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Home My WebLink About2483 FAIRWAY DR - Building PermitsCITY OF COSTA MESA BUILDING DIVIS/ON DEVELOPMENT SERVICES DEPARTMENT PEAMIT — - (714) 754-5273 • Fau (��a) 75a-aess •-www.ci.costa-mesa.c��ILDING PERMIT Job Address: 2483 FAIRWAY DR Suite: Viciniry: Primary Occ: R3 Type of Construction: V-N Parcel Number: 11910236 Zoning: Appiicane HURLEYRICK , Address: 23251 PERALTA DR UNIT R . _ , -, . Phone: ;:. 714.951-6724 LAGUNAHILLS � � -Zip: 92653- - .�s: =: � _ ... _ _ owner SKOLDQUIST, BIRGITTA I TR Address 2483 FAIRWAY DR , . - : � � . ' ' � � `��Phone: ��949-646-9700 COSTA MESA, CA . � . � - � Zip: 92627-1309 „ Contractor: ,"'HURLEY ENTERPRI$ES"" " Address: � 23251 PERALTA DR'��` � UNIT R � Phone: 714.951-6724 - � LAGUNA HICLS � �_ Zip: , 92653 . , License: 314183 �� . Address:. �_ Zip: Phone: License: Eng:_ Address: r PERMIT Nl 942 77 FAIR DRIVE, COSTA MESA, CA ISSUED BY: Status: ISSUED Applied: 10/28/2005 Issued: 10/28l2005 Phone: License: SCOPE OF PERMIT .;.iTEAR OFF EXISTING COMP SHINGLES OVER WOOD AND THE BUILT UP PART TOO.INSTALL7/16" OSB WITH'I LAYER 30L8 FELT � "COMP.�SHINGLES �INSTALL BUI�T'UP, ROOF ON THE FALT PART. ' - " - � - � , , �_ ` FEESUMMARY..f:.,...,. y Plan Check: , $0 00 ' - Calc Valuation: 5s,� - Permit: ;- $18125 Claim Valuation: Ss,+ SMIP Res: $0`.99 SMIP Com. ' $0 00 , . Other. - - $0:00 Inspection: $0.00 Totalr $182.24 , F'LHNNINIi tk LVNINIi SETBACKS ' MAINSTRUCTURE Front 0-0 -- Rear 0-0, , Left 0-0 �,.Right 0-0 ACCESSORY F�ont� 0-0 � ="Rear 0-0.- • � ,-Left �•�0-0-.,�.,� - Right , 0-0' � �� PARKING � Existina:��.,- 0 � Reauired: �0 - - ° 'Pr000sed.' "" Q'�,'�� - _ , . � � , -�- � ,. . . � RRI _I� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and 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 abe 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, required Inspeetlona and Tinal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pei FOR �NSPECTIONS CALL: (714) 7545626 264&4fi (fl�00) 50 YR all WORKERS' COMPENSATION DECLARATON: . � - . I hereby eHirtn under penalry ot perjury one of ihe following tleclarations: �--� ❑ I heve antl will malntain a certiticate oi consent fo seli-Insure for workers' compensation, es provitletl tor by section 3700 ot tha Lebor Cotle, for the pertortnen' of the �wOrk for which this pertnit i5 i5suetl. . ' I have end will maintain woAcers' compensation insurance, as required by section 3700 ot the Labor Code, tor t ance of Ihe work for which this pertnit is luued. w �e}r�s' c,omc�o-e�n�satlon Insurance carrier end policy number are: I�� ^ (` Earnor: �� I U I Y.�� olicy Num er: V) � chon n e�e completed i/ the permit Is valued af one hundred dollars ($100) or less. J . ❑ I c in ihe p ormen t�e w rk for which ihis permit is issued, I shell not employ any person man so es to become subject to the workars' ompensati law oi Califo ia, nd a ee that if I should become subject to the workars' ' lons of Saction 700 of t e Labor Co4e, I 5hall forthwith Gorply with � s pro isi s. �1 App wM Signatur Dete: j li ��V � WAR ETOSECUREW KERS' ENSATIONCOVERAGEISUNLAWFULMIDSHALLSU&IECTAN OCRIMINPLP NALTIES DCIVILFWESUPTOONEHUNDRED THOUSAND DOIIARE (b10J,OW), IN A�DITIIXJ TO THE COSi OF CAMPENSATIIXJ, OAMAGES AS PROVIDED FpR IN SECiION 3]W OF THE LABOq CODE, IMEREST, AND ATTORNE`fS FEES. I�RACTORS DECLARATION: ihat I am licensed undefr pSr �visions of Chapter 9(commencing with Section 7000) ot Divisi e Busi ss and Professions Code, end my license is in full L�1� �� U �,i 5 —.._ . CI��.' 3�l CONSTRUCTION LENDING AGENCY: ❑ I here6y aRirm that there is e construction lending agency for ihe performance of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lentler's Address: Signature: Date: OWNER-BUILDEP DECLARATONS: I hereby ettirm that untler penelty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe fallowing reeson (Sec. 7031.5, Business end Profeulons Code: Any ciry or counry which requires e pertnit to construct, alter, improve, demolish, or repair any sirucWre, pnor to its issuance, elso requires the applicaN for such pertnit to file a signed statement ihat he or she Is licensed pursuent to the provislons ot ihe Contrectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Cotle) or that he or she is exempt therelrom and the 6asis for the elleged exemption. Any