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Home My WebLink About264 SANTO TOMAS ST - Building Permits CITY OF COSTA MESA 44I �q BUILDING DIVISION F ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT JIrrql Sb* rr,1044" P03-00769 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 264 SANTO TOMAS ST Status: ISSUED Suite No Applied: 11/20/2003 Issued: 11/20/2003 Vicinity: �-,/'� / Parcel Nunmber: 43920205 ISSUED BY: /V K-� Applicant: TIMOTHY NOCK Address: 11612 KNOTT ST Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 Owner: PLESA, STEPHEN MICHAEL TR •�9 • Address 264 SANTO TOMAS AVE ` �W '►I Phone: 1)15 COSTA MESA,CA Zip: 92627 Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Phone: (714)895-1246 • GARDEN GROVE,CA Zip: 92841 License: 707775 • Arch/ Eng: , Address: Phone: Zip: License: SCOPE OF PERMIT CHANGE OUT WATER HEATER. • FEE SUMMARY AMT QTY AMT ' QTY AMT QTY ISSUE FEE $23.50 - Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) ,$0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units ' , $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher N$0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 2446-46(6400) DECLARATIONSlat 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 work Compensation nsurance carrier and policy number are: /C)Q?a Carrier: I €21,-rVAI- Policyl K'Number: GU' (This section need not be completed if the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o California,and agr••1.t If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr Q — O Applicant Signature: v \ Date: //1-- /-7— WARNING:FAILURE TO SECyRE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLLARE($100,00,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licerjapd 4Cd oYisions of Cha ter 9(commencing with Section 7000)of Division 3 of the Busingaar.P/ fessions Code,and my license is in full force and effect.Lk.N (0 i' J Class N ( �(� Contractor's Signature: Date: /r - LI) - V 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).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have-the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.•property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,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 WIII 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)?❑ 0 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 a Eermit 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 Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑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 .li. ................................... 8 (If yoes',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 end 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 Caste Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. atyfe Of a al r(s) Date And/`,,((I pllcant 7h Date ;ODE A, INSPECTIONTYPE PAIE INTmALQ ;OQEI IffSPECTIQN TYPE PATE 1NTTm9LS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing C.--(1' [�l h' O9 by 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 COSTA MESA - BUILDING DIVISION F 1,11, ,) DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER , P5RMIT 1#4.* 1303-01000 %ftoamid (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us PERMIT A" 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING Job Address: 264 SANTO TOMASe Status: ISSUED Suite: Applied: 06/12/2003 Vicinity: RESIDENCE AND GARAGE Issued: 06/12/2003 Parcel Number: 43920205 Zoning: Applicant: MILLER, DALE ISSUED BY: it. Address: 13781 NEWHOPE ST Phone: (714)534-6398 GARDEN GROVE,CA Zip: 92703 Owner: PLESA; STEPHEN MICHAEL TR Address 264 SANTO TOMAS AVE Phone: COSTA MESA,CA Zip: 92627 Contractor: DALE'S ROOFING Address: 13781 NEWHOPE ST Phone: (714)534-6398 GARDEN GROVE,CA Zip: 92703 License: 503508 Arch : Eng: Address: Address: • Phone: Phone: Zip: License: License: SCOPE OF PERMIT RE-ROOF OVER EXISTING COMP ROOF WITH 40 YEAR COMP SHINGLES. INCLUDES GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,500.00 Permit: $111.25 - Claim Valuation: $4,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS j f l WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of penury 