HomeMy WebLinkAbout2858 DRAKE AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOS7A MESA, GA 92626
Job Address: 2858 DRAKE AV
Suite No
Vicinity: REAR YARD
Parcel Nunmber: 14154503
Applicant: SMITH, DEBRA LYNN
Address: 2858 DRAKE AVE
COSTA MESA, CA
Owner: SMITH, DEBRA LYNN
Address 2858 DRAKE AVE
COSTA MESA, CA
Contractor: OWNER-BU ILDER
Address:
Arch / Eng :
Address:
PLUMBING PERMIT
Phone: 714-557-9022
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License: 0
Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING PERMIT FOR GAS OUTLET FOR A FIRE PIT.
1 GAS OUTLET (7-0)
ISSUE FEE
Backflow irrigation
Backflow Preventer
BathWb
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drein, Rainwa[er
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Interceptors (Sand Auto )
AMT
$23.50
$0.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
$6.15
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation 50.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 k) $0.00
Receptors 50.00
Septic Tank 50.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0:00
Sink, bar $0.00
Sink, commercial y0.00
Sink, Floor � $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
an
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Status: ISSUED
Applied: 71/15/2001
Issued: i1115/2001
ISSUED BY: �
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (ToileQ
Water Heater / vent
Waler Piping (Inst or Rep.)
WaterRe-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
50.00
50.00
$0.00
$0.00
50.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
TOTAL CALCULATED FEES: $29.65
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Californla slaWtes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: This permit shall automatically expire and become void it work is no� commenced wlthin 180 days, or if work is suspended or abandoned
tor a period of 180 days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inepeetions end final approval must be obtained. Failure to obtain inspections and final approval vnll result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446i8 (6W)
WORKERS' COMPENSATION DECLARATION:
I hereby aNirm untler penalty of perjury one oi Ihe followinq declarations:
❑ I have end will maintain a certificate of consent to self-Insure for workers' compensation, as provided tor by section 3700 of ihe Labor Code, for the pertormence of the
work tor which this pertnit is issuetl.
❑ I have and will meimain workers' compensation insurence, as required by section 3700 of the Lahor Coda, for the peAortnance o� Ihe work for which this pertnit is issued.
My workers' compensation Insurance carner antl policy num6er are:
Carner Policy Number:
(This secfion need not be complafed il fbe permit is velued at one hund�etl tlollars ($f 00) or less.)
❑ 1 cartily thet in the peAortnance oi ihe work tor which Ihis permit is issued, I shall not employ eny person in any manner so as to become subject to the workers'
compensation laws of Califomia, and egree Ihat II I should become subject to the workers' compensation pravisions of Sectlon 3700 oi the Labor Code, I shall forthwit�
Comply with lhese pmvisions.
Applicant Slgnature: Dete:
WARNING: FNLURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL AND SHALL SIIBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
TFKKISAND OOLLARE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAhL1GES AS PROVIDED FOii IN SECiION 3]Ofi OF THE LABOR CODE, INTEqEST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby eHirm ihat I am Ilcensed under provisions of CheO�er 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, end my license is in full
force and eMecL Lic. N Class N
Conirector's SignaWre: Date:
CONSTRUC710N LENDING AGENCY:
❑ I hareby affirtn that there is a construction lending agency for the peAormance of the work for which �his permit is issued. (Sec. 3097, Civil Code).
Lentlefs Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby effirtn that under penalry of perjury that 1 am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Businass anC Professions
Coda: Any ciry or county which requires a permit to construct, aiter, improve, demolish, or repair any sWCNre, prior to its issuance, also requires ihe applicant tor such pertnit
to file a signetl statement thet he or she is licensetl pursuant to lhe provisions of the Contractors License Lew (Chapter 9(commencing with SecOon 7000) of Divislon 3 ot lhe
Business end Professions Code) or thet he or she is eaempt therefrom end Ihe basis tor ihe alleged eaemption. Any violetion ot Section 7031.5 by any applicant for e pem+.
subjects the epplicant to e civil penalty of not more than fiva huntlretl aollers ($500).):
$�� I, as owner of Ihe properry, or my employees with weges as iheir sole compensation, WILL DO TNE WORK, antl ihe siructure Is not intended or oHeretl for sale (Sec.
