HomeMy WebLinkAbout1610 CORSICA PL - Building Permits 't
4` � CITY OF COSTA MESA
6 BUILDING DIVISION
On h ..�l DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
�. to 1601-01120
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1610 CORSICA PL Status: ISSUED
Suite: Applied: 07/19/2001
Vicinity: RESIDENCE 8 ATTACHED GARAGE Issued: 07/19/2001
Parcel Number: 13919108 Zoning: R1 R1
Applicant: DIVILA, ELIAS ISSUED BY: /1
Address: 19651 EDUCATION LN.
Phone: (714)968-6135
HUNTINGTON BEACH,CA Zip: 92646
Owner: WIDLOWSKI, KENNETH
Address RAYMOND -..
COSTA MESA,CA Phone:
1610 CORSICA PL Zip: 92626
Contractor E D ROOFING SYSTEMS CO
Address: 19651 EDUCATION LN.
Phone: (714)968-6135
HUNTINGTON BEACH,CA
Zip: 92646 License: 672009
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF:T/O EXISTING ROOF,REPAIR SHTG AS NEEDED, 1 LAYER 30#FELT,APPLY 25-YEAR"ELK PRESTIQUE"
COMP SHINGLES. 24 SQUARES
FEE SUMMARY
Plan Check: $0.00 • - Calc Valuation: $4,895.00
Permit: $111.25 Claim Valuation: $4,895.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
Total: $111.76
PLANNING & ZONING =
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 ' Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448<e(8/00)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
r�
`N- I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My workers'` compensation Insurance carder and policy umber are:
—D2
Carrier:
.7-0*
—'''r 67- PFi� Policy Number: I —I S T
(This section need not be completed it thepermit is valued at one hundred dollars($t00)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 pr n
Applicant Signature: Vim___ �Z._ CJ�t.4J.1f Date: 0-7- I -1 6
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLL,RE(5100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business arme�rd, fe I
P ons Code,and my license is in full
force and effect.Lia a to '7 -00 q e-m q 141c - Class s (�
Contractors Signature: l? - ,�= c�•�--� Date: C`1— 1 9 — O
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions 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 drivers license. 0 Yes ❑No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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? ❑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? ❑Yes 0 No
(Section 25533 of the Califomla Health and Safety Code,with some exceptions.requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aPPermit 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 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
(It"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
B (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal er(s) Date
And/Or Au horized Applicant Date
CODE# INSPECTION TYPE BAT€ INITIALS CODE. INSPECTION TYPF PAN 1NTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /� .-'/, 208 Final Plumbing
200 Final Re-Roof 7-2-col 044 r 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate2023 2/ 9/6) 5.00 IL
_ - ,.- P P 9 declarations.ns.
CITY OF COSTA p MESA pCONTRUCT N PERMIT NQ„/� �� TRACT NO. LOT NO. UNIT NU.
!&IO C1�YSIX1- YI ' o' /lSTRU /
Projece Address / �;I �n U '
Applicant's Mailing Addres$ g (-Y�(2‘),ray l ' TYPE OF CONSTRUCTION NEW U ADD U ALTERATION terREPAI R •
/')p r! ps/1 (NO-C162()
'1 )
CI CONVERSION CI DEMOLISH ❑ OTHER - . A.P.# Zone
Owner's Name CC 1. .CrY1 1 Phone t/`f C162O i
'nn DESCRIPTION OF WORK/USE OF BLDG.
