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HomeMy WebLinkAbout3113 ROOSEVELT WAY - Building Permits •w9 CITY OF COSTA MESA 4 BUILDING DIVISION o r/. -�I DEVELOPMENT SERVICES DEPARTMENT PER NUMBER v y I�11 PERMIT 07-00198 4ite4po NO R01110 . (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.a&MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3113 ROOSEVELT WY Status: ISSUED Suite No Applied: 04/03/2007 Issued: 04/03/2007 Vicinity: WATER HEATER TO BATHROOM Parcel Nunmber: 14169323 Applicant: ELLIS, JOE /j/ Address: 3801 LENAWEE AVE ISSUED BY: Phone: 310-838-0408 X120 CULVER CITY,CA Zip: 90232 Owner RICE, STEPHEN E Address . 3113 ROOSEVELT WAY _ - Phone: . COSTA MESA,.CA ; Zip: 92626 Contractor ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU Address: 3801 LENAWEE AVE Phone: 310-838-0408 X120 CULVER CITY,CA Zip: 90232 • License: 679898' . - SCOPE OF PERMIT • REPLACEWATER INE FROM WATER HEATER TO BATHROOM. "' 1 WATER PIPING ' Na • OTHER WORK AUTHORIZED WITH THIS PERMIT. . FEE SUMMARY AMT QTYAMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 _ __ Landscape Irrigation _ _$0.00 0 - Swimming Pool $0.00 0 Backflow Preventer $0.00 0 . - - P-Trap . $0.00 0 Trap Primer $0.00 0 Bathtub • $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) -$0.00 0 Vacuum Brkr Bkfow(1-4) $0.00 0 Connect(Ice,Soda,ete) , , $0.00 0 - Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 , 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher • $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor - ,,$0.00 0 Sewer Connect' $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof , ; $0.00N, 0 Shower $0.00 ' •0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 ' .0 - -Sink;bar $0.00 0 Water Piping(Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 ' Sink,commercial $0.00 0 - Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 . - Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) •• . $0.00 , 0 , Sink,kitchen, $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) '$0.00-,' o • ". Sink;service/mop $0.00 0 • OTHER - " $0.00 Gas Repipe - A,$0.00'/ Q Spa(private) $0.00 -0 . • VIOLATION $0.00 Gas Service $0.00 ' 0 ' Spa(public) $0.00 0 • PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 . 0 TOTAL CALCULATED FEES: $33.30 _ COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: E 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'co aao ranceperferandlicy number are: Carder:— /a7 VIVID PolicNubr: i/U -£ , g -700 7 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work f ti's permit' ' sued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California re.l ' •/ Id• ubject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions Applican[Signature: 'j p, Date:� WARNING:FAILURE TO SECURE WORKERS'1/ PENSATION COVERAGE":UNLAWFUL AND SHALL SUBJECT AN EMPLOYER-TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION•0 THE COST OF COMPEN 'TION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license- .•:r;,• ' io > :pter 9(commencing with Section 7000)of Division 3 of the Business aqd Pro) ioa5 Code,and my license is in full force and effectrLicr R. • iwe// S Class# i Contractor:s.Signature- ` I ,/� _ Date !/-3,-)-c)-77 CONSTRUCTION LENDING AGENCY: • ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 01 the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is 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. O Own-a q- -Dei d/Or uthorizn /Dated CODES INSPECTWN TYPE 'ATE 1Nili1ALS CODE! INSPECTION TYPE PATE INTITIALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical �t 1266 Pool Spa Final 208 Final Plumbing " ! -Li -07 aI YI�� 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 _ PROJECT ADDRESS: 3113 ROOSEVELT WY UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 048746 'OQ/NER'S NAME: HAMILTON ADDRESS: SAME PERMIT NO; B 048746 PLAN CHECK NO: N GOVT: N SUPP : N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF COMP 0/ COMP SQ FT: 3, 000 ADDRESS: UNIT: CLAIM VALUE: 3, 000 . 00 CALC—VALUE: 3, 000 . 