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HomeMy WebLinkAbout168 BROOKLINE LN - Building Permits r 4 - -• CITY OF COSTA MESA BUILDING DIVISION i K ^'�� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • vnvw.ci.costa-mesa,ca.us 0. 11.141 FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER. M08-00053 PERMIT TYPE MECH STATUS: ISSUED APN: 41916415 DATE ISSUED: 04/16/2008 ISSUED BY: BJK JOB ADDRESS: 168 BROOKLINE LN CM Suite/Unit: Vicinity: CONDENSER AT REAR OF UNIT SO. FT: 0 SCOPE OF WORK: CHANGE-OUT OF A FAU AND NC (CONDENSER AT REAR OF UNIT). 1 INST FAU < 100K BTU, 1 COMPRESSOR 3-15HP/500K BTU NO OTHER WORK AUTHORIZED WITH THIS PERMIT. OWNEj DOBASHI, MARY LOUISE S Address: 168 BROOKLINE Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: LEMOND,RICK Address: 25920 IRIS AVE Unit:STE 13 A400 PHONE: 951-486-0337 City/State/zZip: MORENO VALLEY,CA CONTRACTOR: TELFORDJONES INC License No. 856936 Address: 25920 IRIS AVEUnit: STE 13 A400 PHONE: 951-486-0337 City/State: MORENO VALLEY,CA ZipCode: 92551 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $65.45 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $65.45 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. 1616 INixed s E pZTF INTmRLj 206 FinalINSFEec TanP/• - DAgrAtAier 1818 Axed System Final Fire Prevention 208 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 rinal Re-Roof 210 Final Electrical 201 rinal Block/Retaining Wall 212 Final Fire Prevention 202 rinal Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy �, I WORKERS'COMPENSATION DECLARATIOI Owner ID verified by dr. ,ic. ❑Yes ❑ No I hereby affirm under penalty of perjury one of the Iollowing 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,ras provided for by section 3700 of the Labor Code. for the pedoger ce of the work for which this permit is issued. ,1.d, o/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('we(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized cS279TLr by Ws permit,and that no building structure,scaffolding,falsework,«demolition Carver' or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (nuns sepal need nor tie Completed Ithe perm,isvalued at one bundled dmarS($100)prless) 2.Art 2,Sec.341,Title S,California Administrative Code). Policy Number:' �,3vpp'L 50146,-' 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 worke compensation provisions of Section 3700 of Applicant's Signature Date the Lab. qp, sem.c comply with these provisions. #1:1100 17j t Division of Industrial Safety Permit Number: pplbi§Slgna we Daley HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ING: 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���rrrisyyyin full force and effect. `,/6.�Oc2-6 a registration form for acutely hazardous materials? 0 Yes ❑No Lic:# 2-7.....• am Class#- exceptions, 25533 of the California Healtheand Mesa Code, with somet b / K�e D� each usrequires registration with the Costa nsa Fire Department y each business which at any one time has on hand a quantity of acutely COnvaaOYS Slgnalwe 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 STRUCTION 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 Lenders Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the Califomia 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 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 License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications 1«non-residential building permits). 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? 0 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 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 O 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 0 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-his permit until final inspection. gnalure of -, er(s) /Date �7 ' Signature Dale _ dig 3057<6(3/07) •nd/pr Authorized AppLonl Date PROJECT ADDRESS: 168 BROOKLINE LN (C:, b b UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 067595 OWNEWSNAME: DOBASHI , MARY LOUISE S ADDRESS: 168 BROOKLINE PERMIT NO: M 067595 PLAN CHECK NO: N GOVT; N SUPP : N • COSTA MESA, CA 92626 CONSTRUCTION TYPE : V—N PERMIT TYPE : MEC PURPOSE: OTH 979 8335 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : INSTALL NEW A/C & FURNACE SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 / PERMITTEE: COAST TECH SERVICES (714 ) 589-6592 ADDRESS: 14 SANTA CATRINA COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT RANCHO SANTA MARG. CA 92688 ###########+r#####################ac+f###n#.