HomeMy WebLinkAbout1081 SEA TERRACE LN - Building Permits r
4Qc CITY OF COSTA MESA
4I @ BUILDING DIVISION '
rl'� g DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
4. iia PERMIT
`� B03-00939
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1081 SEA TERRACE LN Status: ISSUED
Suite: Applied: 06/04/2003
Vicinity: Issued: 06/04/2003
Parcel Number: 42201313 Zoning:
Applicant: NELSON, ERIC ISSUED BY:
Address: 1081 SEA TERRANCE LN
Phone: 949-631-1444
COSTA MESA,CA Zip: 92627-4035
Owner: NELSON, ERIC
Address 1081 SEA TERRANCE LN
Phone:
COSTA MESA,CA Zip: 92627-4035
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: _ Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CHANGE OUT 7 WINDOWS THROUGHOUT EXISTING S.F.D.DIMENSIONS WILL REMAIN THE SAME. REPLACE WITH MILGARD,DUAL PANE,
ALUMINUM WINDOWS TO MEET 1997 UNIFORM BUILDING CODE REQUIREMENTS.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $1,900.00
Permit: $66.20 Claim Valuation: $1,900.00
SMIP-Res: $0.50 .
SMIP Com: $0.00
Other: . $0.00
Inspection: $0.00 - •
Total: $66.70 -
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
2445-48(WOO)
DECLARATIONS ',�
WORKERS'COMPENSATIONOECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: 1
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
ydI 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 nd agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. • /� l`
Applicant Signature: Act L // Date: 6/7/OJ
WARNING:FAILURE TO SECURE WORKERS'COMPS ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lia.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
o 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 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 en 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 . • / Business and Professions Code for this reason:
Signature: [
Expires: 05-
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 ANO 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 thisqpplication a adns
mit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes D 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 11 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 end 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 h 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 r insgectiory�j(rposes agree not to occupy or allow occupancy of any building authorized by this permitLuntiilfinn inspection.
Signatur'�//Offf Legal Owner(s) V/7 01
to
And/Or Authorized Applicant Date
BODE/ INSPECTION TYPE PATE 1NTRIALS CODE! INSPECTION TYPE PAIL INTRIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval //JJ
2 Final
203 Final Sign25e i//
204 Final Demolition 250 Final Building/Occupancy w�*iy%
CITY OF COSTA MESA
'4;�" BUILDING DIVISION
F, ,,,, ,� PERM! NUMBER
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
+g^°°;4199-01392
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1081 SEA TERRACE LN Status: ISSUED
Suite: Applied: 08/31/1999
Vicinity: UNITS 1081-1087 Issued: 08/31/1999
Parcel Number 42201313 Zoning:
Applicant: KLAKOVICH, DAVID ISSUED BY:
Address: 7045 HITES COVE - - .._
CA r; ,/ '
�. -Phones 209742-5779..
MARIPOSA i/ " - , 7 .Zip: 95338 ' ' • '
Owner: SEABLUFFCANYONWHOA ' //
Address 2064-MEADOW.VIEW LN. .
CAS ' '' ' / - - Phone :(949)631 9086 ,- .A` '
,;`COSTA MESAV \ - - - Zip:" 92626 �;`,?- , =\
)/ / \
Contractor / PONDEROSA ROOFING \N c / 2 \''1v,
Address:' 7045'HITESCOVE `,,.,,N/ ' ' \,‘ y'/.,
• , , r� CA ,//, Phone: 209-742-5779 �; � ��
MARIPOSA "- N = -
Zip: 95338"7 License- 615531 -
-
' Arch ' .--v . - ' : : Eng: i - . -z , - . ,,H
Address: - -,:-'" _, ''Address: ' ,
1T- - ` ,-,Phone:; _ - Phone:
r - " /
I ,; - _ N 't'
` Zip :. I 'a,�'-" -"License: %'2 `/License: - ' \ '
- A - ' -
SCOPE OF PERMIT , ' `
. i REROOF EXISTING 4-UNIT RESIDENTIAL BUILDING.TEAR OFF EXISTING SHAKE ROOF'WITH EXISTING SHEATHING
TO REMAIN. INSTALL 1-LAYER OF 30#FELT UNDERLAYMENT&'REROOF WITHCLASS'B'WOOD SHAKES(65
SQ). .. . .. - ._ ..
