HomeMy WebLinkAbout2853 EUROPA DR - Building Permits1'� \ � � .� . .
CITY OF COSTA MESA
BII/LD/NG D/V/SION
F � 77 FAIR ORIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (774) 754-4856 • www.ci.costa-mesa.ca.us
`? FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER. B07-00947
PERMIT TYPE B ROOF2 STATUS: ISSUED,
DATE ISSUED: 09/26/2007
. ISSUED BY: RMD
JOB ADDRESS: 2853 EUROPA DR CM , Suite/Unit:
Vicinity: HOUSE AND GARAGE ROOF� � . -� - _ , ;, , - �,`
Squares: 2700 � � �, , � . � - � -. -Valuationr .. . $5,000.00
SCOPE OF WORK: TEAR OFF (E) ROOF MATERIALS, INSTALL 1 LAYER OF 30# FELT ON A 4:72 PITCHED ROOF AND REROOF
WITH 40 YEAR COMP SHINGLES ON ATTACHED HOUSE AND GAR4GE, APPROX 19 SQUARES AND.TORCH DOWN ON
8 SQUARES OF FLAT ROOF. REPAIR AND REPLACE SHEATHING AS NEEDED. - .
OWNER: JOHNSON, DENNIS P �-- ' Address: . 2853 EUROPA DR - � Unit:
PHONE: 714-751-0457� �� " � ' ��' City/State/Zip: COSTA MESA, CA� ' . �
APPLICANT: JOHNSON, SCOTT � �
PHONE: 714-777-0040 � �
CONTRACTOR: MC CORMACK ROOFING
Address: 1216 N HANCOCKUnit:
City/State/Zip: ANAHEIM, CA , 92807
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspedion Fee:
TOTALFEES
Address: 1216 N HANCOCK '
City/State/Zip: ANAHEIM, CA
License No. 643700
PHONE: � � 714-777d040
CELL:
� . Unit: :SUITE 107
SUITE 107 � �
i' License No.
� �. $o'oo '-; �
$111.25 .
$0.00
$111.25
License No.
, PHONE:.
PHONE:
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;,. �
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NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requiremenls under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAVS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
COOE1, INSPELTONTYPE � INTIiIRLS CODEt INSPELl10NTYPE � INTRI�LS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final �/ � 208 Final Plumbing
200 Final Re-Roof �7 `� '�'► 210 Final Elecvical
201 Final Block/Retaining Wa0 212 Final Fire Prevention
202 Final Factory Fire Place 220 Finai Planning Approval
203 Final5i9n 222 FinalSite
204 Final Demolition ' _ 250 Final Building/OctuDanty
WORKERS' COMP�NSATION DECLARATION:�
I hereby aKrm under penalty of perjury one of the vnng declaralions: �
❑ I have antl will mainlain a cerliflcate of consent to self-lnsure for woikers' `;,.
compensa[ion, as provided for by section 3700 0( the Labor Code. for the
peRormance of lhe work.(or which Ihis permit is issued. . ,
�I have and vrill mainlain workers' compensalion insurance, as requiretl by
tion 3700 0( the Labor Code, (or [he peAormance o( the work for which I�is
permit is issuetl. My workers' compensation Insurance carrier and policy
number ar :
�Carrier? � � � L� � �/ � /'
(rhasenanneed�,q\t bewmd�ejfeenNe mrrtu�ame alonehunCratlOollars(Et00Jo��ess)
Policy,Number '-�\� "-� ��^
❑ I certity that in Ihe peKormance of the vrork for which Ihis permit is
issued, I shall not employ any person in any manner so as lo become subject
to the vrorkers' compensation laws of Califomia, and agree that if I should
become subject to the workers' wmpensa[ion provisions of Section 3700 of
the Labor Code, I ahall fo th2omply with these provisions
/�--_. � � �lz�� � �
�Appliwnfs5i nalure �Dale .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby affrm that I am licensed under provisions of Chapter 9(commencing
wit� Section 7000) of Division 3 of the Business and Professions Cotle, and
my license is in full force and effect.
��� / i ,.. � � p I"riass #_ - � '3 �
/� %
C ' � 9 ��/o�
� Convap Si9naWre. �0 �e_
CONSTRUCTION LENDING AGENCY: -
❑ I hereby atfvm that there is a constructbn lentling agency for the
perfortnance of the v.ork for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name:
Lender's Address:
Signalure Dale
OWNER-BUILDER DECLARATIONS:
I hereby affirm that untler penalry of perjury that I am E%EMPT FROM THE
CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5.
Business anC Professions Coda: Any city or county which requires a permit to
wnsWct, alter, improve, demolish, or repair any slrucNre, prior �o 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 Contrectors
License Law (Chapter 9(commencing wit� Section 7000) of Division 3 0l the
Business and Professions Code) or that he or she is exempt Iherefrom antl
the basis for the alleqed exemption. Any violation of Section 7031.5 by any
applicant tor a pertnit subjects the applicant to a civil penally of not more than
fve hundred dollars ($500).):
❑ I, as owner o! 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 vrork himsel( or hersel( or through his or her ovm
employees, provided that such improvements are not intended or oNered �or
sale. If, however, the building or improvement is sold vrithin ona year of
completion, the owner-builtler will have the burtlen of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner o( the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construcl the project (Sec. 7044, Business and
Professions Code: The contractws License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts (or such projecl vrith
a conlracta(s) license pursuant to the Contractors License Laws.).�
❑ I am exempt under sec.
Business and Professions Cotle for Ihis reason:
305]-46 (?/0])
Ovmer ID venfietl by tlriv e. � Yes ❑ No A �""\
Oriver's License No. Expires:
Verification of Ownership by (rype of document, i.e. - property lax bill or d'eed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATIONl. , .
❑ I hereby ceAify thal no excavation frve (5) or mofe (eet in depth into which a
person is requiretl to tlescend, will be made in connection with work authorized
by this pertnit, and that no building struclure, sc�fdding, falsewurk, or demolitbn
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2. M 2, Sea 341, Title B, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to tlo work which would
require a permit from the Division o! Industnal Safety, as noted above, unless
such person has a permi� �o do such vrork lrom the division.
Applicanfs Signalure
Division of Industrial Safety Permit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building xcupant need lo fle and
certify a Business Plan for emergency response lo release or threa[ened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Cali(omia Heallh and Sale[y Code requires, wi[h some
exceptions, that a Business Plan be file0 with the Costa Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantiry o( hazardous matenals equal ro or greater ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard tempereture and pressure).
2. Does or will the applicant or present or future building occupant neetl to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0! the Calitomia Health and Safey Code, with some
excep�ions, requires regist2lion with lhe Cosla Mesa Fire Department by
each business which at any one time has on hand a quantity of aculely
hazardous materials equal to or greater Ihan a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compressed gas at standard
temperalure antl pressure).
