HomeMy WebLinkAbout1588 SAN BERNARDINO PL - Building Permits.,
NEWPORT-MESA UNIFIED SCHOOL DISTRICT 3 3 8 7.
4, CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: () ) City of Costa Mesa District Receipt No. 1(02.-00
( ) City of Newport Beach
( ) County of Orange Plan Check No. 1300.00031
Applicant: V- t T t-1 HART-
Address: ISS 6A-K1 ae12 PlA-g0 (t--Lp P . Cosa till=-9A , CA 12&C. )
Telephone Number: [a41) GA-, _ ,.0„ 0 ,
Tract/Parcel and Lot Number(s): 429 . 32-t . 34
Location of Project: IOS 'A1•1 13ERt.lAl2 ) IKID _PL . C.49T-A MSSA , G4 q 2_67'2-
Number of Square Feet of:
Residential Space 2=7 +0 x $1.84 Total +504- ( _ 6.0
Commercial and
Industrial Space x $ .30 Total
CommerciaUlndustrial Project is: (Check One)
_ Warehouse Motel /pPreschool
MovieRRepair
& D Bank 1 Autoital
Theater Neighborhood S alii _—
Hospital
Mini-storage Racquet/Health JUL 1 9 2000 _ Large Office
Heavy Industrial _ Hotel Office Bldg.
Regional Shops Medical Office CITY OF COSTA MESA _ Restaurant
Light Industrial Office Park Fast Food
__ This project is exempt because
ihis certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School District.
By: V - M EA-AO
Authorized Representative
The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not
true,then this certificateteshall automatically terminate and the appropriate City/County shall be n�otifiied.
Date: '//l1 0 C) /` e! / /(9{CJ
// A leant
`oSTn MFS
F 9 . CITY OF COSTA MESA
t ! BUILDING DIVISION
i 1) PERMIT NUMBER
�; DEVELOPMENT SERVICES DEPARTMENT O
PERMIT 1\ E00"00695
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1588 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 07/19/2000
Vicinity: WHOLE HOUSE Issued: 07/19/2000
Parcel Nunmber: 42532134
Applicant: HART, KEITH B ISSUED BY:
t2.-----
Address: 1588 SAN BERNARDINO PL
Phone: (949)646-6901
COSTA MESA,CA - Zip: 92627
Owner: HART, KEITH B •
Address 1588 SAN BERNARDINO PL
Phone: (949)646-6901
•
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
•
Zip:
License: 0 -
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR 2-STORY ADDITION TO EXISTING SINGLE FAMILY RESIDENCE. INSTALL
30 LIGHTS,40 OUTLETS,20 SWITCHES, 1-200 AMP ELECTRICAL SERVICE, 1 MOTOR TO 10 HP,
1 COMMUNICATION DROP,AND 1-200 AMP SUB-PANEL.
REF: B00-00831
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 $27.30 30 up to 50 kva/kw $0.00 0
Recept Outlets $34.60 40 up to 100 kva/kw $0.00 0
Switches $22.00 20 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 $30.50 1 Misc.Conduit $0.00 0
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 $4.75 1 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 $1.00 1 Investigation Fee $0.00
Sub panel to 200a $30.50 1 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 $174.15
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. oY
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 expiratioCn,oi tthis 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
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: • Policy Number:
(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
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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 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.# Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
1X-1,-Owner 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 exe p nder a Business and Professions Code for this reason:
(Signa ; cede ,- (
Expires:_eelf _
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,Califomia 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).
rdous...rnat__...-_..)?...
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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes U No
(Section 65650.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
__ _.__
6 Will any pan 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).
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 vanity 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-d cn d prope for Inspec pure as.I agree not to occupy or allow occupancy of any building authorized by this p it until final inspection.
�. 15 / 7/�/ 9
Signature Of Legal Owner(s), r / /a a_,_____r_.,.
le—
And/Or Authorized Applicant Date
CODE• INSPECTION TYPE PAI INTRIAl4 GOOF tNsPEcTIoNTYPE .Alg INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing ,
200 Final Re-Roof _ 210 Final Electrical Pr/or,
_
201 Final Block/Retaining Wall 212 Final Fire Prevention 1/
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
HO MFS
CITY OF COSTA MESA
i !" BUILDING DIVISION
i=' PE T NUMBER
r; DEVELOPMENT SERVICES DEPARTMENT 0
ai PERMIT \\`�
M1`"PORTfU�95A
M00-00291
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1588 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 07/19/2000
issued: 07/19/2000
Vicinity: WHOLE HOUSE
Parcel Number: 42532134 ISSUED BY:
Applicant: HART, KEITH B I`
Address: 1588 SAN BERNARDINO PL
Phone: (949)646-6901
COSTA MESA,CA Zip: 92627
Owner: HART, KEITH B
Address: 1588 SAN BERNARDINO PL
Phone: (949)646-6901
COSTA MESA,CA Zip: 92627
Contractor OWNER-BUILDER
Address:
Phone:
•
Zip:
License: 0
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
MECHANICAL PERMIT FOR 2-STORY ADDITION TO EXISTING SINGLE FAMILY RESIDENCE.
INSTALL 2 FAU'S UP OVER 100K BTU, 1 GAS PIPING,3 FACTORY FIREPLACES,&3 VENT
FANS.
REF: B00-00831
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $36.40 2 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $6.15 1 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $31.95 3 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $21.75 3 Over'50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000dm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $119.75
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 codd all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.ofihis permit.
FOR INSPECTIONS CALL: (714)754-5626
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: - Policy Number:
(This section need not be completed lithe permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO THE MKT 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(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# _ Class N
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penally 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 properly,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,end 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 exemptunder sec. Business and Professions Code for this reason:
Signature: / Cr- (
` xpires`
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 ❑No
(Section 25505 of the Califomia 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 0 No
(Section 25533 of the Califomia 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a rmit 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 0peNo
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes in NO
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 II a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If'ryes",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 ell stale 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 lawsandcity ordinances relating to building construction,and authorize representatives
of the City of Costa Mesa to enter upon the
above-4e;pribed pro rty for i p ction pup es.I agree not to occupy or allow occupancy of any building authorized byxthispe it until final inspection.
/� / a CJ
�ignalure Of Legal Owner(s)- LDate -- --
And/Or Authorized Applicant Date
CODE ri INSPECTION TYPE DATE JNTITIALf3 CODES INSPECTION TYPE INTRIAL$
P,
1616 Fixed System Final Fire Prevention 206 Final Mechanical S-a6-04
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
•
•
`0ti MFS
9. CITY OF COSTA MESA
rFt BUILDING DIVISION
� DEVELOPMENT SERVICES DEPARTMENT c�`DV PERMIT NUMBER
h a
PERMIT IQ
7`, •t...*ro�e. P00-00389
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1588 SAN BERNARDINO PL Status: ISSUED
Suite No Applied: 07/19/2000
Issued: 07/19/2000
Vicinity: WHOLE HOUSE
Parcel Nunmber: 42532134 ISSUED BY:
Applicant: HART, KEITH B
Address: 1588 SAN BERNARDINO PL
Phone: (949)646-6901
COSTA MESA,CA Zip: 92627
Owner: HART, KEITH B
Address 1588 SAN BERNARDINO PL
Phone: (949)646-6901
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
. Address: - •
' Phone:
Zip:
License: 0 .
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING PERMIT FOR 2-STORY ADDITION TO EXISTING SINGLE FAMILY RESIDENCE. INSTALL 3
BATHTUBS, 1 DISHWASHER, UP TO 4 GAS OUTLETS, 1 SHOWER, 1 BAR SINK, 1 KITCHEN SINK, 5
WASH BASINS,4 WASTE&VENT SYSTEMS,4 WATER CLOSETS,& 1 WATER PIPING.
REF:B00-00831
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 $29.40 3 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 $49.00 5
Dishwasher $9.80 1 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 $39.20 4
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $39.20 4
Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $9.80 1 Water Piping(Ins(or Rep.) $9.80 1
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) $6.15 1 Sink,kitchen $9.80 1 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: $235.45
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 j
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 C/
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.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: • Policy Number:
(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
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
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 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.).
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, end who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I amaze t u er sec. Business and Professions Code for this reason:
+
1 Signature: r — Date: SILT-•-•
Owner ID v Ifie by driver's license. ❑Yes 0 No 1_,Driver's-Llcense No. Expires:—
Verification
xpires:-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? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and PreventionProgram for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia 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? ❑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 a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? yes j�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? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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 complyywith all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
abov�s e insp do purposes.I a ree not to occupy or allow occupancy of any building authorized b thiperm'� final inspection.
S -nature Of Legal Owners)r / Date
And/Or Authorized Applicant Date
CODES INSPECTION TYPE DATE INTRIALS CODEC INSPECTION TYPE IAF INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing I CD'3 I'CI)) Q N
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
• `Og1n bFS CITY OF COSTA MESA '
0. S BUILDING DIVISION•
DEVELOPMENT SERVICES DEPARTMENT A,JA0%J PERMIT BER
PERMIT B00-0 31
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1588 SAN BERNARDINO PL Status: ISSUED
Suite: Applied: 06/08/2000
Vicinity: NEW 2-STORY ADDITION ATTATCHED TO GARAGE • Issued: 07/18/2000
Parcel Number 42532134 Zoning:
• Applicant: HART, KEITH B ISSUED BY:
Address: 1588 SAN BERNARDINO PL
Phone: (949)646-6901
COSTA MESA,CA Zip: 92627
Owner: HART, KEITH B
Address 1588 SAN BERNARDINO PL
Phone: (949)646-6901
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER •
Address:
Phone:
Zip: License: 0
Arch : Eng:
•S.,
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 2740 SQ FT 1ST&2ND STORY ADDITION TO EXISTING SINGLE FAMILY RESIDENCE.
