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Home My WebLink About1939 SANDERLING CIR - Building Permits • ��9 CITY OF COSTA MESA .� 4. BUILDING DIVISION r� > • ,,, -,r$ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. Wrglik!t .SO' PERMIT 0 803-00913 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1939 SANDERLING CI Status: ISSUED Suite: Applied: 06/02/2003 Vicinity: Issued: 07/22/2003 Parcel Number: 13948123 Zoning: R1 R1 X1,1 ��//� Applicant: HUDSON, HANNIS ISSUED BY: C-//911-- Address: 1939 SANDERLING CL Phone: 714-979-7265 COSTA MESA,CA Zip: 92626 Owner: HUDSON, MARY S Address 1939 SANDERLING CIR Phone: COSTA MESA,CA Zip: 92626-4735 zto :59,9 Contractor: Address: Phone: Zip: License: Arch : Eng: QUALITY PLUS CONSULTING ENGINEERS Address: Address: 27532 SONCILLO Phone: Phone: 714-951-5777 MISSION VIEJO,CA Zip: License: 92630 License: C044535 SCOPE OF PERMIT 770 SO. FT.FIRST FLOOR ADDITION TO AN EXISTING SFR.SCOPE OF WORK TO INCLUDE:EXTENSION OF MASTER BEDROOM AND EXTENSION OF TWO ADDITIONAL BEDROOMS,ADD NEW BATHROOM,EXTENSION OF FAMILY ROOM,33SF INTO GARAGE,AND LIVING ROOM.ADD KITCHEN NOOK AND NEW ENTRYWAY. EXTEND GARAGE 140 SQ. FT. EXISTING 4 BEDROOM SFR TO REMAIN 4 BEDROOMS.EXISTING 2 BATHROOM RESIDENCE WILL BECOME A 3 BATHROOM RESIDENCE. 40%OPEN SPACE REQUIRED:60%OPEN SPACE PROVIDED FEE SUMMARY Plan Check: $623.19 Calc Valuation: 594,550.00 Permit: $958.75 Claim Valuation: so.00 SMIP Res: $9.46 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,591.40 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 24-0 Rear 30-0 Left 10-0 Right 5-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it 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 thispermit. FOR INSPECTIONS CALL: (714)754-5626 2448.46(6/00) • DECLARATIONS �-- WORKERS'COMPENSATION DECLARATION: I hereby affi munder penalty of perjury one of the following declarations: - • ❑ I have and will maintain a certificate of consent to sell-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.) XI 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 C lilomla,and agree that If I should b ome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr Ions. /� Applicant Signature: Data: 1-2'2 -O 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 DOLUIRE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 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.Uc.a Class a 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 Cade). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement Thal 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 su jects the applicant to a civil penalty of`not more than five hundred dollars($500).): I,as owner of theproperty, employees ofes or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intendedhereon, 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 Ls 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.). m 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 exe under sec. Business and Professions Code for this reason: Signature: - Date: ' - 22-O l Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: ilat-..--"t—O'f 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 Irom the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Data: 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 fo_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 II an RMPP is presently required has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No __ ..._ _____ _ ill 5 Does or coo the tcAir ou present ar emen b isding occupant other for the work which is the subject of this application eggarmil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ 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 the facility to be constructed under thi of s permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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 allot the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (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 ply with all state laws • ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ pr arty for inspectdee not to occupy or allow occupancy of any building authorized by this permit until final inspection. 1 —zZ -nom Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE it alSPECRON TYPE BRIE EJTmALS LODE' INSPECTION TYPE gJ RIDDEL$ 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 NEWPORT-MESA UNIFIED SCHOOL DISTRICT N° 4292 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: Q�) City of Costa Mesa District Receipt No. 1L ( City of Newport Beach ( ij' Ni) County of Orange 1 �j> Plan Check No� �- Applicant: 7\. \. s 14' J'1 S. .vZ-v ad a✓/ Address: ) _79 S q, / / Cecc/< / m `'k`S-¢/ C4— `l1� ( I ` Telephone Number: 7 /4f— . 7Gst-- Tract/Parcel and Lot Number(s): / Location of Project: $ i?;c9 P-1:14....--4-.1 GY lc1 c.- `j. ��/ Number of Square Feet of: Se I Residential Space '7 70 Lf x $1.84 Total 4 j/ 1 ID 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 Pemits 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: 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/County shall be nbtified2823/2:86 PUS 1416.68 nCFi#:01 E++119819 // Date: A 2 22- o f Applicant • • `40" CITY OF COSTA MESA 4 BUILDING DIVISION f ____ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J arra a PERMIT E03-00647 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1939 SANDERLING CI Status: ISSUED Suite No Applied: 07/22/2003 Vicinity: Issued: 07/22/2003 Parcel Nunmber: 13948123 Applicant: HUDSON, HANNIS ISSUED BY: Ceor 1939 SANDERLING CIR Phone: 714-979-7265 COSTA MESA,CA Zip: 92626-4735 Owner: HUDSON, HANNIS AND MARY S 9 • Address 1939 SANDERLING CIR sti ) ' � � Phone: 714-979-7265 ,In, COSTA MESA,CA Zip: 92626-4735 1 Cltb Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT 770 SQ. FT. FIRST FLOOR ADDITION TO AN EXISTING SFR.SCOPE OF WORK TO INCLUDE: EXTENSION OF MASTER BEDROOM AND EXTENSION OF TWO ADDITIONAL BEDROOMS,ADD NEW BATHROOM,EXTENSION OF FAMILY ROOM,33SF INTO GARAGE,AND LIVING ROOM.ADD KITCHEN NOOK AND NEW ENTRYWAY. EXTEND GARAGE 140 SQ. FT.REF.: B03-00913 ELECTRICAL TO INCLUDE:4 LIGHT FIXTURES,5 SMOKE DETECTORS, 12 OUTLETS,8 SWITCHES, 1 SERVICE TO 200 AMPS,AND 1 TEMP POWER POLE. 