HomeMy WebLinkAbout830 Santiago Rd - Building Permits�
CITY OF COSTA MESA
.
o�""'Fs, BUILDIWG DIVISION
F_, � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
�, ` FOR INSPECTIONS CALL: (714) 754-5626
�"°"°"°"� PERMIT NUMBER: P10-00090
PERMIT TYPE PLUM STATUS: ISSUED
APN: 14154110 DATE ISSUED: 07/02/2010
ISSUED BY: RMD
JOB ADDRESS: 830 SANTIAGO RD CM
vicinity:
Suite/Unit:
SCOPE OF WORK: PLUMBING PERMIT FOR COPPER REPIPE (RECONNECT 13 FIXTURES).
OWNER: FRANCOIS PATRICIA Add255: 830 SANTIAGO RD
PHONE: 714-549-2877 City/State/Zip: COSTA MESA, CA
APPLICANT: PER4LTA, JOSE Address: .
PHONE: 800-806d374 City/State/zZip:
CONTRACTOR: MASTERSERVINC
Address: 560lIBRARY ST
CitylState: SAN FERNANDO, CA
ARCHITECT:
ENGINEER:
ZipCode: 91340
License No.
License No.
License No. 580017
PHONE: 800-806-7374
CELL:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$33.30
$33.30
PHONE:
PHONE:
m
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for lhe 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 fnal approval will result in the expiration of this permit.
CODE N. INSPEGTION TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 FinalSign
204 Final Demolitian
pAIE IN1111AL CO�Ep INSPEGIIONTYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electncal
212 Final Fire Prevention
220 final Planning Approval
222 Final Site
250 Final Building/Occupancy
DATE IN1111AL5
���7'�l7 �
WORKERS' COMPENSATION DECLARATION: Owner ID venfied by driver's license. ❑ Yes ❑ No
I hereby aKrm untler penalty of perjury one of the following declaralions: Driver's License No. Expires:
❑ I have and will maintain a certificate of consenl lo self-Insure for workers' Veri(cation of Ovmership by (type of document, i.e. - property tax bill or deetl):
compensation, as provitletl (or by sec�ion 3700 of the Labor Cotle, for Ihe
pertormance of lhe work (or which �his pertnil is issued.
❑ I have and will maintain workers' compensation insu2nce. as required by
sectbn 3700 0! Ihe Labor Code, !w Ihe pedortnance o( the work for which this DIVISION OF INDUSTRIAL SAFEN PERMIT CER7IFICATION:
pertnit is issued. My workers' compensalion Insurance wrrier and olicy � I hereby certrfy that no excavation frve (5) w more feet in depih into which a
num6er �are+�:,//,, /�/7 n person is requiretl to descenQ will be made in connectbn with work authorized
G�riier `,�,��i�/"/ � 7 � 'e-� ✓ �� blj�pi it, and that no builtling structure, sc�fdding, (alsework, a demolition
--1 �-mvdi ling thereof, will be more ihan thihy-six (36) tee[ high. (Chap. 32, Grp
(rnissectunnAedrpfDe etetlethece�46 aluetlalon �untl�edcbNars(51� 0)wless
� /� �^ / 2, Art Sec. 341, Title 8, Califomia Administ2tive Code).
Po�GyNumber. c./ �
i ❑ As owner-builtler. I will not employ anyone to do vrork which would
❑ I certify that in the peRormance of the work for which this permit is require a permit from the Division of IndusMal Safery, as notetl above, unless
issued, I shall not employ any person in any manner so as to become subjecl such person has a permil to tlo such vrork from the division. .
ro the wnrkers' compensation laws of Califomia, and agree ihat i/ I should
become su6ject to the workers' compens tion provisions of Section 3700 0(
Applicanl'S SignaWre Date
the Labor C� all fortp � h com �hese provisi ns.
