HomeMy WebLinkAbout163 DEL MAR AVE - Building Permits 4` "'Fsp CITY OF COSTA MESA
BUILDING DIVISION
>:� ,, � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F�..p,_ ,,:d PERMIT E07-00043
''ban��a"q`'��.s�
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaaIECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 163 DEL MAR AV Status: ISSUED
Suite No Applied: 01/18/2007
Vicinity: Issued: 01/18/2007
Parcel Nunmber: 43916123
Applicant: BOBIE, JOHN /
Address: 5858 DOVETAIL DR '1'/
Phone: 818-735-7876 ISSUED BY: `//"
. �/i
AGOURA HILLS,CA . Zip 91766 •
Owner: PICKENS, GARY - - , ' .
Address 163 DEL MAR AVE , _ _
`� Phone: - - - ' _
•COSTA-MESA,CA/' Zip: 92627 - • ' .
•
Contractor: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWY . '.
' Phone: 714-777-7777
YORBA LINDA,CA Zip: 92887 , '
License:799170
- SCOPE OF PERMIT
. .; "REPLACE CLOSET FURNACE AND ADD NEW NC UNIT(2.5 HP)UNIT(CONDENSER IN BACKYARD). .
REF: M07-00036 - - ,
N - 1 RES A/C PKG " .
FEE SUMMARY , -
Quantity Quantity
ISSUE-FEE 523.50 .` Temp Dist System/Lighting $0.00 0
Temp service test $0.00 - Busway/100 ft -. $0.00 0
•Res.a/c package . $54.50 Standing Section - • $0.00 0
New Res(1-2 units) 50.00 --0- - - - - - Misc Electrical Equipment - $0.00 0
New Res(3tunits) ,, • 50.00 0 -- Transformers"up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 , .
Lighting Fixts $0.00 0 ' up to 50 kva/kw • $0.00 0
Recept Outlets $0.00 • 0 up to 100 kva/kw $0.00 0
Switches • - 50.00 • 0 over 100 kva/kw . $0.00 0
Non Res Appl - $0.00 0 '• Low Voltage Equipment $0.00 0
Res Appl - 50.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a A` 50.00 0 Misc.Conduit., $0.00 , 0
Service to.1000a ., % '\\N s0.00 , 0 Misc.Conductor $0.00 .' 0 '
Service over 1000a • '50:00.- ' 0 . „ ' - . Circus(gen or ride)-. :'. "$0.00 0
Motors to 1 h'p , . 50.00•I"." 0- . Circus(mech ride or lights) $0.00 0
Motors to 10hpy i ' 50.00-* 0 - Christmas Tree Stand ,-$0.00 . 0
Motors to 50hp • ", -$0.00 • --: 0. Fireworks Stand
Motors to 100hp $0.00", • 0 $0.
• Other Electrical Fee - 00
Motors over 100hp N �H, $0.00 /. --- 0 -- ' - _ i
Communication drops - 50.00 0 - Investigation Fee $0.00 -
Sub panel to 200a • " 50.00' 0 Plan Check Fee $0.00,
Pole Light Pkg , 50.00, . ' 0 , • . - Reinspection Fee , $0.00"
Sign Circuits 50.00, 0 '
Temp Pwr Pole 50.00 - 0 TOTAL CALCULATED FEES '$78:00
Intermed Pole - ' -
COMMENTS/SPECIAL CONDITIONS
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
2446-46(6/00)
DECLARATIONS - •
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I 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.
-Er' I 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 permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: 0-mplovets cone Policy Number: FN-SOCaOk$6C-I
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance ork hich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Waffle,and that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these visions.
Applicant Signature: -Date: k 1 ( r0.3—
WARNING:FAILURE TO SECU�'ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND m I ARE($100,000),IN ADDITION TO THE COSTOFCOMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm tnat I am licensed under revisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.ye.ft 4a a ( Class a Ca-O r C3 fp
Contractor's Signature: Date: - 1 /18/O W
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).