Address �T I 'P/ S Main Building: Accessory Building:
' Arch/Eng., License No. TYPE OF PERMIT El GRADING_:„..E;( FOUNDATION El STRUCTURAL E Front 0
Address . • ❑ TENANT ❑ ELECTRICAL IJ PLUMBING ❑ MECHANICAL 8 Rear N
0 i A I
Contractor's Nam- - , .���� Phone �QS ❑ OTHER C Right N
PROJECT DESCRIPTION SQ. FT. • OCCUPANCY G
Address n(mailing) (307 •� I \ K Left R
3 CON STRUCTION TYPE VALUATION$ $
City License No. ZONE GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided _
0
' 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 - • T
my license is in full force .nd of ect. n _ $
License Clams - -_/ Li,c se o. � P / RECEIVED FEB • 6
Date I- i-5� Signature if / ,l2L/JJr111 n ' PLUMBING FEES
) WORKERS'COMPENSATION DECLARATION Bar Sink Showers • •
ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self4nsure or a certificate •
of Workers'
�Compensation Insurance, or a certified copy theSepf (SecC n Backflow Preventer Service Sink • Automatic Washer Transformer 0 15-50 KW -
\ 3800, Lab. !''I 1 A✓��� r r^/yl
c Policy No. Company C 'F LL.( I(/Jl Backflow Irrigation Sewer •Cap ❑ 50+KW
Construction Pole Sub.
7
rt ified copy Is hereby furnished.
\ Cer ifi popsysed with the city a mg si .� Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
V Date )-tLO l / Applicant /I/' ✓l .t
, EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps' -
(This section need not be completed if the permit is for one hundred ($100)or
' less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel - •
I certify that in the performance of the work for which this 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-6 -•
Workers' Compensation Laws of California. - "
Date .Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 01615+NOTICE: 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 Microwave
comply with such provisions or this permit shall be deemed revoked.
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 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 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 I D1Sp�
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).
$ 3 I, as owner of the property or my employees with wages as their sole Reinspection Fee $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 0 Zonis Approved By
Date
sale. If, however, the building or improvement Is sold within one year of com- - - -- - Canopy Type II 0 g pP •
pletion,the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove for the purpose of sale). '/.1,,\n p�,�jl--r
LJ 1, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By �V 1 Date fJ (1V 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 00100,000 BTU 0100,000 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 $ SMIP _ $
proof oftheir Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration
PLAN-CHECK $ PERMIT
0 I am exempt under Section - B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ \> ISSUANCE $
Date Owner Heating System& Ducting Registers - • PLAN CHECK 25% $ ENERGY P.C. $ '
I hereby certify that I have read this application and state that the above DO-100,000 BTU 0100.000 BTL 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% $ MICROFILM $
Inspection opu ice city to enter upon the above-mentioned roperty for I
MECHANICAL $ TOTAL FEE $ s�Inspection ou nes nCter upovli�—/ p 1Signature -�/T/ 7
Drivers' License or SS# SS1e - Reinspection Fee $15 Issue Fee PLAN-CHECK 25% $
-
CMF 0865-46,rev. 10/84 White - Building; Canary . Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL &SPA
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
6. Electrical UFEft Grnd. 57. APPROVAL TO COVER;GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.LTest
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-TrapttJ 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 0 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 b-(-Y 7 L.-CO
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 MVA CONSTRUCTION PERMIT - PERMIT NO. TRACT NO. LOT NO. UNIT NO. - . . -
Project Address - ii ID L-.Lz 1 opi '' P 2-q 6 I �" r 1 _e _/ ._-
"1 l e /1 TYPE OF CONSTRUCTION Li NEW LI ADD LI ALTERATION )XREPAI R
Applicant's Maiiin dress, ////�� ru-< y
gg7,,QQ�/d� / /' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Address Name q/�1;u�"/�/���� Phone 4 "��� DESCRIPTION OF WORK/USE OF BLDG.
Address uW r ' `t , 1 I S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRA DI NG FOUNDATION ❑ STRUCTURAL E
Front O
Address ((��r : ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear • N
Contractor's Nam-�rt'"�e I L' �� ❑ OTHER A 1
"ragO naafi 1 PROJECT DESCRIPTION SO. FT. OCCUPANCY
'C Right N
Address(mailing/
ose g) G� (YLt��/l� CONSTRUCTION TYPE VALUATION$ K Left R
City License No. _ ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
i^,, I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: REr FIVFD J U L 2 9 1989 Q
�/ with section 7000) of Division 3 of the Business and Professions Code,and M
6t my license is in f II fore- and effect. d v. T
MW License Class _ _ ,I,I 'cr se Jr. •IL .4 S
Date t - W Signature ��rf .i f_ 1st PLUMBING FEES f
WORKERS' COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-Insure or a certificateELECTRICAL FEES
1rof Workers' Compensation Insurance, or a'certified copy thereof (Sects n Backflow Preventer Service Sink
Automatic Washer Transformer ❑ 15.50 KW
�, 3o00, No1-1('yl,Ia (�_�� Sit t„ -"1r f yl
Policy Nie 7 Company Stale- 1 1.1! ` Backflow Irrigation Sewer Cap0 50+ KW
�—t^entified copy Is hereby furnished. Construction POIe Sub.
