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Home My WebLink About1146 DORSET LN - Building Permits ,f . .: .4 p ' US, CITY OF COSTA MESA 4BUILDING DIVISION Y • l.,,�-,� DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER �. lr/�a PERMIT , y�'�o�'�# B01-00476 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1146 DORSET LN Status: ISSUED Suite: Applied: 04/10/2001 Vicinity: NEW PLAYROOM ATTACHED TO REAR OF HOUSE Issued: 05/31/2001 Parcel Number: 14114212 Zoning: • Applicant: ALFI, JOHN J ISSUED BY: Address: 1146 DORSET LN . Phone: (714)557-0706 COSTA MESA,CA • Zip: 92626 Owner: ALFI, JOHN J Address 1146 DORSET LN Phone: (714)557-0706 COSTA MESA,CA Zip: 92626 Contractor OWNER-BUILDER Address: Phone: Zip: License: 0 • Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT- ' - CONSTRUCT NEW 264 SQ FT DEN ATTACHED TO THE REAR OF EXISTINGSINGLE FAMILY RESIDENCE. • FEE SUMMARY Plan Check: $245.21 -- - -- - ' -Calc Valuation: $23;256.00 Permit: $377.25 - - ' / - Claim Valuation: : SO.00 SMIP Res: $2.33 . • SMIP Com: , $0.00 - Other: ' $0.00 Inspection: $0.00 . Total: - $624.79 <, , , PLANNING & ZONINGr: c-.' ,‘ /'' ' SETBACKS - - < ; i, „/ ; '/ MAIN STRUCTURE Front 0- 0 - Rear 0-0' Left '0-0 - Rigtrt -0-'0 ACCESSORY Front 0-0 ' Rear 0-0 Left 0-0 v Right 0-0 - PARKING Existing: .0 _ _ • Required: ,0 Proposed: 0 - , /.- , 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 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all- required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permits- FOR INSPECTIONS CALL: (714)754-5626 /V 2446-46 2446-46(W00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: ._ Carrier: Policy Number' - - - (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($l00,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.LIc.a Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license purse t to th ontractors License Laws.). /' ❑ I am exem nder c. Business and Professions Code for this reason: ('1 — ( — 0 ( 'Signature: - „ A !Date:— --6- f—n t Owner ID veri d by drivers license. 0 e4 0 No ' Orivers License No. . !Expires:, C7Y - Verification Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Ttle 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes IBJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes El No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICA OF CO "LANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. Ie to c• ply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-de 'bed>4•: • CITY OF COSTA MESA 4 BUILDING DIVISION F ,,,' '41 DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER • PERMIT /01-00444 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1146 DORSET LN Status: ISSUED Suite No Applied: 05/31/2001 Vicinity: NEW DEN ADDITION Issued: 05/31/2001 Parcel Nunmber: 14114212 ` Applicant: ALFI, JOHN J - ISSUED BY: Address: 1146 DORSET LN - Phone: (714)557-0706 COSTA MESA,CA Zip: 92626 Owner: ALFI, JOHN J Address 1146 DORSET LN Phone: (714)557-0706 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 SCOPE OF PERMIT. ' ELECTRICAL PERMIT-FOR-NEW DEN ADDITION TO EXISTING SINGLE FAMILY RESIDENCE.INSTALL , 3 LIGHT FIXTURES,9 RECEPTACLE OUTLETS,3 SWITCHES,&UPGRADE EXISTING ELECTRICAL - - ' PANEL. _ REF: B01-00476 - - - FEE SUMMARY - . Quantity - - Quantity; ,- ISSUE FEE $23.50 • `..Temp Dist System/Lighting $0.00 .0, 7 ' ' Temp service test $0.00 ,• $.,: Busway/100 ft $0.00 , Res.,,a/c package $0.00 -. Standing.Section $0.00%„: 0 New Res(1-2 units) $0.00 0 'Misc Electrical Equipment_ .. $0.00 0• .^ , New Res(3+units) $0.00 ,-:-' 0-. . . . ,Transformers.up to 1rkva//kwt.,-..-'„$0.00' 0: Pool/Spa ' $0.00 Cr up to 10 kva/kw $0.00/ ' 0 /. Lighting Fixts , - $3.30 ' \3 - up to 50 kva/kw <7.,,-$0.00. i„,,,-0 ; ' Recept Outlets z\ <; $9.90. ..,,9,'", ' , kv ' - up to 100 a/kw'�.7 $0.00. ,//`0 / ./ Switches .c $3.30 3''c';' " - -, over-106kva/kw ,--$0.00, ' 0 %. '// Non Res Appl $0.00 r - - 0 Low Voltage-Equipment ,c. '%$0.00-/ 0, , Res Appl $0.00 ' 0 Low Volt Wiring System/Ckt ` ' $0.00 -1 0 Service to 200a . ' $30.50 1 Misc.Conduit . "$0.00.. , 0 Service to 1000a $0.00 ' 0 . , 'Misc.Conductor , • ' $0.00 0 Service over 1000a $0.00 - 0 Circus(gen or ride) / $0.00 0 Motors to 1 hp $0.00 0- Circus(mech ride or lights) ' ' . $0.00 0 Motors to 10hp $0.00 0 _ Christmas Tree'Stand' - • $0.00 0 Motors to 50hp $0.00 0 -Fireworks'Stand. $0.00 0 Motors to 100hp $0.00 0 Other Electrical 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 Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $70.50 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 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. . FOR INSPECTIONS CALL: (714)754-5626 /i / 2446-46(6/00) DECLARATIONS (Th:1 -, WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compeesation Insurance carrier and policy number are: _ Carnet Policy Number:---- (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.If Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: • Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Coda:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursu t to Contractors License Laws.). ❑ I am°ramp ride ec. ^ — \ Business and Professions Code for this reason: Signature: __ Expires: ()Y Verification wnership by(type of document,i.e.-property tax bill or deed): 1 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3,2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or wilt the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (It"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLI• CE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to •ompl ith all state laws and city rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described i ope for inspection p ses.I ree not to occupy or allow occupancy of any building authorized by this per it until final inspection. /T // O Signature Of Leg Owner(s) _ ,Date And/Or Authorized Applicant Date ;OPE P INSPECTION TYPE PATE INTRIAL$ CODE( INSPECTION TYPE PEE INTRIALS 1616 FixedolSystem Final Fire Prevention 206 Final Mechanicalmbi 1266 Pool Spa Final 208 Final Plumbing » 200 Final Re-Roof 210 Final Electrical 0110 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 1J� CITY OF COSTA MESA BUILDING DIVISION > •.J .,"r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER nj' PERMIT +m afi' IUIIH Mnzn3 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1146 DORSET LN Status: ISSUED Suite No Applied: 07/27/2001 Issued: 07/27/2001 Vicinity: Parcel Number 14114212 ISSUED BY: LI�I Applicant: ALF!, JOHN J - ' "! - Address: 1146 DORSET,LNi) _ /, %, r i Phone: 714-557-0706 ,-• COSTA MESA,CA .. . Zip: 92626- ' " . .IN Owner ,, ALFI,JOHN-J ,A Address:: 1146 DORSET LN _ \'. -\\ �" - Phone: COSTA MESA,CA Zip: 92626 - - , • Contractor: OWNER-BUILDER - Address: . . Phone: ' - Zip: _ - A License:0 SCOPE OF PERMIT ` MECH PERMIT TO ADD AN A/C UNIT TO AN EXISTING SFD WITH A DEN ADDITION. 