HomeMy WebLinkAbout1788 CAPETOWN CIR - Building Permits CITY OF COSTA MESA 1/2
r� BUILDING DIVISION
F°• .., .. l� 77 FAIR DRIVE.COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
A. FOR INSPECTIONS CALL: (714)754-5626
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PERMIT NUMBER: M08-00148
PERMIT TYPE MECH STATUS: ISSUED
APN: 42452129 DATE ISSUED: 12/03/2008
ISSUED BY: YH
JOB ADDRESS: 1788 CAPETOWN CIR CM Suite/Unit:
Vicinity:
SO. FT: 0
SCOPE OF WORK: REPLACE 115 BTU FURNACE IN GARAGE.
OWNER: KIM,CHRISTIAN 8 JI S Address: 1788 CAPETOWN CIR Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: COBURN, GARY Address: 1958 PLACENTIA Unit:SUITE F
PHONE: 949-642-7444 City/State/zZip: COSTA MESA,CA
CONTRACTOR: COOL SOLUTION INC License No. 699258 •
Address: 1958 PLACENTIAUnit: SUITE F PHONE: 949-642-7444
City/State: COSTA MESA,CA ZipCode: CELL:
MECHANICAL PERMIT FEE SUMMARY +410,
MECH ITEM FEE: $41.70
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $41.70 db.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE A INSPEMUM pig it CODE INSPECTION TYPE r� PAIL
1616 Fixed System Final Fire Prevention 206 Final Mechanical \a -Qt]
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
i l .
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driv;cense. 0 Yes 0 No s
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit Is Issued. .
❑ , I nave and will maintain workers'compensation insurance, as required by
section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: •
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
t fG
number are;, ter- person is required to descend,will be made in connection with work authorized
Cartier:
^ -1Y�r/r14) by this permit,and that no building structure,scaffolding,falsework,or demolition
(r Aor dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp
(This section need ps¢be mn ppte nep w�a al one nu.�med dalars(Sree)akssl 2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number: U(�,"/\'/t a `'],f`e2_
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the •rkers' compensation provisions of Section 3700 of Appnwm's Signature Date
the La'fr Code,I shall f: h,'th comply with these pr v'si
Division of Industrial Safety Permit Number:
Ap .nls Sig 1 1 ilc Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORK RS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my licensel,s lin/ II�ce ands.-ct. ^A a registration form for acutely hazardous materials? ❑Yes 0 No
Lic.# V` AS P Class# �- sr (Section 25533 of the California Health and Safety Code, with some
W
AT exceptions, requires registration with the Costa Mesa Fire Department by
11 1 r#11111 each business which at any one time has on hand a quantity of acutely
III 'J.'1.ctor's Sig _ur bate 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
CONSTRU ION L •ING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature • Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes',the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property,or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044.Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
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 8. (If'yes",attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty'of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws.and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH -
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date -
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION 'OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described properly for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this p- mit until final inspection.
Signature of L_s. Owner(s)
Signature Date is. \ " � pvte, al�
305746(3/07) ` , '
And/or•uthorized Ap:i3 /VI• Date o
PROJECT ADDRESS: 1788 CAPETOWN CIR UNIT' 70 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: G 05118C
OWNER'S NAME: KAUFMANN & BROAD
ADDREss: 180 N. RIVERVIEW DR PERMIT -NO: G 051180 PLAN CHECK NO: 00717 91 A GOVT: N SUPP: N
SUITE 300
ANAHEIM, CA 92808 CONSTRUCTION TYPE: V N PERMIT TYPE: ELE MEC PLU STR PURPOSE: NEW
921-0500
(-4 ARCH/ENGINEER: MIKE WOODLEY REG.NO.: C15730 JOB DESCRIPTION : SFD AND GAR SQ FT: 2, 910
ADDRESS: 180 N. RIVERVIEW DR UNIT: 300
PERMITTEE•
KNAHEIM MN & BROAD CA 928019 ) 921 0500 CLAIM VALUE: 169, 417. 00 CALC-VALUE: 172, 657 . 70 GROUP OCC: R-3 /M-1 `
'I ADDRESS: 180 N. RIVERVIEW DR 300 COMMENTS: REF PLN-CK 234-89 A
ANAHEIM - CA 92808 +e***>E** •*RF*Fr********+F******F6*****************+ +r****+r•*******x****+E******x*+r*****
LICENSED CONTRACTOR DECLARATION: I • - •a irm that I am lice -•under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Po •ssions Code.and my license n in fun force, effect. / / SETBACKS
CITYLIC.: 0I4�6q894 STATE LIC.: 3 • • • C •.5: B-1 .
