HomeMy WebLinkAbout2118 SANTA ANA AVE - Building Permits ,
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CITY OF COSTA MESABUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENTPER T NUMBER
PERMIT4. B03-02174
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caa..UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2118 SANTA ANA AV Status: ISSUED
Suite: Applied: 12/19/2003
Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 12/19/2003
Parcel Number: 42616109 Zoning:
4/111.
Applicant: FAUBERT, TRACI ISSUED BY:
Address: 8902 SAILPORT DR
Phone: (800)854-0011
HUNTINGTON BEACH,CA' Zip: 92646-2664
Owner: BAIRD, ARTHUR F TR
Address 1091 SALINAS AVE
Phone: )Pf'Pr
COSTA MESA,CA Zip: 92626-1612 r�-!`•
Contractor: STAR COURSE ROOFING CO.
Address: 8902 SAILPORT DR
Phone: (800)854-0011
HUNTINGTON BEACH,CA
Zip: 92646-2664 License: 532778
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
• SCOPE OF PERMIT
REROOF RESIDENCE AND ATTACHED GARAGE:INSTALL NEW 1-1/2 X 2 EDGE METAL,NEW METAL FLASHINGS,20-YR FIBERGLASS
SHINGLES OVER EXISTING SHINGLES.NEW DURA RIDGE CAP.23 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,680.00
Permit: $97.25 Claim Valuation: $3,680.00
SMIP Res: $0.50 •
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00 - •
Total: $97.75 •
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
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(WOO)
I
DECLARAT&ONS;, s
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
11 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.
y w rl�teprs, -��/�
ompypsation insraneecarrier and policy number are: i CD 2
Carrier: aILII ePolicy Number: % J ` " J
(This sec n need not be •mpie ed if the p rmit is valued at one hundred dollars($100)or less.)
o I certify that in the •�j ormance of the rk for which thi permit is issued,I shall not employ anynerson inany manner so as to become subject to the workers'
compensation lawCalifornia,and roe t at if I sho d become subject to the workers'compensationprovisions of Section 3700 of the Lay or Code,I shall forthwith
comply with these• • ii'•n 4C)
Applicant Signature.\L F 1 Date: 112 ✓ "��J
WARNING:FAILURE TO S'CURE WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO C MINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),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 tic d Y deyy��rpyi s of^ apter 9(commencing with Section 7000)of Division 3 of the Business app fessions Code,and my license is in full
force and effect.Lic.# q gg''�I 'I p Q Class# I C `, ,
Contractor's Signature: ✓✓✓e\�/� C/' ,- Date: /�- ' 'I-'n c
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).):
O 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 ❑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 hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 13 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (if"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under 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 purpose I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
gnature Of-LegdJJv+ner( �4_.-.t
T / _' )43
te�
An r uthoriz Applicant Date
ODE C INSPECTIONTYPE WE IKTmAL5 CODEC INSPECTION TYPE MI INMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof _S`—�'G 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
}• 'AI)JECT ADDRESS: 2118 SANTA ANA AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 053791
rt OWNER'S NAME: K.K. & ASSOC. -
ADDRESS: 1 '8458 BOLSA CHICA PERMIT NO: B 053791 — PLAN CHECK NO: N GOVT: N SUPP: N
HUNTINGTON BEACH
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCH/ENGINEER: 840-1420 flEG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : REROOF COMP OVER COMP SQ FT: 2,000
PERMITTEE: CLAIM VALUE: 2, 000 . 00 CALC—VALUE: 2, 000. 00 GROUP OCC: R-3 /
PEflmI
aooTTE : CAL—CUSTOM ROOFING ( 714 )974-3542
1442 E. LINCOLN 372 COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
ORANGE CA 92665 *************************** **TE************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
• CITYDate:
LIpG,.:�0�4�68 1 STATE LIC.:435425 D . C
��Date:/!V= Signature:_ _ _ _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affir that ldy a certificate of consent to sell-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY No.: 1256413-91 EXP.DATE: 07/10/92
,COMPANY: STATE PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO:
' -2 CCeen�ilied copy is herebyerfurnished. [X Certified copy is filed with the fly Building 'ision. PLANNING NOTES>
/—/ /� _ >
ale. 0 Applicant: *******************************************************************3Fif**********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATIO (Thi ctjon need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
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: l_
Cate: Signature: '
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : / DATE: et
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. C�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work tor APPLICATION ISSUED BY: DATE• / '7Q
which this permit is issued(Section 3097.Civ.C). ************************** ** ** ****3(.* ***{e.************.*.**.*.)(.*********.**. *.**.*.