00 GROUP OCC.: R-3 / PERMITTEE: CAL—PAC ROOFING ( 714 ) 583-0884 ADDRESS: 9272 JERONIMO 120 COMMENTS : REROOF COMP 0/ 1 LAYER COMP IRVINE CA 92718 ******x** ********aE**+e >F* *******>Eerer***>E*x** daeE**oEN*er** ***************EE**atet*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIR EMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and ect. SETBACK S cin us.: 0�4�2 3� 14 STATE UC.:512 8 06 —/g'`F) � Date: CI _ Signature: MAIN BUILDING ACCESSORY BUILDING / "MINERS'COMPENSATION DECLARATION: I hereby affirm that l have a cerci ate consent to self-insure or a certificate of Workers' FRNT : FT IN REAR: FT IN FRNT: FT IN REAR: FT IN mpensationtnsprgncg,gr ic�rtified cppythereof(Section MOO,Lab.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: U i EXP.DATE: 04/01 /91 COMPANY: SUPERIOR NAT. PARKING REQ: PROV: PARCEL : 14169323 ZNE: REF NO: El Certified copy is hereby furnished. IN Certified copy is h • ith e city Buil.' g Divii. PLANNING NOTES> I , ' > • Date: 8J a_1'Q�) Applicant: �f:i._.I/ �. ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need be.: pleted d the permit is for one hundred($100)or less). DEVELOPMEN T SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I s 'I not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY • DATE: Date: sou: BUILDING APPROVED BY NOTICE: afterstmaking this declaration,wiyou should become subjectmithe Workers'merevoked. Compensation provisions of the Labor DATE Code,you must forthwith comply with such provisions or this permit shall be deemed rvo CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY �_r� DATE: G S Z9a1 Q which this permit is issued(Section 3097,Civ.C). ********************** > aisl'x:s.a:s:s '********************. -**7.R***.**.x.*W** LENDER: **********************************,, • n **- ************************************** ADDRESS: LEGALIZATION :N F E E S 4 M M A R Y 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 ELECTP C MECHANIC FIRE SMIP/RESP GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,improve,demolish,or PERMIT 5 4 . 0 0 - repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 0 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLANSMIP/NON R E S and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by `any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). 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 o structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS—--—> 54 , 50 0 . 0 0 0 . 00 54 , 50 5 4 . 5 0 . 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 ; 54 . 50 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 lar the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property, 54 . 00 . 50 p : Th, Co tractors' ate License withaw licensed contractorslyto nto owner of construct property project builds or improves ov,Business❑ and whProocontractsThe projects tatconlratcLawiens prsuatoo teotrctors'Sate Law) lathereon ******************************************************************************* and who contracts for such projects ryth a contractor(s)license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's Compens¢eon insurance should be provided to me. INDIVIDUAL F E E BR EAKDOWN 0 I am exempt under Section: B.&P.C. • for this reason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST Date: Owner: SFR 3000 REROOF BY VALUE RESIDENIAL NOZONE 1 . 00 3 00000 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. , Date: Applicant: I hereby certify that I have read this application and state that the above information is erect gree to comply with all city and county `'s n e n KF DETECTOR ordinances and state laws reefing to building construction and• by authorize representatives o city to enter upon the above-mentioned property for inspection purposes. Date: 8/ r�.uil �� Signature:GUMilAS ///l l.sn : LEC UIRED � 01 00068277-05063273 TOT `451: Driver's License or Social Security r y DATE: 08/24/90 TL9E: 09:44 -------------•—Ir anteink—Revenue;Goldenrod—Assessor • CONSTRUCTION AND PLANNING POOL & SPA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit # 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap • 63. Heater & Vent-Final 13. Roof Drains • 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑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 