HomeMy WebLinkAbout1816 ALASKA AVE - Building Permits CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us
P'7 . FOR INSPECTIONS CALL: (714)754-5626
%%moo PERMIT NUMBER: E08-00171
PERMIT TYPE ELEC STATUS: ISSUED
APN: 13958110 DATE ISSUED: 05/21/2008
ISSUED BY:
JOB ADDRESS: 1816 ALASKA AV CM Suite/Unit:
Vicinity:
SCOPE OF WORK: ELECT.WORK-FOR INTERIOR REMODEL-8 FIXTURES, 1 OUTLET&3 SWITCHES.
REF: B07-00568
GENERAL CONT. FOR THIS PERMIT SUBCONTRACTED BY OWNER TO DO OTHER WORK LISTED ON 607-00568.
OWNER: HEDLEY,KERRY L - Address: 1816 ALASKA AVE Unit; •
PHONE: - City/State/Zip: COSTA MESA,CA
APPLICANT: FRACKER,JEFF Address: 4152 MANZANITA Unit:
PHONE: 849 500-9319 City/State/zip: IRVINE,CA
•
CONTRACTOR: TRANSCONTINENTAL CONSTRUCTION CONCEPTS License No. 444289
Address: 4152 MANZANITAIJnit: PHONE: 949 500-9319
City/State: IRVINE:CA ZipCode: 92604 CELL: •
ELECTRICAL PERMIT FEES •
•
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $36.70
Reinspection Fee $0.00
TOTAL FEES $36.70
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 will result in the expiration of this permit.
CODE O. INSPECTION TYPE DATE IN1111ALS CODE II INSPECTION TYPE DATE IN1111ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 9-1-- (
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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's lice 3 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,a'demolition
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sedan need not be completed ifthe permiis valued at one hundred dollars($100)or less)
2,Art 2Sec.341,Title B,California Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
„,121-1 certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
' issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
becom ubject to the workers'comp sation provisions of Section 3700 of Applicant's Signature Dale
the C°�e, shall fo with comp with these provisi s.
�nApish
shall / Division of Industrial Safety Permit Number:
/v( Appli Slgnawre Dak/ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full orce and effe . a registration form for acutely hazardous materials? 0 Yes ❑No
Lic.# -a -f Class# (Section 25533 of the Califomia Health and Safety Code, with some
W' S- �,./0 Y' exceptions, requires registration with the Costa Mesa Fire Department by
�l -u (/ at (/ o each business which at any one time has on hand a quantity of acutely
'%ntracisrt' Ign.u- Date 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
C e 'STRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: _ 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.
Stgnalure Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑ No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes',attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
0 I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Dale
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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
authoriz�by this permit until final ins.ection.
Signature Date �L //j 'J weer ) I D,
3057-46(3107) T pp air
dtorA ze.Applicant Dalt
/
•CITY OF COSTA MESA
4 BUILDING DIVISION
rj ..a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT B07-00568
%broas N
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.&LJILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
•
Job Address: 1816 ALASKA AV Status: ISSUED
Suite: Applied: 05/02/2007
Vicinity: MASTER BEDROOM/BATH Issued: 07/31/2007
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number 13958110 Zoning:
Applicant: HEDLEY, KERRY
Address:
Phone: 949-679-3324 ISSUED BY: In
Zip:
•
Owner: HEDLEY, KERRY L
Address 1816 ALASKA AVE
Phone: 949-679-3324
COSTA MESA,CA Zip: 92626
Contractor OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : SUSAN SECOY Eng: SHUCRI YAGHI
Address: 45 PLAZA SQUARE Address: 112 E CHAPMAN AV
Phone: 714-639-4367. SUITED Phone: 714-997-9120
ORANGE,CA _ ORANGE,CA
Zip:. 92866 • . License: C22263 - 92866 License: C43205
•
SCOPE OF PERMIT
INTERIOR REMODEL TO RAISE THE EXISTING MASTER BEDROOM ROOF STRUCTURE AND ADD A SKYLIGHT IN THE MASTER BATH OF AN EX
SINGLE-STORY SFD.
ZERO LOT-LINE PROPERTY.
