HomeMy WebLinkAbout2879 ALANZO LN - Building Permits<
CITY OF COSTA MESA
�,0'�pMFy'q BUILDING DIVISION
F4�� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: BX09-00265
PERMIT TYPE B MISC STATUS: ISSUED
APN: 14156324 DATE ISSUED: 12/22/2009
Zoning: , ISSUED BY: RMD
JOB ADDRESS: 2879 ALANZO LN CM
Viciniry: ROOF
SQ. FT: 300
Suite/Unit:
Primary Occ: Const Type :??
V a I u a t i o n: 510, 00 0.00 .
SCOPE OF WORK:
INSTALLA710N OF A 3.136 KW ROOF MOUNTED SOLAR PHOTOVOLTAIC SYSTEM (14 PANELS) WITH 2 AC/DC, 1 MISC
CONDUIT, 1 MISC EL EQUIPMENTA DN 1 INVERTER FOR A SFD.
OWNER: IREY LANCE A
City/State: COSTA MESA, CA
Phone: 714-708-3731
APPLICANT: CROWELL, DAVID
City/State:
Phone: 714-444-3592 .
CONTRACTOR: DAVID CROWELL ELECTRIC INC
Address: 3100 AIRWAY
127
City/State: COSTA MESA, CA
Zip Code: 92626
ARCHITECT:
Phone
ENGINEER:
Phone
FEE SUMMARY
Building Plan Check:
Building Permit:
Electrical �PermiC
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
TOTALFEES
Address:: 2879 ALANZO �N
Zip Code: 92626-4203
Address:
Zip Code:
License No. 800789
Phone 714-044-3592 Cell:
License No.
License No.
$117.81
$18125
$62.10
$1.00
$0.00
$1.00
$393.66
Unit
Unit:
Unit: SUITE
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval vrill result in the expiration of this permit.
CODE/. INSPETONflPE DATE INTf71AL5 LO�EO INSPECiIONTYPE DAIE INTI71pL5
1676 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing �Z, ' �
200 Final Re-Roof 210 Final Electrical �
20� final Block/Re�aining Wall 212 Final Pire Prevention
202 Final Faclory Fire Place 220 Final Planning Approval
203 FinalSign 222 FinaiSite 1Z � �
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSA710N DECLARATION:
I hereby affrm under penalry of perjury one of the following declarations:
❑ I have antl will maintain a certificate of consent to self-Insure for workers'
compensation, as provitletl for 6y section 3700 of the Labor Cotle, (or the
performance of the work for which Ihis permit is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by
secl'an 3700 of [he Labor Code, for the pedortnance of the work for which this
permil is issuetl. My vrorkers' compensation Insurance carrier and policy
number are^L4 � ���
Carrier: .� SU..f'O.v..CQ �_ f9a
(Thrs sectpn neetl not be mmpleted AMe permn is value0 al one huntlrM CWlars (Sf 00) w less )
Policy Number: W�� �. � b Zfl �� 2
❑ I certify tha[ in the peAormance of the work for which this permil is
issued, I shall not employ any person in any manner so as to become subject
ro[he workers' compensation laws of Cali(omia, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
t e Labor C e, I shall forthwi ply wilh these provisions.
� Z L
Applicanfs SignaWre ` Dat
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, INTEREST. AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Lit # CIasS # � � t �
` z, Z 0
ConVactor'S SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby a(frm that there is a construction lending agency for the
per(ormance of the work fa wfiich ihis permi� is i55ued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Dale
OWNER-BUILDER DECLARATIONS:
I hereby affrm [hat under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for lhe (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
constmct, altei, improve, demolish, or repair any structure, prior to its
issuance, also requires ihe applicant for such permil to fle a signed slatemen[
thal he or she is licensed pursuant to lhe provisions o( the Contractors
License Law (Chap[er 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or [hat he or she is exemp[ therefrom antl
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as owner of ihe propeny, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl 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
thereon, and who does such work himself or herself or lhrough his or her own
employees, pmvided that such improvements are not intended or oKered for
sale. If, however, ihe building or improvement is sold within one year of
completion, the owner-builder will have lhe burden of proving that tie or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of ihe property, am EXCLl1SNELY CONTRAC7ING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The contractas License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracts (or such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code tor this reason:
Owner ID veri(ied by drivei o license. � Yes ❑ No
Driver's License No. Expires:
Venfication o( Ownership by (type of document, i.e. - property [ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certRy that no excavation frve (5) or more feet in dep[h into which a
person is required to descend, vnll be made in connection vrith vrork authonzetl
by this permit, and that no building s[ructure, scaf(dtling, falsework, or demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Califomia Adminis[rative Code�.
❑ As ovmer-builder, I will not employ anyone to tlo work which woultl
require a permit from the Division o� Industrial Safety, as noted above, unless
such person has a permit [o do such work from the tlivision.
Applitanfs SignaWre
Divisi0n Of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre buil�ing occupant need to fle and
certify a Business Plan tor emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of Ihe California Heal[h antl Safety Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantiry of hazardous materials equal to or grea[er [han a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
a� standard femperaNre and pressure).
