HomeMy WebLinkAbout2020 BALEARIC DR - Building Permits 4 _ CITY OF COSTA MESA
F 1 .�1 BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
4. VICO PERMIT PERMIT MBER
"Immo 898-01447
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
•
BUILDING PERMIT
Job Address: 2020 BALEARIC DR Status: ISSUED
Suite: Applied: 08/13/1998
Vicinity: Issued: 08/21/1998
Parcel Nunmber: 13945313 Zoning: R1 R1
Applicant: PETER ZAZZARA
Address:
Phone: '
Zip:
Owner: MUTCHIE, WILLIAM E
Address
COSTA MESA,CA _ - Phone: 714-751-5267 ,
2020 BALEARIC DR. Zip: 92626 •
Contractor: ZAZZARA CONSTRUCTION
Address: 428 S PIXLEY"ST
Phone: 800-469-2845
ORANGE,CA Zip: 92868
Licensed 656782
Arch/Eng:
Address: • -- - -
Phone: . •
-
Zip:
License:
SCOPE OF PERMIT
An 89 square foot family room addition in rear of house. > . -
• FEE SUMMARY
Plan Check: $89.21 • ---- ?. Calc Valuation: $7,253.50
Permit: ' $137.25 _ -/ Claim Valuation: $2,000.00
SMIP Res: $0.73 i
SMIP Com: $0.00 - 1
Other $0.00 - -
Inspection: $0.00
Total: $227.19
PLANNING &ZONING
SETBACKS -
MAIN STRUCTURE Front 0-0 Rear 28-6 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES: •
4
r , f
. i - o
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 •
/ I
DECLARATIONS c )
-
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: rerpor Ffnc-,PO Policy Number/91/17
(This section need not be completed i/the permit Is valued et one hundred dollars($10 )or less.)
❑ I certify that in the performance 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 California,and a ree that if I shoul ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwit -
comply with these provisions. p
:,Applicant Signature: Date: U ' 2/- `0
WARNING:FAILURE TO SECUR WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE MAT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Se Ion 7000)of Division 3 of the Business and Plyfessions Code,and my license is in fu�
force and effect.Lic.# S - Class N �� �{
Contractors Signature: � f Date: lam/0/•/5
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).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty 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
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end 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 CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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 contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property 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 more 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 and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑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? ❑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? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit 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 0 No
(Section 65850.2 of the California Govemment 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? ❑Yes ❑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? ❑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 AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
u a s Date
`6
And/Or Authorized Applicant Date
CODE I INSPECTION TYPF DATE DITIDAL$ CODF( INSPFCTION TYPF DAB ItUIBALS
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
204 Final Demolition 250 Final Building/Occupancy /Z'0 s
2446-46
4(4 a CITY OF COSTA MESA
►#' BUILDING DIVISION
1-' •"`r': ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
kni%frtigiso;; PERMIT I
vP99-00621
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2020 BALEARIC DR Status: ISSUED
Suite No Applied: 10/27/1999
Issued: 10/27/1999
Vicinity:
ISSUED BY:
Parcel Nunmber: 13945313
Applicant NOCK,RON - '
S
Address: 11612 KNOTT ST -
CA . , Phone: (714) 895-1246 -.
GARDEN GROVE Zip: 92841 -
Owner - MUTCHIE, WILLIAM
Address 2020 BALEARIC-DR "
CA - - Phone: (714)751-5267 .
• COSTA MESA Zip: 92626 "
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST '
CA ._ Phone: (714) 895-1246
GARDEN GROVE : Zip: 92841 _
• . •
- License: 707775 „ -
Arch/Eng:,
• 'Addressr •
Phone: E '
•
Zip: 6 6D
DAA • c4icvl hi
, License: • o
N
SCOPE OF PERMIT_' ' I t
WATER HEATER. i
. FEE SUMMARY i
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool • $0.00 0
Backflow Preventer $0.00 0 • P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 - - • Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System- $0.00 0 - Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors . $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor •$0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop '$0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80:
COMMENTS/SPECIAL CONDITIONS
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
DECLARATIONS (� J C �)
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
0....A...Nark for which this permit is issued.
