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Home My WebLink About433 BROADWAY - Building Permits0 PHOJECTAOUflE55: Q33 BAOADWAY OWNEX'S NAME: SHARI'lEY ANN GAINEH TR nooeEss: 433 BROADWAY COSTA MESA.CA 92627 714) 646-3809 AflCN1ENGINEEfl: FOONESS: flEG.NO.: UNIT: UNIT: PEflMITTEE: LUKE RC�OFING ( 719 ) 633-8798 aooness: 448 S MONTGOMERY ORANGE CA 92667 �. LICENSEO CONTflFCTOfl DECLABATION: I �ereby a�lirm �ha� I am Iicense0 under D�ovisions o� Chap[er 9(commencing wi�h Seciion ' �000� ot �iWsion 3 0l t�e Business an0 Pmlessions Coae. an� my license is in fulliorce ana eltect. cirruc.: 062058 sTaTeuc.:672569 c C-3° — OS/95 ate �' J` Q Signa�ure: ��i��c5� : REFS' COMPENSATION OEC flATION: I here�y aflirm Iha� I have ehifica�e ot sem ro sel4insure or a ceni�iwte of Workers' Compensation Insurance. or a certitietl copy I�ereo� (Section 3800. La6. q. POLICY NO.: E%P. OATE: COMPFNV: I ❑ Cetlified caDY is hereby �urnishetl. ❑ Certi�ied copy is filed wit� the ciry BuilUing Division. Oate: Fpplicant: E%EMPfIONFBOMWOPREflS'COMPENSATIONOECLANPTION: Qhissec�ionnee1notbecomplettHtlthepermiti5�oronehunOreO(5100)orleu). I cehily �hat in the petlormance of Ihe work br wAich �his permi� is issu� I shall no�mploy any per n i ny manner so as ro hecome sub ct Io the Workeri Compensation LawS oi Califomia. � te' � ��' 4 �— SignaNre: NOTICE: It, alter making this aeclaration. you shoultl become su� o t�e Workers' Comper� tion Dmvisions of tAe Labor Code. you musl fo�hwilh camply with such provisions or this permil s�all be tleemetl re�d. CONSTBOCTION LENDING RGENCY: I here�y allirm thai ��ere is a tons�mttion 1¢nding agenty for the peAormance of �Ae work fOr which this permn is issuetl �Sec�ion 3097. Civ. C�. �i � j'�� ^��0� LENOEB: �% 3�� L aoonEss: ['' j'� OWNEfl BWLOEfl OECLFNATION: I hereby al�irm I�a� I am exempt fmm Ihe Con�rac�ors tate Lice-ns�CawTOTlhe followinq/gpyon �Section 7031.5 Business antl Pm�essional Cotle�. Any ci�y oi county which reQuires a permii to cons�mc�, al�er, impmve, demolish, or repair any s�mciure. Drior to its issuance. also reQuires �he applicant �or such Dermi� to �ile a signed statemenl Iha� �elshe is licensetl pursuant lo the pmvisions al the Coniractors' State License Law (Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business and Pmiessions CoOe) or �hal he/she is exempt iheretrom antl the 6asis �or Ihe allegetl exemption. Any viola�ion ol Section 7031.5 �y any applicant lor a Oe�mil sublects Ihe ap0licani lo a civil penal�y ot not more than �ive hundretl dollafs (E500�. I, as owner of the pmpeny or my employees with wages as Ineir sole compensation, wili tlo the work, ane the ❑ s�mcWre is noi in�entled or oifereA lor sale (Section 7044, Business an0 Pmiessional CaOe: T�e Cantrac�ors' Sta�e License Law tloes not apply lo an owner ot a pmperiy who 6uiltl5 or improve5 ihereon, antl who tloes such work himsel�/hereelf or �hrouA� his or her own employees, pmvitletl �hai such impwvemenis are noi intentletl or onerea for sale. I�, however �he buil0ing or 'mprovemeni is soltl wi�hin one year o� comple�ion, Ihe owner will have �he burtlen o� pmving he/she Aid no� bui10 or improve �or �he purpase oi sale�. I, as owner ol ��e pmperry, am exclusively comraming wi�h licensed coNmc�ors �o cons�mct �he pmlec� �Section 7044, Business ❑ and Pwlessions Code: The Contrac�oK S�ale License Law tloes nol apply �o an awner of Oropetly who �uiltls or