HomeMy WebLinkAbout2742 ALBATROSS DR - Building PermitsCITY OF COSTA MESA '
`� pMFSy BlIILDING DIVISION
i�� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
k�.b.�m'�
PERMIT NUMBER: 609-00078
PERMITTYPE B ROOF2 STATUS: ISSUED
APN: 13947618 DATE ISSUED: 05N412009
ISSUED BY: BJK
JOB ADDRESS: 2742 ALBATROSS DR CM
Vicinity: RESIDENCE AND ATTACHED GARAGE
Squares: 3000
Suite/Unit:
Valuation: $13,000.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE: FRONT PORTION OF RESIDENTIAL ROOF (21 SQUARES) WITH
STEEL ROCK (ICC #ER-5218; 1.5# PSF). T/O"EXISTING SHAKE ROOF, REPAIR/REPLACE SPACE SHTG AS
NEEDED, 1 LAYER SHARKSKIN UNDERLAYMENT, REROOF WITH "LIMITED LIFETIME STEEL ROCK WITH
APPEARANCE OF SHAKE. REAR ROOF (9 SQUARES): 7/16 OSB SHTG, 1 LAYER SHARKSKIN UNDERLAYMENT,
APPLY "30-YEAR COMP SHINGLES." PITCH 5:12
OWNER: MOOR�, THOMAS R
PHONE:
APPLICANT: MORRIS, TIM
PHONE: 714-572-8714
CONTRACTOR: MORRIS COMMERCIAL ROOFiNG INC.
Address: 2138 TYNES DRUnit:
City/State/Zip: PLACENTIA, CA 92670
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$223.25
$0.00
$1.00
$224.25
Address: 2742 ALBATROSS DR
City/State/Zip: COSTA MESA, CA
Address: 2138 TYNES DR
City/State/Zip: PLACENTIA,CA
License No.
License No.
PHONE:
License No. 887623
714-572•8714
CELL:
PHONE:
PHONE:
Unit
Unit: :
NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMI7 EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPEC710NS: 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 resWt in the expiration of this permit.
CO�E N. INSPECTONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 FinalRe-Roof
207 Final BlocklRetaining WaU
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
��TF INTITIALS
A
COOEt INSYEC110NTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
2/2 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
UATE IN7I71AL5
� .
WORKERS' COMPENSATION DECLARA710N:
I hereby aNirm under penalty of perjury one o( the following declarations:
� I have and will maintain a certifcate of consent [o sel6lnsure (or wo�kers'
compensation, as providetl for by section 3700 of [he Labor Code, for Ihe
performance of [he work for which Ihis permit is issuetl.
,1,� I have and will main[ain v.orkers' compensation insurance, as required by
� ec n 3700 of the Labor Code, for the pedormance ot the vrork for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are�� � � \
C0[rier+ �t N �h
(Thrs sMron nttd r(p't�be Lwfm/ple(etl tli�hle cp�eimrt rs vdluetl at one �undretl tlollars (5f00) oi less )
Policy�fdomber: � 7� l �P�.�[ u
❑ I certify Ihat in ihe performance of �he work for which this permi[ is
issued, I shall not employ any person in any manner so as to become subject
to lhe workers' com � R-leay-e nia, and agree that if I should
become sub' the workers' compensation p visions of Section 3700 of
the Labo ode, hall forthwi[h compty with these provisions. j �� _
/
WARNING�AILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLfARS
($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 aKrm lhat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of D' ' he Business and Professions Cotle, and
my license is in (u �lrce and effec�. �7G�
L'��t o�� Clascy� —J /
' O
C n acto' f aiure �31sr-
CONS UCTION LENDING AGENCY:
� I he y aKrm tha[ there is a consiruclan lending agency for the
peAormance of �he wurk fa wfiich Ihis pertnit is issued. (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
SignaWre
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalry 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 lo its
issuance, also requires ihe applicant for such permil b fle a signed slatemen[
that he or she is licensed pursuanl to the provisions of the Contrectors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business antl Professions Code) or Iha[ he or she is exemp[ theretmm and
the basis (or Ihe alleged exemption. Any violalion of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve hundred tlollars ($500).):
❑ I, as ovmer of Ihe propeny, or my employees wiih vrages as their sole
compensation, WILL DO THE WORK, and the structure is not intendetl or
oBered for sale (Sec. 7044, Business and Professions Code: The Contrectors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such vrork himself or herself or ihrough his or her ovm
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvemenl is sold within one year of
completion, the owner-builder will have the burden of provinq that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construc[ the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not appty to an ovmer of
property who builds or improves thereon, and who contracts for such project vrith
a contraclor(s) license pursuant to the Con[ractas License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre
309-a6 (3/0])
+ ,
Owner ID veri�ed by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (rype of document, i.e. - property taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlrfy that no excavalion fve (5) or more feel in dep[h in[o which a
person is requiretl [o descend, will be made in connection with vrork authorized
by ihis pertnit, and that no building siructure, scaHolding, falsework, a demolition
or dismantling thereof, vrill be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from Ihe tlivision.
