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Home My WebLink About987 CHEYENNE ST - Building PermitsCITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT t1Ti�%��I�ilt�' (714) 754-5273 • Fax (714) 754-4856 . 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT JobAddress: 987 CHEYENNEST Suite No Vicinity: Parcel Nunmber: 14172426 Applicant: GRIGAS, JOHN Address: Owner: Address: Contractor: Address: , . Phone: � � . � . . Zip: ' - .. Status: ISSUED Applied: 05/18/1998 Issued: 05/18/1998 WAMBOLDT;.KAREN LOUISETR � � - > ,�_� ' ��'��.�� 987 CHEYENNE ST - ` � � � =�� - ' � <� � ` _ i ��i\ � - Phone: �� ;��_: � � � . �� .. �" COSTA MESA,CA-. Zip: 92626 = `; ;� ,��. �� /" �V�, . . . �\.w �� -;� • �. �r DICKSONS INCORPORATED ,,,' �� 01918,S�MAIN ST ��' . . � ' � , SANTA ANA CA ArchlEng: ' _ Address: � � � ISSUE FEE Inst FAU <100 k BTU � Inst FAU >100 k BTU � � Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance � Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 70000ctm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater $22.00 $13.25 $0.00 $0.00 $0.00 $13.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 .. � ��. ��Phone:� � . , , - , ,Zip:.�, 92707 - • � _ .. � . ' . . Licenset40732T:� �:., ... ' r . , . - . _. . � .-�. . � ��. Quantity . \ Phone: .. . , . ; � Zip:. . " ' , . Cicense: � � � � �_ ; SCOPE OF PERMIT _ ,'/ i replace fau, install new 3 ton a/aunit' "" -- � _ �'� FEE SUMMARY � � - Repair / Alt Absorbtion Unit _ � . _ - "' Repair / Alt Refrigeralion Unil � ; � , � ' Ventillation System - � � � . Evaporative Cooler " : � � � ",�Corrimercial Incinerator . . - � Domestic Incinerator � � � Compressors /Abso�ption Svstems �- � Up to 3,hp / t00.k BTU - '�,, � 3 To 15"hp / 500 k BTU � ' '15"To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU . - Over 50 hp / Over1,750 BTU , � 6ole�s Up to 3 hp 3To15hp � - � ' 15to30hp� 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee � Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS Quantity .� �$0.00 - 0 ��.$0.00-'� 0 $0.00 .0 � . $0.00 � 0 " $0.00' 0 $0.00 0 � $0.00 0 , $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $48.50 EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a penod of 180 days. . INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inapeetlons end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. ' FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATON DECLARATION: ,- '� I hereby eHirm under penalry of perjury one of the tollowing declarations: ❑ I have end will meintain e certHicate of cnnsent ro self-Insure for warkers' compensetian, es provitletl for by section 3700 of Ihe Lebor Code, for Ihe pertartnence oi the wark for which this pertnit is issuad. � ❑ I heve entl will maintain workers' compensetion insurence, es required by section 3700 of the Lahor Code, tor the performance of �he work tor which ihis pertnit is issuetl. My workers' compensetion Insurance cerrier end policy number ere: ,' Cerrier. Policy Numbec (This secfion need not be comp/eted il fhe Oermif /s valued af one hundred dollars ($100) or less.) ❑ I catlify ihat in the pedormance of the work br which this permi� is issuetl, I shall not employ any person in any manner so es to bacome sub�ect to ihe workere' compensation laws of Celifamla, and agree that if I should become sub�act to the �vorkere' compensatlan pravisions oi Sectlon 3700 of the Lebor Cade, I shall forthwith comply with the provi5/ion,,5.— �/7� 'A` /'' � � ,' �� ('� !�1� Applicant SlgneNre: �1 C�C�L.'f0.�1 � h9 �.