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HomeMy WebLinkAbout128 CLEARBROOK LN - Building Permits / _.. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. r PERMIT TRACT NO. LOT NO: UNIT NO'. ! �IT�oF cosTA MESA CO' _STRUCTION PERMIT /-C (� • • I 8240 12/04/86 5:00 TL • 1. Pralect Address I• • ,� r _q (UJ /_ •• - r�-5/ i. • . .. ,- 1. Applicant's Mailing Address �'L,,J2 h I',{� TYPE O_ F CONSTRUCTION U NEW ❑ ADD ❑ ALTERATION LI REPAIR - 1‘ I ' / /,'1 ❑ CONVERSION. ❑ DEMOLISH ❑ OTHER _ _ 1 , �� _ _ . . __ _ _ .Zone _ Owner's Name! � .rl PhoneR. DESCRIPTION OF.WORK/USE OF BLDG. '- - - Address • • -) - • , S Main Building: Accessory Building: I Arch/Eng. - i License No. TYPE OF PERMIT ❑ GRADING ❑ F 1rvDATION ❑ STRUCTURAL T Front 0 Address - - ❑ •TENANT ❑ ELECTRICAL' UMBING ❑ MECHANICAL • B Rear N lit A nII�/ t hone ,'ii , ❑ OTHER A g • Contractor's Name ! " Ir /� X� + _ j PROJECT DESCRIPTION SQ. FT. OCCUPANCY C 'Right- G Address(mailing) ' I , CO N ST RUCTI ON-TYPE VALUATION,$ s Left ' R City License No. i..°)07.3 ZONE , GRADING CU.YDS. ACRES I • LICENSED CONTRACTOR DECLARATION I Ping. Ref.# ;Parking'.Req./Provided ' , E • I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ' I I • Q • - , - Planning Notes: p } o[ with section 7000) of Division 3 of the Business and Professions code, and - - RECEIVER L L V O. �• , I�UU - T1 my license is in fullcef nd effect. /�i /i--ry•1 , • , f '• $ Scense Class 4 / ce .e lyfls/1('/(`VA' I . 4A� ,ate' .li Signature SJ�VI_I_•� ,A- i - PLUMBING FEES • . W WORKERS'COMPENSATION D'�LARATION - •-' . - - ' • • I hereby affirm that I have a certificate of consent to self-insure or a certificate ' Bar Sink . Showers' ELECTRICAL FEES of Workers' Compensation Ins ranee, or a',certi d copy thereof (Section • Backflow Preventer - • Service Sink ) 3600, Lab. Automatic Washer Transformer ❑ 15-50 KW �) r Policy No.'Y !)4�d • Company ✓ Backflow Irrigation' , • Sewer Ca ❑ 50+ KW d P`' I . Construction Pole Sub. t • y� Certifie copy Is hereby furn ish¢tl. _ �iCe4t'fi p filed with the city ,I Is' n Bathtubs I • j Sewer Connection - Cooking Unit Meter pup to 100 amps 'Datef I '�J`J KE RS• ant�V Y" /U^. / - `. - EXE PTIONPTION FeO MMA WORKERS'COMPENSATION DECLARATION ; Clarifiers - . Solar Collectors: - - - - Dishwasher Meter Dover 100 amps I / (This section need not be completed if the permit is for one hundred ($100) or _ - _ - - - Iess).' Dishwasher} ' . ' Solar Piping _ - ' Dryers ❑Gas DElectric . Sub Panel ' I • I certify that in the performance of the work for which this permit is issued, I _ . 't ' I - shall.not employ any person in any manner so as to become subject to'the Drinking Fountains Solar Tank • Fan Motors 00-1 HP ❑1%-6 Workers' Compensation laws of California. , . Date. Signature - Floor•Drains ' ' Swimming Pool in/Spa I _ - . F.A.U. - Inc.Solar ❑9-15 HP X16-15+ NOTICE:If,after making-this declaration, you should becomesubject'to the. .— • -- - - - - - - --. Workers' Compensation provisions of the Labor Code, you must forthwith ; Floor Sinks 1 ` Urinal I ' I FixtufeS MiCrOWave comply with such provisions or this. permit shall be deemed -revoked. CONSTRUCTION LENDING AGENCY •'•! . T - Gas'Service Outlets i I hereby affirm that there'is a construction lending agency for the performance Water ClosetDevice Boxes Pole Light of the work for 'which this permit is issued (Section 3097A,Civ. C.) I i •• • Lender's Name - - •i;.. Interceptors i ; Water Heater L _ Outlets Range 1 .. .. -.Lender's,Address : • :- . ` . . .