HomeMy WebLinkAbout1082 EL CAMINO DR - Building PermitsCITY OF COSTA MESA �-
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: P10-00099
PERMIT TYPE PLUM
APN: 14162114
JOB ADDRESS: 1082 EL CAMINO DR CM
Vicinity: GARAGE
STATUS: ISSUED
DATE ISSUED: 07/28/2010
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: PLUMBING PERMIT TO SEWER LINE REPAIR LOCATED INSIDE OF GARAGE.
OWNER:
TALIAFERRO, GRAYCE L
PHONE:
949-887-6954
APPLICANT:
TALIAFERRO, GRAYCE L
PHONE:
949-887-69$4
Address:
City/State:
ARCHITECT:
ENGINEER:
N rC M104iaEinf�9 Z
ZipCode:
Address:
City/State/Zip:
Address:
City/State/zZip:
License No.
License No.
1082 EL CAMINO DR
COSTA MESA, CA
1082 EL CAMINO DR
COSTA MESA, CA
License No. 000000
PHONE:
CELL:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$48.15
$48.15
PHONE:
PHONE:
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE 1. INSPECTION TYPE DATE INTITIALS CODE INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 9--3o- Ao , �
200 Final Re -Roof 210 Final Electrical
201 Final Block/Retaining Well 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
WORKA' COMPENSATION DECLARATION:
I hereby affirn under penally 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.
❑ 1 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:
(TMs section need rrof Oe cern feted tl the perml is valued al one hurWieO ddlars (3100) or less)
Policy Number:
❑�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 York compensation laws of California, and agree that if should
be" subject to the workers' compensation provisions of Section 3700 of
the r Code, I shallfo it omply with these provisions.
AILApplican s�5ignatur! DatQe
WARNING: FURE-✓TO" SE/ RE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), 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. #
Contractor's Signature
Class #
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 of build or improve for purpose of sale.).
as owner of the property, am EXCLUSIVELY CONTRACTING WITH
ENSED CONTRACTORS to construct the project (Sec. 7044, Business and
rofessions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a centracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business nd Professions Code for this reason:
�. Date
Owner ID verified by driver E] license, E]Yes E]No
Dr�as�License �Expires:� I%
Verification of Ownership by (type of document, i.e. - property lax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or mom 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, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, Califomia 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.
Applicant's Signature
Division of Industrial Safely 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? ❑ 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 ❑ 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? ❑ Yes ❑ No
5. Does or volt the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ 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 ❑ 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? ❑ 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 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 with all slate laws and city
ordinarr s relating to building construction, and authorize representatives of
the C of Costa Mesa to enter upon the above-described property for
inspe n purposes. I 99ree ndT to occupy or allow occupancy of any building
aut rite by this p u C final inspection.
aW(e.oLlegaL er(sl Date U
And/or Authorized Applicant
Date
r
w _
City of Costa Mesa Buifding division
77 Fair Drive, Costa Mesa, CA 92626
Costa Mesa 714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit # 4`10 -6aCPq4'1
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in yyo r name listing yourself a e builder of the
property improvements specified at I � ( C/nmrN0
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
13' ilBe''' building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
CrtI understand building permits are not required to be signed by property owners unless they are
§p—onsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that
I, -Pay protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
#en,e_numlbers
-1..understand Contractors are required by law to be licensed and bonded in California and to list their
lon permits and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors,
d'fhe total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
e�considered an "employer" under state and federal law.
4& 1 understand if 1 am considered an "employer" under state and federal law, I must register with the state
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
lawsmay subject me to serious financial risk.
understand under California Contractors' State License Law, an Owner -Builder who builds single-family
structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
ib i
*8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable
&—any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
keI understand I may obtain more information regarding my obligations as an "employer" from the Internal
venue Service, the United States Small Business Administration, the California Department of Benefit
aymnts, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
#I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand
Zil the party legally and financially responsible for proposed construction activity at the following address:
1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
ide by all applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
i or`m'ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the
ublic. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notanz tion, or other verification acceptable to the agency is required to be
presented when the permit i ssued to verify the property owner's signature.