Lender's Name: Lender's Address:
Signature: Date: •
OWNER-BUILDER DECLARATIONS:
I hereby affirm tnat 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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I 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 0,California 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? 0 Yes 0 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? 0 Yes ❑No
(Section 25533 of the Califomia 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 Califomia 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 II 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 imputation apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet 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
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. 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 uses.I agree no o occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Oft - 0
t14 ate
(e
nd/Or Authorized Applicant Date
•
WOE I IN$PEC11NTYPtDApA INTIALS CODEI gl$PECTIONTYPI p TE
1616 Fixed System Final Fire Prevention 206 Final Mechanical i 3—b"9- fir
1266 Pool Spa Final 208 Final Plumbing
•
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 BuildinglOccupancy _
I. - • • 1
4` A 55111F
MCITY OF COSTA MESA •
BUILDING DIVISION
,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
b. t +%iL . PERMIT M07-00036
--Pomo st
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 163 DEL MAR AV Status: ISSUED
Suite No Applied: 01/18/2007
Issued: 01/18/2007
Vicinity: CONDENSER AT REAR SFD
Parcel Number: 43916123
��
_
Applicant: BOBIE, JOHN ISSUED BY:
Address: 5858 DOVETAIL DR
Phone: 818-735-7876
AGOURA HILLS,CA _ Zip: 91766 '
Owner: - GARY-GARY
Address: 1 163.DEL MAR AVE .
Phone: - '
2 COSTA MESA,CA' Zip: 92627
Contractor: SERVICE'CHAMPIONS .
Address: 22911-SAVI RANCH PKWY
Phone: 714-777-7777 ' '. ,
YORBALINDA,CA Zip: 92887 .
, - -.' License:799170
- . : ."SCOPE OF PERMIT ,
_-/ ;', - REPLACE CLOSET,FURNACE.AND ADD NEW A/C UNIT(2.5 HP)UNIT(CONDENSER IN '
BACKYARD). •• - - - -
REF%E07-00043
-
-1-INST FAU<100K BTU, 1 COMPRESSOR UP TO 3 HP/100K BTU
/ ' ' _FEE SUMMARY . '
- Quantity ' Quantity
ISSUE FEE , $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $14.80 1 , , Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 '0' - - _ Ventillation System, $0.00 ' 0
Repair/Alt Cooling/Heat v $0.00. ', z _ ' -r- ."" _ Evaporative Coble -- --
$0:00 0 -'
!Fist/Rep.•Reces`s WallIHtr $0.00 '- 0. '- Commercial Incinerator $0.00 -0
Refrig Sys<100'k BTU.., $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU . $0.00 0 Compressors/Absorption Systems - -
Gas.Piping • $0.00 0 Up to 3 hp/100 k BTU . ' $14.70 1
Factory Fireplace - $0.00 0 _ 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box - - ',\ $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan,/Single Duct‘ . `� $0.00 0 . Over 50 hp/Over 1,750 BTU . , $0.00 0 •
Appliance,'': ''', $0.00. _0 Boilers , r -
•Fire Dampers $0.00° 0". Up to 3 hp _ - $0.00 0
Smoke Dampers V '$0.00,. 0 - _ 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent 'jam ,', $0.00:,-�0, - 15 to 30 hp - - , $0.00 0
Air Handlers< 10000cfm ‘ ' $0.00'-..-0 - . . 30 to 50 hp - - - ,
Air Handlers> 10000cfm N , , $0.00 0 , Over 50 hp . � - $0.00 0
Floor Furnace " $0.00. ' 0 - - • Other Mechanical Fee -
Floor or Suspend Heater . . ' •$0.00 ,0 Investigation Fee $0.00
Plan Check Fee $0.00
• Reinspection Fee $0.00
TOTAL CALCULATED FEES $53.00
COMMENTS/SPECIAL CONDITIONS
NOTICE:_ The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
. regulations.(Ord. No.92-28,§1, 12-21-92) •
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days.or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46 16100)
DECLARATIONS (\
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
.)Er `I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Cit.ppC)P-CS Covt^P Policy Number: F-P-I3OGx0 l$Oy
(This section neeb not be completed#the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the wo . •r which emtit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cal •• '-, .. hath d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr• ' Ions.
