HomeMy WebLinkAbout282 PRINCETON DR - Building Permits. �.
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CITY OF COSTA MESA �
0'rtpMFq BUILDING DIV/SION
r�� 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
R"wo�Re A�'
PERMIT NUMBER: 609-00171
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 14139210 DATE ISSUED: 08/26I2009
ISSUED BY: BJK
JOB ADDRESS: 282 PRINCETON DR CM
Vicinity: RESIDENCE AND ATTACHED GARAGE
Squares: 2500
Suite/Unit:
Valuation: $8,000.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING COMP ROOF AND PLYWOOD, INSTALL NEW 1/2"
CDX OVER EXPOSED PORTION OF ROOF & 7/76" OSB SHTG OVER ATTIC AREA, 2 LAYERS 15# FELT, APPLY
"30-YEAR MALARKY COMP SHINGLES." PITCH 3:12 2500 SQ FT
OWNER: WILSON, JOHN D
PHONE:
APPLICANT: CAUCHOIS, RAYMOND
PHONE: 714-962-4250
CONTRACTOR: ACCURATE ROOFING
Address: 17171 ROTTERDAM LNUnit:
City/Slate/Zip: HUNTINGTON BEACH, CA
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTAL FEES
$o.00
$153.25
$0.00
$1.00
$154.25
Address: RT 5 WILSON CORNER
City/State/Zip: KAUFMAN, TX
Address: 17771 ROTTERDAM LN
City/State/Zip: HUNTINGTON BEACH, CA
License No.
License No.
PHONE:
License No. 726093
714-962-4250
92647 CELL:
PHONE:
PHONE:
Unit
Unit: :
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § 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 pertnit to be considered legal, such work must comply vrith 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.
UE/. INSPECTIONTYPE DATE INII11RL5 LOOEO INSPECTONTYPE DRTE INiRIRlS
1676 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof � 210 Final Electrical
201 Final BIocWRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Dertwlition 250 Final Building/Occupancy
,
,
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the tollowing declarations:
❑ I have and will maintain a certifcate o( consenl lo self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code. for Ihe
peAormance ol the work for which this permit is issued.
�_� ❑ I have and will mainlain workers' compensation insurance, as requiretl by
sectbn 3700 of the Labor Code, for the pedormance of the vrork for which this
pertnit is issue . My orke ' compensa�ion Insurance wrrier and policy
number are:
(Camer:`
(TnissM' nneed ro16em d nmepe�mrtkvaWedaronehundiedtlalars(8t0o)oiiess)
Policy.Number. r �T ( � � /
❑ I certi(y that in the peAormance of the woB 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 Califomia, and agree that if I shoultl
become subject 6 th workers' compensation provisions ot ection 3700 of
�the L Cod I sh �forthwith comply with these provision
�— 4 Z�G o
Appl¢anfs Signalure Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, antl
my license is�1in (ull �fonrce and effect.
C'Lia �L � V � �Class #�-�� G � �
a
Comraz�orsSigna�ure ate �
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn tha[ there is a construciion lending agency for the
perfortnance o( the v.ork for which this permil is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Atltlress:
SignaWre �ate
OWNER•BUILDER DECLARATIONS:
I hefeby aKfm thai under penalty o( Oerjury Ihat I am EXEMPT FROM THE
CONTanCTORS LICENSE lAW fof lhe f011ovnng rea50n (SeC. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any sWcture, pnor �o its
issuance, also requires the appliwnt tor such permit to fle a signed statement
that he or she is licensed pursuant to ihe provisions of the Coniractor5
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Code) or that he or she is exemp[ Iherefrom 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 ot not more man
five huntlred dollars ($500).):
❑ I, as owner of the property, or my employees wiih vrdges as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oHered for sale (Sec. 7044, Business and Prolessions Code: The Contractors
License Law does not apply to an ovmer of property who builtls or improves
thereon, antl who does such work himself or hersel( or Ihrough his or her own
employees, provided ihat such improvements are not intended or oHered for
sale. If, however, the building or improvemen[ i5 sold within one year Of
completioq the owner-builder vnll have the burtlen of proving that he or she
did no1 build or improve for purpose ot sale.).
