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Home My WebLink About1212 DONEGAL PL - Building Permits RICHARD LUIZ 5071 LOYOLA AVENUE WESTMINSTER, CA 92683 Report of Special Inspection ?reicct Nam / V 4e & Address 4-'�'�•— bO-C*4-rI `t-A- _ et nn tisl� C ?c N bcr �9�-6i (.0 • InspcctionTypc(s) Gunite Inspection Datc(s) [ Z_—(Z-- D [ ) Periodic [ XXX ) Continuous Describe Inspection Made, including Locations: Inspection of the swimming @ the above address on 12_ _est Tcs.s Made: CJ(UNITTL z1N� ��GC�sf7vrT^ IZaAA LAJ To:al Inspection 'lime Each Day: • Date 112-7-42--CP Noun I e-it/Z l:ems Requiring Correction, include uncorrected items previously listed Commems: o the best of my knowledge, the work inspected was in accordance with the Building Department _aprovice design drawings, sped, tc�and applicable workmanship provisions of the U.B.0 • ;,.rept as noted abov Signed: Date l 2.."'11-1-c3 I .C. B .O. # Full Name: Richard T. Luiz Registration No. 1075691-49 Concrete FORM 51.01.is 28 sia ,6 r/- .,.CITYQF COSYA MESA • , BUILDING DIVISION 1e, DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER F1 i PERMIT Ns. B03-01961 e°° (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1212 DONEGAL PL Status: ISSUED Suite: Applied: 11/12/2003 Vicinity: Issued: 11/12/2003 Parcel Number: 14104614 Zoning: R1 R1 Applicant MC DOWELL, TIM Address: 1212 DONEGAL PL ISSUED BY: Phone: COSTA MESA,CA Zip: 92626-2750 Owner: MC DOWELL, TIM Address 1212 DONEGAL PL Phone: COSTA MESA,CA Zip: 92626-2750 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INSTALL AN INGROUND POOL IN REAR YARD.SPA IS 16 IN.ABOVE GROUND. MAXIMUM 6-INCH RAISED DECK AT REAR OF PROPERTY. FEE SUMMARY Plan Check: $217.91 Calc Valuation: $21,000.00 Permit: $335.25 Claim Valuation: $21,000.00 SMIP Res: $2.10 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $555.26 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 5-0 Left 0-0 Right 5-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448.46 WOO) DECLARATIONS I . WORKERQS'"tOMP,ENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and agree that if I should become subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: _ Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($1170,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • acI,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ill/// ��\ Code:The contractors License Law does not apply •an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant tot =Contractor ense La '. ❑ j . exempt un.-ec. Business and Professions Code for this reason:eir � ' �- 0 •• miff: by driver. Icense. -es 0 No • o. _ - Ex,ides: Verification• Ownershr • (type of 'ocument,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health end Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to compl ith all state law and city o •inances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prop:v'rr inspectioaprdroses.>• re,•' o occupy or allow occupancy of any building authorized by this permit until final inspection. • t gnature•ylr:gal • ner(s) ate And/Or Authorized Applicant Date CODE 9 INSPECTION TYPE DAIS IIMEALS LODES INSPECTION TYPE PATE R41Aka 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign _ 222 Final Site &4 ?) 204 Final Demolition 250 Final Building/Occupancy 1 Sz7G6.t'1T �. k4:14 &rey 06 duel Vteda ?�cclucsw REQUIREMENTS TO � ABANDON IN-GROUND r SWIMMING POOLS 1. Obtain a demolition permit from the Building Division. The fee is based on the valuation of demolition and fill. 2. Obtain construction access permit from Engineering Division, 4th floor, Costa Mesa City Hall. 3. Break out and remove a three foot square section of the bottom at each end of the pool. 4. Remove the coping and the bond beam around the perimeter of the pool to 12" below grade. 5. Provide a soil compaction report,certifying a compaction of 90/95% at the time of final inspection. 6. Remove and cap electrical to main service. 7. Remove and cap gas line to main service. 8. Remove and cap water line to main service. • 9. Re-establish proper drainage: 2% from Building • 1% to an approved disposal area Please contact the Building Division at(714)754-5273 if you have any questions. 2501-46 (REV.9/96) t_nwe,oho, utv.it ' • 1 3150B 1998 CALIFORNIA BUILDING CODE 31508 L C Division Il-PRIVATE SWIMMING POOLS(STATEWIDE) - A C C ,VOTE:There ann./anon"are xuhject to local careror ient modification.tion. The applicable lora/government requirements at the time of application for a building Apermit si ou/d be verifier/. CNOTE:Thew eanulanes became applicable vonnumeigy January 1. 