Applicant Signature: 'Date: r (� I s/ 7
WARNING:FAILURE TO SECUR,=•KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINALPENALTIESAND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(S1 W,.•, N ADDmON 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 affirm that I am lice ed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lie.it 't -F0 -Class// CZ O
Contractor's Signature: Date: '2C5 l/1S/0 q
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(5500).):
❑ 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.). .
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I 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,California 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 0 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? 0 Yes 0 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).
. .r. .
3 Does or will the applicant or presentt or futureuture 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? 0 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 ap.ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet 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? 0 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 • TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I ag1ee-trcompy with-all slate I a••-ei• • •nances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-defcri•=dproperty for inspe ' r( _ :gree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature 0 -:al Owner(s) Pate
I1 (804
And/Or Authorized Applicant Date
;ODE! INSPECTION TYPE Pug INTRIAL@ CODEC INSPECTION TYPE n r��`,��•rrrrr�JJ fNTRIAL$
07 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical `//3/ /113)0
1266 Pool Spa Final 208 Final Plumbing
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 Buiiding/Occupancy _ •
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APPROVED
CITY OF COSTA MESA
PLANNING DIVISION
SUBJECT TO BLDG. DEPT. REG.
NOTE: ADDITIONS, DELETIONS,
OR CORRECTIONS SHALL BE .
APPROVED BY THE PLANNING DIV.
- &Y:--( ` - DX f.4 \C
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INSULATION/� CERTIFICATION
• ! ( 3 4L 4 C 05 ta—ruts-tOrf 'ai 4 3�
Number anti Street City County
SubOwNron Lot Number
DESCRIPTION OF INSTALLATION
ROOF DP /4
Material ^ r ` I pp Brand Name _Ow�5 r
LResistance
^� r
Thickness (inches) o Thermal R sistance (R Value) I Q1
EXTERIOR WALL
Material Brand Name
Thickness (inches) Thermal Resistance IR Value)
CEILING
Batt w Blanket Type Brand Name
Thickness finches) Thermal Resistance IR Value)
Loose Fill Type Brand Name
Minimum Thickness(inches/ ' Number of bags • Weight per bag _ Ib •
Area Covered Iht2) Thermal Resistance (R Value)
FLOOR, ELEVATED
Material Brand Name
Thickness (inches) Thermal Resistance IR Value)
FLOOR, SLAB 1
Material 'Brand Name -
Thickness (inches) Thermal Resistance IR Value)
Width (inches)
FOUNDATION WALL
Material Brand Name _ r
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
I hereby certify that the above'insulation was installed in the building at the above location in conformance worth the
current regulations setting Energy Conservat Un Standards for new resident La) buildings (located in Title 74 of inc
California 4dmirtstrattve Code).
General Contractor (Buhler) License Nu nut,
Signature anc Title Date
Sun Contractor (Inwuhon Aoonulor) License Number
-- - Signature ant Tine Date
Figure d -1 Example of a compliance certificate
4-9
Applicant to fill in all spaces within heavy border lines and.sign all appropriate declarations. 8765 10/1:16/82 1 33.47 TL'
CITY,OF COSTA MESA___. P IT - - - - TRACT-NO.• O NO. .' :BCDG.'NO:" ----
CONSTRUCTION PERMIT
0 - � ' SCP •
Project Address .• -: TYPE OF CONSTRUCTI I a x.r `-- - --•s•-
!6� IDEL ri�e.c /'✓c..am,��k - •.G.,�+�,
'-Owner. (5.42% LA•''?,c ieeiv 'Ss&".'Phoue(,,gr. .tj/La) •0 NEW '❑ ADD- ALTERATION 'a;- - [/�L _ t
Address j4.; DEL date 1 = • _ 0_REPAIR ❑.CONVERSION'❑DEMOLISH.