impmves �hereon antl who conirac�s for such pmlecis wi�� a contracmqs) license pursuam m �he Contractors' Sla�e License Law�. I am aware �hal prool oi �heir Worker's Compensa�ion insurance shoul0 be D�ovitled ta me. � I am eKempl wder Section: B. 8 P. C. for mis reason: �a�e. Ownec I do hereby ceni�y Iha� I am aware oi an0 untlerstantl Ihe requiremen�s of Cali�ornia Heal�h and Sa�ery Code Sec�ions 25505, 25533, antl 25534 antl Ihal I or any IUWre bwltling occupani will/will no� (circle one) neetl Io camply wiih saitl state codes antl �he requiremenis tor a permit tar canstmc�ion or mo0ifica�ion irom ��e Fir Ouality Managemenl �isVict. FesiOen�ial corelmc�ion aODlica[ions are exempi �mm Ihese provisions. Oale- llpplicant: I hereby ceruly I�al I have reatl Ihis appl¢aimn antl s�ate Nat��e above iniormalion is correct 9e�eio comply wi�� all ciry antl counry oreinances antl s�ate iaws relating to bwlding constmetion anA hereby aut�orize reDre matives o t� iry to enter upon ihe above-memione0 pmperiy for inspeciion purpases. �e �C� -� � g'r' SignaNre'. ri�ers �icense or Sociai Secunry x: t64t�a6 Whne—Builtling: Green—Coee Enlorcemenl; Canary—Applicanl: Pink—Revenue; Goldenrotl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069078 PERMIT NO; H 069078 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION : T/OFF REROOF W/COMP, 1000SF HACK OF ITOUS SQ FT: 1,900 CLAIM VALUE: 1,900,00 CALC—VALUE: 1,900,00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTORS ARE REQUIRED PER U.B,C. 1991 ***u-*itx-i�x-iFar#*ic�***itir**it�t*ar*�t*+t**�t*****�r****�t****�*it*+rit�t-x��t�t�t**+�***�r�*+r**at*�t*�r**+t* 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 ------------ MAZN BUZLDING ---------- --------- P.CCESSC�RY BUILDING --------- FRNT; FT IN REAA; ' FT IN FRNT; ET IN ftEAR; FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING RE • PROV; PARCEL; 11733107 ZNE; REF NO; PLANNING N TES> � iE fE iE jf �IF if if if !f'lf !F iE iF iE �k iE iE iE 1! 1E iP iE iE �E iE ik ik iklE it if iF ik if fE fE iE iF iE if iE if iE iE fE if �F �lE ik il� 1E iE iE fE 3E iE N- iE if iF iE iF iE �E 3E 3E �F # 3E fE �f i^ ff iE iE if if iE 1E D E C� E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVEP BY L1ATE: BCIILDING APPROL'ED BY : DATE; p,� APPLICATION ZSSUED BY; DATE; � � "1 iEiEiEiFjEiFiEiEil�EiEiEiEiEiFifitikikifjfiE .. w� it iFififiEit�EifiEific. 3liE ih i(� iE 1E iE iE # 1E i(-1E iElE 1F iE iE iF iE 1t i! 1k fE i! iE iF iE iE iE itlf iE ik iE iE k iE fE iF iE ik if if iE iE jE iE jh iE iE iE k 1! ft if iE iE iE k iF f! iE 1ElF 1F 1E iE iE ff if iF 1E if 1! if �E �3f fE iE iE iE LEGALIZATION;N F E E S U M M A R Y STRUCT[IRAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECAANIC FIAE SMIP/RES GAADING PEAMIT 43,00 .50 `PLAN SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 43,50 0.00 0,00 43,SQ� 93.50 .00 � REVENUE DIVISION TOTALS--� COLLECTED: 43,50 'C�VER/SH(iRT; 00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLP.N—CHECK 43.00 .50 it ik it �'R� �lE 1f �l! f! iE ft iE ik iE iE iE iF it iF 11� iElE iE # iE fE iE �F ff 1f 1! k i4 iE iE i@ 1p f! i!!E fE 1E iE ik iE iE i! ff if !f 1E ff iE iF iE iF #'iE if i! if jE iF if iE �E �)f fE iE if iE i! jf 1E fE iE iE iE fE 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 SFR 1900 REAOOF BY VALUE RESIDENTIAL NOZONE 1.U0 1,900,00 END OF FEES . V O1 UJ158?53-001631`9 Y CeT 43,�p DATE: 10lG3/44 TIME: rJ9:21 x- -- CONSTRUCTION AN6 PLANNING • _JL & SPA APPROVAIS Permit # Date Inspector APPflOVALS Permit # Date Inspector t. Temporary Electrical Service or Pole 52. Pooi & Equipmenc Location 2. Soii Pipe�Undrgrnd. 