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Home My WebLink About153 DEL MAR AVE - Building PermitsCITY OF COSTA MESA BUILDING DIVISION / PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT PERMIT P00-00206 (714) 754-5273 Fax (714) 754-4656 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT .lob Address: 153 DEL MAR AV Suite No Vicinity: Parcel Nunmber: 43916162 Applicant: NOCK ,RON Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: USHIRO, RUSSELL KIYOSHI Address 153 DEL MAR AVE COSTA MESA, CA Contractor: NOCK PLUMBING Address: 11612 KNOTT ST, Arch / Eng : , Address: .GARDEN GROVE, CA WATER HEATER. QTY Status: ISSUED Applied: 05/01/2000 Issued: 05/01/2000 ISSUED BY: `/ L' = Phone: (714)895-1246 Zip: 92841 Phone: Zip: 92627 Phone: (714)895-1246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT' , FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System S0.00 Connect(Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (1-4 outlets) $0.00 Gas (Over 4 outlets) $0.00 Gas Repipe $0.00 QTY Status: ISSUED Applied: 05/01/2000 Issued: 05/01/2000 ISSUED BY: `/ L' = Phone: (714)895-1246 Zip: 92841 Phone: Zip: 92627 Phone: (714)895-1246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT' , FEE SUMMARY AMT QTY AMT QTY Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 ft) $0.00 0 '. Vacuum Brkr Bkflow(1-4) $0.00 0 Receptors $0.00 0 - Vacuum Brkr Bkflow(5+) $0.00 0 Septic Tank $0.00, 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect . $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower $0.00 0 Water Heater / vent $12.30 1 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00, 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 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) 7545626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to sell-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. .hl have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permitis issued. My workers' compensation nsurance carder and policy number are: G� ^- Y• T Carrier: rel �� Policy Number: /VW 'j /— (This section need not be completed it the permit is valued of 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 C omia, and agree that if I should become subject to the workers' compensation provisions of Sectio7/=L a Labo shall forthwith comply with these provis ns ,NIPlbflrM9igf1a10 e: �� I Date: �(1 ll SINNARNING: FAILURE TO SECURE WORKERS' �MPENS._,„—, rngP.o.�P ;r � �._� 6_yF� p, AN vra TO CRIMINAL PENALTIES AND C141 FINES UP TO ONE NDRED THOUSAND DOLLARE(S100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37 THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of_hapj mmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ed�ff.eerc4l� l Class p -^ ContracteYSSig ure: Date 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. (Sec. 3097, Civil Code). Lenders 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) of 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 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 offered 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 himself or 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 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 Code: 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 contractor(s) 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 drivers license. ❑ Yes ❑ No Drivers 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 feet 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, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code), ❑ As owner-builder, 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: Date: 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? ❑ Yes ❑ 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 one 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 applicant 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, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building Occupant require for the work which is the subject of this a plication aEEemnit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). e Will any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑ Yes ❑ 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 is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8 (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. I 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. �Signature Of Legal Owners) KZ1D nzed Applicant r ate c CODE 1, INSPECTIONTYPE 2AH INTMA SOPS INSPECTION TYPE DATE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �— 1266 Pool Spa Final 208 Final Plumbing .