HomeMy WebLinkAbout1112 DENNIS DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. WhILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1112 DENNIS DR
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number:
41207443
Zoning:
R1 R1
Applicant:
GICAS, JAMES A
SMIP Com:
$0.00
Address:
1112 DENNIS DR
Inspection:
$0.00
Total:
$0.50
Phone:
714-360-0193
MAIN STRUCTURE Front 0-0 Rear 0-0
COSTA MESA, CA
Zip:
92626
Owner:
GICAS, JAMES A
Address
1112 DENNIS DR
Phone:
COSTA MESA, CA
Zip:
92626
Contractor:
OWNER -BUILDER
Address:
Phone:
Arch :
Address:
Zip: License: 000000
Phone:
Eng:
Address:
ISSUED BY:
Status:
ISSUED
Applied:
09/25/2003
Issued:
09/25/2003
Phone:
Zip: License: License:
SCOPE OF PERMIT
PERMIT TO FINALIZE EXPIRED REROOF PERMIT B01-01549 BY CURRENT PROPERTY OWNER.
Plan Check:
$0.00
Permit:
$0.00
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$0.50
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0
ACCESSORY
Front 0-0 Rear 0-0
PARKING
Existing: 0 Required: 0
NOTES:
FEE SUMMARY
PLANNING & ZONING
Left 0-0
Left 0-0
Proposed: 0
Calc Valuation: $0.00
Claim Valuation: $0.00
Right 0-0
Right 0- 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspectlons 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) 7545626
!"sae (am)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for'iNe performance of the
work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My workers' compensation Insurance Carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ 1 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'
ccmpensellon laws of Callfemia, and agree that it I should become subject to the workers' compensation provisions of Section 3700 o1 the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]08 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. k Class x
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby 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
Cade: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he 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 /avm
r ftimprovements
ensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec.
7044, Business and Professions Code: The Contract rs 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 employe , p are not intended or offered for sale. If, however, the builtling or improvement is
sold within one year of Completion, the owner-build illf proving that he or she did not build or Improve tar purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY C ENSED CONTRACTORS to Construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not ap to of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License La s.).❑ 1 am exempt under sec. ess end Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) teat high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, 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 has 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 the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ElJo
(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 It en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully Compiled with? ❑ Yes ❑ No
...........................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes Ll No
(Section 656SO.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
..._....... ........._..................... —.....___..................................... __............................ _................................. _._................... .........__................................................................__.........._......................_.............._..............._.........
6 Will any part of the facility to be Constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
...................._................_._.................................._._..._._...._.._.._.................................__............................_...._........._......._..__._.....................
....................,"i".............--_...._...._............._._.....
....__._..........__..........
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No
................_._............_................. .._._._._................. ......................................................... ___......... ........ ....._._.__.._......................_.__........................................................................... _.......... _-................ _............ _._........................
B (If yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to Comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenity under penalty of perjury that I have read this application and state that the information given is
t. I agree to comply with all state law and city ordinances relating to building construction, and authorize representatives f the City of Costa Mesa to enter upon the
above ascribed property fo pect(on oses. I agree not to occupy or allow occupancy of any building authorized by this er It until fin inspection.
