HomeMy WebLinkAbout1871 PARKCREST DR - Building Permits(714) 754-5273 •Fax (714) 754-4856 www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 1871 PARKCREST DR Status: ISSUED
Suite: Applied: 01/18/2005
Vicinity: ROOF Issued: 01/18/2005
Parcel Number: 42431107 Zoning:
ISSUED BY:
Applicant:
TIM MCCARL —
7 --
Address:
Address:
126 COMMERCIAL WY--
-
;�
Phone:
949-548-5569
-
COSTA MESA, CA , "
Zip.
92627 I.
Owner:
F,RIEDRICHSEN, ELDON A TR
Address
1871 PARKCREST DR
Phone
�.. �.. ,.... % A j- \.,��
COSTA MESA, CAS
Zip:
92627
'
Contractor:
G L R. ENTERPRISES INC/DBA CRANK
BROTHERS ROOFING ._
o",
i
Address`
126 COMMERCIAL WY
,
Phone:
949-548-5569
-
COSTA MESA, CA
Zip:
92627
License:-,
828379.--
-
Arch Eng:
Address: - - �' - ..Address:
` 'Phone: Phone: `
Zip: License: `� License:
Y. SCOPE OF PERMIT:
TEAR OFF EXISTING ROOF. INSTALL CLASS A, ASTM.HOT MOP FOR FLAT, ROOF, 30 YEAR COMPOSITION SHINGLES AND
REPAIR/REPLACE SHEATHING AS NEEDED. 14 SQUARES.
FEE SUMMARY
Plan Check:
Permit:
\SMIP Res:
SMIP Com:,
Other:
Inspection: "
Total:
$0.00 ° Calc Valuation: $3;595.00
$97.25 V Claim Valuation: $3,595.00
$0.50
$0.00
x`$0.00-
$0.00
$97.75
i.
PARKING Existing: 0, Required: '0 Proposed:0 -
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
SETBACKS\
MAIN STRUCTURE. Front
ACCESSORY Front,
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) 7548828
246648 (6100)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit Is issued. I
i lave and will maintain workers' compensation insurance, as required b section 3700 of the Labor Code, for the performance of the work for which this
y pe permit H issued.
M workers' compensation Insurance camr and policynumber are:
�1ii�� 2 — -Z 66 C%
(This section need not be completed /f fhe perml Is valued at ane hundred dollars ($100) or less.) 1
❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws f Ilfppr IS, end gree that if I Quid become subject to the workers' compensation provisions of Section 3700 of the Labor Cade; I shell forthwith
comply with these 45
gnature?"'_ Date: .. 1 1 1 �
FAILURE TO SRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTHE AND CIVIL RNES UPi TO ONE HUNDRED
THOUSAND DOLLAR E (sl ), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I
LICENSED CONTRACTORS DECLARATION:
I herefirm Chet 1 em licensed, der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business antl Professions Code, and my license is in full
fort effect. Llc. N - w Glass N AJ —
Contractoe. * neturo�� " Da
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).
Lender's Name: Lenders 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
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or off ore tl 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: Date:
Owner ID verified by drivers 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, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume o1 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). I
............. _ .. ..........._..................
thppli
2 Does or will e acant or present or future building occupant need to file a registration form For acutely hazardous materials. C] Yes ❑ No I
(Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or:200 cubic feet of
compressed gas at standard temperature and pressure). j
............................................................................................................................................................................................................................................................................................................................................................................................
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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and (filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
................................................................................................................................................................................................................................................................................. ...........................................................................................
4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
................................................................................ ...................................... .................................. .......................... ............................ .................... ................................... .... ... ..... ........ ....... ..................................... ............. .........................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this,.a,.ppplication aomit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 Yes 8 No
(Section 65050.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
..........................................................................................................................-...........................................................................................................................................................................................................................................................
8 WIII any part of the facilityto ba constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
.............................................. ...-.................................................... ................................................................................................................................................................... _.... __ ...... .... ..
7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑ Ves ❑ No
......................................................................................................................................................................................................................................................................................................................................................................