Applicanfs Signature Da�e
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERtALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupant need to file antl
certify a Business Plan for emergency response to release or threatened
release ot a hazardous material? ❑ Yes ❑ No
(Section 25505 0( [he Cali(ornia Health and Safety Code requires, with some
exceptions, ihat a Business Plan be filed with the Cosla Mesa Fire
Department by every business which has at any one time during a reported
year a quantity o( 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 Ihe applicant or present or tuture building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
excep�ions, requires registration wi�h Ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry 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 al s�andartl
tempereture and pressure).
3. Does or will the applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevention Pmgram for acWely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safery Code provides that the
Costa Mesa Fire Department may require ihe preparation, certifca[ion and
filing with lhe Fire Departmen[ of an RMPP by businesses which are requiretl
to register acutely hazardous materials with the Fire Department.
4. I( an RMPP is presently required, has Sec�ion 25534 of Ihe Califomia
Health and Safety Code been fully complied wi[h? ❑ Yes ❑ No
5. Does or will the applican[ or present or future building occupant require for
the work which is the subject of this application a permit for such constmction
or motlifcation from the South Coast Air Quali[y Management DishiCt or from
any other air polWtion control dislnct or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia Govemment Code requires that the requested
information be fumished on applications for non-residential building permits).
6. Will any part of the facility lo be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
Qf'yes", Ihe faciliry must meet Ihe requirement of Sections 25534 and 42303
of the Califomia Health and Safety Code).
7. I( a permit from the South Coast Air Quality Management District or other
air poliution control district or agency is required for the work which is the
subject of Ihis applicatioq have all of the tlisclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance from the appropriate air pollution
control oRcer).
CERTIFICATE OF COMPLIANCE I ceAify that under penalty of perjury the
iMormation given above is correcL I agree to comply with all state laws and
city ortlinances regardinq Hazardous Materials and Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correc�. I agiee to comply with all state laws and city
ordinances relating [o building construclion, and authonze representatives of
the Ciry of Cosla Mesa ro enter upon the above-described pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until finai inspection.
Sign egalOwneqsj Da
U
ndlorAN ze4A pLcanl ie
ADP���ant to fill in all spaces except those within �eavy Oortler lines antl si9n ail aoo�ovriate tleelantions. / 2( QB 6/ I 2/84 c�r_� a0 T_
CITY OF COSTA MESA CONSTRUCTION PERMIT- PERMIT NO. TRACT NO. LOT NO. UNIT NO. �' ' 4
ProjectAddress Z�42 Albatross Dr. � ���'� �
qpplicant'sMailingAddress 1872 N. Case St.� OYang2 66 TVPEOFCONSTRUCTION NEW Aoo aLTERATiorv REPAIR�
MOORE THOMAS R. 979-5325 � CONVERSION ❑ DEMOLISH ❑ OTHER q.p. # � Zone
Owner'sName � Phone DESCRIPTIONOFWORK/USEOFBIDG. �'1�anoa nnt Fnrnnro-anA
Address 2742 Albatross Dr. , Costa Mesa 2' - on A a d a i f S Main Building: Accessory euilding: ;
E Z
Arch/Eng. License No. TVPE OF PERMITn GRAOING FOUN�A710�rv} STRUCTURAL T Front p
Address - ❑ TENANT y{� ELECTRICAL ❑ PLVMBING �q MECHANICAL A Reaf ' . N
Contractor'sNamP Anderson Air Conditionvno�e 998-6850 �'OTHER ' _ .
