HomeMy WebLinkAbout1169 BISMARK WAY - Building Permits a.
�c 9 CITY OF COSTA MESA
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BUILDING DIVISION
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} DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
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PERMIT
ro /B00-01718
6.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca. LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
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Job Address: 1169 BISMARK WY Status: ISSUED
Suite: Applied: 10/24/2000
Vicinity: SIDE PROPERTY LINE Issued: 10/24/2000
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Parcel Number: 14160113 Zoning: R1 R1 - • •
Applicant: ANDERSON, GARY
ISSUED BY:
Address: 164 E WILSON ST •
Phone: (949)689-3858
COSTA MESA, CA Zip: 92627
Owner FELDE, DAVID & PATRICIA
Address 1169 BISMARK WAY
Phone:
COSTA MESA,CA Zip: 92626 ,
Contractor: ANDERSON MASONRY
Address: 164 E. WILSON ST
Phone: (949)689-3858
COSTA MESA,CA
Zip: 92626 License: 739159
Arch : Eng:
Address: Address:
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Phone: - Phone: .
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Zip: License: •License:
SCOPE OF PERMIT
65 LINEAL FEET OF 6'HIGH BLOCK WALL BETWEEN 1165 AND 1169 BISMARK WAY, SETBACK OF 45'. 1
FEE SUMMARY
Plan Check: $31.14 Calc Valuation: . '$1,300.00.
Permit: $47.90 -- -- - -Claim Valuation: ' mop
SMIP Res.: $0.00 -
SMIP Com: $0.00 -
Other: $0.00
Inspection: $0.00 '
• ' Total: $79.04 ,
• - PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear. 0-0 Left 0-0
ACCESSORY Front 0-0 , Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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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 it 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 and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
'OR INSPECTIONS CALL: (714)754-5626
146.46(6100)
DECLARATIONS f l )
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.
❑ 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 permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued of one hundred dollars($100)or less.)
'Th
(certify that in the pemance of the work f• hich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws o I alifomia,and agr= .t if I - ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr• Isio•S.
C Applicant Signal----.---
u e? `ir y •e/ I r`Date:`� lG , ' (5�
______----
WARNING:FARUE TO SECURE WORXE '-' • PENSATION COV�GEIUNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND On I ARE($100,000),IN AD%'ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed un r • t (commencing with Section 7000)of Division 3 of.the-Business and ProfeySion Code,and my license is in full
force and effect.Lic.a� Class' #—" C 17'
C�ractor's.Signature:, /I t � t t ' , (Date:---7 ....Z !,_7f/Q/
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.(Sec.3097,Civil Code).
Lender's Name: Lender's 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,atter,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 property,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 driver's 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 five(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,Title 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? ❑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 gallons,
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 fully complied with? 0 Yes 0 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? Yes P No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 end 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? ❑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 AND AUTHORIZATION OF ENTRY: 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 all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described�•erty for inspection rpos-s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
AW'llif e•al Owner(s) Date
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A •OrAuthorized'A•3Icant" Date ">x=,
CODE t . •.�! • PAIS 1NTIPAL£ CODE I INSPECTION TYPE PAIS 1NTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 11-6.. 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
N.
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•THIS SI ETCH IS FOR INFORMATIONAL PURPCEES •SOLID WALLS/FENCES BETWEEN 2'-e&6'IN HEIGHT SHALL
ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE.
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND •SOLID WALLS/FENCES SHALL NOT EXCEED 2'6•114 HEIGHT
WTIYI THE INFORMATION PROVIDED ON IL. 1.1:no WITHIN 10'OF THE FRONT PROPERTY LAZE(NOT CURB LINE).
A T_T. 7 0A/ ii-4. D •VERIFY DISTANCE FROM CURB TO PROPERTY LINE
PI/ S al ''JJ AND SHOW ON FLAN. VERIFICATION FROM THE CITY'S
r I-., Cf.R V SSS ENGINEERING DIVISION IS REQUIRED. CALL(714)754-5343
•.. - PL.L.? I !NG IV noN.
