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Home My WebLink About967 DENVER DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 967 DENVER DR Suite: Vicinity: ROOF Parcel Number: 4180$130 Applicant: KENNETH DEAN ALCANTRA Address: 24787 WINTERWOOD DR LAKE FOREST, CA Owner: MC KNIGHT, MARY JANE Address 967 D�NVER DRIVE COSTA MESA, CA Contractor: KENNETH DEAN ALCANTRA Address: 24781 WINTERWOODDR LAKE FOREST, CA Zip: 92630 Arch : Address: � Phone: Zonin9: ,Phone: (949)837-5376 Zip: 92630 Phone: Zip: 92626 Phone: (949)837-5376 License: 544282 Eng: Atldress: Slatus: ISSUED Applied: 03I18/2003 Issued: 03/18/2003 �_ j• / � : —`� Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING WOOD SHAKES. INSTALL 1/2" SHEATING AS NEEDED, 30 YEAR COMPOSITION SHINGLES, CLASS A, ELK PRESTIQUE, AND 30# FELT. 2,000 S.F. IS FOR FRONT OF THE RESIDENCE AND ATTACHED GARAGE ONLY. WILL NOT REROOF FLAT AREA. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0• 0 ACCESSORY Front 0-0 PARKING Existina: o Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY Calc Valuation: Sz,s5o.o0 Claim Valuation: 82,s5o.00 PLANNING R ZONING Left 0-0 Right Lek 0- 0 Right Proposed: 0 NOTICE: The work authorized by this permit sha71 comply with a!I ap,plicable handicap access requirements under Calilorn'�a staiutes and relaied regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor 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 applicabla codes, and all requlred Inapeetions end final approval must be obtained. Failure to oblain inspections and final approval will result in ihe expiration of thls permit. FOR INSPECTIONS CALL: (714) 7545626 zaas-ae (eroo� WORKERS'COMPENSAnON DECLARAnON: � � I here6y aNirm untler penelry of perjury ane at t�e following declarelions: ❑ I heve end will maintaln e cenilicate ol canseN to selbinsure lor workers' compensation, as pmWded tor by section 3700 0l the Le�ar Code, lor t�e pertortnance of tha work tor which Ihis pertnit is iuuetl. ❑ I have entl will melntein workers' compensation insurence, as raquiretl by section 3700 of the Lebor Code, for the perfortnance of Ihe work for which this pertnit is issued. My workers' comper�setlon Insurence cerner antl policy number ere: Carrior: Policy Number: (This secfion need not be comp/eted i1 the permit is valued ef one huntlred dollars ($100) ar less.) �I certify Ihat in the peAortnance of the work for which this permit Is Issuetl, I shell not employ eny person in any manner so es to 6ecome subjact to the warkers' compansetlon lew5 ot C li ie, a a ree t�at Ii I h0uld become Sub�ecl to lhe workers' compensalion provislons of SecSlon 3700 ot Ihe Lebor Cotle, I bhall brthwilh comply with thesa pro '' ns. /, % Applicant Signeture: �• �`— Date: 3/' 8/ 03 WARNINp: FAILURE TO $ECUPE WOFKERS' COMPENSATION COVERAOE IS UNIAWFUL AND SHNLL SUBIECT AN EMPIOYER TO CRIMINAL PENALTIES AND GVIL flNES UP TOONE HUNDRED T}Nri1SAN� OOLLARE (5100.000), IN FDOITION TO THE WST OF ODMPENSATION, DAM4GES AS PHOVIDED FOR IN SECTION 3]O6 OF THE IABOfi CqDE, IMEREST, AND FTTOFNEY'S FEES. LICENSED CONTRACTORS DECLARATON: I �ereby eNirm that I am Iicensetl untler provisions of Chepter 9(commencing with Section 7000) of Division 3 ot lhe Business antl Profassions Catle, antl my license is in tull force end eflact. Lic. N -Sy� Z'� Z Class q 3 , Contractofs5igneWre: Date: ? �8 03 CONSTRUCTION LENDING AGENCV: ❑ I hereby aNirtn that there is a construction lending agenty for the pedortnance ot t�e work for which Ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lentlefs Neme: Lentler'S Atldress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm the� under penelry oF perjury Ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe tollowing reeson (Sac. 7031.5, Business and Professions Cotle: Any city or county w�ic� requires e permit ro conswct, alter, Improve, damolish, or repair eny strucWre, prior to its issuance, elso requires the epplicant tor such permit to file e signed stetement thet he or she Is licensed pursuent to the provlslons of the Contractors License Law (Chapter 