HomeMy WebLinkAbout2897 EL RIO CIR - Building Permits�
CITY OF COSTA MESA
��`""'R BIIILDING DIVISION
F4�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax i714) 754-4856 • www.ci.costa-mesa.ca.us
° � FOR INSPECTIONS CALL: (774) 754-5626
4�� �'
PERMIT NUMBER: BX10-00128
PERMIT TYPE B MISC STATUS: ISSUED
APN: 14156209 DATE ISSUED: 07/02/2010
Zoning: , ISSUED BY:' , KJB
JOB ADDRESS: 2897 EL RIO CI CM Suite/Unit:
Vicinity: - Primary Occ: - � - - Const Type :??
SQ. FT: 0 � � Valuation: �$375.00 � �
SCOPE OF WORK: " �� '- " � ��
PATCH DRYWALL, PAINT, TERMITE REPAIR. MISC ELECTRICAL TO 1NCLUDE: 1 LlGHT FIXTURE, 2 OUTLETS, 1 SW17CH.
OWNER: RUFF, ROLAND R
City/State: FULL�RTON, CA
Phone: 714-526-9140-
APPLICANT: CAMP, RICHARD
City/State: LONG BEACH, CA
Phone: 714-825-4420
CONTRACTOR: SE�UOIA CONSTRUCTION
Address: 5081 BERKELEY AV-
City/State: WESTMINSTER, CA
Zip Code: 92683
ARCHITECT:
Phone
ENGINEER:
Phone
Monday thru
FEE SUMMARY .
9uilding Plan Check:
6uilding Permit:
Electrical Permit:
SMIP Residential ,
SMIP Commercial
Bldg Std Admin Fund
Address:: 2013 OXFORD
Zip Code: 92831
. � Address: 2631 PETALUMAAVE
Zip Code: 90815
License No. 800258
,_ ._ ... ,
Phone 714-891-4525 Cell:
License No.
License No.
$0.00
$23.50
".. �.$27.90
$0.00
$0.00
$1.00
Unit
Unit
_ Unit
7:00 am thru 7:00 pm. SaVudays -9:00 am lhru 6:00 pm. Prohibited all hours - Sundays and the following Federal Hoiidays:
:w Years Dav. Memorial Dav. Intleoendence Dav. Labor Dav. Thanksoivino Dav and Christmas Dav
NOTICE: The work authorized by this permit shall comply wilh 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 orper 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 expiretion of this permit.
CO�EX INSPECTIONTYPE OATE INTITIALS CODEx INSPECTIONTYiE �A7E INTITIRlS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing �p�.,.,
200 Final Re-Roof 2W Final Electrical 76?U—�D G�' �`��� Lc,�/c�l
207 Final Block/Retaining Wall 212 Final Fire Prevention J
202 Final Factory Fire Place 22o Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy d- -r �� n yo--
�
WORKERS' COMPENSATION DECLARATION: �
I hereby aKrm under penalry of perjury one of lhe following tleclarelions:
❑ I have antl vrill maintain a certificate of consent to sel(-Insure for workers'
compensation, as providetl for by section 3700 of the Labor Code, for �he
pedormance of Ihe work for which Ihis permit is issued.
❑ I have antl will maintain v.orkers' compensation insurance, as required by
section 3700 of the Labor Code, for the peAortnance of lhe work !or which lhis
pertnit is issued. My vrorkers' compensation Insurance carrier and policy
number are:
Carrier.
(Thisseqonneeerplcemmpplete0�d/thepeimn�svaluetlal ehunOretlCdlars(5100)orless)
Policy Number �YJ`L
�certify that in lhe pertormance of th work (or which lhis permil is
ued, I shall not employ any person in any manner so as to become subjecl
lo lhe workers' compensation laws o� Califomia, antl agree that if I should
become subject to the wo rs' compensation provisions of Section 3700 0(
lhe Labor Cod �'+'alPf wi comply with ihese provisions.
� r � �' �
Applif2n�'s Sigp /e Da�e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S
(5100,000), IN ADDITION TO THE COST OP COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby a(frtn Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Protessions Code, and
my license is' full force and eHect.
Lic. # Class # �7 �).
