HomeMy WebLinkAbout2009 ALISO AVE - Building PermitsCITY OF COSTA MESA
B!/ILDING DIVIS/ON
F � 77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax17,�4aLsa-�TsN www.ci.costa a.ca.us00550
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FOR INSPECTIONS CALL: (714)7 5616'
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PERMIT TYPE PLUM STATUS: ISSUED
DATE ISSUED: 10119/2007
ISSUED BY: CAC
JOB ADDRESS: 2009 ALISO AV CM
Vicinity:
SCOPE OF WORK: WATER REPIPE WATER METER.
OWNER:
PHONE:
APPLICANT:
PHONE:
Address:
City/State:
SIMPSON, PATRICIA L
JUAN GUTIEREZ
949-631 �663
GODFELLAS PLUMBING C0.
356 E 20TH ST
COSTA MESA, CA ZipCode: 92627
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FEE: $43.10
TOTAL FEES: $43.10
Suite/Unit:
Address: 2009 ALISO AVE
City/State/Zip: COSTA MESA, CA
Address: 356 E 20TH ST :
City/State/zZip: COSTA MESA, CA
License No. 580859
PHONE: 949-631-4663
CELL
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: PERMIT EXPIRES 180 DAYS FROM DATE OP ISSUE OR DATE OF LAST INSPECTION.
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 f nal approval will result in the expiration of this permit.
CODEi. INSPEC710NTYPE UAT IX1111AL5 CODEt INSPECTIONTYPE DATE INTITIRLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical �
1266 Pool Spa Final 208 Final Plumbinq � 0.31 _ 07 �.�
200 Final Re-Roof 210 Final Electnwl
201 Final BIaWRetaining 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/Occupancy
WORKERS' COMPENSATION DECLARATION:
I �ereby affirm under penalty of perjury one of the following declaretions:
� I have and vnll maintain a certificate of consen[ [o self-Insure for workers'
compensation, as provided for by section 3700 of the Labor Cotle, for the
peAortnance of the work (or which this pertnil is issued. .
❑ I have antl will maintain workers' compensalion insurance, as required by
sectbn 3700 of Ihe Labor Cotle, for the peRortnance of the woik for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier:
(Th6 serYon nttN�rof be rompefetl il tne permil is valuedat one hundretl dallars (St00J arless.)
Policy Number:
I certify that in Ihe performance of [he work for which this permit is
is etl, I shall not employ any person in any manner so as to become subject
lo t e vrorkers' compensation laws of California, and agree that if I should
be me subject to the workers' compensation provisions ot Section 3700 of
t e La or Code, I shall to with co ly with these provisions.
— d7
Apphcanfs - —
W ING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAI
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($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 affrm lhat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my li s m II fo1rc�,e and effect. /-+ /_
ic V _ 61es l�'� � 5�
��9-a�
Cantrac ' S a e
CO RUCTION LENDING AGENCY:
❑ I hereby affrtn that there is a cons[ructbn lending agency for the
pertomiance of the work fa wfiich this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
Signaiure Da�e
OWNER-BUILDER DECLARATIONS:
I hereby affrm 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 counry which requires a permit to
construct, alter, improve, demolish, or repair any s[ructure, 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 vnth Section 7000) of Division 3 of the
Business and Pro(essions Code) or that he or she is exempt [herefmm and
the basis for the alleged exemption. Any violalion ot Section 7031.5 by any
applicant for a pertnit subjects the applicant to a civil penalty ot not more than
fve hundred dollars ($500).): �
❑ I, as owner of the property, or my employees with wages as Iheir sole
compensation, WILL DO THE WORK, and the structure is not intended or
oHered �or sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer 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, ihe building or improvement is sold within one year of
completion, lhe owner-builder will have the burden of proving Ihat he or she
did not build or improve for puryose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The contrdctas License Law dces not apply to an owner of
pmperty who builds or improves thereon, and who cont2cts for such project with
a contractw(s) license pursuant to the Contractors License taws.).
❑ I am exempt under sec.
Business antl Protessions Code for this reason:
SignaWre
305]-A6(3l�])
Owner ID veriTed by driver's i. .❑ Yes ❑ No
Dnver's License No. Expires:
Verifica[ion of Ownership by (type of documen[, i.e. - properry [ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby ceRify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection vrith work authonzed
by this pertnit, and that no building structure, scaffolding, lalsework, a demolition
or dismantling thereof, will be more than thirty-su (36) feet high. (Chap. 3.2, Gry
2, Art 2, Sec. 341, Title 8, Califomia Atlminist2tive Code�.
❑ As owner-builder, I vnll not employ anyone to do work which would
require a permit fmm the Division o� Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicanfs SignaWre Dale
Division of IndusMal Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will ihe applicant or present or future building occupant neetl to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 of the California Heal[h and Safety Code requires, with some
exceptions, that a Business Plan be fled with ihe Costa Mesa Fire
Deparimenl by every business which has at any one time during a reported
year a quantity o( hazardous matenals equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressetl qas
at standard tempereWre and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form �or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire DepaRment by
each business which at any one time has on hand a quantity of acutely
hazardous matenals equal to or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperaWre and pressure).