violation of Section 7031.5 by any applicant for e pertnit subjects the epplicant to a civil penelty oi not more than five hundred dollers ($500).): ❑ I, as owner ot the properry, or my employees with wages es their sole compensation, WILL DO 7HE WORK, and the strucNre is not intended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Comractors License Law tloes not apply to an owner ot propetly who builds or improves ihereon, and who does such work himself or herself or Ihrough his or her own employees, provitled ihat such improvements are not intended or otteretl for sale. tl, �owever, the building or impmvement is sold within one yeer of complation, ihe ownerbuilder will have the burden of proving that ha or she did not build or improve for purpose of sele.). ' ❑ I, as owner of the property. am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to consiruct ihe Oroject (SecJ044, Business and Professions Code: The comractors License Law tloes not epply to en owner of propeny who builds or Improves ihereon, antl who contracts for such project with e contractor(s) license pursuant to tha ConireCtors license Lews.). ❑ I em exempt under sec. Business entl Professions Cotle for this reeson: Signature: Date: Owner ID veritiatl Dy dnveYs license. ❑ Ves ❑ No Dnvers License No. Expires: Verifiwtion of Ownership by (type oi tlocument, i.e. - property tea bill or deed): DIVISION OF INOUSTRIAL SAFETY PEHMIT CER7IFICATION: ❑ I hereby cetlity �hat no excave�ion five (5) or more feet in depih into which a person is required lo descend, will be made in connection with work euthorized by ihis pertnit, and ihat no builtling swcture, scettoltling, falsework, or tlemolition or Oismantling thereoi, will be mora than thirty-six (36) faet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celifarnia Adminisiretive Code). ❑ As owner-6uilder, I will not employ enyone �o tlo work which would require a permit irom the Division of Industriel Sefety, es noted above, unless suc� pereon hes a permit to do such work irom the division. Signaturo: Date: Division ot Intlustrial Safery Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 W ill Ihe epplicant or present or fuWre buildinq occupant need to tile entl certity e Business Plan for emergency response to releese or ihreetened releese oi a hazerdous matonal7 ❑ Ves ❑ No (Section 25505 ot the Celifornie Heallh end Safety Code requires, with some ezceptions, Ihat a Business Ptan be filed with the Costa Mesa Fire Depertment by every business which has at any one time dunng a reportetl year a quantity of haiardous materials equal to or greater than e weight of 500 pounds, or a volume ot 55 gallons, or 200 cubic feet ot compressed gas at standard tempera�ure and pressure). 4 B ............................................................................................................................................................................................................................................................................................................................................................................. Does or will the applicam or present or tuture building occupam need to file a registration form for awtey hazardous metenals? ❑ Yes ❑ No (Section 25533 ot ihe Califomla Heallh and Satety Code, wlth some excepUons, requi�es regisiratlon with the Costa Mesa Fire Depariment by aach business which at any one time has an hend e quantiry of acutaly hazartlous materials equal to or greater ihen e weight of 500 pounds, or e volume ot 55 gallons, or 200 cublc feet of compressed gas et stendard temperature end pressure). ............................................................................................................................................................................................................................................................................................................................................................................. Does or will the applicant or present or fuWre builtling wcupam need to prepare an RMPP (Risk Management end Prevention Program tor acutety hazerdous materials)? ❑ Yes ❑ No (Section 25534 ot the Califomia Heaith and Safery Code provides that the Costa Mesa Fire Department may require the preDaration, certitiwtion and tiling with the