HomeMy WebLinkAbout643 DARRELL ST - Building Permits0
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT �
Job Address: 643 DARRELL ST
Suite:
Vicinity: FAMILY ROOM
Parcel Number: 42215311
npp�icant: PENA, RUBEN
Address:
Zaning:
Phane� '714-835-1519 �
ISSUED BY:
... ., . � , , Zip: � 1 ' .
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Owner. MORALES; SANTIAGO � ,
Address 643�DARRELL'ST,� , , -� - - �;',`�
% � � � Phone: ��
�COSTA�MESA, CA , _ Zip: 82627 - ' �� �� -� �
�� ��'�
Contrector: OWNER-BUILDER ' ,�Y�s��q��
Address: ' " .. . � ' � �
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_ . .. Phane:
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- , , ' Zip:'. . License::-000000 `� � `?� � •�A •�: �
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� � �Arch : . ; � ; . ' ` , ' En9: . �, , . , , � .
� Address: � - ' �-Address: � , . � � �
, . . . - .. Phone: � - - . _ � _ . Phone: ,
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� Zip: � , � License: � - � � �• License: � . . '
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� SCOPE OF PERMIT � � � �
; CONSTRUCT 481 SF FAMILY ADDI710N AT THE REAR OF AN EXISTING SINGLE-STORY SFD \CHANGE EXISTING BDRM TO AN OFFICE AND
� ADD A SKYLIGHT (ICBO #3933). NO ADDITIONAL�PL'UMBING FIXTURES: . � � � � . � �� ;
� � .._. ._ .. ._/. _ :` _ .�. . . � . 1� � ,
.'..,PLANNING � "' . . . _ � _ � _ , . � ,
�
- : LOT SIZE�= 6,100 SQ.FT. r �'� � � �' i , �
�.�RESIDENCE & GARAGE = 2,093 SQ FT -- � � � — — � � � �ri ' � I
% � ' %
� �DRIVEWAY=4,17SQ:FT. '-'` � � /.—�., _. - '!� - :='i l�,•� - _ 1 �
' LOT COVERAGE'.= 2,510 S�.PT. (41%) �. .. - � .' � � ,J��;'� - _ . -i. - � . ' -
OPEN SPACE = 3.590 SQ.FT. (59°/ ) . _ -- � �-: � • '. �
, . � �� i,� � �.'l, ��
, r.S .
Status: ISSUED
Applied: 02/24/2004
Issued: 10/28/2004
�`�� �, V � FEE SUMMARY''_ - ! );1/l r�= -� ,� ;
Plan Ch'eck�: '�� '�$385.94 - _ . Calc Valuation'.�1.' ' -; , ,Saa,aaa.ao
`� �Pe�mit: �� $593.75 _.",:=`^:���, - � �"�-; - Claim'�Valuation� �� -�, i� �, ' So.00
SMIP�Res: $4 44 �. �" , • ��; /� �"��
SMIP�Gom: . $000��. � : ���� - ,'��
�Otlier: $0 00 � � � � ' � > �% � - . �.� ,,��
��_ ,. /
� c '
Inspection �, �,$0:00-� � � - � ` �, -� � l!� , s %�
<,� - . � �. � �i; �. �,�. f�
�`\ !�'j �,> `�....'�� '\ .. - ��i �\: i � �
Total• ��$984:13. . , ' -_ ,�. �;' "�� ��`�;
' ' ' ' PLANNING & ZONING � .
SETBACKS � __ � �,- ' �, �' �' ,_ = ,
_ ,5 �
` � ' . l .. ./ i ' . � � `
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia�statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or it work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such woik must comply with all applicable codes, and all
required inspectione and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545826
2446-CB(8/00)
WORKERS'COMPENSAnON DECLARATON: . � � �'
I hereby eflirtn untler penalry of Derjury one of the lollowing tleclarations: � � �� �� � �
❑ 1 have end will mainWin a certificate of consent to self-Insure tor workers' compen'setlon,'es Orovided tor 6y section 3700 of Ihe Labor Code, tor Ihe pertortnance ol the
work for which this pertnil is issuetl. .
❑ I have anG vrill maintain workers' compensallon insurance, as requiretl by section 3700 of Ihe Labor Cade, tor the pertortnance of Ihe work for which this pertnit is issued.
My workers' wmpensation Insurance carner antl policy number are: .
Cerrier: Policy Num�er:
�is s� tion need not be complefed i/ the permit is valuetl al one hundred dollars ($100) or less.)
I cartity that in ihe peAormanc 1 ork for which Ihis ermit is issued, I shall not employ any person in any manner so as to become su6ject to tha workeB'
compensation laws of Califor �, end ag�e iha ' hould become subject b the workars' compensation provisions of Section 3700 of tha Labor Code, I shall forthwith
comply with these pravisio . �A/C
Applicant Signeture: �
WARNING: FAILURE TO SECURE
TFKKISAND DOLLARE (5100,OW),
�� oe,a: n /! — z � —�'y
UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVI� FINES UP TO ONE HUNDRED
ON, DAMAGES AS PROVIDED FOR IN SEGTION 3]O6 OF THE LABOR WDE, IMEREST, AND ATTORNEV'S FEES.
