HomeMy WebLinkAbout117 CLEARBROOK LN - Building Permits • t
CITY OF COSTA MESA
# , BUILDING DIVISION
Fa, "tilr; 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov
$ FOR INSPECTIONS CALL: (714)754-5626
a°"°'""° PERMIT NUMBER: M12-00001
PERMIT TYPE MECH STATUS: ISSUED
%.,-- s:..dr,
APN: 41914119 DATE ISSUED: 01/03/2012
ISSUED BY: MDM
JOB ADDRESS: 117 A CLEARBROOK LN .CM Suite/Unit: , A
Vicinity: - - ,
SQ. FT: 0
SCOPE OF WORK: REPLACE-EXISTING FURNACE - - -
OWNER: DANIEL,SARAH L TR - Address: 15 NORTHA-MPTON.CT -Unit:
PHONE: - • City/State/Zip: NEWPORT BEACH, CA
APPLICANT: GEORGE HENDERSON , - - -Address: Unit:
PHONE: 714-240-3001 '• City/State/zZip: .
CONTRACTOR: GEORGE HENDERSON`A/C AND HEATING SVCS License No.' ' 613883 " 1'1:12-00001
Address: P 0 BOX 2247Unit: :-.PHONE: (714)240-3001 -
City/State: LA HABRA,CA • . ZipCode: 90631 -- - - CELL: ' ' ,
Ar .. , . . •
.
MECHANICAL PERMIT'FEE SUMMARY .,
MECH ITEM FEE: _ - .. $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: - { .$0.00-
TOTAL FEES: $38.30 '
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e1`-01.°001
'NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28,§ 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
'required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
.CODE A, INSPECTION TYPE DATE INTI➢AL$ CODE A INSPECTION TYPE OATE INnnIAL$
/J
1616 Fixed System Final Fire Prevention 206 Final Mechanical x — /-19-, n c
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 r , `' , ._p I
:204 Final Demolition 250 Final Building/Occupancy
WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver s license. ❑Yes 0 No f
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(]his section need not be competedethe Paint is valued at one hundred dollars WOW or IOW 2,Art 2,Sec.341,Title 8,Califomia Administrative Code).
Policy Number:
0 As owner-builder, I will not employ anyone to do work which would
I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
slued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should•
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Cod I shall forthwith comply wi these provisions.
,`� ♦ r I�) ,� Division of Industrial Safety Permit Number:
Appliran Signature D to HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license isisJin fullforceand effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# If r 3 d > S _ Class# t " PO/I ' 1 t/G'Y'(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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
0 I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑ No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8 (If'yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
�gna ire o Leal Owner(s) I Date
Signature Date 4 "ti..... I I, / %' I
305]46(3/W) - And/or A horized Applicant ate
Simplified Prescriptive Certificate of Compliance:20108 Residential HVAC Alterations CA'-IR-ALT-HVAC
Climate Zones 1 and 3-7 ''
Site Address: f / 7 y4 C i.£7?1'C /'i Ktj,IcEnforcementAgency: Date: Permit ii:
eo51t-14 WIPCY3 � //3111.
Conditioned , Duct insulation
Equipment Type' List Minimum Efficiency° Floor Area requirement Thermostat
0 Packaged Unit Over 40 ft of ducts �tt
umace I�AF[JE to coP Served by system added or replaced in PG1i Setback
I Indoor Coil a�SEER HSPF (If not alreadypresent,mus[be
Condensing Unit 0 EER Resistance (7((7U sf unconditioned space installed)
0 Other r R 6 (CZ 1,3-5)
/..Equipment Type:Choose the equipment being installed;if more Sian one system,use another CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Efficiencies:13 SEER,7 8%AFUE,7.7HS PF for typical residential systems.
