HomeMy WebLinkAbout1109 DANA DR - Building PermitsCITY OF COSTA MESA
BUILDING DIVISION
iA$ 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
v FOR INSPECTIONS CALL: (714) 754.5626
PERMIT NUMBER: B09-00136
PERMIT TYPE B ROOF2 STATUS:. ISSUED
APN: 41207421 DATE ISSUED: 07127/2009
ISSUED BY: BJK
JOB ADDRESS: 1109 DANA DR CM Suite/Unit:
Vicinity:
Squares: 500 Valuation: $4,000.00
SCOPE OF WORK: REMOVE/REPLACE SIDING (ICC #ER1410) AT AN EXISTING SFD. 1 LAYER 40# LATHE, METAL EDGING AND
SBS ASPHALT SIDING. 500 SO FT
OWNER: HIRATA, DANIEL J
Address: 1109 DANA DR Unit:
PHONE:
City/State/Zip:
COSTA MESA, CA
APPLICANT: SHUR, TIM
Address: 344
ROOSEVELT AV Unit:
PHONE: 805-647-2813
City/State/Zip:
VENTURA,.CA
CONTRACTOR: SHUR ROOFING
COMPANY
License No. 386491
Address: 344 ROOSEVELT AVUnit:
PHONE:
.805-647-2813
City/State/Zip: VENTURA, CA
93003
CELL:
ARCHITECT:
License No.
PHONE:
ENGINEER:
License No.
PHONE:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$97.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
TOTAL FEES $98.25
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9228, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE i. INSPECTION TYPE DATE INTMALS CODEC INSPECTION TYPE DATE INTMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical
201 Final Slock/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site S1 �J'
` n 1c OW�}
204 Final Demolition 250 Final Building/Occupancy l� tid�ZS •TI9
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 workers' compensation Insurance carrier and policy
number are:
Carrier 57-,-11Fe-ti0
(This section need not be completed tl the permR is valued atone hundred Collars (8100) w less)
Policy Number: CP 3 a
❑ I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the L shall forthwith comply with these provisions.
Applimnt'sSignature Date �
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and 2_ Does or will the applicant or present or future building occupant need to file
my license is in full
force and effect. q a registration form for acutely hazardous materials? El Yes El No
LiC # _> 3 9 l ! f Class (Section 25533 of the California Health and Safety Code, with some
/'� / q exceptions, requires registration with the Costa Mesa Fire Department by
Int l� 7 Z_7/C) / each business which at any one time has on hand a quantity of acutely
Cpmraadr s'Signawre 'Datehazardous 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Owner ID verified by driver's license. ❑ Yes ❑ No
Driver's License No. �:.Tkes.
Verification of Ownership by (type of document, i.e. - progeny 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.
Applicant's Signature
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 fled 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).
Lender's Address:
Signature Date
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
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 applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "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 for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature orie al Ownegs) �f Date p�
30576 (3/07) Signature Date
(714) 754-5273 • Fax (714) 754-4856
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
BUILDING PERMIT
Job Address: 1109 DANA DR
Suite:
Vicinity: RESIDENCE & ATTACHED GARAGE.
PERMIT NUMBER
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 04/13/1999
Issued: 04/1311999
ParcelNunmber: 41207421
Zoning: R1 R1
ISSUED BY:
Applicant: SHUR, TRACEY
Address: 2307 VAIL AVE
Phone: 310-370-0703
REDONDO BEACH, CA
Zip: 90278
Owner: HIRATA, DANIEL J
Address 1109 DANA DR
Phone:
COSTA MESA, CA
Zip: 92626
Contractor: SHUR ROOFING COMPANY
Address: 2307 VAIL AVE
Phone: 310-370-0703
REDONDO BEACH, CA
Zip: 90278
License: 386491
Arch :
Eng:
Address:
Address:
Phone:
Phone:
Zip License:
Zip:
License:
SCOPE OF PERMIT
REROOF: T/O EXISTING ROOF TO SHTG; RESHEATH WITH 1/2" CDX PLYWOOD.
REROOF WITH PROTEX
SHAKE/SHINGLE. 31 SQUARES.
ICBO #ER -5492 (5.8# SQ FT).
FEE SUMMARY
Plan Check: $0.00
Calc Valuation: $12,000.00
Permit: $187.25
Claim Valuation: $12,000.00
SMTP Res: $1.20
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $188.45
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. 9248, § 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
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 work8rs'{�p mpens tion Insurance carder and policy number are:
Carrier: �Srt�7P �U/'Y� Policy Number:
(This section need not be completed if the permit is valued at one hundred dpllars ($100) or less.)
❑ 1 certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these p visions.