###################u####w#ax###x#*####u# LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licen under provisio of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my lice is in full fore d effect. SETBACKS ctTYuc.. 05:168 STATEuc,:355425 c s: C2 EXP: 12 /94 MAIN BUILDING ACCESSORY BUILDING Date:_ Signature:. FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN i:!ORI oR.OpOMPENS a ION DECa LLArlieATION:copy thereofhrebyof(Section Sat I avba c) a of consent to self.insure or a certificate of Workers' LEFT, FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN JLIrCelfCOMPAN.:n EXP.DATE: PARKING REQ: PROV: PARCEL : 41916415 ZNE: REF NO: erNv: PLANNING NOTES> J Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. ###############!f#'leti#####X###?E##########*###################Y####K###*###M###### Date' Applicant: DEVELOPMENT S E R V I C E S R E U I R E M E N T S EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not F,/pleted if the p. .ft is for one hundred(S100)w less). Q I certify that in the p. ormance• the work for which this permit is issued,I sh.;not employ any• on in any manner so as to become ow s�/,�ublect to I We •rs'Com• nation Laws of California. ZONING APPROVED BY DATE: ` Date: signature: BUILDING APPROVED BY : DATE: __ _ NOTICE' I,alter . ing this declaration,you should c subject to the Workers'Compensation provisions of the Labor Code.you must I MOMOcomply 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 B Y : DATE: ��I/�ji�(- iF which this permit is issued(Section 3097,Civ.C). ###################### i ############################x########+f### if 1F{' f# af# LENDER: ##############dFY.+E#####t #a##1F#####at###+t###+t#######+cri##+E#############44####x##### ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18,00 repair any structure.prior to its issuance.also requires the applicant Ior such permit to file a signed statement that he/she is licensed 2 5 E SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)al Division 3 of the Business PLAN 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 penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00 BUILDING—DIV—> PERMIT ISSUE PLAN.—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 18 . 00 15 , 00 0 . 00 33 . 00 33 , 00 . 00 ❑ 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 tittered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 33 , 00 OVER/SHORT• 00 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 alf 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 33 . 00 ❑ and Professions Code: The StateContraprojects with License Law does not apply to anownerContractors*property who burns Law).ves thereon ######################################################M###########i*.#####+f###### and who contractsnCO for such projects with a License La)license pursuant to the Contractors'State License I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN k ❑ I am exempt under Section: B.8 P.C. for tiffs reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date. Owner: MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00 I do hereby certify that lam aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00 9 , 00 25534 and that Ior any future building occupant will/will not(circle one)need to comply With said state codes and the requirements for a END OF FEES permit for construction or modilication from theAll Management District.Residential construction applications are exempt from these provisions. Date: Applicant: ' I hereby certify that I have read this application and state that the above infer•dlfsn is come • gree to comply with all city and county ordinances and stat ws relating to building construction and hereby author' epresenlaC i his city to enter upon the above-mentioned • / property Iocmsp lion purpooss/s [. / KDate l`/C 4 / t7 9 Signature: G� 01 DD162262—D0162262 TOT 33.00 Driver's Li se or Socia Security e: DATE: 06/14/94 TIME: 11:30 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNIN'N PL dig SPA 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 b. Electrical UF ER Gird. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conrialt-Ur irgrnd. B. Foundation 59. Gas Pipe, C Uno i,.r.1.,Test i 1 j 9. Coater Pipe-Undrg•^d. 60. Backwash Lines. P•Trap. 0 Undrgrnd, 10. Structural Floor Systcrn • 61. APPROVAL TO DECK 11. Property Sewer Lire & 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 0 Gas Oil 25. Root Sheathing 74. Overhead Hydro 26. T.Bar Ceiling (StructuralI & Monocoat 75. Dry Chemical 27. Frane and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing • • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80 FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 7 ' 35. Final Gas Pipe-Test 14-IA- --G r., 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backf low Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 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 7Ar'''''.."."' PROJECT ADDRESS: 168 BROOKLINE LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 06759E OWNER'S NAME: DOBASHI, MARY LOUISE S ADDRESS: 168 BROOKLINE PERMIT NO: E 067596 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH 979 8335 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ELECTRICAL WORK ONLY SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: COAST TECH SERVICES ( 714 ) 589-6592 ADDRESS: 14 SANTA CATRINA COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT RANCHO SANTA MARG . CA 92688 ##########################################################################AF#### LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed unr ovisions at Chapter 9(commencing with Section Z ON INC R EQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is' , force and ef; t. SE T B ACK S CITY uc.: OG/516 STATE LIC.: 355425 c , s: t {P : 12/94 • 1,//(� ,� -� / MAIN BUILDING ACCESSORY BUILDING Dam:— r Signature: FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN WORKERS'COMPS SATION DECLARATION: I hereby affirm l at I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT; FT IN LEFT : FT IN RGHT; FT IN "jompensation Insurance.or a certified copy thereof(Section 3800. Lab.C). ' 'LICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV; PARCEL : 41916415 ZNE: REF NO: 0 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> , > Dale: APPlicant: ############################################################################### DEVELOPMENT SEJIVICES REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECORATION: (This section ne Aot be completed if ermit is for one hundred($100)or less). I certify that in the p; ormance(I the work for which this permi ssue hall no ay person in any manner so as to become 1 subject topWe ers'Camp soft Laws of California. 1/ ZONING APPROVED BY DATE: XDale: ( Signature. (� •NOTIC If,after m. ng this declaration,you should ubject to the Workers'Compensation provisions of the Labor BUILDING APPROVED B Y DATE: _ Code. O.must to with comply with such provisions or this permit shall be deemed revoked. (e1/4/44:: 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.Cry.C). #####################1F ######.####+F###############if############ iF # ## LENDER: ######################## E####### ##########+E########################## ##%-#### ADDRESS: LEGALIZATION: N F E' E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRICC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 50% pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN SMIP/NON—RES 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 penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 7 . 50 15 . 00 0 . 00 22 . 50 22 . 50 . 00 J 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 REVENUE DIVISION TOTALS--> COLLECTED• 22 . 50 OVER/SHORT: 00 improvement is sold within one year at completion,me owner will have the burden of proving he/she did not build or improve ( BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK .—� for the purpose of sale), I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 22 . 50 ❑ and Professions Code: The projects Contractors'State License Law does not apply to an owner of property who builds Law).oves thereon ############################################################################### and who contracts for such projects with a e License La)license pursuant to the Contractors'State License am aware that proof of their Worker's Compensation insurance should be provided to me. IND IV IDUAL F E E BR EAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 1 MOTOR/POWR APPARATUS 1 . 1 — 10 . 0 HP 7 . 50 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 7 . 50 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 permit for construction or modification from the Air Ouahly Management District.Residential construction applications are exempt from these provisions. , Date. Applicant: I hereby certify that I have read this application and state that the above informati. is •rr ct.I .re' o comply with all city and county ordinances and state laws relating to building construction and hereby..t.orize re. -se .i s. is y to enter upon the above-mentioned 01 00162263-00162263 7.0 11— 22.50 Xproperty for inspec en parpas� DATE: 06/14/94 TIME: 11:31 Dale L� Signature: Driver's Lice ear Soci Security<: 1641-40 Wane—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • CONSTRUCTION AND PLANNINU I�S SPA 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 UF ER 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 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 # I 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas G 0:1 23. Gas Pipe-Rough & Test j 72. Underground Flush T 24. Roof Framing 73. Undergrnd.Storage Tank C Gas C 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 I 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final /n/�-[{/80. FOOD CERTIFICATE ISSUED 33. Final Electric 9 a t ggattel Notes: 34. Final Heating & Air Conditioning / (((/// tFF////// ___ 35. Final Gas Pipe-Test 1 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final f 42, Backflow Preventer 43. Back-low Irrigation 44. landscape Irrigation System + 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 ADDRESS OF BUILDING: 168 BROOKLINE LN MT: CITY OF COSTA MESA — BUILDING PERMIT OWNERS NAME IF KNOWN: DOBASHI, MARY LOUISE S PERM NO: H 072658 ADDRESS: 168 BROOKLINE COSTA MESA,CA 92626 PERMIT NO: B 072658 PLAN CHECK NO; N GOVT: N SUPP ; N APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH ARCHITECT ORENGNEER: LIC.140: JOB DESCRIPTION . 'C/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 2 , 924 ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: 2 , 924 . 00 CALC—VALUE: 2, 924 . 00 GROUP OCC : R-3 / c0NTRACTarsNAME: STOUT ROOFING INC ( 310 ) 923-6775 CONTRACTORS MAILING P 0 BOX 4309 COMMENTS : SMOKE DETECTORS REQUIRED PER 91 UBC ADDREss: DOWNEY CA man, 402536 ***' *****-ISiE******+E**M•ik*fit*k******lE)E****IF)Ex•3E1E3E1EBE****1f3k1ElE1FN•iExiE*iEif1E+E)t************** 90241 WIT: 7. O N I N G R EQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm underpenalty penury that 1 am licensed under provisions al Chapter 9 SETBACKS (commencing with Section 7000)of Divisin 3 d 0he Business and P end my loan is M full force effect. T -rt. .No.: 059377 uc.cASs: C 39 uc.Nc: 025 6 E 10/ 5 MAIN BUILDING ACCESSORY BUILDING rn Y FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN � 9� Cdaador> LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN NCR BUILDER?DECLA�N:I hereby alum under prely of perjury that I am exempt from the Contractors ' w for the if.: wing reason(Sedlon7031.5 Baines and Professions Cade:Any ay or county which reauie•a Perna a eamohd, •improve. PARKING REQ: PROV: PARCEL: 41916415 ZNE: REF NO: olish,or repel any sawn,odor to is issuance.abo requires the applicant for WO pemO to file a signed steamed that he or she PLANNING NOT E S.