HomeMy WebLinkAbout2371 RUTGERS DR - Building Permits 4` 9 CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
��r,,.r��ia PERMIT
t.444,.1411
P05-00017
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se
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT •
Job Address: 2371 RUTGERS DR Status: ISSUED
Suite No Applied: 01/07/2005
Issued: 02/07/20
Vicinity:
ISSUED BY:
Parcel Nunmber: 14147305
Applicant: COAST ROOTER PLUMBING HTG &NC
Address: 17390 MT CLIFFWOOD
Phone: (714)241-1414
FOUNTAIN VALLEY Zip: 92708 .(\�
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• Y
Owner: RAY, LAWRENCE J TR //11��('�
Address %CARRUTHERS,BENTLEY J y•� yl a ,0 I
COSTA MESA,CA Phone: y
2371 RUTGERS DR Zip: 92626 G
•
Contractor: COAST ROOTER PLUMBING HTG &NC
Address: 17390 MT CLIFFWOOD •
Phone: (714)241-1414
FOUNTAIN VALLEY Zip: 92708
License: 529127
SCOPE OF PERMIT
WATER HEATER CHANGE OUT,
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 Bkllow(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(Ins(or Rep.) 50.00 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
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
244646(WOO)
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
work for which this permit Is issued.
gI 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 carder and policy number are: 1 7/ ZUU
Carrier: S ITr p1 1-TcL art-,0 Policy Number: (O so
11
(This section need not be completed If the permit is valued at one hundred dollars(5100)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,a agree mat If h d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. _ i
Applicant Signature: Date: 7i 7
WARNINO:FAILURE TO SEW RE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIO ES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000).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 of Chapter 9(comm ncing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.g Lic.ter SZ41 I 7—7 f[ Dlassate:# - {p / _
Contractor's Signature: // ,"`' Date: 21-yes--
_
/7 LA9 r
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: Lenders 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 DMsion 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: Data:
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:
❑ 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 filo 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). A
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 ermit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 0Yes I�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 pert 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 Air(Duality 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
1 above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
` Sig turd O Legal Owner(s) n Date
oc
A thorized Applicant Date
LODE I INSPECTIONTYPE RAIL MALE LOPE/ INSPECTION= RAIL REGALE
1618 Fixed System Final Fire Prevention 206 Final Mechanical (�
1266 Pool Spa Final 208 Final Plumbing 3-ii 'OR c? s
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: 2371 RUTGERS DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 066317
OW
} NER'S NAME: RAY, LAWRENCE J TR
ADDREss: %CARRUTHERS BENTLEY J PERMIT NO: B 066317 PLAN CHECK NO: N GOVT: N ,SUPP; N
2371 RUTGERS DR
COSTA MESA, CA 92626 iCONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE; OTH
1 644-8084
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O, & REROOF W/COMP , SHINGLES SQ FT : 4, 825
ADDRESS: UNIT:
CLAIM VALUE: 4 , 825 . 00 CALC—VALUE: 4 , 825 . 00 GROUP OCC : R-3 /
PERMITTEE: TOM HYER ROOFING ( 714 ) 847-9332
AOORESS: 17662 METZLER LN B COMMENTS: REROOF 2800SF RESID & GARAGE, SMOKE DETECTORS REQUIRED PER 91UBC
HUNTINGTON BEACH CA 92647 ****************SAF****3F*3r**3f**********+6********************FBF*3e***************-* t
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 I the Business and Professions Code,and my license is in full force and elle $ E T H A C K S
CITYuc.: 1)44 732 STATE LIC.:575002 STATE c 9^
/ Dater a� signal MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPE ATKINDECLARATION: Iherebyaffirm atIhaveacertificateofconsenttoself-insureoracemficateofWorkers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation l s r ye. a certified cop thereof(Section 3800,Lab.Cl. LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
�DucYND.: z8J-94 UNIT 255 EXP.DATE: 01 /01 /95
commANY; STATE FUND PARKING REQ: PROV: PARCEL ; 14147305 ZNE: REF NO:
E Certified copy is reby furnished, 21 Certified co. ' i h I. city Building sign. PLANNING NOTES>
Winn - '
Dale' APPli .. , � ********************************************************************ie3(-*********
EXEMPTION FROM WOR ERS'COMPENSATION DECLARATION: (This section need n.4 impleted if the permit is for one hundred($100)or less). D E V E 'L OP MENT SERVICES R E Q U I R E M E N ,T S
I certify that in the performance of the work for which this permit is issued. sha employ any person in any manner so as to become -. f
subject to the Workers'Compensation Laws of California. ZONING APPROVEDBY -
Date: Signature: —
DATE: --
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. n,.t_
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY ; > DATE: �
which this permit is issued(Section 3097.Civ.C). ********************je**********************llltee*********************** � **
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT7 2 . 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 . 50
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING DI t' > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
7 structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 72 , 50 0 . 00 0 , 00 72 . 50 72 . 50 . 00
does not apply to an owner of a properly 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
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 72 . 50 OVER/SHORT: 00
forme purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware .)E.N..*****,.,.*..)E.x.*.*.***-*.*****.***,****.***.*-*,*-**********,*****,****************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE BREAKDOWN
❑ I am exempt under Section: . B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dales Owner: SFR 4825 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 825 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Ouahty 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 correct.I agree to comply with all city and county
ordinances a d state aws relating to building construction and berth authorize re I resen Alik his city to enter upon the above-mentioned
property4IseCt n purposes.