❑ I, as ovmer of the propeRy, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business an0
Professbns Cotle: The contractws License Law dces not apply to an ovmer of
pmperty who builds or improves Ihereon, and who contracts fOr Such prqecl with
a conlrac�w(s) license pursuant to lhe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
JOS]-a6�J/0])
Owner ID venfied by tlriver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Venfcation of Ownership by (ype of tlocument, i.e. - pmpetly tax Dill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation Me (5) or more leet in dep(h into wfiich a
person is required to descend, will be made in cmnectbn vnth work authonzed
by this permit, antl that no building struc[ure, scaFfdding, falsevrork, or tlemoli�ion
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry
2. Art 2, Sec. 341, Title 8, Califomia Atlministrative Code).
❑ As owneo-builder, I will nol employ anyone [o do vrork which vrould
require a permit from the Division of Industrial Safery, as noted above, unless
such person has a permit to do such vrork fmm the division.
ApPliwnfs Signa W re
Division of Indushial Sa(ety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or pre5ent or Wture building occupant need to file and
certily a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, vrith some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Departmen� by every business which has at any one Iime during a reportetl
year a quantiry of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet o/ compressetl gas
at standard temperature and pressure).
2. Does or will the applicant or present or (uture building occupant neetl to fle
a registration form for acutely hazardous materials? ❑ Ves ❑ No
(Sec�ion 25533 of the California Heal�h and Safery Code, with some
exceptions, requires registration with Ihe Cos�a Mesa Fire Department by
each business which at any one time has on hantl a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume o! 55 gallons, or 200 cubic feet of compressetl gas at stantlard
temperaNre antl pressure).
3. Does or will the applicant or present or fuWre building occupant need to
prepare an RMPP (Risk Management antl Prevention Program !or acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Califomia Health antl Safery Code provitles that the
Costa Mesa Fire Department may require the preparation, certifcation and
filing wi[h ihe Fire Department of an RMPP by businesses which are required
to register aculely hazardous materials with the Fire Department.
4. II an RMPP is p�esemly required, has Section 25534 of the Califomia
Health and Safe[y Code been fully complied vrith? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupan[ require for
the wOrk which is the subjecl ol this application a permit for such construction
or modification from the South Coasl Air �ualiry Management DisMct or fmm
any other air pollution control district or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that Ihe requesletl
information be fumished on aOPlications far noo-residential �uilding permits).
6. Will any part o! ihe facility lo be constructed under this permit be within
1000 feei irom the outer boundaries of a school? ❑ Yes ❑ No
Q('yes", ihe (acility musl meet the requirement of Sections 25534 and 42303
of the Cali(omia Health and Safery Code).
7. If a permit (rom the South Coast Air �ualiry Management District or other
air pollution conhol district or agency is required for Ihe work which is the
subject o! [his applicalion, have all of ihe disclosures prescribed by California
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", a�tach certifcate of compliance from the appropnate air polWtion
control oKcer).
CERTIFICA7E OF COMPLIANCE: I certify that under penalty of perjury the
in(ormation given above is correcL I agree to comply with all state lavrs and
city ordinances regarding Hazartlous Materials antl Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state Ihat
ihe information given is correct. I agree ro comply with all state laws and city
orainances relating to building consWction, and authorize representatives of
the Ciry of Costa Mesa to enter upon [he above-described property (or
inspection purposes. I aqree not to occupy or allow occupancy of any building
authorized lhi permil until fnal inspection.
aWr lLegalO.mer�s) Date
ndlor AulpOnz¢0 Applitenl Da e
9
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(714) 754-5273 • Fa�c (714) 754-4856
CITY OF COSTA MESA
BDILDING DIYISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
JobAddress: �ISZ PRINCETON DR
Suite:
Vicinity: HOUSE & GARAGE
ParcelNunmber: 14139210
Applicant: FERGUSON, DON
Address:
Owner: WILSON, JOHN D
Address RT 5 WILSON CORNER
BUILDING PERMIT
Zoning:
Phone:
Zip:
Phone:
KAUFMAN, TX Zip: 75142
Contractor: DICK FERGUSON ROOFING CO
Address: 10721 STANFORD
GARDEN GROVE, CA
Zip: 92840
Arch :
Address:
Phone:
Phone: (714)539-2823
License: 484900
Eng:
Address:
PERMIT NUMBER �
Y B99-00664
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 05/13/1999
Issued: OS11311999
Phone:
Zip � License: Zip: �icense:
SCOPE OF PERMIT
REROOF - T/O, INSTALL 2 LAYERS OF 15# FELT, NEVJ TIMBERLINE 25 COMPOSITION SHINGLE ROOF.
