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HomeMy WebLinkAbout1120 SALVADOR ST - Building Permits iii CITY OF COSTA MESA 4BUILDING DIVISION > q al a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER f t ,,,,„.,,,,,r1 t ra •PERMIT P03-00576 ,gyp (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1120 SALVADOR ST Status: ISSUED Suite No Applied: 09/05/2003 Issued: 09/05/2003 Vicinity: Parcel Nunmber: 14161424 ISSUED BY: Applicant: HALAJIAN, VAL Address: 7338 ETHEL - - - Phone: 800-444-8865 NORTH HOLLYWOOD,CA Zip: 91605 Owner: ': TILLY, WILLIAM D 1 , , Address 1120 SALVADOR ST • , Phone: , COSTA MESA,CA Zip: 92626 Contractor: ALAP ASSOCIATES GP • Address: 7338 ETHEL Phone: 800-444-8865 , NORTH HOLLYWOOD,CA Zip: 91605 License: 771905 4Z Arch / Eng: - � ,.�CYC�'�I Address: - - 9A-w I( Phone: Zip: - License: SCOPE OF PERMIT . WATER HEATER CHANGE OUT. . FEE SUMMARY AMT QTY AMT QTY AMT OTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 - Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal / $0.00 0 Clarifier System ' $0.00 0 - Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units \ $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 . Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set " $0.00 0 Drain, Floor $0.00 . 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 ‘ Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain.Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 .> Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS 7-1 ----1 WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: O 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 rk for which this permit is issued. I have and will maintain workers'compensation insurance,es required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insur carrier and policy number are: Carrier: `9141.C(._., Policy Number(N C 2'Y2 3 9 to , (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 700 o the Labor Code,I shall forthwith comply with these provisi . Applicant Signature: 4 Date: Cl. WARNING:FAILURE TO SECURE RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 10CIVI FINES UP TO ONE HUNDRED THOUSAND OOLARE($100,000),IN ADDTnON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: - I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N Class a Contractor's Signature: ` 1/ --./.2Date: LLL Cle. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: • Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031,5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or She Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 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 Ucense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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, (Will not employ anyone oto 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 —17-1;i3- (Section No one time has of the hand alifornia HealthaBand Saefyhazardous with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any q yequal 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 Flre 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 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 0 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 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 re 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. v „ ignalure Of Legal Owner(s) Ir •, e And/Or Authorized Applicant Date CODE i INSPECTION TYPE PATE. ILLS CODE! INSPECTION TYPE DATE KERN& 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 P,^�ICNIENCINEER:R CT ADDRESS: 1120 SALVADOR ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 055129 OWNER'S NAME: TILL? WILLIAM D ADDRESS: 1120 SALVADOR ST PERMIT NO: B 055129 PLAN CHECK NO: N GOVT: N SUPP; N COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT 5456381 REG.NO.: JOB DESCRIPTION : T/OFF RESHT REROOF W/ COMP SQ FT: 4 , 500 ADDRESS: UNIT: ' CLAIM VALUE: 4, 500 . 00 CALC—VALUE: 4, 500. 00 GROUP OCC: R-3 / PERMITTEE WILLIAM TILLY ( 714 ) 545-6381 ADDRESS: 1120 SALVADOR COMMENTS: T/OFF RESHT REROOF W/ COMP CM CA 92626 *************************************sFSF+ERE**+E**********RFSERESEj ****** FSE************ LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIR EMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in tuff force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3600.