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 $9.90 9 up to 50 kva/kw $0.00 0 Recept Outlets $13.20 12 up to 100 kva/kw $0.00 0 Switches $8.80 B 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 $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 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, mid 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) 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: Cartier: Policy Number: (This section need not be completed it the permit is valued et 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 nd agree that if I should be me s ect to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio . Applicant Signature: Date: L-az-a3 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(swum,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 4 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). Lenders 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 Cole:Any city oricounty 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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sueels the applicant to a clvil 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,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 em axe rust ander sec. / Business and Professions Code for this reason: Signature: a.. c. ��/01111, Date: 7 `Z 2.43 �L Owner ID verified by drivers license. • Yes 0 No Driver's License No. / Expires: C.-21 a 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 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 aP plication a_oermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes Lf No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'ryes",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 COMPIJANCE 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. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I ff1SPECTION TYPE PATE 1fITPALE CODE. IfSPECTION TYPE PATE 1NTMALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical ��11 1266 Pool Spa Final 208 Final Plumbing 21(4//210 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 501 MF 9 CITY OF COSTA MESA BUILDING DIVISION 1, :. ,. DEVELOPMENT SERVICES DEPARTMENT PERM! NUMBER t• PERMIT jecvma its P03-00455 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1939 SANDERLING CI Status: ISSUED Suite No Applied: 07/22/2003 Issued: 07/22/2003 Vicinity: Parcel Nunmber: 13948123 ISSUED BY: Applicant: HUDSON, HANNIS Address: 1939 SANDERLING CIR Phone: 714-979-7265 COSTA MESA,CA Zip: 92626-4735 Owner: HUDSON, HANNIS AND MARY S Address 1939 SANDERLING CIR Phone: 714-979-7265 COSTA MESA,CA Zip: 92626-4735 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch/ Eng : Address: Phone: Zip: License: SCOPE OF PERMIT 770 SQ. FT. FIRST FLOOR ADDITION TO AN EXISTING SFR.SCOPE OF WORK TO INCLUDE: EXTENSION OF MASTER BEDROOM AND EXTENSION OF TWO ADDITIONAL BEDROOMS,ADD NEW BATHROOM,EXTENSION OF FAMILY ROOM, 33SF INTO GARAGE,AND LIVING ROOM.ADD KITCHEN NOOK AND NEW ENTRYWAY. EXTEND GARAGE 140 SQ, FT.REF.: B03-00913 PLUMBING TO INCLUDE: 1 BATHTUB, 1 DISHWASHER, 1 GAS EARTHQUAKE VALVE, 1 GAS(1-4) OUTLETS, 1 GAS REPIPE, 1 LAUNDRY TUB, 1 SEWER CAP, 1 SHOWER, 1 BAR SINK, 1 KITCHEN SINK,2 WASH BASINS,2 WATER CLOSETS, 1 WATER HEATER,AND 1 WATER RE-PIPE. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $9.80 1 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 $19.60 2 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 it 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 2448.48(800) 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.) V2' 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•:Ilfomla,and agree that if - Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro •-ions. Applicant Signature: — 4/i, Date: fl' ' E _ 3 WARNING:FAILURE TO SE URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 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.tl Class a 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 sgbjects the applicant to a civil penalty of not more than five hundred dollars($500).): Poll I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,end 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 properly,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 mpt under sec. Business and Professions Code for this reason: Signatur • 11 Da : r7)--.°2-" -6, Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: (-a! --D / 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,Califomla 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 end 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 Califomla 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 55850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No I, (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 ❑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-describe pro (Hrty for inspection purees .1 a r occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal ner(s) Date Z —03 And/Or Authorized Applicant Date 101E}, INFixed Sys emON7K PATE gilmELi 206 INSPEFinal ec ng,11E KUALA 1616 System Final Fire Prevention 206 Final Mechanical " 1266 Pool Spa Final 206 Final Plumbing (1 ��zS 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 .3 CITY OF COSTA MESA 4 BUILDING DIVISION f°.