FEE SUMMARY
Plan Check: $0.00
Permit: $99.75
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $100.25
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0. 0
Rear 0- 0
Required: 0
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$4,313.00
$4,313.00
NOTICE: The work authorized by this permit shall comply with all appliceble handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12•21•92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 deys, or if work is suspended or abandoned
, for a penod of 180 days. '
INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapeetlone and tinel epprovel must be obteined. Failure to obtain inspections end final epproval will result in the expiration of this permit.
�, FOR INSPECTIONS CALL: (714) 754-5626
WORKERS'COMPENSAnON DECLARATON:
I nereby ettirm untler penalry of perjury one oi ihe following tlaclerations: - �
❑ I have entl Will maintain a certiticale ot ponsent to self-Insure Por workers' compensation, es provided br by sectlon 3700 ot the Lebor Code, for Ihe pertortnance of [he
work for wh�ch Ihis pertnit Is issued.
� I have and will meintain workers' compensatlon insurence, as required by seclion 3700 of ihe Lebor Code, for the peAortnance of the work for which thls pertnit Is issueC.
My wa�e(s'�mpe�tion Ipsurance cartier and polic.y number are; n c/
Carner. �Ci y U �✓(lr � � Policy Number. . d �S — � /
(This sectian need not be camp/etetll! the permit Is velued at one hundred dollers ($ f 00) or /ess.J
❑ I ceniry ihet In the peAormence ol the work tor which t�is pertnit is issued, 1 shell not employ any person in eny menner so es to become subject to the workere'
compensation lews oi domia, and agree that i1 I should become subject to the workers' compensetion provislons of Sedion 3700 of the lebor Cotle, I shall forthwith
comply wlih ihese pro ns.�//J C� 7 p G
ApplicenlSlgneWre: �/i!��� Dete: J`�7—! /
WARNINO: FAILUR� TO SECURE WORKERS' COMPENSNTION COVERAGE IS UMAW FUL qND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTES AND CIN� FlNES UP TO ONE MUNDFEO
T}IOUSANO OOLLApE (5100,OW). IN ADOfTION TO THE WS� OF �MPENSATIIXJ, DMIAGES AS PROVIDED FOR IN SECTION 3]O60F THE Ll�BOR COOE, IMEREST. AND ATTORNEV'S FEES.
LICENSED CONTRACTOPS DECLABATON:
I here6y aflirm ihat I em Ilcen d under rovislons of Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe Business ntl Pmlessions Code, end my Iicense is In full
force end ettect Lic. a ���� � Class q � 3`�
ConlrectolsSigneWre: 11r�J/'r� Date: S'/�—�% �i
CONSTRUCTON LENDING AGENCV:
❑ I hereby aHirm that Ihere is a consimction lentling agency lor ihe pedormence of the work for which this permlt Is issuetl. (Sec. 3097, Civil Cade).
Lentler's Fleme: Lender's ACtlress:
Signawra: Date:
OWNER-BUILDER DECLARATONS:
I hereby eflirm that under penalry ot Derjury Ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for t�e following reason (Sec. 7031.5, Business and Protessions
Coda: Any ciry or county which requires a permit to consiruct, alter, Improve, demolish, or repair any shucWra, prior to its issuance, also requires the applicent for such pertnit
to tile a signetl stetement that he or she Is licensed pursuent ro the proNsions oi Ihe Contractore License Law (Chapter 9(commencing with Section 7000) oi Dlvision 3 of Ihe
Business and Protessions COCe) or thet he or s�e is exempt ihereirom end the besis For the alleBetl exemption. Any violation of Section 7031.5 Dy any epplicant for a pertnit
suD�ecls the applicant to e civil penalry of not more then Me hundred ddlars ($500).):
❑ 1, as owner of Ihe property, or my employees with weges as their sole compensatlon, WILt DO THE WORK, end Me stmciure is not IntenAeA or olfered for sala (Sec.
