HomeMy WebLinkAbout275 PRINCETON DR - Building Permitsr. �
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PERMIT TYPE
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, � � CITY OF COSTA MESA
BI/ILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER�P07-00608
PLUM
JOB ADDRESS: 275 PRINCETON DR CM
Vicinity: HALLWAY CLOSET
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
12/06/2007
RMD
1
SCOPE OF WORK: LEGALIZE WATER HEATER CHANGE OUT WITHOUT PERMITS, LOCATED IN HALLWAY CLOSET FOR A
SFD.
OWNER:
PHONE:
APPLICANT:
PHONE:
MORRISON, JACK M TR
MQRRISON, CAROL
714-540-7546
CONTRACTOR: OW NER-BUILDER
Address:
City/State: , ZipCode:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $35.80
TOTAL FEES: $35.80
Address: 275 PRINCETON DR
Ciry/State/Zip: COSTA MESA, CA
Address: 275 PRINCETON DR
City/State/zZip: COSTA MESA, CA
License No. 000000
PHONE:
CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(omia staNtes 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 vrith all applicable codes, and all
required inspectians and final approval must be obtained. Failure to obtain inspections and final approval vnll result in the expiration of this permit.
CO�Et INSPECTIONTYPE DATE INTI11RL5 CODEI INSPECTIONTVPE DR,T INTITIA
1616 Fized System Final Fire Prevention 206 Final Mechanical �j�`�
1266 Pool Spa Fingl 20B Final Plum�ing Z -� (./J ��
Z00 Final Re-Roo( 2�0 Final Electncal
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 Demolition - 250 Final Building/Owupancy
f , . i
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty o( perjury one of the (ollowing tleclarations:
❑ I have and will maintain a certifcate of wnsent to self-Insure (or woBers'
compensation, as provided for by section 3700 of the labor Code, for ihe
peAormance of the wOrk for which lhis permit is issued.
❑ I have and will maintain vrorkers' compensation insurance, as required by
section 3700 of the Labor Code, for the peAormance of the work for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier
(Tnis secfan neM rwt Oe cvmpefed il t�e permrt ¢ value0 al one nuntl�ed cbllars (Ef 00) a less.)
Policy Number:
� I'Certi(y Iha[ in Ihe pertormance of the work (or which Ihis permit is
ed I shall not employ any person in any manner so as to become subjecl
to the workers' compensation lavrs of Califomia, antl agree Ihat if I should
become subject to the workers' compensation provisions of Section 3700 ot
[he Labor Code, I shall forthwith comply with these provisions.
� �¢>>ci��n-¢a.-�. ��' � —��
���eioj n�rs�,siv�uae�'- Daie`_��u.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNIAWFUL 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, INTEREST, AND
AITORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I herehy aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) o! Division 3 of the Business and Professions Code, and
my license is in full force ana eHect.
Lic. # Class #
Canlractor's SigiaWre Dale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum ihat there is a consiruction lending agency fw Ihe
peKortnance o( Ihe wurk for which Ihis permit is issued (Sea 3097. Civil Cotle�.
Lender s Name:
Lenders Address:
Sig�uwre Da�e
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury lhat I am EXEMPT FROM THE
GONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5.
Business and Professions Code: Any city or counly which requires a permil lo
construct. alter, improve, demolish, or repair any structure, prior to its
i55uance, also requires Ihe applicant for such permit b fle a signetl statement
that he or she is licensetl pureuant to lhe provisions of lhe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Code) or that he or she is eaempt therefrom antl
the basis for lhe alleged exemption. Any violation o! Section 7031.5 by any
applicant for a pertnit subjects the applicant lo a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as ovmer of the property. or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and the sWcture is not intended or
oRered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
lhereon, and who tloes such vrork himself or hersel( or Ihrough his or her ovm
employees, provided that such improvements are not intended or oKered tor
sale. If, however, the building or improvement is sold wiNin one year o!
completion, the owner-builtler vrill have the burden o( pmving Ihat he or she
did not build or improve for purpose of sale.).
[by�yS _�I„as'owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
L/ ICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl
Professions Code: The cont2ctas License Law dces not apply to an owner of
propeny who builds or improves thereon, and v.ho contracls tor such project with
a contractor(s) license pursuan[ to Ihe Conlractas LicenSe Laws.).
❑ I am exempt untler sec.