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: 1� 1 'L^7 q
Carrier: CO/-PfW 1 /-a Policy Number: kiwaY ( / 3 ctio -
(This section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance 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 California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisi
Applicant Signature: i-S --t Date: / O -zg- 5
WARNING:FAILURE TO SECURE •ORKERS'COMPENSATION COVERAGE •• I AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION•DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under ov' ions o apter 9(commencing with Section 7000)of Division 3 of the Business and P1rofeessi ns Code,and my license is in full
/
force and effect.Lic.# D / 2 Class a C�J�
Contractors Signature: SS Date: //7 —'ZS '9 5
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 penalty 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
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ 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 far 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 CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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 contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property 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 more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califo`ia!Administrative Coder,-L u
❑ 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: 'iLI' 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 and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑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,ore volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
o
2 Does or will the applicant or present or future 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 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 end pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program far 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 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code beennfullyy with?with? ❑Ves ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application&p8ermit 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 0 No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Willl any
ny ppaart of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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? ❑Yes 0 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 AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Own /O �[jajj(e7—1 Q
•
U An uthorized Applicant Date /)
CODE Y. INSPECTION TYPE p.AT& INTRIALS CODE INSPECTION TYPE Rtsig INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 5'1Y C3j
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
2446-46
_ 1
CITY OF COSTA MESA
a? BUILDING DIVISION
PER
. r14 . MITjNUMBER
o
DEVELOPMENT SERVICES DEPARTMENT M9
�4iNtoommio;4
; PERMIT
B99-01355
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2020 BALEARIC DR Status: ISSUED
Suite: Applied: 08/24/1999
Vicinity: PITCHED AREA OF ROOF ONLY Issued: 08/24/1999
Parcel Nunmber: 13945313 Zoning: R1 R1
Applicant: CHURCHILL, RICHARD ISSUED BY:
Address: 4425 FOREST GLEN RD - . .
CA " ' . ,Phone: (714)974-0456 ' -
•
ANAHEIM Zip: 92807 - -
Owner: MUTCHIE, WILLIAM
Address 2020 BALEARIC DR
CA - - Phone: (714)751-5267 - _
COSTA MESA ' - Zip: 92626
Contractor: CHURCHILL CONTRUCTION
Address: 4425 FOREST GLEN RD ,
CA , Phone:. (714)974-0456 -
ANAHEIM - •
Zip: 92807 License: 660990 .
Arch ...... Eng: -
Address: .. Address: ..
•
- -1 Phone: Phone: ,
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING HOUSE&ATTACHED GARAGE-PITCHED AREA OF ROOF ONLY(18 SO).TEAR OFF EXISTING
SHAKE ROOF&RE-SHEATH WITH 1/2"OSB. INSTAL 1-LAYER OF 30#ASTM FELT UNDERLAYMENT&REROOF WITH 40
' YR. COMPOSITION SHINGLES.
FEE SUMMARY . % .‘-
Plan Check: ' $0.00 ,,- r Calc Valuation: . $5,300.00
Permit '. $125.25 ,' Claim Valuation: $5,300.00
SMIP Res: $0.53
SMIP Com: ' $0.00
Other: $0.00
Inspection: $0.00 -
Total: • $125.78 -
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 Existing: 0 Required: 0 Proposed: 0
NOTES:
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
4
DECLARATIONS
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 o1 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.)
