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Home My WebLink About2377 COLUMBIA DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 Job Address: 2377 COLUMBIA DR Suite No Vicinity: Parcel Nunmber: 14145312 Applicant: Address: Owner: Address PLUMBING PERMIT COAST ROOTER PLUMBING HTG & A/C 2737 S CRODDY � STE D SANTA ANA, CA N10RIHI�, FUfv11K0 TF2 2377 COL BIA DR COSTA MESA, CA Phone: (714)241-1414� Zip: 92704 Phone: Zip: 92626 Contractor: COAST ROOTER PLUMBING HTG & A/C Address: 2737 S CRODDY STE D SANTA ANA, CA Arch / Eng : Address: Phone: (714)241-�414 Zip: 92704 License: 529127 /' � , Phone: 2ip: - -- -' � - Cicense: ISSUED BY: Status: ISSUED Applied: 03/08/2004 Issued: 03/OB/2004 SCOPE OF PERMIT - - C/O OF WATER HEATER. - � - � ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect pce,Soda,etc) Dental Units � Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Founfain Expansion Tank Gas Earthquake Valve AMT $23.50 $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 QTY 0 ' 0 0 0 0 0 0 0 0 0 0 0 0 . FEE SUMMARY. � �r �� : . , AMT� :.��TY Laundry Tub / Washer " $0.00 �� 0 � - � � -�Landscape Irrigation $0.00 0 `� � �� ' - P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors $0.00 0 SepUcTank ' $0.00 0 � Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower , $0.00 �0 Sink, bar ' ' $0.00 0 , � - .Sink, commercial � $0.00: -:�0 ", � Sink, Floor , - " � �$0.00� - - 0 SumpPump Swimming Pool - ' Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash 8asin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service , AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 �u0.00 $12.30 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 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 180 days. , .. . INSPECTIONS: In order for lhe work authorized under this permit to be considered legal, such work must comply with all applicable codas, antl all requlred Inspeetions end 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 2aas�ae Idoo) WORKERS'COMPENSAnON DECLARAnON: � - - I hereby affirm untler penalry of perjury one of the tollowing tleclarations: ❑ I heve end will malntain a cetlitiwle of consent to self-Insure tor workers' compenselion, es provided for by seclion 3700 of ihe Lebor Cotle, for lhe pertormance of the work for whic� Ihis pertnit is issuetl. I have entl wlll maintain workere' compensation insurance, as requiretl by section 3700 of tha Lebor Coda, for the pertormance ot the work for which this pertnit is issuetl. y workers' compansation Insurence carner and policy number are: �� S _ O� Carrier c�%l�r— �UN � P�ber: �s section need nof be cromplered il fhe permit is velued et one hundred dollers ($100J or /ess.) �I certiy that in the paAormance of the work fo which this permit is issued, I shall not employ eny person in any manner so as to become subject to the workers' compensation laws of alifomia, antl t at If I s�oultl become subject to Ihe workers' compensation provisions of Section 3700 of Ihe La or Code, I shell torthwith I with these r isions. z Ap ican� Si aNw: ' � WARNING: FAILURE TO SECU E ERS' ENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLL4RE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOF IN SECTION 3]O6 OF THE LABOR fADE, IMEREST, AND ATTORNE`f5 FEES. LICENSED CONTRACTORS DECLARATION: I hereb m ihat I am licensed under provisions of f Lic. # Iractofs ignaWre: wi�h Sedian 7000) of end Profassion5 Cotle, antl my license 15 in full CONS7RUC710N LENDING AGENCV: ❑ I hereby attirm Ihat ihere is a construction lentling agency for the pedormance oi ihe work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lentler's Name: . .. .