1998,to a private.single family hone Jar which a communion permit fora new swimming Apunt has been issued an or after Jarumry 1, 1998. A C A C L A SECTION 3150B-DEFINITIONS to afford protection that is equal to or greater than that afforded by A L A any of the devices set forth in Items 1-1. inclusive. A L • C As used in this division, the following tens have the following C L C meanings: Reference:Health and Safety Code Section !15922 C L A Authority: Health and Safety Code Section /8942(6) C L A APPROVED SAFETY POOL COVER means a ntanually or AB 3305. Statutes 1996. C.925 A L A. power-operated safety pool cover that meets all of the perfor- A A mance.standards of the American Society for Testing and Materi- A L C n(s(•15TH), in compliance with Standard F/346-91. SECTION 31528-ENCLOSURE;REQUIRED A L C CHARACTERISTICS CA L A• ENCLOSURE means a fence, wall or other barrier that iso- C L clates a swimming pool from access to the home. 31528.1 An enclosure shall have all of the following characteris- C L C• EXIT ALARMS means devices that make audible, continuous tics' C L • alarm Counds when any door or window that permits access from I. Any access gates through the enclosure open away from the C L C• the residence to the pool area, that is without any intervening en- swimming pool and are self-closing with a self-latching device C L C closure, is opened or is left ajar. Exit alarms may be battery oper- placed no lower than 60 inches(1524 mm)above the ground. C ccited or may be connected to the electrical wiring of the building. 2. A minimum height of 60 inches 11524 mm). A PUBLIC SWIMMING POOL means a Brimming pool aper- 3. A maximum vertical clearance from the ground to the bottom A CA aced for the use of the general public with or without charge,or for of the enclosure of 2 inches(5! torn). C t C the use of the members and guests of a private club. Public swim- C tL. C ening pool does not include a swimming pool located on the 4. Gaps or voids. if any,do not allow passage of a sphere equal C L C grounds of a private single-family home. to or greater than 4 inches(102 nun)in diameter. C C 5. An outside surface free of protnaions, cavities or other A C L A $ WLt1M/NG POOL or POOL means any structure intended A L A for sr swimming or recreational bathing that contains neater over physical characteristics that would sen-e as handholds or foot- A L A /8 inches(457 inn)deep. "Swimming pool" includes in-ground holds that could enable a child below the age of five years to climb A L A and above-ground structures and includes, but is not linmited to. over. C E A hot tubs. spas. portable spas and nonportable wading pools. Reference: Health and Safety Code Section 115923 C C Authority:Health and Safety Code Section 18942(b) C • - C Reference: Health and Safety Code Section 11592/ AB 3305. Statutes 1996. C.925 - C C Authoring: Health and Safety Code Section /8942(h) C C AB 3305, Statutes /996. C.925 A A SECTION 3153B-AGREEMENTS TO BUILD;NOTICE C L A OF PROVISIONS A L A• SECTION 3151B-CONSTRUCTION PERMIT,- A L SAFETY FEATURES REQUIRED Any person entering into an agreement to build a swimming pool A L A shall give the consumer notice of the requirements of this article. C L CCommencing January 1. 1998. except as provided in Section Reference: Health and Safety Code Section 115924 c L 3/54B. whenever a construction permit is issued for construction Authnrin•: Health and Safety Code Section 18942(6) A EC of a new swimming pool at a private,single-family home. it shall C AB 3305. Statutes /996. C.91_5 A L A be equipped with at least one of the following safety features: C L A 1. The pool shall be isolated from access ro a home by an endo- A L C SECTION 3154B-EXEMPT FACILITIES C L; A the that meets requirements of Section 31528. A L C 2. The pool shall be equipped ed with an approved ooh 3154.1 B The requiretnents of this article shall not apply to any of A L ( pP pPsafetyp C A the following: A C cover. C A 1. Public swimming pools. A A 3. The residence shall be equipped with ext alarms on those A A doors providing direct access to the pool. 2. Hot tubs or spas with locking safer'covers that comply with C C the American Society for Testing,Materials-Emergency Perfor- C CA 4, A11 doors providing direct access from the home to the swim- mance Specification(AST.M-ES 13-89). A C ening pool shall be equipped with a self c'lu.ring, self-latching de- 3. Any pool within the jurisdiction of any political subdivision C A vice with a release mechanism placed no lower than 54 inches A A (1372 mm)above the floor that adopts an ordinance for swimming pool safety that includes CA C requirements that are at least as stringent as this division. C A C 5. Other means of protection, if the degree of protection af- 4. An apartment complex or any residential setting other than a C C foaled is equal m or greater than that afforded by any of the de- A single fnrnilc borne. A C rices set forth in Items 1-4. inclusive, as determined by the C C building official of the jurisdiction issuing the applicable building Reference: Health and Safety Code Section 115925 A e permit.Any ordinance governing child access to pools adopted by Authority: Health and Safety Code Section 18942(6) C A a political subdivision on or before Januar- I. 1997, is presumed AB 3305, Statutes 1996, C.925 A 1-294.16 CHAP.31B,D1 V.1 1998 CALIFORNIA BUILDING CODE FIGURE 3113-4 FIGURE 318-5 A E Cq LL C L A L AL CqA L C L CL A L 111111111' A L C /'m n. C L A if 11/0111t;;;;;1111141; C C level "64111111111111111 ■■ S'min. A L 11111�� CCA E 1� 'I 1'min. I A L 111 ■ iI2'nw C L C i:-nom" vwMtv,' A E Mm A A C L A L C A C A C A A EA LL FIGURE 318-4—PERPENDICULAR FENCING DIMENSIONS ON SLOPING GROUND ' C E Al C LL .. CE C A C C C C A CL A C INSIDE OUTSIDE C E CL lz. A L 5' Cl dear / A L Fentlnp space�/ ��/ C IL C L .00 • CE. C uc/' A L A C C L A L AE 2E CL AL A L _ CL A FIGURE 3113-5—EFFECTIVE FENCING HEIGHT A L . 