HomeMy WebLinkAbout1680 RHODE ISLAND CIR - Building Permits �' CITY OF COSTA MESA
t<'�"'_ s _ BUILDING DIVISION
>• ; 1 - •` DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F 1 w...ta 1
PERMIT
' B02-02080
it'bieropuro°`.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa �DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1680 RHODE ISLAND CI Status: ISSUED
Suite: Applied: 12/30/2002
Vicinity: Issued: 12/30/2002
Parcel Number: 13961153 Zoning:
*_______
Applicant: MILLER, MATT
ISSUED BY:
Address: 905 S CALICO CL - - .-
Phone: -(714)226-0747 - - "
ANAHEIM,CA , ' Zip: 92804
•
Owner TENG HAN YUAN " •
Address -2522 STEEPLECHASE LN
' DIAMOND BAR,CA " - - Zip: 91765
, • - - /' / '.v=AA
•
Contractor: `ALL PRO ROOFING
'Address: 905 S CALICO CL
Phone: (714)226-0747
ANAHEIM,CA
Zip: / 92804;" ' Licenser 768511 - - - -
•
Arch.:
•
Address: - - Address: ,
Phone: ,
- - _ '.�''-
N.
Zip: License: - '-.License: -
,
N.-
SCOPE OF PERMIT
' TEAR OFF EXISTING ROOF,INSTALL-SHEATHINGCOVER-WITH.30 YEAR COMP SHINGLES. `5
Y -
-.
. FEE SUMMARY `,'
i Plan Check: • $0.00 - i",,- Calc Valuation. X34,527 00
Permit $111.25 — - - ' - Claim Valuation i,' - -$4,527:00
SMIP Res:, $0.50 - i` • - • i
\SMIP Corn: $0.00 / ori
- Other $0.00 ." I 7-,,,,' i
�7Inspec
, tion: 40.00
�.
;yTotal: $111:75
i%
- PLANNING &ZONING • /-
SETBACKS\ �' �, i/ " ,�
MAIN STRUCTURE-Front 0-0 Rear- 0-0
ACCESSORY "-Front 0-0 ' Rear - 0-0 Left 0-0 _ Right '- 0-0 / '/
PARKING Existing:- - 0. /- Required: ,, 0 - ' Proposed: - 0 .. i
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448-46(6/00)
. ,
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 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
artier: Policy Number:
/s sec n need not be completed i/the permit is valued at one hundred dollars($100)or less.)
certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so a to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Secti n 3700 of a Labor Code,I shall forthwith
comply with these proves' ns. 1 �I0/
Applicant Signature: �2/L�� -�- Date: I SO
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES ND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.a / Class k �7
Contractor's Signature: f/ /Q� Date: / i 3O \h
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.(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).):
❑ 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 offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does riot 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. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I 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,An 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e
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? 0 Yes 0 No
(Section 25505 of the California 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 of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California 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).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit 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 prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance front 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.
•
,(tyx _ Sign Ot wner(s)/�I 1270 )0/0:
1 0/ !'� ;
lVI)I 1V/\"'6♦Authorized Apollo n'3 t- — 1//r U'ff3feLl
CODE I INSPECTION TYPE PAIS INIIDALS CODE INSPECTION TYPE PAIL IKEM.Na
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 05/OA 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy
• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF,COSTA Iy1 St4� C $T UCTION PERMIT : v PE •i Op TRACT NO. LOT NO. UNIT NO, a p I
'(I/O �N[1n/j� Si �/ / /�� //1�3 I25k 7/10/9,7
SOC.' I T
Project AddressI,{.yfl� ' / / IVsli[ H I f� // '
Applicant's Mailing •ddress _ /�'!L $ _ f ,. 1 TYPE OF,CONSTRUCTION ❑ NEW ADD H ALTERATION L_YR EPAIR r
' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name D1. - Phoney % • 0 _ A.P.# _ _ _, - _ - _ Zone
r DESCRIPTION OFWORK/USE OF BLDG. -'
Address - S. / tel/ / 1 - • S Main Building: Accessory Building - Z
Arch/Eng.' • License♦No. TYPE Or PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front O
Address • • _ ❑ TENANT ❑ ELECTRICAL. PLUMBING ❑ MECHANICAL B Rear , N
/' n/� yy1 p�qn/� •
I
Contractor's Name • tC, /� 'Y�.//////�����tV! /l�'J/ Phone O`sNNII�S • - ❑ OT.HER A G
• Address(mailing) 6 4lW� 3� 1 Y 1/ • PROJECT,DESCRIPTION SQ. FT. OCCUPANCY K- Right' N
/t/'y.2 • CONSTRUCTION TYPE VALUATION$ S Left j R
CityiLicense No. ly /v
ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parkin pa y E
LICENSED CONTRACTOR DECLARATION . -. g Req./ProvL d�J01 M
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarksj- • - I Planning Notes: ' - • - L 7
with section 7000) of Division 3 of the Builness and:Professions Code,and ' . -• - r 1
my license is in full f. d effect. �' . •
_ RECE1JED `��� T
Date 0.-A.. ti� Signature ���L /' /�- PLUMBING •FEES
WORKERS'COMPENSATION DECLARATION • Bar Sink • • •
lereby affirm that I have a certificate of consent to self-Insure or a certificate _ _ . Showers ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Se tion
Backflow Preventer. - Service Sink
s8o0, Lab. c,4„.„,„ •'1 _ r - • ' _ Automatic Washer- Transformer 0 15-50 KW
•
\ Policy No. /"f WaH-R� Company`7/Llifl Fr Backflow Irrigation • Sewer Cap ❑ 50+, KW -
- Construction Pole Sub.
