HomeMy WebLinkAbout334 ALVA LN - Building Permits( \ ,1
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�• CITY OF COSTA MESA �
B!/ILDING DIV/S/ON
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 NUMBE M08-00004
PERMIT TYPE MECH
APN: 42629511
JOB ADDRESS: 334 ALVA LN CM ;
Vicinity: HALLWAY CLOSET -
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 01/0812008
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: CHANGE OUT FURNACE'<100 K BTU LOCATED IN HALLWAY CLOSET.
OWNER: HOOD, WILLIAM A � , - -
PHONE:
APPLICANT: PARSONS, GORDON �
PHONE: 94g-056-0064 -
CONTRACTOR: ABC HEATING AND AIR CONDITIONING
Address: 2282 ORCHARD ORUnit: PHONE: 949-056-0064
City/State: NEWPORT BEACH, CA ZipCode: 92660
MECHANIGAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: � , $0.00
INVESTIGATION FEE: - • $0.00
REINSPECTION FEE: °$0.00
TOTAL FEES: $38.30
Address: HOOD, EUNICE M UniLCOSTA MESA, CA
City/State/Zip: 334 ALVA LN
Address: 2282 ORCHARD DR Unit:
City/State/zZip: NEWPORT BEACH, CA
License No. 810461
CELL:
NOTICE: The work aulhorized by this permit shall comply vnth all applicable handicap access requirements under California statutes and related
iegulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval vrill result in the expiration of this permit.
COOEtl. INSPECTIONTypE OpTE IN7171AL5 CO�Ep INSPEL110NTYPE DrIE INTITIR -
1676 Fixed Syst@m Final Fire Prevention 208 Final Mechanical P/A � % �
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Rbof 210 Final Electricyl
201 Final Block/Retaining Wall 272 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign ppp Final Site
204 Final Demolition ' 250 Final Building/Owupancy
.,
WORKERS' COMPENSATION DECLARATION: �
I hereby aKrm under penalty o( perjury one o( the following declarations:
❑ I have and will maintain a certifca[e o( consent to self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
peAormance o( Ihe work !or which this pertnit is issuetl.
❑ I have and will maintain workers' compensa�ion insurance, as required by
section 3700 of the Labor Code, for the performance of the work (or wfiich this
permit is issuetl. My vrorkers' compensation Insurance carner and policy
Cnumberare: �a� ����
arrier: , � �/� / P
(inis secYun need not be compleletl AlheVe^^d u valuetl al one huneretl dollars (St00) orless )
/' in /
Policy Number: ��i / G/ �
❑ I certify that in the pertormance of the work for which this permil 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 shoultl
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply with Ihese provisions.
. �l�'��� �i/ ----- / -S -O'�
Ap0licanfs SignaWre � Date
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 DOLLARS
($100,000), 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:
I hereby affirtn 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 (ull force and eRect.
Lic. # �l �/ �J/ Class # � — ZG
c— / —
. _ !o�! / -�i /"'� / ' ('a —G pi
Co�°ctor's5ignaWre Date _,
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn ihat there is a construction lending agency for [he
pedortnance of the wurk for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty o( perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Professions Code: Any city or county which requires a permit to
construct, alter, improve, tlemolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to fle a signed s[a�ement
thal he or she is licensed pursuant to the provisions o( ihe Contractors
License Law (Chapter 9(commencing wi[h Section 7000) of Division 3 of the
Business and Pmfessions Code) or that he or she is exempt therefrom and
the basis for the alleged ezemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more ihan
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and ihe strucWre 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
[hereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of provinq that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CON7RACTING WITH
UCENSED CONTRAC70RS to construct the project (Sec. 7044. Business and
Pmfessions Code: The contractars License Law dces no[ apply to an ovmer of
property who builds or improves thereon, antl who contracts for such pmject with
a cont2ctor(s) license pursuan[ tothe Conl2ctors License Laws.�.
❑ I am exempt under sec.