3. Does or will the applicant or present or future building occupant need lo
prepare an RMPP (Risk Management and Prevention Program !or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safety Code provitles [hat the
Costa Mesa Fire Department may require the preparation, certification antl
fling with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous malerials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 ot the Califomia
Healih and Safety Code been fully complied wi[h? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is Ihe subject of this application a permi[ (or such construction
or modifcation trom [he Sou[h Coas[ Air Quality Management Disiric[ or (mm
any other air polWtion control district or agency? ❑ Yes ❑ No
(Section 658502 0! the Califomia Govemment Code requires that the requesled
infortnation be fumished on applications far non-residential building pertnits).
6. Will any part of the facility to be constructed under Ihis permit be within
1000 feet trom the outer boundaries of a school? ❑ Yes ❑ No
Qf "yes", the facility mus[ meet the requirement of Sections 25534 and 42303
of the Califomia Heal[h and Safety Code).
7. If a permit (mm the SoWh Coast Air Quality Management Distnct 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? ❑ Yes ❑ No
S. Q('yes", aflach certi(cate of compliance from the appropriate air polWtion
conirol o�cer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
in(ormation given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazartlous Materials and Emissions.
Siqnalure Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that 1 have read ihis application and state that
the information given is correcL I agree to comply wilh all state laws and city
ordinances relating to building construction, and authorize representatives of
ihe Ciry of Costa Mesa to emer upon me above-described propeAy for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permi[ until final inspection.
'gnaWre of Legal Own (s) Dale
_ �
ulhorizetl Ap D le
�
I �
OJEC�AOOPESS: Z O O 9 AL I SO AV
OWNEP'SNAME: SIMPSON, PATP,ICIA L
aooness: Z009 ALISO AVE
COSTA MESA,CA
RflCHIENGINEEfl:
FOOXESS:
� V �N�,:
92627
nec.No.:
UNIT:
PEFMITTEE: JOHN EGAn PLUMB SERVICE ( 719 ) 642-2013
aooeess: q88 E 77TH ST 101A
COSTA MESA CA 92627
LICENSEU CONTBACTOB OECLl�BATION: I �ereby af�irm Ihat I am licensetl untler provisions of Chap�er 9(commencing wilh Section
7000� ol Dimsion 3 ollne Business an0 Piofessions Cotle. and my license is in fulllor[e and eifect.
cirvuc.: 05t,5911 srarEuc.:636255 ss: C 39 EXP; 10/99
I�ate: �� �=t � y � Signaiure��� __
WOpREBS' COMPENSp710N oECLANATION: I hereby a t�at I have a certilical onsent m sel4insure or a cetlificate of Workers'
ICompensalion Insuran[e, or a cenified copy �hereol �Sec�ion 3800, La6. C).
POLICY NO.: E%P. DRTE:
COMPANY:
7 CeN�ied copy is here�y tumishe4 ❑ Certilietl copy is �iled wi�� Ihe city Building Division.
�a�e. AOP�icanC
E%EMPTIONFHOMWOBNEPS'fAMFENSRTI0N0ECUBRTION: QAi55ec�ionnee4na�bewmpleletlilNepermi�i5�oronehunU�eA�3700�ar1e55�.
I ceriity �hal in IAe peAormance a� �he work for which �his permit is issueq I s�ail no� employ any person in any manne� so as �o become
suDlec� I Ine Workers' Compensalion Laws of Calitomia. � /�
�aie'. � — I � `� � Signa �/�� % /
NOTICE: II. a�t¢r making this Oetlaralion, you s rWd om�ih oBers' COmpensa�ian pmvisions Of the Labor
Catle. you musl larthwilh comply with such pr ns or �his permii shall be tleeme0 revokeA.
CONSTBOCTIDN LEN�ING RGENCY: I here�y affirm Ihat ��ere is a cons�mclion lentling agenry tor Ihe De�ormance o� the work for
which Ihis permi� is i55ue4 (Sec�ian 3097, Civ. C).
LENOEfl:
RDOflE55:
OWNEF BUILOEfl OECLAHATION: I herehy allirm Ihal I am exempt Imm the Contrac�ors' S�a�e LicenSe Law �o� �he following reason
(Section 7031.5 Business and Pmfessional Cotle: Any ciry of counly w�ich requires a permi� �o conStmcC al�¢r, im0�ove, demolish, or
repau any stmtlure, prior Io its issuanre. also requires �he applicant for such Dermii �o �ile a signed statemenl Ihai he/she is licensed
pursuan� lo Ihe pmvisions oi Ihe Contractors' Slale License Law (Chapter 9(commencing wi�h Section 7000) o� Oivision 3 0l IAe Business
and Prolessians Code) or �hal he/she is exempi therelmm and the basis for ��e allegetl exempiion. Any viola�ion oi Section 703L5 by
any apPlicant lor a Oe�mit subjects Ihe aDPlicant �o a civil Denalry ol nol more Ihan five hundre0 dollars (5500).
