HomeMy WebLinkAbout2243 RUTGERS DR - Building Permits Dyt"Mac CITY OF COSTA MESA ]1
BUILDING DIVISION
. rj.�,.A. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
Ipl.rw':'':Inlet
v PERMIT
602-00116
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2243 RUTGERS DR Status: ISSUED
Suite: Applied: 01/24/2002
Vicinity: Issued: 01/24/2002
Parcel Number: 41906110 Zoning:
Applicant: DEBI PANGBURN ISSUED BY: /-
Address:
Phone: 714-526-0351
• Zip: •
Owner: PALMER, FRED G
Address UNIT 202
NEWPORT BEACH,CA Phone:
•
2043 WESTCLIFF DRIVE Zip: 92660
Contractor FAIRWEATHER ROOFING INC
Address: 1007 W GROVE AV
Phone: (714)997-9449
ORANGE,CA
Zip: 92865 - License:. 770565
Arch : Eng:
Address: - Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT .
T/OFF AND REROOF RESIDENCE,700SF FLAT AREA W/BLT AND 2200SF SLOPED AREA W/COMP SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: s4s50.00
Permit: $111.25 Claim Valuation: $4s50.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
•
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 , Rear 0-0 Left 0-0 Right 0-0
PARKING Existing:. 0 Required: 0 Proposed: 0
NOTES:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(WOO)
DECLARATFOMS s 1
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for tle performance of the work for which this permit is issued.
My coo ars'co en a co er end II u bar are:
Carrier: —^she ms.—r— PQ. Number:
(This section need not be completed if the permit is valued at one hundred dollars($ 0)or
❑ 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, agree that if I should become subject to the workers'.compensation provisions of S ction 3700 1 the Labor Code,I shall forthwith
comply with the ovi n5. BJo2-
y Applicant Signature: ✓v /�� / Date: I E��V
WARNING:FAILURE TO SECURE WORKERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES ND CIVIL RNES UP TO ONE HUNORECr
THOUSAND OOLLARE($100,000),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 lice '• ••er• • "o of_ Chapter 9(commencing with Section 700)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.# _ to�t/Y'�� / Class a
Contractor's Slgnetur:s►`• V / Date: .--
CONSTRUCTION LENDING AGENCY:
❑ 1 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: 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(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 Drivers 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 Cale).
❑ 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? ❑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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-I No
(Section 65850.2 of the Califomia Govemment 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 Califomia 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 Califomia 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.
C:43(1,..). Signature Of Legal Owner(s) / I 1 Date
Q4 U /
Anr Authorized Applicant bate
CODE I Iff$PECTION TYPE WI INTRIAL4 CODE if INSPECTION TYPE USE 1CLS
1616 Fixed System Final Fire Prevention 208 Final Mechanical
1266 Pool Spa Final208 Final Plumbing
200 Final Re-Roof 2:15a OZ— 6PC 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
4. '�p�MF q - CITY OF COSTA MESA
I,40?.wenn. ', BUILDING DIVISION PER NUMBER
r I ' . 1 DEVELOPMENT SERVICES DEPARTMENT
`. PERMIT 99-01130
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2243 RUTGERS DR Status: ISSUED
Suite No Applied: 11/30/1999
Vicinity: Issued: 11/30/1999
Parcel Nunmber: 41906110
Applicant: MUMY, BRET ISSUED BY:
Address: 5232 BOLSA AV
UNIT 9 Phone: 800-498-9287
HUNTINGTON BEACH Zip: 92649
Owner: PALMER, FRED G
Address 1048 IRVINE AVENUE#330
Phone:
NEWPORT BEACH,CA Zip: 92660
Contractor ALADDIN RECONSTRUCTION EXPIRED
Address: 5232 BOLSA AV �?
UNIT 9 Phone: 714-379-1094 DATE 75 'I 0 1
HUNTINGTON BEACH Zip: 92649 v/( .Q
License: 656332 V/ 1 (` ���1y:��,p�l/- "
SCOPE OF PERMIT
REAPIR DAMAGE CREATED BY CAR.REPLACE POST,FRAMING AT GARAGE,DOORS.
REF B99.01904, 1 OUTLET AND 1 CONDUIT.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $1.10 1 up to 100 kva/kw $0.00 0 '
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $18.20 1
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp - $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $42.80
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754.5626 -
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
4, workfor 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 Ls issued.
My workers'compensation Insurance carrier and polity number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued et one hundred dollars($700)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
com•I with these provisio .
•pplican .ignature: // 131 S 7
WARNING:FAILURE TO SECURE WORKERS COMPENSATION GE IS UNLAWFUL AND SHAH SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),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 here affirtn-thal m licensed under provisions of Chapter 9(commencing with Section 7000)of D orthea $loess and Professions Code,and my license is In full
rce and effect. 6 -.?72 Class 0
Contractors Signature: u--1l r
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Cale).
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(commencing 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).):
O 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 onthrough 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 ofdompletion,the owner-bdilder will have the burden of proving that he or she did not build or improve for purpose of sale.).