- __ Lender's Address: _ Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aHirm ihet under penalty of Derjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry whic� requires a permit to constmct, alter, impmve, demolish, or repair any sirucNre, prior to its issuance, elso requires the appliwnt for such permit to tile a signed stetement that he or she is licensad pursuant to Ihe provisions of ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Protessions Code) or thet he or she is exempt therefrom and t�e hasis for the allegetl ezemption. Any violation ot Section 7031.5 by eny epplicant for e permit subjects the applicent to e civil penalry ot not more ihen five hundred dollars ($500).): ❑ I, as owner of ihe pmperiy, or my employaes with wages es their sole compensation, WILL DO 7HE WORK, and ihe structwe is not intended or ottered lor sale (Sec. 7044, Business and Professions Code: Ttie Contractors License Law does not apply to an owner ot properiy who Ouilds or improves thereon, and who does such work himself or harself or Ihmugh his or her own employees, provided ihat such improvements are not intentled or oflered for sale. If, however, Ihe building or improvement is sold wilhin one yea� ot comple�ion, the owner-builtler will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner ol ihe properry, am E%CLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to conslruct ihe prolect (Sec. 7044, Business end Profeuions Code: Tha contrectors Llcense Law does not epply to en owner ol pmperty who builds or impmves thereon, antl who coniracts for such project with a wntrector(s) licensa pursuant to the Contrectors License Wws.). ❑ I am eaempt under sec. Signature: Owner ID verified by dnvers licensa. ❑ Yes ❑ No Business an0 Professions Cotle tor this reason: Verification ot Ownership by (type ot document, i.e. - propeny tex bill or deed): Drivers License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity tha� no excavation fiva (5) or more teet in depth into which e person is requireG to descend, will be made in connection with work authorizad by Ihls permit, antl thai no building stmcture, scattolding, talsework, or tlemolition or tlismantling �hereot, will be more then thitly-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Ttle e, Calitornia Atlministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Industrial Sefery, es noted above, unless such person hes e permit to tlo such work from �he tlivision. Signeture: Date: Division at Industrial Safery Permit Num6er. CERTIFlCATE OF COMPLIANCE AND AIIT}IORIZAi10N OF ENTTiV: I certify under penalry of perjury that I have reatl this epplication end state that ihe information given is correct. I egree to comply with all state laws antl ciry ordinances rela�ing �o building constmction, antl euthorize represantatives of fhe Clly of Cos�a Mesa to enter upon ihe ebove-described properry for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until finel inspection. COpE �. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 ' Final Demoliiion Q,�F IN fQQ� INSPECTONTYPE 206 Final Mechanical 200 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy PSIE 1NIII1�L$ 3.n_Q`F � PflOJEJ:TRUUBESS: 237% COLUMBIA DR uN�T: CITY C�F COSTA MESA — BUILUING FERMIT PEP.hi NO; B 067477 � -OWNEfl'SNFME: I�(ORIHIRO, FUMIKO TR nooRess: 2377 COLUMBIA DR PERMIT NO: B 067477 PLAN CHECR NO; P.i GOVT: N SUPP: N COSTA MESA,CA 92626 CONSTRUCTIc�N TYPE: 5—N PERMIT TYPE: STR PURFOSE; ALT AflCN/ENGINEEfl: AOOXESS: FEG.NO.: UNIT: PEFMITTEE: TOP QUF�LITY ROOFING ( 7i4 ) 35$-919A pDOflESS: 27�JS8 SANTA MARGARITA PKWY 273 MISSION VIEJO CA 92691 LICENSEO CONTHPGTOX OEGIAHATION: I �ereUy a�firm thal I am Iicen5e0 un0e� provisions of Chap�er 9(commencing with Sec�ion 7000) ol Drvson of Ihe Business antl Pwtessions Cotle an my license is in full force and eHec� i 0-` 8 3 3Q 6 STFTE LIC.: 6 1 7 1 7� cus�Q C/�/73 9� /q �a�e: � � G _` � Signatur � !' ` • V � OH¢EflS' C PE ATION DECNPATION: I hereb ifirm hat I have a cenificaie of consent to s-insure cetlificate of r rs' Campensalion Insurance acarlified cOpy �hereof ( 3800, Lab. 'C!. POLICV NO.: 1 L b.i �f � O— y] E%P. URTE: `� S/ O S/ 9 4 comrnxr: STATE FUND �enilletl c y is h reby fumishetl. '�' Cenified coD is flleA with the ci4� Bullding Divl6lo . � l� Ap0lican . V �' E%EMPTION OM RREflS'COMPENSATIONDECUflR UN: (Thissedionneeanot0etampleledil�heper is�orone nAreA�$100�ar1 cetlily �hai m �he petlormance oi the work for which t'S mi� is issuetl, I shall no� emplay any person in any manne� so as to become ;ubleci lo I�e Workeri' Compensation Laws o� Cali�arn . Dare: Signamre: NOTICE: If, after making Ihis declaration, you shoultl become sublect m the Workers Compensation provisions o1 ��e Labor Code. you mu5i fo��with comply with such pmvisians or �his permi[ shall 6e deemetl �evokea. CONSTHIICTION 1EN01NG AGENCV: I hereby affirm Iha� �here is a cons(mclion lentling agency for the pedormance o� �Ae work �or which Ihis permi� is issued (Seciion 3097. Ci¢ C�. LENUEN: aooAess: OWNEfl BUIL�Efl �ELUflRTION: I Aerehy a�lirm ihai I am exempt Imm Ihe CanVactors' S�a�e license Law for the fallowing reason (Sec�ion 7031.5 Business ane Pwfessional Cotle: Any city ol counry w�ich requires a permii Ia cons�mct, aller, impmve, tlemolis�, of repair any stmcture, prior lo iis issuance, also requires IhC apDlicanl for such permit to �ile a signetl 5�a�emeni �ha� helshe is IicenSeJ pursuant Io �ne pmvisions of ihe Coniractors' Stale License Law (Chapter 9(commencing with Section 7�00) ot �ivision 3 of the 6usiness antl Pmfessians Cotle) or Ihat helshe is exempi Ihereimm antl lhe basis for t�e allegetl exemp�ion. Any viola�ion of Sec�ion 7031.5 by any apPlicanifor a permit sublec�s Ihe apD�icanl �o a civil Penalty ot not more Ihan �ive hundrt0 doliars (5500). I. as owner ol ��e pmperiy ar my empIoyeeS wi�� wages as iheir sole compensaiion, will Ao the work, anA tAe ❑ stmcmre is not imentletl or ofiereU for sale (Section 7044. Business an0 Pmiessional Cotle'. The Coniracmrs' State License Law tloes nol apDly ro an owner oi a pmpeny who huiltls or impmves iherean, antl who Ooes such work �imselVherseli or thmugh . his Or her own employee5, pwvitletl thal Su[h impmvemenis are nol intended or Oifered fOr 5ale, tl, however Ihe building or imD�ovemenl is sold within one year ol completion, the owner will have t�e 6urAen of Droving Ae/she tlid not builtl or im0�a�e lor ihe