Date: ? / Signature: l ZL1.L �1.. MAIN BUILDING ACCESSORY BUILDING
NORKERS'COMPENSATION DECLARATION: I hereby affirm that I h./certificate of consent to self-insure or a certificate of Workers' FRNT: 15 FT IN REAR: 13 FT IN FRNT: FT IN REAR : FT IN
Compensation Insurance,or a certified copy thereof(Section 3800 b.Cl. LEFT: 6 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 4189-1090 EXP. DATE: O3/O7/91HIQP1�C1/S1. QF.(���
1 COMPANY: TRANS, INS , PARKING REQ: 2 PROV: 2 PARCEL: 429!L11 t: �T(� �• r PA-88-40
7 Certified copy is hereby furnished. Ci Certified ..• is filed with the cit. Building islon. PLANNING NOTES> NEW SINGLE FAMILY RESIDENCE WITH ATTACHED TWO CAR GARAGE.
,L"y > HALF OPEN PARKING SPACE PER UNIT PROVIDED ON SITE,
Date. 3� I-7` Applicant: /_/ IE
'�' _ L� **************************************************** **************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section nevi not be completed if the permit is for one hundred($100)or less). D E V E L O P M E N T -SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issue shall not employ any person in any manner so as to become
sublet(to the Workers'Compensation Laws of California. ZONING APPROVED BY )1- L_ i '--! ;.-'
DATE: ( ZZ-7'1
Date: Signature:
NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY et'. 1-LiI L L7 6A-r---) ' DATE: "/\'
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: . -� DATE•
which this permit is issued(Section 3097.Civ.C). ***************************** .LLS:r.et4r.., ,=a+- f *********************.*.
LENDER: ********************************** - .****** ' **********************************
ADDRESS: LEGALIZATION:N FEE S U M ' A R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC ECHANIC FIRE SM I P/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 895 . 00 41 50 8 2 ,9 9 28. 25 12 , 09
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5 Z ��$ 2 5 SM I P/NON-RES
Ind Professions Code)or that he/she is exempt Therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 145 . 44 �r
ny appticant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 .00 15s,00 1 5 . 00
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLA --CHECK 'TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 1059 . 83 33 . 00 "14 5 , 4 4 12 3 8 . 27 1238 . 27 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 1238. 27 OVER/SHORT: . 00
improvement is sold within one year of completionthe owner will have the burden of proving he/she did not build or improve,for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 895 . 00 44 , 50 97 . 99 9.3 . 2 5 12 . 09 145 . 44
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware ************************X************JS*****************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL ..1.4.FEE BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N. UNIT COST TOTAL COST
Date: OwnerSFR 2371 DWE-TYPE V-WOOD FRAME -GOOD 69 . 00 163, 599 . 00
I do hereby certify that I am aware of and understand the requirements o1 California Health and Safety Code Sections 25505.25533,and SFR 76 RES-BALCONY, EXTERIOR STAIRWAY 13 . 80 1048 . 80
25534 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requirements for a SFR 463 RES-GARAGES TYPE V 17 . 30 8, 0 0 9 , 9 0