7044, Business antl Professions Code: The Contractors License Law dces not apply to an owner of property who builds or improves Ihereon, and who does such work
himself or herself or ihmugh his or her own employees, provided that such improvemenis are not intentletl or offered for sale. tl, however, the building or Improvement is
sold within ona year of completion, the owner�builder will have ihe burden of proving that he or she did not builtl or improve for purpose of saia.).
❑ I, es owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and Professions
Cotle: The contractors License Lew tloes not apply to an owner ot properry who builds or impmves ihereon, and who contracis tor such project with a contrecbr(s)
license pursuant to ihe Comracrors License Lews.).
❑ I am e:empt un ar _ eusiness and Professions Code for this reason:
Signature: �- �� Date;
Owner ID verifietl 6y tlriver's licensa. Ves ❑ No Dnvers Licensa No. � �
Venfication of Ownership by (type of document, i.e. - properry tau bill or deetl):
ExDires:
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N:
❑ I hereby cenify ihat no azcavation five (5) or more feet in depth iMo which e person is required to descend, will be made in connection with work authorized by ihis
pertni6 and that no building siructura, scattolding, falsework, or tlemolition or dismentling thereof, wiil be more than ihirty-six (36) faet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title B, Califomia Adminisirative Code).
❑ As owner-builder, I will not employ enyone to do work which woultl require a permit from the Division oi Intlustriel Sefety, es noted above, unless such person hes e
permit to do such work from ihe division.
Signature: Date:
Division of Industnal Safery Pertnit Number:
CERi1FlCATE OF COMPLIANCE AND AIffHORVA710N OF ENTRY: I certity under penalry of perjury ihat I have read ihis application and state thet ihe infortnation given is
corred. I agree m com ly th-e)I state laws end ciry ordinances relating Io building construction, antl authonze represen�atives of ihe Ciry of Costa Mesa to enter upon the
above-described pr er ins(�ection p p es. I egree not to occupy or allow occupency oi any building authorized by this permit un/t�'I final inspection.
"� �/�.�/ �/
SignaWre Of Legal Owner(s) Date
And/Or Authorizetl Applicent Date
COpE t. INSPECTIONTYPE Q�E
1616 Fixetl System Final Fire Prevention
1266
200
Pool Spa Final
Final Re-Root
207 Final Block/Retalning Wall
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition
INTRIRLS C�DFd INSPECTIONTYPE
206 Final Mechanical
208 Finel Plum6ing
210 Final Electricel
212
220
Final Fire Prevention
Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
Q�¢ 1MmAL5
�1-
(714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us . 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 2858 DRAKE AV
Suite:
Vicinity: REAR OF SFD
Parcel Number: 14154503
npp�icant: SMITH, DEBRA LYNN
Address: 2858 DRAKE AVE
COSTA MESA, CA
owner: SMITH, DEBRA LYNN
Address 2858 DRAKE AVE
COSTA MESA, CA
Contractor: O W N ER-BU I LD ER
Address: -�
Zip:
Arch :
Address:
Phone:
Zoning:
ISSUED BY:
Phone: 714-557-9022
Zip: 92626
Phone:
Zip: 92626 .
Phone:
License: 0
Eng:
Address:
Status: ISSUED
Applied: 11/15/2001
Issued: 11/15/2001
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 376 SF LATTI CED PATIO COVER ATTACHED TO THE REAR OF A SFD ( EXTEND ACROSS THE REAR FROM
RIGHT SIDE TO DINING ROOM POP OUT). ,
Plan Check: $90.51
Permit: $139.25
SMIP Res: $0.61
SMIP Com: $0.00
Other: $0.00
Inspection: - $0.00
Total: $230.37
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existina: o
NOTES:
Rear 19-6
Rear 0. 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 13-3
Right 0- 0
$6,061.12
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inapeetlone and final approval must be obtained. Failure to obtain inspections and final approval will resufl in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
?448�481fl�00)
WORKEHS'COMPENSATON DECLARAnON:
I hereby aHirtn untler penalry of perjury one of the tollowing aeclaralions:
� I heve end will meintain e certiikste ol cronsent to selt-Insure br workers' compensation, es O�ovided for by section 3700 of Ihe Lebor Code, for the pedormance of ihe
work tor w�ich this pertnit is issuetl.
