HomeMy WebLinkAbout2527 ALDER LN - Building Permits�
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�� �- COSTA MESA BUILDINGSAFETY DEPARTMENT
' P.O. BOX 7200 COSTA MESA,CALIFORNIA92626
For Applicant to Fill in Completety — Use Ink Only
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OWNER
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CITY NeW
CANSTRUCT�ON
BRANCH
ADDRESS
AflCHITECT
CONTRACTOR
ADDRESS
CITV
STATE
LIC. NO.
SIZE
OF �OT
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LIC. NO.
INO.OF BL�DGS.
NOW ON LOT
Separate permi[s are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORA
I hereby acknowletlge that I have reatl this application and state
that the abova info�mation is correct antl agree to comply with
all laws reBulating builtlinB construction, antl I shall not employ
any person in violatian of the workman's compensation laws of
the State of California.
I hereby certify ihat I m prope�ly licensed as a contractor under
the State of Califor 'a usiness antl Professions Cotle, Division 3,
Chapter 9, an t lic ses are in tu rce and af7act, or I
am exempt f o rQ�vi ot th t of California Business
antl Professt e DiJ'j o te
Signature of
Permittee
Authorized ABent
� as� � �-asz�
4 7767 IIO%27/78 I� I'1�.46CKT�f
APPLICATION FOYt��RU@�(�1�41EI���1IT -� a-"-
A.P. NO
BUI I.DING
ADDRESS
IRE
APPROVED
E
DATE
BLOCK
ZONE NO.OF % USE OF NEW
��� PLAN$ C.� BUILDING
YARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDING
DISTANCE BET. I BET. MAIN &
MAIN BLDGS. ACCE55. BLD�
VAR. #"?.� ....,,� _ , DATE ,..
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NOLD FOR
�TE �Q �d �-7i
REOUIREMENTS
THE AMOUNTSHOWN UNDER VALUATION IS FOR
TNE PURPC6E OF ESiA8LI5MING A PERMIT FEE ONLV:
VALUATION PERMIT FEE $
'�~ PLAN CHECK $ , G
$/.f� �� TAX $ B
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CITY OF COSTA MESA
BUILDING DIVISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.costamesaca.qov
�.�Poq�O�s ..`^ 1 FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: P12-00201
PERMITTYPE PLUM
APN: 43917209
JOB ADDRESS: 2527 ALDER LN CM
Vicinity:
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
11108I2012
MDM
SCOPE OF WORK: WATER HEATER, SAME LOCATION
NOTE: Final aqproval of permit shall not.be arented until access to the dwellinq unit(s) is provided for verification of the
installation of smoke and carbon monoxide alarms bv the citv inpsector. See attachement with iob card. (residential onlv)
OWNER: HORIUCHI, ELLEN L
PHONE: 714-777•1238
APPLICANT: HORIUCHI, ELLEN L
PHONE: 714-777-1238
CONTRACTOR: OW NER-BUILDER
Address: PHONE:
City/State: ZipCode: �
ARCHITECT:
ENGINEER:
CELL:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $35.80
TOTAL FEES: $35.80
Address:
- ' � City/State/Zip:
Address:
CitylStatelZip:
License�No. PHONE:
License No. PHONE:
2527 ALDER LN
COSTA MESA, CA
2527 ALDER LN
COSTA MESA, CA
License No.:000000
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.
COOEN. INSPECl10NTYYE DATE INTrtNL3 CODEt INSPECl10NTYPE OAIE INTITIpLS
1676 Fixed System Final Fire Preven6on 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing /:Z �� •�/Z�
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
�WORKERS' COMPENSATION DECLARAT
I hereby aKrm under penalty of peryury one of ine following declarations:
❑ I have and will maintain a certificate of consent to sel(-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of ihe work for which this permit is issued.
❑ I have and will mainiain vrorkers' compensation insurance, as required by
section 3700 of the Labor Code, for the perfortnance of the work for which this
pertnit is issued. My workers' wmpensation Insurance carner and policy
number are:
Carner.