Business and Professions Code for this reason:
_�sL � � .a �. ,____- �� —� , 0'-1
�Slgna�ore_.�� � oa�e
305]<6 �YO)� L---���^-
�. ,
Owner ID verified by dnve .[�Ves ❑ No�_,
Driver's�License�No.- Expires: «—�� � �a—
��
Venfication of Ownership by (rype o( document, i.e. - pro0erty tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certAy thal no ezcavation five (5) or more feet in depth into which a
person is required to descend, will be made in conneclbn with work authonzetl
by this permit, and that no builtling slruc[ure, scaffdding, falsework, a demolilion
or dismantling thereol, will be more than thirty-sa (36) feet high. (Chap. 3.2, Gry
2, M 2, Sec. 341, T�le 8, Califomia Adminislrative Code).
❑ As owneabuiltler, I will not employ anyone to do work which woultl
require a permit from 1he Division of Intluslrial Safery, as noted above, unless
such person has a permit lo do such work from the tlivision.
Appliwnl's Sgnalure Dale
Divisi0n of Industrial Safely Permil Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre builtling occupant need lo file and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Sa(ery Code requires, with some
exceptions, that a Business Plan be filed with the Cosla Mesa Fire
Depariment by every business which has at any one time tluring a reported
year a quaNity of hazardous matenals equal lo or greater Nan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperaWre and pressure).
2. Does or will the applicant or present or future 6uilding occupant need to file
a registration form for awtely hazardous malerials? ❑ Ves ❑ No
(Seclion 25533 of the Calilomia Healih and Sa(ety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business vfiich at any one lime has on hantl a quantity of acutely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl
temperature antl pressure�.
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Cotle provi0es that the
Costa Mesa Fire DepartmeN may require the preparetion, certifiwtion and
filing with the Fire Department of an RMPP by businesses which are requiretl
lo register aCutely hazard0u5 malerial5 wilh the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health antl Safery Cotle been (ully complied with? ❑ Yes ❑ No
5. Does or will the appliwnt or present or tuture building occupant require for
the work which is lhe subjact o( Ihis applicalion a pertnit for such conslruction
or modifcation from the South Coast Air dualiry Managemenl District or from
any other air polNtion control Oistrict or agency? ❑ Yes ❑ No
(Sectbn 65850.2 0( Ihe Calilomia Govemment Cotle requires that Ne requested
infortnation Da fumished on applicalbns (a rarr-residential building pertnits).
6. will any part o( the tacility to be constructed under this permit be within
1000 feet fmm the outer boundaries of a schoal? � Yes ❑ No
Qf yes', the faciliry must meet the requirement of Sections 25534 and 42303
of the Califomia Heallh and Safe�y Code).
7. I( a pertnit from the South Coast Air �uality Management DisMcl or other
air pollution control disMct or agency is required for Ne work which is the
subject o! this application, have all of the disclosures prescribed by Califomia
Health antl Safety Code Seclion 42303 been made? ❑ Yes ❑ No
8. Qf'Yes", attach certificate of compliance from the appropriate air pollution
control offcer).
CERTIFICA7E OF COMPLIANCE: I certiy that under penalry of perjury the
information qiven above is correct I agree to comply with all state laws and
city ordinances regarding Hazardous Matenals and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury thal I have read Ihis application and state that
the in(ormation given is correct I agree to comply wit� all state laws and ciry
ordinances relating to building consWction, and authonze represematives of
the Ciry of Costa Mesa to enler upon the above-0escribetl property for
inspection purposes. I agree not lo occupy or allow otcupancy o( any building
aut "ap.d by this permit until final inspection.