I. as owner ot ihe propetly or my employees wiih wages as ��eir sole compensa�ion, will tlo �he work, and the
❑ s�mciure i5 noi in�entled or o��ered lor Sale (Section 70a4. Business an0 Pmfessional Code: TAe Coniractors' Staie licen5e Law
does na� aD�ty �o an owner al a pm0erty who builds or impmves thereon, an0 who does such work himseli/herself or through
�is ar her own em0loyees. pmvided Ihat such impmvemen�s are not inlenUetl or ottere0 �or sale. I�, however �he 6uiltling or
impmvemeni is sold wi�hin one year o� comple�ion, �he owner will have Ihe �urden o� proving he/she Ditl nol 6uiltl or improve
lor ihe purpose ol sale�.
I. as owner of �he pmDerty, am exclusively contrac�ing wilh licensetl conVaciors �o canstmc� Ihe pmjec� (Sec�ion 7044, Business
❑ antl Pmfessions COAe� The Coniractors' State Lirense Law tloes not apO�Y �o an owner of pmDeM who builtls or impmves thereon
antl who comracls lor such pmlecls wi�h a contracmqs�license pursuant m �he ConVacmrs' Sla�e License Law�. I am aware
Iha� pwo� o� iheir Worker's Compensation insurance should 6e provitled �o me.
�I � I am exempi un0er Section'. B. 8 P. C.
�or Ihis reason:
Date. Owner.
I do �ere�y cenily that I am aware of antl understantl ihe reqmrements oi Califomia Healih an0 Safety Cotle Sections 255�5, 25533, an0
25534 ane thal I or anY �uture builamg occupan� wililwill nol �circie one) neea lo comply wi�h saiA Slaie codes an� �he reQuirements tor a
permit for consimc�ion or motldication imm ��e Air �ualiiy Management �isiricL Resiaemial canstmdion applica�ions are exemp� �mm
IhPSe pfavi5i0n5
Oate NpPlicani'
I hereby certity thal I have reatl Ihis aDP�ica�ion antl slaie lhat �he above intorma�mn is correc�. I agree �a comply wi�h all ciry anU counry
ordinances antl slatelavi5reialinglobuilding consimclion and here�y authonze represen�atives o�this cirylo enteruponihe above-mentionetl
propetly far inspeclion pmposes.
Oa�e � ` � � f � Slgna�ur . �
T �
odver's License or Socia� Secun�y x:
16a1-<6 Whi�e—Bmltling�, Green—Code EnbrcemenC Canary—Applicant Pink—Revenue; GolCenrotl—Assessor
CITY OF COSTI: MESA — BOILDING PEP,MIT
PERP9IT NO: P 06`16U8 PLAN CHECK NO; N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLO
JOB DESCRIPTION : REPLACE RUPTUP.ED GAS PIPE FR0;4 yETER
CLAIM VALUE:
CALC—C�ALUE :
PERM NO: P 06760C
COCT: N SUPF: N
PURPOSE: AT_T
SQ FT:
GROUP OCC: R-3 /M-1
COMMENTS; REPLACE DAMAGED GAS PIPE FROM METER TO P.ESIDENCE
�**#u+a+��rf�#**N-##**+�#u�icas*�ricu+�*#*�#�t�*�a*�#u��+s#�#��u��#*tx#+cu*#ac�#*#.u*x-#�r*+c�«-rr�*u
Z O N I N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN HUILDZNG ---------- -------- ACCESSORY BUILDIDJG -- -----
FRNT; FT IN REAR; FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGY.T: FT IT!
PARKING REQ• PROV: FARCEL; 42624125 Zr1E: REF �Id;
PLAPdNING NOTE5:
i
#f!�iruie�#*is�rit�uit-�*ux##*#*it�r#�k�-�v-##n�tin*#�•*�u###+o-+r#�+tz��utr��*��+t#r+s�r.�x���w�:�tsr+t��*#*�r*+a�
D E V E L O P P9 E N T S E R V I C E S A£ Q U I R E M E h T S
ZONING APPROVED BY ___ DATE:
BUILDIAIG APPF.O�'ED BY : P�T�.
APPLICATION ISSUED BY: � PATE• � ����C(�
##if1EiF#�1E#�N-#i�##±ciF#�iE#iEiE#`# +r�' �"�R'�'�'�,"$'�"�'�*#if#Y�##Y�##3F'83F �;a
iEjf�jflf#�lE### IE#!F#MfR#�lf#?fiFiEifif#'#iFi��#!F####i4#1EiR###1F##ifjf#!(�iF#iF1f#lf1Fx#�EiFiF#�1f#M#iF###1R�1F{EY-aR#'IF#'-af-
LEGALIZATION;N F E E S II M M A R Y STP.00TURAL SEGP4E:�T:N
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/P.ES GRADZPIG
PERMIT 7,00
�5� SMIP/NON—RES
PLAN
ISSUE FEE 20.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAZD DUE
TOTALS----> 7.00 20.00 0.00 27.00 27,00 .00
REVENUE DIVISION TOTALS--> COLLECTED: 27.00 OVER/SIIORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC EIRE SMIP/TOT ,RADING PLAN—CHECK
2%.�� '
#if#i`iEitiEiFiFic�#iE###iE#iEifiE#?E#ifiEiE####%iE�Y1FiEit�iEitif�fAfiE####t#iE#jEaf#i(�i4##3'1E�jfi�#i£#iE#is####�1F##af+f##
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 UAIIT COST TOTAL COST
PLU 1 GAS SERVICE 7,00 7,00
END OF FEES
�i OQI623�8—Od16230$ T C1T 27,OQ
DATE: O5/15l94 7IpfE: 15�48
CONSTRUCTION AND PLANNING
APPROVALS Permit # .
