HomeMy WebLinkAbout256 DEL MAR AVE - Building Permits_�; .� j�,osta Mesa �uilding Department �� • APPY.ICATION FOR PERMIT
, -� 171 EAST 20th STREET ' '_ ^_ B�� L D�I�.�.G.�....._._..��.
'.�7 R COSTA MESA, CALIFORNIA '
I'OR OF�'ICE USE ONLY '
FOR APPLICANT TO FILL IN � � Receipt No. Permit!No. ;
Building n r/ /�LI ��/� i
Address /G�/G9 6/F�• r� i t ;� � . � � �: �
Costa blesa, Cifl„11f01711$ Aeceivedjby Date Rec'd. Date �ssued f
i S = �U— �iS`f% .
Nearest / � �� -
CrossSt. �/� �' FSI�W%S%� Building � - f �
Add4�ess �
Maller •, 1 CiOStfl� M0S&� Ci'd�017118. � �
Addresa � x � NeaFest j , � �
. Tel. Cross St. F - �{
City No. Zone No. ot T e I Grou
ArchiteCtor Lic. � L"/� I Plans I YP � � i�!
Engineer No. Approved ` � � ' 1
— • 6y i � Date ; j
Addre55 ' S � � CORRECTIONS � �
� _ City Lic. , _ _
Description � No. / � Block I Tract//
(Attach Metes and Bounds)
��I�/ � No. of Bldgs.
Size of Lot ��(/ T� � Now on Lot �PY
USeaf I No.of No.of
Existing Bldg. /jrGy�j4f� , F.amilies� Rooms
Setback Line from ► Rear Yard Z j�
Center of Street �0 Side Vard 5
DESCRIPTION OF WORK
New I/� I Alteretion I I Addition I
Repair I I Moving I I Demolish I
� Building c��/ � No.of �
Size �p /� Rooms - � Stories
�terior Wall I I Roof
O
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~Z
a'N : a8 D
r
_Eering WQOd I Covering�J7/ry(►/�zd APPR,Q`7��`
Use of New �--'e�' '��� Foundation Location Inspectar D.ate
Building /'Gi.(��i+.
Forms, Materials, •
Under-Pinning
Frame: Fire Stops, - .
Bracing, Bolts �
� Lath.lnt. '
I hrreby acknowledge that I have mad this Application -
1nd state that the above is correct and agree to comply Lath. Ext.
with al] Citv Ordinances and State Laws regulating
buildinn con �ru t�ion. Plaster, Int. .
Signature of 'y—{� � /i���
Permittee �V�P/1LK.� � '
Plaster, Ext.
Authorized Agt. � � .
Masonry Reinforced
Valu,ation - ` /� � / Permit Fee $ 3 y -�
$ !�(L Plan Check $ j�j� Bond Beam
, Feea' $ � / FINAL
l+orm 't0a GA 1M 12-53 �
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(714) 754-5273 • Faz (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 256 DEL MAR AV
Suite:
Vicinity:
Parcel Number: 43920101
Applicant: DANIELS, DOUG
Address:
.l
�J
owner: DOMINGUEZ; MARCELA
Address 256 DEL MAR'AVE -, .
i � .
� , "�COSTA MESA, CA .
Contractor CHANEYJ.DANIELS
.Address: 1617 E EDINGER
Status: ISSUED
Applied: 10/18/2001
Issued: 10/18/2001
Zoning:
ISSUED BY: �
Phone: 714-558-7747
2ip: \
Phone:
Zip: 92627
�
` \ '( �
, \ �
��
. , �� 1
�DA`� � .
� , . Phone: .714-558-7742 , " .
SANTA ANA, CA � � � � � � �
� � ,
Zip: � 92705 • License:- 627028 � �� . " �, �
Arch : . , - Eng: - � ' ,
Address: ' - , • , - ,� � � ' Address: � - ` - ' � '
. , , ' . -- � Phone: - . . � �: Phone: - - ' . '
, . " . . - . �`•, � i . - . . - ., �
� Zip: - � � . License: , - 'License: �
SCOPE OF PERMIT
�� CHANGE OUT WINDOWS IN'RESIDENCE TO VINYL WINDOWS. BEDROOM WINDOWS�SHALL COMPLY WITH UBC 310.4 . �
,,._ _ ` .. ____ ._. .._. " - � ,
FEE SUMMARY
Plan Check: $0.00 _ Calc Valuation: sa,3ss'oo
Permit: , $111.25 -- - . - � ' Claim Valuation: „ g4,sss.00,
� _ SMIP Res: $0.50 � � ,�'� ,; , _ �
SMIP Com: $0.00
Other: $111.25
Inspection: $0.00
Total: $223.00
SETBACKS-. � �
MAINSTRUCTURE�Front 0-0
� .