LENDER: ***************************************** *************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractors'State License Law for the totlowing 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 45. 00 5 0. •
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensedSMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
S
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE •
I. as owner of the property or my employees with wages as their sole compensation, win do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID / DUE
•
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 45. 50 0.00 0. 00 45. 50 4 5. 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
improveor ments solwn d employees,
one year of completiothat such n. vements theownerawill have not )the burden ed or ffered ol provingshe/she did noter the buld or iimprove REVENUE DIVISION TOTALS--> COLLECTED: 45. 50 OVER/SHORT:r 00
torthepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 45. 00 • 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST • TOTAL COST
Date: owner: _ •
SFR 2000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00a 1, 000.00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification Rom the Air Quality Management District.Residential construction applications are exempt from ' I
these provisions,
Date: Applicant:
I hereby pettily that I have read this application and state that the above' ormation' orrect.I agree amply with all city and county
ordinances and state laws relating to building construction and hereby au ¢arena• .alive t to enI ranee'
property for inspection purposes.
/ C
!ff-'— e/
Signature: - •
•oma✓ ;:e•. -- -
Driver's License or Social Security a:
Applicant:Pink—Revenue:Goldenrod—Assessor
/"
.r l 1
`4 CONSTRUCTION AND PLANNING I POC SPA
.D
APPROVALS Permit # ate Inspector APPROVALS Permit # Date Inspector
il
1. Temporary Electrical Servicedr Pole J 52. Pool & Equipment Location .,
2. Soil Pipe-Undrgrnd. w t''?? -„et ' 53. Steel Reinforcement _'
-2 -, C ;r I. .1'
°'3,ifcictrjcalCondult;Unlity•Uhdgrnd 54. Forms
5
.4.uElectrical Condujt 4.Jr drgrnd. 55. Electrical Bonding
't - ^
"-15*-eel FIeeinforcerWlit56. Rough Plumbing & Pressure Test
jtb(i'- ctrical OF ER
'" Grnd. k 57. APPROVAL TO COVER-GUNITE
--J•. Footings %S a. 58. Electrical Conduit-Undrgrnd. 'C
-,f- ,", n/
er 8. F:dundation mt=' rt. i.. +ya + 59. Gas Pipe, 0 Undrgrnd., Test
�}
y 9.Mater Pipe-Undrgrnd. /;l•) t,�f 60. Backwash Lines, P-Trap, 0 Undrgrnd. /% ;I
10. Structural Floor System rid rh '' / . 61. APPROVAL TO DECK ft
f-
11. Property Sewer Ling.& Ho se7Con ction 62. Backwash & Receptor-Final Py ,1 1
.2 /��1 .41'
12. Sewer Cap :! f w / r 63. Heater & Vent-Final r! -;/'
13. Roof Drains .r / �� 64. Plumbing System - Final V .
14. Rough Plumbing :0 65. Electrical-Final / 5
15. Rough Electric2J-Conduit 66. Solar System-FinalImo/
_
16. Rough Electric-Wiring 67. Fencing & Access Approval i `j
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20;rfiough Factdsy rcijcplace T. rKry, :Lt" 4' E. ,D 7'; a PPR�Os.VALS!DGPermn # k •
• -Cep *ref r S ;.•t t r' r, _ ti -
21?pul s, inJ Strl Wkf II :-•• -••
• c--CSS 4S _ x' M* 470. OndjgrqunlHy�..�'ro xK
22. Ducts, Yentitating xi 0-.S +' S Cx -+71. ProductrPt-,ping 0:05s O.Oil
S n •t - _r .
23.'.Gas Pipe Rough &'Test I tr.;
S x ,�, C„ tc �:l * ',72. Underg ouund Flu i'S,� < 6
V 'n 0.8 I tr t:� , +.J .w l3, C '• "Y - v ,l `rr K T V
24;cRo J Framirig >,.. I _ x > 0 _ -may •• S73WUndergrnth.Storaye'ra kk I0 Gas 0 Qtl