�•_IInpI ' I �I
.❑ I, as owner of Ihe�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 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:
❑ 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 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 neod 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 It an RMPP is presentlyrequired,has Section 25534 of the Califomia Health and Safety Code been fully complied compliededwith? 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 apermit 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 LJ No
(Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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.
Aff/ ntiatt //j
r 30 ^
r • •Or Authorized aT.1RSE� a
CODE 0 INSPECTION TYPE PATE ININAA6$ CODE 1 INSPECTION TYPE PATE. effT$AS$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
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
•
1.4
I 40 UFsy CITY OF COSTA MESA
a; . BUILDING DIVISION
r( DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
°•„� n PERMIT B99-01904
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2243 RUTGERS DR Status: ISSUED
Suite: Applied: 11/30/1999
Vicinity: Issued: 11/30/1999
Parcel Number: 41906110 Zoning:
Applicant: MUMY, BRET iM
Address: 5232 BOLSA AV ISSUED BY: (-/w✓
UNIT 9 Phone: 800-498-9287
HUNTINGTON BEACH , Zip: 92649
Owner: PALMER, FRED G
Address 1048 IRVINE AVENUE#330
Phone:
NEWPORT BEACH,CA Zip: 92660
Contractor: ALADDIN RECONSTRUCTION
Address: 5232 BOLSA AV
UNIT 9 Phone: 714-379-1094
HUNTINGTON BEACH
Zip: 92649 License: 656332
Arch : Eng:
•
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REPAIR DAMAGE CREATED BY CAR. REPLACE POST, FRAMIN
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $32,000.00
Permit: $462.45 . • , Claim Valuation: $32,000.00
SMIP Res: $3.20
SMIP Corn: $0.00 -
Other: $0.00
Inspection: $0.00
Total: $465.65
•
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
•
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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
JIECLARATIONS
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.
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:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work 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
co ya• ' • these provi
A•plicant Signet Date: O /
WA-• • : AILURE TO S URE WORKERS MPENSATI OVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COS OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
Iy_affum .. .ensed under provisions of Chapter 9(commencing with Section 7000)of Di :.< Business and Professions Code,and my license is in full
for ' . G fl Class#
r. rector's Si. ature: ,i— // 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).
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 t0 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.-properly 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 equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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 tiling with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
g.occupant
require
for
....___csubject er_._-_ construction
modification
5 Does e will the oast or present a future building o oat y other for the work ntch isdl the sothis application app.ermit for such construction or mo
from the South Coast Air Quality Management District or from any other air pollution controldistrict or agency? 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 Califomia Health and Safety Code).
... from
h....0 other
7 a permit fhav tae South Coast Air ri Management ert DistrictHeat or dair pollution controlndistrict 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? ❑Ves 0 No
...---......_ ac ponc officer). ..-___....,,.._
8 (If"yes",attach certificate of compliance from the appropriate air pollution control ier
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 COMPUANCE 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.
/fr
troll f /D�e
And/Or 'uthorized • nt i
CODE N INSPECTION TYPE --DER INTITIALS CODE* INSPECTION TYPE DATE INTRIALS
16t6 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing
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 lines and sign all appropriate declarations.
C OF COSTA MESA • PERMIT NO. TRACT N��, LOT NO. BLDG.NO.
_
CQNSTRUCTION PERMIT ' B Pa 5 S 27 2• 3429• 13/U'j/;�;,i 93.72 TL
Igi Applicant's Mailing Address - /61 I ' TYPE OF CONSTRUCTION U NEW U ADD U.ALTERATION Al REPAIR
Project Address .0a�a+�1� CV Iv-e.A.Ar5 �c.I�j '
0 CONVERSION DEMOLISH 0 OTHE{��/,.� j�� '
Owner i Neme V I'�r P 'J, g '`e' tr...- Phone v ! l-014 DESCRIPTION_OF WORK ✓lull^ . I r'r�`•`c� c.a-li 9r f1�s''i
I j� ,Q'�� �y ZONING REGULATIONS
\ Address Na$ y' fly0`Lrrs"�M,, 1,�s,�' TYPE OF PERMIT LJ GRADING U FOUNDATION U STRUCTURAL A.P.Wdi fe e 'pfr•/0 ZONES
I Arch/Eng. ` c-"•`^J'"' y License No. 0 TENANT ❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL PLNG. REF.gra BUILDING /J lemof/
Address 777 0 OTHER (C TO BUILDING I/ caTRArx ("it CT�,— //
(Q �'• .� ^� q 6y.` - O REAR YARD(TO P/LI / O
Contractor's Nem:- •�rv✓ e4�ef W 'hone 616-00.94 PROJECT DESCRIPTION SQ. FT. rN OCCVPAf•{CV PROPERTY LINE ' „ ' „
CONSTRUCTION TVPF VALUATION$ T�✓777 LEFT SIDE YARDS �"Q RIGHT SIDE YARD `� -Q
License No.
