HomeMy WebLinkAbout182 BROOKLINE LN - Building Permits ADDRESS OR M9LWG 182 BROOKLINE LN wit CITY OF COSTA MESA - BUILDING PERMIT
UNNERSNAMEOI raft YI , TAE PERM NO: E 08456':'
aaoRE55: 182 BROOKLINE LN
- COSTA MESA,CA 92626 PERMIT NO: E 084569 PLAN CHECK NO: N GOVT: N SUPP : N
1PPL.MARIW ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : ADD A/C SQ FT :
ARCH.OR MI ADDRESS: WIT:
CLAIM VALUE : CALC-VALUE: GROUP OCC: R-3 /
WNTMCTCRS NMS: CRYSTAL AIR ( 714 ) 534-2593
CONTRACTORS WANG 11801 MAC STREET COMMENTS: REF:M-84567
ADDRESS: GARDEN GROVE CA MCN*/ 655036 + + *'*n'*'******;e+t***tic;EiEit*ii•;r;e*;r;E;E:tv(iFrtiF:4itie-ii;riiiEiFic*;i*it;i•*-ieit;i7i***;:;e* ;e;i•w;r;t;t;tyr;r*;t;r;r;i;:*ic*
92641 WIT: Z ONING REQUIREMENTS
LI ED CONTRACTORS DECLARATION:I hereby gem under pruly of perjury that I em Tcereed radar Provisions a Chegr 9 SETBACKS
with Section 7000)of Division 3 of the Business and Profeniw Code end my lone is M hof force and affect
CT'uc NO.: 042006 UC.CLASS: C-20 �j 036 EXP : 03/98 MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
'Tree. -6- '47 Commas:, LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
NE BUILDER DECLARATION:I hereby affirm under sanely of perjury that I ern exempt from the Conttte'an License Law for the
reason(Section?031.5BusirsaandPMesdanCede:AnyayomarrywhichreearesapermittomMut.mer,inproe. PARKING REQ: PROV: PARCEL : 41916466 ZNE: REF NO:
.,m h,or repel any Salome.prior to its issuance.also requires the applicant for loch Permit to No a sipred ewrnru that he or aha PLANNING NOTES>
r1 - pungent to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)a Division 3 of the >
Business and Professions Code]a that he or the is exempt therefrom and the basis for the dleged essrD s.My videtfoSectionn of Sion
7031.5 by thy exacta for a permit subjects the applpara to a ofd penally of not more then five hundred dollen 155030. *************************************************lf**********************1:*****'li
❑ I.morawdiMprowryormyemPloYeeewithwagesestheiedecanpenselian.witdoOrwdkWNaetmcavaisnainteded DEVELOPMENT SERVICES REQUIREMENTS
or offend for sale(Section 7044.SUNNIS,and Pm fences Code:The Comrades License Law does not applytoan Mimeo of property
who but,or inproves thereon.and who does such work times'a herself 0 trough his or her own employees.provided that such
improvements are not mended or offered for see.I,however the bolding or inpwernen is sold within one year of completion.the ZONING APPROVED BY DATE:
owner.buil:er will have the burden of proving he of she did nor build or Improve for the purpose d sae).
❑ I.esowerd the amenauaivel Contracting with licensed contractors the project 7011.Business and BUILDING APPROVED BY : DATE:ElProfecontractsProfesonsch Code:The Connecta License Law Roes nor appy ban owner of poprly Out"ho buor loathes thereon and hep contrafor suprojects with a contractor(*)licensed pursuant to the Contractor*Liare Law).
APPLICATION ISSUED BY: DATE:lamaemnderserdnn: B.APc. athuCin
: ***** * ******* Jfx* et**
Date Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby candy that I am aware of and understand the requirements rel Caiotda Health end Safari Code Sealons 25505.25533.and
15531.and Nm l or any Mame Lulling occupant will/pep not(circle one)need b Cos*wall gid Mere poles and the NM:teenr"for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
aprmit la construction*/modification from the Aa iaic�augeenw District.Residential construction applications ane exempt from these PERMIT 11 . 00
provisions.