53. Steei Reintorcement 3. Etectrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Co�dui2-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcemer; 56. Rou�h Plumbing & Pressure Test � i 6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNIT[ i 7. Foot�ngs 58. Electricai Conduit�Undrgmd. ! 8. Foundation 59. Gas Pipe, � Undrgrnd., Tesc � 9. 4'+ater Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, Ci Undrymd, i 10. Struaurai Floor SYstem 67. APPRQVAL TO DECK j 17. Property Sewer Line & H'ouse,Connection "bL, Backwash & Recepmr�Flnai 1 12. Sewer Cap 6�i Heater & Vent-Pinal � i 13. Roof Drains � Cv:' plumbinr; System - Fina� ' I 14. Rough Plumbing , G��i,. ElecVica6Final �t i 55. Rouyh Electricai-Conduit � 6G. Solar SYstem-Final � � 16. Rough Electric Wiring - 67. Fencing & Access Approval � i7. Roagh W'ving Sign 68. APPROVED FOR PLASTEftiNG ' i 18. Rough Electrical�T 8ar Ceiling 69. PO4L?SPA SYSTEP,iS FINAL ' 19. Rough Neatinq & Air Conditioning PIRE DEPT. REQUIREMENT I 20. Rough Factory Fireplace APPROVALS Permit # � 21. Oucts, in Structure 70. Underground Hydro 22. Ducts, Venafiatinq 71. Product Piping IJ Gas i?Oil 23. Gas Pipe�Rough & Tesi 72. Underground Flush 24. Roof Fram�ng 73. Uodergrnd. Stora9e Tank � Gas ❑ Oil 25. Roof Sheathing <��-�� (v� 74, Overhead Hydro 26. T�Bar Ceiling (Structurai} & Monpcoa; 75. Dry Chemicat � 27. Frame and Flashing , 76. Dry Standpipe � 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. insuiztion 78. FIRE PREV. FINAL 30. Dry�vali Na��n9 HEALTH DEPT. REQUIREMENT 37. Piaster Broa�n Coat 79. FINAL WSPECTION ^. � 32. Electricai Po�ver h�eterFinal 80. FOOD CERTIFICATE ISSUED ' 33. Final Elect��c Notes: �QG /�i/ �� ; �� 34. Final Heating & Air Conditioning ( 7 35. Finai Gas Pipe-Test 36. Hood or Canopy ' 37. Final Pattory Firealace ` 38. Final Plump��g j 39. Water Service�Final 40. Gas Service�Finai i 41. Soiar �omestic-Finai � 42. Backflow Preventer j 43. Backfiow Irrigation i 44. Landscape irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. F WAL STRUC"(URE & BUILDING �� 48. FINAL PLANNING ' 49. Electric Re�ease xc Edison 50. Gas Release to Southern California Gas Co 51. CERTIfICATE OF OCCUPANCY No. Date � E L �a �� '�—� -/�poileant to fill in all sDaces exceot those within neavr'Sortler lines ana si9n all apvropriate tleclarotions. '��'V OF COSTA ESA CO STRU ION PERMIT P MIT O. TRA T.O - LOT (�j UNIT N6. . projectAadress '� � �� " Ap(ilicant'S Mailing Addre55 � TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR _ ❑ CONVERSION ❑ OEMOLISH OTHER q p# r Ou7ner's Name �T �� DESCRIPJLON OF WORK/USE-0F BLqG. �Se� WU'( l P(�VTtNYV1- Address Arch/Eng. License No. Address Contrector'sNam ' Phone�%7��' Address (mailing) � [� _— Ciry LicenSe No. f `�/� IICENSED CONTRACTOR DECLARATION I heteby atti�m thai I am licensetl untler provision5 ot Charter 9(commencing with secfion ]000) of Division 3 ot the Business antl Pwtessions Cotle, antl my license is in full fOrt ntl effect. ^,` 11l � License Class �^� n'�p se� N��o.��_ Date �f' ��'� c'��ae�.��%Y/KU'� WORI(ERS'COMPENSATION DECLARAT I hereby a(firm that I have a certificate ot co ent to self-insure or a certiflcate of Workers' Com ensation nsu ce, or a certifietl copy thereo( (Seciion 380Q Lab.