HomeMy WebLinkAbout2287 ELDEN AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c���LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2287 ELDEN AV
Suite:
Vicinity: RESIDENCE WITH ATTACHED GARAGE
Parcel Number. 42605412
Applicant: MC CARL, TIM
Address: 126 COMMERCIAL WAY
Zoning:
Phone: 949-548-5569
COSTA MESA, CA Zip: 92627
Owner: PARISH, R PAIG AND HEATHER L
Address 2283 EIDEN AVE
Phone:
COSTA MESA, CA Zip: 92627-1740
Contractor: GARY REES DBA CRANK BROTHERS ROOFING
Address: 126 COMMERCIAL WAY
Phone: 949-54&5569
COSTA MESA, CA
Zip: 92627 License: 736549
Arch :
Address:
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 10/07/2003
Issued: 10/Ot/2003
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF RESIDENCE WITH ATTACHED GARAGE: T/O 3 EXISTING ROOFS, REPAIR/REPLACE SHTG AS NEEDED, FELT PER MFGR'S SPECS,
APPLY "20-YEAR CLASS A FIBERGLASS SHINGLES " 14 SQUARES
Plan �heck: $0.00
Permit: $0.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $0.50
SETBqCKS
MAINS7RUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existinq: o
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANfVING & ZONING
left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
so.00
30.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 7, 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.
INSPECTION6: In orcler for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all
requlred inapeetiona and Iinel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 754-5626
2666d81NW)
WORKERS' W1�PENSAY�N DECLARATION: �
I hereby attirtn untler penalry ol perjury one of the followinq declarations: , � �
❑, I have and will mainiain e certllicate oi consent to self-Insure for workers' cnmpensation, as pmvided tor by section 3700 of tha Lebor Code, tor the pedormance of the
� work for which Ihis pertnit is issued. �
� 31 have antl will maintain workers' compenSaUon insurance, es required by section 3700 of Ne Labor Code, for the peAortnance of the work for which this pertnit is luuetl.
My worke com ensation �In^surence rner antl policy number are: '
Carner. ��--t� P.� I��l N C� Policy Number. I�) ���I q 2— O �.Z � �_�
(Th/s socfion ne nof e comp/etetl il the permi! is veluetl at ane hundred dollars ($100) or IessJ
❑ I cenity ihat in the pert ance ol ihe work lor which I�is permit is issued; 1 shell not employ any person in any manner so as to become subject to the workers'
compensation laws oi fo la a egree � t Ii I should b ome subject to the workere' compensetion provisions af Saction 3700 ot the Labor Cotle, I shall forihwith
comply wit� t�ese q(pv o. �
Applltant Siqneture: DB�e: I b / 1 / �
WARNING: FAILURE TO SECU ORKERS' COMPENSNTION COVERAGE IS UNLAWFIIL AND SHALL SUBJECT AN EMPLOYER TO CRIMINA� PENALTIES A CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000�, IN ADOITION TO THE COST OF COMPENSATION, DAMFGES AS PROVIDED FOR IN SECTION 39W OF THE LABOR WDE, IMEREST, AND AiTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm that I em
force end eNecL Lic, a+
Gontractor's Slgnature:
of Chapter 9(commencing with Section 7000) of Division 3 0l the Business end Professions Cotle, and my license Is in tull
Class q �
�� ` Dete: � 1 �� i O Z
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm Ihet there is a construction lentling agency for the peAormance of the woM tor which this permit is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lentlers Atldress:
Signature:
Da�e:
OWNER•BUILDER DECLAFiATIONS:
I hereby aHirtn that untler penalry ol perjury Ihet I em EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Protessions
Code: Any ciry or wumy whic� requires e permit fo consimct, elter, improve, tlemolish, or repeir eny stmcture, pnor to its issuance, elso requires the appliwn� for such pertnit
b tile a signed stetement Ihet he ar she is Ilcensed pursuent to the praNsions of the Contractors License Lew (Chapter 9(cammendng with Section 7000) of Division 3 of the
Business enG Professions Code) ar thet he or sha is ezempt thereFrom and ihe besis for ihe elleged exemption. Any violation of Section 7031.5 by any epplicent tor a permit
subjects the epplicant to a civil penalry of nol more than tive huntlred tlollers ($500).):
❑ I, as owner oi Ihe properry, or my employaes wilh wages es their sole compensa�ion, WILL DO TME WORK, entl Ihe structure Is not intendetl or otteretl for sale (Sec.
7044, Business and Professions Code: Tha Coniractors License Law dces not apDly to en owner of properry who 6uilds or improves ihereon, and who tices such work
himselt or herself or through his or her own employees, provitletl thai such improvements ere not intended or oHeretl tor sale. If, however, Ihe building or improvemem is
soltl within one year ot completion, the owner-builder will heva the burden ot proving ihal he or she did not build or impmve for purpose of sale.). �
❑ I, as owner ot the pmperty. em E%C WSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business end Professions
Code: The comrectors License Law tloes not appry m an owner ol pro0erty who builds or Improves thereon, antl who contracts lor such pro�ect with e cnntractor(s)
licen5e OurSuant to �he ConlreC�ors License Lews.).
