HomeMy WebLinkAbout3001 DONNYBROOK LN - Building Permits�
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CITY OF COSTA MESA
�,��'�pMFq ' 61IILDING DIVISION
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i� „. � 77 FAIR DRIVE, COSTq MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wwi.ci.costa-mesa.ca.us
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�. � FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BX10-00279
PERMIT TYPE B MISC STATUS: ISSUED
APN: 14116512 DATE ISSUED: 1 211 3 /2 01 0
Zoning: R1, ISSUED BY: KJB
JOB ADDRESS: �3�1_DONNMBROOK"LN'CM Suite/UniL
Vicinity: Primary Occ: 31 Const Type :??
S�. FT: 495 Valuatlon: $9,900.00
: ;.
SCOPE OF WORK:
CONSTRUCT 8 FT HIGH BLOCK WALL PER CITY STANDARD. 64 LINEAL FEET. NO RETAINING OR SURCHARGE ON WALL.
OWNER: DILLON, LEE E
City/State: COSTA MESA, CA
Phone:
APPLICANT: MORAD, OSHRAT
Ciry/State:
Phone: 818 519-7706
CONTRACTOR: DIVINE DEVELOPERS INC
Address: 4872 TOPANGA CANYON BLVD
355
City/State: WOODLAND HILLS, CA
Zip Code: 91364
ARCHITECT:
Phone
ENGINEER:
Phone
FEE SUMMARY
Building Plan CheCk:
Building Permit:
Electrical PermiC
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
Address:: 3001 DONNYBROOK LN
Zip Code: 92626
Address:
Zip Code:
License No. 884148
Phone 800-985-5518 Cell:
License No.
License No.
$0.00
$181.25
$0.00
$0.00
$0.00
$1.00
Unit
UniC
Unit: SUITE
TOTAL FEES $182.25
HOURS FOR CONS7RUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am ihru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
� New Years Dav. Memorial Dav_ Indeoendence Dav. Labor Dav. Thanksaivino Dav and Christmas Dav
NOTICE: The work authorized by this p�rmit shall comply with all applicable handicap access requirements under California statutes and relatetl
regulalions. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in lhe expiration of this permit.
CODE 1. INSPECTION TPE OATE INiIPALS COUE / INSPELPON TYPE UATE IN110�LS
1878 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof +� 2 W Final Electrical
201 FinalBlock/RetainingWall p��) MP � 212 FinalPirePrevenlion
202 Final Faclory Fire Place 220 Final Planning Approval
263 Final Sign 222 FinalSite y
204 Final Demolition 250 Final BuildinglOccupancy /� 3_ 11 MP��
�
WORKERS' COMPENSATION DECLARA710N:
I hereby aKrm untler penalry of perjury one ot the tollowing declarations:
❑ I have and wilbmaintaiQ.a cehi(cate of consent to self-Insure for workers'
compensation, as �rovided tor by section 3700 of the Labor Code, for the
performance of the work for which �his permit is issued.
❑ I have and will maintain vrorke�s' compensation insurance, as required by
sectbn 3700 of the Labor Code, (or the per(ortnance of the v✓ork for which this
permit is issued. My workers' compensation Insurance carrier and policy
n{1m6EGa�e:
�
m
(TnrtsedonneednotGeromdefeddlhe mutavalue0afinehu�qie00qtlars(S100)oi/ess)
�e� ?�. -�� �
❑ I certi(y that in the peAormance of the work for which lhis permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws o/ California, and agree that if I should
hecome subject ro the vrorkers' compensation provisions of Section 3700 of
[he Labor d I shall forthvrith comply with these provisions. /
- F SSIBnat e� l�YR�' I �
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOILARS
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LA80R CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pmtessions Code, antl
my license is in full Force and eflec�. 2
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CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirtn that there is a construction lentling agency !or the
pertortnance of the work for which this pertnit is issued. (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
SignaWre Date
OWNER-BIIILDER DECIARATI0N5:
I hereby aKrm thal untler penalry of perjury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follovring reason (Sec. 703L5,
Business and Professions Code: Any cily or counry which requires a permit m
consWct, alter. improve, demolish, or repair any stmcNre, prior to its
issuance, also requires the applicaM for such permit ro file a signetl statement
that he or she is licensetl pursuaN to the pmvisions of the Contractors
License Law (Chapter 9(commencing vnth Section 7000) of Division 3 ot the
Business and Professions Code) or that he or she is exempl therefrom anC
the basis for the allegetl exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve hundred dollars (5500).�:
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucWre is not intendetl or
oBered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner o( property who builds or improves
ihereon, and who does such work himself or herself or through his or her ovm
employees, provided that such improvements are not intended or ofteretl for
sale. I(, however, the building or improvement is sold vnthin one year of
completion, the ovmer-builtler will have the burden of proving ihat he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to constmct Ihe prqect (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply lo an ovmer of
property who builds or improves thereon, and who contracts for such project with
a cont2cta(s) license pursuant to the Cont2ctas License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for Ihis reason:
9051-a6(3i01)
�
Owner ID verified by tlriver's license. ❑ Yes ❑ No
Driver's License No. Fxpires: _
Venfication o( Ownership by Qype of document, i.e. - property tax bill or deed�:
DIVISION OF INDUS7RIAL SAFEN PERMIT CERTIFICATION:
� I hereby certify that no excavation frve (5) or more feet in depth into wfiich a
person is required to descend, will be made in connection wiih work authorizetl
by this permit, and that no building slructure, scaffdtling, falsewnrk, a demolition
or dismantling Ihereof, will be more Ihan thirty-six (36) feet high. (Chap. 3.2, Grp