Business and Professions Code for this reason:
Siqnawre
309-46(J/0])
,
1�'. i
Owner ID verifed by dnve�� � Ves ❑ No
Dnver's License No. Expires:
Verification of Ovmership by (type of document, i.e. - pmperty lax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICA710N:
❑ I hereby certAy that no excavation (rve (5) or more feet in depth inlo which a
person is required to descend, will be made in connection vrith work authonzed
by this permit, and that no building siructure, scaffdding, falsewnric, or demolition
or dismantling thereof, will be more Ihan [hirty-5iz (36) feet high. (Chap. 32, Grp
2. Art 2, Sec. 341, Title 8, Califomia Administra�ive Code).
❑ As owner-builder, I will not employ anyone to do work which vroultl
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to tlo such work from lhe division.
Applican(5 Si9^aWre Date
Division of Indus[rial Safe[y Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future builtling occupant need to file and
cedify a Business Plan for emargency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Seclion 25505 of the Cali(omia Health and Safety Code requires, with some
eaceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time tlunng a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pountls, 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 tuture building occupant need to file
a registration (orm for acutely hazardous malerials? ❑ Yes ❑ No
(Section 25533 of ihe Califomia Health and Safe�y Code, wilh some
excep[ions, requires regi5tration wi�h the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazartlous materials equal to or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or WWre building occupant need to
prepare an RMPP (Risk Managemenl antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Cotle provides that the
Costa Mesa Fire Department may require ihe preparation, certification and
filing wi[h [he Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with Ihe Fire Department.
4. I( an RMPP is presen[ly required, has Section 25534 of the Califomia
Heallh antl Safety Code been fully complied with7 ❑ Yes ❑ No
5. Does or will the applicant or present or tuture building occupant require for
ihe work which is the subject of ihis application a permit for such construction
or modification from �he Soulh Coasl Air Quality Managemen[ Dis[rict or from
any other air polWtion control district or agency7 ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that lhe requested
information be fumishetl on applications for non-resitlential builtling permits).
6. Will any part of the faciliry to be consWcted under Ihis permit be within
1000 feet from [he ou[er boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of Ihe Califomia Health and Sa(ery Code).
7. If a permit from the Soulh Coast Air Quality Management District or other
air polNtion control tlistrict or agency is requiretl (or the work which is the
subject of this application, have all of the disclosures prescribed by Calitornia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'j�es", attach certificate of compliance from the appropriate air polNtion
control oKcer�.
CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury the
information given a6ove is covecL I agree to compty with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Da�e
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 correct I agree m comply with all state laws and city
ordinances relating to building consiruction, and authorize representatives of
the Ciry of Costa Mesa lo enter upon Ihe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any builtlinq
aulhorized by Ihis permit unlil final inspection.
SignaWreoiLegalOwner�s) Date
�%'/,v,�ir%S %�—. �'_ !� l' �
Nnd/o�Aul�otlzetlAppliWn�" Dale
� ;r
PflOJECT ADOBES �' 3 3 4 ALVA LN
OWNEH'SNph1E: HOOD, WILLIAM �i
�'RD?IflE55: HOOD EUNICE M
334 ALVA LN
COSTA MESA,CA
AflCHIENGMEEF:
92627
NEG.NO.:
UNIT:
A�OHESS: UNIT: �
PEFMITTEE: EUNICE M. HOOD ( 714 ) 646-2252
nooRess: 334 ALVA LN
COSTA MESA CA 92627
LICENSEO CONTHACTOfl UECLABATION: I �ereby a��irm �hat I am licensed unAer pmvisions o� Chap�er 9(commencing wil� $ection
7000� of Oiv�sion 3 0� Ihe Business and Pmiessions Cotle. an� my license is in lull lorce antl eifect. "
CITY LIL.: STATE LIC.: CLA55: _
�am�. Signature:
WOPNEBS' COMPENSATION UECIAflRTION: I hereby affirm �ha� I �ave a cenificate ol consen� b sel4insure or a certificate oi Worke�s'
Compensation Insurance. or a certdiee copy ihereoi (Section 3800. Lab. C�.
POLICY NO.: EXP. DATE:
`COMPRNY:
p Certi�ied copy is �ereby Wmished. ❑ CertAietl copy is �iletl wi�h �he city Building Oivision.
Dale: pOD�icanl:
E%EMPTIONFBOMWOPKEflS'fAMPENSATIONOECIAflPTION: �Thisseclionnee0no�becompleteOiitAepermilislaonehunOre0�3100�orless�.
