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HomeMy WebLinkAbout332 REIMS LN - Building Permits r . ,. CITY OF COSTA MESA . a ' BUILDING DIVISION • z.r �I DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER f -t 17-- PERMIT B05-01326 stitPoho`►Q (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.aLILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 332 REIMS LN Status: ISSUED Suite: Applied: 08/05/2005 Vicinity: ROOF,4-PLEX AND ATTACHED GARAGES Issued: 08/05/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 43914113 Zoning: Applicant: DEBORAH SIMMONS Address: 9582 HAMILTON AVE - C� SUITE 281 Phone: 714-960-8329 ISSUED BY: HUNTINGTON BEACH,CA Zip: 92646 nuc 7 &ty Hoag :>.. Owner: �f' • Address 332-RfIMSLN- ;f 7I �cuJ k. E 46L,*2_I 2.""'C=-, d_ 3It1q 1 Phone � 2 Cap GOSTAMESA,.C.4_ s_TOS TI/N�)1CA Zip t 26 027 ,''.,'1 • Contractor HIRSCHMAN, RP'8 SONS INC. <' • Address: <9582*.HAMILTON AVE ' '"'� �"" y, ` ra, SUITE 281 - Phone: 714-960-8329 3` z $} ° - HUNTINGTON BEACH • ae,Q e s ,CA °r t� Zips 92646 License: 781923 „i _ a..'t;., Arch : r ^ Eng: Address:; - Address: - 'a- Phone: ;-- Phone: Zip:, / � � License a� License. �,� f'Ssia ' - SCOPE OF PERMIT - '�`' TNG`:EAR OFF EXISTIROOF INSTALL 1 LAYER OF 15#FELT,40 YEAR COMPOSITION SHINGLES,AND REPAIR/REPLACE SHEATHING AS NEEDEE SQUARES FOR 4 PLEX 4 PLY BUILT UP SYSTEM FOR ATTACHED GARAGES.24 SQUARES.' , a 4 ra° t . r FEE SUMMARY .. Plan Check $0 00 Calc Valuation , /Z7,291.00 Permit: ' -$422.05 • *z,„ � Claim Valuation a 2, •SMIP'Res $2 73 P- -; SMIP Com $0 00 s ) Other $0 00 Inspection: $000 `° r Total $424.78' . ,z* PLANNING`& ZONINGAes, SETBACKS r,= MAIN STRUCTURE Front 00 tea¢.Rear 0-0t,' Left` 0 0 jeiTlifg Right 0-0 Yt ACCESSORY Front 0 0 Rear 0 0 Left 0-01- • Right 0'0 z' PARKING Existing: 0 Recuired 0 Proposed 0 . • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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 2446-48(WOO) • • DECLARATIONS ir fl 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 rk 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 work setlon Insurance carder and policy number are: Q-A 00 Carder: ewJuJYL-�� Policy Number: (This section need not be completed if the permit/s valued at one hundred dollars(5100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with these costo �s.. /Q� /1n,/Inn � � )J� Applicant Signature: iV'J"�Y R J // V✓ r r`s I� Date: �/� /�/� WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SURIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND not I ARE($100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens d nil r vls�Qns of Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is In full force and effect.Lic.# r/ 1 cg-�j Class# S GfY i Contractor's Signature: -�LiYn�YYtB�L Data: R)/61D5 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm mat 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: Lender's 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 properly,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 end Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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.Art 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 a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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). I 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 Calitomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire . Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 a plication akPermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? j�Yes LI 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 from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials end 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. n , fit $ at'=Of Legal Owner(s /,pate TO 5--- An.Or Authorized Applicant Da e CODE IL INSPECTION TYPE PATE 1EEAU CODE 1 INSPECTION TYPE PAM P!Il➢ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final T 208 Final Plumbing 200 Final Re-Roof 12 2Q�(DI r- 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 • S People for RQ6 00536 X +)( gt.: t. ►=I'� la ., Name.=, r ". F . Relationship,_,- Phone 1 ,�:` Phone 2 Trust Primary I. ►.�BACf:BQY'HOp OWNER' 714.508.9070 IJo�1YF HIRSCHMAN,RP AND SONS INC CONTRACTOR 714-9608329 No No _ "' �t - SIMMONS,DEBORAH APPLICANT 714-960-8329 No No �'' 'cs„ I :r r -""'-•.•-../.;••;-s . s ri' It's j' V . t Yr-;‘:&'``.•.\./".A.4.-- `y 1 x7 w .1s"' -F r.1..dye+'.:-.t '}+''1"i...i.Sa+v 4' ;x� ..u''t"-Or' , ' _ '.f U date, '' " Name. BACK BAY HOA iIUWNER J P Address 1: C/O OPTIMUM PROPERTY MGNT ' '+i` Pnmars Name r' Add r _ *..r.,-1,2:; Address 2:117731 IRVINE.CA Address 3: SUITE 212 - Address 4:1 ' -ZIp:192780 ' C7A/E/D n +Fre. .ok Phone 1:1714-508-9070 •Phone 2:1 -' - Delete • - d ¢ t 4 EMail` _ y ..r f- ' Refresh ' t a wF Date` 04/11/2008 License Notation _. b _.;` .r .-----.--74.-4,4•3i it Trost" t .. .1 _ .'Accounts I' Mare ' c.,1"; gi•r ti I; {�, i > `Bacl:Stop a 3r _ KI. • r s.S :,j', a �OxOPP.SSI4Yy.AKa7 " CC' EL � a + ;1ynp.rigl (}i s rpt q ;+ r • Cl 'th RY.mIRr IA+ mF3" t �'39'< PteP f { : " I 'm4 [ ti �el 6a 211t1 }It ia. n " lnrt°:e4u t� i6i nNtI .n {t i , if t.v Ft +I1 I .: it .; r � dtA} ao .1 s I i . '1s ""-.- � .'. n. 'PERMITS'Phir®32 Bit 02004-Ascela,IK.All Righb Resen Licensee:Costa Mesa CA-City Of :''`' ~[Serial Number:6013 Users:040��Version:v.5.1.19; - r' St8%dT ° i ® � t � . 11'' fs't^x A. V L'�M� ;. `�,� I a I.... ezi) ;u M CITY OF COSTA MESA BUILDING DIVISION > � , DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER IF la PERMIT P05-00316 It (714)7`544-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • - PLUMBING PERMIT • Job Address: 332 REIMS LN Status: ISSUED Suite No Applied: 04/29/2005 Issued: 04/29/2005 Vicinity: �/ /AJ Parcel Nunmber: 43914113 ISSUED BY: Iv Applicant: SZABO, KEVIN Address: 1730 MT.CLIFFWOOD Phone: 714.241.1414 ' 17390 FOUNTAIN VALLEY,CA Zip: 92708 - Owner: DAIGLE, JOSEPH C ' , - Address 332 REIMS LN Phone: - COSTA MESA,CA Zip: 92627 Contractor: COAST ROOTER PLUMBING NTG &A/C . Address: 17390 MT CLIFFWOOD Phone: (714)241-1414 FOUNTAIN VALLEY - Zip: 92708 License: 529127 SCOPE OF PERMIT - WATER HEATER CHANGE OUT • - FEE SUMMARY AMT QTY AMT QTY „ " AMT " QTY ISSUE FEE - $23.50 Laundry Tub/Washer -$0.00 " 0 Sump Pump - ".$0.00 0 • Backflow irrigation $0.00 0 Landscape Irrigation ..$0.00 0 Swimming Pool - $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer - , $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 " Urinal • - - '$0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) ..$0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0:00.„-0 Vacuum"Brkr Bkflow(5+) $0.00 0 Dental Units - $0.00 . 0 Septic Tank $0.00 ' 0' _ Wash Basin ,$0.00 0 Dishwasher, - $0.00 , 0 i - .,Sewer Cap for Demo $0.00 -0 .- -Wash Basin Set , $0.00 0 Drain, Floor . $0.00 ' 0 ' Sewer Connect '$0.00 0 Waste and Vent System" / '$0.00 0 Drain, Rainwater ' - $0.00 0 Sewer Private Line ' $0.00 0 -Water,Closet(Toilet)/ . / $0.00 0 Drain,Roof - $0.00 0 ' , .'Shower " $0.00 0 - ,- Water Heater?"vent / , $12.30 1 Drinking Fountain . $0.00 ' 0 Sink,bar . $0.00 0. - Water Piping(Inst or Rep.) $0.00 0 Expansion Tank , $0.00. 