� / � Division of Intlus[rial Safety Permit Num6er
pi� m�,gya ai HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNIN AILURE TO SECURE WORKERS' COMPENSATION COVERAGE �� Will Ihe applicant or presen[ or future building occupant need to file antl
IS U WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAI �ertify a Business Plan for emergency tesponse to release or Ihreatenetl
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑ Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensetl under provisions of Chapter 9(commencing
with Sec[ion 7000) of Division 3 of the Business antl Professions Cotle, antl
my license is in (ull force and ef(ecL �
uc.: _ OD e�s�;r
G� O
C reeroi"s'8 at� .1 _ ie.,,�
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that �here is a constructbn lending agency (or ihe
peAortnance of the aork ta which this permit is issuetl. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrm Ihat untler penalty o( perjury Ihat I am E7(EMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business antl Pmlessions Code: Any city or counry which requires a permit to
construct, alter, improve, demolish, or repair any slrucWre, prior to its
issuance, also requires the appliwnt lor such permil to �le a signed statement
that he or she is licensed pursuant lo Ihe provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pro(essions Code) or that he or she is exempt therefmm and
the basis for the alleged exemption. Any violation of Sec�ion 7037.5 by any
applicant for a permit subjects Ihe applicant to a civil penalry of not more than
fve hundred dollars ($500).):
❑ I, as ovmer of lhe property, or my employees wilh v2ges as Iheir sole
compensation, WILL DO 7HE WORK, and the structure is not intentled or
oKered tor sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes not apply to an ovmer of pmpeAy who builds or impmves
thereon, and who does such work himsel( or herself or thmugh his or her ovm
employees, pmvided Ihat such improvements are not intended or oKered for
sale. If, hovrever, the building or improvement is sold wilhin one year of
completion, the ovmer-builder will have the burden of proving that he or she
did not build or improve tor purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business and
Professbns Code: The cont2ctors License Law dces not appry to an ovmer of
property who builds or improves thereon, and who contracts !or such project with
a cont2cta�s) license pursuant to the Contractors License LavS.).
❑ I am exempt under sec.
Business and Professions Cotle for �his reason:
SignaWre
JOA�46 (3/0))
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, tha[ a Business Plan be filed wi[h [he Costa Mesa Fire
Department by every business which has at any one time dunng 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 (eet of compressed gas
at standard temperature antl pressure).
2. Does or will Ihe applicant or present or (u[ure building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0( Ihe Califomia Health and Safery Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry of acutely
hazardous materials equal to or greater Ihan a vreight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at s[andard
temperature and pressure).
3. Does or will the applican[ or present or (uNre building occupant neetl ro
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0/ Ihe California Heaflh and Safety Cotle provides Ihat the
Costa Mesa Fire Department may require Ihe preparation, certifca�ion antl
(ling with the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous matenals with [he Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safery Code been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre huildin9 occupant require for
the work which is the subject of this application a permit tor such construction
or motlifcalion from the SoWh Coast Air Quality Management District or from
any olher air polWtion conhol district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
infortnation be fumished on applications ta noo-residential Duiltling pertnits).
6. Will any part of the (aciliry ro be constructed under this permit be within
i 000 feet from the outer boundanes of a school? ❑ Ves ❑ No
Qf yes", Ihe facility musl meet the reqvirement of Sections 25534 and 42303
ot the California Health antl Safery Code�.
7. If a pertnit fmm the South Coast Air dualiry Management DisMct or other
air pollution control disMct or agency is require0 for the work which is �he
subject of this application, have all of the disclosures prescribetl by Califomia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certifcale o( compliance from ihe appropria[e air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
information given above is wvecL I agree to compty with all state lavrs and
city ortlinances regarding Hazardous Materials and Emissions.
Signalure Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penaliy of perjury that I have read this applicalion and state that
the information given is correcl. I agree to comply wifh all slate laws antl ciry
ordinances relating to building cons[ruction, and authonze representatives of
the City of Costa Mesa to enter upon the above-descnbetl property for
inspeciion pu�poses. I agree not to occupy or allow occupancy o! any building
aWhorized by this permit u ti nal'nspe '
Si wre o a neqs) Date O
�"
anv/d'rArilHarTzotl. dioTt �'._
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DfiIVE, COSTA MESA, CA 92626
Job Address: 830 SANTIAGO RD
Suite No
Vicinity:
Parcel Nunmber: 14154110
Applicant: GRODSKI, STEVE
Address: 2737 S CRODDY
STE D
SANTA ANA, CA
Owner: JENNINGS, WILLIAM E
Address 830 SANTIAGO RD
COSTA MESA, CA
PLUMBING PERMIT
Phone: (714)241-1414
Zip: 92704
Phone:
Zip: 92626
Contractor. COAST ROOTER PLUMBING HEATING & AIR CONDITIONING
Address: 2737 S CRODDY
STE D � Phone: (714)241-1414 � �
- SANTA ANA, CA , Zip: 92704
License: 529127 �
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
REPLACEMENT OF WATER HEATER
ISSUE FEE
Backflow irrigation
Backflow Preventer
Bathtub
Clarifer Sysiem
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outleLs)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oiq
Interceptors (Sand Auto )
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation � $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ff) $0.00
Receptors 50.00
Septic Tank 50.00
SewerCapforDemo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0:00
Sink, Floor $0.00
Sink, kitchen 30.00
Sink, service/mop §0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0 .
