HomeMy WebLinkAbout1050 SANTA CRUZ CIR - Building Permits -,01-11!ct. CITY OF COSTA MESA•
BUILDING DIVISION
: DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
b. 1 /s •I PERMIT
4rIbfro,, 04.
ROO
M04 00A84
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1050 SANTA CRUZ CI Status: ISSUED
Suite No Applied: 09/14/2004
Issued: 09/14/2004
Vicinity: �J
Parcel Number: 41206118 ISSUED BY:
Applicant: MARTIN, DONALD A
Address: 1095 SALINAS AVE
Phone: 714-979-7396
COSTA MESA,CA Zip: 92626
Owner: MARTIN, DONALD A
Address: 1095 SALINAS AVE
Phone:
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License:000000
SCOPE OF PERMIT
CONSTRUCT 222 SF ADDITION TO CREATE A NEW FAMILY ROOM TO AN EXISTING
SINGLE-STORY SFD.REF.:B04-01269
MECHANICAL TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $13.70 1 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 $0.00 0 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 $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU- - $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
•
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
fora 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 all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this it.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(WOO)
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:
_ _lit
section need not be completed if the permit is valued at one hundred dollars($100)or less.) ,
lty, 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'
t b: compensation laws of California,and agree t t If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thes rovlsio�ns. [� /� ---.{� /� /'
Ap Ilceni.Signalure: �/T-ue2- FSG C X. ,GICs t_. FOSU;v- 'y -- /47 0 7
w A ',FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER'TO'CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
USAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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.Lk.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
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
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 Cede: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 AcirD, am exem�tlmder sec. Businexcs and Professions Code for this reason: ,/'
tura: I �, :t.t, 1. ), A ( ;"-Date:'_S .�17' •• O
r
r1OZerifietl by driver's license. .ffi Yes 0 Nov egs License No= Expires/ — 200 Ca
Verification of Ownership by(type of document,i.e.-property tax bill or deed):�r" --_
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation fie(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 6,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? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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).
8 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 ❑No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:1 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-qqescribed property for insp ction Poses.I agre not to occupy or allow occupancy of any building authorized by this permit until final inspection.
n-Cate . a_-.) `1- /'/ -D 4
'natu[e�_-Of Legal Owners) D"ate" ,
And/Or Authorized Applicant Date
100E# Fixed System PAIS INTfTIAL$ 006 Final Mechanical
_a_
�3�,/ `g
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical QT
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
•�� CITY OF IOSTA,MESA •
@ BUILDIN°G DIVISION
„„,, s 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
l;t
.51...111.111r�� PERMIT
4.
!rte
'hy4arem, c B04-01269
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1050 SANTA CRUZ CI Status: ISSUED
Suite: Applied: 07/14/2004
Vicinity: Issued: 09/14/200
Parcel Number: 41206118 Zoning: R1 R1 e
Applicant: MARTIN, DONALD A ISSUED BY:
Address: 1095 SALINAS AVE
Phone: 714-979-7396
COSTA MESA, CA Zip: 92626
Owner: MARTIN, DONALD A
Address 1095 SALINAS AVE
Phone:
COSTA MESA,CA Zip: 92626 .
Contractor:
Address:
Phone:
Zip: License:
Arch : Eng: PIN CHING LI
Address: Address:
Phone: _ Phone: 905-595-7755-
Zip: License: License: 38408
SCOPE OF PERMIT
CONSTRUCT 222 SF ADDITION TO AN EXISTING SINGLE-STORY.STD.
PLNG: - - - -
LOT SIZE=6,000 SQ.FT.
RESIDENCE= 1,797 SQ.FT. •
GARAGE=454 SQ.FT. -- - -
DRIVEWAY=400 SQ.FT.
LOT COVERAGE=2,651 SQ.FT. (44%) _
OPEN SPACE=3,349 SQ.FT.(56%) •
. FEE SUMMARY
Plan Check: - $217.91 • Calc Valuation: $20;512.80
Permit: $335.25 Claim Valuation: $0.00
SMIP Res: $2.05 • • -
SMIP Corn: $0.00 .
Other: $0.00. '
Inspection; $0.00 - �
Total: $555.21
•
PLANNING &ZONING
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 c es,;a d all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration off isipermit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS '
WORKERS'COMPENSATION DECLARATION: '
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
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:
is section need not be completed it the permit is valued at one hundred dollars($100)or less.)
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'
4 '
compensation laws of California,and agree th ' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith
comply with these gstvisions.
CQ . 'i
p.:Fleet Signature: Oates ? /44 — 0`
WARMNG FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLO'Y'ER TOCRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($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.Lie,# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY: •
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
s 'acts the applicant to a civil penalty of not more than five hundred dollars($500).):
11,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.
'a:'-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
imself 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.). •
D OI as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sac.7044,Business and Professions
''� ode: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 contrafctor(s)
I ense pursuant to the Contractors License Laws.),
' e i m e et under sec. Business and Professions Code for this reason:
arg are: 7Cr lAe — ' ' y� Date:, c''' /4/ ` O 4f
LrOww rfD'vei:ified by driver's license. Ip(Yes 0 No Driver's:License No:)-/ NOIExpia:P/a - Z 006
Verification of Ownership by(type of document,i.e.-properly tax bill or deed: II
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).
