HomeMy WebLinkAbout846 CENTER ST - Building Permits' i \ �+�.�� - ' —'' � '..r�-� I. � . _
���•� '�U�CJ'� 0 6.�' �i"_;r'�,•_�...�%
COSTA MESA BUILDING-SAFETY DEPARTMENT � NOV 1 ��2
P. O. BOX 377 COBTA MBBA. CALIPORNIA � FINP,�!CE pEP{,
For A lieanf fo Fill In Com lefel CIIY OF Cf1ST�7 r,7Fcn
PP P Y � APPLICATION FOR PERMIi
TYPE OR PRINT
BUILDING g46 Center Street A B C D ./ (i BUILDING
ADDRE6S > > >
COSTA MESA. CALIFORNIA FOr Office Use Only
OWNER
D311tt1&ll & Brummell Enterprises neceirr No. fe �ir��
ADDRE6S 1�' 2 E. OCeSil Fx'Orit Re��� er I cyrin' c�gi�en.�or���esueot
�p ��
c�n Balboa No0r31807 BUILDING �JC
ADDRE6S
ARCHITECf TEL 7 5 COSTA MESA. CAL ORNIA
OR ENGINEER W.T. Jordan N�Lj.• �. 1 /
ADDRESS 771 w. 19th St. Costa Mesa FIRE . /� L
ZONE TVPE ✓ ' GROUP /
CONiRAGTOR OWIIer B1aT. APPROVED
BY DATE
ADDRESS ���--- ZONING
ZON NO.OF UBH OP NHW
CITY _____ �� vLANe au�Lolna
6TATE�_��� TEL. �_��_
��1 ��r� OHBCRIpTION t � �- � �
SIZE y�O�XYCO� I NOWOON LOT� I / /
OF LOT A. P. NO. f/ b� ��'r� � ^
USE OF YARDS EVES
EXI6TING BLDG�--���� APPROVED AL OWED
9RBACK LINe FROM �O � �j �� �CHNTBR ��HB BT•�� .^
cenTeR oP BiRHeT O REAR YOARb FRONT 7 V FT. �L 1 IN.
SIDE YARD I LEF'f V 1 I RIGHT V, R. SIDE FT. IN.
DESCRIPTION OF WORK � FT. � IN.
L. SIDE
NEW I X II ALTERATION I II ADDITION I REAR �. FT. .. IN1
REPAIR I A MOVING II DEMOLISH I BYPROVE �DATE � O� Z-�� 6'
BUILDING 28,�5 NO. OF 2� 2 '
BIZB ROOMB STORIES �� � ;
IXTERIOR WALL S'f.11CCO ROOF rock (�� �y_� ; O �Y1
GOVERING I COVHRING /'jlC. ST�. R� C�' pq,� �ui�
US OF BUILDING AND WORK TO BE P RFOR ED
�+ Unit Apt.Bldg. & det F'Laund.Rm. Q�,i _ Z� �=,,,�y,j-_ �
._ y;� 00 p� —/ 4 ���
I H¢REBY ACKNOWL8Ofj8 TXAT 1 HAVH PBAD THIB /.PPLIWTION �THg AMOUNT 9HOWN NOBR VALUAT�ON IB FOR THE
ANO 6TATE THAT T VC 18 CO ECT AND AGRCH TO COM- pUPP088 OP EHTABLI8HIN0 A PEflMIT FEE ONLY.
eu�LnlNa cons I� u'o N ce9 w sTwTe uwe R6ouuilNa VALUATION /�
SIGNATURE OF PERMIT FEE S���/�J
PERMITfE , /� ��CO
/� / �
S / " PLAN CNECK S /��• �
AU7HORIZED AGENT
TOTAL PEE r�`
.,•�, '•�% 18799
�OSTA MESA BUILDING.SAFETY DEPARTMENT
P.O. BOX 9f7 COHTq MB9A. CALIFORNIA
For Applicanf fo Fill In Completely
TYPE OR pRINT
BUILDINO �
AOORESS
COSTA MESA, CALIFORNIA
■ MAIL
�az.r.��rx.;�
STATE
LIC. NO. 1 N .
SIZE ��' NO.OPBLDOB.
OF LOTJ �• S � < Q� NOW ON lAT
USE OF
EXISTIN� BLD�. /
BCTBACK LINB FROM i't r/
DESCRIPTION OF WORK
BUILOIN6 /L' N
SIZE / I R
EMERIOR WALL ,��. I
COVERINa
USE OF BU ILDING AND WORI
C'dvt��r�Te .� -
'1 HBPEBY ACKNOWLHOOH TXAT 1 ryAVH pHAp THIB APPLICATION
AND BTATB TXAT TX8 ABOVE IB CORRECT AND A6RHH TO COM.
PLY WITH ALL C�TY ORDINANC88 AryD 9TAT8 LAW9 qeOULATINO
BUILOINO CONBTRUCTION.
. AUTHORIZEDAGEN'j�(i!� '�/rJ7N�' : .
BUILDINO
L80�L
FE RECEIVED �
` iEB' z o
fINANCE D�.
APPHCATfdN �F'tlR. FERMRA .
BUILDING
For Office Usa Only
REC8IPT NO. P¢gMyqyp. _ �
�'
�
YARDS APPROVED
MAIN BUILDINO
DIBTANCE BET.
MAIN BLD69.
VAR. #
�
owreiseuao
'-7n_/
ZONING
uae ar new �7
am�otNo
� ���
T� �
D�i— � r�
1AN6 BHALL BE LE58 THAN
. L.
<U.B.C.REOUIREMENTI
YARDSAPPROVED
ACGESSORYBUILDIPo6
V Ff. ^
BET. MAIN Q /
ACCESS. BLDGB. � n
DATE ��(�
APPROVED'7rJD�60
OATE L � �'D- L i
p
BQ. FT. ' O
TN8 AMOUNT BXOWN UNDEP VALUATION IB POR THB ='
PUHPOBH OP ESTIIBLIBHINQ A PEqMIT FEH ONLY, p
VALUATION o
�/ �l PERMIT FEE $ � _
P f/�1! m
$ � O.�tJ i.�0 c
. �i • �e. 6
�" _
COSTA MESA . '
tUCTION PERMIT
e
APPlicent's Mailing Addrea '-'^•"r" — .
