HomeMy WebLinkAbout1162 DORSET LN - Building Permits PROJECT ADDRESS: 1162 DORSET LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 0:733
OWNER'S NAME: BLAIR JOHN LELAND TR
ADDRESS: 1162 tORSIT LN PERMIT NO: B 057883 PLAN CHECK NO: N GOVT. N SUPP. N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT
966-0556
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF REROOF W/COMP SHINGLES SQ FT; 4 , 500
L ADDRESS: UNIT: CLAIM VALUE: 4 , 500 . 00 CALC—VALUE: 4, 500. 00 GROUP OCC: R-3 /M-1
PERMITTEE: NEWPORT ROOFING ( 714 ) 645-0104
ADDTTEE: NB177 RIVERSIDE AV CA 92663 COMMENTS• REROOF 3000SF RESIDENCE & GARAGE
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions if Chapter 9(commencing with Section Z O N I N G R E Q U I R E M E N T S
7000)of Div' u 1 usiness and Profs iws C d my license is in f I�,yn^feet. S E T B A C K S
X02 4 � 5444
°p3�
CITY LIC." STATE LIC.: C L MAIN BUILDING ACCESSORY BUILDING
Date: l7ZZ�I92- Signature: — FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm tha ave a cenifica•of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
Compensation IesOa2c6i 52c8t4ie91py thereof(Section 3800, Lab.07/01 /9 2
POLICY NO.: STATE EXP.DATE: PARKING REQ: PROV: PARCEL; 14114216 ZNE: REF NO:
COMPANY: PLANNING NOTES>
Certified copy is hereby furnished. LJ Certified copy is filed with the city : '• • • on, >.
1 Date: ✓/2 /rl` Applicant: Km/ / . ' D E V E` L O P M E N T SERVICES R E Q U I R E M E• N,.�T S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This s':Ion need not be com• If the permit is for one hundred($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 ZONING APPROVED BY DATE: 7i-
subject to the Workers'Compensation Laws of California.
Dale: Signature: BUILDING APPROVED BY : DATE: �n
NOTICE:If.after making this declaration,you should become subject 10 the Workers'Compensation provisions of the Labor 442DATE: ^
ie o 1/
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED B Y• (
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for .*.**.*..x.*.*.*.*..****.. /*.**.***.*.*.*..**.*****.**.*.*..***.***.****..**.*.**.*****.***.**.*.***.*.**.* *.*
which this permit is issued(Section 3097.Civ.C). **************4******************************************************.**********
LENDER:
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Stale License Law for the following reason PERMIT 7 2 . 0 0 . 50y
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or SM I P/NON—RES
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed .
PIAN
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business q
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID y DUE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and thea TOTALS----> 72 . 50 0 . 00 0. 00 72 . 50 72 . 507'. . 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law •
hoesnotr applywloan owesr pfadedperty who buildsmrve improvessartrot ndd whodoessuch wo.k .however thbrldror REVENUE DIVISION TOTALS--> COLLECTED• 72 . 50 OVER/SHORT: . 00
ugh
dies of pwn o an Dene.ofoaiprd thaterty such imdor prs are he n,intended orodoes for swor I h however the buildingroor
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for the purpose of sale). 72 . 00 . 50 0
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business - "r
❑ and Professions Code: The Contractors'State License Law does not apply 10 an Owner Ofpropertywhabwldsorimprovesthereon *******************************************************************.4Ej{.**********
and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B. s P.C. TYPE QTY DESCRIPTIO N UNIT COST " TOTAL COST
for this reason:
Date: owner: SFR 4500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 500. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES ;.'
25534 and that tor any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a -
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ••
these provisions.
1,'
Date'. ApplicanP.
I hereby certify that I have read this application and stale that the above information is correct.I o comply with all city and county • . ��
ordinances and state laws relating to building construction and hereby authorize representabv - city to enter upon the above-mentioned
property for ins oection pu oses. 01 00117957-00117958 T! :I)TI %'.T..S'.1 7
• ///�1J (�/��E /p Signature: �7 DATE: 06/23/92 TI7lE: 16:13
. X%/ Lr� e�Date'Drivers License or Social Security F:
1641.46 White—Buildma'.Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
.
CONSTRUCTION AND PLANNING POO WA
-APPROVALS Permit # - • Date Inspector APPROVALS Permit # Date - Inspector
• 1. Temporary Electrical Service or Pole - - . 52. Pool & Equipment Location •
r
•
2. Soil Pipe-Undrgrnd. . • • 53. Steel.Reinforcement - .• . - '
3: Electrical Conduit Utility-Undrgrnd:' i 54. Forms .
:4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel,Reinforceinent •- 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 &TReceptor•Fina) ,
1 -
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; Rdugh-Factory Fireplace - 't ,:. - r - . APPROVALS :. Permit# -'
21. DUcts,in Structure ` 1 .` 70.>Underground Hydro ,.
22. Ducts;.Veritilating- ": i 71. Product Piping'OTGas OOil
23: Gat Pipe-Rough& Test '" r or `_ 72. Underground Flush, -
24. Roof Framing ;° -
73. Undergrnd.Storage Tank 0 Gas O.OiI
25. Roof Sheathing_ . A .6`' V 74. Overhead Hydro v
-71{ - Z G . .'dd v o
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical s
27: Frame and Flashing76.°Dry Stand•p"ipe" :r
28. Lathing 81 Siding - 77. FIXED•SYSTEM•FINAL✓ T
29. Insulation l k 78. FIRE PREY. FINAL -, •_
30. Drywall Nailing a - -HEALTH DEPT. REQUIREMENT
31. Plaster..Brown Coat T , ° 1.. 79. FINAL INSPECTION ''' -- -
' 32. Electrical Power Meter-Final • j - 1 80. FOOD CERTIFICATE ISSUED L. 1
•. 33. Final Electric -` " ' -
- m Notes: , `
'' 34. Final heating& Air Conditioning I el - - _ _
• 35. Final Gas Pipe-Test ' r.
36: Hood or Canopy - • i . . • 7 ,
1
37: Final Factory Fireplace I '' 1 ' 1 -
• 38. Final Plumbing • "u - _, '
; 39. Water Service-Final .. i = c
40. Gas Service-Final - •
41. Solar Domestic-Final - ,i .
c.
42: Backf low Preventer• 4. ,: . -'t _ -
43. Backflow Irrigation' • f • _.
-.