I certity Ihat in Ihe petlormance o� Ihe work for whicA this Oermil is issued, I shall not emD�oy any person in any manner sa as �o hecome
subjec� to Ihe Workers Compensa�ion Laws ol Califomia.
Dale: Signature:
NOTILE: II, alter making ihis aeclaratian. you shoWd �ecome sueiect ta the workers' Compensation pmvisians oi the La6ar
Cotle. you musl Iorihwilh comply with Suth pmvisions or thi5 permii 5hall be Oeemetl revokeE.
CONSTHOCTION LENDMG AGENCY: I hereby aflirm �hat ��ere is a conslmc�ian lending agency tor Ihe pedormance ot �he work �or
which Ihis permil is i55ue0 (Sec�ion 3097, Civ. C),
LENOEP:
aoonEss:
OWNEfl BUILOEH OECLAflATION: I hereby aflirm �ha� I am exemp� irom �he Coniractors' S�a�e License Law for Ihe bllowing reason
(Seclion 7031.5 Business antl Pw�essional COUe: Any city o� counry which requires a permit to cons�mc�, al�er, impmve, demolisR or
repair any siNCNre. prior ta Its issuance. also requires the applicant for such oermit to file a signe0 statement �ha� he/sne is licensed
Oursuam m �he O�ovisions of Ne Comracmrs' Sta�e License Law (C�apter 9 �commencing with Sec�ion 7000) o� Oivision 3 af ��e Business
antl Pmiessions Cotle) or tha� he/she is exemp� �here�mm antl �he basis br ihe allegetl e�emplion. Any violation oi Section 7031.5 hy
any aDPlicanifor a permit su6jecis Ihe apPlicanito a civil penalry ol not more ihan five hun4re0 dollars (5500).
I. as owner of t�e propeny or my em loyees with wages as Iheir sole compensation, will tlo ihe work, and �he
❑ stmcture is not intentlea or otferea tor sale I�c�ion 70aa. Business antl Pw�essional Cotle: The Contractors' Slate License Law
� tloes noi aDPly �o an owner o� a prope�y who Ouiles or improves Ihereon, an0 who Uoes such woB himSelVherself or thmuAh
his or her own emptoyees. pmvitled Ihat such improvements are noi inten0e4 or oifered lor sale. Ii, however Ihe builtling ar
impmvemeni is sold wi�hin one year of comple�ioq the owner will have �he �urden of Omving he/s�e ditl noi build or impmve
for �he purpose of sale�.
Y I, as owner ot the pmperty, am excNsively conVacting with licensetl con�raciors �o constmc� �he pwjec[ (Sec�ion 7044, Business
L7 antl Pmie55ions CoOe: The Contrac�ors' S�a�e License Law tloes no� apDly �o an owner o� O�oDenV H'ho builEs or improves Ihereon
antl w�o conVacts for such pmle��s wi�h a conVacmr(s�license pursuant Io Ihe ConVactors' Slate License Law),I am aware
ihat pmol ol lheir Worker's Compensa�ion insurance should be pmvitletl to me.
� I am ezemp� unaer Section: B. 8 P. C.
tor mis reas n �;7 /� �
Date: _L,�I�/�� Owner �"`"�"—" �
I tla herebY cenily Ihal I am aware ol and untlerstantl ��e requiremems of Cali�amia Heal�h and Sate�y Cotle Sec�ions 25505, 25533, antl
2553d and ihal I or any IWure builtling accupanl willlwill no� (circle one) need �o comply with saitl state cotles and ihe requiremenis lor a
permii for cons�mc�ion or motldication �mm Ihe Air Ouali�y Management Districl. Resitlential consimclion applica�ions are exemD� ��om
Ihese pmvisions.
