HomeMy WebLinkAbout3088 ROANOKE LN - Building Permits •
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA�7ME p(, (j`J�N$TRUCTION PERNAT /�/ PER N TRACT NO. LOT NO. UNIT NO.
.Project Address 7�'2rrJ /10AP30eL AA) Lidlot'X(0. I 6 Co/FS
Applicant's Mailing/��11drrnss�j / 3 a . L • 1 TYPE OF CONSTRUCTION DI NEW U ADD Li ALTERATION U REPAIR
Owner's Name (/"+mac Phone ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OP-'PERMIT ❑ GRADING�❑yPOUNDATION ❑ STRUCTURAL E Front Q
❑ TENANT ❑ ELECTRICAL L7 PLUMBING ❑ MECHANICAL
B N
Address ��,Jl������111111 / , pppp n/1 ////��7/1� A Rear I
Contractor's Name8taPis44 tin( /culP Phone/ /c/•�4/00.. ❑ OTHER C Right G
Address(mailing) ls3 d. LNI, �-/��,0` PROJECT DESCRIPTION SQ. FT. OCCUPANCY K
n/)q (% CONSTRUCTION TYPE VALUATION S S Left
City License No. �1`715
R
PiZONE._ GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION ng. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:, nn ny s� r -sem-- PlanningNotes: , Q
with section 7000) of Division 3 of the Business and Professions Code, and /�ST/-1�-L.0 4./ 7A / L �� f [ . �! - 4 5f1ff0 M
my license is in full for a • e fecL ' , RECFNEU U L 1 l�./d T
Licens• Clas lc- s/ / 1-V1066-9 S
Date . Mir Signature - A_ a . PLUMBING I FEES •
N.
WORKERS'COMPENSATION DECLARATION Bar Sink Showers '
I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES
•
of Workers' Compensation Insurance, or a cer d copy thereof (Section Backflow Preventer Service Sink
��/(� • Automatic Washer Transformer 0 15-50 KW
3800, Lab. DI /Y d UO I
Policy No. l /`/d Company eaue Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
�ertified copy is hereby furnished. S
CertVigo cpjLled with the city B Divl I n.\ Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date / —( , y Applicant ,ei, ��/r .r✓WlS -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishhasher Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that in the performance Of the work for which this permit is Issued, I -
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1'h-8 -
Workers' Compensation Laws of California. _
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
NOTICE: If,after making this declaration, you should become subject to the _ Int.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Li ht •
I hereby affirm that there is a construction lending agency for the performance g
of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors / Water Heater qqV0
Lender's Name p rx Outlets Range I•
Lender's Address Kitchen Sink Water Service
OWNER BUILDER DECLARATION Switches Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code:'Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section-7000) of
Division 3 of the Business and Professions Code) or that he/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
enalty of not more than five hundred dollars($500). •
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, anq the structure Is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves _
thereon, and who does such work himself/herself or through his or her own DEVELOPMENTSERVICES REQUIREMENTS:
employees, provided that such Improvements aro not intended or offered for Boiler Hood or Type I ❑ ZoningApproved
sale- If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 pp By Date
pre thewill ownerhave the burden of proving he/she did not build or im- Duct-Under Ground
p�1rovforove , the purposesesale). i Building Approved By • Date
LJ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ( Dat
tractors to construct the project (Section 7044,Business and Professions Code: �(f
• The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
❑ l am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# ' Fire Dampers
PLUMBING $ 970 0 ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM 5
sentatives of t cty o ei ter` u,on tele above-mentioned property for �+s
Inspection purpj - / /
Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865.46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor 01 00021557-00021557 TOT 5.Vb
nATP. .M1 Inn lnn tr.+'.- •.-r.
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & 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
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, E Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final •
13. Roof Drains 64. Plumbing System - Final.:
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 0il
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 v,
31. Plaster Brown Coat 79. FINAL INSPECTION j .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 1,
33. Final Electric Notes:/.„ q_yq- tem gyp_ L, g,p
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy •
37. Final Factory Fireplace
38. Final Plumbing Zo-JI Ca
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. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. _ Date •
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CO �$7TR'/U1 C ION P R,1MMIT IT NO([� TRACT NO. LOT NO. UNIT NO. 6017 10/27/86
5.00 T1.
• Project Address _�Or1 R vi� Q �'� f I • � - �� DI NyE
�(.�L(A_vI✓tp TYPE OF CONSTRUCTION U NEW DI ADO H ALTERATION IJ REPAIR r
Applicant's Mailing dr ss t7 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name 'A�I/1/1 Phone �O�qa ���� DESCRIPTION OF WORK/USE OF BLDG.