(Ihis secfion neetl not 6e canpleletl i(fhe pennit is valued at one huMretl tlollars (S100J akssJ
Policy Number:
❑ I certiy that in the pertortnance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensation provisions o� Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
Applicanfs Signature
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
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 L4BOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrtn 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 #
Contrector's SignaWre Dete
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrtn that there is a consWction lending agency for the
performance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signatura De�e
�OWNER-BUILDER DECLARATIONS:
I hereby affrm that under penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5,
Business antl Professions Code: Any ciy or counry which requires a pertnit to
constmct, alter, improve, demolish, or repair any stmclure, pnor to its
issuance, also requires the applicant for such permit to f le a signetl statement
that he or she is licensed pursuant to the provisions of ihe Contractors License
Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business
an0 Pro(essions Code) or that he or she is exemp[ [herefrom and the basis for
the alleged ezemption. My violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than fve hundred
d�ol/lars ($500).):
� I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and lhe structura is not intended or
oHered for sale (Sec. 7044, Business and Professions Code: The Contrectors
License Law does nol 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 improvament is sold within one year of
completioq the owner-builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the projed (Sec. 7044, Business and
Professions Code: The contrectors License Law does not apply to an ovmer of
property who builds or improves Nereon, and who contracls for such project with
a contractor(s) license pureuant to the ConVactors License Laws.).
❑ I am exempt under sec.
Business and Profassions Code for this reason:
Owner ID venfied by �._ _�!s license. ❑ Yes ❑ No
Dnver's License No. Expires:
Verifcation of Ownership by (type of documen[, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify Uiat no excavalion five (5) or more fee'%fi depth into which a
person is required to descend, will be made in conneclion with work authonzed
by this pertnit, and that no building structure, scaffolding, falsework, or demolition
or dismantling ihereof, will be more [han thirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Calitornia 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 vrork from the division.
SignaWre Oa[e
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or (uture building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release o( a hazardous material? ❑ Ves ❑ 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 quaMity
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 m file
a regisVation form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registretion with the Cos[a 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 at standard temperaWre and
piessure).
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 Safery Code provides that the
Costa Mesa Fire Department may require [he preparation, certifcation 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 Sa(ety Code been fully complied with? ❑ Yes ❑ No
5. Does or will tha applicant or presen[ or future building occupant require for
the work which is the subjec[ of this application a permit tor such wnstruction
or modifcation fmm lhe South Coast Air �uality Management DiSMct or from
any other air p011ution wntrol districl or agency? ❑ Y85 ❑ No
(Section 658502 0( the California Govemment Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part o( [he facility [o be construcled under this permit be within
1000 feet from the outer boundaries of a school? ❑ Ves ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit fmm the South Coast Air Quality Management District or other
air pollution con[rol 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? ❑ Yes ❑ No
8. Qf "yes", attach certifcate of compliance fmm the appropnate air pollulion
contml officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above�s correct. I agree to comply with all state laws and
city ordinances egard�g Haz2rdous Materials and EmissionsL.
v . ✓ „/." —_. �� (1 '��
/ Sigea/tp-re�/p Y- Date
CERTTFICA E( tOF COMPLIANC AND AUTHORIZATION OF ENTRY: I
certity under penalty of peryury that I have read this application and state that
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building constmc[ion, and authorize represen[atives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not [o occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
Signa�ueeo�LegalOvme�s) Date
SigneWre Dete AntllorAuthonzetlApplirant Data
305]-96(3I0])
_._..----..__.__ . .
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����� � �,��a � 77 �air Uri �e, Cost� IUiesa, CA J262�6 _, �.�
�- 714-754-�27., / Fa>: 714-7,�4-4856
d�V��IEE� �'�U�LD�E� �'E��FNCA�,ThO�[�
Permit#�'�"��
Disclosures U F.orrns for Owner- 3uilders F�,ppl��iny 1or Construction Permits
��Pp.RT.qAlT( NQT�GE TO PRPP�RTI' pV11NER
Dear Property Owner
An application for a building permil has.been submitfed inj( oy�- am� listiy�jl �ot�self a� the builder of the
properly improvements specified at (i'.> � � lil ���� :
We are providiny.you with an Owner-Builder AG<nowletlgment and Information Verification orm to:malce you
aware of your responsibilities and possible risk you may incur by haviny this permit issued in yow' name as the
Owner-Builder. We wili not issue a buiiding permit until.you have read, initialed your.understanding of .
each .provision, signed, and returned this form .fo us,at..our official address indicated. An.agent of the �
owner.cannot execute this notice unless you, the property owner, obtain the prior.�ppr.oval of the permitting
authority.