FEE SUMMARY
Plan Check: $1,137.34 .Calc Valuation: $234,270.00
Permit: $1,749.75 Claim Valuation: - so.00
SMIP Res: $23.43
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $2,910.52
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 20-0 Rear 33-0 Left 16-0 Right 5-0
ACCESSORY Front 67-0 . Rear 10-0 Left 5-0 Right 40-0
PARKING Existing: 2 Required: 2 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
In. 1
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(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
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions 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.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
_ _sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and wh contrggqcccts for such project with a contractor(s)
license pursuant nt to the Contractors License Laws.). -7 /a o
❑_.I.am ex mpt nde sec. Business and Professions Code for this reason: /
� gnetum� L
O
Owner ID v rifled by driver's license. ❑Ves 0 No rDrivefsLlcense No. (Expires:_ 7- 7Q '�
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:
I 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 Califomia 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 ❑Na
(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 permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with 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.
SgnatureOf LegaPOwner(s)— Late
And/Or Authorized Applicant Date
CODE r. INSPECTION TYPE DATE, INTITIALE C 0 • INSPECTION TYPE &La INTITIALS
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 Q 1,
244646
ADDRESS of BUILDING( SAN BERNARVINV a urs: CITY OF COSTA MESA — BUILDING PERMIT l(/q( / - WC)I l)
OATIERS NAME IF MOWN: HART, KEITH B
PERM NO: B 08562E
"-- HART, HOLLY R
1588 SAN BERNARDINO PL PERMIT NO: B 085628 PLAN CHECK NO: 01418-97 L GOVT: N SUPP: N
COSTA MESA,CA 92627646-6901
APDL.(MUM ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: NEW
ARCHITECT OR ENGINEER: OPTION ONE ENGINEERING ue�: 48386 JOB DESCKlYIION : 656SF DWELLING ADDOVER 7345E GARAGE SQ FT: 1 , 390
ARCH.OR ENG.'S ADDRESS9M:20311 ACACIA 240
NEWPORT BEACH CA 92660 CLAIM VALUE: 50, 000 . 00 CALC—VALUE: 74 , 472 . 20 GROUP OCC: R-1 /U-1
CONTRACTORS NAYS:
COMMENTS: "HART RESIDENCE"
CONTRACTORSMMUND R'1!'RT'lC1C**iiiiR'1t1t1tx**ft%'R'If9t'RRR1F1wx R**x****ft1F***R'RR**ifiiiiik iiiiik**:rnfri t'X1t'h1t'ft T"R TR 1i ii-****** 9t'N'1!
ADDRESS: MC.NO.: ZONING REQUIREMENTS
UM: S E T B A C K S
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I ern licensed under provisions of Chapter 9
(commencing with Section 7000)of Div on 3 of the Business and Professions Code,end my license is in bunand effect.
CITY LIC.No.: MC.CLASS: LIC.No.:
LAP : MAIN BUILDING ACCESSORY BUILDING
FRNT: 20 FT IN REAR: 10 FT IN FRNT : FT IN REAR: FT IN
Data: Contrador: LEFT: 5 FT IN RGHT: 5 FT IN LEFT : FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby elfin under penalty d perjury that 1 am exempt from the Contractors License Law for the PARKING REQ: PROV: PARCEL : 42532134 L N E: — L MU REF t N V:
dowing reason(Section 7031.5 Business and Professors Code:Any city or county which requires a pease to oonatmct,alter,improve,
widish.or repaid any structure.prior to its issuance.also requires the applicant for such permit to Nee signed elaenm reNeth or she PLANNING NOTES> DEMO EX. 1 CAR GARAGE. BUILD NEW GARAGE Wi 2 BDRMS ABOVE +
e licensed pursuant to the provisions of to Contractors License Lew(Chapter 9(commencing with Section 7000)of Division 3 of the 11,..---1ST FLR CONNECTION W/ E X. SED . 9-5 C V RR:MODIFY F T. E L E V
Business and Professionstfora elatsmhstshe is exempt to therefrom eerd thenot basis for the dlegnddremprOe. violation550 . Section ii it it di*********46,M,********************************x ie ik ie w ie ii ii ie rri*is n ii dr it ii ie it;ie iv it ie di it x it side it iiia
Busi.ebyanyeoflsioaeperilhat hctotshe is exemtohdef penalty thnbtsisrfo than aceed exedpto, (Sy .
❑ I.as owner o the properly or my employees with wages as Nei sob compensation,will do to work,and the slnclure is not intended D E V hili O P M E N T SERVICES REQUIREMENTS
or offered ler sale(Section 7044,Business and Professions Code:The Contractors License Lew does not apply to an owner of properly '-(-'r '^��
who builds or improves thereon,end who does audi work himself or herself or through he or her own employees,provided that such --�-
ownerbmeMaarehovithrcbrorprhowever.did theilbuilding prie fo drawee of withinoneyeardmmplaton,Ih ZONING lTVG APPROVE]) BY ••
�J1 DATE
o
improvements
will have the burden of offered for he or she die not build or improve la the purynse ode). !^i
❑ I.as owner of the properly.am exclusively contracting with licensed contractors to mW
nudtheproject(Section7014,Businessand BUILDING APPROVED BY : A DATE: SI
Professions Code:The Contractors License Law does not apply to an owner of who builds or improves thereon and who / ,.(m.� cJ
._ contracts for such propds with on (s)licensed pursuant tothe License Law).__ _ __
BY /V H V K UlLULtt APPLICATION ISSUED BY : DATE:
em exempt u con: R.&P.C.,M Nb
' ie ie ie it it it ie ii it if iF ii ii ilii ii ii iixxii itx7ex xxx xxzzxxvezxzz wen x 3ex*xxvezzzxxxai ii ii it is ie ie iP iE iizzzzzzzzzzie it
&.e: owner: 1/44 -.- LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I . do he,• aeniN that 1 em aware d and understand the requirements d h California thea and&day Cade medians 25505,25533.and
•NsIor any future building oddment will ywll not(circle one)need to comply withsaid stern codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANICFIRE SMTP/RES GRADING
,' for construction or modification from the Ab�ityMaanagement Distrid.Reaidenlal oonstmdon applications ere exempt from mase PERMIT
731 . 00 7. 45
. SMIP/NON—RES
Date: Applicant -- PLAN 475 . 15
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedwatona: ISSUE FEE E fC`
❑ l have and el maintain a certificate o consent tosei-insure for workers'compensaton,asprovded for by Section 3]OOd the Leber BUILD ING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE.
Code,for thepedennanceofteworkforwNchNepermiteesued. TOTALS----> 738 . 45 0 . 00 ' 475 . 15 1213 . 60 1213 . 60 . 00
have end will maintain workers'compensation insurance.as required Section 3700 of the Labor Code,for theCil"
❑ penreq byperformance dlh
work for which Ne permit is issued.My workers'compensation insurance cattier and policy number we: t E_--_
Garner: REVENUE DIVISION TOTALS--> COLLIECTED: �— 762. 82 OVER/SHORT: . VU
Policy Number: -- - - - - - BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN—CHECK
(This section need not be completed 1bepmrest is for one hundred dollars MOO)or less.) 731 00 7 45 24 , 37
❑ I codify Net in the performance of the work for whkh thio permit a issued,l shall not employ any postern in any manner o n to x. .il'ieieie'rt'leiEieitie'leieteieiiitii'itieiiiiiiir'itit3tftzitxtleltii'iriFie'rtiti<iertititieit'ltii3titieiijtiiii* sit'***it'ii'ieieieieieieieitxii'iiliit..xx
became subject to the workers compensation laws d California,and agree that e I should become&aped to the wonders'
compensation proveore d Section 3700 d the Labor Coda,I shall forthwith comply wvh Nessa provisions. - IND I V I D U A L! F E E BREAKDOWN
Date: Apploam:
TYPE QTY U h b L_ ti I Y 1 1 v' N UNIT COST TOTAL COST
Warning:Failure to secure workers'compensation coverage Is unlawful,and shall sublet(an employer to criminal penalties and
SWWIection
fines up to one hundred thousand dollars($mOQ009A M addition b the cost of comperualbR damages es Provided for In
Sectin 3706 of the Labor Cods,Interest,and afamsys/ese SFR 7730 DWE—TYPE V—WOOD FRAME —GOOD 80 . 60 58, 838, 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty d n
perjury that there is a concoction lending agency car the SR /34 RES—GARAGES TYPE V 21 . 30 15, b34 , 2V
performance of the work for which this pewee is entad(Section 3097,Civ.C). END OF FEES
LENDER'S NAME: I �r^
LENDER'Smathis
ADDRESS: sip �.q,,(�L, ��/)
Ind slate taws
have need the application and date that the above inlamalionacarred.l agree to comply with all city and county dpropcaa '{is• 1,81
and laws reletip to building Construction and hereby authorize representatives d the city to enter upon the above-mentioned doped). dY�l
for inspection purpoaea. HOLLY L Y HART .��n ,..F fp :,• i vPSR owts+ t� s v IRO. 05 1997 b 0 1
xt-i %
psta 1(-5,--C7 Pm�� �s Fk ��D �p� �L�
P'` e''�
CITY/,OF COSTA MESA L�
Signature ApplcanVCOMredor t v
10 31RS
(5151-46.W P) White-Building A Safely:Green-Fife;Canary-Appficent:Pink-Revenue;Goldenrod-Assessor
I II
• CONSTRUCTION AND PLANNING PC A SPA .