�ertified copy is hereby furnished.
D Ceytif r�op15.liled with the city II ' I{torrrjjj'''/// ��' ��I Bathtubs' • • _ ' . Sewer Connection _a i _ _ _ f Cooking Unit , ' Meter ❑up to 100 amps '
Date Et r4iffl d l ' Applicanty �t /I"✓t -
EXEMPTION FROM WORKERS'COMPENSATION DE LARATION / Clarifiers Solar Collectors- - i Dishwasher . ' - Meter Clover 100 amps
• (This section need not be completed if the permit is for one hundred ($100) or _ - '
•less). . Dishwasher - - Solar Piping - -- • ' Dryers ❑Gas ❑Electric • Sub Panel '
• 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 Drinking Fountains Solar Tank - • Fan Motors❑0-1 HP ❑1%-8
Workers' Compensation Laws of California. - _ _ _
Date Signature .• Floor Drains 1 Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP'❑16-15+'
-NOTICE:If,after making this declaration,you should become subject to the _
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks UrinalFixtures
comply with such provisions or this permit shall be deemed revoked. Microwave •
CONSTRUCTION LENDING AGENCY i Gas Servic¢ . Outlets . Water Closet •
I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
• of the work for which this permit is issued (Section 3097 'Civ. C.) —
Lender's Name Interceptors I r Water Heater g Outlets • Range
Lender's Address-. Kitchen Sink •' _ Water Service -- . - . . •.Switches - - Sign - -
OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law,for the Lavatories Auto-Wash Garbage Disposal •' 1 Standing Sections
following reason (Section 7031.5 Business and Professional Cod& Any city or -
•
county which requires a permit to construct,alter,improve,demolish or repair . . P-Trap . ' Generator ❑0-5 KW ❑5-15 KW Trash Compactor Laundry Trays - - :
any structure, prior to its issuance, also requires the applicant for such permit -
to file a signed statement that he/she is licensed pursuant to the provisions of • Roof Drains - -
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of - ,
livision 3 of-the Business and Professions Code) or that he/she is exempt - - ' - '- .- - -
mrefrom and the basis for the alleged exemption. Any violation of Section •
.031.5 by any applicant for a permit subjects the applicant to a civil - r ' -
penalty of not more than five hundred dollars ($500). iI :
0 I, as owner of the property or my"employees with wages 'as their sole Reinspection Fee I $15 Issue Fee $ 3 - •
' -
compensation, will do the work,and the structure is not intended or offered 1 - Reinspection Fee $15 Issue Fee ' $ 3
for sale (Section. 7044, Business and Professional Code: The Contractor's MECHANICAL FEES -
- 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 -
DEVELOPMENT SERVICES REQUIREMENTS: '
employees, provided that such improvements are not intended or offered for Boiler Hood Or Type I 0 •
• sale.:lf, however, the building or improvement is sold within oneyear of com- Canopy Type II 0 ' - Zoning Approved By _ Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground i -
• prove for the purpose of sale). -• - Building Approved By Date �7 �/1
❑-1,as owner of the property, am exclusively contracting with licensed con- Duct-Structural , Refrigeration System Application Issued By Date-,/_ALL
tractors to construct the project (Section 7044,Business and Professions Code: C
The Contractor's License Law does not apply to an owner of property who , Duct-Ventilating . 00-100,000 BTU 0100,000 BTU • SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware'that BUILDING PERMIT $- SMIP _ ,$
proof of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple ❑ • System Repair/Alteration .