VI certify that in the performance 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these vi 'ons. �7[ �+p
Applicant Signature: Date: 8-'2- -9"
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND OOLLARE(S10O000),IN ADDITION TO THE(Cosi OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
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.# lO G o g 90 Class# Q
Contractor's Signature: Date: k-2-411-fl
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 penalty 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
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ 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 CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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 contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property 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 more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,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 and 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 Califomia 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-"--_ as. . ..requi Section
f-t.he Health Safety
been full- wit-- --.------ __—_--._--_-___
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code fully complied with? 0Vas ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes LJ No
(Section 65850.2 01 the California Govemment 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? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 0 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 AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
9natur Legal Owners) tete
iZ
And/Or Authorized Applicant Date
CODE Y INSPECTION TYPE DATE INTRIALS POE Y INSPECTION TYPE jam INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final Aq 208 Final Plumbing
O
200 Final Re-Roof p �Jf" ` / � 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
2446-46
4,4a*4a*r CITY OF COSTA MESA
,,,.,,
r , BUILDING DIVISION
t1 4.""-, ', ' DEVELOPMENT SERVICES DEPARTMENT /
TA. PERMIT PERMI NUMBER ✓
%bongo die.
E98-00897
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2020 BALEARIC DR Status: ISSUED
Suite No Applied: 08/21/1998
Vicinity: Issued: 08/21/1998
Parcel Nunmber: 13945313
Applicant: PETER ZAZZARA
Address:
-
Phone:
• Zip:
•
Owner: MUTICHIE, BILL
Address - _ - „ , -
COSTA MESA,,CA Phone: 714-751-5267 . • , .
2020 BALEARIC DR - Zip: 92626 -
Contractor: ZAZZARA CONSTRUCTION .
Address: 428 S PIXLEY ST .
Phone:,:,, 800-469-2845
ORANGE,CA : - Zip: 92868
' 'License: 656781 '
SCOPE OF PERMIT
FAMILY ROOM EXTENSION,2 FIXTURES, 3 OUTLETS AND 1 SWITCH,RE:B98-01447.
FEE SUMMARY
. • QuantityQuantity.
ISSUE FEE $22.00 ., - , --- :Temp Dist System./Lighting $0.00 0 .
Temp service test ' $0.00 - Busway/100 R ' r $0.00 0 •
Res.a/c package $0.00 - -- - Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transforrners.up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 -0
Lighting Fixts $2.00 2 up to 50 kva/kw $0.00 0
Recept Outlets . $3.00 3 up to 100 kva/kw $0.00 • 0
Switches $1.00 1 - over 100 kva/kw $0.00" 0 '
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 '
Service to 200a $0.00 -0 - Misc.Conduit - • - $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 ' 0 Circus(gen or ride) - $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 ' 0
Motors to 10hp $0.00 . 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand • $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $28.00
Intermed Pole $0.00 0
COMMENTS I SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work Is suspended or abandoned
fora 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
DECLARATIONS i I tom/
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 sell-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'corn enation Insurance carrier and p 'icy number are: �i
Cartier: Policy Number. /577-GU
(This section need not De completed If the permit is valued at one hundred dollars($100)or less.)
O I certify that in the performance 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 California,and agree tha should beco e subject to the workers'compensation provisions of Seaton 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: vv0 'SC G% Date: -.7/
WARNING:FAILURE TO SECURE RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under.rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Pr ssions Code,and my license is in full
force and effect.Lic.# . - Class# 7,4E5 Contractor's Signature: - 7).• /3 J�' _ Date: A- 7�
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 penalty 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 tile 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
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O 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 CONTRACTING WITH LICENSED CONTRACTORS to construct the project(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 contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property 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 more 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 and 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 eppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? PI Yes LJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health end Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agencIs 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 0 No
6 (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 AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
- : u : •- ... c _ Date
An. -r Authorized Applicant Date
CfDF* INSPECTION TYPE DATE IIOMS COOF f INSPECTION TYPF DATE III/01ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing �Q__J
200 Final Re-Roof 210 Final Electrical /0 OR;•
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
2446-46
:fait liCime'e
ADDRESS OF BUILDING: 2020 BALEARIC DR WIT: CITY OF COSTA MESA — BUILDING PERMIT t'cnn IVV: b v1 J. .:.,<
I OWNER'S NAME IFKNOWN: MORRIS, TOM R FLOOD: AE-46
ADORES MORRIS, JACKIE L PERMIT NO: B 071392 PLAN CHECK NO; N ‘...uv L : IN purr : IN
2020 BALEARIC DR
:OSTA MESA, CA 92626548-5569 CONSTRUCTION TYPE : V—N PERMIT TYPE: STR PURPOSE: ALT
A APPL.MAILING ADDRESS:
JOB DESCRIPTION ; T/OFF & RE—ROOF W/BUR SQ FT; 1 , 567
ARCHITECT OR ENGINEER: UC.NO.:
ARCH.ORELN:.'S ADDRESS: UMT: CLAIM VALUE; 1 , 567 . 00 CALC—VALUE; 1 , 567. 00 GROUP OCC ; R-3 /
CONTRACTOR'SNAME: CRANK BROS ROOFING CO ( 714 ) 548-5569 COMMENTS: SMOKE DETECTORS ARE REQUIRED
CONTRACTOR'SMMLNG 126 COMMERCIAL WAY *****sF+car.*+c******.>Fx*tf***x*x********-u***xxxxa°ao-x*tcx*,F***4*x .a...N.xxxa<*;cuxxx -x-+E*xx***-w.