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I RESiOEMCE RESIDENCE
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it(i) - TY OF Ca.-TA MESA
< I A APPRE VED
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EY 04,4Gate d •' ' •ez.)
'Ks set of plans aril;soecifi icns MUST be ke ton this job at all times and' is un.wful l
,.ok=anyatangcs ratecatrnonsarrewthout4ittonpennasiontram then. . Suildini.
T'Safety,Ciiy of Osla Mesa
NO- -0(1 w
In • The stamping A this plan at specification;SHA he held to per rt or t J an my:-
6. • .4 the viola:io"of ny pr visieas if env City c Con Mesa Oraman a or St:•: Ia
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a 1> } s-'7 L` ,ii a'ail a%p?r9 C+!lett atiOl and t ec,me null and,. id _.b ling
' RE90ENCE I • •r: �.,... i
it RESIDENCE - _. ..' RESIDENCE ' ' '• RE n 4 jn u'a'.:;:'•.:r.
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1` •. .,�n 6. MGI �OC< RAM, SET BCC '
-- � ' _ 9
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BLOCK WALL LAYOUT FOR BUILDING PERMIT
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PLANNING DIVISION
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TYPICAL 611 CONCRETE BLOCK FENCE
Cement Coping Optional a � ��" GENERAL- NOTES
Channel Block With 1.3/8 �'�� _I -- I 1 nal
Horizontal Top of all
Fences inj M. MORTAR: One Part Plastic Cement, and
Three Parts Sand
IOW GROUT: One Part Cement Three and
For Fences 5'or Less 'uu ? 2 One Half Ports Stood
Vert. Bars 3/8"0 at 4' •0"O.C. OY� I ___ I.
-
a x COPING: One Port Cement, Three
For Fences Higher Than 5' '• 1--
0
Parts Sand
Vert.Ban 3/89'm at 32" 0.C, I� > w - . CONCRETE: Well Mixed 1:2-1/2: 3-1/2
I i on = II
Max of 7- 1/2 Gallons of
Fill Cells Solid With Grout. I'll > z �' Water Per Sack of Cement
Where Steel Occurs III
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Reinforcing Steel Shall �I F 'A �� . GROUT MAY BE POURED FROM THE TOP
Coil form to Sec.A1639 Ir• w O _ OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
A.S.T.M. lIII Z ~ > fl - CELLS AND AREAS OF HORIZONTAL REIN
All Steel to be Lapped �� n _ _ _ - _ FORCEMENT SHALL BE CLEAR,CLEAN 6
It
1- FREE OF ALL MORTAR DEBRIS,ETC.
24" or to Code I t _ - _
NATURAL GRAD] III �' o • II�
TE
d ;aY/r, a
O e
• 4 •��
CONTINUOUS TOP
CONTINUOUS TOP I • r
A BOTTOM I WIDTH ,�__ TO 16' 0 C MAX
SEE CHART s
BELOW
HORIZST EEL MUST BE TIED IN Li OC DTII CF E8RTHTCOTH
PLACE AT TIME OF TRENCH I/3 THE HE!GIN OF FENCE
INSPECTION. BI'LOW BOTTOM OF FOOTING
ID" j2.. SCALE: I/2' = Ir
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FOOTING REQUIREMENTS CHART
WALL HEIGHT 6 o 4' 3'
WIDTH14' 14 12" . . 12"
THICKNESS 10" . • .. . 10" -. 8 " 8 "
DEPTH OF EARTHTOOTH 24" 20" • . . . 16" 12"
SPACING OF EARTHTOOTH 12' 14' 16' 16'
k
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BUILDING DIVISION
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OWNER Newport Homes Inc, - - DATE 7-9-62
JOB ADDRESS 1169 Bismark Way BUILDING PERMIT NO. 17498
GENERAL CONTRACTOR S. V. Hunsaker & Sons VALUE $ 15){11.00
AP No. LOT 37 TRACT 4653 FIRE ZONE DESCRIPTION OF WORK Res/Att.Gar.-
INSPECTIONS Signature DATE GROUP T&J TYPE V ZONE R-1
Soil Ain 7-/7 YF;. PERMITS ISSUED
Gas y Es y SUBCONTRACTOR _ DATE NUMBER
Water �U/ �� �r
Rough Corn. Refrig. ❑ Air Cond. 0
Rough Heating _ y" � '" tat L.
