HomeMy WebLinkAbout963 DENVER DR - Building PermitsPFOJECT ADDNESS: 9 6 3 D ENVER DR uNiT:
...OWNEfl'S��'+aME:BERNARD SOAN B
aooness:963 DEN�ER DR
COSTA MESA,CA 92626
5408116
PflCH/ENGINEEH: flEG.NO.:
AOUflESS: UNIT:
PEflMITTEE:JOAN BERNARD ( 714 ) 540-8116
aooeess:CM963 DENVER DR CA 92626
tICENSED CONTBACTUH OECLAflRTION: I �ere�y a�hrm ��a� I am licensed untler pmvisions ol Chapter 9(cammencing with Sec�ion
7000� ol DiNsion 3 0l Ihe Business ana Pmiessions Coae. and my license is in lull force and effect.
QTY UC.: STATE LIC.: ClASS:
�ate' Signalure:
WOBREBS' COMPENSpTION OECLAflFTION: I hereby aftirm I�at I �ave a certilicate ot consent lo sel4inmre or a ce�ilicate o� Worker5'
Compen5aiion Insurante, or a cetliliea copy Ihereo� (Seclion 3800, Lab. C).
POLICY NO.: E%P. ORTE:
COMPANY:
7 CeOilied copy is hereby fumi5he0. ❑ Cenilied coDY �5 filetl wi�h Ihe city Builtlinq Division.
Date- Applicanl
EMPTION FBOM WOflHEflS' COMFENSPTION OECLAPRTION: (This sedion neea no� be comple�eA il lhe De�mit is tor one hunOreA �8100) or less�.
certify thal in the pedormance of Ihe work far whicM1 �his permit is issued, I shall not emD�oy any Oerson in any manner so as �o become
subject lo I�e Workers' Compensation laws ol California.
Oare: �-L 7 � 9'3 Signamre: �
NO ICE: If, alter making Ihis de ara�ion. you shoultl come subject to the Worker5' ComDensation pmvi5ions ol Ihe Labor
Code. you musl totlhwi�h comply wi�h such pmvisio or Ihis permit s�all be deeme0 revoketl.
CORSTBUCTION LENUING AGENCY: I here�y ailirm Ihal there i5 a cons�mction lentling agency for ��e pedormance o� ihe work for
whic� ihis permit is issue0 (Section 3097. Civ. C�.
LENDEH:
aooREss:
OWNEB BUILDEB OECIANRTION: I hereby aflirm I�at 1 am exemp� �mm the Conlractors' Sta�e License Law lor Ne lollavnng reason
�� (Seclion 703t5 Business antl Pmfessional Code: Any ci�y ot counly which requires a permi� lo wnsimct, aller, impmve, tlemolis�, or
repair any SlmcWre, Orior to its issuance, also requires ihe applicani lor such permit to tile a signed slalement iha� helshe is Iicense0
pursuam m Ihe pmvisons of the Comrac�oK S�ale License Law (Chap�er 9(commencing wM Section 7000) ol Division 3 0� the Business
antl Prolessions Code� or Ihai he/she is exempi Iherelrom ana I�e Dasis �or �he allegetl ecemplion. Fny violation of Sec�ion 7031.5 6y
any aODlicant�or a permit subjecls iM1e aDPlicanl�o a civil penalry ai not more Ihan �ive huntlre0 tlallars (E500�.
I. as awner ol t�e pmDeny or my employees wilh wages as IAeir sale compensation, will do lhe work, an0 ��e
❑ slmclure is nol inientletl or oi�ered for sale (Seclion 70a4, Business antl Pmlessional CoOe: The Coniracmrs' S�a�e License Law
Uoes nal apply �o an owner ol a pmperty w�o Ouiltls or impmves thereon, antl who does such work himsel�/hersel� or IAmugh
Ais or her own emDloyees, proviEetl �ha� such impmvements are not in�entletl or oft¢red lor sale. II, hawever t�¢ Guiltling or
imD�ovement is sald within one year oi com0lelion. �he owner vnll have Ihe DurCen ot pmving he/she Oi0 no� buila Or impmve
lor ihe purpose ot salel.
I, as owner oi �he pmpeny, am exclusively conVac�ing with licensetl conlrac�ors �o constmc� �he pmlecl (Section 70E4, Business
❑ and Pmie55ion5 Cotle: The Conimctors' Stale License Law Ooes no� apply Io an owner ol Oroperry who UuilJs or impmves �herean
antl who conVacis lor suc� pmjecis wi�h a conlraclor�s�license pursuanl Io Ihe CanVaciors' $late License Law),I am aware
Ihat pmai ol I�eir Worker'S Campensaiion insurance shoul0 be pmntle0 lo me.
7� � am exemp� unaer SeciionB P% O 4 4 �. 8 P. C.
mr mis reasore ALL WORK BY OWNER
Date- , 7 / �13 Owner. ! Ln--�'�—�
10 ere�y cenify tnal I am aware ol antl unaerstanU Ine requirements of Ca mia Neal�� an0 Salery Cotle Seclions 25505. 25533, an0
2553d anOlhai I or any IUWre �uilamg accupanl will/will not �circle one� nee Io comply wiih saitl s�ate codes anOlhe requiremenis �or a
permit Im constmclion or motli�ication Irom Ihe Air �uahry Managemenl OistricL Residen�ial [ons�mctian aDPlications are exempt fmm
I�ese piovisions.
Oai¢: Applitani:
I �ereGy certify �hat I Oave reaa ��is aD0lica�ion antl slate ihat Ihe above inlormation is
oremances and siate laws �elating Io �uiltlmg canstmclion antl here�yautlwrrze represent
�pmperty,�orinspeclan purposes. ^ �
oaie: r/ � I �J' Signalure: _
�
�riv 's Gcense or $ocial Security r:
I agree �o comply wi�h all city an0 county
��is ury Io en�er upon Ihe above�mentionea
�6<t-a6 White—BmlOing: Green—Cotle Enlorcemem; Canary—Applican�: Pink—Revenue: Goltlenro0—Asseswr
CITY OF COSTA MESA — BUILDING PERMIT ,
PERMIT NO: B 062494 PLAN CHECK NO; N , ,
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF REROOF W/ CLASS C SHINGLES SQ FT: 2,500
CLAIM VALUE; 2,500.00 CALC—VALUE: 2,500.00 GROUP OCC; R-3 /M-1
COMMENTS: SMOKE DETECTORS RE� PER UHC#1210
�r�r*««�r*+�r�e*�r�rr+e*�r��r�*�r�r�r**�r�r *�**��r�rx**�r�*�r*�r�rr�r*�r�r***�*�rx�*�r�*w****�r�rx**�r�r**��*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ'• PROV; PARCEL: 41808131 ZNE: REF NO;
PLANNING NtSTES>
i
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D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N 1' S
20NING APPROVED,HY DATE;
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY; DATE; O� �
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kitifif�t�fififlf�fkiFlkifiF�flflfifififiFlfkitkiFMifMkikikikkiFlFiki MiFlklklf�F�f�FikiFiFkiFiFikilifkkiFkiE%iflklk�Flfif�EiFiFifiFikiFikikiklF
LEGALIZATION:N F E E U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECT IC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54.00 ,50
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 54,50 0,00 0.00 54,50 54,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 54,50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
54.00 .50
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I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2500 REROOF HY VALUE RESIDENTIAL N020NE 1,00 2,500,00
END OF FEES
w
a1 00140512-00140513 T ll T 54.50
DA7E: 06/07/93 TIME: 10:14
� CONSTRUCTION AND PLANNMG
APPROVALS Permit T`-
71. Temporary Elecv�cal Sarvice or Pole
2, So4.Pipe-Undrgrnt�.
