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HomeMy WebLinkAbout1010 SECRETARIAT CIR - Building Permits CITY OF COSTA MESA BUILDING DIVISION i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 w�wsa FERMI B00-01913 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaga.u.s. PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1010 SECRETARIAT Cl Cl1 Status: ISSUED Suite: Applied: 11/27/2000 Vicinity: Issued: 11/27/2000 Parcel Number: 41237151 Zoning: R1 R1 Applicant: DE BERRY, ROBERT WILLIAM ISSUED BY: Address: TR COSTA MESA,CA Phone: 1010 SECRETARIAT CIR Zip: 92626 Owner: DE BERRY, ROBERT WILLIAM Address TR COSTA MESA,CA Phone: 1��� 1010 SECRETARIAT CIR Zip: 92626 EI\Y YYY WA Contractor: , E I �� Address: DA Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISITING ROOF, SHEATH AND INSTALL MONIER LIFETILE LESS THAN 6 LBS. PSF. ICBG ER5-2656. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,300.00 Permit: $153.25 Claim Valuation: $7,300.00 SMIP Res: $0.73 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $153.98 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' 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. ❑ 1 have and will maintain workers'compensation Insurance,as required by ser}lon 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 if the permit is valued at one hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and 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. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADOPTION 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.Lic.4 Class M Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that lie or"she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busine 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 the applicant to a civil penalty of not more five hundred dollars(5500).): 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 Li se aws.). ❑ I am e a nder se . Business and Professions Code for this reason: iSnature:— J _ Date: 11/8 bb Owner ID ven led by drivers license. Yes 0 No `Driver's License o) (Expires:• \ /0* S 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,wit 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 Cale,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 0N (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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which Willa subject of this a plication a ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 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 pan 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 Guiltily 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: CERT• •TE OF COMPUANCE AND • ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct 'e to amply with all st: s a•- • ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-.:- +d p .arty for i peat•- • •• es.I ag -:not to• upy or allow occupancy of any building authorized by thi permit until fipection. ja7/ nal ' s Signature of Legal Owner(s)4) Date And/Or Authorized Applicant Date ;ODE I INSPECTION TYPE PAN INTITIAL8 CODE I INSPECTION TYPF DALE =ALB 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • _fiNcEO?ADDRESS: UNIT: OWNER'S NAME: 1010 SECRETARIAT CI CITY OF COSTA MESA – BUILDING PERMIT PERM NO: B 053294 ADDRESS: DE BERRY ROBERT WILLIAM �, 1010 SECRETARIAT CIR PERMIT NO: B 053294 PLAN CHECK NO: 02306-91 S GOVT; N SUPP: N COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD ARCNItNGINEER: S4S-7.858 REG.NO.: JOB DESCRIPTION : 87SF ATTIC CONVERSION SQ FT: 88 ADDRESS: UNIT: CLAIM VALUE: 3, 000 .00 CALC–VALUE: 1, 214 . 