HomeMy WebLinkAbout3024 CEYLON RD - Building Permits�
CITY OF COSTA MESA
BUILD/NG DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: E08-00154
PERMIT TYPE ELEC STATUS: ISSUED
APN: 13918105 DATE ISSUED: 0413012008
�-�'--.,':,;ISSUED BY:
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JOB ADDRESS: 3024 CEYLON RD CM �Suite/Umt -_
Vicinity: � � - - -
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SCOPE OF WORK: REPLACE &`UPGRADE�70�AMB:�SERVICE TO 200 AMP. SERVICE�= SAME'LOCATION.
OWNER: VESTERBY
PHONE:
APPLICANT: ESTES,
PHONE: 714-03fi
CONTRACTOR: CHI
Address: P O
City/State: COt
Electrical Plan Check
Electrical Permit Fee:
Reinspection Fee
TOTAL FEES
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RENEE M> Address: 3024 CEYLON RDr Umt ,��;y�::
%� � _ . 'City/State/Zip: ; COSTA�MESA CA z.,
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i2 ���" � City/State/zZip:�����COSTA-MESACA �: ��;
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fY CON$TRUCTION'INC� License No. :861162 ';'^ ' ':
{ 2992Umt:_� . . -PHONE ; 714-436-0202 . :. + . ' ; i;
MESA.CA�.; .� �ZipCode:.92628.-:' .. '. � �' CELL:�'�. .�;.. ;'i
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NOTICE: The vrork authorized by this permit shall comply with all applicable handicap access requirements under Califomia stalutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 780 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, and all
required inspections and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiraGon of this permit.
C0� . INSPEC710NTYPE
1616 Fixed System Final Fire Prevention
1266 Poot Spa Final .
200 Final Re-Roof
207 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Slgn
204 Final Demolition
OATE IXIITALS COUEt INSPEC710NTYPE
206 Final Mechanical
208
210
212
220
222
25
Final Plumbing
Final Electrical
Final Fire Prevention
Final Planning Approval
Final Site
Final Builtling/Occupancy
DA1E INIRUL
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WORKERS' COMPENSATION DECLARATION: Owner ID verified by driver's lics ] Ves ❑ No
I hereby aKrm under penalty ot perjury one of the followinq declarations:� �� Driver's License No. Expires:
❑ I have and will maintain a certifcate of consent to self-Insure for vrorkeis' Veri(cation of Ownership by (type o� document, i.e. - property tax hill or deed):
compensation, as providetl for by section 3700 of the Labor Code, for the
p`er/formance of the work for which this permit is issuetl. � �
C��y have and will maintain v.orkers' compensation insurance, as required by
secl'qn 3700 of l�e Labor Code, for the performance of Ihe �xork for which this' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy � � hereby certdy that no excavation five (5) or more feet in tlepth into which a
num6er are: erson is required to descend, will be made in conneclion vrith work authonzetl
�/ ��-�--� � I/� ��O r�Yj �� ihis permit, and that no builtling stmcture, scaHdding, falsework, a demolition
Carnec � I or dismantling thereof, will be more [han [hihy-six (3fi) feet high. (Chap. 3.2, Grp
(T�is seCion need�at Ge mmpkfetl!!he peimR is valuea at one huntlicd tldlars (S100J or less )
2�^ _ OOD ���� 2' Art 2' Sec. 341, Ttle 8, Cali(omia Administra[ive Cotle).
Poiicy Number: ii
�� ❑ As ownerbuiltler, I will not employ anyone to do work which would
❑ I certify that in ihe pedormance of the work (or which this permit is require a permit from the Division of Industrial Safety, as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to tlo such work from the division.
to the workers' compensation laws of Califomia, and agree lha[ if I shoultl
become subject to ihe workers' compensation provisions of Section 3700 of
the LaDor C de, I shall orthvnth comply with these provisions. Ava���ncs s�9�awre oaie
��C//�^ Division of IntlusMal Safety Permit Number.
