HomeMy WebLinkAbout462 COSTA MESA ST - Building PermitsI�
(714) 754-5273 • Fex (7/4) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 4s2 COSTA MESA ST � Status: ISSUED
Suile No � Applied: 10/12/2005
� Issued: 10/122005
Viciniry: �
Parcel Nunmber: 42632203
Applicant MARET IRENE KUNZE ISSUED BY:
� ��
Address: 462 COSTA MESA ; " .,;,;�
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� � �-- : , Plione �949-675-2729
COSTA MESA,�CA _- . - , Zip 92627 � � - ` ' •
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Owner KUNZE,�f�LICE C TR ,�d` � � �� �' �n � � �
Address �=���1325 JOSEPHINE STREET."- � ,� �
_ .
` - Phone: � ` '
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"BERKELEY�CA� - Zip: 94703-1113 ��'� �
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,Co"ntracto'r ` OWNER BUILDER ° "�
, - -�Address. ^.: � ' �;; � . ..,:� .
Phone. ' ` '=-x � >��
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. � � ,-,� � ,.� �License � 000000 - � �
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, 6EGACIZE �
� ;'EXISTING�1
SCOPE OF PERMIT '§ '
OF THE WATER HEATER FROM THE KITCHEN-TO THE.EXTEI
��, ;�.. ,.. . . . ...�u .. . .. �. . . ,� .,
'F �� "=�d'"�� � � � ;FEE SUMMARY .�� �
. '�AMT, .aTY . .... . . . , ... � AMT � ., .��. ..
ISSUE FEE' ��„ .$23 50 =,-r.� Laundry Tub / Washer� $0.00 0;
B2ckflow irrigahon ;- $0 00 - �0 ' ., Landscape Irrigahon „ $0.00 0
Backflow Preventer '� $0 00 , �0 `'-P-Trap . . $0 00 � 0
Bathtub ' ;�$OOO,w.,.-�0 � "r-PressureRegulator_ "-�� $0.00� -;0 �..� .-_s -
Clanfer System, p,,,, $0.00 '0 , Process Piping (per 10 ft) $0 00 - 0 �
ConnectQcelSodaetc) „ `°$OOD -�0�'� Receptors $0.00 0
DentalUnite �',�,$000�:�.0�` SepticTank �,$000 0 �
Dishwasher;,,+ :+ $0 00 ':� 0 Sewer Cap tor Demo � $0 00 - 0 �
Drein, Floor ` '.�� �$0 00 '� 0 Sewer Conned $0.00 0
Drain Rainwater ,,"�+`£" �-- $0 OOo�? `_0- Sewer Private Line , $0.00 0
Drain, Roof " ' $0 00 �' :- -0, Shower ' ' .� � � $0.00 -0
DnnkingFounlain I�,,, $000 . �0"' Sink�bar6 ,�4 ., - ,.$0.00 0
Expansion�.-Tank ` - $000 ��� -0� , .Sink, comme�cial . � $OOOc-;= 0,� �
Gas Earthquake Valve $0.00 �, ` -0 �. �' � � , _._Sink �Floor�.�" $0 00'���- 0
Gas(1-4outlets) �$000 `:A °�� t,�Sink;kitchgn- �- $000 0 ,2
Gas(Over4outlets)„ �� SO.00:;A 0.. Sink,serJice/mop --' $000'= �0�-
Gas Repipe •,$0 00' ,. 0 .�'_Spa (private)��� � $0 00',?��0 "
Gas Service $0.00. � --- 0 .z :Spa (public)� $0.00 � ::0�.:=-
" AMT �
� Pump � :? ' -$OAO � 0
ming Pool ` ��� $0.00 - 0
Primer � - ��� -'$0.00 ` �0
�
� =- c ",:-- '� -=$0;00 = 0
umBrkrBkflow(1-4) $0.00.;., 0
um�BikrBkflow(5+).,�, �$0.00' .0
�.Basin t� -- '$0.00.--' 0
i-BaSin Set ' . $0.00 � 0
e anG Vent System �'����. �$0:00 0
�.r Closet (Toilet) ' --- , $0.00 0
r.Heater/vent --- .�'� $12,30 1
�.r P,iping Qnst or Rep.) $0.00 0
irRe-pipe , ': .�..$0.00 0
ir�.Service �, r.� `;$0.00 0
r Softener ' �- � $0.00 0
ER- :� $0.00
ATION �, $0.00
d CHECK -� - - $0.00
Interceptors (Grease Otl) �$0.00�� 0 � - ` -i� - •- •'REINSPECTION �- $0.00 0
Interceplors (Sand Auto )",�� $0 00 � ' � 0 � - � � � � "
g�. �
� A TOTAL CALCULA,TED FEES: 535.80
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COMMENTS / SPECIAL CONDITIONS °
„ `.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•2B, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire end become void if work is not commenced within 1 BO days, oi if work is suspended or abandoned
for a period of 180 days. .