Plan Check: $463.94 •. - Calc Valuation: $60,000.00
Permit: $713.75 i /. .w. • Claim Valuation: $60,000.00
SMIP Res: $6.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,183.69 .
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existinq: 0 Required: 0 Proposed: 0
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 ( I) f
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 workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
tdenify that in the performance): the work for which this•ermit's issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califo :,and agree hat If I shy d bec• ''subject to •, 'orkers'compensation provisions of Section 337700 of the Labor Code,I shall hwith
comply with these provis': - //,/' �l' �, `. /^,,/��
App leant Signature: 'i2a 7 /dI / -S (Date: �f( /l 6//
WARNING:FAILURE TO SECURE WO'KERS'of PENSATION COVERAG COMA UL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ALT S AND CIVIL FINES UP TO NE HUNDRED
THOUSAND DOLLARE(Mom,IN•••TION O THE COST OF COMP TION,D MAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABO-COTE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: r-____-.----"I
I hereby affirm 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.Lic.# Class#
Contractor's Signature: Date:
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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penally 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
su ects the applicant to a civil penalty of not more than five hundred dollars($500).):
C _ ) 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 CONTRACT' - WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law doe 'not apply to an owner 4 property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursua to the Contractors Lict se L- s .
❑ I am exe :'g. n. r i - : siness and Professions Code for this reason: / e�� a
6lgnaturei LSM tP r ��,/�
r Expires:..'/Z—d7_,
Verification of Ow hip• (type of document .e.-prope• 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-ore than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 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 end certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California 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 California 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 aEernit 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 LI 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? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California 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
8 (If yes",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 ORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. Ito comply with all state ws and • ordinan relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above les ed prope f r inspe0cti ryos s re to occupy or allow occupancy of any building authorized by thi per t until final inspection.
3
[Sign t e L/ga Owner(s) (47r _Data
( And/Or Au�otd Applican Date
CODE I INSPECTIONTYPE PAI 1NTITIALS CODET INSPECTION TYPE PAIS UIIIIIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 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 (}� lsl�
204 Final Demolition - 250 Final Building/Occupancy • 11-9-M t/1
r. 'r~ , i
ofia_ CITY OF COSTA MESA
9 P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
), I Ai
/' z,
' Va DEVELOPMENT SERVICES DEPARTMENT
-IfT!REDy
New State Law:
Swimming Pool Safety Act of 2006 (Assembly Bill 2977)
Effective January 1, 2007
California Health and Safety Code Section 115928 "(d) Whenever a building permit is issued
for the remodel or modification of a single family home with an existing swimming pool,
toddler pool, or spa, the permit shall require that the suction outlet of the existing swimming
• pool, toddler pool, or spa be upgraded so as to be equipped with an anti-entrapment cover
meeting the current standards of the American Society for Testing and Materials (ASTM) or
the American Society of Mechanical Engineers (ASME)."
Address/Permit Number
Permit Applicant or Contractor's Affidavit (Please check appropriate box):
n There is an existing swimming pool, spa, or toddler pool on this property. I will
install an anti-entrapment device that conforms to this law, and I understand that the
installation of this device is required prior to final building inspection approval.
[� There is no swimming pool, spa, or toddler pool on this property.
/ `AeY' iiE_ti •
Name (please pint)
/
Signature/Ill te
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)754-4856 • TDD(714)754-5244 • wv.v.ci.costa-mesa.ca.us
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. 4- (r .3 DATE/AZ -H-49
LOT NO. 41-
ADDRESS / p g P� a
The developer of the above entitled tract desires to sell the
above set forth lot prior to the time that the tract has been
completed and its streets accepted by the City of Costa Mesa .
The undersigned, by executing this agreement, acknowledges
that ( -they) (aws- were) advised
that this tract has not been given final inspection nor has
it been accepted by the City of Costa Mesa as having complied
with the conditions of approval which were imposed by the city
at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by
surety bond.
The undersigned agrees to indemnify and hold the city harmless
from any claim resulting in damage or personal injury to the
undersigned by reason of the aforementioned 4uncoleted condition.