� �� _Cy) 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 264616 P CITY�FCOSTA'MESA CONSTRUCTION PERMIT ,Project Address /.S3 die C 4 r Applicant's Mailing Address r ' Owner's Name 2/�Src L'-- U,e�� Phone Address /J_–:? p,–=Z .Ll� Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No. 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 force and effect. License Class License No. Date Signature 'ORKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section .1800, Lab. C.) Policy No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Date iApplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or ecer certify that in the performance /ny� rk for which this perms 1syed, I shall not employ any person in aet so as to a ject o the Workers' employ nsa(yo�t.Laws of CDate Z–� d d SignatuNOTICE: If, after making this dec,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 i 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 to the provisions of 'he Contractor's License Law (Chapter 9 (commencing with Section 7000) of vision 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section J31.5 by any applicant for a permit subjects the applicant to a civil penalty 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 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, the owner will have the burden of proving he/she did not build or im- pro 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 Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor( license pursuant to the Contractor's License Law). I am aware that Proof off their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. ]Rr this reason Date r1 .–�.- owner Information Is correct. I and state laws relating t Sentatives of IN s city inspection our roses. Signature Drivers' license or SS # have read this application and state that the above agree to comply with all city and county ordinances o building constrq¢j ion, and hereby authorize repre- to entY upon t-fl� abaxe-mentioned property for CMF 0865-46, rev. 10/84 White - Build pncant TO Till in all spaces except those heavy border lines andsign all appropriate declarations. )0. LOT NO. UNIT NO. M 32/.3 o ... I ' TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. l am' /NG 6/%0/7 TYPE OF PERMIT LJ GRADING LJ FOUNDATION xJ STRUCTURAL ❑ TENANT. ❑ ELECTRICAL PLUMBING`L-' MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. TFT - OCCUPAN� Y��J C ON STRUCTION TYPE V7_7 ,VALUATION$-sv--s< ZONE - GRADINGCU.YDS. ACRES_ Remarks.\\_ _ Q ht�, FEES 3ar Sink Showers 3ackflow Preventer - Service Sink 3ackflow Irrigation -. Sewer Cap 3athtubs - Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Sw' ming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen. Sink - Water Service Lavatories Auto -Wash P–Trap Laundry Trays Roof Drains Generator ❑0-5 KW 05-15 KW Reinspection Fee I $15 I I - Issue Fee I $ 3 Reinspection Fee I $15 Issue Fee FEES T DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By .-� rx-1-:)—�-. Boiler Hood or Type 1 ❑ Duct - Under Ground Canopy Type II ❑ Duct -Structural Refrigeration System Duct -Ventilating 130-100,000BTU 0100,000 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG# Fire Dampers YH ting System & Ducting Registers 0-100,000 BTU ❑ 100,000 BTl Reinspection Fee 1 $15 1 1 Issue Fee Canary - Applicant; Pink - Accounting; Goldenrod - Assessor A.P. # S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: 4838 2/08/88 Building: Parking Req./Provided Zone 24400 -TC - Z O N I N G R E G – — T S SUMMARY OF FEES– BUILDING PERMIT ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter El over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Mot 0-1 HP Ell 'h -B F.A.U. 44c. Solar 119-15 HP El 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range - Switches Sign Garbage Disposal Standing Sections Generator ❑0-5 KW 05-15 KW Trash Compactor $ 3 SUMMARY OF FEES– BUILDING PERMIT $ SMIP PLAN CHECK $. PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ ZSr.CL7 TOTAL FEE PLAN CHECK 25% $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector T POOL & SPA APPROVALS Permit # - _ Date 1 Inspector) tY�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. r. 55. Electrical Bonding r 5. Steel Reinforcement: •� 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grid. I - 57: APPROVAL TO COVER-GUNITE 7r Footings .. X58. Electrical Conduit-Undrgrnd. 