❑ I have antl will maintain woMers' compensation insuranca, as required by sectlon 3700 of Ihe Lahor CoOe, for Ihe peAortnance ot ihe work lor which fhis pertnil is issued.
My workers' campensatlon Insurance cartier antl policy number are:
Carrier: Policy Number.
(lhis secGon need no( be comp/efed illbe permit is veluetl et one hundred dWlaa (5/00) o� less.)
❑ I certity that in tha peAortnenca oi the work for which this pertnit is iuued, I shall not employ eny person in eny manner so as to become subject to t�e workers'
compensetion lews of Cellfomia, end egree Ihat H I should become sub�ect to Ihe workars' compensetion provislons at Section 3700 0l the Labor Code, I shall forihwith
comply with thesa provisions.
Applicant Signeture: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHRLlSUBJECT AN EMPIAVER TO CiUMINPI PENALTIES AND CML FlNES UP TOONE HUNDRE�
TFIOUSAND OOLURE (5100,000), IN ADDIiION TO TME CO6T OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SEGTON 31080F THE LABOR CODE, IMEREST, AND AiTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm that I em licensed under provisians of Chepter 9(commencing with Section 7000) of Division 3 of Ihe Buslness and Professions Cotla, end my license Is in full
force entl eHect. Lic. k Cless a
ContractoYs Signature: Date:
CONSTRUCTON LENDING AGENCV:
❑ I hereCy eNirm thet ihere is a constmction lending agency for the pedormance af ihe work for which ihis permil Is Issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATONS:
I hareby aHirtn thet under penelly of perjury tnat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which raquires e pertnit to consiruct, alter, improve, Oemolish, or repair eny structure, pdor to Its issuance, elso requires ihe appliwnt tor such permit
ta tile a signed statement thet he or she Is Iicensed pursuent to the provisions of tha Contrectors Llcense Lew (Chepter 8(commencing wit� SecUon 7000) 01 Dldsion 3 ot t�a
Business antl Professions Cotle) or �het he or she is exempt therefrom and the besis tor the ellegetl exemption. Any vidation oi Section 7031.5 by any applicent far a pem+.
subjects the epplicent to e civil penalry ol noi more than tive hundred dollars (5500)J:
I� I, as owner ot t�e property, or my employees with wages es their sole compensation, WILL DO 7HE WORK, end the sWcture Is no1 intendetl or oHered tor sale (Sec.
7044, Buslneu antl Pmfesslons Cotla: The Contractors License Ww does not apply to en owner of property who 6uiltls or improves thereon, and who does such work
himself or herselt or through his or her own employees, provided ihat such improveman�s era not Intended or oHeretl tor sale. If, however, Ihe building or improvement Is
sold within one yesr ot completion, tha owner-builder will have lhe burden of proving ihat he or she did not 6uild or improve for purpose ot sale.).
❑ I, as owner of t�e property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pmfessions
Code: The conirectors Llcense Lew does not eppty to an owner of Oroperty who builds or Improves thereon, and who contraas br such project with e wmractor(s)
license Our5uenl to lhe Conirattors LicenSe Laws.).
❑ 1 em e:empt un r �— eusiness and Professions Coda lor t�is reason:
Signature: -�- y��9/a— Date: //�/ S�� �/ ,
Owner ID venfied by driviir's license. ❑ Ves ❑ No Driver's License No, Expires:
Verilication of Ownership by (type of Document, i.e. - properry tax 6ill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certlfy ihet no excavatlon five (5) or more faet in depth into w�ich e person is requirad to descend, will be made in connaction with work authorized by this
permit, and t�et no building siructure, scaHolding, talsework, or demolition or disman�ling t�ereol, will 6e more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, California Atlminisiretive Code).
❑ As owner-builder, I will not employ enyone to tlo work which would require e permit from ihe Division oi Intlustrial Sefery, as noted ebove, unless such parson hes e
permii Io do such work from tha division.
