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HomeMy WebLinkAbout2960 ROYAL PALM DR - Building Permits ci:1•:/' r ' CITY OF COSTA MESA ' ' " Oe BUILDING DIVISION F • t PER N „ I a. � DEVELOPMENT SERVICES DEPARTMENT NUMBER BER UC PERMIT 05-01127 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesas usILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2960 ROYAL PALM DR Status: ISSUED Suite: Applied: 07/07/2005 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 07/07/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 13920414 Zoning: R1 - I . Applicant: BIZZELL, JIM Address: 2130 NATIONAL AV ISSUED BY: ' _ - - Phone: 714-404=8377 / - COSTA MESA;CA - ) Zip: 92627 - - - _ I Owner CRITES, JAMES D TR - Address /2960 ROYAL PALM DR"-. ' ' - - - - - r - — Phone COSTA MESA,CA - - , Zip: 92626-3813 - - Contractor: OWNER-BUILDER ` Address: j 77/,),7 _Phone: Zip: ' 2-„ ' .'License: .000000 'Arch . - _ - Eng: Address:- ' -'.fit '''`* - - _ Address:. -Phone:" Phone: ` 'Zip: ' " , License: -\ 'License: .- i -,: -- ./ rt. -SCOPE OF PERMIT„ ,- -: : REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING COMP ROOF;REPAIR/REPLACE SHTG AS NEEDED,2 LAYERS 30#FELT, APPLY"40-YEAR COMP SHINGLES."27 SQUARES - - - - - - . FEE SUMMARY _ Plan Check: $0.00 - - — `�- ' /-- - Calc Valuation: $5,800.00 ,. Permit ',\ $125.25 - ' i, /- - Claim Valuation: ,,/,,i'' ' $5,800.00 ' SMIP Res: ,,: $0.58 2//, ' SMIP Corn: $0.00 ' 'Other $0.00 " p Inspection ' $0.00 ii Total: $12583 _ % �.. 7 .v NV -/ v,- PLANNING&ZONING72)..-,' SETBACKS A MAIN STRUCTURE'Front 0-0 ' Rear 00._ 1• _ Left-- 0-0' = - Right .16-61/ ACCESSORY Front''0-0 Rear 0-0 ---- -- Left----0„0 -'. `'' \ Right 0j0"/-' PARKING Existing: 0_...- ' -Required: 0 - i \ ,\ Proposed:_' 0 - 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 fora 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 ,, ° 0fl - WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: 4p��i $ tion need not be completed if the permit is valued at one hundred dollars($100)or less.) 1/4 fir—I certify that in t performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation I of CalifD agree that If I should become subject to the workerscompensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the rovision �9 Ap icdri{s e: L[^ Date: WARNING:FAILURE T S RE WORKER COM ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES Up TO ONE HUNDRED THOUSAND DOLLARE($ ADD).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.N Class• Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders 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(commenting 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).): VI,as owner of the properly,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 Cede:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license • rsuant to the Contractors License Laws.). ❑ I am ex%.t under s n ` � Business and Professions Code for this reason: • t4igDd(tire � !� � E_iqpires: VedficatIon o • nership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this?Application a pemit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes IJrNo (Section 65850.2 of the Califomia 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? 