1 INST - ' FAU< 100K BTU, 1 COMPRESSOR UP.TO 3 HP/100K BTU.REF:B01-00476 - / - - FEE SUMMARY Quantity - ' Quantity. ISSUE FEE $23.50 - Repair/Alt Absorbtion Unit � '$0.00 '-0/ Inst'FAU<100 k BTU $14.80•• •1 - • - - 'Repair/Alt Refrigeration Unit .: ' $0.00 0. - Inst FAU>100 k BTU • $0.00 - 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 -0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping. $0.00 0 '` x..- - :" . Up to 3 hp/100 k BTU / .$14.70 -1, Factory.Fireplace -' $0.00 0 "' . 3 Td15 hp/500 k BTU $0.00 0 ` Hood w/Meth,Exhaust $0.00 0 15 To 30 tip/1,000 k BTU - $0.00 0' VAV Box \ , ,,, $0.00 0 30To 50hp%;1;750 k.BTU - ' $0.00' ,0 Vent Fan/Single Dud" $0.00 - 0 . Over 50'hp/Over 1,750 BTU $0.00 , ' 0 Appliance $0.00, 0 Boilers Fire Dampers , ' ,0 Up to 3 hp - , .$0.00 0 Smoke Dampers $0.00 03 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp , - $0.00 0 Air Handlers> 10000cfm $0.00 -0 Over 50 hp. $0.00 0 Floor Furnace ' $0.00' 0 - Other Mechanical Fee - Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 . Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $53.00 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 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 �� 2446-46(6/00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: t Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). ' Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a peri+' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is /gold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). Ld' I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Cale:The co rectors (cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractors) license purs t to t Contractors License ws.). ❑ I am exem nd ec. Business and Professions Code for this reason: _ Signature: Date: L / — Owner ID verili by drivers license. Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). 1 ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: ` Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aRermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L-I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUAN AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to co ly w' all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr f s n/pu�rposes. greeoccupy or allow occupancy of any building authorized b s permit until final inspe n� Signatur 1 Legal Owner(s) ate And/Or Authorized Applicant Date CODE I. INSPECTION TYPE, . LAM INRTIAL OODE$ INSPECTION nil gL. 1616 Fixed System Final Fire Prevention 206 Final Mechanical )0-1 -n1 = 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy • j, „\ CITY OF COSTA MESA , 4 BUILDING DIVISION Y •y •„r. f. DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER F r /a PERMIT J Sok., 04. Rmso 01-00456 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1146 DORSET LN Status: ISSUED Suite No Applied: 07/27/2001 Issued: 07/27/2001 Vicinity: Parcel Nunmber: 14114212 ISSUED BY: 1 Applicant: ALFI, JOHN J ;-.% - �. Address: 1146 DORSET,LN;. - ' Phone: 714-557-0706" /' COSTA MESA,CA ' '� Zip: 92626 ` i N\, . Owner:, ALFI, JOHN"J ' Address 1146 DORSET LN - , Phone: '�. , ' COSTA MESA,CA Zip:- 92626 ' , Contractor: OWNER-BUILDER , Address: ' __ Phone: - . Zip: ' License: 0 - Arrch / Eng: - , - " • Address: • - Phone: Zip: ' , License: . . • SCOPE OF PERMIT PLUMBING PERMIT TO RELOCATE A HOSE BIB&FUTURE BATHROOM REMODEL FOR A SHOWER IN AN EXISTING SFD. 1 SHOWER, 1 HOSE BIB ) - ' FEE SUMMARY ' " ' AMT QTY _ _ AMT QTY ;. AMT QTY ISSUE FEE $23.50 ; Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation` /$0.00 0 , .Landscape Irrigation $0.00 0 ' Swimming Pool $0.00 0 Backflow Preventer ' $0.00 • 0 P-Trap $0.00 0 - Trap Primer ' ' ' $0.00 0 Bathtub • $0.00 0 Pressure Regulator $0.00 0 Urinal ' $0.00 0 Clarifier System • ' $0.00 0 Process Piping(per 10 ft) $0:00 ' 0 ' Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 ' ." 0 Receptors $0.00 0 . Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.03 0 ' ' Septic Tank $0.00 0 Wash Basin' ' $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 -Waste and Vent System $0.00 0 Drain,Rainwater $0.00 . 0. Sewer Private Line $0.00 0 , ' 'Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 - Shower $9.80 1 - Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 - Sink,bar ' ,$0.00 ' 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0:00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $9.80 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $43.10 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 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS r) f • a WORKERS'COMPENSATION DECLARATION: - _ I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) . ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE MST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perm+' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The antra-:s License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pu , an o the Contractors License(aws.). ❑ I am axe ••t u •.r sec. - . Business and Professions Code for this reason: Signature: r__ __ Expires: //— Of—0 Y Verificatio of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LI No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANC D AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to co...