HomeMy WebLinkAbout2017 CAPELLA CT - Building Permits 04` 1 Mt CITY OF COSTA MESA
4 BUILDING DIVISION
:J„' ..t DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
F t4 �%a t PERMIT
4 06-00286
itok m#
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2017 N CAPELLA CT Status: ISSUED
Suite: Applied: 02/21/2006
Vicinity: ROOF Issued: 02/21/2006
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 13940106 Zoning: R1
Applicant: ROBERT WHITNEY
Address: PO BOX 15396 IMO
4 A i✓1
Phone: 949-548-0769 ISSUED BY: I V\' /1
NEWPORT BEACH,CA Zip: 92659
Owner CROWELL, JOANNE M
Address 2017 N CAPELLA CT
Phone:
COSTA MESA,CA Zip: 92626
Contractor WHITNEY ROOFING
Address: PO BOX 15396
Phone: 949-548-0769
NEWPORT BEACH,CA
Zip: 92659 License: 406022
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF(E)WOOD SHAKE MATERIALS, INSTALL 1 LAYER OF 15#FELT AND REROOF WITH 30 YEAR COMP SHINGLES ON ATTACHED
HOUSE AND GARAGE,APPDX 24 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,900.00
Permit: $139.25 Claim Valuation: $6,900.00
SMIP Res: $0.69
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $139.94
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 . Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation:as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O-^-'1'have.anil will maintain workers'compensation insurance,as require.by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
1/My workers'com•=nation Ins anc'carrier and policy number are
-Carrier,..../
Carrier f „r EPd@y Number:. c2-yS_ i%
,(this section need not•e completed if the permit is value• one hundr d dollars($100)or Iese)
O I certify that in the performance of the work ch this permi issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califomia,and a. - ' I shoul. •e •me subject to the workers'compensation provisions of Section 37 01 th Labor Code,I shall forthwith
comply with these provisions.
ApplicantSignature: =- /6-/ Date:` --D < 'fiy OG
WARNING FAILURE TO SECURE WORKERS'•s'-E ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE ES At CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($lo ,ocO),IN ADDITI••T•-THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR DE,I EREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under •Jeons of hater 9(commencing with Section 7000)of Division 3 of the Business and P fes '.ns •de,and my license is in full
forceend'effecrtic.-R--, • ',, i 0661 2' LClass' mage
fCPntractor's Si—gnat— ure:v friar Cite. ani
r-.--— r / L—__
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.(Se .3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document.i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation live(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Tltle 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions. that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallon,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been Cully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes 0 No
(Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits).
6 Wilt any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AN' ' •r •RIZATION OF E. -Y:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with al ws and city ordina es relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for'. .. purposes.I agree .t to occupy or allow occupancy of any building authorized by this permit until final inspection.
d 441/11
/. %✓ eget O errs) 6,7t/Dat
Yo
nit"-ro red Applicant Date T
yppLL INSPECRONTYt* ME INTRIAL5 CODE* INSPEC1108.TYPE PATE nil
1616 Fixed System Final Fire Prevention 206 Final Mechanical _
1266 Pool Spa Finalq 6/p,(//'� 208 Final Plumbing
200 Final Re-Roof 2-z 7 a- ' `� 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
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
!� / /) Permit No. £f) 1 — (O
Property Address 4f 0/1 00( 4 ( QIC{l/€ "0a, r
Owner J O Au ./-• (.040..0 II
Contractor 11/7141 !2-2/0
State Contractor License Number y CGO L Classification ff 3 9
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 15, and Appendix 15 of the latest adopted edition of the Uniform
Building Code, and the installation instructions of the manufacturer.
❑ yfurther certify that I am the owner of the property. (Owner-Builder permittee only).
I further certify that I am:
ILK--Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this
certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
/Se Z
Company or orporaie Name
7n5
Addre
Received by Building Division /her-- net/ /V 0 LJ /
By: 49/4(4
Si. ature Det
, 0f� ,c
Init' Date Printed or Typed Name
0990-46 MW 6A0 White Building Div.:Canary-Contractor:Pink-Owner
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA M A CONST UCTION PERMIT I PERMIT NO. TRACT NO. LOT NO. UNIT NO. A P #', Zone /
Project Address 0//�7,, S. ea,oe LLA 83$G 75 i�( S Main Building: Accessory Building:
Applicant's Mailing AddressaW0 N 94C r/y2}•a 4/TO 0tA^ki_L: TYPE OF CONSTRUCTION LI NEW ❑ ADD LI ALTERATION IF\REPAIR E Front Z
Owner's Name 1.1>Y't•9hT ❑ CONVERSION ❑ DEMOLISH ❑ OTHER_ T
O
ar N
ap�0/7 S_—��4 Phone Lj,�j'OI'TIO�OF yryJR15jU�SC F BU J D Dom• ,`I C RI ht N
GL9 /t ,C /cC ?'t' r. .