8:%Foundation ,% 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. /• r 60. Backwash Lines, P-Trap, ❑ 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 1r7. Rough Wiring Sign 68. APPROVED FOR PLASTERING ,18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1°> 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT C' APPROVALS Permit # i-- O 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro ;^ 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush •' / - .24. Roof Framing 73. Undergrnd. Storage Tank IDGas ❑Oil r 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical t, 27. Frame and Flashing - _ 76. Dry Standpipe Gr`' r,• 28. Lathing & Siding ,' 77. FIXED SYSTEM FINAL1_ 'ej . 29. Insulation 78. FIRE PREV. FINAL li 1 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 - _ r- Notes: r•) - 34. Final Heating & Air Conditioning 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 lr-.} 44..Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations I 47. FINAL-STRUCTURE &BUILDING 48. Special�Requirements Completed 49. Electric' Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ; cmill _,C!TYpF COSTA MESA CVSTRU TION,PERMIT 'Project Address Applicant's Mai l'R Address Owner's Name �_Z one Address Arch/Eng: is se N Address Contractor's Name - Address Imail ingl City License No. LICENSED CONTRACTOR DECLARATION ' I hereby affirm that I am licensed under provisions of Charter 9 (commencing 160 with section 7000), of Division 3 of the Business and Profess i 5 Code, and my license 5 i fu force a� act. Q I License Citr/-(-�/p 'ens Date��%�'I11'"(�d Signet t WORR9R5' PENSATION DE RATION '+ereb affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy t�eof (Section d00, Lab. C.) , Po'<y No. Comp y Lj-'L% ertif iep�l cop�r is here y furni hed. /, ! er],jfied, cjbp{� js'filed with the city Bu 1 ng Dives f/ l (This sec>(ion n$ed not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date - Signature NOTICE: If, after making -this declaration, you should become subject to the Workers' Compensationprovisions 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�l am exempt from the Contractor's License, Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which reauires.-a permit to construct, alter, improve, demolish or repair to file a signed statement that he/she is licensed pursuant to the provisions or theContractor's License Law (Chapter 9 (commencing with Section 7000) of "vi sion'3 of the Business and Professions Code) or that he/she isexempt refrom and'the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to.a civil ,.enalty'of not more than'five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044,. Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ., I. as owner of the property, am exclusively contracting with licensed can. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of propertywho builds or improves thereon-, and who contracts for such projects with a con- tractor(s),license pursuant to the Contractor's License Law). I am.aware that Proof of ,t heir. Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B.'& P. C. for this reason . Date, - Owner I hereby certify thatI have re tl this ap cation and state that the above information is correct. I agreer�atfiQl wi + all city and county r ances and state laws relatin b tll cons ructi n, a reby out ri repre- sentatives of this y o nt Po the bpv -m tioned op rty for inspection purpo „� Signatur - Data Drivers' License or 55 of :ant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. .LOT NO: fUNIT NO. z�142. TYPE OF CONSTRUCTION LJ NEW LJ ADD ._. ALTERATION LJ REPAIR 3' ❑ CONVERSION ❑ DEMOLISH ❑ OTH DESCRIPTION OF, WORK/USE OF BLDG. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION & STRUCTURAL , ❑ TENANT 1-1EL ICAL ❑ PLUM ING 1:1 MECHANICAL ' ❑ OTHER . PROJECT DESCRIPTION SO. FT. OCCUP CONSTRUCTION TYPE VALUATION$ ZONE GRAOINGCU.YDS. ACRES I Remarks: Bar Sink Backflow Preventer " Backflow Irrigation Bathtubs Clarifiers Drinking Fountains FloorDrains Floor Sinks Gas Service Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee, I Showers Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping ' Solar Tank Swimming,Pool w/Spa Outlets r Wafer Closet Water Heater Water Service Auto -Wash Laundry Trays r $15 Issue Fee Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple C Firepl/Fact BIL. ICBO # Heating System & Ducting - ❑0-100.000 BTU 11100,000P / CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000 BTU System Re Alterati $15 Issue Fee FEES 117 7/!