❑ I em exempt under sec. Business and Professions Code for this reason:
SignaNre: Date:
Owner ID verilied by drivers license. �] Ves ❑ No Drivers License No.
Verilicetion of Ownership by Qype of tlocument, i.e. - pmpany tan bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Eapires:
❑ I hereby certify thai no excavaiion five (5) or more fee� in depih into which e person is required to descend, will be matle in connection with work authorizetl by this
pertnit, end thet no building struaura, scaHolding, falsewoB, or tlemolition or dismantling ihereoi, will be more then thirty-six (36) feet high. (ChaD� 32, Gry 2, Art 2, Sec.
341, Tltle B, Celitomia Adminisirative Code).
❑ As owner-builder, I will not employ enyona to da wark which wauld require e permit trom the Division of Industriel Setety, as noted ebove, unless such person has a
permit to tlo such work trom the division.
Signature: Date:
Division ot Intlustnal Safety Permit Number.
CERiIFICATE OF COMPLIANCE AND AUTMORVATON OF EMAY: I cenity under penalty of perjury that I heve reatl this epplicetion and slate that ihe intormation given is
wrrecL I egree to wmply with ell stete laws end ciry ordinances relating to building consiruction, and aui�orize representetives of ihe Ciry of Costa Mesa to enier upon the
ebove-descnbetl property,for inspection purposes. I egree not to occupy or ellow occupancy of eny 6uilding euthorized by this permit until tinal inspection.
400E I. INSPECTONTYPE
1616 Fiaetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
207 Final BIocWRetaining W ell
202 Finel Fectory Fire Place
203 Flnel Sign
204 Final Demolition
PAIF It{�ALS
� �
CO�E 1 INSPECTION TYPE .
206 Final Mechenical
20B Finel Plumbing
2/0 Finel Elec�rlCel
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Si�e
Final Builtling/Oxupancy
/u�Dat
03
Date -'
Pdg 1[�
,PflOWNEflS �z8 � t�DEN Av
TEr�RY LEE
'' noox�s>: SA?:E
y rJ40-8.�.2�
nHCHIENGINEEP:
AOOHESS:
sec.xo.:
UNIT:
I1NIT:
'E"miTTEE: TERRY I,EE ( 714 ) 540-8225
AUDBESS: z?S7 ELDEN AV �
C.M. CA 92626
LICENSED CONTNRCTOfl OELIABAT10N: I �ereDy atlirm ��ai I am licensea un0er pmvisio�s ol C�apier 9(commencing wit� Seclion
70110� af Oivision 3 of ihe Business an0 Prolessians Coae. an0 my license is in full force anE ellecl.
CITY LIC.: STATE LIC.: CNSS:
Oaie: Signamre:
WOHI(E85' COMPENSR7ION OELLANpTION: I nereEy aflirm inat I have a cenilicaie of consent m selbinsure ar a cenificate of workers'
CompenSalqn Insurance. or a C¢nili¢a coDY �hereo� �Section 3800, la�. C�.
POLICY NU.: E%P. ORTE:
COMPANV:
� 7 Cetlilied copY is herehy Wmi5he0. ❑ Cetli�ie0 coDY is liled wi�h �Ae city Builtling �ivision.
Ua�e: AppliWni:
E%EMVfION FHOM WOflNEPS' COMPENSBTION UECUPRTION: IT� ��n nee0 not Ce completeG il IIM p2rm1 is fo� one hunOretl (510� ar less�.
I certify Ihal in I�e pedormance ol Ihe wark lor w�ich this permil is issuea, 1 shall nat employ any Oerson in any manner so as to become
subleci to IM1e Workers' Compensaiion Laws o� Calilomia.
Oaie: Signature:
NOTICE: II, afler making this eeclaratian, y0u shoula Decome suble�� �o tne wodters' ComDensation o�onsions ol ihe LaLor
CaGe, you mus� lo��wilh comD�Y �Ih suc� pmvi9on5 or tNs permit SIWII Ge Ueem¢4 revok¢C.
CONSTBUCTION LENOING RGENCY: I Aer¢�y alfirm �hai Ihere is a conSVuclion lenaing agency for Ihe pedarmance ol t�e wark lar
wAich t�is Dermit is issuetl (Section 3097, Civ. C).
LENDEfl:
AOONESS:
OWNEfl BWLOEX OECIAflRTION: I �ere0y allirm Ihai I am e�empi �mm IAe fAnlrat�ors' S�ate License Law for �Ae lallowing reamn
(Seciion 7031.5 Business ane Pm�e55ional CoOe: Any city o� coun�y w�ich requires a permii to conitNc�, alter, im0�ove, demolish, or
repair any slmcWre, prior to its issuance. also requires ine apolicant lor sucA permit to file a signea statement tAat ne/she is licensetl
Oursuanl to Ihe D�ovisions al Ihe ConlractoK S�a�e License Law (Chapter 9(commencing wi1� Seclion 7000) ot �ivision 3 0� I�e Business
an0 Pmlessions Cotle) or Ihal he/she is exempl i�erefmm antl I�e hasis lor t�e alleged exemption. Any violation ol Sectian 703L5 Gy
any applicani lor a p¢rmii SUGltqS Ihe aOFliCanl �o a[ivil penally o� noi mor¢ I�an �ive hunOreA O011ars (5500).