..... ( y P P ...
8 If es", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Ignature egal Owner t
Kut OrieBd1Appllcan_1R,,,_
CODE t. INSPECTION TYPE gl,¢ INTQJ06$ CODE INSPECTION TYPE 2AH INID9L$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1288 Pool Spa Final L-- 206 Final Plumbing
200 Final Re-Roof _� 210 Final Electrical
201 Final BlocklRetalning Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Omupancy
PROJECT ADDRESS: 1871 PARKCREST DR UNIT:
OWNER'S NAME: FRIEDRICHSEN ELDON A
ADDRESS: 1871 PARKCRE§T DR
COSTA MESA,CA 92627
(714)646-8618
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: I.EE ROOFING (714)642-7223
ADDRESS: 1653 SUPERIOR
CM CA 92627
LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70DO) of Diva ion 3 of the Business and Professions Code, and my license is in full force and effect.
CITY LIC.: 028751 STATE UC.: 349686 CLASS: C-39
Date -7— i 3 —474 — Signature: —4:4
WORKERSCOMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers'
Compensation ftpl %cgrtilied Ty thereof (Section 3800, Lab. 66/30/92
POLICY NO.: USF&G CO. / EXP. DATE:
COMPANY:
Certified copy is hereby furnished. 11 Certified coD�lile�he city BpiltlingDin.
Date. 7 ��it-3— 9/ Applicant Q414— visi/
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ill or less).
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become
subject to the Workers` Compensation Laws of California.
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 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 helshe is licensed
pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I, as owner of the property ormy empployees with wages as their sole compensation, will do the work, and the
El 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 himself/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 or improve
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
Eland Professions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractorls) license pursuant to the Contractors' State License Law). I am aware
that proof of their Workers Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Date: Owner:
I do hereby cantly 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 Cal Management District. Residential construction applications are exempt from
these provisions
Date Applicant:
I 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 authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. �eke•
Date: '7_ 2 '?�9�
1641.46 While—Building; Green—Cotle Enforcement: Canary—Appticant; Punk—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM
PERMIT NO: B 053015 PLAN CHECK NO: N X;
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; RE -SHEATH & RE -ROOF W/LIGHT WEIGHT TILE SQ FT:Seg,
CLAIM VALUE: 2,500,00 CALC-VALUE: 2,500,00 GROUP OCC: R-3 /M-1
COMMENTS- SMOKE DETECTOR(S) REQUIRED IN HOME.
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 REQ: PROV: PARCEL: 42431107 ZNE: REF NO:
PLANNING NOTES>
>
###########;##9f•##############################################ia#######.#######x416##
D E -'VL 0 P M E N T S E R V I C E S R E Q U I R E M E'.N�'2 S
ZONING APPROVED BY DATE..:,
BUILDING APPROVED BY DATE: /
APPLICATION -ISSUED BY: 3F14 - DATE: /A3 -i F�•
riF3r iF 'iFifiF £iFiFiEiFiF########## 'r#
IF#!###############K###9E #94#############
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 54,0050
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 54.50 0,00 0,00 54,50 54,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 54,50 OVER/SHORT; ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
54.00 .50
############################################################################34##
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2500 REROOF BY VALUE RESTDENIAL NOZONE 1,00 2,500,00
END OF FEES
61 00092850-06092851 TOT 54.50
DATE: 07/23/91 TIDE: 11:19
CONSTRUCTION AND PLANNING-
POO ..PA
APPROVALS Permit # Date
Inspector
APPROVALS Permit z#
Date
Inspector
r
-1. Temporary Electrical Ser Dice or Pole
r
52. Pool & Equipment Location
,
2. Soil Pipe-Undrgrnd. 0>o"
~
W
53. Steel Reinforcement
GJ
3. Electrical Conduit rtsir
Utility-Ugrnd.
