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Home My WebLink About1084 CORONA LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 1084 CORONA LN Status: ISSUED Suite No' APPlied: 10/03/2005 RR Issued: 10/03/2005 Vicinity: Parcel Nunmber: 14162315 Applicant: E J ELLIS - ISSUED BY: Address: 3801 LENAWEE AVE Phone: (310)253-5229 _ CULVER CITY, CA Zip: 90232 Owner: GILMORE, THEODORE R 3RD , Address 1084 CORONA LN Phone: COSTA MESA, CA Zip: 92626 Contractor: ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU Address: 3801'LENAWEE AVE Phone: "(310) 253-5229 CULVER CITY, CA Zip: 90232 - - License: 679898 SCOPE OF PERMIT `- REPLACE WATER HEATER LOCATED IN THE GARAGE. FEE SUMMARY AMT QTY AMT ,'CITY AMT ISSUE FEE $23.50 Laundry Tub / Washer -- - $0.00 0 SumpPump $0.00 .0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool . $0.00 0 Backflow Preventer .$0.00 0, P -Trap $0.00 0 ` Trap Primer $0.00 0 Bathtub'," ' ;'$0.00• 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System - $0.00 0 Process Piping (per 10 ft) - $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 A Receptors $0.00 0 Vacuum Brkr BkBow(5+) - $0.00 0 Dental Units - ',$0.00 ,0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drains Floor ., $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, • Rainwater - $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 - '0 Shower $0.00 0 Water Heater/vent - $12.30 1 Drinking Fountain - $0.00 - 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve - - $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 , 0 Sink, kitchen $0.00 0 -- Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 - Sink, service/mop $0.00 0 OTHER . $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 , 0 VIOLATION . $0.00 Gas Service - $0.00 0 Spa (public) $0.00 0 -PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto )- $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-48(6100) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued, - I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workerscompen -tiioon Insure cam nd policy umber are: ' Cartier: { � uiv� Policy Number: /613 2-7-6 7 (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ I cenity that in the performance of ih work fo his pe i s sued, I snail not employ any person in any manner so as to become subject to the workers' compensation laws of California, gr a Id com subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' MPENSATION COVERAGE UNLAWFUL AND SHALLSUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000). IN ADDITI O THE COST OF CCppAN1�PEN TION, OAA4IGES ASQRONIDED FOR IN SECTI OS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION:! I hereby affirm that I am licensed u r jsi espter 9 (commencing with Section 7000) of DW on 3 the Business aySl Projggsi9n5 Code, and my license is in full force and effect. Lic. A Glass N vJ Ci Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: 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 Cade: 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).): . ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself w 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. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................o....................................file..........gi-s-ir-a...........o.....................................a.r................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazartlous materials? ❑Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ....................,........................-........................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................... .................................................................................................................................................................................................................,............................................................. 5 Does or will the oast it or present or tutus building occupant require lir the work which is the subject c this a plication aPPeNo for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � 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 pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ 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 ...............................................................................................................................................................................-..... ....................................................................................................................... ....................................... ........................................ 