Aypl�nl's Signa�ure L_Oat�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Sec[ion 7000) of Division 3 of the Business and Protessions Code, and
my license,is in full force and effect.
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uo-u� � Class#- /
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onl2ct SignaWre vDale
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
peAormance of ihe work fa which ihis permit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
Signature Date
OW NER-BUILDER DECLARATIONS:
I hereby aKrm ihat untler penaity of perjury thal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe (ollowing reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any strucNre, prior to i[s
issuance, also requires the applicant tor such permit to file a signed statement
tha� he or she is licensed pursuant to lhe provisions of the Con�ractors
LicenSe Law (Chapter 9(commencing wi[h Section 7000) o( Division 3 of Ihe
Business and Professions Code) or [hal he or she is ezempt there(rom and
lhe basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty ot not more ihan
five hundred dollars ($500).):
❑ I, as owner of [he property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the stmcWre is not intended or
oftered for sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law does not apply to an owner of property who builds or impmves
thereon, and who dces such work himself or herself or through his or her ovm
employees. provided ihat such improvements are not intended or offeretl for
sale. If, however, the building or improvemenl is sold within one year of
comple[ion, ihe ovmer-builder will have Ihe burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCWSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044. Business' end
Professions Code: The coniractors License Law dces not apply.to an owner of
property who builds or improves thereon, and who contracts for such project with
a contracta�s) license pursuant to the Contractas License Wws.).
❑ I am exempt under sec. -
Business and Professions Code (or this reason:
SlgnaWre Date
305)�A6�3/0])
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or present or future building occupant need to Lle and
certify a Business Plan (or emergency response ro release or threatened
release o� a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceplions, that a Business Plan be (led with lhe Cos[a Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantiry ot hazartlous matenals equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
al stantlard temperature and pressure).
2 Does or will the applicant or presen[ or fu[ure building occupant neetl to file
a regis[ration /orm for acutely hazardous materials? ❑ Yes ❑ 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 [ime has on hand a quantity of acutely
hazartlous materials equal to or greater than a weight of 500 pountls, or a
volume ot 55 gallons, or 200 cubic (eet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or IUWre building occupanl need to
prepare an RMPP (Risk Managemen[ and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health ana Safery Code provides that the
Cosla Mesa Fire Department may require ihe preparation, certification and
filing with [he Fire Department of an RMPP by businesses which are required
to regis[er acutely hazardous materials with the Fire Department.
4. If an RMPP is presentty require4 has Section 25534 of the Califomia
Heal[h and Satety Code been (ully complietl wilh? ❑ Yes ❑ No
5. Does or will [he applicant or present or future building occupant require for
the work which is the subject ot this application a permit for such consWction
or modiLcation /rom the South Coast Air Quality Management Distric[ or from
any other air pollu�ion control tlisMct or agency? ❑ Ves ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
intormation be fumished on applications fa non-residential builtling pertnits).
6. Will any part of the facility ro be cons[ructed untler [his permit be within
1000 feet from ihe outer boundaries of a school? � Yes ❑ No
Qf "yes", the facility must meet the requirement o( Sections 25534 antl 42303
of the Cali(ornia Health antl Safety Code).
7. If a permit from the South Coast Air �uality Management Distnct or olher
air polWtion con[rol district or agency is required for the work which is the
subject of this application, have all of the tlisclosures prescribetl by California
Healih and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. (If'yes", attach certificate.of compliance from ihe appropriate air pollution
control oKcer). � �
CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the
information qiven above is correct. I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions. �� .
SignaWre pale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certity under penalry of perjury Ihat I have read this application and state that
the information given is correct. I agree to compty with all state laws and ciry
ordinances rela[ing [o building construclion, and authonze represenlatives of
the City of Costa Mesa to enter upon the above-descnbed properly for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by ihi5 permit until final inspec[ion.