54. Forms
!L-
nI
4. Electrical Conduit-Undrgrnd%- : r'
55.. Electrical Bonding
.5. Steel Reinforcement '"
56. Rough Plumbing & Pressure Test
ElectricalUFERGrnd. -
57. APPROVAL TO COVER-GUNITE
L 7. 'Footings
58. Electrical Conduit-Undrgrnd.
^
Z. Foundation r •^-'`
59. Gas Pipe, 0 Undrgrnd„ Test
_ -
_ 4 -Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
L
.'
10. Structural Floor System - s
61. APPROVAL TO DECK
11. Property Sewer Line & House..Connection
"•
62. Backwash & Receptor -Final
12. Sewer Cap;
_ r
"� -
63. Heater &Vent -Final
d,
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. POO USPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS '•- Permit # '
,
'
20! Rough Factory Fireplace
21: Dulls, in Structure. .. .;
- 70. _Underground Hydro
22. Ducts,.Ventilating-
- -
71. ProduC`tPiping I-1Gas OOiI
23` Gas Pipe -Rough &Test
72. Underground Flush
24. Roof Framing
/
��:
--•
73. Undergrrid.StorageTank'DGas 00il
25. Roof Sheathing
,(v
-
74. Overhead'Hydro_- ..
26. T -Bar Ceiling (Structural) & Monocoat
+
75., Dry Chemical
27: Frame and Flashing
76. Dry Standpipe ` -
28. Lathing & Siding, . - ,
-
77.' FIXED SYSTEMFINAL '
' 29. Insulation78.
FIRE PREY. FINAL �-
' 30. Drywall Nailing--
1�
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat r
.;
79. FINAL INSPECTION - -
32. Electrical Power'Meter-Final
I �•�:
80. FOOD CERTIFICATE ISSUED
- 33'. Final Electric
Notes:
• 34. Final Heating & Air Conditiorgng
r7.
35: Final Gas Pipe -Test
,
36. Hood or Canopy;
37 Firial Factory Fiieplace
•�'
g
'
- 38. Final Plumbing
39. Water $ervice-Final -
i
'
`• - -" - -
. 40. Gas SerNice-Final
41. Solar Domestic-Final-
omestic-FinaF42:
42.'Backflow Preventer
,
43. Backflow Irtigation
'. '
'• -
. 44. Landscape Irrigation System.
-
45:• Sound Attenuation r
' >
- -
46. Handicap Regulations
47. FINAL STRUCTURE&BUILDING
48. FINAL PLANNING
49. EI* ctri Release to Edison
''
1
50. Gas Release to Southern California Gas Co
i
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CFTY•OF COSTA MESA
IP RMI NO.
�E�- GL
TRACT O.
LOT NO.
�/
BL
�'
4322. 21/10/83. --
CONSTRUCTION PERMIT.
11
K;,L' 1
Applicants Mailing ddress;
TYPE OF CONSTRUCTION LJ
NEW X ADD U ALTERATION LJ REPAIR
_
s
❑CONVERSION ❑ DEMOLISH
1:1 THER
Project Address
C /
Owner'sName hoe
DESCRIPTION OF WORK
I GREGULATIONS-
Address' %5 r 7 �.Pi J•
IOF
-
'TYPE PERMITS-/ GRADING FOUNDATION STRUCTURAL
.- y I I
A. P. sW Z /- ZONE
Arch/Eng. - License No.
❑ TENANT t�0 ELECTRICAL
I�-y
IVPLUMBING ❑ MECHANICAL
PLNG. REF.,,*
- BUILDING
Address - -'
❑,IO,THER
' -
.+
TO BUILDING
/
`�gl—, 1
Contractor's Nam - - hone'
PROJECT DESCRIPTION SQ. FT.
OCCUPANC
PROPERTY INE
REAR YARD (TO P/U
Address (mailing) - ' 11
-
'CONST RUCTION TYPE ✓
-
VALUATION Y2.
f fr RIGHT SIDE YARD 5f--O-f
_.
,
I
20Nj: GRADING
CU. YDS. :ACRES
Q.
�- PROVIDED �'
License No.