APPROVALS Permit# - Date Inspector APPROVALS Permit #
J - Date • Inspector
:«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. ElectricalOPERGrnd. - 57; APPROVAL TO COVER-GUNITE •
7, .Footings1 ` • 58. Electrical Conduit-Undrgrnd. .
B. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test-
9.-Water Pipe-Undrgrnd. - . : -60. Backwash Lines, P-Trap, 0 Uhdrgrnd.
_ 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.E Rough Factory Fjreplace . ' _" APPROVALS - Permit# "
21,-Ducts,in,Structure: -- •- t _ - - .ti - 70.-Undefgiound Hydro
22. Dulls, Ventilating : 3 - " ! 'y 71. Prodtict'Piping0 Gas DOil
23..Gas.Pipe-Rough & Test ; - _ - n _ 72, Underground Flush -• -
24. Roof Framing : : - - - t r, 73. Undergrnd.Storage Tank D Gas 0 Oil
25. Roof Sheathing 31 /' �(/s'S'- , 7.4..Overhead Hydro..
26. T-Bar Ceiling (Structural) & Monocoat ' . -- `.'a. 75.'Dry'Chemical -• - - ; '•
27. Frame and Flashing 76. Dry Standpipe-
28. Lathing-& Siding. ; - Ti ' ^ ',1...i '• -it 17, FIXED SYSTEM FINAL - r
29. Insulation , - •- •• - L. ti _78. FIRE PREY. FINAL "
30- Drywall Nailingf
-. HEALTH DEPT: REQUIREMENT
31. Plaster Brown Coat: - - 79. FINAL'INSPECTION - - _
32. Electrical Power tvleter-Final I ' . 80. FOOD CERTIFICATE ISSUED - '
33. Final Electric `r Notes: ell b/£r Ot r0 ee )r v-
34. Final Heating& Air Conditioning- w!! [�G - f•'
35. Final Gas Pipe-Test, :. . , - :-
36. Hood or Canopy - • -
37,.Final Factory Fireplace _ , - - - .:
38. Final Plumbing - j _ - k - --
• 39. Water Service:Final , - - c
40. Gas Service-Final _ - - - • - . . - •
41. Solar Domestic-Final ..." - "
42. backflow Preventer ... -
43. Backflow Irrigation. - - - - 2.
,44. Landscape Irrigation System - -- - • - • : J ' . - Z �•
45- Sound Attenuation •
:46-.Handicap Regulations - - - -
47, FINAL STRUCTURE & BUILDING - -
. 48. FINAL PLANNING . , si • • -
49; Electric Release to Edison _ _ -
50. Gas Release to SouthernCalifornia Gas CO -- - • -
51, CERTIFICATE OF OCCUPANCY -
No. Date
r
2306
NEWPORT-MESA UNIFIED SCHOOL DISTRICT •
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES •
PURSUANT TO AB 1600 AND AB 181
To: (�) City of Costa Mesa District Receipt No. 0/3`/8?
( ) CityofNewportBeach 10541?
( ) County of Orange } I� Plan Check No. l4lgg7
e 1 04 } l N1�-�
Applicant: Q A^
Address: ISBS &! g`€ zn n t \ L • Oil
Telephone Numberjl i*) (04Lip w i(;)
Tract/Parcel and Lot Number(s): Q
Location of Project: 1c8` S� &��a DwO \ L - t CM
Number of Square Feet of: '/ • O
Residential Space e 77 5 x $1.84 Total /6p 05 . O8
Residential/
Sr. Citizen Space x $ .30 Total
Commercial and
Industrial Space x $ :30 Total
Commercial/Industrial Project is: (Check One)
Warehouse Motel Preschool
R & D Bank Auto Repair
_ Movie Theater _ Neighborhood Shops Hospital
Mini-storage Racquet/Health Large Office
Heavy Industrial _ Hotel _ Office Bldg.
Regional Shops Medical Office Restaurant
Light Industrial _ Office Park _ Fast Food
This project is exempt because
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this •roposed development may now be issued by your jurisdiction.
Checks are to be made payable to Newport-Mesa Unified School I rict.
By. /
Authorized Representative
The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not
true,then this certificate shall automatically terminate and the appropriate City/ unty shall be notified. .
t
Date: f ( ? -01 _ 14 .i -
Applicant
1700 SAN HLKNAEWINV YL CITY OF COSTA MESA - BUILDING PERMIT e97- QO _v
ADDRESS OF BUILDING: UNI:
OWNER'S NAME IF MOMHAK1 , KEITH B PERM NO: E. 08562S
ADDRESS' HArT, HOLLY K
1588 SAN BERNARDINO PL PERMIT NO; E 085629 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 9262 /646-6901.
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE; V—N PERMIT TYPE: ELE PURPOSE: NEW
ARCHITECT OR ENGINEER: OPTION ONE ENGINEERING MHO
.: 48386 JOB DESCRIPTION : 656SF DWELLING ALLOVER 734SF GARAGE SQ FT :
ARCH.OR ENC.'S ADDRESS: LU311 ACACIA OMT: 240
NEWPORT BEACH CA 92660 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-1 /U-1
CONTRACTOR'S NAME " ART ..
CONTPACTORS MNIING COMMENTS : HART RESIDENCE' REF:B-85628
W W W ii********W ie ii W ii ii ii ii ie ii****************************************W**ii**ii*****W*Wii*
ADDRESS: LC.NO.:
DMD Z ON ING REQUIREMENTSS
LICENSED CONTRACTORS DECLARATION:I hereby elfin under perwAy d perjury that
1 am tensed under provisions d Chapter 9 S L 1 )j AC K S
(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license a in IMD IWF®and effect.
CITY VC.NO.: UC.CLASS: UC.NO.: LAP MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT : FT IN REAR: FT IN
Dale: Contractor: LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby Arm under penally of perjury that I am exempt from the Contractors License Law for the PARKING KL PkOV: PARCEL; 42532134 LNL: REF NV:
Atoning reason(Sedan 7031.5 Business and Professions Cole:Any csy or county which requires a peto construct,cher.improve,
emdth.or repel any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he or she PLANNING NU T E S>
a licensed pursuant to the provisions of the Contradors License Law[Chapter 9(commenting with Section 7000)of Derision 3 of the >
Business and Professions Code]or that he s r she is exempt therefrom and the bafor the alleged exemption.M y violation of Section -
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than Tree hundred dollars($5001). ********W*****W***W****W*****WWWWi;**W*ii************W W*******ii****W********W*W**
❑ I,as owner cfthpmpeny wmyempayees with:sages as their sole compensation win do the work,and the structure lsnd intended DEVELOPMENT S •E R V I C E S REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Codde:The Contractors License Law does riot apply l0 an owner of property kit .
who buids or improves thereon,and who does such work himself or herself or through his a her own employees,provided that such
improvements are not inlendedwdleredforsate.N.however.the building or knprovementssold within as yam of completion, ZONING APPROVED BY LATE:
owneriouilder will have the burden d proving he or she did not build or improve for the purpose d sale).
❑ I.as owner of the properly.am exdusivey contradng with licensed contractors to construct the project(Sedan 7044,Business and BUILDING APPROVED BY .
DATE:
Contract=Profeasiona Code:The Contract=License so
Law does t apply an of who to ownerproperty who or improves thereon and who ..i'.
L_I contracts for such propria writ acract ))licensed pursuant to the Conlfadwa License wl__ _-- —_ _.. _,,
t1Y /094 ___—_
urn: �ptu rye-Lga B.APreaeorF VW UlLL K APPLICATION ISSUED BY: DATE:
I � 1 � • � 1/ **********************xxxxxxxxxxxxTvxxxxx xxxxxxxxxxxxxx****ii***** xx xx*
Lie Owner: ` LEGALIZATION:N F E E SUMMARY STRUCTURAL EGMENT:N
' reby candy that I am aware of and understand the requirements of Caldomad
Health and Safety Code Sections 25505.24413.end
one)andwillnotwith BLDG PMT PLUMBING ELECTRIC , . MECHANIC FIRE SMIP/RES GRADING
nlorconevudionwmodi9ratanhom'heAv Ouabm
lYMagement Dimnq.Residential mnetrudion applastam
nee exemgfrom these PERMIT 38 .:25 ,
provisions.