Daie: Applicant:
I hereby cer�ify I�al I have reatl ihis applica�mn antl 5�aie thai Ihe above informa�ion is correcL I agree Io comply wi�h all ciiy antl counry
ordmances ane Slalelaw5relaiingto builtling conslmc�ion anU here0 u�horizere0�e5¢niative5 O��his tity�o ent¢rupon�he above-menlione0
pioper�y far insoeclion purpa5e5. �)
Dale: ��y� Signature. ��^� � `� � 'ri"s"�"�
Driver's Cmense or Socia� SeaAry q:
i6ai�46 Whi�e-9wltling: Green—Gotle Enlo¢emenc Ganary—Applicant: Pink—Revenue: Goltlenmtl—Assessor
CITY.OF COSTA MESA — BUILDING PERMIT ,
PERMIT NO: B 051958 PLAN CHECK NO: N , ,
CONSTRUCTION TYPE: 5—N PERMIT TYPE; STR PURPOSE: ALT
JOB DESCRIPTION : PARTIAL RESHEATH 6 REROOF W/ASPHALT SQ FT: 6,500
CLAIM VALUE: 6,500.00 CALC—VALUE; 6,SOO.OU GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTOR(S) RE�UIRED IN HOME.
***��**�*******�*�r****�e�r***�*� +�******�****�r*****�r*�c***�*x�*�r**�*+r�**�rx******�**
2 O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FANT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV: PARCEL; 42629511 ZNE: REF NO:
PLANNING NUTES>
>
��**�*�*�***���**�*�r�****�r****�+��***�rx�**�e�r�r��r�*�r**�**�r***�r****�r�**�+r******�****
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T 5
20NING APPROVED BY DATE;
BUILDING APPROVED HY
APPLICATION ISSUED HY;
�f 1F if IF iF iF iF iF 3F iF 3E if af iF IE iE if iF iE if if iF
iEiElEIEiliElFlEifiFiflE*iElEiE3EiEMiFiFifiEiEiFifiEififif�ifiElEiEaf9Fifk F�f3E i iFiEiFiEiE�E±F
LEGALIZATION;N F E E S U M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 90.00
PLAN
ISSUE FEE
DATE;
iFaFaFIF Kif i1�D iE iE i(� if �Ei�'iF789FF�iF iF
iF iE iE aE iE �E iE iF ik if if 3E iE jf iE IE iF if iF 1F if �F if iE iE
STRUCTURAL SEGMENT:Y
FIRE SMIP/R65 GRADING
SMIP/NON—RES
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 90.65 0.00 0.00 90,65 90.65. ,00
REVENUE DIVISION TOTALS--> COLLECTED: 90.65 OVER/SHORT: 00
BLD90P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOS GRADING PLAN—CHECK
iE if it iE jf iEif if if iF iE if if if it ik �)k if IF �ElE iE iF iE it if 3E jE at �E IF jf �1t if it if iF iE iE 3E if �t aF jE if iP iE k iP if iP if iE it iP IE iF iF iE iEiE 3E iP aE iP IE iE it iE iP iE if 1E 3F iE jF it 3F 3F
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 6500 . REROOF HY VALUE RESIDENIAL NOZONE 1,00
END.OF FEES
�
�
6,500.00
01 'GOu5:73+-!'i:t3?.;?7' T� �;— ;: .
L'kTE� Q5;0'%^i 1.."!�: In.'?�
CONSTRUCTION AND PLANNING P� PA
_„APPROVALS Permit #- Date Inspector qppROVALS Permit # Date Inspector
1.'Temporary Electrical Service or Pole 52. Pool & Equipment Location - .
� 2. Soil Pipe-Undrgrnd, 53. Steel Reinforcement
r .
-3.�Electrical Conduit Utility�Undrgrnd. 54. Forms
� 4. EI"ectrical Conduit-Undrgmd. 55. Electrical Bonding
;'5.'.$teel Reinforcemen"t 56. Rough Plumbing & Pressure Test '
* 6�Electrical UFER Gmd. 57. APPROVALTO COVER�GUNITE :.
� .� ,
- `7.''Foo'tings � 58. Electrical Conduit-Undrgrnd. • -
� 8� Foundation ' 59. Gas Pipe, O Undrgrnd., Test -
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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 �c 64. Plumbing System - Final
14. Rough Plumbi�g -' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electri �Wiring 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
-. - -- - ' ;�z' � ,� - .
20r Rough Eactory Fireplace %:-�� '4 v _ _ ` ' �APPROVALS 'C Permit # �' '
� .r r_ .x�t - T. � i.. � ..