Signawre: Date:
Division oi InCustrial Sefery Pertnit Number:
CER7IFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTRV: I certity under penelry ot perjury that I heve read this epplication entl state ihat the information given is
correcL I egree to comply w' stal aws and ciry ordinances relating to 6uilding constructlon, entl au�hodze representatives ot ihe Ciry ot Costa Mese to enter upon the
ebove-descnbe0 pro ins ction pu . I agree not to occupy or allow occupanty ot any building au�horizeC by this pe� iI unt/il inal inspection.
/i//S/or
SignaNre OI Legal Owner(s) Date
And/Or Authorizetl Applicant Date
CODE �. INSPECTION TYPE
1616 Fixetl Systam Final Flre Preveniion
1268 Pool Spe Final
200 Final Re-Roof
201 Finel BIocWReteining Wall
202 Final Fectory Fire Place
203 Final Sign
204 Finel Demoll�ion
Q�g INTITI�LS
COUE I INSFECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Si�a
250 Final Builtling/Occupancy
�
3-1- 02
I[�LS
�
NOTE� SHOW AND DIMENSION PROPOSED
PATIO COVER AND YARD AREAS
�
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PLANNING
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DltiiSi��cd t)F ��ilLuiN�
CI'i't OI CC STA FAE:
AP, 62�JVED
f�is set of plans znd sp§ciiMat' ��s .4'' T he! ept cn this job st all limes
sf
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SEE DETAILS ON REVERSE SIDE
�6�-Of 1
ROOF SHEATMING W/ �-`
� '� I " OVERHANG
ILX �/yRAFTERS
AT !� O.C.
OROP PATIO
FLOOR 2'
to ia 2r.;,•,-,r ,
i ^:i(r�I SiB�C � �'
S�OPE TO DRAIN
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T4STRAPEA � DE 1�,��
FOR POST- BEAM Q
CONNECTION. o .�
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26 GA. G.I. FLASHING
WOOD FLOOR
CONSTRUCTION
SIDE ELEVATION
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PosTs v�c s�e�
`' � PLOT PLAN � CONSTRUCTION DETAILS
201e+5,ROOF CONNECTION
DETAILS
CONT.
LEDCaER
CONT.
�EDGER
ID BLOCK
I/2�� DIA. % 5" LAG SCR.
A7 32�� O.C.
DETAIL I
CR 9 CL ��TECO"
GRIPS OR JOIS7
NANGER
3/8° DIA. X 5�� LAG SCR.
AT (b" O.C.
DETAIL 2
IO�e�aOR LIGHT WEIGHT ROOFS
ONLY CONNECTION DETAILS
2�7( FACIA—MIN.REO.
RAFTER
APPROVED METCL
HANGER
DETAIL 3
�avEr�Pr�ar
s�ncEs n�rnrrir�rr
BUILpInIG SAFEI'Y DIVISION
�
AODRESS� a��� �?-�'�'� �`��
CONTRACTOR:
ADDRESS:
RAFTERS
CARPOAT, POACH OR PATIO
NOT SUPPORTING CEILING
SIZF. SPACING SPAN
2"x4" 12"O.C. 9'-6"
16" 8:-0"
24" 6'-6"
32" 6'-0"
48" 5'-0"
2"x6" 12" 16'-6"
16" 14'=6"
24" 12'-0"
32" 10'-6"
48" ,8'-0"
2"x8" 24" 15'-6"
32" 13'-6"
48" 11'-6"
4"x6" 24" 17'-0"
32" 15'-0"
36" 14'-0"
4"x8" 24" 21'-0"
32" 19'-0"
36" 18'-0"
48" 16'-0"
4"xL0" 32" 22'-0"
36" 21'-0"
48" 10'-0"
72" 17'-0"
PATIO COVER
TYP. PLANS
DATE: i1��slo�
PHONE � '� � ;L� � S %-9oaol.
LIC. N0.
PHONE�
RAFfERS AppROVED FOR
LIGHT WEICHf ROOF COVER OF BUILDINC PERMIT
LATH, FIBERGLASS, ALUM,
By Date
SIZE SPACING SPAN
2"x4" 16"O.C. 9'-6"
24" 8'-0"
32" 6'-6"
48" 5'-6"
2"x6" 16" 16'-6"
24" 14'-6"
32" 12'-0"
48" 10'-0"
2"x8" 24" 19'-0"
32" 15'-6"
48" 13'-6"
HEADERS
LIGHf WEIGHT ROOF ONLY
SIZE POST SPACING
4x4 6'-0"
4x6 9'-0"
4x8 12'-0"
4x10 15'-0"
CARPORT, PORCH OR PATIO
SIZE POST SPACING
4x4 5'-0"
4x6 8'-0"
4x8 10'-0"
4x10 12'-6"
GENERAI. NOTES:
L. These plans must be
kep[ on the job at
all [Sme during
cons[ruc[ion.
