HomeMy WebLinkAbout873 DEEP CREEK - Building PermitsCITY OF COSTA MESA
05`°"'"s B!/ILDING DIVISION
F�� 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: P10-00092
PERMIT TYPE PLUM
APN: 93506037
JOB ADDRESS: 873 DEEP CREEK CM
Vicinity: GARAGE
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
07/08/2010
RMD
SCOPE OF WORK: PLUMBING PERMIT TO CHANGE OUT WATER HEATER TO A TANKLESS WATER HEATER LOCATED IN
GARAGE. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. ' �
OWNER:
PHONE:
APPLICANT:
PHONE:
PHI�LIPS, ELIZABETH J ��
IBANE2, ADOLFO B ' -
600•503-2666 - � -
CONTRACTOR: ECONO AIR
Address: 4915 E HUNTER AVE
City/State: ANAHEIM, CA �
ARCHITECT:
ENGINEER: ,�
A
ZipCode: 92807
-Address: -%KAYA, STEVEN W� COSTA MESA, CA
City/State/Zip: 873 DEEP CREEK . �, �
Address: . � � - � -
City/State/zZip: � . . � . �
� License No. 445220 .
' PHONE: 800-503-2666 �
� .. ' CELL: �� - .
License No.
License No.
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT.FEE: '
TOTAL FEES:
50.00
$35.80
$35.80
PHONE:
PHONE:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No, g2-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permrt !o be considered legal, such work must comply wilh aN applicable codes, and all
required inspections and final approval must be obtained. Failure lo obtain inspections and fnal approval will result in the expiration of this permit.
LOOE t. INSiECTIONTYPE OATE INTITIALS CO�Ep INSPEC7IONTYPE DATE IN1111AL5
1616 Fixed System Final Fire Prevention ' 206 Final Mechanical ��
1266 Pool Spa Final 208 Final Plumbing �g/,._2j19�8��C1/ '
200 Final Re-Roof 210 Final Elecirical
201 Final Block/Retgining Walt 212 Final Fire Prevention
202 Final Factory Fire place 220 Final Planning Approval
203 FinalSign 222 Final Site
204 Final Demolilioq 250 Final Building/Occupancy
WORKERS' COMPENSATION UECLARATION:
I hereby atfrm under penalty of perjury one of the following declara[ions:
❑ I have antl will maintain a certifcate of consent to self-Insure tor workers'
compensation, as provided for by section 3700 of the Labor Code, for the
peAormance of the vrork for which this permit is issued.
❑ 1 have and will maintain workers' compensation insurance, as required by
sectbn 3700 0( the Labor Code, for the performance of the vrork for which this
pertnit is issueC. My vrorkers' compensation Insurance carner antl policy
number are:
o,am�s: c,� �-u-�.,,-.�. . �-,.�.�-�--
(�nis seaion need mt be mnpe(M aMe pemia a vaNed at me hunOretl wnars (5100) orless.)
Pol�cy Number: � �� �c_ �'i ! Y"-( 6 �U 6 �'�-a �%
❑ I certify that in the peAormance o( the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the vrorkers' compensation laws of Califomia, and agree that if I should
become subject to lhe vrorkers' compensation provisions of Section 3700 of
the Labor Code, I shall forthvrith comply with these provisions.
G�C�, '7 -� - !a
�+ol�ik jSiBoaWre ate
(/ "
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SUBJECT AN EMPIOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm ihat I am licensed untler provisions of Chapter 9(commencing
vrith Section 7000) of Division 3 0( �he Business and Professions Code, and
my license is in full force and eflect.
Lic, ��` �l"tv Class # ���'r Z��
¢a o � �"* _ `% _ �7 � / C7
�- tloYSSignalur�- rD�e�l�ey
f�.. �'„
CONSTRUCTION LENDING AGENCY:
❑ I hereby a(fum that lhere is a consWction lending agency for the
peRormance of the v.9rk for which this permit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Da�e
OWNER-BUILDER DECLARATIONS:
I hereby affirtn that un0er penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or counry which requires a permit to
construct, alter, improve, demolish, or repair any structure, pnor to its
issuance, also requires the applicant for such permit to file a signed statement
[hat he or she is licensed pursuant ro the provisions of the Contracrors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of Ihe
Business and Professions Cotle) or tha[ he or she is exempt therefrom antl
the basis for the alleged exemption. Any violalion of Section 7031.5 by any
applicant for a permit subjects Ihe applican[ to a civil penal[y of nol more Ihan
five 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
ofteretl for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himsel( or herself or throu9h his or her own
employees, provided that such improvements are not intendetl or oKered for
sale. If, however, Ihe building or improvement is sold within one year of
wmpletion, the owner-builder will have the burden of proving that he or she
Gid not build or improve for purpose ot sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to cons[ruct the projecl (Sec. 7044, Business antl
Professions Code: The cont2ctas License Law dces not apply to an owner of
property who builds or improves thereon, and who contracts for such projecl with
a cont2cta(s) license pursuant to the Cont2ctas License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signawre
305]-46�3I0]�
Owner ID verifetl by tlriver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ovmership by (rype of document, i.e. - property lax bill or tleetl�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cert'rfy that no excava[ion frve (5) or more feet in Oepth into wfiich a
person is requiretl to descend, will be made in connection with work authonzed
by this pertnit, and that no builtling structure, scaffdding, falsework, or tlemolition
or dismantling Ihereo(, will be more than Ihirty-six (36) feet high. (Chap. 32, Gry
2, Art 2, Sea 341, Trtle 8, Califwnia Atlministrative Code�.
