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�0180
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING •7 � � L
ADDRE55 p(
OWNER
MAIL �. _ —
aTv �;U C TA M A-<
L�ENDER�ION � A S µ
BRANCH
ADDRESS ��
ARCHITECT ---
OR ENGINEER
�—
CONTRACTOR
cirr �F
STATE
LIC. NO.
SIZE
OF LOT
USE OF
EXISTING I
SIZE OF'
NEW BLDG
EMERIOR
GOVERIN
USE OF B
NG AND
NO. OF
RQOMS
qQOF
CpVERI
KY� BE
TEL.
NO.
�r_ du����
s T
TEL.
NO..'�p0 9.2.3
GTY �LIC.NO.� OQ
� NO.OF BLDGS. �
NOW ON LOT
CJ Pl G r
STORIES
�� C1+ N �'O 5 NC
RFORMED
Pd10
APR 7_8-69�„SF001514�
APPLICATION FOR BUILDING PERMIT
��ED DA E RECEIVED DATE ISSUE
-�ci' �i s�•- 2 �-
No. //9- /4'?- 6� `�ioi�2
BUIIDING /J�
AODRESS p/(
� TRACT �7� �C
W A
OWNER
USE
FIRE
ZONE TYPE
APPROVED �J��
BV �
Z E NO.OF SE
— �/ PLANS BUIL
VARDSAPPPOVE� V
MAIN BUILOING AC
(FROM C/L STR
FflONT
FT L
T
L. SIDE FT.
o�,.o �OI�r 'fi_
DI5TANCE BET
MAIN BLDGS.
VAR. #
C.U.P.�W
APPROVED �
VALUE
$
—T
` GROU�P/ �/
DATE / y�+
DF NEW
)ING .
4RDSAPPROVED
BET. MAIN &
ACCFSS, BLp
DATE
��
1 heraby ecknowletl8e Met 1 have reatl this application entl stete
thnt the above Informatlon is corteet antl eB�oe to comply wlth
ull Inws rOBule[Ing builtlinp cOnstrJctiOn, antl I she�l not amploy
any person In violation of the warkman's companfatiOn lawa Of
tha Steto of Calitornia. �
I hereby cerNfy that I em properly Iicensetl es e contrector untlar 5�. FT. p
the Stata of Cali(ornia Businass and Profeuions Cotle, Dlvialcn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR a
Chap[ar 9, antl that such licenus e�e in f�ll forco antl effect, or I THE PURPOSE OF ESTqBLISHING A PERMIT FEE ONLV: Q
om aRompt from the prOvislons of [he State of Calitornla Busineas VALUATION
antl Professions Cotle, Division 3, Cnepter 9. �2 /Q � N
� PERMIT FEE S m
Slp^atura o�i�t /31. O % D /
Permlttee �l-ar�� 5/.S 0 PLAN CHECK $ �0' � 0 E
0
/ O, � LL
Authorizatl ABant TOTAL FEE $( � O
OWNER QHURCH� JACK
JOB ADDRESS 28� Del Mar Avenui
GENERAL CONTRACTOR Natiornride
A"b. 119_1 2-62 LOTpor 2 T
,h cCTIONS
SOIL
GAS
W ATER
ROUGH PLUM0ING
PROP. SWR. LINE � HOUSE CON. �
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH NEATING AND AIR CON�ITIONING
TEMPORARY SERVICE OR POLE
UNOERGROUND � POW�R �
ROUGH wIRING
TRENCMES FORMS STEEL REINF.
F�OOF SYSTEM
BONO BEAM STEEL REINFORCE
SMEATNING
FRAME ANO FLASHING
LRTNING — IN OUT
PLASTER, BROWN COAT
5 � =TURAL, FINAL
MV i-NG, VENT., REFRIG. qN0 A.C., FINAI
PLUMBING, FINAL AN� GAS TEST �
ELECTRIC, FINAL
BUILDING, FINAL
DATE
JUP J TYPE
SUBCONTRACTOR
PERMIT N0.
�
�
�I
h.
�I
POJECT AO�HE55: Z R 3 D EL MAR AV
OWNEfl'SNRME:CAIHY COTTRIiL
nooRess: SAME
548-3334
NflCHIENGINEEN:
FODflE55:
PEPMITTEE:�.RANK BROS ROOFING CO
nooeess: 126 COMMERCIAL WAY
COSTA MESA
LICENSEO CONTHACTOB OELIAHRTION: I hert0y affirm �� m IicenseA um
7000� ol Divivon 3 0l ihe 9usiness antl Pmiessions CoOe. E y license is In
cirruc.:005993 STATELIC.9OS6% cuss:
�ale'. � �'� � Signalure: _
uNiT: HLDG 3
HEG.NO.:
I1NIT:
(714)548-5569
CA 92627
9 (commencing wii� Sec�ion
WOFNEPS' COMPENSATION DECIANATION: I here that I have a cendicate of cansent to selbinsure or a cenificate of Workers'
Compensaiion�nbuj ce.�pr.a,cyctJie4i o`py� ction 3800, tabO i/ O I/ J 4
POIICY ND.: O 7.7 V IV EXP. UATE:
•comenNr:STATE FUND
� Ce ihe0 copy is �ereby fumis�ea. Certihe0 coOY � e �� �he city Builtling Division.
�a�e: ���� � Applicanl���� �
E%EMPTION FHOM WOflKEflS' COMPENSATION DEQAMTION: (Th¢ secfian neeG mi Ue comDleteE if fhe permii is lar one hunGreG (5700) or less�.
I cetlity Ihai in the pedormance oi t�e work lor whic� th¢ permil is issuea. I s�all nal employ any person in any manner so a5 �o become
sublec� Io Ihe Workers' Com0en5aiion Laws oi Califomia.
Dare: SignaWre:
NOTICE: It, afler making �his tleclaralion, you shoul0 Uecom¢ subject Io I�e Workers' Compensation pmvisions ol the Labor
Code. you musl �oM�nih comply with suc� provisions or INs permit shall Ue tleemeC revokeG.
CONSTBUCTION LENOING AGENLY: I hereby allirm I�ai t�ere is a consimc�ion IenOing agency for the p¢dormance of lhe work �or
whic� I�is permii is i=sued �Seclion 3097. Civ. C�.
IENUEB: ;
aoosess:
OWNEB BUILOEfl DELLAflFTION: I �ereby atlirm t�al I am e�empl �mm I�e Conlradors' $taie License Law lor ihe following reason
�Section 703t.5 Business antl Pwlessional Cotle: pny ciry oi caunty w�ic� repuires a Oermit ro construct, aiter, imD�ove, Oemolish, or
repair any slmclure. Odor Io i15 issuance. also repuires I�e appliwnl tor such Dermil to �ile a sipned Slatemenl Ihal he/she is licensetl
pursuam�olhe pmvisions ol��e Conlraclors' Slate License Law�Chap�er9(commencing vnth Sectian 7000) oiDivision 3 o�lhe Business
ana Piole55ion5 Cotle) oi I�al �e/she is exempi Ihereirom ana I�e Uasis lor t�e alleqe0 eeemption. Any viola�ion o� Sec�ion 7031.5 by
any applicant for a Dermit SUCletls Ihe aODliwnt ta a civil penalty ol no� more Ihan live huntlreG Eollars (E500�.
I, as owner ol Ihe properiy or my ¢mploy¢e5 vnlh wages as ��tir sole compensa�ion, will do �he work, and Ihe
❑ s�mmure is no1 imentletl or olferea for sale 15ection 70aa, Busmess antl Fmleuional Code: The Convactors' S�a�e License Law
does nol apDly Io an ownei of a D�oDeny who builtls or impmves I�ereon, and w�o Aoes such work �imselllAerself or ��roug�
�is or �er own employees, pmviaed Nal such improvements are not inlen4eE or offereJ for sale. II. �owever the builtling or
impmvemenl is sold wiihin one year oi comDletian, Ihe owner will �ave ihe burCen ol pmving �e/she Oitl nol �uild or imDmve
' lor I�e purpose ol sale).
I, as owner of Ihe property. am exclusively coniracling wiih Iicen5e0 [onlmclor5 io con5�mci ihe pmle�� (,Seclion 7044, Business
❑ and Prolessions COC¢: ihe CanlroClors' Slaie Lkense Law tloes n0i apply IO an avmef o� D�operty wh0 OUtldS or imD�oves lher¢On
and w�a coniracls for such pmje[Is wit� a wntracloqs) license pursuant lo Ihe Contraclors' Sla�e �icense Law�. I am aware
Ihai pmol of Iheir WorkeYs Compensation insurante 5M1ou10 De O�ondetl �o me.
� I am eeempi un0er Seclion: fl. A P. C.
lor ��is reason: ,
Oate: ' Ownec
I tlo �ereby certily I�a� I am aware ol an0 unEerslan� Ihe �epuiremenls oi Calilomia Heal�� and Satety Catle Seciions 255Q5. 25533. an0
25534 and lhat I or any IUWre Outltlmg occupanl will/will nol (tircle one) neetl b comply with sald slate codes and Ihe requiremen�s �or a
permi� lor conslmclion or mo0dica�ion �mm ihe Aii Ouahiy Management �islricl. fle5iden�iai con5imction applicaiions are eaempt Imm
the5e provisions.
oate: Auvlicant:
I h¢�¢by c¢itAy Ihat I have r¢d� ��i5 aOPlica�i0n dnd Slai¢ t�al Ih d Ov¢ in�Ormaiipn i5 [O�retl.
orOmancesands�alelawsielatingloOuilOmgcon5im[Iionan0� e autlror¢erepresenWiives
pmpe�ty for inspetlion pu�Doses
Date�� Signa�ure:
Driver�s �¢ense or Socia� Security >:
wilh II ciry and counry
o�above�mentionetl
164La6 Whi�e—Buil�ing: Green—Cotle ENTCemenC Lanary—Applicam: Pink—Revenue; Gol�enroa—Assesmr
CITY OF COSTA MESA — HUILDING PERMIT EItM NU; bl/.b.
PERMZT NO; B 061269 PLAN CHECK NO; N c,U '; N SU�r: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STk PURPOSE; ALT
JOB DESCRZPTION : T/OFF REROOF W/FIBERGLASS SHINGLES SQ FT: 1,847
CLAIM VALUE: 1,897.00 CALC—VALUE; 1,847,00 GROUP OCC: R-3 /N-1
COMMENTS; REROOF 1200SF RESIDENCE W/FIBERGLASS SHINGLES
�**��r**�*��e�r�e**�r*x-*���x ���x�x**�r�*�u�****��**�*��c��r*�x*x��*��*#x�� x�***� x������*x��
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 BOILDING ----------
FRNT: FT IN REAR; FT IN
I�EFT; FT IN RGHT: FT IN
--------- ACCSSSORY BUILDING ---------
FRNT; FT IN REAR: FT IN
T,EFT; FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL; 43919224 ZNE: REF NO:
PLANNING NtSTES>
>
!E if iE 3E 3f i! �lE iE if iE �f if it if9f ik iE 1E iE if iE 7f if iF 1E if �1E iF it # 1E �lE 3f if -lE if �1(� if if iE ik iE i!� if iE *�1f� if ii� if -%� iE ik iF 3f %� f[� 1E iF 3E �)E iElh 3E iEiE iE iE ff 3E iF 3E-)F i(� iF iF iF if it
D E V E.�L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROV£D BY : DATE;
APPLICATION ISSUED BY: �— DATE; ��
!(�lEiFiklkifiEiEiE�EiEffiEiEilit7EfElF'lfif%�7FiFiF�3F3F%itiFiF3FiriFiFiFiFiF'iFiF iF��� r'iFiF�riEx�Ttif3F3FiF1Elh�Ih1Elfif•�7(��1E�ltiElrf�c�clrfr ifif
1t f!!E 1E i! 3F 1E iE iE iF iE 1E if ik iE ik if !E �lklk 1Flf itlE 1Elk if 1E 1E It 1FlE iElElt iF iE IE 1E-)h%iE iE if iE %1f it if iElE� if ii� �E 1E i!� if� �1h dF # 1(�!E iF �if� iE 141t iF 3f-ik if if !E if iE iE 3f 36 if
LEGALIZATION:N F E E S U M M A k Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 43,00 ,50
SN, I P /NON—ftES
PLAN
ISSQE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 93.50 0.00 0.00 43.50 43.50 ,00
REVENUE DZVZSION TOTALS--> COLLECTED; 43,50 OVER/SHORT: ,00
BLDG PMT PLUNHING ELECTRIC MECHANIC FIRE: SMIP/TOT GRADZNG PLAN—CHECK
43.00 .50
If dF if iE if jf 1f 1f ik k k i! �f k k ik iF itlE iE 1f ff ff !(� k if iE if 3Elf if ik it if �rt iF 3f if ik k if- k if ik iE ik iE �1F if # iF if IE iF k iF-]E Ik i( iE It itiEif it IE if iE M-K� IE �f !f iE iE if 3hlF it
I N D I V I D U A L F E E A R E A K D O W N
TYPE (ZTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 1847 REROOF BY VALUE RESZDENTZAL NO'lONE 1,00