�fl_-���..;� � �- b- O�
Signalureol�egalOwneqs) �-Date-^"^"--
An0/w PulbonxeE Applit'anl Dale
(714)754-5273 • Fax(714)754-4856
CITY OF COSTA MESA
BIIILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
JobAddress: 275 PRINCETON DR
Suite:
Vicinity: HOUSE & GARAGE
Parcel Nunmber: 74139302
Applicant: COVER RIGHT ROOFING
Address: 14262 ALLMAN PL
S.A. CA
Owner: MORRISON, JACK M TR
Address 275 PRINCETON DR
-� COSTA MESA, CA
Coniracror: . COVER RIGHT ROOFING
Address: 14262 ALLMAN PL
S.A: CA
Zip: � 92705
Arch :
Address:
Phone:
BUILDING PERMIT
Zoning:
Phone: (714)832-0113
Zip: 92705
Phone:
Zip: 92626
Phone: p14)832-0113
License: 615852
- Eng:
Address:
PERI�IT NUMBER
�
�/899-01197
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 08/02I7999
Issued: 08/02/1999
ISSUED BY: �-0 0 1
I
Phone:
� � Zip � -� � � License: Zip: � License:
' SCOPE OF PERMIT
,� REROOF - T/O, USING EXISTING SHEATING, INSTALL 2 LAYERS 15# FELT, NEW 30 YEAR ELK COMPOSITION
SHINGLE ROOF. '
� Plan Check:
` Permit:
` SMIP Res:
SMIP Com:
Other:
� Inspection:
Total:
$0.00
$99.75
$0.50
$0.00
$0.00
$0.00
$100.25
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0. 0
PARKING ezistinq: o
NOTES:
Rear 0-0
Rear 0- 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0. 0
Pro osed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0. 0
$4,259.00
54,259.00
NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepectlona end final epproval must be obtained. Failure to obtain inspections antl final approval will result in the expiretion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSATON DECLAHAnON:
II hereby atlirm unOer penelry af per�ury one of the tollowing tladarations:
❑ I have end will maintain a �ertificate ot consent to selFlnsure tor wwkers' compensatlon, es provltleA tor by section 3700 ot Ihe Lebor Code, lor the peAormance of Ihe
�work tor which this permii Is Issued.
I have and will maintaln workers' oorripensaUm insurance, as requiretl by section 3700 ol the labor Code, lor ihe peAortnence oi Ihe work ta whkh this pertnit is iswed.
My workers' crompensati0� ��surence carner anA policy number ere:
Cerder. Pollcy Number:
(Th/s sectlon need nof be completed �tl� perm/t!s veNed et one AunOreAdollers (3100J or /ess.)
❑ I certiy that in the perto�ngrtce oi Ihe work far which this permit is issuetl, I shall not employ eny person In eny manner so es to become subject to the workers'
compensetlon laws of C61' 6mta, and agrea t if I shoultl become suD�ect to ihe workers' mmpensetlon provisions ot Sectlon 3700 oi the Lebor Code, I shall fotlhvrith
comply with these pr �s.
AppllceniSigneture: �—T� � __ Date: ����
WARNW�: FAILUFE TO SECURE W TION ODVERAGE IS UNIAWFUL AND SHAIL SUBIECT AN EMPLOVER TO CRIMINAL PENALiIES AND GVIL FlNES UP TOONE HUNDRE�
THOUSAND WLLARE (5100,000�, IN ADDRION TO THE CUST OF C01.1PENSATION, DAMAGES AS PROVIOED FOR IN SECTION 3708 OF THE IABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm ihet I am Ilcensdd under pravisians of Chapier 9(commencing with Sectlon �000) ol Dlvislon 3 of Ihe Business end Professlons Catle, entl my license Is In lull
lorco entl eHecL Lic. a ��,r�e2 _ Class N�4
ConlrectorsSignalure: — -�� Date:_�'/.=�� >
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm that there Is e construction lending egency lor the peAormence of the work lor which this permlt Is Issued. (Sec. 3097, Civll Cotle).
LendePs Name: Lentlets Address:
Signeture: Deie:
OWNER•BUILDER DECLARA'nONS:
I hereby aNlrm thet untler penalry of per�ury Ihet I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which raquires a permit to construct, elter, improve, tlemolish, or repair any sWCWre, pnor to its issuence, elso requires the appliwnt For such permit
to file e signed stetement thai Me or she is Ilcensed pursuant to the provisions of Ihe Contrectors License Lew (Chepter 9(commendng with Sec4on 7000) of D'Msion 3 of the
Business end Prafesslons Catle) or thet he or she is exempt therefrom and �he basis far the alleged exemptlon. Any vlolatlon at Section 7031.5 by any applicant tor a pertnit
sub�acts the applicant to a civil Penalry ol noi more then five hundred dollars ($500).):
❑ I, es owner of the property. or my employees with wages es their sole compensation, WILL DO THE WORK. and the structure is not intentled or otteretl for sale (Sec.
7044, eu5ineu end Prolessions Catle: The Contrectors License Law does noi appty Io en rnvner ol propeny who �uiltl9 Or improves Ihereon, antl w�o tloes such work
himself or herself or Ihroa9h his or her own employees, provitled that such improvements ere not intentletl or oHered br sale. If, however, the building or impmvement is
sold within ane year af completion, ihe owner-builder will hava the burden of proving Ihat he or she did not builtl or improve far purpose of sale.).