Date � am�i01 00156654-00156655 TOT 72.50
Driver's Licenses Social ecunty a: DATE: 03/07/94 TIME: 08:19
164646 White—Building;Green—Code Enforcement Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING IL& 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
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, 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 & Heusetonnection " _ 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 O Gas ❑Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas O Oil
25. Roof Sheathing c3-7-qct6- 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat t�- 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. 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
39. Water Service-Final
40. Gas Service-Fin&
41. Solar Domestic-Final
42. Backflow Preventer i
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 3-My G
48. FINAL PLANNING J / •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
61, CERTIFICATE OF OCCUPANCY
No. Date
•
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PE MIT NO.
Z�7 TRACT NO. • LOT NO. UNIT NO.
CITY OF COSTAAJ�mESA CONSTRUCTION PERMIT / G A.P.# 141 - 473 -• D S Zone g i
Proi-gtet '1`resf .r .3 ,e ctr .2/d!.$• d/2/ 5' � 2Gl'S3 J Ca t
AyPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR S Main Building: Accessory Building:
Apr.-t• jiai ling AddressA �.5277Ai4.?_/6��eal/e Co � _ Front '+ 4C- •�
�L 4c0_e€y« Al. ,C�! Phone s-/I ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T _ --r/ r te O
Owi s N�e � � ✓- z;-'p ESCRIPT ION OF WORK/USE OF BLDG. - - - A Rear poi , °fan / or , 1- N
Aeaess `f I_
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION U STRUCTURAL I C -Right S - G
Address /'� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL s - Left R
Contractor's NamP U-//4j Phone ❑ OTHER •
Ping. Ref.# Parking Req./Provided E
PROJECT DESCRIPTION SQ. FT. OCCUPANCY i O
Address(mailing) _ Planning Notes: i", b ,7jtat_ yyyci •�;1,�„♦_,M
• .CONSTRUCTION TYPE VALUATION$ '�J_Ir\J � "b
City License No. T
ZONE GRADING CU.YDS. ACRES S.
LICENSED CONTRACTOR DECLARATION - -^ 1 /�
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: to O / r s-3l ,- 4{ ,A _ p An /f-
•
with section 7000) of Division 3 of the Business and Professions Code,and - ` l/� .1V"'�W��`•'^'2 �4 vL
my license is in full force and effect. - ELECTRICAL FEES '
License Class License No. -
'ate Signature - PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW
DRKERS' COMPENSATION DECLARATION Construction •Pole Sub. ❑ 50+KW
.nereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink $ho Showers
of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.) •
Dishwasher Meter
Policy No. Company Backflow Irrigation Sewer Cap ❑over 100 amps
ACertified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Bullding Division. Bathtubs Sewer Connection
Date Applicant Clarifiers Solar Collectors Fan Motors❑0-1 HP ❑1'/:-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION
•
(This section need not be completed If the permit is for one hundred ($100) or Dishwasher Solar Piping E.A.U.
less). Inc.Solar 09-15 HP 016-15+
I certify that in the performance of the work for which this permit is issued I Fixtures
shall not employ any person in any manner es to become sub' t to a Drinking Fountains Solar Tank - Microwave
Worker Co pensa /j Laws of Califo ia.