END OF FEES
1.84"/.00
t,'��RUCTION AND PLANN[NG
APPROVALS Permit #
t. Temporary Electrical Service or Pole
2. Soii Pipe-Undrgrnd.
3. Electrical Conduit Utility•Undrgrnd.
4. Electrical Condwt�U�drgrnd.
5. Steel Reinforcement
6. Electrical UPER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgrnd.
70. Structural Ploor System
11. Properiy Sewer Line & House Connection �
12. Sewer Cap ,
13. Roof Orainz �
74. Rough Plumbing �
15. Rou9h Eiearical-Conduit
16. Rough Electric Wiring
77. Rough Wiring Sign
78. Rougb Electrica6T 6ar Ceiting
19. Rough Heating & Air Conditioning
20. Rough Factory FirePlace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & 7esc
24. fioof Framing
25. Roof Sheathing �
26. T�Bar Ceiling (Structurall & Monocoat
27. Frame and Flashing
28. (,athing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coai
32: Electrical ?ower Meter-F�nal
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Finat FactorV Firep�ace
38. Finai Pl�mbing
39. LVater Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backfiow Irrigation
44. Landscape Irripation System
45. Sound Attenuation
46. Handiwp Regulations
47. FINALSTRUCTURE&BUILDING !
48. FINAL PLANNING �
49. Etectric Release to Edison
50. Gas Release to Southern California Gas Cn
51. CERTIFICATE OP OCCUPANCY
Yo. _ Date
Date
PO, � SPA
Inspector qppROVALS Permit #
52. Pool & Equipmen[ Location
53. Steei Reinforcement
54. Forms
55. Electricai Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER�GUNITE
58. Eloctrical ConduibUndrgrnd.
59. Gas Pipe, O UnUrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgmd.
61. APPROVALTODECK
62. Backwash & Receptor-Final
63. Heater & Vent�Final
64. Plumbing System - Finai
65. Electrical•Final
66. Solar System-Final
67. Fe�cing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping O Gas 7 Oil
72. Underground flusl�
73. Undergrnd. Storape Tank O Gas ❑ Oil
� �� 74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
� 77. FIXEO SYSTEM FINAL
; ' 78. FIRE PREV. FINAL
! � HEALTH DEPT. REQUIREMENT
� 79. FINAL INSPECTION
j 80. FOOD CERTIFICATE ISSUED
� � Notes;
8
Date �Inspec2or
i
-,
�G � .
\�� ,� AOO���ant to lill in all s0aces except those wlt�in neavY �ortler Iines anE sign all approoriate tleclantions.
,er7Y0F.;�pSTnmEsn CONSTRUCTIONPERMIT _ '
Projecs Oddross _%�.�—�L I7'lii e �!/E
�
Appicant's Mailing Address 2�3 OEG //rR2 �
� PN'% Q!/,P�9A/ Phone.��i3�J
Owner's Name
Addreu �` �i-� �,1rl.._ M�� Co4T/+ F'� 5,y� '
Arch/Eng..�A/ /7'/�i.Wr,9w/ LicenxeNo.S-ZtiS� �
Address �] %�7 w /�/f/�(5..� A✓C f 2
w
Conttactor's Nama V;,�.^9E2 f ��,.rY Phone � �-6iui
Addreulmailingl-+�F /7.� CT.
City.License No. �_y Z� 7-
LICENSED CONTRACTOR DECLARATION
1 he�eby aHirm [nal I am Iicensetl untler prOvi5iOn5 of Ghdrter 9(commCnCing
with section 7000) ol Dlvision 3 of the Business antl PrateSslonS Cotla, antl
my license is in tull fOrce antl ¢tfect. ':? 3/��
LICCOSC CId55 L�C O58
Oale�''�Q.'� Si9nalure
WORKERS'COMPENSATION �ECLARATION I
bere�y aHirm tna[ I have a certitiwt¢ of ConS¢nt t0 5¢It-InSure oF a certiflca[e
Worke�i' Compensa[iOn InSuranca, or a certifletl copy thereOt ($eGtion
Pol�'�c�Y No. �n n z3 � � ComPanY � /�� `�" ��[Ny
BCertifietl copy is bereby turNzhetl. � '
Certifietl�ppy is I)'J C wi[h tne city Builtling Divisl
�ateT �' �"7+ n� ApPlicant� �%t�-f�
EXEMP,TION FROM WORKERS' GOMPENSATION DECLARATION
(This saction neetl not be completetl it tha permit is tor one �untlratl (EI00) or .
less).
I certity tha[ In the perlormance o1 th0 work fOr which thi5 pe�m�[ is Issuetl I
shall not employ any peroon In any mannei so as t0 becoma Subjett to t�¢;
Workers' Compensatlon Laws oi Calitornla. �
Da[e. Si9nature
NOTICE:It,alter makinq this tleUaradon, you ihoultl become suDject to the
Worker5' COmpCnSdtlOn prOvi5IOn5 0/ thC LBbOr COtla, you musl lofthwith
comply wilh Such p�ovi5ion5 0� Inis pe�mlt Sha�l bG tleematl revoketl.
CONSTRUCTION LENDING AGENCV
1 nereby atflrm tnat tnere is a consVuction lentling agency for the p¢rtormance
of tho work for which thls pOrmit Is ISsuetl (Settion 309] Civ. C.)
Lentler'S Name
l.entler's Atltlress
OWNER BUILDEN OECLARATION
I heroby aflirm thal� I am oxempt frOm [he Contractor's LlcenSe L.aw iOr the
tollowing-reason (SeeBon 7031.5 Buslness antl Prof¢islonal Cotla: Any dty or
county wNch requiies a permit to conslrutt, aller, improva, Oemolisb or repair
any structurc, prior to Its issuancu, also wqWres the applicant for such ocrmlt
to file d SlgnOtl 5lalemEnt Ihdt Ile/She Is IlcenS¢tl pufsu2nt to th¢ prOviSlOns of
the Contraclor's License Law (Cnapter 9(CommBnUng with Section 7000) of
"vlSiOn 3 of tne Buzlness and Prolession5 COEe) Or that he/she Is exemo�
retrom dntl Ih¢ ba515 for the all¢qOtl uxnmpHon. Fny violatlon ol SocUon
11.5 by any applitant fOr d pe�mit sub)ac[5 tha applitant [o a clvll
Odlty of not mo�e lhan /iv¢ huntlretl tlolldR (5500).
� I, ds owno� of Ih¢ propOrty o� my Cmployees with wage5 a5 thalr 5018
mmpen5alio0, will tl0 �he wo�k, antl Ine st�Utture IS not InlCnticO o� oHeretl
for sale (SeGtion 7044, 9u5ine55 antl Pro1855ional COtla: The Conlratlor'S
Licansc Law aoes mt aoo�v to an owner oi a property who bulltls or Improves
tbereon, ana wno tloes such work nlmself/nersell or throvgn Ns or ner own
em01oy ee5, provitletl thdt zuth Improvem¢nti are nOt Intentled or olteretl to�
salG. It, hOwevet, th0 builtling or improvament is SOItl witnin On¢ year ol COm�
PlttiOn, t�e Owncr will hav¢ [hu burtlon 01 O�oving he/ShC tlltl not builtl o� Im-
p/Ove for lne purpose 07 sale�.
❑ I, az own¢r Of lne prOPetly, am a%clusivnly cont�acting wlth Ilcen5e0 cOn-
Vactors (O wnziract the projeCt ($eclion 7044, Busin¢52 and Protessions Code:
The Contractor's LicenSe Law d0¢s nOt appty lo an owne� of pm0erty who
builtls or ImOroves thereon, antl wbo conVac[5 tOr zuth O�OjectS witb a con-
Vacto��sl license Owsuant lo the COM�actor'S Licenze Law). 1 am aware Ihat
proof of tbeir Worker's Compensation insurance 5�oultl be provlOeA to me.
❑ 1 am ezempt untle� Se<tion B. 3 P. C. fo� IhiS red50n
Date Owner
I h¢reby tertify that I have �eatl [ni5 applicatlon and State [hat i�e above
information iz correcL I agree to comply witn all dty antl county ortlinantes �
. antl state laws relating to builtlin9 �onstructlon, ana hereby authorize repre-
sentatives o/ [his cily [o ente� upon the abova-mentionrtl P�operty for
inspectlon puryp 5 �] 2 �j
Signature � �Gi� Y-� Daia��Qf�
Drivers' Li �� -���%�
a���
TVPE OF CONSTRUC
❑ CONVERSION
ADD U ALTERATION U REPAIR
DEMOLISH tJ OTHER A p �6
,�USE OF BLDG?` � ��� 'v w �
�' A�' � S Main Buildin9: .
E
TVPE OF PERMIT IJ GRADING � FOUNDATION STRVCTURAL T Front
❑ TENANT � ELECTRICAL O PLUMBING ❑ MECHANICAL B Rear . 37'
❑ OTHER ' �: ,
PROJECT DESCRIPTION SQ. FT. �- oCCVvnNCv - C Right aj
��� ����'( �Q(y��� K Left
� CONSTRVCTIONTYPE VALUATIONSI: ' S
ZONE � GRAOINC CU. VDS. AC RES P�ng. Ref. #
Remarks: _ _ . �J ry �� S � no �� � ���' Planning Notes: �
Sink
Preventer
Irri9ation
Floor Drains '
Floor Sinks
Gas Service � Outlets
Interceptors
Kitchen Sink
Lavarories .
P-Trap •
Roof Drains ' � '
Reinspection Fee � S75
Boiler
DuCt� Under GroUnd
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 aru O i oo,000
Reinspection Fee � $75
i. CINF�65-46, rev. 10/B4 Whit¢ - Bulltling: Canary - Applicant: Pink - Accoun[inq; GOItl¢nrotl - A55e55or
��
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping '
Solar Tank
Swimming Pool w/Spa
Urinal
WdtCf CIOSft.
Water Heater
Water Service
Auto�Wash
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration Sysiem
�aioo,000eru Oioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES f-�7�1�IJ S��
� X//"]'�
Automatic Washer- '
Construction Pole Sub. �
Cookin9 Unit
Dishwasher �
Dryers ❑Gas ❑Electt
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
3582 9/22/86
2one
Acce55ory Building:
'_. _/��.�.� �
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter �up to 100 amps
Meter �over 100amps
Garhage Disposal
Generator �0-5 KW �5-15 KW
g�Reinspection Fee
FEES
DEVELOPMENT SEFj
Zaning Approved By �
Building Approved By
Appliptian luuad Bv_
$ 3
$15
Su6 Panel
Morors O0.1 HP O1 R� 8
Inc.Solar �9�75 HP 016-15+
Microwave
Pole Light
tiange
Sign
Standing Sections
Tresh Compactor
Issue Fee
195.10 TL
Z
O
N
I
N
G
R
E
Q
M
T
FEES �
5 3
SUM ARV OF FEES /�
BUILDING PERMIT $ 0� SMIP $ L� IO
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. 5
ELECTRICAL '$ .GRADING 5
P�ANCHECK 50% $ � MICROFILM S
MECHANICAL $ TOTAL FEE 5 ��
PLAN CHECK 25% $
�
CONSTRUCTION AND PLANNING POOL & 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 Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit�Undrqrnd. 55. Electrical Bonding � '�
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electrical UFER Grnd. � �O '�� ��{f 57. APPROVAL TO COVER-GUNITE
7. Footings � s'('�Yi � ( b 61b fj� 58. Electrical Conduit�Undrgmd. -
8. Foundation ' � P� Q�' 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. ` 60. Backwash Lines, P�Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - final
14. Rough Plumbing 65. Electrical-Final -
15. Rough ElectricabConduit 66. Solar SYstem-Final "
i 6. Rough Electric Wiring 67. Fencing & Access Approval � t
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Under9round Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Fiush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing C 13 Q� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ''
27. Frame and Fiashing �� _ � 76. Dry Standpipe
thing iding ( 77. FIXED SYSTEM FINAL '
29. Insulation �,{ Q�' 78. FIRE PREV. FINAL .
30. Drywall Nailing g p HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat �(� Q� 79. FINAL INSPECTION . �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED? . �
/ n
33. Final Electric Notes: �� � a'i w.p-�h2�t . �
34. Final Heating & Air Conditioning � .
b D �e.
35. Final Gas Pipe-Test ( [,, ��rR ��L,OK �JQ-
36. Hootl or Canopy � a �
. �L �
37. Final Factory Fireplace ��
38. Final Plumbing
39. Water Service-Final i b s t �
l
40. Gas Service-Final
41. Solar pomestic-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 `
i.
