HomeMy WebLinkAbout253 ROBIN HOOD LN - Building Permits �(c CITY OF COSTA MESA
•
BUILDING DIVISION
:r ..arB DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t CI •/ PERMIT
• M00-00553
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 253 ROBIN HOOD LN Status: ISSUED
Suite No Applied: 12/26/2000
Issued: 12/26/2000
Vicinity:
Parcel Number: 42621302 ISSUED BY:
Applicant: CLARK, WILLIAM
Address:
Phone: 909-944-1340
Zip:
Owner: WOLF, RENDA LOU
Address: 253 ROBIN HOOD LN
Phone:
COSTA MESA,CA Zip: 92627
Contractor: SOCO AIR CONDITIONING
Address: 6892 CARNELIAN
Phone: (909)944-1340
ALTA LAMA CA Zip: 91701
License: 333239
Arch/Eng:
Address:
Phone:
Zip:
License: •
SCOPE OF PERMIT
REPLACE WALL HEATER.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU <100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $14.80 1 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $38.30
COMMENTS I 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
2446-46(6100)
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.
❑ 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 carder and policy number are:
Carder: 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 1 should be me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. ///�_
Applicant Signature:
eat T Date: 47t—v1 (o— 0 a
WARNING:FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED
THOUSAND DOLLARE(S/00,000),IN ADDIRON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR COOE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commendng with Section 7000)of DMsion 3 of the Business and Professions Code,and my license Is in full
force and effect.Lie.a Class a
Contractor's 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.CMI Code).
Lenders Name: Lenders Address:
Signature: `fr 7. Date: � — L• — 0
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 DMsion 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 penally 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 properly,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(hereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers 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:
I 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 end 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).
�_.. or ....._...._....___..
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 0 N
(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 ❑No
5 Does h or willo the applicant u present or future buildingsoccupant mother air the work which Is the subjectage c this a estion a0ertnit for such cons Wctbn a 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).
his pem_..bewithin 1 —
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(if'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under 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.
S' matt Of eget er(s) Date
& AnWbr Authorized Applicant Date
CODE# IN6PECTION TYPE DATE ILLS CODE t INSPECTION TYPE QAIE
1616 Fixed System Final Fire Prevention 206 Final Mechanical ) -2-1
1266 Pool Spa Final _ 208 Final Plumbing _
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
'CT ADDRESS: ,c, kC::Y - :... UNIT: ^,"'7 -=•:-y MESA - E:,ILI -:?G PE ....:: ?n3:" _ - - :.
NER'S NAME:,,- :•, ,-
AODRESS:••-�- _ `H s. - - .. _
C:STAJ .._5A, _A- °:6:7
CQNSTRL -T:D:. Ti7E - .: . ER.•:7 Ti:E . PLL .-.,:.. D:.=. nEi•
ARCH/ENGINEER: - REG.NO.: JOE Z E5CR :- CCL A MESA HONE I:'PR: .'ENz:: . La?: - -
ADDRESS: UNIT: _CLAIM VALUE: CALC-VALLA_- ;P.__: " -_ • z
PERMITTEE:Pi..7F.ER F' J:•.I: ij ! 710646-0300
.. ^•
ADDRESS: 454 N \Ei:?IRT FL COMMENTS: MISC. PLUMBING REPAIR 6 REPLACEMENT
-`• CA 92663 **it**jfrc?t**** f#**44*K *i* 113En**********44:-***ate 4 w Se* S. k*.Ss it f.- , *s ***c . +:*, 4 . +„..1. 4 o-...wt.
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING RV Ekr I
E
RE :C 7 S
7000)of Division 3 of the Business and Professions Code.and ' nse is in full force and elle
/mmmyyvvy��rr��� n S E -
E A _ Y. c
v/OffY LIC.: STATE UL.o 4 2 7 3 6 C S' 3 re
Date: S- I+ 53 Signature: 4--14 3 LL
MAIN BUILDINGT ACCE°SGR'1 t--- m-.:GWORKERS'COMPENSATION DECLARATION: I hereby Affirm rho I have a certificate of consent to self-insure or a certificate of Workers' FRIM; 1\, REAR: FT I\: F.t.iii: FT :S REAR: FT
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT T L< RGHT : . I?: -.r-.• a _.. ._i_, - IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL : 42.62: 302 ZN°: REF :•:D;
Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOT E S>
z• > ..