INSPECTIONS: In order tor the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all�
requlred Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
zeeaea�aroo)
WOAKERS'COMPENSAnON DECLARAnON: . �- � . ' � �
I hereby aflirtn under penalry of perjury one of the following declarations: ' _ � , •� �
❑ I have entl will malntain a certificate ot consent to selFlnsure tor workers' compensatlon, as provided for by section 3700 ot tha Lebor Code, for the peAormence of ihe �
work tor which f�i5 pertnit 15 i55ued. , -
❑ I have end will maintain workers' compensation insurance, as requiretl by section 3700 of ihe Lebor Code, for Ne peRortnance oi Ihe work for which Ihis pertnit is issued.
My workers' wmpensatlon Insurance ca�der antl policy number are: . �
Carder: Poliry Number:
(fhis section need no( be complered i/ the permit is valued af one hundred dollars (5/00) or less.).. . ... . ..
❑ I certity Ihat in the performance of the work for which ihis permit i5 issued, 1 shall not employ any person in any menner so as to become sublect to the workers'
compensatlon lews of Califomia, antl egree that If I shoultl become su6ject to the workers' compensetion provislons ot Section 3700 of the Labor Code, I shall fort�with
comply wilh Ihese proNsions.
Applicam SigneWre: Date:
WARNING: FAI WRE TO SECURE WORKEHS' COMPENSATION COVERAGE IS UNLAW FUL AND SHAIL SUBJECT PN EMPLOYER TO CRIMINAL PENALTIES AND qVIL FlNES UP TO ONE HUN�RED
THOUSAND DOLLARE (E100,000), IN ADDRION TO THE W5T OF COMPENSNTION, DAMAGESlS PfiOVIDED FOR IN SECTION �O60F THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATON: ��'� 9S��'
I hereby attirm that I am licensed under pmvislons oi Chapter 9(commencing with Seat'1on 70Q0) ot Division 3 of the Business antl Professions Code, antl my Ilcense Is in full
force entl ettect Lic. q .i�° ��lau M
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 �ereby aHirm that there is a construction lending egency for the peAortnance of the work tor which this pertni� is issuad. (Sec. 3097, Civil Cotle).
Lenders Name: Lenders Address:
SignaWre: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby ettirtn Ihet untler penalry ot perjury Ihet I am EXEMP7 FROM TME CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Busineu end Protessions
Code: Any ciry or counry whic� requires e permit m construct, elter, improve, demolish, or repair any sirucNre, D�or to its issuance, elso reduires the applicant for such pertnit
to flle a signetl statement thet he or she is licensetl pursuant to Ihe provisions of Ihe Contractors License Lew (Chapter 9(commencing with Section 7000) oi Division 3 of tha
Business and Professions Code) or thet he or she is exempt theretrom end t�e basis for ihe elleged eaemption. Any violatlon of Section 7031.5 Dy eny applicent for e pertnit
subjects the epplicant to a civil penalry of not more Ihan five hundred dollars ($500).):
❑ I, as owner ol the property, or my employees with wages es their sole compensa�ion, WILL DO THE WORK, and the siructure Is not intentletl or oflered tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law tloes not apply to an owner ot propeny who builds or improves thereon, and who does such work
himself or herseH or Ihrough his or her own employees, providetl that such improvemenis ere not intended or ottered tor sale. It, however, ihe building or improvement is
sold within one year ot completion, �he ownerbuilder will hava the hurtlen of proving that he or she did not builtl or impmve tor purpose oi saleJ. '
❑ I, as owner of lhe properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cotle: 7Te wntractors License Lew tlaes not appy to an owner ot pmperty who builtls or Impmves thereon, end who coniracts for such projact with a contracror(s)
_J�cense pursueni to ihe Contrectors License Laws.).
Business and Pmlessions Cade for ihis reason:
� w�D verilied by drivefs license. Yes ❑ No
Vedfication of Ownership by (type ot tloc , I.e. - proDerty Iaz bill or
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certily Ihat no excavation frve (5) or more teet in depth into which a parson is required to descend, will De metle in connaction wiih work euthorized by this
pertnii, end thai no building s�ructure, scaHolding, falsework, or tlemolition or dismaniling ihereof, will be more than Ihirry-six (38) teet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Tltle e, Calitamia Adminisiretive Cotle).
❑ As awner-builder, I will not employ anyone ta tla work which would require a permit from the Division of Industnel Setery, es noted ebove, unless such person has e
pertnit to do such work irom the division.