- Kitchen Sink . .. .. .1 . l- .' Water Service'-- - -I - -. - - - - ' Switches I - -I' Sign -- '- - - • - 11 OWNER BUILDER'DECLARATION - ' L hereby affirm that am exempt from'the Contractor's License'Law for the i Lavatories , Auto-Wash I i Garbage Disposal • Standing Sections following.reason (Section 7031.5 Business and Professional Code: Any city or - - :ounty which requires a permit to construct,alter,improve,demolish or repair ' P-Trap Laundr Tra S f " Iny structure, prior to its issuance, also requires the applicant for such permit I Y. y Generator 00-5 KW.❑5-15 KW Trash Compactor , • :o file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains , • - 7 the Contractor's License Law(Chapter 9(commencing with Sectlons7000) of - - _ - _ I i ' • I 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 , , - . 7031.5"by any applicant for a permit subjects the applicant to"a civil ' i . - ' malty,of not more than.five hundred dollars($500). ; ' ' I t - f , j LJ i; as owner of the property or my employees with wages gas their sole Reinspection•Fee ! $15 , , Issue Fee , $'3 1 compensation, will do the work, and the structure is not intended or'offered • for sale (Section 7044, Business'and 'Professional Code: -The Contractor's MECHANICAL _ Reinspection Fee I $15 Issue Fee ; _ -,$ 3 - License Law does not apply to an owner of a,property who builds or Improves - FEES I thereon, and who does such work himself/herself or through his or her own (DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for ; L-----.----"' 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 c,) 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 7. Footings i 58. Electrical Conduit-Undrgrnd; - 8. 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 .a 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 ElectricafT 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 i 72. Underground Flush • 24. Roof Framing I . 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing • 74. Overhead Hydro • 26. T-Bar Ceiling (Structurall•& 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 NailingHEALTH 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 - • • 38. Final Plumbing OA? 4 - 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 - . . , t .< l Y _ ' Alt _. s IAF _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PE _ RMI U. TRACT NO. LOT NO. . UNIT NO. Project Address /c9r •(i/P/2.72H O©/% kit- ?abaci •' - 1166 9/30/65 - ;�e00 TL' Applicant's Mailing A dress - - - ' TYPE•OF CONSTRUCTION -❑ NEW IJ ADD L I ALTERATION LI REPAIR �` _ • ,.� ; CI CONVERSION El DEMOLISH ❑ OTHER A.P.# Zone Owner's Name - ' vOrnP%7 Phone _ DESCRIPTION OF WORK/USE OF BLDG: ' - • . • Address - - ' - - ' - ; S Main Building: , ?ccessory,Building: • ,. _ Arch/Eng. - ' License No.• TYPE'OF PERMIT ❑ GRADING= ❑ FOUNDATION ❑ STRUCTURAL - T Front - - -_ - - _. 0 Address - - '' i -' _ •❑ TENANT .❑ ELECTRIC-AL :❑ PLUMBING ❑ MECHANICAL ' B Rear - - : - - - • - N Contractors Name -V �- / �L � ?'one ryl '❑ 'OTHER = - _ - 1 ' C Vii �C��V Ls PROJECT DESCRIPTION, SQ. FT. OCCUPANCY C Right l - G Address(mailing) Left : ,:- : • - ! /y� CONSTRUCTION TYPE ' -VALUATION$ S , City License No. - /. J - - ZONE ' ' GRADING CU.YDS. 