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 lot inspection pu mos. I gr of to occupy or allow occupancy of any building authorized by this permit until final inspection. I hatune W IS, n Authorized Iicant /f �J Date CODE 1. INSPECTION TYPE PATE INTMALS CODE I INSPECTION TYPE DATE iNTmALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing zc •„(l,.l-OS 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Well 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 BUILDING PERMIT Job Address: 1084 CORONA LN Status: ISSUED Suite: Applied: 03/29/2002 Vicinity: RESIDENCE W/ATTACHED GARAGE Issued: 03/29/2002 Parcel Number: 14162315 Zoning: Applicant: GILMORE, THEODORE AND VICKIE ISSUED 6Y: Ge�'�'— Address: 1064 CORONA LN , Phone: 714-957-1846 COSTA MESA, CA Zip: 92626 _ Owner: GILMORE, THEODORE R 3RD Address ,1084 CORONA LN - Phone: COSTA MESA, CA Zip: 92626 Contractor: OWNER -B U I L D E R Address: Phone: Zip: License: - 0 Arch Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING AND REPLACE ROOF TO RESIDENCE AND ATTACHED GARAGE. APPROX. 2700 SF. COMPOSITE, ASPHALT SHINGLES. 40# FELT. FEE SUMMARY Plan Check: $0.00 — Calc Valuation: $5,200.00 Permit: $125.25 Claim Valuation: $5,200.00 SMIP Res: $0.52 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: , $125.77 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) 7545626 ta484e (6=) DECLARATiONS it WORKERS' COMPENSATIOTI DECLAgAT10N: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers' compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' C compensation laws of California, and agree that iffIII Should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thesCeyrevismR,s.—O L A t'Slgnatum:, // /per ��Q2� Date: W iV TNG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR LADE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. If Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: 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 mole 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. 7040, 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 coniractor(s) license pursuant to the Contractors License Laws.). ❑ I am exem r sec. Business and Professions Code for this reason: -6ignatdre:9 Date: O nety Verified by driver's license. Yes ❑ No rs Licen'se No:�./ Verification of Ownership by (type of document, 1.6. - 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, Art2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .._...................._........................._._...................... ...... .............. ___.......................... _._............................ _........................_._..................... _...................................... _..... _.... _................. -............ _........... ......... _................. _.............. _.__........ 2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety 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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ hlo (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .............................................................................................................................................................................................................................................................................................................................................................................. .............. 4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ...........................................................................................................................................................................................................................................................................................................................................__................._.............._. 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication agennit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .......................................................... cili............................................._.........................rrit..............ithi......................................................................................................................................................................................................................... 6 Will any pen of the facility to be constructed under this permit be within 1000 feet Irom the outer boundaries of a school? ❑Yes ❑ No (if'yyes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....................................................................................................................................................................................................................................................................................................................................... 