❑ As ownerbuilder, I will not employ anyone to do work which vrould
require a permit from the Division o( Industrial Safety, as noted above, unless
such person has a permit to tlo such work from the division.
AOPlicanfs Signalure
Division o( Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre builtling occupant need to file and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health and Satery Code requires, with some
exceptions. that a Business Plan be filetl vrith the Costa Mesa Fire
Department by every business which has at any one time dunng a reportetl
year a quantity of hazartlous materials equal to or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic fee[ of compressed gas
at stantlard temperature and pressure).
2. Does or will the applicant or present or tuture building occupant need lo file
a registralion fortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safely Code, with some
exceptions, requires regishation with Ihe Costa Mesa Fire� Department by
each business which at any one time has on hand a quantity of acutely
hazartlous materials equal to or greater Ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feel of compressed gas at slandard
temperature antl pressure).
3. Does or will the appliwnt or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifcation antl
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials vnth [he Fire Deparlment.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied vrith? ❑ Yes ❑ No
5. Does or win the applicant or present or fuwre builtling occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or (rom
any other air polWtion conVol tlistrict or agency? � Yes ❑ No
(Sectbn 658502 0( the Califomia Govemment Code requires that Ihe reques[etl
information be fumished on applications fa noo-residential builtling pertnits).
6. Will any part of �he facility to be conslructed under this permit be within
1000 feet fmm the outer boundaries of a school? ❑ Yes ❑ No
(If'yes", Ihe faciliry must meet the requirement o( Sections 25534 and 42303
of the Cali/omia Heal�h and Safety Code).
7. If a permit from the South Coast Air Qualiry Management District or other
air pollution control distric[ or agency is required (or the work which is the
subject of this applicatioq have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certificate of wmpliance from the appropnate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
infortnation given above is cortect. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
ceAify under penalty of perjury that I have read this application and state that
the information given is correcL I agree ro comply with all slate lavrs antl city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon Ihe above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by lhis permit until fnal inspection.
S�egal(lw�n,�<� Date
` �j�'r�.t 7 —�' —/v
.. �?O?3�.z(VG�1Wnt . �.��
PreScripTi��c CerEificate uf Cunzpli.,_
Jtaridentitd filYeratiori.r
R
Gencr:d ]nlnrmalimi
f�esldential
EC.d+�-,�
cr-ir.-nLr
Q'x�,e7 uf�)
� I t: ��-°b'�i:ies- I
Sitc ndAress: I Lnlurcemen� Agencp: / /.,�7,i ,IV ),nc '? � �_ i �
�� Vr/l 1 "' t
Builtlin, lypc L'lJingic Familr ❑ Idolti Family � Cirale thr Froni Urientetion: h', E, S, Vd; or degrees
Projeci 7ype�. ❑ Hlterntions ❑$nvelope � Feuesvatioii D kuof !
Conditioneel Plooi fn'e�i (CFN): %�T_ 7�eplucemeni or Chanee GW ❑ Luci 1!enlncemeni ❑\Mnter Heate.r
N07E: 7Yiis f�nvr is nol in Gc uxer! Ynr Nernlr Gin.en�ur.led lSuildin�.c nr Additinn.r
lnsnln't�nn Nal��es Fnr Opnquc SLrincex (Jor Fun'ing ua�e Ihr Alosa crnd Fnu�rinb Slri��v C'm�.snveiiw� �iiblr lielmv), � .
Assem611' Alteratim� . ,
0 Opeiunt of iranieA cti�dtr almre—�ILercuiona- thnr invoh,c �he openfn� oJllvc fi�omecicnvip' o(n wtdl, ceiln�e, o�.Jloor mus� in.sml( Ihc
mcindtunrl' »>ininnmi in.siJtnion nnlue per §J50 jm� lhc nhered u.fa'emi�h�. Fill in Cohmms �i —C and emer mm�datorp insidu�ion value in Colvnm H.
❑ ltepl:�cem ent oi- enti re �issembl y— Replacemen� o/ ai emire rvnll. ceil ing, nr _/l aa� ns,sembfp reguire:; O�c insiull ntinn nf Comyrnieni
Yucki�snr-L ina•ulatinn nolvc inTuLle ISI-C. Fill iu Coh�mns d— J. � .