Applicant Signatur . Date:
WARNING: FAILURE TO SECURE WORKE(1 COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000), IN ADDTI N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed un r pi.si sof Chapter 9 (commencing with Section 7000) of Division 3 of the Business��nd Professions Code, and my license is in full
force and effect. Lic. M V Class
Contractors Signatur 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: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).):
❑ 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.
7144, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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).
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 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 applicant or present or future building occupant require for the work which is the subject of this application a parmit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If -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 for Inspection purposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final Inspection.
ignatu f egal Owner(s) to
And/Or Authorized Applicant Date
CODE I, INSPECTION TYPE DATE 7LDmALs CODE I INSPECTION TYPE p INTITALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof If -1 210 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
2""6
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
(CITY OF COSTA MESA PE MIT NO. TRACT O. LOT NO. BLDG. NO.
'CONSTRUCTION PERMIT ► -22oC-
Address 114 ,&Lrla wive,
Arch/Eng. License No.
Address
Contractorml- IhV I AfP�[xY?YS h/. Phor
Address
10 I 14:. T)Tf T v�.
.ICENSI5D CONTf2ACTOR DECLARATION T-
hereby affirm that I am licensed under provisions of C
nen ting with -section 7000) of Division 3 of the
Tofessions Code, I
nd IIc5nse is In full rcj
n s / Lc eN
PIMP,e Signatuj -1 )-
NORKE S' C ENSATION DE AR ATION -
hereby affirm that I have a Certificate of consent o
:ertificate of Workers' Compensation Insurance. or\
TYPE OF COrTRUCTION
L=
- ❑ NEW VADD I] ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER 11
DESCRIPTION OF WORK
TYPE OF El93-`FOUNDATION PERMIT1J �'. -
X / GRADING " STRUCTURAL
"- ❑ TENANT�I] ELECTRICAL ❑PLUMBING -❑MECHANIC
9 (Com -
ass and ❑ OTHER
fgct. PROJECT DESCRIPTIO
/(1_Jn7rlt SQ. FT. Sgt i
(Sr¢ or a OCC UPANCYXa-CONSTRUCTION TYPE
ad C py VALUATION ONE
I/ GRADING CU..VOS. ACRES
L'7 Certified copy is hereby furnished. -- - REMARKS: -
❑ Certified copy Is filed with the city Building Division.
v
rp
Lender's Address
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for
/
(This section need not be completed if the permit Is for one hundred
the following reason (Section 7031.5 Business and'ProfeSSlons"Cotle:-
Any city or county which requires a permit t0 construct, alter,
WATER SERVICE ALTERATION
($1001 Or Ieas1.
GAS SERVICE OVTLETS -
_
I Cert fy that p the performance ce Of the wor k.for which this.per mit Is
issued, 1 shall not employ any person in any manner so as to become
PLU ING
PLAN CHECK
subject [o the Workers' Compensation Laws of California.
BATHTUBS
-,
SHOWERS
Date Signature
_TOILETS
URINALS -
NOTICE: It after making this declaration, you should become'subjecl
to the Workers' Compensation provisions of the Labor Code, you must
forthwith comply wlin such provisions or this permit shall be deemed
LAVATORIES
DOUBLE LAYS
revoked. . - - .. - -- -- . .
CONSTRUCTION LENDING AGENCY
KIT.SINKS
--DISHWASHERS-
SERVICE SINKS
-
- .SUMPS -
- -
1 hereby affirm that there is a construction lending agency for the per.
formance of the work for which this permit is issued (Section 3097
CI C)
'
Lender's. Name
FLOOR SINKS FLOOR DRAINS
Lender's Address
DRINKING FOUNTAINS
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for
INTERCEPTORS -CLARIFIERS
--SWIMMING POOL-PTRAP' -
the following reason (Section 7031.5 Business and'ProfeSSlons"Cotle:-
Any city or county which requires a permit t0 construct, alter,
WATER SERVICE ALTERATION
Improve, demolish or repair any structure, prior to its Issuance; also re.
quires the apt licant for, such permit to file a signed statement that he
GAS SERVICE OVTLETS -
Is Ii tensed pursuant to the provisions of the -Contractor's -LicenseLaw
(Chapter 9 (commencing with Section 7000) of Division 3 of the
WATER HEATERS - - BTU OUTPUT t
Business and Professions Code) or that he is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by
SEWER CONNECTIONS -'
any applicant for a permit subjects the 'applicant to -a civil' penalty
of ,not more than five hundred dollars ($500).
•PLAN CHECK
El I, as owner of the property, or my employees with wages as their
SOLAR TANK `-- COLLECTORS-- - -
sole Compensation, will do the work, and.the structure is.not intended
or offered for sale. (Section 7044, Business and Professions Code: The
SOLAR PIPING SVS.