Fire Depanment of an FiMPP by businesses which are required to register acutely hazardous metenals with the Fire Depanment. ..................................................................................._......................................................................................................................................................................................................................................................................................... If an RMPP is presently required, has Section 25534 oi ihe Celitomia Heelth antl Safery Cotle been tully complieA with7 ❑ Ves ❑ No .............................................................................................................................................................................................................................................................................................................................................................................. Does or will tha aoolicant or oresent or tuture builtlino occuoant reauire for ihe work which is ihe sublect ol this eoolication a oarmil for such constmctlon or motlification irom the South Coest Air Oualiry Menagement DisMct or imm eny other air polWtion contml disMct or eqenc�+ LJ' (Section fi5850.2 ot ihe Celifornia Govemment Code requires that ihe requested inlormation be furnishad on applica� ........................................................................................................................................................................................................................................................... W ill eny part of [he faciliry to be cons�ruc�etl untler �his permit be within 1000 feet irom ihe outer boundaries of e schi (tl'yes", the tacility must meet ihe requiremant ot Sections 25534 antl 42303 ot the California Health end SaFery Cod ............................................................................................................................._......................._._......................_.............._...................................................._.. If e parmit from the South Coast Air �uality Menagement DisMct or ather air pollution control tlistrict or agency aoolication. have all ot Ihe disclosures o�escnhetl bv Califomia Health antl SateN Code Section 42303 been made7 CERTIFICATE OF C regerding Hazardous SignaNre: CERTIFICATE OF wrrect. I agree)e tor non-residential builtling permits). .............................................................................. ❑ Yes ❑ No for ihe work which is Ihe subject ❑ No Ihat under penalry of perjury the informetion given ebove is correct. I agree to comply with all state laws antl ciry ordinances Date: )RIZATION OF ENTRYi'I cenity under penalry of perjury ihat I have reatl this application and state that Ihe Informa�ion given is end city ordinances relating to building conslrudion, antl authorize representatives of the Ciry of Cosle Masa to enter upon Ihe e�.l�gree not to occupy or allow occupancy of any building authorized by Ihis permit uMil finel inspectlon. LODE t. INSPECTIONTYPE Q�,F �MIfI�LS 1616 Fizetl Sys�em Final Fire Prevention l!— 1266 Pool Spe Final � 200 Final Re-Root 201 202 203 204 Final Block/Retaining Well Final Factory Fire Place Final Sign Final Demolition COOE� INSPECTIONTYPE 206 Final Mec�anical 208 Final Plumbing 210 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 'Final Building/Occupancy �7]i�l:�ii�7.141 � AOVlicant to lill In all sDaees axcapt those wilhin IteavY �ortler Iines anC si9n all apDroprlate tleclarations. Cf7Y OF cOS7A MEsn CONSTRUCTION PERMIT ProjectAddress ��3 F(),/✓ ��!- �✓ � Applicani's Mailing Address • .�S°.l�/� //i01 / A.S�' � Owner's Name ��; Phone Address ti,q+ �%% Arch/Eng. License No. Address Contractor's Nam Phone Address (mailingl ' City Licenu No. LICENSED CONTRACTOR DECLARATION I hereby atfirm [hdt I am Iicensetl untle� provi5ions ot Charter 9(commencing wi[h section 7000) of DiviSion 3 of the BuSiness and ProteStionS Cotle, an0 my Iicense is in IW tore antl ettec[. License CI s Llcqn,�lJpl , �y,�� Date Si9nature / X�%�l/� WORKER ' COMPENSATION DECLARFTION 1 hereDy altirm that I have a cer[ilicate of consent to self-insure or a certificate � Workers' Compensation Insurance, o� a cerUfi¢tl cOOY Nereot (Section d00, Lab. i%�l��yyt �� Policy No. E Company �Certifietl copy i5 hereby tutnishetl. � Cer 'e OY i5 tiletl with the city tli jyisjpq/ q�,� i,^ Date APPlicant f{A ��1 �'T A' l. EXEMPT ON FROM WORKERS' COMPENSATION DECLARATION (Tnis se<tion neetl not be compleletl if the permit ii �o� one huntl�etl ($300) or Icsz). 