•III:y wit, all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro•' f. i pection pun• es.I agr not to occupy or allow occupancy of any building authorized by this permit until final inspection. tea • 7 z7 - 0 ( / Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE MATE 18TRIAL$ CODE# INSPECTION TYPE DALE INTRIAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing g'o4—CI l ON 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy "FailliLult"'6wLwrlD: 1146 DORSET LN °NTi CITY OF COSTA MESA — BUILDING PERMIT E1Q *tl: ALFI, JOHN J FLOOD: X 47 PERM NO: B 079997 ADDRESS: 1146 DORSET LN �, COSTA MESA,.CA 92626 PERMIT NO: B 079997 PLAN CHECK NO: N GOVT: N SUPP : N APPL.MALDIG ADDRESS: • CONSTRUCTION TYPE: V—L - PERMIT TYPE: STR PURPOSE: OTH ARCHITECT ORwwNaR: LK.NO.: JOB DESCRIPTION PARTIAL /OFF & RE—ROOF W/COMP SHINGLES SQ FT: 2, 000 ARCH.OR ENG.'S ADDRESS: WIT: CLAIM VALUE: , 100 , 00 CALC-VALUE: 2, 000 , 00 GROUP OCC: R-3 /U-1 CONTRACTOR'S NAME: CONTRACTOR'SSWUNG COMMENTS : X ADDRESS: UC NO.: *****************************RE***********RE************************************* wet ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby atfim under penalty of perjury that I am licensed under provisions of Chapter P SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in fun force and effect. CITY LIC.NO.: LIC.CLASS: • LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING Dam: Contractor FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT : FT IN OWNER BUILDER DECLARATION:I hereby affirm under pendy of perjury that I am exempt from the Contractors License Law ler the following reason(Section 7051.5 Business end Professions Code:Any city IX county which requite,a pem,b to wnapud,alter,improve, PARKING REQ:: P RO V: PARCEL: 14114212 Z N E; REF NO: •- dish.or repel'any atuture,prior to its issuance.also requires the applicant for such permitto file statement signed sement dW he or she Q licensed pursuant to the prmsios d the Contractors License Law[Chapter 9(commencing with Section 7000)of Division a of the PLANNING NOTES> 'nese and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section - > 031.5 by any applicant for a permit subjects the applicant to a Owl penally of not more than fee hundred dollars(55COD. *************.****************************************************************** rl I,as owner o the property or my employees wsh wages as lhei sole compensation,will do the work,and the structure s not intended D E V E'L O P M E N T S E R V I C E SR E U I R E M E N T S A— or offered tor sale sale(Section 7044,Business and Professions Code:The Contractors License Law does notapply ow to an nod popery Q who buide or inerovn thereon,and who does such work himself or herself or through his w or her on employees,provided that such improvements are nal intended or offered for sale.II,however,the building or inprovement is sold within one year of completion.the ZONING APPROVED BY . DATE: owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). ❑ I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The contractors License Law don not apply to an owner of properly who builds or improves thereon end who BUILDING APPROVED BY : DATE: contracts for aids protects with a mntrecta(s)kensed pursuant to the Contractors License Law). •I ti exempt am - ^^«-i ce_ 6�96B. ef•bthis� APPLICATION ISSUED BY: D4*TE4* (e ************************************** * ************************** * * ** hereby certify that lama ederM understad the requirememed Celffomia Health and Safely code Sections uws,25533,and LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT: Y a peermiio that connetlonorrrndifwno buiosupant lding the AAiCna not Dii.Idmd.Residentiald to comply wkh constrctipon app� arand e1eermg front tementshese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 62 . 25 . 50 Date: Applicant: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirmunder penalty of perjury one of the following dada:mierw: PLAN ElIhave and wilmaintain acertificate al consent toself-insure for workers'compeoration,asprovidedfor bySection 37oodthe Labor ISSUE FEE Code,for the performanceofthewor,forwhichthispermiisisued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE o I have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code.for the performance MINI TOTALS----> 62 . 75 0 . 00 0 . 00 62 . 75 62 . 75 . 00 work for which this permit is issued.My workers'compensation insurance carrier and policy number are: Cattier: REVENUE DIVISION TOTALS--> COLLECTED : 62 . 75 OVER/SHORT: . 00 Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK is section need nor be co.np/arad I the permit ía for one hundred dollars/51001 or Man.) 62 . 25 - . 50 o 1 eerily that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to became subject to the workers'compensation laws o California. and agree that if I should became subject to the workers' ******************************.K-**********.M.**.M.********************************** compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with those provisions. Date: Applicant: INDIVIDUAL F E E BREAKDOWN • Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject an employer to criminal penalties end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines rig to one hwmdred thousand dollars(3IO0,000),in addition to the cost of compensation,damages as provided for In Section 3706 of the Labor Code,Interest,end attorney's feet SFR 2000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 000 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty al perjury that there lea coretntalon lending agency for the ENDOF FEES performance of the work for which this permit is issued(Section 3097,Cb.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and mate that the above information is carred.I agree to campy with all city and county ordinances and alma lionrmnp to building construction and hereby representativesauthorize city toe thisenter upon the above-mentioned property p )T Ly j for inspection purposes. iAiil�litlb L JAMIL ALFI Print Name tr^/ / ...---7) 1., V^ Date:/o•—/6-26 DATE Signature ican 01 00217253-00217259 TOT 62.75 DATE: 10/16/95 TIME: 13:42 (5151-46.WP) White-Building&Safely:Gran-File:Canary-Appicent:Pink-Revenue:Goldenrod-Assessor 4/11,VSTRUCTION AND PLANNING - s POOI t # A 'Date Inspector % r Date Inspector 'PROVALS Permit # \._..