HomeMy WebLinkAbout1999 ROSEMARY PL - Building Permits - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. \I. 7.711111111111
- P�`'��IT NO. TRACT NO. LOT O UNIT NO. L
C roj OF COSTA MESA• CO!/NISTRUCTION PERMIT 4...L — '9�P9 ' /6'70. Z 3897 5/31 /85 I1in.70 T
--PProject Address /999 tt/fern/WV PL.3Ce 7 ! 11{{�� rr I Ai
l
me- - TYPE OF CONSTRUCTION 07.NEW a ADD L'H ALTERATION U REPAIR -€
'Applicant's Mailin/g�' el.4 Address _j _ A
�x;PW//J � ��N4✓44 Phone 1142-35°3 ❑ CONVERSION CI-DEMOLISH ❑ OTHER ppp�la"" A.P,#4Z 7 032--Q3 Zone A-/
Owner's Name DESCRIPTION OF WORK/USE OF BLDG. ur+ � '+u l
Address /999 w- '9'MA/eVIt-• as�11 v E Main Building:, P /9 / Accessory Building: Z
Arch/Eng. License No. • TYPE OF PERMIT ❑ GRADING 1�l�I FOUNDATION II STRUCTURAL T Front /V '`/�X r 1/ O
Address - ❑ TENANT K ELECTRICAL XPLUMBING ❑ MECHANICAL Rear / *? / _
Contractor's Name t9�'U6fC..__ Phone ❑ 'OTHER C Ri ht - / N
• PROJECT DESCRIPTION "SO..f.I w- OCCUPANCY __ g 3'L Lr "tom
Address(mailing) :Clf90 S Left �/ rJ L; �/ G
•
CON ST RUCTION TYPE VALUATION $ Y� _ / R
City License No_ ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATI• ON - Ping. Ref. # Parking Req./Provided E
I hereby affirm that I am licensed under provisio of C rter 9 (commencing , a,, Q
p� d Remarks: - Planning Notes: l l0 LA b�S n M
with section 7000) of Division 3 of the BusinEcs 'en� r fessions Code, and _ /-
my license is in full force and effect. /`/) T
Q�•+ 90— C ` 6In P A n ..,, 1 ' O d/1 A 4 ao e $
License Class peens / , ` J aPLJUMBIJNG FEES �+ Yl.0 //Wf l�L/f{' "-v"v"u-iLP�
Date Signature. ,
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 certified copy thereof (Section Backflow Preventer Service Sink 3800;Lab. C.) • - - - Automatic Washer Transformer 0 15-50 KW- I -
Policy No. Company • Backflow Irrigation Sewer Cap - Construction Pole Sub. 50+ KW
R.Certified copy is hereby furnished. "
Certified copy is filed with the city'Building Division. • - Bathtubs - Sewer-Connection • Cooking Unit ' ivl eter up t0 100 amps '
Date Applicant - I, '
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Coo
(This section need not be completed if the permit is for one hundred ($100) or Dlshvva5her / -._/ wr
less). Solar Piping . _ ' Dryers ❑Gas ❑Electric Sub Panel Thy KJ
I certify that in the performance of the work for which this permit is issued, I —
shall not employ any person in any manner o as to become subject to the Drinking Fountains Solar,Tank Fan Motors❑0.1 HP ❑1'h-8
Workers' Cy1np nsa•jlo Laws of California. �/ — _
.,Date -�'Y� Signature «r� "�•�� Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE:If,after making this declaration,you should become subject to the .. - InG.Solar ❑9-15 HP ❑15-15+ ,
• Workers' Compensation provisions of the ,Labor Code, you must forthwith Floor Sinks Urinal Fixtures 02.0 O..
comply with such provisions or this permit shall be deemed revoked-- Microwave L•C.�
CONSTRUCTION LENDING AGENCY 2
I/ Gas Service /'Outlets Water Closet 90 Device Boxes Pole Light
hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is, issued (Section 3097 Civ. iC.)