7044, Business antl Professions Code: The Contractors license Law tloes not epply to an owner of property who builds or improves iheraon, and who does such work
himself or hereeN or ihmugh his or her own employees, provided that such improvemeNs are not intended or oRered for sale. If, however, the building or improvemem is
sold within one year of completion, the owner-builtler will have ihe burden of proving thet he or she did not builtl or improve for purpase of sale.).
❑ I, as owner oi the property, am E%CIUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to consiruct ihe pro�ect (Sec. 7044, Business antl Professions
Code: The contrectors License Ww does not appty to en owner of property who huilds or improves ihereon, end who contrects For such project with a coNracbr(s)
license purguant to the Contractors License Laws.).
❑ I em exempt under sec. Busineu antl Professions Code tor ��is reason:
SignaWre: Date:
Owner ID ventieq by tlnvers license. ❑ Ves ❑ No Dnvefs License No. Expires:
Venfication ot ownership by (rype ot Gaument, i.e. - proDerty tex bill or tleetl):
DIVISION OF INbUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certlty �het no excavation five (5) ar more feet In depth into whlch a person Is requlred to tlescend, wlll be mede In connection wlth work euihonzed by ihis
perml�, antl thet no Duiltling structure, sceMolding, falsework, or demolifion or dismantling Ihereol, wlll be more then thirry-six (36) teet �Igh. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle e, Celitornie Atlministretive Cotle).
❑ As owner-hulltler, I will not employ enyone to do work which woultl require e permit from Ihe Division of Industriel Safety, es notetl above, unless such person hes a
permit to do such work from ihe division.
Signeture: Dete:
Divisian ol Induslrial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORVATON OF ENTRY: I certity under penairy of per�ury that I have read ihis application and state that Ihe information given is
correct I egree to comply with all stete laws and ciry ordinances relating to builtling construdlon, entl authonza representatives of the Ciry ot Costa Mesa to enter upon the
above-descriDed proparty for insDection purposes. I agree not to occupy or ellow occupancy of any hulltling euthorized Oy this pertnit umll final Inspection.
Signature Ot Legel Owner(s) Date
�,,,,� S-/3-9' y
—� AnNOrAuthorizedAppiicant Daie
CODE t. INSPECTIONTYVE
1816 Fizetl 3ystem Final Fire Prevemion
1266
200
201
202
203
204
244fi-db
Pool Spa Final
Finel Re-Roof
Final Block/Retaining Wall
Final Fectory Fire Plece
Finel Sign
Finel Demoli�ion .
Qeg ii�s
`� �
COOE II INSPECTION TYPE
206 Final Mechanicsl
208 Final Plumbing
210 Finel ElecMcal
212 Finel Fire Preveniion
�220 Finel Planning Approval
222 Finel Site
250 Final Builtling/Occupancy
B.AIE �Ak,4
PNOJECTPOOPEy: .,�$Z PRINCETON Dft
OWNEfl'SNAME: YLITT KEN
AUOflE55: �Fi.� P{21NC.r.T�N llFi
COS7'A MESA,CA 92626
546-72�9
PflCN/ENGINEEH: flEG.NO.:
AOORESS:
uNrt:
UNIT:
PEflMITTEE: EARLS PLUMBING ( 714 ) 772-3470
nooxess: 7 533 Ta, I.INCULN
ANANfiET.M C:A 9280I
LICENSEO CONTPPCTOfl OECIAXATION: i hereby affirm Iha� I am licensed under pmvisions o� Chap�er 9(commencing wilh Sectmn
7000� ol Div��sion 3 af I�e Business antl Pwtessions Cotle, antl my license is in full force and eflect.
c�Tr��c.:005938 STATELIC.:ll%ESI cuss:C-36
Oate: Signamre:
WOBREXS' COMPENSATION OECLAflATION: I hereby aHirm �ha� I have a certi�ica�e oi conseni ro sel4insure or a cenitica�e o� WorkerY
comPensatian �s�a$ce� � a certitied couy mereoi (seaion 3aoo. �an. �I.j / U 1/ 9 2
POLICY NO.: E%P. DRTE:
camraxr: BEAVER
� Cetlifled copy Is hereby lumishetl. � Cetllhed copy s hle �iHMhe-e0.y ullOing �Ivision.