Address o(4�, , Ie S Main Building: Accessory Building:
Arch/Eng. -. License No. -.- • _ TYPE OF PERMIT ❑ GRADING EL,
❑ F NDATION U STRUCTURAL E Front ZO
Address / yy�� nn !!11 ❑ TENANT ❑ ELECTRICAL `t UMBING ❑ MECHANICAL B Rear , • N
Contractor's Nam•
�it I I,f /1 Phone[15Q�/QV5 ❑ OTHER - A C Right N
• Address(mailing) • 014,{'L. PROJECT DESCRIPTION 50. FT. OCCUPANCY K G
CONSTRUCTION TYPE VALUATION$ S Left
City License No, c] -5a3 CONSTRUCTION
- R
LICENSED CONTRACTOR DECLARATION ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
I hereby affirm that.I am licensed under provisions of Charter 9 (commencing Remarks: , Planning Notes:
0
with section 7000) of Division 3 of the Business and Professions Code, and M
my license is in f f.r e and effect. •••7 1R T
Wrens- las ./0_ 'ce se No. //1 \Yt=+`+(
• r / 4 ECF IT. i 2 't 198t S
Date I ` ,a .l' Signature £jr.- �/ , AY - PLUMBING • FEES 1
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure ora certificate - - ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Stiction - - s
• 3600, Lab. O,). Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15.50 KW
Id%sY-' Cap Construction Pole Sub.
Policy No. �n 7 J�� Company ����/�.1t�7� - Backflow Irrigation Sewer 0 50+KW ,
,-Certified copy is hereby furnished. -
Cer'tIi/1,ed pnj�i filed with the city B di is' rti,/� f /�d"� Bathtubs Sewer Connection : -• Cooking Unit Meter'Qui to 100 amps
Date-/ V- t1 Applicant ,,,�,[/(1'-�1 A•'�
•
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers - Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is far one hundred ($100)or Dishwasher
less).' Solar Piping I .0 a' Dryers ❑Gas ❑Electric Sub Panel •
�.,• I certify that in the performance of the work for which this permit is Issued, I .
•
shall not employ any person in any manner so as to become subject'to the Drinking Fountains • Solar Tank Fan Motors 00.1 HP ❑1'h-B
Workers' Compensation Laws of California. — ,
\ Date - Signature _ Floor Drains - Swimming Pool w/Spa F.A.U.
1 —NOTICE: If,after making this declaration, you should become subject to theInc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
'� comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water ClosetDevice Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097- Civ. C.) Interceptors Water Heater Outlets Range Lender's Name g '
Lender's Address • Kitchen Sink Water Service - Switches " Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code:•Any city or - Garbage Disposal Standing Sections
' county which requires a permit to construct,alter,improve,demolish or repair P-Trap • Laundry Trays Generator 00.5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9 (commencing with Section.7000) of .
' Division 3 of the Business and Professions Code) or that he/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
oenatty of not more than five hundred dollars ($500).
