HomeMy WebLinkAbout1158 DORSET LN - Building Permits •
CITY-OF COSTA MESA
4 - BUILDING DIVISION
F y ri -4i DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
• PERMIT
4%.011.9T003# B00-01880
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.au�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1158 DORSET LN tlU Status: ISSUED
Suite: Applied: 11/20/2000
Vicinity: Issued: 01/03/2001
Parcel Number: 14114215 Zoning:
Applicant: ALFI, JAMIL ISSUED BY:
Address:
Phone: 714-546-1806
Zip:
Owner: ALFI, JAMIL E
Address 1158 DORSET LN
Phone:
COSTA MESA, CA Zip: 92626
Contractor:
Address:
Phone:
Zip: License:
Arch : Eng: REZIR, FARHAD
Address: Address: 18141 BEACH BLVD.
Phone: SUITE 295 Phone: 714-841-0337
HUNTINGTON BEACH, CA
Zip: License: 92648 License: 3970
SCOPE OF PERMIT
ADD 947 SQ. FT.TO EXISTING RESIDENCE. EXTEND KITCHEN AREA,ADD ONE MASTER BEDROOM,ADD ONE NEW
BATH IN MASTER BEDROOM AREA AND ADD ONE FAMILY ROOM. REMODEL BATHROOM AND KITCHEN, REPLACE WINDOWS.
• FEE SUMMARY
Plan Check: $573.14 Calc Valuation: $83,968.50
Permit: $881.75 Claim Valuation: $0.00
SMIP Res: $8.40
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,463.29 -
PLANNING &ZONING
SETBACKS •
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right • 0-0 .
ACCESSORY Front 0-0 Rear 0-0 Left' 0-0 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 permit. of
FOR INSPECTIONS CALL: (714)754-5626
//�J
246646(6'00)
T
WI
COMPENSATION LARTIN / -
hereby affirm under penaltyNSAOof perjDECury oneAof
Othe:
following declarations: • r • --.•,• 14
❑ 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 TOONE HUNDRED
THOUSAND DOLLARE($100,000),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 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
tryithin 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.).
wner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
oe: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 exam t under sec. Business and Professions Code for this reason:
_LSlgna :./_ _ Date: 3 a I
Owner ID verified by driver's!icons . 0 Yes 0 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).
❑ 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? 0 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? 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 akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? al 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? ❑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? ❑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 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
,}abbove-described property for inspecti purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
V
U. nature Of Legal Owner(s) J '/rn/
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE OAirt IEWAALS CODER 1NSPECTIONTYPE RAIE IIMIALB
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy /W2VD/ 0 La$ 4
9 CITY OF COSTA MESA
•
BUILDING DIVISION
). %
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 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 it 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 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 x
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: 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 permit
subjects the applicant to a civil penally 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 pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason: •
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 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).
❑ 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? 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,,ppermit 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 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? 0 Yes ❑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? 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 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.
(^)`SigOpture Of eget Owner v1 /: / O ' Date
'(nd/Or Authorized Ap icant i Date
CODE I INSPECTION TYPE PAIL INTrTIALS CODE INSPECTION TYPE MILE I
1618 Fixed System Final Fire Prevention _ 206 Final Mechanical /Wel `
l/
1266 Pool Spa Final 208 Final Plumbing if /W (8
el
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
CITYOF COSTA MESA
ea
BUILDING DIVISION
> r.� ,. DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
It. ��� i
PERMIT 01-00038
4%PoRmso.4'
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1158 DORSET LN Status: ISSUED
Suite No Applied: 01/16/2001
Vicinity: Issued: 01/16/2001
Parcel Nunmber: 14114215
Applicant: ALFI, JAMIL ISSUED BY:
Address:
Phone:
Zip:
Owner: ALFI, JAMIL E
Address 1158 DORSET LN
Phone:
COSTA MESA,CA Zip: 92626 ,
Contractor:
Address:
Phone:
Zip: •
License:
SCOPE OF PERMIT •
REF: BOO-01880. ELECTRICAL FOR ADDITION AND REMODEL OF SFR. 25 LIGHT FISTS., 37
• OUTLETS,20 SWITCHES, 1 RELOCATE AND UPGRADE SERVICE TO 200 AMPS.
FEE SUMMARY
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 $25.65 25 up to 50.kva/kw $0.00 0
Recept Outlets $34.41 37 up to 100 kva/kw $0.00 0
Switches $22.00 20 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 Volt Wiring System/Ckt $0.00 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 $136.06
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
2446-48(WOO) - 6I
DECLARATIONS ,rTh •r"--'
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 Cale,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.)
❑ 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(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.Lic.M Class N
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 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 properly,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 driver's license. ❑Yes 0 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 then 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 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? 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).
t u u e. occupant
need 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 appernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any pan 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? ❑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 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.
