HomeMy WebLinkAbout1124 DENNIS DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.gA,4PLDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1124 DENNIS DR
Suite:
Vicinity: RESIDENCE & ATTAHCED GARAGE
Parcel Number: 41207440 Zoning: R1 R1
Applicant: SELL, RON
Address: 18032 LEMON
Phone: (714)528-1758
YORBA LINDA, CA Zip: 92686
Owner:
PERRINE, JOHN E
Address
1124 DENNIS DR
$167.25
Phone:
SMIP Res:
COSTA MESA, CA Zip: 92626
Contractor:
SELL ROOFING COMPANY
Address:
18032 LEMON
Phone: (714)528-1758
YORBA LINDA, CA
Zip: 92686 License: 323842
Arch :
Address:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 04/30/2001
Issued: 041302001
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF: T/O EXISTING SHAKE, '12" OSB, 2 LAYER 30# ASTM FELT, APPLY "EAGLELITE MALIBU" TILES (5.5
PSF; ICBO #4660).
21SQUARES
Plan Check:
$0.00
Permit:
$167.25
SMIP Res:
$0.89
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $168.14
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
NOTES:
Rear 0-0
Rear 0-0
Required: 0
FEE SUMMARY
Calc Valuation: $8,900.00
Claim Valuation: $8,900.00
PLANNING & ZONING':-
Left
ONING
Left 0-0 Right " 0- 0
Left 0-0 Righter, 0- 0
Proposed: ..0 -
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 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
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
2"646 (6/00)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
I have and will maintain workers' compensatbn insurance s required by section 37(X1 of the Labor Cade, for the performance of the work for which this permit is issued.
My workers' coe atio Insurance ser and poli umber are: //
Carder: / 6
Policy Number:
(This section nee of be cotrPlateci it thii permit is valued at one hundred dollars ($100) or less.)
❑ 1 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 Celifomia agree t if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: /v1( Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000), IN ADDMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under prov�0 0 ;hapter 9 co ening with Section 7000) of Division 3 of the Business and Profession3god�1 and my license is In full
force and effect. L p / Class e — `7
Contractors Signature: n Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code).
Londers Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) at Division 3 of the
Business and Professions Code) or that he or 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 two hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sate (Sec.
7044, Business and Professions Code: The Contractors License Lew does not appy to an owner of property who builds or improves 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 sale. It, however, the building or Improvement is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cade: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Orivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more loot in depth Into which a person Is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding. lalsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Administrative Code).
❑ As ownepbuilder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Dale:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify 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, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of 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 at standard temperature and pressure).
.................................
...............__.............................._.._.._..................._..........................____....................................................................................................... ........................_....................�......__.
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
we time has on hand a quantity of acutely 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 at standard temperature and pressure).
..................................... ......_................................._.__....._.__.........._____.............___................. _.............. .... ............................................................................................ _._......... _.............. _................... __............ _�
3 Does or will the plicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ ;To
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and tiling with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
...................__..___._.,............."yreq.._.._..._._._......ecti_............_...._.............._.__H........_...andSa............................._........................................................................_......._.__................_............___.
4 If en RMPP is presently required, has Section 25534 of the Californiaornie Health end Safety Code been fully complied with? El s* ❑ No
.__.. ...........�--........_.. __.__.._.................. __............................................................___�._.__..
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this ,a,,ppplication aEEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control disMct or agencJt 6 Yes LJ No
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
................................_...................__..........._.._......_...........__..._......_........._...................._._...._...................__............................._......................................I.............. ............_.............._..............._.__..........._____._..
8 Will any part of the facility to ba ccnsWcled untler this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No
(If -yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
............ __......................_..........................._.__...................... _......... __......... _.... _..... _....................... _.__................................. ............................................ ................... ................ _.......... _..... _................. _._................
__...__.
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency i5 required for the work which is the subject of this
application, have all of the disclosures prescribed by Calilomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
................. _.....................__..................._._............................._..........._—....................._—_...................................................................... ....................... ............................. _............... ._ ............ __................
_
B (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. l agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of 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.
Signature19
Oi al s) Date
2ti-3v-6 4
And/Or Authorized Applicant Date
cODE 1, fNSPECTION TYPE am iKTM9L5 CODE INSPEOON TYPE gd¢, INTITIAL^�
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing
200 Final Re-Rootf z� �� 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Foctory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
r
` COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 I
s
N
000
RECEIVE BV PERMLTU Cj�o �tl"496452
For Applicant to Fill in Completely — Use Ink Only
C NN
BUILDINGA.P.