O 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 application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes IJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 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? ❑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
abo described property for insp. '.n purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
tiro - _ ! 11 A-_-o 7- / 4' - o 9
fp Ignature Oi Legal Owner(s) .f.-b- ale
And/Or Authorized Applicant Date
CODE f INSPECTION TYPE DSA F INTITIAL$ CODE• INSPECTION TYPE PAS =All
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 -L v tt�
204 Final Demolition . 250 - Final Building/Occupancy - IZ.JI '
I%
IF CITY OF COSTA MESA
r *� •
BUILDING DIVISION
> .. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F 1I PERMIT
704-01004
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1050 SANTA CRUZ CI Status: ISSUED
Suite No Applied: 09/14/2004
Vicinity: Issued: 09/14/2004
Parcel Nunmber: 41206116 � /
Applicant: MARTIN, DONALD A ISSUED BY: i:/
Address: 1095 SALINAS AVE
Phone: 714-979-7396
COSTA MESA,CA Zip: 92626
Owner: MARTIN, DONALD A
Address 1095 SALINAS AVE • .
Phone:
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
CONSTRUCT 222 SF ADDITION TO CREATE A NEW.FAMILY ROOM TO AN EXISTING SINGLE-STORY
SFD. REF.: B04-01269" 1
ELECTRICAL TO INCLUDE:2 LIGHT FIXTURES,4 OUTLETS,AND 3 SWITCHES.
•
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 $2.20 2 Up to 50 kva/kw I $0.00 0 -
Recept Outlets, $4.40 4' up to 100 kva/kw $0.00 0
Switches - $3.30 ', 3 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 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
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
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 yri
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) eee���
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
i -
❑ 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:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
311 certify that in the performance of the Work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that i should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thesbovisi�ons.
pelica
n n`a�lure: !l-- 71-- - . - ata:-, - /N --
WARNING: AILF URE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND CO LARE(3100,000),IN ADDITION TOME COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
'iKI,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 tor 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.).
a =-I:am ex pt under sec. Business and Professions Code for this reason:
Signature:
ExpGe" ( '2vo 6
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,Gm 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O 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? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap_ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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? 0 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 COMPLIANCE MD 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 scribed property for inspe purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
rr Q, . - / Gk
�5-Ilgdature.Oi-LegaVOwner(s)r �:;`+ Coate raw
And/Or Authorized Applicant Date
PODS t INSPECTIONTYPE - PAIE INTITIALS CODE. INSPECTION TYPE , PAM INIMALA
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final • - 208 Final Plumbing 7
200 Final Re-Roof 210 Final Electrical /Z-n3't '
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' - '
ADDRESS OF auILGNO: 1050 SANTA CRUZ CI WAY
CITY OF COSTA MESA — BUILDING PERMIT
OWNER'S NAPE IF 1040M1: MARTIN, DONALD A FLOOD: AH-38 PERM NO: B 075655
d '! ADDRESS: MARTIN, HELEN M
1095 SALINAS AVE PERMIT NO: B 075655 PLAN CHECK NO: N GOVT: N SUPP: N
ADPL LURING ADDRESS:
COSTA MESA,CA 92627
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
MCNRECT DR ENGINEER: UC'ND: JOB DESCRIPTION : T/OFF & REROOF W/BUILT UP ROCK SQ FT: 2 , 185
MCN.OR ENG.'S ADDRESS: 11W:
CLAIM VALUE: 2, 185 . 00 CALC—VALUE: 2, 185 .00 GROUP OCC: R-3 /
CONTRACTOR'S NAPE: CRANK BROS ROOFING CO ( 714 ) 548-5569
CONIRACTORSYMWG 126 COMMERCIAL WAY COMMENTS : SMOKE DETECTORS ARE REQUIRED IN EVERY BEDROOM & HALLWAY
ADDRESS: COSTA MESA CA LI' 408677 ft*** itis+E+E**+t*****+tutit*****atxxstat*i(- iE**itit*it******** Eat****x*+t*+titin+E*****iE>,Eat*+E*******
92627 015fi ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter e SETBACKS
(commencing with Section 7030)of Division 3 of the Business and Prelessins Code,and my license S in full force end effect.
CITY LIC.NO.: g UC.CLASS: LIC.
gq005/���,j59�3 i C39 408677 EXP: 06/96 MAIN BUILDING ACCESSORY BUILDING
Date:/lir"/ / �S Contractor: ��~� �� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
E/ i LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWN R BUILDER DECLARATION:I hereby affirm under pe .rjury that I am exempt from the Contractors License Law for the
fisheye's reason(Sedan 7031.5 Business and Professions•... . y City or county whits requires a permit to consmld,Mer.improve.