Onaque Su� face Detlils inr the lurreo
/+ � b J C
Yroposed S�cnm��
Frami� e
Ta�/ Assembly l�ame Niaterial
ID' or7yoe� and5iz='
�
—�
.Nore- For 7in'red assemLlies, nccm�niino (m' Con�inu
rtiuned uf 1Nass \§�alls see Furrin� St
ll T; P
Stnndard
Tiiiclmess, i
Suacing, U- �� 7H47able
or Other' ' iacior' '� Number3
insulation G-value, see PnXe JA<-3 m�d Eq�
Cunstructiun T�ible belnv;.
Values From ]A4 Table
Framed Continuous ]A4
Cavin� ]nsulation Assembly
J
Hssemoly
U-iactor"
use Ihe d4ass and
1. For 7ng/!D indicoie fl�e identillcation name tlm� n�niches !he 6trilding plana'. �
2, l�idicnie Ih^ fissenvblr Nnme or qye: koof/Ceiling, N''alls, Floa's, Slabs, Crawl Space, Loors and etc...lndica�e the Frmne�rype and Size: ror
Wood, Meinl, Metal Buildinga, Nlass, en�er 2s4, 2zG, or etc... see JA4,ia�' o�her yossi6le,n-ame rype assemblies.
3. cmer tlie Uiiclmess for mass in inche,c or Suacing benneen fi-aming members wuer; I G'or 24 "OC; ar Glhei:io�� aIl other assem6h� descriprion
sirch ns Cnnc+'e1e SanduricH Parrel, Spaiedrel Paner, Log�, Strair Bnle Pa�eel and erc_..
ti. Dnsed on d�e Climn�e Zonc; emer ihe S�andm-d U-faaa,jrorv Tablc l.il-�, C or D/or euch d�ereni asse�nbfp Name ar n�pe.
5. Emer Ihe Tubic mm�ber litai cfw�ei,r rea�embles tiic prouoa�ed as•e�en�'b(r.
(. Enrei� d�c N-��aiue lhur ia� berng ittstullecl in Ihe iaa(1 cuvirr or betH,eeir lhe,liruning: otl�ere,is'c, entec "0 ".
Z Lnier !hc Cm�linunu.�, Lis�daiinn R-i�niue (or !he proposed ua'semb!)'; otherwisc. emer "0„
S. Lnier liie ro�m nnd colamn of (hc U-fnctm�-valuc bna�ec! ou Colurrm FTnble Nrtmber a+d eiver Ihc ds.xemblp U-facmr in Colvm�n J �
J. Thc ProU��.sed de'sembli� L%/creror. Cotarnnr J, mur� br equo! iu rn� les.c tlran Ure Sumdrvd C�=/oc�or nr Cnlanm E to cnrnp7i'.
Pm'rine Su�ins Consiruction 7al�le �I'oi 1Viasn Walle Unl��
q ]s C b � F � G H � 7 J 7i L M
Ih'apuxetl J'ruperLies otM:�suun' and Cuncrelr. Addt:d Lrim•iUr or EXteriur �Insnl:ii'mu I
�'��nIL:Prunilie(m'ence InTm�ring5p;mrSruw Re1erL•ucu
.lninl Anuuudia T�ihle �I.3.5.4.3.G. A.39 ,luinl A��cullia 7ahlc 4.;13
U V� ,� 1 � - �✓
u: L �' c S L'c' � u: e
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o �' .� � 4�.. -. ', m TJpJ�
hxxcmbic �- � � g �� � o�_ . .- _
� /lSSCIT��
ar
1Vr,�s:. Ivmnuoi .INA'I�ihlc �� I � =- ��-, a � - s e' " a Y
'fblclwes"� ,IYPc' 7Vu01irei' - � W' � � G � N �' � N L�-�ilCtOf�'� �,OTIIIIICIII
) �� � � � �
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1argi.xir�nian 7vtinnbm�: licguu�aiion Uaic/7'imc: HL'"1;SYrrimder:
2(111L' lie.ridential Comp7innr.r• Fornz�� itug�esi 'lh(IJ
Prescriptive Certificate�oi'Cumpli�nce: ]'iesidential C7;-1]L�
Resirlei:tial Aheratinns _ - � (Y���r 4
�
Lis� woter heaters and boilers for both domestic hor water (DHN'J hea(ers and hydronic syarn hea[ine. liidiviaual dwel(ino DH)d'heaters must be
gas m' propRne frred, med mav aot exceed 50 gullons. No/ warer pipe insulatio�r n'om theOHN' heater to Jhe ditchen(sf and mi af! �ardergromrd
hor water oioes is reauired in all comooneiv nackn�es in a0 climnte zonea.
WaterHeater7ype/Fuel Distnbution7ype Number 'Ianl: Ener��Facroror Tan}:1nsulacion
Tvoe'' (Standard. Recirculationl' I ln Svstem Capacin� (eaq Thertnal Efficienev I R-Value'
). 6id�ca�e Type (Stw'nge Gav, Heai Pump, Irtstantanern�s, ete)
1. Tiic neH� woter heater rype sha!/ bc limi�ed [o eatural gas, lique(ed yeiroleuni �as, or tiie esistino (uel qye.
3. 7fecfrcidating svslems se�ving rnulnple dH�ellino units shi�ll n�eel lhe recirculalion reguirements a(i�750ln). The Prescriptive r-eqn�iremenis do
nm allon• the ins�a(lation q/n recirculaiing water neatino svstem (or sing(e Awelling writs. .