503 SMIP/NON-RES
Date: Applicant: PLAN
WORKERS COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE 22 . 00
❑ Ihave end WImamma acaaAiateofconsent toadlinraebworkers'coparrWion.saSection o
provided for BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.fathe pedamanceothe work ta:Mich missued. TOTALS----> 11 . 00 22 . 00 0 . 00 33 . 00 33 . 00 . 00
-1 I have and a mesas Mas'consensual insurance,as required by Section 3700 of the Labor Code for the wdammpe of the
work for which this permit issued.Myworkers'°°mpen'M°ninsurance carrier rdpdiyrmbrra' REVENUE DIVISION TOTALS--> COLLECTED : 33 . 00 OVER/SHORT: . 00
Oenro BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
Policy Number
33 . 00
(1f' ion need nor be competed/led perms u for one hundred dodos(5100)or fan.)
.. aY that in the pedomapce of the work fa white this perms b'.. ...,Ishag not employ any pram kmany mwwes go to *.********iiiiitiiiiiiii****ii**********ii***ii*****iiia-icii******ii******ii************ii******ii
subject to the workers'compensation law d - jib. that A should become subject Io the workers'
peprovisions a Section 37000 d the Labor Code,I I ►/ mm*with those patdme. I N D I V I D U A L F E E B R E A K D G W N
Dm 1. " �'t Applicant: ��,it-�t_
amino:Feguns to secure wortw'conpraaUon soseroa la unlawful,and Mall sub*:an employer to Criminal proms+and TYPE QTY D E S l' R I P T I O N UNIT COST TOTAL COST
cMl fins+so to ms hundred thousand dollars($IO4000A N adddon to or cert of compensation,damps+as provided for In
Secton3706 ofine labor Code,Interest.ananomef less ELE 1 MOTOR/POWR APPARATUS 1 . 1 - 10 . 0 HP 11 . 00 11 . 00
ONSTRUCTION LENDING AGENCY:I hereby affrn under penally of pereuy that there is a camruoicn lending agency for the END OF FEES
etas of the M for which this perm is issued(Section 3097.CN.C).
LENDERS NAME
LENDER'S ADDRESS: EX=
I cmily that I have read this application and state t the abovei I:metat Icard.Iion.tor nlply witn.gay andcounty ordinances
and elate laws redoing to Witdig construction eby euhaae reprenemmives of this dty 1p amr upon the atlpw m.mian.d 1propedY
forin'pactbnpgrpoeea. L H BT.LL DATE
09-05-1997/02:25 141/833.CJ
PrimRCPTG:31-CJ11868
c.�D� Q^S-q-7 PERMIT:084569
Signature oenw
AgeA a
Fea�G
(5151d6.WP) White-Building 8 Safety:Green- maty-App5canl;Pink-Rewmn;Goldenrod-Assessor
_ _ . -
CONSTRUCTION AND PLANNINI, I . & 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash-Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer 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 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 PREY. 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. Backflow Preventer
43. Backf 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
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA PIT Iy0 � TRACT NO. LOT NO. :BLDG.NO.
g
CONSTRUCTION PERMIT -^ v�,/ -
•
�P Project Address/ / /peso,('/„/P 1,40„0, TYPE OF CONSTRUCTION 2582 1 /05/83 5403 TL
CA Owner /, e sod Phones5LjbjsJj ❑ NEW 0 ADD 0 ALTERATION (A�n
Address ,9M i0 0 REPAIR 0 CONVERSION ❑DEMOLISH ,r7 ZONING REGULATIONS
Arch/Eng. License No. 0 OTHER
Address DESCRIPTION OF WORK A.P.#
ZONE PLNG. REF.Tr
O ContractorrAe 64/..-A- '2144 :Thp Phone-992 -3y?A TYPE OF PERMIT BUILDING TTOp 9gLt1�I�p,N3
N AddressSETBACK CIL ST. PROPERTY LINE
�J 33 41 L. i(✓,A/7I ❑GRADING 0 FOUNDATION ❑ STRUCTURAL SIDE VARD
LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICALPLUMBING OMECHANICAL SIQE YARD
I hereby affirm that I am licensed under provisions of Charter 9 (corn- RIGHT
mencing with section 7000) of Division 3 of the Business and 0 OTHER
Professions Code, tl m y license Is in full force and effect. REAR YARD (TO P/L)
License lass 6 License 6,;(1/.74-F.7 PROJECT DESCRIPTION
�) PKG.SPACE REQ. PROVIDED
Date/rj-Y -P� Signature _42-:/../../...1- /_.-,L7 SQ.FT.