21.' Ducts, in St�ucture. �... - T _ , 70. Und rground Hydro �
22. Ducts, ?ientilating • � �„� } 1" " , 77, produci P_iqing O Gas ❑ Oil
23., Gas Pipe•Rough & Test r. �:;' ,. � -- 72. Undergiourid Frsli,,. :, J
24.��Roaf Framing >' . � : � �. .. �u � ' 73:� UndergrnH.Stora,g�e,Tank-OGas ❑Oil �
25. Roof S�eathing � : T , .� R '� �= _ � 74: Overhead�Hydro,� ` '„
�-
26:.�T-Bar Ceiling (St[uctural) &^Monocoat � ' 7 n�• � 75" Dry Chemical � _ '- �: �+:
c �r ., • c.._ ..
27:•�FrameandF�ashing :�4: '' _.. Y J.� � 76'�DryStaridP_iPe - ; ' `
. 28.� Lathing��& Siding-�. � _ '��Si: * �. ••� ^ 77r FIXED $YSTEM`I,FINAL �
''29. Insulation '� �'` �' � �� _ �`' � � � � 781 FIRE PREV. F6NAL .� �, �
= 30. Drywall Nailing--�+ � �� I i'.�� � V HEALTHiDEP7..REQUIREMENT
_31.Plaster9rownC3af.,.. .�.,r '� � �� 79. FINALINSPECT40N � " _
a
-� 32: Electrical Po er:Meter�Final � *.. � � 80:. FOOD CERT� ATE ISSUED ��
,, 33?Final Electric r�! .� � �` ' f` Notes: - :�� . . �-
,,:
��=34r Fi el Heating &1Air Conditi0ning; '' '� '� � � ', q "
� �,� /�,
f
35i�Final Ga"s Pipe�Test ''" • ` ' • � T = ' '� ��
,- - - - r ,r
y
i 36. Hood o�:Canopyr , 7�' _ . � � ,i ;F . � �~�- . .
x ,r , -'
-'37��Final Factory Pireplace, � ' �; � � ' '
c• . I � �
- i `.... „ ; �•: •-F' �� . �.
'.38. Final Plumbing . �,i . I � . � • � ...
. 39. Wafer Service�Final � '" � ' '.r .- .� •" i
' ' � i � G' '
�,40. Gas Seruice;Final � - � : ' �, � � � � '
��41. Solar pomesticFinal : � • . � ' -
':, �, w n ��
�� 42. Backflow Preventer � � � � � � '' . �, _ �
-. �
43. Backflow Ircigation� � - ' � -- ' - . -
r
�i x . � s �
„44. Landscape Iriipation System,.,,, ; w ., - - , r. �� ' o . _
- - . ��w - • : _. - . . .
:5:45.:Sound Atte6uation ��• '* ` , • � - - = % �
t T f• 1 '
. �46.. Handica-p Regulations �' ' � _ " r-y �
��47.�FINAL STRUCTURE & BUI�LDING �"�Zc�c�' (e(,..�i �. :�� _
46. FINAL PLANNING ' �r ' : � " " .
,. � i 2
49: Electric�Release to.Edison : � � � .
,50. Gas Release to Southern Ca{ifornia Gas Co ; j � ' ` '''l' .
I •
.51. CERTIFICATEOF,OCCUPANCY , , ,r;�, • . �
N0. Date
Applicant to fill in all spaces exceD� those within heavy portler Iines anE si9n all avProoriate tleclaratians.
!�ITY OF COSTA STRU TION PE IT
' ' !/ E . ry1.
� Proiect Address .
Applicant's Mailing /�ddress
Owner's Na e S AN Phone
Address � . �Y�
qrcn/Eng. License No. �
Address /
Contractor's Nam �Q. 1 � • Phon y� '
Address (ma'I'nal w�-% %5/ �S G /� ��S �A �//� f)
City Licensc No. �q�.(p Q 5/
LICENSED CONTRACTOR DECLARATION
I bereby aftirm [hat I am licensetl untler provisions ot Charter 9(commencing
with section ]000) ot Division 3 of the Business antl Protessions Cotle, antl
my license is in lull orce � ffect. �
Licens C ess Lice e
Dale Si9nature
WORKERS' COMPENSATION DE LARAT N
I hereby aHirm that I have a certificate of consent to selt-insure or a certificate
" Workers' Compensation Insurance, or a certifietl c py thereof (Section
;00, Lab. C.)
