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Home My WebLink About3076 ROANOKE LN - Building Permits O'er FS, ID CITY OF COSTA MESAme `' BUILDING DIVISION > PERMIT NUMBER ° F"1� ' DEVELOPMENT SERVICES DEPARTMENT i PERMIT PM 16377 roo 00377 (714)754-5273 • Fax(714)754-4656 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 3076 ROANOKE LN Status: ISSUED Suite No Applied: 07/17/2000 Issued: 07/17/2000 Vicinity: `%% ' ISSUED BY: Parcel Nunmber: 14151211 Applicant: NOCK, RON Address: 11612 KNOTT ST Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 '��j 49 Owner: COLVER, FRANK W • Y� 'hi Address 3076 ROANOKE LN "rI Phone: w+C COSTA MESA, CA Zip: 92626 Y►'� Contractor: NOCK PLUMBING Address: 11612 KNOTT ST • Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 License: 707775 Arch / Eng : Address: Phone: Zip: License: SCOPE OF PERMIT 1 WATER HEATER CHANGE-OUT. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump WOO 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 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 COMMENTS/SPECIAL CONDITIONS • 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 DECLARATIONS r'" 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 for which this permit iS issued. EVIhave and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this ht4Xf7?3 (Pa7C permit is'issued. My workers'compensation Insurance carrier and policy number are: 4 is Carder: �L� Policy Number. C (This section need,not be completed i/the permit/s valued at one hundred dollars($100)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 shall forthwith comply with these prlS�Ttsloq Applicant Signature: VV1I Date: / / WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE f$100,0 30),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 ••- •r y '• .f 6j1 er 9(commencing with Section 7000)of Division 3 of the Business and PP1cfessjonpCode,and my license is in full force and effect.Lie.# ►_ - / Class# C ! o Contractors Signature: Date: 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 ProfessionsCotle)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 toga civitpenalty.of not more than five hundred dollars($500).): -er.rr a re , O 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 ownlemployaes,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.). r ❑ I, as owner of the property, am E%CLUSIVELY 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 properly who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O 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 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 ode time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑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? ❑Yes 0 No ...._..... __l...t_. or present __...-_ which ube- pli' 5 Does or willo the applicant ouliyy a ar future building occupant at y other for the work ontch lathe subject age of this application a0Permit 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 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? ❑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 ❑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 ell 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. Signature Of Legal Owner(s) Date at A�'='�'rthonp• / Date CODE a. INSPECTION TYPE PATE INTITIALS CODE( INSPECTION TYPE PALE INTRULS 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing -S 4- 0? Ay l 200 Final Re-Root _ 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 2446-46 4`4y't>A M(c 4> - CITY OF COSTA MESA BUILDING DIVISION >N• r,' , DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER � PERMIT 600-01510 q� (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.CduAL DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 3076 ROANOKE LN COIStatus: ISSUED Suite: Applied: 09/26/2000 Vicinity: HOUSE&ATTACHED GARAGE Issued: 09/26/2000 Parcel Number: 14151211 Zoning: R1 R1 Applicant: SLOBOM, SUSAN ISSUED BY: Address: 208 DEL CABO Phone: (714)777-7107 SAN CLEMENTE,CA Zip: 92673 Owner: COLVER, FRANK W Address 3076 ROANOKE LN Phone: COSTA MESA,CA Zip: 92626 Contractor: PRIDE ROOFING Address: 208 DEL CABO Phone: (714)777-7107 SAN CLEMENTE,CA Zip: 92673 License: 390685 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(21 SO).TEAR OFF EXISTING WOOD SHAKES& RESHEATH WITH 1/2"CDX PLYWOOD. INSTALL 1 LAYER OF 30#FELT UNDERLAYMENT&REROOF WITH"EAGLELITE ALHAMBRA"-ICBO#4660/5.5 LBS. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,300.00 Permit: $139.25 Claim Valuation: $6,300.00 SMIP Res: $0.63 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 • Total: $139.88 - PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. _ - FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS I " WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ,_,/work for which this permit Is issued. f -A1C I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. l --My coo pompe ation Ins nce carper and policy number are: G f/ G CCarries C- ZP f-i/Nf Policy NCenber:C�9 S ,ob l Y d / _(this section need not be completed if f jpermit is valued at one hundred dollars($f00)or less.) ,_S ❑ I certify that in the performs aril the work for which is--permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Call ncia,and agree that If I o I• •ecome subject to the workers'compensation provisions of Sectio 3700 of the Labor Code,I shall forthwith comply with these Prov' ns. 'Applicant Signature: I� r--Date:-- WARNING:FAILU SECURE WORKERS'•• SATIN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CR ANAL PENALETI S AND GVIL FINES uP TO ONE HUNDRED THOUSAND RE ISl00,C00),IN••• • •THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: /J I hereby affirm that]am licensed under revisions of Cha ?J(commencing with Section 7000)of Division 3 of the Busines and Professions Code,and my license Is In full force and ettecl`Lic_R, n Gess a- Contractor's Signature: - �— /'Date: : Agar' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore 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 ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation thee(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,Title 8,California Administrative Code). El 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 ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑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 materiels)? ❑Yes ❑No (Section 25534 of the Califomia 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 requiretl,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit 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 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? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). __._.a _.... 7 Ifa a permit fromv the South Coast res Quality ed Management DistrictHeor dhSr airpollution ioncontrol district03ben agency is required for the work which is the subject of this epplicatlon,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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 cor2tur�rs) with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abofor inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. T d 5 ateh rAn Authorized'ApPlicant /1 ate ;ODE I INSPECTION TYPE RAM lIf Sia CODE' INSPECTION TYPE PATE MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final / 7 208 Final Plumbing 200 Final Re-Roof (&/l-CO at' 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTAMESA / CO STRERMIT a 313�1 �j A.P.# Zone Project Address 7b1 W e- R r J S Main Building: Accessory Building: Applicant's Maili ,d_dress 1�s TYPE OF CONSTRUCTION LI NEW ❑ ADD H ALTERATION H REPAIR E Z r `�t•�,..ta 1D'� Pho ,r r Q�7 ❑ CONVERSION El DEMOLISH El OTHER T Front • O Owner's Name w��"`�^�A<-- ` — '" T DESCRIPTION OF WORK/USE OF BLDG. I B Rear N Address Arch/Eng. _ - License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL C Right G 4 Address p1�y� t�-� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S - Left R Contractor's Name.);esfo rcrt co rArT pho (8999wi •yo7 111 OTHER i Ping. Ref.# Parking Req./Provided E Address(mailing)CD s" 0 w. PROJECT DESCRIPTION SQ. FT. OCCUPANCY Q I 7 �� 25 PROJECT Notes: CONST RUCTION TYPE VALUATION$ M City License No. T — —`_..