� ) �� y¢s � ' - y--- ' Policy No. SdLL1.\1�— Company � ��a� � ret �Certifietl copy is hereby fumishetl. Certifietl tp�Y�s filed wi[h the ci[y B tl'nq Divi o Date fr'al"d"f � qpplicant � EXEMVTION FROM WORKERS' COMPENSATI DECLARATION (Thissection neetl not be com0letetl if the permit i or one huntlretl (5100) or less). I cer[ify that in the performance ot the wo�k for which thls Oe�mR i5 is5uecl I shail nat employ any person in any manner so as to become subject to t�ie Wo�kers' Compensation LawS of Cali(Omia. � Date Signature -NOTICE: If, after making this tletlaration, you shoultl become subjett to th¢ WorkerY Campensatian provisions of ine Labor Cotle, you must for[hwi[h comply with such p�ovisions or thi5 permi[ shall b¢ tleemetl �evoketl. CONSTRUCTION LENDING AGENCV 1 bereby affirm that tM1ere is a mns[ruction lentling agency tot tne performance ot ihe work for which this permit is issuetl (Section 309] Civ. CJ Lentler's Name Lentler's Htldress OWNERBUILDER OECLARATION � I hereby affirm that 1 am exempt from the Contractor's License Law for [ne followin9 reason (Section ]03L5 Business antl Grofessional Cotle: Any city or munty which requires a permit to construct, alter, improve, tlemolish or repair any structure, prior to its issuance, also requirez the applican[ for such permit to tile a signetl statement that he/she is liwnsetl pursuant to the provlsions ot the Contra[[or's License Law (Chapter 9(commencing with Section 7000) of Division 3 of Me Business antl Professions Cotle) o� that he/she is exempt therefrom antl the basis for the allegetl exemption. Any violation of Sec[ion ]031.5 by any applitant tor a permit subjects the applicanf to a civll penalty of not more than five huntlretl tlollars ($500). ❑ I, as owner o( the oroperty or my employees with wa9es as their sole compensation, wi11 tlo the work, antl the structure is not intendetl or ofieretl for sale (Section ]064, Business antl Pro(essional Cotle: The Contractor's License Law tloes not apply to an owner of a property who bullds or improves thereon, antl who tloes such work himself/herself or through his or her own employees, provitletl tliat such improvemanis are not intentletl or ofteretl for sale. If, howeveq the builtling or improvement is soltl wi[hin one year Of com- pletian, the owner will have the burtlen of proving he/she ditl no[ bulltl or im- ve for the purpose ot sale). I, as owner of the O�operty, am exclu5ively mntracting with licensetl con- t actovs to construct the project ($ection ]044, Business antl Pro�e55ion5 Cotle: The Contractor's License Law tloes not appty to an owner of property who builtls or improves thereon, antl who conttacts to� such p�oject5 wlth a con- � tractor(s} license pursuant ro the Gontractor's License Law). I am aware that I proof oi their Worker's Compensation insurance shoultl be provltletl to me. I'� ❑ I am exempt untler Section—� �, & P. C. for this reason Date d - [ 1�� Owner I hereby certify that, I have rea� intormation is correct. I agree to antl state laws r ating t bu' tlin sentatives of t s city o er inspection pu s Signature Drivers' License or 5 TVPE OF PERMITp� LJ GRADING � FOUNOATIO�,V I(J` STRUCTURAL ❑ TENANT ty ELECTRICAL PLUMBING .rn MECHANICAI ❑ �OTHER � _ _ PROJECT DESCRIPTION SQ. FT. nrri ipnryrv �— "' _ _� CONSTRUCTIONTVPE VALUATIONS �Z�� ZONE GRADINGCU.YDS. ACRES— Remarks: Bar Sink Backflow Preven