50. Gas Release to Southern California Gas Co , a. =
51. CERTIFICATEOFOCCUPANCY �
rv' ,
No. Date � _
�
R. HANLEY CONSTRUCTION CO.
GENERAL CONTRACTOR
445 E 177H ST.. STE C, COSTA MESq CA 92627
CA LIC. 373148
Additions
Patio Enclosuras B08 HANLEY
Remodeling (714) 650-8141
February 10, 1987
City of Costa Mesa
Building Department
77 Fair Drive
Costa Mesa, CA. 92626
Gentlemen:
This letter is to certify that there was proper drainage for
the sewer line at 283 Del Mar, Costa Mesa, California. The sCope
was away from the house, toward the street. �
A�11 connections were to code, inspected and passed by the
City of Costa Mesa Building Department.
Sincerely, _
R. HANLEY CONSTRUCTION COMPANY
Robert Hanley
RH:bkm
�
t
Applicant lo fill in all sDaces except those within heavy Oortler Iines antl si9n all aDOropriale Eeclarations.
ci7v OF COSTn mESA CONSTRUCTION PERMIT
ProjectAddress•� a-p3 nE�- n^V12 e� �
ApplicaM's Mailing Address yys p' / 7�� (!T � L� � M• r1�G z'.
Owner'sName ��7 �u-24�n1!) Phone 5-�33!
Address -'y� 3 17 E�- N^ /i'iZ
Atch/Eng. �A,�;%M �AJ License No.
Address ���✓
Contractor's Nam �'y�E Phone G f0 -(si y/
Addresslmailing) � � ��f�� �•�""�•
City License No. /7Xl'�^/jx 3 �/2 �iZ '
LICENSED CONTRACTOR DECLARATION
I h¢r¢by atti�m inat I am Iicensetl untler proviziOns of Chdrter 9(rommencinq
with section 7000) of Dlvislon 3 of tho Business antl Professions Cotle, antl
my license is in fu11 /f�orc antl eifect. ` �1 /
LICCpSE CId55 �'�/ � _� mc i ense��f O} /� ��� b
oate ,���- $�e Si9nature ��a �T_�-`�� /`TY' -- n-k�
WORKERS' COMPENSATION OECLARATION '
hereby affirm tnat I have a certificate of consent to seli-insure or a certificate
f Workerz' Compansation InSurance, or a certl(ietl copY thereot (Section
3800, Lab. C.)
cor�r No. �in�'23 -YL S�'c moanr �Tl3"Tcf Tu,v�
�Certifletl cooY is hereby lurnishetl. ,
CerUfietl copy i fllea with the ciry Bui in Divisi
Date ��-'%Z�� Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLAf2ATION
(Tbis zectiOn n¢¢tl n0[ be cOmpletetl if the permii is fo� On¢ huntlretl (E O) or
icss).
I cerNfy that in [M1C p¢r�Orman<e of the work fOr which this p¢rm�t i5 issuetl, I
snall not employ any pe�son In any manne� so as to become subject [o the
Workers' ComOensalion Laws ot California.
Oate Si9nature
NOTICE: If, aRer making Ihis tleclaration, you zhoultl betome subject to the.
Workers' Gompensation provisions of [he Ldbor Cotle, you must for[hwith
comply wil❑ suc❑ 0/ovisions or [M1is petmlt shall Oe tleemeG revoketl.
CONSTRUCTION LENDING AGENCV
I nereby aitirm ihat tnere is a consVucUon lentling agency for the pertormance
Ot the wOrk for whiGh this plrmlt is i55uetl (Sectlon 309� Civ. C.)
Lentler's Name
Lentler'sAtltlress _
OWNER BUILDEN DECLARATION
1 hereby affirm thae I am exampt from the Gonlracror's Licenze Law for the
following reason (Section 7031.5 Business antl Profezsional Cotle: Any city or
counly whicb �equiro5 a pe�mit to con5t�uct, dlt¢q lmprove, tlemolish or repal�
any structure, prior to its Issuance, also requires the applicant far sucn permit
to file a 5l9ned stalement thai he/she Is llcensetl pur5uant to the provisions ot
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
��,ik`]ivision 3 of t0e Buzinesz antl Protess�ons Cotle) or thaC he/she is exemOt
,��t¢r¢Irom antl th¢ Dasis fo� Ne all¢g¢tl exemptlon. Any viOla[ion ot Section
�; 031.5 by any apDlicant for a pe�mil subject5 the applicant lo a tivil
���¢rldlty of not more than five huntl�etl tlollars (5500).
I, as owne� of Ihe property or my employees with wa9e5 as their sole
componsation, will tlo the work, antl the structure is not intentletl or afferetl
for sale (Section 7044, Business antl Protessional Cotle: The �Contractor's
Litense Law tloes not aop�Y to an owner ot a property who builtls or improves
thereon, antl who tloes such work himself/her5¢It or thrOugh his or h¢r own
employees, prOvitleO that SUCh improvement5 are not intentletl or affe�etl tor
sale. If. M1owever, the bulltling o� improvemeni IS Soltl within One year of mm-
O�etlon, the owncr will have the bu�tlen of proving he/sne tlitl noi bulltl o� im-
prove tor the purpo5e of sale).
❑ I, a5 Owne� of the p�operty, am exclusively contracting with IicenSeO con-
tra<tors to mnstruct the project (Section 7044, Business antl Professions Cotle:
The Contractor's License Law doe5 not apply to an owner of pwperty who
builtls or improvns lhereon, antl who contracts for such prolect5 with a con-
tractor(S) I�cense pursuant lo the Contractor's License Law�. I am aware that
� proof o( itleir Worker's Compensation insuran<e shoultl be provltletl to' me.
❑ I am exempt untler 5¢ction B. & P. C. for this reason
Dato' Owner
I hereby certify tnaf I' hav¢ reatl this ao��icatlon antl state that the above
information is wrrect. I agree to comply with all city antl county ortlinances
antl SWte laws relating to builtling conz(ruG[iOn, antl hereCy authO�iie �epre-
sentatives of this city to enter upon the above-mentionetl property tor
inspectio❑y yryp5 .
Signatur¢ lGd Da[e ���- W��'�
Drivars' LicenSe or 55 �' _
;_. _ _ „ by .
TYPE OFCONSTRUCTION NEW ADD ALTERATION ' REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING
❑ TENANT ❑ ELECTRICAL
❑ OTHER
PROJECT DESCRIPTION Sq.Fr._
CON STRUCTION TYPE VALUATION�$
GRADINGCU.VDS. AC
1 FOIINDATIrnON lJ STRUCTURAL
PLUMBING V�-MECHANICAL
Remarks: ����(�
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwdsher .
Orinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trep
Roof Orains
Reinspection Fee
FEES
�
Service Sink
Sewer Cap
' Sewer Connection �
� Solar Collectors
. Solar Piping
Solar Tank '
Swimming Pool w/Spa
Urinal
� Water Closet
Water Heater
Water Service
Auto�Wash
Laundry Trays
$15
Boiler
Duct - Under Ground
Duct - Sttuctural
Duct - Ventilating
Exhaust System ❑ Multiple
PirepUFacL BIL ICBO #
IHeating System & Ducting
�0.100,000 BTU 0100,000
Reinspec[ion Fee � $�5
CMF 0865�46, rev. 10/84 Whl[e - Builtling; Canary - Ap0licant; Plnk - Accounting; Goltlenrotl - AssesSor
Issue Fae
Hood or Typel ❑
Canopy ' Type II ❑
Refrigeration System
❑o-ioo,000eTu ❑ioo,aoo
System Repair/Alteration
Fire Dampers �
' Registers
Issue Fea
5
A.P. �W
S Main Buildi
E
T Front
e Rear �
A
C Right
K Left
S
Ping. Ref. # '
Planning Notes:
Washer
Cooking Unit
Dishwasher
Dryers �Ga
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
�wncnes -
Garhage Disposal
Generator �0.5 KW
� j i \ � �`' �r �, � e
r '
• 4 �
f . t - N
�y76ne
Acc2sso`ry,8 ui Idingx
� �� 4VJ� � • Z
O
•� N
I
r N
G
R
Parking Req./Provided E
Q
M
T
S
ELECTRICAI
Trans(ormer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amUs
Meter �over100amps
Sub Panel
Mo[ors � 0� 1 HP � 1 h- 8
Int.Solar �9-15 HP �76-75+
Microwave
Pole Light
Range
$tanding Sections
5 KW Trash Compactor
$ 3 f
� Reinspection Fee $15 luue Fee
FEES
�DEVELOPMENTSERVICESRE�UIREMENTS:
, ZoninB Approvad By
Building Approved By
Aooliotion Issued Bv n
3
� SUMMARV
BUILDING PERMIT $ �
PLAN CHECK 5
PLUMBING ' $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $ �-q�
MECHANICAL $ __/� "-
PLAN CHECK 25% $ _I . V
SMIP $
PERMIT
ISSUANCE 5
ENERGV P.C. $
GRADING $
MICROFILM $
TOTAL FEE $
FEES
$ 3
�I
CONSTRUCTION AND PLANNING
APPROVALS Permit #
i. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3.'Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgmd.
10. Structural Floor System
71. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning ��
20. Rough Factory Fireplace
21. Ducts, in Structure '
22. Ducts, Ventilating ,
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Freme and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat �
32. Electrical Power Meter-Final
33. Final Electric '
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 pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation .
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
Date
Date
POOL & SPA
Inspector qppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding �
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electriwl Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTODECK
62. Backwash & Receptor-Final ,
63. Heater & Vent-Final
64. Plumbing SYstem'- Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
�j' FIRE DEPT. REQUIREMENT
APPROVALS Permit # � _
� 70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storege Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical �
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
, HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
Date � Inspector
>
�
Aoplleant to fill fn all soaces ezceDt those within neavY boreer Ilnes ane sign all approDriate Eeclarations.
CI7Y OF COS7n MESn CONSTRUCT�ON PERMIT
Projec(%,ddress EC � � Q V
/1pplicanYs Ma' �ng Address ��,����
O�aner's Name k /h6ne�Z�
Addre55
ArchlEng. License No.
Address n
Contractor's Nam��6%(l)G_IQ� �JU1 C.�n�✓� �Phone
Address Imailing) �`- �
City License No.
LICENSED CONTRHCTOR �ECLARATION
I her¢by affirm that I am licensetl untler provi5ion5 of Charter 9(Commencing
witn section 7000) of DiviSion 3 of the Buslness antl Grofessions Cotle, antl
my Ilcense is in full force ana eitect.
LicenSe Class Licanse No. �
Datc Si9nature
WORKERS'COMPENSATION DECLARATION
�ereby alfirm that I nave a cerliticate ot consont to self-Insure or a certiilcate
. Workers' Compensation Insuunce, or a certifietl coDY thereof (Sectlon
3800, Lab. C.)
Policy No. ' Company
BCertifietl copy is hereby fumi5hetl. '
Certifietl copy is (iletl with the city Builtling Oivision.
Date Applicanl
EXEMPTION FROM WORKEFS' COMPENSATION DECIARATION
(Thissection nettl no[ be comp�etetl if the permi[ is tor on¢ huntlretl ($300) or
less).
I certify that in the performance oi ihe work for which this perm�t Is Issuea, I
zhall not employ any oerson in any er .�s to be e s Mo t e
WorkeFe{ C nsnt.i� Laws, Ot Cali ra 1
Date [SJ�%__�f �Signature
NOTICE: If, atter making [his tlecla�ation, you Shoultl betome SubjCct [o the
Wo�kers' ComP¢nsa[ion provisions of the Labor Cod¢, y0u must to�thwith
mmply with such p�ovlsion5 or [his permil s�all Oe tleemetl �evoketl.
CONSTRUCTION LENDING AGENCY
1 he�eby at�i�m lhat there i1 a conztruttiOn lentling agency fo� the pertormaneC
of the work for which thls permit is IsSueC (SeCtion 3097 Civ. C.)
�entler's Name
Lentler's Atltlress
OWNER BUILDER OECLARATION '
1 nereby aftirT that I am ex¢mPt 1�om the Contracto�'S LiCCnse L.aw iOr the
following reason (Section 7031.5 Business antl Pro(essional CoOe: Any city or
wunty whic� �equires a Oe�mlt to Const�uct, dlter, imp�ove, dem011sh o� �epair
any strucWre, priOr to iti is5udnce, also reqWr¢s lhe aOP���ant fOr such permit
to iile a signea statement that he/she is licensetl pursuant to the provisions of
�he Con[ractor•s License Law (Chapter 9(commen<ing wlth Section 7000) ot
ivizion 3 of lbe� Business antl Profezzlons Cotle) or that ne/she is exempt
erefr m antl the basis for the allegetl exemption. Any vlolation ot Section
03 by any applicant tOr a Oermit Subjects the applicant t0 a civll
e Ity of not more than five huntlretl t1011ars (5500).
1, as owner of the property Gcr� y 0� Y `'�'� "�"'�` '�°�' `"'�`
uNMiakien, will tlo the work, antl the structure Is not intenCetl or offeretl
. tor—sale (Se<tion 7044, BuSiness antl Professional Cotle: The ConVactor'S
'� License Law tloes�not apDly to an owner ot a property who builtls or improves
� thereon, antl who Ooes such wo�k him5¢If/he�self o� througb hi5 0� bet own
Iemployees, prOvitleE tnat such improvements are noI intentletl o� offeretl fo�
sale. If, bowever. lhe builtling or ImProvemen[ I5 sOltl wlNin One year o1 mm-
ple ' n, Ihe owner will have the bu�tlen Of provin9 he/sne tlitl not buIIC or Im-
for the purpose of sale).