%
4-UNIT BUILDING:UNITS 1081, 1083, 1085,&1087.
�� - - _r. /', - .
-- - - FEE SUMMARY/`',- ' ' '
Plan Check: `' ' $0.00 ' ,/ / Calc Valuation: , $22,000.00
Permit: $349.25 -- r Claim Valuation: $22,000.00
SMIP Res: .$220 _ _ . . 1
SMIP Com: ,$0.00 , �-
Other:, `-,$0.00
Inspection: $0.00 .
Total: ' $351.45_ : ,.,
PLANNING"&ZONING , ' ,
SETBACKS . ,
MAIN STRUCTURE Front .0--0 ' - Rear 0-0 Left 0-0 . , Right ' 0--0 :
ACCESSORY Front 0-0"" w 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
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ ave 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.
c My workers'compensat 'n Insurance carnd policy number are:
�
Carrier: S-74 //, 74fi Policy Number:
(This section need not be completed If the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work f 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 Californ nd agree t t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisi �
Applicant Signature: / C4-1_,.../ Date: �X17 /J`7
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: .
I hereby affirm that I am license u r isi ns of Chapter 9(commencing with Section 7000)of Division 3 of the Business�Qnd P,rgfeJ ions Code,and my license is in full
force and effect. a---i7 A Class# C......—`S-J
Contractor's Signature: • A Date: ,c--,3/_ 55
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.).
❑ 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,Califomia Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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? ❑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 greeter than a weight of 500 pounds,ora volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2......... ill the or
future
occupant
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves 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).
........... will pli .. RMPP
ana... .... ndPr-' ogr- uey..- ...at. ..- ..
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Preventmon 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.
......... P-s- . t ..r..q.i. Section
of.the. a Safety
C.. been fully
4 If an RMPP is presently required has Section 25534 of the California Health and Safety Code fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�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? ❑Yes ❑No
(It'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 ❑No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S. natureOf Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE 2,9L€ INTNPI.S CODE I INSPECTION TYPE LAM INTIM S
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final / ', ,144L 208 Final Plumbing
200 Final Re-Roof q-_u- -6 210 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
2446-46
L�
i . CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO.SM 121 DATE
LOT NC. 30
ADDRESS 1081 Sea Terrace
The developer of the above entitled tract desires to sell the above set forth
• lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that (he-she-they)
(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition. rie. undersigned acknowledges that this
1
agreement is _ssie solely for the .:enefit of the city and does not inure to
the benefit of the undersigned or any of them.
BY
. A7T'p7n1TR,® Purchaser
11LL�-flf(_"ff((1�1 ifl� J - GR.- 0.7 COM ANY
1U� BY lj z
CIN OF COSTA MESA Develope and/or authorized
PLANNING DEPT. representative
SUBJECT TO BLDG. DEPT. REG.
//,/���� GREAT WESTERN .
• BY✓ID .. DATE.... 3 Z.Z. BY $P.IIIhjG$ LOAN ASSOCIATION
DIRECT R OF P(ANNIN6 ` rI rr nd6Y"t:kL o J.Z Mr(J
DEPLhLY NiLLS, CALIF. 90211
. a'GE PfiLSIPLNt
• , CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. DATE
LOT NO.
ADDRESS
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement , acknowledges that (he-she-they)
(was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
BY Oic— (\SUL�N�1J'�
Purchas r
BY
Developer and/or authorized
representative
BY
Lender
. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY qF COSTA MESA CONSTRUCTION PERMIT PERT N��� TRACT NO. LOT NO. - UNIT NO.