1_ n - - TYPE OF PERMIT . GRADING . FOUNDATION I• STRUCTURAL 9
. . /Eng. License No. K G
Address �n /� �y� 0 TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left
B 4 J eOOF,A/ey CO.eb3 ,�rp01 ❑ OTHER I 2.3 Ping, Ref.# Parking Req./ProvidediRE
Coillactor's Name Phon _ I Ala-
utq CUP _ _ _Address Imailing0O4O .Q. S4Cr44'a aro O res C 04, PROJECT DESCRIPTION SqFT. 700 d d$ 6LCUPANCYmr G^ Planning Notes:p �s CONSTRUCTION TYPE ��) VALUATION$,S�City License No. 3 p Ion I I
ZONE GRADING CU.YDS. ACRESI
LICENSED CONTRACTOR DECLARATION TL Jr
�
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks�SIKh �P 1 / �-I-� l'; ui ;y { 1l
with section 7000) of Division 3 of the Business and Professions Code,and
ELECTRICAL FEES
my license is in try fors ...d effect. I etdS ut ft / 1n • 1
Licen a Class ` O 'can - o. IS'S mss' l Sec. �7—�0
•
Date3 6 -a? signatu�-�'•�•�/ '- _ PLUMBING FEES
Automatic Washer Transformer 0 15-50 KW
WORKERS'COMPENSATION DELL• RATIO , e Bar Sink Showers Construction POIe Sub. 0 50+ KW
I hereby affirm that I have a certificate of cons nt to self-insure ora certificate '
of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter Dup to 100 amps
3800, Lab. C.) Dishwasher Meter Dover 100 amps
H
Policy No. Company Backflow Irrigation Sewer Cap
Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
"'Le Applicant Fan Motors O0-1 1X-8
!MPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors ,
s section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.U. Inc.Sol 9-15 HP 016-15+
I certify that in the performance of the work for which th er s issued, I Fixtures •
shall not employ any person any manner so bE o ile ub ct to the Drinking Fountains Solar Tank owave
Worker o ansa t oGG��a ws off C \am tlY
Date a Signat ur Floor Drains S ming Pool w/Spa Boxes Pole Light
NOTICE: If,after making this declaration, you sho become s bject to th0 Devices Range
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTIONLENDING AGENCY Gas Service Outlets Water Closet Switches Sign
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.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service - _Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I 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
county which requires a permit to construct,alter,improve,demolish Or repair P-Trap Laundry Trays
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 Reinspection Fee $15 Issue Fee $ 3
therefrom and the basis for the alleged exemption. Any violation of Section
-
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500). $ 3 l DEVELOPMENT SERVICES REQUIREMENTS:
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee Il
compensation, will do the work,and the structure is not Intended or offered Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date
License Law does not apply to an owner of a property who builds or Improves �p
=reon, and who does such work himself/herself or through his or her own Hood or Type 0 Application Issued By -_ _ • Data i ;I� -7
foloyecs, provided that such improvements are not Intended or offered for Boiler
.d. If, however, the building or Improvement is sold within one year of com- — Canopy pe II 0 SUMMARY OF FEE
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground
Prove for the purpose of sale). BUILDING PERMIT $ 72-DU SMTP $ t .Sa
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refr' ration System PLAN CHECK $ PERMIT
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 0-100,000 BTU 0100,000 BTU • PLUMBING $ ISSUANCE $
builds or improves thereon. and who contracts for such orolects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that y ❑ Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
Exhaust System
proof oftheir Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
IDI am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG db Fire Dampers PLAN CHECK 50% $ MICROFILM $
Date owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $
I hereby certify that I have read this application and state that the above ❑o-100,000 BTU 0100,000 BTL
information is correct. I agree to comply with all city and county ordinances - PLAN CHECK 25% $
and state laws relating to build' g construction, and hereby authorize repre-
sentatives of this cit o e er up the above-mentioned property for
inspection our
' -
�r..3i,
0865.46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
•
CONST�ION AND PLANNING POOL &SPA
APPROV -3ermit# 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 Utilify-Undrgrndr 54. Forms
4.-Electrical Conduit-Undrgrnd. i> 55. Electrical Bonding '
5. Steel-Reinforcer-gent ' 56. Rough Plumbing & Pressure Test '
6. Electrical UFEA Grind. 57. APPROVAL TO COVER-GUNITE '''
7.:Footings i 5 58. Electrical Conduit-Undrgrnd.