, as owner of the prope�ty, am exclusively con[�aGting wltn licensea con-
(dCIOR IO COfISLNCI Ih2 O�OIQ« (SCCIIOO %O4A� BUSI0255 dOtl Professlon5 Cotle:
The ConVactor's Llcense Law tloes not apply to an owner ot property who
builtls or Improves thereon; ana who contracts for such proiects with a con-
Vacior(s1 license•pursuant to the Goncractor's l.icense Law). I am aware that
proof of their Warke�'s Compensa[ion insuranc¢ inoultl be P/ovitletl [o me.
❑ I am exempt untler $ection B. & P for thi5 reason
il. 2 � � _�9
n � ! - Q_ o
I hereby certity inat I have reatl this appliGatlon ana state tnat Ihe above
informatlon a correct. I agree to comply with all City antl munty OrtlinanCGs
antl state laws relatin9 to building construction, and hereby au[horize re0re-
sentatives o(�, this Lity to enteyp pon the aboy� -mentlonutl Oroperty for
insoectron dWonsef . / �_ //i. _ � !/ ✓_ n� r-ff
Signature� wi�Ap/
Drivers' License or 55
CMF OB65-46, rev. ]0/04
PERMITj,110. ��``�„ TRACT NO. LOT NO. UNIT NO. �
� v /
TYPE OFCONSTRUCTION NEW %�DD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, #
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRVCTURAL
�O TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHAfJICAL
❑ OTHER
PROJECT DESCRIPTION 5a. FT. OCCUPANCv_
C O N 5T RUCTION TYPE V A LUATION $
ZONE GRApING CU. VDS. ACRES—
Remarks:
Sink
Preventer,
Irrigation ' �
Drinking Fountains
Floor Dreins
Floor Sinks
GasService Outlets
Interceptors
Ki[chen Sink �
'—Trap
Roof D
Service Sink �
Sewer Cap �
'$ewer Connection
Solar Collecrors
'Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Goset
Water Heater
. Water Service
Au[o-Wash
Laundry Trays
FEES
Reinspectian Fee I $15 I I , Issue Fee I $ 3
Duct� Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.Blt.ICBO# '
Heating System & Ducting
❑0.100,000 BTU �100,OOOB7i
Reinspection Fee � $15
White - Builtlinq; Canary - Appllcant; 7ink - Accounting; GolGenrotl - Assessor
Hood or Type I ❑
Canopy ,Type II ❑
Refrigeration System
00-100,OOOBTU ❑100,000
System Repair/Alteretion
Fire Dampers '
Registers
luue Fea
S Main Bwldrt
E
T Front
8 Pear
A
C Righ[
K Left
S '
Pln9. Ref. #
Planning Notes:�
Automatic Washer.
Construction�PoleSub. �
Cooking Unit
Dishwasher '
Dryers ❑Gas_ �ElecVic
Fan
F.A.U.
Fiztures
Outlets
Switches
Garbage Disposal
Generator �0.5�KW
6157 10/28/86
Zone
Accessory Building:
ELECTRICAL '
Transformer ❑ 75-50 KW
❑ 50+KW
�
Meter LJyp to t00amps
Meter over 100 amps
Sub Panel
Motors O41 HP O 7 h- B
Inc.Solar �9�15 HP �16-15+
Microwave . '
Pole Light .
Range
Sign
Standing Seccions ' •
Trash Compactor
Reinspection Fee $15 Issue Fee
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By -
Building Approved By
Aaoliption Issued 6V �
$ 3
SUMMPCRV OF FEES
BUILDING PERMIT $ � SMIP $
PLAN.CHECK $ PERMIT
PLUMeING � $ - ISSUANCE $
PLAN CHECK 25% $ —y������ NERGV P.C. $
ELECTRICAL � �'L���"j�.(�(J� �ADING 5
PLANCHECK 50% $ —¢�s�`�-J''�ROFILM $
MECHANICAL $ TOTAI FEE $
PtAN CHECK 25% $ .
18.00 TL
FEES
$ 3
Z
O
N
I
N
G
R
E
�
M
T
$
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVA�S 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 UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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 Dreins 64. Plumbing System - Final
74. 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 OGas ❑Oil
23. Gas Pipe-Rough & Test. 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION -
32. Electrical Power Meter-Final /`�� 80. FOOD CERT�FICATE 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 pomestic-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 Southem Califomia Gas Co - ' �
51. CERTIFICATE OF OCCUPANCY �
No. Date •
' � ApPlicant to flll in all ipaces except those wi[hin heavy EorEer lines anC sign all aDDropriate tleclara[ions.
CiTY OF COSTA MqE�SA CONSTRUCTION PERMIT �Mf� NO: � y 37�o LO�T � 7 UNIT N0.
Projeci Address ��J ? `l7,���yL'- /1/1A-/1 I�'U� "oL' ) U Z'
tlpplicant's Mailing dress e,LD_Ln[Z.LK/YA TYPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR
/T ❑ CONVERSION ❑ DEMOlISH ❑ OTHER
Owner'sName �1'T ���'L/I/t.�-� Phone Tc�-333 DESCRIPTIONOFWORK/USEOFBLDG. �nn�'+%� ��/��'�� AP #
Address � n�� %Z+�olZ
y7� ���—/--L---
Arch/En9. /S-�N /�_ey-�r�'-'/.Sl*f License No. r-� S� �y
Address Zi,/% e../ �1R/%�� �,�p �d �, a� OQA�
Contractor's NamP�Ql��c/IT-1�2��y Phone G Cn- 6/Y
Addreulmailing) 'j!�/,� �e'�' /7fC S"T. �lf� L�7G7_
CiryLicenseNo. Q�Z�-c
LICENSED CONTRACTOR DECIARATION
1 hereby affirm that I am licensed untler provisions of Charter 9(commencing
with section 7000) of Division 3 of the Business antl Professions Cotle, antl
my license is in tu�J fprce ana effect. �� 3/ y�
nLicense Class F�/ .�7" ��icense
] Date��n�'����� Si9nature_��{�,(C'�� �`1.i--
�D 'V00.KE0.5'COMPENSATION DECLARATION I
�ereby attirm [na[ I bave a certiticate ot con5ent [O self-insure or d c¢rtiticdte
� : Workers' Compensation Insu�ance, o� a certifletl copy inereot (Section
\3800, Lab. C.)
Policy No.�e_�1 3.�_� Company s%l%"%�cT ��f�
' eCertifietl copy is hereby furnishetl.
CerYfietl coOY I5 filetl wi[h the cify Builtling Div�on� /- �
Date/��'�e '�6 AOPiicant jf /?a•n_ i•�ra.:
EXEMPTION FROM WORKERS' COMPENSATION OECLARATI
(This section neetl not be compleletl it tne Oermit is tor one buntl�etl (5100) o�
iess).
I certify iha[ In the perfo�mance ot tne wo�k to� which this pe�m�l is Issuetl, I
snall not employ any person in any manner so as to become subject to Ihe
Workers' Compensatlon Laws Of CalifOrnla.
Date Si9nature �
NOTICE: If, after making this tleclaratlon, you shoWa become sueject to the
Workers' Compensation provisions of tM1e Labor Cotle, you must tortnwitb
comO�Y w�th such p�ovisions o� thi5 permi[ Shall be tleGm¢tl revoketl.
CONSTRUCTION LENDING AGENCV� -
I hereby alfirm tnat there is a construction leneing a9ency for the pertormance
ol the work for whicN this permit is`issuetl (Sectlo�309T Civ. C.)
Lentler's Name.
Lentler'S Atltlress
OWNER BUILDER OECLQ�RATION �
I herCby afflrm that I am exempt frOm the ConVactor'S Llc2nse Law �for th¢
following reasOn (Seclion', ]031.5 Bu5ina5s antl Profeszional Cotle: Any tlty or
county whlcn requires a permit to construct, aiter, Improve, tlemolish or rapair
any structure, prlor to Its issuance, also requlres the applicant tor sucn permit
t0 flle a signetl ztatement� thdt he/Slle Is Ilcen58tl pur5udnt to the ploviSiOns Ot
'he Contractor's �icense Law (Cnapter 9(commencin9 with Section 7000) ot
ivision 3 0( lhe Busine55 antl Profe55iOn5 Cotl¢) o� that he/she 75 ¢xempt
,e�efrom dntl tne ba5iz 70/ the allegetl exemptlon. Any vfoldtion of Section
� 031.5 by any applicant for a Permit subjects [he applicant to a tivil
, eenalty of not more than flve huntlretl tlollars (E500). /
L.1 I,�as owner of the property or my employees with wagas as their sole
cOTpensation, will tlo th¢ wOfk, antl the slfucture i5 nOt int¢ntletl of offeletl
for 5ale (Se<tlon ']044, Business antl Professional Cotle: The Con[ractor's
. LiGense Law tlOes not dppty [o an own¢r ot a p�operty who builAs o� Im0/ove5
lhereon, antl wM10 tloes such wo�k himself/h¢rs¢If or tM1rough M1is or her own
employces, provitletl tM1ai sLch improvem¢nts a�e not inte0tletl or ottered fa�
Sale. It, however, [M1e bulltlin9 or imp�ovement I5 soltl wfthin one year ol rom-
� pletlon„tne ownor will hdve the bu�tlen of proving he/she Uitl not builtl or IT-
prova torihe ourvose of sale).
❑ I, as owner of the properiy, am exclusively conVacting with Ilcensetl con-
. Vactorsto constru<t tne o�oiect ISection ]044, Businezs antl Professions Cotle:
The Contractor's License law does not apply to an owner ol p�o0erty who
builtls or improvez thereon, ana wno contracts far such projects with a con-
'tractor(sI Ilcense oursuant to the Contractor's License Law). I am aware that
� proof o( their Wo�ker'S Compensafion insurance Shoultl be providetl to me.
❑ I am exempt untl¢� $eclion B. & P. C. fo� this reason
Date "
I h¢reby certify [hat i
iniormation is correct.
antl state laws relafin9
Sentatives of lhis city
inspection ur es �
Signature '�
Orivers' License r 55 3
Owner
have reatl this application antl state that tne above
agree to comO�Y w�[h all tlry antl county ortlinances
o buptlin9 conslruclion, antl hereby authorize repre-
[O en[� abOve-mentionetl P�oOarty �or
r
Date l�� C ��
_
,f� — n�y- 'I ,�,� RT S Main Buildi
E
TVPE OF PERMIT GaaDirvG FOUrvDAriON SraVCTU A� T Front
� ❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MEGHANICAL B Rear
❑ OTHER %�
PROJECTDESCRIPTION $Q.�FTj� �y�� 7-_._OCCUPANGV �J—� K Right
CONSTRUCTIONTVPE i VALUATIONS� $ Left
20NE. GRADING CV. VDS. ACRES Ping. Ref. #
aemar .,. �. �--yy � � Planning Notes:
Sink
Preventer
Irrigation
Dishwasher
Drinking Fountains
Ploor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories '
P-Trep '
Roof Drains
Reinspection Fee � $15
Boiler -
Duc[-Under.Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heatin9 System & Duceing
❑ 0-100,000 BTU � 100,000 6T�
Reinspec[ion Fee � $15
1F 0865-46, rev. 30/84 White - BUlltling; Canary - APPlicant; Pink - Accountin9; Goltlenrotl - Assesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
$olar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Re(rigeration Sys[em
❑o-ioo,000sru ❑ioo,000
System Repair/Alteration
Fire Dampers .
Registers
laue Fee
$ 3
$ 3
Auromatic Washer .
Construction Pole Sub.