thesetfor provisionsuction or modification from the Air Quality Management District.Residential construction applications are exempt from ELE 2 371 NEW RES BLDG FOR 1 OR 2 UNITS/ SQ FT . 03 82 . 99
MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
Date: A•-_------- MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 .00 9 . 00
I hereby certify that I have read this application: d stale that the above i •rmation is correct.I agree to comply with all city and county MEC 1 GAS PIPING SYS 1 - 4 OUTLETS 3 . 00 3 . 00
ordinances and state laws relating to building constr 'in and herebyauthoriz' epresentativf /.if this cit toer r)upon he abut/Am-•ioned NEC 1 GAS PIPING SYS 5+ OUTLETS PER OUTLET . 75 . 75
property for inspection purposes. NEC 1 FACTORY FIREPLACE 6 . 50 6 . 50
Date: 3` /�7f/ Signature: ./�jLl- ' " eri al PLU 2 BATHTUB Cl 03021/004:261/165i T a, 4 .PLU 1 DISHWASHER DDATE: 2.'00'9'_ TIC` o=:= 200
Drivers License or Social Security
1641-46 White-Building:Green-Code Enlacement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
CQNSTMCTION AND PLANNING -POO_ _ SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1;Temporary Electrical Service-or Pole 52. Pool & Equipment Location i
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3.:Electrical Conduit-Utility-Undrgrnd. 54. Forms
..4. Electrical ConduitUndrgrnd. 55. Electrical Bonding
5. St_eet lieinfor`cementi 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings " - 58. Electrical Conduit-Undrgrnd.
8, ,Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final
12. Sewer Capa• 63. Heater & Vent-Final
13. Roof Drains _ 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
-17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
_>.1
20.1Rough Factory Fireplace i.•' _ _ • - ' _APPROVALS •. Permit#
21.'Ducts,in Structure; ' . .. - _ : .r 70. Underground:Hydro ,
22. Ducts, Ventilating : - '''.4 71. Product`Piping 0 Gas 0Oil
23.,Gas PipeERough & Test r ` , 72. Underground Flush,
24. Roof Framing. - - F `73.r Undergrnd.Storage Tank 0 Gas 0 Oil t -
25. Root Sheathing 6 f- ,h1 Cv'i% • 74. Overhead Hydro:
26. T-Bar Ceiling (Structural) & Monocoat .. .1 , 75i-try Chemical
27. Frame and Flashin .•?, - ' r "�' J 'i -•:;: .•I:
'
. 9G q,/ (/� 76. Dry StandPlPe
_
28. Lathing& Siding - , - . la- ••c/G ,-77FIXED SYSTEM.F ,INAU - > I' ' " "
29. Insulation 10i /� �ej 78. FIRE PREV. FINAL _" s - - „
`
'"30. Drywall Nailing Glit C(4. , HEALTH DEPT: REQUIREMENT_' .Ci
31. Plaster Brown Coat' - r . `/z-sr (o Lt J, ; ,79: FINAL INSPECTION; , - - f, , 4
32. Electrical Power Meter-Final - ft
,t/y�� ,80.,_FOOD CERTIFICATE ISSUED ^}� ��ii -, lC''
33. Final Electric Notes; - -
'34. Final Heating:& Air Conditioning, , 71,6141) Cia; new sputa' r�rQ� 3 3
-35.'Final Gas Pipe' Test: . ,- 1 . 7/Z/n is ' i9_4,� - " - +M-'R' '
j
.36. Hood or CanoPY - - •. . : • t
37. Fin& Factory Fireplace , e-6a SD G ��i
38. Final Plumbing ,• 9 _ V�-(. LSD i, _ - .. • ,
•
39. Water Service-Final' p+'' _ 8"�Q! C-Co :r - " ' , .
;40. Gas Service-Final ' °` . '"
41. Solar Domestic-Final -
,
42. Backflow Preventer' :4i - - . - -
43. Backflow Irrigation - - '
,44. Landscape Irrigation System. , - Iii.,, _ _
-45._Sound Attenuation V: . •
46. Handicap Regulations -
J. "
•
47. FINAL STRUCTURE & BUILDING, /w <
48: FItNG +cit-:.y C.'.:C r_ZZty 'l= - ;
49.:Electric Release to Edison / " _
50..Gas Release to Southern California Gas Co , - - . _ ° . .
