HomeMy WebLinkAbout1168 DORSET LN - Building Permits la, Its
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A CITY OF COSTA MESA
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BUILDING DIVISION
F i , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
Sboa.rmioest ✓B02-00966
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1168 DORSET LN Status: ISSUED
Suite: Applied: 06/27/2002
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 06/27/2002
Parcel Number: 14114217 Zoning: / /
Applicant: KELLY, ANTHONY ISSUED BY:
Air
LI
Address: 13052 EDWARDS
Phone: (714)895-6677
WESTMINSTER, CA Zip: 92683 ,
Owner: CONTRERAS, DAVID E
Address 1168 DORSET LN -
Phone: - -
COSTA MESA,CA. Zip: 92626 -
Contractor: AFFORDABLE ROOFING & REPAIR
Address: 13052 EDWARDS , . '
Phone: (714)895-6677
WESTMINSTER,CA . ' .
Zip: 92683 License: 755616 •
Arch : Eng:
Address: Address:
Phone: • Phone:
Zip: License: License:
SCOPE OF PERMIT_
- REROOF:T/O EXISTING COMP SHINGLES, REPAIR SHTG AS NEEDED,.1 LAYER 15#FELT,APPLY"40-YEAR COMP
SHINGLES"23 SQUARES '
•
FEE SUMMARY •
Plan Check: $0.00 Calc Valuation: $5,600.00
Permit: $125.25 " - 'Claim Valuation: $5,600.00
SMIP Res: $0.56
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.81 - .
•
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front . 07,0 - Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•r
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: _
O 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: 34 t- -R-bnd Policy Number: 34 /9-l(p-2cb�
(This section need not be completed i/the permit is valued et 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 Califomia,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: 1 ' QZ7- OR--
WARNING:FAILURE TO SECURE WORKERS'COMP AT1ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100000),IN ADDITION TO E COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060f THE LABORCODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under.rovisions 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.# r Class# 0.35 c(- C.
Contractor's Signature: - Date: 4'-? 7 .-
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).):
O 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,Califomia 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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia 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 Califomia 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 appermii for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI 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).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia 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.
S atu f Le al Owner(s) Date
And/Or Aut ed Applicant Date
;ADE V INSPECTIONTYPE neat 1NTITIAL$ COPE# INSPECTION TYPE LAM ;MALI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final p 208 Final Plumbing
200 Final Re-Roof Z d �l (t-t# 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
PROJECT ADDRESS: 1168 DORSET LN ' UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 064213
OWNER'S NAME: CONTRERAS, DAVID E •
ADDRESS: CONTRERAS, CHARLOTTE J PERMIT NO: M 064213 PLAN CHECK NO: N GOVT: N SUPP: N
1168 DORSET LN
COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH
751-3208
" ARCH/ENGINEER: REGMO.: JOB DESCRIPTION : REPLACE FAU & INSTALL A/C UNIT SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
PERMITTEE: GRAHAM BROS INC. ( 714 ) 546-1653
ADDRESS: 2952 CENTURY PL COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT •
COSTA MESA CA 92626 *+F+E**********+E*+F+E+E********************************************************* ***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMENTS •
7000)of Division 3 of the Business and Professions Code. an, [cense is in full force and effect. • SETBACK S
CITY LIC.: p 059 STATEuc.: 2486, • CLASS: C-20 •
Date':49 t 28(9 signature: —Iwo t MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FR NT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800, Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: WC1161030226013 EXP.DATE: 08 /01 /94
COMPANY: LIBERTY MUTUAL PARKING REQ REQ1 PROV: PARCEL: 14114217 ZNE: REF NO:
❑ Certified copy is hereby furnished. 12 Certfie ed with the city Building Din. PLANNING NOTES>
Q �{ ( 1 S•p)�� y
7 e• �12V1 1� APPI 11 l7VY� ************************************3EiF*****************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E R- V ICES REQUIREMEN TS
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
sublect to the Workers'Compensation Laws of California. ZONING APPROVED BY t).` DATE:
Date: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. •' C rp�.7� ///,,, 7
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance at the work for APPLICATION ISSUED BY: r
••KLi . 28 �—L
i�Li iiiFFF DATE: #
3097.issued(Section *********.***********.*.********.*****.***.******* ********************** ***** **
LENDER: *******************************************************************************
ADDRESS: •
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18,00
repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% $MIP/NON—R ES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 18 . 00 15 . 00 0 . 00 33 .00 33 . 00 . 00
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 employees,provided that such improvements are not intended or offered tor sale.If,however the building or REVENUE DIVISION TOTALS——> COLLECTED: 33 . 00 OVER/SHORT
improvement
theepurrpose offs sale)nIn 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
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business - 33 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ****************************************************.****************.***********.
