HomeMy WebLinkAbout2421 RICHMOND WAY - Building Permits CITY OF COSTA MESA
4esi114Fsv BUILDING DIVISION
F t, l 0 77 FAIR DRIVE,COSTA MESA,CA 92626 •• (714)754-5273 •• Fax(714)754-4856 •• www.costamesaca.gov
°. BF FOR INSPECTIONS CALL: (714)754-5626
4`1,..‘);-i). ^d
PERMIT NUMBER: M12-00007
PERMIT TYPE MECH STATUS: , . ISSUED
APN: 41916563 -'1DATE ISSUED: 01/10/2012 '
• - ISSUED BY: CAC
JOB ADDRESS: 2421 RICHMOND WY CM • Suite/Unit:
Vicinity: -
SO. FT: 0 _ .
SCOPE OF WORK: FAU AND AC UNIT CHANGOE OUT AT THE SAME LOCATION. -
FAU AND AC UP TO 200 K BTU -
OWNER: SCHINDLER;DAVID ALLEN ' - Address: 2421 RICHMOND WAY Unit:
PHONE: 714-979-2948 .. City/State/Zip: ' .COSTA MESA,CA
APPLICANT: LAURA YENUOLONIS , Address: 1225 GRAPHITE DR: Unit:. -
PHONE: 951-280.3113 - City/State/zZip: CORONA,CA- � . ri,,., 1f � ,
. ,1 I2 000
CONTRACTOR: A R S • License No. 791820 - ' •
Address: 1225 GRAPHITE DRUnit: 'PHONE: 951.280.3113., . . -
City/State: CORONA,CA ZipCode: 92881 : CELL:
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $53.10
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: • $0.00 •
REINSPECTION FEE: $0.00
•
TOTAL FEES: $53.10
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 I/ INSPECTION TYPE DATE INTI11ALS CODE# INSPECTION TYPEkla.
DA IN AL
:1616 Fixed System Final Fire Prevention 206 Final Mechanical
.1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
1201 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 );1
WORKERS'COMPENSATION DECLARATION: - Owner ID verified by driver's license. ❑Yes ❑ 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.
t;SI have and will maintain workers'compensation insurance, as required by
sion 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
n e. 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
rrier: \ CSD� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(miss on a not be comp ed Alhe penult is valved al one hundred dollars MOO)or less)
2,Art 2,Sec.341 Title B,Califomia Administrative Code).
P ' tuber: ` ,, Q —11,j2 VDb&ob\O\‘ •
0 As owner-builder, I will not employ anyone to do work which would
O 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
the Labor Code,I shall forthwith comply with these provision Applicant's Signature Date
li_ Division of Industrial Safety Permit Number:
A.fmmRia!nature HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE NWRKERS'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
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
m li ense isinfull force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No
\�,$�,.Q Class# C'1(� I �(p (Section 25533 of the California Health and Safety Code, with some
��� exceptions, requires registration with the Costa Mesa Fire Department by
N.
aAe
- � � 32 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
CONSN LENDING AGENCY: temperature and pressure).
O 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
performance 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)? 0 Yes 0 No
(Section 25534 of the Califomia 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 ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished 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 ❑No
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 8. (If",es", attach certificate of compliance from the appropriate air pollution
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
01I, 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 Dale
properly who builds or improves thereon,and who contracts for such project with
a contractor(s)license pursuant to the Contractors License Laws.). CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
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.
Signature of Legal Owner(s) Dal
Signature DateIII
3057-46(3te7) 41 ' 6 o\. _\O• . Ai 10 1
•n. or A ooze. '.plioant lb �.P
• ' CITY OF COSTA MESA
o, t
BUILDING DIVISION
stet.
