HomeMy WebLinkAbout3154 BRAY LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mes�,�q�DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 3154 BRAY LN
Suite:
Vicinity: ROOF
Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N
Parcel Number: 14163122 Zoning: R1
App�icant RICHARDSON, MILLER
Address: 1651 E 4TH ST
SUITE 239
SANTA ANA, CA
owner: PLOSKI, EVE R TR
Address 3154 BRAY LN
COSTA MESA, CA
Contractor. GUARDIAN ROOFS
Address: 1651 E 4TH ST
SUITE 239
SANTA ANA, CA
Zip: 92701 �
Arch :
Address:
Zip:
Phone:
License:
Phone: 714-770-7968
Zip: 92701
Phone:
Zip: 92626-2606
Phone: 714-770-7968
License: 847279
Eng:
Address:
Status: ISSUED
Applied: OS/31l2006
Issued: OS/37/2006
Phone:
License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 30# FELT, WOOD CREST, 50 YEAR COMPOSITION SHINGLES AND REPAIR/REPLACE
SHEATHING AS NEEDED. 31 SQUARES INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00
Permit: $20925
SMIP Res: $1.17
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: 5210.42
PLANNING & 20NING
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existin : 0
Calc Valuation: $i�,�3s.00
Ciaim Valuation: S�i,�3e.00
Rear 0- 0 Lefl 0- 0 Right 0- 0
Rear 0- 0 Left 0- 0 Right 0- 0
Reauired: 0 Pr000sed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Cali(ornia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRA710N: 7his permit shall automaticatfy expire and become void if work is not commenced wifhin 180 days, or it work is suspended or abandoned
for a period of 1 BO 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
requlred Inspections entl final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOp INSPECTIONS CALL: (774) 7545626
�
WORKERS' COMPENSATION DECLARATION: , ,/- .. :
I hereby affirm under penaiy of perjury one of the tollowing tleclarations: .. . ' ' . ,
❑� I heve and wlll malntain a certificate of consent to self-Insure for workers' compensetion, as provitled for by section 3700 of �he Labor Coda, tor ihe pertormence of the
work for which this permit is issued.
� hAeve entl will mainiain workers' compensation insurance, es requiretl by section 3700 of Ihe Lebor Cotle, for the peAortnanca of Ihe work tor which this permit is issuetl.
My work rs' compensa/ti�n Insurance carner antl poli umbe�r eY /�-�.��r'
ar���P C .'O!'{ � � �C �UM�� P icy Number: �� �J V ""�/ � ^ % 'rn
(7his section neetl no( be complefeC il (he permrt is va ued e7 ( one hun�d dollars ($700) or less.)
❑ 1 certity Ihat in the pertortnance of Ihe work br which Ihis pertnit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws oi Cal'f ia, a ag t t If I sho become subject to the workers' compensatlon pmvisions of Section 3700 ot Ihe Lebor Code, I shall forthwith
complywiththese si . � (�,
`_— � � — V/
AppFcan(SignaNre: � :. Dete:
WAANW6rfAILURE TO SECURE WORKERS' CAMPENSATION CAVERAOE IS UNLAWFUL AND SHALL SUflIECT AN EMPL�IMINAL PENALTIES ANO dVIL INES UP TOONE HUNDRED
THOUSAND OOLLARE ($100,000), IN AD�ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIQV 3]O60F THE LABOF CADE, IFIrEREST, AND AiTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm ihat I am licensed under provisic
with Section 7000) of Division 3 of the Business and Prafessions Code, and my license is in fµll
'Cl�gr ^- Q
�`s�`�Sl�—�� ?