1 certi/y lhat in the performance ot the work tor whlch this Oe�m�t IS i55u¢tl, I zhall not emoloy any person In any manner so as to become subject to the Worken' Compensation LawS of Calitornia. - . Dato Signature 'NOTICE: If, at[¢r making LhiS tl¢cla�a[ion, you ShoW� become subject to the Workers' COmpensation provislons ot.lhe Labor Cotle, you must forthwi[h Campty with such provislons or tM1is pe�mit ihall be tleGmeO �evoke0. CONSTRVCTION LEfJDING AGENCV I nnreby aifirm that there is a conztruction tentlin9 a9en<y for tho performance ot lho work for which lhi5 permit is issu¢tl (Section 3097 Civ. C.) Lentler's Name Lentler's Atldrezs OWNER BUILDER �ECLARATION I horoby attlrm that I am axempl irom the ContractorY l.icense Law tor tha /ollowing reason (Sectlon ]031.5 Buslnass antl Protosslonal Cotlo: Any city or counry whicn rnquires a permlt to construct, alteq imorovo, tlemolish or repalr any structure, prior to its Issuanca, also requires tho applicant for sucn permit lo /ile a signetl italement lhdt ha/shc is Ilcens¢tl pursuant to th0 Provi5ion5 Of tha Contractor's License Law (Chapler 9(commoncing with Soctlon ]000) oi Divlsion 3 of the Businoss antl Prolessions Cotle) or lhat he/she is exempt ;?here(rom antl tne bazis lor the alle9etl exemption. Any violatlon ot Section �';�031.5 by any applicanl tOr a permit subjec�s t1m applicant to a Civll ,'�..�enalty ot not more Ihan tiv¢ hundretl t1011ars (b500). ❑ 1, as owner o1 lne propc�ry Or my emplOyces with wa9es as Ih¢ir sole compansation, will tlo the work, ana tne slructure is not intentletl or ofteratl lor sale (Section 7044, Businezs antl Professional Coda: Tho Contractor's License Law tloes not appty to an owner ot a property who builtls or improvas lhareon, antl who tloes sucn wOrk nimselt/iterself or through his o� her own employeos, provitletl lnat Suth ImprOvement5 ar0 not Intentlod o� oflered to� sale. It, hOwevet, the bulltlin9 or ImDrOvement is soltl wltM1ln ono year of com- plution, U�v owner wlll hava the burtlen ot proving hc/snu tlitl not builtl or im- prova for tlta purpOsa ot saloJ. ❑ I, as owne� of Ihe property, am exclu5ivery conVac[ing wllh licensetl con- baGtOrs to con5[ruct lne pro)ect (Seclion 7044, Busin¢55 antl ProfeSSlonS COtle: Tho ConVactor's license Law does not aPPry to an owner oi property wM10 builtls or improves theraon, antl wn0 contracts lor suc� proj¢<ts with a con- trac[or(s1 license pursuant�to the GonVactor'i License L.aw). I am aware tnat � prool o/ ttleir Worker's Compensation insuran<e Shoultl ba provltleE to me. i❑ I am exempt untler Sec(ion B. d P. C. tor tn6 reason Date Owner I hmeby ce.tify that I have reaa tnis application anC state that tne above In/OrTation is correct. I agree to compty with all dty anU county ortlinanc¢s antl state laws relating to builtlin9 �onsVuction, antl ncreby autnorize repre- sentatives of this c'ty to enter upon (ne above-mentlonetl Property for inspection p se / Signahre Da[e� Driver5' License or SS � � _...... __. �O Z 33 TVPE OF CONSTRUCTION NEW ADD ALTERATION EPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, �6 DESCRIPTION OF WORK/USE OF BLDG. 5 Main Buildi E TVPE OF PERMIT GRAOIrvG�/ gOurvDATIOrv S7RUCTURAL T Front ❑ TENANT ❑ EIECTRICAL L!d"PLUMBING ❑ MECHANICAL A Rear ❑ OTHER PROJECT DESCRIPTION 5�. FT. OCCUPnNCv C F7i9ht K CONSTRUCTIONTVPE VALUATION$ g Left ]ONE GRADING CU. VDS. ACRES Ping. R¢(. �h Remarks: ' Planning Notes: Bar Sink Backflow Preventer Backtlow Irrigation �rinking Fountains Floor Drains Floor Sinks Gas Service Outlets In[erceptors Kitchen Sink Lavatories P—Trap Roof Orains Reinspection Fae $15 Boiler Duct�UnderGround Duct - Strucwral Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,0008T1 painspection Fee I $15 CMF 0865-46, rev. 10/84 Wnite - Bui101n9; Canary - ApPlicant: Pink - Accounting; Goltlenroa - Assessor Showers Service Sink Sewer Cap Sewer Connection $olar Collectors $olar Piping Solar Tank Swimming POoI w/Spa Urinal Water Closet Water Heater Water Service Aum�Wash laue Fee Hood ar