2. Does or will ihe applicant or present or future building occupant need to fle
a registration form for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 0( the Califomia Health and Satety Code, with some
exceptions, requires regisiration with Ihe Costa Mesa Fire DepartmeM by
each business which at any one time has on hand a quantity of acutely
hazardous ma�erials equal to or grea[er Ihan a weigh[ of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at standard
�emperature and pressure).
3. Does or will the applicant or presenl or (uture building occupanl need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provides tha[ the
Costa Mesa Fire Department may require the preparation, ceAifcation and
fling with �he Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous materials vnth the Fire Department.
4. I( an RMPP is presently required, has Section 25534 of the Calitornia
Heal[h and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will Ihe appliwnt or present or future building occupant require (or
the work which is the subject of Ihis application a pertnit for such cons[ruction
or modification from the South Coast Air Quality Managemenl Dis�rict or from
any other air polWtion conlrol tlistrict or agency? ❑ Yes ❑ No
(Section 658502 0( the Califomia Govemment Code requires that Ihe requested
intortnation be fumishetl on applications fa non-residential building pertnits�.
6. Will any part of the facility to be constructed under this permit be within
1000 feet from Ihe outer boundanes of a school? ❑ Yes ❑ No
(If "yes", �he facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health antl Safety Code).
7. If a permit from the South Coasl Air Quality Management Distnct or other
air pollution contml tlistrict or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safely Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFlCATE OF COMPLIANCE: I certify Ihat under penalty of perjury Ihe
information given above is wrrecL I agree to compty with all slate laws and
city ordinances regarding Hazardous Materials and Emissions.
SgnaWre �ate
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 ciry
ordinances relating [o building constmc[ion, and authorize representalives 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 fnal inspection.
SignaWre galO�w1ner�s) Dale
SignaWre Date ` / � �Z/ZZ/Qq
3051-46 (3/0]) lor Au orixetl AOPlicant -� D� �
! ApO�icant to fill in all ipaces excepl ihose within heavY bortler lines antl sign all appropriate Oeclaratians.
� CITY UF C7STA �MlESA CO TRUCTION PERMIT � � PERMIT NO! � � I TRACT NO. � ILOT�NO.t I UNIT NO.� ' �-T-1f- T � � � Tr ��I^ �_ ��
�. Proiect Address �Y `% 1 � � � � �i �� �i� �Is � 1 � i i I � � i � I � I ( I I I I � ; Iry-LIaT -i_ _�__.
� � � 1 .� I TYPE OP CONSTRUCTION � NEW I ADDi `ALTERATION REPAI R � � ' �
ApplicanYsMailin ddress. � � � i � � � � � f
� � � ' � � ,� CONVERSION I ❑ DEMOLISH ❑ OT�R f � I I q,P. # I � � � � � ���y Za�?
Owner's Name i - "1' hone �� + '"'"�" ''y---�- ,. . _ - .S_ _ ' _'r' � '_'�J"` _'__ ___' _
� DESCRIP,TI N OF,WORK/U$� OF, BLDG. , . � i
AddreVss � � � i � � ' i I I ' +' I d! S , ' ' q -. S Main Building: I � j , �Accessory Building:j �
� I ` E '
� A�ch/E�9.' � � ' Lic¢n52 NO. � TVPE OF E IT �❑ �RA�ING� �FOUiNDATION STRUCTURAL I � T FfOnt � � I � � � I � � � � �
Add�255 � I � ' � i ❑ TENANT �❑ ELECTRICAL I❑ PIUMBING � MECHANICqL B Rear � � ' ' I ! �
' 1 I ' � � I❑ OTHER I �:: I � I .� 1. � i � I � I � A 1 � ( � ( � ' I �
I Contrector s Name � Ca � Phone i r -, - � � i - � , -C-'Right j -� -'-' "' � -- �' -- ' -' -�— —
� ' l % E.�L.�l�U '� I �� PROJECT DESCRIPTION. SII.�T. � i 1'S i . oCCUa N�� V. 1 i i �� I I fi 1
� Address (m i"�pl � � � � -' + ' � . . �U � K . � � �
' ��],�/y'/ � �, i � iCONSTRUCTIONTVPE � � � ' IVAL�UATION S LeR � I � � � I I � I � I