WORKERS'COMPENSATIO ECLARATION OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE $
I hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY DATE
certificate of Workers' Compensation Insurance, or a certified copy
thereof(Section 3gao Wb. C.). ^� GRADING CU.YDS. ACRES SPECIAL CONDITIONS:
Policy No. N c/I�CrLn Company`/eg✓Cil �/✓S
r certified copy is hereby furnished. REMARKS:
ertified copy Is filed with the city Building Division. -
.EMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit Is for one hundred
($100) or less).
certify that in the performance of the work for which this permit is -
issued, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK
subject to the Workers' Compensation Laws of California. UWELLINU bH KHOt
Date Signature BATHTUBS SHOWERS SO FT SO FT
NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW__1-10 KW
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50+ KW
revoked.
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP50+HP
formance of the work for which this permit Is Issued (Section 3097
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES
Lender's Name
Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby affirm that I am exempt from the Contractor's License Law for
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP l LUNS I KUL IIUN
Any city or county which requires a permit to construct, alter, POLES METERED SUB
Improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB
quires the applicant for such permit to file a signed statement that he
is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE AMP
(Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT 1 UQ
basis for the alleged exemption. Any violation of Section 7031.5 by _
a^” applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
of more than five hundred dollars ($500). .--
, as owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS _•.� 's -•
s...e compensation,will do the work,and the structure is not Intended
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE
Contractor's License Law does not apply to an owner of a property ? es D�APPLICATION APPROVED BY DATE
who builds or Improves thereon, and who does such work himself or ISSUE FEE �.1
through his own employees, provided that such improvements are not
intended or offered for sale. If, however, the building or Improvement MECHANICAL PLAN CHECK
Is sold within one year of completion, the owner will have the burden SUMMARY OF FEES
of proving he did not build or improve for the purpose of sale). BUILDING
HEATING SYSTEM 0-100.000 BTU
PERMIT $ SMIP $
❑ I, as owner of the property, am exclusively contracting with AND DUCTING
licensed contractors to construct the project (Section 7044, Business 100,000+ BTU PLAN CHECK $ PERMIT 4 s f
and Professions Cotle: The Contractor's License Law does not apply to . �1 ISSUANCE $
an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ C`7/
tracts from such projects with a contractor(s) Iicesned pursuant to SYSTEM GRADING $
the Contractor's License Law). 100,000+ BTU PLAN CHECK $
O I am exempt under Section B.& P.C.for this g01 LE RS BTU ELECTRICAL $ $ •
reason MICROFILM $
Date Owner SYSTEM REPAIR,ALTERATION PLAN CHECK $ TOTAL FEE$
.51..�
I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $
AD-
information is correct. I agree to comply with all city and county PLAN CHECK $ LESS
ordinances and state laws relating to construction,and hereby authorize VANCE P PC $
representatives Af this city to ente upon the above mentioned _
property fat/ sny i urpp s. n Y� id-v_F,L
Signature /(( �•J Date FINAL FEE $
Drivers' License or SS yr�� ISSUE FEE
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor 2.je_9Dy -g r �n/s, eel-7,24J
CONSTRUCTION AND PLANNING p POOL&SPA • •
•
APPROVALS Permit# P'.5 [(,8�' Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil Pipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
5. Steel Reinforce 47. Rough Plumbing & Pressure Test
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undrqrn
8. Foundation 50. Gas Pipe, ❑Undrgrn,Test
