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Home My WebLink About111 DANBURY LN - Building Permitsnoz (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 111 DANBURYLN Suite No Vicinity: ENCLOSURE OFF PATIO Parcel Nunmber: 41916335 Applicant: GLOVER, LORIE Address: 2737 S. CROODY SUITE D SANTA ANA CA PLUMBING PERMIT Phone: 714 241-1414 Zip: 92704 Owner: ESTRADA, ROSALIND ANNE & CLYDE, CHRIS HAROLD Address - 111 DANBURY LN. CA- Phone: (714) 557-04023 -COSTA MESA, ' Zip: 92626 Contractor: Address: Arch/Eng: Address:, COAST ROOTER PLUMBING HEATING & AIR COND 2737 S. CRODDY SUITE D SANTA ANA CA WATER HEATER CHANGEOUT. "Phone: -714241-1414 Zip: 92704 License: 529127 Phone: Zip: License: SCOPE OF PERMIT PERMIT NUMBER P99-00428 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07/26/1999 Issued: 07/26/1999 ISSUED BY: COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 FEESUMMARY AMT QTY _ AMT QTY AMT QTY ISSUE FEE $22.00 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System, $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(i-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units "$0.00 0 Septic Tank - $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater • $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater / vent $11.00 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $33.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 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 mairlaln workers compensation insurance, as required by section 3700 01 the Labor Code, for the performance of the week for which this permit is Issued. Imo' My Coo is. conn ens don Insurance carder and policy number are: Carder: i� I t '0 i Policy Number: (This secflpa ee not corn fed it the p rmit Is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' 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 $hall forthwith comply with these provisions. Applicant Signature: 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 DOLLARE ($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 [I.cens d under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Lic. a 9/ ^% Class k 03% Contractors Signature,��—�_ Date: (O CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cade: Any city or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).): ❑ 1, as owner of the property, or my employees with wages as their sole Compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself 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.). tu d ❑ I am exempt under sec\ Business and Professions Code for this reason: Signature: \>_J In / X 21( �I 4 . Date: Owner ID verified by drivers lic`en'se: �'JELes ❑ 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 Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel 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 Cade, 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 ..matt-tater 3 Does or will the applicant or present or future buildinginn occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous meterials)7 ❑ 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 RMPresently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-I No (Section 65850.2 of the California Government Cade 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 Cade 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. 1 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. __ �SlyFst a at Owner(s) r� 1) is And/Or Authorized Applicant Dat copE t, iusoccTIONTYPE IMN 1NTITI9L$ CODEj INSPECTION TYPE )DATE INTRIALS 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 Block/Ri Taming Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2"6 46 Requested Inspect Date: Tuesday, June 30, 2009 Site Address: 111 DAN BURY LN CM ENCLOSURE OFF PATIO A/P/D Information Activity: P99-00428 Type: PLUM Sub Type: Status: EXPIRED Const Type: VN Occupancy: Use: Insp Area: Owner: ESTRADA, ROSALIND ANNE & CLYDE, CHRIS Phone: (714) 557-04023 HAROLD Applicant: GLOVER LORIE Phone: 714241-1414 Contractor: COAST I:OOTER PLUMBING HEATING & AIR Phone: 714 241-1414 COND Description: WATER HEATER CHANGEOUT. Notice: PERMIT IS EXPIRED BY LIMITATION - WEIDE MJ Requested Inspection(s) Item: 150 MISCELLANEOUS INSPECTION Requestor: Assigned To: Action: Time Exp: _ Inspection History Requested Time: 08:00 AM Phone: Entered By: ZWART_B K 60 Action: EXP Expired as , l=N REPT131 Run Id: 12233 CITY OF COSTA MESA BUILDING DIVISION 7 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: 08-00029. PERMIT TYPE MECH APN: 41916335 JOB ADDRESS: 111 DANBURY LN CM Vicinity: GARAGE SQ. FT: 0 STATUS: ISSUED DATE ISSUED: 02/26/2008 ISSUED BY: YH Suite/Unit: SCOPE OF WORK: REPLACE C/045,000 BTU FURNACE IN GARAGE OWNER: ESTRADA, ROSALIND ANNE Address: 111 DANBURY LN Unit: PHONE: (714) 557-04023 City/State/Zip: COSTA MESA, CA APPLICANT: LAURA YENULONIS Address: Unit: PHONE: City/State/zZip: CONTRACTOR: ALLIED PLUMBING - HEATING - AIR CONDITIONING License No. 610780 Address: 422 JENKS ClUnit: PHONE: 714-998-4300 City/State: CORONA, CA ZipCode: 92880 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: 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. OE p. INSPECTION TYPE DATE INTITIALS CODE/ INSPECTION TYPE jf �� / 7�AT INTMAU ` 1616 Fixed System Final Fire Prevention 206 Final Mechanical y zL v dG�C.Vra� �//7I0 X ''iM(/�y(✓\ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DECLARATIOI. I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. iqr) 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 peril is issued. My workers' compensation Insurance carrier and policy //number arej bab� TNS `'Carrier. l� Sys- 'YThaseCipnne mtbecpmplet dtheperm3issvvaalluWatmehun ted0b#ars�i1$100)p il.) �Pollcy Number: il.x_.