Lender's Name —•. - / .ON/' - Interceptors Water Heater - Outlets g 2 2O
/V C" Ran e TU
Lender's Address Kitchen Sink Water Service r
OWNER BUILDER DECLARATION - — / Switches Sign Q 20
•
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories , Auto-Wash -
followin9 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 /�,
any structure, prior to its issuance, also requires the applicant for'such permit P-Trap Laundry Twys —727—00Generator ❑0-5 KW 1:[ Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains rpjr(al�l
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 ///jjj
• therefrom •and the basis for the alleged exemption. Any violation of Section . I - ��,/
031.5 by any applicant for a permit subjects the applicant to a civil - - fir/
ienalty of not mote than five hundred:dollars ($500). '• - , _ I
go,. as owner of the property, or my employees with wages as their sole Reinspection Fee Y $15 Issue Fee $ 3 '
compensation, will do the work, and the structure is not intended or offered YYY ' ' - • Reinspection Fee ' $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 • DEVELOPMENT SERVICES REQUIREMENTS: '
employees, provided that such improvements are not intended or offered for Boiler I Hood or Type I 0 Y-�,�.�
sale. If, however, the building•or Improvement Is sold within one year of com- ---- Canopy Type I1 ❑ Zoning Approved By M /L-1L�o Date J C
/�//��
pletion, the owner will have the burden of proving he/she did not build or im-. Duct-Under Ground Building Approved By Date==`
prove for the purpsale). -
❑ 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:
The Contractor's License Law does not apply to an owner'of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU 'SUM RV 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 $ rSa •SMTP $ D.SR?proof of their Worker's Compensation insurance should be provided to me. /�•
i PLAN CHECK $ e�. Z 'PERMIT : •
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG 4 Fire Dampers ISSUANCE CE $
-- - - -r— PLUMBING ' $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ a Jr ENERGY P.C. $
I herebycertifythat I have read this application and state that the above ❑0-100,000 BTU ❑100,000 BT a":41111"7'7: p0
PP. D.p MICROFILM ADING $
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 this city to enter upon the above-mentioned property for PLAN CHECK 50%
Inspection purposes. , S 6.85
Signature �C,/ Date J MECHANICAL $ .�'l0 TOTAL FEE $� // p ZO •
Drivers' License:or S S# • - Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ rte. 70
s
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 . •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - -
1; (S. Steel Reinforcement 56. Rough Plumbing & Pressure Test
V 6: Electrical UFER Grnd.1 `(,'? 57. APPROVAL TO COVER-GUNITE • '
il
7:,Footings 144,,L ( r 7 - 58. !Electrical Conduit-Undrgrnd. ' . - '
8. Foundation "V- - 59. Gas Pipe, 0 Undrgrnd., Test -
.
- 9'. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd. •
•
-10.-Structural Floor System 61. APPROVAL TO DECK .
11.7 Property Sewer Line & House Connection • 62. Backwash & Receptor-Final Il
J
:12: Sewer Cap • 63. Heater & Vent-Final - !
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing /6//s/C(.tt1 = 65. Electrical-Final /,
15. Rough Electrical-Conduit - , 66. Solar System-Final .
;16. Rough Electric Wiring MMt1 5 (PO 67. Fencing& Access Approval
7* 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 :;'f 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test .. 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing • 144/ 03 74. Overhead Hydro
'. 26. T-Bar Ceiling (Structural) & Monocoat - _/•,G/ - • 75. Dry Chemical
27. Frame and Flashing 1 i�l bC 76. Dry Standpipe
28. Lathing &.Siding 77. FIXED SYSTEM FINAL '
• 29. Insulation S 78. FIRE PREV. FINAL
30. Drywall Nailing> )I/.5ja f7S HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I( : )4t ,/!c Di 79. FINAL INSPECTION
W
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric • - Notes;$ nfr- -- D - / , /< D$J4/A'
34. Final Heating &,Air Conditioning - '~ -
%'• • ill/4:7
35. Final Gas Pipe-Test - O/,,
y% z 9/ i ,
36. Hood or Canopy / �/ -
37. Final•Factory Fireplace
38. Final Plumbing ,
39. Water Service-Final-
40. Gas Service-Final 411/40 ,43 . . - '
\ 41. Solar Domestic-Final •
L , 42. Backflow Preventer . '' , !.•
43. Backflow Irrigation -7
- •�..,;:•;i. •
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 -I ' '
