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Home My WebLink About1150 DORSET LN - Building PermitsC (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1150 DORSET LN Suite No Vicinity: Parcel Nunmber: 14114213 Applicant: BELL, RALPH Address: 11801 MAC ST Phone: (714)534-2593 GARDEN GROVE, CA Zip: 92641 Owner: MC ALEER, SHIRLEY J TR Address 1150 DORSET LN Phone: COSTA MESA, CA Zip: 92626-2861 Contractor: CRYSTAL AIR Address: 11801 MAC ST Phone: (714)534-2593 GARDEN GROVE, CA Zip: 92641 License: 655036 SCOPE OF PERMIT REPLACE FAU AND ADD AIR CONDITIONING UNIT Status: ISSUED Applied: 06/11/2002 Issued: 06/11/2002 C� ISSUED BY: 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 2406-46(6/00) FEESUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 ft $0.00 0 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 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kva/kw $0.00 „ 0 Lighting Fixts $0.00 0 .................up to 50 kva/kw $0.00 , '0 Recept Outlets $0.00 0 .................up to 100 kva/kw $0.00 0 Switches $0.00 :, 0 ..................over 100 kva/kw ; , $0.00,' 0 Non Res Appl $0.00 0 Low Voltage Equipment - $0.00 0 Res Appl $0.00 0 Low Voll Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 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 $12.30 1 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 $35.80 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 2406-46(6/00) DECLARATIONS 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' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This action need not be completed if the permit is valued at one hundred dollars ($100) or less.) IJM ;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 thes r ns. C 1AApplicant Signature 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 TOTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affinn.Mat .I amlicensed undorprovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Businestn4P fessions Code, and my license is in full �forca ,;To act. as �7. OS - amass, dd�J Contractr=lgna re: CDate CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 s civil penalty of not more than five hundred dollars ($500).): w: ❑ I, as owner of the property,oror my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for cele (Sec. 7044, Business and ProfessionsCode: 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. It, 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.). ❑ 1, as owner of the property; am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers 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). ❑ 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, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................................................... ........................................................................................................................................................................................... ............................................................... I .......... .................... 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................................................................................................................................................................................................ ,............................................................. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (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 ❑ No ...... ......................................................_.............................................................................................................................................. ..................................................................................... ...................