/ ^ `Lr" � �
ConVactor's ' lure Date
CONSTRUCTION LE ING AGENCY:
❑ I hereby atfirtn that there is a consWction lending agency for ihe
peAortnance of the work fa v+hich this permit is issuetl. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atldress:
Signalure
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or [he following reason (Sec. 7037.5,
Businass and Professions Code: Any city or county which requires a permit �o
construct. alter, improve, demolish, or repair any slrucWre, prior to its
issuance, also requires the applicant (or such permit to file a signed sWtement
that he or she is licensed pursuaN to the provisions of the Conhactors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pro(essions Code) or that he or she is exempt therefrom antl
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant lo a civil penalty of not more Ihan
Ove hundred dollars ($500).):
❑ I, as owner of the property. or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strvcture is not intendetl or
oKered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of propeny who builds or improves
thereon, and vfio does such vrork himself or herself or lhrough his or her own
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvement is sold vrithin one year of
completion, the ovmer-builder will have the burden of proving that he or she
did not build or improve tor puryose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construct lhe projecl (Sec. 7044, Business and
Professbns Code: The cont2ctas License Law dces not apply to an a.vner ot
property who builds or improves ihereon, and who contracts (or such project with
a contracta(s) license pursuant to ihe Contractors Ucense Laws.).
❑ I am exempt under sec.
Business antl Professions Code for this reason:
SiqnaWre
1057�a6 (107)
Ovmer ID verifetl by drivera ncense. ❑ Yes ❑ No
Driver'S LicenSe No. Ezpire5:
Veri(cation of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certdy ihat no eacavation frve (5) or more feel in tlepth into which a
person is required to descend, will be made in connection with work authorizetl
by this pertnit, antl Ihai no building slrucWre, scaffdtling, (alsework, or tlemolition
or dismantling thereof, will be more than thirty-sin (36) fee[ high. (Chap. 32. Grp
2, M 2, Sec. 341, Title 8, Califomia Atlminisf2tive Code).
❑ As owner-builder, I will not employ anyone [o tlo work which vrould
require a permi[ from the Division of Industrial Safety, as notetl above, unless
such person has a permit to do such vrork from the division.
Applit'2n1'S SignaWre
Division of IndusMal Safety Pertnit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicanl or present or FuNre building occupant need to file antl
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Satety Code requires, with some
exceptions, ihat a Business Plan be filed with the Costa Mesa Fire
Depariment by every business which has at any one time during a reported
year a quantity of hazardous matenals equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard temperature an0 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 Cali(ornia Healt� and SaFety Cotle, with some
exceptions, requires registration with the Costa Mesa Fire Departmem by
each business which a[ any one time has on hantl a quantity of acutely
hazardous materials equal to or grealer than a weight ot 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas al standard
temperature antl pressure).
3. Does or vnll Ihe applicant or present or (uture building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0( ihe Califomia Health and Safery Code provides Ihat the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are requiretl
[o register awtely hazardous malerials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of ine California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or (uture building occupant require for
the work which is [he subject ot this application a permit (or such consWction
or motlification from the South Coast Air Qualiry Management DisMc[ or (rom
any other air polWtion control districl or agency? ❑ Yes ❑ No
(Sectbn 658502 of [he Califomia Govemment Cotle requires ihat the requestetl
information be fumished on applications for noo-resitlential building pertnits).
6. Will any part o( the facility to be constructed under Ihis pertnit be within
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf'yes". Ihe faciliry mus[ meet ihe requirement of Sections 25534 and 42303
of the California Health and Safery Cotle).
7. If a permit from the South Coasl Air Quality Management Districl or other
air polNtion contml district or agency is required (or the vrork which is the
subject of this application, have all of the tlisclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certifcate of compliance from the appmpriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
in(ormation given above is correcL I agree to comply with all state laws and
ciry ordinances regarding Hazardous Matenals and Emissions.
Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certity under penalty of perjury that I have read this applicalion and state Ihat
the information given is correcL I agree to compty vnth all state laws and city
ordinances relating [o building consWction, and authorize representatives of
the City o( Costa Mesa to enrer upon the above-descnDetl property for
inspection purposes. 1 agree not to occupy or allow occupancy ot any building
authonzed by this permit until fnal inspection.