LJ 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 -
Reinspection Fee I $15. Issue Fee $ 3
•for sale se- (Section Business and Professional Code: The Contractor's MECHANICAL FEES
-
t
License-Law does not apply to himself/herself
f a prole or who builds or improves _ _ _ _ _ __
thereon, and who does such work or through his or her own r DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements.are not Intended or offered far Boiler •
CanopyHood-or Type I ❑ • '
sale. If, however, the building or improvement is sold within one year of com- r _ Type II ❑ Zoning Approved By ' Date •
.pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Data /
prove for the purpose of sale). __ ____-.-__- - / / ;1 rl //
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ) L I \ Date1O ,D.7
tractors to construct the project (Section 7044,Business and Professions Code: !(
The Contractor's License Law does not apply to an owner of property who '� Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU
. builds or improves thereon, and who contracts for such projects with a con- SUMMAflV OF FEES
tractors) license pursuant to the contractor's License Law). I am aware thatExhaust System ❑ Multiple❑ System Repair/Alteration •BUILDING PERMIT $ SMTP $ •
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason u Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING - $ 0-e) •
ISSUANCE, $
Date Owner Heating System& Ducting Registers
PLAN CHECK 25%' $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BTL .$ GRADING $
information is correct. I agree to comply with all city and county ordinances ELECTRICAL
and state laws relating to building construction, and hereby authorize repre-
sentatives of his city to en er upon he above-mentioned property for $ z.�
inspection la 0:11/ n I i / /yy,-ie Ll/ _ MECHANICAL $ TOTAL FEE $ 50 v
Signature /b/'/(f�f • fate (� 0 A(O Reinspection Fee $15 • Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License r SS# ' -
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant: Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
•
3. Electrical Conduit Utility-Undrgrnd. 54. Forms -•t'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. Footings 58. Electrical Conduit-Undrgrnd. _ r
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,J Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DEC1
K11. Property Sewer Line & House Connection 62. Backwash & Receptor-Fit al
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing &Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70: Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 3-147 (_CO
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. Special Requirements Completed
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
. No. Date - 9
q CITY OF COSTA MESA
t 41 q�e le) BUILDING BUILDING DIVISION PERMIT NUMBER
1- .j DEVELOPMENT SERVICES DEPARTMENT
Ta. ®® PERMIT
(1`°*^ ° 699-01605
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 3088 ROANOKE LN Status: ISSUED
Suite: Applied: 10/5/1999
Vicinity: HOUSE 8 GARAGE Issued: 10/5/1999
Parcel Number: 14151208 Zoning: R1 R1
Applicant: GAL PELETZ ISSUED BY: S
Address: 2011 WARFIELD AVE
Phone: (213)305-8263
REDONDO BEACH,CA Zip: 90272
Owner: ALL, KENNETH OSGOOD
Address 3088 ROANOKE LN
Phone:
COSTA MESA,CA Zip: 92626
Contractor: GAL PELETZ
Address: 2011 WARFIELD AVE
Phone: (213)305-8263
REDONDO BEACH,CA
Zip: 90272 License: 752913
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF-T/O, INSTALL 1/2"CDX ROOF SHTG, 1 LAYER OF 15#FELT AND 25 YEAR CLASS"A"COMPOSITION
SHINGLE ROOF.
•
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,200.00
Permit: $125.25 Claim Valuation: $5,200.00
SMIP Res: $0.52
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $125.77
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
l DECLARATIONS •
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.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is 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 it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date: /U ' 5 •9l
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($100000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# ?s•-•2 5// Class a /2
Contractor's Signature:- Date: /v • 5, S 1
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.).
O 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. ❑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 Cede).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
' permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
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?? ❑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 a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No
(Section 65650.2 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 Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal er(s) Date
ha
1,17 Autheriz.d Applicant Date
CODE I INSPECTION TYPE DAIL INTmALS CODE I INSPECTION TYPE DATE INTRIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �,Q 208 Final Plumbing
200 Final Re-Roof /o -4-y! / 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
OWNER WILEY, MR. GEORGE DATE 11-15-78
JOB ADDRESS 3088 Roanoke Lane BUILDING PERMIT NO. 47063
GENERAL CONTRACTOR W.R. Parker DESCRIPTION of WORK Add Family Rm.
AP No. 141-512-08 LOT TRACT FIRE ZONE VALUES 6.000.
INSPECTIONS Sig Dote TYPE V GROUP 7 ZONE R-1
SOIL
GAS P RMITS ISSUED
SUBCONTRACTOR
Dote Number I Signature
WATERis
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE El HOUSE CON. ❑
PRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 9
ROUGH WIRING ///,,,-A/�; /....5-77 Heating and Vent.
TRENCHES I_f FORMS 9 STEEL REINF. elidi 0 /�`y,/
FLOOR SYSTEM /rr,/(((/���f/'A1 G Y iU
BONO BEAM L STEEL REINFORCE n
SHEATHING 4.' O- -z -
FRAME AND FLASHIN— rir. ist
LATHING — IN "-1 OUT I♦r & -riaii
PLASTER. BROWN COAT -.' d 7-79
v
STRUCTURAL FINAL E' ttri'/ce / //h1
HEATING. VENT., REFRIG. AND A.C., FINAL M/rF--�J V�OLC/./agnC�/
PLUMBING, FINAL AND GAS TEST 11
ELECTRIC, FINAL C- 3/s.