a a� Co 1 • .' - f1
AfCiyne N •'j Z(F ZONE GRADING CU.YDS. ACRES PKG.SPACE REQ. PROVIDED 3
License No. __ �� a�, - ,
LICENSED CONTRACTOR DECLARATION Remarks: _ STREET WIDTH ' PARK FEE$ '
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing •. ' .,J
with section 7000) of Division 3 of the Business and Professions Code, and -" SPECIAL CONDITIONS: ,�•s ,r �.
my license is Int I for 0 and effect. . -+� I�.�T yaL-�I/a'
License CI ss L • tea Ijrj PLUMBING
Date P,) Signature 7- _ - - _ - r� rr Bar Sink Sewer Cap ELECTRICAL
Aj.„,2RKERS•CO PENSATION DECLA-ATION -- - .
m•yareby affirm that I have a certificate of consent to self-Insure or a certificate Backf low Preventer - - • Sewer Connection Automatic Washer - Meter Dover 100 amps
Workers' Compensation Insurance,.or a certif d copy thereof (Section '
Construction Pole Sub Panel
• 3800, Lab. C!) Backflow Irrigation Solar_Collectors,_ - .
Policy No. til y Is her by en Company - Cooking Unit Sub Pole y•
Certified copy Is hereby furnished. Bathtubs Solar Piping
'Cardillo cop is iled with the city Bu0�'ys���'� Io 1 , Clarifiers Solar Tank Dishwasher Motors ❑0-1 HP ❑115$
Date vrorr49 Applicant ✓2�k j —.L -'-
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dish Washer Swimming Pool,w/Spa.' _. Dryers ❑Gas ❑Electric Inc.Solar D9-15 HP D16-15f
(This section need not be completed If the permit is for one hundred ($100)or _ .-
less)' Fan Microwave rs,
Drinking Fountains Urinal
I certify that in the performance Of the work for which this permit Is Issued I r
shall not employ any person in any manner so as to become subject.to the IF.A.U. Pole Light "
Workers' Compensation Laws of California- Floor Drains Water Closet - -
Date Signature • I I - Fixtures •
•
NOTICE:If,after making this declaration,you should become subject to the Floor Sinks • Water Heater _ Range , - -
Workers' Compensation provisions of the Labor Code, you must forthwithDevice Boxes '
comply with' such provisions:or this permit shall be,deerlled revoked.• ' 1 Gas Service ' Outlets, Water Service Sign
•
CONSTRUCTION LENDING AGENCY -
Outlets Standing Sections I
I hereby affirm that there Is a construction lending agency for the performance, Interceptors • _
of the work for; which this permit Is Issued (Section 3097 Civ. C.) Switches
Lender's Name _ . Kitchen Sinks Trash Compactor
•
Lender's. Address - -
OWNER BUILDER DECLARATION Lavatories Garbage Disposal
-
I hereby affirm that I am exempt from the Contractor's License Lav; for the p-Trip- Generator 00.5 KW D5-15 KW ,
following reason (Section 7031.5 Business and Professional Code: Any city or P - • .
county which requires a permit to construct,alter,improve,demolish or repair . . Transformer ❑15-50 KW '
any structure; prior to Its Issuance, also requires the applicant for such permit Roof Drains
•
to file a signed statement that he/she Is licensed pursuant to the provisions of •
050+KW
>.Contractor's License Law.(Chapter 9 (commencing with Section 7000)of _ ReinspeMion Fee $15
S 2Ion'3 of the Business and Professions Code) or that he/she is'exempt ' Showers - - Reinspection Fee $15
p"efrom and the basis for the alleged exemption:•Any„violation'of,Section Meter ❑up to 100 amps Issue Fee - I .$ 3.
'"31.5 by any applicant for a permit subjects the applicant to a civil •
�y •Q
malty of not more than five hundred dollar?($500). Service Sink Issue Fee $ 3 •
Zoning Approved By Ck'G•/IGS' Date cS S�Aa”
LJI, as owner of. the property or my employees with wages as their sole . MECHANICAL o
compensation will do the work,and the structure is not intended or offered . Application •Approved By nate •
' for sale•(Section 7044, Business and'Professional Code:.The Contractor's -- -- - --_ --- - - - -- -- - -- _ _ — -
License Law does not apply to an owner of a property who builds or Improves Boiler ' . Refrigeration System -2
p E
thereon, and who does such work himself/herself or through his or her own Application Issued By _ nate ��� A
employees, provided that such improvements are not intended or offered for Duct-Under Giound ❑0-,100,000 BTU ❑100,000 BTU, • ,
sale. If, however,the building or improvement Is sold within one year of com- I SUMMARY OF FEES
pietion, the owner will have the burden of proving he/she did not build or im- .S�
rove for the purpose of sale). , Duct-Structural - System Repair/Alteration 'BUILDING PERMIT $ ��,5� ' SMIP ' $
V' rye
as owner of the property,am exclusively contracting.with licenses)con- Duct-Ventilating • PLAN CHECK $ 36.7"2' I PERMIT
Q tractorsto construct the project (Section 7044,Business and Professions Code: -. _ • ,
The Contractor's License Law does not apply to an owner of property who Y PLUMBING $ i ISSUANCE $
builds or improves thereon,and who contracts for such projects with a con- Exhaust System ❑ Multiple❑
tractor(s) license pursuant to the Contractor's License Law),q PLAN CHECK $ ; GRADING $
❑ I.am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit.ICBG# , . t t
Heatin 'S stem& • ,• ELECTRICAL $, - $
Date Owner g, Y Ducting i , MICROFILM $
.. f hereby-certifymationthat I have rto comply
application and state tnat•Ihe above ❑a100,0008TU-❑100,000 BTI PLAN CHECK' • $
•Information Is correct. I agree to comply with all city and county ordinances ,MECHANICAL $ TOTAL FEE $ '
and state laws relating to building construction„and hereby authorize repro- i .
