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Home My WebLink About1114 SAN JOSE AVE - Building Permits w, CITY OF CO)TA MESA ,, ,°`yam�) BUILDING DIVISION i.r ..'�4 I DEVELOPMENT SERVICES DEPARTMENT 69&000M7 PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1114 SAN JOSE AV Status: ISSUED • Suite: Applied: 06/02/1998 Vicinity: - Issued: 06/03/1998 Parcel Nunmber: 41204327 Zoning: R1 R1 Applicant: DOYLE C. FORTH & CO Address: 1075 REDDING AVENUE Phone: (714)556-7165 COSTA MESA,CA Zip: 92626 Owner MILLER, ROBERT Address MILLER, SUSAN COSTA MESA,CA Phone: 1114 SAN JOSE AVE Zip: 92626 Contractor: Address: Phone: Zip: License: Arch/Eng: Address:' Phone: Zip: • License: SCOPE OF PERMIT INSTALL 342 SQ.FT. LOFT INSIDE EXISTING LIVING ROOM FEE SUMMARY Plan Check: $97.34 Calc Valuation: $9,000.00 Permit: $149.75 Claimed Valuation: $9,000.00 SMIP Res: $0.90 . SMIP Com: $0.00 Other • $0.00 Inspection: $0.00 Total: $247.99 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 . Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing,' 0 Required: 0 Proposed: 0 NOTES: EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • DECLARATIONS [`+s arm, 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. O 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/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,a•- .gree the I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. / Applicant Signature: -/ ' • Date: WARNING:FAILURE TO SECURE W I RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(SI W,000), /•DITION 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. •vislo•.. of Chapter 9(commencing with Sectio .7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.# //./i�• 6 .0‘ Class# / ...p Contractor's Signature: ✓ ,' / Date: �O 3 CONSTRUCTION LEND! �AGENCY: ❑ I hereby affirm that ere is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business end 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.). O I am exempt under sec. Business and Professions Code for this reason: • Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ' ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore 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 end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 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 aEermit 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 Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made. 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE.OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. re Of Legal Owner(s) Date -9,S And/Or Authorized Applicant Date BODE INSPECTIONTYPE DATE INITIALSCD➢EI IttcPF.TION TYPE DATE INImAIS 16 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 p �T 204 Final Demolition 250 Final Building/Occupancy /9—Tie aV 244646 ' ,, CITY OF COSTA MESA E - y' 4 BUILDING DIVISION 1.' ..,..- ' DEVELOPMENT SERVICES DEPARTMENT E98-00489 , tar�y� PERMIT PERMIT NUMBER (714)7'54-5w2773 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 1114 SAN JOSE AV Status: ISSUED Suite No . Applied: 06/03/1998 Vicinity: Issued: 06/03/1998 Parcel Nunmber: 41204327 . Applicant: FORTH, FORTH Address: Phone: Zip . Owner: MILLER, ROBERT Address MILLER,SUSAN' COSTA MESA,CA . Phone: 1114 SAN JOSE AVE Zip: 92626 - Contractor: DOYLE C FORTH &COMPANY Address: 01075 REDDING AV Phone: ' COSTA MESA CA Zip: 92626 • License:454306 ' • • SCOPE OF PERMIT 12 FIXTURES,8 OUTLETS&6 SWITCHES FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 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 $12.00 12 up to 50 kva/kw $0.00 0 Recept Outlets $8.00 8 up to 100 kva/kw $0.00 0 _ Switches $6.00 6 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 • 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 10002 $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 _ Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 - Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $48.00 Intermed Pole . $0.00 0 COMMENTS/SPECIAL CONDITIONS • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all . required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O 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 if the permit is valued at one hundred dollars($100)or less.) O I certify that In the performance of t = work or which this permit Is issued, I shell not employ any person in any manner so as to become subject to the workers' compensation laws of Califomla, - . agrey9at if should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. �� Applicant Signature: J/ aa/- � Date: /o— 3—99c, WARNING:FAILURE TO SECURE •RKERS'COMPENSATION COVERAGE IS UNLAWFtA.AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000,.