HomeMy WebLinkAbout2978 CROFTDON ST - Building PermitsC
Aop�icant to fill in all soaees except those witnln neavY Doraer Iinas ana sign all aporooriate tleclarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. . TRACT NO. LOT NO.� UNIT NO.
ProjectAddress 2978 CROFTDON. COSTA MESA
Applicant'sMailingAddress 1441 S. ANAHEIM BL.. ANAHEIM
Owner•srvame EUGENE CONNELL phone 545-0232
Address ��8--� nFR Tn(1N- fnSTA MFCA 9 6 fi
Arch/Eng. LiCense No.
AAdress
Convactor'sName KINNEY AIR COND,__phone 772-1441
Addresslmailingll�t4.1�- PlJAHFiM RL.� ANN�iFIM Q2805
CiryLicenseNo. ���?1$ .
LICENSED CONTRACTOR DECLARATION
I hereby aflirm that I am Ilcensetl untler provisio�s oi Charter 9(commencing
with sec[ion 7000) of �ivi5lon 3 ot the Busines antl Protes i nt Cotle, antl
my Iicense is in tu�t�ce a�a ettec . 19]SH
�License Class " L ce
Date ��0—RS Siqnature v�n�n�� ��n �
WORKERS' COMPENSATION DECCARN�FI N'1 �COND.
I hereDy ailirm that I have a certiiitate of mnsent to 581LInsure or a certlflcate
ot Workers' Compensation Insurance, or a cert�fietl copy tbereof (Sectlon
3800, Lab. j -
Pon�r No. C24300353 comca�r INA
Certifietl copy is hereby furnis�ed
Da[eert�jierL�oPx�filetlwl�tPPhcanl` B� 1 sl n
i 3 a
E%EMPTiON FROM WORKE0.5' CO �T �Y {i�C
(Tbis section neetl not be mmpletetl it the permit Is lor one huntlretl (5300) or
less).
I certity Ihat In �h¢ perfo�mance 01 thG work !a� �yhich this p¢rm�t Is Issuetl, I
shall no[ employ any pe�son in any manne� so d5 [O become subj¢Cf to the
Workers' Compensation Laws of Callfornia.
Da[e Signature
'NOTICE: 11, alter making this tleclaratlon, you sqoultl become subjoct to tha
Wo�k¢rs' Compansation Orovisions ot t�e Labor COCo, you must torthwith
comply wilh zuch Orovisionz or IhiS permil zhall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I M1areby atti�m that [he�e is a conSlruction lending agenCy tor th¢ Oe�lo�manG¢
ol the work for wnich this permit is issuetl (Sectlon 3097 Civ. C.)
lAntler'S Ndme
Ltntler's Atltlrciz
OWNER BUILDEH pECLARATIOfi
I hereEy aillrm that I am exempt irom the Con(ractor's Ucense Law lor the
following reason (Section ]031.5 Buslnes5 and Protas5ional Cotle: Any tlty or
to
[ho
IT
lhcralrom antl lne basil fOr Ina aIIC9etl ex¢mption. Any vlolallon ol Sec�lon
7031.5 by any appliwnt tor d Permit subjeCtS tho applicant to a Civil
�enal[y ot not more than five huntlretl tlollars (ES00).
U I, as ownor o1 the proparly or my employoe5 wph wagos as lhair sole
compensatlon, will tlo tne work, antl tne ziruct4re is not intentletl or oileretl
10� SdIC ($¢CtIOO %044� pu5In055 anC PrOf¢SSiqpol COtlC: Th¢ CO(IfIdGlO!'S
Llcense Law tlOes not apply to an ownCr ot a property wl�o builtls or Improves
thcreon, antl who aoes such work hlmsetl/hers8tl or throu9h� hls or her own
Cmployees, provi0etl lhat sucn Improvemenls arp nOt Intentletl Or oHoretl 1or
wle. tl, howover, the builtling or Improvement ig soltl wlthin one year ot com-
O�Olion, the owner will have tha burtlen Of proving �e/She tlitl not builtl or im-
prOve�fo� lhe purpose o� sale).