Type 1 ❑ Canopy Type I I ❑ Refrigeration $ystem ❑4100,OOOBTU ❑100,OOOBTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Su Cooking Unit � . Dishwasher Dryers ❑Gas ❑Eli Fan F.A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0�5 KW aie2 8/06/B5 Zone Accessory Building: Parking fleq./Provided ELECTRICAL Transformer ❑ 75-50 KW ❑SO+KW Meter ❑up to 100 amps . Meter ❑over 100 amps $ub Panel � Motors 00.1 HP O 1 X- 8 Inc.Solar �9-75 HP �16-15+ Miaowave Pole Light Range ; Standing Sections 5 KW Trash Compactor S 3 I �= Rainspection Fee $15 luua Fee FEES �DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approvad By Building Approved By Appliwtion Issued By S 3 5.00 TL Z O N I N G R E Q M T S FEES S3 SUMMAHV OF FEES BUILDING PERMIT $ SMIP S PLAN CHECK $ � PERMIT PLUMBING 5 ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ �_ PLAN CHECK 25% $ •. CONSTRUCTION AND PLANNING - � � POOL .6PA APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspec*or ' 1. Tempor2�y Electrical Service or Pole 52. Pool & Equipment Location �2. Soil Pip¢-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -4. Electrical Conduit-Undrgmd. � 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .7. Footin�s 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Floor System 67. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 4�2. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing � 65. Electrical�Final 15. Rough Electrical-Conduit 66. Solar SYstem-Final - 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 8ar Ceiling 69. POOLISPA SYSTEMS �fNAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, V¢ntilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O Oil 25. Ruof 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. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heacing & Air Conditioning 35. Final Gas Pipe-iest 36. liood or Canopy 37. Final Factory Fireplace 38. Final Plumbing �(� d+'.J. G� 39. Water Service-Final 40. Gas ServiCe-Final 41. Solar pomestic-Final � ' 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation . 46. Handicap Regulations 47. FINALS7RUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - � 50. Gas Release to Southern California Gas Co , � 57. CERTIFICATE OF OCCUPANCY No. Date ' n��rea�� m ru m au zoaces witnin neavv eortler Iines antl sian all aoorooriate tleciarae�nna CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG. NO. CONSTRUCTIONPERMIT � 8765 II/30/8I I.0.00 Project Address ' wp � �/j TYPE OF CONSTRUCTION � . �`• � OWner _ : Phane ❑ NEW �ADD ❑ ALTERATION ' Addre55 9fj � ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ZONING REGULATIONS Ar[h/Eng. LiCense Na. ❑ OTHER DESCRIPTION OF WORK � P"P' � Addre55 � ZONE PLNG. REF. � � Contractor � �� Phonef � DD TYPEO PERMIT B o TpBUi�p irvG Addr¢u SETBACK L 5T. PROPERTY LINE �j 7 � ❑ GRADING ❑ FOUNDATION ❑ STRUCTVRAL SID,,VARD LICENSED CONTRACTOR �EGLARATION ❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHANICA L5EOE VA I hereby affirm tnat I am Iicensetl untler provislons of Charter 9(com- RIGt�T mencing with sectlon 7000) of Dlvislon 3 of tM1e Business antl ❑ OTHER REAR YARD (TO P/l) Professions Coae, antl my Iicense is in full farce antl eftect. pROJECT DESCRIPTION . ., License Class License No. PKG. SPACE REQ. PROVIDED Da[e Signature SQ. FT. WORKERS'COMPENSATION DECLARATION - � OCCUPANCV_CONSTRUCTION TVPE STREET WIDTH PARK FEES I hereDy affirm that I have a certificate ot consent to self-Insure or a VALUATION ZONE ZONING APPROVE� BV DATE certiticate of Workers' Compensatlon Iniurance, or a cer[ifletl copy th¢reot (Sectlon 3800, Lab. C.). GRADING GV. VOS. AGRES SPECIAL CONDITIONS: . Pnlity No. Company 'erti(ietl topy is hereby furnlshetl. - REMARKS:' a� . :ertifietl copy is filed with the clty Bulltling DIWSion. EXEMPTION F0.0M WORKERS' COMPENSATION DECIARATION (Thls sectlon neetl not be completetl it Ihe pe�mlt IS to� onG huntl�etl _ . (SI�Q� OI 1255). I c¢rtity tM1at In Ihe pertormanCC Ot [he work fo� whith thi5 pe�mit i5 Issuetl, I shall not employ any parson in any manner so as to become PLUMBING PLAN CHECK � ELECTRICAL PLAN CHECK - Subject to the Workar5' Comp¢nsation l.aws ot Call(ornia. _ Oate Si9nature BATHTUBS SHOWERS � ' NOTIGE: It after making fhiz tleclaratlon, you shoultl become subject TOILETS URINALS " GENERATOR 0-1 KW_1�10 KW to the Workers' Compensation