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: 03/14/2002
I ssued: 03/14/2002
���
� ' � �"
► ' � �
, ► , '► �
�
AMT
Sump Pump $0.00
Swimming Pool $0.00
Trap Primer $0.00
Urinal $0.00
Vacuum Brkr BkFlow(1-4) 50.00
VacuumBrkrBkFlow(5+) $0.00
Wash Basin g0.00
Wash Basin Set $0.00
Waste and Vent System $0.00
Water Closet (Toilet) $0.00
Water Heater / vent $12.30
Water Piping (Inst or Rep.) $0.00
Water Re-pipe $0.00
Water Service $0.00
Water Softener $0.00
OTHER $0.00
VIOLATION $0.00
PLAN CHECK $0.00
REINSPECTION $0.00
TOTAL CAICULATED FEES: $35.80
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statNes 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 ihe work authorized under ihis permit to be considerad legal, such work must comply with all applicable codes, and all
requlred Inspectlons and flnal approval must be obtainetl. Failure to obtain inspections and final approval will result in the expiratlon oi this permit.
FOR INSPECTIONS CALL: (714) 754-5626
[aao-w law�
WORKERS'COMPENSAnON DECLARAnON: � '
I hereby aMirtn under penalry of perjury one of Ihe tollowing daclarations:
❑ 1 have antl will maintain a certificate of consent to selbinsure for workers' compensatioq es provided tor by section 3700 of the Labor Code, for lhe pertormence ot the
work for which Ihis permit is issued.
jQ;, I have and will main�ain workers' compensation insurance, es required by section 3700 of Ihe Labor Code, for Ihe perfortnance of the work for which this partnit is issuetl.
My work m ensa�ion uranc/e1 carrier and policy numbar ara: / /
�rer:>^ u� IJ IIcy:Number:-- I b�l� Z� O ' O z—
�section need not be complefed il (he Oeimit is valuetl et one huntlre0 tlollars ($100) or /ess.) �
❑ I certify that in the performance of t�e Work for which this permit is issued, I shall not employ eny person in any manner so as to become subject to the workere'
compansation laws ot California ntl gree at if I should �ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I sha0 forthwith
comply with ihese provisions. � �� � / C/ O� j .
� n6Signstiue:- – . (�, Date: _ _
WARNING FAILURE TO SECURE WORKERS' COM NS �ION CAVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSANDDOLLARE�$100,000),INADDITIONTOT COSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am licensed under provisio
CONSTRUCTION LENDING AGENCY:
9(commencing with Section 7000) of Division 3 of ihe Business and Pr4fessions Code, and my license is in full
essik- C `�i �
;L — _ ie:.._ '�/9 -r>?/
❑ I hereby aHirtn that there is e construction lending egency for the pedormance ot the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lendels Atltlress:
Signeture:
OWNER-BUILDER OECLARATIONS:
Date:
I hereby aRirtn ihat under penalry of perlury that I am EXEMPT FROM THE CONTFiACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or county which requires a pertnit to construa, elter, improve, demolish, or repair eny structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement ihat ha or she is liCensed pursuam to 1he provisions ot ihe Conirectors License Ww (Chapter 9(commencing with Section 7000) ot Division 3 oi the
Business an� Professions Cotle) or that he qr she is e:empt therefrom and tha basis for the allegetl ezemption. Any violation of Section 7031.5 by any applicant for e pertnit
subjects ihe epplicant to a civil penalry of not more than five hundred doilers (5500).):
❑ I, as owner of ihe properly, or my empibyees with weges es Iheir sole compensalion, WILL 00 THE WOHK, antl the stmcWre is nof in�entletl or ofleretl (or sale (Sec.
7044, Business and Protessions Code: She Contractors License Law does not appty to an owner of property who builds or improves thereon, and who does such work
himself or herself or thwugh his or her own employees, provitletl ihat such improvemenis ere not intended or otteretl for sale. If, however, ihe building or improvemen� is
sold within one year of completion, the owner-builder will have the burden of proving Ihat he or she did not build or improve for purpose oi sale.).
❑ I, as owner oi the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Professions
Code: The contrac�ors License Lew dops not apply to an owner of property who builtls or Improves thereon, antl who conbacis for such prolac� wi�h e coniracbr(s)
license pursuant to ihe Contractors Licanse laws.).