-- : APPROVALS Permit # • i. TemporaryElectricalService or Pole I 52. Pool & Equipment Location l _ 1 • 2. Soil Pipe-Undrgrnd. - I 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. .1 54. Forms 4. Electrical Conduit-Undrgrhd. - 55. Electrical Bonding ,,- 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE _r 7. Footings 58. Electrical Conduit-Undrgrnd. A B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test el 9. Water Pipe.Undrgrnd. I 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System ' - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains , 64. Plumbing System - Final • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# • 21. Ducts, in Structure - 70. Underground Hydro A 0, 22. Ducts, Ventilating 71. Product Piping OGas 0 Oil : - 1 23. Gas Pipe-Rough & Test72. Underground Flush t 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil •.r-i i ��9'/Q 25. Roof Sheathing �/i 74. Overhead Hydro - �"' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing _ - 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREY. FINAL - 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: • T . 34. Final Heating& Air Conditioning • . 35. Final Gas Pipe•Test • ----‘ . r - 36. Hood or Canopy i _ ' 37. Final Factory Fireplace :1 38. Final Plumbing • 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer - T , 43. Backflow Irrigation - 44. Landscape Irrigation System - 45. Sound Attenuation - - - •, 46. Handicap-Regulations 47. FINAL STRUCTURE & BUILDING • 48. FINAL PLANNING -1 , v 49. Electric Release to Edison0.--) • t 50. Gas Release to Southern California Gas Co - . 51. CERTIFICATE OF OCCUPANCY 3 No Date - ADDRESS OPBMLNNG: 1146 DORSET LN uhT: CITY OF COSTA MESA — BUILDING PERMIT OMNERS NAME if Qcmb ALFI, JOHN J FLOOD : X 47 PERM NO: P 081736 ADDRESS: 1146 DORSET LN • COSTA MESA,CA 92626 PERMIT NO: P 081736 PLAN CHECK NO: N GOVT: N SUPP: N 557-0706 APPL.YAWNS CRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH ARCHITECT OR ENGINEER: UC ND.: JOB DESCRIPTION : DISHWASHER CHANGE OUT SQ FT: ARCH.OR 010.5 ADDRESS: WIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / coxmACTOWSNAME: NOCK PLUMBING ( 714 ) 895-1246 CaimACTORSMMINIo 11610 SEABOARD CIR COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT ADDRESS: STANTON • CA UC.NO.; 707775 ******* ESE** x*xSr**StiET *******+t*SEx** *********** *iETE**SEx*+E********SriE*RETr*+e**HESE**** 90680 BHT: Z ON ING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 S E T B AC K S (commencing with Section 7000)of Diveon 3 ol the Business and Professions Code,and my license is in full force and effect. CITY LW.NO.: 0 6 status: C-36 uc.NO 7 EXP: 02 /97 MAIN BUILDING ACCESSORY BUILDING + FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: ( Contractor > rr:FT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN • OWNER BUILDER CLARATION:I hereby affirm under penaly of perjury that I am exempt from the Contractors License Law for the following reason(Section 70315 Business and Professions code:Any city Of county which requires a permit to construct,atter,improve, PARKING REQ: PROV; PARCEL: 14114 212 Z N E: REF NO: 'smolish,or repair any structure.prior ahs issuance,also requires the applicant for such permit to file a signed statement that he or she PLANNING N V T ES> icensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the ainess and Professions Code)or that he or she is exempt therefrom and the basis for the alleged esempton.Am'videton of Section > u31.5 by any applicant for a pennheubMds the applicant to advil penally of not more than five hundred dollen(S5001). ******************************************************************************* ❑ I.as owner o the propene or my employees with wages as their ode compensation,wgl do the work,and the rnrdure is not intended D E VE L OP M EN T SERVICES R EQUIREMENTS ' or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not applyto en owner of propeny who builds or improves thereon,and wfo does such work or himself herself or through his or her own employees,provided that such improvements are not intended or offered for sale.R.however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE: ownerbuider will have the burden of proving he or she did not build or improve for the Perigee of sale). ❑ I,as owner of the praferly,am exclusively contracting with licensed contractom to construct the project(Section 7044.Business and BUILDING APPROVED BY ; DATE: Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon end who contracts for such projects with a contrector(s)licensed pursuant to the Contractors License Law). ❑ Iamexemrunder Seaiort: B.8P.C..for the reason: APPLICATION ISSUED BY: DATE: 2-2(- 9 -7 ******************************************* *** ***************************fl** Dale: Owner: LEGALIZATION:N .F E E SUMMARY STRUCTURAL SEGMENT;N I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and - 25534,and that Ir any future building occupant will/will not(circle one)need to comply with said state codes end the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING e permit for construction r modification from the Ab Dually Management Dimrid.Residential construction applications are exempt from these provisions. PERMIT 8 . 75 Dina: Applicant: 2 5t SMIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm wider penally of perjury one d the following declarations: ISSUE FEE 22 , 00 o lhave and will mamas aartRireteoconsent dsag-insure for workers'compensaton.asprovdedfrbySecon3700othe Labr BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Cafe.for the orfrmanceofthe wwkf«short this permkle®nod. TOTALS----> 8 , 75 22 , 00 0 . 00 30 , 75 30 . 75 . 00 cI have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,forthe e performance of the work for which Ibis permit is issued.My workers'compensation insurance carver end policy number are: Carrier: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 30, 75 OVER/SHORT: 00 Policy Number NWC 52114101 09/01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK section need not be completed r the;wank is for one hundred dollars($100jor less.) 30 . 75 Li I cattily that in the performance of the work for which this petrel is' shall not employ any person in any manner so as to become subject to workers'compensation lawn d California, I should berme cabled to the workem' ******************************************************************************* compensation of 3700 of the labor Cole.I \ ort h py Inose prod sone. I IND I V I D U A;L ; F EE BREAKDOWN Date: 20 2 7 Applicant: c s Warning:Failure to secure workers compensation coverage Is unlawful,and shall subject an employer to criminal penalties and —TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars f$100,000A in addition to the cost of compensation,damagep s as rodded for In Section 3705ofthe L.aborCode,Interestendatromeys/oda. PLU 1 DISHWASHER 8 ,7-5 8 , 75 CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perury that there is a construction lending agency for the END OF FEESl �.c-n performance o the wok for which this permit is issued(Section 3097.Civ.C). r rl( {l� r�-.