I, as Ownet ol t�e OroOeny or my employees wilh wages as I�eir soie compen5aiion, will do i�e work, antl Ihe
� stmcmre is not imenaea ar offe�etl lor sale (Secuon 704a, Business and Pmlessional CoOe: The Cantracmrs' State License Law
does nol a0�ly to an owner of a pmperty who builds or improves l�ereon, and wAo aoes such work himself/Aersell or ihmugh
his or her Own em0loye¢S, pmvide0 Ihal Such impmvemenls are nol inlentled or offereA lor sale. It, however Ihe bUiltling Or
impmvemenl is sold wilnin one year of comoletion. Ihe owner will have ine Curtlen ol proving Ae/sAe Oid nol 6uiltl or improve
lor Ihe DurD�e ol sale�.
I. as awner af the pmDeny. am exctusively comraciing wiih licensetl conVatlors Io conslmci �he pwlect �Sec�ion 7044, Busines5
❑ an0 Pmiessions COde: The fAnlrati0r5' State Lkense Law does no� ap01y Io an mvner ol pmpeny who bmltls or impmves �hereon
antl w�o ConVatls br Such pmjed5 with a Wn(ratlor(5) IitenSe DurSuan� to Ne ConVatlors' Sfate LiCense Law). I am aware
I�ai pwoi ot iheir Worker's Compensation insurance shaultl 6e pmviOeU Io me.
� I am enemp� untle� Section: B. 8 P. C.
lor I�is reason;
�ale: _ 1 � ' Owner: — " —
I tla hei¢Ey C¢tliiy ��al I am aware 01 ana untlersland Ihe reQuiremenl5 oi Cali� nia Heauh ay Saleiy Code Sections 25505. 25533, an
25534 and Ihai I or any lulure EuilOing atupant will/will noi (circle one) neetl o comON wUR 5ai0 s�ate cotles anC I�¢ repuirem¢nts �or a
permit lor consbuclion or mo�ilicalion Iwm t�e Air Oualily Management DiSVict. fle5idenlial conSlmtiion aOD�ication5 afe exempt Irom
I�ese pravisions.
Daie: A ianl:,
I heie0y cetli�y Ihai I have reaa I�is apPlitaii ana vale
oidmance5an051aIeWwSRlalingla�vil0ing on5imction:
pmpeny loi insoecuon purooses.
Daie� //—�' L�— Signalure'.
o�i�e�'s �icense oi sociai secwiy a:
inbrma�ion is correci. I agree �o comply wilh all Ciiy anA counly
]r¢er¢O�eunlalive5a���iSCilylo enterupOnlAe aUOve-mentian¢e
i W b<6 WM1ne—Bmitling; Green—Co�e Enlomemem: Canary—Ap icanl; Pink—Revenue; olEenrotl—Assessor
CITY OF CUSTA N.ESR - BUILDaNG PER'�!IT
PERMST NU: P 05494A PLAN CAECK NO: N
CONSTkUCTIUN TYPn: PERMIT TYPE: PiU
JOB DESCR1PT10N : GAS LINE FOR STOVE 6 Ln'dN a"PRI1`RLe.R
Ci.AIM VALUE: CALC-VALUE:
l
PERN, 110: P OSv94
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
GROLTP OCC: R-3 /
COMMEN'PS: NO STRL?CTURtIL WURK [�UTHOR.i'LED
�� �'s �1E 1i ie �f dE �% iE #� # 1E dE% Y- i4 �� if �� df if �)E ik �lf i( �IE-1E M# if �lE iE iF iE iEif�-1f if if If �k �lf iF �lf �k �iE #f �f Y d! dE �?f YE �iE iE % IE-K #-IE ��f iE Jf if �1E-Y,� :K •Y. if �]E �} if Y. iE �lE IE )f
Z O N I N GS ER'TEB�AUCjRRSE M E N T S
--------�---- MAIN AUILDING ---------- --�------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT., IN FRN'I': FT IN REAR; FT IN
LEFT: FT IN RGAT: FT . IAI LEFT; FT IN RGHT: FT 1N
PARKING RE�• YRUV; PARCEL: 00000000 ZNE: REP NO;
PLANNING N TES>
i
3E ie iE ii R if ii iF #.'t' if 1F iP 1F if iF # iE 7F 1F Y iF'1F � 3E iF 1E if !F if # ii�iE Ih ii� 3't iF IE 1E if 7E ie iE i(-# iF1E'jF iF iFff ii� iF iE if !F if ik iE Y'+('i�Y # i!� 1F ii� iE ic if -1e if ic iEiE if i:� iF i!�
D E V E L O P:/e E N T S E R V I C E^ R E Q U I R$ M E N T 5
?OhING APPROVED �Y `� IrA'fE;
HUIiDING APPROVED BY : DAT�;
APPLICATION ISSJED HY: `� �pATE: —,�\I%[�I/C�
iF�N�if3FRiFM�3FiF3EiEtEif•�N�iE�7f3i��ifX�lFiF3F�if%'iciFxFTc7F7F'$'�iFTciFiriFiF iF��. fFTeirgiF�F;'�rFTr3FiF3bifif�lP-li�iFl�IFiF3E7�`h'SFh3Fi"cl'�k�ifif
if �IE if � i!� �1f iF 3F ?t if 1f if iF if� if if k 3i �k %iF if af i4 iE ii iE }:.if� 3E ie iE tf?e aElE iFjE 3!� if je �lF !f !E ie 3f iF aF 3: ii� 3e aE i'r iE iFiE 3(� 3E �lE if i: dF �e iF i4 it� ie?e iE if i4 jF Y�? Y iE �k?E if
LnGALIZATSON:N r E E S U M M A R Y STRUCTUR1�i, SEG,'�!ENT:N
BLDG PMT Pi.UMBING ELECTRIC MECiiANIC FZRE SMIP/RES GRADING
PcRNIT 4.00
�Jr"%
�LAN
ZSSUE FEE 3.00
Bi7ILDING-DIV-> PERMIT ISSUE PLAN-CHECK
TOTAI,S---->. 4.00 3.00 0.00
REVENUE DTVISION TOTALS--> COLLnCTED:
BLllG PMT PLUMBING ELECTRIC M£CHANIC
�.�� . '
SMIP/NON-r�ES
TOTAL PAID DiiE
7.00 /.00 ,00
7.OU OVER/SHORT: .00
FIRE SMIP/TOT GRADING PLAN-CHECK
iF i+.� iE 3M1 1f !E iE �%iF''E K� ik % Y.� if % 3E ii� 1f i'r �N� �"t � jc iE iE 3E %� %� 1f 3f-�IE�N� �(� ir �f-� iE jF �1E }} j(� if If K� �F 3f �(� if 3E if ib,Y� K� if -1E if # iE }'� it iF if % ik IE 3F �(� !f If�ji ii- iE iE 3c i!� iF 3f�'A�
I N D T V I D U A L F E E B R E A K D O W N
TYPn QTY D E S C R I P T I�O I�' UNIT COST TOTAL COST
Pi�U 7 GAS PIPING SYS OF:' 1 TO 4 UUTLETS 2.00 � UO
PLii 1 LAWN SPRI�KLER SYS'F�"M ON 1 MET'ER 2, 00 �,�0
-END OF FEBS
.�.. �\
m
.rt
.. . ( -= _ , . . .
c
I
.
NS+�RUCTION AND PLANNING
:�PPROVALS Permit#
� TemPorory Electrical Service or Pole
L. Soil Pipe-Undrgrnd.
• 3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrqrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe�Undrgrnd.
10. Structural Floor Svstem
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. fiough Electrical�Conduit
� 16. Rough ElectricWiring
77. Reugh Wiring Sign
18. Rough Electrical�T Bar Ceiling
19. Rough Hea[ing & Air Conditioning
20. Rough Factory Fireplace
21. Ducts,in Structure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
37. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplacc
3g. Finar Plumbing
39. Water Service�Final
40. Gas Service�Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
4�. FINAL STRUCTURE & BUILDING
48. FINALPI.ANNING
49. Electric Release to Edison
50. Gas Release to Southem Califurnia Gas Q
57! CERTIFICATE OF OCCUPANCY
No. Date
POO� SPA �
Date Inspector pppROVALS Permir # Date Inspector
52. Pool & Equipment Location -
53. Steel Reinforcement
54. Forms
55. Electrical6onding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER�GUNITE
58. Eiectrical Condui[�Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
67. APPROVAL TO DECK
62. Backwash & Receptor•Final -
63. Heater & Vent-Final - .
64. Plumbing System � Final .
65. Electrical-Final �
66. Solar System-Final
67. Fencing & Access ApProval
68. APPROVED FOR PLASTERING
69. POOI/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
� 76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
� HEALTH DEPT. REQUIREMENT
79. FINAL �NSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:((lul4( KOONQ. /�p���(�;,,lciT'G4qp-1.60
L iG�J
L�0
0
/
i'
Applicant to fill in all soaees except those witnin heavy bortler lines ana si9� all approvriate tleclarations.
CITV PF COSTA MESA CONSTRUCTION PERMIT
Project Adtlress 228� ELden Ave
� Applicant's Mailing Address rens dW V
Owner's nlame P� Dellea phone 963-498
Address 20082 HarboY �112
ArchlEng. License No.