SignatureLegal Owne ( I IC/ D / Date
n`At prized iApplicant (`/ Date
CODE I INSPECTIONTYPE PEE JNTTAL6 POE INSPECTION TYPE gAIE pill
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing /)
200 Final Re-Roof 210 Final Electrical i2.27 cl / i2C/
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
CITY OF COSTA MESA
BUILDING DIVISION
> • orzaa : , : DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
rtPERMIT
M01-00017
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1158 DORSET LN Status: ISSUED
Suite No Applied: 01/16/2001
• Issued: 01/16/2001
Vicinity:
Parcel Number: 14114215 ISSUED BY:
Applicant: ALFI, JAMIL
Address:
Phone:
Zip:
Owner: ALFI, JAMIL E
Address: 1158 DORSET LN
Phone:
COSTA MESA,CA Zip: 92626
Contractor:
Address.
Phone:
Zip:
License:
Arch/Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
REF: B00-01880. MECHANICAL FOR ADDITION AND REMODEL OF SFR. 1 REPAIR/ALT
HEATING/COOLING SYSTEM, 1 REFRIG.SYSTEM, 1 KITCHEN HOOD, 1 VENT FAN, RELOCATE
1 APPLIANCE VENT.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU >100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $14.80 1 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/Mech Exhaust $10.65 1 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 $7.25 1 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 $0.00 0
Inst or Relocate Appl Vent $10.65 1 15 to 30 hp $0.00 0
Air Handlers c 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 $80.55
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) L/
DECLARATIONS 7"-N
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 cdmpfeted 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 FINES UP TO ONE HUNDRED
THOUSAND DglARE(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.tJc.# 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 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 properly,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 driver's license. 0 Yes 0 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).
❑ 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? 0 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? 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 aEermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LI No
(Section 65850.2 of the California Government Code requires that the requested information be fumished 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? ❑Yes ❑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 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
riinspection purposes.I ggggupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Leg Owner(s) / J n pa14 )
I
'.And/Or Authorized.Applicant I Date
;ODE I. INSPECTION TYPE 11rImALS CODE. tNSPFCTION TYPE !/ ItI�ILS
1616 Fixed System Final Fire Prevention 206 Final Mechanical L
1268 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
ADDRESS OF BUILNIO 1158 DORSET. LN UM1 CITY OF COSTA MESA - BUILDING PERMIT
a.WJWSNAMEIFaaMN: ALFI, JAMIL E FLOOD: X 46 PERM NO: P 083925
ADDRESS 1158 DORSET LN •
COSTA MESA,CA 92626 PERMIT NO: P 083925 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.SWUNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH
•
ARCHITECT OR ENGNEER: UC.NM: •
JOB DESCRIPTION : DISHWASHER CHANGE OUT SQ FT:
ARCH.OR EMI ADDRESS: INT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
CONWACTDIRSNAME: NOCK PLUMBING ( 714 ) 895-1246
•
CafmACTOf7S MIMMMS 11612 KNOTT ST COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT
ADDRESS GARDEN GROVE CA ucx0.: 707775 ************etataFiEatatatiFeF****i4+tiE*#at*+FiF*iF+eiraEetatatetitatititat**at*****atatat*at*iE+E*#****afitatft*****
92841 WUT 17 Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally d perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code•and my license is in full force end effect.
CRY UC.NO.: LIC.CLASS: LIC.NO.:
0 0386 C-36 ` 707 75 EXP: 02/98 MAIN BUILDING ACCESSORY BUILDING
'ld/9 Contractor /` y�/�Jt�/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
JLEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
0 ER BUILD R DECLA TION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the
wing reason(Section 7031.5 Buckles,and Professions Code:Any city«county which requires a permit to cnewn,mer,improve,
demolish,or repai any structure,pdor to its issuance,also requires the applicant for such permit to file a signed statement that heorshe PARKING REQ: PROV: PARCEL: 14114215 ZNE: REF NO:
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section
7031.5 by any applicant lore permit subjects the applicant to a chit penally of not more than Me hundred dollars lSSOoD. *******************************************************************************
❑ I,as owner of the property or my employees with wages as their sole compensation,will do the work,and the tincture is not intended
or offered lor sale(Section 7044,Business and Professions Code:The Contractors License Law does noappylo an Omer of property DEVELOPMENT SERVICES REQUIREMENTS
who buids or improves thereon,end who does such work Nmself or hersel 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 me yew of completion,the
owner-budder will have the burden of proving heor she did not build or improve for the purpose of sale). ZONING APPROVED BY DATE:
o Las owner of the property.am exclusively contracting who licensed contractors to canmad the project(Section 7044.Business and •
Professions Code:The Contractors License Law does nor apply to an owner d properly who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractorls)licensed pumuant to the Contractors License Law).
❑ lemexempt under Senn: B.APc..fix this reason: APPLICATION ISSUED BY 3ciF E DATE;
Date: Owner ********************************************** ****************34* **
•
Idohereby certify m
thatIaaw«eoandunderstandtherequirementsofcaliomiaHealthandSaeySections LEGALIZATION:N F E E SUMMARY STRUCTURAL S GMENT:N
35534,and that I or any future building occupant will/win not(circle one)need to comply with said nate codes and the requirements for
,a permit for construction or modification from the Ai anageent Dindd,Reeidentiatconstngon applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions.