provislons of the Labor Cotle, you must TRANSFORMER . forthwith comply with such provisions or this permit shall be tleemetl LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW=50+KW - revoketl. _ CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS MOTORS 0-1 HP_1-30 HP 1 hereby affirm that [here is a construttion lentling agency�lor the pe�- SERV ICE SINKS SVMPS (�NC.50LAR) 30-50 HP 50 + HP - formancebf tbe viork Por whltt� this permit Is issuea (Sectlon 3097 Civ. C.). ' � � FLOOR SINKS • FLOOR DRAINS FIXTURES ' OUTLETS SWITCHES Lentler's Name Lentler's Atltlress � ORINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS ' ' I nereby attirm that I am exempt from tne Contractor's License Law for the following rea5on (Section 7031.5 Business antl Professlons Cotle: SWIMMING POOL PTRAP Any city or county wnich requlres a permit [o cons[rucl, alter, POLES METERED SUB improve, tlemolish or repair any struc[ure, prior to its issuance,also re� y.�q7ER SERVICE HLTERATION PANELS MAIN SUB quires tne applicant for zuth p¢rrtlit to flle a signetl statem¢nt tha[ he is licensetl pursuant to the provisions of the ConVacto�'S License Law GAS SERVICE OUTLETS SERVICE ' ' AMP (Chapter 9(commencinq with Sectlon �000) o( Division 3 oi tM1e Business antl Prdessions Cotle) or that he is exempt thereirom antl the yyqTER HEATERS BTU OUTPUT ba56 (or tne allegetl exemplion. Any vlolation of Sec[ion ]031.5 by appliwnt for a permit suD�ects the applitant to a civil penalty SEWER CONNECTIONS � . ' ' " ' ' rt more than five nuntlretl tlollars (y500). � , az owner of lhe property, or my omployees with wa9es as their SOLAft TANK � COLLECTORS ' �ole� Compensation, will tlo the work, antl the struGlure is nol Intentletl . _ or offeretl for sale. (Sec[ion 7044, Business antl Pro/essions Cotle: The SO�AR PIPING SYS. ISSUE FEE ContrattOr's Licensa Law tloes not apply to an owner of a Property qPPLICATION APPROVED BV DATE who builtls or improves tM1ereon, antl who tloes suGh work Itimself o� ISSUE FEE tbrouqh his own amployees, Orovitletl tM1at such improvements are not IntentleE or offeretl for sale. I(, nowever, the bulltlin9 or improvement MECHANICAL PLAN CHECK $UMMARV OF FEES � is soltl within ono year of completion, tM1e owner will have the burtlen of prOving he tlitl not builtl Or improve for tbe purpose of sale). HEATING SVSTEM Od00,000 BTU BUILDING ❑ I, as owner of the property, am exclusivery conVacting witM1 . PERMIT S SMIP . E li<ensetl contractors to construcl the projec[ (Sectlon ]044, Business AND DUCTING 100,000 + BTU PLANCHECK $ PERMIT antl Professions Cotle: The Contracror'S License I.aw tloes not appty to ISSUANCE 8 dn owne� of property who builtls o� imprOv¢5 [hereon, antl who Gon- REFRIGERATION 0-300,000 BTU PLUMBING $ bacts from such projects with a contractor(s) Ilcesnetl pursuant to SYSTEM 100,000+gTU PLANCHECK $ GRAOING E [he Contrac[or's License Law). ❑ I am exempt untler Section B. & P. C. for tbls BOILERS BTU ELECTRICAL g E reason PLANCHECK $ - MIGROFILM § SYSTEM fiEPAIR, ALTERATION �,r� � - TOTAL FEE E Date � Ownor MECHANICAL $�L� I hereby.certity Ihat I have reatl [his applicatlon antl state tha[ the above EXHAUST SVSTEM MULTIPIE ' LE55 AO- Information is mrrecL I agr¢e to comply with all city antl County PLAN CHECK $ VANCE PC 5_ ortlinanc¢5 a state IawS relaling to con5lruction, dntl h¢r¢by authONie ' � �ep�esentat e of Ihis cily lo the above ention¢tl 1�- / �� property r inspec]Aon p se� ��u -/rl � d � FINqL FEE S_L_ Signature l � Da[¢ Drivers' cense or 55 � � I V E FEE � � - CMF0965-46 W�I[e-tlwlaing;Wnary-N.ppucanc;rmK-taccounung:�oiaenroowssessm ,'. , ; CONSTRUCTION AND PLANNING POOL & SPA, _ �' . � • APPROVALS permit# M-IR�oU' Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location Soil ipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electricai Conduit-Undrgrn 46. Electrical Bonding � . tee ein orce 47. Rougli Plumbin & Pressure Test 6. Electrical UFER Gtn 48. APPROVALTO 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-Tra ❑ ndr rn 10. Structural Floor System 52. APPROVALTO DECK 11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 14. Rough ElectricConduit ' �56. � Electrical-Final 15. Rough Electric-Wiring 57. So�ar System-Final 16. Rough Heating & Air Conditioning • encing & Access Approval 17. Ducts in Structure APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathin NOTES: � 22. Frame and Flashin . r � o � 23. Insulation `� Q. C � 2 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 pomestic-Final 35. Landsca e S rinklin S stem ' 36. Sound Attenuation 37. Handicap Regulations 38. FINALSTRUCTURE&BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date ApDi��ant to flll in all spaces witnin neavy DorOer Ilnes anO sign all CITV OF COSTA MESA PERMI� yo. �� CONSTRUCTION F�ERMIT C�s^ �l Addres4 Address Contractor AddreSs te Ceelarotior BLOG. NO. TVPE OF CyO�NSTRUCTION Phon �J ❑ NEW p� ADD ❑ ALTERATION - ❑ REPAIR ❑ CONVERSION ❑DEMOLISH License No. � ❑ OrHEa DESCRIPTION OF WORK I hereby affirm that I am Iicensetl untler provislons o( Charter 9(com- mencing wlth 5ettion ]000) of DIvI51on 3 of [he BU51ne55 antl Professions Cotle, antl my Ilcense Is In tull forca antl oHect. llcense Class Ucense No. Date Slgnature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate ot consent to self-insure or a certltl�zte o� Workers' Compensation Insurance, or a certifietl copy thareof (Settlon 3800, Lab. CJ. P�Iicy No. Co'mpany 'erHfietl copy Is hereby furnished. .ertifietl copy Is filetl with tne city Builtling Dlvision. EXEMPTION FROM WORKERS' COMPENSATION DECIARATION (Thls sectlon n<¢tl nOt be COmplet<tl If the perTit IS tOr On¢ huntlretl S$1001 or less). certfry that in the performance of the work for which this permit is issuetl, 1 snall not employ any person in any manner so as to become sublect to the Workers' Compensatlon Laws of California. Ddt¢ SlgnatUfe NOTICE: It after making thi5 tlecldrdtiOn, y0u ShOultl b¢Com¢ zubj¢Ct to the Workers' Compensation provlsions ot tne l.abor Cotle, you mus[ forthwit� comply with Such provi5ion5 or th15 permit Shall be tleemetl revOk¢tl. CONSTRUCTION LENDING AGENCV I hereby attirm [hat there is a con5truction lentling agency for the per- formance of the work for whlth this permit is issu¢tl (SeCtlon 3097 Civ. C.). ' Lentler'S Name Lentler's AEtlress �+.ny ary or coun[y wnicn r[ Improva, tl¢m011sh O/ /epai� any qWr¢s thC appll�nt for su<h pei Is Ilcensetl oursuant to Ih¢ Drovl Bu5ine55 antl Prd¢ssi0n5 Cotle) ol tllat he IS exempl tharelrOrtl antl th0 basls for the allegetl exemptlon. Any violatlon of SecUon 7031.5 by � applicant tor a p¢rmlt subjec[s [he appllcant to a clvll penalty rt more than five buntlretl tlollars (5500). ,'a5 owne� of [ne p�operty, o� my em0loyee5 wlth wage5 d5 th¢Ir hOR COmpensatlon, wlll tl0 lhe work, antl thC struGturE is nOt int¢npetl or offeretl lor sala. (Seclion 7044, Business antl Protesslons Cotle: The Contractor's License Ldw tloes not apply to an owner oi a property wh0 bulltls o� Improves [hereon, antl who tloM such work hlmself O� ihrOugh h15 own employeei, provitl¢tl tita[ such IrttP�Ovements a�e not Intendatl or ottered Por salo. It, however, the builtling or Improvement Is soltl wiihln one year oi completlon, the owner w111 ham tne bvrtlen of provinq he tlitl nol builtl or improve ior the purpose of wle). ❑ I, as owner of the proper[y, am exclusively contracting with Iicensatl mntractors to consVuct the project (Sactlon 7044, Buslness antl Professions Cotle: Tbe Contractor's LlcenSa Ldw tloes not apply to dn Owner of propetty wh0 builtls o! ImprOv¢S [h¢r¢On, dntl wh0 can- traGts from Suth pr0)ects wlth a ConVactor(s) Iicesnetl pursuant to the Contractor's License l.aw). ❑ 1 aM ¢xempt untl¢r 58cHOn reason��'�' 7 � Date ��/'3��/ O p�. �� . that I have reatl�[hi�applicatlon anC state tna[ TYPE OF PERMIT � ❑ GRADING(,�/ ❑ FOUNDATION �STRUCTURAL ❑�TENANTXJ ELECTRICAL�UMBING ❑MECHANIC, - \ ❑ O`fHER � ' � PROJECT DESCRIPTIO`�N 5�. FT. y^��- �q OCCUPANCV CONSTRVCTION TVPE �L�'�' � VALVATION ZONE ��' GRADING CU. V I�v ACRES —�� PLUMBIN� BATHTUB$ TOILETS LAVATORIES KIT. SINKS SE0.VICESINKS FLOOR SINKS � DRINKING FOUNTAINS INTERCEPTORS $WIMMING POOL W ATER'SER V I CE GAS SERV ICE � WATER HEATERS SEWER CONNECTIONS SOLARTANK SOLAR PIPING SVS. ISSUE FEE PLAN CHECK SHOWERS URINALS- DOUBLE LAVS $VMPS FLOOR DRAINS . CLARIFIERS PTRAP AITERATION OUTlETS BTU OVTPUT COLLECTORS MECHANICA{�/ PLAN CHECK HEATING SVSTEM 0-]00,000 BTU_ AND DUCTING 300,000 + BTV _ REFRIGERATION 0-100,000 BTV_ SVSTEM 100,000+BTU_ B91.