3. Does or will Ihe applicant or present or fuNre building occupam need to
prepare an RMPP (Risk Management antl Preven[ion Program for acu[ely
hazardous materials�? ❑ Ves ❑ No
(Section 25534 0� the Califomia Heallh and Safery Code provitles that the
Costa Mesa Fire Department may require ihe preparatioq certification and
fling with lhe Fire DepaRment of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Dces or will Ihe applitant or present or future building occupaN require for
Ihe work vfiich is Ihe SUDjeCI of IhiS application a permi� fOr SUch Cons[NC[i0n
Or modification (rom the South Coast Air Quality Management District or from
any other air pollution conirol district or agency7 ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that the requested
informalbn be fumishetl on applications far non-resitlential builtling pertnits).
6. Will any part o! lhe facility to be construc[etl untler Ihis permit be vrithin
7000 feet (rom lhe outer boundaries of a school? ❑ Ves ❑ No
(If'j�es", Ihe facili[y musl meet the requirement of Sections 25534 and 42303
o( Ihe Calilomia Health and Safety Code).
7. If a permit from the South Coasl Air Ouality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all o/ the disclosures prescnbed by Califomia
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. (If'yes", attach certificate of compliance from.the appropriate air pollution
control oKcer). .
CERTIFICATE OF COMPLIANCE: I cerlify that under penalty of perjury the
information given above is correct. I aqree to wmply with all state laws and
cily ordinances iegarding Hazardous Materials antl Emissions. "
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
the information given is correcL I agree ro comply with all state laws and city
ordinances relating to building construction, and authonze representatives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this pertnil until fnal inspection.
Signaturc eB IOwner(s) ale
� / --- �%� i�-�
AnOlor,Aut�or tlNppliram � Date '
AVG���ant to fill in all soaas ezcept lnose witnin heavY eoraer Ilnes ana sign all aoProo/�ace tleclarations.
PER T N TA�IE'f.MG. LOT NO. UNIT NO.
CI7Y OF cOS7A M�ES7A CONST UCTION PERMIT 7 t7/' A,P. # za�a
Project Address ��3 � �C� /Q, �%�%'� �•� C�" I" S Main Building: Accessory Building:
�� � n "'.,�. TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR E Z
ApplicanYs Mailing Address ✓� � � �' �%%
' � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front 0
Owner'z NameD��(y. � $ JO ,O � phone � ' - �
DESCRIPTION OF WORK/USE OF BLDG. 6 Rear N
Address � � y � ��U �COiJFa- CLLC'Ti4 ,�i% SF� . . A I
Areh/Eng. %ti/� License No. TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL I K Right G
Address ❑ TENANT ❑ ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL �, $� Left
❑ OTHE(3 R
Contractor's Nam r% LDRS _phone 6 Ping. Ref. # Parking Req./Provided E
PROJECT DESCRIPTION SQ.FT. OCCUPANCY n
Address (mailingl� (� �� � CONSTRUCTION TVPE VALUATION $ Planning Notes: M
City License No �3 � 2pNE GRA�ING CU. VDS. ACRES
LICENSED CONTRACTOR OECLARqTION � S'
�I hereby atfirm that I am licensetl untle� Orovi5lOn5 0( Charte� 9(commencing Remarks:
wi[h section ]000) of Division 3 of tne Bu5ine55 antl Pro(e55iOn5 Code, antl
my license is in tun rce antl eftecL ELECTRICAL FEES
Licensg Class �icen5e No.1�q�ez
�_ Automatic Washe� Transformer ❑ 1&50 KW
Date�L&.1'�l�Sl9nature ���� PLUMBING FEES
, WORKERS' COMPEN ATION DE ARATION Bd� Sink ShOwE�S COnst�uCtiO� POI¢ $Ub. � 50+ KW �
I hereby atti�m tM1at I have a certiticdte ot consent to selt-insu�e o� a certificate -
eL� r' 'Vorkers' Co�m/pensation Insurance, or a certifletl copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up ro 100 amps _
V . Lab. C.1/O �3 � ��-T� �+ t7/Yi� - - '..
� _y rvo. _' � Company ( / Backflow Irrigation Sewer Cap _ Dishwasher Meter ❑over 100amps
�Certifietl copy is hereby furnlshetl. � � Dry2r5 ❑Gas pEl¢cttic Suh Panel
Cer�Irti py i filep th the city wltling Division. Bathtubs Sewer Connection
Date^'�� ��`�4PPlitant�,4���++4�" _ Fd�
EXEMPTION FROM WORKERS' COM NSATION DECLARATION Cla�ifief5 . Sola[ Collector5 Motofs �0.1 HP �1'h - 6
(This seciion neetl not be completetl if the permit is tor one huntlretl ($100) or Di5hwd5her F'P"U' �
less). Solar Piping Inc. Solar �9-75 HP �76-15+
I certiry that in the performance of tne work (or which this perm�t is issuetl, I � Fixtures Microwave
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank � F� � ��
Work¢r5' Compensation Laws of California. D¢viCC BOx¢5 -
Date Si9nature Floor Drains �` Swimming Pool w/Spa �. Pole Light
NOTICE: If, afte� making this tleclaration, you Shoultl become SubjeGt to the �utl2ti fldn 2 �b
Workers' Compensation provision5 Ot [M1e Labor COtle, you must forthwith FI00� SInkS Uiipol 9 �_
comply wilh Such provisions ar tM1is Oe�mit shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV D SWitChes Si n
Gas Serviee Outlets Water Closet 9
I hereby affirm that [here is a construction lentlin9 agency for the Oertormance Garba e Dis osal
of tM1e work for which this permit is issuetl (Section 309� Civ. C.) Interceptors Water Heater 9 P Standing Sections
Lentler's Name
�entler's Atltlress Kitchen Sink Water Service Generator �0-5 KW �5-15 KW Trash Compactor
OWNER BUILDER DECLARATION
1 hereby affirm lhat I am exemp[ trom the Contractor's License Law for the LavatOries AutO-Wash
following reason (Section ]031.5 Business antl Professional Cotle: Any tity or
county which requires a permit ro construct, alter, improve, tlemolish or repair P—Trap Laundry Tra'ys �
any st�ucture, prlor to i[s issuance, also requires the applicant tor suth permit
to tile a si9netl statement thaT he/she is licensetl pursuant to the provisions oi Roof Drains •
the Contractor's License Law (Chapter 9(tommencing with Section 7000) ot
DiviSion 3 of the Buziness antl Protessions Cotle) or ihat he/she is exempt Reins ection Fee '�s
th—�from antl the Casis for the allegetl exemption. Any violation of Section P $15 Issue Fee $�.
' S by any applicant for a permit subjects the applicant to a civil
� L:y ot not more than five huntlretl tlonars (E500). DEVELOPMENT SERVICES REQUIREMENTS:
as owne� of the property Or my employees with wages as thei� sole ReinSpBttiOn FBe $15 ISSU¢ FBe $ 3
compensation, will tlo the work, antl the structure is not intentletl or offeretl 2oning Approved By Date
lor sale (Section 7044, eusiness anG vrofessional Cotle: The Contractor's MECHANICAL FEES Building Approved By Date :�
License Law tloes not apply to an owner ot a property who builtls or improves
theleon, antl who tloes such work him5elf/Ilelself or through his or hEr own BOiI¢I HOOd Of T 21 ❑ %�PP��mtioll ISSUBd By Ddt �I��
employees, provitleG tltat Such Imp�ovements are no[ Intentletl or o(teretl fo� VP
sale. If, however, tM1e builtlin9 or improvement is soltl within one year of com- Canopy Type II ❑ '
oletion, the owner will have the burtlen ot provin9 he/zhe tlitl not builtl or im- Duct- Under Ground SUMMARV OF FEES
n�ove for the vurpose of sale). BUILDING PEflMIT $ SMIP $.