�„C,y II 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us• `• 4. pm* . FOR INSPECTIONS CALL: (714)754-5626 A' PERMIT NUMBER: B08-00278 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 13948123 DATE ISSUED: 10/03/2008 ISSUED BY: RMD JOB ADDRESS: 1939 SANDERLING CI CM Suite/Unit: Vicinity: HOUSE AND GARAGE ROOF Squares: 4200 Valuation: $12,000.00 SCOPE OF WORK: TEAR OFF(E)ROOOF MATERIALS,INSTALL A MINIMUM OF 1 LAYER OF 30#FELT ON A 3:12 PITCHED ROOF AND REROOF WITH 50 YEAR COMP SHINGLES(PER CONTRACTOR CLASS"A"ASSEMBLY)ON A HOUSE AND GARAGE,APPRQX 4200 SF.REPAIR AND REPLACE SHEATHING AS NEEDED. OWNER: HUDSON, HANNIS AND MARY S Address: 1939 SANDERLING CIR Unit: PHONE: 714-979-7265 City/State/Zip: COSTA MESA,CA APPLICANT: BATIOFF,JOHN Address: Unit: : PHONE: 714-381-7974 City/State/Zip: CONTRACTOR: MODERN ROOFING INC License No. 807881 Address: 2219 W OLIVE AVUnit: SUITE 282 PHONE: 8188485050 City/State/Zip: BURBANK,CA 91506 CELL: ARCHITECT: License No. - PHONE: • ENGINEER: License No. PHONE: • FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $209.25 ' Reinspection Fee: $0.00 TOTAL FEES $209.25 GREE rr 2 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord,No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE/ INSPECTION IYPFp NITT&LS CODEI INSPECTONTYPt IN11f14L$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof (P—if-of €si 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver.license. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expic's: k. ❑ I have d will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): I comae ion, as provided for by section 3700 of the Labor Code, for the • pert since 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • permit is issued. My workers' compensationrInsurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet hi depth into which a number are: person is required to descend,will be made in connection with work authorized I,,} by this permit,and that no building structure,scaffolding,falsework,or demolition -Carder: e or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This sed=an t bmm plated the penn4 is valued hundred dollars less) 2 Art 2Sec.341,Title 8.California Administrative Code). Policy Number: 1 3 oa C I} llp 7 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Apq;wmfs Signawre Date the Labor Cod I shall 1 rth comply with these provisions. ��„ \/ / 11 � `bj Division of Industrial Safety Permit Number: nt's grature Dare HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1, Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file my license is t full force a d effect. /� a registration form for acutely hazardous materials? ❑Yes 0 No Lic.# c Class# ` (Section 25533 of the California Health and Safety Code, with some /y- �� ,y exceptions, requires registration with the Costa Mesa Fire Department by r f each business which at any one time has on hand a quantity of acutely Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safely Code been fully complied with? 0 Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Profession. Code:An city or count which resuires a permit to or .,.' .tion from the South Coast Air Quality Management District or from j construct, alter, imp e t-molls /Spire'aire ure . .r ,O I a pr. o &i pollution control district or agency? 0 Yes 0 No issuance,also requirsi3(u- apptican f r suer'permit, 1 d- a.;ta1 @a - z . (-- .n •.17•0.2 of the Caon applications fa notCoddrnqul building therequested ct he r she islice e• , en t ` th=e pO. r or�3 0t e to t .,M t. i Q.r,,,r-,Ps R. furnished on applications fa non-residential permits). License Law(ChaDte+O((Ka. enc= 'th 6�cgQs r sp�i .,f of tsio Ch1' e Business and Professions Code)or that he or she is exempt t erefrom and 6. "- -ny part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work'himself or herself or through his or her own 8. (If yes attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). • completion, the owner-builder will have the burden of proving that he or she • CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and • 'rb city ordinances regarding Hazardous Materials and Emissions. ❑ 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 Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupyyy,,,or allow occupancy of any building authorized by tht{p rmil fina Pec1r f Signature ia Leg. err L Date Signature Date - ��J��/ 'CI7J 3057-46(3/071 Andla A ho and Applicant ` `� Wh too 1 'F 9 CITY OF COSTA MESA rA BUILDING DIVISION > •! „,,� ,, r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER v yr�a PERMIT e, M03-00342 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1939 SANDERLING CI Status: ISSUED Suite No Applied: 07/22/2003 Issued: 07/22/200 / Vicinity: 11, Parcel Number: 13948123 ISSUED BY: '' Applicant: HUDSON, HANNIS Address: 1939 SANDERLING CIR Phone: 714-979-7265 COSTA MESA,CA Zip: 92626-4735 Owner: HUDSON, HANNIS AND MARY S Address: 1939 SANDERLING CIR Phone: 714-979-7265 COSTA MESA,CA Zip: 92626-4735 Contractor: OWNER-BUILDER Address: . Phone: Zip: License:000000 SCOPE OF PERMIT 770 SQ. FT.FIRST FLOOR ADDITION TO AN EXISTING SFR. SCOPE OF WORK TO INCLUDE: EXTENSION OF MASTER BEDROOM AND EXTENSION OF TWO ADDITIONAL BEDROOMS,ADD NEW BATHROOM,EXTENSION OF FAMILY ROOM,33SF INTO GARAGE,AND LIVING ROOM.ADD KITCHEN NOOK AND NEW ENTRYWAY.EXTEND GARAGE 140 SQ. FT. REF.:B03-00913 MECHANICAL TO INCLUDE: 1 INST FAU< 100K BTU, 1 GAS PIPING AND 1 HOOD W/MECH EXHAUST. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0Ventillation 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 $0.00 0 , 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 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 $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dempers $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> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee 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(8/00) 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 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 it the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif ia,and agree that if I should be me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with these prowsi Applicant Signature: Date: 1.