Si n Wreo(LegalOw er�s) �Q 'O�
;� �.�;�
An or AutM1o'z'eG Applirant �—DBIe �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job/+ddress: 3024 CEYLON RD
Suite:
Vicinity: RESIDENCE AND GARAGE
Parcel Number: 13918105
Applicant: BARTELL, MICHAEL
Address: 3b24 CEYLON RD
COSTA MESA, CA
Owner: VESTERBY, RENEE M
Address 3024 CEYLON RD . - �
� L �� � -
" �COSTA MESA; CA-� ".
Conhactor. �
Address:
Zip: �
Arch :
Address:
Zoning: R1 R1
Phone: 714435-0874
Zip: 92626
Phone: - , � .
' Zip: 92626 '
Phone:
License: � �
Eng:
�. Address:
ISSUED BV:
Status: ISSUED
Applied: 08/72/2003
Issued: OS/12/2003
� � Phone: - - Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING COMP ROOF, INSTALL SHEATHING, FELT AND COVER WITH 50 YEAR COMP. INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$111.25
$0.50
$0.00
$0.00
$0.00
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0=0
PARKING Exi" stinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
PLANNING & ZONING
Left 0- 0
Lek 0- 0 '
Proposed: 0
Calc Valuation: gs,000.00
Claim Valuation: gs,000.00
Right 0- 0
Right 0-0
NO710E: The work auth4rized by this permit shall comply with all applicable handicap access requiremenis under California statules and related
regNations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order �or ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inapeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
taas-as (a�oo�
WORKERS' COMPENSATION DECLARATION: � _ '
I hareby aHirm untler penalry oi perjury one W the following tleclarations: � ' ' . �
❑ I heve and will maintain a certificete ot consent to seli-Insure for workais' wmper�ation, as pmvided tor 6y section 3700 of the Laba Cotle, br the pedormance of ihe
work for which thR permit is issued. - �
❑ I have and will mainlain workers' compensetion insurence, as required by section 3700 of the Labor Cotle, for the partormance ot the work for which this permit is iuued:
My workers' compensa�lon Insurance carder and policy numDer are: �
Cerrier: � Policy Number:
(Thls section need not be comp/eted i! the permif is valued af one hundred dollars ($100) or Iess.J
❑ I cenity that in the perfortnance of the work for which this permit is issued; I shall not employ any person in any manner so es to become sublect to tha workers'
compensation laws of Califomia, and agrea Ihat If I shoultl become sub�ed b the workers' compensation provisions ol Section 3700 of the Labor Code, I shell forthwith
comply with these provisions.
Applicant Signeture: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNL4WFUL AND $HALL SUBJECT AN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3lW Of THE LABOR COOE, IMEPEST, AND A1TOfiNEY'S FEES.
UCENSEDCONTRACTORSDECLARATION: �,
I hereby aNirm Ihat I am licensetl under provisions of Chapter 9(commancing with Section 7000) ot Division 3 of the Business and Prolessions Code, end my license is in full '
force and eNecL Lic. N Class A �
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCV: '
❑ I here6y aNirm that there is a construction lending agency for the peAormance of the work for which t�is permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: lenders Address:
Signewra: Date:
OWNER-BUILDEP DECLARATONS:
I hereby attirtn that under penalry of perjury thet I am E%EMP7 FROM TME CONTRAC70RS LICENSE LAW for the following raeson (SecJ031.5, Business end Protessions
Code: Any ciry or couNy which requires a permit to consWct, alter, improve, tlemolish, or repair any stmcWre, prior to its issuance, also requlres ihe applicant for such pertnil
to file a gned statement ihat he or she is Ilcensetl pursuant to the provisions ot t�e Coniractors License Lew (Chapter 9(commencing with Section 7000) oi Division 3 oi the
Busine and Prafessions Code) ar Ihat he or she is exempt therefrom and the besis for Ihe alleged ezemption. Any violetion of Section 7031.5 by eny applicant tor a permit
subje the applicant to a civil penalry af nat more Ihan tiva hundred dollars ($500).):
I, as owner of Ihe property, ar my employees with wages as iheir sole compensation, WILL DO THE WORK, and ihe stmcture Is not intended or oflered for sale (Sec.