• �,, I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
11.41 PERMIT
etb4cr ss 411 L . B04-02129
(714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2421 RICHMOND WY . Status: ISSUED
Suite: Applied: 12/17/2004
Vicinity: Issued: 12/17/2004
Parcel Number: 41916563 Zoning:
•
Applicant: GRAY, WAYNE ISSUED BY:' ' 4
Address:
Phone: 949 707-5222
Zip:
Owner: SCHINDLER, DAVID ALLEN
Address 2421 RICHMOND WAY
Phone: - '
COSTA MESA.CA • Zip: 92626-6540 • - •
Contractor: Q M H S INC
Address: 21907 ERIE LN -
Phone: 949-707-5222
LAKE FOREST,CA "
Zip: 92630 License: 591333
. Arch : Eng:
Address: - - Address:
Phone: Phone:
•
Zip: License: License: .,
•
SCOPE OF PERMIT
NON-STRUCTURAL"LIKE FOR LIKE"REPLACEMENT OF 5 WINDOWS, PATIO SLIDING DOOR, FRONT DOOR&GARAGE DOORS(APPLICANT
TO COMPLY WITH EGRESS REQUIREMENTS IN BEDROOMS). -
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,500.00
Permit: $111.25 - -- • - - - Claim Valuation: $4,soo.6o
SMIP Res: $0.50
SMIP Com: $0.00 • • -
Other: , $0.00 - ,
Inspection: $0.00
Total: $111.75
- , PLANNING &ZONING
SETBACKS
MAIN STRUCTURE'Froth 0-0' Rear j O-,Q Leff 0.0 . Right- - .0-0,- -/ '
ACCESSORY .Front 0-0 Rear 0-0 Left 0-0 , Right 0-0
PARKING Existing: 0 Required: 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
2446-46(6/00) •
WORKERS'COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of they •ing declarations:
❑ I have and will maintain a certificate of conse....a 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. .
❑ ')lave 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' e ation In once artier and policy number are: -7 T ,, _`//
Cgnier: !e///t P7Number: ///SO77— G!
(This section need not be complete•if 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 as to become subject to the workers'
Compensation laws of Califo d agree that if I should become subject to the workers'compensation provisions of Section 37 of th Labor Code,I shall forthwith
comply with these p
.s / /L
pplicant Signature:� � car
CDete: 7�
WARNING:FAILURE TO SECUR WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI S AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license. n.er•rov. .•nss f Chapter 9(commencing with Section 7000)of Division 3 of the Business an Professions Code,and my license Is in full
and effecLic.t. # a _ Class#
Contractors Signature: ' — Date: ..r
/
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:
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 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 driver's 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,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 hes 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).
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 akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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 pan 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
B (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.
•ii'•:'• e of egal Owner(s) Date
/271-7/
arAuth•-' .. •iplidant • Date'-tr
CODE A INSPECTION TYPg WI INTTfIAL5 CODE E INSPECTION TYPE DAIS WTTIIAL$
1618 Fixed System Final Fire Prevention 206 Final Mechanical •
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 2
204 Final Demolition ' . . - 250 Final Building/Occupancy '7 ZikejiC`
I. ‘
ADDRESS OFBUILDIND: 2421 RICHMOND WY DMT: CITY OF COSTA MESA — BUILDING PERMIT
°Ni eSNAME'Fl04ay"' LEITH, NANCY Y TR FOR PERM NO: B 073614
ADDRESS: HOWARD D LOVELESS TR
17775 S W ALEXANDER ST PERMIT NO: B 073614 PLAN CHECK NO: N GOVT: N SUPP : N
ALOHA,OR 97006
APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: VN PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: U0.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/ COMP SHINGLES SQ FT: 2, 999
ARCH.OR ENG.'S ADDRESS: LINT:
CLAIM VALUE: 2, 999 . 00 CALC—VALUE: 2, 999 . 00 GROUP OCC : R-3 /
CONTRACTO'SNARE: STOUT ROOFING INC ( 310 ) 923-6775
CONTRACTOR'SMMUNG P 0 BOX 4309 COMMENTS: SMOKE DETECTORS REQUIRED PER 91 UBC
- ADDRESS: I)DeNMEY CA uc.NO.: 402536 +1'*K'*'*'**'***+A*'**********'****+E****ii•iti(-*iE+E*1E*ftiE*+E****Ik7E1E1NiE+rfEiEiFlErtifi ***fit**iE***1EiE1E1EM'***
90241 LNC: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under•- - perjury that I am licensed under provi' of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Proles'• ode,end m cense is in full force effect.