ADDRESS: COSTA MESA CA uc.ND.: 408677 Z ONING REQUIREMENTS
92627 WIT: SETBACK S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 MAIN N H U I LD I N G ACCESSORY E S..0OR Y B U I L D I N G
(commencing with Section 7000)of Division 3 d the Business and Prof ions Code,and my license i ' ull force and effect.
/c ua.No.: 005993 utccuss: C39 a O.: 408677E; 06 /95 FRNT: FT IN REAR ; FT IN FRNT; FT IN REAR: FT IN
oma,/ 3-k-9- Contractor: �- LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under perjury that)am exempt from the Contractors license Law ler the PARKING REQ; PROV: PARCEL : 13945313 ZNE: REF NO:
folbwig reason(Section 7031.5 Business and Professions ' ny city or county which requires a permit to construct,alter,improve. PLANNING NOTES>
demolish,or repair any structure.prior to As issuance,also requires the applicant for such permit 10 file a signed statement the he or she
a licensed Wrsuanl to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the >
Business and Professions Code]or Mal he or she is exempt therefrom and the basis for the allegedexampli3n.Any violation of Section ***************************************x********sE*******x*****x*****ac*=}F***xx**xx
7031.5 by any applicant fora permit subjects the applicenI to a civil penalty of nel more than fee hundred dollars Iss00I). DEVELOPMENT SERVICES REQUIREMEN TC
❑ I,as owner d 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(Section 7044.Business and Professions Code:The Contractors License Law does net apply to enamor of properly
who builds o inprove°thereon,and who does such work himself or herself or through hi or her cern employees.presided that such ZONING APPROVED BY DATE:
improvements we not intended or offered for sale.f,however,the building or improvement is sold within one year of completion,the
owner-builder wilhave the burden dproving he«she did not build the BUILDING APPROVED BY PATE:
❑ I.as owner d property,operym,eexdta vely contracting W th licensed contractors to conniver the project(Section 7044.Business and MI `
Professions Code:The Contractors License Law does nor apply to an owner of property who builds or improves thereon end who DATE: J
contracts for ear prows ash a contrado(s)licensed pursuant to the Contractors License Law). APPLICATION ISSUED B Y; C
❑ Ism exempt under Section: B.B PC.,fer
Chia reason: `f*****************#1f*********1(*dE***.n*,Q4ry ***x- W***Y***#*1F********if* -Y * .. **
******************************************************+f**************3x*****ii*x*
Date: Oremer:
LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby eddy that I am aware of and understand Me requirements of California Health and Salary Code Sections 2.5505,25533,and
25534,and that 1 or any tenure Wilting ocapwn will/will not(circle one)need to campy with said state codes and the requirements M
a permit for mdtnwtion or modifcationhantheAipulty Management Did rid.Residential construction°ppEcekxm ereexempt from thaw, BLDG PMTPUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. 37 . 00 aions. . 50
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 end wil maintain a medicate of consent to'eV-insure for workers'compensation,as provided for by Section 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
/ Code,for the perfome ,ofthawwkforwdmhthapamkieasaed. TOTALS----> 37 , 50 0 . 00 0 . 00 37. 50 37 . 50 . 00
70 I have and wit maintain workers'compensation insurance.as required by Section 3700 of the Labor Code.ler the performance of the
aid for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Canner: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED; 37 , 50 OVER/SHORT; 00
Policy Number: 2137-y7UNIf22'4 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN—CHECK
(This section need not be completed f the perms is for one hundred dollars(51001 or less) 37 . 00 . 50
❑ I candy that in the performance of the work for which this penis ''s issued,I shall not employ any person in any manner so as to
become subject to the workers'compensation Laws d Cm mIn.and agree that f l become subject to the worked' ***5+*******************4*****if*************1F*****k.***********4*******x***..*.p.*.*enhi
compensation provisions of Section 3700 of the Labor Code.I]�I forthwith comply provisions.