9. Water Pipe-Undrgrn 51. Backwash Lines. P-Trap. ❑Undrgrn
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing 55. Plumbing System - Final
14. Rough Electric-Conduit 56. Electrical-Final
15. Rough Electric-Wiring - 57. Solar System-Final
16. Rough Heating & Air Conditioning - 58. Fencing &Access Approval
17. Ducts, in Structure 59. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathing
22. Frame and Flashing NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test
31. Final Plumbing /713 4.95",e
32. Water Service-Final
33. Gas Service-Final
34. Solar Domestic-Final
35. Landscape Sprinkling System •
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date
ADDRESS OF SLALOM 1a2 BHUO15L1NE LN MT: CITY OF COSTA MESA - BUILDING PERMIT
OWNER'S NAME IF IiNNx: VI , TAE PERM NO: M 08456',
AODREss: 182 BROOKLINE LN
COSTA MESA,CA 92626 PERMIT NO: M 084567 PLAN CHECK NO: N GOVT: N SUPP: N
ARPL.WOUND ADORES& CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: OTH
ARCHITECT OR ENIIIEER: UCNO: JOB DESCRIPTION : ADD A/C SQ FT:
ARcx DR ENG.'S ADDRESS: uMr: CLAIM VALUE: CALL-VALUE: GROUP OCC: R-3 /
CONTRACTOR'S NAME:YARNS
AIR ( 714 ) 534-2593
caRRAcroRWNAatO 11801 MAC STREET COMMENTS : X
GARDEN GROVE CA 655036 *************iF**tikifiEiF****3tifft*ifiFifwitiFitiF#iiitiiiE3iiiiFieifiEiEiEiEiFiEiF****if*ifiriFirifiiiiieriieieieirieiFie*huhu*
ADORES&
92641 "c'ND'`
WIT: ZONING REQUIREMENTS
S
UC ED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that 1 am licensed under provisions d Chapter 9 SE TB ACK
( ng with 1J»Division 3 d the Budeew, Prdeeaona Code.yd(Winans is in rut force and effect.
uc NO.: O liVb uc.mAs4 C-1 A m. DJ03b EXP : 03/98 MAIN BUILDING ACCESSORY BUILDING
�
y FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
DVB: '[/ --5-.---t7 Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
1E BUILDER DECLARATION:I hereby affirm under penally of perjury that 1 em exempt from the Contractors License Law for the
Sowing reason(S«aion7031.S Runless and Professions Code:Any city or county which requires a Permit to consented.after.improve. PARKING REQ: PROV: PARCEL: 41916466 ZNE: REF NO:
amdeh,or rapes any structure.prier to in issuance.also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES>
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing%eh Section 7000)of DNSion 3 of the >
Business and PrdecanmC permitRd*he aheelsexem t a therefromand the basis tor the allegedudre dollarn.juryviol�tiond Section ***********************************************************************i6*******
Bs1.5 synoyrcie2nts ademNhathao the eiseemp°thdefpenandy thnamatorthan aweexedptin.aIsyviol
❑ I.ee owner dors Propem a my employees wlh wageaaamel sole compensation.win do the work,ed the souaWto i not Intended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 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 orthrough his or her own employees,provided that such
improvements are not intended or offered for sale.It however.the building or mamvement is sold within one year d completion.the ZONING APPROVED BY DATE:
awner.builer will have the burden of proving he or she did not build or improve for the purposed sale).
❑ I,as owner d the property.em exclusively contracting with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of properly who build or improves thereon and who
contracts for such projects with emMraaoN.11icensed pursuant mthe Contractors License Law). APPLICATION ISSUED BY: DATE:�
❑ Ism exempt under Section: B.A PC..for this reason:
Date: Owner: LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGAENT:N
I do hereby unify NV I ern aware d and understand the requirements 01 California Health and Safety Code Sections 25505.Pccns,and
25534.and that Ire any future building«.wpantwif/will na(circle one)need to comply with saidalae odes and the requirement5S BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit foroonswaionor modification from the Ar Duality Management District.Residential mnetrMun appfutiom are exempt from these PERMIT 13 . 25
provisions.