1. 7emPorary Electrical Serv�ce _r Po�e
2. Soil PiDe-Undrgmd. •
3. E.ectrical Condwt UtiLty-Uncirgrnd.
4. Electrical Conduit�Und�grnd.
5. Stee! Re�nforcement
6. E eCtncal UFER Grnd.
I. Fooiings
B. Foundation �
9. Wate� P�pe�Undramd. .
10. St� ucturai Floor Sys!em �
77. Property Sewe� Line & HouseCortnec.ion
i2. Se�.v�r Cap
73. Rcof Drains �
t4. Rau9h Ptumbing
75. ftouyh Electricai-Condu�t
16. Rough ElectricYt�iring
17. RouBh Wiring Sign
18. Rou9h Eiectrical-T Bar Ce:hng
tg. Ro.,gh Heat�ng & A�r Cond�2�on�ng
20. Ro..�sh Factory F,replace
21. DuCis, In Struct�re
22. D�cts, Vent�lanng
23. Gas Rpe�Rough & 7est
24. Rocf 'rraming
25. Rocf Sheathirg
26. T�Bar Ceiling i5tr�ctuail & Monocout
27. Frame and Flyshing
28. Latf+ing & Siding
29. �ns��ation
30. Dryriail Naiiing
31. P�auer Brown Coat
32. Electncal Powzr A9eter-Finai
33. Fna Electric
34. Fina� Heating & Air Co�ditfoning
35. Fina� Gas PiDe-Test
36. Hood or Canopy
37. Final FaciorY �ireplace
38. Final Ptumbing
39. Water Service�Finai
40. Gas Servlce-Final
41. Soiar Oomestic-Final
42. Backflow Preventer
43. Backfiow irrigation
44. Landscape Irrigation System
45. Sound Atcenuation
46. Hand�caP Regutations
47. FINAL STRUCTURE & BUILDING
4$. FiNAIPLANN4NG
49. Electne Release to Ed�son
50. Gas Release to Southern Cafifornia Gas G
Date
�` .
POO SPA
Date Inspector I qppROVA�S Permit �k
�
52. Pool & Er�wprnent Locat�on
� 53. Stec' RC�n(orcercen;
- �- ------ -
+ � 54. Forr�s
� 55. EICC;ri�al6Gti):nra
-� 56. Ruugh ?iu�nu�ny & P•�.su�e Te<:
__.' i __-�--___-`__' - T-
.^_. i 57. APP;iQ�/AL'OCOVcRGUJ E-
1 55. E,ecr �a� Ctrr„n��nargrntl.
.-___�__� ______ .- -__ _
� � 59. G�s P.Pe, � Urd�9r�.:.. Te�t
i _
'�- -- ��i sa. s„ ,:asi� L�.�ics. ? r.:.Q. :. � ���.
---=j-' f------------ ------ -
� 61. iaPPPOVi.L TO :;EC<
�'-��acic��ash & Rrcepto� Firal
� 63. Heater & Vent�Finai
64. Plumh�nc� System - F�nal
65. E4ectrica4�Fina�
66. Solar SYstem-Final
67. Fencing & Access Approval
68. APPFi4VED FOR P�ASTERING
6�J. POOL,'S�A SYSTEI,1S FINAI.
FIRE DEPT. R[QUIREMENT
APPROVALS Permit �
Date �Inspector
70. Undergrowd H�J�o -I
71. Protluct P'��,rn� " G�s C O,� J i
72. Unde�9ro-� d F'ur�� �-
73. U�dery,n��.S;or:;.eTa��k��'Gas =0'.
74. O�.erhrad f�v;..o
75. C v Chem r.ai �
76. D�y StanCo oe
77, FIXED SYS?EG' Fi��A�
78. FiRE PREV. FI\�AL _�_
HEALTN DEPT. REQUIREi�7CNT
79. FINALINSPECTICV `,
80. FOOD CERTIFIGqT� �SSUED_�
Notes:
� -� $�'"sl �' / -1 x/.s-L_ /� �/
PPOJECT ROOflESS:
OWNEP'SNPME: ��09 p+i'ls� AV
— �1Ess: �IN.PSON PATR7CIA L
j 2009 ALfSO AVE
COSPA vESA,CA 92627
RBCN/ENGINEEfl:
aooxEss:
HEG.NO.:
uNir:
uNrt:
PEHMITTEE: pETRONELLA ROOFING ( 714 ) 548-1645
AOOPESS: �6?Cl .N�w��.�,1,
�:�5�'� M�S$, CA 92E�27
LICENSEO CONTHACTO 0�LP ON: ere y allirm thal I am licensed untler pmvisions o� AaD�e� 9(commencing with Sec�ion
7000) ol Drva�on 3 0l ihe Business ana Pmlessions CoOe. dnG my license is in lull force and efiec�.