2. All framing to be
Douglas Fir N� �
gtade minimum.
3. Rafters may no[
a[[ach to facia ex-
cept for 10]�roofs
as shown on detail
20lb�roofs must use
a continuous ledger
at[ached as shovn
on de[ails 4klt#2,
4, LSght weigh[ roofs
may at[ach to facia
for 14' span max.,
spans over 14 must
use a continuous
ledger as shown in
detail 113. �
f�'yy��Imprq G�,
I�JUU Uul9�JU
(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 2858 DRAKE AV
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 14154503
npp�icant: SMITH, DEBRA LYNN
Address: 2858 DRAKE AVE
COSTA MESA, CA
Owner: SMITH, DEBRA LYNN
Address 2858 DR4KE AVE
-COSTA MESA,CA'
Contractor OWNER-BUILDER
Address:
Zip:
Arch :
Address:
Zip:
Phone:
License:
Zoning:
Phone: 714-557-9022
Zip: 92626
Phone:
Zip: 92626
Phone:
License: 0
, Eng:
Address:
Status: ISSUED
Applied: 11/15/2001
Issued: 11/15/2001
Phone:
License:
_ _ o�.vr� vr rortiru i
REROOF: T/O EXISTING WOOD SHAKE, SOLID SHTG TO CODE, 15# FELT PER MFGR SPECS, INSTALL 30-YEAR "GAF
DIMENSIONAL ASPHALT COMPOSITE SHINGLES" AND SHINGIE RIDGE. 35 SQUARES - �
Plan Check: $0.00
Permit: $125.25
SMIP Res: $0.60
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.85
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existinq: 0
NOTES:
Rear 0-0
Rear 0- 0
Reauired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0-0
ss,000.00
$s,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regula�ions. (Ord. No. 92-28, § t, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. ''
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 7545626
:466-66�6I00)
WORKERS'COMPENSAnON DECLARAnON: �
I here6y aHirtn untler penalry ot perjury one ot Ihe following tleclarations:
❑ I heve end will maintain e certificate oi consent to sel(-Insure for workers' compensation, es provided tor by section 3700 ot Ihe Lflbor Cotle, tor ihe pertortnance of ihe
work for which this parmit is issued.
❑ I have and will maiutain workers' compensation insurence, es required by seciion 3700 of the labor Code, Por the pedormence ot the work for which this permit is issued.
My workers' compensatlon Insurance cerrler and policy number are:
Carrier: ' Policy Number.
(Trils secfion neetl not be comp/eted i! the permit is va/ued et one huntlretl dollars ($100) or /e55.J
❑ I certity that in ihe pertormance of the work for which this pertnit is issued, I shall not employ eny person in any manner so as to become sublect to the workers'
compensation laws oi Celifomla, end egree that it I shoultl become subject to the workers' compensation provisions of Sectlon 3700 ot t�a Labor Cotle, I shell forthwith
cnmply with these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDPED
TFIOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMhGES AS PROVIOED FOR IN SEGTION 3�O60F THE LABOR CADE, IMERESi, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECIARATION:
I hereby affirtn ihat I am licensatl untler provisions of Chapter 9(commencing with Section 7000) oi Division 3 of �he Business and Professions Code, antl my license is in full
force antl eflect. Lic. M Class k
Con�rettor5 SignaNre: Da�e:
CONSTRUCTION LENDING AGENCV:
❑ I hereby afrirm ihat ihere is e construction lending agency for the peAormance of iha work br which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn that under penalry oi parjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which raquires a pertnit to construct, al�er, improve, demolish, or repair eny structure, prior to its issuance, also requires the applican� for such permit
to file e signed statement thet he or she Is licensetl pursuant to Me Orovisions of ihe Coniradors License Lew (C�apter 9(commencing with Section 7000) ot Division 3 of tha
Business end Professions Code) or Ihel he or she is exempt therefrom and tha basis for the ellegetl exemption. Any violation of Section 7037.5 by eny applicant tor e pertri:
subjects the epplicant to a civil penalty oi not more than five hundred dollars ($500).):
�I, as owner of Ihe property, or my employees with wages as iheir sole compensation, WILL DO TME WORK, and ihe structure Is not intantletl or ottered for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law tloes not apDly to an owner ot property who builds or improves ihereon, and who tloes such work
himseN o� herself or ihrough his or her own employaes, providetl �hat such improvements ere not Intended or ottered ior sele. If, however, ihe building or Improvement is
sold within one year of completion, the owner-builder wi�l �eve ihe burden of proving that he or she did not build or improve for puryose of sale.).