'ACRES ' ' R LICENSED CONTRACTOR DECLARATION _ Ping. Re. # Parking_Req./Provided E I hereby.affirm that I am licensed under provisions of Charter.9 (commencing Remarks: , • Planning Notes: _ M with section 7000) of Division 3 of the Business and Professions Code, and - - ' my license is in full • - ndeffect. I '- I• • i - . - T Nr License . • lass _a - I .4 Lie se so: d0 / - • - S. I Date I - lr —40 Signature'' t 2' / : lJ 7' r PLUMBING FEES , 1 WORKERS'COMPENSATION DECLARATION 1 • , I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ' ELECTRICAL FEES of Workers' Compensation_Insurance, or a certified copy thereof-(Section _f --- Backflow Preventer. - - - - Service Sink' 3800, Lab. �)) rr11 j ,.-/') i - - - - Automatic Washer - - Transformer ❑ 15-50 KW- - -; ' Policy No.1-11. hti�0l ,U" Company /Y%J. I Backflow Irrigation Sewer Cap ❑ 50+ KW i 1 Construction Pole Sub. • Certif ietl copy is hereby furnished. ` - • - • Cer ed Q9q4 is fd6d'Nit hthe city .ir.: eiv'.!o Bathtubs Sewer Connection Cooking Un Meter Cup to 100 amps I Date (�{/ifs..- �O 7 Applicant ./�A %i AMS ,.� EXEM PTI011N FROM WORKERS'COMPENSATION Der LARA •N Clarifiers ISolar Collectors + Dishwa Meter Doverj100 amps � •(This section need not be completed if the permit is for one hundred ($100)or Dishwasher less). I - , Solar Piping I Dr OGas DElectric ',Sub Panel • I certifyithat lin 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 • Drinking Fountains ' I Solar Tank n i ' Workers' Compensation'Laws of California. ' I - _ Motors ❑0-1 HP ❑1%'B , Date I • Signature - ' Floor Drains ' Swimming Pool w/Spa' - F.A.U. 1 :Inc.Solar❑9-15 HP 016-15+ NOTICE:If,after making this declaration, you should become subject to the - Workers' Compensation provisions of-the Labor Code, you must revoked. th 1 . . Floor Sinks, -. .-- Urinal t rT' Fixtures - - - - - Microwave ' comply 'with. such provisions or this .permit I shall be deemed ' - tot,' 4Q. :� r CONSTRUCTION LENDING -AGENCY' ' t , ' • , - , . _ Gas Service Outlets - .Water Closet V - - I hereby affirm that there is a construction lending agency for the performance - ` s Device Boxes , Pole Light of the work for which this permit is issued (Section 3097 Civ. ;C.) , _ -t. Interceptors -/ Water Heater ..(�.�' _ 2 (J(J Outlets : Ran e ' • Lender's Name - _ �,j f v g ' Lender's Address ' - • _ _ I Kitchen Sink "_ - Water Service 'A"S% ^ Switches •' ' OWNER BUILDER DEC L'ARATION r Sign ; I hereby affirm that I amexemptfrom the Contractor's License Law for the . Lavatories. - • '1 Garbage Disposal 'Standing Sections ' I ' following reason (Section-70315 Business and Professional Code: Any city or .. county which requires a permit to construct,alter,improve,demolish oprepair p47rap i ' - - Z Generator ❑0-5 KW❑5-15 KW Trash Compactor• any structure, prior to,its.issuance,'a iso requires the applicant for such permit - - �_- p to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains• - - ' (the Contractor's License Law(Chapteri9 (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 - _ - 1 l , ' 703E5 iby, any applicant for a permit, subjects-the applicant to a civil ' ' - r _S+ ` ' ' penalty of not more than five hundred ddllars'($500). - - ' _ .I Issue ,. I• _ 3 r. n -, I ' U I, as owner of the property'or my:employees with wages as their sole ' ReinspectioncFee ' $15 I Fee $ '- r compensation, will do the work, and the structure is:not intended or offered . - Reinspection Fee • ,I $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 own - - . _ DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for • Boiler j • 'Hood or Type I ❑ • _ l sale. If, however, the building•or improvement is sold within one year of com- . - i Canopy Type I ❑ - Zoning Approved By _ Date pletiu n, the owner will'have the burden of proving-he/she did not build or im- Duct::: Under Ground -Building Approved