/or authorized representative � > � aY : r, �. _r�'� %�,.,: .,n.. � 'L'ender a , - _ ..�-- .�.....-......... � � �-.-...�__ .._....-..�..:-:,:..-•--..__T__ __ �,..-- --- ^_... —.�____-__ . i � AOOlicant to till in all spaces exeept [�ase within neavy Oortl¢� lines antl sign all approDriate tlecla�ations. �i�oF COSTA i�tEsa CONSTRUCTION PERMIT . Project Address �5'y5' i°L�MF,eir �.Gnc,c Gas�"irFs��62G � S/�il+G � Applicant's Mailin ddress �" Owner's Name O�i✓ {�.�1/l/{yr//P Phone SyU- 93.�% Address s/��%C Arch/En9. License No. Address Contractor's Name Phone Address (mailing) City License No. .. LICENSED CONTRACTOR DECLARATIO I hereby afti�m that I am licensetl untler provi5ion5 0� Ch rter 9(commencing with Section ]OOOj of Division 3 ot the BUNpess a tl fessions Cotle, antl my license'is In full force antl etfect. y 1 License Class �—� �cen e Da[e Signature WORKERS' COMPENSATION DECLARATION ' hereby affirm that I have a certificate of consent to selt-in5ure or a certificate .f Workers' Compensation Insurance, or a certitietl copy thereof (Section 3800, Lab. CJ Policy No. Company 'i BGertitietl cooY is hereby furnishea. Certifietl copy is filetl with the city Builtling Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl if the permit is to� one hundretl ($100) or less). I certify that in the pe�to�man rk ( ich thi5 perm�t i5' ie�j I shall not employ any person jm any m nn i� ec subj tdN�e workersGCy_m�a ion Law�ot calitor ' , , f/ Date LY � Si nature ' 'NOTICE: If, after making thi3.tlecla� on, you shOultl becq �e subject to th¢ Workers' Compensation provi3vo f the Labor Gotle, y6u must torthwitM1 comply with such.provisions or tnis permit shall be tleemed revoketl. CONSTRUCTION LENDING AGENCV • I hereby affirm that th¢re is a construction lentling agency for the performance of the work for which this permit is issuetl ($ection 309] Civ. C.) Lentler'S Name LenOer's Atltlress _ OWNER BUILDEH DECLARATIOIV I hereby affirm that I am exempt from the Gontractor's License Law for the following r¢ason (Settion 7031.5 Business antl Prot¢55ional Cotle: Any city or county whicb �equires a pe�mit to const�uct, alt¢r, imOrove, tlemolish or repai� any structure, prior to its issuance, also requires tne applicant tor such permit to file a signetl statement that he/she is Iicensed pursuant to the provisions oi the Cantractor's License law (Cha02er 9'(commencing witM1 Section 7000) of 7ivi5ion 3 of the Business antl Protession5 Cotle) or that he/she is exempt ae�ef�om antl [he basis for the allegetl exemption. Any violation of Section /031.5' by any applicant foi a permit'subjec[5 the applicant to a civil �enalty of no[ more than tive huntlretl Oollars ($500). I, as owner of the Oroperty or my employee5 with wages as thei� sole compensation, will tlo the work, antl the structure is not intentletl or otteretl i0I Sd�C ($BC�IOO i044� BUSIOE55 dOd PIO(255100d� Cotle: The COlIIldCLOf'S License Law aoes not apply to an owner of a property who builtls or impioves thereon, antl who tloes such work himself/her5elf or tM1�ough his or he� own employees, provitletl tM1at such improvements are not intendetl