- 3. ElecWcal Condui4 UUlity-Undrgmd.
- �;4; E�lec4���a1 Condu�t�Und�gmtl.
-.�.�. . _
�S. Steel Reinforcer;ienc
,___"_ -
�` Eiectricai UF�Gmd
_ �. ---
i., Foot�ngs
"8, FoundaUon 'L
9. lh'ater Pipe�U.^.dr9rnd.
10. $tructural Ploor System
11. 7ropetty 5twer lihe & House ConnecUon
12. $:.ver C<ip i
13. Roof Dra��s __ „
14. Rou�h Plumbing �
15. Rough Eiectnqi�Contlwt
16. Rough ElBctriG Wirinc�
77. Rough Wlnn�'Sign
18. Rough Eleciri�al•T Bar Ceil�ng
19. 7ough HeaLng & Air C;ondrtioning
- l �__ l_� �• r � ' ;
2G;: Rovgh'Eacc�ry fiEeplace i ?'i �.
2}. �C.'ii, ill �truC:.�:fC � • . .- • �
c- c � : -
r ��
2$: D�cts,:k�enYlating r
23. Ges P,pa qa:�h &.Tes: . J= ; �
24z Ront Fr_aming �- : ' '�' -
25. Roa; S�c�Y�� ng - J; ��. �(�
Z¢r T�"oar Ce�iing (S�racturall � 4�Aq�ocoat
2Z� Fiemeand.FlasFri3g , .�
. 28. �2thiri�,& SidirfL+; • ^ r' C x
., . . ., y
29. Insulation ��- � �
� : . r.-�:
30. Drywatr Naiiing,�', �
. 31. Piasteq$rot^n Coat y : �
. 32, Electnc,31 Ppwer'Meter�Fin�__
' 33: Fic�al Elect.sc � � ^ i :
k--v-+�a: � _
� 34:_ Fi�al H�Oat���9 & A`ir C�ndrtioh+m� ,-
r-, -i: -
3`'r.' F�rc! Cts P�pa�ToS,t _ ' .: �.
�
; 36. Haad ot Car.opy'�'_ ' � '� ' ' �
- 3T. Fival Fycio'Y Firep'.acrr - - ,
' 38. Finai P[umbmg '
` 39. INater $¢rvice�Final .• , �
40. Gas Serv�ce��mal - s � +
' 41. Solar pome:ticF�Baf � � '�
42. BackflowPreventer� �
43. Backflow II#igatic�p j,s� f.
�. 44. Lacdsc�p¢7rnqatiDn SYsteai. �-= � �
� + * i
' 45, Sound,At�+uation x .
' 46. Handiap acguiation, .
47: FINAL S7�UCTURE & BUILDWG �
4A: f.,yAL P4APlN1tiG � .
49. Elettric"Reieasx i�; Etlison �
50. Gas Reteaseao Southem Cafifornia Gas Co
51. CERTIFIGATE OF OCCUPANCY
Date
Date � Inspector
:
POO SPA ,
APPROVALS Permit:=_�_
52. Pool & Equ;n�nant Locat�on �
53. Stccl ReinforccTent �
54. Forms .
55. Etectrical8ond�ng -
56. Rough Piumb�ng & Pressure L:st
57. APPROVAI_ TO COVER�GUhiTE
58. Eloctncal CurdwFUndrgrntl.
59. Gas P,pe, C Uru�g-nd , Te;t �
60. Back�vash L��,es, P�Trap. � U�Jra�;�d
67. APPROVt�.LTODECK
62. BaNc�:ash & A�ce;�:c Finai �
fi3. Ncater & VcnEF�r.�i
64. ?i�mb'rg Sys:rm - f,,,.�1
G5. Eie^trica6Fine
66. Sa�ar Systvm�Pindi
67. Fencin� & Accexs AnPruva3
68. APpROVED FOR PLP.STERI,'VG
-- �69-. POO-L�SPASYSTEMSFINAL
: 4 � F�qE ��.PT�REQUIREtsf �T - � ,
S x ;, �APPf{OVAb`S'�' P�imit �' ' ` I
�-�••--� ---'
��� i 70. Und�^r�'ia�`•7 Hydra ' ___
V¢ x� 71. ProticiH����ing `7�.is �i,�.0i1 � ;
- "?'.0 ---r..--�- - - - . � --- . _.�
" �'y 72. Un�crg�c.i.�`n Fh_; - •- i
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7G. Occ�lzaa Nvu � ` ; `
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76. Ory Stzr`Yts�r�.- z . ; I
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_'I;� s 77� FIXED SYyTEj�T-INAL� �-, '
7F� PIRE PREV. F,It��L x% � � i '
-``. � �H.EALT,k�! DEf?:T. REQUIFt�MENT �
• - -1
� 79. FIn1A 6:;,�'CCTi�N �~�=_ I �
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Date I Impecmr I
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PflOJECi PDOHESS: 9 6 3 D ENVER I)R
_ oweewsenme:BERNARD, J'OAN B
aooness:463 DENVER Dk
' COS7'A MESA,CA
�
AflCH/ENGINEER:
ROONESS:
UNIT:
92626
HEG.NO.:
UNIT:
PEflMITTEE:SOAN AERNARD (714)540-8i16
noonEss: 963 DENVEk DR
C,M. CA 92626
LILENSEO CONTNACTOX OELLABATION: I �ereby af�irm ��at I am Iicense0 unEer pmvisions ol C�ap�er 9(commencinq wi�h Section
]000� ol Drvision 3 of Ihe Business ana Pmlessions CoGe, antl my license is in lull lo¢c anG effec�.
CITY LIC.: 57ATE LIC.: CLASS:
oatel Signature�
WOHMEflS' COMPENSATION OECIRHATION: I hereDy allirm Urat I have a tertilicale ol cMsenl �o sell�insure Or a cer�ilicaie ol Workers'
Comoensa�ion insurance, or a cenilietl copy ihereol ISection 3000. Lab. C1.