Project Address, 'g `— � �
Owner's Name A' � � hone� � ���
Atldress ���; `� �` P•� 1`,�••• �w �lU(J\(a VLN(�.+
ArchlEng. _��N Licenm No. � 7�_
Address -
Contmcmr'a Name Qw NF-C�. Phona
Addrea (mailing) -
license No: � �
LICENSED CONTRACTOR DBC�AATION
1 �ereGy affirm that 1 am IicenSetl untler provlslons of Charter 9(commencin9
wlth Sectlon 7000) of Dlvlzlon 3 of t�e Buslneu anE %ofasslon: COGe, an0
my Iicense'is In full force antl eNect.
L'Icenu Class � License No. �
Date• Signatufe
WORKERS' COMPENSATION DECLARATION �
I heraby nfflrm that 1 have a certlflwta oT tonsent to self-Insure or a.certifiwta
of Workers' Compensatlon Insuranca, or a certlfietl coOY t�ereal (Sectlon
380a, LdD. CJ � ' ; � �'
Pollcy No. � � Company ' �
CartHleC�copy is �ereby furn�5he0.
Cer[Ifletl topy IS flletl with tha CIty,Bulltling DivislOn. '��;
Data � AOV���ant
EXEMPTION,FROMWORKERSCOMPENSATIONDECLARppp��� ION�'�
(Thls sactlon naeA no[ be comDletetl H the Derrt�ll Is /or, one huAtl�btl (5100)y�_
Iassl. � 1 �i ' /
I<artilv that In the oerforman�'��or �na wor�ry��pl th pertn t I5155uAtl, I
�OP�kant Co fill In all sDate3lxtept tbose wlthin �eavy Do�El� Ilnes anE sl9n all apF
RMI O. TRACT NO. LOT NO.
� — 77Z dJe,,e�.�'t�c',� � 9D 2
TYPE OF CONSTRUCTION NEW ADD ALTERATION
� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
( DESCRIP710N OF�v� RK �L���+�� ���
CNsf+vCE K/TCi/EN L4YovT. rAD��
TVPEOFPERMIT GRADING FOVNDATIO�
❑ TENANT �ELECTRICAL PLUMBING ❑ MECHANICAL
❑ ATHER
� PRWECTDESCRIPTION Sq.FT.�_ocCUaAplcv
CONSTRUGTIONTVVF ✓ VALUATIONS �Ri
20N€ GRADINGCU.VDS. 'ACRES
Remarb: ' . .
Oate V���� �:Wqgn9tura � � � L����
NOTICE: If, aftar making this declaratlon, you sh tl e sub)ect to•the'-
Workeri' Com0en5aUon provisions of t�a Labor Cotla, you musi foR�with.
comply wit� such provisions'or this parmit,s�all ba tleameE"'rovoked.
CONSTPUCTION LENDING AGENCV �
of �the woirk thar lhaith thl5nstrucUt nile 155uetl 9;� 4Rn 30�Z f Civ a C}' .
LenCerY Name. 'n%�"�`�N �'M�
LenAer's Atltlre�' ' " � ��N
OWNER BUILDER OECLARATION - . - �
the
the' :
31.5 Gy any apPlicant for a permit sub7ects'the appli<ant to a-civil � �
" �alty ot not more [han five hUntlretl tlollars (E500). . �
I, as OW�B� o( Ihe propartY o� my employees wlth wag85'as th0i� sole
COrtIpBnSatiOn will OD the WoiR, dnC the St�uctu�e�ls not IntanCetl or oftomtl
!or sale (Se<llon 7044, Busln¢ss'anA Professlonal Cotle:iThe ConVactor'S
License Law tloes not apply to'9� owner of a O�oparty who bulltls or imProves '
i thereon, antl who tloes such work himself/�ersel/ or lhrough �is or her own
mpl0y aes, plOviOetl Ihdt SUCh �TprOvBminti ale nOt I�tantlatl of oftalatl fof
le. If, howevar, tha builtling tlr improvemen[ is soltl within one year of <om-
lon, t�e owner wlll have IhC burEen of proving M1e/sha tlltl not build or im- '
rove forthe purposa of sale)'. � , . : � �
I, as ownar of Ihe property, am exclusively contracting with Ilcensetl con-
lractorsto conztruct the;Oroject (�ction 7044, 8usineis antl Pwta55ion5 Cotle:.
� The Contractor's Llcense Law does not apply to an owner o! property who
bullCs or Improves thereon, antl who contracts for suc� projacts with a con-
' traclor�s) Iicensa pursuant to th0 Contra<tor's License Law), .
❑ I am examOt unCar Saction B. 6 P. C. for this reason
' Date ' � Owner � ' �
1 heraGv. certifv-that-I:ham reatl Wis aoP��catlon antl tata that tha'above�-� �
Drivars'
Sink
kflow Preventer
kflaw Irrigatian
Drains
Sinks
• Sewer Cap
� - � $BNR! COnn2[tiOfl
Soler Collectors �
Solar Piping
� Sotar Tank � - � '
Swimminq Pool w/Spa;:
Urir.al � � -
. Water Goset �
• •" Water Heater �
Outlets , Water Service
Kitchen Sink '
Lavatories, , .
P—TraP ' `
Roof Drains .
