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HomeMy WebLinkAbout109 CLEARBROOK LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 109 CLEARBROOK LN Status: ISSUED Suite: Applied: 01/13/2003 Vicinity: ROOF Issued: 01/13/2003 Parcel Number: 41914121 Zoning: Applicant: CAMPBELL, WAYNE ISSUED BY: Address: 888 COTTONWOOD ST. Phone: 909-736-1430 CORONA,GA ,'� - Zip: 92879-3062 Owner: HALE, ANITA'TR Address /70 TIDEWIND , Phone: i /,IRVINE, CA - Zip: 92812 \-\\n Convector: PEACE ROOFING Address: 888 COTTONWOOD ST Phone. x-909-736-1430 CORONA CA Zip. -� 92879-3062 License:`, 712823 Arch l s� - =� Eng Address: / - �; - - Address:' Phone: - Vi: �� Phone: Zip: "License: A License: . /-... •_ /r's-'� -„-J //'. Jt:UYt-UF YtKMI L, -y. TEAR OFF EXISTING ROOF AND REPLACE WITH NEW HOT ROOF.,4_200�5; F,FOR,TRLPLEX. \; I FEE SUMMARY .Plan Check: $0.00 Calc Valuation. �%� -_x$6.000.001 Permit: $125.25 -' - - ` y - Claim Valuation $6,000.00` -SMIP Res:' $0.60 'SMTP Com: $0.00 Other:. $0.00 Inspection: $0.00 / _ `Total . $125.85 /. PLANNING & ZONING MAIN STRUCTURE'Front ;0-0- - Rear 0-0 - Left 01'0 "-Right -�\0-0, 'Front\ i' ACCESSORY ,0-0 Rear 0-0 Lek 0-0 Right: PARKING Existin -0' Required: 0 Proposed: o NOTES: ,. 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 2446-46 (6100) DECLARATIONS WORKEiS'xCOOENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - ❑ 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. ❑ 1 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. My workers' compensa3ylin� ur ce carrier nd olicy number are: Carrier: l� 11 Policy Number: (This section need not be complet d if the palmi is valued at one hundred dollars ($100) or less.) 1e6rtihy that in the perfornande 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' 1 compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these prsions. cam-S� 3- 0 7 4;..! e Zg WARNING: FAILURE TO SECURE RKERS' COMPEN TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full " •fome'ancleffect Llc-N �Cfess'ft.'--> (� _Contractor.s.Signature: Date;, /— /, —,n S CONSTRUCTION LENDING AGENCY: ❑ 1 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). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing 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 statementthat 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 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 awn 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.). ❑ I am exempt under sec. Business 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 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 B, Celifomla 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 WIII 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 Dees 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 apartment of an RMPP by Dusinesses which are required to register acutely hazardous materials with the Fire Department. ........................................................................................................................................................................................................................................................................................................................................................................................... 4 If en 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 pr®sent or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes I9 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ........................................................................................................................................................................................................................................................................................................................................................................................... B Will any pan of the facility to be constructed under this permit be within 1000 feet 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). ._..........._........._..........._......................__....v........... ................ .................. ....................................... ............................................_.______........... _....................................... ._...__....­....................... __........... _..................... ....... 