POLICY NO.: E%P. OATE:
COMPFNY:
❑ Cerli�iea toOY �5 her¢�y lumis�ea. ❑ Cenitie� copY.S'I���etl wiih i�e ciiy BuiJ�ng Division.
oate:
ADDlicanc
ENEMPIIdN FPUM WOflNEBS' COMPENSATION OFLUflFTI0N1,(fnis section neea no{be com0leteE if Ihe permi� is lor ane huntlretl (5100) or less�.
I ce�i�y I�at in Ihe Oedormance al Ihe work far which this b�rmit is i55ue0, I sh� not employ any person in any manner so as to Decome
5u01ec o I�e Workers' Compen5ation Laws ol Cali�ornia. /� L�� �
/ L.
Dale: SignaNte: 141��
ICE:II. afler making t�is Oeclaration, you s�0ula ome SUGIe���o the Workers' ComOensation provisions of the labor
e. yrou must forthwitn comD�Y ��h sucn pmhsio or ihis permit stWll �e Oeemea revake0.
CORSTflUtTION LENUING RGENLY: I nereby affirm that there is a wnstruclion lending aBemy for t�e pedormance ol ihe work for
wnicn Inis oermii is issuee �Stttion 3W7, Civ. CI.
LENOEfl:
RDDflE55:
OWNEfl BOILOEN OECLl�BATION: I hereby afiirm I��t I am exempt �rom Ihe Conlraclors' S�ate License Law for Ihe following rea5on
(Sec�ion 7031.5 Business an0 Pmlessional Code: Any ciry ol coun�y which requires a Oermit �o cons�mc[, al�er, impmve, demolish, or
repair any sfmcfore. priorloils i55uance. also requires the applicant for suc� perrttit ro lik a SrgnM siaiement Ihat he/She is licertsed
oursuam Io Ihe provisions ol Ihe Coniranars' S�ale LicCnse Law (Chap�er 9(commencing wi�h Seclion 70W) o� Oivisian 3 0l �he Business
ana Pmlessions Code) or Ihat ne/she is exempl therelmm an0 t�e hasis lor Ine alleged exemo�ion. Any violation of Seqion 703L5 by
any appli[ant for a permil Suble��s ihe applicant �o a civi� penalty o� nol more Ihan five hundre� tlollars (55011).
� I. a5 owner oi ine D�aOeny or my empIpy¢¢s vnlA waAes as iheir 5ole com0ensation, will Oo �he work. antl �ne
simcmre is noi intentletl or ollered lor sale (Se�tion 70aa. Business anA Pmlessional Cotle: The Contracmrs' State License Law
Ooes nol apply Io an owner ol a pmperty w�o Ouilds or impmves ihereon, antl w�o Aoes such work �imsell/h¢rselt or thmugh
�is or he� own emDloy¢es, pmviae0 that such improvemenls are nol intentle� or ollereA fat sale. Ii, however the �uilding or
imD�ovement is sol� wiihin one year o� comple�ion, ��e owner vnll have I�e �urUen of pmving he/she tli0 not build ar impmve
for ine ouroose ol sale).
I. as owner oi ��e properiy, am eeclusively con��ac�ing with licensetl coniraclors lo consimcl ��e pmleci �Sec�ion Ip44, Business
❑ and Pmle55ion5 Cotle: IDe COnVat�ors' Sia�e Litense Law tloes no� apply 10 an awner ol pmp¢ny wha �uilOs or impmves lher¢on
antl who [onlratis lor SUch pwletl5 wiih a cOnlracloqs) litenie OUrsuanl �o �he Conlratiors' State License Law�. I am aware
I�at Dwol ol t�ei� Wo�ker'S Comp¢nsalion in^,urance s�aWA Ue D�ovitle0 to me.
� I am exemD� untler $eclion: 6. 8 P. G.
loe �nis reason:
oa�e:��l/r/993 a,me�: +�_a�
I Qo ner y cehily hal I am aware ol antl uneers1an01he requiremenis af C rnia Healin tl Safety Cotle Sections 25505, 25533, antl
25534 tl Ihai I ar any �ulure Uudding ocCupanl will/will noi (tirtle on¢) nee o tomply wilh Saitl Slaie cotles antl �tle reqUiremeni5 for a
permil �or conSlmciion or moUificaiion �mm Ihe Art Ouali�y Managemenl �iSUict. Re5i0en�ial constmc�ion applicaiions are exempi fmm
Ihesc pmvisions.
�alc: Np0lican��.
I nem�y cerlily Ihal I have rea4lM1i5 aOPhcation and Sld�e Iha� the above inlormalion is correcl. I agree to comply wiih all Cily antl cowry
arUinanwsantlslaielav�srelatingto�uiltlingcon9mclionandherehyam�orieerepres ativesa�lhiscily�oenteruponiheahove-men�ione0
D�oOe � in5peciion Durposes.
Oale ���s2 �� SignaWr¢: ���
od�e �cense o� sociai secum� �:
�60t�a6 Wbite—Builtling; Green—Cotle Enlomert�enC Canary—Applicanl; Plnk—Ravenue: Golaenroa—Asseswr
CITY UF' COSTA MESA — BUILL)ING PERMIT P�KM , UbJl �
PEkMIT NO; B 063108 PLAN CHECK NO: N GO 'I; N SUYY: N
CON5TRUCTION TYPE; PERMIT TYPE; STR PURPOSE: REP
JOH DESCRIPTION ; REPAZR RAZN DAMAGE TO 2 BEDROOM CEILINGS SQ rT: q00
CLAIM VALUE: 400.00 CALC—VALtJE: 400.00 GROUP OCC: R-3 /
COMMENTS; NO OTHER WORK AUTHORIZED BY THIS PERMIT
�e*��x��e�***��e�r�x�r�*x�x �*****xx�*k*x��r*+t��x�x���**�x�#�*xx**x �#�r���****��**� ��c�*x*#�t
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- -------- ACCESSORY BUILD:T.NG ---------
FRNT: FT IN REAR: FT IN FRNT; FT IN AEAR; FT IN
LEFT; FT iN RGH'I': FT IN LEFT; FT IN RGHT: FT IN
PARICZNG REQ• PROV: PARCEL: 41808131 ZNE:; REF NO;
PLANNING NOTES>
>
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A E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.T S
7,ONING APPROVED BY DATE;._' __
BUILDING APPkOVED BY : , DATE; ,
APPLICATION ISSUED BY; DATE:�S���
flififiFiflElFfEff�)flflfiflE!!%lEifiFlFiF1E�FifiFTf�iF#iF3F7fiFiFiFiF�Fif�3f3fi7FiF -�t3F3f�f�TFiFTf3F7f1flFit%�iEiEiElf�ll�ih iF�k
iF k ik ik ik iE if !f iF iE iElt k fE i! iE iE if !t if if iE 1E 1E ik iE iE iP k 1E if if 1E iF iE �f 1E it iE if ik �Elf iE iF if if iE iF ir if !F 1E N 1E fk iE if iP if ik iE!(� 1E iF 1f 1F i[� if iF 1E fE iflE if �lE iE K� iE
LEGALIZATION;N F E E S U M M A R Y STROCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTRZC MECHANIC FIkE SMIP/RES GRADING
PERMIT 15.00 50
SMIP/NON—RES
PLAN
ZSSUE E'EE
BUILDING—DIV—> PERMIT ZSSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 15.50 0,00 0,00 15.50 15.50 ,00
REVENUE DIVISZON TOTALS--> COLLECTED: 15.50 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
15.00 .SO
1t if If 1E if iE ik iElE i! iE lE if it fE i6 ik 1E ik iE iE �lE i4 iF �)E it �lE if iElE 3F if !f ?E iE iE iFlf iE # 1! iE iE iklElE iE 3F 3E iE if # fE If �IM1 JE 1f ik �f fP iE iF iE �1F �6 �E if Ik iF i6 ff 1F ih iE iE iF %iE?f
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N
SFR 400 ALTER BY VALUE RESIDENTIAL N07.ONc
END OF FEES
UNIT COST TOTAL C05T
1,00 400.00
O1 001?31bb-00143167 T�� T 1�.50
DATE: D7/2D/93 TIItE: d9:09
� CO?iSl RUCTION AP1D PLANNING
� APPROVALS Permu;,=
�� i. Tenpara�y Ele�tncal Se�v�ca or Pole
I 2. Soil Pipe�U�drgrnd.