Showers " . '
Servite Sink �
�
• f
Roiler , • - �
- Strutturel
-.Venti
lating. _ � _
tem ❑ Multiple ❑
BIL ICBO iW
em & Ducting ,
i�BTU � 100,000 BTI
,,.��.y ....... ... .....--'.-...-.._ _.,...,__...... .-"- nooaor ❑ '
n u n tne �veT n(lonetl rty tor TypOI
roo s. � �Z�Nt Yi3 '. Cano T e
�
�� Registers
rav. 12/82 Whlte - BUIltling; Canary - Applicant: Pink - Accounting; Goltlenrotl - Aise55or
n
9
REPAIR '
��
A. Y. 91° —I O\ 7� I'
PLNG. REF. qW
TO BUILDING
PF PE V I
LEFTSIDE VARD
PKG.SPACE REQ.
STREET W�DTH
SPECIAL CONDITIONS:
Automatic Washer
Consiruttion POIe�
Cooking Unit � -
Dishwasher �'
Dryers ❑Gas !�f
Fan.
F.P,.U. '
Fiztures
Device Bozes
Outlets � � .
1076 o/2a"/fl:�
� ' �
BUILDING
ecronrr ri� eT
X REAR VARD (T0 P/U
RIGHTSIOE VAflD
PROVIDED
PARK FEE E
; � ',:/ L � �� Gaibage Disposal
f0
� Generatar �0-5 KW 05-15 KW
p , �. Transformer �75�SOKW �
r
�� . � ��5U+KW
Reinspection Pea ' .7�f}�
_ Issue Fee _ �!$ 3
�Meter LJover100emps .
Sub Panel '
'Sub Pole ' �
Motors �0-1 HP ❑1X-8 � �
Inc.Solar 09-15HP 016-15+
�Microwave
Pale Light ' . �
Ran9e - ' ._ . ' - -
Standing Sections �
Trash ComOactor
�Reinspection
� laue Fea
I Fl:i.S,-; T.
0
iANICAL . ' � ' ` ' ' ' 6 � �83
�� Applieation Approved By � __Date
Refrigeration System - ' ' ' '' ' ; ' �
�� �, i Applintion Iaued�By � � �ate
❑o-ioo,000eru ❑ioo,000eru .. ,
,� 'SpUM_M—ARV OF FEES �
System Repeir/Alteration � �, � , ; j , I�BUILDING PERMIT $ � , SMIP � � $ • �'�
� � .+'`L'� •�P,L'ANCHECK� $ �/•SZ. PERMIT. � - �
. � ' %t ; -. PLUMBING $ 107.� � ' ISSUANCE . $ � ,
' � 1
' . ' � '� �. � .. �PLAN CHECK, $ ' ; GRADING � � $ '
• -r :�; ELECTRICAL $, 0 . $
�- � - � ' PLAN CHECK• � $ � � MICROFI�M , � $
-�' ° � ., TOTAL:FEE� $ ,
� a � "MECHANICAL $, �
Reimpection Fee :�.. wrE15 pLAN CHECK $ — LESS �' � �
. ' ADVANCEDPC $
laua Fee ' ;`�' �S 3 � � _ FINAL FEE � � $ � �8S 4�
;
•1 = -- - -- .. 1
�, �� , .�...-,.--- '� ��-- -, POOLc&5PA - . . �--' - r --.
� CONSTRUCTION�AND�PLA NING � � �..r. i� : �' . . i ' .�
"� .cDate-�� +,Inspector'�' - - . � Date� Inspector
..'{�.APP,ROVALS �, Per:mit�#� �' , � : ..:� , . ' APPROVALS ... Permit # . . . '. a . , .
- �
, :f. TemporaryiElectncal Service or.Pole ���� •� ^ i ,� o? , �� `52.', Pool &�Eqwpment Location ; , �• "1 .`..
/ `•` 2. 'Soil Pipe-Undrgrnd . � � Y _ � , ' � °� -' � v �� ,, � ° � �'53.� Steel Reinforcement . _ . - ' , � u _�� ;
- . . . � ,. ; . „ � . . �. _ � .- _ � - -
,= 3. ,ElectricahConduit UtilitwUridrgrnd � �. ,� - - - . � ar�-, �54.. Forins "' - � � � � - - , : �i
"t 4. Electrical Conduit-Undrgrnd� -`- � -' ^ =' '-' � =�� ' ^ r ` � ' �
, _ _ ; F �o ..� ;.� :55: Electrical�Bonding .
��� � .";� o�.� j:-c:ia:�� . ' . _
' 5: Steel Reinforcemenf �, ��� . �_ -�, . 56. Rough Flumbing�& Pressure Test � ' _ -�
6: �Electrical:UFER Grnd.. �� � �• � � r t'- 57`-' APPROVAL TO COVER-GUNITE . •,_ i
' 7. Footings ` ' . ' 4 i o �,� f . � � a _' i ;`��', 58. ElectricaLConduit-Undror�.i.. •. . . � •'.2
8. Foundation , I I j � _ - � �, `� ' °' f = ' 'S9. �Gas��Pipe,�O:Undrgrnd,,'Test - ��'
� I -i � � o - d- ,1 . - r.
i
9. 'tNater f�ipe-Undrgrnd. '� � � � �' �; �- -`;60. Backwash Lines, P-Trap, � Undrgrnd. .,
r� � ' � n` C
10. Stiuctural�;FloorSystem � � � � ' � ^�� :'�� �-.61. APP,ROVALTO�DECK � - - �
11. ,P,roperty Sewer Line &IHouse�Connection. � ` 'i � 62. Backwash &-Receptor-Final � - ' 11
: i
�Z• SQ°"Qi Cay�•� , =j � � F � � ! . Heater &.Vent-Final. �".. , . � •
13. �Roof.Qrait�s�. � `i -.- . , �:r , _ • ' -'�. - - ' - .�
� - � (%fK`rj �x;r-rk��c `y-�3� � 4. PlumbingSysYem--,Final� .
� 14. Rough'Pliimbing� ' . � °-�a ! ; � - - ��65. Electrical-Final" �- �- � -
0
-,,75.�.Rough'Electriral=Conduit�'-', �j��-''- �'��;.?`"�.'�-�`-"�-66�Solar�System-Finall - � - ,��,- �
1
�, . . , '-, ' . .