+�0 I LENDER'S NAME: LENDER'S ADDRESS: _ FEBI certify that I have mad this application and stale that the above information is correct.I agree to comply with al city and county ordinances EXPIRED L 26 1997 - and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above•memioned properly EXPIRED for inspection purposes. RON NOCK /, r:n.• >+: \Print Name- ' • DATE la 12_2/% 7 kola , "r COSTA MESA Date: lav SgneluredOn*hrlAgmVAppiranUGonlredr • (5151.45.WP) White-Building S Safety;Green-File;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor ' POOL oA CONSTRUCTION AND PLANNING - - - , APPROVALS Permit # Date Inspector - APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole - - 52. Pool &Equipment Location ' 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement • _ ' 3.`Electrical Conduit Utility-Undrgrnd. 54. Forms ' ' •4.tElectrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement_ - -56. Rough Plumbing & pressure Test _ - u.6. Electrical UFER-Grnd. '57. APPROVAL TO COVER-GUNITE .T. Footings - • - - - - 58. Electrical ConduitUndrgrnd; • 8. Foundation - - - - ' - - . ••59. Gas Pipe, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. ' ,60, Backwash Lines, P-Trap, 0 Undrgrnd. - - 10. Structural Floor System • . 61. APPROVAL TO DECK, . 11. Property Sewer Line_& House Connection - , '62. Backwash & Receptor-Final - 12. Sewer Cap + 63. Heater &-Vent-Final - ' 13. Roof Drains - - . - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final •15. Rough Electrical-Conduit - ,_ ' 66. Solar System-Final . • 16. Rough Electric Wiring - _ ' 67. Fencing'& Access Approval. 1 17. Rough Wiring Sign - - 68. APPROVED FOR PLASTERING • 18. Rough ElectricaI:T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • 19. Rough Heating & Air Conditioning • - • FIRE DEPT. REQUIREMENT - . - 20. Rough- Factory Fireplace _ - _ I-"'' APPROVALS Permit# ` 21.,Ducts, in Structure. _ _ -n : 70,Underground Hydro 22. Ducts, Ventilating t' x , r _ ' 71_ Product:Piping O Gas 0 Oil 23. Gas;Pipe.Rough &Test n t -. , '0' Yom. - 72. Underground Flush ,d 24..Roof:Framing - - • _ F - = 73. Undergrnd.Storage Tank 0 Gas O'Oil 25. Boat Sheathing :' a. 5 rY •- '_ " 74. Overhead Hydro , 26. S-Bar Ceiling (Structural) &Monocoat +' - _ 75. Dry Chemical ,,_ - _ - 27. Frame and Flashing; ` _ - ' _ .. - _ 76. Dry Standpipe-._ _ 28. Lathing& Siding - � . Z. • - 77'. FIXED-SYSTEM FINAL_ - _ ' • • 29. Insulation <.. r a 7,8. FIRE.PREV. FINAL - - ..4.,.9' " 30. Drywall Nailing - :-HEALTH DEPT.-REQUIREMENT ' 31. Plaster Brown Coat t. . _ _ ; is _ 79. 'FINAL INSPECTION - - 32._Electricaf:Power Meter-Final _ x _t v .* 80. FOOD CERTIFICATE ISSUED .. 33.:Final.Electric -' _ c. . Nates: AL)/ t=: 34. FinalHeating-& Air Conditioning_ s_ . • 35.'Final Gai Pipe-Testy .. ' ± �r - .. . . • 36. Hood or Canopy :• v - - `* t , ...._. -- - rr. 37. Final Factory Fireplace -- - ; 1 38. Final,Plumbing ; a - i 39. Water Service-Final : _ - x 40. Gas Service•Final . •- _ - .; -, , ' ' 41. Solar Domestic-Final -. - -r, •i a _ . _ - 42.-8ackflow Preventers - r* _ - 43. Backflow Irrigation` -- - - ° 44. Landscape Irrigation Systemr r) '45.1.Sound Attenuation' - 46. ,Handicap Regulations _ -_ .j t" 47. FINAL STRUCTURE& BUILDING - a' - -S _..o - - - - �` vµ 1 48.'FINAL PLANNING ,_ -49.-Electric Release to Edison • 50. -Gas-Release to Southern California Gas Co r - -51. CERTIFICATE OF'OCCUPANCY - No. Date ,� , Applicant to/ill mall spaces exec t those within heavy border lines and sign all appropriate declarations. ' - . - •PER NO TRACT NO. L TNO. _ 8967 2/•)/let. TY OF COSTA MESA COIF\$TR UCTION PERMIT y1� / /�Q UNIT NO. C • '41'Project Address �� vie t Lc.) � . .i, r (/ PL s U/�� I�''rll_ 95—"*__ I �j� V r Applicant's Mailing Address' "."2 ra-e / ' y!�K)Sc N - TYPE OF CONSTRUCTION' LJ NEW .ADD �. ALTERATION Ll REPAIRJ' ' ' ' ' ��y ` r,❑CONVERSION ❑ DEMOLISH ❑ OTHER 1 Owner's Namer�� - L r+! Phones Sl—'r/ I -• Ay. ii...// ___/Z./.� — l_ Zone P1 - ) 9 s t wS • ' DESCRIPTION OF WORK/USE OF BLDG, i ' /I� Atldress %/ / • !� 5 ( - I i 'c • . _ S Da'...B •9tl'y. /LL'h-. _Aeee5M1c17BuiJA'^l r'Qi�Ut•s/ookt Arch/Eng. n License No. l ' ' TYPE OF PERMIT I ❑ GRADING - 0-FOUNDATION /�IJsy�STRUCTURAL - T Front - a9,( ,. f?Mi* O Address; -• +, i • ❑ TENANT ,❑ ELECTRICAL ❑ PLUMBING 0 MECHANICAL B . - • N ' Contractor's Name v7✓l7 0" `[. AL S I,1 p¢(iC(JPhone' �'yb�b L 'OTHER ! ' i A• Rear ftwoo /� - _ y13•C�7 J - Address(mailing) �"> �-<% r �"r($D h1 i PROJECT DESCRIPTION,. SG. FT. .,I j Q�. _ .OCCUPAN�V_� �.C Right !b�•1 • ; • !7-!' 1' /� G City License No. .�.^ S 2 - i • CONSTRUCTIONTVPE V— f VALUATIONS P. ' S Left' /Y Tr/T�LLJ(J [�' L-a R. LICENSED CO NTRAC/TOR DECLARATION ' ZONE - GRADING CU.YDS. 'ACRES "'-'• Ping. Ref.# Parking:Req./Provided ,- E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:' �' t • Planning Notes: s M with section 7000) of Division 3 of the Business and Professions Code, a - i T, my license is infujinfgrce and effect. 'id, �. � .4's—s' s //J,IIrt/,- , 1/ q•0/ • S • Licen Class ')/ Li nse A "f (O J '�-(}'t- ,'lD •.J1P - Date , "rt Signature • I ) • PLUMBIN FEES ' ! -. WORKERS' COMPENSATION DECLARATION i • •ereby affirm that I have a certificate of consent to self-iniure dr a certificate ' ••' Bar Sink Showers ELECTRICAL , FEES Workers' 'Compensation Insurance, or a certified copy thereof (Section Backflow Pmventer • Service Sink' L •�+/ '/ a .,000, Lab. c.) ' - a Jam' Automatic,Washer Transformer 0 15-50-KW Policy No. ' Company r Backflow Irrigation j Sewer Ca - . 'n ❑ 50+KW , Certified copy is hereby Turn ishetl. • /` p .-..'+!' I �, Construction Pole Sub. • • - Certified copy is filed with the city Building Division. ••••,.; _ - l (Bathtubs •" ' ‘ Sewer Connection ,_ •. Cooking Unit ' ,vi Meter ❑up to 100 amps • Date Applicant -+T - - �/1 '• - EXEMPTION FROM WORKERS'ICOMPENSATION DECLARATION .. ') Clarifiers .- - -- Solar Collectors' - I , /dl Dishwasher' - - - Meter Clover 100 amps• - "' (This section need not be completed if the permit is for one hundred ($100)or, ' Al' - • less). , l - • Dishwasher Solar Piping _ -). - j .