❑ I, as ownar OI the O�operty, am ezclusively Cont�actlng with Ilcenzetl con-
lraclors to construCt Ihe project (Sectlon ]044, Qusiness an0 Prote551ons Cotle:
The Cont�acloYs License Law tlOes not apply to an owner of property who
builtls or Improves tnereon, antl who contracts ior such projects wltn a con-
tractor(sV Ocense pursuant�to Me Contraciols �Icense Law). I am aware that
proot o( thelr Worker's Compansation InSuranCO s�oWU 08 prOvldetl to me.
❑ 1 am enemp{ untler Section B. b P. C. tor t�is reason
Oate Owner
I hereby certify that I have reaC Ihis applicailon and state that the above
iMormatio is correct. � agree to comply itn aii city antl county ortllnances �
antl state ws relating to builtlin9 cons(r ction, antl hereby authorize repre-
senta[ive5 f this Cit [ nter �� nl�. e a � enti etl property for
Inspection U G KI ��( A��e 7-30-85
, Signature
I Drivers' Licensa or 55 � — — `
t �o � 8'�
TYPE OFCONS7RUCTION NE
❑ CONVERSION ❑ DEMOLISH
ADD ALTERATION REPAIR
OTHER
;. TNcrni LAT.I(�L�F AIR
TVPE OF PERMIT[-�, LJ GRADING U FOUNDATI�O{�N� �lJ STRUCTURAL
❑ TENANT y�,qELECTRICAL ❑ PLUMBING JF7.�ryviECHANICAL
❑ OTHER
P,ROJECT DESCRIPTION 50. FT.�S�� oCCvvANCv
CONSTRUGTION TVPE VALUATION S %� 3�R.00
ZONE GRADINGCU.YDS. ACRES
Remarks:
Bar $ink
Backflow Preventer
Backflow Irrigation
Bathtutis
Claritiers •
Diihuvdsher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories � ,
P—Trap
Foof Drains
Reinspection Foe � $15
Duct-UnderGround
Duct - Structural
Duct � Ventilating �
Exhaust Sysrem ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting ,
❑aioo,000 eru Oioo,000er�
Reinspection Fee � $15
AF 0865-46, rev. 10/84 WM1ite - Builtling: Canary - qOplicant; Pink - Accounting; Goltlanrotl - Asseisor
Showers
Servite Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or , Type I ❑
Canopy Type il ❑
Refrig¢ration System
C�0-too,000eru ❑too,0o0
System Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES
$ 3
4
$ 3
f�3p�# D�2ilt8 j�
�
A.P: iW
S Main Buildi
E
T Front
e Rear
A
C Right
K Left
S
Ping. Ref. qW
Planning Notes:
Automatic Washer -
Cansuuction PoleSub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F,A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW C
Fee
0499 911'9/6�a
ELECTRICAL
iKW
$15
2one
Req./Provided
:Transformer LJ 15-50 KW
❑ 50+KW
Merer ❑up to 100 amps
M¢[¢r ❑over 100amps
Sub Panel � �
1 Motors�61 HP{�X7'h-83HF
Inc.Salar �9-15 HP �1G75+
� Microwave .- -
Pole Light
Range
Standing Sections i
Tresh Compactor
luue Feo
DEVELOPMENTSERVICES REQUIREMENTS:
Zoning Approved By
Buildine APProved By
�Io�O TL
Z
O
N
I
N
G
R' �
E
Q
M
T
S
FEES
�
$ 3
� SUMMARV OF FEES ' .
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE 5 '
PLAN CHECK 25% $- ENERGY P.C. $�
ELECTRICAL $ ' 4•SO. GRADING �$
PLAN CHECK 50% . $ ' MICROFILM $ �
MECHANICAL $ �-�O TOTAIFEE �$ 11.SO
P1AN CHECK 25% $ ' ,
CONSTRUC710N AND PLANNING POOL & SPA
APPROVALS - Permit# Date Inspector - AppROVALS Permit# Date Insp>cror
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 Reinfo�cement 56. Rough Plumbing & Pressure Test
� 6• Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8: Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK
11. Proper[y 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 SYitem-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 OGas ❑Oil
� 23. Gas Pipe-Rough & Test � � 72. Underground Flush �
� 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing ' • 74. Overhead Hydro