CONSTRUCTION LENDING AGENCY:
❑ I hereby aNirm that ihere is a consiruction lending agency for the peAormance of ihe work tor which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
SignaWre: _
OWNER•BUILDER DECLARATIONS:
Lender's Atltlress:
Date:
I here6y aNirm thet under penalty of perjury Ihet I em E%EMPT FROM 7HE CON7RAC70RS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business antl Professions
Code: Any city or county which requires a permit to constmct, alter, improve, demolish, or repair any simcture, prior to its issuance, also requires the applicaN for such permit
to file a signed statement ihat he or she is licensetl pursuant to the provisions of the Contractors License Lew (Chepter 9(commencing with Section 7000) of Division 3 of ihe
Business and Professions Code) or ihat he or she is exempt therefrom antl the basis for Ihe alleged ezemption. Any violation of Section 7031.5 by eny epplicent for a pertnit
subjects ihe applicant to a civil penalry of not more ihen tive hundred dollars ($500).):
❑ I, as owner of ihe property, or my employees wlih weges es iheir sole compensation, WILL DO THE WORK, and iha struc�ure is not intended or otteretl for sale (Sec.
7044, Business antl Professions Code: The Contractors License Law does not apply to an owner of propeny who 6uilds or improves ihereon, and who tloes such work
himself o� herselt or ihrough his or her own employees, provided that such improvemenis are not Intanded or ottereC for sale. If, however, the huiltling or improvement is
sold within one year of comple�ion, ihe owner-builder will have the Durtlen of proving that he or she did not builtl or improva for purpose ol sale.).
❑ I, as owner ot the properry. am EXCLUSIVELV CONTRACTING WITH LICENSED CONTFiACTORS to construct Ihe project (Sec. 7044, Business entl Professions
Code: The comracbrs Licensa Law does not apply to en owner of pmperry who 6uilds or impmves thereoq and who cdntracts tor such project with e contractoqs)
licen58 pursuant to lhe Con�raclors License Lews.). �
❑ I am exempt under sec. Business antl Professions Code for ihis reason:
Signalure: Date:
Owner ID verifiatl by tlrivels license. ❑ Ves ❑ No Drivers License No. Expires:
Verificetion ot Ownership by (type ot document, i.e. - property tax 6ill or deedJ:
DIVISION OF INUUSTRIAL SAFETY PEflM1T CERTIFICATION:
❑ I hereby certity ihat no excava�ion tive (5) or more feat in depth into which a person is required �o tlescentl, will be made in connection with work euthonzed by ihis
permit, antl that no building siructure, scalloltling, felsework, or demolition or dismantling thereot, will be more than thirty-six (36) feet high. (Chap. 3.2, Gry 2, Art 2, Sec.
341, Ttle B, Calibmia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Indusirial Safery, as noted ebova, unless such person has e
permit to do such work from the division.
SignaWre: Date: -
DiviSion of InduStnal Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF EMRY: 1 cenity under penalry oi perjury that I have read ihis application and stata that ihe intormation given is
correct. I agree to comply with all state laws and ciry ortlinances relating to building construction, an0 authonze representatives oi the Ciry of Costa Mesa to enter upon the
above-tlescribed property tor inspection puryoses. I agree not to occupy or allow occupancy ot eny builaing aut�orizetl by this permit until final insDection.
CODE N, INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof �
201 Finel Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Finel Damolition„
QOjF INTITIRLS
�1 �
4QQ�E INSPECTIONflPE-
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Preventian
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
Q�jf INTRI�LS
,lobAddress: 3154 BRAY LN
Suite:
Vicinity:
Primary Occ: R-3 Dwellings/ Cong Res <10
Parcel Number: 14163122
Applicant: STEVE JANOSIK
Address: 7621 E STANDREW PL
Type of Construction: V-N
Zoning: R1
Phone: 714-259-5120
SANTA ANA, CA Zip: 92705
Owner: PLOSKI, EVE R TR
Address 3154 BRAY LN
Phone:
COSTA MESA, CA Zip: 92626-2606
Coniractor: ALUMINUM ROOFING SPECIALISTS-DIAL ONE WINDOW REP
Address: 1621 E ST ANDREW PL
SANTA ANA, CA
Zip: 92705
Arch :
Addrsss:
2ip:
Phone:
License:
Phone: 714-259-5720
License: 523043
Eng:
Address:
Status: ISSUED
Applied: 09/28/2005
Issued: 09/28/2005
Phone:
License:
SCOPE OF PERMIT
REPLACE 8 WINDOWS AND 1 PATIO SLIDING GLASS DOOR THROUGHOUT S.F.D. WITH VINYL, DUAL PANE TO MEET 1997 U.B.C. EGRESS
REQUIREMENTS.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
I nspection:
Total:
$0.00
$125.25
$0.60
$0.00
$0.00
$0.00
$125.85
SETQACKS
MAINSTRUCTURE Fronl 0-0
ACCESSORY Front 0- 0
PARKING Existina: o
Rear 0-0
Rear 0-0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0• 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
$6,000.00
$6,000.00
NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requiremenis under Calitornia 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 1 BO days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIQNS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
2d46d8 (8�W)
WORKERS' COMPENSPTION DECLARATION:
I hareby eflirtn untler pen&Ity of per�ury one ol the following declarations:
❑ I have and will malnteln a cartificate ot consent to self-Insure for workers' mmpensation, es proWtletl for by section 3700 oi Ihe Lebor Code, for the pertortnance of the
work tor which this pertnit Is issuetl.