. Project Address /o(/ Sea_p�T/ ernsy��/y/�/�e//{�-'i/n�l • 11f� !�//
•
'Applicant's Mailing Address ?3OY",2 //(Vl/fe owe �^ TYPE OF CONSTRUCTION El NEW H ADD U ALTERATION 'L� REPAIR
��•Sen Phone O`71a-,2o7o ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# • Zone
Owner's Name DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING OiFOUNDATION T - - O
❑ STRUCTURAL Front
Address J/;/ ��U��/�(j/�y/�(-� ,,�/���.r ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL BA Rear N
Contractor's Name SYf/�/��j%!(� U/ i S1 [{22 ❑ OTHER
Yi% PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) ���� G K G
CONSTRUCTION TYPE VALUATIONS S Left
City License No. (678/7,3ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping, Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: PlanningNotes: 1 7 1986 O
with section 7000) of Division 3 of the Business and Professions Code,and RECEIVED OCT 4 M
my license is in full or e .nd effect. �//�4�J S
Licens- e / -Li : ,e N. Y G /
3/4. Date '� Signature ///// %_ PLUMBING FEES
�.J( WORK RS COMPENSATION DECLARATION Bar Sink Showers )
hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
•
'. Workers' Compensation Insurance, or a certified copy thereof (Section
I ,800, Lab.,C,.' , '/ .f�,[p �_ fie Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW
Policy No.-(�( qss3`�-Orr Company s/�/V / Vim' '�`- Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW
ertified copy is hereby furnished.
Cer��/�[/il �j filed with the city ,4 n. Bathtubs Sewer Connection - Cooking Unit Meter Cup to 100 amps
Date 15// - i 0 KERSAppl'anOMPE SATI
EXEMP ff✓✓✓✓✓✓FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100) or
-
less). ) Dishwasher Solar Piping o,t, Q Dryers ❑Gas DElectric Sub Panel
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - Fan Motors.❑0-1 HP ❑1'/a-8 •
Workers' Compensation Laws of California. _
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-75 HP 016-15+
NOTICE: If,after making this declaration,you should become subject to the — -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks UrinalFixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097, Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name - 9
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 Standing Sections
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
any structure, prior to its Issuance, also requires the applicant for such permit Trays 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
-aivisian 3 of the Business and Professions Code) or that he/she is exempt
ierefrom and the basis for the alleged exemption. Any violation of Section
031.5 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 Reinspection Fee •I $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves -
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 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type 11 ❑ Zoning Approved By Date
Motion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Date Approved By
trove for the purpose of sale). Building 'O ar/0rpm.
LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date ( 6 `o
tractors to construct the project (Section 7044,Business and Professions Cade:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating DO-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
' tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their worker's Compensation insurance should be provided to me. PLAN CHECK $ a PERMIT /
❑ l am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ 5• D ISSUANCE' $ r--(//
Date owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ !!!
I hereby certify that I have read this application and state that the above 00-100,000 BTU ❑100,000 BTI. _ ELECTRICAL $ GRADING �$
information Is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to a ter upon the above-mentioned property for �+/�j)
inspection puyyds'- / //SyC v MECHANICAL $ TOTAL FEE $ _`Joy
Signature 6� _ Date ; ` U Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
.� Drivers' License or SS t
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor 01 00017269-00017269 TOT 5.00
CONSTRUCTION AND/PLANNING - . . POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .+
r
3. Electrical Conduit Utility-Undrgrnd. 54. Forms •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -_
5. Steel Reinforcement .56. Rough Plumbing & Pressure:Test
6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings,. 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ,
9. Water Pipe Undrgrnd. 60. Backwash Lines, P-Trap, D'Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK -C'
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 0Gas 0Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank OGas OOil
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 .
IV
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 /24* ceo •
39. Water Service-Final
40. Gas-Service-Final •
•
41. Solar Domestic-Final
•
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation •
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY - -
No. Date •
•
♦ - jp CITY Of COSTA Mi „
L` '_'!ILDII'!G SAFETY DEPAR.nnENT
POST IN CONSPICUOUS PLACE
ON THE JOB
•
•
DTE IsaED 7
A.P. NO. PERMIT NO.