26. T-Bar Ceiling (Structurap & 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 . (Q�'Z`/ .Uv'1 Notes:
34. Final Heating & Air Conditioning � / (,ryD �
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 pomestic-Final _ _ �
42. Backflow Preventer -
43. Backflow Irrigation �
44. Landscape Irrigation System �
45. Sound Attenuation . � .
46. Handicap Rec�ulatio�s � , .
47. FINALSTRUCTURE & BUILDING �
46. Special Requirements Completed ;
49. Electric Release to Edison . - � � � ' �
50. Gas R'elease to Southern Califomia Gas Co ' ;
51. CERTIFICA7E�OF OCCUPANCY • �
No. � " Date ' . -
AOP��eant to fill in all spaces except thase within M1eavy bo�0er lines anC sign all appropriate tleclarations.
CITl3 OF COSTA MESA pC�ONS RU/C�TI N PERMIT PERM1 O._ . _ _ TRACT NO. LOT NO. UNIT N6.
Project Address �� �p ��Or�/�.�^ �h
ApplicanYsMailing dress a //W �%'�1��
Owner's Name Phones `r �a�'
Address v��h �
Arch/Eng. License No.
Address ��^///�����n
Contractor's Name_����� ,�P.,7h.or�p �
Adtlress (m�'�'�N � /� �G7— �L��
City License No. L2v���
LICENSED CONTRACTOR OECIHRATION
1 hereby atfirm Ihat 1 am licensetl untler provislon5of Char[er 9(commencing
with section 7000) oi Division 3 of the Business antl Professions Cotle, antl
ny license is in tull r ntl effect. p
_icensp��,� e e ly�'/��nu'�
� Date � 5'9 t �
` WORKE 5' OMPENSATION DECLARATION
I hereby atfirm lhat I have a certificate oi consent to selbinsure or a certificate
1 of Worke�s' CompenSatiOn Insurance, o� a certifiE Wpy [here✓of (Sec�
Pol��ioy No: �AIQ3/L-�� Company � / , l�
-. X
rtifietl copy is hereby furnishetl. �� �� �
Ce� i' s f'letl wifh the ciry I /
Date APPlicant�
EXEMPT N OM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if [he pe�mit is for one huntlretl ($300) or
less).
I certity that in the performance ot the work for which this perm�t is issuetl, I
sM1all not employ any person in any manner So a5 to become subject to Ihe
Workers' Compensa[ion Laws o( Calitomia.
Date Si9nature
NOTICE: If, after making this tleclaration, you shoultl become subject [o tM1e
Workers' Compensation provisions of lhe Labor Cotle, y0u must forthwilh
romply witM1 such provisions o� this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 nereby affirm that there is a construction lentling agency for the performance
ot the work for which [hi5 permit is issued (Seciian 3097 Civ. C.)
Lentler's Name
Lentler•s Aatlress
OWNER BUILDEH DECLARFTION •
I hereby aftirm that I am ezempt from fhe Contractor's License Law for the
following reason (Section ]031.5 Business antl Professional Cotle: Any city or
county wM1ich requires a pe�mit to construct, dltEq Improve, tlemolish or repai�
any st�ucture, prb� to it5 is5uance, also requi�es the applicant for Subh permit
to tile a signetl statement that he/she is licensetl pursuant to the Provision5 of
_ the Contraclor's License Law (Chapter 9(commencing with Section 7000) of
� Division 3 of the Business antl Profesvons Cotle) or that he/she is exempt
therefrom antl the basis for Ihe allegetl exemption. Any violation of Section
]031.5 by any applicant tor a permit subjects tM1e applicant to a civil
pendlty of not more than five huntlretl tlollars ($500).
❑ I, as owne� of the propErty or my employee5 with wages as their sole
compensation, will tlo the work, antl the structure Is not intentletl or oifer¢tl
for sale (Section �044, Business antl Professional Cotle: The Con[ractor'S
License Law tloes not apply to an owner of a property wno builtls or Improves
thereon, antl wno does sucn work himself/nerself or through nis or her own
employees, p�ovitletl that such improvemen[s are not in[entletl or offeretl for
'sale. If, howeveq the builtling or imp�ovement is soltl within one year of com-
-pletion, the owner will have the burtlen ot proving he/she tlitl not builtl or im-
p�ove for the purpose of sale).