Nolicy No. 5� o��a Compa �
�Cettifietl copy is he�eDy furnishetl.
CRr "e c " filetl with the ci y ' b IviSio
Dat( Applica
EX PTION FROM WORKERS' O PENSA ON DECLARATION
(This section neetl not be completetl if the perm t is tor one huntlretl (E100) or
less)
I certify that in the pe�fo�mance of the wo�k for which this permR is i55uetl, I
Shall not em0�oy any per5on in any manner so as [o become subject to Ihe
Workers' Compensation Laws ot Cali(omia.
. Date Signature - ,
�NOTICE: If, after making this tlecla�ation, you zhoultl become subjeGt to tM1e
Workers' Compensation provisions ot the Labor Cotle, you must forthwith
comply wi[M1 such pravisions or thi5 pe�mit shall b¢ tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that there is a construction lentling agency for the perfo�mance
of the work tor wnich IhiS permit is issuetl (Section 309] Civ. C.)
Lentler'S Name
Lentler's Atldress
OWNER BUILDER �ECLARATION -
I hereby affirm Ihat I am exempt from the Cont�acto�'s License Law for the
following reason ($ection ]031.5 Business antl Protessional Code: Any city or
county wnich requires a pe�mi[ to construc[, alter, imp/ove, tlemolish or �epalr �
any sfructure, prior to its issuance, also requires the applicant for sucn permit
to file a siqnetl statemen[ that he/she is Iicensetl pursuant to the provi5ion5 of
the Contractor's License Law (Chaoter 9(commencing with Section 7000) of
Division 3 ot the Business antl Professions Cotle) or that he/she is exemp[
'here(rom antl the basis tor the allegetl exemption. Any violation ot Section
031.5 by any applicant fov a p¢rmit subjects the applicant to a civil ,
enalty of not more than five M1untlretl tlollars ($500).
❑ I, as owner ot the property or my employees with wages as their Sole
compensation, will tlo the work, antl the structu�e is not in[entletl o� o/feretl
for sale (Sec[ion 7044, Business antl Professional Cotle:. The Contractor'S
License �aw tloes not apply to an owner oi a property who buiids or improves
thereon, antl who tloes such wo�k himself/M1ersel( or through his o� her own
employee5, p�ovltletl lhat such improvements are not intentletl or ofteretl fo�
sale. If, howeveq the builtlin9 or improvement I5 sold wltllln one year ot com-
pletion, the owner will have the burtlen of proving he/sh¢ tlitl mt builtl or im-
prova fOr tne purpose ot sale).
❑ I, as owner of the property, am exclusivery conttacting wl[h licensetl con-
tractors to construt[ the project (Section 7044, Business antl Profe55ion5 COtle:
The Contractor's License Law tloes not appry to an owner of property wno
builtls or improves tnereon, antl who contracts for such projects wlth a con-
tractor(s) license pursuant�to�tM1e ContraCtor's License Law). I am aware that
proof of Ihei� Worker'S Compensation insurance shoultl be provided to me.
❑ 1 am exempt untler Section B. a P. C. for this reason
Date Owner � �
1 hereby certity that have reatl [hiz pplication antl state that the
intormation is correc . agree to co wkh all city antl county ortli
antl state laws rela - to builtling n ruction, antl he�eby authorize
sentatives of this ' y to en e above-men[ionetl proper
inspectlon pur
Signature Date/ - 2•
Drivers' Lice se or 55 �
r� �7q � � -3� _.... ..�.