0 , Sink,commercial - $0.00 -0 ,Water Re-pipe', - _ $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 , . Water Service', $0.00 0 Gas(1-4 outlets) $0.00 -' 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 " 0- Spa(private) $0.00 0 - • VIOLATION $0.00 Gas Service $0.00 0 " Spa(public) - $0.00 0 , . PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 . . _ REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 - , - TOTAL CALCULATED FEES: $35.80 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 2446-46(6/00) DECLARATIONS n , n 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. 10+�-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: //__ Q�R.�-yam 7 ' I S't-Arrt Fv N D Pocky Numbe l-7&8 V`J v-�/O,( This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 1 certify that in the performance f the work for whic this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif() i and agree t f I ould become subject to the workers'compensation provisions of Secti n 3700 f the Labor Code,I shall forthwith comply with these provisions . �n o A-.., n,,9r�as�r9.' - - Date'_ l-1 WARNING:FAILURE TO SECURE WORKERS, ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-r_2 O'CRIMLAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),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 Gree eat eeSign ice SZ-1�7 ell)a C— 6 Genlreplofs.Si:,.=T-e: D�j�'—417.Z1/0 C. evesPrIL 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: Lender's Address: Signature: Date: I 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 o1 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 not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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.Gm 2,Art 2,Sec. 341,Ttle 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 a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: I 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 tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 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? 0 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 a2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Govemment 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 Nes',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 from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. atur::1 Legal Owner(s) , jJ q /�Date 4 "-moi . // t 1rer.AuthorizedApplic CL.pate---j ME a INSPECTION TYPE DAIS INTITIALS CODE( INSPECTION TYPE PAIL INTRNLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical __ /i 1266 Pool Spa Final _ 208 Final Plumbing 1.44747//LJ[j�_�L 200 Final Re-Roof 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 • _ ," - ' 7 / Applicant to fill in all spaces except th• ose within heavy border lines and sign all appropriate declarations. map PERMIT NO. TRACT NO. LOT NO. UNIT NO. i /,•5GE ' S/'' ,' T CITI�OF COSTA MESA CONSTRUCTION PERMIT • B 36a¢8 f '3 �� r - Project-Address '>;1 C 7.2'I S L,� ;;��II I ,, I CC ,, ,,..Lr • i TYPE OF CONSTRUCTION ❑ NEW 'SADD D ALTERATION U REPAIR , I Applicant's Mailing Address �/`WI ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# _A Zone Z. ,•I Owner's Name Lr-J/L.L/A en m I L.1•ca PhoW46 yigOt� - -- ��t —�i°kl - 3 .. . 2 / DESCRIPTION OF WORK/USE OF BLDG. �L-GOAL Address 33;-�7wvs Cnsta /��=5+9_� S Main Building: Accessory Buildi Arch/Eng. - License No. ' i TYPE OF PERMIT ❑ GRADING 1E FOUNDATION �'• STRUCTURAL ' .I. T Front - ZO Address - - • ❑ TENANT 41 ELECTRICAL El PLUMBING ❑ MECHANICAL R Rear N - Contractor's Name DIAIA1,AZ. AWL-LI f:/t•• phonerri • /r)� , ❑ OTHER .. • 'A - I • PROJECT DESCRIPTION SQ. FT./St- in OCCUPANCY ,,�J` C Right N ' Address(mailing) - ♦•�` K G CONSTRUCTION TYPE VALUATION S. g,3&1' go $ Left City License No. ZONE • ' GRADING CU.YDS. ACRES R ' LICENSED CONTRACTOR DECLARATION I y Ping. Ref.# • Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / / •7/ �� ��6�$7� Planning Notes: M • with section 7000) of Division 3 of the Business and Professions Code,and - e 4 f 24 J eon 4 my license is in full force'and effect. pp /�' �/ r` 'nett- rr���ynnn tl�' sv� 4-24144"'• License Class License No. Li- •1G �'24-rD ��4�'-YSIlf 4'/� ~� oa'- '�"J' ON-. `fl'"� ' S Date Signature - PLUMBING tf FEES' t WORKERS'COMPENSATION DECLARATION Bar Sink Showers 'hereby affirm that I have a certificate of consent to self-insure or certificateELECTRICAL FEES a Workers' Compensation Insurance, or a certified copy thereof (Section • .00, Lab. C.) Backflow Preventer • Service Sink ' ' - Automatic Washer Transformer 0 15-50 KW Policy No. Company • Backflow Irrigation _ Sewer Cap' ' " Construction Pole Sub. 0 50+KW 8 Certified copy is hereby furnished. - ' Certified copy is filed with the city Building Division. Bathtubs Sewer Connection ' .- Cooking Unit . Meter ❑up to 100 amps Date Applicant - ' . EXEMPTION FROM WORKERS'COMPENSATION 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 • Dryers'❑Gas ❑Electric Sub Panel in I certify that in the performance of the work for which this permit is issued, I. . _ • shall not employ any person in any manner sof q,5 to become subje to the Drinking Fountains • Solar Tank - . Fan Motors 00-1 HP 01%-8 ' Workers/�o e n Laws.of Calif�ni q / - _ Date `7 Signature Cali-192X, sh ff • Floor Drains` Swim g Pool w/Spa , - F.A.U. NOTICE:lf,.after making this declaration, you sho °come subject to the - _ Inc.Solar ❑9-15 HP 016-15+ , Workers' Compensation provisions of the Labor o , you must forthwith ' Floor Sinks' - (nal Fixtures comply with such provisions or this permit be deemed revoked. - Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets r Water Closet 1 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.) Interceptors Water Heater Outlets • Lender's Name - '//'� Range 20 •Lender's Address Kitchen Sink . Water Service - - • • Switches OWNER BUILDER DECLARATION Sign I hereby affirm that l-am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or •�- Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap .1 r, Laundry TraysGenerator DO- ❑5-15 KW - ' any structure, prior.to'its issuance, also requires the applicant for such permit p �' Trash Compactor - to file a signed statement that he/she is licensed pursuant to the provisions of ROOF Drain the Contractor's License Law(Chapter 9 (commencing with Section 7000) of. Division 3 of the Business and Professions Code) or that he/she is exempt - - -refrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil _ nalty of not-more than five hundred dollars($500). ' I I �I, as owner of the property or my employees with wages as their sole °Inspection Fee 6 $15 Issue Fee $ 3 S. - compensation, will do the work,and the structure is not intended or offered - —. Reinspection Fee $15 Issue Fee , $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL • S - ' 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 REQUIREMENT S-5-'2: �` ' (1 employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 a .21 sale. If, however,the building or improvement Is sold within one year of com- I-- Canopy Type I Zoning Approved By ate pletion;the owner will have the burden of proving he/she did not build or im- Duct-Under GroundBuilding Approved By Date • • �srove for the purpose of sale). LJcl, as owner of the property,am exclusively contracting with licensed con- - Duct-Structural . Ref riger - n System ,Application Issued By Dat: 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 .-100,000 BTU 0100,000 BTU - SUMMARY OF.FEES builds or improves thereon, and who contracts for such projects with a con- G tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ' System.Repair/Alteration ' • BUILDING PERMIT $ 74. 50 I SMIP $ _ 0 • 5' / proof of their Worker's Compensation insurance should be provided to me. • _ • _ PLAN CHECK $ _ PERMIT ❑ I am exempt under Section B.& P.C.for this reason • Firepl/Fact.BIL ICBG Fire Dampers PLUMBING $ SS UA NCE $ - Date ..% IC.)� Or 0 C /� I Or Heating System ucting Registers - PLAN CHECK 25% $ ENERGY P.C. $ - I hereby certify that I have read this applicatio ld state that the above poi 00,0 TU 0100,000 BT 3 • $� GRADING $ _ information is correct. I agree to comply with all C•If' and county ordinances ELECTRICA L $ and-state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ O •4,0 MICROFILM, .$ _ sentatives of this city to enter upon •p bve-mentioned oper y f inspection •rrp•.es / / �� MECHANICAL • / '$ TOTAL FEE $ 5-"5-171: Signature Dat / Drivers' License or SS �__ • - Pink -Accounting; Goldenrod - Assessor I POOL&SPA- - r - ' .. CONSTRUCTION•AND-PLANNING .. • APPROVALS •Permif# Date Inspector, APPROVALS Permit# ' , - Date Inspector 1.'Temporary Eledt'ical Service or Pole . 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd: 53. Steel Reinforcement , , 3: Electrical Conduit Utility-Undrgrnd. 54. Forms . 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing'& Pressure Test ' • 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation - . 59. Gas Pipe, 0 Undrgrnd.,Test 9., Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. • • 10. Structural Floor System 61. APPROVAL TO DECK i. 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 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 ' 14 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing . -74. Overhead Hydro , 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical - • ' •• • 27. Frame and Flashing (14)? /,/�/ 76. Dry Standpipe ' 28. Lathing& Siding GGGTTT 77. FIXED SYSTEM FINAL . 29. Insulation 78. FIRE P,REV. FINAL • r' ' 30. Drywall'Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . - 79. FINAL INSPECTION - _ , . 32. Electrical Power Meter-Final •-. ///��0. FOOD CERTIFICATE ISSUED 33. Final Electric �_ //J Notes: 34. Final Heating & Air Conditioning /�/� 35. Final Gas Pipe-Test - -' 36. Hood or Canopy IT 37. Final Factory Fireplace - 38. Final Plumbing - 39:Water Service-Final ' '40. Gas Service-Final - 41. Solar Domestic-Final - r eel 42. Backflow Preventer 43. Backflow Irrigation . , - - :44. Landscape Irrigation System 45. Sound Attenuation - ' 46. Handicap Regulations - . , • ' 47. FINAL STRUCTURE& BUILDING loll-3/ !_� _• 4 48. Special Requirements Completed / t1" - - 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co •' - . 51. CERTIFICATE OF OCCUPANCY 4 No. Date el . . . �(. . CERTIFICATE OF' COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCHOOL DISTRICT bx Developer/Applicant : 41.)ILL�HM , /14 TLC=" ' Add ress : '3 3a•- /2.&..../fin S - LN 0,6) t. 4 Telephone Number :/K' ' A4c2- —`Ior)--,-)— 1 1 ``� } Tract/Parcel and Lot Number(s ) : 43 (3— / 41 — i 3 Location of P.roj.ect : CTc i�vt, Number of Square Feet of y p ' � JV-' Residentquare ace /x8;83 x � a 0 Total 3�' J- Number of Square Feet of :' ,^` , N X.-0 . - Commercial 'and e{ r Industrial( Space ` x „$_0'. 25 Total - . V, -"- -1— The.. p,ravisio`n"sl.of-'Go'ver'nmentx- Cod'e Section 5.3080 are n'af ' '" - - applicable . •p'* ..- �!�`1 ', , . 