PROJECT DESCRIPTION 5a. FT. oCCUCANCv C Fli9ht N
Addresslmailing) 1872 N. CH50 St. Orange 92665 .
CONSTRUCTIONTVPE VAWATION$ g Left
` CjtyLiC¢nSeNO. OL�iZ3H ZONE GRADINGCU.VDS. ACRES - R
�a LICENSEO GONTRACTOR OECLA ION Ping. Ref. # Parkin9 Req./P�ovided E
1 hereGy atfi�m [hat I am licensetl tler rovi5ion5 ( harter 9(commencing Remarks: Pldnnin9 NOtes: M
/ with section 7000) ot Oivision 3 t[he B ss ntl Prote55ion5 Cotle, antl
\ my license is in full force antl effec . ' ' � � � T
� License Class — i en No. 25!S�0 , S'
Date �+�R/R4 ' Signature PLUMBING FEES •
WORKERS'COMPENSATION E L R ON � Ba�Sink ShOw2f5 � '
1 hereby aHirm that I have a certitic te b m sent ro self-insure or a certi(icate ELECTRICAL FEES
ot workers' Compensition Insuran e, r a certltietl c thereot (Section gackflowPreventer - ServiceSink
3800, Lab. C.) � • ' . AutOmatiC WaSher � Transformef ❑ 15-50 KW
Poiicv No. 440-83 om y � e und ' Backflow Irrigation - Sewer Ca � ❑ 50+ KW
P ConstructionPoleSub. '
L] Certifietl copy is hereby furnishetl. � '
�'J cercitie� �cqpy is filetl with the cit I i v' io Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps �
Date �/�i/ft�+ Appli[ant
EXEMPTION FROM WORKERS' P SATION ECLARATION Cldrifier5 . $OIdfC011eCtOrS Dishwash¢r M¢t¢r ❑Over 100dmp5
(Thizsection neetl not be wmplet i the parmil is f one huntlretl ($300) or '
less). Dishwasher Solar Pipin9 Dryers ❑Gas ❑Electric Sub Panel
I certify [hat in tM1e performance ot t e work for which this permk is issuetl, I
shall not employ any person in any manner so as to become subje<t to the Drinking Fountains Solar Tank � . Fan � Motors 0-1 HP 1%- 8
WO/kets' Compensation Laws of Cali(omia. , ,
Date Si9�ature ' Floor Oreins Swimming Pool w/Spa F.A:U. Inc. Solar 09-15 HP �i6-15+
NOTICE: If, af[er making this tleclaration, you shoultl become subject to the
Workerz' Compensation O�ovisions of the Labor Gotle, you must forthwith FloorSinks-' Urinal — Fixtures - - Microwave
comply witn such p�ovi5ian5 or this pe�mit SM1all be tleemetl revoketl. '
CONSTRUCTION LENDING AGENCV GaSServiCe Outlets Wa[efCloset � � DevlCeBoxei PoleLiht
1 hereby aftirm thal there i5 a construction lentling agency tor the performance 9
oi the work far wh[`ryAthis Oermit is -issuetl (Section 3097 Civ. CJ Interceptors WatEr Heater Outlets Range '
Lentler's Name 1V/
Lentler's Adtlress � - Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION � �
1 hereby affirm that I am exempt trom the Contractor's License Law for the • l.avatories .