-/57 1 i A.P. # .Zone S Main Building: Accessory Building: E T Front Sign B A Rear Generator 00 KW ❑5-15 KW C Right K Left Ping. Ref. # Parking Req./Provided Planning Notes: DEVELOPMENT SERVICES Zoning Approved By . Building Approved By Application Issued By REQUIREMENTS: 4Z- - Date Date Dat^-----� , - '- ELECTRICAL , - Automatic Washer Construction Pole_ Sub.; - Transformer ❑ 15-50 KW E1 50+KW ENERGY P.C.$ELECTRICAL' PERMIT E $13$3 GRADING• $.PLAN MICROFILM<. .$ FEE. $ Cooking -Unit - Meter ❑up to 100 amps Dishwasher Meter EJ over 100a s Z O N I N G R E , O M T S FE �• IFan I I Motor" -1 HP❑1%-8 i .A U. Inc. lar ❑9-15 HP ❑16-15+ Fixtures icrowave Device Boxes Pole Light Outlets Range Switches-- - Sign Garbage Disposal Standing Sections Generator 00 KW ❑5-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee - $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By . Building Approved By Application Issued By REQUIREMENTS: 4Z- - Date Date Dat^-----� , U BUILDING PERMIT. PLAN CHECK PLUMBING PLAN CHECK 25%$ CHECK 50%. MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ - $.- ,TOTAL $ ENERGY P.C.$ELECTRICAL' PERMIT E $13$3 GRADING• $.PLAN MICROFILM<. .$ FEE. $ - CONSTRUCTION AND PLANNING APPROVALS Permit '+ - .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-Undrgrnd. 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, 0 Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK / 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 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. D ucts, Ventilating, 71. Product Piping Cl Gas C1 Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24: Roof Framing - 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat '75. Dry Chemical 1 ; 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 B0. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test - 36. Hood or Canopy _ i 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 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7 // 7 �- 48. Special Requirements Completed 49.. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co - - ,.• 51. CERTIFICATE OF OCCUPANCY No. Date - - - i,�; 1 - iJ1• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. VlI y•Ut-UUSIA IVIENA GUINJI rSUl.l IUIV t'Cr11v111 Pioject Address /-5" 3 D4 L tis* /2- Appl icant's Mai ling Address /:�r'3 'T%CL Owner's Name' t- I -I aA"!,20 Phone 4 ��-S�C3 Address /d^-', Z, [7 e�Z- .f-iAA.' M✓L Arch/Eng. License'No. Address Contractor's Name Phone Address (mailing) 1 / City License No. 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 force and effect. l License Class License No. Date Signature 'ORKERS' COMPENSATION DECLARATION ereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a,certified copy thereof (Section 3800, Lab. C.) Policy No. Company ACertified copy is hereby furnished. - t . Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this perms Is issued, I shall not employ any person in any m ner, so as to become s tett to the Workers' Com pen sats n Laws of Ca lifo a.wA/�� Date ��Sis decle NOTIC :. I f, of er making this declaral ion, you shoultl b¢Wme 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 permitis 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 to the provisions of ,ap Contractor's License Law (Chapter 9 (commencing with Section 7000) of ";;ri Sion 3 of the Business and Professions Code) -or that he/she is exempt Jj,'refrom and the 'basis for the alleged exemption. Any violation of Section -J31.5 by any applicant for a permit subjects the applicant to a civil XaI, Ity of not more than five hundred dollars ($500). ' as owner of the property npensaften•, 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, the owner will have the burden of proving he/she did not build or im- prove vefor the our 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 Law does -not apply to an owner of property who builds or improves thereon, and who contracts.for such projects with a con- tractors) license : pursuant to the Contractor's Llcense.Law). Iam aware that proof of their Worker's Compensation' insurance should be provided to me. ❑ 1 am exempt under Section -B & P. C. fpr this reason A Date t — 'o A -e have 57B8 ,.4/09/87 I c 8.00 ;TL i TYPE OF CONSTRUCTION El NEW U ADD U ALTERATION REPAIR CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. - SUMMARY OF FEES A.P•# _ _ _ Zone -i BUILDING PERMIT $ Main Building: •Accessory Building: ' TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT, ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES T Front y PERMIT , O B A Rear ' N I C Right - - - t $ N S