Contractor(Documentation Author's/Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Pro Cessions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24,Parts I and 6 of the Cali fornia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with the permit
application. (�
Name: MI_(m YriS' 146:-Wbcn s U N Signature: \\`\\�\)`1q
Company: Date:\
GC-untris 14Pla-DI•ntaD1- file d- Wts-7- 1 i/ 3/11,
Address: License:
4qi 14DLtIs c1rccc,be j G / 3 },4- 3
City/State/Zip: L I 12 7
14 1414to e W ' 96 1 Phone: 7( 3/ 2 it 2.> 3/11>1
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2008 Residential Compliance Forms March 2010
PROJECT ADDRESS: 11.7 CLEARBROOK LN UNIT' CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 052873 •
OWNER'S NAME: GUIDINGER SARAH L •
ADDRESS: 107 VIA ORVIETO PERMIT NO: B 052873 PLAN CHECK NO: N GOVT; N SUPP: N
NEWPORT BEACH, CA 92663
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR . PURPOSE: ALT
',01ARCM/ENGINEER: NEG.NO.: JOB DESCRIPTION : REROOF 3000SF RESID 5 ATT GARAGE W/BUILT SQ FT: 3, 120 .
ADDRESS: UNIT: -
'_A CLAIM VALUE: 3, 120. 00 CALC—VALUE: 3, 120, 00 . GROUP OCC: .R-3 /M-1..
It PERMITTEE: WHITNEY ROOFING ( 714 ) 548.0769
ADDRESS: PO 15396 COMMENTS : T/OFF RESHT S RERF W/ CLASS "A" FIBRGLS
NB 92659 ********4*******************sE*yE***+r********TE**+F**************** ***************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am lic•• ed unde provisions of Char r 9(commencing with Section Z O N I N G R E Q U I R E M E N T ../'ERI P>���f°� ��
7000)of Division 3 of the Business and Professions Code.and m ense is in II force and eff•• S E T B A C K S tb�1,f i\ �•J �✓ •
CITY LIC.: 02 035 STATE LIC.: 6022 `r`
R ' _ MAIN BUILDING ACCESSORY B agf� pn_
Date: ( 1— Signature'. I/ e�;J---
WORKERS'COMPE SATIONOECLARATI I hereby affirm that have.certificate ofconsenooself-insumOracenilicale of Workers' FRNT: FT IN REAR: FT IN FRNT FT xIN •REfiH: 1� IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab. C). LEFT: FT IN RGHT: FT IN LEFT: FT IN ,RGHT: FT IN
POLICYNO.: 285910000328 EXP.DATE: 01 /0 •
1
copy is hereby oMCertified
nNed cSTATE PARKING furnished. lace ed copy is filed with th city Buil ivision� •
`/ I, ANNINGRp PROV: PARCEL: 13947404 INE: REF NO:NOTES>
Date' I7�t Applicant: ///�6 / **************>******************************************************.*"**********
EXEMPTION FFM WORKERS'COMPENSATION DECLARATION: (This section need not be mpleted if the permit is for one hundred(5100)or i). D E. V E L 0 P M E N T SERVICES R E Q U I R E M E N;,;T S
I certify that in the performance of the work for which this permit is issued,I shall no employ any person in any manner so as to become V'
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature: • .
NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: '�_
• Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: A DATE: 7- j1 1
• which this permit is issued(Section 3097.Civ.C). . ****************************************** *************************. * ** .k-*** •
LENDER: ******************************************************************************* .
ADDRESS: LEGALIZATION:N F E E. . SUMMARY STRUCTURAL SEGMENT:Y "
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC • FIRE SMIP/RES` GRADING
(Section 7031,5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 6 3 . 00 . 50',
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMI P/NON RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by' ,A
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the ' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID .4, DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 63 ,.50 0 , 00 00 0 . 00 63 . 50 12 7 , 0 0 t, "' —63 . 50
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 REVENUE DIVISION TOTALS--> COLLECTED• 63. 50 OVER/SHORT: 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
•I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63. 0 0 , 5 0 i?'•
'
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **********************************************************************t****-*****
that proof of their Worker's Compensation insurance should be provided to me. I ND I V -I D U AL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C. v�
for this reason: TYPE QTY DESCRIPTIO N • UNIT COST TOTAL COST
•
Dale. Owner. SFR 3120 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 3, 120 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ,)
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from P
these provisions. • r
• c'
• Date: Applicant: a et
I hereby certify that I have read this applicatir and state that the ahoy• formatiot is car ct I arree to comply ith- city a county
ordinances and state laws relating to building'onstruction and hereb .uthorize rep' entativ -l!['. ity to enter ur.nth o entioo _ .�j
properly for inspection purposes. I ..