; r,oi6., �Iough,Elec'iric Wiring� ,, i E � �� li-s i ' -` ` -" ,' {„-�"�67.! Fencing &�Aceess Approval, � . � .-{- , • �_
� `.1!1'/. R'ougli N(iring.Sign�: ,y r I � . '+ I � I : I' I � - �' � i � �68.� APPROVED FOR.PLASTERING ; _ � , ' �' ''
= y 18. �Ro'ugh°Elect�ical:T'Ba%Ceiling. ,� I' : � ; � � " � � .; � . � � � : ' . . .
�- I� 69. POOUSPA SYSTEMS FINAL "
18. �Rough`Heating &�Air Conditioning �� . � � � i � � � � � FIRE DEPT. REQUIREMENT . ' ' � � , _
� �0! �Rough;Factor�'y Fireplace � i i, �� I � I � ' � � � APPROVALS'� � Permit # �- ,
� r21. �Ducts, in Structure� "' ;` � u' � I i � ; � i 70.� Underground Hydro � �
- �, ti . � � � � � � . . .
�ii22. Dyc[S::V�ntilating � � � � I ,� , i I '� ' '
� � ,� � � � �� i71.� Product Piping OGas OOiI � i � �
.:. : ..r � . � ,r� ! I --j ' 7'_ -:.L'� :-: ..-- - -- - . . - " -�"- -_ - '- �- - '
� ��F2' Gas�Pipe ;Rough & Test 4 � �� � T � s � � 72.' Unde'rground Flush �
'� �c , i.i _ I ,�� I � i �
`� j1'Q � ;Roof Framing: � �� � �i;� �, , I �,^. -� �� "�I�' �73.� Undergrnd. Storage Tank O Gas , � Oif , , j �
, �
� 25. �Roof Sheath�ng � '� ; � '�^ : I :-�," t��C 74.' Overhead HYdro ' .. , � � � ,
c
j - - .' . -' . � , i ' � � . . �
: � 26. T-6ar Ge;ling (Struc[ural).& Monocoat-� : = � � =! ' ',_'� . J5.� Ory Chemicai � � .
.. i i .�
",.27. �Frame�antl Flashing� , �� P ; ' 76,� Dry Standpipe - ' - - ' , ,
�i �'t.
�.^28..klathing&�Siding� � � j � � ` �i ' ���j � ! ��� 77., FIXEDSYSTEM�FINAL � . j ��
`�� 29.�Insul2tion -R. � I�, m I " i'. i I � I � I � � ��$•� FI�RE PREV,. FINAL � . i �
tl - -- �. :' . � - � � ^. I I �� t . i j � . f � . . � I . .� i :
. Di,ywail-Pl,ailing i , : ", � i i � I ' � I INotes:. � •f ' !f /f iJ •
i,. �' . . - - -- -� �-- - --- -- . .. .
° '•- . Plastgr�Brpwn Coat. "� , 1 I i' . ��- � �(�-�-� ; i M��H3g��, �� /Qoo � - .
^ � ' . ,.. � , �
r �� ;�32. �EI'eci�rical'Power Meter�Final � '� '� 1 � s;' � . �,• � i:';; � •'�'�^; ' '' � ' , � _
'� � 1 I '_� � Z21=,�3 Cc � y: � ,-
' 33. Final El�ctric � , !�; ' / . � . i ' .
_' � 34. Final Heating &'Air�Co�ndi,tioning' � �{-(('8'3 °�1� {/���
� A ' � T. 1.. 1- 1 1 1 (/� �
35. Final GaS'Pipe=9'est��'= ;,� i T j. � i. l(�lLf f71 � �� -
36. Hood. or �Canopyr � I � I .T , ' � ;,I ii � i ^ � .. � � ( � �
i.��" iv.�'�yl �� in��� rl� j � '.. - .
37. Final F.,ae[ory Fireplace -. � y � c� . �� �� �.. ,' � �" I � , _
o � i
38. Final�FlumBing � I � �-t` { 'I cj n ; � ['�1L-&3 , 6�°"'° , I I ' ,_ _1 . '' . -
39. Water Service-Finali (. �.' �� �� I I' � � , .
i i i � � -`
40. Gas Seivice-Final �. i � � � �� � I � � � ; ' � �'_ � . n a .' ..
41. Solar D'omesticFinal � � � ' � � � � _; _�_ ' � � � � ' ` , ��=j ,
e: � i ( F- -F---r - -�- - '- -
42. Backflow�Preventer� e � � ' � ;;n, �- . � - -- � -7 � - - ---- -- - - - �. - "S.' j, F a 7"�.
43. Backflow.lrrigatfon s I � � ?�I^ j' I' ' ' � � i ; � ; � ' , , � "
,�- 'I; I I M�-1- 'I'-I :, �, �'; � �
44. LandssaPe Irripation(SY�tem { � j'n C_ �"!' I., �^ �: I a' i .,' � � � � ' '
�� m
1 4 _ T • r 1 ' p' � I ' 1 : I i i . ; ' . "
45. Sound�I,Attenuation j�l ° I R 1 I II � r � , ( � � „I � � i - , ' ' � `. . .. " _ � - ... .
.�:' ' _ ._: I I I . t �.(I„-;i i � � .� ' , ..r . . _ .