CITY LIC.: STATE LIC.: CLFSS:
032605 00460707 C� ,j
Oaie� Signalure� .�
WONREPS' COMPENSATI01 OECLANATION: I hereby a ir I have a cenificate sem m selbinsure or a cenificate ot Workers'
Cotnpensalion Insurance. or a cetlJietl copy ��ereof (Sec ioq 3800, Lab. C�.
roucrNo.: Y079987..g2 EXP.�ATE: O%IOII9Z
COMPRNY: STATE FUNI�,
� Cerli�ie0 coOY is hereby fumi5he0 L3� Cerli�ietl copy is filed with the city Building Oivision.
Jale: U ' � � ( / AUPbt . �
E%EMPTION FBOM WONKEflS' COMPENSATION OECLPfl ION: (lle 5et�ion n¢eA na� �¢ complere0 il Ne permii i5 �or one hwdred �$100) ar less�.
1 tetlity Iha� in Ihe p¢r�orman[e ol Ihe work �ar which I is pefmii i5 i55Ue4, I shall not emDloy any person in any manner so as to heCome
subleci lo �he Workers' Compensatmn Laws ol Califomia.
Oate: Signature:
NOTICE: II. ailer making this declaralian. you shoWd bpcome suble�< <o �he Workers' Compensation provisions o� Ihe Labor
CoOe. yau mus� totlhwilh comply with such Omvisions or this permit shall be Aeemed revokea.
CONSTHOCTION LENOING NGENCY: I hereby aifirm I�at Ihere is a cons�mc�ion lentling agency lor �he per7ormance o� ihe work for
w�ich Ihis Dermit is issued (Sec�ion 3097. Civ. C�.
LENOEH:
AOOflESS:
OWNEX BOILDEfl OECLABATION: I hereby allirm �ha� I aR� exemD� ��om Ihe Contractors' Sla�e License Law for �he �oliowing reason
(Section 7031.5 Business and Pw�esvanal Cotle'. Any ciiy ol coun�y w�ich requires a Oermi� lo conSVuct, alter, impmve, demolish, or
re0au any simcNre. prior lo �ts issuance, also requires ine applicant for such permit to file a signeA statement �hat he/she is licensed
pursuam 10 �he pmvisians ol Ihe Contrac�ars' Slale License Law (Chapier 9(commencing wi�h Section 7000) o� Oivision 3 al Ue Business
and Prolessions Cotle� or t�a� he/5he is exempi therelmm apd �he 6asi5 for lhe alleged exemp�ion Any viola�ion of Seciion 7031.5 by
any applicani �or a Dermit sublects the aDPlicanl �o a civil penal�y of no� more Ihan live hunAred dalla�s (5500�.
I, as owner ol Ihe pmperty or my employees wi�h wages as their sole compen5a�ion, will tlo ��e work, and �he
❑ stmcture is nol imendetl or o�fered for sale (Seclion 7pq4, Business antl Prolessionai Coae: TAe Contraclors' S�a�e Gcense Law
aoes not apply lo an owner oi a pmDehY w�o OuilOE or impmves �hereon, an0 who does such wark himsel�/he�self or �hmugh
�is or �er own employees. pmvideJ IAaI such im0�ovemen�s are no� iniendetl or otlered �or sale. I�, however ��e builtling or
impmvemen� is sold wi�hin one year ol comple�ioq the owner will have I�e burden o� pmving �e/she ditl noi DuilA ot improv¢
for Ihe purpose ol sale�.
I,as ownera�the pmDe��Y.am exclusivety con�rading wi�hlicensed conlrac�or5io con5imcl�he pmlect(Sec[ion 7044, Business
❑ and Pwlessions Code: The Conlrac�or5' Sta�e Licens¢ Law Eoes noi appty to an owner oi Omperty who builds or impmve5 �hereon
antl who coniracls �or such pwlec�s with a coNractpr(5) license pursuanl �o �he Contracioa' Sta�e License Law),I am aware
Nat D�ooi of their Worker'S Compen5aiion insurance shoultl be pmvidetl to me.
� I am exempt un0er Sec�ion'. 8, g P, C.
br this reason:
�aie: Owner
I tlo hereby cenilY Ihal I am aware o� antl untlers�and t�e requiremenis of Califomia Healt� ana Salely Code Sec�ions 25505, 25533, antl
25534 and Ihal I or any �ulure builAing occupani willlwill noi �circle one) need to comply wi�� said s�ate cotles antl Ihe requiremen�s �or a
permil lor consimclion or matlifica�ion irom ihe Fir Ouality Managemen� DisVicl. Fe5i0ential wns�mclion ap0lications are exemp� fmm
�hese provisions
Oale: Applican�:
Ihereby cetlitythalihave reatl Ihis applica0on antl slale Iha� �he a0oveinlorma�ion is [arrecl.lagreeio comply wilh all ci�y anU counly
ortlinances antl siate laws rela�ing to builtling consimdiun antl hereby authorize representalives of ��is cily lo enter upon the above-mentionea
pm0erty loi inspec�ion pu�poses
�ate V � � �� $ignature'
Onver's L¢ense or Soaal Securay a: .