Date'. ''— Signature: . A ...)9(/
01 00092257-0009225Ki 1PD-T c i.5U
Driver's License or Social Secur y 5131DATE: 07/17/91 TIME: 09:07
1641-46 While—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Ass ssor
• • POC .;PA -
CONSTRUCTION AND PLANNING
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 5 53. Steel Reinforcement
3'.;Electrical Conduit Utilitv-Undrgrnd. s 54. Forms
4.:Electrical Conduit-Undi'grnd. 1 55. Electrical Bonding - - -
. r 5.•-Steel Reinforce--Ment • 56. Rough Plumbing & Pressure Test •
, .i„ ejElectrical UFER.Grnd. ' 57. APPROVAL TO COVER-GUNITE _ (.
s.' 7.'Footingsc - 58.' Electrical Conduit-Undrgrnd.
-- .
z 8.;-Foundation -:rt °' 59. Gas Pipe, 0 Undrgrnd.,Test
•
91 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 p/ • 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 .
r
19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT -
•20:-Rou h Factor Fire lace - ; _ t ,u. . v
g Y p - �APPRQVALS'•.:•=Perm it#
21.'Ducis,in.Str.uctuSe' . , ' x *170. Undergrpund Hydro - '
22. Ducts, Ventilating- - t'- y .71. Product Ping O Gas OOiI
23..Gas Pipe-Rough & Test • -72. Undergr'ounll Flush;-r - C.
24. Roof Framing - - ' ,73: Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing , ` - ,_ :2.. 74:. Overhead'Hydro '
26.'T-Bar Ceiling (Structural) &•Monocoat .1 ��- T._ -. 75.'Dry Chemical t - ._
27; "Frame and Flashing I ' 7 76i Dry StandplPe C> ' `"
'-28."Lathing&Siding , ,_ „ 77. FIXED SYSTEM FINAL•
'29. Insulation r' _ " " •' ' ' * � r , 78,FIRE PREV. FINAL • - -•:.130. Drywall,Nailing `. , -4 I is • HEALTH:DEPT-. REQUIREMENT
.31. Plaster Brown Coat' _ l 79:�FINAL INSPECTION - '
32.--Electrical Power-Meter•Final i • 4. 80.nFOOD CERTIFICATE ISSUED
33.-Final Electric - • •. I 'y 'Ll Notes: - y '}
--34.-.Final Heating.& Ali7Conditioning I It , a '
i
35. Final Gas Pipe- Test- r - L. , . r -
.36. Ho d or Canopy `r I. .r, .,- ,r
37!'Final Factory Fireplace .• • -
-38. Final Plymbing :. - .i • ;'• • , 2:* . - -C -. -
,`39. Water Service•FinaI I F` rt- •
40. Gas Service-final : ' i• • ' ' '
Cis
-41. Solar Domestic-Final ' ,• r
42.'BackfloW Preventers j f i -
t V
`
43. Backflow Irrigation .. + u - -
u - 5
44.;4Landscape Irrigatign System - ,,•y r - `
_
' 5-45..Sound Attenuation - . r- -
46. Handicap Regulations it. i ',.;
47 ,FINAL STRUCTURE & BUILDING7-2Z-9( t4-61 - 7rLz -pi( 4 /e teD l/ 'J c /e
48?FINAL PLANNING ' ,• ' r' ti [(/
' c 49:3-EIe'ctric Release to,Edison - - :< * r .t '• • - ,,
50. Gas Release to Southern California Gas Co ' • II •- - -
•
51. CERTIFICATE OF OCCUPANCY' ', ,- 4, ., -
No. Date
Pr, —11111111
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
• CLLT� YOF COSTA MESA I CONSTRUCTION PERMIT _ PER/EMIT NO. -j./��- TRACT NO. LOT NO. UNIT NO. 7932 '2IBI /B5 -. "' 7PQfl' I L
Jefoject Address I J 7 •Cik-/�g 3 J2,o o%L- • • . ' •r • I
Applicant's Mailing Address _ • TYPE OF CONSTRUCTION U NEW"U ADD LI ALTERATION U REPAIR - - 't -
❑ CONVERSION' ❑ DEMOLISH ❑• OTHER - Zone,
Owner's Name ��Tf p�A/�e�S Phone' 1 'DESCRIPTION_ OF WORK/USE OF BLDG. '
Address - - - •' S Main Building: , Accessory Building:
i , - .. E • Z