0 Yes 0 No (If'yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South-Coast-Ali-daily Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • r p Sig ure Oj)Lygal Owner(s) Date 41. !q.;•O AvthoncalTAppUcant CD,DD ,F • CODE I I,': II., a . PATE =ALE CODEI INSPECTION TYPE PAM =AU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final �7` 208 Final Plumbing < 200 Final Re-Roof 22--05s!� 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 Slte 204 Final Demolition 250 Final BUIIdInyOccuftency DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER This Permit# TO APPLY FOR PERMITS Street Addresses rl ^'2 (/V/�• -{to / 1I 1°V' I�al m (3r. C M AP Number: 1. I (we), r5 remota_ Il to s , declare that I am the Owner of Title of the above referenced real property, and that I (we)hereby authorize: Name: 7I m /I zzct) Telephone Number: 7(LI Li0q- 8377 Street Address: 913D t\10-4-(Ona ) Roc /(�� 7 City: WSZ� MCSc State: (�� Zip: 0 1 10 L7 to obtain permits in my behalf,as owner/builder,for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa,as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that.TI-Ii-11/4/ ( the foregoing is true and correct. r '" Executed this 7th day of v I-(-1 y 200 , at 6356_ I /1 SC , California. Print Name: 2Zre� -Oa_ antes Signature: ✓A _ t -oi Date: 7/7/D Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 0779-46(rev.11/00) OWNER HOMES VALLEY INC. • DATE 6-16-59 JOB ADDRESS 2960 Royal Palm Dr. BUILDING PERMIT NO. 9622 GENERAL CONTRACTOR Dike & Colegrove VALUE $ 15,571.00 AP. No. LOT 28 TRACT • FIRE ZONE DESCRIPTION OF WORK Res. Watt.gar. INSPECTIONS_7=A—C4 DATE I GROUP I & J TYPE V ZONE "-- Underground Soil ///yc'U.G. Water /y-{5 7 - -S_ PERMITS ISSUED Underground Gas SUBCONTRACTOR DATE NUMBER Overhead Water and Gas ss,, _ q_ r� �i_ Rough Heating /.Lt, �f !Lf i__l"��. _g-S".S 9_-2_a_9 7 Rough Plumbing 2 G/ ,Z-5 L .,":2-2 Sr i .5---2,257._-L17 i_7_. 11 Miscellaneous �� ] n Prop. SwrfLine—Houseiton . St. Swr. Y/i w1ysl r..t,ifi-- tr..l - Y/'f-46)'3 ( 79/ k Sprinkling System _ 1 Heating, Final / - - d Plumbing Fixtures I &L :2.4. le _ ./r Final Gas Test / Ar). /-'S-4 j �1" _ Construction Pole / Underground Power Rough Wiring . . fV� . <:C/ A-4,4/ u u//0,77x, ,I'.--,7,—. 9 t/ -,S9/4/ Trenches TvForms r Steele-4 1* /47.S") Floor Systern Steel Reinforce Chimney Re-Rod Bond Beam Sheathing • /7✓3r4I- "R-(-ry Frame and Flashing f/3'.1}- 1/-1-- 51Y Lathing, In /c Out J' eki-, 9 -2-94, Plaster, brown coat Y /9./OL /0-/ f- Plumbing Fixtures, Final / it. 6601 I _ Electric Fixtures, Final /f�j?L / R'cCJ Building, Final OCCUPANCYI __ I Form 270-3M-4-$9 " 962 , i'f jUN•1i�lea COSTA MESA BUILDING-SAFETY DEPARTMENT lr.r DEPT.r gg P.O.BOX 317 COSTA MESA, CALIFORNIA r i'ltupl UC E)EP I. FOR APPLICANT TO F/LL IN COMPLETELY APPLICATION FOR PERMIT L^TYPE OR PRINT BUILDING ADDRESSBUILDING 2960 Royal Palm Dr. COSTA MESA, CALIFORNIA FOR OFF/CE USE ONLY 4 I RECEIPT NO. I >'62 v OWNER Homes ValleInc. MAIL RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS CoSta S. 17th St. i4 E—/5--55% /4-c2 CITY CoSta Mesa TNo.LI81159 ADDRESS ARCHITECT Carlson& LIC. OR ENGINEER NO. COSTA MESA, CALIFORNIA Middlebrook ADDRESS Garden Grove ZINE FORE CON Dike& •Colegrove, Inc.R L I cSTATE O. 167293 APPROVED DATE ADDRESS 419 E. 17th St. . Costa Mesa ZONING LEGAL LOT qp 3r2 ZONE INO.OF IUSE OF NEW , DESCRIPTION NO. 28 I BLOCK TRACT 2 PLANS BUILDING `- APPROVED • i. / /- A.P.NO, BY J DATE 4//b !,, SIZE 65 X 105 I NO.OF BLOCS. YARDS EVES OF LOT NOW ON LOT none REQUIRED ALLOWED USE OF (CENTER LINE STO CO= EXISTING BLDG. FRONT FT, IN. I