❑ I, as owner of the propefty, em EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 70M14, Business antl Prafessions
Cotle: The contractors liaense L-aw does nut appry to an owner ot property wtw builtls or improves thereon, and who contracts Por such prqect wiih a contractor(s)
license pursuant to the CA�tractors License Laws.).
❑ I am exempt untler sec. Business antl Professions Code far this reason:
Signa�ure: Date:
Owner ID verified by drivefs license. ❑ Ves ❑ No Driver's License No.
Verification oi Owners�ip by (rype of documem, i.e. - property �au bill or deed):
Fxpiras:
DIVISION OF INDUSTRIAL SAFE7V PERMI7 CERTIFICATION:
❑ I hereby certly t�el no eXcevetion flve (5) or more teet in depih into which a person Is requlred to descentl, wlll be mede in conneaion with work authonzed by Nis
permit, entl ihet no bulldln9 structura, scaHalding, falsework, or aemolitlon or dismentling t�ereot, will be more then Ihlrly�six (36) teet high. (Chap. 32, Grp 2, An 2, Sec.
341, Ttle B, Celilornie Adm�nislrative Cotle).
❑ As ownerbulltler, I wlll no� emplay anyone to do work which would reqWre e permit Imm the Divlslon of Industdal Safery, es notetl ebove, unless such person has e
permit ta do such work Irom Ihe divislon.
Slgneture: Date:
Divisian of IndustAal Safety Perm�l Number:
CERTIFICATE OF COMPLIANCE /WD AUTHORIZATION OF EMAV: I certity under penalty of per�ury Ihat I heve reed this epplicatlon antl state ihat the infortnation given is
correcL I agree to comply wlih all stete lews and ciry orGinances relating to builGing construc�ion, end euthoriza representatives ol the Ciry of Coste Mese to enter upon the
above-tlescdhetl propelty tor InsPeabo purposes. I egree nol ro occupy or ellow occupanry of eny builtling emhodzetl by thls permit until Bnal inspection.
Ot Legel Owner(s) D te
�.�---- �/a��
nhodzed A�ollcant Date �
COOE �. INSFECTIONTYPE
1616 Fi:etl System Finel Fird Preventlon
1268
200
207
202
203
Pool Spe Final
Final Re-Rooi
FIneI8locWReteininp Well
Finel Fectory Fire Plece
Final Sign
204 Final Demolitlon
2a48-a8
BaIE �5
. � //Z✓J
COOE� INSPECTIONTYPE
208 Final Mechenical
20B Flnal Plumbing
210 Finel Elecirical
212 Final Fire Prevenilon
220 Flnal Plenning Appravel
222 Final Site
250 FIneIBullding/Occupancy
2AIE II�Li
Applicant to fill in all spatts excevt ihose within heavy.00rtler lines antl sign all apvropriate aeclarations.
CiTY OF COSTa�M/7ES ONSTRUCTION PERMIT
Proj62t Address �d �� ���tiY-f �T�U .
Applicant'sMail'yn�oA�d�dr�r�c< /S33 � ��:iCq����� �7j�
Owner's Name a_LK�IL2� ��� Phon�✓�' '� � �I
Addrezs
Arch/Eng. Licenu No.
Address �
Contractor's Nam St . ` L m hone a
Address Imailingl ��I�`((''� w
City License No. C "��
LICENSED CONTRACTOF DECIARATION
I hereby affi�m thal I am licensetl untle� provi5ions o( Charter 9(commencing
with section 7000) of Division 3 of ihe Business antl Pro/e55ions Cotle, antl
my license is in full tor a�j� Itect. I �� q
Licensp� I�ss��--��-- —���+-p--�-��4 Icej� Na���lT�1 �
Date Y-X�A�X �'��a� �a � /f � � )� U �//SA?9,S
1, ""ORKERS' COMPENSATION DECLARATION
\ :reby aHirm that I nave a certificale of consent to seif-insure or a certlticate
Workers' COmpensatiOn Insurance, o� a ce letl coOY thereof (Settion
� a800, Lab. C.)
� Policy No. ���D Company !�V��.
�Gert'jji¢tlhopy_)g�flteGbwlthrtnehcrtY Byt}dir�lj DiyiSi�( / A, ,�S
Date Y d�Td' Applicant r�1 (-+ 1L�•i
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl it the permit Is for one huntlretl (5300) or
I¢55).