3 Ci:�ctnca! Condu�i Utdrty�Undrgmd.
i
Ir 4. ElectnCul Condu;t�Undrg�nd.
�� 5 Stzc R:ir�o.cemen[
f 6� Ei •.t-,�a. UFER Grnd.
^ 7. Fooungs
�- --
Id Foundat.on
� 9. N�.ater P�.pe�Untlrgrr.d.
�
� iC. 5'-�_ct��:�' Fioor SYster�
i 1.�'•�na�.y S: c�zr Lin� 15• Hou.e Connection
. ',2. Sa:vc- Gip --
, 13. Roat przin5
�- - -
i i4. Ruuu�.� Plumbing
� '5 Ru ion E'aclricabCOnduit
`iG. 3n„9n Electrlc'.".'irina
� 17. Ru�..�h C:inng $.gn
lE. Rn�qh ElcetrieaDT Bar Ceil��g
'O Rr..yh Heaciny & A'r Cor.d:;.oning
� _ ,a., _ ,-.a�:orq Y�:.:G' a,._ - -
I 71 D .=!i.'n S:ructur�
29. D�..•s. Venrl�anrg
�a> Pipa�Rough & Test
24. Ruot f-ram�ng
� q�.q• 5�.,.arn�ng _
� 2E� T�[„ ., ,,�Lt�u::u�:+" E ii'onocoat
i
Z:. i=..�nrar.i F'aslvm
t__ __ __
28. L..th nn E Siding
�---
� 23. In�i',t�nn
�-
� �]. U w. a i'da��l�ng
�_--
� j'. �� . itr �lO:�n CJLt
� 3?. E�, ctr,r.� Po�.�e� eter Fina.
�
C 33. Fmzl E!ectnc
34. F�nal keaUng $� A�r Condrtionmg
� -35. F�nal Gas Pipe�Test .
� 3G. Hn^d or Car.�py
3l. F,��,;� F_cto�v Fvepiacc
�8. Fira� Piumbing
39. \Vatcr Service-Final
40. 3�q S.'�. �e'e-Fina�
�_-__ __
I41. Sn�a� Cr•�n�si�c•fina!
�2. G -�G�f;ori P�eventtr
�3. B�cl:flow Irrigation
4n Landscape Irrigation SYstem
45. Scund Attenuation
�. Hcndicap Regulatio�s
47. FIA!AL S7RUCTURE & BUILD!NG
48 Fii;qLPLANNIh1G
4�J. Eizr.tric Release to Edison
5G. Gas Releasr to Southern California Gas
51. CERTIFICATE OF OCCUPANCY
Oate
Date
r
�
POOL .PA �- -'--�
Inspector p�ppROVALS Permit �:?
_-�
52. Pool & Equ�pment LucaGon
53. Steel Reinforcement _ �
54. Focros
55. Eiettrical Bond.ng �
56. Rough Plumbing & Pretaure Tesi '
57. APPROVAL TO COVFR GUNITE
� 58. Electrical Condu�t�Undrgrnd.
59. Gas Pipe, i� U�Urgrnd., iest
_�
� I 6�. 8ac:cvtash Lnes, RT�ap, � Un_^a��tl
- ! -- _
� 61. APAROVAL TO DEC!C
-•-
� 62. Batkr.ash & �?ece��tur�f�n�l
63. Heater & Vent•Final �
63. Plumhing SYstem - F�nel ,
65. Electrical�Final
66. Solar Slsiem•Final
67. Fencing & Acccss Anpro�al
68. APPftOVED FOR PLAS7ERIWG
69. P06VSPA SYSTEti1$ F INAL
FIfiE DEPT. NE�UIHFil'IEiVT
'_ �
i � APPROVALS Pcrmtt '---
i
�
70. Underg�o�ns� H�,dro
71. Produci Plpir9 f i Gas �.Oil
72. Underground Fluah
73. Undergrnd.5tor2gc T�nk !� Ga. �' 0�!
74. Overheatl Hydro
---- --,I
Date Inspecta� ,,
T" �
�---
� �
P
75. Dry Chcm!cai �
76. Dry StacdP�Pe � � ----�-� -��_- - •
__-____._._ _�-_ _-'
7%. FIXED SYSTFh.' FIf:AL � _�
78. FIRE PREV. FIA:AI �
NEALTH DEP"i. F��Q;;IRE':�c � 7
79. FINAL INS;�EC'IiJ:•�; - � - ----- �----- i---�--�
-_-__..._ . -___-_. _ �_--__ __J-_-__"
80. FOODCERTiFi(;ATt iSSu_�) I
-------- -L----1---- .
Notes:
-- �
i
---- -- --i
- ----- '
Applicant lo fill in all spaces excev� �nose within �eavy eorCer Iines antl sign al1 aDPropriate Geclarations.
CITY OF COSTA MESA - pERIdIT NO. . TRACT NO. LOT NO. BLD . .
CONSTRUCTION PERMIT -
Pioject Address ' 9 3 D e n v e r r. �
Applicant's Mailin9 Address I S 2 S S. 5 i n c i a� i r ��
Owner's�Name B' 'r n a � d � vhone 5 4 0- 81 16
Address � ci 5 RI f -
Arch/Eng. � License No.•
Address - � ' -
Contractorls Nam= �0 m a r - S(h 1 a r K i n a/ Sp��� S S o � a r
Address�mailing) �SZS S- -Sinclair Anaheim
City LicPnse No. � Q� �� 3 '
LICENSED CONTRACTOR DECLARATION '
1 hereby,aifirm that I am licensetl untler provisions of Charter 9(commencing
with section 7000) of Division 3 of B siness antl Grofessions Cotle, antl �
my litense is in full force antl etfect.