-' - C. ZONING REGULATIONS e. •-•-•
I Arch/Eng: _ , _.. _ •__ . :. License No.. .. , nILI OTHER: • � f -
�D CRIPTION OF�W�Q�RKa�/rF''CW ��G.'fd'� !A'P'%F1 �' �f ' "' +• '! r' _I
' _. e),I�CG' t SVI , 1,447-
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G )/� � C�7 �(/--5ZONE PLNG. REE.l• -'1•
'•COntractor _ VA.M3 F----._ -_ ,Phone -- - TVPE'OF PERMIT' '-- j -` BUILDING ��0 EIRl4V GNE- -
Address _ _ __. ., " _ -- "" t SETBACK C/L ST. -
O GRADING ❑-FOUNDATION STRUCTURAL' SIDE YARD
LICENSED CONTRACTOR DECLARATION . - - 't. .- -3 J LEFT -
❑ TENANT ,- ELECTRICAL' �PLU MBING-OMECHANICAL SIDE YARD
/...60r.
Thereby affirm'secti 1'am licensed under provisions of Charter 9 (cam I; r.• RIGHT I .-r
mencing with section 7000) of Division 3 of the Business and, ,D,OTHER_ - -.--- �� I'�• - •-
Professions Code, and" my' license is In full-force and effect. "REAR YARD(TO P/L) r./
-a
. 'SQ_ T S CRIPTION _
license Class -License-No. - 7- 0 ' ._ - PKG.SPACE RED. PROV 1DED' - ;.
Date - .Signature 'S�._FT. ,.- �. _ -
WORKERS'COMPENSATION DECLARATION . ;•OCCUPANCY_ • CONSTRUCTION TYPE- y - STREET WIDTH r PARK FEE$ _ _
•
I-hereby affirm that I have a-certificate of consent to self-insure or a, -VALUATION ZONE ZONING APPROVED BY , `' 'J DATE / M -
certificate of Workers' Compensation Insurance, or a certified copy , .., _ , ,. , /, ' (1 .. ___ _ __ a" I /O LD r„
thereof(Section 3800,Lab.C,). - - ..GRADING CU.YDS. ACRES SPECIAL CONDITIONS: ' s _ .. /'.
-y No. Company _ ._ ...._ __ .. - r . „ . - ,. - .
:rtitied copy is hereby furnished. _ 1 REMARKS: ' _ ._ . - I.
_ertified'copy'is filed with the city Building Division. . -
-' -
_
•
EXEMPTION FROM WORKERS'.COMPENSATION DECLARATION - - ' -` - - -
(This section need not be completed if the permit is for one hundred -.. _ . - _ '-' ---.--
($100) or less).. . _ . - - - . -. . . . . ..- . _ . - - • - - .-
I certify that in the performance of the work or which th' permit is _ _ _
issued, I shall.not employ any person-I a manner so o b come PLUMBING' "'t� -Ti PLAN CHECK" ELECTRICAL PLAN CHECK. •
subject to the Workers'Compensation La California. ' -• UWILLIrv� VHHHtat
/b S-fd` ///E/ - BATHTUBS - SHOWERS. • - ., . r
Ic Date Signaiure /r J`�0�.� SQ FT GO FT
NOTICE: If after making this d roti you shall become subject TOILETS ,c 1 -.,-, ,URINAL'S , "_ "- GENERATOR 04 KW 1-10 KW,• '_.' '
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER _ __.. _
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE'LAVS • " - - - (APPLIANCE 10-50 RCA/ 50 + KW - .