50% • SMIP%NON—RES
Date: Applicant: PLAN -
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE 22 . 00
❑ Ihave and wilmantaoacertificate dconsent tosehMeure for workers'compensation,mprovidedfobyRadian 37OOdthe Labor BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.for the pedormance of the wok for which this permit s issued. TOTALS----> 38 , 25 22 . 00 0 . 00 60 . 25 60 , 25 . 00
❑ I have and wit maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance d the
work krwnidr this perms is issued.My workers' •
n innce conier.nd perky number are: REVENUE DIVISION TOTALS--> I.OLLEC:TED: i-.. 60 , 25 OVER/SHORT: 00
Carrier BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP%TOT GRADING PLAN—CHECK
Policy Number:
(This section need not be completed if the peers is for one hundred dollars MOO)or leas.) 60 . 25 n
❑ Icen(y that in the performance 4th work for which this pamunaiand that employ person in any manner isoess'lo
W*WWWW************ii*ilii**iiiiiiSSS*S********************ii******************W****Se
become subject to the workers'compensation laws of California, and agree that d I should become subject to the workers'
x*
compensation provoime d Sedion 3100 d the Labor Code.I shall fanhwith comply with those provisions. INDIVIDUAL ....,FEE BREAKDOWN
Date: Applicant:
TYPE wiz L L S L_. K 1 V 1 1 V N%' UNIT COST TOTAL COST
_. Warning:Failure to secure sweetie compensation coverage/a unlawful,and shall subject an employer to criminal penalties and
civil gnu up to one hundred thousand dollars($104000),In add/lion to Me coal of compensation damages as provided for in •
Section 3706 o Me Labor Code,!Meant,andattomay'a/ees. LLL 12 FIXTURES, _LIGHTING _ 1 ST 20 EA. 1 . 00 1_2 , 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that them a a construction lending agency for the LLL L U kECEPT/V UTL ET 1 S T L V LA. 1 . V U L t , 00
performancad the work forwhich thispems is issued(Sectan 3097,Cis C). ELE 2 RECEPT/SWITCH 1 ST 20 EA. 1 . 0_0_ 2 . 000
LENDER'S NAME: ELE 1 MOTOR/POWR APPARATUS 0 , 0 — 1 . 0 HP 4 . 27 4 . 25
LENDER'S ADDRESS: ENL V YF
ei
I certify that I have read this application and staleis that the above informationcorral.I agree to comply with an
with all dry and county ordinances
m!!�''mm��'�
and stale laws rehab°to bulking oonwuc ion and hereby authorize representatives of this dry to enter upon the above-mentioned property D
fes inspection purposes. HOLLY HART )
p� owNt(LS l�"t�vESj
Pont m viiiJ11 TE`r itT « e*Tt-r.,0e .: 1 NOV 05 1997
Bigrst AOenVAp Y anucontredw To LAI Ica- CITY OF COSTA MESA .
(5151-46.WP) white-Building&Safety:Green-Rle:Canary-Appicant;Pink-Revenue;Goldenmd.bsessor
•
CONSTRUCTION AND PLANNINGPC & SPA
APPROVALS Permit # Date Inspector L "APPROVALS Permit# Date Inspector
•
1. Temporary Electrical Service or Pole ' , 52. Pool & Equipment Location
2. Seidl Pipe-Undrgrnd. - • 53. Steel Reinforcement
3. Electricak.Cohduit Utility-Undrgrnd. - ' 54. Forms - - .
4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding
• •5. Steel Reinforcement I 56. Rough Plumbing & Pressure Test '• ��-
J i
_6. Electrical DEER Grnd. I � WG 57. APPROVAL TO COVER•GUNITE- ' .
f i
7.-.Footings._ ,- - 58. Electrical Conduit-Undrgrnd. .
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test ' .
•
9. Water Pipe-Undrgrnd. - r. 60. Backwash Lines,"P-Trap,0 Undrgrnd.
10. Structural Floor System . " 61. APPROVAL TODECK �,,.!
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 - �.,
g ., 65. Electrical-Final ,
' 15. Rough Electrical-Conduit :. 66. Solar System-Final '
-
16. Rough Electric Wiring i 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 Fleplace - 37 4. 71 APP 30 ACS Permit#"
21.-Ducts,in Strnctu�er :' = 70.-'Undetgroubd Hydro ' ,
22. Ducts, Ventilating; _ - a ` 71. ProduckPj ping't7,Gas ,0 Oil
23.-Gas.Pipe4Rough & Test n._ q J: . 72, Underground FIush - -
24. Roof Framing : r , - i .A Y
-^ , ? 7.1. Undergrnd.Storage Tank D Gas 0-TI '
25. Root Sheathing , , t. - 7`4. Overhead Hydio
26.--T-Bar Ceiling (StrUcturall &:Monocoat _ - y . 75. Dry Chemical - •
27. Frame and Plashing; ._. , J.: 76. Dry Standpipe
28. Latlhingr& Sidingr7 v r _ '• •' 77. FIXED;StSTgN FIN4L -, ;i 2
' 29. Insulation ,r1- - .. :. 7B. FIRE PREY. FINAL r - - '
c_ 30. Drywall=Nailing i I, _ HEALFIi_DEPT.1REQUIRE(v1ENT
K q
- 31. Plaster Blown Coat, - . . s ;r ,• 79. FINAL INSPECTION _ i
32.*Electrical Power Metec-Final i 1., : 80. FOOD CERTIFICATE ISSUED
J _
33.'-Fina1 Electric - -. , [Votes:-
�13 1_f k67. �0 4&''P_AR71I��=1}NRcRGRoUNp
34Final Heating;& Air Conditioning- '� >:'. `,- ..17----
. ,
r. 6--r-f8_ T�A•�r.�v, f- tri -ci]_�l«,1G l,cxz G('
35. Final Gay& Pipe-Test,` x ,1 r •` ., // �/ - , ` _ --
O K._X�F�t" , 'z
36. Hood or-Canopy .: - ' "i•, •• : - -�" _
- r _ 'ti. n 5 t r. • TI
37.-Final Factory Fireplace . - ,_ ( - ,- r -�
. _
r,.
38. Final Plumbing • - [ - _ •- • a ' s,-- rte)
39. Water Service-Final' • - `4% -rr
ra
, 40. Gas Service-Final : :T1 I -, -7 - _ - - - -- "
r 41. Solar Domestic-Final - .. - -
42. Backflow Preventer, ,; .
4.
-43. Backflow Irrigation', -• - •
I. • . •
:44. Landscape I4rigation Systems r - _ • • i _ _
'45. Sound Attenuatiori r - 1. ti, ri-• '-
-46.,Handicap Regulations :5
- - -
47. FINAL STRUCTURE & BUILDING i ''' '
•
48. FIN'ALPLANNING - . , T.
'n •
49. Electric Release to Edison i' -
50.,Gas Release to Southern California Gas Co - ', - •
51. CERTIFICATE OF OCCUPANCY , -. -
-
- - '
No. Date
/J ♦1. y
♦
/ 1 _•.
ADORESSOFBULLDWG Dbb S NBtKN KUINU YL OMT: CITY OF COSTA MESA — BUILDING PERMIT
n7---- ol0/at _
INMEas YAM 100MBART, KEITH B PERM NO: P Ub5b31
ADDRESS HART, HOLLY R
1588 SAN BERNARDINO PL PERMIT NO: P 085631 PLAN CHECK NO: N GOVT: N SUPP: N
"O�A MESA, CA 92627646-6901
Apel.WARM ADDRESS CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: NEW
ARCHITECT OR ENGINEER: OPTION ONE ENGINEERINGtieND.: 48386 JOB DESCRIPTION : 656SF DWELLING ADDOVER 734SF GARAGE SQ FT: .
ARCNOR ENG.'S ADDRESS: 20311 ACACIA WIT: 240
, NEWPORT BEACH CA 92660 CLAIM VALUE: CALC—VALUE: GROUP MCC: R-1 /0-1
CONTRACTOR'SNABS '
CONTRACTORS xMlwD COMMENTS: "HART RESIDENCE" REF:B-85628 1.
is ii-Yr ii-ie ie it*ii-Ye'is it bei*******ie it ie ieieieieitieisitis irii**iii er it is is be irYe ie***ieisisisitis**dodrie**x ie ie ii Yr**it it ie Ye*is ii Si x it it
ADDRESS: UC.NG:
gMr: ZONING REQUIREMENTS
SETBACKS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in Wm"and effect.
Cm LIC.NO.: LIQ CLASS: LIC.NO.: EXY: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: LEFT; FT IN RGHT: FT IN LEFT : FT IN RGHT: FT IN
OWNER BUILDER DECORATION:I hereby affirm under penalty of perjury that I am exempt frau the Contractors License Law for the
ilbwing reason(Seddon 7031.5 Business and Professions Code:Any cey or county which requires a perms to construct alter,improve, PARKING REQ: PRu V: PARCEL: 42532134 Z N E: REF NO: '
e
coolish,or repair any structure.Mot to is issuance,also requires the applicant for such permit to file a signed statement that he or she PLANNING N V T E S>
is licensed pursuant to the d)provisions of the she is xe License Law[Chapter 9a is(commencing Rid Sectioni ].M v Divisionon 3 e theBu >
7031,5 by and PrdeaioruCapalortsuthe hesisexem to a&ilnalty thosisfathe alleged dolfa.A55violationdSermon *YE**Yr ieie ii**ieic ii x SWie'chic'sis'V'VS****Yr is ie de it ie ie ie ii x irie ie Speirs ie5 ieie itbeit YE ii*ie Tait'a Yr*Si Yr ie ii'*Yr**iE to a jar jr Si ie ie ii
]031.5 any applicant for a permit subjects the applicant a evil penalty of not more than Ms hundred dollen(5500)).