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 Celifomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................. ............................ .......................................................................................................................................................... ...................................... -................................................................ . B (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 -des ribed property for pection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. I y� S' at Ot gal wner(s) / / 3� Date ZATd/ 1M0ttZGd'Applicama CODE I. INSPECTIONTYPE MR ItgrTIALS CODE • INSPECTION TYPE 266 INTMAUS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof z"— 'ice— 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 2G4 Final Demolition 250 Final Building/Occupancy Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. j ' - 0319 10/16/84 5.L� 7 it CI - F COSTA MESA C NSTRUCTION PERMIT P PER T NQl TRACT NO. LOT NO. UNIT NO. Project Address /O.% C �N JJ I - - Applicant's Mailing Address Owner's Name Ari: V -, - Jz >''J-� Phone % Address TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR 11 CONVERSION El DEMOLISH El OTHER - DESCRIPTION OF WORK/USE OF BLDG. A.P. # Zone S Main Building: Accessory Building: ' Arch/Eng. License No. Address' � ❑ TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL 11 TENANT El ELECTRICAL ❑LU MECHANICAL PMBING ElRear -. ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CON ST RUCTION TYPE VALUATIONS ZONE GRADING CU.YbS. ACRES E T, Front Z O B N Contractor's Name'Q 6-� p�/'7"$. Phony /4 %L/ Address (mai ling) 25774 9R//A f7 IV4 1D �. _ City License No. �� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full for a and effect. ,- License Class '-^ , nse No.^ZZ 703 • A C Right I N S - Left G R Ping. Ref. # Parking Req./Provided - E Remarks: - Planning Notes: Q M T S. PLUMBING FEES r- Date "r^/ — / Signature Bar Sink Showers ' ELECTRICAL FEES ` WORKERS' COM ENSATION DECLARATION I I hereby affirm that I have a certificate of consent to self-insure or a certificate - of Workers' Compensation Insurance, or a certified' copy thereof .(Section 3800, Lab. CJ - - Backflow Prav¢nt¢f Service Sink. Automatic Washer Transformer ❑ 15.50 KW +- Backflow Irrigation Sewer Ca Cap - Policy No. Company ( 8 Certified copy is hereby furnished. Certified copy i5 filed with the city Building Division. ❑ 50+KW Construction Pole Sub. Bathtubs Sewer Connection Cooking Unit Meter 0u to 100 amps Date Applicant - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers _ _ Solar Collectors Dishwasher Meter ❑Over 100 amps (Thissection need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any mann e so as to-sgcome sub1"act to the Workers' Compensation Laws of CalifE?� ///—_l /) Date Signature , -C/ �' /�t' NOTICE: If, after making this declaration, you should become subject to the Dishwasher Solar Piping Dryers ❑Gas ElElectric : Sub Panel Drinking Fountains 1 Solar Tank Fan Motors ❑0-1 HP ❑1'/x- 8 Floor Drains Swimming Pool w/Spa. F.A.U. Inc.Solar, 09-15 HP 01615+ Floor Sinks Urinal - Fixtures - - Microwave - Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be'deemed revoked. Gas Service Outlets Water Closet 2 zo Device Boxes Pole Light 1 _ 9 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a Construction lending agency for the performance Interceptors Water Heater Outlets Range ' g of the work for I Is per 't- is issuetl, (Section 3097 Civ. C.) Lender's Name Lender's Address Q re 7/ _ - - OWNER BUILDER DEC ARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5' Business and Professional Cade: 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Divi Sion 3 of the Business and Professions Code) or that he/She is exempt 1 Kitchen Sink Water Service - - Switch¢s Sign Lavatories Garbage Disposal 9 P 'Standing Sections - P—Trap - Generator ❑ ❑ 0-5 KW 5-15 KW Trash Compactor Root Drains - , - / II 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 enalty of not more than five hundred dollars ($500). I, as owner of the property ormy employees* with wages as their sole compensation, will do the work, and the structure is not for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 com- pletion,'the owner will have the burden of proving he/she did not build or im- move for the purpose of sale). LI I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an,owner of property who builds or improves thereon, and who contracts for Such projects with a con' tractor(s1 license pursuant to the Contractor's License Law). 