revoked. I . _ _ -
CONSTRUCTION LENDING AGENCY . - - - 'KIT,SINKS - - - DISHWASHERS _ • - " - ' MOTORS 0-1 HP ,1-10 HP - `1 '
I)hereby affirm that there is a construction lending agency for the per- SERVICE SINKS •' , r SUMPS '- -- ---- - --( NC.SOLAR)' - 10-50 HP_-'-50$HP a :• - -----..a,
formance of the work fir zwhich this permit is issued (Section 3091 • - + -• 'r' '
Civ- C.). ,.!'APIA s.d -_ _ ., -- - - F LOOR SINKS 'FLOOR DRAINS - - - - FIXTURES 'OUTLETS SWITCHES f I, - , f
Lender's Name
'
Lentler's Address - - .. - DRINKING FOUNTAINS• . • " - - 'GAS TUBE SIGNS
' ' .'-1 HI _
OWNER BUILDER.DECLARATION INTERCEPTORS— - CLARIFIERS - - i POLE LIGHTS ' j , a
t ,
he Contractor's License Law for -
the following reason (Section 7031.5 Business.and_Professions Code:. _SWIMMING'POO —P TRAP — ' " - -- -- -LUrvo I.HUL.•l ION--- - - - _ ,
Any. city or"county which requires L a permit 'to construct, alter, 1 POLES METERED SUB.' i -+
improve,demolish or repair any structure, prior.to.its issuance,also.re- WATER SERVICE" --'--"ALTERATIONS ' PANELS MAIN •,-:� . SUB r
quires the applicant for such permit to file a signed statement that he _ __ '' - '
is licensed pursuant to the provisions of_the.Contractor's,License Law -GAS SERVICE -' ' OUTLETS 1 SERVICE AMP, , . ' 1 I,r• - g, -
(Chapter 9-(commencing with .Section 7000) f Division 3 of the _ _ __ _
B"•:nes, and Professions Code) or that he is exempt therefrom and the WATER HEATERS " -BTU OUTPUT"- ",'� - ' - - s•1 '
or the alleged exemption. Any violation of Section 7031.5 by _ _ _ .-4.
plicant for a permit subjects the applicant to,a_civil.penalty -SEWER'CONNECTIONS"' '^ "'- " - - '.- - _ _- - ' - ' -
more than' hundred dollars ($500). _
` .
as owner of the property, SOLAR TANK-
co.w.c,Pawpensellew, will do the work, and the structure is not intended _ ___ __
or offered-for sale.-(Section 7044,-Business and-Professions-Code: The; "SOLARTPIPING SVS. ' ISSUE FEE - +•,'^ - Y
Contractor's License Law does not apply to an owner of a property
who builds-or improves thereon,-and who does-such-work-himself or' '" ISSUE FEE' r " ". r -APPLICATION APPROVED BY DATE ibis-id)
through his own employees, provided that such improvements are not _ -
intended or offered for-sale. If, however, the building or improvement' - MECHANICAL PLAN,CHECK UMMARV OF FEES, <'' - '
is sold within one year of completion,the owner will have the burden - 01- r.
of -proving -he-did-not build. or improve for-the •purpose.of-sale): -- BUILDING - O 1
HEATING SYSTEM 0-100,000 BTU PERMIT_ - $ • ' -' .n.SMIP _La- '.$ - _
❑ 1, as owner of the property, am exclusively contracting with- AND-DUCTING .-"" - r
licensed contractors to'construct the project-(Section 7044, Business 100,000 +BTU PLAN CHECK $ - •3 PERMIT' - ' .•
and Professions Code: •The Contractor's License Law does not apply to - - - ISSUANCE '$
a r Such
builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ _ -'• •
tracts from Projects with a contractor(s) Iicesned -pursuant to. ..SYSTEM ---- - -, - -- '- --
the'Contractor's'License Law): '" 100,000 + BTV- ' " • _: ,, ;PLAN CHECK $ _ I
❑ lam exempt under.Section B.& P.C.for this BOILERS BTU ELECTRICAL $ - .$
reason _ _ _ - - _ - -,
SYSTEM REPAIR,ALTERATION PLAN CHECK $ {
Date Owner - TOTAL FEE$- -
I hereby'certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ -
.VANCE
ordinances is atle .1 agreeito comply,tion, all city-and county rise - PLAN CHECK $ .VANCE PC �$ -representatives
ordinances and state la relating t construction,and hereby authorize
representatives of t city .to a to upon- the above mentioned - - _ /27s (47
property for ins n purpo a / �'S�� /JJ' T '
Drivers' •
cense •�i .e ( Date - - - -
>: FINAL FEE $ •
Drivers' License or- S.4• 7144)_ - ISSUE FEE - - • - - - - - -
CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNING •1 ' '' i_ , POOL&SPA• • . ' _