License pass ' se No.' ' 45 � � 20
�ate ��pp—�� Signature �
WORKERS'� OOMP,ENSATION �ECLARATION -
�it�A;hereby affirm that I have a certiticate of consen SeILi sure or a certiticate
a,,°��� Workers' Compensation Insurance,� or a ce ifie copy thereof (Section
���h100. Lab. C.) •
Poii�y No. - � n F�4 z 4 R � co_''J �a r
❑ Certifletl copy is hereby turnishetl. (/ ^� '
i�`Ccrtifietl copY �s filetl with the cit)�� �tlin C�
oate - Applicant
.EXEMPTION R M WORKERS• COMPENSATION DEC RATION. . '
(This section neetl not be completetl it the permit is for on untlretl ($100) or
less) (
I certity that in the pe�Jo�mante Ot the wo�k to� which this p¢rmit is Issuetl, I
shall not employ any person in any manner so'as to become subject to the
Wo�ke�s' Compen5ation Laws ot Califomia. , ,
Date Si9nature
NOTICE: If,'after makinq this tleclaration, You shoultl become subject to the
workers' Compensation provisions-of the �Cabor Cotle, you must forthwith
comply wiM such provisions or .this, permit snall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV � " ��
I hereby aftirm that there is a wnstruction lentling agenq for the perto�mance
ot the wo�k .to� which this pe�mit is issued (Section 3097 Civ. C.)
Lentler's Name
LenOer's Atltlress �
OWNER BUILDER DECLARATION � '
I hereby aftirm that I am exempt fiom the Contractor's License Law for the
followinq reason (Section 7031.5 Business antl Professional Cotle: Any city or
counly which �equires a� permitto cOnst�uct, alter, improve, tl¢molish o� repai�
anv stn�cture_ orior to its issuance. also reauires the aoolicant fo� such oermit �
¢/rom antl the basis fo� the allegetl exemption. Any violation ot Section
LS by any apP��cant tor a� permit subjects' the applicant'to a civil
alty oi not more than five huntlretl tlollars (5500).
I, as owner of the property or my employees with wa9es as their sole
ipensation, will tlo tne work, antl the structure is not intentletl or ofteretl
sale (Section 7044, Business antl Professional Cotle: The Contractor'S
�nse Law tloes not apply to an owne� ot a property who builtls or IiTp/oves
'con, antl who tloes such work fiimself/herself or througM1 his or her own
oloyees, provitletl that such �improvemen[5 are not intentletl or offeretl for
. I/, however, the builtling or imp/ovement is Sold within one yea� o( cOm- �
ion, the owner will have the burden Of proving he/she tlitl not builtl or im-
re forthe purpose of sale). �
I, as owner ot the property, am exclusively cont�acting with Iicensetl COn-
tors to mnstruct the project (Section �044, Business antl Professions Cotle:
Contractor'S. License Law tloes not apply to an owner ot property who
tls or improves thereon, antl who contracts for such projects with a con-
tor(5) license pursuant to the Cont�acto�'S License L.aw).
I am ezempt untler Section B. & P. C. for this reason
Date owner �
infnrrme[ione istc rec :Itlaeree�to comolvPwitn al� citv antl coanN ortlinances
TYPE OF CONSTRUCTION LI NEW � L.J ADD LJ ALTERATION . LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# -
� DESC�2IPT.IONOGWORK S MainBuilC
oiar uoRies
TYPE OF PERMIT . GRADING FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING� � MECHANICAL ' • A Rea�
❑ �OTHER � ' C Right
PROJECT DESCRIPTION Sa.FT. oCCUaarvCv K
CONSTRVCTIONTVPE 'VALUP.TION$ � g Lef[
ZONE GRADING CU. VDS. ACRES P�ng. Ref. #'
Remarks: y. —yX ` �� . Parking Req./P
Bar Sink '
Backflow Preventer '
Backflow Irrigation
Ba[htubs
Clarifiers
Dishwasher . .
=1oor Drains '
RoorSinks .
uas Service
Interceptors
Kitchen Sink
Lavatories ' '
P—Trap
Roof Drains
Reinspection Fee
Service Sink '
Sewer Cap �
Sewer Connection •
Solar Collectors �
Solar Tank
Swimming Pool w/Spa
Urinal
Outlets . Water Closei
Water � Heater
. Water Service '
$25
Boiler
Duc[- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.81L ICBO #
Heating System & Ducting
❑0.100,000 BTU �100,000
ISignature /"/''� i/ � �' Date0�lLq�( I I
�rivers' License or 55 qF ' / Rainspection Fee
'CMF 0865-46 rev. 7/83 Wnite - Builtling; Canary - APPlicant; Pink -Accounting; GOltlenroC -Assessor
$25
FEES P�anning Notes:
7939 2/el/05
�
-. zone
- ' Accessory Building:
� Park.Fees $ �
ied
;
i �
i� AutomaticWasher
• (p � ConstructionPoleSuh. �
— ' - � r^'� '" Cookin Unit ... ' ' ' .' `
� Isue Fee - . $ 3
1ANICAL � FEE
Hood or Type I �
Canopy Type I I ❑
Refrigeration System
❑aioo,oaoaTu ❑ioo,000gru
System Repair/Alteration
Issue Fee I $ 3
9
Dishwasher i .
Dryers �Gas ❑Electric
Fan 1
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generetor DO5 KW �5�15 KW
Transformer � 15-50 KW
❑ 50+KW
Meter ❑up to 100�amps - r
Meter ❑over 100 amps .
Sub Panel , , �
Inc.Solar I
Microwave
Pole Light
Range
I HP �1%-8 '
9-15 HP �16-15+
Standing Section!
Trash Compactor
120�0 TL
Z
O
N
I
N
G
R
E
Q
U
I ,
R
E
M ,
E
N
T
IReinspection Fee I 325I Issue Fee - I $� 3 I
PUBLIC SERVICES RE�UIREMENTS:
2oning Approved By Date
Application Appraved 6y Date
Applintion luued By Dat��
SUMMARV OF FEES �
� BUILDING PERMIT $ SMIP $ '
PLAN CHECK $ PERMIT
PI,UMBING $ I LI'� CC� �SSUANCE $
PLAN CHECK $ ENERGY P.C. $ �
ELECTRICAL $ �• S� GFADING $
PLAN CHECK � $ MICROFILM $
MECHANICAL $ TOTALFEE $ T •� �o
PLAN CHECK $ .
�EONSTRUCTION AND PLANNING - - ' . P00 ;PA _ �
_ ARPROVALS' Permit # ' -. Date � Inspector� AppROVALS Permit # � Date Inspector
:: 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-Undrgind. _ � ' 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-Undrgmd.