1
44. Landscape Irrigation System.. - . .t ,.• ,. c -
45: Sound Attenuation - - - ^� -
. _ •, . .- 1
46. Handicap Regulations -
47. FINAL STRUCTURE & BUI LDING •
T)•�_C�ZO'�/ ,� .. F ✓'��
48': FINAL PLANNING : .' -
ff [' F Pt-IP -77:1-dr-1-0371-17- _ !�
40. Electric Release to Edison • - , -1 -
N _
50. Gas Release to Southern California Gas Co :_ ' 4, ' o
51; CERTIFICATE OF OCCUPANCY , -, , -
No. Date
•
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -
CITY OF COSTA A' 011��II$$��TRUCTION PERMIT/ A P`FiR�T� I TRACT NO: LOT NO. UNIT N6. 87I2 12/15/86 28.50 TL
�roject Address �L./o�� u-.../•-t� (J��O� 6'8. - aREPAIR - '•
Ap714icant's Mailiqng/Address •- ( ) - ,TYPE OF CONSTRUCTION • U NEW LI ADD U ALTERATION aREPAIR �.
•
Owner's Name 7VO��� • s'S P,� Phone - ❑ CONVERSION ID DEMOLISH ❑ O ER A.P. I Zone '
ESCRIPTION OF OR /USE OF BLDG. CPrn-PDTC - �'cyn.1l Doer
Address S Iq'V�"t'� i SMain Building: Accessory Building:
,E Z
Arch/Eng. ' • ' License No. ` 1 . TYPE OF PE MIT GRADING ❑ FOUNDATION STRUCTURAL T Front. - 0
Address - ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING• ❑ MECHANICAL B Rear' - . . N
1 {� a{1/�-r�—�[ps--s/<`(� ❑ ,OTHER _ A
Contractor's Name 1-- r C " \ 1llG one wsr_..ic/d�7`-'� 'C Right • - ,r N
,Jp PROJECT DESCRIPTION SO. FT.2 r• M Left
^,, h,,
CONSTRUCTION TYPE VALUATION$5 t_gjn $
City License No. �I �f en ZONE GRADING CU.YDS. ACRES - E
LICENSED CONTRACTOR DECLARATION • 'PIOg. Ref.# • Parking Req./Provided
Q
"I hereby affirm that I am licensed under provisions of Charter 9 (commencing" Remarks: • -Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code;and • ' -
my license is in f force ansl effect. •,�n C^ _ ' .• T
License Class --�1 Y License No -(�J li �.�/A'' $
k WO AD/AR •
1nP�c' G FEES ,
uc WORKERS' COMPENSATION DF LA RATION Bar Sink a�Sh er I ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate - '
\ Workers' Compensation Insurance, or a cg�-�ified copy thereof (Section Backflow Preventer s' �¢r0
)0, Lab. Cn I�0� � I �;_ I_ _ nl I //)�� 'O Auto uratic Washer Transformer ❑ 15-505 KW
• ,licy No. tel. on-panyTV L J-1'1CMC1'll '((.11/ Backflow trigon J/' Se Construction Pole Sub.
Certified copy is hereby'furnished. •
�X(yl� I' ,
to tified copy is "e with the city DpAi v�iisnion Bathtubs { } ySe r Connection 1 Cooking Unit Meter Dup to 100 amps
Date Applican / 3 z� 66 ��.���sss f (Da Y
EXEMPTION FROM WORKERS'O P SATION RATION Clarifiers '�,1 oI Solar Collectors Dishwasher Meter ❑oyer 100 amps •
i (This section need not be completed if the permit is for one hundred ($100) or `
less). Dishwasher 1 113
Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that in the performance of the work for which this permit is issued, I iyl
shall not employ any person in any manner so as to become subject to the Drinking Fountal s III° Solar Tank Fan ' Motors 004 HP ❑1'/x-8 •
Workers' Compensation Laws of California. , _
-
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE:If,after making this declaration,you should become,subject to the _ IOC.$Olar 09-15 HP ❑15-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal' Fixtures - ' - - - -
comply with such provisions or this permit shall be deemed revoked. Microwave' ,
CONSTRUCTION LENDING AGENCY Gas Service Outlets . Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for _which this permit is issued (Section 3097 Civ.' C.) Interce tors - " Water Heater -
Lender's Name p Outlets Range
Lender's Address - - Kitchen Sink ,Water Service • ' Switches Sign
OWNER BUILDER DECLARATION ,
I hereby affirm that I am exempt from the Contractor's License Law for the - Lavatories Auto-Wash '
following reason (Section 7031.5 Business and Professional Code: Any city-or - Garbage Disposal Standing Sections
• county which requires a permit to construct,alter,improve,demolish or repair P—Trap . Laundry Trays •
- Generator ❑0.5 KW ❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
tfdgerefrom and the basis for the alleged exemption. Any violation of Section _ ' • -
-:„31 5 by ,any applicant.for a permit subjects the applicant to a civil;
-alty of not more than five hundred dollars($500). I • $ 3
I, as owner- of the property or my employees with wages as-their sole Reinspection.Fee' I $15 Issue Fee -
compensation, will do the work, and the structure is not intended or offered Reinspection-Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business-and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves • - '
thereon, and who does such work.himself/herself or through.his or her.own DEVELOPMENT SERVICES REQUIREMENTS: ' •
employees, provided that such improvements are.not intended or offered for Boiler Hood or Type I ❑ • r
sale. If, however, the bur tling'or improvement is Sold within one year of con-- - - - Canopy Type II0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or in--' Duct Under Ground
_ Building •
Approved ByDate
rove for the purpose of sale). 'CAA
\ -6
l', as owner of the.property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System 1 Application Issued By' J Date� ��
tractors to construct the project (Section 7044,Business and Professions Code: ` ,
The Contractor's License Law does not apply to an owner of property,who Duct-Ventilating _ ❑0-100,00('BTU ❑100,000 BTU SUMMASY OF FEES
builds or improves thereon;and who contracts for such projects with a con- - - • - -7 O ZJ 'CO
tractor(s) license pursuant to the Contractor's License Law). I am aware that i Exhaust System 0 Multiple 0 ' System Repair/Alteration BUILDING PERMIT' $ S 14• SMTP $
proof of their Worker's Compensation insurance should be provided to me.' • — PLAN CHECK $ PERMIT
❑ I am exempt under Section B.&IP.C.for this reason Firepl/Fact.Blt. ICBG# , • f Fire Dampers I PLUMBING $. ISSUANCE $ l
Date Owner Heating System&Ducting 1 Registers
PLAN CHECK 25% $ _ ENERGY P.C. $i
l-hereby certify that(i nave-read this application and state that the above--- - ❑O-100,000 BTU 0100;000 BT - - — ”' -" ' - ELECTRICAL - GRADING $,
information'is correct. I agree to comply with all city and county ordinances • i , $
and state laws relating to building construction, and hereby authorize repre- - PLAN CHECK 50% $ MICROFILM $
sentatives of thi city to enter upon the above-mentione property for
inspection purp2S 1 ' - MECHANICAL ._ S 0
Signature ' 6 WA .' i 1 •
Reinspection Fee ' $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84' White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
- POOL `A _
NST,RUCTION AND PLANNING - ..