-
__
LICENSED CONTRACTOR DECLARATION I }
Remarks:
'
�
PARK FEE $ -
Ihereby affirm that I'am iicensetl untler provisions of Charter 9 (commencing
'
LLEFDED
with,section 7000) of Division 3of the Business antl Professions Cotle, antl
_
;
ITIONS:
1 _
my licensors In full force and:effect. I ' -. - •
'
r
License Clan' I License No! I i
I
PLUMBING
Date" ' Signature II
33,R KERS' COMPENSATION DECLARATION
Bar Sink
Sewer Cap
-
ELECTRICAL ,
::?lreby.affirm that 1 have a.certlflute of consent.toself-Insure ora cartifttate..1
- 1 BeckflowPreventer -
-Sewer Connection`-. ('- . -L,
_ Automatic Washer. ....
! - 'Meter_ Dover 1_00 amps;
Workers' Compensation Insurance, of a certified. copy thereof (Section{I
-
_
- -
•
'r
3800, Lab. C.) r ! , 1
Backflow Irrigation 1
;
Soler. Collectors ,
t
- Construction Pole •
Sub Panel
Polity No. - 1 Company "'"
HCertified copy Is hereby furnished. ' ' I r, 1
-.
' Bathtubs
o
-" ' - �, -
Soler Piping 1 r ,
,�
Cooking Unit -'
✓- c
Sub Pole
1
riffled copy Is filed with the city Building Division..,: I 1 . "
_Date _ t '� Appnwnt - - -- '- " - ' ' - - - - • _ `_'_
Clarifiers
-
Solar.T_ an_ k (� +,{
Dishwasher
'
Motors ❑0-1 HP ❑1 XA
EXEMPTION;FROM WORKERS COMPENSATION DECLARATION
'
I Dishwasher 1 { ,
Swimming Pool wlSpa
DryerS-❑Gas,'❑EleCtilc'�'
- 'rl dd.$olar`09-15 HP ❑16-15+
`
(This Saction need -not be completed if the permit is�for one hundred (§100) orl_I
less).. -.th /
-
_
- - •,
Fan' '
,r
Microwave
.err
that ioy-a performance of the work for which this permit is Issued I
I all
,
Clinking Fountains 1
r
Urinal' �," •�
1
no
shall not employ any parson in any mapM1eyso ay�(c� bacpme su[�ecl. to toe'
"• %l `,:,1
-
1 1
- V
r
F.A.U. 1
Pole Light r
g -'
Workers^, Pmp satlz ws of CahfayFly .._ / / I f
���
{ FIUor Drains ,
Water Closet ` r /`)
1
Date /�J�-a-Signature C L�•�L�
NOTICE: Ql after making this declaration, you slioWdbecome-subjecPto the -�
—% Fluor SmksJ - -.
_
-Water Heater.. I -. -.
n
L Fixtures _
9 ,
_ Rana '_ _
_ Q Yo
Workers' Compensation provisions.of the Labor Code, you,.must forthwith
comply ,with) such provislons-or, thist'permit shall- be'deemed� revoked:;
`' Gas Service Outlets'
Witer`Service - I
Device Boxes
_
Sign.
I
CONSTRUCTION' LENDING AGENCY -
p.
S Outlets
Standing :
l
' / )
I
I hereby affirm that there Is wconstruction lending age pcy, for the performance
Interteptdfs ]
•x
_ - _ - 1
�•
Sections
O
of the :Work for which this, permit is -issued -(Section 3097. Civ. C.)
•'
,
_
-
Switches
1
Lender's Name • ``
Kitchen Sink _
r
- l z i
I
p
i I 1
Trash Com actor
P
O
Lender's Adoresz .: I
-
Lavatories "'
_
��
• Garbage Disposal I
I
OWNER BUILDER DECLARATION, f / t
, r
i �ti,
I hereby affirm that I am exempt'from tne.Contractor's. License Law for the
-
Generator, 00.5 KW ❑5-15
KW
following reason-(Section=7031:5 Business and Professional 'Code: Any city or
P—Trap•
_ -• _ +
1
'county which requires a permit to construct, alter Improve, demolish or, repair
``
Transformer 15-50 KW
any structure, prior to Its.issuance,.also requires the appiicanbfor such permit
Roof Drains ~ '
/
'a
tp file a'sione tl statement that he/she Is licensed pursuant to the provisions of
Contractor's License Law, (Chapter 9 (commencing;with Section 7000) of
1 - - ti: ' C
',•
;
-
' ❑50+ KW i
r, I
Reinspection Fee
.