Address
Convactor'sNameAC�{e@ PZCf & HtQ IIIC.Phone7S9-91O1
Address (mailing) 5457 Cr�nshaw BZVCl
City Licenu No. �3�2�3
LKENSED CONTRA[TOR OECLqRAT10N
I hereby affi�m tha[ 1 am licensetl untle� provisions of Charte/ 9(commencing
with section 7000) of Division 3 of the �usiness antl Professi�o/q s Cotle, antl
my license is in fu11 force ana eifeqL �r✓�✓1 Sr�/ i�.���%--7�dA-1— R—i��i—
D ten�e�ldi a���
� S'anature
WORKERS' COMPENSATION D�CL�TION
I hereby affirm that 1 have a certiflcate ot consent to self-insu�e or a certificate
f Workers' Compensation Insurgnce, or a certitietl copy thereot (Section
300, Lab. C.
Policy No.6 h�%R% Compan
BLeCertifietl copy is hereby /urnls�¢tl.
a(t {�q(i�cqqy�s fileE wAPPI cdnt tlin 5
1/L3/i37
EXEMiTION FROM WORKERS' COMPENSATION DECLARAT ON
(Tnissection neetl not be comple[gtl if the permit is for one huntlretl (g100) or
less).
I certify that in the perfo�mance of the work tor which tM1is pe�m�t is issued, I
shall mt employ any pe�son in dny manner so as to become subject to Ihe
Workers' Compensation Laws of Califomia. \
Da[e Si9nat4re
NOTICE: If, afte� making this tleqaration, you shoultl become subject to the
Workers' Compensation provisioqs of the Labo� Code, you must torthwith
wmply wi[h such provisions or this pe�mit shall b¢ tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that there is a con5�ruction lentling agency fo� the performance
of the work for whicb this permit is issuetl (Section 3097 �Civ. C.)
Lentler'S Name M
Lentler's Atlaress
OWNERBUILDER DECLARATION ��
1 hereby affirm that I am exempt itom the ConVactor's License Law for the
following reason (Section 7031.5 Business antl Professional Cotle:^Any city or
county wM1icM1 requires a pe�mit tp �onsVuct, alter, improve, tlemolisn or �epair
any 5[ructure, prior to it5 issuanCe, also requires the applicant for such permit
to file a siqnetl statement tM1at h0/5M1e is licensetl pursuant to [he provisions ot
the Contractor's License Law (Cnapter 9(commencing with Section 7000) of
Division 3 of the Busine55 antl Professions Cotle) or that he/she is exertipt
-;,,b�erefrom antl the basis for the allegetl exemption. Any violation o� Section
.;.31.5 by any applicant for d permit subjects tlte appliCanl to a civil
"-�nalty ot not more than five huqtlretl tlollars ($500).
��L� I, as owne� ot the O�op¢rry Or my employee5 wilh wages as their sole
Compen5ation, will tlo the wo�k, antl the st�ucture is not intentletl or offe�etl
tor Sale (Section 7044, Business antl Professional Cotle: Th¢ ContractOr's
License Law tloes nat apply to an owner ot a property who builtls or improves
thereon, antl who tloes such work himself/herself or through his or her own
employees, provitletl that such improvements are not intentletl or offeretl for
sale. If, Itowever, tne buil0ing or improvemenf is soltl within one year ot com-
pietion, the owner will have the burtlen of provin9 he/she dltl not builtl or im-
�rOve for the purpose of sale).
U I, as owner of the property, dm exclusively contracting wi[n licensetl con-
tractorstd construct the pro�ect (Section 7044, Busine55 and Professions Cotle,
� The Contractor's License Law does not apPly to an owner of property who
builtls or improves thereon, and �yho contracts (or such projects w�tn a con-
tractor(sl iicense pursuant to th¢ Contractor's License Law). I am aware that
prooi of thei� Worker'S Compeqsation insurance shoultl be Drovitletl to me.
❑ I am eaempt untler Section B. & P. 0.lor thi5 reason
Date Owner _
I h¢reby certify Ihat 1 have redtl fh
informalion is co�rect. I a9ree to cort
antl zta[e laws r!a builtliry c�
sentatives of is i ��4�yy
inSpeCtion rpos //
Signature �l
Drivers' License or 55 �k
CMF OB65-46, rev. 10/84 White -�u' tl
at the abOve
ty ortlinantes
:horize �eD�e-
property for
TYPE OFCONSTRUCTION U NEW LJ ADD Ll ALTERATION ](yREPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER p�p #
DESCRIPTION OF WORK/USE OF BLOG. 3O—G3 �AT H Rep dCE
� S Main Building:
E
TVPEOFPERMIT GRA�ING ❑ FOUNOATIOr�N STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL � PLUMBING LJ MECHANICAL 6 Rear
❑ OTHER A
PROJECT.�DESCRIPTION SG1. PT. oCCVPANCv C Right
CONSTRUCTION TVPE VALUATION 3 348.60 S Left
ZONE GRADINGCU.YDS. ACRES Pln Ret #
R<marks:j
Sink
Preventer
Itrigation
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
$15
Boiler
Duct - Under Ground
Duct - Strucmrel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ a� oo,000 sTu � i oa,000
Reinspection Fee
APP���anh Pink - Acco�nting; Goltlenrotl - Assessor
$15
g.
