HomeMy WebLinkAbout938 GOLDENROD DR - Building Permits• CITY OF COSTA MESA � .
BlIILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: P09-00100
PERMIT TYPE PLUM
APN: 41221317
JOB ADDRESS: 938 C.�OLDENROD DR CM
Vicinity: THROUGH OUT HOUSE
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
08/21I2009
RMD
SCOPE OF WORK: PLUMBING PERMIT FOR A COPPER REPIPE THROUGH OUT HOUSE INCLUDING NEW WATER SERVICE
FROM METER TO HOUSE. � - � � .
OWNER: SCHMENK, DANIEL l
PHONE: 714•549-5121 .
APPLICANT: SACDYPHOUD, KRISTSANA
PHONE: 714-239-6743
Address: 938 GOLDENROD DR
City/State/Zip: COSTA MESA, CA
Address: 11008 WHITEWATER AVE
City/State/zZip: MONTCLAIR, CA
CONTRACTOR: ALL AMERICAMREPIPE License No. 866538
Address: 17008 N/HITEWATER AVE � �
PHONE: 866-099-PIPE .
City/State: MONTCLAIR, CA ZipCode: 91763 CELL:
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
50.00
$43.10
$43.10
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California staNtes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF IAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approvai must be obtained. FaiWre to obtain inspections and final approval will result in the expiration ot this permit.
CODEN. INSPECTIONTYPE DATE INTTALS CODEt INSVECTIONTYPE OATE INIITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical q a�^'' ���///���
1266 Pool Spa Final 208 Final Plumbing Q {�y�
200 Final Re-Roof 210 Final Electrical
201 Final8lock/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 22o Final Planning Approval
203 Final Sign 222 FinalSite
204 Final Demo�ition 250 Final Building/Occupancy
a
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalry of perjury one of Ihe following declaralions:
❑ I have and will maintain a certifcate of consent to sel(-Insure (or workers'
compensation, as provided for by section 3700 of the Labor Cotle. tor the
peAormance of the work (or which this permit is issued.
❑ I have and will maintain vrorkers' compensation insurance, as required by
section 3700 0( the Labor Code, for Ihe peAormance of ihe wnrk !or which this
permit is issued. My workers' compensation Insurance carrier antl policy
number are: I
�arriecr�� _ �n . + (^ t �..
(This se[fbn nee0 not be mmpleted A(hepe�mR is valuyed al one huntl�edCMlars ($100) w less J
Policy.Numtier �_ S r(� � 2 S 7 f U-�i �
❑ I cehify ihat in the performance of [he work for which [his permit is
issued, I shall not employ any person in any manner so as [o become subject
to the workers' compensation laws of California, and agree that it I should
become subject �o the workers' compensation provisions of Section 3700 of
the Labor Code, I all (orthwilh comply with these pmvisions.
.��_-_ Ub/ 21 / 2 00 �
! Applicanl's'99naWre �.,°a��
a
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
IICENSED CONTRACTORS DECLARATION:
I hereby aKrm tha[ I am licensetl un0er provisions of Chapter 9(commencing
with Section 7000) of Division 3 ot the Business antl Pro(essions Code, and
my license is in full (orce and effect.
u�..��g� b=s��3 p-... . c�55.�� .C:3 6
� _..._.�. � D$/?I/2����
Cdntranah S(gnzwre (Oale�-
CONSTRUCTION LENDING AGENCV:
❑ I hereby affirtn that there is a constructbn lending agency for the
peAormance o( Ihe v.ork fv which this permil is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atldress:
OWNER-BUILDER DECLARATIONS:
I hCfeby aKfm lhat Untler penalfy o/ perjury lhal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or lhe (ollowinq reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit to
construcl, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant (or such permit to fle a signed statement
that he or she is licensed pursuant to the provisions of Ihe Contracrors
License law (Chapter 9(commencing wi�h Section 7000) of Division 3 of the
Business antl Pro(essions Code) or Ihat he or she is exempt therefrom antl
the basis !or 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 hundretl dollars (3500).):
❑ I, as owner o! the property, or my employees with vrages as their sole
compensation, WILL DO THE WORK, and the strucWre is nol intendetl or
oftered for sale (Sea 7044, Business and Protessions Code: The Contrac[ors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such vrork himself or herself or through his or her ovm
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 provinq that he or she
ditl not build or improve for purpose of sale.).
❑ I, as owner ot Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Pmfessions Code: The contractors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who coniracts !or such project vrith
a contracta�s) license pursuant to lhe Coniractors License Lavrs.).
❑ I am exempt untler sec.
Business antl Professions Code for this reason:
� �
Owner ID verified by tlriver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by pype of documen�, i,e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certi/y Iha� no excavation five (5) or mo�e feet in tlepth into which a
person is required to descentl, will be made in connecCron wi�h vrork au[honzed
by this pertnit, and that no 6uilding sWclure, scaRdding, (alsewnrk, or tlemolition
or tlismanUing thereof, will be more than thirty-six (36) fee[ high. (Chap. 32, Grp
2, M 2, Sea 347, THe 8, Cali(omia Administ2tive Code�.