followin9 reason (Section 7031.5 Business antl Professlonal Cotle: Any city ar Garbage Disposal Standing Sections
ounty which requires a permit to wnstruct, alter, improve, Gemolish or repair P—Trap Generator �65 KW �5-15 KW Trosh Com actor ,
ny structure, prio� to its i55uance, also �equire5 the applicanYtor such"pe�mit P
!o tile a signetl siatement that he/she is licensetl pursuant to Ihe provisions oi Roof Drains �
� he Contractor'S LiCenS¢ Law (Chapter 9(commencinq with Section ]000) of
Division 3 of tne Business antl Profezsions Cotle) or that ne/she is exempt
therefrom antl the basis Por the alle9etl exemption. Any� violation of Section
7031.5 Gy any applicant for a pe�mi[ subjects the applicant to a civil
�endlty of not more than tive huntlretl tlollars ($500). ,
LJ I, as owner oi the pro0erty or my employees with wa9es as their sole Reinspectiom Fee $15 IOsue Fee $ 3
comoensation, will tlo tne work, antl the structure is not intentletl or otferetl Reinspection Fee $15 Issue Fee $ 3
tor sale (Section 7044, eusiness antl Professional Cotle: The Contractor's . MECHANICAL FEES
Licenu lzw tloes not apply to en owner ot a property wno builtls or improves
thereon, and wno aoes sucn work himself/herseli or throu9h his or her own DEVELOPMENT $ERVICES REQUIREMENTS:
employee5, proviCetl that suth improvements are not intentletl or ofTe�etl fo� Boiler HOOd O� Typ¢ I ❑
Sale. If, however, Ihe builtling cr improvement is soltl within one year of com- �nOpy Typ¢ I I. ❑ Zoning Approved By DatB
pletion, the ownet will have the burtlen of proving he/she tlitl not builtl or im- Duct - Under Ground BUilding ApprovOd By DdtO
�rov¢ to� Ihe putpose ot sale). /�
I, as owner of the property, am exclusively contracting wifh licensetl con- Duct -Structural Refrigeration System � Appliption luued By Dat
Vactors to construct the pro�ect (Section 7044, Busine55 antl Professions Cotle:
The Contractor's License Law tlaes not apply to an owner ot property who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES
builtls or improves thereon, antl who con[racts for such prolects wlth a com -
tractor(sl license pursuan't to the Contractor's License Law). I am aware that Exhaust System ❑ MWtiple ❑ System Repair/Altera[ion BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance shoultl be provitletl to me.
- PLAN CHECK $ PERMIT
❑ 1 am exemp er 5ection B. & a. C. for this reason Firepl/Fact. Bit. ICBO # 2%-HP COIR ressor 4 �� PLUMBING $ ISSUANCE $
�ate owner Heating System & Ducting COO].1R C011 �+ � PLAN CHECK 25% $ ENERGV P.C. $
I hereby ertity t at i have read tnis pii ation and st5te mat the above �' 0.100,OOOBTU �100,OOOBT Q.�Q ELECTRICAL $ 5.5� GRADING .$
informa[i n is corr pt. I agre t c mp h all city antl county ortlinances
antl state laws �e t/ n9 to il co tr � ian, a hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of I' tit t e r u n e abo - ention�for E�iC1C FAR 2.��
inspectlon s .