9(commencing with Section 7000) of Divlsion 3 of the Business end Professlons Code) or ihet he or she is exempt therefrom and Ihe basis for the elleged exemption. Any vlalatlon of Saction 7031.5 by eny applicant for e permit sub�ecis ihe epplicant Io e civil penalry of not more t�an tive hunCred tlollars ($500).): ❑ I, es owner ol ihe property, or my employees with weges as thelr sole compensatlon, WILL DO THE WORK, entl the siructure I5 not intended or oHered tor sale (Sec. 7044, Business end Professions Code: The Contrac�ors License Lew Goes not epDly to an owner of property who builds or improves Ihereon, and who tloes such work himseli or herself or through his or her own employees, providetl thet such improvements are not intended or ottered tor sale. If, however, the buildinq or improvement is sold within one year of completion, the owner-builtler will have the �urtlen ol proving Ihat he or she did not builtl or improve lor purpose of sale.). ' ❑ I, as owner oi the property, am EXCLUSIVELV CONTRACTING WI7H LICENSED CON7RACTORS to construct the pro)ect (Sec. 7044, Business antl Professions Cotle: The contrectors License Lew does not aOP�Y �o en owner ot property who �uiltls or improves thereon, end who contracts for 5uch project with a wniractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under Sec. Busineu entl Prof055ion5 Code for ihis reason: SignaWre: Date: Owner ID venlied by drivers license. ❑ Yes ❑ No Dnvefs License No. Expires: Varification ol Ownership by (rype of daument, i.e. - property ta< 6111 or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity ihet no excavetion flve (5) or more feet in tlepth Into whlch a person Is raquired to descend, wlll be matle in connection with work authonzed by ihis permit, and ihat no building strucWre, scaHolding, lelsework, or demoli�ion or tlisman0ing thareol, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, 71t1e 8, Cellfomia Atlminisirative Code). ❑ As ownerbuiltler, I will not employ enyone ro do work which would require e permit irom the Division of Intlustriel Safety, as notetl ebove, unless such pereon hes e permit to do such work from iha division. . Signature: Date: Division o1 Industrial Salery Pertnit Numbar: CERTIFlCATE OF COMPLIANCE AND AUiHORIZATON OF ENTAY: I certity untler penalry of perjury that I have reaC this application entl stete that the intortnetion given is correct. I egree to ply with all state laws end ciry ortllnances relating to building consiruction, end authorize representatives of the Ciry ot Costa Mesa �o en�er upon ihe ebove-descri rop r�nspection pses. I egree not to occupy or allow occupancy of any building authorized by this pe until final inspection. ��8 /O 1 '%� �� i nature Of L gal Owner(s) 3/� � D�o 3 % ' AnNOr Authonzed Applicant Date CppE I, INSPECTIONTYPE � � 1616 Fi:etl System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Root 201 Finel BIocWRetaining Wall 202 Final Factory Fire Place 203 204 Final Sign Final Demolition P97F IMRIpLS �2 �fJ 7s�`+�� CODE� INSPEGTIONTYPE � 206 Final Mechanlcel 20B Final Plum6ing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency �U.L IMfMLS � � y .00'trssa�a��oe+o: 967 DENVER DR owxexsxweiva+wn+:MC KNIGHT, MARY JANE ��967 DENVER DRIVE COSTA MESA,CA 92626 549-7527 �w�. �uura wox�ss 1fICNRECT OR ENtlNEFX: uxr: FLOOD: X 47 uc. ra.: IPCII.ON FNG'S AUOPE53: UNf: 'coNm�crarsru�eNOCK PLUMHING (714)895-1246 cam�ctoxs�uiwc11610 SEABOARD CIR woeess:STANTON CA uc.ra.: 707775 90680 �M: 110EN5ED COMHRCTOflS DECLAHATION: 1 Mreby ellim uMn pera�y d pepury Nm I em IiromeA urder provisiom al CMpls B (cwnmendrp wiih Senion'l000� d Oiviaun � d Ihe Buaineee eM Pmteaeans Code, eM my licenae ia in hll larca eM efled. cmuc.No.:050386 uc.cuss:C-36 uc.r+o.: �07775 EXP: 02/97 od,: /a/�1 /9L oom�ae,: i�0� iL�A"l�/ �^ —� OWNEF BUILUEX OECLANATION: I Mreby etfirm under penely d perjury �hel I em evmq fmm tM Conlretlas Lioeme Lew lor Ma bwip �aemn (Sedan 10.t1.5 Buaiima eM Prdesaoiu Code: AnY cry'rc oouMY xfiidi reVuiree e Oerm4 to conawn. al�x. imMae. noleh, a repei eny