HomeMy WebLinkAbout1168 PRINCESS CT - Building Permits •
CITY OF COSTA MESA
A �,y BUILDING DIVISION
4 I a 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
.). ff FOR INSPECTIONS CALL: (714)754.562 •
6
PERMIT NUMBER: B10-00277
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 41207347 DATE ISSUED: 09/22/2010
ISSUED BY: BE
JOB ADDRESS: 1168 PRINCESS CT CM Suite/Unit:
Vicinity:
Squares: 0 Valuation: $4,000.00
SCOPE OF WORK: TEAR OFF EXISTING ROOF AND INSTALL 1 LAYER OF 40#FELT AND AND METRO SHINGLES ICC ER REPORT
NUMBER 5626.COOL ROOF NOT REQUIRED.
OWNER: WOZNIAK,SAM Address: 1168 PRINCESS CT Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: WESTERN ROOFING SYSTEMS Address: 13672 ONKAYHA Unit: :
PHONE: 714-778-6294 City/State/Zip: IRVINE,CA .1 0.0 027 7
CONTRACTOR: WESTERN ROOFING SYSTEMS License No. 675902
Address: 13672 ONKAYHAUnit: PHONE: 714-778-6294
City/State/Zip: IRVINE,CA 92720 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $97.25 it[:POR
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
i Snit:
TOTAL FEES $98.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 311812010 -PER CMMC Sec. 13-279 unit:
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm.Prohibitied all hours-Sundays and the following Federal holidays
New Years Day, Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day • .� t <`
•
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: 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 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.
CODES. INSPECTION TYPE DATE INTITIALS CODE r INSPECTION TYPE DATS ' TIN71PALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof )/yO N.16 /rit�L>`i 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention ------------
i
202 Final Factory Fire Place 220 Final Planning Approval t
203 Final Sign 222 Final Site • _.,w ;.,..ey..:_
204 Final Demolition 250 Final Building/Occupancy
S S
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 0 Yes 0 No
-I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
perfor nce of the work for which this permit is issued.
I 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I hereby cert'rfy that no excavation five(5)or more feet in depth into which a
permit is issued. My workers' compensation Insurance carrier and policy
number are: person is required to descend, will be made in connection with work authorized
Carrier: GUAla 4 x P" by this permit,and that no building structure,scaffolding,falsework,a demolition
(This section need not be complege0 d the perms(is valued at one hundred datars(6t0o)or less) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp
2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number: C ems. /0.S /�
0 As owner-builder, I will not employ anyone to do work which would
O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued. I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Cod- hall forthwith comply with these provisions.
2712D-V>
ivision of Industrial Safety Permit Number:
Applicant's Signature DatHAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one lime during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. 7 S a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# O2C Class# (Section 25533 of the California Health and Safety Code, with some
/ ` /2 z4 ,1 exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date 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 al standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
O I, as owner of the properly. or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
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 8. (If yes attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044.Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.), certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
'k/�/ Sigrygwre or Legal Owner(s) A )/f),ate
Signature Date G O
305]-46(3/0])
..—
And/or AulM1onieO Applicant Dale
ADDRESS OFBUILGN3: 1168 PRINCESS CT UMT: CITYOF COSTA MESA - BUILDING PERMIT -° 000 23. ,
CNNER'SNAME IF MOWN: WOZNIAK, SAM FLOOD: AHL37 PERM NO: B 08564E
ADDRESS WOZNIAK, SHIRLEY
1168 PRINCESS CT PERMIT NO: B 085648 PLAN CHECK NO: 03499-97 L GOVT: N SUPP: N
COSTA MESA,CA 92626
APPL.MAIUNO ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ADD
ARCHrTECT ORENGNEER: tit.N0.: JOB DESCRIPTION : ADD 307SF TO SECOND STORY SQ FT: 2, 149
ARCH.OR ENG.'S ADDRESS: UHT:
CLAIM VALUE: 2, 149 . 00 CALL-VALUE: 9 , 100 . 00 GROUP OCC: R-3 iU-1
CONTRACTORSNAME
CONTRACTOR'S MMUMi COMMENTS : 2ND FLOOR ADDITION WITHIN EXISTING STRUCTURE
ADDRESS: UC NO.: wxxxxxxxxwxxxxwww wwwwxxxwxx Xxie fe ie ieltIY It'il'ieie it irx7r ie ie ie iewwwxw wire ii iE ie it ie ie iE iE ie ve ie ie ie it ie ie iE ie ie ie ie ie it ie ie
DMT: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby dem under pawky of Perjury that I am licensed under provisions of Chapter 9 S ETBACKS
(commencing with Section 7000)of Division 3 d the Business and Professions Code,and my license a in full force and eted.