— 1(_0� �v�i(p .��0� 1 ❑ 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 Califomia, 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 provisions. Apphcant's Signature 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 my license is in full force and effect. ('% Class# V OIiJ^ !/ COnlratlpr's Signature Date CONSTRU ON LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: 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 contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 3057<613107) Owner ID verified by ddv-.., lice,.__. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation fNe (5) or mom feet in depth into whini person is required to descend, will be made in connection with work authorized by this peril 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: Date 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 Safely 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 for 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 Califomia 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 Califomia 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 Of "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely 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 Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and slate 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. 1 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignature of Le Ownegs) Dale -0 la Authpniee Applicant Data PROJECT ADDRESS: 1 1 1 DANBURY LN OWNER'SNAME: ESTRADA, ROSALIND ANNE ADDRESS: 111 DANBURY LN COSTA MESA,CA 92626 ARCH/ENGINEER: ADDRESS: REG.NO.: UNIT: UNIT: PERMITTEE: STOUT ROOFING INC (310)923-6775 ADDRESS: P O BOX 4309 DOWNEY CA 90241 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pmlessroos Code. and my license is in full force and direct. CITY ui 5 9 7G7' ESTATE LIC.: 4 0 2 5 y)As� 39 EX 10/95 Date: WON S, MPEN TION DECLARATION: I hereby affirm Cha have a certificate of consent to sell -insure or a denificale of Workers' Compensation I u(pnAe2o{,a,peJfilied copy thereof (Section 3801. Lab. 65/19/95 l. 5 / 1 9 / 9 5 POLICY Na.: tltl LL bb 77 `JJ EXP . DATE: U COMPANY: AIG ��-yy El Certified copy is hereby furnished. LJ` Certified Co led witithnthe city Building Division. Date: 1 gali^_ Applicant'. T a' , I EXEMPTION FROM WORK RS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: 11, after making this declaration, you should become subject to the Workers Compensation provisions of the Labor Code. you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tending agency for the performance of the work for which this permit is issued (Section 3097, Cry. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: 1 hereby affirm that I am exempt from the Contractors' State License Law for the lollowing reason (Section 7031.5 Business and Professional Code: Any city of 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 helshe is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property or my can loyees with wages as their sole compensation, volt do the work, and the Elstructure is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/hersell of through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building of improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). L as owner of the property, am exclusivelyy contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' Stale License Law does not apply to an owner of properly who builds or improves thereon and who cent acts for such projects with a CantrdCtor(5) license pursuant to the Contractors' State License Law). I am aware that proof of (heir Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any luture building occupant will/will not (circle one) need to Comply with said state codes and the requirements for a permit for construction or mode icatron from the Air Duality Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned Property �lot J Inspectiongurpos . AA 0� Dale: Signature Driver's License or Social Security x: 1641-46 While—Building: Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT BUILDING PERM NO: B 06960 PERMIT NO: B 069607 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION T/O RESTH 6 REROOF W/COPM 6 HOT MOP SQ FT: 2,508 CLAIM VALUE: 2,508,00 CALL—VALUE: 2,508,00 GROUP OCC: R—i / COMMENTS: REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE, REgUIRED M M M M M M M MifM M M MM M MMMM MM M M MMM M M M M M M M M M M MM M M M MM MMM MMMMM M MMMM M MMMM MM M M M MM MMMM M A M MM M Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 41916335 ZNE: REF NO: PLANNING N TES> > M MM MMMMMMMMMM MM MM M M M M MMMMM M M M M M M M M M M MM M MMMM MM MM MM MMMM M M M M MMM M MM M M M M M MM M MMMMMMM M D E V E.L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: /' DATE: d� i!i(-if iF iE iE if if lE iE ik iF if if lF i4 i41f if if if if i iF if if iE iE ik ih if if i! ilil M MMMM MM M M M M M MM M M MM M MM M M M M MMM M l M ChM M M MM M M M M OltMM MM MM MM MMM M M M M MM M M M M M M MM M MM M M M MMM M LEGALIZATION:N E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES; GRADING PERMIT 54,00 ,50e' SMIP/NON-AES PLAN ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 54,50 0,00 0.00 54,50 54,50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 54,50 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 54,00 ,50 MM M M M M M M MM M M M M M MMMMM M M M M M M MieMMMMM MMMMMMM M MM MM MM M M MMM M M M MM MMMM M M M M M M M M M M MM M M M M M M I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 2,508,00 END OF FEES 01 69170662-00170663 TOT DATE: ,0/23/?4 TIME: 13:23 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd., 53. Steel Reinforcement 3. -Electrical Conduit Uilllty-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. B. Foundation - 59. Gas Pipe, ❑ Undrgrnd„ Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ' Ii . Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64, Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric -Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68, APPROVED FOR PLASTERING 18. Rough Electricah7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19, Hough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS - Permit # 20.:Rough Factory Fireplace - 21. -Ducts, in StrAturq ,. ,. - 70. Underground Hydro 22. Ducts, Ventilating'. 71. Product -Piping 0 Gas 000 23.1. & Test - - 72. Underground FIUsh 72. 24. ,Roof Framing - 73. 'Undergrnd. Storage Tank 0 Gas El Oil 25. Roof Sheathing &/d ••74. Overhead Hydro 26. T-Baf Ceiling (Structural) & R4onocoat - •t - 75.1Ory Chemical 27. Frame and Flashing _ 76. Dry Standpipe 28. Lathing & Siding 1 77. FIXED SYSTEM FINAL '29. Insulatidn r 78. FIRE PREY. FINAL 30, Drywall -Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown,Coat .� ., 79. FINAL ItiSPECTION 32. Electrical Power Meter,Final • r r - 80. FOOD CERTIFICATE ISSUED 33. :Final Eli"ctric -. ' - Notes: - 34. Final Heating .& Air Conditioning_' 35. Final Gas Pipe -Test 36. Hood or Canopy t 37. Final Factory Fireplace '38. Final Plumbing r, I ' 39. Water Service-Finai' I I - 40. Gas Service -Final'. - - 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation _ 44. Landscape Irrigation System 45. Sound Attenuation- - - 46. Handicap Regulatiogs - - - - 47. FINAL STRUCTURE & BUILDING -7 IM // �cua/ 48. FINAL PLANNING' - 49. Electric Release to Edison -- 50. Gas Release to Southern California, Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date DATE 6-1-64 JOB AP No. LOT 17 RACT 5160 FIRE ZONE DESCRIPTION OF WORK res w/att ga INSPECTIONS Signature DATE GROUP MJ TYPE V ZONE Soil Gas — SUBCONTRACTOR PERMITS ISSUED NUMBER DATE Water Rough Com. Re ig. Air Cond. 0 Rough Heating v Rough Plumbing Miscellaneous Prop. Swr. Line ❑ House Con. TSL Swr. ❑ -C 9 i963 40 Sprinkling System 1 Construction Pole Underground ❑ Power d•_] / Rough Wiring z -G qr Trenches p Forms ❑ Steel Reinf. ❑ kif (p Floor System Bond Beam ❑ Steel Reinforce ❑ Sheathing Frame and Flashing Sprn Lathing — In ut 1p/ ' y) Plaster, brown coat-- Refrig. q Air Con, p Final Heating, Final Plumbin Fixtures, Final Final Gas Test. S Electric Fixtures, Final G _ Building, Final OCCUPANCY ' 22178 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA. CALIFORNIA I t1WNFR San Vista Building Co. CITY Los Angeles 11, Cal TEL 37187 ARCHITECTS LevanaS TEL OR 37010 OR ENGINEER Raymond NO. ADDRESS 3432 Via Oporto, Newport Beach CONTRACTOR Rmn Viqt-a I! ADDRESS 1166 . 58th Street CITY Los Angeles LIC.TNO. 192782 No AD 37187 SIZE OOFLOT 20 X 70 NO.WONLOT USEOF EXISTING BLDG. None SETBACK LINE FROM CENTER OF 6TREET 1 REAR YARD BIDE YARDI LEFT O I RIGHT O DESCRIPTION OF WORK NFW I X II At TPRATInM I I AO1111IN FEE RECEIVED NAY 1 9 ION FINANCE DEPT. APPLICM0WFC00tTAMWSA BUILDING For Office Use Only Recel � Y D 7S VKO L��//��IIIN DATRIESUED � lal BUILDING ADDRESS BYP O FIRE- ZONE �x:TJ 4 ` TYPE -�{.-. GROUP c APPROVED BY DATE ZONING r DATE Pune USe F ne aul 11104 a LEGAL _ .. �.. ..NO. lyl-3�3-� 'E: NO EAV E OVERHANG SHALL BE LESS THAN TO BIDE 3 REAR P. L. EB .OWED (U. B. C. REQUIREMENT YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING BUILDING, NO. OF / 3 U SIZE a l ROOM9 STORIES 2 VAR. C.U.P. COVERINGEXTERIOR JtUCCO I ROOOF ING Shin le ACCESS. SLOGS. BYP O USE OF BUILDING AND WORK TO BE PERFORMED APPROVED Residence 6-6er-asys-E 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THA HE ABOVE IB CORRECT AND AGREE TO COM. PLY WITH ALLI IT ORDINANC88 AND STATS LAWS REGULATING BUILDING CONSTRU ION. 6) BET THE AMOUNT SHOW PURPOSE OF EGTA VALUATION BET. MAINS F ACCESS. SLOGS. Z W DATE APPROVED DATE W / a U3l{i Q. 1 VALUATION ISFOR i A PERMIT EE�OxnNLY./LY_. FO V: C d1T FEE $ j U. R y'/ J CHECK S G 0 C 7 LL FEE