Backflow Irrigat Bathtubs Clarifiers Drinking Fountains Floor Drains � Floor Sinks Gas Service Interceptors Kitchen $ink lavatories P-Trap Roof Drains Reinspection Fee CovCo - <S'7 PLUMBING FEES Showers . Service,Sink � Sewer Cap ' ' Sewer Connection, � � $olar COIIectOfS - ' Sola� Pipin9 • y�: _ Solar Tank , �� - Swimming Pool w/Spa ' Urinal Outlets I � Water Closet Water Heater Water Service A uto-W ash Laundry Trays $15 Boiler Duct- UnderGround Duct - Structurel Duct - Ventilating ' Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # �Heating System & Ducting �4100,000 BTU 0100,000 BTI Fee � $15 Issue Fee Hood or �pe I ❑ Canopy Type I I -� Refrigeration System ❑aioo,000eru ❑ioo,000 System Repair/Alteretion Fire Dampers Registers ' Issue Fee $ 3 I —L FEES $ 3 5 Main 8uilding: E „ �y T Front G��, ARear C Right SLeft Ping. Ref. #. Planning Notes: / Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Deyice Boxes Switches `� Garbage Disposal Generator �0-5 KW �5�75 DEVELOPMENTSER Zonin9 APProved BY_ Building Approvad By Aoolication Issued Bv_ R BUILDING PERMIT� $ PLAN CHECK $ PLUMBING $. PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 5096 $ MECHANICAL $ PLAN CHECK 25% $ i�y,3') 8��/i�: Accessory Building: ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter LJup to 100 amps Meter ❑over100amps Sub Panel Motors00-1 HP�1'f.-8 Inc.Solar �9-15 HP �16-75+ Microwave � Pole Light Range Sign Standing Sections Tresh Compacror luue FEES $ 3 �FEES � , SMIP $ � PERMIT � ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM $ '7 �^� �'� TOTALFEE $ ...2_.c'P.�. CMP 0865-46, rev. 10/84 White - 6uiltling: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor ' .� . �„ "' CONSTRUCTION AND PLANNING APPRiiVALS Permit # ?. �emporary Electrical Service or Pole . + 2. Soil Pipe'Undrgrnd. � 3. Electrical Conduit Utility-Undrgrnd. s 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings 8. Foundation � 9. Water Pipe-Undrgrnd. 1 , 10. Structural Floor System 1 t. Prope'rty Sewer Line &�House Connection 12. Sewer Cap 13. Roof Drains 1'4. Rough Plumbing- 15. Rough Electriral-Conduit 16. Rough Electric Wiring 17. Rough Wiring Sign � 18. Rough Electrical-T Bar Ceiling ' 19. Rough Heating & Air Conditioriing 20: Rough Factory Fireplace 21. Ducts, in. Structure � � 22. Ducts, Ventilating � 23. Gas Pipe-Rough & Test 24. Roof Framing � 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat ( 27,. Frame and Flashing . 28:" Lathing & Siding 29. Insulation 30. Drywall Nailing 31 . Plaster Brown Coat � 32. Electrical Power Meter-Final ' 33. Final Electric ' 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood 'or Canopy � � 37. Final Factory Fireplace' , I 38. Final Flumbing � . � � J 39. Water Service-Final � 40. Ga's Service-Final ' � �i 41. Solar pomestic-Final ' � 42. Backfipw Preventer � 43.�Backflow Irrigation � � 44. Landscape Irrigation System, � 45. Sound Attenuation ' ; ' 46. Handicap Regulations � �• ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed; 49. Electric Release to Edison ,' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Date Date � Inspector vc� � �v � ✓�i U��? I L6,� ' POO L & SF. APPROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing SYstem - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOODCERTIFICATEISSUED Notes: ,(L//a��:-%� �an� 0 0 Date �Inspector ♦ APC��ant ta fill In all sDaces eaceD� t�ose within haavy Eo�tler Ilnes