LICENSEDCONTRACTOR$ DECLARATON:
I hereby affirm thai I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Cotle, and my license is in full
force end ettect. Lic. # Clau k
Contreciofs Signature: � Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aflirm fhat Ihere is a construction lending agency for the pertormance of ihe work tor which this pertnit is issuetl. (Sec. 3097, Civil Cotle).
Lender s Neme: Lentler's Address:
Signature: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby eftirm ihat under penalry of perjury thet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Protesslons
Code: Any ciry or�county which�.requires e permit to consiruct, alter, improve, tlemolish, or repair any swcWre, pnor to its issuance, elso requires the applicant tor such pertnit
to file a signed statemeni{hSUtie or she i9�licensetl pursuant to the provisions of the Comrectors License Law (Chapter 9(commencing with Section 7000) ot Division 3 oi the
Business and Pmfeasions'Code)�or ihet fie or'sha is exempt therefrom antl Ihe basis for the elleged exemption. Any violation of Section 7037.5 by any applicant tor a pertnit
sub�ec�s ihe appliwnt to a civil penalty o( not rtio�e than five huntlred dollars (5500).):
� I', as owner ohihe property, or my employees with wages as Iheir sola compensa�ion, WILL DO THE WORK, and Ihe sWcture is noI intended or otteretl for sale (Sec.
7044, Business and Professions Ccde:tThe Contractors License Lew does not apply to an owner of pmperry who builds or improves ihereon, antl who tloes such work
himseli or herself or through his or her own employees, provitled Ihat such improvemems are not iniended or oNeretl for sale. If, however, the building or improvement Is
sold within on year of completion, ihe owner-builder will have �he burtlen of proving Ihat he or she did not 6uiltl or improve for purpose of sale.). '
❑ I, as owner � he pr LUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consWct ihe project (Sec. 7044, Business antl Professions
Code: The ors License Lew es not apply �o an owner oi property who builds or improves thereon, antl who contracts for such project with a comractor(s)
license p ant to the Comractors ' ense Laws.).
❑ I am e t und r .� Business antl Professions Code for ihis reason:
signaNr : oate: Z d' — P y
Owner I ' . �Yes ❑ No Driver's License No.�' � Expires: D// �i-a
Veniicati i Ownership by (rypa oi document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N:
❑ I hereby certity Ihat no exwvation five (5) or more feat in tlepth into which a person is required to tlascenq will be made in connection wiih work authonzetl by this
permit, and Ihat no building siructure, scaHolding, falsework, or demolition or dismantling ihereot, will ba more ihan thirry-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, TWe 8, Calitornia Atlminislrelive Code).
❑ As owner-builder, I will not employ enyona to tlo work which would require e permit from the Division oi Industnal Sefety, as notetl ebove, unless such person has e
permit �o tlo such work from ihe tlivision.
SignaWre: Date:
Division of Indusinal Setery Permit Number:
CERTIFlCATE OF COMPLIANCE AUiHORVA710N OF EMAY: I certify under penalty of perjury that I have read this application antl state that ihe information given is
correcL I agree to compty wlth all ate I ances rela�ing to building wnstmction, end authonze representa�ives ot ihe Ciry of Costa Mesa to enter upon the
ebove-descnbed properry for insp � n purposes. I agree no 0 occupy or allow occupancy of any building authorized by this permit until final inspection.
COOE t, �Nsvecnoxrrve
1618 Fixed System inal Fire Preventlon
1268 Pool Spa Final
200 Final Re-Roof
201 Final Black/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition �
Data
�d " 2 P"cf'
Date '
CQpE� INSPEC710NTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention,
� 220 Final Planning Approval
222 Final Site �
�. 250 Final Building/Occupency � • �
DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
Street Address: �° �� 3 � aq �/t � L L
Bldg. Permit #
This Permit #
AP Number:
1. I(we), 5 s} .✓ T/ A G d /r/ �/ZAL ,E �l , declare that I am the Owner of Title of the above
referenced real property, and that I(we) hereby authorize:
� e. �(� p��� L'� / G N��' T phone Number. '/�/ �� 3 i�� / S� g
treet Address: 7 O Qy �, � Cc / D E p/ ?kl L rj % '
��Y� CLA N<A A- /'� 41 S� : l/1 Zi�: `%01- 7!%
to obtain permits in my behalf, as ownedbuilder, for��(JGl�yw l%( � ��it�s-ac�0
at the above referenced property. 30 ���
S� ` �O�{ - D / / �O
2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa, as required by State of California laws.
