HomeMy WebLinkAbout124 CLEARBROOK LN - Building Permits-- --••••�,
Job Address: 124 CLEARBROOK LN IWO i A MtSA, CA 92626
Suite: Status: ISSUED
Vicinity: Applied: 09/09/2005
Primary Occ: R3 Issued: 09/09/2005
Parcel Number: 41914110 Type of Construction: V -N
Zoning:
NOTICE: The work authorized by this permit shaft comply with all applicable handicap access requirements under California Statutes and related
regulations. (Ord. No. 92-2s, § 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
fora period Nof 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 Inspection$ 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(6=)
l
.111111,
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0/1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, 1pr the pertornanco 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 Cade, for the pertormanco of the work for which this permit is issued.
/bly\workers' compensatlon Insurence carder end poll ,n-uhmcbbeer are. . _ 2 ) �/
'Carrier: ) 0 ZN (J IwnP T-c.islr� olicy umber: _ I / 6� L Yo
i Hon need not be completed if the permit is valued at one hundred 0) or less.)
❑ 1 certify that in the performance of the work or which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califoryia, and agr4 that if I should become subject to the workers' compensation provisions of Sectloi3��the Labor Code, I shall forthwith
comply w th these pro(vlZslon (GC)
pplicant Sig ure: Date:
W FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN E O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3105 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CaNTRACTORS DECLARATION:
I her m I am licensed under provisions of Chapter 9 (commencing with Section 7000) of DivisiD a Business arW Professions Code, and my license is in full
force nd effect. Lic. q —T� T./ y 12c 434/ lass a ('S.c/ /
Cont cto 51 tura: 4:-A` _ Yl.% Date: 7 11 i�-
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 Cade).
Lenders Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($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 own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification at 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 6, California Administrative Cade).
❑ 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 hes a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
...................................................................................................-..................................................................................................................................._..................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will
theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ NO
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
............................................................................................................................................................................................................................................................................................................................................................................................
4 If an RMPP is presently. required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
...............__..... .............. ...._.........I-_.. ------ ...-----------
.........................................................................fo.......
............................................................................................................................................................
.............................................
5 Does ar will the applicant ogpresent or future builtling occupant require for the work which is the subject of this 2pplicaticn apennit for such construction or modification
from the South Coast Air Quallty,Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the,Celifornia Government Code requires that the requested information be furnished on applications for non-residential building permits).
............................................................:_.>.._._:._................................. ................................................................................................... .................................................. ........................... ............. ...........................................................................
6 Will any part of the facility to Depristructed under this permit be within 1000 feet from the outer boundaries of a schocil? ❑ Yes ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
...................................................................................................................................................................................................................................................................................................."....................... ...............................................................
7 If a permit from IhetSouth 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 Cis,Dlosures prescribed by California Health and Safety Code Section 42303 been made? 11 Yes [:1 No
.
........................._7.....«.-..::...-.............................................................................................................................................................................................................................................................................__...............................
8 (If yes", attach certificateiof compliance from the appropriate air pollution control officer).
CERTIFICATE OFI'WMPLIANCE: 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 stslia laws anty ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described' property for inspect n purp ej' I agree not to occupy or allow occupancy of any building authorized by lhi;,per it )IIntil final inspection.
6i ra
Vcyry'r Signature Of Legal Owner(s) Date
A'r d/D honzed Applicant Dat
CODE 1. INSPECTION TYPE PATE INTMAL CODE INSPECTION TYPE 26.TE INTMAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final .���, ����, 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Block/Rebuning Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. '
NO LOT NO III
CITYOF COSTA MESA C STRUCTION PERMIT M�II
Project Andress
,Applicant's Mailing Ad�ry ss
Owner's Name .E�'7DDF,�J Phan
Address rJ�A�G
Arch/Eng. License No.
Address
Contractor's Nam n O�iurmhone _3
Address (ma"tnnl llnopLA
City License No 3
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 cc d effect. - .[it/�/'S 7
License las - - ce s No
'ate - '
Signature
ORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure or certificate
of Workers' Compensation Insurance, or a certifi d copy thereof (Section
3800, Lab. C") yo
����
Policy No- ,/i Company
ertified copy is hereby furnished.