ai�unure, pnor �o ib ewence, eko requirea �M apdimnl irn mah partnn ta fib a ag�xd nelemenl thel M a eM iice�sad pu'eueni �o �he provisbm d Iha Comredas licenae law �Chepter 9(mmme�i�p with Setlun )Odl) d Divuion 3 of the Buainem eM Prdeaiau COEe� or Ihei he a Ma o memq �haelrom eM the beae la Ne ellepeA caemqion. My videlion d Sedion ]W 1.5 b/ eiry epd�� Iw a parmn aubpae the epd�� to a wil pmelry ol rwl mae iMn (xe huMred dollen �5500I1� ❑ I, es ovmer d iha O�openy a my empbyeae wih weBes av iMF eole mmpenealion, xill do Me xak, end �he avudure u�w inteMed «dlered M ule (Section )obe. eusnees vM PmleavonaCod.: rM Comredon Lioeroe laweoes mi WVNto en owriar d pw�Y ww d,u: « mwd+� m�,.�d wno eo� s�n.on nm.dr «n.nae «waron ns «ne. �.mcbr«.. w� �nm won �mwo„�+,m� �e �a �M�eed «m«�e i« s�. n. no.�,. me w�umo «mw�«a e.da.mnm o�. v� a�,da�,, ma ownarbuilder vnll M1eva tM buMen d paving M or eM d'M mt buik or improve la IM WT^ae d eele�. � 1. m owror d tM MOPaM. em e�dusiveN con�red'mG wuh liceiued wnvectas to conmua Ns WM%� (Setlion 1061. Bwimss eM pm/meime Code: The Comreews lieense Lew doea m� eppy ta en ox.br d peopeny Ma EuiNe a mipiwee IMraan uM xfio wnvena Iw such P�a wnh e contreear(a) IcenwE Oun�en� to �M CaNratlon Liceme Lew�. � I em exemq wAer Section: B. 8 P.C., fa Nia reeson: Daie: �++e�� i ao ne�W cen�ry mei i� ewme a e�d ��da�s�ena me reqwm�ams a c�nomie Haenn e�d sdmy cad. sm�s zxws, zssaa, e�w ?5530. and tM1e� I ar env Mure Wibi�q ocwpem will I wYl nw (tlicb me) neaE lo mmply wIh mk qa�e mde� eM �he rpuiremanb br Dele: AOD�� WONKEP'S COMPENS�TION DECL�FATON: I he�eby elfirtn uMu peneM1y d perjury me d IM /dbwirp Eetleretum: � 1 heve ud wil meinlein a canAicme d mnean� to sell-inaure for v.oikere' campenamon, o prwked �a by Setlion 3)00 d ihe lebor coeo, i« m. rono�o. d�n� w�x i« wi:�n m�. v�u � �a�.d. _ fl � neve d,a wi� meimeei wone�e wmw�+�on ir�,reMe. e. r.a��rea M seaia, a�oo a m. un« cod.. a. me w�«md,oe a m. X-' wwk Iw xfiiM Ihie paimn ia iaeueE. My workers' canpanmibn inwrence ranier eM po4q numbar ere: c�a�: GOLDEN EAGLE EXPIRES Patir N�mee.: 0 9/ O 1/ 9 7 (This secfiar naed nw be completeC I the pmmrt is br one hundred ddlers /SIDJI w bv.) ❑ I cerlH � in Ihe pa�iamvwa d iM woA br which this pe�mil c i»ued. 1 ahell iw1 empby enY Daeon in enY menmr ao n�o bacm�e wbjed to tM wksn' canpensmbn kxs d Cdif«nie. eM pree Nm d 1 ehouk became abptl lo �M xaken' comc,,,.dim ion. d s.aian r�ao m ma �en« coa>. i en n can,oN �na. por.na�.. ome: /b�i ��_ naw�c C e - Wam/�q: F�Uun ro�xun worMri mmpxuetlon core�eps /s un/swNl, �ndMs/l ub/ec! en �mplqw ro cAMrul peneltlp �n0 e/v/l Arro� �p ro om hundred HauaelM GWlen (S10Q000), In eWltlon ro(h� erose ol romp�wHort ��pu u povlCetl br In Srotlon 3)O6 0l Ms f�borCOM, /ntMuf, enC ettornsyl Isu. CON5T11UC110N LENUINO AOENCY: I M�eby eifirm uMm pe�Wiy d per'µy tlw thera o e mmlrWfian bMirp eperv.y b tM peAarmeMe d Ihe wwk la whidi t�e pe�mY ia esued (�bn 909J. Civ. CI. LENOEfl'4 NAME: LENDER'S ��DPE%: 1 ceitiy Ihet I hm�e reed Ihis applicetim end alele �het Ihe abave inlame�ion is mrtea. I epree to comON �h ell dly eM muMy ordi�wwr and ewa kxa reletnp lo buildinp constrWio^ eM hereby eulhorixe ra0��eiives d ihia aryto anier upon tM ebove�mentioneE piapery Iw inspadan W�W�s� RON NOCK Pnn� Nam �—�P o�.: � � Signelura W OxneHlqanVRpDlicenUGonvma (5151�18 WP) Whno-BuiMip d SelelY: GreerFla: Ganery-ADC�ent: Rnk-Reeenue: (3okeniaE-Nanan CITY OF COSTA MESA - HUILDING PERMIT PERM NO: P 080109 PERMIT NO: P 080109 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION : C/O DISHWASHER SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT *��**�***�*****�*�x �+�� **� *��****�**'+�***x'*+�� r**�**�**+�******�r+�**� �*��*+r*x �**� *� 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 HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT ZN 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: 41808130 ZNE: REF NO: PLANNING NdTES> % IE fE IE 1E fE ik 1FlE iE 1E 1! iE iE 1E If !E 1E 1E iE if 1F 1E iE iElE 1E iF iE iF if 7F if 1E ih iE iE 1F If iE Ik It IE