Date: Applicant: ********i!]kY,('# 'Afji*tft4************. .tFtPfF�f****at•.a'R}! r-f.****1 ll'i. Yiftl'itnr>'Y' .*. k-L.*. **_*. **"it
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This - need not be ted if the paint isI�dred(S1 )or less). D E V E L O P M E N SERV : _ _ S �. R E Q .. I R E M E M. _
I c ily that in the performance of the work for which this permit' ssue , shall no mph any per 'n a er so o become
-
is(to the Workers'Compensation Laws of California, r Q t T i
c \ ZONING APPROVED BY DATE:
Date: )4-`1 3- Signature: - c_
NOTICE:It,after making this declaration.you shOorfd become blest to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : - ,. — -T E
Code,you must lonhvnth comply with such provisions or this permit gull be deemed revoked.' _—_�-'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for theeperformance of the work for AP PL CAT I0:2 I SS JED B Y• ����� �.- LATE: (j,tri 493
which this permit isissued(Section 3097.Chi.C). -.. **********fit******#.:'-K . -”,-,ttit••.:kit res:sf:-tit,-w*0'4*4.xr •+.t:ie-' ,it 4:4 le
LENDER: l *******it**********if+t*** - - r*4f43 *cif***3efF41 .f•iF4###ix ta:;TF##,F3f:.a*<ttie4' *+ .. ..•-SS in sir r-..`nisi-x,:
ADDRESS: LEGALIZATION:N F E E SJMNARY STRUCTURAL _EGM:ENT: ::
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECT?-C MECHANIC FIRE s.:
xIP/RES GRA:CMG
(Section 7031.5 Business and Professional Code: Any city o1 county which requires a permit to construct,alter,improve,demolish,or PERP I- 49 . 00
repair any structure.prior to its issuance,also requires the applicant for such permit to fife a signed statement that he/she is licensed ,. E•-C4,
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2_ +P/M_..-R E S
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70.31.5 by PLAN
any applicant far a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE2 0 . 0 0
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUIL DING-DIV-> PERM_ '”
T ISSUE PLAN—CHECK OTA_ Pit Jt
❑ structure is not intended or offers for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 49 . 32 20 . 00 0 . 00 69 . 00 S9 . 00 . ..0
does not apply to an owner of a property who builds or improves thereon,and who does such work himselflhersell or through
his or her own employees.provided that such improvements are not intended or offered for sale.II,however the building or i T T 7i: C '��
improvement is sold within one year 0l completion,the owner will have the burden of proving he/she did not build or improve REVENUE D I C I S.ON T 0 T AL S--> OL L E C TED• 6 9 . 0 0 OL_R/.,Ha..T: CO
lor the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GAA:ING PLAN-CHECK
I,as owner of the property,am exclusivehy contracting with licensed contractors to construct the project(Section 7044.Business 69 . 00
❑ and Prolessicrs Code: Tice Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contractslor such projects with acontractor(s)license pursuant to the Contractors'State License Law).l am aware *,*****.***tl.4a*ac*****is*c-4c*** ****if'4•f***lkit** ********it*I: S'.K'**Yr*i(*Vii*****i;it:. * :t"t ** ***
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR EAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: - TYPE QTY D E S C R I P a : 0 N UNIT CCET TOTAL _DET
Date: Owner:
PLP 1 BATHTUB 7 . 00 7 . 00
I do hereby cantly that I am aware of and understand the requirements of Caliloroia Health and Safety Code Sections 25505,25533,and ,,
25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements for a L L J 1 SHOWtR 7 . 00 7• 0 0
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from pi.,,;, I SINN, K I T CHE.% 7, 00 '7 • 30
mese provisions, PL J 2 ::ASH BASIN 7 , 03 - • ,i w
Dale' Applicant: PLC 'j WATER CLOSET ( TOILET) 7 . 0`0 7 . 03
PL I WATER HEATER AND/OR VENTT 7 . 00 7. C3
I hereby certify that I have read this application and state that the e nformation is correct.I agree • • with all t and county END OF FEES
ordinances and state laws relating to building construction and h- ' auth rue r entatives oft cit to enter u i r the e-mentioned
prop ty for inspection purposes. /
Date:S' )EI' j Signature: - c,/ oi. oo139102 -001391024/93 1008 69.00