SETBACK LINE FROM CENTER OF STREET 501 REAR YARD 361 R.SIDE r'".. FT. IN. SIDE YARD I LEFT 101 I RIGHT 51 L.SIDE 70 FT. IN. DESCRIPTION OF WORK REAR aFT. IN. NEW I XII ALTERATION I ADDITION I / REPAIR I I MOVING DEMOLISH I SIZENOOF BUILDING 1560 NO.OF 7STORIES 1 O0 EXTERIOR WALL ROOF COVERING Stu C CO COVERING Rork USE OF BUILDING AND WORK TO BE PERFORMED Single family recrrienee with attached garage. Kali 120CR I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT ESTAB UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF BTABLI6HING A PERMIT FEE(ONLY, BUILDING CONSTRUCTION. VALUATION .��[) 7C SIGNATURE OF / PERMIT FEE $-Jviov PERMITTEE 1./..4 0 15,571 PLAN CHECK $ .'� are AUTHORIZED AGENT Dike & Colevrove. TnC- TOTAL FEE $ .yy„jj(} 4 OWNER WESTERDARL, Jay DATE 1-31-72 JOB ADDRESS 2960 Royal Palm Drive BUILDING PERMIT NO. 34078 J GENERAL CONTRACTOR Owner-Bldr. DESCRIPTION of WORK Block & Retaining wall APNo139-204-14 LOT TRACT FIRE ZONE VALUE $ 500.00 _ INSPECTIONS Signature Date GROUP J TYPE III ZONE R-1 _ t SOIL PERMITS ISSUED V _ GAS SUBCONTRACTOR Date Number Signature Skt.WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE n HOUSE CON. n SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND n POWER ROUGH WIRING / Heating and Vent. TRENCHES —FORMS [STEEL REINF. c . .y// 1_ FLOOR SYSTEM BOND BEAM n STEEL. REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT n PLASTER, BROWN COAT STRUCTURAL, FINAL Electric _ HEATING, VENT., REFRIG, AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL M I_ C 2/7h '2— — — — — BUILDING, FINAL ,w` . ,. _} J4078 PAID COSTA MESA BUILDING-SAFETY DEPARTMENT :i'`` 3i-7?t++E"01016 a*****5.00 P.O.BOX 1200COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely' • REG"G E�V DATE RECEIVED DATE,ISSUE BUILDING 9 re O ea /rL� z_diPn Yl , /-3/, / J3/p _7 ADDRESS f• / p of P - NO. OWNER ,44f �G.r-/ rfl4/4L MAIL BUILDING L O //�� Q t/ L ADDRESS At ' ,r//�J ADDRESS �' • t f //j4L/ti o� ydO t ernpr d boa aU CITY COS 7 ke.f4 NO L57,414 y6 P�r TRACT���` {�a LO BLOCK ZQ CONSTRUCTION-F- ," • NEW ADD ALTER REPAIR MOVING DFMOI ISH OLENDER /!r O/f/2 am iv J O BRANCH _i rn OWNER?XV. 1ie--t fct LB CO—I ADDRESS VALUE -w ARCHITECT TEL. USE $ - Q OR ENGINEER N O Q FIRE u ADDRESS ZONE TYPE iGROUP� W Z CONTRACTOR 69 4/4/// _ ,C BYPROV ED BY DATE 03 .J m ADDRESS • O W ZOryy� NO.OF USE OF NEW�.e ZI-- CITY - TENO. A /'•' (PLANS a BUILDING/h , 1724 1 wO STATE CITY YARDS APPROVED ' YARDS APPROVED l/isy to CC LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING DO (FROMC/L STREET) - .f SIZE ' NO.OF BLOF LOT 6.0 x ,/,0“5-- NOW ON LOS FRONT FT. 6'6 FT. USE OF . EXISTING BLDG. R.SIDE FT. I— SIZE OF NO.OF p Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT. CC l tEXTERIOR WALL ROOF COVERING COVERING REAR FT. r,. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. - BET,MAIN& d MAIN BLDGS. ACCESS. BLOW.a O t/r/1o/ t-? L %i+/e.4 P FT C.U.P.# APPROVED fn /1/74 - id/7H t - 41. I— APPROVED. / • . `_t p W/ TN at/o a to 54T'✓i dy✓ ~.1 1 I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of IA the State of California. • CO Z I hereby certify.that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions'Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR j ' Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PEHMrV FEE oNLY: • an, exempt from the provisions of the State of California Business ix VALUATION J G't"T co and Professions Code, Division 3,Chapter 9. PERMIT FEE $ �� N .s �' B Signature of %/ ../ et.