❑ 1, as owner of the property, am exclusively contracHng with licensetl con- Duct- Structural , Refrigeratfon System PLAN CHECK $ PERMIT
(ractorsto construct the Oroject (Section 7044, Business antl Professions Cotle:
Tne ConVactor's License law does not appry to an owner of property who Duct � Ventilating ❑0-100,0008TU ❑100,000 BTU PLUMBING $ . � O �SSUANCE $
bulltls or improves thereon. antl who cont�acts for Such oroiects wkh a r.on-
traclor(s) Lcense pursuane ro ene Convactors License Law). I am aware that Exhaust System ❑ MWtiple ❑ System Repair/Alteration PLAN CHECK 25% $ ENERGV P.C. $
proo/ oi their Worker's Compensation insurance shoultl be provitletl to me. ELECTRICAL $ ��-S GRADING $
I] 1 am exemo� untler Section B. & P. C. tor this reason Firepl/Fact. Blt. ICBO dk Fire Dampers MICROFILM $
Heatin S stem & Ductin Re isters PLAN CHECK 50°,6 $
Date Owner 9 Y 9 9 MECHANICAL $� TOTAL FEE $=��
1 hereby certify that I have reatl this application antl state that the above ❑0.100,000 BTU 0700,OOOBT PLAN CHECK 25%
Information is correct. 1 a9ree to comply with all tlty antl county ortlinances $
antl State laws �ela ' to builtlin9 construction, antl he�eby dutho�ize r¢pre-
s¢ntatives o( Ihis cit to enter upon fhE above-mentionetl rope�ty
' InspeCtion purpos ��,� �
Si9nature • � < I� $ �
Drivers' Licen 55 � `- " Reinspection Fee $15 Issue Fee
oa aoaz3zab-nooz4ao� -ea�-r s,,;c
0865-46, rev. 5/88 White - Builtling; Canary - ApO�i�anp Pink - Accountin9: Goltlenrod - Assessor DATE3 QjJ12/aq �rME: i2; iJ'
`-
CONSTRUCTION AND PLANNING P'JOL R• SPq
APPROVALS Permit # Date Inspecfor AppROVALS Pe�. .. # Date Inspector
1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location
2. Soil Pipe-Undrgrntl. � 53. Steel Reinforcement
�
3. �Electrical Conduit Utility-Undrg�nd. ', , � 54. Forms ''
u
4. Etecirica� Conduit-Undrgrnd. ' '« , 55. Electrical Bonding �
5. Steel ,Re�nforcement�� �� � •'I 56. Rough Plumbing & Pressure Test .
6. Electrical UFER Grnd�� ,,: �' 57. APPROVAL TO COVER-GUNITE i;
�7. Footings � � ���� {1 �� 58. Electrical Conduit-Undrgrnd. . 7 �
8..Foundatlon a' �i � 59. Gas Pipe, � Undrgrnd., Test `
9l Water, Pipe-Undrgrnd. � -{ , �` 60. Backwash Lines, P-Trap, O Undrgrnd. '
10. Structur�l Floor System ` �'� ' 61. APPROVAL TO DECK
11, Property.Sewer Line & HouseConnection ':1 � 62. Backwash & Receptor-Final
. '
12. Sewer Cap �i. '' - ' 63. Heater & Vent-final
13. Roof Drains i -, , � 64. Plumbing SYstem - Final -
74: Rough Flumbing 1' � 65. Electrical-Final a'�
15. Rougfi Electrical-Conduit 66. Solar SYstem-Final
16.� Rough Electric Wiring � Z� � 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 Condifi�ning �� �Ci L� FIRE DEPT. REQUIREMENT
�, ;
�2Q. Rough Factory Fireplace APPROVALS Permit #
21�. Ducts, in Structure � �
70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
a 23. Gas Pipe-Rough & Test ' 72. Underground Flush �. j��
�t 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. �Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. .Lathing & 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 :L �
33. Final Electric Notes:
34. Final Heating & Air Conditioning 27 ��A �,.
35. Final Gas Pipe-Test � t� (� �
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing ' (�p '�,'
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final �
42. Backflow Preventer � i') � .�-
43. Backflow Irrigation � ' � y
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations :='
47. FINALSTRUCTURE&BUILDING ,��
48. Special Requirements Completed
49. Electrie Release to Edison �
50. Gas Release to Southern California Gas Co "� �
51. CERTIFICATE OF OCCUPANCY - "' �
No, Date �
,
__ _AOO��tant to fill in all spaces except those wit�in heavY DorOer lines antl sign all app�o0riate tleclarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT � �MIT NO. TRACT NO. LOT NO. . UNIT NO. , . . �
Project Address Z$53 Europa Dr. . � , � . " '
2853 Euro 8 DT. TVPEOFCONSTRUCTION NEW AD� ALTERATION REPAIR
AppliCant'S Mailing Addre55 p ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' �
ow�e�•s Name Johnson. Dennis P. phone �51-0457 A'P' # ZO"e
DESCRIPTION�OF WORKNSE OF BLDG:
Address 2853 Euro d DT. - � � ' � . S Main Building: ' Accessory Building: -
Arch/Eng. ' License No. TVPE OF PERMIT�a� GRADirvG ❑ FOUNDATION ❑ STRUCTURAL T Front p
Address' ' ❑ TENANT I�E�ECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear . . N '
ContfaCtor'sName E.S.T ' ho�e S9H—S113 - ��OTHER - � ' A �
11600 Monarch St. �GdTderi GTOVO PROJECT DESCRIPTION St;. PT. occUaaNCv K Right G
Address Imailing) Left '
32193 CONSTRUGT�ONTVPE ' VALUATION$ $
City Lic¢nse No. ZONE GRADING CU. VDS. ACRES � ' ' R
LICENSEO CONTRACTOR DECLARATION ' PIOg. ReF. # Parking Req./Provided E
1 herebyaffirm [hal I am licensetl untler provisions of Char[er 9(commencing , qemarks: ' ' PldOniOg NOtES: �
with section 7000) ot Division 3 of the Business antl Professions Cotle, antl i M
my license,is in ❑t ce antl eftecL � .
Ucense Class �-1� �ice e o. 31170 � _ S.
Oate • — — Si9nature � ' t PLUMBING ' FEES
WORKERS' COMPEN TION DEC RATION Bdr Sink ' . ShOwers ' �
y, ,.,!,ereby affirm that 1 ha a cer '' e of consent to selt-insure or a certificate ' ELECTRICAL FEES
;. Workers' Compensatio urance, or a certifietl copy thereot (Section gackflow Preventer '. - Service'Sink ' �"' ' ' .'
