HomeMy WebLinkAbout368 15TH ST - Building Permits(714) 754-5273 • Fax (714) 7544856 • www.ci.costa-mesa.ca.us 77 FAIR UHIVE, Wb I A MtSA, UA VZSZb
BUILDING PERMIT
Job Address: 366E 15TH ST
Suite:
Vicinity: REAR PROP LINE
Parcel Number: 42531105 Zoning:
Applicant: STUBBLEFIELD, DEAN
Address:
Phone: 949-759.0874
Zip:
Owner:
STUBBLEFIELD, DEAN L
FEE SUMMARY
Address
1215 SAND KEY
$31.14
" -
Phone:
$47.90
CORONA DEL MAR, CA
Zip: 92625
Contractor:
OWNER -BUILDER
Address:
SMIP Com:
$0.00
Phone:
Arch :
Address:
Zip: License: 000000
Phone:
Eng:
Address:
Status: ISSUED
Applied: 01/20/2004
Issued: 01/20/2004
ISSUED BY:
Phone:
Zip: - License: License:
SCOPE OF PERMIT
CONSTRUCT 6 FOOT HIGH BLOCK WALL 61 LINEAL FEET ALONG REAR PROPERTY LINE PER CITY STANDARDS.
NOTES:
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 became 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
FEE SUMMARY
Plan Check:
$31.14
Calc Valuation: $1,220.00
Permit:
$47.90
Claim Valuation: $0.00
SMIP Res:
$0.50
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$79.54
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. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and became 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 mijintain 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 thApermit is issued.
❑ 1 have and will =it" workers' compensation Insurarxe, as required by section 3700 of the Labor Code, for the Performance of the work for which this pemaf is Issued.
My workers' competion Insurance carder and policy number are:
Carrier: Policy Number:
(This section need nor be Completed 11 the pemur is valued atone hundred dollars (5100) or fess.)
' Z 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 11 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: /Q -c . ✓f. � /. __,-r Date: k, zO "Ot-%
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE 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 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. Uc. 0 Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby attire that there Is a construction landing agency for the performance of the work for which this permit Is Issued. (Sec. 3097, Civil Code).
Lenders Name: 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).):
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.).
❑ I am exempt under sec. Business and Professions Code for this reason:
'Signature: AQ-C�e.a. .r . .../7.%--G.,./ /<
\ 7 Expires:
Verification of Ownership by (type of docu/meent, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation two (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, lalsework, or demolition or dismantling thereof, will be more than thlrty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 6, 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: Data:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 WIII the applicant or present or future building occupant need to file and conity a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Sectlon 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costs Masa Fire Department by every
business which has at any one time during a re nod 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 excep(Ions, 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 eppplicent or present or Future building occupant need to prepare en RMPP em
(Risk Managent and Prevention Program for acutely hazardous rrlatedals)7
❑ Yes ❑ Jo
9Sectlon 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
apartment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
...................._................... ..... ___...................__..._.........................................__...................._.._....................__..................................................... .................................................. ........................_._................_................._...
4 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
................_......................__.................._.........................._............_..._.......... ___._................__.......................... ............................................................ ............................................... _.........._....._..................._.
5 Daes ar will the applicant or present or future buiid-mg occupant requlre for the work which Is the subject of this R12plication egemit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? UYss U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
..................................................................._.__................................................_..............._..___.....................__.................................................................................... ........ ___...... _.............alit_...._._ ..
e Will any pert of the facility to be constructed under This permit be within 1000 feet from the outer boundaries of a school? ❑ Ves ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
............._.............. it fro........._._—_—_.._.alit__a .._.___—..__...distr......__..._....ncy is
7 If a emit from the South Coast Air Quality Management District or other et pollution control district or agency is required for the work which is the subject of this
applicetlan, have all of the disclosures prescnbetl by California Health and Safety Code Section 42303 been made? ❑Vas ❑ No
.........alit..........—_._._..__..._.........................___...�___-._
B (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 Mese to enter upon the
above-described property tot Inspection pErposes. I agreerpot to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sigliature Of Legal0/nor(s) Date
And/Or Authorized Applicant Date
CODE a. INSPECTION TYPE gt jE INTITIALit CODE# INSPECTION TYPE gA¢, INTITIA�
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Rs -Roof 210 Final Electrical
201 Final Slock/Retaining Wall Z 212 Final Fire Preventlon
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Bullding/Occupancy
PROJECT ADDRESS: 368 E 15TH ST UNIT` C
OWNER'S NAME: I . C . D . A .
y ADDRESS: 1 2 1 5 SAND KEY
CORONA DEL MAR
CA 92625
ARCH/ENGINEER: 759-9194 REC.NO.:
ADDRESS: UNIT:
PERMITTEE: DEAN STUBBLEFI
ELD (714)759-9194
ADDRESS: 368 E 15THT
COSTA MESA CA 92627
LICENSED CONTRACTOR DECLARATION: I hereby affirm I am licensed under provisions of Chapter 9 (Commencing with Section
7DOO) of Division 3 of the Business and Professions Code. and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a Certificate of consent to self -insure or a certificate of Workers'
Compensation Insurance, or a certified copy thereat (Section 3890. Lab, C).