7044, Business and Professions Code: The Gontractors License Law dces not apply Io an owner of property who builds or improves thereon, and who does such work
himsetl or herseli or through his or her own employees, provided Ihat such improvements ere not intended or oflered tor sale. tl, however, the building or improvement is
sold within one year oi complelioq the owner-builtler will have'the burtlen oi proving ihal he or she did not build or improve for purpose ot sale.). '
❑ I, as owner oi ihe pmperty, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to wnstruct the project (Sac. 7044, Business and Pmfessions
Cotle: Tha contrectors License Law does not apply to en owner ot propehy who builds or Improves Ihereon, and who contracts for such project with e conirector(s)
license pursuant to Ihe Contractors License Laws.).
I em xempt und r sec. ��J Business and Professions Code for ihis reason:
Sianatur Q _Bb,�_ib .ol JX
.� � Expires:
Veniiwtion af Ownership by Qype af document, i.e. - property ivc bill or deed):
DIVISION OF INDUSTq1AL SAFETY PERMIT CER7IFICATION:
❑ I hereby certity Ihai no ezcavation five (5) or more teet in tlepth imo which a person is required Io descen4 will be made in connection with work euthorized by this
pertnit, and that no building swcture, scettoltling, talsework, or tlemolition or tlismantiing thereoi, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle 8, Calitomia Adminisirative Code).
❑ As owner-builtler, I will not employ anyone to do work which would require e permit trom the Division of Indusinal Safety, as notetl above, unless such person has e
permil ta do such work from the division.
Siqnature: Date:
Division of Indusirial Safety Permit Number:
CER7IFlCATE OF COMPLIANCE AND AUh10RIZATION OF ENTRY: I certify under penalty of peryury ihat I have read ihis application and state ihat the information given is
correct. I agree to comply with ell state laws end city ordinances rela�ing to huilding consimction, end authorize representalives of ihe City ot Coste Mesa to enter upon the
ebove-describetl propetly for inspection purposes. I egree not to occupy or ailow occupency of any builtling authorized by this permit until finel inspection.
COOE I. INSPECTIONTYPE
1616 Fized System Final Fire Prevention
1266 Pool Spe Finel
200 ' Final Re-Foot '
201 Final BIocWRetaining Well
202 ,� Final Factory Fire Place
203 Finel Sign
204 Final Demolitian
Q�� � ` INi1fIRL5
rZ �
:,� �.. ,
:�„�
CODEI' INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212
220
Final Fire Prevention
Final Planning Approval
222 Final Site
250 Final Building/Occupency
�
DECLARATION OF AUTHORI�Y BIdg.Permit#/�
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS This Permit #
AP Number:
1�� (we), _�P� L--P O/ / ��V Cr.U�" , declare that I am the Owner of Title of the above
{��
referenced real property, and that I(we) hereby authorize:
Name: ��'.�'/9 �i/ ��TiJ"/ C l / ' Telephone Number: %% ��\� "' " � L�
.�
Street Address �� �/� � � `
Ciry: �s�'� O � /l�� State: �� J Zip; ��V -z �
to obtain permits in my behalf, as owner/builder, for '1`�L_�
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I(we)� shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of pery'ury that the foregoing is true and correct. /
Executed this � day of �7G19��3/7 2Q�� , at ��S/ ��r.si� , Califomia.
0779�d6 (rev.11100)
C
Date: . ' CY//%�� �
Note: This authorization does not grant authonzation to perfortn the work as owner,
it solety provides for limited power of attomey to secure ihis permd in any behaH.
11
.CITY OF COST MES ONSTI
Praject Address � �
Applicant'sMaily ddress �'S3?
Owner's Name �-
Addreu m �
Arch/Eng.
Address
Contractor's Name
Address (mailing�
City License No. � �
LICENSED CONTRHCTOR DECLARAT
1 M1ereby af(irm tM1at I am licensetl untler i
with section ]000) of Divlsion 3 of tne
my license is in full fqsje apQeffect.