1-294.15 Af CITY OF COSTA MESA 4 BUILDING DIVISION j .,,, �ie.._ 4,) DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER t T4s r PERMIT J41,�!r"� 'O4roamm`. 03-00592 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIV ,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1212 DONEGAL PL Status: ISSUED Suite No Applied: 11/12/2003 Issued: 11/12/2003 • Vicinity: Parcel Number: 14104614 ISSUED BY: Applicant: MC DOWELL, TIM Address: 1212 DONEGAL PL Phone: 714-754-0778 COSTA MESA,CA Zip: 92626-2750 Owner MC DOWELL, TIM Address: 1212 DONEGAL PL Phone: COSTA MESA,CA Zip: 92626-2750 • Contractor: OWNER-BUILDER Address: Phone: • Zip: License:000000 SCOPE OF PERMIT REF B03-01961.IN GROUND POOL AND SPA.HEATER. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 - Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 - 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $10.65 1 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp ,- - $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee • Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: . ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Cods,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be Completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIEOT AN EMPLOYER TO CRIMINAL PENALTIES AND CMIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lic.N Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of t party,am XCLUSIV • CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The con .15 Licen so :w d•: t:.ply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license purs o the Cod•':ctors Li•= . .ws.). ❑ I am exe•,• under se Business and Professions Code for this reason: Signature: `- Date: //• /1' 0 5 Owner ID v: tied by dri :re licons: Yes 0 No Driver's License No. ((, Expires: Vedficatlo' of Owner'ip by(typ-of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lYes ❑No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (It"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE D AUTHO TON ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with tate law d city anc relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for' pection oses.I occupy or allow occupancy of any building authorized by this permit until final inspection. • /f• / y • 03 Sign re Of Le I Owner(s) Date And/Or Authorized Applicant Date NU it IMSPECTION TYPE BATE INTmALS LOOS( INSPECTION TYPE fan ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical C'-� CI-St 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,5J "r ' CITY OF COSTA MESA 4q BUILDING DIVISION > :l r,,.o' ,� DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER PERMIT 03-00751 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1212 DONEGAL PL Status: ISSUED Suite No Applied: 11/12/2003 Issued: 11/12/2003 Vicinity: Parcel Nunrnber: 14104614 ISSUED BY: Applicant: MC-DOWELL, TIM Address: 1212 DONEGAL PL Phone: 714-754-0778 COSTA MESA,CA Zip: 92626-2750 Owner: MC DOWELL, TIM Address 1212 DONEGAL PL Phone: COSTA MESA,CA Zip: 92626-2750 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng : Address: Phone: Zip: License: - SCOPE OF PERMIT REF B03-01961. IN GROUND POOL AND SPA. FEE SUMMARY • AMT QTY AMT - QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $60.75 1 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice.$oda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 '0 . Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 264646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES uP TOONE HUNDRED THOUSAND DOLLARE(Steeple).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.4 Class 4 Contractor's Signature: _ Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any City or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to o civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). . I,as owner of the pro.'rty,am EXCLUSIVELY CO r -'ACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contra • --License�fi:s not app • .n owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuan • e Contract• (cense ❑ I am exempt •er sec. Business and Professions Code for this reason: Signature: Date: /1' / Z ' 0 3 Owner ID yen':d by driver's cense. '. Yes 0 No Driver's License No. Expires: Verification • Ownership ,y(type of doc ment,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: J ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). —~ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yea U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application.have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLJ•—• AND A 'IZATION OF NTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to compstate I= nd city or ' ces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described proper.Alr inspectio • roses.I a o occupy or allow occupancy of any building authorized by this permit until final inspection. Si. ature Of Le Owner(s) Date And/Or Authorized Applicant Date ;ODE I INSPECTION TYPE DAME ILITTALE CnpF I INSPECTION TYPE PATE MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 9-7-09 7= 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,5" 99 CITY OF COSTA MESA 'agBUILDING DIVISION F 1 __ _ DEVELOPMENT FERMCT S DEPARTMENT PE 03-00936NUMBER te (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1212 DONEGAL PL Status: ISSUED Suite No Applied: 10/08/2003 Vicinity: Issued: 10/08/2003 Parcel Nunmber: 14104614 Applicant MC DOWELL, TIM ISSUED BY: C/ AA- Address: 1212 DONEGAL PL Phone: 714-754-0778 COSTA MESA,CA Zip: 92626-2750 Owner: MC DOWELL, TIM Address 1212 DONEGAL PL Phone: COSTA MESA,CA Zip: 92626-2750 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT INSTALL NEW 200 AMP PANEL. FEE SUMMARY Quantity _ Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 . 