CITY LIC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor LEFT: FT IN RGHT : FT IN LEFT: FT IN RGHT : FT IN
OWNER BUILDER DECLARATION:I hereby affirm under porky of perjury that I em exempt from IM Centred=License Law for the
following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a perms to amend.aver,improve. PARKING REQ: P ROV; PARCEL: 41207347 LIVE: R 1 REF NO:
demolish,or repair any erudure,prior to its issuance,also requires the applicant for such permit to fib a signed slalemeM that he a she
is licensed pursuance Iheodeorlh d Ne CmuSee License Law(Chapter 9(commencing with Section 7000)d Division 3d the PLANNING NOTES> INTERIOR ALTERATION TO CONSTRUCT A 2ND FLR INSIDE AN :-EX. SFD
Business and Profession Code(or that he o she a exempt therefrom and the Dazs far theehundred
exempien.Any violation d section > WILL FILL AN EXISTING CATHEDRAL CEILING.
applicantad ige
7931.5 by any applicam for a Permit subjects the applicant to a n°M d cot mere than five hundred dollen POO. ieiFirieititichit'iEicii•iiiEitii**iiiiieieieieieieiEieieieitieicicit-iFicieieiiieieiiiEiEie**hiller-ieiiii•ieiiieieieieiciFiciriiieieieirie***ieir***
❑ I.m closer dthe properly of my employees wih wages m Ilei sole compensation,cell do the wurfr.and die smpwre a not intended D E V E L O P M E N T SERVICES R E S„) U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Code:T a Comecon License Law does ml apply to a owner of property .^
who bolds or improves thereon.and who does such work himself or here or through he a her own employees,provided that with
j 1�
improvements are not intended a offered for sale.If,however,the building o inprovanen u sold within one year d completion,tor r/VI NA
wnaauiler wit have the burden d proving he or she did not dad or improve la the purpose d sale). ZONING APPRG'v E'u BY LATE: 1
el I m owner d IM prcoemy.am exclusively oodrite°with licensed contreclm w construct the project(Section 7044.Business and _ _ l'O
Professions Code:The Contractors License Law does nit appy to a owner d properly who bells or improves thereon and who
BUILDING APPROVED lY Y DATE: I
contracts for such proieds with a centrals)licensed pursuant to the Contractors License Law). r 7
__-_
❑ lean exempt under Section: B.APC„bllda racoon: APPLICATION ISSUED ,BY: �: 4];;; DATE; gag-7
ww wwww XX wXww Xwwxww Xxxxxw Xxft,wwwwwwwwwwwwwx Xww'ltwx'1tTwww sew sew 9e'T'lexiexw'RwwlexX thin Xw Xx'le le
Date: OwnerLEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT :Y
I do hereby certify that lam aware of and undemend the requirements of California Health and Safety Code Scan 25505,25533.and
25534,and that I or any Move building oowpmt will/will POI(cope ane)need to oomph with said stale codes and the requirements for
apemm for construction oncdtcWion from the AiiWanaregemeMDi rice Residential mwanabnepplr Mmareexempwm these BLDG PMT PLUMBIN&., ELECTRIC MECHANIC FIRE SNIP/RES GRADING
provisions. PERMIT 162 . 25 . 91
Dale Applicant
PLAN 105 . 46 -'• SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby dram under penalty of perjury one of the following declarations: ISSUE FEE ” T
❑ Ihave and wilm°invenecertificate dconsent loWhimsey for workers'oanpmsat'yr,mprovided for rdd
b)8aon3)OotMLebar BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.mrthe pedama,°.dthe waaio,hmiapeielmred. TOTALS----> 163 . 16 0 . 00 405 . 46 268 . 62 268 . 62 . 00
o I have and wit m°imain workers'comp permit
snaation insurance.as required by Septan 3700 of the tabor Code,b the perfornnape d the
work for which the permit is issued.My woken'compem°tian insurance wrier and policy numbs we:
Caner: REVENUE DIVISION TOTALS--> COLLECTED: 220 . 03 OVER/SHORT: . 00
Policy Number: BLDG PM! PLUMBING ELECTRIC MgCHANIC FIRE SMIP/TGT GRADING PLAN-CHECK
(suis mita need nit b.completed l the perm*a b ane Mored dawns/51X1 of Am) 162 . 25 . 91 56 . 87
o I conly that in the performance of die work to which this panne is issued.I shelf rnu employ any person In any manner so as It -
becon,e au ed Io the workers'concerest n law d Caldarse and epee OW E I should become subject to the wo.ta°' et se w se sew................w w lie....w w s w w et.... ....
lelet XXwwwwxwwwwwwwwwwwwwwX wXXwxxxwwwwwww XXXwirwiewxwrier ie is ierbe ierrxier-or xrick Terrier ie is sirric
compensation Proiecns a Section 37D0 d the labs cod.,I shall forthwith aompy with Inose provisions.