Carti ' d yp ' ed with the city Bull gg.Diyiisi$���i/
Date 'X Applicant �"/S G/r.L
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section 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 issuetl, I
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 become subject 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 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
1 hereby affirm that I am exempt from the Contractor's License Law 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
yny structure, prior to its issuance, also requires the applicant for such permit
file a signed statement that he/she is licensed pursuant to the provisions of
+„:
L
CONSTRUCTION AND'' -PLANNING
APPROVALS Permit #
Date
'Inspector
POOL & SPA -
APPROVALS Permit #
Date
Inspector
1. Temporary Electrica�-,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 LIFER Grnd.
57. APPROVAL TO COVER-GjJ ITE
7. Footings• i GJ�
58. Electrical Conduit-Undrgrnd'.:
8. Foundation C-7
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 Connection
62. Backwash & Receptor- Finalj
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
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank []Gas []Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75: Dry Chemical
27. Frame and Flashing
�•
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL
I
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
36. Hood or Canopy
37 -Final Factory Fireplace
t
38: Final Plumbing
39. Water Service -Final -
•'
i - - !
40. Gas Service -Final
�t41. Solar Domestic -Final
a
,42. Backflow Preventer
-- ` '•
f:
43. Backflow Irrigation
- I
,,44. Landscape Irrigation System
; 45. Sound Attenuation
46. Handicap Regulations
r, j
47,: FINAL STRUCTURE & BUILDING
48:'Special Requirements Completed
t _
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
-• �,
51. CERTIFICATE OF OCCUPANCY
No. Date
-
PROJECT ADDRESS: 1124 CLEARBROOK LN
OWNER'S NAME: PHIL 6 JANE MAZZAGATTE
ADDRESS: 4141 BALL RD #118
CYPRESS
CA^90630-3400.
(714)828-7557" `
ARCHIENGINEER: -
ADDRESS:
UNIT: ABC
REG.NO.:
UNIT:
PERMITTEE: MEADOWS CONTRACTING (714)354-7742
ADDRESS: 7980 BOLTON AV
RIVERSIDE CA 92503
LICENSED CONTRACTOR 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 Cotle. a my license is in full fWeffecCITY LID.: 0 5 17 17 STATE LIC.: 5 8 0 0 2 CLAS : B
Date: /1%, 3 nr pQSignatureWORKERS' COMPENSATION DECLARATION: I hereby atlir t I have a cerlilicade of ertificale of WorkersCompensation Insurance. or a certified copy thereol (Seco n 800. Lab. Cl.
POLICYNO.: 1154024-89 E .DATE: 09/0
COMPANY: STATE FUND
❑ Cepheid copy is hereby furnished. Ex Codified copy is it d with the ci Building Di island.
Date: / �, 9 63 , 9a Applicant: '
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: IT section need not be completed it a it is to ne hu ed ($100) or less).
I cendy that in the performance of the work for which this per i issued. I shal' not employ a n in no so as to become
subject to the WorkersCompensation Laws of California.
Dale: Signature:
NOTICE: If. after making this declaration, you should be me subject to the Workers' mpens ploy ons of the Labor
Code. you must forthwith comply with such provision this permit shall be deem evoked
CONSTRUCTION LENDING AGENCY: I hereby affirm Ilia t ere is a construction lendin agency to the performance of the work for
which this permit is issued (Section 3097 Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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 Contractors' State 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 a civil penalty of not more than five hundred dollars ($500).
I, as owner oftheproperly or my empployees with wages as their sole compensation, will do me work, and the
❑ structure is not intended or offered for sale(Section 7044, Business and Professional Code: The Contractors' State 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 awn employees. provided that such improvements are not intended or offered for sale. It, however the building or
improvement is sold within one year of completion, the owner wi11 have the burden of proving he/she did not build or improve
for the purpose of sale).
I. as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' Stale License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractods) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section'. B. 8 P. C.
for this reason
I do hereby certify that I am aware of and under:
25534 and that I or any Injure building occupant
permit for construction or modification from the
these provisions.