� City Lic¢n N � �'� / /"' � � T � � � � ' , �20NE � � � � jGRADING CU� VDS.- � ' ACRES � I � � ' � • �
I LICENSEO CONTRACTOR DECLARATION � �I � � '� � ' � ' . 1 � i t a : i � � ,PIntJ.R2f. � � � � � � ;Pa�king�Req �PrOvided (
�� I he�eby aftirm;thap I am licerisetl untlet provisions of Charter 9(commencing Remark5: � LL i r• ; i i I � s i I ' I S I � p�annin NOt2S: � � 1 ( ��,
I f
with section �000) bf Division 3 of the Business antl Professions Cotle, an'tl � � � � �� �' ��- I- , 9 � � t � � � �_��� � � �
� iY license Is in ful �Jorce � ffect ' � I � i I I i �` I � y I �. ' � I^� � I O! I I W' j � �! 1 i i ' I � ��' I. ' J' I�' -� ! 3 (
'cense lass � - L en � � ' ' � � � � � i � � - � j •' n� � � � �
ate " Signatur t � ' � 1 i� � � i�� i_" PLUMBING ��; � ! � � _FEES �' '-- I i �'_' i ( y1 I Y;. "_. rr � w i �„ � I �
ORKER$' COMPENSATIO DEC � I i i I � -� ' u �- � - � '� ' a � � -� ' � � t i ^ � I ^
BarSink �.� �� i �_i, � ;Showers I_ i�_ � C) � � �= . �.- I�' �; �__ � I"' ��� �� � � �ELECT.RICAL� C �
�' I hereby aifirm that I nave a c rtific sent to self�insure or a certificate I L , �� , ,. � ,,
i of Worker5' Compensation I su�a , r a certifietl copy thereof (Section ' � < ' ` �,'+ �" �- � � � r �
� � Backflow Prevanter i� I �;, � IService Sink, i=, I'' I=� � i�` 1 ° Automatic Washery I° � J� ,Transformet'0 15 50 KW
3800. Lab. C.) 1 . � . I i � � . .. . . ' . � 1 �;?�
�Policy No. � , Company � � � � Backflow�lrngation � y � � L $ewer,Cap �„ j � � c � 1 � n - - - 1 , - � ' � � 'DIW +�KW
eCertified copy is hereby fumishetl. � j � -_ � -- � I . I i j j Construction-Pole Sub , i ,, 1 j, -_ i j
Certifietl copy is (iled with the city Builtling Division: � I i � Bathtubs � u�:� I= i'� � cv Sewer Conneciion � n ��, i� �:r �� �`�Cooking Unit_ I� �, Meter� Oup to 100.amps �:�
, Date � � APPlitant ' 1 � � '� .0 f .� _ � - f, � ' r � � : -
� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION I 1 Clarifiers' n � T � I tai 1 �- n'$013f COII¢CtO�Sr� � c I;: 7}`j �l I � j �: Dishwasfier� �+ � � �. '_'
�, n � ,Meter I Dovei,:100 amps
(Thisseclion neetl mt be mmpletetl'if the permit is for one huntlretl ($100) o� - y r �� - � - �
iess).� ' , • � � Dishwasher� . _ ` I � -= I'- !Solai Piping� � � � � i : � � y j � I � ! r Dryers �Gas_ DElectnc� .�n i :S�ubPanel . � � =. � � � �
I certify that in the pertormance of,tM1e o�k r which thi5 per h s issuetl,-1 -� . ,: . ,. - -�
shall not employ any person In any manner s a to e' jecLto the Drinkiri9 Founta�ns � � Solar Tank ��` �.J � I-% '� � � Fan � I µ i ;.
Workers' o en n Laws of Galifor '. � . , ^ � , �. �� � �MotOrs 00-7�.HP Q1 VzryB� M
5 l,
/
i i t I
Date Siqna[ure � ' � � ' ' � Floor Drains� -� . 1 ' � � ^ � � Swimmin Pool w/S a' i ^ � ' � � �� � a �% �� -' � � � T
NOTIGE: If, after_m kin9'this tleclar ion, yo s u[ .ti ome_subiect,to_the�._ ' I � - g P � I T `\ � � Fi�A-U !^� � f � �� inc Solar"�' 9-15 HP Q76!15'+
� Workerz' Compensation provi5ion5 f the b Gea you must forthwith Plooi $inks � r � � ^ r . � � r � - � � l � i '
. 1 , , iUrinal i � � r � � Fixtures Microwave
comply wi[h such �prov�sions o� his. p m �a be tleemetl rewked. � ' - - I I . 1 t I I � I i �
� CONSTRUCTION LEND�NG�AGENCV � � � � Gas$¢rviC¢ ' �OuU2[5 ,W2t¢LCIOSE[ � I I � � ' � � �' �
� , � 1 . . ! I t � i ! Device Boxes � I � � Pale Cight i � j
1 hereby affirm that there is a constructi'on lentling ency tor �the pertormance � , 1 .
of the work for which [his permit is i55uetl (Sectlon� 309] Civ. C!) ; ! � � � � � � �
Lentler's Name I i Interceptors I I � �Water Heater i I � 1 I � Outlets I � � � � Range � � �
. � : � � . : � . . . . i i
. , . � � . , . . : .
' __"_._ ,.'�.__:. � � . I i i � v:.,,i,,,,, c:..� � � f I ' Iu�...�. c_i..:_,. ! ' i I I i I � , �. , � � , � i : i �
OWNER 9UILDER OECLARFTION . . � � ... 1 : 1 - - • . � • � . � � �'- . ' i -� ----:-- � 1 � : • �'y• • 1 i !