❑ I, as owner ot ihe properry, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRAC70RS to consiruct the prolect (Sac. 7044, Business and Protessions
Code: The contractors License Lew does not apply to en owner o� properry who builds or Improves thereon, and who contracts for such project wllh e contrector(s)
license pursuant to the Coniractors License LawsJ.
❑ I em exemp c. L
Signature: .
Owner ID verified by dnver's license.
❑ No
Business and Protessions Code for �his reason:
Ex,��e5: ia-r=n
Verifica�lon of Ownership by (type of dacument, i.a. - propeny tex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavetion five (5) or more feet in depth into which a person is required to descend, will be made in connection with work euthorized by this
permit, antl that no builCing structure, scaHolding, falsework, or tlemolition or dismantling thereof, will be more then thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Administretive Cotle).
❑ As owner-builder, I will not employ enyone to tlo work which would require a Dermil lrom the Division of Industnel Sefery, es noted above, unless such person has e
permit lo da such work from ihe division.
Signature: Date:
Divisian of Indusiriai Satery Permit Numbec
CERTIFICAlE OF COMPLIANCE AND AUiHORRATON OF EHTRY: I cehiy under penelry ot perjury that I have read this epplication and state �hat ihe intormation given is
correct I egree to compl Uh all state laws end city o�dinances relating to building construction, end authorize representatives of the City of Costa Mese to enter upon the
ebove-dflscrib tor In p A purya5es. I agree not to occupy or allow occupancy of any building aNhorizetl by this per it unf final inspection.
�/��'%m�
� SignaWre Ot Legal Owner(s) � Da�e
An[llOr Aut�orized Applicant Date
LODE I, INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
126fi
200
Pool Spa Final
Finel RB-Root
201 Final Block/Retaining Wall
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolilion
PdIE INTffULS
r ��OZ, p!7 ,
3�t�
CODE I INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Appro�al
222 Final Site
250 Final BuildincyOccupancy
Q9g 1[�Lfi
�OWNER
JOB ADDRESS
GENERAL C01
A� UO' t41-
Il :CTIONS
soi�
GAS
W ATER
ROUGH PLUMBING
PROP. $WR, LINE Q HOUSE CON.
SPRINKLING SYSTEM
SCEL
ROOGH HEATING AND PIR CONOITIONING
UNDERGROVNO U POWER
ROUGH WIR�NG
TRENCNES FORMS
FLOOR SYBTEM
BOND BEAM n STEEL RE
SHEATHING
FRAME ANb FLASMING
LATNING � IN OUT r
PLASTER, BROWN COAT
ST �TURAL. FINAL
H. IG, VENT., ftEFR
PLUM6ING, FIN/L ANO
ELECTRIC, FINAL
BIJILOING. FINAL
F
DATE
FIRE ZONE
SUBCONTRACTOR
■a.�
� �2332
o:
� COSTA MESA BUILDING-SAFETY DEPARTMENT
� P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Complefely
eui�oiNc SO .a/2�i�.C.c
ADDRESS
OWNER ��jy / � . {�YIGL//WY�S
OC7 13-7 PO A1000 553� ****39.60
LNSG
APPLICATION FOR BUILDING PERMIT
FECE11/EO BV DATE RECEIVED DATE ISSUED
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A.P. NO. � ' P�R�T�� �
BVILDING ag�8 L�
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w0 STATE CITY �'ARDSAPPROVED
N� IIC. NO. LIC. NO. MAIN BUILOING
�� SIZE NO.OF BLIX'>S. (FROM GL ST )
I _/�
OF LOT NOW ON LOT FROM
VSE OF �
EXISTING BLDG. SI
� SIZE OF � � NO.OF /
Z NEWBLDG. � ROOMS / STORIES I L.SIDE
V EXTERIOR WALL ROOF
COVERING S L(.('� COVERING REAR
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a MAIN BLDGS.