LSU Z
SignaTurivOlf Legal Owner(s) Date
And/Or Authorized Applicant Data
CODE I. INSPECTION TYPE gag INTmELS CODE. INSPECTION TYPE gag 11MEL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �j 208 Final Plumbing
200 Final Re-Roof 1j-7-o3 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final BuildingtOccupancy
(714) 764-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
.lob Address: 1112 DENNIS OR
Suite:
Vicinity: HOUSE & ATTACHED GARAGE
Parcel Number:
41207443
Zoning:
R1 R1
Applicant:
SELL, RON
$0.89
Required: 0
Address:
18032 LEMON
Other:
$0.00
Phone:
(714)528-1758
YORBA LINDA, CA -
Zip:
92686
Owner:
SMITH, DIANE P
Address
1112 DENNIS DR
Phone:
COSTA MESA, CA
Zip:
92626
Contractor:
SELL ROOFING COMPANY
Address:
18032 LEMON
Phone:
(714)528-1758
YORBA LINDA, CA
Zip:
92686
License:
323842
Arch Eng:
Address: Address:
Status:
ISSUED
Applied:
10/0112001
Issued:
10/01/2001
ISSUED BY:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE & ATTACHED GARAGE (29 SQ). TEAR OFF EXISTING SHAKE ROOF &
RESHEATH WITH 1/2" OSB. INSTALL 30# FELT UNDERLAYMENT & REROOF WITH "EAGLELITE MALIBU" (ICBO
#ER4660/5.8 LBS).
Plan Check:
$0.00
MAIN STRUCTURE Front 0-0
Permit:
$167.25
SMIP Res:
$0.89
Required: 0
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $168.14
SETBACKS
MAIN STRUCTURE Front 0-0
Rear 0-0
ACCESSORY Front 0-0
Rear 0-0
PARKING Existing: 0
Required: 0
NOTES:
FEE SUMMARY
Calc Valuation: 58,900.00
Claim Valuation: $8.900.00
PLANNING & ZONING
Left 0-0 Right 0-0
Left 0-0 Right 0-0
Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
k ,
r
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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, for the performance of the
work for which this permit is issued.
❑ 1 fiave and will mai twin workers' compensation Insure , as required by section 3700 of the labor Code, for the perfor ianco of the work far which this permit Is Issued.
— My workers' co sari Insurenc artier end p y number are:
_Carder: Policy Number:
(This.secflon need not be compWad ed /f the permit Is valued at one hundred dollars ($100) or less.) k ----
El
___❑ I 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, a"ree that If 1 spyuld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions. / /�� �- --- 1 _//_ /-0
Applicant Signature: � l�� :Date:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WO60F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I,am licensed under provisi Js o C�avter a (co ending with Section 7000) of Division 3 of the Business and Prof ions a nd my license is in full
force and effect. Lia k } 7 `I , G Class a) L
v
Contractor's Signature: ; Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: 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 couety.whlch requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
t0 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 Cade) 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 perr4l
subjects the applicant to a civil penaly of not more than five hundred dollars ($500).):
tit
❑ 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 hei 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 Drivels License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or dead):
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 Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a•
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 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 Pian 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 t0 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 the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
9Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
apartment 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? [I Yes ❑ No
..................................................................................................................... ...........................................................................................................................................................................................................................................difi................
5 Does or will the applicant or present or future building Distrct occupant require for the work which Is the subject of this application e,gpermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes 1._I No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building pomlits).
.........._............... ............. ___.................................. ..... _._..... _................................ _..___...................... _........................... _..................... _........................................ _......................................... __..__.._.................. ..._........................
6 Will any pen of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
........................................................................................ .................. ................................... .................................. .................................. ............................................................................................................ ..............................................................
7 If apermit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
......_................................._.... ........... ................ ......_............ ....... .... ................... ....._.............. ..... ...__.............................__................._..........................__--____..__......................_..................................._..................
attach certificate of comIli anco from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspectio rp0 s. I agre of too py or allow occupancy of any building authorized by this permit until final inspection.
Sig a erc or( / �Date
And/Or Authors ed Applicant { � e / `O
CODE 1. INSPECTION TYPE PATE INITIALS CODE I INSPECTION TYPE Qeg INITIAL$
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/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 1 250 Final Building/Occupancy
ADDRESSOFBIAIDI '1112 DENNIS DR Uw;
ONNEI7s NAME1FKRDNNSMITH, DIANE P FLOOD: AH -38
ADORE55:1112 DENNIS DR
COSTA MESA,CA 92626
641-0929
APDL. MMI91O MUM
ARCHITECT OB ENGU EEM
ARCH OR ENO: S ADDRESS: uw-.
coNTRAcTwsNAIE�-NOCK PLUMBING (714)895-1246
caTBAcronmAllwD11612 KNOTT ST
ADDRmGARDEN GROVE CA Clots.: 707775
92841 caw.. 17
LICENSED CONTRACTORS DECLARATION: I hereby affirm under moody d perjury Net I mm Inemed under praMons of Chapter 9
(asnmeMrg soft Section 7000) of Dimmest 3 of rhe Busima and Professions Code. and my Emma is In full lace end effect.
