HomeMy WebLinkAbout155 FLOWER ST - Building Permits , T `9 CITY OF COSTA MESA
4 BUILDING DIVISION
. i .4. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
lotPERMIT /
Sbmanaano se
M06 00010
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 155 FLOWER ST Status: ISSUED
Suite No Applied: 01/13/2005
Issued' 01/13/2005
Vicinity: •
Parcel Number: 42523318 _ - ._ ISSUED BY: 4:
Applicant: RODRIGUEZ,IDLEFANSO -
Address: 7050 LAMPSON'AV- • ' I ' - ��
Phone:i 714-530-7320 " ! ' , ,<'
/GARDEN GROVE,CA Zip:--- 92841
Owner .ADAMS,RYAN
Address: 2412 LOS OLIVOS LN
- Phone: 949-5009771 / / - J
' LA CRESCENTA,CA Zip: 91214-3130
,1. c
Contractor ' EMPIRE PLUMBING \
Address: 7050 LAMPSON AV ' . , ^
' Phone: 714-530-7320 ,
•GARDEN GROVE,CA Zip: 92841 • - - -
•
• . - License:794154
, i
SCOPE OF PERMIT
REMOVE FAU AND REPLACE WITH 35K BTU7.AT THE SAME LOCATION: _
' - -
•
FEESUMMARY .
' Quantity •- Quantity
ISSUE FEE -' $23.50 . Repair/Alt Absorbtion Unit 1 $0.00 0,
Inst _FAU<100 k BTU, $14.80 -1- - -• . _ t' .Repair/Alt Refrigeration Unit • *$0.00' - 0.
Inst.FAU>100.k BTU. $0.00 0 _ -. , _Ventillation System $0.00 0 1
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler
Inst I.Rep.Recess Wall Htr $0.00 0 Commercial Incinerator . j $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator / ;$0.00 0 i
Refrig Sys>100 k BTU •,'-‘, $0.00 0 Compressors-/Absorption Systems 2://:•••
Gas Piping �.. - $0.00 0 .2......":"-s-‘. '- 1.1.Up to 3 hp/100 k BTU � �;. i $0.00' -0, .,
' Factory Fireplace.- $0.00 0 `3-To-15 hp/500 k BTU i.v/ -$0.00 0
Hood w/Mech Exhaust _ $0.00 0 •- . 15 To 30-hp/1,000 k BTU ,-;',/.7 " , $0.001 -0'
VAV Box ' • $0.00 0 - ' - 30 To 50 h /,1750 k.BTU - %" $0.00 .0
Vent Fan/Single Duct- $0.00 - 0 • - _ Over 50 hp/OJer'1',750 BTU- ' - $0.00 • 0
Appliance : • $0.00 0 . Boilers
Fire Dampers $0.00 0 Up to 3 hp. ,, - /$0.00 0
Smoke Dampers' • $0.00 0 • /,,,->•-c//
;> x$0.00 0
Inst or Relocate Appl Vent, $0.00 '0 - '• _ ' 15 to 30 hp ; - $0.00 0
Air Handlers< 10000cfm./ $0.00 0 ---",,I"- - - 30 to 50 h' ' A t • '�
p- ,/ i $0.00 0
Air Handlers> 10000cfm. $0.00 ,0 . Over 50 h .-' <../ ,/ $0.00 0
Floor Furnace " $0.00 0 _ Other Me hanical.Fee ' " „%%
Floor or Suspend Heater - $0.00 0 , Investigation Fee' %"jl $0.00
Plan Check Fee' H : $0.00
'
• ' Reinspection Fee G/-j•- $0.00
-_ - - - - _ . -TOTAL CALCULATED FEES $38.30
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
-work for which this permit is issued.
• I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
(,�My w rkers'compensation Insurance carrier and policy number are: L
Carrie' A Rem/c/a✓P y([/oLi Policy Number:"0371 Roo VX
(This section need not be comp eted if-the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with.these prrction�j _m..