• PLAN CHECK $ TT ' PERMIT _
0 I am exempt under Section B.& P. C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers - L ' ISSUANCE • $
PLUMBING $. S
• Date Owner • • Heating System& Ducting Registers PLAN CHECK 25% 'S• - • ENERGY P.C. '$ ' - -
-
I hereby certify .that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BT ELECTRICAL $ GRADING . $-'
information is correct. I agree to comply with all city and county ordinances.
and state laws relating to building construction and hereby authorize repre- PLAN CHECK 50% $ '(. MICROFILM $ -
sentatives of this city to enter up•' the above-mentioned property for _ _ r� •,
inspection OK os` , , -/
, Reinspection Fee - $15 Issue Fee $ 3 PLAN CHECK 25% $ - ,
= T.0B6``rev.10/B4 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor -
CONSTRUCTION AND PLANNING ' _ POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement "'*
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. .55. Electrical Bonding
5. Steel'Reinforcement . 56. Rough Plumbing & Pressuretest .
6. Electrical UFER Grnd. ' .. 57. APPROVAL TO COVER-GUNITE
r-,
7. Footings - 58. Electrical Conduit-Undrgrridl '
. r:
8. Foundation - 59."Gas Pipe, 0 Undrgrnd.,TOS
9. Water Pipe-Undrgrnd. , .. 60. Backwash Lines, P-Trap, 0/Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK
• 11, Property Sewer Line & House Connection - 62. Backwash & Receptor-Final •
12. Sewer Cap" 63. Heater & Vent-Final
13. Roof Drains - 64. Plumbing System - Final t
14. Rough Plumbing 65. Electrical-Final.
15. Rough Electrical-Conduit - 66. Solar System-Final '
16. Rough Electric Wiring 67. Fencing & Access Approval -
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS-FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# , , - .
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating. 71. Product Piping 0 Gas 0 Oil -
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing " - 73. Undergrnd.Storage Tank`❑Gas 0 Oil '
25. Roof Sheathing .- . , . 74. Overhead Hydro . -a . ..
. 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical i .'
27. Frame and Flashing 76. Dry Standpipe '
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation . 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat " • 79. FINAL INSPECTION . .
32. Electrical Power Meter-Final I 80. FOOD CERTIFICATE ISSUED --
33. Final Electric • Notes:?fl,.fV C.f.�. Yom. 20.3 (J.P.� I-CZ
34. Final Heating & Air Conditioning - _'
7
35. Final Gas Pipe-Test
36. Hood or Canopy• . . .
37. Final Factory Fireplace / r _ •
38. Final Plumbing ---
39. Water Service-Final
40. Gas Service-Final -
41. Solar Domestic-Final - '
42. Backflow Preventer
43. Backflow Irrigation .-
44. Landscape Irrigation System i
45. Sound Attenuation - - -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. -Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date - i'
•
I. _ _ T - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ _ - - -_
CITYa , 1•1111
mos ima .
OF COSTA MESA oQ�v S q CTI ON PE PE 1
TRACT NO. LOT NO. UNIT NO. • , -
)1280 hY►Doe j ' (Iiv'Je, I •
Project Andress Li
�� Y • , '
Applicant's Mailing Address -Hour ,•� � J/ •, . TYPE OF CONSTRUCTION Li NEW U ADO Li-ALTERATION 1"[ -REPAIR REPAIR
Owner's Name Phone r� `
CI CONVERSION El DEMOLISH ❑ OTHER —. - - - - _ .
•
A.P.# - + .- Zone
DESCRIPTION OF WORK/USE OF BLDG.