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAK D OWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: owner: MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
I do hereby teddy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 .00 9 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit far construction or modification from the Air Duality Management District.Residential construction applications are exempt from END OF FEES
these provisions.
Date. Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county•
•��� , DATE:E: 09/25/93 TIME: 11:18
1641.46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
•
' CONST tUCTION AND PLANNING POOL 'A
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:ElectucalCondeitUtility-Undrgrnd?;_; 54. 'Forms '
4..Electrical Conduit<S drgrnd,• t' - • 55, Electrical Bonding. ,
.
5._SteetrEieinforcegtenf 56, Rough Plumbing & Pressure Test •
6....
Electrical UFER:Gelid. - 57. APPROVAL TO COVER-GUNITE '
ii l:footings - -' • 58. Electrical Conduit-Undrgrnd. yti,
7 8r. oundation ,': .. ` .• 59. Gas Pipe, 0 Undrgrnd., Test
,1• r -
•9!-Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. '
I 10.rStructural Floor System 1 61. APPROVAL TO DECK '-1
11: Property Sewer Line`& HobieConnection - 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 '
1 16. Rough Electric Viring • ' 67. Fencing & Access Approval
i <r
17. Rough Wiring 'Sign 68. APPROVED FOR PLASTERING
•
i
18. Rough Electrical-T Bar Ceiling 69. POOLJSPA SYSTEMS FINAL
•
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- _ ',-It7'
20P'Rouah Factory Fireplace o:, 1 * t ,� '' ; 1APPROVALS-F=Permit# ' ''t"
21:-Duds,in.Structure. -.. .. .^~ 0 i ,-,„ -.70. Underground Hydro 4
22, Ducts, Ventilating:: i' _ " _-'•71- Product;Prping O•Gas GxOil
p' Rou h & -Lest r ~• 3+ •_• ' _
23•,Gas ipe; ^g - -iir 1 r r _.t 't .72- Underground Flush -i
24: Roof Framing r I r: t- 4 0 �} =73;:jUndergrnd:StorageTankOGas ❑011 '
25. Roof Sheathing [,b �: •• - 'n :- -•i: `t. "7q- ,Overhead Hydro.,
26:.T-Bar Ceiling (Structural) &'Monocoat >` '7 '.k 't. 75 Dry Chemical "
27: Frame and Flashing. ,.. �, l ; • 76. Dry Standpipe 1 �"4 .1
a
`-.28. Lathing& `I a Sidingca -1 --101,3i t 7". ••, 7 1 77;_'FIXED SYSTEM SINAL' ...- •
x'29. Insulation •• x •. . r•
:;.* 2 r a N. 78,^FIRE PR EV. FINAL .•: .' ,- •s
r30. Drywall Nailing r-'e I I 4 ' HEALTHtDEPT ,: REQUIREMENT
`-'31- Plaster BrowrkCoat; , ,z,y 1 I F x ,.79:TFINALI1 PECTIriN t .r
--32."Electrical Power Meter;Final I fix `80,rFOOD CERTIFKOATE ISSUED lc"
.._33:-FirtHl EI-ectric -''r i.7 j ` r"Nses: J ;.n i r7 t• ''nor.-.
ic34.,Fina3 Heating;& AiaConditigning- - ?pi! LEOE w :,t:...• - - O
,35,'Firial G Pipe-Test'` _ ti I" ,1
, 1:,
Hood orCCanopy• o ' * '" ' ,"t 'A •• ._
,. , ,....-e •-
�• _ - , , I .` ,T-1 ,•r • ,r C .