Cooking Unit
Dishwasher ' '
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
�evice Boxes '
Outlets �
Switches
Garbage Disposal
Generetor �b5 KW O5-�
5545 10/20/86
zona
Accessory Building:,
Parking Req./Provided
ELECTRICAL '
Transformer ❑ 15-50 KW
❑ 50+KW
. Meter ❑up ro 100 amps �
Meter �over 100 amps
Sub Panel
Motors �0-t HP 01 X- 8
Inc.Solar 09-15 HP �16-15+
Pole Light
Fange
Si9n
Stending Sections
5 KW . Trash Compactor
� Reinspection Fee � �$15 � � luue Fee
DEVELOPMENT SERVICES REQUIFiEMENTS:
Zoning Approved By
BuildinB APP�oved By �
Appliwtion Issued By
13.00 TL
FEES
$ 3
2
O
N
1
N
G
R
E
Q
M
T
S
, . SUMMARV OF FEES . � '
BUILDINGPERMIT $ SMIP $
PLAN CHECK • $ �/y-��— PEFiM1T
PLUMBING . $ •�"=. ISSUANCE '- $
PLAN CHECK 25% $� OO � ENERGV P.C. $
ELECTRICAL $ GRADING $
PWNCHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ �'3, 08
PLAN CHECK 25% $ ' '
CONSTRUCTION AND PLANNING � POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. f 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. e �l ,� 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
i t. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
7 3. Roof Drains 64. Plumbing System - Final
74. Rough Plumbing �� x{�! g� .�' 65. Electrica6Final
15. Rough Electrical-Conduit 66. Solar System�Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. 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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil �
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe •
28. �athing & 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:
y� .% a-,
34. Final Heating & Air Conditioning , ,jf�
35. Final Gas Pipe-Test ' •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing ����7J � '
39-. Water Service-Final �
40. Gas Service-Final �� 1�/� •
41. Solar pomestic-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 • � ' �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
.lob Address: 282 DEL MAR AV
Suite: C
Vicinity: NEW SFR WITH ATTACHED GARAGE
Farce� Number: 43920123
Applicant: ENGLERT, RAY
Address: 2165 S GRAND AVE
SANTA ANA, CA
owner: HABITAT FOR HUMANITY
Address 2165 S GRAND AVE
SANTA ANA, CA
Contractor. OWN ER-BU I LDE R
Address:
Zip:
Arch :
Address:
Zip:
Zoning:
Phone: (714)434-6200
Zip: 92705 �
Phone: (714) 434E200
Zip: 92705
Phone:
� License: 0
Eng:
Address:
Phone:
License:
Status: ISSUED
Applied: 10/04/2000
Issued: 06/05/2001
ISSUED BY:
_ Phone:
License:
� '� . SCOPE OF PERMIT_ ' �
CONSTRUCT NEW (772SF 1ST FLOOR�, 728SF 2ND�FLOOR) -1500 SQ FT (5'BEDROOM/2 BATH) SINGLE FAMILY
RESIDENCE, WITH 403 SQ FT ATTACHED GARAGE & 135 SQ FT FRONT PORCH FOR "HABITAT FOR HUMANITY" (UNIT �
C)� . � �
REF: DR00-19 � — � - ' --- � - - . - ,
. .. . .__ .'. _ " i. _ .. , .
� � FEE SUMMARY�� %'- �� �
Plan Check: $791.54 - - , - Calc Valuation: �:)/ , � . 8iss,ass.�o
Permit: $1,217.75 Claim Valuation:�i ;. ' i� S,o.00
SMIP Res: - $13.95 ` - :;�'% �
SMIF Com: $0.00, "' � �' ' � �
Other: � ' $0.00 � � � `, _ �� �
� _ ;'
Inspection: $0.00�,���- _ . - ,� � � - '; � � .
��� i ^ A �`� ` ; . „ �� ; ' j" />� j�� i =
Total:�� $2;023.24 � �-� � � � ;:� < , ,� � 'i
� � ,', ; ' �- ��. _ � c =.i; �, �� � "• � � ���
_ �.;� �
r--
�` ' � PLANNINC3 & ZONING. -, �`'�• � v / _,�
SETBACKS �� � .� _� �-� - ; / � , �. A� �' � /,,'�
MAINSTRUCTURE Front 20-0���.,, �Rear 10=0 � Left ��10-�0- �}�.-�� Right%�10=0
� �..>�-.. �:; .A�.'-;� i, `= �����
ACCESSORY Front 0-0 ��Rear��0-0� . _ Left_ . A-0�;;�-5�=�� Right 0.0
__ _ - ._..i!%` - -
PARKING Existin : 0 Reauired: 10 � - Pr000sed: 10
NOTES:
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 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl��
required inspeetlons 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
2446-46IN00)
WORKERS' COMPENSATION DECLARATION: '
I hereby attirm untler penalry of perjury ona ot the following tleclaratlons:
❑ I have end will maintain e cenificate of consent b self-Insure for workers' co�ensation, as provitled tor by section 3700 of the Lebor Code, br the peAortnance of ihe
work for which Nis permit Is IuueE. •
❑ I �ave an0 wN maintain workers' compensaGon insu2nce, as requirad by section 3700 of the Labor Code, for ihe peAortnance ol t�e work for which Ihis permit is issued.
My workers' compensation Insurence cerder entl policy number ara:
Carrier. Policy iJumber:
(Tbis sectlon need nof be comp/eted i/ the permif Is va/ued e( one hundred ddlars ($100) or less.)
❑ I certity that in the peAortnance ot Na work for which this permit is issued, I shall not employ any person in any manner so es to become sublact to Ihe workars'
compensalion laws of Califomia, end egree that II I shoultl become subject to Ihe workers' compensation provision5 of Saction 3700 ot the LeDor Cotle, I shell fort�with
compty with these provisions.
Applicant Signature: Date:
WAHNING: FAILURE TO SEWRE WORKERS' OOMPENSATION COVEPAGE IS UNIAW FUL AND SHALL SUBIEGT AN EMPLOVER TO CFIMINAL PENALTIES AND CIVI� FlNES UP TO ONE HUNDREO
TFKKISAND OOIURE (5100,000), IN A�DfTION TO THE COST OF WMPENSATIIXJ, DMIAGES AS PROVIDED FOR IN SECTIIXJ 3]O60F THE IABOR CODE, IMEREST, ANO ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm Ihat I em licensed under provisions ol Chapter 9(commencing with Section 7000) of Division 3 of iha Business antl Professions Code, and my license is in full
torce and eftecl Ua a Class u
ContradoYs Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirtn Ihat there is e construction lending agency for the peAormance of the work for which this permit is issuetl. (Sec. 3097, Civil Code).
Lenders Name: � Lender's Address:
Signature: Date:
OWNER-BUILUER DECLARATIONS:
I hereby eflirtn thal unCer penalry of per�ury lhet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business entl Professions
Code: Any city or counry which requires a pertnit to construct, alter, improve, demolis�, or repair any sirucNre, pdor �o it5 Issuance, elso requires the epplicant tor such permit
to tile e signetl statement thet he or she Is Iicensed pursuam to the provisions of the Contredors License Lew (Chapier 9(crommencing wIN Sectlon 7000) of Dlvision 3 of ihe
Business end Prolessions Code) or that he or she is exempt therefrom and the basis tor the allegetl exemption. My violatian ot Section 7031.5 by any epplicant for e permit
subje he applicant Io e civil penalty of not mOre ihan tive hundred dollar5 ($500).):
. I,.as owner of the properry, or my employees with weges as Iheir sole compensation, WILL DO THE WORK, antl the structure is not intended or oHeretl tor sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does not apply �o an owner of property who builtls or improves �hereon, and who does such work
himsetl or hersetl or through his or her own employees, providatl that such improvements are not intended or oNered br sele. If, however, tha builtling or impmvament is
sdd within one year at completion, Iha owner-builder will have the burden oi proving ihat he or she did not build or improve lor purpose ol sale.).
❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Protessions
Code: The wniraaors License w tloes not appty �o en owner ot pmperty who builds or improves thereon, and who contracts for such pmjec� with a contrector(s)
licen5e pur@yarkto-thaFon r5 License Laws.).
�
Owner ID ver�fied by
Verificelion of Ownei
Businett and Pmfe�sinn� CMw fnr thic reasnn�
EG�ens9�� 0 Yes ❑ No
(rype of umenL i.e. - property ta: bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby certity that no excevetion five (5) or more feet in depih into which a pereon is required to descend, will 6e ma0e In connection with work euthonzetl by this
permit, and that no builtling structure, swNolding, talsework, or demolition or dismantling thereof, will be more than thirry-six (36) teet hig�. (Chap. 32, Grp 2, Ar12, Sec.
341, 71t1e B, Califomia Atlminisirative Cotle).
❑ As owner-bulltler, I will not employ enyone to do work which would require a permit (rom the Division of Indusirial Sefety, as noted ebove, unless such person hes a
permit to do such work from the division.
SignaWre: Date:
Division ot Industrial Safery Pertnit Number:
CER71FlCAiE OF COMPLIAN D AUTHORI N OF ENiAY: I certify under penalry of perjury that I have read this application end state that the informetion given is
correct. I agree � y wi�h all state ws tl'1 ortlinances relating ro builtling constmction, and au�horiza representatives of Ihe Ciry of Costa Mesa to enter upon the
above-descri ed property 4 inspecC ary gree not to occu w allow occupancy of any building authorized by this parmit until finel ins ction.
V
- --- �o-.= /
ignat e al _(s) , Date_ �_ � �
� � �.� —_ ---�s
Antl/ r Authonzed A icant Date
COOE I. INSPEGTIONTYPE
1676 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
207 Final BIocWRetaining well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
jI�F IMRIRL
COOEI INSPECTONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Octupancy
Q� INTITIALS
�Gi J� ..�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
282 DEL MAR AV
TEMPOR4RY POWER POLE
43920122
ENGLERT,RAY
Address: 2165 S GR4ND AVE .
SANTA ANA, CA
Owner: HABITAT FOR HUMANITY
Address 2165 S GR4ND AVE
SANTA ANA, CA
Contrecror.
Address:
OWNER-BUILDER
Phone: (714)434-6200
Zip: 92705 -
Phone: (714) 434-6200
Zip: 92705
Phone:
Zip:
License: 0
ISSUED BY:
Status: I SSU ED
Applied: 06/O5/2001
Issued: O6/05/2001
" ' : .SCOPE OF PERMIT �` -
INSTALL TEMPORARY POWER POLE�FOR NEW�3-UNIT DEVELOPMENT.FOR "HABITAT FOR
HUMANITY". , � - - � � �-
' . . REF: B00-01590, B00-01594, & B00-01595 . , � � ,
. . - � �i>, � .. _ . ,�._ . �_.
. � --- - -- - - --- " _ ' -- - � ,� . . , ' .
- FEE SUMMARY� � � ;:,�
�,
- �Quantity ., � - , � - Quantiry",� .
ISSUE FEE $23.50 Temp DistSysterti / Lighting $0.00 �Oi � � � . � , �
Temp service test � $0.00 „�Busway /100 ft '$0.00 �%0; �
Res. a/c package' � , $0.00 -�.: � � ���, � Standing Section �$0.00 -�r%0 � � � , - � ,
New Res (1-2 units) �- ,$0.00 � 0 - � ' "" � � Misc Electrica,I,Equipment $0.00 j % 0
New Res (3+units) ; $0.00 0 _ � � � �Transtormers up l0•1 kva/kw_ $0.00%i 0 .- `� , � � �
.
Pool/Spa ' $0.00�_ i--.�O�:r �, , � � ' � -...uptotOkva/kw-=J:'-"��',$0.00� 0= "
.�:
Lighting Fixts. � � - $0.00�. 0 ` , � . . .. ..up to 50 kva/kw � $0.00 � -1 0 �
Recept Outlets� � � � ; �/ $0 00��� � ��0 <_ �� :. .. ..up to�100 kva/kw� �.� j$0.00 � j ,�0 / ',' -
Switches � � � $0 00, � � 0�: � .. � .� .. %over 100 k4a/kw"�� $0'00 �- �� 0 / �/
Non Res Appl � � , ,$O.00��S �0�,= `` � � `" ` Lovi Voltage Equipment�%''� $0 00;� � �0,�' /�
Res Appl � $0.00 �� � � 0 �' ' � Low Volt Wiring�5ystem / Ckt,( ��$0�00 � ; 0, ��-
Service to 200a � � � � $0:00 � � � 0' -, Misa Conduit ` � ` '$0.00 /, 0,�
Service to 1000a ' �$0_00 �� ! 0 � . Misc Conductor.� . ��- � � $0 00:;� , 0
Serviceover1000a ��$0.00; � 0 _ Cirws�(genorride)�,_) � .$0.00 -'� 0
Motors to 1 hp $0.00 �- �- 0 � - Circus (mech ride or lights) ;,� ;$0.00 0
Molors to 10hp $0.00 '� ' = 0 " � ��.-�Christmas Tree Stand �'', " , �$0.00 0
Motors to 50hp $0.00 ��� � 0 �-� _ Fireworks Stand„- i'-' � � $0.00 0
Motors to 100hp $0.00 0 � . � � � �Other Eleotrical Fee � $0.00
Motors over 100hp $0.00 0 � -��� � -� �
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Cirwits $0.00 0
Temp Pwr Pole $23.50 1 TOTAL CALCULATED FEES E47.00
Intermed Pole $0.00 0
COMMENTS / SPECIAL CONDITIONS
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 780 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all.
required inspeetions 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
2d46�46(fi/00) _
'�
WORKERS'COMPENSATION DECLAAAnON: — , �
I �ereDy aflirm unaer penalry of perjury one oi ihe following declaretions:
❑ I have and will maintain e certiticE�a ot consent to self-Insure for workere' compensation, es provided tor by section 3700 oi ihe Lebor Code, For ihe performance of the
work for which Ihis pertnit is issuetl.
� I have and will meinWin workers' c�Pensatlon insurenca, as reduired by SeMion 3700 of the Labor Cotle, for ihe perfortnance oi the work tor which ihis pertnit is issued.