❑ I em exempt under sec. Business and Professions Cotle tor this reason:
Signature: Date:
Owner ID veniietl hy driver's license. ❑ Ves ❑ No Drivefs License No.
Verification ot Ownership by (type ol tlocument, i.e. - property tax bill or deed):
Eapires:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feat in depih into which a person is required to descend, will be made in connection with work authorized by Ihis
permit, and that no building stmcture, scaHolding, falsework, or demolition or tlismantling thereof, will be more ihan ihitly-six (36) feet high. (Ghep. 32, Gry 2, Art 2, Sec.
341, Title B, Califomia Adminisirative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom ihe Division of Indusirial Safery, as noted above, unless such person has a
permit to tlo suc� work from lhe division.
SiqnaWre: Date:
Division of InduSirial Satety Permi� Number:
ICERTIFlCA7E OF COMPUANCE AND AUTHORVATION OF ENiAY: I certity under Oenalry of perjury that I �ave read �his application and state Ihat iha infortnation given is I
correcC I agrae to comply with all s:ate lawg antl city ordinances relating to builtling consiruction, end authorize representatives oi �he City of Coste Mesa to enter upon Ihe
above-descnbed propeny for inspeaion purposes. I agree not to wcupy or allow occupancy of any building authorized by this parmit until tinal inspection.
COOE �. INSPECTIONTYPE
1616 Fixed System Final Fire PreveNion
7266 Pool Spe Final
200 Finel Re-Roof
201 Final Block/Retaining Well
2p2 Final Factory Fire Place
203 Final Sign
204 Final Demolition
PATE INTITIpLS
COOE 1 INSPELTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
-�" G�' �Z_
aeg u�s
PHOJECTAOUPESS: �}3O SANTZAGO RD
OWNEfl'SNAME: ,7ENNINGS, WILLIAM E
nooeess: JENNINGS, SUSANN M
830 SANTIAGO RD
�_` COSTA MESA,CA 92626
AflCHIENGINEEH:
POONESS:
pEG.NO.:
UNIT:
UNIT:
PEpmiTTEE: CALZFORNIA ROOF LIFE (719)847-7663
aoosess: ggql MINT AV
WESTMINSTER CA 92683
LICENSEU CONTflACTON OECLl�NATION: I hereby allirm �ha� I am IicenseA un0er pmvisions ot Chapter 9(commencing with Sec�ian
7000) of �ivision 3 oi the Business antl Pmlessions Code, antl my 6cense is in lullforce antl ef�ec�.
crtruc.:r09229�5Q sTaTeuc.:5U9623 c�^s C—.i�
Oate: � !�� ` � Signature: _ �/
WOflNEPS' COMPENSRTION DECIAflATION: I hereby affirm I 1 �ave a cetlilica of c6rtsent to self-insure or a ce�ilicale ot WOMers'
Compen5aiion Insurance, or a certilie� copY �hereot (Section 0. lab. C).
Poucvxo.:1021135-93 ex.oarE: 06/O1/94
tOMPANY: STATE FUND
� CeNiiea copY is hereby fumi5he0, � Ceriifiea copy is liled wil� �Ae ciry Builtlin �ivision.
oa�e ,�ol.i�� nvPi��am: '
E%EMPTION FflOM WOFRENS' COMPENSp710N OECLAPATION: (Thi ec�ion neetl not �e cample�etl ii � permi� is br ane hundred ($100) ar less)
I cetlity Ihai in Ihe performance of t�e work lor w�ich t�is permi�' i55ueQ I shall no� employ an erson in any manner so as to �ecome
sublecl to the Warkers' Compen5aiion Laws oi Calilamia.
Oa�e: Signature:
NOTICE: Ii, atter making Ihis tleclaralion, you shoultl become sublec� to �Ae Worker5' Compensation pmvi5ion5 ot Ihe Labor
Code. you musi �otlhwith camply wilh suc� pmvi5ion5 or this permi� 5hall he deemetl revokea.
CONSTflUCTION LENUING AGENLY: I hereDy allirm Iha� there i5 a cans�ruction lending agency br ��e perlorman[e ol �he work tor
which Ihis pe�mit is i=_suetl (Seciian 3097, Civ. C�.