1 am aware that proof o their Worker's Compensation insurance should be provided to me. L11 am exempt under Section B. & P. C. for this reason I - Reinspection Fee $15 Issue Fee $ 3 I Reinspection Fee $15 Issue Fee $ 3 - MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved B !tate pp y Building Approved By Data M Application Issued By r 11 Dat Boiler Hood or Type I ❑ Canopy Type I1 11g Duct - Under Ground Duct - Structural _ _ Refrigeration System E10-100,000BTU E1100,000BTU rl Duct - Ventilating - ' SUMMARY OF FEES BUILDING PERMIT $ ,SMIP $ PLAN CHECK $ PERMIT I PLUMBING $ 7 •00 ISSUANCE - $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICSO # Date Owner I hereby certify that Chave read this application and state that the above information is correct. I agree to comply with all city and county ordinances Heating System & Ducting ❑0-100,000 BTU 0100,000BT PLAN CHECK- 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection — r— ( Signature. /7/ ` PLAN CHECK 50%, $ MICROFILM $ MECHANICAL $ TOTAL FEE $—.,G-on PLAN CHECK 25% $ Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor " CONSTRUCTION AND PLANNING APPROVALS Permit # Date - Inspector - - - POOL & SPA. - .APPROVALS Permit # Date Inspector. 1. Temporary ElectricalService or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. -Steel Reinforcement Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement 56.' Rough Plumbing & Pressure Test - 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - , 59. Gas Pipe, 0 Undrgrnd„ Test P. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd.' 10. Structural Floor System , 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final - 12. 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 Bar Ceiling 'I 69. POOL/SPA SYSTEMS FINAL ' 19. 'Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS. Permit # �. 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping OGas .O Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - ._1 73. Undergrnd.Storage Tank 0Gas 00il 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. 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 Heating & Air Conditioning 35. Final Gas Pipe -Test /O��TI,/`7 36. Hood or Canopy ' 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final - 40. Gas Service -Final (OZ/jh( ' cO 41. Solar Domestic -Final 42. Backflow Preventer - 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound ..Attenuation -• 46. Handicap Regulations 47. FINAL STRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF. OCCUPANCY No. Date , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA . CONSTRUCTION.PERMIT PER T NO. - TRACT NO. LOT NO: 'UNIT NO. `- �Q'. Y K1 i i� 3k AA CRS 7 Project Address NaI I /ipplicant'S Mailing`/A)d�d e55 rNNa lfk- i �,s7 TYPE OF CONSTRUCTION NEW ,ADO ALTERATION REPAIR L1�C�-P_�,P _ PhnnEJ CONVERSION ❑ DEMOLISH F-1 OTHER _ A.P.# Owner's Namea �J DESCRIPTION OF WORK/USE OF BLDG. - Address N�%�_` P51.1� - S Main Building: ' . E Arch/Eng.'. License No. TYPE OF PERMIT ❑ GRADING Irl LFOUNDATION STRUCTURAL T Front' ' ❑ TENANT ❑ ELECTRICAL LS PLUMBING ❑ MECHANICAL B Address Rear ' Contractor's Nam Ph ne Rt94 OS ❑ OTHER A hA� PROJECT DESCRIPTION 'S0. FT.OCCUPANCY 1 C - Right- OCCUPANCY ighY - Address (mailing) ,�i,Q. / ni 1 I K Left ` City License No. V Q '/ / CONSTRUCTION TYPE—,VALUATION$ S 5 ZONE GRADING CU.YDS: ACRES PI Ref # 1 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business'and' Professions Code, and r license is in full((p�� tleffect. Liceas las .�r!CO Date' Signaturep WORKERS' COMPENSATION DECLARATION I hereby affirm -that I have a certificate of consent to self -insure or certificate of Workers' Compensation Insurance, or a'certified copy thereof.(Section ( 3600, Lab. C. l Policy No. }�CG78LG7�5 Company ertified copy i5 hereby furnished. "Mon. p in Ce �fiog opX.�n iVIled with the city /" 1/�i A'I ion. Date lam] nC Q EXEMPTION FROM WORKERS'COMPENSATION DECLARATION' (This section need not be completed if the permit Is for one hundred ($100) or less).' I I certify that in the performance of the work for which this permit is iszuetl, shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature - NOTICE: If, after making this declaration, you should becomesubjecL to. the .._ Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or' this permit shall be deemed _ revoked. CONSTRUCTION LENDING AGENCY I''. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 •Civ. C.) Lender's Name Lender's Address„ OWNER BUILDER DECLARATION I hereby affirm that I am exempt fromithe Contractor's License,+Law for the following reason (Section 7031.5 Business and Professional Code:�Any city tor 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/she is licensed pursuant to the provisions Iof the Contractor's License Law (Chapter 9 (commencing with Section 7000) of .Division 3 of the Business and Professions Code) or that he/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 d civil enalty. of not more than five hundred dollars ($500). I,' as owner of the property or my employees with wages as their sole t compensation, will do the work, and the structure is not intended or offered for 'sale (Section.7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. Ilf, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- '-prove for the purpose of Sale). I ❑. I, as owner of the property, am exclusively ocontractings with licensed con- ' tractors to construct t`^ ^•^0^^• • ^^ •^^ ••••^^"'^ ""^^` r^ '. The Contractor's Liu builds or improves 11- tractor(s) r Vactor(s) license purs proof of their Worke ❑'I am exempt untler Pin Dater •^ ME an Fee $15 Boiler Duct -Under Ground uant to the Contractor's License taw). I am aware that' 1 is Compensation in surance' should be provided to mer' Exhaust System•-❑ Multiple 1:1Section B..& P.'C:_for this reason ., Firepl/Fact BIt..I CBO # Owner- - - ' - Heating System & Ducting J have read this application and state that the above'. `� • ❑0.100,000 BTU El 100,000 BT Iagree to comply with all city and county ordinances ' 3 to building construction; an hereby authorize repre-- y toenterupon-th above-mentioned properrtty-y. for Date Drivers' License or SS # Reinspection CMF 0665-46, rev. 10/847 WhiteBuilding; Pink - Accounting; Goldenrod - As Issue Fee $ 3 Hood or Type L , Canopy Type I1 ❑ - Refrideration System t 00-100,000BTU-0100,000 BTU ' System -R epa it/Alteration I' Fire Dampers 7, Issue Fee $ 3 1,15138 10/14/86 _ Zone Accessory Building:. ` r Parking Req./Provided FIVFn ncj --- 3486 ELECTRICAL _ - ler ' _ Transformer ❑ 15.50 KW In Sub.. I _❑ 50+KW Meter. El up to 100 amps " Meter ❑over,t00amps ❑Electric - Sub Panel - - Motors ❑0-1 HP ❑ 1.'/:.- 8 Inc. Solar' 09-154016-15+ Microwave Pole Light Sign ' II Standing Section i KW 05-15 KW Trash Compactor 5:00 TL Z O N I N G R E O M T S FEES F Reinspection Fee - I $15 Issue Fee - $ 3 .DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By I "- Date _ Building Approved By Date ' I SUMMARY OF'FEES . 1 > 1 BUILDING PERMIT $ SMIP r $ r PLAN CHECK $ - - PERMIT O • PLUMBING $ -ISSUANCE $ - PLAN CHECK 25%. $ ENERGY P.C. $ -_ - �, �-GRACING I $ ELECTRICAL $ _ PLAN;CHECK .-50%' $ MICROFILNI _ $ MECHANICAL $ _TOTAL FEE $��`• PLAN CHECK 25% $ ; CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel: Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE y 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation i 59. Gas Pipe, ❑ Undrgrnd., Tes<i ; 9' Water Pipe-.Undrgrnd. 60. Backwash Lines, P -Trap, O U6drgrnd. 10. Structural Floor System61. APPROVAL TO DECK !11 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final S 12. 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- r 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22: Ducts, Ventilating 71. Product Piping OGas 0Oil - 23: Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 0 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. Insulation 78. FIRE PREV. FINAL - 30. Drywall Nailing HEALTH DEPT. REQUIREMENT • ", 31. Plaster Brown Coat 79. FINAL INSPECTION I 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 39. Water Service -Final. 40. Gas Service -Final , 41. Solar Domestic -Final 42. Backflow Preventer .. 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co - '• 51. CERTIFICATE OF OCCUPANCY No. Date £ ' '- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. + PER NO. TRACT NO. - LOT NO. UN T v OF COSTA M SA---/CtONSTRUCTION PERMIT., Project Address , �Q �l Lf%Qe �pyr- I rr Applicant's Mailin Address _ r• (y������ + Owner's Name a--F'�—c� Off' Phone Address Arch/Eng. 