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $30.50 1 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 - Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6//e) DECLARATIONS I t �� WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Llc.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have'the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does-•t.•ply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant •the Contr : ors Lic: Ce :ws.). exam. der sac. Business and Professions Code for this reason: r --- •. re: - `. Date: /O Owner ID veil'=d by ers licen .. C 0 No • e s 'cense •. - Ex•• .5: Verificatio •f Owners ip by( •: of document,i.e.-property tax bill or de:. : DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIAN AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply w' II state la nd city or ances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propert Inspectio oses.I (o occupy or allow occupancy of any building authorized by this permit until final inspection. //Zur #Cs) Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE QATE INTRUL$ CODEC INSPECTION TYPE >ATE L LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -^Y -t 200 Final Re-Roof 210 Final Electrical }}"/q e 201 Final BIocWRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy `, 6 CITY OF COSTA MESA BUILDING DIVISION > 0� ,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMB - -4• rill PERMIT EO 0 StIbleareso se (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1212 DONEGAL PL t Status: ISSUED Suite No Applied: 11/12/2003 Vicinity: Issued: 11/12/2003 Parcel Nunmber: 14104614 Applicant: MC DOWELL, TIM ISSUED BY: Address: 1212 DONEGAL PL Phone: 714-754-0778 COSTA MESA,CA Zip: 92626-2750 Owner: MC DOWELL, TIM Address 1212 DONEGAL PL Phone: COSTA MESA,CA Zip: 92626-2750 Contractor: OWNER-BUILDER Address: . • Phone: Zip: License: 000000 SCOPE OF PERMIT REF 803-01961.IN GROUND POOL AND SPA. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $49.50 1 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 _ up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 • 0 Motors to 50hp 50.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-413(64 0) DECLARATIONS I I • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cede,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: 0 I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors 'cense Law.oes not:-.ly to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) i e pursuant to '=Contract.icense j I am exempt - sec. / Business and Professions Code for this reason: Signature: ., Expires: . Verification of Ownership•y(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feel high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Salary Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUAN E AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply all state la nd city of -ces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope r inspection ores.I..ine of to occupy or allow occupancy of any building authorized by this permit until final inspection. Si ature Of -eaIOwner(s) Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE BAIL MEMO CODE( INSPECTION TYPE BAIL annALO 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 11-7-04 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy IIIMI MI= MIMI LLJiNIEEL �____ , TEST SPECIMEN AND COMPRESSIVE STRENGTH DATA S ET (LCC'2 `! .moi.-- 2 a PROJECT NAME: McDowell INSPECTORS NAME: Richard Luiz PROJECT ADDRESS: 1212 Donegal Place INSPECTOR'S LICENSE NO.: On File Costa Mesa,CA INSPECTOR'S SIGNATURE: On File PERMIT NUMBER: 803-1961 SET IDENTIFICATION NUMBER: NR CAST DATA(ATTACH DATA SHEET OF OTHERS WHEN AVAILABLE) CAST DATE 12/12/03 DESCRIPTION Concrete Grout Mortar Shotcrele Masonry Pnsm IOt ter.GUNITE I CONTRACTOR Owner Builder SPECIFIED Pc•PSI 2,000 CEMENT TYPE 'V SUBCONTRACTOR Triforce CAST BY Luiz Inspections ADMIXTURE N/A ENGINEER OM Dasol NO.OF SAMPLES 2 WATER ADDED N/A CONC.SUPPLIER N/A TOTAL YDS.PLACED N/A SLUMP N/A PLANT N/A TICKET NUMBER N/A AIR CONTENT - MIX DESIGN NO. 4 1/2-1 CAST TIME N/A AIR/CONC.TEMP. N/A LOCATION IN BLDG.: Bottom of The Swimming Pool NOTES: NR= Not Reported Test specimens were 3-in.x 3-in.x 3-in.cube samples cast using wire mesh(no mold used). COMPRESSIVE STRENGTH DATA DATE SPECIMENS RECVD. 12/23/03 EQUIPMENT USED Forney DR2000 REPORT DATE 12/26/03 SN OF EQUIPMENT 99108 TECHNICIAN NAME C.Henriquez-Supervisor CAUB.I REGAL DATE 2-03/2-04 t SPECIMEN AGE AT TEST TEST SPECIMEN DIMENSIONS-IN.' AREA LOAD F'c BREAK IDENTIFICATION TEST DATE TIME 1 2 3 4 SQ.IN. LBS. PSI TYPE' 1 NUMBER DAYS 6 4 7 I Hen C010102A 14 12/26/03 7:00am 3.182 3.180 3.155 3.156 10.04 42,118 I 4156 j 0 3.711 3.712 3.712 3.711 1+.171 C01010213 14 12/26/03 7:03am 3.145 3.143 3.188 3.187 10.02 33,008 3,293 0 3.478 3.477 3.477 3.777 (1.121 - Avg. F'c2s= 3,745 -a 'Specimen dimensions 1•4=width and length of each face at midhelght:4 through 8=specimen height at midwidth. 