`��O--VW� lS�`�"�� Date: /� i CJ � WARNING: FAILURE TO SECURE WORKERS' COMPENSATION ERAGE IS UNIAWFUL SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE MUNDRED TTqU$AN� DOLLARE ($100,000), IN ADDITION TO THE COST OF dJA1PENSATION, DAMAGES AS PROVI�EO FOR IN SECTION 3]O6 OF THE LABOR CODE, INfEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLAHATION: I hereby eHirm thet I em licensed yn.d�p av' a otf�hapter 9(commencing with Section 7000) of Division 3 of the Business tl Pro�gssioru�Cod�e, and my license is in tull j � � force antl eHec�. Lic. # �i 1 � �' l ciess « � — �„ V \ � Contractors Signeture: �+�/�ifi� , � Date: � � D, CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm Ihat there is a construction lentling agency for Ihe peAortnance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lendets Address: SlgnaNre: OWNER-BUILDER DECLARATIONS: Date: I �eraby affirtn thet untler penelry oi perjurylhat I am E7(EMPT FROM THE CONTRACTORS LICENSE LAW for tha tollowinq reeson (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair eny siructure, pnor to its issuance, also requires Ihe applicant for such permit to file e signetl statement Ihat he or she Is licensetl pursuant to �he provisions ot the Contraqors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe Business and Protessions Cotle) or ihat he or she is exempt therefrom and the basis for ihe alleged exemption. Any violatlon ot Section 7031.5 by any applicant lor a pertnit subjects Me applicant lo a clvil penalry ot not more ihan five hundred tlollare ($500).): � ❑ I, as owner of the property. or myemployees wlth wages as their sole compensation, WILL DO THE WORK, and the structure is not intentletl or otFered for sale (Sec. 7044, Business and Professions Code: The Coniractors License Lew does not aDPly to an owner oi proparty who builds or improves Ihereon, antl who does such work hlmself or herself or Ihrough his or her own employees, provitletl that such improvements are not intended or offere0 for sale. It, however, the building or Improvement is sold wit�in ona year of completion, ihe owner-builder will have the burden of proving ihet ha or she dld not builtl or improve for purpose of sele.). ❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ta construct the prqect (Sec. 7044, Business and Professions Code: The contrectors License Law does not epply to en owner of property who builds or improves ihereon, end who contrac�s for such project with e conirector(s) licensa pursuant to the Coniractors License Laws.). ❑ I am exempt under sec. Business antl Professions Code for Ihis reason: SignaNre: Da�e: Owner ID venfied by tlnver's license. ❑ Ves ❑ No DriveYs License No. Verificetion ot Ownership by (rype ot document, i.e. - property Ia�c bill or daed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certily thet no e:cavatlon tive (5) or more faet in depth into which a person Is requlretl to tlescanq will be made in connaction with work authorizetl by ihis pertnit, and Ihet no building structure, scaHoltling, telsework, or tlemolition or tlismantling t�eraoi, will be more then thirty-sia (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle 8, CelNornla Atlministrativa Cotle). . ❑ As owner-bullder, I will not employ enyone to tlo work which would requlre a pertnit irom ihe Division of Industrial Sefery, as noted above, unless such person has a pertnit to do such work from �he tlivision. , SignaWre: Date: Division of Industnal Safery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AUiHORVA710N OF ENTAV: I certity under penalry of perjury thet I have read ihis epplicetion and state that ihe intormalion given is correct. 