Applicant Sig ature: �-:L i 7/.(�,� ��'���J�j/�))T 'Date:.; /3 q 6
WARNING:FAILURE TO SECURE WORKERS'COM S�.TJ,pN ERAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOYER TO CRIk PENAL ES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE cT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm.that I,am liens nd r pr.visions of Chapter 9(commencing with Section 7000)of Division 3 of the Business an. Professions Code,and my I'cense Is in full
force and effect:Llclk) '"
Contractor's Signature: • / -Date: i
1
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
. license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec.
341,lttle 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
B (If Nee',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 state laws and city ordinances relating to building construction,and authorize representatives of the City 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 permit until final inspection.
Signature Of Legal Owner(s) ate
nd/ Au zedrApplicant :13.
cODE I INSPECTION TYPEDAn INRRALS CODE I INSPECTION TYPE rx D!u rill 1818 Fixed System Final Fire Prevention 206 Final Mechanical 1 'a C7"Q 5 r r4
1288 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
•
r PROJECT ADDRESS: 155 FLOWER ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 061467
OWNER'S NAME:WHEELER, ROSE L TR
ADDRESS: %SEROTE JANICE PERMIT NO: E 061467 PLAN CHECK NO: N GOVT: N SUPP: N
2412 LO OLIVORS
LA CRESCENTA, CA 91214 CONSTRUCTION TYPE: 5—N PERMIT TYPE; ELE PURPOSE: OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ELECTRICAL SERVICE CHANGE OUT SQ FT:
ADDRESS: UNIT:
CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 /
PERMITTEE: PALMER ELECTRIC ( 714 ) 548-9457
ADDRESS: 783 NEWTON WY COMMENTS : NO ' B ' PERMIT INVOLVED
COSTA MESA CA 92627 *******>FSE***********x> *** * x-> **:< **** *+E*t *** * :q.x*.>E.x..********** ***x*.x-*.U.><.x..x.*.>E
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed der provisions of Chapter 9(commencing with Section Z ONINGS ER1'ERQAUC I SETBACKS E M E N T' S
7000)of Division 3 of the Business and Professions Code,and my license is full force and effect.
CITY LIC. 39402 STATE LIC.:477402 (�CLA 'C-10
`, Date: 2Z Signature: 9 MAIN BUILDING ACCESSORY BUILDING
/ WORKERS'COMPENSATION DECLARATION: I hereby affirm t t have a Certificate of consent to sell-insure or a certificate 01 Workers. FRNT: FT IN REAR; FT IN FRNT: FT IN REAR ; FT IN
Compensation Insurance.or a certified copy thereof(Section .Lab. C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 42628116 ZNE: REF NO:
D Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: ********************************:**9F*:***1E%***!E*3E*%***fE*iEfE1(***3E**********1F****If**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be mplete if the permit is for one hundred($100)or less). D E V E L O P M E N TJr;4E`,R. VICES C E S REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shall nrnplo any person in any manner so as to become • : l
_
subject to thP�Workers'Compensation Laws of California. / r ZONING APPROVED BY _ , i DATE;
Date: �' Signature:
NOTICE:If.after making this declaration,you should become su Jyle to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY / ./ DATE:
Code, you must forthwith comply with such provisions or this plf t shall be deemed revoked. / 1
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a nstruction lending agency for the performance of the work for APPLICATION ISSUED B Y• i •.f -.' DATE• 3122(q
which this permit is issued(Section 3097.Civ.C). **)(-*******)E**i(-**lE*)(-*****************Lf*****K7r*3L- it*******fe************3rxir+rir*-***.**
LENDER: ****************!f******************:*LE*******************iE*******Ik*****9(********
ADDRESS: LEGALIZATION: N F E 'E' SUMMARY STRUCTURAL SEGMENT; N
/, f
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 1 8 , 5 0
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed S 0% SMIP/NON—RES
pursuant to the provisions of the Contractors'Slate 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 PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DI V—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 18 . 50 15 . 00 0 . 00 33 , 50 33 . 50 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his roher mnt is employees.provided that mpl ion.the nts are not intended bddeoof pr lir sale.If, id not d rbuildingmr or REVENUE DIVISION TOTALS--> COLLECTED: 33. 50 OVER/SHORT; , 00
improvement