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 14161424 ZNE: REF NO: J Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is lot one hundred($100)or less). D E V E L O P M E N T 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.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY : DATE: Date: Signature: NOTICE:It.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. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED Brms.., DATE- Ill ) which this permit is issued(Section 3097.Civ.C). ******************** '-e-�''''---"' - - ' - ********** if ******* LENDER: ******************** ********************************** ADOREss: • LEGALIZATION:N F E E s U M MAR Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELE' RIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,atter,improve,demolish,or PERMIT 72 . 00 J 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 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RESS and Professions Code)of 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(5500). ISSUE FEE I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSU: PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered lor 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 property who builds or improves thereon.and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or 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 for the purpose of safe). 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 . a, and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law).l am aware **********************************,********************************************* that proof of thein Worker's Compensation insurance should be provided to me. I N D M D U A, L F E E BREAKDOWN u I am exempt under Section: B P 7044 B.A P.C. mrthis reason: ALL WORK BY OWNEG TYPE QTY D E S C R I P T I .0 N UNIT COST TOTAL COST Dale: //-1S— 9 ) Owner: '`T� II • Ido hereby certify that l am aware of and understand the requirements of California Health and Safety Cod Sections 25505,25533,and SFR 4500 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 4 , 500,00 25534 and that l or any future building occupant will/will not(circle one)need to comply with said state cod s and the requirements for a END OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. / Date: II Applicant: ' I hereby certify that I have read this application and state that the ab ormation is correct.I agree to comply with all city and county " ordinances and state laws relating to building construction and here aulhori representativ this city to enter upon the above-mentioned F 'w " _ — - v� =IT'('.- property lot inspection purposes. •- der Dare- II--/S—. 9 / Signature: —.4-- Driver's iDriver's License or Social Security ,• 164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor CONSTRyCTAND PLANNING PI & 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 z ._ 3. Electrical Conduit Uiility-Undrgrnd. 54. Forms :•4+.Electrical Conduit?Undrgrnd. 55. Electrical Bonding •'.5.:`3t'pel Reinforcement 56. Rough Plumbing & Pressure Testa -- • N'6;�'El ctrical OF ER.Grnd. 57. APPROVAL TO COVER-GUl t-t ,u . -•-C , • 7.•19otings ;� 58. Electrical Conduit-Undrgrnd. 1 t � .pFoundation 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 Lin€& House Connection 62. Backwash & Receptor-Final 12. Sewer Capy 63. Heater & Vent-Final • 13. Roof Drains L. 64. Plumbing System - Final f : 14. Rough Plumbiijg t 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 Electric`a1-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT V7. - 20:'Ro9h Factory Pii-eplace 'tn '- " c S x WPPRO;/A S• D.Pernhit# < :' - _ 21. Ducts,i0-Str cture, '..r.- �' � �" ' J "' 3t -`:70. Undetgrqund_Hro ,z 22. Ducts, Ventilating" • - ? a: ' ' 71. Product`NSibg Gf'Oas &Oil f I - - ti n• 23.;Gas Pip£Rough & test i. , _ _,, 72. Undergrntst FIJsh__ - --' •• 24.v-Roof Flaming . • '4 Y ;� i• a • 73. Undergrna!Storage;Tank ID Gas 0 Oa 25. Roc) Sheathing 'r; •C r ,(1 .D '74.'Overhead riydro-r .� x 26. T-Bar Ceiling (Structural) &4Nonocoat 'r - .r. • 75.-Dry Chemical - 27.-Fr4tne and Flash('pg. '^ 'r' ° 76: Dr Stan r 0:- r ,, h1 ,• 7_28. Lathing_-& Siding =. : • C:s-4 t >_ • ^ - 77.c.-FIXED 9YSTENF1h1NALt 1 - "r ALM r • "29. Insulatit n Tr r - :.i ". • �. 'f- 1 t+ 78..;:iFIRE PREV. FINAL -> .r X30. DrywalhNaittng O . t I HEALTH'DEPT; REQUIREMENT 1. Plaster Brown Coit, ,c I E. v ,79 rFINAL Ir gECTIQN ` .-32.,-Electrical Power Metet:Final t 0J • a 80..-FOOD IA FOOD CTIFATE ISSUED i- �334Fi(fel Etic_ trii• .y ' r S ?, Notes: (c ':. . _ er_ �Q C 34, Firg1 H ting`,& Air-Conditioning ( !, !♦;p Y s T. 35._Final Gas Pipe-Test' 7- - _1S ^ " •'S ,i36. Hood or-Canopy . " ,• =` o .�t;.• - rn e -4 -..:1 .37-Fin31 Factory Fireplace T. - ' 'A ° - T. rp .t .' - :L. . ;`38. Final Plumbing _ t ^ ^ 4t39. Wattir Service'Finalr - I :r,rl r 0 ;n40. Gas Service-Final , • _,- • .; - t t j,,; -.y~ • v41. Solar Domestic-Final s: •• r , ! - a: - ' . - , •, 42.Backflow Preventers ' j' 43. Backflow Irrj atiorr - s . '�'• - , u:T• m44. Landscape Irfiga[ion System-.,,,•; t; r _ _ _ _ • . I o 4'45.±Sound Atteouation •1- ^ * >�' '`� _r i - • . .. '1 IP . .1 v, _ v. '46.,Handicap Regulations .; ' •• p Co •'T 47SFlf AL STRUCTURE & BUILDING G1 /G(L'e ' - - _ _, _ rr G 48!-:FINAL PLANNING : n.: i >'. n ,,1 - :49r.Eleetric Release to-Edison . • I _ � V - I, F _ I` r - 50. Gas�,Regase to Southern California Gas Co ; E; - - r"-, + i-• ,51. CERTIFICATE OF OCCUPANCY -• , . No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. r� CITY OF COSTA MESA CO STRUC ION PERMIT PER °0 097/ TRACT NO. LOT NO. UNIT NO. 5I 79 2/I I/86 Fq� T� . Project'b.ddress //an �a Iva ©r /j('/ ,Applicant's Mailing Address Owner's NameTYPE OF CONSTRUCTION LI NEW U ADD U ALTERATION Le�/REPAIR - CO 7�11 / Phone0595 !l ❑ CONVERSION ❑ DEMOLISH CI OTHER A.P.# Zone ESCRIPTION OF WORK/USE OF BLDG. Address ZJ nit,r ryI�• S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING OUNDATION U STRUCTURAL E Front ZO El TENANT El ELECTRICAL PLUMBING El MECHANICAL Address ,) A Rear N " A „h QOQS ❑ OTHER C Right N Contractor's Nam- �1.11. • Phone C G Address(mailing) C / .Y� L • r�' PROJECT DESCRIPTION SO. FT. OCCUPANCY S Left D� / CONSTRUCTION TYPE VALUATION§ City License No. i ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: //'n �/h Planning Notes: O with section 7000) of Division 3 of the Business and Professions Code, and 1(lOC M my license is in fu -and effect. , (—t RCCEI�IED FEB 17UV T License la " •• / I ••s; 0 a J _ S Date " WA! Signature �''It1�U • . �_i v PLUMBING FEES _ A N 'YORKERS'COMPENSATION DECLARATION Bar Sink Showers iereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES A workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - 3800, Lab. ) / rr11 p fj - Automatic Washer Transformer 0 15-50 KW Policy No. e�/4i /d 0 Company JCn V1-1 Backflow Irrigation Sewer Cap0 50+KW 9 Construction Pole Sub. ertifietl copy is hereby furnished. Cerci i_e,cppy ik d with the city�il iv' iyy�� 2 Bathtubs Sewer Connection Cooking Unit Meter pup to 100 amps Date pNff/I ��11�� Applicant AA Yl� EXEM TIO FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps (This section need not be completed if the permit is for one hundred($100)or less). Dishwasher Solar Piping Dryers OG as ❑Electric Sub Panel I certify that in the performance of the work for which this permit Is issued I • shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0.1 HP 01%-B Workers' Compensation Laws of California. _ Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9.15 HP ❑16-15+ 'NOTICE:If,after making this declaration, you should become subject to tile Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance 9 of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors / Water Heater �.,s Outlets Lender's Name ( e t/ dt. Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbo a Dia oral following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap structure, prior to its issuance, also requires the applicant for such permit p Laundry Trays Generator ❑0.5 KW❑5.15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains ,.