HomeMy WebLinkAbout2006 CAPELLA CT - Building Permits J it ,
CITY OF COSTA MESA
IIIkr BUILDING DIVISION
Fx ''a 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
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FOR INSPECTIONS CALL: (714)754-5626
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PERMIT NUMBER: E09-00230
PERMIT TYPE ELEC STATUS: ISSUED
APN: 13940210 DATE ISSUED: 08/31/2009
ISSUED BY: BJK
JOB ADDRESS: 2006 N CAPELLA CT CM Suite/Unit:
Vicinity: REAR SFD
SCOPE OF WORK: ELECTRICAL PERMIT FOR 220V CIRCUIT TO SPA&CIRCUIT FOR A FAN.2 CIRCUITS, 1 CEILING FAN,2 OUTLETS
(INTERIOR SFD&GARAGE)
OWNER: WILLIAMS, DAVID Address: 2006 N CAPELLA COURT Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: WILLIAMS, DAVID Address: 2006 N CAPELLA COURT Unit:
PHONE: 310-350-1848 City/State/zZip: COSTA MESA,CA
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: Unit: PHONE:
City/State: ZipCode: CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $36.30
Reinspection Fee $0.00
TOTAL FEES $36.30
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.
CODER. INSPECTION TYPE DATE INTITIALS CODED INSPECTION TYPE DATE INIITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical LZ/2 3 '(A -( •`�'
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
•
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver License No.
Expires: 77.13
❑ 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 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,cc demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed dlhe permit is valued at one hundred dollars(SI 00)or less)
2.Art 2Sec.341,Title 8,California Administrative Code).
Policy Number:
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 workers'compensation provisions of Section 3700 of
Applicant's Signature Dale
the Labor Code,I shall forthwith comply with these provisions.
Division of Industrial Safety Permit Number:
Applicant's Signature Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS' 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? 0 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 license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (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
Contractor's signature Date 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
CONSTRUCTION LENDING 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 ElNo
(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 furnished 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 0 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? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
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.
-� LICE D 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 contractors)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 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 property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized b . is permit until final inspection. /.�J
Alr ` �j 3��j r 5 � ignature of Legal Owner(s) - Date
.Signature I Date' ‘---)id
305746
a05]<6(]IW) And/or Authorized Applicant Date
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City of Costa *Iesa cBui&ding Division
,1
Costa Mesa 77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit# f� () '-"-Or-g---30
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at 2Z00C KJ, CjP-EGC.A «; c--775"771 fl`raZ) 72-6
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
LOCI-understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
..e/l/nd
. I understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�,3(1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
or her name instead of my own.
- 4. I understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
aunderstand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
Are dential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
9.. I understand I may obtain more information regarding my obligations as an "employer" from the Internal
J
Revenue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
......../
I am the party legally and financially responsible for proposed construction activity at the following address:
--� 1 . I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
'--'I2by. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to verify the property owner's signature.
7
Signature of property owner _ f/
Date: / 7 7
•
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s)to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature: Date:
3148-30 CALBO Jan 1,2009 OB Packet template 2 of 2
CITY OF COSTA MESA
en Jut BUILDING DIVISION
F ! .�1 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714)754-5626
fi
PERMIT NUMBER: E09-00203
PERMIT TYPE ELEC STATUS: ISSUED
APN: 13940210 DATE ISSUED: 08/05/2009
ISSUED BY: KJB
•
JOB ADDRESS: 2006 N CAPELLA CT CM .Suite/Unit:
Vicinity:
SCOPE OF WORK: SERVICE UPGRADE TO 200 AMP/NO RELOCATION OF SERVICE.