Signature: Date:
Division of Industnal Safety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUfHORIZATION OF EMRY: I certity under penalry of perjury thet I have read this application and stata Ihet Ihe informatlon givan Is
wrrect. 1 egree to comply with all state laws end ciry ordinances relating to builtling construction, and authorize representatives oi t�e Ciry of Caste Mesa to enter upon the
above-descnbed piop rty f inso� pection purposes. I agree not to occupy or allow occupency of any building authonzed by this permit until final inspaction.
�_� I�l I LidS�
.r5tg�aWreOtLegeiOwner(s)�'=-v.'�—_ �Date "-�:
� � ���Fcv=.
And/Or Authodzed Applican[ Date
COUE I. INSPECTIONTYPE
.1616 Fixed System Final Fire Prevention
12fi6 Pool Spa Final
200 Final Re-Root
201 Final BIocWRetaining Wall
202 Final Fadory Fira Place
203 Final Sign
204 Final DemoliUon
� pAI€ INLITI�LS
COOE� INSVECTIONTYVE _
206 Finel Mechanical
20B Finel Plumbing % /
210 Finel Electnwl
� 212 Finel�Fire Prevention
'- 220 Final Planning Approval '
222 Final Site
250 Finel Building/Occupency
PAIE
�
i
COUNTY OF ORANGE
BUILDING REPT.
636 No. Broadway
Santa Ana� Califordia
Phone: KI 2-6211
�
; _ .�.
Application for Building Permit
AND FOR A
Certificate of Use and Occupancy
Permit No.----�1-�_�P-O-'s ---,-
: f
Date-----�Q�.3-F-�V-9-�--'------------------
/
OWNER'S NAME---_---_��T-_Q��.-�%_____�_+ _--___- ___-- PHONE:Hse��.on_82s7_
------- ---- ---- - --- - - -
MAILING ADDRESS----i� -Ee i�%iil SL'S�A@*i __... CITY -----Q08LQ__iq88Q--------------
---- - - - ------ -- -------- ---- ----- - -- -
Name _-.
Address
c;ry ---- - ..
s�a�e
L;c No. ------------- -
(Acchirect or Engineer)
Phone
(�earQe t�i, Holetein & 3on�
Name.----------------'------------'------------------------------------
(Contracror)
Address.__iQQ �'S�--i7t'ril .�itii'90ti----------------------
c�t Qoete 2te9a
v-- -- ... - - --- --- -- --- --------- -- ------ --- - - ---
$tate �79rfflA pq Q
Lia N .�"�'w_...'""""""L71-------Phoneo��aon_8292--
PROPOSED USE: -- R88S�OAOA -- -- --- - --- - - - -- --- - --- - - - -
- --- - --- - ------- ------ --------- - -
Z. JOB LOCATION._----��z"--t`-�J'7"A----/fE3.t-"r�-----Oofl1f8__IieBe----------_____------------
(House No.) (Name of Sorect) (Town or School Distric[)
i. LEGAL DESCRIPTION: Loc...__\r�_--_--_------_-------Block.----_--__- __-___-._-._--_-_-Tracc__�B�
---- -- -- -... ---
(Meres and Hounds Description—Use reserse side oE form/)
4. CORNER LOT ( ) INTERIOR LOT (�/ ) THROUGH LOT ( ) SLOPE OF LOT ( )
5. SIZE OF BLDG.:'f�/_ t._ZG 6--.AREA:___�J�--------.--_-_SIZE OF LOT:_�.x. /.3_�AREA: _7�1v.�-_---._
6. HEIGHT OF BLDG.: _.__�8�_.._.__.._._..___.___CEILING HEIGHT:.__._._89__.__.__.__.___ NO. OF STORIES.__.___l.___.__.__
7. NO. FAMIL,IES ____._1 __.______....Size of Smallest Bedroom: __��_k.�.�-.__ Size of Kitchen: __p_k._/_ __Y______.____
8. EXTERIOR WALL CONSTRUCTIOI�£:'_o"'�_5��00 INTERIOR WALL COVERING ...___Pi(�8�'e81`_.___._.__
(Frame, Stutto, Em.) � (Plaeter-Dr wall, Etc.)
Y
9. SETBACKS: Front Yard From Cen[er Liae of Street_--_�f___---------___--___-.----_-____-_'_---_-_'-__-__._-_---'-_-_----"--_.-
i G
Nearest Side Yard ____ .._____._Rear Yard.___.O..:j�____.Distance in Feet Between Bldgs. on Same Lot.__..��___..___-
1U. A COMPLETE PLOT PLAN IS REQUIRED, SHOWIIVG ALL STRUCTURES AND USE OF EACH.