a
Q VAR..$
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� � � Tl r APPROVED �
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VI hereby acknowledBe that I have reatl this application antl state
� that [he above intormation is to��ect antl agree to comply with
� all laws regulating builtling construction, and I shall not employ
� any person in violation of the workman's comp¢nsation laws ot
y tha State of Celifornia.
? I he�eby ca�tity that I am p�opa�ly licansatl as a contrsctor untla� Sn'
the Stata of California Business end Professions Code, Divisicn 3, THE AMOU�
Chapter 9, antl thet such licenses ere in full torce and effect, or 1 THE PURPOSE
am exempt from pe provisions ot the Stete ot Calitornia Business VALUATION
antl Professions a�±e, Divislon 3, p pter 9.
VL !
Signamre o j �/� ,f
\ Permlttee ' �/
�� Authorizatl ABent
LOT� BLOCK
G(J�(1C�cLP�Yib
� VALVE j� j �
/ �J
��/�— GFOU—P �
— DATE/(!^/,J' ,
iE OF NEW NV'�
IILDIN� �
VARDSAPPROVED
BEf. MAIN &
ACCESS. BLD
OATE
APPROVED
b
T. o
SHOWN UNDER VALUATION IS FOR '
�F ESTABLISMING A PERMIT FEE ON�V: �
¢
a6 -DO �
PERMIT FEE $ �
�
/'� m
PLAN CHECK $ / • O(/ E
�n_ � LL
TOTAL FEE
... , ..
4 - �.4L�48
r �•-
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA MEBA. CALIPORNIA
For Applieanf io Fill In Complefely
TYPE OR PRINT �
BUILDING Zg58 Drake Avenue
ADDRES3
• COSTA MESA GALIFORNIA
ADDRESS 3800 E. (�iOBSt �1 }lW8
��7y � Cotona del Mar' No.OR
ORCENGI EER �CCO COip Np.OR
n�ooFn� 3800 E. Coast HiQhwav
3800 E
arr Corona del Mar Calif.
�jG7N0 JHHOH�SB-1 No: OR 34220
BIZE NO. OP BIDO
„F � „r 6100 SF � �„W ,,., ,...°None
BHTBACK Llxe FROM 4O � - 1�� REAR YARD
CENTHR OP STREET
SIDE YARD I LEFT %� � I RIGNT G�
DESCRIPTION OF WORK
�slzeO1�0'-6"x49'-1l�goMs V STORIES 1
w/attached garage
I HEHElY ACKNOWLHDG¢ TXAT 1 XAVB RE�D iM18 APPIJGTION
ANO BTAT¢ THAT THE ABOV¢ IS CORR6CT AND AGIiBE TO COtl-
PLY WITH ALL CITY ORDINANCES AND BTATH LAW9 R60ULATINO
BUILDINO CONBTRUCTION.
sicNnTURe oFMESA DEL MAR DEVELOPMENT C0.
� AUTHORIZED
FE� RECEIVED
gr JUL 121�u1
FINANCE DEPT.
CI?Y Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For OffPce Use Only
rtece� er I oeTe R0G8NED I JU�eTp
1
BUILDING
ADDRH88
COSTA MESA. CALIFORNIA
ZONING
20NE n / I NO. OF '] I U86 OP N
iv PlANB v BUILDINO
Y"
teo�� .�'✓h �� l V Y �
oescni� �[
�eaemn uHe ar.�
,
!
7�'-�i
Living Area - 1306 SF
Garage Area - 414 SF
Cov. Porch - 28 SF
TNB ANOUNT BXOWN UNDeR VALUAT�ON l0 FOP TX6
PURP08H OP EBTABLIBXIN6 A PERMIT I66 ONLY.
ALUATION I
1 7 �
$ 13 , 643 .Q� I PLAN CHECK S//!