or offeretl for sale. It, however, the builtlin9 or improvement is soltl within one year of com- pletion, the�owner will M1ave tM1e burtlen of proving he/she tlid not builtl or im- � prove tor tM1e purpose of sale). � . ❑ I�, as owner of the property,�am exclusively�cont�acting with IicEnsetl con- tractorsto construct the project (Section ]044, Bu5ine55 and Professions Cotle: The Conl�actor's License Law tloes not apply to an owner ot property who build5 br improves thereon, antl who cont�acls for such prolects with a con- tractor(s1 license pursuant to tne Co- _ r's License Law�. I am aware that proof o( thei� Worker'S Compensa on ins nce shoultl be provitletl to me. ❑ I am exemot untler Sect' B. biy. G tor j�s �son Date _IL� I hereby cer information i antl staty,.Jev sentatj�/€5 O( `�L , . ....... .--. —. .--. .,,.,, ,.,,. /9�s 6 ��g�s7 1�9 — TVPE OFCONSTRUCTION LJ NEW ADD ALTERATION REPAIR ❑ CONVERSION � DEMOLISH ❑ OTFIER DESCRIPTION QF WQF�C/,�1SE OF BLDG. ��+✓✓«T d BDR�t Ti /h�ts%F_2 TVPE OF PERMIT�—y� LJ GanolNc LJ FOUNDATION 1�J STRVCTU ❑ TENANT .CI ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5Q. F7. ocCUaArvG� CONSTRUCTIONTYPE �� VALUATION$�i ZONE GRA�INGCU.VDS. ACRES_ Remarks: Sink Preventer Irrigation Drinking Fountains Floor Drains ' Floor Sinks � Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Root Drains Reinspection Fee � $15 Boiler Duc[- UnderGround' � Duct-Strucmral ' Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,aoo eTu O i oo,000 Reinspection Fee rev. 10/84 White - Builtlin9; Canary - APplicanh Pink - Accountin9: Goltlenrotl - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water C1052L Water Heater Water Service Auto-Wash laundry Trays laue Fae Hood or Typel ❑ Canopy Type I I ❑ Refrigeration Sys[em ❑0-100,000 BTU ❑ 100,000 E ❑ Sys[em Repair/Alteration Fire Dampers Registers ' $15 I I � Issue Fea FEES A.P. �W •S Main Buildi � Front B Rear A C Right K Left $ Ping. Ref. # Planning Notes: 5405 6/24/B5 �O Zone Accessory Building: L Parking Req./Provided.'�. Automa[ic Washer Construction Pole Su6. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes � Outlets Switches Garbage Dispoul ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps, Meter ❑over100amps- Sub Panel Motors OO-1 HP �,t�h - 8 Inc.Solar �9-15 HP Oi6-15+ ag Microwave Pole Light Range Generator �0-5 KW �5-75 KW $ ..3 � �— ' Reinspaction Fee FEES �DEVELOPMENTSER Zoning APProved BY_ �'Building Approved By ApplicatiOn IssUed By_ $ 3 $15 ; Standing Sections Trash Compactor Issue Fee FEES $ 3 Z O N I N G R E Q M T S SUMMARV OF FEES ; BUILDING PERMIT $ �2- � SMIP $, ...FJ� PLAN CHECK $ � � . l�] PERMIT � PLUMBING , $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $� ELECTRICAL $ �ni.�fl GRADING $ � PLAN CHECK 50% $ �- /iln � MICROfILM $ MECHANICAL $ TOTAL FEE $ /� / 93 . PLAN CHECK 25% $ � � CONSTRUCTION ANDPLANN7NG APPROVALS Permit # 1, Temporary Electrical Service or Pole -- 2. Soil Pipe-,Undrgrnd. �3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. - 5. Steel Reinforcement - 6• Electrical UFER Grnd. 7. Footings 8. Foundation . � � 9. Water Pipe-Undrgrnd. . 