CITY uC.N0.050386 Lic.cLAss:C-36 Llc. 07725 EXP: 02/98
Dere: 31 s Con
OWNER BUILDER DECLARATION: I hereby alfim under tonally d perjury that 1 mm exempt from the Contractee Litems Lew 1« the
'Nlswig rowan (Smion 7031.5 Business and Professions Coda: Arty cmy or mumy ehich Mu'vee m perms to crosumn. Mer. improv.
Mand, or repair any, structure. Prlfa In its ma usocs. also, reculles the applicam for Mldl fwd to Ne a signed eratemeM and he or she
icm and mremm to tM amisiam of the Contractors License Lew [chapter 9 fmmmenutD warn Section 7000) d DNiion 3 of the
„seers and Prdesskaw Cade) Or That he or she ie em -pt tMehat and the bees Its IM aEepnd exemption. Am violation of Smion
7031.5 by any applicant la a permit subjects IM epplimm to a amt Mnaby, of not more [hen fee Wnchod cement; [5500]).
❑ I, m own« Of the vrumry, or my mmpoyee, wah wa9aa as their We compensation, well do the work, and the stmcturo Y rot intended
or Mored for near (Section 7064. Buersm and Professions Cade: The Conlradon License Law does rot apply to an comer 0 Pmpeny
wM hullo «knprova [hereon, and also dura much wok himeel or henell or m ouyh his or her own employees, provided that such
impo orients are nor trisected or offered for mals. W. however. IM building or bnpnwrnm is add within one year of completion. Ne
ownen_bMder ei5 ham the Wdan of proving M or Me do not budd or unpramw la IM puryma of mar).
❑ I, Or owner of the prcp", am utluaivaly aomrmnrp with limned conomam to construct the project (Section 70u, Bmvrms mrd
Profeabns Coda. The Contractors Licata Law center close M sooty to an cenr properly end tmwu thWilde or prereond n awho
contracts for such Projects with a mmra cons) licensed pursual to IM Contractors License Law).
❑ I on exempt under Section: B. & P.C.. M this reams:
Date: owner
I do hmeby candy Nal I aro awere Of and understand the repuirommh of Caddomm Ilsabh and Sooty Cade Seaiom 25505. 25533, and
25534. and Ilial I or ary Mum buiWinp cmpent will I wil nm (acle me) need to campy with most Yate adv and IM requirement. M
Date: Applicant:
WORKER'S COMPENSATION DECLARATION: I hereby alfim under mnalfy of pvjury oro of he following declensions:
❑ I My and ail ma rtan a ceneicam, of comment to aenineura for worknoo' commnsalsn, as proyids i for by Section 37M of the leba
Code. for IM performance of the work 1« wlvch this penin I. issund.
X❑ I My end 01 maintain varum' compensation insurenee, me required by Becton 37M of the Labor code, l« the Performance d IM
w«k t«which Ni pemah®a.d. Mr soon G0
Coro:: 17 EN EAGLt�p mmbererm: EXPIRES
kap` Policy Number: 09/01/97
r xm asterion need nor be canpleted y the peml is br oro hundred dollars 15'1001 or bans)
❑ 1 canny that in the pedomance of the vol, b which this Perron is iuued. I shall M employ any Person in any manner m or to
became subjej to Ilm I Drums' commination leve of California, and nae that n I .hmld become abject to the worker'
co mmnsation rovniolre 1 Section 3700 d IM lab« COM. I .MII I Pyea provreas.