�R5 BTU SVSTEM REPAIR,ALTERATION EXHAUSTSVSTEM MULTIPLE Signature - '� Date�1LLL�L�Ld..L Drivers''I�nse or 55 ak � ., � � � ISSUE FEE CMF 0 5-46 Whlte-Builtling; Gnary-Appliwnt; Pink-Accountinq; Goltlenrotl-Assessor 7036 10/19/81 ZONING REGULATIONS ZONE REAR VARD (TO P/L) PKG. SPACE REQ. STREET WIDTH ZONI NG APPRO V ED E SPECIAL CONDITION! ELECTRICAL PLNG. REF. � PROVIDED PARK FEE $ PLAN CHECK GENERATOR p.l KW_ 1-10 KW _ TRANSFORMER APPI.IANCE 10-50KW_50+KW_ MOTORS p-1 HP_1-10 HP _ • �(INC.SOLAR) 30-SOHP SO+HP_ FIXTURES OUTLETS SWITCHES � GAS TUBE SIGNS - POLE LIGHTS PANEIS MAIN SVB SERVICE AMP ISSUE'FEE �LICATION APPROVED BV a 201 „26 TI.� DATE SU-MMtARV OF FEES PERMIT G 5—�qO��i�� $MIP S-0._g� PLAN CHECK b—(_/ip_2 PERMIT PLUMBING E T. r- �SSUANCE $ GRADING $ PLAN CHECK 5 ELECTRICFIL E�y�. E PLAN CHECK y MICROFILM § MECHANICAL $ S , � TOTAL FEE $ � PLAN CHECK g LE55 AD- VANCE PC $ . FINALFEE $�('1L�11 � CONSTRUCTION AND PLANNI G \�.�- • . •POOL & SPA _ . � . • APVROVALS Permit # - l� Date Inspector pppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location Soi ipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit-Utility-Undrgm �` ,;•, 45. Forms 4. Electrical Conduit-Undrgrn ` 46. Electrical Bonding . tee ein orce � 47. Rough Plumbin & Pressure Test - ' 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE 7. Footings S .xJ 49. Electrical Conduit-Undr rn B. Foundation 50. Gas Pipe, ❑ Undr rn Test 9. Water Pipe-Undrgrn 51. ckw sh Lines P- r ndr rn , 10. Structural Floor System 52. APPROVALTO DECK 11. � Property Sewer_Lihe.& House Connection 53. Backwash & Rece tor-Final 12. Street Sewer Connection � � ��54. �Heater & Vent•Final 13. Rough Plumbing 14. Rough Electric-Conduit �56. Electrical-Final 15. Rough Electric-Wring GC `57. ' Solar System-Final i 6. Rough Heating & Air Conditioning ' • encing & Access Approval 17. Ducts in Structure APPROVED FOR PLASTERING 16. Ducts, Ventilating . 19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing ' 21. Roof Sheathin 22. Frame and Flashin z NOTES: 23. Insulation /� _ / 24. Lathing'& Siding 25. Drywall Nailing ' 26. Plaster Brown Coat 27. Electrical 7ower Meter-Final 28. • Final Electric - � � 29. Final Heating & Air Conditioning 2.� /-�SiSr7� 30. Final Gas Pipe-Test 31. Final Plumbing , 32. . Water Service-Final �� 33.' �Gas Service-F.inal ' 34. Solar pomestic-Final 35. Landsca e S rinklin S��em 36. Sound Attenuation - 37. Handicap Regulations � 38. FINALSTRUCTURE&BUILDING -y 39. Special Requirements Completed 40, Electric Release to Edison 41. Gas Release to Southern California Gas Co. - 42. CERTIFICATEOFOCCUPANCY � � ' � No Date z��xg�� or 4 rRACT 40 • a_�aR�� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BO% 31] COSTA MESA. GALIFORNIA FEE RECEIVED � JUL 13f961 FINANCE DEPT. �ur ur cwiR mwn fOR APPL/CANT TO f/LL /N COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING �/ p-� ` ADDRESS � Y o' COSTA MESA. CA IFORNIA FOR Off/Cf USE ON[Y OWNER I RECEIPT NO. I� (�yrt��. ST CTION CO. I C. ��j MAIL HECE D BT I D=TE RECEIVED I UATE 196UED ApDRESS EAST � TH STREET � 7—/' -(�� GITV COSTA MESA TN�pM BUILDING ADDRESS ORCHITENEER NONE N�o. COSTA MESA. CALIFORNIA ADDRESS FIRE ZONE TYPE GROUP STATE APPROVED CONTRACTOR 'P�L LIC. NO. BY DATE AODRESS ZONING LEG/�l I L�T �% I I 3 9 � 20N NO.OP UBE OF NEW DESCRIPTION NO. � BLOCK TRAGT �—I I P�ANB Z. I euiLoiNc �� A.P.NO. APPROVED LCI�a 7/II SIZE // i/7 ��D.�.! D I NOW ON �oTg O rARDS EVESATE ORD /J OF LOT (p(!% Jv qEQUIRED ALLOWED 3 7 / USE OF (GENTER LINE ST.) EXISTING BLDG. NONE FRONT �B FT. C L IN. SETBACK LINE FftOM � �/ � � CervrEt+ ov ernEET D REAR YAR s Q R. SIDE � FT. 3 IN. r � � N SI�E YARD LEFT O RIGHTS �� L.SIDE � FT. _�- IN. DESCRIPTION OF WORK REAR � Z FT. ^�- IN. NE� I X II ALTERATION I II �1DDITION I REPAIR I IIMOVING I IIOEMOLISH I BUILDING NO.OF SIZE I ROOMS STO/�RIES � EXTERIOR WALL IROOF ��J �+/ �. COVERING COVERING u/ J/7.lAf USE OF BUILDING ANO WORK TO BE PERFORMED � I �� a SINGLE FAMILY RESIDENCE AND e ATTACHED GARAGE H30`� �J � PLAN N0. D �/ 1 HEflHBY ACKNOWLHOGE THqT 1 H�VE READ THIS AppLICATION THE /�MOUNT 6HOWN UNOEfl VALUATION �8 fOR THE qND STATE THAT THE ABOVE IS CORFECT /.NO AGREE TO COM- pUNPOSE OF EBTABLIBHING A PEpMIT FEE �NLY. PLY WITN ALl CITY OFOIN�NCEB ANO STATE L1W3 FECULATINp eUiLoirvG COrvein�� ' ypLUATION /� SIGNATUqE OF PERMIT FEE $�� PERMITfEE�� L<i�,!//C i1��/V�`""""" ` �J', (M PLAN CHECK $ �� AUTHORIZED AGENT $/ J�� ' TOTAL FEE $ V/ �