anA. si9n all aDP�opriate aeclarotions. ciTY OF ;OSTA MESA CONS�RUCTION PERMIT ProjectAddress �3�6ro� /{pplicant's Mailing Address Owner's Name �� 4�� S�n f% [.0 Phone �`« �3SfZ%y Address t'i3-3 �Y(7(]C!!A/Q-.0 Arch/Eng. License No. Address e-� Conttactor'sNam - Phone `��- �a�� Address(mailing) C � CityLicenseNo. ��7 LICENSED CONTRACTOR DECLARATION I hereby atfirm that I am licensetl untler provisions of Charter 9(commencing with section 7000) of Division 3 of the Business antl Grofessions Cotle, antl my license is in full for antl eHect. License Class �� l i e s �� - Date r�-7-Sf Si9natvre WORKERS'COMPENSATION OECLARAT I hereby affirm that I have a certlficate oi co ent to selt-insure or a certificate o( Workers' �CJomqpenpsation Insurance, or a cert�if-l-e�tl.�.c�opy cthereot (Section Po00Y No. o�-'� 1 V� Company �.""�n f �L"�� certifietl copy iz hereby fumishetl. Certifietl� opy�1 iletl with [he city Bu' i g ivis Date LO' L' 7D Applicant EXEMPTION FROM WORKERS' COMVENSATI DECLARATION (Thissettion neetl no[ be completetl it the permit fOr one huntlretl ($100) o� less). I certify that in SM1e perfo�mance of the work fOr which this perm�t is issuetl, I shall nOt employ any person in any manne� so as to become suDject to the workers' Compensation Laws of Calitornia. Date Signature `NOTICE: If, a(ter making this tleclaration, you shoultl become subject to the Workers' Compensation O�ovisions ot the Labor Cotle, yop must (ortnwith comply witn sucM1 p�ovisions or tnis pe�mit shall De tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby atfirm that there is a construction lentling agency tor tne per(ormance of tM1e work (o� which this permit is i55uetl (Section 3097 Civ. CJ Lentler's Name �entler's Atltlress OWNER BUILDEH �ECLARATION I he�eby affirm that 1 am exempt trom the Cont�acto�'S Licenze �.aw /o� the followinq reason (Section 7031.5 Business antl Professional Cotle: Any city or county whiGh requires a permit [O const�uct, alter, Improve, tlemoli5h or �epai� any structure, prior to its issuance, also requires tne applicant tor such permit to file a siqnetl statement that he/she is licensetl pursuant to the p�ovision5 of the ConVactor's License Law (Chapter 9(commencinq witb Section ]000) oi Division 3 ot roe Business antl Professions Cotle) or tha[ he/she is exempt therefrom antl the basis /or the allegetl ezemp[ion. Any violation ot Section ]031.5 by any applicant for a permit subjects the applicant to a civil �enalty of not more Ihan five huntlretl tlollars ($500). I, a5 owner of the prOpe�ty or my employees with wage5 as their sole compensation, will do the work, antl tne structure is not intentletl or ot(eretl for sale (Section 7044, Business and Protessional Cotle: Tne Contracror's License law tloes not apply to an owner ot a property who builtls or improves ihereon, antl who tloes such work M1imself/herself or [M1rouqh his or her own employees, provitletl that such Improvemen[s are not intentletl or otteretl for sale. If, however, the building or improvement is soltl within one year ot com- pletion, the owner will nave the burtlen ot proving he/she tlitl not builtl or im- r ve for the purpose o( sale). I, as awne� of the property, am exclusively contracting with IicenSed con- t actors to construct the oroject (Section 7044, Business antl Professions Code: The Contrac[or'z License l.aw does not apply to an owner ot property who builtls o� improves thereon, antl wno contracts fo� such proje[ts with a con- t�ac[or(sl license pursuant to the Cont�acto�Y License law�. 