40 GROUP OCC: R-3 / PERMITTEE: ROBERT DEBERRY ( 714 ) 545-1858 ADDRESS: 1010 SECRETARIAT COMMENTS: EXISTING ATTIC C M, CA 92627 i:if*K*****x****ifM*KK#7Fink***'k***if**r*************iEfl*$****Klfl.i:%*?t*****X**#**K*3H4 LICENSED CONTRACTOR OLCLAKATIDN: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7 ONING REQUIREMENTS 70001 oc Division 3 of the Business and Processions Code.and my license is in lull force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I herebyallirm that I have a certificate of consent toselbinsure 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 RGH T: FT IN LEFT: FT IN RCH T: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 41237151 ZNE' R1 REF NO: "7 Certified copy is hereby turnished. ❑ Certified copy is Wed with the city Building Division. PLANNING NOTES> INTERIOR ALTERATION TO CONVERT A PORTION OF ATTIC SPACE TO > SECOND FLOOR AREA INSIDE AN EXISTING SINGLE FAMILY REYC. a: Applicant: if if if-*K#if ie if#iE if 9f if iE Bf Bf K L'jFif iE iE if if if#'K if#•Ki6 H if r K if if#3f K if#*it K K###K K is k if K-lf K if if 1E#Bf#K 4V K i(3E 5'KJC•x K 1f k 44 if if EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be eomphle0 if the permit is for one hundred(5100)or less). D E V E L O P M E N T SERVICES R E Q U I R E M E N_XS 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 - subled to the Workers'Compensation Laws of California. ZONING APPROVED B Y , DATE: ., Date: Signature: J NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY- DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED ED B ' rr��— —�—� DATE: Gc7 which this permit is issued(Section 3097.Civ.C). iKiki *KKfii #ii *iiiifis:m _ - 'ikf#ik}KKf' TT0F :Wit* LENDER: ********3E**if********n4***3E* ' . it#KaEi***Kif***V**1EB(****k *-X* *KK*.K*4(3f.K *7.K#KYr1E#TE-)** ADDRESS: LEGALIZATION:N F E E S U 'r M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR?_ MECHANIC FIRE SHIP/RES,. GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 31 . 00 .50' repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensedr pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 ac the Business ' SMIP/NON-RES and Prolessions Code)or that he/she is exempt therefrom and the basis tor the alleged exemption.Any violation of Section 7031.5 by PLAN 20 . 15 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE rA.• • I. as owner of the property or my employees with wages as their sole compensation, wit 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–---> 31 . 50 0. 0 _ 20 . 15 5 1 . 6 5 51 . 65 • ' . 00 does not apply to an owner oc a property who builds or improves thereon.and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered tor sale.If,however the building or I improvement is sold within one year of completion.the owner will have the burden of proving be/she did not build or improve REVENUE DIVISION TOTALS––> COLLECTED• 31 . 50 OVER/SHORT: ' ' . 00 , . for the purpose of sale). 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 31 . 0 0 t' . 50 dand 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'Slate License Law).lamaware ..K.K.Kih3Fitlr.i(.ii.A.x.3;.i6.K3{-x'K..KK.ir.X..****.K.iEif.if-i(.i(.Kif.4f.i(.iF..x.ik Kiuii.ie.Kif.i(.K#Killf.if.t(.if.1E.x.x.K.if.iEN.K..KitKY.*.**K.if.' .3i.K.if.i:.x..y.M. that proof of their Worker's Compensation insurance should be provided to me. • o am exempt under Section: B.8 P.C. INDIVIDUAL- F E E B R E A K D O W N tor this so TYPE QTY D E S C R I P T I •O'N • UNIT COST •/TOTAL COST Date: J •/sit Owner: /L i // / ✓., _ ' Ido herebyeN/mat am aware of and understand the requirements of California health and SafetyCode Sections 25505,25533,and SFR R 8 8 DWE–INT. ALTER TYPE V–WOOD F R –GOOD 13. 80 ' 1 , 214 . 40 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 END OF FEES ,.f permit car construction or modification from the Air Natty Management District.Residential construction applications are exempt from .- these provisions. Data: Applicant: ' / / I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county "' (� ordinances tand in pectin purpose to building construction and hereby au nzer present ive (this)thiscilyg the above-mentioned y 'property for in pectron purposes. / Date' figj�( Signature:e\/%✓/'v'4�� a , _ .r,.-I _ _ X - ., v Driver's License or Social Security Applicant:Pink—Revenue:Goldenrod—Assessor ; CONSTRUCTION AND PLANNING POOL 'A Date Inspector Date Inspector i APPROVALS Permit# APPROVALS Permit # 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soi;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 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, O 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 ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ft(obi �) 76. Dry Standpipe 28. Lathing & Siding rr� 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 • Notec: /// I - ' 9 �! 