-cdsion l3 -of the Business' and Professions Code) or that he//she-Is exempt r
lefrom-and the basis for the
- ! Showers I I ^I
Reinspection Fee
`,
Meier, O'up 100
'Issue
alleged exemption: Any violakton=of----- -n
1.5 by.'any applicant lona subjects the•applicant to
r
/
' -
to amps
Fee'
'aw
$ 3
t/1
1/ per a civil ,
e ally lot more than five hundred dollars (§500): i -. . , „ 1
Cas owner of the
,
I Service Sink 1 - t I I , Issue Fee ! j ', $ ?'
]gging Approved By
Date
fy6`n
.property
will tla the work, and the structure is not intended or offered
for Sale 7044', Business and, Professional,Code: - The Contractor's
I
MECHANICAL V. . �'-'
gpplitation Approved By
) ate
(Section
License Law does not apply to'an owner of a property who builds or Improves
t.. ,
Boiler. (
Refrigeration System I '-
Refrigeration
'1
�.
Appljution Issued By
1
Data
thereon,'and who !does such work himself/herself or through his or her own
employees, provided that such Improvements arelnot Intended or offered for
Duct - Under;Ground -
,
❑0-100. 00BTU 0100,OODBTU'
%-
. sale. If, however, the building or Improvement is sola within one year.of com-
,
I
i
SUMMARY OF FEES ( '
ptotic n, the owner,wi 11 have the burden of proving he/she did not build or Im-
9 rove for the purpose of sale). 1 ` i ;
Duct - Structural I
-
System Repair/Alteration 't
%_�%
'
•,'BUILDING PERMIT $
I ,
��: 5'O' SMTP I, $ {
sz
O'
I, as owner of the property, am exclusively contracting-withlicensed con-
tractors to construct the.project.(Section 7044,.Business and Professions Code:_
'
Duct- Ventilating _ -_�� _!
__ _ _ _
-
J PLAN CHECK s
I
3� 1 PERMIT
The Contractor's License taw dd oes not apply to an owner of property who
builds or I m proves't hereon, and who contracts for such projects with a con. I
1
Exhaust System 0 Multiple ❑f'PLUMBING
_
t $-
.Q� ISSUANCE $
tractor(s) license pursuant to the Contractor's License Law). v
-
/
GRADING $
0 l.am exempt under Section - B. 6 P. C. for this reason
Firepl/Fact. Bit. ICBO 5@
I I ,
' PLAN CHECK, $
,
I
'.
ELECTRICAL; ' $
•I�O $
Date , ovine
1
Heating System & Ducting
I
PLAN
I_
MICROFILM $ •`
I hereby certify that -a above '
thinly sd
• �
00-100,0000100,0008
- � � -� - �
-
CHECK $O.
r
-
onIs ordinances
county thence,
.formation is correct, 1 agree to comply with all Uty and county
in roe to with all city a
,BTU
v'
'
MECHANICAL $
' TOTAL FEE' $
antl-state laws r Idling to building coheir uction,lantl hereby authorize repro-
and -state viz
,
Hood or Type I ❑' i
I
�'
I I
-
sentatives of s'c 'toer upo the bove-mentioned property .for
Inspection p se
Caro Type ll ❑'
Reinspection Fee'
, I .A-•
$15
f PLAN CHECK $.
I LESS
ADVANCED
,
/,
- Accounting; Goldenrod - Assessor
-�CONSTRUCTION.AND,PLAJ)INING r T 'F114
Date
- : : c : POO."•'PA .