ACCESSORY Front .0-�0
PARKING Existinp:� o
NOTES:
.
PLANNING & ZONING .
� Rear. A- 0 -Left 0- 0 Right � 0- 0 %
�. �Rear 0- 0 Lek 0- 0 Right� � 0- 0� �
Re uired: � 0 Proposed: 0 � .
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inepeetions and Tinal epproval must be obtained. Failure to obtain inspections and final approval will result in tha expira�ion oi this permit.
FOR INSPECTIONS CALL: (714) 7545626
LC&4fi (NW �
WORKERS'COMPENSAnON DECLARAnON: ��
I �ereby aHirtn untler penalry ot perjury one o1 the tollowing Aeclarations: �
I heve end will maintain a cetlificate of consem to self-Insure for workers' compensation, as providetl for by section 3700 of the Lebor Code, lor the pedortnance of the
wo tor which Ihis pertnit is issue�.
have end wiil maintain workers' compensa�ion insurance, as reQuiretl by section 3700 of ihe Labor Code, for the pertortnance of the work for which t�is pertnit is Issuetl.
My workers' compensation Insurance carner antl policy number are:
Carner.
(fhls section need no� be completed i/ the permit is velued al one hundretl tlollers
Poliry Number:
❑ I certiy that in tha peAortnance tha work i r which Ihis pertnit is issue4 I shall not employ any person in eny manner so as to become suDject to the workars'
compensetion laws of Celitomia d egree t 'f I should Decome subject to ihe workers' compensatlon Omdslons ot Sectlo 3700 oi iha Labor Cotle, I shell forthwith
comply with these p sions. ' O� ��/
Applicent Signeture: Date: � I /
WARNIN�: FNLURE TO SECVRE WORKER ODMPENSATION COVERAGE IS UMAWFUL AND SHALL SUBIECi AN EMPLOYER TO CRIMINAL P ALilES D GVIL FlNES UP TOONE MUNDRED
T1qUSPND DOLLARE (5100.0OO�.IN ADDRION TOTHE WSTOF COMPENSATIIXJ, DMNGES AS PROVIDED FOR IN SECTION 3]W OF iHE LABORCODE, INiEREST, MlDATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm that I am licensed un proNsic
torce en0 ettect. Lic. a
Contrectors SlgnaNre:
with Section 7000) of Divisian 3 oi the Business and Professions Code, end my licensa Is in full
Class q
Date: _ � /
CONSTRUCTION LENDING AGENCV: .
❑ I hereby attirm that there is a construction lending agency for the peAormance ot the work lor which this pertnit is issued. (Sec. 3097, Civil Code).
L»nders Name: Lendefs Address:
SignaWre: Date:
I hereby ettlrFn Ihet under �penelry of perjury that I em E%EMPT FROM THE CONTBACTORS LICENSE LAW for t�e following reason (Sec. 7031.5, Business end Pmtessions
Cotle: Any ciry or wunry;which�requires e pertnit ro construct, alter, improve, demolish, or repair eny structure, prior to its issuanca, also requires the applicant tor such permit
b file e signed slatemen� Ihet he oCshe is Iicensed pursuent to the provisions of the Contractors License Law (Chapter 9(commencinq with Sectlon 7000) of Divislon 3 oi the
Business end ProFeuions Code) or 1het�fie or she is exempt therefrom and Ihe besis for the ellegetl ezemptian. Any violation o1 Sedion 7037.5 by eny epplicant for e pem:'
subjects the applicant to e civil penalry of not more ihan five huntlred dollars ($500).):
❑ I, as owner ot the property; or my,employees with wages es their sole compensation, WILL DO 7ME WORK, and Ihe sirucWre Is not intended or ofleratl tor sale (Sec.
7044, Business end Professions Cotle: Tha Contractors License Law does not apply to an owner oi property who builds or improves thereon, and who tloes such work
hlmselt or herself or Ihmugh his or her own employees, provided that such improvements ere not intended or ottered tor sale. It, however, the builtling or improvement Is
sold within one year ot completion, the owner-builder will �ave �he burden ol proving that ha or she did not build or improva tor purpose oi sale.).
❑ I, as owner oF the D�operty, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the projact (Sec. 7044, Business end Professions
Catle: The conirectors License Law tloes not epply to en owner of property who builds or Impmves iherean, entl who comracts for such project wlth a cantredor(s)
license pursuaM to Ihe Contractors License Laws.).
❑ I em exempt under sec. Business antl Professions Cotle tor this reason:
Signature: Date:
Owner ID venfied by drivefs license. ❑ Ves ❑ No Dnvers License No. Expires:
Verification ot Ownership by (rype of document, i.e. - properry tax 6ill or tleetl):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION:
❑ I hereby certify thet no exwvation tive (5) or more teet in depth into which a person is required to descend, will be made in connection with work euthorized by this
permit, and that no building siructure, scattdding, falsawork, or demolition or dismantling thereot, vnll be more than thirty-six (38) feet high. (Chap. 32, Gry 2, Atl 2, Sec.