4. Theeuernal wnier heaunt� tmik and nines sh�dl be ir�sulnted io n�ee� Ovc renuir-er��ents o(��Y50(i1. .
I(eg�.cu�mion lviunGer. l(e;�isrradon Ilain.,�Time: HcRS l'roviuee
200d' Residen�ial Compliuiree rwms A4ur
FIL'',1:5 V�IQFJCATJOI�' SDI11MA7.)` Ti�e en7or-aemeni ug�nc7�shmild pnra:neeial iiuemion io l6cHEl;.`,�ii9earin�e:: e'peci)icrl u, iine
checldist Lelmr. �i coumleiedoi�clsigned CI-d]i Fnrm fn� nll l'nc men.riu�er. a7�ecijleclshn/! Le submFtteA tn Yiir ir+rilding inspecmr Gejnrr jin�il
�IlUcf SCtllin�� �� iCSiill� HL/tS'ncrificnhon israqnn��et/fot �hi.� mcua�airc- �
❑ i'�S ❑ IVO 1'li5-Li Cllniute "Lune: J uud y-I G, if morc thau 4111iuear ieel oi new nrreplacsnicm ducu:;u�e i��sitil]eU iii uucondltiuue�
sp,�ce. the ducl:. aire to B� seuled uei tiJ 52(i�)1D(i and the nawh' insialle�f duct� mc w h� iuswnieA pei t� 1� I(i�l l ll.
❑�XCLII'T101�: Lxis[ing duct s��stem;; th:il w�r extended; �vhieh nre cunstructed, inxul�ned ui' vemied �viCh ;isbesius.
❑�'�S ❑ 1VC) YL+S ]u Climu�e `Lmie:`2 and 9-] 6, if the e>:istim� space� conditiouiug spsient (HVHC eqwpmeni and duciingi i;. r�placed, the
ducts ai c �o b:: s�aled pei { 152(b)] Li.
❑ 1'iS 0 1V0'Y�S ]ii Cl�mete `Lune& ° antl 9-] G, if the existin�� HVAC equipm�m iti repluced iincluding th� replao�m�m o1 ihe. air handla�,
ou�doa- �ontieusin� nnii oi n spiii systen��; coohng or hentin� coil, or th; $�mac: li�ai ezc'nnnger� [he ducts .n�e to L:
. sealed per g152(b)lE.
, . ❑ E]:C�PTlO��. Luct systemr thnt nre dncumented w Lm�e Ueeu previuusly sealed contirmed UvunrL HL,P.S .
- �veriticatioii iu:�ccurdance �vith-prucetiures in.the�Sdcierenec Tdesidential Ap��endb: 1U�3, ...
� �� ❑�XC�PTJO��, Luct svstems with less thau 401iuear feet in uncuiiditiuned space.� �� .�� �� ��
❑ EXC�PT10n: �xisiin,� ducl svstem.c cunstructed. insulnted m� sealed ivith asbestos.
Rei'r1°eF'ani ChaYve - Sj�llt Sl'StBm HERS verijicn/iDn isrequv�ed fm� ihir measio�c � � �
❑ Y�5 ❑ NO Y�S�. ln Clitnat� Zones 2 antl 5-15, wl�en tht esisting H\�HC equipmeni is replaced jincludin�� ti�_ Teolacemeni ot"the air
� handler, ontdoor condensing uni� of a sp}ii sys�em A/C o� heat pmnp: eoo)ing or heacin� eoil: or th� iuraxe� hee�
exr.hano,=,�i a r.=iri�erant cliaro� measuremem sliall b� vB�15ed nei' 11i2YblIF.
Central Fan Inte�rafeo fCFI} Ventilaiion Spstem and Fan Vi'at� Drah
The ventilaiion remiirements of FI50(ol do no� aoolv to e�istint� residen[ial homss.
Ducted Splii Sysiems - Air Conditioners and Heat Pumps: Airflow HCRS verijicaiimi is reguu'ed (orlhia measurc.
❑ 1'LS ❑ NO 1'L+S: ln Climate Zones 1 U through 1 n, wlieu th� existing space-conditioning sYstem (HVhC equiument anci duc[iugj is
reolaced. the aidiov.� and ian wan draw siiall be veriiied oer � 152(bl l Ci to mea the reauireinents oi' 91 �l (f17B.
I certlir thal this (
1Jame: �
Compam�:
E ��
,4doresc:_
�y'� S
Cuv/State/ZiL�
ancl
G�,�--c •
� • g�7
� �
Lat�.