=�'�JO, Lab. Cj � . Auromatic'Washer Transformer ❑ 15-50 KW .
�Policy no. ' 1042904 � company State FURd 8ackflowirri ation - � . ❑ 50+KW �
9 Sewer Cap Construction Pole Sub. .
�(CCertifietl copy is hereby furnishetl. . -
ert' ' tl y iletl with the city Builtling Divisi � Bathtubs ' ' � Sewer Connection � ' Cooking Unit � Meter ❑up to 100 amps � �
U�-f�' 8%J` �:'S.T
Date APPIi<ant Clarifiers � . � Solar Collecmrs Dishwasher , Meter ❑over 100 am s�
E%EMPTION FROM WORKERS' GOMPENSATION DECLARATION . P �
(Thissection neetl not be completetl if the permit is for one huntlretl ($100) or
less). Dishwasher Solar Pipin9 � ' Oryers ❑Gas �Electric Sub Panel � .
I certify that in tM1e pe�formance of the wo�k for which thi5 perm�t is iszuetl, I .
snall not employ any person in any manner so as to become subject to me Drinking Fountains Solar Tank ' Fan
Workers' Compensation Laws oi California. , Motors DO-1 HP �1'/:-�8
�ate Si9nawre ' Roor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If, at[er making lnis tleClaration, you shoultl become subject to the InC. Sola� 09-15 HP �16�15+
Wo�kers' Compeniation provisions ot the Labo� Cotle, you must forthwith FIOo�SinkS - U�inal . - Fixtu/25 ' � -
comply witM1 such p�ovisions o�.this.permit Shall be deemetl revoketl. Microwave
CONSTRUCTION LENDING�-AGENCV '' GdSService OuU¢t5 Wdt¢lCIOSet � DeViCeBOx¢5
I ne�eby affi�m that the�e is a conrt�uction lentling agenry tor the performance P012 Light
of the work for wM1ich this permit is issuetl_ (Section 3097 Civ. C.) Interce tors �� �� Wat2r Heater . � � �
Lender's Name ' P Outlets Ran9e
Lentler's Adtlress - � � Kitchen Sink '- - � Wa[er Service �
OWNER BUILDER OECI.ARATION ' _ _ Switches Sign �
I hereby affirm that I am exempt (�om the ConVaCtor's License Law for thE Lavarories � ' ''
tollowing reason (Section 7031.5 Business antl Professional Cotle: Any city or Ga�bage Disposal Standing Sections
County which �equires a permit to construct, alter,�improve, tlemolish o� repair p—Trep
any structure, prior to its issuance, also requires the applicant tor such permit Generator DO-5 KW �5-15 KW Trash Compactor
to file a signetl stalement that he/she is licensed pursuant [o the p�ovizmns of ROOf,D�ains � - �
the Contractor's License Law (Chapter 9(commencinq with $ection 7000) of
�JMvision 3 oi the Business antl Professions Cotle) or that he/she is exemPc . Load M mt.Device ].1 �Q
,.Y' efrom and the basis tor the alle9etl exemption. Any viola[ion ot $ection . '' ,
"Y'"`�1:5 by any applicant to� a permit subjects Ue applicant to a civil �
�' T'ialty oi not more than tive nuntlretl tlollars ($500). - . �
����� I, as owner of the prooerty or my employees with wages as thelr sole Reinspeitian Fee ` $15 , Issue Fee $ 3 ' .
� compensation, will tlo the work, and the structure is,not intentletl or oHeretl
tor sale (Se<tion 7044, Business antl Protessional Cotle: The Contractor's ' MECHANICAL FEES Reinspectian Fee $15 Issue Fee $13) �Q
license Law does not apD�Y to an owne� Of a property who builtls or imp�oves
thereon, and who tloes such work himselt/herseli or through his or her own - � . DEVELOPMENT SERVICES REQUIREMENTS:
emplOyees, provitletl Ihat sucM1 improvements are not intentletl or offeretl fo� BOiI¢� HOOd O� Typ¢ I ❑
sale. It, nowever. the builtlin9 �r improvemen[ Is soltl within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletion, the owner will have the burtlen Of p�oving he/she tlitl not builtl or im- Duct - Under Ground - guilding Approved By Date
�rovG fo� the purpose ot sale). -
I, as owner of the propeity, am ezclusively contractin9 with licensetl mn- Duct -Structural Refrigeretion System Applirvtion luued By - Dat
tractors to wn5truct the project (Settion 7044, Business antl Professions Code: .
The ConVactor's License l.aw does not applv to an owner of �property who Duct - Ventilating ❑0�100,000 BTU '❑100,000 BTU SUMMARV OF FEES
builtls or improves tbereon, antl who contracts for such projects with a con-
Vacmr(s Ocense pursuant ro the Contractor's Lirense Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/AI[eration ' BUILDING PERMIT �$ SMIP $
proot o� their Worker's Compensation insurance snoum be provi0etl m me. . PLAN CHECK $' PERMIT
❑'I am ezempt untler Section B. & P. 0.�or this reason Firepl/fact. BIL ICBO #, � PLUMBING $ �SSUANCE $
bate Owner Heating System & Ducting PLAN CHECK 25°h $ ENERGV P.C. $�
i heretiy�certity that I have read this appiication and state that the above ❑U100,OOOBTU �100,0006T ELECTRICAL $ 26.�� GRADING $.
in(ormation is correcL I a9ree to comply wlth all city antl county orainances
antl state laws relating to bwltling m struction, and hereCy authorize repre- PLAN CHECK �50% $' MICROFILM $
sentatives of this y to ente� up n the above- entlonetl p�operty fo�
inspectlon purposes.� L 04-18-89 MECHANICAL $ TOTAL FEE �$
26.00
Signafure S�J)I�+� _ Date painspection Fee �$15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' license or SS �
� GMF 0865-46, rev. 4/84 White - Builtling; Canary - Applicant; Plnk - Accounting; Goltlenrotl - Assessor u+ u'JUJi1C0—UVUJl7p4 1 1J 'I �[�,O(]
flATC•_ fiA19^.!�O TTMr� !n.��
, CONSTRUCTION AND pLANNING � POOL PA
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-Undrgmd. 55. Electrical Bonding .
5. Steel Reinforcement - 56. Rough Plum6ing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �
7. Footings " 58. Electrical Conduit-Undrgrnd. •
8. Foundation . 59. Gas Pipe, O Undrgrnd., Test -
9. Wa[er Pipe-Undrgmd. . 60. Backwash Lines, P-Trap, � Undrgmd.
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
76. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. "fiough 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 � Gas ❑ Oil
� 23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monowat 75. Dry Chemical �
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINqL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
� 31. Plaster Brown Coat 79. FINAL INSPEGTION � �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric '/ � Notes:
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 U�i
r74
40. Gas Service-Final ('7
r
41 . Solar pomestic-Final `
42. Backflow Preventer '�� . ,
l`.7
43. Backflow Jrrigation : ,., , 'T..., '
�
44. ,Landscape Irrigation System�
45. Sound Attenuation ,`
46. Handicap Regulations q
�
47. FINAL STRUCTURE & Blc1�LDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date ,'
AOP���ant to flll in all soaces excev� inose wltnin neavy Cortler Iines anG sign al1 aoProvriate tleclantions.