LENUEP:
aooeess:
OWNEH BOILOEB OECLABBTION: I hereby allirm Iha� I am exempt Imm the ConUac�ors' State License Law for �he lollowing reason
(Sec�ion 7031.5 Business antl Pmlessional Code: Any ciry o� counry which requires a permi� to con5imet, aller, impmve, tlemoli5h, or
repair any slmciure. prior lo ils issuance. also requires �he ap0licant for suc� Oermil lo file a signetl s�a�ement �hat he/she is licensed
pursuant �o �he pmvisons ot Ihe Coniraclors' Sta�e License Law (Chapter 9(commencing wil� Sec�ion 7000� of Oivision 3 oi Ihe Business
anG Pmfe55ions Code) or Ihal he/s�e i5 erem0� �here�mm antl ��e basis lor Ihe allegetl exemptian. Any viola�ion of Sec�ion 7031.5 hy
any aD0licant lor a perm�t sublecis I�e applican� to a civil penally ol nol more than fiv¢ hunOreA tloliars (5500).
I, as owner oi the pmperty or my emPloyees wi�h wages as I�eir sole compensation, will Oo I�e work, and Ihe
❑ SINCW�CiS �OIiOiEfItlC4 OfO��C!¢tl�OfSdIE�$ection 7W4, Busine55 anA PmfesSionalCode: The Coniractors' S�a�e License Law
tloes noi aD01y to an owner ol a propetly who Ouiltls orimpmves Ihereon, and who tloes such work �imSelNherself orihrough
his ar her own employees, pwvitled Ihat such impmvemen�s are not intentle0 or offerea for sale. If, however the 6uil0ing or
impmuemenl is soltl within one year al campleiion, �he owner will have Ihe bur0en of pmvmg he/she did not 6ui10 or impmve
lor I�e purpose ai sale).
I, as owner o� the pmpeny. am excWsively conVactmg wi�h licensetl contractors to cans�mct the pmlect (Section 7044. Business
❑ antl Pmlessions Coae'. The Conlraclors' Sla�e License Law does not apply to an owner af pmperty who huilds o� improves thereon
antl who conirac�s fOr 5ut� pr0letls wilh a ConiraC�or�s) litense pursuant IO Ihe Con�rattOrs' Sta�e LiCenSe Law). I am aware
thal pmoi oi Iheir Worker'S Compensa�ian in5urance shoultl be pmvitled Io me.
� I am exempl under Seciion: B. 8 P. C.
bt �nis reason:
Daie: Ownec
I ao nereby cenify Ihat I am aware ol antl untlerstantl �he requiremenis oi Galilomia Heallh ana Salety Cotle Sections 25505. 25533, and
25534 and ��at I or any IUlure bulltling occupanl willlwlll nal (cvcle one) neeA lo campty with saitl s�a�e eoaas and ihe requiremen�s for a
permi� �or consimction or modihcation �mm �he Pir Ouality Management �isVic�. Residenlial cons�mction apDlica�ions are exempt tmm
Ihese nmvisians.
�aie'. ApPlicanP.
I hereby cenily �hai I have read ihis aDPlication antl slaie ihat
ortlinances ana staielaws relaiingto �uilding consimc�ion andl
pmpeiry �ar inspection purpo,�sfes�.
Date: S Z�'�r' Signamre: _
oriver's �icense or sociai Seamy a: .
164t�d6 `/�hite—Builtling; Green—Cotle EnlorcemenP, C
information is mrrecL I agree Io comply wit� all ci�y and counry
orize repre5enlaliveyp� ��is ciry to enler u0on the above�men�ianetl
Goldenmtl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; B 067263 PLAN CHECK NO; N
CONSTRUCTION TYPE: V—N
PERMIT TYPE; STR
�
PERM NO: B 067263
f
GOVT: N SUP+f�;�"N •
PURPOSE : OTII
JOB DESCRIPTION ; T/OFF SHEATH & REROOF W/COMP SHZNGLES SQ FT; 4,675
CLAIM VALUE: 4,675.00 CALC—VALUE: 9,675.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTOR REQUIRED PER 91UBC, REF.00F 2500SF RE� yCE �p
�x**�r*�**�***���c***�*��**�****�c�+�**�*�c******�r*�+�**�*******x**�Qf/fi��I� ! ��
Z O N I N G R E Q U I R E M E N T S n C
------------ MAIN BUILDING _____S E T H A_C—K_S ACCESSORY BUILDING�UIf7�Q
FRNT: FT IN REAR: FT IN FANT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 14154110 ZNE; REF NO:
PLANNING NOTES>.
� -.