� I have and will maintain workere' compensation Insurance, es requiretl by section 3700 of the Lebor Catle, for ihe peAormance of Iha work Por which Ihis pertnit is issued.
My workers' compensatlon Insurance carrier end policy number are:
Certier. iS`l A TE �J A1 l> i � . ". . .. • � : L,;, r poiicy Num�er. � �o� �Z a � �
(ThAs secNon need nat be �mp ered il tne permif Is velu t one huq�,(ed dollarsF��(310_Oj or less.) �: -
❑ 1 certity thet in the peAormance of the work for which l is pemf�l i3 issued;PshaA�not employfany person In eny manner so es ro become suDject to the workers'
compensatlon laws a� Calilomla, end agree Ihet If I should become subject to the workers' wmpenselion provislons of Sectlon 3700 of the Labor Code, I shall forthwlth
comply with these pro ions. r� � (� /
Applicent Signeture: 4Nt� .�,41A i Date; � - 9/'Z81��
WARNIHO: FAILURE TO SECURE WORNERS' ENSATIOfJ COVERAGE IS UNLAWFUL AND SHFLL SUBJECT PN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNORED
T}IOUSAND DOLLARE (5100,000). IN ADDITION THE COST OF COMPENSATION, DPM4GE5 AS PROVIDED FOR IN SECiION �O60F THE UBOR COOE. INTEREST, AND ATTORNEY'S fEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eflirtn that I am licensed u�nd�er .p�ro.rvi�sions ol Chapter 9(commencing with Section 7000) of DiWsion 3 ot t�e Business an Pmfesslons Code, and my license Is in full
force�entl eXact. Llc. p 5�,.�,ry3 </l ✓Cless a �,
Cantractor'sSigneture: �iu ��i,� C--Dete: C��g- F1i
i i
CONS7RUC710N LENDING AGENCV: v
❑ 1 hereby aHirm Ihat there is a consiruction lending agency for Ihe pedormance of t�e work tor which ihis parmi� is issued. (Sec. 3097, Civil Coda).
Lenders Name: Lender's Address:
Slgnature:
OWNER•BUILDER DECL�7AnONS:
Date:
I hereby eHirm thet under penelry ol perjury thet I em E%EMPT FROM 7HE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7037.5, Business antl Protesslons
Code: Any city or counry which requlres a Dermit to construct, alter, improve, demolish, or repair eny strucWre, prior to its issuance, elso requires the applicant tor such permii
to file a signetl stetement �het he or she is Ilcansetl pursuant to the provisions ol ihe Contractors Ucense Lew (Chflpter 9(commencing with Sactlon 7000) of Division 3 oi the
Business end Proteuions Code) or Ihet he or she Is exempt theretrom and Ihe basis tor tha elleged exemption. Any violation of Sedion 7031.5 by any epplicent for a pertnil
subjecis the epplicent �o e clvll penalry of not more t�en five hundrad dollars ($500).):
❑ I, as owner of iha properry, or my employees wl�h wages es thelr sole wmpensation, WILL DO THE WORK, end the structure is not intendetl or oflered for sale (Sec.
