HomeMy WebLinkAbout190 15TH ST - Building Permits(714) 754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 190E 15TH ST
Suite:
Vicinity: MAIN OFFICE, MIDDLE BLDG, & BREEZEWAY
Status: ISSUED
Applied: 04/06/2001
Issued: 04/06/2001
Parcel Number: 42534102 Zoning:
Applicant: YOUNG, MIKE _-_ ISSUED BY:
Address: 1015 E CHESTNUT
Phone: (714)953-5444
SANTA ANA, CA Zip: 92701
Owner: PARK,'JACK H
Address 789 PAULARINO AVE
Phone: _ -
' COSTA MESA, CA Zip: 92626
Contractor: YOUNGS ROOFING CO, INC
."Address:, 1015 ECHESTNUT - ��,•,
Phone: (714) 953-5444 -�
SANTA ANA, CA `
Zip: 92701 • •License: 568560
Arch ; _ Eng: -
Address:
Address:%
Phone: - Phone:
Zip: - License: License:
/ SCOPE OF PERMIT
REROOF PORTION OF EXISTING COMMERCIAL BUILDING & BREEZEWAY FOR -"OCEAN BREEZE CHILDREN CENTER". TEAR
OFF EXISTING ROOFING FROM BUILDING & RESHEATH WITH 7/16" OSB. INSTALL 30# FELT U_NDERLAYMENT &
REROOF,WITH 30 YEAR FIBERGLASS SHINGLES. ALSO, REMOVE EXISTING BUILT UP ROOF SYSTEM & INSTALL NEW i
B.U.R. SYSTEM,_- - )'
— FEE SUMMARY ii' % ' 1 I
Plan Check: $0.00 Calc Valuation: $7,35o i
Permit: $153.25 Claim Valuation �� ; ;'rte $7 350.0
SMIPRes, $000
MIP Com: ,
$1.54
V '-Other:
$0.00
tapection.
$0.00
MAIN STRUCTURE Front,'070,,-
,Rears _0-0
\\
Total:•
$154.79
0-0
PARKING Existing: 0
Required::_
o
NOTES:
8
NNINLi & LUNINU
,Left 0-0 'A Right 0-0
Left 0.0- Right� �"0-0
._Proposed:- "-_C"
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 expirationof this permit.
FOR INSPECTIONS CALL: (714) 754-5628
2aas,4e (6=)
SETBACKS \\
MAIN STRUCTURE Front,'070,,-
,Rears _0-0
ACCESSORY Front 0-0
Rear
0-0
PARKING Existing: 0
Required::_
o
NOTES:
8
NNINLi & LUNINU
,Left 0-0 'A Right 0-0
Left 0.0- Right� �"0-0
._Proposed:- "-_C"
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 expirationof this permit.
FOR INSPECTIONS CALL: (714) 754-5628
2aas,4e (6=)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a cenificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
1!m?_
_wthis permit is issued.
—of the Labor Cade, for the performance of the work for which this permit is issued.
�/,ATA % d �,r /1/� -Policy Number:. ! �Y
-(This section need not be completed i7 the permit is valued atone hundred dollars IS 100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws o1laws o1 Cel1p, and gree that it I should become subject to the workers' compensation provisions of Section 300 0l the Labor Code. I shall forthwith
comply with ret �- visio 3�
Applicant SigneluDate3: —T /
WARNING: FAILURE TO SECURE W PENSATICN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIE 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 aRirm that.Lam Ilseps d under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busines antl Pr lessions Code, and my license is in full
force and effect. u-,,.. = S f".0C1asa aJ 3
Contractors S1 I9nan_ure:_�S Date: o
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
1 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.).
❑ 1 em exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Driver's 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 Cade).
❑ 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 cortify, a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled 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
...2..........D....o..e...s....o..cr uwbiilcl..t.feet ....a..op...fp...compressed gas at standard temperature and pressure).
....................... j_.in
.fr.autj...„...r........?......Y..... ............❑. No...........................................
.....
cont opaset or future buidgoccu ant need to file a registration form for acutely materials ❑es
(Section 25533 o1 the California Health and Safety Code, with some exceptons, 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 Ii en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
.............................................................................................. __.___......................................... -............................................. _.................................... ...................... .........................................................................................................................