BY Th
urch'r
B& , I —%,
Developer . d7• authorized
represent. ive
Lender
VPROJECTADDRESS:
1816 ALASKA AV UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 061446
OWNER'S NAME: S I EGEL LYNN
ADDRESS:P ,O, BOX 235 PERMIT NO: B 061246 PLAN CHECK NO: N GOVT: N SUPP: N
DOUGLAS CITY
CA. 96024 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
A ( 916 ) 463-4639
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : APPLY 30YR COMP OVER WOOD SHINGLES SQ FT: 3, 610
ADDRESS: UNIT:
CLAIM VALUE: 3, 610 . 00 CALC-VALUE: 3,610 . 00 GROUP OCC: R-3 /M-1
L PERMITTEE:COLLINS ROOFING COMPANY ( 714 ) 891-7475
ADDRESS: 15672 WILSON ST COMMENTS: PERMIT INCLUDES SOME HOT MOP WORK IN REAR OF�EHOME,
MIDWAY CITY CA 92655 #****** ##*�r** x*x�E******yP**�E*******�k**�6#1�#AEyk#�r**********### >E##***************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. SETBACKS
CITY LIC.:030664 STATELIC.:3576 4igli &C 39
Date: 3' 4 X93 signataS —Ar,ppMAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereb -Hum lh. I have a,,Ccertificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
'nmpensatioo,nso ranre., pa rtifig,copy thereof Section .00,Lab—C1—
U7/01 /93
LEFT; FT IN RGHT: FT IN LEFT; FT IN RC>HT: FT IN
LILY NO.:11 V 0000 77 P.DATE: /
coMPANY:STATE FUND PARKING REQ; PROV: PARCEL: 13958110 ZNE: REF NO:
0 Certified copy is hereby furnished. til Certified i i is filed ' e y Building Division. PLANNING NOTES>
lik
%-.-- Date: .--t9 3� Applicant: D E V E. L O P M E N T SERVICES REQUIREMENTS
EXEMPTIONTROM WORKERS'COMPENSATION DECLARA'IN: (Th.section need not be completed if the permit is for one hundred($100)or less).
I certify that in the performance of the work for which his p• • is issued,I shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of Calif. ZONING APPROVED BY DATE:
Date. signature; BUILDING APPROVED BY : DATE:
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ,
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• /n r DATE: .3/ 3
which this permit is issued(Section 3097.Civ.Cf. ****'#*')E**"1f'!E'***'***'*'****�P'***k .'�x3F+& * ** */t #' **k*******#******it• *3.##******
LENDER:PROVIDE SMOKE DETECTORS *********************************************' ****************rf***************
ADDRESS: PER THE 1991 ED, OF UBC LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
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 63 , 00 , 50
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or That he/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). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
structure is not intended or offered far sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 63. 50 0, 0 0 0 , 00 6 3, .J 0 63 , 50 , 0 0
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersel/or through
his or her own employees, provided that such improvements are not intended or otiered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 63 , 50 OVER/SHORT: . 00
orimprovement is soldfsale).)hin 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 SMIP/TOT GRADING PLAN-CHECK
for the purpose 01
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00
50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon •
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware *LIB**'***'************"**'****'**##***#******#*#*************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.&P. C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner SFR 3610 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 610 . 00
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 state codes and the requirements for a 2 ,
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ,.