01NNEP.'8 ACYNOINLEDGMENT AND \/�P.IFICP.TION OF INFORMATION -
DIRECTIONS, Read and initial each statement below to signify you understand or verify this information.
`fi 1. I understand a frequent practice of unlicensed persons is to have the property ownerobtain an "Owner-
Builde�" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be hetd liable and subjecf to serious financial rislc for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may nof provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limiis of my insurance coverage for fnjuries to worl<ers on my property.
�2. I understantl bullding permits are not requiretl to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�3. I understand as an "Owner-Builder" I am the responsible party of reco[d on the permit. I understand thai
I may protec[ myself from poiential financial rislc by hiring a licensed Contractor and having .the permit filed in his
or her name instead oi my own.
�4 I understand Contractors are requlced by law to be licensed and bonded In California and to Ilst their
license numbers on permits antl contracts.
�5. I understantl if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($5DD), inclutliny labor and materials, I may
be considered an "employer" untler state and federal law.
-��. I understand ii I am consitlered an "employer" under state and federal law, I must regis'ter with the state
and federal government, withhold payroll taxes, provlde workers' compensailon disability insurance, and
contribute to unemployment compensation for each "employee." I also untlerstand my failure to abitle by thesG
laws may subjeci me to serious financial risk.
L� 7• I understand under Califomia Contractors' State Llcense Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subconiractors and the number of struciures does not er,ceed Sour wilhin any calendar year, or all of
the worl; Is performed under contrac� with a licensed general building Conlractor.
�8. I understand as�, ari Owner-EtuilGer ii I sell U�ie� properry ior whid�i Ihis p�rmil is issued, I may be helU liaC�le:
oi iny financial or personal injuries sustamed by any suhsequenl owner(,) th�l rssull �rom any latent
constructiori de(ec[s ui the worl<manshil', or maCerials. �. �� .
�G' « .,
9. I uriderstand'� may obiain -more iniorma4on reyarding my obliyauons as an "employer" from the Internai
kev�nue Servic�, thu Unitecl States Small BusinFss Administra'tion, fhe Caliiornia D�partm<•ni o( 9�nefil
Payments, and the Calrfornia �ivision of Industrial Accidents I also understand I may contacf fhe Califomia
Contractors' State License F1oard (CSLB) al 1-f100-321-CSLB (2752) or www.cslb.ca gov for more in(orma(iori
abouf licenscd contractors.
�10. I am aware ot and r,onsent to an Owner-Fsuilder Y�uilding permit applied for in my name, and underst�nd
fi�a( I am the party legally and financ.ially respon&ible for prqpos�d construction actiVity al fhe following aUdress
��11. I agree that, as the parry legalty and financially responsible for this proposed construction activity, I will
abide by aIl applicable laws and requirements tna� yovern Gwner-Builders as well as employers.
� 12. I agree to notify the is.suer of this form immediately of any.additions, deletions, or changes to any of the.
ihformation I have providetl on this form. Licensed contractors are regufated by laws designed to protect the
public. If you contcact with someone who does not have a license, the `Contractors' State License Board may be
unable to assist you with.any financial loss you may sustain as a result of a complaint. Your only remecly against
unlicensed Contractors: may be in civil courY. If is also important for you to understand that if an unlicensed
Contractor or empioyee of that individual or firm is injurod while workiny on your property, you may be held
liable ior damages If you o5tain a permii as Owner-Builder and wish to hire Contractors, you will be responsible
ror veri'rying whether or not those Contractors are properly licensed and the status of their workers'
eompensation insurance coverage. _
Before a building permit can be issued, this form must be compieted and signed by the property owner
and returned to ttie agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarrzation, or other verrficafion accepfable to the agency rs required fo be
presented when the permif fs issued fo verrfy the roperty owner's signafure.