NO. `//-2 — a70 _
ADDRESSte-AIAI /
OWNER OR ^/
B VILDING
ADDRESS &,I �j
TENANT Q•~
UNIT OR
MAILING
SPACE NO.
ADDRESS
TR LOT SLK.
EL.
TNO.
.NCO. �
! �
CITY S -p
211
NEWVING ADD ALTER REPAIR MODEMOLISH
LENSTRUDTIDN
LENDER
BRANCH
II II �1--
OWNER Y --..J QN I /RT
ADDRESS
USE RQs��e 'W I VALUES/ 7(J
ARCHITECT TEL. c 7sS
OR ENGINEER J
/J
i'�� —�
ADDRESS S'Q
ZONE TVPE —� GROUP
CONTRACTOR
APPROVED
BY 41 DATE 2-7-90
ADDRESS
TEL .
CITY NO. 731
STATE CITY
APPROVED SETBACKS
LIC. NO. :�VD $ LIC. NO.
512E NO.OF SLOGS J
(FROM C/L STRE TI
OF LOT NOW ON LOT /
FRONT
USE OF
EXISTING BLDG. i
O FT. b
Separate permits are required for
L. SIDE FT.
electric, plumbing and heating work.
p
d
REAR 0 FT.
VSE OF BUILDING AND ORK TO E PERFORMED
PLANNING ACTION
DATE
/
APPRVED
O
APPROVED I —{�
.fin
c?D
O '-'
I hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
i
any person in violation of the workman's compensation laws of
O
The State of California.
1 hereby certify that I am properly licensed as a contractor under
SQ. FT. vcJ
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
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
VALUATION
and Professions Code, Division 3, Chapter 9.
PERMIT FEE S
Signature ofn
/ sL PLAN CHECK $ , J
Permttee +�
i
$ I4 q _
TAX S
or
/ D • O
Authoriao ant Date �7'
TOTAL PAID $
3�0
000
'COSTA MESA BUILDING -SAFETY DEPARTMENT
n .1nn r._CTw..cc. /gal lCl\Oalla.1.1.
For Applicant to Fill in Completely — Use Ink Only
BUILDING
q
ADDRESS C
/\
OWNER OR
TENANT
MAILINGS
ADDRESS
TEL.
CITY
NO.
CONSTRUCTION
BRANCH
ADDRESS
ADDRESS
ADDRESS /S,
CITY 1/r�&— 4NOL/17/
STATE C TY
LIC. NO.3G�a 3 LIC. NO.
SIZE NO. OF BL
DGS
OF LOT t� rNOW ON LOT
EXISTING BLDG. ���J �Z%F �✓ t
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PE,JFOBMED
1 hereby acknowledge that I have read this application and state
that the above Information Is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
em exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
Signature of
Permittee
or / _
Authoriz gent Date
7828 12/04/79 20.00 TL
APPLICATION FOR STRUCTURAL PERMIT
CE V PERMIT ND - A
A.P..PNO.`.
BUILDNG
ADDRESS ADDRESSS
UNIT OR
SPACE NO.
Trj,(JO _ - LOT :77
NEW I ADD ALTER REPAIR MOVINGALTER IREPAIR MOVING
OWNER
ED
APPROVED SETBACKS
(FROM C/L STREET)
REAR FT.
PLANNING ACTION
DATE
APPROVED
E
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
VALUATION PERMIT FEE E , Q�
PLAN CHECK E r SO
$ TA% E J O
TOTAL PAID E 70 DC)
OWNER RON TATE DATE 12-04-79
JOBADDRESS 1124 Dennis Drive BUILDING PERMIT NO. 91 1
GENERAL CONTRACTOR G. P. Z. Const. DESCRIPTION of WORK Patio Cover
e.412 -07Z-23 LOT 37 TRACT c866 FIRE ZONE VALUES 1300.00
IN_. ECTIONS
Si nature Date I
TYPE
v
GROUP
I ZONE
SOIL
SUBCONTRACTOR
PEPMLTE SS
GAS
Date Number Si nature
WATER
Plumbing
ROUGH PLUMBING
r
PROP. SWR. LINE HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER E]
ROUGH WIRING
eptinalmd
ent.
TRENCHES 1_3 FORMS STEEL REINF. 0
SO
FLOOR SYSTEM
BOND BEAM 1 STEEL REINFORCE
SHEATHING
IL
FRAME AND FLASHING
LATHING — IN j OUTInk_
PL. -TER. BROWN COAT
5"URAL. FINAL
HE. iNG. VENT., REFRIG. AND A.C., FINAL
PLUMBING. FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING. FINAL
45021
Uo �`, MOSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
PAID
NOV 10-77FHSAOO 555#* 109.78
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY I DATE RECEIVEDIMP.. Teti mn
OWNER
v �s
LDING
MAIL 508 29th Street
ADDRESS
TEL _
CITY TE6
LOT BLOCK
CONSTRUCTION
—
PLANS
ALENDER
STATE CITY
YARDS APPROVED
BRANCH
tADDRE
rdes West Develn ent C
ADDRESS
VALUE
Atd. Gar. $ 61,100.