Arch/Eng. " 'License No. TYPE OF PERMIT ❑ GRADING- ❑ FOUNDATION ❑ STRUCTURAL . - T Front . ; r . • O
Address• - • . • ' ' • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear . .- - . N
•• ' IG' /t ,. ❑ OTHER - - v A 1
Contractor's Naini A' A p) N . Phonel-/y - C Right - - N
Address(mailing)272- 2 /GAT//vh - b P. PROJECT DESCRIPTION SQ. FT. • OCCUPANCY K - •
- - _ G
CONSTRUCTION TYPE • VALUATION $ $ Leftr r i
City License No. — . 52'5-7/ a - ZONE GRADING CU.YDS. ACRES - - - R
LICENSED CONTRACTOR DECLARATION . Ping: Ref.# Parking Req./Provided - 0
.. E
• I hereby affirm that I am licensed under provisions of.Charter9 (commencing , Remarks: _ Planning Noses: r M
with section 7000) of Division 3 of the Business and Professions Code,and - -
T r
my license is in full force and effect. n!< ' S
License Class Lic s o ' -
DateJ_ - 2 / -"C!S'- Signature An I I PLUMBING FEES• A i ;
WORKERS'COMPENSATION DECLARATION Bar Sink . Showers ELECTRICAL FEES 1 ,
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 ' Backflow Preventer. _ Service Sink -
3800, Lab. C.) - -
- . • - Automatic Washer - Transformer-❑ 15-50 KW - '-
PolicyNo. Company Backflow Irrigation Sewer Cap' • I Construction Pole Sub, . 1 050+KW '
❑ Certified copy is hereby furnished. ' '
❑ Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit 'Meter ❑bp to 100 amps
•
Date - Applicant . j •
EXEMPTIONFROM WORKERS'COMPENSATION DECLARATION Clarifiers , i ' • - Solar Collectors . . Dishwasher - Meter Dover 100 amps i '
(Thissection need not be completed if the permit is for one hundred ($100).or • ' - - - " '
less). Dishwasher Solar Piping • Dryers ❑Gas. OE Sub Panel •
I certify that in the performance of the work'for which this permit is issued, I ' .
•
shall-not employ any person in any manner o as o come subject to the Drinking Fountains Solar Tank - Fin Motors❑0-1 HP ❑1%-B
• Worked Compen anon'Laws of Calif r is /yj`G'
,f— .,Date r,I- .7/ —F Signature ,(_,/ /r✓ Floor Drains Swimming Pool w/Spa F.A.U. Inc Solar 09-15 HP ❑i6-15+
• ' 1 'NOTICE: If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks ' •
Urinal Fixtures
comply with' such provisions or this-permit shall be' deemed revoked. ,Microwave
CONSTRUCTION LENDING AGENCY i , - Gas Service Outlets Water.Closet `' /yam Device Boxes
I hereby affirm that there is a.construction lending agency for the performance ' - - l int 'Pole,Light
of the work for which this permit is issued (Section 3097 Civ. C.) . Interceptors Water Heater Outlets Range Lender's Name •
•- 9
Lender's Address - - - Kitchen Sirik Water Service ' • Switches
OWNER BUILDER DECLARATION ! -- - - - -- - - - - , - - Sign
I hereby affirm that I am exempt from the Contractor's License Law for'the ' Lavatories , , 'Auto-Wash - - Garbage Disposal ' i '
following reason (Section 7031.5 Business and Professional'Code: Any city or - 9 P ,Standing Sections. ,
county which requires a permit to construct,alter,improve,demolish or repair P—Trap - c. s '
any structure, prior to its issuance, also requires the applicant for such permit Laundry Trays, �I Generator ❑0-5 KW ❑5-15 KW •Trash Compactor ,
to file a:signed statement that he/she is licensed pursuant to the provisions of Roof Drains - .