rptheepurpoof sawithin one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING PLAN—CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts tor such projects with acontractor(s)license pursuant to theContractors'Slate License Law).I am aware *****************************************************************************-**
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: owner: ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18 . 50 18 . 50
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: '
I hereby certify that I have read this application and state that the above information is correct I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize repesentatives this city to enter upon the above-mentioned
properly for ins' 2.-
purposes
Date: �2 Signature'. t • 1
Drivers License 01 Social Security ,./ C /`Z: .. . ,, :IF , I
1641.46 White—Building:Green—Code Enforcement:Canary-Applicant:Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING- POOL d SPA
Date Inspector Date Inspector
• APPROVALS Permit # APPROVALS Permit #
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-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57.!APPROVAL T0COVE R-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 2 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. -' _ • 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
10. Structural Floor System.__ .- t "i 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
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70, Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
2-3. Gas Pipe-Rough & Test 72. Underground Flush
• 24. Roof Framing 73. Undergrnd.Storage Tank 0 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 & Sidingi ' 77. FIXED SYSTEM FINAL
29. Insulation I 78. FIRE PREY. FINAL
30. Drywall Nailing l HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I I 1 7e FINAL INSPECTION
32. Electrical Power Meter-Final (!3 • !or FOOD CERTIFICATE ISSUED
-t- '
33. Final Electric N-.est
34. Final Heating& Air Conditioning 1
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace I �(
38. Final Plumbing I-
39. Water Service-Final ' I
40. Gas Service-Final �
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap RegulationsI • r
47. FINAL STRUCTURE & BUILDING I I
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
I .
, Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
- CITY OF COSTA .'MESS/ CONSTRUCTION P RMIT • PEIT NO, � TRACT NO. • LOT NO. UNIT NO.
o?J DO A.P.# • IZone
Project Address' J /��fact- S _ - -,H-
Applicant's
{(/�(��� III S Main Building: Accessory Building:
Applicant's Mailing d rress /✓ 1ecO TYPE OF CONSTRUCTION U NEW a ADD H ALTERATION REPAIRE
•
q �� / w95 �.5 ❑ CONVERSION -❑ DEMOLISH ❑ OTHER T Front - - -
Owner's Name //f/��//y�� Phone ta'7J 01�7I DESCRIPTION OF WORK/USE OF BLDG. - - 8 Rear N
Address Sr'l.//l.C/ \ A I
1 C Right N
Arch/Eng. License No. - TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL K G
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL - $. Left Fi
Address I S ❑ . THER Ping. Ref.# Parking Req./Provided E
�4 LII I / ; Phone
Contractor's Nam ? ?SeriPROJECT DESCRIPTION SQ. FT. - OCCUPANCY O
Address(mailing) � ,_ 'v,� CONSTRUCTION TYPE VALUATION$ Planning Notes: M
City License No. ZONE GRADING CU.YDS. ACRES tp p
LICENSED CONTRACTORDECLARATIONRECEIVED JUN IJH.7 $
l.hereby affirm that I am licensed under provisions of Charter 9 (commencingRemarks: -
with section 7000) of Division 3 of the Business and Professions Code, and
My license is in full fesN •`✓a•d effect. /n�7 'V ELECTRICAL FEES
License la R / i- i 'ce a N•. 4l(/ r5jj / - - _
Date /" Mali Signature������ _ L Lai - PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
i WORKERS'COMPENSATION DECLARATION •Construction Pole Sub. ❑ 50+ KW
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers
'f Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter Cup to 100 amps
300, Lab.,�.) �n '�J��q e Backflow Preventer Service Sink _
I olicy No. /QJg3U-$9 Company V:! I �"" w\ Backflow Irrigation Sewer Cap Dishwasher • Meter Dover 100 amps
\ li,,CertCertified copy is hereby furnished. Dryers ❑Gas', Electric Sub Panel
ert�'�jjietl J({��p is_flletl with the city B in is n// //,/ Bathtubs Sewer Connection _
Date (Q'IU • s5 Applicant _�E/LL///L/ Fan Motors❑0.1 HP 01%-
EXEMPTION FROM WORKERS'CO ENSATION D ARATION Clarifiers Solar Collectors
(This section need not be completed if the permitisfor one hundred ($100) or F.A.U.