ZC ti op led with the city )dir,+i n.// �� Bathtubs Sewer Connection
�} ee(�I�� ��"�/ �'__[L..,,�� jt� ��// Cooking Unit Meter Duo to 100 amps
Date I
(2
-l� 'U ! _Applicant f/C_ CCICE --- • '�
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(Thissection need not he completed If the permit is for one hundred ($100) or Dishwasher
less). ' Solar Piping 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 LawsofCalifornia. Motors ❑O-1 HP i1%-8
Date Signature Floor Drains - SwimmingPool w/Spa -
NOTICE:If,after making this declaration, you should become subject to the p F.A.U. • Inc.3olar ■_-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. Fixtures Micro. .ve
CONSTRUCTION LENDING AGENCY Gas Service Outlets ( Water Closet / Device Boxes
t hereby affirm that there is a construction tending agency for the performance r•le Light
of the work for which this permit is issued (Section 3097:Civ. C.) Interceptors Water Heater ts
Outle
Lender's Name - Range
•
Lender's Address - Kitchen Sink Water Service
OWNER BUILDER DECLARATION Switches Sign
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 LaundryTrays
any structure, prior to its issuance, also requires the applicant for such permit Generator ❑O-5 K Va5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the piovisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section'7000)of '
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
enaity of not more than five hundred dollars($500).
U 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 - 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 dons 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 0 ZoningApproved By
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 pp oved Date
prove for the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground Building Approved By "/l/� Date al._4_ O'7
Prove the purpose of sale). /``1 (1 t3
❑ I,as owner of the Property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors tri construct tie 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 0 , 00 BTU SUMMARY OF FEES
builds or Improves thereon,and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Re • Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me.
ID PLAN CHECK $ r PERMIT
I am exempt under Section . B. & P.C.for this reason Firepl/Fact.BIt. ICBO# F' ampers PLUMBING $ 9 .0 ISSUANCE $
Date — Owner • Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above • 00-100,000 BTU 0100,00 L - 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 repro- MICROFILM $
sentatives of his city to ent` upon the above-mentioned property for PLAN CHECK 50% $
•
Inspection os- C MECHANICAL ' $
Signature -/ i
)
CMF 0865.46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor +
�) CONSTRUCTION AND-PLANNING POOL & SPA
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
. co
1.'
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
r
5. Steel Reinforcement 56. Rough Plumbing & Pressure Int
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE,
-
7. Footings 58. Electrical Conduit-Undrgrndr-
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test!
9. Water Pipe-Undrgrnd. : 60. Backwash Lines, P-Trap, 0 Ufiirgrnd.
10. Structural Floor System 61. APPROVAL TO DECK al
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 D Oil
23. Gas Pipe-Rough &Test 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
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:,
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test -
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing y_/1!-f C.00 .