OWNER: CRUTCHLEY, KENNETH L TR Address: 2006 N CAPELLA COURT Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: TAYLOR,THOMAS Address: 8211 TERRY DR Unit:
PHONE: 714-842-9700 City/State/zZip: HUNTINGTON BEACH,CA
TO9-00.203
CONTRACTOR: WILSON ELECTRIC License No. 693150
Address: 8211 TERRY DRUnit: PHONE: 714-842-9700 • •.• •
City/State: HUNTINGTON BEACH,CA ZipCode: 92649 • -•
CELL: . - - - _
.tom
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE#. INSPECTION TYPE DATE INTITIALS CODEX INSPECTION TYPE DATE INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing __`_'--' —
200 Final Re-Roof 210 Final Electrical Ia4J. 14
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
• n•5
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑No
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 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 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
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure.scaffdding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This section need not be completed if the permit is valued at one hundred dollars($100)or less)
2,Ant Sec.341,Title 8,California Administrative Code).
Policy Number:
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 sub'ect to the workers'compensation provisions of Section 3700 of Applicant's Signature Dale
the Labor e,I all forthwit comply with these provisions.
•
0„7/0511,411 Division of Industrial Safety Permit Number:
nppltens Signature HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'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 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
taiy_C!s$�" - — a -ass Y (Section 25533 of the California Health and Safety Code, with some
OY(Of p exceptions, requires registration with the Costa Mesa Fire Department by
! each business which at any one time has on hand a quantity of acutely
j 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
CONSTRUCTION LENDING 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)? 0 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 Dale
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 ❑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 ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment 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 8 (I/"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
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
0 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
a contractor(s)license pursuant to the Contractors License Laws.). CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
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 property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
atu of Legal Owner( Date
Signature Date � � BI/or(0
7
3067-6613/07) Andlor urtioriTh Applicant t:l nate:,
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
F COSTA MESA CONSTRUCTION♦ IPERMIT PEFST NO.� TRACT NO. LOT NO. UNIT NO. •
1 ct Address 1 DO Nr Cet click ` DI3C1
•
K�FU• �' caw d 3 4{� Mil e TYPE OF CONSTRUCTION ❑ NEW ❑ ADD LI ALTERATION LI REPAIR r 4905 9/10/87 27-qn TL
pp icant's Mailing Address (/`
Owner's Name �C rix cI.1'Ty IeFY� Phone$ Q'-Stsb ❑ CONVERSION ❑ DEMOLISH El OTHER re- ! p F. q,p.# - Zone
�Ae9(o /V. ry�pp/)a 60STLt fc DESCRIPTION OF WORK/USE OF BLDG. �/'91�Pn*
Address n6 S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front O
Address ❑ TENANT ❑ ELECTRIC.AL El PLUMBING El MECHANICAL B Rear N
,y, $e El OTHER Y'00 Ft♦1 A I
Contractor's Nam• / ✓ Ph e .7 J C Right N
Address(mailing) cid/OPA11 P al ? / 2u eat e cab F PROJECT DESCRIPTION SQ. FT. 2100 OCCUPANCY Ree K G
u q CONSTRUCTION TYPE VALUATION$ rji $O 'V $ Left
City License No. -r SOD
`
ZONE GRADING CU.YDS. ACRES y- E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in full force and effect.
License Class •
Ice se N4.Z/9/7-2 s
Date - Signature 7 7I . -x 4261 PLUMBING I FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section _., ____
3800, Lab. C.) Backflow Preventer Service Sink
Automatic Washer Transformer 0 15-50 KW
)icy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub.
0 50+ KW
Certified copy is hereby furnished.
. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
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 be ome suyject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 011A-8
Workers' oripe%9lon Laws of Californipl _
Date �-10"-"D 1 Signature rllOxa� �0�;aiFloor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09.15 HP 016-15+
NOTICE: If,after making this declaratlo you should become subject to the —
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name -
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION -
I hereby affirm that) am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires:a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor
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 Roof Drains
the Contractor's 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 any applicant for a permit subjects the applicant to a civil
pelnalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
npensation, will do the work, and the structure is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3
.' sate (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By Date
sale. If, however, the building or improvement is sold within one year of con- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date �i f�
prove for the purpose of sale). - (� y�H//F J
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By_ Date / /Ti V
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARYds FEES
builds or improves thereon, and who contracts for such projects with a con- a�1
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ 7, SMIP $ t so
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
❑ I am exempt under Section ((�1 B.8. P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ _ ISSUANCE $
Date �-=tom._ Owner gV344et Ee jSw4t4i3� Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this cit to enter upon the above-mentioned property for r7 e
inspection purposes. I 9_/07 MECHANICAL $ TOTAL FEE $ -R / ^-�O
Signature
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting;Goldenrod =Assessor
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS t Permit# Date Inspector APPROVALS Permit# Date Inspector
1,"-Temporary Electricaliervice 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings r' 58. Electrical Conduit-Undrgrnd.