�o �D D E Permittee V 6C� ✓C $ PLAN CHECK $ F LL b Authorized Agen/ ` TOTAL FEE $ ._ . . i- - . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . -FrreL'It elect COSTA MEA �r5ONSTR C IO�PERMIT PERMIT NO. TRACT NO. • LOT NO. UNIT NO. j.� Project Adar¢55 2.960 ICO/�2C nuke, IJi•- -BFP-"3138 '1-g - S �• - 9603 11 /16/87 . t-. ft Appficant's Maiing Address sonic . TYPE OF CONSTRUCTION ' LJ NEW ❑ ADD LJ ALTERATION LJ REPAIR I A O '1 L / p .0 CONVERSION L7 DEMOLISH LI OTHER A.P.# �'JJ� < /I is�I --ref I Zone R--1 '• Owner's Name OA/so Le (,✓t SG�en/c Phone 66'Z�2fl ,. - Goo" l 2960 Y l/ Pet � C r y))�l g - •DESCRIPTION OF WORK/USE OF BLDG. Re-rnoe PL . IZesr'depict Address fort et en o -; S Main Building: Accessory Building: Arch/Eng. _ License No. • TYPE OF PERMIT ❑ STRUCTURAL E Front • � Z GRADING El FOUNDATION Q ' Address ,�//t1 / ❑ TENANT ® ELECTRICAL 'W PLUMBING LI MECHANICAL B Rear - N Contractor's Name (OW roLeiVeGta de Vt Phone I• ❑ OTHER - - C 1 r ' PROJECT-DESCRIPTION SQ. FT. • OCCUPANCY C Right N Address(mailing) - G - 9, - . , CONSTRUCTION TYPE VALUATION$ S/000 K Left City License No. ' ,,. ._ZONE - GRADING CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION • ",i Ping. R¢f.# Parking Req./Provided hereby affirm that I am licensed under provisions-of Charter 9 (commencing Remarks: 'Planning Notes: 11 4rhfor. a. 4406 Th.S to / M with section 7000) of Division 3'of the Business and Professions Code, and- . - gp�Q,,J,l',,l`M'ye(�/1�T 1� T my license is in full force and effect. - i - •� J��k•V/`�✓✓` Y )1¢✓1.e p/c+�- 'S„i:� License class License No. ^^ - - $ • Date Signature .. • PLUMBING - FEES- � • RKERS'COMPENSATION DECLARATION ELECTRICAL FEES •`-,.� • ' 'j_ Bar Sink Showers . cc w;reby affirm that have a certificate of consent to self-Insure or a certificate - ' 1•41,•'workers' Compensation Insurance, or a certified copy thereof (Section , Preventer Service Sink $800, Lab. C.) Automatic Washer Transformer. 0 15-50 KW Policy No. Company L” ' Backflow Irrigation Sewer Cap � • - Construction Pole Sub. 0 50+ KW • 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. 1 Bathtubs - • Sewer Connection 2... CC Cooking Unit Meter Dup to 100 amps • Date Applicant ,. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - • . Clarifiers Solar Collectors - DishwasherMeter Dover 100 amps • (This section need not be completed if the permit Is for one hundred($100) or less). ,i 1 I Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the w• for whit is ermit is issued,1 shall not employ any person in any ma so a me subject to the, Drinking Fountains Solar Tank. j Fan • Motors 00-1 HP Di'/-8 / OC Workers' Con' e tion Laws of Califor - t Date 7/_1f art-_ Signature / - ` Floor Drains SwimmingPool w/Spa X P F.A.U. Inc-Solar ❑9-15 HP 016-15+ NOTICE:If,after making this declaration,you 5 ouldbecome subject to the -• Workers' Compensation provisions of the Labor Code, you must forthwith Floary Sinks Urinal _ 3 Fixtures Microwave .. 6e,' comply with such_provisions or this permit shall be deemed revoked. - - • CONSTRUCTION LENDING AG ENCV Gas Service Outlets% � Water Closet Z Q(.• -S Devic¢Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance • -' - l:Z� of the work for which this permit is issued (Section 3097' Civ. C.) ', ' - r� Lender's Name a Inteiceptors .