11. For (a) Footing: Width _.___.. S p R
1� -_-------------___- De th in Ground.---'_-�._._..--.-___-Width of Wall --_-_�p. __--__
Accessory
Bldgs. and b Size of Studs:.__?`_[__�..� ..__.S acin 1�� 'CC Material of Floor����._...._
Similar ( � --_.__.._ p g._._.._______________'_`
$tructures: M
(c) Size oF Floor ]oists: �.-_g_8---_'__---__-_-- Spating .-.-_Zg._-.-_----. --_-__-__"CC
(d) Size of Rafters: -_-__Q--�_�__-- ______---'_Spacing _ _.
Z� r- -- - ------"CC
1?. VALUATION OF PROPOSED lo/ORK: Including all labor, plumbing, electrical wiring,. heating, fire sprinklers, paint-
ing and sewage disposal �-_ �3-.��_-_--__-__---_-______-_ •
- - — - �
13. I I-iEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN
THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WOitK--WIc,L-COiar'OxcH-'ro f+i:L
LAWS OF THE COUNTY OF ORAIVGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
- -----Signed:---�-------- - -- ---�-'----�i��`T�-----"- .
- ----
(A waer)
Plans Filed:-`-------------------------------------- �f� �
. R�� ���%.r`rrf .
Bldg. Pennic
Plan Check
To[a( - -
Reccipc No.
Paid to
Dace ----------'
1�7:�
SM-9- O
FEES:
FOR DEPARTMENTAL USE ONLY
0o GROUP-----1-.�=...- ------
-----'--
> o TYPE ------�._----
�o------- ' DIST. C.��
��-- MAP---------- -- -- ---- - ---
� S ----
y- ------
�G SHEET NO.------ -----------
-- --------
� - �
(Authorized Agent)
Cr�NG BY
APPLICATIO ._____ _ _ � HEALTH _ ___.___.____.__..__.
��/\k�
ZONING -__����`� FIRE
MARSHA L.-----------------
PLAIVS AND
SPECS-- -- ---- ----- - STATE --------- ----- - -
CORRECTIONS ENGINEER
VERIFIED--------------_ CAL._----------- ---------
� IVf�Ipi�`I �i t�l � ' COUNTY 6U L�'n.1'�-'
�. Y1. VUi�U �t.� I�\SP_i,TOR
._____._____'__________ .'.____________..._.._-__._.-__.__'________ _'.__.___.
________._____
DEPUTY � �_f
//u.v
COUNTY OF ORANGE
BUILDING DEPT,
636 No. Broad�eay
Santa Ana� California
Phone: KI 2-6211
,- _�.
'' � 3/� D
Pennit No.-------'------------ -----
- �,, ; lication for Building fGrmit � -
AND FOR A
Certificate of Use and Occupancy
�o - � .,ra--- -- ----
Date------- -------------------------
1. OWNER'S NAME_------�A$T _ORAIKiE__A��B------------------------------.--------------- PHONE:$q&OOEl--$�%-
MAILING ADDRESS----1GO._E� ._�,rl�i1_�Li�B@L-----------------------------.. CITY --OGB�i(}--AS@fla ---- -
I�'ame
Address
c�ty -
State
Lic. No.
(Archicect or Engineer)
Phone
PROPOSED USE: __ d���'_-___--_--___-__.
IVame (�(� '.� H
r�e : . - cic��;oin�o£� -Sonn ---------------
Address_ �.�--ri�-_1.�%�1_a�iiT!i�'ti----�-----------------------
c«y -Qoa�e-.:ona ---- - -- -- -- - -
Scace
Lic. No�],Q�,�,(iQ.-.-_--�_-.____- Phone
z. JoB LOCaTION----------'rz�G �-=----E---�ST,i---�IE,£.Q-----�'T-------OOBLA_.I;@AB----------------------------------
(House No.) /'/ (Name of Stree[) (Town or School Dis�rict)
3. LEGAL DESCRTPTION: Loc __..Y_T.�____________._____Block ___.__.._ _Tracc .___'i?„�_
------ --- ----- -- - - -- --- -- -
(Meres and Bounas Description—Use reserse side of form)/
4. CORNER LOT ( ) INTERIOR LOT (✓) THROUG[-I LOT ( ) SLOPE OF LOT ( )
5. SIZE OF BLDG,; _�._�_.�____.AREA:__3BQ__SQ._S_� ___.SIZE OF LOT: vC_7y__�3d-----ARBA:_7�6.�__.__
6. HEIGHT OF BLDG.: _ 14�_____.____ ._____..CEILING HEIGHT
NO. OF STORIES.__3,.____._______
7. IVO. FAMILIES ._____.__._._.__.____._._______ Size of Smallest Bedroom: ______ Size of Kitchen:
8. EXTERIOR WALL CONSTRUCTION:_P�2!dQ!$...SLtlOOD-.-.-.I[VTERIOR WALL COVERING ..___
(Frame, Stucco, Etc.) ' (Plaster�Drywall, E�c.)