3. As ownedbuilder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any olher parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this day of
�
0�]9-66 (rev.t t/00)
Print
Date�—o`� S`– Q �
20_,at
Note: This authorization does not g2nt authorization to perfortn the work as owner,
it soley provides for limited power of attomey to secure �is pertni[ in any behalf.
, Califomia.
May 19, 2005
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
DEVELOPMENTSERVICES DEPARTMENT
BUILDING DIVISION
NOTICE OF PERMlT EXPIRATION
Santiago & Lidia Morales
643 Darrell St.
Costa Mesa. CA 92627-2403
PERMIT NUMBERS:
FOR:
PROJECT ADDRESS:
804-00417, E04-01140
Addition
643 Darrell St., Costa Mesa
Our records indicate the above listed permits were obtained for property improvements or
alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4
Expiration, permits are valid for 180 days from the date of such permit, or the date of your
last inspection for the project and additional fees may be required to finalize expired permits.
According to our records, the permits listed above have not had an inspection for a period
exceeding 'I80 days. If you have a signed inspection card indicating an inspection was
conducted within 180 days from the date of this ietter, please contact this office so we may
correct our recards.
If you need to request an inspection please call our Inspection Request Line at
714-754-5626. I you wish to request an extension, requests must be made in writing
addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances
and listing an estimated date of completion. If you do not have an approved final inspection,
your permits will expire on June 3, 2005.
If you have any questions, please contact the Building Division at 714-754-5273, between
8:00 a.m. and 4:30 p.m., and a staff member wili be happy to assist you. The accuracy of
records affecting your property is our goal and we appreciate your working with us to resolve
this matter.
Sincerely,
�, .�.�1.�,����21" -
Mary Jane Weidenkeller
Office Specialist II
Building Division (71<) 754-5273 • Code Enbrcemenl (714) 754-5623 • Planning Division (714) 754-5245
FAX (714) 754-0856 • TDD Q14) 754-5244 • www.ci.cos�a-mesa.ca.us
(714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
643 DARRELL ST
FAMILY ROOM
42215311
Applicant: PENA, RUBEN
Address:
�.
Owner: ,MORALES, SANTIAGO.
Address �: 643 DARRELL ST ,
/ �. � . � , _ , -
. - , COSTA MESA, CA� ��
�
Phone: 714-835-1579
ZIP
Phone:
Zip: 92627
Status: ISSUED
Applied: 10/28/2004
Issued: 10/28/2004
ISSUED BY:
i �
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Contracror: � OWNER-BUILDER �`����� � %�,�' '•ti,��,
' . -,Address:_ . ,�i� . _ .' . �� :� t _ . ,,
. , " . , , , . � Phone: � ' . � . , . ' ,\...
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'_ . ' . . - i: ZiP: ' . , • -
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, � " � �Cicense: 000000 � ' ' ����� '
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v.
SCOPE OF PERMIT ` � � �
CONSTRUCT 481,SF FAMILYADDITION AT THE REAR OF AN EXISTING SINGLE-STORY SFD. CHANGE '
� EXISTING BDRMTO AN OFFICErAND�ADD A SKYGGHT NO ADDITIONA6 PLUMBING FIXTURES. �; i� :
. 15 LIGHT FIXTURES,-0S�OOTLETS}15�SWITCHES� -�= ' �-�' �r -- � � � �-� ' � ' ,
-,�`REF:604-00417 . . _ .. � . _ - . . . - . -. . " , '
.'r -- - �'.'�. "
_ �,� - --
- = -- - — -FEE�SUMMARY . - ' � �- . � f -. r
• ' ,�' !' � � , . ,,
. " ' � Quantity � � �' • - � _ �"/ i � � , Quantity !.r.- ' � `,� '
ISSUE F,EE � . $23.50 Temp Dist System / Lighting . $0.00 0,;- ;' ` / �: v' ��s� 1
Teqip service test � � $0.00 Busway /100 ft_ ,-' $0.00 Oi .' � ,� ,. � �, (
Re's. �a/c package, � � � $0.00 Standing Seclion � $0.00 �0�� � ! � � � ' `1 ��
New Res�(1-2�units) � ' `� . $0.00 0 .,, r���Misc Electrical Equipment $0.00 i�0�! (' �, / J �'��
New Res�(3+units), �� ��'�� ,$0.00 0 .,:v-=-a';, Sransformers u to 1 kva/kw $0.00 %�60�
P "'� (� ;�i,'j
.r; �. �� �' ....0
Pool / Spa �� �����$0.00 0 - � "� � � . �� p'to.70 kva/kw $0.00 �;�0 � �,, , �
. . ,. ,- - ...........
Lighting Fixts � , '$16.50 15 =-,�% �- � � - .. .:......up to SO.kva/kw _ $O.00,�i 0 � � , ;�, /
� .
.