t64b46 White—Bwltling�. Green—Code Enlorcement; Canary—ApplicanC Pink—Revenue', Goltlenrotl—Assessor
CITY OF COSTA MESA — BI7ILDING PERMIT PERM NU; H 05318
PERMIT NO: B 053186 PLAN C:iECR NO: N GOVT; N SiIPP: N
CONSTRiJCTION TYPE: 5—N PERMIT T'YPE; STR PURPOSr: ALT
JOB DESCRIP`tION ; RE—SHEATH E RE—ROOF WITH CLASS "A" COMP SQ FT: 4,100
CLAZM VALUE: Q,100,00 CALC—VALUE: 4,100.00 GROliP OCC: R-3 /M-1
COMMENTS• SMOhc. DETECTOR(S) RE�UIRED IN HOME.
ce�**�t##x�i�x�*#�#*a��t��*#�i�*���*�*�� i���c�+r**x�*#�*x�*##**v�u�x��**��i�����**�*�rx�**��x-*x��##*x�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUZLDING ---------- -------- ACC£SSORY HQILDING --------
FRNT: FT IN REAR: FT SN FRNT; FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT I7� RGHT: FT IN
PARKING RE�j • PROV; PARCEL: 42624125 ZNE: REF NO:
}�LANNING N15T:;S>
i
# iF �k �E 3E iE 1E �N- IE if # iF iF 761E 3f 3F ik 3f iF T'� # ic iF if �1F ��7E iE 3E lf ####�E Y.� i6 # 3E i41F # iE if k iF �1i� ##E i� 3(� iE iF # iF iF jF # if iF �E ii� 1E ## H� )E iE 3F �F 14 iF ##?F 3i� # iF
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 N, E N T S
7.ONING APPROVED BY DATE:
BUII�DING APPRQVED BY : ��,_% DATE;
APPLICATION ISSUED BY•�----��i� /. DATE• ��
iEiE!(�3fiflFiE?FiEiEfFiF#iF3E�1Ei(�if;tiflElF£� ��' s�L��9rif lf ] iFiF '�f IF�Ti;FIF'F7i�3F�if�ieR3fiFiEifiRifik {E�(�
iFiFiFifififiF#%#ihi(�i(�1ElEif#i?iF#iF!lii�i(�!'tfF#fFiFie#iF�]FiElfifiEiflf�if# "IEiF?fifiEiF:E-%�ifieiEir#iciFitifififiFiEl(�it#if3EiF�E3ERi##iEiF3Eif�
LEGALIZATION:N F E E S U,N M A R Y ST'RUCTURAL SEGN.ENT;Y
BLDG PMT PLUMBING ELECTRIC NECAANIC FIRE SMIP/AES GRAiIING
PERMIT %2.00 .50
SMIP/NON—RES
PLAN
ISSUE FEE
BJILDIi�1G—DIV—> PERMIT ISSUE PLAN—CHECY. TOTAL PA3D DUE
TOTALS----> 72.50 0,00 0,00 77..50 "/2.50 ,UO
REVENUE DIVISION TOTALS--> COLLECTED: 72,5U OVER/SIiORT: .OU
BLDG PMT PLUMBING ELECTRIC ,KECHANIC FIRE SMIB/TOT GRADING PLAN—CHECK
72,�� ,5�
�F 3F iF �E # jE iE IF # 1F iE �If iE * 3f iE aE if iE if iF i4 3f i(� iF 3f if 161F 3F �k iF iF iF #!E 3(� �lE IE iF if� if !f !F iE 3L� f'r i(� iF IF fE% # ff if if iE �)f 3e �1(• iE �f iE 3f iE If If ?E if iF k?E ii lf lF �lE IE iF iF
I N D'I V I D U A L F E E H R E A K D O W N
TYPE [J'TY D E S C R I P T Z O N UNIT COST TOTAL COST
SFR 4100 REROOF' BY VALUE RESIDENZAL NOZONE 1,00 4,100,00
END OF FEES
(I'I .�•LIQ':'7'i r,ryi..i - -
DnT�t CS; �1' � �`� ?:, � _,:I =„
CrNSTRUCTION AND PLANNING
6;PPROVALS Permit #
1_�Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility�Undrgrnd.
4, E.ectrical Conduit-Undrgmd.
5. Steel Reinforcement
6. Eecvical UFER Gmd.
7. Footings
8. Foundation
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Dreins
14. Rough Plumbing
15. Rcugh Electrical�Conduit
16. Rcugh Electric Wiring
17. Rcugh Wiring Sign
18. Rcugh Electrical�T Bar Ce�ling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. DuCts, in Structure
22. Ducts, Ventilating
23. Gas Pipe•Rough & Test
24. Rooi Framing
25. Roof Sheathing
26. T-Bar Ceiling (Structurall & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31 . Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & F.ir Conditi0ning
35. Final Gas Pipe�Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BU�LDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas G
51. CEFTIFICATE OF OCCUPANCY
No. Date
Date
POO �A
Inspector ,4PpROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER�GUNITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines,P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor�Final
63. Heater & Vent-Final
64. Plumbi�g System � Final
65. Electrical-Final
66. Soiar SYstem-Final
67. Fencing & Access ApP�oval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
77. ProductPipingOGas ❑Oil
72. Underground Flush
73. Undergmd.StorageTank �Gas ❑Oil
� " 74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
" 78. FIRE PREV. FINAL
� ��';' HEALTH DEPT. REQUIREMENT
. 79. FINAL INSPECTION
� " S0. FOOD CERTIFICATE ISSUED
Notes:
:
�,:
Date � Inspector
r
a ��,
,w
� � r- � o . 3�, .;« �, a�
sY aV k�� � 9� .^. fir� .a'PW% YI'4.:
...�-�i 5 � �r -r , � ��,a� -at..�
carinspection,a � Testyn,gfEngtii
,�
�
�;���
�ti� � -
,� �� _ -
-�f�� -
� , _ _
:• 'i�i! k'F .l�iv' IRl! � /
� "�' �y SoilxFoundafion E[na/ysis�� ,��+..- �"r r3�% � � r �`c�Y w��ri
•' � x �' � � .:,,. Chemica] Anal sis�'t'"
��r.,'�f�r!i�..a._r.er.....a._v��dt��•c l.,re�. Y. K^a°
' '__�.,' __.__ .. . _._' _.____ . . _ _ __-_._...___.