purpase ol sale�. I, a5 owner o� Ihe pmpetly. am erclu5ively conlraclinA wilh licensetl conVac�ars �o consimct �he pmle�� (Section 7044, Business ❑ anU Profe55ion5 COde: The Conlractors' Slale LiCeilSe Law does no� apDly �0 an Owner of pmperty who 6uiltl5 or impmv¢S ther¢on and who conVacls lor sucn pmlects with a contracmqs) license pursuant to the Contractors' State License Law). I am aware iha� pmol of �Aeir Worker's Compensation insurance s�ovla be provided lo me. I� I am e�empl untler Section: B. 8 P. C. �or this reason: Date: _ Ownec I tla �ereby cendy Iha1 I am aware ol antl untlerstanA Ihe rtquirements of Caltlomia Health anG Sa�ery Cotle Sec�ions 25505, 25533, antl 25534 anU Ihat I or any fulure builtling occupanl willlwill no� (circle one) neetl to comply with said state codes and ihe requirements for a permil lor cons�mction or motlilicaiion imm �he Air Oualiry Managemen� �isVici. ReSi�enlial constmc�ion applicaiions are exemp� from Ihese pmmsians. Oate: ApplicanL _ I hareby cartlfy Ihal I �ave rea� �his appllcation antl sta�e �Hal Ihe aboue In�armationis correci. I agree�o compl with all city antl counry ortlinances antl sialel wsrelatingto Ouildinq con5imc�ian antl ere6y aNhorizerepresenia�ives olihis ciryro enier onthe ahove-mentionetl pmpe�ly lOr inspet�in O�oses. � � A w I �_ _ ` � nver's License or Somal Securiry p. 164t�n6 Wnpe—Builaing�, Green—Cotle Enlo¢eme� Canary—Appl¢am: Pink—Revenue; Goltlenro0—Assessor JOH DESCRIPTION ; T!O REROOF W/ COMP. SFIINGLES SQ FT; 2,OQ0 CLAIM VALUE: 2,OOO.QO CALC—VALUE: 2,000,00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 E�ITION OF THE UHC ��r**�r�e�e�*******�*�-�-*�e-�******�**+r*+�**�r***�*+r****��+�*�c*�c�c*��:*�xa*�*+rr��+�x*�w�xx�� Z O N I N G R E Q U 2 R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESs`ORY BUILDING --------- FRNT: FT IN REAR• FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARRING RE��; PROV; PARCEL: 14195312 2NE; REF NO; PLANNING NOTES> > �E k-'4 k iE 1E �lE if if if 1f * if-if If iE it i! iE �lE # if iE �lf iE fE 1� if if if iE iE if iF iE # �E iE 1f iE #E iE iE ff 9E if iE M jE iE # iE if M+f i�} iE if iE iE af �lf iE #�E?E iF L� -lE if -ti- if'R� iE iE iE iF �1t-iF 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 P7•'T S ZONING APPROVED BY , _ PATE: � PUILDING APFRUVELI BY ; DATE; /� APPLICATION ISSUED BY; �� (7 P't— 3t-�it*�t*�t***�e-�+rxit�?�ar*�tie*+t�r+r�*it*r*xir��+�x:-+t'!�r*�r*�-±�-*.�-*x��**�r��:**x�+t*DiAt*+.Er�i-*x,�.aE .*N- �:iri�*** ��**�r*�**�r�:**��r,�*x*+t*�*u�t+��*at+r*�r+t+t�t�r�+r+�***�r��,r**+tx*x�r�r�r+��*�*�it+�x-��t*�*��*+r�. LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMEING ELECTRIC MECHANIC FIRE SMIP/RES GRADING --- PERMIT 45,00 .50 SMIP/NON—RES PLAN ISSOE FEE BUILDING—DZV—> PERMIT ISSUE PLAN—CFiECK TOTAL PAID DUE TOTALS----> 45.50 0.00 0,00 45.SQ A5.50 ,00 REVENUE DIt'ISION TOTALS--> COLLECTED: 45.50 OVER/SHORT; ,QO BLDG FMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECR 95,00 ,50 i: it 1t if if # iF iE %iE iE iE 1E if �1f iF it� if i! k# ir 1E 1f ik iE Y.-1f T: !h # iE iE fE iE #' if iE iF if iE 1E 1E?E i(-ik if if �1F M iE ii �w V� iF iE �E iE M ik i6±f if if-?t iE it i4 i! jE iE iE �f 1F ih # i!