2. Ad 2, Sec. 341, Ttle 8, Califomia Administ2Me Code).
❑ As owner-builtler, I will not employ anyone [o do work which would
require a permit from the Division of Intlustrial Safery, as noted above, unless
such person has a permit to do such vrork from ihe division.
AOWiranl's Signawre Date
Division of Industrial Safety Permit Number.
HAZP.RDOUS MATERIALS AND EMISSIONS CERTIFICA710N:
1. Will Ihe applicant or present or fuNre building occupant nee0 to file and
certify a Business Plan (or emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Cosla Mesa Fire
Deparimenl by every business which has at any one time tluring a reportetl
year a quantity of hazartlous materials equal to or greater than a weight ol
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standard temperaWre and pressure).
2. Does or will the applicant or preseN or (Wure building occupaM need to file
a registration fortn for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazar0ous matenals equal ro or greater than a vreight o! 500 pounds, or a
volume of 55 gallons, or 200 cubic feel ot compressetl gas at standard
�emperalure and pressure).
3. Does or will the applicant or present or fuWre building occupant neetl to
prepare an RMPP (Risk Management an0 Prevention Program !or acutely
hazartlous materials�? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provides that the
Costa Mesa Fire Department may require the preparalion, certification and
filing wi�h ihe Fire Department of an RMPP by businesses which are required
to register awtely hazartlous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Heallh and Safely Code been fully complietl with? ❑ Yes ❑ No
5. Does or vnll the applicant or presen� or fuNre building occupant require for
ihe work which is lhe subjecl of Ihis application a permit for such constmction
or motlifcalion from the South Coast Air Quality Management Distnct or from
any other air polWtion control disMtl or agenty? ❑ Yes ❑ No
(Sectbn 65850.2 of the Califomia Govemment Coae requires that the requestetl
in(wmation be fumishetl on applications fv rrornresitlential building pertnits�.
6. Will any part of the facility to be construcled under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
Qf'yes", the faciliry must meet the requirement of Sections 25534 antl 42303
o( Ihe Cali(Omia Health antl Sa(ety Cotle).
7. If a permit frOm the South Coast Air Quali[y Management Districl or other
air pollution control disirict or aqency is required for the work which is the
subject of this application, have all o( lhe tlisclosures prescribetl by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", atWch ceAificate of compliance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury Ihe
inlormation given above is conect I agree lo compty wilh all stale laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaNre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1
certify under penalty of perjury thal I have read this application and state that
the intormation given is wrrecL I aqree to wmply with all state laws antl ciry
ortlinances relating to building construction, and authorize representatives ot
the City of Costa Mesa [o enter upon the above-described propetly for
inspection purposes.�l agree rrot Io occupy or allow occupancy of any buildinq
authorized by Ihis permil until (nal inspeclion.
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NING
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�yKaRle�a Planning Div.
Subject to Buildi g Division Regs.
Any Revision must be approved.
Re uired Prior to Buiidin Final:
OYES R O Zoning Inspection
OYES C�1�0 TraKcl Park Fees
/z��s1/v
gy;� Date:
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(714) 754-5273 • Fe�c (714) 754-4856
Job Address:
Suite:
Vicinity:
CITY OF COSTA MESA
BUILDING DIY/SION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
3001 DONNYBROOK LN
FRONT, SIDE, & REAR PROP LINES
Parcel Nunmber: 14116512 Zoning: R1 R1
Applicant: MULLER, AL
Address: 17824 LA LIMA � , . .