'Break type designation per ASTM C39 Figure 2:a=Cone,b=Cone and SOP,c=Cone and Shear,d=Shear,e=Columnar COMPLIANCE WITH SPECIFIED STRENGTH I COM ' TS:Complies / ...... AUTH•RIZED SIGNURE - ' I vat Vt 10600 Pioneer Boulevard, Suite G • Santa Fe Springs, California 90670 • (562)903-Oh10 lay rSA010n1-1c1 A 4k . BUILDING DIVISION, DEVELOPMENT SERVICES DEPARTMENT PERM MBER b. IPP1PERMIT °• • " '; P03-00660 (714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1212 DONEGAL PL Status: ISSUED Suite No Applied: 10/08/2003 Issued: 10/08/2003 Vicinity: Parcel Nunmber: 14104614 / � ISSUED BY: 16424. Applicant: MC DOWELL, TIM Address: 1212 DONEGAL PL Phone: 714-754-0778 COSTA MESA,CA Zip: 92626-2750 Owner: MC DOWELL, TIM Address 1212 DONEGAL PL Phone: COSTA MESA,CA Zip: 92626-2750 Contractor: OWNER-BUILDER • Address: 1 Phone: J Zip: License: 000000 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT UNDERGROUND GAC-rifiNG FOR FUTURE POOL AND SPA. �- tiCv O' 11t'iJ FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0. Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.'No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-48(6/00) DECLARATIONS I •• WORKERS'COMPENSATION DECLARATION: • . I herebyaffirm Under penalty of perjury one of the following declarations: ❑ I have and this ea certificatesof consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the pertortnanca of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars WOO)00)or less.) El I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DCLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Llc.It Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License 'does n:# apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) /license pursuant t e Contra .f- Lice s.). v T I amexempt u sec. �� Business and Professions Code for this reason: ^��l /Signature:,- — --. Date: .OwnefID verifi by driver. licens.. El-yes 0 No Drivers License-No. Expires: Verification Verification of wnership•y(type of •ocument,i.e.-property tax bill or dee DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this . permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). • ',,7 ,,a,) f . . 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes El No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (II yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? El Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLJANC- �• AUTHO- TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply wit, : tate laws 'd city ordin:,-Lys rel.VI g to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property f.. pection p,•(, I ogre o• u6v or allow occupancy of any building authorized by this permit until final inspection. ., - / r8 'No; Sig 're Of Lega4} !'(s) Date) And/Or Authorized Applicant Date CODE 6 IftISPECDONTYPE MR EMI& CODE0 JNSPECPONTYPE DME IifallaL4 1616 Fixed System Final Fire Prevention 206 Final Mechanical � "-03 9 /� 1266 Pool Spa Final 208 Final Plumbing ID"i'VaN 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 1 CD/y// Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. - ICITY OF COSTA MESA P� ^IT NO. Q - TRACT NO. ! LOT NO. BLDG.NO. CONSTRUCTION PERMIT /t/ ~-l�4Q • 6022 8/ I 3/82 7.00 It Project Addr ss - ` TYPE OF CONSTRUCTION // t Owner Fq , ..//GG� Phone ❑ NEW . ❑ ADD 0 ALTERATION //. f -- Address//CC-// ' - f ��_. l - - ' -❑ REPAIR ❑ CONVERSION ❑,DEMOLISH / L/1� Arch/Eng. • License No.- 0 OTHER ZONING REGULATIONS • OL DESCRIPTION OF WORK ' A.P. rJ Address' q 'r ZONE PLNG. REF. 4+ --,, .erI J�f / 7 TYPE 0-GRA ING BUILDINRTpgLII�pINGC /J , SETBACK C/L 5T. PROPERTY LINE g$.S / /�� 1M -r ❑'GRADING ❑ FOUNDATION ❑ STRVCTURAL L DETYARD lintr NSVED CON RACTOR D C ARATI ��/_ • ❑ TENANT ❑ El EG.TRICA PLUMBING ❑MECHANICAV SIIDEE YAHU I hereby affirm that I am licensed under provisions of Charter 9 (tom- //v RIGHT mencing with section 7000) of Division 3 of- the c SITS and OTHER . Professions , -f d y license is Ir l' l o •• •r +ffect. ,\ REAR YARD(TO P/C) Licen -CI. • - • / • . PROJECT DESCRIPTION -- - i - PKG.SPACE REQ. PROVIDED • Date - "'S Pure 7�& �� _ SQ.FT. WORKERS''COMPENS•TION DECLARATION OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE$ I hereby affirm that I have a certificate of consent to self-insure or a ALUATION ZONE --- ZONING APPROVED BY • 'DATE certiffiggte- f Workers' Compensation Insurance or •a certified copy e'1bo lfi i 3 b. .) GRADING CU.YDS. • ACRES - SPECIAL CONDITIONS: , Certified copy is filedhereby furnished. REMARKS: �� _��j - _ _- 1 .J Certified copy is filed with the city Building Divi n.• EXEMPTION FROM WORKERS' COMPENSATION DECLARATION /] '- - (This section need not be completed if the permit is.for one hundred _ - - ' ($100) or less). mss.( I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become , PLUMBINGPLAN CHECK ELECTRICAL PLAN CHECK • subject to the Workers'Compensation Laws of California.