•
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 ; _ _ I i •
7031.5 by' any applicant for a permit subjects the applicant to a civil - - • - '
enalty of not more than five hundred dollars($500). I
•
Li I, as owner of the property or my employees with wages as their sole '•Reinspection.Fee - I I$15 I Issue Fee $ 3 '
•
compensation, will do the work, and the structure is not intended or offered - - Reinspection Fee ! $15 . •Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's ' - MECHANICAL FEES -. - -
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 ownDEVELOPMENT SERVICES REQUIREMENTS: •
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 _
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II' ❑ Zoning Approved By Date
pletion,the owner.will have-the burden of proving he/she did not build or im- Duct-Under Ground ' , i i
' prove for the purpose of sale). Building Approved By Date •
• 0 I, as owner of the property, am exclusively contracting with licensed con- i Duct-Structural • Refrigeration System Application Issued ByIgN) Dat: igi
. 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 Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES '
builds or improves thereon, and who contracts for such projects with a con-_. .
• tractor(s) license pursuant to the Contractor's License Law). I am aware that 1 Exhaust System D Multiple ❑ System Repair/Alteration BUILDING PERMIT , $ • SMIP $ •
proof of their worker's Compensation insurance should be provided to me. PLAN CHECK . $ PERMIT
❑ ram exempt under Section B.8 P.C.for this reason ' Firepl/Fact.Blt. ICBG# Fire Dampers . '• ISSUANCE $ i
'
PLUMBING $ • 1r
Date owner' Heating,System& Ducting Registers i •
PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify.that I have read this application arid state that the above ❑01OQ000;BTU 0100,000 BT GRADING $
. information-is correct. I agree to comply with all city and county ordinances . ELECTRICAL $
and.state laws relating to building construction, and hereby authorize repre- - MICROFILM i$ I '
, sentatives of.this icity to enter upon the abve-mentioned property for . r PLAN CHECK 50% , $
-
inspection pur o s. • ,./ 'Fr,.
Signature '
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% '$ - , ,
CMF 0865-46,rev.10/84' white -'Building; Canary'-Applicant; Pink- Accounting; Goldenrod - Assessor - ✓ f
•CONSTRUCTION AND PLANNING POOL &SPA /
APPROVALS - Permit # Date Inspector 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
S.-Steel Reinforcement 56. Rough Plumbing & Pressure Test -
6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE _ '
7. Footings - • 58. Electrical:Conduit-Undrgrnd.
I Bf Foundation -. - ' - 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd., ' - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System • _ _ 61. APPROVAL TO DECK
11. Property Sewer Line & House Connectign 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
• 20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure • 70. Underground Hydro
22. Ducts, Ventilating' 71. Product Piping 0 Gas 0 Oil
23.•Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing •73. Undergrnd.Stdrage Tank 0 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 PREY. 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 l t3- tea
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 Preventers '
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 . . .. ..1 l No. - Date _ - . _
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N° 2183 C
P. 0. Box 317
Costa Mesa, California
The Building located at :LUT Clearbrook Lane, Units A, .8, C
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group g il' — Occupancy.