Signature of property owner ���G%, (7�Lr �� \ � Date: �/! '�Z
Note: The iollowing Aufhorization Form is required to be r,omplet�d by the properiy owner only when
designatinq an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORfZATIOt� OF AG�NT TO ACT ON PROP�P.TY OWNcR'S B�HALF
Excluding the Notice to Property Gwner, the execu5on of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope oi Construction Project (or Descrip'tion of Work):
Project Locatlon or Address,
Name of Authorized Agent:
Address of Authorizetl Agent:
Tel No
I declare under penalty of perjury that I am the property� owner for the address listed above and I personally iilled
out the above Iniormation and certify its accuracy. I�ote: A copy of the owner's driver's license, form
notarizaFion, or other verificaiion accepfaole fo fhe agency is requrred fo bn presented when fh� permif rs issued
to verify the properfy owner's signature.
Froperty Owner's.5ignature:
3148-30 CALBO Jan 1, 20U9 OB Packet template
Date:
2of2
A0011650FBUIlDWfi: 2527 ALD�R L�+
QYlIIR51UYEIFpqMl: HORIUCHI, EliL�.N'L
NDPE55: �SZ% ALDER LN
'' COSTA MESA,CA
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LICENSED CONTNRCTORS DEC4IRATION: I hereby eRim uMx parWy d pee"ryry thm I em Iceevad uMr povqions d Cheqr 9
(mmme�rq vm� &xtion 1000) d Oirmion 3 d Ua B�a�a erd Pmlpeiona Coda. uq mY ��ea w in h0 farce vd slleq.
cm uc. No.: uc. cuss: uc. No.: EXP :
oa�<: comreao.:
OWNER BUIl.OEP DECLAflATION: I Mreby eifirm uMer penely ot perjury �hm I em evamp Imm tM COMredae licenee lew In IM
taww:ro � ts«aw� �oai s a,::b.s �d a�d�v cod,: n�y o�r «owmr wn� �vd� e w�n m�ewa. en«. �v�o,*.
damd'eh, w rpai eiry n'ucture. p'v �o ea uauerca. etro reQui�ee iM appl'rem la ach pmmu io Rb e agroA emtemem thm he or aM
c licensed W�+NI lo tM povisona d the Convetlon Lioenee lew �Cheqar 9(mmmmviq wnh Seaion ]OW) d pviion 3 d Ihe
Businea erd Rdeeaiona Codel a tAel M a sM a uamq thaehom eM IM batis lar IM aAepetl memqion. My videtion d Setlun
]031.5 W enY eGW� lor e pertnil wbpee the epplicaM to e cnl parolry d rat mwa then frve huNred dd4n �S,iWII.
�] I, m owiwr d the praperly a my employeae v,ih wages ea Ihei ede compemetion, xill do �ha work, vM Ihe el�uctu�e w ml inteMed
n ollered ror eele (��a� ��, 6usineea ena PMeaeiona eotle: Tna comreaae Lironee law tloes �at eppryto en ownxa p�ope�ry
who WJde a mpeovea therean, end x1w does sueh Mak MmeaH a heneY ar Nrouph hi a her awn empbyaes, pwided �hm weh
imqwememe ue mt inleiMeE or dlered Iw nele. tl, however, iM buidinB a inqwemeM w eald wnhin pro yav d mmda�. �M
ovmiar-0uiMm will have tM WNen d qwirp M or ahe did ml WiW a imqove lor IM puryme d eeb).
� I. m oxnar d �M O�O�Y. em uduarvdY mnveurtq wth liumed canbenon �o � the p9� (Seaion 10M. &n'nme anE
r�w�. coa.: rne comreco�. ��.�.. ie.. ems na eoWv a��, d aw«�r .no w�u r impo.�e. m.�.on .m wno
conirecb Iw wW peqeea v.nh e mMreGorts) f naed po`re��to`iM ConlraGws Liceme law) ,\
uemq unEar Section: B. 8 P.C., br IMs nay .
ete: `C Owner: � Csa:. .