ARCHITECT TEL.s.
OR ENGINEER Frank Spangler NO 673 -ADDRESS
NO. OF BLOCS
GROUP IJyL1CONTRACTOR
2240 Newport Blvd. Newport BchTYPE
bwrgel•
NOW ON LOT
DATE _
ADDRESS
ONE
NO. OF
USE OF W
TEL.
CITY NO.
—
PLANS
BUILDI
STATE CITY
YARDS APPROVED
YARDS APP OVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZE
NO. OF BLOCS
(FROM EET)
OF LOT A rox. 60' X 8O�
NOW ON LOT
ONT FT.
FT.
USE OF
EXISTING BLDG.
F
Separate permits are required for
L SID FT
FT.
electric, plumbing and heating work.
REAR FT.
FT. '
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLOCS.
ACCESS, BL
VAR. qf- /j K ia-1 I Z L A
DATE
A house ,Plan # 3 1 o,_PRIOYIA. r"`'I' I ..._, ��d1191/7 / I
I hereby acknowledge that I have rlild this appiltAtion and state
that the above Information Is corrcWt and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
�^
I
S;
o
HOLD FOR SPECIAL
REQUIREMENTS.;
SO. FT. 2295
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
the State of California.
1 hereby certify that I am properly licensed as a convector under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licensee are In full force and effect, or I
em exempt from the provisions of the State of California Business
and Professions Code, Ivision 3, Chapter 9.
Signature of / /�%
Permittee ,lea ra.cp yi /�/rL) -�
r
m_
O
q
of
f
U
VALUATION
$ 61,100 .
PERMIT FEE E
PLAN CHECK $ 105.5010
TAX $ 4.2$
Authorized Agent ^�'f%'L�GGhs
TOTAL PAID $ ��
DF COSTA ME/$q/J• CONSTRUCTION gCPERMIT%19
T Address __ iU '
;ant's Mailing Address ` !R / Lc/ Ffr i7`a'P FJNha
Arch/Eng.(,_( License No.
Address _ " r' L� IG-
Address 'mailing) A 76
City License No. 7 i
LICENSED CONTRACTOR DECLARATION -
I hereby affirm that I am licensed under provisions. of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full f rce and effect.
License Class nsry
Date Signature
t/G1�
'SKERS' COMPENSATION DECLARATION
'eby affirm that I have a certificate of consent to self -insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lzb.C.) IY'91i� 9t / N
) -
Policy NJ.p�Company
Certified copy is hereby furnished. -
GertifieQ copyr �i�s f�iled with the city B ding iviSi 01)
Dates - _ �-'f- Apt Z-7
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Th issection need not be completed if the permit is for one hundred (S100) or
less). 1.
1 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 becomeisubject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to tfie
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097:CIv. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, Improve, demolish er repair
any structure, prior to ils'i Ssuance, also requires the applicant for suCh permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
Contractor's License Law (Chapter 9 (commencing with Section 7000) Of
Islon 3 of the -Business and Professions Code) or that he/she is exempt
efrom and the basis for the alleged exemption. Any violation of Section
-.s1.5 by any applicant for a permit subjects the applicant to a civil
Enalty of not more than five hundred dollars ($500).
1, as owner of the property or my employees with wages as their sole
compensation, will do;the work, and the structure is not intended or offered
for sale (Section 7044, 'Business and Professional Code: The Contractor's
. License Uw tloes not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not Intended or offered for
sale. If, however, the building or improvement is Sold within one year of Com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License l.aw does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects wltIn a con-
tractor( license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation insurance Should be provided to me.
10 1 am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read this applica[i
information is correct. I agree to comply with a'
and state laws relating to building construction,
sentainspection
of thisi to e r p n the b
inspection pur
Signature
Drivers' License or SS -4
CMF 0865-46, rev. 10/84 White - Building; Canary
tate that the above
d county ordinances
eby authorize repre-
toned property for
Date
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
r
15ou
1
0445 7/30/86
IIla5..61 TL
TYPE OF CONSTRUCTIONLJ NEW ADD ALTERATION
❑ CONVERSION ❑ DEMOLISH ❑ OTHER ''
DESCRIPTION OF WORK/ E OF BLDG. W Al
�- a CD �0 �y e^-
REPAIR
//''
ty
A.P. # - -
Zone
1ANICAL FEES
E
Main Building: Accessory Building:
DEVELOPMENT SER VICES REQ4UIREM
Zoning Approved By
TYPE OF PERMIT G ADING �p FOUNDATION rO N-�Cy1�STRUCTU RAL
❑ TENANT CA ELECTRICAL IP PLUMBING DCMECHANICAL
ElOTHER
T
Front I
Z
O
B
A
Rear
.