- Date Inspector - 'Date • Inspector.
Aq,�ROVALS . Permit# APPROVALS • Permit# _ ,
'1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location - I •-
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -
3. Electrical'Conduit Utility-Undrgrnd. 54. Forms
4: Electrical Conduit-Undrgrnd. . .. 55. Electrical Bonding _
5: Steel-Reinforcement i,, - 56. Rough Plumbing & Pressure Test. . ..
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE . , -
7_ Footings - 58. Electrical Conduit-Undrgrnd. .
8. Foundation 59. Gas Pipe; O Undrgrnd.,Test i
^9. Water Pipe-Undrgrnd. ,: 60. Backwash Lines, P-Trap, ID Undrgrnd -
10. Structural Floor System - 61. APPROVAL TO DECK
-. 11. Property Sewer Line & House Connection • 62. Backwash.& Receptor-Final '
.12. Sewer Cap - - 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System - Final . -
' 14. Rough Plumbing:^ - -65. Electrical-Final -
,15. Rough Electrical-Conduit 66. Solar System-Final . - _ .. .-
• -16. Rough Electric Wiring ` • 67. Fencing &Access Approval - . __
-17: Rough Wiring Sign '68. APPROVED FOR PLASTERING ' -
:18. Rough-Electrical-T Bar Ceiling •
69. POOL/SPA SYSTEMS FINAL , ,
19. .Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -
20. Rough Factory Fireplace . ' - , APPROVALS Permit#
21. Ducts, in Structure . ' --- 70.. Underground Hydro " , --
22."Ducts, Ventilating - 71. Product Piping O Gas ❑Oil F '
23. Gas Pipe-Rough&Test _ 72: Underground Flush' - -- - -
• 24. Roof Framing ;-.' 73. Undergrnd.Storrage Tank ❑.Gas 0 Oil 7 - .
' 25. Root Sheathing ,74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,
• 27. Frame and Flashing 76. Dry Standpipe ' i -
28. Lathing & Siding 77. FIXED SYSTEM FINAL • ' .
- ' 29. Insulation78. FIRE PREV. FINAL -
30. Drywall Nailing - . HEALTH DEPT. REQUIREMENT ' ,
_31. ;Plaster Brown Coat ,.; - 79. FINAL INSPECTIO,N , - ' - - . - .
32. Electrical Power Meter,-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: -
34. 'Final Heating & Air Conditioning - . - ..
35. Final Gas Pipe-Test• - I - - - .. - - •
•
36. Hood or Canopy, - , is _ r
37. Final Factory Fireplace. . . . , _ - "
38. Final Plumbing - .• `
39. Water Service'-Final ; .
.
40. Gas Service-Final
41. Solar Domestic-Final - - .
42. Backf low,Preventer• -
43. Backflow'Irrigation - - _ ;
I
4. Landscape Irrigation System ' I -
-
45. Sound Attenuation - -
" . _
46. Handicap Regulations .. . . .
47. FINAL STRUCTURE & BUILDING ' . i
v ,
48. Special Requirements Completed: , . . ,
49. Electric Release to Edison . I,. '
i 50: Gas Release to Southern California Gas Co • _
51. CERTIFICATE OF OCCUPANCY - , • . - t '
I No= Date • - - - - - - ---
F . --„ .Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. c _
!. _ - PERMIT NO. TRACT NO. LOT NO. UNIT NO. '
CITY OF COSTA ME (�}O T,R/�UCTION P RMIT �362'� .
• Project Address ,) /, N530 .:Er`. rk"./' 4$ • 1 -71 u I I -I� ,
Applicant's Mailing Address " • r. TYPE OF CONSTRUCTION , _ ❑ NEW H ADD ❑ ALTERATION ,U,REPAIR '
Owner's Name ' _ _ Phone "- CI CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
DESCRIPTION OF WORK/USE OF BLDG.' -
Address •
- ;_ " ' - - S Main Building: Accessory Building:
! LJ4 •
Arch/Eng. License No. TYPE•OF PERMIT ❑ GRADING ❑ FOUNDATION lI�� T Z
STRUCTURAL Front O
Address
LI TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - - N
I-
Contractor's Name '• • -t — - Phone ' r t ❑ BOTHER A I
- - 'PROJECT DESCRIPTION SQ. FL-.--e
- - OCCUPANCY .C Right N
Address(mailing) a - - '1 - / r . K G
- . - CON ST RUCTION TYPE 1. VALUATIONS I'r - ( S Left • ,
City License No. - 4 I ZONE GRADING CU.YDS, • ACRESE
LICENSED CONTRACTOR DECLARATION - _ _ Ping. Ref.# Parking Req./Provided -
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: 1 - - • M
with section 7000) of Division 3 of the Business and Professions Code, and. - • •_ •
♦ my license is in full force and effect. - - _ - ' T
License Class `- ' ' License No.' • • - • - - - - S
Date _.. - - - Signature '-' -t" 1• - - PLUMBING FEES e '
WORKERS'COMPENSATION DECLARATION - Bar Sink Showers I " ELECTRICAL -FEES
I hereby affirm that I have a certificate of consent to self-Insure or a certificate ,
' Workers' Compensation Insurance, or a certified copy thereof (Section- Backflow Preventer Service Sink - -
,� 00, Lab. C.) Automatic Washer Transformer 0 15-50 KW
-olicy No. :.r •-• J "' •^COmpanyt' -- • 4• • r;-s' I,I Backflow Irrigation Sewer Ca i 0 50+ KW
) p I _ I Construction Pole Sub.
A
Certified copy is hereby turn a cit
t Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Me.ter ❑up to 100 amps
cc1�� Date' '• Applicant - r '- ••' .r -
4`?\ " EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher _ Meter Dover 100 amps
q (This section need not be completed if,the permit is for one'hundred ($100) or
7k. less). Dishwasher Solar Piping Dryers ❑Gas DElectric . Sub Panel •
- I certifythat in the performance of the work for which this perm •it p tis issued, I .