s
demolish,orrepai any smrcture.prior to its issuance.also ..the applicant for such torus a signed statement that he«she PARKING REQ: PROV: PARCEL: 41206118 ZNE: REF NO:
is termed pursuant to the provisions of the Contractors as Law(Chapter 9(commencing with Section 74000)of Division 3 d the PLANNING NOTES>
Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemptAn
ion. y violation d Section > • ,
7031-5 by any epplirant fore perms parity dMdoll
subjects the applicant toe Mil ptynod more then e hundred en)550011. 1 1
*******************************************************************************
❑ I.as owner of the property or my employees with wages as their sole compensation,will do the work.and the stmcture is nit intended
"r offered for sale(Section 7044.Business and Professions code:The Contractors License Law does net apply to an owner of propend DEVELOPMENT SERVICES REQUIREMENTS
who builds or improves thereon,and woo does such work himself or herself or through his or her own employees,provided that such
owns°'�i rill h have hemon of provered ing or horshowever,nbuilddsormpprrovimprovemente for the m�of sale)."'y"`a completion.the ZONING APPROVED BY : DATE:
❑ I.as owner of the property.am exclusively contracting with licensed contractors to condrua the project(Section 7044,Business end -
Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: I • ,
contracts for such projects with a contractions)licensed pursuant to the Contractors License Law). /
❑ lam exempt under Inn: B.&PC..for this reason: APPLICATION ISSUED BY: ��`� DATE: 71-'79 C�
Date:(42— Y" 73= owner: ************************* :.de ._a_:::• ********** ****** ****
I do hereby certify that I aaware of and understand the requirements of California Health and Safety Code Sections25505,25533,and LEGALIZATION:N N F E E S U M • A R Y STRUCTURAL'S EGM ENT:Y
m
25534.and that I or any future building occupant will/will not(circle one)need 10 comply with said stale codes and the requirements for
e permit for oonstruction ornodificationfromtheAi QualityManagement Didnd.Residential constmaionapptcetions are exempt from Nese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES ' GRADING
provisions. PERMIT 54 .00 . 50
Date: Applicant SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the foeowin°declare'ions: PLAN
❑ I have and wmamaintaina comfiest.of consent to self-insure for workers'compensation.as provided ICI by d by Sean 3700 the Labor ISSUE FEE
it
Code.for the perfonnanceothe wonlorwhich this permit isissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I have andel maintain workers'compensation insurance,as required by Section 370)of the Labor Code.for the perforntence of the TOTALS----> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00
X work for which the permit is issued.My workers'compensation insurance caner and policy number are:
G01A0r: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT: 00
Poky Nun°e 28h5 951N5T221 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOTT GRADING PLAN—CHECK
(This section need nor be completed f M the panne is one undyed 1001 or less.
. 50
❑ I candy that in the performance of the work for which this remit is issued.I shall not employ any person in any manner so as to
becomes ion o worked'co70O heaboril laws California. thnd agree that Jshose become subject to the workers' *******************************************************************************
Tit --
subject t of the workers'kers' e of the labor fCode,I wag comp with should
a.
Date: { /7 - , sApplicant: < t1t.e ZSS IND I V IDUAL F E E BR E AK DOWN
Warning:Failure so secure workers'compensation coverage Is unlawful,and shall subject an employer to criminal penaltiesand TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil/Mos up to one hundred thousand dollars(5104000),In addldon to the cost of compensation,damps as provided ler In
Section 3706 of the Labor cod.,lnrereat and etromev'e lees. SFR 2185 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 185 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally d Parity that there is a cominidion lending agency for the
performance d the work for which this pent is shad(Section 3097.Cr.C). END OF FEES
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and stale that the above imdmdion is coned.I agree to cdnpfy with all city end county ordinances
and state laws relating to buillig conaoudon and hereby authorize representatives of this city to enter upon the above-mamboed property
for inspection purposes.
It JIM G.' NK
.r Print Nem.
I �/p O1 Qti1Sc#47-,bq;�.;7yu -:..-�-t- c
4.—....-1. Data/ �� / '� C''NIE: i. y , a •. .i.t. (�^,..- t
Signature of Owner/Agent/'•• ontrador
( -46.WP) White-Buildng&Safety:Green-Fla Canary-Apptrant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL. .. SPA
.AAPPROVALS 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 ConduirUtility-Undrgrnd. 54. Forms •
'4.:Efeetrical Conduii-Undrgrnd. 55. Electrical Bonding
t:5. Steel Reinforcement.p- 56. Rough Plumbing & Pressurb"Test
-r •
-
- S;tEtectrical UF ER Gftid: 57. APPROVAL TO COVER-GUNITE
` t.1-Footings58. Electrical Conduit-ldndrgrnd.
• $. Foundation 59. Gas Pipe, 0 Undrgrnd..Test '
9. Water Pipe-Undrgrnd. 60. Backwash Lines,R-Trap, 0 Undrgrnd.
• 10. Structural Floor System61. APPROVAL TO'D.ECK
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 7 66. Solar System-Final,.
16. Rough Electric Wiring' • 67. Fencing & AccesrApproval
17. Rough Wiring Sign 68. APPROVED FO,aI PLASTERING
18. Rough Electrical-1' Bar Ceiling' 69. POOL/SPA SYSTEMS FINAL '
19. Rough Heating & Air Conditioningter• _ FIRE DEFT. REQUIREMENT
20. Rough Factory-Fireplace - --. -„,...,-1 ... . ._ . .
• T. ` APPROVALS,-,`Per`tnit# '
r
21. Ducts,In Structure • - •• • _ 70. Underground Hydro '
_
22. Ducts;Ventilating y t„ ;,71. Product-PI-king CIG-as DOil
23. Gas Pipe-Rough'& Test - - r " ' - -72. Underground Flash'-
24. Roof Framing r ; .:73. Undergrnd:StoregeiTank 0 Gas 0 Oil
25. Roof Sheathing6y"��{�/���
1. 7�rQ�y�_•• �,. 74r-Overhead Hydro..