�*irx+t�*it��*it+�*�*�ititit*iF*it*it*ir�r***rtiEx*�x**��r***��r*****�r�r�r**�***���*ititx���*�*at*it*+t
D E V E L(� P M E N T S E R V I C E S R E Q U I R E M E N�T S
ZONING APPROVED BY DATE; ��
BUILDING APPROVED BY : DATE;
APPLICATION ISSUED HY: DATE: J �
itificlEiEiEiElFiEiE�7EiciF{EiEiEicififit-�iEif iE it iEiElEiEiEiEiEjEiF1F i ciri ritiE�itif
* iF iE iE iE iE if i4 #: iF jf iE iE ik iF �1f iF iE �E �E iE * iE if iF iF iFlf �f # iE iF iE if iE iE 1f 1f� iE aE 1f jFlE if jF jE �1F iE iE iE iE iE if,1F 1f ff 1K iF 1E iE if iE �%iE if� iE if !f iE if if iF aE iE �k- iF iF i! if
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72,00 50
PLAN SMIP/NON—RES
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72,50 0.00 0,00 72,50 72,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 72,50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
%2,0� ,rJ�
iF iE fE iE 1f 1F 1F fF if iE iE iF �E if if iE %iE jk if if �F 9f iE if iF iE !E iE if iE jE �F aE-1E iE if iE if iF if %iE iE iE iE iF iE k iF ih 1f if if iE fE 1E if iF iE if fE ff if if if if if �E 1E if iE iE jF jE if iF df jE
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I Q N UNIT COST TOTAL COST
SFR 4675 REROOF HY VALUE RESIDENTIAL NOZONE 1.00 9,675.00
END OF FEES
�i 001.�927-00160928 T U T 72.s0
DATE: O5/23/94 TI11E: 10:29
� •
�NSTRUCTIOP! AND PLAN\IP1G
APPROVALS ?ermit ��.-
1. Temporary Electr.cnl Ser nce or Pole
2. Sod Pipe-Undr9rnd. �
3. Elr.ctricai Conduit Uti�ity�Und�gmd.
4. Electrical Condwt�Urdrgri�d,
5. S��e� Re �to�cemem - -- _-
6. FI^[I�.nI UFE� Grnd
1 Fooi�rgs __-__
8. FounUation •
�. :':a'er P�pe�U�.drarr:i_ _ ' _-
10. S:v�tu*al FICG Syc'em
7i.Pro?c�1VSer.e�Lir.F:;!� . :,orr.rc!.en
72. Scarer Cap - -' .
13. Roof Dra�ns _ _
14. Rough P�umb�ng _
15. Rough Electricai-Con�urt
7G. Raugh Electric�'J;ring
17. Fough N��nng $iyn
18. Rough Electtical�T Bar C^d�ng
19. 7oi,�h iizat�r.g & A,� Cu�.d�L: n���g
2G RO�;h �ac:0^: ��'[p'.o:
�21. D_C'.'�r Str�ct�r .
�-- _ _- _. _
I92. 0!r;, l'ant �aTi�; ----
73. Gas P�pc�Rou91i N� 1 �:rt
24 Roof F�ami�g _ -
Z�. P�nt Sh�:�!; •'� _ _._ _ _ _ --
26. T�3 r C��'.�+e'St.�i �:�� .i u. 'Je,occa
27. Frame and FIaS�i��9___
28. Lath:ng & Sid��9
29. Insulatwn _
� 30. D��:�:,�I Pe„4^g
�� --
� 31. ,.�;rr B��:tn C-..•
i' _- _- � __ __ __-
°9 £'eeL c.l P�!'.e-'.l:te '-- , _ ----
33, firtl Electnc
rl 34. P��-I Hcat.rS n+A-� C;,�.;^ o-�, -
I
35. Fi-cl Gas P���.T:=.;
�}'.cod o; :.ncpv- - - --
�------ - - - - - ---
i3J. F,..a� Ftcto•v F.�r�,.; . i.
l__ _ ___-
�38. Fin31 Pl;:mbing _ __
39. Wa!rr Service�Fir.al
� 40. Gas Serv�ce-F�na! � !