341, Tula 8, Califomia Atlministrative Code).
❑ As owner-builtler, I will not employ enyone to do work which woultl require e permit irom ihe Division of Industrial Safery, es noted above, unless such persan hes a
permit to do such work fmm the division.
SignaWre: Date:
Division of Indusirial Satery Pertnit Numbar:
CERTIFlCATE OF COMPLIANCE AND AUTMOR¢A710N OF ENTTiV: I cenity under penalry oi perjury that 1 have read this application antl state that the Infortnation given is
correct. 1 egree to comply with ell state laws antl city ordinances relating to builtling construction, entl authonze representatives of the Ciry of Costa Mesa to enter upon the
above-described proDerry for inspection puryoses. I agree not to occupy or allow occupancy of eny 6uilding authorizetl by this permit until finel inspection.
CODE t. INSPECTIONTYPE
1616 Fixetl System Final Fire Prevention
1266 Pool SOa Final
200 Final Re-Root
201 Final BIocWReiaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolicion
Pa¢ INTRIALS
GOOE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevantion
220 Final Planning Approval
222 Final Site
250 Final Building/Occupency
PAIE It�LS
RDDNESSOf9WLpNG: L J b 11tL �/�'� fiV
Q1MEX'SNAYEIFIMONM: SI.HMSLl, THMMY
�,00nEss L7b LEL %77�R f�liih
C057k MESA,CA
wa�. wuuxa �ooxEss:
j 1fICHRECTONFNCdlEEN:
I ANCH 011 ENO: S INORE55:
UNT:
�J�bL%
uC No.:
UNT:
LONTXACTdI'SNRME:
car+m�croas xuuNc
woxEss: uc. ru.:
uxr:
LICENSE� COMFRCTOXS DECL�RAPON: I hereby M'rm under perely d pa�jury thm I em licereed �mder pweiona d Chaqr 9
(mmmeui�p wilh Seclbn'l000) ��A^ a a�� �inms enE PMovona Code. erd mY �� a in lull lace uM elled.
CRY LIC. NO.: LIC. CLA55: �IC. NO.: ' E� Y:
ome: convaa«:
OWNEP BUILUER UECLANRTION: I hareby tlfirm uMx peraly af perjury thet 1 em eumq Irpn the Com�aqas lioerua lew Ip Na
�Jbxin9 ieason (Setliw ]W 1.5 Busiims eM Rdwbns Code: AnY ctY a couM�/ Mfiitli �Wuirea a Permil lo cmrhucl. Mx. imMwe.
y-.wmoleh, a repe'v eny evuclure, pnor b As eeuerce, dao reQuieae the epdicent Iw euch permil to fib e epmd etetement tlut M a eM
IiceneeE W�uent �o ihe prwiuma d ihe Conireclma Licenae Lew �Ghapter B(mmme�ip xtllh Sed'on ]000) d Divbion � d ihe
�usinem end PrMesaiona COEe� or Ihel ha «ehe ia azamq Iherehan end the besn la the elbped axemqun. My videton M Sspion
)031.5 Ey enY aDd� Iw e permn wbpUa IM epplicen� lo a mil panelly ot �wl more Nen fxe huMred Edbn �5500�1.
&] I.avownerdtMPWanY«myemWWeeewthwaO�mlheiaobcanP��.WIEOIhexoA.eMNsetuNeebnaliNeMeE
a oflmed br seb (Seciion )066. Busime+ud PMaeaonaCade: The Comradas Lvue lewdoo m� WWY�oan anw W VrW�Y
wM b�ids a inpovee IM1e�ean, ard Ma Eom euM xwk Nmntl a hena0 ar ihraqhlre a her own employeee. provideE ihN ac�
imo�'emema ara nd inleiMed a dlereE la eele. II, howewr. �M Wildiip ar inqwemeM ie aald wilhin aro yev d campblian, IM
o�,.w�u« �;n na� ma wmao m v,w��a na o, sna ab oa aam a �mv�,. r« ma wmona a.w).
❑ I. m ox�rer d Ihe propaM. ��dusivey contredmp vmh licenead convacbre b conatrvd Na pojact (Sedion �ON. Buei�es aM
Proleavona COCa: The Can�reaon L'cenae law doea ewi epply to en owrer d papMy w1w Wilda a impwen Iha�eon end who
Cp11�lBC191IX 81N�1 pf0�%19 WI�I 6¢ldIBCIOf�!) �CBI19Bd p112U011� �O I�1B riM�fBf�M �IMlB �dW�.