`_ ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DE ARATI• ` I hereby affirm that I am licen.ed under provi-ons of • to 9 (commencing Remarks: � �� S P /k with section 7000) of DIvlsi• 3 of the ausi ess an' Pro. sslons Code, and �'t my license is inaull force and affect. ELECTRICAL FEES License Class a' 5 . Al 'Licen o. • 1 + l/ / PLUMBING FEES Automatic Washer Transformer 0 15-50 KW Date 7 �$Q Signatu�.. WORKERS'C6MPENSATION DECL• 'ATION / Construction Pole Sub. 050+ KW I hereby affirm that I have a certifica - • •nsent to self-insu'-rtificate, Bar Sink Showers Workers' Compensation Insu . ce, or a .tattled copy (Section Cooking Unit Meter Duo to 100 amps 0, Lab. C.) Backflow Preventer Service Sink Policy No. Comps Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps �]tCertifietl copy is hereby fur 'e cit ��e� Dryers ❑Gas ❑Electric Sub Panel LK Certifie py ' e with t is city B • Bathtubs Sewer Connection Date �+-6��`L� APPIi..nt ��..�- —�+� Fan Motors ❑0.1.HP ❑1%-8 EXEMPTION FROM WORKERS'Ce '' ATION DECLARATIN r Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ less). Dishwasher Solar Piping I certify that in the performance of the work for which this permit is issued, I Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE:It,after making this declaration,you should become subject to the OUtI¢ts Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction lending agency for the performanc¢ Garbage Disposal of the work for which this permit is issued (Section 3097 Civ. C.) InterceptOfs Water Heater - g p Standing Sections ' Lender's Name Lender's Address Kitchen Sink Water Service Generator 00.5 KW❑5-15 KW Trash Compactor OWNER BUILDER DECLARATION Lis�Q1sn� G ' 1.1c I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash ( I'l11• all- 594 LIAM Lrf following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains IF C>" the Contractor's License Law(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee �$/,1Pr •refrom and the basis for the alleged exemption. Any violation of Section P $15 Issue Fee 11.5 by any applicant for a permit subjects the applicant to a civil .:arty of not more than five hundred dollars($500). . DEVELOPMENT SERVICES REQUIREMENTS: ' L) I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or-offered Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date License Law does not apply to an owner of a property who builds or improves __-_- _ I�• ❑.•sl-J��C,� thereon, and who does such work himself/herself or through his or her own • Application Issued By `J Date r/I fff /f`•v 111 employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I D sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ SMIP $ • 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • tractors to construct the project (Section 7044,Business and Professions Code: - PLAN CHECK $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon. and who contracts for such oroiects with a con- - ENERGY P.C. $ tractors) license pursuant to tne Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK 25% $ proof o their Worker's Compensation surance should be provided to me. twin-� •GRADING $ 1.: I am exams - Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers ELECTRICAL $ PLAN CHECK 50% $ MICROFILM $ Date Owner Heating System& Ducting Registers ^ ^ 50 I hereby certify that I ha - rea• this •-•lication and state that the above 00-100,000 BTU 0100,000 BTL MECHANICAL $ 'TOTAL FEE $ O�oL ' informat on is correct gr-e to ompl th all city and county ordinances PLAN CHECK 25% $ and stat- laws relati •uildi • construe• ,and hereby authorize repre- . sentative of th'. • '•�enter upon t • e-mentioned property for Inspectio •urpo es s , 4.- ,L� � Signature , rlE� �� D fe T� ��i�� • - 01 TOT ,, Reinspection Fee $15 Issue Fee $ 3 000112n-11227419°0. �. Drivers' License or 55 - •• •�AIEe 05/22/25 TLtlL: 12:12 0865-46,rev.5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor o IF a' CONSTRUCTION AND PLANNING / POOI 'PA APPROVALS Permit Dae 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE . 7. Footings58. Electrical Conduit-Undrgrnd. 8., Foundation , • 59. Gas Pipe, 0 Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System • 61. APPROVAL TO DECK , i 11. Property Sewer Line & House Connection t 62. Backwash & Receptor-Final 12. Sew%Cap r 1 63. Heater & Vent-Final . 13. Roof-Drains 64. Plumbing System - Final 14. Rough Plumbing ' . 