`°' Dryers ❑Gas ❑Electric i ISub Panel } I I certify that in the performance of the work for-which this permit Is issued, I - '— shall not employ any person in any manner so asap become g ect to the Drinking Fountains Solar Tank ''' ` .� Fan' •('' Worker,5' Compensjttign.Laws of Calif, '// �/ ' 'f/ _ Motors❑0-1 HPe ❑1%-g a, �J . Date 4.9 ^ 3-7 7'L- Signature /r f!Y y Floor Drains' Swimming Pool w/Spa• / ' F.A:U. ^,Inc.Solar ❑9-15 HP-❑16-15+ NOT E: If,after making this declarati you should become subject to the Workers' Compensation provisions of the Labor _Code, you must forthwith Floor Sinks . Urinal WO com I with suchprovisions or this -- 3 FiXtur25� j,_' Microwave r ' • p y - permit shall be deemed revoked. ^3 I CONSTRUCTION.LENDING AGENCY - i Gas Service Outlets Device Boxes i Water Closet' i' 1 hereby affirm that there is a construction lending agency for the performance -" _ ,... - -. 'l�, POIe Light , of Lender'sthe work for which this permit is:issued, (Section 3097 Civ. C.) , _ . • I �� Name - - , Interceptors Water Heater I ) 3 Outlets.'. „. r - - Range Lender's Address . Kitchen Sink rV" ' Water Service l .•2'�,J•34 Switches - : ' Si n _ OWNER BUILDER DECLARATION - 1^`""'4-•^•`�]J • _ g ' s �`/��/�r(�� I hereby affirm,that I am exempt from the Contractors License Law for the '/ Lavatories. Auto-Wash •" /y� ^� " • iI �f /1ry following reason (Section 7031.5 Business and Professional Code:•Any city or - .- - Garbage,Disposal ,Standing Sections 1JV county which requires a permit to construct,alter,improve,demolish or repair • P-Trap y LaundryTrays' anstructure, prior to its-issuance, also requires the applicant for such permit , Generator 1:16-5 KW❑5-15 KW Trash Compactor q to file a cSignedontractor's 'statement'that he/she is Iicenmeencin uant to the provisions of , Roof Drains n _ . • spe Contractor's License Law (Chapter 9 (commencing with Section she is exempt of - . . - _ - . •-$: -� , �.rereion 3 of the'Business and trom and the basis for the alleged le xe eons xemption. Any that la[on of Section - r, ij93L.5 ,by any applicant for a permit. subjects the applicant'to .a civil - ' i ! - V _ -t I " enalty of not more than five hundred dollars ($500). - r LJ l as owner of the property,,or my employees with wages as their sole , , Reinspection Fee 1 , I $15• Issue Fee - $ 3 '- • - ' compensation, will do the work, and the structure is not intended or offered 1 '� - ' for sale (Secion 7044, Business and Professional Code: The Contractor's , • ' - , . • MECHANICAL _ Reinspection:Fee" $15. 'Issue Fee • $ 3 License Law does not apply to an owner-of a property who'builds or improves ' FEES • thereon, and who does such work himself/herself or'through his or-her own DEVELOPMENT SER VICES REQUIREMENTS: , .' p employees, provided that such Improvements are not intended or offered for Boiler , Hood Or Type I ❑ - a— 7—O sale. If, however, the building or improvement is sold within one year of com- - Canopy Type II' ❑ Zoning Approved-By — - Date L,, pletion, the owner will have the burden of proving he/she did not build or,lm- Duct- Under Ground I --Buildin A roved B • prove for the:purpose of sale). - - 9 pp_ Y Date I ❑ I, as owner of the property,am exclusively contracting with licensed con- 1 Duct-Structural Refrigeration System IApplication,lssued By'� T / Dat¢tf-O-W— tractors to construct the project (Section 7044,Business and Professions Code: I {) _ The Contractor's License Law does not apply to such er of property who ' •Duct-Ventilating - ❑0-100,000 BTU ❑109,000 BTU ' • ( ,� SUMMARY OF FEES ,;,, builds or improves thereon, and who contracts for such projects with a con- _ "i \> ' /L tractor(s) license pursuant to the Contractor's License Law). am aware that OC BUILDING PERMIT) $ 3I'ci .C3 t SMTP ' $ 9•- 39' Z Exhaust System ❑ Multiple m System Repair/Alteration , Proof of their Workers Compensation insurance should be provided to me. } PLAN CHECK `t A. i -.CI PERMIT ' ) ❑ Pam exempt under Section B.& P.C.for this reason ' Firepl/Fact.Blt. ICBG 4,2 J Fire Dampers 0C'ea G•- I •tea -PLUMBING $ I �'' ' �� ISSUANCE [i' $ Date _ Owner _ Heating System& Ducting Registers _ �• CD (' 1 - }; I 6 ENERGY P.C>' $ i ;PLAN CHECK :25% $ ' i hereby certify that I have read this application aril state that the above 00-100,000 BTU 0100,000 BT , ,r a+ ` information is correct. I agree to comply with all city herebycounty ordinances • • I' • 7E LECT,R ICAL , e, $ Y, b GRADING i $ and state laws relating.to bui ding cro�6❑struction,and authorize repre- 1 .PLA NN CHECKn 50%' �'1 i d MICROF I L9 03 W/1i $ ' sentatives of'th15'cl to er I- the above-menlionetl property for i ./ , $ ' Inspection r ses. ,J, I i I TOTAL FEE n $ D „ ?—'/'51•C " MECHANICALS $ I. Q I Signature `j , ! Date ' _it i G. Drivers' nse or•SS I Reinspection Fee $15 ; Issue Fee $ 3 PLAN CHECK 5725% $ '>I- �,O CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor ♦i .._r_,. - . - -. ... hakise iONSTRUCT ION AND PLANNING ' - • POO WA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 11. Temporary Electrical Service or Pole 52. Pool & Equipment Location i . • 2: Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility Undrgrnd. _ - - . , 54. Forms ' 4. Electrical Conduit-Undrgrnd. Bonding 4 5. Steel Reinforcement - `t°� 56. Rough, Plumbing & Pressure Test • 6, Electrical UFER Grnd. • • �'v -IAPPROVAL • • `� . V 7. Footings • /_ �` • . • 8. Foundation - -�gC, / 59. Gas Pipe, ■ Undrgrnd., 9. Water Pipe-Undrgrnd. _ .I . ■ Undrgrnd. 10: Structural Floor System Cs448) 1 SJs, 4L„,, APPROVAL • DECK 11. Property Sewer Line & House ConnectionReceptor-Final 12. Sewer Cap _i, cs- 13. Roof Drains 64. Plumbing 14. Rough Plumbing 11-Z4-YL 65. Electrical-Final - •15. Rough Electrical-ConduitSolar 16. Rough Electric Wiring J i -4, e__Q_ Approval 47. Rough Wiring.Sign I 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling ..--, . _ 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning 6--.c-44.440 FIRE DEPT. REQUIREMENT 20.. Rough Factory Fireplace ;i APPROVALS Permit# • 21-. Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil _ 23. Gas Pipe-Rough & Test; • 72.{Underground Flush • ' I 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Roof Sheathing '4v• (a i DAIp 74. Overhead Hydro 26.,T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . 27. Frame and Flashing • � it/y- �L, 76. Dry Standpipe • - 28. Lathing & Siding •:-:-. I' 9/4 /L 77. FIXED SYSTEM FINAL 29. Insulation �ZZ/� 78. FIRE PREV. FINAL 30. Drywall Nailing a3 L Vc.- HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat: - /CVO, I � 79. FINAL INSPECTION - • • 32. Electrical Power Meter-Final80. FOOD CERTIFICATE ISSUED 33. Final Electric • f 2 (-8G E#4 Notes: 3 i frc9 II2/ < 34. Final Heating & Air Conditioning 5tg� - Lam' . weat}.,I AXI Oi.�LLA �./h ern .- 35. FinalGas`Pipe-Test SAO c. F/iac /Go` c- -a4etSh7/ rrso' 36. Hood or Canopy - / &it' 1c51" au_ IF I iZgPtAGF ail-4 Kis 37. Final Factory Fireplace14:11. �" 6 5I �rslmill, o/K To Aprelp 2 FCooa 38. Final Plumbing, ' S-26t 86 C.G.1j AnJLAfr/ i MAni,/ rr-Avvvlni 1PMn.1 r: 39. Water Service-Final 11.E Wrr nEi $4bT. -A 'teat•IL W/T1JOLt1 40. Gas Service-Final f 41. Solar Domestic-Final Q >6 gg $ c ) . lni ` ; �Tii 42. Backflow Preventer 6` ! (i l . 43. Backflow Irrigation • ' I 44. Landscape Irrigation System 45. Sound Attenuation r- 46. Handicap'Regulations / �j� 47. FINAL STRUCTURE& BUILDING �2'J//'� /,0I 3 / , c 2O 3c1 I,F-Bs-8sC OF 48. Special Requirements Completed "(J jj�O v '"V 49. Electric Release to Edison _ ' 50. Gas Release to Southern California Gas Co - -- • 51 , CERTIFICATE OF OCCUPANCY - •: No. - Date , / - _ - - _ _Appl, nt to fill in all spaces except those within heavy boder lines and sign all appropriate declarations. - ca• l TY OF COSTA MESA - CONSTRUCTI N PERMIT • PO. y�- • TR—.T.:.. ..-7 . LOT•T _ ,UNIT NO. i '�4,_:._ -' ° ` F - •- Project Address -/j yL Pet RC I rr1 Z� • e " �� `•' "r _ I'734 8/20/a6 .-.92 ;TL 1S_ Z 5-•-2-1-$'I pt 1t-4 So - TYPE OF CONSTRUCTION ❑ NEW l�/l - 1 pplicant's Mailing AddressYSJ-ADD LI ALTERATION H REPAIR ❑,CONVERSION D.DEMOLISH ❑ OTHER • Owner's Name d fiK �L F f PhoneCr)T°h C - - . 'I - A.P.# J / —��'Z a._. - - , Zone �,��-. _ (7 DESCRf'�TIQ NO F(9Q�ji ly/USE�9F�� / ` ' Address �/ YI- ..Dv RS_E-- - r • F�� {—•/ KNl r . aka 1/�[G�l�� S/ ®N S Main Building: r Accessory Building: • • Arch/Eng - , License,No. TYPE OF PERMIT ❑ GRADING FLl OUNDATION X STRUCTURAL l T Front Q Q I ' Q Address ' - •rte • -r^ •❑ TENANT ❑ ELECTRICAL ❑ PLUMBING C MECHANICAL B Rear N Contractor's Name Pr'✓1r& 0U 57t U&flt4 Phone S 3G"6e'�-•1'b �fy❑'OTHER - _ - • _ �j A _f - _ ' . r I Id St PROJECT DESCRIPTION SO..FT. 'i I' /'� C Right N OCC VPAN Y �•(p Address(mailing) ). S 2.4', ,. 'nR - ,(C 'K G • F' eC ON ST RUCTION TYPE T. VALUATION$ Cr tee! ;$ Left � ' City License No. • _. ./ - I I R c�..20NE • ' GRADING CU.YDS. - ACRES - ' Pln Ref.# • . ' Parkin ' ' I E LICENSED CONTRACTOR DECLARATION - -- _t• , , g.; g Req./Provided 1 I hereby affirm that II•am licensed under provisions of Charter 9 (commencing 1 Remarks: /�- 2;2:.Ce ' . .p Planning Notes: �l ,n �,(I'Oa.LilJwa ' 1 I M with section 7000) ofcDivision 3 of the Business and Professions Code, and _ • - tJ my license is in fu force and effect. •� ll.,r x!tr - • I - I - i T •' License Class • kens: • . ✓•9. 3/�J - - ,. - ' -• - , , $. Date 7')f -'7 -et Signature • f .! • _ - , - • ' PLUMBING ' FEES' - ' ' - - WORKERS' COMPENSATION DECLARATION gen Sink Showers • J ` I hereby affirm that I have a certificate of consent to self-insure ora certificate ' - ._ - ' • - - ELECTRICAL 1 FEES of Workers' Compensation Insurance, or a'certified copy thereof (Section ' ' - - - - `00, Lab. C.) ,- Backflow Preventer • Service Sink Automatic Washer • Transformer 0 15-50 KW • !icy No. Company • Backflow Irrigation Sewer Ca r- : -❑ 50+ KW • - Lt Certified copy is hereby furnished. • p- Construction Pole Sub. - - ❑ Certified copy is filed-with the city Building Division. Bathtubs I ' Sewer Connection Cooking Unit ., Meter Dup to 100 amps Date 1"c Applicant _ — --. i EXEMPTION FROM WORKERS'COMPENSATION DECLARATION " Clarifiers I , Solar Collectors • Dishwasher -• • , Meter Dover 100 amps ' (This section need not be completed if the permit is for one hundred ($100) or - - - _ . ' less). Dishwasher . Solar Piping Dryers •❑Gas ❑Electric . • . - Sub Panel - ' ' I certify that in the performance of the work for which this ermit is issued, 1 I - _1 .. - ' shall not employ znya person.in any manners asfty beccypn ubject to the Drinking Fountains Solar Tank Fan Motors,❑0-1 HP ❑1/:-8 - - WorDate l( Compen 5 - a. Lawsbt ure / / J/ �• - _ - % I __ + Date, / �,efte •Y' SignatureCarta. •lYrs.L, Floor Drains -' • Swimming Pool w/SpaF.A.U. .Inc.Solar Og-15 HP• ❑16-15+ NOTICE:If, per making this decla , you should•become subject to the , - - - - ' Workers' Compensation ,provisions of the Labor.Code, you must forthwith —F100l Sin kS - i - • ' , comply with such provisions or this permit shall be deemed revoked. Urinal Fixtures • Microwave CONSTRUCTION-LENDING AGENCY . • Gas Service Outlets f • Water Closet . I hereby affirm that there•is a construction lending agency for the performance Device Boxes POIe Light - ' - , of the work,for ,which this permit is issued (Section 3097 Civ. C.) Interce tors ' 'r Water Heater - Lender's Name J��J� p * Outlets r t Range I _ •- Lender's Address • - • A - ' - - Kitchen Sink ' - - - Water Service' ' -- - ' '•-• Switches - •- -' ' - - OWNER BUILDER'DECLARATION Sign , I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ... ,t{ - pro.. -Auto-Wash • . following reason (Section 7031.5 Business and Professional Code: Any city or - Garbage Disposal Standing Sections i • s county which requires•a permit to construct,alter,improve,demolish or repair ' P-Trap ,..y , , _ - Lau ndry,Trays Generator❑0.5 KW❑5-15 KW !I I any structure, prior to its issuance, also requires the applicant for such permit trash C.Ompact0! to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains. - - • the Contractor's License Law (Chapter 9 (commencing with Section 7000) of �� ' Division 3 of the Business and'Professions Code) or that he/she is exempt - - -'- - " - -' ' therefrom and the basis for the alleged exemption. Any violation of Section • 1 - - . ' • '031,5 by any applicant for a permit subjects the applicant to a civil - - I nalty of not.more than five hundred dollars($500). 