■`M'
%d
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature:
Date:
3148-30 CALBO Jan 1, 2009 OB Packet template 2 Of 2
CITY OF COSTA MESA
CALIFORNIA 92628-1200 P.O. BOX 1200
DEVELOPMENT SERVICES DEPARTMENT
September 26, 1994
Dear Costa Mesa Property owner:
In reviewing past permits, we find that work has been done on your
property located at 1082 E1 Camino Drive, Permit No. B65989, for a
roofing permit. The permit is valid for 180 days from issuance or
your last inspection, per Section 303 (d) of the 1991 Uniform
Building Code. Should we not hear from you within 10 days, your
permit will expire as stated herein and additional fees will be
required to finalize the permit. Failure to final a Building
Permit could possibly impact the future sale of your property.
To activate the above permit, please follow these steps:
1. Telephone (714) 754-5626 or 754-5627.
2. Request an inspection; state address, permit number, and type
of inspection.
3. Be sure to have working smoke detector's as required per
Section 1210(a) of the 1991 Uniform Building Code.
4. Have an adult present at the property at the time of
inspection to provide us access.
Should you have any questions regarding this process, please
contact me at (714) 754-5273.
Thank you for your cooperation.
Sincerely, ��%Q, �(�
I /1
Y anda Huapaya V
Permit Processing Specialist
I
77 FAIR DRIVE
Building Division (714) 754.5273 Code Enforcement (714) 754.5623 Planning Division (714) 754.5245
FAX (714) 5567508 TDD (714) 754-5244
UNIT:
F
ME: 1082 EL CAMINO DR
ESS: TALIAFERRO, JOHN E
1082 EL CAMINO DR
COSTA MESA,CA 92626
ARCHIENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE:
ADDRESS: JOHN TALIAFERRO (714)549-0019
1082 EL CAMINO DR
LICENSED CONTRACT19 OEHAHATION: I hereby affirm that I am licensed und(CpilrymSsJ6C9j6r 9 (commencing with section
7000) of Division 3 of the Business and Professions Cade. and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers'
Compensation Insurance. or a certified copy thereof (Section 3800, Lab. C).
POLICY NO.: EXP. DATE:
COMPANY:
r] Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division.
Dale: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARAT"1hiss1sCspluer1mc,1te1S(
.(�etl not be c�meeted it the permit is for one hundred(S100) or less).
I certify that in the performance of the work for which Ihn
9lploy any person in any manner so as to become
subject to the Workers' Compensation Laws of Candorate'
FT IN REAR: FT IN
�-
IN
A'
SignatuDTICE:
FT IN RGHT: FT IN
If, after making this declaration, you shojest
to Ih orkers' Compensation provisions of the Labor
Code. you must forthwith comply with such provrmit
shall a deemed revoked.
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 (Section 3097, Civ_ C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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 be/she is licensed
pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/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 (3500).
I, as owner df,the property or my employees with wages as their sole compensation, will do the work, and the
Elstructure is not intended or offered for sale (Section 7044, Business and Professional Cade: The Contractors' State License Law
X does not apply to an owner of a property who builds or improves thereon, and who does such worn himself/herself or through
his or her own employees. provided that such improvements are not intended or offered for sale. It, however the building or
improvement is sold within one year of completion, the owner well have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7944, Business
❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law),I am aware
that proof of their Worker's Compensation insurance should be provided to me.
F -]I am exempt under Section: B. 8 P. C.
for this reason: * I
Z-� q Owner:
I do hereby certify that I am aware of and understand the requirements of rnia Health and S Cotle Sections 25505, 25533. and
25534 and that I or any future building occupant will/w 11 not (circle one) need to comply with said Stn a codes and the requirements for a
permit for cru structmn or modification from the Air Dually Management District. Residential construction applications are evempt from
these provisions.
Date: Applicant
I hereby certify that) have read this application and stay
ordinances and state laws relating to building construction
properly for inspection purpose
ate' �� Signature:
Driver's License or Social Security k:
164146 While—Building: Green—
correct. 'gree to comply with all city and county
ups ofJY/icity to enter upon the above-mentioned
Punk—Revenue; Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT _E—M, H9
PERMIT NO: B 065989 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V-5
PERMIT TYPE: SIR
PURPOSE: OTH
JOB DESCRIPTION T/O 6 REROOF W/COMP, SHINGLES SQ FT: 3,900
CLAIM VALUE: 3,800.00 CALC—VALUE: 3,900,00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM S HALLWAY
ie aE iF eE 1E BE 1E iE iE iE it iF 1E * 1E * * BE BF fE aE ie i6 * '/E !E iE i6 iE lE iE ie 1E �k if 1E if- if * 9e if * iE BE iF * * eF iE 1E iF iF iF iE 9f if iE iE * fE lE iE iE 1f iF iE iE il-iF 4f iE iE TF iE iE * iE * eE
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ----------
---------
ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT
IN
FRNT:
FT IN REAR: FT IN
LEFT: FT IN RGHT; FT
IN
LEFT:
FT IN RGHT: FT IN
PARKING REQ; PROV:
PARCEL:
14162114
ZNE; REF NO•:,.