CTION PERMIT
�
�__
Phon
_License No.
Applicant to fill in all spaces except those wilhin heavy bor0er lines antl si9� all
PER NO-_ . ' TRACT NO. LOT NO. �
N
rvisions ot Charter 9 (wmmenting
ssiness antl Professions Cotle, antl
Date �"�//-'rx Signature / r�R LAJ�'l'YI.C+M✓�
�ORKERS' COMPENSATION DECLARATION
iereby affirm that 1 have a ertificate of consent to self-insure or a certificate
Workers' Compensation Insurance, or a ce�jlti tl copy thereof (Section
.800, Lab. C,) /R��/ I ,
Polity No. 6���� ComPanY � �✓�� .
❑ Certifietl mWpjy isp hye1,rtleby furnishetl. . � �
�'Cer[�� /Y �d_1X WAPPhcan�tY B��q ,Orv�n�` �1 1�� fAAMd
Date �( 1� j�
EXEMPTION FROM WORKERS' COMPENSATION DECIARATION
(This section neetl not be com0leted if the permit is for one huntlretl ($100) or
less).
I certify that in the.pe�fo�mance of the work tor which this perm�t is issuetl. I
shall not empioy any person in any manne� so as to become subject to the
Wo�ke�s' Compensation Laws of Califomia. -
Date ' ' Signa[ure �
"NOTICE:'If, atte� making tnis tlecla�ation, you shoultl become Subj¢ct to th¢
Workers' Compensation provisions oi the Labor Cotle, you mu5t forthwitb
comply with such� provisions or tM1is permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV �'
I hereby aifirm that there is a construction Ientlin9 a9ency for the performance
of tne work far which Ihis permit is issuetl (Section 309T•� Civ. C.)
Lentler's Name
LentleYs Atltl�ess -
OWNER BUILDEH'bECLARATION �
1 hereby afti�m that I am exempt from the Contractor'S License Law tor the
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
county whlch requires a pe�mit f0 construct, alteq improve, tlemolish o� repair
any structure, prior to its issuance, also requires the applicant Por such permit
to file a signetl statement that he/she is litensetl pu�suant to the provisions of
the Contractor's License Law (Chapter 9(commencing with Section ]000) of
�ivi5ion 3 of the Business and Professions Cotle) o� that �he/she is exempt
nerefrom antl the basis tor the allegetl exemption. Any violation ot SectiOn
/031.5 by any applicant for a permit subjects tne applicant to a civil
�enalty of not more than five hundretl tlollars ($500).
I, as Owne� of the property or�my employees with wages as their sole
� Wmpensation, will tlo the work, antl the structure is not intentled or ofteretl
' i01�SdIC (SECLI00 %OAA� BUSIf1E55 dOCI PIOi255100d1 Cotle: The COOIfdCI01'S
Li[ense Law tloe5 not apply to an owner ot a property wno builds or improves
thereon, antl who tloes such work nimseli/herself or through his or her own
¢mployees, p�ovitletl that such imOrovements are not Intendetl or ofteretl tor
sale. It, however, IM1e builtling or improvement is soltl within one yea� ot com-
pletion, the.owner will have the burtlen of provin9 he/she tlitl not builtl or im-
��ove tor tne purpose of Sale). '
I, as owner of the property, am exclusively mntractin9 with Ii<ensetl con-
tractorsto construct the project (Section �044, Busines5 antl Profes5ions Cotle:
The ContracrorR License Law tloes not appry-to an owner of property who
builtls or improves the�eon, antl who mntracts tor such O�ojects with a can-
�' tractor(s).hcense-pursuant to the Contractor's License Law). I am aware that
I proof of thei� Worker'S Compensation insurance shoultl be provitletl to me.
I� ❑ I am exempt untler Section B. & P. C. for tnis reason
Date
I hereby certify�tha[
information is correct
dlld SIdIE �dWS IQldllfl
sentatives ot this cil
inspection purposy�./.