Y -- • _ • -, -tr. •
25. Roof Sheathing ' s f- a I'• °• O =?7 ••rt, -L. C.
verhead�fiydro,a-
x d - tr 'J' U , -
et
26.�I--B'af Ceiling (St(_nctural) &,�Aonocoat *. _ co ,r,a .r 75 TD_ry Chemical
�S Y 27:-Frame and Flashinfu1 * .. tt 76:-Giy StanMifi e %s: ' % tr u:
:.I:CU: A c >' a3„* ..., .-r X
r28. - Stdin4•x u. rltq!� .t * Yt; :r >• +2'� x - :u
72 - : r > w >: + 77.; FIXED SYS• ;-1.7FINAIz
c - J .. .. .. .: _, ;tom _
>29. Insulation -r• K O •• •' -?; -'' i' I t�, ; 78`-FIRE PR EV. FIIV4L x ti -„,,:i. y
•�30. Drywall-Naigng pc a j r �., 4 , - HEALi1H:UEPTi REQUIREMENT
_. . ± ... F. 20 r
-31. Plaster 'owpCdZ' ,r ! ,r.r s I -2*4,3 r79PFINALIIQ+SgECTI� N :+ - `L1 a
rd 1 rr r 1 •Y / LP. .
i- - i :r7 1
_32_-Electricd PcrSer dylerter,Final, * co I L x. r800 FOOD CERi2iFiG 4�TE ISSOED'
-,. - ,_ 'q:s C 'r:
33: Final Elebtrid I z' 7 11 " 1'' riNotps: = x ri
':34-.,Fin 7 Haatin & F�'G'o iti Ini'2 LL y '� i:.2=� f f +2 11 t
4 2d' 9 $� n x ix i::>r s
35-Final Gas Pipe-Teti- s * I I.•: * C :r; V. r c.
I .. •r .. Y: •-. ,'t :r to - ... -Ii-
y36:-Tho or Canopy::* ^< I a * n I ` sz r ^to a t'
-37irlal Factory Fic`MateT, I c` C r 4
CII ; , d r s , - J
:tFt
0 R
3: ti; '. Ci 1 ?' :k rt < Lr' 7 Y
-38. Fina) Plumbing y (J 1 0 4 . 'r S - x In a
-39. Water Service-Finalt i o x I t C` t7 4 t.
rt. l 1' I - tr I x .7 Y -J i C
? . 7 ' I--.12.. • rr I"- to
,r40Gas Service-F�anal :i tri �ttt•LT' S t •?I I t ` '^J :c' x
s41. Solar Domestic-Final i :• r I y a. <'U - >-
.. .. tr v: , . Ir 0 - > T
42-iBackflow Preventer^. IV e O I C ''� C- 4. _ .S
. .
43. Backflow Irr atiom W.iS t * * tit?..C6 t 0
s v t . . x -J 13 7 n
x44. Landscape Itligatiap SystergJ, r u: :° trf - �, 1,-:7,.. ...1:. t: ni ;I c� * 4v o
g45.'•6ound Atten -
uation ' •u;;-• rr + >-. F- t- F-i: ». "+ P.+ 1-4 O N tgkt it
•-1 •-• .. .. Ir rn in - C" I
46'`Handicz Re ulations S 4 fn '• ' ••* ` _- • c -'
P. C -., a. c .t: co ..s
'47*FINALSTR-UCTULiE & BUILDINGW S 't�>
480INAL PLANNINCj ; 1.01.1 . •,. I I %� * I '
t _ ,:
�49:JElectric Release to Edison r. I lit y ?' C - _ 0
50"cGasv,RellOse to Southern California Gas Co t I I ' [I p S C y ll k .J o
'51. CERTIFICATE OFZOCCUPAISCY ., ; 0 X _. ;j
No. Date
t
5 c_4ssoeiates
Property Management-Bookkeeping
16458 Bolsa Chica St.,Ste. 297
Huntington Beach,CA 92649
(714)840-1420
September 11, 1991
City of Costa Mesa
The property located at 2118 Santa Ana, Costa Mesa CA is equipped
with the required amount of functional smoke detectors per
rooms .
Thank you,
Kathleen A. Kampen
Property Manager
•
1'
\,
r cc. , t-f7-at/ - Ce„ k
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY 3F �OSTA MESA CONSTRUCTION PERMIT PER NO.S ^ TRACT NO. LOT NO. UNIT NO.
�T,.- t Address _7118 Snntn Ann Ave C M `�73� r�'l II����II
Applicant's Mailing Address 126 CnmmP.l"C int Way, r Al 92Fi2 TYPE OF CONSTRUCTION LJ NEW ❑ ADD ks-u ALTERATION U REPAIR n U DQ ibc ^^ — TI
❑ CONVERSION ❑ DEMOLISH ❑ OTHER 1A.P.# Zone
Owner's Name 4, Fre i"dn./d Phone._650=424.98 DESCRIPTION OF WORK/USE OF BLDG. reS/ll'ent in!