MECHANICAL $ ��n TOTAL FEE $ ii _ S(1
Signature a e peinspection Fee $75 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' nse or 55 # —
CMF 0865-46, rev.4/84 White - uiltling; Canary - APPlicant; Pink -Accounting; Galtlenrotl -Assessor � '
CONSTRUCTION AND PLANNING L& SPA
APPROVALS Permit# Date Inspector qppROVALS. Permit# Date Inspector
1. Temporary Electrical Servlce 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 Gmd. �� • ,. ,. 57. APPROVALTO COVER-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. 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 O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing . 74. Overhead Hydro ' �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ' 79. FINAL INSPECTION
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � �%r� (.�� Notes: '
34. Final Heating & Air Contlitioning �y/ LgQ
35. Final Gas Pipe-Test -
36. Hood or Canopy � � � - �
37. Final Factory Fireplace �
38. Final Plumbi,ng
39. Water Service-Final � "
40. Gas Service-Final •
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation '
44. �Landscape Irrigation System �
45. Sound Attenuation �
46. Handirap Regulations _
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�
ADD��eanl to fill in all spaces exce0� tltose within heavy Oortler lines antl si9n all approDria[e tleclarations.
CITY O� COSTA MESA CONSTRUCTION PERMIT PER T NO. TRACT NO. LOT NO. UNIT NU.
Project Address '�
ApplicdnYs Mailing Address
� Owner's Name T..P AiY�'i(L�QP /��� Phone
Address �%7SL� �rlll/f'TQl� L/`"' �
Arch/Eng. �� License No.
Address p.���p�/
� Contractor's Nam � Phone �SZl7LOp
G �SZl
�. Addresslm�'I'nnl ��p �� �tl
City License No �3�d
LICENSED CONTRACTOR DEGLA0.ATION
� M1ereby a(tirm that I am li[ensetl untlev provi5ion5 ot Chartev 9(commencing
with Section ]000) of �Ivision 3 of Ihe Buziness antl Profe551on5 Cotle, antl
my license is in f W forc et�ect. g �sa i
PLicense Class ' icense
Date Signature
WORKE 5' MPENSATION DECLARATION
I hereby aitirm ehat I have a certificate ol consent to self-insure or a certi�icate
of Workers' Compensa[ion Insuiance, or d certifietl copy thereof (Section
3800, Lab. C.) Cs r�'
�P icy No. d�'p �'lYYK��6U Company% 1j�� %NJA%Q
rtif—letl p�o,-py Is f�letlbwith thehc�y Builf�i�j��,�J� �j� i
Oate�,�h� Applicant �,( /�y( �%���
EXEMPT�ON ROM WORKERS' COMPENSATION DECLAR TION
(Tnis section neetl not be completetl if the permit is for one huntlred ($300) o�
less).
I certify that in the performance of the work fOr which this pe�m�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws ot Calitotnia.
Date Signature
NOTICE: H, aiter makin9 this tleclaration, you shoultl become subject to t�e
Worke�s' Compensation provisions of the LabOr Cotle, you mu5t /orthwitM1
comply wi[h zuch provisions or this permlt shall bE tlEemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby aifirm that there is a construction lentling a9ency for the performance
of the work for which thi5 permit is issuetl (Section 3097 Civ. C.)
l.entler's Name
LentleYs Adtlress
OWNER BUILDEH �ECLARATION
I hereby aftirm that 1 am exempt trom the Contractor's License Law (or the
�c Ilowina reason lSection 7031.5 BuSiness antl Professional Cotle: Any city or
res the
setl our
thelefrom antl the baSK tOr [he allegeO exempUon. Hny viola[�on oi �ec[ion
]031.5 by any applicant tor a�permit subjects tne applicant to a civil
�nalty ot not more tban five huntlretl tlollare ($500).
LJ I, as owner o� the property or my employees witn wa9es as their sole
compensation, will tlo the work, antl the structure is not intentletl or offered
for sale (Section ]044, Business antl Professional Cotle: The Contractor's
License Law tloes not apply to an owner of a property who builtls or improves
[nereon, antl who tloes sucM1 work himself/he�self or [hrou9h his or her own
employees, provitletl that such improvemen[s a�e not intentletl or offeretl for
sale. If, however, the builtling or improvement is soltl within one year of com-
plelion, the owner will have the bu�tlen Of proving he/she tlid not builtl or im-
prove tor the purpose of sale�.