I M1ereby affirm that I am exempt from the Cwtractor's License iLaw for the Lavatories � � � � � �AUtO-�'�1d5h ( � j I � � � Cid�bdJE Di5pO5dl � � � SLdOdIOg S2cLiOnS �
following reason (Section� 7031.5 Business antl Protessional Cotle:.Any city or ' � � � ' ' ' � � � � � � �
county which requires a permit to construct, alter, improve, tlemolish or repair P-Trap i j � i Laundry Trays j � I � � � � Generator � 0-5�KW �5-15 KW � �
any sVucture, prio� to its issuance,'also requires the applicant forsuch�permit • ' � � � ' . � � � � T�25h CompdCt01 � ;
o file a siqnetl statement that he/she is licensetl pursuant tmthe provisionz of I � � i � � 1-`) � � � .
ie Contracror's License Law (Chapter 9(commencinq with Section ]000) of Roof Orains � � .� � � � i I � + � I i � � 1 � � � f �
�ivision 9-ot-�the-�Business�antl Professions Cotle)-or-that-he/she-is-exempt----- - -- - -r—T--r----- - y-- ' - ' ' ' -
[herefrom antl She Dasis tor tne allegetl exemption. Any violation of Section I � I � � I` � � I i f I ~� � � � � � � I I ' ! � � I
�� �031.5 by any ap0licant to� a permit subjects the� applicaM [o 'a ciJil � i � � � I 1 � � � � . I ; ,
'� penalty�of'not more�than five hundretl tlollars ($500). , � � � � I ! � � ' �� � � � � $ 3 � ' � i � i � � � � � � I � �
�� � I,�� as� owner of the property or my employees with wages as thei� sole R¢in5pectiOn Ffe j I $15 � V I �Issue Fee I � � I_; I
� compensation, will tlo�the work, antl the structure is not intentletl or oiferetl � � Reinspection Fee '-'$15 � Issue Fee � j i j �
. i fon'sale• (Section-��044, Business and Professional Cotle: The Contractor,'s �- � i I MECHANICAL I { � , � �_FQES � ' � � � � � �
License Law does:not apply to an owner of a property viho builtls'or improves '� ' � ' � � �� ' ' � -.
! � thereon,.ana wno;does such work himself/herself or through his�or her own -'� � i-r � � i c r.. DEVELOPMENT SERVICES REQUIREMENTS � I ��'
employee5, provitletl thatsuch improvements are not intentletl oq offeretl fpr BoiIG/ I- I � I � � Hood-O� Type I '� � � � � I I _ � ' � �_ �
� 9 P -' _ � I Ca'noPY YPe I I � I ��' - Zonin9 APProved BY� � o i � � Dete_
sale': If,-however,:tbe builtlin or im rovement is soltl wlthin-one year of com- I , ,
I-pletion, lM1e owner will-have the burtlen of proving he/she tlitl not builtl or im- DuCt - Undei.Ground � � � _. I �T I � I I m�� I: � Y Buildine'APP�oved By I— � � � i�;�' ' Dat; _
°-prove for the purpose of sale). . , . � _ , ' ' - . , ' i � � i � ' i � . �
��:1", a5 owne� of�the property, am exclusively contracting with IicensetlPcon- DiiCt-St�uctuf3l � I ; Refrigeration System � I �; I�' � APPIiCdtion ISSued By � •= � Ddt�
tractOrSto construct the Oroject (SECLI00 �044. B11510055�dOE PIO1C551005 COdC: �� - � � � I � I I � I � I
I The,�Contracto�'s �License law does not apply to an=owner'�of-property_wno Duct - Ventilatin � ' �< DOc100,0�0 BTU �'��100,��0 BTW � D� I �_ `''' � � j ,��$U RV OF FEES -` I` � L� ��
1' builtls or Improv¢s Ihereon, antl who contracts for such projec[siwithla�con- ^• -- � 9�� ; �-�+' , ;". �„' _ I- I . I`� �i I 4, N r��� I � c . � Z
� I �
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' 1 ti � I — - C
tr . I i -I IN P� IT
actor r n" w I em aware that< � BU LD G ERM SMIP
S Ilcense � u suant to the Con[ractor's Lice 5¢ La � 1 $� $�c
I ) 0 ) $ St I
�❑ Muld le ❑ em Re air A
'� ExhaustS Stem Y / Iterabon. � �.c
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.c J � I . I - o'
' probi of their Worker's Compensation insurance shbultl be provitletl.to'me ' , � I-. . -� . �� I C I : u �
� L7 1 am exempt urider Section e. & P� C for this ieason � '-' FirepVPa'cc�Blt.;IC80 # � t_ i � Fire Dampers %� � � ��;' =' _� '�� P��N CHECK ; Z$� �` � 1PERMIT� I o�?�
� � � � � � � _ . . � i : u � - i � ISSUANCEI U S �
'.. � x _ � i P,LUMBING. � � n.$.