less). Dishwasher Solar Piping Inc.IncSolar 09-15 HP ❑16-15+'
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 Drinking Fountains • Solar Tank FixturesMicrowave
Workers' Compensation Laws of California. Device Boxes '
Date Signature Floor Drains Swimming Pool w/Spa r Pole Light ' •
NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor-Code, you must forthwith Floor Sinks Urinal Outlets Range
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign '
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.) Garbage Disposal Standing Sections
Lender's Name Interceptors i Water Heater
-
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
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 Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of -
Division 3 of the Business'and Professions,Code) or that he/she is exempt - - -- Reinspection Fee I $15 Issue Fee $ 3
"terefrom 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
fillik
natty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
� -t , as owner of the property or my employees with wages as their sole Reinspection Foe $15 Issue Fee $ 3
L nsation, will do the work, and the structure is not intended or-offered Zoning Approved By Date
f comp =(Section 7044, Business and Professional Code: The Contractor's MECHANICAL L FEES Building Approved By Date
for sr...,"L[dw who not apply to an owner f a property through
builds or improves.
erese L rlqd.who does such work himself/herselfs or In ends his or her own Application Issued By cip-Dat
thereon, .fir ovidth that such improvements are not Inwithin or offeredof c for Boiler Hood no oy Type ❑
employees,ho p .s the llbuilding dof pro i sold within one yeariof rem- -- 'Canopy Type II 0 SUMMARY OF FEES
sale. If, thwi, ill have the burden of proving he/she did not build or im- Duct-Under Ground
prove thetowner s '.ot sale). • - BUILDING PERMIT $ SMIP $
prove for wn r the
erty, am t7 44, contracting ing with licensed ode- Duct-Structural • Refrigeration System _
0 t rs owner of ct P, ect (Sections 7044, to
and Professionsfproperty
Code: _ PLAN CHECK $ PERMIT SUA
Thetors t actor's L the eri, d wh not gra t to rans owner ie pro ithta who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU $ 5�� ISSUANCE $
The Contractor's License 'La who contracts for such oroiects with a can- PLUMBING
builds or improves thereon. yo-,aecontractor's License Law). I am aware thatExhaust System D Multi le ❑ System Re PLAN CHECK 25% $ ENERGY P.C. $
' tractor(s) license pursuant to the .e,:.lon insurance should be prowled to me. P pair/Alteration
proof of their Worker's Compensatls., ELECTRICAL $ GRADING $
B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers
❑ lam exempt under Section--t B. - PLAN CHECK 50% $ MICROFILM $ _ •
Owner -7.,. - Heating System&Ducting Registers MECHANICAL
Date ut.;ation and state,that the above ❑0-100,000 BTU 0100,000 BTU $ TOTAL FEE $ ��
I hereby_ certify that I have read this app ,SII cityand countyordinances PLAN CHECK 25% $
information is correct. I agree to comply with andherebyautorize repre-
the state laws relating to building construct ion.'rve-mentionetl property Pfor
sentatives of this city to e ter pon [he ab.. P p h p
inspection atre purr;/" ,/ ' :Date "/V Q-/ Reinspection Fee $15 Issue Fee $ 3 01 00035625-00035625 TOT 5.00
Drivers' License or SS 9f • - DATE: 06/19/89 '55
TIi7E: IQ.