5 Does ar will the applicant or present or future building occupant require for the work which is the subject of this a plication 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? LJ Yes LJ No
(Section 65650.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
....._..._........... ...................... _... _...................... _......... _............................. ........_._................ ___........... _.._.._........................ ............... ........... _.... .................... ......... .... ..............._.... ...........__...._...............................................
6 Will any part of the facility to be constructed under this permit be within 1000 feel 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 tram 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 Califomia Health and Safety Code Section 42303 been made? [Dyes ❑ No
_..............................._.........................Gl-e-........_.._._..lia.................._.__.........................__....................._..trol........icer)........................__........................................_................................................_....................._................................
8 (If yes", attach cortilicate of compliance from the appropriate air pollution control officor).
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 AUTHORIZATIONL 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 slate laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
And/OrAuthorized-Applicant-- &Date -
CODE P. INSPECTION TYPE 2AH INTRIALS CODES INSPECTION TYPE pAjf. INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
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/Occupency
PROJECT ADDRESS: 190 E 15TH ST
OWNER'S NAME: PARK JACK H
ADDRESS: 789 PAULARINO AVE
COSTA MESA,CA 92626
548-2550
ARCHIENGINEER: REG.NO.:
t ADDRESS:
UNIT:
UNIT:
PERMITTEE: GRAHAM BROS INC. (714)546-1653
ADDRESS: 2952 CENTURY PL
COSTA MESA CA 92 6
LICENSED CONTRACTOR OECUMTION: I hereby at irm t m licensed under provisions I Cha er 9 (commencing with Section
7000( o1 Division 3 of the Business and Professions C . and my a is in lull force an effect.
CITY uc.: 005963 STATE uc.:2 604 SS: C—
Date : 1 ' Sr a re: _
WORKERS' COMPENSATION DECLARATION: I hereby a um t I have a cenificate of consent to sell -insure or a certificate of Workers'
CompensationiTetlyy gf p cRrtjOe62p rdoi,rlron 3800. Lab. C)
POLICY No.: 1blUJVLLGV 1 EKP.DATE: 88/01/93
VNIPANY: LIBERTY MUTUAL
J Certified Copy is hereby furnished. 7X Cenlfi copy 6 life 'In the city Buildi i Sion.
Date: 1 ' �1� AV'
F• Q__
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (IA's section need not be competed i1 the permit isfor one hundred (5700( or hiss).
I certify that in the performance of the work for witch this permit 6 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: If. 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 INS permit shall 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 lot such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' Stale 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 lot the alleged exemption. Any violation of Section 7031.5 by
any applicant lot a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
❑ I. as owner of the property or my emp chees with wages as their sole compensation, will do the work, and the
structure is not intended or altered lot sale I5echon 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 himselfitherselt or through
his or her own employees, provided that such improvements are not intended or offered for sate. It, however the building or
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).
I, as owner of the progeny, am exclusive)y contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' State License Law does omit apply to an owner of property who builds or improves thereon
and be 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. B. 5 P. C.
for this reason:
Dam: 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 future building occupant will/will not (circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air uahty Management District. Residential construction applications are exempt from
these provisions.
Dale: Applicant:
I hereby certify that I have read this application and statea ormation i5 correct. I agree to comply with atl city and county
ordinances and state laws relating to buildingconstrua�ndaulh'0 epresentatvesI thi5 city to enter upon the above-mentioned
property for inspection purposes.Dale: ` ` ✓
164146 While—Buildino; Green—Cade Enforcement; Canary—AnolicanC Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 06054
PERMIT NO: M 060547 PLAN CHECK NO: N GOVT: N SUPP:
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: OTH
JOB DESCRIPTION : INSTALL WALL HEATER SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
Z O N I N G S E T B A C K S R 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 RIGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
42534102
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
BUILDING APPROVED BY
APPLICATION ISSUED BY:
DATE:
DATE:
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LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 9 00
25t SMIP/NON—RES
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS ---- > 9.00 15.00 0.00 24,00 24,00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 24,00 OVER/SHORT;00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
24,00
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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 D E S C R I P T I O N UNIT COST TOTAL COST
NEC 1 INST/RELOC RECESSED WALL HEATER 9.00 9.00
END OF FEES
CONSTRUCTION AND PLANNING
PC & SPA
APPROVALS Permit #
Date
Inspector
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Servg-e or Po lfe _
52. Pool & Equipment Location
2. it Pipe-Uncirrd� 1-'
53. Steel Reinforcement
,'%(l:ete`jeal Conr i`,6}ility-Undrgrn(T
54. Forms
0 41':1:'18ctr4cal Cond13h; rndrgrnd, 1+-•
55. Electrical Bonding
S9el �IainforcemedE
56. Rough Plumbing & Pressure Test
v
,x
-�fiLIZctricalUFEB*6rbd. •L 4-- r.