I 78. FIRE PREV. FINAL 30. Drywall Nailing i HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric i iI ; Notes: 34. Final Heating& Air Conditioning 1• I I 35. Final Gas Pipe-Test • 36. Hood or Canopy I (' 37. Final Factory Fireplace i 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 19/q/ Q y, , 48. FINAL PLANNING +- 303 j7 j' et 94 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • • - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - P T TRACT NO. LOT NO. UNIT NO. 0433 7%30/86 ' 5.00 TL • CITY OF COSTA MESA CON TR UCTION P R •IT � '7.p'2 •- - --- ' Project Address . /��- - // •, 1 Applicant's Mailing A.dress' ...C> iron._/.I • TYPE OF CONSTRUCTION L I NEW U ADD U ALTERATION V REPAIR ' ' • Owner's Name CAve n/� /t) Phone q •-/ ❑ CONVERSION DEMOLISH ❑ OTHER A.P.# • -• - I Zone '�,/Qs//e '(' DESCRIPTION OF WORK/USE OF BLDG. Address. l-1 S Main Building: Accessory Building: •Arch/Eng. License No. TYPE OF PERMIT U GRADING L-I OU NDATION ❑ STRUCTURAL E Front p Address E TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear N Contractor's Name - / / . ..n_/ /. one$' 99_02.5 ❑ 'OTHER - - - C Right N I ,� ' r ' PROJECT DESCRIPTION SQ. FT. • OCCUPANCY K g G Address(mailing) ? A 9730 CONSTRUCTION TYPE VALUATIONS g Left R City License No. ZONE GRADING CU.YDS. ACRE LICENSED CONTRALTO R,DEC LARATION _ $- Ping. Ref.# - Parking Req./Provided E I herebyaffirm that I am licensed underprovisions of Charter 9 (commencing cin Q 1 g Remarks: Planning Notes: MI with section 7000) of Division 3 of the Business and Professions Code, and ' •JUL1986 T my license is in full o e .nd effect. ' ' License I. y et 4 r. ' e i0 •' RECEIVED2. 1S Date '.`i Signature Cr��f� 1"�i . . PLUMBING FEES . ' WORKERS'COMPENSATION DECLARATION Bar Sink • - Showers ELECTRICAL FEES IN I hereby affirm that I have a certificate of consent to self-insure or a certificate " - f, ` ` Workers' Compensation Insurance, or a certified, copy thereof (SeFtion Backflow Preventer _ - Service Sink _ Automatic Washer Transformer ❑ 15-50 KW 300, Lab. q /y 1 ///��� ,/� Policy eqJ��p'�' Company ����[�/ Backflow Irrigation1 ' Sewer Cap - - Construction Pole Sub. "" 0 50+ KW \ —` Certified copy is hereby furnished. ' - Cer co filed with the city ild' yryo / Bathtubs Sewer Connection - ' CookingUnit Meter C to 100 amps - Date ION FROM7 Applicant( e (/L D���i�( _ Clarifiers - Solar Collectors - Dishwaher • Meter Dover 100 amps EXEMPTION WORKERS'COMPENSATION DECLARATION _ (This section need not be completed if the permit is for one hundred ($100) or less). / Dishwasher Solar Piping Z O() Dryers '❑Gas DElectric • Sub Panel - I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains .Solar Tank ' Fan - Motors❑0-1 HP ❑1'f.-B ' Workers"Compensation.Laws of California. • - _ _ Date Signature Floor Drains Swimming Pool w/Spa - F.A.U.• 'NOTICE:df,after making this declaration,you-should-become subject to the -' . - - -• - Inc.Solar ❑9-15 HP 016-15+ Workers"Compensation provisions of the Labor Code, you must forthwith ' Floor Sinks Urinal , comply with such provisions or this permit shall be'deemed revoked. ' Fixtures Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets. Water Closet Device Boxes ' I hereby affirm that there is a construction lending agency for the performance 'Pole Light I . of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name - Range , Lender's-Address - - - - - - " - - Kitchen Sink - 'Water Service - .. , - - I - t Switches. - Sign OWNER BUILDER DECLARATION , - - I hereby affirm that I am exempt from the Contractor's LicenserLaw for the l Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or •9 P Standing Sections , county which requires a permit to construct,alter,Improve,demolish or repair P-Trap •structure, prior to its issuance, also requires the applicant for.such permit p Laundry Trays Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt t ' efrom and the basis for the alleged exemption. Any violation of Section , 15 by any applicant for a permit subjects the applicant to a civil - . • city of not more than five hundred