POLICY NO.: EXP. DATE:
COMPANY:
❑ Cerplied copy is hereby furnished. ❑ Certified Copy is filed with the city Building Division.
.ale: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (Tho section need riot be completed it the penrot is for Lane hundred (5700) or leas).
I Comfy 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.
Date: Signature:
NOTICE: It. alter making this declaration, you should become subject to the Workers Compensation provisions of the Labor
Code. you must forthwith comply win such provisions or This permit sham be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a Construction lending agency ler the performance of the work tot
which this permit is issued (Section 3097, Cry. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any pity 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 lite a signed statement that he/she is licensed
pursuant to the provisions of the ContractorsState License Law (Chapter 9 (Commencing with Section 7000) of Division 3 01 the Business
and Professions Code) or that he/she i5 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 live hundred dollars (5500).
1, as owner of the property or my empployees with wages as their Sole Compensation, will do the work, and the
❑ structure is not intended or offered for sale (Mucan 7044, Business and Professional Cade: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himselflhersell or through
his or her own employees, provided that such improvements are not intended or ollered for sale. If, however the building or
improvement is sold within one Year of completion. IM owner MR have the burden of proving he/she did not build or improve
ter the purpose Of Sale).
I, as owner of the property, am exclusively contracting w In licensed contractors to construct the project (Section 7044, Business
C1 and Professions Code: The Contractors' State LiCense Law does not apply to an comer of property who builds or improves thereon
and who contracts for such projects with a contactor(s) license pursuant to the Contractors' Stale License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
am exempt under Section: BP704 4 B. A P. C.
orthis
treason:
All, WORK BY OWNER
Date: =T— Omer: .CIL.+.dfl�
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 269;5, 25533, and!
25534 and that I or any future building occupant wilOwill not (circle one) need to Comply with said state codes and the requirements for a
permit for construction or modification from the AirAir Dually Management District. Residential Construction applications are exempt from
'these provisions.
Dale: Applicant:
I hereby certify that I have read INS application and state that the above information is correct. I agree to comply with all city and county
ordinances and stale laws relating to building Construction and hereby autt0% reo esentatives of this City to enter upon the above mentioned
property tar inspection purposes.
, -It
Lua'` -
DateSignature: .
� -P
_
Drivers License or Social Security:
'.-Aa Pink—RwenueGoldenmin—Assessor
�l
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: G 05124
PERMIT NO: G 051240 PLAN CHECK NO: 00548-91 S GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE MEC PLU STR PURPOSE: ALT
JOB DESCRIPTION ADD 4TH BEDROOM 6 REMOVE HOOD W/EXHAUST_ SQ FT: 5,000
CLAIM VALUE: 5,000.00 CALC—VALUE: 5,000.00 GROUP OCC: R-3 /
COMMENTS: LEGALIZATION SUBJECT TO FIELD INSPECTION
+��+r**x*TEir*EE*iE�E�E r. +rlr+E**x ��r�E�xTExx+E+Ex+rlr�r�*�+E��***x•x)ESE*xx•x**�r��r�Tr+r*��TrEEx �Exr��Er*x•+E�aE*
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: 42531105 ZNE: R2 REF NO:
PLANNING NOTES> INTERIOR ALTERATION TO LEGALIZE THE CONVERSION OF A REC/
> EXCERCISE ROOM TO A 4TH BEDROOM,
kMkk�t+tit*>E*xiE*x•iE*a!�E*it*xi�x�t �iE iP iE it iP*�rx•�t*tt �t it Lt �t+P*:t+E*�xx xir*r. �E iEr*+P �E�if+tf�*�E *+t iP x•x•i��F'�E �E tP x�tit �E
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: _U /4Z&
BUILDING APPROVED BY ;_--�5 ' DATE: ��fv
APPLICATION ISSUED BY: DATE:
k MMkkkk#kMkkkkkkkkkMkk kkkk#kkMkk xk
k ikkMkkkkkkMMkkkMkkkkkMMkkkkkkkkMkMkMkkkMkREMM Mk MkkkkkMMkMk#kMkkkMkkkMkMkMkkk
LEGALIZATION:Y F E E S U M M A Y' STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 144,00 8,00 22,00 31,00 .50
25% 50% 25% SMIP/NON—RES
PLAN ISSUE FEE 93,60 3,00 15,00 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 205,50 33,00 46,80 285.30 285,30 .00
REVENUE DIVISION TOTALS--> COLLECTED; 238.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK.