1 am awa�e that proof of tnel� Worker's Compensation insurance Shoultl be provitletl to me. ❑ I am exempt untler Sectlon-l- B. & F. C. for this reason a � i Date that I nave reatl ihis a rect. I aqree to comply atino to builtlino cons[ � Drivers' License or CMF 0865-46, rev. 10/� :atlon antl sta[e that [he above i ail tlty antl county ordinances on, antl hereby autho�ize rep�e- above-mentionetl //p��operty for �- �ate Cv��_f� � � � � TVPE OF C�NSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH OTa�ER DESCRIPTIONOFJ�LORK/USEQFBLDG.1,��1 E [C (le S��fUIK'- TVPE OF PERMIT LJ GRADING LY FOUNDATION LI STRUCTVRAL ❑ TENANT C�I ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5Q. F7, oCCUaArvGv CON STRUCTION TVPE VAIUATION $ _ ZONE GRADING CU. VDS. ACRES_ Remarks: . 1 71 7 �� Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P-Trep Roof Drains Reinspection Fea � $15 Bailer Duct - Under Ground Duct � Structural Duc[ - Ventilating Exhaust System ❑ Mulciple ❑ Firepl/Fact.8lt. ICBO # Heating System & Ducting ❑P700,000 BTU �100,OOOB7 Reinspection Fee � $15 White - Builtlin9: Canary - APPlicant; Pink - Atcounting; Goltlenrotl - Assessor PLUMBING $hOw¢!5 $ervite Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping ' Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays laue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration Sys[em ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 FEES $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: �L 12�Z ,.,,....,n.. IQ�6:! t� Zone Accessory Building: 2 O N 1 N G R Parking Req./Provided E M S ELECTRICAI Automatic Washer Transformer ❑ 15-50 KW Construction PoleSu6. � 50+ KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garba9e Dispoul Generator DO-5 KW �5-15 KW Meter „2Qup m 100 amps Meter ❑over100amps Sub Panel Motors �0-1 HP 01 %- 8 Inc.Solar �9-15 HP 016-75+ Microwave - Pole Light Range Standing Sections Trash Compactor Fee �$15 � � Issue Fee FEES $ 3 DEVELOPMENT SERVICES RE�UIREMEN7S: . Zoning Approved By Date Building Approved By Date� APPliption Issued BY � Date /V e!'d � SUMMARV OF FEES � BUILDINGPERMIT $ SMIP $� PLAN CHECK $ � PERMI7 PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ---p-��- ENERGV P.C. $ ELECTRICAL $ �• V � GRADING $ PLANCHECK 50% $ � MICROFILM $ t� MECHANICAL $ TOTAL FEE $ �O'v PLAN CHECK 25% $ � CONSTRUC710N AND PLANNING POOL & Sra '- 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. Raugh Plumbing & Pressure Test . 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE -7. Footings � 58. Electrical Conduit-Undrgmd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 70. 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 Elearic 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 OGas ❑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. Electrical Power Meter-Final a 80. FOOD CERTIFICATE ISSUED 33. �Final Electric Notes: � 34. Final Heating & Air Conditioning �(/s�dt�� 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing • 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � � 42. Backflow Preventer ., � 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation � 46. Handicap 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 / OWENS-CORNING • Fiberg as Building Insulation The contractor named below certifies that the Owens-Corning