❑ As owner-builder, I will not employ anyone �o do work which would
require a permit from Ihe Division of Indus[rial Sa(ety, as no�ed a6ove, unless
such person has a permit to tlo such vrork from Ihe division.
AppliWn�'s SignaWre
Division o! Intluslrial Safety Permit Number _
HAZARDOUS MA7ERIALS AND EMISSIONS CERTIFICA710N:
1. Will the applicant or present or tuture building occupant neetl to fle and
certify a Business Plan for emergency response to release or Ihreatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 0( lhe Califomia Health and Safety Code requires, with some
ezceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has al any one time during a reported
year a quantity of hazardous materials equal ro or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet o( compressed gas
at standard temperaNre and pressure).
2. Does or will the applicam or present or future building occupaN need to fle
a registra�ion form (or awtely hazardous materials? ❑ Yes ❑ No
(Sec�ion 25533 0! the Cali(ornia Health and Safety Code. with some
exceptions, requires registretion with the Costa Mesa Fire Department hy
each business which at any one time has on hand a quantiry of awtely
hazardous malerials equal to or greater [han a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at stan0artl
IemperaNre and pressure).
3. Does or will the applicant or present or future builtling occupant neetl ro
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the CaliFornia Health and Sa(ety Code provitles Iha� the
Costa Mesa Fire Department may require the preparation, certifcation and
filing with the Fire Department o( an RMPP by businesses which are requiretl
to register acutely hazardous materials with [he 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 vnll the applicant or presenl or future builtling ottupanl require (or
the work whiCh is Ihe subject o( this application a permit for such consiruction
or modifcation from Ihe South Coast Air �uality Management DisMct or (rom
any olher air polWtion control district or agency? ❑ Yes � No
(Sectbn 658502 of the Califomia GovemmeN Code requires Ihat the requested
informa�ion be fumi5hed on applications for non-residential builtling permits).
6. Will any part of the lacility to be constmcted under Ihis permit be within
1000 leet from the outer boundanes of a school? ❑ Ves ❑ No
Qf'yes", �he tacility must meet the requirement of Sections 25534 and 42303
of the Cali(omia Health and Safe[y Code).
7. If a permit trom the South Coast Air Quality Management District or other
air polWlion control tlistrict or agency is required for Ihe vrork which is the
su6jecl o( this applicatioq have all o( the disclosures prescnbed by Califomia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is correct I agree to comply vrith all state laws and
city ortlinances regartling Hazardous Materials and Emissions.
SignaWre 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 wilh all Sta�e law5 and city
ordinances relating to building construction, and authorize representatives of
the Ciry o( Costa Mesa to enter upon �he above-described property (or
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
' naWre of �egal Owneqs� Da�e
SignaWre Oa�e �� (���,Q �/ z O! �
305]�a6(YO)) � AnCI q�'AQ'OIi4aN�% �Oa{e,iv'�
,
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�.�LDING PERMIT P FAIR ORNE, GOS IA MtSA, GA y2626
JobAddress: 938 GOLDENROD DR Status: ISSUED
Suite: Applied: OSl31/2005
Vicinity: Issued: 05/31/2005
Primary Occ: R Type of ConstrucEon: V-N
Parcel Number: 41221317 Zoning: R1
npplicant: RICHARD SHqFER _ - ISSUED BY:
Address: 1621 E ST ANDREW PL- � -� -'- _- _
- � � � � Plione. � (714) 259 5120 � -
1
SANTA ANA,-CA} � ,r= ' � ' ' Zip , 92705 , - �
'�`�'� \. � � �l . _
, ; � . : ,,. � � _ � -`� , , . . . . .
Owner. SCMMENK;,DANIEL�L ' '
Address ,''938 GOLDENROb DR� .- " � � _ �_ � _ ; , , �, � � �: �
. . , i . Phone: � �
, , �� . ,
� �'r
� ".<COSTAMESA, CA�'� � Zlp: 92626 , _ ' . � .� �
j/�:�' � _ . \� •� . ..
Contracror: ACUMINUNIsROOFING SPECIALISTS/DIAL ONE WINDOW REP '`.; -' ' '
,: �.. .
Address: ;- ; 1621 E-ST�ANDREW PL � � .� � -
' ' . Phone: (714) 25&5120 . �'` � �
, SANTA ANA, CA , �
- . - 2ip: 92705 _ _ . . Lioense: • - 523043
� , ; �l�, . - . _
Arch : , � ' -� Eng:
'Address: . . � ' , � , � " � � •Address: � - .
' . , i �<�- ��,.'Phone: �- . . " � ,,Phone:
, . � � �"_ "" � - � .
� ' Zip: r .' �" �" _ ' ` License: � , Licenser
. . . :l.- . , � ��
' ,T � ,. ' i . :� SCOPEOF PERMIT: ,' -
REPLACE 11 WINDOWS AND 2 SLIpING�GLASS DOORS�THROUGHOUT S':FiD'TO MEET 1997 U.B.C. EGRESS REQUIREMENTS. HEADERS
WILL'REMAINTHESAME. �� - `�� �� � ��-- �- � .-'��� : . �'
��• �� ` 'FEE`§UMMARY �:�.' � . � �
. " `' -----' - �--_. :.,r� __.. - ' - .