ReceptOutlets.�, - � $16;50: . -=15.;<�;, ' � ;' � .............upto100�kva/kW'�', --$0,00' 0� �.-� /
Switches � � �' \ j$16:50 � �� 5 - = - .� � - �..:...... `....over 100 kva/kw . $0.00 0 � � � %
Non Res Appl���� -� �� � 50.00 '�. ; 0� Low Voltage Equipment _�� $0.00=/- 0� %'�
Res Appl �� <,�' $0.00 , �-0� ;- - . Low Volt Wving System / Ckt �' $0.04 � � 0 � �� i
Service to 200a ���"� � $0�00� . � 0�" � ` � Misc: Conduit ,-: $0,00� � �0� , �! �
Service to 7000a � � � . �$0.00 � 0 ` ��-. - Misa ConiJuctor�� � ,� � � $0.00 , � 0�-' �'
Service over 1000a � �, � $0.00 � . ��0 ��� - Circus (�gen or�ride) , � , $0.00 , 0 �,
Mators to thp �: $0.00 '-,: .. . � .0- '�' ` �. , Circus (mech dde or lights) � , $0.00', ,. 0
Motors to tOhp '�$0.00 �„ ' - 0 • -. _�_/ � : . Christmas Tiee Stand � � $0.00� ,' 0
Motors to 50hp $0.00 °-. � , . 0 � � � , Fireworks Stantl - •,- i$0.00 0
Motors to 100hp $0.00�-'� � 0�__ � ��-' � \ Olhe�.ElectricafFee �. '"- r/� �-$0.00
Motors over 100hp $0.00 "-0" ' ` , - - , � i: � '; --�' �
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, 1241-92)
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 penod of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be consldered legal, such work must comply with all applicable codes, and all
required inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (774) 7545626
zs+e-ae feroo)
WORKERS'COMPENSAnON DECLARAnON: � � � ry . � . � �
I hereby eflirtn under penalry ot perjury one of the following tledarationsi , _ ,
❑ 1 have entl will maintain a cenificate of consent to setl-Insure for workers' compensation, as provided for by section 3700 ot the Lebor Code, for the pertormance ot ihe
work lor which this permit is iuued. . . '-
❑ I have and will meintain workere' compensation insurance, as required by section 3700 of the Labor Code, for t�e pertortnance ot tha work for which Ihis Oartnit is issued.
My workers' compensatlon Insurance cerrler end policy number are:
Carrier:
(This secfion nee0 nof be u
I certity that In ihe per
�compensatlon laws oi
comply with t�ese pro
Applicant Signetura:
WARNINGFAILURETOS CUi
TFIOUSAND DOLLARE ($1 .Od
LICENSED
the permit is valued af one hundred dollars ($100) or /ess.)
ADDITIIXJTO
DECLARATION:
Policy Number:
I shall not employ any person in any manner so as to become sublect to ihe workers'
to the workers' compensatlon provisions of Section 3700 oi the Labor Code, I shall torihwith
Dete: �� '. _ Z'd� — �' �
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FWES UP TO ONE HUNDRED
1TION, OAMAGES AS PqOVIDED FOR IN SECTION 3]O60F THE LABOR CADE, INTEREST, ANO ATTORNEY'S FEES.
I hereby attirm Ihat I am Ilcensetl under provlsions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, end my license is in full
fome antl eflect. Lic. # Cless a
Cantractors SignaNre:
Dete:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aflirm that Ihere is a construction lending agency for Ihe pertormance of ihe work tor which this permit is issued. (Sec. 3097, Civil Code).
Landefs Name: Lenders Adtlress:
Signawre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aflirtn thai under penalry of perjury thai I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business end Pmtessions
Cotle: Any ciry or counry which requires a Dermit to consirucL alter, improve, demolish, or repair any structure, pnor to its issuance, elso requires the applicant tor such pertnit
to tile a signetl statement that he or she Is IlcenSeC pursuant to Ihe provisions ot the Contractore License Law (Chapter 9(commencing with Sectlon 7000) of Division 3 ot the
Business and Professions Cotle) or that he or she is a:empt therefrom and Ihe basis for the allagetl exemption. Any violation of Section 7031.5 Dy any epD�iwnt for a permit
subjects the epplicai ft� a c� I pena,lry of not more than five huntlretl tlollars ($500).):
❑ I, as owner oLthspfbperly or�my employees�with wages as Iheir sole compensation, WILL DO 7ME WORK, and the sWCWre is no1 intendetl or ottered tor sele (Sec.
7044, Business'anAProfessionsCode�Ttie�Contractors License Law does not apply to an owner of pmperry who builds or improves thereon, end who does such work
himself or herselt or Ihrough fiis oi�hei own�employees, provitletl iha� such impmvements are not intended or ottereC br sale. If, howaver, the building or improvement is
sold within ona.year ot wmpletion, the owner-builder will have ihe burden of proving ihat he or she did not builtl or improve for purpose of sale.). '
'+�c_.