Rt. Saar pomesUc�•�r�:
42. �.�ostlo�v Prev6nier--�--- -
43. Batkfiow Irr�gJtion
4� 4. L�ndicdpe Irnqai�r�tiystrm
s.-y _________
`_ ..-
� �i5. S7und A[ienUat�,o�_ >
7--- - -- ---
� 46. F;ard�ran 4e� �'�! ��•i✓
I'� `�_--
, 47. FiidALSTRJGTL��_�(�j"�"-DI�G
t __
; ! 1
. 48. �:iJAL'LAiJi�:INCy •
� _""1S,£lec!�ic Rzlease to ��iSoe +2�-
� Gas Release to Southern �ifornia 6
� .',T CEH?IF�CATE OF (iCCUPA�CY
. '' Datc
Dace � Inspetior
-�---- PO� .�SVA-- i------ � -
I
APPROVALS Permit -� Date Inzpecto�
I
52. i'oal 1S E4uli�mcnt LocaYo^ . -�
53. Steel Reinforcement
54. Forms ~-- � �
_ �-_1_� � __
�55. Electrical Bondm{� I -`
�G. Rou9h Plum.b.rg #�'r,.,:�r� Tzs: , ---�--~
' - -- �--- -- --
� 57. �PPFlOVA�.TCrCC1VEH�GIi�!ITE I! �
'' _' - ' �-_-_ ' .,
58. Electncal Condu���UndrGmn. � I �
- - - --- ---r -'� ----'_L� . ,
55. C.,s P�pe. '� U� ��n^ d. Tist ; ,
, L� !; •c'�av.an L re -P�T.ac. : . �-��rg�� a. -� -- - ; -�- --
T_.___- -_ _ . _-_-___---' ___.�-_- _..
�� S' Fl°?ROVALTOC_.'< ,
1-- --- ---'- --�-- �
� G2. 3iCc..,.sh 'L A�.c. t;, Pi,r_� � - --�- - -
�
� 63. �i�_atar & Vc�,l.b, ;.. �T .
� 3".. ',Umbinq Sys(rm F•^-1
65_�!ectrical�Fieai _
6G. Solsr 5ystem�F,na�
67. Fencinp & Aceess Anun�v+l
G8. APPROVED FOR PLASTERING
G9. POOL!SPASYSTc�+SFINAt
F�RE OEPT �iE0U1RER�:El�T
.>?PROV/�i_S ',:ri. �,: �.
y'-._-- ___- `__-1- _ -
70. i:r'.d.:rgrcu�t; H�, . �.�
J --_ ..
�. PruductPpi�c_�(;.i' -0�1 � _ __'
-� - -
i7. Underqrou�J F!�,�s� ,
73. i:nd�r�rn•,.St�;.� . .�;25 :.� t�� ���_� �
- ---- - - � - - - - � - - - -*----
�Zy�4yt�r„�_ ,,;. a,�•,�-�_�,'='= - - -- -�
t � 75. Dry Gliem:c.,' �
- - - - ------ --- ---- --� " - - � - -
-- 7G. Dry St::nc r�„�e `
77. FIXED SYSTC\i_iNAL _ _
78. FIHE PREV. FINAL _ _ i �_
HEALTH DEPT. REQUIRE^:i=N"
� !!; Fi�:Pi �'•.SPECT � - - -----�-y � -�- --
_�'_ t___' -_____.__ ' _ .r__.
� I ' A� 'rOUD CEH �,F� :i�.TF �.SSi.ED ''
_'_ _
-�_____ ;._____-.-____ _ __ ___ _J "_--_. .1___ .
� �Uot�s:
--- '- - - - �--- --- - - - - - - - -�-' - -- -- -
__- _ -_ i _ _ __-_____.. _. _ _ __ __ ___
--1---�--+------i - - --- - - - -- -------- - -- -- - - --
OWNER FIELDS, C. DATE 11-8-76
BUILDING PERMIT N0. 429tf7
No.
SUBCONTRACTOR
W ATER
LINE I I HOUSE CON.
POWER
RDUGM WIRING
TRENCHES FORMS STEEL REINF
SHE�THING
fR�ME AND FLRSNING
LRTHING - IN n
PL�STER. BROWN CO�I
STRUCTUR�L.FIN�L
XE�TiHG. VEHT., RE�R
PLUMBING. FIN�L �N�
F
�
0.
a
�
�
F
�
F
Q
0
..1
Q
7
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...1
a
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o.
O
C
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3
� �
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to FiU in Completely — U nk Only
BUILDING h
ADOflESS R SO CA�wTiAr a
MAII �
ADDRESS
CITV ��'
CONSTRUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT
ADDRESS
CONTRACTOR
ADDRESS
CITV •
STATE
LIC. NO. � sj
SIZE
OF LOT
USE OF
TEL.
NO.
TEL.
TEL.
NO.
CITY
LIC.N .
NO. OF E
NOW ON
Separate permits are required for
electric, plumbing and heating work.
USE OF BUIL�ING ANO �'�'ORK TO BE PERFORA
',�i_n_-•r.u_/�r �.7�„ ^--•'''�p',c��
i.-p.. 1' 6 �
P IC ION EOR STRUCTURAL PERMIT
R V DATE REGEIVED E 1^�UE
� ai
PERMIT NO.