I certify tM1at in the pe�formance of tha work fov wfticM1 tnls pe�m�t is i55uetl, 1
shall not employ any person In any manner so as to become subject to the
Workers' Compensa[ion Laws of California.
Date Si9nature
NOTICE: If, atter makln9 this tlaclaration, you zhoula become subject to the
Workers' Compensation provi5ion5 Of [he Labo� Cotle, you must forthwith
compty with SUCh prOvisions or this pe�mit shall be tleemeG-vevoketl.
CONSTRUCTION LENDING AGENCV
I hereby atfirm lhat there is a construction Ientlin9 a9ency for the per(ormance
of (he work fOr which th15 permit iz i55uetl (Section 3097 Civ. C.)
lenaer's Name
Lentler's Atltlress
OWNER BUILOEIi dECLARATION -
I hereby affirm that I am exem0� irom tbe Gontractor•s License Law tOr the
followin9 �eason (5¢clion 7031.5 Business antl Professional Cotle:.Any city or
county wnich requires a permit to construtt, alteq ImDwve, tlemolish.or repair
any structure, prlor to ils issuance, also requires the applicant for such permit
to tile a siqnetl SWtement lM1al he/she is Ilcensetl pursuant to Ne pivvisions ot
'he ContracloYs License Law (Chapter 9(wmmencing witn Section 7000) ot
'vision 3 oi th¢ Busine55 antl Prolession5 Cotle) or that he/she is exempt
erefrom antl the basis tor t�e allegetl Gxemption. Any viOlation of Section
. J31.5 by any applican[ 10� a permit subjects the ap0licanl to a civil
penalty of not more than five Ituntlretl Dollars (E500).
❑ I, as owne� of lhe p�o0erty o� my employees with waqes as their sole
compensation, will tlo the work, antl the structure is not intenCetl or offerea
for Sal¢ (Section 7044, Buslnes5 antl PrOfG55ional Cotle: The COntlactol's
License Law tloe5 not applY �O an owner o( a property wno builtls o� impmves
theteon, antl who tloes SUCh work himself/her5¢II or througn his or her own
employees, provltletl that such improvemen[s are not intentletl or offeretl for
sale. If, however, lhe bulltling o� improvement Is Soltl within one Year of com-
pletioq tne owner w111 nave Ihe burtlen ot proving he/she aItl not builtl or im-
prOve for the purpose of Salo).
❑ I, a5 owner ol the prOperty, am excluzively conVacting with Ilcensetl mn-
Vaciors to const�ucl [he project (Seclion 7044, 6usinesz antl Professions Cotle:
The Conlractor's Llcense Law doe5 not apply to an owne� of property who
builtls or improvez thereon, antl who contracls for suth projects with a wn-
Iraclor(s license pu�suant lo lhe ConVactor's LIC¢nse Law). I am awa�e tnat
Oroof o� [heir Worker'S COmpensa[lon insurance shoultl be provitle� [o me.
❑ 1 am exempt untler Section B. S P. C. for this reason
Date
Owner
I have r¢atl Inis
1 aaree to como
Signature /�9V , f.( i
Drivers' License or 55 �
tion antl stale that the above
all city antl county ortlinances
n, antl hereby authorize repre-
bove-mentlonetl _orooertv fo�
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER � A.P. #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TVPE OF PERMIT GRAOING FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT ❑ EIECTRICAL ❑ PLVMBING ❑ MECHANICAL A qear
❑ OTHE(3
PROJECT DESCRIPTION Sa. Fr. occuPANCv C Right
K Lett
CONSTRUCTION TYPE VALUATION $ $
20NE GRAOINGCV.YDS. ACRES p��g,Ref.#
Remarks: � Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Interceprors
Kitchen Sink
Lavatories
P—Trap
Roo( Drains
Reinspection Fee � $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heating System & Ducting
❑o-i oo.000 eru O i oo,000 sT
Reinspection Fee � $15
CMF OB65-46, rev. 10/84 Whit¢ � Builtlin9; Canary � Ap0lican[; Pink - Accounting; GoltlenrOtl - ASSBSSor
Showers
Service Sink
SewerCap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Isue Fae
Hoodor Typel ❑
Cenopy Type I I ❑
Refrig¢ration System
❑o�ioo,000eru ❑ioo,000eTu
System Repair/Alteration
F ire Dampers
Registers
Issue Fee
$ 3
$ 3
Automatic Washer
Construction Pote Sub.