Dale: Applicant: PLAN 25Y SMIP/NON RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of pantry one of the following dedefalions: ISSUE FEE 22 . 00
o mune adwiImaintain acerlxiwedmn+enttoseN.iraaelot workera "peraaon, sprd
compensation,as BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.for theperforma,p.ofthewapaned
Issued. TOTALS----> 13 . 25 22 . 00 0 . 00 35. 25 35 . 25 . 00
❑ I have end wit maiman workers'compensation insurance,as required by Section 3700 d the Labor Coda for the performance d the
workfa which this°err"nuissued.Myworkers'compensation insurance m'da and policy"t"'"°'°`°` REVENUE DIVISION TOTALS--> COLLECTED: 35. 25 OVER/SHORT: . 00
Caner:
eM BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
Policy Number:
is section need not be completed I the peon*is ler one hundred dollen/Sf00)or Mn.) 35 . 25
candy that In the performance d the wall for with this permit is I shall not employ any person in any mauler ao as to *********************'rb**********�i'******'1('**** '******1E***********9E**1('************
subject to the workers'compensation laws of Car that d I should berme subject to the workers'
pe ion provisions of Section 3700 d the Labor Code,I sit h compy with those provisions. I N D I V I D U A L F E E B R E A K D O W N
/e' L -5—"fl APWc.m: /
ming:Faaure to secure workers'compensation coverage/.unlawful,wshell subject an employer to cymbal panaceas and TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
dvgenw 06 m onehundredCode,
dollars($100.000A In rddlrbnrorm seer of Compensation.danepuupaviddrorin MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 13 . 25 13 . 25
Section 3708 of the labor Cod,hu.rsah and ademey's Iwo
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty d perjury that there is a construction lending agency for the END OF FEES
pedamance of the work for valid,this peml is issued(Section 3097.Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS: y-
I cmiN that I have read this application and awe that the above information is corned.I agree to comply with all city and county ordinances In Om X P R P
and state laws reeding to budding conarudkin and hereby authorize representatives d this city to enter upon the abovamerdned property Plitt S D
for inspection AL PH BELL A AI . at6 5�i !� Pect/oBS 09-05-1997/82:23 Pn/535.25
/' / Dp T:084567
�� Delo: `"_*7 Nd �1g, ` PERI'iIT:084567
Signature.Owner/Agent/A•• , .ntrador � W ^a
(5151d8.WP) White-Building A Safety:Gree antory-Applcanl:Pink-Revenue:Goldenrod-Assessor
-
CONSTRUCTION AND PLANNING PL . &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 56. 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#
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
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
3$. 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
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
1
ADDRESS OFBWLDRq: 182 BROOKLINE LN UMT: CITY OF COSTA MESA - BUILDING PERMIT
OHNERS NAME IF KNOWN ZIMMERMAN, DAVID L PERM NO: B 072661.
ADw1Ess 19082. HOMESTEAD LN
HUNTINGTON BEACH,CA 92646 PERMIT NO: B 072661 PLAN CHECK NO: N GOVT: N S'UPP: N
APPL.MAIIING ADDRESS CONSTRUCTION TYPE: VN PERMIT TYPE: SUR PURPOSE: OTH
ARCNITECT OR ENGINEER: DC.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 2, 924
ARCN.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE; 2, 924 . 00• CALC-VALUE: 2 , 924 , 00 GROUP OCC : R-3 /
CONTRACTORS NAME STOUT ROOFING INC ( 310 ) 923-6775
DONTRACTORSMMIING P O BOX 4309 COMMENTS: SMOKE DETECTORS REQUIRED PER 91 UBC
emus, DOWNEY CA uC.NG, 402536 **;F>E;F*****;F**tE;Fst**********;F*+ESF*; ****st*>EBF***;c*** *µ;E*iE****>E*IF;E-IF>E>Fx-*x*iE*+r*;t*r;F-TE**
90241 WIT: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under Perely• cry Oat lam licensed under p• ••• of Chapter P SETBACKS
(commencing with Section 7000)of Division 3 o1 the Business and P and my license b in ful force i.b.effect.