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. ve and will main workers compensaf urance,as req i by section 3700‘Of the Iibor Code,for the performance of the work for which this permit is Issued. My works ' ens do In rola c. er and o'cy number : (J(� r�Lf,r�/'. Carder: C Vim— Policy Number Z U.S- I 1 I ce (This section nee not be completed if the permit is valued et one hundred dollars(St 00)or less.) 0 I certify that in the performance of the work for which t ' permit is issued,I shall not employ any personin any manner so as to become subject to the workers' compensation laws o a I rnia, agr that If Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr vislo s. r Y n f Applicant Signature: I Date: C — t 2_' 03 WARNING:FAILURE TO SEC ORNERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDmON 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 provii' ns of Cheat:./:: ommencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# // i Class# Contractors Signature: '1 ,j 7 Date: CO _" 12'C:Aj 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 Code:The Contractors License taw does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: _ Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,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 nazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? 0 Yes 0 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 sir pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described// property for inspection rposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / 1 /J / And/Or/r Of Legal Owner(s) co —1 �1 Date,� /(i,GilL(/P/ And/Or Authorized Applicant L Date - CODE - CODE t INSPECTION TYPE DATE INIRIAL$ CODE It INSPECTION TYPE LAIL ILLS 1616 Fixed System Final Fire Prevention 206 ,Final Mechanical 1266 Pool Spa Final `- � 208 Final Plumbing /' 200 Final Re-Roof J"C') 6 s-I 210 Final Electrical 201 Final Block/Retaining Well 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 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. NO. TRACT NO. LOT NO. UNIT NO. CITYOFCOSTAMESA CONS/RUM-ION PERMIT A.P.# Zone Project;Address (� /� 7DQ "/�'/y/pyJp�1 _ � � 9�c S Main Building: Accessory Building: Applicant's Mailing Address 233 Yea ��/ (NOl(AV W a TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION REPAIR E Front Z c/� /��-/1�/�'� ❑ CONVERSION ❑ DEMOLISH LI OTHER i T 0 Owner's Name PI Phone(th 5' — I a� B N q ,p DESCRIPTION OF WORK/USE OF BLDG. Rear Address Lxt V • q I TYPE OF PERMIT U GRADING FOUNDATION U STRUCTURAL I C Right . N Arch/Eng. License No. _ - _,./11:1K G Address �q�s El TENANT ELECTRICAL PLUMBING III MECHANICAL $ Left R Contractor's Nam- aut L •hone WO CI OTHER Ping. Ref.# Parking Req./Provided E g ��Q �'/-- PROJECT DESCRIPTION SQ. FT. OCCUPANCY M Address(mailing) 933 0Z 777 C/ Planning Notes: 73005- CONSTRUCTION TYPE VALUATION$ T City License No. ZONE GRADING CU.YDS. ACRES tr��/ ( L r DECpp S LICENSED CONTRACTOR DECLARATION RECEIVED D1 3 IQRR I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and my license is in ful_fo • and effect. ELECTRICAL FEES License Class— c- se . ' i. ' PLUMBING I FEES Date _ ' / 7 Signature ! i / r Automatic Washer Transformer 0 15.50 KW //"/ - � � 050+ KW WORKERS'COMPENSATION DECLARATION Bar Sink Showers Construction Pole Sub. • •hereby affirm that I have a certificate of consent to self-insure or a certificate I . Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps JO, Lab•.�C7.j� /, or ,r�/� Backflow Preventer Service Sink Policy No./q/q._`7 -tla Company • )"w"alt Backf low Irrigation Sewer Cap Dishwasher • '• Meter Cover 100 amps rtifietl copy is hereby furnished. Dryers ❑Gas• ❑Electric Sub Panel Cert fietliateiled with the city B tMi ii /' Bathtubs Sewer Connection Date ',']1 u Applicant P! �/�(— � Fan Motors 00.1 HP ❑1h-8 EXE PT ON FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (Thi s section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.D. Inc.Solar 09-15 HP 016-15+ I certify that in the performance of the work for which this permit is Issued, I Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. Device Boxes Date Signature Floor Drains