—22--D3 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 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 0 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction tending 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 properly,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 amex t under sec. Business and Professions Code for this reason: Signature D- . _ • ! 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,fatsework,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 ❑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 ❑No (Section 25534 of the Calif omia 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 o....l h.... .r present future ul ing occupant 5 Does or will theapplicantoasAiror present or emebusting o from at other for the work which isi 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? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 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 ❑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 pr rty for inspectio ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. -7.. 3 Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE f INSPECTION TYPE DSII gaL5 CODE( INSPECTION TYPESC / QAC Iul'1:1- ' 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 4. PROJECT ADDRESS: 1939 SANDERLING CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BE 05228`_ O'WNER'S NAME: GARCIA, JAMES D ADDRESS: GARCIA JUNE E PERMIT NO: BE 052285 PLAN CHECK NO: 01923-91 S GOVT: N SUPP: N 1 1939 SANDERLING CIR COSTA MESA,CA 546-3873 92626 CONSTRUCTION TYPE: PERMIT TYPE: ELE STR PURPOSE: ADD ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ENCLOSE 114SF PATIO, UNDER EXISTING ROOF SQ FT: 2, 500 ADDRESS: UNIT: CLAIM VALUE: 2, 500 . 00 CALC—VALUE: 2, 500 . 00 GROUP OCC: R-3 / PERMITTEE: JUNE GARCIA ( 714 ) 546-3873 ADDRESS: 1939 SANDERLING CI COMMENTS: X C.M. CA 92626 ****************+E****x** ****ff********x***T6*Nit***•NTk*****x>Fa6*NT6****RE** **N+c***** LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMEN TS 7000)of Division 3 of the Business and Processions Code.and my license is in lull force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: 29 FT 6 IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: 12 FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV• PARCEL : 13948123 ZNE• R1 REF NO: ❑ Certified copy ishereby furnished. 0 Certified copy is filed with Necity Building Division. PLANNING NOTES> ENCLOSE AN EXISTING 114 . 1 SQ. FT. PATIO, ONLY. • > • ate. Applicant **********************************-lE****if************IE**-%*****If************T6N-*** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1(p)or less). DEVELOPMENT • S E R VICES R E Q U I R E M E N -T S I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner se as to become 5. subject to the Workers'Compensation Laws of California. ZONING APPROVED B Y c,p DATE: (o ( ry q Dale: Signature: 1 NOTICE:If,atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APP ROVED BY : - DATE Code.you must forthwith.comply with such provisions or this permit shall be deemed revoked. •_ • . CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE. CO C which this permit is issued(Section 3097,civ.C). ***************************************3F * *************************** * *** LENDER: ************************************************************************}:****** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 5 4 . 0 0 6 . 00 . 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant t0 the provisions of the Contractors'State License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business 50$ SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 35. 10 , any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5w). ISSUE FEE - 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—Dry--> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE W structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'Stale License Law TOTALS— —> 60 . 50 15. 00 35 . 10 110 . 60 1 10 . 60 . 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 sate. If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 110 . 60 OVER/SHORT: 00 tor purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TUT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 4 • 00 21 • 0 0 50 3 5 10 ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with acontractor(s)license pursuant to theContractors'State License Law).I am aware *if**********************************•N********************************!L•********* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: O.&P.C. for this reason: / TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST /� Ow Date. 6/171 ner ,tu cC a' �� SFR 2500 STRUCTURAL BY VALUE PER $1 00 1 . 00 2, 500 . 00 I do hereby certify that I am aware of and understand the requirements f Cal to is Health and Safety Code c i ns 25505,25533,and ELE 2 FIXTURES LIGHTING 1 ST 26 EA. . 75 1 . 50 25534 and that I or any future building occupant wit/will not(circle one) eed •comply with said state code a d the requirements for a ELE 4 REC EPT/OUTL E•T 1 ST 2 0 EA. . 75 3 ,0 0 permit for construction or modification from the Air Duality Managemen ''strict,Residential construction applications are exempt from Nese provisions. ELE 2 RECEPT/SWITCH 1 ST 20 EA. . 75 1 . 50 END OF FEES DateApplicant' I hereby certify that have read this applicationn anddstate that the above information is correct.I agree to comply with all city and county (,// ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above.mentione property for insppeej ion urposes. Date. �1y / Signature: � U/( . ^T":•[1(;55/41 7,L::: 1641-46 White—Building:Green—Cade Entorcemen• GP—Applicant:Pink—Revenue:GOIdenlod—Assessor ' y-, CONSTRUCTION AND PLANNING - POOL & .4 N r"APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. JJJ 57. APPROVAL TO COVER-GUNITE 7. Footings /�r Di62- 58. Electrical Conduit-Undrgrnd. 8. Foundation r 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 jj / 66. Solar System-Final "% 16. Rough Electric Wiring Q// 4, (/ 67. Fencing & Access Approval 17. Rough Wiring Sign Cf68. 