IE 1! fF fE 1E 1E 7F iE fE �E1E �)E iE iE IE �E iE iF 1E if 1E iE ff 1E 1E fE fE iE iE if 1E 1E 3E �E ik if IE D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPAOVED BY DATE: HUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: � DATE; �� —2.2-qG fE�EfE1EklfflikfFlfiEiElFi(-iElEiElfiElElEiF7FTFif3fiFifiF3f3fiFiF3F7FifiFTF3FiF3FifiFiF�Fil- �F�if7f'ifiFif3FiE1klEiFiFlfiflElEiE��iFfEiE LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 8.75 258 SMIP/NON-RES PLAN ISSUE FEE 22.00 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 8.75 22,00 0,00 30,75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CAECK 30.75 1F�EfffElEiElEfEffiFiElEiEiEifiFiE kifiElEiE1EiE1E1E1ElE1k1E k1E1F1EfE1EiE1E1E k1E3EfEfEfEiflfiElEfElElEfEfElklEfFfElfiEfEfEiEiFlEiEiElfifiEfEfkiEiFlFiFiEik�E 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 PLU 1 DISHWASHER 8.75 8,75 END OF FEES EXPI]��'� � � DATE !�� O1 Q11217731-Q0217731 Tt3 T 3Q,i5 DATE: 10/23/95 TIflE: i1:4g CONSTRUCTION AND PLANNING . P�� SPA '"-�"s� APpROVA�S Permit # Date lospector AppROVALS Permit # Date Inspec2or 1. Temporary Electriral Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '-3. Electrical Conduit Ut(Iity�Undrgmd. 54. Forms . 4. Elearical Conduit�Undrgrnd. � 55. Etectrical Bond�ng 5. Steel Relnforcemenc � 56. Rou9h Plumbing & Pressure Test - 6. Electricai UFER Grnd. 57. APPROVALTO COVER�GUNITE . 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe�Undrgrnd. . " 60. Backwash Lines, P�Trap, C.', Undrgmd. � 10. Structurai Fbor 5Ystem � 61. APPROVAL TO DECK �. � 1 t, Property Sewer Line & House Connection 62. Backwash & Recepmr�Final 12. Sewer Cap 63. Heater & Vent-Finai 73. Roof Drains � 64. Plumbing System - Final 74. Hough Plumbing , 65. ElectricabFinal 15. Rough Electricai-Gonduit - 66. Solar System-Finai 16. Rough Electric'Wiring � 67. Fencing & Access ApAroval i7. fiough l'diring Sigr� � 68. APPROVED FOR P�ASTER�NG 18. Rough Electricai-7 Bar Cei�ing 69. POOUSPA SYSTEMS FINAC ' 19. Rough Heating &%{ir Conditionin4 FIRE DEPT. REQUIREMENT 20. Rough Factory Firepiace � � APPROVAlS Permit # 21. Ducts, in Siruczure _ - � � 70. �Underground Hydro 22. Outts, Ventilating . . 71. Product Piping !7 Gas � Oil 23. Gas Pipe-Rou9h & Test �-� - 72. Underground Flush 24. Roof Framing - - ' - 73. Undergrnd. Smrage Tank Ci Gas ❑ Oil "�� ' '; l,- 25. Roof. Sheathing _. '. � .� 74. Overhead Hydro � � 26. T-Bar Ceiling fStructurai) & Monocoat -� � 75. Dry Chemical S�-� � 27. Frame and Plashing - � . -. 76. Dry Standpipe - �� 28. Wthing & Siding - ". � - 77. FIXED SYSTEM FINAL •- 29. Insulatio❑ � . 78, FIRE PREV. PINAI ' 30. D:ywail�Nailing � ' , HEALTH DEPT. REQUIREMENT 31. Piaster Brown Coat� , . 79. FINAL INSPECTION 32. �Electrical�Power Meter-Finai 80�. FO00 CERTIFICATE ISSUED � 33. Final Eiectria - _ ' � � Notes: - 34. �Final Heating & A�rConditioning - _ 35. Final Gas Pipe-TeSt� � . � � � - � 36. Hood or Canopy - - ' " • 37. Final Factory FirePlace � 38. Pinal Piumbin9 - � � 39. Water Service�Fina� - „ ' 40. Gas Service-Final - _ 41. Solar pomeeticPinal - �' . ` ' . A2. Backflow Preventer � � � - . . 43. Backflow Irrigatio�' ' - . '44. Landscape Ir�igat�on System - � . 45. Sound Attenuati0� '- ' � - - , � '46. Handicap Regulations " , _ _ ,. : 47. PINAL STRUCTURE & BUILDING ' " 48. FINAL PLANNING ' 49..Efectrie Releasx to EdSson _ ' 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY No. Date � CITY OF COSTA MESA CONSTRUCTION PERMIT Applicant !a fill in all spacas excepl i�ose wllhin �eavy Cortler . PERMIT NO. TFACT NO. L .4 � Project Address �-% !�n//✓�e�r � sf Applicant's Ma�iling 'A"ddress :��3 7�eC'". h✓ �✓ �—�� Owner'sName �..r� C Phone�`>-7 � Address q� �N�IPr �qS �/�,'��t � Arch/Eng. License No. ' Addres5 ' c Contractor's Neme��^ �.�� 'P/� Sn arp " ' 'Phone �// �n� Addiess Imailingl^� 2—LYl✓'��/Z/� � �� City License No. �' � � 3 fl b �-3 LICENSED CONTRACTOR DECLARATION • � I hereby affirm that �I� am Iicensetl untler provlslons ot Chartar 9(commencin9 with settlon 7000) ot Divislon 3 of tne Buslness antl Professions Cotle, antl my Iicense is in full forc�tl effect. /' Litens CI � r�w��n�.e No.