HomeMy WebLinkAbout2726 SANDPIPER DR - Building Permits CITY OF COSTA MESA
4� 9 BUILDING DIVISION
>• ____tallI IA DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
I,.
PERMIT
: PERMIT
0 -� 604-00339
roa„io e° •
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2726 SANDPIPER DR Status: ISSUED
Suite: Applied: 02/11/2004
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 02/11/2004
Parcel Number: 13953122 Zoning: R1 R1
Applicant: SHULMAN, JOE ISSUED BY:
Address: 7721 ETNA CL
Phone: (714)536-5116
HUNINGTON BEACH,CA Zip: 92648
•
Owner: WADE, VERNON L TR
Address 2726 SANDPIPER DR
Phone:
COSTA MESA,CA Zip: 92626-4738
Contractor SHULMAN ROOFING
Address: 7721 ETNA CL
Phone: (714)536-5116
HUNINGTON BEACH,CA
Zip: 92648 License: 690617
Arch : Eng: - -
Address: Address:
Phone: Phone:
Zip: License: • License:
SCOPE OF PERMIT
TEAR OFF WOOD SHAKE,INSTALL SHEATHING AND COVER WITH 30 YEAR COMP SHINGLES.INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,190.00
Permit: $167.25 Claim Valuation: $8,190.00
SMIP Res: $0.82
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.07
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6'00)
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
ork for which this permit is issued.
I have and will maintain workers`compensation insurance,as required by section 3700 of the Labor Code,for performance of the work for which this pemlit is issued.
My workers'compensation Insurance carrier and policy number are:
fit
Carrier: Rslicy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
0 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 Calif. ie,end agree that If I should become subject to the workers'compensation provisions of Sectl3700/the La r Code,I shall forthwith
comply with these provisi.
Applicant Signature: -.. /7-w, Date: ( ( 0
WARNING:FAILURE TO SECUR CAPERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,n•,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F 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: -- ai. .
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 fore permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If Nes*,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 California Health and Safety Code Section 42303 been made? 0 Yes ❑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 end 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.
?re Of.� J
'gal Owner(s) Date
/Spy
.
•nWOr Authorized Applicant Date
CODE F INSPECTION TYPE PMTS INTRIALE GOOF I INSPECTION TYPE lalrl ItIIUI$LS
•
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final .rehl/�� 208 Final Plumbing
200 Final Re-Roof • mit _ 6210 Final Electrical
201 Final Block/Retaining Wall P 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
PROJECTADORESS: 2726 SANDPIPER DR UNIT: CITY OF COSTA MESA – BUILDING PERMIT rtnui row: ru- »., .
OWNER'S NAME: WADE, VERNON L
ADDREss: 2726 SANDPIPER DR PERMIT NO: P 059350 PLAN CHECK NO: N call vis : N *Durr : 4i
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5–N PERMIT TYPE: PLU PURPOSE: OTH
( 714 ) 549-1224
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REPIPE WATER SERVICE 6 HOUSE SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC–VALUE: GROUP OCC: R-3 /
PERMITTEE: C.J, MARTIN PLUMBING ( 714 ) 82.1 -1564
ADDRESS: 713 NANCITA COMMENTS: NO 'B ' PERMIT INVOLVED
ANAHEIM CA 92801 i('XX-1(%X'%X"% X-ie XXX*Xit*XE*%it**XX***1E X**MY X%iOeli k'it-X')** Fit#%)EK%IEk***X*a *Xfl*X*3***-***4c3E***K
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G R EQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full torte and effect. SETBACKS
clnm: 057122 munic.:555755 cuss: C-36
/ Zest-Ai MAIN BUILDING ACCESSORY BUILDING
._, Dale: "2.-Z- y2 signature:_ __ . —/_" FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: Ihereby affirm Mat l have a certificate of consent to sell-insure or a certificate al Workers' LEFT: FT IN RGHT: FT IN LEFT• FT IN RGHT: FT IN
Compensationsura a( e
ifi oeP thereof(Section 3800.Lab.R.I. /0 1 /93
POLICYNEXP. PARKING REQ: PROV: PARCEL: 13953122 ZNE: REF NO:
COMPANY:: 4"4. a STATE FUND,yy, PLANNING NOTES>
'❑ Certified copy is hereby furnished. U Certified copy is filed wit he city Building Division. >
�. / J�J�_ 1 14.***iEif****iE#)b##iEiE#iEie******** E****#iEiE****iE#)EiE#i63HEiiiEiEiEY.-)E#iEi6-1F*********iE3ftF?EifiEiE?i****
Date: Jo-- 2 –91 Applicant: e /,!�",/6 DEVELOPMENT S ERVI C E S`- . REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be competed if the penin is fa one hundred(5100)0r 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 ZONING APPROVED BYDATE
subject to the Workers'Compensation Laws al California. •
Date: Signature: BUILDING APPROVED BY : DATE:
NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor _ .,
Code.you must mnnwitn comply with such provisions or this permit snag be deemed revoked. APPLICATION ISSUED B Y: ^ /'A – �/,} DATE: frviv9
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perlormance of the work for �, ,
which this permit is issued(Section 3097.Civ.C). *********) *X********** sit' :+.*e,t- ' - /rte.. ' .c 'A- " ttr ' 'iFiiiEiE#ifiEif3FiEiEiF-F ' 9F!Enit**
**iFiEiEiFiE**1EieiEiFiEfF*XXtox*u*iE**iF161ElE*x****iE*lEiEXiFiEiFXMO iE*iE****-1FXiE*iEiF*X'M a#*iE*tie*iE#iF## ## e
LENDER: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm than I amexempt from the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7, 00
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SM I P/NON–RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commenting with Section 7000)of Division 3 al the Business P LAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 2000
.
any applicanuarapermit subjects the appicam laacn+I penalty of not more than live hundred dollars(s500). BUILDING–DIV–> PERMIT ISSUE PLAN–CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the TOTALS––--> 7. 00 20, 00 0 . 00 27, 00 27 . 00 , 00
❑ structure is not intended or offered or sale(Section 7044.Business and Professional Cade: The Contractors'State License Law
does not apply to an owner of a progeny who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED- 27, 00 OVER/SHORT: 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN–CHECK
for the purpose of sale). 27. 00
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properrywho builds or improves thereon .%.{(.Te##i4iei(Xi4XiLeE-X#4EX****iE****NX#ieX.MiE##iE#iEXii iEikiEX4EiEiEiEXiFiE#ie#iEiE##Xie#KiEiE3E##iE3fiiiF#iE##iE iE##
and who contracts far such projects with a contractar(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
It I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTI O N UNIT COST TOTAL COST
Date: Owner: PLU 1 WATER RE–PIPE 7, 00 7, 00
I do hereby certify that I am aware of and understand the requirements al California Health and Safety Code Sections 25505,25533.and END OF FEES
25534 and that I or any future building occupant wilVwlll not(Circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and stale acus relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
properly for inspection purpses.
�- Date: /ce ^ 2 9 i Signature: - . .
Driver's License or Social Security x:
1641-46 While-Budding:Green-Code Enforcement:Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POO, WA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
•
32. Electrical Power Meter-Final - ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ,
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing /Welt C49
39. Water Service-Final
40. Gas Service-Final -
i
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING `
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PROJECT ADDRESS: 2726 SANDPIPER DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 054211
OWNER'S NAME: WADE, VERNON L
ADDRESS; 2726 SANDPIPER DR PERMIT NO: P 054211 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N • PERMIT TYPE: PLU PURPOSE: OTH
549-1224
ARCH/ENGINEER: REG.NO.: SOB DESCRIPTION : REPLACE WATER HEATER SQ FT:
ADDRESS: UNIT:
•
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: GENERAL INSTALLATION CO. ( 714 )753-2541.