CA -, ' �� � Phone: (714)963-8813
FOUNTAIN VALLEY � � � � Zip: 92708
i � ,
Owner: DILLON, LEE E '
Address 300YDONNYBROOKLN
� �;��� ,
���, � � ,
� , �COSTA MESA, CA ,
�';i �
Cont�aotor: �� HERITAGE�MASONRY CO
,Address �1�7824.CA.LIMA'�
. -r.i L,A '�. =/
,. . - - , FOUNTAIN VALLEY
-. ' - .Zip: , 92708,'
Arch '. . , - - ' . ,
Address: � � r � � �
. . � . �' phone:
PERMIT NUMBER
B99-01219 v
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Phone: ': ` ` . � - �
Zip: 92626 �� •, .
Phone:. (714)963-6813
License: � 493750 ,
' � '� _ . -i� Eng.
� . � � Address:
Status: ISSUED
Applied: 08/05/1999
Issued: 08/09/1999
�—.�
.' � � �. � �� �
���;
Phone:
4
.. � ,.- .. .� ,. , ��
: . Zip: � •r' � - License: " � License: �
�� �_ �� . � . .
' i � � SCOPE OF PERMIT � `
� CONSTRUCT�184 LIN. FEET OF BLOCK WALL 6 FEET HIGH"ON PORTION OF SIDE AND REAR PROPERTY LINES AND AT �
� � A TEN FOOT FRONT SETBACK . , � � �� � - - � � �� � � � � � ,
Z � � � FEE SUMMARY ' �
�-. Plan Check: ' ' ` $56.71 � � � - � < � �—; � � ' � � - - Calc Valuation: � Ss,sao.00
\ Permit: ', $87.25 _ _ /" ; � Claim Valuation: . 83,eao.00
, SMIP Res: $0.50 , '
�SMIP Com: $0.00 - - � '
Othe'r: � $0.00 - — � � �
� � -- -� . . ,
`=�Inspection:��. . ��$0 00 . �
`����„ .., . �
� �,Totel: $144.46 � - �. "
PLANNiNG 8� ZONING '
- i: � . r _ �
SETBACKS�- �� • � � „ .
MAIN STRUCTURE "Fmnt 0- 0 Rear 0- 0� _ Left - 0- 0 Right 0- 0 �
ACCESSORY
PARKING
NOTES:
Front 0- 0
Existinq: 0
Rear 0- 0 Lefl 0- 0
Re uired: 0 Proposed: 0
Right 0-0
INOTICE: 7he 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 permii shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
�or a period of 180 days. �,
INSPECTIONS: In order for the work authorized unde� ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetlone and flnal approval must be obtained. Failure to obtain inspections and final approval will result in [he expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON OECLARATION:
I hereDy affirm under penelty of perjury one oi the following daclarations:
❑ I have end will maintain e certi�icate of consent to self-Insure tor workers' compensetion, as provitletl for by section 3700 oi Ihe Lebor Code, for Ihe pertormance oi the
�, �work for which this parmit is isSuetl.
1G i have and will maintain workers' compensa�ion insurance, as required by section 3700 ot ihe Lebor Code, tor ihe pertortnance of ihe work tor which this pertni[ is issued.
My workers' com ensation InsUrenc �carriIer and policy number ere: Q�� �
Carner � C VII�� PolicyNumber. �� (/�2 / G,
(This section need nat be completetl �� the`permi Is val d af one hund�etl tlollers ($100J or less.) —T�— .
❑ I certify thet in the pertormanGe of the work for which this permit is issued, I shall not employ eny person in any manner so as to hecome subjeq to the workers'
compensation laws of and agr Itl become subject to the workers' compensetion provisions of Section 3700 of ihe La6or Code, I sha0 fonhwith
comply wit� these pr visions. c� 2,
Applicant Signawre: ��� Date: � � \ "� � 1
WAFNING: FAILURE TO SECURE WORK8R5' COMPENSATION COVERAG IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNOREO
THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF CAMPENSATION, OAMAGES AS PROVIOED FOR IN $ECTION 3]O6 OF THE L4BOR GO�E, INrEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby attirm that I am licensetl nder rov sic
torce end eHecl. lic. #
ContrectofSSignaWr. —
ol Chapter 9(commencing with Section 7000) of Division 3 of the E
Class k
Date:
CONS7RUCTION LENDING AGENC�:
❑ I heraby aHirm ihat ihere is a cOnstmction lending agency for the pertormence ot the work for which this permit is issued. (Sec. 3097, Civii Code).