��/O� Date �� Sig at e '"'� -'7RKER5'COMPENSATION OECLARATION ' �reby attirm that I have a certlticate ot consent to self-insure or a certiflwte - Workers' Compansation Insurante,' o� a ceriifieC copy thereof (Sectlon , 3800, lab. Cy � Pollcy No. ��Q � Company 0 ��. // . ❑ certifie cop�is hereby turnishetl. i // /�4� I�#S ^ �etl pa y is tlletl with the city Builtli LviS{6n. �D� �l APPlicant 6CT E MPTION FROM WORKERS' COMPENSATION DECLARATION (This section neatl not be complatetl it tha permit is for one huntlretl (y100) or 1255). I cartify ehat in che performan<a oi the work for whlch this perm�t Is Iszuetl I shall not employ any per50n in any Tanner so a5 to b¢COme SubjeGt to t�e Workers' Compen5ation Laws of Callfornia. Date Si9nature NOTICE: If,iafter making this tleclaration. You shoultl become subject to the . Workers' Compensatlon provislons of the Labor Cotle, you must•torthwith comply .with such provisions � or this permit shall be tleemetl revoketl. CONSTRUCTION IENDING AGENCV � ' I nereby atfirm that there is a constructlon Ientlin9 a9ency for che performance of the work tor whlch. this Dermi is Issuetl (Section 3097 Civ. C.) I..entler's Nama I..enCer'S Atltlre« � OWNERBUILDER DECLARATION � I hereby aftirm that 1 am exempt from the Contractor'S LI<ense Law for the following reason.(Section 7031.5 Buslnass antl Professlonal Cotle: Any city or county which requlres a Dermlt to construct, alter, Improve, tlemolish or repair any structure, prior to Its issuance, also raqulres the applicant for such parmit eo file a sionee statament that he/zhe Is Iicensetl oursuant to the orovlsions of �efrom antl the basis for the allegetl exemption. Any violation of Section i1.5 by any applicant for a permit subjects the�appliwnt to a civil alty of not more than five huntlretl tlollars (E500). , � I, as owner oi the Oroperty or my amployees �with wa9es as their sole ioensation. will tlo tne work, antl the structure is not intentletl or offeretl [neteon, ana wno aoe5 Sucn woru mmsert/nersert or mrou9n ms or nar own employees, p�ovitletl that su<h Improvamencs are not intentletl or ofteretl tor ule. If, however, the bulltling or Improvement is soltl within one year of com- plation, the owner wlll nave the burtlen of Proving ha/she tlitl not builtl or im- ��ove for the purpose of 5ale). I, as owner oi the property, am exclu5ively contracting with IlcenSeU con- t�actorstd construtt the project (Settion 7044, Businasz antl Profezsions Cotle: The Contractor•s Licensa Law does not apply to an owner of proper[y who builtls or improves thereon, antl wM10 contracts tor such projacts with a con- tractor(s) Iicensa pursuant to the Contractor's Licensa Law1. ❑ l.am enempt untler Section B. 6 P. C. for thls reason Date ' Owner �I nereEy certlfy that I have reatl this appllcaUon antl state that the aEove Infotmation Is correct. � agree to comply with all clty antl county orAlnances antl state laws relatin9 to builtling constructlon, antl hereby authorize repre- sentatives of thls cl y to ent r upop the above-mentionatl propert tor InSDectlon purpos��' ��L � ��`/1/� Date 3P - // d �sS TYPE OF CONSTRUCTION , O�CONVERSION �❑ I TVPEOFPERMIT LJ•GRADiNG '0 TENANT ❑�ELECTRICAL ❑.OTHER PROJECT DESCRIPTION 5(i. FT.— , CONSTRUCTIONTVPE . ZONE GRF Ramarks: _ . � � Sink Irrigation Clarifiers ' Dishwasher ' Drinking Fountains Floor Drains Floor Sinks - ' Gas Service Outlets Kitchen Sink � Wvatories � P—Trap Roof Drains � - Reinipeetion Fee $25 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating ExhaustSys[em ❑ Mul[iple Firepl/Fact. BIt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 Slgnature Drlvers' Llcanse or 55 � �`,�� I I Aeinspec[ion Fee � I $25 CMF 0865-46 rev. 12/83 W�ite - Builtling: Canary - Appllcant; Pink - Accounting; Goltlenrotl - A55essor anE sign all appropriate tleelarations. ADD LJ ALTERATION LJ REPAIR IFOUNDATION U STRUCTURAL PLUMBING ❑ MECHANICAL VALUATION $ NG CU. VDS. A( Showers Serviw Sink ' Sewer Cap Sewer Connection Solar Collectors1, C� Solar Pipin9 Solar Tank Swimmin9 Pool w/Spa Urinal Water Closet Water Heater Water Service laue Fae Hoodor Typel ❑ Canopy Typell ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Issue Fee fEES $ 3 $ 3 �� A.P. �p •S MainBu — E T Front 8 Rear A — C Right _ K Left — S — ,Ping. Fef. # Use of Building: Planning Notes: Aummatic Washer Construction Pole Su6. ^ Cookin9 Unit � ' �IShW35h2f Fan F.A.U. Fixtures Device Boxes Outlets . • . Swimhes Garbage Disposal Generator �45 KW 05-15 . 