Left R Ping. Ref. # Parking Req./Provided t $ E Remarks: $ Planning. Notes: $ MECHANICAL Q M • - r - '$, - ' PLAN CHECK I - 5 • - PLUMBING _FEES Bar Sink Showers - I = I ELECTRICAL FEES ' ' Backflow Preventer ,Service Sink' Automatic Washer i Construction Pole Sub. Transformer "El 15.50 KW ) - ❑ 50+ KW Backflow Irrigation - Sewer Cap • Bathtubs Sewer Connection - Cooking Unit -� Meter . up to 100 amps _ Clarifiers ' Solar Collectors bishwasher - Meter ❑over 100 amps Dishwasher- Solar Piping Dryers ❑Gas ❑Electric - Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP 1:11 % - 8 1 Floor Drains Swimming Pool vv/Spa F.A.U." Inc. Solar ❑9-15 HP 016-15+ ' Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light' Interceptors Water Heater Outlets Range _ Kitchen Sink _' '. Water Service Switches-- -. Sign- I Lavatories Auto -Wash I Garbage Disposal Standing Sections ' P -Trap ,, Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains - Reinspection Fee; Boiler Duct - Under Ground Duct - Structural Duct - Ventilating . Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting rpplication 'arfd state that the above ❑D100,000 BTU 0100,000 r with all city and'county ordinances - :ructi n, and hereby authorise repre- 15 I I Issue Fee I $ 3 MECHANICAL FEES Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑ 100;000 BTU ❑ System Repair/Alteration Fire Dampers Registers 3T sentatives of tm aty tp enter upon t abope-mentioned property for ' inspection ourp '- Signature ? Data _ , Drivers' Lic se or SS• . i Reinspection Fee $15 IF 0865-46, rev. 10/84 - White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $1 3 Reinspection Fee I $15 I I Issue Fee 'DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By - . $ 3 ' SUMMARY OF FEES -i BUILDING PERMIT $- SMIP$,- _ PLAN CHECK $ y PERMIT ' PLUMBING $' - ISSUANCE $ - - PLAN CHECK X25% $ - - -. ENERGY P'.C. $ ELECTRICAL. $- GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL '$ TOTALFEE '$, - ' PLAN CHECK 25% CONSTRUCTION AND PLANNING. APPROVALS Permit# 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-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footings _ - 58. Electrical Conduit-Undrgrnd. - 8. 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 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 E Gas 0Oil - 23. Gas Pipe -Rough & Test 72. Underground Flush ,.. 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas 0 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 zw"80. FOOD CERTIFICATE ISSUED 33. Final Electric 12 Notes: 34. Final Heating & Air Conditioning - • - r.: 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 ' 46' Handicap Regulations ' 47. FINAL STRUCTURE & BUI LDING - 48. Special+Requirements Completed 49. Electric Release to Edison r 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date ' OWNER CORNELIUS, L. G. DATE 1-10-56 JOBADDRESS BUILDING PERMIT NO. 22 GENERAL CONTRACTOR Cornelius & Boling VALUE $ 9,500.00 LOT 35 BLOCK TRACT 376 Residence & Gar. GROUP I & J TYPE V ZONE Rh FIRE DISTRICT 225n INSPECTIONS I DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench �Z Foundation Forms and Grade to Garaged /^/ :4 Rough Framing Plumbing, Rough to Slab Plumbing, Rough Complete -Tp Temporary Pole Wiring, Rough —�`�- Heating, Rough Heating, Final - /^ 1�-� %/ � -(�A ,.�/�� Sewer, House Se#fie,.TwWwar Cesspo0132 " .�f/�pti(�� 2 , i& Lathing, In 'j, - OutX A —7— —Plastering Plastering Plumbing, Final, Fixtures Com ete — \j Plumbing, Final Gas Test Wiring, Final Occunancv F'orm 210 G -H 1500 1-55 Costa Mesa Building Department 177 EAST 20th STREET • _�,- COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN Costa Mesa, California Owner i Mail �1nI , �' � Address �C �C. (py City &UC7-,4 /Z!,67110-NeI,4�T7 JG� 1 Addres.5 L I!7 a 7`—G/.r T -JY 4-11A Attach Metes and _I No. of Bldgs. Now on Lot Center of New L� Sizeng��/v Y/ No. rn \ Size TTn (B Rooms StoriZsl Exterior Wall Roof Coverinq J%U CG.�� Covering �J I hereby acknowledge that I have read this 2 and state that the above is correct and agree with all City Ordinances and State Laws building construction. Signatureof , Permittee � Authorized Alit. Valuation FFee e $ , k $ o $ �� ..L $ S RM 204 S -BP 2M 5-55 APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY Address " Costa Mesa, California NO. OT i ype P lanS CORRECTIONS Under•Pinning Frame: Fire Stops, Bracing, Bolts dication comply Lath. Int. ,ulating Lath. Ext. "� Plaster, Int. Plaster, Ext. ,/, O D Masonry Reinforced c Bond Beam O FINAL