• 45385
BUILDING ADDRESS
1081 Sea Terrace
' TRACT LOT BLOCK
10018 _ 30
NEW ADD ALTER REPAIR MOVING DEMOLISH
- % - .
OWNER '
THE GHu;Orlei CO.
• use
I Rna.v/att_ Sarno
PI Re TONE TYPE GROUP
• PAN-MTI V T & .T
1 ' :1. '1' : '. '..T/YL I.WQ",.f'3k.;•:ns.,
SETBACKS
Front Yd 3'4" Side Yd. R 0t L_ ' Rear 8'2n •
' Side Yd. R L Real
' BUILDING INSPECTION RECORD
TO KEEP BUILDING PERMITS VALID, WORK MUST BE COM- '
' MENCED WITHIN 60 DAYS WITH ROUTINE INSPECTIONS AT
LEAST EAC 120 DAYS THEREAFTER UNNTIL�COMPPLETED.
STRUCT RAL �R}�,,�,,tppyt-;J//l��/DATEr,,
Trenches 4 Forms 4
WAWA
Floor System WAWA_ -10-7 !
r.
Steel SheathingReintrni '��
'
Frame and Flashing
unite
1 Insulation E - ISWSa
tfillIMISla
f Lathing IO
ttIMIEF
•
Dry Wall Nailing IOWAN et-11--7 l
Plaster,Brown Coat
Sound Attenuation
Ir. Handicap Regulation
FINAL PA�./
PLUMBING
Soil yip.
iz /6
Underground Water �� t��j'�,//" '••-' /'� to r •
_ Rough Plumbing !/ .%/ ,�' 5.
Prop.Sewer Line and House Conn I/. //-41-71
Street Sewer Conn. 'h / 11 Z4142
7I �
Water Service h) gt-p-i>
I Sprinkling System
ay• e'/y ' 4,-/s-ay
Gas Test
FINAL Ate ettn•;p
HEATING, AIR-COND.AND REFRIGERATION
Rafe. Lines,Pressure Test j' —
' Ducts,Underground Or ,- /2-Z 'iF
Ducts,in Structure r%r - / T -d-7,r7
Ducts, Ventilatingi.:4.1 f / f/7 T
. Rough Heating and Air-Cond. r j--/L•'7f
• FINAL / /G/� 3-1/-7 9
+ ELECTRICAL l� —
Temporary Service or Pole ����
• Underground • �,1"�>> '/ -;zZ-7y
1 Power Mater a
L7Rough Wiring /•�-�',�FINAL ,411,41.49
Do not occupy this project until final inspection has
been made and occupancy has p?ird
Building Final it•jf
Special Requirements
Occupancy •
•• " xQ NOTICE9
24-hr. notification required when the job is ready for inspection. You
must furnish PERMIT NUMBER and the JOB ADDRESS FOR EACH
' RESPECTIVE INSPECTION. CALL 556-5273.
APPROVED PLANS SHALL BF,ON JOB AT ALL TIMES
CMF 0559.96 •
•
' 45385 4481 I/19/76 Cr 9.2.71 TL
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
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING �A r '€w'r
BUDRENS!/ /f�' 7 C/CJC/fCG
(the gregory company //5 n PER4I 3
OWNER A.P.NO. e7 J
MAIL 3187-g airway ave BUILDING
ADDRESS ADDRESS/4n .y4- 7-Ase,e
TEL TRACT LOT BLOCK
CITY costa mesa To.751-3850 001 30
CONSTRUCTION NEW ADD ALTER I REPAIR (MOVING DEMOLISH
LENDER Xr
BRANCH •
ER the gregory company
ADDRESS
ARCHITECTiimmdo harrISOn�lorenZln .EL751_3g5, USE w/att gax`tb`$33�•�
OR ENGINEER O.