7', ' shall not_employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors Do-i HP Di,4 8
Workers' Compensation Laws of California.s . Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-75+
NOTICE: If,after making this declaration, you should become subject to the
r-, Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - Fixtures Microwave
• comply with such provisions or this permit shall be deemed revoked. ,
LsCONSTRUCTION LENDING AGENCY
7 Gas Service Outlets Water Closet Device Boxes Pole light
affirm that there is a construction lending agency for the performance
�.-` off the the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
i„iii- - Lender's Name _ .
5 Lender's Address Kitchen Sink Water Service Switches Sign
',- OWNER BUILDER DECLARATION
I hereby'affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash 'Garbage Disposal i Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P—Trap - Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9 (commencing with Section 7000)of
_ Division 3 of the Business and Professions Code) or that he/she is exempt -
' -•erefrom and the basis for the alleged exemption. Any violation of Section . . - _
31.5 by any applicant for a permit subjects the applicant to a civil •
nalty of not more than five hundred dollars($500). -, , •
4 J I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
r .compensation, will do the work,and the structure is not'Intended or offered I - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - ' MECHANICAL I FEES
License Law does not apply to an owner of a property who builds or improves _ •
- . . _ - S _ __�
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are'not Intended or offered for Boiler, Hood or Type I ❑ •
sale. If, however, the building or Improvement is sold within one year of corn- - Canopy Type I I 0 • Zoning Approved By - - - • - Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under GroundBuilding Approved By Date
drove for the purpose of sale). ,` ` .
LI I ,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date'
tractors to construct the project (Section 7044,Business and Professions Code: - ,
The Contractor's License Law does not applylto an owner of property who Duct-Ventilating _ 00-100 000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- - - �f r , >
- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration - BUILDING PERMIT. $ SMIP $
proof of their worker's Compensation insurance should be provided to me. _ PLAN CHECK $ I ' PERMIT;
❑ I am exempt under Section B. &P.C.for this reason Firepl/Fact.Blt. ICBG# . Fire Dampers ISSUANCE $'
PLUMBING $
Date owner • 1 I Heating System&Ducting' - i Registers , ENERGY P.C: $
PLAN CHECK '- 25% $I
I heresy certify'that;I have read this application antl state that the above - • ❑0-100,000 BTU 0100,000BT - - - - - GRADING $,
information.is correct. I agree to comply with all city and county ordinances - .1 • ' ELECTRICAL $,
and state laws relating to building construction, and hereby authorize repre-, . , - , MICROFILM! $;
PLAN CHECK 50% $
inspection
fives of this city to'enter upon the above-mentioned property for, • - I
inspection purposes. ) / I ! I I - MECHANICAL - $i TOTAL FEE $! -,r i • '1` t�
Signature i• •t It k-'1 t•-I I Date,C .- 4
• Drivers' License`or SS;# I ' • Reinspection Fee 1 $15 I Issue Fee I $ 3 PLAN CHECK 25% $ I ,
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod " Assessor
. CONSTRUCTION AND PLANNING POOL 'A
Date Inspector - Date Inspector
APPROVALS Permit# APPROVALS Permit#
:1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
• 3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
•
6. Electrical UF ER 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 - APPROVALS Permit# _ •
21. Ducts, in Structure 70. Underground Hydro - '
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush - - - --
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas D Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding • 77. FIXED SYSTEM FINAL
29. ,Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION
32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED
-
33. Final Electric • Notes:
• 34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test - - - -
36. Hood or Canopy •
37. Final Factory Fireplace
38. Final Plumbing •
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation - •
44. Landscape Irrigation System
45. Sound Attenuation' - '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison • •
•
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. _ Date _
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF,COSTA MESA CONSTR CTION P RMIT • PERMIT N TRACT NO. LOT NO. UNIT NO. - • (O 1•5" 12I I B.,• •
-
1 - 7 �ti1 NO!)
c T�
Project Address • ��G� /la�J/•� I r1 i /oC1
Applicant's Mailing Address GPo J✓ f E //..�/,.,j/./.../.
•/ ' TYPE OF CONSTRUCTION ❑ NEW u ADD LI ALTERATION LI REPAIR -
p /dl ❑.CONVERSION ❑ DEMOLISH ❑ OTHER A p # - ` - - _,
.Owner's Name' •
n� /d,�[✓2 Phone _ DESCRIPTION OF WORK/USE OF BLOGI. - -
Address'. �7-�01 0 ltd/ �A� - • _ - f E Main Building: Accessory Building: • ,
Arch/Eng. ij n -�,, / 4/... License No. 'S'y�o6'g/g TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION LJ STRUCTURAL - • T Front - - . O
Address . 0c/`2"� 'b� c-��1ry i '__ /0/ . ❑ TENANT' ❑ ELECTRICAL:111 PLUMBING MECHANICAL MECHANICAL _ -B Rear 5 ' N
—L�q C' /r� ./ Art. • s . El OTHER - . . . A - I,
Contractor's Name one SYJ� C Right . ' ; • N
D PROJECT DESCRIPTION ' SQ. FT. OCCUPANCY
I Address(mailin'g)/JJ Va'e�.-/'^✓ /�/f i��/1%� l�2 ��
CONSTRUCTION TYPE - VALUATION S Left _ . , . c - R
City License NQ/ ...//.. P ZONE GRADING CU.YDS.- ACRES , ' : E
LICENSED CONTRACTOR DECLARATION _ Ping, Ref.# Parking Req./Provided '
- Q
I M1 eby;affirm that I am licensed under provisions of Charter 9 (commencing Remarks: CVO\ - Planning Notes: ( - M
wi section 7000) of Division 3 of the Busines nd Professions Code, and ` v T
y !cense is in full forse and ffect. �i/� , I ,
L}�fense Class C— C -.2 License No. Yy,�CJ S
`Date��'"�E� ' nature _ '^ . • PLUMBING FEES ..
��
\vs' WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
4.10hereby affirm that I have a certificate of consent to self-insure or a certificate •
I - -4.e'- Workers' Compensation Insurance, or a certified copy thereof (Section, - Backflow Preventer - -Service Sink •- - - - _
b. Automatic Washer Transformer 0 15:50 KW
I ,-olicy No. y/CS��'.��� Company J 6/al Backflow Irrigation Sewer Cep' - ❑ 50+KW '
. P - Construction Sub.
BCertified copy is hereby furnished. • � _
•Certifief copy is filedyith the city B ing Division. Bathtubs Sewer Connection Cooking Unit...! Meter Duo to 100 amps
Dat /2�4�-� Applicant( -
EX 'PTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers , Solar Collectors Dishwasher ' Meter Dover 100 amps
(This section need not be completed if the permit is-for one hundred ($100) or - - - -
less). Dishwasher Solar Piping Dryers ❑Gas '❑Electric Sub Panel
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 Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1'/a-8
•
Workers' Compensation Laws of California. - -.