46. Handicap;Regulations� � , � �� I ( � . I r: � � � �. ' " �
47.� FINAL STRUCTURE &�BUILDI�NG �� I � J�Z-ZZ i� ;(� � � j � i ; � : , � '' -
48. Special. Requirements Completed� h ' I . I �'; � ' ? � , . ' i ' � � � . � .
o � � �- i J I � I. � -'i-
49. Electr�c Release�to Edison� � j % �..r_1_.�._�'_�_ ��-' _!"'"� ' _' _ ' _ �_ ' ' J,
50. Gas Relesse Co Southem California Ga's Co � � � � � � ; � : �� � � -; � .,'��� ' � . � ' � ; �
51. CERTIFICATEOF`OCCUPANCY 4 �.�_.: -�- � ! '- _''' ._G. �-.,__�/' ;` -,�. `> ". r
No �` � � ( Date � � � I � � �_.� � .i:. �: • , . �� � :
�
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Pfl0.1ELTR�DflESS: 846 CENTER ST
OWNEH'SNRME:ANDERSON CONNZE
nooxess:17220 NE�JHOPE ST #224
FOUNTAIN VALLEY,CA 92708
APCHIENGINEEN:
ADONE55:
flEG.NO.:
uNir:
UNIT:
PEHMITTEE:MCCAAE DEVELOPMENT, INC. ("/14)540-2698
nooaess:17260 NEWHOPE
FOUNTAIN VALLEY CA 92708
LICENSEO CONTBACTOfl OECtAFATION: I hereby allirm thal I am IicenSeO unaer pmvisions ol CAaD�er 9(CammenCing wilh $¢ttion
7000) ol Urvision 3 0� Ihe Business ana Pmiessians CoOe. antl my license is in lull b¢e anA e��eci.
ciTr uc.:0 3 6 a STRTE LIC.� 6 6l3 S q cuss:
Oaie: Signamre: P— _
� � ��
WOflKEflS' LOMPENSATION OECIANnT10N: I nere�y al(irm Ihat I i¢au ol conuni ro selbinsure or a certificate ol Warkers'
Compen5ation Insurance, or a ttrtifiea coDY thereol �Section 3800. Lab. C�.
POLICYNO.:iSOSB6Z—�Z E%P.DPTE:12IOSI93
comvnNv:ST6ATE FUND
❑ CeRified copy is her/e�y Iumis�e0. � Cerlilied coDY is IileO vnlh Ihe ciry Builtlin Division.
Da�e: 21��` `3 Applicant: � �es
EXEMP�IONFflUMWOflKEflS'COMPENSATIONOECIANAT10N: (Thissec�ionneetlnotbetomple�¢Gili�epermitis�oronehundretl�$1q1)orless�.
I �etlily that in Ihe pedormance ol t�e work lor which I�is permi� is issueq I s�all not employ any Derson in any manner so as �o 6ecome
5u01ec1 lo I�e Workers' Compensalion Laws ol Cali�ornia.
Oa�e: SiA�amre:
NOTICF. Ii. afier making I�is GeClaralion. you ShOWG betome suble�� �o Ihe Workefs' Com0en5alion pmvisi0n5 Of �he Labor
Code. you must fonMnt� compry wit0 such provisions or INs Dermil shall be Ueemetl revoke0.
CONSTBUCTION LENOING AGENCY: 1 here0y aifirm tnat there is a constmction lenaing aAe��Y �or tAe peAormance of t�e work lar
wnich Ihis permitis issued (Setlion 3097. Civ. C�.
LENOEfl:
AOONESS:
OWNEN BUILOEP oECIABRiION: I nereDy atlirm Inat I am exempt Imm ine Cantracmrs' S�ate License Law for tAe following reasan
(Seclion 70]7.5 Business antl Professional Coae: Any ciry ol county which requires a Dermit to construcl, alter, impmve, tlemolisR or
repair any slmcN�e. D�ior �o ils issuance. also requires �he applican� tor such permit Io file a 5igne0 Slalemeni Ihai helshe is licensetl
pursuam to �Ae pmvisions o� ��e Comracmrs' Siate License Law �Chapter 9(commencing wiN Seclion 7000� of Oivision 3 oi �he Business
anU Pmlession5 Catle) or I�ai �e/She is exem0� �her¢�mm ana Ihe Gasii lOr ��e allege0 ezempli0n. Any vi0laiion o� Seciion 703/.5 by
any aDDlicant Ior a Dermit subjects tne aoP�icam m a civil penalry of not more tAan live huntlretl Oollars (5500�.
I, as owner of the pmpeny or my empIoyees wilh wages as ineir sole comDensation, will Oo ihe work, and ihe
❑ sttucmre is nol imenEea or oflerea �or sale (5¢[bOn 70EC. Busine55 an0 Prole55i0nal CaOe: The fqn�rat�ors' S�a�e LiCenSe Law
. does not aOPly lo an owner ol a pwpeny wM Euiles ar impmves ihereon, and w�o does such work himself/herself or thmuAh
his or �er own employees. pwviaed Ihal SucA impmvemen�s are no� intenaea or o�leretl �or sal¢. It, howeventhe building or
impmvem¢nt is soltl vn�hin one year al camO�eUon, Ne owner wll �ave ��e Gurtlen ol prOving �e/she tlitl noi buila or improve
lor the ourpose.of Salel.
'I;'as ownerof I�e pm0eny. am ¢x[lusively contracting wiih licensea convacmrs to consimct tAe Dmject (Section 70aa, Business
❑ anE Pmfessions Code: The Cqnlratiors' Stale License Law Qoes iroi apply Io an ovmer ol 0�operry w�o bmlEs a improves t�ereon
antl wlw coniratls br such pml��s vnth a conlractor�s�license pursuanlio Ihe Conira[IorS' $Iate License law�.l am aware
thal O�oof ol �Aeir WOBer'S Campensa�ion insurance Shoultl Oe provided Io me.
� I am e�empt untler Sec�ion: B. 8 P. C.
lor this reason:
�ate: Owner
I tlo nere�y ceNfy ihat 1 am aware ol ana unaerstanA Ine requiremenis ol Califomia Healih and Salety CoOe Sections 255U5. 25533, ana
25534 an4l�ai I or any fuWre builtlmg occupant will/will not (circle one) neea lo compty wilh saia Sla�e codes and the requiremen�s tor a
oermi� lor canstmciion or motlilication Imm Ihe Fir Ouali�y Management Dislric�, Residen�ial cons�Nction applica�ions are e�empt �mm
IhCSE pf0V1510lI5.