Use of Building Triplex withattached garage
Legal Description le1-3!+3-03
(See reverse side for Metes and Bounds)
Building Permit No. $ Electrical Permit No. 23261 Plumbing Permit No. 44079
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 _
CLFARBROOri{ LAM CORPORATION by _ - '
Date 7 Mitt 25, 1965
i,Thi3 Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
;f except by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Farm 3U34-1M-11-63-S_B P
,,vt. 22828 FEE RECEIVED
'COSTA MESA BUILDING-SAFETY DEPARTMENT AUG 17 1964
P.O.BOX SIT COSTA MESA,CALIFORNIAFINANCE DEPT. •
•
f I'1& pg�STA MESP
For..Applican (tp Fill ln'Completely APPL I N PERMIT
T,� `•oR PRINT • BUILDING
117 }{ E/.,c-parl� ^ rte, n For Office Use Only
BUILDING I' r�-�✓�nX
ADDRESS \. L RECEIPT NO. PERMIT No.
COSTA MESA, CALIFORNIA 22828
RECEIV DA%ECEdke DATE ISSUED
'OWNERC[PARA,R DK L.ANe CoRp oRAr,'o y AIi� 2 4 �it
MAIL BUILDING
ADDRESS /04C I/IAA b DRe e_ ADDRESS (,' ^'�
TEL. ZONEIRE - TYPE 7 GROUP ('t''l'-1
CITY bewp Rr ReACh NO.9T 4)-90 "�( - I
APPROVED
ARCHITECT TEL. BY DATE F
ORENGINEERL.A VAAI 4L/ ( • No.GJ;-]DIn Ill
ZONING X
44U-esti/Rn6finLNew�otirBPAch f-Xitn er W
O ZO NO.O BUEOPNEW j I
COI PIAN BUILDING I/,'ry{� a
CONTRACTOR LId(1 l�O NST- O • Igil ++ 4 z
V
(— :YAM
p LEGAL j//A/)
ADDRESSLIJ
yy�� 10 q.] t J AMVI A0/I L DESCRIR'ION ��JI, C J 1 ✓\ a
CITY/ve-WpORr Repo,! A.P.NO. f I ` .31'±-3-,-3 .a
�? _ / NOTE: NO SAVE OVERHANG SHALL BE LESS THAN Q
LIC..NO.'I�S 1 IC,/ -^,N/O. C—'3 J z'Jp 30"TO SIDE a REAR P.L. W
OFLOT Iab —So��S`y 1 I NOW OrvLOTB`tr� ALLOWED (U.B.C.REQUIREMENT)EAVES y
,` YARDS APPROVED YARDS APPROVED CC
USE OF MAIN BUILDING ACCESSORY BUILDING Q
EXISTING BLDG.
' (FROM CLL.STREET) Mg
CENTER LINE FROM ./� ./ FRONT -C OFT. FT.
CENTER OF STREET- i)�V REAR YARD �O
SIDE YARD I LEFT �o I I 'RIGHT G I R.SIDE �� FT. FT.
DESCRIPTION OF"WORKL.SIDE /T Fr. Fr.
(-------
NEW t' _I ALTERATION _ ADDITION AR L} _ FT.. FT.
J I
DISTANCE BET. BET.MAIN&
REPAIR i MOVING -. MAIN BLDGS. ACCESS.!SLOGS.
VAR.# DATE
BUIL
DING/11/-,++x 3i-1'R40MS 1-. STORIES 1 C.U.P.# APPROVED
SIZE
EXTERIOR WALL ROOF '. APPROVEDI I ,AI , rte// //,
COVERING c7"/"CC.-0 I COVERING Roe-A BY 1 'Vy DATE `/ / -✓
USE OF BUILDING AND WQ�1{ EPERFORM�D I l ` I o �2r(/DC(./
-n I L-e)( cYY�c��22W1 e l.i, (/v33(['-- ([! . jf 1 o'l t ,JU J
je
't,R A&e, 14-T7-At h e/ 2x/9 7 o FT. 7 t
rg r 3mpT o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT,SHOWN UNDER VALUATION IS POR THE S
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. o
PLY WITH ALL CITY ORDINANCEG AND STATE LAWS REGULATING VALUATION / m
BUILDING CONSTRUCTION. N
SIGNATURE OF n ' ./f PERMIT FEE $ V j
PERM InEP �ylf S 46/ r.I / C CK /t O
AUTHORIZED AGENT R N A ///���==/// 5 ,2 //a�t-
�1 +� TOTAL FEE7