10. Structural Floor System ` 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 74. Rough Plumbing 75. Rough Electrical-Conduit - 16. ,Rough Electric Wiring . 17.:Rough Wiring Sign � 18.•Rough Electrical-7 Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace ' 21. Ducts, in Structure 22. Duas, Ventilating 23. Gas Pipe-Rough & Test 24.'Roof Framing 25. Roof 5heathing . 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing � 28. Lathing & Siding � 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric � 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 pomestic-Final 42. Backtlow Preventer i 43. Backflow Irrigation 44. Landscape trrigation Sysiem 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison . 80. Gas Release to Southern California Gas Co Bt: CERTIFICATE OF.00CUPANCY No. Date Date POG SPA Inspector qppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement ' ' 54. Forms - 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE . , 58. Electrical Cqnduit-Undrgrnd. �, 59. Gas Pipe, O Undrgrnd., Test � 60. Backwash Lines, P-Trap, ��Undrgrnd. 61. APPROVAL TO DECK r' ' 62. Backwash & Recepior-Final ' 63. Heacer & Vent-Final � 64. Plumbing SYstem - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit# 70. Underground Hydro 71. Product Piping OGas ❑Oil 72. Underground Flush � 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. �iNAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED �7 Notes: Date � Inspector � 0 �� ' • i �J �LZ � . - .,�1�, �.r - � +� ci�l.' .. - I 4 ]3cdruoms, 2 Ralhs � ,: - ' �l.;l,;.<�^ � For Inspectia�s . L;u•gc L;�;,,,,, r,�o�u �ti� ' '' �'' S��acious ith Fireplac . _ ��!��f� �� , ' (�:u•<Icn'�Vie�v T� amily l;o rn �� Carden Vic�v ICitcl�en ivitic ]nrge 1❑ ''` i �� ,, ° �g x -., 'i � t� r .�. �c� GGa",°`,� ;'�',� "".."= • ?:�4�� - L'i•calcf:isl Ares at�d P,�tio Pass- hr� ,�] � t` �.,��, ,r�, �i L1c�,rantllfasterl3c�Iroo,n.Suite,vi i � �/.��} ,�� .� . . I�fIVilCO Y3.1�j1 �..�:.' t . . ' � �. +L� r � 111(C3701' (�' � ' r . . . . _ . �'•afic Access Dooi• . . �t. , ;.. '�, � . J ,r„� ' 'z`•; - F � �' �... ;..,. . .. . } `"- AMlLY,ROOM .Y , .4EUROOM 4 , '" : ` ;� ��`� t Y `E THE";MARTN -1; .: � oa � I�... K , . . .., . .. . ... . .. .. . . _ . . ;' ,....: ., . .�. .- _ . .. , : . . .. OQM.3 -;,: . t . - - _ � :,.: - . ,� ' �� ' ,,,,:. '::,,V �G3'� ��i�G'�'/`// � --�� z . . + �/ " BREAKFAST J . � � f S��/�� . , PAN. �_ _ . '�, . . ' r a TAY ' i . �yy�� ; o ... , � . . . . n � d � . BAT71 .� • . ,, �;-, � /J � � ' GARDEN VIEW . coqr :<. . , �� /% ' -KI7CHEN ' O ' I. � � / //' , y,� ,/��jj I i , BEDROOM 2, ,,. C�( � 00 �---� � ; . �, .. .. . . . . ' ' � a.Q ._ _$iuij � _ � . �PP`ROVED . -- � �� .� . . ... ., ' ,. :. -. � . ::. �. . . '. CLOSEi . � � pF � Ciir of o o Mesa Building Dep'� � ` d •, -- _ � a,� N •:_r.:- .. .." a o o ;� ' �. 2- � S T R U C T PP:RaVAI OPJtY ° CMASTen,'�.. M A S T E R B E D ROOM f O� J� z�' a� THESE PUNS MUST, BE GN JOB Af LL T1MES �� I�I�TU`—R�OM eA7H �:- _'�'' SUITE�+;�:�: �� Z e • p� xE No CM�r�Es .wiTMo� PRI00. APPB�� SE?AAATE � RMt.TS ARE F.E�UEFfp . �� ' ' '_. 0 Z Q DEPT. -' � F�R. E;.k( ,P,ICdz, P!L'r/gf?