-f_ � " —�i-.23-�y Sia
Rough Plumbing L/ -f7fl _ citc-2oc[iv 7=9_6r- 36,2 6 ✓ ,J
Miscellaneous .Otw.,, r o, k-a/ ;I - 4yG ___ / {"
Prop.Swr.Line ❑.House Con. ❑'St-Swr. 0 ✓/_ JUL 2-7 j96 aM
—PL�J s (-c]N�"'R 24 /G t- 55 ,�P
Sprinkling System �� /r 1
Construction Pole op,U
Underground ❑ Power ❑
Rough Wiring / ?f-Z_9-v7-(C /nG_ Xomlte- (�_" cZ/ ),‘ / p /
o ,:v,
Trenches.' Forms g Steel Reinf. 0 0 7-i0 6'
Floor System (�
Bond Beam ❑ Steel Reinforce 0 � �a
Sheathing isic >;i-yfp-(ty
Frame and Flashing en ,c,-)/-6').
Lathing — In E9—Out EP-- 414-0 Q-/5�6 7-
Plaster, brown coat ,?8'4.) /o-2i (,2
Refrig. ❑ Air Cond. 0 Final
Heating, Final Of s' 4-ge-
Plumbing Fixtures, Final . ,,-/Fv„ -
Final Gas Test/vC it
Electric Fixtures, Final T.1 it If.2/-l4
Building, Final =1-1 r 1/_n1..2'7.
OCCUPANCY *l t //_y j 6t
FORM BU4-5M — 7-61 1'(4 98
FEE RECEIVED
• 17498 JUL 101962
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. .
P. O. BOX 917 COSTA MESA. CALIFORNIA .V
CITY OF COSTA MESA
For Applicant fo Fill In Com etely APPLICATION FOR PERMIT
TYPE OR PRINT - ?- '
BUILDING
BUILDING/// 9 /his/teK �/A/
ADDRESS v
cos
�l�A�MESA. CALIFORNIA_ For Office Use Only
arso, rn Homes Inc.
RECEIPT NO. I 1.11
OWNER /.`T L7CJ
MAIL 1602 W. Almond RECEIV¢h BY I DATE RECEIVED DAE ISSUED?
ADDRESS - �l/ I 7-9-c,
TEL. BUILDING
CITY Orange NO. ADDRESS
ARCHITECT TEL COSTA MESA. CALIFORNIA
OR ENGINEER Ramberg & LoWreY NoKI7-6131
ADDRESS 2127 No. Main St. Santa Ana FIRE I/
ZONE TYPE V GROUP
CONTRACTOR S• V. Hunsaker & Sons APPROVED
BY DATE
ADDRESS 15855 Edna P1 Roe ZONING
Irwindale ZORE / I NO.OF USE OF NEW`✓.y '74..yty
CITY ,fl/ PLANE" 2. 1 BUILDING (/IE-W
ucTNO. 16492fl NO. ED 8-7361. DESCRIPTION 37 y6-r3
SIZE
COX
0 I NO. OF'BLDGS. 0
OF /��/' /ONOW ON LOT. A.P.NO.
USE OFYARDS EVES
EXISTING BLDG. • APPROVED ALLOWED
SETBACK LINE FROM CO (CENTER LINE ST.)
CENTER OF STREET L'/ REAR YARD /;7 FRONT .�_-S-FT. IN.
SIDE YARD I LEFT r I RIGHT c/6// R.SIDE -S FT. 6 IN.
DESCRIPTION OF WORK r
L.SIDE FT. IN.
NEW In V ALTERATION I II ADDITION I REAR 2 7 FT. -- y IN..
REPAIR I I MOVING II DEMOLISH BYPROVED `t�Ff-417,1,9,0 DATE 7/s/6 2.