ADDRESS: 6558 WEST BLVD. COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
LOS ANGELES CA 90043 *************************** *******x-+P**************+ *** *******************IE***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force an. •feet. SETBACKS
CITY LIC.: 0 0,6 ,53'STATE LIC.: 1518 3 9�cu C ,
7e / / 'MAII BUILDINGEAACCESSORY BUILDING
WORKERS'CO PENSATIONDECLARATION: Ihereby affirm that lhave acemhcateo loselbinsureoracertificateofWorkers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
Compensation Ia e o c tifleticopythereof(Section3800.Lab LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
POLICY ND.: �`9b004 EXP.DATE: Li4 /01/92
COMPANY: NMIC PARKING REQ: PROV; PARCEL: 13953122 ZNE: REF NO:
7] Certified copy is hereby furnished. EX Certified copy is filed with the city Buildim •• bn. . PLANN ING NOTES>
2
E�EMPTIO FROM WORKERS'COMPENSATION DECLARATION:: (IDis carted DEVELOPMENT SERVICE S REQUIREMENTS
I certify that in the perlormance of the work for which this permit is issued.I shall not employ any person in any manner so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date; Signature' BUILDING APPROVED BY : DATE;
Code.y:If.after making this wideclaration.youhshould become or subjectemito the Workers'mrvoked,Compensation provisions of the Labor ^
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ��/ /' / L
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: L•IYA l-1 DATE• �— v(f
which this permit is issued(Section 3097,Civ.C). ********************** - ��- - - ' *******************1f**
LENDER: ***********************************. ************************************)E****
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 2 00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 35 t SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business pLAN
and Professions Code)or that he/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(5500). ISSUE FEE 3 , 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2. 00 3 , 00 0 . 00 5 , 00 5 . 00 , 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 5 . 00 OVER/SHORT• ,00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
tor the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contractsfor such projects with a contractors)license pursuant to the ContractorsState License Law).l am aware ***********************'********************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner' PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a
permit for construction or modification from the Air Ouatity Management District,Residential construction applications are exempt from
these provisions.
Date: Applicant: r' QLrinn' r`'. C'- _"4 - .- r
I hereby Certify that I have read this application and state that the above information is correct.I agree to comply with all city and county r..ATE T ;i/U>• .. T T I C ..
ordinances and state laws relating to building construction and hereby autho'e representatives of this city to enter upon the above-mentioned
properly for inspection purposes.
sis—/g —7 —9/— 5
Driver's License or Social Security re
164146 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANT ING r POO SPA ppp
APPROVALS Permit # Date Inspector APPROVALS Permit # _ Date Inspector
..
1,. Temporary Electrical Servicelop Pole /1/152. Pool & Equipment Location %7
2. Soil Pipe-Undrgrnd. I ;if. 53. Steel Reinforcement .• j
n.
3. Electrical Conduit Utility-Undrgrnd. '% 54. Forms ..
• 4. Electrical Conduit-Undrgrnd. , I 55. Electrical Bonding 07/. r%
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 4 1 • 57. APPROVAL TO COVER•GUNITE ti -
9. ;Footings Y t 58. Electrical Conduit-Undrgrnd. +
- 8.'Foundation • ,; 59. Gas Pipe, 0 Undrgrnd.,Test V'
9.•Water Pipe-Undrgrnd. "/ %, 60. Backwash Liner,P-Trap, 0 Undrgrnd.
10. Structural Floor System i';',... ,f' 61. APPROVAL TO DECK • (V
11. Property Sewer Line & House Connection,, 62. Backwash & Receptor-Final y✓ -
12. Sewer Cap ^. 63. Heater & Vent-Final .4
13. Roof Drains "
64. Plumbing System - Final 1
✓ v ,i
14. Rough Plumbing s' t/ 65. Electrical-Final �•
•
15. Rough Electrical-Conduit 9 •n 66. Solar System-Final
16. Rough Electric Wiring 9 - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20.- Rough Factory Fireplace , . - • APPROVALS --Permit#
r 1
21'Ducts, in Structufe _ 70. Underground Hydro
22. Ducts, Ventilating 71. Product-Piping 0 Gas 0 Oil
23.-Gas Pipe-Rough & Test 72. Underground Flush -
24. Roof Framing . • 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74, Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
27-. Frame and Flashing76. Dry Standpipe '
28. Lathing& Siding . 77. FIXED SYSTEM FINAL
29. Insulation _ 78; FIRE PREV. FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coati 79. FINAL INSPECTION
32. Electrical Power Meter-Final ;.e.> . 80. FOOD CERTIFICATE ISSUED
33.'Final Electric _ ' . Notes:
34. Final Heating & Air Conditioning - ` , - -
.n.
35. Final Gas Pipe-Test '
36. Hood or Canopy. . . - . : - .
37. Final Factory Fireplace I.
38. Final Plumbing _ - �Ojj{��(( G
39. Water Service-Final
40. Gas Service-Final . _ '
• 41. Solar Domestic-Final
42: Backflow Preventer I , ' .
43. Backflow Irrigation '
44. Landscape Irrigation System '
45. Sound Attenuation , C
46. Handicap Regulations _
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING •
.
- '
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY ,
No. _ Date
VWIVPilt -- - Ltl1G
JOB ADDRESS BUILDING PERMIT NO. 26942
GENERAL CONTRACTOR Mesa Verde BIdrs. ,InCDESCRIPTION OF WORK lies.w/att.Gar.