1 egrae to comply with ell state laws and city ordinences relating to building consiruction, and authonze representatives of the Ciry of Costa Mesa to enter upon the ebove-dascribed proparry for inspeclion purposes. 1 agree not to occupy or allow occupancy of any building authorized by ihis permit until final inspection. COOE 1. INSFECTON TYYE 1616 Fixed System Finel Fira Prevention 1266 Pool Spe Final 200 Finel Re-Roof 201 Final BIocWRetaining Wall 202 Finel Fectory Fire Plece 203 Final Sign 204 Final Demolition 2d46A6 DAg U1TID915 S %(ci'� � `i�? Data �Q�l INSVECTIONTYPE 206 Finel Mechenicel 208 Finel Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Finel Planning Approvel 222 Final Site 250 Finel Building/Occupancy �.I JIII.. • • • • � 'o .A.,` CITY OF COSTA MESA - . , _ � BUILDING DINISION � DEVELOPMENT SERVICES DEPARTMENT � ._ _ FAR_OOd95 �� PERMIT . PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT JobAddress: 987 CHEYENNEST Suite No Vicinity: Parcel Nunmber: 14172426 npp�icant: GRIGAS, JOHN Address: Phone: Zip - owner: WAMBOLDT; KAREN LOUISE TR Address 987 CHEYENNE ST � COSTA MESA,CA . '. - Contractoc DICKSONSINCORPORATED Address' 01918 S MAIN ST Phone: Zip: Status: ISSUED Applied: OS/18/1998 Issued: 05/18/1998 _ , � � ,., . ' � - . � \ 92626 -�, .. _ � ' � "� �-= .., � ., ,� A�: _.,,' � - . A��,\ / . � ,' , , � - Phone: � . .,. . � � , il SANTA ANA CA Zip: �Y-92707 � ' � -' License:40132T :�. ' ' ' SCOPE OF PERMIT electrical work incidental to mech work. run a 230circuit for 3 ton a/c uni 0 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res-(3+units) Pool / Spa iighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp . Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Lighl Pkg Sign Circuits Temp Pwr Pole Intermed Pole. $22.00 $0.00 $54.50 $o.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 Quantity 0. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting � Busway /100 ft ' _ � ^ - Standing Section .' ' _ " - Misc Electrical Equipment - ` Transforiners up to 1 kva/kw ............._'.up to 10 kva/kw � ..............:..up.to�50 kva/kw � ...........'....up�to 100 kva/kw ..................over 100 kva/kw ; Low Voltage Equipment . Low Volt Wiring System / Ckt . - � ' � Misg Conduit ,�� -Misa Conductor . , : �Circns ( gen or ride) � . • Circus"(mech dde or lights) . � ' . Christmas Tree Stand ` - , � . � Fireworks Stand" ' � - ' Other Electrical Fee � Investigation Fee Plan Check Fee , � Reinspection Fee Gluantity $0.00 0 $0.00 0 $0.00 0 . $o.00 o `� , $0.00 0 $0.00 0� $0.00 0 $0.00 �0 $0.00 � 0 $0.00 0 $0.00 ' 0 $0.00 0 $0.00 0 $0.00 0 $0.00 , 0 $0.00 , . 0 � . $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E76.50 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 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 tinal approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 . 7 ,"7 WORKERS' COMPENSATION DECLAHATION: �' �� I hereby affirtn under penalty of perjury one oi ihe following declaretions: .. . ❑ I heve end will meintaln e certiticate of consent to self-Insure for workers' compensation, es provitled for by section 3700 af tha Lehor Cotle, for the pertortnence of ihe work for whiCh t�i5 pertnit is i55ued. � ❑ I heve end wlll maintein workers' compensation insurence, es required by sectian 3700 of the Lebor Cotle, for ihe performance ot ihe work for which ihis permit is issued. My workers' compensatlon