Oate: � _ \ ` ApplicanC ������ :�•�
E%EMPiION FHOM WOflHEPS' COMPENSRTION DECLAflPTION: (This sec0on neee not be campleletl i� Ihe permil is for one �undrea (5100) or less).
I rer�ily Iha� m I�e pedormance of �he work tor which Ihis permit is i55ueQ I shall no� employ any person in any manner so as �o become
Su01e�� �o Ihe WO�k¢R' Compensation Laws ol Cab�ornia.
Oate: SignaWre: '
NOTICE: I�. afler making Ihis tleclaralion, you shoultl hecome su6lec� �o �he Workers' Campensa�ian pmvisions of the Labor
Cotle. yau musl tortAwith comply wiih such pmvisions or this Dermi� shall �e tleemetl revoked.
CONSiNUC7lON lENOING AGENCY: I hereoy allirm Inat inere is a conslmction lentling agency Ior Ihe peAormance of Ihe work for
which Ihis permil is issuea (Sec�ion 3W7. Civ C).
LEN�EH:
PDOPE55: �
OWNEN 6UILOEfl �ECLl�NATION: I hereby a��irm Ihat I am exempt from the Contracmrs' S�a�e License Law for Ihe following reason
(Sec�ion 7037.5 Business and Pm�essional Coae: Any ciiy ol counry which requires a permit �o wnstmc4 alter, impmve, Aemolish, or
repair any struc�ure. prior Io ils fssuance. also requires the aODlicant �or such permi� to lile a 5igneA sla�emen� �ha� he/she is licensea
pursuant m �he Dmvisions ol �he Contracmrs' State License Law (C�apter 9(commencing wilh Section 7000) of �ivision 3 oi ihe Business
and Pmiessions Code) or �hat he/s�e is exempt therefmm and ihe basis for �he allegea exemption. Any violaiion of Sec�ion 7031.5 by
any aDDlicant �or a permi� suble��s the applicanl �o a civil penal�y o1 no� more than live hundretl tlollars �$500�.
I. as owner of ihe pmpeny or my employees with wages as t�eir sole com0ensatioR will tlo Ihe work, and ihe
❑ s�mcWre is not m�enUed or otleretl �or sale (Seaion 7044, 9usmess antl Prafessional CoOe: The ConVactors' Sta�e License Law
' does nol apPly �o an owner ol a pmperty who builds or improves �hereon, and who tloes such work himSelVhersel� or ihmugh
his or ner own employees. pmvieetl inat sucn impmvemenis are not inteneetl or oflereJ for sale. if. however the builtling or
impwvemenl is soltl within one year of com0�etion. ihe owner wili have ihe burden of pmving �e/she di0 not 6uiltl ar improue
for ihe purpose of sale).
I.as owner olihe propeny.am e�clusively conirac�ing with licensed contrac�ors�o constmc�lhe Dmjec��Sec�ion 7044, Business
❑ antl Pmlessions CoUe: The Coniractors' Siate License �aw Ooes nol appty to an owner af pmDerty who DuilUs or impmves �hereon
antl who [onVads lor such pmjects with a contrac�or(5) license purSuanl to ��e ConVac�ors' State License Law). I am aware
I�at pmo� o� their Worker's Compensa�ion insurance should be provi0ed lo me.
� I am exempt under Seclion: B. 8 P. C. -
lor ��is reason:
Date'. Owner.