DATEDriver's License or Social Security a:
1641-46 White-Building:Green-Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
•
CONSTRUCTION AND PLANNING I POO' ,,PA
APPROVALS Permit ':- _I Date Inspector ' APPROVALS Permit I O,to 11m.oect'+•
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51. Gcii :IFICATE Oi= GCCUPAiiCY
v _ J
PRUJECT ADDRESS: 253 ROBIN HOOD LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 061997
OWNER'S NAME:WOLF, RENDA LOU
ADDRESS: 253 ROBIN HOOD LN PERMIT NO: E 061997 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92627
CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: 0TH
I ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : UPGRADE ELECTRICAL CIRCUITS SQ FT:
' ADDRESS: UNIT: '-
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
PERMITTEE: R,M,H, ELECTRIC ( 714 ) 646-7372
ADDRESS: 165 23RD ST 2 COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
C.M. CA 92627 #########u#±E########E#*## ###############################################'n#####
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY LIC.:024014 STATE LIC.:3 2 5 7 3 8 CLASS:r• ^ r
Date:_f/,� 3 Signature: N � _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: hereby affir hat have a cedilicaCe N on t to self-insure or a certificate of Workers' r RIV T: FT I N REAR: FT T N FRN T: FT IN REAR: FT I N
Compensation Insurance.or a certified copy thereof(Section 3800, Lab.CI LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.:O 783255-92 EXP.DATE: 11 /09 /93
COMPANY:STATE PARKING REQ• PROV: PARCEL: 42621302 ZNE: REF NO;
❑ Certified copy is hereby furnished. D Certified copy is filed with the city Buildin ' 'on. PLANNING NOTES>
9 Date: 71/4/1/ 7 Applicant ) #################################jam############# f######### E## f###%############jE
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: ( is section need not be c e If the permit is for one hundred($t00)or less). DEVELOPMENT S E 4R V I C E S R E Q L I R E ,M E N S
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. ZONING APPROVED BY DATE:
Date: Signature:uBUILDING APPROVED BY
Code.y:If.after making this dpy with s,you should become i subjectmithe Workers'mrempensation provisions of the Labor x . DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: _ DATE: "J/
which this permit is issued(Section 3097,Civ.C). ###################### *crit* x R"%-ie • x • - u• - ##-#########ft x'{7
„ui;T##
LENDER: #######################################lE#######N:####3f#?E########################
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or P ERM I T 6 75
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed Zj O% SMI P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Cade)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 ,00
I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'Slate License Law TOTALS——--> 6 . 75 15 . 0 0 0 . 00 21 , 75 21 . 75 . 00
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 employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS—> COLLECTED• 21 . 75 OVER/SHORT• , 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose W sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 21 . 75
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware 3F##############################################################################
that proof of their Worker's Compensation insurance should be provided to me, INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: ELE 1 FIXTURES: LIGHTING 1 ST 20 EA. . 75 • 75
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 3 REC EP T/OJ i LET 1 ST 20 EA. . 75 2 . 25
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 2 RECEP T/SWITCH 1 ST 20 EA, . 75 , 7 5
permit for construction or modification from the Air Qualify Management District.Residential construction applications are exempt from
mese provisions. ELE 1 MOTOR/POWR APPARATUS 0 , 0 — 1 ,0 HP 3 , 00 3 , 00
END OF FEES
Date'. Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
for inspection pu dues. " ' ,e 01 00138378-00138378 TOT 21.75
prop
Date:
Date Signature: .....Jr. DATE: 05/03/93 TIME: 13:14
Drivers License or Social Security a:
il
i\ 1641-46 While—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
r,
• CONSTRUCTION AND PLANNING POO` 'PA J
s Date . p P
Ins ector Date Inspector 1
APPROVALS Permit # APPROVALS Permit #
r 1. Temporary Electrical Serviceo? Pole
P v 52. Pool & Equipment Location
2. 51.1 Pipe•Undrgrnd. • - 53. Steel Reinforcement
j y
3. Electrical Conduit Utiiity-Undrgrnd. 54. Forms
4. Electrical Condurt-Undrgrad 55. Electrical Bonding I
5. Sleet Reinforcement 56. Rough Plumbing & Pressure Test i
6. Eactricat OF ER Grnd. 57. APPROVAL. TO COVER•GUNITE i
7. Footings 58. Electrical Conduit-Undrgrnn. .
3. Foundation f
_) 59. Gas P,pe, C; Undrgrnd.,Test y
9. 6:ater P.pe-Undrgrnd. - 60. Backwash lines, P-Trap, ❑ 'Jrdrgrrd 1
I
`10. Structural Floor System ' ' 61. APPROVAL TO DECK
11. Prapc ty Sewer Line & House Connection 1' . 62. Backwash & Receptor•Final -
12. Sewer Cap ' • 63. Heater & Vent-Final - , I
I- --
13. Roof Drains 64. Plumbing System • Final •.'
✓
14. Roush-. Piumb.ng 65. Electrical-Final V
t
15 Rough Electrica' Cond.,i: i 66. Solar System!- nal
Id. Rough Electric Wiring 6/. Fencing & Access Approval
I
17, Rough Wiring Sign Ca. APPROVED FOR PLASTERING
_ _ I
18 Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL }
19 Rough Hearing & Air Conditioning � FIRE DEPT. REQUIREMENT I
2C. Rouge Fac'ory F Erep:ace i APPROVALS Permit ;T_- -i I
21. J. as, a. Structure 70. Underg.euro Hyriro
2.2. Dt,-ts, erer1h Titin 71. P•odui. P.:.rg `;G•;, F_Oil
23. Gar P P--Rough & Test ( 72. Urdc'.rou- o Flub
74Roof Framing
73. Undergrnd.Storaya Tank : Ga; 0 :
I -
252.:701• S!�.at: ing - 74. Occrhead Hydro --- - ----- �
2.:701•i 26. T-2-kr Coiling IStructural; & Monocoat 75. Dry Cier':ca1
127. ! me and Flashing -- - ------- - 76. Dry 5ta noel ca -- - -- - -
28. Lat'hem] P. S•ding • 77. FIXED SYSTE.'. F-'NAL
1 29. Isu.ztmn 78. FIRE !REV. FINAL
HEALTH DEPT. REQUIRE7.1[{ 'T
r--- - ------- ------ ---- ---- - .
31 P isle are• i Cc.-t • 79. FINAL INSPECTION I-
X32
.i E ;mrie..' Prier Meter Final a0. FOOD CEirft ICAT� ISSUED -�
r
1 32. Firel Electric 48f93 Notes::
04. Final heat.ng & Air Conditioning i
35. Final Gas Pipe Test --- --- ---
36. Hoocl cr Canopy
37. Fuel rectory Fireplace -~ .' - - - --'--' - - ---
38. F,ra. 1':umbing '-- - -- ---------- --- --- ---
r39. Water Service-Final
~
' 40. Gas Service-Final ---1---- ----�
41. Solar Domestic-Final 1
I 42, E-,cleflow Preventer • -,
n3. Bachflo.e Irrigation ----- ----- -----
I--
I
I- - ---- -
- y
I 44. I andscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations - j
47. FINA'. STRUCTURE & BUILDING I
1 78. FINAL PLANNING
-1 49. Electric Release to Edison
I50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Illibe
PROJECT ADDRESS: UNIT:
OWNER'S NAME: 253 ROBIN HOOD LN CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 061474
ADDRESS:WOLF RENPA LOU
253 �2OBIN HOOD LN PERMIT NO; B 061474 PLAN CHECK NO: N GOVT: N SUPP; N
COSTA MESA, CA 92627
Y CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; OTH
ARCH/ENGINEER: UNIT:REC.NO.:
ADDRESS: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 4 , 400
PERMITTEE: CLAIM VALUE: 4 , 400 . 00 CALL—VALUE: 4 , 400 . 00 GROUP OCC: R-3 /M-1
ADORESS:BEEMAN CONSTRUCTION ( 714 ) 650-4474
21661 BROOKHURST ST COMMENTS; REROOF 2400SF RESID & GARAGE W/COMP SHINGLES
H ACA 92646 ##+ ####*### t#X-******************-***************************BM OK *DE
KTG T® 1LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions o Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect.
CITY LIC.: STATE LIC.:619008 cLAss:B
SETBACKS REQUIRED
Date .
_) ' 2� ' 1) Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR : FT IN
Compensation Insurance.ora certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL : 42621302 ZNE; REF NO:
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> •
> . : ,
Date. Applicant. *************BE*-*************************************************#***Af3kr#********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred WOO)or less). D £ V £-L 0 P M E N T SERVICES R E Q U I R S M E''N )T ,S
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. q ZONING APPROVED' BY /`
Dale 3 pr
•- s -3 " / 7 Signature: i Qt„.r.l .,,, DATE: n ‹.