these provisions. EXPIRED
Date: Applicant: I('k,omplete 1f15 tions
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 slate laws relating to building constructer ereby.. rite representatives of this city to enter upon the above-mentioned e
properly for inspection purposes. (� Oy Slg �_�"^'�
Date: �- - /_3 Signature'�*
•
Driver's License or Social Security u:
z. ••t
1641-46 White—Building;Green—Code Enlorcem•nf:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
r ,
•
;
CONSTRUCTION AND PLANNIN.- "IL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' i
a
3. Electrical Conduit Utility-Undrgrnd. 54. Forms I
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 1
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
I
6. Electrical LIFER Grnd 57. APPROVAL TO COVE R-GUNlTE I
I
7. Footings 58. Electrical Conduit-Undrgrnd. I
8. Foundation ! 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd, 60. Backwash Lines,P-Trap, 0 Undrgrnd. 1 i
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 I
13. Roof Drains 64. Plumbing System - Final
I
14. Rough Plumbing ;i 65. Electrical-Final i
15. Rough Electrical-Conduit •i 66. Solar System-Final
16. Rough Electric Wiring . . 67. Fencing & Access Approval I
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
i
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT I
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro I
i
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush 1
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
i
25. Roof Sheathing 5705 W,/ fes 74. Overhead Hydro
26. T-Bar Ceiling (Structural? & Monocoat W 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 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•Fnal r 80. FOOD CERTIFICATE ISSUED
-I
33. Final Electric Notes:
34. Final Heating & Air Conditioning I 1
I
35. Final Gas Pipe-Test I
36. Hood or Canopy •
^I
37. Final Factory Fireplace • '
38. Final Plumbing I
I
39. Water Service-Final
_
40. Gas Service-Final
41. Solar Domestic-Final
i
42. Backflow Preventer •
-1
43. Backflow Irrigation I
44. Landscape Irrigation System •
{
45. Sound Attenuation 0
46. Handicap Regulations rttp��te�pSP
47. FINAL STRUCTURE & BUILDING }
Stg
48. FINAL PLANNING Gate J"`- 1 -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co i+
51. CERTIFICATE OF OCCUPANCY
No. Date
0-1 X30125
Pato
APR 24-69cwsa001319-" ***137.25
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
R ECpE D D2p BECEIVEO DATE ISSUED
BUILDING L ,q , //'� /` -e y
ADDRESS / �/v eteir�,Rd(a-41fQ j2CL� -4--
ADDRESS
�/
PERMIT/NO.
OWNER Hermes Dev. Co, A.P. NO. �_ uv ! 25
MAIL BUILDING / D r a^ n �_�J
ADDRESS 1104 E. 17th St. ADDRESS O (o �[�/
titui
Z46I3I
D. U CITY Santa Ana NO. TRACT 547-7044 LOT BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOLISH
Z
< LENDER United States National Bank
CL 03
J D BRANCH 190 Broadway Ave. WJ_ J �
-I N OWNER /FIJI
m Ill J ADDRESS San Diego Calfornia
CO Y) // VAL E� Sii ,'
-
a ARCHITECT TEL. USE . N/ e(7-/,�' $ 5/Y"/
UN a9R' `n*n K. Dorius NO. 675-1164 FIRE #3
wWW T ADDRESS 2712 E. Coast H y. Corona D. M. ZONE . TYPE .L GROUP ic4-
-y-
.
APPROVED
W Z CONTRACTOR Owner BY DATE
03
J Ir ADDRESS /(ti
W W TEL. Z INO.OF ,USE OF NEW /1`�� /
ZF CITY NO. ` / ( PLANS 3/ BUILDING (F./!'r/
0 STATE CITY YARDS APPROVED YARDS APPROVED U//
N 2 LIC. NO. 252560 LIC. NO. MAIN BUILDING ACCESSORY BUILDING
D O (FROM C/L STREET)
SIZENO.OF BLDGS.
OF LOT 100 X 50 I NOW ON LOT 0 FRONT 013 FT. FT.
USE OF
EXISTING BLDG. _ R.SIPE is FT, FT.
—
I— SIZE OF
Z NEW BLDG. 1782 sq. f t NO.ROOMS 9 1 /1
9 STORIES L.SIDE V FT. FT.
EXTERIOR WALL ROOF Compo pT+ '��)
V COVERING Stucco I COVERING wood REAR Jr/ FT. _ FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
d
a MAIN BLDGS. ACCESS. BLrnS.
IV DATE
p Residence w/attached garage _ C.U.P#V-aS 0 APPROVED S-).)-6 S
APPROVED (/�/,(A/�/I
cn _HY "✓✓� DATEAI
�'//�� �J
/
0
VI hereby acknowledge that I have read this application and state HOLD FOR SPECfA L F
r that the above information is correct and agree to comply with .,�EUUTR M--\"T..
CC all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
N the State of California. _/78c9 d Y4[)3 J co
V V•T L7 co
Z I hereby certify that I am properly licensed as a contractor under SO. FT. 0
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; a
am exempt from the provisions of the State of California Business 2
VALUATION
and Professions Code, Division C. - .-r 9.