dollars ($500). : ,' LII, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (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 Hood or Type I ' ❑ sale. If, however, the building or improvement is sold within one year of corn- - Canopy , Type II 0 Zoning Approved By 'Date pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date ' prove for the purpose of sale). • I: Las owner of the-property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ' �LI�-1 I -Date 7/ %Dhh• tractorsto 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- - - - • tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT •lt ❑ I am exempt under Section - - B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers __SAOISSUANCE $ ��13� f PLUMBING $ SAO Date Owner Heating System& Ducting Registers , PLAN CHECK 25%t $ 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 $ • GRADING $ Information is correct. agree to comply with all city and county ordinances • and state laws+relating to building construction, and hereby authorize repre- - • MICROFILM $ ' sentatives of this ci y to enter upon the above-mentioned property for - • PLAN CHECK 50% $ inspection pAi�I / �) 7 5 p� MECHANICAL $ TOTAL FEE $ O0 Signature I / ie /t Date 6 � � - Reinspection Fee $15 - Issue Fee $ 3 PLAN CHECK 25% $ • Drivers' Lir nse or SS _ - _ CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor s_ -9 CONSTRUCTION AND PLANNING POOL &SPA Date Inspector Date Inspecto3 APPROVALS Permit# APPROVALS Permit# 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 'n 6. Electrical UFER Grnd. 57. APPROVAL TO COVER=GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 6- 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,-Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Tra P Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Firial 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas O Oil 25. Roof Sheathing) 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing, HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing • y.6%y6 Largo • 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ . 91349 FEE RECEIVED .1 COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 1 7 1984 P.O.BOX@IT COSTA MESA,CALIFORNIA r/� TTFIIN��AFFNCrrEnnee��DppEP��T..t�� For Applicant to Fill' In Completely APALICA1 OK1'FOR 'PERMIT I TYPE- OR PRINT BUILDING ADDRESS •all Il flnh`' ve'e 1k- (,d7 For OFEIe Use Only REFor NO, �pq+3T49JyQ� COSTA MESA, CALIFORNIA G 1 /-' �\ RECEIV DBY DAT R747ED MII�HiI88UEI^C4 OWNER �h ROVYI•P , C / /U Jh{1 11 f�j JU l BUILDING ADDRESS tS a2 11-.(`)y C 1�'(1 V'�`S^��I ADDRESS CITY 1 (�I)VYc^\Y. V Q I \'Q1 NO. Cal N39.. • _ •� /� APPROVED ARCHITECT I �\QY- NO.�jQ Sal '/ BY DATE OR ENGINEER I. ., ZONING ` ' ADDRESS Z_ct �\ nen WN No,oP USE ofN PLANE Z/ I BUILDING I/ CONTRACTOR r A• A qC II ` v ���lll///��V/ Ic1 3 I I�QS FIroY eS il LEGAL ADDRE68re 1 1 1 I DESCRIPTION Ile /5/ ,,,a CITY troll V\'c\,t . \)Q\l:. � A.P.NO. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE ^ '' 11 1 TEL. �\ 30"TO SIDE a REAR P.L. EAVES LIC.NO. am 13 1-- NO. 5� I- ) � SIZE t /� `/ ^^ NO OF BLDoe. Y ALLOWED (U,B.C.REQUIREMENT) OF LOT I�JO X I " � I NOWONLOT ,\ YARDS APPROVED YARDS APPROVED USE OF �/ MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. CC�� rX ,�T -1 ' REAR YARD 38' FRON(FROT CS(�FT I FT. SETBACK LINE FROM CENTER OF STREET SIDE YARD LEFT S` I RIGHT S R.SIDE J FT. FT. . DESCRIPTION OF WORK L.SIDE C ((. FT. FT. 4. NEW ` ALTERATION ADDITION REARJ,7�FT. FT. DISTANCE BET. BET.MAIN @ MAIN BLDGS. ACCESS.BLDGS. REPAIR MOVING• DEMOLISH VAR.# DATE BUILDINGIrNO.OF SIZE n ROOMS STORIES C.U.P.# APPROVED EXTERIOR WA ROOF APPROpj • ` COVERING Al L . I COVERING SA\ BY 1 .,r `• USE OF BU LDING A •WORK T• BE PERFORMED r� Ci t,c 1gvA 1 r / J // I HEREBY ACKNOWLEDGE TH I HA READ THIS APPLICATION THE AMOUNT SHOW'UNDER VALUATION IS FOR THE AND STATE TH - ..V IS CORR•CT ANO AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY, O PLY WITH AL CITY OR 88 ANO -TATE LAWS REGULATING (�/Xn._.1 BUILDING co eTRUCTI � VALUATION PERMIT FEE $ %!/I ` v PERMITTER r $/ ) 7 CHECI O l/ LL AUTHORIZED AGENT $ TOTAL FEE p.