Date'. NODlicanc
I hereby ce�tily Iha� I �av¢ Ba0 ihis application ana slate �hat ��e above in�ormation is carrect I agree lo comOM �^�� all ciry antl caunty
or0inances ana stale laws reWling to UmlOmp cWsiNction anA �ere0y aurtnrize repret¢ntalive5 0l Iks Ciry to enter upon tAe ahove�menlione0
pmperty lor inspecuon Durposes. ��/% [���
Daie: a 1� Siqnamre�/"f�ia—/CLt�'-- �+�L��
Dd�er's ucense or Sociai Secudry
16aLa6 W�ne-0uilding; Green—COCe Enlorcement: Canary—Applicanl: Pink—Revenue; GolEenroa—Asseswr
CI�Y OF COSTA MESA — BUILDING PEAMIT
PERMIT NO: B 061136 , PLAN CHECR NO: N
CONSTRUCTION TYPE: 5—N PERMIT TYPE; STR
JOB DESCRIPTION ; T/O REROOF W/3 PLY HOT MOP
PERM NO: B 061136
GOVT; N SUPP; N
PURPOSE: ALT
SQ FT; 5,500
CLAIM VALUE; 5,500,00 CALC—VALUE; 5,500,00 GROUP OCC; R—i /
*�******�r***�*�*D*****�*�x**�F****D�r�r***����i*����**�***��*�*�P.A+��,�TME+y�NT}�-x �r��x�x�s�s�
Z O N I N G R E Q U I R E M E N T S�1\lIVf�C�C I CV 1 VR
S E T B A C K S
------------ M:9IN BUZLDING ---------- --------- ACCESSORY BUIL73IF1�"��D---
FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN kGHT; FT IN
PARRING REO• PROV;. PARCEL: 42419118 ZNE; REF NO;
PLANNING N01'ES>
>
�! if if ik iE if iE if k if iE iE iF iF �E'if iF i! iE iE �E 3E�F i!!F !k if �1F iE iFik iE iE if k iE ik jE �F it k iP )t if� �E it �1E 3E M iF if 3F 3E if IF �k iE k if ik!! if iE 3f jf �E jE 3E #4f.iE jF if 9E if iE fE iE 3f
D E V� 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 rT, $
i .
ZONING APPROVED.HY DATE; �!-;
BUILDING APPROVED BY ; DATE; �
APPLICATION ISSUED BY: DATE• �'� ( �
ikiEiEiE�EiElEikiklfjfiEiE-IF.iEiElEiEiEiFifi! i(�iEltlkikiEiEiFK�E �EiE
1E 1E 1E iE i! i! if if iF iF 3E if 1E iE iE 3E iE 1E it iE if iE if 1f 1E iE iE ik iE ik iE if iE iE iE iE 3t iE 1t iE if if 1t it iE iE 1E iE if # lE 3E ik 3E ik iklf 1E iF iE jf if iF iE �f iE jF 3F jE 3f �lE it ik iF ikiE K-aF 3f
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADZNG
PERMIT 81,00 � 55
PLAN ; ii� SMIP/NON—RES
ZSSUE FEE �'
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECFt TOTAL PP,ID DUE
TOTALS----> 81,55 0,00 �, , 0,00 81,55 81.55 ,00
REVENUE DIVISION TOTALS--> COLL'ECTED: 81,55 OVER/SHORT; ,00
BLDBiP00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOS GRADING PLAN—CHECK
� I
if 1F 4!E it 1E it 1E if 1! iF if if iElF iE if iE 1E iE if 1f iF 1E if iE k iE IE iE ik 1E iE if IE iE iE if��iE it if k ik 1f if it iFlE if ik iE 1E IE if if iE iE if iF iF 1E iElE �E iF if �F IE ff 9t iF ik jt iE if it iEiE lf
I N D I V I D U A L !F 6 E B R E A R D O W N
TYPE QTY D E S C R I P T I O�N, UNIT COST TOTAL COST
SFR 5500 REROOF BY VALUE RESZDENTIAL NOZONE 1.00 5,500.00
END,•OF FEES
� �
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L
CONSTRUCTION AND PLANNING POOI & SPA .
APpROVAIS Permit# Date Inspector p,ppROVAIS Permit# Oate Inspector
7, Temporary Electrical Serviceor Pole � 52. • Pool & Equipment Location �
��
Z, Spil Pipe-Undrgrnd. �� ,; 53. Steel fleinforcement '
3. Efectrical Conduit Utility•Undrgrnd. �' 54. Forms �
4. Eiectricai Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Eiectrica4 UFER Grnd. 57. APPROVAI TO COVEft�GUNITE
7. Footings . 58. Electrical Conduit�Undrgmd.
8, Foundation �_� ' 59. Gas Pipe, O Undrgrnd., 7est '
9. Water Pipe�Undrgrnd. 6�. Beckwash t�in2s, P�Trap, Q Undrgrnd. �
I10. Strucmral Floor System t� '� 61. APPROVAL TO DECK
i t. ProPerty Sewer Line & HouseZConnection 62. Backwash & Recepto��Final •
�2• Sev'�e� Cap , . 63. Heater & VenbFinal
i
73. Roof Orains � :� 64. Plumbing SYstem - Fir.al �
74. Rough Plumbing � � 65, ElActrical-Final
t
15. Rough Electrical•Condui2 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Appruval
77. Rough Wiring Sign 68. APPflOVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOVSPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning PIR� DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Struaure 70. Underground Hydro
22. Ducts, Ventilating � .77. Product Pipin9 O Gas ❑ Oii
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roofi framin9 .73. Undergrnd.Storage.Tank O Gas ❑ Oil