Insurance carrier end policy number are: Certler: Palicy Numbec (This secNon need not be completed i/ the permit is velued et one huntlred Dollars ($100) or /ess.) ❑ I certiy thet In the pertortnance of the work for which this permit is issued, I shall not employ any person in any menner so as to become subleci to ihe workere' compensetion laws of Celifo 'a, end,ag�ge ihC' I uld be a subJect to Ihe workers' compensation provislons oF Section 3700 of the Lebar Cotle, I shall forthwith comply with ihese rovision \1 l ( . � � � / � � Applicant SignaNre: �n� (� ��hG.4 . Date: � ( . WARNING FAILUPE TO SE RE WORKERS' COMPENSATION ERAGE IS UNLAWFUL M1D SHALL SlIB1ECT AN EMPLOVER TO CfiIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE HUNDRED TTpUSAND DOLLARE (E100,000). IN ADDRION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 31W OF THE LABOR CODE, INTEREST, AND AT70RNEY'S FEES. LICENSED CONTRACTORS DECLAHATION: I hereby eflirtn that I em licensed force end aHect Lic. # Contreaors Signeture: �� 9(commencinq with Section 7000) of Division 3 of ihe Busine and Pr u,'�9� Code, and my license is in full /- Class a � "' � lJ i� _ Vj„i..�z�e: / � , � CONSTRUCTION LENDING AGENCY: � ❑ I �erehy affirtn thet there is a cansiructlon lending agency for iha peAortnance of iha work tor which this pertnit is issued. (Sec. 3097, Civil Cade). � Lentlels Name: Lendels Address: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby efflrm ihet untler penalry oi perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professlons Cotle: Any ciry or counry which requires a pertnit to construct, alier, Improve, demolish, or repair eny siructure, prior to its issuance, also requires the applicant tor such permit to iile a signed stetement ihat he or she is licensetl pursuent to the provislons of the Contredors License Lew (ChaD�er 9(commencing wit� Section 7000) ot Division 3 of ihe Business and Professions CoOe) or Iha� he or she is exempt theretrom and the basis tor ihe ellegetl examption. Any violation of Saclion 7031.5 by any applicant for a permit subjecis ihe appllcant to a clvil penalty of not more ihan five hundred dollars ($500).): ❑ I, as owner of the properry, or my employees with wages as their sole compensation, WILL DO TME WORK, and ihe siructure is not intendad or oftered for sale (Sec. 7044, Business entl Professlons Code: The Contractors License Law tloes not apply to en owner oi properry who builds or improves thereon, an0 who does such work himselt or herself or through his or her own employees, provided ihat such improvements are not intended or offeretl for sala. If, however, the bullding or Improvement is sola within one year of completion, Ihe owner-builtler will have �he DurUen of provinq Ihat he or she ditl not build or improve for purpose of sale.). ❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTFiACTORS to construct ihe projec� (Sec. 7044, Business and Prafessions Gode: The con�rectors License Lew does not epply to en owner of propeM1y who builds ar Improves ihereon, end who conireds for such proJact with a coniractor(s) license pursuent to ihe Coniraclors License Laws.). ❑ I am exempt under sec. Business antl Professions Cotle for �his reason: SigneWre: Deta: Owner ID veritied by drivafs license. ❑ Ves ❑ No Driver's License No. Venlication of Ownership by (type of tlocument, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATION: Expires: ❑ I here6y certly ihat no excavation tiva (5) or more feet in depth Into which a person Is raquired to