34. Final Heating & Air Conditioningi e //\ 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.'Backf low Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations // / -� 47. FINAL STRUCTURE & BUILDING t l'�CL ` 4 /q ^ ///jjj TQC 48. FINAL PLANNING ` , [!([/ ( _ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 1010 SECRETARIAT CI UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 053296 OWNER'S NAME: DE BERRY ROBERT WILLIAM ADDRESS: 1010 SECRETARIAT CIR PERMIT NO: M 053296 PLAN CHECK NO: N GOVT: N SUPP: N 'COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: ADD ARCH/ENGINEER: 545—1 B S 8 REG.NO.: ADDRESS UNIT: JOB DESCRIPTION : 87SF ATTIC CONVERSION SQ FT: PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC : / ROBERT DEBERRY ( 714 ) 545-1858 ADDRESS: 1010 SECRETARIAT COMMENTS : REF B53294 M CA 92627 >EX***> *-XM�r+E>f*>F*+F**T � i(*X*�E>E�E�r*�E�E*x�F�6�EXX***#>ESE+E�Ex�c�F�E*T�•f *qtr.*******aE�E�F**-X******K*x LICENSED CONTRALTO DECLARATION: I hereby affirm that I am licensed under provisions of hapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACAS CITY LIC.: STATE LIC.: CLASS: Date: Signature: —— MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 41237151 ZNE: REF NO: c] Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: ****************.-******iF************Fe*_********************ifk-***If**if***'4**+f3r*X.tE** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E R V—£ C E S 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: Date: Signature: NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I herebyaffirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUE DATE ��/y��� 1 which this permit is issued 3097. C). ****.*************'warn' 'xx rr ani.fr+ — . .. Y'¢'s:i ' ' ' *.*****Ok*-ki�e.... tF** ' LENDER: ************************ . .***********".************ii.**+t**********>ii.***ir*h'***iE ADDRESS: LEGALIZATION:N F E E . UMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELF_LRIC MECHANIC :FIRE $MIP/RES GRADING (Section 703L5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 4 50 repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5% SM I P/NON—RES 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 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT SUE 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——--> 4 . 50 5 . 00 0 . 00 19 , 50 19 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If, however the building or improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS— > COLLECTED;. 19 . 50 OVER/SHORT: . 00 k. for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIFIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 19 . 50 © and Professions Code: The Contractors'Slate 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 *.*.*.1E*******************************i'******************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B. 8 P.C. for this eason. f //////�/// TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST „•� Date: CP p/ Ownec /Code Ser - — C , I do hereby cegffy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and NEC 1 INST /REL APPL VENT NOT UNDER PERMIT 4 . 50 4 , 50 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 END OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from A- these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby au pe rep esenlaliv oil ' city to enter upon the above-mentioned property lot in ectl n purposes. �/j/^ Date: Cyl'll// Signature: "�/ 4... j4544-2_ .;•t7Cg U.,;f3,r -h. T;I,e " .:.:ai _. . .....