� Drivers' LicenSe or 55
Owner
have reatl this application antl state that the above-
agree to compty with all city antl [ounty ortlinances
o builtling construction, antl hereby authorize repre-
[o en e( u on the above-mentionetl operty fpy r'
Oate ����V
��
tlCCldfdL10115.
TYPE OFCONSTRUCTION �IJ NEW IJ ADD LJ ALTERATION lJ REPAIR
❑ CONVERSION� ❑ DEMOLISH' � OTHER
• DESCRIPTION OF WOFK/USE OF BLDG.
TYPEOFPERMIT ❑GRADING ❑FOVNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL �
❑ OTHER
PROJECT DESCRIPTION Sa.FT. oCCUaANCY
'CONSTRUCTIONTYPE ' VALUATION$
ZONE �GRADINGCU.VOS. ACRES
Remarks:
BarSink' -
Backflow Preventer
Backflow Irrigation
�rinkin9 Fountains
Floor Drains �
Floor Sinks
u25$ENICC �t1L12S5
Interceptors
Kitchen Sink
Lavatories .
P—Trap
Roof Drains
ReinspeMion Fee � $15
Boiler
Duct-UnderGround
Duct - Structural •
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Healing $ystem & Ducting
❑U700,000 BTU 0100,000 BT
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicanh Pink - Accounting: Goltlenrotl - Asse55or
Showers
Service Sink
Sewef Cap
Sewer Connection
Solar Collecmrs -
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Aum-Wash
Isue Fee
Hood or Typel ❑
Canopy Type II ❑
Refrigeration System
❑0-700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers -
Registers� '
Issue Fee
PEES
$ 3
$ 3
A.P. # ' 2one ..
S Main Building: � ��t��� ZQccessqry�Building: �y-o �T G nr
E 'Z�
T Front' ' , � • ' p
B Rear N
q I
C Right � � . � � ' � N
g Left . G
R
Ping. Ref. # � Parking Req./Provided � ' E
Q
Planning Notes: � . •[^!! � � ry�
I L" T
S
ELECTRICAL - �
Automatic Washer � Transformer ❑ 15-50 KW '
Construction PoleSub. '0 50+KW
Cooking Unit � Meter ❑up m 100 amps
Dishwasher Meter- ❑over 100amps
Dryers ❑Gas ❑Electric ' Sub Panel .
Fan Motors 00-1 HP �1�% -8 .
F.A.U. - IncSolar �9-15 HP �16-1'.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal .
Generator �0-5 KW �5-15 KW
Flange
Sign '
Standing Sections
Trash Compactor
Fee �$15 � � luue Fee
'DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
Building Approved By
FEES
�
�
�
$ 3
� SUMMARY OF FEES "
BUILDING PERMIT $ SMIP - �$
PLAN CHECK $ PERMIT�
PLUMBING $ .�S.CXi ISSUANCE $ _
P�AN CHECK 25% $ ENERGV P.C. $ '
ELECTRICAL �$ GRADING $
PLAN CHECK 50% $ MICROFILM $ � �
MECHANICAL $ ' ,TOTALFEE $ ���, .
PLAN CHECK 25%� _$ ' �.
CONSTRUCTION AND;PLANNING
APPROVALS Permit•#
1:.Temporary Electrical.Service or Pole
2 Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4.. Electrical Conduit-Undrgmd. ,