❑ I, as owner ot the property; em,EXCLUSIVELY CONTRACTING WITH LICENSED CONTFACTORS to construcl Ihe project (Sec. 7044, Business and Professions
Cotle: The coniractors Licanse Lew tloes nbt eppry to an ownar of property who builds or improves ihereon, and who contrects tor such project with a conirector(s)
license p rsuam t rs Licensa Lews.).
i
❑ I am e nd se Business and Professions Code for Ihis reason:
Signature: Date: fl / O� 1_ da_? �/
i
Owner I e� d b s license. �Ves ❑ No Dnver's License No. Ezpires: �/+i $—O .�
Verific i of O rship b ot tlocument, I.e. - properry taz bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity that no excavation five (5) or more feet in depih into which a person is required to descenQ will ba made in connection with work authorized by this
permit, and ihat no building sVucture, scaMolaing, falsework, or demolition or dismantling t�eraoi, will 6e more Ihan thitly-six (36) taet high. (Chep. 32, Grp 2, Ar12, Sec.
341, Ttle B, Calitornia Adminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Industrial Setety, es natetl ehove, unless such parson hes e
permit ta do such work irom ihe division.
Signature: Date:
Division of Industnal Safety Permit Number:
CERTFlCATE OF COMPLIANCE AND AUTHORIZJITON OF ENTHY: I certily under penalry oi perjury Ihat I have read this application and state ihe� ihe iniormation given is
correct. I agree to comply witlygll state laws end ciry ordinances relating to builtling consWction, and authonze representatives of lhe Ciry of Costa Mesa to enter upon the
above-described property for jf�pectio�es.1@gree not to occupy or allow occupancy oi any building authonzed by this pertnit until finel inspection.
CODE I, g5p�,� . PdIE INi1TIAL5
1616 Fixed Sy em Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
207 Final Block/Retaining Wall
202 Final Factory Fire Place �
203 Final Sign
204 Final Demolilion - � �
COOE� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval �
222 Final Site �
250 � ' � Final Building/Occupency
Date
/A, Z���S(
°Date � �
PAIF 1�4$
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D e s� S ne�---
CITY OF COSTA
Project Address �
1 �R.^nlicant's Mailing
: t_<:°,
{ �_,„,,. --'s Name _
License No.
MIT
Applicant to filt in a1l spaces except those within heavy Oortler lines ana sig�ll appropriale Eeelarations.
�ERMIT N0. ` O TRACT NO. LOT NO. - UNIT NO. P .
Address
Convactor'� Nama 'C�.A�t-Co_�+� n�,��o �����1� y
Address (ma I'nnl �' �r, .3Lrn �a �" �F��-�.�i
City License No. �v 9� �
LICENSED CONTRACTOR DECLARATION
I hereby affirm thdt I am Ilcensetl untl � prOvi ons ot Charter 9( ommencing
WIIh 52CI100 i00�) Of �IVISIOfI 3 O} IE 8U5 CS dfld I}Q55�0 Cotle, antl
my ficense is in fuil /o e an ct. � �
License lass Li se
Oate ^ Si9nature
WORKERS'COMPENSATION DECLARATION '
I bereby atfirm tM1at 1 have a certificate of consent to self-insure or a certiticate
p of Workers' Compensation Insurance, r a cer ifietl w y thereof (Se ion
\ ` '900, Lab. C.y� ���
lcy No. .�+ Co any
Certifietl copy i5 her¢by fumishetl.
\ D�Cert�-[�c hpy isrtijptl wAPPhcantY B in9 D visi . .
.L d'�I
EXEMPTION FPOM WORKERS' COMPENSATION DECLARATION
(Thissection need no[ be completetl ii the permit is tor one huntlr¢tl ($300) or
less).
I tertify tha[ in the performance of th¢ work tor which this p¢rm�t i5 i55uetl, I
sha11 not employ any person in any manner so as to become subject to tne
Workers' Compensa[ion Laws of Galifornia.
Date Signature �
NOTICE: If, after mdking this tletlaration, you sM1oultl become subject to the
Worker5' Comp¢n5ation provision5 O( the Labo� Gotle, you must (or[hwith
campty' with such provisions or this permit snall be tleemetl revoketl.
CONST0.UCTION LENOING AGENCV
I hereby afiirm that there is a construction Iendin9 a9ency for the per(ormance
ot the work ior which this permit is issuetl (Section 3097 Civ. CJ
Lentler's Name
Lentler's Atlaress
OWNER BUILDER DECLHRATION
I hereby aifirm that I am exempt (rom fne Contractor's License Law tor the
following reason (Section ]031.5 BuSiness antl Protessional Cotle: Any city or �
munty which �equires a permit to const�uct, dlter, imp�ove, Cemolish or repai�
any structu�e, prlor to its issuance, also �equires the applicant tor such pe�mit
to file a signetl Statement that M1e/sM1e IS licensetl pu�suant to th¢ provision5 of
the Contractor'S License l.aw (Chapter 9(commencing with Section 7000) ot
Division 3 of the Business antl Professionz Cotle)'or that he/she is exempt
therefrom antl the basis for the allegetl exemption. Any violation of Section
]031.5 by any applicant for a permit subject5 the appli<ant to a civil
nalty of not more than (ive huntlretl tlollars (E500).