Lendefs Name: Lenders Atldress:
Signa�ure:
OWNER-BUILDER DECLARATIONS:
Dete:
and my license is in full
I hereby aNirm ihat under penalty of perjury ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW tor [he following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or county which requifes a pertnit to consiruct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires �he applicant for such permit
to file e signed statemem that he or she is licensed pursuent to the provisions of ihe Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or ihet he or she Is exempt t�areirom end ihe basis for Ihe ellegetl ezemption. Any vioiation oi Section 7031.5 by any applicani tor a permit
subjects the epplicant to e civil penalry of not more than five huntlretl tlollars ($500).):
❑ I, as owner of the property, or rny employees with wages as their sole compensation, WILL DO TME WORK, entl the strucWre is not intended or otteretl for sale (Sec.
7044, Business and Professions Cotle: The Contractors License Law tloes not epply to an owner of property who huiids or improves thereon, antl who does such work.
himself or herself or through his or her own employees, providetl that such improvements are not intentlad or offered for sale. If, however, Ihe building or improvement is
sold within one year of completioq the owner-builder will have ihe burden of proving that he or she did not builtl or improve for purpose of sale.). '
❑ I, as owner of ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Professions
Cotla: The coniractors License Law does not apply to an owner of propeny who builds or improves thereon, and who coNracis for such project with a contracbr(s)
license pureuant to the Contrac�ors License Lews.).
❑ I am e:empt under sec. Business and Professions Cotle for this reason:
Signature: Date:
Owner ID veniietl 6y dnvers license. ❑ Ves ❑ No Dnver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certify thet no excavadon five (5) or more teet in depih into which a person is required to descend, will be matle in connectlon with work authorized by this
permit, end thal no building stmcture, scattoltling, falsework, or tlemolition or dismantling thereof, wlll be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title B, Celifornia Administfative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Indusinal Safery, as noted above, unless such person has a
permit to do such work from ihe division.
Signature: Oate:
Division of Intlustnal Safery Pertnit N�m6er.
CERTFICATE OF COMPUANCE AND AUTMORVATION OF ENTRV: I certify under penalty of perjury that I have reatl (his application and state ihat tha infortnation given is
correcL I agree to comply with all state laws and ciry ordinances relating to building consimction, and authorize representatives of the Ciry of Costa Mesa to enter upon ihe
ebove-described pmperty tor Inspec�i0n purposes. I egrea not to occupy or allow occupancy oi any builtling authorized by ihis permit until tinal inspeaion.
Siqna re OF Leg Owner(s)
And/Or Authori plicant
COpE M, INSPECTIONTYPE
161fi Fiaetl System Final Fire Prevention
7266
200
201
202
203
Pool Spa Final
Finel Re-Roof
Final Blxk/Retaining Wall
Finel Factory Fire Place
Final Sign
204 Final Demolition
1[�jE INTRIALS
� I q Daje �
���
Dace
COOEY MSPECTIONTYPE
206 Final Mechanical
208 Finel Plumbing
210 Final ElecMcal
212 Final Fire Prevention
220 Final Planning Approvel
222 Finel Site
250 Final Building/Occupancy
DRTE INTITIALS
i�'J�2�- 0/Zl�
• IHIS SKEiQ-I LS FOR IIv'FORW.'f;ONAL PURP�"6
ONLY. APPLICANf 15 RFSPONSIBLE FOR PROVIDWG
AN ACCURATE REPRF5FN7A770N OF TFffR PROPFR'[Y
IN CASE liIE SHAPE AND SiZE DO NOT CORRFSPOND
WfIH'IT-IE INFORMAITON PROVIDID ONiHI55HEE7'.
• SOLID WALLS/FEN�S BEIIYE�SI 2'fi' k 6' iN Fff1CHf SI-lALL
BE SEI'BAIX A7IFA5f 10' FROM FROPR PROPER'IY LINE.
• SOIID WA1L5/FFN�S SHALL NOT HX� 2' 6' P] i-Q�SG}fi
WITF�J 10 OF hIE FROM PAOPFR'IY IaIE (NOf NRB IWE).
BLOCK WALL LAYOUT FOR BUILDING PERMIT
��o ( �o� �Y ��
PLANNING DIVISION
TYPICAL 6�� CONCRETE BLOCK FENCE
CementCopin90p��onal �
Channel Block �N��h 1 �J78 �
Moriiontal TPP ol all
Fentes
For Fentes 5' a� lesa
Ven. Bart 3/B"4s a� 4' �0" O.C.
For Fences Higher Than 5'
Vert. Ban 3/8"m at 32" O.C. �
Fill Cells Solid Wi�h Groul
WAere Sleel Ot�urs
qnnlmcing Sleel $hall
Conlo�m lo Sec.A�15�79
A.S. T.M.