By • DateLJ _ rove for the purpose of sale). p Aa,,(� I, as owner of'the property, am exclusively contracting with licensed con- 1 Duct-Structural Refrigeration System Applidation Issued By Date ' U _ ' tractors to construct the project (Section 7044,Business and Professions Code: _. : I The Contractor's License Law does not apply to r suchan'owner of property who Duct-Ventilating - - ❑0-100,COO BTU ❑100,000 BTU • _ builds or improves thereon,and contracts for such projects with a con-1- -- -+- -- •• - _ '� SUMMARY OF FEES tractor(s) license pursuant to the contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration i ,y _-BUILDING PERMIT . $ SMTP $ proof of their Worker's Compensation insurance should be provided to me. i • ' ''.PLAN CHECK $ PERMIT ❑.I am exempt under Section ' B. 8, P.C.for this reason • Firepl/Fact.Blt. ICBG# , /}(� SSUANCE $ • "1� ! 'PLUMBING $ $5 ' ENERGY P.C. $ Date owner . Heating System& Ducting ' PLAN CHECK 25% $ ' I hereby certify that I have read this application and state that the above-' 001 00,000 BTU 0100,000 BT: - _ GRADING $ , information is correct.•I agree to comply with all city and county ordinances �E LECTRICAL $ , and-state laws relating to building construction, andihereby authorize repre- : $ .MICROFILM $ sentatives of this ct to enter u-on the above-mentioned pro ert f x� '_PLAN CHECK 50% S,tel inspection Pur.; es '' (�/ MECHANICAL $ TOTAL FEE $ , (/C� Signature , or SS AW — Date Reinspection Fee • $151 ! Issue Fee •$ 3, PLA N'CHECK 25% Drivers' License or SS Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor - - _ - - ' ' CONSTRUCTION AND PLANNING - _ jOL & SPA Date Inspector Date - Inspector APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location • , 2. Soil Pipe-Undrgrnd. - 53. Steel Reinfdreement - 3. Electrical Conduit,Utility-Undrgrnd.` . . -y: 54. Forms 4. Electrical Conduit-Undrgrnd. ' - . } 55. Electrical Bonding 5. Steel Reinforcement ' • - . 56. Rough Plumbing & Pressure Test • ' 6. Electrical UFER Grnd. • 57. APPROVAL TO dOVER-GUNITE •• , 7. Footings58: Electrical Conduit-Undrgrnd. ` 8. Foundation ' , ••59. Gas Pipe;O-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-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 .❑Oil . ' 23. Gas Pipe-Rough & Test - 72. Underground Flush. .. - - - "- 24. Roof Framing ' ' - .73. Undergrnd.Storage 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 �r r� 28. Lathing & Siding 77•?i.FIXED SYSTEM FINAL ' • J 29. Insulation ' . f8:• FIRE PREY. FINAL . • • 30. Drywall Nailing iV 7 HEALTH DEPT. REQUIREMENT ' 31. 'Plaster Brown Coat I 79/FINAL INSPECTION - 32. Electrical Power Meter-Final '*80. FOOD CERTIFICATE ISSUED 33. Final Electric - 1 Notes: 7-16.86, Lerr C.A2O . LiO Ilia 34. Final Heating & Air Conditioning - -4 9'-2 S"Sft, N0 Ot'tf 14-nne•L.Ct> 35. Final Gas Pipe-Test - ' - C.,-Kc_ As- PTc-2- .24. o.'P,C L.t•D 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 ' I 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. O3I 7 I.0/16/84 O.0❑_ IL •, CITY OF SOSTA MESA CONSTRUCTION PERMIT PE IT /y�� TRACT NO. LOT NO. UNIT NO. - Pr ect Address .1,a.7 C_�F AR R �{hCO3C 1 M . ( 5' ' ) 3i Applicant's Mailing dress TYPE OF CONSTRUCTION' ID NEW U ADD ❑ ALTERATION LJREPAI R • A/d • ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. I Zone Owners Name Ali C F 1�t'yA� Phone • DESCRIPTION OF WORK/USE OF BLDG. Address - S Main Building: - - Accessory Building: Arch/Eng. License No. • TYPE OF PERMIT. 