5. Steel Reinforcement �
6. Electrical UFER Grnd.
7. Footings �,:
8. Foundation �' ��
9. Water Pipe�Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connectian
12. Sewer Cap . �
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign �
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing �
25. Roof Sheathing�
26. T-Bar Ceiling (Structural) & Monocoat
27.� Frame and Flashing
28. Lathing & Siding
29. Insulation � �
30. Drywall Nailing � �
31. Plaster Brown Coat
32. Electrical Power Meter-Final -
33. Final Electric .
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 pomestic-Final �
��42. Backflow Preventer
�'43. Backflow Irrigation
�4'4. landscape Irrigation System
.45. Sound Attenuation � ,
� 46. Handicap Regulations _
47.�FINALSTRUCTURE&BUILDING �
48.' Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Ca
Date
POOL & SPA . �
Date Inspector � qppROVALS P �t # " Date Inspector
7• Z/•
�
�
�
ermi
52. Pool & Equipment Location -
�53. Steel ReinforEement
54.� Forms�
55. Electrical Bonding � r:> -
56. Rough.Plumbing & Pressure�Test
57. APPROVAL TO COVER-GUNITE
c.s
58: Electrical Conduit-Undrgrnd>
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O'Undrgrnd.
61. APPROVAL TO DECK �-��
62. Backwash & Receptor-Final '
���
63. Heater & Vent-Final �)
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical �
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION �
80. FOOD CERTIFICATE ISSUED �
Notes:
r . �
� )
r
i "' •
,.« ..
f,
._
i.� i . . .
. 'a �
. vI+ `
(:- �•
� \
� • 9�0'�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] CpyTp MESA, CALIFORNIA
i fOR APPUCAMT TO F/[[ /N COMPLE7FLY
• TYPE OR PRINT ' n
BUILDING Ja n� w//
ADDRE55 �l OC Q-Qi.u��,
1
COSTA MESA. ALIFORNIA
MAIL 10835 Santa Monica Bl�%d.•
ADDRE55
c�T� Los Angeles TN�r23287
OR EN'GENEER L.C. Maior NO.
ADDRESSZZOIS S. p3iC71IIOLSLIt BZVC3..
LEGAL ILOT �j
UE6CRIPTION NO. JO
A.P. NO.
OF LOT� OZ _ O� X
USE OF
EXISTING BLDG.
8ET9ACK LINE FXOM / �p� �i� I
CENTEF OF 6TREET SP �F��' REAR YAR�G R.5
SIDE YARD I LEFT S� I RIGHT S� L. 5
DESCRIPTION OF WORK
FIRE
ZONE
:d BLVC�..
3363 =°"E
TRAGT
APPF
9Y
NO.OF BLOGS. � ypp�
NEW I X II ALiERATION I II AODITION I
REPAIR I IIMOVING I IIDEMOLISH I
BUILDING �746 ROOMS 6 STORIES �
SIZE
EXTERIOR WP��uCCO I RooF � wood. shingl
COVERING COVERING
USE OF BUILDING AND WpRK TO BE.PERFORMED -
Dwelling-new construction
� -� �t .�.,.�__. . �
1 HEREBY �CKNOWLEOGE TXAT I H/�VE FEAD THIS RPPLICATION
AND STRTE THAT THE ABOVp �g CpqRECT AND RGREE TO COM-
PLY WITH ALL CITY OROIN6NCE5 ANO STATE LRWS REGULFTING
BUILDING CONSTRUCTION. �JJ
SIGNATURE �)�)�.J�^ � / �� j
PERMITTEE � �/A77
AUTHORIZED AGENT �' ���D���
:%��J..'.X�.. . .
�`L �cC�.illEi�
C,r- PAA'f z 6 1959
�INAh'CE DEPT.
G�TY OF CO,CTq �rgA
APPLICATION FOR PERMIT
BUILDING
FOR Off/CE USf OMLY
I PECE�PT NO. I O
� , ��`�"l' �
F�1 EO BY I �TEJi2ECE�E�D� I ���iP✓ISBLm��
/ ttl
�ss 5 %J 7 U ' ! /\�/O �./ � l �1
COSTA MESA.
NO. OF I USE OF NEW '
PLqNS BWLOING�._
ST.1
FT. I N.
THE AMOUNT SNOWN UN�Efi VALUpTION IS FOR THE
PIlRPOSE OF ESTRBLISHING A PEFMIT FEE ONLY.
VALUATION �J
- PERMIT FEE $ � / fI
$/ J� �Z� PLAN CHEGK S( O��
/ `
TOTAL FEE S S �-