❑ I, as owner of the property, am exclusively conhacting with licensetl con-
[racto�sto consVuct the project (Section 7044, Busine55 antl Professions Cotle:
The Contractor's License Law does not apply to an owner ot property who
builtls or improves tM1ereon, antl who contracts for Such projects with a con-
tractor(s) htense pu�suant to the Contracto�'S License Law). I am aware that
proof of their Worker's Compensation insurance shoultl be provitletl to me.
' L7 1 am ezempt untler Section B. & P. C. tor this reason
Date
I hereby certify that
information is [orrect
and state laws relatirn
sentatives of this ij
inspection oG�o�O
Signature ru:�sv�
Drivers' License or 55
owner
have reatl tnis application antl state that tne above
agree fo comp!y wi[h all. ciry antl county ortlinances
o builtling construction, antl hereby authorize repre-
to enternuDon the above-mentionPtl Property for
TYPE OF CONSTRUCTION U NEW LJ ADD LJ ALTERATION L7 REGAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT ❑ GRADING �.f FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL lJ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.Fr. ocCUCArvGv
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES
Remarks:
Sink
Preventer
Irrigation
Dishwasher
Drinkin9 Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fee � $15
Boiler
Duct- Under Ground
Duct - Struccural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0100,000
Reinspection Fee � $75
CMF 0865-46, �ev. 30/04 WM1ite - Builtling; Canary - Applicanh Pink - Accounfing; Goltlenrotl - Assesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
A uto-W ash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeretion Sys[em
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. �f`-
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. �1`-
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electric
2051 12/23/87
` Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Trensformer ❑ 15-50 KW
❑ 50+KW
Fan
F.A.U.
Fixtures
Device Boxes
Outle[s
Switches
Garbage Disposal
Generator DO-5 KW �5-15 KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors � 0-i HP 01 Yz - 8
InaSolar 09-15 HP �76-15+
Microwave
Pole Li9ht
Range
Standing Sections
Tresh Compactor
5,fl0 TL
FEES
$ 3 '
�— Reinspection Fee $15 Issue Fee $ 3
FEES
TDEVELOPMENT SERVICES REQUIREMENTS: '
I 2oning Approved By Date
+I Building Approved By Date
I Appliwtion Issued By � Dat�
$ 3
SUMMARV OF FEES -
BUILDING PERMIT $ SMIP
PLAN CHECK $ �.�� PERMIT
PLUMBING $ �,Z--"�+ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
$
Z
O
N
1
N
G
R
E
Q
M
T
S
CONSTRUCTION AN,D•PLANNING , POOL & SPA '
APPROVALS PcrmiY # . Date Inspector � p�ppROVALS Permit # '' Date luspector
1. Temporary Electrical;&erviceor Pole � 52. Pool & Equipment Locationcn •
� i
2. Soil Pipe-Undrgrnd.��� 53. Steel Reinforcement .�
3. Electrical Conduit Utility-Undrgrnd. 54. Forms � i.z�% .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding !;�
5. Steel Reinforcement 56. Rough Plumbing & Pressure,Test
6. Electrical UFER GYnd.� � 57. APPROVAL TO COVER-GUNITE
i t�
7. Footings, 58. Electrical Conduit-Undrgrnd;�
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Strucwral Floor SYstem 61. APPROVAI TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final � � � .
73. 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-7 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 OGas ❑Oil
23. Gas Plpe-Rough & Test 72. Underground Flush - . .
24. Roof Framing 73. Undergrnd. Storage Tank O Gas .� 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 MeterFinal S0. FOOD CERTIFICATE ISSUED ''-'y-�, ..
33. Final Electric Notes: �
i .