--- Driven Driver's License or Social Security a: 1641.46 White-9uhding;teen—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor • CONSTRUCTION AND PLANNING • POO, ,PA 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 • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER 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, 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 OrI 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 1 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 fi11+M (7� bIJE 35. Final Gas Pipe-Test 1 l �"` 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 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 1010 SECRETARIAT CI UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; E 05329° OWNERS NAME: DE BERRY ROBERT WILLIAM ADDRESS: 1010 SECRETARIAT CIR PERMIT NO: E 053295 PLAN CHECK NO: 02306-91 S GOVT; N SUPP: N COSTA MESA,CA 92626 • CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ADD ARCH/ENGINEER: 545-1858 NEG.NO.: • ADDRESS: UNIT: JOB DESCRIPTION : 87SF ATTIC CONVERSION SQ FT: PERMITTEE: CLAIM VALUE; 3, 000 , 00 CALC-VALUE: GROUP UCC: / ADDRESS: ROBERT DEBERRY (714 ) 545-1858 1010 SECRETARIAT COMMENTS : REF 853294 C.M. CA 92627 ***)E'N*xXNkENN)E3E#iEN#iE%IF9flf%#iEN1FiE3F1Ek4f%k NiENif MiE9E% H* ****a6T ****iEdF>FiEiE4ESPlfiflfiEli•3EiE#1F1E>E#dFdflElEdf LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZO N I N G REQUIREMENTS 70001 of Division 3 0l the Business and Professions Code.and my license is in full force and elfect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: -' MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby alfirm that I have a certificate of consent to sell-insure or a certificate of Workers' F'RNT: 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.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL; 41237151 ZNE: R1 REF NO• Certified copy is hereby furnished. 0 Cenihed copy is filed with the city Building Division, PLANNING NOTES> INTERIOR ALTERATION TO CONVERT A PORTION OF ATTIC SPACE TO > SECOND FLOOR AREA. ZNSIDE AN EXISTING SINGLE FAMILY RES, Date: Applicant: if#N iE ie#if 9E k%NN if%iE#*%#NN%TE#.%*aEN#iE.%4E.><ii-3!i,E#iF iE9EIF 8E 4e 7i-iE.)f dETF#N ii 4E 0c%9E BE*#NN N#*iE ii%if%iE'r:.%N 9E%#ai-dE M ac• EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S"-E R VICES R E Q U I R EMENTS 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 9 n subject to the Workers'Compensation Laws of California. ZONING APPROVED BY -- DATE: OU �`�l J — Date: Signature: NOTICE:IL alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : ' 1--, DATE Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby alfirm that there is a construction lending agency for the performance'of the work for APPLICATION ISSUED B?: ��_� DATE: • which this permit is issued(Section 3097,Civ.CI. i( .%Bf#iF if.%.IE{E{E.)F iE IE IE lf.%1E I!-%%-Ie•is _ �C •+^�' ;%'' -- rs n.x{Ei{It NiP4'.4Evt• •- ' ' iFY, LENDER: **OEBE.%****N-•%k1�'N****N*TF****%**.**.*,k,., < x" • fi#'3EIElE9E9EAf04##Ni0N3ENth#-ie9LiEiFN4E#NiEiE%OF)E1ENN4FY.%# ADDRESS: LEGAL.LZATION;NF E E vS '�1 M M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby alfirm that I am exempt Irom the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELEC•'.,R'IC 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 5;.•2'5 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 50%. SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 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($500). ISSUE FEE 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, wi11 do the work, and the BUILDING-DIV-> PERMIT ISS E 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———— > 5 . 25 15. 0 0 0. 00 20 . 25 2 0 . 2 5 . 00 does not apply to an owner 01 a property who builds or improves thereon,and who does such work himself/herself or through • his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or T r Y improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE D I VIS ION TOTALS- > COLLECTED: 2 0. 2 OV R/SHORT: 00 for the purposeol sale). 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 20 , 25 LII 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 contractors)license pursuant to the Contractors'State License Law).l am aware 3F3FIE3F 3E39N•lF3L'N'I('!fN'3E1eiEiFiEi('#TEr*lE#IflEIr#1EiE1Ei:NaERdE TL-lF3F***IF1F'k1'r'li#If1FM 1e 1FiE#3f)IETt#R%LFiE)EIhk 3F#k N.y63eiEiF30#3f that proof 01 their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C, rofproperty�� �i� /'%1/ , TYPE QTY DESCRIPTION UNIT COST TOTAL COST Date: v�"� �/ owner: ELE 1 FIXTURES, LIGHTING 1 ST 20 EA. . 75 . 75 I do hereby certify at l am aware 01 and understand the requirements of California Health and Safety Code Sections 25505,25533.and ELE 5 REC EPT/OUTLET 1 ST 20 EA, , 75 3 . 