'I -License Nott' Address P, 0f�! ' "P, I Contractor's Nam ^hone City License No. LICENSED CONTRACTOR DECLARATION Z I hereby affirm that I am licensed under provisions of Charter`9 (commencing with section 7000) of Division 3 of the'Busihess and Professions'Code; antl my license is in fun force and effect./, License Class / -License No. w Date Signature i! r' . W. WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or, a certificate f Workers' Compensation Insurance, or a certified copy -thereof (Section 3800, Lab. C.) Policy No. ICompan v, - -' 8 Certified copy is hereby furnished. + ry!s Certi copy is filed with the cit'y Building Division., / 7 Date d Applicant EXEMPTION FROM WORKERS' COMPENSATIDN'DECL-ARATION 'I (This section need not be completed'if the permit is"for one'hundredl($100) or Ie55), b ,i a r ✓ { I certify that in the performance of the work for which this permit is issued,.l`( shall not employ any person in any. Anne +so sato become subject to the Worker�'lpo nsation Laws of Cali Ia//Q d��¢Iy�--�—, Date //LL��d Signature WX� rtf NOTICE: C after making this declaration, you r Cod , ne tfo h the Workers' Compensation provisions of the Labor Code, u ue forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that the which a construction lending agency for the performance C..) of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's LicenseLaw for the following'reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that -he/she is exempt :herefrom 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 pep2ity of not more than five hundred dollars ($500). 0 1, ar�tlwner—ohfltrnroperty—ol-'my—employees^withwage;_as"Neirsote^ cerrb6 satiom, will do the work, and the structure is not_intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/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 com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. f91 this reason Date � 9iY h Owner 1 hereby certify that I have rein information is correct. I agree to and state laws relating to buildir sentalives of this city en inspection purposes. Signature Drivers' License or SS 9P __ 333 o O SUMMARY OF FEES BUILDING PERMIT $ - 'SMIP $ PLAN CHECK $ PERMIT PLUMBING $- ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ PLAN CHECK '25% $ ;TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION REPAIR f �❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Building: �^ $ 3 TYPE OF PERMIT 0 GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front +❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B ` '❑ OTHER J A Rear C Right ,PROJECT. DESCRIPTION SQ. FT. OCCUPANCY KLeft ,-/CONSTRUCTION TV PE VALUATION$ $ ,f1 ' LONE` GRADING CU.YDS. ACRES 1 Ping. Ref. # Remarks Planning Notes: r Preventer Irrigation Dishwasher Drinking Fountains Floor Drains' Floor Sinks Gas Service Outlets Kitchen Sink - - Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO+ Heating System '& Ducting ❑ 0.100.000 BTU ❑ 100.000 BT Reinspection Fee 1 $15 IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor r1BING FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors - Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service - Auto -Wash Laundry TAT\ ,.. rue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000BTU 1-1100,000 System Repair/Alteration Fire Dampers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit 96L3 Accessory Building:, Parking Req./Provided Lu , Zone - ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter Dub to 100 amps Meter Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10-5 KW 05-15 K Motors E10-1HIP Ell h - B Inc. Solar 09.15 HP 016-15+ Microwave Pole Light Range Sign - Standing Sections W Trash Compactor S 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By . Building Approved By 'Application Issued By y FEES $ 3 Z O N I N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ - 'SMIP $ PLAN CHECK $ PERMIT PLUMBING $- ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ PLAN CHECK '25% $ $ 3 CONSTRUCTION AND•PLANNING APPROVALS Permit•# C, r Date Inspector POOL &SPA APPROVALS Permit# Date •. Inspector 1_tTemporary Electrical•Service or Pole 52. Pool & Equipment Location „ 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms t 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 1 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. / 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pide Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. 