Owner:
his of California Health and Safety Code Sections 25505, 25533, and
me) need to comply with said state codes and the requirements for a
mend District. Residential construction applications are exempt from
Date: APP "m
11
I hereby certify that l have read this application and state tha a above information is
ordinances and stare laws relating to building construction and y aumonze represent
property for Inspection purposes. �r
Date: �� —. Signature:
Driver's License or Social Security n:
1641-46 Wh le—Build,na: Green—Code Enforcement _ CJharv—Aoolicarn Pink
I agree to comply withII City and county
his cit ender pont eabove mentioned
c
ue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO:,P 04970
PERMIT NO: P- 049706 PLAN CHECK NO: N, GOVT: N SUPP: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION ; INSTALL TWO GAS SERVICES SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: R-1 /M-1*
COMMENTS:,*
Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN BUILDING ---------- ---------
ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT:
FT IN REAR: 'FT IN,
LEFT: FT IN RGHT: FT IN LEFT:
FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 41914110
ZNE: REF NO:
PLANNING NOTES>
>
**if•ik**iE BE BE iE**iF*iE BP iP*iE*BE BE ik**************BFiP iF**RE iEiP it i(•iE***iE******iEiF***BE
FE *9E RP**iE********
D E V E L O P M E N T S E R V:^I C E S:'., R
E Q U I R E M E N T S'
ZONING APPROVED BY `
DATE:
BUILDING APPROVED BY
DATE:
APPLICATION ISSUED BY:
DATE:
***BP If 1F BE)E**1E iE lE *BE lP lF iE BE fE fE IE F
BE iE Rf iF 861E iE iE*BE **7FF�7F iF iE
iE 1E FE iE iE*BE iF BFiE fE iP iP iflP*if***fE iEit*BE***BP *Rf lE iE **iE iPiP •F*iPiP*iP*it•iE***iP*9E*9F*1E**BP
BEiE iFiPie REiEiP*iP iE BE it Bt
LEGALIZATIONz,N F E E S U A R Y
STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/RES GRADING
PERMIT 4'5Y
SMTP/NON—RES
PLAN
ISSUE FEE 3,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTAL PAID DUE
TOTALS ---- > 4.00 3.00 0.00
7.00 7.00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 7.00
OVER/SHORT:00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
SMIP/TOT GRADING PLAN—CHECK
7.00
k *iFif iP *iF *iF iP***iF** 3P*BP***BF iF 9F iE*iE*iP 9E*IE BE BP*iF iF*iE BE iE*RE**iE9E iP iE
iE*iE BF*iE iE iE it*RE iF BE*RF 1EiF iEiE iE iE BE iF*iE*iP*iE
I N D I V I D U A L F E E B R
E A K D O W N
TYPE QTY, D E S C R I P T I O N
UNIT COST TOTAL COST
PLU 2 GAS SERVICE
2.00 4.00
END OF FEES
01 00073152-00070152 T CFT
DATE: 10/30/90 TIIE: 1 .07
t.00
CONSTRUCTION AND PLANNING
PL-L & SPA
APPROVALS Permit #
Fpiatelnspector
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
-
52. Pool & Equipment Location
� •- ni
2. Soil
{ S
2. Soil Pipe-Undrgrnd..
53. Steel Reinforcement
,
� r
_,3.�Elettric`al Conduit,Uiility-Undrgrnd:-""
54. Forms
- 4.Conddit.Undrgrnd.;'' r.�
55. Electrical Bonding
r..
.Electrical
h+r•.-
5„§e'eljReinforcementj d
56. Rough Plumbing & Pressure Test
•6; ElectricalUFEB�Grntl. x
57. APPROVAL TO COVER-GUNITE
`';7.aFooiiilgs ',•-,•Zr4?
58. Electrical Conduit-Undrgrnd.
'
'-'8; Foundation -�
`�
59. Gas Pipe, O Undrgrnd., Test
---
__-
_ -
9:�Water'Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, O Undrgrnd.
Structural Floor`System
61. APPROVAL TO DECK
1:1". Property Sewer Line-& House Connection
.
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
y
13. Roof Drains v
- %j.
64. Plumbing System - Final
?
�%
14. Rough Plumbi6l; %�
F
; �'`
65. Electrical-Final
=%y
15. Rough Electrical- Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing &Access Approval
"17. Rough Wiring Sign
^18.
68. APPROVED FOR PLASTERING
Rough Electrical,T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
_ _ _ _
_
y � ;•,-ILC:-• C:
-APPROVALS? -_ (-Permit '
20.vRouah F.actocy F[Peplace I t;'ol
D C':r
• rn �'cfr !-.r
x
1i o
1] H
21.jputts, in-StrUCLUfEz
's
!^ ��„ +:
4-•`/0. Underground: Hydro i.