,�,/ PERMIT FEE $ 91. Q w
N
Signature of - `7C m
Permittee it 473- /
PLAN CHECK $4/5• 6J o
u.
Authorized Agent TOTAL FEE $ j
Vn1NLR BERMES DVVET,OPMEW Um L 5-1-69
JOB ADDRESS 1816_Alaska Avenue BUILDING PERMIT NO. 30125
GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Residence W/Att. Garage
AP No. LOT 44 TRACT 6693 FIRE ZONE VALUE $25,473.00 _
INSPECTIONS Si.nature Date - GROUP I & 3 TYPE V ZONE R-1
SOIL I f Z'y/is PERMITS ISSUED
GAS �T?i �L SUBCONTRACTOR I —
// / CYC tea"" Date Number Signature
WATER u S / Z'Z[G7 C� ,r rei(eP/l u,mbin yO� ��
ROUGH PLUMBING / i{Ji/GieCs%�i��? 2-- L�� 7;O?[
PROP. SWR. LINE HOU$E CON. 9z3G/C. �Y �� a".
SPRINKLING SYSTEM / / e/Lt/d. de-yr--2,f( , l!y 'x.19/a,
MISCELLANEOUS `
ROUGH HEATING AND AIR CONDITIONING `i� 7 /5./17
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER E c
ROUGH WIRING^ r�T p //4-p y Heating and Vent. _ • }
TRENCHES W FORMS izg STEEL REINF. n fin f 'fl-(, ��(��pp �������y{{l�! � j 6 -'g./ e �
FLOOR SYSTEM .44 P-77,9 �'�"!lam 'r[/lrr.�Y.�.0=L•c h.-q'J / z,
BOND BEAM n STEEL REINFORCE n ���
SHEATHING /i 7-/(,"--6Q
FRAME AND FLASHING 'i `TrC/
LATHING — IN X OUT Ri "P rn-r9-‘y,
PLASTER, BROWN COAT 9-f-r�7���///
STRUCTURAL, FINAL /
t �/ _
HEATING, VENT., REF RIG. AND A.C., FINAL _ Art iAi 1 i',d yam'.. r/ 4-
PLUMBING, FINAL AND GAS TEST Cf4 fl'ff"4j' '
ELECTRIC, FINAL jr22
BUILDING, FINAL 7j/ />- / -e1Lo" ?' )-,-
SPECIAL REQUIREMENTS 4 _I
ADDRESS OF SALMNO: 1816 ALASKA AV ' UNIT: fri CITY OF COSTA MESA — BUILDING PERMIT
mw dgeem: DE WILDE, RONALD A FLOOD : AE-37 PERM NO: B 074034
ADDRESS: DE WILDE, JANE
1816 ALASKA AVE PERMIT NO: H 074034 PLAN CHECK NO: N GOVT : N SUPP : N
COSTA MESA, CA 92626979-6177
APPL.MAIURO ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT ORENG?IEER: MAO.: JOB DESCRIPTION : T/OFF ROCK ROOF & REROOF W/SAME SQ FT: 2 , 000
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 2, 000 . 00 CALC—VALUE: 2, 000 . 00 GROUP OCC: R-3 /
coNTRACTGRSNAIIE: CHAMPION ROOFING ( 213 ) 259-0451
CCNIRACTORSMMUNG 3257 VERDUGO COMMENTS : SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY
ADDRESS: L .A. CA uc.No.: 429481 ****************************************************** -+E*******dE+E*****+E->Ex+E*****
90065 AMT, Z ON ING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter S $ E TB ACK $
(•. '- drq with Section 7000)of Division 3 of the Business and Professions ode,end my license le In lull lore,end effect.