Date: L Applimnr: y.r�.�( —
Warning: Failure ro m.cure workers' compensation wwno 1. unlewNl, and tlroll o Almf an mploym to cdmlml peruNu and
dyll Rrs. up bens hundred tMunnd doffs. f$100, 000), In addition b Me cost of compswfbn, damapm Or provided for In
Sxtlm 3704 of Me Labor Code, Interest, and AMMOY'S fames.
CONSTRUCTION LENDING AGENCY: 1 hereby Affirm under penalty d perjury ththesh
that mass a construction Washing a0oncy for a
Performance dM
twork for which Ihi mm l h maned (Smnn 3097. Cm, C).
LENDER'S NAME:
LENDER'S ADDRESS:
I candy Our 1 have read this application and Yate thin IM above inlamatbn is comm. I timer to comOy ehm all dry and mumy adinergce
ad state Tawe nht'eg to WiMiW h
g aamrmion hereby authorize nommed a
nharms this ay to anter upM on 1above-maationed property
m
lar rpdg
en mrpneesRON NOCK
int Nana
Data:
Sgrwuro of OanedAOenvAPpacanllcomrm«
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CITY OF COSTA MESA — BUILDING PER
PERM N0: P 082217
PERMIT NO: P 082217 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION DISH WASHER CHANGE OUT SQ FT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
----------
MAIN
BUILDING
----------
---------
ACCESSORY BUILDING ---------
NT:
FT IN
REAR:
FT IN
FRNT:
FT
IN REAR: FT IN
FT:
FT IN
RGHT:
FT IN
LEFT:
FT
IN RGHT: FT IN
RKING
REQ:
PROV:
PARCEL:
41207443
ZNE:
REF NO:
ANNING
NOTES>
8,75
22,00 0,00
30,75 30,75
,00
EVENUE DIVISION
TOTALS-->
COLLECTED:
30,75 OVER/SHORT:
.00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
iE 1E fE fh dE iE
k dh ih iL' if if rt * it df
1f k fE * iL iE ie iE 4 fF fE ie * k 1h * irk k iF * 4 irk 1E iE iE iE iE it St iE it IE
if ih iF ih iE iE iE * if 1k dE iE df irk if iE if ih if yf iE it if dE')F * if iF lE
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
ONING APPROVED BY
UILDING APPROVED BY :
APPLICATION ISSUED BY: //L
IE SE IE*firiE ♦E 1E iEM1E iE irk iF if ♦E*1F i(♦E iEfE
LEGALIZATION:N F E E S U M M A R Y
DATE:
DATE:
—3/-
STRUCTURAL
3i-
STRUCTURAL SEGMENT:N
BLDG
PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES
GRADING
ERMIT
8,75
258
SMIP/NON—RES
LAN
SSUE FEE
22,00
UILDING—DIV—>
PERMIT
ISSUE PLAN—CHECK
TOTAL PAID
DUE
OTALS ---- >
8,75
22,00 0,00
30,75 30,75
,00
EVENUE DIVISION
TOTALS-->
COLLECTED:
30,75 OVER/SHORT:
.00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING
PLAN—CHECK
30.75
if ♦f * iE SE lE * dh 1k dE dF d(' iE dE iE dF 1F 1F fE * * *!E i4 iF N: dE iE * dE iE iE ♦E * * dk iE iE dE d0 dF fF it dF dk 1f df irk it dE dE df dh dF lE dF ik'lk dE 1E 7F iE dE 1I -1E if-iE d(-dE 1E df dF iE 1E 1E dh Ih
I N D I V I D U A L F E E B R E A K D O W N
QTY D E S C R I P T I O N
1 DISHWASHER
EXPIR
ED
enrr/.� Pf 2
END OF FEES
UNIT COST TOTAL COST
8,75 8.75
c,�� MtLIi 3 x,1997
CITY. OF COSTA MESA
CONSTRUCTION AND PLANNING -
APPROVALS Permit # Date
Inspector
POO' SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement -
56, Rough Plumbing & Pressure Test .