26. 7-BariCeiling (Stru&?.urall & MorLBcoat - ;IL. 75_;Dry Chemical " ` ' '
27. Frame.and Flashing - - - >• 'J. 76. Dry Standpipe -
28. Lathiag&9iding • ` •
.T •- t = ' 77,"•FIXEDSYSTE FINAL. -.
t x i„.4 icH :, 7 ;.,, r,
' 29. Insulation - -. -, - 78,-..F IRE PR EV. FINALc. c -
30. Drywall Nailing" . x r t HEALTH.DEPT; R'EOOIROMENT
' 31. Plaster Brown Coat - i I r rr79. FINAL INSPECTION t
1-
32. E4ectricaIPbwei Meter-Final ` ' - 80. FOOD CERTIFICATE ISSQED•_ -
33. Final Electric -. _.t Nojes: - -:r -
y . •. , '
X34. Final:heating&'Air'Conditioning- - = r -= ., - -
l -
35. FinaltiasEipeiPest ; - :. _ I _- - -
r
-36. Hood:or Canopy i = - - - -
37. Final Factory Firedtace •__ - t
38. Final Plumbing a" - . - -
••39. Water Service-Final',. a >. -
-. . k. Y_
-40. Gas Service-Final / • -, •.:- t
- r : ' I. - c •
-
_
-41. Solar Domestig•Fin31 s, .. " 0 I - . - -
-42. Backflow Preventer^-r - r ..-I--F • :t -r
43. Backflow Irrigation'• ,. - - a :r •
44. Landscapejrrigation System "'/1.' • r? t
•- - -n 1 Y •
46. Spund Attenuation c „ -. 11n. ` r
46. Handicap Regulations,. - I './: _ •S _ _ = x
47. F1NAh STRUCT•UREE& BUILDING iii_i6.Yrj /% !- '
48. FINAL PLANNING r l - - '
49. Electric Release to Edison ' -
50. Gas Release to Southern California Gas Co "
51. CERTIFICATE OF OCCUPANCY i 1 .
No. _ Date
PROJECT ADDRESS: 1050 SANTA CRUZ CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 060423
OWNER'S NAME: MARTIN, DONALD A
ADDRESS: MARTIN HELEN M PERMIT NO: B 060423 PLAN CHECK NO: N GOVT: N SUPP: N
1095 SALINAS AVE
COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: (714 ) 979—796 REG.ND.: JOB DESCRIPTION : RESHEATH 6 REROOF( 1 /2"CDX S"TIMBERLINE" ) SQ FT: 2, 310
0 ADDRESS: UNIT:
CLAIM VALUE: 2, 310 . 00 CALC—VALUE: 2, 310 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: HARBOR ROOF CO. INC. ( 714 ) 541-5930
ii ADDRESS: 909 EAST WALNUT COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UBC.
SANTA ANA CA 92701 **************************** **************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and elect. SETBACKS
•
_ CITY LIE.: 041664 STATE LIC.:375422 c Ss: C�3A �,A�,
Dale: 'a — ' /� Signature:_ !"'—G' MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby alfirm 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 Insyranee.Qr$certified copy thereof lection 38W,Lao. 1. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 285-7L—UNIT014b EXP.DATE: 1 /01 /93
COMPANY: STATE FUND PARKING REQ• PROV: PARCEL: 41206118 ZNE: REF NO:
Certified copy is hereby furnished. GS Certified copy is filed with the city But Division. PLANNING NOTES>
--/-
Applicant:Date *******************************************************************.************
DEVELOPMENT S E R V I C ES R E Q Q U I R E M E NST" S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This sedan need not be completed if the per for one hundred(5100)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. ZONING APPROVED BY DATE: _ .
Date: Signature:
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: /
Code,you must forthwith comply with such provisions or this Permit shall be deemed revoked. J(!�7 7///(//�[J/ /'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: / ](,.{{,,..EE [[ `_i� iEiF(SL j� **************4430*********DATE. / .
which this permit is issued(Section 3097.Civ.C). ***************************N�H7F*i e * iF**4 * *** ** * ********44 **
LENDER: ************************************************* **************4*104********
ADDRESS: LEGALIZATION:N F E E S U M MARY STRUCTURAL SEGMENT:Y
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 PERMIT 54 . 00 . 50.E
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON- RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by •,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S5w). ISSUE FEE ..
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID a DUE
❑ structure is not intended or offered for sale(Section 7044.Busihessand 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 REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT• .00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for purpose of sale). BLD54 PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I. s owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business •r
❑ and Professions Code: The Contractors'State License Law does not appy to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to theContractors'Stale License Law).I am aware 44444EE444*444*'*****'44******4*4*'*'**444444****4****4*44444*********4***444444****
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.A P.C. /
for this reason: TYPE QTY DESCRIPTIO N UNIT COST /.TOTAL COST
/
Date: Owner: SFR 2310 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 310. 00
I do hereby cenity that I am aware of and understand the requirements of CaliforniaHealth and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/wig not(circle one)need to comply with said state codes and the requirements for a /
permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: /1•
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 1
ordinances and state laws relating to building construction and hereby authorize represen,ivesol this city to enter upon sabove-mentioned J
property f r inspection purposes. L
Dale: " �� 1 Si '
Signature: A _ ,.
Driver's License or Social Security 0:
Pink—Revenue;Goldenrod—Assessor
or
CONSTRU'TION AND PLANNING POG SPA
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service dr Pole . . 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electripl 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, Fodtings 58. Electrical Conduit-Undrgrnd.
8. Foundation . 59. Gas Pipe, 0 Undrgrnd., Test
-
. 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor.System ` • 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap • 63. Heater & Vent-Final-
13. Roof Drains . 64. Plumbing System - Final
14. Rough Plumbing ' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
i
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS f'IMAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20, Rough Factory Fireplace _ - APPROVALS -Permit 4 '
-
21.'Duets, in Structure
70. Underground H•idro
22. Ducts, Ventilating R - 71. Product Pipipg El Gas Mil
23. Gas PipetRough &Test 11 1 . . 72. Underground Flush:!
24. Roof Framing - • - a '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 I •' 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT, REQUIREMENT
31. Plaster Brown Coat 79.-FINAL INSPECTION
32:.Electripl Power Meter-Final { 80. FOOD CERTIFICATE ISSUED
33. Final Electric I Notes:
;341 Final Heating & Air Conditioning I' .1
35. Final Gas Pipe-Test I I .
36. Hood or Canopy ME l
37. Final Factory Fireplace
38. Plumbing
W � •
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 j • -
47. FINAL STRUCTURE & BUILDING /7 t/ I CNS /// �I �l�
48: FINAL PLANNING {!� ,!!/! //•` ��`� (((DDD���vLvvv
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co I I I .
51. CERTIFICATE OF-OCCUPANCY
No. Date
4*
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTAtMESA PE MIT NO. TCT NO ,LOT N BLDG.NO. /al /�[� .1a_o HQ Ijl
CONSTRUCTION PERMIT d -/at727 / / T76R--a--rye,
Project Address 0 - , a. TYPE OF CONSTRUCTION NEW LI ADD U ALTERATION U REPAIR ,
Applicant's Mailing Ad ress ' . N En - ❑ CONVERSION ❑ DEMOLIS_H1❑ PTHER A.B # J//2-O 6/ -/ (Zone CR-'
Owner's Name Phone/9,9'7,1n DESCRIPTION OF WORK jlfact. STC_ rip 7 �r g
Q' p S Main Building: Acces ory Building: 2
Address /09S S .SO r/IOf TYPE OF PERMIT ❑ GRADING U FOUNDATION ❑ STRUCTURAL E Front — � J 0
Arch/Eng. License No. N
Ell ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear gy-� �� q� N
Address C �/�// // ( /- n ❑ OTHER • P'
Contractor's Name .- .J7777`J-tar/r d �A'7 �/fA Phone/ S:1051S PROJECT DESCRIPTION SQ. FT.7,9//4Fa- (I' OCCUPA Y p/s K Right ,°2b ' G
Address(mailing)/44530 / t' S �r+� CON STRUCTION TYPE VALUATION$ AV/ s Left —_ t'sy'T�' Y�- 1 R
3 L� E
City License No. ZONE GRADING CU.YDS. ACR S Ping. Ref.# Park.Fees $ .- . ' 0
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided .-----.----- UI
I hereby affirm that I am licensed under provisions of Charter 9 (commencingR
with section 7000) of Division 3 of the Business and Professions Code,and - Use of Building: r' ' •
my license Is in ull force and effect. / /, E
License Class i Lirn N r PLUMBING FEES PlanningNotes: �/,C• b ipy� J T7 - E
6_„te Z� Signature %' - / /l . . — «-CCC �I�'”
dlRKERS' COMPENSATIONDECLARATION Bar Sink Showers „2",.. S7L . ,ti.� �p0p�k , N
',Thereby affirm that I have a certificate of consent to self-Insure or-a certificate Backflow Preventer • Service Sink CJ// _ T
of Workers' Compensation Insurance, or.a certified copy thereof (Section $
3800, Lab. C.) •
Backflow Irrigation Sewer Cap £ ELECTRICAL FEES
Policy No. Company -
A
Certified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15.50 KW •
Certified copy is flied with the city Building Division.
Date Applicant
Clarifiers Solar Collectors Construction Pole Sub. 0 50+ KW
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher
(This section need not be completed If the permit is for one hundred($100)or
Solar Piping Cooking Unit Meter Duo to 100 amps
less). - DrinkingFountains '
I certify that in the performance'of the work for which this permit is issued I Solar Tank Dishwasher Meter Clover 100 amps -
shall not employ any person in any man so as to besu let to the
-
Worker ' Compensation Laws of Califor Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric • Sub Panel
DateO / te (T S� Signature�' J
NOT I ,iaftar king this tleclar ion,you should become subject to the Floor Sinks Urinal - FanMotors 00-1 HP ❑1''At 8
Workers' Compensation provisions of the Labor Code, .must forthwith
comply with such provisions or this permit shall bea deemed revoked. Gas Service • Outlets Water Closet F.A.U. Inc.Solar 09-15 HP ❑16-15+
CONSTRUCTION LENDING AGENCY -
1 hereby affirm that there is a construction lending agency for the performance Interceptors • Water.Heater Fixtures
Of the work for which- this permit is Issued (Section 3097 Civ. C.) Microwave
Lender's Name Kitchen Sink Water Service Device Boxes tPole Light 1 -
LenOer's Address Lavatories
OWNER BUILDER DECLARATION Outlets . Range _
I hereby affirm that I am exempt from the Contractor's License Law for the P-Trap , •
-
following reason (Section 7031.5 Business and Professional Code: Any city or • Switch¢5- Sign _ '
county which requires a permit to construct,alter improve,demolish or repair - _
Standing Sec
-
.ny structure, prior to its issuance, also requires the applicant-for such permit Roof Drains Garbage Disposal tions' ":"!
file a signed statement that he/she Is licensed pursuant to the provisions of
a Contractor's License Law(Chapter 9 (commencing with Section 7000)of -
_
•
,vlslon 3 of the Business and Professions Code) or that he/she is exempt - Generator ❑0-5 KW ❑5.15 KW Trash Compactor.
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 Reinspection Fee I $25 Issue Fee $ 3 '
�aenalty of not more than five hundred dollars($500).
LJ I, as owner of the property or my employees with wages as their sole MECHANICAL Reinspection Fee $25 Issue Fee •� $ 3
compensation will do the work,and the structure is not Intended or offered FEES
for sale (Section 7044, Business and Professional Code: The Contractor's - ----- --4.4 - , PUBLIC'SERVICES REQU1 EME TS:
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0 Wei • /� ,�^/,�/.
thereon, and who does such work himself/hersolf or through his or her own Zoning AppIoved By �NV Date 1/l/V /
employees, provided that such Improvements are not Intended or offered for Canopy Type 11 0
sale. If, however, the building or improvement is sold within one year of com- Duct-Under Ground Building Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- S�/�T!
�
prove for the purpose of sale). Duct-Structural Refrigeration System Application Issued By • ,l()„,/ / Data
U I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating ❑0-10d',000 BTU ❑100,000 BTU I t� SUM ARV F FEES
The Contractor's License Law does not apply to an owner of property who I q
builds or improves thereon, and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System:Repair/Alteration BUILDING PERMIT $ ? • C SMTP • $ ' LS"
tractors) license pursuant to the Contractor's License Law). n I D PLAN'CHECK $ /1-7/ '-3 Cr PERMIT '
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# • I�gl�f C{IOf1S PLUMBING 4 ISSUANCE $
Date Owner Heating System& Ducting a it.u '-{0 ,
'P.LA N.CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑D700,000 BTU ❑100,000 BTI{ SIS ��,�- ELECTRICAL $ GRADING $
Information is correct. I agree to const application
all city antl county rizfinances
and state laws relating to building const uction, and hereby authorize repro- LJr7{E; _.�- PLAN CHECK 50% $ MICROFILM $
sentatives of th Ity to ant p e above-mentioned property for / /fir
Inspection p [ OJa�y (y1 (. p, CHANICAL $ 3 6, o v
Signature(' l Date) '� -oY TOTAL FEE $
Drivers' License or$5 3 � Reinspection Fee - $25 •. j, Issue Fee 7 $ 3 AN'_CHECK 25% $ - \
CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink•Accounting:Goldenrod -Assessor -
.CONSTRUCTION AND PLANNING - _ PC. & SPA
APPROVALS Permit-# • Date Inspector APPROVALS Permit# Date' Inspector
F'.
r i. Temporary Electrical Service or Pole i 1 52. Pool & Equipment Location _ t .
2. Soil Pipe-Undrgrnd. S3. Steel Reinforcement
3. Electrical ConduibUtility-Undrgrnd. , ' 54. Forms - . •.
• 4: Electrical Conduit Undrgrnd. • - 55. Electrical Bonding
, s,
5. Steel Reinforcement • . 56. Rough Plumbing & Pressure Test '
-6. Electrical�CJFER Grnd:, 57. APPROVAL TO COVER-GUNITE '
7. Footings * S E Nar,E - S.Z e,y,4 f3 58. Electrical Conduit-Undrgrnd. - -
• 8. Foundation 1 59. Gas Pipet‘p Undrgrnd.,Test
9. Water Pipe-Undrgrrd.. t'- 60. Backwash Lines, P-Trap, 0 Undrgrnd. '
10. Structural Floor System . /. 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection I -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 ,
1
l' 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 I
j 25. Roof Sheathing . 74. Overhead Hydro . ,
.: 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical , I • . r:
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation ' '78. FIRE PREY. FINAL ii
30. Drywall Nailing - , ,HEALTH DEPT. REQUIREMENT..
31. Plaster Brown Coat , ' 79. FINAL INSPECTION
32. Electrical Power Meter,-Final 80. FOOD CERTIFICATE ISSUED I
33. Final Electric Notes: s_2.-rf Coa$EC7 d- pAo
34. Final Heating & Air Conditioning
te RE PLACE RI~n E RIG K r• /-1 .41F
35. Final Gas Pipe-Test - VI/V1-1/ CON CR>:TE CNAIk-1-5 MAlNDM:Mt
36. Hood or Canopy ' - 3 " jTFL TO FFFRTH C.LFAI'SRNCE..j_P
37. Final Factory, Fireplace /06 CA SNo�
tD �E OH ' 'fTlo• p
38. Final Plumbing COV FR POST,
39. Water Service-Final
40. Gas Service-Final '
-
41. Solar Domestic-Final
42. Backflow Pre'venter '
43. Backflow Irrigation •
44. .Landscape Irrigation System
45. Sound Attenuation I EXPIRED
46. Handicap,Regulations IncOm Iete nspections
47. FINAL STRUCTURE Sr BUILDING Dat?. _/:S.
�p? �SIg
•
48. Special Requirements Completed' I P
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY ' - - .
No. Date __
CITTY OF COSTA MESA REQUEST FOR OCCUPANCY
/
TRACT NO. lQ 9 2 " DATE 7 � J^-
-l7
LOT NO. / /
ADDRESS ( 0 S eD XIC&I,1 6127-
The
7/The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-s4te-tteyt
(was 'e r-w eY advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition. V
BYdGJ 4-
P ch as
BY
Developer and/or authorized
representative
BY
Lender
OWNER HELTZER ENTERPRISES - C. M. DATE 9_86_69
JOB ADDRESS 1050 Santa Cruz Circle BUILDING PERMIT NO. 30872
GENERAL CONTRACTOR Same DESCRIPTION of WORK Residence W/Attached Gar `_
AP No. _ LOT j7 TRACT 6.38 FIRE ZONE VALUE $ 22,034,00
INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-1
SOIL MS -i-2d PERMITS ISSUED
GAS SUBCONTRACTOR
Date Number Signature
WATER Attompi' fl _ PI bing
ROUGH PLL/MBING //I�' C -2--76 7�1j�//q�� 7O �re .-a: 6} ,V-�3�s rr//(�`-
PROP. SWR. LINE /[^HOUSE CON. Ii P1 G:6 &-7b }/rq• /Si9'70a."/ S-7 51- 7A
SPRINKLING SYSTEM /� YVl
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING -�,'7[1
TEMPORARY SERVICE OR POLE " -/Cf-JG
UNDERGROUND ❑ POWER ❑
ROUGH WIRING -IZ.2U Heating an Yent/.//y ,y/ �J �j
TRENCHES C FORMS IU STEEL REINF. ® 4 Cy-7y0 j4Yti�.471 z C& tJ /D 7,-)1,-e--
FLOOR
FLOOR SYSTEM 44-4 I0 Zean {(tea)vtCa. S-.-7,? 7!J 17/tL/ —
BOND BEAM n STEEL REINFORCE in
SHEATHING 4 sv,7 6,
FRAME AND FL kSC F1/9/74a ab /T 0
RL
LATHING - IN µL OUT W .64 .ill
7Y -
PLASTER, BROWN COAT f'J'7/j/{O
STRUCTURAL, FINAL yyy///,,,��� ,'• FE'le ric c
HEATING, VENT., REFRIG. AND f.GiN�6ti'� ' Al 9 0 Q^76 ,{" A i j Apg y✓t/.i3 .0127/7-4.e.xed
PLUMBING, FINAL AND GAS TEST n �/] � Q 7e) '/`6 % L%' to':/ /e 1 .O--
ELECTRIC, FINAL �"/Yj r r-25-76
BUILDING. FINAL / -77
PAID
• 30372142v 1 2-69cn5A00 405* ***124.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECE ,, D E RE.C_IV DATE ISSUED
BUILDING 1050 Santa Cruz Circle / �a� � SEP 2 6 1969
ADDRESS
Heltzer Enterprises—Costa Mesa �, //��PERMIT NO.
OWNERMAIL P A.P. NO. / �'FSZ.v'/"`�^ ,— -1
BUILDING - '�� f L
ADDRESS
740 No. La Brea Ave. ADDRESS a ✓ �
3
LB
U CITY L.A. Cal. NNILI O. 937-2171 TRACT L. 663V I LOT 17 BLOCK
I— Z
Z < CONSTRUCTION United California Bank NEV
DD ALTER REPAIR MOVINf: DFMOI CH
ON LENDER
0- o . Main Office
C BRANCH
w CO / /y
J OWNER
m LU ADDRESS 6th and Spring, L.A.
VALUE
m ARCHITECT TEGonzales L.
N Frank OR ENGINEER No 532-6878 USE A40 $�dP 3
z ¢ 1336 E. Chapman Ave. ,Orange,Cal. FIRE Q/
w cc ADDRESS ZONE TYPE GROUFC is
0_1-9 APPROVED
IliJ Z CONTRACTOR George .1. Heltzer & Assocs. BY DATE
mZ
J cc ADDRESS Same as above
'D w ZONE NO.OF USE OF NEWSingle Pam.
o= TEL.CITY NO. RL 'PLANS 2 BUILDING Res. W/BtC.Gar.
Z H
w STATE 201098 LIC.NO.1707 CITY YMA NS BUILDINGAPPROVED YARDS APPROVED
ACCESSORY BUILDING
co cc LIC. NO.
D O (FROM C/L STREET)
SIZENO.OF BLOCS.
OF LOT I NOW ON LOT FRONT raT. FT.
USE OF �rr�r
EXISTING BLDG. B,SIDE ¶)FT. (IL-- / /
I— SIZE OF NO.OF
Z NEW BLDG. ROOMS STORIES L.SIDE 5 FT.
VEXTERIOR WALL ROOF
_ COVERING COVERING REAR FT. FT. ..