ereby unily �hel I em ewere d eM uMers�aM ih��q,,�q "ramama d Cdfomie HeeXh eM Se/ery Gode Seabm 25505.25533, eM
YS,UI. vM thm I or eiry Mure buiNirp oowpant will / wifb,(dacN me) � to comply wY� eek mle ooEee enE IM iequ"vemaMv far
e Pe�mil taeoneleuelion artadifimlbnhanlMAr�'anepeme�i Diarid. Ravdenlial wMrud'di ePG�ianerasssmV�ham IMsa
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De1e: AppliceM: -
WONKER'S CONPENSATION DECL�RATION: I Mreby elfirm uMer pe�aM1y d paijury «r d Ma lallovrirp Eetleratione:
� I have eM vrip meintein e ceMiticele d mneant io aell�inwn Iw xoMan' compeneation, m prrnked fa by &eeun J]OD d tha lebor
Catle, lw �M pe�loimeue d ihe xork br wlich ihia pemin u usuad.
❑ inevee�a.a�m.:�..o�wa.�oomo����,�..a.nc��adWs«abna�ooam.�.no.cod..ro,m.w�dm.
work lor whch iho P�n ia muW. MY wM�en' comG�W bn mwreMa mmer eM Odic/ m�mbm ve:
c�,:
rd�rN�mne�
(Thia senivn r�sed na be candereOl �hs pmr'a is br one hunemC ddlers /41DJ) a Iw.)
� I cerlry ihel in Ihe perloimenw M ihe wak tor whch t�ie pertnit ie issuatl, I ehell �wl amqoy eny penon in eny mennar eo m lo
become eubiea m ihe woMn' cwno�aef lewe o/ celitwni., ena wrea ihm B I enouN becwn. wbiw m �ha worlmn'
wmpenulim peoviaiona ot Seaion 310o M iM1e I.ebor Code. I ehell lalhwil� oompy wiN Ihoea piarieione.
Dele: ApqiceM:
Waminp: F�llvn ro ascun woilren'ronperuetlon rovuap� li unlawN4 siW shsll �upJM an emplqw ro cNM�ul pwltla �M
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CONSTPUCTON LENDING AOENCY: I hereby elfi�m under panelry d parjury �hel Ihen ie e mnsvueian bMinp epanty br tlro
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LENDEN'S NAME:
LENDEN'S A�DPESS:
I unM thet I Iwa read ihis Mdieetion uM 9ele ihm the eboua inlmne�ion o wered. I W�� lo eamWY wnh M til�' uq eouM/ ord'vienma
aM state lewe rektiq lo buikvq conmruaion ud Mreby eulMr¢e rapesenieiivea d tho ury io enter upm tM ebvre�maruioried paparry
�����°��°��°� ELLEN H�]RIUCHZ
_ t-,
(5151J6.WP)
D�e: �2-��SC
8 Sdery: GreemFle; Cerery-Appicant; Pink-Revenue; Goldenro�/uasmr
�CITY OF COSTA MESA — BUILDI�IG PERMIT PERM NO: P U80779
PERMIT NO; P 080779 PLAN CHECK NO:
CONSTRUCTION TYPE: V—N PERMIT TYP£: PLU
JOB DESCRIPTION : REPLACE WATER HEATER
CLAIM VALUE:
CALC—VALUE:
N GOVT; N SUPP; N
PURFOSE: OTH
SQ FT;
GROUP OCC: R-3 /
COMMENTS: X
+�+�*+�**+�if+e*+�*+�+r�c�+fieiE+�ie*iE+�****it*�*�*��it*ic*�e*�it��*�*ie****xx*�***�*�**�*ieie�r****+�*��c
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ: PROV; PARCEL: 43917209 ZNE: REF NO:
PLANNING NOTES>
i
1E 1F iE iE ik 1E 1f 1E 1E 1E 1E 1E IElE 1E if if-1E 1E 1ElElE 1E iE 1E iElE 1E 1ElF jE 1E iElF 1f �f 1F 1F iE iE 1E IE fElE iE iF fE if k fE 1Elf 1E iE iE iE'lE 1E ik 1E 1F 1! 1E i! iE 1E iE 1ElE 1F iF iE 1E 1k 1E IF iE iFlE
D E V E L O P M E N T S E R V I C E 5 R E Q U I R E M E N T S
ZONING APPROVED BY ,
DATE:
BUILDING APPROVED HY : DATE:
APPLICATION ISSUED BY; /� �
( DATE•
iFifiEiflE�fiF1E'N-1E1h1E1Ei(-1Flb1ElFIkiE1E1E3f3F3FiFiF�iF3f��F��F�iFiF �3F �FiF��F7F3F7F�F{Fi�i��f3F1E1F1FiE1EiE1flEfEiE 1E1Y