All Sleel to be Lapped
I4" or Io Code
NATUFIAL GRADE
.�..y \
�,�n,. �,���a :
TW07/8"QBAAS -��
CONTINUOUS TOV I
6907TOM y_{
L
HO4�i5TEEl MUST BE TIEU IN
VLACE AT TIMi OF iRENCH
INSVECTION. p
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SEE CMa
� BELOW
WIDTH . . . . . 14��
THICKNESS . . .10��
DEPiH OF EARTHTOOTH 24'
SPACING OF EARTHTOOTH, i2'
GENERAL- NOTES
MORTAR; Ona Part Plasfic Cemenf, ond
TAret Parls Sond
GFOUT: One Varl Cement Th.ee anA
One Half Ports �ond
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Well M�red C2-I/2:3-I/2
Ma� ol 7- I/2 Gol;cns of
Waler Per Sock ol Ceme�t
GROVT MAV 0E POUNED FROM �NE TOP
OF THE FENCE IN CEllS WHERE STEEL
OCCURS.
CELLS AND AREAS OF NON120NTAL HEIN
FORCEMENT SHALI BE CIEAR, CIEAN b
FREE OF ALL MONTAR DEBRIS, ETC.
H C�' C4RTNTCOTH
V! h1E HE�GTH 0� fENCE
BELOW BOTTOM OF POGTiNG
FOOTING REQUIREMENTS CHART '
14: .
1 O.,
20"
14� .
BUILDING DIVISION
12"
8�
I6'�
16'
SCA�E: I/2'� = 1'
12"
8"
12"
16'
CITY OF cOSTA MESA ONSTRUCTION P RMI�
Project Address � UQ� O h ✓1 �Q V {^O U�
Applicant's Mailin-g bAddress �O S T/4 e S/� -
Ownel'sName -Ou� �� ���H Phone SS7-�/Sy:
Address 300/ �,n h h e v� hpol�e
i . . .� �
Arch/Eng. License Pjo.
pgg��i�is QC�. O a D�l �'. -
Convactor's Nam v'Q � e// hone �—%' �
Address (mailingi -l� O � %G �^.%-�%' .�«^-�ik c C � •
City Licenze No. �'�Sg
IICENSED CONTRACTOR DECLARATION
I hereby alli�m lhat I am IiCenseO untler provi5ions ot C�arte� 9(mmm¢nCing
with sediOn 7000) ot DlviAion 3 OI Ihe Bu5ine55 antl Prof¢SSions Cotle, antl
my license is in lull rce antl effect.
License CIa55 _ ' LiGense N.�' 7 a-
oate %+' � ��-��/ Signg(ure
�, WORKERS'COMPENSATION DECLARATION
' I hereby aHi�m lhal 1 have a certiflcate Ot consent to SGIf-insure o� a certificate
d Workers' Compensation Insurance, or a certitied copy thereof (Section
i800, Lab. C.) +, we �s.� � � 1,
�I Poli Y No.Y/�%�'Flr";=p1- ComPanY �Gi IL IW��.yt� ��
ertifietl copy is hereby lumishetl.
Cert'fi r�1 c y is filetl with Ihe city ByJ'} Qn<YPAvisio�A O�ia�
Dale�e4�-- AppliCart/t, �J�
E%EMPTION FROM WORKERS' CO PENSATION DECIARATION
(Thissection neetl nat be coMpletetl if the permit I5 for one huntlretl ($100) or
less).
I c¢rtity lhat in Ihe p¢rfOrrqance Of Ihe wo�k for whlch [his p¢�m�t is i55uetl, I
shall not employ any peison in any manner so as to become subject to the
Workers' Compensatlon LaWS of CaIlPomia.
Daie Signature
NOTICE: It, after making t�is tleclara[ion. You shoWC become subjeci to the
Worke�s' Comp¢nsdtion p�OviSiOns of the Ldbor Cotle, you muzf fOrtnwlth
compry wilh such orovisions or Nis permR shall be tleemetl revoketl.
GONSTRVCTION LENOIryG AGENCV
1 h¢r¢by afti�m thal there ii a ConstructiOn Ientling agenCy for the pe�totmanGe
ot the work lor wnicn (his Oermit is issuetl (SeCtiOn 3097 Civ. CJ
L.enCer's Name
LRntler's Atltlress
OWNER BUILDER DECLqRATION
I hereby a/tirm lhat I am exemp[ irom the Contractor's License Law for the
tollowin9 reason (Sectlon 7031.5 Business antl Professional Cotle: Any city or
county which r¢qui�es a pe�mit to con5t�uct, alt¢/, imprOve, demollsh o� repai�
any structure, prlor to Its �55uance, also requires the applicant (or such permit
to /ile a Signetl slatGment [hat h¢/She Is IiC¢nsetl pu/suant to the p�ovi5ion5 of
the Con[ractoYs License Law (Chapter 9,(commencing with Section ]000) ot
nivision 3 of the Business antl Profes5ions Cotle) or [hat he/she is exempt
�erefrom antl thE bas15 f0� the allegetl exemption. Any viOlation of Section
J31.5 �y any applicant for a permit subjec[s the applicant to a tivil
�enalty of not more than tiVe hundretl tlollars (5500).