51. CERTIFICATE OF OCCUPANCY • - '-
1 No. Date 17 .. . ;.:,;.` ..
PROJECT ADDRESS: 1999 ROSEMARY PL 0N1T: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 061712
OWNER'S NAME:LA MANNA GERALD R
4r 66"1":1999 ROSEMARY PL PERMIT NO: B 061712 PLAN CHECK NO: 01220-93 S GOVT; N SUPP; N
COSTA MESA, CA 92627
CONSTRUCTION TYPE; V-N PERMIT TYPE; 5TH PURPOSE; OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; CITY STD BLOCK WALL
ADDRESS: UNIT: SQ FT; 4
CLAIM VALUE: CALL-VALUE: 80 . 00 GROUP OCC: M-1 /
PERMITTEE:JIM JENNINGS MASONRY ( 714 ) 645-8512
ADDRESS: 170 EAST 17TH STREET 206 COMMENTS : REF B61703
COSTA MESA CA 92627 #######################x######################*#; *#Uc#################,E##+6*#r.###
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of hapter 9(commencing with Section Z ONING REQUIREMENTS '
7 0)of Division 3 of the Business and Professions Code,and y U ense is'• full force and of e t. SETBACKS
TrLIc.:024547 sTATELIc.:3927 1 j. li "e.l
l 1 11,11 -- w.
Date:—_I-I z_1 °T3 signature. �r�.�l A MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l 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.or a certified copy thereof(Section 3800.Lab.CL. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICYNo.;1182768-92 EXP.DATE: 0 5/0 1 /93
cOMPANY:STATE FUND 1 Y � � PARKING REO: PROV: PARCEL : 42603230 ZNE: R1 REF NO:
Cemhe copy is hereby furnished. fi Certifie co i: IA it ici i . 1 n. PLANNING NOTES> CONSTRUCT 4 . 5 ' LONG BLOCK WALL AS INDICATED ON SUBMITTED
V v // T
> PLANS.
Date. Applica : Air ################### ###############*###########################################
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION. (This section need not be completed if the permit is for one hundred($100)or less). DEVEL OPMEN T SERVICES REQUIR EMEN TS
1 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
1 subject to the Workers'Compensation Laws of California. ZONING APPROVED BY 2 [%�— ' r' i ) DATE: c2'7'-/ '3
Dale: Signature: _
NOTICE:If.after making this declaration,you should become subject 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 fending agency for the performance of the work for APPLICATION ISSUED BY: ,�=7' DATE:
which this permit is issued(Section 3097.Civ.C). ##################****. . . ,t• 'mss' --a:se�—'-- *• x"ir ##########iE## d1r#ft rtie##
I LENDER: . #######################: 'x orfs#######!E#lE#############N•########################
ADDRESS: LEGALIZATION:N F E E S JMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING EL ECTR-` 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 15 . 00 , 50
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 to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the BusinessSMI P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 9 . 75
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5001. ISSUE FEE
I. as owner of the property 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'State License Law TOTALS----> 15 . 50 0 . 00 9 . 75 - 25. 25 25 . 25 . 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--->
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve COLLECTED- 25. 25 OVER/SHORT• . 00
for the purpose of 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 15. 00 . 50 9 . 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).I am aware #{p##.7p########################################lE#########K•######JFIt##.i(.#########?f##
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. SFR 4 RES-CONCRETE BLOCK WALL / FT. 20 . 00 80 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES
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
permit for construction or modification from the Air Quality Management District,Residential construction applications are exempt from
these provisions.
Dale: Applicant- EXPIRE D
I hereby certify that I have read this application and stale that I afro e imr 1 tion i c rrect.I agree to comply with all city and county
I(1COEn 1)
late lrsPe�tL
dinances and state laws relating to building construction. e). .0 L yes of this city to enter upon the above-mentioned f
///y orrdinancLtLIan scuotale
relattiseg. F/ r l _
v Dare: I / 1✓ 3ata 41 - --9-.)—
Signature�111 , �:`� 01 00137134-00137136 TI_lT 25.25
Driver's License or Social Security
1641-46 While—Building:Green—Cade Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
(
•
ar0NSTRUCT ION AND PLANNING POOL .PA
d r'PROVALS Permit-n Date Inspector APPROVALS Permit# Date Inspector
1tTemporary Electrical Service or Pole 52. Pool & Equ'pment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Ut lity-Undrgrnd. 54. Farms I
•
4. Electrical Conduit-Undrornd. Tis. Electrical Bonding 1
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
6. Electrical UFER Grnd 57. APPROVAL TO COVER-GUNITE
- - I
7. Footings - 58. Electrical Conduit-Undrgrnd. _
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test -
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 & Receptor-Final
12. Sewer Cap _ 63. Heater & Vent-Final
'3 Roof Diains 64. Plumbing System - Final
- i
14. r.uugh Plumbing 65. Electrical-Fnal
15. Rough EIectr cal•Condwt 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrica6T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL J
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro I'
22. Ducts, Ventilating 71. Product Ening 0 Gas C Oil
23. Gas Pipe-Rough & Test 72. Underground Flush •
•
24. Roof Framing 73. Undergrnd.Stora;e Tank 0-Gas 0,Oil -'
25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & ivbnocoat 75. Dry Cheri ca', . _
27. Frame and Flashing 76. Dry Standp;pe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
It;
29. Insulation 78. FIRE PREV, FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power MeterFinal I 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 1
1
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test • {
36. Hood or Canopy
37. Final Factory Fireplace '
38. Final Plumbing
39. Water Service-Final I -
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. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
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1,SAID PLANS,.