34. Final Heating & Air Conditioning � •._-''
35. Final Gas Pipe-Test • �
36. Hood or Canopy .
37. Final Factory FirePlace .
38. Final Plumbing {-ZH�B �D '
39. Water Service-Final � � " - . �
40. Gas Service-Final . • '
41. Solar pomestic-Final ' - , � ;
, 42. Backflow Preventer � ' '
43. Backflow Irrigation � . � � -
44. Landscape Irrigatian SYstem � . �' -
45. Sound Attenuation - � � � .
46. Handicap Regulatians � -� � , � �
47. FINAL STRUCTURE & BUILDING � �
48..Special Requirements Completed � ' � �
49. Electric Release to Edison - . �
c .
50. Gas Release to Southem California Gas Co . : '. -'
51. CERTIFICATE 0� OCCUPANCY , . �
No. Date � ' ' " � .
. ,
\ �
�,�
-t.^r
ACP�icant lo fill in all Spaces except �hose within heavy boraer Ilnas ana si9n all apGrooriate Oeclarotions.
CITo �'F COSTA MESA CONSTRUCTION PERMIT
.,i Pi ect Address '�-�����'�'�w 5�
� Appiicant's Mailing Address S/� K+-e -
Owner'sName 2v��.^-o �UKw'�-�� PhoneiSH���61.1'2
Address 2q`%p� C ^o-'T1"^�. 54
Arch/Eng. License No.
Address
Contractor's Name Phone .
Address (mailing)
City Licen N
LICENSED CONTRACTOR DECLARATION
1 hereby aftirm that I am licensetl untlet provisions ot Charter 9(mmmencing
witn sectlon ]000) oi Division 3 of the Business antl Professions Cotle, antl
�ny license is in full force antl efiect.
_icense Class License No.
Date Si9nature
WORKERS' COMPENSATION DECLARATION
1 hereby affirm tnat I have a certificate of consenc to self-insure or a certlficate
of Workers' Compensation Insurance, or a certi(ietl copy thereot (Section
3800, Lab. C.) '
Policy No. Company -
8 Certifietl copy is he�eby furnishetl.
Certifietl copy is tiletl with the city Building Division.
Oate APplitant
EXEMPTION FROM WORKERS' COMPENSATION DEGLARATION
(Thissection neetl not be mmpleted it the permit is fo� one huntl�etl ($300) or
lesz).
I certify that in the performance ot tne work for whicM1 this pe�m�t is i55uetl, I
shall not employ any person in any manner so as to become subiect to the
Workers' Compensatlon LawS of Califomia. ,
Date Si9nature
'NOTICE: If, atter making this tleclaration, you shOultl become subject to the
Workers' Compenzation p�ovision5 of the l2bor Cotle, you must forthwrth
comply with SucM1 p�ovision5 or tM1is pe�mit shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV '
I hereGy affi�m that SM1ere is a const�uction lentling agency fo� tM1e pe�tormanC¢
of the work for which this permit is issuetl (Section 309] Civ. CJ
Lentler's Name
Lentler'S Aatlress
OWNER BUILDEN DECLARATIOfJ
I hereby aftirm that I am exempt tram tne Contractor's License Law tor the
� following reason (Section ]03L5 Business antl Professional Cotle: Any city or
�..���tv ..,nirn .enuvec r oermit to ronstruct. alter. imOrove, tlemolish o� �epair
to fiie a si9netl statement [Yldi I1E
the Gontrac[oYs License Law (Ch
Oivisian 3 of the Business antl
therefrom antl the ba5is (o� the
]031.5 by'any applicant tor a
ee0dlty of not mor¢ Inan tive hun
IJ 1, as owner of tbe property
wmpensation, will tlo [he wo�k,
for sale (Sec[ion ]044, Busines
License Law tloes nof apply to an
thereon, antl who tloes such wo
employees, p�ovitletl that suCh i
sale. It, howevev, the builtling or
plelion, the owner will have the
pro far tne purpose of sale).
�I,eas owner of the property, a
Vacto�5 to construct the Oroject (
Th¢ ConVactor'S License Law tl
bui105 0� improves thereon, antl
tractor(sl license pursuant to the
proof ol their Wo�ker'S Compe
❑ 1 am exempt untler Section
Date �� -�- o- 4 r Owner
1 her¢by certify that I have reai
infnrmatim is mrrecL I aarea [o
I�rivers' License or�!