� iP I N D I V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TC�TAL COST SFR 2Q00 REROOF BY VALOE RESIDENTIAL NOZONE 1.00 2,000.00 END UF FEES O1 OOIb1690-00161691 T�] T 45.;0 DATE: 06/D6/94 TIFIE: �$:26 , . CONSTRUCTION AND PLANNING POOI & SPA •. APPROVALS Permit,�' ' Date Inspector qppROVALS Permit3k Oate Inspector l. Temporary Electriwl Serv� or.Pole �. ;� :' 52. Poat & Equipme�t location � i 2. Soil Pipe-Undrgrnd. /-^ �`� 53. Steel Reinforcement ( �' " 3. Electrical Conduit Utility-Un�d,rgrnd. r� 54. Forms '�:, ` 4. ElectricA� Conduit-Undrgrnd. 55. Electrical Bonding 'y 5. Sceel Reinforceme�t 56. Rouah Ptumt�ing & Pressure Tzst 6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE 7. Footin9s \ /"�'� 58. Etectrical ConduirUncrgrnd. i �. r 8. Foundation -^�""'� ; 59. Gas Pipe, C� Undrgrna., Test � � 9. Water Pipe�Undrgrnd. � 60. 6ackwash Lines, P�Trap, C Undrgmd. I ( 10. Strucwral Floor System ( 61. APPROVAL TO DECK �_., ; 11. Property Sewer line & House Connection �� 62. Backwash & RecepiorPinal ��' ` r• 1 12. Sewer Cap ,._ • 63. Heater & Vent-Final -� � 13. Roof Drains � �� 64. Plumbing System - Final `.�� , � 14. Rough Plumbing ' �•� 65. Electrical-Final } 15. Rough Electrical-Conduit '�.�i 66. Solar SYstem-Final �� i .- . 16. Rough �IectricN�iring � �� 67. Fencinc� & Access Approvai r i 17. Rough Wiring Siyn I 68. APPROVED FOR PLASTERING � 1 r; i 18. Rough Electrical�T Bar Ceili�{` 1 y � _ 'i !� ' g' , ) 69. POQL/SPASYSTER�SFINAI • ! 19. fiough Heating & Air Conditioning � P1RE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS � Permit # I 21. Ducts, in Structure 70. Underground HYdro ' �22. Oucts, Ventilatin4 77. Product Piping f7Gas ❑Oii � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof rraming 73. � Uncierymd. Storaye Tank O Gas ❑ Oii i 25. Roof Sheathing G=?-Q�( �Lti(pf 74. Overhead Hydro � 26. T�Bar Ceiftng (Structurat) & Monocoat 75. DrY Chemical `� 27. Frame and flashing � 76. Ory Standpipe 28. i�athing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEAITH OEPT. REQUIRE141ENT � i 37. Plaste� Brown Coat 79. FINAL INSPECTION . i 32. Electncal Powzr Meter-Pinal 80. F000 CERTIFICATE ISSUED 33. Finai Electric Notes: ' 34. Fina4 Heating & Air Gonditiorting � � y 35. Final Gas Pipe�Test .� 36. Hood or Canopy � 37. Final Fectory Fireplace � . i 38. Fioal Piumbing - � 39. Water Seroice-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � . j 43. Backflow Irrigation � 44. Landscave irripation System ' ' 45. Sound Aitenuation .� 46. Handicap Regulations - , • � 47. FINAL STRUCTURE & BUI�DING 6„� ,A �, 48. FINAL PLANNING f 49. Electric Re�ease to Edison � :i' 50. Gas Release to Southern Califo�nia Gas Ca 51. CERTIFICATE OF OCCUPANCY No. Date Property Address Owner � l Contractor __ !, CITY OF COSTA MESA BUILDING DIVISION �" ROOF COVERING CERTIFICATION 23� "1 Co 1.�.�.b� w i �L.-'O � O✓� /iti ✓ Permit No. f7 �P� `t'1_i D r� �� / ! p Q State Contractor License Number b� 7 �� 0 Classification �'� 3-I I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the manufacturer. ❑ I further certify that I am the owner of the property. (Owner-Builder permittee only). � I further certify that I am: �l Owner of sole proprietorship company ❑ Full partner of the company ❑ Limited partner of the company ❑ Officer of the corporation I certify that as an authorized officer or agent of the company or corporation, I am empowered to make this certification, which shall be binding on all successors or assigns of the company or