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. Properiy 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 Wlring Sign � � ' ' 68. APPROVED FOR PLASTERING
' 18. Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL
�19. �Fiough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace , APPROVALS Permit #
21. Ducts, in Struciure � � , 70. Underground Hydro
. 22. Ducts, Ventilating � � 71. Product Piping O Gas ❑ Oil '
23. Gas Pipe-Rough & Test � � , - � 72. Undergrouhd Flush
� 24. Roof Framing . ' ' - 73: Undergmd�.StorageTank OGas ❑Oil
25. Roof Sheathing .. ' 74. -Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical' '
27. �Frameand flashing � ' 76. Dry,Standpipe
28. Lathing&Siding , , ' , 77. FIXEDSYSTEMFINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT: REQUIREMENT
31. Plaster Brown Coat � ' . 79. FINAL INSPECTION
�
32. Electrical Power Meter-Final, ' � � S0. FOOD CERTIFICATE ISSUED
33: Final Electric � � y %,fv' � Notes: .
34. Final Heating & Air Conditioning � � ' �
35. Final Gas�Pipe-Test . ' � - ' � �. _
36. Hood or Canopy � ' , � , '
37. Final Faciory Fireplace � ! � �
38. Final Plumbing ' . . , ' ' '
39. Water Service-Final - � -
40. Gas Service-Final � , ; ,�
47. Solar pomesticFinal � • (�� � ,
42. Backflow Preventer ' � . �
'
43. Backflow Irrigation - ; � � �
44. Landscape,lrrigation System � �
, ,� .
45. Sound Attenuation � '
46. Handicap Regulations . , .
47. FINALSTRUCTURE&BUILDING - - � -
�
48. Special Requirements Completed ' . , �
49. Electric Release to Edison , . - � �
50. Gas Release to Southern California Gas Co • � �
51. CERTIFICATE OF OCCUPANCY ,
No. ' ' Date ' ' � -
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SPANNER MOUNTDETAIL . -
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COLIECTOR ` -
" PANEL MOUNTING BRACKET
,_ .
ROOF MOUN7ING BRACKET :.
, , ..
SILICONE .; : `
STAINLESS STEEL
WASHER SHINGLES
� �
SHEATHING
i
C'
I
I
'WOOD SPACER BLOCKS
(SIZED TO FIT SNUGLY
BEIWEEN SPANNER & ROOF
SHEATHING-2" X4" M1N.j -
1-8d NAILAT EACH
. SPACER
ROOFING MASTIC"
� RAFfER
�
WASHEfi
LOCKING
NUT
SPANNER (2" X 4" MIN.
FOR i 6" SPAN OR 2" X 6"
MIN. FOR 24" SPAN OR
UNISTRUT P4000�
1-70d NAIL AT E4CH
RAFfER
� THREADED BOLT 3/a" MIN.
(SPECIFY MINIMUM SIZE
$� QUANiII�
'Spacer Block(s) . `
1. Spacer blocks should`be instailed wdMn 1 inch of thru-botL
2: When boit is within 2" of a rafter only one spacer block will be required on the opposite
side of the bott, away from the rafter.. .
3. Two spacer blocks required when the boit is more than 2" from rafter.
`
•• Root Sealant—Required behveen mountin� hardware and shingieslsheathing. Bolt holes
shail be sealed to prevent moisture penetraUon. >.:: =`` .
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SPANNER MOUNT DETAIL . � �. . -
- ; ,_ _ -
7 _COLLECTOR ` -
' PANELMOUNTINGBRACKET
ROOFMOUNTING BRACKET :-:`. _
-' .
SILICONE -:._ :�" .. ..
STAINLESS STEEL
� WASHER SHINGLES
, �
SHEATHING
�
C '
,
I
'WOOD SPACER BLOCKS'/
(SIZED TO FIT SNUGLY
BETWEEN SPANNER 8 ROOF
SHEATHING-2" X 4" MIN.) -
�-Sd NAIL AT EACH'
SPACER �
ROOFING MASTIC"
' RAFTER
I
�
WASHER
LOCKING
NUT
SPANNER (2" X 4" MIN.
FOR 16" SPAN OR 2" X 6"
MIN. FOR 24" SPAN OR
UNISTAUT P4000�
1-10d NAIL AT EACH
RAFiER
� THREADED BOLT3'e" MIN.
(SPECIFY MINIMUM SIZE
$� QUANITI�
•Spacer Block(s) . - . , ...:
1. Spacer blocks should be installed within 1 Tnch of thru-boit ,
2: When bolt is within 2" of a rafter only one spacer block will be required on the opposite
side of the boR, away from the rafter.. . '
3. Two spacer blocks required when the bolt is more than 2" from rafter.
•' Roof Sealant—Requtred between mounting hardware and shingleslsheathing. Bolt holes
� : . sha11 be sealed to prevent moisture penetration: ;. . : = `' .
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- � : . LAG BOLT MOUNTING DETAIL `<
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. SIUCONE � . u
, ...
` `' �GALVANIZEDLOCKWASHER
.. : .... : ,-. .
-. . _.. ,f..: :-..- . ` `GALVANIZEDWASHER- � ` - ;;,� �.:;:"
._:; _ . .
_... � �: ..: SHINGLES - . . , r.' . .
.. : _:=..-:.-.• : .. . .... ...:. � .
. . SH�ATHING
. 2" (MIN.)` � .
.. ROOF MASTIC
' -LAG BOLT : • _
C (GALVANIZED) . pqFTER -
MIN. OF.1.5 TIMES SHANK DIAMETER
� . . . OF BOLT
.'Lead Holes Required—Pre�rill lead holes for the sfiank a2100% of the shank diameter.
� ` Lead holes for the threads ai 60-75?rb' of the.shank darneter.;: .' _:.:: ': _,
�•. �`1
•'Roof Sealant required between mounting angle and shingleslsheathing. Bolf holes shali .
be sealed to prevent moisture peneVaUon. Fill bolt hole with sealant pnor ta inserting bolt
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� � � , , ��� � SOLAR�. .GOLLECToRS � -�y 70 , i
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L I ' _°'' ` ,`4, P d�7.�ALVE GIRCUTATOR . 3-WAY ,� � >i* �J�,j} #4 ,�J� ,,�� .:
ti � .�, i�^� r EXPANSION � VALVF; •� ,.� ; � ,, . ' i �fy{?�,4 ,
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�' `, �, r�+` ir TANK CONTROL GAUGE ::. . ry, t a.' a rto 'y x,. i s �� i u
�ast ... r , ri � � i� t� n
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� a .�s . , ti . � � �. , ,, PRESSURE , + , �.`,��,�� r .,n ,r � � , �.,
, , r�a�f , y ; MVXING�'�`�!�D; ' '" CHEGK. � � � ".� 7�5r,� �a1��W , ` e 3i/,4 e i`+ 1 R
�f . �` �i�7�` t: � �'� � � � REIIEF VAIVE 4 � � r w� S � - E�j<�'" sh ," , },
� � � VWE. � i i' � 9�,,�t�t,� `> ;!g i„r$. r
r�, ,�,,, µ� , � '; •VALVE �,: � , q , : , , > 2 ,� �> ( �., � ,r , {_ •, � ;
�� i.) ). t�C i , . i , � ' . . �� 2Ji � f fl rtv>I � ' 1! � I� �i L 1]f 7��7r �' f
y j��s ,�� � ti�� . , _ , ��.� . ., ` _v � +..," S�i(�J;�r S�, f a
'r �y !' f�� '^ � �t 1 i i t i 1 . . . iv�i � f ,y� F�w'\ 9
� , • I . . � � . F I ll .VALVE r i � � w .�
� � � • �,x , ' , , .q AUXICIARYr � ` , t �e rl t:�r� �, x.