57. APPROVAL TO COVER-GUNITE
'`•s.". tings }
58. Electrical Conduit-Undrgrnd.
y'
_
•- &foundation n;r
59. Gas Pipe, 0 Undrgrnd., Test
c
ti
9PWater Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, 0 Undrgrnd.
'
u
10. Structural Floor System _
61. APPROVAL TO DECK
11. Property Sewer Lire & House Conn4aion
62. Backwash & Receptor-Final
12. %ver Cap v 0 a.
63. Heater & Vent-Final
13. Roof DrainsT
64. Plumbing System - Final
14. Rough Plumbi; T
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric-yiring
I
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
%PPR21VAVR`-DCPe It71
20?' of h E3ctoey Fireplace S•T. xti
< s
21 �DuFfs, i0Str_VctyU �iS
:7 x .c
770. Undergr'oMci HOro
22, Duds, V,entilatirig
X71. ProducLP$ipg Ms C�Qii
23.'fia ip RCVZ
O &• est 1 _OS
T
r, r r
;
PROJECT ADDRESS: 190 15TH ST
OWNER'S NAME: JACK PARK
ADDRESS: 789 PAULARINO
CM CA 92627
645-5171
ARCH/ENGINEER:
ADDRESS:
UNIT:
r>
REG.NO.:
UNIT:
PERMITTEE: UALITY DESIGN PLUMBING (719)638-2328
ADDRESS: 1601 MAC ST
GARDEN GROVE CA 92641
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 Prole
ssions Code. and my license is in full force and effect.
CITYDate llc. 19 STATE uc.:62636^^� ctAss:—C-3. ��
Date: Signature: —If1'.�
WORKERS' C PE SATION DECLARATION: I hereby affirm that I have a canonicals of consent to self -insure or a cent icate of Workers'
Compensation Insurance. or a candied copy thereof (Section 3800, Lab. C).
POLICY NO.: EXP. DATE:
^DMPANY:
Conrad copy is hereby furnished ❑ Comfort copy is tiled with the city Building Division.
Date: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it / Perrin i5 for one hundred (3100) at less).
I supplythat in the per0 mance of the work for which this permit is issued. I shall opt employ by person i any manner so as to become
subject to the /orker Compensation Laws of California. �
,�77 .p
Date: Signature._ 134114lLy i,41 / y A- Il
NOTICE: f, aIle making this declaration, you should become subject to the Workers' Com ensati n 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 lending agency for the performance of the work for
which this permit is issued (Section 3097. Civ. 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 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 ContractorsState License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business
antl Prolessions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant Ior a permit subjects the applicant to a civil penalty of not more than live hundred dollars (3500).
I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale (pectlon 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 himseff/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 will have the burden of proving he/she did not build of improve
for the purpose of sate).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
Eland Professions Code: The Contractors' State License Law does not apply to an owner at propeny who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' Slate License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason: '
Date: Omer
I do hereby sanity that 1 am aware at and understand the requirements 01 California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant w Alwill not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby cattily that I have read this application and stale that the above information is the above information is cou I. I agree to comply with all city and county
to comply with all city and county
ordinances and state lawsr tingto building construction and hereby aodmr¢erepresentatiset this ci y to enter upon the above-mentioned
properly for inspe me p poses.
Date: Signature:
Driver's Lice se or Social Security a:
164146 White—Building: Green—Code Entorcementk Canary—Applicant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 054942
PERMIT NO: P 054942 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
JOB DESCRIPTION REPLACE KIT SINK 5 MOVE WATER HTR SQ FT.