❑ i�„�,mp�/�m�1n, s«i�: e. a v.c., m. mm /^1
De�e: �U � G Y ` � O.mx: /+^� ✓W/ .
/
I do hereby cMity thel I em ewere d vN uMeAtend the requiremeMe ot Celiomie Hael�h uM Selery Cada Seqona 25505, n533, vM
255�C, end ihet I a eny lulure Wiki�p arvpam xill / wJl not �aeck arc) neatl to comply wIh aeitl abb codes vW IM requi�emenb br
eDsrmAlwmrevudionamod'diationhomiMRi u3eTi T�ly anape^an�0istrirl.RevEe�uieloumivaionePP�'miaroareuemqlmmNsa
pwisune.
o�a: rod�:
WORKER'S COMFENSRTION UECLPfiATION: I Mreby elfiim uMx penelly W pe�jury wr d tlre blbxirq ddvmuna:
� I here enE xil meintein e unXicele d coneem ta eeM-iruun br xpken' compeme�on, u prwidad I« by SWun 3'lOD d the lebor
coe.. i« ma reno��,oe a ub � ia..i:�n m� re�a �. �o�,d.
❑ � nev. ena wi� mdmen.mMa.� cano�o� imureze, e. m���e M seaion amo a m. �m« code, ro, m. ro�+«menoe a m.
wwk la xfiid� thb prmn 6 mueE. MY wa�' �Oanselbn imueerce anir eM pdiry numbr w:
c�.:
Palicy Number: -
�(This aenion med rrot 6e comP� � the pemi't ie ior aro hundreJ dolbrs /51001 a bse.)
� I cMM � in Ne perlomwice d the work lor whch �hie ymmG u beueE. I MNI ml employ enY Ve� in enY meniwr w m lo
becanb au4� to IM xaka�s' mmG+�uiion bwe a celEoma. vd earea thet il I ahwk bxvm viEi+d m �M Malun'
compewtian povisbrre d Seaun 3]00 d tM lebor Code. I ehdl IMhxi1M1 campM wiN Noea pwieima.
Dma: Apqicene
W�mInO� F�Nuro ro��cun wotlreri rompxu�tlon rovernp� b unbwlul, �nd alv/l auDpet an employer ro ulMryl pemltlu md
elvll I/rM� ,q ro rn� h�ntlrM fMuuM AWYn (SfOq000), In �rltlltlon ro tli� emt ol rompxwtlon, A�m�pi aa povMW !or In
SxHon 9lW o/ tl�s LeEorCOM, Irrteroaf. �M ettomsy i/su.
CONSTNUCTION LENqNO RGENCY: I hmaby eMrtn uMer penely d parNry �het ihse o e wnnrud'an bnEi�p epeMy M tM
perbrmerce d IM xak iar xfiid� �he Va^^i w weued (Sedion 308). CN. CI.
LENDER'S NAME:
LENUEfl'3 AUUPE55: .
I cenity ihm I have ned Nia epplicetion uM mme thet the ebove iMwmelion is cortw. I ep�ea io wmply wilh dl ary vM couny wdineiKea
eM ate�elewsrele�iplo buikipconatrWon eM herebyainhw¢eiepreaenle�rvee dt�ietilyloenterupmlMebove�menlionaE pioperly
fp irepeaion Wryams.
ii�MMY SCriM3uT
.Pfdm Nama n {� yn �/
^r^--� . �i /�w.. � � Dme: � v � L 4 � / /
-�ipneture erl/penUApPYrenVConlream
(515td6 WP) W�ile-BuilEip d Sele1Y: Greart-Fle: Cenery-Fppirant: Rnk-Ra.enw: (3oMmro�Asaeewr
CI?z uF �GS7A MESA - BUiLLiNG PEHMZ'I
Pe�RMIT ivu; M 085464 FLAN CiiECK NU: iv
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CUMMENTS: Nu vI'HER WGRK AU"tHUFtIZEL bY THI9 YERMI7
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McC 1 INST rGRi:-AIRiGRAv•ri.iRN <= iv0 ri b7u 13.25 13.�5
fiNL} OF Y tF.S
18-2A-1997/84:28 Pq/f35.25
ftCPTH:81-8814605
PERMIT:085464
�
CONS`fFtUCT10N AND PLANNING
APPROVALS Permit # �
1. Temporary Elec[rical Service or Pole
2. Soil Pipe-Undrgrnd. �.
'.3: Electriwl Conduit Utility-Undrgrn8.
' �;,4. �lectrical Cond�it�Undrgrnd.
� ;5. ,Steel Reintorcement '
� 6;� ��ectrical UFER Grnd. - �
�: o.
?�'7� Footings "
- . voc�" "sPa
-Date Inspector qpPROVALS . Permit # Date Inspector
. - �� 52. Pooi & Equipment Location
53. Steel Reinforcement �
' - 54. Forms ' - � '
� 55. Electricai Bonding . . ..
� . 56. Rough Plumbing & Pressure Tesi ,
57: APPROVALTOCOVER�GUNITE=
� ' . 58; Electrical Conduit�Undrgmd. �
� � , .59. Gas Pipe, O Undrgrnd„ Test �
. s
9. Water PiDe�Undrgmd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Fioor Svstem , � ' 67. APPROVAL TO DECK � �
11. Property Sewer Line & HouseConnection .. '. ' , 62. Backwash & Receptor-Finaf -.
12. Sewer Cap - - . • � ' r � •63. Heater & VenrFinal
13. ROof Drains . • '� � 64. Plumbing SYsrem - Final
, .
14. Rough P4umbi�9 :, - .. 65. E�ectrical-Final
15. Rough Elect�ical-Conduit `�T , . ' . ' 66. Solar Svstem-Final ' � ,
16. ROugh Eiectric Wiring , �- � 67. � Fencing & Access Approval
17. Rough Wiring Si9� � - "68. APPROVED FQR P�ASTERING .
18. ROugh Electrical�T Bar Ceiling �� -' '69. POOLISPA SYSTEMS FINAL
79. �Rough Heating & Air Conditioning �" ' - " - " � � PIRE DEPT. REQUIREMENT
' t ' _ � n i i ' 7 -�:p _ ( -, s
20. 'ROu$h Pattori FicePlace . ^ - � .- � � '' APPROVAIjS�:J Pe{mit # .' 'n
21.��bucts, in_Struaure :: � •• •• .+ .: � - 7 � ' 70: Under�ro'urid Hydro `
- =r
22. .Ducts. Ventil7lin , " , - � _ � � v ~ ,• . ^
� 9,� � �� �-� 77. ProduFt�Piping G,Gas �Oii
23.'Gas 6ipe-.Rough &�Test � - i. �7 � 1, �� �- - 72. Underqround Fivsh " �
24. �ROof Framing' ^ t �--' " F�-� �; .� �, �"' •= 73. Undergrnd. Stora�ee Tank+ C� Gas ❑ Oil
25. Roof.Sh athing _ �: �� �7 � �; r� 7qt Overhead Hydro� !
26. T-Bar Ceiling ($tru`c4uraq & Ma�o�oat �] ` � y r 75. Dry Chemical _, j ��l - ,-`
27. �Frameand Flashing� � ��' ':� 76. Dry Standpipe'-J+`a �' �
26. LBth'ing & Siding-_ �; "' y ��� �?' '- ' "� "�� 77 FIXED.SYSTEh �FINA,`L..� -. -
r � � ' ' �K 7g, FIRE PREV. FIPIAL �%
29. Insulation � . - •• r � � -. '�
30. DrYwali Nailing :: �� � F � � t�: : ,-,H€ALTN DEP7.�AEQUIR�EN
�, 31. Plaster Binwn,CoaG ;_, .. r ; � �e n 79� FINAL LNSPECTiON �� �
� 32.`Electrical Power Meter�Finai � � ti � � '`.
tr
r .r� I.
33. Fine3�ElecGic� " � , ,. I
34. Final Heating& AirCo�ditioning.� � b S� �
f!/�/_ •
35. Final'Gas Pipg Tes� {. ; ;- - i �K
•W 1 �
36. Hood or Canopy �^ � � � � �' ^ � K -� }�"
' 37. �Final.Factory Fireplace - , � ., ."� � � � �;
38. Final Plumbing 5� �� �� _ ' ; `(f
y [!'
39. WBrer Service•Fi�al � _ � �- ` � ��
C � 1 „F
40. Ges Service-Final n � n.� - +- ' 'r
�
' qt, Solar pomestio-Fina9 = ' " ` � � � '
F H � � ��
42. Backflow Preventer. � � i �R
, r
� 43. BackfloLv irrigation � - - � �
i
44�. Lendscape Irrigation System :' �' T! � "'
� :i
45. Sound Attenuation" � ^ ' � � '�
- . , t �Tj
'46. Handicap Regulatior+s .• ' � . +�
47. FINAL STfiUCTURE & BUILDING ' �- �`
48t FINALPLANNING� - � �i.