22. Ducts, Ventilating•^%•77,
productlPi in O'Ges ❑;Oil
g
n .r -
V r•
n r-y .
l-p
23.rGas`,Pipe Rough&'j(est tri
T iT
',1
1-i W. T
' h'1 �. "•'l"
Underground Flu`S'
�y
`,
_72.
24rRoo`fFramin9; rr -
*? O
r x
S73.mUndergrnB.StorR'Tankf]Gas ^OOil
25. Roof Sh_w thin s :G.4
9
t>7 to
O Ci+ .
_,F .:
F-
"74.=Overhead Hydro
, .r
> ;w
26. T-Bar Ceiling (Structural) &'Monocoat
rj
75!7Dry Chemical ..
rJ'
27.''Frameand Flashin' ;D`~
9y.
'r -
to
76TDr Stand"i a �v
Y
:-,
P.P_
v28. Lathing`& Siding c:
z'
77.c^^FIXED SYSTEM-FINAL v
_.
"29.Insulation x'O :S
z q
70FIREPREV.FINAL y�
i+30. Drywall Nailing ••
y {
i is x
�.:.+ �•HEALTHlDEPT.t REQUIREMENT
5 31. Plaster Biowp,Coat"
i ^ti, x
IFi'NALCTINSgECTI(ZN v
r r
_
.r79
Power Meter;Finali
,<r.;
r>:.
r80..,FOOD CERTIFICATE ISSUED
C.•32:;Electricdi
I
Electric ^
"
�1Notes:
�33:•:FirM
'll
34.-Final Heging_& Air,.Conditioning�
h' :
x S ;'U s C
r
''L
i
-35FFinal GSs Pipa-Test' `•'
�� (`r(Q�
C*
CI .^. tr1:� a. Cr• O
.a
'` no v`• i R'
Hood
X ,
`.✓
.36. or.CanopY to i
-
t
sF
}� is
;:37:=Final Factory FirePlacsx to y
M
I :38. Final Plumbing * fit,,:
`{ `('
(.k li.
V' ;S '•D
v
a39. Water Service-Finch o
a i
f SIS' 1:
T s
`40. Gas Service-Final `�
+n, W c; Cr it
�. lel 1
:. UN_ v
���41. Solar Domestic-Finals I-1 ••
C
_�
f
`-42i=Sackflow Preventer
I
-
v
43. Backflow Irryation� i'S:7
2
r',
x
X44. Landscape Ir%i ation System t-4
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x cJ N N.L� x tu O
7:45.:Sound 'Atterivation_ amu; t
£ [�
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•
_46-Hand icA Re ulations - S
t7
a
_j i '�`� -• _ .c
•47 ,FINAL STRI.ICTURE & BUILDING
48:.'FINAL P LAI4NING
;49.ElectricRelease toIdison -
,rF .I
r�
7 •r k
50_,Ga�Release toSouthern California Gas Co
-
{ +�-�;. ;
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251. CERTIFICATE OF OCCUPANCY
;
:_ f' MCI,
No. Date
I
3
Applicant to fill in all
CITY, O6 COSTA CONSTRUCTION PERMIT
. Project Address ��///C.(D
Applicant's Mailing Address
Owner's Name �1.L1 A� •� v Phone
Address 104 OL A0 , roc r =- A
Arch/Eng. License No.
Address _
c /
Contractor's Nam `m r � Phone ��- yJ✓
Address (mailing) 1hhJ3'2r LTJ-.Clay>COe-�
City License No.
J �A
LICENSED CONTRACTOR DECLARATION
1 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 fo e S effect, 206Y9License Class Li a No.
Date I'�Ip' ^ Signature .j Ir�y//l A
WORKERS' COMPENSATION DECLARATION
hereby affirm that 'I have a certificate of consent to self -insure or a certificate
' Workers' Compensation Insurance, or a cert ed Copy thereof (Section
E800, �! Lab. C) j� I I I
Policy No. - ✓�rl �I' Company ✓6W)A ��
�ertified copy is hereby furnished. r
e rtifie copy 1f_'l with the city Bui din�%�lw on%
Date ��//'+" Applicant & /� /(&>!/7%4!