8. Foundation " , 59. Gas Pipe, O Undrgrnd., Test 1•S
9r'Water Pipe-Undr1 grnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 0'
-
10. Structural Floor System r 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap S i; 63. Heater& Vent-Final
13. Roof Drains 64. Plumbing System - Final ai
14. Rough Plumbing r 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 -re APPROVALS Permit#
r
21. Ducts, in Structure L: ,e', 70. Underground Hydro
22. Ducts, Ventilating 'r , 71. Product Piping 0 Gas 0 Oil
23. Gas Pipf-Rough & Test -1.4.-0 72. Underground Flush '
24. Roof Framing ' 73. Undergrnd.Storage Tank OGas ❑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 # - " 1i 78. FIRE PREV. FINAL
30. Drywall Nailing 11�}J. HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coatj. .: ' 79. FINAL INSPECTION }}II I32. Electrical Power Meter-Fina.. - 80. FOOD CERTIFICATE ISSUED
33. Final:Electric Notes:3 MO(e-5 p 'r- oft 060
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final •
42. Backflow Preventer }
43. Backflow Irrigation '
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 960
7 .
48. Special Requirements Completed
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co _
51. CERTIFICATE OF OCCUPANCY
No. Date
• 1400F COVERING CE IFICATION
• •
Permit No. D -567 c
Property address
' g20/7 S C09/4e C(4
Owner 4i rr 1-94 rContractor l) 4 S POo (2 ` '`/`J C0'
•
State Contractor License Number ?Gag Sc Classification Let 3 7
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the 1979.Uniform Building Code, as
amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
❑ I further certify that I am the owner of the property. (Owner-Builder permittee only).
❑ I further certify that I am:
I ' Owner of sole proprietorship company
❑ Full partner of the company
Li Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to
make this certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the
Building Division for acceptance.
t:��
j 1 1 l^+O•
Company or Corporate Name
cc"Ca 11'1 Syc rA- Pei e.dTl
Address
at A—A/Fr eft . 9 ?--G G 7
Received by Build.ng Division by: signature SIP- Date
S'—.avitr� Y J� ve s
, iti Date Printed or TypedName
Space for Notarial Statement for authorized officer or agent
•
CMF 0990-46 White-Building Div.;Canary-Contractor;Pink-Owner
•
APPLICATION FOR A BUILDING PERMIT
Tract Block Lot co
BUILDING PERMIT NO. Electrical c
Permit No. _
79-5-P7` C.
• Building Permit No. / 9J �' m
Address �n,n'-•C
D
Cross
Mechanicalo. a
Area Street Permit No. p-
m
Owner t Type of Project: ElNew ID Alter ❑ Addition
Address q / < 11,�G��l� i ElRepair ❑ Convert Open,. ❑ Occupancy Pmt.
(/ J V A.P. Sup.Dist./
City l'.+. )
-S!A Iti7�4-� Zip���-� Phone S)S ��yk insp.Area
Architect/ Zone Spf.Prof. No.
Designer License No.
Setbacks P/L Front C/L St. Street Width
Address
Yards Left Right Rear
City Zip Phone
Eave Proi. Left Hight F.P.
Engineer License No.
Parking Spaces Required Provide Covered
GAddressI
Strutt No.of No.of
a City Zip Phone Height Stories Family
-% FeePark Fees H Yes Fee
co LICENSED CONTRACTOR'S DECLARATION Required No C.T. Receipt
m I hereby affirm that I em licensed under provisions of Chapter 9
t (commencing with Section 7000 of Division 3 of the Business and Zoning Approved BY: Date
Professions Code,eng my license is in lull force and effect).
License Clan License Number
T Date Contractor Misc.