� I, as owner of [he p�operty or my employee5 with wages as lheir Sole
impensation, will tlo the work, antl the structure is not intentletl or ofteretl
for saie (Section 7044, Business antl Protessional Cotle: The Contractor's
License law Ooes no[ apply to an owner ot a p�operty who builtls or improv¢s
thereon, antl who tloes such work himself/hersel� or throu9h his or her own
employees, provitletl [M1at such improvements ure not intentletl or oReretl tor
sale. If, however, the builtling or improvement is soltl within one year of com-
pletion, the owner will have the burtlen ot provin9'he/she tlitl not bulltl or im-
prove far the ourpose ot sale). ,
❑ I, az owne� of the property, am excluslvely cont�acting with IlcenSetl con-
� tractorsto construct the project (Section 7044, Business antl Professions Cotle:
- Tne Contractor's License Law does not apply to an owner of properry who
.-builtls or imorovez thereon. ana who contracts for such oroiects witn a com
� tractor(s) license pursu5nc to me ConVacior•s License Law). 1 am aware that
proof of tneir Worker's Compensation insurance snoultl be provitletl to me.
❑ I am exempt under Sestion B. & P. C. tor this reason
n
Date
.I hereby cer i t
intormation i on
antl state law I:
5¢Ofdiiv¢5 Of �5
inspection p p
Signature
Drivers' LicenSe or
6865-66,rev. 5/BB
ntl
TVPE OF CONS7RUCTION y�i�.MEW LJ ADD U ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OT R
DESCRIPTIOrv� OF Wqr� K/USE OF BLDG. �l'�P'' �d �S"w
�DmA �S/L�A�< L.'lc.s'S ' '
TVPEO PERMIT GRADING ❑FOUNDATION%-�STRUCTURAL
-- �TENANT ❑ ELECTRIGAL ❑ PLVMBING ❑ MECHANICAL '
❑ OTHER
PROJECT DESCHIPTION 5c1. FT. occuPANCv/�
CONSTRUCTION TVPE _� VAIUATION $ ��/ lQ+• '
20NE GRADINGCU.VDS. ACRES
Remarkz: _ _ _ 'Y4✓.. _ � _. _ __ . _ "_ _ _ /I
Sink
Preventer
Irrigation
king Fountains
�r Drains
rt Sinks
Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
$75
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating .
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIL iC80 #
Heating System & Ducting
❑0.100,000 BTU O 100,000 BT
Heinspection Fee � $15
White - Builtling; Canary - Applicani; Pink - Accounting; Goltlenrotl - Assessor
_ /Z t 0
Shower5
Service Sink
Sewer Cap
Sewer COnnection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater �
Water Service
Auro-Wash
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.100,OOOBTU ❑100,0008T
System Repair/Alteration
Fire Dampers
Registers
laue Fee
A. . #
S Main Building:
E
T Front
ARear
C Right
K . Left
S
Ping. Ref. #
Plannin9 Notes:
FEES Automatic Washer
Cons[ruction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Outl¢t5 '
Switches
Garbage Disposal
Generetor 00.5 KW C
�
2ona .
Accessory Building:
Parking ReqJProvided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up ro 100 amps
Meter ❑over100amps
15KW
N
i
N
G
R
E
�
M
T
S.
FEES
Sub Panel
Motors �41 HP �1;% - 8
Inc.Solar 09-15 HP 016-15+ '
Microwave � f '
Pole Light ' �
Range .
Sign
Standing Sections
Trash Compactor
$15 � � Issue Fee
$ 3 DEVELOPMENLSERVICESREQUIREMENTS:
�2oning Approved By
FEES ' Buildine APP�oved By
I
Appliotion Issued ey
SUMMARY OF'�
BUILDINGPERMIT $ �,�. aV
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL - $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
$ 3
SMIP $ �. J_�
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING $
MICROFILM $
TOTAL FEE $ 33 �3_a
01 C0039555-00{138668 :��Y 'n.5��
OaTE. 07l25/,°,9 ili7�° IC��'
(`�� \ \\\ . . .. . .. . _ . . .
CO Uf�ION AND PLANNWG ' POOL & .
APPR A�S Permit # Date ' Inspectoi pppROVALS Permit #
1. Temporary Electrical Service or Po;e 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. '�� � 53. Steel Reinforcement
��
i�
� �Electrical Conduii Utility-Undrgrdd•. ' � ,^; 54. Forms
�i;. ,
�,4��Electrical Conduit-Und�grnd. ' ' 55. Electrical Bonding -
5. Steel ReinforcemenP� ' ' '� �' - 56. Rough Plumbing & Pressure Test
-�
:"6.'i Elect}ical UFER Grnd':� � 57. APPROVAL TO COVER�GUNITE
4� � y', � �
7�, Footings ' - � �, 58. Electrical Conduit-Undrgrnd.