;Wr f Le Owne�) Da�e
� /',� ��Z�t(�
� Ana/or Aul�wi e AOPb�ant Dale
CITY OF COSTA MESA
BIIILDING 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. M07-00569
PERMIT TYPE MECH STATUS: ISSUED
DATE ISSUED: 12/13/2007
- - . ISSUED BY: RMD
JOB ADDRESS: 2897 EL RIO GI CM '� ` Suite/Unit: :
Vicinity: GARAGE " " � � � - - - ' � - . � .�'
SQ. FT: 0 . -� � ,.<." .. ,��-. , ; .. . , � _ ., , -....,'
,
SCOPE OF WORK: CHANGE OUT 100 OOO.BTU�FAU LOCATED IN GARAGE FOR A SFD.��. �
,..r
4
{�` G,
!1
OWNER: CASTELLANQ; LOUIS P,TRUST, . Address: � 2897 EL RIO CIR Unit: .
PHONE: 714-556-0842' ' - - - � ; ^��CitylState/Zip: � COSTA MESA, CA �-'"� ��� ���� ;
APPLICANT: ELLIS, E J,��JR r � � - � Address: . Unit: - - � , � �.
PHONE: . 310-838-0408 ;':' J , . "" City/State/zZip: - � " '� , ,
CONTRACTOR: ORANGE�CO SVS INC DBA GEORGE �BRAZIL PLU License No. 679898.� �� -� ,'>�
Address: 3807�'-LENqWEE'AVEUnitr '- � ' � �'- ��PHONE:� 310-838-0408X120
City/State: CULVER CITY, CA�r � . �ZipCode:� 90232 " � � , � ' CELL: � " ,
.. . , . . .. . .
• , � . ._, _. ..�.._. ` � "4�
�- ll F ' ' " �. � .. . - ,
\wl
MECHANICAL PERMIT FEE.SUMMARY _. '
MECH ITEM FEE: , ' �i�'_. . ,$4170 - ' . - „ �
PLAN CHECK FEE: � , - , $0.00 " , � -. . �
INVESTIGATION FEE: - � ' $0 00 " �
REINSPECTION FEE: � <<�$0 00 . � � � - �
TOTAL FEES: $41 70 �
�:' � -�
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia staWtes 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 wmply 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.
COOE/, INSPECTONTYPE DpTE INitlIRLS LOOEN INSiEC7I0NTVPE O�TF 71TIAL5
1618 Fized System Final Fire Prevention 206 Final Mechanical I '� ' ��
7266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roo( __ 210 Final Electncal
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Finai Demolition
212 Pinal Fire Prevenlion
220 FinalPlanningApprovaf
222 Final Site
250 FinalBuilding/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm untler penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of wnsent to 5elf-Insure (Or workers'
compensation, as provitlea for by section 3700 of the Labor Code, for �he
peRormance of �he work for which this permit is issuetl.
I have and will maintain workers' compensation insurance, as requiretl by
bn 3700 of the Labor Code. /w the peAormance of the work for which this
pertnit is issuetl. My workers' compensatlon Insurance carrier and policy
number are: �� � �r✓D
/ Carrier. r7/�
I (Tni55eqqnneedrrofEecnmpeleddl�/ p�em('rda���'yj�yeEa��/en�'uri-tl+r �� lE1Q�lwless)
l Palicy Number �-�i ` �E�/`—I� � �J�
❑ I certify that in Ihe performance of the work for which this pertnit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensalion laws of CaliFomia, and agree ihat if I should
become sub�p,cf to the o om , nsation provisions of Section 3700 of
lhe Labor od f �i omply lh these provisions. J
���{ ���
Ap nfsSignaWre oale
WARNING: FAILURE TO SECUR WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL 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
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn 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 f f jce and Hect. /� �O
CLic # Class # V �
iy-�-a�
Nr iB�aWre Date
CONSTRUCTION LENDING AGEN Y:
❑ I hereby af(vm tha[ there is a cons[ructbn lending agency fw the
perfortnance of [he v.ork fa wtiich this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's AOtlress:
SignaWre '�: `- . Dale
> 1 i.;
OWNER-BUILDERDECLARATIONS: �+`"` � ..�J
I hereby a(firm that untler penalty of perjury that�l �am�EXEMPT�FROM 7HE
CONTRACTORS LICENSE LAW tor the following reason (Sec:` 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit m
conSWct, alter, improve, Cem01i5h, or reDair any structure, prior to it5
issuance, also requires the appliwnt for such permit to fle a signed statement
that he or she is licensed pursuant to the provisions of the Contrectors
License Law (Chapter 9(wmmencing wi[h Section 7000) o( Division 3 of the
Business and Professions Code) or that he or she is exempt therefmm and
ihe basis tor the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permil subjecls the applicant lo a civil penalry of not more [han
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 strucNre is not intended or
oHered (or sale (Sec. 7044, 8usiness and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or lhrough his or her ovm
employees, providetl that such improvements are not intended or oRered (or
sale. If, however, the building or improvement is sold within one year of
completion, Ihe owner-builder will have Ihe burden of proving that he or she
ditl not build or improve for puryose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to wnstrucl lhe projett (Sec. 7044, Business and
Professbns Code: The coniractors License Law dces not appty to an ovmer of
property who builds or improves thereon, and wfio contracts lor such project vnth
a contractor(s) license pursuant ro the Coniractors License Laws.).