My workers' compensatian Insurance carrier and policy number are:
Carrier: Policy irum6er
(Th(s section need nof be completed il the pertriit is valued af one bundred dollers ($100) or IessJ
❑ I certiTy t�at in the pertortnance of the work for which this pertnit is issuetl, I shall not employ any person in eny manner so es to become suDject to the workers'
compensation laws o1 Calitomia, and agree that if I should become subject to the workers' compensatlon provisions of Secilon 3700 of the Labor Cotle, I shell forthwlt�
compty with these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SEWRE WORKERS' COMPENSATION COVEMGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNORED
THOUSAND OOILRHE (E100,000�. IN AODRI(F1 iOTHE COST OF COMPENSAiION, DAMAGES AS PROVI�ED FOR IN SECTION 3)06 OFTiE LABOR CODE, INiEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLAFA710N:
I hereby affirtn that I am licensed under p�ovisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in tull
torce ena ettect. Lic. x Class x
Comrectofs SlgnaWre: Date:
CONSTRUCTION LENOING AGENCY:
❑ I hereby aNirtn ihat there is a conStruciion lending agency for ihe performance ol ihe work for which ihis pertni� is issued. (Sec. 3097, Civil Code).
Lentlers Name: Lenders Address:
SigneNre: Date:
OWNER•BUILDER DECLARATIONS:
I hereby etfirm Ihet untler penalry of peflury ihat I am EXEMPT FROM THE CONttiAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Protessions
Cotle: My ciry or counry which requireS e pertnit to wnsiruct, alter, improve, demolish, or repair any strucWre, prior to its issuanca, also requires the applicant tor such parmit
to file a signed statement that he or shd Is Iicensed pursuent to Ihe provisions of the Cantrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Professions Code) or thet he or she is eaempt therefrom and ihe besis for the allagetl exemption. Any violation ot Saction 7031.5 by any epplicent for a pertnit
ub' e flpplicant to a civil penalry P� �ot more than five hundretl tlollars (5500).):
_=1,—es owner ot �he property, or my employees with wa9es as their sole wmpensation, WILL DO 7HE WORK, antl the sirucWre is not intendetl or oflered for sale (Sac.
7044?Busineu antl Professions C�e: The Contrectors License Law dces not apply ro an owner of properry who builds or improves thereon, an0 who does such work
himseH or herseN or Ihrough his or her own employees, provided ihat such improvements are not intendetl or oNered for sale. If, however, the building or improvement is
sold within one year of completion. the owner-builtler will have t�e burden of proving that he or s�e did not builtl or improve for purposa of sale.).
❑ I, as owner of Ihe property. am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 704d, Business and Protessions
Code: 7Te w nsa s not apply to en awner ol property who bullds or improves thereon, and who contrects for such prolect with a contractor(s)
licensgp uant ro ih onirec� icense Laws.). �
antl Professions Code forthis reason:
by
ves ❑ No
Vetltication of Ownership by (rype of document, i.e. - properry tex bill or
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify thet no exwvation fWe (5) or more feet in Cepih inio which e person is requiretl to descand, will be made in connectio� with work authorizetl by this
permit, and that no Duilding structure, scaHoltling, falsework, or demolition or dismantling thereot, will be more than ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia ACminisiral�e CoOe).
❑ As owner-bullder, I will not empl0y anyone to do work which would require a pertnit from t�e Division ol Industnal Safery, es noted above, unless such person has e
permit ta tlo such wark irom Ihe division.
Signawre: Date:
Division of Indusirial Safery Permit Number:
CEHTIFlCATE OF COMPLIANCE AND A�O IZA710N OF ENTAY: I certify under penalty of perjury that I have read this application and state that t�e infortnation given is
correct. I�at w� mly�oi all state la G ciry orCinances relating to builtling construction, and authorize representatives of the Ciry of Costa Mesa to enter upon the
ebove-d scnbed prop y for � specf ecs. I agree not to o� py or allow occupancy of any building authonzed by ihis pertnit until final inspection.
Si et f � viner(s) � � �- — � � �� D�/ j
� I -_.r"i"�`�
:1�
nd/OrA��hanze Applicant Data
GOOE I, INSPECf10NTYPE
7616 Fixed System Final Fire Preve��ion
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
zoz
203
204
Final Faclory Fire Poace
Final Sign
Finel Demolili0n
o"re INRfIRL
OE I INSPELTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Finat Planninq Apprwal
222 Final Si�e
250 Final Builtling/Occupancy
Q�7F INTffIALS
/_� �
Job Address: 282 DEL MAR AV
Suite:
Vicinity:
Parcel Nunmber: 43920122
Applicant: ENGLERT, RAY
Address: 2165 S GRAND AVE
SANTA ANA, CA
Owner: HABITAT FOR HUMANITY
Address 2165 S GRAND AVE
SANTA ANA, CA
Contractor: OWNER-BUI LDER
Address:
Zip: .
Eng : GALL, ANDREW
Address: 15101 RED HILL AVE
GRADING PERMIT
Zoning:
Phone: (714) 434-6200
Zip: 92705 � �
Phone: (714) 434-6200
Zip: 92705
Phone:
License: 0
Phone: (714)259-7900
Slatus: ISSUED
Applied: OB/07/2000
Issued: O6/05/2001
ISSUED BY:
TUSTIN, CA '
Zip: � 92780 - License: C20259 - - .
.-. - �� -� � ti . , - . , � - .
_ ' ` -SCOPEOF PERMIT �
_ ;
CUBIC YARDS GRADING FOR 3 NEW SINGLE FAMILY RESIDENCES FOR "HABITAT FOR HUMANITY". '
1379 � , � - � " � '
. _ . �_ - _ , i ,
Plan Check:
Permit:
Other
I nspection:
Total
NOTES:
$44.00
$0.00
$209.00
$0.00
$0.00
$0.00
$0.00 - �- �-
\
� ; a253:00���.���
� ,- � �
, ,�,
FEE.SUMMARY � �--�- -- ',�� " � ,1 ' �
�' , Calc Valuation:i,,: so.00_
� -. i.,' � � .
� _ �,
. ��
-. t.. -
«< .. j r
� �. � ;i
` ' . ',> s /�� �. . � .
� �
_ . " _ .�/� . " 'i
�'ii� i / � - , , , _
` � c''/� ��. ��/ � j
�
__`�ti_ � . �� � : ,. �!% � �A�i��� /U
NNWG:& ZONING� � Cl,�; ;��'; `� ,�
-- -� \ V i i�,
� . - l .
� // �
� �. � — ��ii;.(:
- `�,-
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit�
FOR INSPECTIONS CALL: (714) 7545626 ���
2446�4fi(6/00)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm untler penalry of Oerjury one oi the following declarations:
❑ I heve and will mainiain e certiticete ot consent ro self-Insure for workers' compenpalioc,�es.�yovided for by section 3700 ot the Labor Code, tor ihe peAortnance of Ihe
work for which Ihis permit Is 155ued.
❑ I have arM will maintain workers' compensafion insurance, as required 6y section 3700 of the Labor Cade, tor Ne pertortnance of the work tor which this permil is issued.
My workers' compensation Insurance carrier and policy number are:
Cerrier Policy Number:
(This secfion need nof be comp/eted i! the permit is valuetl ef one hundred dollers ($f 00) o� Iess.J
❑ I cenity ihat in the peRormance of Ne work for which this pertnit is issued, I shall not employ any person in any menner so as to bacome subject to the workere'
compensatlon lews of Caltlomla, end agree that tl I ahould become subject to the workers' compensation provisions of Section 3700 oi the Labor Coda, I shall forihwlth
compty wiU Ihesa provisions.
Applicant Slqnature: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UMAWFUL M!D SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALilES AND GVIL FlNES UP TOONE HUNDRED
hKK1SAND DOLIARE (E100.000). IN ADDRIIXJ TO iHE COST OF IXNAPENSATION, DAMAGES AS PROVIDED FOR M SECTION 3106 OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSEO CONTRACTORS DECLARATION:
I hereby affirtn that 1 am licensetl under provisions of C�apter 9(commencing with Section 7000) of Division 3 ot t�e Business antl Professions Cotle, and my license is in tull
brce an0 eNect. lk. M qass #
Coniractofs Signeture: Date:
CONSTRUCTION LENDING AGENCV:
� I hereby ettirm that there is e construction lending agency for the performance of ihe work for which this permit is issuetl. (Sec. 3097, Civil Code).
Lendefs Nflme: Lenders Atldress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirtn thet under penalry ol perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW far the tollowing reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry which repuires a permit to consirucL alter, improve, demolish, or repair eny sWcture, pnor to its Issuance, also requires the applicant for such permit
to file a signed slatement Ihat he or ahe Is IlcenseC pursuent to the provislons of the Comractors License Lew (Chapter 9(commencing with Sectlon 7000) ot Dlvislon 3 of Ihe
Business entl Proleulons Code) or that he or she is ezempt therefrom antl tha Cesis for Ihe elleged exempiion. Any violation of Section 7031.5 by any applicant for e pertnil
subl e epplicant to a civil penalry ol not more than tive hundred dollare ($500).):
"'I,-as owner ot the property, or my employees with wages as t�eir sole compensation, WILL DO 7HE WORK, and the sWcture is not intended or oHered for sale (Sec.
r.704'4, Buslneu antl Professions CoOe: The Con�rectors License Law Ooes not apply to an owner of properry who bUiltls or improves ihereon, antl who does such work
himseN or hersalf or ihrough his or her own emD�aYees, provided ihat such improvements are not intended or oHered lor sale. If, 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 build or improve for purpose of sale.).
❑ I, as owner of the pro erty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pmtessions
Code�. Th� ors cens w does not apply to en owner of pmperty who builds or improves ihereon, antl who contracts for such pmjact with a contrecbr(s)
liceysepursuan eCon LicenseLaws.).�
Owner ID v6niietl by dn�ers licbrrs4
Veritiwtion oi Ownership by (type of
an0 Professions Code for this reason:
❑ Ves ❑ No
i.e. - properry tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATON:
❑ I hereby certity ihat no eacavation five (5) or more teet in depth into which a person is required to descen4 will De mede in connection with work euthorized by this
pertnit, and that no building siructure, scalfolding, telsework, or demolition or dismantling ihereol, will he more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Adminlsiretive Code). �
❑ As owner-builtler, I will not employ anyone to do work which would require a permit from the Division of Indusiriel Sefety, as notad above, unless such person has a
permit ta do such work from the division.
Signature: Date:
Division oi IntlusMal Safery Permit Number.
CERTIFlCA PLIANCE A OR2A710N OF EMAY: I cenity under penalry of peryury ihat 1 have read this flppliwtion and state t�at the intormation given is
wrre gree to com ly wit II and ciry ortli ances relating to building construction, end authorize representatives ot ihe City of Costa Mesa to enter upon ihe
ve-Cescribed prop ion pury ses. I a e eFlo-occupy or allow occupancy ol eny building authorized by ihis pertni until iinal inspecGon.
� _ __.__ .� � - ,j- o /
r t t.LegalOwner(s)�' Date
t�
CQOE 1, INSGECTIONTYPE
1616 Fixetl System Final Pire Prevention
1266 Pool Spa Finel
200 Finel Re-Rooi
201 Final BIocWReWining Well
202 Final Factory Fire Place
203 Finel Sign
204 Finel Demolition
Pdff UiIIDELi
CODE I INSPECTION TYPE
20fi Final Mechanical
20B Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
B�iE 1[�4$
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626
Job Address: 282 DEL MAR AV
Suite No C
Vicinity:
Parcel Nunmber: 43920123
Applicant: ENGLERT, RAY
Address: 2165 S GRAND AVE
SANTA ANA, CA
Owner: HABITAT FOR HUMANITY
Address 2165 S GRAND AVE
SANTA ANA, CA
Contractor: OWN ER-BU I LDER
Address:
Arch / Eng :
Address:
PLUMBING PERMIT
Phone: (774) 434�200
Zip: 92705
Phone: (714)434-6200
Zip: 92705
Phone:
Zip:
, License: 0 ,
' ..,. _. . . . � -� ._. . _
_ r 1;,..�._ .. _... ._.
Status: ISSUED
Applied: O6/OS/2001
Issued: 06/05/2001
ISSUED BY:
� . Phone: - - �
� ��
--' - -�ZiP� -- --- - ;��i �= - - .
_ <. _. __,
License:
' PCUMBING PERMIT FOR NEW SI
� HUMANITY" (UNIT C). INSTALL 2
� � WASHER 1 KITCHEN SINK 2 Wi
SEWER-LINE & 1 WATER SERVII
REF:B00-01595 �� " . _ �'
� �� �
�F PERMIT ' �
Y RESIDENCE 8 ATTACHED GARAGE FOR"
R COMBOS, 4 GAS OUTLETS, 1 GAS SERVI(
2 WATER CLOSETS, 1 WATER HEATER,-1 P
� !%%
.> . - � . �ci � - „--'.=., i, �
� - ��,�,
l / �
� � ��" _ _ � - '� •
�;
I� , 1 � '
�BITAT FOR i ',�,� � �
�1,.