' Planning Notes. �
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Conneceion
Solar Collectors
Solar Piping
Solar Tank
Swimmin9 Pool w/Spa
Urinal
Water Closet
1 Water Heater
Water Service
Auto-Wash
Issue Fee
FEES
$ 3
Zone
Accessory Buildi
Parking Req./Provided
EIECTRICAL
Auromatic Washer Transformer ❑ 15-50 KW
Construciion Pole Sub. � 50 + KW
Cooking Unit Meter ❑up ro 100 amps
Dishwasher Merer ❑over 100 amps
Dryers ❑Gas ❑Electric Sub Panel
Fan Morors �0-1 HP �1 %- B
F.A.U. IncSolar �9-]5 HP �76-7$+
Fixtures Microwave
Device Boxes Pole Light
Outlets
Switches
Garbage Disposal
Generator �0-5 KW 05-15 KW
Standing Sections
Trash Compactor
Reinspection Fee I$15 luue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
YPeI ❑ Zonine APProved BY
Canopy Type I I ❑
Building Approved By
Refrigeration System
❑0-700,000 BTU ❑100,000 BTU
System Repair/AI[eration I
Fire Dampers
Registers
Iwue Fee $ 3
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ ��� PERMIT
PLUMBING $ 8�'Cf(.1 J•O� ISSUANCE $
PLAN CHECK 25% S ENERGV P.C. $
ELECTRICAL � GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
GR?E: Q"s/qd/89 TIiiE: 14:34
FEES
$ 3
2
O
N
I
N
G
R
E
Q
M
T
S
CONSTRUCTION AND PLANNING POOL & SPA
�'APPROVALS Permit�# - Date Inspector AppROVALS Permit# Date Inspector
�
� 1. Temporary Electrical.Service or Pole 52. Pool & Equipment Location
2.V�Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit UtilitY-Undrgmd. 54. Forms
� 4. Electrical Conduit-Undrgrnd. 55. Electriral Bonding =:�ie,
5. Steel Reinforcement 56. Rough Plumbing & Pre u e�est
6. Electrical UFER Grrid. 57. APPROVAL TO COVER-GUNITE
�`_ t n
. 7. Footings �:i� . . � . 58. Electrical Conduit-Undrgrnd-
i
" "-8. Foundation � � � ' ' 59� Gas Pipe;i0 fUndrgrnd�� Test� '' . �� ,�< �, �. �
�
9. Water Pipe� Undrgmd. 60. Backwash Lines, P-Trap :�LUndrgrnd.
10. Structural�Floor System 61. APPROVALTO DECK_? �--�
17. Property Sewer Line & House�Connection 62. �Backwash & Receptor;F.inal�-i
12. Sewer Cap �'� 63. �Heater &� Vent-Pinal -
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign ;r 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling �:ii, 69. POOUSPA SYSTEMS FINAL
. 19. Rough Heating & Air Conditioning ��-' FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit # ,
21. Ducts, in Structure 70. Underground Hydro � �
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Root Sheathing �},. _ _ , J4. Oyerhead Hydro _
26. T-Bar Ceiling (Structural)'&�Monocoat -- ` � "" ""` � -"" �'75. Dry Chemical'-`-J"'a �". -�•- _ _ � - _ _ _
27. Frame and Flashing , 76. �Dry Standpipe ,
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation . 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH OEPT. REQUIREMENT
31. Plaster Brown Coat . 79. FINAL INSPECTION '
� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes:2-7-gq L�T �}p�, [,��' �
34. Final Heating & Air Conditioning .�-
35. Final Gas Pipe-Test
� 36: Hood or Canopy � �
F' �� •I
�37: Final Factory Fireplace . , �y • � - r . .
-'38. Final Plumbing 2 , /n r �? , '
�G,l r - :
-39. WaterService-Final � " � � y� ' ��
- r�.
� 40. Gas Service-Final � •'� ' � � � � ' • ' '
!
:41. Solar pomesticFinal ! � � ' � ' '
. �. > ,
�42. Backflow Preventer ��� " - - .
%
i ;
/43. Backflow Irrigation ' � .
".'44. LandscapelrrigationSyStem . � . � .
/ l'
45. Sound Attenuation � , � � . . �
46. Handicap Regulations � � - . �
47..FI.NAL STRUCTURE & BUILDING ' � '
48:'Special Requirements Completed , � . -
49. Electric Release to Edison '
�, � ..
50. Gas Release to Southern California Gas Co �� ��� ' -- .
51. CERTIFICATE OF OCCUPANCY . ,
No. Date _
_ �r,`'.
PHOJELiA00HES5: �zH'� tI�DEI� AV
OWNEfl'S NAME: 1 LRRY LBE
nooxess: SAME
540r8?25
AflCH/ENGMEEfl: .