��� _��.
li Applicable D CE 4. or � C�PE
(CertiGcation ill:
Phon_Q�
O�"�ST��i' ?�
i) nSi6Pr Iiuildinn Dexicncrb� J�:�ciaratiun ,9t;itemenl �
7 am eliFiblc undei Diviuion ? ai thc Culiiomin Busines� eind'I'iofessionc Codc io uccepi responsibility loi thc bulldin��, d�slgn idenu � un^
lhi:�, Cenif�ica�e of Coinpliance.
7 cer�iiy lhai lhc em;rg�' Icu�ure:�. unA perlormanec cpeciiictuion:� im� the'ouild'in�� design Identliied nii thi�.: Ccrlificxtc uf Cumpliancc cun(orm
tn lhclw�uiremen��s nfTillu'L4,1'�in:. ] and L ul thu C:ulllurniu Codr ufRe�ulaiions.
Thc buildii�;� tlesi�n Jemure;: hientiGed ou Ihi:. Ccriiiic�nu uf Cumpliimcc tu�c cunsistem v�11L the lulnrmaiiui� prnviued io ducunr�m Ibi:,
i�ulldm< <icai�u m� Ihe ulher �ipphcnblc eumphunec'I'orm:.- wuiP.shect:,; culculu�iun:., plam: uutl specifietuiun:. suimutted in Aic enfurcenrvni
a�enc�� lu; ni�urnval wid� lbia 6ulirinr�uermi7 ,ipoli:;;llini�.
Ivtim�
C,ump'any.
nddres:�.�
���,,�s����r����.
Si�nuuv�-.
l�utc:
Lic�nc :
I'nmre.
Trn �er.cLrtttrrce o� g�re,vtiwv. re�m�drn�� tke b+rr,,.gi� Stmtdrvrl.t, ernn« c� thr Eiarrrdi ]lotliir�� «i: 7-1llll�-;; '-r;3Ull.
he�i.erranun l��mriimr l(et�i.vruuun Lmc/11me' l-1F•1;� !'ruvicier.
G.,�„�i,.: '111/10
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i.
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PFOJECTAOOflESS: 87� D�,'EF3 CjZt,EK
OWNEH'SNAME: VILLAGE CREEK HOMEOidNERS
aooeess: ASSOCIATION
3429 TIMBER LAKE
CM VA 92626
uxiT:
PPCH/ENGINEEfl: (,HESTER CARVILLE Rec.xo.:Cl$305
, aooness: 7.9 z Z ARMC)UR ST uxir:
S.D. CA 92111
_PERmmEE: pHOENIX ENTERFRISES INC, ( 213 ) 690-9559'
AUOflE55: Q 1 j_ COMERC I AT, WAY � . •
LA HABRA CA 90631 �
LICENSEo CONTHACtOP OECIABATION: I hereby a��irm �hai I am licensed untler pmvision Chapler 9(com ing wi�� Sec�ion
7000 of �ivrsion 3 0l Ihe Business antl Professians Code. and m license is in f uce Flect.
I r
c�rvuc.: ' sTnr'��.:376639 c� : j — _
i s� �
Da�e- — Signature: . �l '
WOpNEBS' COMPENSRTION OECU TION: I hereby attirm tha� I ha a ce�ifica�e oi consent Io self�insure ar a ceni � le of Workers'
"mpensa�ion c c rti�ied copy I�ereoi (Section 3800. La6.�{�
icr xo.: �� ���� E%P. OATE: �+ 7� O S I 9 S
�JMPANY: CA COMP 6 FIRE ' ,
Cetltlietl copy is hereby fumishetl. ❑ Cenilietl copy is �ile i� e cy Building �ivision.
�ate. - Applicam: /
E%EMPTION FNOM WOBHE S' COMPENSATION OECIABATION: (This sedion need not �e cample�etl il �he permii is lorone are0 (5100) oNess�.
I ceNty iha� in ��e peAormance ol lhe work �or which this permi� is issuetl. I shall no� employ any person in any manner so as �o become
suGlecl to I�e Workers' Compensation Laws o� Califomia. ,
Daie: SignaWre: ' � -
NOTICE: II, afler making �his OeclaraUon; yau should hecome suhlect Io �he Workers' Compensation pwvisions af �he La�or
Catle, yau must forlhwiih compty wilh such pmvisions or Ihis Dermit sha�l 6e tleemetl revoke0. '
CONSTFOCTION LENOING ACENCV: I herehy aliirm I�a� �here is a cons�mction lending agency �o� �he pedormance oi �he work lor
whlch �his permit is issuetl (Seciian 3097. Crv. C), • •
LENDEfl: '
- aooness: - - -
OWNEB BUILOEfl OECLAXATION:, I hereby a��irm �ha� I am exemp� Uom Ihe Cantrac�ors' Slate License Law �or the following reason
�Section 703L5 6usmes5 ana Piofessional Code: Any city o� coun�y which requires a permii ta conslmci, alter, impmve.'Oemolish, or.