•[7-36:
137.Fin'a1 FSctory Fire,plade. • • - + 1. r'
38. Final Phimnbing - n I -1 , I i�; Li
.'39. Water Service-Final* I x o aim
40. Gas Service-Final 1. trir s n ' ! 1^ , ,0• , _,•z
' '41. Solar Domestic-Final''' I I, a a,r
1"42,1Backflow Preventers -y -• ti ., a .,-
e
43, Backflow Irrigation! '',= r;-' - -'
+ r I
'44. Landscape Ikiigation System •.,ii., -• : r^ -.. U.r 1
'A5::Sound Attenuation •n• - : --x > ..,
'46. Handicap Regulations * z - t
47'FINAL STRUCTURE & BUILDING e i - c-
% t__,14 ,
48: FINAL PLANNINd i - I � .,Pt, 4 't v �
• .-49:�Electric Release to Edison * rti
50-_Gas-Release to Sou{hern California Gas Co t ! I' � s L� �.�:
51. CERTIFICATE OFiOCCUPANCY •
i r
No. Date
_, _ = —
ApplicanCtomi,a�.. •- -_ -- _— _ —
CITY OF C I '/A •y CONSTRUCTION PERMIT PE(JgMIT NO TRACT NO.: LOT NO. UNIT NO.: •- • _ _
Protect Address II 1.26 1 e t S^6 I � 6 - - l t `) 1st i I - •
'Applicant's Mailing Addressl ee Cc rt N: TYPE OF CONSTRUCTION • `'.0 NEW..H ADD U ALTERATION U REPAIR , - I X395 ' L/.n 1,/OG - .. __
Owner's Name' I\t'( 0. 'Ck Phone- - - -❑,CONVERSION' ❑DEMOLISH ❑ OTHER - AP # • (
a .DESCRIPTION OF WORK/USE OF BLDG. _
Address !M•C - - I _ ��'tl - . . • `• S Main Building: - - :Accessory Building:: , - - -
Arch/Eng. • A�1 - License No. -' TYPE OF PERMIT i ❑ GRADING L'J--FOUNDATION ❑ STRUCTURAL: T Front • , -- I' O
/I!/A t ❑ TENANT ❑ ELECTRICAL PLUMBING CO MECHANICAL B ' N
Address )) G+\S�"k.i.\e -r t A Reaf -
Contractor's Name /GlIf <�IV % Phone$s9'y D,S' OTHER
Address(mailing) C.L&rt.. -C�Lf1:f�/f)Tf Vls/tt Cc.. Q.�7%y PROJECT DESCRIPTION SO. FT. I OCCUPANCY C Right ` .t 1
Q0
G
W - - CONSTRUCTION TYPE - VALUATION$ S Left -
C)'-'
I�' City License No. 30•):jS ZONE • - GRADING CU.YDS. 'ACRES R
v - LICENSED CONTRACTOR DECLARATION - Ping. Ref. ' Packing Req /Provided, i E
�, Phereby affirm that I am licensed under provisions of,Charter 9-(commencing ' Remarks: i I ' Planning Notes: IC M
( with section 7000) of Division 3 of the Business and Professions Code,and . - - - T
my license is in full force and effect. L - f -
� ��/� ` • S ,
License Class_=3440 Licens o.
Date 2. r signature c, : PLUMBING l FEES ,
WORKERS'COMPENSATION D =q-RATION Bar Sinki
Showers ELECTRICAL FEES
I herebyaffirm that have a certificate of consent to self-insure or a certificate 1 -
of Workers' Compensation Insurance, or a certified copy'thereof (Section _ - _ _. .. - _ T _. _
3800, Lab. C. co-do
/ ' Backflow Preventer-- _ , Service Sink'
14�� f�.s� Automatic Washer, Transformer 0 15-50 KW
P 'icy No. (L)t ( Company V� Backflow Irrigation Sewer Cap - 0 50+KW(J Construction Pole,Sub. 4 •
Certified copy is hereby furnished. '
-
I CeJified copy ' filedswith the city B g Divisior. , Bathtubs ' ) Sewer Connection Cooking Unit Meter Dug td 100 amps
ate S-.-a.3-"S" Applicant p�'J"/Jyra tic T' -
•EXEMPTION FROM WORKERS'1COMP ENSATION DECLARATION .L - Solar Collectors ,,_ - -, - - _ _ Dishwasher . ... _. Meter ❑over100amps.._ _•,.—1- •_.
(This section need not be completed if the permit is for one hundred ($100)-or .- -
-
less). . - e' Dishwasher • Solar Piping , • . ZCO 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 any manner so as to become subject to the - Drinking Fountains Solar Tank Fan - ' !