❑ I,asownerelthepropendormyenpkyeeswithwagesastheirsobcompensalbn.willdothework.andprestructureisnotintended DEVELOPMENT SERVICESKREQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner d properly (,,/_
who builds or improves thereon.and wte does such wok himself or herself or through he Of her own employees,podded that such
•
improvements are not intended or offered fa sale.IL however,the building or improvement u sod within one year of completion,the ZONING APPROVED BY — LATE;
owner-budder will have the burden of proving he or she did not build or improve la the purpose of sale). r•A-- -
❑ I.sowner o the properly,am exclusively contracting with licensed contraction to construct the project(Section 7044,Business and BUILDING APPROVED BY : DATE:
Professions Coda:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who n
Ie to sudh pgects with A mnttpdp e)t caned pursuant to the Conft ' e Law&.__ _ —_ _ _ _ ._.OF /049 �WN K BU LUtR ADPL1l.AITUN ISSUED BY; LATE:•RampunderSeclbn: 8.8 P.C..bthb iiTairaieieieWW7tIt7tWSiriEii**WWWVxxxx'tetetxxatxxtex V xxSrlexsr*nrxxxitivyr-w eieieTairaieieTaira x ter x sowner LEGALIZATION:N F E E S U M M A R Y STRlC1URAL SEG ENT:N
certify that Iern aware of and understand the requirements o California Health and Safely Code Sends 25505,25533.and MmlaanyMureslwill/wllnal(drionelneedtocomplywisheaconeandtherequk^memsfa BLDG PM1 PLUMBING ELECTRIC MECHANIC FIRE SMIP%RES GRADING
or construction or modification from the Rx eManagement District.Residential construction applications are exempt from these PERMIT 103 . 00
provisions.
25% SMTP/NON—RES
Dale: Applicant:l PLAN_ FEE
_ _ _
WORKER'S COMPENSATION DECLARATION:I hereby alunder penally d perjury one Mowing el the bwing declarations: ISSUE !•E E 2 2 . 0
❑ !have and MI maintain a carded,ol consent to sell-insure for workers'compensation,as provided for by Session 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code lor the pedamanceof the work for which this permit isissued. TrJTALS----el 10:3 . 00 22 .00 0.00 125.00 125 . 00
Elm
I have and wit maintain workers' npensmas un insurance, required by Seddon 3700 of the Labor Code.tor the performance of the l U
work for which this permit is issued.My workers'compensation insurance Maier and policy number em: y( •ys.lyJ 11.1.!{1'11 l 1 L� \!.'1_
tttt t1V 1 ' ' t-J/Av. **w: �' �z : E1Ei__LJyERISHuRi: •00
•
adwyrrdamber. - —- �' L t�i4 PEST`I LlTrM6 f ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—LIECK
(This section need not be completed(the permit is for one hundred dollars($100)or less.) 125 . 00
❑ I cenly that in The Mdormence of the work for which this!serer is issued,I shell not employ any person in any manner iso s to
• become subpe c the workers'compensation lexis of California.and agree that lf I shouts became subject to the workers'
ieitif-"iiia ie ie Takia ieieiewww ieieieienieieieieieieieieieieieieitieieieieierteieieieitieieieieieieseieieireriierieiiiiieie s-ieeiicie-i-W•eriiiiitieieii
compensation provisions d Section 3700 el the Labor Code,I shall forthwith eompy with those provisices. IND I V IDUAL F E E BREAKDOWN
Date: Appleant:
Warning:Failure to secure workers'compensation coverage Is unlawful,end shall subject an emploYecropInit. QTY 11 E S L H 1 Y 1 1 V IV UNIT COST TOTAL �OS1
civil finesup to one hundred thousand dollars(Sfnaoo0).In addition to the cost of compensation,damages s as aspenalties and
provided for In
Section 3706 of the Labor Code,Interest and atromey'a fees FLU 1 BATHTUB 8 . 75 a7_5_
PLU 1 LAUNDRY TUB OR WASHER 8 . 5 8'
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally of perjury that there is a construction landing agency for the . y 7
performance of the work for which this permit is issued(Section 3087,Civ.C). PLU 1 SHOWER 8 . 75 _b, 75
LENDER'S NAME: PLU 3 WASH BASIN 8 . 75 z 25
LENDER'S ADDRESS: PLU 2 WATER CLOSET ( TOILET ) 8 . 75 11 50
I certify that)have read this appimionand male mat the above intamatiteiscored I agree to complywnhell city and county ordinances PLU I WATER HEATER AND/OR VENT ! eau 11,VG
and state lairs relating tobuildsgcMmrudion and hereby authoricerepreeentmiveedth)alt toeMer upon theeboas-mentioned properly PLU I SEWER, CONNECTION TO BUILD 1, ��ee 2 ' � : V 22' 00
forinspldionpurpees. HOLLY HART END OF F : I
Pd 'N0V 0 5 1997
Q, r !�S �1
'Pm NEIz`sQ1, T
i� 'At Data:
Signature- ' . AgenApplicant/Contractor CITY OF COSTA MESA
(5151de.W P) White-BuildingA Spey;Green-FIe;Canary-Applicant:Pink-Revenue:Goldenrod-Assessor E1 1 1 S ���.5(�h 0 to 0(31 `LAS
- CONSTRUCTION AND PLANNING ' - r PC & SPA
Date InspectorDate Inspector
R`PRUVALS Permit # 1 f APPROVALS- Permit#
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - '
2. Soil Pipe-Undrgrnd. • - 54o-I2S Esn/-- 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54, Forms I - .
' 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding _ 1
- S.:Steel Reinforcement - 56. Rough Plumbing& Pressure Test :
•
6. Electrical OF-ER Grnd. 57. APPROVAL TO COVER-GUNITE
• 7.,F9otings. , ' 58. Electrical Conduit-Undrgrnd.
• 8.Foundation - 59. Gas Pipe, 0 Undrgrnd., Test -
9.-Water Pipe-Undrgrnd. - . 60: Backwash Lines,P-Trap, 0 Undrgrnd:
. 10..Structura'I Floor System61. 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. Eiectrical-Final , .
15. Rough Electrical-Conduit- - :66. Solar System-Final
16. Rough Electric Wiring • - - • -- ‘.67. Fencing-,& Access Approval . '
c.
. 17. Rough Wiring Sign - a- ; `68, APPROVED FOR PLASTERING - 1
18. Rough Electrical-T Bar Ceiling I - ' x'69. POOL/SPA SYSTEMS FINAL
19.'Rough Heating & Air-Conditioning - FIRE DEPT:REQUIREMENT -
20.;Rough Factory Fireplace .. L - _ ; *' APPROVALS ' Permit#`
21: Ducts,in Structure, ., •• - - - 70.-Underground Hydro ! .
22._Ducts, Ventilating; k _ ? 1,
. i _ 71. Product Piping O,Gas �L1Oil
23.:Gas Pipe.Rough & Test o r -• y 4 - 72. Underground Flush
24,•Roof Framing 7:4 `, ' ' ° _ ,I •. 72. Undergrnd.Storage Tank 0 Gas 0'011
25. Roof Sheathing 74. Overhead Hydro •
26.,T -Bar Ceiling (Structural) &.Monocoat ; _ - ', 75, Dry Chemical ,' _
27.-Frame and Flashing 76, Dry Standpipe m .
28. Lathing'& Siding. " . t: • - " '•? •'k 77. FIXED:SYSTEM FINAL '' _ _ -
rT' I r
29. Insulation ,• - 78: FIRE PREY. FINAL - T.
30. Drywall-Nailing t._ ` i , _' ' HEALTH DEPT.'REQUIREMENT '2
31. Plaster &own Coat: ; I .r. 791-FINALINSPECTION • : - -
32. 'Electrical Power Metei•-Final • . II, 'T1 80. FOOD CERTIFICATE ISSUED ,.
33.T-Final Electric , l',, r I I- Notes: r , , • r n ,
- 34,_Final Heating,& Air Conditioning. - • - it.. I J •-;,.
35.'Final Gas Pipe-Test° i _ ' _ '
36, Hood or Canopy • - r - - .
. - • 1 - , i C I
37..Finai Factory Fireplace_ - - ^ -
38. Final Plumbing (a/r -+ r - - >-
39. Water Service-Final ' - -,
I
40. Gas Service-Final . .- - I' i•
41. Solar Domestic-Final : " •' }
if : '
-
42. Backflow Preventer - i - - - - ?: ;,-t
43. Backflow Irrigation' - i r• 4 - - • • • • • •
y
:444. Landscape Irrigation System:1-H ' _ - r , •• , - ,-,
. ,
=45.-.Sound Attenuation
-46..-landicap Regulations - s •c r 1.-.)• 47. -FINAL STRUCTURE& BUILDING t _ 1 '` - -
,
•
48,. FINAL PLANNING . • - i. . I 1'l .it
49:.Electric Release to Edison F %'! ,- '
` 450, Gas Release to Southern;California Gas Co • - _ • "' •
51. CERTIFICATEOF,OCCLIPANCY , - - . - - -
No. Date
giADDRESS OF BUILDING: 1700 SAN xf nfNAlDINu rL eaters ' CITY OF COSTA MESA - BUILDING PERMIT 1 - OOO
OWNER'S NAME IF IINIySN: HART, KEITH B PERM NO: M 0
- ADDREss HART, HOLLY R
1588 SAN BERNARDINO PL PERMIT NO: M 085630 PLAN CHECK NO: N GOVT SUPP: N
COSTA MESA,CA 92627646-6901
ApPL.MuuNGADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: NEW
ARCHITECT OR ENGINEER' OPTION ONE ENGINEERING see NO: 48386 JOB DESCRIPTION : 656SF DWELLING ADDOVER 734SF GARAGE SQ FT:
ARCH.OR ENG.'S ADDRESS: 20311 ACACIA gfR: 240
NEWPORT BEACH CA 92660 CLAIM VALUE: CALC-VALUE: GROUP OCC: R-1 /U-1
CONTRACTOR'SNAME COMMENTS : "HART RESIDENCE" REF:B-85628
CCNTRACTORS MMIBID x ie it ie rt w ie#ie i4 X:le ie ii ie w it ie it ie>e if ie it ie ie ie ii it ir>t ie it it w ie it 7t i<it iw ii w ie ie it ri 7r iF i'de ie ie tir ie>f it it w N h*tf>r ie if ie ie iF*if it x it ie it tir de 1R
ADDRESS: UC NO.:
UPC: Z O iv L N G REQUIREMENTS
SETBACKS
LICENSED CONTRACTORS DECLARATION:I hereby eflirm under penally of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license S in full In and effect.