CITY UC.NO.: p 9 377 UC,CLASS: 39 LIC .� 6 EX 10 95 MAIN BUILDING ACCESSORY BUILDING ----
-. I, FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: ��' Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors Licena Law for the
IS'ylowing reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to mrotrucl,altar,improve,
`rimoleh,or repairPARKING RE PROV: PARCEL: 41916563 ZNE: REF NO:
•,4;,=• any structure.vi prior of itseContrac also requires the[Chapter nt for(such permit Io file a signed statementof sat he or she .� _��
$'yIncensed and Prole to the ode)or that the she sae License Law)Chapter 9 basis for thnt all wi'h exemption.e7000)of Division 3 e the PLANNING N TES>
7031.S b Professions Code]or he or she is exempt therefrom and the lot the alleged 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 tt500]). fEiE****1E1EHEiEiE********1E1E1E1E1E1EfElEiE1E1E1FiEiEiE1E1E1E1E1E1E1ERElEIE1EIE)E1E1FiEiE1L1EiE1E1E1EfEiEiE1E1E#9E1E1E1ElElk.3flElE#1E3(1EK-iE1E
❑ 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 D E V Ey/L OP MENT SERVICES R E Q U I R E M E Nt';T S
w offered for sale(Section 7044,Business and Professions Code:The Contractors License Law drowrot apply to an Ownerof property
who budde or improves thereon.and who does such work himself or herself or through hew her own employees,provided that such y
improvements are not intended ora offered for sale.If.however,the building orimprovementovement is sold within one year of completion,the ZONING APPROVED' BY DATE: • t,+
owner builder will have the burden of proving hew she did M build or improve for the purpose of sale).
o I.es owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
Professions Coda:The Contractors License Law does not apply to an owner of properly who builds or improves thereon and w, BUILDING APPROVED BY DAT E
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). .
❑ lamexempt under Secfion: B.A P.C.,for this reason: . APPLICATION ISSUED BY: DATE: �5
*********************************************** tt*********** **
Date: owme LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of Cstfomia Health and Safety Code Sections 25505,2551t,and
apr4,and othat loany r mo ficatinfng omtheA Quak/ yMl M(gi¢leme)needteidmpiw conssuctsn applictinsdtM requirements BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
2pem,H for construction nor utebaonhomthe nt will/GtyMotr(circle
teisnie to comply with swonte codes anare e rempremetsese for
provisions. PERMIT 54 . 00 . 50
Dale: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of penury one of the following dad r°tons: PLAN
ISSUE FEE
❑ I have and Cods,frshepeainaianceonaeatedwnsenttohisperureforsued. compensation,asprwdedfor bySection 3700ofthe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Cate,lwtheperfamaroedthe wwkfor w ntnepemltieiaed. TOTALS----> 54 . 50 0'. 00 0 . 00 54 . 50 54 . 50 . 00
I have and wit maintain workers'compensation insurance.as required by Section 3700 of the Labor Code.for the performance of the
N work for which the permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier TATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT: .00
Policy Number: 04494110004687 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed thepermit is for one hundred dollars or lase) 54 .00 . 50
❑ I coney that in the pedormance of the work for which the permit is I shall not: ploy any person i manner so as to
beerxne subject Io t sworkers'compensation of Celifomia, r that '' should become re tit° *OW **************************************************************************IF****
compensation d Sea
J�^37(aJ�jf m code' h1/r'. t 'mv INDIVIDUAL F E E BREAKDOWN
Date: "'�7 '� / Applicant: •
•
Waning:Failure to secure workers'compensation coverages unlawful,end shall subject en employer to criminal nettles and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines sty to one hundred thousand dollars(S104000),M eddldon to the cost of compensation,damegas asprovided for In
Section 3706 of the tabor cede,Interest and a"orntey'sfees. SFR 2999 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 999 . 00
• CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency ler the END OF FEES
performance of the work for which the semi is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
•
I certify that I have reed this application and state that the above information is correct.I agree to comply with all city end county ordinances
end state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly
for inspection purpose RL ENE ,BURFO:y
/'rint Nero
(A AWSUF
,fj 9_9s' 01 00187654-00187655 TOT 5¢,, 0
- :nature aowner/Agent/AppLronUCennd«
aD018 DATE: O8/0419 TIME: 09%10
(5151•45.WP) White-Building A Safety:Gran-File:Canary-Appecant:Pink-Revenue;Goldenrod-Assessor
.