144,00 11,00 37,00 46.00 .50
kkkkkMkkkkkkkkkkkkkkkkkMMMkkkkkk kikk kMkkkMkMkkkkkMkkkkkkkkkkkkMkikkkkkkMkMkkkkkxk
I ND I V I D U A L F E E B R E A K D O W N
TYPE QTY D- ND S C R I P T I O N UNIT COST TOTAL COST
SFR 5000 ALTER BY VALUE RESIDENTIAL NOZONE 1,00 5,000,00
MEC 1 INST/RELOC RECESSED WALL HEATER 9,00 9,00
MEC 1 INST HOOD W/DUCTS FED BY MEC EXHAUST 6,50 6,50
PLU 1 SINK BAR 2,00 -00
PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2.00 2.00
ELE 1 MISC CONDUCTOR NOT LISTED REQ PERMIT 11,00 11.00
END OF FEES
r
Oi COCE1E7i—QCC818i5 707 ,,^ -
DATE: 03/04/91 TSir: 12:56 __.
WNSTRUCTION AND PLANNING
APPROVALS Permit # Date
Inspector
POOL A
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
,
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
--
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
' 5. Steel Reinforcement;
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnt1.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final ,
13. Roof Drains
64. Plumbing System - Final -,
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
'
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL '
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS' Permit #
20. 'Rough Factory Fireplace
21. Ducts, in -Structure
70. Underground Hydro
22. Ducts, Ventilating
_
71. Product Piping 0Gas 00il
23. Gas Pipe -Rough &Test
-
72. Underground Flush
24. Roof Framing -
- _
-
._73. Undergrnd. Storage Tank OGas 00il
25. Roof Sheathing
-
74, Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
1
=
75. Dry Chemical
27. Frame and Flashing 1
_
76. Dry Standpipe
28. Lathing & Siding - -
S
77. FIXED SYSTEM FINAL
29. Insulation. - "'
78. FIRE PREY. FINAL
30. Drywall Nailing -
/'- 1;
HEALTH DEPT: REQUIREMENT
.31. Plaster Brown Coat_•
�.�.,,
�� '
79. FINAL INSPECTION ,
32. Electrical Power Meier -Final .
/.:r:
80. FOOD CERTIFICATE ISSUED
33. Final Electric
° '' ,
.
•�) q- /'•'.'
'Notes:
•34. Final Heating& Air -Conditioning:
i-
35. Final Gas Pipe -Test
' -
•- •' '
36. Hood or Canopy
37. •Final -Factory Fireplace
38., Final Plumbing
39. Water Service -Final -
l
;!
'-• - -
40. Gas Service -Final r
/i -
,41. Solar Domestic -Final
42. Backflow Preventer.'
43. Backflow Irrigation
r
44. Landscape Irrigation System -
-
- -
45.�Sound Attenuation -
46. Handicap, Regulations
47. FINAL STRUCTURE & BUILDING
4
'.
48. FINAL PLANNING.
49. Electric Release to Edison
.r
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 368 E 1 5TH ST
OWNER'S NAME: I , C , D . A ,
ly 'ADDRESS: 1215 SAND KEY
COR NA DEL MAR
759-9194
ARCH/ENGINEER:
ADDRESS:
REG.NO.:
UNIT: A
UNIT:
PERMITTEE: DEAN STUBBLEFIELD (714)759-9194
ADDRESS: 368 E 15TH ST
COSTA MESA CA 92627
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 Professions Code. and my license is in full force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure at a certificate of Workers'
Compensation Insurance. or a certified Copy thereat (Section 3800. Lab. C).
POLICY NO.: EXP. DATE:
COMPANY:
❑ Cemlfied copy is hereby lumished. ❑ Cerblied copy is tiled with the City Building Division.
.ate: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (Thissedion need notbecompleted nine permilisforonehund(ed($100)orless).
I family that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become
Subject to the Workers' Compensation Laws of California.
Date: Signature:
NOTICE: II, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor
Code. you must fonnwall comply with such provisions or this permit Shan be deemed revoked.
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 (Section 3097. Civ. Q.
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following 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 he/she is licensed
pursuant to the provisions of the Contractors' State 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 live hundred dollars ($500).