0865-46,rev. 5/88 White - Building; Canary -Applicant; ?Ink -Accounting; Goldenrod - Assessor
. . . . . , . _ ,
11 '' t PA
•
• CONSTRUCTION AND PLANNING POOL, 4 •
- -
APPROVALS Permit# Date Inspector Date Inspector •
APPROVALS Permit t.•
1..Temporary Electrical Service or Pole 52. Pool & Equipment Locati-.ri-n-
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �•.,�_
3. Electrical ConduitUtility-Undrgrnd. - 54. Forms
4.'Electrical Conduit-Undrgrnd. - - 55. Electrical Bonding _ '
'II__5..Steel Reinforcement • , 56. Rough Plumbing & Pressure Test
6. Electrical UFER-Grntl. • - 57. APPROVAL TO COVER-GUNITE r
7. Footings - • 58. Electrical Conduit-Undrgrnd. t
MA.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test °.,,
9. Water Pipe-Undrgrnd. T 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
,20: Rough Factory Fireplace APPROVALS Permit#
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 0 Gas 0 Oil af
25'.1 Roof Sheathing 74. Overhead Hydro
26: T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 1 77. FIXED SYSTEM FINAL '
29. Insulation 78. FIRE PREY. 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
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing 7(211‘51 (,,gip
39. Water Service-Final - '
40. Gas Service-Final '
41. Solar Domestic-Final j
42. Backflow Preventer �••r•f n •
43. Backflow Irrigation a •�
n .
44. Landscape Irrigation System j
45. Sound Attenuation ' -? !-1'
46. Handicap Regulations... - •
47. FINAL STRUCTURE& BUILDING •
48. Special Renuirement5`ompleted
49. Electric Release to Edison
r -
50. Gas Release to Southern California Gas Co -i; VA--
51. CERTIFICATE OF OCCUPANCY =-+--•
No. Date - '/
w
for
Q 808 FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT• // ASA?
P.O. 317 NA! CE DEPT.
COSTA MESA.A. CALIFORNIA - RNA!
FOR APPLICANT TO FILL IN APPL iFIrONAF& PERMIT
BUILDING /.) S 9 a cLX BUILDING
ADDRESS
��/OSTA///M'EISA./(�fCCALIFF/ORNIIA////////// / q FOR OFFICE USE ONLY
OWNE1 -�l"A-/'C/(J // ✓.- /JLI�/liC/l 6/2 2t RECEIPT NO. ^VP'FN�MIT No
MAIL //nn , , ` / Xr'jJ(ly�lite./ RECEIVED BYDATE RECEIVED/ (S_•][ DATE CISSUED
ADDRESS
/�,/615-''�/7�/F/ etza-14 QL ......--",--7--- /7�/i S, ,,,-oZ G, -.Se
BUILDING
CITY UCLY�C�/ 19'Z! �J TN04iesi-4/3� ADDRESS
ARCHITECT LIC.ENGIN
OR ENGINEER NO. COSTA MESA. CALIFORNIA
FIRE
ADDRESS ZONE
ZONE NO.OF TYPE GROUP
,,..s ,^,,n, '9 � // CITY LIC. 1-T 4. PLANS I /
CONTRACTOR �W/LVG/ NO. l 3 I< (/
ADDRESS/S5 tet eilbyh 716A/ 5- /da BPPRO VSa pp a CYT !; ,BE .
LEGAL LOT (�/ �'Sy C CORRECTIONS� iJ�'j
DESCRIPTION NO.sJ/4 BLOCK /3 TRACT3 7 7 CITY OF COSTA MESA
A.P.NO. / f 7 *--- 1 ., 3 - /7 PLANNING DEPT .
SU
512EUJttU' IBLUO. UtVI. Ht.
OF LOT iO 3� NOW ON LOT / i
f) / rvo.OF SLOGS.
.
EX STUNG Lfe /A_ • K.—/ / . . 4,„,f�• /.r/ II e C.
SETBACK LINE FROM
Q PLAN TeCH.
-
CENTER OF STREETREAR YARD
SIDE YARD RIGHT 22 ft LEFT J
DESCRIPTIO OF WORK
NEW ALTERATION ^ ADDITION r �I 'I L/• ®/��/ j
/ ` • i .08lit��a Mesa
l0 •
rte,
REPAIR MOVING DEMOLISH T III �Id /j
BUILDING °K2 ..jj�� NO.OF Jl "lll\\\)11
SIZE ' ROOMS STORIES / �i gy /I�p✓ I i-9`=
EXTERIOR WALLL� �� ROOF Sy .f v./ L
Plane tI®t �„n t
COVERING n7DOVE1JSE OF aliTiuena Mak noeke SQ
With-
BUILDING ��iGe�j^^7�- �Q:.GG�C/ �/J�
tout prioraPPro�l®f Dept.