VATE" . ,
� '
\ .,�, � \ � ��,c� FEE-SUMMARY'', ��i� �i�_`�G� /ij
�,
� : AAMT� i� QTY . �'-,� ` '_•.: , � � , .. . AMT '�,QTY�� /�1�.��� �%" �'�
ISSUE FEE V� $23 50- � � � , Laundry Tub / Washer �- $9 80 � "1 �,�.A Sump Pump� �
BackFlow irrigalion ' �$0.00 � 0 - �/ ' � Landscape Irrigation " $0.00 , 0 ,;� �, ` Swirr�ming Pool �
BackFlow Preventer $0.00� . , 0 � " � " P-Tiap� ' - �$0.00,-.'. 0�. � � � "Trap Primer'
Bathtub $19.60� � '2�� , � Pressure Regulator � � - $0.00 �0 -- -Urinal --
Clarifier System $0.00 �' 0���, ProcesS�Piping (per 10 ft)- $0,00 - 0� "o%Vacuum 8rkr Bkflow(1-4)
Connect (Ice,Soda,etc) $0.00 0 - Receptors - � � $0.00 . 0 , . ' Vacuum Brkr Bkflow(5+)
Dental Units $0.00 0 Septio Tank �, , -'$0.00 ��"0� .� Wash Basin
Dishwasher $0.00 0 Sewer Cap for Demo _-. �$0.00� 0 Wash Basin Set
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System
Drein, Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet (Toilet)
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater / vent
Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.)
Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service
Gas (1-4 outlets) $6.15 1 Sink, kitchen $9.80 1 Water Softener
Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER
Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION
Gas Service $9.80 1 Spa (public) $0.00 0 PLAN CHECK
Interceptors (Grease, Oil) $0.00 0 REINSPECTION
Interceptors (Sand Auto ) $0.00 0
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$19.60
$0.00
$0.00
$19.60
$12.30
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
0
0
0
0
0
0
2
0
0
2
1
0
0
1
0
C
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
� � COMMENTS I SPECIAL CONDITIONS
EXPIRATION: This permit shall automatically expire an ecome voi i wor is no commence wi in 180 days, or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal. such work must comply with all applicable codes� and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will resufl in the expiration of this p_ ermit/
C /
FOR INSPECTIONS CALL: (714) 7545626 � �/
244&-08(&00)
WORKERS'COMPENSAnON DELLARAnON: � �
I hereby eMirm under penalry oi perjury one of the following declerations: �
❑ I have end will mainleln e certilicate of consent to selt-Insure for workers' compensation, as pravidad for 6y section 3700 of the Labor Code, for the pertormance of ihe
work tor whiCh lhis permll is I55uBC.
❑ 1 have end will maintain workers' compensatlon insurance, as raquiretl by seclion 3700 of the Labor Code, for the peAormance ol the work tor which this pefmit is issueG.
My workers' compenution Insurance wrrier and polity number are:
Carrier: Policy rvumber:�
(This secNon nee0 not be cnmpletetl i! fhe permit is valued et one huntlretl tlollars ($ f00) or less.)
❑ I certity that in the peAormance of the work for which this pertnit is issued, I shell not employ any person in eny manner so as to 6ecome subject to the workers'
compensation laws of Callfomla, end egree thet If I should become sub�ect to the workers' compensation provislons of Saction 3700 ot Ihe Labor Code, I shall torthwith
wmply with these provisions.
Applicant Signeture: Date:
WARNIN(i: FAILURE TO SECURE WORKERS' COMPENSATION C1�VERAGE IS UNLAW FUL ANU SW1LL SUBJECT AN EMPLOYER TO CflIMINAL PENALTIES AND CML FINES UP TO ONE NUNDFiED
T/10USAND DOLLARE (5100,OW), IN FODITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIOED FOR IN SECTION 31080F THE IABOR CODE, ItJrEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS OECLARATION:
I �ereby aHirtn that I am licensed under provisions of Chapter 9(commencing wilh Saction 7000) ot Division 3 0l ihe Business and Protessions Code, and my license is in full
larce and ettect. Lia A Class N
Contrectafs Signawre: Dete:
CONSTRUCTION LENDING AGENCY:
.❑ I hereby aNirm that Ihere is e wnsirudion lending agency for the peAortnance ot t�e work For which this pertnit is issued. (Sec. 3097, Civil Code).
I, Lentlefs Name: Lendefs Address:
I, Signeture: Date:
OWNER•BUILDER DECLARATIONS:
I hereby effirtn ihat untler penalry ot perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Code: Any dry or counry which requires a pertnit to wnstrud, alter, improve, tlemolish, or repair any sWCNre, pnor to its issuance, elso requires ihe applicani for such pertnit
to file e signed stetement Ihet he or she is licensed OursuaN to Ihe provisions of Ihe Gomrectors License Lew (Chaptar 9(commenGng with Section 7000) oi Dlvislon 3 ot the
Business end Professions Cotle) or that he or sha is exempt iheretrom antl the basis for ihe alleged ememption. Any violation ai Section 7031.5 by any applicant for e permit
,-�subl the epplicant to a civil penalry of not more than tive huntlrad dollars ($500).):
as�owner of ihe pro0erty, or my employees wiih weges as �heir sole compensation, WILL DO THE WORK, and ihe structure Is not imentled or ottered tor sale (Sec.
,,,,_7044; Business antl Professlons Code: The Contractors License Law does not epply to an owner of property who builds or improves thereon, and who does such work
himself or herselt or th�ough his or her own employees, Drovided Ihat such improvements are not intended or oHeretl for sale. If, however, ihe building or improvement is
sold within one year ot completion, ihe owner-builder wiil heve ihe burden ol proving ihat he or she did not build or improve for purpose of sele.).
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business and Professlons
Code: The contractors Llcense Law tloes not apply to en owner of propeny who builds or improves t�ereon, and who wntracts lor such projact with a contrector(s)
license pursuant to Ihe CoNractors Licensa LewsJ.
Business antl Pmfessions Code for ihis reason:
�Owner ID venYl¢Uby driver lice}is�� � 0 Ves ❑ No !-
�
Vediicatlon of Ownership (type oi tlocument, i.a. - propeRy Ia: bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION:
❑ I hereby cenify Ihet no excavetion five (5) or more feet in depih into which e person is required to descend, will be made in connec�ion with work authorized 6y �his
permit, and that no building siructure, scattolding, falsework, or demolition or dismanUing thereof, will be more than Ihirry-six (36) tee� high. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle B, Calitomla Administrative Code).
❑ As owner-huildar, I will not employ anyone to do work which woultl require e permit from Ihe Division oi Indusirial Safety, as noted above, unless such person has a
permit to do such work irom ihe division.
SigneWre: Date:
Division ot Industrial Sefary Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AIJTHORVA710N OF ENfTiY: I cenify under penalty of perjury that I have read this application and state Ihat t�e information given is
correcL I egree to wm ate laws ciry ordinances re ating to builtling construction, and authorize representatives of t�e Ciry of Costa Mesa to enter upon the
above-desc _ rope y for ins u ion pu �e5. I egre ot to py-er311ow occupancy of any building euthonzed by this pertn/it/�until fin`^al insp�e}ction.
(f� - U=i/ /1
Si� reAtLegalO r(s) �Date--
And/Or Authonzetl Applicant Date
CODE �. INSPECTIONTYPE Q�j� IMIiIRLS
1616 Fixed System Final Fire Prevention
1286
200
201
202
203
Pool Spa Final
Final Re-Root
Final BIocWRetaining Well
Final Factory Fire Placa
Final Sign
204 Final Demolitian
COOE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�
�'�
JU�
�
Job Address: 282 DEL MAR AV
Suite No C
Vicinity: UNIT C
Parcel Number: 43920123
Applicant: ENGLERT, RAY
Address: 2165 S GRAND AVE
. SANTA ANA, CA
owner: HABITAT FOR HUMANITY
Address: 2165 S GRAND AVE
SANTA ANA, CA
contractor: OWNER-BUI LDER
Address:
MECHANICAL PERMIT
Phone: (714)434-6200
Zip: 92705
Phone: (714) 434-6200
Zip: 92705
Phone:
Zip:
License: 0
Status: ISSUED
Applied: O6/05/2007
Issued: O6/05/2001
ISSUED BY:
SCOPE OF PERMIT
MECHANICAL PERMIT,FOR NEW SINGLE FAMILY RESIDENCE & ATfACHED GARAGE FOR �
"HABITAT FOR HUMANITY" (UNIT C). INSTALL 1 FAU, �1_GASPIBING, & 3.VENT FANS.
REF: B00-01595 `, � . � - � - .. - . .. � ' .'
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >700 k BTU -
Repair / Alt Cooling/Heat ° �
Inst / Rep. Recess Wall Htr
Refrig Sys <100.k BTU �
Refrig Sys >100 k BTU , ,
Gas Piping
Facto Fre lace
� � _- _.FEE SUMMARY � . :_
QuantiTy -. - ; - - ' Qu�antity
i
$23.50 Repair/AltAbsorbtionUnit � � $0.00 0
$14.80 1 Repair / Alt Refrigeration Unit .�$0.00 "0 1�
$0.00 0 Venlillation System ��� "' -$0.00 . 0 �.�
$0.00 0 Evaporative Cooler ���� / -�$0.00�, 0 � �
�>,i,
$0.00 0 '- � �� = Commercial Incinerator , . ,, '_ $0.00� 0 � :
$0.00 0 ��'" �.� � �Domesticlndnerator ,��;`% �$0.00 ;'.0 �
�� �� $0.00 0 �
� �56.15 .. 1 . � .
ry i p � ,$0.00 - 0 �: �
Hood w/Mech Exhausl , �;�- �$0 00� 0"
VAVBox - ;� ,'/ �� $000 0�_
Vent Fan / Single Duct:� � r �$21 75 3 "ti �
Appliance � � �
Fire Dampers .
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 10000cfm
Air Handlers > 10000cfm
Floor Furnace
Floor or Suspend Heater
��' i $0 00 0 � �',
� $0.00� � � 0 ..
� $0,00� �0. � - .
' � $0.00�, 0 �
�- $0.00 0 �� ,
�$0.00�� �0. .
$0.00 _ 0 , ,
$0.00 0 .' `
� Conipressors / Absorplion Systems ,i i
, ""sUpto3hp7100;kBTU.�_ . %',� � �. $0.00 �0
� � �- 3To15hp�/SOO�k;BTU�'�` �-;,��' ` $0.00�/ 0
� - " �= -15 To�30 hp / 1,000 k BTUj' � , �- $0.00 � 0
� ;�30 To�50 hp I 1 750_k.BTU�� �� ",�� J �$0,00 0
.. . : �Over 50 hp / Over:1;760'BTU � v � ;�, -$0.00 0
, , ' � �.Boilere. r� . ���-' /': �
� - Upto3�hp� �,�V�,-, � . $0.00 0
3 To 15 hp, , ' , �� $0.00 0
_ � 15 to�30 hp , � � � �� � _ $0.00 0
- 30to50hp_',� 'l -'i�" $0.00 0
, ,� �. Over50=hp ' .�;,sc� .� $0.00 0
- ' OlherMechanicalFee'; ��
, - - � InyestigatiomFee � � "� $0.00
- ' `�PIzn.Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES 566.20
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by ihis 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 no� commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorizetl under this permit to be consideretl legal, such work must comply with all applicable codes, and all
reqWred inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit� �
FOR INSPECTIONS CALL: (714) 7545626
zaae�as (a�oo�
WORKERS'COMPENSAnON DECIARAnON: � �
I hereby aXirtn unCer penalry of perjury one o� the following declarations:
❑ I have entl will maintain a certificate of consent to selbinsure lor workers' compensation, as provitletl for by section 3700 oi tha Le6or Code, for the pedortnance of the
work tor which this permit is issuetl.
❑ I have and will maintein workere' comp9nsation insurance, es requiretl by section 3700 of the Labor Code, for the perfortnance of the work for which this permit is issued.
My workers' compensation Insurance �ernar and policy number are: .
Cercier. Policy iJumbec
(7his secGon need nof be camp/eted il fhe permif is ve/ued et one hundred ddlars ($100) or less.)
❑� I certity that in l�e peAormance ot Iha work for which lhi5 pertnit i5 issued, I shell not employ any person in any manner so es to become subject to Ihe workers'
compensation laws of Calitomia, end agree Ihat if I should becoma subject to the workers' compensatlon provisions ot Seciion 3700 of the Lebor Cotle, I shell fonhwith
comply with t�ese provisions.