corporation. I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building Division for acceptance. Received by Building Division BY: � � 6 �� InRial D 0990J6 WhitaBuilOing Div.; Canary-CanVactor, PinkAvner Z��Sg SSiov� IG��C � �ompan�po ' 1 Atltlress �/� i. �b vo � �. � Printed or rype< #2 73 p�„�f _ W y�6r( Applicant �o /ill in all spaeei except those witM1in neavy Dortler Iines antl sign all approDriate Oeclarations. � CITv-oF COSTA MESA . CONSTRUCTION PERMIT Project Address ' Applicant's Mailing A dress Owner's Name �Qr/y� Phone 75/-R�S Address ��T�/ � Arch/Eng. � License No. Address 4�—/� Contractor's Name Phone 1J.117�� . Address (m 'I' 1 �. /_�� ' O 3 ' Ciry Licen�P Nn �� LICENSED CONTRACTOR DECLARATION � Phereby at(irm thdt I am licensetl untler provisions of Charte� 9(commencing WI(h 5¢CllOfl i000) Of DIVI5100 i Of (Y1C BUSIpQ55 dlltl PlOf25510f15 COtl2� dOd � my license is in full f tl etfect. (_ License l+ss / 'cen e No V' Date Si9nahre � WORKERS'COMPENSATION DECLARATION , � .� I hereby affirm that I nave a certiticate o/ consent to self-insure or a certificate \ of Workers' Compensation Inwrance, or a certifietl cooY thereot (Section 3800, Lab.lt/1/f/fjxC/ o,�j " , —i.. %., .T_', .,. � Volicy No. �°� IJ '4S "1 Company �%lUY'C/ /�(i��Y�6� � fertifietl copy i5 hereby turnishetl. � � Cert' ietl cap i tiletl with the ciry J n��ej►�� te i�� Applitant ��` (, . EXE�ION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completetl if the permit is for one huntlretl ($S00) or less). I certify that in the pe�fo�mance ot the wo�k tor which this perm�t is issuetl, I shall not employ any person in any manner so as to become subiect to the Workers' Compensation Laws o( California. Date Si9naWre NOTICE: If, atte� making thi5 tleclara[ion, you shOultl become suble« <o tne Workers' Compensation provisions of Ihe Ldbor Cotle, you must forthwith comply with such provisions or tM1is permit sltall be tleemetl �evoked. � CONSTRUCTION LENDING AGENCV I hereby affirm that there is a construction lentling agency tor the performance of the work ,lor which [his permit is issuetl ($ectlon 3097 Civ. CJ Lentler's Name LenGer's Atltlress " OWNER BUILDER DECLARATION ' I hereby affirrti lhat I am exempt from the Contractor'S License Law for the following reason (Section 7031.5 Business antl Profezsional Gotle: Any city or county whicM1 requires a pe�mit to consVuct, alter, improve, tlemoli5h or repair any strucWre, prior to its issuance, also requires the applicant tor zuch permit' to file a signetl statement thaf he/She is licensetl pu�suant to Ihe prOvisions ot the Contractor'S License Law (Chapter 9(commencing with Section 7000) ot � Division 3 of the Business antl Professions Cotle) or that he/she is exempt therefrom and the basis for the allegetl exemption. Any violation of Section ]031.5 by any applicant for a permit subjects the applicant to a civil , enally ot not more than five huntlretl'tlollars ($500). � I, as owner of the property or my employees with wa9es as their sole -�mpensation, will tlo the wo�k, antl fhe st�u[ture is not intentleG o� ofter¢tl sale (Section ]044, Business antl Professional Cotle: The Con[ractor's ense Law tloes not apply to an owner ot a property who builtls or impmves ,.ereon, antl who tloes such work him5elf/he�self o� thiough his or het own employees, provitled tnat such improvements are not intentletl ar offeretl tor