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
JU 35E�
UL\1G 0-4-0)
JOB ADDRESS 1610 Corsica Place BUILDING PERMIT NO. 24507
GENERAL CONTRACTOR Air-Vent DESCRIPTION OF WORK Sun Shade
)410 3140. 139-191-8 LOT TRACT FIRE ZONE VALUE $ 356.00
INSPECTIONS Signature Date GROUP 3 TYPE IV ZONE C-1
SoilI PERMITS ISSUED
Gas SUBCONTRACTOR Date I Number I Signature
l Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con..O
iiSprinkling System •
Miscellaneous _ •
Rough Heating and Air Conditioning •
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing !//Jp' q,/c
Lathing—In 0 Out 0
Plaster, Brown Coat
Structural, Final Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final
Building, Final abi 7//3/6C
i, -24507 MESACBSTA
1 COSTA MESA BUILDING-SAFETY DEPARTMENT C`TYO'�
P.O.BOX 517 COSTA MESA,CALIFORNIA
AUG 4 1965
For Applicant to Fill In Completely 4PPLICATION FOR PERMIT
TYPE OR PRINT ILD N !.,
BUILDING / e For h to ljT)
ADDRESS /(f/0 O 2 S I C IQ Pi...
RECEIPT NO.
' COSTA MESA, CALIFORNIA74, n7
flLCEIV[+ - D7KIRK
p 8 06
6 .. ! G6�
I / A K'111111 CCS, . i
//
OWNER all - 2LFS ae.b5cr
IL / ADDRESe /6/0 Co 2.5 ICA
MA
ADDRESS //„/o co es;c 4 p2.
FIRE
�1.T TEL. ZONE
PR 3 JtY� ROUP
CITY C , /r7. NO.S¢.f/S•?
ARCHITECT / TEL. APPROVED �y /{'
OR ENGINEER RC1 ,PA 4.e NO. �� BY DATE 7S.N14 V�
ADDRESS 31 7 / N , de----R.R./h i al A ZONING
Z •" ZON / NO.OF n I BUI Dcr��yk
/4
/I PLAN: p(/ BUILDING ��'
CONTRACTOR /l £ - 1/C.J I _ ��Q04.1
-57
/y� �1 / M�' LeOAL
ADDRESS �I Po fS S. ilMeoCilFS I lie '/c DESCRIPTION / Q
CITY f`,)/�(..E' _-� A.P.NO. / ;c ICl/-
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE a / � 7/2 T .No S 3 c -.336.E 8O TO SIDE@REAR P.L.
LIC.NO.
EAVES
SIZEOT W/AO X /06/ I NO.OF01-1,013.NOW QN LOT / ALLOWED (U.B.C.REQUIREMENT)
OF L
S. YARDS APPROVED YARDS APPROVED
USE OF ` J , MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. cI �l
(FROMe/.h,e �[EET� '/�Ark
SETBACK LINE FROM FRONT `�`- FT.
CENTER OF STREET REAR YARD //B l
SIDE YARD I LEFT I RIGHT R.SIDEQf FT. FT.
I
DESCRIPTION OF WORK 1..SIDE /9 FT. Fr.
D V is
NEW ALTERATION ADDITION REAR
DISTANCE BET. BET.MAIN ft
REPAIR _MOVING DEMOLISH MAIN BLQGS. ACCESS.SLOGS.
VAR.# DATE
BUILDING NO.OF
SIZE ROOMS STORIES C.U.P.* 1 APPROVED
EXTERIOR WALL I ROOF APPROVED% 1`. I ,4/'_r
COVERING COVERING BY v/ y ATE IOII
USE OF BUILDINAND WORK TB PER ORMED
A 4.._._ rth_ 4, o>,
Y K !- C_ 23! SO.FT. N
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 CON. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION cc
•
BUILDING CONSTRUCTION.O �/y�.� N
SIGNATURE OF / I , - d ■ PERMIT FEE $ O
PERMITTEE L r''�, / C b% G
L. /� i 3J 6 PLAN CHECK $ C
AUTHORIZED AGENT c` O �Y^ �i �) E
A TOTAL FEE $
OWNER COMESA, INC. DAT9-1b-S9
JOB ADDRESS 1610 Corsica Place BUILDING PERMIT NO. 9291