51. CERTIFICATE OF.OCCUPANCY - , ._ � _ •
No. Date
PROJECT ADDRESS: UNIT:
OWNER'S NAME:
ADDRESS: PERMIT NO: G 051180 PLAN CHECK NO: 00717-91 A PAGE: 2
******+r*******)******+ ***************+E*****************SELF+F***y7**r.***************
ARCH/ENGINEER: REG.ND.: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
ADDRESS: UNIT:
PLU I LAUNDRY TUB OR WASHER 2 , 00 2 . 00
PERMITTEE: PLU 2 SHOWER 2 . 00 4 . 00
T ADDRESS: PLU 1 SINK, KITCHEN 2 . 00 2 , 00
PLU 4 WASH BASIN 2, 00 8 . 00
LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section PLU 3 WATER CLOSET (TOILET) 2 . 00 6 . 00
7IXI0)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. PLU 1 WATER HEATER AND/OR VENT 2 . 00 2. 00
CITYLIC.: STATE LIC.: CLASS: PLU 1 WATER SERVICE 2 . 00 2 . 00
Date: Signature: PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2 . 00 2. 00
YORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' PLU 1 GAS PIPING SYS 5+ OUTL-PER OUTLET 50 . 50
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.Cl. PLU 1 GAS SERVICE 2 . 00 2 . 00
POLICY NO.: • EXP.DATE: PLU 1 SEWER, BUILDING / TRAILER 5 . 00 5. 00
COMPANY: END OF FEES
TI Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division.
Date: Applicant:
EXEMPTION FROM WORKERS'COMPENSATION OECLARATIDN: (This section need not be completed if the permit is for one hundred MOM 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.
Date: Signature:
NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked.
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(Section 3097,Civ.C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: 1 hereby affirm that 1 am exempt from the Contractors'State License Law for the following reason
(Section 7031,5 Business and Professional Code: Any city of 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/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
ny 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(Section 7044,Business and Professional Code: The Contractors'State License Law '
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/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 will have the burden of proving he/she did not build or improve
for the purpose of sale).
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I urn exempt under Section: B.8 P.C.
for this reason:
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a T�GG
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from DUPE 7 A W E REECF-"F- F f:•-.-A. —
these provisions. 01 f n€' ( : A.ain TM-r
Date: Applicant. DATE: 031U1/91 TIli : 19:19
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes.
Date- Signature:
Driver's License or Social Security a:
1641-46 White—Building;Green—Code EntorcemonL Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTIONAND PLANNING .TOOL ,PA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UPER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System • Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace_ . _ APPROVALS Permit #
21. Ducts, in'Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 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 Ceding (Structural). & Monocoat ' 75. Dry Chemical
27. 'Frame add Fla'sFtirfg.:.� r ,rJ :c T- 76. Dry Standpipe
28. Lathing & Siding u' • 77. FIXED SYSTEM FINAL
29. Insulation - �' 78. FIRE PREV. FINAL
30. Drywall Nailing i ;e r *- . HEALTH DEPT. REQUIREMENT
31. Plaster Biowa'Coat ' - 79. FINAL INSPECTION
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED
33. Final Electri49 Notes:
34. Find( Heatingr& 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 7 •
44. Landscape Irrigation Sys`tein ; -
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
I PTA
IWA ENGINEERS •
17390 Brookhurst Sfreet,Suite 100
Fountain Valley,California 92708
(714)968-1221 •FAX(714)968-9286
July 26, 1991 J.N. 207-05
City of Costa Mesa
Building Department
77 Fair Drive
Costa Mesa, CA 92628
Attention: Mr. Victor Clift
Subject : Fine Grade Certificate
Dear Mr. Clift:
I hereby certify that the fine grading for Lot 70 of Tract 13224
were graded as shown on the precise grading plans for said project .
'a//1 2,WA egeti
Llewellyn !b Incledon, R.C .E. 17593