AND ,SPECl/ICATITS O. FROM PREVENTING
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I . ' I I II HUILDING OPERATIONS BEWG CA RIED THEREUNDER WHEN
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^ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
t - - PERMIT NO. TRACT NO LOT NO. UNIT NO.
4 COSTA MESA CONSTRUCTION PERMIT L3E _ 193 /V l (p76 J as - -4531 6/10/B5 68.03 TL
/999 7�oSEnlAPfi PC.
Project Address W
Applicants Mailing Address S4/2E 4.5 .48 TYPE OF CONSTRUCTION U NEW O ADD Li ALTERATION U REPAIR
C+�1e 4 L4i/y/f4W Phone 612-3660; ❑ CONVERSION El DEMOLISH ❑ OTHER A.P.M /L e,.-.03 7 Zone cz ,
Owner's Name DES RIPTION OF WORK/USE OF BLDG. SQ r1T "'1(/ L/
Address - /999 .POSEMAr v PL. = S -Me6,Buildhg: Acceccnry Rnilding:
Arch/Eng. OL!/d1F.e License No. _ TYPE OF PERMIT GRADING�'+a FOUNDATION STRUCTURAL T Front1. �'"-4p ' 0
Address -- - _ ❑ TENANT ® ELECTRICAL ❑ PLUMBING ❑ MECHANICAL • A Rear 4' -+o N
Contractor's Name AA/A/e42 . Phone ❑ 'OTHER
/ PROJECT DESCRIPTION SQ. FT. /loo OCCUPANCY C Right •�2 4 H N
Address(mailing) / �r.p.^ K Left / 1 G
CONSTRUCTION TYPE V -� VALUATION$ 21Lw S S R'
City License NO. ZONE GRADI NG CU.YDS. • ACRES
LICENSED CONTRACTOR DECLARATION • _ Ping. Ref.# Parking Req,/Provided E
I herebyaffirmthat I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: j St race addm'or -tO te N1
-with section 7000) of Division 3 of the Business and Profe cions Code, and • I p" �09'p r^+Vz► 1 q� ,tea,s
my license is in full force and effect. - II a-I-Mated eKt S�"I�a !/1wr Lim{.' T
License Class Lic nse fJO. — - t~1 �/� S
Date Signature \\ PLUMBING FEES
WORKERS' COMPENSATION DECLARATION r Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificateELECTRICAL SEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink. - -• 3800, Lab. C.) - Automatic Washer Transformer ❑ 15-50 KW '
Policy No. 1 Company Backflow Irrigation Sewer Cap .
Construction Pole Sub. 0 50+ KW
i Cert if led copy is hereby furnished. -
Certified copy is filed with the city Building Division. Bathtubs i Sewer Connection - Cooking Unit Meter ❑up to 100 amps i
Date • Applicant
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). • Dishwasher Solar Piping . - - 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 01%-8
Workers' Compensation Laws of Californy�
Date I:5-4-AI Signature �/I�C-ru. is[�+...�s�'a '• Floor Drains Swimming Pool w/Spa F.A.U. ' Inc.Solar 09-15 HP 016-15+ '
'NOTICE: If,after making this declaration, you should become subject to the ' - -
. Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal - /• Fixtures -/ Microwave . '�
comply with such provisions •or this permit shall be deemed revoked.
. CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for-the performance 9
of the (work for which
Lender's Name A..)A..)0/Ye.this permit; is issued (Section 3097 Civ. C.) ,. Interceptors Water Heater g Outlets Range
Lenders Address - Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION I . ;Si
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 repairP-Trap Laundry Trays Generator 00-5 KW ❑ KW Trash Com actor
•
any structure, prior to its issuance, also requires the applicant for such permit ._ P
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 O
7031.5 by'any applicant for a permit subjects the applicant to a civil - - ,
LJenalty 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 - r '
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $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 DEVELOPMENT SERVIC O /RE E TS:
employees,�provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By r Date
056
pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground _ Building Approved By IA 1 l4 tc Date fCD(moi
prove for the purpose of sale). ' -j/ /0/Cys
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By /( r Date
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 - 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- _ 50
tractor(s) license pursuant to the Contractor's License Law). I am awarethatBUILDING PERMIT $ -32. SMTP $ n
(f Exhaust System 0 Multiple 0 System Repair/Alteration
proof o their Worker's Compensation insurance should be provided to me. PLAN CHECK $ 21 ^ 3 PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ 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 ❑0.100,000 BTU 0100,000 BTL - ELECTRICAL $ 3 ,.CP� GRADING $
Information is correct. I agree to comply with all city and county ordinances �^t9
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50°,6 $ . MICROFILM $
sentatives of this city to enter upon the above-mentioned property for •
Inspection purposas. lo.�s. MECHANICAL $ TOTAL FEE $ e
Signature ,,r SS --�f1//f Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Date
Drivers' License or SS Bs
a
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL a SPA
52. Pool & Equipment Location
lif
53. Steel Reinforcement
APPROVALS Permit# Date Inspector APPROVALS Permit - _ Date Inspector
'1. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
/** 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
. 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
I 7. Footings 58. Electrical Conduit-Undrgrnd. '
8. Foundation S Xn 9/(2A_
�� c"----c"---- 59. Gas Pipe, 0 Undrgrnd., Test .
9. Water Pipe-Undrgrnd. 60.60. 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
13. Roof'brains - 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final 1
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 0 Gas 0 Oil
25. Roof Sheathing ►a 4,C e 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ii l/ p 76. Dry Standpipe
28. Lathing& Siding / .� / 77. FIXED SYSTEM FINAL
29. Insulation cr 1 78. FIRE PREY. FINAL
30. Drywall Nailing fli7(Acce 1 1 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat iaj+zi8c. p5 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 -
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 I
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co I ,
51. CERTIFICATE OF OCCUPANCY
No. • Date •
i
ANGE COUNTY BUILDING DEPARTMENTIlek
APPLICATION FOR PERMIT
636 North Broadway B U e L D I N /�
SANTA ANA, CALIFORNIA vi
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
RECEIPTO. PERMIT NO.
BUILDING 199 7 1 f3 I So 3 // 3
ADDRESS /tom.
SCHOOL DIST. RECEIVED BY DATE RECD. DATE ISSUED
OR TOWN _
NEAREST 02,0
/ [`may)_
CROSS ST. (j,� , / 97,3 -'5 / 9.-(5" -.
OWNER pDIRE RE55NG // 7 Pr9 -
MAIL GEORGE M. HOLSILIN & ;')WJ
ADDRESS y� C c SCHOOL DIST.
1$ E 6 E. 1/(l St OR TOWN
NEL.
CITY
COSTA MESA, CALIF. NO. NEAREST
c
ARCHITECT OR LIC. ZOryq� I NO. OF I TY U
I GROP
ENGINEER NO.
6/y/`J/ PLANS Z
ADDRESS ////,, /
ONTRACTORORGE M. HULJIr.1ly G NO BY ,,Uv((,, DATE)
.• E. 171; CORRECTIONS
ADDRESS rneTA INFRA CALIF.
LEGAL
DESCRIPTION I LNOT 7—I BLOCK I TRACT/1 it
(ATTACH METES/@ BOUNDS) NO.OFJ�
SIZE OF LOT W O.03
Y r 9 I NOW ON LOTS v
USE OF I NO. OF I NO. OF . -•)2
EXISTING BLDG. FAMILIES ROOMS
SETBACCENTER KOFI STREETNE M So SIDE YARD (REAR YARD s \
DESCRIPTION` OF WORK / $
NEWl /ALTERATION I I ADDITION D
Z
D
REPAIR I I MOVING I I DEMOLISH I T.