7044, Business and Professions CoGe: The Coniractors License Law dces not apply to an owner of property who builds or improves Ihereon, and who dces such work
himselt ar harsetl or through hls or her awn employees, provided ihat such improvements ere not Intended ar oNered lor sele. If, howevar, ihe building or improvament is
sold within one year oi wmplation, the owner-builder will have the burden ot prodng ihel he or she did not build or improve for purpose ot sale.). '
❑ I, as owner of t�e prPperry, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRAGTORS to construct Ihe project (Sec. 7044, Business antl Professions
Code: The comrectors Llcense Law does not apply ro en owner oi propeny who �uiltls or Improves thereon, end who comrects lor such pmject with a contractor(s)
license pursuant to the Cantrectors License Lews.).
❑ I am exempl under sec.
Signature:
Owner ID verified by dnve(s license. ❑ Ve5 ❑ No
Business and Professions Code tor this reason:
Vedtication of Ownership by (�ype ot daument, i.e. - property tax blll or deed):
DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION:
Drivers License No.
Da�e:
Expires:
❑ I hereby ceritly ihat no excavation tive (5) or more faet in depih into which e person is required to descend, will be mede in connection with work authonzed by this
permit, end that no building structure, swflolding, falsework, or demolition or dismantling I�ereol, will be more �hen thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celitomla Administretive Cotle).
❑ As owner-builder, I Wiil not omploy enyone to do work which would require a permit irom Ihe Division of Intluslnel Sete�y, as nated abova, unless such person hes e
pertnit to do such wo� <<om Ihe division.
Signature: Date:
Division of Industnal Safety Permi� Number:
CERTIFlCATE OF COMPL�NdCE AND AUTHORIZA710N OF EN7AV: I certity under penalry of perjury thet I heve read this application antl state that the infortnation given is
correct. I egree to comply wlih ell stete laws antl ciry ortlinances relating to building consiructlon, end authorize representetives of the Gity ot Costa Mesa to enter upon the
above-descnbed pmperty for inspection purposes. 1 agree not to occupy or allow occupency ol any builtling authorized by this pertnit until final inspection.
COpE 1. INSPELTIONTYPE
1fi16 Fixetl System Finel Fire Prevention
1266 Pool Spa Finef
200 Finel Re-Roof
201 Finel BIocWRetaining Well
202 Final Factory Fire Placa
203 Finel Sign
204 Final Demolition
PdIE IN�i1RL5
COpE 1 INSVECTION TYPE
206 Finel Mechanical
2�B F(nel PlumDing
210 Pinel Elacincal
212 Finel Fire Preventlon
220 Final Planning Apprwal
222 Final Site
250 FlnalBullding�Occupanq
♦ �� �
November 15, 2002
CITY OF COSTA MESA
P.O. BOX 7200 • 77 FAIR DqIVE • CALIFORNIA 92628-7200
fROM THE DEPARTMENT Of PU8L7C SEAVICES/ENGMEEAIN� DIVISION
Ms, Eve R. Ploski
3154 Bray Lane
Costa Mesa, CA 92626
SUBJECT: REQUEST FOR THE CITY TO PARTICIPA7E IN FIFTY (50) PERCENT
OF THE COST TO DESIGN AND CONSTRUCT AN EIGHT-FOOT HIGH
SLUMPSTONE ARTERIAL WALL ALONG 3154 BRAY LANE
ADJACENT TO FAIRVIEW ROAD
Dear Ms. Ploski:
The City of Costa Mesa is in receipt of your e-mail, dated November 10, 2002,
requesting the City to participate equally with you for the design and construction costs
of an eight- foot high and 60-foot long slumpstone arterial wall along your propeRy
adjacent to Fairview Road.
City Council, at their regular meeting of July 16, 2001, adopted Resolution No. 01-49,
amending the City's Streetscape and Median Development Standards, to allow City
participaticn in the design and construction/reconstruction costs of private aRerial walls.
This incluces design standards for construction of new arterial walis along residential
neighborhoods, within private property.