I N D I V I D U A L FEE BREAKDOWN
Dale: AppceM:
Warning:Sedum to noun wokari compensation coverage is unlawful,and shall subject an employer to criminal pp/tlse and TYPE QTY L t S l R 1 Y 1 1 0 N UNIT COST TOTAL COST
civil fines W to one hundred thousand dollars(51a{tplA in adgtlon to the cot of compensation,damages as provided for In >'
Section 3709 of the Labor Coda Intens,and attorneys feat
SFR 9100 ALTER BY VALUE Rts4DEJ,I1=N-•--
11AL NOZONE 1 . 00 9, 100 . 00
CONSTRUCTION LENDING AGENCY:I hereby atfinn under penally of perjury that there is a co°Nrudion lending agency for the END OF FEES
performance of the work for whim this pans its esued(Section 3097,Civ.C).
LENDER'S NAME
LENDER'S ADDRESS: .l
I certify that I have read this application and date that No above intention is coned.I agree to campy with all dry and county ordinances
and state laws relating l0 budding construction and hereby authorize representatives cites thy to enter upon the above-mentioned property
for inspection purposes.
SAM WOZNIAK
11-06-1997/01:04 P11/f220.G3
Print Name - RCPT0:01-0015116
PERMIT:085648
Date:
Signature of Owner/AgeP/AppiwWContrada
1\ (5151.46.WP) White-Ouildig&Safety:Green-Ale;Canary-Appirem;Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit Date Inspector 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 I
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings -_ 58. Electrical Conduit•Undrgrnd.
8. Foundetron 59. Gas Pipe, O Undrgrnd., Test
. f
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
20. sough Factory Fireplace - APPROVALS ,- Pe'rmit#
-,
21. Ducts, in Structure _ •• i - 70. Undergiolrrid Hydro
22. Ducts, Ventilating . ' r a; . 71. Product Piping 070as 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. -Roof Framing' - . . 73'. Undergrr d.Stor'ke Tanl4 0 Gas ❑Oil
25. Roof Sheathing - • 74, Overhead Hydro 4
_ - s
26. T-Bar Ceiling (Structural) & Monocoat r 75. Dry Chemical .
27. Frame and Flashing' &-3-`17 61 76. LDry Standpipe • •
28. Lathing & Siding , : _ ' 77. FIXED $Y.STEM:FINAL
,
29. Insulation1 is 78: FIRE PREY. FINAL : -
30. Drywall Nailing • /2- q-17 44101----- - HEALTH DEPT.REOUIREMENT
31. Plaster Brown Coat . , 79. FINAL 11JSPECTION -
32. Electrical Power Meter,Final - 80. FOOD CERTIFICATE ISSUED
33. PinaI.Eleetric - . . . -. - Iy . Notes: a ...,---11- pracy e
34. Final Heeling& Air Conditioning - Gat'- ' /� ��,L - p6y -Ga '
35. Final Gas Pipe•Test /tot
36. Hood or Canopy - - '-
•
37. Final Factory Fireplace • _
38. Final Plumbing '• -
39. Water Service Final i
40. Gas Service-Final :
41. Solar Domestic-Final
42. Backflow Preventer •
43. Backflow Irrigation • .
44. Landscape Irrigation System • . {
-- 45. Sound Attenuation -
. r •
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING Y'-W.4 Gc 4i
48. FINAL PLANNING - . �!/ r .
•
• 49. Electric Release to Edison - • - '
• 50. Gas Release to Southern California Gas Co
51, CERTIFICATE OF OCCUPANCY •
No. Date
ADDRESS OFBMLDINO: 1168 PRINCESS CT BMT: No . S lv4Am A CITY OF COSTA MESA - BUILDING PERMIT
OMNERS NAME IF KNOWN: WOZNIAK, SAM FLOOD: AHL3 / PERM NO: E 085649
ADDRESS: WOZNIAKt SHIRLE_Y
1168 PRINCESS CT PERMIT NO: E 085649 PLAN CHECK NO: N GOVT: N SUPP: N
'' •
COSTA MESA,CA 92626
APPL.MAIMNCADDRESS; CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: ADD
ARCHITECT ORREf NEER: UC.NO.: JOB DESCRIPTION : ADD 307SF TO SECOND STORY SQ FT:
.+ ARCH.OR ENO'S ADDRESS: BMT:
I CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /U-1
CONTRACTORS NAME:
CONTRACTOR'SMMIING COMMENTS: 2ND FLOOR ADDITION WITHIN EXISTING STRUCTURE, REF #B85648
ADDRESS: IX NO.: **********W xzxzxxxzxxxxzxzzxxzxxii:xzzzzit'zxxxxx xxxxxzxxz xxzziex**is'W ie Xiezzxxzhi-xzxxxx
BMT: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affim under penalty of perjury that I ant licensed under provisions of Chapter 9 S ETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my Dos se is in fug lata and effect.