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a_LPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Lj Yes LJ 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). . ..................................................... -.................................................................................................................................................................................................................................................................................................................................... 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .................................................................................................................................................................................................................................... ........... .... .................................. ... ..................................................... - ............. ................. B (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ftlure Of Legal Owner(s) - Date And/Or.Authorfze l Applicant Date— CODE A. INSPECTION TYPE DATE INTITALS L DEA INSPECTION TYPE ITE INITTIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical M � 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 (714) 754.5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1150 DORSET LN Suite No Vicinity: Parcel Number: 14114213 Applicant: BELL, RALPH Address: 11801 MAC ST Phone: (714)534-2593 GARDEN GROVE, CA Zip: 92641 Owner: MC ALEER, SHIRLEY J TR Address: 1150 DORSET LN Phone: COSTA MESA, CA Zip: 92626-2861 Contractor: CRYSTAL AIR Address: 11801 MAC ST Phone: (714)534-2593 Status: ISSUED Applied: 06/11/2002 Issued: 06/11/2002 ISSUED BY: .L GARDEN GROVE, CA Zip: 92641 License: 655036 - SCOPE OF PERMIT ' REPLACE FAU AND ADD AIR CONDITIONING UNIT - 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 Ventilation 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 Up to 3 hp / 100 k BTU - $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp / 500 k BTU $0.00 0 Hood w/Meth Exhaust $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp /.1,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00-- -0 - . Over 50 hp / Over,1,750 BTU $0.00 0 Appliance $0.00 0 Boilers - Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp '$27.15 1 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 $65.45 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 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 result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7645626 2"646 (6800) r DECLARATIONS WORKERSCOMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 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: (Thi section need not be completed if the permit is valued atone hundred dollars ($100) or less.) �7I 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 Apphcdht:Sign- acture WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3703 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full ,formarldeflect-L`i� n fS D ) A cclai tl=> c --AD 1__ c�Slgrla`ture: ��, . J 1 �Dete:—+ [g -11 -!1 L+ CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code), Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a 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.). ❑ 1, 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby cor ify 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, 1 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 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal t0 or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................-............................................................................................................................................................................................................................................................................................................. 