(,O Date Inspector - - - - Date Inspector . •
APPROVALS Permit # 'APPROVALS „Permit#
1. Temporary Electrical Service or Pole - 43. Pool & Equipment Location .
2.- Soil Pipe-Undrgrn „ - I- 44. Steel Reinforcement: - ' , '- -•
- - . , ,•, ,
• 3. Electrical Conduit Utility-Undrgrn~; •-' :;; • ' _. 45: Forms -. - _- ,
4. Electrical Conduit-Undrgrn _. - •- _ 46. -Electrical Bonding -
5. Steel Reinforce ' 47. Rough Plumbing & Pressure Test ' - . - - -
6. Electrical UFE_ R Grn • i � , ' ' ' ' 48:, APPROVAL TO COVER-GUNITE
7. Footings- • A . , -, - --r.:.•., ' - - 49. Electrical Conduit-Undrgrn- . . . • - -
I 8. Foundation ..„4, -`, . . 50. Gas Pie; " ' " '
p ❑Undrgrn,Test'
9. Water Pipe-Undrgrn - . ' 51; Backwash lines,P-Trap, ❑'Undrorn .. . %
10. Structural Floor•System _ . 52. APPROVAL TO DECK . .r:, '
_ •11:, •Property•Sewer`tbine&:House Connection - - 53.' Backwash &-Receptor-Final .• '. .. ,
12. ' Sfreet Sewer Connection . 54. Heater'& Vent-Final � '
13. Rough Plumbing - - • 55 Plumbing Svstem-Final _ - . ' _
14. Rough Electric-Conduit '56. Electrical-Final-" - _ . -
15. ' Rough Electric-Wiring - - - 57. Solar System-Final - • ,. •.
16. Rough Heating & Air Conditioning - - ' _ _ ,. - 58. Fencing & Access Approval •
17. Ducts,.in Structure • • : • -, '59. APPROVED FOR PLASTERING • • .
18. Ducts, Ventilating _
19.• Gas Pipe-Rough &Test .._ _. - '60. POO L/SPA SYSTEMS F INAL - - _
20., Roof Framing ' , -- - fh_�a_P�. - S - . . __ .. . . -
21. ' Roof Sheathing' • • ' - ' ' - -- . - '
22. ' Frame'and Flashing - - - . ' _ _ _ _ - - NOTES:. �o, 5tJ I., .((-2t ' ' • ' ' ' '
23. Insulation - .. '' . . . .- . - • . - - -
24. Lathing & Siding _ . _ ._ .. _- - '. " . _. _ _ - _ _ .
. 25. • Drywall Nailing - _ _ .. - _ , , ! , . , •
. 26. Plaster Brown Coat .• ' . . . __ - _ - _ _" .. . ,
' 27. . Electrical Power-Meter-Final • - _ - - _+ . . _ _ _ .-. ' . '•' .