(Dale) .ne�—4F /r App : A INDIVIDUALI D U A L F E E B R E A K D O W N
tv6•g• TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
srning:Failure to secure workers'compensation co unlawful,end shell subject sit employer to alMne penaltin and u
civil tines up to one hundred thousand dollars(5104,.'.r addition to the cost of compensation,damages as Provided ler/n
Section 3706olthe Labor Cods,Interest,end attorneys tees SFR 1567 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 567 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this pemd is issued(Sedcn 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS)
I certify that I have read this application and stare that the above information is coned.I agree to comply with at dty and county ordinances
and slate laws relating to Wilding construction and hereby authorize representatives of this ply to enter upon the above-mentioned properly
for inspection purpose- /
a .�.Qe�C5C.47 1NC
case 01 00177776-00177777 TOT -14
• a / Date:. •-•-•. -----.57 DATE! 03/08/95 TIF1E2 09:15 ,,
Signalu'. ,r/Agent/ pefcan Pt'Irador
(5151'46.WP) White-Building&Safety;Green-File:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING - •PQOL& SPA
APPROVALS Permit # Date Inspector Date Inspecto?
APPROVALS Permit #
.
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding = .; .
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. , _.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. t " ' 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Codnection 62. Backwash & Receptor-Final .
12. Sewer Cap 63. Heater & Vent-Final r
13. Roof Drains 64. Plumbing System - Final '
14. Rough Plumbing l 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 n Oil
25. Roof Sheathing 3-,9-et - 6 Call- 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
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FI NAL STRUCTURE & BUI LDING _"3., ? bet,/f
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
I /
19133 FECRECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT MAfl.2 2 1963
P.O.BOX 317 COSTA MESA,CALIFORNIA y
NANCE DEPT.
For Applicant to Fill In Completely APPLICATiQj4JFog FPEJ AJTA MESA
074/ s.-3 yr/ TYPE OR PRINTjl,f BUILDING
9 For Office Use Only
BUILDING p0 ao lJ✓
'n.
ADDRESS Q e Q'/(,G e. . (J
RECEIPT NO. PER yF NO.L��
COSTA MESA. CALIFORNIA II* ,»
RECEIVED -Y DATE RECEIVED JOIATE ISSUED
} v (t l�� U / ,,5)..., 3—a maR 2 2 1963
OWNER -[��
BUILDING
MAIL . ADDRESS
4G
ADDRESS �3 7-z4.4.0 -L, S449- FIRE
lf/{/\/,7y/
� �I¢¢. TEL. ZONE TYPE GROUP 2
_CITY ej}.a -}�t•[O-e..- NO. 0 3 9 {
ARCHITECT p� / ' TEL. 77z APPROVED DATE
OR ENGINEER/,�{1?���iL /�-///�D //y� NO.