4190 2/10/B4 �� 2one Accessory Building: Park.Fees $ � ELECTRICAI Transformer ❑ 15-50 KW ❑ 50+KW . Meter ❑up to 100 amps , Meter ❑over100amps Sub Panel Motors � 0.1 HP � 1'h - 8 Inc. Solar 09-15 HP 016-15+ ' Microwave Pole Light - Range Si9n -Standing Sections � ��Trash Compactor � Reinspeaion Fee � �$25 � laue Fee PUBLIC SERVICES REQUIREMENTS:. 2oning APProved BY • Building Approved By Aoolication Issued Bv � l � �11�J0 T�. FEES $ 3 O N I N G R E I R E N E N T SU�M—MA��RV FEES T BUILDINGPERMIT $ �� '� SMIP $ `��// PLAN CHECK �$ r�— PERMIT PLUMBING . $ , D V ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ � ELECTRICAL $ GRADING $ PLAN CHECK 50% $ � MICROFILM $ MECHANICAL $ � TOTAL FEE $ � PLAN CHECK 25% $ . . .�CONSTRUCTION�.ANDPLANNING' - ' • - .- P�� PA '� ' APPROVALS Bermit. ',Date- �' 'Inspector ' � � � Date In's ector ' # . APPROVALS Permit,# P ;y , . . - 1. Temporary Electric8l Service�or�Pole ,. �_ � 52. Pool &�Equipment Location � �� 2' Soil Fipei Undrgrnd.E �' _ i � t �. � ' 53. Steel Reinforcement � � ; , .-�3. Electrical Condui4 Utility-Undrgrnd. . � 54.. Forms'- � � ' � - � ( , � 4. F�lectrical Conduit-Undrgrndr �- �- 55: Electrical Bonding� .( - � ' 5: Steel Reinforcement . � - 56. Rough Plumbing & Pressure Test - i - v 6: Electrical UFER'Grnd. �. ' � 57,- APPROVAL TO COVER-GUNITE i 5 7. Footings � �a i � � ; : � "' - . 58. Electrical ConduiNUndrgrnd. � - 8. Foundation '� ;: d - : � " 59. Gas Pipe, O Undrgrnd:, Test � � � � 9. Water:Pipe-Undrgrnd. c� = i - 60. Backwash Lines, P,-Trep, O Undrgrnd. � 70. Structural Floor System ' 61. APPROVAL TO DECK �� ' 71. PropertY Sewer Line�&,House Connection 62. Backwash & Receptor-Final .�. I 12. Sewer Cap � � � � - ' � � � - 63. Heater & Vent-Final. - - ' I 73. Roof Drains � � 64. Plumbing System - Final . , I�� 14. Rough Plumbing � ' 65. Electrical-Final � • � " . 15. -Rough Electrical-Conduit ' ; - 66. Solar System-Final - ' 16. Rough Electric.Wiring - - . 67. Fenciny & Access Approval � . - , � ' - 17. Rough Wiring Sign , - 68.� APPROVED FOR PLASTERING �' - 18. Rough Electrical-T Bar Ceiling � �69. POOL/SPA SYSTEMS FINAL .- 19. Rough-Heating,& Air Conditioning ' FIRE DEPT. REQUIREMENT , � � � ' 20. Rough Factory Fireplace ' � - APPROVALS Permit # . � i - - 21. Ducts,'in Structure �, .� � � 70. Underground Hydro . "22. Ducts, Ventilating ' ' � � � 71. Product Piping O Gas��OOiI • ' •� � • 23. �,as Ripe-Rough & Test ' ' � . ; �, • 72. Underground Flush � ' � � 24. Roof�Framing -� �� 73. Undergrnd.StorageTank �Gas ❑Oil � , ' 25.�Roof Sheathing ' � -� ' � . � � 74. Overhead Hydro i 26. T-Bai 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. PlasterBrown Coat � , �' 79. FINAL INSPECTION � 32. Electrical Power MeEer,Final {� � 80. FOOD CERTIFICATE ISSUED , � 33. Final Electric � , Notes: / 2�� , L•� 34. Final Heating & Air Conditioning; � � � � , • 35. Final Gas Pipe-Test � . , "' . . � ' � � - - � .� . . . 36. Hood or CanoPY . � �. . � � . - � � 37. Final Factory Fireplace � � , - 38. Final Plumbing � . � � , � . ' " s i 39. Water Service-Final , � i � �' N �'� /� ' � 40. f;_Secvice,F,�al ' � � ---� � �� n /� 1. Solar pomes�`-Final�i . � � � - � � � ckfiow Preventer - ��' � ' � � .._. . . f. 43. Backflow�lrrigation � �, , � � � � � � � - 44. �Landscape Irrigation System ' i � � ' � , . � • 45. Sound Atten'uation i � � ' ' ' � � � � , � 46. Ha,ndicap,Regulations ' � � • � '� � � . ' � � ' 47. FINALSTRUCTURE&BUIGDWG � � � : ' - � 48. Special Requirements Complefed; i - . , � � � � � � ' - i 49. Electric iielease to Edison ', � - � , • '- � - � � • � 50. Gas Release to Southern Califomia Gas Co ' '' . ' , �. , 'i i. 51. CERTIFICATE OF OCCUPANCY • - � , -,- 'r ; - -, No. ' - . Dafe = .r � - - '- ' -'- _ -'. .. _ . � . Aoo��eant m e1111n all CITV OF COSTA MESA ?