� � Ye�' � � 1 k ! � � � � y ;. �'d:.!(v�te.7 �j ��Jrty4 Y
r...�, ... �� TCMPCDd711RF: -SOLAR �STOQAGE � . ' � S�
�
r �;. . . �}t'' �7i1 H�TER " a�, � t !i'� P ; � w� ��'� l�.
.�, �TANk LHECK i, j?{ 5�t,,.:`� F °�',, r���:%df''rri;"F'�
�,.w , �: VALVE _�r , �,�, 7 � ,> h , �� !} $ ��' `��e
��if}fl� ,.� �.\ �� 'l .l.! ltk iq�!�, . �t�... <r��� '�1i,��
iiM1�ni; S�r 1 . i . . ' ��' �1 . ��1 T1 � �,� ��. ! � �di 3�r+�Y�� � r �. J ,i ��� tv �r~� �`x� f.
J�fViR,•� <' (, � � � �•� �QRMN ' WAIER f �;l�fy�1 �h'��I�iP {I �t' r�(! �t !4 ,��I4r� �rt#.
�!�� n n n VALYE SUPPLY ��w;;"r;,�'' ° a. '(,3 ,�, ,��<<fi���� :
y ,�-'v v'.'"v, `- ., ,.,w �� �,' ,4� .`��r��� `l�
' ? t `�' €� � (�;` ' `�
'�t�°BUILT �IN,..NEAT� �,� ` � "� � +� �5`�'„;{' , ; ` �� r Y,t��R�ii'. :'�J r '
��z:�:� ExCNANGER . .�--- • '' �, ;`.^,;s' �� .,3, ' ��' ��'��'J�' '
�: . � <: , :�;,F, r.� �
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� Closed Loop Residential
MANUAL
AIR flEL1Ef VAWE'
COVERMADEOFTEMPERE�GLA55
POR STRENGTH AND DURABILITV
FFEEZE INHIBITOF /.%i��/��
�NON�TOXICI TO PREVENT
FREE2INGANDCOAAOSION / �
SELECTIVELY-COATED ABSOR9ER
1dADE OF COPPER FOR IONG UFE
AND ABILITV TO TRANSFER NEAT EFFICIENTIY
�COPPERINICKEVBLACK CHROME�
ALLCOPPER PLUMBING
USEOTHROUGHOUTSVSTEM
PIPE INSUL4TE� THROUGHOUT
C.
TEMPEPING VAIYE
��
NETURN
FFOM
.ECTOHS
�
C
NOT WA7ER TO FI%TURES
� COLO WATEP
� SUPPLY
78P VALVE � ��'
,
,
D.H.W. System
� — � SENSOR
i
i
/
i
/
/
/ EX7ERIOq-GRaDE
/ AIUMINUM FOR LONG LIFE
�
�
_ //// SUPPLY TG
�J�� LOLLELTOPS
�J
CIflLULATOH
— PRESSUaE GAUGE
� OIFFEFENTIAI LONTFOI
BUILTIN ORAIN VALVE
MEAT E%CHANGER
f00UBLE WALLI
. PFESSORE NELIEF YaLVE
. FILI VA�VE
CNECK VaIVE
�
DflA1N VALVE
7
'
��7
'
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ADD���ant to fill in all soaces ezcept those within heavy Eortler linet an0 sign all apo�ooriate aeclarations.
CITY OF COSTA SA .0 NSTRUCTION PERMIT PER T NO. _ TRACT NO. LOT NO. UNIT NO_
Project Address � t1 .
Applicant's Mailing Address A"
Owner's Name � Phone
Address �
Arch/Eng. License No.
Address
Contractor's Name Phone s �
Address (m '�� � 1�. E�,'��'( � �
City Licencr Nn VV /_��
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licenzetl untler provisions ot Charter 9(commencin9
with section 7000) of Division 3 of tne Busine55 antl Profession5 Cotle, antl
my license is in tul},(or e antl effect.
D tenjg s�T„_,�� �+ - �gi � se '�'Z��,.,�
��lY�� 5'9 t � �
WOR�ER 'COMPENSATION �ECLARATION
' he�eby aHirm thal 1 have a certifiCate of consent l0 5¢If-insure or a certiflcate
Worken' Compensalion Insu�ance, o� d ce�tlfietl cop thereof (SeGtion
10. Lab. Q.J.,/���/ ^^ .
7Lf L/ X61
Yolicy No. w � V( Company �
E�MPfIOCFROMIWORKERSaCOMPE� �CLA0.ATION
(Thlssection need not be cOmpletetl if Ihe permit is fo� one hunGretl ($300) or
less):
I certify that in the performance ot Ihe wo�k tor which this pe�mR is issuetl, I
shall not employ any person in any manner so as to become subject to Ihe
workers' Compensation Laws of Catilornia.
Date Si9nature
NOTICE: If, atte� making fhis tlecla�ation, y0u shOultl become subject t0 the
Workers' Compensatlon provisions o! the Labor Cotle, you must forthwlth
compry with such provlsions or tbis permit sball be tleemetl revoketl.
CONSTRUCTION LENDING HGENCV
1 hereby affirm Ihat [here is a cons(ruction lentling a9ency (or the perfo�mance
of the work for which this permit is issuetl (Sectlon 3097 Civ. C.)
Lentler's Name
Lentler's Atltliess
OWNER BUILDER DECLARATION
I hereby affi'rm that I am exempt from the Contractor's License Law for the
followinq reason (Section ]031.5 Business antl 7rofessional Cotle: Any city or
county wnich requires a pe�mit to cOnst�uCt, alte�, improve, tlemolish o� �epal�
any slructure, prlor to its issuance, also requires the applicant for such permit
to file a signed statement-lhat he/sne i5 Iicensetl pUrsuant to th¢ Provi5ion5 0(
the Contractor's License Law (CM1apter 9(commencing with Section �000) of
�ivision 3 ot the Business antl Professions Cotle) or that he/she is exempt
�efrom and the basis tor tne allegetl exemption. Any viDldtion of Section
'�L5 by any applicant tor a permit subjects the applicant to a civil
dalty of not more than live huntlretl tlollars (g500�.