Address `'0 • I S Main Building: Accessory Building:, I
Arch/Eng. License No. TYPE OF PERMIT• ❑ GRADINGrr�❑IFOUNDATION ❑ STRUCTURAL •• T Front 01000(4077-00004077 'TOT `.o
CI TENANT Ill ELECTRICAL L .PLUMBING ❑ MECHANICAL B N
Address• � Rear t• -
Contractor's Name • Iii. 2rtaia' Ph ❑ OTHER -- • _ - _ C Right _A . _ . • N
n - ,orA,c¢ PROJECT DESCRIPTION .5q. FT. OCCUPANCY - G
Address(mailing) a: ' r,. 7 af'EYp ' / K -
3D237 ftr CONSTRUCTION TYPE VALUATION$ S Left - R
City License No. C/ /'-/ ZONE - GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION - J. Ping. Ref.4 Parking Req./P�rovi¢�Q O
I hereby affirm that am licensed under provisions of Charter 9 (commencing Remarks: V `�, Planning Notes: RECEIVED MAY oo �t7 M
with section 7000) of Division 3 of the Business and Professions Code, and sA - T
my license is in full force and effect. ' $
License C s ins- No. PLUMBING - I 'FEES
nTii
Date a. Signature -
c )RKERS'COMPENSATION DECLARATION Bar Sink - Showers ELECTRICAL FEES
areby affirm that I have a certificate of consent to self-insure or a certificate • . -
. Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer _ Service Sink -
3800, Lab. C.) py Automatic Washer Transformer ❑•15-50 KW
\ Policy No. ��f03//%g Company C.1 / �/�it Backflow Irrigation Sewer Cap - - 0 50+KW '
Construction Pole Sub.
.4Certif ietl copy is hereby furnished. '
Certi lea( sow,filed with the city B ' 'in• •' "sio Bathtubs Sewer Connection Cooking Unit. - Meter Dup to 100 amps _
Date d�i5"f1 rt Applicant _ .../ - a - ' - .
, EXEMPTION FROM WORKERS'COMPENSAT ON DECLARATION Clarifiers Solar Collectors - Dishwasher , Meter Dover 100 amps •
(This section need not be completed if the permit is for one hundred ($100)or •
less). ( Dishwasher ,--- 'Solar Piping 12_� Dryers EGas DElectric ' Sub Panel •
I certify that in the performance of the work for which this permit is issued, _
shall not employ any person In any manner so as to become subject to the Drinking Fountains' Solar Tank Fan •• ' Motors ❑o-1 HP D K-8 '
Workers' Compensation Laws of California. •
Date Signature Floor Drains Swimming Pool w/Spa - F.A.U. Inc.Solar ❑9-15 HP 016-15+ •
-NOTICE:If,after making this declaration, you should become subject to the - - - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks . Urinal Fixtures
comply with such-provisions or. this permit shall be deemed revoked. - Microwave
CONSTRUCTION LENDING, AGENCY - C) Gas Service Outlets Water Closet Device Boxes Pole Light '
I hereby affirm that there is a construction lending agency for the performance '
of the work for which this permit is issued (Section 30971-Civ, C.) Interceptors Water Heater Outlets Range
Lender's Name • '
Lender's Address - , - - Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal • Standing Sections
• following reason (Section 7031.5 Business and Professional Code:-Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit • Generator ❑0-5 KW ❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
'he Contractor's License Law,(Chapter 9(commencing with Section 7000)of _, • -
livision 3 of the Business and Professions Code) or that he/she is exempt - • ,
•
.herefrom 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). $ 3 .•
❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee • _
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 -
for sale (Section 7044, Business and Professional Code: The Contractor's - - MECHANICAL FEES ,
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 DEVELOPMENT SERVICES REQUIREMENTS: . ' -
employees, provided that such improvements are not intended or offered for Boiler • Hood or Type I 0
sate-If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 • Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building• Approved By Date •
prove for the.purpose of sale). '/�
CII, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System 'Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU - SUMMARY OF FEES
builds or improves thereon,and who'contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ ' SMIP $ •
of Exhaust System 0 Multiple 0 System Repair/Alteration
proof their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT.
/ g,,,• 0 I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG 4 Fire Dampers PLUMBING $ � O� ISSUANCE $
Date Owner Heating System& Ducting • Registers PLAN CHECK 25% $ ENERGY P:C. $
I hereby certify that I have read this application and state that the above 1:0-100,000 BTU 0100,00087 ELECTRICAL $ GRADING : $ . .