BUILDIN NO. OF
SIZE ��/+y�,,.j ROOMS 7 .STORIES - •
EXTERIOR WALL✓+'1CCO ROOF Camp. • •1
COVERING • ' I• ( COVERING • ' I •
USE OF BUILDING AND WORK TO BE PERFORMED
Single Family Dwelling n°t ���X �-�, g
with Attached Garage 67A4r" ,3F' 4.
Plan g 9
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I THE AMOUNT SHOWN UNDER VALUATION IS POR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OR, ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF S. V. Hunsaker & Sons . PERMIT FEE $ -51-7i
PERMITTEE s/5; ///_' -
[(/.Q�/./,/J�� �// PLAN CHECK $ 0) 4- —1
AUTHORIZED AGENT dr ' TOTAL FEE -7 d 0
- E
PROJECT ADDRESS: 1169 BISMARK NY-- 4 UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 05932_
OWNER'S NAME: GILHOOLEY, ROSEMARY A
ADDREss: 1169 BISMARK WAY PERMIT NO: P 059323 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA ,MESA, CA 92626
CONSTRUCTION TYPE: V-iN PERMIT TYPE: PLU PURPOSE: OTH
546-0720
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REPLACE SWER LINE SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: 750 . 00 CALC-VALUE: GROUP OCC; R-3 /
PERMITTEE: DAVID KIRBY ( 714 ) 821-0727
ADDRESS: 2849 W. SKYWOOD CIR. COMMENTS • SMOKE DETECTOR REQUIRED IN THE HOME
ANAHEIM CA 92804 ********************************* * FBF***********14***,6**+r****x*u*** ***********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETB ACK S '
I
CITY LIC.:.051145 STATE LIC.:580871 CLAss:_ B
.. /0' I •q 2 Signature: I MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have akenifitat€of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
Compensation lPsurapteq[q,tppJJtifietl copy thereof(Section 3800.Lab.r{:). LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 1 1 b 11./.7-9 1 EXP,DATE: 11 /0.1 /9 2 -
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COMPANY: STATE FUND PARKING REQ: PROV: PARCEL: 14160113 ZNE: REF NO:
D Certified copy is hereby furnished. 2 Certified copy is filed with the city Building Division. PLANNING NOTES>
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te: DDlicanC -) D E V E L O P M E N T S E R V I C E S',i REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section n not be completed if the permit is for one hundred($100)or less).
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become _
subject to the Workers'Compensation Laws of California. .1 ZONING APPROVED BY DATE:
Date: Signature: BUILDING APPROVED BY : DATE:
NOTICE:If,after making this declaration.youshould become subject to the Workers'Compensation provisions of the Labor _
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. I .
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; :Ir7 DATE• A._4.1.---"t _.
whichthispermitisissued(Section 3097,Civ.C). ***************************to***** '***tri, . +- y ,Fft**********fi-*********** ** ** ,
LENDER: ************-******************************tc************************************
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 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 1500
,
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed - 5'% .CIM IP/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of 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 20 . 00
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and theBUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 15 . 00 20 . 00 0 . 0 0 35 . 00 35 . 00 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 35 . 00 OVER/SHORT- U 0
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT ' GRADING PLAN-CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 35 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors' State License Law).l am aware ******************************************************if************************
Mat proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner. PLU 1 SEWER, CONNECTION TO BUILDING EACH 15 . 00 15 . 00
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
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 Duality Management District.Residential construction applications are exempt from
these provisions.
I heApplicant:
hereby /
ifd that I laws
ttl this ingtion and slate that the above informationarepresentatives
ist ties agree to complyterwith all city and boned
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes.
Date: /8 .1 q 2— Signature:_/ . 1 ID 01 0017'111:5-0112513S ""''C T e_L1D—
Driver's License or Social Security a: QATE: lUlulr'4^ - -' "'— '
1641-46 while—Budding:Green—Code Enforcement:Canary—Aoolicant;Pink—Revenue:Goldenrod—Assessor
i ,r . _JL & SPA '. ' - '
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CONSTRUCTION AND PLANNING_ _ _
Date Inspector - Date Inspector
, APPROVALS Permit # - APPROVALS Permit #
1. Temporary Electrical Service Or Pole • ' 52. Pool & Equipment Location
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2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - -
3. Electrical Conduit Utility-Undrgrnd. 54..Forms - - -
4. Electrical Conduit-Undrgrnd. 55. Electrical Banding
5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
' 6. Electrical UF ER Grnd. 57. APPROVAL TOCOVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd.