CRY LW.NO.: UC CLASS: UC.NO.: LAY: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
"sae:
Contractor: LEFT : FT IN RGHT: FT IN LEFT: FT IN RGHT: F T IN
YNER BUILDER DECLARATION:I hereby affirm under penalty o perjury that I am exempt from the Contractee License Law to the PARKING REQ: PRO V: PARCEL: 42532134 Z N E: REF NO:
.olbwing reason(Section 7031.5 Busiless and Professions Code:Any city or ooumy which requires a perms to oedeud,alter,improve,
demolish.or repair any structure.prior to its issuance,also requires the applicant for such permit l0 file a signed statement Mut he or she PLANNING NU T E S> ,
is licensed pursuant to the provisions of the Contractors License Law!Chapter 9(commencing with Section 7000)of Division 3 of the >
Business end Professions Code}or Lha he Cr she S exempt Iheretron and the basis for the alleged exemption.My violellen of Section ......... ..... .... .. .....
7031.5 by any applicant for a permit subjects!he appicanl to a civil penalty of nal more then five hundred dollen,(S5031). W''sxx]f't'ver'cxef'cpEiEitiiii•itieii'iFirar]eiiieieieiiiixieieiciEscicxxscitiiieieieieii3eieifir•*iiieiiieie ieieii•ieiiirieicxieje*idicicicicri.xn.ri.x
❑ I,as ovmer of the propeny or my employees with wages as thei sole compensation,will do the work and the structure is not intended DEVELOPMENT S E R .V I C E S REQUIREMENTS
or offered for sale(Seclon 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property
who builds or improves thereon.end who does such work Nmse or herself or through his a her own employees,provided that such _ _ ---
improvements are not intended or offered for sale.g,however,the building or improvement S sold within one year of completion.the ZONING AP Pit V V ED BY Y ..__ - DATE:
owner-builder will have the burden d proving he or she did not build or improve for The purpose of sale).
BUILDING
DATE:
• I,es comer dthe property,erre exclusively edoe with licensed contractors to carrstrW the project(Section 7016.eon and
bU1LL 1Nl� APPROVED BY
Professions Code:The Comrades License Law does not apply to en owns of propedy who brills or improves thereon ad wive —
.- contracts for such projects over a not rr((e)licensed pursuant to the Contractors " few).!_ - -- 1
tlY yU IH U NG UU1 DER APPLICATION ISSUED BY1 1j `— DATE: L
■ exempt under Section: B.Sp.D.,fa this ie ie ie ie ie ie ie icxii ie iE ie ie i<ic iF is it ie iei wststsesestsrievrnxnnwth-srth-* eieieieiei-iris se se sewn**
(— �� 7 corse - LEGALIZATION:N h M A R Y STRUCTURAL SEGMENT:N
eby tants that I am aware of and understand the requirements d Cellonle Health and Solely Coda Sadirons 25505,25533.and I
and Nml a any Mum building occupant will one)need to comply with said stale codes and the requimments ler BLDG PMT E 7ECHANIC FIRE SMIP/MES GRADING
a pastil for construction ormodicatinfronthe Ak Oueliy Management District.Residential cMvfion eppicaiae ere exempt from these PERMIT
25 . 25
provisions.
Applicant: PLAN
25* SMTP/NON-RES
Date: Ap
PLAN
I WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dederattum: ISSUE FEE22 . 00
certificatem
❑ Iheve and ora maintain certificate of nsenllo self-insure for workers'comrmaSectionpeiem as provided forby Sion 3700 of the Lab« BUILD ING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for the pedomtancedthe work for which this permit isissued. TOTALS----> 25 . 25 22 . 00 0 , 00 47, 25 47. 25 , 00
] I have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the
work for which this permit is Sued.My workers'compensaion insurance carrier and d policy number are: REVENUE DIVISION TOTALS--> COLLECTED: i— 47. 25 OVER/SHORT: . 00
i Caner BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIPiTOI GRADING PLAN-CHECK
Policy Number:
(This section need not d l A
be completethe nne is ror one hundred dellen(SI001 or lees.) 47. 25
❑ Iamity Na in Ste pedamence of the woth for which this permit is Sued,Isbell nal employ any parson in any manner so esu **iei***i<icx,ir,k**iridic SiiSSie*Sdeiedeieibdeieie* ieicifirit iiia SSicie SSSicSicdeie ibieieicde*icieie iris icde ieieiie c e circ a cern
become subject to the workers'compensation laws d California,and agree Na it I should become subject to live waken' ..'
compenealen provisions of Section 3700 of the Labor Cole.I.hal fonhwilh comply with those provisions. • INDIVIDUAL F E E B R E A K D O W N
•
Date: Applicant:
TYPE QTY D C S L 22 1 e 2 .1 u N UNIT COST TOTAL COST
Warning:Failure to secure warfare compensation coverage la unlawful,and shall subject an employer to criminal percales and
eke fines up to one hundred thousand(loiters(5104000),In emildon to the cast of compensation,damages as provided for In
Section3706 of the Labor Cods,Interest,and attorney's fees. MEC 1 INST FORE-AIRiGRA'v FURN _<=__100 K BTU 13_ . 2_5 13_ ,25
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury the there e a mrMrutlton lending agency for 1M MEC 1 GAS PIPING SYS 1 - 4 OUTLET1 S 7. 7 V 2.50
pedormanceof the work for which this pens+is issued(Section 3097,Cb.C). MEC 1 VENTILATION FAN CONN TO SINGLE DUCT 6 . 50 6 .50
LEN'S A'SNAMS: END Ur
II. LENDERS ADDRESS: 7�
A I certify that I have read this application and date that the above information is coned.l agree to oomph/withal city and oountYodkunen D. .' E"r's t
�j and state laws relating to building construction and hereby authorize representatives of this thy to enter upon the above-mentioned property
for insp dion purposes. HOLLY HART f I
PeCK OrWMEC5 —ECP
OLLTs'�T . NOV 05 1997
Print Nem{ 11/4,4m* TEILN t t 1 15 5- ( veri o IJ \V ....
!{- <]/��scant adorr \ Date: 1 (S 47 _ �p I�tI 5 S CITY OF COSTA MESA
II
Signature d�AgehVApplcenUCantrecto
` ruaerFFle_ C—emery-AppGeem;Pink-Revenue:Oddeo
nmd-Aseees
•
' CONSTRUCTION AND PLANNIR_ 1 JL & 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 LIFER Grnd. , 57. APPROVAL TO COVER-GUNITE.
7:1Footings. ; = • 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. PropertySewerLine & 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
•r8.
Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINALRough Heating & Air Conditioning FIRE DEPT_ REQUIREMENT 0.`Rough Facto"ry Fireplace • _ APPROVALS _ Permit# -1. Ducts,in Structure. - _ i 70. Underground Hydro
..
22..Ducts, Ventilating _ ,. 71. Product Piping Gas .O Oil
23.:.Gas-Pipe-Rough & Test _ 72. Underground Flush -y
24.-Roof Framing z 73. Undergrnd.StorageTarik OGas O'Oi1
25. Roof Sheathing A p ,� , . ., • - 74. Overhead Hydio_
26.-1-Bar Ceiling (StPLctural) &=Monocoat ' - ,' - 75, Dry
-- t - . - , Chemical_ -
, 4., ,
27-'Frame and Flashing - E tl,. 76- Dry Standpipe - -
28. Lathing;& Siding. l - y = ;- - •'I "( "R 77, FIXED_SYSTEM FINAL, - r A s
•
29. Insulation r _ > _ I I t: -IK 78, FIRE PREY• FINAL e - •'l
-
r 30. Drywall Nailing _, ' 1 _ I ft ' HEALTH DEPT:'REOUIREMENT
31. Plaster Brown Coate : , I I k i� 75. FINAL INSPECTION L'
1.
32.. Electrical Power'tvteter-Final ' j it r 80. FOOD CERTIFICATE ISSUED ,;."
33. Final Electric , i ,, . I f r r Notes: i ,• i s S r:
34. ,Final Heating & Air Conditioning: • (jiLacill 5�), ;;, t r i .: _ - .