/,�/�34 G+� _. ZONING '
ADDRESS g/7A ./{ft. (,Y�•Y, (J%LLEL.4L/-Y4ZONE NO.OF I USE OF NEW
/ �� PLANS )� BUILDING 6 /1_„
CONTRACTOR C f/iy dY`�' �� �`f
Y •� \�. �/� LEGAL _L� l�L/ I n I 1 Y b
ADDRESS 4G a.+ a Y/7 ZS/1Y7�
DESCRIPTIO N6�L/ r i lV" �( 0
CITY f[„Qp-se<_J A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE
LIC.NO. /p- TEL 90"TO SIDE 8 REAR P.L.
p 7�G G TE ��3-0 39S
ySIZEJ / EAVES
OF LOT / o �c,�o b NOW ON LOTS O ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
LI (FROM
I REAR YARD�� FRONT C �FET)
FT.
SETBACK LINE FROM
CENTER OF STREET 7 7
SIDE YARDI LEFT I RIGHT R.SIDE FT. FT.
DESCRIPTION OF WORK / L.SIDE 9 FT. / FT.
NEW ,1( ALTERATION _ ADDITION REAR (96, FT. 6 7l FT.
DISTANCE BET. BET.MAIN B
REPAIR MOVING DEMOLISH MAIN BLOCS. ACCESS.BLDGS.
BUILDING ,�(( ,�..JJ,, NO.OF p VAR.# DATE
SIZE 0/014 7• ROOMS O STORIES R C.U.P..L#' APPROVED
EXTERIOR WALL ROOF COVE / APPROI� ✓ •�/7
-C
COVERING COVERING BY t,J Cle. 'A DATE
USE OF A' �J�T/QQEj/
PERFORMED`(
'
76
- a 2 B / LC7/o SG.FT.1_5--'e
D 6 N
7.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO UNDER VALUATION IS FOR THE F•
AND STATE THAT THE AB VE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
-
PLY WITH ALL CITY ORMNA CES AND STATE LAWS REGULATING VALUATION •--I� 0
BUILDING CONSTRU ON. �+ / N
SIGNATURE OF _ / -, c• PERMIT FEE $ B
PERMITTEE C a CCC �Q�C G
F
$422 3 -9a_ E 0
AUTHORIZED AGENT / A
TOTAL FEE $ /60/'
•
OWNER PACESETTER WEST-JOINT -VENTURE DATE 3-22-63
JOB ADDRESS 2020 Balearic Drive BUILDING PERMIT NO. 19133
GENERAL CONTRACTOR Andros Land. Company VALUE $ 22,592.00
AP No. LOT 149 TRACT 11.348 FIRE ZONE DESCRIPTION OF WORK res att gar
INSPECTIONS Signature DATE GROUP
GROUP I&J TYPE V ZONE R]-
Soil �� 7",/� 3 ISSUED
SUBCONTRACTOR
Gas DATE PERMITS NUMBER
Water �3-i17r/y
Rough orn. Refrig. 0 Air Cond. 0
Rough Heating ed 7- - A, rJ✓ 5/fCd3 YS77
Rough Plumbing ..0t. - �' _- - _ nF _. -, - .3.QO 4/6-
M
SS
Miscellaneous / / ` �/ r
Prop. Swr. Line �d House Con.0 St. Swr. 0 /- ' _ _. _�_ , ! e/ G-49 -4 3 3.5-" ei
Sprinkling System ////```
Construction Pole / r 2/j.I it'
Underground 0 Power ;❑
Rough Wiring • P\ r .-2 .1i_Tinrt-._ ... _'_ -o
r-- Jzrr
Trenches Y Forms p- Steel Reinf. R I y.:43.6J
Floor System , i 4.3 -e
Bond Beam 0 Steel Reinforce 0
Sheathing 6-- o-{
Frame and Flashing _ - 7- .
Lathing - In [$—Out-per / L--4)
Plaster, brown coat _ ', . 4,- .6.-1 3 .
Refrig. 0 Air Con. ❑ Final
Heating, Final Q.6/_ 5- e7
Plumbing Fixtures, Final {� / `
Final Gas Test /) /C G-G7
Electric Fixtures, Final /T/y,tz. /pr3-63 _
Building, Final /.-/A'Ip/7 I
OCCUPANCY 1
Form BU4-5M-3-63—S-B P