ITYu•.w..42725uc.cus': C-39 uc.No. 9 81 1
EXP: N /95 MAIN BUILDING ACCESSORY BUILDING
'
�/ iLIP FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
Date: Contract . �c LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
0. ER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt •• 4 Contractors License Law for MM
allowing reason ISedion 7031.5 Bunten and Professions Code:Any city or county whim • -.a .omit to construct der,Improve. PARKING REQ: PRO V: PARCEL: 13958110 Z NE: REF NO:
demolish,or repair any structure.prior to its issuance,also requires the applicant for such•. H to I.a signed statement that he or she PLANNING NOTES>
is licensed pursuant to the provision of the Contractors License Law[Chapter S(commend•. Section 7000)of DySlon Sc?the
Business and Professions Code]or that he or she is exempt therefrom end the basis for the alleged exemption.Amy violation of Section >
7031.5 by any applicant for a permit subjects the applicant to s chit penalty of not more than lie hundred dollar j5500j). **************.********************************************************DRi********
❑ I,as owner o the property or my employees with wages as their sole compensation,will do the work,end the structure is no Intended D E V E, L OP MEN T SERVICES REQUIREMENT S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not appy to an Omer of property
who bolds or improves thereon,and who does such himself himsor herself or through he or her own employees,provided that such
improvements are not intended or offered for eels.If,however,the building or Improvement is sold within one year of completion,the ZONING APPROVED' BY DATE: •
ownerbuilder will have the burden of proving he or she did not build or improve for the Wrpcee of sale).
o I,as owner of the properly.am exdtshey contracting with licensed contractors to oonstrud the project(Section 7044,Business and BUILDING APPROVED BY : DATE: _ -
Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon and who
conlrecb for such projects with a contractor(.)licensed pursuant to the Contractors License Law). C. r
❑ Iant wend under Section: B.AP.C..for this reason: APPLICATION ISSUED BY: A a.& DATE: )
********************** iii; **********-4S **
Date: Owner: LEGALIZATION: N F E E S MMARY STRUCTURAL S GME T:Y
1 do hereby certify that I am aware of and understand the requirements of Cdiomia Health and Safety Code Sections 25505,pcs+1,end
25534,and that I or any future building occupant will/soil no(circle one)need to°omplywhh said date codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification from the Abri tyRey, agement Ditlda.Residentialconstruction appicauions are exempt from these
provisions. PERMIT 45 . 00 . 50
Date: Applicant: - SMIP/NON—RES
PLAN . '
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following deda.mtons: ISSUE FEE
❑ Ihave and wiimaintain ecedcateorconsent toseKiruure lc(workers'oompensaion,nprovidedfor bySedbn3700othe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL ' _ PAID DUE
cde,t«moped mance of me work for wham the permb is Issued.
TOTALS----> 45 . 50 0 . 00 0 . 00 45 . 50 .•,. ` 45 . 50 . 00
I have and wit maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the 4 ft, •
work for which this permit is issued.My workers'Zngne y�rr(Ileurance watered poAW number are: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 45. 50 OVER./SHORT: . 00
Canter: U 4 1 t1
Policy Number. LUYVU080 05/01 /96 BLDG PMT
00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TO.OT GRADING PLAN-CHECK
rthis asdion need nor be completed)the pearl is for one hundred dollars(SI,, or lass.)
❑ I candy that in the performance of the work ler which this permit Is iso shell not empty y panon in any manner so as to
become subled to the workers'compensation lawn of California"... t..• H I J:•... Sc. subs.• to the worke. *******************************************************************************
.pe.... lion• • Bions of Sedb 700 of the labor Code,I • with th•f previi I N D I V I D U A L F E E B R E A K D "O W N
•ate: --•
-4 Apptheth . • •
AL.?sesi /�
Warns••:Failure to azure workers'compensation coverage l undewM,end shall a . employerto criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Ma w to one hundred thousand dollars($f04000)•In addition to the coat• ton dents as pnv/dad ror In �.