. Plan`Check: $0.00 , _ ' : ', _ , '~_ ', .Calc Valuation: Si3,000.00
Permit: , $223.25
� SMIP Res: $1.30
SMIP•Com: ` $0.00
Other: �$0.00
Inspection: $0.00
Total: = $224.55 , - - �
,.. ' ����_ '� '
SETBACKS . � � ;' �
MAIN STRUCTURE Front , 0- 0� �,�� Rear 0- 0
ACCESSORY Front , 0- 0�- ��. •Rear 0-,0
PARKING Existin : 0 Re uired: 0
/�" ` ClaimValuation: .' Si3,000.00
<�. - � - � , � ;
_ , �
-.. -, ;j % '
� f_ ',
PLANNING& ZONING ":-�=i� /!� � :// ; ; ` ,.
. . _ -�'.�� / �� � �....
� . � - � �`: ; �:�� ;
, Left 0-0- � _ Right �_�0=0' ,
;;1�-":'. �`�' -i.�/
, � Left � 0- 0 � '� Right � 0- 0 ' -
J�
� � .Proposed:'" 0� � �� �
NOTICE:. The work.authorized:by this permit•shall compty with all applicable handicap access�requlrements under California statutes and related
regulations: (Ord. No: 9248; § 1, 12-21-92)
EXPIRATION: This�permit shall automaticafly expire and become void�if work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180�days.
��INSAECTIONS: In�orderfor the work�authorized;under this pettrrit fo be�consideredlegal,.such�work must�comptywith all�applicable coUes, antl ali
required-Inapections and final approval must be obtained. Failure to�obtain inspections�and.final approval will result in the expiration of this permit.
FOR INSPECTIONS'CACL:. (7�14):7544b626;
�
WORKERS'COMPENSAnON DECLARAnON: � ' ' �
I hereby aHirm under penalty oi perlury one ot the following decleretions: ' . - .,
❑ I have end will maintain a certificata of consent to sel4lnsure br workers' compensation, as providetl for by section 3700 of the Labor Cotle, for the pertormence of Ihe
work for which Ihis permit is issued. '
�ave end will meintain workers' compensation insurance, as required by section 3700 ot t�e Labor Code, for tha peAortnance ot ihe work for which Nis pertni[ is issued.
%M�y workers' co pen aUon Ins ce car � r and polity number are: �i /�
��rier:��-!�� PolicyNumber;�-_ 2.��n�i^a�0�
fs section need not be completed i/ the permit is velued af one hundred dollars ($100J or Iess.) �
❑ I certity that in ihe performence of lhe work for which this permit is iuued, I shall not employ any person in any manner so as to �ewme subject to the workers'
compensetion laws of Callfomia, and ree that if I shoultl become subjacl to ihe workers' compensation provisions of Section 3700 ot ihe Labor Code, I shall forthwith
comply with ihese Drovi '
Ap litant Sfgnaiure:,--�� Date: �:. S/��/O�
AR IMW�10'. FAIL R�E �TO'SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPIOYER TO CRIMINAL PENALTIES AND CIVIL FINES I1P TOONE HUN�RED
THOUSAND OOLLARE (5100,000), IN ADDITION TO THE CQST OF COMPENSATION, DAMhGES AS PROVIDED FOR IN SECTION 310fi OF TME LABOR CODE, INTEREST, AND ATTORNEY'$ PEES.
LICENSED CONTRACTORS DECLARATION:
9(commencin9 with Saction 7000) of Division 3 ot the Business antl. rofessions Code, and my licanse is in tull
� Class�#-. T' � I
Date: s � ^� �
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm ihat ihere is a consiruction lending agency for ihe peAormance ot the work for which ihis pertnit is issue0. (Sec. 3097, Civil Cotle).
Lenders Name: Lentlefs Address:
Signa�ure:
Date:
OWNER•BUILDER DECLARATIONS:
I hereby aNirm that under penalry oi perjury ihat I am EXEMPT FROM THE CON7RAC70RS LICENSE lAW tor Ihe following reason (Sec. 7031.5, Business antl Professions
Code: Any city or county which requires a permit to constmc6 elter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such pertnit
to flle a signed stetement ihel he or she is licensed pursuent to ihe pravisions of ihe Contrectors License Lew (Chepter 9(commencing with Section 7000) of Division 3 of the
Business end Professions Code) or Ihat he or she is exempt iherefrom end the basis tor the alleged exemption. Any violation of Sedion 7031.5 by eny applicant for a permit
subJects the epplicent to e civll penelry oi nat more than five hundred dollars ($500).):
❑ I, es owner oi Ihe Droperty, or my employees with wages es ihelr sole compensation, WILL DO 7HE WORK, end the stmcture Is not inientled or oflerad tor sale (Sec.
7044, Business antl Professions Cotle: The Contrectors License Ww does not apply to an owner oi properry who builds or impmves thereoq antl who does such work
himself or herself or through his or �er own employees, providetl ihet such improvements are not intended or oNered for sele. If, however, the builtling or improvemant Is
sold within one year oi completion, the owner-builtler will heve the burden of proving that he or she did not Duiitl or improve for purpose of sale.). -
❑ I, es owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business antl Professions
Code: The contrectors License Law doas not apply to an owner of property who builtls or improves thereon, antl who contracis tor such project with a contractor(s)
licen5e Oursuan� �o ihe Contrac�or5 License Laws.).