Cooking Unit
Dishwasher
Zone
Parking Req.
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW �5-75 KW
Sub Panel
Motors 061 HP � 1'/:,- 8
Inc. Solar 09-15 HP �16-15+
Microwave
Pole Light
Range
Sign '
Standing Sections
Trash Compactor
I Rainspection Fee I$15 � ' Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
2oning APProved By
Building Approved By
_ n
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
$
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ �—�s.y— PERMIT
PLUMBING $ �.1�(.� ' ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $ -
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $ !'��
MECHANICAL $ TOTAL FEE $ �1..w �
PLAN CHECK 25% $
et �ooi�uss-cnai7oaa -�e�-r s.o�
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permir# Date Inspector qppROVALS Permit # Date Inspecto�
. ��
i. Temporary Electrical�Service or Pole 52. Pool & Equipment Location ,
2. Soil Pipe-Undrgrnd. -' 53. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-G�UNITE
7. Footings 58. Electrical Conduit-Undrgrnii. �
8. Foundation 59. Gas Pipe, O Undrgrnd., Test' •
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ' 63. Heater & Vent-Final
73. Foof 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, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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 ��
.�
33. Final Electric Notes:
34. Final Heating & Air Conditioning �.��'
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace � .
38. Final Plumbing (Z � jJY �n - '
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. �FINAL STRUCTURE & BUILDING � � � � •
48. Special Requirements Completed , � , �
49: Electric Release to Edison .
50. Gas Release to Southern California Gas Co � �.
51. CERTIFICATE OF OCCUPANCY ,
No Date
\
� -..
OWNER COLLEGE PARK DATE 3-1Z-SY
JOBADDRESS 275 Princeton Drive BUILDINGPERMITNO. #(�j8'z
GENERAL CONTRACTOR H3I'b02' Construction VALUE $ ],1�200.00
LOT �.�. BLOCK TRACT 31(� Fi.BS. W det 8T'.
GROUP I& J TVPE V ZONE FIREDISTRICT 1�661
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
. . DATE I NUMBEH
Foundation Forms and Grade to G
Rough Framing
Plumbing, Rough to Slab '
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough
Heating, Rough
Heating, Final
5ewer, House �� Sewer, St.
Septic Tank or Cesspool
Lathing, In Out �,
Plumbing, Fin�al, Fixtures
Plumbing, Final Gas Test
Wiring, Final
OCcupancy
FORM 210 3M IO�vS
' '" � 61
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 31�
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL
BUILDING
ADDRE55
OWNER C
MAIL �f
A�ORESS G
cirv $ANTA
ARCHITECT
OR ENGINEER
ADORE55
%rj PRINCETON DRIV.E �
COSTA MESA. GALIFORNIA��,-,�
�E�^� LOT
DESCFIpT10N �.Jp. I I
A.P. NO.
51ZE 6�. x t o
OF LOT
USE OF
E%ISTING BLDG.
$ETBACK LINE FROM—��
CENTER OF STREET
SIDE YARD RIGHT
P A R K N o. i:: �m: :. ;�K;
MAIN S7,�" '"
n�iF. T�o.Ki 555i
LIG .
NO.
i �� ���. �62�
NO.
TEL.
NO.
BLOCK TRACT
NO.OF BLDGS.
NOW ON LOT
REAF YARO � �
� LEFT �
DESCRIPTION OF WORK
NEW �( ALTERATION ADDITION
REPAIR MOVING DEMOLISH
BUILDING NO.OF
SIZE I ROOMS STORIES
E%TERIOR WALL ROOF
COVERING ' COVERING
BUELDINGEW RESIDENCE E:. �ETACHED
FE: RECEIVED
���,.�,,��,�� --�
FlNANCE DEPT.
CITY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. P�NjUT�a�
BUILDING
ADDRESS
COSTA MESA. CALIFORNIA
FIRE
ZONE
. ZONE � � NO.OF TYPE j
C\�J:A1I� ]
STPTE THAT TME /�BOVE IS COflRECT nND nGREE TO COMPLV WITX nLL
CITY ORD�NFNCES.�ND ST.�TE L�WS RELVLATING 9UILOING CONSTFUC�
TION: VqLUAT10N
SIGNATURE OF r, P K NO
PERMITTEE
' • ,• $ � � �2��
AUTHORIZED AGENT {
CORRECTIONS
PERM�T FEE S
PLAN CHECK S
TOTAL FEE 5
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