Section 3705 of the Labor Coda Intens,and attorney's/era SFR 2000 REROOF BY VALUE RESIDENTIAL NOZONE , `1 . 00 - 2, 000 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that M. . a construction lending agency for the END OF FEES — t
performance of the work for which this permit is bald(Section 3097,Ci.C). r
LENDERS NAME:
LENDER'S ADDRESS: r
I certify that I have • •this application end state that the above Information is cored.I agree to comply with all city and county ordinances y (n
and slate laws . hog to butdhg construction end hereby authorize repmentativee of this dry to enter upon the above mentioned property ��(.�K E DETECTOR s��v.r E'•'1 1
or .pudic r Poses. KIMBERELY MILLER S )
i—ter/moi _ REQUIRED l ;g�5 ��
--Aornr •Tl _ i�� . la's Date:69 / SCC
Are. . +., 'nit Enka" o? cost \
N VIZI
(5151•45.WP) Wh ng&Safely:Green-File: anary-Applicant:Pink-Revenue:Goldenrod-Assessor CII
JNSTRUCTION AND PLANNING • POC SPA
oAPPROVALS Permit# - Date Inspector APPROVALS Permit# Date Inspector
+,. Temporary Electrical Service or Pole 52. Pool & Equipment Locatidn,' A
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 OF ER Grnd. 57. APPROVAL TO COVER-GUNITE -
7. Footings 58. Electrical Conduit•Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test •
9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, D pdrgrnd.
tJ
10. Structural Floor System • / 61. APPROVAL TO DECK - '
11. Property Sewer Line & House Conrfection 62. Backwash & Receptor-Firfal (
12. Sewer Cap - 63. Heater &Vent-Final '
13. Roof Drains64. 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 1
..
17. Rough Wiring Sign 68. APPROVED FOR PLASTER'1NG -
i
18. Rough Electrical.T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT
20. Rough Factory FireplaceAPPROVALS 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
25. Roof Sheathing q_Z[-elm a 4,(7 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding ' • 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
LI
33. Final Electric Notes: 1'i
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 Domestic-Final
42. Backflow Preventer e 71 9 - --fear m,f
iC AO-
43. Backflow IrrigationA`��,��/)_ Cr�P ko 76 v y
44. Landscape Irrigation System ����'"` *c. �.,'
45. Sound Attenuation
qb`1llJ /ter- ofF .(/or crosal,Xr:�
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ` -G_Q9' 4_,6 O
4$, FINAL PLANNING /� -
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co ., ,t_
51. CERTIFICATE OF OCCUPANCY
No. Date
ADDREVSS OFBUILMNG: 1816 ALASKA AV UMT: CITY OF COSTA MESA - BUILDING PERMIT
OWNEBWNAUE IF KNONN: DE WILDE, RONALD A FLOOD : AE-37 PERM NO: IB 074286
^-` AeDBEss: DE WILDE, JANE
1816 ALASKA AVE PERMIT NO: IB 074286 PLAN CHECK NO: N GOVT : N SUPP : Y
:OSTA MESA,CA 92626979-6177
APPL.MIMING ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: OTH STR PURPOSE: OTH
ARCHITECT ORENCINEER: UC.NO.: JOB DESCRIPTION : T/OFF ROCK ROOF & REROOF W/SAME SQ FT:
ARCH.OR ENG.'S ADDRESS: LINT:
CLAIM VALUE: CALC-VALUE: GROUP OCC : R-3 /
CONTRACTOR'S NAME CHAMPION ROOFING ( 213 ) 259-0451
CONTRACTORSMAIUNG 3257 VERDUGO COMMENTS : REF: B-74034
ADDRESS: L .A. CA uc.ND.: 429481 -x********tt******Rt***********x->E-xM -***-x**M************->f***M****x**x-****K- -->E +tMN***
90065 DMT: Z ON ING R EQU IR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I ant licensed under provision,of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force effect.
uc.7s4 725 LIC.cuss: C-39 a EXP 11 /95 MAIN BUILDING ACCESSORY BUILDING
GG66//�I�G\\[[ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
at ( �� Contractor ( LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
NER BUILDER DECLARATION: hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the
��j bwvgreason(Section]031.5BusiessendPrda„ronscode:Anyctyaeaantywmmeciyarnsapecmumwwwd,anecimprove. PARKING REQ: PROV: PARCEL : 13958110 ZNE: REF NO:
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
PLANNING NOT E CC���� )'
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the H✓ '' I ,
Business and Professions Cork(or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >. l v
7031.5 by any applicant for a permit subjects!he epplkantto a civil penalty of not more than fire hundred dollars[S5001). ***************!****************************************************** *********
❑ I.as ow er of the property or my employees with wages as their sole compensation.rdB Co the work.and to stmdure is not intended D EV E j L OP MENT SERVICES R E Q U I R E M E N T 5
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply loan awns of property
who hike or inproves thereon,and who does such work himseff or herself or through he or her own employees.provided that such
improvements are rot intended or offered for sale.H.however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE: I
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I,as owner of the properly.ant exduswety contracting with licensed contractors to construe the project(Section 7044,Business end BUILD I NCAPPROVED BY
Professions Code:The Contractors License Lew does not aim*
to an owner of property who builds or improves thereon and who �. DATE: r
ppy
contracts for suchprojects with a contmctor(s)licensed pursuant to the Contractors License Law).