❑ I am exempt untler sec.
Signature:
Owner ID venfied by dnvers license. ❑ Ves ❑ No
Business and Professions Code for ihis reason:
Verilicetion of Ownership by (type of document, i.e. - properry tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFIGATION:
Driver's License No.
Date:
Expires:
❑ I hereby certify ��et no excavation five (5) or more teet in tlepth into w�ich a person is required to descend, will be mede in connection with work authonzed by this
permit, and that no building strudure, sceflolding, felsework, or demolition or dismantling t�ereoi, will be more ��an ihirry-six (38) faet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Title B, Calitornie Adminisirative Code).
❑ As ownervbuilder, I will not employ anyone to do work which would require a permit irom ihe Division of Industrial Sefety, as noted ebove, unless such person hes e
permit to tlo suc� work trom the division.
SignaWre: Dala:
Division of Intlusirial Sefery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTAY: I cehiy untler penalry of perjury Ihat I have read this applicalion and state that the information given is
wrrect. I agree to comply with all state lews antl ciry ordinances relating ro building construc�ion, and authonze representatives oi the Ciry oi Costa Mesa to enter upon Ihe
above-tlescribed property tor inspection puryoses. I agree not to occupy or ellow wcupancy of any buiiding authorized by Ihis permit until final inspection.
COOEI, INSPECTIONTVPE' '
1676 Fiaed System Final Fire Preventian
1266 Pool Spe Final
200 Finel Re-Roof ' '
201 Finel BIxWRetaining Wall
202 Final Factory Fire Place -
203 Final Sign
204 Final Demolition
DRTE
�
CODE1 �INSVECTIONTYPE
206 Final Mec�anical�
208 Finel Plumbing
210 Final Eleciriwl
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Site
Final Builtling/Occupancy
�
PAIE
� I�
INTRIALg
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
GARAGE.
,lobAddress: 938 GOLDENROD DR
Suite:
Viciniry: ROOF
Parcel Number: 41221317
Applicant: RON SELL
Address: 18032 LEMON
YORBA LINDA , CA
Owner: SCHMENK, DANIEL L
Address 938 GOLDENROD DR
COSTA MESA, CA
Contractor: SELL ROOFING COMPANY
Address: 18032 LEMON
YORBA LINDA , CA
Zip: 92686
Arch :
Address:
Zoning: R1 R1
Phone: (714) 52&1758
Zip: 92686
Phone:
Zip: 92626
Phone: (714) 528-1758
License: 323842
Eng:
Address:
Status: ISSUED
Applied: OB/19I2002
Issued: 08Jt 9I2002
�> �
ISSUED BY:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE EXISTING ROOF. INSTALL tl2 OSB, 30# FELT, EAGLELITE ICBO 4660. 2700 S.F. INCLUDES ATTACHED
Plan Check: $0.00
Permit: $167.25
SMIP Res: $0.89
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.14
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0-0
PARKING Exislinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Reouired: 0
FEE SUMMARY
PLANNING & ZONING
�en a o
Lek 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0- 0
58,900.00
58,900.00
NOTICE: The work authortzed by this permit shall comply with all applicable handicap access requiremenis under Califomla statutes amf retated
regulations. (Ord. No. 92•28, § 7, 12•27-92)
EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 1 BO days, or if work Is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the vrork authorized under ihis permit to be considered legal, such work must comply with all epplicable codes, and ell
requlred inspectlona and flnel epproval must be obtained. Failure to obtain inspections and flnal approval will result in the explration of thls pertnit.
FOR INSPECTIONS CALL: (714) 7545828
tae�e �a�oo�
WORKERS'COMPENSA�ON DECLARAnON: .
I hereby eBirtn under penalry ot pequry tlne of ihe followlnp dadarailons:
❑ I heve end will meintain e cenilicate of consenl to self-Insure for workers' wmpensation, es provitletl lor by sectlon 3700 of Ihe Lebor Code, for the peAormence oi the
work lar which thi5 pertnil Is issue0.
��I �ave end will meintaln workers' ca�pensatim �naurence, aa required by secUm 3700 of the Labor Code, lor the pertomia�e oi t�e work for which Ihls peimil is issuetl.
My workers' co ns lon Insfi ce cerrler polry number ere: ! /
Cemer.•_�(��L e PollCyNumDer. �d�6�,_S-7�
(Thls secflon need nol be completed ll(pe permit velued et one hun0ied dollars ($100) or less.)