ADOHESS:
xec.xo.:
UNIT:
UNIT:
PEHMITiEE: '['ERRY LEE f 724 ) 540-8225
nooness: z 2 g 7 ELDEN AV
C.M, CA 92626
LICENSED CONTBACTOP DECU1flATI0N: I here0y allirm Iha� I am licensetl un0er prouisions of Chap�er 9 �commencing wi�� Section
7000) ol Division 3 of Ihe Business and Pmlessions Caae. antl my licen5e is in �ull force and ellect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signawre:
WOBHENS' COMPENSpTION OECLABRTION: I �ereby allirm t�at I �ave a cerlilica�e ol consent �a 5ei4insure or a certi�icate oi Workers'
Compensa�ion Insurance, or a tenilietl coOY �hereof (Seclion 3800, La�. C�.
POLICY NO.: E%P. ORTE:
COMPANY:
❑ Cetli�ied tOpY is he2by WmiSh¢tl. ❑ Certilietl copY is filetl wi�h �he city Builaing �ivision.
Oale: Appliuni:
E%EMPTION FflOM WONNEPS' COMPENSATION OECIAXATION: (TNs seclion nttV iql De comple�e0 il Ne permil is for one �u�reG (5100) or less�.
I cerlily Ihal in Ihe peAorman[e o� IM1e work br w�ich ihis permit is i55ue0, I shall no� employ any De�son in any manner so as �0 6ecome
sublecl to ihe Workers' ComOensation Laws ol Califomia.
�ate: Signature:
NO7ICE: If. alter makinA Inis aeclara0on. you sAOWd �ecome subject to the Workers' Compensalion pmvisions of ihe La6ar
Code. you mus� �onhwitn comply wi�� such provisions or t�is Oe�mil Shall he tleemeU revokeE.
LONSTNUCTION LENOING RGENCY: 1 here�y a��irm t�al l�ere i5 a ton5�mtlion lenaing agency fOf lh¢ p¢tlOrmance ol Ihe xrofk �or
wnicn I�is oe�mit is issuea �Sttiion 31197. Gv. C�.
lENOEfl:
aooeess:
OWNEB BWLOEP oECUHRTION: I here6y allirm �hat I am exempt Imm Ihe ConlraCtoR' State License Law lor tne followinA �eason
(Seclion 7031.5 Business ana Pwlessional CaEe: Any cily of county whic� r¢quires a De�mi� to consimct, alter, impmv& Uemolish, or
repair any Slmcture, O��or Io ils issuance, also r¢quires t�e applicanl �or suc� permil Io �ile a signetl s�atemen� Iha� he/s�e i51ic¢n5e0
Oursuant lo Ihe pwvis�ons ol l�e ConVac�ors Siaie License Law (C�apler 9(commencing with Section 7000) ol Division 3 al ��e Business
anU Pmlessions Code) or t�at �e/s�e is eremD� ��erelrom ana Ihe basis lar ��e allegeG exemD�ion. Any violation ol Sectian 7031.5 6y
any aD0licanl br a permii suble��s Ne apD�itan� lo a civil penalry af not mOre than �ive hunOretl Oollars (5500).
,+� I, as owner ol Ihe pmperty or my employees with wages as Iheir sole compensa�ion, will tlo the work, an0 ��e
L•�l stmcmre is nol imentletl or oiferetl lor sale (Section 7044, Business an0 Pmfessional CoOe: T�e Contracmrs' Siate License Law
does not apDly la an owner ol a properly who builUs or ImD�oves Iher¢on, and who tices such work �ims¢If/hers¢II or Ihmugh
his or �er own emD�oyees. pmvidetl ihat suctl impmvemenis are not intendeE or oHered lor sale. II, however t�e Luildinp or
impmvement is sWa wilhin one year ol Complelion, ine owner vnll nave tne euraen ot omvinp he/she tlie nat build or imD�ove
lor the purpose o� sale�.
1, as owner oi �ne pmpeny. am eKclusively coniracting with IicenseA con(rac�ors �o cons�mti Ihe D�olec� (Sec�ion 7044, BuSiness
❑ anA Pm�eSsionS CAtle: T�e Contratior5' S�aie Litense Law tloes nol a001y �o an owner ol prop¢rl9 who UwIOs or improves Ihereon
and w�o conlracls lor such pmlecis vnih a conlracior�s�license pursuanito I�e Contracbrs' Siate LicenSe Law�. I am aware
I�ai pmal ol Iheir Worker's Compensa�ion insurance 5hoN4/ �e pmvided Io me.
� I am e�empl under Seclion: B. 8 P.,e.
br �his reason: �j' � /f
Date:�tl ^ ! � 1 Owner: C ��
I do Aereby cenily I�at I am aware ol and untleisiand t�e reQuiremen�s ol C omia Heal anA Salely Cotle Sec�ions 25505, 25533, and
2553< an0 I�at I or any IWure builtling occupam wiNwill no� (circle one) n.0 �o com01�%wim saitl state codes and i�e requiremems for a
permil tor conslmction or modil¢a�ion �mm �he Air Oualily Managemenl Oi9ticl. Resitlen�ial conslmclion applications are exempl Iwm
��¢5e pi0vision5.
�al¢: ppp� ani:
I h¢�¢Gy ceriity I�al I �av¢ ieaG ihi5 a001italio n0 slate itat I�e above in�ormation is correcL I agree Io compty vri�� all uiy andy unry
a�Omance5antl51alelavrsrelalinqlo�uiltlingc Slmclionantlh hor¢ere0�esemaliueso� hisulyloemeruponiheabove�m€mionetl
piopetlY lor inspeciion pwposes.