1, as owner of the property or my employees with wages as their sole
wmp¢nsation, will tlo the �york, anC ttte Slructure i5 not intentletl or ofteretl
for sale (Settion 7044, BuSinesS antl Profe55ional Cotle: The ContractOr's
License Law tloes not apply to an owner ot a proper[y who builtls or improves
thereon, antl who tloe5 such w0/k hlmself/he�selt or th�ough his o� her own
employees, provitletl tnat sucn improvements ara not Intentletl or oHeretl for
Sal¢. If, howeve�, tne buildin9 0� Improvement IS Soltl within one year of com-
pletion, the owner will have the burtlan of Provinq he/she tliq not build or im-
nrove tor the purpose oi sale).
❑ 1, az owner of Ihe property, am exclusively mntracting with licensetl con-
tractors to mnsbuct t�e project (Section 7044, Business antl Professions Cotle:
The Contractor's License Law Coes nol apply to an owner ot property who
Guiltls or imoroves tnereoq, antl wno contracts for such oroiects with a r.on-
tractor(s1 Ircense pursuan[ [o me ConVactor•5 License Law). I am aware thac
proof o1 tneir WOrker'S Compensa[ion Inw�ance snoultl be provitletl to me.
❑ I am exempt untler Section 8. & P. C. for this reason
Date
sentatives
Inspectior
Owner
certify that I ha�e reatl this applitatlon antl state that the above
on is torrect I agree to comply with all tlty antl munty ortlinan<es
laws relatin9 to builtlinq conztructlon, antl hereby authorize re0re-
of tnis Uty to enter ypon_th� above-mentionetl property for
ant to fill in all spaces excepl those wit�in heavY bo�tle� lines anG si9n all apOropridte Eaclarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
3 7� A.P.�W
S Main Buildin9:
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E
❑ CONVERSION ❑ �EMOLISH ❑ OTHER T Ffont
DESCRIP'y�ON OF WORK/U$60F BLDG. ���l��E=rnl'*s I A Rear
��b �sr�_�,- , .
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL � C Aight
K Left
\O TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $
❑ �o7tiER ' Ping. Ref. #
PROJECT DESCRIPTION Sc1. F7. oCCUaANCv �3 Planning Notes:
CONSTRUCTIONTYPE_Z--Al VALUATION$�SSO�
ZONE GRAOING CU. VDS. ACRES
G
Bar Sink
Backflow
Backflow
Bathtubs
Clarifiers
Drinking Fountains �
Floor Dreins \
Floor Sinks �
GasService Outlets
Kitchen Sink
Lavarories
P-Trap
Roof Drains
Reinspactian Fae
$15
3oiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
�ai oo,000 eTu o� oo,000
""���•��y "•�� -' - - ' - --- ReinsPeaionFee I $15
Drivers' License or 55 �� ' ' -
OB65-46, rev. 5/88 vdnite - Builtling: Canary � Applicant; Pink � Accounting; Goltlenrotl - Assessor
•
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping.
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Tra'ys
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeratlon System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
ES Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outl¢t5
Switches
Gar6age Disposal
Generator �0.5 KW C
$ 3
FEES
$ 3
Accessory
Parking
ETLECTRICAL
I I Transformer ❑ 15�50 KW
y-J ❑ 50 + K W
Meter Llup w 100 amps
Meter ❑over 100 amps
Sub Panel . �
Motors�Q1 HP�tYh-8
Inc.Soiar �g-15 HP �16-15+
Microwave
Pole Li9ht �
Range
Standing Sections
15 KW Trash Compactor
I Rainspection Fee �$15 � � Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
8uilding Approved By
Aaolication Issued Bv �/g'��
SUMMARV QFI
BUILDING PERMIT $ Q��. D��
P�AN CHECK $
PIUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
FEES
$ 3
SMIP $ _ . .S�
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $
TOTALFEE $ �/''�7
O
N
I
N
G
R
E
�
M
T
S.
a_ ocn4o:.�-_:�Yaiz7 ��� .:.s_
t�kTE: OE!'tiiZ9 '.I!?E� 0':??
i, . �',. . ' .