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 Bar Ceiling "-', 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating l� .71. Product Piping 0 Gas ❑ Oil 23. Gas Pipe -Rough & Test I 72. Underground Flush - 24. Roof Framing r' 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat °•`f ,� 75. Dry Chemical 27. FrameandFlashing t, • r� • 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 L� 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED f)1 33. Final Electric Notes: L EFT- CA(P-D. 34. Final Heating & Air Conditioning r 35. Final Gas Pipe -Test ae 36. Hood or Canopy - 37. Final Factory Fireplace - D7 -'G 38. Final Plumbing 39. Water Service -Final Qsem�V�ifl 40. Gas Service -Final .41. Solar Domestic -Final -44 �6Q o ' 42. Backflow Preventer .. - T - e/ •7- / pr 43. Backflow Irrigation �A < `!� L A4. Landscape Irrigation System _ i �•'t - ' ' ✓' _s "45. Sound Attenuation 46. Handicap Regulations ' I -ti 47. FINAL STRUCTURE & BUILDING . r , 48. Special Requirements Completed 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY ,• No. Date r LIMITED STATEMENT OF RESPONSIBILITY TO WHOM IT MAY CONCERN: �/61 Lf 2P 'mak _4c Street. Address Bldg. Permit # This Permit # AP Number I, , as Owner in, Title of the above referenced property, do hereby authoriz . __�2tcr __ -- Name Telephone No. Street Address 665t_;r, a-- ca-. ^'a.. 51.., to obtain permits in my behalf, as owner/builder, for at the above referenced property. Should ang person become an employee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. ��_h Ift Printed Name Date Signatur 077946, rev. 6187 City of Costa Mesa Building Safety Department CERTIFICATE OF O C C U P A N C Y N? 2180 C P. O. Box 317 Costa Mesa, California The Building located at ' 109 CloarbroOt Tgr-ea ilri .to A., B.; C has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group I IT & J Occupancy. Use of Building Tri nT ax'cri'th ssttsr'}ts+i, n=ge__ _ Legal Description (See reverse side for Metes and Bounds) Building Permit No. %�8 Electrical Permit No. 2xXZ Plumbing Permit No. 44081' Floor Load Signs have been installed as Room Capacity Signs have been instaled as required under Sec. 2308 U. B. C. required under Sec. 3301 (1) U. B. C. 17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency. (b) A new certificate of occupancy shall be obtained whenever there is a change in: 1) Occupancy classification of a building or portion thereof 2) The number of apartments or guest rooms 3) Ownership If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California Administrative Code, Title 8, Chapter 9, Article 8. Number of apartments— and/or guest rooms ISSUED TO: Building Official CT..WATMR0(K TATTP, (',0:M)CMATT0TS by i Date 7An�v�h ? TcS )This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form Bu34—lar-11-63—S-a r %S 22800' c6su MESA BUILDINGSAFETY DEPARTMENT P.O. BOX 317 COSTA MESA, CALIFORNIA For Applicant to, Fill In Completely Tl UPRINTILDING 0/ DRESS II�T� COSTA MESA, CALIFORNIA ARCHITECT TEL. OR ENGINEER 'A DRESS %�iAI/'OQ IQ.T^ /Ir RT /.32/ NO. AY NOW 01 F SETBACK LINE FROM 1RD LEFT IO' RIGHT ' (O DESCRIPTION OF WORK �I II_ I II• ROOF w USE OF / a F 7 huh U 1 HEREBY KNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 'AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF PERMITTEE - O AUTHORIZED AGENT /0 f _A4,1,44 FEE RECEIVED AUUGT 17 1964 FIN� BI1MNCE V IT, . For Office Use Only. RECEIPT NO. PI 2830 REC61 D Y R[CH HD A�q'L�] K.44 S'jU196 1 BUILDING . ADDRESS FIRE r' ZONE TYPE GROUP J� APPROVED ' BY DATE ZONING l ZO P 1 NO. OP USE OF NE I l PLANS BUILDIN LEGAL .O DESCRIPTION 2,[ I� A. P. NO. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN 30' TO SIDE & REAR P. L. EAVES ALLOWED (U. B. C. REQUIREMENT) YARDS APPROVED YARDS APPROVED 'MAIN BUILDING ACCESSORY BUILDING (FROM C/ STREET) FRONT ',/ �FT. FT. 7 R. BIDE FT. FT L. SIDE / FT. FT. �IBAR FT. FT. DISTANCE BET. BET, MAIN 9: MAIN BLDGS. ACCESS. BLDGS. VAR.# DATE C. U. P. # Aw APPROVED APPROVE .-/ T 'G BY DATE J / ;? 9 7 BQ. Fr. 7 ©o THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. VALUATION, / PERMIT FEE $ PLAN CHECK 5 TOTAL FEE