0 GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front - - p Address �• ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 0-MECHANICAL B Rear - •• N / ❑ OTHER Contractor's Name A A A //'1 R . I Phon - Right , Address(mailing/2,4-2J 4 13A 11a 7!1✓E /) r, /l/ PROJECT DESCRIPTION SQ. FT. OCCUPANCY - K Left G !lIJJ 'S 3 CON STRUCTION TYPE VALUATIONS $ City.Llcense No. . ZONE ' GRADI NG CU.YDS. ACRESR LICENSED CONTRACTOR DECLARATION - - Ping. Ref.# Parking Req,/Provided E I.hereby affirm that I am licensed under provisions of Charter 9 (commencing • Remarks: . •' I Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and ' my license is in.full gforce and effect. ' . - T License Class_C-...Ler r!. Licen ',$.3 , S. Date//tj-A— f)y' Signature -:?,-r-«'/ •rd r PLUMBING • FEES , ' WORKERS' COMPENSATION DECLARATION Bar Sink Showers - I hereby affirm that I have a certificate of consent to self-insure or a certificate 1 , ELECTRICAL i FEES of Workers'. compensation Insurance, or.a certified copy thereof (Sectionacw BkfloPreventer Service Sink - - - - 3800, Lab. C.) . Automatic Washer •_ Transformer 0 15-50 KW Policy No. Company - Backflow Irrigation Sewer Cap _ Construction Pole Sub. - 0 50+ KW 8 Certified copy is hereby furnished. - — ' 4 Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit , Meter ❑up td 100•amps Date Applicant - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers , Solar Collectors Dishwasher - Meter Dover 100 amps ' (This section need not be completed if the permit is for one hundred ($100) or , - ' less). Dishwasher i Solar Piping Dryers ❑Gas ❑Electric'; 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 to...become subje to the ' , Drinking Fountains l Solar Tank i • Fan f Workers' Compensation Laws of Californ' - - Motors 00.1 HP ❑1%-8 , Date//T"/•s'� F % signature Y`! dl.-7'/1- Floor Drains Swimming Pool w/Spa F.A•t U. Inc.Solar ❑9-15 HP 016-15+ ' 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 - - - ' comply with such ,provisions or this permit shall be'deemed revoked. , Fixtures - Microwave. - - - - CONSTRUCTION LENDING -AGENCY t - - .f GasSr I evice Outlets: -Water Closet Z (�'' Device Boxes Pole Light ' I hereby affirm that there is;constructionLending agency for the performance g of the work for ,c-h(w�Jf'`t/his pe it s , sue (Section-3097 Civ. C.) p - Outlets Ran e • Interceptors _Water Heater Lender's Name n p 9 Lender's Address b t �‘ ...e.44.7 """t�: ' Kitchen Sink - Water Service • Switches • Sign OWNER BUILDER ECLARATION • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories , ' following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal 'Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P=Trap ' ' , - - any structure, prior to its-issuance, also requires the applicant for such permit ._ Generator 00.5 KW 05-15 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 - - 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 Reinspection Fee • $15 Issue Fee • $ 3 compensation, will do the work, and the-structure is not intended or offered '" - Reinspection Fee I $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 own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ 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 • Building Approved By - Date move for the purpose of sale). - U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By • Date 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 00-100,000 BTU '0100,000 BTU S MMARY OF FEES builds or improves thereon, and'who contracts for such projects with a con- tractor(s) license pursuantto the Contractor's License Law). I am aware that ❑ BUILDING PERMIT $ SMIP $ Exhaust System Multiple ❑ System Repair/Alteration proof of their Worker's Compensation insurance should be provided to me.