repair any simcWre, prior to its issuance, also requires the applicant for such permit to file a signe0 slatemenl ihal �e/s�e is licensetl
pursuant lo the provisions af Ihe Comracmrs' State License Law (Chap�er 9(commencing with Section 7000) of Oivision 3 0� �he Business
antl Pmfessions Code�.or �ha� helshe is exempt thereirom and the ba5is lor I�e a�lege0 exemp[ioa Any viola�ion ol 5¢c�ion 703L5 by
any appfcant �or a permii sublec�s ihe applicanito a civil penally oi naf more Ihan five hunOretl tlollars (5500). �
I. as awner o� �Ae pmpetly or my employees wit� wages as �heir sole compensa�ion, wili tlo Ihe work„and ihe
� simc�ure is no� intended or o��ered for sale (Section 7M4, Business ana Professional CoOe: The Contracmrs' S�ate License Caw
. tloes not apply to an owner of a pmperty who �uiltls or impmves ihereon, an0 who does such work himsell/hersell or �hrougn
�- his or her own employees, pmvidetl Ihat such impmvemenls are not intenAed or oi�ereU fo� sale. I�, �oweve� ��e Ouiltling or
improvemenl is soltl wilhin one year ol comple�ion, �he owner will have �he �urden o� pmving helshe did not huild o� improve
for Ihe purpose ol sale�. '
I, as owner af Ihe pmpeny, am exclusively contrac�ing with licensed coniraqors �o consVucl lhe prole�USec�ion 7044, Business
❑ and Pmlessions Code: The ConVacbK S�a�e License Law tloes nol apPly �o an owner ot D�oDehY who builds or impmve5 ihereon
-and who conVacisiar suc� prolec�s with a coniracmqs�license pursuant to ihe Coniraciors' State License Law�.l am aware
t�at Omol of t�eir WOBer'S ComOensation insurance s�oultl.be pwvitled to me. :i�
� I am exempt under Seclion: B- 8 P. C. ' '
for �his reason:
Date'. Ownec .
I do here0y cenily t�at I am aware ol and unaers�antl ihe requiremenis af Calilomia Healih anU Salety Cotle Sections 25505. 25533, an0
2553A antl �ha� I or any fuWre Ouiltlmg occupant willlwill not (circle one) neetl �o comply with saitl s�a�e co0es and �he requiremen�s for a.
permii tor constmdion or mo0ilicaiion �rom Ihe Air �ualily Managemen� Oistricl. Fesitlen�ial con5�mciion applica�ions are exempt irom
I�ese pravisfons '
Oate: ApplicanC.
I hereby cer�ify Nal I have reatl Ihis aDPlica�ion antl 51atelhai Ihe above ' r ation i orrect lagree to comply vnlh alic��y antl counry
ortlinances and 5�aie laws relating to builtlmg consimclion and hereby on repre tives of ��is ciry •n upan Ihe above�mention tl
pwpetly for inspection purposes
Dale: ��� SignaWre:
Driver's License or Social Security n:
tfi4i�66 WM1ne—Bmlding'. Green—Gotle Enbmemem'. CanarV—APPImanC Pink—Revenue: Goltlenma—Assessor
CITY Oc COSTA MESA — HUILDT_NG'PERMIT ; PERi�f NO: B OSOG03
PERMIT NO: B 050603 FLAN CHECK NO: 00108-91 A GOVT: N SUPP: N
CONSTRUCtION TYPE:•V-N -!PERMIT TYPE: STR " PURPOSE: REP �
JOB DESCRIPTSOV' : REPAIR SETTLEMENT•DAMAGE : �Q FT; 193 �
CLAIM VALUE: 14,300,00 CALC—VALUE: '14,300.00 � GRUUP OCC: R-3 / •
COMMENTS:�BUILDING SETTLEMENT REPAIR/FUUNDATION ,
3E 3E iE if iF if iP if if iE jF if it �)k k if jE iF )E iF IF IE iP 3E �If 1E jE iE iF 3F fE jF it 3flE iF 3E 3E 1( %)F 3E if 3f IE iE 3E 3E ib 3E jf 3F �E iF �)E iE iE �E iF 36lE K iF 3c 1f 3f 1E �E 3E iF 3E iF iE if 34 3'r 3E 3F iE
Z O N I N G R E Q U I R E M E N T S,
� -S E T B A C K S �. �
FRNT: Fr MAIN HUILDING ---------- --------- ACCESSVRY BUILDING ------ r— �
IN REAR; FT IN FRNT; ��FT IN REAR: FT --IN
LEFT: FT �IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ ^ PROV; PARCEL: 93506124 'LNc; R2 REF NO:•.'