—I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET, BET.MAIN&
a-
1 MAIN BLOCS. ACCESS. BLDGS.
Residence with attached garage cU.P# APPROVED
0 —
NPlan No.402 _AAPPROVED
O FILA-_� -DATE l0 6 /6 9
UI hereby acknowledge that I have read this application and state /✓/',
D that the above information Is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
I— any person In violation of the workman's compensation laws of
CO the State of California. /97 a 9 Y3-3 4j9 m
ZI hereby certify that I am properly licensed as a contractor under SO. FT. O
the State of California Business antl Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R
am exempt from the provisions of the State of California Business
VALUATION m
and Professions Code,Divis n 3,Oh..ter 9. S/�� r.20 N
sT ��/)))a PERMIT FEE $ e O
Signature of / - J2 I 2�r L�j"C' F
Permittee $ O . ✓/ PLAN CHECK $ T E
p
Authorized Agent g /02 s—e u
` TOTAL FEE $
OWNER SCHUPl'L, Charles DATE 3-20-72
JOB ADDRESS 1050 Santa Cruz Circle BUILDING PERMIT NO. 34455
GENERAL CONTRACTOR Hawaiian Landscape DESCRIPTION of WORK Patio Cover j_
I4, AP No.412-061-18 LOT TRACT FIRE ZONE VALUES 300.00
INSPECTIONS Signature Date GROUP J TYPE V ZONE H-1
SOIL PERMITS ISSUED
`1 GAS SUBCONTRACTOR
. \ Dote I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE HOUSE CON. 9
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND 9 POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES 9 FORMS 9 STEEL REINF. 9
FLOOR SYSTEM
BOND BEAM rl STEEL REINFORCE f-1
SHEATHING
FRAME AND FLASHING
LATHING - IN 9 OUT
PLASTER, BROWN COAT
STRUCTURAL. FINAL Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
34455 PAID
\t . ?0-71--:OO 760* *****5.02
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely DATE
7. r RECEys(E V `g;(E REGE.IVF�� L _EISSUED
�p_7y
ADDRESS 05 O S4,0.04 eau x _ �/.r , P//''ss//LL JJJJ��Oa/�'/�/ // orG/
ADDRESS //( �1 /� (- (\''1/�/� /'"1 /441-1
'�Q L—_
OWNER
C t{ A 2 Led U rT E A.P.NO. �'0b{ -I g PERMIT `J44J
�s BUILDING L A . 1
z
AMAIL DDRESS SAnie ADDRESS IO 'O SANTR CRUZ /
0-0 CITNQMSS-TA V s4 NOL TRACT L�3 Q LOT 17 BLOCK
Z2
Q CONSTRUCTION NEW ADD ALTER AIR MOVING nEMDI LSH
am LENDER k l'I y-'�C
J) BRANCH OWNER C (-IA IZL s 5CM u1 11.E
m J ADDRESS /� VALUE [PO
J
m USE ARCHITECT TEL. SF Pr/PPO-1 O C.dV�,_t� $ 2 D O
Q OR ENGINEER NO.
V N FIRE
Z Q ZONE TYPE 1/ GROUP
w K ADDRESS
d W APPROVED /J //+� 3/
J O CONTRACTOR (.1 AUJA 1 f APO LA flJOCAPE BY ��/� DATE tr^z
lnz �I
JQ ADDRESS 14872 C4kJ►'�!I-Itl'f4 U .
Ww 1 ' -1 "� //Ii�,r^ I �j� r� ZONE Q NO.OF USE OF NEW pf}T'(b
Zt CITY t40NTI IV i-roni it4C64 NOL✓7"ONOIL' R. PLANS2ii BUILDING �VG�
LBO STATE t�'''�'1 CITY YARDS APPROVED YARDS APPROVED
n CCILIC.NO. 2 J `g I Z LIC.NO./?f/ MAIN BUILDING _ ACCESSORY BUILDING
D O (FROM C/L STREET)
SIZE NO.OF BLDGS. J _
OF LOT V Q sC ( Q o I NOW
ON LOT FRONT "4).FT. FT.
USE OF
EXISTING BLDG. �tLS S 0tAA r rC-.
R SIDE Z C> FT. FT.
I- SIZE OF 1[may/' al NO.OF 1
Z NEW BLDG. / ROOMS STORIES L.SIDE V7 FT.r FT.
VEXTERIOR WALL ROOF --ZZ 'r
COVERING COVERING REAR 3 7 FT.- FT.
..J USE OF BUILDING ANO WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
d MAIN BLDGS. ACCESS.BLDGS.
O. -.1 VAR..* DATE
1-1 �t�%W&(G-Hr--11-7-7✓ (O �"� G C.V.P.qW APPROVED
I- APPROVED (5. 7�
N —BY Lb DATE 3I h)--
Z
O
C~.7 I hereby acknowledge that I have read this application and state 81-14 re-
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
y the State of California. • m
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3, THE AMOU I HOWN UNDER VALUATION IS FOR •
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
CC
am exempt from the provisions of the State of California Business VALUATION
and Profession ode,Division 3,Chapter 9. Ca m
(/v PERMIT FEE $ N •
Signature of at
Parm Ittee ®�w`^^-'({ $ PLAN CHECK $ E
r 'n ♦ �/ u
Authorized Agent /a . [� TOTAL FEE $