- _ uwtLLiN - GARAGE Date Signature BATHTUBS • SHOWERS - - SO FT SO FT NOTICE: If after making this declaration, you should become subject TOILETS • _ URINALS GENERATOR 0-1 KW______ KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER - ' forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - APPLIANCE 10-50 KW 50+ KW , revoked. _ • CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP- 1-10 HP" - ' I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS • SUMPS - • (INC.SOLAR) 10-50 HP 50 + HP' - formance of the work for which this permit is Issued (Section 3097 Civ. C.). " - - FLOOR SINKS FLOOR DRAINS - - FIXTURES "OUTLETS SWITCHES - Lender's Name Lender's Address DRINKING FOUNTAINS' GAS TUBE SIGNS - OWNER BUILDER DECLARATION - INTERCEPTORS CLARIFIERS - POLE LIGHTS I hereby affirm that I am exempt from the Contractor's License Law for t the following reason (Section 7031.5 Business and-Professions Code: - SWIMMING POOL P TRAP • - - - LUNS I HUL I IUN Any city or county which requires a permit to construct, alter, POLES METERED SUB Improve,demolish or repair any structure, prior to its Issuance,also re- ' WATER SERVICE - - ALTERATION - PANELS MAIN SUB • - quires the api.licant for such permit to file a signed statement that he - - - Is licensed pursuant to the provisions of the Contractor's License Law ' GAS SERVICE. OUTLETS " - SERVICE AMP - • - (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT` - -•sis for the alleged exemption. Any violation of Section 7031.5 by - - ' • - V applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS' - `� '' -- - - not more than five hundred dollars ($500). . Li I, as owner of the property, or my employees with wages as their ' SOLAR TANK - COLLECTORS ' ' • ' sole compensation, will do the work,and the structure Is not intended _ ••• ' or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUEFEE Contractor's License Law does not apply to an owner of a property _ _ _ __ who builds or improves thereon, and who does such work himself or ISSUE FEE APPLICATION APPROVED BY •L/N. DATE 8//'j/iy through his own employees, provided that such improvements are not - intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK Is sold within one year of completion, the owner will have the burden SUMMARY OF FEES of proving he did not build or improve for the purpose of sale). � BUILDING - $- .SMTP $ V HEATING SYSTEM 0-100,000 BTU/ PERMIT' o I, as-owner-of the property, am exclusively-contracting with AND DUCTING" - - licensed contractors to construct the project (Section 7044, Business 100,000 +BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to. • �� - - ISSUANCE -$ an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ e r. -tracts from such projects with a contractor(s) licesned pursuant to • SYSTEM - - - • - - GRADING $ the Contractor's License Law). 100,000 +BTU PLAN CHECK $ , • • ❑ I am exempt under Section ' —- B.&'P.C.for this BOILERS BTU - ELECTRICAL $ • '$ reason -- • - - - .Owner - TOTAL'FEE$ MECHANICAL $ I here• ertify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE LESS AD, -- • 'Info a on is correct.- 'agree to nply with all ci and c•unty "PLAN CHECK $ - VANCE PC $_ _ ordina•ces and state , I i•• tup, struction,and • re• ' a ori - , re., entatives-of J- ter upon the •ov• r do 'tl p •perty for in r 0• Pa �•/r !... , - .'/ / ��i/i as e A I L� . FINAL FEE $l • 0 b r rivers'License or �� •- ISSUE FEE - - - • f'1 D - - - F 0865-46 White-Building;Canary-Applicant; P" k-Accounting;Goldenrod-Assessor r • • CONSTRUCTION AND PLANNI G POOL&SPA., . • APPROVALS Permit# L� Yy9q Date Inspector APPROVALS• . , Permit# _ '__ -Date. • Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location •. - _ - 2. Soil Pipe-Undrgrn 44. Steel Reinforcement - " �• -' ''- ` 3. Electrical Conduit Utility-Undrgrn 45. Forms - 4. Electrical Conduit-Undrgrn 46. Electrical Bonding . - - 5. Steel Reinforce 47. Rough Plumbing &-Pfessure Test '- - - --- - - • •-- __.�_ - - 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE - = - - -- *- •- ;‘- 7. 7. Footings 491 Electrical Conduit-Undrgrn 8. Foundation - 50. . Gas Pipe, 0 Undrgrn,Test' - `:. ' - 9. Water Pipe-Undrgrn • 51. Backwash tines, P-Trap, ❑Uridrgrn- "- - ' - ' 10. Structural Floor System 52. APPROVAL TO DECK -- 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection • 54. Heater & Vent-Final 13. Rough Plumbing _ 55. Plumbing Svctem -Final 14. Rough Electric-Conduit •' - • ' - ' '-$6. Electrical-Final • 15. Rough Electric-Wiring 57. Solar System-Final 16. Rough Heating & Air Conditioning 58. Fencing-&-Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing - - 21. Roof Sheathing 22. Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat • 27. Electrical Power Meter-Final 28. Final Electric �J��(� • 29. Final Heating & Air Conditioning F/7-12- 1-'? „ 30. Final Gas Pipe-Test . ' 31. Final Plumbing 32. Water Service-Final • 33. Gas Service-Final - 34. Solar Domestic-Final 35. Landscape Sprinkling System • - • - 36. Sound Attenuation 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 ` bJOB ADDRESS 1212 Donegal Pl. BUILDING PERMIT NO. 39699 U GENERAL CONTRACTOR Owner Bldr. DESCRIPTION of WORK Block Wall AP No.141-046-14 LOT TRACT FIRE ZONE VALUES 900.00 I ECTIONS Signature Date TYPE 111 GROUP U ZONE Hl Et. - PERMITS ISSUED GAS SUBCONTRACTOR Date Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER D ROUGH WIRING ,^� Heating and Vent. • '/ TRENCHES ❑ FORMS fl STEEL REINF. `j 4070. - - FLOOR SYSTEM BOND BEAM fl STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT rl PLASTER, BROWN COAT STRUCTURAL. FINAL • H IG. VENT.. REFRIG. AND A.C., FINAL PL./HIDING, FINAL AND GAS TEST n ELECTRIC. FINAL BUILDING, FINAL /ME rif CPFrIAI PFOIIIRFMFNTA A 39699 „rt 1 n-7:Fr- 00 328= *****9.