- "•
Date
FAPPROVALS Kermit#-
or
- APPROVALS Permit# * '
-
Inspector
,
•- q1_ Temporary Electrical Service or,Pole
- ,
o= -
'..52: Pool &'Equipment Location'-,
2: Soil Pipe Undrgrnd.- _ ' i91�63�
Steel Reinforcement
- =°
c
•-; 3; Electrical Conduit Utilitv-Undrgrnd � ;"
"_
- - o
'54. Forms
• '4: Electrical Conduit-Undrgrnd'. - e ' '
° _
' " _
•'55.: Electrical Bonding
5: S[eel,Reinforcemenf "' . - S
:; ; ^ • '
f3 =-
56. Rough Plumbin'&'Piessure Test "
c. ,
'
6: 'Electiical'UFER Grnd.; ' - i ,'
„ -.
oz �'
57: APPROVAL TO;COVER-GUNITE.,,
�.
7. Footings' i I i; _
A-(4-813
�i
`58' Electrical-Conduit-UndrarAd:?
(Gas
_
8. Fountlatiori j
x•59. Pipe} ❑.-Undrgrnd., Test=
9. Water Pipe-Undrgrnd. +
/gyp;
!'69. Backwash Lines,,%P-Trap,17 Undrgrnd.
10. Structural Floor System�j%��p '�-'
,3_�g�"
B !ra
61. APPROVAC'TO DECK':'
11. Property Sewer Line & HouseConnection
Backwash&•Receptor-FiCal
12. Sewer Cap !_;;
1
S• "3
--63. Heater &_Yent-Final .
13. Roof'Drains ' I
1
_- • _ 1
-'_64. Plumbing'System • Final
_
14. ,Rough Plumbing t -22313
65. Electrical-Final-
lectrical-FineP15.
15.RougWElectrical=Conduit' ; T" - -'"' -
T--, -r-
- ",- -
--66. Sola'r,System-Final - -- -
--" -
16 Rough Electric Wiring -;.e
-6C-C `'
67: Fencing & Access Approval"
-
':`17. Rough-Wiring�Signr'.
68, APPROVED FOR PLASTERING
'
}
18. ,Rough Elegtrical;T'-Bar, Ceiling ,! ; I •
_ c ' i
' '
69. POOL/SPA SYSTEMS FINAL `
1
. 19t & Air'Conditioning 1 +
{
j
FIRE DEPT.•REQUIREMENT.
ARough,Heating
t ,
APPROVALS Permit# _
-
20., Rough -Factory Fireplace,•j j� (
'
! -
!�1. l.Ducts, in Structure
I
I
70 ' Underground Hydro
,
;,'22. Ducts, Ventilating ". c j j! {
71.! Product Piping O Gas 0 Oil
, ,..
.23.'Gas Pipe -Rough & Test I j
r
72. Underground Flush'
X24., Roof Framing,`; �..
I .'
N n: 1 r^
ro
73. Uudergrnd. Storage TanOO�Gas O Oil
,
i
Roof Sheathing
174.E Overhead Hydro
_25.
1.26. IT -Bar Ceiling (Structural),& Monticoat� !
' { LL� '
�' i �,
75., Dry Chemical - - -
27:1 Frame and Flashing'
76.1 Dry Standpipe ..
!
28:•,Lathing &'Siding, . ; 1 ;I 1 1
-IH -$j
g �%✓�I
77. FIXED SYSTEM FINAL
29_!Insulation78.
FIRE PREV. FINAL
130. Drywall Nailing >�" ! ';
I i
B�'✓r
Notes: "
,
_
31.'Plaster Brown Coat• } • ; 1 ,� _i.
32. Electrical Power Meter -Final
1
33. Final Electric_ f ,f 1
�S,Ss3.
_ L°.�
-s,`.3 3:
34. Final Heating &,Air Conditioning '
;t.,r
35. Final Gas Pipe -Test
36. Hood or'Canopy- .• 1 , , �; i ;,
! _ l
• -�
' .. - = - , , - i
37. Final Factory Fireplace
38. Final Plumbing;
39. Water!Service-Fin6l:'1;
40. Gas Service -Final .^ :�; i it i
I !