35.•�Firlal Gas Pipe-Test; _ ,', , l! y. .2a • , _ . . .• t~` - •
36. ?Hood or Canopy ' - - ! , IC r. _ __
- D . .r n - f '//'
37:;Fina1 Factory Fireplace.: ,_ - r .. • ;!.% . ,
- 38. Final Plumbing T _ _ I (i _ , , - -
z. r L
39. Water Service-Final; " r' 1, ,_
40. Gas Service-Final . , I. .0 _ - . v '`- '--- �-
41, Solar Domestic-Final- - '" -' -
42, Backflow Preventer, • a I _
- 43. Backflow Irrigation . . , -
-44. Landscape Irrigation System. a.', - ' 7
-45',_Sound Attenuation - - -- - -
. 46...Handicap Regulations _ - x .
•
471-f INAL STRUCTURE & BUI-LDING _-_- t - ,
48. FINAL PLANNING ,
.49- Electric Release to Edison . 4- -, •
-50. Gas-Release to Southern.California Gas Co , - - • _ _ . • L -1
51-. CERTIFICATE OF-OCCUPANCY - -
No. Date
AD fffeOi(WILDING: 1588 SAN BERNARDINO PL INT: CITY OF COSTA MESA — BUILDING PERMIT
.DNNERSrNAMEIF MICYR& HART, KEITH B - PERM NO: B 08390E
I ADDRESS: HART, HOLLY R •
1588 SAN BERNARDINO PL PERMIT NO: B 083906 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92627646-6901
MLINO
&FPIJADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR • PURPOSE: DEM
•
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : DEMOLISH DETCHED GARAGE SQ FT:
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 200 . 00 CALC—VALUE: 1 ,000 .00 GROUP OCC: R-1 /U-1
CONTRACTORS NAME
CONTRACTOR'S MING COMMENTS: "HART RESIDENCE" DEMOLITION ONLY
ADDRESS: UC.NO.; *****************************Sr*+r*******SE+E+r******************+E******:R+r****;'E ****
MMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I em licensed under provisions of Chapter 9 SETBACKS
(commenting with Section 7000)d Chosen 3 of the Business and Professions Code.and my license is in lull face and effect.
CITVLIC.NO.: UC.CLASS, LIG. EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Comrade: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
P BUILDER DECLARATION:I hereby Aim under penally of perjury that I am exempt from the ContractorsLicense Law for the
reasonrequirese, PARKING REQ: PROV: PARCEL : 42532134 ZNE: • REF NO:
eolith,or repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he or she
icensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Divion 3 d the PLANNING NOTES>
_aridness and Professions Code)or that he or the is exempt therefrom end the basis for the alleged exemption.My violation of Section > s;ate
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred ddlw[SS001). *********************************************************************,**********
0 ,I,as owner of the property or my employees with wages as their sale compensation.will do the work,and the armours is not intended DEVELOPMENT SERVICES R E Q U I R E M E N -T S
or offered for sale(Section 7044,Business and Professions Coda:The Contractors License Law does not apply to an owner of property 17-'
who burls or'improves thereon.and who does such work himself or herself or through hi or her own employees,provided that such 1-•
improvements are not intended or offered for sale.f,however.the building or improvement Is sold within one year of completion.the ZONING APPROVED BY DATE:
ownerbuilder will have the burden o proving he or she did not build or improve for the purpose of sale).
❑ a e owner Code:T the am eLawde"Baes licensed lu n l"sept`opertyact froItIXhe °w"d«mdp�e'0"�Ban Business and
BUILDING APPROVED BY : DATE: ..,`
Contracts IIX such projects with a Cantrador(s)licensed pursuant to the Cadractors le ' ;1
*********************4****************
exempt Seplin:BP7044 B.ap.c..rorr. Baso O ILDER APPLICATION ISSUED BY: lit ' DATE:
.15-"CI 1 ;� ************************************** ** ** ******************** ,*4*�"" LEGALIZATION:N F E E S M M A R Y STRUCTURAL GMENT.Y
• ereby certify drat I em aware of and understand the requirements of California Health and Safely Cade Sections 25505,p4933,and 7 1
.and forcon lIXice rmurebuidirgoovhentvell/ Man(gcleaD) itd.R campywlhaekdatacndei tions areerequiremmttsfor BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
e parmH fnd that I ran amoeHbadonIrani occupant l twit ot(drclent one) ee tosidentialomply mnstmd'sate cousand thexempt hoetsthese for
provisions. PERMIT 34 . 75
Dale: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of gm following declarations: I SSU . 5 O
ISSUE❑ BUILDING-DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Hume,endhe mvmein a certificate work consent which to seg insure ler sued. eompersetbn,n provided for by Section 3]00 d IM labor
Code, performance wank fa wNph mi pemmiiaued. TOTALS----> 35 . 25 0 .00 0 . 00 35 . 25 35 . 25 . 00
❑ I have and will maintain workers'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 35. 25 OVER/SHORT: 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed it the permit is for one hundred dollars(5100)or less.) 34 . 75 . 50
❑ I candy that in the performance of the work for which this permit is issued,I shalt not employ any person in any manner so as to
became subject to the workers'compensation laws of California,and agree that if I should become subject to the workers *******************************************************************************
campensaton provisions of Section 3700 of the labor Code.I shalt forthwith comply with those provision.. INDIVIDUAL F E E BREAKDOWN
Date:_ _ Appliant:
Warning:Failure to secure erotism'compensation crewels unkneful,and shall subject en employer to criminal penaltiesand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil Nov tip to one hundred thousand dollars($100,000),M addition to the cost of co pensatio"damage,as provided for In
Section 3706of the Labor Cods,Intense,and"tome✓+rose NO FEES WERE SELECTED FOR THIS PERMIT
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the -
performance of the work for which the name u issued(Section 3097,Civ.C).
LENDER'S NAME:•
H}� (((���sss���
LENDER'Sthis
ADDRESS;
iDIndp
l wsreaig to eepngconend datnhutMabohiMormdonimea t srthy t oom upon hlf dryerdwumned iroperly
and state laws relating to building construction and hereby authorize reDreaentativea of this cyto enter upon the abovememonnd properly
for inspection purposes. '
HOLLY HAST JUL 2 51997
•
1�
Dae: -1-a-Ssi 7 CITY OF COSTA MESA
Signet re enVApp4cenpcta
Cmtre
(515115.WP) Whit- a•A Solely;Green-Fla;Canary-Appicant;Pink-Revenue:Goldenrod-Assessor
• CONSTRUCTION AND PLANNING - POC . SPA
! -
Date Inspector Date Inspector
fisAPPROVALS Permit# - APPROVALS Permit# .
- 1. Temporary.Electrical Service or Pole ' 52. Pool & Equipment Location
-
2. Soil PiPe-Undrgrndit: . 53. Steel Reinforcement
_,�3.(Electrical Conduit Utility-Undrgrnd. - . 54. Forms
4.-Electrical Conduit-Undrgrnd. al 55. Electrical Bonding ':
;.-S..,S{eel Reinforcement _, 56. Rough Plumbing & Pressure Test _
'.-66 Electrical UFER Grnd, - -• 57. APPROVAL TO COVE R-GUNITE--
t=7?'Jbotings 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 . - 3 62: Br.
ackwash & Receptor-Final •
'�o .
'12. Sevier Cap - _ ' -
. - 63. Heater & Vent-Final ,
•
13. Roof Drains : '¢- 64. Plumbing System - Final . ' 7. r
h Plumbing
_ -
14. Rough ;n 65. Electrical-Final
15. Rough Electrical-Conduit - - _ m 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-�
.-5 -1 r'4- `r -. ''.-1 X 4: r-'
20. Rough F`actoiy FIr place 1 lgm <L'' :t' C. :1 �a tr APPI OV1{_S=9 P emit# '' >'
I S tr' CZ L r 'C. -1 f''.1' ( y •y l,)�. • V
21. D'ucti,in-Strgiture,i. •, - rr i•--4< t S O -'+_ 70.LUnde[grairid Hirdro 1'
22. Duels, Ventila inq tT' ' tJS k q;a- " 71. Prod uci i in , '.Gas Oil
id.e i * �, O FS: a p 9 Q
Y I -c .• Cr )--it t r- pi 1 ' •...“-- t
23. Gas;P.ipe:Rouc}:t & Tgst --,s * m 1 r_t. - 72. Underground Push. r.
24. Roo:Framing- t I "= i*1' ^ ' > r_,It 73: Undergrnd.Stdr'aiTan it0Gas 0Oil
.1.x a ... ri m ••J :v. _' s_ •-•r- o-
25. Roof,Shwthing r„."---; .1/4:,-.. v v,, c > tut 74u_Overhead Hydro a
26. 11,-Bit Ceiling (Strlcttural) & Mo�nocoat .*. -� ti "a tom`' 75j:`_DrY Chemical f-o , H Cy
27. Frame and fl'Flash. _ * a' m
a e' ,i 2- 7b. Dry Staadplpe5.^^ t* =
--28. Eatt;ingil,Th Siding•....1.7-..1 .a ';Q^ ^' -x Z "i: 7Z: FIXE0:9ySTE A FINA ,, -'
. . .. a . _ c.. r .,i .•i kr �.. 4, 1 U
(1 c ` r-. r. „ -• ,r: m !r 73 --. I
•29. Insulatio4 . m .. f j x 7$ FIRE PREV. FINAL * 1> r' j �
_ .-i
'•1 30. Drywall:Nailiag •y : 1 _ t IC M-j ALTN DEPS 1-REQi11REMENt/` w,..