Clrruc.No.: 05' 377 Lic.CuSS: C 39 um.N• E 25 6 EX;". 10 95 MAIN BUILDING ACCESSORY BUILDING
RNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
orae: / i Contractor: .L �/� �e...t.L._1. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
/INNER BUILDER ,EC 'ATIO :1 hereby affirm under pe : of perjury that I em exempt from the Contractors Lice .e Law for the
following reason(Section 7.•1.5&mixers and Professions Code:Any cay or county which requires a permit to•. . alter,Improve. PARKING REQ: P RO V: PARCEL: 41916466 Z N E: REF NO:
demolish,or repel any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he or she
PLANNING NOTES>
is licensed pursuant to the provisos al the Contractors License Law(Chapter 9(oommendng with Section 70001 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 w
for a permitbjedit s the applicant to a obi penalty ci nmore than fire hundred dollars[55001). *********************************************** *********jE***********.**********
ID I.as owner of the popeny«my emploreee with wages as thei sole compensation,will do the work,and the etmdun is not intended DEVELOPMENT SERVICES R E
or offered for sale(enntian 7044.Business Professions Code:The Contractors License Law does not apply to an owner d property Q !J I R E M F. N T f`J
who butes or improves thereon, such and who does suwork himself or herselfor through his or her own employees,provided that such
improvements we not intended or dieted for sale.If.however.the building or inpwement is sold within one year of completion,the ZONING APPROVED, BY DATE;
ownerbuilder wit have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.es owner of thepropenv.ant exduwelyaomradi,g with kennel concocts to construct the project(Section 7044.Business and BUILDING APPROVED BY
Professions Com:The Contractors License Law does not apply t0 an owner d property who builds or improves thereon and who DATE: '
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law).
❑ Iamexempunders«dph: B.a P.C.,for this reason: APPLICATION ISSUED BY; DATE; l/,y/� —a S
IE ***********************************- ** ************************************ .*
. Date; ow w: LEGALIZATION:N F E F. M M A R Y STRlJCTURAl, SEGMENT: Y
I do hereby certify that I em aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,end
25534,and that I or any future building occupant will/soil not(circle ane)need to comply with said state codes and the requirements ler
t apermifpmmtmctbnormodifmionhdnthe Airt ys yntsnepanmtDidrid.R®denablcondnvfonappkatonsareexemptfromNese BIhnG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 54 . 00 , 50
Dae: Applicant: SMIP/NON-RF•S
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one d the following declarations: PLAN
ISSUE FEE
❑/Chewand ova m.id.:h.centrtiat.dam..mm..n;neum tor walkers'Pamp«,suon..a provided fp by Section 37ogdthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK Ti(4)1711:
OTAL PAID DUE
\7.{�1/ Cnde.f«the pedom,eh,aedthe work d«which this permit is issued.
TOTALS----> 54 . 50 0 . 00 0 . 00 54 , 50
54 , 50 00
I have and toll maintain workers'comperwatikn.' ons 25505,25workthis insurance carrier and policy number are:
Carrier: STATE EXPIRES REVENUE. DIVISION TOTALS--> COLLECTED; 54 , 50 OVER/SHORT: 00
Policy Number. U4494000U4bl5 / 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not beppnderadi thepermt<roronehudreddmarsa •• plea,) 54 . 00 . 50
❑ I certify Net in the performance of the work for which this permit is shell not employ any person in.A armor so as to
becomesubjt to the workers'compensation laws of Caaoma. . ree that l should became su y. to the rlsrs' *************************************************MS**********************.*****
compensation of Section 37 d the Labe`Cede stet those provisions. INDIVIDUAL F E E BREAKDOWN
Date C� z 9� �pl4 �'r :tee . ,�r
Warn/ng:FalIud
/rows
wo*er�ronpensation coverage(undwmn,and shall subject an employer to odrrt snaffles and TYPE. QTY D E S C R I P T I O N UNIT COST 'CO'CAL, COST
civil tines up to one hundred thousand dollars(610g000),In addition as the coat of compensation,demsps a vlded ler In
Section 3706 of the labor Cod,Interest.end alromsy's lees. SFR 2924 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 924 . 00
CONSTRUCTION LENDING AGENCY:1 hereby affirm under penally of perjury the there is a cvnstuticn lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.Ca.C).