°""' PERMIT 8 , 75
Date: Applicant: 25% SM I P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following deduati ns: PLAN
•
❑ I have end wit maintains certificate of consent to self-insure for workers'compensation,as provided for by Section 370001 the ISSUE FEE 22 , 00
Code.for the performance ofthe work lorwhich this permit oissued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
.n
thave and win maintain workers'compensation d
n insurance.as required by Section 3703 of the Labor Code.for the performancethe TOTALS----> 8 , 75 22 . 00 _ 0 . 00 30. 75 61 , 50 -30 , 75
work for which this permit is Sued.My workers'compensation insurance canier and policy number are:
Cartier fnrnr:U i:AnTS EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 30. 75 OVER/SHORT: . 00
Policy Number: NWC 32114101 09/01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
his section need not be completed i the permit lab one hundred dears(5lC0J or lase.) 30. 75
❑ nearly that in the performance of the work for which this perm is issued,I shall not employ any person in any manner so as to
bempan subject tel Ihe waMenin 3700 of the laws d California.and ah co R should become subject to the workers' *********************************************************************,**********
pne su p•• stoma. rape s the Labor Cada 1 a .h:: • those bealms.
Date: / INDIVIDUALApplicant: I D U A L F E E BREAKDOWN
Ws •:Failure to secure works 'compensation soverag.IsunlewM,and shall .pit ansmploysrto • -' . TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
lines up to one hundred thousand dollars(Sutg000),M addition to the cost of compensation,damages es Provided for in
action3706 of the Labor Cods,Interest,and attorney'.tee.. PLU 1 DISHWASHER 8 . 75 8 . 75
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that them is a construction lending agency for the
performance of the work for which this peon is issued(Section 3097,Ci,.C). END OF FEES
LENDER'S NAME: EXPIRED
p�
LENDER'S ADDRESS: L•�y^Lp �yi�� •
I certify that I have read this application and dale thel the above information is coned.I agree to comply with all dyed county ordinances FYI-+_ P E D p
and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly eCe>/
for inspection purposes.
• •CK DAA 07-30-1997/10:22 Apr/$30.75
7 Name RCPTN:U1-0009908
- At - Data 7/ / PERMIT :083925
Signature. s :/Agent/Appkcan ;intrer.
(5151d6.WP) While-Building A Safety:Green-Fn anary-Applicant:Pink-Revenue:Goldenrod-Assessor
1
-
CONSTRUCTION AND PLANNING ) , POOL 2A } -
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 Conduil•Utility-Undrgrnd. • .54. Forms ,;,-•
!�4;�Electrical Conduit-Undrgrnd. 55. Electrical Bonding . ' • •
•
.5jS>-reel Reinforcement'
- 56. Rough Plumbing & Pressure'Test -
6.: Electrical UFERrGrnd. - 57. APPROVAL TO COVER-GUNITE •
2-'7.'Footings f-i+min , , - 58. Electrical CondiritiUndrgrnd. . • , 1 ,w�-_.,
_ 8.:Foundation •i~ a• 1 - 59. Gas Pipe, 0 Undrgrnd.,Test" ' • • it i
T .
9. Water Pipe-Undrgrnd. °; - K - t - - , 60. Backwash Lines`P.Trap, 0 Undrgrnd.. .
10. Structural Floor System ' .i - 61. APPROVAL TOID'ECK;+
11. Property Sewer Liner& House`Connection 62: Backwash &Recep.tor-Final ,\. `_ .
12. Sewer Cap - "-"r'
_ _ _ 63. Heater & Vent-Final •, •
13r . Roof Drains : -, - I -64. Plumbing System -)Final . • •-
.
•
i-4. Rough Plumbing, n 1 . ', . • , _ - 1:4 ' .65. Electrical-Final -E , .
v
15. Rough Electrical-Conduit / ' 66. Solar System-F ii!3a1� " ' • �.
i.