65. Electrical-Final /`igi 15. Rough Electrical-Conduit 66. Solar System-Final (((((( 16. Rough Electric Wiring 67. Fencing & Access Approval . 17'. Rough Wiring Sign 68. APPROVED FOR PLASTERING //JJ 18. Rough Electrical-T Bar Ceiling. 69. POOL/SPA SYSTEMS FINAL {o/(/�j q erg 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT G •r 20:Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test I ; 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 PREV. 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: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test 77 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final e 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. Special Requirements Completed 49. Electric Release to Edison . •- 50. Gas Release to Southern California Gas Co _ . _Al , 51. CERTIFICATE OF OCCUPANCY No. Date l -•t , - - N. z-2oV/SU:G1 - LiraE irt ----- - , - ---.- — - — I- - --1 -I - - - -, I - -- --- — -- _ .SPA _-_-_i, - . _ _. Cil DesSLG - . • - _ M2 MR$ co NSR . . . ------130 6 __QJDA t4D K - _ OWNER NORTHGATE - DATE JUL 5 1963 JOB ADDRESS 3076 Roanoke Lane BUILDING PERMIT NO. 19997 GENERAL CONTRACTOR Bonner Construction, Inc. VALUE $ 18,721.00 AP No. LOT 26 TRACT 48991 FIRE ZONE DESCRIPTION OF WORKSng.Fam.Dt1.W/S INSPECTIONS Signature DATE GROUP I & J TYPE V ZONE RI Gar Soil At 7-77-- f PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water y q Mtn-.we Rough C m. Refrig. 0 Air Cond. 0 _ Rough Heating S!% .S"2d-/,j -�.-.......e..5 JUL 2.6 'AAA Rough Plumbing 4//- 4—?2'L) �it- eni-z" .UI 1 2 19W }.i. �o > Miscellaneous Prop. Swr. Line Vliouse Con.0t. Swr. 0 /. _ G- - 4R i ,_ AUG g_I96;, Sprinkling System 4i 0Le__.., AUG 1 6 ' - Construction Pole ',SSV Underground ❑ Power .0 P Rough Wiring {-e3 t -yrs. 4,� ,p-,i--63 - .20 9 9 Trenches LI, Forms ik Steel Reinf.J4' ill Floor System ,Q-y ;? Bond Beam 0 Steel Reinforce 0 Sheathing Mr Q�a/� Frame and Flashing - -Air- - Lathing - In 2- Out r i_ina�/� Plaster brown coat /V%ji • / - Refrig. 0 Air Con, .p Final Heating, Final /Vffs /0"23-CR Plumbing Fixtures, FinalC- .- )*-P-G J Final Gas Test }'X-- 7 -- A--2--C a E Building, i al lFes, Final /f /O too-"l"V'3 - • OCCUPANCY C Form BU4-5M-3-83—S-33 P 19997 COSTA MESA BUILDING-SAFETY DEPARTMENT 1( P.O.BOX 317 COSTA MESA,CALIFORNIA L L di/ C1 -V E D For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPETOR PRINT � )489!4_26 RN/A��NflIL®LM�.Lr��• ADDRESS St • C P\1 r4M l 1/1 c j1 Av✓ 1�'��OUI � �� JI1 lY RECEIPT NO. rE/1MI�g COSTA MESA. CALIFORNIA I llJl�L.•/�lL�� RECEIVED BY CIA'p R7I L DATE ISSUED OWNER Northgate /C/ /V [/ JUL 5 1963 BUILDING ADDRESS 13311 Golden West ADDRESS FIRE �/�I.),9_ CITY WestminsterL Cal.-----1;694;4.842 NO. ZONEAP TYPE GROU �(� ARCHITECT TH1�! r BYPROVED DATE OR ENGINEER C. Hiller N "3r-2OO7 ADDRESS BOX 11, Anaheim, Calif. ZONING i Constr. 1 I NO.O Ue8 OIT N L Boner Constr. / PLANE _•ELLLi'11-q1� Q CONTRACTOR Inc.TI1C. _ ( /� ///q� ADDRESS 133W. Golden West,. LEGAL / lV L� Tg Y-'l ,c? CITY Westminster, Cal. A.P.NO. r p NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC..NO. Z1701µ9 NQ p- 897-78214 90'TO SIDE¢REAR P.L EA60 x 100plus LES SIZEI NO.OFELOGS. O ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. — IFROMC/L STREET/ SETBACK LINPROM [ ��yy��/�� p CENTER OR 8TP88TT O1 plus REAR YARD 101 FROryTBFLJ FT. PT. SIDE YARD' LEFT 1401 I RIGHT 1 51811 R.HIDE FT. ) (} /D'/ FT. • DESCRIPTION OF WORK L.SID 'C'FT.1 87fO if---- Fr. j A NEW X ALTERATION _ ADDITION REAR FT{O Y `/ F'r. DISTANCE BET. BET.MAIN @ MAIN BLDGS. ACCESS.BLDGS. REPAIR MOVING DEMOLISH BUILDI q, [ NO.OF VAR.* DATE SIZE 'L4 19IIx5O 191t ROOMS 7 STORIES 2 C.U.P.* fyy APPROVED EXTERIOR WALL I ROOF APPR•`, • ,lr I'),1,1.1 (9 �/8lG COVERING COVERING sh' P : BY ` 11, L'P' DATE VV VV USE OF BUILDING AND WORK TO BE PERFORMED fg�y ','j Single family Watt garage �/( 44l$9.2iCel/ al Q. 43yn` N sD.Fr. I HEREBY ACKNO •• T I HAVE EAD THIS APPLICATION THE AMOUNT SHOWN UNDER VALUA ON IS FOR THE AND STATE TH. THE AB.' ORFIEC AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. p PLY WITH AL CITY ORD T TH LAWS REGULATING VALUATION / BUILDING CO'STRUCTIO i /PERMIT FEE $ /'S1 r-/I R-A D' SIGNATURERMIEEOe nick" _ PERMITTED $ / 4V7.21 co T a J� '`/( 4 AUTHORIZED AGENT \ TOTAL FEE $ 9-r 1y(/