•
C CONSTRUCTION AND PLANNING POC SPA
APPROVALS Permit# Date Inspector APPROVALS . Permit # Date Inspector
M
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
i
2. Soil Pipe-Undrgrnd. " - 53. Steel Reinforcement
-
4:7 Electrical Cond4it Utility•Undllgrnd. _ 54. Forms ' -
nE-4?Eie`etrical Conduct-Uotirgrnd. 55: Electrical Bonding `
W5 Steel Reinforcergeef• 56. Rough Plumbing& Pressure Test
Th-116. Electrical UFER:Grnd. 57. APPROVAL TO COVER-GUNITE -
it;;79. 6otings ' - 58. Electrical Condiiit,Undrgrnd. • C ••
: 8-•:Foundation a-- 59. Gas Pipe, 0 Undrgrnd.,Test ;°
,
rr!C u.u. o --n. -'
?'s•;9'.'1BFater Pipe-Undrtjr . ,• _ 60. Backwash Lines, P0Trap, I?Undrgrnd.
10. Structural Floor System : , • 61. APPROVAL TO DECK
Fi. Property Sewer Line.& Housetonnection 62. Backwash & Receiior-Filial
12. Sewer Cap ' 63. Heater & Vent-Final r-- •
13. Roof Drains • - 64. Plumbing System - Final '
14. Rough Plumbing:, -r7 ,• - 65. Electrical-Final -
15. Rough Electricaiondui
- t *,7 66. Solar System-F\ai,
16. Rough Electric Wirin, .., '' 67. Fencing & Access Approval > r
17. Rough Wiring Sign ... Y 68. APPROVED F3PPLASTERING •.r•
18. Rough ElectricaGT Bar Ceiling''' • - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DELPT.�EQUIREMENT
20. Rbug FaW ori Fit ace • •;;; a:; , ` - e.A,Cmz .APPRAVeLPeit# ` >4 �
21. Ducts;in Strumurr* - •• � . " 7 -..* • 70. :17nderg7ound Hydro
22. RuctF Veiitila�'ingNy C;,• -: . ---d. cr ;. 71. Produi•Fping�7Zas Q• Oil.
23. Gas P4Rpe- ug5 & Tit c ^,S s a Q J= c
72. Underground Flusfir
24. fCoof ra?Ring" F x ;A , ;r 73" Undergrnd.Stotto Tank,0 Gas .0 Oil
25. Roof>Shes1"hing• n�. • `C . - • f'7 q4'
6 ,,aa,t�* , 74;+OverheadHydr6._ • •Ir . . •
26. T-BaVCeiling (Strati brag & M ino.'�bat • "7 fi 75.: Dr Chemical -_- " ,=.
• 27. E;iameand.Fl4 ting ...;: t:- .+' :- G?. 76. Dry Stan -d Pipe '
y _ - _ - r
28. Lathing QSidi "`ng E - T" 43 `' •• •. •:; 77. FIXEDYSTE(01',rINAt ._ rn
29. Insulation• tf. is -. S .- * 7g FIRE PREY. FINAL
5 :.