Date ' -' - � Owner �� � � �- � '" � z Heatin'g SYstem &�Ducbng� � _ I , .Registe�s I � I „ � G , = i `�' ? � i � P�,qN�GHECK �25Y , $ � � ! ( �ENE,RG �P C.�n $ �
I hEreby certify ,Ihat I have reatl tM1is application antl�state that the atioJe � �- 00100000 BTU 01000008T I y ��-• i '. I"� ' � � GRADING I'$ �
information is cL I agree to comply with all city antl`county, ortlmances �' _ = i- =-- �� i= I- I-� I r � -� =�� i a � 3 �:� � 2% ' ELECTRICAL �, I'$ v �� �. �,_ �.. _
antl'state laws rela o b iltling c truction, antl-hereby auJhorize repre- e _ � ` � • �, c� u; � � �,, �.: - �� . I` � G � PCAN�CHECK �50%� $: �. � i�� MICROFILM �. $ �'
. sentatrves�;Ot- hi5� it - n �er ( the above-enentmnetl .propErty for ` ,� ; � ' � � r i L, I -- ' � ` � � � � � ' i � np
insPection PU�P es. .� � = 11 .� _. � W S . I I -i I 11 I"' C (� � �� �' I 3I I"' I.] T! i- 1. I Sf �l i I �. 1`J I W �
� SlgnatuFe i t ' � Daie i• � i � i � MECHANICAL � I . $ � .TOTAL FEE $
��Q', y - I M I � . C'l tc S . � cJ �(L b i '+� I v; C r^ I c •I T. � t. � � n � �z I cJ Pi > t M V'i
"Driver '' License o' S� 'f' � v I F'� I M�,� �^ .» peinspeMion Fee � cb I v$�5�- I � �•� � I luue F,eel n� �� I v ��$ 3.� I .� -, P�L�AN-CHECK `-25% $' �� � � � ! I
CMF 0865-4 , r . 0%84 - W " e - Builtling; Canary - Applicant Pink - Atcounting; Goltl¢nrotl - Assessor -� �'_ __�__ . _..�_ _�._._��__�___._. __.-��--_-._—_.____ . • _ _-- - _.� _�-__ __._-�--__
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CONSTRUCTION AND�PLANNING POOL & SPA �
APPROVALS Permit# � Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Se�vice 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � 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 Elecirical-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 O Gas ❑ Oil '
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas OOiI
25. Roof Sheathing 1i 1 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 t �
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
36. Hood or Canopy
37. Final Factory Fireplace � ,
38. Final Plumbing _ ' � '
39. Water Service-Final . •�� �' ' '
� . '
40. Gas Service-Final - � ' '
i
41. Solar pomestic-Final • ' !
�.
42. Backflow Preventer � � � , --
�43. Backflow Irrigation � ' � ^' ' ,
� i ,
'44. �andscape Irrigation SYstem � � . � . . ,
�45. Sound Attenuation , , � '
' �46. Handicap Regulations � � . � � , .
47. FIfVALSTRUCTURE&BUILDING �id� � I � ��l
�O
' 48..Special Requirements Completed , � � �
49. Electric Release to Edison ` • ,
.�
50. Gas Release to Southern California Gas Co � ,.
51. CERTIFICATE OF OCCUPANCY .'
No. Date
J
PXOJECT AOUFESS: q 8•� (j ALAN GO L,N
�AWNEH'SNAME: 17ONA�HG'Y� nQNFiLT� �
aooeess: z�i'19 Ai,r�1VZ0 LN
C05TA MESA,CA 526?6
ANCHIENGINEEN: '� a 5 — � � � ` flEG.NO.:
AUGHESS:
UNIT:
UNIT:
PEFMITTEE: nONHAhEY Di)DiALG (7i4)595-807�
aooRess -�}� /9 AI.�N70 �An�:
COS'I'A NBSA CA 92626
LICENSEO CONTflACTOB OECLAflATION: I hereby aHirm ��al I am licensetl under provisions oi Chapler 9(commencing with Section
7000) of �rvision 3 of the Business and Pm�essians Code. antl my lice.nse is in full brce and eHect.
qTY LIC.: STATE LIC.: CIASS:
�ate: Signaiure:
WOflKEflS' COMPENSFTION OECIABATION: I �ereby atiirm t�al I have a cenificate ol conseni Io sell�insure or a certificate oi Workers'
Compensalion Insurance. or a cer�ified coDY ��ereo� �Sectian 9800. Lab. C�.
POLICY NO.: EXP. UpTE:
COMPANY:
❑ Ce�i�ietl tODY i5 hereby lumishetl. ❑ Ce�i�ie0 tOpy is Iiied wi�h tAe Ciry Building Divi5i0n.
Oaie: Applicani:
EXEMPTION FBOM WOBREBS' COMPENSRTION DECLBBATION: (This section need not be complete0 ii Ihe permit is for one huntlred (3100) or less�.
I cerlity �hat in ��e petlarmance o� the work lor whic� t�is permit is issue0. I shall nol em0loy any per50n in any manner so as �o become
sublecl lo Ihe Workers' Compen5aiion Laws ol Ca�ifomia.