_ •_•C.71.
047063
COSTA MESA BUILDING-SAFETY DEPARTMENT 90271'-,1,/15/78 54.50 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APP I AT N FOR STRUCTURAL PERMIT
-For Applicant to Fill in Completely— Use Ink Only
REC DATE RECEIVED TE SSUED
BUILDING c(� `r / -i5-- it
ADDRESS -�p p /eO�'�OIkG //V' E, Y/L-
-/K A /C7 _ _ ERMIT NO.
MAILOWNER K lc/O///�" / BUILDNG
ADDRESS ,�,Pa gyp.¢ E p ADDRESS WI/9c 0 Q �of e L„ ,
CITY CD574 //ftrs - NOL _537 3S`, TRACK/ V LO,T�' 5' BLOCK
CONSTRUCTION NEW ADD ALTERAREPAIR MOVING OFMOI ISH
LENDER /lent fr'
BRANCH ��.[
OWNER c---EO
ADDRESS �1 q /� Emil /��7,,�,,VALUE /f�� �
OR ENGINEERITECTiAw�i�-J NO. / 7.357 USE a �'✓ • ^r/•f /�+'r "r//�
/' 6'
FIRE
ADDRESS /2-3 7/ ,4l,,.G Sr 4-•(9 - ZONE 'YPE GROUP_
m^n4E BYPROVED /�/'/c�J
CONTRACTOR 2 {//pPC/L � BY y � DATE(Pic `
ADDRESS/?O/s'ja r 270, n
// ZONX/ NO.OF USE OF NE //
CITY/Cf6r t/!/ YE�j TEL-p 7,0 PLANS:22 BUILDING Q,m n'1
HI
STATE // CITY YARDS APPROVED YARDS APPROVED
LIC. NO. 306‘ZY LIC. NO. MAIN BUILDI ACCE ORY BUILDING
SIZE NO.OF BLDGS. (FROM C/L STR I
O. OF LOT NOW ON LOT FRONT � F�. ere /7J FT.
G USE OF
EXISTING BLDG. R.SIDE. T FT. FT.
COI
F Separate permits are required for L.SIDE p24/FT. FT.
electric,plumbing and heating work.
0-. REAR
i
REAR I FT. FT.
[.. USE OF B ILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
Q / MAIN BLDGS. ACCESS.BLDGS.
0Y1 v n .J 1/rv�-6/ VAR.# DATE
"'I 0 'eC.U.P.# APPROVED
7
.r-1 �liV R< eTE//c /X
IX • C/
W •
Cl. I hereby acknowledge that I have read this application and state n
W., that the above information is correct and agree to comply with m
I:6 all laws regulating building construction, and I shall not employ
Z any person In violation of the workman's compensation laws of o
the State of California. n�� m
I hereby certify that I am properly licensed as a contractor under �r-�(� SO. FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR &
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 36 a
and Professions Code,Divis on 3,Chapter 9. n
/�'w "I.
//n LAN CHECK $ /f
Signature of / ` $ /�� G o
Permittee /l (/�/• TAX $ LL
-O
Authorized Agent ..
TOTAL PAID c t h
OWNER NORTEIGATE DATE JUL 5 mg
JOB ADDRESS 3088 Roanoke LaneBUILDING PERMIT NO. 19994
GENERAL CONTRACTOR Bonser Construction f Inc. VALUE $ 16,332.00
AP No. LOT 23 TRACT 4{594 FIRE ZONE DESCRIPTION OF WORIKSng.Fam.Dw1.W/8,1
INSPECTIONS Signature DATE GROUP I & J TYPE V ZONE R1 Gar.