Date' g—Signature 4�l.[.11i Floor Drains Swimming Pool w/Spa Device Boxes Pole Light
NOTICE: If,after making this declaration, you should become lett tot - - •-
Workers' Compensation provisions of the Labor Code, you m t forth h Floor Sinks UrinalOutlets Range
comply with such provisions or this permit shall be deemed revoked. 1 7 1
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet -s 1 Switches Sign +W.
I hereby affirm that there is a construction lending agency for the performance 8 .
of the work for which this permit is Issue(' (Section 3097 Civ. C.) Interceptors ! Water Heater ,Garbage Disposal Standing Sections t
Lender's Name - •-Lender's Address Address Kitchen Sink Water Service • Generator 00-5 KW 05-15 KW Trash Compactor -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash v' • v . G 1
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 Trays 'r - 'L• I
ny structure, prior to its issuance, also requires the applicant for such permit
file a signed statement that he/she is licensed bursuant to the provisions of , •- ti
i
e Contractor's License Law(Chapter 9,(commencing with Section 7000) of Roof Drains
_division 3 of the Business and Professions Code) or that he/she is exempt • Reinspection Fee ! $15 Issue Fee • $ 3
-
therefrom and the basis for the alleged exemption. Any violation of Section - .n
7031.5 by any applicant for a permit subjects the applicant to a civil —v
enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: _ b1
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee 'tonin Approved By - p
compensation, will do the work, and the structure is not intended or offered $ 3 g pP •1 Date td'I�' O�
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL —FEES ,Building Approved By -J Date
License Law does not apply to an owner of a property who bungs
or her own Application Issued By 4s or improves _ - •U - • ^-' i I^ ,,,�
thereon, and who does such work himself/herself or through %ThDate
lli
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 11 0 r, SUMMARY OF FEES ,
pletion, the owner will have the burden of proving he/she did not build or inn- . /--
- Duct-Under Ground i •
r ve for the purpose of sale). BUILDING PERMIT $ Z SMIP $' kI
ypI, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System :..:.'t'•
ra
•tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ 'PERMIT
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU ,PLUMBING $ ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con- ENERGY P.C. $
•
tractor(s) license pursuant to tne Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration '_PLAN CHECK 25% $
proof oftheir Worker's Compensation insurance should be provided to me.
• GRADING $
• 0 I am exempt under Section B.& P.C.fo this r- •n Firepl/Fact.Blt. ICBG# Fire Dampers
ELECTRICAL $
��.� p yy ./ -•PLAN CHECK 50% $ MICROFILM $ �
Date/ .7.CLO.-R Owner .a 'Cr _ �I Heating System& Ducting Registers - - MECHANICAL $ �-{,� -�
I hereby certify that I have read this application and state 'at the-able ❑0100,000 BTU ❑100,000 BTL. TOTAL FEE $ I - -
andation is correct. I agree to comply with all city and county ordinances - PLAN CHECK 25% $
and state laws relating to building constructlo , and hereby authorize repre-
seeaJtatives of this city to enter upie th• f•Ove-mentioned property for
inspection •ur•as- . /`� .
•
Signatur• _ . - '� Date . / ".
Drivers' License or SS# _ __ - .•_ -- Reinspection Fee I $15 Issue Fee $ 3 01 00014286-000142$33 T ri T 48.35
DATE: 09/13/88 TINE: 11:36
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
' CONSTRUCTION AND PLANNINL L &SPA •
APPRjVALS Permit Date Inspector APPROVALS Permit#
Date Inspectot
1. ipora-y Electrical Service or Pole 52. Pool & Equipment Location I •
I
2. Soil Pipe-Undrgrnd. I 53. Steel Reinforcement
I
3) Electrical Conduit Utility-Undrgrnd. 54. Forms I
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •
5. Steel:Reinforcement 56. Rough Plumbing& Pressure Test
.
6; Electrical UFER Crnd. 57. APPROVAL TO COVER-GUNITE .
?. Footings SV 9��/88 _06 58. Electrical Conduit-Undrgrnd. I �
8. Foundation -'I/- • 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 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13.I 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
1
:17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
• '18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
119. 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 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 ` . 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: y2.4 68
34. Final Heating & Air Conditioning LYI2 ,���L�
L
35. Final Gas Pipe-Test `VC(' i V oK CU (sa o Did
-
.36. Hood or Canopy• //
37. Final Factory Fireplace
38. Final Plumbing
.39. Water Service-Final
40. Gas Service-Final
. 41. Solar Domestic-Final
:42. Backflow Preventer .