❑ I certiy Ihat in Ihe pertortnance oi t�e work tor which tNs pertnit is issueq 1 shall not employ any person In eny manner so as to becwna subject to ihe workera'
compensatlon laws ol Calitomia, end e �at tl I shau become subJect ta t�e workers' compensatlon provlslons at Sectlon 3700 ot Ihe Lebor Cotle, I shall IoMwith
comply with Ihese D�oWsions. / / � /
ApPI_ I�cant:SlpnatJre: �� �l Data:� T—/ — Q�
WARNINO: FAILURE TO SECURE WORKERS' �P�'�TON COVEMOE IS UMAWFUL M!D SHML SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES M1D GVIL FlNES UP TO ONE MUNDRED
TMOUSAND DOILAflE (5100.000�, IN ADORION TO THE COST OF WMPENSATIIXJ, OAMAGES AS PROVIDED WR IN SECTIpJ 3108 OF THE LABOR CODE, INTEREST, AND ATTORNENS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm t�et I em Ilcensetl untler provisions ol C�aO�er B(cammenpng with Sectlon 7000) of Divlsion 3 0l Ihe Business and P� sslory�CyQe, entl my license is in full
��0_fCBQfItl91�BG1.LIC.M CIB99'A� � %
Contredafs Signature: ��� �,�� 6G Date: / O^ 3/-- O?
CONSTRUCTON LENDING AGENCY:
❑ I hereby ettirm Ihet there is e const�+c�ion lendinp apency for Ihe pertortnance ol the work for which Ihls permll Is issued. (Sec. 3097, Civil CotleJ.
Lendefs Neme: Lender's Address:
SigneWre: Date:
OWNER-BUILDER DECLARA710NS:
I hereby etfirtn Ihet undar penelry ot perjury �hat I em EXEMGT FROM TME CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business antl Professiwu
Code: Any ciry or counry which reQuires e pertnit ro construct, eller, improve, tlemolish, or repair eny strucWre, pnor to Its issuance, elso requlres the epplicant tor such permit
ta tile e signed stetement Ihet he or s�e Is licensed pursueN to the pwvisions oi Ne Contrectors License Lew (Chapter 9(commenGng wlth Secikn 70W) ot OlWsion 3 W the
Business entl Pmfeuions Cade) or that �e or she is exempt Iherefrom and the basis br the elleged exemptlon. Any violation oi Sectlon 7031.5 by eny applicent for a pertnit
sub�ects the epplicant to e clvil penelty o� not more then Ilve huntlred Aollers ($500).):
❑ I, es owner of the properry, or my employees with weges es thelr sde compensetion, WILL DO THE WORK, entl t�e simcture Is not intended or otteretl tor sele (Sec.
7044, Business and Professions Coae: TTe Contrectors License Law tices not eppty lo an owner oi proporty who bullds or impmves thereon, entl who does such work
himsetl ar hersetl or t�rough his or her own employoes, provided Ihat such Improvements ere not Intended ar oMered tor sale. If, however, iha building or Imprwement is
sold within one year oi completlon, �he owner-builder will have the burtlen of Oroving that he or she did not builtl or improve lor purpose of sale.).
❑ I, as owner of tha property, am EXCLUSIVELY CONTRACTING WfTH LICENSED CONTRACTOfiS to construct the project (Sec. 7044, Business antl ProteSsions
Cade: The mntractars LJcense Law does not eppty to en owner ot pwperry who builds or improves Ihereon, and who contracts for such pro�ect wit� a contractor(s)
license pursuant to Ihe Contrectors Llcense LawsJ.
❑ 1 em exempt under sec. Business and Professions Code for ihis reason:
SlgnaWre: Date:
Owner ID verified by drivafs licenso. ❑ Yes ❑ Na Drivefs Litense No.
Verllicallon of Owners�ip Dy (type ot dxument, i.e. - property tan bill or tleetl):
DIVISION OF INDUSTRIAL SAFEtt PEAMR CERTIFICATION:
Expires:
� I hereDy certity that no excavetion (Ne (5) or more faet in depth inro which e person is raquired ro descen4 wlll be made in conneclion with work authorized by thb
permi6 and that no building stn�cture, scaMoldinp, talsework, or demolitlon or dismantling thereot, will ba more ihan thirty-six (36) feat �igh. (Chap. 32, Gry 2, An 2, Sec.
341, Titla 8, Celilamle AtlmlNSifetNa Code).
❑ As owner-builtler, I will not employ enyone to do work which would requlre a Oormll Irom ihe Division of Intlusirlal Sefety, es noteO eDWe, unless such person has e
pertnit to do such work Irom I�e dlNsion.
Signeture: Oate:
Divlsion ot Industrial Selery Permil Num6er:
CERTIFlCATE OF COMPLIANCE AND A�ITMORVAiION OF ENTAY: I ceniy under penalry ol perjury that I heve read this application end state Ihat the infortna6on given is
correct. I egree to compty with ell stete laws antl dry ortlinances relating to building constructlon, and authorize representatives of Ihe Ciry of Costa Mesa to enter upon Ne
ebove-descnbed pmperty tor InsfyeEl'yl� purposes�eg�e�r�t to occupy w ellor, occupancy ol any building euthonzed by Ihis pertnit unlil linel inspectian.
COUE �. INSPECTIONttVE
1816 Flxetl System Finel Fire Preven/ion
1286 Pool Spe Finel
200 Final Re-Rool
201 FInnI B1ocWRetelning Well
202 Finel Fectory Fire Plece
203 Finel Sipn
20C Flnal Demolitlon
� I��
'L(e� 'i^
cooe� insrecnonTrve
208 Final Mechanitel
208 Final Plumbing
210 Final Electricel
212 Final Flre Proventlan
220 Flnal Plenning Approval
222 Final S%a
250 Final Bulltling/Occupancy
���
PAg Iti�dLfi
I/
Applicant lo till in all spaces except lhose within heavy Gortler Ilnes antl si9n all a0V/opriate tleclarations.