� • Water Heater -S Outlet{: Range / D0 Lend'er's Address Kitchen Sink Water Service .. Switches Sign �1"� ' OWNER BUILDER DECLARATION _ 'i` I hereby affirm thai'I am exempt from the Contractor's License'Law for the Lavatories y„ - Auto-Wash Garbage Disposal a Standing Sections ' following reason (Section 7031.5 Business and Professional Code:;Any city or - - �� • county which requires a-permit to construct,alter,improve,demolish or repair . P-Ti-ap, Laundry Trays Generator ❑0-5 KW D5-15 KW Trash Compactor • any structure; pdorto.its issuance, also requires the applicant for such permit - - - _ j to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - - ',*;'ie Contractor's License Law(Chapter 9(commencing with Section 7000)of - ;,;.ision 3 of the Business and Professions Code) or that he/she is exempt - `i'refrom and the basis for the alleged exemption. Any violation of Section . 031.5 by any applicant for a' permit subjects the applicant to a civil - �oenalty of not more than five hundred dollars($500). `J[1 I, as owner of the proper/3r or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 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 DEVELOPMENT SERVICES E UIREMMEEN S thereon, s, who does t su work himself/herself arel f of through his or her own I ❑ �] - / `!..!{��- employees, provided that such improvements are not Intended or offered for Boiler Hood or TypeZoning Approved By '/r,(-r p"w')// Date v sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 - _. 5 � pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By i'�- l� Date lL/6"O ' rove for the purpose of sale). /�(L Y . - I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date tr c/ors 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 - • SUMMARYOFFEES builds or improves thereon, and who contracts for such projects with a con- SQ J O SMTP $ 0 5 tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System D -Multiple D System Repair/Alteration BUILDING PERMIT $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ 3Z3 PERMIT 0 I am exempt under Section . & P.C.for this reason Firepl/Fact.Blt. (CBO# • Fire Dampers PLUMBING $ i/ ISSUANCE $ Date //-/6ff Owner Heating System& Ducting Registers • PLAN CHECK 25% $ Z • tJ l7 ENERGY P.C. $ I hereby certify that I have read this application and state that the above - D0-100,000 BTU 0100,000 BTU - 7^ 00 GRADING $ information is correct I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relati to building construction, and hereby authorize repre- PLAN CHECK 50% $ 2' .f0 C7 MICROFILM $ sentatives of this it to en._ up the above-mentioned property for ' ' inspection purpose Signature .,.r. Date 7/-f C-of' — - MECHANICAL $ TOTAL FEE $ 105 • g Drivers' License or SS/fr #40 Fee $15 Issue Fee - .$ 3 PLAN CHECK 25% $" ,CMF 0865-46,rev. 10/84 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor 1 . 'CONSTRUCTIONAND/PLANNING 1 . ' ' z POOL & SPA APPROVALS Permit .# Date Inspector _APPROVALS Permit#1/ • Date Inspecto 1:Temporary Electrical Service or Pole 52. Pool & Equipment Location .. r l ' 2. Soil Pipe-Undrgrnd. - • 12.-3'137 CEO : 53. Steel Reinforcement ' . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . r 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' . •r 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test f 6. Electrical UFER Grnd'. 57. APPROVAL TO COVER-GUNITE , • 7. Footings ' ' 58. Electrical Conduit-Undrgrnd. 