❑ 1, as owner ot the property or my employe¢5 with wage5 as their Sale
compensation, will tlo [he wo�k, antl the sVUCtWe is not intentletl or otfe�etl
for sale (Section �044, Business antl Professional Cotle: The Contractor'S
License law tloes not apply [o an owner ot a properry who builds or improves
[hereon, antl who Ooes such work him5elt/her5¢It o� through his or h¢r own
employees, provitletl that such improvements are not intentletl or offeretl for
sale. If, howeve�, the builtlin9 0� Improvement Is soltl wilhin one year of com-
' pletion, the owner will have tne burtlen oi proving he/zne tlltl not builtl or im-
�rove for tM1e purpose of sale).
I, as owner ot the property, am ezclusively <ont�acting with licensetl con-
t�aclors to construct the pwject ($ection 7044, Business antl Prote55ion5 Cotle:
The eonVactor's License Law tloes not applY to an owner oi property who
builtls or improves thereon. antl wno mntracts �or such owiects with a con-
tractor(s) license pursuan[ m me Contractor•s License Law). i am aware tnat
proof of [heir Worker's Compensation inswanca Shoultl b¢ provitletl to me.
❑ I am exempt untler Section B. & P. C. tor this reason
Date
Signature fA/.
Drivers' License or
— Owner
I nave reatl this apolication antl siate Ihat the above
I agree to compty wrth all tity antl coun[Y ortlinances
i to builtlinq construction, and hereby authorize re0re-
y[o en[e� u n the above-mentionetl P opert fo�
rl
Date �
�
TVPE OF CONSTRUCTION LJ NEW LJ ADD LJ AL
❑ CONVERSION ❑ DEMOLISH ❑ OTHER _
DESCRIPTION OF WORK/USE OF BLOG.
TVPEOFPERMIT LIGRA�ING LI VNDATION LISTRVCTVRAL
❑ TENANT ❑ ELECTRICAL LVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION S4.F7. oCCUaArvGv—
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES—
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks'
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains �
Reinspection Fee � $15
Duct- Under Ground
Duct - Strucmral
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FirepUFact. Blt ICBO dk
Heating System & Ducting
❑0.100,000 BTU 0100,000BT
Reinspection Fee . � $75
0865-46, rev. 5/BB Wnite - Buiitling: Canary - Applican[; Pink - Accountinq; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinali
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Type II ❑
Refrigeration System
❑aioo,000eru ❑ioo,000aT
System Repair/Alteration
Fire Dampers
Registers
� Issue Fee
R
A.P. #
S Main Buildi
E
T Front
6 Rear
A
C Ri9ht
K Left
$
Ping. Fef. #
Planning Notes:
FEES Automatic Washer
Construction Pale Su6.
Cooking Unit
Dishwasher � .
Dryers ❑Gas "��Electri<
Fan �•
F.A.U.
Fixtures
Device Boxes `
O utlets
Switches
Garbage Disposal
Generator �0-5 KW �5-
$ 3
3 3
2one
Bui
Parking Req./Provided
_ � .noe
ELECTRICAL
Transformer ❑ 75-50 KW
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over 100 amps �
Sub Panel
Motors OO-1 HP O i%-$
Inc.Solar �9�15 HP �i6-15+
Microwave
Poie Light
Range
Standing Sections
15 KW Tresh COmpactor
� Heinspection Fee �$75 � � Issue Fea
OEVELOPMENT SERVICES REQUIREMENTS:
Zonin9 APProvad By
euilding Approved By
FEES
$ 3
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1
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Q
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SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLANCHECK $. PERMIT
PLUMBING $ _�/_�� ISSUANCE $ �
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROfILM $
MECHANICAL $ TOTALFEE $ ��
PLAN CHECK 25% $
ei 000a2�a9—ccu<s2.,�+ Fc.:-r
'L'ATE: G5/ �2i99 i :fti_: �rr;. i: �
Ge_.�-,
COIVSTRUCTION AND PLANNING POOI 'PA
Date Inspector Date Inspector
` APPROVALS Permit # APPROVALS Permit #
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. Elecvical Conduit-Undrgrnd. .
8. Foundation � � 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. • . 60. Backwash Lines, P-Trap, O Undrgmd.
10. Structural Floor System � � , 61 . APPROVAL TO DECK
] 1. 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
. i
"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
v
�z0. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22.�Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24.'Fioof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro .
\
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �-� � !�' �
39. Water Service�Final ;.�,
40. Gas Service-Final S�i '
41. Solar pomestic-Final�
r-:
42. Backflow Preventer ��, ���
43. Backflow Irrigation f%" ��', � V
;
44. Landscape Irripatiori System � �1
45. Sound Attenuation� .
46. Handicap Regulati6ns
47.' FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southem California Gas Co /,% r`y ,
51. CERTIFICATEOFOCCUPANCY _.%;�
No. Date !�
z����
COSTA MESA BUILDING-SAFEfY DEPARTMEM
P.O.BOX 917' COBTA ME�p�CpL�pORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
ILDIN6 �
JRESS CJ� � I�FNl��'-� �lR I YE
COSTA MESA, CALIFORNIA
. _T, . _ , . � %
V MAIL
STATE
LIC. NO
SIZE
OF LOT
USE OF
TEL.
FEE RECEIVED
JAN 2 7 1965
FINANCE DEPT.
cirr oF cosrpMF�p
APPLICATION FOR� PEItIGIIT'
BUILDIN6
For Office Usa Only .
q@CE�PT NO. I
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DESCRIPTION OF WORK
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4v GA G� /�QN ,i7'
1 XEREBY ACKNOWL8DO8 THAT 1 HAVB qGD TN18 APPLICATION
AN� BTATE THAT TH8 ABOVfi I8 CORFEM AND AOREB TO COM-
PLT WITX ALL QTY ORDINANCiG AND BTATB LAWB HfiOOLATINO
BUILDIN� CONBTPUCTION. �
SIGNATURF OP �TfL!%j � %L/d"d'
PERMITTE
AUTHORIZ6D A6HNT
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( 1 - /t I "' �
OVERHANGSHALLBELESSTHAN
YARDBAPPROVED
MAIN BUILDIN6
DISTANCE BET
MAIN BL�68.
VAR. �i
YARDS APPROVED
:CESSORY BUILDING
BET. I
ACCE
OATE
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0
THE �MOUNT 9H0 N UNOER VALU�TION IB FOq TH@ �
PUFP098 OF 88TABLISXIfJO A PfiRM�T FEE ONLT, 0
VALUATION YJ�% m
PERMIT FEE $ / O �
�
�yG�s � 3 �
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^7 LL
TOTAL FEE $ /// ��