CITYOFCOSTqqq��/�ES�A �U��CTO ERMIT PERMIY1�l0_ __ TRACTNO. LOTNO. UNITNO.
Proj;ct Address —{-r:.ZQ_ V � i� 1',
Applicant's Mailing Address _ _ qI. .yy+
Owner's Name Phone.l{y��0
Address �- �-�Q �
ArchlEng. License No.
Address pp
Con[racto�� N CS�Q_0.J�fS- L�X1�. NG✓pho ep� 'lZ
Address (mailingl.�L�� ��'�- � � �(+Q
Ciry License No. � b ��' �[]
LICENSED CONTRACTOR DECLARATION
I hereby aHirm thal I am Iicensetl untlar provislons ol C�arte� 9(commencing
wiiM1 section ]000) oi Division 3 0l the Businesz antl Protezziont Cotle, antl
my IicensG i5 in /uil torce antl efiect. � ..� �_ �� , i
,00,
a(tirm that I have a certiticate ol i
-- - o��,nce, or
wi[h the
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This seclion neetl not be mmpletetl it the permit i5 tor one huntl�etl (E300) or
I¢55�.
I certify that in the pertormance of the work (or which [his permR is Bsuetl, I
Shall no[ employ any pe�5on In any manner zo as f0 beGOm! Subjecl to [ne
Workers' Com0en5ation LawS ot Calitomia.
Date Si9nature
NOTICE: I(,alter making this tleclaratlon, you shoultl become subject to the
Worker5' Compensation provlsions of lne Labor Cotl¢, y0u mu5t forthwith
comply wil� such prOvisioni or this perml[ snall be tleeme0 �evoketl.
CONSTRUCTION LENDING AGENCV
1 M1e�eby aHirm lhat there I5 a conslructlon lentling agenty fo� lne performdnG¢
of [he work to� which this permit i5 ISSuetl (SeCUOn 3097: Civ. C.)
Lender's Name
Lentler's AOU�est
OWNER BUILDEN bECLARATION
I hereby atll�m that I am exem0� from [hC Cont�acto�'S LICCnSe I..aw ior UE
followin9 reason (Sectlon 7031.5 Buziness antl Prote55ional Cotle: Any city or
county whlGh requiies a permil to conslrutt, dltCq Improva, tlemolish"Or �opair
any sVUGture, 0/lor [O Its issuance, also reqWros lhe applicant tOr su[b permit
to /il¢ a siqnetl SWlBment Ibal h¢/She Is IicenSetl puRudnt lo tlle plavl5iOn5 Ot
the Contractor's License Law (Cnapter 9(commencin9 w��n `+e«�on 7000) of
Olvislon 3 of thc Busines5 antl Profe55ian5 Cotle) or lhal he/ShC I5 oxom0�
ercfrom antl the ba5i5 /o/ the allegetl Cxemptlon. Any v101atlon ol $ection
31.5 Dy any appli<ant tor a permll SubjeCls iha applicant to a civil
� nalty of no[ moro Man live huntlretl tlollars (E500).
L� I, a5 owne� ot tM1e propmry or my amployee5 with wa9e5 a5 Nair sole
<ompensatlon, will tl0 lha work, antl t�e SlruGtura is nOt IntenEatl or o/terotl
fOr sale (Se<tiOn 7044, Bu5ine55 antl Pratessional Cotl¢: Tha Conlractor'S
Licenso taw tloes not dPply Io an owne� ol a prope�ry who builtls or Improves
thormn, antl who tlo¢s sucl� work'M1imseH/M1ersel/ or lhrOu9h hIs o� 1mr own
employeas, provitletl tM1at Such improvements are not Intentletl or oftoretl fo�
SaIC. It, M1owevaq the bull0ing or improvement is soltl wilhin on0 yea� ot com�
pletlon, the owncr wlll havo tho burtlen ol proving hc/shc ale not bulltl or im-
p�ova ior tM1e purpoSe oi sale).
❑ I, as owner ol the properly, am excluSively coni�actln9 wlth Ilcensetl con-
tractors lo construct lM1e projec[ (Section 7044, Business antl Pro�essions Cotle:
The Contraclor's License Law aoes not appty to an owner ol property who
bulltls or Improves thereon, antl who contracts lor such projects with a com
lractor(sl Iroense pu�sudnt to the ConVactor'S Llcense Law). I am aware that
proof o( thelr Worker's CompensaUon insuran<e Shoultl be provitl¢tl to me.
❑ I am exempt untler Section B. d P. C. for this reason
Date Owner
I nere0y certity that I have reaa tnis application antl state tnat the above
information is wrrecL I agree to compty with all tity antl county ortlinancaz
antl sta[e laws relaling to builtlinq const�uclion, antl he�eby authorixe rep�e-
sentativei Ot this city to enter upon lh¢ above-mentionetl O�operty fo�
Inspedlon Qu�rposes. �n � � _l � f
Signature "C�\c ��na. �G. . ��--� Daiu 1 O
Drivers' License or 55 � /
CMF OB65-46, rev. 10/84 Wblte - Builtling: Canary
TVPE OF CONSTRUCTION LJ NEW U ADD .''_4.hLTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p.�y
DESCRIPTION OF WORK/USE OF D.