CLAIM VALUE: 400.00 CALC-VALUE: GROUP OCC: E-3 /
COMMENTS: REPLACE KIT SINK b MOVE WATER HEATER
7. O N I N G S E T B A C K S`R E Q U I R E N, 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 REO• PROV: PARCEL: 00000000 ZNE: REF NO:
PLANNING N TES>
>
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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 DATE:
APPLICATION ISSUED BY: `
LEGALIZATION:N F E E S
BLDG PMT PLUMBING ELECTRI_
PERMIT 4.00
DATE:
"�---� DATE • fir# 0
M M A R Y STRUCTURAL SEGMENT:N
MECHANIC FIRE SMIP/RES GRADING
25% r
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING --DIV->
3.00
PERMIT ISSUE ,BiAN-CHECK
TOTAL PAID
DUE
TOTALS ---- >
4.00 3.00 0.00
7.00 7.00
.00
REVENUE DIVISION TOTALS--> COLLECTED:
7.00 OVER/SHORT:00
BLDG PMT
PLUMBING ELECTRIC f�CHANIC
FIRE SMIP/TOT GRADING
PLAN -CHECK
7.00 e
####K##i:#######K####-%###K#####K#K•#,)t#ii•#-%#ir########K#iF####le#######li##############
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.0
UNIT COST
TOTAL COST
PLU 1
SINK KITCHEN
200
2.00
PLU 1
WATEA HEATER AND/Qty VENT
2. 00
2.00
;!END OF FEES
CONSTRUCTION AND PLANNING
'APPROVALS Permit #' Date
Inspector
PO( 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 Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER drnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
.1. 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
r'2��1
[.CD
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 OOil
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
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: Rj`� �
34. Final Heating & Air Conditioning
M
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 Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
,
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Go
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 190 E 15TH ST
OWNER'S NAME: CEA BREEZE CHILDREN CENTE
ADDRESS: SAME
�CHMNGINEER: REG.NO.:
ADDRESS:
UNIT:
UNIT:
PERMITTEE: BOYER CO (714)642-2431
ADDRESS: 1760 MONROVIA AVE A-20
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.: 449070 STATE tic.: S 6690 cuss: C10
Dale:gnature: ij�--p�~k_&/\.—
WORKERS'COMPENSATION7co: thereby affirm that I.lavea Certificate o1CMa
sent to self -insure or of Wors
rke
cemhed'
Compensation Insurance. ora [eniliro ropy thereof (Section 3800. Lab. CI.
POLICYN0.:1137424-91 EXP. DATE: 04/01/92
YMPANY: STATE
Certified copy is hereby furnished. IN Cc ified Copy is tied with the city Building Division.
,7)
Date: / Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This secmn neeOnot be completed if Ue meant o fa oro hLNWMd 18100) or I.
1 Certify that in the de form nce of the work for which this thereof is issued, I shall not employ any person In any manner So as to become
subject to tqe rk C r*7afon Laws at California.
Date: / I Signature:
NOTICE: if. after making this declaration. you should became subject to the Workers Compensation provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. e
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency lot the performance of the work for
which this permit is issued (Section 3097. Civ. Q. �•1
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 ContractorsState 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 10 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
❑ stucmre is not intended or offered for sale (Section 7044. Business and Professional Code: The Contractors' Slate License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered lot sale. 11, however the building or
improvement 6 sold within one year at completion, the owner will have the burden of proving he/she did not build or improve
lot the purpose of sale),
I. as owner of the property. am exclusively contracting with licensed Contractors to construct the project {Section 7044, Business
❑ and Professions Code: The Contractors State License Law does rot appy to an owner of theme rry who builds or improves Iherecin
and who contracts for such projects with a contractor(s) license pursuant to the Contranors' Btale License Law), I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section: B. 8 P. C.
for Itis reason:
Date: Owner:
Ido hereby Certify that Iam aware of and Understand the requirements of California Health a
25534 and that I or any future building Ottoman wiMivl not (circle one) need to comply with
permit for construction or modification from the Air Grainy Management District. Residential
these provisions.