AP No. LOT 65 TRACT 6237 FIRE ZONE VALUES 32,495.00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONER1
Soil ( t.G. fes- 'G-`J SUBCONTRACTOR PERMITS ISSUED
Gas Date I Number I Signature
Water • umbing
Rough Plumbing Orr lfl' %t11r 1,717. !13.41. s1rEnt 1-43i/
Prop. Swr. Line pelouse Con. t: �`-a if- II �/ /, /�%,�� 5 j��yZ
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning S' 'f --C-
Temporary Service or Pole
Underground O Power 0
Rough Wiring 7-2.`•67 ,,, eating apd V nt.
Trenches p Forms in Steel Reinf. ® /p, .•••--7--c7,,/ �{i,i�,. A Jf e] sr-V-‘7 .4-2;73
Floor System fiat yr_/7--E7 Jf j///!
Bond Beam U Steel Reinforce 0
Sheathing ref '" 7-/7-G
Frame and Flashing ryny9 y--2Y7
Lathing— In Out p �4( g-i-t7
Plaster, Brown Coat hM4 5-,.-67
Structural, Final ectri p J n
Heating, Vent., &frig. and A.C., l 0, (p kat/ O/G, �at, 74[p(7 f(7,/77
Plumbing, Final and Gas Test 1-1-7�F
Electric, Final 14--
Building, Final A i. -
26942
PPR 25-67cfsn00127PAIO 2' * 147.0C
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 317 COSTA MESA,CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
Lot 65 TYPE OR PRINtTract 6237 BUILDING
BUILDING -2 726 For Office Use Only
ADDRESS
RECEIPT NO. PERMIT NO.
COSTA MESA. ;Tr:ORNIA / Li n�` ,2
Recyd�D la D Scn/f$D!o' r//"'/7
Mesa Verde Builders Inc. /�� kJl G� 7`— ISSUED
OWNER
MAIL o BUILDING
ADDRESS 2850 Mesa Verde Drive ADDRESS /�
TEL. ,aq{Cyx1 FIRE (//��/l I
CITY Costa Mesa, NO. O39S ZONE TYPE GROUP I\y YUJ —'
ARCHITECT TEL. 'S4 BYPROV ED DATE
OP 3INEER Kaltenbach
NO.
8.046
ZONING
ADD-ESS :23 E. 17th St. Santa An. 6 /��
e er.a :tn. .ers nc. ZON/C/ NO.OF _ USE
W
CONTRACTOR M YI.X)ST(PrAci/Vnl' Vc Inc. q
LEGAL // _-��
ADDRESS 2850 Mesa Verde Drive DESCRIPTION CJ IGS-//1• /0237
CITY Costa Mesa A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.STATE 21877318 TTq
X T . 549-0395 SO'TO SIDE 3 REAR P.L.
V /0, I NOW ON LOT GB. O EAVES
SIZE NO.OF OLDALLOWED (U.B.C.REQUIREMENT)
OF LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET/
SETBACK LINE FROM FRONT ,�/ FT. FT.
CENTER OF STREET REAR YARD S
SIDE YARDI LEFT I RIGHT R.SIDE FT. FT.
DESCRIPTION OF WORK L.SIDE Vb FT. FT.
NE X ALTERATION _ ADDITION REAR 3 FT. FT.
DISTANCE BET. BET.MAIN O
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDING NO.OP VAR•# DATE
SIZE %itW REEN ROOMS Share ORIES C.U.P.# APPROVED /
EXTERIOR WALT,, ROOF APPROVED /r {/�� lL� i'174‘,7
COVERING Jt UCCOI COVERING Shingle BY /Y/��Oy{�A� 1-, DATE -
USE OF BUILDING AND WORK TO BE PERFORMED
New Residence ao (p/
irk— ,d n L a o
O� / ,�Q.PT. 6
I HEREBY ACKNOWL GE THAT I HAV EAD THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F
AND STATE THAT T E ABOVE IS CO CT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 9� u
BUILDING CONSTRUCTION. 7 „
SIGNATURE 017)114:43 ,/// PERMIT FEE $ O
PERMITTEE ""- [J [ i _ °
$ 3 7 �S-' PLAN CHECK $ / E
AUTHORIZED AGENT11.
TOTAL FEE $ /97—