8iTFou dation � _,, _ �� � 59. Gas Pipe, O Undrgrnd., Test
9.•Watei Pipe-Undrg�nd. - ,� 60. Backwash Lines, P-Trap, O Undrgrnd.
10.•Sfiuctural Flooc'System �_.-- . .-fi 61. APPROVALTO DECK
�11'�Property Sewer Line & House Co�nection - � 62. Backwash & Receptor-Final
12. Sewer Cap �. �- ��- ra. �� ' 63. Heater & Vent-Final �
13. Roof Drains ' '.S„ � ' 64. Plumbing System - Final
14. Rough.P.lumbing `' � }� 65. Electrical-Final
15: Rough ElectAical-Conduit� 66. Solar System-Final
��
�1�6. Rough Electcic Wiring �" 67. Fencing & Access Approval
r
�17�. Rough W�irig Sign � „� 68. APPROVED fOR PLASTERING
18. Rough Electrical-T Bar Ceili�g � 69. POOL/SPA SYSTEMS FINAL
'�9. Rough .Fleating & Air Conditio�ing FIRE DEPT. REQUIREMENT
20. RougFi Factory Fireplace �. f APPROVALS Permit #
21. Ducts, in Structure jA � 70. Underground Hydro
22..Ducts, Ventilating _ j„� 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test ^ tj� 72. Underground Flush
24. Roof Framing � "��� 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing �., "� 74. Overhead Hydro
26. T-Bar Ceiling (Structurall &',Monocoat 75. Dry Chemical
27. Frame and Flashing u_ n 76. Dry Standpipe
28. Lathing&tiSiding , 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
39. Water Service-Final �
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation .
44. Landscape Irrigation System
45. Sound Atienuaiion
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING �Z�y
48. Special Requirements Completed
�
49. Electric Release to Edison
4�. Gas Release to Southern California Gas Co
\ \ERTIFICATE Of OCCUPANCY
Date
c�
,v
f
�
�
Date � Inspector �
. •. �
�m
. ..__- � ���
Property address
Owner
Contractor
r`:
RI..�F COVERING CERTI�ATION y'�.� �
GO
A, Permit No. ��3g4 � �
Pi ( v ✓ .
State Contractor License N mber ''�I �� �� �� Classification � r v,�
•_ I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the 1979 Unifocm Building Code, as
amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer. ,
❑ I further certify that 1 am the owner of the property. (Owner-Builder permittee only). �
� I further certify that I am:
� Owner of sole proprietorship company , , .. ,
❑ Full partner of the company
� �❑ Limited partner of the company
� Officer of the corporation '
_ . . _.. ... .._.. _ . . �
' I certify that as an authorized office�'or agent of the company or corporation, I am empowered to
make this certification, which shall be binding'on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the
Building Division for acceptance.
Received by Building Division by:
��� �/���
nlHal afe
" � � Company or Corporate Name
- - - r�2.C� / ,� �1 �'a,-� �•��
.�
=�9
- i� �-...�,. � �-- - � � t
Si9natu� ' � , �� " Date' �� ' -
�,w�� /C /il. �
� Crintetl or Typetl Name
Space 1or NotaNal $�aiamen[ for authariaaE officer or agont
r. . .. . ' . , ,
d
CMF0990-06 WnItB-BUIltlingOiv.;Cdnary-ContrdCtOv;Pink-Owner
�
owtvEx Santa Ana Ranchos �A'I'E 9-30-58
IOB ADDRESS iil�� W_ Tlarrwl l S+.raat. B[lILDING PERMIT NO. 76�1
GENERAL
AP. No. LOT Yl TRACT
I & J �rvPF V
INSPECTIONS
Pinal Gas Test
�. T'� ove VAL[IE $ 15�327•00
FIRE ZONE DESCRIPTION OF WORKSll]gle RBS. Atb. G3T'.
DATE
��
SUBCONTRACTOR I DATE
NUMBER
1� o � � �EE q�ECEfVED
COSTA MESA BUILDING DEPARTNIENT Mf�I�/�1��{��{'���
P. O. BO% 31'! �,j�}���( {/���
COSTA MESA. CALIFORNIA' �Mq� /�R N1QTA tl[Y
�a�! CJ !!WI �f/�
FOR APPLICANT TO FILL IN APPLIGATION FOR PERMIT
BUILDING BUILDING
A�DRE55
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
' RECEIPT NO. i�i@/1{�Jp�
OWNER
� llll
. vcr.civFn rav nnTr R[rciv[o nnTr icciirn
MAIL
ADDRE55 � E
CITY COSYa
ARCHITECT CF
OR ENGINEER
AODRE55
\
CONTRACTOft
LEGAL
DESCRIPTION
A.P. NO.