I tlo here�y cerlily that I am aware ot anA under5tan01he repuiremen�s ol Califomia Healih antl Safery Cotle Seclions 25505, 25533, antl
25534 ana Ihat I or any IUWre buildmg occupan� will/will not (circle one� neea Io compN with said state co0es and I�e requiremen�s �or a
permil lor conslmction or motlification iwm Ihe Air Oualiry Management DislricL Resitlenlial constmciion apDlicaiions are exemp� �mm
Inese pmvisons. !J� �j� ^
oa�e: `_ \ ` _- `\ AOPlicanc .�G. =�'�'�' �' •
I hereby cetlify IAai I have reaA ihis application and state that �he aAove inbrma�ion is correci. I agBe to compty wi�h all ci�y an0 county
orainances antl stale lavrs relaling �o building tons�mclion antl �ereby aNhorize representa�ives at �his city Io en�er upan �he above�men�ionea
pmperry far inspection Ourpases. v
Oale' `_1� � I Signamre:� �"sr� � ���
oriver's �icense or sociai sewnty x:
l6abo6 Whlte—Bmltlmg; Green—Cotle Enlorcement Canary—AOPI¢am; Pink—Revenue: Goltlenmd—Assessor
CI'iY Ur CUSTA NESA — BiJSLilI^:G PERM7:1' PERM '�O: P 0515':
PERMI'I" NO: P 051523 PLAN CHECK NG: N GOVT: N SUPP: PV
CONSTRUCTIUN TYPE: V—N PERMIT TYPE: F�U PURPOSE: UTH
SOH DESCRIPTTON : CHr�NGE OIIT WATcR' HEATER SQ F'I';
Ci�AIM VALUE: CALC—VAL"JE: GROUP OCC: �-3 /
COMMENTS: INSTALi, WATER $EATER
�k.N..l(..IE �%�3E dE�%� k�7f �7f 9C� iE iC-� if af #�?E �?f it+E # dt �� iFd(� if *�1F�IE �)f� �k iE 1E-lf 3h-%� lE if �If *�%�3E 4' if iE if 1� �%if jf iE 3E 1E �%�?F�� -0E �% iE if �If K�X i( �K 3f� iE-If�iE )F �Y iE iF it �Y -1E �
7. O N I N G R E: Q U S R E M E N T S
S E T B A C K S �
------------ N.AIN avI?,vING ----------
F?tN2: FT 1N R�AR; FT IN
LEFT: FT LN kGAT: FT IN
--------- ACCcSSORY HUILD'ING --------
FRNT: FT I13 REAR; FT ItV
LEFT: FT IN RGHT; 'r'P IN
PARKSNG REO: PROV; PARCEL; 14139210 'lN�.; REr NO;
PLAiUNZI3G �tUTES>
!
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D E V E L O P M E N T S F. ft V I C a S, R E Q J I R E M i. DI i 5
ZONING APPROVED BY DATE:
BUILDING APPROVED 'dY ;
1
APPLICATION I�SUED BY: �
1F1EiEiFifkif*+3ti4#FfE+�#f3fif#iEitkiE � r r . r�iF) + 1 tc
�eiFiEjfi�:itK�i6jfi!�iE}ffi(�±Fi4#�#k3ffEi(�iE3EiFihiE+:-IFK�#1f�if#F3Eif?fiE. �
LEGAiIZATION;N ' F E E S U
� DAT.::
DATE; `�-S/ 7 �
3i��iFiE +� � �: .
i(� , tE . iF i4'lE IF �k'� � h .. . iF� ' ii
. K
Y. ' a� •
iFfE. iEif9Eif%?E..N- V�
lFifif .IFiEti�?fiE?E. if�i!##!3FlEir..4iQ
R Y STRiJCTJRAL SEGMENT;rI
HLDG PMT Pi,U�SBING ELECTRIC MECHANIC FIRE SMIP/RES GRADSNG
PERMIT 2,00
258 SMIP/NON—��S
PLAN
ISSUE FEE 3.00
BUILDING—DIV—> PERMii ZSSlin PLAN—CHcCK TOTAL PATD DUE
TOTALS----> 2,OQ 3,00 0.00 5,00 5,00 ,00
REVENiiE DIVISION TOTAI,S--> COLLECTED; 5,00 OVER/�HOkT• 00
BLDG PMT PLUMBTNG aLECTRIC MECHANIC FIcZc SN,IP/YOT GRADING PLAN—CAECi(
J.00
ii� tE �f !F iP iE if # if� k� 3E 3F 3E �k iE !f i4 if fF �F i't 3E ih 3f �i 3F 1E iF iF lE # iE iF iFjE %if 1E jf 3f if fE if iE fE iF'f i'rjE 1's IE iE ik if iE?41F 1� #�f:� iE le �F ii� if 3F �f !E ii-i(� iF 3f i!�'!� #'• 1F �i 1F ��
I N D I V I ll U A i F E E b R E A K D 0 W N
TYPE QTY D E S C R I P? I O N UNIi COSP TOTAi COST
PI,U 1 WATER HEATER AND/OR VENi 2,00 2,00 /
END OF FEES �
�
rJ� �Q�)h57J:�—'�lil)w�i�ij � _J- l�•�il
dATE: Odl35i41 TiH„: 7.C:0%
CONSTRUCTION ANOPLANNING P��' 'PA
� APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
� t. 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
B. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. .