❑ Iamexempt under Section: B.AP.C.,for this reason: APPLICATION ISSUED BY: Ad DATE:
**************.W******* t * ************9* *1r
Date: Owner: LEGALIZATION : N F E E SUMMARY STRUCTURAL S MEI, (: Y
1 do hereby certify that I am aware of and understand the requirements of California Health end Safety Code Sections 25505,25533,end
25534,end That I or any Mute building occupant will/will not Icircb orae)need to comply with said stale codes end the requirements for
a permitfor construction or modification from the Ai Ouaby Management District.Residential construction appicmions are exempt from these PERMIT BLDG
30 p00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
Provisions.
Dale: Applicant: SMIP/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE
❑ I have and vril maintait a certificate of consent lo seff-insure for workers'compensation,as provided for by Section 3703 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
ode.for the performance of the watt for which this permit is issued.
I have and will maintain workers'compensation insurance,es required by Section 3700 of the Labor Cade,for the performance of the TOTALS----> 30 . 00 0 , 00 0 . 00 30. 00 30 . 00 00
work for which this panne is issued.My workers'compensation insurance carrier end policy number are:
Career: ZENITH EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 30 . 00 OVER/SHORT: . 00
Policy Number: 20400080 - 05/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed r the patina is for one hundred dollars($100)or less.) 30 . 00
❑ I certify that in the performance of the work for which this perms is issued,I shall not employ any person in any manner so as to
become subj to the workers compensation laws of California, and agree that R I should become subject to the workers' *******************************************************************************
ru
tio sic Section 3700 of the Labor CodeI shall forthwith
compxwith t oosse P'°`^T'/Q�^ /� INDIVIDUAL F E E BREAKDOWN
C \ ApplicantV V V4-�re to secure workers'compxuadon coverage fa unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST 7: _ TOTAL-T CAS T
. II fines up to one hundred thousand dollars($104000),In add?flon to the coat of compensation,damages as provided for In J. =- 1Ls S
Section 3705 of gra Labor Cods,interest,and attorney's fess INS 1 BUILDING RE-INSPECTION FEE 30 . 00 uR.?E:xlcc - •.:.P•' 3 vi-irtO 10Br6
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that(here is a Instruction lending agency for the END OF FEES
performance of IM work Sithis penpermitts issued(Section 3097,cin.C).
LENDER'S NAME: (/////
LENDER'S ADDRESS:
1 certify that I have read this application and stale 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 representatives of this city to enter upon the above-mentioned property
for inspection purposes. MIKE ALLEN c DUF•e_ IC-tti,YL� Lam: f:.,_._Y_ye*j�
° 9i 0^1li:•f. '- .-r,i 442`. .e o e 3-*
,�'�•��` __e Dale: DATE; 0°/2.4/9.`.i TIPEt 10:7 .
Signature of Owner/AgentlApplcann
•
(5151-45.WP) White-Building&Safety;Green- ., ary-Applicant:Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING Kit SPA
r }4PPROVALS Permit# Date Inspector APPROVALS Permit # _ Date Inspector
• 1. Temporary Electrical Service orrPore' 52. Pool & Equipment Locatidn •
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement C
3. Electrical Conduit Utility-Undrgrrid. - 54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
6, Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 i,lndrgrnd.
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
25. Roof Sheathing et,"Z`ir Si 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 PREY. 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 Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING q�_ 6(N/.L
L (/
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date -