8. Foundation, - 59. Gas Pipe, 0 Undrgrnd:,Test 9. Water Pipe-Undrgrnd. •. 60. Backwash Lines,P-Trap,0 Undrgrnd. ' 10. Structural Floor System . . 61. APPROVAL TO DECK I 11. Property Sewer Line & House Connection j2_3-a'7 Led62. Backwash & Receptor-Final , 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains • • - 64. Plumbing System - Final . • 14. Rough Plumbing -• 12.3-87 Lo) 65. Electrical-Final - ' 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring (€1,043- 4::::a1.767-. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING , 18. Rough Electrical-T-Bar Ceiling i 1 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 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 //.SS? , 78. 'FIRE PREY. FINAL 30. Drywall Nailing `/// s//,��! All HEALTH DEPT. REQUIREMENT 1 „ 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ,, - 8f1. FOOD CERTIFICATE ISSUED n ' 33. Final Electric t ., /3219 /' // dotes: rle 'Amtx cAc ; J v{ d liN�� S 34..Final Heating & Air Conditioning • jzr / i i01,1 M1A>`l sr e �)or ` . Gtnno.-1.4... 35. Final Gas Pipe-Test ? 0 JJ s� (Z_ _R e n..• � , 36; Hood- or Canopy - .y�f J� 37.. Final Factory Fireplace . 38. Final Plumbing . - 8 � dl LED :� pct `� �.v �.� vs .\q1 al 39. Water Service-Final - - 40. Gas Service-Final • v -, , ,41. Solar Domestic-Final Jc.�Oi� i5trf . f//vh / • •42. Backflow Preventer - /- J • • 43. Backflow Irrigation 1• _ , - 44. LandsEape Irrigation System 45-Sound. Attenuation " - 46. Handicap Regulations N '� 47. F.INALSTRUCTURE & BUILDING Cf ��./ - 48. Special Requirements Completed ( / . - 49. ElectricReleaseto Edison - - 50. Gas Release to Southern California Gas Co • - / 51. CERTIFICATE OF OCCUPANCY, . / No. Date ., . . -- - _- - - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCT' I '• 'ERMIT PER IT NO. TRACT,NO. 'LOT,NO. UNIT No. •1 Project AddressC--•=0 �Y�i--• d.�_� 314 - 2%st'2 ?'45 ' - I 43956 1+2/07/67 f 31ofl5TL Applicant's Mailing Addres�i Li-s:�;.- ca •�',-7�YPE OF CONSTRUCTION NEW' Cr ADD ❑4ALTERATION ❑ REPAI R `❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ - _ `� ' .rte le-Phone 1/• .. - ../.d !. A.P.# I. .2 LQ.�' -.'�c�. _ Owner's Name , • D��fSSS���FRRiIPTI F eR /US F BLDG - Address Z��' x �C-�'b..t �'� '�j7f � '\kT Bi v S Main Building: Accessory Building: Arch/Eng. License No. ' TYPE F PERMIT GRADING' FOUNDATION ❑ STRUCTURAL T Front • • ( t O Address sN,1� ❑ TENANT '❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N �c F4 --' 1Z :❑ OTHER_ s A •Rear • Contractor's slialLtS 1 _ . _ - ' _�1/ .. _ _ Address(mailing)7 r ,��� G. PROJECT DESCRIPTION: 'SG. FT. OCC UPAyCV t-�7/1"l�_ K Right G ( CON STRVCTION TYPE ✓ VALUATION$ �o�•O. Op $ Left ' - 1 City License No. 'ZONE ' (GRADING CU.VD5.- ACRES - , - R LICENSED CONTRACTOR • -CLARATIO �s Q , - Ping. Ref.# • 'Parking-Req./Provided E , l hereby affirm that lam lic•nsetl under,pro is'•ns of Carter 9 (commencing Remarks: 3'2 LE • 5TO•• �of_,�„y/'a v ' • ' , Planning Notes: j L, 1 M with section 7000) of Divi ,on 3 of the B s' ess and 6•rofIessions Code, and �. my license is io full ford a j�.-ct: B. 1 %da, '. - - -- ' • T n jo License C as ' LI S Date I. !� Signaturr—i,/_��r [�i_ 1PLUMBING •: ' 1 FEES ' . l , • ' ')RKE-S'OOMPENSATION DECLAR• ION Bar Sink Showers , - 1 - ELECTRICAL. FEES " veby affirm that I have a certificate of conse o 5-f-insure or a certificate -- .. , - • Workers' Compensation Insu . ce, . a ',riffled copy thereof (Section - - , • oaoo, Lab. C.7.