25. Roof Sheathing �j/�3 � 74. Overhead Hydro
���
26. T-6ar Ceiling (Structurall & Monocoat . 75. Dry Chemical
27. Frame and Flashin9 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation . . � � 78. FIRE PREV. FINAL
i
30. Orvwall Nailing � � HEALTH DEPT. REQUIREMENT
37. Plaster 6rown Coat � ' I � 79. FINAL INSPECTION
32. Electrical Power Meter-Final � � I 80. FOOD CERTIFICATE ISSUED
33. Final Etectric � I . Notes: �-,_ _ /// / ' `
s.ri• i!.td�1., SAf_o lt_Q�
34. Final Heating & Ai� Conditioning I � i _ / /J � �
- " . L-�%/-'i'c-�[ K_. �s/_0=p-�
35. Final Gas Pipe�Tesc ' ' � �
36. Hood or Canopy � � -
37. Final Factory Fireplace I �
38. Fina� Plumbing � j j
I
39. Water Service-Final . � I �� ,
40. Gas Service•Final '
� i
47. Solar pomestic-Final � '
' t r
42. BaGkflow Preventer I '. � .
43. Backflow irrigation=:.' -
44. Landscape IrripatiorcSystem
45. Sound Attenuatiort;,- :,� .
46. Handicap Regulatioh's � �: /`
� 47. FINALSTRUCTUR��&S:SILDWG �( /�3 �-�;-
V/ K/
48. FINALPLANNING.�_ � �� I � ;
49. Electric Release to fii1sonl ; f �'
50. Ga3 Release to Southern�alifornia Gas Cq I � � � �
51. CERTIFICATEO,OECUPANCY
No. �,��Date
_ _ HOP�ican[ w nu �n au spaces eace0� ��ose wltOm IleavY �oroer unes ana si9n au appropnaro aenarax�ens.
CiTy,,n�F COSTa, MESq CONSTRUCTION PERMIT PER T NO. `'�-- TRACT NO. LOT NO. UNIT NU. ' 6I 34 9/26IB7 I5,50 T
' Proit�t�lddress y ENTf/� S � � 3 � N l' � � ' . .
pp �, (�=7 GU� � ��� TYPEOFCONSTRUCTION NEW AD� LT ATIOjy. REPAIR
i4�licant'sMaili�(qA�dd/r�e �/ /� �
��2� �jCION (O Phone s•o�i,s � CONVERSION ❑ DEMOLISH ,❑ O �R f ,P,# zo�e
Ovuner's Name • l DESCRIPTI N OF WOR SE F BLDG.
Address �D i�� G!'.G�,/V�2 �f� � p� � S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TVPE OF PEFMIT GRA�ING FOUN�ATION STRUCTURaL T Front p
Addr2i5 ❑ TENANT ❑ F�ECTRI�, L❑ PLUMBING ❑,MECHANICAL A Reaf N
Convactor'sName � �J O� Phon�v30-s1d/ � OTHER ��l f� /1 JN '� Right " � �N
Address�mailingl�/y��/���GCJL� �2 ��1/.y��//� PROJECTDESCRIPTION SQ.FT._��.— Q��orr�ionnicy�� K - G
City LiCense No.`F� i. � CONSTRUGTION TVPE VALUATION $��a g Left
ZONE GRADINGCU.VDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. R¢f. # Pd�king R¢q./P�Ovid¢d E
�
�I hereby atflrm that I am licensetl untle� provl51on5 of Charter 9(mmmencing Remarks: ' Planniny NOt¢5: ' ' M
with SacHon 7000) of Divislon 3 of tha Business antl Proteszions Cotle, antl 7
my license is in tuu force effect. 5 7 y S
� Uce �la s ' ense �
' Date � Signature PIUMBING PEES
WORKERS' COMPENSATION DEC ARATION Bar Sink ShOwers ELECTRICAL FEES
I hereby alfl�m Ihat I have a certifiCdte 01 tOnsent to selt-InsUre Or a certiticate
of workers' Compensation Insurance, or a certNietl copy thereof (Sectlon Backflow Preventer Service Sink ' � 15-50 KW
3800, Lab. � ` �7 <lutomatic W25he� Transform¢r
PolicyNo y��^ CompanyS�,�' /V�.[l Backflowlrrigation $ewerCap ^-'�' . ❑50+KW
�Cartifi¢tl copy i5 hereby fumishetl. ,
Ce tle op ij� iletl with the Uty B ing Div ' n. Bathtubs Sewer Connection Cooking Unit eter ❑up to 100amps
Date � ���� / Applicant
EXEMPTION FROM WORKERS' CO NSATION DEC ATION Clarifiers SOlar CollectOrs Dishwa5hef Me[ef r 100 amps
(This zectlon neetl not be Completetl if the permit Is for one huntlretl (g100) or
iess). Dishwasher - Solar Piping Dryers ❑Gas ❑Electtic Sub Panel '
1 certlfy [hat in lhe performance of [he work 10� wnlch thls Oe�m�t is izsuetl I
shall not employ any person in any manner so as to become subject ro tf�e Drinking Fountains Solar Tank Fan Motors �0.1 HP 01'h- 8 �
Workers' Compensation Lyws ot Califomia.
Date _Si9nature Floor Drains Swimming Pool w/Spa F.A.U. InaSolar �9-15 HP 076-15+
NOTICE: If, afte� making this tlecla�ation, y0u snoultl become subject to tne
Workers' Compensation ptovisions of th¢ ldbo� Cotle, you muzt fo�thwith FI00� $ink5 U�intl FixtU�ES Microwave
comply wilh Such p�ovlsion5 or tnis pe�mit Shall bG tleemetl revok¢tl.
CONSTRVCTION LEND�NG AGENCV GaSService OUIIetS WaterClOset DeviceBoxeS PoleLight �
1 hereby altirm that tliere is a<onstruction Ientlin9 agency for the Oerformance
' iOt the wolk for which [his pelmit i5 Isiuetl (5¢ctlan 309] Civ. C.) InLEIC¢ptOfS - Wdt¢f H2dtCI �utl¢t5 RdOgE �
Lentler's Name
�entler's Aatlress � Kitchen Sink Water Service Switches - Si9n � - -
OWNER BVILDER DECLARATION
1 hereby afilrm that I am exempt irom the Contractor's �I<ense Law for the Lavatories Auto-Wash Garbage Disposal ' Standing Sections �
followin9 reason (Section �031.5 Business antl Professional Cotle: Any city or �
� county which requires a qermit to construct, alter, improve, tlemolizh or repair P—Trap Laundry Trays Generator �0-5 KW �5�15 KW Tresh Compacror
any structure, prlor to ity issuance, also requires the applicdnt for such permit
to ti�e a signetl starement that ne/she Is ilcenzed pursuant to the provisions oi Roof Drains
the Conlractor's �icense I aw (Chapter 9.(<ommencing wi[h 5ection ]000) of
Division 3 ot the Bu5ins55 antl Protessions Cotle) or that he/she i5 exempt
.. the�efrom antl tne basis for the allegetl exemption. Any violation o( $ectlon •
7031.5 by any ap0licant tor a permit subjec[s tne applicant to a civil
�enalty of not more than five buntlretl tlollars (E500). '
�J I, as Own¢r of the ptoperty or my ¢mPloyees with wages as Iheir sole ReinSpectiOn FBe $15 IssuO Fee $
. compensatlon, w111 tlo tne work, antl tne structuro Is not intentletl or oiteretl Reinspeetion Fee $15 Issue Fea $ 3
for sale �Section �044, Business antl Pro(essional Cotle: The Contractor's MECHANICAL FEES
License Law tlOes not apply to an own¢r of a O�operty who builtls or Imp�ov¢5
thereon, ana who tloes sucn work nimseli/nerseli or tnrouqh niz or ner own goiler Hood or Type I ❑ � D ELOPMENT SERVICES RE�UIREMENTS:
emoloyees, orovitletl that such improvements are not intenaea or otteretl for . 2oning provad By Date
, sdle. If, howeve�, lhe bui�din9 or Imp�ovement is Soltl wilhin one year ot com- CdnOPy Typ¢ I I ❑
, pletion, the owner will have the burtlen oi proving he/she tlitl not builtl or Im- Duct - Under Ground Building Appraved By Date
prove tor the Pu�Dosa OT ga�e).
❑ 1, as owner ot the-proverty, am exclusively contractln9 with licensetl con- Duct - Structural Refrigeration System Applifation Issuad By Dat
tlaCtOrs f0 con5bu<t the project (Section 7044, Busines5 antl PrOtessiont Catle:
�. The Contractor's License �aw doez not apply to an owner oi property who Ducl - Ventilating ❑6100,000 BTU ❑100,000 BTU SUM OF F ES -
builtls o� ImOroves thereon, antl who contracts for Such p�oj¢tts with a<on- '
tractor(s ucense pursuant to rne Contractor's Liconse Law). I am aware tnat BUILDING PERMIT $ SMIP ��
proof o� Ihei� Worker'S Compensation Inzurance shoultl be provitletl to me. E%heUSt $ySt¢RI ❑ MWtipl¢ ❑ System Repair/Alteretion
PLAN CHECK $ PERMIT
❑ 1 am exempt untler Section e. & P, �. for this reason Firepl/Fac[. Blt. ICBO �i`- Fire Dampers PLUMBING $ ISSUANCE $
. Date Owner Heating System & Ducting Re9isters � pLqN CHECK 25% S ENERGV P.C. $
� I hereby certi/y that I have reatl this apo�ication antl state that the above ❑0�100,OOOBTU �700,0008T $ GRADING $
• information is torrect. I agree comply with all <Ity antl county ortlinances ELECTRICAL
' antl siate laws relati g t tling c tructlon, antl hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives o/ this t ent n tbe above-mentionetl property tor . C
4.� Insoectlon Ourpo � MECHANICAL $ /� J�
TOTALFEE $
Si9nature
CMY Utltib-46, �ev. 30/Uo White - BUlltling: Canary - Appucant: Plnk - Accounting; Goltlenrotl - AsSGsso�
_ � !
CONSTRUCTION AND'PLANNING - POOL&SPA �
APPROVALS Perrriit# Date Inspector qppROVALS Permit# Date � Inspector
�
1. Temporary Electrical SCrvice 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. ElectricalUFER�Grnd. 57. APPROVALTOCOVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrn �: ; 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor Sys em 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 Electrica6Conduit � 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing &�Access Approval - .
17. Rough Wiring Sign � , 68. APPROVED FOR PLASTERING �!
�
18. Fough Electriral-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL i,•� ��
�
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT r�
20. Rough Factory Fireplace APPROVALS Permit # �n � f; '
.� ��
-21. Ducts, in Structure _ 70. Underground Hydro� .��i „
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil -;. �p
23. Gas Pipe-Rough & Test 72. Underground Flush L� ;�:'r
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oii�� � i'
r:�
25. Roof Sheathi'ng 74. Overhead Hydro I.��':'
n
26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical C.' �ti
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. REQUIREM�NT F ���
31. Plaster Brown Coat 79. FINAL INSPECTION r .�,
32.� Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED ;' '
33. Final Electric Notes: ,y �
34. Final Heating & Air Conditioning ;��"
35. Final Gas Pipe-Test
36. Hood or Canopy � ; � ��
li: ,I .i./�. '�
37:�Final Factory Fireplace � �� �,'�r;n y �� �} �
- 7 V V .
38. Final Plumbing ��. r�.: •; f°+ �y a.
3��Water Service-Final Jti/ J' � rI' -��' ;' .
r"f.i % . . i 1.
40. Gas Service-Final �'1/ /• �= � � �,; a
i
��41. Solar pomestic-Final �;J � - U � ; j ,�� ,
r � i
�A2. Backflow Preventer � !� I�:� �' j i � ��
�
,�43. Backflow Irrigation . �r% `�? ,�p � (� �� `
iL� f ' L�� � w:' " � e
(,4�. i,L'andscape Irrigation System � :.^ ' U s�
V • •
g5��So d Attenuation ' �- H J�! j' ,'I
..
46. �landicap Regulations '��� {��,n�; �' J'' :Y
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;,49. Electric Release to Edison !, �n � . �
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51. CERTIF�CATE OF OCCUPANCY . V � y.
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