1
8. Foundation 59. Gas Pipe,0 Undrgrnd., Test
r .
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, ❑-Undrgrnd. - _
'10. Structural Floor System 61. APPROVAL TO DECK
•
' 11. Property Sewer Line & House Connection Ld/,Lht Lt7 62. Backwash & Receptor-Final
•
12. Sewer Cap l 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 - I r 77, FIXED SYSTEM FINAL •
29. Insulation I , I 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 4
36. Hood or Canopy
37. Final Factory Fireplace '
38. Final Plumbing Wilit 6.442 I
.39. Water Service-Final
I
I
40. Gas Service-Final
41, Solar Domestic-Final I
42. Backflow Preventer I i I
- 43. Backflow Irrigation
44. Landscape Irrigation System I
I
45. Sound Attenuation I
46. Handicap Regulations
47. FI NAL STRUCTURE & BUI LDING
48. FINAL PLANNING
49 Electric Release to Edison • I
50. Gas Release to Southern California Gas Co I
51. CERTIFICATE OF OCCUPANCY I
No. Date - i
PROJECT ADDRESS: 1169 BISMARK WY - ' UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 059978
OWNER'S NAME: GILHOOLEY ROSEMARY A
ADDRESS: 1169 BISMARK WAY PERMIT NO: E 059978 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE ' PURPOSE: OTH •
• 546-0720
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPLACE SWER LINE SQ 'FT:
ADDRESS: - - - UNIT: -
•
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: DAVID KIRBY A714 ) 821-0727
ADDRESS: 2849 W.— SKYWOOD CIR. COMMENTS: *
ANAHEIM CA 92804 *******************************************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS .
70001 of Division 3 of the Business and Professions Code, and my license is in full force and effect. - SET- BACKS • p
CITY LIC.: 05114 5 STATE LIC.:580871 CLASS: B
• Dale: I •1.1 - j r' Signature: /' 1' MAIN BUILDING ACCESSORY BUILDING
c, FRNT: FT IN REAR: FT IN FRNT: FT IN 'REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have certificatdof consent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation 1 syyragyc ppj[ rtili yy thereof(Section 3800.La )
POLICY NO.: I.1. �� �L EXP. DATE: 1 /01 /93
COMPANY: STATE FUND,yyI PARKING REQ• PROV: • PARCEL: 14160113 ZNE: REF NO:
' ❑ Certified copy is hereby�furnished. L^I Certified copy is filed with the city Building Division. PLANNING NOTES> _ •
H 7 ' I ��`. /•.t ******************************4***if********************************************
Dale:_ 7•' DECApplLARATION:
f DEVELOPMENT S.-E' 'R V I C E S REQUIREMENTS
1 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This 5ectioe need nol be templeted if the permit is for one hundred(as to or less).
•
1 I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become
• subject to the Workers Compensation Laws of California. ZONING APPROVED BY ?: . DATE:
Date: Signature' BUILDING APPROVED BY : DATE:
NOTICE:N.after making this declaration,wiShu should become or subjectmito the Workers' rempensation provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. • Sr J /
•
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: 7_ " * DATE: l(((* ���
• which this permit is issued(Section 3097,Civ.C). ************************ * F**i Fi * ****** ' ' * w **** ******************
LENDER: ******************************************** *********************************
ADDRESS: LEGALIZATION:N FEE S U M M •A R Y STRUCTURAL SEGMENThN
OWNER BUILDER DECLARATION: I hereby affirm that I 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 PERMIT1}5 0
repair any structure,prior.to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed• J O Z SMI P/NON—RES
pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of 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 .