��+ IT NC CONSTRUCTION PERMIT �-I�(�. c Address same Address Contracror wit�in heavy Do�Cer linei antl sign all apOropriate tleclaralion _ TRACT NO. LOT NO. -BLDG. NO. JY'1V8 TVPE OF CONSTRUCTION , 1 PhOn ❑ NEW � ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑OEMOLISH LiCenSe No. - ❑ OTHER DESCRIPTION OF WORli '-y� ar LOl LICENSED CONTRACTOR DECLARATION I hereby aftirm that I am IlcenseE untler provlslons of Charter 9(com- mencing with settion 7000) of Divislon 3 0/ tM1e Businazs an� Protessions Cotle, a�c1C�,I1my Iicense I5 In full forte f}g(tt. Lltenie CIx55, �C"'`� Lltansa No. �� " Date-�--"'— Si9nature WORKERS' COMPENSATION DECLARATION � I hereby a(firm [ha[ I have a certltiCdte 01 consent to se1Lln5ure or a certlticate of WOrk¢r5' Compen5dlion InsUranca, or a<ertifieC Copy lhereot (Sectia� 3 00,�j C • PnIICY NO(•PTS� —h% i I ComPanY T71fj11'R'Y.. 'TYI(jP,ll]Yll.' 'erti(ietl m0Y is hereby tUrnishetl. .ertifietl copy 15 tiled with the city Bulltlin9 Oivision. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thiz 5ection neea not be complatetl.iLthe p¢rrtlit is fOr one huntlretl (E100� or Iess). 1 cert y that in the p¢rfOrmanGo ot tha wOrk tor whith this permll IS Issuetl, I shall not employ any person in any mdnner so as to become subject to the Workers' Compensation Laws of Califomla. . Date Si9nature � NOTICE: If after making th6 Ceclaratlon, you 5houltl become subject �to Ihe Wo�ke�s' Compen5atlon p�OVI510ns Ot tM1¢ LaDo� Cotlo, you mu5t torthwith cOmply with such ptovislons o� th15 permit Shdll bG deGmeG �evOketl. � GONSTRUCTION LENDING AGENCV \ 1 hereby affirm that [here is a construttlon lentling aqency tor the per- 1' torTdnce of the work tor whith th15 permi[ Is Issuetl ($eclion 309� � Civ. C.). Lentler's Name �entler's Atltlress r� G �n • OWNER BUILDER DECLA0.ATION I hereby affirm that I am exempt from tho Contractor's License Law tor the tollowin9 reazon (Section ]031.5 BuSiness antl Prolesslons Cotle: Any tlty o� county whiCh r¢quirCs a pevmlt to con5truct, alla�, Improve, tlemolish Ov repair any structure, prior ro Its issuance, al5o re- quires the applicant for such permit to flle a signetl statement that he is litensetl pursuant to the provisions of the Conlrac[or's LicenSa l.aw (Chap[er. 9_ (commenting with Sectlon 7000) o/ Dlvislon 3 of the Business antl Professions Cotle) or that he is exompt therefrom antl tbe basis for tbe allegetl exemption. Any vlolatlon of Settion 7031.5 by appliwnt for a permit'subjects the applitant to a clvil penalty >t more tM1an tive huntlretl tlollarz (y500). , dz owne� of tM12�.property, or my employfes wlth wages a5 thCih soie compensation, WIII'tlb [he work;.Tntl the SVucture is nOLintentletl� or otfered for sale: (Section 7044, Business antl Professlons Cotle: The Contractor'S Li<¢nSe;IWw(tloes not apply to an owne� o( a property wh0 builtls O/ Improves llie�eon, dntl who tloes Such work hims¢If ot th�ou9h his own employee5, PrOvitletl lhat such ImprOVGmen[5 are not Intentletl o� offeretl for sale. It, M1oweveq the builtling or�improvemant is soltl within one year ot completion, the owner wlll have the burtlen of proving he tlitl not Guiltl or improve Por the purpose of sale�. ❑ I, as owner ot th¢ property, am Bxcluslv¢ly coMraGting with licensatl contrattors to construtt the pro)ect (Sectlon 7044, Buslness antl Pro�essiohs Gotle: Tne Contracto�'s Llcense Law tloes not app1Y to an owner of property who builtls o� ImprOv25 lhe�eon, antl who COn- tracts from- such projects wit� a tontrattor(s) Iicesnatl pursuant lo the Contractor's License taw). ❑ I am exempt und¢r SeGtion B. & P. C. for IhIS reason Oate Owner I hereby certity lhat I have reatl [bis application antl sta[e thdt [h¢ dbove information is correct. I agree ro comply with all city antl county ortlinances antl sta[e laws relaiing to construction, antl hereby au[horize repfesentative5 of ihi5 City IO ent¢t upon [h¢ dbOv¢ Tentionetl property. for inspectlon Putposes. l.Z_.