Dale- SignaWre:
NOTICE: If, alier making �hi5 deClarali0n, y0u should becOme Suble�t t0 ��e Workers' COmpen5aii0n pmvi5i0n5 0� Ihe Labor
Code. you mus� fotlhwi�h comply wi�h suc� pmvisions or t�is permi� shall he tleemed revoke�.
CONSTflULTION LENDING RGENCY: I hereby afiirm that there is a constmclion lentling agency for the p¢dormance of t�e work for
which Ihls perm711s Issued (Sectlon 3097. Clv. C�.
lENOEfl:
AODflE55:
OWNEB BUILOEP OECIABATION: I hereby aflirm �hat I am exempt Irom �he ConVactors S�ate License Law for �he following reason
(Section 7031.5 Business and Pmlessional CoOe: Nny ciry oi cowty which requires a permit to conslmct, alier, imD�ove, Oemolish, or
repair any simcWre. prior lo its issuance. also repuires Ihe aOPlicanl for such permit lo file a signed statement that he/she is licensed
pursuam m �he pmvisions ol Ihe Contraciors' Sta�e License Law (Chap�er 9(commencing with Sec�ion 7000) of �ivision 3 oi t�e Business
and Professions Code) or �hat he/5he is exempl I�ereimm antl t�e ba5i5 lor IM1e allege0 exemp�ion. Fny violaiion o� Section 70315 Ay
any applicanl for a permit Subleci5 Ihe aD0lican� �o a civil penally o� no� more �han live M1wdrea tlollars ($500�.
I. as owner of Ihe D�oDeny or my employees with wages as Iheir sole compensation, will tlo ine work, and ihe
simctureis notintenAea oroffereUforsale (Sec�ion 7044. Business and ProfessianalCotle: 7he Coniractors' State License Law
tloes not apPly �o an owner o� a pmDerty who builtls or impmves thereon, and who tloes such wo�k himself/herself or �hrough
his or her own employees. pmvitletl that such impwvements are noi inien�etl or o��ered �or sale. II, however lhe 6uiltling or
lmprovemenl is soltl wilhin one year o� compleiion, the owne� will have Ihe burtlen ol pmving he/she Ai0 no� buil0 0� impmve
for ihe purpose ol sale).
I, as owner ot the pmpeny. am e�clusively con�rac�ing wi�h license� comracmrs m consimm �he prolec� (Seclion 7044, Business
❑ antl Pm�essions Cotle: The Coniractars' Sla�e License Law tloes nai appry �o an owner o� pioDerty who builtls or improves thereon
antl who conVacls �ar such pmlects with a conlrac�m�s�license pursuan� to ��e Coniractors' S�aie license Law�. I am aware
Ihat pmol oi iheir Worker's Compensalion insurance should be provitletl to me.
� I am exemp� under Section: �770 4 4 B. 8 P. C.
lar mis reason: A7 'L Wi�Rf( c� Y OidNt, �
Oa�¢: � �'� ^�1 Own¢r /Y.�. G r
I tlo hereby certify Ihat I am aware o� antl uneerstana ihe requiremenis ol California Heallh antl Sa�ery Cotle Sections 25505, 2 33, and
25534 and I�at I or any Wture builtling occupan� will/viill no� (circle ane) need to compty wiih sai0 slale co0e5 an0 the requir ents lar a
permi� �or consimclion or moai�ication �mm �he Pir Oualily Managemenl Districl. Re5i0eniial co ion apPlica�ions re exempt imm
Ihese pmvisions. �'^ /
� oale'. L � (_��� Aoplicant� ��� '�
Ihereby ceitity �hal I Aave reatl this ap0licalion and sta�e ihat Ihe above in�or fion is correct. I agree Io comply wi�h all iry antl county
oidindnces antl stale laws relating �o building cons�mciian ana here�y aNhoriie reD�esenta�ives of 1- cit lo en�er upon Ihe a ove�men�ianeA
pmper�y �or inspection purpases. � /� l /
�a�e: � � � �� � Signalure:� � � „� dx�
nvor's Llcense ar Social Security a: )
1646a6 W�ne—Builtling: Green—Gode EnlorcemenC Canary—Applicam: Pmk—Revenue: GalEenrotl—Assessor
CI7'Y OF COSiA N,wSA - AUILDING PcRMIT PERN NO: H 0517<3;
PERiYI'P NO: B 05179"L PLAN C��CK NU: 0135'�-yl S GQVT: N SUPP: N
CQN�TRCiCT10N TYPE: V-N PERN,IT TYP�: STR Pi:RP05�: OTI�
JOB DESCR.T_P'!'ION ./9 i.F. 6'HIGH CITY STD BLOCK WAi,L S� FT: 79
CLAI1+1 VALUE: 2,2�U.00 CALC-VAI�UE: 1,5fSU.00 GkQI7P OCC; R-3 /
CUN.•MENlS: SN,OFE D£T'�C2'Ok R��UtEtED i.N TfiE HOM:
34ifR1EliifiF#�Y1F1(�'F.�:�k•34%�iFiE�If-?F�fr#i'ri'r3i9F leY.3f�?Ei'r�lFii-3EaE�1Eii�iiii�iEif3Fii�ie#'�iEi:fe�l'rif3FY•1�3fifN�1F#�iki(-1FiEN}kiEii�'.i�i{,3Fif#3%�1e1E?E
Z O N 1 N i; R E Q U I R E M E N T S
S � T B A C K S
---------- N,AIN HJILDI?vG --------- --------- ACCESSORY HUIi,UING ---------
FI2N'C: FT IN �EAR: F2 iN FRivT; FT ZN RtAR: rT �N
LEFT: PT IN �GiiT: F'T IN i.,EFT: cT T.N RG3T: FT TN
Y�ARKING Rfi�: PROV: PA�Cci,: iA156324 7.NE: R1 REr NO:
PLANNING N TES> 79 LINEAL .Fc�OT RLOCK WALL 3JIuT ON THE PROPERTY LINE.