�5; �j �� a� o' THE ISSUAYCE OR GRk>lTINC OF A PER�1!L OIZ RPP(tOVAL � ��f.T�t�;;, ��fifV`fI.ATIR'G F��!�� . ' � L-� � � - � " - � . � ��v� � � . � CF PLAD'S H\'D.Sf'EC1F!CFFIONS SHALL NC[ Cf CONSiRUEO, � � ti��ait cH,��ii" t;� � ' �� ' �+ Gi.H:i v---, TO BE A PEnYIT fOR, OR AN l,FPRO'/AL C^,' ��^�'� Vl�.AllO:� � _,�,._,�_ ,_ _,._ I '_ O i SE�VICE � .� � OE hNY OF THE !`ROUlS:O.^;? CF �IHI� CJ9E. N7 PF1Cdlf PR6 , '"''.� �NTRY � .. �. � , . ^��-_,, SioRncE > � . $L'MIA'G 10 CI'IE AUTNORliY 79 'Vlq1AiE OR CAYCEL' iHE '� F�� ^•;," �1 : L 9 � + � � � . ' ' . . o �fROVI�IONS GF THIS CpCE SHALL B� YN.ID, EXLFPf IA SO . . � . ! � .. .�.J r . . � . �� , ' � �AR FS TNE KOHK Oft USE Y1'HICH 1( AUTHOdIZc$ IS !A'M�1 ,L' � . - •: • ; . . � . . ' . . " � . ' � " , � - , ..,it.� .:�: - ' � . . . ' � . . � 1HE ISSUANCE OF A fCR,NI� BPSED Ui'C4 VLh'79 AND ` • . �•1�', ;. '. .�. �. . i S _ • . - � ,� • . SPECIFlCATIGNS SfiALt kU( PREVECT'iHB PL^,LDLV�,; OfFlC1AL' " . ' - .' - . . . . . ._.. �. �.._._...1 � . "� � • -•?.? . � '� .. � � FROM TNEREAFiCR RCQU�RING 7HE CC:tR['_Tl;tf C= 4'tRLF!$ '_ � ' ' � ! . � ` � � � - �" IN.ShIOFLANSMO SPECIfICAT10[:i crr^v r�r�riv6 . -. .. -� .. . �--- � `-•� i . � � 7W0=CAR��:=;>:��." . ' (� � 5 • . �;.". � BUI! DINC OPERFTIONS 6EING ChRR:E) CY iHCft',7f.W�'.8 WHEi_'� " ' , � - . � � �. - ',;:; ; �; I �', . ` GARAGE� • � ' . (j�.. �'y �. IN \'t^LH110NUf iHiS CUU60N Of A:.7 Q�Hi:i O(N4YAtlG� . . " .,:,,_,., . �. ; S'..:�+y:.s� � - . . � , .' , ! CP� ' C' li:E C"Y. ., . . : � : •�: ' �1 ii' li:�'.,•�;i.:sl ��q"rC.'Y� !t . . ' ' '. '. � , . . . . __. . .. . .. . Ih! � �t:oirlEu.�FD�F��xLGIT!�O��i'A��_1� , .� ... � .�..: � � � - " " .. . � fifQUiHEM:fi7S � � ' . .. ' . . , . � . ... �, � ��—� '...' ' . � , ,. �.. ..' ��-- � � = S's a �� P�� ,u,.�o��,L c��' �--P�� 1�b�� s�� ,�,� ��-�-Q,��' aa R�� l� �1,�- ��k��s .�-� ��.s�l �.� � , „-� r�-�- ��-- � �i�� .u9��s•s�p(�.2, ,w��G.,� - .. �"' i��. / ` �� r �� .f��-�.,�= �� U..9:ne's d v� `i �ve� n-v�v �`�v �✓�% �'�4Ste.1',� e�.. e[�u Q�-e. c�-� c�w' �` �, `�ie.. w�t�e� �� c.�e� �-�ne�,��,.�,� c��`s �i-�nc.� �J�a� �'ari��: 'ea.�rG �ti�. e� �,��cs� ��c ��-- ,Q�.c�.�� fi��. �uer.+� �.�,� U�Dcs-.�(.�� -� �1�r.e., �-- n,e�. �c� 1�� 2,��w � � � �s"��-e `�� c�s• �I �C9C�'/ �7'4��'�n�,`.� w -crc� �+n'�a�0 l �'VtR � � � �,�.`Q v � \ t`�U-�� ( CITY OF: COSI Project Address �pplicanYs Mail ' ADP��ant to fi11 in ali spacez ezcept those within �eavy boreer lines antl sign all aDVropriate aeclarations. PERMIT PERMIT NO. �/� � TRACT NO. LOT NO. UNIT NO. M 3 �— _ TVPE OFCONSTRUCTION NEW DD ALTERATION REPAIR Address o" Arch/Eng. License No. Address Convacror's Nam h(gp} e � Address (m� �'�� (,,_, `� � City Licen�a Nn .J, LICENSED CONTRACTOR DECLARATION I M1ereby affirm that I am licensetl untler provisions of Charter 9(commencing with section ]000) oi Oivision 3 of the Business antl Professions Cotl€, antl my license is In 11 r ana etfect. •��` � Lire s � li se N� Date� $ignatur OR ERS'COMPENSATION �ECLARATION iereby atfirm that 1 have a certiticate oi wnsent to selt-insure or a certificate ot Workers' Compen5ation Insu�ance, o� a cer/t�ifietl co y thereot (SeCtion 3800, Lab„F�y�.f]i\n�(Z Company L�� PolicY No.