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Home My WebLink About1085 DANIELLE DR - Building PermitsJob Address: 1085 DANIELLE DR Suite No Vicinity: Parcel Nunmber: 41207418 Applicant: ELLIS, E J, JR. Address: B4301779 Owner: LADJEVARDI, EBRAHIM Address 1106 SAN JOSE AVE ISSUED BY: Phone: Zip: Phone: COSTA MESA, CA Zip: 92626-1660 Contractor: ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU Address: 3801 LENAWEE AVE Phone: 310-253-5229 CULVER CITY, CA Zip: 90232 License: 679898 Status: ISSUED Applied: 01/17/2007 Issued: 01/17/2007 SCOPE OF PERMIT 1 WATER HEATER CHANGE OUT FOR SFD. FEE SUMMARY AMT QTY -- -- AMT, QTY AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer _ $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 _ Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkftow(1-4) $0.00 0 Connect (Ice,Soda,elc) $0.00 0 - Receptors $0.00 0 - Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank ,$0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor - $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen - $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 '0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service - $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 -. 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00, 0 ' TOTAL CALCULATED FEES: $35.80 COMMENTS/ SPECIAL CONDITIONS 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: Tliis 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 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. FOR INSPECTIONS CALL: (714) 754.5626 2"6-46 (6100) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declar tions: ❑ 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. CiMy' workers' compensation I-n;�once c rand Do/I�'c�v number are: / /L / j /� ''% arrier: ��(� "eJ/ , �/ J I Lpolicy Numbac `j 6 - `� L"(� - -00 / (� s'lection need �e comp eted if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work to hi this per is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Ca am nd agree if uld subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provision . '/ Applicant Signature: Date r/' [ `D � WARNING FAILURE TO SECURE WORKERS' PENSATION COVERAG S UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION THE COST OF COMPEN TION, DAMAGES AS PROVIDED FOR IN SECTION 3]06 OFTHE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license .0 ryv0 lapter 9 (toll mencIng with Section 7000) of DivisioLDI sines antl fe Ions Coda, and my license is in lull force and affect. LiC. -�7- CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction Onding agency for t e performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Oate: 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, alter, 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 Ucen a 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, provid;d 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 ownef 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. Bust{less and Professions Code for this reason: Signature: — Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill pr 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, falseworx, 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 4lie and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No II (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Pian 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 andel, pressure). applicant or present r future building Occupant need to file a registration form for hazardous .i..... ......................................... ..................................................... .... 2 Does or will the pp p e o g p g o acutely h s materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with soT.a 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 materia s 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 in ad to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes [J 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 regi ter acutely hazardous materials with the Fire Department. ................................................................................................................................{{r....................................................................._....................-............................................................. ............... .............. ....._................ .............. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been . . fully complied with? [I Yes El No .......... ............................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future builtling occupant r quire for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from anyrother air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that,the requested information be furnished on applications for non-residential building permits). ................................................................................................................_:.................................................................................... ........................ ............... ........................ 6 Will any pan of the facility to be constructed under this permit be Within 1000 feet from the outer boundaries of a school? ❑Yes ❑ N0 (It "yes", the taCility. must meet the requirement of Sections 25534 nd 42303 of the California Health and Safety Code). ...... .................................................1............................................................................................................................................................................................................................... 7 a 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 He¢Ith and Safety Code Section 42303 been made? ❑Ves ❑ No .................fc...............n..................................... ................................................................... r). ................................................................................................................................................................................ attach ceniticate of compliance from the appropriate p Ilution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. 1 agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: i CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTAV: certify under penalty of perjury that I have read this application and state that the information g]the correct. I agree to Comply with all state laws and city ordinances relabng to building construction, and authorize representatives of the City of Costa Mesa to enter up above-described property for inspection purposes. Ie rea not to occupy or allow occupancy of any building authorized by this permit until final inspection. r If a Own (s)�:67 ,0 7 r_A /Or. uthonzed Ap cant ale4 - CODE Ii. INSPECTIONJTPE DATENTI�CODEN INSPECTION TYP DATE IN IA 1616 Fixed System Final Fire Prevention 206 Final Mechanical y ` 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 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 • 4(,�`'t MF CITY OF COSTA MESA . BUILDING DIVISION PER NUMB PERMIT ER F _ DEVELOPMENT SERVICES DEPARTMENT �• �; 00-01044 (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1085 DANIELLE DR Suite: Vicinity: HOUSE & ATTACHED GARAGE Parcel Number: 41207418 Zoning: R1 R1 Applicant: SELL, RON Permit: $167.25 Address: 17072 ROSEBUD SMIP Com: $0.00 Other: $0.00 Phone: (714) 993-3328 YORBA LINDA, CA Zip: 92686 Owner: LADJEVARDI, EBRAHIM Address 1085 DANIELLE DR Phone: COSTA MESA, CA Zip: 92626 Contractor: SELL ROOFING COMPANY Address: 17072 ROSEBUD Phone: (714)993-3328 YORBA LINDA, CA Zip: 92686 License: 323842 Arch : Eng: Address: Address: Status: ISSUED Applied: 07/12/2000 Issued: 07/12/2000 ISSUED BY: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (29 SQ). TEAR OFF EXISTING SHAKES & RESHEATH WITH 1/2" OSB. INSTALL 2 LAYERS OF 30# FELT UNDERLAYMENT & REROOF WITH "EAGLELITE MALIBU" (ICBO #4660) 5.7 LBS, Plan Check: $0.00 Permit: $167.25 SMIP Res: $0.89 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.14 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existing: 0 Required: 0 NOTES: FEE SUMMARY Calc Valuation: $8,900.00 Claim Valuation: $8,900.00 PLANNING & ZONING Left 0.0 Right 0-0 Left 0-0 Right 0-0 Proposed: 0 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 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 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. FOR INSPECTIONS CALL: (714) 754-5626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 insure, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. l �My workers' compnet and p fEy number are: 'Cerner: re/% w-40-/ Policy Number.'. Q 6 .(Thisaecfion need not be completed of the permit is valu d at one hundred dollars ($100) or less.) ❑ 1 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 CeI forni agree tha if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions Applicant Signature: WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I.am.licensed under P�gvissron3Q C�j �°r'% (commencing with Section 7000) of Division 3 of the Business and Prgjessions ori, and my license is in full force and effect. Llc. N 'Yf� �7 i5n ly Class y > ((�G J Contractors Signature e7 r l' g _ �a�. I (Date: — - � G — � � — O 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). Lenders Name: Lenders 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, alter, 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 ($5G0).): ❑ 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ 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: ❑ 1 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 ❑ 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? ❑ 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 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. ........... .------ I'll - ......----....... .......I- .......------------ -------------------. ........I............. ............ ... ...--.. ...-----.-....... 