CITY LIG.NO.: LIC.CLASS: LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt Iron the Contractors License Law for the
following reason(Section 7031.5 Business and Professions Coda:Any cry ar county whidr requires a permit to construct,alter,improve, PARKING REQ: PRO V: PARCEL: 41207347 Z NE; REF NO:
demolish,or repair any structure,prior tons issuance,also requires the applicant for such permit to file a signed statement that he or she
is licensed pursuant to the provisions d the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NU 1 ES>
Business and Professions Code)or that he of she is exempt therefrom and the basis for the alleged exemption.MY violation of Section > -
7031.5 by any applicant fora permit subjects the applicant to a civil penally d not more than lee hundred dollars)550)1. k .= •-..-- - S e**kV** h-- i----
feiexiexie><*******ie iEx ie ie iexi2 iF ie ie ie ie ie it it i•:iezzzxzxx xxz**Se zxz zxxxxxii iixii>rx ie ie ie ie ii iE>rxiE ii fe ii ie hi*
❑ I,asowner dthe Properlyw mwemPbyees wlthwages av then sole oomveneation,will do the weer,end Be evuwre is net intended D E V E L O P M E N T S ElR V I C E S R E Q U I R E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly r:
who bolds or improves thereon,and who does such work himself or herself w through his c her own employees,provided that such AA 1
improvements are not intended adlered for sale.ff.however.the building or improvement is sold within one year completion,the ZONING APPROVED BY DATE; Y` (2"
owner-builder will have the burden of coving he or she did not build or improve for the purpose d sale). I
I,as ower of the properly.am exduaiveN contracting with licensed contractors to construct the project(Section 7016.Business and r
Professions Code:The Contractors License Law does not apply to an owner d properly who builds or improves thereon and who BUILDING APPROVED BY : V TV�'S DATE: /!/�
contracts for midi projects with a const+(+)licensed pursuant to the Contractors License Law). (�/1,/Tr Ji ' '✓
11
❑ lam exempt under Section: B.d P.C.,la thls reason: --- _ ., _ _.. ISSUED _._
APPLICATION BY: DATE:
• www-ltwltfFwwww'R'RR91'wwwKitwwwwxxxx xxxx xxxxxwwwww*hxxxxxhxxnrstWnxftxxx'RYt'1Fxxx It illi in fix x Jtft
Date: Owner • I LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby cattily that lam aware of and understand the requirements of Cadiornia Health and Sally Code Sections 25505;25533,and
25531,end that I o any hdure building oaupent will/wit nor(circle one)need to comply with said rote codes and the requirements ler
apermit for o modification from the AirDuality Management District.Residential coast/Wien appicationaare exempt imm these BLDG PMT PLUMBING ELECTRIC MECHANIC FIXE SMTP/RES GRADING
provisions. PERMIT 43 . 25
Date: Applicant 50% SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby aMnm under penally d perjury one d the following dedatat : PLAN
bna
❑ ISSUE FEE 22 , 00
have and will maiden a certificate of consent to self-insure for workes'compensationas provided for by Section 3700 of the Labs BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Coda for the performance d the work for which thie permit is issued,
❑ I have at mainon workers'compensation insurance.as required by Sedum 3703 d the Labor Code,for performance d the TOTALS- > 4 3 . 2 7 2 2 . V U V . V V 6 7 . L S 6 5 . L S 00
and WI
work for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Gamer: REVENUE DIVISION TOTALS--> COLLECTED: 65 , 25 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed I the Penni is for one hundred dollars/$1001 or lass.! 65 . 25
❑ I cedny that in the performance of the work for wets this permit is issued,I shell net employ any person in any manner so as to
become subpct to the wwken'canPersation taxa o CadRomla,est%res Nal R I shagd became subject to the wetter' ie it ieieieii ie iikiifieieiedeieirieieieiiiriiiiiieitiiiiiiticilii•iiieiciiieiiiiiiiiiiicicii iiiciiiiiiieieieieiric w ie laic is ii is it is ici'iikiciiiiiciiit-inti'icii
compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions.
INDIVIDUAL F E E BREAKDOWN
Date: Applicant:
Warning:Failure to secure workeri compensation coverage I.unlawful,and shall subject an employer to criminal penalties end TYPE QTY D E S l K 1 Y 1 1 U N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(S100,000),In addition to the coat of conpersatiots damage.ea provided for In
Section 3705 of the Labor Cods Interest,and atomey'sMet ELE 20_ FIXTURES, LIGHTING
_1_ST 20 EA. 1 , 00 20 . 00
CONSTRUCITON LENDING AGENCY: I hereby affirm under penal/d perjury that there u a constriction lending agency ler the ELE 5 FIXTURES, LIGHTING ADDITIONAL EA. . 65 3 . 25
peMoonanaed the wok for which this ottani is issued(Soden 3097,Ch.C). ELE_ 11
RECEPT/OUTLET 1 ST 20 EA. 1 . 00 11 . 00
LENDER'S NAME: ELE 9 RECEPT/SWITCH 1 ST 20EA. 1 . 00 9 . 00
LENDER'S ADDRESS:
END OF FEES
I certify that I have read this application end state that the above information ls overect.I agree to comply with all cry end county ordinances
end state laws relating to building construction end hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection pu
inspection -
sAM WOZNIAK
11-06-1997/01:05 PM/$65.25
Print Name RCRTIi:01 0015117
PERM I T:085649
Signature of OwnentAgenvwDat,;
appiO/Contractor
y(5t SI da WPI White-Building A Safety:Green-Rae:Canary-Apptcant;Pink-Revenue;Goldenrod-Assessor
. i
ler
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector 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 UF ER Grad. 57. APPROVAL TO COVER-GUNITE
•7: Footings 58. Electrical Conduit-Undrgrnd.