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
ess).
certify that in the -performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject 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 ^
1 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 from the Contractor's License Law 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 Sectiohr7000) of
livision 3 of the Business and Professions Code) or that he/she is exempt
ierefrom and the basis for the alleged exemption. Any violation of Section
031.5 by any applicant for a permit subjects the applicant to a civil
nnalty 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 (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).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Coue:
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). Iam aware that
proof of their Worker's Compensation insurance should be provitled to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
hereby certify that I have read this application and state that the above
Information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this cit fo. a ter upon the above-mentioned property for
inspection purob �, f D� I� [/
Signature //'�/ 1 ,(/I .l�%/i12� Date T/'DD
Drivers' License or SS -r
except those within heavy border lines and sign all appropriate declarations.
TRACT NO. I LOT NO. I UNIT NO:
TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION LJ REPAIR
Showers
❑ ❑ ❑
.Service Sink
CONVERSION DEMOLISH OTHER .. ._
A.P. #
DESCRIPTION OF WORK/USE OF BLDG.
-7
Clarifiers
Solar Collectors .
Dishwasher
Main Bui
TYPE OF PERMIT GRADING ❑FOUNDATION ❑ STRUCTURAL RAL
T
Front
. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
B
Urinal
❑ OTHER
A
Rear
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
C
K
Right
CONSTRUCTION TYPE VALUATIONS
S
Left
.ZONE GRADING CU. YDS. ACRES
Ping. Ref. #
Remarks:
Planning Not
Bar Sink
Showers
Backflow Preventer
.Service Sink
Backflow Irrigation
Sewer Cap
Bathtubs
Sewer Connection
Clarifiers
Solar Collectors .
Dishwasher
Solar Piping
Drinking Fountains
Solar Tank
Floor Drains
Swimming Pool w/Spa
Floor Sinks
Urinal
Gas Outlets
Wate loset
Interceptors
L Water Heater
s
Water Service
Lavatories
Auto -Wash
P—Trap
Laundry Trays
Roof Drains
$
Reinspection -Fee 1 $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
110-100,000 BTU ❑ 100,000 BTi
Reinspection Fee 1 $15
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Issue Fee;
Hood or Type ❑
Canopy Type I I ❑
Refrigeration System
00-100,000BTU 1:11100,000BTU
System Repair/Alteration
Fire Dampers
'Registers
Issue Fee
$ 3
FEES
$ 3
4781 •2/08/86 : 5,UU 'TL
I
• � e
' _ t Zone
,Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
I I Reinspection Fee 1 $15 1 1 Issue Fee I. S 3 1 1
DEVELOPMENT SER
Zoning Approved By—
Building Approved By
REQUIREMENTS:
- ELECTRICAL. 1 -FEES -
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
El 50 + KIN
Cooking Unit
Meter. ❑up to 100 amps
Dishwasher
Meter ❑over 100 amps
Dryers -❑Gas ❑Electric
Sub Panel
Fan '
Motors ❑0-1HP Ell % - 8
F.A.U. -
Ina Solar 1-19-15 HP ❑16-15+
Fixtures
Microwave
Device Boxes
Pole Light
Outlets
Range
Switches
'Sign
Garbage Disposal
Standing Sections
Generator ❑0-5 KW ❑5-15 KW
Trash Compactor
I I Reinspection Fee 1 $15 1 1 Issue Fee I. S 3 1 1
DEVELOPMENT SER
Zoning Approved By—
Building Approved By
REQUIREMENTS:
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP
$
PLAN CHECK
$
PERMIT
v ISSUANCE
$
PLUMBING
$
-
PLAN CHECK
25%
$
ENERGY P.C.
$
ELECTRICAL
$
- GRADING r
$
PLAN CHECK
50%
$,
MICROFILMS
$
MECHANICAL
$
TOTAL FEE
$
PLAN CHECK
25%
$
,
CONSTRUCTION AND PLANNING - _
APPROVALS Permit
`D ate -
;Inspector
, +POOL &SPA
_ -
APVALS Permit # +4
PRO
-
Date'
i 1
Inspector
1'.: . Temporary Electrical,Service or Pole52.