FIRE
3187-g airway ave
ADDRESS ZONE TYPE V GROUP I&J
re Or construction co APPROVED
CONTRACTORpg g Y BY DATE
ADDRESS 3187-g airway aye ,
• NO.OF USE OF EW
CITY costa mesa NOL.'(51-384 a f... „ ,PLA ' BUILDIN '
i
F STATE CITY YARDS APPROVED YARDS APP OVEN
�" LIC.NO. 28598 LIC.NO�o8179 MAIN BUILDING ACCESSORY BUILDING
plat( SIZE 427r x992 tNO.OF BLDGSO (FROM C/L„$TREET) it
B. OF LOT NOW ON LOT -OST /D FT. FT.
Q USE OF
.N. EXISTING BLDG. R.SIDE O FT. FT.
to
M Separate permits are required for L.SIDE Z FT. FT.
electric,plumbing and heating work.
W -REAR I FT.!/ FT.
E.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
AMAIN BLDGS. ACCESS BLOCS.
..I VAR. 1 -' DATEC '
Q _ �G!(J 1 L,/ APPRO�q�Jy. pdt.
> attached gore es f/' ,ATE (U /
00 HOLD FOR SPECIAL REQUIREMENTS
a
0 I hereby acknowledge that I have read this application and state m
cg that the above information is correct and agree to comply with n
p+ all laws regulating building construction, and I shall not employ e)m k
Z any person in violation of the workman's compensation laws of
W the State of California. II r� '1
3 I hereby certify that I am properly licensed as. •ntractor under 12'Y'9 SO. FT. `I'31 garage a \
the State of California Business and -rofessio• ode, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m I\
Chapter 9, and that such licenses :*e I o II • ce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e -.
am examp o the provisions • the ra„ f California Business VALUATION d O
antl Prof sions C stla, Division Chn�e PERMIT FEE $ A
-
Signet a of I� �t/���II /i PLAN CHECK $ Oar o •• V
Permittee a �_ $ .{� {Y)f0 r` TAX a,3S $ ?Oar
U y
Authoriz_ �--_ i {{{YYYY vv TOTAL PAID $ ,rsw
gc3Kr
COSTA MESA BUILDING-SAFETY DEPARTMENT 7270 3/13/78 139.00 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 7270 3/13/78 I39a000KT0
APPLICATION FOR-STRUCTURAL PERMIT I A
For Applicant to Fill in Completely— Use Ink Only
(j ,L L _ ) RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING bog
1
�.(/J(4J&,45/
ADDRESS
.0� 6 • PERMIT NO.
OWNER A.P.NO. _
MAIL BUILDING I i�id
ADDRESS ADDRESS /d 9LAtz • — '"f�Q 7
TEL.
CITY NO. TRACT LOT BLOCK
CONSTRUCTION NEW I ADD ,ALTFR I REPAIR MOVING DEMO'ICH
LENDER
BRANCH `
OWNER elle; i ' . 6.
ADDRESS , s UE /
ARCHITECT TEL. USE Ad. d j. S ....,----11
OR ENGINEER NO
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
441„CONTRACTOR AP DATE
ADDRESS ZONE INO.OF USE OF NEW
TEL. PLAINS BUILDING
CITY NO.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE INO.OF BLDGS. (FROM C/L STREET)
0. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
EXISTING BLDG. R.SinF FT. _ FT.
co
FSeparate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work. REAR FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QMAIN BLDGS. ACCESS. BLOCS.
7-1
_&..,. 4� C VAR. DATE
Q NC.U.P.0APPROVED
' APPROVED
_AY DATE
a
0. • ...
I hereby acknowledge that I have read this application and state n
yz that the above Information is correct and agree to comply with m
0. all laws regulating building construction, and I shall not employ
z any person In violation of the workman's compensation laws of m
5 the State of California. m ,
I hereby certify that I am properly licensed as a contractor under SQ. FT. a
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
o
am exempt from the provisions of the State of California Business
PERMIT FEE /�/� a
S
and Professions Code, Division 3,Chapter 9. �;y/s�0 m
PLAN CHECK E ai
Signature of / e
A -
Permittee STAX $ U.
2
Authorized Agent TOTAL PAID Authorized Agent TOTAL PAID U
$