❑�1, as owner ot [he property, am exclusively contracting wi[h licensetl mn-
tractors t6 construct the prqect (Section 7044, Business antl Professions Cotle:
The Contractor's License Law tloes not apply to an owner of oroperty who
builtls or improves thereon, antl who contracts for such projects with a con-
[ldt[Of(Si IICC(152 plllSOd(IL IO II1C COII(IdC[OI'S LICCOSC LdW�. � dT dWdIC (hdt
proot of their WOrkeY's CompenSaUon insurance Shoultl be provitletl to me.
❑ I am exempt untler Section B. L P. C. (or this reason
Date Owner
I hereby certify that I have read tnis application anC state that the above
informatlon is correct. I a9ree to comply wiih ail Gty antl county ortlinances
antl state laws relati94 to byil0ing Cons[ruction, antl here0y authotiie �epre-
sentatives of [his�lty/�fcy�Enter upp,p the above-mentionetl p�operty for
Signdture
-a q� �2
TVPE OF CONSTRUCTION ivF
❑ CONVERSION ❑ DEMOLISH
DESCRIPTION OF WORK/USE OF
QADD U AL RATI LI REVAIR
OTHER — !'19�
TYPE OF PERMIT LJ GRA�ING LJ FOVNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ M� HANICAL
❑ OTHER
PROJECT DESCRIPTION � 5a. F � oCCuaa v
CONSTRUCTIONTVPE � VALUATION$�
ZONE GFApINGCU.VDS. ACRE9��
Remarks: ���,�A
� �S ��',CHGtJA�
Bar Sink _
Backflow Preventer
Backflow Irrigation
rinking Fountains
loor Drains
loor Sinks
d5 $EfVIC2 Ol1tIEL5
Kitchen Sink
Lavatories
P—Trep
Roof Drains
Reinspec[ion Fee � $15
Boiler
Duct - Under Ground
Duct � Svuctural
Duct � Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact BIL ICBO #
Heating SYstem & Ducting
❑0-t00,0006TU�' 100,OOOBT
Reinspection Fee
L �rivers' License or 55 � / � �
CMF OB65-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accountin9; Goltlenratl - qssessor
$15
$hOWEfS n��
Service Sink
Sewer Cap
Sewer Connec[ion
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
N/diEf C�052i
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Fiefrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fae
FEES
$ 3
$ 3
A.P. # -
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planninp Notes:
Automatic Washer
Construction Pole $ub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �65 KW 05-15
Zone
Accessory Building:
ELECTRICAL
Transformer ❑ 15�50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors OO-1 HP O1 Y- 6
Inc.Solar �9-75 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
� Reinspaction Fee �$15 I I Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
Zo�ing Approved By
Building Approved By
Application Issuad By /
FEES
$ 3
SU� pyRV, �O�� FEES
BUILDINGPERMIT $ �V_I� SMIP $ 1�S
,. PIAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENEFGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $ q
MECHANICAL $ TOTALFEE $ �O"�
PLAN CHECK Z5% $
Z
O
N
I
N
G
R
E
Q
M
T
5
\
CONSTRUCTION ANp pLANNING POOL & 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 Plum6ing & Pressure Test
6. Electrical UFER Gmc1. 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 Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOUSPA 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 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 (Structural� & Monocoat 75. Dry Chemical .
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV, FINAL' �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ,
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing ' �
39. Water Service-Final '
40. Gas Service-Final
47. Solar pomesticFinal .
42. Backflow Preventer '
43. Backflow Irrigation
44. Landscape Irrigation System �
45. Sound Attenuation �
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING ``� � � �� ��� �,C��-(�►�,�
48, Special Requirements Completed
49. Electric Release to Etlison . �
50. Gas Release to Southern California Gas Co ^�` '
r
51. CERTIFICATE OF QCCUPANCY '
No. Date � � � '
Lot 89 .