� SYJIM POOL'- 2009 Aliso - Costa Mesa
� � . � i.� . . .
, --� ""_ Sample frorn, . . . Wa I I S . . _ . _ ..
Architect
Contrs�ctor � � - . . � � � . . -
,Miz - ,Hand Pzck. = Bay Ready Mtx, .
0
� �1'ater, gal./sk. cement �'
, Slump ; . .
Date cast 8- � LF-58
•°;i'
Datetested II-2I'-58 , B-2E3-58 9-Ii-58
Cylindcr iv'o. I . . I-B I-C
_ CO\IPRLSSIO\' TLS1; - 7 days 14, days 2�3 days
Total load to destruction, lbs �15,500 � __ _ _ _ __ 66�000 __ _ __ -�_ 88 �,000. ..
Poi�nds per sqiiare inch I� fi10 2�3}5 3 i 115
' Cqlinder made by. J. E i f f ' � ��
d�• �, �o � �0 I2 .
Cy linder delive'red b}� ' J. E f f f � ��, �lf:e�"� �
- VEQ �
� Cylinderreceivedon 8-�5-58 ' . S`P 17 , ,
x '��Fr tV
• Note: 28 aay test complies with specific'ations. ���'ot���
` Bui/c'ing p�pLEsa �
\
� ; , ���--
{'4 I
cc: Corson Pools 2 '
� T�\'INI\G LASOR TO IGS F SOUT .R\' CALIFORfiT'a"'"
Costa Mesa BIdg,Dept.�2 ` �D� .
. , SA Lab ' /U'
.. , w�� w�roe» w�e mewrr�o e� TM� cwnou�ru� �no��en oi cuawr�. �vrwoeiun6n roe Muc�non er piw w�rowr�. cwmwuor,�. on u.
. . C�1MCTtI1�OMORI�[Y/�I�OIMOTX[M1�1�[�[ItV[Ot[NDINGWI�WI��T[MIVIIbVAL/.�/�YVTV/�LrIMT[CTIDNTOCLI�MT��TN(N�LICANOW11�lLV[�. .
�Costa. Mesa Bw g De�artment
� �. o. s ! �
'+ COSTA MESA, �IFORNIA
FOR APPLICANT TO FILL IN
, Building 0 / S a
Addresa L_
Costa Mesa, California
Nearest � ,
Cross St.
Owner%�gf�/� � �r �i��AM
Mail t" // R � � d N-O , dn
Address �7 G- .oDv
Address 2 F�
_ . S
Size of Lot
l�se of
Existinq BI
7� b!/).J�'� ���1//1a��� �
fi i% AN' Noy L�QLf 7
£�Ti„ii �/,�, �N,ead
' I Block I Tract�l�i5
� INo.of /I No.of
Families Rooms
�m �, RearYard ?/
. �; d Side Vard !, �
CRIPTION OF WORH �7
X I Alteration I I Addition I
Hepair � I Moving I I Demolish I
Buildin9�ss No. of /
Size
Exterior Wal
Covering �
Use of New p� S,
Buildina 7�
APPLICg� ON FOR PERMIT "
�4��� B�ILDING� '
FOR OFFICE USE ONLY
Receipt No. Permft No.
�y�3�
Received by Date Rec'd. Date Issued
�� �— 7—SG d'—�'-��
Buildin
Address
Costa Mesa, California
Nearest
Cross St.
Zone jJ No. of Type Grou ./
/«% I Plans I ! Y
REG.
PLAN TcCH. / ' J
O
�
_ ' , • ,n
Z
D
r
Stories � , - - - . . . �
S/i A -V. APPROVAI.�.S.
q- Foundation Location I Inspector I
Forms, Materials,
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Latb. Int.
with all City Ordinances and State L.aws regulating
building construction. Lath. Ext.
Signature of
Permittee � � Plaster, Int.
Aulhorized Agt. plaster, Ext.
Valuatlon Permit Fee $ ..�J oZ — Masonry Reinforced
$ � .�/ � bO� Total heck $ � �o '� gond Beam
Fee $ �� FINAL
_'OliM xaa �o.ss o. r. a s.
PLOT PLAN
Show Iocation and disYances from
property tlne and between buiidinga
� ' {
'r��
0
.,�;, _� r'1-U�EST�'�oErc . . .' i'r� �r
: �'
� L
.�i i � r
� ! .
. � ' � \ f ,`. .1 \
> � ��
A
`� . i� 'rl 1
0
� �1
r ���.� � .