Date Signature Floor Drains Swimming Pool w/Spa - F.A.U. . Inc Solar 09-15 HP 016-15+
workers'
If,after making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal - - -- - Fixtures
comply with such provisions or this permit shall be deemed' revoked. Microwave -
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet . Device Boxes
I hereby affirm that there is a construction lending agency for the performance - Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) • -
Interceptors Water Heater • Outlets Range •
Lender's Name
Lender's Address - Kitchen Sink - Water Seivice ' Switches Sign .
' OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt-from the Contractor's License Law for the Lavatories Auto-Wash ' Garbage Disposal Standing Sections •
-
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of •
Roof Drains
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that-he/she is exempt ,
-3y erefram and the basis for the alleged exemption. Any violation of Section - -
:c'i,y1.5 by any :applicant for •a permit subjects the applicant to a civil .
-='"salty of not more than five hundred dollars($500). _
'`-i] I, as owner of the property or my employees with.wages as their sole • Reinspection Fee I $15 Issue Fee $ 3
•
compensation, will do the work; and the structure is not intended or offered 1 ' Reinspection Fee ' ! $15. Issue Fee I $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - - MECHANICAL I FEES
1 License Law does not apply to an owner of a property who builds or improves - - • - • - ... _ 1 _ —� -
thereon, and who does such.work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for • Boiler Hood or Type I ❑
sale, If, however, the building or improvement is sold within one year of com- , Canopy Type II EI4 Zoning Approved By nate
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground. _ Building Approved By Date
grove for the purpose of sale). ' - ,
LL I, as owner of the property, am exclusively.contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By Date / .-hdt'5"
• tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such'projects with a con- - - ... - ,
tractor(s) license pursuant to the Contractor's License Law). I am aware that' Exhaust System ❑ Multiple ❑ System Repair/Alteration I •
BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK ' $. PERMIT '
' I: I am exempt under Section .B.A P.C.for this reason LFirepl/Fact.Blt. ICBG# —1111
Fire Dampers /� �} PLUMBING $ ISSUANCE $
Date - owner He mg System 8r'BYIe'ehtg Registers T OV ' ENERGY P.C. $ •
��/j} PLAN CHECK 25% $ I
I-hereby certify that I have read this application and state that the above • e[. ,100,000 BTU 0100,000BT.
F - - - ELECTRICAL $ - ' , GRADING $
information is correct: I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $. I MICROFILM $
sentatives of this city to, enter upon the above-mentioned property }Ori ,
inspection purposes. ��� ' • MECHANICAL $ �' o" TOTAL FEE $' r.W
Signature I - Date .
Drivers' License or SS 9F � Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ ' ,
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
'
' CONSTRUCTION AND PLANNING . POOL °A
/17 -- Date. Inspector - - Date Inspector
APPROVALS Permit#• r -r APPROVALS Permit#
• rail..Temporary Electrical Service Or.Pole 52. Pool & Equipment Location -
•;•2.r Soil Pipe-Undrgrnd.• 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. . . 54. Forms ..• ' •
' 4.'Electrical Conduit-Undrgrnd. 2 . .55. Electrical Bonding •
i. 5. Steel Reinforcement: • - . - 56. Rough Plumbing & Pressure Test
','•6.*Electrical UFERGrnd. 57. APPROVAL TO COVER-GUNITE . •
'
. -7. Footings' .' 4t ' - 58. Electrical Conduit-Undrgrnd.
-.
8. Foundation re ' - 59. Gas Pipe, 0 Undrgrnd.,Test - - .
-9. Water Pipe-Undrgrnd. • - 60. Backwash Lines,P-Trap, 0 Undrgrnd. . I
10. Structural Floor System - - 61. APPROVAL TO DECK .
1.1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final, - .
12. Sewer Cap, r - ', 63. Heater & Vent-Final ,
13. Roof Drains 64. Plumbing System - Final '
14. Rough Plumbing, , _ 65.'Electrical-Final -
•
.15. Rough Electrical-Conduit - 66.. Solar.System-Final , ___
,16. Rough Electric Wiring • 67. Fencing & Access Approval
' -17. Rough Wiring Sign 68. APPROVED FOR PLASTERING -'
-18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20, Rough Factory Fireplace ' ' APPROVALS Permit# - '
. 21. Ducts, in Structure 70. Underground Hydro - i'
22: Ducts„Ventilating 71. Product Piping 0 Gas 0 Oil '
1.23.,GasPipe-Rough & Test . - -• 721 Underground Flush . .•
. -
;r24.'Roof Framing - - - 73. Undergrnd.Storage Tank 0 Gas.,0 Oil ' - - - :- i
' 25. Roof Sheathing 74. Overhead Hydro •
26. 'T=Bar Ceiling (Structural) & Monocoat' . 75. Dry Chemical
27. Frame andFlashing - . ,1 76. Dry'Standpiipe -.
• 28. Lathing& Siding I , 77. F,IXED SYSTEM FINAL -
29. Insulation • ;i ' '78. FIRE PREY. FINAL
30. Drywall Nailing , : HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • - - - 79:- FINAL INSPECTION - - - - _
X32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric /' + Notes: - -- ,
i. 34. Final.Healing & Air Conditioning C r
' iz/445- J -' - . -`
35. Final Gas Pipe-Test. '_ ' ' - -- - , - - -
36. Hood or-Canopy - . - - . •. -
u -
37. Final Factory Fireplace ' - , - _ '
•38. Final Plumbing i (Z//Cf,Ar Lata - - • '
39. Water Service-Final' •
40. Gas Service-Final ' - -
41. Solar Domestic-Final • '
42. Backflow.Preventer' ' • -
43. Backflow Irrigation - - - _ ,.
44 .L
. andscape Irrigation System ' - - , . •
45. Sound Attenuation - - -
46. Handicap-Regulations ' - -
47. FINAL STRUCTURE & BUILDING - . ' i '
48. Special Requirements Completed -1 -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - .
51'. CERTIFICATE OF'OCCUPANCY " '
No. Date _ '
-_ - y _ �N.