sale. If, however, (he builtlin9 o� �mprovemenf i5 Soltl within One yea� o( com- pletion, the owner will have the burtlen ot proving he/she tlitl not builtl or im- prove !or the purpose ot sale). ❑ I, as owner of the property, am exUusivery contracting with licensetl con- tractorsto construct the'project (Section 7044, Business antl Professions Cotle: The ConVactor's'License l�w tloes not apply to an owner of properry who builtls or improves thereon. antl;who contracts for 5uch oroiects with a mn- tractor(s1 Lcense pursuan[ to me Contractor•s License Law). I am aware-that � prool of thei� Worker'S Compensation inw�ance shoultl be provltled to me. ❑ 1 am exempt untler Section B. & P. C. for this reason ' Date Owner I hereby certify that I M1ave reatl this application antl into�mation is co�recL'I ag�ee to comply wi[h all tity x antl'state laws relating to builtling CanStruction, antl M Sentatives ot tnis cit to ente� upOn the above-mei inSpeCtion pu� �� Z /� ,. $ignature �� /�� Drivers' License or 55 � � that the above mry ortlinances uthorize repre- i orooertv for / T�Q iC� I I .� - I_...__. TYPE OF CONSTRUCTION NEW ADD ALTERATfON � REPAIR ❑ CONVERSION� O DEMOl.15H. O OTHER � DESCFIPTION OF WORK/USE OF BLDG. - TVPE OF PERMIT LJ GRADING _l.J FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL KiPLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. �- OCCUPANCV_ C O N ST RUCTI ON TYPE V A LUATI ON $ ZONE � � GRAOINGCU.VDS. ACRES— Remarks: Sink Irrigation Dishwasher Drinking Fountains ' Floor Drains Floor Sinks Gas Service �Outlets Interceptors Kitchen Sink � Lavatories Roof Drains ReinspeMion'Fee � $15 Duct- UnderGround Duct - Structural Duct-.Ventilating • � Exhaust System ❑ Multiple Firepl/Fact Blt. iC60 �k Heating System & Ducting ❑0-100,000 BTU 0100,000 Reinspection Fee � $15 0865-46, rev. 5/88 White - Pink - Accounting: Goltlenrotl - AsSessor Showers Service Sink Sewer Cap ' Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet -Water Heater Water Service � iiUiO-WdSh -_ Laundry Treys Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑ai oo,aoo eTu O i oo,000 System Repair/Alteration Fire Dampers Registers laue Fee FEES A.P. # S Main Buildi E T Front' ' B Rear A C Right K Left S Ping. Ref. # Planning Notes: Automatic Washer Ganstruction'Yole Sub. Cooking Unit. Dishwasher ' Dryers ❑Gas;:�Electric Fan • F.A.U. - Fixtures Device Boxes � OutletS • � Switches Garbage Disposal Generator �0-5 KW �5�1 Izone . _ Building: � , ELECTRICAL � Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors �0-1 HP 01 %- 8 IncSolar �9-15 HP �16-15+ Microwave Pole Light . Range __ t�tanding Section 5 KWT Trash Compactor Reinspection Fee ,$15 � , � luue Fee � $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By FEES Buildin8 APProved By ��' Application Issued By ^ $ 3 SUMMARV OF FEES � BUILDING PERMIT $ SMIP PLAN CHECK $ � ERMIT PLUMBING $ �SSUANCE PIAN CHECK 25% $ ENERGV P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% $ O N 1 N G R E � M T $. FEES $ 3 �i ODD42?34-CD04223Y ; i al' S.t?L� OATE: OS/li/89 _T'IPIE: !b:2� . .. . . : . . .. . ...._ .� . 6 �-�-\ . . , . , .., . . ._. , � CONSTRUCTION AND PL�ANNING . POOL & SPF c� APPROVALS Permit # Date Inspector qppROVALS Permit # � Date Inspector • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. ro r � 53. Steel Reinforcement r�, 3:'iElectrical Conduit Utility-Undrgrnd. �- 54. Forms . . 