16. Rough Electric Wiring:- - - �� 67. Fencing Accen Approval ' - I
. 17. Rough Wiring Sign - ... _ 1 68. APPROVED Ft R-PLASTERING^ •'• 1•, i
18. Rough Electrical:5T Bar Ceiling ! ° ' 6917 POOL/SPA SYSTEMS FINAL I. - 7. '„.
- .19.` Rough Heating & Air Conditioning ' . ' . -- - FIRE DEPT.REQUIREMENT
t CarE 6^ 8 O .D C i 171. DE H .. } y
20. Rough Fator, ;Firgpaace 1 yr., , .. S ,•,t ,. PPR V�La-4F.-Permit#
�c -C i
21. butts;in'Structuremv •• • r. S O -t :3(70.' :tlnderg'ro`1771 Hydro "
22. Ducts Ventila -ng^ t 1 - * S ";* "71, Produ rl in C�Gas
A. t +'. •'- C. E,4; n; ciAp g L Oi l
23. Gas Pipe-#ough &Test _ ;,is xL M C � c.....::.t: r .72. Undergrdtnd FhisR •
24. RoorFramin t ^F ••^ .r "• 7 *
9•' O i. ' ". ,. ,�e 7g Undergra.Sto rz`44:Tank+i7 Gas ❑0!I
25. Roof_Shea_thing E.:, :y ,v •I Y v > ti.* 74J Overhead Hydr
26. T-Bar-Ceiling IStru�c�tbra0 & NI"o�C'nat *. n - 7 75.Dry Chemical F„t7' e " h 'ti
27. Flame and-Flashin .-.- t 1; y. 3* r. . .`
�.:. -'_ T 7fi. Dry Starltipipe �_ v .t z
-28. Lathing &Siding EC + r! ^"•Sre 'x t: < • " 7i FIXED STEA ar A t
>• :t l • .• ? ' •. mfr J 1 3 ...
29. Insulations J* •• t. _ it: 7ar' FIRE PR EV. FIN'PAL E ' 'cr.: PI
30. Drywall trailing ti r H SLv J �EPLTHDEP7 REQUIREMENT
M131. Plaster Brown Coat,* LT:^ a r.; tr79 FINAL IN&PECTtBN .t , .i
.--432. ElectricaG801We1 Nfetcr-Final : *, «; 't15Q`tyFOOD CERTIFtc'ATE ($SUED•,
33. _gna l;E leCfr lc tilla: v ( Is Nates: •y „ Y + a rr,
34. F_inaCHeating 81 Air•Gonditioniri S i a- s -* a
v rr 't;J: * S: .• l t•) 10.E f 1/4-1
35. Final-GasPipe Test * Cry •• t 1--+ �F 0 x0 .•,r-4 +: IT'
A, 4. mil r _!7.
-•36. Hood'or Canopy t �.- ' T 7 t o i f�: c z :,o i r
-. c• .-i, 4.-14. rl 1 Yyl 4- .i' i r•. ` 177 :C0 .* til ;r�
T S.� 4-...
t. ('E 1+: L l 1 * -;
:;37. FinarPactory FireplaFe x _. ,r ; r .i !V
- 38. Final:Plumbing r' i -•N 1 fi •`-f S H c '-�
... - ry 4: r ,~ S .K
-739. Water-Service- • n'' I r" i' `"'r" ! a
��Y y
,,40. Gas Service-Final :. -a ^;r.-r• .s yr., 114: is _-cu s
,-,1....... „ r I t, c.. • rut .: d
41. Solar Domestic-F inal4, = nt -- * O f �;. ,may`„ r= . , D
42. Backflow Preventer K' r i - l r
r,1 •_,_, .,-, s "1 rrr) It E-.
-43. Backflow Irrigax
tion '. :y,= •-- i.• 3. „` 'r 0 n z-
..,)
'':'J
, 44. LandscapeilrrigationtSystem tz^7^ c' - 41 D '.7.‘f. : to of ^• :• :.. -. ..1 u
.. r .t' J nt'_-' - t
45'. Sound Attenuation ` - F-, "k ' J �` ,r,•< 4.
T.
• 46. Handicap.Regulation;. - r .p w 'Cr, L,
S • 'o = x
-- e ! ie r rn n ;5 .l' -
47.• FINAL STRUCTURE & BUILDING '- ;1 tr. .1 -v 5 I-
:i:. , --11.
r _ s - 'r
_
481, FINAL PLANNING i F- - ! -" -Ii:-'71 ,TI i •
-
rte• ,� ! �Y:
49. Electric Release to Edison #: _ x
50. Gas Release to Southern California-Gas Co a �r:r �. -1~• "^1717
.4 , . - , .. '):- ,-• 4 '1 .�
51. CERTIFICATE OF OCCUPANCY : _ t. -The ; :i.i ,. e -4
No. Date
ADDRESS OFSUIL.7jt0: 1158 DORSET LN. UMT: CITY OF COSTA MESA - BUILDING PERMIT
Oy/NEB.NAMEIPIwONN: ALFI, JAMIL E FLOOD : X 46 PERM NO: B 079827
*ooans: 1158 DORSET LN
COSTA MESA,CA 92626 PERMIT NO: B 079827 PLAN CHECK NO: N GOVT: N SUPP : N
546-1806
APPL:MMISM ADORES& CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: DC.NO: JOB DESCRIPTION : T/OFF & REROOF W/COMP. SHINGLES SQ FT: 2, 500
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: 2, 500 . 00 CALC-VALUE: 2 , 500 . 00 GROUP OCC: R-3 /U-1
CONTRACTORS NAME:
CONTRACTORS MAKING COMMENTS . X
ADDRESS: •
UC.NO.: *******************************************************************************
WIT: ZONING REQUIREMENTS .