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 un provi 'ons Chapter 9(commencing with Section 7000)of Division 3 of the Business end Profestsjons Code,and my license is IVA_ force and effect.Lis.It ? 5''5V366 / Class# 17 7 Contractors Signature: /- Date: h r 3---69T ,ss CONSTRUCTION LEND AGENCY: El hereby affirm th there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: • Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,es 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,end who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes , ❑No (Section 25505 of the 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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Application a ermit for such construction or modification a_ from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which 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 penally of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. . �/ ::nature Of Legal Owner(s) Date /. -3 -9, i And/Or Authorized Applicant Date I. INSPECTION TYPF DATE INMIS Or f INSPECTION TYPF DATE MAAla` �6 FixedSystem Final Fire Prevention 206 Final Mechanical 1266 PoollSpa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 6/1ig • 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 Bullding/Occupancy 2448.4e • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT - PERMIT NO. TRACT NO. LOT NO. UNIT NO. ' Project Address \\\A Sr nr t A Q�`_' I � O I 9828 •I��I p/ep 13.00 Tl Applicant's Mailing Address \\LaO0 et \(li1QAe Ll TYPE OF CONSTRUCTION U NEW .1� ADD LI ALTERATION Li REPAIR ❑ CONVERSION ❑ DEMOLISH e OTHER A.P.# Zone Owner's Name \Los\ \AC11-a3\C.d-C\-- Phone DESCRIPTION OF WORK/USE OF BLDG. \\\� S n-Tort Qll'C� Address S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERM! GRADING LI FOUNDATION E - O U STRUCTURAL Front W ` Address ••� til ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name £ -%' 6�rC. dlione%4%-sue III C Right N L�7 PROJECT DESCRIPTION 5Q. FT. OCCUPANCY pv�_ K G \,((''��. CityAddLicensess e in. \\�Q\ "��nCh CON ST RUCTION TYPE VALUATION $ Left R W City License No. CTO \Q� ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E OLICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed der provisions o -r 9 (commencing Remarks: Planning Notes: M with section 7000) of Division of the Busines .nd Prole I s Code, and T my license is in full f rce and :. feet. t�, t License Class C- t S Scense No 3\\1�' $' Date 1O-VO Signatu� ` - PLUMBING FEES WORKERS'COMPENSATION DEC • -ATION• Bar Sink Showers hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES .of Workers' Compensation Insurance, or a certified copy thereof (Section — Backflow Preventer-- - Service Sink - - - • - - - _ 3800, Lab. CJ //`` Automatic Washer Transformer ❑ 15-50 KW Policy No.k+=CV Irzolgq�3 Company Cfl('nN NAN-sotea T� • Backflow Irrigation Sewer Cap0 50+KW 9 Construction Pole Sub. 8 Certified copy is hereby furnished. . Certifie0 co y s filed with the city Buildiag.gw ion. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date `n�to Applicant C.7 ( YIG - EXEMPTION ROM 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 z' Dryers OGas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is Issued, I • shall not employ any person in any manner so-as to become subject to the Drinking Fountains Solar Tank _ Fan Motors❑0-1 HP 01%-8 Workers' Compensation Laws of California. - _ Date Signature Floor Drains Swimming Pool w/Spa F.A.U. NOTICE:If,after making this declaration,you should become subject to the —� Inc.Solar 09-15 HP 016-15+ • Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance • • of the work for which. this permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater Lender's Name p Outlets 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 following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal 'Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap • . any structure, prior to its issuance, also requires the applicant for such permit - Generator 00.5 KW 05.15 KW Trash Compactor '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 LOQ`Detc�� -P�"nR(\� �U CEJ to Division 3 of the Business and Professions Code) or that he/she is exempt 'therefrom and the basis for the alleged exemption. Any violation of Section _ 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). - LJ I, as owner of the property or my employees with wages as their sole Reinspection'Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure Is not intended or offered - Reinspection Fee ' I $15 Issue Fee $ 3 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 i thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not intended or offered for yp sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 , - Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building Approved By Date