Funding (or this work is r�oi available in fiscal year 2002-2003. Nowever, since the
subject wzll is a qualified wall, under the guidelines of the program, there are two
options: 1) l"he City will take the lead in engineering and consiruction of the wall, or 2)
The properry owner will take the lead in the design and the consfruction of the wall.
Since the subject wall is only 150 lineal feet and a considerably small project, it is more
economical for the properry owner to take the lead. The City will include fifty percent of
the total design and construction costs for the next fiscai year's (03-04) budget and wiil
present it to City Council for their review and consideration. The Councii's budget
hearing for the next fiscal year is in June of 2003.
In order to prepare a budget request to City Council, an estimate of the design and
construction costs for the subject wall must be submitted to the Public Services
Department, Engineering Division, for their review and approval. The property owner
shall construct the wall per the City's Streetscape and Median Development Standards,
Section 8. Further, this is a private wall and wifl be constructed within the private
propeRy. The property owner shall provide construction documents and follow all
guidelines enforced by building provisions and obtain a permit from the Development
Services Department.
PHONE: (714)75a-53a3 FAX: (71a)75a-5028 TDD: (7/a)75a-52aa
www.ci.casta-mesa.ca.us
Upon the City Council's approval of the budget, written correspondence from the City
will be forwarded to you agreeing to the fifty percent financial participation. The City
shail pay the approved amount within 35 days of the completion of the wall construction.
At this time, we do not recommend that you proceed with the design and construction
until we have obtained approvai from the Council to contribute fifty percent of the costs.
City staff looks forward to working with you on this worthwhile project. Should you have
any questions-please contact Bart Mejia at (714) 754-5291.
Sincerel �~� rf' J
Munoz
ineer
c: William J. Morris, Director of Public Services
Rick Brown, Building Official
Burt Morgan, Chief Pians Examiner �
Bart Mejia, Associate Engineer
�
`
AOP�ieant to fill in all spaces exceot those within heavy eortler lines antl sign all approoriate aeclarations.
Ci7Y oF cOSrA mESA CONSTRUCTION PERMIT
Projg�tAddress ��54 �T'ay LnT. G.M. 9z6z6
Apptia'iR'sMailingAddress ��26 CQIIImerC1H1, C.M. 92627
O�=:r's Name �1T'� E Ploski vnone 546-4029
:"ced�es� �1.5_4 13r'aTLn � C M. 92626
Arch/Eng. License No.
Address
Contractor's Name �'ank SY'OS. ROO�lrig CO phone 548-55
Address(mailing) 126 Commercial, C.M. 92627
City License No. 0�5993
LICENSED CONTRACTOR DECLARATION
I he�eby affirm tha[ I am licensetl untler proY�slons of Charte� 9(commencing
with section 7000) of Division 3 ofjhe Bu4�ness antl Profession e, anch
my license is in fuu rorce a?p ejfgct.� / � ��q //
Oate — Signature �/�" '
WO KERS' COMPENSATION LARATION
1 hereby altirm that I have a rC} mate ot consent to self-insure or a<ertiticate
of Worker5' Compensati�Surante, or a�ertifietl copy the�eof (Section
3800, Lab. CJ
aolicy No. %R''j�Z4—$% companv �tatP Pnnd
❑ Certitietl coOY is hereby furnished.
�l( CerJ�f ietl 0.Y. ye tl witn the city B Itli i �o
oate 7"'� �/ Applicant �'��'�S. Roofin.2 CO.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if the permit is for One huntlretl ($100) or
less).
I ce�tify that in the perfOrmance ot the work fOr whi[h this perm�t i5 issuetl, I
shall not employ any pe�son In any manne� so as to betome subjeGt [o the
Workers' Compensation Laws ot Caliiornia.
Date Signature
NOTICE: If, after making Ihis tleclaration, you shoultl become subject to the
Workers' Campenwtion provisions of [he Labor Cotle, you must forthwith
comply with such 0/ovisions or tnis perf��t shall be tleemetl r¢wketl.