:-----
44
,riie� o
- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ++r.' r, 52DL1 87p 63 fiL,
• • PERMIT NO. TRAC NO. - LOT NO. UNIT NO. i
-' CITY QFCOSTA•MESA CONSTRUCTION PERMIT ¢, a-p �'ycj8 � LL (� _ •
rojectioildrese Ino 2- T • C,CtdX ''�� �/ 1 T /b•Applicant's Maili.^ ddress I I'�� ^��i9 - Ll.) ' TYPE OF-CONSTRUCTION I ❑ ANEW KADD TiLJ ALTERATION LI REPAIR )
( Li CONVERSION ❑'DEMOLISH ❑ OTH R n
(� Owner's Na71:a C•.a"'l'L'�i4itJ. �-/a 1 n Phone 9C.(•-O.:J��L A.P.# /L.�/ /� -��p _ Zone lIC i ,
, "DESCRIPTION OF WORK/USE OF BLDG.' gtfTCds4%f-�--K-f�iMnOL+FJ •
�, Address • it f,�i DCL%S(LT L� _ f.!, •^ S Main Building: Accessory Building: •
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING IX.
❑ STRUCTURAL E Front '2(DfZO
TENANT ELECTRICAL.Ia PLUMBING ❑ MECHANICAL CBAK ' N
Address l 1 �� Q OTHER A Rear (.0 f ' ..z.......,/e.'..... ...-'--':II.
, Contractor's Name �/ 7 Phone QtCr'q•+ 4_Z - C Right - -- -
Address(mailing) • / PROJECT DESCRIPTION SQ. FT. !r oCCUPArvCx p K G
CON STRUCTION TYPE VALUATION $3 '1 • 80 $ Left I .
CitR
y-License No. ' ZONE GRADING CU.YDS. •• • AC IIES' Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION - Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:,. : ' Planning Notes: „,„r, �etin p i as _ i ') M
with section 7000).of Division 3 of the Business and Professions Code, and ,
/ryy a�,,�,��'��`'���' /�� i
my license is in full force and effect. ' • V r T
• License Class • - License rNo.— - ' ., . $
•
Date Signature •
PLUMBING ' -FEES' •
•
WORKERS'COMPENSATION DECLARATION Bar Sink Showers • ' - -
1 hereby affirm that I have a certificate of consent to self-insure or a certificate - ELECTRICAL - FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section - -
3800, Lab. C.) - Backflow Preventer Service Sink . . ' _ Automatic Washer Transformer 0 15-50 KW
•\icy No. Company Backflow Irrigation' Sewer Cap • • -
Construction Pole Sub. .❑ 50+KW
Certified copy is hereby furnished. - •
-
Li Certified copy is filed with the city Building Division. Bathtubs , Sewer Connection Cooking Unit Meter :hp to 100 amps•
Date ' • Applicant . . . , -'
_EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers I Solar Collectors; • Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or - '
/ less). 1 D_ ish washer Solar Piping . 2'O'O - Dryers.❑Gas ❑Electric ' Sub Panel -
I certify that in the performance of the work for which this permit is issued, I; • - - - •- ' • •
shall not employ any person in an anneyJ so as to beco subject to the, •- Drinking Fountains I ' Solar Tank Fan Motors ❑0-1 HP ❑1%-S -.-
Workers' C mpens tion Laws of Cal rnia�/ /J .ANf � _
• Date,.. _ • Signator/ mss- [�/0.� !' ' Floor Drains ' I Swimming Pool w/Spa • F.A.U. •- •
NOTICE: f,after making this declaration, you.Should become subject to the '• - - Inc.Solar ❑915 HP ❑1fi-15+'
Workers' Compensation provisions Of the Labor Code, you must forthwith'. i FIOOLSinks Urinal
comply with such 'provisions or this permit shall,be deemed revoked. •-d - - Si- -s
Fixtures Microwave + -
CONSTRUCTION LENDING AGENCY • • Gas Servic¢ .Outlets/' Water Closet
•• Device Boxes Pole
I hereby affirm that there is aiGons[r uc[ign lending agency for the performance - - - -` - Light
of the work'for!which this permit is issuetl (Section 3097• Civ. C.) -
,a• - ; Interceptors ',S`• ;f'` '.' »•r Water Heater , ' - Outlets:' - Range _ f•
Zp
Lender's Name - - .
Lender's Address • - /t Kitchen Sink . •• %�` Water Service . •' . . 2. no - y Switches ' - - Si n• -
-OWNER BUILDER DECLARATION - 3 g Q- 60
I hereby affirm that.1 am exempt from the Contractor's License LaW for the Lavatdries ;_-±,.;11-•,,,•-; Auto-Wash , - Garbage Disposal • Standing Sections
following•reason (Section.7031.5 Business and Professional Code: Any city or - - '
county which requires-a permit to construct,alter,improve,demolish or repair P-Trap\ ;+µms .] ' Laundry Trays Generator 00-5 KW ❑5-15 KW
any structure, prior tdits.issuance, also requires the applicant for such permit - • Trash Compactor
•
to file a.signed statement that he/she is licensed pursuant to the provisions of Roof-Drains - '
the Contractor's License Law (Chapter 9(commencing with Sections7000) of .'w'•' %'+ 9 'v ,
- Division 3 of the-Business and Professions Code) or that he/she is exempt - .. - - - . . - - -
therefrom and the basis for the alleged exemption. Any violation of'Section
7031.5' by any applicant for a permit subjects the applicant to a civil t - -
Yl,.falty of not more than five,hundred dollars($500). •
I -- • 3
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ .
':'-`" pensation, will do-the work,and the structure is not intended or offered i ' - Reinspection Fee , $15 Issue Fee $ 3
r sale (Section 7044; Business and-'Professional Code: The Contractor's • MECHANICAL .FEES
• License Law does not apply to an owner of a property who builds or improves • -
' thereon, and who does such:work himself/herself or through his or her own - • DEVELOPMENT SERVICES REQUIREMENTS: ^, r 4.1187:r I lib 7 '
employees, provided that such improvements are not intended or offered for let Hood or - Typ•
e I 0 `'{`''11// � ((}��� �� '7, .//.