..OSTA nMESA CONSTR UCTI ON PE JvIIT �j PE T N(y �/ 7RACT NO. LOT NO. UNIT NO. A P# Zone
ress y��L�-7 /�U.C�UG.dA �iAtfl�it ///E.i� a S MainBuilding: AccessoryBuilding:
� .nt'S Maili g Addre52 N O�/I . TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E Z
O er'S Nam A ��- �7 � CONVERSION ❑ DEMOLISH ❑ OTHER ' T F��^L O
��ti'� Ol�ji�s� Phone � s DESCRIPTION OF WORK/USE OF BLDG. B fiear N
' Address �sZ�%S'3- �CIiZD�/'� LUS M�e$/� %� �
� Arch/Eng. ���� LicenseNo. TVPEOFPERMIT GRADiNG FOUNDATIOrv STRUCTVRaL � K. Ri9ht G
Addre55 ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MEGHANICAL '� g� Left R
Contracmr's Nnme � �� Phone �� ❑�OTHEa Ping. Ref. # Perking Req./Provided E
Address (mailing) � L $(xi�! �^lN/-��� PR0.IECT DESCRIPTION 5�. F7. OCCUPANCv� p�anning Notes: M
�� �� CONSTRUCTIONTVPE V/+LUATION$ '�.Z.O .—� T
CityLicenseNo ZONE GRADINGCU.VDS. ACRES
LICENSED CONTRACTOR DECLARATION S'
• I here�y affirm that I am IicenSetl untler provisions of Cha�te� 9(commencinq Rema�ks:
with Section 7000) o( Divislon 3 of the Business antl Profes5ion5 Cotle, antl
,� my Iicense is in force antl effect. i�ap, � ELECTHICAL FEES
Licen e CI ss LI ens No. r o
� Date '� Z 5'9 t �
PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW
� WORKERS' COMP NSATION D LARAT N Bar Sink Showefs COns[rUCtion PoleSub. ❑ 50+ KW
I hereby affirm lhat I have d C¢rtifitdte o/ ConSent t0 zolf-inSurG Or a certificate -
workers' Com ensation Insurance, or a certifietl copy t�ereof (Sectlon Cooking Unit Meter ❑up ro 100 amps
� o, �ab. C. �--../ �� Backflow Preventer Service Sink
icy No. , 3 3�'� ComPanv -�-'✓iQ'�� /�✓/✓L7 Backflow Irrigation Sewer CaP Dishwasher Meter ❑over 100 amPs
�Certi/ietl copy Is hereby furnishatl. Dryers ❑Gas ❑Electric Sub Panel
Cer itietl copy 7 iletl wi[h the clry i Ing Divislon. Bathtubs Sewer COnnCttion
Oate! ��� � Applicant Motors �61 HP �1'h-8
E%EMPTION FROM VJORKERS' CO ENSATION DECLARATION Cld�ifiCrS $018f COII¢CtOrS Fdn
(Tn;s section nectl not be completetl i the Dermit i5 (or one huntlretl (y100) or F.A.U.
iesi . Dishwdsher Solar Piping Inc. Solar 9�75 HP 076-15+
I certify that in the perlormance of tbe work for which this permR is issuetl, I Fixtur¢5 �
snall not employ any person in any manner so as to become subjeci to the Drinking Foun[ains Solar Tank Microwave
Work<rz' Compensation Laws ot Californid. �
oate Signature Floor Orains Swimming Pool w/Spa Device Boxes Pole Light '
NOTICE: If, a/[er making ihis tleclaration, you 5houltl become subject [o the Outlets
WorkRs' Compen5dtion pfovisions of th¢ LdbOr COtl¢, y0u mu5t fof[bwith FIOOf $iOkS Ufip81 Rdn9¢
comply wit� such provi5ion5 or this permi[ shall �e Ueemetl revoketl.
CONSTRUCTION LENDING AGENCV �i Switches Sign
I h¢r¢Dy atfl�m that there IS a co05(ruttiOn I¢ntling agency to� [h¢ Petfo�mance d5 S¢rvic2 �Ud¢[5 Wdt¢� CIOSCL -
of the wolk to! which this p¢rmit I5 ISsuetl ($ection 3097 Civ. C.) IntEIC¢ptOfS Wdt¢f H¢8[Cf G2f62gC Di5pO5Zl SL80ding $2Cti005
Lentler's Name
�enaers natlress Kitchen Sink Water Service � Generetor 00.5 KW OS-75 KW Trash Compactor
OWNER BUILDER DECLARATION
I herc�y aHl�m Lhat I am exempt irom the Contracto�'S LicenS¢ l2w fo� the WvatO�i¢5 AUtO-Wdih
tollowing reason (Section ]033.5 Busine55 antl Professional Cotle: Any city or
tounty which �equires d permit [o con5truc[, alte�, imprOve, tlemolish or repai� P—Tf2p Laundry Trays
any structure, orior to its issuance, also requires the applicant for such permit
to file a signetl statement tbat he/ihe is Iicensetl pursuant to the provisions of Roof DfainS
the Con[ractor's License Law (Chapter 9(commencing with Sec[ion 7000) of
Division 3 of the Business antl Professions Cotle) or that he/she is exempt Reinspeetion Fee $15 Issue Fee $ 3
' "•re(rom and th¢ basis for the allegetl exemption. Any violdlion o( Section
1.5 by any applicant f0� a pe�mit Subjects tha applicant to d civil
� eity ot not more than tive nuntlretl tlonars (5500). DEVELOPMENT SERVICES REQUIREMENTS:
u I, as owner of the proper[y or my employees wit� wages az their sole Reinspeetion Fee $15 Issue Fae $ 3 .�Zoning ApProved By Date
�compensation, will tl0 th¢ wo�k, antl tne Sbu[hre Is not in[¢ntletl o� ot(eretl
� tor sale (Section 7044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES Building Approved By Data
Litense Law tloes not apply to an owner of a property who builtls or improves � �.L
` ther¢on, antl who tloe5 such work himselt/herself or through his o� h¢r own BQj�Q� HOOd Of T 21 ❑ %�PPliration ISSUed By Det
employees, provitletl that such Improvements are not Intentletl or offeretl for YP '
I sam. Ir, howeveq the bulltling or Improvement is soltl within one year of com- Canopy Type II ❑ 'SUM ARV OF fEES
pletion, th¢ Owne� wlll have the buttlen o� prOving ne/she tlitl no( builtl or im- Duct - Und¢/ Ciround ,�y�
i' � prove for me purpose of sale). �BUILDING PERMIT $ s' SMIP $ �, v
❑ I, as owner of the oroperty, am exclusivaly contractln9 with licensetl <on- Duct-Structural Refrigeration System ��P�AN CHECK $ PERMIT
Vactors to construct the projecl (Section 7044. Business anG Professions Cotle:
E_ Tne ConVactoYs License Law does not apply to an owner o/ property who Duct- Ventilating ❑0-100,000BTU ❑100,000 BTU PLUMBING $ ISSUANCE $
builtls or improves thereon. antl who contracts for such oroiects with a con-
tractor(s} Lcense pursuane to �ne Contractors License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration � P�N CHECK 25% $ ENERGV P.C. $
� prooi of tneir Worker's Compensatlon insurance shoultl be provitle0 to me. �ELECTRICAL $ GRADING $
, ❑ I am exempt untler Sectlon B. & P. C. �or this reason Firepl/Fact BIL ICBO # Fire Dampers � MICROFI LM $
PLAN CHECK 50°� $ ,/
� Date owner Heating System & Ducting Registers '. MECHANICAL $ Y� �J, S�
1 hereby certify that I have reatl this application antl state that the above ❑P700,000 BTU �100,000BT TOTAL FEE $
iniormation I correct. I agree to comply with all Uly ana <ounty ortlinances � PLAN CHECK 25% $
antl state 1 s elating to builtling consbuctlon, antl hereby authorize repre-
sentatives i t i city to enter upon the above�mentionetl Oroperty for
. inspectlon p �'�
Signature • Da[e � lT �
� Reinspection Fee S�5 �ssue Fee $ 3 OS OQ024204-Q002420� t�ro' 4�.,,D
Driverz' cense or SS $ r -+- - t c
0865-46, rev. 5/98 Whit¢ - Bulltling: Canary - Ap011cant; Pink - ACCOunting; GoltlenrOtl - HSsessO/ YHI C� U1/ 1L/23Y I 1�IG� li � IL
�. T,. �.