28. ' Final Electric _ _ _ _ _ - _ - - - -- , . -
29. ; Final Heating& Air Conditioning - _ - _ , , - _ `.. . .. ' ' • ° •
30. ' Final Gas Pipe-Test _ _ . . . _ - ' . I -
31. Final Plumbing - -
.32. : Water Service-Final , _ _ _ > _ �- - -,- _ - _ , • • - -
' 33: =Gas Service:Final , ' '' - ' ' ' -. - . . .- • - - -
34. Solar Domestic-Final ,,z„ • - _ .
35: ' Landscape Sprinkling System. • - t_. - • , . . . ,
36. Sound Attenuation _-, - _ •_ .
37. Handicap Regulations - _. . - __ _ - '
38. FINAL STRUCTURE & BUILDING �, S 3: I ' ' . , ,
39. Special Requirements Completed ,
40. Electric-Release to Edison _ _ •
41. Gas Release to Southern California Gas Co.' ' - ' _
• '42. CERTIFICATE OF OCCUPANCY ., .„
-No ' - Date • --
•
OWNER SMITH, JAMES C. / DATE 11-30-55
JOB ADDRESS 163 Del Mar BUILDING PERMIT NO. 2110
GENERAL CONTRACTOR Owner-builder - VALUE $ 10,1156.00
Subdivision #11
L 35 BLOCK TRACT 376 Dwelling & Att. garage
GROUP I & J TYPE V ZONE R4 FIRE DISTRICT 2129
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
— E / -f- Yo —
Footing Trench .�
, Foundation Forms and Grade to Garage
Roughlbng,Rough
'� 3
Plumbing,Rough to SlabC 6yda.p�.��L�CSJJ„
Plumbing, Rough Complete Y _ 7 ..y- , .4.."...0,4---.47.„4,0). /c - C33 '3
Temporary Pole a ,J,4J-40-r-1/7A-1,---. //-o2Q-.c Ii2 QhT
Wiring, Rough i---1:3(21 3-�rj Ji [ rYs6�-, //-o21-SSi /(o9lc. —
Heating, Rough v�1e-c.'�`I 2 '!r� < n
Heating, Final -7/vS. _7//-,(4. �j�4i . y nerYe2- -m 02_/(=r% L/5''0 —
(Sewer�, Hou_se t4 Sewer,St. '� . t?'UC. eL-vv / j,/,SL .237
Sentic.7aalFr�cesspool7—W,p y/may-3€ ,rt/pie-E2F . 3-/-St 3 ? —
I ig, In Al-Ajt-t Out -t3 3 `it 6
I- .wring yu d0
Plumbing,Final,Fixtures Complete
Plumbing,Final Gas Test/0�`/ r /24 61;1t j
Wiring,Final /re
A 7•
f
Occupancy / .-2JdS '
Form 210 C-14 1500 1-55 2110
igiCosta Mesa Building Department ; }��/APPLICATION FOR PERMIT
COSTA MESA,Ilh— 111 EAST gCALIFORNIA th STREET ,1-"^�'"`� BU . D NG 1
'1/4 FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permit No.
Address I/�-5 VEL /A Ad - r 7/ D
Costa Mesa, California Recei by Date Rec'd. Date Issued
�� t f----n-//-3o ;c:
Nearest TL 7�ra ./ �l "
Cross St. G !/ Building �/
Address
Owner %JAM£'S C . 5.A/1711Costa Mesa, California
Mail 06 A�t/ Atm"
Z
Address 9 /Y'1 ,! A YG /+r,se; Nearest
��1 Tel. Cross S .
City twPO�'j SJg�n� No.gm -"1619 Zone,' i/ I No.of I Type / Group
Architect or tic. T Plans T-
Engineer ����� No. Approved
by Date
alpIress CORRECTIONS
City
Contractor
Caev/�geep No. tic.
Address
t
DescriptionNo Block 20
"\ c�-^a
� ..1!
(Attach Met and Boun 't / \ Vt
No.of Bldgs. ` w/ „ - r
Size of Lot 6o X/QL I Now on Lot /,/�L/E 1Ei� O
Use of I No.of I No.of mW( ,- u SQhr) A
Existing Bldg. Families Roosv `. 3
Setback Line from e - Rear Yard Z t' - `t�U Z
Center of Street So- Side Yard r� I prep y
DESCRIPTION OF WORK C rose N `vu--(�
i ,, 1/2
New ✓ I Alteration I Addition I .�� w- �iirrw
Repair I I Moving I I Demolish IdOn Sr C .
Building/Z 00 ij . No.of 5 / ' i- h
Rooms Stories /. ra
SILrior wall Roof
overing AGO 6t1lect Covering G' UEG nfiS
' 'PROVALS
BUuseldofinNg ew / /C.,,,, (Paint
/1/6- +I Foundas
Location
Insp
estop Date
Forms,
?t �_ Under-Pinning
Frame: Fire Stops, .
1 Bracing,Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply p Lath. Int.
with all City Ordinances and State Laws regulating j
building construction. s Lath. Ext.
Signature of
Permittee 'Plaster, Int.
Authorized Agt. i " </�, ��(� E Plaster,Ext
Valuation ti. 4hAt Permit Fee $ .2-6 - c c Masonry Reinforced
Plan Check$ S---- c c Bond Beam
$ . Total 0 0
FINAL
Fee
..., _,- ... $ 3
FORM 204 5-RP 2M 6-55' F /I