TEI.
NO.�•
LIC.
NO.
CRY LIC.
r� NO.
A TEL
NO.OF BLOGS.
NOW ON LOT
usE oF
EXISTING BLDG.
SET9F<H LINE FROM
cervrea or sraecr 54� REAR YARD ���
RIGHT rj� LEFT p�
DESGRIPTION OF WORK
NEW X ALTERATION I AOD�TION
REPAiR
BUILDING
SIZE
E%TERIOR WALL
COVERING
USE OF NEW'
NO. OF
ROOMS 7 STORIES
ROOF
COVERING CniRf).
FIRE
ZONE
BY
.3a
COSTA MESA. CALIFORNIA
DATE
CORRECTIONS
with attached garage.
Plan 120B
1 MEREBY nCKNOWLEDGE TMAT I XAVE REF� THIS 4PPL1<nTlOrv nND
$TATE THAT THE FBOVE I$ CORRECT PNO RGREE TO COMPLY WITH ALL
CITV OFDINANCES RND $TAT WS REGV�PTING BUIL[IING CONSTRUC-
T�o�. vnwnnoN
SIGNATURE'OF C
PERMITTEE
}y�'Y T_ $ 15,327.00
AUTHORREOAGENT yyaa � COZP�gIOYB� 111C•
PERMIT FEE S
PLAN CHECK S
TOTAL FEE S
VM{
owxER MqTSCHENBACh'EI2, bAUTb DATE 9-30-59
JOB ADDRESS 6)i3 W. DarrPll St. BUILDING PERMIT NQ lOh)i9
GENEAAL CONTRACTOR
INSPECTIONS
House
Form 21
Oc�mer—fildr.
' 11 TRACT
I DATE
GROUP J
SUBCONTRACTOR
Block
' � � �=EE RE�E�VED
�.� � . :����� ��- 3 � _ � �, � �
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P.O. BOX 31� COSTA MESA. CALIFORNIA CITY OF COSTA MESA
fOR AAAUCANT TO F/LL /N COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT , BUILDING .
BUILDING //� � /�F�
ADDRE55 V/ p t 1/ �/
COSTA MESA, CALIFORNIA FOq OFFICG USE OiILJ
OWNER
� � �;d �rs�h �= yb�� � _ . � FECEIMNO. ������o.
MAIL S /� RECEIVE� BY (�DATE RECEIVED�j DpTE JISSUEO
ADDRESS t7 �:. C � � l . /i�'"''� / .� Y%il ���/ � / iJ-�
ArI��/`OJl_ TEL. BUILDING
CITY (V� CJ f'T NO. ADDRE55
ARCHITECT ��c. COSTA MESA; CALIFORNIA�
OR ENGWEER � : I+ NO. 1
AODRESS ZONE TYPE /J� GROUP N
. C/� 1 STATE BYPROVE � �/h� DATE �- �`
CONTRACTOR �J Y LIG.NO. -�
ADDRESS ^w� � /ZONING
LEGAL I LOT '� I I y� y I ZONE� / I NO. OF /J I OSE OF NEW
�ESCRIPTION NO. Y� BLOCK TRACT P�/NS �t'-� euaoirvc
A.P. NO. �/C-� /`-"- BYPROVED y J/� D TE -� �
r/ U'
SIZE � No.oF e��cs. ypRDS EVES
OF LOT � I Now oH �or REOUIRED ' ALLOWED '
LISE OF � ICENTER LINE STJ ,n /
EXISTING BLOG. FRONT V FT. T IN.
SETBACK LINE FROM /� j�� O%Y
CENTER OF STREET REAR YARO q, SIOE v Fi�. N.
SIDE YARD ILEFT IRIGHT L.SIDE FT. IN.
� DESCRtPTION OF WORK .
b REAR �- FT. IN.
NEW I II ALTERATION I II ADDITION I� 1
REPAIR I II MOVING I II DEMOLISH I
BUILOING NO.OF '
SIZE ROOMS STORIES
EXTERIOR WALL I ROOF
COVERING COVERING
USE OF BUILP�MG AND'/JORK TO BE QkRFO�MED {}�; _
I HEFEBY ACKNOWLEDGE THAT 1 HAVE FEAD THIS APPLICATION '
ANO STATE THPT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN VNOER VALUATION IS FOR THE
PLV WITH ALL QTY ORDINANCES AND STATE LAWS REGULATING PURP09E OF ESTqBLISHING A PERMIT FEE' ONLV.
euaoirvc corvsTnucnorv VALUATION i
���L�,� ' J ��V
SIGNATUF2E 0���� ���� l� PERMIT FEE $ �{ .
PERMITTEE ��'` ;iv
G
$ � � PLAN GHEGK � �
AUTHORIZED AGENT ' �� .�� � dY�
TOTAL FEE $