I, as owner of the property or my employees with wages as their sole compensation; will do the work, and the 'BUILDING—DIV—> PERMIT ISSUE ' PLAN—CHECK TOTAL PAID ' ' DUE
•
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—=--> 1 . S 0 1 S. 0 0 0.0 0 16, 50 16. 5 0 • 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or REVENUE DIVISION TOTALS--> COLLECTED: 16 . 50 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 ol 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 16. 50 •
• ❑ and Professions Code: The Contractors State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware *******************************************************************************
mat proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
•
❑ I am exempt under Section: 8.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dale: Owner ELE 1 FIXTURES LIGHTING 1 ST 20 EA. . . 75 • • 75
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 1 RECEPT/SWITCH 1 ST 20 EA. .75 • 75
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 END OF FEES
permit for construction or modification from the Air Duality 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 information is correct.I agree to comply with all city and county _ .
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned • '
property for inspection purposes.
Dale: i i'17
-1 I Z Signature: / C i ATI 74 L ' 'it
• ti iitl, —.-
Driver's
Drivers License or Social security a:
1641-46 White—mudding,Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
• t
I 1
'
CONSTRUCTION AND PLANNING 1-00L& SPA.
APPROVALS Permii# Date Inspector APPROVALS Permit # • _ Date Inspector
1. Temporary Electrical Sere or Pole i; 52. Pool & Equipment Location .
I
•
' 2. Soil Pipe-Undrgrnd. rc4 53..Steel Reinforcement
;_;3.--, i�ctrisal Congilify=L7ndrgrnCn - 54. Forms
�. .._-
cvs. Electdtal Conduit Fladrgrnd. . ' ' 55. -Electrical Bonding
12_,. el inforcifrl iT . <- < 56. Rough Plumbing & Pressure Test S
I- cactrical OF EliGrnd. 57. APPROVAL TO COVER-GUNITE `.c.
-c r- - •.,r t
" .r otings ? co 58. Electrical Conduit-Undrgrnd. ";
3- .„''F• O oundation - • [ - - 59. Gas Pipe, 0 Undrgrnd.,Test -
= \
S. Water Pipe-Undrgtnd. - . -• 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor jstem . . 61. APPROVAL TO DECK,
11. fhoperty Sewer Line-a& Haase Connection - 62. Backwash & Receptor-Final - ,-
l
12. Ster Cap ....-
63. Heater & Vent-Final
13. Roof Drains •r 64. Plumbing System - Final
14. Rough Plumbijty `' 65. Electrical-Final
• 15. Rough Electrical-Conduit 66.:Solar System-Final
16. Rough Electri6NViring 67..,,Fencing & Access Approval
17. Rough WiringSJ'gn 68. APPROVED FOR PLASTERING '
18. Rough Electrifal-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL '
19. Rough Heating &Air Conditioning • FIRE DEPT. REQUIREMENT -
ir C: -fl n-5 r•-• t. _ -- C-.' c tt---•.CC i-4 c x r:q:rl .
20t1Rot3lh Eactaty FEeplace I Xto •Z'2 is C C e'x rAPPROVAUSCOPeimit # * >- '2"
CC CO C x I S Er `C K S IS:5 X f < 014-4 E-5 > 5 Cr Tin
�+ I-+ .< i -e-. x S x H "" "r. `1 7 ty x r
21.>.1D" uc(s, inIStFecti.4 I '.. ,. ,.^S- x S r* x ,70. Undergro H}g1ro ,K
q S. 2 re A' { .C3 C
22. Dui':Ss, wpnt[tatiri A i CJS x S q:+; * ^71. Produ E Ing O1Sas E Oil
r. n a :gi* n xc-• .r n r-xxs ` - ,
23CC, as ip Roth &• est 7�i x to c.. 0x x ,'72. Undergrgni Flu z# r,
i-
y .. .y , ..a V GAJ n J. i-• S w .". A .-Y r
24mRa4 Ftaming x I FF-, ••r. -s > 0 cr .c x ,S73PUndergrn1.Stoita Tank'OGasOOil"
x x r-* :[ I (ILA_
25. Ro[�f Sfathin x X itt x -r, tr) O co x .S G v -r=- c
9 x v �, x r co* x 74•^.,Overhead Hydrt-
" { ^ s -.