• PLAN CHECK $ _ PERMIT 0 I am exempt under Section B. & P.C.for this reason • Firepl/Fact.Bit. ICBG# _ PLUMBING $ b-n o ISSUANCE $ Date Owner - . Heating System& Ducting • _ PLAN CHECK 25% $ ENERGY P.C.' $ I hereby certify that I have read this application and state that the above ❑o-100,000 BTU 0100,000 BT ELECTRICAL 'GRADING $ information is correct. I agree to comply with all city and county ordinances $ and state laws relating to building construction, and-hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this cit to enter upon the above-mentioned property for inspection pure• -5 Signature j .a ze."-,__,._ Date//7/C�r� '/ - • MECHANICAL $ 'TOTAL FEE $ •oo Drivers' License or SS# •< ') Reinspection Fee $15 Issue Fee $ 3- PLAN CHECK 25% $ CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - .. • - - POOL &SPA •- CONSTRUCTION AND PLANNING" _ - . .. APPROVALS . Permit# .Date Inspector APPROVALS Permit# - Date 'Inspector .01. 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. : I. 55. Electrical'Bonding , . t 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, 0 Undrgrnd.,Test. . 9. Water Pipe-Undrgrnd. ' - 60r 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. • . a 64. Plumbing System - Final • 14. Rough Plumbing 65. Electrical-Final 7 • 15. Rough Electrical-Conduit - - - 66. Solar System-Final - - - 16. 'Rough Electric Wiring , . - • 67. Fencing & Access Approval - - - • - - - 17. Rough Wiring Sign " ' - - 68.E 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# r 21. Ducts, in Structure 70. Underground Hydro ' • . 22. Ducts;'Ventilating ' • 71. Product Piping Gas 0 Oil ` 23. Gas Pipe-Rough & Test 72., Underground Flush, 24. Roof Framing 73. Undergrrid.Storage 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 i . 77. FIXED SYSTEM FINAL 29. insulation 78. FIRE PREV. FINAL ' ' 30..Drywall NailingHEALTH 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 • ./0//704(6" . 36. Hood or Canopy , - - . 37. Final Factory Fireplace - ' 38. Final Plumbing - i ID/r 7/it? C/f," 39. WateriService-Final - ` 40. Gas Service-Final , I /04/!i c4-17 - 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. --•• - .. -. , 4 " 50. Gas Release to Southern California Gas Co S • 51. CERTIFICATE-OF OCCUPANCY r • - ' , No. • _ Date ' IC n 40 r sJECT ADDRESS: 128 CLEARBROOK LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 065654 r. OWNER'S NAME: HOOK ALICE H TR ADDRESS: 33682 PEQUITO DR PERMIT NO: B .065654 PLAN CHECK NO: N GOVT: N SUPP : N ' DANA POINT,CA 92629 • CONSTRUCTION TYPE: V—N PERMIT TYPE: SIR PURPOSE: ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O ROCK ROOF 6 REROOF W/BUR SQ FT; 5, 010 ADDRESS: UNIT: PERMITTEE: HOLMES ROOFING COMPANY ( 714 ) 997-5684 CLAIM VALUE: 5, 010 . 00 CALL—VALUE: 5, 010. 00 GROUP OCC: R-3 / ADDRESS: 990 N. ELM ST COMMENTS SMOKE DETECTORS ARE REQUIRE) PER 1991 U. B.C• ORANGE CA 92667 *****�tx+E�rsr*****�F+t�E�E�r****�E**�H**+r* �E�E** **�E�r+r+t�E+t+E**�r�Ex* +c*******SE********+Csr****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that)am licensed under provisions of Chapter commencing with Section ZO N I N G R Q U I R EMENT S 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S CI STATEuc.:6078949 CLAS =39 9L signature:_ r•�' MAIN BUILDING ACCESSORY BUILDING �iKERS'Cr PEN TION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Csmpensatio `nswancee..or a unit ie_d copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: 1 L 346403 3 EXP.DATE: 04 /01 /94 COMPANr: STATE FUND PARKING REQ: PROV; PARCEL : 41914111 ZNE: REF NO: ❑ Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. PLANNING NOTES> L> Date: Applicant: *********************************************'!E********************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the perm) for one hundred($100)or less). DEVELOPMENT S ER V I C LE•tS REQUIREMENTS I certify that in the performance of the work for which this permit is i ,I shall not eyptoy any hers n any ner so as to become ;• _ �. the / Compensation Laws of California. // '. lea/y/J �!// ZONING APPROVED BY �_— DATE: DdI" 9 Signature: _ 'c-- el NOTI If. ter king this declaration,you should ecome subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : I 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 : e DATE: which this permit is issued(Section 3097.Civ.C). **************:********************** - ** *************************** ** LENDER: • ********************************************'iW�f*,*.******************************* ADDRESS: LEGALIZATION:N F E E S U MM A R Y STRUCTURAL SEGMENT :Y I 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 F IRE SM I P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 8 1 •00 — repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed r✓ S O pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES and Professions Code)or That he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL ' PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 81 . 50 0 . 00 0 • 00 81 . 50 i 81 . 50 • 00 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 completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 81 . 50 OVER/SHORT: . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT-i"' GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business —, ; 5 0, ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon OtTEC 1 O ir5 , and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware * ** ********************************************************************* That proof of their Worker's Compensation insurance should be provided to me. REQUIRED ❑ I am exempt under Section: B.8 P.C. D I V I D U A L F E E B R E A K D. 0.W N • for this reason: TYPE QTY DESCRIPTIO N • UNIT COST TOTAL COST Date: Owner SFR 5010 REROOF BY VALUE RESIDENTIAL NOZONE 1!. 00 I do hereby certify that l am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 5, 010 . 00 , 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 END.' OF FEES �. permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from ,.t RI ; :r these provisions. �� r!.})• n C Date: Applicant: _ E X is 1 t. D .y'' I hereby certify that I have read this application and slate that the above informati n is correct.I agree to comply with all city and county �nco�TPlete )f:SNuCLLOTIS ordinances and state laws relating to building construction and here thorize re sen nes of this city to enter upon the above-mentioned - 1-- property for inspe tion iurposes. •' , " " 01 60153542 001,A 7"CET 81.50 ' Dale. / signawre. OATS: 01/11/94 TII1E: 11:31 Driver's Li ase or Social Security 7, .{yT� t641'46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor ;; W; l °' I CONSTRUCTION AND PLANNING F_ ,L & SPA APPROVALS Permit�`r. Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. $oil Pipe-Undrgrnd. 53. Steel Reinforcement 3.'Electrical Conduit Utility-Undrgrnd. 54. Forms - 1. 