1. - ; i Ad, as owner of the property or my employees with wages as their sole Reinspection Fee' l $15 Issue Fee $ 3 - . compensation, will do the work; and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee ' $ 3 ' for sale (Section'7044, Business'and Professional Code:'The.Contractor's , ' MECHANICAL FEES - • License Law does not apply to an owner of a Property who builds or improves - - • - - thereon, and who does such•work himself/herself or through his or her own • - _ DEVELOPMENT SERVICES REQUIREMFf1,TS: ' - ' employees, provided that such,,jmprovements are not intended or offered for Boiler 1 Hood or Type) 0 • 1I`-'ll. �,( �y��/� /f es sale. If„however, the.building S.improvement is sold within one'year of com- 1 - • ' Canopy Type II ❑ ! • Zoning Approved By - 1✓`+ry'� - Date / .+ pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground [�-�/�• ' prove for the purpose of sale). • I - • Building Approved By ! •Date �`oz0iccr� ❑ h, as owner of.the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date / tractors to construct the project (Section 7044,Business and Professions Code: ' The Contractor's License Law does not apply to an owner of pro perty.who Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU - SUMMARY OF FEES ' 'builds or Improves thereon, and who contracts for such projects with acon- '` 7• tractor(s),lmense.pursuant toithe Contractor's License Law). I am aware that - - - BUILDING PERMIT $ S, (SO SMTP - .$- ' Or 5-70_proof of their Worker's Compensation insurance should be provided to me. Exhaust System'� -Multiple ❑ System Repair/Alteration — - PLAN CHECK $� .28. 9Z PERMIT- ❑ 1 am exempt under Section B. & P.C.for this reason- • Firepl/Fact.Bit ICBG# Fire Dampers - ISSUANCE $ Date .. Owner • HeatingSystem'&DuctingRegisters • : PLU • MBING ' • $ _, - PLAN CHECK 25% $ - ENERGY P.C. $^ . i hereby certify correct I have read this application and state that the above - - 00-100,0001 . BTU ❑100,000 BTI. - • - GRADING $ ' information is correct. I agree to comply with all'city and county ordinances ELECTRICAL .$ - • - and state laws•re ti to b ing co str ction, and hereby authorize re re- - 1 - -MICROFILM $; snspec io of t to i r p _ f�e above-mentioned pro erty for_ _ PLAN CHECK 50% $. • - . _ p • Inspection ses /6/ �'(T1'� �1 MECHANICAL $ - . ,TOTAL FEE -$, •�`?"`Z Signature Date .'rd - • • - Drivers'J se or SS 'Reinspection Fee '$15 • Issue Fee �$- 3 PLAN CHECK 25% '$ • • `,CMF 0865-46,rev.10/84 - Applicant; Pink -Accounting; Goldenrod - Assessor ' _ • _ - -S i • / � - NSTRUCTION AND PLANNING. POOL &SPA ' I 'PPROVALS , Permit# Date Inspector APPROVALS Permit# - Date Inspector 1: Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. . ' 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. - FF 57. APPROVAL TO COVER-GUNITE 7. Footings Y f f t ✓ . 58. Electrical Conduit-Undrgrnd. • . 8. Foundation' - 59'. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - -60. •Backwash Lines„P-Trap, 0 Undrgrnd. . 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . • 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains. - 64. Plumbing System - Final ' . , i 14. Rough Plumbing •. - . 65. Electrical-Final 15. Rough Electrical-Conduit . 66. Solar System-Final . . 16. Rough Electric Wiring 67. Fencing & Access Approval • -1 •- i 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS,FINAL ' ' • 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • ,-. 20. Rough Factory Fireplace APPROVALS Permit# , ' - 21. Ducts, in.Structure 70. Underground Hydro , 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24.•R'oof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing I00 • VC, 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat ',ft { 75. Dry Chemical . • r 27. Frame and Flashing �(� 76. Dry Standpipe28. Lathing & Siding g vC- 77. FIXED SYSTEM FINAL 29. Irisulation 172A ii� Vt- 78. FIRE PREV. FINAL - 30. Drywall Nailing - /// A HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 9/ O e,�/ 79. FINAL INSPECTION .. • . 32. Electrical Power Meter-Final os /G/- ' 80. FOOD CERTIFICATE ISSUED l 33. Final Electric Notes: (� , 34. Final Heating.8/Air Conditioning • /j,�� .° I/ _- _ /L . . 35. Final Gas Pipe-Test ' • i''. 36. Hood or Canopy - . 37. Final:Factory Fireplace 38. Final Plumbing - . - • . 39' Water Service-Final - - '.40. Gas Service-Final - • '41. Solar Domestic-Final - ' A. . ..42. Backflow Preventer - 43. Backflow Irrigation ' 44. Landscape Irrigation System - ' 45. Sound Attenuation - , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 00, /lf Aazca //_ k / 48. Special Requirements Completed . 49. Electric Release to Edison - - 50. Gas Release to-Southern California Gas Co - . - • 51. CERTIFICATE OF OCCUPANCY" \ No. Date _ _ ,,, \ LOT 46 TRACT 4395 16321 FE RECEIVED JAN 3 11962 • COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX 817 COSTA MESA. CALIFORNIA CITY OF COSTA MESA .11 1 For Applicant to Fill In Completely APPLICATION FOR PERMIT . _I TYPE OR PRINT / / BUILDING "ADD EISS // (O ,(T/o/Seri( // ,,�(.ne COSTA MESA. CALIFORNIA For Office Use Only I I RECEIPT NO. I PER��FIIG"2 1 'OWNER K. &K DEVELOPMENT Co . , INC. � VVff LL// MAIL RECE VED BY DATE RECEIVED I DATE ISS" ADDRESS 1555 PLA CENT IA AVENUE,, I 1-- -9- .1 JAN 31 19b2 CITY NEWPORT BEACH TEL. 63227 BUILDING - - ADDRESS ORARCENGI EER NONE HITECT NO. COSTA MESA. CALIFORNIA • FIRE / ADDRESS ZONE TYPE GROUP\�.,,{� 1APPROVED �/ CONTRACTOR K. W. KOLL BY DATE . ADDRESS 1555 PLA CENT IA AVENUE ZONING ZONE NO.OF USE OF NEW/�y n9.-J,J.y. RV CITY NEWPORT BEACH R -� ( PLANE a I BUILDING 4. 4 r q4,. LIC.NO. / LEGAL ..c STATE' 61195 NOL:• M .__0-3227 - DESCRIPTION LOQ" 96 Te y37.S— SIZE /� � NO. OF SLOGS. OF LOT i..< .4 /Ob I NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG, NONE APPROVED ALLOWED SETBACK LINE FROM ��]] / (CENTER LINE ST.) CENTER OF STREET �d I REAR YARD_23 C' FRONT SO FT. IN. SIDE YARD I LEFT 7/ I RIGHT 7 / R.SIDE 7 FT. " IN. DESCRIPTION OF WORK L.SIDE 7 FT. " IN. NEW I X II ALTERATION I II ADDITION REAR 2 3 FT. L/LIN. REPAIR I LOVING I °DEMOLISH I APPROVED /� BUILDING /..3/0Sy ff NO. OF / BY ay-4 DATE //30/62. SIZE�(/ar 5/0 KrtO ROOMS // STORIES EXTERIOR WALL p ROOF L-Orh/0O y��U. 0-TU J COVERING UC COI COVERING S'I)in Je -' USE OF BUILDING AND WORK TO BE PERFORMED / >V �> 12. SINGLE FAMILY RESIDENCE WITH ,- fe5 ' TT ATTACHED GARAGE. . PLAN # .2/9I 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. N ) VALUATION SIGNAPERMITURE OF /C'�(/ ,�/ � PERMIT FEE $ X61— N $ /I/J� �•— PLAN CHECK $ ,�a to `Y' S AUTHORIZED AGENT TOTAL FEE $ ,3-7V----- O 4