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 14,552.00
AP. No. - LOT 51 TRACT 2522 FIRE ZONE DESCRIPTION OF WORK Res.I4/att.0arage
INSPECTIONS 1'_26,0 DATE GROUP TYPE ZONE Al
Underground Soil/k0-$ U.G. Water/V}fS S---L2-5j PERMITS ISSUED
SUBCONTRACTOR
Underground Gas DATE NUMBER //
Overhead Water and Gas I�
Rough Heating /MS 2 717--5Y/. 1te7 h%ZZw/C c . / -7-5 7 -1---7V/ 111
Rough Plumbing MITC --.20--.4 /�:r('/z*).1 « 15 .5'=///-5 7
Miscellaneous , $ ,. n I MN
Prop. Swj- Line- House1Con. St. Swr. 7/4,/vi .-1 j—bt:,1/44/- _ 27 y,/c-9 / 4-4 SAY. .-,
Sprinkling System " ' / -7 1
Heating, Final /14,15 G SYl Wi,-\,
Plumbing Fixtures /1/1 fs ig,'-� Imam
Final Gas Test/-t- �l"(/ f`
Construction Pole \ `)
Underground Power /ry
Rough Wiring /kms ..74i5-e/ 44 > Gr/- , .) 7%1 . --/,2 -SS 4-.4 5-2-}
Trenches Forms Steel}>tf , .5 ,.t.='3V
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing _
Frame and Flashing ,j ' /-.sz
Lathing, In G Out C- /S/3i
-Sct
Plaster, brown coat R-M— 9
Plumbing Fixtures, Final
Electric Fixtures, Final /1 =i,/2r_ef
Building, Final .r 'irCu
OCCUPANCY /
Form 210-3M-4-59 9291
9291
.* Et ICEsV��
COSTA MESA BUILDING-SAFETY DEPARTMENT co" MAY 18 1859
P.O.BOX 317 COSTA MESA, CALIFORNIA FINANCE DEPT.
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION' FOR�"PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1610 Corsica Pl.
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
Comesa, Inc. I RECEIPT NO. I Y pE ITl%
OWNER Y
MAIL /lC� E. 17th }• REC E Y DATE
•RECEIVED
.p DATE ISSUED
ADDRESS 41 E U 4. J —/ - 9 6.5=151-31
CITY Costa Mesa TNO.LI81159 AD RESS
ARCHITECT Carlson & LIC. COSTA MESA. CALIFORNIA
OR ENGINEER MiddlE'hrook NO.
ADDRESS Garden Grove FIRE
Dike ZONE f < //�/�
Coiegrove, Inc. STATE 167293 APPROVED % ' DATE J//
• CONTRACTOR LIC.NO. / 9
ADDRESS 419 E. 17th St. Costa Mesa ZONING /
LEGAL LOT r��(� ZONE NO.OF USE OF NEW
DESCRIPTION I NO. 51 I BLOCK I4/Pl.l /�L/�,'f)PLA,1N/S/ I BUILDING ����,�J�–///%//
A.P.NO. BYPRL{/D.r. lI" DATE 5-4—/3- /
SIZE 60 $ 100 I NO.OF BLDOS. noneEVE$
YARDS
OF LOT NOW ON LOT REQUIRED ALLOWED
USE OF (CENTER LINE ST.) �J�
EXISTING BLDG. none FRONT J `" FT. IN.
SETBACK LINE FROM
CENTER OF STREET 551 REAR YARD 221 R.SIDE S' FT. IN.
SIDE YARD I LEFT 5t I RIGHT 51 L.SIDE FT. IN.
DESCRIPTION OF WORK >�
REAR "v FT. IN.
NEW I X II ALTERATION I II ADDITION I
REPAIR II MOVING I II DEMOLISH I
I
SULDING I/+50.
SIZE ].4 ROOMS 6 STORIES 1
EXTERIOR WALLetuCCO ROOF Rock
COVERING • !COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
Single Family residence with
attached double garage.
140A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTION. //'''' VALUATION
SIGNATURE OE �'%s�rG'�.Tj,/�. PERMIT FEE $ 31}.00
PERM ITTEE _�I 17.00
$ 14,552. PLAN CHECK $
AUTHORIZED AGENT
Dike e & Colegrove, Inc. 51.00
TOTAL FEE IS