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECE ED Y DATE RECEIVED DATE ISSUED BUADILDING DRESS /L1 DoNIC�AL Ptr CM �"111 3- )0-7 3-ID 7S OWNER 13Q/ PARk R A.P. NO. L t -o4o- ,&f PERMIT NO. MAIL �1 rL� ,,7l ,t II `, _ BUILDING ADDRESS SAM /T 5 44,0 yt' ADDRESS V�_XL rt) tac aC,nAC - iL U city ra IA MP3 4 NoL. Cy 9-let TRACT ( 1 I LOT rig BLOCK Z d CONSTRUCTION /k(/�),r,(pt NEW I ADD ALTER REPAIR MOVING nEMOI ISH — F' LENDER0 am J r BRANCH ' J(/) OWNER 03 J ADDRESS VALUE -CO ARCHITECT TEL. USE $ J Q OR ENGINEER NO. U FIRE �/.f• 11 Z a ADDRESS ZONE TYPE f I s GROUP O.W ill ) //� APPROVED -� J O CONTRACTOR 15/DJVe J? /l /I r BY DATE — JetADDRESS 1.1.1.11, ~- TEL. ZO NO.OF USE OF NEW t Z H CITY NO. ( PLANS Z BUILDING .st W ArIL W O STATE CITY YARDS APPROVED YARDS APPROVED N sc LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING DO S. (FROM C/L STREET) SIZE INO.OF BLOC OF LOT NOW ON LOT FRONT FT. 1 `��-c FT.t USE OF /� EXISTING BLDG. R.SIRE FT.. FT. I— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. '— FT. CEXTERIOR WALL 1 ROOF _ COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 1 MAIN BLOCS. ACCESS.SLOGS. O �/& C,� �Q // C.U.P.# APPROVED 1 co AP—ELY f \ 97.j DATE a/'to -7T Z ��J 0 STATE U I hereby acknowledge that I have read this application and state r that the above information is correct and agree to comply with , CC all laws regulating building construction, and I shall not employ /Q I— any person In violation of the workman's compensation laws of ✓-I H the State of California. TAX m ZI hereby certify that I am properly licensed as a contractor under •. FT. OW the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses ere in lull 'force and effect,or 1 THE PURPCGE OF ESTARLISHING A PERMIT FEE ONLY: t CC am exempt from the provisi�WI' Cha N �,6 oo of the State of California Business VALUATION and Professions Code,Divisi ter 9. 9--,,/� PERMIT FEE $ 7 te Signature of c CO Permittee $ PLAN CHECK $ E o Authorized Agent u. TOTAL FEE $ ` LC:IOWNERPARKER. BOB DATE 5-6-70 ' JOB ADDRESS 1212 Donegal Place BUILDING PERMIT NO. 31803 GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Comm. Block Wall _ 1/4_1c. GENERAL Na• 141-046-14 LOT 175 TRACT 2671 FIRE ZONE VALUE $300,00 I ECTIONS Signature Date GROUP J TYPE ITT ZONE R-1 SOIL PERMITS ISSUED GAS SUBCONTRACTOR Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND fl POWER ❑ROUGH WIRING Heating and Vent. TRENCHES FORMS ❑ STEEL REINF. Aic-kf FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING • LATHING - IN n OUT n PLASTER, BROWN COAT -TURAL, FINAL _ Electric h MG, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL p� y�� BUILDING, FINAL /0LW s1;7/7? • MAY —6-70cR,A00 224 ii*****5.G0 31803 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely yy J // RECEIJ,/E�p DATE RECEIVED DATE ISSUED BUILDINGDRE / 4 / 2_ O V&&AG /2L. i � Lein--YY////yy�J 5-6 5_�_70 ADDRESS '/ ,// �J,f1Q OWNER /.?o13 l�A i?/lei? A.P. NO. /yBUILDING /J#7k-/ ,-/pn(l�J.yy,/J Z ADDRESS SAME,. 6MAIL ' 48� Vt- ADDRESS //a/N /� ' IC[�. Re • CL 0 CITY (F ' fA MESA NOL 5g91 TRACT c2,47J I LOT/ 'V BLOCK Z Q CONSTRUCTION C45 hi NEW ADD ALTER REPAIR (MOVING DEMOLISH O m LENDER J V BRANCH �( t �_ IL A� ' J N /OWNER /C )..,0 VQ ht.) CO J ADDRESS I yy.. ,,,�. ppV� ALUE sea J Q ARCHITECT �_ TEL. US (�/[(�r.Li $ �].(JU //rf l OR ENGINEER NO. VCC FI ? �/y w cc ADDRESS ZONEffjja.Ly � ((L��J �� y /T�Y/Pl E.11l� GROUP -/ 7 JZ CONTRACTOR l/V teat BVC,�.Q,V`d/(// /'(� DATE�/—(O"/Q m Z �/ J K ADDRESS t W W ZONE NO.OF y USE OF NIS ZF CITY ' NO. —i PLANS of BUILDIN � t/e — 0 STATE �_ • CITY YARDS APPROVED YARDS APPROVED LU to X LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D 0 (FROM C/L STREET) S1ZENO.OF BLDGS. OF LOT I NOW ON LOT FRONT FT. I-1. USE OF EXISTING BLDG. R.SIDE FT. D FT, I— S1ZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. SFT. VEXTERIOR WALL ROOF , _ COVERING COVERING REAR FT. I-I. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& n MAIN BLDGS. _ACCESS. BLDGS. a Q VAR.# DATE 0 C.U.P.# ////// APPROVED /1 zj9,/D6 1UAl6 1.--- _BYAPPROVEQ// f DATF (-5-1 7r0 O (/ UI hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with _ CC all laws regulating building construction, and I shell not employ I— any person in violation of the workmen's compensation laws of CO the State of California. m Z I hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Divisicn 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR >• Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of he State of California Business t[ VALUATION PERMIT FEE S %S-oo and Professions Code, ivision 3, apter N D Signature of v• m Permittee A $ 00 - PLAN CHECK $ �-' E I Authorized Agent u. TOTAL FEE $ ' 00 AUG 2 11951 OWNER CHRISTY, WALLACE L. .