49. Electric Release [o Edison � ' �� �
5�� Ges Release to Souchem Caiifornia Gas Co • .�
_51; CERTIFICATE OF OCCUPANCY "
No. Date
FOOD CERTIF(
es: _
�
`ATE I�SUED� �T
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PflOJECT AOOPESS: Z S 6 D EL MAR AV
� OWNEfl'SNAME: PAUL TROEGNER
noonEss: 2 5 6 D EL MAR AC'
•r COSTA MESA
'/ CA 92627
AflCHIENGINEEN:
aoonEss:
NEG.NO.:
UNIT:
uNiT:
PENMITTEE: PAUL TROEGNER (714)695-9d76
aooeess: 2401 VIA MARINA
NEWPOAT BEACH CA 92650
UCENSEO CONTBpCTOB UECLABATION: I �ere�y atfirm Ihal I am licensetl under provisians of Chapter 9(commencing with Section
7040) o� �rvaion 3 0l Ihe Business antl Pmlessians Code, antl my license is in �ull farce antl eilec�.
CITY LIC.: STATE LIC.: CIASS:
Da�e: Signa�ure:
WOBREHS' COMPENSATION OECIAPATION: I hereby aflirm ihat I have a cerliticate oi consent m selbinsure or a cenificate of Workers'
Compensaoon Insurance, ar a ceni�ied copy Iherea� (Section 3800. Lab C)
POLICY NO.: E%P. UATE:
comeaxr:
� Certrtied copY �s here�y WmislteA. ❑ Cetlifietl coDY is liletl with �Ae ciry Builtling Division.
Oate: ApDlicani:
E%EMPTION FROM WOBREBS' COMPENSpTION OECUBPTION: (This seciian neetl no� be [omple�e0 if ihe permit is lor one Auntlre0 (5100) or less).
I ceriify �hat in ��e pedormance ol Ihe work tor whic� �his Dermii is �ia% 0. I 5hail not employ any person in any manner so as to become
su�lec� to �he Workers' Campensalion Laws of Califomia. ////
Oa�'' � � G � y SignaNre: �/ i��A�i+��
NOTICE: II, afler making Ihis tleclaraiion, you shoultl become subject �p•fhe WorkeR' Compensalion provisions ot ��e Labor
Code. you must fo�hwii� comply with suc� pmvisions or �his permii shall Ue OeemeO revoked.
CONSiflUtTION LENOING PCENCV: I here0y alfirm Ihal ihere is a canstmc�ian lending agency lor Ihe pedormance oi �Ae work for
wAich IhiS permil is i55ued (SeClion 3097, Crv. C�.
LENOEP:
nooness:
OWNEB BUILOEP DECIAHATION: I hereby afiirm Ihal I am exemp� �mm ��e Con�raciors' Slaie License Law for Ihe following reason
(Section 7031.5 Business and Pmlessional Cotle: Any ciry oi counry which repmres a permit �o consimct, al�er, impmve, tlemolish. or
repau any slmc�ure, Onor �o Iis Issuance, also reqwres Ihe applicant for such permit �o file a signed sta�emenl ��a� helshe is Ilcensetl
pursuani to ihe provisions oi Ihe Conlraciors' Sia�e Licenre Law (C�apter 9(commencing wi�h Section 7000) oi Oivision 3 0� Ihe Business
and Pm�essions Cotle) ar Ihat helshe is exempl lhere�mm and the basis br �he allege0 exemp�ion Fny viola�ion oi Section 7031.5 Dy
any applicant for a permil sublec�s Ihe applican� to a civil penal�y oi not more �han �ive hundretl dollars (5500).
I, as owner o� �Ae pmperiy or my employees wilh wages as their sole compensation, will do Ihe work, and the
❑ slmclure is nol imended or ol�eretl �or sale (Section 7044, Business and Protessional Cotle: TAe Coniracmrs' Sia�e License Law
Ooes nol apply lo an own¢r o� a properly w�o builds or impmves th¢reon, and who OoeS SUt� woB �imselllhersel� or Ihmugh
his or her own employees, pwvitled Iha� such impmvements are no� inten0ea or olfereU lor sale. Ii, however Ihe builtling or
impmvemenl is solA wil�in ane year of complelion, ihe owner will have ihe burden of pmvinA he/she Oi0 nol builtl or improve
for ihe purpose ol sale).
I.as ownerollhe pm0eny.am exclusively coniracting withlicensed conVac�ors�o consirucllAe O�olec1�Seciion 7694, Business
❑ antl Prolessions CoAe: The ConVaclors' S�ate License Law does not apON �o an owner a� D�opetly who builds or impmves I�ereon
antl who coniracls lor such O�oleds wi�h a conVac�or(s�license pur5uani to Ihe Contraclo�s' Slate License Law�. I am aware
�ha� prool ol I�eir Worker'S Compensation insurance shoultl be pmvitled Io me.