an
Safety Code Sections 25505, 25533 ,
and
said state codes and the requirements fora
construction applications are exempt from
Date: Applicant:
I hereby certify that I have orae this appbca n and state that the above information is correct. I agree to Comply with all city and county
ordinances and statelaws relating to builth construction and herebb�y authorize representatives Of this City to enter upon the abpve-mentioned
properly for m, ecti n ur osgS, C (j f� n n -�\ /
Date: C� Signature://I
Driver's License or Social Security e:
164146 While—Building: Green—Cade Enforcement; Canary—Applicant; Pink—Revenue; Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05535
PERMIT NO: E 055354 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE; OTH
JOB DESCRIPTION UPGRADE SERVICE, MISC ELECTRICAL WORK SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO STRUCTURAL PERMIT ON FILE
iF IE X 9E9E if #IFdF if ie BE iF BE BE iE if dE 3E 9E * of iE iE iE iE jf if if iE lE iEit iF )F9E iE iE # iE if .y * df iE N iE if iEif iE � -1e.)E * yE iEiE �(• iEjF iF Irif.)E 9F 3Edf of 9e )E iE iE X M fE M 9F ie
Z O N I N G S E T B A C K S R 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 REO• PROV:
PARCEL:
13912236
ZNE:
REF NO:
PLANNING N TES>
TOTAL PAID DUE
TOTALS ---- > 25.75 15.00 0.00
40,75 40.75 .00
REVENUE DIVISION TOTALS--> COLLECTED:
40,75 OVER/SHORT: •00
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING PLAN—CHECK
40.75
N' Be IE if' if iF iE iF IE iE IE iE iE iE iFTF i(" iF 3E")E iI' BE * � iF * 1e 4e iE iE Ie K' ii ie iE M' IF aE 36 9F x-iF iI' IE' iE iE jF IE iE
IF iF iE IE BE iE iE iE BF iE iF
iF jF iE iE jE iF IE')I' it IE' it aF IF i(' iE' } Y'IE'Y'
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:itU5
iE 3E BF BE iE iF iE iEiE iF 9E if le it•if iF iE i(BE 3F iE iE w
•iF 9h 3i 1F*IE if ii -Br iF t it 9e
#.y( 4F lE iF if IF yE iF iE yf 1E 9E BE iF 3i- aF iF ie 9F fE if it at IE aF iE aE * iF iE iF iE Ax iE iE 1E �e k 1E BF ie iE 9f * 9E T6 3e iE iF 3F iE?E 1E 4F aF iF9F 3M1 4E B6 iE iE iiR 4F iE 1E iF % * * iF iF 4F if *- Y -1E
LEGALIZATION:N F E E S U M M
A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 25.75
50%
SMIPIN6N—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK
TOTAL PAID DUE
TOTALS ---- > 25.75 15.00 0.00
40,75 40.75 .00
REVENUE DIVISION TOTALS--> COLLECTED:
40,75 OVER/SHORT: •00
BLDG PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING PLAN—CHECK
40.75
I
Tr:
)f 1F 1F iF iF 9f iE 1E ae iE iE AF ih # iE iF %if iF 9L R * N9E id, 4E ae �lF IE 3E * * BiiE #1F iF 9F iE Ile TE RE iE BE # 36 iE iE if ie iE IE BE �e iF M iE iE ie 3f * k 3FiF at-Sf-IF iF * iE 3F is iF BF if iE iF * Be
I N D I V I D U A F E E
B R E A K D O W N
r,
TYPE QTY D E S C R I P T I O N
UNIT COST TOTAL COST
ELE 5 RECEPT/SWITCH 1 ST 20
EA. 3.75
ELE
2 SUB—PANEL
,75
11,00 22.00
END OF FEES
EXPIRED
Incomplete Inspections
Oate Sig ,V�y�(�y
f � t
CO J^OWIUCTION AND PLANNING
APt•ROVALS Permit #
Date
Inspector
PC S SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
-
52. Pool & Equipment Location
6;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 Grnd,
57. APPROVAL TO COVER-GUNITE
' 7. Footings
58. Electrical Conduit-Undrgrnd.
'
8. Foundation -
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, O Undrgrnd.
10. 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
15. Rough Electrical-Conduit
/
��f/Q
Q
65. Electrical-Final
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. POOUSPA 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 0 Gas O'Oil
23. Gas Pipe-Rough &Test
72. Underground Flush
24. Roof Framing
73. Undergrnd.Storage7ankOGas ❑Oil'
25. Roof Sheathing -
'74, Overhead Hydro,
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
r
27. Frame and Flashing.
76. Dry Standpipe,
28. Lathing & Siding.
77. FIXED SYSTEK RNAL
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
34. Final Heating & Air Conditioning
-
Notes: '" q r�'��,
_ L
r'
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 Domestic-Final
42. Backflow Preventer ..
43. Backflow Irrigation��"•
44. Landscape Irrigation System .: -
E X P I R E D
45. Sound Attenuation
46., Handicap Regulationsoi
If1Conlp @ e.in5txdi0nS
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
'
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
j
51. CERTIFICATE OFOCCUPANCY
No. Date