O i am exempt under sec.
Business and Pmfessions Code for lhis reason:
Srgnawre ' Dale
J057-a6(3/0])
Owner ID verified by tlnver's li� ,. ❑ Yes ❑ No
Driver's License No. Expires:
Verification o( Ownership by (lype of documenl, i.e. - properry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certRy tha[ no excavation Me (5) or more (eet in tlepth into wfiich a
person is requiretl lo tlescend, will be matle in wnnectbn with work autFrorized
by lhis permit, and [hat no building strucNre, scaffdding, false�wrk, or demolition
or dismantling thereof, will be more than thirty-su (36) fee� high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8. Califomia Adminisirative Code).
❑ As owneo-builder, I will not employ anyone to do work which woultl
require a permit fmm the Division of Industrial Safery, as noted above, unless
such person has a pertnil to do such wnrk from the division.
Appliranl's Signalure
Division of Industnal Safety Pertnit Number: _
HAZHRDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant need to file and
certify a Business Plan for emergency response to release or lhrea[ened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 0( the Calitomia Health antl Safety Cotle requires, with some
exceptions, that a Business Plan be filed with the CosW Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantity o� hazardous materials equal lo or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compresse0 gas
at standard temperaWre and pressure).
2. Does or vrill the applicanl or present or future building occupant neetl ro file
a registration form for acutely hazarUous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
exceptions, requires registration with �he Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 qallons, or 200 cubic teet of compressetl gas at slantlartl
temperature ana pressure).
3. Does or will the applicant or present or tuture building occupant need to
prepare an RMPP (Risk Management antl Prevention Program !or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code pmvides that the
Costa Mesa Fire Department may require [he preparation, certification and
fling with the Fire Depanment of an RMPP by businesses which are required
ro register awtely hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of lhe California
Health and Safety Code been fully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or future builtling occupan[ require for
Ihe vrork which is the subjec[ of this application a pertnit /or such cOnsiruc[ion
or modification trom the South Coast Air Quality Management DisMct or (rom
any other air polWtion Gontrol disMct or agency? ❑ Ye5 ❑ No
(Section 658502 of the Cali(omia Govemment Cotle requires ihat the requested
infortna[ion be (umished on applications for ran-resitlential building pertnits).
6. Will any part of the (acility lo he cons[ruc[ed under lhis permit be within
1000 feet from lhe outer boundaries of a school? ❑ Ves ❑ No
Qf "yes". Ihe facility must meet Ihe requirement of Sections 25534 and 42303
ot the Califomia Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air polWtion control district or agency is required for the work which is the
subject of this application, have all of the disUosures prescribetl by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", atlach certificate of compliance from the appropriate air pollution
conlrol offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correcL I agree to comply with all state laws and
ci[y ordinances regarding Hazardous Ma[erials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury Ihat 1 have reatl this application and state thal
lhe information given is correcL I agree to tomply with all slale laws and city
ordinances relating to builtling construction, and authonze representatives of
me Ciry ot Costa Mesa to enter upon the abovetlescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorizetl by this permit until final inspection.