Pool & Equipment Location
1
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
+
54. Forms' c
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding -
5., Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.,
_
57. APPROVAL TO COVER.GUNITE
7. Footings
58. Electrical ConduiYUndr§thd.
'
8. Foundation,
-
59. Gas Pipe, ❑ Undrgrnd.,Ut
.,
9. Water Pipe-Undrgrnd.
_
60. Backwash Lines,!P--Tragi1,] Undrgrnd.
i
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
- t
r
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
71. Product Piping ❑Gas 11 Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
,
24. Roof Framing
73. Undergrnd. Storage Tank O Gas O 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.E FINAL INSPECTION
32. Electrical Power Meter -Final
80.FOOD CERTIFICATE ISSUED
~'
33. Final Electric
-
Notes:-'
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
'
36. Hood or Canopy
37. Final Factory Fireplace
-
38. Final Plumbing
Geo
- - •'
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
t
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 -
a
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N?
P. O. Box 717
Costa Mesa, California
The Building located at 3011 r- 3PRP'ra>?ea�3�^�—Fktiv9 lt B, .
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group H Rt rTOccupancy.
- of Building Trip2ex w1th i .i 1 r garnge
Legal
(See reverse side far Metes and Bounds)
Building Permit No. PP437l Electrical Permit No. 23251; Plumbing Permit No. ldilcq
Floor Load Signs have been installed as
required under Sec. 2308 U. B. C.
Room Capacity Signs have been instaled as
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—.3 and/or guest
ISSUED TO: Building Official
PTTMEIB IZ ?ATM. CDIiPCR4'TMiW byyl=i
Date Nlh++sb 25, 1965
This Certificate of Occupancy SHALL BE posted in a conspicuous placeon 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. Forst BUa IM -1143—S -B P
4
OWNER SUPPLE, -John
JOB ADDRESS 124 Clea
GENERAL CONTRACTOR Mc
AP No. 141-711-09 LOT
DATE
ok Lane, #4-. BUILDING PERMIT NO.
TRACT FIRE ZONE VALUE $ 7.000.00
INSPECTIONS
Signature
Data
TYPE v GROUP
I - ZONE
SOIL
SUBCONTRACTOR
M
GAS
Oct. Number Si naL
WATER
Plumbin
ROUGH PLUMBING
PROP: SWR. LINE ❑ HOUSE, CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING'
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
Heatin Ond Vent.
TRENCHES Lj FORMS STEEL REINF.
i"=',
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
o
•� `.
FRAME AND FLASHING
(,•
LATHING — IN OUT
o_
PLASTER, BROWN COAT
STRUCTURAL. FINAL
HEATING, VENT., REFRIG. AND A.C., FINAL
•J
PLUMBING, FINAL ANO GAS TESTELECTRIC,
4-v
FINAL
c -BUILDING.
FINAL
IQL.
--/
43082
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING 1 n /I /%, — _ i I. ,
"'s` "r:i'1P4�ti=•�atl y?; t .... r :}E)1i.JV
APPLICATION FOR STRUCTURAL PERMIT
EC$1VFj%,BV I DATEBF.CEIV_FD nA 1 s11.
OWNER
ZONE
NO. OF
,USE OF NEW
MAIL
TEL.
BUILDING
ADDRESS
BUILDING �-
ADDRESS
CIT �. N
/-
CITY C
TE
NOL.
TRACT
LOT
CONSTRUCTION
ACCESSOR YBUILDING
NEW
I ADD
TALTER
I REPAIR
FRONT FT. n
FT.
Q
LENDER
BRANCH
F
OWNER
rn
ADDRESS ------------
FSeparate permits are required for
L. SIDE F
ARCHITECT —STEL.
us KJ
OR ENGINEER
NO,
electric, plumbing and heating work.
REAR FT.
F
W .USE BUIING AND WORK TO BE PERFOR ED
F OF
FIRE
BET. MAIN
ADDRESS
_LD
Q- --
ZONE T PE
CONTRACTORM,
1—e —
�'•
t iw
APPROVE
BY
D
ADDRESS
ZONE
NO. OF
,USE OF NEW
TEL.
PLANS
BUILDING �-
CIT �. N
STATECITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. C. NO.
MAIN BUILDING
ACCESSOR YBUILDING
SIZE NO. OF BLDGS.