descand, will be made in connection with work authonzetl by this permiL end thet no builtling structure, scettolding, telsework, or demolition ar dismantling ihereof, will be more ihen thirry-siz (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomie Atlminisirative Cade). � ❑ As owner-bulltler, I wlll not employ enyone to tlo work which would require a pertnit irom iha Division of Industrial Sefety, as notetl above, unless such person has a pertnit to do such work from the tlivision. SigneWre: Date: Division of IndusMel Safery Pertni� Number: CERTIFlCATE OF COMPLUWCE AND AUTHOR¢ATON OF ENTTiY: I certity under penalty of perjury the� I have read �his epplicetion end state that the intormetion qiven is wrrect. I egree to comply with all state laws and ciry oMinances relating to building consiruction, entl euthodze representetives ot Ne Ciry of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorizetl by ihis permit until final inspedion. COOE I INSPECTIONTYVE 1616 Flxed Sys�em Finel Fire Prevention 1266 Pool Spa Final ' 200 Final Re-Raaf � 201 Final BIocWRetaining Wall 202 Flnel Fectory Fire Plece 203 Final Sign 204 Final Demolition 269&da 5 / 8 ° `�% �'i oate �g ��bf f�QyEj INSPECTIONTYVE 206 Final Mechanical 20B Final Plumbing 210 Final Eledncal 212 Final Fire Preventian 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy ♦ l5 � �41.� e PHOJECT AOOflESS: 9 g 7 CHEYENNE ST OWNEfl'S NPME: WAMBOLDT ALEXANDER TR aooxEss:. �375 RIV�RSIDE DR SANTA ANA,CA 92706 AflCN/ENGINEEP: � 7 1 4� flEG.NO.: ' aonness: UNIT: uxir: PEHMITTEE: R,H. HUILAING (714)524-2920 aooAEss: �0��0j2 pP.O, BOX . LICENSEO CONTBpCT0i1b�C[AN�A1N: I �ereDy alfirm iha� I am licensetl untlaCr pr�ovisio�n ��ap�er 9(commencing with Section 70001 ol Diwson 3 0l the Business antl Pmlessions Code, and my license is in lull brce and eilecl. CITY LIC.: STATE LIC.: � SS: 051782• 55331,0�,,� /� C�39 Oai¢'. —(_(—�� SignaNre: —}� -��9 WOHNEflS' COMPENSA710N �ECIAflFTION: I hereby aifirm ihal I �ave a ceriili➢31e oi consem m -i ure ar a cenilicaie o1 Workers' Compensa�ion Insurance. or a certifietl copY �hereo� (Seaion 3800. LaO. C�. roucrNo.: 1143259-90 EXP.ORTE: OAIOLI9S COMPANY: STAT� FUND ,] Certifietl caDY is nere y fumi5�e0. � Certi�ied copy is ' - th/e�ciry Builtling �ivisian. �ate: � �` � �� ApD�icanc ✓U" � v E%EMPTION FBOM WOBREBS'COMPENSATION OECLAHATION: Qhissec�ian neetl nolbe mplele0ilthe permi�' � e hunOretl�$700�or1e55). I certify �hat in Ihe petlormance ol the work far whicn �his permit is i55ue0. I s�all not employ any perso any manner sa as �o become su�lec� �o Ihe VJorkers' Compensation Laws of Cah�omia. Oale: ' SignaNre: NOTICE: II. afler making I�is Oeclaration, you shoultl become sublect �o the Workers' Compensa�ion D�ovisions of I�e Labor - Code. you musl forlhwilh comply with suc� pmvi5ion5 or Ihis permii shall Ue Deemed �evoke0 CONSTNUCTION LENOING RGENCY: I hereby al�irm Ihal Ihere is a tonstmc�ion lending agency for Ihe Dedormance ol Ihe work lo� w�lc� thls permn ls issued (Sectlon 3097. Civ. G�. LENOEfl: AOOflE55: OWNEP BUILOEP OECIABATION: I hereby alh�m Iha� I am exemp� �mm Ihe Contracior5' State License Law for Ihe Ioilowing reason (Seclion 7031.5 Business and Pmlessional Cotle' Any ci�y ol coun�y which requires a permit to cons�mct, altei, impmve,�tlemolish, or repair any SlmcWre. prior �o iis issuance. also requires �he applican� tor such permit �o file a 5igne0 s�a�ement �ha� helshe is licensetl pursuanuo Ihe pmvisions ot Ihe ConVamors' Slate License Law (Chapter 9(commencing wilh