2 Does or will the applicant Or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity Of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this,aplication a, Lmirrit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? a Yes LJ 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? ❑ 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? ❑ Yes ❑ No ...8..........(..I.f...".y...e..s...".., ..a...t.t..a..c...h................................................................................................................................................................................................................................................................................................................cert.ific..ate of.c.o...m.plian.ce........ from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sture Of Legal Owner(s) - Date e •AuthorIzad'Appllcant GDa e7 CODE I. INSPECTION TYPE DATE INITIALS CODE INSPECTION TYPE UU� �) IIR�IMELS 1616 Fixed System Final Fire Prevention 206 Final Mechanical a7 /N %j "--`-,7-) 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1150 DORSET LN Suite No Vicinity: Parcel Nunmber: 14114213 Applicant: KAMINSKY, PAUL Address: 11612 KNOTT'ST Phone: (714)895-1246 GARDEN GROVE, CA Zip: 92841 Owner: MC ALEER, SHIRLEY J TR Address 1150 bORSET LN Phone: COSTA MESA, CA Zip: 92626-2861 Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Arch / Eng : Address: Phone: (714)895-1246 GARDEN GROVE, CA Zip: 92841 License: 707775 Phone: Zip: License: Status: ISSUED Applied: 06/24/2002 Issued: 06/24/2002 ISSUED BY: SCOPE OF PERMIT WATER HEATER CHANGE OUT. 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 $0.00 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 $0.00 0 - Water Heater / vent $12.30 1 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 $0.00 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: $35.80 COMMENTS I 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: Thispermit 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 244646(6/00) F -A DECLARATIONS WORKERS' COMPENSATION DECLARATION: 1 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 Wit 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 if the permit is valued at One hundred dollars ($100) or less.) z ❑ 1 cantly that in pedorma h 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 aws of Calif a e Thai it I should become subject to the workers' compensation provisions of Secl'joon 37 it of the Labor Code, I shall forthwith Comptywithe: IIXK cp 9�/ 02� Applicant Signature: Date: / I WARNING: FAILURE TO SECURE WORKERS' COMP ATION OVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES AND 6AVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO E COSTO COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I en u e pro 'sions orChapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. p Class p Contractors Signature: Date: 14 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construct) 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 fallowing 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 pernit 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).): ❑ 1, 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.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) 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 e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or, future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..............................................................................................................................................................................._........................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cade, 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 ❑ No .................................................................................................................................................................................................,............................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-1 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? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................ .................................. ............... _.-.................................. -................. ............._...... ......._......... ...................... ............................ I............... .............................................................. _............................... ....... ........ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No _..... .............. ........................................................................................................................................ ..........................................................................._............... .............. __...................................................................... 8 (II yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-describednspec' urposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection, I i gf C� Of gal Owners) � - CAndfOr Authonz�d Applicant f i Date CODE I. INSPECTION TYPE pATE 1111117TRUS CODE f INSPECTION TYPE 2M IBIIDALi 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing Vy 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 ADDRESS OF BUILDING: 11 Du L)Vit5h I LN OWNERS NAME IF KNOWN: MC AL EER , DAVID T ADDRESS. 1150 DORSET LN COSTA MESA,CA ADPL. MAILING ADDRESS, ARCHITECT OR ENGINEER: M. OR ENG'S ADDRESS: UNIT: FLOOD: X 47 92626 LIC. NO.: cohnflAcTors N.e1. CALTON ROOFING (714)549-8862 CONTRACTOnMAIM 3125 MC KINLEY WY ADDRESS: COSTA MESA CA utfic, 587704 92626 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under penely of perjury thou I an licensed under pr.vW. of Chapter g (mmme"ars with Sectlon ]000) a Dieisces n 3 d the Sudrwand Pmbon sas Code. my Iiml as is i R tweed A wee. CITY LIC. NO, 051149 LIC. Cuss: C 39 u�: 5 % i0P E y : 0 9 atm — 7 Cenbad«:le ER BUILDER DECLARATION: I hereby affirm under penaly of perjury that I am memyt from IM Contractors License Lew for the following reason (Section 7031.5 Buainma and Professions Code: Any city or ccunly whits requirss a permit to com uc. after, improve, Ymolsh, or repair my auueum, pior to its Issuance also requires the ynplimnt for such pnmh to fib a signed sNtemenl Neu M or am Iiumewl pursuant m the pro a ccs of the Canlred«s Iiceme Lew [Chapter 9 (commencing with seder, ]ODD) of Derision 3 of the .. and Prof.. Codel or that he or end I, mempt therefrom and the M® for Ute asgad manprlon. Arlt' vcdton of Seaton ,031.5 by my appcanl for a Wait subjects the appear, to a evil penalty of M more than Me hundred do0me NSOOD. ❑ 1. as, awmr of the property or my employees wkh wages m their ode mmpersation, will do the earth, and the smadurss mi intended or o$ered for We (Swoon 70aa, Business and Professions code: The Cmtraceom Loanse Lawdms non appy loan owners prop" wM Muds or inpmvee (hereon, and who due such work Nmself or henal «thrash M or her own employees, provdnd that such improvemms we not intmdnd or dferea for sale. N. however, the Minting or inprovemem is sold within we year of completion, the owmr-builder will have the burden of proving he or she dd not Mid or improve for the WTme of said). ❑ I. m owner of the Pep". am mdusivefy contractus van licensed contracdors to comwess for project (Sedan ]Cera. Business And Pmfestims Cade: TM Contractors, L'cer e, Lew does sot apply to an center of property waw Mils or Ynpwm thereon end who contacts for mot Maeda w th a cornrectans) Iteral pursuaa to the Cmtrad«a License Law). ❑ 1 am es<mpl under Section: B. 8 P.C., for this reason: Dote: Owner: I do hereby tenth, Most I am aware of and understand IM requirements of CaTomia heafth and Salty Code Sections 25505, ?5533. and 2553x, and Nat I or my future Wiling co upeol will / will rte (circa ate) need 0 campy with said este cods nd the rpuiremmb for apamit/«mnauuctionormadifxatianhamtMAi=7W_magemmt