CMF OBfiS-46, rev. 30/84
�
/she is licensetl pursuant to tne provislons or
apter 9 (commencin9'N�<n Section ]000) of
Profe55ions Cotle) or Ihat M1e/she is exempt
allegetl exemption. Any violation of Section
pe�mit Subjects the applicant to a clvil
tlretl tloliars (g500).
or my employees�with wages as thei� zole
antl the structure is not in[entletl or offerea
s antl Professional Code: The Cont�actor'S -
owner of a proper[y who builtls or improves
rk himselt/herself or throuqh his or her own
mpwvements are mt intentletl or offe�etl fOr
improvement is soltl within one year of com-
burtlen of proving he/she tlitl not builtl or Im-
m exclusivety contractinq wi[h licensed con-
Section �044, Business antl Professions Cotle:
oes not apply to an owner of property who
who cont�acts tor sucn project5 with a con-
Con[ractor's Lirense Law). I am aware that
nsation insurance shoultl be provitletl to me.
B. & P. C. tor this reason
this ap lication antl state �at the above
>mpty ith all tlty antl c ntY ortlinances
constr ctlon, antl here authorize repre-
�pon tne above-mant' netl property fo�
Date /'�'4c-Q3~
��—
TYPE OF CONSTRUCTION LI NEW U ADD LJ ALTERATION ILJ REPAIR —
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p.#
DESCRIPTION OF�WORK/USE OF BLDG.
- . S ' Main Building:
E
TYPEOFPERMIT GRADING FOUNDATION STRVCTURAL T front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - A Reaf '
❑ ,pTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCV C Right
K
CONSTRUCTIONTVPE VALUATION$ S Left
ZONE GRAOING CU. VOS. ACRES p�ng. Ref. #
Remarks: ' Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Dreins
Floor Sinks
Gas Service'
Intercep[ors
Kitchen Sink
Lavatories �
P-Trap '
Roof Drains
Rainspection'Fee � $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting�
❑ a i oo,000 sru � i oo,000 eT
Reinspaction Fee ' � $15
White - Builtling; Canary - Applicant; Pink - Acmunting; Goltlenrotl - Assesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater '
Water Service
Auto-Wash
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑ �
Fefrigeration System
❑0.100,000 BTU ❑100,000 E
System Repair/Alteration
P ire Da mpers
Registers
Issue Fee
FEES
$ 3
$ 3
Automatic Washer
Construction PoleSub.
Cooking Unit " .
Dishwasher
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Swi[ches
Garbage Dispoul
Generetor DO-5 KW C
4537 II/2q/85
Zone
Parking Req./Provided
ELECTRICAL .
Transformer ❑ 15�50 KW
❑ 50+KW
Meter ❑up to t00amps
Meter ❑over 100 amps
Sub Panel
Motars �0.7 HP � 1'/: - 8
Inc.Solar �9-15 HP 076-75+
Microwave
Pole Light
Range
! Standing Sections
5�75 KW Trash Compacror
' Reinspection Fee I $15
DEVELOPMENTSERVICESREQI
2oning Approved By
Building Approved By
Issue Fee
3oQt Tl.
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
SUMMARVOFFEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUM8ING $ � ISSUANCE • $,
FLAN CHECK 25% $ ENERGV P.C: $
ELECTRICAL $ GRADING $
PLAN CHECK', 50% $ MICROFILM $ � �
MECHANICAL $ TOTALFEE $ ,C_
PLAN CHECK 25% $
CCNSTRUCTION AND PLANN...S �'OOL & SPA
Date Ins ector �
PPROVALS Permit # P APPROVALS Permit # Date Inspeitoi
� 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
-2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
3. Electrical Conduit Uiility�Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
� 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7:'Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation ' 59. -Gas Pipe, O Undrgmd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrical-Final
. 15. Rougfi Electrical-Conduit . 66. Solar System-Final _
i6. 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 �Gas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush
24. RoofFraming 73. Undergrnd.StorageTank�Gas ❑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 �( Z7,�}- �.� -
39.�Water Service-Final
40. Gas Service-Final .
41. Solar pomestic-Final
42. Backflow Preventer - •
43. Backflow Irrigation �
44. Landscape Irrigation System
'45. Sound Attenuation � . ' ' �
46. Handicap Regulations � - � •
47. FINALSTRUCTURE&'BUILDING � ,
48. Special Requirements Completed ,
49. Electric Release to Edison
50. Gat Release to Southern California Gas Co _
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER� �COME HOMES
JOBADDRESS
Street
DATE
BUILDINGPERMITNO.