CSG C� .f-9' Z- e4,GCd/lam ee�G�;'/ �/ �ill
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND // _ 'f' 1"L—QL_
STATE THAT THE ABOVEANIS CORRECT AND AGREE TO COMPLY WITH ALL ��L/1�. C/�/,
CITY ORDINANCES AND ATE LAWS REGULATING BUILDING CONSTRUC,
TION. e-227#5
/' /A� /y,{,'/� / �/ ' / VALUATION
S RMITUfE SIGNATUOF �-G�L.(5/ /'-'•Kd`--d( 72� n - ��v7 PERMIT FEE 5
e-�l✓ PLAN CHECK S
S /
AUTHORIZED AGENT TOTAL FEE $ 473 -- 'I'll
1 A
/.\ -
la it 10413
COSTA MESA BUILDING-SAFETY DEPARTMENT FE RECEIVED
P.O.BOX 317 COSTA MESA.CALIFORNIA V/ CI
IZ 4C9
FOR APPLICANT TO FILL IN COMPLETELY APPLICATISMN RQ MIT,
TYPE �O OR PRINT B�rk& ESTA MESA
BUILDING /•5 /. �w",� 1 '
ADDRESS 5 �Gz'V'eij FOR p
C/j,�'JCO�STA/I MESA,nCALIFORNIIA OFF/CE USE ONLY
OWNER rZCL[.t&-4M. (�[�((i.",i. RECEIPT NO. I� �PEfIM4'I�lQ.
MAIL jr- ,. RECEI�j(EDeBY DATEATiRECEIVED ,i TE ISSUED
ADDRESS /5-S .�Jj7'4�1�-�_�r�- iY /. �[ 7—�/./IY-.?-J`-/l' Y-.a3 'i/
CITY (4 taZs- tunic_ TND.ii V i// ADDRESS 13-.5- -J ` ec#e l
ARCHITECT LIC. COSTA MESA, CALIFORNIA
OR ENGINEER NO.
ADDRESS FIR
Z TYPE/ GROUP
/���� w STATE �[/
CONTRACTOR 0; t) LIC.NO. BY VED DATE/ g
ADDRESS /3-.J a-ec . - ZONING •
�tie!, :0
/4 ZYAr.V.�
LEGAL LOT / ZONE }.• lI I PLANS I USE OF NE
DESCRIPTION NO. ° BLOCK TRACT ( (V//p(1 PLANS BUILDING
A.P.NO. / /7-./,1? '/7 APPROV€ O�1 /�� T c '~ .
�jBY ,,,•�, /V rrj�' DATE % ��� -
OIF LOT 7.0 /J NO.OFO BLDGB. A YgROS I/ "ALES •
/ NOW ON LOT®`Jl��✓' REQUIRED ALLOWED
USE OF _ /._ _ (CENTER LINE ST.)
EXISTING BLDG. }Ff@'(LEL.F ^}Twn. FRONT - •SFT. f IN.
SETBACK LINE FROM 1l� �'A'a? ..
CENTER of STREET ((/ 5 � REAR YARD R.SIDE J FT. IN.
SIDE YARD LEFT f ^t000 I RIGHT ter. a.� L.SIDE J FT. IN.
DESCRIPTION/OF WORK REAR SFr. IN.
NEW I I ALTERATION I `/
jl II ADDITION I
REPAIR +�I V MOVING I DEMOLISH I
BUILDING O<<"rl,/'4'/ O.OF L/ STORIES
SIZE �v//,
EXTERIOR WALL "4$_I ROOF
ERING
COVERING OT.•'L' %
USE OF BUILDING AND WORK TO BE PERFORMED
Oo AI� .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTR�UCT/Ily9/1kp f VALUATION
PERMSIGNIATTEE TURE OFYY ' �t1 . U� PERMIT FEE $ ��T ,�Od
$ / �PL:AN CHECK $�V� C2 .'AUTHORIZED AGENT { TOTAL FEE $ f 0
o