Address j S Main Building: Accessory Building:
Arch/Eng. License No. • TYPE OF PERMIT ❑ GRADING. ❑ FOUNDATION ❑ STRUCTURAL E• Z
Front O
Address • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ( BA Rear N
Contractor's Name_CCGI]LLRr. Ran?%ng Ca Phone 5148-5539 ❑ OTHER - - C Right _ N
o PROJECT DESCRIPTION SQ. FT, 2, 75n OCCUPANCY rig't, 5 K g - G
Address(mailing) Cn/Ilm?r!%I • • • L' • 7 CONSTRUCTION TYPE re . . VALUATION$3 h9-4 nO 1 $ Left
City License No. _,__ 993 •
ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking R
eq./Provided R
'Q
LICENSED CONTRACTOR DECLARATION
•
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: , M'
with section 7000) of Division 3 of the Business and Professions Code,and T
niy41license is in full force and effect.
License Class—C-' ) Ljyense' I,LQ4F _� S
Date_ Signature G PLUMBING FEES
9/rc3f85— �
:� WORKERS'COMPENSATION DECLARATION , Bar Sink , Showers ELECTRICAL •
- FEES
, 'hereby affirm that I have a certificate of consent to self-insure or a certificate ,
1 if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sing
3800, Lab. C. ---'- ' - - - - - - Automatic Washer Transformer O 15-50 KW
\ Policy No. /'Z✓C!184462 Company -Home Backflow Irrigation Sewer Ca - 0 50+ KW
Cap _ Construction Pole Sub.
X Certified copy is hereby furnished. -
X Certified copy is filed with the city Building Division. /� Bathtubs Sewer Connection, Cooking Unit Meter ❑up to 100 am• ps
Dai®./ 3�$5 Applicant a SOD " U♦j.— - —
EX TI N FROM WORKERS'COMPENSATION DECLARATIO Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or - - - - • _ _ ..__ _
less). , Dishwasher $afar Piping I Dryers ❑Gas DElectric Sub Panel • .
I certify that in the performance of the work for which this permit is issued I - - - _ I�
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan
Workers' Compensation Laws of California. _ Motors❑0-1 HP 01%-8
Date Signature • Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+
'NOTICE: If,after making this declaration, you shouldbecome subject to the • -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor SinksUrinal Fixtures Microwave .
comply with such provisions or this permit shalt be deemed revoked. -- ' '- ' - — -
CONSTRUCTION LENDING AGENCY ' Gas Service Outlets - WaterCloset Device Boxes
I hereby affirm that there is a construction-lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets
Lender's Name Range 7
Lender's•Address Kitchen Sink Water Service - Switches Sign
OWNER BUILDER DECLARATION - ' .
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
•
fo)lowing reason (Section 7031.5 Business and Professional Code: Any city or ._ •
9 P ',Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - Generator 00-5 KW ❑5.15 KW t '
any structure, prior to Its issuance, also requires the applicant for such permit - Trash COmpaotOr�
10 file a signed statement that he/she is licensed pursuant to the provisions of - - - - - I < - ,
the Contractor's License Law (Chapter 9 (commencing with Section 7000)of , Roof Drains - __ .�•
Division 3 of the Business and Professions Code) or that he/she is exempt . -
therefrom'and the basis for the alleged exemption. Any,violation-of Section , •
7031.5 by any applicant for a permit subjects the„applicant to a civil - '? '+ '
gnalty of not more than five hundred dollars($500).' - 3' —
•L I, as owner of the property or my employees with wages as their sole Reinspection Fee - $15 ' Issue Fee
Compensation will do the work,and the structure is not intended or offered yILJ einspection Fee I $15 Issue Fee'. $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL • : FEES '.
License Law does not apply to an owner of a property who builds or improves
thereon, and who'does such work himself/herself'or through his or her own - A DEVELOPMENT SERVICES REQUIREMENTS:•-
_,
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale, If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By _ Date .