Drove for the purpose of sale). / 1 IJ oI, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat /U 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 ❑0100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- ' tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK - $ - PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ PERMIT ISSUANCE $ Date Owner - Heating System& Ducting PLAN CHECK 25% $ T .ENERGY P.C. $ - Thereby certify that I have read this application and state that the above 00100,000 BTU 0100,00087E ELECTRICAL $ )2,-Oa GRADING $ Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ _ sentativ o this city to tater 44ppbDn the above-mentioned.property for inspecti Signature e J`'\J ` � Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.4/84 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 52. Pool & Equipment Location /2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System- Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 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 76. Dry Standpipe 28. Lathing &Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION • 32. Electrical Power Meter-Final / 80. FOOD CERTIFICATE ISSUED �r 33. Final Electric of ,/w� Notes: 34. Final Heating & Air Conditioning 7 G. 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 • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date MYMN 1 . ,I • WI Cad.DI IU COSTA MESA BLULDIa-SAFETY DEPARTMENT APPLICA A_AN FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVE/3Y PERMIT - For Applicant to Fill in Completely —Use Ink Only (GI X N° 4 7 7 5 2 BUILDING A.P. NO. 1/ A — d -? - SS-- ADDRESS 1114 San Jose Ave. BUILDING TENANTOEROR Wimbledon Assoc. ADDRESS 1114 San Jose Ave. MAILING 1470 Jamboree Rd SPUNATCE NO. 42 ADDRESS — TR.N BLK. LOT Newport Beach TEL.640-680( 010275 42 CITY NO. NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION Imperial Savings & Loan LENDER x BRANCH Pasadena Wimbledon Assoc. 114OWNER 92)ADDRESS 61 S. Lake Ave USE PRD VALUE .., A ARCHITECT OR ENGINEER Corbin/Yamafuj i NOL.549-712 " ,�I//JJ , / S�['I� o-�V ADDRESS 17992 Mitchell So. , Irvine ZONE Pate— TYPEr— GROUP A - 3 McLain Dev. CO. APPROVED po CONTRACTOR BY DATE t/20/O ' ADDRESS 1470 Jamboree Rd CITY Newport Beach No1640-6800 E'+ STATE 273875 CITY 18873 APPROVED SETBACKS LIC. NO. LIC.NO. SIZE NO.OF BLDGS. 0 (FROM-e^tts?REET),9L A. OF LOT NOW ON LOT FRONT W^ FT. •C USE OF EXISTING BLDG. R SIDE LS FT. H F5• Separate permits are required for L.SIDE . 7 FT, electric,plumbing and heating work: �-I 'c al REAR Pi5 FT. GU I. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q L/ A `3 ZGr X78-3j DATE APPROVED 07--7 n New Cone+r„ration > APP RYo Q� DATE t( CS/1atI F S1nglA amily AWAI I tog w Hx OLD FOR SPECIAL REOUIRFMFTt QI hereby acknowledge that I have read this application and state o' a that the above information is correct and agree to comply with n A. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of a W the State of California. 1T"1 I hereby certify that I am properly licensed as a contractor under a ace SO. FT. 5-17 the State of California Business and Professions Code, Division 3, THE AMOUNT SH N UNDER VALUATION IS FOR roV' Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OFESTABLISHING A PERMIT FEE ONLY: e V� am exempt from the provisions of thState of California Business VALUATION PERMIT FEE $(423 rt N. and Professions Code, Division 3,Chap =r 9. n Signature of / Al 2 PLAN CHECK $ eno �t/� o Permittee ��1/,L�aa� $ /%�//� /- TAX $ re LL v, Or (�iiLlal 1 l 3 , U Authorized Agent Date TOTAL PAID $ r f OWENS-CORNING Fiberg s Blanket Insulation • The contractor named below certifies that the Owens-Corning Fiberglas • Blanket Insulation used carries the NAHB Research Foundation, Inc. label for assured thermal performance and that the Blanket Insulation is in- stalled in conformance with current energy conservation regulations, California Administrative Code,Title 25, State of California, in the building located at: /0/t/ -Sa,) _Ia sr 4 , ,/d0775— Street Lot Number Tract Number Exterior Walls Owens-Corning Fiberglas Blanket Insulation - 2/2 Thickness R-Value Ceilings „ Owens-Corning Fiberglas Blanket Insulation Thickness R-Value Floors • Owens-Corning Fiberglas Blanket Insulation Thickness R-Value Foundation Walls . Manufacturer Type Thickness R-Value General Contractor - License No. By Title Date ISignaturel // • Insu lati on tractor �f✓-'-c+o ..4,2-44.1- license No. ,?.36/125-- By_ __ Title Il" Date "�/i A'.. I ignature) ei OWENS/CORNING FIBERGLAS Homeowner Copy (White) • o••••�. . State Copy (Yellow) • Builder Copy (Pink) • OWENS-CORNING FIBERGLAS CORP. Insulation Operating Division Pub.No.16-BE-6995-A keno in u S A..July 1977 Fiberglas Tower,Toledo, Ohio 43659