Diems.Ra®dendiwomrvdion appiratioroanesemp h«nNme pw alons. Dare: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby Affirm under Wary or mrjury one of the fdlwirs dederatons: ❑ I have ane will maintein a caftiute il mto sent insure wxkeri mmpaneatbn, m provled r« by Sadiron 3]00 a the labor coact. for the pedmmume of the wand for sMi wldcn Nis poser is s tweed. ] I have and eu maintain enndera• mmpn,aaton insurance, m remixed by Section 3700 of Ne Labor Code. for IM performance of the work f«wndn thisCp�® mud My workers S3�ATEx FUND and poky number are: EXPIRES Policy Num dei — 01/01/98 mix section nese not M completed a the pmrra is for and humored doll. I$I071 or law) ❑ maty the in the padormanm d the teak f« whloh [hie permit s iesund, I shall ml employ penin In alry manner m m tan become cubjed to the wonders' compmsution Awe d Cadmus, and ogres Nat N ohm aubjed to the compnmtlmn provisions of Section 3700 of the Labor Code. I ah`a[Sfmhw�itth ooanpry efts S� Applicant X- Le /w T. m--11'✓r/ng: Falun ro heuroal Mem mmpmmtlon04"), In unlikes and coal f Wil an employe ro l jai p yn Aend dull on 3 up to sons Labor CC Noollrtd away woD,OmA In eddltbn ro Ns coat pl mmperbedon, damNpl m pmvWed br In $oCNOn 3%/N OI NO LIiIO/ DmdJ, InII/IlI, 1/d IIIPMey'I iM1. , CONSTRUCTION LENDING AGENCY: I hereby affirm under penafty of perjury thin them is a construction andinp Mmcy M the performance of the suck for which this perm is issued (Sedan 3091. Ce, C), LENDER'S NAME: LENDER'S ADDRESS: I candy that I leve read this applcaion and mate [hat the above information is sorted. I agree to coupy with all dry Lid county ordinerrml and state laws relating to building construction and hereby authorize representatives of this city to enter upon the ebwe memined prop" for inspeawn Wrmses. MIKE CALTON (5151.".WP) WhIG-Building A Safely; Cree le: Canary-Appimnt; Pink -Revenue; Ooldenmct AMseesor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 083931 PERMIT NO: B 083931 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION T/O SHAKE INSTALL 1/2" PLWD AND COMP SHN SQ FT: 5,200 CLAIM VALUE: 5,200.00 CALL—VALUE: 5,200.00 GROUP OCC: R-3 /U-1 COMMENTS: REROOF iF dE��*�**��*RFMiF RE Ri dE*****RE dE iE dE*iF dE SE �ERr�E+E*+E �E rr*RE+r RERr Rr Rr�F RERH**+E*+r*REQ*rr*�*rE RE��E+E RE**�H*RE��sF+E*RE Z O N I N G R E Q U I R E M E N T S S E B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN —LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 14114213 ZNE: REF NO: PLANNING NOTES> C� dE RE*dFdh*irk irk**ih irk ih cif',Nrif irk dF***db dF*dFiE BF*dE df dh dE cit dE*iE*irk***iE**MRF****RF*dE iE**iH iH dE dh RE dE dEiF*dE iE HE iH It iE BE RE iE dtdE iE Bt Rt D E V E,..I.. O P M E N T S E R V I C E S R E Q U I R E M E N ji, S ZONING APPROVED'BY DATE: BUILDING APPROVED BY ; DATE: r.1 i APPLICATION ISSUED BY: DATE: RF iF dE irk*dtiF**dE irkdH dE if dE dE**dE*** �i�iFii*iE***Rt dE dE dE ** LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 112,25 .52 PLAN SMIP/NON—RES ' ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 112.77 0.00 0,00 112.77 112.77 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 112.77 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 112.25 .52 dEM dF iH*dP*dF irk dH**dF*irk*dF irk irk*dF df dh dE*dF df if cit dE dk*dE irk df*df dE dE RE RE REdEk*iE***dE*Rh BE dE*iE irk dF iH*dE RE RF dE iE RE iE cit RF REdt dE RE dF*dE dH iE* I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 5200 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 5,200.00 END OF FEES 07-28-1997/83:36 PHA112.77 RCPT0:01-8009819 PERMIT:083931 CONSTRUCTION AND PLANNING'r POOL ,PA 1� t Date �' Inspector APPROVALS Permit Date Inspector APPROVALS Permit# 1., Temporary Electrical Service or Pole 52. Pool & [Equipment Location ' 2. Soil Pipe-Undrgrnd. t' - - - 53. Steel Reinforcement 3.%Electrical Cond'ujt_Utillty-Undrgrni . 