-.4-1'11 . - - 1 ^ Backflow Preventer - 'Service Sink • - , Automatic Washer • 'Transformer LI 15-50 KW • ' en, �pt.I I,� •tN NJ t \ . Policy No. Com••ny Backflow Irrigations Sewer Ca 0'50+KW • ❑ Certifi c Py is hereby i urnished. � , - n Construction Pole Sub - _ - • Cerufi tl c filed with the city Bui/!•� / Bathtubs e - • 'Sewer Connection Cooking Unit • Meter 0-up to,100,amps Date • • ••hcant /• - ' • EXEMPT ON ROM WORKER OMP I NSATION DECLARATION Clarifiers •k ; Solar Collectors • ' - Dishwasher' ' 5 Meter ❑over�100 amps (This section need not be completed.if th- permit is for one hundred ($100) or _ - - less). Dishwasher - - Solar Piping -. I certifythat in the - Dryers ❑Gas- ❑Electric' Sub Panel • • performance of the Work for which this permit is Issuetl • , shall not employ any person in any manner•so as to become subject to the Drinking Fountains Solar Tank Fan Workers' Compensation Laws of California. - - . '- • - -,Motors❑0.1_HP ❑1 h-B. •; . , Date ' Signature Floor Drains - • Swimming Pool w/Spa ' F.A.U. - Inc.Solar 09-15 HP ❑16-15+ NOTICE: If;after making•this declaration,-you-should become subject to-the- - - . . . --- - Workers' Compensation provisions of the Labor Code; you must forthwith Floor Sinks ' comply with such provisions or 'this permit shall be deemed revoked. 'Urinal Fixtures .Microwave CONSTRUCTION L'ENOING AGENCY 1 Gas Service Outlets Water Closet Device Boxes ' Pole Light - •i - I hereby affirm that there,isa construction lending agency for'the performance g of the work for ,which ,this permit :is Issued (Section' 3097 Civ. C.) Interceptors ,Water Heater ' - ' Lender's Name `ffi p I Outlets - Ranga -Lender's Address - ' --- -- - - - - •- -- Kitchen Sink - ' - - Wate• r Service - -- •-- ) - Switches ' - r Sign - - ' -' OWNER BUILDER DECLARATION . _ I hereby affirm that.l'am exempt from the Contractor's License Law for the - Lavatories .Auto-Wash Garbage Disposal Standing i ' following reason (Section'7031.5 Business and Professional Code: Any city or -Section's , county which requires:a.permit to construct,alter,Improve,demolish or repair 'P-Trap Laundry Trays • Generator 0.5 KW❑5-15 KW ' any structure, -stateto its h uance,he is requires the applicant for such permit ❑ s Trash Compactor i ` to file a Contractor's -statement that he/she is licensed pursuant to the provisions of ROOF Drains :,:e Contractor's License Law(Chapter g with Section 7000) of _ _• _ _ _ _ '!]iision 3 of the Business and'Professions Code) or that he/she is exempt- i , - - - - - ' io31:5om and the basis for the alleged exemption. Any violation of Section - • . ' . • • • �''A.enal5 .by any applicant for a permit subjects the,applicant to a civil ' • -i r penalty of not more than five hundred dollars,($500). . II r ' i , I, as owner, of the'property or my employees with wages as their sole Reinspection Fee 1 I' $15 Issue Fee ' 3 i - I ' • compensation, will do the work,and the structure is not intended or offered ffffff - Reinspection Fee $15' Issue Fee , $ 3 ;for sal& (Section 7044, Business and Professional Code; The Contractor's MECHANICAL : 'FEES - MS . 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 1 DEVELOPMENT SERVICES REQU � I i• - employees, provided that-such improvements are not intended or offered for Boiler Hood or Type I 0 - - ( e/r� (2.