CONSTRUCTION LENDING AGENCV
I herety affirm tha[ [here I5 a mnstruction lentling aqency Por the performanc¢
of [he work tor which tM1iS permit is issuetl (Section 309] Civ. CJ
Lsntler's Name
Lentler's Atltlress �
OWNER BUILDER bECLARATION
I hereby affi�m Ihat I dm exempt from Ihe Can[�acto�'s License Law for the
followin9 reason (Section 7031.5 Businezs adtl Professional Cotle: Any ciry or
county which requires a permit [o cons[ruct, alter, improve, tlemolisM1 o� repair
any structure, pnor to its issuance, also requ�res the applicant for such permit
to file a 5iqneG statement that he/she is Iice05etl pu�suant to the provisions ot
the Contractor's Licenie Law (Chapter 9(cort�mencing with Section 7000) of
Division 3 ot the Business antl Profesvons Cotle) or that he/she is exempt
the�efrom antl the basis for the allegetl exert�Ption. Any violation of Section
7031.5 by any applicant fo� a permit stlbjec[5 Ihe applicant to a civil
�enalty of not more than five huntlretl tlollar4 (5500).
LJ I, as owner of the property or my emp�oyees with wa9es as their sole
compensation, will do the work, antl the structure is not intentletl or offeretl
(or sale (Section ]044, Business antl Prof625ional Cotle: The Contractor'S
License Law tloes not appty to an owner of a P�operty who builtls or improves
thereon, antl wno does such work himself/dersel( or Ihrough his or her own
employees, provitletl that suth ImproveinentS are no[ intentletl or offeretl for
sale. If, however, the bulltling or improvement is soltl within one year of rom-
pletion, Ne owner will have the burtlen of p�o��ng M1e/she tlitl not builtl or im-
p�ove for the purpose of sale).
❑ I, as owner of the property, am excluSivOry contracting with licensetl con-
Iractoro to construtt the projeot (Section ]044, Business antl ProtesSions Cotle:
The Contracto�'s License Law tloes nol appry to an owner of prop¢rty who
builtls or improves tnereon, antl who contra�ts tor such projects with a con-
Iractor(s) ucense pu/suant to the ConVactor'S License Law). I am aware that
proof of their Wo�ker's Compensation insu�ance shoultl be ptovitletl to me.
❑ I am Exempt untle� Section B. & P. C. to� thi5 reason
Date _
I hereby cer
iniormation �
antl state IaH
SEII{dIIV25 Of
Signature
Drrvers'
CMF 0865�/t�E
_ Owner _
I have reatl ihi
I agree lo com
to builtlin
to en
or 55 �
above
nances
repre-
ty fo�
.B 30l37 _
TVPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER A P #
3R�E$CRIPT1Q,NQ WORK/�JSE O,F.BLDG �mOV2 BX15%121 shakes
install 1,�855 l. I112a1LN1 S}13iC2S. Rr@W i�➢2���--- S MainBuilding:
TVPE OF PERMIT GRADING ❑ FOUNDATION C]I STRUCTURAI. T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 6 Rea�
❑ OTHER %�
PROJECT DESCRIPTION 5�. FT. 3 � � occuPANc�sing e C Right
CONSTRUCTIONTVPE r�S1deI1�C].SZ VALUATION$ $7 451.10 S Left
ZONE GRADINGCU.VDS. ACRES p��g.Ref.#
Remarks: Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irriqation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor SinkS
Gas Service Outlets
InterCeptoYs
Kitchen Sink
Lavatories
P—Trap
Roof D ins
Reinspection Fee � $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL Blt. ICBO #
Heating System & Duc '
❑0-100,000 BTl 100,000 BT
ReinspeMion Fee � $15
rev. 10/B4 White - Builtling; CaPary - APPlicanh Pink - Acwuntlng; GOltlenrotl - A55esm�
Showers
Service Sink
Sewer Cap
Sewer Connectio
Solar Colle rs
Solar P' ing
So r Tank
wimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service
Auto-Wash
Issue Fee
Hoad or Type I ❑
Canopy Type I I �
70-�00 BTU ❑ 100,000
>ystem Repair/Alteration
Fire Dampers
Registers '
FEES
$ 3
Issue Fee � $ 3
Automatic Washer
Construction Pole Sub.