Workers' Compensation Laws of California.. - , Motors 00.1 HP ❑iX-.8
.Date ' Signature Floor Drains Swimming Pool w/Spa, F.A.U. i •
NOTICE:If,after making this declaration, you should become subject to the - _ Inc.Solar 09-15 HP ❑76-15+
Workers' Compensation provisions-of:the Labor Code, you must.forthwith Floor Sinks- ' - --- - -- - r - - Urinal - . --I
comply Iwith such provisions_ or this permit shall be•deemed revoked. • FixturesMicrowave
CONSTRUCTION LENDING AGENCY • ' • Gas Service ' -Outlets 'Water Closet, - Device Boxes ' '
I hereby affirm that there is a'constructio lending agency for the performance POIe Light
Of the ,work for which this per i is i issued (Section 3097 Civ. C.), - - • - -
tRnder's' Name _ , _ Interceptors Water Heater Outlets Range
Lender'siAddress - ' Kitchen'Sink • Water Service - •• Switches Sign
OWNER BUILDER OECLAR ON ' - .. - - '
I hereby affirm-that I am exempt from the Contractor's License Law'for the Lavatories - Auto-Wash ' - I1
following reason (Section-7031.5 Business and Professional Code: Any city or - Garbage Disposal Standing Sections i
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundr Tra s
any structure, prior to its issuance,-also requires the applicant for such permit - y y * Generator ❑0.5 KW ❑5-15 KW Trash Compactor
!to file a signed statement.that he/she is licensed,pursuant to the provisions of •
ROOF Drains -- -• - t •
•
the Contractor's License Law(Chapter 9(commencing with Secshe i 0exe of _ ' - ,
Division' 3 of the Business and Professions Code) or that he/she is exempt 1 . - - . i _ - - - -
. therefrom and the basis for the alleged exemption. Any violation of Section - - ' ' '
:':y031.5 by any applicant for a permit subjects the.applicant to -a civil - - " _ • •
-
>°natty 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 - c 111 - Reinspection Fee $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 , - ' -, i - - DEVELOPMENT SERVICES REQUIREMENTS:- ,
employees, provided that such-Improvements are not'intended or offered for Boiler - i , Hood or Type I • ❑ - - .
•
sale. If, however, the building or improvement is sold within one year of corn- - - • - Canopy : Type II ❑ ' • •'j Zoning Approved By Date_'
pletion, the owner will have the burden of proving he/she did not build or.im- Duct:Under Ground ' iBuilding Approved By Date
prove'for the purpose of sale). -- - - - •- - - _ _ '
0 I. as owner of the property,am exclusively contracting with licensed con- Duct-Structural ' ' Refrigeration System ' Application Issued By ' _ _ • ' Date I
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 0100,000 BTU ' - -- SUMMA V OF FEES l - - •
builds or improves'thereon, and who'contracts for such projects with a con- - - -
•
tractor(s) license pursuant to the.Co ntractor's License Law). I am aware that ' Exhaust System 0 Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ ' ,
proof of their Worker's Compensation insurance h old be provided to me. PLAN CHECK $ • , PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# - Fire Dampers '
' PLUMBING $ •. --},CAD 'ISSUANCE • $
. Date owner' j • Heating System& Ducting Registers ENERGY P.C. $ -
• PLAN CHECK 25% $
I hereby certify that I have read this appli ation and state that-the above-'- - 00.100,000 BTU 0100,000 BT • -- ' -"' - GRADING
$
information is correct. I agree to comply with all city and county ordinances i ELECTRICAL ' $
and state laws relating to building construction, and y authorize repre- PLAN CHECK 50% $ I MICROFILM $ : '
sentatives of this city tyyy en upo���jjj abo coned property for
. inspection Purpose //� ��g� _ r0
Signature o'C Date MECHANICAL $ TOTAL FEE $
Drivers' License # Reinspection Fee $15 Issue Fee • $ 3 PLAN CHECK 25% $ '
s •
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
Ii. .
• CONSTRUCTION AND PLANNING ,.- ' - r 4. - POOL c A -
APPROVALS Permit# Date' •Inspector • APPROVALS Permit# Date Inspector •
1. Temporary Electrical Service or Pole _ - 52. -Pool &Equipment Location •
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement
'3. Electrical Conduit Utility-Undrgrnd - 54: Forms .