>
'h �lf If iE fE 3't+: # 3F # it Y� �% ii� if M�'t- }i 3f ?"r 3F #' 3(� 3(� fF �(� �k -x iF k iF 3e iF 3't iE'.�t i'r iF if !F 3c iF Si� 3e ih IF iE %� R w-�N� �7'r 3't }? ii� 1(� R i: �%� k� iF k iF 1't 3i� !i� )b i�?-k #'.e �i� �i� ff ii� if iE Y
n r V E L O P M E N T S E R V I C:. S R E Q U I R E M a N T S
7..ONING APPRQVEU bY DATE:
BUILDING APPROVED BY :_ UIaTE:
APPLZCATZON SSSUED BY: DAT'E; �� — /
ki(�iC�iffe##k+eiF3eii�3!�i(�k�fzik3ei(K�IFif . -� v �� '4'�F'giFTi'�.�'£-TrTr'Fif�lcii;faF#}..iFki(CA�-�64
?EiEI(�N�if�lEjFii�i:iFiE�:3f1f�3E1F1EiEiEif�k�lEiEifli�3FiE3%-kiF)fiE�C�ifN�dElFif#k . (�iPirj'r#�iE9FiEjEii�%�ikfE3M1k�3f�dE�E3e?c3f#'ti•lE3i�iiiFi(�Nff3!��Fi�'�#:�a..::rt-%�k
LEGALIZATiQN:N F � i S U M M A R Y S'TRiJC7JRAi. SEGMENT:Y
Si,DG PMT PLUNFiI�3G ELECiRIC MECi-IANI'C P2�� SMIP/rZc.S GRADING
PERMIT 3'7.00 SMTP/NON-RES
i�i.f» [ 4 . � 5 .
iS5liE FEE
BUILUING-DIC'-> PERMIT ISSIIE PLAN-CH�CK TOTAL PAID Di7r
TQTALS---> 37,50 0.00 24.05 61,55 61.';5 .OU
REVENUE DIVi:,ION TOTAi,[�--> C:OLI�$CTED; 61.55 OVt;R/SHC3RT; .00
BLDG rNT Pi,UN,HING BLECTRIC NinCHAI�?IC FIR3 SMIP/TOi GRADING FY,AN-CH�CR
37.00 .50 2�.Q5
iF �k # k i6 ##�Sf fF?�: IF iElP i'r R 1�: N� iF }'. K k iE fE 1f # Y if k 361F ib A= 3F !:- 1'r If i(� ie 1E if ?E iF i!� Y.� i4?i� i� if %� �fE X� #�k i(� �1r ii� 3P 7E �1f� if 3e 141i� M it Y� ti� Y� 3i� �If 3P K� iE �7F 1:� 3E �k 3f�?r
I N D 7 V Z L' U A L F E E H R E A K D O W N
TYFE QTY U E S C R S P T i O N UNIT CUST TOTAi COS'i
SFR %° RES-CC7NCRn'TE �I�OCK WAI,L / FT. Z0.00 1, `_�80, 00
E1dD OF F2t,.5
"� LvLA�'.i.—��'�,� ii`- ' �s_- °n
Gti7C: G- r ��',;>i ';; _, ;,.;5' ___--
_— --,�� _
CONSTRUCTION AND PLANNIN� & SPA
� 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 �.
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVEF�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. -
10. Structural Floor System 61. APPROVAL TO DECK '
11. Rroperty 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 ApP�oval ,
17. Rough Wiring Sign 68. APPROVED FOR PLASTER�NG
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Fattory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑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 (Structureq & 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 .
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING �
48. FINALPLANNING
49. Elearic Release to Edison '�
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
a
i p
` � '�I C'lr�4C7�
CG,aTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 3f7 COSTA MEBA. CALIRORNIA
For Applitanf fo Fill In Complefely
TYPE OR PRINT
■ MAIL
COSTA MESA. CALIFORNIA
602� S r
IF L�31Ca
NO. OP
eeie�cK uNa vrsom ,.r REAR YARD
C¢NTER OP ST(iEH 1 11
I 1� � I 6' �
SIDE YARD LEFT RIGHT
DESCRIPTION OF WORK
_._... �XX �� -------�--. � �� ---�- --
■ USE
FEE RECEIVED�
Lot 73, �'act l��04, lan 3-E
FINANCE DEP�FP11/96y
CITY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RHCEIP� NO. P6RMIT NO.