4 If an RMPP is presently required has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a pllcation appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L7 No (Section 65850.2 of the California Government 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 feel from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California 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 Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ 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 property for inspection purposes. I agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. Si eget Ow r ) /pate G And/Or Authorized Applicant - (Dat CODE 5 INSPECTION TYPE P&M INTRIALS CODE I INSPECTION TYPE PATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final208 Final Plumbing 200 Final Re-Roof 7' Z $ -0O' 210 Final Electrical 201 Final BlocklRetaining Wall 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 2446.46 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERMIT O. TRACT NO. LOT NO. BLDG. NO. CONSTRUCTION PERMIT — p� TYPE OF CONSTRUCTION ❑NEW ❑ADD ❑ALTERATION f ' Project Address/09-5 Owner Phone _ -j S 8/cL/['.� FJoCCJ Address Q ��, p s ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER NTNG ZONING REGULATIONS Arch/Eng. License No. DESCRIPTION OF WORK A P ZONE PLNG. REF. yr Address Contractor - yt /,L[.vC ,� Phone ,3St,G77d TYPE OF PERMIT ❑GRADING ❑ FOUNDATION ❑STRUCTURAL ❑ TENANT ❑ ELECTRICAL OLUME31NG ❑MECHANICA BUIEDINGING SETBACK C ST. I❑ YARD SIDE V WC PERTY LINE Address S / n !) [. Yj/ LICENSED CONTRACTOR DECLARATION 9 I hereby affirm that I am licensee under provisions of Charter (com- section 7000) of Division 3 of the Business and ❑ OTHER RIGHT man ting with Professions Code, an my license is in full force and eff ct. � PROJECT DESCRIPTION REAR YARD (TO P/L) License Class an se N / itic SQ. FT. PKG. SPACE REQ. _ PROVIDED _ F Date 9-9-1 Signature ,, WORKERS' COMPENSATION DECLARATION - OCCUPANCY_ CONSTRUCTION TYPE STREET WIDTH PARK EE q I hereby affirm that I have a certificate of consent to self -Insure ora VALUATION ZONE .ZONING APPROVED BV DATE certificate of Workers' Compensation Insuranc or a c� Ified copy thereof (Sect) 3200 Lab. C.). 43�/e // �� GRADING CU. YDS. ACRES SPECIgL CONDIT C PoIICY No. `� Company - : tified copy IS hereby furnished. REMARKS: - -ertified copy is flied with the city Building Division. L e XEMPTION FROM WORKERS' COMPENSATION DECLARATION G - (This section need not be completed It the permit is for one hundred - - Or less. S$loo) certiffy that n the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers Compensation Laws of California. BATHTUBS SHOWERS Uvv!�LLINU _t_ Date Signature NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_ 1-10 KW to the Workers' Compensation provisions of the Labor Code, you must - TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW -50 + KW revoked. - KIT. SINKS DISHWASHERS- MOTORS 0-1 HP HP - CONSTRUCTION LENDING AGENCY -1-10 I hereby affirm that there Is a construction lending agency for the per. SERVICE SINKS SUMPS (INC. SOLAR) 10-50 HP 50 + HP formance of the work for which this permit is issued (Section 3097 FLOOR SINKS FLOOR DRAINS FIXTURES 'OUTLETS SWITCHES Civ- C.), Lender's Name Lender's Address T DRINKING FOUNTAINS Li -S oS,o4.- 5,? GAS TUBE SIGNS INTERCEPTORS CLARIFIERS POLE LIGHTS OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for SWIMMING POOL PTRAP' POLES METERED SUB the following reason (Section 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, WATER SERVICE ALTERATION PANELS MAIN SUB Improve, demolish or repair any structure, prior to its Issuance, also re- quires the applicant for such permit t0 file a signed Statement that he GAS SERVICE OUTLETS SERVICE AMP Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS <' applicant for a permit subjects the applicant to a civil penalty '._dot more than five hundred dollars ($500). SOLAR TANK COLLECTORS as owner of the property, or my employees with wages as their r3.1,.., f' le compensation, will do the work, and the structure is not IntOnded or offeretl for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SVS. ISSUE FEE Contractor's License Law does not apply to an owner of a properly ISSUE FEE APPLICATION APPROVED BY DATE who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES 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 did not build or Improve for the purpose of sale).•BUILDING HEATINGSYSTEM SYSTEM 0-100,000 BTU PERMIT $ SMIP $ I, as owner of the property, am exclusively contracting with 1:1 1, AND licensed contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to _ ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ QD tracts from such projects with a contractor(s) licesned pursuant to SYSTEM GRADING' $ the Contractor's License Law). 