sentatives of • e ep ��on the ab y�x>mentioned pr pert for Hood or Type I ❑ ' Reinspection Fee $15 ' LESS
r - inspection pus 43r LDS!//� _ /• Canopy Type U ❑ PLAN CHECK• $ - ADVANCED PC $
VD Signature 7 %'rte”" ' Date �J
Drivers' License or SS# • Registers Issue Fee $ 3 FINAL FEE $ - q `
CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor •`
1, :CONSTRUCTION;AND PLANNI G Al,, r • -: -F'66;;;;;-.."-PA
,-rt. t ' - - Date Inspector ��• - Date Inspector
_ r APPROVALS Permit# - _ :APPROVALS Permit#
1^ Temporary Electrical Service orEPole 52:. Pool & Equipment Location ' - - -
i• •V boil Pipe-Undrgrrid - r - 7 _.a ° " •\ a ' .' '53.'Steel Reinforcement •., r _j ;
3: ElectricalConduitUtility=Undrgrnd. ,54, Forms.y .• _
`
4� ElectricalcConduit-Un`d"rgrnd, ; ° i .'L ,. • 55= Electrical Bonding . - - ;
5 Steel Reinforcement • ' v -56.; Rough Plumbing&Pressure Test - - , , 1
6' Electrical UFER Grnd,- �- _ ' ' • __ 571•APPROVALTO COVER-GUNITE
7, Footings! / ' r - ' • ' ..58.' Electrical Conduit-Undrornd. -
8. Foundation .1 i - - .c _. - ' 59. Gas Pipe,-0-Undrgrnd:,Test' :
9, Water) Pjpe-Undrgrnd:`r :60. Backwash Lines',-P-Trap, 0 Undrgrnd, - - -
10. Structural Floor System 4 61. APPROVAL TO DECK _ '
11, Property Sewer Line&'House Connectibn' ; •' 1 -• -
62. Backwash& Receptor"Final - •" -
12, Sewer Cap - . - ` ' - -63. Heater &Vent Final - .--•••
13. Roof'Drains - '64, Plumbing System- Final - '
_
14. Rough PMumbing •_' ' ' - - - 65. ElectricarFinal
-r 4'15. Rough Electric"a1=Conduii1r (-- - *--' '----1 ,-' -66.• Solar System-Finarr - - - '-- - "
-H:: '- r '- _ ,
^16.'Roughs Electric Wiring f :t = i -; _ : 67. Fencing &Access Approval - - --
17. 'Rough'Wiring',Sig'ni ', ; i^' I:� I ', "' ' , 68.. APPROVED ( _
' 18: Rough Electrigl-T Bar Ceiling ' ;' 1 - ' ' ° i I • '69, POOL/SPA SYSTEMS FINAL '
' 19. Rough Heating & Air.Conditioning ! ! FIRE DEPT, REQUIREMENT " , - '
20. Rough-Factory Fireplace i 1 I APPROVALS Permit# .r
21- Ducts, in Structure. i ! 70. Underground Hydro •
- ,`22. Ducts;-,Ventilating I 71. Product Piping 0 Gas 0 Oil
:23.,Gas Pipe-Rough &Test ' `72.' Underground Flush ' •
r-24.`Roof Framing- ' • ' _ . t n ' ,.: o I.. ' _ 73: Undergrnd.Storage Tank D Gas D Oil ' • •
-. , , , $'46•-$3 4
25- Roof Sheathing . i i 74. Overhead Hydro '
26. ,T-Sar,Ceiling (Structural).& Monocoat ; 75. Dry Chemical -
.• •27. Franie and Flashing - i ; ' IV/6.P 13 76. Dry Standpipe - '
' 28. Lathing& Siding 3 , ' I ' 9•(5-83 :Q 9A'1 X77. FIXED SYSTEM FINAL •
29. Insulation ;', , 178, FIRE PREY. FINAL .
F - 30. Diywall Nailing ` 1 1 '" 4.76,g:3 U ?Aii Notes: '
al '31. Plasier'Brown Coat r n ; • I 1 I 4:23-4. - - - .