E Address Proposed Use
I. - of Structure
LL City and Zip Phone
N CONSTRUCTION LENDING AGENCY
r I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097, ClaCone Code
Class Const. Year
Civ.C.).
C
Lender's Name USE/OCCUPANCY SIZE SO. FT.
Lender's Address
OWNER-BUILDER DECLARATION
r I hereby affirm that I am exempt from the Contractor's License Law )
m for the following reason:
0 I, as owner of the property, or my employees with wages as their 2.
sole compensation, will do the work, and the structure is not
.0 intended or offered for sale. 3.
0 1, as owner of the property, am exclusively contracting with ,
licensed contractors to construct the project.
r 0 I am exempt unger Sec. , B&PC for this reason 4'
ar
Tn. Dete Owner
E WORKERS'COMPENSATION DECLARATION Total Valuation
8 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required ❑ Yes ❑ No
or a certificate of Workers Compensation Insurance, or a certified
C copy thereof. Grading Pmt
5 Policy No _Company Required ❑Yes ❑No Pmt. No.
- ❑ Certified copy is hereby furnished.
O. Rough Grading 'D
Q ❑ Certified copy is filed with Orange County,EMA. to
Approved by: Date
Date Applicant 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE 2
(This section need not be completed if permit is for 5700 or less). 3
3
I certify that in the performance of the work for which this permit is C
issued, I shall not employ any person in any manner so as to become to
subject to the Workers'Compensatior aws o`�f.'9Q(,alifornia. PERMIT FEES
Date(' -S ki Applicant -%etc 9---
NOTICE TO APPLICANT: If. a r m in this Certificate of Structural $ Plan Check Si
Exemption, you should become subject to the Workers'Compensation
provisions of the Labor Code,
Special
vest.
you must forthwith comply with such Electrical $ $
provisions or this permit shall be deemed revoked. Invest.
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-Grade
POSE Inspection $
-�- fr/ Pre-Grade Permit
' TC),
9.f App ' ant or Agent Date Rec.No. $ Issue $
L lrVS L-tr/(r'm '
i rant Applicant's/Agent's;game
All spaces within this box must be completed to pror Che I Issuance
Plan By: I -netl:
CMF 0335-46(BU-28) rev.6/80 ,.
APPLICATION FOR A BUIL `IG PERMIT
Tract q 3 Li 5 Block Lot /_ r BUILDING PERMIT NO. Permit Electrical
No.
EW
tp .
E
AddrBuildess
5� / 6 Plumbing to
Address '`� d "'� S , � ./J am Permit No.
rr Cross / Mechanical 6
Area Street
„--
J{U V r Permit No. ca.
Owner U I I r ) r. ; Type of Project: ❑ New ❑s Alter Addition R
Address 2- 0 , ")
0 / ) s r `n -� Ps//A (LT r ❑ Repair ❑ Convert El Demo El Occupancy Pmt.
City n O_ `ZIiPf� Phone A.P. Sup.Dist./
l"n‘ :-%P (y)ffs ra 61 La ,”�yy Insp.Area
Architect/wr (; -a l0 035'/ Zone SPI.Pmt.No.
Designer Nq/Ij£L'�� License No. r
Address 1 (� / .- Setbacks P/L Front C/L St. Street Width
3(' 7 Il r>/arul�c hn -L
Yards Left Right Rear
cityX5'//•1 fn 5/I Zip,�‘).6Phones-5.-b-w
Eave Prot. Left Right
, Engineer License No.
•C Parking Spaces Required Provide Covered
S. Address
m City Zip Phone Struct No.of No.of
Height Stories Family
-V Park Fees yes Fee
LICENSED CONTRACTOR'S DECLARATION
as Required No C.T. Receipt
el I hereby affirm that I am licensed under provisions of Chapter 9
t (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date
7. Professions Code,and my license is in full force and effect).
S License Class License Number
T Date Contractor Misc.
E Address Proposed Use
of Structure
jr. City and Zip Phone
a CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
S performance of the work for which this permit is issued (Sec. 3097, Clas TYPe Code
Civ.C.). Class Const. Year
C
Lender's Name USE/OCCUPANCY SIZE SQ.FT.
Lender's Address
J OWNER-BUILDER DECLARATION
y1.
I hereby affirm that I am exempt from the Contractor's License Law
afor- following reason:
I, as owner of the property, or my employees with wages as their 2.