• 8• Foundation 59. Gas Pipe, 0 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
1.4. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit. " i o. Solar System-Final
16. Rough Electric Wiring !z (�/ I 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
20. Rough Factory Fireplace . .z r - APPROVALS ' Permit#
21. Ducts, in Structure -. .: `- : . - 70. Underground Hydro
22. Ducts, Ventilating'• ' - 71. Product Piping C7Gas DOil
23. Gas Pipe-Rough & Test : 72. Underground Flush •
24. Roof"Framing" -- - : -, 71 Undergrnd.Storage Tank 0 Gas D Oil
25. Roof Sheathing - , . 74,. Overhead Hydro.
26. -1--Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical ' A
27. ,Frame and Flashing , - • • - • 76. Dry Standpipe '
28. Lathing &Siding -',, 77. FIXED SYSTEM FINAL
• I
29.•Insulation , L •. , 78: FIRE PREV. FINAL - -
' 30. Drywall Nailing ; " - HEALTH DEPT.-REQUIREMENT
31. Plaster Brown Coat. ;: - • -• ' ti 1 79. FINAL INSPECTION •
32. Electrical Power MetertFinal / • 80. FOOD CERTIFICATE ISSUED
33. Final Electric: :' '`itge' QZ /,/ 7' ' Notes: i T
34. Final Heating& Air Conditioning_: .�
35. FinalGas,Pipe-Test „ i - - : ' .. -.
-. 36. Hood or Canopy ` -! I H
37. Final_Facfory Fireplace V i. •
38. Final Plumbing -
39. Water Service-Final ' • ,
.
.40, Gas Service-Final - .
• 41. Solar Domestic-Final - - li t; ,
42. Backflow Preventer . .. -
43. Backf low Irrigation ' ; ' , ' `
44. Landscape Irrigation System : 1• - -
45. Sound Attenuation ' • '
46. Handicap,Regulations -, -
47. FINAL STRUCTURE & BUILDING '
48. FINAL PLANNING' .. . • " - . .
•
49. Electric Release to Edison ," ` - 1
•
50. Gas Release to Southern California Gas Co - - - "- - - : •
51'. CERTIFICATE OF OCCUPANCY. . ' - •
No. Date
BUILDING PERMIT LOG
EMPLOYEE:
ADDRESS:
PERMIT NUMBER: TYPE OF PERMIT:
VALUATION: SQUARE FOOTAGE:
PERMIT FEES:
DATE: TIME IN TIME OUT ACTIVITY.
// 1t
) - e/ � weir
ONLY ONE ADDRESS PER SHEET-TIME IS TO BE CACULATED TO THE NEAREST 15 MINUTES
PLEASE BE AS SPECIFIC AS POSSIBLE IN RECORDING ACTIVITIES
' atrOFBUILDING: 1168 PRINCESS CT UNIT: CITY OF COSTA MESA — BUILDING PERMIT
`w.NERS NAME IF KNOWN: WOZNIAK, SAM FLOOD: AHL37 PERM NO: b 08564e.
ADDRESS: WOZNIAit SHIRLEY
1168 PRINCESS CT PERMIT NO: B 065648 PLAN CHECK NO: 03499-97 L GOVT: N SUMP : N
._ COSTA MESA,CA 92626
APDL.MAURO ADDRESS CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION ' : ADD 30 7SF, TO SECOND STORY SQ FT: 2, 149
ARCH.OR ENG.'S ADDRESS: UHT:
CLAIM VALUE: 2, 149 . 00 CALC—VALUE: 9, 100. 00 GROUP OCC; R-3 /U-1
CONTRACTORS NWE:
CONTRACTOWSMAIUNG COMMENTS : 2ND FLOOR AUDITION WIIHIN EXISTING STRUCTURE
ADDRESS: MM.: *Yt*li'IF IF'!t1'*A1'FYI*YI'YF'IFf''i'*11'1F'It T'R 1t R'1lRRR RxRRxxxRxxxx xx xxRxRftX R9tx RR RRRxRR R xxx RRRRRRRR
UM: Z ONING REQUIREMENTS
OCENSED CONTRACTORS DECLARATION:I hereby slim under penaky of perjury that I am licensed under provisions of Chapin 9 SETBACKS
(commencing sib Section 7000)01 Division 3 d the Business and Professions Code.and my license is in full force and effect.