••.,fie Contractor's License Law(Chapter 9(commencing with Section 7000)of --vision 3 of the Business and Professions Code) or that he/she is exempt �� _ O31.5 by and the basiscfor the alleged txsmAey violationpic t ofa Section ii-ii/031.5 any applicant for a permit subjects the applicant to a civil _ e0 I, a of not r more than reprty hundred dollars($500). LJ I, n owner of the property my employeesctwith intens d f sole Reinspection Fee 1 $15 Issue Fee $ 3 compensation,(Section ec, will ao the work,and the f oIsnot :n TndeC or offeredracto1 - Reinspoetion Fee I $15 issue Fee $ 3 Lor nse awe to an and Professionalf a Code: The Contractor's MECHANICAL FEES erese Law does not apply to owner f a property Orwho builds or improves thereon, and, who does such work himself/herself of through his or ear own DEVELOPMENT SERVICES REQUIREMENTS: , employees,If, hthat such improvements are ootld Intended oeaofr red c for Boiler Hood oType ❑ sale. If, however,hewthe building ng improvementfro i sold within one your of nom- Canopy Type I I 0 Zoning Approved By Date- prove , the owner will nave the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date prove for the purpose of sale). �1 / ElI,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Date d '11-464,tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 04100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof off their worker's Compensation insurance should be provided me. PLAN CHECK $ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG* Fire Dampers PLUMBING $ 7500 ISSUANCE $ • Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000671 Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $' GRADING $ and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this city to '.ter upon the above-mentioned properly r inspection P .o / r r MECHANICAL $ TOTAL FEE $ (.5-04Signature 6 „SI , - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White . Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING PO i 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 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: 6`/9/87 °meat 9S am 803 oFr, zeta 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-Final 41. Solar Domestic-Final . 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed a 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - . 20200 COSTA MESA BUILDING-SAFETY DEPARTMENT F !nj P.O.BOX 317 COSTA MESA,CALIFORNIA E E t," �I V to zu L ' 5963 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT FINP1UIEDINIGn. BUILDING Cflar Olffice.(USen,OSIX ADDRESS 1120' Salvador Street 1' VRecvlP/rJrvo. IY f�Mrc NO. COSTA MESA, CALIFORNIA 0I Igen " DATE ECEIV DATEIBBUtD OWNER ' Mesa Del Mar Development Co. ref f 7 ez 6 Jul2 4 198a BUILDING MAIL . ADDRESS 3800 E. Coast Highway ADDRESS TEL Oriole IRE ZONE TYPE GROUP cm Cnrnna Del Mar, Calif.No.' 3_4220 APPROVED OR ENGINEER MaccO Realty Coaj t Oriole BY DATE ADDRESS /� Same as above 3'4220 ZONING ZONE NO.OF UBE OF NEW D1LLFj1• 1C'LI• R-1 I PLANS I BUILDING w/ att gar. CONTRACTOR Mare Realty Co. 2 LEGAL ADDRESS Same as above DESCRIPTION Tat. Rl 'Pro et 5023 CITY A.P.NO. none CaALC a3 above I - NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC.TNO. 207343-A-SB-1 NQ. Oriole 3-µ22O 30"TO SIDE A REAR P.L. EAVES SIZE 1 OF LOT 721 x 971 ' NOWo„LOT°None ALLOWED <U.B.C.REQUIREMENT/ YARDS APPROVED YARDS APPROVED USE OFNone MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C/LATREET) SETBACK LINE FROM Q ❑ CAU CENTER OF STREET 481 REAR YARD 28 1 611 FRONT4 FT. FT. SIDE YARD I LEFT D I I RIGHT R.SIDE i-0 FT FT. l6' DESCRIPTION OF WORK L.SIDE 1 NEW %. ALTERATION _ ADDITION _� REAR �� F7.,� FT. 1 DISTANCE BET. BET.MAIN& REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING ! NO.OF VAR.1C DATE SIZE K1LIx5.�O toROOMS R STORIES 2 C.U.P.# APPROVED EXTERIOR WALLWOOd & I ROOF APPROVE• COVERING COVERING A An a . 1 BY 3 DAT - -. USE OF BUILDI T•TTORK TO BE PERFORMED Single family dwelling w/attached Dwelling 2274 S ” garage. plan 600-DR Garage 453 S.F. N SQ.FT. ° I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATIONI THE AMOUNT SHOWN UNDER VALUATION IS FOR THE• AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m BUILDING CONSTRUCTION. �7�" N PERMIT FEE $ /al —" o SIGNATURE OF MaCCO Resit CO. _ . PERMITTEE "7 By:y:..; .X.,2, s 23,985.00 PLAN CHECK $�//"5 0 0 AUTHORIZED AGEN TOTAL FEE $/AL 5 !7