- Y " ' . -
32. Electrical Power Meter-Final I
33. Final Electric i -
„ 34. Final Heating &Air Conditioning I , ; „
35, Final Gas Pipe=Test _ : . , - - - -
36. Hood or.CanopY•. • , , - - , ' , • I ;. .. •
37. Final Factory Fireplace , !r- i ; ; I ' , , - , ,
38. FinalPlumESing• ,;-•• , • ; I i i I , .
39. Water•Service"Final:; ' '
40. Gas Service:Final;; , , , ' •
•
41. Solar D.omestic-Final ' _ •
42. Backflow Preventer -
43. Backflow Irrigation ( I = :. • i -
\ 44. Landscape Irrigation System) --) 1 - ,
45. Sound Attenuation'- ' ''• I • '
46- Handicap Regulations; 1 ! I `_ ' C
p
\47. FINAL STRUCTURE*&BUILDING . '' frdirs .J4 '
f
'8. Special Requiremi, ,
ents Completed •- ' r(
\, Electric Release to'Edison ' i -. ¢ ._- _ I I_ _ - 2
,
"Gas Release to•Southern California Gas Co ' ' ! I 'I . ,
\ERTIFICATE'OF, OCCUPANCY ' l . ' _ • `'
11 Date 1 • I : ! i ,
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. f"
CITY OF COSTA MESA ' PERMIT NO. ,/ TRACT NO. LOT NO. BLDG.NO. I _
CONSTRUCTION PERMIT £ ?ZO�
/ '7S�C�Cn 4191 5/13/d'; 7g a7 P.
•
Applicant's MailingAddress ' G'>"1f6'--� -
pp s� �jel�/ - TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION .REPAIR
Project Address {p/�'"e}.,' Kms-•<p�C�/ . ❑ CONVERSION El DEMOLISH ❑ OTHER ' - ' - '
•
Owners Name AS A✓Zs ice_cae4T •PhoneS✓t/JS ' /, DESCRIPTION OF WORK - .-
/� ri � /� _ _ ZONING REGULATIONS
•
Address pr•"7 S/'3 •� tNrc'G a • TYPE.OF PERMIT,.T�QQ 0 GRADING U FOUNDATION U STRUCTURAL A.P.Ss. ZONE
Arch/Eng: • - License No. ❑ TENANT 'Lu ELECTRICAL ❑ PLUMBING ❑ MECHANICAL PLNG.REF. •'M•- BUILDING
Address • ❑,OTHER cFTperr i•h CT
,,,tea / TO BUILDING'
P.ec - tCz'tb 'rte PROPERTY LINE - REAR YARD (TO P/L) -
Contrector's Nama _ Phone y-� 3'�7a PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing/ •/379Le .1N SL#T0— D , CONSTRUCTION TYPE ' VALUATIONS LEFT SIDE YARD RIGHT SIDE YARD -
License No. �n
S/'36c�eJ� • ' ZONE •- GRADING CU.YDS. AC RFC PKG.SPACE REG. PROVIDED '
•
LICENSED CONTRACTOR DECLARATION Remarks: - J ' 7 "133- i STREET WIDTH PARK FEE$ • -
Ihereby affirm that I am licensed under provisions of Charter 9(commencing : d -
with section 7000) of Division 3 of the Business and Professions Code,and . - ' ( SPECIAL CONDITIONS: I • - , -
my license is In full fo a and effect. `
L•(cense C -ss' ^ O - !• i ' . , PLUMBING - •
, ,
Data Signature ,.• �� - '
>; OR RS'COMPENSATION DEC LA RAT(•N Bar Sink • Sewer Cap ELECTRICAL I
r'''"ereby affirm that I have a.certiflute of consent to selNnsure.or a certificate - Backflow'Preventer - - • Sewer Connection - -- - Automatic Washer '.. Meter Clover 100 amps' - - _
`^'i Workers' Compensation Insurance, or a certified copy thereof (Section , Construction Pole
3800, Lab. CJ , ,Backflow Irrigation •
Solar Collectors - •
'Sub Panel - .
R
Certified copy li hereby furnished. I . Bathtubs I • Solar Piping Cooking Unit 'Sub Pole r
• Certified copy Is filed with the city Building Division. - - , Dishwasher • 'Motors ❑0-1 HP ❑1 Ya$
' Date 1 Applicant ' ! I j • ' Clarifiers Solar Tank 1
• EXEMPTION/FROM WORKERS'COMPENSATION DECLARATION - Dryers ❑Gas. ❑Electric , , Inc; ,Solar 09-15 HP-01-6-15.+
This section need not be completed if the permit Is for,one hundred ' ' Dishwasher ( Swimming POO(w/Spa :
less)- t I 1 ! I I - Fan; ' i i �Microwave `
• I certify that in the performance in
of the work for which this,permit is s ed I Drinking Fountains Urinal 1 ! ! • I i / ' - I
shalh not employ pn person any manner s•-as •e •, a s c .to the - F.A.U. • I (Pole Light I '
Workers' e/Oiyi n Laws of California. II i Floor Drains f ! Water Closet, ` ' '
Date ° Signature • . / ; Fixtures • , i I /.
Water Heater! --- ' IGU
NOTICE:If;al er making this declaration, you- -ould become-.ub)ect to the •
- Floor Sinks - -- - .- - . '3. •1 -I
!Range , - .!