CITY LIC.NO.: UC.CLASS: LIG.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Comrades LEFT: FT IN RGHT: FT IN LEFT : FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penady of perjury that I am exempt from the Contractors license Law foe the
lolawkg reason(Section 7051.5 Busies°and Professions Code:My city or county which requires a pared to oorutnuct,akar,impoa. PARKING REQ: PROV: PARI:EL: 41207347 Z N E: 1i 1 REF NO
damoleh,o repair any structure,prior to is issuance,also requires the applicant for such perms to file a signed statement that he a she
ie licensed pursuant to the provisions d the Contractors License law[Chapter 9(commencing with Sedan 7000)d ONelon 3 d the PLANNING NOTES> INTERIOR ALTERATION TO CONSTRUCT A 2ND FLR INSIDE AN Ei{. SFU
-- EXISTING
• and Professions Caper m that he a e is aromaacivil
therefrom and The buss fel The hoeallegedhu dexemption.Airy violation d Section > WILL LL t 1 LL AN EX 1ST 11V1d L LR L CEILING.
7031.5 by an)'alplaart ToraDerma subjects the applicant toadsil pensydtet more then five hundred dollars lsSOOU. ..*** . . ''.. '' . . . '' . •"' •--- --'- "' '' .
RR**dt Ytxx>f si ie iexyf>W ILieie+FILLRAN +F•••..•.. RAL INitw lilt fFw x>rxxir i'iF wst'llw llwxl<x>rxx
❑ L as owner of Me lialieya mY employees wilt wages as Ovi sole°ompamali«h MO do me work.and me statins u not'Mended L E V E L V P M E N I S E R V I C E S k E u l7 I k E M E N I S
or offered for sale(Section 7044.Business end Professions Code:The Contractors License law does not apply to an owner d Droned',
who bolds or inprwea thereon.end who does such work himself or head or through he a her own ambit's,,provided that such I I f y�/
improvements are room.neee«dlered l«sale.lf,however,the heUdinp«knprowtnenteeoM erne«e year of mmpMion,the ZONING APPROVED BY : DATE: -(� yr
ownerbuilder wig have the burden d moving he or she did not build or improve for the purpose d sale).
❑ L u owner of the mopeds.ern udusivslj a Lawdoe with Icenlud corianders To coimud the muted(Swion 7044.Business and Wi-g-
cannelr r«u Code:The s with c License does not appy to en owner d prop«ty who bdds a Improves Thereon and sic bU1LL1Nita AYPRVL ED b Y UATEcontracts to and.procts vAN a cedraem(s)liccensed pureuant To The Contractors License law).
❑ I are exempt under Section: B.AP.C.,for the reason: APPLICATION ISSUED BY: DATE: 'It / q---/ A
fF'RlF•Ien..R*wii'IF'H***Rft len etsly*sr x 1F x Ti x ai....it xxx Rx ltx RxxT'xRx RX*iv wwwwwwwwwwri•es IFR RR RRRR Mail
D ate: Owner "LEGALIZATION:N F E E SUMMARY SIRUCTURAL SEGMENT:Y
I do hereby cendy that I am aware of and understand the requirements of Callornia Neagh and Safety Code Sections 25505,,cann.and
25534,end that I or any future building occupant will t MU not(circle one)need to comply with said stale codes and the requirements ler
a permit for couvuctbn Or modification from the Air itty.anagemenIDidrid.Residenlidemdnefan appFmiare°n exempt fromthine BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 182 . 25 . 91
Date: Applafot: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally d peray hone of the following dedwatau: PLAN 10 5. 4 6
ISSUE FEE
• ❑ Coeefortwumanlaince«MeaudrmaeniTosdinswerossued. mpeneelan,oprodMf«by Sedan3700SIM ab« BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAIL DUE
cads.t«the p.rmman<eathe w«kf«wlxh miss permeai®aed. TOTALS----> 163 . 16 0.00 105. 46 268. 62 268. 62 . 00
❑ than and nil melmaa workers'compensation isurance,es required by Sedan 5700 of the Leber Code.for The performame d the
work for which this permit is issued.MY workers'compensation insurance eerier and Polity number see:
Carder: REVENUE DIVISION TOTALS--> COLLECTED: 220. 03 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This seduce need not be competed I the pemrx b for ore hundred dollars 1$100)or lest) 162 . 25 . 91 56. 87
o 1 candy that in The petonrisnce of the work for which this permit is issued,I shell not employ any person in any manner so as to (
become*MOO to the workers'compensation laws d Cafnomia,and agree tat I I ahouk become subjed.to the worker' - ""' .......... .. .