/��` �'���/�� S Main Buildi
TVPEOFPERMIT GaADING FOUNDAl7 N�STRVC7URAL T Front
❑ TENHNT ❑ ELECTRICAL PLVMBING ❑ MECHANICAL B Rear
❑ OTHER A
C Right
PROJECT DESCRIPTION Sa.FT. OCCUaANCv K
CONSTRUCTION�TVPE VALVATION$ S Le(t
20NE GRADING CU.YDS. ACRES P�ng. Ref. #
Remarks: Planning Noces:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service OuUets
In[erceptors
Kitchen $ink
Lavarories
P-Trap
Roof Drains
Reinspection Fee � $15
Boiler
Dutt� Under Ground
Ducc � Sttuctural
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/Facc Blt. ICBO �h
Heating System & Ducting
❑ o�i oo,000 eTu O i oo,000 aT
ReinspeMion Fae � $15
; Pink - AGcountlng: Galtlenrotl - A55es5or
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinel
Water Closet
Warer Heater
Water Service
Auto�Wasb
Isue Fae
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
�0-100,000 BTU ❑ 100,000 BTU
System Repair/Alteration
Fire Oampers
Registers
luue Fee
FEES
S 3
5 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F,A,U.
Fixtures
Device Boxes
Outlets
Switches
Gar6age Disposal
Generator �0�5 KW �
Fee
95?9 4/;�p/^.'
2one
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑50+KW
Meter �up to 100amps
Merer �over100amps
Sub Panel
Motors O0.1 HP O 1 Y, - 8
Inc. Solar 09�15 HP 016�15+
Microwave
Pole �ight
Range
Standing Sections
5 KW Trash Compacror
$15 luue Fee
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By
Building Approved By
Aoolication Issued ev
�
Jo�" i;
S 3
Z
O
N
I
N
G
R
E
Q
M
T
S
SUMMARV OF FEES "
BUILDING PEFMIT $ SMIP $ '
PLAN CHECK $ �p PERMIT t1.G�l
PLUMBING $ � ISSUANCE $ __ ��L
PLAN CHECK 25� 5 ENERGV P.C. $
ELECTRICAL $ GRADING 5
PLAN CHECK 50% $ MICROFILM 3__�
MECHANICAL $ TOTAL FEE 5 �
PLAN CHECK 25% $
CONS7R UCTION AND �PLANNI NG POO L& SPA
APPROVALS� Permit:# Date Inspector p�ppROVALS Permit# Date Inspector
i..
1. Temporary��lectrical�Ser4ice 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. Stee! Reinforcement� --, 56. Rough Plumbi�g & Piessure�Test
6. ElectricalUFERGmd:� 57. APPROVALTOCOV'�R�,Gi1NITE
,.� -
7. Footings 58. Elecvical Conduit-UndtgrPd.
8. Foundatio � 59. Gas Pipe, O Undrgmd.J Test
.i
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System , 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & ReceptorPinal
72. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing SVstem - Final
14. Rough Plumbing 65. Electrical-Final
75. Rough Electrical-Conduit 66. Solar Syitem-Final
16. Rough Elec[ric 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. Ducis, Ventilating 71. Product Piping O Gas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.SrorageTank OGas ❑Oil �
25. Roof Sheathing 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe .
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL !,
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
i;
� 31. Plaster Brown Coat 79. FINAL INSPECTION �1�'
32. ElectriCal Power MeterFinal 80. FOOD CEftTIFICATE ISSUED �- �
33. Final Electric Notes: �
i,
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test ,
36. Hood or Canopy '
37. Fina� Factory Fireplace �_
38. Final Plumbing ,S�[�/�� LE� � '
39. Water 5ervice-Final � � ,
40. Gas Service-Final . . .
41. Solar pomesticFinal , - � � • ,�"• �
42. Backflow Preventer ' ' ' '
�
43. Backflow Irrigation � - .
� 44. LandscaPe Irrigation Sys[em � �
45. Sound Attenuation ' ' "
.
�46. Handicap Regulations � '
47. FINALSTRUCTURE&BUILDING . ' � � .
�;.
48. Special Requirements Completed �� • .
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co � .'
51. CERTIFICATE OF OCCUPANCY ,. � � '.
..
No, Date '
.. �.
r \, �.`.
\
- �
1
, CI7
r _
iF COSTA MESA REQUEST FOR OCCU1 ;Y
. ,.
TRACT N0. �S� 7 �
IAT N0. � �% Q
nnD�ss 93 S Go/�F��ocQ �
;,
• 'I
DATE ', .3 7�
The developer of the above entitled tract desires to aell the above set
forth lot prior to the time that the tract has been completed and ita streece,
accepted by the Ctty o£ Coeta Mesa.
i:r
, The undersigned, by executing this agreemen:,. acknowledges that
(he-she-they)�(was or were)�il�(/i� advised that�thie tract hae
not been given final inepection nor has it been accepted by the City of Coata Mesa
as having complied with the conditions of approval which were imposed by the City
at the,time the final tract map was approved.