Swimming Pool w/Spa Pole Light NOTICE: If,after making this declaration, you should become subject to the e Outlets Ran Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9 comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - Switches Sign Gas Service Outlets Water Closet 9 I hereby affirmk that there Is a permit issue (Section for the performance C.) / - Of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater 2 Garbage Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Water Service •• Generator ❑O-5 KW 05-15 KW Trash Compactor , OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash -- . following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays • any structure, prior to Its issuance, also requires the applicant for such permit • to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of r''•Ision 3 of the Business and Professions Code) or that he/she Is exempt Reinspection Fee 515 Issue Foe from and the basis for the alleged exemption. Any violation of Section $ 3 .5 by any applicant for a permit subjects the applicant to a civil _ey of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS: C1, as owner of the property or my employees with wages as their sole Reinspection Fee ! $15 Issue Fee $ 3 Zoning Approved By Date compensation,ec, will do the work,and the of scion is not intended Contractor's oofferrd fpr nse (Section of a ly to an antl Prf a proper Code: The mroves MECHANICAL FEES Building Approved By — Date e _ License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own Hood - Application Issued By _ Dat employees,f, provided that such are not thinintendedor offoftl for Boiler or Type ❑ sale. If, however, the building or improvement Is sold within one year com- Canopy Type II ❑ SUMMARY OF FEES I) p , the owner will have the burden of proving he/she did not build or im- prove m- Duct-Under Ground .s proverove for the purpose of sale). • BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ e1 PERMIT tractors to construct the project (Section 7044,Business and Professions Code: • • The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU V - PLUMBING $ �.� ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- ENERGY P.C. $ tractor(s) license pursuant to me Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration I PLAN CHECK 25% $ proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $ 0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. IC80# Fire Dampers MICROFILM $ PLAN CHECK 50% $ Date Owner Heating System Si Ducting Registers MECHANICAL $ TOTAL FEE $ 5°0 I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upo, the above-mentioned property/1 for O inspection pur ,d' /e /l/^O p Signature LL _ Date! (� C Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 O1 00027997-00022997 T/�g n 0865-46.rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor DRTEt 12/21/($8 TIME r cea 09:57 r- . , CONSTRUCTION AND PLANNING P001 SPA APPROVALS Permit Date Inspector APPROVALS P.....iit# ,Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement , • 3.'Electrical Conduit Utility-Undrgrnd. 54. Forms 4.!Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement' - 56. Rough Plumbing & Pressure Test 6.,Electrical OF ER Grrid. 57. APPROVAL TO COVER-GUNITE • 7. 'Footings 58. Electrical Conduit-Undrgrnd. • .8. Foundation ' i 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 , I 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 X1'7"Rough Wiring Sign 68. APPROVED FOR PLASTERING 18/ Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19!' Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: (Z_Z?- LEFT-C.44-0. L,C,0 34. Final Heating & Air Conditioning 5727/8 1 Gf.F.r--c a Lzv 35. Final Gas Pipe-Test 36. Hood or Canopy 37- Final Factory Fireplace J 38. Final Plumbing _ 12C��..(' 6-60 39. Water Service-Final ( . 