Date: _ f/���� Signature'. _ `�`—
IOrrvei's �irense or Socia� Securiry r:
t6ab<6 Whne—Builtling; G�een—Cotle Enlorcemenl; Canary—AOP����C Pink—Revenue: Goltlenroa—Assessor
CITY OF COSTA MESA — BQILDING PERMIT PERM NO: n 05494`_
PERMIT NO: E 054995 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRT7CTION TYPE; PERMIT TYPE: ELE FURPOSE: OT$
JOB DESCRIPTION ; ELECTRIC LINE FOR STOVE SQ �T:
CLAZM VALUE: CALC—VALUE; GROUP OCC: R-3 /
CO."1MENTS: NO STRUCT[JRAL WORK AUTFiORIlED
iE �1� iF 3F # �iF �1{� #f iE if �%�1E �N 1E �k iE �% # k � �k if -)E �f iE if ic �3E if iE �ie �%dE �lf ie iE �k �IE �%�)F �X.- d'c -k ic 1E �1F fE �1E �/F �3f iE%�t �7E iF �X� �% 7e �� �lf �k IE �%�7f �Ii �}E �M df •� if �%� k dE iF 3E 3f �� # �f
'L O N I N G R E: Q U I R L M E N T S
ssrBacxs
------------- �1AZN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT ZN REAR: FT 7N ERNT: FT IN REAR: FT IN
LEFT: F'T IN RGHT: FT LN LEFT: FT IN RGHT: FT IN
PARFiZNG REQ• PROV: PARCEL: 00000000 7.NE: REF NO:
PLANNING NOT'ES�
?
iE if 3E i(� if iF 1i �le ie # if iF if�9F jc?F 3i lE if iE iE iF fE 3f �f !e 3F! IE !E?E iE+�e 3i� iF k iF IE iF ie �t a't 3F � iE �lE if?f 34 ii+r }'. iF a: i�?i if 3f 3E iE iE jF iE ii�lf } s 3f iF ie ir ic iE #f iElE if +E
D E V z L O P M a N T S E R V I C E S R E Q U I R E M c N T S
}r
70NiNG APPROVED BY �� DATE:
BUILDING APFROVED BY : DAiE:
APPLICATION ISSUEn BY: �'.� DATE• �� �a�
ie3e3t�ifihl(3f�iFiFY�1E341EiF3i�3c1'r1P1EjEiFiE �c . . r . . ar .. . r iFiEiFii�#•if3EibiPiF w� �iFif
� if #% IE ±C� lE # K� lE fE 3(- lE �lf 3F �-Y.� 1E �1f 3f-1E iE iE if if iE # 3f M iE jf if i4 i'r iE # fE iElE � iF �1F iE if 1f # iE if # 3f 3f lE jE ie �E k� If i(� 3F �7i� #�Jf �lE iF 3f� )E ie iF iF ie #E ?�. 3f. }'. a(. �(. r;. {(. }'.
LEGALIZAT'ION:td F E.E` 5 U M M A R Y STRiICTURAL SEGMcNT:N
, BLDG PMT PLUMBING. ELECTRIC MECHANIC FIRE SMIP/RLS GRADZNG
PER,MZT , � 3,00
508 SMIP/NON—RES
PI.AN �
ISSUc FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECh TOTAL PATD DUE
TOTALS----> 3.OU 15.00 0.00 18.00 18.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 18.U0 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SA7IP/TOT GRADING PLAN—CHECK
18.00
x')f' if if iE if' if if if if ii' if ih ii'!i' ii'?f ii' 1(' iF }.' {: i{' 1! ii' li'?E if' 3i' if' it' IE ii ii'-le if if iI' ii"� 1i' iE if'If' ii' ii' iF if if ic �(' if if lf 1i' i'r IF if i%if"1E i't iF } if' ik i(' iI' iF iP i't �t 1f"Y."14'iP i?' iF iF
T N D I V I D U A i F' E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNZT COST TOTAL COSi
ELE 1 RES APPLIANCF. NOT OVEk 1,0 HP 3.00 3,00
END OF FEES
�'.�fr,'.t rf,�r,.ri. '. �: ,,
^y`P-. '.a�%�_� . . . . .
CONSTRUCTION AND PLANNING POO� & SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
.7. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -�
3. Electrical Conduit Utility•Undrgrnd. 54. Forms �• •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough P�umbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgmd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test . '
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final � � �
7 3. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical•Final �
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring � 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. DuMs, Ventilating 71. Product Piping O Gas � Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Cei�ing (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. F NAL INSPECTION
32. Electrical Power Meter-Final 8',. OOD CEPTIfICATE ISSUED
33. Final Electric �/��(}p��_ N�•-..
! «'!
34. Final Heating & F,ir Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service�Final
40. Gas Service-Final
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FiNAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co . ,
� 51. CERTIFICATE OF OCCUPANCY
No. Date