sale. If, however, the building or improvement is sold within one year of com- 'Canopy Type II 0 Zoning Approved By LNyL/ Date
pletion, the-owner will have the burden of proving he/she did not build or im- Duct- der Ground { - Building Approved By Date /��(1
prove for the purpose of sale). • 0
- - 0 as owner of the property, aria exclusively contracting with licensed con- Duct-Strut Refrigeration Syste Application Issued By ' ,\ Date
tractors to construct the project.(Section 7044, Business and Professions Code: -
The Contractor's License Law does not apply-to an owner of property who - , Duct-Ventilating ❑0-100,000 I ❑100,000 BTU - • - SUMMARY OF FEES - - '
builds or improves thereon, and who contracts for such projects with a con- - •
-
tractor(s) license pursuant to the Contractor's License Law). I,am aware thatBUILDING PERMIT $ 4 4 • 5 0 SMTP $ 0 .5 d
of Exhaust System 0 Multiple Syst epair/Alteration
proof. their Worker's Compensation insurance should be provided to me. PLAN CHECK •
$ 7 93 PERMIT
i: I am exempt under-Section B. & P. far this reason Firepl/Fact.Blt. ICBG# •' -.Dampers '
• •
PLUMBING $ 7 - ^O CnE ISSUANCE • $
• Date/' r oner fit" Heating System& Ducting Registe y - PLAN CHECK -25% $ ENERGY P.C: $
I hereby certify'thatIwhave read this application and state that the above ❑0-1,00,000 BTU 0101•r 106T •GRADING; $
information is correct, I agree to comply with all city and county ordinances - '• - ELECTRICAL $
and state laws relating-to building construction,and hereby authorize repre- PLAN CHECK 50% $ o 'qtr MICROFILM $
' sentatives of s city to enter ypon the above-mentioned propert glut _ .I Q
i�nnspection put is s/ - ,r1'1 (/ �� Dat 34 ❑ - • MECHANICAL $ TOTAL FEE .$ O '
tf rivet ure'���vr—.v'�-T '` //j' .
`�ri vers' License or 55• ( •- - nspection Fee I -r$15 - Issue Fee PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor - - - -
•
•
' 'CONSTRUCTION AND'FLANNING �� POOL &SPA •
APPROVALS !Per mit# Date ; ,Inspedtor= ` ' Date Inspector
+ - .rqr ;,;APPROVALS Permit#
j
1. Temporary Electrical,Service or Pole - 52. "Pool & Equipment Location
' 2. Soil Pipe-Undrgrnd. yam{Y7. Lep 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. . 54. Forms ,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . ' ,
5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test . ,
6. Electrical UFERGrnd,'- 57. APPROVAL TO COVER-GUNITE •
7. Footirigs 58. Electrical Conduit-Undrgrnd. • . •
' 8. Foundation - - • - ' -• ' 59. Gas Pipe, 0 Undrgrnd.,Test
-y
9. Water Pipe•Undrgrnd. ' 1-17 C.(O ' 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 .
t
13. Roof Drains 64. Plumbing System - Final • •• '
14. Rough Plumbing ' - 11720-.17 t.41) 65. Electrical-Final, • -
15: Rough Electrical-Conduit ' • 66. Solar System-Final '
16. Rough Electric Wiring- . 4-24.).-57 t40. 67. Fencing & Access Approval -
17. Rough Wiring Sign - , • 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling! - 69. POOL/SPA SYSTEMS FINAL
• 19. Rough Heating & Air Conditioning • • - FIRE DEPT. REQUIREMENT •• '
• 20'•,Rough Factory Fireplace ' .APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro '
22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil
23. Gas Pipe-Rough & Test - i 72. Underground Flush
24. Roof Framing i : ' - 1 73. Undergrnd.Storage Tank 0 Gas 0 Oil 't
25. Roof Sheathing - 74.:Overhead Hydro -
26. T-Bar Ceilingr(Structural) &•Monocoat i . 75. Dry Chemical ' . . -
27. Frame and Flashing • 1 /17; h( . 76. Dry Standpipe ,
28. Lathing & Siding Y/ ��7 � '
1��/0// 77. FIXED SYSTEM'FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing , ' Al 7/ HEALTH DEPT. REQUIREMENT r
31. Plaster Brown Coat � , 79. FINAL INSPECTION • •
32. Electrical'Power Meter-Final - r...����••+��. G 80. FOOD CERTIFICATE ISSUED. - - ,
33. Final Electric , - 9 757 `� Notes:///e F.-.I c/%c• . E' /�� '•
34. Final Heating & Air Conditioning• ' - �X;7JG_ �/
35. Final Gas Pipe-Test - g ,� /._
36. Hood or Canopy . . ���"���vV��j ,
37: Final Factory Fireplace
38. Final Plumbing . • 6-717 LCD - •
• 39. Water Service-Final - , - - ' . .
'40: Gas Service-Final . •
:41. Solar Domestic-Final •
:42. Backflow Preventer -
43. Backflow, Irrigation - -
•44. .Landscape Irrigation System - - -
45. Sound Attenuation . •
•
e
46. Handicap Regulations - / To7.
,
L•
47. FINASTRUCTURE & BUILDING /t• /.
48.,Special Requirements Completed - ! I .L • • .
49. Electric Release to Edison - - - V'
50. Gas Release to Southern California Gas Co - , r;
51.;--CERTIFICATE OF OCCUPANCY. . . • -
•No. .:- Date _ _ . - . , ,
i.
JOB ADDRESS$CR11(S2 Pm-Ret Jane PERMITNO.29381
GMLR
ENERAL CONTRACTOR Atlas Builders DESCRIPTIONoiWORK Add 2 Bdrms. & Enlarge Bdrm.
AP mo. 141-142-16 LOT az
TRACT 4395 FIRE ZONE VALUE E 800.00
pp1 ;TIONS Signature Date GROUP I TYPE Y ZONE R-1
M= I PERMITS ISSUED
GAS SUBCONTRACTOR
WATER Date Number Signature
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE 0 HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOS6, y�i^� ti &,i`�
ROUGH HEATING AND AIR CONDITIONING 4-,u/ /Z6-
TEMPGRARY SERVICE OR POLE
UNDERGROUND 0 POWER 0 'r
ROUGH WIRING - 2-/(i-N Heatin• •_d VV/_nt.
TRENCHES Fill FORMS Malin '��I'• �� a���yaeya ailrr
FLOOR SYSTE /00- 11-7f-Le
BOND BEAM n STEEL REINFORCE n .,,ray
SHEATHING �.,�t l'p/nt0 i -//-4T
FRAME AND FLASHINGO/C c..r1,L11W' /V/� 7 /iiri /2-/6-6%
LATHING - IN E OUT 2 /r/0,e1 /1-/ff-&d-
PLASTER, BROWN COAT /41j41 /2_y J,(
5r - IU AL, FINAL / Elect iL /� /
C , VENT., REFRIG. AND A.C., FINAL Kb- /2-/G--.i(!/J/',7;e1. (tO ng:n3/4if -H ,
P. NG, FINAL AND GAS TEST f
ELECTRIC, FINAL /f//\/ /4'5/Koh' _
BUILDING, FINAL ,,rit /2:51-gal— •
SPECIAL REQUIREMENTS
•
ID
NOV 18-68- 00 867* ****-. 1:50
29381 •
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •
APPLICATION FOR BUILDING PERMIT
For Applicant to F. in Complet y RECEI ED BY DATE CEIV D DATE ISSUED
BUILDING J /,_ _ / - /I-/8 GiY I H-020-67
ADDRESS ..•
�./�/®ICY. L �-� y / rM� (}.