BUILDING Jo NO. OF
SIZE 0 7 ROOMS S STORIES i
EXTERIOR WALLROOF /J
COVERING I COVERING 9.24•N
*DNEW '
DING
��•666NG �0,���,
7
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APPROVALS
FOUNDATION: LOCATION INSPECTOR DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS UNDER-PINNING RMMATERIALS. //nl/1 1 �,`'*)
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FRAME: FIRE STOPS. .EMI /' V �\
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES BRACING, BOLTSS.
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. .J 1
LATH. INT. ',///
SIGNATURE OF a - LATH. EXT.
PERMITTE . /J f _ _ /
/n/
PLASTER. INT. /, Jr2J/
AUTHORIZED AGT. 4.. --4-� t
,LACA-
PLASTER, EXT.
PERMIT FEE $ MASONRY REINFORCED
VALUATION S ger�� ^
PLAN CHECK $ �JJ/(�� BOND BEAMTOT /�
® FEEAL $ ! / FINAL C�l'� //a-LI
SM 3-30.53
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PLOT PLAN y
Show location and distances from
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=;.UNTY BUILDING DEPARTMENT APPLICATION FOR rLRMIT\i
636 North Broadway BUILDING
SANTA ANA, CALIFORNIA
I• FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY •
/� ! / /� ^ /R�y)C�EIPT NO. PERMIT NO.�.
BUILDING (fY_/`•i•�••"'wvy.Yl� V � I �� ✓ /
ADDRESS
ORHOOL TOWNDIST. r1 . . _ K -ECEIVED BY DATE REC\DD.. '� 4DATE ISSUED
CROSS ST. i,
,. r,' 9:,'_l '•J / /E -��
OWNER CELlirr cpi Nnl STCIN R SANS ADDRESS ' .. A .- .......,r,,,........,r,,,.: MAIL
ADDRESS l, 166 E. 17th St
SCHOOL DIST.
OR TOWN i
COSTA MESA, CALIF.TEL. .l, -
CITY NO. NEAREST
CROSS ST.' •
ARCHITECT OR LIC. I NO. OFI TYr, I GROUP
ENGINEER NO. t PLANS I�
ADDRESS rrnnr•r 71 IIsi OTrI,, o on,N APP(OVED (//11/, JI''2 ) al..- •
ccee t LIC. BY /l/ ' DATE��/ 1
ONTRACTOR 1WE- 171hSt NO. / / \ CORRECTIONS
ADDRESS COSTA M•••�ESA, CALIF.LEGAL Lo
1 /
tl
DESCRIPTION I NOT Z`I BLOCK I TRACT / �8"
(ATTACH METES 8 BOUNDS)
io
o
A )3 CI
I NO. OF BLDGS. 0
SIZE OF LOT NOW ON LOT
USE OF I NO. OF I NO. OF
EXISTING BLDG. FAMILIES ROOMS - -
SETBACK LINE FROM: j •�4fr REAR YARD
CENTER OF STREET /r3 r SIDE YARD S
DESCRIPTION OF WORK - °,
6
NEW I n I ALTERATION I I ADDITION I //j Z
REPAIR I I MOVING I I DEMOLISH I / D
r
BUILDING B C./ 0 NO, OF /
SIZE ROOMS STORIES
EXTERIOR WALL I t_ I ROOF
COVERING �(/�-��O COVERING •
TDFNGNEW
DI
U
APPROVALS
FOUNDATION: LOCATION INSPECTOR DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS. MATERIALS. /)/� /`_I�Q 43
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING ✓/(w/� Y `]�J
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS, 1 / /3
BRACING. BOLTS �/✓ 1 5-3
AND STATE LAWS REGULATING/NGBUILDING CONSTRUCTION.
CONSTRUCTION.
/r(r '••"�w LATH. INT.
SIGNATURE OF �- �h. LATH. EXT. 1/-/3 vJ
PERM ITTEFAl---...0
/1L �J —
AUTHORIZED AGT. ®/V —`"✓ ' ��ff PLASTER. INT. ,�.eL.
rPLASTER, EXT. �/ /-1.-
PERMIT
- .-
PERMIT FEE $ MASONRY REINFORCED - .
VALUATION el^I// I/.0I PLAN CHECK $ j
BOND BEAM ,, L/�
TOTAL c /FINAL -..e;',4 /-2-/-/ /
FEE S. )
, OM 9-30-53
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STREET•
PLOT PLAN '
Show location and distances from
property line and between buildings. _
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