,
NOTICE:II,after making this declaration,you should become sub( to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: .'.,
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• DATE: '771.23 15
which this permit is issued(Section 3097.Civ.C). *******.**.******************************* 4 *it**It***** it it** *
*x ********** Ty *x
Kt• frTA**#
LENDER: ******#********************************************************* **iGJE`**********
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code. Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 00 /. 5
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant lv the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business j SMIP . 50
pursuant
and Professions Code)or tat helshe is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE F££ ' / r
I, as owner of the property or my employees with wages as their sole compensation, win do the work, and the BUILDING—DI V—> PERMIT ISSUE PLANS"CHECK TOTAL PAID ) DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 72 , 50 0 . 00 0 . 00 72 , 50 72 , 50 , 00
does not apply to en owner of a property who builds or improves thereon.and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale. It,however the building or 4' t /
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COL'L'ECTED• 72 , 50 OVER/SHORT• . 00
torthepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 • . 5 0
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
•
and who contracts for such projects with acontractor(s)license pursuant to the Contractors State License Law).l am aware ****** *************** **,,***********'f(•********,*************#*****#**If-*#***iF*#d(**3E
that proof of their Worker's Compensation insurance should be provided to me. r
❑ I am exempt under Section: B. a P.C. I N D I V I D U A L F E E BREAKDOWN •
for reason: •
TYPE QTY DESCRIPTION UNIT COST ' TOTAL COST
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 4400 R EROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 4 , 400 , 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from /
these provisions. 4,.
Dale: Applicant:
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county i,r
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
propertyforinspection purposes.^os •
D �j/J�
'�} Date:3 -1.3 ! 3 Signature: L 7J1 �. � / .
/
Driver's License or Social Security or:•' . ._ -
1641-46 While—Building;Green—Code Enforcement:Canary—ApplicanC Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING
POOL . ,,PA
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.
B. 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
11. Property Sewer Line & House,Connection 62. Backwash & Receptor-Final
12, Sewer Cap 63. Heater & Vent-Final 1
13. Roof Drains 64. Plumbing System - Final --{I
14. Rough Plumbing 65, Electrical-Final
i
15. Rough Electrical-Conduit 66. Solar System-Final 11
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 I'
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing jze Arri74. Overhead Hydro
26. T-Bar Ceiling IStructurall & 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: 4,e'y ,tqma.-5-, scar j s _-
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy i
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final r
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. SoHandAttenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING s%5- / I 53,,,•.�R-� pP//�l as-
�j/
48. FINAL PLANNING � !
49. Electric Release to Edison.
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY -
No. Date
_ i
`� 7172 .
A
COSTA MESA BUILDING DEPARTMENT JUL 2i-53ruyjr4-375c. ****54A0
P.O.BOX 317
COSTA MESA. CALIFORNIA I•
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ABUILDING
DDRESS 253 Robin Hood Lane BUILDING
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. A/
OWNERShpi•wnnd Fnregt, DoVeloners 41 P I !�/
MAIL RECEIVED BY DATE RECEIVEDDATE ISSUFE
ADDRESS 1700 Netmort Blvd. 779_ »1 . 7— /--sef AUG 4195B
TEL. BUILDING hewnort Beach OR 3-124( o
ARCM -CT LIC.
ORE JEER Raymond Levannes NO. u 747 COSTA MESA, CALIFORNIA
FIRE
ADDRESS ZON[[[[E
NOF
CITY LIC. PLOA NB T� Z��P
CONTRACTOR flan Cnnst.rllCtl OTl NO. ?Cal20VIIlN�*i
��\.DJ•`'
ADDRESS 3700 Newport Blvd. 1: CR 3-1240 BYPROVED DATE
LEGAL LOT pp CORRECTIONS
DESCRIPTION NO. L3 BLOCK TRACT 3289
A.P. NO.
SIZE NO.OF B
OF LOT 751 X SOI NOW ON LOTnone
USE OF
EXISTING BLDG.
SETBACK LINE FROM
CENTER OF STREET 41' REAR YARD all
SIDE YARD RIGHT 101 LEFT 71
DESCRIPTION OF WORK
NE% - X ALTERATION ry ADDITION
REPAIR MOVING IIIpl11 DEMOLISH
BUISIZE 1700
NO.OF
1700 ROOMS STORIES 1
EXTERIOR WALL wood ROOF
_COVERING Stucco COVERING shake shingle
USE OF
BUILDING Dwelling
Att. garage 400 sq. ft.
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION AND I
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. ( VALUATION
{{//--��// /f alyl��]L��.-� PERMIT FEE $3^ 6
SIGNATURE OF, / , F I — 111000
PERMITTEE 1111 ,l.i l
sic, 99 7 Oro PLAN CHECK S/I'
LOO ✓
AUTHORIZED AGENT TOTAL FEE S. /U
9'"`