. _ , ,�
TRUCTION ANDPLANNING , POOL 'PA
Date Inspector Date Inspector
bVALS Permit # - APPROVALS Permit #
i
. Temporary Electrical Service or PoIA , 52. Pool &,Equipment Location .,
2. Soil Pipe-Undrgmd. �.',� �' ' 53. Steel Reinforcement �• n
3.'Elecfr�i�ca' Condui4�Utili�y-Undrgrn8. � ��� � 54. Forms !�'�
4. �Electrical Cond �t,Undrgrnd. '.�� 55. Electrical Bonding
5. �Steel Reinforcement � i '"� 56. Rough Plumbing & Preswre Test . � j
6. �Electrical UFER Grnd i �;� � 57. APPROVAL TO COVER-GUNITE I �
�
7..Footipgs ��'A i _ 58. Electrical Conduit-Undrgrnd. '
.8. Foundation ' �' 59. Gas Pipe, O Undrgrnd., Test "�
9rWa4er Pipe-UndrgmUi ` �� 60. Backwash Lines, P-Trap, � Undrgrnd. .-�•
10. �Structural Floor Sy�tem . , i . 61. APPROVAL TO DECK ���
1�1. Property,Sewer Line'& House Connection �" r 62. Backwash & ReceptorFinal �
12. Sewen Cap V I i "' � . 63. Heater & VenrFinal
,. -
13. Roof D�ains •� �' !� . � 64. Plumbing System - Final
14. Rough Plumbing � � �, 65. Electrical-Final �
i
15. Rough Electric5l-Conduit 66. Solar System-Final
,1�6: Rough Electric Wiring 67. Fencing & Access Approval
J17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
�18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
-75. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20r Rough Factory Fireplace . APPROVALS Permit #
21.� Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & l'est � 72. Underground Flush
24. Roof Framing �1 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & 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:
34. Final Heating & Air Conditioning (� �
35. Final Gas Pipe-Test fM -�G- O
36. Hood or Canopy
37. Final Fac[ory 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
. i,
45. Sound Attenuation . ,)
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING �. �
48. Special Requirements Completed
49. Electric Release to Edison
i •
50.�Gas Release to Southern California Gas Co ^ •�
51. CERTIFICATE OF OCCUPANCY .% '
N0. � Date ,r' n
�
�
ADD���anl to fill in all zpaces except ihose witnin heavy Eo�Ce� Iines anE sign all appro0�iate Eaclarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CITV OF CqSTA MESA CONSTRUCTION PERMIT ��5� �� /�,� � A.P. #�
Pro"�_A�ddre`� z8 53 CU�ppA L•M j
AppliE'anY,iAailingAddress�$S3 �u120DA C�.aSTa ME�A
'Owner'sName �D�iP=N19 ,Oii'MSON phone751_pe5.%
Address 5 C—u vl� p A
�
FjcelT/Eng. UD R� V 2. LicenuNoGE 2g•�f�
Address����.��oW EN 'JT �i�QpEN �7Ro�Y
Contracror'sNam�e y� M�°+O ��'��Qi$_ph�9neql�g�5Qo8
Addresslmailingl-�'+�2 k�L7EL�ROOr pf. M(fl'4T• �aµ
City License No. Z �3 �3
LICENSED CONTRACTOR DECLARATION
I hereDy affirm that I am Iicensetl untler provisions of Charter 9(mmmencin9
with sec[ion �000) o( Divislon 3 ot the Business antl Pro(essions Cotle, antl
my license iz in tul force and efiect ' I�q A_$ �
License Class Licenza No. 'Y
Date tQ'� _ $"5'9 t '1(i�Ld//h�""a
WORKERS' COMPENSATION D LARATION
I hereby affirm tnat I have a certiflcate of consent to self-insure or a certiiicate
't Wo�ke�s' CompenSatiOn InSwance, o� a cecrt,,l(Ietl coyp.�y the�reot ($ection
oo, �b. ,�.��3 3 p L Companyo(�LLCJM.
olicy No.
�Certifietl caOY �5 hereby fumishetl. " �
Certifietl copy is filetl with the city 'Itling Divizion
o,ce i0-•(-- 9' st- qpp�iGdnt
EXEMPTION FROM WORKERS' CO ENSATION DECLARATION
(This section neetl not be complete0 it the permi[ is for one hunaretl ($300J or
less).
I c¢rtity [hat in the performance of th¢ work fo� which this pe�m�t is issUetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Ldws of Calitornia'. '�
� Da[e Si9nature
NOTICE: It, after making this tleclaration, you shoultl become subject to the
Workers' Compensation provisions of the Labor Cotle, you must torthwith
complY �+��h SucM1 p�ovisions or thi5 permit Shall be tleemetl tevoke�.
CONSTRUCTION LENDING AGENCV
I hereby attirm that there is a construction lentling a9ency for the pertormance
of the work tor which this permif is issuetl (Sectlon 3097 Civ. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILOER DECLARATION
I hereEy affirm Lhat I am exempt from the ContractorY License L.aw for the
following reason (Section 7031.5 BuSiness antl Professional Cotle: Any city or
county which requires a permit to construct, alter, Improve, tlemolish or repair
any st�uGtu/e, p�ior to its issuanc¢, also �equires the ap0�icant f0� such pe�mi[
to file a si9netl Stat¢ment that he/she Is licensetl pu�sudnt to the p�ovisiOns oi
' the Contractor'z License Law (Chapter 9(commencing with Section 7000) of
Division 3 of the Business antl Professions Cotle) or that he/she is exempt
;: f.�herefrom antl the basis for tne alle9etl exemption. Any violation of Section
,rz131.5 by any appliwnt tor a permit subjects tlte aOP���ant to a<ivil
"'nalty ot no[ more Ihan five huntlretl tlollars (5500).