GENERALCONTRACTOR j��Mma Hnmrag VALUE m 8�%C)O.00
�oT 50 e�ocK TRACT 2896 Single ��es. w/att gar
GROUP I& J TVP� V ZONE RL FIRE DISTRICT 7(lOA
INSPECTIONS
Foating Treneh
Foundation Forms and Grade
Rough Framing � � �
�
Plumbing, Rough to Siab
Plumbing, Rough Complet
Temporary Pole
Wiring, ROugh
Heating, Rough
Heating, Final
�--
Sewer, House �&ewe
Septic Tank or C�q pool
Lathing, In � Out
Plumbing, Fin.al GasTest / �jr J'I)G
Wiring, Final ,��✓�
Occupancy ��,�
FOHM 210 3M 10�93
DATE I SUBCONTRACTOR I PERMITSI9SUED
DATE I NUMBI
�
S
.-.�.dosta Mesa Bnilding Department APPI,ICATION FOR PERMIT
;,�' P.O.Box3�� ���� BUiLDING '
"'� COSTA MESA, CALIFORNIA
FOR OI�'FICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permit No.
Buflding �Q c��
nddreu Croftdon Strset J
Costa, Mesa, California Receiv d Date Rec'd. /Date Issued
Nearest �� '��u �`� `� " /�' ��
CrossSt. Bek9t Building -
Address
owner Yfelcor,ie Hoirs s, I:ro.
Mail Costa Mesa, California
Address E%28 1^lestminster Ave., Nearest
Tel., Cross St.
City �BStR[121SteT Np,Mfem. 5%11 Zone No.of Type Group�y�
Arch(tect or Lic.
�� I Plans I 1 �
Engineer No. Approved
b Date
Address CORRECTIONS
,u City Lic.
Contrectorel0o� HOmes, Inc. rya, 1�2%8 �, � ,'
�
address 6b28 Ylestminstor Ave., f. '
Legal Lot � �. a� � ' —� __ .
Description I No. 50 I Block � I Traet2Sa6 ' .-
`; 1 n - .
fAttach Metesand 6eundsl – " �� - .
Size of Lot 5axlaz � Now on Lot N
vseot I No.oi I No.
Existing Bldg. NOI1e Familles Roc
Setback Lfne from __ Rear Yard ,e
New � X � Alteration I I Addition �
Repair I I Moving I I Demolish I
Building _-'�n No.of
Size �5�W Rooms �J Stories 1
ExteNor Wall Roof
Covering Stuaco Covering Y�ood
Use of New
Buildfng Sin�le familv residence
snd tv+o oar gara�e attaahed.
I hemby acknowledge that I have read this App7icatic
and state that the above is correM and agree to comp]
with all Ci a s and e Ia� re latir
building const �-/�j
Signatureof '/�``'J�'
�
Permittee n.. !/ ni�J // l _
: � ��_ . , . - .
APPROVALS
Foundation Location Inspector
Forms, Materlals�
Under-Pinning
Frame: Fire Stops,
Braeing, Bolts
Lath.int.
Lath. Ext
Plaster, Int
Valuall n� Permit Fee $ %� a � Ma
� •-�� � Plan Check $ � � � Bo
$ � Total —
Fee $ �� � I FII
aM zoa io.ee o. e. n s. .
Date
a
�
2
D
r
PLOT PLAN
Show locatlon and dlslances Trom
property Iine and between buildings
. !"..
,.- `.w
a, ;, �_c . oba ,.� • � � _
, cosr. ¢ �
,'P,Y i c;-55P�t9E5A '63.,. • i,: ?3.�;)
.:Y'._ a .. .. .. : J::-.