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd. �
i �
10. Structural Floor System � 61. APPROVAL`TO DECK •
17. 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 r
15. Rough Electrical-Conduit � 66. Solar SYstem-Final •
16. Rough Electric Wiring - 67. Fencing & Access ApP�oval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTEFING � ��
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 O Gas ❑ Oil
23. Gas Pipe-Rough & Test . 72. Underground Flusli
24. Roof Framing 73. Undergmd. Storage Tank � Gas ❑ Oil �
25. Roof Sheathing � ' � 74,�Overhead Hydro .
26. T-Bar Ceiling (Structuraq & 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 MeterFinal ' �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 Q� (,�� � . �
39. Water Service-Final � ) +�
�
40.,GasService-Final . , �
41. Solar pomestic�Final �
42. Backflow Preventer . �
43. Backflow Irrigation � -
44. Landscape Irripation System , .
45. Sound Attenuation .
46. Handicap Regulations � �
47. FINALSTRUCTURE&BUILDING -�� ,
48. FINAL PLANN�NG
49. Electric Release to Edison . .
50. Gas Release to Southern California Gas Co � i� � -
51. CERTIFICATE OF OCCUPANCY � .
No. Date
OWNER (;OT,T.R(�P PARK DATE 3-1Q �%
JOBADDRESS pg2 pr,n_et�n Th,i��P eUILDINGPERMITNO. ��y59'Z
GENERALCONTRACTOR Harbor �onstruction VALUE $ 11.�ZOO OO
LOT Q1 BLOCK THACT jl� Res �II�d@'t gar
GROUP �I Sc J TVPE V ZONE FIRE DISTRICT� Ll6%],
PERMITSISSUED
INSPECTIONS OATE SUBCONTRAC70R
„� _� „ _ DATE � NUMBER
Footing Trench
Faundation Forms and Grade to
Plumbing, Rou
Plumbinq. Rou
_ s `s'7 I 'f 3 Z
Sewer. St.
Lathinq, In Out
Plumbing, Fin�al, Fixtures Complete r11 LS I���%-:
Plumbing,Fin.alGasTest S� eS
I
Wiring, Final 1•. � �!o_ u _
Occupancy � y � I� � _4
PoRM 210 3M 10-v5
�
, �.,,:. _ �s�71
COSTA MESA BUILDING DEPARTMENT
� P.O. BOX 31�
COSTA MESA. CA�IFORNIA
FOR APPLICANT TO FILL IN
eui�oiNc O
ADOREss __2Vz PRINCFTOPI l7R1\/F
COSTA MESA. CALIFORNIA
OWNER COLLEGE P
aTv SAn
ARCHITECT
OR ENGINEER
CONTRACTOR ��lCi/✓(�(
��
A��RE55
LEGnL �,OT
oEscAiPrioN No. 2
A.P. NO.
s��E 6
OF LOT
USE OF
EXISTING BLOG
TEL.
NO.
LIC
NO.
LIG.
NO.
TEL.
No.or e�ocs.
NOW ON LOT
wE GRom �[�/
CENTEPrcOF STFEET `�Yfi � REAR YARD
DESCRIPTION OF WORK
NEW X ALTERATION I ADDITION
REPAIR MOVING DEMOLISH
BUILOING NO.OF
SIZE ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
BUELDFNGEW RESIOENCE PY. DETACHED
rtE RECEIVED/�
`�-� �"'� - � � � � �� � `�°l
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. PE��1}Qy.�
J
AecEiveo ev onrE RECEiveo MARr; in �co
1 4
Bl11LDING
PDDRE55
COSTA MESA. CALIFORNIA
FIRE
ZONE
ZONE NO.OF TYPE GRO
� PLPNS �
APPROVED
BY pATE
CORRECTIONS I
STATE TMAT TNE R90VE IS CORRECT nND aGFEE TO COMPIY WITH wLL
CITY OROIN4NCE5 /�ND STHTE LPW$ REGIIIPTING Bl11LUING CONSTPIIC�
norv. VALUATION
SIGNATURE OF
PERMITTEE F
� $ ���z�0
AGENT
PERMIT FEE $
PLAN CHECK $
TOTAL FEE $