Sig ur tLe9 (s /� /���
AnG/or Aulb 24 Ap0 ��nt � Date
f„ITY OF COSTA MESA .C�NSTRUCTION PERMIT �� �
'' "� ' Z897 E� R/o C/.PCIE � . � �
�' Project Address
AppllcanYsMailingAddress �ZA47 EL R/O �'/.l�CLE -
owne�'s Name LOUiCS P. Cl�S7ELLAN�none 556-084Z
ndd�ess 2 P 97 EL R/O C/kL" LE �'
Arch/E�ng: ' ��!� " License No.
� Address �� -
Convactor's Name Phone �
Address (mailingl
.City License No. " �
�LICENSED CONTRACTOR DECLARATION '
-I nereby a��irm [ha[ 1 am licensetl u r ovisions of Charter 9(commencing
� wi[h SCctlon 7000) of Oivision 3 f Bus' ess antl Professionz Cotle, antl
my license is in full force an0 effe
-LICE052 CId55 IC2052 NO.
�Dale� Signature '
WORKERS'�COMPENSATION DEC R �
I hereby affirm tha[ 1 have a certific e of mnsent to self-insure or a certliicate
' ` Wotke�s' Compensation Insurance, or d certifietl Wpy thereot (SeCtion
00, Lab. C.) • '
olicy No. ' Company
�Certifietl�mpy is he�eby furnishetl. � ' •
�Certifietl copy is filetl with the city Builtling Divisian. , ' '
Date Applicant ' � �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be"mmpletetl it the permiTis for one huntlretl ($300) or
IC55). �
I certity that in the perto�mance of the work fo� which this perm�t is issuetl, I
shall mt employ any person in'.any man�n$ � so as to c e subjec to the�
Worker = ens t�y � Laws of'Caliform}!�
. Date "jJ—Si9nature /1S/J+U'�� '�fQ
'NOTICE if, after making this tleclaration� you shoultl become subject to t e
tNorkers'_Compensation.0�ovision5.of the' Labor Code, you must forthwith
comply wilh such provisions o( tnis permit shall be tleemetl revoked.
CONSTRUCTION LENDING AGENCV ' ' •- .
1 heteby atfiim that th¢re iz a cbnstruction lentling aqency for the performanc¢ �
of Ihe .work for .which tM1is pe�mit is issuetl (Section 309] Civ. CJ
LenGer�s`Name '
�entler's Atlaress -
OWNER BUIL�ER �ECLARATION � � ' ' '
I nereby.aftirm that 1 am ezempf from.the Contractor's. License Law for the
following reason (Section 7031.5 Business antl Professional Cotle:-Any city or
county which-repuires a permit to wns[ruct, alter, improve, tlemolish o� r¢pair
, any SVuctu�e, p�ior to its i55uance, also requires the applicant tor such pe�mii
to file a signetl statemen[ that he/she is licensetl pursuant to the p�ovisions of
the Contractor's License Law (Chapter 9(commencing.with Section ]000) of •
Division 3 of the Business antl Professions Cotle) or that he/she is exempt
"+erefrom antl' [he basiSTor th¢ allegetl exemption. Any violation of Sectlon
31.5 by any applican[�fo� a permit Subject5 the applicant to a civll
ii aalty of not more than five hundretl tlollars ($500). � � . ,
J I, as owner of the pwpe�fy or my employees with wage5 as'thEir sole
compensation, will tlo tbe work, antl ihe st�ucture is not intentletl or oite�etl�
tor sale (Section ]044, Business antl PrOfesSional Cotle: The Cont�acto�'S
License Law tloes not apOty to an.owner of a property who buiitls or improves
thcreon, antl who tloes such-work�hienselt/herself.or throu9h his or her own,
employees, provitletl that such improvement5 are not intentle0 0� offeretl for
sale. If, however, the builtling or improvement is Soltl within one y¢ar of com-
pletion, the�owner will have the burtlen o� proving he/she aitl not builtl or im-
p�ove forthe pu�pose of Sale). . . '
I, as owne� ot the property, am exclu5ively'conVactinq wifh lic¢nsetl Con-
ractors to construct the project (Section 7044, Business and P�ofe55ionz Code:
The Contractor's License Law aoes not apply to an owner of orooerty who
builtls or improves the�eon; antl who'conttacts fo�'Such'project5 with-d con-"
tractor(s1 license pursuant to the Contractor's License Law). I am aware that
proof o� theit Worket's Compen5a[ion insurance sM1oultl, be provitletl to me.