.
The City assiunes no liability for the enforcement of the conditione
necessary for approval other than those conditions protected by aurety bond.
The undersigned agrees to indemnify and hold the City.ha�;mleae from.
nny claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned ttncompleted condition.
x
J
. . BY
/ . .�.^—� � e �/
4
s
+_ar;,.��; � � •,; � . - , Purchaser , 4 .
4 � � . � Z • � . � .
1, �I . I � �
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�
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,, a , � .
i �
�.:, . ... •"A��,.:��: , � i, .
-� �:;.��;;::;;;;.:;;;>_.:'' Developer and or suChorized
! `. ,. ���. ' repreaentativa '
;' �'� ,fr.. r. ; � - . � � .
't7.;�•`'>:i':I '.�:, ,� . •Bi � /I iC.vcCC[/. /.(Y.C.�Ulh+ � �'�
i: .,;.t�.'� : : % � •
� ; �'• ' ' � � • 1 Lander '
�!)I•�'•i1:P. ��I..��'i'� ' �'� � '�.1' , �.1 �rFY._ i� � ...
. I
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JOB ADDRE55
GENERAL COI
AP No412-2]
I! CTIONS
so._
GPS
W ATER
ROUGN PWMBIN(
PFOP. SWR. LINE
SPRINKLING SVS'
MISCELLANEOUS
ROUGM HEATING ANO RIR CONOITIONING
UNDEFGROUND �_f POWER U
ROUGH WIRING
TRENCHES l/ FORMS STEEL R
FLOOR SYSTEM '
BONO BEnM [] STEEL REINFORCE
SNEATMING
FRAME nN� FLASHING
LRTHING — IN OUT
PLASTER.BROWN COAT
EIECTRIC
BUILDING
cocnei
/ENT] REFRIG. RNO A.C., FINAL
FINRL ANO GAS TEST �
FINAL
FINAI
SUBCONTRACTOR
Lot74
�792.7
401 COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant�o Fill in Completely
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==^•-7-7''css:00 's45Y *-�'142.£s8
APPIICATION FOR BUILDING PERMIT
FECEI VHD BY DATE PECELV6D neTc icci i
arwin Southern California lnc. AP•No•�
BUILDING
16255 Ventura Boulevard ADDRESS
TEI. TR/
cinn. [:alifornia No.986-8890
BRANCH 16255 Ventura Boulevard
nooaess Encino, California
ARCHITECT TEL.
OA ENGINEER Larwin No. 273-4464
ADORESS 9100 Wilshire Boulevard Bev.Hil
CONTFACTOfi Larwin Southern California
ADORE55 162$5 Ventura Boulevard
TEL.
cirv Encino, California No. 986-8890
l C NO. ].9].�11 IICYNO. $-1
OFLOT 6O X LOO INOWONLO� O
USE OF
E%ISTING BLDG.
SIZE OF NO. OF
NEW BLDG. 1784 ROOMS STOFIES 1
EXTERIOR WALL qOOF
COVERING 6tLLCC0 COVERING WOOd shingle
USE OF BUILDING AND WORK TO 8E PERFORMED
CORSt
I hereby ocknowlatlga that 1 have reetl this appilcation antl s[ate
Nat tha abOvo iMo�motion is cOrrect and aB/ee to comply with
all laws ropulnting builtlin8 construction, antl I s�nli not employ
any parson in violotlon oi Me workman'a compensation laws ot
tbu Smte of Californie.
� horoby cortity thnt I om properly licensetl as a controctor untler
th¢ Stnte of Califbrnio Business antl Profassions Cotle, Divisicn 3,
Chopter 9, and thac sueh licenwz ore in full forca antl affoct, or 1
nm ezompt from � pr visions of tha Siote oi Celifornie Bosiness
antl Prafossion o ivisi n 3, Chapter 9.
SiB�ature —, �%
Pormitte ��
AuMorizetl Agont
OWNER (%\�!/Ge
s �� �L
FIRE
ZONE � T
APPROVED
Bv
ZON NO.OF
PLANS
VARDS APPROVED
MAIN BUILDING
(FFOMGF •_g,A 'yy�
ROM �l � FT �
f�P--
R. SIDE SFT
L SIDE J FT,
REAR FT.
OISTANCE BET.
MAIN BLOGS.
VAR. �
C.U.G. #
APPROVECY, .�/ � i
� v+-T—
HOLD }-pR SPF�
THE AMO
THE PUpP(
VALUATION
s Z§,900.00
LOT / BLOCK
� `
� �/ALUS / w
/ (O Lz
.�/if
GROUP y
DAT — �
USE OF NEw
BUILDING
VARDS APPROV
ACCESSORV BUILDII
BET. MAIN &
\ �m
0 (�
NDER VALUATION IS FOR m\l 7
iHING A PERMIT FEE ONLY: Q J\
d1T FEE s 94.00 cmi \
7
� CHECK $ 47.00 E
`o
>L FEE S 141.00 �`