9. SETBACKS: Front Yard from Cen[er Liae of
�
. '/ /
Neacest Side Yard___.�__._.._._Rear Yar3.______._._____.Distante in Feet Between Bldgs. on Same Lot ___TQ.__.__._......____.
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTCJRES AND USE OF E.ACH.
11. For (a) Footing: Width ._x'�p---__-___'--___-. Depth in C'iround _�M--___.__------.Width of Wall _$M-__._---_-.__-
Accessory 7
Bldgs. and b Size' of Studs: _._Z_k_�_._._____S atin ��__..._____..__"CC Material of Floor
Similar ( � - P 8_.___.,.____- �%lii�ii�..'______
$tructures:
(c) Size oE Floor Joists: -_--______----.__----._ P S
- --.5 acin ---�----------- -- - '
(d Size of Rafters: _.____[.�..--�_�---._-___-----_--S acin '<
) P 8 .._-�.�. p----- --- CC
12. VALUATION OF PROPOSED WORK: Induding all labor, plumbing, electrical wiring, heating, fire sprinklers, paint-
ing and sewage p y�___7�_ � .
dis osal O--'-----------'----------
13. I HEREBY CERTIFY THAT TO THE SEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN
THIS APPLICATION IS CORRECT AND THAT THE CO[�ISTRUCTIOLV WORK WILL CONFORM TO ALL
L.4\k�5 OF TH� COULVTY OF ORAIVGE AND THE STATE OF CALIFO.RNIA APPLICABLE THERETO.
. . \ /�
. . _ ..._______Signed:_______ .__._.__ � _--,/.f-.___. __. _____i .___.._ _._..__�i►+ZiE-r_.'___.___
Q' p,� ��I C��T• c— wner)
Plans Filed:-__----�-------_ d---__�_ `�___- ��`'� .�v�
------ By:_------------ -" / '--- ---"- -- -- - -------------�------------
------------
� � "(Authorized Agen�)
FOR DEPARTMEIVTAL USE ONLY
Bldg. Permit
Plan Check
Total - -
Rereip[ I�o.
Paid ro
DA
SM-9-50
FEES:
eo
- $-----�-
.0 /m �-- --
���
GR O UP---- _L_ _ _- --- ---
TYPE-- -�-------
DIST,
MAP-. _-� - -
SHEET NO.___�_____...__
CH C NG BY
APPLICATIO ___-_---.. HEALTH___--------_----._-_.
FIRE
ZOIVING-- - -- --- -- - MARSHAL----- --- --------
PLANS AND
SPEC'5.---- -- .. STATE.-- - ------ - ------
CORRECTIONS ENGINEER
V ERIFIED - - - -- --- CAL. ------- --------------
PERMITI OIYVHUE �CJh-rY[U _nv;
-- � I\SP_;:iOF
CEPUi'� e�
Applicant to fill in all svaces witnin heavy bortler Ilnes antl sign all aDoropriate aeclarations.
' CITY OF"COSTA MESA' " ' ve•a� IT NO. � � TRACT NO: LOT NO. � '� BLDG. NO. ' � , ' - � � � - ' ` - -'-'
iCONSTRUCTIONPERMIT /`/—a��7 � -
ProjectAddress � �_��_� - TYPE OF CONSTRUCTION 1� � � f � }± � I 9 I,/26/82 7.0� �
. h= . 25 .
�Ownel , Phone -Q ❑ NEW ❑ ADD ❑ ALTERATION - . - - , �- � '
�AddtEss -��� - ^ � -��REPAIft ❑CONVERSION ❑DEMOLISH �� _
Arch/Eng. ' ' - - � � License No. - 'D�OTHER ZONING REGULATIONS �
Address - . � . . . . . DESCRIPTION OF WORK A'P"� �
- ' ZONE PLNG.REF..� '
Contractor' q, - �t'QQQWy Phone O TVPEOFPERMIT� � - � •' - BU D - TpeU i�oING � •
' Addfe55 � -- -- SETBACK C L ST. PROPERTV LINE-
' .r G• ❑GRAOING ❑ FOUNDATION ❑STRUCTURAL LEDTVARO- , � .