Cookin9 Unit
Dishwasher
Dryers ❑Gas OEleci
Fan
F.A.U.
Fixtures
Device Boxes
Outieis '
Switches
Garbage Disposa
4922 9/10/87
Zone
Accessory Building:
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Generetor �5 KW �5-15 KW
Meter LJup to 100
Meter ❑over 10
Sub Panel
HP Oi'/a-8
15 HP �16-15+
Pole Li9ht
Range
Sign
Standing Sections
Trash Compactor
I Reinspection Fee �$15 ' � Issue Fee
DEVELOPMENTSERVICESREQUIHEMEN7S:
Zoning Approved By
Building Approved By
Appliwtion Issued BV
31052 ?"
EES
$ 3
SUMMARY OF FEES
BUILDING PERMIT $ 3�. �b SMIP $ � 5�+
PLAN CHECK 3 PERMIT �
PI.UMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING 5
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ 3 '�
PLAN CHECK 25� $
Z
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N
1
N
G
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Q
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CONSTRUCTION AND.PLANNING POOL & SPA
APPROVALS �Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,
2. Soil Pipe-Undrgrnd. 53. Sieel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Co�duit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 5S. Electrical Conduit-Undrgrnd.
8. Foundation ' S9. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnq. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor Syscem 67. APPROVAL TO DECK
1.t. Property Sewer Line & House Connection 62. 8ackwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T @ar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' APPROVALS Permit # -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � 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 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 pomestic-Final �
42..Backflow Prevenier
43. Backflow Irrigation -
44. Landscape Irrigation System -
45. Sound Attenuation
46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING �p � ��
48. Special Requiremenis Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,`
N0. Date
owNER ��R AAI�L OF FAME
GPNERAL CONTRACI'OR 1+�
AP No. L01'
INSPGCTIONS
Gas
coat
INC.
nnT� NOV 2 9 7962
CiUILDING P�RMIT NO.
1RACT 437o I'IRG 70NL DGSCRIPTION OY' WORK
J1 Signnture DATE GROUY I&�' TYPE' V 7.ONP•.
_4��j/ I •�� YFRM�
f�--'y�- i "✓—`1 SUI3CONTRACTOR T,�,r,�,.T
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C06iA MEBA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PRINT
BUILDING 3isy a ,O� L��f/F
ADDRE59 ��
COSTA MESA. CALIFORNIA
1 MAIL
TEL.
SIZE ! � NO. OP B1D08.o
OF LOT OOOO ' xow oN LOT
USE OF
EXISTING BLDG. � NORO
96TBACK LINB FROM 54' REAR YARD �O•
GENTER OP BTFi[ET
SIDE YARD I I.EFT 51 I RIGHT 5�
DESCRIPTION OF WORK
ILOING , _ _ _ NO. OF
FEE MR����VED
Lot 8, Tract 4356�1a�i'� -B
FINANCE DEPT.
APPLICATION F��ERfvII�TA MESA
BUILDING
For Offlce Use Only
PECHIPT NO. . ReRMJ,j�O.
BY
DATB IBBUHD
COSTA MESA. CALIFORNIA
ZONING
ZON NO.OP UBE OP N8W F y ��n i
�—� IPLANB � BUILDINO�,yIqYJ 9RY.
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A. P. NO.
YARDS EVES
APPROVED ALLOWED
(C6NT[R LIMC 9T.)
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I HEfl6BY ACKNOWLEDOE THAT I HAVE RlAD iH18 APPLIGTION THE AMOUM 9HOW UNDHf
ANO BTATE THAT THE A V8 �8 CORRECT AND AGREB TO COM- pUpp09E OP E9TA9L19HINC
PLY WITH ALL CITY OR 1 ANCEB D TE LA P80l1LATINO
em�o�Ha coxs , u j x.1 � VALUATION
9IGNATUBE O / PERM
PERMI7TE V�' $ /��/��
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AUTHORIZED AGENT
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VALUATION IB pOR THe
A PERMIT PEE ONLY.
' FEE $ � �'—�
:HECK $ o� � � .�J