•
I ' ' i 1
'�I
!
, i
41. Solar bbmestic-Final '.'• I ''
I
1
•'' ' 1 .+-• " ,
42. Backflow P,reventei r i f >;n,;
_� _j -
I
-- _ _ *- I " 'r ,, '•
43. Backflow Irrigation,
44. Landscape • Grigation�System l��,� -
;fir,
'
i - -
45. Sound, •Attenuation -1,
I_
46. Handicap Regulations' ! "
' ;--
'
i - • -�
47. FINAL STRI,ICT�VRE,&BUILDING,
48. Special Reg4UWBr�ents Completed F
' , • ,
I t
49. Electric Release toi Edison
50. Gas Release•to,Southern California Gas Cb
1
, , r' �'
-
t •�!
51. CERTIFICATE', OF OCCUPANCY '_
_i_' _ -
._
t.. _ _ J ; ;•
No ;I I ' Date
i-
-
-
�ts'p ��c, -
DEC-2-7oPCBSAA—S°00 182* ***133.50
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
a 63 For Applicant to Fill in Completely
REC IVED V O, TE9 ECEIV D DATE ISSVEDI
BUILDING
_9
(� 7CJ
ADDRESS /
PERMIT NO.
OWNER �/
A.P. r7 rll-'a (!
BUILDING p� —v
MAIL
ADDRESS O
Z
LulADDRESS
a L)
CITY TEL
_ ��
TRACT LOT BLOCK
ZQ
CONSTRUCTION
W A A
O N
LENDER
am
J �
BRANCH
J N
OWNER
Q W
m J
ADDRESS
'w VALUE �
J Q
ARCHITECTEL6
USE $�C �.
V
OR ENGINEE/✓�S NM
Q
FIRE �{I-
w m
ADDRESS Y j% Q y
20NE TYPE GROUP�'r
o- W
APPROVED
W Z
CONTRACTOR T Qom/
BY DATE
JO
_
to Z/
J m
ADDRESS
W W
TEL
ZON NO.OF USE OF NE
�=
I PLANS BUILDING
CITY NO
_ZF
W O
STATE CITY
YARDS APPROVED YARDS A ROVED
In Ir
LIC. NO. LIC. NO.
MAIN BUILDING ACCESSORY BUILDING
7 Q
(FROM C/ T ET)
SIZE NO.OF BLDGS.
OF LOT Q X NOW ON LOT
RONi FT. FT.
USE OF
EXISTING BLDG.
S. SIDE FT,FT
I—
SIZE OF 01/ NO, OF
IX.20
5
Z
NEW BLDG. ROOMS STORIES
L. SIDE FT.
FT.
Q
EXTERIOR WAL
ROOF.7.04—Ar-4- f
�/
COVERING ✓<GO
COVERING
R FT.
FT.
-
J
R RMEDEAR%.,
USE OF BUILDING AND WORK TO BE PEO
DISTANCE BET.
BET. MAIN &
1
a
MAIN SLOGS.
ACCESS. BLDGS.
<V
AR
DATE
O
Q
C.U��Pqq.
APPROVED (p l.,�J)
~W•E
�syfL-�lj—
A
O.�/
C/
Z
O
I hereby acknowledge that 1 have read this application and state
HOLD FOR SPECIAL
REQUIREMENTS
t~i
D
chat the above Informatioh is correct and agree to comply with
cc
all laws regulating building construction, and I shall not employ
F•,
any person In violation of the workman's compensation laws of
/
(A
the State of California.
et
?
I hereby certify that I am properly licensed as a contractor under
SO. FT. G
o
THE AMOUNT SHOWN UNDER V L ATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A I+PIiMIT FEE ONLY:
am exempt from the provisions of the State of allfornia Business
VALUATION
and Profess] e2od ivislon 3, Chapter
PERMIT FEE $
N
�V
Signatur
Perms !/1YJ i;w
$
PLAN CHECK $ /
E
Authorized Agent
TOTAL FEE $/�_2�
y/ �rt7
/ v ��
LL