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 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 Flashing b 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation //if r0/4 78. FIRE PREV. FINAL - - 30. Drywall Nailing V//!%ted * HEALTH DEPT:REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-FinaluR 80. FOOD CERTIFICATE ISSUED .33. Final Electric ?f n) i i Notes: 34. Final Heating& Air Conditioning lll` 35. Final Gas Pipe-Test- 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final • 40. Gas Service-Final - - 41. Solar Domestic-Final - 42. Backflow Preventer 43. Backflow Irrigation - -44,. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7('11ql,/4 7 48. FINAL PLANNING 7 +�'V 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. - Date t ODRESS: 1939 SANDERLING CI CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 063257 • ,OWNER'SWNER'SNAME:GARCIA, JAMES D aDAAEss:GARCIA JUNE E PERMIT NO: B 063257 PLAN CHECK NO: N GOVT; N SUPP: N 1939 SANDERLING CIR COSTA 'MESA, CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT ARCH/ENGINEER: 546-3873 REG.NO.: ADDRESS UNIT: JOB DESCRIPTION : T/OFF RESHT. REROOF W/COMP SQ FT: 3, 000 CLAIM VALUE: 3, 000. 00 CALC—VALUE: 3, 000 . 00 GROUP OCC; R-3 / PERMITTEE:JUNE GARCIA ( 714 ) 546-3873 ADDRESS: 1939 SANDERLING CIRCLE COMMENTS• SMOKE DETECTOR REQUIRED IN THE HOME PRIOR TO FINAL COSTA MESA CA 92626 *************************** *********************>E******* "****** -*x LP#********** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON I NG R EQUIR EMEN TS 7000)of Division 3 of the Businjss and Professions Coder and'my d5ense is in full force and effect. SETB ACK S CITY LIC.: STATE LIC.: CLASS: Date: % Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800, Lab.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING RE • PROV: PARCEL: 13948123 ZNE: REF NO: Certified copy is hereby furnished. E Certified copy is filed with the city Building Division. PLANNING NOTES>, > Date'. Applicant: *****************************************************************." • -*********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V EL OP M EN T S ER V ICES REQUIR E M E N ;:P 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 thew kers'Ctomoensation Laws of California. ZONING APPROVED. BY�? ° 8 DATE: te: 1 50193 Signature`` w�-Q- Y-�' NOTICE:If, fter making this declaration,you shoccome subject to the Workers' rrensation provisions of the Labor BUILDING APPROVED BY : / DATE: Code.you must forthwith comply with such provi ice'or this permit shall be deemed��1111LL skeet `� .-y am/, CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• di • /Lira DATE: / �,3d �:J which this permit is issued(Section 3097,Civ.Cl. ************** ******* Y ' *' - *********/********** LENDER: ****************************************** ::***************** -: . *********Bt****±t ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCT •4, EGMENT: 1{ OWNER BUILDER DECLARATION: I hereby affirm that I 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 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 5 4 0 0 . 50-.1 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON.RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE ir' I, as owner of the properly or my employees with wages as their sole compensation, wit 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----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 • 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If.however the building or improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 54 , 50 OVER/SHORT; ••-" , 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADINCrPtLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 • 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).l am aware **.*.*"*-*.*.*.*",*.*.*******fE*.******,***********.7(.***.******************•**** , **,************ that proof of their Worker's Compensation insurance should be provided to me. p I am exempt under secoon:B P 704 4 B.a P.C. I ND I V ID U AL F EE BR EAKDOW ' for reason: ATV0 wpAK BY OWNER �� TYPE QTY D E S C R I P T' I O N UNIT COST ,�'OTAL COST L Q WjQk�Q, Owner R� I do he eby c rlily that am aware of and ui stand the requirements of California Meati and Safety Code Sections 25505,25533,and SFR 3000 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 3, 000 . 00 25534 el al l or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit fo construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. ,,X" Date: Applicant: n 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 state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. `p .____...-----00r- 1 340)93 Signature: ' ��a -- 01 00143892-00143893 0 TOT 31 54. 0 Driver's License or Social Security ) 1641-46 White—Budding:Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor r. , r-' CONSTRUCTION AND PLANNING POG . SPA I APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector tg 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 Plumping & Pressure Test ' 6. Electrical UFER Grnd I 57. APPROVAL TO COVER•GUNiTE 7. Footings 58. Electrical Corciu t•Undicrno. 1 • 8. Foundation 59. Gas Pipe, 0 Urdrgrnd . Test i j 9. Water Pipe-Undrgrnd. 60. Backwash Lire:, P-Trap, C' Ur.d:crnd. -, 10. Structural Floor System 61. APPROVAL TO DECK J 11. Property Sewer Line & House Connection62. Backwash & Receptor Fin:- 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System • Final -I 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final I 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 l 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMEAT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts.-Vent dating 71. Product Pining 'I Gas 2' Oil . 23. Gas Pipe-Rough & Ten 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 22 Gas _' G I . ___r- 25. Roof Sheathing l/ . 