�UI..Y\\ (/ �`J Certifietl copy is hereby fumishetl. C rtif'p.� o�'i filetl with tne cit i tlipq qvai ^r� j,. i Date Applicant�� - � � �L��C_ EXEM 101 FROM WORKERS' COMPENSATION OECL RATION (This section neetl not be rompletetl it the permit is tor one nuntlretl (5300) or less). 1 certify that in tM1e pe�tormance ot the wo�k for which this permi( is issuetl, 1 sM1all no[ employ any person in any manner so as to become subject to the Workers' Compen5ation laws of Califomia. Date Siqnature NOTICE: If, a([er making tnis tleclara[ion, you shoultl become subject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith compty witb such provisions o� thiz permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereCy affirm that there is a mnstruction lentling agency tor Ihe performance of the work for which this permit is issuetl (Section 3097 Civ. CJ Lentler's Name LentleYs Adtlress OWNER BUILDEH bECLARATION I hereby affirm that I am ezempt from the Contractor's License Law for the foilowing reason (Sec[ion 7031.5 Business antl Professional Cotle: Any ci[y or county which �equires a permit to construct, alter, improve, tlemolish o� repair any structure, prior to its issuance, also requlres Ine applicanl for such permrt to file a siqnetl statement that he/she is licensetl purouani to the p�ovisions ot the Contractor's License Law (Cnao�er 9(commencing witn Sectlon J000) oi Division 3 of the Business antl Professions Cotle) or [hat he/she is exempt theref�om and the basis for the allegetl exemption. Any violatiOn of $ection ]031.5 by any applicant for a Permit subjects the applicant to a civil eerldlty of not mo�e Ihan five huntl�etl tlolla�s (E500). L� I, as owner ot the property or my employees witn wages as their sole comoensation, wili tlo the work, antl the structure is not intentled or offeretl for sale (Section 7044, Business antl Professional Cotle+ The Contraclor's License Law tloes not apply co an owner of a property wno builtls or improves thcreon, and wnn aoes such work himselt/herselt or through his or her own employees, provitletl that such improvements are not intentletl or offeretl for sale. If, howeveq the builtling or improvement is soitl within one year of com- pletion, tM1e owner will have the burtlen Of proving he/she tlitl not builtl o� im- �rove fo� the purpose of sale). I, a5 owne� of the property, am exUusively mnt�actin9 with IicenSetl Con- tractors to construct the project (Section 7044, Business antl Protessions Cotle: TM1e Contractor's Litense Law tloes not apply to an owner of property who builtls o� improves lhereon, antl who contracts to� such prolecls with a con- tractor(s) i�cense pursuant to tne Contracmr's License Law). I am aware thaY proot of thei� WorkeYs Compensation insurance shoultl be provitletl to me. ❑ 1 am exempt untler Sectian 8. & P. C. for this reason Date Owner I h¢reby certify iha[ I have rea intormation is wrrecL I agree to antl state laws r¢lating to builtlir sentatives of this city tq/�enter inspection y��posqs./�n, //� r� DriverY License or 55 iz tate tnat the above tl county ortlinances :by authoriie repre- ioneC .pr er y� t r /� /L Dafe -� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p.