OWNER $1iF'F''�,L &. NiCAD1� DATE 8_8_56
JOBADDRESS 2009 AZ].SO Ave. BUILDINGPERMITNO. #3I136
GENERAL CONTRACTOR Saffell & McAdam VALUE $ ].3,360.��
�, 2 BLOCK TRACT 2993 xes. w/att. gar.
GROUP I Sc J TVPE V ZONE RLL FIRE DISTRICT 3464
PERMITSISSUED
I SP T ON AT SUBCONTRACTOR DATE NUMBER
1 �j'N'n`� �- y�
F�tinaTre � -�f%'_� %�
and Grede to Garaae��� Q-
toS�ab '�'Y7/".f2 IS/�'S/.S'!o I i�i... N%,.r_<. �, I.f�/ni„C�I G O-�-.1 —
Pole �/--�� ___ �� /�Sc ,a / r i' ..' G . i �' /T, :J ! ..7 . -� �,� —
�5h �//1.�, �-!✓' fi '/�Insnr.�,n,�1.1.� ��'r�-7_-_R�' /� c7-.``5' �4_tS �-
uan(D.�r . . n.�, � S �'l� _�.,� �,.�s „ �-2��t'/ /_/ 7/ —
'$ewer, House%]}�Kb/f9�5 " er, $t. /�:,ti,•� (1(,��tl Q / j��� b �S3 ( S ^
'� t��
� �'c Tank or�C�sspool �
. .ig, In'� Out; ' i � �01 "�
Plastering � `. ) � Y/. � '
Plumbing, Final, Fixtures Comp�ete .S �r b
-�5- s ' 7� � ��t�—
Plumbing,Fin•alGasTest �.$�—/�G /� 3� 6 � J
Wiring, Final � $i _ � �
Occupancy � �! 1 �
FORM 210 3M 10-05 3��
" `','• ��4 �l'�/� l s
. " �r�--o�
COSTA MESA BUILDING DEPARTMENT
. P.O. BOX 31�
COSTA MESA. CALIFORNIA
��� ��CEI�lE�
(i�1 - ����� � ,
FINAIVCE DEPT.
nirv nr nneTn nnrcn
vu� vi vv.iin mwn
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING � BUILDING
AODRE55 Q
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
�. I� RECEIPT NO. �RMIT NO�
OWNER � Y
MAIL RECENEO BY OATE PECEIVE� Xj�qTE I/S5 ll ,?y/
ADDRE55 O O , �S " �/ S u
TEL. BUILDING Q/(S, Q
QTV NO. ADORESS 2�� / �
ARCHITECT" (� � LIC.
oR Er�GiNeeR L� � No- COSTA MESA. CALIFORNIA
FIRE
ADDRES i ZONE
ZONE NO,OF TYPE GRO�IP
ITY LIC. / �/ PUNS�. �.�J'"' �
CONTRACTOR NO. ���/ V
ADDRE55� � �O � y � aVP kei DATE
�E�A� �or _`) x99,� CORRECTIONS
oESCeiPnoN NO. f� BI.00K TRACT
A.P. NO.
o z Tl? f�e.'�.' �I ;` �^'� e� - i�/r�.o� ,.
SIZE NO.OF BLOGS.
OF LOT S X G now oN �o• I
USE OF �
EXISTING BLOG.
$ETB4CK LINE FROM '$
C[rvlen oF srn[[i Sy� � REAR YAR� .j �
� �C�C'Tj� ,� �
SIDE YARD RIGHT S LEFT (^j.' ❑�ir,
DESCRIPTION OF WORK [�L��'�h'��� D�r�• �
T tCG•
SUB c..• �'
NEW X ALTERATION ADDITION �� �
REPAIR MOVING DEMOLISH ���a D�
Bl11LDING NO.OF p�AN �-"' �
SIZE / � ROOMS STORIES /
EXTERIOR WA�L ROOF
COVERING COVERING
USE OF NEW � _ %%
BUILDING O�Q•L
1 MEREBY 4CNNOWIEDGE THwT I HqVE REPD TH15 qPPLICnT10N aNp
STATE THPT THE ABOVE IS CORRECT ANO AGREE TO COMPLY WITH PLL
CITV OPDINPNCES /�NO STPTE L/�WS REGULATING 6llILOING CONSTRVC-
iiorv. /.�f/1 � VALUATI ON
SIGNATVREOF ��! IIAA�.w PERMITFEE � f��
PERMITTEE ��P" �� � /�
3` �/ Q PLAN CHECK S 6'^
_ / $
AUTHORIZED AGENT ✓ TOTAL FEE $ � � �
OWNER A. Neeb OCT 2 8 t�o8 DATE �3-1-5�
JOB ADDRESS 2009 Aliso StrePt BUILDING PERMIT NO. %2�S
GENERAL CONTRACTOR Corson Pools VALUE $ 3,100.00
AP. No. LOT 2 TRACT 2993 FIRE ZONE DESCRIPTION OF WORK SW1IR POOl
� [IP .T TYPE li . ZONE Rl PLAN NO. 72I1CS
INSPECTIONS
roat
F�..,.� Gas Test
v
SUBCONTRACTOR � PERMITSISSUED
DATE I NUMBEI