17 6c.,,# 74 Overhead Hyoro 26. T-Bar Ceiling (Structural) & fvlonocoat t 75. Dry Chemical 27. Frame and Flashing 76. Dry Standp:rc - 28. Lathing & SidingI I i 77. FIXED SYSTEM FINAL 1 -i29. Insulation j 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT REQUIREMENT 31. Piaster Brown Coat 'j -%� 79. FINAL INSPECTION I • 32. Electrical Power Meter-Final j 80. FOOD CERTIFICATE ISSUED 33. Final Electric . i i ?�• Notes: 34. Final Heating & Air Conditioning r I 35. Final Gas Pipe-Test I 36. Hood or Canopy i /'.. i 37. Final Factory Fireplacei . 38. Final Plumbing j _---- --- 39. Water Service-Final i j 40. Gas Service-Final . i 41. Solar Domestic-Final I • - 1 42. Backflow Preventer 43. Backf low Irrigation -__- - ---1 44. Landscape Irrigation System 45. Sound Attenuation Pl 1 46. Handicap Regulations .. 47. FINAL STRUCTURE & BUILDING _ �v, . . T-�� -' 48. FINAL PLANNING 1 49. Electric Release to Edison -a 50. Gas Release to Southern California Gas Co J • 51. CERTIFICATE OF OCCUPANCY I No. Date V e Applicant to fill in all spaces except those within heavy border lines and sign all appropriatdeclarations. / CITY OF COSTA MESA CCO�,NSTRUCTION RJRMIT PT 1-1,391 ERMIT NO. 52 NO. LOT NO. UNIT NO. Project Address (�1�=1 ._{/p,�wdde(r'�l intg &rGie�1 -- ' � � /��/,/(�/ 4 Applicant's Mailing Address/ !3/ r )All ?RL/hoc" 0 l ccc TYPE OF CONSTRUCTION U NEW LJ ADD H ALTERATION U REPAIR OwP/js Name ��,///777GGG El CONVERSION El DEMOLISH ❑ OTHER ^^ g l /272 9' RS 70- 6/9e-C/4honr� -_73 A.P.# I — T5')l 2 3 • Zone 939 ,St9 t/''6 Ober DESCRIPTION OF WORK/USE OF BLDG. _ - , _Address l :. _ _ S Main Building: !.-A'Y. rayl ItrkT{ lAcces.__ .. wilding:.. _ . ,-- Zr. Arch/Eng. License No. TYPE OF PERMIT El GRADING ❑ FOUNDATION ❑.STRUCTURAL - T Front 5'Y`fb' re & F•Q_ 0- 0 Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING '❑ MECHANICAL - •. B Rear 17 / N ' ❑ OTHER A /_ N Contractor's Name Phone -" - - - C Right VJ G PROJECT DESCRIPTION SQ. FT. OCCUPANC�Yt _ K Address(mailing/ CONSTRUCTION TYPE - I VALUATION$ J u 0 b '— $ Left T 70 R City License No. ZONE •.GRADING CU.YDS. ACRES • LICENSED CONTRACTOR DECLARATION Ping. Ref,# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 51)� Planning Notes: k,�s.�rTQ J--J e I A .G iy�A M 0 with section 7000) of Division 3 of the Business and Professions Code, and I e_i my license is in full force and effect. �,//� 1/� 35.€S- O 0, �/y'/1 / -t Q T License Class License No. ,V T`�'S �� "�� ti\ V- ]0�L7 S Date Signature \\\ ?Lc. 44�I St LUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink '1 Showers ELECTRICAL FEES ereby affirm that I have a certificate of consent to self-insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink ' -1/300, Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No, Company Backflow Irrigation Sewer Cap Construction PoleSub. 050+KW eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or ' less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I ��((,,�� shall not a •toy any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan ' Motors y Q-1 HP ❑iM-B .� /v • Workers' •• p- y -n .ws of Calif n .r� _ Date • .I. Signature t� -�- Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE: f,of••r making this decla to you shoul become Subject to the — — - Workers' Compensation provisions f e Labor C e, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or is permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY l Gas Service Outlets Water Closet 7., Sb Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Name Range Lender's Address Kitchen Sink Water Service Switches .Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW❑5-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000)of 'ivision 3 of the Business and Professions Code) or that he/she is exempt erefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee .$•B - for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law 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 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 q sale. If, however, the building or improvement is sold within one year of coma Canopy Type II 0 Zoning Approved By Date �•AD'6B pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground 1)4-- prove },(�_ mp prove for the purpose of sale). Building Approved By �"�`t• Date 7 — 1 --8 ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By crs'. Date 1.---1—C•1B tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- tr.tor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. _ . - PLAN CHECK $ PERMIT ❑ I am ex= pt uncle Section B. & P.C.for this reason Firepl/Fact.BIL 'CHO# Fire Dampers PLUMBING $ C ISSUANCE $ Heatin g g' ENERGY P.C. $ I he f Own •er ' 7 - g System& D n Re esters PLAN CHECK 25% $ I hereb ce ify that I have res• application state that the above El 0-100,000 BTU 0100,000 BTI. ELECTRICAL $ I C)� GRADING $ informs Ion is correct. I agree to l ply with all ci and county ordinances and state laws relating to benter - construction, an. hereby authorize repre- sentatives of this city to enter upon tale above-mentioned pr••er for QJ inspection punas f � -- _ MECHANICAL $ TOTAL FEE $ '17 Signature to _ ___ Reinspection Fee $15 Issue Fee $ 3fir - PLAN CHECK 25% $ CMF 0865-46, 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING - POOL& SPA APPROVALS PermitW Date Inspector I 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.A APPROVAL TO COVER-GUNITE ibSir7. Footings 58. Electrical Conduit-Undrgrnd. Q�8. Foundation' 59. Gas Pipe, aUndrgrnd.,Test t1/9g 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 i,., 69. POOL/SPA SYSTEMS FINAL : /0�q ' 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 - -, P 28. Lathing & Siding 77. FIXED SYSTEM FINAL - . 