C sole compensation, will do the work, and the structure is not
.5 intended or offered for sale. 3
0 I, as owner of the property, am exclusively contracting with
licensed contractors to construct the project.
at ❑ i am exempt under Sec. B&P Jor this reason 4.
6 ,Oat,/ %S'9) Owner
E WORKERS'COMPE S IO ECLARATION Total Valuation
3 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required ❑ Yes ❑ No
or a certificate of Workers' Compensation Insurance, or a certified
C copy thereof. Grading Pmt. Grading
8 Policy No. Company Required ❑Yes ❑No Pmt.No.
.a ❑ Certified copy is hereby furnished. Rough Grading S
0. ❑ Certified copy is filed with Orange County, EMA. Approved by: Date 1a
Q Date Applicant 3
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE Z
(This section need not be completed if permit is for $100 or less). C
I certify that in the performance of the work for which this permit is 3
issued, I shall not employ any person in any manner so as to become o
subject to the Workers'Compensation Laws of California. PERMIT FEES
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with such ElectricalSpecial
provisions or this permit shall be deemed revoked. $ Invest. $
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE Plumbing $
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $
ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON
THE ABOVE fyt ENTIONED PROPERTY FOR INSPECTION PUP- Pre-Grade
POS \/��(,,. 4_ i — S.-)
Inspection $
Signa of dpplicam or Agent Date Rec.Pre- rade $ Permit $
111111 Rec.No. Issue
Print Applicaht's/Agent's Name
All spaces within this box must be completed to process Plan Approve
Check By: !� Approvetl:
CMF 0335-46(BU-28)rev.6/80
• -h - FEE RECEIVED
16551 MAR 2 1962
COSTA MESA BUILDING-SAFETY DEPARTMENTFINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPJF OR PRINT BUILDING
BUILDING /—_, o,' /74,N'TQle" - 414142
ADDRESS O,/,,j/4,-,A'
'/V 1--‘7,0C//y NrI--
�jCOSTA MESA. CALIFORNIA For Office Use Only
p,91/E 4t rrtt '4 4rgr RECEIPT NO. (6P7l5RM5T NO.
OWNER MAIL / �� ReceJYeD BY TE 3E5lLVEf_ �p�o�wiE TB�eD
ADDRESS/4 8. /.iNo.PCr/7 4 /C/ ?-,Etre
2 j062
CITY /OSTA Airs1c 4e. TO.ry/ *us_
ADDRESS
ARCHITECT nnet f/ TEL. COSTA MESA. CALIFORNIA
OR ENGINEE &J. -/Jf3t�l'/� Nn�O. X05 3. 17/
/ _ a ��J/��/y�
ADDRESS 977/2) nretL 4 AVC/ 469//EiM ZONE TYPE V GROUP �l " f/
CONTRACTOR /4/V020S /FIND f 'O, APPROVED U
/1714>
BY DATE
ADDRESS /L S'd /Ai/Nae/14 be... ZONING
ZON8 NO.OP USE OF NEW S J, 9'�/G1
CITY &&(T N /ICS,* (Agti�ir /� R—I I PLANS Z I BUILDING [Jy,/q# 9q),
E
LSIC.NO. I / (O/ TNO. /((,9C/J I� LEGAL LO�- 6/ /N / 3'/ /
LESCRI DESCRIPTION
SIZE ( NO. OF BLDO6.//
OF LOT IOC X_ /6 NOW ON LOT WE A.P.NO. ~—�-
USE OF YARDS EVES
EXISTING BLDG, APPROVED ALLOWED
SETBACK LINE FROM / (CENTER
�J /(CENTER LINE GT.) IT
CENTER OF SEET (00 REAR YARD /7 FRONT O FT. IN,
SIDE YARD I LEFT /r I RIGHT /S R.SIDE 1 3 FT. IN.
DESCRIPTION` / OF WORK L.SIDE / 8 FT. IN.
NEW I �` I ALTERATION III ADDITION I REAR l 1 7FT. IN.
NI
REPAIR I II MOVING II DEMOLISH I APPROVED W.(4 a DATE 21/6/G.-L-
a-62a
BUILDING �j f) NO. OF 2 �/
SIZE /U /Q ROOMS STORIES
EXTERIOR WALL Waco ROOF /000.61
COVERING 6— //
TO COVERING SNHK6 j 1,31):'
USE OF BUILDING AND WORK TO BE PERFORMED
4/N6GE Fqn/tV eeS/GENRE e CI CI
1 i i- -e'NE ,,,la44 r
P--5.-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
S = ATURE OF PERMIT FEE $ -
- RMITTE • _e
7/ 'Le" 4\ Sc9 //� PLAN CHECK $X2— r
ORIZED A ' T / �j�C �� s
�— K
TOTAL FEE $ l/X J D
u
•
• 17893 FE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT SEP 27 1982
P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
For gqApplicarAFill In Completely APPLICATION FORRIPERRFTCOSTA MESA
p ,/ . 7 TY E OR PRINT BUILDING
ADDRESS �j; / A/�
ADDRESS COSTA MESA. CALIFORNIA/ ✓/'- , For Office Use Only
P i /// RECEIPT NO. 179
OWNER /� �-/Y
MAIL RE, V�,�Y 1 DATE1RECEIVEED DATE ISSUED
ADDRESS f f --a`7--bo� kt 17— cO e
/J TEL. i
CITY i( NO. ADDRESS �jJ
ARCHITECT TEL.
OR ENGINEER NO. COSTA MESA. 41LIFORNIA
ADDRESS FIRE �/ /
n ZONE TYPE (y GROUP -
CONTRACTOF f(� APPROVED
�T BY DATE
ADDRESS ',L i (/(+ ZONING
J/�J� ZONs NO.OF j USE OF NEW-./QC
CITY r^J ' /'� f)-I PLANE (� BIIILDINO !OJ '1 Wqf'-�
TEL
LIC.TNOjOG�Sa.y(�7 NO --,4597(44 DESCRIPTION `ct / 93 'S' 9
SIZE y NO, OF BIDGB. O L,
OF LOT (6 -/��' NOW ON LOT / A.P.NO. / 3 / - / ca -I3
USE OF •
YARDS EVES
EXISTING BLDG / APPROVED ALLOWED
SETBACK LINE FROM (CENTER LINE ST.)
CENTER OF STREET REAR YARD FRONT -1-Z."f FT . ----` - IN.
SIDE YARD I LEFT I RIGHT R.SIDE FT. F-) IN.
DESCRIPTION OF WORK �•
ff L.SIDE 4YY FT. CIN.
NEW Ij�
V II ALTERATION I II ADDITION I REAR FT.- . ;; -IN.
REPAIR IMOVING II DEMOLISH I BYF'ROVEG�j GQ��� DATE 7/AT /cL
BUILDING NO. OF
SIZE ROOMS STORIES
EXTERIOR WALL-----I ROOF
COVERING COVERING
USE OF BUILDING AND WOR
UUIIILDDINNGANDWORK TO BE PERFORMED _ qiete Lk2G` e
gar WA _ —1 "i' / /N--"'Ce6 /,(
-VS'
/
"X6 'Xi� '— "Xd 'X7o=Ixh1a/
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 CONSTx GTO/�}�. L VALUATION
SIGNATURE OF '^ PERMIT FEE $
PERMITTEE /I �j %%�� m
: '( $��U PLAN CHECK $ /11/
AUTHORIZED AGENT rc
TOTAL FEE $ 6 •�
17945 F E RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT OCT 1 1962
P. O. BOX 317 COSTA MESA, CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely APPLICATI tJTikVA-MESA
TYPE OR PRINT
BUILDING 2 0/7 JOBUILDING
ADDRESS COSTA IL!"A For Office Use Only
/,�'�/1 'n/� RECEIPT NO. 111945
OWNER J 'I ///•
MAIL il, RECE ED BY I DA n RECEIVED DAT- ISSUED
ADDRESS Ra O •,L - -, �o�i -Sias'.F
/ TEL.
/+ _ J'" BUILDING 070/
CITY vPiil.,d NO. ADDRESS a' /-/e,
ARCHITECT TEL. • COSTA MESA. CANIA
OR ENGINEER NO.
ADDRESS FIRE
ZONE / TYPE GROUP, •/
CONTRACTOR I..).--1'4a."--n APPROVEDC4//'�/� /�/ /`�
BY '--17 L DATE riL,01-,/C
ADDRESS ZONING •rpt'
ON 1// I NO.OF USE or NEW,r IIVL !�
CITY �' PLANS Y I
/BUILDINp-G�/ /
STATEIC. TEL. LEGAL LD / 1 -3 `'/- 9
LIC.NO. NO. DESCRIPTION
SIZE .]�/ �. NO. OF BLDG&.