OWNER V i� '!/E� A.P. NO. i�l— Iy.1 [ r %3NQ �
.�" /� BUILDING /���� p�
A DDA ESS ��/ O/�E �/ Gs�L-�� ADDRESS j I���//at r ' (//[^�-fr^,"'
CL U CITY ,G<�f.GQ/ NE4:sy6�68'LU LU
TRACT477.,C �J LOT 7 rY- BLOCK
ZZ _ NE ADD - TER REPAIR MOVING DFMOLISH
< CONSTRUCTION
d m LENDER / �•Z��
J O< LB BRANCH ! /J ✓
J OWNER �` z-
m J ADDRESS 0 1a9 VALUE
-CO ARCHITECT TEL S $
J < OR ENGINEER TE
C.7)(4FIRE 1/
W 2 ADDRESS ZONE TYPE ✓ GROUP
aw
�/� ,J APPROVED
J O CONTRACTOR d % ,/%(( BY DATE if—.V1..6.:€1,1
Z _ i /J� iQt ,u.�µL
CO 2 ADDRESS - �.,i/�if/ R'-i A �'t
W W ZO NO.OF USE OF NE
ZICITY / �� Z✓ NO� 5�'3 •- ' PLANS BUILDING f
W O STATE �J '/ CITV YARDS APPROVED YARDS APPROVED
N CC LIC.NO....,!/� �/�f' LIC. NO. MAIN BUILDING ACCESSORY BUILDING
•
DO - I (FROM C/L STRE I
SIZE NO.OF BLDGS. .A-I'
/ ') r
OF LOT ,16 NOW ON LOT / FRONT 4- I�j FT.
USE OF r
EXISTING BLDG. 4 .-�i/ ,e. _RIDE 39- FT. FT,
re
o.
Z NEW BLDcS••00 'ROOMS STORI $ / L.SIDE FT. (7 FT.
Q EXTERIOR WAL ROOF �� 7 /� el f
V COVERING uO COVERING"; ((// REAR 7 FT. 6 Y FT. -
J USE OF BUILDING AND WORK TOB PERF RMED DISTANCE BET. BET.MAIN&
O. 2t.-'4A # 2.6t€ - /27Oi E MAIN BLOCS. ACCESS. BLDGS.
0
VAR.* DATE
O .4A/a ,j4/,(„ e,eitte /,s,p 6Q C.U.P.# APPROVED
G/ APPROVEO(p/W tile;:i2dimeiihiAy
N �Y
Z
0
~ I hereby acknowledge that I have read this application and state
DI that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
I"' any person in violation of the workman's compensation laws of
CO the State of California. •
56 aS
Z I hereby certify that I am properly licensed as a contractor under SO. FT. o
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: a
am exempt from the provision - •-State of California Business VALUATION
and Professions Code, Div' ' - 3, Chap • 9. Awl op
PERMIT FEE $ /, U-V N
/%- L/ O
CO
Signature of , - / // I�,�..�(
Permittee `/ vs , $ I //I// PLAN CHECK $ /D. 50 €
/ a LL
Authorized Agent ` TOTAL FEE / •�(/
Lo,- TRACT 4395 •
F E RECEIVED
�� 16317 JAN 3 11962
6 COSTA MESA BUILDING-SAFETY DEPARTMENT //tt FINANCE DEPT
.p�
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely , APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING //6.2vo/.Se Lon e.....
ADDRESS
COSTA MESA. CALIFORNIA For Office Use Only
RECEIPT NO. Pl 17
OWNER K 'S( K DEVELOPMENT CO., INC.
MAIL _ RECEIVED BYI DATER _..1 ,D TE IBBl1E
ADDRESS 1555 PLACENT IA AVENUE
I.� G'C. 1 oL7�(o JA31 1982
CITY NEWPORT BEACH NO"1I 63227 BUILDING
ADDRESS
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NONE NO. ---- 'Jiff. Z
ADDRESSf/
FNIRE TYPE GROUP
CONTRACTOR K. W. KOLL APPROVED
BY DATE
ADDRESS 1555 -PL ACENT IA AVENUE ZONING
ZONE 'Z.::
O.OF USE OP NEW Si y,W.(. re
CITY NEWPORT BEACH /�–� PLANe a I BUILDING w/yN,na
STATE TEL. LEGAL
LIC.NO. 61195 NO. DESCRIPTION 2-.0$ re H3 93
SIZE / . / ' NO. OF BLOCS.
OF LOT I ' X /Q0 NOW ON LOT 0 A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. NONE APPROVED ALLOWED
SETBACK LINE FROM e (CENTER LINE.ST.) LJ
6
CENTER OF STREET aid ,
// REAR YARD �5- FRONT 3r(y7 FT. IN.
SIDE YARD I LEFT 7 / I RIGHT 7' R.SIDE ( FT. —
IN.
DESCRIPTION OF WORK L.SIDE 7 FT. —_ IN.
NEW I XII ALTERATION I II ADDITION I REAR a S FT. J IN.
REPAIR II MOVING II DEMOLISH APPROVED J A DATE / 30/6 z
BUIL-GING 310 6997" NO. OF / h .P/J /1,0
SIZE‘)/94° 37° Sy f� ROOMS qL/ STORIES 1 (f l�°�I�f")/
EXTERIOR WALL / ROOF 10/n/oos`i/� /� X_ill [//
COVERING STUCCO COVERING d`
USE OF BUILDING AND WORK TO BE PERFORMED ✓f- i/� A/ .
SINGIE FAMILY RESIDENCE WITH .... j •
ATTACHED GARAGE.
s (/�Jy
PLAN # 3 ,q •
HEREBY ACKNOWLEDGE THAI HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
SND STATE THAT THE ABOVE Ti8 CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
LY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
)UILDING CONSTRUCTION. VALUATION
IGNATURE OF /J .4d.�� / PERMIT FEE $ '�� H
ERMITTEF 7 /'•r�`�- //_ ��{ /,P/ a
$ /((// / PLAN CHECK $ /L/ -- • 4
1UTHORIZED AGENT 5–Y-- 0
TOTAL FEE $ LL