4.'Electrical Conduif-Undrgrnd. �i? 55. Electrical Bonding . ' .r 5 Steel Reinforcemeni!,j 1 � r= 56. Rough Plumbing & Pressure Test " ^ 6^ Elecirical UFER.Grnd;' 57. APPROVAL TO COVER-GUNITE �-.7 1 � 7.,Footings ��,, ' �� 58. Electrical Conduit-Undrgmd. - 8'�Foundation -�� j'' � 59. Gas Pipe, O Undrgrnd., Test '�� : i A� -'i � . � 9� Water Pipe-Undrg�nd. - f � i ,, � 60. Backwash Lines, P-Trap, O Undrgrnd. '�� i• .10. Structural FIoo�Sy_stem y.� yY ,,� � 61. APPROVAL TO DECK �•. 11. Property Sewer Line & House Co��?ction `/ `% 62. Backwash & Receptor-Final � 12. Sewer Cap p� � � f 63. Heater & Vent-Final •� i 13. Roof'Drains `� �r ^ 64. Plumbing System - Final �� ' 14. Rough Plumbing:� � �' 65. Electrical-Final � i 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 �0 Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Unde�ground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat- 75. Dry Chemical �� 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulat�ion - 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 37%PlasterBrownCoat 79. FINAL•INSPECTION � 32. Electrical Power Meter-Final 80.�FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37: Final Factory Fireplace � 38. Final Plumbing q�D VRni 39. Water Service-Final � � � 40. Gas Service-Final j7�� 41. Solar pomestic-Final �� 42. Backflow Preventer ��' '�j� 'Tz 43. Backflow Irrigation � . � � ni 44. Landscape Irrigation System ,.� � 45. Sound Attenuation , J . 46. Handicap Regulation's�` . ��> 47. FINALSTRUCTURE:&BUILDING " c�. 48. Special Requirements Completed . , 49. Electrie Release to Edison � f�^f} 50. Gas Release to Southem California Gas Co �� '�y' '�� 51. CERTIFICATE OF OCCUPANCY /,� y; „ No. Date ^r' OWNER DIKE Bc COLEGROVE DATE 7-1Z-5� JOB ADDRESS 2477 Columbi � nri va BUILDING PERMIT NO. 5�139 ` GENERAL CONTRACTOR Sama � VALLIE $ 11.260.00 AP. No. LOT 11i1 TRACT 2955 FIRE ZONE DESCRIPTION OF WORK I & J INSPECTIONS � DATE � SUBCONTRACTOR coat Gas Test / S"' .Hts< I/ilzc-c-�I /`A OPuX _ �� /�I / 1 i� PERMITSISSUED ! J " �, �' 541'7 COSTA MESA BUILDING DEPARTMENT P. O. BO% 3I� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN OWNER MAIL 'ARCHITECT OR ENGINEER LEGTL �p OESCFIPTION NO. A-P. NO. SIZE OF LOT ii(1 v COSTA MESA. CALIFORNIA and Colegrova F_ 1�{,h Street TEL. Mesa �� Li � aI•l �j LIC. 1v1+�1 o rnn4 NO. '[j P.il Iii'OV 9 CITV LIC. ke and Cole�ove N� 4615 TEL. NO � r D � BLOCK TRACT NO.OF BlDGS. �M ��OW ON LOT ' SETBACK LINE FROM C[Ni[A oF sin[Ei ([�(�� REAR YARD 22� �7 SIDE VAR� � RIGHT " 6� LEFT � " DESCRIPTION OF WORK - NEW ALTERATION ADDITION REPAIR MOVING OEMOLISH BUILDING NO.OF � SIZE • ROOMS STORIES EXTERIOR WALL ROOF COVEqING COVERING USE OF NEW BUILDING Cinol u Fnmilv AeciAcnnu nwi FEE RECEIVED �� 2-�, i q r7 FINANCE DEPT. � �. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY /�I lo oZ)�cti�7-/��i BUI�fJING ADDRE55 COSTA MESA. CALIFORNIA FIRE ZONE 20NE pO,N'F TYPE// GROIq / APPROVED � /� BY OATE � CORRECTIONS � � 2e Y i � +� PL.1Nh ' DEPT. SUBJEC( TO e G. D . • � �% O� PLAN'Tc 1 MEREOV iCKNOWLE�GE THPT I HPVE REFO TMIS FPPLICFTION RNO STATE TNAT TME ABOVE IS COFPECT ANO AGREE TO COMPLV WITH ALL CITV OFOINPNCES AND $TATE LPWS REGULATING BUIL�ING CONSTRUC� iiON. � � � VALUATION SIGNATURE OF � PERMITTEE � 11�26�•� � AUTHORIZE� AGENT PERMiT FEE $ PLAN CHECK $ TOTAL FEE S "OM!