N
I
PROJECT DESCRIPTION SO.F 2 OCCUPAtf//I.1CY
CONSTRUCTION TYPE Y VALUATION$1���
ZONE GRADING CU.YDS. ACRES
Building Approved By
Application Issued By
C
Right
Date �7 _3O
Dat
N
S
Left
G
R
$
$
$
25% $
$
50% $t
Ping. Ref. # Parking Req./Provided
-
SMIP $ 0,%
PERMIT
ISSUANCE $
ENERGY P.C. $ _
GRADING S
MICROFILM $ -
-E
Remarks: 0. '7
Planning Notes:
M
C. Z,42Z —44 S
MECHANICAL
$`(�`�U�
s
TOTALFEE
-•' PLUMBING FEES
Bar Sink Showers
$ 3
_ ELECTRICAL
'FEES
-• /a
g3ckflow,Preventer Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
j] 50+ KW
Backflow Irrigation Sewer Cap
' Bathtubs Sewer Connection
-
c' J ��
^ D— mow'
Cooking Unit
Meter, ❑up to 100 amps
-
Clarifiers Solar Collectors'
Dishwasher
Meter Clover 100 amps
Dishwasher Solar Piping
-
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains Solar Tank t
Fan _
Motors 110.1 HP ❑1 %- 8'
Floor Drains Swimming Pool w/Spa
F.A.U.
Inc. Solar 1:19-15 HP El 16.15+
Floor Sinks Urinal
Fixtures
Microwave
Gas Service Outlets Water Closet
—
-
Device boxes
Pole Light
Interceptors Water.Heater
Outlets-
Range
a�
Kitchen Sink '- Water Service
Switches
Sign
Lavatories - Auto -Wash
Garbage Disposal
Standing Sections
P.=Trap - - Laundry Trays
Generator ❑0-5 KW 05.15 KW
Trash Compactor
Roof Drains
'I
-
Reinspection Fee 1 $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,000
Reinspection Fee 1 $15
Pink - Accounting; Goldenrod - Assessor
Issue Fee
$ 3
Reinspection Fee
$15 Issue Fee
$ 3
1ANICAL FEES
Hood or Type I ❑
HoodCanoo
DEVELOPMENT SER VICES REQ4UIREM
Zoning Approved By
7r ^/
Date jp
Type 11 ❑
.
Building Approved By
Application Issued By
Date �7 _3O
Dat
Refrigeration System
❑o-100,000 BTU ❑100,000 BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK
ELECTRICAL
PLAN CHECK
$
$
$
25% $
$
50% $t
SUMMARY OF FEES
�d�. -S'O
Z
(�
-
SMIP $ 0,%
PERMIT
ISSUANCE $
ENERGY P.C. $ _
GRADING S
MICROFILM $ -
SystemRepair/Alteration
Fire Dampers
Registers
MECHANICAL
$`(�`�U�
TOTALFEE
�p
I
$.�%.in
Issue fee
$ 3
PLAN CHECK
25% $
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r --4v' �
c' J ��
^ D— mow'
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
0
1. Temporary Electrical Servfe`e'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 LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
1-i6Q
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
/1•-20-66
(,&)
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
Z,
L�17
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test
72. Underground Flush
'
24. Roof Framing
73. Undergrnd. Storage Tank 0Gas ❑Oil
25. Roof Sheathing
N Qp
74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
'
27. Frame and Flashing
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76. Dry Standpipe
28. Lathing & Siding
8%
,Q jeF
77. FIXED SYSTEM FINAL
29. Insulation
87
DIS'
78. FIRE PREV. FINAL
30. Drywall Nailing
G
p#i
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter-Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
_
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Notes: 1Z 4 4O!G
34. Final Heating & Air Conditioning
(-3t�-97
C&D
n
Yb 7'
35. Final Gas Pipe-Test
-
-•
36. Hood or Canopy
2 �p IiN�'L Cigi.Gf�- GDpil,�tCTio
37. Final Factory Fireplace
IVO APNOe V/
38. Final Plumbing
L0c6
..