�O_O: Slgnature Date V V Driv¢rs' License or SS av� . __ __ TVPE OF PERMIT ❑ GRADING ❑ POUNDATION - � STRUCTURAL ❑ TENANT E"� EIECTRICAL �PLUMBING ❑MECHAI ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY_CONSTRUCTION TVPE VALUATION ZONE GRAOING CU. YDS. ACRES PLUMBING TOILETS LAVATORIES KIT. SINKS PLANCHECK SHOWERS URINAL$ DOUBLE LAVS DISHWASHERS SERVICESINKS SUMPS FLOOR SINKS FLOOR DRAINS DRINKING FOUNTAINS ' INTERCEPTORS CIARIFIERS SWIMMING POOL ' P TRAP WATER SERVICE ALTERATION GASSERVICE OUTLETS WATER HEATERS BTU OUTPUT SEWERCONNECTIONS ISSUE FEE - ,PLAN HEATING SVSTEM 0-300,000 BTU AND DUCTING 100,000 + BTU REFRIGERATION 0-300,000 BTU SVSTEM 100,000 + gTV BOILERS BTU SVSTEM REPAIR,ALTERATION EXHAVSTSYSTEM MULTIPLE ISSUE FEE CMF 0865-46 White-Builtling; Canary-Appliwnt; Pink-Atcountin9: Goltlenrotl-Assezsor _ O120 12/31/81 15.50 ZONING REGULATIONS �i.P. iF ' . . ZONE PLNG.REF.� REAR VARO (TO P/L) PKG.SPACE REQ. STREET WIDTH ZONING APPROVED 8� SPECIqL CONDITIONS: ELECTRICAL 7ROVIDED PARK FEE S PLAN CHECK GENERATOR 0-1 KW_1-]0 KW TRANSFORMER APPLIANCE 30-50 KW_50 t KW MOTORS 0-1 HPX 1-10 FIP pNC.50LAR) 30-SOHP SO+HP FI%TUftES OUTLETS SWITCHES GAS TUBE SIGNS POLE LIGHTS ' PANElS MAIN SUB $ERVICE AMP ISSUE FEE APPLICATION APPROVED BV� SUMMARV OF FEES BUILDING PERMIT S PLAN CHECK $ PLUMBING g •D PLANCHECK b— ELECTRICAL S� PLAN CHECK" 5 MECHANICAL E PLAN CHECK ' S� SMIP PERMIT ISSUANCE GRADING S S S S MICROFILM $ TOTAL FEE S LE55 AD- VANCEPC $_ �{ FINALFEE §� CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil ipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding . tee ein orce 47. Rough Plumbin & Pressure Test 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE � � 7. Footings - 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final 12. Street Sewer Connection � � - - 54. Heater & Vent-Final 13. Rough Plumbing ' 14. Rough �IectricConduit - ' •�56:�,Electiical-Final 15. Rough �Iectric-Wiring� �, � 57. Solar.System-Final - 16. Rough Neating & Air Conditioning � - � -- � - - - � encing & Access Approval 17. Ducts, in Structure APPROVED FOR PLASTERiNG 18. Ducts, Ventilating 19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing � 21. Roof Sheathi� 22. Frame and Flashin NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Qrown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Ha,ating & Air Conditioning � 30. Final Gas Pipe-Test 31. Final Plumbing ..�----�- / �Q i i ! Dh. O. 32.' Water Service-Final � 33. Gas Service-Final ' 34. Solar pomestic-Final i �F,cre.r ..� Z 35. Landsca e S rinklin S stem 36. Sound qttenuation • 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date � COSTA MESA BUILDING-5,4FETY DEPARTMENT P.O. BO%]ly COSTA MlBA, CpLIFORNIA For Applicanf fo Fill In Completely 7YPE OR PRINT BUILDINO / �.N✓E I ✓�� ADDRE58 6 COSTA MESA. CALIFORNIA OWNERS ✓l✓A SVNnS'.% n /Y MAIL — ADDRS88 � .S' /4� _ / i i THL. � �eoe� FEE RECEIVE� JAN 2 7 1965 FINANCE DEPT. CITY OF COSTA MESA APPLICA710N FOR PERMR BUfLDtNG f0� �fflt8 U58 �O�}/ RaC[IPT NO. I PE11N�T NO. sr NOTE: NOEAVEOVER LIC.TNO. � _3 NO. � ''`J�,3�j 30^T081DEQREAR EAVES OIF LOT S6 �' �D � I Hp`y pry �tD. .' ALLOWED YARDSAPPROVED USE OF MAIN BUILDIN6 EXISTIMG HLDO. f FROM C/L BTRfiET 6ET0ACKLINHPNOM i��. s i� ve��r C�« i DESCRIPTION OP WORK BUILOIN6 SIZE EXTERIOR L USE OF BUILOIfiG AND WORK TO BE PERFORM6C S� ND ,L W%NG / No "' G _ =' �ti✓ �3' 1 HEqEBY �CKNOWLHOOB THAT 1 HAVH NHAO TXI6 APPLICATION ANO BTAT! TMAT TH$ ABOVH IB CORRlCT AND AOR88 TO COM. vLY WITH ALL CITY ORDINANCiB ANO 6TAT[ �AWB RiOULATINO BUILDINO CON9THIICT�ON. / SIGNATUREOF �� / PERMITTEF -��'"L7, AUTHORIZEO A6EryT RPJ1R � D18TANCE MAIN BLD( VAR. i� ZONING "-ILI—V/ HAN6 SHALL BE LESS THAN . L. (U.B.C.REQUIREM6NT YARDSAPPROVED � ACCES$ORV BUILDIN6 DATE APPROVED I-77•- /,b��s %7,6��v�� i�- � �. ;4- y�i3 � m . TN! AMOUNT 9XOWN UNDEP VALUFTION 19 POq TH8 F' PUFP056 OP 88i�9L18HIN0 A PEPMIT FEE ONLY. p VALUATION Q m PERMITFEE $ /�iS� � � .3� ��y m s � _ a