29. Insulation 78. FIRE PREV. FINAL, o (, 30. Drywall Nailing HEALTH DEPTY EQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION,- 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning • 35. Final Gas Pipe-Test - , 36_ Hood or,CanoPY 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations / 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison , ft 50.4GasRelease to Southern California Gas Co -' 51. CERTIJFICATF,OF OCCUPANCY f' 'At No. Date 0 wNC:X GRAY, PAUL 1A. Milt. 1V "LV—b7 OB ADDRESS 1939 Sanlerling Circle BUILDING PERMIT NO. 21t$21 ENERAL CONTRACTOR Owner - Builder DESCRIPTION OF WORK 11 Pilasters P No. �9_W31_p3 LOTTRACT FIRE ZONE VALUE $ 1♦.QQ.QQ �rNSPECTIONS oil I Signature Date GROUP J TYPE jjj ZONE R-1 ' PERMITS ISSUED Gas SUBCONTRACTOR Date I Number I Signature Water ; Plumbing Rough Plumbing Prop. Swr. Line 0 House Con. 0 Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground ❑ Power 0 Rough Wiring Heating and Vent. Trenches [Forms 0 Steel Reinf. 0 . -trilti fe a 7 Cs----- Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, Brown Coat Structural, Final Electric _ Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final Building, Final_ r g io�yft// _ 2482 ear-a els20;1 6 - �— • -0CT COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1$0 COSTA MESA, CALIFORNIA 02E20 . For Applicant to Fill In Completely - APPLICATION FO rtRMIT TYPES OR`�PRINT 1 / �t AUIWII� ty BUILDING \ ' 3 x1e4t erz1_l06CII2cLF MIO_i ,(f(. c�{{jZQJ\On • ADDRESS RECEIPT NO.--...f [KNIT NO. COSTA MESA, CALIFORNIA Al 7dR9I �• DAT RICE ED IQ,/ED OWNER ` a V� C1-261 y - - 0 CI . /4 20 6 • • MAIL `C A vvr '� • i• ADDR �(�• I� J1{•61 L �, r[� f� i . . �,in1 . . s CITYH \ 0S 4 Nis A TILL. 5451 ,: ;1� �••GROUP VIGINEER in �, DATE /a 201 ZONING 1.O ' ADDRESS ZONE I PNO.HSI I sUYDI NN0EW L 1 - GONTRAuR 41 W NI T V 'SW. _ i MON/ ADDRESS CITY A.P.NO. / 3 l — 7 5(/— t2-3 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL 8011 TO SIDE B REAR P.L . LIC.NO. NO. VES SIZE I NO.OR SLDGB./' EAVES (U.B.C.REQUIREMENT) 2. OF LOT NOW ON LOT 1 ' ` YARDS IN BUILDING ACCESSYARDS ORY BUILDDING i USE OF COJ^L�,.'� MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. 4 CENTER OF STREETF _ REAR YARD a PT. SIDE YARD I LEFT I RIGHT FP glini. FT. • DESCRIPTION OF WORK 4.5101 PT. FT. I / di �. , r ALTERATION ADDITION .• REAR PT. PT. DISTANCE BET. BET.MAIN e REPAIR MOVING DEMOLISH S MAIN BLOCS. ACCESS.BLOCS. BUILDING NO.OF VAR.# DATE .4 SIZE ROOMS STORIES C.LI.P.$ , APPROVED EXTERIOR WALL ROOF - AFPROV '' DD ^ _ av COVERING I COVERING SY �OiY , -ATE /0/a-e �n it • USE OF BUILDING AND WORK TO BE PERFORMED y 01 `' 1 l 1`� it--1\S— �(ZS 1 SG.PT. il I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION _ THE AMOUNT SHOWN UNDER VALUATION IS POR THE S AND °TATE THAT THE ABOVE IS CORR CT AN AGREE TO CON. _ PURPOSE OF ESTABLISHING A PERMIT FE[ ONLY. $I PLY UI WING ALL CITU O ZS AND ATE WS REGULATING VALUATION 00 SUILDINGCONBTRU N. \Y/\1 SIGNATURE OF QAA II PERMIT FEE, E PERMITTEE "_`"I AUTHORIZED AGENT s zoo 3.CDC w TOTAL FEE 5 Lot t,s,A FEE . RECEIVED 9 I R23 MAR 31 1964 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA.CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING ADDRESS 1939 Sandarling Circle RECEIPT NO. ERMIT NO. COSTA MESA. CALIFORNIA 7 IR�3. REC[IV D[Y TE RECEIVED DATE ISSUED OWNER Pemba Subdividers, Inc. -3/- F7' FPR 1 4 1964 BUILDING MAIL 2850 Mesa Verde Drive ADDRESS ADDRESS Pd' CITY Costa Mesa NG.5490395 ZON ,EH TYPE GROUP (1Y9 AR1 'TECT E.G.Kaltenbach TEL.5478046 BYPROVED DATE OF ANEER NO. 1833 E. 17th St. , Santa Ana ZONING ADDRESS (��,.. ZONE NO.OF I USE OF Naw sing. Pam. .� Jwner S a nit' R-1 I PLANS 2 BUILDING w'// att gar. CONTRACTOR - Lot 1. rf LEGAL Loo 4 Tract 2 ADDRESS DESCRIPTION .1 5 69 CITY A.P.NO. none 187318 EL NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TSO'TO SIDE a REAR P.L. LIC.NO. p NO. EAVES SIZE 847f 10�7.0(L I NOW GN LOT .O ALLOWED (U.B.C.REQUIREMENT) OF LOT X � T g/ 7/ YARDS APPROVED YARDS APPROVED EXISO NO BLDG Y)%7a v-/ 41.7,7 kok t MAIN BUILDING ACCESSORY BUILDING �M� (FROM C//L^SSTREET) 33 SETBACK LINE FRbM 50! 1 FRONTLJV FT. FT. CENTER OF STREET REAR YARD SIDE YARD LEFT 157 I RIGHT 12' R.SIDE / . FT. DESCRIPTION OF WORK L.SIDE I SFT. FT. N. X ALTERATION ADDITION REAR 30 FT. FT. DISTANCE BET. BET.MAIN e REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.SLOGS. BUILDING 2 139 NO.OF6 1 VAR.�F DATE SIZE r/ ROOMS - 3;17E4 C.U.P.# APPROVED EXTERIOR W�1kding I ROOF APPR S �\11 , z / Sh COVERING OLDDD LLLlll111CCU COVERING hmgle BY 11 7 )AAM DATE 0 e c USE OF BUILDING AND WORK TO BE PERFORMED 111 MMM `YYY Single family with attached garage. C{�V/,/ House 1,741 sq.ft. Garage 425 sq.ft. Plan 41-CR /95/6 BQ.FT. a-1H7" ra o I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION I FOR THE E AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINA CES AND STATE LANA REGULATING VALUATION 6e — BUILDING CONSTRUCTION. STATE / SIGNATURE OF /J I PERMIT FEE 5 O PERMITTER �.L/ !/` ..�f14., G $ 070 .30/= PLAN CHECK $ 33 o 0 AUTHORIZED AG N TOTAL FEE $ 9. — Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CIT4OF COSTA MESA PERMIT NO. TRACT LOT O. BLDG.NO. i CONSTRUCTION PERMIT 13 a 33 . l • 8960 7/14/81 54. 12 Tl Project Address C C` i ' - - • • ' •- / /-j9 .�AA•'G eL Yew/yy C!/•• ` TYPE OF CONSTRUCTION Owner 5A/..G(/ Mei)_vw Phonen_75h7 0 NEW 0 ADD 0 ALTERATION Address 4739 sANdc r/_/ivy Cir. 0 REPAIR 0 CONVERSION �❑DEMQ ISH Arch/Eng. 0 OTHER JJ CC/{ PVA L4- l0 / ZONING REGULATIONS License No. _ Address DESCRIPTION OF• WORK2 �(`-{- A.P.$ /f$j 119 0.5-7 , a Contractor •� _. `r T I - ZONE K YY �^ PLNG. REF. C1/7/s' P/Lt1AM MAsoh'r hdne7�y/ /ff TYPE OF PERMIT t BUILDING TTpp gg��11I``ppINC J \C� N/ S, ' SETBACK.0/L Sr PROPERTY LINE Address - 0 GRADING 0 FOUNDATION (ASTRUCTURAL SIDE YARD /i_y iyi__ �J LICENSED CONTRACTOR DECLARATION ❑ TENANT 0 ELECTRICAL ❑PLUMBING..