43. Backf low Irrigation - -
•
44. Landscape Irrigation'System ' - ' I • . - EE
45. Sound Attenuation 1
46. Handicap Regulations I EXPIRED
47. FINAL STRUCTURE & BUILDING Inc° plete nspections
48. Special Requirements Completed // Jm n4 :
Date (6 at Sig ,'mal-s-
49. Electric Release to Edison ll((((
50. Gas Release to Southern California Gas Co
51. CERTIFICI TE OF OCCUPANCY ,
No. Date
Applicant to fill In all spaces within heavy border lines and sign all appropriate declarations.
CITY OF'COSTA'MESA PERMIT NO- TRACT NO: LOT Nu.'--BLDG.NO. -
' CONSTRUCTION PERMIT M -SIcP7 ,10 f
Project Address 2371 RUTGERS TYPE OF CONSTRUCTION I;' - '
Own"MRS•CARRUTHERS Phone 979 198E 0 NEW "- ❑ ADD 0 ALTERATION 1 pp (] '
Address2371 RUTGERS COSTA MESA ' 0 REPAIR 0 CONVERSION 0 DEMOLISH •T l O 1952
ING REGULATIONS
Arch/Eng. - License No. ❑'OTHER DESCRIPTION OF WORK REPLACEMENT OF '. .
Address -
80,000 BTU UPFLOW GAS FURNACE CITY I FzC961A MESA PLNG. REF.44,
Contractor A—AMES PLUMBING—HEATINGPhone 530 2440TYPEOFPERMIT BUILDING TpB l ING
SETBACK C/LST. PROPS RPV LINE
Address fO422 TRASK AVE -GARDEN GROVE CA, 0 GRADING 0 FOUNDATION 0 STRUCTURAL - SLOE YARD
EFT
LICENSED CONTRACTOR DECLARATION - ❑ TENANT 0 ELECTRICAL ❑PLUMBING XMECHANICA `S IDE YARD
I hereby affirm that I am licensed under provisions of Charter 9 (corn-
mencing with section 7000) of Division 3 of the Business and 0 OTHER -
00 Professions Code, and my license Is In full force and effect. REAR YARD(TO P/L)
G— License Class - C-20 License No -2 50 307 PROJECT DESCRIPTION •
PKG.SPACE REQ. PROVIDED ,
• ciatel0/1R/82 Signature A-AMES PLUMB INC—HTG ' Sq. FT.
WORKERS'COMPENSATION DECLARATION OCC UPANCV_CONSTRUCTION TYPE STREET WIDTH PARK FEE$
I hereby affirm that I have a certificate of consent to self-Insure or a VALUATION ZONE ZONING APPROVED BY I DATE
certificate of Workers' Compensation Insurance. or a certified copy - - -
thereof(Section 3800 Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: ,
C y Policy NoWP82076419 - Company FREMONT -
❑ Certified copy Is hereby furnished. REMARKS: -
XCertified copy Is filed with the city Building Division. , •
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - -
(This sectionneed not be.completed if the permit is for one hundred _ . . _ _ - - - _($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 PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK
subject to the Workers'Compensation Laws of California. - - - Uw tLLINb - VHHAbt
Date - Signature BATHTUBS SHOWERS 50 FT SO FT
NOTICE: If after making this declaration, you should become subject TOILETS URINALS - ' GENERATOR 0-1 KW_1-10 KW
to the Workers' Compensation provisions of the Labor Code,you mustTRANSFORMER
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - - - APPLIANCE - 10-50'KW_50 + KW
revoked. . . - -
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS -MOTORS 0-1 HP_1.10 HP - - ..