I,as owner of the property or my amDlevees with wages as their sole compensation, will do the work, and the
❑ structure 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 himselflhersell 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 will nave the burden of proving he/she did not build or improve
far the purpose of sale).
I,as owner of the property, am exclusivelyy contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code. The Contractors' Blate License Law does not apply to an owner at eropertwho builds or improves thereon
and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
® I am exempt under Section: 13P 704 4 B. 8 P. C.
for this reason: ALL WORK BY OWNER pq
Dale: �' Owner4
I do hereby certify Ihat I am a are of and understand the requirements of California Heallh and Safely Code Sectio) 25505, 25533, and
25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirementsfor a
permit for construction or modification from the Air Ouality Management District. Residential construction applications are exempt from
these provisions.
Dale: Applicant:
1 hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby aumorNe representatives of this city to enter upon the above-mentioned
properly lot inspection purposes.
Date �� —L —L Signature: /L
Driver's License or Social Security
1641.46 While—Building: Green—Cade Enforcement: Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA BUILDING PERMIT PERM NO: EP 05123
PERMIT NO: EP 051239 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PLU PURPOSE: ALT
JOB DESCRIPTION : LEGALIZE LNDRY & CAP SINK IN CLOSET SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: LEGALIZATION SUBJECT TO FIELD INSPECTION
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Z O N I N G S E T B A C K SR E Q U I R E M E N T 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: 42531105 ZNE: REF NO:
PLANNING NOTES>
>
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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 W� DATE: c:3/y Al
BUILDING APPROVED BY ; DATE: 3I
APPLICATION ISSUED BY: DATE:
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LEGALIZATION:.Y F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 8,00 22,00
253 503 SMIP/NON—RES
PLAN
ISSUE FEE 3,00 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS--.--> _ 30.00 —118,00 _ 0y. 00 48,00 48,00 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 48,00 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
11.00 37,00•
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I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
ELE
PLU 1
PLU 1
MISC CONDUCTOR NOT LISTED REQ PERMIT
LAUNDRY TUB OR WASHER
SINK; KITCHEN
END OF FEES
UNIT COST TOTAL COST
11
.00 1.00
.00 12.00
2.00 2,00
01 00001876-00081877 T rJ T S.G;i
LATE: 03/04/91 TInE: 12:`3
OONSTRUCTION AND PLANNING
POOL A
APPROVALS Permit # Date
Inspector
APPROVALS Permit #
Date
Inspector
-
-1
1. Terpporary Electrical Service or Pole
-
52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
' 5. Steel 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, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK --
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final -
12. Sewer Cap
63. Heater & Vent -Final
r
13. Roof Drains •-
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final r.�
'
15. Rough Electrical -Conduit
66. Solar System -Final
-
16. Rough Electric Wiring
67. Fencing & Access Approval
'
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS",'CPermit #
20. Rough Factory Fireplace
•
21.,Ducts,in- Structure
-.
.70. Underground:Hydro
22. Ducts, Ventilating - -
-
:71. Prod uct.Piping OGas ❑Oil
23. Gas -Pipe -`Rough &' Test
-
72. Underground FlusFi-
24. Roof. Framing
-73. Undergrnd. Storage Tank 0 Gas ❑ Oil'
l
25. Roof. Sheathing
'"
-
"74,- Overhead Hydro -
26. T -Bar Ceiling (Structural) & Monocoat
r
C -
75: Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28.''Lathing& Siding- x77.
FIXED SYSTEM -FINAL"
29. Insulation
78., -FIRE PREY. FINAL ,r
X30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
•.31. Plaster Brown Coat
��
4i �'
FINAL TNSPECTION
-,
,79.
32. Electrical, Povver MeterFinal'
80. FOOD CERTIFICATE ISSUED
33.'Final Electric
.Y" f.
Noyes:
X34..-FinslHeating`&Air Conditioning. '
�f ._`•1
�`
01
•• .' � •.
35. -Final Gas Pipe -Test
-
„36. •Hood or Canopy . _.
37. Final Factory Fireplace
•'�•
'
38. Final Plumbing a '•
. 39. Water Service -Final -
•. ,
.= '
40. Gas Service -Final
41. Solar Domestic -Final - ••
�� +
r
_
42. Backflow Preventer
43. Backflow Irrigation
-
?
n
,-44. Landscape Irrigation System,45.
-Sound Attenuation "
46. Handicap Regulations
_
47.. FINAL STRUCTURE & BUILDING
c
48. FINAL PLANNING
49. Electric Release to Edison
%v•.
,•�
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOF'OCCUPANCY
„
No. Date