Workers': Compensation provisions of,the Labor. Code, you int forthwith, • Device Boxes ,
comply with such provisions: or 'this'.permit 'shall be•deemed revoked., •• Gas Service j Outlets• Water Service Sign' t
• CONSTRUCT:ION'LENDING AGENCY I ' - - / -hereby -
1affirm that there is a;consterm it lendingagency for the • • ' 3
Outlets
g y performance, InLercePtors 'Standing Sections - ,
of the work /ori which:*thin permit Is ;Issued (Section •3097 Civ C). —-
I Lender's, Name : _ • = - Kitchen Sink - - ^ • Switches • Trash Compactor , ,
Lender's Address .. r I - ._ .. . •
OWNER BUILDER DECLARATION' - • I Lavatories', . '1 •-• , ` ! , Garbage Disposal• , , - ,
1 hereby:affirm that I am exempt,from the'Contractor's,License Law for the - - •- Generator ❑0-5 KW ❑5-15 KW i •
following reason (Section 7031.5 Business and Professional Any city or j _ ' P-Trap' - rI , , •
-county which requires a permit to construct,alter Improve;demolish or repair • - • Transformer ❑15-50 KW •
any structure, prior to its issuance,ealso requires the applicant for such permit ' Roof Drains - ' i. L. ., I I ••
to file a signed statement that he/she is licensed pursuant to the provisions of ' - •I • -• ❑50+KW'. '
..Contractor's License Law(Chapter 9(commencing with Section 7000)of - - - Reinspection Fee $16
i;sion'3 of the Business and Professions.Code) or that he/she:Is:exempt ' i Showers r - I - Reinspection'Fee , $15 - - - -
`;tefrom•and the basis for the alleged exemption- Any violation-of;Section - ' - Meter Cup to 100 amps 'Issue Fee, ` '$ 3. •
7031.5 byaany applicant for a permit subjects the'applicant to a.civil ' ___ - - '
enalty of not more than five,htindred dollars($500). r S¢rvice Sink• L. Issue Fee $ 3 r •
' , . i Zoning Approved By • •Date - 1
co i,":-"as:owner of the property or my employees with as their sole ! !
compensation,-(Sen wilLdo the work;and the structure.Is not intended or offered • i - • MECHANICAL Application Approved By Date for sale-(Section 7044, Business'and Professional Code: The Contractor's --- - - - - - - - - -- -- _ - �-�/r�/,/-�� f ,
License Law does not apply to an owner of a property who builds or improves Boiler 1 ! Refrigeration System ' #0---?I thereon, antl who'does,such work himself/herself or through his or her own t Application Issued By / /•--� 'Date -
employees, provided that such improvements are:not Intended or offered for • Duct-Under Ground ❑0.100,000 BTU ❑100,000 BTU - •
•
sale, It however,the building or Improvement is sold within one`year of com- SUMMARY OF FEES
. pletlon, the owner will have the burden of proving he/she did not build or Im- I , •
' prove for the purpose ofsale). • I i s Duct-Structural 1 System Repair/Alteration 'BUILDING PERMIT $' SMIP $ I
U I,as owner of the property,am exclusively contracting:with,)Reel-lied con •-
' tractors to construct the'project (Section 7044,.Business.and.Professlons Code:.; Duct-Ventilating '-, - _ ! - : -, --1 PLAN CHECK $ PERMIT
The Contractor's License Law does not apply to an owner of property who • '
l builds or improves thereon,and Who contracts for such projects with a con- ' i Exhaust System ❑ Multiple❑' t I PLUMBING $ 1 ISSUANCE ' $ '
tractor(s) license pursuant to the Contractor's License Law).: 1 I I 1 (PLAN CHECK' D$$ I • GRADING I • $ '
Q. ❑ ram exempt under Section B,&P•.C.for this reason Firepl/Fact,Bit. ICBG# L/ ) 4
I - - I 'ELECTRICAL.' I ^$$-. $ ' . •
J • Date - Owner' - • t Heating System& Ducting . ,PLAN CHECK' VS ' j
I hereby:certify that I:have-read this application and state that the above I _ _ _ .I MICROFILM $