_ 30. Drywall f>tailirig �y _ 1..... 4 S _k IEALTH''DEPT.•REQUIREMENT
=(31. Plaster Brown;Coaa* -, I t' -'79. FINAL INSPECTION .s
a 32. ElectricaPower MgtJr"Final i >_ v -4 -t80.=FOOD CERTIFtd'TE I SJ.IED -
Z , r -r r G 'F :l rt . . t 4-
33. FinaciElectric,; - ;,; I _ Notes:
7- _ - 1 er - M - _-34- Finak-ieiiingl& A r 6on�fitionirti= r x ; it r -ti -S t- F r
C -
35. Final Gas Pipe:Test 4.., c'' .'. * r ;,I ' ' -
-i _ I - . 1
L36. Hood,or Canopy _ * Z. I er-_� . . c > . . .. ..c a
1 ".
-1 r ry,r' - ! �'^ J * •
y 37. Final.Factory Fireplace ,- _ -- * :< = : N
-c-
-I38. FinaPPIur tbing x r`v . ' r ^ t J ,---. 2
r
' `
' 39. Wate7Service-Final r r.
n 40. Gas Service-Final r ra > rn
ri
M ,; = r - „
41. Solar Domestt2Fina;. IY x y* _. ▪',., A. -
-'42. $ackflow:Qreventer .- cu .r 7 >t- • t z -
43. Backflow Irrigation ; - r --- -``
r' -
44 . LandscapelrrTgation•SystemVT� - - - •.
45. Sound Attenuation ,. ._, •. -• ;. s l� rr _ c *
45. Handicap Regulations r- + , 4‹. I': 00 S
47. F'iN4t. 5TRUCTURf& BUILDING /f f�qf 6 ) . ,
6 r
48. FINAL PLANNING:1 -L^ ;. cu V .ri r . c
•n -, _ � i. C ,
49. Eiectiic Release to Eirison ' * i Y -
50. Gas Release to Southern CaliforniaGasCo •r • =- r
.. • - - n V r1 _
Si. CERTIFICATE OF OCCUPANCY 4 r - - -
No Date .!'
•
OWNER SAN MIL RiI MS COMPANY TATE 6-1-64
JOB ADDRESS 21421 pi rhmnnd Way BUILDING PERMIT NO. 22270
GENERAL CONTRACTORsame VALUE $ 14,:35.00
AP No. LOT 220 TRACT 551(,(1 FIRE ZONE DESCRIPTION OF WORK yen v/ntt Par
INSPECTIONS - Signature D, ' GROUP Tgir TYPE Vri ZONE It/
Soil �j r » SUBCONTRACTOR PERMITS�ISSUED
Gas ' DATE NUMBER
Water
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating ✓�,�/, /��J61./ C� y, �Fr 3,3 2 0 -
Rough Plumbing /p/ / , AyyI�/1/- (dR -�"(iKJ 6-v--Ic V //ii tt(o./ -- k
Miscellaneous ,-,/ r� /r \ n
Prop. Swr. Line 0 House Con. 6Q St. Swr. 0 �,u/ /J,y'2i 1 (';rit,c F';,--c . DEC 9 1963 4 0 7 6 T` OIL
Sprinkling System :OIL
Construction Pole �I6ti
Underground 0 Power 0 I i
Rough Wirinfy .1 AV - '-')/ r SEP 1 ? 1964 3 4 5 0 -
PM
Trenches , Forms ( 'Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing nt_,# a
Frame and Flashing &y jt - Matra' �.