i
� ❑.1 am exempt untler Section , ,B. P. C. for tM1is reason
i I , �
nTrP % o � L�t�
P hereby'certify�that I have�reatl is application dntl state-that the above
iNormation is wrrect. 1 agree to comply with all city antl munry ortlinances:
and state laws relating to builtlinq construction, antl hereby authorize repre-
sentatives of thi5 cit to enter upo Ihe above-mentionetl p� per for
Ip5 2CLIOf1 OI OSES
CD
fill in ali spaces excepi
within heavY
lines anG sign all appropriate Ceclarations.
JT NO. " UNIT N6. ' r, � ' •,
TVPE OF'CONSTRUCTION �LJ NEW U ADD LJ'ALTERATION !LJ REPAI
❑'CONVERSION� ❑-DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/u SE OF BLDG.. - �
/J o — n n-o�Il
TYPE OF PERMIT GRAOING FOVNDATION � STRUCTVRAL '
.- ❑ TENANT.❑ E�.ECTRICAL ❑ PLUMBING O MECHANICAL
❑ O7HER ' . `p • .- ..
PROJECT DESCRIPTION SQ. FT. � �'p d OCCUPA'NCpV,���
CONSTRUCTIONTYPE _ VALUATION$�
20NE ' GftAOINGGU.VOS. ACRES
'Remarkx' , ', . . ' '
Bar Sink
Backflow Preventer-r--
Backflow irrigation . �
Bathtubs
Clarifiers �
Dishuvasher
Drinking Fountains �
Ploor Drains
Floor Sinks
iid5$2NICE • �l1tIEL5
Interceptors
KitchenSink' � -
laJamries - �,
Roof Drains - - .
Reinspection Fee� $15
Boiler ' '
Duc[-,Under Ground� �
Duct - Structural �
........-..���.......��y ' . _'
Exhaust System ❑ MWtiple C�
FirepllFact.Blt.IC80# �'.
Heating Sys[em & Ducting'
❑ ai oo,000 aTu O i oo,000 e�
� P P � ' 1
Signature Date % � � -
Drivers' License 55 � � ! Reinspectian Fee ' $15
IF 0865-46, rev. ]0/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assezsor
I
ABING � � FEES
Showers � • � +
Service'Sink � • -'
Sewen Cap - '
Sewer�Connection
$012f COIICCLOfS
Solar�Tank' '.
Swimming Pool w/Spa
Urinal
Water Closet ., .
' Water Heater
- Water Service
'� Auto-Wash. _
Laundry Trays �
Issue
'Hood or Typel ❑ ,�
Canopy Type II ❑ -
Refrigeration System
Oo-too,000�eru ❑too,000sru
Fire Dampers
Registers
luue Fee
0
'$ 3
,FEES
� '
�$ 3
A.P. # '�
S . Main Buildii
E
T Front
B Rear �
A
C Right
g Left '
�Ping. Ref. #
Pianning Notes:
Automatic Washer
Construction Pole
Cooking Unit
Dishwasher
Dryers ❑Gas ❑
Fan
F.A.U.
Fixtures--
Device Boxes
. . • � � � � � �4 �
.. `.. � , . ; -
� - .. , - �
ilding:
/���Rji,king Req./Provided
0�� "
` ,
°CTRICAL �
' �, Transformer ❑' 15-50'KW
. ❑ 50+KW �
Meter ❑up to 100 amps .
Meter ❑over700amos
lectric Sub Panel '
� Momrs �0-1 HP 01 %- 8 '
Inc. Solar �9-75 HP 016-15+
� - -nn:,:..,u��.,e ' - -
Switches '
Garbage,Dispoul ,
Generator DO-5 KW �5-75'KW
�
= Reinspection Fee . $15
�
� DEVELOPMENTSERVICESREQI
t Zonin'g Approved By �
�.