;4. Electrical Conduit;Undrgrnd. • 55. 'Electrical Bonding
5. Steel..Reinforcement _ • , - 56. Rough Plumbing & Pressure Test -
•
L 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, O'Undrgrnd. ,
10. Structural Floor System - - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . - - -
12. Sewer Cap 63i Heater & Vent-Final `
. 13. Roof Drains - 64. Plumbing System - Final c. . •
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 •
z -22. Ducts,'Ventilating 71. Product Piping 0 Gas0 Oil
23. Gas Pipe-Rough&Test - : I - 72. Underground Flush
- . 24. Roof Framing .. - • 73. Undergrnd.Storage Tank 0 Gas 0 Oil - . '.
25. Roof Sheathing 74. Overhead Hydro
26, T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .• .
1 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 I '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
•33. Final Electric •
Notes: y/jl�r 4 07(opo (.go
34. Final Heating & Air Conditioning -
35. Final Gas Pipe-Test - - - ' . =
36. Hood or Canopy' ,
37. Final Factory Fireplace.
,'/ 1
38. Final Plumbing
rater LEO " •
39. Water Service-Final • 7 ,
40. Gas Service-Final •
41. Solar Domestic-Final i
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 • , . ' I °;• '
51. CERTIFICATE OF OCCUPANCY
•f NoI
. ` - - • Date - .- -- . .- -
11
? LOT 41 TRACT 4395
•
16316 FIE . RECEIVED
JAN 3 11962
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. 0. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely CITY OFCOSTA MESA
PPP Y APPLICATION FOR PERMIT
j rTYP(E/�JOR PRINT BUILDING
ADDRESS /,
AGd' oTSe7 Lan P.-
COSTA
iCOSTA MESA. CALIFORNIA For Office Use Only
-DEVELOPMENT
RECEIPT NO. 116
OWNER K & K DEVELOPMENT Co., INC. 1 1113
MAIL RECEIVED BY I DATE RECEIVED 1 DATE ISSUED
ADDRESS 1555 PLA CENT IA AVENUE / k". /-02- '-&- IAN 11 146
•
CITY - NEWPORT BEACH TNOMI 63227 BUILDING
ADDRESS
ARCHITECT TEL. COSTA MESA. CALIFORNIA
OR ENGINEER NONE NO.
FIRE
ADDRESS (�
ZONE TYPE (��/ GROUP ,..9. IO
CONTRACTOR K. W. KOLL APPROVED
BY DATE
ADDRESS 1555 .PiACFNTIA AVENUE ZONING
gte
CITY [ ' NEWPORT BEACH / ZONE-3227 _( I PLANE CI BUIL-019a y.catL 9:E OP NEW �°'
STATE
LEGAL
LIG. 011 95 NO.' M I 6-3227 DESCRIPTION LO- v /I� T 1 3 Sys
SIZE /- f NO. OF BLDOB.
OF LOT &� X/oo' NOW ON LOT 0 A.P.NO.
USE OF YARDS EVES
EXISTING BLDG. NONE APPROVED ALLOWED
SETBACK LINE FROM !�O / p/ / ,, (CENTER LINE ST.)
CENTER OF STREET J REAR YARD✓p d(� FRONT S� FT. IN.
SIDE YARD I LEFT 7' I RIGHT 7' '7
R.SIDE FT. IN.
DESCRIPTION OF WORK7 FT. IN.
L.SIDE
NEW I X II ALTERATION I II ADDITION I REAR 2 L3p6.
FT. IN.
REPAIR II MOVING I II DEMOLISH I APPROVED CO/�444 DATE 1/347/‘Z
BUILD G/SDS FE NO. OF �/ �1
SIZE .Q 797s of ROOMS / STORIES 1
EXTERIOR WALL ROOF &m,"
COVERING STUCCO COVERING .54,75/e., IL.YYII _/960P/
USE OF BUILDING AND WORK TO BE PERFORMED ✓✓ ��
37A1
SI NGI F FAMILY RES_LaEN CE WITH /
I/ .
TTACHED GARAGE/ • 1
PLAN # es- /) _ //]'j�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION L/THE AILIINT 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 V--
C4
'�/
SIGNATURE OF '/) 14 it'd-a-- PERMIT FEE $ 3 /
PERMITTEF /� ILn_
$ /� D/`� PLAN CHECK $ /7— �'
AUTHORIZED AGENT
TOTAL FEE $ /`� A