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SE E:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 11.00
258 SMIP/NON—RES
PLAN
ISSUE FEE 22.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAIb DUE
TOTALS----> 11.00 22.00 0.00 33,00 33.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 33.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
33,00
ik iE 1E iE iF if ib 1E 1k 1f if if iE iF if 1f iElf iE if 1f 1f df !f 1E �f fE ik iE iElf 1E iE'lE 1F'IE iF iF 1E 1E 1ElE 1E iE'lElF iE if� iF 1(� ik'IE iE 1f jE iF iE 1ElF if 761k iE 1E iE if 1E iF'IE iE iflf iE ik 1k if 1Fif jf
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
PLU 1 WATER HEATER AND/OR VENT 11.00 11,00
END OF FEES
01 aQ22�562-0022DS62 T C�T
6ATE: 12/Ob!95 TI�fE: Q8:1}3
�
�•3.00
CUNSTRUC7ION AND PLANNING P00� aPA
H�PPROVALS Permit�-` Date Inspecto"r ' APpROVAIS Permit# Date Inspettor
t. Temporery Etectrical Service or Pole 52. Pooi & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steei Reinforcement
3. Electrical Conduit Utility-Undr9md. 54. Forms
4. Electrical ConduibUndrqmd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electricai UFER Grnd. 57. APPROVAL TO COVEfl�GUNiTE
r
' 7. Footings 58. Electricai Cqnduit-Undrgrnd.
� 8. Foundation 59. Gas Pipe, � Undrgr�d., Test
9. Waier Pipe-Undrgrnd. 60. Backwash �ines, P-Trap, O Undrgrnd.
10. Structural Pioor SVstem 61. APPROVAL TO DECK
i t. Property Sewer �ine & Nouse Connection 62. Backwash & Recepxor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Dreins 64. Plumbing System - Final
14. flough Plumhing 65. Elactrica6Final
75. Rough Eiectrical-Conduii 66. Solar System�Finai �
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiiir.g 69. PQOUSPA SYSTEP.^S FINAL
19. Rough Heating & Air Conditioning PIRE DEPT. REQUIREMEN7 I
20. Rough Factory Fireplace - . APPROVALS Permit #
21. Ducts, in Structure ' - 70. Underground Hydro
22. Oucts, Ventttati�g 71. Product Pipin� fl Gas ❑ 014
23. Gas Pipe-Rough & Test - 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing . - 74. Overhead Nydro �
26. T-Bar Ceiling {gtructuraQ & Monocoat . 75. Dry Chemical
27. Frame and Plashing . 76. Dry Standpipe
28. Lathing & Siding . 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PFiEV. FINAL
30. Drywall Nailina - HEALTH DEPT. PEQUIREMENT
37. Plaster Brown Coat 79. FINAI INSPECTION
32 Electrical Power Meter-Final .� 80. FOOD CERTIFICATE ISSUED
33. Finai Electric ' Notes: �
34. Final Heating & Air Cond�tioning
35. Final Gas Pipe�Test � `� '7 G�% �Y�_
! � �=v
36. Hood or Canopy !
37. Pinal Pactorv Fireplace � '
- 8 Pinai Plumbi�g � -
39. Water Service-Pinai ', �
4Q. Gas Service-Final , -
47. Solar pomestic-Final
42. Backflow Preventer
43. Backflpw Irrigation ' -
44. �andscape Irrigation SYsiem -
45. Sound Attenuation -
46. Handicap Regulations . ' _
47. FWAL STRUCTURE & BUILDING �
48. FINAL PLANNING �
49. Electric Release to Edison -
5�. Gas Release to Southern California Gas Cn
57. CERTIFICATE OF OCCUPANCY
� No. Date •
� . �