-"'t� I, a5 owne� of the p�operty o� my employee5 with wages as thei� sole
compensa[ion, will tlo the work, antl the struciure is not intentletl or offeretl
tor sale (SeCtion 7044, Business antl PrOfessional Cotle: The ContraGtor'S
� License Law Coes not apply to an owner of a property who bulltls or improves
'� thereon, antl who tloes such work himself/herself or through his or her own
I� employees, provitletl that such'improvements a!e not intentlad ol otter¢tl fOf
sdle. If, nowever, the builtlin9 or ImProvement Is soltl wlthin one year of com-
pletion, tne owner will have the burtlen of proving he/she tlia not builtl or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contractin9 wlth Iicensatl ton-
t�actors to Const�uct the project (Sec[ion �044, Bu5ine55 antl Profe55ion5 Cotle:
The Contractor•5 License l.aw tloes not apPly to an owner of property who
builtls or imoroves thereon. antl who contracts for such oroiects with a con-
tractor(s1 I�cense pursuan[ ro rne Contratior•5 License Law). I am aware t�at
p�oot o( tbelr Wo�ker'S Compen5atlon Insutance Shoultl be provitletl to me.
' L7 I am exempt untler Section B. & P. C. for this reason
Date
1 hlreby certify
iniormation is cc
antl state laws n
sentatives oi th
inspection purpo�.
ignature
DNvers' Liceaze�
OBfiS-46,rev. 5/88
_ Owner
iat I have reatl this application antl state that the above
�ct. I agree to comply with all tliy antl county ordinantes
ting to builtling construction, an0 hereby authorize repre-
' y to enter upon the above-mentlonetl property for
Date �`" ��
55 � � ���`�-/
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMHING ❑ MECHANIGAL
❑ OTHEF
PROJECT DESCRIPTION S�.FT. ocCVPANCV -
CONSTRUCTIONTYPE � VALUATION$ �
ZONE GRADINGCU.VDS. ACRES
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks '
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap
Roof Diains
Reinspection Fee
$75
Duct-UnderGround
Duct - Structural
Duct - Ventilating �
Exhaust System ❑ Multiple ❑
FirepUFact. Blt. iCBO dk
Heating System & Ducting
❑0.100,000 BTU 0100,OOOBT
Reinspeaion Fea � $15
Wnite - Builtling; Canary - Appllcani; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap .
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash �
laue Fee
Hoodor Typel ❑
Canopy Type I I ❑ �
Refrigeretlon System '
❑aioo,oaosTu ❑ioo,000ar
System Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES
§ 3
$ 3
S Main Buildi
E
T Front
B Rear . a
A
C Right
K . Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole
Cooking Unit
Dishwasher
Dryers ❑Gas �
Fan
F.A.U. ..;� `.
Fiuture5 { �''
Device eoxes
OuLleti
.- Zone
Accessory Building: � `�,
2
O
N
I
N
� G
R
Parking Req./Provided E
i� �
M
T
✓� s.
�c�m
EL--ECTR AL FEES
� Transformer ❑ 15-50 KW
❑ 50+KW
Garbage.Disposal. � '
Generator �0-5 KW 05-15 KW
Reinspection Fee � $15
Meter Oup to 100 amps
Meter ❑over100amps
Sub Panel
Motors O0.1 HP O1'f, - B
Inc.Solar �9�75 HP �16-15+
Microwave � • �
Pole �ight
Range
Si9n
Standing Sections
Trash Compactor
luue Fee
$ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zonine APP�oved By Date ��'�" SS
Building Approved By � - Date
� Application Issued By Date % b- 3%-8�
' Sl� M RV OF FEES
BUILDINGPERMIT $ � �Da SMIP $ /• ��
PLAN CHECK $ PERMIT
PLUfyJBING $, � ��UANCE $
PLANCHECK 25% $. ENERGVP.C. $
�ELECTRICAL $ ' � GFiADING $
PLAN CHECK 50% $ � MICROFILM $
MECHANICAL $ TOTALFEE $ / �'3�
. 1 .� PLAN CHECK 25% $
. 01 (IOD18'ali-Q001�312 7C��' '� /
- i`.ATE: IO/31!°u8 TI11E: i5:4'
CONSTRUCTION AND PLANNING
�APPROVALS Permit #
2
1�� Ter�porary.El'ectrical Service or Pole
w ;
2r�Soil PipB-Undrgmd. �i
_ i + '1 .
3� Electricel �oc�cjuit Utiliry-Undrgrnd:
I-UFER (ii'nd. � �:
7.' Footing's � � ' ' • � �
8T FouR{lation �I _ �
93' W�te? Pl�e-UriSiryrnd. .i�
10.,St�uctufal Flqor System !'
11:Property$�wer Lin��& HouseConnection
12.SeweOCaPf E��j,_ .:_.
. �• Li-
1 3. Roof�Drair�5 ,? ��� °_� ',�r
�. �
14. Rough Plum��incf , � ''~
15. Rough Electrical-Conduit
i'6. Rough Electric Wiring
17�. Rough Wiring Sign
18: Rough Electrica6T Bar Ceili�g
19t Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure � .
22. Ducts, Ventilating ��- +
23: Gas Pipe-Rough & Test '� -,�
. ��
24': Roof Framing '•"� '
��•.