Soil rhe 7/7 PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water /WS7-syC3
Rough Km. Refrig. 0 Air Cond. 0
Rough Heating /14/-S $--&=G? JUL 2 E 1963 ...tan —
Rough Plumbing fi 7///- $-fl-,(,Q -7 JJL 1 2 1963 .`> i—
Miscellaneous
Prop. Swr. Line❑ House Con. 0 St. Swr. 0 -`-/ ? , /ir , 1,-,- - II In g lig, 3. 9 �,
Sprinkling System e-----
S D�1,P-(? v ._� AUG 1 6 1963 '?Zy.-. 11 /!1
Construction Pole /g! 1
Underground 0 Power 0 eat/
�y / ]'"
Rough Wiring �/, Q..ez 7 l,, �� -'n-'3- moo .,P-.,.---s3 2 .-y-e.. -�
Trenches IS'' Forms —Steel Reinf. A—
Floor System7_2
Bond Beam 0 Steel Reinforce ❑ � y f�
Sheathing 'Antra _
Frame and Flashing 4.---
Lathing—In Out re
Plaster, brown coat /Z'"' c_ •— - re3
Refrig. 0 Air Con. i❑ Final 1147,-S-
w,
Heating, Final )14,- /Gyp-(,S
Plumbing Fixtures, Final /Q 7
Final Gas Test
Electric Fixtures, Final W
Building, Final /Q�98 3
OCCUPANCY I
Form 13U4-5M-3-63—S-B P
.
19994
- COSTA MESA BUILDING-SAFETY DEPARTMENT FEE RECEIVED
.
P.O.BOX 317 COSTA MESA,CALIFORNIA
PII 2 kW/
For Applicant to Fill In Completely1� APPLICATION FOR`PERMIT
TYPE (OR PRINT 4891,-23 FFJNAI ('€L P.T,...',
BUILDING "'�OB� (QO O , /I laue
li'l i rQl fV UJs1Y'LJIfy
ADDRESS
K r RECEIPT NO. pl
COSTA MESA. CALIFORNIA P1 94
RBCEIV D DY RE E VED DATE ISSUED
OWNER NORTHGATE 5TE 7 3 JUl 5 lot,
MAIL 'I BUILDING
ADDRESS 133/41 Golden West ADDRESS
41
•� 1 FIRE /),,�
CITY Westminster, Cal, NOL.897-1824 ZONE TYPE V GROUIJ49-
L� [ /y�
APPROVED
OR ENGINEER C• Hiller N0335-2O0 BY DATE
ZONING
ZO
ADDRESS Box 11. Anaheim. Cal. )�
NO. USIOF los
L
1 I PLAN!E I DUIL[Il ti•OI
CONTRACTOR Bonser Construction, Inc. Vi
DGCAL IPTO 192. egv ,y 23
ADDRESS 13341 Golden West,
CITY Westminster, Cal. A.P.NO. -00%1'
NOTE: NO SAVE OVERHANG SHALL BE LESS THAN
STATE1� TEL. p t� 30'TO SIDE&REAR P.L
LIC.NO. 21501/9 NO. 897•-7821.E
EAVES
OSIZE
F LOT 601 x 101.981 I NO.OF SLOGS. G ALLOWED (U.B.C.REQUIREMENT)
NOW ON LOT YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. •••
(FROM C/L 6TRE .
SETBACK LINE FROM 501 REAR YARD 29 t FRONT f/FT. / PT.
CENTER OP STREET .J C✓ Y//
SIDE YARD LEFT 157 I RIGHT 57 R.SIDR J./ / FT.
DESCRIPTION OF WORK L.SIDE/3,5i FT.� FT.
NEW X J ALTERATION ADDITION I
REAR FT. FT.
lI
DISTANCE BET. BET.MAIN A
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
VAR.# DATE
BUILDIN r NO.OF
SIZE PIU X 731 ROOMS 7 STORIES 2 C.U.P.#4� 1� APPROVED/,
��
EXTERIOR WALL I ROOF APPROVE " l l% 19.-C3
COVERING Stucco COVERING shingle BY DATE
USE OF BUILDING AND WORK TO BE PERFORMED ( /
Sing)e family dwelling Watt garngn 1v
, /63 6
x/1.3 eRQ 4,1071 °/ N
64.FT. c
I HEREBY ACKN• OOF• I�• 'A•= -EAD THIS APPLICATION THE AMOUNT SHOWN UNDER VA ATION IS FOR THE F
AND STATE T. T THE A ORREC AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. 0
PLY WITH A CITY OR• • ST TE LAWS REGULATING
BUILDING C.NSTRUCTI• VALUATION n ,�j� N
PERMIT FEE $ 4-7,61) N
SIGNATPERMITTEE 004, ,/ • .� /� '� I
$ /V�tl�'� EC o
V (j _' y L
AUTHORIZED AGENT TOTAL FEE $ DV)6y