LICENSED CONTRACTORS DECLARATION:I hereby a64m under penally of perjury that I em licensed under provisions of Chapter 9 SETBACK S
(co mmendng with Section 7000)of Division 3 of IM Business and Professions Code,and my license is in full tome and ailed.
CITY UC.NO.: LIC.CLASS: LTC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
�{moh,or repair any structure.prior to to issuance,also requires the applicant for such nem*to file a signed statement that he or OWNER�laBUILDER DECLARATION:I hereby affirm under penalty of perjury that 1 nn exempt from the Care
ddors LicenseaiLaw for the
' wog reason(Section 7031.5 Business and Professions Code:Any ay or many which requires a penult to mestun.alter,improve.
PARKING REQ• P RO V: PARCEL: 14114 215 Z N E: REF NO
dPLANNING NOTES>
licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing d
ng with Section7000) Division 3 the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.MY violation of Section >
y�o1gl.S by any applicant for a permit subjects the applicant to adal civil penally of nmore than live hundreddofra e )55001). *******************************************************************************
}V I.as ow er d the pmpeny or my empoyeee with wages as their sole compensation.will do the work,and the structure is not intended D E V E!L OPMEN T SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business end Professions Code:The Contractors License Law does not apply to an owed property
who bolds or improves thereon,and who does such work himself or hissed or through his a her own employees,provided that such
improvements are not intended or offered for sale.lf,however,the building or knprovemeM is sold within one year of completion,the ZONING APPROVED f BY DATE
pump,ownerbuilder win have the burden of proving he or she did not build or improve for the pump,of sale).
o 1..owner of the propertconsconstruct
,am exclusively contractile with licensed contractors to co " the praise,(Section 7044.Business and BUILDING APPROVED BY : DATE:
Professions Code:Code:TContractorsss License Law donot appy to an owe of properly who'builds or improves thereon end who /yanti contracts for such projects with a contractor(s)licensed pursuant to the Contractors licensee Law).
I am exempt under Section: •B.APC..for this reason: APPLICATION ISSUED BY: DATE:
�� �nd °"m°`1L9�7-' 9(' LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT: Y
hereby minify that 1 erre esu a acrd urderelerM the requirements a California Health and salary Code Sections 25505,25533,and
25534.and that f or anyhnure building occupant will/wit not one)needlocomph with said stale codeserld the requirements ler BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING •
a permit forconstnlction or modification from the ArO uCty�anagenent District.Residential constructioconstruction
ruction applications ere exempt from these
provisions. PERMIT 74 . 75 . 50
•Dale: ApplicantSMIP/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE
o I have and nil maintain a certificate of consent lo self-insure for workers'compensation.as provided for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for the performance dthe work for which this permit is issued. TOTALS----> 75 . 25 0 . 00 0 . 00 75 . 25 75 . 25 . 00
❑ I have and will mental workers'compensation insurance,as required by Section 3700 d the Labor Code.for the performance of the
work for width this permit is issued.My worked'compensation insurance cattier end policy number are:
• Carrier REVENUE DIVISION TOTALS--> COLLECTED: 75 . 25 OVER/SHORT: 00
Polley Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be competed y the penal is for one hundred dollen/5100)or less) 74 . 75 . 50
❑ I cents that in the performance of the work for which this panni is issued,I shall not employ any person in any manner so as to
become I should become subject to the workers' *******************************************************************************
compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with those provisions. INDIVIDUAL F E E BREAKDOWN
Date! Applicant:
Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subset an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines rpt to one hundred thousand dollars(5100,000),M addition to the cost of compensation,damages as provided for In
Soudan 3706 oft 0e Labor CoA,intense,and afomeys few. SFR 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 500 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097,Div.C). E I �Y
LENDER'S NAME:
LENDER'S ADDRESS: ^ �,(/��'{`^'y1/Ty�I�
Ind statheals reling to buildis ing
conn struction
datntheethe aboveinformationis tmns o testeto campywith h ayand mutonod ordinances IIA —v)� l / (/_
andstaterelating enees. buildrq and hereby bone innerepreesnlativeeatM silo enter upon the aboro meMoned properly Y 1 /,,chit/
for inspection purposes.
JAMIL ALFI
Pnni N T a 01 00216513-00216514 TOT 75.25
Date �CL7-7- / DATE: 10/07/95 TIME: 13:36
Signature Agent/Applicant/Contractor
e(5151.46.WP) White-Build'vp 8 Safety:Green-Rte;Caney-Applicant;Pink-Revenue;Goldenrod-Assessor
-.411111111111111111111
'CONSTRUCTION AND PLANNING POC SPA
APPROVALS Permit # -D"ate Inspector • •APPROVALS hermit # Date Inspector
t
1. Temporary Electiical Service or Pole &. 52. Pool Equipment Location • 7
,
6 2. Soil Pipe-Undrgrnd. - I 53. Steel Reinforcement ' ' _
-
3. Electrical Conduit Utility-Undrgrnd. 54. Forms .
- _ 4. Electrical Conduit-Undrgrnd. 1 '55. Electrical Bonding _ -,
if
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test -•
6. _Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '
:7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 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 .