25. �Roof Sheathing i�'• � J
r r
26. T-Bar Ceiling (Structural) & Mor�coat
27.•� rameand Flashing
28. Lathing &.Siding '
29. Insulation �
30. Drywall Nailing • �"�!
31. Plaster Brown Coat� •
32. Electrical Power Meter-Final
i•
33. Final Electric �• �
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
,3G. Hood or Canopy �
' 37. Final Factory Fireplace
38. Final Plumkiing . �
1
39. Water Service-Final i j
'40. Gas SerJice-Final i • -
41. Solar pomestic-Final . ,
4�. Backflow Preventer '
43. Backflow Irrigation �
� L
44. Landscape Irrigation SYstem
45. Sound Attenuation ,
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. F�lectric Release to Edison
50:�Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Jo. ate
�
Date
��
�
POOL ?A
Inspector p�ppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
5S. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. 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
6S. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Undergraund Hydro
71. Product Piping � Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storege Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL'
78. FIRE PREV. FINAL
� HEALTH DEPT. REQUIREMENT
�l
/ 79. FINAL INSPECTION
S0. FOOD CERTIFICATE ISSUED
Notes: .�,o...... ' _�. -.,_ .,�
i
Date � Inspector
; .:
i ,
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"ITY OF COSTA ME�'�
-�:ALIFORNIA 926284200 P.O. BOX 7<u0
Insulation Certificate
� �'�� �v/'d/.� �� � � �1c--�,�
x�„n� � s�e� �/ �1 csty
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County Subdivision Lot Number
Description of Installation
ROOF
Ma[erial Brand Name
'lltickness (inches) 'Ihertnal Resistance (R-Value)
EXTERIOR W_—A�LL
Material T/�6.�rHqSS BrandName �IUE/�'s ��4/Y/�"�
'Il�iclrness (inches) ? i/, // 'Ihem�al Resistance (R-Value)
'—G�—
CEII,ING �ct>Gi✓S//� G���'i n�d
Batt or Blanlcet Type T y' Brand Name �B�/�S / v! /d /Y //�GG �
'ItiicFa�ess (inches) '� 'r 'ILertnal Resisrance (R-Value)
I.aose Fill Type Brand Name
Contrxtor's minimum installed weight/ft lb Minimum thiclrness inches
Manufact�er's installed weight per square foot to acheive Thermal Resistance (R-Value)
RAISED FLOOR
Material
Tliiclrness (inches)
SLAB FLOOR
Matecial
Tl�ickness (inches)
Width (inches)
FOUNDAT[ON WALL
Material
'Ihickness (inches) _
Brend Name
'Ihertnal Resistance (R-Value)
Brand Name
'Ihermal Resistance (R-Value)
Brand Name
'Ihermal Resistance (R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in confonnance with
ffie current Building Energy Efficiency Standards for new residenual buildings contained in TiUe 24 of the
Califomia Administradve Code.
� M�'� �� � p c r� s /'8�9f� �
Generel Connactor (Builder) Licefae Number
� �%� .�wfi �- y� - 8�
�—�ignatute end Title Date
Licrose Number
Da�e
OWNER
JOB AC
SOIL
OUGH PLUM9ING
ROP. SWR. IINE
PftINKLING SVST
NEATING ANO AIR CONDITIONI
RAflY SLRVICE OR POLE
�ROUNO � POWER ❑
WIRING
BOND BEFM U STE
SHEATHING
FRAME ANO FLASHING
LATHING - IN n 1
PL "TER, 9ROWN COAT
5 (URAL. FINAL
DATE 9_�j_�j
BUILDING PERMIT N0.
SUBCONTRACTOR
- Pa,° i 0.5C
- �Q�1�J. ` '�P 73-75�,.s-00105�'� *,:�*
CO O7 BOXE 200 c�0 D�a M SaFCn I ORN�IA 9 626 T��O ✓ 79
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use [nk Only
ftECEI OATE FECEIVED D E I�ED
BUILDING � ,/� l
ADOflESS Tl G
�O ` I _. � l� � 3 .� �../ ER
OWNER A.P. NO.
MAIL �1 n r.. C' i 1 n_ O A BUILDING �OJ J L�.l2Q0? �� �
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OWNER
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FIRE
ZONE VP
/' APPROVED
�� �p� BV
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CITV / � NO�
� c No, Na1-Avaf JAb�P. LICVNO. ��
OF �OT 7 O'/\ I D S � NOW ON LO �
ezisTiN� e�oc. � ti c- �L n S ec•� p�7' ! D
Separate permits are required for
- electric, plumbing and heating work.
USE OF BVII�ING AND WOfiK TO BE PEFFORMED
�'JNS`���-�/�-l�ON Q'F L;Vr/osed Pa�'o
iA-lvr,�N✓� �
I hereby acknowletlge thet I have �eetl this application antl state
that the above information is correct antl eBree to comply with
all laws fegulating builtling conrt�uction, end I shall not employ
any person in violation of the workman's compansation laws of
the State ot Calitornle.
I hereby certify that I am properly Iicansetl as a contractor under
che State of Californie Business entl Professions Code, Division 3,
Chapxer 9, and that such Iicensas ere in tull forca and effect, or I
am exempt from the provisions of tha State of Californla Business
antl ProfBssions Cotle, Dlvision 3, Ghaptar 9�
Signature �
PermltteB �
Authorizatl Agen
ZONfy ��]" INO.OF
/� 1 PLqNS �
VARDS APPfiOVED
DISTANCE BET
THEAMOUNTS
THE PVRPp6E Of
VALUATION
$ �OO ''
/VALUE O � QO
S o �
�
GROUP
DATE ���
/ ��
E OF NEW EN.�'-LC,
ILDING pR.T� b
VARDSAPPROVED
.CCESSOPV BUILDING
BET. MAIN &
ACCESS. BIDi
DATE
APPROVED
JN UNDER VALU
'ABIISHING A PERI
PERMIT FEE S
PLAN CHECK $
TAX $
TOTALPAID $
n
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� N
JN IS FOR m
=EE ONLY: "
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OWNER PACESEPTEE2 WE3P JOINT VEE[�TPPPURE DATE 3-22-63
JOB ADDRESS 2 53 �ropa Drive BUILDING P�RMIT NO.
G&NERAL CONTRACTOR AnArna T.anA Cc�mna.nv VALUE S 22. SQ2.00
AP No.
I 'ECTIONS
LOT '2$ TftACT l}3!�$ FIRE ZONE DESCRIPTION OF WORK res a.tt gST
DATE � GROUP �� TYPE v 7.ONE
SUBCONTRACTOR I DATE NUMRER
;
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C48TA MHBA� CALIPORNIA
For Applicant fo Fill In Completefy
TYPE OR PRINT - a
BUILDIN6
ADDRESS
COSTA MESq, LIFORNIA
� ARCHITEGT
NO. OP BLOO6.
ezis m� e�.ou.
BETBACK LINE PROM G
DESCRIPTION OF WORK
■ EXTERIOR WALL
I HEHEBY ACKNOWLEO�
ANO BTATE THAT TH8
PLY WITH ALL CITY H
BUILDINOCONeTRU IC
SIGNATUREOR �
PERMIttE
AUTHORIZED AGENT
70
� I HAVB HEAD TN18 APPLICATION
19 COHPECT PNO A6REH TO COM-
�E8 ANO BTAT$ lAWB q80ULATINO
FEE REC��.VEU
�MAR 2 Z
FINANCE DEPT.
APPLICATIO��F,Oljl{PE61,rQiA MESA
BUILDING
For Office Use Only
R[CCII✓l NO. P6N % ry% �
/
Y DAT[ R[CHIVBD OATE199UED
."�/��<.�. MAR22.toa•
F�ae
ZONINf3
z / r+o. op u
vuna wi
�
LEOAL �/L . . ) 1 !'�
YARD9APPROVED
MAIN BUILDINO
VAR.#
BHALL BE LE9S THAN
YAR�SAPPROVED
ACCESSORYBUILOIN6
BET. MAIN 8
ACCE55. BL[
DATE
7�/�64.FY. �J (%�Ar m
TX8 AMOYNT BHOWN UNDBP VALUATION 19 POP TH8 F
PURP098 OP 88TABL�BNINO A PERMIT FE6 ONLY. 0
VALUATION � — ry
PERMIT FEH $ �
$ �a 59a_ .� - �
¢
0
J /D�� LL
TOTALFEE $
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