. .. 'Jiltltx ftti lFtt SiIt<RR Rat'w ]itFRx RR R***RR* tie x*xx R***x ire RIF IF it RRRjt It li R'Rxli T'T'x T'
compensation provisions of Section 3700 0l the Labor Code.I shall forthwith comply wish those peoweore. INDIVIDUAL F E E BREAKDOWN
D ale: Applicant: ,
Warning:Failure to es
enure workers'compendon coverage hi unlawful.and tall subject en empl�to a1MUMI penalties and TYPE QTY U E S L R 1 P 1 1 0 N UNIT COST TOTAL COST
chrll Ifns up It One hundred thousand dollen(f10G011OA In addition be dee cost of compensation,damages as provided for In
Section 3706 of the Labor Cod,Interest,and elmney's fees. SFR 9100 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 5, 100.00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there e co
a nstrudion ending agency forthe e END OF FEES
performance of the work for which this penal is d
issued(Sean 3097,Civ.C),
•
LENDER'S NAME:
LENDER'S ADDRESS:
I candy that I have read this application and stete that the above iMamation is correct.I agree to comply with all city end county ordinanme
and state laws relatkg to building consuudan and hereby authorize representatives of this city to enter upon the above'mentbned properly
for inspection purposes. SAM WOZNIAK 11-06-1997/01:04 Pit/i220.03
Print Nome RCPT0:01-091:116
PERMIT:085648
Dale:
Signature of Ovmer/AgenuAppkcantCantrador
4
I5151d6.WP) Whae-BuiMac A Safety:Green-Fle:C°rerv-AmArm.Pink-nevem r•netdenmd-Asseemor
•
PROJECT ADDRESS: 1168 PRINCESS CT ' UNIT: 0 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P - 044681- -
OWNER'S NAME: WOZN IAK •
' - - • -
ADDRESS: SAME AS ABOVE PERMIT NO: P 044681 PLAN CHECK NO: - N GOVT: N SUPP: N
•
CONSTRUCTION TYPE: PERMIT TYPE: PLU . PURPOSE: . NEW
ARCH/ENGINEER: . • REO.NO.: JOB DESCRIPTION : WATER • SERVICE • SQ FT: .
ADDRESS: . •
' UNIT: .
CALC-VALUE: GROUP OCC: . /- ' ,
CLAIM VALUE:
PERMITTEE: A-AMES PLUMBING & HEATING ( 714 ) 530- 2440 '
' ADDRESS: 10422 TRASK AVENUE COMMENTS: • • • '
GARDEN GROVE • CA 92642 ****x**************************yE***** *>E *+t*** ***** *****erg*********>E ***TF****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section • Z ON I N G - REQUIREMENTS '
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. - • SETBACKS .
cmuc.: 006664 STATEuc.:250307 CLASS:C36 • • •
Date:_/O'it C — T4 signature: S-- 2 & Q • -"' MAIN BUILDING ACCESSORY BUILDING --
WORNERS'COMPENSATIONOECLAfUTION: Iherebyaffirmthatlhaveacertigcataolconsent toself-insure pracertificate alWorkers' FRNT : FT IN REAR: • FT IN FRNT: 'FT IN REAR: FT ' IN
WORKERS'COMPENSATION PEqra�q,O}�NOy��DeQD �Oapy.{LAIh�eerQe'b 3800. LEFT: FT IN' RGHT: FT IN LEFT: FT IN RGHT: FT •' IN ' 1
POLICY NO:: /JWI`x�V /1 447.1JU EKP.DATE: v/7IU1 /9U
COMPANY: NATIONWIDE PARKING REQUIRED : PARKING PROVIDED : PARCEL : 41808125 ZONE: •
❑ Certified copy'is hereby furnished. gj Certified copy is filed with the city Building Division. • PLANNING NOTES>
>
Dale: Applicant: ***********************************************iE**bE**************************34*
EKEMPOON FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)a less). •
D E V E L O P M E N T S E R V I C E Sit.•E Q U I R E M E N T S
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. C - ZONING APPROVED BY DATE:
Date: IO-w - sig signatoul �lD�a�-¢_. BUILDING' APPROVED BY : - DATE: '
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 APPLICATION ISSUED B Y: i DATE:
which this permit is issued(Section 3097,Dv.C). ***********************************************************************lF*7FKY*7**
UNDER: **************************eE**************************************************** ,
ADDRESS: LEGALIZATION:N F E F SUMMARY STRUCTURAL SEGMENT:N '
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors State License Law for the fallowing reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT . 2 , 0 0 ,
repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed - 2 5 t SNIP/NON-RES'
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN ' •
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). ' ISSUE FEE 3 . 00 ' •
'I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV--> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors%State License Law TOTALS----> 2 , 00 ' 3 - 00 0 . 00 5 . 00 ' a . 00 . 00
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 REVENUE DIVISION TOTALS--> COLLECTED :: 5 . 00 OVER/SHORT• . 00 '
Improvement is sold within one year of completion,the owner mill have the burden of proving he/she did not build or improve
forthepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
•I.as owner of the property,am exdusivety contracting with licensed contractors to construct the prefect(Section 7044,Business
5 . 00 '
t
ap
❑ and whohoecontra tsdo such projects with atcoicenseLaw dens pursuatoo hContrctors'&ato icensor Taw).I as aware *********************************,*****************************************N****
and wcontracts for such projects with a eLice ctogs)license pursuant to the Contractors'state builds Id Law).tem aware
that proof o1 their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAKD OWN
❑ I am exempt under Section: B.d P.C. I
forthisreason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: PLU 1 WATER RE-PIPE 2 . 00 2 , 00 '
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and • END OF FEES '
25534 and that I or any future building occupant wilUxill not(circle one)need to comply with said state codes and the requirements for a -
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from • •
these provisions. f
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned ,
property for inspection purposes.