PLANNING NtSTES> FOUNDATION REPAIR. ' '
. _ 7. . _ _ � . � l ,.�' . -•
�1E a(�!F �F iE 1F IE iF iE if iE iE 3E �E it �F iF 3f• iF iF �1F df ab 3E 3(� if lf �)f iF �IE iF 3E iE Ih if 3E 1E jE if if �E IE if 34 if if 343F k iE iF if jF iE ib ff fE 3E )f 3E �F iE �!h iE if 3F iF iE �F iF �f iF iE 3E # lE iE 3f �E
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N`T S
ZONING APPROVED BY :� �-- � DATE: fJ%l$`�J
BUILDING APPROVED HY' ; 4� /c:p.�i—i/ DATE: , d' �
APPLICATION ISSUED BY DATE:
iE 3F IF iF iE �f IE )f if 3E 3E aE 3f ik k 3f if iE 3k 3f 3f �iF7FiFiE iF fFif 1f K 34 if aE jf'iF'iF'�k'�R��3E iE
-1F�f�EiEiF�f�EiflE�k3EIE4FjfaFlflfiFjkjElElEi(-iFifiE3Ed �if3EikaF149fiEM�3EiFifiEiElflFififiFiblflEifiEiEiEikiE�fiE3E3F1E3f3ElEifIf3F�EiE
LEGALZZATZON;N F E E, S U M M A R"Y STRUCiURAL SEGMENT:Y �
BLDG PMT PLUMBZNG EL TRIC MECHANIC � F•IRE SMiP/RES GRADING
PERMiT 162.00. _ 1,00 !
' �SMIP/NON—RES
PLAN 26.33 , ; �
ISSiJE FF.E � �
BUILDING—DIV—> =PERMZT ISSUE.' PLAN-CAECK TOTAL' PAID 'DUE
TOTALS----> 163,00 0.-UO 26'.33 189.33 iF19,33 ,00 '
REVENUE DIVISION TOTALS--> ' COLLECTED; 189,33 OVER/SHORT; � 00.
BLDG PMT PLUMBING ELECTRIG�MECHANIC FIRE SMIP/TOT GRADING PLAtv—CHECK
162,00 , 1.00 ' 26,33
iF *%� if IE 3F 3E %iE �If 1E iE iE i(� fF iE iF �IElE iE iE �1E jE 3E 3E iE ih iE if �FlE �Jf if j(� df iF iE �f IF M� if 3f If iF if iF �E iF fE if jf IE iE 1F �E iE 3E IE 3E lE jF 3E iE iF �3E iF IF iF iF ib iF 1E 1F 1F 1F 3F if iF �f
I N D Z V I D U A L ,F E E B R E A K D O W lv
r
TYPE QTY D E S C R I P T 2 O N' UidiT COST TOTAL COST
SFR 193' STRUCTCiRAL, BY VALUE PER $100,00
-� END OF FEES
500,00 14,300.00
I
. �
Di FiQU73765-�QD?S7i0 g'�o-9' • !��'.53
4Ai'E�' t1I123i91 7iP1E; 1?:#J /
l%
CONSTRUC710N AND PLANNIN, .� & SPA �
APPROVALS Permit # Date Inspector qppROVALS Permit # Date I'nspector
1.' Temporary E�ectrical Service or Pole _ 1 52. Pool & Equipment Location '�
i
2. Soil Pipe-Undrgrnd. � , _, „� - 53. Steel Reinforceme�t �'
3: Etectrical Conduit Utility�Undrgmd. ; � - 54. Forms �-
4.�Electrical Conduit�Undrgrnd. '� � 55. Electrical Bonding - �
r �
, 5. �Steel Reinforcement • , 56. Rough Plumbing & Pressure Test .'
6. Electrical UfER Grnd. x . 57. APPROVAL TO COVER�GUNITE .
7. Footings � 58. Electrical Conduit-Undrgmd. -
.
- 8. Foundation� .' � � 59. Gas Pipe, O Undrgrnd., Test ����
9. Water Pipe-Undrgrnd. � ' n 60. Backwash Lines, P�Trap, O Undrgrnd. ��' n
10. Structural Ploor System �'� -� i-; 61. APPROVAL TO DECK ✓ �r.-�
11. Properry Sewer Line & House Connection _1 62. Backwash & ReceptorFinal �
,/�
12. Sewer Cap .� � 63. Heater & Vent-Final i
73. Roof Drains � i� �� � 64. Plumbing System � Final /�
14. Rough Plumbing - '\ .�i � 65. Electrical-Final
t
15. Rough Electrical-Conduit," t ^ 66. Solar System-Final ''�
16. Rough Electric Wiring r,1 � 67. Fencing & Access ApProval
17. Rough N/iring Sign � j� 68. APPROVED FOR PLASTERING �
18. Rough Electriwi•T Bar Ceiling �' 69. POOL/SPA SYSTEMS FtNAL
19. Rou9h Heating & Air Conditioning % ' FIRE PEPT. REQUIREMENT "
20. Rough Factory Fireplace • t - _ ' • ° •AppROVALS� '-Perinit# �`�
.
21.�Ducts,in_Structuie'. , � , . 70. Underground HYdro �
22. Ducts, Ventilating � �; . , • :71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rouqh &�Test , '� ,, . 72, Underground Flush .
24.� Roof Framing � . - � • 573.� Undergrnd: Storage Tank O Gas ❑ Oil �
.