> censed pursuant to the proveic a d the CoNadas License Law(Chapter 9(commencing with Section 7030)of DNdion 3 of the iness and Professions Code]or that he a she is exempt therefrom and the basis for Me alleged exemption.AMY videll=d Baia > 1.5 by and applicant for a permit n4eds Ohe apptrsd to ad*penalyd nal more than two hmdreddoian I5500D. **********WWW***W W WWW WW W WWW W*WWW W**W WW WWWWW W W W*****MW************W************* I,asawe,ofthePa:SWamy MOWS..with their pre compensation. Dansk.anda stricture a not intended DEVELOPMENT SERVICES REQUIREMENTS or filmed for sale(Section 7044.Bushel and Professions Code:The Contractor.License Law does not apply to an owner of property who buids or improves thereon,and veto does such work tinsel a tarsal a through his a her own employees,provided that such • improvements area udeded or offered for sale.K.hewwer.thebtOdig or improvement is sod within one yeard completion.the ZONING APPROVED BY DATE: owner-buiber wig have the burden of proving he Of she did a bile or improve la the purpose of We). • ❑ I.as owner of the property.amexclusively mntraanawith kensedcontraataa to omea,d 9n project(Section 7044,Business and BUILDING APPROVED BY : DATE: Professions Coda:The Cash License Law does not app*to an owner of properly who balls a Inpraves thereon and who contracts la such pm ads with a contractor(s)licensed pursuant to the Cavtedas License Law). • ❑ I con exempt order Seamon: B.&P.C..for this reason: APPLICATION ISSUED BY: DATE: (/yrs **********W**************************WWW ******************W*********MM* *** Data: Owner: LEGALIZATION:N F E F. SO MARY STRUCTURAL SEGMENT: Y I do hereby way that I am aware d and understand the requirements d California Health and Sdety Code Sections 25505,25533,and 25534,and des l or any Mus building snow cent l Wil not(slab eel need to corp*will said stale codas and the requirements kr BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING apunc for cadWction or modification from te ASTMKTranagement Distrb.Residential construction appIcmimaae exempt from these PERMIT 54 00 . 50 provisions. Date: Applicant: PLAN SM.T.P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby siren under penny d puny one of the blowing dedaabs: ISSUE FEE ❑ I have and wil mainteM•certificate d consers to sed.insure for workers'comperes:km na provided for by Sectkn 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE / Code.for adthe this TOTALS----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00 I have and W maiden vodkas'c rnperuatbn instance.es required by Satin 3700 d 0e tabor Code,for the performance of the % I work Ia which this pane is issued.My worka • insuranceinsurance rerrir ad policy number we: CCaworkers' . EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT: 00 Policy Hunter tivvyvu0004687 10/19 /95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PT,AN—CHF..CK (Rus section need nal be completed i w perm/is for pre hundred dcders(Stop/or lm) 54 . 00 . 50 ❑ I Deni that in the performance of the work kr whkh this permit is$.. .. temploy any penan ir manner so as to becam nbja ti the cnpradion laws d CaMahua. atshould become I .. tothe .Az / .INDI. VIDUAL FEE BREAKDOWN Dae: / sol a Warning:Failure to e •ricers compensation coverage s unlawful,and shell subplot an employer to crate •°nettles and TYPE. QTY D E S (: R I P T I O N UNIT COST TOTAL.. COST err civil(Ines up to. hundred thousand&Wars(ttO4000). addition to Me cost of comminution damages a • •vISed for In Section 3rosofthsLeber Code interest end adomry•ties. SFR 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 924 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that them's a construction nem agency for the END OF F EES performance of the work for which this pool is issued(Section X97.CN.C). LENDER'S NAME: LENDER'S ADDRESS: I candy that I have read this applioton and data that the above bdanwion is cora.l agree locompf Mth a0 city arid county ordinances and state laws ridding to building conmurmn and hereby authorize representatives of this city to enter upon the above-mentioned property 10f°a0Btl10A OprDO°e' Iiii ENE BUR�FORD, -��1/ Far w / , /' / 01 001?3,3}-^9:C3:t•41 TOT ♦ its i i/ ate: i DATE: 0"U5'9 0,6/U5'7f TTi,E' 10,.52 AIIIIIIIIiiiiSiiiiMPF (Si SI-4 .WP) Whda-Bhdd g 5 Safey,Green-ie:Cmwy-Appimd:Pink-Revenue:Oddmnmd-As•emr 11111111, CONSTRUCTION AND PLANA" OL& SPA 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-Undrgrhd„ 54. Forms 4. Electrical Conduit-Undrgrnd. '• 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 1 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ 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• • - - i 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping Of 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 .4r..24•95- € 44e 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat. 