.Buildin9 Approved By
i'
Pole Light
Range
Sign
; Standin9 Sections '
Trash Compactor '
issue Fee
tl
Z �
" O
N
: N �
G
R
� E '
Q
� M
� T
5
FEES
$ 3
Date '
�S � � ' SUMMARV OF FEES 1 ' • �
lt ��' BUILDING PERMIT� $ ��' L%� � SMIP � � $' . ,iO
� � - PLAN CHECK ' $ � PERMIT i . �
PLUMBING � � $ ISSUANCE ' $�
PLAN CHECK . 25% $; ' ENERGV P.C: $' �
C � ELECTRICAL . . $ , GRADING ' $ . �
P�AN CHECK 50°k $ � MICROF,ILM � $'
— � MECHANICAL $ TOTALFEE $ / j�• �.1�
' PLAN CHECK � 25% $ ' ' ' i i ,
� CONSTRUCTION AND PLANNING . POOL 'A '
t APPROVALS Permit # Date Inspector AppROVALS Permit # "' . Date Inspector
�, .
1'. Temporary Electrical Service or Pole 52. Pool & Equipment Location
?� Soil Pipe-Undrgrnd. ' 53. Steel.Reinforcement . ,
3. Elect�ical Conduit Utility-Undrgrnd. �=;a 54. Forms �' �;�
:Y
4:�Electrical Conduit=Undrgrnd. . 55. Electrical Bonding '
5�"Steel'Reinforcement - 56. Rough Plumbing & Pressure Test ,�'��
,:L
-6 Hectrical UFER Grnd. � . 57. APPROVAL TO COVER-GUNITE -�
;�
7::'Footjhgs - 58. Electrical Conduit-Undrgrnd. '�'�-
8`Foundation � � 59. Gas Pipe, � Undrgrnd., Test ��,�,
9� Watea:Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, � Undrgrnd. � '���.i
tO.StrucfuralFloorSystem � 61.APPROVALTODECK '��"
11:: Property,Sewer Line & House Connection ''',t 62. Backwash & Receptor-Final �4•�'
12. SewerCap '��' 63. Heater & Vent-Final +'A �`
13. Robf �Dreins 64. Plumbing System - Final t '
14. Rough Plumbing `' '65. Electrical-Final � , �
15. Rougli Electrical-Conduit 66. Solar System-Final
16. jRough 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
20..Rough Factory Fireplace APPROVALS Permit#
21. DuCts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil '
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing , 73. Undergrnd.StorageTank �Gas ❑Oil .
25. Roof Sheathing � �. 74. Overhead Hydro
26. T-Bar Ceiiing (Structural) & Monocoat . 75. Dry Chemical , � �
27. Frame and Flashing _ 76. Dry Standpipe
28. Lathing & Siding � 77. F�XED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL •
30. Drywall Nailing �HEALTH DEPT. REQUIREMENT -
37. Plaster Brown Coat ' 79. FINAL INSPECTION - -
32. �Elearical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes: p d'
34. Final Heating & Air Conditioning � � �S 7/�
35: Final Gas Pipe-Test ���
36. Hood or Canopy '
37. Final Factory Fireplace , .
38. Final Plumbing
39. Water Service-Final � •
40. Gas Service-Final
41. Solar pomestic-Final -
42. Backflow Preventer . ��
43. Backflow Irrigation • '
44. ,Landscape Irrigation System . �
45. Sound Attenuation �
46. Handicap Regulations . _ '
47. FINAL STRUCTURE & BUILDING �/� '
48. Special Requirements Completed �
49. �Electric Release to Edison •
50. Gas Release to Southern California Gas Cv , � "
i51. CERTIFICATE OF OCCUPANCY �; -
N�o. • Date � ' ' �
� � �COSTA MESA BUILDING-SAFETY DEPARTMEN
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
�
For Applicant [o Fdl in Completely — Use Ink Only
ADORE55 Z�77 �'�
�/0 C'/.�('[E
OWNER OR � , � C�STELL�9
TENANT
MAILING �� EL �L� C�N LF
ADD RE55
CITV �j �S� yJ�S� �A N�L.7�G'Q
CONSTRUCiION
BFANCH
AD�RESS
ADDRESS
CONTRACTOR
ADDiiESS
GTV
F STATE
� LIC. NO.