PLANNING NOTES>
>
iF iE 1f 8E if ie * * BE ik iE if BF 8E * if dE i6 iE it iE Bt BF iE * iE iE BE Be 1f %!E
* iF 1E jE iE iE i6 fE iE iE iF if ie iE iE 1E BE lE
if eE *lA 1E iE ie if iE 1f iF fE * iE ie iE * 9f le•iF iF 1E BF fE iF 1E 9F aE iF
D E V E L O P M E N T
S E R V I
C E S R
E Q U I R E M E N'T S
ZONING APPROVED BY
DATE: y
BUILDING APPROVED BY :
DATE; Y
APPLICATION ISSUED BY:
DATE;
�FaFaF*�*Sr�P**9E*aFaF+Fx*�-Br*BfeE
e6**aEiF3E BEiEiFif
BE 1E iE iE 'Elf aE BE i6 e6 iE4 BE ie BE it iE if iE if iE iF l6 iE iE BE iE it if ie fe
iF 16 aE 9E*16 BE ie 9Eif if iE d6lf BE if 4i6 ie
aE iE if*ae iF iE if iE aE lE iE %4E iF BF iE iE iE iE ie jF ie eE eE iE BE
LEGALIZATION:N F
E E S U
M M A R Y
STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING
ELECTRIC
MECHANIC
FIRE SMIP/RES GRADING
PERMIT 63,00
50
PLAN SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 63,50 0,00 0,00 63.50 63.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHOAT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
63,00 .50
BF iE 1f 1E eE * BF k ff e! iE lE 1E iE lE if if iE Bf 1E ie iE BE BE 1E Bf # iF iE ie BE BE 1e !f k * iE 1e * iE if e! k ie ik if ik iF iE 1e eF lE of ie * eE aE Bf Bf BE iE iE ee 1E iE 1E 1E 1E iE iE fE it iM1 iF iF 9E iE aE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3900 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 3,900,00
END OF FEES
SMOKE --DETECTOR
REQUIRE®
01 00155168-00155169 TOT 63.50
64TEC 02/09/9: TIME: 09:26
0DNSTRUCTION AND PLANNING
.PPROVALS Permit # Date
Inspector
POOL SPA
APPROVALS Permit #
Date
Inspector
I. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility
54. Forms
4. Electrical Conduit -Undrgrnd.
4.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58, Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
„ -
60. Backwash Lines, P-Trap, 0 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 -
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
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas 0 Oil
23, Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
25. Roof Sheathing 2-10
_Ayf4
(a
74• Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
s'
"i
29. Insulation
-
78. FIRE PREF. FINAL
,
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT 1. - I '
31. Plaster Brawn Coat
79. FINAL INSPECTION
32. Electrical Power Meter-Final
80. FOOD CERTIFICATE ISSUED
p..
33. Final Electric
Notes: I fi
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41, Solar Domestic-Final
(,
i
42. Backflow Preventer
1
43. Backflow Irrigation
44. Landscape Irrigation System
'
45. Sound Attenuation
46, Handicap Regulations
i
47. FINAL STRUCTURE &BUILDING
-x ! �,q
fy
s
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
t
-.-Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT
Project Address
Applicant's Mailing
Owners Name-��':Ss.e� Phone '9
Address
Arch/Eng. License No.
Address f
Contractor's Name �1 ((( Phone DS
Address lma'I'npl 9(3aC1 1 i� ,��
City License No S23a 'I
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in W�fp antl effect. 7
Lice n Cas 'ce se
Date Signature / 2_—
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure or a certificate
Workers' compensation
Insurance, or a certifiieev c_cap�.y thereof(Se tion
Company
Policy No.