TYPE OF CONSTRUCTION NEW ADD /�.LTE ATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER L
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT ❑ GRADING FOUNDATION STRUCTURAL
TENANT ❑ E ECTRICAL ❑ PLUMBING ❑ MECHANICAL
�OTHER �QO��kG ,�1.. wqLL
PROJECT DESCRIPTION . FT, oCCUcaNC`v
CONSTRUCTIONTVPE VALUATION$ ,�J�
ZONE GRADINGCU.YDS. ACRES
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks -
Gas Service Outlets
Interceptors
Kitchen Sink
Lavamries -
P—Trap
Roof Drains '
ReinspeMian Fee � $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating Sys[em & Ducting
❑ai oo,000 eru o i oo,000
peinspection Fee � $75
CMF o865-46, rev. 10/84 White - Buildin9; Canary � AOPlicant; 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
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0-100,0006TU ❑100,000
System Repair/Altera[ion
Fire Dampers
Registers ` _
luue Fee
A.P. # '
S Main Builtli
E
T Front
6 Rear
A '
C Right �
K Left
s
Ping. Ref. #
Planning Notes:
,
4815 I/U2/B5
�5 Zone
Accessory Building: �
i
6�,' , ; /
— %i �)10
T PL "
a � Ac ,t -
, Parking'Req./Proviqed
ELECTRICAL
Automatic Washer Transformer ❑ 15-50'KW
Construction Pole Su6. � 50 +`KW
Cooking Unit Meter ❑up to 100amps
Dishwasher • Meter ❑over100amps'
Dryers ❑Gas �Electric 'SubPanel ��
Fan Motors �O-i HP �1%v ;8
F.A.U. . Inc.Solar �9-15 HP �.16-15+
Fixtures Microwave
Device Boxes Pole Light
Outlets qange
Switches Si9n
Garbage Disposal ; Standing Sections
Generator DO-5 KW �5-15 KW Trash Compactor
Al�ic T�_
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
$ 3 I
�— Reinspection Fee $75 Issue Fee $ 3
FEES
�DEVELOPMENTSERVICESREQ MENTS:
Zoning Approved By �k� —� Date � — � —R�
Building Approved 6y Date —
APPlitation Issued BY �'''� Date %��- '(45
$ 3
� SUMMARV OF FEES '
BUILDING PERMIT $ ���� SMIP $
PLAN CHECK $ �� • a � PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM . $
MECHANICAL $ TOTALFEE $
PLAN CHECK 25% $
a �
�.
t
�" CONSTRUCTIONANDPLANNING � POO� ,PA
Dat�., Inspector Date Insper.tor
APPROVALS � Permit # . r� APPROVALS Permit #
1. TemporarY Electrical Service or Pole ,„; 52. Pool &.Equipment Location �
2. �Soil Pipe-Undrgrnd. . � � �� � 53. Steel Reinforcement '
. �
3 Elec4ric�i4Conduit�UYi4ty-Undrgrnd. 54. Forms � � %�� ,'
,: Eleck,ical Conduit-Undrgrnd. 55. Electrical Bonding . ��
5%�Steel ReinforcemeFl%� �' , � �� b �S 56. Rough Plumbing & Pressure Test .
6� �Etect;ical UFER'Grnd. ' 57. APPROVALTO COVER-GUNITE . ''�
�,
^r;
7:�Fpotiqgs; .;;f, '. f. , 3 l. 58. Electrical.Conduif-Undrgrnd. �
8:,Founda�ion " '; � 59. Gas Pipe, O Undrgrnd., Test '
9.'.W�ter Pipe-Undrgrnd. � , 60. Backwash Lines, P-Trap, O U+drgrnd. . �
10. St�uctural Floor Syst�m � ", 67. APPROVAL TO DECK
. 1�i. Froperty Sewer Linet& House Cor�n�,ction .� ' 62. Backwash & Receptor•Final
12. Sewer Cap �=; � ' r.; 63, Heater & Vent-Final �
r -.
13''Roof Drains •� � � � �' • 64. Piumbing System - Final •
� .,
14. Rough Plumbing' � 65. Electrical-Firml .�
15. Rough Electrical-Conduit 66. Sotar SysterttFinal .
16. Rough Electric Wiring • 67. Fencing & Accea Appraaml
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating,$i'Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory F7replace • APPROVALS Permit #
� 21. Ducts,in Structure - 70. Underground Hydro
22. Ducts, Ventilatin,g 71. Product Piping � Gas ❑ Oil �
�
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing �`- . 73 Undergrnd. �torage Tank O Gas ❑ Oil �_
25.'Roof Sheathing r�� - 74. Overhead Hydro - �.
_ 26. T-BaS Ceiling (Structural) & Monacoat 75. bry Chemical
27. Frif�e and Flashing � � ' 76. Dry Standpipe . .
28. Lathing & Siding � - - 77. � FIXED Sl'STEM FINAL
29.•Insulation �" 78. FIRE�PREV. FINAL .� .