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................_............................___......................................................................................................................................................................... B (IF "yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 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 pu ey agree not to occup� allow ocgypanWny building authorized byL�Lhi/} permitntil final inspection. S Mature Ot Legal Owner{s)� /tSC�l' fJ l Date c^J And/Or Authorized Applicant Data CODE I. INSPECTION TYPE PATE INTITA S CODE INSPECTION TYPE PAIS iNTmALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Ra Roof 210 Final Electdcal 201 Final BlocklRetaining Wali 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 :ement Coping Optional Channel Block With One 318°0 Nori:ontal Top of all Fences For Fences 5' or Less Vert. Bars 3/8'0 at 4' -0" O.C. For Fences Higher Than 5' — Vart. Bars 3/810 at 32" O.C. :=ill Cells Solid With Grout — Where Steel Occurs ReinfrllSteel.Shall r:onfor o Sec.A-15-39 A.S.T.M. All Steel to be Lapped 15 " or to Code NATURALGRADE TWO 3/8" BARS' CONTINUOUS TOP & BOTTOM TYPICAL 6" CONCRETE BLOCK FENCE —WIDT SEE CI BELOW FOOTING REQUIREMENTS WALL HEIGHT 6 5' 1 14' _ _ WIDTH OF FOOLING 14" 14"IF THICKNESS OF FOOTING 10" 10" e DEPTH OF EARTHTOOTH 24" 20" 16 SPACING OF EARTHTOOTH 12, 14' 16 OWNERS NAME: City. of Costa Mesa, California JOB ADDRESS: Building Department 7 -G. -A4 GENERAL- NOTES MORTAR: One Port Plastic Cement, and Three Parts Sand GROUT: . One Part Cement Three and One Half Ports grand COPING: One Part Cement, Three Parts Sand CONCRETE: Well Mired N 2�(2 1 3�2 Mar. of 7%2 Gallons of Water Per Sack of Cement GROUT MAY BE POURED FROM THE TOP OF THE FENCE CELLS AND AREAS OF HORIZONTAL REIN- FORCEMENT SHALL BECLEAR. CLEAN & FREE OF ALL MORTAR DEBRIS, ETC. BONDS SHALL BE PROVIDED BY LAVING BLOCKS IN STRETCHER COURSES SO THAT VERTICAL JOINTS ALTERNATE IN EACH COURSE. rH OF EARTHTCOTH 1/3 THE HEIGTH OF FENCE BELOW BOTTOM OF FOOTING. SCALE: 1/2 Is = 1' STRUCTURAL APPROVAL ONLY SEPARATE PERMITS ARE REQUIRED FOR F.LECTRICAL, PLUMBING, HEAMNO, VENTILATING AND- T;.EFR:Lt—RATION WORK TFiiS NUMBER MUST ACCOMPANY ALL INSPECTION REQUESTS FOR DUPID!NGS WHERE PERSONS ARE TO BE EMPLOYED. WE SUGGEST THAT THE STATE OF CALIFORNIA OIVISION OF INDUSTRIAL SAFETY DE CONSULTED FOR ACDITIONAL f T_OUifiEMENTS. APPROVED City oSCCMesa Building Deft. ��—CA7 1� THESE PLANS MUST BE ON JOB A ALL TIME,. i MAKE NO CHANGES WITHOUT PRIOR APPROYAJ I OF DEPT. THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF PLANS AND SPECINCATIC"IS SHALL NOT DE CONSTRUED TO BE A PERMIT FOR, OR AN A.PPROIAL CF, ANY VIOLATION ANY OF THE PROU-! SLIMING To C: THIS CODE. NO PE7MIT PRE- f UTO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS CODE SHALL OE VALID. EXCEPT IN SO FAR AS THE WORN OR USE WHICH ITACIHORIZE.S IS LAWFUL, I THE ISSUANCE OF A PF 1 SPECIFICATIONS SHALE NOF PREVENTTHEDDI' D'NG Of, IC1AD FROM THEREAFTER REOUIRIA'G THE CCRRCCTIO:I 0: fyo_S III IN SAID PLANS AND SFLCIFICATIONG OR FROAI PREVENTI:lT BUILDING OFFRATIONS BEING CARRIE) CA THEREUNDER WHI>l IN VIOLATION OF THIS CODE OR OF ANY OTHER OF THE CITY. t AU ION ELECTRIC. LINE C.EP RANLUE tl RE MWISC1 IN ACCORD CE WITH sTA I -E SAFETY G LA IONS, IF CONSTRUCT REOUIR S RKERS.EOU PMN CRANES OR HOISTIN(co%,tuEViCES Ti ELECTRICA!"II LINES, FACILITIES, Cf!LL SOUTH' IMMEDIATEL (714)895- R 714)895' R UNIDERGROUNg ELECTRIC 2N CALIFORNIA EDIS N COMPANY 1111o111C1 STREET 4 vU wA-fA- 4 Ill 11, i1►1 li► O 1 11111o1Mo1 • 27 r ,4 t &Vv sem' \ " Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ' IT`Y OT COSTA MESA ONSTRUCTION PERMIT Project Address tl Applicant's Mailing A dress 4y�V Owner's Namm O �hone7C��g� Address Arch/Eng. License No. Address / Contractor's Namd eN to /r, Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 100, Lab. C.) olicy No. Company 8 Certified copy is hereby furnished. Certified copy is.filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner o as ��(tttaaa,,, become subject to the Worker, Co pen t' n Law9 of CaliforpT4. ` J Date Signature 6� i -.2yn 2( NOT I : If, fte making this tleclaration, ydtf should becorme subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name _- Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I.am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Cotle: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to,its issuance, also.requlres the applicant for such permit t0 file a'signed statement' that he/she is licensed pursuant to the provisions of the Contractor's License.Law (Chapter 9 (commencing with Section 7000) Of . Divisipn.3 of the Business and Professions Code) or that he/she is exempt • ther rom and the bas is'for