COSTA MESA BUILDING-SAFEfY DEPARTMENT
P.O. BOX 91] CO$�p MHBA, CALIFORNIA
For Applican! fo Fill In Completely
TYPE OR PRINT
BUILDINti
ADDRESS 2 42 Albatross Drive
� COSTA MESA, CALIFORNIA
■ ARCHITEGT
�OO I NOWOI
.'�J
� 6ETBACKLINEFROM �n� 7n�
DESCRIPTION OF WORK
9�2 RbOM9 6 BTORIEB �
�n9 I RooF S a_e 8�
■ US60F
Garage 462 sq.ft.q Plan 51-AR
1 HEREBY ACKNOWLEO08 THAT � XAVB pP.AO THIB FPPLICATION
AND STATE THwT TH! ABOV6 IH CORRECT AND AOREE TO COM.
PLY WITH ALL CITY OqDIN�NC40 ANO BTAT[ LAWB p80UL�TINO
BUILOINO CONSTqUCT10N.
SIGNATURE OF
PEftMITTE
AUTHORIZEO A6 '
�tE RECEIVED
�p $1 1964
fINANCE DEPT.
CITY Of COSTA MESA
APPIICATION FOR PERMIT
BUILDING
For Offtce Use Only
PBCEIPT NO. pE M T O.
� l �n.�
necei�sn er 3 E 3/1VeV� Af'�T l e�u1964
yli 6
ZONING
ZONi NO.O� U980RN6W
R�� rLl�NB /1 BUILDINO W
C.
LEOAL � � n.. ... . ..
BHALL BE LE98 THAN
YARD3APPROVED I VARDSAPPROVED
MAIN BUILDING ACCESSORY BUILDIN6
3�
VAR.#
DATE
�� P '��
N
S�. �. �
THE AMOUNT 6HOWN UNCER VALUATION 18 ROR TH6 �
PUFP08E OF EBTRBLISHINO A PERMIT FEE ONLY. �
VALUATION � m
// PERMIT FEE $ / ✓ �
$ /�� ��/ L C E O�✓/J ¢
1 • 4
COSTA MESA BUILDING—SAFETY DEPANTMENT
P.O. BOX 1Y00
Coata Mesa, California , so�
CONTRACTOR �
Addreu 6558
City I,
State License No.
City License No.
NUMBER TYPE(
TRAGTNO. PECD.BR (rit�� / ���
LOT NO. DATE I66UbD
BUILDING USE (�/O //
a a
Zip Code90043 ouilding
naa�es: 2742 Albatross Dr.
I ��Ou' C36 Owner Moorc�
Te1.No. g53=254• pddress 2�42 Albatross'�Di'.
OR ITEM FEE City COSt.d MC.'Sa'`� �l \'� % TeI.No.��
1 hereby acknowledge, tliat I%ha e read this application and
hine state that the above is, cor?ect and agee [o comply wi[h all
City Ordinances and�Sta[e Laws regula[ing plumbing.
1 cer[ify�_thaf Ijpossess the above valid S[ale of California clas�
Gcation�or,�l am [he legal owner of the residen[ial property de-
scribed above.
��� 1 ceiHfy that t have obtained a permit from the State Division of
,` `� , Industrial Safety foc excava[ions, othec than swimming pools, five
� feet deep or dee�p�er a�nd� /intyo which a person is requiced to descend.
.d"� i� 7;�,. a" Signature oj //C/ /Y��/7fi���
___ _ �.i _�C� _ _. Permittee
wa�er �nener ^
Warer Heater and Vent
Gas System .. . Outlets . . .
Hoof Drains
Water 1'iping Alceration
BackOow Fkeventer
Lawn Sprinklers (Res or NomRes
F'ruperty Sewer ... Feet
Solai Piping
Cesspool, Septic Tank
Sewer Cap
Miscellaneous
Sub-To[al
�n P'ee
Fee �
7m'AL FEE I 6
CMF 0450-46
INSPECTION RECORD
APPROVALS
BLDd. PERNIIT
f
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