54. Forms <4tIlectrical Conduit-Ui}drgrnd. - 55. Electrical Bonding ., J.:Steel Reinforcemens_. 56. Rough Plumbing & Pressure Test ' 'r ElectricalUFE$�Grnii. '57. APPROVAL TO COVE R-GUNITE _ 7:.Footings T< --" 58. Electrical Conduit,Undrgrnd. X81 Foundation 59. Gas Pipe, 0 Undrgrnd., Test M . 9. Water Pipe-Undrgmd.;" 60, Backwash -Lines; Wrap, O*Undrgrnd. ' 10. Structural Floor System tl" 61. APPROVAL TO,DECK 11. Property Sewer line_& House -Connection _ 62: Backwash &:RecQgtor-Final 12.'',Sewer Cap - 7. - 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!.W_iriig 67; Fencing & Acceis-ApProval` -- ' 17. Rough Wiring Sign - - 68: APPROVED F6R'PLASTERING " y18. Rough ElectricaliT Bar Ceiling - -69. POOL/SPA SYSLEMS FINAL - -19. Rough Heating &'Air'Conditioni g Y � � FIRE' DEPT. REQUIREMENT io APPROVUS;C Permit #� t•- 20.a�ough Factory Fir".eplace �� F� * T �",± �. 21.'Oucts, in_Structure x - •- g S ^ ,--^ 70.-'Underg'r'& nd Ijydro _ 22.,Duc2R, Vantilaytin9='4 iin_'q Q:Gas toil 71.•Prod¢t~ c r- 23. Gas;l?ipe-Rough &_Test 72. Underground Flush" ." t ",. 24. Roof=Framing• `' .j T 73, Undergra'd. Storage fian4 ❑ Gas 17'Oil 25. RoofShtithing Dr < v�, • /I - 74a -Overhead Hydro ✓ x 26.--T-Bar Ceiling (Structural) & Mojacoat # e v :_� 7Z 75, bry Che�migal 7 *rD P1 27.z rame and Flashing, 1s o! r 5 ;. t�.:• 76.• Dry Staa6pipe�•'� i. n „ r ., 28. Latfng & Siding + ti "' "=t _ . S FIXEDo-=STE69'�INAi. - Y 73, SY .1 11 7 _ 29. Insulation t. _ s •• i 1 78'. FIRE PREY. FINAL- " 30. Drywall Nailing �, w �; ( � LHEALTN DEPT:REQUIf�MENT r 31. Plaster Brown ;Coat <, S 1 t I I ft ^• 79' FINAL LfNSPECT10N "i: 32.1-Electricaf-Pmwkr Meter -Final i %t` 807 FOOD CERTIFd;CATE ISSUED -33.:Kinal;ElectricY i tr;�: �:-. I'."� Notes: _y -:R7 :,:'� 0 ••ITI ~ _�" i. w 34.,,5in947Heating_& AirConditionigj .^• s r "" G; S :�: ,fi S t77 r T -4 4z .n } 35.Final-GaS Pipe"t,-,Testes I _ r 36. Hood -or Canopy :.a t^ -" �' ; f• i =- ' s,•^ -��` _ rn •--1 • 37.'6inal;Factory Firep�aceh �• 1 ., ._ t lel , .r i (i! ` 1 t v 38. Final:Plumbing * v ' ✓ r I i tb K - ""' '"� -� `-- s M. .L - 39. Watei lu Seivice-Final ; _ t' 1 1 1f. f `-� P7 J , 40. Gas Service -Final T :, @7T s ,: r. I I k% ^:� I,w i. - 41. Solar DoNsttc-Fina. 's 1• * r�• I ` yr.- `� _ 42. 'Back f low:Pre venter .i, ;j I tit ^• 43. BackfloZIrrigation r t-, i44. Landscape Ircigation Systema_' ^• i t^ '7 :~:,: "' '.v `+ _ 45. Sound Attenuationx , r46. Nandicap.Regulations J - r • _ - •- .�' ' 47l FINAL STRUCTURE & BUILDING 481. WINXL PLANNINGI ,N .11 49. Electric Release to Edison -50. Gas.R.,elease to -Southern California Gas Co . - - - n .z ., " CERTIFICATE OF OCCUPANCY = - -511 No. Date _ T. 77 . APPI�.O�D _ - _ I CITY OF COSTA MESA - ' - - PLANNING -DEPTt _ _.. _ _ SU I:{7 70 F_ - BLDG. DEPT ,REG„ %% DATE DIRECToY OF-PLAMNINO _ SSV_ - • I �= -- - _ - r RUCTURAL A .P - ROVq! Q' - PARATE: *R _t -- i costa - '- _ _S - PERMIT : ARE. RE UIR FOR ELECTRICA �- - - VENTILATING WITS- - HEATING,- INS.: -AND - -`_` REFRIOERq _ C' : of Mesa Building DePt. ; { DA o- U -BY.- - - - _TF,•IEs PLANS MUST, -BE ON :JOB'AT'ALL"TIMES • APPROVAL I y TION- WORT( MAKE ,CHANGES_ WITHOUTPRIOR' �— • r�t)i�tt-#- - - -THI NUir,t4ER-� IjST - ._-._ , :. - THE ISSUANCE OR GRANTING OF R PERMIT OR APPROVAL OF PLANS AND SPECIFICATIONS -SHALL 4NOT.-BE CUtl§ RUm - -- -• .'_ !0 BE-A-PERMII- FOR, -OR AN-AFFROVAL OF ANY VIOLATION + I A" OMPA Y_ } - lJ PRE - OF -ANY 0!-TNE PROVISIONS OF'lHIS•COOE NO PERMIT PRE- - __.SPECT {REQUESTS-' r- �y SUMINO TO -GIVE 0.UTHORITYj TO VIOLATE- OR -CANCEL- THS -PoR BUIEDINGS WHERE -PER -SE-E MPLOYED -t1'�E ,6S ARE TO- STATE] OF: CALIF�J (j}(njE HAi THE - �- , . INDUSTRIgI-SAFETY FAR -AS THE: WORK OR"USE WHICH-IY- I-__ __ . dAWFUi_i µ , ___ _ .