75 25534 and that I or any future building occupant wilevill not(circle one)need to comply with said state codes and the requirements or a ELE 1 RECEPT/SWITCH 1 S T 2 0 EA, . 75 , 7 5 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. END OF FEES Date. Applicant: I hereby certify that I have read this application and state that the above inlormation is correct.I agree to comply with all city and county ordinances and slate laws relating to building construction and hereby out ize re resentatives of this city totoenter upon the above-mentioned property for p q purposes. 1..."//7���Y i/ Date �/9 I Signature: '/�4.1l._.Driver's License or Somal Security a: - ' - •- 1641-46 White—Building:Green—Code Enlorcernem:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor ' CONSTRUCTION AND PLANNING POC SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. Foil 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 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, O 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 7a7/q/ /y -+ 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 ❑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 F,.�yY/ 80. FOOD CERTIFICATE ISSUED 33. Final Electric 7/ -77W ' L ji„p�otes: 34. Final Heating & Air Conditioning /// G '='r 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 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa P ng Department Post Office Box 1206 rpp�j �jj� f� 77 Fair Drive C0�I` ►I ° Costa Mesa,(714) 56-5245fornia 92626 RECEIVED C!1'r nv en'T+ MESA REQUEST FOR OCCUPANCY (Single Family Residential or JUN 2 'j 1978 Condominium Units) AM PM 7i819i10ill►2l1l2�41516 Tract No. 9901 Date June 27, 1978 Lot No. 48 Address 1010 Secretariat Cir, G.M. 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, they) %.r 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. *fa& As: / 'ufchaser • Developer n� he R Represres entattivee d' By Lender CMF 0569-26 PAID C�c 4 'Id 21.77CM54001110* ***308.51 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely —Use Ink Only PP TION FOR STRUCTURAL PERMIT /� // �7 R C I BY D TE CEIIVED it'-- �ISSS�UED BUILDING ADDRESS /0/4 .Yr it6�Qr f `-'�'I� I �� - - L`'�fl ' 7} OWNER FOLEY FAMILY TRUST A.P.NO. /46-os? -36 PERMIT NO. BUILDING MAIL2101 E. Fourth St., #100 ADDRESS 1010 Secretariat Circle ADDRESS CITY Santa Ana, CA 92705 eio:543-9471 TRACT 9901 I LOT 48 BLOCK LENDER U.C.B.CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOLISH X BRANCH 1010 N. Main St. y//� OWNER lL� 1 FYM� klii 7\ ADDRESS Santa Ana, CA 92704 I ges„An Cnpy` ARCHITECT Lang TEL. USE S 1 OR ENGINEER Hales-Langston NO. 547-0862 FIRE ADDRESS 777 S. Main, #105, Orange 92668 ZONE T E T GROUP Ji LI- APPROVED /� / �7'1 CONTRACTOR Foley Construction Co., Inc. By OnT�Q 'elf. ' ADDRESS Salle as above TEL. ZONE NO.OF USEIOF NEW CITY NO. (�./ PLANS Z BUILDING E STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE INO.OF BLOCS. (FROM C/L STREET) OF LOT NOW ON LOT 0 FRONT 2f,FT. FT. Q USE OF � .-, EXISTING BLDG. N/A R.SIDE 472T. FT. CA i FSeparate permits are required for L.SIDE 5 FT. FT. electric,plumbing and heating work. W - _REAR Z,5 FT. FT. (—, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& - Q _MAIN SLOGS. ACCESS. BLOCS. e New construction, single family C u o w DATE APPROVED > detached, Plan 2, 4 Bedrooms. APPRO P. `�' /0 20-7 7 z 31;1b Wit SPECIAtATEEQUIREivIENTS cu O I hereby acknowledge that I have read this application and state � IX that the above information Is correct and agree to comply with m a• all laws regulating building construction, and I shall not employ z any person in violation of the workman's compensation laws of .TTWii the State of California. m 2105 SD. FT. /tar. 513 sg.ft. I hereby certify that I am properly licensed as a contractor under 0 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, end that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: to am exempt from the provisions of the State of California Business VALUATION a and Professions Code, vI Ion 3,Chapter 9. PERMIT FEE y�/�3 Ln Signature of PLAN CHECK $ /0/� 50 o U. Permittee $6 300 TAX $ %r Q/ U Authoriz t !� I TOTAL PAID y •36, . 57