Sec�ion 7000) o� Oivision 3 0� Ihe Business and Pmlessions Coae) or t�at �e/she is eeemp� ��erefmm ana ��e basis for �he allege0 exemption. Any violalion ol Section 703L5 by any applican� �or a permit su�lect5 �he applican�to a civil penally ol not more ��an five huntlrea tlollars ($500). I, as owner ol Ne pmveny or my employees with wages as ineir sole compensation, will tlo the work, ana Ihe ❑ Slmqure is noi inlenAed or oileretl tor 5ale (SeC�ion 7044. Busine55 and Pmfe55i0nal Cotle'. T�e ConVatiors' S�a�e License Law does no� aDPty �o an owner o� a pmperiy who builds ar impmves Ihereon, and who does such wo�k himSelVhe�self or �hmugh his or her own employees. pmvitled �hat such impmvemen�s are nol inten�ed or oflere0 �or sale. I�. however Ihe building or impmvemen� is sold within one year ol campletioq �he owner will have ��e burden o� pmving he/she did not 6ui10 or imDmve �or Ihe purpose o� sale�. . ' I,as owneroflhe propeny.am exclusivety conlraciing wiN licensed con[ractorsto constNc��he pwlect(Sec�ion 7044, Business ❑ antl Pmlessions Cotle: The Contrac�ors' State License Law tloes nol apply lo an owner oi OroDenY w�o builUs or improves Ihereon antl who conirac�s for such projec�s with a tonlractor�s) license pursuanl lo Ihe Coniraclors' Slate,License Law�. I am aware I�ai pmof o��hert Warker'S Compensalion msurance ShoWd be provi0etl �o me. � I am exempt under Seciion: B. 8 P. C. � br ihis reason: �ate: Owner I tla �ereby cenity ��a� I am aware oi an0 un0erstantl �he reqwrements ol Cali�omia Healt� and Safery Code Seciians 25505, 25533, antl 25534 antl that I or any fulure builtling occupzni willlwill nol (cirde one) neeU lo comply wilh saiU s�a�e cotles antl �he reQuirements lor a permi� b� consimction or motlilicalion �mm��e Nir �ualiry Management Dislric�. Resitlen�ial consiruction aDDlicalions are ezemp� imm Ihese pmvisions. �ate. qpplicant: I here�y cenilyiha� I have reatl Ihis applicaiion antl s�aii ortlinan[es and s�ate laws relaling lo bwltlmg conslmction pwperty for inspeqion purposes. / �a�e: �7=p[�_ Sig a�l ture'. �rivefs License or Sacial Securily Appl¢anC Plnk—Revenue'. Goltlenrotl—Asseswr � CITY OF COSTA MESA — BUILDING.PERMIT PERM.NO; H 04979 PERMIT NO:•B 049798 PLAN CHECK NO: ' N GOVT: N SUPP: N CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE:,ALT JOB'DESCRZPTION : RESHEATH & REROOF 1/2"PLY/25YR COMP SHIN SQ FT; � 3,200 CLA'IM VAI.I7L•': , 3, 200, 00 CALC—VALUE; 3, 200. 00 GROUP� OCC: R-3 /M-1 COMMENTS: SMOKE DETECTOR(S) RE�UIRED IN HOME, i If�kifiFikiEiElEif�lEilMiFiflfjfifiFiEiE1FMlF1f�FiFlf�flFiF if1EiF)EiEiElFiEafiFlEifiE.lEiFiEiElEik1ElEiPiFiE�f1FiE +�+� dE_ Z O N I N GS ERTEHQAUC IKRSE M E N T 5�� U�� ;�.`"� ------- ---- MAIN BUILDING ---------- --------- ACCESSORY BUI'LD71ad��-- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN LEFT; FT IN RGHT: FT IN ' LEFT; FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL: 14172426 ZNE; REF NO; � PLANNING NZSTES> . • ' � � 3fifififikitiEiF3fiFififlFlFiFkiFififiFififiEifitififiFifiFiEifiEiEiF1E1F*IEIf�1FiF�f1E3EiE1f1FiE3f3EiFiEiFif3ElfiflfifiFiFiFIFiEiE±E�Fifif4lfiFifiEkifiFiE � D E V�E L O P M E N T S E R V I C.E S R E Q U I R E M E N'�T, S ZONING APPROVED HY ' DATE: �" BUILDING APPROVED HY : DATE: APPLICATION'ISSUED BY: � "�1 DATE: �� ir�kiticitiF **ieieitititieitlr *irit�rit k3f T •��F7 F7E FiF1Fi6iFiFiF7FiF3FiF�ElE*aEiEit **itit IE�F iF1EiFifiFiFiEitiFiEifikiFlEiEiFiFIFiFif�ikklEikiFitifiEifitiElkiFiFkiElFiliEifi iFkiE{ Eif3f�E3E1FiEifiFiElEiE1EiE3EjE1E�lfihaEaklEiEiFikiEiFifiFiFiFiEiE3f � LEGALIZATION;N F E E S U M M,A R Y STRUCT'URAL SEGMENT:Y �� BLDG PMT PLUMHING ELECTRIC •MECRANIC . EIRE SMIP./RES GRADING PERMIT 63,00 >; • ,50 ' ` SMIP/NON—RES ' PLAN . , ISSUE FEE ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK�`' TOTAL � PAID DUE TOTALS----> 63,50 0.00 0.00 63.50 63.50 ',00 REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHORT: ..QO HLDG PMT PLUMBING ELECTRIC MECHANIC �.FIRE SMIP/TOT GRADING PLAN—CHECK � 63.00 � .50 � � iFit if it iF ik IF iF iE iE iE k dF if k!f iE il� ik iF If iE lF 1F iE iF 3t 1! iF if If iF 1E if iF iE iF if iE k 1F iF if 1F,1E iF if iF 1f if IE �F iF iFlE it 3f if IEiE 1E If if iF if iP �lt if IF if if iF iE 1F If IF it if if � ' I N D T V I D U A L`', F E E B R E A K D'O W N TYPE QTY D E S C R I P T I O N,� UNTT COST TOTAL COST SFR 3200 REROOF BY VALUE RESIDENIAL — N020NE , 1.00 3,2Q0,00 END OF FEES ! • A � lZ 3C�i7�IG?"44Q��33 �7_!� cS,�,J7 L'�7E; 1!liii/9Et TIt1E: i`:23 i . CONSTRUCTION AND PLANNING "� - PG. _ d SPA � APPROVALS Permit # Date �� Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service;oi Pole,_.,ti . 52. Pooi & Equipment Location � 2.ySojLPipe-UndrgrPn,d. J f�� F 53. SteelReinforcement p3;=Electrical Conduit�UtQity-Undigrnd.;�:'� 54. Forms � %4'�Elecirica� Conduit=Undrgrnd. �' ,"-�r', � • 55. Electrical Bonding �'� :(� � rt �J . � :�5_�Steel Rei�forcement `�rr 56. Raugh Plum6ing & Pressure Test - �6. ElecYrical UFER=Gmd. �� 57. APPROVAL TO COVER-GUNITE � ,nafr�t � . t9,;;F-ooiings r� � 58. Electrical Conduit-Undigrnd. � ��B:�Foundation �� .. 59. Gas Pipe, O Undrgrnd., Test � G r,e-n -i �'9:��iVater Pipe�Undrgrnd. � S� 60. Backwash Lines, P-Trap, C] Undrgrnd. • 10~Structural Floor System � -- 61. APPROVAL TO DECK .� 11�?;Property Sewer Line`& Hpu'e,Connection �, 62. Backwash & Receptor-Final � 12. Sewer Cap �, ;�, ,. y � � 63.. Heater & Vent-Final �� 13. Roof Drains �, - 64. P�umbing Systerti - Final 14. Rough Plumbing` `" .�` 65. Electrical-Final � • 15. Rough Electrical.Conduit �� ' 66. Solar SYstem-Final - 16. Rough Electric Wiring r � 67. Fencing & Access ApProval i-1 77. 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 � � - . - - -- - - � Cr�r.uu �• a. a. N 20. Rougfi FactorK Ficeplace ��T? eC" ^ G a C:!: ��ppROVACS��= Rermit # '� ?` �� Cq E' I.Sb' ti:•Q .t. � .� C'+ . J �%. �4tirtir > � G: tV J`- 1..a t^t' r.` :p r-r -1 ':.4, v. 2. .�i-�-`vy Li> �- L�7 21. O:ucta, in`Structurq�p� .. .. y..��_, � ;c [� : :M �. �ZO. Undergrovnd`NYdto x 22. Duct? Ventilating'-a� i :J5 ?_ ^ �' 6A � r7�7 product Pjwng O'GaS ❑ Oil n7:- i F d C: c.ic: u. �' - ' i ti. ? � C r.'Y. ;" f... � nc� '., Q5 ;.�+ 23. Gps P1PQ;Rough & Tgst � ,❑: :� ,r ,x �y� , �7,Z, Undergrourtd FIusR i?�v M f.. �.,� 24. Roof�raming ;y ' F: � ��(� f3 9p� o' �,�' �3. �Undergrnd=Storage;Tanok �Gas ❑piP 25. Roof'Sheathin '''`;' '� �` �`� r•� [n :. n;x ��- v r�--c x � 9 .y : v:.� � � ;�77. � ��4. iD.perhead Hydro p' �. . 26. T:BarCeiling (Stru�tural) & Mo�ocoat �r ^ t�n : �� i 75. �D�y Chemical ^^ � �-� ='� � 27. ;F�ame and,Flashin'". r�� m Y: `� �•.^•', n;�, :•: S ca t� �.. :�1.. ��rr,n: + c• r�:r . 76.'Dry StandP_lPe, t-t� z O :J ~r . .. : ' )�J V -T /....� . _ ... �� Lr �28• Lathing &:Siding ^:V :. ^�Sx � � ?' •�i �•a� � 77. cpIXED SY�STEM�F��AL * v r• 29. Insulation� � ^,' {' '� �`.; '�� R' 78.=FIRE PFEV. FINAI� r 7 q b � � 130. Drywall Naili g ��-�t. �' ,� � �+ � � ., = r• :� � HEALTH �EPT. REQUIREMENT 31. Plaster Brown,Coaj,;:` S �,,..� �� r/.'� ;.79.'F�NAL IN�ECT101V v i32. .Electrical,Power Njeter�final i �� :t. v � � � .50. �EOOD CERT�7aTf ISSUED � � 33.'Pinah'�Elec`tric.