Fiberglas 8uilding Insulation used carries the NAHB Research Foundation, fnc. label for assur�d thermal performance and that the Building Insulation is installed in conformance with current energy conservation regulations, California Administrative Code, Title 24, State of California, in the building located at: 3 '' �clwa OSr.a /� �/l'!C� Address City Tract Number Exterior Walls ,�� Owens-Cornino Fiberqlas Type_�� Insulation Ceilin�s � Owens- ornina Fiberqlas Type Insulation Floors Owens-Corninq Fiberqlas Type Insulation Foundation Walls �� '�'�_ Thickness R-Value � �.30 Thickness R-Value Thickness R-Value Manufacturer Type Thickness R-Value Homeowner Copy (White) State Copy (Yellow) Builder Copy (Pink) OWENS-CORNING FIBEflGLAS COHP. PuO. No. 16-BLfi995-B Insulation Operating Division �imo in U.S A.. Jan., t994 cony.�qni e isa2 owens-commq F��oe�qiee co�o. Fiberglas Tower, Toledo, Ohio 43659 , , • _ . ... . .... ..'. ;: � \ � -, - � .. ..:;�: ,: � �%, .. ., ;Y ,�, ... � , . ,.., , . -. =�c . -� � , -_ � y . - , ,t - ..- ,.�.. - , " �i. _ � �� ' ' . '., n ;' ` , :�+, , ' �, • - . �:,. ` ' - � � . . � . ., .� , • ,' � ROY CHAFEY ROOFING COMPANY LIMITID WARRANTY HOT TILE SHINGLFS 969z LiJDERS AVENUE, GARDEN GROVE, CA., 92644 (714) 636-1747 LOCATION �33 Broadway Costa H�Iesa Ca. street & no, city state (zip) OWIVER name street & no. city state zip APPLIED BY Roy Chafey Roofing 9692 Luders Ave., Garden Grove, Ca. 92644 DATE OF COMPLETION 9�26�85 WARRANTY PERIOD_�S�.YRS. FROM DATE OF COMPLETION. WARRANTY APPLIES TO ADDITION ONLY. THIS LIMZTED WARRANTY IS ISSUED AND ACCEPTID IN LIEU OF ALL OTHER EXPRESS OR IMPLIID WARRANTIES AND EXPRESSLY EXCLUDES LIABILITY FOR CONSEQUENTIAL DAMAGES. This Limited Warranty is personal to tha original owner and is NOT transferable. The roofing was applied in a workmanlike manner and a w�itten warranty has been furnished the mortgagee for delivery to the purchaser of this proper'ty. I certify that I am authorized to sign this certification on behalf of Roy Chafey Roofing and that, by the signature hereinafter made, Roy Chafey Roofing, is duly bound under the terms and conditions of the cextification. In the event that the certification as to condition of the roof and roofing, based on examinati0n of visible elements, on the date of trie inspection hereinbefore referred to,is subsequently found to have been inaccurate and that a prudent inspection should have revealed existing deficiencies, then and in such event the Certi£ier hereby agrees to make such expenditures as may be necessary to make or cause to be made the repairs found to be necessary provided such faulty condition is determined to have been in existence on or before the date of this certification. I flirther certify that I have no interest, present or prospective, in the property, buyer, seller, broker, mortgagee or other party involved in the transaction. DATE Oct. 30th, 1985 SIGNATURE STATE LICENSE N0. 405737 TITLE 04dNER (114) 5Y7-2111 czia� aai-ssss State License No. 201162 ' D�6�7 � CON CTO , INC. 10666 Be�ch Blyd. St�ntoe, Calitornla 90680 Novembeh i, 19&5 TO wHU�b1 IT MAY CONCERN: Re: 433 BxaadWay, Coa�a Meda, CaP.i,bonvu.a Th,i.a .i.s �a a,sewce �the C.i,ty ab Co�.ta Me�a .thc�t .the homeowneh and H�,-Lo Con�.t�cacton�s, Inc. a�t�sfi,s �tha,t �he c�w,i.nage gham -the neiv naom .to .the hfiiceet .i,s cavi.ecz. n � Sam �ocuman, Pne:s�,devi,t Hcvco2d Shan.key, Owneh