Contractor's License Law does not apply to-an.owner of a property
_ _
ISSUE FEE I'
who builds or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not
GRADING $
MECHANICAL PLAN CHECK
Intended or offered for sale. If, however, the building or Improvement
Is sold within one year of completion, the.owner will have the. burden
SVSTEM 0-1:000 BTU '
--HND DUCTING' `0 - -
100,000+BTU
of proving he did not build or improve for the purpose of sale).
El00HEATING
I,'as owner"of-the property, am exclusively- contracting with
licensed contractors to construct the project (Section 7044, Business
and Professions Cotle: The Contractor's' License Law does not apply to
REFRIGERATION 0-100,000 BTU
an owner of property who builds or Improves thereon, and who con-
tracts from Such projects with a-contractor(s)-licesned pursuant to
theContractor's License Law).
SYSTEM - -- - --
100,000 +BTU
❑_ 1 am exempt under Section B. & P. C. for this
reason - - -- -
BOILERS BTU
Date' Owner -- -
SYSTEM REPAIR, ALTERATION
I hereby certify that I have read this application and state that the above
EXHAUST SYSTEM_ MULTIPLE
Information is correct. I agree comply with all city and county
_
Ordln a n ccs a state laws rela n to post r uction, and here by au horiae
representati a of this city a ter upon .the above) tioned
property t i pe on pLL ses.
Signature / .I are
Drivers' Licen r SS YR ) ISSUE FEE - - - --
CMF 0865.46 White -Building; Caeary-Applicant; Pink -Accounting; Goldenrod -Assessor
0143 1/04/82 64.02 TL'
- ZONING REGULATIONS
KW_
I KW
A.P. rl 7 -
0.1 HP
10-50 HP_.
ZONE _ PLNT,,G-•
- FIXTURES
gRLEIF. p�
SETBACK C ST PRIJPEIRTV INE
SWITCHES
VA R11 _
41 fl'�7RIEI FG
- -
SIDE
HTA i p
- -POLE LIGHTS-
REAR YARD (TO P/L) G -
--''
,PKG.SPACEREQ. PROVIDED '
•PLAN CHECK
STREET WIDTH - PARK -FEE E - -
PERMIT
SPECIA6 CONDITIONS: /
O _T
u) /l � X /S' lei
.ELECTRICAL 'PLAN CHECK
OR
GENERATER
TR ANSFORM
- ,APPLIANCE '-10-50
0-1'KW_1-30
KW -50
KW_
I KW
MOTORS
'(INC. SOLAR) _
0.1 HP
10-50 HP_.
1-10 HP _
50 -+-HP
- FIXTURES
OUTLETS'
SWITCHES
- GAS TUBE SIGNS
- -
$J. O
- -POLE LIGHTS-
-
--''
•PLAN CHECK
$ R.%`C 02
.PANELS- -MAIN - -
SERVICE - -
AMP -
" ISSUE FEE
- - •'
- -
APPLICATION APPROVED BY
- DATE/
SUMMARY OF FEES
-BUILDING -
'PERMIT
$J. O
SMI P.,. ,$ _yr 1
n
•PLAN CHECK
$ R.%`C 02
PERMIT
ISSUANCE
PLUMBING
$ "
GRADING $
PLAN CHECK
E '-
E,
1 ELECTRICAL
$ -
PL -AN -CHECK-$
-
MICROFILM $ a� _
MECHANICAL
$ -
TOTAL FEE E
PLAN CHECKS
LESS AD. a
VANCEPC--
'
_
FINAL FEE $ h 2
CONSTRUCTION AND PLANNING
APPROVALS Permit # •� 2 o Date
POOL & SPA
InspectorgppROVALS Permit # -Date. , Inspector
1.
Temporary Electrical Service or Pole
43.
Pool & Equipment Location - - - -
2.
SoilPipe-Undrgrn_ - _
44.
Steel Reinforcement -
3.
Electrical Conduit Utility,Undrgrn _
_ 45.
Forms
4.-
- Electrical Conduit-Undrgrn _
46.
Electrical Bonding -
5.
_Steel, Heinforce
47.
Rough Plumbing & Pressure Test - .
6..
Electrical UFER Grn _
48.'
O ER -GUN ITE
• APPROVAL TO COV
7..
_Footings _ _ _
49.
Electrical Conduit-Undr rn -
.8.
Foundation.
50.
Gas Pipe, ❑ Undr rn, Test .
9.
-Water Pipe-Undrgrn
51.
Backwash Lines P -Trap,❑ ndr rn - • •+� ••
10. --Structural Floor System
52.
APPROVALTO DECK - - -• - --
1. •_
Property Sewer Line SLHouse!Oonnection
- 53.
Backwash & Receptor -Final -
-12.
Street Sewer Connection _ -
54.-
Heater & Vent -Final -
13.
. Rough plumbing _ _ -
_ - - -- - --
14.