- _- p�E ISSUANCE'0 A P,(RMli 8A5EO UPON PLANS AND - IC iIOMS SHA6E N E -THE BUIl01NG OFFIpAII S r*'GrF LV Nt - ' + • _ ' DIVISION OF - _ ADDIflONAL RE BE CONSULTED - c FROM THEREAFTER �REQUIRINO THE CORRECTION OF ERRORS' - -FROM' I 1 RE . FOR. I _ S— IN SAIp PLANS AN SPRCIFICATIONS' OR PREVENTIN01 IN ILOINO QPERATI INO Q(f�iIEBZN fE U WHEN, 1 I VIOIIIFI@A9E. Oft_OOff_t��OE ��1Yf ��N WHEN " ' + - - G - - -- - -- - - - - - - - OF"IQI 6 I I _ - 7i, vim,' _. 1: f ::::: t :. : UWNtR D. MCALEER UAlt 10-10-79 JOB ADDRESS 1150 Dorset Lane BUILDING PERMIT NO. 48940 GENERAL CONTRACTOR L. J. Haussler DESCRIPTION of WORK Alum Patio Cover AM. 141-142-13 LOT 45 TRACT 4395 FIRE ZONE VALUE$ 950.00 INWECTIONS Si nature I Date ITYPE GROUP ZONE GAS OIL SUBCONTRACTOR MITS SS Dale Number Signature WATER. Plumbin ROUGH PLUMBING PROP. $W R. LINE HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND I] POWER C] ROUGH WIRING Hectina and Vent. TRENCHES r7 FORMS 0 STEEL REINF. ED i FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT 1&2.BROWN COAT 5URAL, FINAL HE NG, VENT., REFRIG. AND A.C., FINAL PLUMBING. FINAL AND GAS TEST ELECTRIC, FINAL BUILDING, FINAL 10 SPECIAL REOUIREMIZNTS Dat sigi CL' COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 4649 j0/10/79 10.50 TL APPLICATION: FOR STRUCTURAL PERMIT RECEIVED By PERMIT NO 48940 PI For Applicant to Fill in Completely — Use Ink Only ADILDING DRESS \ A.P. NO. OWNER OR �C �� TENANT BUILDING ADDRESS UNITOR MAILING SPACE NO. ADDRESS TR.N LOT BLK. TEL. CITY NO. NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCHc OWNER ADDRESS VALUE Ob ARCHITECT TEL. USE $ OR ENGINEER N ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR. BY DATE 7'� (� SG/CC /s�E ADDRESS TE CCjITY N STATE CITY APPROVED SETBACKS LIC. NO. ( LIC. NO. SIZE / NO. OF BL[Na5. 41 y X t I (FROM C/L STREET) Xk_FT�' OF LOT NOW ON LOT FROM USE OF /f 77'f %s F YI-r T EXISTING BLDG. ,(j IDE Separate permits are required for L. SIDE –5 FT. — electric, plumbing and heating work. f — �— REAR FT. USE OFTBULLDING A WORK TO BE PERF D _ PLANNING ACTION ,U \ GAJ (y ' DATE APPROVED • APPROVED DATE bila 1 hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person In violation of the workman's compensation laws of the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business and Professions Code, Division 3, Chapter 9. VALUATION PERMIT FEE $ 0 100 Signature of PLAN CHECK $ �— Permittee -`� S (/ TAX $ –G ar ( Authorizetl Agent Date TOTAL PAID $ Lf� T�45 'TRACT 4395 16320 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA e For Applicant to Fill In Completely TYPE OR PRINT BUILDING /Lv `71 lS,�i / ,q Q— SS ADDREJ .(/ .(-Q COSTA MESA. CALIFORNIA FSE RECEIVED I JAN 3 11962 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use. Only RECEIPT NO. 0�. NER COINC.G� 2 }TE 7-' DATE 188UED RECEIYED BY 7177-'L-1.1471 /Y-6.�-I JAN 31 1962 IL DRESS CE T AVENUE / TEL.TY NEWPORT BEACH NO.MI 6 22 [ADDRESS BUILDING ADDRESS NEER NONE COSTA MESA. CALIFORNIA No. ----- FIRE O ZONE TYPE GROUP APPROVED BY DATE CONTRACTOR K. W. KOLL ADDRESS 1555PLACENTIA AVENUE ZONING CITY NEWPORT BEACH ZONE /{�—/ NO. OF (ne Z FLA USE OF NEW S",y Z7' -R.'. euILO1NO q, ail ai / LIC.TE TEL.NO. 61 NO. .M I . 6- 22 LEGAL t t [1S %� 1i3 DEBCRIPTION SIZE / I NO. OF B --S. O OF LOT O Now ON LOT A. P. NO. USE OF YARDS EVES EXISTING BLDG. NONE APPROVED ALLOWED SETBACK LINK FROM J� / (CENTER LINE eTJ CENTER OF STREET REAR YARD �S FRONT 'S/ FT. IN. I.LEFT - I SIDE YARD RIGHT R, SIDE 7 FT. IN. DESCRIPTION OF WORK 7 L. SIDE FT. —j IN. NE' X I ALTERATION I I ADDITION REAR Z S FT. IN. REPAIR II MOVING DEMOLISH AAPPROVED�//I DATE INN NG %$L NO OF�JII 4442 BZEC R06M6 //J STORIES 1 EXTERIOR WALL ROOF COVERING STUCCO COVERING iiC�(// USE OF BUILDING AND WORK TO BE PERFORMED j - NG FAMILYRESIDENCE WITH % ATTACHED GARAGE. / ' PLAN # �J I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIGTION THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 3" BUILDING CONSTRUCTION. SIGNATURE OF �'� H ,1A PERMIT FEES PERMITTEEy/ $ ) �/ /r PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE 4; / �—