26c,T-Erer Ceiling (Structural) &'Aonocoat a tc a M* * 757 Dry Chemicalrri
.. .. x �S x , ."-4- .-ic x F r„ xJ. '--;•r _
27 Frsne apd Flashin 'co
�-,;s x �, W x 78`Dry Stan ti.pe V m x S ``' n
i-1i28 La ' Int+ .•c --Mu x ),x .� xy .. •.� .V J
1- Pli S.4' g& Siding ic c, ^Irk cc r - I 44••x * 777 FIXED .-P.-, 1ISINAEx ` ��'
"29. Insulatgtt * 0 S •• '° ' x ;r, . lc x x JN
78sFIREPREY. F14951_ * ;. -r,' 3
U J.
30. DrywallNailingxa t� * S ' z: r
' V w .HE,P,LTFFiDEP&..REQUIREN#ENT
ic31. Plaster (frown Coa _S i trtr. �x z tr79`.�FINAL IittJ'SP,ECTFQ( x7 '�s
'¢ x I "r-
x ,x :t :.---- .Lj * t c-
E-32 pElectrical Power Mstct-Final! x ;.+ �...x x .rr.80;r,FOOD CERTIFedit. E ISSUED
a.331Firj I E t"ctr' " cri : //sr,'•�• /f , x `)N`41nes: ` �"
C , i !ter. ,JS .rt l x .1
;t,34F,Finel Ffeatini& Rii5 r onditiprt�,g C-, ' x x '',, •,S rj;4 .* s
v •^ r * .�+ n t rJ yr is :-- ----.
35;2Firfal Gas Pii5'e-Test to * I is * noaa c,^, :ns x m C
i .- . *C24 .• C .- / * ac 2. SO C-i.--i a: NCi:tr
y JS ..(`, x r
w36- Ho9d or Canopy x I rr'-; 4-4 x CI -%r < z co :5 ^^tr
_ S 7 - C , T•; .l- -x Y •r r- x cc 45'-1'r
-137c-fin-al Factory Fireljate, i :�`r `" . ^' % * 'C r. :s cern
M x
`. * Cr: - 4' S I •• •• 0 * :u y - „' *
.-t38. Final Plumbing x Ci I • • x K S I-I s. T
-
r
539. Water Service-Final I co :K s x C; -iv] -. tc -
* S I ? Z K * w mo x :II'XI
: 40. Gas Service-Final x rr <(rrtr S +r ;r1 x * „n, ° .�;
541. Solar Domestic-Finals C -- 3 t I y:v r A,
x rrl ;k x * :t' io .,T K X C
t 42?Backf low Preventeyr, `- t;;',1 " F.
K 4 Oi. r 17 ,'-!
43. Backflow Irrbatiorit tt:SS * * X SF x C
t .v. f:S r .x: .0 n . .
144. Landsca,pe G,:rigation Syster>xtnn rr, - Ox -K N Cu LC Ci.) c CC! ^.lP.r
S45CSound Attenuation l-+.:[F- .T' fi X '-• i- =•>' x ^ l-t r; -'Co •`;:'rt x
rr rC n' . ., * (T! rr 'p x x :- a C C - .1--C
J46-;Handicafl RiAulaticibs C * C CC S CC ,„ x
S �- 3 ° . Q .e O G: *
47SFIiML STRt9CTURE & BUILDING -k - " of s • s
n+ . S I xi x I r
I tr[r ?i '- 'i'x .c U '.0 -' a ..
48c41S LPLANININCi
o49�Electric Release to+.Edison i x `-ev 5 8 E CC i 5 ,_:.c 4
y .. .• r I .: :k :n Q .r, x
x x tt x :K ti c c:c
LL,50sGa�Release to SouEhern Califncnia Gas Co ,; ,, r. � . 0t x C
0--;5-1. CERTIFICATE O OCCUPANCY x * : '' ;. mo •r r-
No. Date