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 . - - L. _- * APPROVALS Permit # - •-
21. Ducts, in.Structure _ ; `_ 70' Underground Hydro
22. Ducts, Ventilatin - • - .
9 ; _ _, 71. Product-Piping•OGas 0Oil
23. GasiPipe`Rodgh & Test _ i _ ,, F72. Underground Flush - .
24.,Rooj Framing. . _ r : ;/ - /� : 73. Undergrnd.Storage Tank O Gas O-Oil ; .� ti
25. Roof Sheathing ? /) "71r-C4. Overhead Hydro - `
26..T-Bar.Ceiling (Structural) &_Monocoat 7 r - 75. Dry Chemical - ,,` ' C
27. Frame and Flashing - _ r _ -' 76. Dry Standpipe"-'` I
28."Lathing& Siding a: : 77. FIXED fSYSTEMFINAL T 'i
• 29. Insulatin r - -. • . 78. FIRE PREY. FINAL - 7) 1
..
r
30. Drywall Nailing - - HEALTH DEPT.-REQUIREMENT .
31. Plaster Brown Coat: _ . _ 79. FINAL INSPECTION
32.-Electrical Power Meter-Final r r " 80. FOOD CERTIFICATE ISSUED '
33.,Final Electric R ' Notes: _ ' - _. t-
34.-Final Heating& Air Conditioning:; , 't _ _ --
_
35. Final Gas Pipe-Test _ - r _
36. Hood or Canopy . - -.- ` . , - .
37..Final Factory Fireplace - - _
38. Final Plumbing - ' - -
39. Water Service-Final ' -
40. Gas Service-Final - _ - .
41. Solar Domestic-Final r - I
- 42, -Backflow Preventer' - - " --
T -
43. Backflow Irrigation- - - =
144. Landscape Irrigation System--._,r`. o'k i- -
45. Sound Attenuation' - -- - - - -
46. Handicap Regulations - -•
47. FINAL STRUCTURE & BUILDING _
48.'.FINAL PLANNING �, _ .
49, Electric Release to Edison . - ,
50. Gas Release to Southern California Gas Co , , - - -
51. CERTIFICATE OF OCCUPANCY -
No Date .,
r
MeV •• •11•Ilalili mil
ADDRESS OF BUILDING: 1158 DORSET LN MIT: CITY OF COSTA MESA — BUILDING PERMIT
0YMERSNAMEIFomitALFI, JAMIL E FLOOD : X 46 PERM NO: P 082218
ADOREs%1158 DORSET LN
COSTA MESA,CA 92626 PERMIT NO: P 082218 PLAN CHECK NO: N GOVT: N SUPP : N
546-1806
APPL•WANG ADDRESS CONSTRUCTION TYPE: V—N PERMIT TYPE : PLU PURPOSE: OTH
ARCHITECT ORENGNEER: UC.NO.: JOB DESCRIPTION : DISHWASHER CHANGE OUT SQ FT :
ARC%OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
CONTRACTOR'S NAME:NOCK PLUMBING ( 714 ) 895-1246
ccNTRACTORSMAllmG11612 KNOTT ST COMMENTS : NO OTHER WORK' ASSOCIATED WITH THIS PERMIT
AuoREss:GARDEN GROVE CA uc.No.: 707775 *******N-*+Ex*** ESE*it**+ESE*sEititN-************iE*** -+E+E+A+E+E*****************u************
92841 .u. 17 Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)d Division 3 of the Business and Professions Code,and my license is in lull force and effect.
CITY LIC.NO.:0503861 UC.cuss:C-36 LIc.NO.: 707775 : EXP: 02/98 MAIN BUILDING ----- ACCESSORY BUILDING
Dae: r( �! 1 cr camre««: 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 penalty of perjury that I am exempt from the Contractors a.: ._a •a
'owing reason(Section 7031.5 Business and Profession°Code:Any city«county which requires apamn to construct,alter,improve , PARKING REQ: PROV: PARCEL : 14114215 ZNE: REF NO:
,dish.or repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES>
ceased pursuant to the provisions d Us Contractors License Law(Chapter g(commencing with Section 7000)of Deeion 3 d the
.usinea end Professions Code(or that he Or she is exempt therefrom and the basis for the alleged exemption.My violation of Semon >
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5001). *******************************************************************************
❑ I.esownerdlhepropenyurmyempbyeeewihwagesastheirolecompensation,Wldotework.andtestructureisnotintended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044.Business and Professions Cab:The Contractors License Law does not apply to an ownerd property
who builds or improves thereon,end who does such work himself or herself or through he or her own employees,provided that such
improvements are not intended or offered for safe.f,however.the building or improvement w 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.em exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such project,with a contrador(s)licensed pursuant to the Contractors License Law).
