HomeMy WebLinkAbout334 REIMS LN - Building Permits CITY OF COSTA MESA
enMFq BUILDING DIVISION
MI I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
11111,4 . FOR INSPECTIONS CALL: (714)754-5626 •
`h'oa„e n 4"
PERMIT NUMBER: M09-00113
•
•
PERMIT TYPE MECH STATUS: ISSUED
APN: 43914114 DATE ISSUED: ' 12103/2009
ISSUED BY: BJK
JOB ADDRESS: 334 REIMS LN CM Suite/Unit:
Vicinity: CLOSET
SQ. FT: 0
SCOPE OF WORK: CHANGE-OUT AN 80,000 BTU IN THE CLOSET OF AN EXISTING DWELLING.
NO.OTHER WORK AUTHORIZED WITH THIS PERMIT.
OWNER: GEOHEGAN,TRACY A Address: 334 REIMS LANE Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: JACOBY,ERIC Address: Unit:
PHONE: 818-735-7876 City/State/zZip: •
CONTRACTOR: ADD AIRE INC. License No. 906705
Address: 834 W PRODUCTION PLUnit: PHONE: 714-997-2969
City/State: NEWPORT BEACH,CA ZipCode: 92663 • CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $38.30
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 OF 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 final approval will result in the expiration of this permit.
CODE N. INSPEcnoN TYPE DATE INnTIALS CODE% INSPECTION TYPE DATE INIITIALS
'-
1616 Fixed System Final Fire Prevention 206 Final Mechanical /- &Liur0
1266 Pool Spa Final 208 Final Plumbing
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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivPLs'license. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
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
s tan 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: - - .. _/ �4-- or dismantlin thereof,will be more than thirty-six(
36high.(Chap.
p feet Cha 3.2,Grp
(This s�•� i _ , �
need be mnptetedd tith /e permits valued a
tl el e owed•.ars I!s) . 2 pn2 Sec 9341,Title B,California AdministrativeCode).
Policy Number: 9 2-?l 2.-1-17
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
Applicant's Signature Dale
the Labor e.I shall .rthwith comply with these provisions.
(y/3 O Division of Industrial Safety Permit Number:
Sit.nature date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE • SECURE •RKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force♦ and effect. 6.--
a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# i� v S Class# G� (Section 25533 of the California Health and Safety Code, with some
) exceptions. requires registration with the Costa Mesa Fire Department by
_ =�3/0� each business which at any one time has on hand a quantity of acutely
actor's 9 lure Date hazardous materials equal to or greater than a weight of 500 pounds, or a
• volume of 55 gallons, or 200 cubic feel of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
perfomiance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction. and authorize representatives of
Business and Professions Code for this reason: 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.
-Sygnatoe tLegai er(s) Date
Signature Date , / ty/1/Q g
3057<6(3107)
Andbr Author ed Applicant Date
ADDRESS OFBUILDING: 334 REIMS LN UMT: CITY OF COSTA MESA - BUILDING PERMIT
OMNEBSNAMEIFIDIORN: DAIGLE, JOSEPH C PERM NO: B 073275
• ADDRESS: 332 REIMS LN
COSTA MESA,CA • 92627 PERMIT NO: B 073275 PLAN CHECK NO: N GOVT: N SUPP : N
•
APPL.MAIIg4G ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OlH
•
ARCHITECT OR ENDMEERt UC NO: JOB DESCRIPTION : T/OFF AND REROOF 'W/CLASS A 3 PLY ROCK SQ FT: 2, 200
ARCH.OR END'S ADDRESS: . UHT:
CLAIM VALUE: CALC-VALUE: 2, 200 . 00 GROUP OCC: R-3 /
coxmACTasmAmE: ROSS & BARROWS INC. ( 714 ) 557-7440
CCHTRACTOITS SIMUNG 260 E. ALTON AV COMMENTS : GARAGE ONLY
ADDRESS SANTA ANA CA uCNo.: 327802 ************ --x-StxxitRESS+tRERk****Rk*xSS**SH*RESERSRtRt****x*atRE3c-* -+r***StN*RkSHRtx-*****,+E*****it-****'*
92707 uMr: --- Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions d Chapter 9 SETH ACK S
(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force end effect
C LIC.NO.:020924 UC.CLASS: C-39 uc.NO.: 327802 EXP ; 11 /95 MAIN BUILDING ACCESSORY BUILDING ----------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
contractor `, LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
R BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the
wing reason(Radian 7031.5 Mailed)end Pmfescions Cede:Any ay«aunty which requires a permit to arnbuct aver,improve, PARKING REQ: P RO V: PARCEL : 4 3 9 1 4 1 1 3 Z,N E: REF NO:
'emolsh.or repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she
r licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Oi+'vion 3 of the PLANNING NOTES> ,
Business and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation ci Section >
7031.5 by any applicant for a permit subjects the applicant to acivil penalty of not more than fire hundred dollars 1650OI). ******,****************************************************************.*********
❑ I.asovmeroftheproperly«myempoyeeswilhwageseslheisolecompensation.eeldothewakendthestructuresnotinteded D E V E L O P MEN N T SERVICES R V I C E S R E Q U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does nd apply to an owner of properly Q
who builds or improves thereon,ed who does such work himself«herself or through his or her own employees.provided that such
intendedimprovements are not intended offered for sale.It,however.the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
owner-builder will have the burden of of
proving he or she did not build or improve for the purpose sale).