Lathing— In m/Out•[y • Gizi c .. Sttf _'
Plaster, brown coat ` a- _ y- Sot'. - iI '
Refrig. 0 Air Con. 0Final i---- L,.,........____- ----e°`
Heating, Final /- S 47'b
Plumbing Fixtures, Final /•-
Final Gas Test / _ / 5/
Electric Fixtures, Final ja Z-s-G i`
Building, Finale' ,jr of-i"
I
OCCUPANCY
Form BU4--6M�-63—S-B P HOLD F 1. zITcL^L E'IEQIJI&EMFNTS
COSTA MESA BUILDING-SAFETY DEPART.._. T i EE RECE"'y D
P.O.BOX 317 COSTA MESA,CALIFORNIA CdA 1.1 9 19
For Applicant to Fill In Completely APPLICAF N PERM
TYPE OR PRINT • ct;vIai1M&STA !ASA
/� /. - For Office Use Only
BUILDING 24 / T l. /1 T A I
ADDRESS oC%OI LY�G'tl"•._--"_•-"f(/ Al RECEIPT NO. 2527ryo.
COSTA MESA, CALIFORNIA 7
RECE BY DATE RKDEIVBp DATE ISSUED
\nL1J�) .5---1 Y (/� JUN .1 1964
MAILowNERSanrA� v-I �2�( �IXQ iI���`r/j�� ` ABUIL ING
DDRESS
ADDRESS I I lD /�'� �• �]�g 'al s �7 ar/ `�� `
• FIRE
CITY 'tQ.a l / 1. , // NOLN?`)/ / ZONE - TYPE: GROUP / `✓c
ARCHITECT // /t TE •I I APPROVED - DATE
OR EN INEER/ALA. ..�a�.... N• •; 1 10 CJ ZONING •
a
ADDRESS . 2- .C`.AI- ait it`^�`^'(��IL,�,.TD•�JAd esair ,6
CONTRACTOR Sa a �J iO--Y�-�y _ �� A, -
{1 j /y� 1 LEGAL
ADDRESS 1' { In ID e s A- DESCRIPTION .4,„1,,,, Z^ (/ D / / 2-
CITY V. /` NO,{y,/I^/�� y/�/J A.P.NO. /v J - Jl/.3 .
STATE /C /I� Q'f NO•Y/ J/ L�2I/ / SO"I TO SIDE B REAR PE: NO EAVE H LNG SHALL BE LESS HAN
LIC.NO. 9. - o Ci
O 9 D I NOW ON LOT O EAVES
SIZE NO.OP CLOGS. ALLOWED 'IU.B.C.REQUIREMENT/
OF L
YARDS APPROVED YARDS APPROVED
USE OF /!ln ., I� ' MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. 1' h__ C..- - -
SETBACK LINE FROM I FRONT(FROM Qi L�'r Fr ET) FT CI
CENTER OP STREET I 3 ' REAR YARD n J\
SIDE YARD I LEFT 0 - I RIGHT C R.SIDE 0 FT. FT.
DESCRIPTION OF WORK . L.SIDE 00 FT. FT.
NEW n ALTERATION N ADDITION REAR FT. FT.
DISTANCE BET. BET.MAIN Q
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDING NO OF Y�NN, Rj/./ _ VAR.# DATE
SIZE c2Q X3 . ROOMS.S STORIES .Z C.U. •'I APPROVED •
rr
EXTERIOR WALyy� ROOF •APP'•V 1. / .
COVERING (JI COVERING BY 1,WI W GATE i. `'
CC
UILDI AND WORK T BE ERFORMED
et
,f.1Vit y -� /348 ', - 0a' o _�
SQ.FT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOW NDER VALUATION IS FOR THE F L7
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. S.'
PLY WITH ALL CITY.ORDINANCES AND STATE LAWS REGULATING VALUATION 0.N
' BUILDING CO RUCTION. '/CY S
SIGNATUR .. PERMIT FEE $ /Ya ,
PERMITTEr B
0
AUTHORIZED A T - - E
TOTAL FEE $ 72. in,