❑ I am exempt under Section: B.8 P.C..tor this reason: APPLICATION ISSUED BY: DATE: -✓"3f—c7
DatCaner LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N
I do hereby codify that I ern aware of and understand the requirements of California Health end Safety Code Sections 25505,Pc;13,and '
25534,end Mat I or any future building occupant will I will not(dmle one)need to comply wih said mate codes and the requirements for
apennn f«construction or modification from the Air —yTennetm
agerment District.Residential are exempt theseBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT
8 . 7 5 •
Date: Applicant: 25% SMIP/NON RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the folbwing declarations:
PLAN
ISSUE FEE 22 . 00
❑ I have consent BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
code. «tMperfomspedthawork f«whmMlepermHeesued. TOTALS----> 8 . 75 22 . 00 0 . 00 30 . 75 30 . 75 . 00
0 I have end will maintain workers'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the
7i� work for which this permit is issued.My workers'compensation insurance canter and policy number are: `
Carder: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 30 . 75 OVER/SHORT: . 00
Policy Number: NWC 32114101 09 /01 /97 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
,,nix section need nor be compbfed I the permit is for one hundred dollars($1001 or ins) 30 . 75
❑ 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
Dae:
become subjed to the 'compensation laws d Cakfomia,ed eth
g at U l ,. MoarbK
b eud t°the wwka°' *******************************************************************************
compensation Pr of 3700 d the Labor Code.I shaft forth ply I'- provisions.
/�'�\ 11 3 / ) L Applicant:Warning: bkai compensation Failure secure wonmpcompensationcompensationtipn rovaapsb unlawunlawful,wends an
fir subject to criminal r, INDIVIDUAL
TYPE QTY . DESCRIPTIO N F E E BREAKDOWNUNIT COST TOTAL COST
' civil fines up to one hundred thousand dollars(5103,000),In addition to dna coal of compensation,.....ea a provided for In
Section 3705 o1 the Labor code,Intact and etbmsy's lyes. PLU 1 DISHWASHER 8 . 75 8 . 75
• CONSTRUCTION LENDING AGENCY:f hereby affirm under penaly of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this penni is issued(Sedco 3097,Civ.C). w J
LENDER'S NAME: 4�/s ) :
LENDER'S ADDRESS: EX
Ia
a S
]� } I.
I end sty that haverela read this application end des that the above information acorrect.oft agree to complywith all city end county ordinances ^� 1t, ! �.rr�� 1 ��l`t�,
and stale laws relating to building construction and hereby authorize representatives this city to enter upon IM above mentioned property ✓ ryvys/� VI 1 v J s„
for Inspection pur°ns°'RO>`t NOCK •G
Uri
Pdm Nemo / I 77 ,yl.l_I. Uf nnr: ,
/ l+iiu r. 'lL
Dater
signature d OwnerlAgentlAppicantrConlred«
es
(5151-46.W P) White-Building 8 Safely:Green-File:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING : - POC SPA •
Date Inspector - Date- .-Lnspector
APPROVALS Permit#• - -APPROVALS Permit #
1. Temporary Electrical Service or Pole. , • 52. Pool &•Equipment Location '
2. Soil Pipe•Undrgrnd. - - ' : 53. Steel Reinforcement
3. Electrical Conduit-Utility-Undrgrnd. ; - ' 54. Forms' - -
4. Electrical Conduit-Undrgrnd. . - 55: Electrical Bonding; - i
5. Steel Reinforcement56. Rough Plumbing & Pressure Test -
6.: Electrical UFER-Grad. i :571 APPROVAL TO COVER-GUNITE •
7. Footings - • ; 58'. Electrical Conduit-Undrgrnd. , v
1
8. Foundation - 59. Gas Pipe, 0 Undrgrnd„-Test
9. Water Pipe-Undrgrnd. -• ' ' ' -60. Backwash Lines, P-Trap,'❑ Undrgrnd.
10. Structural Floor System '• - 61. APPROVAL"TO DECK i ; . '
11. Property Sewer Line & House Connection --62. Backwash &=Receptor-Final ' _ '
12. Sewer Cap - • -63. Heater & Vent-Final .- I - ' '
•
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 & Acce`ss Approval '
17. Rough Wiring Sign - i 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling .. -- 69: POOUSPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning - - - • - - _ : FIRE DEPT.-REQUIREMENT .- - -