pletion,the owner will have the burden of proving he/she did not build or im- - Duct- Under Ground Building Approved By Date
•
prove for the purpose of sale). ,
Q I, as owner of the property, am exclusively contracting with licensed con- ' Duct-Structural Refrigeration System Applicationgssued By @ -.�Date 9 3 _
tractors to construct the project (Section 7044,Business and Professions Code: ' i(
The Contractor's License Law does not.appty to an owner of property who - Duct-Ventilating . 00-100,00¢BTU 0100,000 BTU SU F FEES _
builds or improves thereon, and who contracts for such projects with a con- • - - _ A -
• trector(s) license pursuant to the Contractor's License Law). I am aware that - . BUILDING PERMIT S SMIP . .$ . .J
proof of their Worker's Compensation insurance should be provided to me. Exhaust System ❑ Multiple❑ System Repair/Alteration •
E X-P I R t 0 PLAN CHECK $ PERMIT
❑ I am exempt under Section B.&P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers D r 8Ct ODS ISSUANCE $
•Date Owner Heating System& Ducting Registers If1W)H�IOtC I r• PLUMBING $ ENERGY P.C. $PLAN CHECK 25% $
I hereby certify rect I have read thismapplication all and state that the above ❑0-100,000 BTU 0100,000 BTI. - GRADING $ •
information is correct agree to comply with all city and county ordinances Sig -CECTRICAL $
and state laws relating to building construction, and hereby authorize repre- _ - Ott@ �-'' PLAN CHECK 50% ' $ MICROFILM $ '
sentatives of this city to enter upon �qe abve-mentioned property for - -'1 COspection purposesrT> // - - _ MECH/�NICAL $ - TOTAL FEE $ �'C�r `-'
Signature C/6� U•--� Date d
Drivers' License or SS# - 9/23/85 Reinspection Fee $15 Is}ifr�q'e Fee $ 3 PLAN HECK '25% $
CMF 0865-46,rev, 10/84 White - Building; Canary - Applicant; Pink -Accounting: Goldenrod - Assessor `I.. . . ' '
AONSTRUCTION AND PLANNING POOL &SPA
i
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
'1 r,Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, U 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
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 (Structurals.& Monocoat 75. Dry Chemical . .
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
•
- 7
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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
, 40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer 1. -
43. Backflow Irrigation 1
44. Landscape Irrigation System EXPIRED
Inrom lete Inapartions
45. Sound Attenuation
46. Handicap Regulations Uate _ / IQ _
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co ..
51. CERTIFICATE OF OCCUPANCY
4
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _
CITY OF COSTA MESA CONSTRUCTION PERMIT - PERI MIT NO. /� TRACT NO. LOT NO. . UNIT NO.
. Projectddress _2118 Santa Ana Ave., C.M. . , QKJ aO5L/� 7 Er^aQJ Tl
*XI
l 9955 9/ 11 /85
Applicant's(tarring Address 126 Commercial, C.M. 92627 • TYPE OF CONSTRUCTION. ❑ NEW H ADO 7C� ALTERATION LI REPAIR - �.
' 6504498 ❑ CONVERSION ID DEMOLISH C7 OTHER - • p,p # -
• Zone
Owner's Name •.1. Fr__i_walCl -
Phone
•
DESCRIPTION OF WORK/USE OF BLDG.
Address cnrgP ,,, S. Main Building: Accessory Building: • .
�s degtl. fi=r -
Arch/Eng. License No. . TYPE OF PERMITLJ DING IJ FOUNDATION ❑ STRUCTURAL T Front 0
Address ' • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear , N
Contractor's Name_Crnfl1f-BCas• RfQ•�Q• Phone' 548-5569 ❑ -OTHER A • 1
Address(mailing)_1.26 Cam int:awl. C Al. 92627 PROJECT DESCRIPTION SQ. FT, OCCUP.%N/yrytmeat• K Right G
CON STRUCT I ON TYPEreSlddehtlal • ,VALUATION$]/TJ"•"" $ Left '
City,Licerise No. (705999 R.
ZONE GRADING CU.YDS. ACRES Ping, Ref.# Parking Req./Provided - E
LICENSED CONTRACTOR DECLARATION 0
I hereby affirm that I am'licensed u ,er provisions of Charter 9 (commencing Remarks: - Planning Notes: - _ M
with section 7000) of Division 3 .�the Business and Professions Code, an. - - '
my license is in full force and effectT
License Cla s_ r- Y License��y
Date_ 1- 85 Signature L�/e a. . Vii% rd.". ' PLUMBING . . FEES • S
WORKERS' COMPENSATION • -
-Ain
Bar Sink Showers ELECTRICAL FEES -
I hereby affirm that I have a c- icate of consent to self-insure ora certificate
•
if Workers' Compensation rance, or a certified copy thereof (Section - Backflow Pr¢venlef -- Service Sink "'
3800,'Lab. C.)- - Automatic Washer Transformer 0 15-50 KW
Policy No. .211lC1_1i _y Company Home • Backflow Irrigation •
Sewer Cap0 50+KW • ' •
Certified copy is hereby turn fished. Construction Pole Sub.