. 30. Drywall Nailing . , HEALTH DEPT. REQUIREMENT
31.-Plast�r Brown Coat 79. FINAL INSPECTION ,
32. Electrical Power IGleter-Final ' " 80'. FOOD CERTIFICATE•iSSUED
33. Final Electric � Notes: _ ' " � �
34. Final Heating & Air Conditioning " �
35.-Final Gas Pipe-Test . . � ' � .
�36. Hoo'd or Canopy � � ' � . � � � � � .
37. Final'Factory Fireplace - � . � � � � �
38. Final Plumbing � . .
39. Water Service-Final � � . . � -
40. Gas Service-Final � � � - �
41. Solar pomesticFinal � � - � � -
42. Backflow Preventer � - � - . �
43. Backflow Irrigation . - � _ � .
44. Landscape Irrigation System . - . �
45. Sound Attenuation , . , � . � � .
46. Handicap Regulations . � � � .
47. FINALSTRUCTURE&BUILDING d � . , � - ,
48. Special Requirements Completed � � � -
49. Electcic Release to Edison
50. Gas Release to Southern California Gas Co � � �
51. CERTIFICATE OF OCCUPANCY � � -
INo. Date � � . . � . . . . .
�
� '
%�• ' 6�6'`�
COSTA MESA BUILDING DEPARTMENT
P. O. BOX 31]
COSTA MESA. CALIFORNIA
FOR APPLICANT TO FILL IN
BtIILDING 334 Alva Lane
A�DRE55
COSTA MESA. CALIFORNIA
OWNER C-RAY, INC.
ADDRE55 419 E. 17th Street
TEL.
cirv Costa A1esa r,o. Li-8-1:
ORC NIGENEER ��(j�qhTnnj{ NO.
� i••"• QTV LIC.
NO.
E. 17th St.
�E�A� LOT 34
DESCRIPTION NO.
A.P. NO.
51ZE 75 x 80
OF LOT
USE OF
E%ISTING BLOG.
., .,, ..,��:�
.. _ ��a ����,,�6 v ��
� �� �s
�{ - �- 3- S$ �� a�
FINA�'CE DEPT.
cirv nr r�STA ft1ESA
APPLIC;4TION FOR PERMIT
BUILDING
FOR OFFICB USE ONLY
Bl11LDING
nooRess
Li-8-1159 �BPPROV
NO.OF BLOGS.
NOW ON LOT TLOTLE
SETB4CN LINE FROM p
cervreA or sraccr �,I},!� REAR YARD ZS�
INEW
RIGHT 7��5,� LEFT I�•���
DESCRIPTION OF WORK
X ALTERATION ApDITION
STATE THAT THE RBOVE IS
CITV ORDINANCES PNO ST�
TIOrv.
SIGNATURE OF
PERMITTEE
DEMOLISH
NO. OF /
ROOMS p STORIES
ROOF
COVERING C(1ffIT1.
COSTA MESA. CALIFORNIA
AND AGREE TO COMPLV W!TX FLL
iEGULATING BUILOING CONSTPUC�
__ � _ A VALUATION
- TYPE� GROVP
FNS / �
> /
�/J//i DATE / ��7 s/
CORRECTIONS
I� 12�O1��VV
AUTHORIZED AGENT ��e & Cole�rove, ZIIC•
PERMiT FEE $ �j,O�OO
PLAN CHECK S 1S�o�
TOTAL FEE $ L.S.00
V M!
OWNER
JOB ADDRESS
GENERAL CO]
AP. No.
� ° I & J
li.._ c.CTION$
Trenches Forms
coa[
c�iavr TNr.
334.�Ilva Lane . -
�Tox Dike & Colezrovi
C 3li TRACT 1( �� FIRE ZONE
TYPE ZONE
DATE
Steel �%�� � S "30 `S. °
/G
Chimney Re Rod
�7if'OE' � `r'� � ' �!3
C".4 �f.d- 7�/ �f 3�
� �ti U �-�A_I�
SUBCONTRACTOR
BIIILDING PERMIT NO. -
..._...... ,� o,..
m
:- �t. .,:as Tesc !!;/.4, i.. N' 14— y—b`&1' .
-Coustrurtinn �ole �Z.���(/U _ .. -
PERMITSISSUED
e