LENDER'S NAME:
LENDERS ADDRESS:
I certify this 1 have reed this application and stale that the above information is cared.I agree to comply with dl city and county ordinances
and state laws relating to build . . ,udion and hereby authorize representatives of this city to enter upon the above-mentioned properly
for inspection purposes.
E. ' ENE :URFORD/
/
A, `��/�r/ / - 0i 03183446-00183447 TOT 54.5,
Signatureol.•. .. Agent/ .•• -or DATE: 06)05/95 LIMI.: 10:34
(5151-46.W P) White-Building&Safety:Green-Fle:Canary-Applicant;Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNINt, _ s " OL & SPA
APPROVALS Permit# Date II/actorAPPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement ••
3. Electrical Conduit Utility-Undrgrntl: 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, ❑ Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Ficial •
12. Sewer Cap - j 63. Heater & Vent-Final '
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final •
15. Rough Electrical-Conduit f 66. Solar System-Final •
16. Rough ElectricWirin `
99 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 Condifionfng FIRE DEPT. REQUIREMENT
t
20. Rough Factory Fireplace - ' APPROVALS Permit #
21. Ducts, in Structure 70: Underground Hydro
22.,Ducts, Ventilatingt 71. Proddct Piping CJGas j7 Oil
23. Gas Pipe-Rough & Test . . • 72. Underground Flush •
24. Roof Framing C • 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 6-(�- '� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:•34. Final Heating & Air Conditioning •
35. Final Gas Pipe-Test
36. Hood or Canopy •
37. Final Factory Fireplace
38, Final Plumbing
39. Water Service-Final '
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System _
45. Sound Attenuation .
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING /I_(}21 . 4 w�f'
48. FINAL PLANNING
49, Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
•
OWNER SAN VISTA BUILDING COMPANY DATE 6-1-611.•
JOB ADDRESS 182 Brookline Lane BUILDING PERMIT NO. 22202
GENERAL CONTRACTOR same VALUE $ 14,835.00
AP No.. LOT 102 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK res w/at+ gar
INSPECTIONS Si nature DATE GROUP I&J TYPE _IT ZONE g3 _
Soil /� _ le PERMITS ISSUED
as SUBCONTRACTOR DATE NUMBER
G
Water WY / 6
Rough Corn. R•friy_ 0 � Cond. 0
Rough Heating /. n s •, S 3 , L
Rough Plumbing , // •i . aa ,‘,„ „,,,,,,-7tc! --/-G ft'3 .+O
MiscellaneousI
Prop. Swr. Line p House Con. St St. Swr. 0 ailinZ g / DEC 9 1963 4 0 66 8t, OA'
Il ,v1
Sprinkling System _off
Construction Pole l iSiGS
Underground D Power ',pg;;f' -5 � q vRough Wiring _. 7/ //Fo77
Trenches 0 Forms 0 Steel Reinf. 0 / rtYlQ 6 /t 6