❑iCertif ietl copy is hereby furn ishetl. ,fit^,, �7 'I
❑i Cer "'e py 's f' tl with the ci t y�jltl ipy{_zl VfSlon// .y n
Date' Applicant_ // /IX
EXEMPTION ROM WORKERS' COMPENSATION DECLARATION
(Thissection need not be completed if the permit Is for one hundred ($100) or
less).
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.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY �I
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued, (Section 3097 Civ. Ci)
Lender's Name
Lender's Address -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
nivision 3 of the Business and Professions Code) or that he/She is exempt
=refrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
malty ofmot more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
LicenseLaw does not apply to an owner of a property who builds or improves
thereon, and who does Such work himself/herself or through his or her own
employees, provided that such Improvements are not intended or offered for
Sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
pTve for the purpose of sale). I
❑ I as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon-, and who contracts for such projects with a Con.
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section 8. & P. C. for this reason
Date Owner
I hereby certify that Ihave rea
information is correct. I agree to
and state laws relating to buildir
sentatives of is city to enter
inspection p p Se
Signature
Drivers' License or S ji�
a
above
lances
repre.
Y for
3 Oro
7.317 10/13/87
5.160 ,TL
TYPE OF CONSTRUCTION LJ NEW LJ ADD EJ ALTERATION
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
REPAIR
A.P. #
i Zone
-
S
, -
Main Building: I � Accessory Building:
TYPE OF PERMIT G RA DING FOUNDATION 57 RUCTU RAL
❑ TENANT ❑ELECTRICAL PLUMBING ❑MECHANICAL
❑ OTHER. -
E
T
Front
1
Z
O
B
A
Rear
NI
I
K
Right
G
PROJECT -DESCRIPTION SQ. FT. OCCUPANCY
CONSTRUCTIONTYPE VALUATION$
ZONE' GRADING CU.YDS. ACRES
r
S
Left
R
,Ping. Ref. # Parking Req./Provided
7
E
Q
Remarks: r
Planning Notes:
M
T
S
- PLUMBING
FEES
Bar Sink
Showers
-
ELECTRICAL -
FEES
Backflow Preventer
Service Sink -
Automatic Washer
Construction Pale Sub.
Transformer ❑ •15-50 KW
❑ 50+ KW
Backflow Irrigation Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Clarifiers _
Solar Collectors
Dishwasher'
Meter Clover 100 amps
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric•
Sub Panel -
Drinking Fountains
Solar Tank
Fan
Moto rs❑0-iHP ❑1'/:-8
Floor Drains
Swimming Pool w/Spa
F.A.U. I I.Solar
1-19-15 HP 1116-15+
Floor Sinks
Urinal
I
Fixtures
Microwave
Gas Service Outlets
Water Closet
Device Boxes
Pole Light
Interceptors -
- Water Heater
—
Outlets
Range
Kitchen Sink -
Water Service
Switches
Sign
Lavatories
Auto -Wash
Garbage Disposal
Standing Sections
P—Trap
Laundry Trays
Generator 00-5 KW 1:15-15
KW
Trash Compactor
Roof Drains
Reinspection Fee
$15
1 :Issue Fee
"
$ 3
Reinspection Fee
$15
Issue Fee
$ 3
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS: -
Zoning Approved By Date
Building Approved By Date
Application Issued By s .'fat
-
Boiler
Hood or Type I ❑
Canopy Type 11 ❑ -
-
Duct - Under Ground
Duct - Structural
Refrigeration System
00-100,000BTU ❑100,000 BTU
'
Duct - Ventilating
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY
$
$
$C90
$
$
$
$
$
O FEES V-
SMIP .$
PERMIT -
ISSUANCE $
. ENERGY P.C. $
GRADING $
_ MICROFILM , $
TOTALFEE $
,
-
C
So•Q"
Exhaust System ❑ Multiple ❑
System Rep-" Iteration
Firepl/Fact. BIt.1CBO #
Fire D pers
Heating System & Ducting
❑01100,000 BTU ❑100.000 BTL
596. ters
•
Reinspection Fee
$15
Issue Fee
$ 3-
CMF 0865-46, rev. 10/84 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA,
APPROVALS Permit#
Date
Inspector
-
1. Temporary Electrical -Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement#'
,
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Uricirgrnd.
55, Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
'
6. Electrical UFER Grnd�:
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd:`
8. Foundation
r
59. Gas Pipe, 0 Undrgrnd., Te L'
,-
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0Undrgrnd.
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
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-
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
i
20. Rough Factory Fireplace
-
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating _
71. Product Piping 0 Gas C Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank ❑ Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
-
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe -
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT -
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
•
33. Final Electric
Notes: 10.2s.97 4F.l�• `�� �� l `
34. Final Heating & Air Conditioning
'
35. Final Gas Pipe -Test
•'
36. Hood or Canopy
37.'.Final Factory Fireplace
i
38. Final Plumbing
I
• 39. Water Service -Final
40. Gas'Service-Final
41. Solar Domestic -Final
•
-
42. Backflow Preventer
4
43. Backflow Irrigation
44. Landscape Irrigation System)"'-�'-
145. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed•49.,
Electric Release to Edison
l
r
50. Gas Release to Southern California Gas Co
- - - -
51. CERTIFICATE OF OCCUPANCY
No. Date
20217
4r ...
COSTA MESA BUILDING -SAFETY DEPARTMENT
r
E
FEE R Epq1V,
E
P.O. BOX 217 COSTA MESA, CALIFORNIA
UU L 2i ,RECEIVED 1.
U
For A lic:nFll In Completely
PPP Y
AFPUCATUILYP�N PERMIT
PLIF Tl? DF
P
TPRINT
r7(K
'�28'EOnly
BUILDINGADDRESS 108mino DrivRlCEIPT
LEGAL
NO.
PE�NfMiT t10�COSTACALIFORNIA
ADDRESS
c,/1017R8C8FV8
A. P. NO. none
CITY above
NO EAVE OVERHANG SHALL BE LESS THAN
BY
=H ¢Q IVHD-
DATE199UED
OWNER C
LIC. NO. -A-SB-1 NO,
EAVES
SIZE
H t
. _
MAIL
BUILDING
ADDRESS
ADDRESS
OF LOT 21 X
TELa
r-rTv CoronaDel Mair. Calif• run -i I.nnn
FIRE
ZONE TYPE GRO
ZONING
w `"':'SS Same as•above
ZONE
NO. OF
PLANS
USEOF NEW
BUILDING
CONTRACTOR Ma.CC R alt Co.
LEGAL
DESCRIPTION
ADDRESS
A. P. NO. none
CITY above
NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL 1
20734 I a2'1Ole 3-li220 !
.NOTE:
SIDE Q REAR
LIC. NO. -A-SB-1 NO,
EAVES
SIZE
H t
No. oP eLD08},**
None
ALLOWED (U. B. C. REQUIREMENT)
OF LOT 21 X
NOW ON LOT
YARDS APPROVED
YARDS APPROVED
-
USEOF
MAIN BUILDING
ACCESSORY BUILDING
EXISTING BLDG. NnrA
(FROM C/LS REET)
SETBACK LINE FROM
CENTER OF STREETI REAR YARD 221
FRONT FT.
FT.
SIDEYARDI LEFT 121-
'I RIGHT 101
R. SIDE OFT..
Fi,
DESCRIPTION OF WORK
L. SIDE,/Fr.
FT.
REAR /' FT. �-
FT.
ALTERATION
ADDITION
DISTANCE BET.
BET. MAIN Q
•^ya
REPAIR
MOVIN
DEM LI6H
MAIN BLDGS.
ACCESS. SLOGS.
YARN{"
DATE
BUILDINNO. OF p
1Y.5O1611
SIZE ROOMS V STORIES 2
C.U.P.#
APPROVED
EXTERIOR WALL Wood BCI ROOF S
COVERING COVERING a
APPROVED
BY W.L.D.
n 9
DATE ":.22-63
BUILDIcoo
WORK TO BE PERFORMED
at ched
a
e.
Garage S,
.
SQ. FT.
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNO9R VALUATION I8 FOR THETE
E
THAT THE ABOVE 18 CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.O
ALL CITY ORDINANCES AND STATS LAWS REGULATINGyALUATION CONSTRUCTION.
UREO PERMITFEE S
E O a CO.r�((f�prBT:
�� s23,JS5 000 LA HEC
/�/JJIZED AGENT Y
TOTAL FEE $ ///V