� OESCRIPTION OF WORK/USE OF BLOG. � i S Main Building: TYPE OF PERMIT GRADING ❑ FOUNDAT� O STRUCTVRAL T Front ❑ TENANT ❑ ELECTRICAI. ❑ PLUMBING MECHANICAL A Rear ❑ OTHER � PROJECT DESCRIPTION 54. FT. � oCWanrvCv C Right K CONSTRUCTIONTVPE �VAWATIONS g Left 20NE GRADING CV. VDS. ACRES Ping. Ref. # Remarks: � � Planning Notes: Sink Preventer Irrigation Dishwasher Drinking FOuntains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories oof Drains Reinspection Fee $hOW2f5l ,,, Service Sink Sewer CaP Sewer Connectii Solar Collectors Solar Piping Solar Tank Pool w/Spa Urinal Water Water Water I $15 j Issue Fae Boiler Duct - Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepUFacL BIL IC80 # IHe,ating System & Ducting �0.100,000 BTU 0700,OOOBT Reinspectian Fee � $15 CMF 0865-46, rev. 10/84 Wnite - Builtlin9: Canary - APP�icant Pink - Accountin9: Goltlenrotl - Assessor Hood or I Type I ❑ Canopy Type I I ❑ Refrigeration System i�-100,0008TU ❑100,000 System Repair/Alteration Fire Dampers Registers luue Fee F Zone Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW ConstructionPoleSub. ❑ 50+KW Cooking Unit Meter ❑up to 100amps Dishwasher Meter ❑over100amps Dryers ❑Gas ❑Electric Suh Panel . Fan Motors OO-1 HP O1 Y� - 8 F.A.U. Inc.Solar �9-15 HP �76-15+ Fiztures Microwave Device Boxes Pole Light Outlets Range Switches Sign ' Garbage Disposal Standin9 Sections Generetor �0�5 KW 05-15 KW Trash Compactor $ 3 ' �— Reinspection Fee $15 luue Fee FEES DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved 8y Building Approved By i /Y Aonlication Issued Bv FEES $ 3 Z O N 1 N G R E Q M T S SUMMARV OF FEES BUILDINGPERMIT $ SMIP $ � PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ � ELECTRICAL $ GRADING $ PLANCHECK 50% $ ��9-,�;�- MICROFILM $ 2� MECHANICAL $ �!'L�tx/ TOTALFEE $ .� PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspecto� 1. Temporary Elecirical'Service or Pole 52. Pool & Equipment Location Y . 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ,.. 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding ^i 5._ Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER,-GUNITE 7. Footings 58. Electrical Conduit-Undrg�nd. 8. Foundation 59. Gas Pipe, O Undrgrnd. �Test 9. Water Pipe-Undrgrnd� � 60. Backwash Lines, P-Trap O Undrgrnd. 70. Strucwrel Floor System 61. APPROVAL TO DECK _) 11. Property Sewer Line & House Connection 62. Backwash & Receptor-F.inal 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. Rougli 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 �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 PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79. FINAL INSPECTION , 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED t'� 33. Final Electric Notes: � 34. Final Heating & Air Conditioning 7/((�� L� .__ 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 pomestic-Final � . 