LICENSED CONTRACTOR OECL'AF ION O TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA SIDE VAR ' '- '" ' -
I hereby affirm chat I am Ilcansetl untler provisions of Charter 9(com- - � ' RIGHT
mencln9 with 5ection' ]000)' ot Dlvislon -3 of-tha BuSinass antl �❑ OTHER -- -- --
VrofaSsions Cotle, and y Iicense is In full force antl e(ect. - . . REAR VARD (TO P/L) �
-�� - - � �e,eN �����' ��PROJECTDESCRIPTION _ _
LIC¢O58qa55 /' � ��/�� . • PKG.SPACEREq. PROVIDED
I'.�.,Z�.P� ' '. K'. �QMtitiT/l� -- SQ. FT.• �
Date Signature � � � � STREET WIDTH � �ARK FEE $ -, �
WORKEBS' COMPENSATION DECLARATION - . OCCUPANCV_CONSTRUCTION TVPE. ,
I hereby affirm lhat 1 have a certiticate of consent to self-insure or a VALUATION � ZONE ZONING APPROVED BV � _ � DATE
tertlfiwte of Workers' Compensatlon Insurance, or a cerHfled copy - �� _ _ _.. ._ _
thereof (SecUoq a�8p0�Lab. C.). : GRADING�CV. VDS. ACRES � SVECIAL CONDITIONS: . �
P/yity No. O�G� ComPanY - _ - . _. . _ ... ' ' " '.�. .�
��'�"''��ertlfietl copy Is here�y iurnlsnetl. - - ' REMARKS: - •- - . . , . _ _
�y-'ertitietl topy Is filetl with the clty Builtling Divlslon. � • '
EMPTION FROM WORKERS�COMPENSATION DECLARATION � ' ' ' ' ' ' - ' '�
(This section.neetl not be completetl it. the permit is for one huntlretl . . , , . .. . . _ . . � � '
($3001 or 1e55). � � � � � � ' � �" '- ' - -.
1 Cert(ty thdt in th¢ perfOtmance ot the wo�k foLwhlch this pe�mit is �
issuetl, I snall not emoloy any person In any manner so az to betome � PLUMBING � '• - PLAN�CHECK' '� �ELECTRICAC PLAN CHECK
subject to the Workerz' Compensation.Laws of California._ . _
Date Signature j BATHTU85 SHOWERS � -� "
�NOTICE: I� after making this tleclaration, you zhoultl become.subject TOILETS URINA�S GENERATOR Q.1 KW_1-30 KW
,to fhe Workers' Compensation provislons of tbe labor Cotle, you must TRANSFORMEft -
forlhwith comply with such provis�ons or this.permit shall be tleemetl LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW_50 + KW -
r¢vOk¢tl. ' �-.- . .
CONSTRVCTION LENDING AGENCV �KIT. SINKS� DISHWASHERS -�MOTORS ' 0-1 HP_3-10 HP � '
I hereby affirm that [her¢ is a ConstruCtlon lentling agenCy for the p¢r SERVICE SINKS' SVMPS ' ' vUNC.50LAR) 10-50 HP=- 50 + HP � - -
formance of tM1e work lor which this permit is issuetl (Sec[ion 309�
Civ. CJ. � � '� � � �� � FLOOR SINKS FLOOR DRAINS FI%TURES OUTLETS SWITCHES ' -
Lentler's Name
Lentler'SAdtlres5 DRINKINGFOUNTAINS - - GASTUBESIGNS ' ' ' .
OWNER BUILDER DECLARATION ' ' � � INTERCEPTORS CLARIFIERS POLE LIGHTS - -� "' ' ' ' '
I hereby affirm Ihat 1 am exempt from Ihe Con[ractor's License Law for
the tollowing rea5on (Sectlon 7031.5 Bu51n¢55 antl Profe551on5'Cotle: 'SWIMMING POOL PTRAP ' ' ' '
Any dty or County wM1ich reqWres a permit to mnstrucq alteq �POLES METERED SUB
improve, tlemolish or repair any structure, prior to its issuan<e, also re- yyqTER SERVICE ALTERATION �� � PANELS '� MAIN SUB " "
qulres tbe appliwnt for such permlt to tile a signetl statement that he
is litensetl pursuanl to lhe provisions of the Conlractor'S License Law GASSERVICE OUTLETS SERVIGE '" -' ' AMP'- ^ -
(Chapter 9(commencing with Section ]000) of Division 3 of the
Business antl Professions Cotle) or that he is exempt Iheretrom antl fhe yyqTER HEATERS BTU OUTPUT `
ba�is for the allegetl exemption. Any violation of Section 7031.5 by
e 'opliwnt'(or"a permit sublecls the applicant to'a clvil penalty SEWERCONfVECTIONS � - " ' " ' - - "' " '
mOre than (Ive huntlr¢tl tlollars ($500).