A.P. NO. G
BUILDI G
AODRESS
TRAC��XI LOT � BLOCK
OWNER L •
FIRE�
ZONE' T
APPR
BV
ZONE , NO,OF
PlANS
VARDSAPPROVED
MAIN BUILDING
(FROM Gl STREET)
FFONT '�-�F�
�
R. SIDE FT
/
L.SIDE �FT.
i
REAR �D FT.
DISTANCE BET.
MAIN BLDGS.
VAR. aW
C.V.P.iy+
APPROVED /"_ ./J
I hereby ecknowledpe thet I have reatl thta application antl state
that iho abovo Informatio� Is corract antl a0rea to compty with
ell laws reBulatinp builtlinB conrtruetion, en0 I shell not emp�oy
any pe�wn in violetion tlf the workman's compansation laws of
the Siaie ot Celifornle.
I hereby cartify Mat 1 em ProDarly Iicensed as a contractor untler S�
ihe Stata of Californla BUziness entl Professions Cotle, Division 3, THE AMOL
C�epter 9, and that such Iicansea era In tull forca and atfect, or I THE PURP«
am exempt from tha p�ovl5ions of the Stata ot Californla Businass VALVATION
and Professlona Cotla, Div�slon 3, ChaD�er .
Sipnature a /� �D
Permlttaa ��• � "�- � $ �
Authorizatl ABent
USE OF NEW
BUILDING
YARDS APP
ACCESSORY
DATE
f SHOWN UNDER VALUAT
OF ES'fABLISHING A PERMIT
PERMIT FEE E
� PLAN CHECK y
TAX E
TOTALPAID E
n
m
'm
m
N
i m
e
a
N
m
n
0
LL
�
U
�a ' . �.�$��o
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. 60X 917 COffTA M88A. GALIPOilN1A
For Applican+ io Fill In Complefely
TYPE OR PRINT
ADDRE65 830 Santiago R08d
COSTA MESA. CALIFORNIA
OWNER Mesa Del Mar Development Co.
aooRess 3800 E, Coast Highvay
��TM Corona del Mar No9R 34220
ARCHITECT TE��R 34220
OR ENGINEER MSCCO COLQ NO.
FE,�/E RECEIVED
4� JUL 121�u1
FINANCE DEPT.
�I 1�� C��A MESA
APPLICATI P R IT
BUILDING
Fo� Offlce Use Only
R6C61R NO. •��1�1[MJT�10�
fl �ft(vY I
RHGHIVHD BY I OAiE R8G81VeD I JUL 1 2g��61
PIRE
COSTA ME6A CALIFORNIA
AODRESS 3800 E. Coast Highway ZONING
an' COLone d01 M.Bc � C81if. ZONe xo. oa u88 OF NeW
� �.r I vtwe�s euuo�Ho
�cTrEio. 98808 SB-1 No: OR 34220 '�n•� .T Z � � �
DltCRIR10N
oF ioT 6200 SF� I NOW ON LOT`Nane A. P. NO,
U82 OP YARDS EVEB
EXISTING BLOG None ppPROVED ALLOWBD
B8T0ACR LIN6 FROM � fCtNTIR YN6 iTJ
CHMeR OR SiR!¢T 48 -$ REAR YARD 36- FRONr `-I- PT.
61OE YARD I LEFT S� I RIGXT 5� R. 61DE �� FT.
DESCRIPTION OF WORK , R,oF � Fr
81ZE � �� ROOM6 STOF
COVCRIING WOOdB$CUCC�COVERING �OOd :
U6E OF BUILDING AND WORK TO BE PERFORMED
Sinele familv residence
attached
I HHRBBV ACKNOWL8�p8 THAT 1 XAV6 RB�D TX16 A/PLIGTION
ANO 6TAT8 TNAT TH6 ABOVH IB CARPLGT AND /�OflHe TO COM-
PLY WITM ALL CITY OHOINANCEB AND BTATe LAW! R80YLATINO
BUILOINO CONBTRIICTION,
eIGNATURE O�SA DEI� MAR DEVELOPMENf CO.
IAUB NORIZED
/ %
Living Area - 1245 SF
GaraQe Area - 390 SF
Cov Porch - 110 SF
TXE �MOUNT BNOWN UNDHM VALU/�TION 1! POR TX8
PURPOB¢ OP lSTI��LIBXING A YBRMIi P66 ONLY.
VALUATION
PERMIT PEE $ • � �
g 13�19Z.�� pLANCHECK $���
