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HomeMy WebLinkAbout2162 RURAL LN - Building Permits R ` 111/ 410 CITY OF COSTA MESA 4. BUILDING DIVISION P RMIT NUMBER F DEVELOPMENT SERVICES DEPARTMENT k4%b•ProinTnio e...s*` PERMIT P99-00620 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2162 RURAL LN Status: ISSUED Suite No Applied: 10/27/1999 Issued: 10/27/1999 Vicinity: Parcel Nunmber: 42612201 ISSUED BY: Applicant: NOCK,RON Address: 11612 KNOTT ST CA Phone: (714) 895-1246 GARDEN GROVE Zip: 92841 • Owner: RAUTUS, STEVEN C Address 2162 RURAL LN Phone: COSTA MESA,CA Zip: 92627 Contractor NOCK PLUMBING Address: 11612 KNOTT ST CA Phone: (714) 895-1246 GARDEN GROVE Zip: 92841 License: 707775 Arch l Eng: Address: Phone: Zip: License: SCOPE OF PERMIT WATER HEATER. FEE SUMMARY AMT QTY AMT 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 Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $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 $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 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 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 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: $35.80 COMMENTS/SPECIAL CONDITIONS IN/IL Se ()Nitta 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 DECLARATIONS 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 � �ork for which this permit is issued. ,1� 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 andmeN��I T policy number are: Carrier: t-DeI �'7r E� Policy Number: r (This section need not be completed It the permit is valued at one hundred dollars($100)or less.) - ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi ions. Applicant Signature: - Date: WARNING:FAILURE TO SECURE ORKER MPENSATIONrUNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOI t ARE($100000),IN ADDITION TO THE COST OF COMPENSATION,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 licensed under provisions ofpier 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.k 77/7 77 7" Class N /L 3r-, Contractors Signature: �'}1 Date: /0 —24- S S 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.). ❑ 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 drivers 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: ❑ 1 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 B,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 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? 0 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 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 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 apemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LI No (Section 65850.2 of 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 ❑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 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.alcsta`te 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. Signature Of Le• i`_or(s) -5 at• 9 •nd/Or Authorized Applicant Date CODE t INSPECTION TYPEAyA INTRIAL$ CODEINSPECTION TYPF DATE INTIRALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing S'/V-' 07 by ly)(a) 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 2446-46 • Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. CITY OF C9S^T�A�MESA CONSTRU ON-1PERMIT - • PEL1rRRMIT NO. l/n TRACT NO. , LOT NO. - UNIT NO. T 71 50 r�;`�67�J ILqu j_ Project Address iSliL/�L Pt/Jeer— I 14 `� • t Applicant's Mailing Addre55i TYPE OF CONSTRUCTION U U NEW ADO LJ ALTERATION ❑ REPAIR ,y,� yCI CONVERSION CI DEMOLISH ❑ OTHER A,P•# _ - Zone Owner's Name }'tet/s+ T�S Phone DESCRIPTION OF WORK/USE OF BLDG. • Address - •- Sain Building: Accessory Building: , Arch/Eng. - - License No. TYPE OF PERMIT L • I GRADING ❑'FOUNDATION ❑ STRUCTURAL' E Front • ' . p Address � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - N Contractor's Namenen te6/H/N6"�___phone 65/C-1-‘64. ❑ 'OTHER - C Right _ - N Atldress(mailing) 7-1Cc• /j&'4tc_ p[?C�, PROJECT DESCRIPTION SQ. FT.' OCCUPANCY K - G ii CONSTRUCTION TYPE VALUATION$ S Left City'License No. _ - ._._-)eel ZONE GRADING CU. ACRES - R LICENSED CONTRACTOR DECLARATION / Ping, Ref.# Parking Req./Provided 1 - E Thereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: t 7 I-7 q 3s Planning Notes: - 0 with section 7000) of Division 3 of the Business and Professions Code, and / , fllV`\,/'•1 my license is in full f rp c@@'1�ryY�1an9 direct. �t�� T LIC¢n5¢C d55f V I � �i e I SJ 7 I S Date �b Signature /�+✓"'� PLUMBING FEES 1 WORKERS'COMPENSATION DECLARATION , / ,800, Lab. C.) ' hereby'af firm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers 2 co ELECTRICAL FEES t Workers' Compensation Insurance, or a certified copy thereof (Section — _, -_ Backflow Preventer Service Sink - Automatic Washer 'Transformer 0-15-50 KW ' „(�.� ,Ks- Policy No. (p1 Sel Company 5 lu'f�v ' - Backflow Irrigation Sewer Cap B Certified copy is hereby furnished. Construction Pole Sub. 0 50+ KW 1 • CertiL ed copy is flied with the city Building Diyipion. ,n (���-vl Bathtubs Sewer Connection Cooking Unit ” Meter ❑up to 100 amps 1 Date 'L Co Applicant -klir11+sL-' ' Cert- .. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter ❑Over 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher ' Solar Piping Dryers ❑Gas EElectric 'Sub Panel I certify that in the performance of the work for which this permit is issued I shall not em ploy,any person in any manner so as to become subject to't fie Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'h-6 Workers' Compensation Laws of California. Date Signature ' Floor Drains Swimming Pool w/Spa F,A,U. olar ❑9.15 HP ❑16-15+ NOTICE:It,after making this declaration, you should become subject to the - Inc.. Workers' Compensation provisions of the Labor Code, you must forthwith Flbor Sinks Urinal - • Fixtures - I comply with such' provisions or this permit shall be deemed 'revoked. 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 of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Interceptors - / Water Heater • 2pa Outlets Range - Lender's Address ' -- .. Kitchen Sink / Water Service 2.. (Y1 Switches _ Sign OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the / Lavatories / Auto-Wash Ad7` 4 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 repair P-Trap Laundry TraysGenerator ❑0-5 KW❑5-15 KW - any structure, prior to its issuance, also requires the applicant for such permit '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 - • - Oivision 3 of the Business and Professions Code) or that he/she is exempt ' ierefrom and the basis for the alleged exemption. Any violation of Section 331.5 by any applicant for a permit subjects the applicant to a civil - - 7,_enalty of not more than five hundred dollars($500). - 3 ' Ll I,'as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee - $ 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 - I 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 com- Canopy Type II ❑ 1-' Zoning Approved By Date pletlon, 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). U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By Date 2-(0 • 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- tractors) license pursuan(to the Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT ❑ I am exempt under Section B.8. P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLUMBING $ ('5- Co ISSUANCE • $ • Date • Owner . Heating System& Ducting Registers PLAN CHECK 25% $ _ q, 00 ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0.100,000 BTU ❑100,000 BTI - -- - - ELECTRICAL $ GRADING $ information Is correct. I agree to comply with all City and county Ordinances • and state laws relating to building constru tion, and hereby authorize repre- sentatives PLAN CHECK 50% $ MICROFILM $ inspection ives of this ity to ter -•on e above-mentioned property for inspection urp r 4--( ��� TOTAL FEE $ Signature Date MECHANICAL $ - �•�� XDrivers' License or SS# Canary -Applicant; Pink -Accounting; Goldenrod - Assessor IA • CONSTRUCTION AND PLANNING POC SPA APPROVALS Permit# Date' Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.. )1/24--cr. �i_�[" 53. Steel Reinforcement 3S Electrical Conduit Utility-Undrgrnd, 54. Forms 4.\YElectrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test F!. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE -7. Footings 58. Electrical Conduit-Undrgrnd. . Foundation 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 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 ❑Oil 23. Gas Pipe-Rough & Test � 72: Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank OGas ❑Oil • 25. Roof Sheathing 74. Overhead Hydro . 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical -ti 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: v.K -TD AA,fit. Sce/,5 L/s,r 34. Final Heating & Air Conditioning Cczmc rV V/378.5- 35. Final Gas Pipe-Test T 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing gel (-Cp 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backf low 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 _ive Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. I037 21J4/8:l !, e-' - 1 . COSTA MESA CONSTRUCTION PEA.M11- P/E,RMIT.N-1O/.' TRAT,NO. LOT O UNIT NO. Address .2.1141 flu RAL 1-N, el V I"T3� I !�/ I . • ._ ../ •7 'tI TYPE OF CONSTRUCTION U NEW ADD L ERATION U REPAIR icant's Mailing Addresrs• - G]S/!I Ru RAC r(.. • `TIT - I' ST VF �A S Phone - ❑ CONVERSION ❑ DEMOLISH OTHER -4---irk T ATION :1J /1�1 SOI . wner's Name 'G/J u �Jr 2.9�� erA/ l? G-•A R{A i.t A.P.sW 2...7-6," t �(r _ I Zone 1Z-1 DES R PT ONO WORK/USE • BLDG. Address X1(02 u?A e• 1-N• - ' 4, r_/I S Main,3uildingfl fl 1s ' I Accessory Building: r AITVT� Z Arch/Eng. License No. TYPE OF PERMIT U G•-•DIN t� OUNDAT ON i4 STRUCTURAL T Front 1 TT - + — ra 1.4,--1D, "s's t-• D `a Address `�!!/ p�J- El TENANT ELECTRICAL •LUMBING MECHANICAL B Rear 1/s--tom {� N •I Contractor's Name OM AS int it shone&La,23n ❑ OTHER A `v '` r�Le���� •I \rr((� Address(mailing/ N 2- - ii ./ 0 m PROJECT DESCRIPTION SQ.'FT- -113 OCCUPANCY C Right 4)(0-P �z Lz _ G Pte% -- 9 . , CONSTRUCTION TYPE V -�' VALUATION$ 3-I U $ Left 5I t•-. • R 111 City License No. �(J a ZONE GRADIING CU.YDS. • - ACRES o4 1 LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking',Req./Provided - E I I hereby affirm that I am licensed under provisions of Charter 9 (commencing -emarks: f� q�-53'3 Planning Notes: n ,.r,, .0 m.J a oi (_' with section 7000) of Division 3 of the Business and Professions Code, and 8✓V 1 01S,LI.JL appl•✓•lttitwl l:t✓•t[A ,,,di / v my license Is in full orce and effect. _ T Licens-.C ass .t ' - License No / Sy' • '/ ��� ��J O..,,LR FOR SPF('1a1 RFO111�Fp7FNTS. ''-...0 (/t2.d •.t ` Date."' '. 1 Signatu ._S .- .. - �; -q - • - PLUMBING FEES . LDe(AL1(a.W 3' PUE ,Tama) J,r-f WS Qt.(/laJ.•PEr))/4, WORKERS'COMPENSATION DECLARATION xB� ar Sink Showers L "EE ',hereby affirm that I have a certificate of consent to self-insure ora certificate ! y -fi '- OC) • ELECTRICAL FE S I f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink .800, Lab.�CJ,•� ,q S' �+/J la 1� !"N� - - • Automatic Washer Transformer 0,15-50 KW Policy No. o ! 7 e 7 Company a7r r r _ Backflow Irrigation Sewer Ca - 0 50+ KW' iii Certified copy is hereby furnished. - p - • t DOn$trdCtlOp Pole Sub. , Certified copy is filed with the city B '.•1„4 Division. • . 4 Bathtubs Sewer Connection • 2(DO ' Cooking Unit ' Meter yup to 100 amps 6Date Applican —- . .i4.• - C—..............._ EXEMPTION FROM WORKERS'COMPENSATION DEC LAR• ION Clarifiers Solar Collectors, Dishwasher Meter Dover 100 amps • (This section need not be completed if the permit Is for one hundred ($100)or Dishwasher ' less). Solar Piping I Dryers�Gas ❑Electric Sub Panel t I /n` t3 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 / Workers' Compensation Laws of California. Motors❑0=1 HP ❑1R-8 r t. Date ' Signature - - Floor Drains Swimming Pool w/Spa F.A.U. . 'NOTICE: If,after making this declaration, you should become subject to the - Inc.Solar ❑9-15 HP 016-15+ I Workers' Compensation provisions of the Labor Code, you must forthwith Floor SinksUrinal . comply with such provisions or this permit shall' be deemed revoked. - - Fixtures ' Microwave - - - - - • CONSTRUCTION LENDING AGENCY - Gas ServiceOutlets Water Closet CO�� Device I 1 hereby affirm that there is a construction lending agency for the performance 2 w` - Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors • • Water Heater pp���� Lender's Name - -ee'� �5”Outlets • Range 3 Lender's Address _ ' Kitchen Sink _ • `' Water Service cC Switches - OWNER BUILDER DECLARATION ' • Z _ .. Sign 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 Businessand Professional Code: Any city county which requires a permit to construct,alter,improve,demolish or repair P-Trap - Laundry Trays ' any structure, prior to its Issuance, also requires the applicant for such permit • - • • - Generator ❑0-5 KW❑5-15 KW ash 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 - • ` serefrom and the basis for the alleged exemption. Any violation of Section ' 1 031.5 by any applicant for •a permit subjects the applicant to a civil ienalty of not more than five hundred dollars($500). ' •• _ - Q ❑ I, as owner of the property or my employees with-wages as their sole Reinspection Fee I $15 Issue Fee $ 3 •' •' / fc - compensation will do the work, and the structure is not intended or offered Reinspection Fee $15 Issue Fee' - $ 3 for sale (Section 1044, Business and Professional Code: The Contractor's ' - MECHANICAL FEES - Si 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 Boiler Hood or TypeDEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for I 0 ��ii,, sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ Zoning Approved By - idlt.10 )N - Date • plelion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground 1 V. r�/•''J��\ �� prove for the purpose of-sale). Building Approved By M titi^-+��_ Date A lr'- , 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural I Refrigeration System Application Issued By Crylia) ' 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 ❑o-100,000 BTU ❑100,000 BTU S RNA V QFF FEES ^ builds or Improves thereon, and who contracts for such projects with a con- - .. b 9 ttactor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT _ $ r rr''•� SMIP $ 2v 5proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ I u-14 PERMIT ' 0 I am exempt under Section B.8 P. C.for this reason Firepl/Fact.Bl t. ICBO# Fire Dampers PLUM•BING $ t Soo ISSUANCE $ Date Owner . i. System& Ducting Registers PLAN CHECK 25% ,$ 3.00 .ENERGY P.C. .$ I hereby.certify that I,have•read this application and state that the above 1 WO-100,000 BTU 0100,000 BTL - �-�L ELECTRICAL $ I2- • 4'Q GRADING, $ information is correct. I agree to comply with all-city and unty ordinances _ _ LL - and state laws relatip to building constr ction, and her authorize repre- PLAN CHECK 50% $ 1 MICROFILM $ sentat ives of chi$ c to enter up n he above-men ed property forJ / inspection pgye5 l��/-D� $ -7•00 'TOTAL FEE $ `7 °. Li/ Signature Da /f MECHANICAL - CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor - - - - TION AND PLANNING - POO- .4 SPA • PRO VALS Permit# - t. Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole ,. 52. Pool & Equipment Location . 2.' Soil Pipe-Undrgrnd. V1 Weer i >� 53. Steel Reinforcement f • ;3.-Elecfrical Conduit Utility-Undrgrnd. . 54. Forms ' jai°lec Tical Conduit-UnilPgrnd. ` !, 55. Electrical Bonding . Steel Reinforcement -. 56. Rough Plumbing & Pressure Test . - 6:: Electricl UFER Grid. - 57. APPROVAL TO COVER-GUNITE ' 7•1 Footings ' : • 2/6/yf for 58. Electrical Conduit-Undrgrnd. B! Foundation .. . -• \ r 59. Gas Pipe, 0 Undrgrnd.,Test , ' 9_ Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. - 10. Structural Floor System . , - 61. APPROVAL TO DECK • .11. Property Sewer Line.& House Connection , • f. 62. Backwash & Receptor-Final 12. 'Sewer Cap r - 63. Heater & Vent-Final 13. Roof'Drains - `" ' 64. Plumbing System.- 14. Rough Plumbing ' 3l7/013' £40 65. Electrical-Final 15. Rough Electrical-Conduit • : 66. Solar System-Final . 16. Rough Electric Wiring I?/� it. 67. Fencing & Access Approval ' 17. Rough Wiring Sign t (p 1�/ ' 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;liough & Test - • '72. Underground Flush 24: Roof Framing 73. Undergrnd.Storage Tank b Gas 0 Oil 25."Roof Sheathing s/bk,r Ds . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashingv-4Q ']L/S5. •b5 76. Dry Standpipe 28. Lathing & Siding Ata 34/1C1C 77. FIXED SYSTEM FINAL 29. Insulation Ala 3A is iy/er � 78. FIRE PREV. FINAL . 30. Drywall Nailing .ir /,q�g . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat( ' �a ,5 ,Y 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 7.12131s5 (IC 80. ,FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 3/7/yr e.Ea ,'-HOLD FOR SPECIAL REQUIREMENTS 35. Final Gas Pipe-Test t t ',&a) $2. Kt-4,t.�..-a7-Ia. S bo frets 36. Hood or Canopy ,Y lox:.,<-,-.4..7)- n aha etryJeAo 37. Final Factory Fireplace 1• /' 38. Final Plumbing - _/.7,1/41.- C.C.c/ ,.s is%C t ,a, -.A-4-e 39. Water Service-Final • ,i 40. Gas'Service-Final ' 5A 44-7N ev,E' te744 coe2BE71d flleri ''e 41. Solar Domestic-Final oar co /3. - /.ciSCi• -7iaaq D, 2.40, • 42. Backflow Preventer [AC/LYl.Y6 rH2CCjN,i'9 Ld//g4Jk(S 5imt/-Par) l//f.�1 43. Backflow-Irrigatiori y,/Tj 'Tua K/ ,L/ 44. .Landscape.lrrigation System - yiirf Died /, _ „ _.,r.tle� 45. Sound Attenuation i "f' - 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 I ' 1 COUNTY OF ORANGE / , `) CrO 7 • BUILDING DEPT. - • , - - - Permit No !/.J 636 No. Broadway Application for Building Permit Santa Ana, California Phone: KI 2-6211AND FOR A Certificate of Use and Occupancy Ir.( I,I� Dare - D Cs, `::1a r. I .) I. OWNER'S NAME ._. .-;� ii.T,t', PHONE- -_ MAILING ADDRESS -1.2.,E.:` i - CITY-.:%C''^.._" .__fir's.-___ Name ...- T-'c) .. , !_�-. sZ„sa_�r7 • Name---- b:n_.'<'.i_5A l•-nrP, (Architect or Engmrei e) ( ontractor) Address tz>9Bi ...'te.y^__....---------�I.-:..._.1 Address...r : ---4£"�•.-:.a-.....r..nt ..} . 1, City _.;Ts \ City. .22:._ _ r.../_ 1'4- , State ' f ).` '. • State ' Lic. No. Phone 1 i • 1 1\ Lic' No. Phone.-:._2.2.s._ .:_u_Fa I, /pis PROPOSED USE: e r�4q-_.= ^� 114.4 r ,• 1 (House No.) (Name of > ,I 2. JOB LOCATION a ) C. _----- _W_t:9-Q : __lam / Street) \.`, A1(`\ (Town or School District) 3. LEGAL DESCRIPTION: Lot l I Bl`�ck Iti Tract iP (Metes and Bounds Description—Use reserse side of form) \t . 11,�\� ,,... • 4. CORNER LOT ( ✓) INTERIOR LOT (''i'\\ ) THROUGHI,LOT\( ) SLOPE OF LOT ( on) 6 R . ilo)S3 �i\ `�3° C myr 5. SIZE OF BLDG.:$..2_X_(_2_-_-_AREA- Q , 3 Sb'. _____.SIZE OF LOT:C;,s____...._-X B7 —AREA: '-- Bneh '17PI;, 6. HEIGHT OF BLDG itis CEILING HEIGHT ?a rlc , __.__ NO. OF STORIES A 7. NO. FAMILIES _ / Size, of Smallest Bedroom' . *I.!: ,O \ Size of Kitchen- 9 Q ) 8. EXTERIOR WALL CONSTRUCTION- 42:,-,-,;-',.-.). INFERIOR WALL. COVERING .__,:7r-all (Frame, Stucco, Etc.) 1• - .1 (Plaster-Drywall, Etc.) 9- SETBACKS: Front Yard from Center Linc of Street Zt Ica � '• Nearest Side Yard Qf Rear Yard Distance in Feet Bet,een Bldgs. on Same Lot .. . ._.. IU. A COMPLETE PLOT PLAN IS REQUIRED,. SHOWING ALL\STRU. ORES ,AND USE OF EACH. 11. For (a) Footing: Width ` a' Depth in Ground _.__I a _..___.._Width of Wall G Accessory >., ..et / Bldgs. and (b) Size of Studs: ___.___l:.r�; Spacing I,:, "CC Material of Floor _t�V.o -p-c, __ .._._ Similar - ( Structures: i , I` , s�CC (c) Size of Floor Joists: ._..�:g1 I11 Spacing .._ '..'•_ C\ • (d) Size of Rafters: I-`:.,!! Spacing +''^ 'M. - "CC�\ ' + \; ',s 12. VALUATION OF PROPOSED WORK: Including all r..�$ $& `ate .0 labor, plumbing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal $... .©t d8 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. *;,... iiT Signed- Y -'---' �S _• s Plans Filed- /y2AZI (Owner) B y (Authorized Agent) FOR DEPARTMENTAL USE ONLY . FEES: CHECKING BY Bldg. Permit - $,-_.___ 1 "8 GROUP.- l____ . P APLICATI ._ t. HEALTH Plan Check $ 2,r • fl TYPE ZONIN � 7 FIRE PLANS ff ,MARSHAL Total - - - $ s__-�UDIST.. PLANS Receipt No. - - _ h MAP / SPEC'S C?_? STA I E.__.._ Paid to - - SHEET NO CORRECT IONSr✓'f ENGINEER Date A_ -zj 1; - VERIFIED ` CAL / I C,W. DONOHUE COUNTY rU PERMIT ' SdED-BY:----•' L l r--TOR DATE /4 .X _- • EP: Y 5M-7.5o ua.a� iGU vn I I l JOB ADDRES162 Rural Lane BUILDING PERMIT NO. 39572 GENERAL CONTRACTOR Owner blur. DESCRIPTION of WORK Patio Cover Enclosed _ Al'I-407"n6-Odd-0-1- LOT TRACT FIRE ZONE VALUE 3650.00 . INSPECTIONS Signature Dote ,TYPE V GROUP J ZONER1 SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date I Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND Ll^ POWER 0 ROUGH WIRING Heating and Vent. TRENCHES 0 FORMS Er STEEL REINF. O FLOOR SYSTEM BOND SEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN El OUT n PLASTER. BROWN COAT STRUCTURAL, FINAL Electric _ HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC. FINAL BUILDING, FINAL ?'k a�?r S(— C',�J rcR —6-75TPaI-,�0O 165* *'r*,:, 7.50 . ., / 39571. • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 190 COSTA MESA,CALIFORNIA 92626 For A ••licant to Fill in Completely . PP ICpTION FOR BUILDING PERMIT RE I ED /„ DATE RECEIVED DATE ISSUED ADDRESS I (� v kap, � I`l 2-/_7.6r- -----_,.. 7� ,,!!�I ,\ �/ s� / PERMIT NO OWNER I ,/. ... - Ru A-�s A.P. NO. /47-033-0/ X572 ��11 BUILDING �/ !�J MAIL ^ / b `Ot c 1J ADDRESS 2/62 ��AL• A• ADDRESS o`ipf W // -0 CITY /"`f 13 , NO.On I Co( A TRACT/g6cg LOTo?V BLOCK CONSTRUCTION t/ NEW ADD ADEMOLISH / REPAIR MOVING 0.O m LENDER /Z \ —s,.., .�yy/�J�(�� JN BRANCH OWNER Tr/^.rf1•AG-S Q W ADDRESS / ''�v �Z -VgLUE / 0 •m ARCHITECT TEL. VSE D J Q OR ENGINEER NO. V Q FIRE rte'(} y1-- W Ir ADDRESS ZONE / , j/ [TYPET..----/ GRQOU�P/`-:/ J Z CONTRACTOR APPROVE „^Y 111 DATEL lY 7� mZ0 �W/ . J r ADDRESS _ W W ZONE NO. USE OF NE A- . 0= CITY NOTEI. R'�/ PLANS o BUILDINGDa/p 4 Z r./ F WO STATE CITY YARDS APPROVED YARDS APPROVED to 2 LIC. NO. LIC.NO. MAIN BUILDING ACCE ORY BUILDING D 0 SIZE ANO.OF BLDGS. (FROM C/L STR T),. ,{/ OF LOT NOW ON LOT FRONT a FT. USE OF EXISTING BLDG. e 5, R SIDE cF T. FT, I— SIZE OF ry NO.OF Z NEW R. I I I ROOMS 4 STORIESL.SIDE tied� FT, a EXTERIOR WALL ROOF — U COVERING Wa OI,-' COVERING REAR e(` FT. ' .J USE OF BUI G AND RK TO BE PERF RMED CL � �LI DISTANCEABET. BET.MAIN& a c MAIN BLOCS. CkerFSS BLDG& 0DATE �e s L�/NJ1�GL0. //�7 C.0 P qW P APPROVED Z19477.0 1. varrG AP ROVED//// /7 / D SP - '-/YS 0 (1//Y.[ 5 \/ I U I hereby acknowledge that I have read this application and state / that the above information is correct and agree to comply with /✓� I- alln laws regulating buildingworkmen's construction, and I shall not employ ( .1�` any person in violation of the workmen's compensotion laws of _ V) the State of California. a`s/� SO. m ZI hereby certify that I am properly licensed as a contractor under `/ FT. O the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: • CC am exempt from the provisions of the State of California Business and Professions Code,Division 3,Chapter 9. VALUATION _ ♦ I� re ��/ PERMIT FEE $ / N > D SigneFermi ur B Fermi ee �— $ G PLAN CHECK $ E o Authorized Agent U. TOTAL FEE $ 7� � v....-.• �) VISIL / I/ J JOB ADDRESS 2162 Rural Lane BUILDING PERMIT NO.39541 GENERAL CONTRACTOR>wner Bldr. DESCRIPTION of WORK Legalize Patio Cover AP No.118-033-01 LOT TRACT FIRE ZONE VALUE $ 480.00 INSPECTIONS Signature Date TYPE V GROUP J ZONE R2 SOIL GAS SUBCONTRACTOR• PERMITS ISS ED Date I Number I Signature \ WATER Plumbing O ROUGH PLUMBING PROP. SWR. LINE n HOUSE CON. ❑ SPRINKLING SYSTEM • MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE _ UNDERGROUND a POWER 0 ROUGH WIRING Heating and Vent. • TRENCHES ❑ FORMS n STEEL REINF. 0 FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT in PLASTER, BROWN COAT STRUCTURAL, FINAL E ectric _ HEATING. VENT., REFRIG. AND P.C., FINAL eU)it2: Q(,L_ f-.Q9-753rs'9( PLUMBING. FINAL AND GAS TEST n ELECTRIC, FINAL .S -3i 7s BUILDING, FINAL L% C PAIL 3954 , I ir'" LV:-75---00 837* ****10.5C COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in /Completely E,` lQAP�jl LIC TION FORryBUILDING/ PE/JRC$M/IT L/ BUILDING / l-. P U R Q L LN R \C!V / V' IA z`I i� ( FIT"Li ISUi.✓ ADDRESS .g [] OWNER �n s�'. RV ' ,S A.P. NO.`t8 '023 ' 01 5- .. PE MAIL / BUILDING CA�L7C� �r 1 ADDRESS I Ir1pr p, S'.P—C ADDRESS C�� s Z / 0. 0 CITY ed.'" Q /J 1°.31°.3a_7 NOL LZ3/GI( TRACT LOT2-- BLOCK Z Q CONSTRUCTION NEW (APD ALTER REPAIR (MOVING DFMOI ISH OI- LENDER /��.� • !�Jt/` am • JN �'BRANCH OWNER c E I2V.A%CS ot Ill ADDRESS I- ,�t-, VALVE 0 m•CO ARCHITECT TEL. USE LC -IZL ' o 10 (QV. $ �� -IQ OR ENGINEER NO. U Q FIRE ''�� WCC ADDRESS ��s ZONE /-/TYPE \� GROUP 1--- -- 0_1-Y W Z CONTRACTOR eL /� BYPROVE �y� DATE l'(i 9-73 ea Z % 6E /NsPercrSD J¢ ADDRESS W TEL. ZO•n���� NO.OF C-- USE OF NEW L\Z-t Z= CITY NO. 1` PLANS BUILDING<7�0 Cel-' STATE CITY YARDS APPROVED YARDS APPROVED lL° co EC LIC, NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING D 0 (FROM C/L ST ET) SIZE, 3,:-.,.,,,els / NO.OF BLDGS. OF LOT ''Qs� (c /J NOW ON LOT I FRONT AlFT. - FT. USE OF *CIT. •v EXISTING BLDG. Re_S . _R.SIDE t }T. " FT. H SIZE OF 02_ NO.OF A Z NEW BLDG. ,I A L L-. ROOMS STORIES L.SIDE A?L, FT. FT. Q EXTERIOR WALL ROOF /q� �./r,. V COVERING COVERING a rri{'a- REARAir FT. FT. - USE OF BUILDING AND WORK TO BE PERFORMS DISTANCE BET. BET.MAIN& a � � �-• �-. MAIN BLDGS. ACCESS. BLOCS. a sCr� `r ^T�/y/J Q VAR.# DATE O t7 t') fC-L L-h' P oV2 a C.U.P.# APPROVED I- APPROVED C I DATE Ir `• r i O �J � � ` U I hereby acknowledge that I have read this application and state V,�' /I that the above information Is correct and agree to comply with p V 111111 CCall laws regulating building construction, and I shall not employ ( any person in violation of the workman's compensation laws of to the State of California. /1 y\\ jr? I hereby certify that I am properly licensed as a contractor under v SO. FT. \ /.i o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION ,t T11 - and Professions Code, Division 3,Chapter 9. // .. Z� o S PERMIT FEE $ !/ N Signature-o7-.-. 7:7,,,S?..1- / 3m Permittee IYI $ �� '�/x. PLAN CHECK $ E 1 / `o Authorized Agent TOTAL FEE $ nu.