8. Foundation • 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undigrnd! ; 60. Backwash Lines, P-Trap, G Undrgrnd.
10. Structural Floor Syster " 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 I 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.
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 0 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 l' _
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED f
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 •
I •
42. Backflow Preventer
•43. Backflow Irrigation I -
44. Landscape Irrigation System
45. Sound Attenuation •
.
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 1/c/ `6 "79-
48. Special Requirements Completed !!!! •
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date _ i
•
16548 FE^ RECEIVE®
:,1.,., . t&Eta
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA, CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
BUILDING .Z_07‘"S-6' Tr nr43¢9 BUILDING
ADDRESS ZOG E 46.7:4 Calf//a CeLerT
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. I l6h48
OWNER P�ES� TTE v GVE57
AMAIL 4 DDRESS /49:9 n/u✓Orn/9 4€. RECEIVI♦D BY I R[CfWW2 I DATE ISSUED 1C
/. fir/ • �/ p p �_ �,� !L1 htAR E2
CITY /(§TFI /-/e=,5(� / C /IL/r NEON)•/Cl/S�
ADDRESS
ARCHITECTTEL COSTA MESA. CALIFORNIA
OR ENGINEER ket 42.7-b N/3leliq NO.Atpey33
ADDRESS %7/ z �/;TELL,vto /11
/ 4140/,--,,,, FIRE _ Q� r
/ / ZONE TYPE GROUP V%J
CONTRACTOR 14/1"00.5L4ND C G. APPROVEDBY DATE
ADDRESS //v S- MA/nenq Ae.-. ZONING aa�
// ^ ACJ // ZONE NO.OF % USE OF NEW$f q,,/`V.
CITY LIZ9 TK PISS- , I///� Rte/ I PLANS L I
BUILDING W/�- A�
STATE /B7/ / / TNO. •'2 9o39s LEGAL 1-0-71-ON r9 /^ y3 t/ 9J
LIC.NO. !� Co /L/
SIZEp NO. OF BLD ./
OF LOT J G X 0 NOW ON LOTA/e.✓
7 e E A.P.NO. _____
USE OF YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM '.� (CENTER LINE ST.) /
4 —
CENTER OF STREET // REAR YARD G FRONT `7 ( FT. IN.
SIDE YARD I LEFT (G I RIGHT -r R.SIDE •-•$--- FT. IN.
DESCRIPTION OF WORK L.SIDE (O/ FT. N.
NEW 'Xi ALTERATION I II ADDITION I REAR Z il FT. IN. •
REPAIR I II MOVING I II DEMOLISH I APPROVED L /I ��� DATE a//6/11-
4-'BUILDING //j3 i{ ROOOMS 6 STORIES / ''/
SIZE 7 �/ /�
EXTERIOR WALL 4:00/ ROOF A.1000 /f� •
COVERING .SY//OC4O COVERING /y ✓y SN.�.t'Es �1��/
USE OF BUILDINQ AND WORK TO BE PERFORMED , n
,N6La _pwitt Y /PE3/Oetha / q r�
44/I =Ls—ass:T-- N _ /
-Iirncyb� 3 ./
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION (
SI TURF OF / PERMIT FEE $ geS) --
P M F 1/ 'V.q��\ $/�/ / }</ PLAN CHECK $ [/7, �J /�)
/A ORIZEO AGENT/I ^���!%�t/�7�--""�'� JVJ(J TOTAL FEE $�J� (�V 0