� i am exempi unoer Sec�ion: B P 7 O 4 4 8� 8 P� ��
m�misreason: ALL WORK BY OWNER F AMIL///���
�a��%� y Owner � ('�+-�./ / .—/1/J�� '
I tlo �ereby cenify thal I am aware ol and untler5iantl Ihe requirements o� Califomia Health ana Sa�y CoOe Sections 25505, 25533, and
25534 ane �hat I or any �uWre �wl0mg oaupant will/will not (circle one) neetl �a comply wi�h 5ai0 state cotles antl Ihe reQuiremen�s for a
permil br conSVuc�ion or mo0ilication irom the Nu Ouali�y Managemenl OiSVic� ReSitleniial c�nSVuc�ion applications are exempt trom
I�ese pmvisions.
oate�. APPlicanl
I hemby ceriity thal I �ave read ihis applicalion and sta�e Iha� Ihe above intorma�ion is correcL I agree lo comply wi�h all ciry end counry
ortlinances antl siale laws relaling to �uiltling consimc�ion and hereby auth - e representa�ives oi Ihis city �o en�er upon �he above-men�ioned
pmper�y lonnspecuon purposes. �%�
Date: � ` S/ � Signa�ure:_G� l � / 'vl��— �� �,��C
i
rrver's �icense ar Sociai Sewriry p:
164L46 Whne—Boileing: Green—Cotle Enlorcemen�; Canary—Applicant; Pmk—Revenue: Goldenmtl—Nssessor
CITY OF COSTfI MESA — BUILDING PERMIT
PERMIT NO: H 066416 PLAN CHECK NO: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR
JOB DESCRIPTION ; REROOF OVER EXISTING COMPO WITA COMPO
PERM NO: B 066416
GOVT: N SUPP: N
PURPOSE: ALT
SQ FT: 2,760
CLAIM VALOE: 2,760.00 CALC—VALUE: 2,760.00 GROUP UCC: R-3 /M-1
COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE �UB+�C/{^�7� n
*��i;-��*��c�c�c*�c+�x*�c�c*�*Zx�O�cN�I*N�G*��R�E****��-�+�**+��-�*�*;���**���Vf�C�iJ���i��f7
S E T H�AUCIKRSE M E N T S�
------------ MAIN BUILDING --- ----- --------- ACCESSORY BUI��,���RED__
FftNT; FT TN REAR; FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGAT: FT IN
PARHING REQ: PROV; PARCEL: 43920101 ZNE: REF NO;
PLANNING NOTES>
�
�1F iF iE iE iE # 1E if ?E 1E iE 9E i( iE iE if iE iE iE i! iF ib'.E fF iE?E fE �E -0f-Yr iE jE iE iE iF 1f-if iE 1E iF iE iF iE !f iE if if 1f if� 1f fE jf -If iF 1f jE iF i; iE iE 3f if 1E j4 iE iE �IFlE �*iF if i41E * iE iE iE if
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,I�i�;T., S
ZONING APPROVED BY PATE: /�'
HUILDING APPROVED BY : _ DATE:,.�'
APPLICATION ISSUED BY: DATE: `���f �
iEiEiEiEiEiE'lfifiE#IE1F1E3f-if�1G9EiE'lEiFiFiF ..' .'Yx�.1F � kfi n� �IEitffiEiFN'3Fah'IEiE�fi�3FR-fF3ii�ifK
ifiEjfifiEiEiElEiE'lE1EiFiEaF'1Fif"ii'iEifil'rE'X'iEiEii'iEiFifi�'#1E9%ifiLi�'iEibifiEifiElf'K'iFif'- i(i''?fiEiffF'�'lE'lEiEiEifiFiEiEiE'I('ifii'ifi!'iEiE#3Fif1(�'YFif'YiE3F
LEGALIZATION:N F E E :S U M M A R Y UTRUCTURAL�'SEGMENT:Y
BLDG PMT PLUMDING ELECTRIC MECHANIC FIRE SMIP/,AES GRADING
PERMIT 5q,00 � .'S0
• SMIP/NON—RES
PLAN � '
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS---=>> 54.50 0.00 t',� 0.00 54,50 59.50 ,00
REVENUE DIllISION TOTALS--> COLb,ECTED: 54.50 OVER/SHORT: .00
BLDG PMT PLUMBI�IG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
54.00 �.r .50
iE jf if %1f iE iE iF iF iE iE iE if i61F 3E � iF if 3E iE if iE iE iF if jF iE 3E iElE iE iE if if iE lflaf �K?t if �E iE iE 1f iE if iE iF if if iE iE 9F 3E iE-)F if it # if iE * iF iE iE iE �)E jE 3R jc JE iP iF iE iE 1E # 1P