& AUDREY E. DATE 1-19-61 JOB ADDRESS 1212 Donegal P1. BUILDING PERMIT NO. 137311 GENERAL CONTRACTOR Owner-Bldr. VALUE $ 1100.00 AP.No. 113-306-111 LOT TRACT _ FIRE ZONE DESCRIPTION OF WORK Reloc.Gar. P SECTIONS DATE GROUP d TYPE V ZONE R1 arground Soil U.G. Water SUBCONTRACTOR PERMITS ISSUED Underground Gas DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches4 e5Forms . Steel /_144-,(/ Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing 'e and Flashing In Out Plaster, brown coat Plumbing Fixtures, Final �1� Electric Fixtures, Final �� rj/, .) krbl Building, Final ' ,l _ OCCUPANCY Form 210-5M-11.59 5-B P 13734 ,N 11- • I 13734 COSTA MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED ( P. O. BOX 917 COSTA MESA. CALIFORNIA JAN 19 taki, Otuir For Applicant to Fill In Com lefel FINANCE DE . PP TYPE OR PRINT P Y API aOPttO MIDI IT BUILDING ` _ /� BUILDING ADDRESS I7.. vur2[ �� COSTA MESA, CALIFORNIA For Office Use Only �` t �/� I f� 1 1 I RECEIPT NO. IA 3S 3�L OWNER LC( ttme--�N. c�-C 11(�dyst11 eAra-Isu.. 1 4± MAIL l� /t ` RECEIVEDIBY DATE RECEIVED DATE ISSUED / ADDRESS k'1-\/- 'Ok.rya '+'e ` /�'�� /". /9' 6/ I /- 19-o n d.‘ 1 TEL BUILDING CITY Ct%n 1LAQ.+.,�\ NO.� �'XS"(k ADDRESS ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER 1 .�� NO. FIRE ADDRESS (� (TA aY—^•�yIAISCY . ZONE TYPE "CROUP CONTRACT APPROVEDB (-1/ DATE i-I�� I ADDRESS , — Z . NING y.._ ZONE I NO.OP USE OP NEW A.. CITY itiPLANS //� BUILDING •••"`111., STATE TEL. .___ LEGAL /- � LIC.NO. NO. DESCRIPTION I+„t t 17 1 'ea(.,\ 2-Lai I SIZOF ( 41 / NO. OF BLOTS. - -- r7 / _ /-/ OF LOT �y X I 1 J NOW ON LOT 7-- 11 3 p P.NO. I/ USE OF. YARDS EVES EXISTING BLDG.( Xv;Ay( APPROVED ALLOWED SETBACK LINE FROM I IC,.,.. I (CENTER LINE ST.) CENTER OF STREET II I% I�1 L\- REAR YARD G t � FRONT ........ T. a?-€/L-. IN. SIDE YARD I LEFT E. - I RIGHT /LID R.SIDE -94/" FT. IN. DESCRIPTION OF WORK L.SIDE FT. IN. NEW I II ALTERATION I II ADDITION I REAR FT. 1. IN. REPAIR I IIMOVING I II DEMOLISH I APPROVED //(/ �J, DATE J 1 9.-6/ BSIZE ''l- 1( X NO. OF}/ ROOMS I STORIES I A/ 0......0.77 EXTERIOR WALL I ROOF COVERING Ss{H a co COVERING S1/-N ^('\%•07..,_ USE OF BUILDING AND WORK TO SE PERFORMED PTA!'a Aug_ — 20-12e..ze`s C'*.t I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. • PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES ANP STATE LAWS REGULATING BUILDING CONSTRU ON. VALUATION SIGNATURE OF `'4o ,� �/ - n! PERMIT FEE S 07' GQ-C.1 PERMITTEE ` e f./ e ' airt? N / s v ' PLAN CHECK $ AUTHORIZED AGENT • L�� E TOTAL FEE $ pr 9.- 6 OWNER COLLEGE MESA CO.- DATE 10-11-56 JOB ADDRESS 1212:.Donega1Place BUILDING PERMIT NO. #3831 GENERAL CONTRACTOR The Hale Ca. VALUE $ 11,368,00 L 175 BLOCK TRACT 2671 Singe dwelling w/det• gar• GROUP I & J TYPE V ZONE Rik FIRE DISTRICT .861 INSPECTIONS DATE SUBCONTRACTOR PERMITS IS UED SS DATE NUMBER Fot ting Trench /O-J - s Foundation Forms and Grade to b Garage //-/S---..57f Rough Framing a, / O I4 / Plumbing,Rough to Slab SO �; ,y/S4 ' ..� `j� .v� /D--i0 'J� 7a 70 ✓ Plumbing, Rough Complete WL e. S 1-So-$4 V Temporary Pole �04M-1M;112--- // Wiring, Rough G�"iSit ,2.29•it iiM . 1/—p/a --a 3/.moi3 Heating,Rough YY) t 5 2,1-4-41 Heating, Final INNS . -29-U7 44€, --):----/_-°`, i.i'_,; 7r 7;i P/ ewer, House 0 /< Sewer,St. mh,s 6--2.1-7 0 . . .. .. ._I.1_ j_tai -S 6 Cr 77 2 9 ';crank or Cesspool L mg, In`'.,` 4 Outl. -/D-r7 Plastering1 -1 -4 7 / Plumbing,Final,Fixtures CompleteMlS • 29_6-7 7 C J Plumbing,Final Gas Test /f ,n6'S S-,�q_ :) \ .0__. /7". 7 G , , e ,/ I/ //� Wiring, Final �LI M�AY rr2 { J' .-uu / t� ` Occupancy £_-'I 6 -.>'`/'-57 Costa Mesa Bailding Department APPLICATION FOR PERMIT 'i r � P. O. Box 317 IgG-_ BUILDING 1 r-4. ' - COSTA MESA, CALIFORNIA wannior FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN 1 Receipt No. I Permit No. Building 5"3/ Address 1212 Donegal Place O Costa Mesa, California Received by Date Recd/G �Date Issued Nearest O „,e, J /c, ��Z Cross St. Loren Lane Building Address Owner College Mesa Company Costa Mesa, California Mail Address 1777 W. Lincoln Avenue Nearest Tel. Cross St. City Anaheim No.KEY 3-3161 Zone I No.of I Type Group/ (J Architect or Lk. Plans k(//Tf jn Engineer Davis & Quigley No. C-1790 Approved �/ by Date Address 43 Malaga Cove Plaza, Palos Verde! CORRECTIONS City Lk. Contractor The Hale CompanyNo. 3422 Address 1777 W._ Lincoln Ave. , Anaheim Legal I Lot I Description I No. 175 I Block I Tract 2671 (Attach Metes and Bounds) Nog size of Lot 64 x 120 Now.of onBldLots. None D Use ofNo.of No.of A Existing Bldg. I Families I Rooms$ - 5 Setback Line from Rear Yard 65 Center of Street 50 Side Yard 13/5 D DESCRIPTION OF WORK r New I X I Alteration I I Addition I 0 • Repair II Moving I I Demolish I ti Building No.of I'' Size 1321 Rooms 6 Stories 1 0 Exterior Wall I Roof — Covering Stucco I Covering Shake APPROVALS - Use of New Foundation Location Inspector • Date Building Single family dwelling with Forms,Materials, detached garage. Under-Pinning ,P Frame: Fire Stops, r,p Bracing,Bolts G I hereby acknowledge that I have read this Application o and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating --A building construction. Lath.Ext. Signature of Permittee THE HALE C Plaster,Int. Authorized Agt. Plaster,Ext. d N Valuation Permit Fee $ 28.00 Masonry Reinforced .0 Plan Check$ 14.00 Bond Beam $ 11,368.00 Total v Fee $ 42.00 FINAL - FORM 209 1055 D.P.5 5. l a • u c u J J 6 n a. is Street PLOT PLAN Show location and distances from r_ �-' property line and between buildings. O 6 Vt CD IA t.O H .