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58, Electrical Conduit-Undrgrnd,
8. Foundation
59, Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ID 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
APPF(OVAL5 Permit #
20. "Rough Factory Fireplace
-
-
21. Ducts, in Structure
-
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O'Gas 0 Oil
23. Gas Pipe -Rough &.Test
72. Underground Flush -
24. Roof Framing
-
73. Undergrnd.Storage Tank 0Gas 0Oil
25. Roof Sheathing
74. Overhead Hydro,.
26. T -Bar Ceiling (Structural) & Mono -coat
75. Dry Chemical -
27. Frame and Flashing _
76. Dry Standpipe"
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30, Drywall Nailing
- -.HEALTH DEPT. REQUIREMENT, -
31, Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
-
Notes: -
34. Final Heating & Air Conditioning
- -
35. Final Gas Pipe -Test
-
36. Hood or Canopy
37. Final Factory Fireplace
=
38. Final Plumbing
,
39. Water Service -Final•
40, Gas Service -Final
41. Solar Domestic -Final
-
42. Backflow Preventer'
43. Backflow Irrigation
-
44. Landscape Irrigation System _
45. Sound Attenuation
46. Handicap Regulations
47. FINAI- STRUCTURE & BUILDING
-
"-
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
-
a
,y
�i
45044.
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
IILDING Itl r\r--1.1k II/ T -Nr::)
OWNER properties West Development Corp.
MAIL
ADDRESS 508 29th Street
DATE ISSUED
CITY Newport Beach, CA
TEL.
ND- 675-45
CONSTRUCTION
LENDER
NG
BUILD41L-1
BRANCH
5EED
ADDRESS
m
ARCHITECT
OR ENGINEER OR Spangler
TnloL673-09
AODRFSS 2240 Newport Blvd.
Newport Bch
CONTRACTOR
ADDRESS
TEL.
CITY NO.
STATE CITY
LIC. NO. LIC. NO.
OF LOT ApproX. 60'x 80, NOW ON LOS 0
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
PAt9
!%10V 70-77cMSF00 580f� ***122.64
APPLICATION FOR STRUCTURAL PERMIT
BY
DATE RECEIVED
DATE ISSUED
n
n
Z f _
P !r _ 44
x
`$866
NG
BUILD41L-1
1^1r
`t
5EED
LOT 40 BLOCKrties
m
SQ. FT.
a
West Develo ent Cod.
m
Gar. VALUEE 73,400.
FIRE
ZONE
APPROVE
NO.011 - I USE
TE II - )V-
YARDS APPROVED YARDS APPROVED
MAIIN BUILDING I ACCESSORY BUILDING I
vac ur ori wnvm .srvv vsvnrt i � ac rc nry nmc� ' DISTANCE BETc'�-F-BET. MAIN 8,
MAIN SLOGS. ��/ 1 ACCESS. BLDGS.
VAR.#7h.e-t .m I A I DATE -7-7
Plan # 4
I hereby acknowledge that 1 haved this ap cation and state
that the above information Is co ct and agre to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Divlslon 3,
Chapter 9, and that such licenses are In full force and effect, or I
am exempt from the pro Islons of the State of California Business
and Professlona Code, (vision 3, Chapter 9.
Signatureo�(/�/
Permittee L
Authorized Agent
TOTALPAID E
n
n
HB r, z�
._ Cl..,,
sic. , NT
ra
u
2790
m
SQ. FT.
a
THE AMOUNT SHOWN UNDER VALUATION IS FOR
m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
PERMIT FEE E
n
0
PLAN CHECK $
117.50
$ 73,400.
TAX $ 5.14
TOTALPAID E