Floor System c g
Bond Beam ❑ Steel Reinforce ❑ r
Sheathing 4I Q- - / 9 XC l C
Frame and Flashing S `4W1R'
Lath1---ng In Out A, m, z"' '6 IF ,I J
Plaster, brown coat .6 < - -- ,_ rCoY WE pc, /
Refrig. 0 Air Con. p Final _ _ r //
Heating, Final - / - -
_
6 1Plumbing Fixtures, Final sf /
Final Gas Test J-ga LJ
Electric Fixtures, Final !� L
-bd J
Building, Final /j, '4
1
OCCUPANCY / . //- .4.-Lf
Form BU4-5 —3-63—S-B P I-TnT Cl1D CDC(`T AT nCllr TTnrn T.-.:,.-
. 22202 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT in 1 9 SI
P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely APPLICWtIIOSFFQ%!AR A •
TYPE OR PRINT BUILDING
y^+- �^ /� /� For Office Use Only
BUILDING/U C��H/` _ _(/,// _• J '
ADDRESS o �¢1C��(/ �,a( RECEIPT NO. �q�y f�
COSTA MESA, CALIFORNIA 2L',CI,J2
R[C BY DATE V6pDATE ISSUED
OWNER U,1NC_ mo03
X�] 4::-./9-(0
tIR64
BUNG
MAIL 1/ b / e [T ADI ADDRESS
FIRE
ADDRESS / {9 / t� 6 /r'�/J J� �r�'
CITY y/ . // N '(Qj/// / ZONE TYPE, GROUP -1.---a-
APPROVED APPROVED
ARCHITECT TEL BY DATE
OR ENGINEE NO. tD
gg t' /J apt ZONING
ADDRESS J ]3�`n'6 � A� t_ vp c NO.OFn _`,7`���i
CONTRACTOR CQ/1,1 Oka_14. 0�6 <� I PLANS . V4
/ BUILDI /j am
ADDRESS/ 1/ Fj{p cr S� • , LEGAL
DESCRIPTION
U�I�A.CJ"' /-'�to VA ���llVl./♦♦i0�
CITY -At ,Q' // A.P.NO. I / l_ 7Jq `B
STATE /9,4 7 j- NO./may/ 7/Q7 SO*TO SIDE @ REAR P..JL OVERHANGNOTE: NO EAVE SHALL BE E33 THAN
LIC.NO. (! /.CEJ /// /
EAVES
SIZE �/ NO.OP SLOGS. ALLOWED (U.B.C.REQUIREMENT)
OF LOT oC O a ATO NOW ON IAT YARDS APPROVED YARDS APPROVED -\J}
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. ini(TY\Y - (FROM C/L STREET)
SETBACKFROM
CENTER LINEFSTREET /trY REAR YARD FRONT qFT,4g FT.
SIDE YARD I LEFT d I RIGHT O R.SIDE fro FT, / FT.
DESCRIPTION OF WORK L.SIDE Fr,, FT. F
REAR 0 FT, FT. W
NEW eke ALTERATION ADDITION V
DISTANCE BET. BET.MAIN @
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
NO.OF / /J �3 VAR.# DATE 5
S-
BUIL -DING .9O X 3-, , /_ROOMS STORMS AC C.U.P.#I_ APPROVED OI
EXTERIOR '/!3S�.{��/�-'.�I ROOF no /J APPt Col; ////
I.(.1
COVERING, I'h^'�K� COV ERIN( Jf.�y�)..-CC. BY \ DATE ,��/ J 't'J / ..'
USE OF BUILDING AND WORK TO BE PERFORMED), 1( Q,
t�� � /n1 LLI
U
D.
(/�/ [/ Ci i
CI---1 .. / .., / lUO sQ.FT/' /.,.(� ° N Ce
I HEREBY ACKNOWLDOE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE £ Q
AND STATE T AB1AGRTOMPURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL THATY O DINANCBSOVE8 CORRECT AND STATEAND LAWS REGULATINGEEO C -
VALUATION
BUILDING CONS RUCTI N ,
SIGNATURE OF ♦ �I PERMIT FEE $ m
PERMITTEE (t{.PNI,/�� u�
1 $ //7/ ' /73�j . •
-LA C ECK - of O
AUTHORIZED,, ENT Aq� J
4
/
aTOTAL FEE $