Y' PP - - ❑6100,000 BTU ❑100,000 BTU-•- -- - - - - i
J , Information is correct. I agree to comply wit, all city and county ordinances 4 I I I MECHANICAL I TOTAL'FEE` - $ r '
•
and state laws relating to bull• ng constru ••n,and hereby authorize repre- ' Hood Or Type I 0 , ! $ Ni 1 I
sentatives of.this city •on • above-mentioned properly for ' Reinspection Fee' $15 PLAN CHECK $ 1 LESS
Canopy, ADVACED PC $
Inspection purposes ,d!�G� • • -Noe I I ❑ A�
Signature , 'dll.if q.•��•
Registers Issue Fee I $ 3 i
- _ I • FINAL FEE; i $ �^
CMF 0865-46 rev.12/82 White-Building;Canary Applicant;Pink-Accounting;Goldenrod -Assessor
_r f:CONSTRUCTION ANDQPLANN ? k;, g 8171°ez: o ?71-_POG - ='SPA• _ -- _ I '
C7 ' ' ,; '4 n €A /O8L -paten :Inspector i -` - Date Inspector
'APPROVALS Permit.#, » S APPROVALS,.: P•ermrt#
rr �� Temporary,Electrical Service d_i:Pole I ' '• '14 I u° i i 52 Pool &`'Equipment Location.` r I I ' c
•rt CI •
H 2: Soil Pipe-Undrgrnd„ z.0 5 0_ °_ F >.> v„ •E 53 Steel Reinforcement _ .' _ 1 . •
3: Electrical Conduit Utility pndrgrnd r_ f 13v . . .54 ' Forms4, r . - _ r ; ,
y 4. Electrical Conduit-Undrgrnd > • ' I ''- i, - 471.„'..1;•.551.1. - n ' - _
e t� E Electrical Bonding' , •- _ -. ,
5. pteel'Reinforcement , n `• - I = o S 1, ;1,- .;o a c : '-.56.,. Rough Plumbing& Pressure Test - -
•6: Electrical LIFER Grnd I' .t.. 1 . r x-;,- o.' " 57: APPROVAL TO COVER-GUNITE• '
7. Footings I : l I ` ,r 1.;!4.;t ,. ` - 'i 168.''Electrical'Conduit-Undrarnr1:- - - • '
8. Foundation I I 1 ' I ' -; - - - j E .` , ¶59• . Gas PIP ralo Undrgrnd.,Test _ ,-,� ` 1.-'
9. Water Pipe-Undrgrnd. - 1 '- :1-; - 'I ''-60. Backwash Lines, P-Trap, 07Undrgrnd..
10. Structural Floor System r i 61. APPROVAL TO-DECK -- - • ' •
11. Property Sewer Line &Mouse Connection; '
, , „_ _ ,� ' Y � I �L62. Backwash &,Receptor-Final -
12. Sewer Cap , I i • :on, 1 i-63. Heater &Vent-Final -
13. Roof;Drains , I I I ,. , 1 , I % y, I '64. PlumbingSYstem-;F.inal, _ _ •-
14. Rough Plumbing : I .3 ' ' ` ° = - - ' 65. Electrical-Final' -• • • -
' "-1&. ,Rough Electrical=Conduit-T -rr .I-- T'1--?-i'-•" - - - II -" '- -- -- • . - -
t. - I { I I 66.,-Solei Sysiem-Final '
16. (Rough Electric Wiring, I - ---f- ri 1 - + - -
, , , I I '�y z ( 4: - �67:`Fencing&Access Approval , . - _ -
- "17.'Rough,Wiririg'ASign12 ,- • I '• I 1i r 2 1 :l I . I :. I ::{ r !: 1. 68. APPROVED FOR PLASTERING - - -
-L-.7..
Ii,18. 'Rough Elecbrical'.T 8a Ceiling (i II I - I - , I ' ' 1 '• I - ' ' � F
I ! f c r , I I : 69.1 POOL/SPA SYSTEMS FINAL
. 19. RoughtHeating& Airtonditidning it I I o I I , I I 1, ' FIRE DEPT. REQUIREMENT - .
Ir
if�1 20. •Rough Factory Fireplace I I I I i I I I APPROVALS, Permit# , • ' - •
I I t 1 i! ! I � I
ti 21. Gluts in Structure, '1 I I I .l I, 1 I I I I I I ,70., Underground Hydro I, ,
,Ia2..'Ducis, Ventilating if ' ,a I I II I: I I I I I I 171_I Product Piping O Gas 000
:23. IGasrPipe-Rough&Test ; ! I ',v ' I i 1 -I-1-T 72.• Underground Flush
,Ii-k4. 'goof Framing, { I : a I • :'n• I s+ N!,ea : -,I- •,73.; Undergrnd• .StorageTank.0Gas -❑Oil - I
- 25;,Root Sheathing 1 1 i Il;, ' I t(r, ; _ I t 15 • 1 .74.; Overl ead Hydro C ' '
x-26. T_Bar Ceiling (Structural),& Monocoat I I I I' I.-;‘,1 I I• ,75 , Dry Chemical - •- -
d. .27. Frame and Flashing i ; I I I is I•. I " 1 l I-. I I i 76.1 Dry Standpipe � ,
•
i N 28. ,'Lathing &-Siding I ; o ' i I II li ( ' I 1 I T{ 1 I 77.1 FIXED SYSTEM . i `, , '
'1 29. ,insulation '7%, S 1 Its :51 I Il ! ' I i i I 1 I I78.; FIRE PREV. FINAL 1