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer t.' 43. Backflow Irrigation I)' 44. Landscape Irrigation System I •\ 1 45. Sound Attenuation 46. Handicap Regulations , .t 47. FINAL STRUCTURE & BUILDING . i 4B. Soecial Requirements Completed 49. Electric Release to Edison l i 50. Gas Release to Southern California Gas Co -- -.2 / 4 51. CERTIFICATE OF OCCUPANCY �aNo. Date i.J I CITY OF COSTA MESA PAR ?EES N° - - 1$7 ee Payment Receipt F Project Address af` Volb - Park Area .77 A. P. No. I ( ! — 1 ,fi — O�j Building Permit No. �y.Iy-• rA Owner's Name 1...fib `,�y�, amicia � 111 Mailing Address T t/ • FEE Single Family * No. of Units @ $455.20 = Multiple Family ** No. of Units @ $321.32 = Total Fee ' S.20 Planning Department Approval P.te I I^7 LO By �..l L Applicant's Signature /// * CRY Ordinance 72-44 / ** City Ordinance 72.45 •*• City Resolution 74.124 �} �� White-Planning;Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-26 10'C,I !YI 1 HOOD s ASSOC.TATFS "n" 6-11-76 4JOB ADDRESS 264 Santo Tomas A..P.,,,P BUILDING PERMIT NO. 42138 `C.GENERAL CONTRACTOR Hood & Associates DESCRIPTION of WORK Res. w/att. gar. `AP No. 119-164-05 LOT TRACT FIRE ZONE VALUE $33,300.00 INSPECTIONS Signature Date TYPE V GROUP I & J ZONER-1 SOIL ylr�.g /1. 2 •� P ,IRMITS ISS{QED SUBCONTRACTOR t GAS Date Number Signature WATER u'I0.. �� 11 •t Z A?� �9 �JPlumblrlg n� ROUGH PLUMBING 1 Y /•.24'./� t /'/ka, /l-?4'&. Tor/O ..--- PROP. . PROP. SWR. LINE Q HOUSE CON.IN a •3 '70.•6- S_.. 1 - ab--77 7/0 5-y r°..---- SPRINKLING SYSTEM ` MI SCEL LANEOUS.414.4.'(CCp j[Z•L.4 I.Y4) ,ryr i/ J TROUGH HEATING AND AIR CONDITIONING ( L5 / It'/ /T - TEMPORARY SERVICE OR POLE akn-ZS. _ UNDERGROUND [] POWER 0 ROUGH WIRING v-T� G I'/O Ti Heating and Vin tt. TRENCHES d FORMS El STEEL PEINF. Q. � rn4N / 1 D i,..' .v i 3CI^jr FLOOR SYSTEM I-I / �^�J �b �.. BOND BEAM L l STEEL REINFORCE ' 1 �/ SHEATHING Ale t. 2.'258•' FRAME AND FLASHING S'Il'e. 1'27;77 Cr. LATHING - IN OUT El /ll�//'5 f --( PLASTER. BROWN COAT rt .2_/C:7-F STRUCTURAL, FINAL /��./QJ��Electric // / (j �� ([� HEATING, VENT., REFRIG. AND A.C., FINAL .- f gDi�.(.�1L i Io- •7fe gnat 4/bL.t�AI/O�+ , PLUMBING. FINAL ANO GAS TEST n - 3•RS / r( /2...2)•70 1'1/7/4/ ELECTRIC. FINAL //(l��1(� 3-Lb"TT BUILDING. FINAL a-7.• WS.9, PAIL It7rP00 72 = 210.,3 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only %/ �J/ ,( RECEI DATE RECEIVED /r7��' F,[1. BUILDING // �„4 S ,S/VX /2):04-5 )4,,E— OWN ldE- 1 `� T I �F�1� ADDRESS (/l1( 1 �/ lY 7 / ^/ n/• c� /J I1,'I C PER T NO. OWNER Q e)eft `F /T.7J �Ci�/�/L'� A.P. NO. l ,/ �� —✓/ BUILDING -/' ,/ MAIL /7Q 3 2 / ADDRESS ,5441/U '7 AO/+-5 A/�F ADDRESS .V x 6 (/ CITY 7S 'N NO.X3/-5/J . TRACT 3yTEL LOT l / BLOCK CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMO! ISH LENDER ,` BRANCH r OWNER ,?/��// OP P�/'?/-SSOC/47S ADDRESS r V•LUE ARCHITECT 'I/ ,1// �j/ •/ TEL '/ SE �.l • L t ,7 �_ $ OR ENGINEER //N A- ` /s'(Q/L (J'/4ry NO S—a Yr` ' ADDRESS /O 9SW/NA/4✓ S/ • piAN4 a- ZIRE u. 1 q _/ p ,q d� ZONE TYPE / GR/OUPr llQd 1' /TSSQI��4-7 g APPROVED (D I/rem CONTRACTOR BY a' DATE ADDRESS Bo )' 3 9 6 TEL ZONE NO.OF USE OF NE CITY 7V,S IC N NO. �+' PLANS BUILDING H ��P 43n- E-. STATE CITYYARDS APPROVED YARDS APPROVED 5 LIC.NO. a 72 , 8 6 LIC.NO.4.Sa ,2_ MAIN BUILDING ACCESSORY BUILDING DJ OCS. (FROM C/�LJSIFeEET) rl d OF LOT CO x /1745-/1745- / I NOW OF ONBLLOT G FRONT FT. D FT. Q USE OF '/ / ti /' col EXISTING EXISTING BLDG. O /C16% _S $1 C) FL C7 FT. dr E Separate permits are required for L.SIDE - FT. �.( FT. O electric,plumbing and heating work. REAR 496T. V I FT. [s7 USE OF BUILDING AND WORK TO BE PERFORMED F DISTANCEABET. ACC.MAIN& Qn MAIN BLIXS. ACCESS. BLOCS.1:1 tz Ex �/J'--- ��J/ VAR..$ DATE •"t /�• Mf/ s C.U.P,gW APPROVED APPROVED t e . '`.,,1 v flrk -a _ Y DATE lJ Ca- I hereby acknowledge that I have read this application and state � r4 that the above information is correct and agree to comply with m R. all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of //,,� E = the State of California. /�/3 ��.5 (o4r1 I hereby certify that I am properly licensed as a contractor under ! SO. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT F E NLY: e am exempt from the p ovisi ns of the State f California Business VALUATION PERMIT FEE $ �. -9 o and Professions Cod Ivi n 3,Chapter �r AAA♦ n PLAN CHECK E /U 50 o Signature of /�/7 o Permittee / /�/c $ 33-1-00 TAX $ r33 u.E u Authorized ant TOTAL PAID E2/ 0♦n