42. Backflow Preventer � � � ' .43. Backflow Irrigation � � - • ' ' • 44. Landscape Irrigation System . � . . ' ' � �45. Sound Attenuation � . � � 46. Handicap Regulations ' - . - " � 47. FINALSTRUCTURE&BUILDING . . - ' � � � 48. Special Requirements Completed , . _ 49. Electric Release to Edison - , 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY w No. Date . . � �� \'. . OWNER IpRy7IN So. Cal. JOB ADDRESS _ Z444 Plt�@T7.8 Plasg fRACI ROUGH PLUMBING PROP. SWR. LINE USE CONy[ SPRINKLING SYSTEM MISCELLANEOUS fiOUGH MEATING AND AIR CONDITIOP TEMPORARV SERVICE OR POLE UN�ERGROUND � POWER � FOUGH WIRING TRENCNES FORMS � STEEI FLOOR SYSTEM BON� BEAM n STEEL REINFORi SNEFTNING FRAME AND FLASHING LATHING - IN OUT PLASTER, B0.0WN COr1T 5* 'TURAL, FINq� H� �G, VENT., REFFIG. AND A.C. PLUMBING, FINAL ANO GAS TEST � ELECTRIC, FINAL BUILOING, FINAL DATE SUBCONTRACTOR �Bl'1 '7�._LI�� /.� ,�-��, -�-�-- 3`��9 �� -�� 3b452 .r• � i-�-;"°'�00 653': t 142.a5 COSTA MESA BUILDING-SAFETY DEPARTMENT cn� "" 5�1C P�O� BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT ForAppicn to ' inCompletely qECEIVED V DATERECEIVED �� / o Te issueo BUILDING . i (�_/p � ADDflE55 PERMIT NQ, OWNER I,yrwin Southern California �+�P�NO. �tiA�'�^ MA 1 L BUILDING ADDRESS 16255 Ventura Boulevard ADDFiESS � CITV ERClIlO� California No�'986-5890 TRACT%SS%-B L0T119 BLOCK CONSTFUC{ION W ADD P LENDER Larwin Southern California BRANCH 16255 Ventura Boulevard / I /'� ADDPESS Encino California �WNER [. G//N C�A�— ARCHIT�CT TEl S S �ES �J �� VALUE �J/ � OR ENGINEER ��1R 5. Calif. N� 273-4464 s`t�Q FIRE K ADDRESS 9100 Wilshire BI.Vd.� BE'.V� H1115 20NE TVPE GRO APPROVE CONTRqCTOF �1'Wlil Southern Calif ornia gY DATE + ADDRE85 16255 Ventura Blvd., TEL. ZONE NO.OF VSEOFNEWS�/ZEiw cirr Encino, California No. 986-8890 P��'L BUILDING UC. No. 191311 � uc�No. B'1 vMAIDN BUILDOING ACCESSORV BUILDDING S¢E NO.OF BLDGS. (FROM GL STREET) oF LOT 6O X LOO NOwON LOT O FRONT 2 FT. FT. USE OF EXISfIN(} gLDG. SI � FT. FT. SIZEOF NO.OF 1 L.SIDE S FT. FT. NEW BLDC. 1740 ROOMS STORIES EXTERIOR WALL ROOF COVERING SCllCCO COVERING WOOCI shingle REA N iS FT. FT. USE OF gU1LDING AND WORK TO BE PERFORMED DISTANCE BET. 9ET. MAIN & MAIN BLOGS. ACCESS. BLDGS. VAR.� DATE C.U.P.�{'+ APPROVED Construction Single Family Residence �'ROVED �_ HOLD FOR ECI L EQ S 1 heraby acknowletlBe thet I hava reatl this opPlication antl ztare that th¢ above informacion is correct antl agrea ro comply wiffi ell laws .egulaUnp builtlin8 co�struction, antl I shall not employ any persbn in violetion of the wprkman's compenution laws of the State at Calitornia. I hareby certify that I am properly licensetl as a contractor under D SQ. FT. � the Stace ef Californla Business antl Professions Cotle, Division 3, T E AMOUNT SHO N UNDER VALUATION IS FOR Chapter 8, antl that such licenses are in full torca antl aftect, or I THE PURPOSE OF ESTABLISHING A PERMR FEE ONLV: am exempt from the provisions of the State ot CalifOrnla Business VALUATION antl PrOf@ssions Cotle, Division 3, Chapter 9. PERMff FEE 5 94. �� Slgnatura of D. DOWIIS PermitSe@ ��_�� 5 26�400 PLANCHECKS 47.00 A�thorized ABent 141 . �� TOTAL FEE S Z . a cwj Z Z� ON am J � J � a] J m J Q U N Z a W ¢ aw WZ J Q m Z J � W w 0 z� w� N � � � F z Q U J a a Q � F y Z O F- U 7 � � N Z