RECE�BY I OqfC R�f�1V�O/ I CR�6•
v /Y
i.Z BUILDING
ADDRESB
! ZQ COSTA MESA. CALIFORNIA
FIRE
ZONE NPE GROUP
APPROVED
BY oATE
ZONING
ZONE NO. OP B OP N6W �
FLANs eNLo1NaLJ
t /L/ / �}-
QBCRIPTION .-_/�-�'/��' �� �(� /
le A. P. NO.
YARDS EVES
APPROVED ALLOWED
t [CeNTLR LIN6 BT.) //
� FRONT 7 � FT. --
R. SIDE � FT. --
L. SIDE / F7.
REAR � � Fi.
APPROVED
_ 9Y G/ ��� Il1TF y/i
NG 5o�X5hl�j�� ROOM6 � STORIE6 �"
OR WALL StUCCOIROOF comp•
�f.�r. trnvwwiMr_
wfattached garage
Garage Area lt76 S F
Covered Porch Area 38 S F
I H6HE9Y ACKNOWLEDO¢ THAT 1 XAVE RlAD TXIB A'PUGTION TH8 AMOUNT SHOWN UNOBR VALUATION 16 POR TH6
AND BTATE TXAT TNE ABOVE I6.CORREGT AND AOR6C M COM- pUPP08H OP lBTApLI8XIN0 A PERMIT F!P ONLY.
PLY WITH ALL CIiY OIiO1NANCEB AND 8iAT6 U1W8 Ii60ULATNO
em�.o�No consrnucnox. VALUATION
SIGNATURE OF � PERMIT FEE s 36 —
PERMI7TE B t JCO •
B�J � ����Q s16,o84�OO PLAN CHECK $ � � �
AUTHORIZED AGENT �,G%
.
? 43799
�' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING "')('� � ./ ^ r �
AODRESS y'D I�/
OWNER / / 1'� Y1 e
AODRESS �/�G � ' • � �' `
CITV Cp� �M�S.LI' NO�.�y /O7
CONSTRUCTION �� , �
L•ENDER
�,� ;..��f?�_ h i.ir:i:`.{;'1 Cr
..S ��"�Ir.i. ��l/ f7��^ I.JU
APPLICATION FOR STRUCTURAL PERMIT
T
. ' ' ' � � .
BRANCH ^
�-- ' - - • ' " OWNER
ADDRE55..
ARCMITECT �-� TEL ^_ SE �
OR ENGINEER NO.
,` � FIRE �
_.,_..�.... . _ ^ � »nnic .
PERMIT NO. /
' O' . '
`VAL(iE'. � "
5
�
CONTRACTOR ��NE) U I I�{ �" B,,rnirvo� DATE �� L
•—. ' _• -• � '�\. .
ADDRESS , • �'` ZONE NO.OF USE OF NEW O
' TEL.�� �D� p�qNS2 BUILDING
CITV � NO.
.�. STATE CITV �'ARDSAPPROVED YARDSAPPROVED _
LIC. NO. \ � ` LIC. NO. �/ MAIN BUILDIN ' -ACCES ORV BUICDING
(z� SIZE /' � / - // �� � NO.OF BLDGS. I (FROM C/L STR ) -
�. OF LOT (p '� v •(j NOW ON lOT t FRONT FT.
a USE OF . � -� : �
� EXISTING BLDG. . �% � � �"SI FT. � � FT. '
y . /
FSeparate permits are required for L. SIDE � FT. FT.
q electric, plumbing and heating work. REAR �CFT., . - FT.
W USE OF BUILDING AND WOflK TO BE PERFORMED '
F DISiANCE BET. ' BET. MAIN & '
QMAIN BLDf35. ACCESS. BLDGS.
J "l/ / C/ '�j� CV� ,1� � . VAR.3}-` OATE \
a -C.V.P.# ,APPflOVED
� � APPROVE � • ,�/ � _
�. L
�
W � � � .
� 1 heraby acknowl¢dge that I hava read this application end state �
n
(y� that the above Information is correct antl agree to comply with m
a all laws regulating buildin8 �onstruction, antl I shall not employ
Wany person In violation of the workman's compensation laws of �
� the State of California. m
3 I he�eby ce�tify that I am proparly licensetl as a contractor untler SQ. FT. w
the State of California Business antl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, antl that such licenses a�e in full torce and etiect, or I THE PUflPC6E OF ESTABLISHING A PERMIT FEE ONIV: "
am exempt from the provisions of the Stete of Califarnia eusiness iO
VALVATION PERMIT FEE $ d
end P�ofessians Cotle, Divis�io�(��jy Chapter 9. � in
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