�. LV_. _ o c �. �- .
t:l' . .. �:cJzc. _
: i�- . .o- � ' r �cl
' . -� '�:
UL:_ .
� �
� . �� .�. �
! � G, ;:;�
bc • •� � u'..
o __ 1.' t �i .
.U:� o:�;,;, �., .. � �o e
�•\�,�v \a'.'�J -� :`�� .�:�)�.,'
` ^ `\ � .
.'�\i_�'l�arJ �.� �,j 1
. •
�..�,-.. � �
-� -. . 1-+.- •. i� : �
` 'i',
ER CONNELL, E. DATE 10-5-70
ADDRESS z978 Croftdon strPPt BUILDING PERMIT N0.
FIRE ZONE
SUBCONTRACTOR
PROP. SWR. LINE U HOUSE CON.
SPRINKIING SVSTEM
MISCELLANEOUS
ROUGH MEATING ANO AIR CONOITIONING
TEMPORARY SEPVICE Oft POLE
UNOERGROUN� � POWER �
ROUGH WIRING
BON� BEAM LI
SHEATHING
FRAME AND FLASHI
LATHING - IN rI
�. .
, � 32315
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O, BOX 1200 COSTA MESA, CALIFORNIA 92626
For Rpplicant to Fi!! in Completely
(iCT -6-7�1000 163� ****16-$0
CMS0.
APPLICATION FOR BUILDING PERMIT
'.EIVED Bv DATE RECEIVED DATE ISSUE
BUILDING �Q—S��(� /O�G'_
ADDRESS " Ej� f.�j ��./1
� A.P. NO. J�� P'S cJT'C I
OWNER
MAIL BUIIDING
Z .
ADORE5S �+DDRESS `
W W TEL.
o- U CITV NO. TRACTp�
~ Z W A
Z Q CAN5TRU�ION
O N LENDER x
dfd ( �
J � BRANCH
J y OWNER
m J ADDRESS
m ARCHITECT TEL. S
J a OR ENGINEER
ZQ � . FIRE
w K ADORESS ZONE
aw
APPROVED
w Z CONTRPCTOR — BV
J �
m z
J � ADORESS G��
VALUE
w W TEL. ZON NO.OF I USE O
ZF CITV .r NO. � P�'�
w � STATE GTV �'ARDS APPROb
N� LIC. NO.�� LIC. NO. MAIN BUILDI�
� O (FROM UL Tp��
SIZE NO.OF BLDGS. /
OF LOT NOW ON LOT ROM F`f
USE OF
EXI5TING BLDG. � � , O FT.
M— SIZE OF NO. OF —
Z NEWBLDG. ROOMS STORIES L.SIOE D FT.
U EXTERIOR WALL ROOF
COVERING COVERING 'k REAR FT.
J USE OF 6UIlDING AN� WOFK TO BE PERFORMED DISTANCE BET.
a MAIN BLDGS.
a
a � � � , �AR. �
O C. V.P. �b
N� \ APPROVED
z
0
VI horaby aeknowledBe that I hava reetl this applieation and state
� that tho ilbove informetion is correct antl oprae to comply with
� nll lows rap�lating builainp consVuction, antl 1 sfiali not employ
F any person in violatiOn o� tha workman'c compensation laws af
y the Stete ot Caliiornia.
ZI haroby Gerti(y that I am properly licensatl as a contrac2or untler �L SQ. FT
the State of Californle Business antl Profassions Cotla, Dlvisicn 3, THE MOUNT S
Chapter 9, entl Mat suc� licenses ara in full (orca antl effect, or I THE PURPO6E OF
om ezampt from the provisions 0� the Sm[e ot Californla Bvstnesa �qLUATION
ontl Profassions Cotla, Division 3, C apter 9.
Sip^otu.o of �
Parmi[roe $ �fV b �
Authorizetl ABa
BET. MAIN &
ACCESS.BLD
DATE
APPROVED
�
-S- y0
b
O
VATION IS FOR '
iMiT FEE ONL�': Q
%- C� d ;
m
.�- V�C) E
0
i ^� LL