-
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS - -(INC.SOLAR) 10-50 HP_50+HP '
formance of the work for which this permit is Issued (Section 3097
Civ. C.): ' - - - FLOOR SINKS FLOOR DRAINS FIXTURES - OUTLETS SWITCHES - '
Lender's Name _ _ _ -
Lender's Address - DRINKING FOUNTAINS t - -- GAS TUBE SIGNS '
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS - ' POLE LIGHTS - -
I hereby affirm that I am exempt from the Contractor's License Law for
-the following reason (Section 7031;5 Business and Professions Code: SWIMMING POOL P TRAP -. '- . - LUNOI KUL I UN -
Any city or county which requires a permit to construct, alter, POLES METERED - SUB - •
Improve, demolish or repair any structure, prior to its Issuance,also re- WATER SERVICE ALTERATION PANELS -- MAIN - SUB '
quires the applicant for such permit to file a signed statement that he
-is licensed pursuant-to theprovisionsof the Contractor's License-Law GAS SERVICE OUTLETS SERVICE - AMP
'Chapter 9 (commencing with Section 7000) of Division 3 of the
lusiness and Professions Code) or that he-Is exempt therefrom and the WATER HEATERS- BTU OUTPUT .- `
oasis for the alleged exemption. Any violation of Section 7031.5 by - ' - • '
any applicant for a permit subjects the applicant to a civil penalty - SEWER CONNECTIONS ' '-• _ . - - -
of not more than five hundred dollars ($500). -
'
0 I, as owner of the property, or my employees with wages ai their SOLAR TANK- COLLECTORS -
sole compensation, will do.the work, and the structure Is not intended -
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE
Contractor's License Law does not apply to,an owner of a property _ _ 0,
who builds or improves thereon, and who does such work himself or ISSUE FEE r I APPLICATION APPROVED BY DATE/Ojpf�
through his own employees,.provided that such,improvements are not /
intended or offered for sale. If, however, the building or Improvement MECHANICAL PLAN CHECK SUMMARY OF FEES '
is sold within one year of completion, the owner will have the burden _
of proving he did nut build or Improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDING • '
PERMIT $ SHIP $
❑ l as owner of-the property, am exclusively contracting with AND DUCTING - - -- - - - _ - '
licensed contractors to construct the project (Section 7044, Business 100,000 + BTU $/.1,,00 PLAN CHECK $ PERMIT
and-Professions Code: The Contractor's License Law does not apply to - - ISSUANCE $
an owner of property who builds or improves thereon,and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ •
tracts-from such projects with a- contractor(s) licesned pursuant to SYSTEM - • - - - GRADING $
the Contractor's License Law). 100,000+BTU PLAN CHECK $
❑ I am exempt under Section B.& P.C.for this BOILERS BTU ELECTRICAL $ $
reason -- - .- - . . . - PLAN CHECK $ MICROFILM $ '
Date Owner SYSTEM REPAIR,ALTERATION TOTAL FEE$
EXHAUST SYSTEM MULTIPLE MECHANICAL $ •
i hereby ma Certif yeIa- thi ...Iic iy n and state that abovetLESS AD-
informatio• s c•rr a• e o amply with all city and county - -PLAN CHECK $ VANCE PC $_- '
ordinan ani• - laws r • construction,and hereby a t •ri ,
repre of this ci • enc- ' ••- the ab/6,ab •-,R "
Sign. ure ` _ Cf FINAL FEE $ $7.00
Drivers' Licen C.S5# � �� ISSUE FEE - - $3.0,1 - .
CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor Y
CONSTRUCTION AND PLANNING ; i i�,` - -.,,- POOL&SPA - '
' it ', ateVr. Inspector - Date Inspector
APPROVALS Permit#'"' 'Si" 1 t : APPROVALS Permit# (•,•
1. Temporary Electrical Service pr Pole,.pi" 2 i -r: ' J./ , 43. Pool & Equipment Location . . ' _ -
2. Soil Pipe-Undrgrn �5 ; 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn- ' S 45. Forms
4.. Electrical Conduit-Undrgrn - '1-nr '-;: w 1 : ! i 46. Electrical Bonding , , , - _
5. Steel Reinforce 47. Rough Plumbing & Pressure Test '
6. Electrical UFER Grn48. APPROVAL TO COVER-GUNITE ""
7. Footings • 49. Electrical Conduit-Undrqrn
8. Foundation 50. Gas Pipe, ❑ Undrgrn,Test _
9. Water Pipe-Undrgrn 51. Backwash Lines, P-Trap.. 0 Undrgrn
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing 55 Plumbing System -Final •
14. Rough Electric-Conduit - '56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final
16. Rough Heating & Air Conditioning 58. Fencing & Access Approval
17. Ducts, in Structure 59. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathing
22. Frame and Flashing NOTES:
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat .
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioning '7%�2._ 467'50e0
30. Final Gas Pipe-Test -
31. Final Plumbing
32. Water Service-Final • •
33. Gas Service-Final
34. Solar Domestic-Final
35. Landscape Sprinkling System
36. Sound Attenuation ' • .
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Completed
40. Electric Release to Edison '
41. Gas Release to Southern California Gas Co. i .
42. CERTIFICATE OF OCCUPANCY
•\*No Date '
OWNER AMHERST DEVELOPMENT CO. DATE 11-13-57 _
JOB ADDRESS 2371 Rutgers Dr. BUILDING PERMIT NO. 6013
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 13,690.00
AP. No. LOT 56 TRACT 2953 FIRE ZONE DESCRIPTION OF WORK Residence w/att gar.
GROUP I & J TYPE V ZONE Rh PLAN NO. 60lt11
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches rm
Fas Steel /Y/4/c2
Floor Syst
Steel Reinforce himney Re-Ro
Bal-Bastm Wan'
Frame and Flashingam/fl-
Lathing, In ^.—Out ,�f' „y /Sf
Plaster, brows' coat Ci�j-%l 4"/AS
Underground soil i>,W/G Pipe Meiji yy- .
Top Out it
Furnace 4.'.y /-a - -...m �� _ 111 , +iraY,lf�7Pk moi ) 41
Gas Vents , ��� •�i'��_
Rough Plumbing /1/Ai /_yP s-g ,,� „�,� �D ;i ly� / 2egit
Cesspool Septic Tank l'
Prop. Swr. Line House Con.^rJ SL Swr. /• $ocO( r «,,,,,/ . /-/0-4 /3 L/� j/�J
Sprinkling System
Heating Final /4,41K -2-sr tj
Plumbing Fixtures, Final /14/{-S . -/ -S.
Final Gas Test / 5—. y/9:1 -_)_.y-Fr I/
Construction Pole II
Underground Power 0
Rough Wiring *0 - Ot L..L.4 ,, - -v.. AN 2 3 19b • 04 8 ' , ,I
Fixtures, Final r _ /'
OCCUPANCY fiff#S .-;_f_5• t� ���"""
Form 210-5M-1-57 / - / f)
/
6044 I EE RECENED
COSTA MESA BUILDING DEPARTMENT /1 3 v(-`—
P.O. BOX 317 FINANCE DEPT.
COSTA MESA, CALIFORNIA
CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING 2371 Rutgers Drive BUILDING
ADDRESS
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
OWNER Amherst Development Co. RECEIPT ND. PGal
MAIL RECEIVED BY DATE RECEIVED DATE ISSUED
ti
ADDRESS 419 E. 17th St. �2y° //tea_ &7 NM 3. 3 195
_CITY Costa Mesa TNO. LI 8-1159 ADDRESS
ARCHITECT Carlson & LIC. COSTA MESA. CALIFORNIA
OR ENGINEER Middlebrook NO.
FIRE
ADDRESS Garden Grove ZONE
�Cy�y
ZONA NO.OF TYPE GR�OUf//7
CONTRACTOR Dike. and Colegr&R,LNrg. 7333 U` PLANS /� �.�C y n _
419 E. 17th St. Inc.TEL APPROVED V oma{/
ADDRESS Costa Wipe NO. LI 8-1159 BY DATE
LEGALLOT 56 2953 CORRECTIONS
DESCRIPTION NO. BLOCK TRACT
A.P.NO.
SIZE NO.OF BLOCS.
OF LOT 81 ]� 104 NOW ON LOT none
USE OF none C
EXISTING BLDG. L
SETBACK LINE FROM 1g�q
CENTER OF STREET Aa¢n 55' REAR YARD 29'
SIDE YARD RIGHT , 5' LEFT 5'
DESCRIPTION OF WORK I •
NEW ALTERATION ADDITION
REPAIR MOVING DEMOLISH
SIZEBIDING 1601 sq. ft.ROOMS 6 STORIES 1
EXTERIOR WALL ,.... ROOF
COVERING stucco COVERING comp.
USE OF NEW
BUILDING
Single familyresidence
O
garage attached.
Plan No. 750C
I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS4ORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND AlE LAWS REGUL G BUIUC•
TION. LDIN CONSTR,,/ VALUATION
.moi 1l�L� %
SIGNATURE OF- i PERMIT FEE S 32.00
PERMITTEE ! 1
Dike
13,690.00 PLAN CHECK S 16.00
AUTHORIZED AGENT Dike and Colegrove, Inc. TOTAL FEE 5 48.00 VBMF