❑ I,as owner of the properly.am exclusively contracting with licensed contractors to cansbuA the project(Section 7044.Business and
Professions Code:The Contractors License Law does nd apply to en owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contrersor(s)licensed pursuant to the Contractors License Law).
❑ Iamexempt under Section: B.&P.C.,for this reason: APPLICATION ISSUED BY. . DATE.
**********************. . . . . . . . . . . ii%' ******************************* 'Dole: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL S G E )1c.' r
NT:Y
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,end ,
25534.and that I or any future building occupant will/wil not(circle one)need to comply with said date codes and the requirements ler
a permit forconerroclbn or modification from the Ak cosy da0em•nt Didrict.Resoddidaa
nnpppm
ionallons are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
Provisions. PERMIT 54 . 00 . 50
Date: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby eln perjury ore under penalty of perjuone of the following dederdbm: PLAN - ,
ISSUE FEE
❑ I have Code,fdMImainmancaniwedarwettoseH-ieepreforworken'compenadion,esprovidedforbySettee3TDDwtheLabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
cde.f«the performance w«kf«wlr<n this permit is rased. • TOTALS----> 54 . 50 0 . 00 - , 0 . 00 54 . 50 54 . 50 . 00
.n I have and wit maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance d the
t� work for which this permit is issued.My workers'compensation insurance artier and policy number are:
Cattier: FOUNDATION EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : — 54 . 50 OVER/SHORT: . 00
Policy Number: W95 /121414 07/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed l the pennx is l«one hundred dollen/61001 or less.) 54 . 00 " . 50
•
o I any that in the performance of the work for which this permit is Sued.I shag not employ any person in any menner o as to
become subject to the workers'compensation lawn d California. and agree did if I should become sobject to the workers' **********************************,***** ****************************************
penadSect'.. 3700 provisions of Sect' 3700 of the Labor Code,I shall forthwith corn with those provisions. INDIVIDUAL F E E BREAKDOWN
`
021Applicant:
'�'",ming:Failure ro secure workers'consolation coverage Is unlawful,and shall subject an employer to criminal penalties and TYPE QTY D E S C R I P T I.'0 N UNIT COST TOTAL COST
civil Mmes Up to one hundred thousand dollars($104000),In addition to the cost o/compensation,damages as provided for In
Section 3705 of the tabor Code,lnterut and auomay'a/au SFR 2200 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2 , 200 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this panel is issued(Section 3097.Cir.C). •.
LENDER'S NAME: 4J
LENDER'S ADDRESS: -'
I,
I certify that I have read this application end state that the above information is correct!agree to comply with all city and acounty ordinances f'
and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection purposes.
NANCEE KILBOURNE
Pdnt.ame 01 60186261-001E6262 TOT 54.50
41 ♦ Date: 1 l7 DATE: 07/171"n TIME: 14:35
1 Signature of• - Agent/Applan tractor
ersees.sss.
(5151-48.WP) White-Building&Safely:Green-Rb:Canary-Applicant Pink-Revenue:Goldenrod-Assessor
•
CONSTRUCTION AND PLANNING
POO_ t 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& Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. I
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. ,,' 60. Backwash Lines,P•Trap, O-Undrgrnd.
10. Structural Floor System J 61. APPROVAL TO.DEECK
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 Wiring67. 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 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing - 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: -fit/se 3/.r7 estiffreat' ! E c
in
34. Final Heating& Air Conditioning r In/1-2„
z siW
35. Final Gas Pipe-Test ./
36. Hood or Canopy 1 .
37. Final Factory Fireplace
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 - -
•
45. Sound Attenuation - -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48- FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY - -
No. Date `--
1
. rADDRESS 332 REIMS LN BI+T: CITY OF COSTA MESA - BUILDING PERMIT -
UWNERSNwEIfR4OA*. DAIGLE, JOSEPH C
ADDRESS: 332 REIMS LN PERM NO; B 073274
COSTA MESA,CA 92627' PERMIT NO: B 073274 PLAN CHECK NO: N GOVT: N SUPP : N
APPL.MAIBIG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: 0TH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF AND REROOF W/CLASS A 3 PLY ROCK SQ FT : 1 , 500
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 1 , 500 . 00 CALL-VALUE: 1 , 500 . 00 GROUP OCC: R-3 /
D0NIRACTORSNA"E; ROSS & BARROWS INC. ( 714 ) 557-7440
CWIRACTORS MALMO 260 E. ALTON AV COMMENTS : GARAGE ONLY
mums: SANTA ANA CA ucNo.: 327802 ************+T** -****SF -BP**+E -Rr+�**+TBP*+T*->E*; ******RERE**RE***+ ******+T - -****->F->E-x -***** -**
92707 Wit+: Z O N I N G R EQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penafy d perjury that I am licensed under provisions of Chapter 9 SETBACK S
(•. ..endrg with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
LIC.CLASS: C-39uc.NO.: 32780MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
I.NO.:020924
BUILDER DECLARATION:I hereby effirm under penally of perjury thattI am exempt from the Contractors License Law for the
. easonlse o 70315&tsieasand PoessionsCede:Any city«wumywhd equiesapermittoWnamd,the,improve, PARKING REQ: PROV: PARCEL: 43914113 ZNE: REF NO:
i:ZJ.pp' mdeh.or repair any structure,prior to in issuance,also requires the applicant for such permit to file a signed statement Nal he or she
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section)oro)of Dimion 3 of the PLANNING NOTES>
.:�:-3usiness 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 apermit subjects the applicant toacivil penally ofnot more than reser hundred dollen.lS6ro1). *********************************************************************/**********
❑ /,as owner of the ProPerlY or mY erneloYees with wages as their sole compensation,wilt do the work.and the structure a not intended DEVELOPMENT S ERVICES R E U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not appy to an Owner of properly Q
who builds or improves thereon,end who does such work himsef or herself or through his or her own employees.provided that such
owprboilerwilllavetheburrdenofprovoffered�gheorshedidnotb'un«r�pprrmaseiwthheeppuurpp�ofursele)�ayea`deomplerran'H'e ZONING APPROVED BY _ DATE:
o I.as owner of the property,am exdusivey contracting with licensed contractors to construct the project(Section 7044.Business and
Professions Coda:The Contractors License Law does not apply man owner of properly who builds or improves thereon and who BUILDING APPROVED BY : . DATE: _
contracts for such projects with a contractogs)licensed pursuant to the Contractors License Law). ��--YY
❑ Iamexempt under Section: B.AP.C..for tisreason: - APPLICATION ISSUED BY: Alf., DATE: ry
Date: owner: **********************W . . . . . . . . . . . . . .. . . tr' ************* * 31 * '
I do hereby certify that lam awareof and understand theLEGALIZATION:N F E E SM M M A R Y STRUCTURAL SE MENT:Y
requirements of California Health and Safely Code Sections 25505.25533.end •
25534,and Mel I or any future building occupant will/wil nor(circle one)need to comply with said date codes and the requirements for h
e permit for construction or modification from the Ai Ouably Management District.Resident&construction applications are exempt these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
providons PERMIT 35 . 00 . 50
Dam: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN
❑ I haveand will maintain a certificate of consent to sen.insurefor workers'compensation,as provided for by Section 3700 of the Labor ISSUE FEE sr
Code.for the performance ofthe work for which tenneisissued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECKispTOTAL PAID DUE
PI have and win mainten workers'campenastion insurance.as required by Section 3700 ofthe Labor Code,ser the performance of the TOTALS > 3 5 . 5 0 0 . 0 0 0 . 0 0 3 5 . 5 0 3 5 . 5 0 00
work for which the permit is issued.My workers'compensation insurance carrier and policy number me:
Carrier: FOTTNTIATTf1N EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : - 35 . 50 OVER/SHORT: . 00
Pricy Numberi W9S7171333 07/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed Ithe permisfor one hundred dollars MOOT orless.) • 35 . 00 . 50
❑ I certify that in the pedarmence 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 lewd of calffomie.and agree that A I should become subject m the workers' *******************************************************************************
compensation provisions of Section 3700 of the Labor Code,I shall forthwith tom with those
" I N D I V I D U A L.. F E E B R E A K D O W N
a s 7 -/ 7 ` Apptcant: oaa o�c i\
I
Ins:Failunfosecure workers'compewtloncoverage IsunlawN(and s gaudjecttaannemployer tocr/mnalpenalties and TYPE QTY D E S C R I P T I 0' N UNIT COST TOTAL COST
linea w m one hundred thousand dollars(100,0001.In addition to the cwt of compensation,damages as provided for In
Section 37a of the Labor Code,Interest,and attorney's fees. SFR 1500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 500 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this perm/'a issued(Section 3097.Cy.C).
LENDER'S NAME:
LENDER'S ADDRESS:
•
I certifythat I have read this application end data that the above information is cared.I agree to complywith all cityend eeirnty ordinances ' 'i
and state laws rektig to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly `f
for inspection purposes. ^`1
NANCEE KILBOURNE
pd Name 01 00136257-00186258 TOT 35.50
jam _ i _ - - Dale: `] �] DATE: 07/17195 TIME: 14:34
Signature of e' ygentiAppfican
(5151-46.WP) White-Building A Safely;Green-Flo, : Appfieent;Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING " POO. SPA
APPROVALS Permit #_ _� - Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole - - 52. Pool & Equipment Locatiori •
2. Soil Pipe-Undrgrnd... 53. Steel Reinforcement
'3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. I.• 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit=Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test •
1
9. Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, 0 Undrgrnd.
1
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 4
12. Sewer Cap _ 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final C'
,l
14. Rough Plumbing - 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring .'
99 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.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe •
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ��9,y- • "`r' • Pr9d r` -
34. Final Heating& Air Conditioning
--�'���`_ r
`OP
35. Final Gas Pipe-Test ' 1 -
36. Hood or Canopy • •1
•
37. Final Factory Fireplace -,
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
I
44. Landscape Irrigation System' •
•45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING ,5 ct� q
I 48. FINAL PLANNING (1 -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY
No Date •
I 960 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT YFIrNcE 3orPt.
P.O.BOX 317 COSTA MESA.CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING ✓ 1S\1 1L For Office Use Only
.3L
ADDRESS RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA _ (('--�� //q
/I7h�)) �J/ r / R EIVED Y �DDAATE RECEIVED DATE-1951/60a
OWNER NOv le R U �/G/h 4Gi✓ C a, J - //a//99 e3 III�INN(p^, 1463
MAIL (1�''J C`�- /L�� /` 'firDING 41 _ 1�7 .
ADDRESS (JJ �J J_ �/i LA c l el l -t-r n(/L DRESS CF l
A-pa
y/ 1/�� ..,(�, FIRE V 1
CITY • - 'a C 4)„ 6- /1,/ NOJR 1O ta9 ZONE TYPE GROU V
T APPROVED
ARCHITECT
%$NEER ( C- / 0.Lj NQ�1� 2BJp BY DATE
Cori ZONING
ADISSS in 0D /il/L(.I7 . cam/ /s+onw c '(/\-F 114(
1/'l - ZON `'I I FLAMBE I USE NE
BUILDINCI `c' ,
CONTRACTOR Jam— (((VIII //' O v1, AAllll\\\
LEGAL /' / /
DESCRIPTION �\ 9 c.f.-It-Wt.?
ADDRESS AIi+---'
CITY f/!L h" d A.P.NO. 'Q}-
STATE // TEL pK SOTTO SOIDE VE REAR P. SHALL BE LESS THAN
LIC,r710.7r-/- 2.5-13-9-/ NO.ipe it ya
�7
_
OF LOT 33 / u � ` Th ' I NNO.OF OW ON LOTS EAVES ALLOWED (U.B.C.REQUIREMENT)
—� YARDS APPROVED YARDS APPROVED
USE OF -' MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. .
(FROMC/L STREET) •
/
SETBACK LINE FROM ,._B FRONT
CENTER OF STREET . J V REAR YARD —
FF' FT.
SIDE YARD I LEFT ----- I RIGHT ----, R.SIDE ® FT. FT.
DESCRIPTION OF WORK L.SIDE CDDFT. Fr,
NF \X ALTERATION _ ADDITION REAR Ip FT. FT.
DISTANCE BET. BET.MAIN 8
REPAIR - _ MOVING DEMOLISH .T MAIN BLDGS. ACCESS.BLOCS.
V
R.# DATE
IM
DING 33��//53�-�ROOMS 7
/3 STORIES
its CAU.P.# ,yl,�y APPROVED
COVERING EXTERIOR WA,.. 7�A(/CCo I COVERINEG ,j' t BYAP444)
DATE 5--42243
USEQP$ ME
N,P.N(A to c_ND C.- TO BE PfA.C/ R/9- 0.GNC/cl.-
Ga.r Ilia A .I S N
T.
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 E ABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION , �T -
m
BUILDING CONSTRUCTION. I� /� /� PERMIT FEE $ In
03 N
SIGNATUREOF I [Situ
/' y{nc. D
,;PERMITTEP I( J/41 LR /T^ l9 '1�J (q E
\\\`\ $a vi2. PLAN CHECK $ 3"521
o
HORIZED AGENT. )]�I.I.s1 - ra �`
TOTAL FEE $ 9 S%J •
1
OWNER DOYLE & SHIELDS Development Co. ,Inc. DATE .6-3-63
JOB ADDRESS 334 Reims BUILDING PERMIT NO. 19603
GENERAL CONTRACTOR Doyle & Shields Dev.Co. ,Inc. VALUE $ 19,417.00
AP No. LOT 14 TRACT 3433 FIRE ZONE DESCRIPTION OF WORK Res.watt.gar.
INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE R-2
Soil 44+5 J-Ay-G.j PERMITS ISSUED
SUBCONTRACTOR DATE NUMBER
WaterGas A/A/-S 72 6.3�
Rough Com. Refrig. 0 Air Cond. 0
Rough Heating [JiJ./-f /2 -4' !Z's�,�„< < JUL . _ tas s. —
Rough Plumbing /!//-/-.S /2-2-0'3 .Zc-..(w. 3 8 sTs —
Miscellaneous /r1P)k6Pt 4 In)/f-{ (s .1'C`,.t^ccei^ 1y- '4 In i-( LI 2,014 /�
Prop. Swr. Line (fid House Con. 20-St. Swr. 0 /I 5 ./)--//-G3 L(/,�LeJ� /7-)'�% 6 b
Sprinkling System -2 ,
Construction Pole a f//Lri6 v-
Underground S Power 0 ,�
Rough Wiring g `;- 79.6 it d Gcr 9-( -6 6 8 7 7
Trenches (rte Forms k' Steel Reinf. 0 72 y-•?j
Floor System ,../ _7--- 7-3.';-5
Bond Beam 0 Steel Reinforce 0 - pt�u,N 6
Sheathing /1/4 /i f/_7 { (V" i I I Jf') /
Frame and Flashing • / 7,-2-A./2„-/z.. `� 4,�' 111 Y"
Lathing — In in-- Out p' ��- e..9/ IP'
Plaster, brown oat �-JL � /S'. �- i4 �y , / 1
Refrig. 0 Air Con. 0 Final / V^/1Y
HeatibFinal /� 19/6 `J Plumbing
Fixtures, Final f/�/� �j'y
Final Gas TesV3
Electric Fixtures, Final /.?' � gg Lyyy- AZO
Building, Final �- z — '-ZP' '/
OCCUPANCY .Fe-2 c E c".c :EQU' .._SENTS
B
Form U4-5M-3-6S—S-B P `G