• t; * r. -
-'31. Plaster Brrown-Cora S , :•r. * I 'r r- 79'. FINALtI$PECT*ON • n rr 3 Q1,' _ , .>,
:32. 'Electrical`Power Ieteter:F nal• - 1: .'a , I Fr, a 801 FOOD CERTI LATE ISFED f C[}.. ear
.33. E'-inal,Elettrici Li; ` '' I'* n r cr -S' -'fit t�., t-.>
r- .+.. -1 I Qt. i I i lir • Notes: •-i yt?t t '; ^ 4' _ 1�+'
t, 1
-i 34. FineYHeeting e Ait.Conditionia s ' 1;i V is X > c'.- a S ^t 2'.-
A; , I I it n 1--+ 1 G-+C: r m =>1. t' -
35. nai'Gas Pipe•Tesri' _ " x h- - , til= * err
w._rw;if
X36. Wed or;Canopy 5.* -'^a i: :i 1 It •2 5C C) . . F, -.
�. ",- .•,» �. _ • 1 _it rt !.O ., tr;
.,37, FInaF,Factory Firepl ce'... `� , '� h: hi 1 't- k
ri
-. 38. Final.,Plumbing c •.0 i -'
F .. .. -. t. , ,- ---
t - f S r z
. H
•39. Water Service-Final ` a * I `.:Yo W
D I t. I i" > v * .-1
..40. Gas Service-Final ° .. S - • !-ii
•
•• _
5'41. :^ I '� <:' A a. _ 1-1-1- Solar Domestic-Final S o m 1 1 l it w t x r'
_
' '42. Backflow Preventers. al .* 1 I lr ;, 1511• • * r, H .y
.. . _t .- ,tiny, t .-; -
--43. Backflow Irngation K X s"S % N * xr +o ; O
..._: t
44. Landscape Irrigation System,;nits x :'- •n r-' _I: a ; .
3 ' r- ?LI't
nr x ._
45. Sound Attenyation* 1.24.-EF--/ '' E r 4K
m • t y _ .* m Y
46. Eandicap Reyuiatior"�s 1_ :, .r' .. .. • t S • l.-U. 1;• *
47+. FJN'AL STR(7CTURE & BUILDING 41/7 1 /` ;^ • i• .
48. FINAL PLANNING.* •• f- - + r0 i _I-- ' ro t,'r % i-•
rr
49. Eledtrlc Release to Edison ; ' t. ° 7
r. .. .. S I I it. .1 •try p
50. Gas-ReleasetD,SouthernCalifornia�Gasco I '{ 'r. �-. - o!=; r C'
. .
n.
51'. CERTIFICATE OF OCCUPANCY"' - ' .* a
No. Date
CITY OF COSTA MESA
BUILDING DIVISION
•
OWNER-BUILDER INFORMATION
Dear Property Owner:
Section 19830 of the State of California Health and Safety Code requires that the City mail
this notice to you as applicant for an Owner-Builder permit, and Section 19831 requires that
you complete the Owner-Builder Verification enclosed and return it, as a precedent to issuance
of the Building Permit.
Section 19830 states in part: "Such notice shall be given by mail; or such notice may be
given to the applicant at the time the application is made for the permit, provided that the
applicant presents identification sufficient to identify himself or herself as the owner." The
Development Services Department accepts a valid California Drivers License or U. S. Social
Security card for identification purposes.
The following information is supplied to you pursuant to this law.
An application for a building permit has been submitted in your name listing
yourself as the builder of the property improvements specified.
For your protection you should be aware that as 'owner-builder' you are the
responsible party of record on such a permit. Building permits are not required
to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself,
you may protect yourself from possible liability if that person applies for the
proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of
California and to have a business license from the city or county. They are also
required by law to put their license number on all permits for which they apply.
If you plan to do your own work, with the exception of various trades that
you plan to subcontract, you should be aware of the following information for
your benefit and protection:
• If you employ or otherwise engage any persons other than your immediate
family, and the work (including materials and other costs) is $200 or more
for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
• If you are an employer, you must register with the state and federal govern-
ment as an employer and you are subject to several obligations including
state and federal income tax withholding, federal social security taxes,
workers' compensation insurance, disability insurance costs, and unemploy-
ment compensation contributions.
Page 1 of 2
CMF 1043-46 (over)
• There may be financial risks for you if you do not carry out these obligations,
and these risks are especially serious with respect to workers' compensation
insurance.
• . For more specific information about your obligations under federal law,
contact the Internal Revenue Service (and, if you wish, the U. S. Small
Business Administration). For more specific information about your obligations
under state law, contact the Department of Benefit Payments and the Division
of Industrial Accidents.
• If the structure is intended for sale, property owners who are not licensed
contractors are allowed to perform their work personally or through their own
employees, without a licensed contractor or subcontractor, only under limited
conditions.
• A frequent practice of unlicensed persons professing to be contractors is to secure
an 'owner-builder' building permit, erroneously implying that the property owner
is providing his or her own labor and material personally. Building permits are not
required to be signed by property owners unless they are performing their own
work personally.
• Information about licensed contractors may be obtained by contacting the.
Contractors' State License Board in your community or at 1020 N Street,
Sacramento, California 95814.
• Please complete and return the enclosed owner-builder verification form so that
we can confirm that you are aware of these matters. The building permit will
not be issued until the verification is returned.
Very truly yours,
City of Costa Mesa
Development Services Department
Building Division
•
Page 2 of 2
754-5273
,OWNER MELT., ROBERT J • DATE 2-7-55
gJOB ADDRESS 1588 San Bernardino Place BUILDING PERMIT NO. 890
GENERAL CONTRACTOR Owner-Builder VALUE $ 800.00
LOT AP#117-221-13 BLOCK TRACT Garage
GROUP J TYPE V ZONE R4 FIRE DISTRICT 901
INSPECTIONS DATE SUBCONTRACTOR •
PERMITS ISSUED
c. ` DATE NUMBER
—
Footing Trench (���"E 3 —/S
Foundation Forms and Grade to Garage
Rough Framing
Plumbing, Rough to Slab a \,
Plumbing,Rough Complete ./ 1/ ', -
-temporary-Pole
,;-
-T.emporar-y-Pole: .- – i • t. . t..._ ,Y iatric/j_`"`
Wiring,Rough �'i� �� `
Heating,Rough �Wh�� a ,`�
2.1
Heating,Final �`�� r. `�
Sewer �� / U /fr
•
Septic Tank or Cesspool _ A" Mill/ /
Lathing -4,/, r A tQ'
Plastering w n �1�
Plumbing,Final,Fixtures Complete ."J
Plumbing,Final Gas Test
Wiring,Final
Occupancy
1 Form 210 0-11 IM 1469
Costa Mesa Building Department , / . APPLICATION FOR PERMIT
111 EASY 20th STREET V
_. COSTA MES ALI FORMA -- -- -I-�-D - -- -'�-__
`Ea -. j FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN . ; {
TVIo. Permit_No.
Address 1S 1 I�*Qjy/3e,eneiRDINO � `_ I f j BuilingZ ��r
v Received'b x Date Rec'd. Date Issued
Costa Mesa, California f ; 1
.2-72Ssl'
Cross S
Nearest �. / , . Building j t
St p Address
/ i • ii7q n ,p
Owner �,, ��� ""'C.. f Costa Mesa, California )
Mail di
Address d , , /_,_ -'L Nearest 1 ;
(� ,� Tel. Cross St. I .
City ., . _ T/WB.� No. . Zone No.of Type I Group
Architect or Lic. i I Plans if I I
Engineer No. Approved 1
`_. by t I Date 1
Address t. I CORRECTIONS e i
/n! O�City Lic.
Contractor (Q. 'p,q/�-iLJGcc_C�6No. t i
1
Address i
LegalLot 1 �[ ` l
Description I No. �� I Block I /T
d J
(Attach Metes and younds)4.P. 1/7— - -/-� - 1
4{4 . 76 a: /, '' No.of Bldgs. j i'
Size of Lot �'i9/!' 2 /3D.2I Now on Lot '. _ ._-_.-. ri ��� O
Use of No.of No.of '' 11►►MtlYY�i� - 222ST��,S77MMM 3,
Existing Bldg. 1OWe.//i 01 Families Rooms r O
Setback Line fromJ.�. Rear Yard a0 i — `-- �,'"- ' s-- '-'`' - Z
Center of Street /0i& Side Yard d • - - _.h.EB,(, 19553
pt55;. ti
DESCRIPTION OF WORK - - - ;.
/i . U1Yf :.COSTA.MESA -
New I l� Alteration I I Addition I '/ �7
Repair I I Moving_ I I Demolish I r �`�v
Building / . No.of - fF_
Size p(07t,20 Rooms / Stories -
Exterior Wall _ ������,,,,,,""""""Roof °
Cse of g , I Covering ������ ��w���,,,��^��^ • ,
APPROVALS
di New
BuuildiFoundation Location Inspector Date
Bng Forms, Materials,
Under-Pinning
Frame: Fire Stops,
£ Bracing,Bolts
Lath. Int.
I hereby acknowledge that I have read this Application I
and state that the above is correct and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
building construction z
Signature of (_-/! Plaster, Int.
Permittee i
,,',- Plaster, Ext.
Authorized Agt. r
_ ' Masonry Reinforced
Valuation 0 Permit Fee $ 0 0
// Dom/ Plan Check $ /, O 0 Bond Beam
$ d ,Total
Fee $ , 00 FINAL
I.nrm 2114 G-H IM 12.FH