100,000+BTU PLAN CHECK $ ❑ 1 am exempt under Section B. & P. C. for this BOILERS BTU ELECTRICAL $ - $ reasonMICROFILM SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE PLAN CHECK $ MECHANICAL $ $ TOTAL FEE $ LESS Date Owner 1 hereby certifythat I have read this application and state that the above information is correct. agree to comply with all city and county PLAN CHECK $ VANCEP PC $_ state laws relating [e construction, and hereby authorize s representatives representatives of this city to anter upon the above mentioned properly f/or=��(sp. a/[tion p POSVS //''�� Sl —' Date FINAL FEE $ 1-, gnatureS� - Drivers' License or SS ISSUE FEE CMF 0865.46 White-Bullding; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TL CONSTRUCTION AND PLANNING APPROVALS Permit # Date POOL & SPA Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. SoilPipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel ein orce 47. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P -Trap.❑ Undr rn 10. Structural Floor System 52. APPROVAL TO DECK - 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Ctonnection 54. Heater & Vent -Final 13. Rough Plumbing - _ .' i55. Plumbina System - Final 14. Rough Electric -Conduit 56. Electrical -Final 15. Rough Electric -Wiring "' - 57. Solar System -Final 16. Rough Heating & Air Conditioning 58. Fencing & Access Approval 17.. Ducts in Structure 59. APPROVED FOR PLASTERING 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough &Test Roof.Framing 60. POOL/SPA SYSTEMS FINAL . 21. 22. Roof Sheathing Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test 31. Final Plumbing 32. Water Service -Final 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date (.�iY OF COSTA MESA REQUEST FOR O(-_.PANCY gk)\J TRACT NO. -(�l o Do(o LOT N0. ADDRESS The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that he she -they) ( or were) kA O GJJ advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. representative 3Y� N on 'en er - is 3 45015 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 ■ For Applicant to Fill in Completely —Use Ink Only BUILDING rl A A//r'I I r 11C1 !19V 10-77cysA00 547; ***109.78 APPLICATION FOR STRUCTURAL PERMIT RECEIVED BY I DATE RECEIVED nerc lam lPn rroperzies west, OWNER ueveiegeenZ D. DATE - O, ADDRESS MAIL ADDRESS SOH 29th St. , TEL BUILDING ADDRESS 6 ' I,j,�j CITY Newport Beach, Ca. NOO75-4910 [[[[ TRACT9HV0 LOT 22 CONSTRUCTION LENDER STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. BRANCH ACCESSORY BUILDING roper OWNER ies v es evf ADDRESS Res VALUE Atd $ OR ENGINEERFrank Spaneler NOARCHITECT`673-0952 FIRE CONTRACTOR Owner APPROVED BY DATE - O, ADDRESS TEL NO. OF USE OF CITY NO. PLANS BUI LOIN andb STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE p 601X8;2 NO.OF BLDGS O IFROM L EET) OF LOTAppr OX. NOW ON LOT NT FT. FT. USE OF EXISTING BLDG. T Separate permits are required for L SID FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. T. MAIN & MAIN BLDGS. ACCESS BLDGS7— Construct single family bedroom CORP 1WAPPROVED .Mk'e DATE hotixle - Plan #3 , "PASA/ _.-_ -;;W/l/77 I hereby acknowledge that I haver/ad this applibation and state that the above Information Is correct and agree to comply with oil laws regulating building construction, and 1 shall not employ any parson In violation of the workman's compensation laws of Me State of California. 1 hereby certify that 1 am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMO Chapter 9, and that such licenses are in full force and effect, or 1 THE PURN am aaampt from the provisions of the State of California Business VALUATION and Professions Code, Ivision 3, Chapter 9. Signature of Permittee 1a�+4�+-/ /7�/' 7C/ s 61,1( Authorized Agent ,///�LLtA [L.✓� C m ?cCl L REQU:"civil IJ ; 0 FT. 2.2Q5 r SHOWN UNDER VALUATION IS FOR m_ OF ESTABLISHING A PERMIT FEE ONLY: e PERMIT FEE f , PLAN CHECK S �. e TAX. 2H f U TOTAL PAID f O 9-77P 1 00 L19 c ;s:. COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED DARSSUED BUILDING ADDRESS PE OWNER A.P. NO. BUILDING MAIL ADDRESS ADDRESS O TEL. CITU TE TRACT LOT CONSTRUCTION NEW I ADD I ALTER REPAIR I MOVING DEMOLISH LENDER BRANCH OWNER ADDRESS V UE E ARCHITECT TEL. OR ENGINEER NO FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR ! BY DATE ADDRESS TEL. ZONE NO. OF I USE OF NEW CITY NO. PLANS BUILDING STATE CITV YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING tFROM C/L STREET) SIZE NO. OF BLDGS. OF LOT NOW ON LOT ONT FT. FT. USE OF EXISTING BLDG. R SInF FT, FT Separate permits are required for L SIDE FT. FT. electric, plumbing and heating work. REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS, BLIXaS. VAR. 906 DATE C.U.P. 906 APPROVED APPROVED DATE I hereby acknowledge that I have read this application and state �a n that the above Information Is correct and agree to comply with m all laws regulating building construction, and I shell not employ any person In violation of the workman's compensation laws of m the State of California. I hereby certify that I em properly licensed as a contractor under SQ. FT. a THE AMOUNT SHOWN UNDER VALUATION IS FOR m the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; am exempt from the provisions of the State of California Business V and Professions Code, ivlsion 3, Chapter 9. VALUATION PERMIT FEE E � J, _ Signature of M PLAN CHECK $ 0 11 TAX E n f u hC7!/7— Permittee d E 7/ TOTAL PAID E Authorized Agent .-•! �