OF LOT //X /00 Ain) X 3S I NOW ON LOT II 0 ` I r ^
A.P.NO.
USE OFi(� YARDS EVES
EXISTING BLDG. nyy1LJ APPROVED ALLOWED
SETBACK LINE FROM
(CENTER LINE ST.) / .,
LATER OF STREET REAR YARD /- ,r FRONT /p
/(` FT.L - _9- 1 IN.
SIDE YARD I LEFT I RIGHT R.SIDE L. FT. '11-* IN.
DESCRIPTION OF WORK L.SIDE G_ (� FT. N.
NEW ALTERATION I V ADDITIONREAR L G \
. IN.
REPAIR II MOVING I II DEMOLISH APPROVED 1 ./�'%FT DATE I^���/'
SIZE
BUILDING/G U.L/ NO. OF
ROOMS STORIES \VI` \\
EXTERIOR WALL i ROOF
COVERING ' ' COVERING
USE OF BUILDING AND WORK TO BE PERFORMED a ' ,rD /
ME _, -
6(/0,--if octieA,79zce2-6
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNTE SHOWN UHING VALUATIONMIIS FOR THE
PURPOSE OF EBTABLIBHINSMIT FEE ONLY.
PLY WITH ALL CITY RDIN CES AND STATE B REGULATING '�'11
BUILDING CONS ION. VALUATION (� �D[_
SIGNATURE O a e PERMIT FEE $ rein'
PERM ITTEFy/� ,.� /'�" o
S A/WI::I PLAN CHECK S
AUTHORIZED AGENT /IDD G"� E
TOTAL FEE ,.it.a//T LL
/
/t,2.o d
1019 4/15/81 42.50 T1.
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT
• P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RECEIVED PERMIT /�7/ `
For Applicant to Fill ininCompletely� y^—Use Ink Only i 5- ,(6 / 7
OnBUly i LDING ,# C7 i / S. CAPE)/(4 CI• A.P. NO. A3$7-402_-��/cyy�J/ �' ,�I
BUILDING nes,/7 C. G 0F
TOENAE TOR`"7 ADDRESS L[J
>f. ,J v.��,' r Ci
-
f% OR
MAILING ) SPACE NO.
ADDRESS �0 / 7 S. al. 1.32:74/4- �l s R.NO. LOT /P / BLK.
^ TEL. ��//
CITY +15�� �I rS/'/,rs NO. ��"3 p�/. NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
J .
LENDER v
BRANCH j
OWNER 3 s ttt✓r, }-
ADDRESS /� + VALUE
ARCHITECT TEL. USE ICZI.V t A-�((I, s 91-grr 3'bO`
OR ENGINEER // /` NO. /// /
ADDRESS ZONE
CONTRACTOR G/ /� BY DATE
/2�L TE `Ir�PEV,41/4/ GROUP ^s--sI
ADDRESS Wl//��--
TEL.
CITY NO.
F STATE CITY APPROVED SETBACKS
LIC. NO. LIC.NO.
{y SIZE INO.OF BLDGS. (FROM C/LST�IEET)J� f/
ar OF LOT NOW ON LOT / FRONT // FT.O
hUSE OF -A/ //
EXISTING BLDG. R SIDE ••-/ FT. D
to
t-,
Separate permits are required for L.SIDE A- N .
Ci
electric,plumbing and heating work. REAR 46IFT. 01
H USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
F
DATE
aV Gt. yr�...R /I`rid- -e/ �`� I APPROVED 3�-j��f/�C/a'
>.• Y// �) APPROVED I DATE 4 _/! 8/
SS ✓
w
aL I hereby acknowledge that I have read this application and state Cl
that the above Information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of L'
[z7 the State of California. t
mixl
I hereby certify that I am properly licensed as a contractor under ✓�� SQ. FT. S O` N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR t0
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: n
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E e
and Professions Code, Division S` hapter 9. -. n
Signature of PLAN CHECK S r
it• r,--- 0 o
Permittee / $ 3 I So/ TAX $ G '70 a.F
Authorized Agent Date f� r/ ` TOTAL PAID S 2.LI ...co U