S OFEOT �O
� USE OF
EXISTING BLOG.
h
�r �BarE
TEL.
NO.
CITV
IIC. NO.
NO. OF BLOGS.
NOW ON LOT
F Separate permits are required for
� electric, plumbing and heating work:
�,�. USE OF BUILDING AND WOIiK TO BE PEFFORMED
Q
7
r
J
a
w
a
�
a
a
z
w
S
3
� APPLIC I(
RECEIVED
�3
A.P. NO. �,/
F�i
BUILDf G'��
tll.i']RE55 �
UM1'T �n
SPNCE f-:C'�[-
R.NO.
� EW A D
� �
OWNER L.
t USE �(.(�I
T
_ ,
ZONE
APPR VED
BV
PPROVE / TI
(FROM C ST I
RONT
�(
�.\ a� ��
7159 �,�BG,06%80 ' I 88.03 7Li
:. . . <_, j. _ _ . ,��:_ . . _ _ . _ , ..,
FOR ;�TRUCTURAL PERb�I���
PERMIT N° - 5Q458
_ G—/_ � — /9
LTER REPAIR MOVING DEN
, QSTG ��4Mlti:
�' �� VALUE
$
ll'�
TVP6�NGROUP R�
PDATE 5—�-
I �ereby acknowlatlge that I hava reatl this application antl state �
that the above intormation is correct and agree to comply with
all laws regulating building consttuction, and I shell not employ �
any person in violetlon of the wo�kman's compensation laws of :
the Staie of California. �� �
l`��O "'
I hereby cartify that I am properly licensed as a contractor undat SQ. FT. �
�
the State of California Business antl Profassions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR p!
Chapter 9, and that such licenses are In full force antl etfact, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
am exampt from the provisions ot the Stete of Celifornia Business a
antl Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE $,2 �_ �
' A/�/ PLAN CHECK $ "�
Signature ot y.�7 I� /� � �� 2' � �
Perm� ttea � Q� S.sC / g TAX $ 2. �� u
p� ' V�
Authorized Agent Date �+ �J TOTAL PAID g �� 0'3
. � a � [�o�
. ,�
COS3A MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX.917 C08TA MEBA. GLIRORNIA
�
For Applicanf to Fill In Complefely
� TYPE OR PRINT �
BUILDING
■ MAIL
u
■ SIZE
COSTA MESA. CALIFORNIA
BETGACK LINa PROM �
CENL¢R OP STRl6T
SIDE YARD I�FT ]� I I
DESCRIPTION OF
OP
GWOO�br$tUCCq COVERING Cedar
BUIL�ING AND WORK TO BE PERFORMED
�EE RECEIVED
OV 1 6 1983
�`�a�cE o��t.
� CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
RECEIPT NO. .CERHKAIO.
BV I DATE RECEIVlO I DAT! 198UeD
COSTA MESA.
APPROVED
ZONFJ / NO. OF F U8E OP N
�i` " PLANB BUILDINPI
�eo�� LOt �9 Trac
oescw�priox
YAR�S EVES
APPROYED ALLO
' lC6NTeR 4N6 9TJ �{/�
FRONT / v FT.
1 / 2
►I
/.S
PLAN 111-AR /�/�i 7 � y(a0 �
1 H6R6lY ALKNOWL8DG8 THAT 1 HAVE RlAO THIB APPLIGTION TryE AMOUNT 8H0 UNDER VALUAT�ON 18 POR THE
ANO BTATE THAT THE ABOV6 IB CORPECT AND AGR88 TO COM• pUPP09E OF EBTA6L18HING • PERMIT FEE ONLY.
PLY WITX ALL CIiY ORDINANCEB ANO 8T/�TE LAW9 RB�ULATINO
Bu1tDIHo CONBTRurnoN. VALUATION
SIGNATURE �F MESA DEL MAR DEVELOPMENT CO PERMIT FEE $ �/—
PERMI7TE `
�� � ✓� ��� � LS � 7.3% .BO pLAN CHECK $ �S,/ �
AUTHORIZED AGENT / Av.a w a b! ri