the alleged exemption. Any violation of Section 5 by any applicant for a permit subjects the applicant to a civil Wally of not more than five hundred dollars ($500). I, as owner of the property as their sole compensation, will do,the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not -apply to an owner of a property who builds or improves thereon, or through his or her own employ and who does Such work himself/herself em9 employees, provided that such improvements are not intentled or offered for sale. If, the owner w ll building a improvement is sold within one year of r im- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ' ❑ I, as owner,of the property, am exclusively contracting with licensed Con- 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 builds or improves thereon, and who contracts for Such projects with a con- tractor(S7 license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insuranceshould be provided to me. ❑ I am exempt under Section B. &P- C. for this reason Date ✓•' - V/_ Owner I hereby certify that 1 have read tM1is appy At Information is correct: I euree t0 comply with all X Signature f/Ar S ,C Drivers' Licens or s� CMF 0865-46, rev. 10/84 White - - Accounting; Goldenrod - Assessor $15 6872 ,6/05/86 l7.OD TC' A.P.# —! (0,z 15 1Zone lif S Main Building: Accessory Building: TFront �. (pjf O 13 Rear N A I C Right If- - N S Le ( G R Ping. Ref. # Parking Req./Provided E Planning Notes:D OI.0 M G L T nf f1 S IMBING - FEES ' Showers - ELECTRICAL - FEES Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 050+KW _ 'Sewer Cap Sewer Connection Cooking Unit Meter ❑up to 100 amps Solar Collectors Dishwasher - Meter Dover 100 amps _ Solar Piping Dryers ❑Gas ❑Electric Sub Panel - Solar Tank Fan Motors 00-1 HP ❑l %- 8 , Swimming Pool W/Spa F.A.U. Inc. Solar 09-15 HP ❑16-15+ Urinal Fixtures- Microwave Water Closet Device Boxes Pole Light Water Heater Outlets Range ' Water Service Switches- Sign - - - - Auto -Wash Garbage Disposal Standing Sections Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Issue Fee S, 3 Reinspection Fee $15 Issue Fee $ 3 iANICAL . FEES Hood or TY Canopy TypRel ❑ e 11 ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENT Date32 Date Dat Refrigeration System - 00-100,000 BTU ❑100;000 BTU - `' BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SU $ $ $ $ $ $ $ $ MARY OF FEES SMIP $ l7.Sa (p PERMIT - ISSUANCE' $ ENERGY P.C. $ 'GRADING $- MICROFILM $ - _ TOTAL FEE $ t 00 - System Rape it/Alteration Fire Dampers - Registers - - Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA 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 o, 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ti 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test y 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE i ;n 7. Footings ` 58. Electrical Conduit-Undrgrnd. y 8. Foundation a .59. Gas Pipe, O Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, D 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas D Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D 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 By FOOD CERTIFICATE ISSUED 33. Final Electric 004�5� 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 01 F 51. CERTIFICATE OF OCCUPANCY No. Date 01 ?02c;3 'COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX a17 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT I'1111=PIIAh11 EP COSTA MESA. CALIFORNIA Mesa del Mar Development Co. 3800 E. Coast Highway . -. - .. _ TEL. same as above same as above 207343 TEL -OR 3-4220 OF LOT ' H.3.1% x NOW ON LMC USEOF none EXISTING BLDG. SETBACK LINE FROM CENTER OF STREET 56REARYARD 29' SIDEYARDI LEFT 51611 RIGHT 1DCt. DESCRIPTION OF WORK _... x 11 ----- --._..I II -- - - 1 54'x41'611 NO. OF 7 2 BUILDI Plan 500 -BR I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THSABOVE IB CORRECT AND AGREE TO COM. PLY WITH ALL CITY gRDINANCBS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF Macco Realty Company PERMITTE By: AUTHORIZED AGENT / FEE �66E!VED RWpp��II 2 ICATION FOR PERMIT FIN ANPrQi[Lgbwa, CIJOUF UILISIA i1lE�Q'�' REDS IPT NO. rA.PR.... TYPE GROU DATE ZONING ORSEOF NEN6 BUILOINO FT LEGAL Lot 64 Tract 5023 DESCRIPTION A. P. NO. none NOTE: NO EAVE OVERHANG SHALL BE LESS THAN BO' TO SIDE B REAR P. L. EAVES ALLOWED (U. B.C. REQUIREMENT) YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING /FROM C/L REET) FRONT PT. FT. ,1Y R. SIDE - V FT. I�0,- FT. L. SIDE FT. FT. REAR FT. FT. DISTANCE BET. BET. MAIN A MAIN BLOGS. ACCESS. BLDGS. VAR.# DATE C. U. P. JL APPROVED APPROVED W. DATE dwellinp 2266 s f arae 460 s.f. SQ. FT. THE AMOUNT SHOWN UNDER VALUATION IB POR THE PURPOSE OP HSTABLISHING A PERMIT FEE ONLY. VALUATION PERMIT FEE a7,5a s 23,925.00 PLAN CHECK 5 5- TOTAL FEE