39. Water Service-Final
v.. 8
40. Gas Service-Final
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ti• r2 G A2 i n q
•41. Solar Domestic-Final
k' •SC - >to
42. Backflow Preventer
-
O,l� "
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
t.
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
r
Applicant to fill In all spaces except these within heavy border lines and sign all appropriate declarations.
CITY OF COSTAMESA CO TRUCTIONt PER IT
Poe��,/
Applicant's Mailing' drdreisQ
Owner's Naryle�l1 ��� Phone7"y�
� Z
Address /�� �6t�.y�f ��•
Arch/Eng. License No.
Address
Contractor's No ,` En��y oneCLQL' z
Address (mailing) h,—Z
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
With section 7000) of Divi Si on 3 of th Business and g0{ey�s�.gd
my license Is In full f e and effect. - YU
Licen sf�l 1 .
Date /� 519na fur
WORKERS'COMPENSAT IO N D LA Rl� ION
lereby affirm that I have a certificate of consent to self sure or a Certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
.,800, Lab. C.)
Policy No. Company
BCertified copy is hereby furnished.
Certified copy Is filed with the city Building Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred (5100) or
less).
certify that In the performance of the work for which this permit is issued, 1
shall not employ any person In any manner so as to become Subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or this permit Shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there'is a Construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any City or
county which requires a permit to Construct, alter, improve, demolish or repair
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant t0 the provisions 01
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
`Ivlslon 3 OI the Business and Professions Code) or that he/she Is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
131.5 by any applicant for a permit subjects the applicant to a civil
nmalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their solo
cpm pensa tion, will do the work, and the structure Is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not Intended or offered for
Sale. If. however, the building or Improvement IS Sold within one year of com-
pletion
E, the owner will have the burden of proving he/she did not build or Im-
5va r the purpose of sale).
IJ I, afos owner of the property, am exclusively contracting with licensed Con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a COn-
lraclor(s) license pursuant to the Contractor's License Law). I am aware that
Proof O( their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
Ihereby certify that I have read this application and state that the above
information is correct- I aoree to comply with all city and county ordinances
or
CMF 0865-46, rev. 16/84 While - Building; Canary
7489 11/19/86 15.00 TL
TYPE OF CONSTRUCTION LJ NEW LJ ADO U ALTERATION LJ REPAIR
FEES
A.P. # Zone
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
S
Main Building: Accessory Building:
Showers
TYPE OF PERMIT U GRADING rl FOUNDATION El STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑
E
T
Front
Z
0
B
A
Rear
N
OTHER
C
Right
N
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION$
S
Left
R
PIng. Ref. c* Parking Req./Provided
E
ZONE GRADING CU.YDS. ACRES
Remarks:
Planning Notes:
D
Nl
Dishwasher
Meter E3 over 100 amps
Solar Piping
S
Preventer
Irrioation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fee I ( $1
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System 0 Multiple
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
00-100,000 BTU 0100,000
Reinspectjon Fee I $15
v
Pink - Accounting; Goldenrod - Assessor
PLUMBING
FEES
Showers
ELECTRICAL FEES
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50 + KW
Sewer Cap
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Solar Collectors
Dishwasher
Meter E3 over 100 amps
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Solar Tank
I
Fan
I Motors 110-1 HP 1:11 A - 8
Swimming Pool w/Spa
F.A.U.
Inc. Solar 09.15 HP 1116.15+
Urinal
Fixtures
Microwave
Water Closet
Device Boxes
Pole Light
Water Heater
Outlets
Range
Water Service -
Switches
Sign
Auto -Wash
Garbage Disposal
Standing Sections
Laundry Trays
Generator 00.5 KW 05.15 KW
Trash Compactor
Issue Fee
3
Reinspection Fee
$15
Issue Fee $ 3
IECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved ByData
Application Issued By Dat
Hood or Type ❑
Canopy Type I I ❑
Refrigeration System
00-100,000 BTU 0100,000 BTU
IL I RMI
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUM
$ _LSG_S�+
$
$
$
$
$
$
$
ff Y. EES
SMIP $
PERMIT
ISSUANCE S
ENERGY P.C. $
GRADING S
MICROFILM S
TOTALFEE $
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
S 3
CONSTRUCTION AND PLANNING
APPROVALS Permit #
I
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit -Un rgrnd.
55. Electrical Bonding
5. Steel Reinforcement \
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
-
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping OGas OOH
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 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
f J
35. Final Gas Pipe -Test
36. Hood or Canopy
37: Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
'
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
0
46. Handicap Regulations
-
47. FINAL STRUCTURE & BUILDING
,
0
48. Special Requirements Completed
I
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
-•
51. CERTIFICATE OF OCCUPANCY
No. Date
-