�' �"" ' i � '�. � � ' �� k' �ftlotes': a ��S ' � r? -\ [s% ✓ YX t%1 i �? I'r Y.: �yiq Y: ��. v :.+' [" P:'. �"' U: I. r-t.�, � �. •.� �. :34. Fina�-Heating�& Air Cond�tion,ings �; 5',1<-f��= „ �. � r'� !� � d C< < .r 35. �Final-Gas-Pipe=Tesnr }W } ^ `i?� �t�.! + ; � ;-; ,n,5 :�. p� ;� _: .'1 '(li R r �� /?. r i:i [jp{ t �n' 36. �-1 d�; _. o: . �l n7 • : i a- �. o. oo� or CanoPY O+-. p4 � �^ n /�,'�7�w" � r C�c z ^�^ 37. Final'Fac�ary FirePface"� � y�� " .: �:7 '�.Y ��' 'Z �q'D � S�� "• Q r-. r� .. .. , ., �: , i38. Final;,Plumbing 'K 'K;y �' � y.'u u��. � � i� ::r, ij r39. Watec:Ser.vice Final =:. �'t- < I�,+ '„ �: re!*; r. r.; i� . � , :: s � U: 1 , t� + i+ �.=J .r S 40 Gas Service�FiYal lf ,., . r•r :- :: _n `, : r"' , • '. ' ` ` � L:' v � 'Lt i ��f� � G•_ n,ru a. '41 . Solar pomesticFinaM� �" :� � � •- �+ Cs � �(' � r n� �-. =� � - ! ] n. i+� • !S' '-10 �I 'T '42. Backflow;Preventer:'r -' �: "� , "' " "� :' ' '� pJ x I �i:: u; ^.ic-. .:y i_. �.a 43. Backflow5lrrigation � � `:S < w � � �-o . � Ly4. �andscaRe Irr gationSystem;y�� ;x p �r� r-; "� � � � '".� '�''- , " �_. .`�� li :::,.. [U �45. $ound AttenUation�+� . -��E-- . ' � -' .- � :� :-+ :-� "'�� C�� =. -• - - c �r. ;r. �;r.� ' L. - _F, + ` �46. HandicaP Regulations - , ._ y� � ' .. .•z:: ^; '^ . ;-,;_, ..rc z �c . .�, �. •� :�^ �. 47. F.iNAL STRUCTURE.& BUJLDING � ��R "�iO �►,�' J tu��S �� a ,, r "' � ' `: - 48. FlNA1 PLANNING: : s t�':�' �/ T c:� �: : , %� 1 �_. !(' t Ft-. . i..: I� ��r. pt V7 �; x �. .49. Elect�ic Release to Edison � ;:3 � � S �� y . :-: r� .r �-= '50. Gas Release to SoutFiem Califor�ia Gas Co ' � � ` '_' '�' � =' ' ; .] 4 .J '-i - I J��f:: F'� r) • �J��) b 'S1. CERTIFICATE OF QCCUPANCY' , � j �7�� , ;, [� �; N0. Date ��' � 28457 ,� sa�.�fl �, �*•**#3:00 COSTA ME5A BUILDINCrSAFETY DFPARTMENT P.O. BOX 12� COSTA MESA� CALIFORNIA 82628 - JOBADDRESS q$7 Chevenne GENERAL CONTRAC70R �gp� � AP No. LOT 1( INSPECTIONS SOIL GAS WATER ROUGH PLUMBING PROP. SWR. I.INE � HOUSE CON. � SPRINKLING SVSTEM MISCELLANEOUS ROUGH HEATING AN� AIR LONOITIONING TEMPORARV SERVICE OR pOLE UN�ERGROUN� � POWER � ROUGH WIRING TRENCHES � FORMS STEEL(iEINP. FLOOR SVSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME ANO FLASHING LATHING - IN n OUY ❑ PLASTER, BROWN COAT STRUCTURAL, FINAL HEATING. VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL ANO GAS TEST � ELECTliIC. FINAL BUILO FINAL DATE SUBCONTRACTOR 27591 COSTA MESA BUILDINGSAFETY DEPARTMENT P.O. BO% tP00 - COSTA MESA, CALIFORNIA B263E for Applfcant fo Fill In Compl tely TYPE OR PRINT eu��oi ADDRESS - COSTA MESA. CALI ORNIA MAIL � II1C . NO. 2 TEL N OF LOT 6O 7C ZOO � Now 'N �w O USE OF , EXISI'INO BLDG. aerewcK un� rnor CHNTeR OP Yn1[[T Q� RiAR Y O 29 • SIDBYARD LiRT 6� RIQHT 6� DESCRIPTIOtd OF WORK - iL•: F�,�� SFP?5-67c�isaOQ o91�"• ;�:��::^.99J�i� APPLICATION FOR PERMR � BUILDIN(i For Office Use Onfy 11[C[Irl'NO. � j(� ZONING xo. o� uac �uns � sun A. P. NO. ! r�.yv � � N0T6: NO HAV6 OV[RHAN6 BHALL �6 LE88 THAN YARDH MPROV HD MAIN BUILDIN6 s Lot lb - B Plan • J� 6sc. r 1 XHRlBY ACKNOWL6D0[ TMI1T 1 MAVB RHI1D TXIB MPLIGTION TIH I�MOVM 84 AHD 8TAT6 TNAT TN6 A80V6 IY CORP6C}�ANO AORE[ TO COM• �URP098 OP [ PLY WITX ALL CITY OROINANCY�TAT[ L11W{ R60YI.ATINO y�UAT10N BUILDINO CONBTRUGTION. SIGNATUR OP a PERMITfH � $ ^� / (�+� o �o i AUTHORIZBD AO[NT YAROS MPROVHD ACCEGSOFY BUILDINO cwre / � � � i � � i a � � 1 y� "' � 0 UNDER VALUAiION IB FOP T18 j 18MIN0 A PHRMIT F8H ONLY. 5 � PERMIT FE8 $ �� p 33� w TOTAL FEE $ � /