1730. ,D ywall Nailing • r h I ' 1L I ! 11 1 1 Notes:; I -
31. Plaster Brown Coat I I I I ., 'I 11 .. i I Ti i I ; .
I
32. Electrical I
Meter,Final I !I ! , I I ! ' i , ii 2 l , -
33. Final Electric I I I I 1 I g)'
= 34. Final Hea'ting.& Air1 Conditioriing u I i ;. 'I c i tr I 1 - _
Heating
1_ In '� 'D 1 I I
I ! , 1. I "
35. Final Gas1Pipe-Test „ r1 ., ,h, i` I;� I^ I 1 .ISI' , I .• It ! r , - 1 - -- - -
v c
36. Hood or CanoPY•`I cl , i _.I ' ,! I . I^ I _ It _ I 1 1 , 1 - I � .;i 7 .
i I 1° I - 1
37. Final Factory Fireplaoe - ,' I , ,t. ; 1 _ -
~ II
38. Final Plumbing ; I . I , o Ii i : :I`" I 1 I i -
•
39. Water Service-Final, I I I "I i1 I I ! : H. I I I I I .- - - -
I i , -
40. Gas Service-Final 1 I I (I 1 I I I I ' I I 1 I I ' I _• .
41. Solar Domestic-Final I I 1 Il I- ++- _-1 _ '---f._ , J, _' _ - I, ,
42. Backflow1Preveritera , Um1 I 1 1 I I 1 ' - '
43. Backflow Irrigation' -"I I I 't2 l - I' i 5 ; ;-;,, ' 1 I _ - -4 • ' 1
44. Landsrra��pe I irigation-System I I '-;.- . ' 1 i ire- ' •:I ' i • , - - _ . -
45. Sound.Attenuation - ;,, Ia1 I r I: • � I " 1 ;I I I 1 -
46. HandicapjRegulations• I 17 i 1 I' -. I I I_- I r l I i ^l I -
47. FINAL STRUCTURE it BUILDING r, j ` i I 1"-- 1 `-I i I ; i ' I , -,
48. Special Requirements Completed i i {� ' r" : I I I - _
e 1 , e i , 1� 1� , I I I
49. Electric Releaselto Edison! ! I 1 -I--4 _1 I '�l_.!_,__ - _ �,__ - 1,--i..1..- {, j � i '
50. Gas Release to Southern California Gas Co I I 1 I
11 ' i1
51. CERTIFICATE OF'OCCUPANCY , L. *_- _ I ---. - -t- --, 1-,- - T ,
1 J .
No ii I 1 I Date . 1 I 1 i I • I__1. 1 I i ' .
'u__.. _i.. .....�._._ ..�.._,;.,..,.+,_�. ., - -- -- - -----'- - - .-. -
8061 U•LE ' �UNEU
COSTA MESA BUILDING DEPARTMENT (� f( spy/S�
P.O. BOX 317 �f o NCL DEPT.
•
COSTA MESA. CALIFORNIA CITY OF COSTA t1ESA . •
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ABUILDING
DDRESS 2243 Rutgers Drive, A, ,C BUILDING
B
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY � //_
O6Estates, RECEIPT NO. PEIJ1
Es
OWNER Towne tates, Inc • V \Vl
MAIL RECEIVED BY DATE RECEIVED D E ISS Fit
ADDRESS 1555. Placentia �yL. ./ // '�.-,1� / y
CITY Newport Beach, Cal.. Two: NI 6-3227 ADDREISS 22 `/3 /I J €45'
ARG 'CT LIC. -
OR' VEER Owner NO. COSTA MESA. CALIFORNIA
FIRE
ADDRESS ZONE 3
cAtalcrAoll Const. Co. CITY LNIOO, 8534 ZONEn
1 2— NO OF 17 TYPE
PLANS ��]` GROUP
fit
�'
EL.
ADDRESS same TNO. same BYPR0D AprA.. CAE be r y/
`ESC` OT
2788 CORRECTIONS
DESCRIPTION NO. 2 BLOCK TRACT
A.P.NO.
SIZE NO.OF BLDGS.
LAY b 11, TT %/''�
OF LOT - 60 $ 100 I NOw ON LOT 0 3 E.. [•,� �A(7 {�
USE OF 1 dd Lr
EXISTING BLDG. may, 71 dt, CT i {n n
SETBACK LINE FROM ((ICf Irt tl r! 1'-4 v;
CENTER OF STREET 45 REAR YARD 10 Li 4. .f(L/./f,.NI;e Yl V. k_ ��/
SIDE YARD RIGHT 10 LEFT 1O r/ v ////r/L� 1 _/1.��yK.t' .
DESCRIPTION OF WORK if ,/�/ DATE
VAR. Nu/fir AaArPROVED _ -1 i
NEW % ALTERATION ADDITION
REPAIR MOVING DEMOLISH '
BUILDING
SIZE /�, 11..2480 sq ft ROOMS 12 STORIES 2
EXTERIOR WALL ROOF hptmop COVERING stucco COVERING Q p
BUILDINGEW Apts. Triplex and attached
- 3 car gatage -, ci e G ' 71
,'j-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC.
TION. 1),..A____1/4_ te' '//y'[/�--_// VALUATION (�
SIGNATURETRE O PERMIT FEE S /T1 fS-O
SERMITTEE
$ ° 7+ PLAN CHECK S o2O. O
AUTHORIZED- GENT TOTAL FEE $ 64.S 0 SMF