, information is correct. I agree to comply with all city and county ordinances
and state taws relating to building consjruction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city a l(toJ(up($n cthe above-mentioned property pfor� - .
inspection purp����
____ 111 ___ _ ..: ... ,.,...,....�.d
^`"-445-4=10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND-PLANNING POOL&.SPA - ' ' '
APPROVALS Permit# Date Inspector •APPROVALS Permit • Date Inspector
-
1:;Temporary,,Electrica$Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. '�• 53. Steel Reinforcement _ 1-4
3. Electrical Conduit Utility-Undrgrnd. .54. Forms . . `� i-•;
4. ElectricConduit-Undrgrnd. 55. .Electrical Bonding 4 coral - '. I
-
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test , �,'
6. Electrical.UFER Gmd;i 57. APPROVAL TO COVER-GUfWTE
7. Footings ` T"• 58. ,Electrical Conduit-Undrgrndn '
nt • •
8. Foundation - - -.- - . 59.-Gas Pipe, 0 Undrgrnd., Tess,
.L:
9. Water PipenUndrgrnd. . . . 60. Backwash Lines, P-Trap, 011hdrgrnd. •
10. Structural Floor System 61. APPROVAL TO DECK :a ••
11. Property Sewer Line & House Connection 62. 'Backwash & Receptor-Final '
12. Sewer Cap 63. Heater & Vent-Final., l ,
13. Roof Drains ' . 64. Plumbing System - Final -
14. Rough Plumbing 65. Electrical-Final r
15. Rough Electrical-Conduit -66. 'Solar System-Final ' -
16. Rough Electric Wiring - - ' 67. Fencing & Access Approval
17. Rough Wiring Sign- • - 68. APPROVED'FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ' - 69. POOL/SPA SYSTEMS FINAL ' ,
19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT '
. - r
20. Rough Factory Fireplace APPROVALS Permit# - -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating • .71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test '72. Underground Flush '. : - ,
24. Roof Framing 73. Undergrnd.Storage Tank 04ias 0 Oil
•
25. Roof Sheathing - - 74. Overhead Hydro 1: , .
26. T-Bar Ceiling (Structural) & Mondcoat 75. Dry Chemical t
27. Frame and Flashing 76. Dry Standpipe i
.
28. Lathing & Siding 77. FIXED SYSTEM FINAL ISI. -
I ,
29. Insulation 78. FIRE PREV. FINAL ;.i
• -
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT -e, .
31. Plaster Brown Coat 79. FINAL INSPECTION . j) •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' �•`
;yr; ' '
33. Final Electric Notes: , - „i
34. Final Heating & Air Conditioning t -
35. Final Gas Pipe-Test • .-. •
•
36. Hood or Canopy •
37. Final Factory Fireplace - ',
38. Final Plumbing • .f3///, ,Ler . • _ . •
39. Water Service-Final •
40. Gas Service-Final _ - •
41. Solar Domestic-Final •
42. Backflow Preventer ' _ .-
43. Backflow Irrigation • • • -
44. Landscape Irrigation System - '
45. Sound Attenuation - ' , - • - - _
1
46. Handicap Regulations - - - •-
47. FINAL STRUCTURE & BUILDING • - - • -
' 48. Special Requirements Completed •
- -
a
49. Electric Release to Edison ' -
50. Gas Release to Southern California Gas Co, - - , -
51. CERTIFICATE OF OCCUPANCY - = •,
No. Date • -
CITY OF COSTA MESA REQUEST FOR OCCUPZtrCY
TRACT NO. t4 cc 2— DATE 3 /f ) et-
LOT
LOT NO.
p
ADDRESS - A Q 4tirres/ �1 _5;
c
The developer ofthe above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-they) (was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
BY /47-3"8 pS /'flow 4e
Purchaser
RECEIVED Developer and/or au or
CITY OF COSTA MESA representative
PI.gININS DEPT.