- 7TQ'� sale. If, however, the building or improvement Is sold within-one year of cam- Canopy Type II ❑ Zoning Approved By, Date I I 1 U� •pletion,-the owner will'have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By /J / Date •grove tar the purpose of sale). 1 r[,,('J n U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System ' - Application Issued By - - ' T Date 1.----.-7--s7 'tractors to construct the project (Seat 'appl,Business and Professions Code: - - • The Contractor's:License Law does n• apply to an owner of.property who Duct-Ventilating ' ' ❑0-100 000 BTU,❑100,000 BTU • SUMMARY OF FEES , builds or Improves thereon,and . • con -.cts for such projects-with a con- - i - ___A tractor(s) license pursuant to t•n Contracto 's License Law). I am aware-that . BUILDING PERMIT $ 'D0 'SMTP • - $ -• J 'i Exhaust System ❑' Multiple 0 System Repair/Alteration _ • . proof of t•-' ',or,- Co sensation ins Hance should be.provided to me. - _ PLAN CHECK $ ° -PERMIT ' o I .. exempt under Sec B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE' $ - ••te •- - ' ' - Heating System& Ducting ' Registers PLAN'CHECK •25% $` 'ENERGY P,C. $ _ hereby certify that h.ve is a•plicat 1n and-state that the a•ove - 00-100,000 BTU C1100,000 1311...— • - GRADING $ _ information is correct I agreeith a city and county ordin.nces - ELECTRICAL $ ' and state laws relati f to but •'O�Cu Cr 'on, ;-d ereby authorize• -pre- - - 7. MICROFILM $ sentatives of:this to F a•-- - '- oned p open - PLAN CHECK 50%_ $ '_ spection purposes �,r�� 1 ��/ ' - • MECHANICAL $ • -' TOTAL FEE $ _31. g 'Sl• lire �i�_ —.a. Date 7/ / _ - Drivers''License /SS ="� -Accounting; Goldenrod - Assessor ' / _ CONSTRUCTION AND PLA NNING 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 f 5. Steel Reinforcement , / 2,y/7 6-'4A 56. Rough Plumbing & Pressure'Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings J2-/9, 7. 44/ 58. Electrical Conduit-Undrgrnd. . 8. Foundation' • /-2:4tl G�, 59. Gas Pipe,-0 Undrgrnd., Test; 9. Water Pipe-Undigrnd. . . ssss - 60.-Backwash Lines, P:Trap,,0 Undrgrnd. 4 10. Structural Floor System ' 61. APPROVAL TO DECK i. '- 11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final - ._ . 12. Sewer Cap , 63. Heater & Vent-Final 13. Roof Drains T _ 64. Plumbing System - Final 14. Rough Plumbing -• 65. Electrical-Final . .j 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# l. - 211 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 - 74. Overhead Hydro ; 26. T-Bar Ceiling (Structural)-& Monocoat - 75. Dry Chemical ' b.. 27. Frame and Flashing - - - 76. Dry Standpipe ` - 28. Lathing & Siding 77. FIXED SYSTEM FINAL , 29. Insulation • 78. FIREPREV.: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: f;7_,14L4 i 0)}4 "1-' (',•,g_0O1('.-I./- • 34. Final Heating & Air Conditioning 35i Final Gas Pipe-Test . • 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing • • - 39. Water Service-Final r r • _ - - ` ' 40. Gas Service-Final . - - 41. Solar Domestic-Final _ - - 42: Backflow Preventer '-. t' , / ' . 43. Backflow Irrigation + - re- . " `44. Landscape Irrigation System • -'E - ; 45. Sound Attenuation 46. Handicap Regulations _ - - - l i • 47: FINAL STRUCTURE&-BUILDING S�� l .48. Special Requirements Completed • 1 49. Electric Release to Edison - '•- . ; '50. Gas Release to Southern California Gas Co • _ 51. CERTIFICATE OE OCCUPANCY _ - '; - No. • ' Date - .