20. Rough Factory Fireplace - - APPROVALS • - Permit#
21. Ducts, in Structure": -`- -' 70. _Underground Hydro
22. Ducts, Ventilating -- . 71. Product Piping ❑Gas •0 Oil
23. Gas Pipe-Rod-9h &,Test _ - 72. Underground Flush -
24. Roof Framing '. - - - - • 73. Undergrnd.Storage Tank 0 Gas all Oil
25. Roof Sheathing ._ r . - 74. Overhead Hydro ,.
26. T-Bar Ceiling (Structural) & Monocoat - - 75: Dry Chemical _ _ -
27. Frame and Flashing .. - , T 76. Dry Standpipe.:::_,- • .
& Siding - " -:28. Lathing "
', ' -'Gt 77. FIXEDTSYSTEM.FINAL _
29. Insulation Ji. - 78. FIRE PREY. FINAL L
30. Drywall Nailing • -, i rr •--HEALTH DEPT. REQUIREMENT '' „s
31. Plaster Brown Coat 79. FINAL INSPECTION ' _
32. Electrical Power Meier:Final
80., FOOD CERTIFICATE ISSUED
33. Final Electric- Notes: - .-
1 _ •' -
a-�
34. Final Heating& Aiflponditioning-- c :
N
35. Final Gas-Pipe-Test • - r
36. Hood or Canopy _, - , _
37. Final Factory Fireplace - _ , _ .
38. Final Plumbing ; 1 - -
39. Water Service-Final _ . -
40. Gas Service-Final - , - i - _
41. Solar Domestic-Final - - •
- • -
42. Backflow Preventer _ _ _ _
43. Backflow Irrigation .
-
t
44. Landscape Irrigation System:. . " I. - '
45. Sound Attenuation- ` -
46. Handicap Regulations - _ '
-47. FINAL STRUCTURE & BUILDING
•
48. FINAL PLANNING'. - .. - ;•
49. Electric Release to Edison _
50. Gas,Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY -
No. Date
•
DECLARATION OF AUTHORITY Bldg. Irma# (J S •�
FOR AGENTS OF PROPERTY OWNER This Permit#
TO APPLY FOR PERMITS
Street Address: //SS zd ac5e- / AP Number:
1. I(we), 47-4 Z67A ALA , declare that I am the Owner of Title of the above
referenced real property,and that I (we)hereby authorize:
ame:s�� 4b/y `- ,4 L j Telephone Number: 7) g- 596 - f p�y
O
Street Address:
City: State:\ Zip:
to obtain permits in my behalf,as owner/builder,for
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of 20 , at , California.
PdnYNarrm
AZ/z, G�-/
LSignature: 7 6
Date: //J/D
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf.
0779-46(rev.11/00) •
LOT 43 TRACT 4395 FEE RECEIVED
16318 .JAN 3 11962
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 317 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT
,p BUILDING '
BUILDING /1St „coinage �{ ` '
ADDRESSCOSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO.
OWNER K & K DEVELOPMENT CO., INC. I PE7163.1 l}J(
MAIL RECEIV BY DATE RECEIVED DATE ISSUED
ADDRESS 1555 PLA CENT IA AVENUE _ JrS _ 029--- JAN 31 1962
1�, BUILDING
CITY NEWPORT BEACH NELII 63227 ADDRESS
OR
ARCENGINEER NONE No COSTA MESA. CALIFORNIA
FIRE /
ADDRESS ZONEIRTYPE {� GROU (7
CONTRACTOR K W Km 1 APPROVED
BY DATE
ADDRESS 1555 PI ACFNTIA AVENUE ZONING
ZONE NO.OFUSE OF NEW S/.r "TAW/4[F.
CITY NEWPORT BEACH fes/ ( PLANS a I BUILDINGW/4 if. slay.
LICTNO. 61195 TEL
MI 6-3227 LEGAL
DESCRIPTION 7-Let` 93 ,Q If 37-c
SIZE ` / / NO. OF BLOCS. _
OF LOT T X I�JC� NOW ON LOT 0 A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. NnN F APPROVED ALLOWED
SETBACK LINE FROMt%/ // / (CENTER LINE ST.)
CENTER OF STREET . c...., REAR YARD �� FRONT ..S 0 FT. IN.
SIDE YARD I LEFT 71 I RIGHT 7 / R.SIDE /7/ FT. IN.
DESCRIPTION OF WORK L.SIDE [ FT. —_ N.
NEW . I X II ALTERATION I II ADDITION __
REPAIR MOVING IIDEMOLISH REAR �'�~ FT. / INZ ,
BYPROVED DATE /30/1‘
/aa, s f I- w/ ,
BUI LWO��NG NO. OF /
SIZE C7.eei- ?7L fe ROOMS (/ STORIES 1 / // G/
EXTERIOR WALL ROOF C (TJ�.
COVERING TUCCOICOVERING PS/J/ncJ% a..
USE OF BUILDING AND WORK TO BE PERFORMED l U J
SINGLE FAMILY RESIDENCE WITH �, .- 7
ATTACHED GARAGE .
-PLAN .// /� I Q
I HEREBY 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 FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
�O� /
SIGNATURE OF /1 /� slf��f - PERMIT FEE $ �J
PERM ITTEF •ail���� °^�7 a B
$ �/ PLAN CHECK $ 7- o V 4
AUTHORIZED AGENT B
I pmmes®ve w TOTAL FEE $ 5c2. :so LL'