CONSTRUCTION AND PLANNING ' POO. SPA
Date Inspector Date Ins ector
�. APPRAVALS1j Permit # ,;, APPROVALS Permit # P
1. Temporary Electrical Service or Pole z 52. Pool & Equipment Location
r
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgind. i.� 54. Forms
4. Electrical Conduit-UndPgrnd. � 55. Electrical Bonding
5; Steel �Reinforcement .;-� � 56. Rough Plumbing & Pressure Test '
6. Elect�ical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
v "
7. Footings .� 58. Electrical Conduit-Undrgrnd.
8. Foundation , ' 59. Gas Pipe, O Undrgrnd., Test
�
9. Water Pipe�Undsgrnd. �� 60. Backwash Lines, P-Trap, � Undrgrnd. ,
10. �Structural Floor System - . 61. APPROVAL TO DECK �
11. Property,Sewer Line & House Connection �- 62. Backwash & ReceptorFinal �
12. Sewer Cap ' . �: 63. Heater & Vent-Final �
- ,.
73. Roof. Drains ' ' 64. Plumbing System - Final
14. Rough Plumbing•, ' i ' 65. Electrical-Final '
15. Rough Electrical-Condui[ :� 66. Solar System-Final
i6. Rough Electric Wiring ,., 67. Fencing & Access Approval
A7'. Rough Wiring Sign r,� 68. APPROVED FOR PLASTERING
18. Rough.Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Fieating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace �,-„� APPROVALS Permit #
21. Ducts, in Struc[ure \ 1 � 70. Underground Hydro
22. Ducts,,Ventilating ��� ' _••� 71. ProductPipingOGas ❑Oil
23. Gas Pipe-Rough & T.est J� �,. 72. Underground Flush
24. Roof 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 Ri Siding , 77. FIXED SYSTEM FINAL
29. Insulation ' � 78. FIRE PREV. FINAL
30. Drywall Nailing ��' ' �� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat'�' r;� , 79. FINAL INSPECTION
�.
32. Electrical Power Meter-Fina�, 80. FOOD CERTIFICATE ISSUED
33. Final Electric • - Notes:6 l6 S
34. Final Heating & Air Conditioning
O O
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final �
40. Gas Service-Final ,
41. Solar pomestic-Final
, y�
42. Backflow Preventer �� �
i:
43. Backflow Irrigation �
�,
44. � Landscape Irrigation System �' ��
�,_.:
45. Sound Attenuation
i
46. Handicap Regulations ,
47. FINAL STRUCTURE & BUILDING
SrrO' !�-
48. Special Requirements Completed
49. Electric Release to Edison �'
�
50. Gas Release to Southern California Gas Co �- '
.
51. CERTIFICATE OF OCCUPANCY `� :.
No. Date
% '
owrvea Colle�e Mesa Co. DATE 9�21�55
g JOBADDRESS 3�1 Donnybrook Lane BUILDINGPERMITNO. 15��
� GENERALCONTRACTOR H31e CO. VAWE $ B�OOO.00
• ..,:s 93 BLOCK TRACT 2�µ1
INSPECTIONS DATE
Footing Trench � `�
Foundation Forma and Grade to Garage
Rough Framing f' lt-Z3
Piumbing, Rough to Slab �,- N-) //- z s-�.
Plumbing, Rough Complete IIM - / /p . � �
Temoorarv Pole _
Heating, Rough
Heating, Final L�-�%
Sewer, House�l j Sewer, St.
Septic Tank or Cesspool
l �`ing,ln � �,'j-�j Out)
1 .ering � �
Plumbing,Final,FixturesCoi plete
Plumbing, Fin,al GasTest l� �'Z
Wiring, Final �/
Occupancy �
Form 210 GH 15001-55
z�
SUBCONTRACTOR
PERMITS ISSUED
I NUMBER
Costa Mesa Bnilding Department 1y APPT.ICATION FOR PERmi�
" e 111 EA8T 20th STREET , 1S / 2 B U 1 L D l N G
COSTA MESA� CALIFORNIA i
FOR OF'N'ICE USE ONLY
FOY� APPLICANT TO FILL IN � Q...�... ti,. � o_.m�. m,
Costa Mesa, California ""�'
Nearest ry
CrossSt Baker su�min�
owoer College Mesa Compaztiy Address
Mail g002 Central Ave,� Nearest
Address
cit Garden Grove No�•Le.9-2158 Za e s�
E gl eer �r D8V19 � Quigley No: C-1790 ppprov�
ndd�esa43 l4alaga Qove Plaza� Palos Verde bY
City Lic.
contrector The Hale Compar�y No 3422
Address $002 Central Ave., Gazden Grove
Le al Lot
Descrgotion No. 93 s�o�k i T�a�t 2341
Size of
Use of
N o.