K Certi/fi nq g•• is filed with the city.8lftding g1/v6lsu. Roof,/n', Co. Bathtubs Sewer Connection Cooking Unit . Meter ❑up td 100 amps '
Date_9/ / // a • Applicant lam/ /1R -
%h. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • . Dishwasher Meter ❑over 100 amps
`
1 (This section need not be completed if the permit is for one hundred ($100)or ' _ I
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the ' Drinking Fountains Solar Tank . . 1 Fan Motors❑0-1 HP ❑1'h-8 -
•
Workers' Compensation Laws of California. - --- _
Date Signature Floor Drains j Swimming Pool w/SpaF.A.U. Inc.Solar ❑9-15 HP ❑16-15+
•
NOTICE: If,after making this declaration,you should become subject to the - •
_
Workers' Compensation provisions of the Labor Code, you must forthwith , Floor Sinks..'
complywith such provisions or this - Urinal - - - -- Fixtures' - - . - ' t
permit shall be deemed revoked. Microwave
•
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes - '
I hereby affirm that there is a construction lending agency for the performance Pole Light u1
of the 'work for which this permit is •issued (Section 3097 Civ. C.) Interceptors • I Water Heater Outlets
Lender's Name Range '
Lender's Address Kitchen Sink - Water Service - Switches Sign'
OWNER BUILDER DECLARATION • _
I hereby affirm that I am exempt from the Contractor's License Law for the . ' ' Lavatories . ' - Auto-Wash •
- Garbage Disposal
following reason (Section-7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap LaundryTrays •
any structure, prior to its-issuance, also requires the applicant for such permit - y Generator ❑0-5 KW ❑5-15 KW ,Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains • . ' - - •
the Contractor's License Law (Chapter 9 (commencing with Section 7000)of - .. 7 -/;:
Division 3 of the Business and Professions Code) or that he/she is exempt - - -. _" -
therefrom and the basis for the alleged exemption. Any violation of Section - •
7031:5 by any applicant for a permit subjects the applicant 'to a civil - '-'• ` '
enalty of not more than five hundred dollars($500). - • I
I; as owner of the property Sr my employees with wages as their sole Reinspection Fee IP $15 Issue Fee $ 3'
compensation, will do the work,and the-structure Is not intended or offered Reinspection Fee I $15 -Issue Fee ' I $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES -
License Law does not apply to an.owner of a property who'.builds or Improves •' -
thereon, and who does such work himself/herself or through his or her own - - . DEVELOPMENT SERVICES REQUIREMENTS: :
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement is sold within one year of com- • Canopy Type I I ❑ Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove-for the purpose of sale). 9-7/-151
,
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By Date Q J
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 ❑0-100,000 BTU ❑100,000 BTU $UM RV FEES -
builds or improves thereon, and who contracts for such projects with a con- - - - `/> ,
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ a • J SMTP $ ..7 v
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
IDI am exempt unoer Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# re Dampers -• ` �E 7 PLUMBING $ ISSUANCE $ -
Date c Owner i Heating System& Ducting • Registers EXP1115pQCtj0fl5 PLAN CHECK 25% $ ENERGY P.C. $ •
I hereby certify th f I have read this applicati• nd • .te that the above - 00-100,000 BTU ❑100,000BTC OMPIete GRADING $ ±
information is corre •. I-agree to comply with . I .rty . d county ordinances ' - - ' �fC ,. ELECTRICAL $
• and state laws relat g to building construct'en .nd •rreby authorize repre- PLAN CHECK 50% $ MICROFILM $ '
sentatives of this - ty t• enter upo • tinned property for ( , Sl@ � - -
•
inspection purposes % - • J_--- MECHANICAL $ TOTAL FEE $ cxtl•OD
Signature
Drivers' Licen!af� ' Date •
__ Reinspection Fee $15
pate Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,r- 0/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor 4
CbNSTRUCTION AND PLANNING .//� POOSPA
APPROVALS Permit# - Date Inspector APPROVALS Permit# Date Inspector
Ti. Temporary Electrical Service or Pole 52. Pool & Equipment Location
I'
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O 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
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 PREY. 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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer i
43. Backflow Irrigation EXPIRE
Inrnmplete Inspections
44. Landscape Irrigation System
Date '(",�Jsig
45. Sound Attenuation
46. Handicap Regulations 1
47. FINAL STRUCTURE & BUILDING 1,
48. Special Requirements Completed
49. Electric Release to Edison
50..Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date