Date: /0-36 - $9 Signature: .•c 1Sa}R t> . .-
.
Driver's License or Social Security
Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING- POOL& SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Serviceor Pole - '' 52. Pool & Equipment Location ;r
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement •
3.-Electrical Conduit Utility-Undrgrnd.' 54. Forms `""
- r
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure-Test
6. Electrical UF ER Grnd. - 57. APPROVAL TO COVER-GUNITE .
7: Footings - 58. Electrical Conduit-Undrgrnd. •
8. Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. j 60. Backwash Lines,P-Trap, 0 Undrgrnd. •
10. Structural Floor System . 61. APPROVAL TO DECK 1
11. Property Sewer Line & HouseCConnection 62. Backwash & Receptor-Final
- 12. Sewer Cap • J4 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 -
20.-Rough Factory Fireplace • . - APPROVALS - Permit# -
21. Ducts,iri 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 (StruEtural( &-Monocoat . . - 75. Dry Chemical
27. Frame and Flashing _ 76. Dry Standpipe • '
28. Lathing & Siding 1 ' - 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 Mete-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 fat*'t 6(1) '
39. Water Service-Final I�/un
40. Gas Service-Final ' ' • - 1 CJ' (o L -
.... 41._ Solar Domestic-Final .. -
42. Backflow Preventer
• •
43. Backflow Irrigation - -- -
44. Landscape Irrigation System • • ` -
45. Sound Attenuation - . . . - -
46. Handicap Regulations - "
. 47. FINAL STRUCTURE & BUILDING'
48-4.-FINAL PLANNING .
. 49: Electric Release to.Edison ',
50. Gas Release to Southern California Gas Co _
51. CERTIFICATE OF OCCUPANCY
No. Date
rs4 i h R I 4
mi 0779 2/21/79pp 3342. I TT��
COSTA MESA BUILDING-SAFETY DEPARTMENT 3779779 00044'7/21 /79 342. ICKF6
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 1 00004474 81•
Wm•
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only
RECnEIIVI
ADDRESSE,Di8�/ lATE CEI DATE ISSUED
BUILDING
Tract 10277, Lot 53 ' �` `
PERMIT NO.
OWNER McLain Development Co. A.P.NO. q/ 2-07/- 04
MAIL BUILDING
ADDRESS 1470 Jamboree Road ADDRESS // bEr
TEL.
CITY Newport Beach NO.E640-6800 TRACT 10277 ' LOT 53 BLOCK
CONSTRUCTION NEW I ADD ALTER I REPAIR MOVING OFMOJ ISH
LENDER
BRANCH A(
OWN e� W SI'
ADDRESS '�V�///�J/Q(J�'Jt` VALUE
ARCHITECT TEL. USE //tt.l . $4e, 70
OR ENGINEER Corbin/Yamafuji No. 752-5567
FIRE 7
ADDRESS 3661 Spruce St. , Newport Beach ZONE TYPE GROUP
APPROVED
CONTRACTOR McLain Development Co. BY DATE
ADDRESS 1470 Jamboree Road
TEL. ZONE NO.OF USE OF NEW
PLANS BUILDING
CITY Newport Beach NO. 640-6800 FoQ-YYIp $
F^ STATE CITY YARDS APPROVED YARDS APPROVED
:r� LIC. NO. 273875 LIC.NO. MAIN BUILDING ACCESSORY BUILDING
IR
NO.OF BLDGS. (FROM C/L STREET)
O. OF LOT 45 x 95 I NOW ON LOT FRONT ao FT. 0 FT.
USE OF
22 EXISTING BLDG. R.SIDE (FT. 0 FT,
CP
E-1
Separate permits are required for L.SIDE 5 FT. 0 FT.
electric,plumbing and heating work. REAR /y FT. 0 FT.
Ld
(..i USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
0 MAIN BLOCS. ACCESS.BLDGS.
.J Single family residence, C.U.P.#VAR. DATE
ZC-78-3V APPROVED iitit7 72.---
New House _AAPPROVED ow lett-
›^
e 1 DATE alAr
a HOLD FOR SPE IAL REOUIREMLNTY
w •
O I hereby acknowledge that I have reed this application and state 'n
c.
Cd that the above Information is correct and agree to comply with
a a.
all laws regulating building construction, and I shall not employ House 2190
Z any person In violation of the workman's compensation laws of 2
...laW the State of California. '
-1
co-
I herebycertifythat I amSO. FT. Garage 585
properly licensed as a contractor under 5
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR a
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 ��op '
and Professions Code, Division 3,Chapter VALUATION PERMIT FEE Ea .+q'�— N
PLAN CHECK E .. —. o
Signature of �' �� m
Permittee E/y 2D0`��TAX E �, U
Authorized /nt ^ U
— TOTAL PAID E� j ./