Rough Electric -Conduit -
56.•
- Electrical -Final
15.
Rough Electric -Wiring - - -
- - 57.
Solar System -Final -
16.
Rough Heating & Air Conditioning _.
encing & Access Approval -
17.
Ducts in Structure -
APPROVED FOR PLASTERING
18.
19.
20.
Ducts, Ventilating
Gas Pipe - Rough & Test
Roof Framing
60.
POOL/SPA SYSTEMS FINAL
21.
22.
Roof Sheathing-
Frame and Flashing -- _
�•
NOTES:
23.
Insulation - -
24.
Lathing & Siding -
25.
Drywall Nailing
26.
Plaster Brown Coat
-
V,",7.
Electrical Power Meter -Final
8.
FinaLElectric -
29.
Final Heating & Air Conditioning
-
30.
- Final Gas Pipe -Test
31.
Final Plumbing
-
-- 32s
-Water Service -Final
33. •
Gas Service -Final
-
34.
Solar Domestic -Final
35.
Landscape Sprinkling System
36.
Sound Attenuation
-
37.
Handicap 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
.Y•
450i'71r
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING // r) )
ADDRESS `t f/�� _ f0_
GWNERProperties West Development Corp
MAIL
ADDRESS 508 29th Street
CITY
BRANCH
TEL
NO.I
ARCHITECT
OR ENGINEER Frank SF' filer No ' 673-095
ADDRESS 2240 Newport Blvd. , Newport Bch
ADDRESS
TEL.
CITY NO.
STATE CITY
LIC. NO. LIC. NO.
SIZE NO. OF SLOGS.
OF LOT ApprnY hot x 90' NOW ON LOT
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
#3
I hereby acknowledge that I heiVread this aj/plicetion and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person In violation of the workman's compensation laws of
the State of California.
I hereby certify that 1 am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or I
am ex ampt from the3vovisions of the State of California Business
antl Professions Cope; Division 3, Chapter 9.
Pormittee
Agent
110V 10-77FAtBL00 561 *** 109.78
R54
APPLICATION FOR STRUCTURAL PERMIT
RECEIVED BY
DATE RECEIVED
DATE ISSUED
A. . NO. Z- 'OZ
P X61
BUILDING
ADDRESS
TRACT 9860
LOT 53
BLOCK
OWNERPropgrtiesDevelopment
S Res. Atd. 'Gar. VALUE 61,100.
RE
DATE
NO.OF w I USE OF
YARDS OVED YARDS APPROVED MAIIN BUILRDING I ACCESSORY BUILDING
VAR.
N
nrnf I! r cnr cnl
iotD FIC,0
SQ. FT. 2295m
N
THE AMOUNT SHOWN UNDER VALUATION IS FOR m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION PERMIT FEE y n
n
PLAN CHECK $ n
0
$ 61,100. TAX $ 4.28
TOTALPAID $ /O
-sem
�a
COSTA MESA BUILDING-SAPIETY DEPARTMENT
PO BOX 1200 COSTA MESA CALIFORNIA 92626
c —� C:A ,00 506 �*-�*211.00
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED BY I DATE RECEIVED DATE ISSUED
BUILDING / /
ADDRESS ( /i/
PERMIT NO.
OWNER zdi
A.P. NO.
BUILDING /D _� A /
MAIL 10/
ADDRESS / Q/J(fj(/
ADDRESS
TEL.
CITY NO.
TRACT
LOT BLOCK
CONSTRUCTION
NEW
ADO RP
LENDER
BRANCH
OWNE
ADDRESS
V UE
USEPUA.
ARCHITECT TEL.
OR ENGINEER
FIRE
ADDRESS
ZONE TYPE GROUP
APPROVED
CONTRACTOR
BY DATE
ADDRESS
TEL.
ZONE
NO. OF
USE OF NEW
CITY NO.
PLANS
BUILDING
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING
ACCESSORY BUILDING
SIZENO.
OF BLOGS.
IFROM C/L STREET)
OF LOT
NOW ON LOT
ONT FT.
FT.
USE OF
EXISTING BLDG.
R. SIDE FT,FT
Separate permits are required for
L SIDE FT.
FT.
electric, plumbing and heating work.
REAR FT.
FT.
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN BLOCS.
ACCESS. BLOCS.
VAR. %%
DATE
C.U.P.9P
APPROVED
APPROVED
RY
DATE
I hereby acknowledge that I have read this application and state
that the above Information Is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
hereby certify that I em properly licensed as contractor under
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or 1
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT FEE S
PLAN CHECK $
Signature of y �/ �/�//
/
TAX $
Permittee��/iCC//%s+-[ %%%TTT �ili/''�'�
$ //
Authorized AO.nt L
TOTAL PAID $.