I N D I V I D U A, L i F E E B R E A K D O W N
TYPE QTY D E S C R I P T I,O Ni UNIT COST TOTAL COST
SFR 2760 REROOF BY VALUE RESIDENTZAL NOZONE
END OF FEES
�
i• i••
r
1.Q0 2,760,00
, 01 00157257-00157258 T+] 7
�ATE: G3l16/95 TI11E: 10:03
J�.JQ
'CVNSfRUCTIdN AND PLANNING P�� _ & SPA ' � � ' ^
APPROVAIS Permit # � Date Inspector AppROVALS Permit # � Date Inspecxor
1. Temporary Electrical Service or Pole 52.'Pool & Equipmeni l.ocation ' �
2. Soil Pipe-Undrgmd. � 53. ,Steel Rainforcement � - �
3. Etecuicai Conduic Utility•Undrgmd. 54. Forms �
4. Electrical Cond�it�Undrgmd. 55. Electrical Bonding
i r
5. Steel Reinforcement 56. Rough Piumbing & Pretsure Test
6. Electrical UFER Gr�d. 57. APPROVAL TO COVER-GUNtTE
7. Footings 58. Electricai Conduit-Undrgrnd.
8. Foundation 59..Gas Pipe, O Undrgrnd., Test -
9. Water Pipe-Undrgmd. .,� 60. Backwash Lines, RTrap. L Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DEGK � ^
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . ,
12. Sewer Cap � 63. Heater & Vent-Final . � �
73. Roof Drains 64. Plumbing System � Final �
14. Rough Plumbing 65. Electrical-Final
�
15. Rough Electrical-Conduit 66. Soiar System-Final . '
16. Rough Electric Wiring � fi7. Pencing & Access Approval
,i
17. Rough Wiring 5ign 68. APPROVED FOR PLASTER WG �, .i
18. Rough Eleciricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit �
21. Ducts, in Structure 70. Underground Hydro
22.Ducts,Ventilating 77.ProductPipingOGas �70i1 �
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Framing 73. Undergrnd. Smrage Tank C Gas ❑ Oil
25. Roof Sheathinq 74. Overhead Hydro
26. T-Bar Ceiliog ($tructural) & Monocoat J5. Dry Chemical �
27. Frame and Flashing 76. Dry Standpipe
28. La[hing & Siding 77. FIXED SYSTENt F WAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plaster Brown Goat � 79. FINAL INSPECTION
32. Electricai Power Meter�Final ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes��� a�� ��� f S.sts� Y
34. Final Heating & Air Conditioning ..� 1� / 'j�//J
l�fii > . o%. ��Tf y_�i�i`�'
35. Final Gas Pipe�Test
.
36. Hood or Canopy . �
37. Final Factory Fireplace �
38. Pinal Plumbi�g '
39. Water Service�Ginal
40. Gas Service�Final
47. Sotar pomestirFinal '
42. Backflow Preventer
43. Backflow Irrigation � �
44. landscape Irrigacion'y4ystem
45. Sound A[tenuation �
46. Handicap Regulatiqns• �i -
47. FINAL STRUCTURE BqdwILDING /j g'
48. FINALPLANNINS`', -,wr �I .-
49. Eiectric Refease to'�d(sba- , �
:v
50. Gas Release to Soufherrt'C�lifornia Gas Cn .;-- �
51. CERTIFICATE OF OCCUPANCY
Na. . � Oate
�.4.
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Property Add
Owner
Contractor _ � !
State Contractor License Number
li
,
�
_.,;;;-..,
Permit No. � `-'� �T ��
Classification
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building
Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
L"J I further certify that I am the owner of the property. (Owner-Builder permittee only).
❑ I further certify that I am:
❑ Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I pertify that as an authorized officer or agent of the company or corporation, I am empowered to make
this certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division tor acceptance.
Received by Building Division
By:
� %f/I �
-- ,.-
0990-46 W�ile-Bpilding Oiv.; Canary�ConVactoq Pink-Owner
O \ �
Co pany or Corpoiate Name
Address
-��� ��'>-�^^ �. 3� /F i�%
SignaWre Date
Printetl or typed name
OWNER ROGERS. DANIEZ D. " DATE lO—B—S4
JOBADDRE83 256 Del Mar BUILDINGPERMITNO. 59j
GENERALCONTRACTOR Owner-Builder VAWE$ 1'j f�_f_},Q.9O ,
. "L�`� ], BLOCK TRACT
,- 17 Dta .l l i� R Gar._
GhvUP' I TYPE V ZONE RLL FIRE DISTRICT �g(�
�' I PERMITS ISSUED
•INSPECTIONS DATE 1 SUBCONTRACTOR DATE I NUMBER
Foun6ation Forms and Grade to
PI
Wirinp,RoughiU(�� iLL� �
Ro
P
/—/A''S.S /�]�%.
�/'1G ti! i�' �/ 6 ;ti
Plumuing, Final GasTest �LQ�[/ . � 5� (�e.� � � iC
Wirina. Final � /�P i � '7—/(%
Form L10 G-H 1M 12-69