25. Roof Sheathing - � _ :j . . .'74.=0verhead �Hydro � .
26. T�Bar Ceiling (Structural) & Monocoat �• -_ 75.., Dyy Chemi�al , •
27; Freme and Flashing; 4 '_ , ' 76. Diy Standpipe : �' ",
28.�Lathing&S�ding •. . . _ �� • 77,--FIXEDSYSTEM.FINAL . .
29. Insulation .� - ". � � �( 78:. FIRE PREV. FINAL .- .i'
i
30. Drywall.Naiting � - � f � - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat; ., . � I I: .,79: FINAL INSPECTION ' �
��32c Electrical Power Meter�Final� - . • j j� • 80.=FOOD CERTIFICATE ISSUED ..
33.�Final Electric , ' -. � �, � 'Notes: ' . : �
, c
34. Final Heating & Aic Conditioning, �� � � i � ; ; . . � . "
.r
35.:Fina1 Gas Pipe-Test', , , � � � '
i � ��':�
n
36. Hood or CanoPY `�- r . � . �� - �� . �% �'�
37. Final Factory Fireplace � ` " � ' � ; ' ' �
38 �-Final Plumbing � . � � . � . _ .
• 39f Water Serviee-Final �� '` �' �
• � � � .
, 40. Gas Service-Final , � , , I � `� � „-
41. Solar pomeSticFinal :. � ' �� �� � ` '
1 � � �
42.'Backflow Preventer_ . � I , _ , , �
43. Backflow Irfigation � ' ' ' � -
- 44. Landscape Irrigation System� � _ ,
�45. Sound Attenuation � � � -
46. Handicap Reg�lations - . . '. ,_ �
47.-FINALSTRUCTURE&BUILDIN q(•" ��
�i' G Q w
48. FINAL PLANNING � '� �. . , .
49. Electric Release to Edison • � � - �
� t i
50. Gas Release to Soufhern California Gas Co 1 I S - � .
i : � -
51. CERTIFICATE OF,OCCUPANCY , . . �
No. Date
OWNER STATE-WIDE Developers Inc. DATE 4-28-76
lOB ADDRESS R�z n.a„ (�TPP�C BUILDING PERMIT N0. 4177� —
�"`LOT TRACT
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GAS
ROUGH Pll1MBING
PROP. SWR. LINE MOUSE CON.
SPRINKLING SVSTQM
MISCELLANEOUS
AIR CONOITIONING
UNDERGROUNO U POWER
ROUGN WIRJJJG
FLOOR
SHEATHING
FRAME ANO FLASHING
LATHING - IN (
PLASTER, BROWN COAT
STRUCTURAL, FINqL
I VG, VENT., REFRI
F. .81NG, FINAL AND
ELECTRIC, FIN4L
BUILDING, FINAL
SUBCONTRACTOR
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_ . .. _./_
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COS7A MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
ADDRESS 873 Deep CReek
OWNER State-Wide Developers, INc:
MAIL
CITV CV
CANSTRUCiION
BRANCH
ADORES',
TE
T
AODRESS �7848 Skypark 81v9 lrvine
CONTflACTOR State-Wide Developers, Ii
ADDRE55 qqF� f,rinr11�9v
TEL.
��TY Cypress No 826-�
LIC.NO. 224��0 LICVNO.
OIF LOT 1 Q, 093 dC►'f5 NOW ON LO �
USE OF
E%ISTING BLpG.
SI2E OF NO.OF
NEW BLOG. ROOMS STORIE:
EXTERIOR WALL a5 er ROOF
COVEFING Wflfl({ COVERING Shake
USE OF BUILDING AND WORK TO BE PERFORMED
I hareby acknowletlga that I hava reatl this application ana state
thet tha above information is correct antl agree to comply wit�
all laws regulating builtlinp c0�struction, antl 1 shall not amploy
any Oerson in violetion of the workmen's compensatlon laws of
the State of Calitornia.
I hareby certity that I am properly licensetl as a concractor untler
the Stero ot California Business antl Protessions Coda, Divizicn 3,
Chapter 9, antl t�et sucfi ficensas are in fWl force and etfect, or 1
am exempt from the provlsians Ot the State ot CallfOrnia Busine85
antl Profassions Cotle, Divislon 3, Chapter 9.
s,a„a�„ -State-Wide Develop./r�� Inc.
Parmittee _ �r��A/ �._
AuchorizedApent �J7[P Presiden�
, �,�,
`i:Y 13-76��;cDO ?02" '`?Z�.�;
APPLICATION FOR BUfLDING PERMIT
BUILDING
ADDRESS 87.3
" I
OWNER
FIRE
ZONE
APPROVED
G�e1�
VALUE
ZONE NO.OF USE OF NI
� �'�� PLANS Z BUILOING
VARDSAPPROVED VARDS
DISTANCE BET
HOLD FOR
THE AMOUNT S4
THE PURP�E OF
VALUATION �
$ w+T+.r.r� ��
BET. MAIN &
ACCESS.BLD
DATE
TOTAL
NG
�
R
�
0
VAIUATION IS FOR �
A PEFMIT FEE ONLY: m
¢
E 8 B"'Q tr
K $ a�s E
0
$ , LL