r-BY
MAR 15 1972 Lender
AM PM
71819t101111211121314151G
A
OWNER MOLULAR TEchnology, Inc. DATE ?-?5-71
JOB ADDRESS 1680 Rhode Island Circle BUILDING PERMIT NO. 3295
GENERAL CONTRACTOR Same DESCRIPTION of WORK Res wiatt_gsr_
AP No. LOT 26 TRACT6582 FIRE ZONE . VALUE $ 30,900.00
INSPECTIONS Signature ,7 Date GROUP I & J TYPE V ZONE R-1
SOIL 9' dt-d /E SUBCONTRACTOR PERMITS ISSUED
GAS Date Number I Signature
WATER
ROUGH PLUMBING < //Y7/ j 77 os- Qn
PROP. SWR. LINE -HOUSE CON. �G' ( //Zit' `72,_a.A) a� �e c"A_//n_7i ,CC
SPRINKLING SYSTEM - iii/// "7
MISCELLANEOUS n / pppp`
ROUGH HEATING AND AIR CONDITIONING e ///_7,.. 1'/
TEMPORARY SERVICE OR POLE j'(�a C//Q" /
UNDERGROUND 7 POWER 7
ROUGH WIRING / _ eatin• a.d Ve J _
iv
TRENCHES ®/FORMS ' STEEL REINF. n p / i Q^- --� iv
FLOOR SYSTEM ,>/fr 0'�-7/ .1 �/ y%bJ/r2 /�J/ •S J/
BOND BEAM n STEEL REINFORCE n 1 d / J
SHEATHING fl-1'4/ U,--.2-0.7/ _
FRAME AND FLASHING �•U, f'^
LATHING - IN 0- OUT a
PLASTER, BROWN COAT V i/C--t' ®/
STRUCTURAL, FINAL �� / . ElectJlis ,An
HEATING, VENT., REFRIG. AND A.C., FINAL /`j/-� y'/a 71- 6�2 �1/+ ��;�J////,o_'� �� �^ r•.-7- :1;:c..."-e< )ijWilai
PLUMBING, FINAL AND GAS TEST 7 r �)/6• Al•!l . C T�LP� Pte/''/ o//
PPLECn ulc PIMAI /7/I"m )_,/L'
33295
COSTA.MESA BUILDING-SAFETY DEPARTMENT JUL 20-71IO
�nO0173 ** 156.00
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEIVEDBy DATE RECEIVED DA ISSUED
(�.1 701—,L £.2. " 7) 15-_W
ADDRESS 1680 Rhnr1P Tcland f innle i
IBJ
OWNER Modular Technology, Inc. A.P. NO. P��jq(33235
BUILDING
MAIL
ADDRESS 1104 E, 17th Street ADDRESS 1680 Rhndrg Island ircle
r.� I
O O CITY Santa Ana TEL
547-9673 TRACT 6582 I LO126 BLOCK
Z4 CONSTRUCTION NEW ADD ALTER(REPAIR (MOVING OFMOLISH
O N LENDER X
am
J D BRANCH
J N OWNER Modul/echnology, Inc.
Q W ADDRESS GJ 1/17
~
CO•CO ARCHITECT Q OR ENGINEER Kermit Dorius, AIA TEL644-7111 USE Resld ce ,�� g
OW FIRE T ,/
WCC ADDRESS 3111 2nd Ave. , Corona Del Mar ZONE TYPE GROUP+ rf
0- W APPROVED V
LLIJ Z CONTRACTOR D er BY DATE
CO Z
CC ADDRESS Same 614
O= CITY TE .Same TOLLU LI., Z' n I (PLANS0BUILDING NE ��/
Z H
(Wn LIC.No. 252549 LIC.NO. 1690 Y Y ARS APPROVED YARS APPRMAIN BUILDING ACCESOSORY BO LDDING
D O (FROM C/L,STREET)
SIZE NO.OF OF LOT 58 x 83 I NOW ON LOTOFRONT a V1FT. /'n
• E.--' FT.
USE OF
EXISTING BLDG. R.SIDE /a_ FT. "'.-- FT.
) SIZE OF2100 SF' NO.OF 0
Z NEW BLDG. ROOMS 7 STORIES 2 L.SIDE FT. FT.
EXTERIOR WALL ROOF
V_ COVERING Per Plans I COVERING Wood ShtnEla REAR ia FT. FT. .
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
1
a MAIN BLDGS. ACCESS.BLDGS.
Q
O Construct new residence with c U.P.44/7 p 8 APPROVED ---7"0-6
I— APPROVED
CU v V J
'Jr 7
1N attached garage. _ay 7TE
itZO GMS /f4
UI hereby acknowledge that I have read this application and state HOLD FOR SPECIA.. REQUIREMENTS
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ • See lot 3I'"1,2.,
F„ any person in violation of the workman's compensation laws of C J �'✓ 1
N the State of California. �/S 6/9/1( Yte
ZI hereby certify that I am properly licensed as a contractor under SO. FT. /[.i �/��' o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDEFUALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
Cr
am exempt from the p sions of the State of California Business
and Professions Cod- • ision 3,Chapter VALUATION Ja 51 At
PERMIT FEE $f ry
m
Signature of {�/,/�//® `` I E
Permittee fit.•^2e /H /yea $_D \L�'� PLAN CHECK $ o
3 Jr.cu.
Authorized Agent9 (j
TOTAL FEE $ •