(FROM C/L STREET)
�. OF LOT NOW ON LOT
FRONT FT. n
FT.
Q
USE OF'VX
.N. EXISTING BLDG. TLE L
SIDE FT
F
rn
FSeparate permits are required for
L. SIDE F
electric, plumbing and heating work.
REAR FT.
F
W .USE BUIING AND WORK TO BE PERFOR ED
F OF
DISTANCE BET.
BET. MAIN
_LD
Q- --
MAIN 8LDGS.
ACCESS. BLDGS.
i••1
'
VAR. #
C.U.P.C#
DATE
APPROVED
7 -
APPROVED
(A
DATE
..1
a
W
a
Q I hereby acknowledge that I have read this application and state
�
a that the above information Is correct and agree to comply with
m
96 all laws regulating building construction, and 1 shall not employ
z any person In violation of the workman's compensation laws of
v
$ the State of California.
3 I hereby certify that I am properly licensed as a contractor under
SO. FT.
N
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
ND
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt f to provisions of the State of California Business
1p
e
and Pro ons Cod Division 3, Chapter 9.
VALUATION
PERMIT FEE $
BBQ
in
n
PLAN CHECK $
mo
Signet of
Permltt
$
TAX $
�
r
2
U
TOTAL PAID $ Q
Authorized Agent
J
..I 22821
FEE RECEIVED
AUG I 1964
• COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MRSA. CALIFORNIA
.•
For Applican t(Q Fill In, Completely
rrIITTFINANCE ��FFrrnnee77D��EPMMT..����
AJW&CATION"FOR PEit16
OR PRINT
BUILDING
BUILDING '
For Office Use Only,
RECEIPT NO.
COSTA MESA, -CALIFORNIA
RECEIV Y DATEISSUED
DATI(R77ED
v/
OWNE
',
BUILDING
MAIL
ADDRESS O Qe -
,
ADORES
-
RE
ZONE
TEL.
c1TY)V,eftnjVr 642AChNO. O
TYPE GROUP
-
ARCHITECT TEL.
AV
APPROVED -
BY DATE
+ZONING
S�
OR ENGINEER U NO. _ Q
41u
- Z
w66DR ss b R70 D Yc
W
- - -
ZO NO. OP USE OP NEW .
PLANS I BUILDING
W
CONTRACTOR % i
_
. LEGAL-` 7
S
ADDRESS Q e Q"
DESCRIPTION
Z [
�/
I J i �L��
1000jIII
CITY 6 If
A. P. No.
NO SAVE N6 SHALL BE LESS THAN
STATE TEL'.
30T TO SIDE B REAR P. LE:
LIC. NO. NO.67 o
SIZELDTS
/ I
EAVES
ALLOWED (U. B. C. REQUIREMENT)
OF LOT O NOW ON 3Ne•
.
.
YARDSAPPROVED YARDSAPPROVED '.
IA
USE OF
MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET)
0
_/ /
SETBACK LINE PROM
FRONT FT. FT.
{LI
CENTER OF STREET REAR YARD
/
SIDEYARDI LEFT - RIGHT D/
R.SIDE FT. FT.
0
DESCRIPTION OF WORK
L. SIDE
�-�
R FT. FT.
NEW ALTERATION ADDITIONtA
TANCE BET. BET. MAIN &
SLOGS. ACCESS. BLDGS.
REPAIR MGOV/I•NG - DEMOLISHN
GI+ ,fJl
9ZEBUI� -/
/.!''ROOMS STORIES
. P.# APPROVED
EXTERIOR .WA ( ROOF RQ�i
�.�By
COVERING T(J CO COV ERINO
ATE "
USE OF BUILDING AND W K Q E PERFO MED
IN`.�A\�J
05 Q
J 1
� I
�
T
e c�i97
9q. Fr.
1 HEREBY AC OWLEDO9 THAT 1 HAVE READ THIS APPLICATITHE
AMOUNT SHOWN UNDER VALUATION IS FOR THE
S
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COPURPOSE
OF ESTABLISHING A PERMIT FEE ONLY.
O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATIUAT10NBUILDING CONSTRUCTION.
SIGNATURE OF
PERMIT FEEPERMITTE
AN CHU
/, -
AUTHORIZED AGENT
TOTAL FEE $