55' ct.�.. v�.�,i T �
Addition
&ize ' 1260 itooms 6 SWries 1
Exterior Wall $tuCCO I R��e,�,,,, Sh2�C0
Coverina
wi
Costa Mesa, California
CORRECTIONS
APPROVALS
Frame: Fire Stops,
Bracina. Bolts
I hereby aclmowledge ihat I have read this Application
and state that the above is rnrrect and agree to rnmply Lath. Int
with all City Ordinances and State Laws regulating
building construCtion. Lath. Ext.
signatureof THE HA[.G COM�A�Ii Y
Permittee Plaster, Int
n . _ �
Vafuaflon LARDI�R permit Fea $
"� Q�Q Plan Check $ � � �
$ � ' Total _
i
__ __
204 5-BP 2M 8-SS . _ _ _
YLV'1' YLE�LV
Show location and dfsiancea from
Property line and between buildinga
� � � '
�.
COSPh
srP2i-SsPDWESfr `6�a A�.''%S.r�
_ . _ • .. . ' � .
�_ _. . _ ' ' ,- '
'AP No. 1%1-16 —1.2LOT 7RACT
INSPECTIOHS Si na+�
�G.,,—_
W ATER
OUGM G4UMBING
PnOP. $WA, IINE � HOUSE CON.
SPRINKLING SYSTEM
MISCELLqNE0U5
ROUGM M(qTING �ND 41q CONOITIONING
TEMPOR�RV SERVICE OR POLE
UNOERGROUNO � POWER
ROUGN WIpING
TRENCNE$ FORMS STEEL REINF. �
FLOOR SYSTEM
BONO BEAM STEEL REINFORCE
SMEPTNIryG
FR�ME RND FLASMING
LATHING — IN OUT
PL�STER,BAOWN C04T
STRUCT11p��, FIH�L
NERTING, VENi.. REFRIG. AND �.C., FINAL
P'
FINAL �NO G�5 TEST '
FIN
DATE
SUBCONTRACTOR
IT
,
��615
' COSTA MESA BUILDING•SAFETY DEPARTMENT
' P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant ro Fill ip Completely — Use Ink Only
BUIIDING �.. � / � • / .. / � _ _ � / ' �
MAIL
ADDRESS
CITY (' 7
w�winwnvrv .r
LENDER
BRANCH �—
ADDRESS ��
ARCHITECT
OR EN INE
�
ADDNESS
TE
OWNER
FIRE
ZONE
APPROVED
6IjUE REWUUI�I
r —/—
/ f/� /
K u�R �
CONTRACTO OD�% A n% //H��O C tlY
ADDFES� w. �S _L
,, 1 TEL. ZON NO.OF �
CITY � /� � }i rya. NO � � P�� •
..F+ STATE CITV �ARDSAPPHOVED
IIC. NO. (I LIC. N MAIN BUILDIN6
� S12E N0.OFB (FROMG �EET)
�. OF LOT NOW ON LQT FT L
a USE OF / /�
� EXISTING BIOG. b
h
FSeparate permi[s are required for s� �f li
q electric, plumbing and heating work. REAR S`
p�. USE OF BUILDING AND WORK TO BE PERFOFMED 045TANCE BET.
Q MAIN BLOCS.
� VAH. �
a � O C.U.P. *
� APGROVED
i'
a �
�
w
0 I �areby eeknowl�tlpe thet 1 a ne0 thlf eDP���atlon en0 Rata
OC tha[ the ebova Informeclon Is conact and epraa to comply wIM
a nll lows rapuletinp builtlinp Gonstruetion, entl I Mnll not employ
Z any perwn �In vloletlon ot t�a workmen's eompsnfaUon Isw� of
Tthe Stata of Calitornle.
3 1 heraby cartify i�et I em p�ope�ly Ilcanwtl af e contractor undar FT.
tne Smte of Celifornle Bu�IneW end Profwlons CoCa, Dlvlsion 3, HE AMOUNT SH01
Chapnr 9, entl that tuch Iica�wt are In full lorco an0 aHact, or 1 THE PURPOSE OF ES
em rxampt irom Ms p�OvIsIO�t Of M� StetB ot CelllO/NG BUdnBp yA�UATION�
enC Profeulom C s, Olvi�lo� 3, Chepttr 9.
Sipnature of �/ /�� � ��
Permltts`i � ���'r-`--� // 1�/1.L _� S
PERMIT � ^
Ej�S�
USE OP NEY� /, y�/
BUILDINC f� ��Ct'�
VAROS APPqOVED
ACCESSORV BUILDING
�
/ • �ir
C
D�4TE
n
a
i
m
N
/N UNDER VALUATION IS FOR m
ABLLSHIN6 A PERMR FEE
u
PEHMIT FEE S �
m
PLAN CMECK 3 "'
0
TAX f LL
i
u
TOTAlPA1D 3 � �
TL
TD