❑MECHANIC L5EFL 7.?._J_ " ' `� + / /, I hereby affirm that I am licensed under provisions of Charter 9 (corn- RIIGHTAR�— 1- mencing with section 7000) of Division 3 of the Business and 0 OTHER - Professions Code, and my ❑cense is in full force and effect. REAR YARD(TO P/I t • t. PROJECT DESCRIPTION License Class License Non PKG.SPACE REQ. nn 0`r'ncD-- Date Signature SQ. FT. STREET WIDTH _ PARK FEE $ WORKERS'COMPENSATION DECLARATION - OCCUPANCY_CONSST8 UCTI N TYPE ZONING APPROV Eoo..ft�t DA /il�j I hereby affirm that I have a certificate of consent to self-Insure or a VALUATION cg b00 / ��44L,�/ certificate of Workers' Compensation Insurance, or a certified copy ) T thereof(Section 3800, Lab.C.). GRADING CU.YDS. - • ACRES SPECIAL CONDITIO S: y No. Company - • .ertified copy is hereby furnished. REMARKS: ❑ Certified copy is filed with the city Building Division. - - -- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed if the permit.is for one hundred • ($100 or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become PLUMBING - - PLAN CHECK ELECTRICAL PLAN CHECK .- subject to the Workers'Compensation Laws of California. uwtLu rvG UA RAGt Date Signature BATHTUBS SHOWERS SO FT SO FT - I NOTICE: If after making this declaration, you should become subject TOILETS •URINALS GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must - TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - APPLIANCE 10-50 KW 50+ KW revoked. CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS _ MOTORS 0-1 HP 1-10 HP I hereby affirm that there Is a construction lending agency,for the per- .SERVICE SINS SUMPS (INC.SOLAR) 10-50 HP + HP formance of the work for which.this permit is,issued (Section 3097 Y Civ. C.)er' -\ _ .1. 1 . ` �t { FLOOR SINISS,,,A FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lende Y•Name` ` - - • i uLender's AddieSa • - 1. \_ - \,N "• t QftJNKUN ING FOTAINS v - GAS TUBE SIGNS OWNER BUILDER DECLARATION ' - INTERCEPTORS - CLARIFIERS POLE LIGHTS - I hereby affirm-that 6am•exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Prpfesslons Code: SWIMMING POOL .- P TRAP LUGS I KUL.IIUN Any,.clty.-orScounty which requires Ia permit. to•construEt„alter, - - POLES METERED SUB improve, demolish or repair any structure; prior to Its Issuance,also re- • WATER S-BRVICE ALTERATION PANELS MAIN SUB quires the applicant for such'permit to file a signed statement that•he ' . is licensed pursuant to the provisions of the Contractor's LlcensetCaw- ;..GASERV ICE. -t. OUTLETS SERVICE AMP Chapter.`9 (EOmmepcing-.with,Section 7800) •of Division 3 of,the ' -siness and Professions Code) or that he is exempt therefrom and the- -WATER•HEATERSBTU OUTPUT Afar the„alleged"exemptlonz,Any violation of Sections 7031.5 by '` ,applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS u.--not more than five hundred dollars ($500). \r ❑ I, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS • sole compensation, will do the work,.and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ' ISSUE FEE Contractor's License Law does not apply to an owner of a property APPLICATION APPROVED BY who builds or improves thereon, and who does such work himself or ISSUE FEEDATE through his own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES Is sold within ono year of completion, the Owner will have the burden CO ' of proving he did not build or improve for the purpose of Sale). BUILDING HEATING SYSTEM 0-100,000 BTU .PERMIT $ 3-7- O SMIP S__.__67-1!a_ ❑ I, as owner of the property, am exclusively contracting with AND DUCTING licensed contractors to construct the project (Section 7044, Business 100,000 +BTU PLAN CHECK $ a/' /a,. PERMIT and Professions Code: The Contractor's License Law does not apply to - ISSUANCE $ an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU. PLUMBING S tracts from such projects with a contractor(s) licesned pursuant to SYSTEM - GRADING $_ the Contractor's License Law). 100,000+BTU .1( \ • ( ,� ; PLAN CHECK $ 0 I am exempt under Section B. & P.C.for this BOILERS BTU • ELECTRICAL S $ reason - PLAN CHECK S MICROFILM $ Date Owner- SYSTEM REPAIR,ALTERATION • TOTAL FEE$ I herebycertif that I have read this applicationEXHAUST SYSTEM MULTIPLE MECHANICAL $ y and state that the above LESS AD- Information is correc I agree to comp y with all city and county PLAN CHECK $ VANCE PC S_ ordinances orig.st a y07s relating to c uction,and hereby authorize representat e4es of t�7s city upon the above mentioned /� property r insp on p 71/40/ FINAL FEE $ 534 Signatur _2 Date Drivers' License or S5 er . ISSUE FEE CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor • CONSTRUCTION AND PLANNING POOL&SPA '- ' APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & E ui q pment Location 2. Soil Pipe-Undrgrn - 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn ' 46. Electrical Bonding 5. Steel Reinforce 2N�4ei '""i 7 �� 8 ,y/ -2-/-11 47. Rough Plumbing & Pressure Test 6. Electrical UFER Gin - U 48. APPROVAL TO COVER-GUNITE 46-7. Footings Sy2 µo7E+s 1-20^91 $221 49. Electrical Conduit-Undrqrn 8. Foundation 50. Gas Pipe, ❑Undrgrn,Test • 9. Water Pipe-Undrgrn 51. Backwash Lines. P-Trap. ❑Undrgrn ' 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55 Plumbing System - Final 14. Rough Electric-Conduit r56. Electrical-Final 15. Rough Electric-Wiring 57. Solar System-Final 16. Rough Heating & Air Conditioning - 58. Fencing &Access Approval 17. - Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathing 22. Frame and Flashing _ NOTES: fir9.6, g-rc, S'tpf,(1 .,,•o��,, 4-4404-2 es . Insulation jL ,aliAo ,yt[a,c n.la oe? "t r �+J+t.�tuvtouo 24. Lathing & Siding CptMq,p,4 - ,nnw9t/ .17.ttdt(.�./n , 13797'r//�'5/ 25. Drywall Nailing QRQ [,'etie-t.•�tO✓r _,lt.�.,-M !.-et-v .c-..�am(Q (J j-$79' 26. Plaster Brown Coat - /- p rt eZ _a.QLLto Ao •`•ki�� 27. Electrical Power Meter-Final /moi / (� _(/� 28. Final Electric c �-�2 29. Final Heating & Air Conditioning 7 0/1" �7 Q h77n_Q 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation • 37. Handicap Regulations 38. FINAL STRUCTURE& BUILDING 1aa41 8 39. Special Requirements Completed _ / 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date