Applicant SigneNre: Date:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AN� SHALL SUBJEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND OOLLARE (E100,OW), IN ADDITION TO T11E C0.ST OF COMPENSATION, DAMAGES AS PROVIDEO WR IN SECTION 31060F THE IABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTAACTORS DECLARATION:
I hereby attirm that I em licensed under proNsions ot Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Proteuions Cotle, and my license is in full
force entl eflecL Lic. N Class a
Contractors SlgnaNre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aXirm t�at ihere is a consiruction lending agency for the perfortnance ot Ihe work br which this permit is issueA. (Sec. 3097, Civil Code).
LenCers Name: Lendefs Address:
SignaWra: Date:
OWNER-BUILDER DECLARA710NS:
I �ereby aHirtn Ihat under penalry at perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Business and Professlons
Code: My ciry or counry which requires e parmit to wnstruct, elter, improve, demolish, or repair any strucWre, prior to its issuance, elso requires the applicant for such permlt
to file e signed stetement Ihat he or she is Ilcensed Dursuant to Ihe provisions ol the Contractors License Law (Chapter 9(commencinq with Section 7000) oi Division 3 oi the
Busineu and Protesslons Cotle) or Ihat he or she is exempt Iheretrom and the basls for the allagetl exemption. Any violation of Section 7037.5 by eny aOPlicant for a pertnit
sul' _t�appllcant to a civil penalry of no� more than tive huntlretl tlollars ($500).):
I, as owner ol Ihe pmperry, or my employees wi�h wages as their sole compensation, WILL UO THE WORK, antl the sirucWre Is not intendetl or otteretl for sala (Sec.
7044, Business end Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, end who tloes such work
himself or herself or Ihrough his or her own employees, provided Ihat such improvements are not Intended or oflered tor sale. If, however, the building or improvement is
sold within one yeer ot completion, the �+'ner-builder will heve ihe burden of proving �hat he or she did not build or improve for purpose oi sale.).
❑ I, as owner of Ihe propeny, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consUuct ihe project (Sec. 7044, eusiness end Profassions
CoOe: The coniractors License Lew Otles not apply to en owner ot property who bulltls or improves Ihereon, antl who contracts for such project wlih a contraaor(s)
license pur� ihe CONractors LiGense Laws.).
sec.
R]
[I Ves ❑ No
Business and Professions Cotle for ihis reeson:
Verification of Ownership by (type of document, i.e. - pmperry tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION:
❑ I hereby cenify that no excavation five (5) or more feet in depth into which e peroon is required to descend, will ba made in connection with work euthorized by ihis
permit, antl that no building strucNre, scattoltling, talsework, or demolition or dismantling thereot, will be more than thirry-si: (36) feet high. (Chap. 32, Gry 2, Ar12, Sec.
341, Tltle B, Celitomia Atlmini5trative G�e).
❑ As owner-builder, I will not employ anyone to do work which would require e permit from ihe Division of Industrial Sefery, es noted above, uniess such person hes e
permit to tlo such work irom the tlivision.
SignaWra: Date:
Division of Industrial Safery Pertnit Number:
CEHTIFlCATE OF COMPLIANCE AND AIJiHORIZATION OF ENTAY: I certify under penalty of perjury that I have read this application and state Ihat tha Information given is
corted. I agree t fyW�" al �5Td� law nd ciry ordinances relating to building consiruction, and authonze representatives of t�e Ciry of Costa Mesa to enter upon ihe
ebove-d � etl prope � or ins et�� ses. I agree not occupy or allow occupancy of any buildinq authorized by this perrtlit until final inspection.
�v rSr =�-1,
Sign urt � g Owner(s)--�""—� 2 �Date_--�
And/Or Au�honzed Applicant Date
COOE I, INSPECTIONTYPE 2AIF �� �
1616 Fixed System Final Fire Prevention
1266
200
201
202
203
204
Pool Spe Final
Final Re-Rool
Flnal BIxWRetaining Wall
Final Factory Fire Place
Finel Sign
Final Damolition .
C00 t INSPECTONTYPE
206 Final Mechanical ��
208 Finel Plumbing
210 Finel Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 FinalBuiltlingiOccupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmbec
Applicant:
Address:
Owner:
282 DEL MAR AV
C
UNIT C
43920123
ENGLERT, RAY
2165 S GRAND AVE
SANTA ANA, CA
HABITAT FOR HUMANITY
Address 2165 S GR4ND AVE
SANTA ANA, CA
Contractor: OWNER-BUI LDER
Address:
ISSUE FEE .
Temp,service test
Res' a/c package
New Res (1�-2pnits)
New Res (3+units)
Pool / Spa
ISSUED BY:
Phone: (714) 434fi200
Zip: 92705 �
Phone: (714)434-6200
Zip: 92705
Phone:
Zip:
License: 0
Status: ISSUED
Applied: O6/05/2001
Issued: O6/05/2001
� � ' ' ?' ,SCOPE OF PERMIT,�� ' � ' �
ELECTRICAL PERMIT FOR NEW SINGLE FAMILY RESIDENCE & ATTACHED GARAGE FOR "HABITAT FOR
HUMANITV' (UNIT C).�INSTALL�NEW ELECTRICAL THROUGHOUT.HOUSE AND INSTALL 1 LIGHT,,1' � �
OUTLET, & 1 SWITCH IN GARAGE. „ � ,
REF:B00-01595
� " , �
FEE SUMMARY _ ` ,�;', ,:, � � : �
Quantity "` � "�- Quantiry' % � � ^
�. $23.50 �-�TempDistSystem/Lighting �$0.00 -%0� � ��•i!
, � $0.00 _-���� i!. �Busway�/100ft $0.00 ���0� ., -� �
�=.: • '
� $0.00 � Standing.Se,ction. $0.00 ;� / 0 ' �'
$84.00 ' 7500 � , MiscEledrical�Equipment _ $0.00�/ 0� '. � -�
-' $0:00� ,-.-�0,. '_ ,' � � :Transforrtiersupto_tikva/kvi r;'.$0.00% 0' �- . �: ,
� � $0.00 � -- 0" . - ........ . ..up to 10 kva/kw $0.00 - � 0 '
Lighhng Pixts , ' / $7.70� V� 1 � - � � %= ....up to 50 kva/kw� "/ $0.00( i % 0 j ', /
ReceptOutlets �`� ��� "<�� $1�10,� � 1A� �- - .:. .....upto�100kva/Rw���$0:00 �/�p' / % f�
Switches � $7'10�, �`�'q� ,` " �� .:._over.t00kva%kw ���$0:00�����0,�'��'
Non Res Appl �
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to SOhp
Motors to 100hp
Motors over t00hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
� $0:00 �- 0 � � - Low Voltage-Eqwpment ��, ��,' = $0.00; � ; 0 �
i
-- $0.00 � i � ' �0 � � Low Volt Wiring System / Ckt '� `; $0:00 ,- �;' 0 "
�,$0.00 ��. � � 0� , Misa Conduit� -� � , � �� ��'' $0.00 � " -0
� $0.00� �'0. Misc.�Conductor�,�� �$Q00,-' 0
$0.00 �, 0 � Cirws ( gen or�ride) -' � � � $0.00� 0
$0.00 ' 0 - . � ' � � Circds (mech7ide or lights). :='���$ODO 0
$0.00 � -� 0� � , Christmas_Tree Stand"� �, $0.00 0
$0.00 0 ' . - � . Fireworks Stand � " $0.00 0
$0.00 0 - - Other Eledrical Fee $0.00
$0.00 0
$0.00 0 Investigation Fee $0.00
$0.00 0 Plan Check Fee $0.00
$0.00 0 Reinspedion Fee $0.00
$0.00 0
$0.00 0 TOTAL CALCULATED FEES b110.80
$0.00 0
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all /
requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. /,'
FOR INSPECTIONS CALL: (714) 7545626
2446d6(N00)
WORKERS' COMPENSATION DECLAPATION: � �
I hereby aXirtn under penalry oi perjury one oi ihe following tleclarations: -
❑ I heve entl will maintain e cerU���a�a of wnsent to self-Insure for workers' compensation, as provided for by section 3700 oi ihe Lebor Cotle, for the paAormance of the
work tor which Ihis pertnit Is i3sued.
❑ I have antl will maintain workels' compensation insurance, as requiretl 6y seclion 3700 of ihe Labor Cotle, for the pertormance of the work for which this Oermit is issued.
My workers' compensatlon InSurance carrier entl policy number ere:
Carrier: Policy iJumber:
(This sectlon neea nof be comp/eted i� fhe permit is velued et one huntlretl dW/aro ($ f 00) or less.)
❑ I ceeify t�at in iha peRarmance oi Ne work tor which t�is pertnit is issue4 I shall not employ eny person in any manner so as to become su6ject to tha workers'
compensetion lews ot Celifomia, and agree thet If I should become sub�ect b Ihe workers' compensatlon provisions oi Sactlon 3700 of Ihe LaDor Cade, I s�all fonhwith
comply wit� these provislons.
ApD�icant Signature: Date:
WNRNINO: FAILURE TO SECURE WORKERS' COMPENSAiION COVERAGE IS UNLAWFUL AND SF41LL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
TLKKISAND DOLLARE (5100.0OO�.IN AOOmON TO THE C0.5T OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION 31O60F THE LABOF CODE, INrEPEST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DEC4�ATION:
. I hereby aNirm that I am licensed untler provisions of Chapter 9(commencing with Section 7000) ot �ivision 3 of ihe Business and Proteuions Code, antl my license is in tull
' torce entl eflect. Lic. A Class #
��� ConlrectoYsSignaWre: Dete:
CONS7RUCTON LENDING AGENCY:
'� ❑ I hereby attirtn that there is a tonsiruction lending agency tor the Oertormance ol the work for which ihis permit is issuetl. (Sec. 3097, Civil Code).
� Lentler's Name: Lendels Atltlress:
Signatura: � Date:
OWNER-BUILDER DECLARATIONS:
I hereby eMirtn Ihflt under penalry ot Derjury Ihat I am E%EMP7 FROM 7HE CONTRACTORS LICENSE LAW tor the tollowing reeson (Sec. 7031.5, Business end Protesslons
Code: Any ciry or counry which reqdires a permit to construct, alter, impmve, tlemolish, or repair eny strucNre, D�or to its issuance, also requires the epplicant for such permit
to tile e signatl statement that he o! she is licensed pursuent to the provisions ot the Coniractors License Lew (Chapter 9(comme�cing with Section 7000) of Division 3 of �he
Business d Professions Code) of Ihat he or she Is e:empt therefrom flnd the basis tor the alleqed e:emption. Any violation of Section 7031.5 by eny applicant for e permit
,su�'_the epplicanl to a cNil pendlty ol not more than five huntlretl tlollars ($500)J:
I, as �ner ot the property, or my employees wlih wages as iheir sole compensation, WILL DO THE WORK, and Ihe structure Is noi intentletl or oMeretl for sale (Sec.
7044, Business and Professions Coda: The Contrectors License Law does not apply to an owner of property who builds or improves ihereon, and who tloes such work
himsetl or �erseN or Ihrough his ar her awn employees, provided that such improvemenis ere not intended or oHered for sale. If, hawever, ihe builtlinq or impravement is
sold within one year ol complotion, the ownar-builder will have the burden of proving that he or she ditl noi build or improve for purpose of sale.).
❑ I, es owner of the properry, em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to consiruct the project (Sec. 70d4, Business end Professions
CoOe: The contractors Licensa Ww tloes not epply to an owner of propeny who builds or improves thareon, antl who comracts for such project wl�h a contrecior(s)
license�ie Cony�actors License Laws.).
Business and Professions Cotle for ihis reason:
Owner I� v ietl b tln f4�wM� ❑ Yes ❑ No
Y
Vediicetion ol Ov+ners p by (type o ocument, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEYY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excava�ion five (5) or more teet in depth into which a person is required to descend, will be mada in connection with work euthorized by this
permit, anC that no builCing siry�iure, scaHoltling, falsework, or demolition or dismantling ihereof, will be more �han thirry-six (36) feet high. (C�ep. 32, Grp 2, Art 2, Sec.
341, Titla e, Calitomia Admini5lretive Code).
❑ As awner-Duilder, I will not employ anyone to tlo work which would require e permit irom the Division of Industnal Safety, as noted above, unless such person hes e
permit to do such work from tF1e tlivision.
Signature: Date:
Division of Industnal Safery Pertnit Number:
CERTIFICATE OF COMPLIANCE AND AIJT}IORI N OF ENTRV: I certify under penalty of perjury Ihat I have read this ep0lication and state �hat Ihe infortnation given is
correcL I agree�scempi wn i ell s laws a y ortlinances relating to builtling conswction, and authonze representatives of the Ciry of Casta Mesa ro enter upon the
above-described pmperty t,/i ction pu �ree not to occupy o cupancy of any builtling authorized by lhis permit u il final inspec�ion.
_ .- - - - �` =S= � �
igna( e Of ner f3Date�=---�'"
' j�Qj�f ,t INSPECTIONiYPE PAIE �NTIiIRLS
I 1616 Fixed System Final Fire Prd�ention
I� 1266 Pool Spa Final
200 Final Re-Rool
207 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
SODE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
Q�jE INTRI�LS
�.-2 3 