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: • 34. Final Heating& Air Conditioning • • 35. Final Gas Pipe-Test 36. Hood or Canopy . . 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backf low Preventer 43. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' 46. .Handicap Regulations • 47. FINAL STRUCTURE & BUILDING /!-l7�G &Ca 48. FINAL PLANNING ( • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date . - UNPILE\ SAN VISTA BUILDING COMPANY VAIt 10-4-by JOB ADDRESS 168 Brookline Lane BUILDING PERMIT NO. 27655 GENERAL CONTRACTOR Same DESCRIPTION of WORK Res. W Att. Garage AP No. LOT 99 TRACT 5160 FIRE ZONE VALUE $ 1 X114.00 INSPECTIONS Si nature Dote GROUP I & J TYPE Y ZONE R-3 SOIL /( S'/d ^Ste., SUBCONTRACTOR PERMITS ISSUED • GAS I Date Number Siana._.e WATER / )j__ D it Plumbin. ROUGH • UMBING AM, / of _+.'eira- 1Arf: f PROP. SWR. LINE Q HOUSE CON. ¢' _ S A. .to SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING 4.b--5 it-e?‘) TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING /90-57 Hearin. and V-nt. TRENCHES 0 FORMS ❑ STEEL REINF. ❑ C/ flalrlajigrin&r i FLOOR SYSTEM SI-IIMIMNI=W- BOND BEAM • STEEL REINFORCE • SHEATHING tar' arfr 'FRAME AND FLASHING ZeraSir;St' NEMMia LATHING — IN Il) OUT Cr _ ___ PLASTER, BROWN COAT li/l��y© STRUCTURAL, FINAL gritL��� �/ /��JJyo�J//HEATING,.VENT., REFRIG. ANO A.C., FINAL $'. 5(�N� f ofHC/�/- �'n/ q7/O/ PLUMBING, FINAL AND GAS TEST n 2-?' / / ELECTRIC, FINAL LIS ' t,6",r rBUILDING. FINAL - ./'!q�a et". ft o 27655 OCT -L1-67E129' ..,.. l. .0 COSTA MESA BUILDING-SAFETY DEPARTMENT �("F P.O. BOX 1200 COSTA MESA. CALIFORNIA 92125 . For Applicant to Fill In Cornish/ay APPLICATION FOR PERMIT TYfRINT BUILDING �/ /`^J"''^''V,II For Office Usti Only ADDRES G/G V ADDRESS l7 O RtenR No. 2i IIrc7Ma COSTA MESA. CALIFORNIA _ ��/ ^ AAl ret RZC. Y DA. IVCD, • Ti19 D OWNER WA �Irrt,/{�lcce f `J /V) ADR � //pp �� ) � BUILDING /1''��ESS -`[et ca d a ct, // -v ADDRESS • /0-41•••14 T[LOf L'IJ�� FIR[ I� ////�{aJ/iJCITY r NO. ZONETYPE(/ OROOM- ARCHITECT /// j /� �,-TlL BYPROV[D �/ DAT[QLOR ENGINEER l' //i �.41/�CQ(.NO. I�-r-Zt, // PPP��� J > c/�/y �1 T �//�//�� ��,, ZONING ADDRESS 'LOO V /7./ �LKV€•CCYL Z07 NO.or USE OF NEW , - ^�I ,{ 5 I PLANS. I-.ESUILDINGca CONTRACTOR CJI Q/, �(P�q/� � LEGAL / //!! [��j , �1/��`�. ///�� ADDRESS "J ce-LAA— t DnCRIrt1O / ( •M.L%(�S ✓ VVV 4)---"1-43/4a 730 -03 CITY ` ' op...,____ A.P.NO. NOTE: NO EAVE OV ERH G SHALL BE LESS THAN STATE TEL SO'TO SIDE&REAR P.L LIC.NO. NO. EAVES OSIZE F LOT (� x 70 I ND oI Ry/'DR'mir ALLOWED (U.B.C.REQUIREMENT) YARDS APPROVED YARDS APPROVED USE OF \ MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. P. (FROM C/L STREET) • BE(DACrI INFER.... 7 FRONT 0 FT. PT. CENTER OF STREET REAR YARD SIDE YARD- -LERIGHT I. R.SIDE D Fr. PT. FT DESCRIPTION OF WORK r...SIDE a PT. PT. REANEW ' II ALTERATION ADDITION PT. FT. II DISTANCE BET. BET.MAIN re REPAIR . MOVING DEMOLISH _ MAIN BLDGS. ACCESS.BLDG8. BUILDINGS , 7,, NO.OF �/� VAR.Jr DATE SIZE t7-/I�../C ROOMS 7 STORIES C.U1.�QP.$QQ /� APPROVED ECOVERING RIOR W�'CQ{,f�N�I COVERINGlieA P F(jIVE/�r LJr / DATEROOF 9- a�� 67 USE OFBUI •INS AMP RKTO BE PERFORMED, l p, p' IQilii O /.L AEP"bn_ 9 7____. /.3080.FT/ Veld'a ' 1 I MEREST ACENOWLEDOE THAT.1 HAVE READ This APPLICATIONEH N U THE AMOUNT NDER VALUATION IS FOR THE AND STATE THAT BOVE 18 CORRECT AND AGREE TO CAM. VPURPOSE Or BLISHING A PERMIT FEE ONLY. PLY WITH ALL CITE OR INANCES AND RATE LAWS REGULATING ALU BUILDING CONSTRU O . 09 44 FEE $ 6c2 — E Tl SIGNATURE OF .i S� /// PLAN CHECK $ r T� C AUTHORIZED AO NT !!!/// (, TOTAL FEE 5 7 D—