4-Electrical Conduit4Undrgrnd" 55. Electrical Bonding - 5. m Steel Reinforcement . - - 56. Rough Plumbing & Pressure Test : -6-Eiectrical UFER:Grnd. 57. APPROVAL TO COVER-GUNITE - { 7. Footings58. Electrical Conduit-Undrgrnd. _{ 8. Foundation 59. Gas Pipe, 0 Undrgrnd„Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap - , _ 63. Heater & Vent-Final - sr 13. Roof Drains T. 64. Plumbing System - Final 14. Rough Plumbing '• \-- 65. Electrical-Final 15. Rough Electrical-Conduit `y. 66. Solar System-Final 16. Rough Electric:Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceding 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20.•Rough Factory Fireplace - _ = :APPROVALS; = Permit #2 21. Ducts, in-Structure . .. ,,‘,5....,1:1 .. - 70. Underground Hydro 22. Ducts, Ventilating • - - 71. Product Piping 0 Gps^g c 23.-Gas Pipe=-Rough &Test • - 72. Underground Flush- i I. cr. , -7 24._Root Framing ., '~73, :Undergrndt StorageTar D s 0Oil 25. Roof Sheathing 1-P--19 6(4111"-- 74. Overhead Hydro TIT 26. T•Bar Ceiling (Structural) & Monocoat 75;.Dry Chemical Ill. Ii I . ie 27. Frame and F! shi - - - ; t ---i a rjg, : • 76. Dry Standpipe -I._ 28. Lathing & Siding- . . } 77. FIXED SYSTEM FINAL' -29. Insulation • • - 78;•FIRE PREY. FINAL- ' • . *30. Drywall Nailing ' • HEALTHLDEPT. REQUIREMENT 31. Plaster Brown Coat ,. 79. FINAL IN;$P�CTIb}N - 1 -32:Electrical Power Meter-Finale • -80.'FOOD CERTIFICATE ISSUED 33. Final Electric { i Notes: 34. Final Heating-•& Air Copditionin' _ 35.•Final Gas Pipe-Test - - - a "' ' 36. Hood or Canopy -. inCornplete11f1$pe6tions• . , - I 37. Final Factory Fireplace A - :.. • f'r�, TTTTTTJJJJJ1 - 1 _ s _38. Final Plumbing1 . 39. Water ServicetFinai t- i -' .40. Gas Service•Final - - - - 'e -- ri - _ . '41. Solar Domestic-Final:- - - , 42."Backf low Preventer' /Z(7. 1Gf ten G /9AufC;I,te 43. Backflow Irrigation V ` /-/ 2,61 {i 44. Landscape Irriqatioh System - - - (r� ( ,wfj""� 1 45.:Sound Attenuation -. - -c 1 46. 1iandicap;Regulations - - . ' •r ,�. _ i 47.-FINAL STRUCTURE & BUJIDINGI 48. FINAL PLANNING : 49.--Electric Release to Edison , _ - 50. Gas Release to Southern California Gas Co - - • , -51. CERTIFICATE OF OCCUPANCY - No. Date sint.4. �I' 'Y OF COS' 'A ML. 47 C. CALIFORNIA 92628-120001 P.O.BOX 1200 J � y, DEVELOPMENT SERVICES DEPARTMENT V'a . 4cq o '�aamE? September 19, 1994 Dear Costa Mesa Property Owner: In reviewing past permits, we find that work has been done on your property located at 128 Clearbrook Lane, Permit No. B65654, for a roofing permit. The permit is valid for 180 days from issuance or your last inspection, per Section 303 (d) of the 1991 Uniform Building Code. Should we not hear from you within 10 days, your permit will expire as stated herein and additional fees will be required to finalize the permit. Failure to final a Building Permit could possibly impact the future sale of your property. To activate the above permit, please follow these steps: 1. Telephone (714) 754-5626 or 754-5627. 2 . Request an inspection; state address, permit number, and type of inspection. 3 . Be sure to have working smoke detector's as required per Section 1210 (a) of the 1991 Uniform Building Code. 4 . Have an adult present at the property at the time of inspection to provide us access. Should you have any questions regarding this process, please contact me at (714) 754-5273 . Thank you for your cooperation. Sincerely, ,ta Y anda Huapaya UUu Permit Processing Specialist 77 FAIR DRIVE Building Division(714)754.5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)556-7508 • TDD(714)754.5244