1 This certifies that the above-named`WDeve`loper/Applicants has paid school faci,l'ity fees in compliance w. th\Government Code Sections 53080 and 6;5'995 . Checks are to be made payable to Nevi p t'-Mesa .0 ifie School District +} c ,,..: G .,N Business Manager ,''/ ' • ' Newport-Mesa Unified School' District The above representation as to square footage is true . Developer/Applicant agrees that if it is later determined that .such representations are not true then this certificate shall ' automatically terminate and the appropriate City/County 'shall be notified . Date : ei,93- 37 ) Developer/Ap�plTifcant _ � _ OWNER DOYLE & SHIELDS Development Co. ,Inc. DATE 6-3-63 JOB ADDRESS 332 Reims BUILDING PERMIT NO. 19602 GENERAL CONTRACTOR Doyle & Shields Dev.Co. ,Inc. VALUE $ 19,1417.00 AP No. LOT 13 TRACT 3433 FIRE ZONE DESCRIPTION OF WORK Res.w/att.gar. INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R-2 Soil Ahtc,_'7�13-L3 PERMITS ISSUED Gas IL2 SUBCONTRACTOR PERMITS NUMBER SJ Water Rough Corn. Refrig. 0 Air Cond. 0 g �y C Rough Heating jt1y 3 /2 N-( S "� -i- Ui 2 2 Plfil _ -935 - Rough Plumbing L a /22 3 .....‘./,‘..-. 1:; "UL 9 1963 #8 -ce MiscellaneousR Prop. Swr. Line Vi/House Con. Er St. Swr. 0 rig" a n2JJ/n/Jvf ,. -7- do4z73 Sprinkling System �r"4 Construction Pole ,136/6,` Underground V Power ❑ 9.45-41 'l Rah Wiring 'tatriaa' £_ct e f'1Let . -- 6 - , c O R 7 5( Trenches- Forms 21/ Steel Reinf. 0 Aar 1 iv- Floor System 7 'Tj Bond Beam 0 Steel Reinforce 0 �"') /, --) Sheathing _fir / _ _ Frame and Flashing . v- ,- ,i -/.rr�lik ,' Lathing - In Out i 7%' ! £w17 `. . _ y ' , ,,-- Plaster, Plaster, brown oat W 48,- - ,3/ 7 n//'" Refrig. 0 Air Con. 0 Final V' Heating, Final 4W-5. z/-/S-q/ in/A / Plumbing Fixtures, Final N7,V a_/3-C;, I i Final Gas Test j lid `✓!'n/ y-/3-Cie Electric Fixtures, Final l if-20 Building, Final If-7.0.6c, • OCCUPANCYHOTn '' zn^�,CL,�, ,',;-QLinannUN LS • Form BU9-5M-2-s3--s-H P 19602. FE/pcEIVED N 3 1983 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 917 COSTA MESA,CALIFORNIA h CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING' For Office Use Only BUILDING 332 9 � ADDRESS RECEIPT NO. PgRMTQ0 COSTA MESA, CALIFORNIA 99 J� ((�� //��J� ((�� AR ED BY DATE RECEIVED DATE ISSUED OWNER Ay./e- /✓X/O/ O heir G, Inc. 3--- `_ C3 J.'."; 2 1963 DING'MAIL ��1/ S RESS V `� o ea .---n ADDRESS ,�p ,3JJ T.(/,,,;lf/Mail lAt I CITY //. aleito 711; Mole, 2,O2D FIRE ZONE TYPE GROU-� i TT yq p APPROVED ARCHITECT Ale.,, ( / LA NO.v //J-O ,c BY DATE OF `WEER ov &' �/ /) ZONING AL J'S Wdf/ �N1mt7n [yV/`H /7 ZO� NO.OF n USE OFNEWSVv IIS ' CONTRACTOR ��1++ Q 1VU''1 I PLANS .✓ I BUILDINq ,�1 VVVW4CII/ -` \^' LEGAL 111///��� —IINIA�w t 3B+ ADDRESS �..J �- DESCRIPTION � O /3 /rat- Y3j A.P.NO.-CD.-- NOTE: O.'f7- CITY ��� C. - NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC.TNO.' o-�i No.P/� y to.- o SO'TO SIDE&REAR F+.L. EAVES OF EOT '?3 'y .3. �D / I NOW ON LOTS ALLOWED (U.B.C.REQUIREMENT) YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. /— / (FROM C/L STREET) SETBACK LINE FROM �J 0,V 111 -�� FRONT 0 FT. FT. CENTER OP STREET if' REAR YARD SEIDEYARDI LEFT .- I RIGHT �- R.SIDE FT. FT. DESCRIPTION OF WORK L.SIDE 0 FT. Fr. NE' x ALTERATION _ ADDITION REAR /3 FT. FT. DISTANCE BET. BET. MAIN 8 MAIN BLDGS. - ACCESS.BLDGS. REPAIR MOVING DEMOLISH VAR.* DATE BUILDINg3 1� s.oNOOM SIZE STORIES C.U.P.# APPROVED ) / EXTERIOR IN WALL/�1U CC I'.COVROVF ERING DE APPROVE 1 l n . - DATE�I 'd� b COVERING vv�� Y`���/�1 USE Oy-t; 0-jjNB 9AND a eRKTO BE PERFOR fi ' ion/*`/ N_./ •v�Lod(fi/JUJ/ 9a-- • BQ.HT. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SH UNDER VALUATION IS FOR THE F' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O 'PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION / 'J m BUILDING CONSTRUCTION. PERMIT FEE $ r/I} y •j SIGNATURE OP/)���� / / - B PERMITTEE '✓•'� S�LIL.L(.�Til C . t�Hi�, 8�/� tip 57 F AUTHORIZED AGENT !/ ` 1 4 - 17d11 c1-411, $ J • C / ��( 0 TOTAL FEE $ 7//..J"