� a5 own¢r of th¢ prop¢rty, or my employee5 with wa9e5 a5 Ih¢ir SOLAR TANK - � COLLECTOR$ " ' '
SOie GOTpensation, wlll tl0 lhe wolk, antl the structurE is nOt intentletl __
or offeretl for sale. (Section 7044, Business antl Professlons Cotle: The SOLAR PIPING SVS. ' �SSUE FEE " � - "
Cont�acto�'s LlcenSe law tloes not apply to an owner of a property -- - - qppLICATION APPROVED BV ' DATE
who buIICS or improve5 thereon, antl who tl0¢s suCh work himselt Or ISSUE FEE
tnrough his own employees, provitletl tM1a[ sucn improvements are not
inlentletl or offeretl tor sale. 11, howeveq tne builtling or improvement MECMANICAL PLAN CHECK $UMMARV OF FEES
is.ioltl wi[hin one yea� ot completion, the ownEr will have.th¢ burtlen . •
ot provinq M1e tlitl mt builtl or imprOve to� tM1e pu�pose ot sale). BUILDING' -'
❑ I, as owner of tM1e Oroperiy, am exclusively contracting with HEATING SVSTEM 0-300,000 BTV �PERMIT $ � SMIP - 8
licensetl conlraclors to construct the project (Secfion ]044, Business ANODUCTING 100,000+gTV P�ANCHECK 5 VERMIT
antl ProfMsions Cotl¢: The Cont�acto�'s'Lic¢nse Law tl0¢5 not apply to - � ISSUANCE $-
an owner of properry who bulltls or improves thereon, antl who con- REFRIGERATION 0-100,000 BTU t PLUMBING $ "
tracts from suth projects with-a contractor(5) Ilcesnetl pursuant to SYSTEM - GRADWG S
[he Con[rac[o�'s LiCenSe law�. 300,000 + gTU PLAN CHECK 5 ' -
❑ I am exemp[ under Section � 8. 8 P. G, for this BOILERS BTU ELECTRICAL 5 a
reason " - ' - " PLAN CHECK g ' � � MICROFILM $
SVSTEM REPAIR,ALTERATION �•
Oate Owner - � - MECHANICAL $� � TOTAL.PEEE
I hereby certitythdt I have reatl Ihis appliGatiOn antl StatG tha[ the dbove EXHAVST $VSTEM MULTIPLE � LE55 AD- � - '
informa[ion Is correct. I agree to compty wifh all ci[y antl county ��p .� M PLAN CHECK $ VANCE PC g_ '
brtlinances antl Stale laws �elating to mnsl�uction, dntl nereby dutho�iie WI.�CY W �
�epre5¢ntatives of this city to enter uPon the above men[ionetl
property for inz0 lo .pu poses. .. ) >
Signatur¢ Date _/� � FINA� FEE S /, �
Drivers' License or 55 � � " 'ISSUE FEE - - � 3 CQ .
CMt VooJ-'�o rvnl[e-tlullaing; (,dnary-HppllCdn[; YIpK-HCCOUn[If19: VOIQ¢nloa-✓a>aw�
. . .
-�
.. " J
CONSTRUCTION AND PLANNING ' � POOL & SPA. �� ,. 1,-- -
� ' �'�` l: �i Date � Inspector ' ' �� � � �� � Date Inspector �
APPROVALS � Permit # " APPROVALS Permit # . � �
1. Temporary Electrical Service or Pole � 43. Pool & Equipment Location -
2. Soil ipe-Undrgrn 44. Steel Reinforcement � � ' � � - � - � �
3.. , Electrical Conduit Utility-Undrgm - 45. � Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce - • 47. Rough Plumbin & Pressure Test � '
6. Electrical UFER Gm 46. APPROVALTO COVER-GUNITE '
7. Footings � - �"- " 49. Electrical Conduit-Undr m ' � �
8. Foundation � � " � ' ' � - 50. Gas�Pipe, ❑Undr rn,Test � -
9. . Water pipe-Undrgrn - 51.� Backwash Lines P-Tra ❑' ndr rn �
10.. Structural Floor System " 52.' APPROVALTO DECK � -
� 11. Property Sewer Line & House Connection " 53. Backwash & Rece torFinal � � �
� 12. StreeY Sewer Connection ' •' � ' 54. �Heater & Vent-Final � - �
' 13. Rough�Plumbing • � • - ' � "
14. Rough Electrio-Conduit • - ��56. Electrical-Finai.- �
f 15. Rough Elecfric-Wiring' ' " �' "` " " �- - - 57. SolarSystem-Final � � '
= 16. Rough Heating & Air Conditioning - � Fencing & Access Approval �
.17: Ducts.in Structure ' - � " ' APPROVED FOR PLASTERING � '
16. Ducts, Ventilating � ' ,
19. Gas Pipe-Rough &Test ' .�, 60. POOL/SPA SYSTEMS FINAL � � ����
� 20. Roof Framing � " ' � � � - �
. 21. Roof'Sheathin � ' � . � • � • - - �
22. Frame and Flashin ' NOTESi ' • � ' . � � � � �
� 23. � Insulation � -' ' � ' ' � � '
24. Lathing & Siding �. �
� 25. Dryoyall Nailing � � � ' -
26. � Plaster Brown Coat � � ' - � �
' 27. Electrical Power Meter-Final � � - � ' -
- 28. Final Electric � � � � � �
29: Final Heating & Air Conditioning - '
30. Final Gas Pipe-Test ' ' � -
31.. Final Plumbing �
32. Water Service-Final ' ' � � �
� 33. Gas Service-Final � -
34. Solar pomestic-Final '
35. landsca e S rinklin S stem � '
� 36. Sound Attenuation � � � � - � � '
37. Hanqicap Regulations - � - � � �
38. FINAL STRUCTURE & BUILDING - � ' � �
39. Special Requirements Completed ' ' �
40. Electric Release to Edison - - ' �' '
41 .� Gas Release to Southern California Gas Co. ' � �� � �
42. CERTIFICATE OF OCCUPANCY ' � ' � � �
No_ '" Date �
F'roject Address
Project Name
Owners Nan�
CITY OF CDSTA MESA
ci,u�oRNu asesa �.o. �ox �aoo
FROM TME OFFICE OF TME D�RECTOR OF BUILDINO SAFETV
� nssR ,�Psw s��
l�ce (r
Owners Address ���? �op /o /�'1vS� $/ • �,d1.
o�mers Telephone G�� � a v� s•
��,,,�t � ��
� ���
City Use Qily
t � I Ge. �.,� fJ 2� ���r, d�e� (strike out all
except ore) do hereby attest that e�layrtent of any person, or persons, is not
anticipated at the time of see�cing the above-referenced pennit. In the event that
any person, or persons, are e�layed under the prwisions of this permit, I shall
imrediately cause a valid Certificate of hbrlonens Corrg�ensation to be filed with the
Costa Mesa Building Division.
I agree to defend at rty own oost, arrl to indarmify arxl hold harmless, the City,
its offioers, agents and/or e�loyees, fran and agairst, arry arc3 all liability,
c3am�ge, costs, losses, claims and expenses, howscever caused, resultirx3 directly
or indirectly fran, or oorv�ected with the i�rovarent under this permit.
I further state that I have cead arid fully imdexstard the i�lications ard re-
sponsibilities of the above statements, and will crniply with all provisions of the
Contractors State License Law found under the Business ard Professions Code,
Aivision 3, Chapter 9, of the State of California.
/ / `�C -c ('- �o n 7 �
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING �/� C � �% �
ADDRESS E) //�
OwNEROR 4/�fC /rUNZE
TENANT I�f- c.-G /\
MAI LI NG /f
ADDRE55.9�'1 (/�g••�'� M�ESL� ST
/� TEL/.
CITY/ i�.rw �ilOtd NO.Ki2-%Q
BRANCH
ADDRESS
ARCHITECT TEL.
ADDRESS
CONTRACTOR v
ADDRE55
TEL.
CITV NO.
STATE - CITV
LIC: NO. LIC. NO. '
OfF LOT ��XI�S 1 I NOW ON LO
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUIIDING AND WORK TO BE PEflFORMED
I hereby acknowletlge thet I have reatl this application and state
that the above info�mation is correci and agree to comply with
all laws regulatinp builtling construction, entl I shall not amploy
any person In violation of the workman's compensation laws of
the Stata ot California.
I hereby cenity that I am properly Iicensed as a contractor undar
the State of Califarnia Business antl Professions Code, Division 3,
Chapter 9, antl hat such licenses are In full force and effect, or I
am ezempt m t provisions ot the SteSe o elifornla usiness
and Protes ons Cotl Division 3, �ter 9.
Signamre f • .
Permittae /��
or /�� � �i�7�
Authorizetl Agant Date
APPLICAT[ON
RECEIVEDBY' 1
A.P. NO. Ll1/.
f�Y
BUILDING �/�
ADDRE55 (7
UNIT OR
SPACE NO.
TR.P{O _� , LOT
PERM[T54e50 TL
OWNER/%��,GG /��.�
USE D�/O ETNOS{Cr�LUE$
ED
APPROV
DATE 7 -
DATE
m
�
>
d
SQ. FT. S d�' �� �
7
THE AMOUNT SH WN UNDER VALUATION IS FOR m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
VALUATION PERMIT FEE $ a
�� n
�' CLAN CHECK $ ^�
S J/ S�Q' �- TAX S ,' f
u
TOTAL PAID S S �..SO